Dr. Tokarek, a 2018 Philly Magazine Top Doc from Abington Dermatology Associates offers insight into new medications and skin treatments, what he loves most about his job, and why he’s proud to be a beach geek.
1. What made you choose dermatology?
One of things I like about dermatology is that you can treat people from childhood into their geriatric years. That’s not true of every specialty. We see such a wide range of ages, skin types and interesting personal histories in the dermatology field, and that’s something I really love about it—it gives me a chance to develop real relationships with my patients. Also, I was looking for something that would allow me to balance work and family. Dermatology is a good example of a career that really does allow you to do that.
2. What part of dermatology do you specialize in?
Although I was trained both in medical and surgical dermatology at the Thomas Jefferson University, my interests have really gravitated toward the complicated medical cases. That includes advanced acne, psoriasis, and even autoimmune disease. I’ve been particularly interested in the uses of new medications for those conditions. Of course, like any practicing dermatologist, I diagnose and treat a great many patients with skin cancer every day.
3. We’ve learned a lot about melanoma in recent years, but what do you think we still need to understand a little better?
It’s so important to understand that sunscreens do a lot more good than harm in helping prevent skin cancer and melanoma. There’s been some controversy about the effectiveness and use of sunscreen, specifically whether the goal is to block out the sun’s rays completely. We are trying to block the worst sort of rays so patients don’t get a burn. On the other hand, we as humans need a little bit of sun to produce vitamin D for healthy bones , so as in many areas of life, sunlight is another item on the list of things best experienced in moderation. I think most people understand that seeking out extra sunlight isn’t the way to go, but I’d emphasize sunscreen is still important in preventing skin cancer.
4. What’s SPF should we use if we’re going to be in direct sun?
We used to say anything over SPF 30 is not more effective than the higher numbered alternatives, but there was a small but interesting study conducted recently where investigators performed a blind trial at a ski resort using SPF 30 and much higher SPF values. Surprisingly, and against conventional dermatologic wisdom, the subjects with the higher SPFs had significantly less evidence of sun exposure. So it may turn out that the higher the SPF the better. There’s still a lot of investigating to do, though. Most dermatologists are also recommending the mineral-based sunscreens with zinc and titanium. Although they tend to be a bit chalky, they seem to work better. I am also a huge proponent for sunscreen clothing—shirts or tops work especially well for children.
5. What aspects of treatment and medicine are you most excited about in the field of dermatology?
There are newer medications that target aspects of patients’ immune systems, resulting in more disease-specific treatments with fewer potential side effects. That’s one of the more innovative concepts in medicine in general, including other specialties such as oncology and gastroenterology, and the trend is only gaining momentum. In dermatology, we’re using these new medicines with great effect in psoriasis, psoriatic arthritis, eczema, hives, and even melanoma. This allows us to decrease our reliance on the older medicines such as the steroid prednisone, or methotrexate, for example, both of which have difficult and numerous side effects.
6. What are some advances you still hope to see?
Diagnostic tools are lagging a bit in dermatology. We dermatologists are still using our experience and our eyes, which are fallible, to make diagnoses. Of course, mistakes can be made no matter how many years a person has practiced or how many cases he has seen. There are existing advances are in treatment, but I’d say there are improvements can be made in the diagnostic tools of my trade.
7. Skincare is often thought of as a woman’s issue. But can you explain why that’s not the case and how you care for your own skin?
As we age, skin loses its ability to hold its moisture, so good skincare is important for everybody. I see many male patients who are concerned with how their skin is aging. Honestly, the simple use of moisturizers on a daily basis really helps the appearance of skin. I’m surprised more people in general and men in particular don’t pick up on this. Men often use harsh soaps or no moisturizers at all. Nivea Men and Axe are examples of products marketed for men. I rely on the Cetaphil brand of moisturizing creams and cleansers in my household.
8. Do you have summer plans with your family?
We travel yearly to Ocean City New Jersey with my wife Monica’s family and also the Outer Banks of North Carolina with my parents. We are beach and pool lovers! But I can promise we’ll be wearing ball caps and the whole family will be covered in sunscreen and protective clothing. We are probably the geekiest looking group out there on the beach, but that’s what you get when you take a dermatologist with you on vacation!