Let’s Talk … #Teledermatology


Teledermatology: the practice of medicine (specifically dermatology) by a board certified dermatologist or physician extender (NP/PA) dermatology specialist, with the patient outside of the clinic. All of these great #acne results can be achieved from the privacy, comfort, and convenience of your own office or home!

Ashira Dermatology proudly presents “Teledermatology Success”

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These great #acne results were achieved by Dr. Francis via an online dermatology portal. The patient NEVER came into the office.

“Teledermatology represents the perfect solution for those too busy or too embarassed to treat their acne! … for a long time, I was too embarrass to go into an office and have a doctor stare at my face….” – Dr. Shani Francis, Ashira Dermatology

Now it is possible to get MD level, professional, medical care for your acne.

“This is a true evolution in medical care for acne” – Dr. Shani Francis

Amazing results that can be achieved with a series of teledermatology appointments

Ashira Dermatology is proud to offer, exclusive, online, video appointments for problems with the hair, skin and nails.

It’s easy to Book NOW for an appointment online with Dr. Francis. Just click the link above. Most insurance accepted.

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Let’s Talk … Hair Nutrition

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There are so many supplements out there … how do you know what works? If effective, are the supplements even needed? Or can we “Eat the nutrients”? These are great questions! In fact, I started my research with some of the same questions in mind.

What I found in the answer is really quite simple, It depends!

In general, nothing replaces good nutrition, but in today’s food world, how do we really know what nutrition is “Good”? Food choices also matter, so what foods are even needed? If we skip meals, can we just add back the missing ingredients with pills?

There are many well established nutrients to support healthy hair growth. In fact, US News and World Report published a nice slideshow about great nutrition options that support healthy hair.

Let’s first discuss what hair actually is: Protein … protein … protein … and a little fat (few other miscellaneous ingredients) . My patients are very familiar with my expression, “the hair gets the left overs” … The body is very smart. If your body does not have what it needs for normal functioning, your hair will not take it first; it truly only gets the what is “left over”. Below are the 3 most important “food groups” for a healthy mane. Eat Well! 🙂

1) PROTEIN. Hair is over 90% protein, called keratin. Keratin, like all other protein is made up of small building blocks called “amino acids” (no surprise to body builders). But hair is unique in its organization. It is highly organized. Think of a rope of yarn, as you pull each section apart, you find yet another roped group of string. It is in this manner that hair is structured, a rope of ropes until you get to the smallest component, the amino acid.

Yang, Fei-Chi, et. al. PeerJ. 2014; 2: e619.

Amino acids. There are 20 main amino acids, 9 are essential, meaning that you can only get these from your diet (what you put into your body), they are: histidine, isoleucine, leucine, lysine, methionine, phenylalanine, threonine, tryptophan and valine; 11 are non-essential, meaning your body does make them.

Foods that contain all nine essential amino acids are referred to as complete proteins. Complete protein sources include:

  • Meat
  • Seafood
  • Poultry
  • Eggs
  • Dairy Products

Soy, quinoa and buckwheat are plant-based foods that contain all nine essential amino acids, making them complete protein sources as well.

Again, hair only gets “the leftovers”. So if you have a protein-restrictive diet (such as vegan), if you are not eating a complete plant-based protein source, your body could be missing one of the important amino acid building blocks of hair. I often ask, “How can your body build it (grow hair), if you are not putting in the ingredients (protein or amino acids)”. It is ok to be a vegan, in fact, I have followed a vegan diet in my lifetime; however, it is extremely important to work with a nutritionist to make sure that you have a vegan diet that is rich with good food choices, so that you maintain good/adequate nutrition. I have had patients, some who are not vegan but were definitely nutrient-deficient, change their diet and notice improvement in the texture and quality of their hair.

2) IRON. Iron is very important to maintain hair texture and density. For some groups of people, getting adequate iron usually is not a major concern. This includes:

  • those that eat meat, especially red meat
  • most men (higher testosterone level)
  • some post-menopausal women
  • hereditary hemochromotosis

For other populations of people, maintaining adequate iron levels in the blood can be challenging without supplementation. This group includes (but is not limited to):

  • women with active and heavy menses (including those with diagnoses of fibroids, menorrhagia, etc)
  • vegans and protein-restrictive diets
  • those with chronic blood loss or bleeding abnormalities (stomach ulcers, inflammatory bowel disease, cancer, hemophilia)
  • people who have had gastric bypass surgery
  • people taking long term proton pump inhibitors (PPIs) for reflux, such as omeprazole

Discuss your personal health concerns with a medical professional and if you are feeling tired or easily fatigued, have poor body temperature relegation (always with cold hands and feet), or are more pale than usual (especially on your lower eyelid) – ask for your iron profile to be checked.

3) Healthy Omega 3 fat.

Healthy fats are the third most important component of a healthy, hair growth supporting diet. There are numerous articles in the medical literature citing omega 3 fatty acid supplementation as helpful for hair loss. Omega 3 fats are anti-inflammatory in nature and studies have reported various benefits in not only hair, but also overall health. Examples of foods rich in omega-3 fatty acids include: salmon and other fatty fish such as canned sardines, fresh (not canned) tuna, shellfish and oysters, and mackerel. Non-fish sources are also rich with omega-3 are: flaxseed, chia seed, walnuts, avocado, firm tofu, canola oil, and brussel sprouts. YUM! Don’t see your favorite here? Visit Myfooddata.com … it is a good reference site to find even more high omega-3 foods and even learn about the different types of omega-3 fat. There is currently no “daily recommended allowance” of omega-3 as with other vitamins; however, “adequate daily intake” is 1600 mg.

A word of caution: Be careful about oral supplements. Supplements are not regulated and many have very high levels of omega-3 fat. Consuming more does not mean that you have more of a benefit! In fact, omega-3 fat tends to have a blood thinning effect. This could cause an increased bleeding risk. Definitely discuss taking supplements with your primary care provider if you are taking blood thinners. Also, you certainly want to stop all supplements, but especially omega-3 supplements before elective procedures such as Botox or other aesthetic procedures, biopsies and surgeries.

Ready for the US News and World Report Hair Nutrition slideshow? Click here to learn more!

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Let’s Talk … Winter Skin Care


BRRRRRR…. If it’s cold and windy … you have to change your skin care routine! Even if its April!!! See below for some of my favorite tips to share

TIP 1: Don’t skip the SPF!

Many assume that “sunscreen” is to protect from the warmth of the sun. Temperature does not matter! UV radiation comes from the sun and can cause sunburns and even skin cancer in the cold! Ever go skiing and come home looking like the beach? NEW research also shows that higher SPFs may provide better protection. Year-round protection is something always recommended by dermatologists. It’s also part of the reason why dermatologists seem to age slower …. MY FOUNTAIN OF YOUTH FORMULA!

TIP 2: Moisturize differently

Windy and cold weather will dry the skin more effectively, which is what you don’t want. Add to this the Hard Water that is typical in the Northern cities and you have a recipe for skin problems: dry, itchy, rough, maybe even rashy. The best way to moisturize is actually using thick, heavy creams (something we call “emollients”). You will need something that you scoop out of a jar, not something you pump out of a bottle. So lotion is not going to cut it! Neither is coconut oil or Shea butter. Sure those are thick when you scoop them out, but once in contact with the heat from your skin, they turn to liquid quickly, making them less effective. Ready to go to the next level? Use those thick emollients when your skin is still damp! This will LOCK in the moisture to your skin and prevent water loss. We measure this feature in a lab with something called, trans epidermal water loss, or TEWL. Based on our lab experiments, we have found that thick emollients, like petroleum jelly are best.

Dr. Francis’ Top 5 emollients: Vaseline, CeraVe healing ointment, Aquaphor, Cetaphil cream, Aveeno eczema therapy. Available Here

TIP 3: Use gentle cleansers

The gentlest cleansers may not be advertised as “all natural” or “99.44% pure”. In fact, some of the most natural cleansers are actually quite hard on your skin. Why? Because pH is more important when considering how hard something is on your skin. Skin wants an acidic pH, closer to 5.5-6. Most soaps are very basic, with a pH closer to 9-10! The soap touting the “99.44% pure” is pure lye! It has a pH around 12! Very harsh!

Common Soaps most dermatologists advise avoiding: Ivory, Irish Springs, Castille Soap (check label, sodium hydroxide is typically added -this has a pH close to 14)

Dr. Francis’ Top 5 gentle cleansers: Dove, Cetaphil, CeraVe, Purpose, Basis. Available Here

TIP 4: Seal cracks with glue!

Cracked skin is PAINFUL. Close those cracks to speed up healing!

One of my favorite Winter HACKS … Crazy glue!
That’s right. Crazy glue. Cracked skin is open, which means that dirt, bacteria, allergens (things we are allergic to), and other irritants can easily get in. The more these get into our skin, the harder it is to heal. Those of us who suffer from this know that it can take FOREVER to heal on its own. Here’s the secret … the crack is the problem! So let’s fix it with a little glue. Our skin is our first line of protection against the environment … when it is intact, it is naturally anti-bacterial, anti-viral, etc. So we must repair our protection and seal the crack to break the vicious crack cycle. Glue does the trick! I know what you are thinking, glue is a harsh chemical, but guess what, many “skin glues” were actually developed to replace stitches. Crazy glue is one of those. The glue gives our skin a chance to heal – and once the crack is sealed, our skin is able to heal itself.

Have a question (or comment)? I have an answer. Leave me a message below. Let’s talk!

Let’s Talk pH!

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pH is one of my favorite things to discuss, maybe because of my background in Biochemical Engineering or maybe due to its powerful influence over hair and skin properties that matter to us all (texture, feel, suppleness, strength, shine, etc). pH or “potential of hydrogen” is a numerical measurement to represent how acidic or basic a solution is. An important fact to consider is that the solution (or liquid) must be “aqueous” or water-based. Oils cannot have a pH.

This is a number scale (it’s actually a logarithmic scale for my math buff readers) from 0-14. The lower the number, the more strong the acid is. The higher the number the more strong the base is. Neutral is directly in the middle and is 7.0. Anything less than 7 is technically considered an acid or “acidic”. Anything greater than 7 is technically considered a base or “basic”.

Here’s how a few common household substances measure up:

https://cnx.org/contents/FPtK1zmh@8.108:5ORVCb_A@4/Inorganic-Compounds-Essential- Illustration from Anatomy & Physiology, Connexions Web site. http://cnx.org/content/col11496/1.6/, Jun 19, 2013.

How does this relate to dermatology (science of the hair, skin and nails)? Hair and skin health is usually optimized at a pH of about 5.5 (Acidic). The important thing to note is that most of the products that we use on our hair and skin everyday (soap, shampoo) has a pH closer to 6.5-8. Some soap, even natural glycerin based soap, has a pH of >9! Ivory soap, was measured at a pH of 12. The further these products get away from our optimal 5.5 pH, the more irritating they can become, which will translate to dry and itchy skin, rashes, dandruff, dry and brittle hair, etc.

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Let’s Talk … Summer Hair Damage

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It’s getting warm and we are already making plans for fun in the sun! In the interest of being proactive … why not discuss how to prevent summer hair damage. An ounce of prevention is worth a pound of cure!S

The Summer environmental stresses lead to increased reactive oxidant species and hair cuticle damage that result in inflammation, protein loss and oxidative stress on the hair fiber.  If caught early enough, before the cuticle is loss, adding moisture, protein and nutrients back to the hair fiber is important, then acidifying the cuticle with acidic pH products will help close the cuticle to reseal the fiber.

Summary (Product Ingredients that will help)

  • Acidic pH products (see below), especially shampoos and conditioners
  • ceramides (see below)
  • sun protection (mineral based makeup and powders), especially those that contain iron oxides are easy to apply to your hair part and will not affect styling — Hats off to that!

See related Health magazine article for products specifics (note: these recommendations may or may not be endorse by me … individual needs/preferences always vary). https://www.health.com/beauty/detox-hair

Wind Damage. Why: Heavy wind will mechanically disrupt hair fiber cuticles (like a tornado to roof shingles), which contribute to protein loss.  This can also happen with excessive detangling and wet combing. 

How to fix: Deep protein-based conditioner treatments, acidify cuticle 

Products that can help: look for products containing ceramides which help seal the cracks in the cuticle.

Sun Damage

Why: Heat from the sun will dry of the protective oil layer on hair shafts and deplete the hair of its natural moisture. Ultraviolet radiation present in sunlight can cause increased DNA and oxidative damage (from free radical species) 

How to fix: Prevention is better than cure. Coating the hair with coconut oil and zinc based products to help seal the cuticle from damage and filter UV before it reaches the fiber. 

Products that can help: Look for products with antioxidants, spin traps. Seek professional deep conditioning and/or protein treatments (not keratin treatment)

Humidity Damage

Why: Excessive environmental moisture can swell the hair fiber and disrupt the cuticle (roof shingle) leading to protein loss and frizzy appearance. 

How to fix: acidify the hair cuticle to lay the roof shingles down; add oil for protective layer to lock out excess environmental moisture. Coconut oil may be a good option to form that protective layer over your hair. It is non-greasy and easily absorbed into hair fibers. If your hair is fine, use less. If your hair is coarse, you may need to add an additional, heavier oil (or other alternative) on top of the coconut oil, occasionally.

Coconut Oil Pulling Benefits and My How-to Guide

Coconut oil

Coconut oil is now popular and widely used as a hair maintenance product. When looking into the published medical literature, some articles were found …

In fact, coconut oil was found to “… reduce protein loss remarkably for both undamaged and damaged hair when used as a pre-wash and post-wash grooming product”

J Cosmet Sci. 2003 Mar-Apr;54(2):175-92.

Products that can help: Look for Shampoos with acidic pH (4-5.5), most are >5.5

Click here to get medical article on shampoo pH … Int J Trichology. 2014 Jul;6(3):95-9.

Chlorine Damage

Why: Chlorine can break through the hair shaft and penetrate to the middle layer of hair called the cortex and bind, disrupting the hair cuticle, pigment cells and key proteins. 

How to fix: Prevent long-term chlorine damage by rinsing hair thoroughly with shampoo to remove excess chlorine. Replace the missing protein and reduce the inflammatory environment. Copper and zinc can be great aids to replace the chlorine molecule in the hair fibers.

Products that can help: Look for products with antioxidants, spin traps. Seek professional deep conditioning and/or protein treatments (not keratin treatment)

Salt Water Damage

Why: Salt changes the pH environment around the hair fiber, which will lift hair cuticles and increase friction between hair fibers leading to loss of moisture and protein.

How to fix: Deep protein based conditioners

Products that can help: acidic shampoos and deep moisturizing conditioners

Styling-Related Damage

Why: Hair that has been in a “maintenance hairstyle” all summer could be over-conditioned and will end up limp and lifeless, similar to the humidity damage.  Prolonged and tight hairstyles, such as weaves and ponytails could end in hair loss called “traction alopecia” 

How to fix: Take a break from the braids and ponytails, allow hair to break. If caught early enough, it should normalize on its own naturally within a few weeks of care. 

Products that can help: N/A – style adjustment. If product buildup is a factor, consider clarifying shampoos.

Have a question (or comment)? I have an answer. Leave me a message below. Let’s talk!

Let’s Talk Shampoo …


Here are a few answers to questions from a recent #Prevention.com article that I contributed to (Article link below) … But I’d like to hear from you! Post your questions in the comments section below.

1. Can you please explain why choosing the right shampoo is so important for your scalp and hair?

Shampoos are one of the most frequently used and important hair care products. They are the foundation of scalp health and can be very helpful or harmful to the condition and aesthetic appearance of your hair fibers (locks). At the most basic level, shampoos are designed to cleanse the scalp and hair, removing all the dirt, oil and hair products that have built up since the last shampoo. If not performed frequently enough, one could be much more likely to develop seborrheic dermatitis, an inflammatory scalp condition that could lead to hair loss and excessive shedding. If performed too frequently, the surfactants (soaps) could strip the hair fiber of its natural moisturizing/protection layer and cause cuticular damage – which typically leads to a condition called “trichorrhexis nodosa”, the medical term for hair breakage.  

2. Can you please provide 3 tips for what to look for when you’re looking at different shampoos in the drugstore? When it comes to ingredients (what to look for, what to avoid), etc.?

Tip 1:pH is one of the most important attributes of a shampoo. Unfortunately, it is often difficult information to find. If it is not printed on the label, one should assume it is around 6.5-7, which is much higher than what our hair prefers, closer to 5.5. The acidic (lower number) pH helps seal the cuticle, which leads to softer, shiny and less damaged hair. Think of shingles on a roof. The higher the pH, the more open the cuticle is, so the shingles can easily break off. If the pH is lower (more acidic) the roof shingles are more closed, which makes the hair fiber stronger, less susceptible to damage and more able to reflect light (shinier). But don’t worry, if not listed, a capful of apple cider vinegar to the bottle of shampoo, should help lower the pH to a better level. Aloe vera juice tends to lower pH as well.

Tip 2:Find out your surfactant. The surfactant is the main ingredient that does the work of cleansing and often foaming; it is usually the second ingredient, preceded only by water. It also has the ability to be the most damaging. This is key for “sulfate-free” shampoos. Often “sulfate free” shampoos still have sulfate, they just are free of sodium lauryl sulfate (SLS), which for some with sensitive skin, could be an irritant. In a recent article published in the International Journal of Cosmetic Science, surfactants were described as having the potential to remove natural skin oil, leading to disrupted skin proteins, skin dehydration, increased skin permeability, all of which contributes to scalp irritation and rashes. An irritated or inflamed scalp can affect the quality and appearance of the hair.

microtip. Do not focus on foaming – a shampoo’s foam is like your favorite car color – we all have preferences, but it does not translate to how well it works. Interestingly, foaming does not directly translate to cleansing ability, so the more foamy a product is, does not mean that it is truly higher quality or gets your hair more clean. But if you must have foaming, “cocamidopropyl betaine” is a commonly used foaming booster; however, use caution with sensitive skin, as this chemical is often also irritating.

Tip 3: There is no “standardized hair”. 23 and me and other personal genomic testing companies have well established how diversified and blended we truly are as a global race. Thus, hair types enjoy that same level of diversity. A one-size fits all modality of thinking should be avoided. Embrace your natural hair texture and choose a product that supports it to enjoy optimal hair health.

3. Now, on to the shampoos! Can you please give us 5 different shampoos for the different ‘hair types’ below? And why you think they’re great picks?

– best shampoo for ‘normal’ hair – See Tip 3 above. Embrace your natural texture and nurture it! It is far healthier to enhance what you naturally have then reverse what your body wants to do (e.g. celebrate those thick curls, let them bounce!)

best shampoo for fine hair. For fine hair, you may want to stay away from the sulfate-free shampoo trends, especially if your hair is more on the oily side. If volume is what you are seeking, volumizing shampoos tend to use small particles called siloxanes to move through the hair fiber to the center and stick there, plumping it up from the inside out. Humectants, such as glycerin and honey could be useful. A more neutral pH, closer to 6.5 will also open the cuticle and allow more water to end individual fibers, thus, giving a more full appearance.  It is important to note that these products product a temporary effect, so the effect usually lasts only 24-48 hrs after shampooing. 

– best shampoo for curly hair. Because of the natural bend of the hair fiber, curlier hair tends to be drier as it becomes increasingly difficult for scalp oil to distribute along the individual curly hair strands. As such, milder surfactants (such as sulfate-free shampoos) are usually needed to avoid overdying hair strands. More acidic pH’s will smoothen the cuticle, reducing frizz and cetyl alcohol is a popularly used, but unknown additive that helps maintain and even restore the nature oil barrier. It is a quite tricky balance, and at some point, if too many hair products are regularly used, a sulfate-free shampoo will not be effective at removing the product buildup, which could lead to problems in the long run.  

– best shampoo for oily hair. If your hair is oilier, or you tend to have a lot of product buildup, a shampoo with sodium lauryl sulfate (SLS) is likely your best option. SLS has been well established as the most effective ingredient for sebum (natural scalp oil) removal. You should also avoid shampoos that contain silicones (i.e. dimethicone), as these ingredients tend to coat the hair fiber and resist removal, which could aggravate the oil problem.

– best shampoo for dry hair. Hair that feels dry would be best served with a lower pH and silicone-based shampoo. While pH closes the cuticle, silicones form a protective layer over the hair fiber that will smooth the texture (less rough feeling). Cetyl alcohol is a currently popular ingredient that helps with detangling and lends to a smoother feel when dried due to restoring the natural lipid content of hair fibers.

– best shampoo for colored hair. The goal is to keep the cuticle as closed and tight as possible to prevent leakage of hair color out the fiber. Thus, the lower the pH the better the shampoo – closed roof shingles. Also, the more coated the hair fiber, the better protected the color, so ceramides, cetyl alcohol and silicones could be helpful here as well. Sulfate-free is likely less irritating, which could help stabilize the fiber, preserving the barrier function; however, sulfate-free is not required as long as the pH is low. 

– best shampoo for damaged hair, lower pH works well for damaged hair and also products with silicones. Also look for products with ceramides. These molecules tend to work like glue, coating the damaged areas of hair fiber to improve strength, fragility and texture. Occasionally, protein-based amino acid ingredients are helpful, but it is best to leave these to a licensed salon professional, as overdoing this can lead to increased brittleness and further damage.  

– best shampoo for thinning hair. Be cautious that you are getting a product with a claim for increased hair density at the scalp level and not just reduced breakage. Several additives have been reported to help stimulate new hair growth including: caffeine, niacinamide, zinc, wheat protein and green tea (EGCG). Look for ingredients that also contain natural DHT blockers, saw palmetto being the most established in the medical literature data. 


Have a question (or comment)? I have an answer. Leave me a message below. Let’s talk!

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Excited to spread education, knowledge, love, happiness, and healing to all seeking souls!

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Let’s talk! Send me your questions, concerns, and love!

Feeling private? Drop an email: DIYDerm@ashiraderm.com 

Have a question (or comment)? I have an answer. Leave me a message below. Let’s talk!