Monday, January 14, 2013

Acne- facts, treatment and myths

What causes acne?

Acne vulgaris also known as acne, zit, pimples is a very common skin disorder, affecting 40-50 million people each year in the US alone. Although acne is considered a disease of youth or teenagers, it can affect people well into adulthood. In a recent survey-based study, 35% of women and 20% of men reported having acne in their 30s, while 26% of women and 12% of men were still affected in their 40s.

The organ in the skin affected by acne is the pilosebaceous unit, this is the hair follicle and it's attached oil (sebum) producing gland called the sebaceous gland. On the skin surface, this is the pore that we see. Four main factors contribute to the development of acne:

1. Ever wonder why acne is so prevalent in teenagers or why you keep breaking out around your menstrual period? Here is the main reason. Increased sebum production: the oil produced by the sebaceous gland is called sebum. The activity of the sebaceous glands is controlled by hormones. When one reaches puberty, hormone production increases dramatically, also around the menstrual cycle (peri-menstrual), the production of certain hormones increase. 

2. The clogged pore. You might have suspected this as a cause of your acne, if so, great thought! On a molecular level, skin cells shed into the pores created by the pilosebaceous unit (hair follicle with its attached oil gland) and the cells are removed so the pores do not become clogged. In acne skin, the skin cells become sticky and are retained in the hair follicle. The sticky skin cells accumulate leading to a process called hyperkeratosis. The sebum and sticky cells continue to accumulate in the narrow pore until the pore ruptures and spills very irritating content into the surrounding skin, this results in inflammation. 

3. Inflammation: this is the way your body's immune cells respond to the content of the ruptured pore described above because the ruptured content is a "foreign substance" and does not belong in the skin. The action of the immune cells lead to what you see clinically. Whether you have a whitehead, blackhead, red acne bumps, tender cysts depends on the way your immune cells respond to content of the ruptured pore that contains accumulated sticky dead skin cells and sebum.

4. Propionibacterium acnes: these micro-organisms live deep within the pilosebaceous unit.
They release enzymes that contribute to pore rupture and stimulate the immune cells to promote inflammation.


Acne treatment

Effective acne treatment should target multiple contributing factors for a long-lasting effect. Combination topical antibiotic/benzoyl peroxide, topical retinoids, oral antibiotics, oral hormone modulators and Oral Isotretinoin are a few of the prescription medicines available in the U.S today. Visit your board-certified dermatologist to determine the best regimen for your acne.

Acne myths

1. Getting a tan will clear my acne: this is not true. Getting a tan may temporarily mask the redness of acne but it will not treat acne. Also, getting a tan increases the risk of premature aging and skin cancer. Always wear a "non-comedogenic" sunscreen with SPF 30 or above if you will be in sun.
2. Washing my face frequently will prevent acne: hygiene is not related to the development of acne. Washing your skin too frequently can irritate your skin and promote inflammation (acne causing factor #3 above). Use gentle cleanser to wash your skin and do not scrub your skin.
3. Popping my acne will make it go away quicker: this may cause the acne to get worse and lead to skin discoloration and scarring. Avoid picking or popping your acne. 
4. Avoid makeup if you have acne: it is okay to wear makeup that is labeled "non-comedogenic." Non-comedogenic means it has a much lower risk of causing acne breakout.
5. Use more acne medicines to prevent breakouts: When it comes to over-the-counter acne medication containing active ingredients such as benzoyl peroxide and salicylic acid, more isn't better. Using too much medication can worsen acne because it leads to dryness, irritation, and more blemishes.
6. Acne is caused by diet: Extensive scientific studies have not found a connection between diet and acne. In other words, food does not cause acne. Not chocolate. Not french fries. Not pizza. Nonetheless, some people insist that certain foods affect their acne. In that case, avoid those foods. Besides, eating a balanced diet always makes sense. However, according to the scientific evidence, if acne is being treated properly, there's no need to worry about your diet.
7. Acne is just a cosmetic disease. Yes, acne does affect the way people look and is not otherwise a serious threat to a person’s physical health. However, acne can result in permanent physical scars and acne can affect the way people feel about themselves.

Friday, November 30, 2012

7 effective ways of slowing the skin aging clock

There are so many creams and gadgets available today that promise youth. However, there are only a few treatments that have been shown in clinical studies to be safe and effective when performed by a board certified physician such as a board certified dermatologist. The recommendations here are primers to help you start the conversation about slowing the skin aging clock with your board certified dermatologist.

1. Sun protection: wear sun protective clothing (wide brimmed hat, sun glasses, Rash guard), broad spectrum sunscreen. No matter what your age is or how far along the skin aging process you are, you will benefit from making this simple change. It's never too late to start sun protection!

2. Retinoid creams: topical retinoid creams are derived from vitamin A and are available over-the-counter as Retinol. Prescription strength retinoids such as Retin-A, Differin are very effective in diminishing fine lines, wrinkles and blemishes. They also slow the skin aging process down at the molecular level by plumping up collagen in the skin. Prescription strength retinoids are much more effective that the over the counter Retinol. Visit your board certified dermatologist for a prescription of a retinoid cream.

3. Anti-oxidant cream: use a moisturizer with anti-oxidants such as vitamin C and vitamin E daily. New scientific research suggests that the combination of infrared and visible light causes about 10 to 20 percent of sun damage. Infrared radiation may also release free radicals and accelerates aging. While UV rays account for only 6.8 percent of solar light, infrared, which we mainly experience as the heat of the sun, makes up 54.3 percent (the rest, called "visible light," is what we see as the colors of the rainbow).

4. Chemical peels: excellent choice used to address mild fine lines and wrinkles and skin discoloration. Chemical peels remove the outer layers of the skin and encourage the growth of new, smoother, radiant skin with even complexion. Chemical peels can range from superficial, medium to deep peels. The benefits of superficial peels last for a few months, while results from deep peels can last several years. Your board certified dermatologist can discuss which chemical peel will be best for you.

5. Botox and Dysport: repetitive movement of muscles of facial expression cause lines and wrinkles. Injection of neuromodulators such as Botox or Dysport can relax the muscles and smooth out the appearance of lines and wrinkles.

6. Dermal fillers: injections of dermal fillers containing hyaluronic acid can add volume and smooth out wrinkles. Hyaluronic acid is a naturally occurring in the skin. Sun exposure, smoking can accelerate the breakdown of hyaluronic acid and lead to volume loss, fine lines and wrinkles.

7. Laser resurfacing: Laser resurfacing uses high-intensity light energy to improve the look of wrinkles and scars by tightening loose skin. The benefits of laser resurfacing usually last between two and five years or longer provided you follow the skin rejuvenation regimen prescribed to you by your board certified dermatologist.

Join me again next week as I discuss another interesting topic in this series.

Thursday, November 22, 2012

Turning back the clock on skin aging

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Turning back the clock on skin aging series

This is a weekly series that focuses on skin aging prevention and treatment. Today's post will provide an overview of the process of skin aging.

While aging is inevitable, the process can be slowed down tremendously with key modifications to one’s lifestyle. There are two forms of aging, intrinsic aging and extrinsic aging.

Intrinsic aging: this is the natural aging process, we are all genetically programmed to undergo intrinsic aging! Intrinsic aging begins in the mid to late 20’s, although one does not manifest the signs of intrinsic aging for decades. Therefore, the earlier we begin to incorporate anti-aging regimens and practices in our daily routine, the better. Some of the changes that occur at the cellular level are: reduction in the production of skin collagen and hyaluronic acid leading to volume loss, reduced coil action of skin elastin and elastic fibers leading to skin sagging and permanently etched skin lines, reduction in skin cell turnover and skin shedding (exfoliation) rate leading to complexion and texture problems.

Intrinsic aging eventually manifests as:
  • Fine lines and wrinkles
  • Thin and transparent skin
  • Loss of skin volume, leading to hollowed cheeks, temples and eye sockets as well as noticeable loss of firmness on the hands and neck
  • Bones shrink away from the skin due to bone loss, which causes sagging skin of cheeks and jowls
  • Dry skin that may itch
  • Graying hair that eventually turns white
  • Hair loss
  • Unwanted hair
  • Nail plate thins, the half moons disappear, and ridges develops

Extrinsic aging is caused by external factors that accelerate the aging process e.g. ultra-violet radiation, cigarette smoking, air pollution, poor diet, gravity, sleeping positions, and repetitive facial expressions.

Ultraviolet radiation is by far the most important factor in this category. Repeated sun exposure leads to DNA damage in the skin, breaks down skin collagen and elastic fibers and impairs the production of new collagen. Over time, the skin loses volume and elasticity and DNA damage accumulates leading to loose, wrinkled and leathery skin. The following skin changes are linked to ultraviolet radiation: freckles, age spots, spider veins on the face, rough and leathery skin, wrinkles, loose skin, a blotchy complexion, actinic keratoses, and skin cancer.

Check out this image published in a recent issue of the New England Journal of Medicine



This unidentified 69-year-old trucker (pictured above) was on the road for 28 years and accumulated lots of exposure to ultraviolet A (UVA) radiation. The man's skin gradually thickened over the past 25 years, leading to a condition called unilateral dermatoheliosis. Note that the condition is worse on the left side of the face, consistent with sun exposure though window glass on the driver side.

Cigarette smoking causes biochemical changes in our bodies that accelerate aging. The nicotine in cigarettes causes narrowing of the blood vessels in the skin, causing impaired blood flow, oxygen and nutrient delivery to the skin. The chemicals in tobacco smoke also damage collagen and elastin. Repeated facial expression (pursing one's lips when inhaling) and exposure to the heat from burning cigarettes contribute to wrinkles.

Poor diet: diet low in vitamin A, C can impair skin cell turnover and skin collagen formation respectively. Vitamin D and Calcium is required to prevent facial bone loss (cheek bones, jaw bone). Facial bone loss can promote sagging of the skin. A diet rich in antioxidants reduces oxidative damage to the DNA from free radicals.

Facial Expressions: repetitive facial movements lead to fine lines and wrinkles. If you perform facial exercises, stop. As skin ages and loses its elasticity, the skin stops springing back to its line-free state, and the grooves made by repetitive movements become permanently etched on the face as fine lines and wrinkles.

Gravity: as the skin loses volume and underlying facial bone loss occurs, gravity pulls the skin downward causing the tip of the nose to droop, the ears to elongate, the eyelids to fall, jowls to form. Overall leading to the feeling that ”one’s face is falling”

Sleeping positions: resting your face on the pillow in the same way every night for years also leads to wrinkles called sleep lines. Sleep lines eventually become etched permanently on the skin. Women, who tend to sleep on their sides, are most likely to see these lines appear on their chin and cheeks. Men tend to notice these lines on the forehead since they usually sleep with the face pressed face down on the pillow. People who sleep on their backs do not develop these wrinkles.

Antiaging recommendation
1.     Sun protection is key
a.     Stay out of the sun between 10:00 a.m. and 4:00 p.m., when the sun’s rays are the strongest.
b.     Wear protective clothing, such as a wide-brimmed hat and long sleeves, when outdoors during the day.
c.      Apply sunscreen year round. Sunscreen should be broad spectrum (offers UVA and UVB protection) and have a Sun Protection Factor (SPF) of 30 or higher. Sunscreen should be applied 20 minutes before going outdoors to all skin that will be exposed. It should be reapplied after sweating or being in water.
d.     Avoid tanning parlors and devices
2.     If you smoke, quit
3.     Eat a balanced diet rich in vitamins and mineral. Vitamin C is essential for collagen production, calcium and Vitamin D is essential to prevent bone loss
4.     Visit your board certified dermatologist to discuss treatment regimens that are best suited to your skin needs
5.     Wear moisturizers with antioxidants (Vitamin C & E)
6.     If you are bothered by visible signs of aging, speak to your board certified dermatologist about the various treatment options available. There are many minimally invasive treatment options with virtually no downtime that can be used to treat signs of aging. Some examples are injectable fillers (Juvederm, Restylane, Belotero, Radiesse, Sculptra) and neuromodulators (botulinum toxin). Laser and IPL devices, radiofrequency  devices , chemical peels, can promote a more youthful appearance.

Join me next week as I blog about another interesting topic in this series.
Thank you.