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Acne

• Will my acne ever go away?

  Most often, acne will go away on its own at the end of puberty, but some people still struggle with acne in adulthood. Almost all acne can be successfully treated, however. It’s a matter of finding the right treatment for you.

• Can what I eat cause acne breakouts?

  Generally, no. The primary trigger of most cases of acne is the fluctuation of hormones. Hormones stimulate the oil glands to produce more sebum, which can block pores. Bacteria can then grow within the pores, causing them to become inflamed and break out.

  That happens at times of major hormonal change, such as during the menstrual cycle, and during the teen years, no matter what you eat. So despite what your grandmother told you, eating too many potato chips won’t make you break out in pimples.

  But there is some evidence that certain diets may have an effect on acne, says Macrene Alexiades-Armenakas, MD, PhD, an assistant clinical professor of dermatology at Yale School of Medicine. Studies, such as one published in the Journal of the American Academy of Dermatology, have suggested that high consumption of dairy products raises the risk of getting acne because of the hormones in milk, cheese, and yogurt. However, subsequent studies have not supported the theory.

  Some patients do not clear after one course of treatment, and a second course of treatment may be an option. Studies show this helps some patients see clear skin. You should wait at least 8 weeks between treatments. The skin often continues to clear for a while after patients stop taking the medicine.

   

• Should I stop wearing makeup if I have acne?

  You don’t have to stop wearing makeup altogether, but you might try switching brands or going with a different type. If you’re noticing breakouts along the sides of your temples, hair creams or gels might be exacerbating your acne, says Alexiades-Armenakas. Look for cosmetics and toiletries with the label “noncomedogenic,” meaning that they don’t clog pores.

• Does acne mean I’m not keeping my face clean enough?

  Not necessarily. In fact, scrubbing too hard at your face can aggravate your acne, and using alcohol-based astringents can dry out the skin. Acne is triggered by hormones, and while gentle, regular cleansing with soap and warm water can sometimes help with mild breakouts, more significant acne requires more than just good hygiene.

• Why does acne appear most often in teenagers?

  The primary trigger for acne is fluctuating hormones -- specifically, the male hormone testosterone. (Women do have some levels of testosterone.) When teenagers hit puberty, their hormones start surging -- and often, so does acne.

• Why do some adults have acne?

  Although the hormonal fluctuations that cause acne are most common during the teen years, they can also affect adults. Women may experience hormonal swings during their menstrual cycle, pregnancy, and menopause that result in acne breakouts.

  Acne can also be a side effect of certain medications, such as anticonvulsants and steroid drugs. Some people may also have a genetic predisposition to acne. One study found that 50% of adults with acne had a parent, sibling, or child with acne.

• What acne treatments are best for me?

  That depends on many factors: your age, whether you’re male or female, how severe your acne is, and how long you’ve had it, among others. There are several options available.

  For mild to moderate acne, many dermatologists will start with a combination of a topical cream or gel containing either a retinoid or benzoyl peroxide along with a topical antibiotic. For more inflammatory acne, an oral antibiotic may be added. For more significant cases of acne, women may be placed on birth control pills or on the drug spironolactone, a water pill which also blocks male hormones.

  Severe cases of acne may be treated with the drug isotretinoin, which is very effective. However, side effects and blood abnormalities must be monitored monthly and requires registration with the FDA to obtain a prescription. There are also various types of light or photodynamic therapies available.

   

• When should I see a dermatologist for acne treatment?

  f over-the-counter treatments, like a topical retinoid or products containing benzoyl peroxide or salicylic acid, along with gentle cleansing, don’t work for you (give them a chance -- it can take 4-12 weeks to improve acne), a dermatologist may be able to help. Severe acne requires aggressive treatment to prevent scarring.

• How do I use Isotretinoin?

  This medicine comes in pill form. You will take one or two pills a day as your dermatologist prescribes.

  Before taking isotretinoin, you must enroll in the iPLEDGE™ program. Created by the U.S. Food and Drug Administration (FDA), this program helps to ensure that patients:

  • Do not start taking isotretinoin while pregnant

  • Do not become pregnant while taking isotretinoin

  Because iPLEDGE™ informs patients about other possible side effects, all patients must enroll in this program before taking isotretinoin

• How long will I have to take Isotretinoin?

  One course of treatment generally takes about 4 to 5 months. You may need a shorter or longer treatment time.

• How does Isotretinoin work?

  This is the only acne treatment that attacks all four causes of acne—excess oil production, clogged pores in the skin, too much of the bacteria P. acnes, and inflammation. This makes isotretinoin very effective.

• Do I need to take any precautions while using Isotretinoin?

  Yes. You will need to learn about the potential side effects before you decide whether to take isotretinoin.

  If you and your dermatologist decide that this medicine is right for you, you will need to do the following:

  • Enroll in the iPLEDGE™ program

  • Return to your dermatologist every month for a follow-up appointment

  • Immediately report any possible side effect to your dermatologist

  • Do not wax to remove hair while taking this medicine, and for 6 months after you stop taking isotretinoin

  • Protect your skin from the sun and do not use a tanning bed, sun lamp, or other indoor tanning device

  • Do not donate blood while taking isotretinoin and for 30 days after you take your last pill

  • Female Patients who can get pregnant also need to take the following precautions:

    • Take the required pregnancy tests

    • Use two approved forms of birth control

• What are possible side effects?

  A number of possible side effects can occur while taking this medicine. It is essential that a woman who is taking this medicine is not pregnant and will become pregnant. Isotretinoin can cause:

  • Severe birth defects

  • Miscarriage (baby dies before birth)

  • Premature birth

  • Other potential side effects include the following.

    • Depression: A connection between taking isotretinoin and developing symptoms of depression/anxiety has been suggested. Dermatologists take reports of depression seriously. Results from some studies, however, show that sometimes patients treated with isotretinoin have fewer symptoms of depression and anxiety. These patients also have improved quality of life.

    • Inflammatory bowel disease (IBD): There have been reports of patients developing IBD after taking isotretinoin. IBD includes Crohn’s disease and ulcerative colitis. To date, research has not found strong evidence to prove this. Results from a recent, large-scale study that looked at this possible connection suggest otherwise. In this study, which involved thousands of patients, taking isotretinoin did not increase the risk of IBD.

  The risk of developing IBD may be linked to having severe acne. More studies are required.

• Other serious side effects that have been reported include:

  • Bad headache

  • Blurred vision

  • Dizziness

  • Nausea or vomiting

  • Seizures (convulsions)

  • Stroke

• More common and less serious side effects are:

  • Dry eyes

  • Dry skin

  • Chapped lips    

  • Nasal passage so dry that nosebleeds occur

  • Diminished ability to see in the dark

• Is it safe to remove hair with wax while taking Isotretinoin?

  No waxing, please. Waxing can cause permanent scars in people taking Isotretinoin. To avoid scarring, you must not wax while taking isotretinoin and for six months after you stop taking Isotretinoin. This applies to hot wax and cold wax.

• Does Isotretinoin increase risk of sunburn?

  If you plan to spend time outdoors, it is important to know that Isotretinoin can make your skin more sensitive to the sun. You can sunburn unexpectedly and quickly. To protect your skin, dermatologists recommend that people taking isotretinoin:

  • Seek shade when outdoors

  • Wear a shirt, wide-brimmed hat, and pants

  • Apply sunscreen to all skin that will be exposed

  The type of sunscreen you use is important. Be sure to use sunscreen that offers:

  • Broad-spectrum protection (bottle may say “UVA/UVB protection”)

  • An SPF of 30 or greater

  • Water resistance

  Because isotretinoin can make your skin more sensitive, it is especially important that you not tan. This includes not using indoor tanning (sunlamps and tanning beds) while taking isotretinoin.

Melasma

• What is Melasma?

  Melasma is an increased pigmentation in sun-exposed areas due to overproduction of melanin. It appears as irregularly shaped grey-brown or dark brown patches on facial skin. Most often symmetrical-matching on both sides of face usually seen on cheeks, forehead, nose-bridge, upper lip and jaw line.

• Does Melasma re-occurs?

  Yes, melasma recurs. Especially, when we are still exposed to the risk factors like sun exposure, use of cosmetics with harmful ingredients, hormonal changes (use of contraceptive pills, intake of HRT, use of anti-seizure drugs) and genetics.

• How to treat Melasma?

  Please understand that treating melasma will really take time. It's a skin disorder found at the deeper layers of the skin, which is why the solution must start from within, hence the need to take capsules. Topical creams only act on the skin's surface, but in order to treat melasma, you need to address the deeper layers of the skin, where hyperactive melanocytes cause overproduction of melanin, the skin's pigment.

• What are the risk factors of Melasma?

  Sun exposure is the major risk factor, Hormonal changes: (pregnancy, taking oral contracentive pills), Phototoxic cosmetics (mercury, salicylic acids), Phototoxic medications: (antibiotcs, anti-epilepsy drugs, nonsteroidal anti-inflammatory drugs)

• What is Chloasma?

  Chloasma is a skin condition that can affect 50-70% of pregnant women. Also known as melasma or 'the mask of pregnancy,' chloasma is characterized by symmetrical patches of dark skin, commonly seen on the cheeks, upper lip, forehead, and chin, that can resemble a mask pattern, almost like a raccoon. People with darker complexions who tend to tan well are more likely to develop this condition. Chloasma occurs most often during the summertime, due to increased sun exposure.

  The exact cause of chloasma is a mystery. What is known is that ultraviolet (UV) light from the sun causes melanocytes, or pigment cells, to overproducemelanin, which is what gives skin its distinct color; the more melanin present, the darker the skin color. Think of it as adding food coloring to icing; the more you add, the richer the color of the
  icing.Hormone fluctuations are also partially to blame for chloasma.Moms-to-be aren't the only ones susceptible to chloasma. Women who are taking hormone replacement medication and/or contraceptives can also develop this condition, and some men do, too. In fact, approximately 1 in every 4 women and 1 in every 20 men will develop chloasma.The good news is that chloasma generally fades away a few months after a woman gives birth or discontinues hormone medication. In some cases, repeated pregnancies can intensify chloasma. Similarly, even if you don't develop this condition with your first pregnancy, it can still occur with subsequent pregnancies.

Dehydrated Skin

• What is dehydrated skin?

  Dehydrated skin means that skin is lacking water. It can be dry and itchy and perhaps dull looking. The overall tone and complexion may appear uneven, and fine lines are more noticeable. While dehydrated skin can be a nuisance, it's relatively easy to treat with the right lifestyle changes.

• How can you tell if your skin is dehydrated?

  If the skin is dehydrated, you may notice itchiness, dullness, under-eye circles, sunken eyes, and/or more noticeable fine lines. Severely dehydrated skin symptoms may include dizziness, dry mouth, lightheadedness and/or weakness.

• How do you test for skin dehydration?

  You can test skin dehydration by pinching an area of skin, such as the back the hand, lift up the skin and then release. If the skin doesn't return to normal, and instead remains lifted, and appears loose, it is a sign that you may be dehydrated.

• What contributes to dehydrated skin?

  Dehydrated skin is caused by external elements (weather and seasonal changes), unhealthy diet (lack of fresh produce) and lifestyle choices (alcohol or caffeine consumption). All of these factors deplete skin's water content, resulting in a less supple appearance.

• Is dehydrated skin more sensitive?

  One of the biggest consequences of dehydrated skin is an increase in sensitivity. When your skin's moisture barrier is disrupted, it cannot properly protect itself from external stressors.

• Can dehydrated skin cause spots?

  Neglecting to treat dehydrated skin can lead to acne breakouts, irritation, dry patches, dullness, and more. The first step to rehydrating your skin is to know what leads to skin dehydration in the first place and how to spot it.

• Does dehydrated skin age faster?

  Dehydration in the skin weakens its defense and creates skin sensitivity, irritation, and premature aging. With dry skin, you may appear to have more wrinkles.

• Does drinking water help dehydrated skin?

  We tend to think that drinking a lot of water can cure dry skin, but the truth is that it's not effective. A normally-hydrated person probably won't see a difference in their skin after drinking an increased volume of water. Dry skin is an external problem and is best treated from the outside.

• Does dehydrated skin produce more oil?

  Unlike dry skin, which is a skin type, dehydration is a skin condition that can affect all skin types, even oily ones. This means signs of oil do not equate to signs of hydration! When the skin is dehydrated (lacking water) it overcompensates by producing more oil.

• Is dehydrated skin and dry skin the same?

  Dehydrated skin means lacks water while dry skin lacks natural oils (also called sebum). Also, dry skin is a skin type, while dehydration is considered a condition. To make the skin look and feel its best, you need to both hydrate and moisturize.

Aging Skin

• What causes skin aging the most?

  Exposure to sunlight is the single main factor in aging skin. Overtime, the sun's ultraviolet (UV) light damages certain fibers in the skin called elastin. The breakdown of elastin fibers causes the skin to sag, stretch, and lose its ability to snap back after stretching.

• What are the physical signs of aging?

  • Fine lines and wrinkles. These are the most evident and often most concern-causing signs of aging for men and women.

  • Dullness of skin

  • Uneven skin tone

  • Dry skin

  • Irregular patches and age spots

  • Rough skin texture

  • Visible pores

• What causes my skin to age prematurely?

  Most of them are related to lifestyle. Some of the major causes include:

  • An unhealthy diet

  • Excess alcohol consumption

  • Nicotine

  • Psychological stress

  • UV radiation in sunlight

  These factors aggravate the increased formation of free radicals which are the major cause of premature skin aging. By making lifestyle changes you can prevent premature aging signs like fine lines and wrinkles.

• Why is our skin thinning?

  Sun damage can also lead to the appearance of thinning skin, as prolonged exposure to UV light breaks down the collagen and elastin proteins that give the skin its structure, strength and elasticity. Additionally, as we age, our bodies naturally begin to produce less hyaluronic acid, which has a plumping effect on the skin (Dermato-endocrinology). Thus, you may notice that your face appears thinner as the amount of hyaluronic acid present in your skin declines. This can also contribute to the formation of facial lines and wrinkles.

• Does stress contribute to aging skin?

  Stress may decrease immune system function, increase susceptibility to infection and trigger inflammation.

  Chronic stress is quickly becoming a major health concern in the United States, and research shows that it can have lasting negative effects on your body and skin. According to a study published in Inflammation & Allergy Drug Targets, stress may decrease immune system function, increase susceptibility to infection and trigger inflammation. These factors, combined with the likelihood that stress may also reduce cellular lifespan, can lead to premature signs of skin aging, including lines, wrinkles and sagging skin.

  Taking steps to reduce stress, such as spending some time in nature, taking a break from work and “screen time” and even listening to music, may help to significantly reduce these risk factors.

• Should I be taking supplements for skin health?

  Nourishing your skin from the inside and out is an integral part of maintaining excellent skin health. Many of the same nutrients that can be beneficial to your skin when applied topically can also help to improve the appearance of skin when ingested orally. One of the most commonly recommended group of ingredients that fits into this category is antioxidants.

  Vitamins C and E have strong antioxidant properties, both when ingested and applied to skin externally. Antioxidants come with a number of health benefits, but primarily, they may help to improve the look and feel of skin by neutralizing the oxidation of free radicals, which can lead to skin damage and premature aging when not neutralized.

• What is the best age to start using anti-aging creams/oils?

  Treating lines and wrinkles before they become deeply set may help to prolong the smooth appearance of your skin’s texture.

  The skin aging process is very individual and can be influenced by many different factors. One can say, that from the age of 25-30 you should start to give your skin the protection it needs. UV filters and adapted anti-aging ingredients, such as creatine and hyaluronic acid, are therefore essential. Skin type and age play an important role in choosing the best face cream.

  While there’s no right or wrong time to begin using anti-aging creams to help maintain the appearance of a youthful, radiant complexion, it may be beneficial to start giving your skin extra nourishment at the first signs of wrinkles.

• Can fillers diminish the signs of aging?

  Definitely yes. Injectable fillers are a safe and effective way to diminish fine lines and wrinkles while restoring volume back into certain areas of the face and regaining an overall more youthful appearance.

• When will I see results after getting a filler?

  This also depends with the filler. Most fillers fill the skin, so they produce immediate — or close to immediate — results. A filler also can stimulate your body to produce collagen, but this takes time.

  • Collagen > Immediate

  • Hyaluronic acid gel > Immediate

  • Calcium hydroxyl apatite > Immediate

  • Poly-L-lactic acid > 2 or 3 weeks

  • PMMA (polymethylmethacrylate) > Immediate

• How long will the results from fillers last?

  Most fillers offer temporary results and require repeat treatments to retain the results.

  Temporary fillers offer one key benefit. These can be injected as needed to replace lost fullness. This is beneficial because no matter what we do, our skin continues to age.

  • Collagen - 2 to 3 months (often longer when treating scar)

  • Hyaluronic acid gel - 4 to 12 months

  • Calcium hydroxyl apatite - 6 months to 1 year

  • Poly-L-lactic acid - 1 to 3 years

  • PMMA (polymethylmethacrylate) - Permanent

Atopic Dermatitis

• Is there a cure for atopic eczema?

  Atopic eczema can be managed effectively through treatment and various methods of self-care; unfortunately, there is no cure for the condition —athough most children will outgrow it before starting school.

• Is atopic eczema contagious?

  Atopic eczema is not contagious. However, should a secondary infection developed due to a virus or bacteria, then this may become contagious and will require specific treatment in order to be controlled.

• What are some triggers for atopic eczema?

  Sweat, soap and clothing. Environmental factors play an important role in triggering atopic eczema. It is not unusual for patients with atopic eczema to note that sweating during exercise, using harsh detergents, or wearing wool clothing can produce itching and trigger flares of atopic eczema.

• Atopic eczema is best controlled by good skin care. True or False?

  Good skin care means that the skin should be kept moist. This is particularly important in children or adults who have atopic eczema. After a shower or bath, before towel drying, a thin layer of an emollient (a greasy substance which water cannot penetrate) should be applied to the wet skin to inhibit the evaporation of skin moisture.

• What types of things can irritate skin in people with atopic eczema?

  Since the environment plays a very important role in skin hydration, the best answer to this question would be dry sand. Anything that tends to dry the skin would be likely to produce irritation in a patient with atopic eczema.

• Is it possible to develop AD as a young adult or even in midlife?

  “Atopic dermatitis normally starts when you’re a kid. Many people tend to grow out of it as they get older and it becomes less of a problem,” says Dr. Feldman. But people who never had AD as a child can develop the condition in adulthood, especially if they face a “perfect storm” of environmental triggers, he says.

  “For example, if they start to use a very irritating soap, it may push them over the edge. Or if someone ends up in a very drying environment later in life — and I think our skin tends to get drier as we get older — that could lead to a type of dry skin dermatitis that would fall into the scope of what we call AD,” says Feldman.

• What are the most common triggers for AD flares?

  Fragrances found in laundry products are high on the list for what triggers atopic dermatitis. “Especially things like dryer sheets that put fragrances into clothes where they don’t get rinsed out,” says Feldman.

  Strong soaps used for personal hygiene, especially liquid soaps like body wash, can really dry the skin out and lead to an AD flare, says Feldman. “Anything that’s good for cleaning your dishes would be bad for the oils in your skin and make AD worse.”

  Very hot baths and showers and dry weather are also frequent culprits when it comes to triggering atopic dermatitis.

• Can a special diet help reduce the symptoms of AD?

  There’s no one special diet for people with AD. “There may be some marginal benefits from things like anti-inflammatory diets, but I think that benefit is really very small compared to the amount of effort it would take to adhere to it,” says Feldman.

  Rather than focusing on diet (beyond following a healthy eating pattern), Feldman suggests focusing on staying compliant with skin care, avoiding triggers, and following your dermatologist’s recommendations on treatment.

• What are the most important lifestyle modifications to make for managing AD?

  Replacing any scented detergents or soaps with unscented options can be a game-changer for many people with AD, says Feldman. “Switch to an unscented detergent, don’t use fabric softener, and use a mild, unscented soap or even a non-soap cleanser on your skin,” he suggests.