Posts Tagged ‘retin-a’

But Dr. Welsh I’m Using Retinol…. Notes from a San Francisco Bay Area Dermatologist

Friday, May 6th, 2011

If you have ever been to my office for anti-aging advice, you know that one of my first questions is whether or not you are using Retin-A. If the answer is “no” then I consider it my duty to introduce you to the most effective anti-aging product available. The facts are indisputable. Prescription Retin-A or tretinoin has the scientific studies behind it that prove it builds up collagen in the skin, which helps reduce wrinkles. It also evens out pigmentation and keeps your skin looking radiant.

Some patients end up using over-the-counter (OTC) products containing retinol, a significantly weaker form of tretinoin, that does not deliver near the same results as its prescription counterpart. As noted in the Boston Globe, OTC products containing retinol and claiming to “lessen the appearance of fine lines” are not scrutinized buy FDA regulators for effectiveness. This means you really don’t know if these products live up to their promises. In fact, companies like Chanel, Elizabeth Arden, Estee Lauder, and Revlon are on the FDA’s “yellow list” for products that may have exaggerated anti-aging claims.

Patients may choose a retinol because they feel their skin cannot tolerate the use of prescription level tretinoin products, especially if it makes them too dry or red. Well, nowadays there are new tretinoin products available at our office like Atralin or Refissa, which is easily tolerated and has reduced side effects, so almost any skin type can reap the benefits of this anti-aging powerhouse. Stick with the real product and see better results!

Nervous about using Vitamin A? Don’t Be. It’s Perfectly Safe! Notes from a San Francisco Bay Area Dermatologist

Wednesday, September 29th, 2010

You may have come across the recent health warning issued by the Environmental Working Group that sunscreens containing the ingredient retinyl palmitate (vitamin A) could pose a cancer risk. This warning garnered significant media attention and has caused considerable confusion among the public. However, an independent analysis published online in the Journal of the American Academy of Dermatology determined that including retinyl palmitate in sunscreens cannot cause cancer in humans, and in fact, “years of research suggests retinoids are helpful in reducing your risk of skin cancer.”

To be clear, retinyl palmitate (which is not the same as tretinoin, or Retin- A, a popular anti- aging cream) when used in sunscreen is not an active drug ingredient, but rather a cosmetic ingredient. Additionally, it can serve as an antioxidant to improve the product performance against aging effects of UV exposure.

The study done by the Environmental Working Group cited evidence from non- human testing on albino, hairless mice that retinyl palmitate may lead to the production of free radicals, which can damage cells and lead to skin cancer, or may speed up the development of tumors. After reviewing the findings, the American Academy of Dermatology announced that there was “no conclusive evidence to indicate the combination of retinyl palmitate and UV radiation causes increased rates of skin cancer.” The AAD also warned that since the mice used in the Environmental Working Group study are highly susceptible to the effects of UV radiation and can develop skin cancer within weeks of exposure with or without retinyl palmitate, extreme caution should be used when relating these findings to humans.

So what’s the bottom line? Lather up, and use your sunscreen freely. Your skin will thank you!

Derm Terms: Notes from a San Francisco Bay Area Dermatologist

Sunday, March 28th, 2010

In dermatology, there are lots of terms for various spots and lesions that may appear on the skin. These terms can be confusing, especially if you aren’t sure which are the “bad” kinds and which are less of a worry.

One of the most common terms is actinic keratoses or AKs, which are most often seen on the face, ears, lips and backs of hands, but can appear on any sun damaged area of the skin. AKs are spots where the top layer of skin is dividing too rapidly. They usually show up as a dry, scaly and rough textured patches of skin. They may be brownish, red or flesh colored. Some may even be crusty..

AKs tend to arise more frequently after age forty, but if you are fair skinned with light colored eyes and have had average to heavy sun exposure they may appear earlier.

AKs are also called “precancers” because if left untreated, they have the potential to progress into squamous cell carcinoma, a potentially deadly form of skin cancer. Because of this potential, it is important to have any AKs treated as they come up. Cosmetically, they make the skin appear more aged and makeup doesn’t cover them very well.

Treatment may include cryosurgery (freezing the spot with liquid nitrogen), numbing the area and scraping the lesion off or use of a prescription cream that targets the damaged cells and destroys them. Luckily, most AK treatments are fairly inconspicuous and the recovery time is minimal. For more extreme cases or areas where there are too many precancers to treat individually, we may use PDT or photodynamic therapy treatment. This process involves a light microdermabrasion to the skin, followed by the application of a chemical that is activated by a laser to eradicate the errant skin cells. This treatment requires you to stay indoors 24 hours afterward. The result is skin that will look, feel and be much healthier.

To prevent AKs and skin cancer, sun safety is always your best bet. Always apply and re-apply sunscreen to exposed areas of skin and do your best to stay out of the sun!

I can never say enough about the benefits of topical retinoids like Retin-A, Refissa, Atralin or Retin-A Microgel, but yet another positive point is that they can actually help the skin ward off AKs. Their exfoliating properties keep these damaged cells from taking hold and help the skin stay smooth.

As always, if you notice any new spots or moles that have changed, have a dermatologist look at them for any potential issues. Be sure to check in with the blog as more derm terms will be discussed!

I Hate My Neck! Notes from a San Francisco Bay Area Dermatologist

Monday, March 15th, 2010

I hate my neck. Or as Nora Ephron would say…“I feel bad about my neck.” Long before Nora Ephron penned her book with this name, men and women have looked in the mirror and seen loose neck skin that didn’t seem to match their facial skin. Why? Neck skin is thin and has few adnexal structures (oil glands, hair follicles) that can give skin more support. Neck skin is often overlooked when applying sunscreen, yet is almost always exposed. Women also begin anti-aging regimes to the face much sooner than they do the neck. Ms. Ephron complained that surgery could do little to improve her neck’s appearance and until recently there was very little we could offer for neck rejuvenation. Now we have quite a few answers!

First and always is skin care. In most instances your neck care routine can be very similar to your face routine. Neck skin can be more sensitive, like eyelid skin, so care must be taken to use “active” products sparingly. A suggested routine for people with normal skin would be to apply an anti-oxidant such as SkinCeuticals C E Ferulic, SkinCeuticals Phloretin CF, RevaleSkin Coffee Berry, Replenix Green Tea Serum or Prevage in the AM then a sunscreen on top. Reapplication of sunscreen is also important during the day, which may be easier with a powder sunscreen, such as Color Science Mineral SPF 30. Banish V neck shirts from your closet for daywear and consider sleeveless tees when you know you might be stuck out in the sun. I always carry a thin scarf to tie around my neck if I am at a prolonged outdoor event. In the evening you may be able apply a small of amount of Retin-A 3-5 times a week. Non irritating brands like Atralin, Refissa and Micro Gel may work best for you. After Retin-A apply a thick, moisturizing cream. I love Neova’s Creme de la Copper which enhances Retin-A’s work in collagen building. Neocutis cream is also great as is SkinCeuticals A.G.E. Interrupter. Sensitive skin types may not tolerate Retin-A on the neck but may be able to try retinols like Replenix Retinol Serum or glycolic acid products found in the Vivite skin care line. There are some home devices that can encourage collagen growth and can be used on the neck. We recommend the Omnilux home LED device and the MTS Roller to help your current products penetrate more deeply into the skin.

Discoloration the neck is usually due to excess sun over the years and can appear as patchy, red brown areas on the sides of the neck. This is called pokiloderma and responds to laser treatments as do brown spots and broken blood vessels. Unsightly growths such as skin tags and flesh moles can also be easily removed in the office. The neck is difficult to treat with chemical peels as it is not as resilient as facial skin. We do have several peels suitable for the neck, but improvements can be subtle.

What’s next! Consider what really bothers you. For crepey skin nothing beats Fraxel laser treatments. These treatments are non-ablative and heal like a sunburn over a week. They are easy to tolerate and very cost effective. In our office a neck Fraxel treatment costs about the same as a syringe of Restylane or Juvederm. You will need 2-5 treatments to see improvement. Treatments can be done every 4-6 weeks. A before and after photo is listed below. Click on the photo to link to the Fraxel website for more results!

If the skin quality seems good but looseness is more of a factor, especially underneath the chin and jowl, Titan or Thermage would be best. These treatments use heat to promote collagen building and focus on tightening of the skin over time, rather than texture. Both treatments have no down-time, which make them simple to fit into any busy schedule. One or two treatments may be required for best results. We can help determine which treatment will be most effective for you.

If “stringy” muscles and “cords” are an issue and are not too advanced an exciting treatment is to use Botox for the neck. This treatment takes about 5 minutes and can improve the neck appearance dramatically, while also preventing future wrinkling.

So, don’t give up on your neck - there is hope out there. Too bad we couldn’t offer Ms. Ephron these treatments before she wrote her book!

Moisturizers vs. Anti-wrinkle Treatment Products: Notes from a San Francisco Bay Area Dermatologist

Monday, August 31st, 2009

A recent article in the UK’s Daily Mail (8/20, Poulter) reported that in the UK, the consumer group Which? tested a number of anti-wrinkle creams and declared that an inexpensive moisturizer was “just as effective as products costing 60 times as much.” Which? tested 12 creams over a six-week period on a panel aged between 35 and 65. High-definition photographs were taken “before and after,” and then were analyzed by a “panel of five experts.” Neither the testers nor the panel of judges knew which creams had been used in order to produce a reliable result.

Articles like this miss the boat! I always say that people shouldn’t spend a lot a lot of money on a moisturizer. Most nationally recognized drugstore brand are really good and work well as “moisturizers”, but what exactly does that mean? Moisturizers do just that, they seal in moisture providing skin hydration. Skin that is hydrated appears plumper and wrinkles appear more shallow. Moisturizers only improve the appearance of skin in the short term and don’t actually “treat” wrinkles. Treating wrinkles and preventing further wrinkles requires active skin care products like Retin-A, alpha and beta hydroxy acids, Vivite glycolic acid products, Kinerase, Neocutis with PSP and antioxidants like Skinceuticals Vitamin C, Prevage, RevaleSkin Coffee Berry and sunscreens. These skin care products are not moisturizers (though they may have moisturizing properties), they are treatment products that have the science to back up their claims of wrinkle prevention and treatment. They also work over many months and years, not 6 weeks which was the length of this study. Effective skin care requires consistent and long term use of active products.

Glow-How: Notes from a San Francisco Bay Area Dermatologist

Monday, June 8th, 2009

What can I do to have that certain “glow” and make my skin look radiant? This is a question I hear all the time as a dermatologist in San Francisco. The answer is luckily more simple than people think! Below are highlights from a recent article in The Skin Cancer Foundation Journal that summarized the topic well along with some tips of my own.

Let’s start with the big picture…

If you have any tan, let your skin fade back to its normal tone. Playing up the coloring mother nature gave you is how to best get your glow-on.

If you have any obvious sun-spots or broken capillaries on your face, a trip or two to a dermatologist’s office can help to diminish their appearance and give your skin a more even-tone.

Maintain the integrity of your skin by wearing sunblock daily.

If you wear makeup, match it to the skin along your jaw-line as closely as possible. To add a bit more glow, you can apply bronzer or blush to the areas where natural highlighting occurs like the apples of the cheeks, center of forehead, bridge of nose and chin. Less is more, so don’t overdo or you’ll turn your glow into an obvious mask of makeup. Pale skin looks best with a light pink blush, whereas darker skin looks best with deeper shades. A fluffly, densely bristled brush works great to apply blush/bronzing powders.

As part of your daily routine….

Cleanse your face morning and evening. You can even use cleansing cloths, if it is more convenient. Cleansers do not have to foam up to be effective, so ask your dermatologist what is best for your skin type.

In the morning apply an anti-oxidant after cleansing. There are many good choices these days, including Skinceuticals Vitamin C serums, Obagi C Clarifying serum, RevaleSkin coffeberry or Prevage MD. Not only will they help protect the skin from free radical damage, but they will help to repair damaged skin cells.

Next apply a broad spectrum sunblock, with at least a 30 SPF. If you are out all day long, be sure to re-apply your sunblock to maintain its protective benefits. If re-applying a lotion is not to your liking, ColorScience makes a dry sunscreen that can easily be dusted on top of your makeup throughout the day.

Cleanse at night to remove the makeup, sunblock and oil build up from the day.

After your skin is dry, apply a Retin-A product sparingly to promote exfoliation of dead skin cells and really get your skin glowing. The less build up of dead skin cells, the less dull the skin will look. It will also help alleviate plugs in the skin, which can lead to acne and blemishes. And best of all, it increases collagen production to prevent and diminish fine lines and wrinkles.

Next up apply a moisturizer. This will relieve dryness associated with Retin-A products and help the skin maintain its natural moisture barrier. Skin that looks dewy reflects back light, adding to your glow.

If you cannot stand the idea of not having some color on your body, be sure to at least choose one of the self-tanning options. Tanning booths will only increase your risk of skin cancer and, really, who wants their skin to look like leather anyway? When applying a self-tanner to your body, make sure to prep the skin by using an exfoliating scrub or loofah, moisturize, then apply the self-tanning lotion. If your skin is dry in certain areas (like elbows and knees) it will absorb more of the lotion and look uneven. Make sure to wait at least 12 hours after shaving your legs to follow these steps. Self-tanners may aggravate certain skin conditions, so if you suffer from eczema or other skin issues, please check with your dermatologist before using any self-tanning methods.

Through my patients, I have seen that the tanning lotion application services offered at salons work very well. They will exfoliate your skin and apply the lotion much more easily and evenly than applying it yourself. I also like the look of Jergens Natural Glow moisturizer. This type of product moisturizes the skin and gradually encourages it to develop a natural color, without looking fake or orange.

Please feel free to contact our office with any questions about products or makeup. Start with these simple tips to get your glow-on today!

Cosmeceuticals and Antioxidants - What Really Works?

Wednesday, May 27th, 2009

You may be hearing the term “cosmeceutical” more and more when it comes to skincare. This fancy term refers to over the counter products that claim to deliver skin benefits similar to those of prescription grade products. The purposes of cosmeceuticals might include, but are not limited to protecting skin from UV damage (sunscreens), reducing free radical formation (antioxidants), improving skin lipid barrier (moisturizers), evening out complexion (bleaching agents and antioxidants), smoothing texture, reducing pore size and improving wrinkles (retinoids and collagen stimulators).

When you read labels on products, you may see they contain vitamin C, enzymes, phytochemicals, etc., but bear in mind that not all cosmeceuticals are created equal. Simply taking an active ingredient and bottling it, does not mean it will actually work when put on the skin. To have an effect, the active ingredients must be in the right concentrations and in the proper formulation to actually penetrate the skin and be biologically available for use by your skin cells. Always be sure to check with a dermatologist first before spending money on products you are unsure of.

It is also important to know that one product alone cannot address every cosmetic skin issue. A combination of cosmeceuticals, such as sunscreen and antioxidants along with prescription strength topicals like Retin-A and hydroquinone (bleaching agent), will give you a balanced skin care program incorporating the best of both product worlds.

My favorite “cosmeceuticals” are antioxidants, which have been clinically proven to combat the signs of aging. Ultraviolet (UV) radiation from the sun and environmental pollutants are known to cause skin damage. They create “free radicals” which are just what their name implies – highly unstable, reactive molecules that steal electrons from healthy skin cells, damaging DNA and destroying the cells. This causes age spots, wrinkles and skin cancer. Antioxidants are important because they significantly reduce the production of free radicals in the skin or absorb these radicals and their byproducts. Vitamins C and E and other compounds like ferulic acid, idebenone, green tea and coffe berrry are all proven effective from trusted sources. These sources include Skinceuticals Vitamin C products, Prevage MD (highest percentage of idebenone available), Topix Green Tea and Revaleskin (coffee berry), which are available in our office or at our webstore. These can help prevent skin cancer and keep skin firm and young looking. For best effect they should be used in the daytime under sunscreen. Please contact the office with any questions about which antioxidant is right for you!

Helping Hands

Thursday, May 7th, 2009

In general, people are now in the habit of using some form of sunscreen on their face each day to protect their skin from sun damage. Hands are another story.

Patients often complain that their hands either “give away” their age or they seem prematurely aged compared to the rest of their skin. Our hands are constantly exposed to environmental elements like water and temperature and they receive a tremendous amount of sun. Yet knowing all the abuse our hands endure, they are often overlooked when it comes to skin care and sun protection. Wrinkles, brown spots and precancerous lesions on hands can nearly all be attributed to sun and UV ray exposure. Also, the skin on the hands is thin, so further breakdown of its collagen by UV rays causes it to become even thinner more quickly than other body parts. Not only does this effect its texture, but aging and unattractive veins and tendons can show right through!

So, what can be done for these under cared for extremities? First of all, prevention is key. Keep a tube of moisturizing sunblock in your purse or carry all and apply often, especially after washing. We recommend sunblocks with at least an SPF 15 that contain some zinc or titanium dioxide (physical blocks that do not degrade as quickly). This will keep your hands from being dry and keep them consistently protected. Consider keeping a pair of gloves in your car and slipping them on before you hit the road. This will keep the sun off your hands when holding the steering wheel, especially for long car rides. Treat the skin on your hands with anti-aging and collagen building products. This is usually easiest at bedtime when you are washing your hands less frequently. We will often recommend that patients use Retin-A mixed with a bleaching cream to lighten brown spots and build collagen. Use caution with any products on your hands as the skin can become irritated more easily. Ask a professional for proper instructions with any product.

There are many treatment options available to help reverse damage on the hands. Chemical peels and lasers are very effective in making your skin look less spotted and wrinkled. Fillers can also be used to plump up the skin on the hands and help reduce the appearance of veins. Please contact our office for more details. In the meantime, be good to your hands, they deserve it!