A North Bethesda dermatologist on applying sunscreen, where skin cancers can hide and what she uses on her own face
When the first-time patient came in for a skin check, she told Dr. Arden Edwards about her chronic cough. Other doctors had checked for pneumonia and cancer but couldn’t make a diagnosis. Then Edwards, a dermatologist who is also certified in internal medicine, noticed that the patient’s fingernails were yellow. Edwards recognized that as a sign of bronchiectasis, a dilation of the airways in the lungs, and called the patient’s internist, who followed up with treatment. “Dermatologists really can have a big role in a patient’s overall health,” she says.
Edwards, 36, always wanted to be a doctor, and remembers in middle school when a family friend who worked at a hospital took her to see a trauma patient in the emergency room. “Rather than being upset by the scene, I was more intrigued,” says Edwards, who grew up in Huntington, West Virginia. “I was so into it—the body and anatomy and how all that works.”
As a student at Georgetown University School of Medicine, where she met her husband, Chris, she was interested in surgery but also liked the challenge of internal medicine. “They give you some clues, and you have to figure out what’s going on, almost like a detective,” says Edwards, who joined Dr. Joy Chen at Advanced Dermatology & Cosmetic Center in North Bethesda in 2013. During her dermatology rotation at Georgetown, Edwards found similarities to internal medicine—the part about solving mysteries—and decided to do a longer residency so she could become certified in both specialties.
Edwards and her husband, an anesthesiologist, live in Cabin John with their sons, who are 2 and 4. Her own skin care routine includes a retinoid, such as Retin-A or Tazorac. “A retinoid is almost like a boot camp instructor for the skin,” she says. “If you have acne, it’s going to clear up the acne. If you have wrinkles, it builds more collagen. If you have psoriasis, it can help thin down thick scales. I was a tennis player growing up, and so I did get a lot of sun. That retinoid to me is correction from all the sun damage I’ve had in the past.”
Edwards wears sunscreen year-round and has been using Neutrogena Oil-Free Acne Wash for 20 years. She tells patients that products don’t have to be expensive—it’s about finding the right fit. One teenage girl with severe acne was depressed after trying lots of over-the-counter treatments that didn’t work for her. “After giving her the education and the right medicine, and telling her to avoid everything else, it was night and day when I saw her at the follow-up,” Edwards says. “When a patient is happy and smiling and feeling good after just some information and teaching them how to take care of their body—that definitely sticks.”
“It is really important to look at non-sun-exposed areas, like the buttocks and the bottom of the feet. If you get a bad mole there, those usually are higher risk. They’re more aggressive in sun-protected areas. People think, it’s only in places where I’ve gotten sun. Not necessarily true.”
“Now there is UPF [ultraviolet protection factor] clothing that you can wear, so it’s got a 50 in the shirt, in the pants, in the hat. That can be helpful, and honestly I have resorted to that because I’m trying to sunscreen my kids every two hours and it’s hard to do the same for myself and actually enjoy vacation.”
Don’t Forget The Ears
“The most common kind of cancer in the world is basal cell carcinoma, and it’s most common on the nose. So definitely make sure you [put sunscreen on] that nose. Make sure you get the ears because all of that is getting sun 365 days a year. For whatever reason, the temples are where I find a lot of precancers and sun damage. And the back of the hands. I can pick out the golfers—they will get skin cancer on the hand that doesn’t have the glove.”
“Half the people who use sunscreen only apply half the amount they should, so when they start with a bottle of SPF 30, that means they’re actually getting an SPF of 15. Make it really thick. Basically a shot glass full to the whole body every two hours. I’m probably in that group of people that don’t put it on as thick as they should, so in my family we use a higher number. I apply a 60 and rub it in. Then I know we’re at a 30, which is protective.”
“One time I had a patient who developed what looked like a wart on the top of her foot. It came up very quickly and I biopsied it, and it was a melanoma. Patients know their bodies so well. If it’s something that feels wrong to a patient, and it doesn’t fit the textbook, oftentimes it deserves a biopsy.”
What She Faces
“My biggest issues have been dry skin in the winter because I wash my hands all the time when I’m seeing patients. That’s probably number one. Poison ivy is my kryptonite. I have had some of the worst cases of poison ivy ever, so an itchy patient will get so much sympathy from me because I know it’s so awful.