Daily Skin Fix

How To Use Retinoids Without Your Face Peeling Off

As many of you know, I am a strong advocate of daily retinoid use for most patients to prevent aging and correct existing damage. There is so much proven scientific data behind them that they are still the gold standard in topical anti-aging treatment. I have been using prescription retinoids and daily sunscreen for 25 years. If you come to see me as a patient, I will likely recommend that you start one of them as part of your anti-aging skin care program. And, of course, if I recommend it, you will do it.

Retinoids are vitamin A derivatives and include over-the-counter retinol, prescription Retin-A, Renova, Refissa, Tazorac, and Differin. Originally developed for acne, they were found to also increase collagen and elastic fiber production, diminish wrinkling, improve brown discoloration, and reduce both roughness and pore size. Retinoids can be applied to the face, neck, back of hands and forearms as these areas also show aging changes from chronic sun exposure.  Apply a pea size amount to each area on completely dry skin in the evening. Most people can only apply it to skin that is off the face every other night because of irritation.

The biggest drawback, and the reason people discontinue retinoids, is that early on they cause peeling and some redness, a process called retinization. The key to success is to use the right form and to use it correctly on a regular basis, not intermittently. Most people do it this way: they use the retinoid; they get dry and peel so they stop until it gets better and then start again. In the meantime the top layer of skin builds up, just in time to peel again when you restart treatment. That is the wrong way to do it. If you do it that way your skin never adjusts and you will keep peeling every time you start treatment again. If you use it regularly without starting and stopping, after about 2 months your skin will stop peeling. You may have occasional episodes of peeling after an environmental insult to the skin, but much of that can be prevented.

Most, but not all, people who have had problems using a retinoid are able to use it successfully if they do it the right way. I often start patients off every other or every third night and work up to every night, but consistently. You can start with the least irritating retinoid and move up to the more irritating product. Gels are more drying and irritating than creams. Refissa and Renova are the least irritating, then Differin, then Retin A, and finally Tazorac is the most irritating. On the other hand, Tazorac gives the most improvement in pore size and acne scars. Another strategy when you are starting treatment is to mix them with moisturizer to dilute them, apply moisturizer before application (if you are having redness, itching or irritation), or after (if you are just dry). And if you have an episode of dryness and peeling later in treatment, you can always dilute them again for a few days. Our Antioxidant Enzyme Peel is great for removing the peeling skin without abrasion.

Mild stinging, redness, peeling and flaking may occur during the first several months and on occasion. This is normal, soreness and irritation are not. Anything that you use on your skin that abrades the skin will cause more redness and peeling. The most common culprits are washcloths, synthetic cotton balls, makeup brushes, or a granular exfoliant. The infomercial technique of applying mineral powder in a circular scrubbing motion with a special brush is the most common cause retinoid intolerance in my clinic.

Discontinue retinoids 5-7 days before waxing, bleaching, peels, microdermabrasion, acne surgery, hair removal, and laser treatments or you will be sorry. If you wax an area that has been treated with a retinoid, strips of skin will come off with the wax when it is ripped off. Other procedures may burn the skin if you don’t stop retinoid use prior to the procedure. That is why the instructions we give with the prescription goes over this. If you didn’t read your instructions, and have an “unfortunate accident” start with a non-fragranced moisturizer and apply it 3-4 times a day to the area where the skin was ripped off.  I like Aquaphor, or Cetaphil cream. Don’t put any toner or active skin care products (glycolic acid, salicylic acid etc.) on it until it has healed. Don’t scrub or pick. As soon as the skin has healed, (pink, not open, crusted or oozing) wear broad spectrum UVA/UVB sunscreen with an SPF of 20 or higher every single day, whether you normally do or not. Avoid sun exposure over the next several months to help keep the area from darkening over time.

Retinoids do make you more sensitive to the sun and you should use sunscreen every day, year round or you are just undoing what you are trying to do. We used to tell patients that they could not use retinoids if they were in the sun, but now we know that, within reason, you may use them if you use sun protection. Of course, I know you are already wearing your sunscreen every day, because you know that it is an essential part of an anti-aging skin care program.  If you are going to the beach, lake, or skiing, discontinue retinoids for a few days before exposure.

To recap:

How to reduce peeling and irritation with Refissa, Retin A, Differin, Tazorac and retinol

• Use it on a consistent schedule—every day, every other day, every third day, not on and off. Work up to every day.

• Choose a cream not a gel.

• Start with Refissa unless you have oily skin and acne. Refissa is in a moisturizing base, is stronger than Renova, and usually the easiest to tolerate. I use Refissa.

• Apply moisturizer underneath to reduce redness and irritation.

• Apply moisturizer over retinoids to reduce dryness.

• Don’t use mineral powder with a brush, use a sponge.

• Don’t use a washcloth or granular exfoliant.

• Stop retinoids 5-7 days before waxing or laser hair removal, chemical peels.

• Wear sunscreen.

Retinoids are very effective as part of your anti-aging skin rejuvenation program. It is worth working with them to be able to use them successfully.

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How to Get Rid of Brown Spots on the Face

“Out, damn’d spot! Out, I say!”  Macbeth Act 5, scene 1

There are things that frustrate you. There are things that frustrate me. And then there is hyperpigmentation, the medical term for increased skin pigment. I can’t tell you the number of times patients have asked me in frustration–“Why can’t I get rid of these brown spots, I hate them! It can’t be so hard can it?”

Unfortunately, yes.

Melanin is the skin’s natural pigment that darkens to protect us from the sun’s skin cancer causing rays. Once sun exposure stops, skin lightens back to its natural color. At least, that’s what is supposed to happen. Damaged or abnormally functioning cells produce discoloration that does not fade. To some degree, the tendency to make abnormal pigment has a genetic basis tied to ethnic background. People with more natural pigment, such as Hispanic, Asian, American Indian, etc., respond to anything that injures or inflames the skin with increased pigmentation.

There are five triggers for abnormal pigmentation—sun exposure, inflammation, injury, hormones and aging. Each of the triggers results in a specific type of pigmentation, and each is more common among different types of patients. In medicine it’s always a good idea to start with an accurate diagnosis, before deciding on treatment and prognosis.  First, look in the mirror and see exactly what kind of pigment you want to improve.

From easiest to most difficult:

In the mirror: Scattered pin-head to quarter size flat brown spots on face, neck, chest, forearms, and hands.

• Diagnosis: Actinic damage from past sun exposure, most commonly in lighter skinned people.
• Treatment: Home skin care, prescription retinoid creams such as Retin A or Refissa, daily sun protection, Intense Pulsed Light (IPL),  GentleWaves, Fraxel Laser.
• Ease of treatment: Moderate.

In the mirror: Tan to dark brown flat or raised growths.

• Diagnosis: Seborrehic Keratosis (age spots), often familial, and more common with age.
• Treatment: First–physician evaluation to be sure they are benign, then destruction with liquid nitrogen, electric needle or Fraxel Laser.
• Ease of treatment: Moderate.

In the mirror: Brown or red-brown discoloration of areas with past acne or injury.

• Diagnosis: Post inflammatory hyperpigmentation (PIHP), most commonly occurring patients with more natural pigment.
• Treatment: Prevention by treatment of acne, not picking, and caution with procedures that can cause pigment such as chemical peels and laser hair removal. Treatment with home skin care, prescription skin bleach, prescription retinoid creams, and for some patients the very cautious use of chemical peels or microdermabrasion.
• Ease of treatment: Moderate—difficult.

In the mirror:  Large dark flat patches of discoloration, usually symmetrical, over cheeks, jawline, forehead and/or above upper lip. It is often more obvious in low light settings, such as at sunset.

• Diagnosis: Melasma or “mask of pregnancy,” is caused by a combination of hormones, predominantly estrogen from pregnancy or birth control, and sun exposure. Once it starts, melasma tends to reoccur very easily with minimal amounts of sun exposure, even if the hormonal trigger is removed.
• I divide melasma into two types: “relatively easy” and “hard.” The difference is dependent on how deep in the skin the pigmentation is found, and whether both the hormonal stimulation and sun exposure can be reduced. Deeper pigment is harder to improve.
• Treatment: Involves both removing the triggers, and using creams and procedures to reduce existing pigment. Daily, year round, broad spectrum sun protection and avoidance of sun exposure is absolutely essential. Reducing hormonal triggers is often a challenge as pregnancy eventually ends, but often the need for birth control continues. Even if the hormonal trigger is removed, the melasma remains “turned on” and even tiny amounts of sunlight cause it to reoccur. Treatment at home with skin lighteners, prescription skin bleaches, retinoid creams, and sunscreen, combined with in-office chemical peels or SilkPeel are tried first.  “Easy” melasma usually responds fairly well to this treatment. For more resistant cases, Intense Pulsed Light, laser, and deeper chemical peels under the supervision of a dermatologist experienced in treatment of pigment, are considered. Results are varied, and these procedures may actually make pigment worse.
• Ease of treatment: Difficult-very difficult.

Overall abnormal pigment, especially melasma, is one of the hardest and most frustrating skin problems that cosmetic dermatologists and their patients deal with. I know, since I have had it myself.

Though Lady Macbeth and I earned our spots in different ways, the frustration is the same.

Next: Let’s dive into the pigment pool in more depth

How to pick like a dermatologist

My lawyer won’t leave me alone unless I remind you of my medical-legal disclaimer so here goes, again:

Electronic message exchanges to, from, or with Dr. Cook do not constitute medical advice, an evaluation, or consultation and must not be considered a replacement or substitute for a formal evaluation in the office. Information and correspondence in this blog does not form and will not result in a doctor-patient relationship. If you desire an evaluation or consultation, contact our office for an appointment. Recommended changes to your present treatment plan or therapy must be approved by your physician. Explanation and/or discussion of off-label services and/or products, if mentioned, do not reflect endorsement or promotion by Dr. Cook and must not be construed as such.

Let’s finish our review of   “Dr. Elaine’s so you think you can dermatology quiz”!!

When should I pull the flaky crust off?

• This instant
• When I want it gone so my makeup will go on smoothly
• When I can rip it off with tweezers and get good, fresh blood
• When the edges are lifted but the center is still stuck down
• When it completely lifts off by itself
• Never

When skin heals, it heals from underneath and the tissue rises up from the depth of the hole to the surface. When it get absolutely flush with the surrounding skin the cells from the surrounding normal skin start to migrate centrally into and cover the central defect. Epithelial or surface skin cells are really smart and they only want to migrate when they can do so absolutely horizontally. They don’t like to climb down into valleys or climb up hills. If you pick off a scab or crust before the tissue underneath has risen to be absolutely flush with the surrounding skin, the surface cells often won’t go ahead and move centrally to cover the hole. If you keep picking the scab off, they finally give up and say “OMG, alright already I will climb down that hole but you will be sorry because now you are going to have a divot, a depressed scar”. Once the surface cells close over a hole, the base stops rising, so it will never be flush with the skin.

Once the skin cells start migrating centrally under the scab, the crust starts to lift up at the edges as a flake. And yes, makeup makes it look worse. If you pick it off when the center is still stuck down you will see either an oozing hole in the center, or it will be shiny and red. Then your skin sends in more healing factors and it gets redder, and just tries to make another flake or crust. And you have put yourself behind another couple of days.

If you want to try to remove the edges that are lifting up, take a soft washcloth soaked in tap water (no not toner or alcohol or what have you) and gently press it on the crust. Do not rub or scrub. Leave it there 5 minutes and then let the area air dry. Often the edges that are ready to come off will lift off by themselves. Then apply a bland (meaning no glycolic, salicylic, etc.) plain moisturizer dot over it and let it soak in. Gently blot off excess.  Then apply your foundation and the flake will be less noticeable.

To cover a pimple or crust/flaky area, do not use concealer. Use a liquid foundation. Apply foundation to your entire face first, if you use foundation. Then put a small dot on your index finger and pat, pat, pat it on the spot. Do not rub. Then, press powder with a sponge over it. Do not rub. The key is to not rub but to press or pat only. If you rub over a healing spot, the foundation comes right back off.

Answer is: When it completely lifts off by itself.

What is the best way to remove those little white beads under the skin?

• Apply Retin-A 37 times over 24 hours
• Squeeze them until they pop through the skin like “Aliens”
• Scrape them off with a fingernail
• Prick the top with a clean, sharp straight pen and squeeze gently.  Once
• Do a reverse osmosis high colonic

Those little white beads are usually milia. Milia are little hard cysts under the skin that look like round white beads when they are removed. Usually they just happen, there is no particular reason.  Some people get them when they use heavy moisturizers, all day wear foundations, waterproof sunscreens, or apply mineral powder with a brush. Milia don’t have a pore so squeezing them won’t make them come out unless you squeeze hard enough to rupture the skin.

The best way to remove them is to gently prick the surface with a clean, sharp straight pin and gently squeeze them. The ones around the eyes and on the eyelids are often very hard to get out, even for me.

Answer is: Prick the top with a clean, sharp straight pen and squeeze gently.  Once. If they don’t come out easily or for those on the eyelids, come in and we will get them out.

 What are the possible complications from picking?

• Scarring
• Permanent pigmentation changes
• Infection
• Delaying treatment of a skin cancer
• Continual harassment from my husband
• All of the above

I can’t tell you how often I see women with bad scars simply from picking. The most common are on the lower face, and are depressed white gouge marks. If you keep picking you will get scars. Often the pigment cells won’t recover and you will be left with a permanent white, depressed scar that doesn’t hold makeup well because there are no pores in the scar. If you have a lot of natural pigment, you may have a depressed scar that is darker than the surrounding skin. If you have a tendency to make keloids or thick scars, it may be raised and thick. None of these is your desired outcome.

Answer is: All of the above.  So stop.

How do I know I am picking too much?

• When I have to use medical makeup meant to cover birthmarks and severe burn scars
• When I spot the Intervention production crew talking to my husband
• I keep a 10x magnifying mirror and tweezers at my side 24/7/356
• I keep picking when I know there no chance that it will help
• When Dr. Elaine tells me so
• All of the above

Women are pickers. Some women are major pickers. Every single woman I tell to stop picking already knows they are picking too much and is causing permanent damage. It’s a weird phenomenon. About half the time they are picking because they want to cover it up with makeup and think it looks worse if they don’t pick the scab off.  The rest are picking because it is there, or pick when they are stressed or anxious. It is an extremely hard habit to break and I wish I had the answer.

Only two things seem to work. The most effective and best solution is to see your dermatologist and get whatever it is you are picking at treated so there won’t be anything to pick at. Usually it is adult acne. We can treat that. The other is to pick one spot, preferably up in your scalp so the scar won’t be visible and pick at that and then leave the others alone.  Good luck with that one.

Answer is: All of the above. We see this all day long, and will commiserate and not judge (though I do tease quite a bit) because we are pickers too. But we are trained, licensed, professional pickers, who know how to do it right and know when to stop, even if it is hard for us to stop picking on ourselves. Come in and we will help you. The best solution is to get what you are picking at treated so you won’t have anything to pick on. Except your husband or significant other.

When should I stop playing junior dermatologist and see a real one?

• When I see scarring
• When I see increased redness, pain, bleeding, or pigment
• When it is not getting better within one week
• For any brown, black, growing, bleeding, or tender growth or persistent sore
• Any growth that I am not absolutely sure is not skin cancer
• When I want the best result possible
• All of the above

Answer is: Hello, all of the above. Class is dismissed. Have a good weekend.

Next: Don’t know. Will have to see what kind of a mood I am in.

Patient Appreciation Week Sale

All Dr Elaine’s Skin Care 20-30% Off
+ Free Shipping

So don’t miss out on our Patient Appreciation Week Sale. All Dr. Elaine’s skin care is 20-30% off, and of course, our everyday free USPS Priority Mail shipping. The sale ends Sunday July 17th at midnight CST.

If you have never tried our fabulous skin care, now is the time. And if you are already a fan, thank you.

Dr Elaines’s Advanced Skin Treatment is a dermatologist (and guess who that might be?) developed clinical skin care line that combines anti-aging cosmeceuticals with proven natural botanicals. Cosmeceuticals are cosmetics that have effects on the skin. The main groups are the peptides, antioxidants, growth factors, and vitamins. They improve fine lines, roughness, blotchy pigment, loss of elasticity, dullness, acne, and stimulate collagen production. Our botanicals are plant derived compounds that are used for their antioxidant, anti-inflammatory, exfoliant, moisture balancing, and collagen stimulating properties.

We offer specialized skin care products for acne, anti-aging, skin pigment lightening, sensitive skin, rosacea and hair and body. Clinical skin care is both a preventative anti-aging strategy and a repair strategy for skin that needs help. It is your everyday health program for your skin, and the foundation of an anti-aging program. Your skin is smoother with a healthy glow, reduction in appearance of lines, wrinkles, acne blemishes and brown discoloration.

If you have never been to our web site SkinTreatment.com here is where you can find what you need: Patient Appreciation Sale Dr Elaine’s Skin Care on Sale 20-30% Off including all skin care on sale through Sunday July 17th, midnight CST. If you know what you need, or are shopping for skin care after our Patient Appreciation Week Sale, these sections are always available, which show our current special offers: All Acne Skin Care on Sale– all of the special offers for our acne skin care, including sets at a discount All Anti-Aging Skin Care on Sale–all of the special offers for our anti-aging, and lightening skin care including sets at a discount All Skin Care Sets on Sale–all discounts on skin care sets or kits All Skin Care on Sale–everything–all skin care that is on sale

If you already use Dr. Elaine’s skin care, take advantage of this great sale to stock up. If you are considering trying it, this is a great opportunity.

Your skin can’t take a joke–so don’t tell it one

Hair and nails forgive and forget. But skin is something else again. It doesn’t forgive and it doesn’t forget. So, I do take care of my skin, and pretty well too. And I have for a long time. That is because skin holds a grudge. If you don’t take care of it , it goes bad on you, and at least some of the damage is irreversible. You can fry your hair, color it blue, lose it from going off birth control pills or after pregnancy and it recovers. Hair just says “whatever, and it grows out just fine. And the kind of hair problems that are really frustrating are not from anything that you do, they just happen, like alopecia areata, and the scarring hair loss diseases.  You can have chipped and damaged nails from working in the garden, you can abuse your nails from wearing acrylics and, within reason, they can recover. Unless you damage the matrix or the nail bed, then you gotta pay. But your skin remembers every unkind thing you ever said about it, did to it, or didn’t do to it (like protect it from sun damage). It really can’t take a joke.

So here is what I do. And I do it every day and every night, without fail. And yes, I use my own line of skin care products, Dr Elaine’s Advanced Skin Treatment, almost exclusively. After all, I developed them, and they are full of both high quality botanicals, marine actives, other natural actives with specific purpose, and various cosmeceuticals including alpha and beta hydroxy-acids, peptides, antioxidants, and vitamins. Since I developed them exactly the way I wanted them, this should  be no surprise to anyone.

My morning routine–First I get up, reluctantly, then:

1. Three days a week I use Dr Elaine’s Antioxidant Enzyme Peel (1 oz 38.99). You have to use it when your skin is completely dry. So I do it the very first thing, I don’t wash my hands or face, and I apply it in a very thin layer. Key word is “very thin” and then I let it sit 30 seconds with my hands in the air, without rinsing them, until the peel liquefies. Next I rub in a circular motion and exfoliate the dead skin. Then I rinse with clear water. I love this product because the papaya, grape seed, and willow extracts in it gently exfoliate without granular particles with the end result that my face reflects light well and glows, but it still allows me to use the retinoid Refissa without the increased irritation of a granular exfoliant.
2. Since I have normal-dry skin, I wash with our Facial Cleansing Lotion (6.7 oz $26.99), using my fingers only, never a washcloth. I love this cleanser–it has glycolic acid to exfoliate, it cleanses well, removes make up and the combined group of natural botanical oils leaves my skin soft and smooth rather than uncomfortably tight.
3. Then I follow with our Gentle Toner (6.7 oz $26.99) applied with a 100% cotton ball. Since I have a tendency to get eczema, and use a fairly potent retinoid every night, I need to reduce the tiny microscopic abrasions that I would get from a synthetic “cotton” pad. I don’t need a drying type of toner, so I use this one that is not drying.
4. Then Dr Elaine’s Correcting Serum (1 oz  $59.99) 2-3 pumps for my entire face and neck. The two things that I feel should be used every day as a basic program, other than sunscreen, is either an alpha hydroxy acid or fruit acid, and a retinoid. Our Correcting Serum has both 8% glycolic acid and a multiple fruit acid complex to exfoliate and promote collagen production, and hyaluronic acid to plump wrinkles and balance moisture.
5. Next I apply Dr Elaine’s Line Diminisher (1 oz $89.99). The peptides Acetyl Hexapeptide-3 and Palmitoyl-Pentapeptide 3 combined with hyaluronic acid help minimize fine lines, and antioxidant green tea calms irritation.
6. Then our Facial Moisturizing Cream ($41.99) in the winter or when I am extra dry or my skin is irritated, or our Hydrating Cream ($39.99) if it is summer or less dry weather. Moisturizers like the Facial Moisturizing Cream that are fragrance free are best if your skin has a tendency to irritation and you are using retinoids like Refissa.
7. Then I apply our Total Eye Renewal (0.5 oz $65.99) to my entire face. Yes, I know it says eyes, and I do use it on eyes,  but also on my face,  because the 3 peptides are very good, it has active Vitamin C, bunches of active botanical antioxidants and I really like the silky smooth effect from the shea butter and silicone base.
8. Then I apply DCL Super Sheer Sunscreen SPF 50 (2.5 oz $24.99) to  my face, neck, chest, forearms and backs of my hands every single day, year round, without fail. I really like this sunscreen because it covers a really broad spectrum of UV, and it is so light weight you don’t even know you have it on.

At  night, no matter how tired I am:

1. Dr Elaine’s Facial Cleansing Lotion
2. Refissa (by prescription $145) to face, neck, upper chest. I apply Refissa to back of hands and forearms every other or every third night.
3. Dr Elaine’s Total Eye Renewal ($65.99) around my eyes after Refissa.
4. Brush on Latisse to the base of the eyelashes (by Allergan–prescription $120 a 3 ml bottle) to grow eyelashes and make them darker–but I only apply it every other night or the lashes get too long and thick. That also cuts the cost, as a bottle will then go 2-3 months.
5. Dr Elaine’s Lip Therapy ($5.99) right before bed so my lips don’t get too dried out.

For Body:

1. Dr Elaine’s Calming Body Wash (12 oz $15.99) in shower which helps my dry skin.
2. Dr Elaine’s Smoothing Body Moisturizer (12 oz $37.99) every night. I am atopic, so my skin is sensitive and rashes easily. That means if I don’t apply moisturizer to my entire body I will itch all night and since I don’t want to do that I just go ahead and use body moisturizer every night. I love the scent, and also the powdery smooth feeling.
3. Then I put our Perfecting Hand and Body Moisturizer (12 oz $36.99) on my feet and heels right before bed. The glycolic acid and fruit oils, soften and repair thickened skin and cracks, and the Evening Primrose oil reduces irritation.
4. If I have been lazy and my heels are really bad I will use Ureacin-20 (4 oz $26.99)on them for a couple of nights. It works really well for thickened calloused heels, but leaves a thin white film on them, so I don’t do it in the daytime.
5. For a little color, in the summer or if I am going on vacation I will use Jergen’s Sunless Tanner ($7.99) for medium to tan skin (just means it has more DHA in it and I get color quicker) or Clarins Self Tanning Instant Gel (4.4 oz)

And that’s how I do my own skin care. I take care of my skin, and I don’t tell it any jokes.

Next: how I do cosmetics

How girl dermatologists do skin care

Female dermatologists are often thought of as the experts on effective, scientific skin care. And that’s because we are. So how does this girl dermatologist, and I use the word “girl” loosely, do skin care? I want to be the best I can realistically be, and that includes my skin. The key to doing the best you can with what you’ve got, it to know what you’ve got. To some degree, you inherit the skin you’ve got. But skin you’ve got is also the result of what you have done, and what you are doing.

Before I became a dermatologist, I always just took my skin for granted and didn’t think much about it. I have moderately sensitive skin, and am “atopic.” Atopic tendencies are genetic, and people who are atopic have skin that is more sensitive than others, gets rashes easier, itches at things others don’t, have little bumps on the upper arms, and often have a family history of asthma or hay fever. If you cut the tags out of all of your clothing, been told you were “allergic” to grass, or wool, or whatever, you are atopic.

Very luckily for me, as a child, adolescent and young woman, I didn’t ruin my skin in the sun. Although I would have loved growing up on the beach, I didn’t.  In Oklahoma City, beaches are hard to find. I wasn’t on the swim or tennis team. We didn’t belong to the country club. Many of my friends would lay out in the backyard and tan. However, sticking to the webbed straps of a wobbly chaise lounge, sweating in the hot humid air, swatting the flies that would continually swarm around was not my idea of fun. So I didn’t do it. Later I was too busy with pre-med and medical school to have any fun outside. So I escaped the early sun exposure that shows up as damage twenty or thirty years later.

I never really had acne as a teen or young woman. Only in middle age, which is not fair and I plan to sue someone, as soon as I figure out who to sue. I pigment moderately easily, and had a decade or so dealing with melasma. Caused by a combination of hormones, either birth control pills or devices, pregnancy or just the hormones made by the body, melasma is a brown pigmentation on the face, especially cheeks and above the upper lip. It is often in a pattern, and I had a delightful set of horns above my eyebrows and a brown pigment moustache.  Melasma drives women crazy, and is incredibly frustrating. I was no exception. Usually it finally burns out, and mine did.

I always ask patients “where is your family from, the old country?” It not because I am just nosy, it is because it makes a difference. The tendency to make abnormal pigment, to get wrinkling with sun damage, to get broken blood vessels and redness, to have sensitive skin all have a genetic basis and that genetic basis is tied to ethnic background. People who have ancestors that had more natural pigment, Hispanic, Asian, American Indian, Black, Middle Eastern etc, respond to anything that happens to the skin, such as pimples, rashes, procedures, treatments, with increased pigmentation. It is hard to fix, so you want to avoid it. If you have light skin, like most Northern Europeans, especially Irish and Scots, and you get a lot of sun exposure over the years, your skin will get thickened bumpy elastosis, wrinkling, loss of elasticity and skin cancer, and you won’t like that either. The list goes on. My family background is German, Dutch, and a little American Indian, so I don’t get sun damage easily, but can make abnormal pigment.

There are 3 components to coming up with your own skin care plan–quiz–soul searching–reality. Kind of like coming up with a life plan.

1. Quiz–What kind of skin do I have?
2. Soul searching–What kind of results do I want?
3. Reality–How much time and money am I willing to spend?

Dr E takes the Dr E  Skin Care Quiz:

• Is your skin very dry, dry, combination, normal, oily, very oily?–Dry
• Do you get breakouts?–Yes, 3-4 per month, painful medium sized pustules and small cysts, and I don’t like it one bit.
• Is your skin sensitive?–get rashy or itchy easily? Yes, didn’t I just say I was atopic?
• If you are out in mid-day sun without sunscreen do you get some immediate darkening of your skin? Yes, a moderate amount
• How much sun do you get daily? Noooooooooooooooooooooooo
• Do you wear sunscreen every day? Duh, yea
• Are you a “soap and water and nothing else”, “I will do 3-4 steps in the morning and same in the evening”, or “as much as it takes” kind of woman? I am a “as much as it takes kind of woman.”
• Are you using any prescription surface treatments like Retin-A, Refissa or for Rosacea? Yes, I have used retinoids in one form or another continuously for the past 30 years.
• Which of the following are a problem–
  • Brown spots–No, see 5 and 6
  • Broken blood vessels–Yes
  • Fine wrinkles–No, see 5 and 6
  • Deeper wrinkles—No, see 5 and 6
  • White “beads” under the skin–Yes, a few
  • Flaking or peeling–Occasionally, from retinoids

Dr E does some soul searching

• What kind of results do I want? Here is what I want–I want have the very best skin I can have.

• I want smooth, uniformly pigmented skin with small pores, minimal wrinkles, no broken blood vessels, no gross brown crusty things, no pimples, and no reddish brown spots after pimples have gone. I want my skin to be approximately in the same place on my face that it was twenty years ago. When I stretch it, I want it to bounce back in less than 10 seconds. And it should not be oily, not be dry, but just right, like Goldilocks porridge.

What am I willing to do to get it?

• No, I am not willing to do a great deal for hair care and nail care. But I am for skin care. Why you ask? All three are visible to the world. All three can make you look worse, or hopefully, better. But, a very important difference. Taking care of your hair and nails make them look better today, but in general don’t influence the appearance tomorrow. I can fry my hair with bleach, color it blue, get split ends and it will still grow it out fine. I can get fungus under my nails, warts around the cuticles, and significant deformity of the nails after acrylics, etc  Although treatment of warts and fungus is difficult and often recurrent, to at least some degree they can be prevented or treated. Preventing nail damage is basically avoiding sharing nail care instruments, whirlpool tubs etc that are contaminated by other customers in nail salons, and not wearing fake nails continuously.
• But skin care is a different story. I can prevent undesirable skin changes, I can improve the ones that are there, and I can change the nature of my skin. In contrast to hair and nails, which are completely replaced when they grow out, skin cells are turned over on the very surface, with lesser turnover under the top layers. That’s why destroyed collagen and elastic fibers, elastosis, scars, pre-cancer, and skin cancer, pigment, broken blood vessels, and brown growths are permanent and don’t “grow out”. Taking care of your skin today makes it look better today and tomorrow. If I don’t take care of it today, it will look worse tomorrow, and some of those changes aren’t fixable.

We all make mistakes in life. It’s just that the consequences of some are worse than others, and some are easier to fix. So the answer to the question “How much time and money am I willing to spend?” Whatever it takes.

Next: what it takes for this dermatologist, every day, to take care of her skin

Don’t miss out on our Spring Fling Sale.  All Dr Elaine’s Skin Care is 20-30% Off and, of course, our Every Day Free USPS Priority Mail Shipping.

The sale ends Sunday, April 24th at midnight CST.

If you have never tried our fabulous skin care, do it now.  And if you are already a fan, stock up.

Dr Elaines’s Advanced Skin Treatment is a dermatologist developed clinical skin care line that combines effective cosmeceuticals with proven natural botanicals.  Cosmeceuticals are compounds that have effects on the skin. The main groups are the peptides, antioxidants, growth factors, alpha and beta hydroxy acids and vitamins. They improve fine lines, roughness, blotchy pigment, loss of elasticity, dullness, acne, and stimulate collagen production. Our botanicals are plant derived compounds that are used for their antioxidant, anti-inflammatory, exfoliant, moisture balancing, and collagen stimulating properties.

Our Ageless Effects Clinical Anti-Aging Skin Care is both a preventative anti-aging strategy and a repair strategy for skin that needs help. It is your everyday anti-aging health program for your skin, and the foundation of an anti-aging program.  Your skin is smoother with a healthy glow, reduction in appearance of lines, wrinkles, and brown discoloration.

Acne is a common problem, that affects people of all ages. Dr Elaine’s Advanced Skin Treatment Perfect Effects Acne Skin Care prevents and treats acne blemishes, pimples, blackheads, and reduces irritation, and red and brown discoloration that occurs after the pimple has healed. It also reduces the dryness that occurs with some acne medications and can be used effectively with prescription acne medications.

For Rosacea and sensitive skin try our hypoallergenic, fragrance free Gentle Effects skin care, to reduce redness, dryness and irritation.

Dr Elaine’s Silken Effects for hair and body care line, with both treatment and maintenance products help reduce dry, scaling or irritated skin and give you beautiful hair.

And finally, try Dr Elaine’s Cosmetics for antioxidant mineral powders and mineral glows, for a healthy looking, natural complexion.

If you have never been to our web site SkinTreatment.com here is where you can find what you need:

Spring Fling All Dr Elaine’s Skin Care on Sale 20-30% Off through Sunday April 24, midnight CST

If you know what you need, or are shopping for skin care after our Spring Fling Sale, these sections are always available, which show our skin care and current special offers:

All Acne Skin Care on Sale

All Anti-Aging Skin Care on Sale

All Skin Care Sets on Sale

All Skin Care on Sale

All Anti-Aging Skin Care

All Acne Skin Care

All Rosacea and Sensitive Skin Care

All Hair and Body Care

All Cosmetics

And if you want to see All Dr Elaine’s Advanced Skin Treatment Skin Care

If you already use Dr Elaine’s skin care, take advantage of this great sale to stock up. If you are considering trying it,  this is a great opportunity.

Choose skin care like a skin doctor:

Full disclosure: I am the founder of Dr Elaine’s Advanced Skin Treatment clinical skin care line, which I formulated and developed based on my assessment of the merits of various botanical extracts and cosmeceutical advances for an optimal anti-aging, acne, sensitive skin and body skin treatment program. Dr Elaine’s skin care is sold in my cosmetic dermatology practice and online at our web site, SkinTreatment.com. Of course, I am biased toward our skin care products, and use many of them daily, especially since I developed them exactly the way I wanted.

When I talk to patients about skin care, cosmetics and hair care, they often ask “what do you use?” and “why do you use what you use?” Because I am a female cosmetic dermatologist, I am expected to have a rigorously scientific analysis of the merits of each product I use. And to a large extent I do. However, there are additional factors that I use to determine which skin care, cosmetic, nail care, hair care, beauty equipment I purchase and use.

My choices are dictated by the following factors:

• Scientific evidence favoring effectiveness in prevention of skin aging, acne, and skin cancer. Since I know preventing skin aging is easier than reversing it, I am willing to use products that may only have benefits down the road. Luckily for me, I have used a sunscreen and retinoid (first Retin-A, then Renova and now Refissa) daily for the past 27 years.

• Scientific evidence favoring effectiveness in treatment of skin aging, acne and sensitive skin. I’m not impressed by the marketing “story”–you know, “this amazingly potent antioxidant, previously unknown to the world, from the fruit of the Friscascucia plant, found only in a remote region of the Himalayas, harvested lovingly by hand by barefoot, chanting Tibetan monks, who even at 90 have beautiful, radiant, unlined skin because they apply Friscascucia fruit daily was discovered by celebrity dermatologist Dr. Special when he met the monks during the pilgrimage to Tibet that was part of his voyage of personal discovery.  And now, brought to you!”

• I want to know the actual science, even if it’s boring. It’s unfortunate that often the “story” is used and accepted as a substitute for the science. There are a lot of ingredients that have a long history of safety and effectiveness. On the other hand, some of the new discoveries, optimization of existing compounds and new uses for older therapies are exciting and backed by science. It’s just that the “story” shouldn’t trump the science.  And by science, I mean controlled, double-blind scientific studies of real effects on real live skin. As any scientist will tell you, an experiment can be designed to give any result you want. So I want the real science, not the marketing story science.

• Ease of purchase. I hate to shop. Thank God for the internet. And Walgreen’s.

• Cost/benefit ratio. I don’t mind paying more, if there is an actual benefit gained. I tend to avoid skin care products at both ends of pricing, the very cheap and the very expensive. Since we produce Dr Elaine’s clinical skin care line, I know how much it costs to include appropriate, quality ingredients in concentrations large enough to have a skin benefit, not just to include them in low concentration for their marketing value. And skin care at the very high end often uses that high price point as a selling point–”if people pay so much for this it must be worth it” without any real increase in value. However in make-up and cosmetics that is not necessarily true. For certain cosmetics, such as mascara, the inexpensive drugstore version is just as good as one that costs 10 times more.

• Sensory effects such as scent, color, texture, stickiness, etc. If I am going to pay for it and use it, I want to enjoy it.

• Persistence of result. If I take the time to put it on, I want it to stay on. I don’t want to put on lipstick more than once, twice at most, a day. I don’t want my nail polish chipping by the next morning. If I cover a pimple, it better stay covered.

I compute the above factors in a complicated mathematical formula, which remains in an undisclosed location in my brain, to determine which skin care, cosmetics, nail care, hair care, and  beauty equipment that I purchase and use on a daily basis.

Next:  My top skin, hair, nail care and cosmetic choices.