Daily Skin Fix

To the consternation of the tanning industry, dermatologists lecture you all the time about the medical and cosmetic dangers of tanning, especially indoor tanning. That is because UV exposure is the single most cosmetically damaging thing you can do to your skin, as well as the major cause of skin cancer. No matter what the tanning industry says.

I know you get tired of hearing it from me. Too bad. But, I am going to cut you some slack. I am going to let someone else lecture you. So listen to our guest blogger, Jourdan Miller, on some of the interesting recent findings that tanning is similar to drug addiction.

I am loaning her my bulletproof vest.

More than Skin Deep
by Jourdan Miller

The prototypical American beauty is typically portrayed as blonde, thin, tall and most importantly: tan. While achieving this California dime look may seem harmless, new research from The Archives of Dermatology reveal that tanning is another form of addiction and as physically detrimental as cocaine abuse.

New York Times author Tara Parker-Pope writes about these shocking findings in her article, Is Indoor Tanning Addictive? “In the study, 78 percent of the most frequent tanners said they had tried to cut down on indoor tanning but had been unable to,” Pope writes. “Frequent tanners reported missing scheduled plans because they had opted to use a tanning bed instead.”

Frequent exposure to UV light produces opioids in the brain, more commonly referred to as endorphins. Indoor tanners report feeling happy, calm and relaxed and brain scans prove that the body is at a heightened state of contentment, writes Parker.

Dermatologist Dr. Robert McDonald says he sees tanning addiction all too often in his patients.

“The problem is only getting worse as affluence increases,” McDonald said of this affliction. “People have more money so their going on beach vacations to [places like] Cancun.”

As the media glamorize beauty, they often make it synonymous with bronzed skin and a youthful, carefree attitude.  Unfortunately, such ideas have a damaging effect on health.

“The threat is so far removed people aren’t paying attention to it right now,” McDonald said. “It’s like saving for retirement, it’s something you should do but if you don’t you might be ok, it’s also like telling a 20 year old ‘you better stop smoking now or you might get cancer in 30 years’; it’s hard to see yourself down the road.”

The human brain responds to UV light and almost immediately a bio chemical reaction triggers an addictive response, McDonald says. With nearly 30 million Americans tanning indoors every year, the habit isn’t going anywhere soon.

“We have 20 times more melanoma than in the 1920s,” McDonald said about the increased frequency of skin cancer. “It’s the kind of thing that happens when you’re young, before 25. It a cycle between the beach and the tanning bed.”

UW-Madison student Kayla Gross’ bronzed-skin-bliss took taken a turn for the worse last May. After developing a strange growth on her leg, dermatologists confirmed that Gross had skin cancer.

“I loved the warmth. If I didn’t go I wouldn’t feel right,” Gross said when asked why she continued the unhealthy habit.

An avid tanner throughout high school, Gross tanned for 20 minutes every other day. No eye goggles, no sunscreen, and no worries.

“I used to say ‘skin cancer isn’t a big deal, they just cut it off and remove it.’” Gross said about her outlook on cancer in high school. “I’ve had basil cell three times now, and I have the scars to prove it.”

While Gross had a wake-up call early in life, many of America’s youth aren’t so lucky.

“There’s a long time before this goes away,” McDonald said. “It’s an addictive behavior that’s only going to get worse.”

Jourdan Miller is a student at the University of Wisconsin-Madison in the School of Journalism and Mass Communication. When she’s not reading the latest article on beauty, fitness or skincare, you’ll find her running along the lake and dining out at the trendy restaurants in Madison. 

 Check out her blog http://jourdanmiller.wordpress.com/

Skin Color Does Matter

Pigment problems are one of the most frustrating things that dermatologists and their patients deal with, and I know it first hand because I have been on both sides of the exam table. To continue with our previous discussion, Out, damn’d spot! Out, I say! Get Rid of Brown Spots on the Face, let’s recap:

There are 4 main kinds of increased skin pigmentation, or brown spot problems:

• Scattered pin-head to quarter size flat brown spots on face, neck, chest, forearms, and hands from sun damage
• Tan to dark brown flat or raised growths from aging or genetic influences
• Brown or red-brown discoloration of areas from past acne or injury
• Large dark flat patches of discoloration from hormonally induced melasma

And they are easiest to hardest to treat, in that order.

The key to doing the best you can with what you’ve got, is to know what you’ve got. To some degree, you inherit the skin you’ve got. The most obvious, and one that has caused problems since our ancestors left the savannah, is skin color. Skin color is primarily determined by the amount, kind, and distribution of protective melanin pigmentation. Racial groups who were adapted to live in the tropical belt, with stronger sunlight, developed more pigmentation to protect against early death from disseminated skin cancer. Those who migrated north where sunlight is much less intense, developed reduced amount of pigmentation, and some also developed abnormal, less functional melanin, manifesting as red hair and freckles on sun exposure.  Less pigmentation allowed increased UV penetration and adequate Vitamin D synthesis to prevent rickets. All well and good, until a red headed, freckled Irishman migrates over a couple of generations, from cloudy Northern Ireland to the sunny southwest United States and takes up ranching or farming. Or as I say to patients so frequently my nurses pull their hair out, “your skin should have stayed in Ireland.”

Other kinds of abnormal pigmentation are more common in groups who may have more natural pigmentation to provide sun protection. Those ugly brown growths called seborrehic keratosis occur in many ethnic groups, but are more common in some than others. Dark pigment after injury, acne or rashes is more common in those with more natural pigmentation. The scourge of the pigment world, melasma, occurs overwhelmingly in women and is more common in those with mid or deeper pigmentation.

So the first thing you need to do is look at your ethnic ancestry. The sun is stronger near the equator and progressively less strong as you more north and south away from the equator. Since natural skin pigmentation changes based on sun exposure take many generations, it is based on your ethnic background many generations past. So we are talking about areas that were inhabited in the distant past, thousands of years ago—the Old World not the New World. For instance, with the exception of Native Americans, those in the US would base it on the area from which your ancestors emigrated.  No, you don’t need to go on Ancestors.com. Most of us have a general idea from our family narrative. Before I get angry email responses that I am trying to start the racial argument, imply superiority of one racial background over another, or correct me on my very simplistic description of the major racial groups or names based on DNA analysis or historical evidence —just stop. I’m a dermatologist discussing this in regards to how your racial or ethnic ancestry affects your risk of pigment changes, how you can prevent it, and what to do about it. Because in this situation, skin color does matter. You can’t handle the truth? Bummer. Get over it.

In a very general sense, if your ancestry is predominantly:

• Celtic (i.e. Irish and Scots) you are at high risk for sun induced pigment, moderate risk of growths and melasma and low risk of post inflammation pigment
• Northwestern European, Germanic or northern Slavic (i.e. English, Scandinavian, German, French, north-west Russian) you have moderate risk of sun induced pigment, growths, post inflammation pigment, and melasma
• Southern European, Mediterranean, or southern Slavic (i.e. Italian, Spanish, Greek, southern Baltic, southern Russian) you have low risk for sun induced pigment, moderate risk for growths, post inflammation pigment and melasma
• Northern Asian (i.e. Japanese, northern Chinese, Korean) you have low-moderate risk of sun induced pigment, and moderate to high risk of growths, post inflammation pigment and melasma
• Equatorial African or Asian, Middle Eastern, Indic; Polynesian Pacific Islander; indigenous Northern, Central or Southern American (i.e. Northern African, Arabian, Persian, Turk, East Indian, Hawaiian, Malaysian, Pakistani, Vietnamese, Native American, Mexican)  you are at low risk of sun induced pigment, moderate risk of growths, and high risk of post inflammation pigment and melasma
• Equatorial or southern African, aboriginal Pacific Islanders—you are low risk of sun induced pigment, moderate-high risk of melasma and high risk of post inflammation pigment

Because humans have been traipsing all over the earth for centuries, mixing up the gene pool, many of us are of mixed ancestry. So in addition to looking at ancestry and to simplify things the Fitzpatrick Skin Type scale was developed. The Fitzpatrick skin type scale is based on your genetic skin disposition regarding how your skin responds to the sun. You can take the full Fitzpatrick Skin Type quiz, and get specific recommendations for your skin type at the Skin Cancer Foundation website. Here it is in summary:

When exposed to sunlight, do you:

• Always burn, never tan–you are Skin Type I
• Usually burn, tan lightly–you are Skin Type II
• Sometimes burn, tan moderately–you are Skin Type III
• Rarely burn, always tan–you are Skin Type IV
• Very rarely burn, tan easily and deeply–you are Skin Type V
• Never burn, always deeply pigmented–you are Skin Type VI

Again, in general:

• Skin Type I is at very high risk of sun induced pigment, moderate risk of growths and melasma, and low risk of post inflammatory pigment
• Skin Type II is at moderate to high risk of sun induced pigment, and moderate risk of growths, post inflammatory pigment and melasma
• Skin Type III is a moderate risk of sun induced pigment, growths, post inflammatory pigment and melasma
• Skin Type IV is at low risk sun induced pigment, moderate risk of growths, and high risk post inflammatory pigment and melasma
• Skin Type V is at low risk of sun induced pigment, moderate to high risk of growths, and high risk of post inflammatory pigment and melasma
• Skin Type VI is at low risk of sun induced pigment, moderate risk of growths, moderate-high risk of melasma and high risk of post inflammatory pigment

We all have different levels of natural pigmentation, and my experience has been that almost all of us are happy with what we have got. And that is good, since we can’t change it. But, with the possible exception of freckles, most of us want to be one uniform color. We don’t want darker spots, blotches or patches of pigmentation because they take the focus away from our natural beauty. When the eye focuses on spots, it distracts from the rest of our loveliness. And makes us look older, since in youth those spots don’t occur. Subconsciously we associate uniform skin color with youth, and blotches and spots with aging. Therefore, if we want to look as young as we can, we need to reduce irregular patches of pigment.

So next: we will start with how to fix spots, blotches and irregular pigment from sun damage

As promised here are my top three anti-aging choices for repairing sun damage:

1. Daily sunscreen, year round. I have been doing it every single day for 27 years. Do I need to refer you again to the previous post “Quit complaining and wear your damn sunscreen“?
2. Daily retinoid (tretinoin 0.05% cream) use. Again I have done this every single night for 27 years.
3. A series of IPL photorejuvenation treatments–usually 3-5. Gives a creamy complexion and is very effective in reducing the signs of aging sun damage.

An often overlooked area in sun damage protection and  treatment–the backs of hands, backs of forearms and the neck. Look at the sun exposed back of your forearm. Now flip it over and look at the sun protected inside. Do I need to say more?

So here is your bonus secret–Just treat the skin on the back of your forearms and hands and your neck exactly the same as your face, especially sunscreen every single day. Many people can only tolerate retinoids to these areas every other night because of dryness and irritation. So alternate tretinoin 0.05% cream (Refissa) one night and a peptide cream or lotion on the other nights. I use our fabulous peptide and antioxidant serum Line Diminisher every other night alternating with Refissa.

Most of us have had a lot of sun exposure over the years, either recreationally, occupationally or just here and there.  The sun powers all life on Earth, warms us, lets us see where we are going and cheers us up when we are down. Those are good things.  And a lot of fun activities are based outdoors, in the sun. But, like many fun activities, sooner or later there is a price to pay. With chronic sun exposure the price is premature aging, spots, wrinkles, sagging, rough skin, growths, pre-cancer and skin cancer.

There is a reason that human skin color is darker the closer the ancestral lands are to the equator–melanin is a barrier protecting against absorbing the sun’s energy which will damage  cellular DNA when the energy is absorbed.  People further from the equator had less need for this protection and needed to be able to produce enough vitamin D through sun exposure in parts of the world where the sun was much less intense, for instance northern Europe.  Some people’s skin is naturally more sensitive to daily sun exposure, especially redheads (who have a less functional kind of melanin) and those of Celtic backgrounds. The trouble comes when you take a person whose skin is adapted for northern Europe, say Ireland or Scotland, and move them to the sunny southwestern U.S. where native skin has a lot of pigment as protection.  As I tell my patients “your skin should have stayed in Ireland”.

We all have our natural level of pigment; our natural skin color at baseline. But when your skin darkens from the sun, that is in response to injury. Your skin will try to protect you the best it can. It is just that sometimes its best is not very good. And in absorbing the energy it is damaged. It’s all a matter of how much.

• The absorbed energy damages elastic and collagen fibers causing sagging, loss of elasticity and wrinkles.
• The broken elastic fibers give a yellowish bumpy surface called elastosis.
• The walls of tiny blood vessels are damaged causing broken and abnormal new veins and redness.
• The outer layer of skin, the epidermis, gets thickened and rough as damaged cells grow in a less orderly fashion.
• Pores get larger as the elastic fibers holding them closed are broken.
• Normal cell turnover is reduced, leading to dull skin.
• Irregular brown pigment and growths develop.
• The rough areas get worse as the degree of pre-cancerous changes advance.
• In some areas the cellular DNA may be damaged enough to develop into skin cancer.

Sounds delightful doesn’t it? And we have to deal with the fact that there is many years lag period between when we had the fun and when we pay the piper. I have many patients who have started to moderate their sun exposure when they start to see the damage but are dismayed that they continue to see new problems crop up. However, the very first step when we are in a hole is to stop digging. So read my previous post  “Quit complaining and wear your damn sunscreen” .  And put down the shovel.

Yes, it was fun; now the bill is due. So how are we going pay that bill?

Next time–Anti-Aging Skin Rejuvenation Plan Step #1–Repair Sun Damage

• Skin Care
• Prescription Retinoids
• Chemical Peels
• Lesion Destruction
• SilkPeel
• GentleWaves LED
• IPL
• Fraxel

DCL Super Sheer Sunscreen

Labor Day marks the end of the summer fun and the beginning of fall responsibilities. This seems like an appropriate time for me to begin belaboring the obvious point–protect your skin from the sun. I am a dermatologist. You came to my blog. This should come as no surprise. There is a reason dermatologists nag at you about sun exposure. Not only is there overwhelming scientific evidence about the dangers of unprotected sun (like unprotected sex), but the throughout the course of our careers we see firsthand the unpleasant effects–wrinkles, saggy skin, spots, roughness, crepe-like skin, dilated blood vessels, large pores, cobblestoning, cysts, and ultimately skin cancer.

I know you have heard all of this before. Some of you even believe me. Some of you are trying to protect yourselves. Recent studies have shown that fear of wrinkles outweighs fear of skin cancer in leading people to reduce sun exposure. I can’t tell you how many times I see a person who looks 20 or more years older than they need to look. And it is almost always due to chronic, day to day sun exposure. And those who smoke and do sun have more than double the damage.

You don’t like sunscreen. I know. You think it is greasy. I know. It smells like sunscreen. I know. The kids hate it. I know. Wear it anyway. Use clothing as protection. Don’t try to tan. Be reasonable.

There are sunscreens that are actually quite nice. Surprise– we sell one. Try DCL-Super-Sheer-Sunscreen-SPF-50. We chose it because it is quite nice, non-sticky. You won’t be able to tell you have it on.

Here is the rundown :

• Avoid sun between 10-4.
• Stay in the shade whenever possible and keep infants under 6 months of age out of the sun. Infants’ temperature regulation ability is inadequate. Sunscreen will absorb through their thin, permeable skin. So keep them in the shade.
• Wear protective clothing-long-sleeve shirt, wide brimmed hat, pants, and UV protective sunglasses.
• Anyone over the age of 6 months should use a broad-spectrum sunscreen with a sun protection factor (SPF) of at least 30 that protects against both of the sun’s harmful ultraviolet rays:  UVA and UVB.
• Look for Zinc Oxide, Titanium Dioxide, Avobenzone or Mexoryl.
• Apply enough-one ounce to whole body. Put on twice the amount you think you need. That means a 6 oz tube should last 6 applications, not 6 years.
• Apply 30 minutes before sun exposure.
• Sunscreen effectiveness is reduced after about 2 hours. Reapply every 2 hours for regular sunscreen, every hour if in the water or toweling off.
• Use a waterproof sunscreen when you swim outdoors.
• Don’t keep it in your car. Sunscreen breaks down in the heat. When it turns to a liquid mess, throw it away.
• Make up with SPF less than 15 is not adequate.
• No sunscreen screens out all rays, you cannot use it as an excuse to stay out longer.
• Realize that an SPF 30 does not give twice the protection of SPF 15.  SPF 15 absorbs 93 percent of the sun burning rays, and SPF 30 has 97 percent absorption. SPF doesn’t measure UVA protection.
• Take special precautions when the National Weather Service’s daily ultraviolet (UV) radiation index predicts UV exposure levels of moderate and above (5 – 10+) or near surfaces that reflect the sun’s rays, such as water, snow and sand.  Whenever possible, stay inside or in the shade.  Use a high-SPF sunscreen.
• If there are any changes in the size, color, shape, or texture of a mole, the development of a new mole, any crusted, bleeding, scaly, “pearly”, or red bumps, or any other unusual changes in the skin, see your dermatologist immediately.

The bottom line is that you won’t regret it. Especially when you look 10 years younger than your best friend. So quit complaining and wear your damn sunscreen.

Elaine Cook MD

Welcome to the SkinTreatment.com blog, opinions and observations of board certified cosmetic dermatologist and creator of  Dr Elaine’s Advanced Skin Treatment skin care line, Elaine Cook M.D.  I’ve been specializing in Dermatology for 27 years, the last 15 of which have been devoted to the practice of cosmetic dermatology, the development of my own skin care  line, and running SkinTreatment.com. This blog represents the summation of the knowledge and experience I have gathered over the years seeing countless patients and developing multiple prototypes for our skin care products. Some of the medical stories happen over and over again, some are more unusual. Some are purely cosmetic. Some are symptoms of underlying medical disease. All are important. All affect peoples lives.

I plan on discussing a variety of topics. Among them: the so-called “cosmetic” skin problems–acne, melasma, rosacea, aging skin, wrinkles, spider veins, cellulite, stretch marks, hair loss, age spots, sun spots, discoloration and more. I will also discuss the cosmetic procedures used to remedy these problems: Botox, Juvederm, Restylane, Sculptra, Laser, Fraxel  Laser, Intense Pulse Light Photorejuvenation (IPL), Thermage, Therma-Frax (also called Fraxage), Sclerotherapy, Chemical
Peels and the various other light-based treatments such as LED and blue light. Finally, I will be using my understanding of the skin in health and disease and my experience developing my own skin care line as a basis to discuss anything and everything about skin care products.

Basically, I will be discussing whatever I want on any given day.