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Wednesday, October 23rd, 2013
During a chemical peel, chemical solutions of varying strengths are carefully brushed onto the skin. The chemicals remove skin cells
on the surface of the skin and stimulate the production of new skin cells below. This leaves the skin smoother, less wrinkled, and more youthful in appearance.
Chemical peels can be used effectively for a wide range of skin conditions including:
â€¢Fine lines and wrinkles
â€¢Shallow acne scars
Chemical peeling can be performed on the face, neck, chest, hands, arms, or legs. It is most effective at changing the appearance on the surface of the skin. Effects of aging in deeper tissues, such as drooping eyelids and loose skin below the chin, must be treated with other procedures.
Chemical peels are categorized by how deeply the chemicals penetrate the skin: superficial, medium, or deep. Superficial peels use mild chemicals, such as alpha-hydroxy acids, which penetrate only the uppermost layer of the epidermis. Medium and deep peels use stronger agents.
A superficial chemical peel is usually sufficient to treat fine lines and wrinkles around the eyes and mouth. These may be referred to as “lunchtime peels”. Patients with minimal skin damage often respond best to a series of superficial peels combined with a skin care regimen, including topical retinoids and daily sunscreen use.
A medium-depth peel is more effective for patients with moderate skin damage, including age spots, freckles, and actinic keratoses. It may be combined with another treatment such as laser resurfacing for maximum effectiveness.
Deep chemical peels may require bandages to be applied for 1-3 days following treatment. In addition, ointments and creams may be
recommended to keep the skin moist. Cosmetics can be applied after about two weeks.
During treatment, most patients experience a warm sensation for about ten minutes, followed by some stinging. Anesthesia may be recommended for deep peels.
In general, the deeper the peel, the longer the recovery.Â A superficial peel produces redness similar to mild sunburn and lasts 3 to 5 days. Medium or deep peels can make the skin look severely burned, sometimes with blistering and peeling for 7 to 14 days. You may be prescribed pain relievers to reduce the discomfort following a deep peel.
Following a treatment, treat your skin gently. Avoid sun exposure because the renewed skin will be tender and susceptible to injury.
Following a chemical peel, your new skin will be tighter, smoother, and perhaps slightly lighter in color than before surgery.
Reviewed and approved by: Valorie Hammock
Monday, September 2nd, 2013
In continuation of our most recent topic on Psoriasis Basics, here is the third article in our series.
Although the cause of a particular outbreak may not be known, some common psoriasis triggers have been identified, including:
- Infection, such as strep throat or staphylococcus (including MRSA)
- Medications, including lithium, beta blockers, and anti-malarial drugs
- Skin injury, including bruises, chafing from tight clothing, shaving, tattoos, vaccinations, or sunburn
- Other skin conditions, such as scabies, blisters, boils, and dermatitis
- Weather that dries the skin, such as cold winter days and indoor heating or cooling
- Hormones, such as the surges that occur after puberty and during pregnancy
- Smoking and excessive drinking
- Other medical conditions that are under poor control, such as diabetes or obesity
Psoriasis Skin Care and Flare Prevention
These steps can ease the discomfort of psoriasis and help minimize flare-ups:
- Identify and avoid triggers. If you’re not sure exactly what your triggers are, consider keeping a diary for a couple months.
- Limit alcohol consumption. Because heavy drinking can trigger psoriasis and interfere with certain medications (methotrexate and others), use alcohol in moderation, or avoid it altogether.
- Take care of your skin.
- Moisturizers help lock in your skin’s own moisture. Use them regularly, particularly after bathing.
- Avoid scratching itchy skin. Cold compresses, topical steroids, menthol-based ointments, and oatmeal baths can curb the itch.
- Bathe in warm (not hot) water, keep showers or baths short, and use fragrance-free cleansers. Gently pat-dry skin instead of rubbing it.
- Do not pick at lesions.
- Protect your skin from the sun during PUVA therapy or if you’re taking retinoids (Soriatane(r) or Tazorac(r)).
- Choose cotton clothing over synthetic materials, which can irritate or overheat the skin.
- Protect your skin in the winter. Step up moisturizing efforts and use a humidifier.
Take care of your whole self. To keep your immune system calm and less likely to trigger skin cell overgrowth, follow the basics of good health.
Get enough sleep, eat a balanced diet, maintain an exercise regimen appropriate to your overall health and drink plenty of water. Importantly, avoid cigarette smoking, which can be a psoriasis trigger and overall health hazard.ã€€ If you have known health issues, such as diabetes, do your best to keep them under control.
Reduce stress. Stress is a trigger for many people with psoriasis. While there’s no way to eliminate stress altogether, there are many ways to manage it, such as meditation, counseling, or exercise. For managing the stress of psoriasis itself, consider joining a support group.ã€€ As always, if you have any specific physical conditions that behave as outlined over the past three posts, please call our office for an appointment right away and we will be glad to evaluate it for you.
By: Jonathan S. Weiss, M.D.
Monday, August 26th, 2013
- Topical medications applied to the skin, including corticosteroids, topical retinoids and vitamin D derivatives
- Oral medications, such as acitretin (Soriatane(r)), cyclosporine and methotrexate.
- Phototherapy and UV lasers
- A new class of medications called “biologics”, including Humira(r), Enbrel(r), Remicade(r), and Stelara(r).
- Type of psoriasis
- Location (scalp, trunk, hands feet, etc.)
- Severity of psoriasis
- Results of previous treatments
- Ease or convenience of a treatment
- Possible side effects
By: Jonathan S. Weiss, M.D.
Monday, August 19th, 2013
- Plaque psoriasis appears as thickened, red scaly lesions called plaques. This is the most common type of psoriasis.
- Guttate psoriasis appears as small, drop-shaped spots on the trunk, limbs, and scalp. This is often triggered by bacterial infections, such as strep throat.
- Inverse psoriasis appears as smooth, red patches in the folds of skin near the genitals, breasts, or armpits.
- Erythrodermic psoriasis appears as a scaly, red, peeling rash that afflicts the entire body. This is an uncommon form.
- Pustular psoriasis appears as pus-filled blisters that can be widespread or localized to the hands or feet. Also uncommon.
Monday, August 12th, 2013
- Irritants-These are substances that contact the skin directly, causing redness and inflammation. They include wool or other synthetic fabrics, soaps and detergents, perfumes and makeup, cigarette smoke, and chemicals (such as chlorine).
- Allergens-Allergens are more indirect triggers, where the skin becomes inflamed and itchy because of an allergic reaction, such as from pollen, mold, or animal and pet dander.
- Stress-While stress isn’t a known cause of atopic dermatitis, it can aggravate flare-ups.
- Temperature-Many people with atopic dermatitis have chronically dry skin that is sensitive to certain climate conditions, such as cold winter weather, indoor heating, or warm baths. Humid environments, such as a sauna, may cause sweating that could trigger a flare-up.
- The person’s age
- The location of the rash (face vs. knee)
- The severity of the flare
- Acute vs. chronic (long-lasting symptoms may require more potent medications)
- Results of past treatments
- Personal preferences
- Topical corticosteroids. Mild to mid-potency corticosteroids are applied to the skin on a short-term basis to bring the flare under control
- Calcineurin inhibitors (Elidel(r), Protopic(r)). Calcineurin inhbitors are non-steroidal medications may be used as an alternative to corticosteroids or in between use of corticosteroids. They too help to reduce inflammation.
- Antihistamines (Benadryl(r), Claritin(r), Xyzal(r), Zyrtec(r)). Antihistamines help to reduce the itching and scratching that can prevent the skin from healing
- Antibiotics. These may be prescribed to treat an underlying bacterial infection of the skin that can be worsening symptoms of atopic dermatitis.
- Oral corticosteroids (prednisone). These may be used to bring severe cases of atopic dermatitis under control quickly. Due to the wide variety of side effects caused by oral corticosteroids, they are generally prescribed for only a few days.
- Immunosuppressants (cyclosporine). These may be considered for severe cases of atopic dermatitis that do not respond to other treatments.
Monday, August 5th, 2013
Atopic dermatitis (AD) is a chronic skin disorder that causes dry, itching, and inflamed skin. The rash of atopic dermatitis comes and goes.
The term eczema is sometimes used to describe atopic dermatitis. Eczema refers to inflamed, itching skin from a variety of causes. Atopic dermatitis is the most common type of eczema.
Atopic dermatitis is very common, affecting 10-15% of people. The severe itching and irritation during flare-ups can be extremely bothersome. The resulting scratching can result in raw skin and skin infections.
Fortunately, most cases of atopic dermatitis respond well to treatment.
What are the symptoms of atopic dermatitis?
The most obvious symptoms of atopic dermatitis are intense itching, along with red, dry skin that is sometimes scaly.
The worsening of atopic dermatitis symptoms is referred to as a “flare”. An atopic dermatitis flare can be triggered by a variety of factors (see below).
The appearance of atopic dermatitis varies tremendously from person to person. Most people with atopic dermatitis experience a short-term flare for a few weeks (acute), during which the skin looks red, raised, and cracked.
Between flares, the skin may appear normal or slightly dry. If the rash lasts a long time (chronic), the skin may start to change appearance, becoming thicker and darker. These patches of thickened skin take longer to respond to treatment.
The appearance of atopic dermatitis also tends to vary depending on the age of the person.
Atopic Dermatitis in Infants
Children less than one year old often have atopic dermatitis widely distributed over their body. The skin is usually dry, scaly, and red. The baby may scratch the skin, leading to scratch marks. The cheeks of infants are often the first place to be affected.
The diaper area is frequently spared because the moisture retained by the diapers prevents the skin from drying.
Atopic Dermatitis in Toddlers
As children reach 2 to 3 years old, atopic dermatitis becomes more localized to areas such as the outer part of the joint, including the front of the knees, outside elbows, and top of the wrists. Older children are also more capable of a vigorous scratch, creating very red and inflamed areas.
Atopic Dermatitis in School-age Children
As children reach school age, atopic dermatitis tends to migrate to the part of the joint that flexes, such as the insides of the elbows and knees. atopic dermatitis may also start to appear on the eyelids, earlobes, neck, and scalp.
School-age children may develop itchy blisters on the fingers and feet known as dyshidrotic or vesicular dermatitis (pompholyx).
Atopic Dermatitis in Adults
Adults with atopic dermatitis tend to have the rash localized to specific areas, particularly the hands, feet, eyelids, back of the knees, and insides of the elbows. However, the skin elsewhere on the body may feel dry and prone to itching.
Atopic dermatitis that starts in infancy often improves by the time the child is 5 years old and usually resolves by the teenage years. However, many people endure atopic dermatitis and need to manage it throughout their lives.ã€€ Stay tuned as I will address the causes and treatments in next week’s post.
By: Kirk D. Saddler, M.D.
Monday, July 29th, 2013
Non-Ablative Laser Rejuvenation
. Laser rejuvenation with “non-ablative” lasers can work on the deep layers of the skin to stimulate collagen growth and tighten underlying skin to remove fine lines and wrinkles. There is also minimal downtime.
. Laser resurfacing with “ablative” lasers accurately removes the topmost layer of skin for the treatment of wrinkles, and deeper scars. Ablative lasers can also induce skin tightening and improve texture and tone. The CO2 laser and erbium:YAG laser are the â€˜traditionalâ€™ lasers used for laser resurfacing.
. Fractional lasers offer a new development in laser technology. They split (“fractionate”) the laser beam into millions of tiny dots. When the fractional laser is applied to the skin, each dot treats just a microscopic section of skin and is surrounded by untreated skin. The skin in the treated area develops new collagen for up to one year, leading to a fuller, more youthful appearance. The skin heals quickly with few complications because the surrounding untreated tissue supports the treated skin.
Intense pulsed light (IPL) (Photofacial)
Intense pulsed light (IPL) is a non-invasive treatment that uses high intensity pulses of visible light to treat a variety of skin conditions, including brown spots or freckling (hyperpigmentation) and facial redness (vascularity) associated with sun damage and rosacea. IPL may be referred to as a “photofacial” or “photorejuvenation”. Typically a minimum of three treatments are recommended at three week intervals to achieve optimal result
Laser light waves can be targeted to the deepest layers of the skin, resulting in skin contraction and tightening. This non-invasive approach can lead to gentle lifting of the face, brow, and cheeks without downtime.
Photodynamic Therapy (PDT)
Photodynamic therapy involves the application of a medicine to the skin that is left in place for a specified time. This helps to sensitize the skin to light. The area is then treated with blue light, IPL, or a laser. The procedure can provide a rejuvenated appearance and effectively treat early changes in the skin that may lead to skin cancer.
Some skin lesions, such as moles, scars, and benign skin growths, may be surgically removed (excised)
Choosing the Best Treatment
Your doctor will recommend a treatment best suited to your personal needs, desires, medical history and skin type.
In most cases, multiple procedures will be combined for the best possible outcome and long-lasting results.
In general, more mild treatments are recommended for those with minimal signs of aging or sun damage, and more aggressive treatments may be recommended for those with more advanced signs of aging or sun-damaged skin.
For instance, those with minimal signs of aging may achieve wonderful results with the use of only topical retinoids, microdermabrasion, superficial chemical peels, and/or Botox.
Those with moderate signs of aging may benefit from the addition of dermal fillers, medium-depth peels and/or IPL (photofacial).
Those with more significant signs of aging may benefit from the addition of ablative laser resurfacing and/or deep chemical peels.
BY: Valorie D. Hammock
Monday, July 22nd, 2013
If you are bothered by visible signs of aging, including wrinkles and age spots, there are a variety of treatment options that can provide a more youthful appearance.
Facial rejuvenation describes the various approaches that may be combined to provide a rejuvenated and healthy look.
Facial rejuvenation can be safely performed in the doctorâ€™s office with minimal if any downtime and can achieve the following cosmetic results:
Reduce the appearance of fine lines and wrinkles
Remove age spots, sun spots and other irregular blotches
Tighten loose skin
Treat damaged blood vessels
Improve overall skin texture, tone and color
Some medications, such as topical retinoids (Renova Â®, Refissa Â®, tretinoin), can be applied to the skin and reduce the appearance of fine lines and superficial wrinkles. They also provide a more balanced skin tone by reducing the appearance of pigmented areas. The benefits of other cosmetic procedures may last longer in those who take topical retinoids.
Topical retinoids of sufficient “strength” to provide visible benefits are available by prescription only.
Cosmeceuticals are skin care products that are available without a prescription. These have other active ingredients, such as glycolic acids, antioxidants and peptides. These too help to improve the texture and appearance of the skin.
(JuvedermÂ®, RadiesseÂ®, RestylaneÂ®)
Dermal fillers “plump” up the lines and furrow in the face, which smooths the skin and reduces the appearance of wrinkles.
(BotoxÂ®, DysportÂ®, XeominÂ®)
Botulinum toxin injections diminish lines and wrinkles associated with facial expression. Botulinum toxin (BotoxÂ®, DysportÂ®, XeominÂ®) is used to treat vertical lines between the eyebrows and on the bridge of the nose, forehead lines and furrows, and wrinkles around the eyes (“crow’s feet”). It may also be used to diminish the appearance of bands on the neck.
Microdermabrasion uses an abrasive instrument to mechanically rub away the topmost layer of skin (epidermis) to provide a rejuvenated appearance. Dermabrasion can be used to treat substantial scarring, discoloration, and sun damage. The results are generally very good and long-lasting.
Microdermabrasion uses small particles to gently “sand away” the topmost skin layer (to stimulate new skin growth. This non-invasive treatment requires no anesthetic, and involves no downtime. Multiple treatments every 2-3 weeks are usually recommended
Chemical peels use a chemical solution to remove the outer layers of skin and stimulate new skin growth. There are different strengths of chemical peels defined by the depth of skin penetration; superficial, medium or deep. Superficial peels, as the name suggests, are the mildest and are often referred to as “lunchtime peels”. The new skin that grows in response to a peel is smoother and less wrinkled, and has a more consistent texture and tone.
Chemical peels may produce reddening and peeling similar to a sunburn, which typically lasts a few days to several weeks, depending on the strength of the peel.
We will discuss Laser treatments in part 2, next week.
BY: Valorie D. Hammock
Monday, July 15th, 2013
Laser hair removal
Involves the removal of unwanted facial or body hair with laser light.
Lasers produce intense light that is absorbed by the pigment in hair called melanin. The melanin absorbs the light and heats up. This heat damages the hair follicle without hurting the surrounding tissue. The damaged hair follicle stops producing hair or replaces thick adult hair with a fine, light-colored hair (vellus hair).
Traditional hair removal methods, such as waxing, shaving, and plucking, remove only the hair shaft. This leaves the hair follicle in place to grow new hair. Electrolysis delivers an electrical current to each follicle that can lead to permanent hair removal. However, it is painful and slow and usually requires multiple treatments over months or years.
Laser hair removal is a safe, effective and convenient alternative to other methods. Lasers can treat large areas quickly, often in the time it takes to shave. Improvements may be seen after only one treatment, but repeat treatments are usually required to achieve desired results. After treatment, the area may appear to have slight swelling and feel like a mild sunburn. These side effects usually resolve within a couple of hours.
Factors that Influence Results
Results of laser hair removal depend on several factors, including:
â€”Lasers are most effective for dark hair. Light hair lacks sufficient melanin to absorb the light and heat up the hair follicle.
â€”Thicker hairs respond better than thinner hairs.
â€”Previously, only fair-skinned people could be treated with lasers for hair removal. Now dark-skinned individuals can also be treated, but gentler and more numerous treatments may be required to deliver the same results.
â€”Arms, legs, underarms, and hair in the bikini area respond best to treatment. Facial hair (chin and lip) tends to be more resistant.
People of all skin colors and hair types will benefit from some delayed hair re-growth for as long as 6 months after one treatment. However, because not all hair follicles are active at the same time, multiple treatments are usually needed to remove all hair from each area. Most people require 3â€“6 treatments, 4 to 6 weeks apart. After the initial round of treatments, your doctor may recommend maintenance treatments once or twice per year.
BY: Valorie D. Hammock
Monday, July 8th, 2013
The exact cause of spider veins is still unclear but several factors can influence the onset. Such factors include: family history, hormonal changes, such as puberty and pregnancy, leg injury, prolonged standing, and being overweight. Birth control pills, or hormone replacement therapy also may trigger them. Spider veins arise more often in women because the female hormones are involved in their growth. Spider veins on the nose or cheeks may be triggered by excessive sun exposure. Sun protections is important to limit the number of spider veins on the face.
Let us know if you would like a consult to have any questions or concerns addressed related to spider veins.