One day, it's tattoos; another, acne, yet another, birthmarks. But every day, says Dr. Jay Kincannon, his work makes him "the luckiest guy in the world."
The tall triathlete Kincannon, 45, revels in his work, his workplace and, he acknowledges, a specialty that allows him to have a life outside the office. The dermatologist with patients at Arkansas Children's Hospital and the University of Arkansas at Medical Sciences gives a rapid-fire account of what he sees: moles, warts, eczema, acne, vitiligo, hemangiomas, rashes, skin eruptions in very sick children, rare blistering diseases, cancer, the weird-sounding and increasingly common (but not serious) molluscum contagiosum virus. His favorite work is treating children with port wine stains and hemangiomas - "I'm your birthmark man," he says - and he likes cases he can "sink his teeth into - like eczema." But he's equally animated when he describes his techniques for removing tattoos, an area he predicts will provide dermatologists with work for years to come. He even spins off, at the request of pleading women, into skin care, how to fend off wrinkles.
In the three and a half days he spends with children, Kincannon sees "what the family practice doctor can't get under control with normal topical stuff" - cystic acne and such - as well as serious, even life-threatening, conditions.
Fortunately, port wine stains - capillary malformations that can cause stroke or overgrowth of affected limbs - are uncommon. Kincannon devotes an afternoon a week to treating these and other birthmarks at Children's, which has become a large referral center thanks to ear-nose-throat Dr. Milton Waner's widespread fame in removing hemangiomas.
More common is acne - in fact, only 15 to 20 percent of children will be spared this bane of pubescence, and Kincannon sees a lot of patients. The bad news: There's nothing new out there for acne (in Little Rock, that is - laser treatments are now in use elsewhere).
Acne is caused by hormonally revved-up oil glands clogged up by keratin proteins (in the skin). It is not caused by dirt, chocolate, Coca-Cola or pizza - "unless you rub your face in the pizza," Kincannon said.
He prescribes Retin A or benzoyl peroxide, agents that over time will keep the clogging skin proteins in check, as well as antibiotics like tetracycline and minocycline. Accutane, because of its side effects (which may include depression), is more rarely prescribed.
There's an art to treating acne, Kincannon says. Different skin types require different approaches. He has to divine what the child will tolerate and how he'll comply. Will he use the recommended pea-sized drops of Retin A or will he overuse it and burn his skin, impatient for therapy, which takes a couple of months, to work? Or will he use any of his medicine at all? Kincannon laughs, talking about teen-age boys who, in the way of teen-age boys, just shrug and grunt when asked if their acne is bothering them. Sometimes, it's the parents, not the kids, in search of a cure.
Another common problem Kincannon treats: Warts. Caused by viruses, they aren't curable. They can be frozen or otherwise removed, and if a child is particularly bothered or has a number of them, that's the way to go. But warts have a limited life span and will also go away on their own, Kincannon said.
That fact may account for the "cures" achieved by folk remedies. Kincannon recalled a boy who came to see him with 200 warts, and he scheduled an appointment to remove them. But when he returned, the warts were gone; his grandmother, using a treatment Kincannon was reluctant to describe, claimed she'd cured him. (He's heard of many folk remedies: potatoes applied to the wart and then buried, stump water, static electricity (via balloon), even dousing the wart with placenta.) Kincannon "takes to heart" his patients' belief in the remedies, but in the end he's a "science guy," one who prefers to practice "evidence-based medicine."
Warts on the hand are one thing; the genital human papillomavirus is another. A type of HPV is known to cause cervical cancer, a disease that causes an estimated 4,900 deaths yearly in the United States. Kincannon, with UAMS dermatologists Tom Horn and Sandy Johnson, is taking part in clinical experiments in the use of candida yeast to treat HPV. The yeast is injected into the wart to elicit an immune response from the body to kill both yeast and wart. The treatment is getting a 70 percent success rate.
In his adult practice, Kincannon removes tattoos - a costly laser procedure, requiring many repeat visits - and cosmetic dermatology, such as facial resurfacing by laser and botox. The latter procedures, he said diplomatically, require good doctor-patient rapport. There is just so much you can do to restore youth to your face. His advice: Bathe or shower in warm water for no more than 15 minutes and immediately afterward apply heavy lotions or oils to wet - not vigorously toweled dry - skin. These lotions need not be expensive: "Vaseline is fine," he said, if you don't have acne.
A caveat: Skin gets its moisture from the air. Despite what you may read in the salon, the amount of water you drink, he says, has nothing to do with the moisture in your skin.