Psoriasis Information March 13, 2013

Lately I have come across a few articles about the skin disease psoriasis so I thought I would share the information here.  I’ve addressed the issue of psoriasis before in this blog (see my post August is Psoriasis Awareness Month), but I wanted to go into greater detail here about this disease.

Just what is psoriasis and how many people does it affect?  In the article The Biology Behind Eczema and Psoriasis in Skin Inc. Dr. Claudia Aguirre explains:

Psoriasis has been confused with eczema, lupus, boils, vitiligo and leprosy. Because of the confusing connection with leprosy in ancient times, psoriasis sufferers were even made to wear special suits and carry a rattle or bell, like lepers, announcing their presence. Only in the 19th century was a distinction made between psoriasis and leprosy, alleviating some of the psychosocial impact of this highly visible and distressing skin disease.9 As with eczema, it presents as itchy, red skin and involves altered immunity. However, its complexities reach far beyond the surface of the skin. People with psoriasis have an increased risk of cardiovascular disease, metabolic syndrome, obesity and other immune-related inflammatory diseases—even cancer. The mysteries behind this complicated and debilitating skin disease are only beginning to be unraveled. Psoriasis is a chronic, inflammatory multisystem disease affecting 1–3% of the world’s population.3 Whereas the rashes on eczematous skin can have irregular edges and texture, psoriatic lesions tend to be more uniform and distinct. Red or pink areas of thickened, raised and dry skin typically present on the elbows, knees and scalp. This presentation tends to be more common in areas of trauma, abrasions or repeated rubbing and use, although any area may be affected. Unlike eczema, psoriasis comes in five different forms: plaque, guttate, pustular, inverse and erythrodermic.

Plaque psoriasis affects about 80% of those who suffer from psoriasis, making it the most common type. …

It may initially appear as small red bumps that can then enlarge and form scales. The hallmarks of this type are raised, thickened patches of red skin covered in silvery scales. The other types are less common and present inflamed skin with red bumps; pustules; cracked, dry skin; and even burned-looking skin. Clients will most likely be under a physician’s care, who will diagnose the type of psoriasis present.

As of today, psoriasis has no cure. A single cause of the disease has yet to be uncovered, but it is known that developing the disease involves the immune system, genetics and environmental factors. In psoriasis, aberrant immune activity causes inflammatory signals to go haywire in the epidermis, causing a buildup of cells on the surface of the skin. While normal skin takes 28–30 days to mature, psoriatic skin takes only 3–4 days to mature and, instead of shedding off, the cells pile up on the surface of the skin, forming plaques and lesions. The underlying reason may be due to the hyperactivity of T-cells, which end up on the skin and trigger inflammation and keratinocyte overproduction. Although it is not known why this happens, it is known that the end result is a cycle of skin cells growing too fast, dead cell-debris accumulation and resulting inflammation.

Many psoriasis sufferers receive medication from their doctors but there is encouraging research that the use of OTC AHA (alpha hydroxy acids) can help improve psoriasis symptoms.  In the post How Alpha Hydroxy Acids Could Help Treat Psoriasis Rebecca Harmon writing on Future Derm explains:

In common plaque psoriasis, the overgrowth of skin cells that collect at elbows, knees, hands, scalp, face and other areas can cause embarrassment and in some cases can be painful as clothing catches and pulls on the dry skin patches.

During a particularly hard-to-manage outbreak in my late 20’s, I was desperate to avoid the greasy and expensive steroid cream ($50 for a small tube) and smelling like the back end of a large coal truck wasn’t working for me either.  My particular case was cosmetically disturbing but not medically-complicated so I decided to stop buying the $50 prescription cream and turned to the beauty industry which was just beginning to offer face cream with AHA’s.

I quickly became a fan as I discovered that the flaky psoriasis patches on my face disappeared with a skin care regimen that included a daily application of the AHA face cream. Those were my stay-at-home-with-babies days, and I was as far removed from research or academic writing as one could be, but I didn’t need the denial of a null hypothesis to tell me that this was working.  I used it twice daily on my face and then started rubbing it in to my elbows and knees.  I still laugh remembering the cosmetic rep who finally asked how much face cream I was using (I ordered a lot of this stuff!).

And, yet, the research is in my favor. One study of 12 patients found that a creams with 15% glycolic acid, as well as .05% betamethasone, respectively, were helpful in reducing erythema, transepidermal water loss (TEWL), and lowering Laser Doppler values (Dry Skin and Moisturizer). And alpha hydroxy acids mixed with betamethasone were found to be even more effective in treating psoriasis in a double-blind, split-face, single site clinical study (JEAVD).

I have experienced mild outbreaks of psoriasis since that period but have continued to treat them with AHA-based lotions with consistent results.

And Rebecca isn’t the only extolling AHAs as a psoriasis cure from personal experience.  In the post We Answer Cara Delevingne’s Skin SOS: Psoriasis Alexandra Owens writes in Allure that:

A few years ago, I accidently discovered that Bliss Ingrown Eliminating Pads relieved my symptoms even better than prescription creams I’d tried. I asked New York dermatologist Doris Day why they work so well. “The alpha and beta hydroxy acids [in the pads] would help thin out the plaques of psoriasis, and the oat extracts, witch hazel, and lavender oil would soothe and hydrate the skin—but I would still apply a moisturizer after using them,” she says. “The nice thing about the ingredients being in a pad is that it’s easy to apply to the affected areas.” Another nice thing: You don’t need to see a doctor to get your hands on them.

When it comes to treating clients with psoriasis at the spa keep things simple and gentle and place an emphasis on encouraging relaxation.  Once again I’ll turn to the Skin Inc. article mentioned above:

Both eczema and psoriasis clients have impaired barrier function and increased inflammation, so your goal will be to protect and repair. Remember to always check first with your client’s physician for contraindications to medications and therapies, because some ingredients may counteract each other. For example, salicylic acid may seem a likely choice for exfoliating psoriatic skin, but could, in fact, inactivate a common topical treatment for psoriasis.

Once a full consultation with the client and possibly her physician is completed, proceed with a treatment using minimal products and procedures. A good way to compensate for minimal skin treatment time is to add on stress-relieving techniques, because there is a psychological component to eczema and psoriasis. Complementary therapies, such as aromatherapy, acupressure, reflexology, massage and inhalation techniques can be coupled with skin treatments to lower stress hormones and control inflammation.

Gentle cleansing and exfoliation is crucial to allow the penetration of rich, emollient moisturizers used on dry, sensitive skin. Avoid harsh exfoliants and detergents, and look for ingredients, such as lactic acid. Use anti-inflammatory ingredients, such as red hogweed, ginger, oats and chamomile, coupled with barrier-repairing oils, including evening primrose, borage, argan and sea buckthorn. Finishing a treatment with a physical sunscreen, such as zinc oxide or titanium dioxide will ensure that harmful UV rays do not cause further damage.

Bottom Line:  Though there is currently no cure for psoriasis there are ways to keep symptoms under control.  Since stress makes psoriasis worse finding ways to reduce stress is an integral part of psoriasis treatment and estheticians can certainly be a positive part of that process.

Further Reading:

• A Look at What Psoriasis Is And How To Treat It – Future Derm
• Psoriasis Patients Flock to Social Media for Support – Skin Inc.
• CDC Puts Psoriasis on Its Public Health Agenda - Skin Inc.

Image from worldinfo.info

May is Skin Cancer Awareness Month May 14, 2012

If there is one consistent subject that I write about repeatedly in this blog it is sun protection.  There is a very good reason for that – non- melanoma skin cancer has reached epidemic rates in the US.  May is Skin Cancer Awareness Month so I wanted to share some important information about the subject with my readers.

According to The Skin Cancer Foundation:

Skin cancer is a lifestyle disease, affecting young women, older men and everyone in between. One in five Americans will develop skin cancer in the course of a lifetime; 13 million Americans are living with a history of nonmelanoma skin cancer, and nearly 800,000 Americans are living with a history of melanoma, the most dangerous form of skin cancer.

But there is good news: because skin cancer is chiefly lifestyle disease, it is also highly preventable.

“About 90 percent of nonmelanoma skin cancers and 65 percent of melanoma cases are associated with exposure to ultraviolet (UV) radiation from the sun,” says Perry Robins, MD, President of The Skin Cancer Foundation. “Everyone, regardless of skin color, should make staying safe in the sun a priority and incorporate sun protection measures into their daily life.”

In my opinion the scariest phenomena occurring right now is the rapid rise in the cases of melanoma among young women who use tanning beds.  Let me be very clear – tanning beds are not safe!  I wish the FDA would ban them entirely.  If someone tells you that tanning beds aren’t harmful they are lying to you – period.

Since skin cancer is almost entirely preventable the key to protecting yourself (and your loved ones) is in your hands.  Remember to:

• Use a broad spectrum sunscreen – 365 days a year.
• Don’t skimp on sunscreen – apply plenty of sunscreen to all exposed skin and reapply every 2 to 3 hours when outdoors.
• Seek shade and wear protective clothing when outside.
• Don’t burn!
• Never, ever use tanning beds!!
• Do self exam to check your moles and to see if you have developed any suspicious lesions.
• See a dermatologist for a professional mole check yearly.

Sources and Further Reading:

• The Skin Cancer Foundation has an excellent website that includes very important information about skin cancer and its prevention.
• If you know someone who uses tanning beds please, please have them read this article:  A Death by Suntan at Age 26.  Just be forewarned – this story is heartbreaking.
• 5 Facts about Melanoma Prevention – Skin Inc.
• This race is a way to raise awareness and money for skin cancer research
• Five Things to Know about Sunscreen – Renee Rouleau blog

Image from skinsheen.com

April is Rosacea Awareness Month April 23, 2012

April is Rosacea Awareness Month so I thought it would be a good time to remind my readers about this skin disease.

Here are some basic facts about rosacea:

Rosacea usually first strikes individuals between the ages of 30–60, and may initially resemble a simple sunburn or an inexplicable blush. Suddenly, without warning, a flush comes to their cheeks, nose, chin or forehead. Then, just when they start to feel concerned, the redness disappears.

Unfortunately, it happens again and again, becoming ruddier and lasting longer each time–and eventually visible blood vessels may appear. Without treatment, bumps and pimples often develop, growing more extensive over time, and burning, itching and stinging are common.

In severe cases, especially in men, the nose may become enlarged from the development of excess tissue. This is the condition that gave comedian W.C. Fields his trademark red, bulbous nose. In some people the eyes are also affected, feeling irritated and appearing watery or bloodshot. Severe cases of this condition, known as ocular rosacea, can result in reduced visual acuity.

Among the most famous rosacea sufferers is former President Bill Clinton, whose doctors disclosed that he has this condition in The New York Times. Others reported to have suffered from the disorder include Princess Diana, financier J.P. Morgan and the Dutch painter Rembrandt.

In new NRS surveys, 69% of rosacea patients said they experienced a flare-up related to emotional stress at least once a month, and more than 90% of the respondents said they had suffered some form of physical pain from their condition. A burning sensation was the most commonly reported discomfort, named by 75%, followed by itching, cited by 65%, and stinging, mentioned by 62%. Other types of pain associated with rosacea included swelling (44%), tightness (42%), tenderness (40%), tingling (31%), prickling (23%) and headache (20%).

Perhaps even more ravaging than its physical effects, rosacea often inflicts significant damage to people’s emotional, social and professional lives.

Source:  Only on SkinInc.com: April is Rosacea Awareness Month – Are You Helping Rosacea Clients Cope?

Though there is no cure for rosacea this skin disease can be kept under control by making lifestyle adjustments (avoiding alcohol and steam rooms, applying proper sun protection, and avoiding other individual triggers) and using the right skincare products.  The right skincare products will be soothing, gentle, and anti-inflammatory.  Figuring out what triggers your rosacea to become worse and then avoiding and controlling those triggers makes a huge difference in how your rosacea looks and then affects your life.

Hopefully in the future scientists and doctors will find a cure for this skin disease.

Sources and Further Reading:

• National Rosacea Society
• My post – Rosacea: Causes, Triggers, and Treatment Options

Image from buynaturalskincare.com

Inflammation: The Ultimate Skin Enemy? January 24, 2012

One of the hottest topics in the skincare and dermatology world is the topic of inflammation and how it affects the skin.  Just as inflammation in the body can lead to disease and aging, inflammation in the skin can cause wrinkles, acne, hives, even eczema and rosacea.  With inflammation so prevalent in our bodies and skin how do you protect yourself and your skin?

What Is Skin Inflammation?

According to the article “Skin’s New Enemy” from Allure magazine (unfortunately the article is not available online):

Inflammation has become the hottest topic in dermatology today, since research suggests it plays a role in acne, aging, skin cancer, eczema, psoriasis, rosacea, and even hair loss.  “After the sun, inflammation is the skin enemy number one,” says David J. Leffell, professor of dermatology and dermatologic surgery at Yale School of Medicine.  …  Technically, inflammation is a necessary self-defense mechanism – the immune system’s response to infection, irritation, or injury.  The body produces inflammatory substances, such as histamines and cytokines, and blood vessels swell, sending immune cells to the skin to kill bacteria, says Bryan B. Fuller, adjunct professor of biochemistry and molecular biology at the University of Oklahoma Health Science Center in Oklahoma City.  It’s a kind of scrimmage, then, at a cellular level, with bacteria and viruses the losers (one hopes).  With foreign invaders vanquished, healing can begin.  The problem is that sometimes, thanks to genetic and environmental factors, inflammation becomes chronic.  Like a runaway train, it gains speed (stimulating production of skin-eroding enzymes) and mows down everything in its path (collagen, elastin).  While there are obvious states of inflammation, like a pimple or a rash, we may not even be aware that our bodies are on “red alert”.

Furthermore, according to the article “Seeing Red” in the January, 2012 issue of Day Spa magazine (once again – not available online):

Non-acute, or chronic, inflammation manifests in various ways, including ongoing swelling in the feet and ankles, sinus issues and skin problems.  “The skin is a telltale,” [Wallace] Nelson [naturopathic doctor and president of M'lis] says.  “In skin, inflammation manifests as acne, eczema, psoriasis and rosacea.”  Many people, including Nelson, see a dietary connection.  We know that compounds in the blood called C-reactive proteins are at high levels when inflammation is present.  “Saturated fats, salt, refined sugars and high-glycemic carbohydrates like those made from white flour are foods that set off C-reactive proteins,” says Nelson.

Dr. Amy Wechsler in her book The Mind-Beauty Connection   explains that most of us are not even aware of the fact that our bodies may be victims of chronic inflammation (pages 174-175):

Eventually, you do have to take note of [inflammation] when it builds up over time and results in an ailment or disease, from simple skin rashes and persistent acne t more serious problems like heart disease and cancer.

What fuels the endless burn of chronic inflammation?  Oxidative stress, or free-radical damage that can cause wrinkles and cancer.  Because free radicals steal electrons from other molecules, rendering those molecules handicapped and damaged, they both trigger inflammation and are created by it.

The sun’s UV light also generates an army of free radicals.  It’s estimated that half of the sun’s skin damage is caused by them.  Inflammation and UV assaults are like a one-two punch to your skin because its major components – fats, proteins, and DNA – are favorite free-radical targets.  The end results is, yes, skin aging: collagen breaks down, abnormal elastin increases, moisture is lost, wrinkles accumulate, and skin cancer may start brewing, too.

How Do You Treat Skin Inflammation?

There are actually a lot of different ways that you can treat your skin in order to reduce inflammation:

• Eat a diet rich in antioxidant foods – think brightly colored fruits and vegetables.  Drink green tea.
• Eat anti-inflammatory foods like those with omega-3 fatty acids like fatty fish (think salmon), flaxseed, and fish oil.
• Follow a low glycemic diet – eliminate white flour, processed foods, and sugar.
• Apply topical antioxidants.  No one antioxidant is better than other; they are all anti-inflammatory and soothing.  Vitamin C, green tea, coffeeberry, and resveratrol are all good antioxidants to try in skincare products.  For more information on antioxidants see my post Skincare Tip: Add Antioxidants to Your Home Skincare Regime for more details on antioxidants and specific product recommendations.
• Quit smoking.  Smoking creates more free radicals and causes vascular injury which the body then tries to repair thus setting off the inflammatory process in the body.  For more information about how smoking negatively affects your skin see my previous post How Smoking Ruins Your Skin.
• Allergies to skincare product ingredients, such as fragrance and preservatives, can increase inflammation.  Once you figure out which ingredients have caused a reaction keep a list with you so you can avoid them in the future.
• Moisture often – skin dryness can lead to the skin barrier, your skin’s first line of defense, being compromised which can trigger more skin inflammation.  A soothing moisturizer can help your skin restore its natural ability to protect and heal itself.  One line of moisturizers to try is from Epionce.  The concept behind this whole skincare line, developed by dermatologist Carl Thornfeldt, is to soothe, protect, and repair damaged skin barriers.  (I’ve been trying these products lately through my job, and I can definitely say that the feel great on the skin and smell wonderful too)
• Protect your skin with sunscreen.  Too much sun can lead to further skin inflammation.

Though preventing skin inflammation (and inflammation in the body as well) can seem daunting you can take some small but concrete steps to protect your skin.  Start by quitting smoking (if you smoke), use skincare products with antioxidants, and protect your skin with both moisturizer and sunscreen daily.

Further Reading:

• The Connection Between Inflammation and “Sensitive Skin” - The Skin Type Solution Library
• Physiology of the Skin: Inflammation and Aging by Peter T. Pugliese, MD and Michael Pugliese – Skin Inc.
• Inflammaging: Changing the Face of Skin Care – Skin Inc.

Image from achooallergy.com

How to Treat Dry Winter Skin January 16, 2012

 

As soon as the humidity and temperature drops almost everyone feels like they need a moisturizer for their skin.  With winter really upon us it’s probably time to change-up your skin routine a bit, if you haven’t already.  Treating dry and sensitized winter skin isn’t that hard.  Tweak your home skincare routine a little in order to restore moisture and balance to your skin.

Why Your Skin Becomes So Dry in the Winter

For a technical explanation on why our skin feels so dry and irritated during the winter, for those who like that, I’ll turn to the Skin Inc. article Understanding and Fighting Winter Itch by Dr. Ahmed Abdullah (if you want a less scientific explanation skip ahead):

Physiology of the stratum corneum

To understand skin hydration, it’s necessary to look at key components of the stratum corneum—the outermost layer of the epidermis that makes skin impermeable, and protects deeper skin tissue and the body at large from bacterial invasion and other environmental aggressors.

The stratum corneum is comprised of corneocytes, which are flattened, dead skin cells; desmosomes, the proteins that hold the corneocytes together; and intercellular lipids. Under a microscope, these components appear to be arranged in a brick-and-mortar manner, with corneocytes serving as the bricks, connected by desmosomes, and lipids playing the role of mortar that surrounds and protects the corneocytes. Collectively, these components create a physical wall intended to prevent moisture loss. However, the individual roles of corneocytes and lipids are equally important.

Corneocytes are mainly composed of keratin, which holds water and gives skin its strength, along with various other compounds called natural moisturizing factors (NMFs). As humectants, NMFs not only hold water, but also attract it; thus, they are essential to the skin’s flexibility and water-holding capabilities. However, they’re water-soluble, which is why skin dries out upon extended water contact from showering, bathing, swimming and hand-washing.

intercellular lipids are comprised of ceramides, free fatty acids and cholesterol. In the stratum corneum, their role is to prevent the loss of NMFs from within the corneocytes. On the topmost layer of skin, they combine with sweat to form the thin acid mantle—the chemical barrier that kills bacteria and regulates moisture loss. What’s more, lipids lubricate the skin and, as such, are a major factor in ensuring smooth texture.

Environmental impact on the stratum corneum

For the stratum corneum to properly protect the body, it must be elastic and flexible, which is only possible when the skin is properly hydrated. Normal, healthy skin is 20–35% water. Each day, it loses approximately a pint of water through transepidermal water loss (TEWL), the continuous process by which water leaves the body and enters the atmosphere via evaporation and diffusion. However, when humidity drops, as it does in cold-weather months, there’s a dramatic increase in TEWL as the dry air pulls moisture from the skin. When the skin’s water content drops below 10%, it begins drying and brings discomfort characterized by redness, itchiness and flakiness. With less water in the skin, the production of NMFs becomes impaired and lipid levels fall, setting in motion a vicious cycle that is hard to remedy.

Add to the mix ongoing or prolonged exposure to irritants, such as soap and even water, and you have a far worse situation. This exposure causes the skin’s acid mantle to disintegrate, which further increases the rate of TEWL and decreases lipid levels. The result is even drier skin that may crack and even become infected.

With less water and fewer lipids to lubricate and protect it, skin no longer exfoliates properly. This is what results in the excessive buildup of dead cells on the skin’s surface, giving it an ashy appearance. It also results in an overall degradation of skin health; skin can no longer properly heal itself.

The short, and very easy to understand, explanation about the cause of dry skin during winter?  I’ll quote Barney Kenet, MD, a dermatologist from New York Presbyterian Hospital and Weill Cornell Medical Center, from the WebMD article What’s Causing Your Dry Skin?:

“Dry air is probably the most common cause of dry skin, especially during the winter,” says Kenet, “It draws the moisture right out of the skin.” Dry skin during winter even gets its own name: winter itch.

While cold, harsh weather does dry your skin, another big problem in the winter lies indoors — the dry heat churned out by your furnace. (During the summer, air conditioning can have a similar effect.)

Tips to Fix Dry Winter Skin

First and foremost, if your skin is feeling dry, tight, and even itchy – simply moisturize.  Start off moisturizing twice a day, in the morning and the evening.  If you feel like you need to moisturize more than do that.  Be sure to apply your moisturizer to damp skin.  Once again according to Dr. Kenet in the WebMD article:

“You have to put on moisturizer when your skin is still damp,” says Kenet, author of How to Wash Your Face. ”That way, the moisturizer is trapping the moisture still on your skin.” Your skin shouldn’t be sopping wet — just pat yourself dry with a towel and put it on. Let it soak in for a few minutes, and then towel off the excess, Kenet says.

It is especially important to moisturize your hands multiple times during the day.  If you use hand sanitizer get one that is a moisturizing formulation.

Don’t take long, hot showers or baths.  Limit your time in the shower so that the warm water doesn’t further dry out your skin.  Don’t use drying bar soaps when you shower.  Switch to milder and thicker shower washes during the winter.

Invest in a humidifier for your home and even for your office.

Bundle up when you go outside so that your skin isn’t directly exposed to the air.

Eat Omega-3 rich foods like cold water fish, walnuts, and flax in order to fortify the skin’s natural oil retaining barriers.

Don’t put away your sunscreen!  Sun protection is as important in the winter as it is in the summer.

Finding the Right Moisturizer

I’ve been using Trader Joe’s Midsummer’s Night Cream moisturizer for years on my body after the shower and find it to be a very cost-effective and great body moisturizer.  When I need an extra boost of moisture for my face I like to use a B5 serum.  GloTherapeutics and Skinceuticals make good ones.   You could also use a moisturizing mask once or twice a week to add moisture back to the skin.  For more product ideas check out this post by FutureDerm about her favorite winter skincare products.

You actually don’t need to spend a lot of money on a moisturizer in order to find an effective one.  Once you settle on one use it often for the best results.

 

Sources and Further Reading:

• Prevent and Soothe Chapped Winter Hands – WebMD
• What’s Causing Your Dry Skin? – WebMD
• Understanding and Fighting Winter Itch - Skin Inc.
• Forecast: Dry and Flaky – DaySpa Magazine
• Fighting Back Against Dry Skin – WebMD
• 7 Tips to Soothe Your Dry, Itchy Skin – WebMD

Related Posts:

• Have I Finally Found My Cure For Chapped Hands?
• Winter Sun Care
• Dos and Don’ts for Winter Skincare
• Winter Skincare Tips

Image from The Metropolitan Museum of Art

August is Psoriasis Awareness Month August 11, 2011

August is Psoriasis Awareness Month so I wanted to use this post to highlight some resources for those suffering from this skin disease.

 

What Is Psoriasis?

According to Dr. Ellen Marmur in her book Simple Skin Beauty (pages 230-231) psoriasis is a condition that is:

 … characterized by thick, red plaque with a white, silvery (micaceous) scale on top.  It’s itchy and painful and can create big fissures on the skin.  It tends to be on extensor surfaces, such as the elbows, knees, and scalp.  There are several types of psoriasis, and some can be quite severe, affecting the joints and causing something called “psoriatic arthritis”.  It can also be mild, manifesting itself as one patch of plaque on the body, such as dry, cracked elbows that don’t soften no matter how much moisturizer you put on.

Psoriasis is a genetic, chronic inflammatory disease where for some reason lymphocytes (immune cells) are attaching the skin, causing cell turnover to accelerate.  Therefore, the dead skin cells aren’t shedding as fast as the maturing cells are rising to the surface.  This pile-up creates a silvery scale on the surface.

Psoriasis Treatments

If you do suffer from psoriasis there are some things you can do at home to help prevent your condition from getting worse.   Once again, according to Dr. Marmur:

Don’t scratch or try to scrub off the scaly skin.  Instead, moisturize with a thick, occlusive cream or ointment twice a day.  Sweat will irritate the skin, as will fragranced products or perfume.  Psoriasis sufferers have to be careful about everything they put on their skin – even sunscreen can sting.  Even one patch of plaque should lead you to see a dermatologist, especially since it’s likely that you will develop others in the future.  It’s important to get a good treatment program to prevent a more extensive outbreak.

So what other treatment options are out?  According to Dr. Amy Taub, as quoted in the article August is Psoriasis Awareness Month; Is Your Spa Ready? online at Skin Inc. :

• Laser. A 308nm laser provides targeted phototherapy treatment for psoriasis offering safe, effective and lasting results. This laser uses a focused beam of ultraviolet light on the affected skin area avoiding exposure to healthy skin.
• Topical agents. In mild psoriasis, where less than 10% of the body surface is affected, topical creams, ointments, gels and lotions are often applied first. These usually consist of steroids, vitamin D derivatives, retinoids (vitamin A derivatives) and tar-based topical treatments. The most common is a steroid because of its anti-inflammatory properties and because it also decreases the redness and scaling relatively quickly.
• Oral or injectables. When psoriasis is more severe or light treatments or topicals have failed, oral or injectable solutions may be considered. They work by decreasing the metabolism in overactive cells thereby decreasing the rapidity with which psoriatic skin is made helping to normalize it. In addition, sufferers now have biologic medications available, also known as “designer” drugs, which attack specific molecular targets in the immune system.

Dr. Taub tells SkinInc.com exclusively about possible psoriasis treatments that are currently in the works.

Awaiting U.S. Food and Drug Administration (FDA) approval, new biologic agents are being investigated at a very rapid pace. New receptor molecules have been identified as targets (called IL-23 receptors) that may be even more specific than the agents that are known about today. The older biologics have undergone many years of study, and the dermatologic community is finally feeling more confident about the long-term safety of these agents as a result of this data. In fact, there may even be some negative consequences of not treating psoriasis. More data is pointing to the fact that having unchecked psoriasis could lead to an increased risk of cardiovascular disease, leading many dermatologists to push more toward treatment as being more conservative.

If you think that you may have psoriasis see a dermatologist immediately in order to start a treatment plan before your condition worsens.  Please see below for lots of online resources for even more information about psoriasis.

 

Other online resources for information about psoriasis and treatment options:

• National Psoriasis Foundation
• Psoriasis – Paula Begoun
• Tim Gunn’s Fashion Therapy for Psoriasis  -  The New York Times
• Psoriasis Health Center - WebMD

Bumps on Your Arms: Solutions for Keratosis Pilaris April 18, 2011

So many people suffer from the following problem yet have no idea what it is.  Red, rough bumps on the back of your upper arms, face (especially in children), thighs, and even backside are actually a skin condition called keratosis pilaris.  According to Paula Begoun:

Keratosis pilaris has a few different forms: It can range from pink to red bumps on the cheeks to small red bumps that aren’t irritated, to pimple-like bumps that are inflamed and red. Overall, regardless of the type, these bumpy rough spots are clogged pores where skin cells have become hardened inside the pore and inflammation occurs.

So how do you treat keratosis pilaris?  In her book Simple Skin Beauty Dr. Ellen Marmur offers quite a number of solutions for keratosis pilaris, which is a form of eczema, along with some interesting insights into this condition (pages 219-220):

Instead of round bumps, dry skin can make triangular, pyramid-shaped bumps, or accuminate papules.  The keratin on top is shaped like a sharp spike which is why the skin is so rough.  There’s no good reason why these bumps are triangular while others elsewhere are round.  …  Like most eczema, the genetic condition stems from dry, sensitive skin and tends to get worse in the winter, when it’s cold and dry.  Ironically, most people with KP tend to do just the opposite of what they should to treat the condition.  They avoid moisturizing the area (thinking it’s a form of acne), when what’s really needed is the thickest cream possible.

The best prevention is slathering on a rich cream or ointment (one that contains occlusive emollients such as petrolatum, lanolin, and mineral oil) regularly to moisturize and protect the skin.  You can’t apply too much.  It will help keep the condition in check and may help it go away. …  When skin is chronically dehydrated, it tries to heal itself and the natural pattern of exfoliation is disrupted.  For this reason, you can use a loofah or body brush to gently scrub off the dead skin cells.  I also recommend over-the-counter lotions such as Lac-Hydrin or AmLactin to be applied once or twice a day.  They contain lactic acid (a great gentle exfoliant for sensitive skin) in a moisturizing base.  Another effective treatment is retinoid lotion, which regulates keratinocyte turnover and helps slough off the heaped-up, pointy dead skin cells.  To accelerate the exfoliation process, a dermatologist can do microdermabrasion and a light chemical peel followed by a deep moisturizing mask.  Once the area is smooth, a field of tiny red dots will be left behind.  They will fade somewhat though probably not completely on their own.  A pulsed dye laser treatment can make the redness go away faster.

Paula Begoun has a different solution for this problem:

Exfoliation to unclog pores is at the top of the list of treatments. Alpha hydroxy acids (AHAs, active ingredients would be lactic or glycolic acid) can help exfoliate skin cells, but these only work on the surface. AHAs can’t get inside the pore to dislodge the plug of skin and sebum.

To get to the root of the problem you need a beta hydroxy acid (BHA) product with the active ingredient salicylic acid and a pH low enough for exfoliation to occur. One other interesting aspect of BHA is that it has antimicrobial properties so it kills the bacteria that may be making matters worse. Plus, because salicylic acid is related to aspirin (aspirin is acetyl salicylic acid) it also has anti-inflammatory properties. Salicylic acid is a brilliant answer to eliminating these red bumps.

 And here is even more advice, this time from the May 2011 issue of Allure:

It’s better to use a chemical exfoliant than a physical one.  That means washes and lotions with alpha hydroxy acids.  Then use a hydrocortisone cream to reduce the redness, and the bumps should clear up in three weeks.

 

In the end, no matter whose advice you follow there are plenty of solution available for treating this common skin issue.

 

Further reading and products:

• Keratosis Pilaris: Solutions for Bumps on the Back of Arms - Paula Begoun
• Why the Skin on Your Arms Is Bumpy — and What to Do About It - WebMD
• Keratosis Pilaris - Yahoo! Health
• Though I have never tried this product I thought I would mention it since it was created just to treat keratosis pilaris:  DERMAdoctor KP Duty
• Allure recommends Glytone keratosis pilaris products
• A drugstore moisturizer you can try is AmLactin

Can You Get Rid of Cellulite? October 27, 2010

Is there any comfort in the fact that anyone can get cellulite?    Thin people get cellulite, rich people get cellulite, beautiful people get cellulite.  About 85% of women over the age of 18 have some degree of cellulite on their upper legs, buttocks, and abdomens.  It can affect you regardless of ethnicity, age, race, weight, and lifestyle choices because cellulite is mostly a genetic disorder.   This lumpy appearance on our thighs, some call it the cottage cheese look, is caused by fat cells bulging upwards – a function of the structure of how the fat and skin fit together.  Our epidermis, the top layer of our skin, has fibrous anchors that go down to the fat layer of our skin, and it is these connections that cause the dimpling appearance of cellulite.  While losing weight may help improve the appearance of cellulite on some people there are many other factors involved in the formation of cellulite that make it a huge challenge to treat.  Of course that doesn’t mean that Americans aren’t willing to try – by 2012 it is estimated that Americans will spend more than $215 on anti-cellulite treatments.

 

Myths About Cellulite

There are so many ideas out there about what causes cellulite and how to treat it.  In a piece on her website Paula Begoun debunks a number of  the biggest cellulite myths:

Drinking water helps: If water could change skin structure and reduce fat I assure you no one would have cellulite, or would be overweight for that matter. Drinking water probably is beneficial (although there is really no research showing how much is healthy versus unhealthy) but there is no research showing water consumption will impact fat anywhere on your body, let alone the dimples on your thighs.

Arguments for high water intake are generally based on the assumption that because our bodies consist mostly of wa-ter (50-70% of body weight, about forty-two liters) and our blood, muscles, brain, and bones are made up mainly of wa-ter (85%, 80%, 75%, and 25%, respectively), we therefore need at least eight 8-ounce glasses of water each day. But assumptions aren’t science and this one is a non-sequitur; it is similar to arguing that since our cars run on gasoline, they always need a full tank to run efficiently. (Source: American Journal of Physiology—Regulatory, Integrative, and Comparative Physiology, November 2002, pages 993-1004)

Water retention causes cellulite: It’s ironic that low water intake is considered a possible cause of cellulite, and the polar opposite—retaining too much water—is thought to be a factor as well. There is lots of speculation of how water retention can affect cellulite but there is no actual research supporting this notion. Further, fat cells actually contain only about 10% water, so claiming to eliminate excess water won’t make a difference and any measurable result would be transient at best. It is true that water retention can make you look bloated and feel like you’ve gained weight, but water itself doesn’t impact fat or the appearance of cellulite. (Source: Journal of Strength and Conditioning Research, November 2003, pages 817-821)Eating a specialized diet can help: A healthy diet that encourages weight loss may help your entire body look better. How-ever, because weight in and of itself is not a cause of cellulite, dieting won’t change the skin structure of your thighs, which causes the dimpled contours to show. For some people cellulite is made worse by the accumulation of extra fat. In those cases, weight reduction may decrease the total area and depth of cellulite. (Source: Clinical Dermatology, July-August 2004, pages 303-309)

Exercise can help: Exercise helps almost every system in the human body, but it won’t necessarily impact the appearance of cellulite. Exercise doesn’t improve skin structure and it can’t affect localized areas of fat. In other words, you can’t spot reduce fat accumulation in a specific area. (Source: British Journal of Plastic Surgery, April 2004, pages 222-227)

Detoxifying the body reduces the appearance of cellulite: Detoxifying the body for consumers has taken on the meaning of purging it of pollutants or any other problem substances in the environment or in the foods we eat. In terms of the way this concept has been mass marketed, there is little research showing credible efficacy as to whether or not detoxification of the body is even possible. However, “detoxifying” the body as it is used in the scientific community describes the process of reducing cellular damage primarily by antioxidants or enzymes that prevent certain abnormal or undesirable cell func-tions from taking place. There is no doubt this is helpful for the body. Whether or not this reduces cellulite is completely unknown because skin structure and fat accumulation are not caused by toxins in the environment. Furthermore, there are no studies showing toxins of any kind prevent fat from being broken down. (Sources: Journal of Endotoxin Research, April 2005, pages 69-84 and Journal of Biochemistry and Molecular Biology, May 2003, pages 258-264)

 

 

Treatment Options

 

Cellulite treatment options fall into two main categories:  topical products and machines.  I’ll also mention mesotherapy which are injections.

 

Topical Products

In my opinion, topical creams that claim to treat cellulite are pretty much a big waste of your money.  I’m certainly not alone in my opinion.  Ellen Marmur, MD in her book Simple Skin Beauty, page 213 writes:

As with most topicals, any visible results wash off or fade away fast.  Again, if any one of these really worked, it would be the hottest product on the market.  …  My advice:  save your money, let the cellulite battle go, and buy yourself a beautiful pair of shoes.  That will have a much better payoff.

Furthermore, Paula Begoun states:

As far as skin-care products for the body are concerned, the litany of options is mesmerizing. Yet there is almost no uniformity between formulas. It would appear, if the claims are to be believed, a wide variety of unrelated plant extracts can deflate or break down fat and/or restructure skin. Looking at the research, however, most articles suggest there is little hope that anything rubbed on the skin can change fat deposits or radically improve the appearance of cellulite.

The hope that botanicals have the answer is odd because not one study points to what concentration of an ingredient needs to be in a formulation, what physiochemical characteristics particular to each active ingredient need to be present, or whether or not these ingredients retain any standardized properties between batches. (Sources: Dermatologic Surgery, July 2005, pages 866-872 and The European Journal of Dermatology, December 2000, pages 596–603)

So as tempting as it is to think that you can solve your cellulite problem with a cream – skip it.   At best these creams and lotions very temporarily reduce the appearance of cellulite.   But there is one thing to keep in mind – a fake tan will make your cellulite less noticeable.  So thinking to invest in a good self-tanner is actually a viable option in order to disguise your cellulite temporarily.  (For a very thorough breakdown of both ingredients and products that claim to treat cellulite see Paula Begoun’s article)

 

What about in office treatments?

 

First let me talk about mesotherapy which I would advise against.  During a mesotherapy treatment caffeine, enzymes, anti-inflammatories, alphahydroxy acids, vitamins, or the drugs phosphatydalcholine and deoxycholate  are injected into the areas of cellulite and fatty deposits.  It is said that these injections help to break up fat cells (fat cells burst and die) and reduce cellulite.  Complications can include ulcers, scarring, deformities, skin infections, and tissue damage.  Mesotherapy is widely practiced in Europe, but highly controversial in the United States.  Currently the FDA has started cracking down on medical spas that offer this treatment, but it has taken the FDA time to look into the practice since it falls outside of FDA regulations.  The American Society of Aesthetic Plastic Surgery along with the Aesthetic Surgery Education and Research Foundation is conducting a FDA approved study on the safety and efficacy of mesotherapy.  There is a hope that in the future there will be both a FDA approved formula for injection and a standardization of procedures, safety, and protocols.   As I already stated, I would stay away from mesotherapy.  Once the FDA reaches its conclusions about this procedure it might be time to reconsider, but overall I think it will never be a good option for treating cellulite.

 

Machines

 

Perhaps you have heard of Endermologie or VelaSmooth for treating cellulite.  Endermologie uses rollers and suction to massage areas with cellulite, and while the device is FDA approved for cellulite treatment that does not prove that it actually works as claims.  At best these treatments are expensive and offer a temporary improvement in the appearance of cellulite.  So try Endermologie at your own risk, a risk mostly to your bank account.  Velasmooth combines infrared light, radio-frequency, and mechanical suction in an attempt to reduce the appearance of cellulite by heating the fat and liquefying it or reducing its size.  As with Endermologie a series of treatments is needed in order to see results with Velasmooth, and once again, treatments do not come cheap.  Results, as always, are mixed.    Personally I would save my money when it comes to both of these treatments.  While there are few risks to your health with these treatments, they also don’t really work.  The only place you will see a real difference is in your bank account.  Save your money!

There are even more procedures out there that claim to address cellulite including cellulite subscissions that uses a needle to sever the anchors under the skin so that the skin looks smoother.  While this might make theoretical sense, it works successfully on acne scars, safety studies are few and far between and the surgery is expensive.

 

 

Bottom Line

 

I’ll reiterate what Dr. Marmur wrote:

Save your money, let the cellulite battle go, and buy yourself a beautiful pair of shoes.  That will have a much better payoff.

And if you really, really want to try something to reduce the appearance of your cellulite before wearing a bathing suit or short skirt I’ll mention it again – use a self-tanner to temporarily disguise the appearance of cellulite.  Above all – don’t believe the hype or anything for that matter when it comes to cellulite treatments.

 

Sources and Further Reading

• Simple Skin Beauty by Ellen Marmur, MD – pages 212-213
• Caution Cellulite:  What Works & What Doesn’t - Paula Begoun
• For a very scientific look at cellulite read Dr. Peter Pugliese’s articles from Skin Inc. – A New Look at Cellulite Part I and Part II.
• Getting Rid of Cellulite:  Rating the 5 Best Current Cellulite Treatments – FutureDerm
• Mesotherapy information:  New Beauty Magazine, Summer/Fall 2010 – pages 66 and 145
• Bye-Bye Cellulite - WebMD
• Iron-Clad Cellulite Solutions – DaySpa Magazine (article not available online) has some good and some outdated information about cellulite treatments.  The article in good for the list of ingredients and products that supposedly fight cellulite.
  Also – this is an important blurb from the FDA website:  Thigh Creams (Cellulite Creams)

 

Another Reason to Love Tim Gunn: He Helps Those with Psoriasis October 11, 2010

I’m a huge Project Runway fan.  I realized that I’ve actually seen every episode of every season except for the very first episode of the first season of the show.  I think this season of the show has turned out to be one of the best, and my favorite contestant is definitely Mondo (who I really hope wins it all).  Anyhow, any fan of Project Runway must have an opinion about Tim Gunn who functions as a mentor to the fashion designers on the show.  Personally I think Tim Gunn is great.  I even read his new book which was interesting to say the least (I mean how many people describe themselves as “asexual”?  If you like Tim Gunn read this book; you can read it in a day or two.  Gunn definitely has some mother issues to work out, but I do appreciate his honesty and integrity.)

But back to skincare issues.  I read a Skin Inc. online article about how Tim Gunn and Dr. Susan C. Taylor (who wrote the book Rx for Brown Skin) are helping people with psoriasis ( Tim Gunn Hosts Online Style Resource for Clients with Psoriasis).  Amgen and Pfizer have launched an online resource center called Address Your Psoriasis! for people suffering from psoriasis with an emphasis on style:  making good fabric choices and finding clothes that are comfortable and breathable.  By teaming up with Tim Gunn and making these tips available online the creators of the website hope to help psoriasis sufferers look good and feel confident about their appearance.

Why is looking good such an issue for psoriasis sufferers?  Let me explain (I’ll quote from the website):

 

Psoriasis is a noncontagious chronic disease in which the immune system causes the skin cells to grow at an accelerated rate. 

Approximately 7.5 million American adults suffer from psoriasis. Although there are several types of psoriasis, approximately 80 percent of patients have plaque psoriasis.

Psoriasis is commonly diagnosed in early adulthood. Certain people may be genetically predisposed to develop psoriasis. A “trigger” often seems to cause symptoms to appear. These triggers may include emotional stress, injury to the skin, some types of infection, or reaction to certain drugs.

While there are several types of psoriasis, the most common form is plaque psoriasis. Approximately 80 percent of patients suffer from plaque psoriasis, which is characterized by skin lesions that appear as patches of thick, red, or inflamed skin covered with silvery scales. Instead of being shed, skin cells pile up, causing painful and itchy patches, which are also referred to as plaques.

While the exact cause of plaque psoriasis is unknown, we know that it is a disease involving the immune system. Certain cells in the immune system become overactive and release proteins called cytokines. Overproduction of these cytokines plays a large role in causing inflammation that leads to development of often painful and sometimes debilitating skin plaques.

In addition to the skin symptoms, plaque psoriasis can also negatively impact people’s lives in other ways. It can:

• Interfere with basic functions, such as sleeping, using hands, and walking, as well as sitting or standing for long periods of time.
• Impact a person’s job performance, with many patients reporting missed time from work due to their condition.
• Cause people to feel helpless, embarrassed, angry, frustrated, and/or self-conscious. This distress may lead to feelings of social isolation.

 

The better you look, the better you feel, right?  I’ve always believed that was true.  Since psoriasis can affect self-esteem so severely I was very happy to see these free online tips that can really help anyone with the condition feel much better about their appearance.   And now I have even more reasons to love Tim Gunn.

Rosacea: Causes, Triggers, and Treatment Options October 7, 2010

Rosacea poses a vexing problem for estheticians and physicians.  It is a fairly common skin condition since it affects around 16 million people a year yet a poll found that 78% of Americans have no knowledge of this condition and do not know how to recognize or treat it.  Perhaps what is most frustrating about rosacea is that there is both no known cause* or cure (though there is ongoing research to determine the cause of this disorder).  Correct diagnosis can be difficult since there is no test for rosacea and symptoms can sometimes mimic those of acne or other skin problems and diseases.  Be sure that you trust the source of your rosacea diagnosis.  I should point out here that we estheticians cannot legally diagnosis health problems and rosacea is classified as a skin disorder.  So while an esthetician may be sure you have rosacea because of her experience be sure to get a physician’s opinion as well.  Plus as you will read below there are treatment options for rosacea that can only be dispensed by physician.

 

What is Rosacea?

 

Rosacea is a genetic inflammatory skin disorder that usually affects the face but can also affect other parts of the body as well such as areas as the chest and ears.  It is particularly common in people with fair skin and light-colored eyes.  Normally the symptoms of rosacea appear after the age of 30, and rosacea is more commonly found in women than men.  But interestingly rosacea is usually worse in men than in women.  Rosacea shows a range of symptoms from mild to severe (see the illustration below).

According to The National Rosacea Society:

 

Rosacea (pronounced “roh-ZAY-sha”) is a chronic and potentially life-disruptive disorder primarily of the facial skin, often characterized by flare-ups and remissions. Many have observed that it typically begins any time after age 30 as a redness on the cheeks, nose, chin or forehead that may come and go. In some cases, rosacea may also occur on the neck, chest, scalp or ears. Over time, the redness tends to become ruddier and more persistent, and visible blood vessels may appear. Left untreated, bumps and pimples often develop, and in severe cases the nose may grow swollen and bumpy from excess tissue. This is the condition, called rhinophyma (pronounced “rhi-no-FY-muh”), that gave the late comedian W.C. Fields his trademark bulbous nose. In many rosacea patients, the eyes are also affected, feeling irritated and appearing watery or bloodshot.

 

 

Sun exposure and other rosacea triggers, more on triggers in a moment, cause blood vessels near the surface of the skin to dilate.  As this occurs the complexion appears red.  This causes the body to send inflammatory cells to the area of the dilated blood vessels and even triggers the growth of more blood vessels in the area.  The body tries to stop this process by creating more veins so that the inflammatory cells can fix the problem but all this does is create more of a problem. 

 

Rosacea Triggers

 

If you have been diagnosed with rosacea you need to take the time to figure out your triggers.  Managing your triggers will help keep your symptoms under control as much as possible.  UV (aka sun) exposure is one of the biggest rosacea triggers.  Using sunscreen and staying out of the sun (wearing a hat as well) are key to controlling rosacea.  Heat, stress, hormones, hot tubs, fragrance, allergies, spicy food, alcohol, exercise, and topical products can all trigger rosacea flare-up or make symptoms worse.

 

Rosacea Treatment Options

 

 First and foremost use your sunscreen everyday if you have rosacea.  Do not forget to reapply throughout the day even if the only time you are “outdoors” is when you are only driving to and from work.  Figure out your personal rosacea triggers and avoid them.  Use gentle skincare products (recommendations below) that contain anti-inflammatory ingredients.

A doctor can prescribe Metrogel (metronidazole) which is a powerful anti-inflammatory.  Some doctors prefer to prescribe Finacea which is azaleic acid, another strong anti-inflammatory ingredient.  Lotions and creams with sulfur, yet another anti-inflammatory ingredient, may also be prescribed.  If those steps are not enough than oral antibiotics such as Oracea may be prescribed.  Hydrocortisone is only sporadically prescribed today to patients, but a low dose of a beta-blocker like propranolol may be prescribed to prevent vasodilation and redness.

In terms of in-office treatments for rosacea IPL (intense pulse light) and laser treatments are available.  IPL is a very effective way to get rid of extra blood vessels and to calm redness.  In the case of severe rosacea a doctor may opt to treat with a laser such as the Vbeam instead of using IPL.

Rosacea patients need to be patient since it usually takes 12 to 16 weeks to see improvement when treating rosacea.  Additionally, as with acne you must be diligent and persistent in treating rosacea since, as of yet, there is no cure for this disorder.

 

Products:

• Obagi Medical, which is a great physician dispensed skincare line, as set of products for rosacea:  Rosaclear
• I have also seen that Avene has a rosacea line though I don’t know anything about it specifically.

 

Sources and Further Reading 

• Taming the Tempest MedEsthetics July/August 2010
• Recognizing Rosacea - Skin Inc. August, 2011
• Simple Skin Beauty by Ellen Marmur, MD – pages 234-236
• The National Rosacea Society is a great source of information
• RosaceaNet  part of The American Academy of Dermatology website
• Rosacea: The Cause of Red Skin  New Beauty Magazine Spring-Summer 2010 – pages 89-92

 

*  There is a theory that rosacea is caused by microscopic skin mites but as with all theories about the causes of rosacea this has not been conclusively proved.