Recently, I was surprised to find a line that gives whole new meaning to the word “cosmeceutical”: Exederm Ultra Sensitive Skin Care. Exederm is a line formulated for sensitive skin that contains no colors, parabens, lanolin, fragrance, sodium lauryl sulfate or formaldehyde. But what really surprised me about Exederm products was relatively high non-prescription concentration of hydrocortisone in the Flare Control Cream - 1%.
Hydrocortisone is a synthetic form of the stress hormone, cortisol, that used to be known as Compound E. Hydrocortisone was developed in order to treat allergic reactions and inflammation, and is used in concentrations of 0.5-1% (as in Exederm products) to treat sensitive skin symptoms. To treat sensitive skin and mild rashes, Exederm should be applied 2-3 times a week until symptoms cease.
Because hydrocortisone is absorbed in the bloodstream, it is well-known that prescription strength hydrocortisone can cause a variety of undesirable side effects (excess hair growth, burning, redness) with repeated use over time. For this reason, I personally use Exederm whenever I have contact dermatitis from trying a new product, and keep it in my medicine cabinet for those emergency cases. I wouldn’t personally use the Flare Control Cream for longer than two weeks at a time, to prevent side effects from occurring.
Exederm Cleansing Wash goes on without a lot of bubbles, which makes sense, with the low concentration of surfactants. Still, it leaves skin feeling clean without feeling dry or tight. The fact that the facial wash is completely free of oil, sodium lauryl sulfate, color, parabens, fragrance, formaldehyde and hydrocortisone makes it perfect for daily use.
Exederm Flare Control Cream contains 1% hydrocortisone, making it extremely effective but not suitable for long-term use. However, it is very effective against red, irritated, and itchy skin; in fact, I would venture to say that this is the next best thing to a prescription, since a doctor would give you 2-4% hydrocortisone, whereas this is 1%. I used it on a patch of poison ivy for the past 2 days (I just got a dog, and I chased her through a park…not a good idea, haha), and it really alleviated the itch. Ahhh….
Exederm Intensive Moisture Cream goes on light, but once on, you can tell that the second ingredient is super hydrator petrolatum. It is very hydrating and feels cooling on a rash. It doesn’t contain anti-aging ingredients or sunscreen, but it is a solid moisturizer that is suitable for anyone with sensitive skin.
Overall, I’m very impressed with the Exederm Ultra Sensitive Skin Care line. I especially love the Exederm Cleansing Wash for everyday and the Flare Control Cream for itchy redness for two week intervals. Overall, I give this line a solid 9/10. (High concentration of well-proven ingredients: 3/3. Unique formulation: 3/3. Value for the money: 3/3. Sunscreen: 0/1).
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July 15th, 2008
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Okay, so I’m not going to sit here and start on a big lament about how a single sunburn puts you at an increased risk for skin cancer. Or about how sunburn only occurs after your cells are already damaged. Nope, not going to do that. ;-) What I am here to write a full blog post about, though, is how to treat a sunburn in seven easy steps:
1. Take an aspirin as soon as possible.
It may sound like illogical advice, but aspirin is a natural anti-inflammatory. According to Dr. James Spencer, a St. Petersburg, Florida dermatologist in this month’s Allure, “Ultraviolet radiation causes inflammation, and aspirin is an anti-inflammatory [that doesn't cause thinning of the skin over time.] “ Less inflammation means less pain, so I say, go for it! (One word of caution: don’t give aspirin to children under 18, as aspirin exposure in children has been associated with Reye’s Syndrome).
2. Try distilled white vinegar.
According to Dr. Audrey Kunin, author of The DERMADoctor Skinstruction Manual, distilled white vinegar takes the sting out of a burn, “once the initial sting from the vinegar wore off.” According to Kunin, “The acetic acid in the vinegar works as a topical NSAID (non-steroidal anti-inflammatory drug).” It doesn’t smell too pleasant, but it’s a nice quick, cheap at-home fix.
3. Shower with lukewarm water - and oatmeal.
Even if you’re Queen (or King, for that matter) of the Hot Showers, lay off for a while. Hot showers can be irritating for a sunburn, according to Dr. Jeffrey Benabio of The Derm Blog. Instead, Dr. Benabio recommends showering or bathing with lukewarm water and Aveeno Colloidal Oatmeal.
Oatmeal has proven anti-inflammatory and soothing properties. In a supplement to the journal Cosmetic Dermatology, it is stated that these ingredients are among the few natural ingredients that are regulated by the U.S. FDA. In addition, in the supplement, it reads that oats have been used since ancient Egypt to manage dry, itchy skin. Colloidal oatmeal, a preparation of ground hulled oat kernels dispersible in water found in Aveeno Colloidal Oatmeal, is helpful to dry skin in four major ways:
- 1. Contains a helpful mixture of components that soothe and/or hydrate skin, including 10-18% protein, 60-64% polysaccharides, and lipids, enzymes, saponins, prostaglandin synthetic inhibitors, vitamins, and flavonoids. In short, oat proteins have high hydration and fat-binding capacities, and have been shown to improve skin’s barrier function.
- 2. Has a lower pH than human skin, which enables absorption of oils and dirt on the skin.
- 3. Positively charged sites of oat proteins help oatmeal bind to negatively-charged parts of the skin, anchoring the moisturizing ingredients into the skin. This helps the ingredient form a thin layer over the skin. (Pretty neat, huh?
)
- 4. Contains vitamin E, an antioxidant.
- 5. In one study, cited here, oat kernel extracts inhibited prostaglandin synthesis to a degree comparable with that of indomethacin, indicating that oatmeal may reduce pain and itching.
4. Use an aloe vera cream immediately after you shower.
Aloe vera is one of the mysteries of the dermatological world: it works, but no one seems to know why. According to Dr. Spencer, “It’s been a sunburn staple since the days of the ancient Greeks and Romans, although no one knows why it works.” Maybe this will be something I devote my research days to in medical school, who knows. ;-) Until then, I recommend Aubrey’s Certified Organic Aloe Vera ($7.78, Amazon.com). (For more on certified organic, click here.)
5. OR try green tea creams or compresses.
A green tea cream works because — surprise! — it’s also anti-inflammatory. Two great ways to get it: one, try a cream with a high concentration of the active part of green tea, the EGCGs, like with the 90% polyphenols found in Topix Replenix Cream ($44.95, Amazon.com). Or, according to Dr. Kunin, you can brew up a batch of green tea, chill it, and make compresses at home. The EGCG will act as an anti-inflammatory through the cool compresses (pretty neat, huh?!) My personal favorite is Tazo China Green Tips Green Tea ($5.95 for a box of 24, Amazon.com).
6. Despite traditional advice, avoid benzocaine or lidocaine.
I have heard from a number of sources to use topical numbing agents, like benzocaine or lidocaine, on a bad burn. However, according to Dr. Jeffrey Benabio of The Derm Blog, “Although [numbing agents] can feel great when applied, they are notorious for causing allergic contact dermatitis. If you think a sunburn is bad, try adding an incredibly itchy, allergic contact dermatitis on top of a sunburn. As one of my patients put it: “Its like being tied down on an ant hill of fire ants.”’ Um, that’s not good. Sooo, stay away from traditional advice on this one, and lay down with some aspirin, vinegar, oatmeal, green tea, or Domeboro instead (see below).
7. Try Domeboro.
What’s Domeboro, you ask? (I had no clue either.) Domeboro ($10.03, Amazon.com) is an astringent solution that has been used for decades. According to Dr. Katie Rodan (of Pro-Activ fame) in this month’s Allure, it’s good for blisters. It’s available in powder form, and can be mixed with water (and yes, also green tea) to form a cool, soothing compress. Now doesn’t that sound nice? 
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June 5th, 2008
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Crow’s feet are amongst the most complained about wrinkles on a patient’s face. And for good reason: “Crow’s-feet are usually the earliest wrinkles to appear on a woman’s face,” says dermatologist Debra Price, M.D., clinical assistant professor of dermatology at the University of Miami School of Medicine and a dermatologist in South Miami. So what to do about crow’s feet?
Take an aggressive approach at home.
To quote Meg Ryan in You’ve Got Mail, “Fight, fight, fight!” Start each day off with a multivitamin that contains vitamin C and linoleic acid, which has been recently reported in a study amongst 4000 women to reduce wrinkles. Next, apply an antioxidant serum and sunscreen or moisturizer with sunscreen, concentrating on the area around your eyes. Be careful that the formulations are tolerated well around the delicate eye area. My well-touted favorites are Skinceuticals CE Ferulic ($107.00, Amazon.com) and NIA 24 Physical Sunscreen SPF 30 ($42.95, Amazon.com), but I also love the new Neutrogena Ultra Sheer Dry Touch Sunscreen SPF 85 ($8.99, Drugstore.com) for ultima supremo sun protection (the most photostable out there, according to some reports). During the day, Dr. Perricone also recommends that you eat a diet rich in fruits and vegetables (for antioxidant activity), salmon (for omega-3s), healthy fats (think almonds and olive oil), and full of water and green or white tea to keep skin glowing. After all, nutrition and skin care together have better results than skin care alone.
At night, use a retinoid cream, followed by a moisturizer with DMAE, niacinamide, or antioxidants, provided your skin can tolerate it. The retinoid treatment is easier to choose: there is 0.5% retinol in Skinceuticals Retinol 0.5 ($32.95, Amazon.com), 0.6% retinol in Green Cream Level 6 ($42.95, Amazon.com) 0.9% retinol in Green Cream Level 9 ($49.95, Amazon.com), and 1.0% retinol in Skinceuticals Retinol 1.0 ($52.00, Amazon.com). You may want to start with a lesser concentration of retinol, applied every 2-3 nights, and gradually work up to nightly use.
As for a nightly moisturizer, Dr. Nicholas Perricone recommends using DMAE, which has been found and reported in two independent studies in The Textbook of Cosmetic Dermatology and Skin Research and Dermatology to significantly firm skin in the undereye area. A product with a high concentration of DMAE is NV Perricone Vitamin C Ester Amine Face Lift ($95.00, Sephora.com), and another designed for around the eyes with slightly less DMAE is NV Perricone Advanced Eye Area Therapy ($95.00, Sephora.com). (P.S.: Free shipping is also available for a limited time on orders of $50 or more from Sephora with the code SHIPPING50 at checkout!)
If DMAE is too harsh for your skin, niacinamide and antioxidants have also been found to have beneficial effects against wrinkles, in various studies. My favorite moisturizer with niacinamide is Olay Regenerist, while my favorite antioxidant moisturizer is RevaléSkin Night Cream.
Once a week, in lieu of your usual nightly routine, use a glycolic acid treatment, provided again that your skin can handle it. (Consult your dermatologist if you are unsure.) Two of my favorite glycolic acid peels are MD Skincare: Dr. Dennis Gross Alpha Beta Daily Face Peel ($75.00 for a thirty-day supply, Sephora.com) and Peter Thomas Roth UnWrinkle Peel Pads ($45.00, Amazon.com). Click here for a full review of the Dr. Dennis Gross peel; click here for a review of the Peter Thomas Roth Un-Wrinkle Peel Pads.
Then go see your dermatologist to look even better.
In the Journal of Plastic and Reconstructive Surgery, amongst many other sources, Botox injections have been found to make a dramatic difference in wrinkles. According to Dr. Jeffrey Benabio, M.D., in this month’s Oprah magazine, Botox injections partially paralyze the orbicularis orbis muscle to prevent it from contracting, which causes further wrinkling (and shows off the wrinkles you already have).
Benabio also recommends injectable fillers, like Restylane, to fill up the lines. Injections generally last 6-12 months, and are usually redone every 6 months. The cost is generally upwards of $500 per injection, but this varies by practitioner.
Last but not least, Benabio recommends dermatologist-strength chemical peels and lasers to stimulate collagen production, keeping the skin firm and crow’s feet production down in the future.
Yes, you can do it!
Always keep in mind that dermatology today is a lot more powerful than in years past. You can improve and prevent wrinkles, but, like everything else, it takes time, patience, knowledge, funds, and dedication.
Let me know what works for you! I love hearing feedback!
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April 23rd, 2008
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If you’re anything like I used to be, you may be savvy when it comes to sunscreen and moisturizers, but when it comes to self-tanning, fuhgedaboutit. :-) Luckily, I have done my research, and come up with the following fail-proof self-tanning guide (let me know what you think!):
Step 1. While you’re in the shower, exfoliate.
Self-tanners interact with the uppermost layer of skin, so if you want even coverage, you need to exfoliate. According to the May 2008 issue of Allure magazine, the exfoliator should be non-oily, because oily scrubs keep self-tanner from penetrating the skin. Two excellent recommendations are Neutrogena Energizing Sugar Body Scrub ($18.02 for two, Amazon.com) which is a gentle sugar scrub appropriate for normal or sensitive skin, and Bliss Lemon and Sage Body Scrub ($30.00, Amazon.com), which is a coarser scrub more appropriate for dry to very dry skin.
Towel dry!
Step 2. Moisturize with a thin coat of lightweight moisturizer.
This step smooths the surface of your skin, prevents streaks, and dilutes the self-tanner a bit to let it glide over the skin smoothly, according to the May 2008 issue of Oprah magazine. You should concentrate the moisturizer more over dry areas such as knees, heels, and elbows, because this prevents the built-up skin cells in these areas from absorbing too much color, according to Allure. My favorite lightweight moisturizer is Vaseline Aloe Fresh Lotion ($3.99, Drugstore.com), which contains soothing aloe and cucumber, soybean, vitamin E, and retinyl palmitate, and leaves skin feeling cool and fresh. It is inexpensive too, which is great, considering that you need to redo this process every few days.
Step 3: Wear tight surgical gloves and apply the self-tanner.
An excellent latex-free glove is by Advanced Tool Design, and is available for $6.53 from Amazon.com. Be sure that the gloves fit snugly - the link above goes to a medium-size glove, but if you think you need small, click here, where they are $11.80 a pair (the cheapest I could find in small).
Next, keep standing. (I also recommend putting a few cheap towels on the floor.) Then, as Kara Peterson, who trains aestheticians at Clarins spas tells Oprah, “Think about where the sun hits…Start off in the middle of your thighs, and the middle of your calves, and blend out.” Your feet and knees only get what is left over. Similarly, on your upper body, start with the middle of your torso and arms, and blend out. Use short, upward strokes with your gloved palm when blending, and be sure to hyperextend your fingers so they don’t touch your skin, according to Allure. You only want the gloved palm rubbing the self-tanner into the skin in circular motions. Any excess residue should be applied to the back of the foot. After you remove the glove (one glove at a time), the excess should be applied to the back of each hand.
Step Four: Moisturize!
Ahhh, I love all this moisturizing… Experts like Linda Hay, makeup artist for Victoria’s Secret, recommend placing a shimmery lotion like Nars Body Glow ($59.00, Amazon.com) all over the back of your thighs, along your shins, and down to your feet, which “has a slimming effect,” according to Hay.
The bottom line
The perfect self-tan takes time and patience. I would reserve a solid hour for the process, more if you can. To maintain your tan, do not bathe or exercise for eight hours.
Also, be sure to moisturize with Nars Body Glow for shimmer or Vaseline Aloe Fresh Lotion for more affordable moisturization daily, and repeat the entire process once a week.
Happy self-tanning…let me know your thoughts!
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April 21st, 2008
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As an aspiring dermatologist, I was often curious about the differences between all of the different types of botulism toxins. As it turns out, according to Dr. Cheryl Burgess’ Cosmetic Dermatology, there are four brands and two types currently utilized by physicians: Botox Medical (Allergan), Botox Cosmetic (Allergan), Dysport (Speywood Pharmaceuticals), and Myobloc (Elan Pharmaceuticals). The differences, which are reported from Cosmetic Dermatology, are outlined below.
Botox Medical
Botox Medical is the form of botulism toxin which has been used for the longest amount of time, having been approved by the FDA in 1989. Like Botox Cosmetic and Dysport, it is botulism toxin type A, which is the most potent of all eight serologically distinct botulism toxins. It is currently approved in over 70 countries, and is used for non-cosmetic conditions such as starbismus, blepharospasm, hyperhidrosis, poststroke spasticity, back spasm, and headache.
Botox Cosmetic
Botox Cosmetic was approved by the U.S. FDA in April 2002 for treatment of moderate to severe glabellar lines in patients 65 years of age or younger. Like Botox Medical and Dysport, it is potent botulism toxin type A. It is commonly used between the eyebrows, on crow’s feet, horizontal forehead lines, neck lines, melolabial folds, and other hyperkinetic facial lines.
Dysport
Dysport is a third form of botulism toxin type A, but unlike Botox Medical and Botox Cosmetic, is not manufactured by Allergan. Like Botox Medical, Dysport is not currently used for cosmetic purposes anywhere in the world. (Besides, this study found Botox Cosmetic was more effective in treating glabellar lines, anyway.) Dysport has been used in the United Kingdom for medical purposes since the early 1990’s and has been used for blepharospasm, hemifacial spasm, and spasmodic torticollis.
Myobloc
Myobloc is distinct from the other three botulism toxins in that it is type B. This is promising, as continued use of one type of botulism toxin leads to the body’s eventual production of neutralizing and nonneutralizing antibodies; however, antibodies to one serotype (say from continued exposure to type A Botox Cosmetic) do not cross-neutralize another serotype (say type B Myobloc). Of course, according to Dr. Cheryl Burgess’ Cosmetic Dermatology, this type of resistance has occurred only in 3-5% of patients. Still, patients in the U.S. can consent to off-label use of Myobloc for cosmetic purposes because Myobloc is FDA approved for the treatment of cervical dystonia, and the safety and efficacy of Myobloc for cosmetic purposes has been demonstrated in several small studies.
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March 17th, 2008
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DMAE (also known as dimethyl MEA or dimethyl aminoethanol) is an anti-inflammatory, antioxidant ingredient that is included in a number of N.V. Perricone M.D. skincare products, including N.V. Perricone Solar Protection for Face SPF 26 ($48.00, Sephora.com). But how effective is this ingredient in fighting the signs of aging, including loss of firmness and wrinkles?
So what is DMAE?
According to “Dimethylaminoethanol: A New Ingredient for Aging Skin” in the Textbook of Cosmetic Dermatology (Baran and Maibach), DMAE is a simple amino base and a synthetic analog of the B vitamin choline. In skin care products, DMAE is commonly used partially as a pH buffer, with a basic pH of approximately 10 in the unneutralized state. In oral supplements, DMAE passes oral toxicology tests in doses up to 1600 mg/day and may be used to improve memory, symptoms of Attention Deficit Disorder (ADD) and to prevent Alzheimer’s Disease, according to Life Extension Magazine. However, according to the Textbook of Cosmetic Dermatology, DMAE studies on dyskinesia and ADD were non-conclusive.
What do studies show DMAE does for the skin?
1. Increased firmness in undereye, cheekbone and jawbone areas. According to a Textbook of Cosmetic Dermatology-cited, 150 subject (women 35-60 years of age), placebo-controlled, randomized, double-blind, multi-center study featuring DMAE, dermatologists rated the improvement in otherwise untreated women’s skin on a one-to-ten (minimum-to-maximum) scale regularly for one month using digital photography, skin color evaluation and water retention measurements in the stratum corneum (the uppermost layer of the skin). At the end of 29 days, it was found that the change in undereye firmness of women treated with DMAE was 5.15, which suggests a great difference after DMAE use (p < 0.05). The change in cheekbone and cheekfold firmness were 6.96 and 7.00, also a great statistical difference after DMAE use (p < 0.05). The change in jawbone firmness was 5.98, statistically significant to a lesser degree (p < 0.1). The results of DMAE on skin firmness were confirmed again in a randomized, double-blind, split-face second study in the journal Skin Research and Technology. Over longer periods of time, DMAE was found to still increase skin firmness in a third study (mentioned in The Textbook of Cosmetic Dermatology) in which 35 subjects used DMAE for 8 months.
2. Increased fullness of lips. For women among the 150 in the first aforementioned study, the average increase in lip fullness was 5.43 on a one-to-ten scale after 29 days of use, again a number that is highly statistically significant (p < 0.05).
3. Slightly reduced wrinkle appearance. This review in the American Journal of Clinical Dermatology cites a study in which 3% DMAE applied for 16 weeks decreased forehead lines and periorbital fine wrinkles and improved lip shape and fullness in a manner that was statistically significant (p < 0.05).
4. Slightly decreased inflammation. DMAE has been called a “moderately acute anti-inflammatory” agent in the American Journal of Clinical Dermatology.
How does DMAE work?
According to Life Extension Magazine, researchers offer two possible explanations for these results. One, DMAE may enhance water retention in connective skin tissue. This would cause for the skin to appear and feel firmer. Two, DMAE has been demonstrated to affect cholinergic transmission between neurons, whether as an inhibitor or an antagonist in the sea urchin. It has been hypothesized that DMAE’s effect on synaptic transmission may promote a form of muscle tightening in the skin. A third study, found in the May 2007 British Journal of Dermatology, discovered that DMAE delivers a fast and significant increase in protective elements around human skin cells in vitro (i.e., in a dish). However, more research clearly needs to be done to see the exact mechanism by which DMAE firms the skin.
Is DMAE harmful?
According to the American Journal of Clinical Dermatology, application of DMAE has been found to be well-tolerated amongst patients, with no differences in the incidence of erythema, peeling, dryness, itching, burning, or stinging between the DMAE and placebo groups. An open-label extension of the trial further demonstrated that the long-term application of DMAE gel for up to 1 year was associated with a good safety profile. (Studies after this time period have not been conducted or published). Although it has been suggested in the May 2007 British Journal of Dermatology that human skin cells cultured with 3% DMAE exhibit a moderate cytotoxicity, this has only been found in this in vitro study. In actual human subjects, DMAE seems to have a good safety profile, as stated most notably in the American Journal of Clinical Dermatology.
What are some skin care products containing DMAE?
1. N.V. Perricone Advanced Face Firming Activator ($120.00, Amazon.com). Contains a high concentration of the AHA glycolic acid, along with alpha lipoic acid and DMAE to increase firmness and reduce the appearance of wrinkles somewhat. It has been found to have efficacy similar to Retin-A, for a similar cost per package and no prescription. For a full review, please click here. Rating: 8/10. A very good product! [Personal note: Based on research, if I were more concerned about wrinkles, I would talk to my doctor about Retin-A or use a non-prescription retinoid cream instead. If I were more concerned about skin firmness, I would use this product. If I was concerned about both, I would not use both together because they contain retinoids and AHAs, which are too strong to use in combination, according to several dermatologists. In that case, I would speak to my dermatologist for a personalized recommendation and probably end up using the Perricone product once/week alone, the Retin-A or non-prescription retinoid cream on the other days. However, this is a personal opinion, and I am not a doctor yet, so please keep that in mind.]
2. N.V. Perricone Solar Protection for Face SPF 26 ($48.00, Sephora.com). Contains DMAE and zinc oxide for UVA/UVB SPF protection. Zinc Oxide has been shown in the Journal of the American Academy of Dermatology to be a safe physical sunblock that is effective in the long-range UVA spectrum. Unfortunately, DMAE is in very low concentration in this product. Rating: 2/10.
3. N.V. Perricone Vitamin C Ester Amine Complex Face Lift ($90.00, Sephora.com). Ironically, it contains a lot more DMAE than vitamin C, despite the product’s name. Should be a good product for firming the skin, although it is expensive, especially considering the low concentration of vitamin C with the rather misleading name. Product rating: 5/10 (a lot of DMAE, but not a lot of vitamin C).
As a result…
DMAE in concentrations of about 3% in topical formulations has been shown to significantly increase skin firmness and to slightly reduce the appearance of wrinkles and skin inflammation. Unfortunately, the efficacy of DMAE has not been compared in any published studies with other established anti-aging ingredients like alpha hydroxy acids and retinoids. Perhaps this is because DMAE is a very well-patented ingredient, most notably by Dr. Perricone, and so companies who regularly conduct research comparing the efficacy of ingredients choose not to include DMAE in their studies, for they could not include DMAE in many formulations anyway. At any rate, based on the current research, DMAE appears to be a very effective ingredient for increasing skin firmness. Happy shopping!
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January 20th, 2008
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Whether intermittent redness or the persistent redness of rosacea, Clinique Redness Solutions Daily Relief Cream ($39.50, Clinique.com) promises to “instantly calm and soothe” and “relieve visible redness, blotchiness, and discomfort.” In fact, over two weeks, Clinique states that use of the soothing cleanser, followed by either the urgent relief cream or the Clinique Redness Solutions Daily Relief Cream, and then the Daily Protective Base SPF 15 should “better skin’s appearance and comfort”. Yet does this product’s ingredients suggest that it has a high level of efficacy?
What is rosacea?
According to Dr. Leslie Baumann’s Cosmetic Dermatology textbook, rosacea is a condition usually found in adults between 25 and 60 years of age that is characterized by facial redness, flushing, papules, and pustules, as well as prominent blood vessels on the face. Although the exact cause of rosacea is unknown, Baumann states that rosacea symptoms usually worsen with AHAs and retinoids, but do well with certain antibiotics, beta-hydroxy acid, and laser treatment of telangiectasias (widely open blood vessels dilated on the surface of the skin). Antibiotics are commonly prescribed to alleviate inflammation in rosacea patients. Laser treatments, such as the dermatological vascular laser (single wavelength) and intense pulsed light heat and damage the capillaries within the reddened skin. A third type of laser, the CO2 laser, is used like a scalpel to vaporize the excess tissue caused by phymatous rosacea (a type of rosacea in which skin is thickened).
According to Dr. Gary Goldfaden, M.D., “In a recent dermatological comparison study, the use of a lotion containing a tea extract produced a 70% improvement in rosacea compared to use of a lotion containing the base ingredients alone. This tea extract is rich in antioxidant polyphenols and contains a variety of potent flavonoids.” Verifying this is a 2003 study in the Journal of Nutritional Biochemistry, which reports that green tea reduces UVB-induced inflammation as measured by double-fold skin swelling. Indeed, Clinique Redness Solutions Daily Relief Cream contains a plethora of polyphenols, with fairly high concentrations of green, yellow, red, and white tea extracts.
Interestingly, however, drinking tea has been associated with flare-ups, as reported in the Journal of the American Academy of Dermatology. Perhaps this is due to the caffeine content in tea. At any rate, topical application of tea has proven to have an anti-inflammatory and soothing effect on reddened skin. Azelaic acid is available as a 15% gel (Finacea) or 20% azelaic acid creams (Finevin).
How does tea treatment measure up to other rosacea and redness treatments?
Currently, no double-blind, placebo-based independent published research studies demonstrate the efficacy of tea polyphenols versus antibiotics, laser treatment, or other topicals, which is unfortunate. However, in the book The Sensitive Skin Syndrome, Dr. Zoe Draelos, M.D. mentions a self-conducted study in which she compared the efficacy of cleansers and moisturizers with 15% azelaic acid and gluconolactone with cleansers and moisturizers with 15% azelaic acid and no gluconolactone. Draelos reports finding that there was a significant reduction with the addition of gluconolactone, which functions as a humectant and increases the water-binding activity of the stratum corneum (the outermost layer of the skin).
A second study, mentioned in a review in the Journal of Drugs in Dermatology, found that use of a sodium sulfacetamide 10%/sulfur 5% cleanser is advantageous for the treatment of “rosacea, acne and seborrheic dermatitis or combinations thereof.” However, this treatment was not compared with the tea polyphenols in Clinique Redness Solutions Daily Relief Cream.
So is this a good OTC treatment for redness?
It would seem so, particularly if used in conjunction with the Daily Protective Base SPF 15, which contains additional soothing tea extracts, sunscreen to prevent additional skin sensitivity, and a clever green tint that neutralizes reddened skin. Of course, the tea polyphenol treatment method has not been compared to a 15% azelaic acid/gluconolactone or sodium sulfacetamide 10%/sulfur 5% cleanser treatment.
In addition, anyone with reddened skin should consult his or her dermatologist, who may prescribe antibiotics with anti-inflammatory effects, or who also may recommend laser treatments to eliminate the problem altogether. While the tea extracts in Clinique Redness Solutions Daily Relief Cream certainly do make a difference, they cannot possibly be as effective as the treatments for rosacea available from your dermatologist. At any rate, however, a solid treatment with independent research backing it, and certainly a clever cover-up with the green-tinted Daily Protective Base SPF 15. I give it an 8/10.
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January 17th, 2008
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Maybe it’s the winter months, According to Dr. Leslie Baumann’s Cosmetic Dermatology, dry skin is a condition that is characterized by the lack of less than 10% water content in the stratum corneum (uppermost layer of the skin).
What are some factors that can lead to dry skin?
According to Cosmetic Dermatology, agents that can lead to dry skin include hot water, detergents, friction from clothing, frequent air travel, pollution, certain chemicals, and air conditioning.
What can be done about dry skin on the body?
1. Limit the length and temperature of your showering and bathing
Although pleasant, hot water can rob your skin of much-needed moisture. Try to limit yourself to water that is warm at best for no longer than 10-15 minutes, according to the University of Iowa Health Center.
2. Use bath oils
Dr. Audrey Kunin, a Kansas City-based dermatologist suggests in The DermaDoctor Skinstruction Manual to use Balnetar Therapeutic Tar Bath ($23.00, Amazon.com) is commonly used by individuals with psoriasis. According to Kunin, “The tar helps alleviate the itching and flaking, while the oil base helps hydrate dry, cracking skin.” As with any bubble bath, watch out for the slippery tub afterwards! Avoid soap, which can be drying. An excellent choice for body wash for dry skin is California Baby Tea Tree Oil and Lavender Shampoo and Shower Gel ($9.95, Amazon.com), with hydrating oils, anti-bacterial tea tree oil, and soothing lavender.
For hands, in the winter months, keep a gentle all-purpose cleanser like Cetaphil instead of soap by the sink, and carry a hydrating hand cream with you. One of my favorites is the facial cream Olay Regenerist UV — it’s small enough to fit into most purses, and with niacinamide and vitamin C to treat signs of aging, as well as additional antioxidants and sunscreen to prevent aging, it works great as a great hand cream year-round!
3. Towel dry and moisturize immediately after bathing
Kunin recommends the Aquis bath towel ($16.99, Amazon.com) which “looks like a towel, but works like a sponge” to quickly remove water fro the skin before evaporation has an opportunity to dehydrate it.
4. Switch between two different kinds of body moisturizers
After you towel dry, increase the moisture content in your skin by applying the right moisturizers immediately.
For the body, Kunin recommends switching between creams. Use “passive protectants” during dry periods to hydrate and enhance the skin barrier, like Eucerin Cream ($15.70, Amazon.com) or Vanicream Moisturizing Skin Care Cream ($5.95, Amazon.com). Then, when skin is more calm, switch to an “active moisturizer” to exfoliate and soften the skin, like AmLactin 12% Moisturizing Cream (pictured above; $14.99, Amazon.com) or DERMAdoctor KP Duty ($36.00, Amazon.com).
In addition, according to the University of Iowa, particularly red patches should be treated with a cortisone gel for 5-15 days. One particularly helpful piece of advice featured in this article said that, if it makes your skin redder and itchier than it was before, you should stop use and talk to your doctor.
5. Evaluate your environment
Humidifiers can help to infuse dry fall and winter air with much-needed moisture.
As A Result…
Don’t let the environment strip your body’s skin of much-needed moisture in the winter. Limit the time and temperature of your showers and baths, use bath oils and hydrating shower gels, towel dry and moisturize immediately after, switch between moisturizers, and try to get a humidifier. These five steps should help alleviate that dry skin!
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January 8th, 2008
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Best Products, Dry Skin Treatments, How to Get Rid of..., Psoriasis Treatments |
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In the harsh winter months, many women suffer from dry lips. When the lips crack at the corners of the mouth, it is a condition known as chelitis, in which moisture accumulates in the area. According to New York City dermatologist Patricia Wexler in the January 2008 Allure magazine, to get rid of cracks at the corner of the lips:
“The best way to heal them is with a rich emollient, such as Aquaphor ($27.25 for two, Amazon.com) which contains petrolatum to seal in moisture [and prevent excess moisture from accumulating in the area]. Apply a pea-size amount to the cracks a few times a day, then rub an oil-free moisturizer [like Neutrogena Oil-Free Moisturizer ($19.53 for two, Amazon.com) on the surrounding areas (this provides hydration without causing breakouts.”
How do you avoid getting dry lips in the future?
According to Wexler: “Avoid waxing, chemical peels, exfoliating scrubs, or glycolic-acid treatments…The area can also be irritated by retinoids or even toothpaste.” As such, use these items with care around the lip area to avoid cracking at the corners of the mouth, particularly during the harsh winter months.
What if my lips are severely cracked?
If your lips are severely cracked at steep angles going down from your lips, you may have angular chelitis. According to Dr. Michael Fisher, M.D. Ph.D., angular chelitis is generally seen in adults with ill-fitting dentures, and in children with overbite, overlapping teeth, braces, poor closure of the mouth and even drooling at night. According to Dr. Fisher, either petrolatum or corticosteroid ointments applied two or three times a day to the corners of the mouth, the avoidance of the habit of lip-licking, and the application of topical antibiotics and anticandidal agents when Candida bacteria is involved may alleviate the severe situations. As always, see your dermatologist with your concerns before you self-diagnose!
One last note…
Thank you for all of your questions over the holidays. December has been a very busy month for me (this is my first year being married during the holidays!), and I appreciate your patience as I research all of your questions. Thank you, and happy continued reading! Please check back; hopefully the answer to your question will be here soon.
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December 27th, 2007
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Dry Skin Treatments, How to Get Rid of... |
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Photodynamic therapy decreases the size of the pores by emitting light at a wavelength corresponding to a peak of the porphyrin excitation spectrum in tissues, which generates a therapeutic effect.
Many women covet smaller pores. Yet, pore size increases with smoking, sun exposure, and age. According to Mount Kisco, New York dermatologist David E. Bank, M.D.: “UVA rays and free radicals degrade collagen, the skin’s support fibers, and decrease elasticity. The goal is to keep pores clean and at their smallest.”
How can pore size be reduced?
1. Retinoids. According to a 2002 study in the Archives of Dermatology, the prescription retinoid cream Tazorac (0.1% tazarotene) was found to decrease pore size. Dr. Bank affirms this: “You have to increase cell turnover [with retinoids] and strengthen the tissue to see results.” Strengthened tissue means tighter skin, and tighter skin means smaller pores.
2. Estée Lauder Idealist Pore Minimizing Skin Refresher ($46.50 for 1 oz., EsteeLauder.com). According to Nicole Catanese for Elle magazine, the product contains the enzyme melanase, which eliminates some pigment buildup; glucosamine, a sugar derivative that helps to break down blockages; and light-reflecting polymers that help diffuse microshadows caused by aged, stretched out pores. According to Estée Lauder’s published reports, subjects observed a 69 percent reduction in pore size after four weeks of twice-daily application.
3. Salicyclic acid based products (2% salicyclic acid). Salicylic acid is an oil-soluble chemical exfoliant that can remove debris from the pore, creating the appearance of skin smoothness. However, according to Dr. Diana Draelos, an associate professor of dermatology at Wake Forest School of Medicine, it cannot measurably reduce pore size, only cleanse the area. Still, according to Dr. Bank: “The goal is to keep pores clean and at their smallest,” so salicyclic acid is excellent to use to clean the pores. However, salicyclic acid does not actually change pore size; rather, it cleans the pores, which enables them to then be closed after cell turnover is increased, etc.
4. Photodynamic Therapy (PDT). According to a study in the Journal of Dermatologic Surgery, over ninety percent of 49 subjects who underwent four or more full-face treatments at 3-week intervals showed visible improvement in pore size, wrinkling, skin coarseness, irregular pigmentation, and telangiectasias. According to eMedicine.com, PDT consists of two steps. In the first step, a photosensitizer is administered to the patient by one of several routes (eg, topical, oral, intravenous), and it is allowed to be taken up by the target cells. The second step involves the activation of the photosensitizer in the presence of oxygen with a specific wavelength of light directed toward the target tissue. This process minimizes damage to adjacent healthy structures. PDT has been shown to kill bacteria associated with acne (P. acnes) and shrink the oil glands, so the pores appear smaller. Unfortunately, PDT is not cheap: $1800 for three sessions. In addition, it is unknown if the effects or permanent, and if not, for how long they last.
What doesn’t work?
1. Alcohol-based “pore minimizing” toners. These substances contain high contents of alcohol to temporarily inflame the skin, which puffs it up, making the pores surrounding it look temporarily smaller. However, unless the sebum and bacteria are removed from the pores, and cell turnover and strength is increased, pores do not look smaller.
2. Glycolic acid-based treatments. According to Dr. Diana Draelos, an associate professor of dermatology at Wake Forest School of Medicine, there are several reasons why glycolic acid does not reduce pore size. One is because glycolic acid cannot enter the oily milieu of the pore and thus does not exfoliate within the pore. Glycolic acid may improve the smoothness of the skin surface, creating the illusion of reduced pore size, but it cannot actually reduce pore size. In fact, according to Draelos, no cosmeceutical ingredient can measurably reduce pore size.
3. Heat steaming and cooling the skin. According to Dr. Bank, “Heat softens sebum to reduce clogging, while cold water constricts blood flow and tightens skin. But neither changes a pore’s size.” Just as with alcohol, any improvement in pore size is only a temporary illusion, and the actual size of the pore is unchanged.
4. Tanning. Not only is tanning just about the worst thing you can do for your skin (other than smoking), but any pores that appear smaller only appear that way because the skin around them is rough and inflamed. Stay away from the sun more than 10-15 minutes without sunscreen twice a week.
So what can I do to improve the size of my pores?
First, see your dermatologist for personalized recommendations. Research from dermatological journals shows that pore size is increased by sun exposure, smoking, and aging, but that first keeping pores clean (perhaps with a salicyclic acid cleanser like Neutrogena Oil Free Acne Wash and/or Estée Lauder Idealist Pore Minimizing Skin Refresher to remove blockages) and then hitting the pores with prescription-strength retinoids to administer a one-two sucker punch of increasing the rate of cell turnover and strengthening the skin should help to close up those pores. PDT therapy, administered by a dermatologist, appears to be promising for reduction of pore size as well, but is costly. Finally, for a temporary fix, alcohol-based toners and heating and steaming the skin may work, but do not actually close up the pore.
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December 14th, 2007
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How to Get Rid of..., Pore Size Treatments, Spotlight On... |
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