Age Spots? Sun Spots? Skin Cancer?

By Kevin C. Smith MD FACP FRCPC

What is that Spot?

As time goes on, we start to notice brown spots and freckles -- “souvenirs of Florida” -- on the backs of our hands and on other sun exposed areas like the upper chest and face. At first these brown spots are small and light colored, but eventually they become a cosmetic problem -- an obvious sign of premature aging of the skin because of ultraviolet damage from sun exposure or from tanning beds.

By using modern high-SPF sunscreens like Ombrelle-60™ or Anthelios-60™ we can safely enjoy outdoor activities like gardening, golf and boating, and greatly reduce the rate at which our skin deteriorates. Patients who get into the habit of applying Retisol-A 0.01% cream (a prescription product which combines a retinoid and an SPF-15 sunscreen) to their faces every morning will usually see a considerable improvement in the appearance of their skin after 1-2 years, and if treatment is continued long-term patients will notice that their skin ages more slowly.

Hats and sun protective clothing can also slow down the rate at which “age spots” appear – and also reduce the chance that we will develop skin cancer. You can learn more about how to prevent sun damage, learn about the early warning signs of skin cancer and see photos of typical skin cancers at Skin Cancer Guide.ca.

The early warning signs of skin cancer include:

• new and unusual growths on the skin
• moles and freckles which have unusual colors or mixtures of colors
• moles and freckles with irregular borders
• growths on the skin which bleed, or which form an open sore which does not heal within a few weeks.

It is not too late for those of us who already have sun spots and age spots. I have seen many patients who had sun damage improve gradually over a period of 3-5 years simply in response to daily sun protection. For those who want more rapid and complete improvement in their sun damaged skin, one or two treatments with the Medlite™ laser can fade or eliminate brown “age spots” on the face, chest and hands within a few weeks.

Intense Pulsed Light (IPL) treatments, for example with the Cutera Xeo-600, can be used in cases where there is a background of tiny freckles and brown discoloration – sometimes erasing 20 years of irregular pigment with a series of 20 minute treatments! Where there is severe sun damage or when a person wishes the most rapid improvement (for example, if a daughter is getting married in two months) a medicine called Levulan™ is applied to the skin for one hour before treatment with the Cutera Xeo-600. Levulan™ is absorbed by cells in the skin which are misbehaving, and then is activated by light from the Xeo-600. The abnormal cells are shed from the skin over a period of 1-2 weeks, revealing fresher, healthier skin – and giving the patient a “fresh start”.

What ever the type of spot – if you have concerns, or if you see changes in its appearance, it is important that you have it inspected by your family physician or dermatologist.

About the author:
Dr. Kevin Smith is a dermatologist in Niagara Falls, Ontario with a particular interest in protecting the skin and in correcting skin problems resulting from aging, rosacea and sun damage. He is an expert in the use of Botox®, fillers, lasers and intense pulsed light to maintain and enhance the appearance of the skin, and have lectured on those subjects across North America, and in Europe, Asia and Mexico. Read more at www.smithlaser.com

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Face Lift - A Treatment for Everyone?

By Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Face Lift is a procedure that most people can benefit from. This may sound too radical but most people feel a need and desire to look their best. When skin creams and lotions, Botox, lasers, chemical peels and fillers fail - face lift may offer the solution that is difficult to resist. Of course, many people are afraid of having surgery and having a "surgical look" but fortunately face lifting techniques have evolved considerably to offer patients less invasive methods that even the most sophisticated patient can find attractive. You can read more information on www.CosmeticProcedureGuide.ca

How The Technique Is Performed:

Face lift remains one of the most effective rejuvenating methods for the aging face. Its technique varies from simple skin excision to complex procedure including the repositioning of muscles, fat and skin. Recent trends in patients desires of having effective facial improvement while minimizing down-time have led to the development of newer, less traumatic, short scar, less recovery methods. Full understanding of the face and neck anatomy as well as the changes associated with aging process is required by the physician prior to undertaking any face lift procedure.

Two key subcutaneous structures are at the core of face-lift surgery - superficial musculoaponeurotic system (SMAS) and platysma. SMAS is a fibrous interlocking, sometimes ill-defined, structure/sheath deep to the skin fat. It extends from platysma muscle (a thin, fan-like muscle that extends from both collar bones to the jaw line) and reaches cheekbones as well as temple and scalp components. These two structures are utilized and modified in most face lift procedures.

As we age, several facial components undergo significant changes. The skin becomes less elastic that is associated with decrease in collagen support. Furthermore, there is modification of the facial fat with respect to its amount and position. In addition, there is remodeling of facial bones that in combination with fat and skin changes lead to aged facial appearance.

Most of the surgical face lifts procedures today are a variation of two-plane face lift - use of the epidermal-dermal component (full thickness skin) as well as the SMAS-platysma component. Optimal results require modification of SMAS-platysma component through resection, placation and/or suspension. It is this modification that is at the core of most face-lifts. These adjusted deep supporting structures provide durable framework over which skin can be safely re-draped. It is imperative to realize that stretching skin alone will not result in any sustained improvement and can lead to skin death, appearance of "surgical look" as well as significant facial distortion and scarring.

The Latest Techniques:

Latest face lift techniques utilize shorter skin incisions and are primarily designed for patients with mild to moderate jowls and neck laxity. With the recent advancements in local anesthetic and, in particular, the development of tumescent anesthesia, most face lift procedures can be safely and comfortably accomplished without the need for the traditional general anesthesia. These modified procedures have accomplished several things. Shorter incisions and local anesthetic make the recovery from modern face lifts much easier than in the past. In addition, the shorter scar and resulting less significant distortion of hairline make these methods much more appealing for modern men and women.

What Every Patient Needs To Do

As with any aesthetic procedure, pre-operative consultation is an optimal time for defining patient's motivation for aesthetic improvement and developing plan of action. It is at this time that patient's desires and fears can be explored. It is important for the patient to ask pertinent questions regarding the expected degree of sustained facial rejuvenation, the length of the scar as well as modification of the temporal and post-auricular hairline. With proper patient selection and optimization of desired procedure, most patients can achieve rewarding sustained results that can benefit most if not all of us at some point in our life.
For more information about skin care, go to www.SkinCareGuide.ca.

About the author:
Mariusz J. A. Sapijaszko, MD FRCPC is the Director of the Western Canada Dermatology Institute located in Edmonton, Alberta. He is also the Clinical Assistant Professor at the Division of Dermatology, University of Alberta, in Edmonton. His areas of expertise include cosmetic and laser surgery. Learn more on www.youthfulimage.com

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Rejuvenating Your Face

Options to restore your youthful appearance

By: Dr Bryce J Cowan BSc MSc MD PhD FRCS(C)

Facial rejuvenation is the term used to encompass all forms of restoring a youthful appearance to the face. It includes the broad categories of:

• Injectables (Botox® & fillers) (See BotoxFacts.ca for additional uses of Botox®);
• Resurfacing procedures (laser treatment, microdermabrasion & chemical peels);
• Surgical rejuvenation (brow lifts, eyelid surgery; facelifts, nose jobs, face and chin augmentation, and neck lifts);
• Topical tretinoin and tazarotene which reverse sun damage and enhance collagen production. (Learn about these acne treatments at AcneGuide.ca)

The normal changes associated with facial aging are the result of both:

• intrinsic (age related fat and bone loss known as atrophy, and skin laxity for example) and
• extrinsic factors (like ultraviolet light / sunlight, chemicals, and smoking).

These factors contribute to biological changes associated with age and create predictable patterns of facial change. An over-simplistic analogy is mimicked by the changes in the helium balloon your child wouldn’t let you throw away. With time there is loss of internal volume (gas in this example) and as a result the covering loses its taught shape, luster, and becomes wrinkled. Moreover, there is a marked change in shape of the entire structure. Naturally, similar changes on your face can be highly distressing especially since many available treatments are being promoted.

Physicians can treat facial aging three ways: through reduction (making the skin “fit”), augmentation (“stretching” the skin back to normal) or a combination of the two.

When it comes to choosing a rejuvenation procedure, the severity of the facial aging must be considered. Here’s a review:

• Wrinkles (individual fine or deep rhytids) are managed well by Botox® or injectable fillers. Although other agents are touted to produce similar results, Botox® is currently unsurpassed in its ability to soften or eliminate wrinkles caused directly by the action of underlying muscles of facial animation. (Botox Facts has more information for you)
• For wrinkles that may not be contributed to directly by facial movement or for depressed scars; superficial or deep fillers (ranging from collagen, hyaluronic acid and poly-L-lactic acid to silicone particles and bone cement and even your own injected fat). These can also be used for wrinkles, scars, and soft tissue augmentation (most commnly lip augmentation).
• When you have wrinkles involving larger areas or if it’s related to sun-damage, the underlying problem commonly lies in the biological changes in the skin itself. Here rejuvenation methods such as laser resurfacing, microdermabrasion, and chemical peels act to restore some of the lost intrinsic biologic properties of the skin and can provide a significant restorative change over these large areas. These treatments use light associated heat, physical sanding, or chemicals, respectively, to remove the surface layers of the skin and hence stimulate a regenerative-like process. Many common skin creams advertised to improve facial wrinkles contain glycolic or other acids used in light chemical peels to help improve the taughtness of your treated skin.
• As the severity of skin aging increases, injection and resurfacing procedures may be combined themselves or with surgical rejuvenation (possibly in a staged fashion).
• Surgical management of more severe forms of facial aging can be through an additive (implants), reductive (excisions or tucks), or combined approach. Modern rhinoplasties (“nosejobs”) are a good example where combined approaches of reduction by excision and augmentation through cartilage grafting are employed. As these procedures typically address changes in the three-dimensional volume (deep structures) and in the skin (envelope or cover) they obviously provide the greatest extent of rejuvenation and can address the greatest degrees of facial change. That said, they do come with a limited amount of scaring and the possibly some temporary numbness. Often these scars, created in lines of election, are fine and highly acceptable with some rare exceptions.
• Topical tretinoin and tazarotene can improve fine lines and the general appearance of the skin. The down-side is that you need to continue to use these topical treatments in order to maintain its effect. Sometimes, tretinoin and tazarotene can be combined with the procedures listed above to enhance the effects.

Although you may hear more and more about treating aging skin with the procedures and products mentioned above, we all know that the best form of care is through modification of your exposure to the extrinsic “modifiable” risk factors, like sun exposure

About the author:
Dr Bryce J Cowan BSc MSc MD PhD FRCS(C) (Reconstructive & Cosmetic Plastic Surgeon, The Skin Care Centre, Vancouver)

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Struggling with your mirror image

Find the treatments for lines and wrinkles
By: Richard Thomas, MD, FRCPC

As we age, the skin droops and develops wrinkles, lines and furrows. Depending on your skin type, you may find your skin to be pre-disposed to wrinkling. But thanks to diligent research and new advances, there are a number of solutions to combat facial lines.

Causes of facial lines

In addition to aging, facial lines can form because of the following:

• Sun damage (Fine lines and wrinkles arise because of irregular thickening of the dermis and because of a decrease in the amount of water held by the epidermis. caused mainly by sun damage.) (Read more at Sun Damage)
• Smoking
• Muscle movement / Dynamic lines (People tend to smile or frown more on one side than the other, or consistently sleep on the right or the left cheek. Crow's feet around the eyes are due to smiling and activity of the eyelid muscles. Worry lines on the forehead are due to contraction of the muscle when raising the eyebrows)
• Gravity is responsible for folds in the skin

What treatment is available?


See your dermatologist for information about what might work well for you, which could include (Also see treatments for sundamaged skin):

• Topical agents which produce collagen in the skin, Vitamin A acids (Tazarotene, Tretinoin, Adapelene) and Vitamin C or alpha Hydroxy acids
• Microdermabrasion has a very modest benefit for very fine lines
• Injectionable fillers such as Restylane (Hyaluronic acid)
• Botox for dynamic lines (Check-out www.BotoxFacts.ca)
• Lasers. Traditionally the CO2 and Erbium lasers (ablative) were used to essentially peel off a layer of skin and then allow a new skin to grow in. Results were impressive but the healing time of many weeks and sometimes months of redness has reduced the use of this approach. Patients with darker skin would often end up with darker skin and those with very fair skin sometimes white skin
• Plastic surgery is usually used to improve skin folds rather than fine lines and wrinkles
• The newer non-ablative laser treatments do not have the down time of the older methods nor do they have the degree of improvement. Repeat treatments with lasers that essentially produce a heating of the dermis, which in turn encourages collagen production, Lasers such as the Nd: Yag, V Beam and Smooth Beam may be used.
• The Fraxel laser is a modification of an Erbium laser that just treats multiple small pinpoint areas of skin allowing a quick recovery after a treatment. We will be hearing more of this in the future
• Cosmetic facial surgery

Prevent it before it happens

You can take steps to protect your skin. You’ve heard it before, and it’s worth repeating:

• Avoid excessive time in the sun, and always use a sunscreen of SPF 15 or higher
• Avoid smoking and exposure to second-hand smoke or other pollutants. Smoking increases facial lines and wrinkles and delays skin healing.
• Exercise. It’s good for the skin as well as for your general health.
• Aging skin feels and looks better when moisturizers are applied regularly. These improve the water-holding capacity of the skin. Choose one that feels nice to apply, doesn't sting or burn or provoke acne
• Use tepid or warm water and a non-soap cleanser to wash your face twice daily
• Drink plenty of water to rehydrate internally. Because moisture content is related to water, not oil or grease, oily-skinned women need to rehydrate as conscientiously as their dry-skinned counterparts
• Eat a balanced diet that includes plenty of fruits and vegetables
• Generally what is healthy for your heart and brain is good for your skin

See your doctor or dermatologist to determine which solutions best suits your experience with facial lines. For more skincare related information visit SkinCareGuide.ca.

About the author:
Richard Thomas, MD, FRCPC is Assistant Professor of Clinical Dermatology, Department of Dermatology, University of British Columbia, Vancouver, Canada.

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Cellulite - Help is on the way

By Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Cellulite - the unsightly dimpling, padded or "orange peel" appearance of the skin is probably one of the most aesthetically troubling concerns of women. Although a lot is known about its appearance, there is lack of good studies assessing the effectiveness of possible treatments. Fortunately, the help is on the way - evidence suggests that topical preparations are one of the most effective, currently available methods that can offer hope for the countless cellulite sufferers. Read about other anti-aging tips on www.skincareguide.ca

Cellulite is an alteration in skin contour creating dimpling and nodularity frequently affecting thighs, buttocks and abdominal regions of post-adolescent women, is not directly associated with obesity and in some of the patients it is severe enough to cause significant personal and social distress.

Despite its frequency, there is no uniform understanding of cellulite's causes. Proposed theories must include the explanations for gender bias (cellulite is mostly seen in women), genetic predisposition (women in the same family have similar degree of cellulite) as well as race (the condition is more common in Caucasians compared to Asians or African-Americans).

The lack of full understanding of cellulite's causes results in multitude of treatments that promises lots but tend to deliver disappointing results. Fortunately, some modalities have shown promising results.

Although there is no cure for cellulite, some habit alterations and topical preparations have demonstrated benefit. Even though, diet and exercise have only mild effect on the appearance of cellulite, they can improve circulation, decrease fat volume and prevent its further deposition.

Topical Vitamin A derivatives, such as retinol, tretinoin, adapalene and tazarotene, have shown benefit in clinical practice. The proposed benefits of these preparations center on their ability to increase collagen deposition in the skin. Other techniques such as liposuction and subcision have offered promises of addressing some of the components of cellulite and are claimed by some authors to produce sustained improvement.

For such a common universally undesirable problem, cellulite offers challenges in its explanation and therapy. The lack of good research adds to the desperation felt by many sufferers. Fortunately, topical preparations consisting of Vitamin A derivatives as well as liposuction and subcision offer help to those most in need. I am convinced that ongoing research will lead to much superior methods of prevention and treatment and offer substantial benefits in the quest to make unsightly cellulite the thing of the past.


Learn more about cosmetic surgery and procedures on www.CosmeticProcedureGuide.ca


About the author:
Mariusz J. A. Sapijaszko, MD FRCPC is the Director of the Western Canada Dermatology Institute located in Edmonton, Alberta. He is also the Clinical Assistant Professor at the Division of Dermatology, University of Alberta, in Edmonton. His areas of expertise include cosmetic and laser surgery. Learn more on his www.youthfulimage.com

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Great Skin Care Tips for the Holidays

It's that time of year; parties, company dinners, family get-togethers and you want your skin to look great through the whole season. Here are some helpful tips to keep your skin looking great for the holidays:

1. Pucker-up Under the Mistletoe: Chapped lips are always a problem in the winter as your lips do not have hair follicles or oil glands to protect them like the rest of your skin. Try making moisturizing your lips a part of your regular skin care routine, care a lip balm or use a lipstick (especially one with SPF protection and added moisturizers). Remember, licking your lips only makes it worse!

2. Resist Popping the Pimple: We've all done it, popped the pimple then regretted it when we saw the red blotchy mark it left. Popping your pimple can make things worse, irritating it further, spreading the bacteria and even leaving a permanent scar. It's better to treat the whole area to prevent new spot. Have acne? Read more on www.AcneGuide.ca.

3. Don't Forget to Exercise: At this time of year with busy schedules, exercise is sometimes put on the back burner, assuming it was there at all! Exercise helps relieve stress (a big factor in aging your skin) and increases the oxygen flow to your skin, promoting younger looking skin.
4. Remember to Keep Smiling: As a child, did your mother tell you to stop making that silly face or it will freeze that way? While it may not "freeze that way", your face will conform to your most common expression. Want a permanent frown? Keep frowning. Want a younger, happy looking face? Keep that smile on your face.

5. Don't Sweat It: Did you know that you can loose up to 2 litres of sweat in an hour! There is also a difference between men and women; Men actually sweat more than women and their sweat has lower pH level. That's why there are different antiperspirants for men and women. If you have problem sweating, you should talk to your doctor. Some have found great success with Botox® injections. Learn about Botox on www.botoxfacts.ca.

6. Don't Get Sick - Wash Your Hands: Washing your hands often and correctly is an important tool to keep yourself and your family well over the season. Remember it's the rubbing action that gets rid of the germs, so rub for 10-15 seconds using soap and warm water.

7. Throw Out Your Old Cosmetics: Take this time of year to review your cosmetics and gauge which ones really need to get tossed. Bacteria can grow on your cosmetics, a danger especially with the products you use around your eyes. A general guide to longevity of cosmetics is:

• Mascara: Maximum of 3 to 4 months
• One year for foundation, oil-based ones can last a few months longer. Remember to review your foundation with what's happening with your skin - maybe it's time for a change?
• 2 years for lip sticks and liners is a general rule of thumb
• Have you cleaned your make-up brushes and applicators? Clean them quarterly or give them the toss
  

8. Tweak Your Tweezing: The best time to tweeze is right after your shower when your pores are open and your hairs are softened. Alternatively, try a warm cloth over your brows prior to tweezing.

9. Quit Smoking before January 1st: What are you waiting for? Smoking ages your skin by encouraging more lines and yellowing of your skin. Smoking decreases the oxygen that goes to your skin, giving it a dull look. Quit today and start seeing the positive changes to your skin (and your health).

10. Get Some Rest: It's important to make sure that you are getting enough sleep during this busy time of year. Sleep is when your body repairs itself. Your skin, hair and nails all show the signs of not enough sleep by becoming dull, dry and your nails can become brittle.

Your skin is the largest organ in your body, so you should be taking care of it year round! Sign-up for your daily skin care tip on www.skincareguide.ca/365skincaretips.html and look great all year round!


Keep Your Skin Looking Fabulous

By SkinCareGuide.ca

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Sunbeds: For and Against

Sunbeds are very popular nowadays. Almost every single female have visited it at least once, it‘s becoming popular even between men. Does everybody who wants to be beautiful and adores sunbaths know everything that should be known about these inventions? Just like with most unnatural things sunbeds has many arguments for and against.

Sunbed guarantees that you will have a plane tan. That‘s what most women and men want. Moreover you won‘t have to lay for hours in exhausting heat. Only a few visits that take about 10 minutes and there you are - nicely brown. You don‘t even have to wait for summer and good weather, it‘s open all the time. Sunbeds are definitely very comfortable, but is it safe?

There‘s an opinion that sunbeds are safer than sun tanning, but it‘s certainly not true. Sunbeds use concentrated doses of ultraviolet radiation. It's the same type of radiation that is produced by sun and is the main cause of skin cancer. It also causes skin to age prematurely. The difference is that the ultraviolet radiation produced by sun is not as concentrated as produced by sunbeds. The more exposure to ultraviolet radiation, the greater the chance of developing skin cancer.

Although the risk is known for most sunbeds users, most of them have an opinion that few times won't do any harm. That is wrong opinion. The skin is harmed from the inside and it may also cause some other skin reactions, which may finally lead to cancer. As far as skin is the biggest organ of human body and has several functions, it is easily harmed and requires special care. Sunbeds has only esthetic function; moreover it may cause damage to your skin.

The reaction to sunbeds differs between men and women. It is common that women take care of their body more than men (there's always some exceptions). What about sunbeds? Do men think unnatural tan is just the same as sun-tan? Would they visit sunbed saloons?

Mostly men get tan naturally, without lying in a beach or using some creams. They don't think it's a necessity for them; however the majority would like to see their girlfriends tanned. When talking about sunbeds men are still too shy to visit it. Of course there are some but its only minority. And they visit it only a few times. When it comes to females the opinion is rather different. Most men think that women should visit sunbeds, the dangers doesn't really matter.

However, both women and men agree on thing: don't get too far. When a person starts visiting sunbeds everyday the skin usually looks dry, aged and unnaturally brown. And it's rather obvious that women and especially men don't like such looks.
Taking care of your body is always good; just try to do everything wisely and don't get obsessed with things, especially the ones that may cause harm to your body. Sunbeds has advantages and disadvantages. Before using it think about arguments for and against it and be sure you really need it. Don't start hurting your skin only because it's fashionable nowadays.

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Food to avoid if you want beautiful skin

Beautiful skin is not just the visible surface; it's a largest part of our bodies. And believe it or not, this part discloses a state of the whole body. Healthy body equals beautiful skin and health problems cause acnes, swelling, colour changes and a bunch of other skin problems. Therefore, the real skin care begins with healthy lifestyle. Everything we eat affects our appearance, so why not take some products out of the menu to keep our skin beautiful?

What we need are carbohydrates, proteins and even fats for proper nutrition, but some of these can affect our health badly, especially if consumed in great quantities. Protein is essential for our health, but protein, combined with trans-fatty acids and saturated fats will not help you at all. Sausage, bacon and ground beef are the products that contain this harmful combination. This trio is bad for your skin, because they make skin wrinkle and fuel the aging processes. Butter and partially hydrogenated vegetable oils contain trans-fatty acids as well. This food is not exactly bad for you, but if you consume it regularly, you will experience skin changes. If these products are on your regular diet, try and stop eating them for several weeks and check the effect your new diet has on your skin.

Nutritionists would never recommend giving carbohydrates up totally, because they are indeed useful. However, some foods that contain carbohydrates come in harmful combinations that make glucose levels in blood spike. And high glucose levels are the perfect condition for skin damaging effects and inflammations to emerge. Pasta, baked beans and raisins are the products that can suddenly raise glucose levels in blood. Although beans and other legumes contain vitamins and beneficial minerals, baked and canned beans are prepared with ingredients that affect glucose levels badly.

Food like cake, bread, sugar, cereal, full-fat ice cream are categorized as high glycemic ones. This means they have a lot of carbohydrates that are digested quickly after consuming. Food that has a high glycemic index can induce acne. And food with low glycemic index is considered to be more useful for your body. Low glycemic foods are whole grains, fruits, vegetables. Eating more vegetables is always a good decision in order to improve your health, but you should choose uncooked vegetables before prepared ones. Potato chips and French fries are made out of potatoes, but you can't call this ‘vegetable meal' a healthy choice.

Alcohol doesn't do any favour for your skin as well, as it forces the body to dehydrate. The more fluids you lose the more dry your skin becomes, and the dry skin causes wrinkles and early aging. Furthermore, regular drinkers have liver problems that influence the health of skin and cause even more problems.

If some of the above mentioned products are your favourite food, don't take it out of your menu too quickly. If you don't eat those regularly, they may be harmless for the health of your skin. Besides, everyone is unique and the things that influence the health of one person, may have no influence on the other, whatsoever. But if you already experience skin problems, changing the diet is a thing worth your consideration.



Author: Vylune P

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The Best Moisturizers: Myth or Medicine?

By Charles Lynde, MD, FRCPC

Who doesn't want smooth, hydrated, healthy skin? From basic formulas that claim to keep skin moist, to concoctions that promise an end to aging skin and wrinkles, the choice of a skin moisturizer can be overwhelming. You can look at information on moisturizers for different skin types.

Product, product on the wall, which is the best moisturizer of all?

Essentially moisturizers are used to replace natural skin oils to cover tiny fissures in the skin, and to provide a soothing protective film. Thus, evaporation of the skin's moisture is slowed, which helps to improve the appearance and feel of dry and aging skin. An effective moisturizer increases water content, reduces water loss, and restores the skin's ability to retain water.

(Scientists say a moisturizer will smooth skin to temporarily make wrinkles less apparent, but unfortunately, moisturizing your skin will not have any long-term effect on wrinkles.)

Look for products that:

• help to make the skin smooth and supple
• duplicate and enhance the skin's natural moisture retention mechanisms
• are good to sensitive skin - hypoallergenic, non-sensitizing, fragrance free, non-comedogenic (Read about Sensitive Skin Other Skin Conditions.)
• absorb rapidly and last long

Remember, too, just because a product has a certain ingredient, that doesn't necessarily mean it has enough of it to make a difference. Dermatologists look for a number of substances to complete a moisturizer's make-up:

• Emollients such as plant and mineral oils, shea and cocoa butter, petrolatum, cholesterol, silicones or animal oils (including emu, mink and lanolin). These lubricating ingredients soften and smooth skin while helping it to retain moisture.
• Water-binding agents that keep water in the skin, called Humectants, are important for skin damaged by sun and dehydration, but they won't help your skin retain water.
• Occlusives, which are substances that physically block water loss in the stratum corneum, or layers of the skin, include: Petrolatum (in a minimum concentration of five per cent is the most effective occlusive), followed by lanolin, mineral oil, and silicones such as dimethicone, which act as a protective part of skin barrier creams.
• Soothing agents and anti-irritants, such as bisabolol, allantoin, burdock root, aloe, licorice root, glycyrrhetinic acid, green tea and chamomile extract, are added to many moisturizers to help skin handle ingredients that may cause irritation.
• Pure mixtures of amino acids are useless as moisturizers, while pure solutions of glycerin are ineffective, and propylene glycol by itself is irritating. However, alpha hydroxy acids, such as lactic acid or glycolic acid, appear to help reduce roughness and scaling.
• Vitamins and antioxidants, including vitamins A, C and E, get mixed reviews. Some experts say these ingredients have the ability to heal and hydrate, while others insist there's little evidence of their effectiveness when applied topically, especially in the quantity found in most moisturizers.

Side effects

Moisturizers aren't without their side effects. If you have these symptoms, see your doctor:

• sweat retention (miliara rubra, i.e.: petrolatum and lanolin)
• irritation (urea; lactic acid; propylene glycol; solvents)
• allergic contact dermatitis (fragrances, preservatives, i.e. parabens, formaldehyde, Quaternium 15 and Imidazolidinyl urea; lanolin; additives, i.e.: vitamin E and aloe vera
• photo contact dermatitis (fragrances, UV filters)

The skinny on skin - five points

• Study the active ingredients listed on labels in order of the amount contained. If soothing aloe vera or vitamin C is 15th on the list, you're not getting much of it
• Be wary of claims that products will increase your own natural collagen or elastin, whose job is to keep skin plumped up and youthful-looking. The molecules in these products are too big to actually penetrate the skin.
• Wash your face no more than twice a day with a gentle cleanser formulated for dry skin. Washing more often can dry your skin.
• Add a few teaspoons of olive oil or lavender-scented oil to your bath.
• Steer clear of added fragrance, preservatives and botanicals, which may irritate already dry skin

Get your money's worth

Which is better? High-end brands or low-cost brands? Drugstore shelves seem to have an overwhelming choice of products, with each company vying for your dollars. Experts say that often low-cost brands are just as effective. You can stretch your money's worth of product by applying your moisturizer on damp skin - it will absorb better.



About the author:
Charles Lynde, MD, FRCPC is Assistant Clinical Professor, University of Toronto Canada. His special interests include paediatric dermatology, cosmetic procedures, contact dermatitis, skin cancer, psoriasis and clinical trials in acne, eczema, and psoriasis.

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Prevent age spots

Most people don't care about aging and problems that come with old age, until the time finally comes. However, a large number of problems and diseases often linked to old age are actually related to the habits a person had when he was young. Age spots (also known as liver spots) are the early signs of an aging organism. Although usually they become clearly visible only when we're older, they start appearing in one's early twenties. What causes age spots and how can they be prevented?

Age spots are as natural as wrinkles; however some blemishes might be signs of skin cancer. Every unusual freckle or mole should be examined by medics, the same goes for age spots. Although the condition is often called liver spots, it is not related to the liver. Age spots were believed to be linked to liver malfunctions until this hypothesis was examined and denied. Liver malfunctions can influence skin appearance; age spots, however, are, for the most part, caused by age and sun damage. Sometimes no measures of prevention can grant clean skin - this is usually because of the person's genetic predisposition. Age spots can even be caused by emotional stress in rare cases.

Basically, age spots appear because of regular exposure to the sun and the skin's inability to regenerate at an older age. Those that enjoy sun bathing (and other sources of ultra-violet radiation) are more likely to have age spots. They appear on the face and shoulders, the back of arms and hands - the parts of the body which endure most of the hazardous exposure to the sun's ultraviolet rays. Protecting yourself from the sun is the best method to reduce the chance of developing "liver spots". Limit the time you spend in direct sunlight and wear clothing that covers as much skin as possible. These measures along with sun block are the most helpful in preventing age spots.

A healthy lifestyle can help preventing age spots as well. The skin regenerates constantly, but the process becomes slower and slower as we grow old. A proper diet and exercise can improve the regeneration process, because they make the skin more elastic. Lifestyle and nutrition have important roles when it comes to the condition of a person's skin. If you exercise, avoid toxins, build up and free radicals, you skin will be able to keep elasticity when you're older. And proper nutrition which provides the skin cells with the humidity it needs helps the regeneration process. Remember that tobacco, caffeine and alcohol are detrimental to the skin.

The spots usually are darker than the normal skin tone, so people often consider them un-aesthetical. Age spots are natural; usually they are neither symptoms nor results of any disease and they don't require a treatment. Many people, however, urge to remove them for cosmetic reasons. The color of age spots varies from light tan to dark brown. The most popular and most affordable way to treat liver spots is bleaching. There are many cosmetic creams for bleaching: the ones promoted by big brands, homeopathic ones and even homemade mixtures. Sometimes age spots are treated as scars, they are both damaged skin areas after all. The harsh way treatmen...



Author: Vylune P

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Treatment of Acne Scars

Early Acne Scars - Prevention, Treatment, and Antioxidants
By Heather Brannon, MD

Acne is a skin condition that affects up to 80% of people in their teens and twenties, and up to 5% of older adults. While many people recover from acne without any permanent effects, some people are left with disfiguring acne scars. There are some topical skin care products and medications that can improve mild scarring, but most acne scars are treated with a combination of surgical procedures and skin resurfacing.

Early Acne Scars
After an acne lesion has healed, it can leave a red or hyperpigmented mark on the skin. This is actually not a scar, but rather a post-inflammatory change. The redness or hyperpigmentation is seen as the skin goes through its healing and remodeling process, which takes approximately 6-12 months. If no more acne lesions develop in that area, the skin can heal normally. Any color change or skin defect still present after 1 year is considered to be a permanent defect or scar.

Treating Early Acne Scars
The post-inflammatory changes caused by acne are part of the skin's natural healing process. There are certain practices and medications that can help facilitate this healing process.

• Unprotected exposure to the sun causes more skin damage and delays healing, therefore wearing a good sunscreen is important.

• Using tretinoin (Retin-A, Renova, Avita) speeds up the skin's remodeling process and helps heal post-inflammatory changes.

• Appropriate formulations of Alpha-Hydroxy Acids (AHAs) and Beta-Hydroxy Acid (BHA) that contain the correct concentrations and are at the appropriate pH also help the skin's remodeling process.

• Picking at scabs should be avoided at all costs. Scabs form to protect the healing process that is going on underneath them. Pulling a scab off before it is ready interferes with the healing and remodeling process, prolonging the time that post-inflammatory changes will be visible.

Antioxidants and Post-Inflammatory Changes
As we understand more about skin damage from free-radicals, it seems that using an antioxidant would help treat post-inflammatory changes or even permanent scars. Unfortunately no good scientific studies have shown that any oral or topical antioxidant prevents or heals skin damage. As a matter of fact, Vitamin E, when applied topically to healing wounds, has been shown to cause more harm than good. As antioxidant research continues, scientists may find a formulation that effectively reverses skin damage, but until then any claims of skin rejuvenation through the use of antioxidants are merely hype.

In July 2001 Jacob et al proposed an acne scarring classification system that also assists in determining effective scar treatment procedures. According to this system acne scars are classified as icepick, rolling, and boxcar based on the appearance of the scar. After taking into account previous accutane use, facial scars are mapped out and a staged treatment plan is developed.

Acne Scars - Icepick
Icepick scars are narrow, sharp scars that make the skin appear it has been punctured with an icepick. They are usually narrower than 2 mm and extend into the deep dermis or subcutaneous layer. Icepick scars are usually too deep to correct with skin resurfacing treatments such as dermabrasion or laser resurfacing.

Acne Scars - Boxcar
Boxcar scars are round to oval depressions that have sharp vertical edges. Unlike icepick scars they do not taper to a point at the base. Shallow boxcar scars are 0.1-0.5 mm in depth and can usually be treated with conventional skin resurfacing techniques. Deep boxcar scars are >0.5 mm in depth and require full-thickness treatment techniques.

Acne Scars - Rolling
Rolling scars occur as a result of tethering of otherwise normal-appearing skin to the subcutaneous tissue below. This process gives the skin a rolling or undulating appearance. Conventional skin resurfacing techniques do not work on rolling scars. They must be corrected by breaking up the subcutaneous fibrous bands.

Acne Scar Treatment After Accutane
An important consideration in the treatment of acne scars is the past use of accutane. There are numerous procedures that can be used to correct acne scars. Each procedure has its own risks and benefits, and several procedures are normally combined to create the smoothest appearing skin. Here is a brief discussion of the more effective acne treatment procedures.

Dermal Fillers
There are many types of dermal fillers that can be injected into acne scars to raise the surface of the skin and give a smoother look. Examples of dermal fillers are fat, bovine collagen, human collagen, hyaluronic acid derivatives, and polytheyl-methacrylate microspheres with collagen. The injection of these materials does not permanently correct acne scars, so further injections are necessary.

Punch Excision
This method of surgically correcting acne scars is used on deep scars such as icepick and deep boxcar scars. This procedure uses a punch biopsy tool which is basically a round, sharp "cookie-cutter" tool that comes in diameters ranging from 1.5 mm to 3.5 mm. The size of the tool is matched to the size of the scar to include the walls of the scar. Under local anesthesia the scar is excised with the punch tool and the skin edges are sutured together. The newly produced scar eventually fades and may not be noticeable. If it is noticeable, it is more amenable now to resurfacing techniques.

Punch Excision with Skin Graft Replacement
With this method the scar is excised with the punch tool as above. Instead of suturing the skin edges together, the defect is filled with a punch skin graft usually taken from behind the ear. With this procedure a color and texture difference may be noticeable, but a skin resurfacing technique can be used 4-6 weeks after the grafting to correct this difference.

Punch Elevation
This method of surgically correcting acne scars is used on deep boxcar scars that have sharp edges and normal appearing bases. The same punch tool as above is used to excise the base of the scar leaving the walls of the scar intact. The excised base is then elevated to the surface of the skin and attached with sutures, steri-strips, or skin glue called Dermabond. This method lessens the risk of color or texture differences as can be seen with graft replacement, and lessens the risk of producing a visible scar as can be seen when wound edges are sutured.

Subcutaneous Incision
Subcutaneous incision, also known as Subcision, is used to break up the fibrous bands that cause rolling scars. Subcision is performed under local anesthesia by inserting a specially beveled needle under the skin so that it is parallel to the skin surface. Staying in the plane between the dermis and the subcutaneous tissue, the needle is gently advanced and retracted in a piston-like motion cutting the tethering bands. This procedure causes bruising which fades after about 1 week. The risks of subcision include bleeding and the formation of subcutaneous nodules. Bleeding can be controlled with proper use of anesthetics and bandaging, and the subcutaneous nodules can be treated with injection of corticosteroids into the nodule.

Laser Resurfacing
Laser resurfacing is a popular treatment for many skin defects. The most popular laser types used for resurfacing of acne scars are the carbon dioxide (CO2) and erbium:YAG (Er:YAG) lasers. Lasers work by essentially burning the top layers of skin to a precise depth. The skin then heals replacing the burned layers with newer appearing skin. The correct post-operative care of skin that has undergone laser resurfacing is a very important factor in determining the success of the procedure.

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What is acne? What are the different types of acne?

Acne (acne vulgaris, common acne) is not just a problem for teenagers; it can affect people from ages 10 through 40. It is not unusual for women, in particular, to develop acne in their mid- to late-20s, even if they have not had breakouts in years (or ever). On the positive side, those few individuals who have acne into their 40s may well grow out of it. Acne can appear on the skin as any of the following:

• congested pores ("comedones")
• whiteheads
• blackheads
• pimples ("zits")
• pustules
• cysts (deep pimples, boils). The pus in pustules and cysts is sterile and does not actually contain infectious bacteria.
  

These blemishes occur wherever there are many oil (sebaceous) glands, mainly on the face, chest, and back.

You can do a lot to treat your acne using products available at a drugstore or cosmetic counter that do not require a prescription. However, for tougher cases of acne, you should consult a physician for treatment options.

What causes acne?

No one factor causes acne. Acne happens when oil (sebaceous) glands come to life around puberty, stimulated by male hormones from the adrenal glands of both boys and girls. Sebum (oil) is a natural substance which lubricates and protects the skin, and under certain circumstances, cells that are close to the surface block the openings of sebaceous glands and cause a buildup of oil underneath. This oil stimulates bacteria (which live on everyone's skin and generally cause no problems) to multiply and cause surrounding tissues to become inflamed.

Inflammation near the skin's surface produces a pustule; deeper inflammation results in a papule (pimple); deeper still and it's a cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil accumulates melanin pigment or becomes oxidized, the oil changes from white to black, and the result is a "blackhead." Blackheads are therefore not dirt, and do not reflect poor hygiene.

Here are some factors that don't usually cause acne, at least by themselves:

• Heredity: With the exception of very severe acne, most people do not have the problem exactly as their parents did. Almost everyone has some acne at some point in their life.
• Food: Parents often tell teens to avoid pizza, chocolate, greasy and fried foods, and junk food. While these foods may not be good for overall health, they don't cause acne or make it worse. Although some recent studies have implicated milk and dairy products in aggravating acne, these findings are far from established.
• Dirt: As mentioned above, "blackheads" are oxidized oil, not dirt. Sweat does not cause acne, therefore, it is not necessary to shower instantly after exercise for fear that sweat will clog pores. On the other hand, excessive washing can dry and irritate the skin.
• Stress: Some people get so upset by their pimples that they pick at them and make them last longer. Stress, however, does not play much of a direct role in causing acne.
• Hormones: Some women break out cyclically, but most women (and men) don't. Some oral contraceptive pills may help relieve acne, but unless a woman has abnormal menstrual periods and excessive hair growth, it's unlikely that hormones play much of a role in causing acne. Pregnancy has a variable effect on acne; some women report that they clear up completely, and others get worse, while many others see no overall change.
• Cosmetics: Most cosmetic and skin-care products are not pore-clogging ("comedogenic"). Of the many available brands, those which are listed as "water-based" or "oil-free" are generally a better choice.

In occasional patients, the following may be contributing factors:

• Pressure: In some patients, pressure from helmets, chinstraps, collars, suspenders, and the like can aggravate acne.
• Drugs: Some medications may cause or worsen acne, such as those containing iodides, bromides, or oral or injected steroids (either the medically prescribed prednisone or the steroids that bodybuilders or athletes take). Other drugs that can cause or aggravate acne are anticonvulsant medications and lithium, which is used to treat bipolar disorder. Most cases of acne, however, are not drug-related.
• Occupations: In some jobs, exposure to industrial products like cutting oils may produce acne.

When should you start to treat acne?

Since everyone gets acne at some time, the right time to treat it is when it bothers you. This can be when severe acne flares suddenly, mild acne that just won't go away, or even when a single pimple decides to show up the week before your prom or wedding. The decision is yours.

What can you do about acne on your own?

Think back to the three basic causes of acne and you can understand why the focus of both home treatment and prescription therapy is to (1) unclog pores, (2) kill bacteria, and (3) minimize oil. But first a word about...

Lifestyle: Moderation and regularity are good things, but not everyone can sleep eight hours, eat three good meals, and drink eight glasses of water a day. You can, however, still control your acne even if your routine is frantic and unpredictable. Probably the most useful lifestyle changes you can make are to apply hot compresses to pustules and cysts, to get facials (see below), and never to pick or squeeze pimples. Playing with or popping pimples, no matter how careful and clean you are, nearly always makes bumps stay redder and bumpier longer. People often refer to redness as "scarring," but fortunately it usually isn't in the permanent sense. It's just a mark that takes months to fade if left entirely alone.

Open the pores

Cleansing and skin care: Despite what you read in popular style and fashion magazines, there is no magic product or regimen that is right for every person and situation.

• Mild cleansers: Washing once or twice a day with a mild cleansing bar or liquid (for example, Dove, Neutrogena, Basis, Purpose, and Cetaphil are all inexpensive and popular) will keep the skin clean and minimize sensitivity and irritation.
• Exfoliating cleansers and masques: A variety of mild scrubs, exfoliants, and masques can be used. These products contain either fine granules or salicylic acid in a concentration that makes it a very mild peeling agent. These products remove the outer layer of the skin and thus open pores. Products containing glycolic or alpha hydroxy acids are also gentle skin exfoliants.
• Retinol: Not to be confused with the prescription medication Retin-A, this derivative of vitamin A can help promote skin peeling.

Kill the bacteria

• Antibacterial cleansers: The most popular ingredient in over-the-counter antibacterial cleansers is benzoyl peroxide.
• Topical (external) applications: These products come in the form of gels, creams, and lotions, which are applied to the affected area. The active ingredients that kill surface bacteria include benzoyl peroxide, sulfur, and resorcinol. Some brands promoted on the Internet and cable TV (such as ProActiv) are more costly but not really any better than ones you can buy in the drugstore.

Benzoyl peroxide causes red and scaly allergic skin in a small number of people, which goes away as soon as you stop using the product. Keep in mind that benzoyl peroxide is a bleach, so do not let products containing benzoyl peroxide leave unsightly blotching on colored clothes, shirts, towels, and carpets.

Reduce the oil

You cannot stop your oil glands from producing oil (unless you mess with your hormones or metabolism in ways you shouldn't). Even isotretinoin (Accutane, see below) only slows down oil glands for a while; they come back to life later. What you can do is to get rid of oil on the surface of the skin and reduce the embarrassing shine.

• Use a gentle astringent/toner to wipe away oil. (There are many brands available in pharmacies, as well as from manufacturers of cosmetic lines.)
• Products containing glycolic acid or one of the other alpha hydroxy acids are also mildly helpful in clearing the skin by causing the superficial layer of the skin to peel (exfoliate).
• Masques containing sulfur and other ingredients draw out facial oil.
• Antibacterial pads containing benzoyl peroxide have the additional benefit of helping you wipe away oil.

What are other things you can do for acne?

• Cosmetics: Don't be afraid to hide blemishes with flesh-tinted coverups or even foundation, as long at it is water-based or oil-free (which makes them noncomedogenic). There are many quality products available.
• Facials: While not absolutely essential, steaming and "deep-cleaning" pores is useful, both alone and in addition to medical treatment, especially for people with "whiteheads" or "blackheads." Having these pores unclogged by a professional also reduces the temptation to do it yourself.
• Pore strips: Pharmacies now carry, under a variety of brand names, strips which you put on your nose, forehead, chin, etc., to "pull out" oil from your pores. These are, in effect, a do-it-yourself facial. They are inexpensive, safe, and work reasonably well if used properly.
• Toothpaste? One popular home remedy is to put toothpaste on zits. There is no medical basis for this. Ditto for vinegar.

What is a good basic skin regimen?

These are all good basic skin regimens that may help with the acne battle:

1. Cleanse twice daily with a 5% benzoyl peroxide wash. An alternative for those who are allergic to benzoyl peroxide is 2% salicylic acid.


2. Apply a gel or cream containing 5% benzoyl peroxide; an alternative is sulfur or resorcinol.


3. At night, apply a spot cream containing sulfur to the affected areas.


4. Use a light skin moisturizer and oil-free makeup.

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