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Monthly Archives: November 2016

Topical Botox Is on the Way

Do you want to get rid of those pesky wrinkles but can’t bear the thought of injections? Then we’ve got great news for you: Scientists have been working on a topically applied version of botulinum toxin, the main ingredient in Botox.

The new needle-free gel formulation of botulinum toxin— called RT001 — was reported in the dermatology journal Skin & Allergy News. Up to 89 percent of 553 patients saw improvement in their lateral canthal lines (aka crow’s feet wrinkles), with no significant side effects in phase 2 clinical studies by California-based Revance Therapeutics. The results lasted for an average of 113 days.

“I think Revance is going to turn the neurotoxin market upside down,” Alastair Carruthers, MD, told attendants at a dermatology seminar held in Hawaii last week.

The more familiar needle-based form of botulinum toxin is a billion-dollar business: Nearly 6 million botulinum injections were done in 2011, according to the American Society of Plastic Surgeons. Doctors are excited by an alternative application that could widen the drug’s appeal and reach.

Topical Botulinum: How Does It Work?

Like injectable forms, topical botulinum toxin relaxes muscles by blocking the release of a neurotransmitter known as acetylcholine. It’s applied by doctors directly to the skin and wiped off after 30 minutes. Besides softening crow’s feet around the eyes, the gel is also being studied to treat hyperhydrosis (excessive sweating), and plans to investigate its use for acne and rhinitis are in the works, according to Revance’s Web site.

But some question whether the topical form will work as well as the injectable drug.

“The results are good, but they probably won’t be as dramatic” as the injections, Frederic Brandt, MD, a Miami-based dermatologist, told the Orange County Registerlast May. That’s because using a needle can more precisely target specific areas. Still, saying bye-bye to needles is bound to have appeal to the estimated 10 percent of the population with belonephobia, or needle phobia.

When can you expect the gel to be available at your dermatologist’s office? Not for a while: RT001 still needs to go through phase 3 trials, or final testing, before it receives U.S. Food and Drug Administration approval.

Top 7 Tips for Healthy Winter Skin

Dry winter air can wreak havoc on your skin — leaving it dry, itchy, and irritated; but there are many simple ways to combat dry skin causes and help keep your skin feeling moist and supple all winter long. Here are 10 ways to get started.

Top 7 Tips for Healthy Winter Skin

1. Invest in a humidifier. Using a humidifier in your home or office will add moisture to dry winter air and help keep your skin hydrated. Run a humidifier in the rooms you spend the most time in, including your bedroom.

2. Lower the thermostat. When it’s chilly outside, what’s the first thing you want to do? Crank up the heat! But central heat can make the air in your house even drier. Try setting the thermostat at a cool, yet comfortable setting — 68°F to 72°F — to maintain healthy skin.

3. Skip hot showers. Although it may be tempting to warm up with a long, steamy shower, hot water dries out your skin by stripping it of its natural oils. Instead, take a 5- to 10-minute lukewarm shower (or bath). You should also avoid using excessively hot water when washing your hands — if the water causes your skin to turn red, it’s too hot.

4. Choose cleanser wisely. The wrong soap can worsen itchy, dry skin. For instance, steer clear of regular bar soaps, since they tend to contain irritating ingredients and fragrances. Instead, start washing with a fragrance-free, moisturizing cleanser or gel. You can also prevent winter skin problems by using less soap, so limit your lathering to necessary areas, such as your hands, armpits, genitals, and feet.

5. Modify your facial skin care regimen for the season. During the winter months, choose cream-based cleansers, and apply toners and astringents sparingly, if at all. Many astringents contain alcohol, which can further dry your skin. Look for products that contain little or no alcohol — unless your skin is excessively oily. At night, use a richer moisturizer on your face.

6. Moisturize frequently. Maintain healthy skin by moisturizing after washing up. “Blot skin dry and apply a thick moisturizer within a few minutes after bathing to seal the water into the skin,” says Linda Stein Gold, MD, director of dermatology clinical research and division head of dermatology at Henry Ford Hospital, West Bloomfield, MI. “It’s best to use a cream or ointment in the winter. Lotions are better in warmer, humid climates. And don’t forget your hands,” says Dr. Stein Gold. “Constant washing will cause the hands to take a beating. Apply hand cream after each washing, and wear waterproof gloves when washing dishes or cleaning around the house.”

7. Apply sunscreen — even in winter. It is still important to protect your skin from harmful UV rays on cold, dreary days in winter. Before going outside, apply a moisturizing, broad-spectrum sunscreen with an SPF of 15 or higher to all exposed areas of your body.

Dry Skin Care Essentials

We all want healthy, hydrated skin, but the reality is that skin can become dry, flaky, and rough. Why? The outer layers of your skin are put together in a type of brick-and-mortar system. Healthy skin cells are stacked with oils and other substances that keep skin moist. When those substances are lost, skin cells can crumble away, which leads to dry skin.

Itching is the No. 1 symptom of dry skin, says Angela Lamb, MD, assistant professor of dermatology at the Icahn School of Medicine at Mount Sinai in New York. Dry skin tends to be flaky, red, and irritated. Your skin may also look dull or ashy (if you have dark skin), which can progress to skin being scaly or cracked. In the worst-case scenario, skin can become thick and leathery.

What Causes Dry Skin?

Dry skin often results when the skin loses water or oil, particularly in climates with low humidity, or during winter months when low humidity and indoor heat affect the natural balance of healthy skin. “Your skin is the primary barrier to the environment and prevents water from evaporating off the surface,” Dr. Lamb says. When humidity is low, more moisture is lost from the skin’s surface and it dries out.

On top of that, certain medical conditions can make you more prone to developing dry skin, including:

  • Keratosis pilaris. As many as 40 percent of adults and up to 80 percent of teens have an inherited dry skin condition called keratosis pilaris, according to the American Academy of Family Physicians. The condition causes tiny red or flesh-colored bumps on the skin, particularly on their upper arms and thighs or on the cheeks in children. The bumps are dead skin cells and make skin feel rough, like sandpaper. Skin may also itch during the winter or in low humidity.
  • Atopic dermatitis. Up to 20 percent of children and 3 percent of adults around the world have atopic dermatitis, according to a 2015 study published in Annals of Nutrition & Metabolism. This is a common type of eczema in which itchy patches of skin form. When the skin is scratched, it may become red and swollen and could crack, weep fluid, or scale. This type of eczema often occurs in people who also have asthma or hay fever.
  • Hormonal changes. When your body is going through hormonal changes, you may notice dry or flaky skin cropping up. It’s something that happens even in babies. Newborns commonly develop cradle cap — flaky, scaly skin on the scalp — as a result of being exposed to mother’s hormones in the uterus, according to The Nemours Foundation. Hormonal changes after menopause can also lead to dry skin.
  • Thyroid disease. One of the early symptoms of hypothyroidism, a condition where the thyroid gland doesn’t produce enough thyroid hormone, is dry skin.
  • Diabetes or kidney disease. People with diabetes or kidney disease may notice dry, itchy skin on their legs due to poor circulation. This happens when the skin is not getting the proper amount of blood flow. In fat, very dry skin is a warning sign of diabetes, according to the American Academy of Dermatology.

How to Go From Dry Skin to Healthy Skin

The main step you can take to heal dry skin: Moisturize, moisturize, moisturize. Applymoisturizer to your body and face at least once a day, when your skin is still damp from the shower, recommends Alisha Plotner, MD, a dermatologist at the Ohio State University Wexner Medical Center in Columbus. In the summer, a thinner lotion will do the job, but in the winter when skin becomes drier, a thicker cream or ointment is a better choice, she says.

Good ingredients to look for in a moisturizer are lactic acid, glycerin, petrolatum, and hyaluronic acid, says Nazanin Saedi, MD, a dermatologist,  director of Jefferson Laser Surgery and Cosmetic Dermatology Center, and an assistant professor at Thomas Jefferson University Hospitals in Philadelphia. Persistently dry areas can also benefit from petroleum jelly, she says.

If over-the-counter moisturizers aren’t enough for your skin, your doctor may prescribe an ointment that contains ceramides, or proteins that help rebuild the skin barrier, Lamb says. Prescription-strength products are especially helpful for eczema and other severe skin conditions. People who have eczema may also get relief from applying cold compresses on itchy skin. Over-the-counter or prescription corticosteroid creams may also be needed to heal the skin barrier and calm inflammation, Dr. Saedi says, but prolonged use can thin your skin, so carefully follow your doctor’s directions about using them. Your doctor may also prescribe oral corticosteroids, but they’re not intended for long-term use.

Another over-the-counter or prescription option is a barrier cream. Barrier creams penetrate a little deeper than standard moisturizers. “Anyone prone to dryness with repeated exposures to detergents, soaps, water, and other irritants would benefit from a barrier cream,” Dr. Plotner says.

For those with keratosis pilaris, moisturizing with creams that have urea or lactic acid helps the itch, but doesn’t necessarily smooth the skin. However, mild chemical peels or topical retinoids may soften the skin.

Other dry skin remedies include:

  • Taking short, warm (instead of hot) showers
  • Using moisturizing soaps
  • Placing a humidifier in your home to add moisture to the air

Although it hasn’t been studied, some doctors believe that polyunsaturated fats, found in fatty fish like salmon and mackerel and soybean and safflower oil,  can help keep the skin healthy, Lamb says.

What’s My Skin Type?

Skin is generally classified into one of four categories: normal, oily, dry, and combination, says Susan Van Dyke, MD, a dermatologist with Van Dyke Laser and Skin Care in Paradise Valley, Ariz. However, your skin type can change as you age, and other factors like genetics and even illness can play a part. “It’s multi-factorial,” Dr. Van Dyke says.

Normal skin, which has a good balance of moisture, small pores and an even tone, is the goal of most skin care regimens. Most people have normal skin, Van Dyke says, but to maintain its good condition, it’s important to minimize its exposure to the sun. A facial sunscreen with an SPF of at least 30 is ideal for preventing wrinkles and other sun damage.

“Put it by your toothpaste and use it,” Van Dyke says. “It doesn’t matter if it is snowing or raining — get in that habit so you always have it on. Incidental sun exposure is what gets you.”

Skin Care: Quieting Oily Skin

Oily skin is identified by an excess of oil (the technical term is sebum) on the face. Some people with oily skin begin to feel greasy only a few hours after washing. “A very oily person would feel the need to wash their face between noon and 5 p.m., because oil has built up during the day,” Van Dyke says. Oily skin can be an inherited trait, but it can also be caused by puberty, which causes oil glands to go into overdrive. You may also notice more oil on your “T-zone” because of all the oil glands in the forehead, nose, and chin.

People with oily skin generally don’t need a regular moisturizer, but sunscreen is still necessary to reduce exposure to UV rays. Choose an oil-free sunscreen, suggests Van Dyke says, one that’s specifically formulated for the face and are less likely to create blackheads and clog pores. “There are plenty of oil-free sunscreens available,” Van Dyke says. “Go to the drugstore, read labels, and try samples of different ones. There’s no excuse not to use sunscreen anymore.”

Skin Care: Soothing Dry Skin

Dry skin, on the other hand, suffers from a lack of natural moisture — there’s little oil to act as a surface barrier and lock in moisture. People with dry skin feel a tightness about their face, and their skin is often irritated. Flaking is another symptom, but it’s not always a sure sign of dry skin. “You can have flaky skin and not be dry,” Van Dyke says. Sometimes, severely dry skin can become itchy and painful, leading to a condition called eczema.

Treatment of certain medical conditions can sometimes lead to dry skin. For example,breast cancer treatment may stop hormone production which could in turn affect the quality of your skin. “This will throw people into a menopausal situation at an early age,” Van Dyke says. “Suddenly, there’s no oil production.” Naturally-occurring menopause can have the same effect; most women begin to experience drier skin as they hit their late forties. To care for dry skin, use a gentle, soap-free cleanser, and moisturize adequately. A second application of moisturizer may be needed during the day, Van Dyke adds.

Skin Care: Balancing Combination Skin

Combination skin is a blend of both oily and dry skin. People with combination skin usually find that their oily skin is concentrated in the T-zone, while their cheeks remain dry. Combination skin can be influenced by genetics and, again, by puberty, when oil glands increase their production of sebum. Sometimes a variety of products are needed to treat combination skin. “You may have to treat different parts of the face slightly differently,” Van Dyke says. For example, a mild cleanser and moisturizer may be needed on the cheeks, while an anti-acne product with benzoyl peroxide might be necessary on the T-zone.

If you’re still not sure about your skin type or the best way to nourish it, consult adermatologist who can recommend an over-the-counter skin care regimen or offer you a physician’s line of products. Look for a doctor who is board-certified by the American Academy of Dermatology. “Your dermatologist is absolutely your best skin-care expert,” Van Dyke says.