Daily Skin Fix

I Hate Melasma:
How to Prevent and Treat Melasma

Finally, the last installment in the Out Damn Spot, Out, Out, I Say series on brown spots on the face, what they are and how to get rid of them. We have discussed brown spots from sun damage, raised brown age or liver spots, brown spots after acne, cosmetic skin procedures or injury. So now, Lady Macbeth, we go on to the bane of the cosmetic dermatologist’s existence, melasma.

I hate melasma. I really hate melasma. What is that you say? “That is a bit harsh Dr. Elaine, hating on a skin disease.” True. But here is why I hate melasma: I have had it. I treat it. It is really difficult to treat. It is really difficult to treat because the factors that cause it are very hard to modify. The factors are hard to modify because they are factors that are part of life: sun exposure, hormones, and skin type. Add to that the fact that the medications that we use are really hard to get right now. Often the treatments we use to treat it cause inflammation, and inflammation worsens melasma. The women who get it often have more natural pigment, which makes them more likely to pigment with treatments for melasma. Melasma is very persistent and sneaky, it often responds to treatment, but waits patiently for a tiny sliver of opportunity to start up again. Then it does, and both patients and cosmetic dermatologists get frustrated. And that is why I hate melasma.

To recap, here is what you see with melasma:

• In the mirror:  Large dark flat patches of discoloration, usually symmetrical, over cheeks, jawline, fore head and above the upper lip. It is often more obvious in low light settings, such as at sunset. It responds almost instantly to any sun exposure. It is hard to cover up with makeup.

• Diagnosis: Melasma or “mask of pregnancy,” is caused by a combination of hormones, predominantly estrogen from pregnancy or birth control pills, 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 always 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 microdermabrasion are tried first.  “Relatively 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.

Melasma is almost exclusively a skin disorder in women, though very occasionally it occurs in men. It is caused by a combination of estrogen, and to a lesser extent, progesterone, hormones, found in birth control pills or devices, naturally occurring during pregnancy or just the hormones made by the body, in combination with sun exposure. It shows up as dark patches of brown pigmentation most commonly on the sides of the face, the forehead, above the upper lip, on the chin, and on the sides of the neck.  Mild melasma appears as small faint brown splotches, but more severe melasma surfaces as patches of light brown skin pigmentation. There is a genetic susceptibility to melasma, and it is more common in women with skin that pigments easily. It is especially common in women with Asian, Hispanic or African American skin type. There are more active pigment producing cells called melanocytes, and the melanocytes are more easily triggered to produce melanin. The excess melanin is stimulated most significantly by sun exposure, but also by heat, and anything that irritates the skin like facial scrubs, brushes, irritating skin creams, medications or treatments. Once melasma is triggered on, even minimal amounts of sun exposure will cause it to darken or return after successful treatment. It is more apparent during and after periods of sun exposure and less obvious in the winter months.

Melasma can occur at either the surface level (superficial melasma) or in the deeper layers of skin (dermal or deep melasma), giving it more of a spread-out appearance. One way to determine whether your melasma is superficial or deep is to stretch the skin. If you stretch out the brown patch and it appears lighter than when the skin is not stretched, then the hyperpigmentation is superficial. If it’s darker when stretched than it is when not stretched, then the pigmentation is deeper.

I pigment moderately easily, and had a decade or so dealing with melasma. It is often in a pattern, which is why it is also called the “mask of pregnancy” 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.

There are two reasons that melasma is so hard to treat. The first reason melasma is so hard to treat is because even minor amounts of sun exposure can darken or reactivate it. It is hard to avoid all sun exposure, especially in women in the age group most commonly affected, 25-40, who may have children with outdoor activities. The other reason is that estrogen and progesterone hormones go along with being female. And women in that age group are faced with the decision to either be on birth control pills, or be pregnant, both of which are triggers.

There is no single treatment that works for all melasma patients; therefore, we develop an individualized treatment plan for each patient. Combination therapy usually is needed and recommended. Because the melanocytes are easily irritated, and when irritated they produce more pigment, we avoid aggressive treatments that may lead to more pigmentation, white blotches, or scarring. Treatment options range from topical bleaching and prescription medications to techniques such as IPL, chemical peels and microdermabrasion as well as lasers and light sources. We plan a stepwise approach to treatment beginning with home treatment, stepping up to office procedures as needed if results to home treatment are unsuccessful. If office procedures are needed, they should only be performed by cosmetic dermatologists with extensive experience in treating pigment problems.

Because of the difficulty in reducing pigment, the ongoing hormonal issues, and the tendency for melasma to reoccur we discuss in detail the lengthy treatment times and commitment needed to success­fully treat melasma to help manage unrealistic expec­tations. We also discuss the importance of and strong commitment to the sun protection program that is central to treatment. But even in the face of our hormones and our lifestyle, we soldier on and treat it the best we can with realistic expectations for improve­ment. And here is what we do:

Home Treatment:

• Daily Sun Protection: Is absolutely essential for successful melasma treatment and should start early and continue throughout treatment and also after melasma has improved to help prevent reoccurrence. Exposure to UV radiation and even visible light activates melanocytes and causes melanin to deposit in the skin. Sun protection with a broad spectrum sunscreen which covers both UVB and UVA with a SPF of 30 or greater used every single day, year round, and reapplied every 2 hours during sun exposure is essential. And that goes for all skin types, even patients with darker skin types who do not routinely use sun protection. But you have to remember that no sunscreen will block out all UV rays, so you cannot put on sunscreen in the morning and go out all day. Patients must limit time in the sun, and wear a hat whenever possible if sun exposure cannot be avoided. As a matter of fact, it is so important, that if you are not willing to modify your sun exposure, stop reading and go play on Facebook. 

• None of the other treatments may be used during pregnancy. If you are pregnant and at risk for melasma, start immediately to protect your skin from sun exposure to prevent melasma. If you are pregnant and have melasma, scrupulous sun exposure will help keep melasma from becoming more established.

• Prescription Hydroquinone (HQ) skin bleach: Hydroquinone is skin bleach that has been used for years. It inhibits the enzyme tyrosinase which is essential in pigment production. It comes in an over the counter 2% concentration, and stronger and more effective 4% prescription concentration. It is effective for approximately 20 weeks of treatment, then the skin becomes used to it, and effectiveness decreases. If used longer than 4-5 months, rarely an irreversible darkening of pigment occurs, especially in patients with darker skin types. It is usually applied twice daily and should be applied to the entire face because bull’s-eye areas of discolor­ation can develop from localized or spot treatments. Unfortunately it is irritating to the skin and if irritation occurs it can actually cause darkening of pigment. It has been very helpful in the treatment of pigment problems, but has recently come under fire from consumer groups and the FDA because of safety testing concerns. The most effective of the prescription forms, in my opinion, was Tri-Luma cream, which is a combination of HQ, a topical steroid, and tretinoin. It can only be used for 2 months at a time because the topical steroid component can cause dilated blood vessels and thinning of the skin if used longer. Currently it is not being produced, and has been unavailable for the last year. Intermittently other prescription HQ products are available, and then they disappear. HQ at 4% concentration is a prescription product, and recently the FDA has been cracking down on products available without prescription that contain 4% HQ. Time will tell if HQ will be banned by the FDA, approved by the FDA, and if so, will a company produce it. After about three to four months, the body increases tyrosinase production and overrides the effects of HQ. Because of this, HQ is used is a pulsed manner, usually 4 months on, 2 months off, to allow it to work again. HQ cannot be used in pregnancy.

• Prescription retinoid creams such as Retin-A, Retin-A Micro, Refissa, Renova, Differin, and Tazorac: Topical HQ often is combined with a topical retinoid, such as tretinoin, which exfoliates the skin and allows for the ingredient to penetrate properly.  Unfortunately, they can be irritating, and irritation increases pigment. So they need to be used cautiously. Retinoid irritation can be reduced by titrating the dosage, changing the dosage to alternate days, and diluting the tretinoin with a moisturizer base. Creams or micro sponge formulations are much easier to tolerate than gels. The key is to have your face completely dry before you put it on at night, and use it on a regular basis, not intermittently. When your face is damp you absorb more and it is more irritating. You can apply it every other night or even every third night to start and work up. If you are having irritation, apply an oil free moisturizer first then the retinoid.

• Over the counter Retinol: The prescription retinoids discussed above are forms of retinoic acid, and are stronger than retinol. Non- prescription, over the counter retinol can be helpful in melasma treatment as long as it doesn’t cause irritation.

• Mequinol such as Solage solution (mequinol 2% and tretinoin 0.01%): If HQ causes the patient too much irritation, a deriva­tive alternative is mequinol.

• Over the counter or natural skin lighteners: include aloesin, arbutin, azelaic acid, bearberry extract, dimethylmethoxy chroman palmitate (Chromabright), ferulic acid, kojic acid, lactic acid, licorice root, lignin peroxidase, mulberry bark extract, N-acetylglucosamine, niacinamide, soy protein, various peptides, and vitamin C especially magnesium ascorbyl phosphate or L-ascorbic acid. These lighteners have various actions including inhibiting the pigment producing enzyme tyrosinase, dispersing pigment, and exfoliating pigment. They can be used for extended periods of time and can be used with other lightening ingredients to speed up the process.

• Every dermatologist and skin care company has their favorite combination. Our Antioxidant Skin Lightener contains aloesin, licorice root, bearberry, niacinamide, the form of active vitamin C magnesium ascorbyl phosphate, (Melfade-J) and dimethylmethoxy chroman palmitate (Chromabright). We use it with our Correcting Serums containing glycolic and salicylic acids, fruit acids, aloesin, and our Antioxidant Enzyme Peel containing papaya to exfoliate abnormal pigment.

Office Treatment:

Office treatments are used if topical creams don’t give enough improvement and to speed results. They must be done very carefully or they can cause increased pigmentation, especially in patients with darker skin types. They should be done very carefully, and by a physician who is experienced in treating pigment problems and skin of color, in other words by a cosmetic dermatologist.

• Chemical Peels: A series of in-office light chemical peels can improve discoloration by peeling off the top layer of pigmented skin cells, and allowing better penetration of other surface treatments. Glycolic acid peels are most commonly used but others include salicylic acid, superficial trichloracetic acid, lactic acid, tretinoin, 14% HQ, and resorcinol peels. They are best when used with home retinoids, prescription hydroquinone or other skin lighteners. Skin may be red, dry and flaky for up to 5 days.

• Intense Pulsed Light (IPL): A series of 3-5 Intense Pulsed Light treatments (IPL, Photofacial, or Photorejuvenation) at a lower intensity than is used to improve sun damage induced dilated blood vessels and age spots can be helpful.

• Particle Free Precision Microdermabrasion/Dermal Infusion such as SilkPeel: SilkPeel particle-free microdermabrasion uses a treatment tip to exfoliate the skin accompanied by application of the skin brightening peptide Decapeptide-12 (Lumixyl) at controlled intensity. It removes surface pigment, and allows better penetration of prescribed home skin treatments. A plus is that there is no redness or flaking after treatment.

• LED Treatments: GentleWaves LED Photomodulation uses a painless light emitting diode treatment and is used to reduce inflammation with other melasma treatments.

• Nonablative Laser Treatments: The Q switched 1064-nm Nd:YAG laser and the fractional lasers Fraxel Restore and Mosaic may be used in patients who don’t respond well to the treatments above or who also desire improvements in mild to moderate wrinkles, large pores, surface irregularities, or acne scarring.

• Ablative Lasers: Multiple treatment sessions with the Pearl 2790-nm Er:YSGG laser combined with IPL and topical treatments in carefully controlled protocols may be used in carefully chosen patients with skin types I-IV if melasma does not respond to other measures.

Sometimes things that seem that they should be easy are not. This is one of those times. With diligence and time melasma can be significantly improved or resolved. But I still hate melasma.

Holiday Sale: 20% Off Botox, Juvederm and Skin Care

Join Dr Elaine Cook and staff at Advanced Skin Treatment Center, 2609 Wolflin Village, Amarillo to celebrate the start of the Holiday Season with an Open House on Thursday, November 17 from 8am to 8pm in conjunction with the annual Wolflin Village celebration. This is a sale you won’t want to miss!

In addition to offering 20% off on all Dr. Elaine’s® Advanced Skin Treatment Skin Care, we have reserved the entire day for patients wanting Botox® and Juvederm® treatments at 20% off! It doesn’t get much better than that. Most people want to look their best around friends and relatives during the holidays especially for holiday photos. With this special, you can ‘Lose Ten Years in Ten Minutes’ and save 20%!

Relax the wrinkles between your eye brows, across your forehead and the crows feet outside the eye area with Botox. With Juvedermyou can plump up the ‘parenthesis’ wrinkles between your nose and the outside corners of your mouth, plump up your lips and fill in the areas below the outside edges of your mouth to give your face a more youthful look. Whether you’re a veteran to these procedures or want to try them for the first time, you should call today to schedule your appointment because we expect the slots to fill up quickly!

Botox and Juvederm first come, first serve, by appointment only. Call 806-358-1117  or email us at skincare@skintreatment.com today to schedule your appointment.

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

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.

Using the proper toner helps to re-balance the skin and will refine the appearance of pores.  By applying a skin-type-specific toner, it can help rid excess residue from make-up and cleansing.  Toning also cleans pores at a deeper level.

Dr. Elaine has two very different toners made for different skin types:

• Ageless Effects calming and pore refining Gentle Toner for normal to dry skin
• Ageless Effects deep cleansing and pore refining Balancing Toner for normal to oily skin

Both of these toners deep cleanse, exfoliate and refine pores.

Toners are meant to be used morning and evening after cleansing with a 100% cotton ball.

If you’ve never used toner, now is the time to start.  If you’ve always used toner, you know exactly what we are talking about!  Don’t leave out this important skin care step.  It only takes seconds each day.

I was reading a survey today that suggested that American women prefer that cosmetics that deliver flawless skin and sun protection, over fashion-forward colors. “Flawless” skin tone was chosen by all participants. Minimizing fine lines and wrinkles was the second response. Regardless of age, these skin-related benefits were chosen ahead of more cosmetic benefits including elongated darkened lashes, colorful full-looking lips, and defined cheekbones.

Young skin is smooth, soft, reflective of light and without visible spots or wrinkles. When we see an individual with those characteristics, we subconsciously classify that individual as young. So it is not surprising that women want to achieve that “flawless skin tone”.

Unfortunately, I often see women wear heavier makeup in an attempt to cover up the spots and wrinkles that age them. Actually, it is best to lighten up on makeup as you age, as heavy makeup often accentuates wrinkles and raised spots. And it also gives a dull surface that prevents skin from the youthful reflection of light. The best option is to treat the signs of aging skin with skin care containing antioxidants, peptides and hydoxy acids followed by a lighter, mineral based foundation powder to help disguise the imperfections. It is often helpful to finish with a light reflecting mineral glow powder to restore the light reflective properties of the skin. More improvement in spots, discoloration, dullness and wrinkling can be gained with aesthetic treatments such as prescription retinoids, chemical peels, microdermabrasion, laser resurfacing, dermal fillers, and Botox.  One of my favorite sayings is “Clear the canvas and start over”.

The good news is that fifty-six percent of American women wear cosmetics and makeup with SPF to provide protection from harmful UV rays with older women more likely to wear SPF cosmetic products and makeup all year round. Since daily sun damage, rather than just episodic bursts of sun exposure, is largely responsible for the spots, roughness, wrinkles and dullness that age the skin this is smart skin care. I don’t see why the number isn’t one hundred percent of women using daily sun protection. After all, prevention is the easiest of all.