Like mother, like daughter

I gave my daughter a hug the other day, and my hand brushed on the back of her arms.  And I felt the bumps.  The same bumps that I have on the backs on MY arms.  Some call it "chicken skin."  Some call it "sandpaper arms."  So what's the deal with these little white bumps?

Keratosis Pilaris (KP) is a very common condition that often starts in childhood.  Anyone can get it, and it tends to happen more frequently in females.  It can be associated with eczema, dry skin, and seasonal allergies (atopic dermatitis), or can be an isolated finding.  It's caused by a buildup of keratin in the hair follicles, and is commonly located on the backs of the arms, inner thighs, and cheeks.  Sometimes it can be found on the abdomen, back, buttocks, and legs, too.  The condition often runs in families.

As keratosis pilaris is a benign condition, no treatment is needed.  It usually gets better with age, especially after puberty, but it can persist into adulthood.  There is no magic cure for KP.  Emollients will often improve texture of the skin.  Glycolic acid, lactic acid, and salicylic acid lotions, urea creams, retinoid creams, peels, and microdermabrasion are all treatments that may improve the appearance and feel of the bumps.  Picking is not recommended, as it can lead to scarring. 

My daughter's got half my genetic makeup- the good, the bad, and the bumpy!

Scar Secrets

"Will there be a scar, doc?"

Dermatologists all over the nation hear this question on a daily basis.  Scars can occur from any injury to the skin, such as: burns, scrapes, cuts, bites, biopsies, surgeries, and more.  The deeper the injury, the more of a risk of developing scar tissue.  The location of injury also plays a role: the more movement in an area, the more of a chance a thicker or wider scar will develop.  Chests, shoulders, and backs are areas more likely to scar.  And although it's impossible to completely prevent a scar, there are ways to minimize the appearance of them.

Clean
Wounds should be cleaned with a mild cleanser and water daily.  Hydrogen peroxide, alcohol, and iodine can be irritating and may actually slow healing.

Cover
Dry or wet?  The old school of thought was to let wounds "dry out and form a scab."  But research has shown that keeping a wound moist and covered with a band-aid actually greatly improves healing.  Aquaphor or petroleum jelly is the best emollient to use.  There is no proven advantage to using an antibacterial ointment like neosporin - in fact, many people are allergic to it and develop itchy reactions.  Vitamin E oils and herbal oils may also result in allergic reaction, and may in fact slow wound healing. 

Protect
Keeping it covered also imparts another advantage: sun protection.  Exposing healing wounds to sun may cause them to pigment and appear dark.  Once they've healed and are no longer covered, sunscreen can be used.

Take It Easy
Limiting movement can help.  Tension causes scars to "spread" or widen.  Avoiding lifting heavy objects or twisting motions will improve the appearance. 

Fine Details
Scars are composed of collagen.  Pressure and massage may prevent, as well as treat, raised or thickened scars.  Injections with cortisone, performed in the dermatologist's office, can help to flatten a raised scar (called a keloid).  Silicone gels such as biocorneum or mederma (contains onion extract) may further improve the appearance of the scar. 

Zap
Finally, laser treatments, such as the intense pulsed light, can be used to lighten the color of the scar.  Acne scars or thickened scars may respond well to fractional CO2 lasers, like the Active FX, or fractionated erbium lasers, like the Fraxel Re:Store 1550.

The bottom line?  Anytime the skin is cut or injured, there can be a scar.  What it ultimately looks like depends on: the depth of the injury, how the person heals, and how it's taken care of. 

New Year's Resolutions

It's a new year.  Time to detox, reflect, and re-new.  Many of us make the most common resolutions, such as working out/losing weight, saving money, and working harder.  Even though we start out strong in January (check out how many people are at the gym this week), resolve can wane by mid-March.  Here are a few resolutions that you actually may enjoy keeping!

Resolution # 1: Drink More Coffee
Hello, Starbucks.  Women who drink three cups of caffeinated coffee a day can reduce their risk of basal cell carcinoma by up to 20 percent, compared to those drinking less than a cup monthly.  These results are based on a large population study: over 113,000 adults who took part in the U.S. Nurses' Health Study and Health Professionals Follow-Up Study. A lesser decrease in risk was seen among coffee-drinking men.

Resolution #2: Drink Red Wine
This is not permission to finish a bottle of malbec.  A small glass of red wine a day contains resveratrol, which is a potent antioxidant found in grapes.  Antioxidants fight free radicals in our skin and body, which are harmful and play a role in skin cancer and aging.  A moderate amount of alcohol has also been found to be heart-healthy and raises levels of "good" cholesterol, or HDL.  Of course, women who are pregnant/nursing or those with medical conditions should not drink alcohol. 

Resolution #3: Eat Dark Chocolate
In a recent study, German researchers gave 24 women a half-cup of cocoa enriched with flavonoids daily. After three months, the women's skin was better protected, less red, and had a smooth appearance after exposure to ultraviolet light. The researchers think the flavonoids, which absorb UV light, help protect and increase blood flow to the skin, improving its appearance.  Plus dark chocolate contains more of those good antioxidants!

Resolution #4: Wear Your Sunscreen
I have to throw this one in: I've said it before and I'll say it again: sunscreen, sunscreen, sunscreen to prevent skin cancer and the signs of aging.  Okay, lecture over.

Happy 2012 and here's to a year of great health and gorgeous skin!

Xeomin - the new kid on the block

Competition is good.  First we had Botox.  Then Dysport came on the scene.  And now we have Xeomin.  They all are neurotoxins that work to smooth out lines in the forehead, around the eyes, improve bunny lines, fix a gummy smile, help smoker's lines, soften the jawline, and relax neck lines (although they're all only approved for the glabellar eleven lines).  So what's the difference between these three muskateers?

How They Work
All three work by temporarily inhibiting release of a chemical called acetylcholine from nerves.  Acetylcholine works as a messenger, telling the muscles to contract.  In a nutshell: no release, no signal, no contraction, no lines. 

Proteins
Botox and Dysport consist of botulinum toxin that is complexed with accessory proteins.  Once injected, the proteins separate from the toxin.  Xeomin does not have the accessory proteins.  Having no proteins may decrease the possibility of developing antibodies to the proteins, which make the injections less (or not) effective. 

How They Act
Both Botox and Xeomin start to work about a week after injection and last about 3-4 months.  Dysport may work a little faster, and may last a little longer, although the results vary.  Some reports have shown that dysport may locally diffuse further than Botox once injected.  Sometimes this means that less has to be injected to achieve a pleasing, natural result. 

Storage
Unlike Botox and Dysport, Xeomin does not need to be refrigerated -- great if we lose power in South Florida during hurricane season!

Most importantly, no matter which you choose, make sure a board certified physician in one of the core specialties: dermatology or plastic surgery is performing the treatment.  Have fun ringing in the new year wrinkle free!

Exercise and the Skin

Thanksgiving was great, right?  The turkey, gravy, mashed potatoes, stuffing, dinner rolls, pumpkin pie.  It tasted so delicious, I inhaled it all.  But by the end of the meal, we all were laying back in our chairs, too full to move.  Belts were loosed, and waistbands groaned at the force of our bloated bellies.  I decided not to wait for New Year's - my resolution was happening early.  It was time to start a running routine.

The benefits of exercise for your heart, muscles, and bones are indisputable.  As I puffed along Turnberry circle, I started thinking about how exercise benefits skin, as well.

Sweat it out
When we run, bike, box, step, zumba, or spin, we sweat.  Sweat functions to cool our body off, but it also flushes and rids the skin of toxins, such as free radicals.  The increase in blood flow delivers more oxygen and nutrients to the skin, as well.  But if sweat sits around on the skin, bacteria can follow.  For people with acne prone skin, cleaning your face/chest/back right after your workout, and removing sweaty clothing can help prevent a breakout.

Say ohm
There's no doubt about it: exercise reduces stress levels.  And if you haven't heard by now, too much stress is not a good thing.  Higher levels of cortisol (increased in stress) can worsen many medical conditions, including skin: eczema, psoriasis, acne, hives, etc.  (See my post on stress and the skin for more information).  Increased cortisol levels may also be linked to increased sebum and oil production, making acne worse.  Keeping levels low through diet, exercise, and breathing may help improve your skin's appearance and overall health.

Dimples
No, not the ones on the face.  I'm talking cellulite.  While nothing has been proven to get rid of it completely, tightening muscles and toning can improve the appearance of legs and derrier. 

But a caveat--  Exercising outside means sun exposure.  Avoiding peak hours (10 am - 3 pm), wearing a broad spectrum sunscreen, and sun protective clothing are all vital to help prevent skin cancers and sun damage. 

So who's joining me for a jog?

You look tired...

Nothing says “I’m tired,” quite like dark, hollow, undereye circles.  “I’m fine,” you insist.  “I got a full night of sleep!”  Your friend looks at your with sympathetic eyes.  “Mmm, hmmm, riiiiight.  Poor thing…” she coos. 

The truth is, sleep (or lack there of) is only one factor contributing to the appearance of hollows under the eyes.  Genetics, allergies, broken blood vessels, and volume loss all play a role.  Although this is a difficult area to treat, there are things that help.

Hollows in the “tear trough” area (the area between the eye and upper cheek) can be improved by replacing volume with filler.  Hylauronic acid fillers, such as Restylane, Juvederm, and Perlane, work well in this area because they are softer fillers.  They are injected deep to restore volume from bone and fat loss.  Deep injections prevent lumps from being seen.  These filler last about 9 months to a year.  Although they improve the hollow, filler won’t do much for the dark color.  Fillers have FDA approval to be used in naso-labial folds.

Eye creams help to hydrate the underye area and temporarily plump the area.  Hyaluronic acid creams fill in fine lines.  Creams with caffeine, like RevaleSkin Replenishing Eye Therapy, help to constrict the area, reducing puffiness.  One of my favorites is the TNS Essential Illuminating Eye Serum, which contains growth factors and antioxidants.  The growth factors have been scientifically proven to stimulate collagen.  Creams can be kept in the refrigerator and then applied; the cold helps to further constrict blood vessels.

If seasonal allergies are an issue, taking a daily non-drowsy antihistamine can help.  Sleeping propped up on two pillows helps decrease fluid accumulation beneath the eyes.  Compresses with chamomile tea can be soothing.

Finally, with any skin condition, taking care of your overall health is essential.  Sleeping a full eight hours, eating a healthy diet rich in antioxidants (green tea, vitamin C, vitamin E, resveratrol, acai, blackberry, etc), exercise, and stress relieving activites (yoga, breathing) are vital to a youthful, energized, beautiful, you!

Winter skin

Just as we change our clothing with the changes in weather, the cooler temperatures also call for changes in our skin care regimen.  Crisp outside air, blowing wind, and indoor heat can lead to chapped lips, cracked hands, and dry skin.  Keeping your skin well hydrated can help prevent these with a few easy changes to your regimen.

Moisturize, moisturize, moisturize: can’t say it enough.  Keep a tube of cream in your purse or pocket.  I like Eucerin, Cerave, and Cetaphil creams for over-the-counter brands.  For creams available in physician’s offices, Lipikar by La Roche Posay is very hydrating.  Many people use lotions, but often, the alcohol found in formulations can be drying.  Also, fragranced products can be irritating and drying, as well.  Toss the "violet lavender rose summer blossoms bouquet" scented lotion.

Harsh soaps can play a role in stripping the skin of its protective lipids.   Mild, fragrance-free cleansers, like Dove and Cetaphil are great.  Avoid using very hot water in the shower, which actually can dry the skin.  Moisturize as soon as coming out of the shower, while skin is still moist.

Fragrances are hidden in other places, too.  Strong detergents can often cause dry skin and rashes.  Perfume-free clothing detergents are a better way to go.  And avoid using dryer sheets in the dryer, which can also irritate skin.  People with sensitive skin also are often irritated by wool, so wearing a cotton shirt under the sweater, or avoiding wool all together can help.

Lips are sensitive to temperature changes.  Constantly licking lips actually dries the lips further, and saliva can be irritating to the skin surounding the lips, causing "lip licker's dermatitis."  I've said it before, and I'll say it again: forget dogs, Aquaphor is man's best friend.  It's perfect for moisturizing cracked heels, dry elbows, lips, and pretty much anywhere else.  That goes for kids' skin, too, which can be extra sensitive, especially if Junior has eczema (see the eczema post for more info on that condition).

Winter's here, folks, so pull on your Missoni for Target hats and mittens and enjoy - just make sure your skin stays hydrated and soft underneath!