Dermatologic Conditions

Health Chatter Podcast

Episode: Dermatologic Conditions with Dr. Mitch Bender

Stanton Shanedling:
Hello, everybody! Welcome to Health Chatter. We’re back after taking a little time off over the summer, and we’re kicking things into high gear with a great show today on dermatologic conditions.

We have a wonderful guest—Dr. Mitch Bender—and I’ll introduce him in just a moment.

First, I want to recognize our fantastic crew who make these shows possible with background research and all the technical details: Maddy Levine-Wolf, who’s recording the show today and also handles research and scheduling, plus Erin Collins, Deondra Howard, Matthew Campbell, and Sheridan Nygard. We couldn’t do this without them—thank you all.

My co-host, Clarence Jones, will be joining us shortly. He’s been with me since day one, and we’ve been doing these shows for over three and a half years now—pretty amazing.

And of course, Dr. Barry Baines is our medical advisor and consultant; he helps us navigate the medical aspects of many of our episodes.

So—welcome, Barry, and now: today’s topic, dermatologic conditions, with Dr. Mitch Bender.

Stanton Shanedling:
Dr. Bender was born out east—right near the Bronx Zoo, actually. He graduated from the State University of New York at Stony Brook, earned his MD at the University of Kentucky College of Medicine, completed his dermatology residency at the University of Minnesota, and now serves as adjunct faculty there.

He’s also the founder of Dermatology Specialists in Edina, Minnesota—I’ll actually be seeing one of his colleagues soon. Dr. Bender has been in the field for a long time and has truly seen it all when it comes to skin conditions.

Mitch, thank you for joining us today and for sharing your insights on a topic that many people tend to take for granted. We don’t always think about our skin until something goes wrong, but it’s incredibly important.

Stanton Shanedling:
Let’s jump in. As a parent, one of the first skin-related concerns you encounter is diaper rash. That got me thinking: are there particular skin conditions that show up at different stages of life—infancy, adolescence, adulthood, and older age?

Dr. Mitch Bender:
First of all, thank you very much for the invitation—it’s fun to be here. And yes, there absolutely are age-related patterns.

In pediatrics we see everything from the relatively mundane—like diaper rash—to certain genetic conditions that manifest on the skin. As we mature, other types of skin issues appear.

In fact, there’s now a pediatric dermatology subspecialty, where dermatologists take additional training to diagnose genetic conditions and other specialized pediatric disorders.

For example: diaper rash is common because urine and stool in the diaper can irritate the skin, and it’s usually easy to treat. But there’s a rare condition called Langerhans cell histiocytosis that can appear in the diaper area and initially be mistaken for simple diaper rash. It’s actually a blood disorder—treatable, but it must be recognized early.

Another example is acrodermatitis enteropathica, a genetic condition where the body can’t absorb zinc; it causes a rash on the face and in the diaper area, and again, needs to be recognized and treated.

So truly, at every stage of life—from birth to older age—different skin conditions can arise and need to be considered.

Stanton Shanedling:
That’s fascinating. What would you consider a dermatologic emergency?

Dr. Mitch Bender:
In adults, certain acute issues show up on the skin that can indicate something serious inside the body.

For instance, people with **infected heart valves—endocarditis—**can develop small spots on the skin or under the fingernails. That can signal systemic infection (sepsis), which needs urgent antibiotics and heart evaluation.

There are also skin signs of severe liver, lung, colon, or kidney disease. The skin itself may not be in danger, but it’s a window to internal illness that requires immediate attention.

So dermatologic emergencies aren’t always about the skin being damaged; sometimes the skin is telling us something urgent is happening elsewhere in the body.

Stanton Shanedling:
Do you see more emergencies in older adults, or does it span the whole lifespan?

Dr. Mitch Bender:
It really spans all ages. Even newborns can have serious skin findings that either indicate a current crisis or a risk of one developing—so we always want to identify those as soon as possible.

Barry Baines:
Thanks, Mitch. Coming from my background in family practice, I tend to focus on the more common skin issues because they’re what most people encounter.

And with summer here—well, today there’s so much haze it’s hard to tell if the sun’s out—but generally, we’re outside a lot. Over the years there’s been more and more written about the dangers of prolonged sun exposure and its effects on the skin.

The skin is the body’s largest organ, and it’s constantly exposed to sunlight. So I thought it was important to bring an expert like you on to discuss this—especially for our listeners who spend plenty of time outdoors.

What should we all know about sun exposure and sun-related skin diseases?

Dr. Mitch Bender:
You’re absolutely right, Barry. And what I’ll share reflects the position of the American Academy of Dermatology, our main professional organization.

We’re particularly concerned about skin cancer—it’s actually the most common cancer in humans.

• Over 5 million cases are diagnosed in the U.S. each year.
  
  
• About 105,000 people die annually from one of the more serious types: malignant melanoma.
  
  
• The overwhelming majority of these cancers are related to ultraviolet (UV) light exposure, often starting early in life.
  
  

Because of this, we strongly advocate for sun protection:

• Use sunscreen.
  
  
• Wear brimmed hats.
  
  
• Consider sun-protective clothing—there’s clothing infused with safe, UV-blocking compounds.
  
  

A few statistics drive this home:

• Today, 1 in 5 Americans—that’s 20%—will develop some form of skin cancer.
  
  
• Back in 1930, the rate of melanoma was 1 in 1,500 people.
  
  
• Today it’s about 1 in 60.
  
  

So, in less than a century we’ve seen an enormous increase in melanoma cases. The good news is that while incidence is rising, the mortality rate has stayed relatively stable, thanks to earlier detection—people are getting skin checks and catching melanomas when they’re still very treatable.

One key takeaway for listeners: sunscreen and hats are your friends. I like to compare sunscreen to wearing a seatbelt in a car. It doesn’t stop you from enjoying life—it just keeps you safe.

Another common concern is about vitamin D. Some worry they won’t get enough if they use sunscreen or avoid the sun. The body doesn’t care if your vitamin D comes from sunlight or a supplement. I take 2,000 IU daily myself. The official recommendation is about 800 IU/day. If you eat a balanced diet and take a supplement, you’ll maintain adequate vitamin D without unprotected sun exposure.

We also strongly advise against tanning beds. There’s clear evidence linking tanning bed use—especially before age 19—to higher rates of melanoma and other skin cancers. Dermatologists simply don’t recommend them.

Finally, from a cosmetic standpoint, chronic UV exposure causes wrinkles, brown spots, and texture changes. So if you want healthier, younger-looking skin, sun protection is key.

If there’s one message I’d like everyone to remember: Use sunscreen, wear hats, and choose sun-protective clothing.

Stanton Shanedling:
That’s such an important message. Barry, go ahead.

Barry Baines:
Yes—thank you. I want to ask about sunscreens themselves. Walk into any pharmacy and you’ll see shelves full of them—different brands, different numbers: SPF 10, 20, 50.

I have two main questions:

1. I know there are different types of sunscreen—sometimes described as “chemical” versus “physical” or “mechanical.” Can you explain the difference?
   
   
2. How does that relate to the SPF number—and is one type better than the other?
   
   

It’s one thing to wear sunscreen, but if it’s not offering enough protection, people may think they’re safe when they’re not.

Dr. Mitch Bender:
Great questions. Sunscreen options can be confusing, so here’s a practical breakdown.

There are basically two main types of sunscreen:

1. Physical (or mineral) sunscreens
   
   
• These contain zinc oxide or titanium dioxide.
  
  
• They work by reflecting UV light—like how a window reflects raindrops. The UV light hits the skin and bounces off, never penetrating.
  
  
2. Chemical sunscreens
   
   
• These use ingredients like oxybenzone, avobenzone, octocrylene, and others.
  
  
• They absorb the UV light—think of a sponge soaking up water—then release it as heat.
  
  

There’s ongoing controversy around chemical sunscreens:

• Studies show that some of these chemicals can be absorbed into the bloodstream, though no harm has been demonstrated yet.
  
  
• Laboratory studies in fish tanks suggested some of these chemicals might harm coral reefs, although it’s unclear if that translates to real-world ocean conditions.
  
  

Because of environmental concerns, Hawaii has banned certain chemical sunscreens on beaches, even though the science is still debated.

For these reasons, I personally recommend physical (mineral) sunscreens—zinc oxide or titanium dioxide. They’re safe for humans and the environment and don’t absorb into the bloodstream. They’re also widely available and affordable.

As for SPF (Sun Protection Factor):

• The American Academy of Dermatology recommends using SPF 30 or higher.
  
  
• SPF 30 filters out about 97% of UV-B rays (the main cancer-causing rays).
  
  
• SPF 50 filters about 99%.
  
  

So SPF 30 is a good minimum; going up to 50 offers a slight extra margin of protection.

Dr. Mitchell Bender:
Does it really matter if you use SPF 30 versus SPF 50? Maybe not that much.
But there are a few practical things to know. First, it’s best to apply sunscreen about 15–20 minutes before going outside so it can bond to the skin and give better protection.

We recommend re-applying every two to two-and-a-half hours, because you sweat it off or it washes off if you’re swimming. Use about an ounce each time — roughly a shot-glass-full — for the whole body.

The physical sunscreens I use can leave a white, chalky look on the skin. There are some very nice cosmetically elegant sunscreens for the face so you don’t have to look like a “white ghost” at the beach. Many of these are tinted and look good, while for the rest of the body you can stick with the basic physical sunscreen. I’m not recommending any specific brands, but you can easily find these online.

People often ask about spray sunscreens. The correct way to use them is to spray on a light coat and then rub it in. Don’t just mist the skin — it’s easy to miss spots and end up sunburned. Also, use sprays outdoors so you don’t inhale the particles. Personally, I’m not a huge fan of sprays, but if you use them properly, they can work.

Bottom line: the best sunscreen is the one you’ll actually use. I recommend physical sunblocks; find one you like and use it consistently. They’re not perfect — a little UV still gets through — but they significantly cut the risk of skin cancer, aging, brown spots, wrinkles, and other cosmetic issues.

Stanton Shanedling:
There are a lot of skin conditions — acne, eczema, psoriasis, rosacea, hair loss, moles, and so on. My daughter has eczema and manages it well, but over the years I’ve noticed new medications coming out. Can you reflect on how prescription treatments have advanced during your career?

Dr. Bender:
Great question. There’s been an explosion of new medications for conditions such as eczema (atopic dermatitis) and psoriasis. Over the past 10–15 years we’ve learned much more about the molecular biology and immunology of these diseases.

For example, in eczema we now know certain interleukins — specifically IL-4 and IL-13 — are abnormally elevated and drive the condition. We used to treat patients mainly with topical or sometimes systemic corticosteroids, which helped many but not all.

Then came Dupixent (I have no financial ties to the company). It targets IL-4 and IL-13. For many patients, a couple of injections can make eczema improve by 90 percent or more.

I had a patient in his late 30s with severe eczema — constant itching, redness, couldn’t sleep, very uncomfortable. We tried all the topicals, but he never had good control and came in every few weeks. We started Dupixent; after the first injection his skin cleared dramatically. He now just needs follow-ups about once a year and continues treatment at home by self-injection, similar to how diabetics inject insulin. There are some minor side-effects to monitor, but generally it’s well-tolerated.

The same revolution has happened with psoriasis. You’ve probably seen the TV ads. These newer biologic medicines are amazing: many patients improve 90–100%. When the first biologics came out 15–20 years ago, the FDA’s goal was just 50% improvement. Today, to get approval a drug usually has to show 90% or better improvement.

So, compared with 10 years ago, our therapies are totally different. The diseases haven’t changed, but our ability to treat them has — and it’s life-changing for patients. Honestly, it’s made being a dermatologist much more rewarding.

Clarence:
I just joined. When I heard we were discussing this topic, I remembered a girl in my eighth-grade class named Margaret who had a lot of visible skin issues. Unfortunately, some kids mocked her.
I wonder about the impact of food on skin. People don’t always think about diet as a cause of skin problems. Can you talk about that?

Dr. Bender:
Great and timely question. The skin, like every organ, needs basic nutrients — protein, minerals such as copper, zinc, selenium — to stay healthy. Vitamin or protein deficiencies can show up on the skin.

Another hot area of research is the microbiome — the community of bacteria in the gut and on the skin. An abnormal microbiome is called dysbiosis.

For example, people with atopic dermatitis often have less-diverse skin bacteria. That imbalance lets Staphylococcus aureus overgrow, leading to boils and infections. Experiments show that re-introducing a more diverse, harmless bacterial mix onto the skin can crowd out the staph and improve eczema.

We see similar links between gut dysbiosis and various diseases. Diet strongly affects the microbiome, and research is exploring its connections to heart disease, brain health, and skin.

There’s also growing interest in anti-inflammatory diets — usually Mediterranean-style or largely plant-based, rich in omega-3 fatty acids. These diets seem to reduce chronic inflammation and oxidative stress, which benefits not just the skin but the heart, brain, and other organs.

Clarence:
That’s really enlightening. I hadn’t realized how much the microbiome affects the skin.
As a community member, how can I talk to people about taking care of their skin, and when should they see a dermatologist?

Dr. Bender:
A few basics: starting in infancy, regular moisturizing makes a difference.
For example, simply applying plain petroleum jelly (Vaseline) to a newborn’s skin has been shown to lower their risk of developing eczema later in life. You don’t need fancy products — just consistent moisturization. Of course, there are excellent dermatologist-recommended moisturizers too, but the key is to keep the skin barrier healthy from the beginning.

If you have a skin condition that’s not responding to reasonable treatment—if it’s itchy, red, rashy, or just not going away—get it checked out. As we mentioned earlier, sometimes a skin change can signal an internal condition that you want diagnosed sooner rather than later.

Here’s an example: I have a friend who noticed a small purple bump on her belly. It didn’t hurt, bleed, or cause symptoms. She thought it was a bug bite, but bug bites usually go away in two or three weeks. Hers didn’t, so—very smartly—she went to her dermatologist. They did a simple skin biopsy in the office, and it turned out to be a relatively rare blood cancer.

Clarence: Plasmacytoid dendritic-cell neoplasm—big name, but essentially a blood cancer.

Stanton Shanedling: Spell that—might take the rest of the podcast.

Mitchell Bender: The point is: that little bump on the skin led to a diagnosis. She went for treatment at MD Anderson and is now doing very well. So if you see something on the skin you don’t recognize, it can be a sign of something going on internally, and early diagnosis usually makes treatment easier.

The nice thing about the skin is that we can see it and biopsy it easily—unlike a lung or kidney biopsy. That lets us get a diagnosis and start the right treatment pathway quickly.

Barry Baines: Sounds like the message is, “If you see something, say something.”

Mitchell Bender: Exactly.

Clarence: I’m a fatherhood doula, so your advice about moisturizing babies really interests me. I’m going to add that to my ‘Daddy Book.’ If you can send me the latest paper on moisturizing newborns’ skin, I’d love it.

Mitchell Bender: That’s been known a long time; the latest paper just confirmed it.
Another important point is soap—people often just use whatever’s on hand, but most soaps are detergents that strip the skin’s natural oils. That can lead to dryness—especially in winter—and can trigger eczema in kids who are prone to it.

There are gentler “soap substitutes” and moisturizers with natural ingredients. For example, there’s a product called CeraVe—spelled C-E-R-A-V-E. It contains ceramides, which are chemicals everyone’s skin naturally has to help lock in moisture. Kids with eczema don’t make enough ceramide, so applying CeraVe cream or lotion helps replenish their skin barrier. They also make a non-soap cleanser that you rub on and rinse off like liquid soap, but it won’t strip moisture.

It’s inexpensive and sold over-the-counter at places like Target. Personally, I use Dove Sensitive Skin bar soap—also inexpensive, I buy it at Costco. Some other brands aren’t bad, but certain skins just can’t tolerate them as well. Something as simple as moisturizing and using mild cleansers makes a huge difference.

Clarence: I’ll add that to my Daddy Book.

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Barry Baines:
Mitch, you work closely with primary-care physicians. How do you see the relationship between dermatologists and primary-care doctors in helping patients with skin issues?

Mitchell Bender:
It’s a great partnership. Primary-care doctors are the first line: they see everything and are very skilled at recognizing most rashes, infections, acne, warts—common things.

But sometimes they see something that looks unusual or just isn’t responding the way it should. That’s when they send patients to dermatology. A good example is changing moles or persistent rashes.

Dermatologists are equipped for skin biopsies in the office. Most biopsies take five minutes with a little local anesthetic—nothing dramatic—and that lets us confirm the diagnosis quickly. So collaboration between primary care and dermatology is essential for catching serious things early.

Stanton Shanedling:
You mentioned earlier that skin cancers are the most common type of cancer. Are there certain risk groups we should be aware of?

Mitchell Bender:
Yes. The biggest risk factors for melanoma and non-melanoma skin cancers include:

• Fair or light skin that burns easily
  
  
• Light hair or eye color
  
  
• A history of frequent sunburns, especially blistering burns in childhood
  
  
• Having many moles—especially large or irregular ones
  
  
• A family history of melanoma
  
  
• Weakened immune systems—for example, organ-transplant recipients or people on long-term immunosuppressive medicines
  
  

And of course, tanning-bed use is a big risk factor, especially at younger ages.

Barry Baines:
You also mentioned earlier that sun damage causes wrinkles and brown spots. People often come in asking for cosmetic treatments. What’s realistic there?

Mitchell Bender:
Good question. The number-one thing for preventing wrinkles, “age spots,” and sagging skin is sun protection.

Once the damage is there, we have treatments—retinoids, chemical peels, laser resurfacing, microneedling, and so on—but none of them fully reverse decades of sun exposure. They can improve texture and pigmentation but prevention is always better.

A lot of people spend thousands trying to undo the effects of chronic UV exposure. If they had simply used SPF 30 sunscreen, a hat, and avoided tanning, they’d have saved money and their skin would look healthier as they age.

Stanton Shanedling:
That’s a powerful point: sunscreen is the cheapest cosmetic you’ll ever buy.

Clarence:
Before we wrap up—what’s your final takeaway message for listeners about keeping skin healthy?

Mitchell Bender:
A few key points:

1. Check your skin. If you notice a mole changing in size, shape, or color—or a spot that bleeds or won’t heal—get it checked.
   
   
2. Protect your skin from the sun: SPF 30 or higher, hats, protective clothing.
   
   
3. Moisturize—especially children and infants.
   
   
4. Use mild cleansers instead of harsh soaps to avoid drying out the skin.
   
   
5. If you have a skin problem that’s not improving, see your doctor early. Early diagnosis almost always makes treatment easier and more effective.
   
   

Barry Baines:
Thank you so much, Mitch. We’ve learned a lot about skin health, cancer prevention, new treatments, and simple daily steps we can all take.

Stanton Shanedling:
Yes, thank you. We really appreciate your expertise.

Mitchell Bender:
Thank you for inviting me—it’s been a pleasure.