Treating Photoaging with PRP Microneedling

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By Dr. Elena Allbritton 

What is photoaging?

Exposure of the skin to the sun’s rays can cause some short-term changes such as sunburns but eventually, it will take a toll on the skin and lead to more long-term consequences. Sun damage to the skin is referred to by several names, including photodamage, solar damage, and photoaging. When ultraviolet (UV) light from the sun or other light sources such as tanning booths, hits skin unprotected by sunscreen, DNA changes occur at a cellular level. Some of the changes happen in the deeper dermal layers of the skin and take years to become visible. Photoaging can also lead to skin cancer.  

Who is susceptible to photoaging?

The short answer is everyone is susceptible to photoaging. The amount of photodamage to the skin depends on skin type, geographical factors such as latitude, and the amount of unprotected sun exposure sustained over time. Individuals with lighter skin tones are more susceptible to photoaging and skin cancer than those with darker skin tones. However, people with darker skin tones can still sustain photodamage, and develop skin cancer and dyspigmentation such as melasma.  

What does the UV index have to do with photoagaing?

The UV index was created to help provide daily guidelines for safer sun exposure and is important in the assessment of harmful UV exposure. Geographical factors, cultural practices, and accessibility to UV protection all play a role in the amount of photodamage and photoaging an individual may experience.  

How to protect against premature aging and treat photodamage: 

  • Limit unprotected skin exposure. The American Academy of Dermatology recommends avoiding exposure during peak hours between 10am and 2pm, wearing broad spectrum mineral sunscreen that protects best against both UVA and UVB, and wearing sun-protective clothing (UPF40+) and sunglasses.
  • Pay attention to the UV index in your location.
  • Reduce inflammation and free radical formation through good nutrition. Antioxidants such as vitamins C and E, lipoic acid, and coenzyme Q scavenge oxidative free radicals generated by solar radiation. 
  • Practice good daily skin care using products containing medical-grade antioxidants, hyaluronic acid for hydration, and retinoids (tretinoin, tazarotene, and adapalene). ** See your dermatologist for a daily skin care regimen consultation to determine what products will work best for your skin.
  • There are many treatment options to improve photoaging. PRP with microneedling is a minimally invasive method of naturally regenerating facial skin. 

What is Platelet-rich plasma (PRP)?

A platelet-rich plasma (PRP) treatment is a relatively simple process that uses the patient’s own growth factors. The patient’s blood is centrifuged, or spun down, to increase the concentration of platelets and includes a mixture of cytokines and growth factors. There is no concern about rejection or disease transmission because it is manufactured from the patient’s own blood. This mixture has anti-inflammatory properties and can be used to stimulate healing.

PRP has been used for years to treat athletes with sports injuries, augment healing and speed recovery from surgery, and to treat degenerative conditions such as osteoarthritis. PRP is also being used to treat acne scars and hair loss such as androgenetic alopecia. It can also be used with microneedling for facial rejuvenation.  

PRP with microneedling

Platelet-rich plasma with microneedling is minimally invasive and rarely causes side effects. The most common side effects are discomfort or bruising at the injection sites. PRP treatments can have varying levels of success with different patients. This may be due in part to the concentration or health of the platelets and growth factors. It is advised to stop taking nonsteroidal anti-inflammatory medications (NSAIDs) such as ibuprofen, aspirin, and naproxen, for 2 weeks in advance of PRP treatment because these medications can impair platelet function and increase bleeding risk.  

What is microneedling?

Microneedling is a safe technique that uses sterile needles for controlled micro-injuries to the skin which stimulate the natural healing process. Tiny micro channels are opened in the skin which allow the growth factors and platelets in PRP to penetrate deeper into the skin. When compared with microneedling alone, PRP plus microneedling can significantly improve the visual appearance of photoaged skin.

Animal studies using PRP show decreased oxidative stress, inflammation, and inhibition of skin cell death leading to improved skin photoaging. Growth factors in PRP stimulate fibroblasts and induce new collagen production. Patient satisfaction tends to be higher with the addition of PRP. Pigmentation, telangiectasias as well as wrinkles are improved which reduces the signs of photodamage.

What to expect when getting Microneedling with PRP

During the procedure, topical numbing cream is used so the patient experiences only mild discomfort. After treatment, there is some mild redness for 24-48 hours. It is recommended that patients avoid exercise for 24 hours after treatment. Mild peeling of the skin can occur several days after treatment. Most patients experience a healthy glow after the first treatment, especially when PRP is added. A series of 3-6 treatments is recommended for the best results. Optimal results occur after 2-3 months due to the production of new collagen and elastin.  

The main benefits of microneedling with PRP: 

  • Collagen production and skin tightening
  • Improvement in skin texture
  • Minimizing of fine lines and wrinkles
  • Improvement in skin tone and discoloration
  • Minimizing pore size
  • Reduction in acne scarring, the appearance of stretch marks, or other types of scars

Interested in microneedling with PRP? Book an appointment with us for a consultation to discuss the best treatment options for you and your skin. Give us a call at 301-652-8081.

 

 

Other resources for information: 

  1. https://www.mdanderson.org/publications/focused-on-health/what-s-the-difference-between-uva-and-uvb-rays-.h15-1592991.html
  2. Comprehensive Review of Ultraviolet Radiation and the Current Status on Sunscreens from PMC Labs: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3460660/
  3. Yan, B., & A., J. (2014). Ultraviolet Radiation, Aging and the Skin: Prevention of Damage by Topical cAMP Manipulation. Molecules, 19(5), 6202-6219. https://doi.org/10.3390/molecules19056202
  4. https://healthmatch.io/blog/top-20-skin-cancer-hot-spots-in-the-world-and-why-theyre-on-the-list
  5. Ultraviolet (UV) Radiation from the Aim at Melanoma Foundation: https://www.aimatmelanoma.org/melanoma-101/prevention/what-is-ultraviolet-uv-radiation/
  6.  American Academy of Dermatology. Prevent skin cancer. 2021. https://www.aad.org/public/diseases/skin-cancer/prevent/how. Cited 1 Oct 2021.
  7. Poon F, Kang S, Chien A. Mechanisms and treatments of photoaging. Photodermatol Photoimmunol Photomed 2015; 31: 65–74.
  8. Fisher GJ, Kang S, Varani J et al. Mechanisms of photoaging and chronological skin aging. Arch Dermatol 2002; 138: 1462–1470.
  9. Kang S, Fisher GJ, Voorhees JJ. Photoaging: pathogenesis, prevention and treatment. In: Gilchrest BA, ed. Geriatric dermatology. Philadelphia: WB Saunders, 2001, 643.
  10. Yaar M, Gilchrest B. Photoageing: mechanism, prevention and therapy. Br J Dermatol 2007; 157: 874–877.
  11. Sambandan D, Ratner D. Sunscreens: an overview and update. J Am Acad Dermatol 2011; 64: 748–758.
  12. Graf J. Antioxidants and skin care: the essentials. Plast Reconstr Surg 2010; 125: 378–383
  13. Charles-de-Sá L, Gontijo-de-Amorim NF, Takiya CM, et al. Effect of use of platelet-rich plasma (PRP) in skin with intrinsic aging process. Aesthet Surg J. 2018;38(3):321-328. 
  14. Alam M, Hughart R, Champlain A, et al. Effect of Platelet-Rich Plasma Injections for Rejuvenation of Photoaged Facial Skin. JAMA Dermatol 2018 Dec; 154(12):1447-1452.

Skin and the Relation to Bone Density

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Do you look in the mirror and see a furrowed brow? Thinking about how to erase those lines that suggest you are worried or angry even when you’re not? You’re likely very aware that Botox does the trick and safely erases “the elevens” between the eyes. But did you ever wonder if forehead lines are an indicator that other tissues, not visible to the naked eye, are also showing signs of wear?

Bone Density Study

Researchers at Yale posed the same question about a decade ago and looked at bone density in 114 women in their late 40s and 50s who were within three years of menopause and not on hormone or bone density drug therapy. They measured the number and depth of the women’s forehead, face and neck wrinkles, as well as the skin’s firmness or rigidity, and then tested their bone density by x-ray and ultrasound. They excluded women who had undergone any cosmetic skin procedures or who may have damaged their skin by tanning beds or extensive sun exposure. The small study demonstrated only an association between decreased bone density and early skin wrinkling, and to my knowledge, there haven’t been larger follow-up studies confirming the observation.

Collagen

Although there may be insufficient data to confirm the association, it’s an interesting idea to think about since the scaffolding of both skin and bones is a group of proteins called collagens. As we age, the changes in collagen that visibly cause the skin to sag and wrinkle are also invisibly affecting bone quality and quantity. According to the CDC, the prevalence of low bone mass, a precursor of osteoporosis, at either the femur neck or lumbar spine or both among adults aged 50 and over was 43.1%. This was higher among women (51.5%) compared with men (33.5%).

Osteoporosis

Of the estimated 10 million Americans with osteoporosis, about eight million or 80% are women. Approximately one in two women over age 50 will break a bone because of osteoporosis. Furthermore, a woman’s risk of breaking a hip is equal to her combined risk of breast, uterine and ovarian cancer. There are 1.5 million osteoporotic fractures in the United States each year, leading to more than half a million hospitalizations, over 800,000 emergency room encounters, more than 2,600,000 physician office visits, and the placement of nearly 180,000 individuals into nursing homes. Hip fractures are by far the most devastating type of fracture, accounting for about 300,000 hospitalizations each year.

Bone Density Screening

Many women (and men) don’t know they have low bone density until it has progressed to the point of fracture that requires both surgical intervention and the initiation of treatment with bisphosphonates. The key is finding out early when you can do something about it. Talk to your physician about a screening bone scan, especially if you have a family history of osteoporosis, if you are a woman over age 65 or if you have risk factors (such as past fracture, certain medical conditions or medications, or cigarette or alcohol use).

Healthy Lifestyle Habits for Skin & Bones

We don’t know whether wrinkles really are a sign that your bone density is low, but we do know that many of the same measures that keep your skin healthy are also beneficial to your bones. Some lifestyle habits you can adopt that promote both healthy skin and bones:

1. Don’t smoke: Avoiding or quitting smoking is strongly recommended for bone health because smoking cigarettes is known to increase bone loss.

2. Alcohol in moderation: Excess alcohol decreases bone density by 2%, dehydrates the skin and exacerbates conditions such as rosacea.

3. Exercise: Weight-bearing exercise increases bone density and it’s also great for your skin: By getting the heart rate up and improving blood circulation, exercise can help to deliver oxygen and nutrients to the skin which stimulates collagen production, and promotes new skin cells, keeping the skin glowing and also helping with anti-aging. An interesting study in Japanese post-menopausal women demonstrated increased bone density in the hip after standing on one foot for 1 minute 3 times per day.

4. Diet: Sufficient Calcium and Vitamin D (through diet and not the sun in order to protect your skin!) are foundational for good bone health. Topical solutions include Solaana MD Healthy Base Layer, which is a Vitamin D enriched cream (available through our online store). Also important is a diet rich with fruits, vegetables and seafood in order to obtain sufficient Vitamins A, B, C, E, K, Potassium, Magnesium and Silica, which are all beneficial to both your skin and bones.

So as you embrace the Mediterranean diet and exercise regularly, you can be assured that you are simultaneously doing what’s best for your skin AND bones. Get your Vitamin D through your diet and supplements and apply sunscreen regularly; you can even apply it while standing on one leg to continue multitasking!

 

 

 

 

Sources:

Brooks M. Skin wrinkles may provide a glimpse into Bone Health. Medscape. https://www.medscape.com/viewarticle/744027. Published July 25, 2020.

Office of the Surgeon General (US). Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville (MD): Office of the Surgeon General (US); 2004. Available from: https://www.ncbi.nlm.nih.gov/sites/books/NBK45513/

Sahni S, Mangano KM, McLean RR, Hannan MT, Kiel DP. Dietary approaches for bone health: Lessons from the Framingham Osteoporosis Study. Current Osteoporosis Reports. 2015;13(4):245-255. doi:10.1007/s11914-015-0272-1

Sakai A, Oshige T, Zenke Y, Yamanaka Y, Nagaishi H, Nakamura T. Unipedal standing exercise and hip bone mineral density in postmenopausal women: a randomized controlled trial. J Bone Miner Metab. 2010;28(1):42-8. doi: 10.1007/s00774-009-0100-8. Epub 2009 Jun 12. PMID: 19521657.

Sarafrazi N, Shepherd JA, Wambogo EA. Osteoporosis or low bone mass in older adults: United States, 2017-2018. NCHS Data Brief No 405. March 2021. doi:10.15620/cdc:103477 What women need to know. Bone Health & Osteoporosis Foundation. https://www.bonehealthandosteoporosis.org/preventing-fractures/general-facts/what-women-need-to-know/. Published February 24, 2022.

Do Personal Care Products Expire?

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cosmetic-expiration-dates

The life-changing magic of tidying up 

We all have too much stuff – in our closets, desks, basements and attics. Nobody wants to throw something away that might come in handy later. I’m no Marie Kondo (just ask anyone who has seen my desk!), but I can tell you that most of us keep personal care products far longer than they are safe and effective. 

Before you pack for your next vacation, look at what you have and discard everything that has expired. Make a habit of doing this regularly. Currently there are no U.S. laws requiring expiration dates on cosmetics.  However, the FDA holds cosmetic manufacturers responsible for ensuring the safety of their products and determining a product’s shelf life. Some manufacturers will include a Period After Opening (PAO) symbol printed on their cosmetic product. This is a tiny image of an open jar with a number on it that reflects the number of months a product is stable and safe for use after opening. Expiration dates and PAO are not synonymous.  An expiration date refers to the shelf life of a product in its “unopened” primary container when maintained under the conditions of storage indicated on the product’s label. 

Generally eye-area cosmetics tend to have shorter shelf lives due to the risk of serious eye infections, whereas lipsticks can be used longer. Most manufacturers recommend discarding mascara in 2-4 months because the wand can become contaminated. It is important to be aware that the PAO is a ”rule of thumb,” and that a product may expire sooner if it has not been properly stored (that tube of sunscreen that you forgot in your car becomes unstable in the heat and the cosmetics in the bathroom are exposed to harmful organisms). If a product looks different from when it was first opened, if there is any change in texture, color, smell or if the product begins to separate, it should be thrown out. Don’t try to rehydrate dried out or cracked products, just send them to the waste basket. 

Not all skin care products are regulated as cosmetics. Sunscreens and over-the-counter acne treatments are considered drugs under the law. The FDA requires that all drugs have expirations dates listed, unless testing has demonstrated the product will remain stable for at least three years. Therefore, if a sunscreen does not have a labeled expiration date, it should be considered expired three years after the date of purchase. When you buy sunscreen without a visible expiration date, write the date of purchase on it so you’ll know when to get rid of it. To maintain the quality of a sunscreen, it should be kept out of direct sunlight and excessive heat. Additionally, if the sunscreen’s consistency or color has changed since you first purchased it, discard it. Daily sunscreen use is proven to decrease your risk of skin cancers and skin precancers. Don’t rely on an old bottle of sunscreen to protect yourself. Your health depends on it! 

 

 

Source:

https://www.fda.gov/cosmetics/cosmetics-labeling/shelf-life-and-expiration-dating-cosmetics 

face mask skin care tips

Wearing a Mask and Caring for Your Face

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While taking walks in Chevy Chase and Georgetown these days, I see most people wearing a face covering.  It is reassuring, as wearing a mask is critical to keeping your family, friends, co-workers and yourself safe from coronavirus. With long-term wear, however, masks can sometimes cause or exacerbate painful and troubling skin conditions. In the past few months, we have seen a significant increase in:

  1. “Mask-ne,” or an acne breakout in the area under and around the mask,
  2. Dry, itchy skin in the same areas on the face,
  3. Redness and pain behind the ears, from the mask straps.

Since there is no question wearing a mask is the right thing to do, here are some tips on how you can manage these conditions while continuing to keep yourself covered.

START CLEAN – washing your face

Masks retain dirt and oil on the skin, so cleaning your face (and your mask) properly before you put one on is even more important.

  • If you suffer from acne, use a non-comedogenic cleanser (one formulated so as not to cause blocked pores) twice a day. Also, use a gel moisturizer and oil-free make-up.
  • Stop using make-up entirely until your skin heals, if you can.
  • For irritated or dry skin use a gentle cleanser.
CHOOSE THE RIGHT SKIN PRODUCTS – moisturize and mitigate irritation
  • Choose products that are fragrance-free.
  • Look for moisturizers containing ceramides, hyaluronic acid or dimethicone.
  • For acne, use a gel, non-comedogenic moisturizer.
  • If you must wear make-up and you have acne, use oil-free, mineral-based products.
  • If your skin is dry or irritated, stop using retinoids, glycolic acids, salicylic masks, peels and scrubs.
  • If your ears are telling you they need a break, try moisturizing behind them to ease redness and discomfort from the mask straps.
MASK TYPES AND ROUTINE – Not all masks are alike

What a mask is made of and how you wear it has an impact on your skin.

  • Wear a mask made of natural breathable cotton fabric. Avoid synthetic nylon, polyester or rayon that can irritate and cause breakouts.
  • Make sure your mask is snug at the edges, but not too tight on your face. A mask that moves around a lot can abrade your skin surface and exacerbate inflammation. Plus, it is more likely you’ll touch your face to adjust it.
  • Rotate wearing different strap types and ear loops in order to cause less irritation behind the ears.
  • Purchase masks with long straps, or strap extenders, that wrap about the back of your head so that the strap does not rest on sensitive skin behind the ears.
  • Take a mask break for 15 minutes every 4 hours when you are in a safe environment such as alone in your car or outdoors six feet away from people.
CARE FOR YOUR MASK, TOO

It is important to regularly clean your mask, so that it is as inoffensive to your skin as it can be.

  • Wash a cloth mask daily in hot, soapy water, and rinse well, unless otherwise specified.
  • When washing cloth masks, use fragrance-free, hypoallergenic soap or mild laundry detergent and skip the fabric softener.
  • If you do not hang your mask to dry, avoid scented dryer sheets as these frequently cause itchy, inflamed skin.
  • If you are using a disposable surgical-type mask, how often you should start a new one depends on how much you use it, if you wear makeup and your specific skin condition. If it is visibly dirty, it is time for a new one.

For DIY help, our online store contains products that will allow you to care for your face during this unique time (mohs-md.square.site).  If your mask-related skin problem does not resolve after a few weeks, prescription medication may help. Call our office to make an appointment.

3d illustration of a woman before and after acne treatment proce

Coping with Stress and Treating Acne

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By Cynthia H. Cameron, NP

Everyone is cooped up at home listening to dire news reports with limited access to many of the activities that help us reduce stress. There are no organized sports for teenagers, no going to the movies with friends, nor trips to the gym. Anxiety is a normal reaction to the conditions we’re all facing. All that stress takes a toll on our bodies, and the effects on our skin are readily visible.

The Relationship Between Stress and Acne

Both teenagers and adults can experience flares of acne as a result of stress. Research shows that in response to negative emotions, our bodies produce more hormones called androgens. These androgens stimulate oil glands and inflammatory cytokines which set the immune system into overdrive and trigger acne flare-ups.

Stress can also lead to repetitive behaviors such as skin picking or touching your face (which we need to avoid to reduce the risk of covid-19 infection). Squeezing pimples and skin picking can lead to infections and scarring which may worsen depression and anxiety.

Many people avoid socializing (even on Zoom!) when their acne flares, leading to further isolation. Studies show  that treating acne can boost mood and self-esteem.

Treating Acne through Telehealth

Over the past few weeks, I’ve seen an increase in severe acne in my telemedicine visits. The good news is that virtually everyone who is conscientious about using the medications and treatments we prescribe sees improvement after a relatively short period of time.

During my visit with a patient, which is performed on a secure HIPAA compliant platform, I take a complete health history, identify possible triggers and inquire about a patient’s diet. In doing so, I am better able to identify and recommend possible dietary changes that may help address the worsening of the patient’s acne. Patients who keep a food diary or record their food intake are often able to identify what foods tend to trigger breakouts.

Diet and Acne

There is also data to suggest that following a low-glycemic diet may reduce acne. Low-glycemic foods include most fresh vegetables, some fresh fruits, beans, and steel-cut oats. Check out these 8 principles of low-glycemic eating. It can also be helpful to minimize intake of sugar and processed carbohydrates and to consider discontinuation of whey protein supplements; milk (but not necessarily all dairy) can exacerbate acne in some individuals.

Tips for Treating Acne Breakouts

In addition to prescription medications that may be applied to the skin or sometimes taken orally, I recommend the following:

  • Wash your face twice a day and after sweating.
  • Use your fingertips to apply cleanser as washcloths and mesh sponges can irritate the skin.
  • Shampoo regularly. If your hair is oily, shampoo daily. Medicated shampoos can help too.
  • Don’t pop, pick or squeeze your acne, which can cause scars.
  • Don’t “spot treat” with your acne medicine. Apply a thin layer to the entire area in order to prevent new blemishes.
  • Use sunscreen that is designed for acne and labeled non-comedogenic or non-acnegenic.
  • If you have acne on the back, avoid using anything that rubs against your back, such as a backpack.
  • Bring all of your skin and hair care products to your televisit so we can review what might aggravate your acne.

Coping with Stress for our Health

When we are stressed, our self-care often takes a back seat. Our diet, sleep quality and quantity, and skin care regimen all play a role in our mental and physical health, including our skin.

During this difficult time, consider the following coping mechanisms:

Nobody needs to live with severe acne nor suffer from permanent scarring. With a combination of evidence-based dermatologic treatment, proper skin care and a healthy lifestyle, you can achieve clearer skin—even in the midst of a pandemic.

Click here to learn more about our telehealth platform and to request an appointment.

 

 

 

 

 

 

Exercising Your Skin

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Happy 2020! It’s a new year, a new decade, and a great time to cultivate habits that improve your health and well-being. If you’re like me, exercise is on your list of resolutions. There is tremendous evidence demonstrating the myriad benefits of physical activity: it’s vital for muscles, bone and cardiovascular system, improves mood and memory, decreases depression, helps with weight loss, increases energy levels and reduces risk of chronic disease.

And here is one more reason to add exercise to your list of resolutions: a healthy body translates into healthy skin.

Research shows that moderate exercise itself can act as an antioxidant[1]. Oxidative stress leads to chronic inflammation and collagen fragmentation, resulting in older looking skin[2].  Antioxidants help protect against these changes.

But did you know that exercising the skin itself might improve appearance? A Northwestern University study by Dr. Murad Alam studied the effects of at-home facial exercises. Women were trained by a certified instructor (www.happyfaceyoga.com) who specializes in resistance exercises for the muscles in the face.

The program, developed by Gary Sikorski of Providence, Rhode Island,  targets the muscles below the skin and fat layers in order to compensate for “age-related volume loss.” Blinded observers found that women who practiced 30 minute face yoga every day or every other day for 20 weeks had significant improvement in upper and lower cheek fullness[3]. The participants were consistently satisfied with their improvement.

This was a small study, limited to middle-aged women, and there was no control group. Nonetheless, it’s intriguing to consider that regular, specific facial exercises might increase muscle size and thus produce facial fullness. Exercising other parts of the body can tone and firm, why not on the face? All it takes is a little self-discipline. Probably easier said than done, but I’m going to give it a try!

 

 

 

 

 

[1] Gomez-Cabrera MC, Domenech E, Vina J “Moderate exercise is an antioxidant: upregulation of antioxidant genes by training.” Free Radic Biol Med 2008; 44 (2): 126-31.

[2] Kruk J, Duchnik E “Oxidative stress and skin diseases: possible role of physical activity.”  Asian Pac J Cancer Prev 2014: 15(2) 561-8.

[3] Alam MA, Walter AJ, Geisler A, Roongpisuthipong, W, Sikorski G, Tung R, Poon E “Association of Facial Exercise with Appearance of Aging.”.  JAMA Dermatol 2018: 154(3): 365-7.

Common Acne Myths

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There are many myths surrounding the causes and treatment of acne. Let’s look at what’s actually true.

Your diet has nothing to do with your acne.

FALSE. There is increasing scientific evidence to support a relationship between acne and diet. Specifically, foods that are highly processed, such as chips, crackers, and cakes, along with “high glycemic foods”, such as white bread, soda, candy, and juice, should be avoided in patients prone to acne.

In addition, certain dairy products may also exacerbate acne-prone skin. A recent study published in The Journal of the American Academy of Dermatology demonstrated that consumption of skim and low-fat milk—but not full-fat milk—was positively associated with worsening acne.

Acne-fighting diets should have plenty of anti-inflammatory foods, including fruits, vegetables, whole grains, legumes, fatty fish, and nuts. Of course, diet alone cannot completely eradicate acne, and should be combined with proven medical treatments to ensure clear skin.

Tanning improves acne.

MAYBE TRUE. While the sun’s rays can temporarily clear up acne, tanning is NOT recommended due to the harmful effects of UV rays on the skin.

However, certain light treatments available at home and in the dermatologist’s office can work to effectively treat acne without the risk of UV damage. Studies have shown that the colonization of the P. acnes bacteria that contributes to acne is reduced when exposed to concentrated amounts of blue or red light. This type of treatment, termed photodynamic therapy (PDT), may also reduce the need for oral medications, like antibiotics, which can lead to unwanted side effects. A typical PDT course consists of 8 weekly treatments. For more severe acne, a topical medication called aminolevulinc acid HCl may be applied prior to sitting in front of the light and can reduce the amount of treatments required to achieve acne clearance.

Acne only affects individuals in their teenage years.

FALSE. Most patients think they will grow out of acne as an adult, yet adult acne—defined as acne over the age of 25—is a common concern encountered by dermatologists. Adult-onset acne is particularly common in females, due to the fluctuation of hormone levels around the menstrual cycle, during pregnancy, perimenopause, and after discontinuing oral contraceptive pills. This type of acne may require specific medications to treat effectively, thus it is best managed by your dermatologist.

Vigorous cleansing will improve acne.

FALSE. In individuals with acne-prone skin, it is important to cleanse the skin twice daily to remove dirt and oils. However, over-cleansing the skin with harsh ingredients can actually trigger more inflammation, making acne worse. A gentle cleanser is best, along with ingredients such as fragrance-free moisturizers, that are not irritating to the skin. While it may seem counterintuitive in patients with oily skin, moisturizers are actually an important part of an acne treatment regimen, as they allow the skin to better tolerate topical acne medications.

Furthermore, when the skin becomes too dry, the body reacts by making more oil, which can clog the pores and lead to more breakouts. Balancing the skin’s natural barrier through gentle cleansing and noncomedogenic moisturizers is best to keep acne to a minimum.

Acne is caused by bacteria.

MAYBE TRUE. Most individuals believe acne is caused by an overgrowth of bacteria, but that is only one component of the pathophysiology of acne. Other causes of acne include inflammation, hormonal factors, and genetic susceptibility, all of which need to be treated in different ways. This is why multiple medications are often used to treat acne, and an acne treatment plan needs to be tailored to each individual.

Acne is not a serious health problem.

FALSE. Traditionally, acne has been thought of as purely cosmetic and not a serious health concern, however, studies have shown that acne can take a toll on patients’ mental health.

Research has revealed that acne can lead to depression, anxiety, and low self-esteem. Furthermore, stress has been shown to worsen acne, leading health professionals to struggle with determining whether a patient’s acne is causing his or her mental health problem or vice versa.

Our bodies respond to stress by producing more hormones (androgens), which can stimulate the oil glands and hair follicles in the skin, leading to more acne. Thus, for acne treatment to be effective, limiting stress and addressing the mental health of the patient is an important part of the treatment plan.

I can clear up acne using at-home treatments.

TRUE, but in-office treatments may be more effective. There are many effective over-the-counter products that can be used to treat acne, such as benzoyl peroxide, salicylic acid, and synthetic retinoids, like adapalene. However, if your acne has not cleared up with these treatments, it may be time to see your dermatologist.

A dermatologist can help tailor your treatment plan to your individual skin type and target specific causes of your acne. In addition, many in-office procedures have been shown to be very effective for managing acne. Chemical peels with ingredients like salicylic acid and retinol, help to reduce the number of new acne lesions as well as clear up the annoying post inflammatory redness acne leaves behind. These treatments are typically not covered by insurance and costs may vary.

Your hair has nothing to do with acne.

FALSE. Seborrheic dermatitis, or dandruff, is a skin condition that commonly overlaps with acne. It typically affects the areas of the body that are rich in oil glands, such as the face, scalp, chest, and back.

Symptoms include greasy scale along the forehead and around the nose, with scaling and itching of the scalp. Treating the hair with medicated shampoos containing ketoconazole, zinc, or sulfur several times a week can help improve the seborrheic dermatitis as well as clear up acne, and are also often an important part of the acne treatment plan.

Sunscreen can worsen acne due to clogged pores.

MAYBE TRUE. Certain chemical sunscreens can irritate the skin and worsen acne in susceptible individuals. However, physical sunscreens, such as those containing zinc oxide, can actually help acne due to their anti-inflammatory effects.

In addition, many sunscreens have other beneficial ingredients that have been shown to improve acne. For example, Elta MD UV clear sunscreen contains niacinamide and lactic acid, two acne-fighting ingredients that keep skin clear.  By carefully selecting a sunscreen, acne-prone patients can actually improve their skin while protecting it from the harmful rays of the sun.

If I have dry skin, I cannot get acne.

FALSE. Most individuals with acne have oily or combination skin, but that does not mean dry skin cannot be prone to breakouts. Dry skin can cause tiny breaks in the skin where bacteria can multiply, leading to inflammation.

Furthermore, the flaking associated with dry skin causes the pores to become clogged, leading to acne. Avoiding harsh, drying soaps and using moisturizers regularly can help to balance the skin and prevent acne in these individuals.

 

Visit a dermatologist who can help identify your skin type and put together a treatment plan for acne, customized for you. Click here to contact us for an appointment.

 

 

References

American Academy of Dermatology Association. Chemical peels: An overview. Retrieved from https://www.aad.org/cosmetic/younger-looking/chemical-peels-overview.

American Academy of Dermatology Association. Adult Acne. Retrieved from https://www.aad.org/adult-acne.

American Academy of Dermatology Association. Acne can affect more than your skin. Retrieved from https://aad.org/diseases/acne/acne-emotional-effects.

American Academy of Dermatology Association. Moisturizer: why you may need it if you have acne. Retrieved from https://www.aad.org/moisturizer.

Cerman, A., Aktas, E., Altunay, I., Arici, J., Tulunay, A., Ozturk, F. (2016). Dietary glycemic factors, insulin resistance, and adiponectin levels in acne vulgaris. Journal of the American Academy of Dermatology, 75(1), 155-162.

Gupta, M., Mahajan, V., Mehta, K., Chauhan, P. (2014). Zinc therapy in Dermatology: A review. Dermatology Research and Practice. Http://dx.doi.org/10.1155/2014/709152.

Ismail, N., Manaf, Z., Azizan, N. (2012). High glycemic load diet, milk, and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatology, 16(12), 13.

LaRosa, C., Quach, K., Koons, K., Kunselman, A., Zhu, J., Thiboutot, D., Zaenglein, A. (2016). Consumption of dairy in teenagers with acne. Journal of the American Academy of Dermatology, 75(2), 318-322.

Rosania, K., Mateja, L., & Weiss, M. Acne Overlaps. Retrieved from https://www.the-dermatologist.com/article/9046.

Singam, V., Rastogi, S., Patel, K., Lee, H., Silverberg, J. (2019). The mental health burden in acne vulgaris and rosacea: an analysis of the US National Inpatient Sample. Clinical and Experimental Dermatology, 44(7); 766-772.

Trending Now: Collagen Supplements for Anti-Aging

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If you read beauty blogs and magazines, chances are you have heard of the latest craze to hit the anti-aging market — collagen supplements. Collagen supplements claim to make the skin look younger, may help with brittle nails, and may even reduce the appearance of cellulite. But do they really work? We examined the current scientific literature to determine if collagen supplementation can transform your skin and make you look years younger.

What is collagen?

Collagen is the most abundant protein in the body and is responsible for the structure, stability, and strength of the underlying tissues. The deposition of collagen into the skin gradually decreases over time as the skin ages, but it can be accelerated due to photoaging from excessive sun exposure. Aside from aging, the biggest reason individuals are deficient in collagen is a poor diet. Consuming animal and vegetable sources that are protein-rich, such as beef, chicken, fish, beans, eggs, and dairy products can help ensure adequate intake of collagen.

The science:

Several limited studies have shown promising results in individuals taking collagen supplements for their skin. These studies have noted benefits in transepidermal water loss (skin hydration), skin elasticity, roughness, and wrinkles. Two separate studies showed a possible benefit of collagen supplementation in patients who have brittle nail syndrome as well as in women who suffer from moderate cellulite. Animal studies further revealed that administering collagen hydrolysates to mice for 6 months led to significantly increased collagen content and density of the skin.

Can I benefit from taking a collagen supplement?

If you are eating a healthy diet and feeding your body all of the nutrients it needs to make collagen, you probably do not need a supplement. However, as the body ages, you may no longer absorb or synthesize nutrients as efficiently as you used to. Taking a collagen supplement can make up for a deficiency if it is present. A 2017 study in the Journal of Agriculture and Food Chemistry showed that collagen hydrolysates can be transferred through the bloodstream directly to the skin, which explains the probable pathway for the beneficial effects of taking a supplement. However, some scientists postulate that the skin is a much lower priority to the body than major muscles, like the heart, diaphragm, and brain, where collagen will be distributed first. Therefore, only patients with a significant deficiency will likely benefit from taking collagen supplements. In addition, the cost and bulk of supplementation may be prohibitive for patients. Supplements in pill form require swallowing six a day to get a 6-gram dose. Powders are often double the price of pills, running from $15-$40 for a month’s supply.

Bottom line:

Limited studies on the benefits of collagen supplements have shown some promise, however, questions remain regarding which patients will benefit and how much collagen is actually absorbed into the skin. Cost and administration may be factors in compliance. It should be noted that for individuals who wish to add more collagen to their diet, bone broth—while not in hydrolysate form—offers six grams of collagen-rich protein and may be a tastier way to get your collagen fix.

 

 

References

  1. Jhawar, N., Wang, J. & Saedi, N. Oral collagen supplementation for skin aging: a fad of the future? Journal of Cosmetic Dermatology, August 14, 2019. https://doi.org/10.1111/jocd.13096
  2. Choi, F.D., Sung, C.T., Juhasz, M., Mesinkovska, N.A. Oral collagen supplementation: A systematic review of dermatological applications. Journal of Drugs in Dermatology. 2019; 18(1): 9-16.
  3. Vollmer, D.L., West, V.A., & Lephart, E.D. Enhancing skin health by oral administration of natural compounds and minerals with implications to the dermal microbiome. J. Mol. Sci.2018, 19(10), 3059.
  4. Hexsel, D., Zague, V., Schunck, M., Siega, C., Camozzato, F. & Oesser, S. Oral Supplementation with specific bioactive collagen peptides improves nail growth and reduces symptoms of brittle nails. Journal of Cosmetic Dermatology; August 2017, available online at: https://doi.org/10.1111/jocd.12393.
  5. Krieger, E. Collagen supplements show early promise for skin and joints, but don’t stock up yet. March 26, 2018, The Washington Post. Available online at: https://www.washingtonpost.com/lifestyle/wellness/collagen-supplements-show-early-promise-for-skin-nails-and-joints/2018/03/23/1cd480e2-27d6-11e8-bc72-077aa4dab9ef_story.html
  6. Schunck, M. Zague, V., Oesser, S., & Proksch, E. Dietary supplementation with specific collagen peptides has a body mass index-dependent beneficial effect on cellulite morphology. Journal of Medicinal Food. Dec 17, 2015: Available online at: https://doi.org/10.1089/jmf.2015.0022
  7. Cruel, J. Does drinking collagen supplements actually do anything for your skin? Self, August 22, 2017. Available online at: https://www.self.com/story/collagen-supplements.

Choosing the Right Sunscreen

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I love France! The food, the wine and …  the sunscreen! This week I’m writing about two of my favorite topics in one blog post: Sun Protection and the South of France!

The weather report from the outside world to us office-dwellers is that it’s been wonderful out there: sunny and not as humid as a typical Washington summer. That helps explain why I am being asked constantly for a recommendation for the best sunscreen. There is of course another reason for needing guidance: there are so many sunscreen options available. Standing in the aisle at CVS trying to pick the right one hasn’t been made any easier with the recent headline: “Sunscreen enters bloodstream after just one day of use, study says…”

That health alert was but a blip in the news cycle, but it was important and I am glad that my patients are still asking about it. The study, published in the medical journal JAMA, showed that four sunscreens when applied in maximal use scenarios (four times daily, on 75% of the body) resulted in measurable amounts of the chemical sunscreen agent passing through the skin to the bloodstream. It sounds alarming, but the study stopped short of looking at the health impact of the discovery and thus additional studies are underway. It’s important to note that all of the chemicals identified in the study are FDA-approved and have been in use for many years, without showing any harm. Likewise, there is strong evidence that regular sunscreen use helps reduce the risk of cancer and premature skin aging, so there is no justification for abandoning sun-safe behavior.

So, what should we slather on in the meantime?

Getting to that answer involves a quick look at the science behind how sunscreens work. There are two general classes of sun protection agents that differ in their method of action. SunSCREENS are those that rely on active chemical agents (with names like oxybenzone) that absorb harmful UV radiation and release its latent energy as heat on the skin surface. This was the class included in the study.

SunBLOCKS work entirely differently. They employ extremely fine-grained minerals, zinc oxide and titanium dioxide, to provide a physical barrier at the skin surface. These inert minerals reflect or scatter the radiation, preventing the rays from ever reaching the skin. In days past, they were the magic in the greasy white paint lifeguards smeared on their noses. Today, these minerals have been refined and formulated in to sheer creams, lotions and sprays that are invisible when worked in to the skin and pleasant to the touch.

Okay, let’s talk about France! 

American dermatologists and others interested in the topic have known for years that you can buy a much wider array of UV-stopping products in Europe. Why is that? This answer requires a brief look at government regulation. European consumer product rules are focused on the accuracy of manufacturers’ claims, which in the case of sunscreens and blocks is about their ability to stop or absorb UV rays. In the US, the Food and Drug Administration assesses manufacturers’ claims of efficacy. However, the FDA is concerned with potential toxicity of the same chemicals within the human body and environment, thus setting a higher bar of regulation. Meeting the FDA’s testing requirements takes considerable time for which many European manufacturers do not have the appetite. Several European brands have cleared this high bar, though, bringing a few sunscreen formulations to the US that have been used in Europe for years. In the meantime, there are many more choices available throughout Europe.

All this explains why on a recent sunny weekend in the south of France an American dermatologist (moi) was SLOWLY browsing a wide array of sun screen products in a charming pharmacy. Even for me, the process was daunting!

So at last, my best sun protection product advice: when reading a product label, be it in France or CVS, use sunblocks that rely on zinc oxide or titanium dioxide and have an SPF 30 or higher. These active ingredients have not been found to cross in to the blood stream, they are non-toxic, they stop UVA and UVB from reaching your skin and some formulations have become so sheer that you don’t even notice you have them on. These “physical” sunblocks are widely available. For years, my office has only carried sunscreens that have fewer chemicals and rely on non-reactive ingredients. If you are heading to the south of France or the south side of your neighborhood pool, you can pick them up on your next visit, or call and we can ship to you.

Blue lagoon

The Benefits of the Blue Lagoon

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Blue lagoon

If you haven’t been to Iceland yet, chances are you know at least a dozen people who have taken the short flight to Reykjavik and spent a few days among the volcanoes, glaciers and geysers.

Last year more than 2 million tourists went to the Island of Fire and Ice with many of them taking a mineral bath in the iconic Blue Lagoon. I hate to be a lemming, but I wanted to see what drove so many to this sparsely populated island and learn first-hand about the dermatologic potential of Iceland’s most famous destination.

I was surprised to discover that the Blue Lagoon is not one of Mother Nature’s best works, but a beautiful man-made spa utilizing naturally occurring geothermal energy in the form of super heated water extracted from a mile below the earth’s surface. It is an ingenious re-use of the excess water from an adjacent power plant. The water is a mix of fresh and seawater and, according to the spa website, the unique algae plants and high concentration of silica directly benefit the skin. They claim the anti-bacterial effects of silica improve psoriasis and eczema and that the mineral water prevents premature aging.

I had to try it, so we booked a day at the Blue Lagoon Retreat, touted as a “transformative journey into volcanic earth.” It’s definitely a transformative setting, with canals and pools of beautiful blue-white water snaking through volcanic cliffs, overlooking mountains and a starkly spectacular landscape. The experience is soothing and relaxing. Once I was able to pull myself out of the warm water I performed the signature “ritual” using scrubs of lava sand and salt, a cleansing silica mask and moisturizing algae oil. It was a sublime end to a memorable day.

Effects of Blue Lagoon Water

According to Icelandic dermatologist Jenna Huld Eysteinsdottir, research on the effects of the Blue Lagoon’s algae and silica on skin cells showed an increase in the genes that prevent skin aging. These were “in vitro” laboratory studies, however, and I am not aware of any that looked at actual patients. Additionally, there is a great deal of evidence that silica, the star ingredient in Blue Lagoon’s skin care line, is vital for healthy joints, skin, nails, teeth and bones. While it is less clear that applying large amounts of silica on the skin will result in reversal of aging, this pure white mineral is very effective in the absorption of oil and can have a positive role in masks for those with acne, eczema and psoriasis. It’s found in many cosmetic products because it improves the appearance of lines and pores, but as far as I know, only temporarily.

Seeking more “in vivo” evidence of the Blue Lagoon’s claims, I looked around at the Icelanders’ skin. With a population of a little more than 300,000 in a sea of tourists, spotting a native Icelander is almost as challenging as identifying one of the elves that are central to the Icelandic sagas and identity. There is no question though that most natives have exceptionally healthy skin – unlined and evenly pigmented. Lack of sunlight may play a role, however, as they live at a latitude with only 5 hours of daylight in winter.

Is the Blue Lagoon Worth it?

So, what’s the upshot? After a few hours of soaking and scrubbing in the ethereal waters of the Blue Lagoon I felt absolutely fantastic and renewed.  From a dermatologist’s perspective there is not yet enough science to support its skin anti-aging claims, but I would still recommend the experience, if only for the restorative powers to one’s psyche. There will be undoubtedly more data on the horizon, and I will be on the lookout. In the meantime, if you have the chance, check the Blue Lagoon out for yourself.

 

Takk Fyrir!