Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Why Is Hyperpigmentation So Hard To Get Rid Of? June 23, 2016

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One of the more difficult skincare problems to solve is hyperpigmentation or dark spots on your skin.  This is also a very prevalent skincare issue that affects people of all skin tones.   Just where do these frustrating spots come from and how can you get rid of them for good? In this post I want to give you some insight into what causes hyperpigmentation in the first place and how to combat it effectively.

How Does Hyperpigmentation Form?

There are a few different types of hyperpigmentation or dark (brown) spots that can form on the skin.  You can get hyperpigmentation from the sun, from hormones, or as a result of an injury to the skin.  This last type of hyperpigmentation includes the marks that show up on the skin after a pimple heals.  (Please keep in mind that while many people call the red or brown marks that are left on the skin after a breakout heals “acne scars” they are definitely not scars but rather hyperpigmentation)   Certain ethnicities are more prone to hyperpigmentation than others.  Interestingly enough the treatment for hyperpigmentation is the same no matter its source.

I’ve been having an internal debate how technical I should be in explaining how hyperpigmentation forms because it is easy to get very lost among the scientific terms and processes that occur in the skin.  I also feel that such an explanation can be a bit overwhelming for non-science people (I include myself in that category).

I decided to take a middle of the road approach in my explanation.  Here it goes.  Your epidermis (the top layer of your skin) contains melanocytes which produce melanin. Melanin determines your skin color and tone. Everyone has the same number of melanocyctes in their skin; your skin color is determined by the amount of melanin activated in the skin.  Melanin is also the pigment that protects your skin from UV rays.  So when your skin experiences excessive sun exposure or prolonged sun exposure year after year, day after day more melanin is produced in order to protect your skin from the sun’s damaging rays.  A tan is actually a sign of your skin’s “self defense” mechanism kicking into gear.  Sorry to say but with every tan you get you’ve done damage to your skin. Dark spots from the sun can show up in a cluster on one area of your face, perhaps on the side of your face that is exposed to a window in your office or while driving, and can take years to appear after the initial damage has been done to your skin.  Many times as an esthetician I find it hard to convince people to use sunscreen on a daily basis simply because the damage daily sun exposure is doing to their skin is not evident at first.  It can be hard to for people to realize that they need sunscreen everyday when the damage they will see from the sun will only show up 10, 20 years later.  So please remember to apply sunscreen daily in order to prevent hyperpigmentation in the future.

Melasma is the hormonal hyperpigmentation.  Many women develop this type of hyperpigmentation during and after a pregnancy or from using birth control pills.  The hormonal changes that are going on in your body due to pregnancy or the use of birth control pills cause this type of hyperpigmentation to form though exactly what doctors are still not entirely sure.  Sun exposure can make melasma worse. Some lucky women may find that their dark spots fade a bit after giving birth, but for many women this type of hyperpigmentation is an unhappy side effect from a happy life event.

Post inflammatory hyperpigmentation is the red, brown, or even yellow marks that are left on the skin after an injury to the skin or after a breakout has healed. Once again as a defense mechanism, in this case a defense against skin inflammation, the body produces extra melanin.  If there is one positive from this type of hyperpigmentation it is usually the easiest kind to get rid of.

Treatment

First of all it is important to keep something in mind when treating hyperpigmentation – there are no quick fixes for this skin care problem.  You need time, patience, and the daily use of skin care products in order to get rid of hyperpigmentation.  If you have had a dark spot on your face for 6 years you cannot expect it to disappear in just a month.  When I say patience I really mean it.  You need to religiously use the right skin care products at home in order to eventually see results months down the road.  Once hyperpigmentation occurs, with the exception of red marks (and some types of brown marks) left on the skin after breakouts heal, your dark spots have no real desire to go anywhere.  If anyone promises you a miracle cure for hyperpigmentation run in the opposite direction.  Also please don’t put lemon juice all over your face and go out in the sun expecting to fade dark spots.  No matter how many times this skincare hack appears in your Pinterest feed you need to ignore it.  You’ll just end up making your skin more sensitive or even causing burns instead of helping your skin if you follow this “tip”.

One of the reasons hyperpigmentation is so hard to get rid of is because you actually have to treat your skin in two different ways at the same time in order to lighten dark spots.  Though the skincare industry is constantly changing and innovating at the moment the accepted way to treat hyperpigmentation is to shutdown or suppress the production of new melanin, prevent the transfer of new melanin to the melanocyctes, and remove the existing dark spots.  This requires a combination of products to achieve; there is currently no one product on the market that can do all three of these things.  Usually hyperpigmentation is treated with one product that supresses melanin production and another product that brings excess melanin to the surface of the skin and then helps it flake off.

In the United States one of the more prevalent skincare ingredients used to treat hyperpigmentation effectively is hydroquinone.  Hydroquinone is controversial for a few different reasons and has been replaced by a host of other ingredients to brighten dark spots because of the controversy surrounding it.  In order to better understand the controversy about hydroquinone I suggest reading Dr. Leslie Baumann’s article that I have listed below in “sources and further reading”.  There is a lot of misinformation circulating about hydroquinone so be sure to educate yourself on this topic before buying into the anti-hydroquinone hype.

Other skincare ingredients that can help treat hyperpigmentation are:  Vitamin C, kojic acid, licorice, arbutin, and azelaic acid.   A product with one or more of these ingredients is best paired with a retinol (or prescription Retin-A) for best results.  You can also use a product that brightens dark spots in conjunction with an AHA exfoliator though keep in mind a strong exfoliator can actually make hyperpigmentation worse or even cause hyperpigmentation for people with sensitive.  When in doubt see a professional in order to create the perfect skincare regime for your skin.  And above all, apply a generous amount of sunscreen each and everyday!  Use at least SPF 30 and make sure your sunscreen protects from both UVA and UVB rays.  Don’t think that your make-up with SPF is giving you enough sun protection because you’ll never apply enough make-up in order to reach the amount of SPF listed on the product.  So be sure to always apply a sunscreen first and then your moisturizer and make-up.

Other Treatment Options

If you have the money for more expensive in-office treatments getting laser treatments from a dermatologist should produce faster results than using just home care products to treat your hyperpigmentation.  Of course you’ll get the best results from a laser treatment if you take proper care of your skin both before and after the treatment.  Follow the advice the doctor or their esthetician gives you; if they don’t give you any before and after advice go to another office.

You can also see an esthetician or dermatologist for a series of chemical peels that coupled with the correct home care regime can help get rid of hyperpigmentation once again faster than if you were just using products at home.  Just as you need a good home care skincare regime before and after a laser treatment in order to get the best results you need to do the same with a chemical peel.

Sources and Further Reading:

My Related Posts:

 

 

Wrinkles and Pimples At The Same Time: Solutions May 5, 2014

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This post was inspired by something I saw on Facebook.  The reality for many women is just as they start to see wrinkles on their skin (perhaps around the eyes or on the forehead for example) they still get an occasional pimple.  This can be both frustrating and confusing.  Yet it isn’t so difficult to find one solution for both skincare issues.

I would like to point out that the skincare phenomena I am writing about here is not adult acne.  While adult acne is definitely on the rise, I am referring here to people who are probably in their late 30s, early 40s and are starting to see the emergence of fine lines while still occasionally experiencing breakouts (for women perhaps around the time they get their period).  This is also different from women who are undergoing menopause and find that they are all of a sudden breaking out.  I’ve blogged about both adult acne and menopause’s effects on the skin in the past.  Those posts are listed below if you would like to look at them.

In my opinion what is happening here is simple: you are starting to see fine lines because sun damage from years before is now becoming visible, and you are still experiencing an occasional breakout because of your hormones (especially those related to your period) and/or stress.  Just as I see the cause of this skincare issue as fairly straightforward so is, in my opinion, the solution: add a retinol cream to your skincare regime at night, make sure you use sunscreen daily, and use an antioxidant serum every day.  Be sure not to go overboard in order to improve the appearance of your skin.  Do not start using anti-acne products meant for teenagers such as Stridex or Clean & Clear.  These products will be much too harsh for pretty much anyone who isn’t a teenager anymore.

Retinol is the ideal skincare ingredient for people experiencing both fine lines and an occasional breakout because it can treat both issues simultaneously.  I’ve written about retinol and Retin-A before in my blog (you can find the posts below), but I’ll explain again why this is a great skincare ingredient.  As Lab Muffin explains in the post Fact-Check Friday: What Does Retinol Do? :

Retinol is a form of vitamin A. Other forms of vitamin A in skincare that you may be familiar with include isotretinoin (better known as Accutane) and retinyl palmitate (another topical ingredient found in many creams).

Things retinol can help:

– fine lines and wrinkles
– skin roughness and dullness
– skin firmness
– pigmentation from age spots
– acne

Retinoids are skin cell normalizers so that means that they speed up skin cell turn-over which will help clear up breakouts, and retinoids help rebuild collagen so they will minimize the appearance of fine lines and wrinkles over time. As such adding a retinol product to your skincare regime is the perfect solution for both fine lines and breakouts.

Just keep a few things in mind when using retinoids (I’m quoting Lab Muffin again):

Retinols can be irritating to the skin, and cause dehydration. To reduce the chances of this happening, you should introduce it into your routine slowly (don’t use it every day to begin with), and use extra hydrating moisturisers.

Retinol breaks down with exposure to light and air. Pick a retinol product in an airtight, opaque container to improve its shelf life.

Using retinol with other excellent skin treatments like AHAs and vitamin C can speed up the skin renewal process, fading hyperpigmentation and wrinkles faster. However, the activation of retinol by skin enzymes is optimal at a higher pH (5.5-6) than the pH for AHAs (3.5). While there isn’t much research on how quickly the pH of skin readjusts itself, waiting an hour or so in between applying the two is a safe bet, or even using one in the morning and one in the evening.

Retinol, much like AHAs, can make the skin more susceptible to sunburn. Wear extra sunscreen when you use retinol so you don’t completely reverse its beneficial effects!

Lastly, keep in mind that you cannot use Retin-A or retinols when pregnant or nursing.

 

So how would this anti-aging, anti-acne skincare regime look?  I suggest cleansing twice daily with a mild cleanser, applying an antioxidant serum in the morning (such as a Vitamin C serum in order to boost the effectiveness of your sunscreen, further prevent the signs of aging, protect your skin from inflammation), and then using a sunscreen with a spf between 30 to 50 (you can also use a separate moisturizer before your sunscreen if you feel your skin needs it).  In the evening after cleansing apply a retinol cream followed by a moisturizer.  Pretty simple, right?

 

Recommended Products:

  • While I am not familiar with all the recommended products in this article I like the approach of this skincare regime since the recommended products are not too harsh.  Remember there is no need to buy just anti-acne products if you only experience an occasional breakout.
  • Cleanser:  I suggest using a mild cleanser such as CeraVe or even Cetaphil.  You don’t need to use an anti-acne cleanser.  That would be overkill for most people.
  • Antioxidant serum:  See my previous posts below for more information about why you want to use an antioxidant serum and in particular a Vitamin C serum.  There are quite a few good (and even great) Vitamin C serums out there, but at the moment my recommendation is to buy one from South Korea.  OST Original Pure Vitamin C20 Serum is excellent and super affordable (even when you factor in the shipping costs). I am using it now and love it.
  • Moisturizers and Sunscreens:  Choose your products according to your skincare needs and the weather in the area you live in.  Some people may need a richer moisturizer and others not so much especially if you live in a humid climate.  Now that Target is selling some of my favorite skincare lines making them accessible to all I would recommend Laneige Water Sleeping Mask as a moisturizer (don’t be put off by the name; it’s a moisturizer), particularly as a nighttime one, and any La Roche-Posay sunscreen, particularly Anthelios Ultra Light spf 60.
  • Retinol Creams or Serums:  There are also numerous retinol products on the market including ones from Roc and Neutrogena, but for my money I would try either La Roche-Posay Effaclar K Daily Renovating Acne Treatment (if you have blackheads and more than just the occasional breakout) or La Roche-Posay Redermic R (if you only have an occasional breakout).

Further Reading:

 

PCOS and Your Skin October 24, 2013

Some of the most challenging skin issues I have ever tried to treat are those of women who have PCOS – polycystic ovarian syndrome.  It is hard for me to forget the skin of one client who by far had the worst acne I have ever tried to help get under control or the client who told me she wasn’t going to try to treat her acne since it was caused by an internal hormonal issue (PCOS) and since there was no cure for PCOS there was nothing she could do for her acne. Both clients got me thinking – is there really nothing you can do for someone’s acne if they suffer from an internal hormonal issue?  That question prompted this post.

First of all, though the focus of this post is skin and PCOS I think it is necessary to very briefly explain what PCOS is and its symptoms.  The Mayo Clinic explains:

Polycystic ovary syndrome (PCOS) is a common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder — enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance).

Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. In adolescents, infrequent or absent menstruation may signal the condition. In women past adolescence, difficulty becoming pregnant or unexplained weight gain may be the first sign.

The exact cause of polycystic ovary syndrome is unknown. Early diagnosis and treatment may reduce the risk of long-term complications, such as type 2 diabetes and heart disease.

Polycystic ovary syndrome signs and symptoms often begin soon after a woman first begins having periods (menarche). In some cases, PCOS develops later on during the reproductive years, for instance, in response to substantial weight gain.

Signs and symptoms vary from person to person, in both type and severity. To be diagnosed with the condition, your doctor looks for at least two of the following:

  • Menstrual abnormality. This is the most common characteristic. Examples of menstrual abnormality include menstrual intervals longer than 35 days; fewer than eight menstrual cycles a year; failure to menstruate for four months or longer; and prolonged periods that may be scant or heavy.
  • Excess androgen. Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair (hirsutism), adult acne or severe adolescent acne, and male-pattern baldness (androgenic alopecia). However, the physical signs of androgen excess vary with ethnicity, so depending on your ethnic background you may or may not show signs of excess androgen. For instance, women of Northern European or Asian descent may not be affected.
  • Polycystic ovaries. Enlarged ovaries containing numerous small cysts can be detected by ultrasound. Despite the condition’s name, polycystic ovaries alone do not confirm the diagnosis. To be diagnosed with PCOS, you must also have abnormal menstrual cycles or signs of androgen excess. Some women with polycystic ovaries may not have PCOS, while a few women with the condition have ovaries that appear normal.

Causes:

Doctors don’t know the cause of polycystic ovary syndrome, but these factors likely play a role:

  • Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar (glucose) — your body’s primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. The excess insulin might boost androgen production by your ovaries.
  • Low-grade inflammation. Your body’s white blood cells produce substances to fight infection in a response called inflammation. Eating certain foods can trigger an inflammatory response in some predisposed people. When this happens, white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). Atherosclerosis causes cardiovascular disease. Research has shown that women with PCOS have low-grade inflammation.
  • Heredity. If your mother or sister has PCOS, you might have a greater chance of having it, too. Researchers also are looking into the possibility that mutated genes are linked to PCOS.
  • Abnormal fetal development. Some research shows that excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working the way they’re supposed to — a process known as gene expression. This may promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Researchers continue to investigate to what extent these factors might contribute to PCOS.

There are different ways to treat PCOS symptoms, remember there is no cure.  Some ways to treat this condition is through medications and another way is through lifestyle changes such as the ones described by PCOS for Dummies:

How to Manage PCOS

If you’re willing to overhaul your diet and start a simple exercise program, you can gain a great deal of control over your PCOS symptoms. Insulin resistance causes many PCOS symptoms, and diet and exercise help control insulin resistance.

  • If you’re overweight, lose weight by limiting yourself to 1,500 calories per day. Losing weight is one of the biggest factors in controlling PCOS symptoms, particularly if you’re trying to get pregnant.
  • Eat regular meals (but don’t pile your plate), and have a couple of small snacks during the day.Don’t let yourself get hungry.
  • Follow a low-GI diet by substituting low-GI carbs for high-GI carbs. The glycemic index (GI) measures how a carbohydrate affects blood sugar. High-GI foods break down quickly into glucose while low-GI foods are absorbed more slowly. Low-GI foods stabilize your blood sugar, while high-GI foods cause a rapid rise in blood sugar levels. Refined sugars are high-GI foods, while fruits and vegetables are generally low-GI.
  • Limit the fat in your diet. Cut down particularly on saturated and trans fats (including fatty meat, butter, cakes, pastries, and cookies).
  • Use as little salt as possible. Look at labels of processed foods to try to keep your total sodium intake below 2,400 milligrams a day.
  • Eat at least five helpings of fruit and vegetables every day.
  • Get some physical activity every day. Half an hour is great, but an hour is even better to help keep your weight under control. Remember to start slowly and incorporate both aerobic and weight-bearing exercise into your routine. You don’t have to do all your exercise at one time — 10 minutes of exercise three times a day is just as good as 30 minutes all at once.

PCOS and Skin

As already mentioned above many women who suffer from PCOS also suffer from acne.  Their acne can be very bad with many papules and pustules and can be hard to control because of the excessive androgen in the body.  While birth control pills may help control some of the hormonal issues associated with this condition, what other lifestyle changes can help the acne caused by PCOS?  While I still believe that using anti-acne ingredients such as salicylic acid and retinol can help pores from becoming excessively clogged with dead skin cells and excess oil, are there any other solutions as well?  According to one article from the website Beauty Bible dietary changes may be the key to controlling PCOS related acne:

First – to explain the underlying situation – Dr Marilyn Glenville, author of Natural Solutions to PCOS, says this:

‘PCOS creates a vicious cycle of hormone imbalances, which has huge knock-on effects throughout the rest of your body. The problem often starts with the ovaries, which are unable to produce the hormones they should, and in the correct proportions. Linked to this is the common problem of insulin resistance. Women with PCOS very often have difficulties with blood sugar levels, which can cause weight gain and the excess insulin can stimulate your ovaries to produce yet more testosterone (the male hormone). Half of all women with PCOS do not have any problems with their weight, yet they can still have higher insulin levels than normal. ‘

The aim, Marilyn says, ‘is to balance your hormones in order to control the hormonal breakouts from the inside out. There is now overwhelming evidence to suggest that diet plays a significant role in helping with PCOS and also increasing the chances of conceiving.’

‘Adapting your eating habits so that you keep your blood-sugar levels on an even keel throughout the day is essential.  If your adrenal glands are over-stimulated by ever-fluctuating sugar highs and lows, they produce too much adrenaline – the stress hormone – and also too much testosterone, preventing ovulation altogether.’

Aim to eat little and often to keep your blood sugar under control and follow a low GI (glycemic index) diet, with little sugar of any kind, including fruit and fruit juices as well as the more obvious cakes, biscuits, etc.

The article also recommends taking various supplements though I recommend you speak to a doctor before following that advice.  I also found a personal testimonial about how one women changed her diet to successful control her PCOS acne:

According to Women’s Health UK, the elevated androgen level associated with PCOS causes the production of DHT, and this leads to acne. Additionally, insulin resistance is also typically part of PCOS, and insulin resistance further increases androgen levels. This leads to even higher DHT levels, and induces more acne breakouts.

Also, as PCOS women consume high amounts of refined carbohydrates, more negative changes occur in the body. Refined carbohydrates have a high glycemic index and consuming them increases your blood sugar. In response to the increase, your body produces more insulin, further increasing your androgen levels.

In short, it’s a terrible cycle that needs to be broken before clear skin can make an appearance.

What do I do about PCOS acne?
After learning all of this information, I finally decided that I should be treating the acne problem from the inside out, reasoning that my skin is only as good as what is circulating in my body. So, after talking to my OB/GYN and a Naturopath, I started tackling my hormonal problems the natural way. I began taking Vitex (Chastetree) to balance my hormones, and began a fairly strict low carb way of eating to treat the PCOS.

I stuck to plenty of fresh fruits and vegetables, ate meat and dairy, and kept my daily intake of carbohydrates below 45 grams (although this number will vary widely by person). I also made sure to drink at least 10 glasses of water every day.

Needless to say, I was thrilled when my skin began clearing up after only 2 weeks. There were fewer pimples, and my skin tone was more even. Motivated and excited, I carried on with my new way of life. Within 6 weeks, my skin was completely clear and smooth – I was cured of my terrible skin. I wanted to shout it from the rooftops! After nearly 15 years of trouble skin, I had a found a way to get the skin I had always dreamed of having.

Even more exciting – my PMS was practically gone, and “that time of the month” was no longer accompanied by a nightmarish number of breakouts.

To this day, my skin is still free of acne, and I couldn’t be happier about it. If you have the type of acne I did, and you think you might have PCOS, talk to your doctor, and try some low carb eating and Vitex – you have nothing to lose besides your breakouts!

I’ve addressed the issue of acne and diet numerous times in this blog (you can read my posts by clicking on the links below in the “further reading” section) so I am definitely a believer when it comes to linking acne and diet.  Do I think that simply changing your diet if you suffer from PCOS will clear your skin?  That’s a hard one to answer.  PCOS is a complicated condition so while it is good to hope for the best when making lifestyle and dietary changes you might have to temper your hopes as well.  Being under the care of the right doctor or naturopath can go a long way in helping you achieve clearer skin and control your PCOS.

Further Reading:

 

Dairy, Carbs, Sugar and Acne: Is There a Connection? September 12, 2013

Filed under: Acne — askanesthetician @ 7:30 am
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I’ve written a lot in this blog about the connection between food and acne and diet and skincare in general.  (See the links at the end of this post)  This post will highlight new research that has emerged about the connection between diet and acne.

From the Skin Inc. article Long-term Research Links and High Sugar Foods to Acne we learn the following:

Review of 50 years of clinical studies indicates there may be a link between diet and acne after all. It’s been a subject of debate for decades, but it seems diet really does have an impact on a person’s complexion.

A landmark overview of research carried out over the past 50 years has found that eating foods with a high glycaemic index (GI) and drinking milk not only aggravated acne, but in some cases triggered it, too.  …

Since the late 19th century, research has linked diet to acne, with chocolate, sugar and fat singled out as the main culprits. But studies carried out from the 1960s onwards have disassociated diet from the development of the condition.

Jennifer Burris, researcher and doctoral candidate within New York University’sDepartment of Nutrition, Food Studies, and Public Health in Steinhardt School of Culture, Education, and Human Development, says, “This change [in attitude] occurred largely because of the two important studies that are repeatedly cited in the literature and popular culture as evidence to refute the association between diet and acne.

“More recently, dermatologists and registered dietitians have revisited the diet-acne relationship and become increasingly interested in the role of medical nutritional therapy in acne treatment.”

Eating high GI foods – foods that are absorbed into the bloodstream quickly – is thought to have a direct effect on the severity of acne because of the hormonal fluctuations that are triggered. High GI foods cause a spike in hormone levels including insulin which is thought to instigate sebum production. A 2007 Australian study showed that young males who were put on a strict low GI diet noticed a significant improvement in the severity of their acne.

Milk is thought to affect acne because of the hormones it contains. A 2007 study carried out by Harvard School of Public Healthfound that there was a clear link between those who drank milk regularly and suffered with acne. Interestingly, those who drank skimmed milk suffered with the worst breakouts, with a 44% increase in the likelihood of developing blemishes. It is thought that processing the milk increases the levels of hormones in the drink.

Another Skin Inc. article expands on what I referenced above:

“The strongest evidence we have to date of a link between diet and acne comes from the glycemic index studies,” says Whitney P. Bowe, MD, FAAD, who is the lead author of the article “Diet and Acne,” published in the Journal of the American Academy of Dermatology. “These studies show that low-glycemic index diets may improve acne. The consumption of high-glycemic index foods appears to trigger a cascade of responses, which can lead to acne through effects on growth hormones and sex hormones,” Bowe adds.

The glycemic index (GI) is a ranking of carbohydrate-rich foods based on their potential to increase blood sugar levels. For example, high GI foods include white bread, chips and white potatoes; low GI foods include multi-grain bread, peanuts, vegetables and beans.

A study of 23 Australian males ages 15–25 who followed a strict, low-glycemic load (LGL) diet experienced significant improvement in acne severity by adhering to a LGL diet. However, the participants in the LGL group also lost weight, which means the LGL diet may not solely be attributed to the outcome. Specifically, studies have also shown that acne improves when the patients’ blood sugar levels are controlled and a low-carbohydrate diet stabilizes hormones.

In addition, a web-based survey assessing the role of a low-glycemic diet in the treatment of acne found that 86.7% of the 2,528 dieters who completed this online survey reported improvements in their skin while following this diet. Still, based on some of the flaws in the design of the study, the results must be interpreted with “cautious optimism,” says Bowe.

Although there is weak evidence that dairy also impacts acne, Bowe says there’s still a possibility that an association may exist. While there were several flaws in the studies, “Dairy does appear to be weakly associated with acne, with the strongest association being skim milk,” according to Bowe. While the exact mechanism behind this association is unclear, she suspects that hormones and growth factors in milk might play a role.

While more clinical research is needed to determine dairy’s impact on acne severity, Bowe advises patients to speak with their dermatologist to determine if certain dairy products aggravate their acne. She also says patients who choose to limit dairy products should supplement their diets with appropriate levels of calcium and vitamin D.

(From Can Eating Carbs Give You Pimples?)

Still not convinced about the connection between acne and diet?  Check out the following information about societies that ate a plant based diet and acne:

Rural cultures with diets high in fruits, nuts and root vegetables have been observed to have a very minimal incidence of acne. Communities of Kitavan Islanders of Papua New Guinea and Achè hunter-gatherers of Paraguay were observed to not even have a single comedo while eating their native diets rich in fruits, coconut, wild foods and fish, with minimal amounts of Western foods. Similar rural cultures, which have zero incidence of acne, suddenly experience breakouts when introduced to a Western culture and diet.  This suggests that the disorder cannot be solely attributed to genetics, but is likely sourced from differing environmental factors.

These studies point to whole foods, such as fruits and vegetables, as having a positive correlation with clear skin. This makes sense: Plants are, by and large, some of the strongest anti-inflammatory food sources available. By increasing daily intake of fruits, greens and vegetables, clients biologically increase their immunity and could potentially decrease signs of acne.

(From The Diet-Acne Connection – Skin Inc.)

So how can you change your diet in order to prevent breakouts?  Here are some suggestions:

Choosing low GI foods

  • Only carbohydrates have a GI rating.
  • Because low GI foods take longer for the body to break down they help you feel fuller for longer too.
  • High GI foods include sugary fizzy drinks, cakes, pastries, chocolate, white bread and potatoes.
  • Low GI foods include fruit and vegetables, wholegrain options such as brown pasta, basmati rice, couscous and pulses.
  • Not overcooking your pasta and vegetables helps lower the GI.
  • Watch for food triggers that may seem to aggravate acne.
  • Keep a food diary and share it with your dermatologist.
  • Be patient. It may take up to 12 weeks of a diet change to determine if certain foods are contributing to acne.
  • Continue following your regular acne treatment routine. Diet changes are only a small part of an acne treatment plan and are meant to be used in conjunction with proven medical therapies for acne.

Have you seen a connection between your diet and your breakouts?  Please share your experiences below.

My Related Posts:

Image from allparenting.com

 

Remembering Two Skincare Pioneers July 23, 2013

Recently two dermatologists who made groundbreaking contributions to the skincare industry passed away.  Both Dr. James Fulton and Dr. Sheldon Pinnell changed the skincare industry as we know making lasting and significant impacts in the field of dermatology and esthetics.

Dr. James Fulton

Dr. Fulton will probably be remembered best for his research and discoveries connected to acne.  He was the co-developer, with Dr. Albert Kligman, of Retin-A, and pioneered cosmetic surgical procedures in order reduce acne scars.

Skin Inc.‘s obituary outlines Dr. Fulton’s career:

Born in Ottumwa, Iowa to Alice Hermann Fulton and James Sr. (a one-time CEO of Cracker Jack), Fulton’s interest in dermatology stemmed from the acne struggles he endured as a pre-teen and throughout adulthood. He earned his bachelor of science and doctor of medicine degrees from Tulane University in 1965, and while there his academic achievements led to his induction into the prestigious Alpha Omega Alpha Honor Medical Society and Phi Beta Kappa Society. While in residency at the Hospital of the University of Pennsylvania, Dr. Fulton met his close friend and mentor Dr. Albert Kligman; together they co-developed Retin-A, a topical form of vitamin A. At the request of Phillip Frost, MD, he relocated to South Florida and earned a PhD in biochemistry under the noted dermatologist Harvey Blank, MD, from the University of Miami Miller School of Medicine in the early 1970s. Fulton and Blank developed benzoyl peroxide gel (Panoxyl) and topical erythromycin (E-Gel).

In the early 1970’s with his wife Sara, Fulton launched a successful chain of 12 acne clinics called Acne Healthcare Centers, opened the Acne Research Institute and developed and manufactured a line of patented skin care products under the AHC and Face Up brands in their FDA-approved manufacturing facilities. Here he invented a high-speed diamond fraise for dermabrasion and was the first to use estheticians in the medical office developing a paramedical esthetician training program.

In 1990, Fulton opened JEF Medical Group, a cosmetic surgery and dermatology practice where he pioneered fat transfer and laser surgery and was the first to use hyperbaric oxygen chambers for post-surgical recovery. In addition, Fulton and Sara co-founded Vivant Skin Care in 1990, a clinical skin care line rooted in Fulton’s patented vitamin A therapies.

Fulton served as mentor and role model for countless leaders in dermatology and esthetics across the nation. Most recently he was volunteer faculty at the University of Miami Miller School of Medicine’s Department of Dermatology and part of the internship program at St. Thomas University. A popular international speaker and teacher, he authored the definitive book Acne Rx and published more than 300 medical articles, the most recent ones being released earlier this year in the Journal of Investigative Dermatology and presented at the Skin of Color Seminar Series in New York City and the Orlando Dermatology & Aesthetic & Clinical Conference.

Fulton volunteered his dermatology services to His House Children’s Home, a private, nonprofit, faith-based foster children organization, to which he provided no-charge medical treatment to the children and hosted a yearly Thanksgiving luncheon. He actively split time between Flores Dermatology in Coral Gables where he continued to see patients weekly and his research lab at the Vivant Skin Care headquarters in Miami Lakes until taking ill in mid-June.

He was most proud of his beloved wife, Sara, who helped him with his PhD, and worked with him in research and in the medical office. She always attended medical meetings with him and helped with his teaching projects. Fulton always told her he couldn’t have done what he did without her. Among his noteworthy achievements were creating more than 50 original skin care formulations, stabilizing benzoyl peroxide in gel form, qualifying as a Full Fellow of the American Academy of Cosmetic Surgery, membership in the American Society of Lipo Suction Surgery and election to the Dermatology Foundation’s Leader Society.

Dr. Fulton passed away from colon cancer on July 4, 2013.

Dr. Sheldon Pinnell

Dr. Pinnell, whose research changed the use of topical antioxidants in the skincare industry forever, also passed away on July 4, 2013.

According to his obituary in Skin Inc.:

Sheldon Pinnell, MD, an internationally eminent scientist, dermatologist, leading scientist behind L’Oreal-owned SkinCeuticals, and J. Lamar Callaway professor emeritus of dermatology and chief emeritus of the division of dermatology at Duke University, passed away peacefully in Durham, NC, on Thursday, July 4, 2013. He was 76.

Pinnell’s investigative research has changed the way the world uses topical antioxidants today. As one of the founding fathers of topical antioxidants, he was the first to patent a stable form of vitamin C proven through peer-reviewed research to effectively penetrate skin, delivering eight times the skin’s natural antioxidant protection.

Before helping to shape the cosmeceutical industry, Pinnell led major advances in the understanding of skin biology and the parthenogenesis of skin diseases. Early in his career, he made seminal contributions to the understanding of Ehlers-Danlos Syndrome and the role of vitamin C in collagen biosynthesis. Pinnell has been globally recognized for his contributions to science and skin care, most recently receiving an honorary membership to the Society for Investigative Dermatology.

Over his lifetime, he also received numerous medical and scientific awards including the “Best Doctors in America, the international Who’s Who in Medicine and HealthcareWho’s Who in Science and Engineeringand Who’s Who in America. Pinnell has published more than 200 scientific articles in peer-reviewed journals on dermatology topics such as photoaging, collagen synthesis, UV protectiontopical vitamin C and other antioxidants. Pinnell also authored approximately 20 book chapters and holds10 patents.

“It is our greatest privilege to have been able to help Pinnell bring his discovery of topical antioxidants to life. Prior to the introduction of topical vitamin C in the early 1990s, skin care professionals were largely limited to sunscreens to protect against the deleterious effects of the sun. It was Pinnell who gave the medical community the confidence to transform the approach to at-home skincare. We are fortunate to have known Pinnell as a scientist, a family man and a dear friend. His life lessons and infectious spirit will remain with us forever,” said SkinCeuticals co-founders Alden Pinnell and Russell Moon.

Further Reading:

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June is Acne Awareness Month June 18, 2012

Anyone who has read the About section of my blog knows that I have suffered from acne most of my life.  My acne lead to an obsession with my skin and that obsession eventually lead me to become an esthetician.  As I write this post I have a large pimple of on my temple and post-inflammatory hyperpigmentation on my chin.  Even though I am 37 my acne struggles are far from over.

Since June is Acne Awareness Month I thought I would gather my acne related posts in one place for my readers.  For good reason this subject continues to interest me, and I will definitely continue to write about it in the future.

My acne related posts:

 

 

Image from gotta-look-good.com

 

Adult Acne: Causes and Treatments May 31, 2012

Filed under: Acne — askanesthetician @ 5:00 am
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There are few things that are more frustrating than acne.  Once we reach our late 20s we figure that we shouldn’t have acne any more but that isn’t true for many, many people.  Case in point Selma Hayek.  Hayek revealed in the May, 2012 issue of Lucky magazine that she suffered from terrible acne as an adult:

“My skin?! When I was 25 and I left being a soap opera star in Mexico to go try to be a movie star in Hollywood and all of Mexico was laughing at me? And I could barely get work as an extra? You want to talk about bad skin? I had acne. And this acne was so bad, it sent me into a severe, severe depression. Like I couldn’t leave the house. I’d wake up in the morning and lie there and touch my face before I got up, just to prepare myself to look in the mirror! “The next stage with that sort of depression is food: too little, or too much. Guess what I did? I mean, I was fat and broken out, I couldn’t leave the house and I couldn’t pay the rent!” A friend, she says, saved her: “Alfonso Cuarón—amazing director—he came to the house. He did not play it down, he did not try to say, Oh you look fine. He said you can’t do this to yourself and taught me to meditate, relax. I got myself back together!” She also went on Accutane. “I didn’t want to, but it cured it. Since then my skin’s forever sensitive and dry.”

Hayek certainly is not alone when it comes to suffering from acne as an adult.  According to The New York Times article When ‘Younger’ Skin Is Not A Blessing:

More adult women are getting pimples than ever before, according to a study presented in March at the American Academy of Dermatology annual meeting. Today, clinical acne afflicts the complexions of 45 percent of women ages 21 to 30, 26 percent of women ages 31 to 40, and 12 percent of women ages 41 to 50, according to the study, conducted by researchers at Massachusetts General Hospital.

What Causes Adult Acne?

Just as with teenage acne hormones play a major role in the formation of adult acne.  As the WebMD article Is Your Skin Hormonal? explains:

Just as you may see a little thinning in your hairline or the slight shadow of a moustache, more blackheads and blemishes are a sign of aging. “About a third of women will get adult acne, usually in their early 30s, even if they didn’t have breakouts when they were younger,” says Beverly Hills dermatologist Dr. Stuart Kaplan. “Starting in your late 20s, estrogen levels decline faster than testosterone.” Because testosterone is an androgenic hormone, it increases masculine qualities (hence the new facial hair) and boosts oil production, plugging your pores and causing blemishes. The difference between adult acne and the teenage type? Small red bumps (not painful, cystic pimples) are more common when you’re older, according to Kaplan, and acne along the jawline or around the mouth are a telltale sign that you’re dealing with a hormonal breakout.

 Furthermore, according to another WebMD article, Adult Acne: Why You Get It, How To Fight It, adult acne is caused by:

Adult acne is caused by sebum, an oily substance produced by the skin’s sebaceous glands. Sebum clogs pores, which attract bacteria and become inflamed. For some adults, breakouts are a result of hypersensitivity or overproduction of androgens (male hormones). But an imbalance in both male and female hormones (estrogen) can also cause breakouts. For women, this can happen during pregnancy, perimenopause, and menopause. Some medications, such as corticosteroids, and cosmetics can also contribute to the development of acne.

 There can be even more causes for adult acne which include:

  • Changes in humidity or weather
  • Cosmetics, skin products or hair products
  • Family heritage or hypersensitivity
  • High-sugar food & drinks that increase oil production which blocks pores
  • Hormones from dairy products, pregnancy or menstrual cycle
  • Certain medications, such as corticosteroids
  • Smoking
  • Stress, which can trigger cortisol that may result in pore-clogging oil

(Source: How To Get Rid of Acne: 6 Treatments You Haven’t Tried!Future Derm)

If I see a client who has tried everything to get rid of their acne I always ask them about their diet and suggest trying a low-dairy, low-glycemic diet.  For some people changing their diet is really what helps their acne.  I also truly do believe in a strong link between what is going on with our skin and our stress levels.  Though I know it can be very, very difficult finding a way to relax can be very helpful for your skin.  But let me emphasize again, as I have done in the past in this blog, that everyone is very different and what could trigger your acne could be something completely different than what triggers your best friend’s acne.  I love Chapter 3: Targeting Your Acne Triggers from the book Healing Adult Acne by Richard G. Fried, MD, PhD because it helps you really track and figure out what is happening with your skin so that you are no longer playing a guessing game about what is causing your acne.

Treatment Options 

First and foremost, I would never recommend reaching for the same anti-acne products that are marketed to teenagers in order to treat your adult acne.  For many adults milder anti-acne products work best.  Having said that the one prescription topical skincare product that is both anti-aging and anti-acne is Retin-A (or tretinoin, its generic name).  There are many different forms of Retin-A available so I suggest seeing a doctor for a run down of your best options if this is the way you want to treat your skin.  Doctors also have available to them in-office light and laser therapies that can effectively treat acne with little or no downtime.  Going to an esthetician for an evaluation of your skin can help you as well since estheticians can also recommend a good home care routine for you.  If your acne is really severe you may have to take medication, but this is a decision that you and your doctor can make together.

According to Bethanee Jean Schlosser, MD, PhD as quoted in Skin Inc.‘s article Hormonal Factors Key to Understanding Acne in Women here are some steps you can take to prevent and treat acne:

  • Schlosser advises patients to use noncomedogenic and sensitive skin products in order to reduce the formation of new acne lesions and to minimize skin irritation.
  • Mild cleansers should be used twice a day.
  • Avoid cleansers or other skin care products with scrubbing particles or a gritty texture, because they can irritate the skin.
  • Use a noncomedogenic moisturizer daily.
  • Apply the appropriate amount of topical acne medications (enough for a very thin layer, generally a pea-sized amount for the face) to the skin. Using more medication than is recommended will not produce better results, but may cause more irritation or dryness.
  • When starting treatment with topical retinoids, Schlosser advises that the therapy should initially be applied three times a week in order for the skin to get accustomed to it. Over time, the frequency of the medication should be gradually increased with the goal of using a topical retinoid every night.
  • Avoid picking, squeezing, popping, or otherwise manipulating acne lesions to minimize trauma to the skin and help reduce the risk of scarring and secondary bacterial infections.

“With acne, it’s important for patients to understand that there are no quick fixes, and none of the therapies used to treat acne work overnight,” said Schlosser. “Clients need to be consistent when using their acne medications and realize that they may not see the full effects of their treatment regimen for eight to 10 weeks—and in many cases, some type of maintenance therapy is required for long-term clearance of acne. ”

Bottom Line: Do not give up hope if you suffer from adult acne!  There are numerous treatment options available and lifestyle changes that you can make in order to control your breakouts.

Further Reading

If you have the time I recommend reading the articles I quoted from above.  Here are some more interesting articles about adult acne:

My Related Posts:

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