Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Skin of Color and Skin Cancer – Everyone is at Risk July 31, 2010

There is a very simple reason why I chose to place a photo of Bob Marley at the beginning of a post on skin cancer and skin of color – Bob Marley died of melanoma at the age of 36.

The Skin Cancer Foundation has devoted a page to this subject (written by Mona Gohara, MD and Maritza Perez, MD) their website which does an excellent job at explaining the skin cancer risks that people of color face:

Caucasians are the primary victims of skin cancer. However, everyone, regardless of skin color, can fall prey to it. Unfortunately, many patients and even some physicians are under the impression that non-Caucasian people are immune to this disease. That is one reason people of color are diagnosed with skin cancer at later stages. These delays mean that skin cancers are often advanced and potentially fatal, whereas most skin cancers are curable if caught and treated in a timely manner. Tragically, this is what happened to legendary reggae musician Bob Marley: What was dismissed as a soccer injury under his toenail turned out to be an aggressive form of melanoma that ultimately caused his death at 36. Mr. Marley’s story reminds us why both medical providers and the public need to be educated about skin cancer and skin of color.  …

 Basal cell carcinoma is the most common skin cancer in Caucasians, Hispanics, Chinese, and Japanese Asians,8-10 and the second most common skin malignancy in African Americans and Asian Indians.8 In all races, basal cell carcinoma is usually linked to UV light exposure. Basal cell carcinomas are mainly found on body parts that receive the most sun exposure (Figure 2). A study from Howard University, Washington, DC, revealed that 89 percent of basal cell carcinomas on naturally brown skin occur on the head or neck.6 The correlation between UV light and basal cell carcinoma in darker skin types explains the relatively higher incidence of this malignancy among darker-skinned populations living in sunnier climates, such as Hispanics residing in New Mexico and Arizona.8,15

Basal cell carcinomas rarely metastasize (spread to other parts of the body). However, one study showed that when Hispanic patients develop basal cell carcinomas they are more likely to have multiple lesions either at the time of presentation or in ensuing years.16 Risk factors other than UV light for basal cell carcinoma in minority populations include previous radiation therapy, albinism (a group of genetic disorders that causes people to have a partial or total lack of melanin), trauma, burn scars (particularly among Asian Indians), other chronic scarring processes, arsenic exposure, solid organ transplantation, and genetic skin conditions.

Squamous cell carcinoma (SCC) is the most common skin malignancy among African Americans and Asian Indians, and the second most common skin cancer among Hispanics and Chinese/Japanese Asians.6,8,17-19 Information from the Singapore Cancer Registry suggests that UV light plays an appreciable role in skin cancer development among fair-skinned Asian populations,10 and a Hawaiian study revealed that the incidence of basal cell carcinoma, squamous cell carcinoma, and Bowen’s Disease (a type of squamous cell carcinoma) was at least 45 times higher in the Japanese population of Kauai, Hawaii (a sunny climate) than among the Japanese population in Japan (a temperate climate).20

UV light is not the primary risk factor for the development of squamous cell carcinoma in brown-skinned persons within the African Diaspora, and the head and neck are not the most common sites for squamous cell carcinoma. Among African Americans and native Africans, squamous cell carcinomas occur mainly on the legs, followed by the anogenital region (including both the anus and genitals) (Figure 2).6,8,21-23 Skin conditions that result in scarring or chronic inflammation, such as discoid lupus; leprosy; burn scars and non-healing skin ulcerations are the main risk factors, along with radiation therapy and physical or thermal trauma.6,8,21-23 Unlike the squamous cell carcinomas that most Caucasians develop, those occurring in people of African descent due to scarring or chronic inflammation can be aggressive, and have a higher tendency to lead to metastasis and death (Figure 3). One reason for this is, again, later detection and treatment.

Melanoma is the third most common type of skin cancer among all racial groups. Although UV light plays a role in the etiology of melanoma in Caucasians, the primary risk factor for melanoma in people of color is undetermined8, though incidence among Japanese and Hispanics residing in both Puerto Rico and South America and Hispanics residing in New Mexico have increased.8,24-26 Among African Americans and others of African descent, Asians, Hawaiians, and Native Americans, melanomas are most likely to appear in the mouth, or in the form of acral lentiginous melanoma — melanomas on the palms of the hands, soles of the feet and under the nails (as in Bob Marley’s case) (Figures 2, 4). Among fair-skinned Hispanics, evidence suggests the trunk and legs as the most likely areas of involvement, and the feet as the most common location in dark-skinned Hispanics.

figure4b
figure4a

Figure 4. Acral Lentiginous Melanoma in a brown-skinned patient.

Other reported risk factors for melanoma in minority populations include: albinism, burn scars, radiation therapy, trauma, immunosuppression, and preexisting moles (especially on the palms/soles and mouth).

Due to delayed diagnoses and advanced stage at disease presentation, the five-year mortality rates of non-Caucasians who have melanoma are higher (in many instances significantly) than those of their Caucasian counterparts.27

The doctors conclude their article by writing:

The US Census Bureau projects that by the year 2050, 50 percent of the US population will be comprised of Hispanics, Asians, and African Americans.28 Now, more than ever, it is pivotal to raise awareness of skin cancer in people of color.

EVERYONE needs to use sun protection on a daily basis.  No matter what color your skin is if you see a suspicious lesion anywhere on your body be sure to have a dermatologist look at it immediately.

Further Reading:  Dark-skinned Clients Encouraged to Receive Skin Cancer Screenings  Skin IncJuly, 2010

 

Drink Your Way To Firmer Skin – Taste Test July 29, 2010

In February I published a post entitled Can You Drink Your Way to Firmer Skin? about Nescafe’s instant coffee with collagen which at the moment is only available in parts of Asia.

I explained in my post that:

It would be great to think that by simply drinking your morning coffee you are strengthening your skin and looking younger with each sip.  Our skin is comprised of two layers – the top layer called the epidermis and the lower layer (or “live layer”) called the dermis.  While the epidermis is primarily made of soft keratin, collagen makes up 70% of the dermis.  The dermis also contains elastin and hyaluronic acid.  As we age collagen and elastin break down and weaken and wrinkles and lines appear.*  As I’ve mentioned in earlier posts the best way to protect your skin, and even slow down this collagen and elastin break down from happening, is to use sunscreen.  Yet wouldn’t it be nice that if all you had to do to repair the damage to the collagen and elastin in your skin would be to drink some coffee with collagen?

Before you get excited and start to wonder when this coffee will be available in the US please realize that it simply doesn’t work.  If collagen is ingested via the mouth it is simply broken down in the stomach and then excreted.  The collagen never gets to your skin. 

 

I finished my post by asking:  how does the coffee taste?

Well now I have the answer to that question!  My husband just returned from a week-long business trip to Singapore, and one of his first stops after arriving in Singapore was to buy me the coffee.  I was very excited when he presented me with package upon his return and was eager to look at the ingredients and try the coffee.

Of course I must confess something:  I absolutely, positively HATE the taste of instant coffee!  When I moved to Israel 12 years ago, a country whose citizens enjoy espresso drinks in cafes throughout the day but almost exclusively drink instant coffee at home, I packed a small french press in my luggage to save myself from the horror of ever having to drink instant coffee.  So truthfully I figured I wouldn’t like the taste of the coffee; I was just really curious to see if I could taste something “different” – the collagen perhaps?  Since the package my husband brought me contained 20 individual servings of the drink I figured that once I had my taste test my husband, who does like instant coffee, would drink it. 

Ok – I hated it!  It turns out that this isn’t even “straight” instant coffee but a premixed drink with coffee, sugar, and cocoa in it.  In my opinion it was sweet and nasty tasting, but my husband declared that it tasted like instant hot cocoa (he meant that as a good thing).  I couldn’t discern any sort of collagen taste at all.

What can I say?  I wouldn’t recommend it as a beverage or as a beauty drink but as a cultural oddity it gets a thumbs up from me.

 

Shine Free: Part II – This One is For Men July 27, 2010

Recently I wrote a post about how to deal with excessively oily or shiny skin – a problem numerous people experience.  I have to admit that the advice I gave in the post was really directed at women and not men.  So I was pleased to see the following article in The New York Times (yes, readers I am once again mentioning an article from The New York Times.  What can I say?  I love reading The New York Times):  Seeking to Shine (Not to Be Shiny).  The article is all about how men also suffer from oily and shiny skin and what they can do to combat the problem.  It turns out that:

Although many men prefer not to use moisturizer — or, at least, prefer not to admit that they do — enough have embraced anti-shine products to make the category blossom. Mintel, the market research firm, predicts that there will be 36 new “mattifying moisturizers” for men in 2010, a 56 percent increase over the number introduced in 2008.

The overall market for men’s grooming products has flourished. Retail sales reached $5.6 billion in 2009, up from $3.8 billion in 2004, an increase of 46 percent, according to Packaged Facts, a market research firm.

 

So good news – men now have as many product options as women when it comes to combatting shiny and oily skin, and they do not need to use products marketed towards women.  I guess this is a bit of sexual equality in reverse.

 

What Freckles Say About Your Skin July 25, 2010

Filed under: beauty,Skin and Skincare — askanesthetician @ 4:03 pm
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What are freckles and what do they “say” about your skin if you have them?

Freckles are an indication of sun damage; no one is ever born with freckles.  Luckily doctors don’t consider freckles dangerous, but since freckles are normally found on people with both lighter skin and eye color they are an indication that that person is at a higher risk for skin cancer.  Of course even people with darker skin can develop freckles.  If you have freckles be meticulous about using sunscreen and be sure to get annual skin cancer checks.

There is even a gene that is believed to be responsible for the formation of freckles.  That gene is called the MC1R gene and is associated closely with fair skin and red hair.  Freckles generally appear in early childhood and can increase with as a result of sunburn.  For some people freckles partly fade with age.

If you aren’t the type to embrace your freckles and would like to get rid of them consider getting laser treatments to do just that.  Or you could use topical lightening products in order to fade the appearance of your freckles – see my earlier post Help for Hyperpigmentation for more information.

 

Sources and Further Reading

 

 

Book Review: The Skin Type Solution by Leslie Baumann, MD July 23, 2010

I’ve already mentioned Dr. Leslie Baumann a few times in my blog mostly in connection to her blog on The Skin Guru on Yahoo! Health.  While for the most part I enjoy reading her blog I never liked the fact that Dr. Baumann continually disparages estheticians’ knowledge and expertise instead of realizing that doctors and estheticians can work well together and that their skills can complement one another.

If you read Allure magazine you are already familiar with Dr. Baumann’s name since she is quoted in that magazine almost monthly.  They even named her one of their top “influencers” in the field of fashion and beauty this past year.  Certainly when it comes to sharing her expert opinion on all matters connected to skincare Dr. Baumann is no stranger to fashion magazines.  Her enthusiasm for sharing her opinion about products has even gotten her in trouble with the FDA.

Besides for her constant media and print appearances Dr. Baumann is well-known for her book The Skin Type Solution which promises to save you both time and money in choosing your skincare products.  Since Dr. Baumann is both a practicing physician and a researcher (more on that later) she claims to have a unique perspective into knowing what products work well and which are a waste of money.  Furthermore, one Dr. Baumann’s contributions to the field of skincare is her expansion of the whole idea of skin types upping that number from five (dry, oily, combination, sensitive and normal) to sixteen. 

In order to figure out where you land on Dr. Baumann’s skin type assessment you need to fill out the questionnaire that is found at the beginning of her book.  The questionnaire measures four different factors in the skin: oiliness vs. dryness, resistance vs. sensitivity, pigmentation vs. non-pigmentation, and tightness vs. wrinkles.  For instance once I filled out the questionnaire and tallied my results I found that according to Dr. Baumann’s criteria my skin type was: OSPT or oily, sensitive, pigmented, and tight (though for the part when it came to tight vs. wrinkled I was really borderline).  I thought that was a good assessment about my skin.  Once you finish the questionnaire and determine your skin type you flip to the section of the book that corresponds to your skin type in order to learn more about your skin including numerous product recommendations.

Each different skin type has its own section that includes lots of information as it relates to that skin type exactly.  The information in each section is then subdivided into categories such as:  “about your skin”, “a close-up look at your skin”, “everyday care for your skin”, “daily skin care”, recommended products, “shopping for products”, “procedures for your skin”, and ongoing care for your skin”.  All good things especially the daily skin care regimes which really explain how and when to use your products; I think is always valuable.  You get a lot of information about your skin – a lot.  What can be confusing is all the asides or ifs and differences.  For example (page 69, paragraph two):

The OSPT Skin Type is quite common among people with medium and darker skin color, like Caribbean-Americans, Latin-Americans, Asians, and Mediterraneans.  Lighter-skinned people from other ethnic backgrounds, like the Irish or English, can be OSPTs, as can a redhead with freckles, which are a form of pigmentation. If the questionnaire revealed that you’re an OSPT, but you don’t experience all the symptoms I’ll cover, your rest result isn’t wrong.  OSPTs share many common problems, but there are some differences, so throughout this chapter, I’ll discuss the various symptoms, tendencies, and treatment options typical for dark, medium, and light-toned OSPTs.

Interspersed amongst the chapters are information about eczema, rosacea, acne, skin dehydration, sensitive skin, skin cancer, etc.  If your specific chapter doesn’t contain information about something you are interested in learning more about you can always use the index in the back of the book to locate the chapter that does.  Because of organization issues like that I found the book a bit choppy.  Of course I read the book straight through and didn’t just read the chapter for my skin type maybe if I had done that I wouldn’t have felt that the book was so choppy.

 

Things That Made Me Say “huh?”

 

There were a number of things that Dr. Baumann wrote in her book that made me raise my eyebrows.  For instance in the chapter for my skin type – oily, sensitive, pigmented, and tight – under the category “skin care ingredients to avoid if acne prone” jojoba oil is one of those ingredients.  I was very, very surprised to see that there since I feel (and I am not the only one) that jojoba oil is actually a great skincare ingredient for acne prone skin needing moisture.  [See my earlier post Ingredient Spotlight: Jojoba Oil for more information]  No explanation is given for including this ingredient in the list of ingredients to avoid.  In addition, Dr. Baumann continually recommends copper peptides as  great anti-aging ingredient.  I found that really interesting in light of the fact that few other experts agree with her.  Take for example what Dr. Ellen Marmur (also a dermatologist) writes about copper peptides in her excellent book Simple Skin Beauty:

Because copper is vital to enzyme function in the body, it follows that it’s also important to the synthesis of extracellular matrix in the skin.  I sound like a broken record, but although the notion of applying copper cutaneously to assist skin function is interesting in theory, it many be ineffectual in practice.  Is there enough concentrated copper peptide in an over-the-counter product, and is it stable?  Can it actually penetrate the skin to have an effect on the enzymatic workings of the body?  Personally, I would rather eat foods containing copper (such as sesame, sunflower sees, and cashews) to be sure the element is getting into my body to do its amazing job.  I’m doubtful [about copper peptides] until stronger scientific data proves the claims.

Lastly, Dr. Baumann recommends using eye creams with Vitamin K in them to help undereye circles.  Though many skincare companies have jumped on the Vitamin K bandwagon there is little proof that it actually does help undereye circles.

Issues like that made me wonder if I should believe everything written in this book.  It made me want to take Dr. Baumann’s advice with a grain of salt.

 

But My Real Issue?  The Product Recommendations

 

Dr. Baumann’s bio at the back of her book describes her thusly:

Leslie Baumann, M.D., is professor and director of Cosmetic Dermatology at the Miller School of Medicine at the University of Miami, and founder of the university’s internationally recognized Cosmetic Center.  She is on the advisory boards or does research for many companies, including Johnson and Johnson (Aveeno, Neutrogena), Avon, Allergan, and others.

 

So guess how often Johnson and Johnson products (Aveeno, Neutrogena, and Clean & Clear) are recommended in this book?  A lot.  So I found it hard to believe when I read the following (page 9):

Instead of letting you waste your valuable time and money tracking down products that wind up in the trash, I will direct you to ones that will really help.  I’ve reviewed the clinical trial date for the products, when available, to offer those proven effective.  Finally, since my patients have used my recommendations, I’ve listened to their feedback and tracked their treatment results to guarantee the efficacy of the treatment approach and product selection for each Skin Type.  All you have to do is take the test, determine your Skin Type, and choose from products in your chapter.  And at least when you splurge on products and procedures, you’ll know you are getting your money’s worth.

The recommendations are independent of any relationships that I have with the companies that manufacture them.  Of course, when I with a company, I know more about its products.  However, I work with over thirty-seven companies and have approached many others for information while writing this book. 

 

I don’t know – I guess I’m not buying her complete impartiality.

I was happy to see that Skinceuticals and Topix products were recommended since they are both great product lines.

 

Skin Type Solutions Website

 

Throughout the book Dr. Baumann continually reminds her reader that they can log on to her website Skin Type Solutions for more product recommendations, to share their thoughts about their skin type and skincare products, and to get more skincare information in general.  The site even has its own version of her skin type questionnaire.  So that made me wonder – why do I need the book at all if everything is online?  Of course, someone had thought of that as well.  While the online quiz will tell you what your skin type is according to Dr. Baumann’s criteria (it took me about 5 minutes to complete the online quiz) it will only give you the briefest of summarizes afterwards about your skin type – no recommended skincare regimes, no product information, and no in-depth information at all.  You’ll need the book for that.

 

Buy It?

 

I would actually recommend NOT buying this book simply because most of the information in the book isn’t going to be relevant for you.  That isn’t to say that I didn’t learn some new things from the book because I did.  There is valuable information in the book, and taking an in-depth questionnaire that forces you to think about your skin is actually great.  Having lots of detailed advice about your skin type is also extremely valuable in my opinion even if I don’t agree with lots of Dr. Baumann’s product recommendations.  So I would recommend that you check the book out of your local library or take an hour to sit in the library, take the skin type quiz, read the section of the book that is relevant to your skin type, and photocopy just that section.  I just don’t see a reason to keep a copy of this book at home.  If you want to have a skincare book at home I will once again recommend the following books (see my reviews):

 

Do French Women Know the Secret to Growing Old Gracefully? July 21, 2010

Have French women figured out how age gracefully (see Catherine Deneuve age 66 above)?  Do they know something that American women must immediately learn?

If one is to believe the article in The New York Times  Aging Gracefully, the French Way – then the answer is yes.  According to author, an American who lives in Paris:

…  even the average Frenchwoman — say, shopping along the Rue du Faubourg St.-Honoré or enjoying a leisurely lunch on the Left Bank, or strolling through the Luxembourg Gardens — seems to defy the notion that, as one grows older, you either have to disguise that process with Botox, eye-lifts, lip plumpers and all sorts of procedures that convey a desperate “youthful” look, or else just give up altogether and let the ravages of time take their toll.

But do these women really have the answers when it comes to the aging process?

Women on both sides of the Atlantic realize that the keys to aging well are obvious, but challenging if you have bad genes, spend too much time in the sun or smoke a lot. But while American women, like me at least, approach personal care with practical efficiency, the Frenchwomen I know regard the pampering of the skin, hair and body as an enjoyable, gratifying ritual.

Looking attractive, at any age, is just what Frenchwomen do, especially the urban ones. For Parisiennes, maintaining their image is as natural as tying a perfect scarf or wearing stilettos on cobblestone streets. Beauty is a tradition handed down from generation to generation.

 

Frankly, the article is a hodgepodge of the author’s informal observations of the chic Parisian women that she knows along with an interview here and there with a French celebrity or doctor.  This article is as a scientific analysis of attitudes and ideas about aging as the science projects you did in grade school, but certainly the article hit a nerve – it received 276 online responses.  Though I did not go through each and every response the ones I did read correctly pointed out that the author concentrated on observing a very small section of the French female population when making her statements about how French women age.  Frankly, I don’t think one nation holds the secrets to aging gracefully.  The idea of how one should look as they grow older is so individual and no one nation holds monopoly over the idea or the methods of achieving that goal.

Having said all that I did find what the author wrote about how French women, or her perception of how French women, care for their skin to be very interesting.  I find myself struggling as an esthetician to educate and convince women of all ages that they must invest in proper skincare products and take the time to care for their skin twice daily.  I cannot tell you how many people I know – friends and clients of all ages – that still resist the notion that they must use sunscreen.  So even though I wonder how much the following statements apply to all French women I was happy to read this:

Frenchwomen also recommend facials, massages and spa “cures” in their campaign against wrinkles, cellulite and saggy bottoms, bellies and breasts.  …  

Of course, it’s easy to look natural if your skin is great. And that may be where the French secrets really are. According to a 2008 Mintel report, Frenchwomen spend about $2.2 billion a year on facial skin care — as much as Spanish, German and British women put together. If you happen to use the bathroom in a French home — something that is not considered polite, by the way — you might see a line of skin care products rivaling a shelf at Duane Reade.

There will be day creams (with sunscreen), night creams (without it), re-pulping creams, serums, moisturizers, cleansers, toners and salves for anything from orange-peel skin to varicose veins. But you might not find much soap. Ms. Caron says she doesn’t use it on her face or her body (except for “certain places”). Madame Figaro magazine recently quoted the French actress and TV presenter Léa Drucker as saying, “The day I stopped using soap, my life changed.” Post-transformation, she uses a hydrating cream.

 

All of this got me wondering – how many estheticians are there in France and is it easy to build up ones esthetics business there?   As my fellow estheticians know estheticians in the US struggle at times to make a living.  Should we all move to France?  Just an idea.

For more of Ann M. Morrison’s tips on aging gracefully see:  10 Ways to Age Like a Frenchwoman.

 

Bodywash that Gives Sun Protection July 19, 2010

In my opinion one of the more intriguing sun protection products on the market is bodywash that leaves behind sunscreen on your body even after you wash off the product.

The wash-on sunscreen works thusly:  the sunscreen is actually magnetically attracted to your skin.  The sunscreen is positively charged and your skin in negatively charged so the active ingredients in the bodywash actually cling to your skin and stay there after you shower. 

This is a great way to get moderate sun protection (the products have a spf of 15) with no hassle.  The bodywash won’t leave behind a sticky or greasy residue or feeling.  Since it is only a spf of 15 this is not adequate protection for a long day outdoors or a day at the beach.  But if you are only walking from your house, to your car, and going to work this will give you enough protection.

Product to try:   Solise

If anyone knows of any other bodywash products with spf please let me know.

Source and further reading:  Simple Skin Beauty by Ellen Marmur, MD, page 84 and SPF Body Wash allure.com

 

 
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