A Conversation with South Coast Dermatology’s Courtney Csikesz, M.D.

Mar 28, 2022

What got you interested in Dermatology? What do you appreciate about spending your days helping to keep your patients’ skin happy and healthy?

I became interested in dermatology after meeting a 9-year-old boy with a rare blistering disorder (recessive dystrophic epidermolysis bullosa) while doing my inpatient pediatric rotation during my third year at UMASS medical school. I don’t think I even knew pediatric dermatology was a subspecialty at the time, but during that rotation, I got to know the pedi derm team well, and I was enamored. I spent some time during my next break shadowing a local dermatologist who is a family friend (and now my current boss!) to see if I enjoyed the basics of dermatology, such as skin checks, rashes, and acne, and I fell in love with the field. I think that dermatology has got to be the coolest medical field – it’s very unique in medicine to be able to see a newborn followed by a 90-year-old, then onto surgery to remove a skin cancer and followed by laser to remove sunspots. I love that aspect of it. I love getting to talk to patients during their skin cancer screenings about the importance of keeping their skin protected from harmful UV rays through sun-protective clothing, sunscreen, hats, sunglasses, shade, and even new options like sun capsules to offer additional sun protection.

How’d you get involved with IMPACT Melanoma?

I became involved with IMPACT Melanoma after my father was diagnosed with melanoma on the eve of my first night of internship back in 2009. I had already been accepted into a dermatology residency and decided that this would be my career path, but I had no idea how much personal relevance would unfold. My father is a fighter. He was originally diagnosed with stage 3b melanoma and was successfully treated in a clinical trial for Ipilimumab. He subsequently, over the next decade, had another deep melanoma develop, and then this past April 2021 was diagnosed with metastatic melanoma after it spread to his brain and his lungs. I can’t help but feel grateful that at least now we have many more options to treat metastatic melanoma, and he has responded very well to Keytruda and radiation. After his initial diagnosis, my father got hooked up with IMPACT Melanoma and later became a board member. As a family, we quickly became invested in this wonderful organization looking to spread awareness about the risks of skin cancer and the importance of early sun protection.

My mother and I have both served on the Shades of Hope Gala committee and have helped with the annual golf tournament. I recently worked with IMPACT Melanoma on their No Sun For Babies campaign. We teamed up with South Shore Hospital and helped distribute sun protection bags to parents of newborn babies. These bags contain sunshades for the car, baby hats, long sleeve SPF clothing, and information on the importance of early sun avoidance and blockage. I am passionate about No Sun for Babies because, as both a pediatric and adult dermatologist, I spend every day witnessing the effects of good sun protection on young kids whose parents have been armed with the knowledge about how to protect their kids from the sun – and the contrasting effects of little sun protection that some of the older generations experienced and now the multiple melanoma and non-melanoma skin cancers that are pervasive as a result. My adult patients often like to reminisce (and cringe) about their days of basking in baby oil and iodine with reflectors to enhance the effects of the sun. Now, we as dermatologists get to arm new parents with the knowledge (and, in this case, the actual products) that they will need to set their child up for future skin health.

On top of being a pediatric dermatologist, you’re also a mother of four. How do you help parents realize the importance of protecting their children’s skin and, further, educating them on the proper application of sun-safe clothing and/or sunscreen?

As a mother of four young kids aged 2, 6, 7, and 10, I find that parents can relate well to my advice on how to best protect their children from the sun in a realistic manner. First and foremost, the best way to protect your skin is through sun avoidance – whether that is avoiding the beach/pool during the peak hours of 10-2 or if you are in those settings, then making sure to have umbrellas or sunshades set up for when kids and adults are not swimming. I am certainly realistic about how much we all crave being outside and in the sun when the weather is actually nice in New England, however, so I stress sun-protective clothing a LOT. In my house, our rule is that the swim shirts stay on until 5 pm – which often leads to a lot of asking what time it is as that ‘happy hour’ for them approaches.

I always stress to my patients that the more clothing they wear, the less they have to worry about time spent on sunscreen and getting sunburns. I also always ask my kids to wear hats whenever they aren’t actively swimming, and I used a lot of neoprene toddler hats that can get wet when they were younger. Last but not least, of course, is the sunscreen. For my patients and with my own children, I always recommend using a cream-based sunscreen (instead of a Spray) to start the day – with an SPF of at least 30 but trending towards a 50. I always encourage them to use more than they think they need and let it dry for 15 minutes before jumping into a body of water. I always spend a lot of time during appointments stressing the need for reapplication every 2-3 hours or after swimming because this is where I find most sunburns occur, and laziness sets in for all of us. For the face, my kids always use stick sunscreens (I love the Neutrogena ones) because they go on easily and don’t drip into and sting little eyes.

I like to reserve the use of spray sunscreens for hair (those pesky parts in the hair need protection too!), ears, and reapplication for the legs – especially when covered in sand. With the findings last spring of many spray sunscreens containing benzene, at this point, I am trying to recommend only using non-benzene containing sunscreens. Similarly, I prefer mineral or physical sunblock to chemical sunscreens. These will only have and list zinc oxide and/or titanium dioxide as the active ingredients. They are particularly important for anyone with eczema or sensitive skin since the chemical sunscreens will irritate the skin. I try to at least have my kids use those for the first application of the day but honestly, I would rather a chemical sunscreen be used than nothing since we know the sun can absolutely cause cancer, but we have no data at this point that chemical sunscreens used in normal amounts are cancer-causing. Not all mineral sunscreens are created equal, and some are very hard to spread, so I like to use Elta MD UV Pure, Neutrogena for Babies, or Blue Lizard Babies.

What’s your personal battle cry as it relates to practicing safe skin pertaining to exposure to the sun’s harmful UV rays?

One of the aspects I focus on is early daily year-round facial sunscreen use because I think if this habit is started early, it is more likely to become a lifetime habit. I use early teenager acne visits as a chance to discuss the importance of using an SPF containing moisturizer every morning containing at least an SPF of 30 (I love Elta MD’s UV Clear for acne-prone patients and Isdin Eryfotono Actinica for adults with sun damage) but I don’t care what brand it is as long as it becomes a habit. The other time I think sunburns occur in greater frequency is when the weather isn’t what was predicted or expected. The old ‘I was at my son’s baseball game, and it was supposed to be overcast, so I didn’t use sunscreen.’

Occasions like this can be easily avoided by at least making sure daily moisturizer or makeup has an SPF built into it. I always remind my melanoma patients that I don’t expect them to hide under a rock for the rest of their lives. I love being outdoors, and I think it is good for our mental health – I just try to arm them with the proper knowledge of how to do that safely and responsibly and encourage them to spread the word to their family and friends. One of the things I love about IMPACT Melanoma is our shared mission to educate the public on these aspects of sun protection and the risk of developing skin cancer such as melanoma.

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