Askanesthetician's Blog

An esthetician explores skincare issues and concerns

What Is Milia and How Do You Treat It? October 10, 2013

There are some skincare issues that, in my opinion, are more vexing than others.  To name a few –  hyperpigmentation, acne, and milia.  Just what is milia, how do you get it, and how do you treat it?

What is Milia and What Causes It?

According to Dr. Ellen Marmur in her book Simple Skin Beauty (pages 201-206) milia and whiteheads are very similar:

… both are closed-over keratin plugs – but milia is not associated with acne.  They are caused by aging and slower cell turnover.  Milia are tiny white bumps formed by trapped keratin compacted in the pore, but there is no bacteria or oil involved.  …

Milia is a case of keratin-obstructed pores caused by skin that isn’t shedding normally.  It is not an acne issue and happens frequently as we age; it generally starts to show up in your thirties.  Milia can also be a side effect of laser resurfacing, because the skin is growing at an accelerated rate (as a wound-healing response) and can trap keratin inside the pores.

The website Dermadoctor expands further on the causes of milia in an article by Dr. Audrey Kunin :

Milia are deep seeded white bumps that form when skin cells become trapped rather than exfoliate naturally. The trapped cells become walled off into tiny cysts that appear like white beads below the surface of the skin. Milia can occur on the skin or even on mucous membranes such as the inner surface of the cheek or the vermillion border of the lips.

As the surface is worn away, the tiny cyst may resolve on its own. Far too often, though, intervention to remove the cyst may offer more rapid resolution.

Why Me?

Milia form for a variety of reasons. Some you can fix, others aren’t so easily dealt with. But you need to scrutinize your skin care routine whenever milia make their appearance. Although some people naturally make milia, and I certainly expect everyone to have an occasional bump at one time or another, milia are often the result of a problem that has affected the skin’s surface.

Are there any skincare habits that contribute to the formation of milia?  According to Dr. Kunin yes there are:

  • No doubt the most common reason milia form is from smothering your skin with heavy skin care products or hair care items. Comedogenic creams and lotions may prevent the sloughing of dead epidermal skin cells. Hidden problem products include make-up removers not labeled oil-free or non-comedogenic, hair spray, hair mousse and gel, heavy sunscreens and some moisturizers. The eyelids are very thin and more likely to experience problems with milia due to cosmetics. Re-evaluate your eye make-up and eyelid make-up remover if you are finding this to be a concern.Certain lipsticks, lip balms and products meant to help with chapped lips may be the cause of little white pearly milia developing around the lipstick edge (aka vermillion border) of the lips. Again, if you see these forming, take a good look at the ingredients on the label.
  • Prolonged History Of Sun Damage
    The formation of milia can also be due to cumulative sun exposure. Aging skin forms a thicker epidermis that may make it far more difficult for skin cells to find their way out of the glands. And thicker skin also makes for more road blocks in the pathway to exfoliation.
  • Porphyria Cutanea Tarda
    Milia can also be associated with certain skin diseases, particularly blistering disorders such as Porphyria Cutanea Tarda. Fortunately, there are other symptoms associated with these blistering diseases. Blisters, for one and increased hair on the face and backs of hands and knuckles, for another. PCT is an unusual disorder. If you have milia, don’t initially jump to the conclusion you have a blistering condition.
  • Genetics
    Sometimes we just inherit certain undesirable skin tendencies.

What Can Be Done to Prevent and Treat Milia?

Both doctors I quoted above believe that regular exfoliation and retinols can help fight milia.  Dr. Kunin explains:

Exfoliation can go a long way in helping deal with milia prone non eyelid skin. By keeping the epidermis thin and smooth, you can cut down on their formation. By mentioning exfoliation, I’m not talking about scrubbing off the top layer of your skin!

Retinol is also very helpful for both fighting and preventing milia. Again, retinol should not be applied to the upper eyelids.

Sometimes milia won’t come out in spite of your best efforts. Then you may need the milia to be extracted by your dermatologist. In a physician’s office, milia are easily removed. The skin is cleansed with some rubbing alcohol or other antiseptic. The skin overlying the milia is gently opened with a sterile lancet or needle. Then pressure is applied with a comedone extractor, and the milia typically pop out. I find that one of the most difficult areas from which to remove milia is the upper eyelid. There simply isn’t a good way to press on the area and avoid the eyeball, so the lid has to be pulled either upwards or to the side, which is somewhat challenging.

Furthermore, since extensive sun exposure can cause milia be sure to be vigilant, if you weren’t already, with using a sunscreen that won’t clog pores.  And if you’ve tried everything to get rid of your milia and it isn’t working please see a professional.  Don’t go stabbing your face with a needle on your own.

Further Reading:

Image from jacintak.com

 

What Is Seborrheic Dermatitis? October 3, 2013

When I was in esthetics school we discussed skin diseases, and I do remember that seborrhea was mentioned.  According to my textbook from school (yes, I still have my textbook) they divide seborrhea and seborrhea dermatitis into two different categories:

Seborrhea: Severe oiliness of the skin; an abnormal secretion from the sebaceous glands

Seborrheic Dermatitis:  A common form of eczema

(From Milady’s Standard Fundamentals for Estheticians, 9th edition, page 203)

Before I became an esthetician I had come across a common form of seborrheic dermatitis which is cradle cap.  My son had had severe cradle cap as an infant so I was quite aware of what that was.  Yet once I was introduced to the concept of seborrhea as explained above, “severe oiliness of the skin”, I didn’t come across this condition at all while working in the US.  Then I moved back to Israel and I couldn’t believe how many people I encountered for facials that would tell me they had seborrhea.  I was surprised to say the least.  I couldn’t figure out how in one part of the world I had never come across this condition and in another part of the world I couldn’t seem to escape it.  I wondered if the definition of this skin condition had changed from country to country, from language to language.  The skincare companies that I worked with in the US never mentioned this condition to me or had products that treated it, unlike Israeli skincare companies that do both.  Truthfully I am still trying to figure this one out, but in the meantime I realized that I better brush up on my knowledge about seborrhea.

What is Seborrheic Dermatitis?

Dr. Carl Thornfeldt in his book The New Ideal In Skin Health defines seborrheic dermatitis as (page 86):

These lesions are usually found on areas of the body with more sebaceous glands, such as the forehead, eyebrows, around the nose and ears, scalp, midchest, and central trunk. It is characterized by greasy yellow scaling on erythematous patches of various thicknesses.  It usually has no itching.  It may be associated with rosacea.  Dandruff is a mild form on the scalp.  It is most common in infants (cradle cap) and elderly.  It may also be flared by physical and emotional stress.

Furthermore, according to the American Academy of Dermatology seborrheic dermatitis is characterized as:

The skin tends to have a:

  • Reddish color.
  • Swollen and greasy appearance.
  • White or yellowish crusty scale on the surface.

One or more of these rashes can appear on the body. Sometimes, the affected skin itches.

Seborrheic dermatitis can look like psoriasis, eczema, or a skin allergy.

What Causes Seborrheic Dermatitis?

The Mayo Clinic explains:

Doctors don’t yet know the cause of seborrheic dermatitis. Factors that may play a role include:

  • A yeast (fungus) called Malassezia. This fungus is one of the normal microscopic life forms that grow, along with certain bacteria, in your skin’s oily secretion (sebum). Creams, foams or lotions containing an antifungal agent, such as ketoconazole (Ketozole, Extina), often help reduce flare-ups, supporting the idea that this yeast is a contributing factor. But seborrheic dermatitis itself isn’t considered an infection, and it’s not contagious.
  • Change of season. Episodes are often worse in winter.
  • Neurological conditions. Seborrheic dermatitis may occur more frequently in people who have Parkinson’s disease and certain other neurological disorders.
  • Stress and fatigue. Stressful life events and situations may help trigger an episode or make it worse through mechanisms that aren’t yet understood. The role of neurological disorders and stress may be related through effects on the nervous system.
  • HIV/AIDS. Seborrheic dermatitis may occur more commonly and tend to be more severe in those with HIV/AIDS.

The American Academy of Dermatology expands on the causes and just who is affected by seborrheic dermatitis:

Who gets seborrheic dermatitis?

People of all colors and ages get seborrheic dermatitis. You have a higher risk if any of the following apply to you.

Age

People in these two age groups are most susceptible:

  • Infants 3 months of age and younger.
  • Adults between 30 and 60 years of age.

Medical conditions

Your risk increases if you have any of these medical conditions:

  • HIV (About 85 percent of people infected with HIV develop seborrheic dermatitis).
  • Acne, rosacea, or psoriasis.
  • Parkinson’s disease.
  • Epilepsy.
  • Stroke or heart attack (recovering from).
  • Alcoholism.
  • Depression.
  • Eating disorder.

Medical treatments

If you are taking any of the following medicines, your risk for seborrheic dermatitis increases:

  • Interferon.
  • Lithium.
  • Psoralen.

Facts about Seborrheic Dermatitis

For adults there is both good news and bad news about seborrheic dermatitis.  The good news is that the condition can be treated by a doctor and/or with proper home care.  The bad news is that this is chronic condition, with no cure. According to the Mayo Center:

Seborrheic dermatitis doesn’t affect your overall health, but it can be uncomfortable and cause embarrassment when it develops on visible parts of your body. It isn’t contagious, and it’s not a sign of poor personal hygiene. Seborrheic dermatitis tends to recur, but you may be able to manage flare-ups by recognizing its signs and symptoms and by using a combination of self-care steps and over-the-counter (nonprescription) medications.

How to Treat Seborrheic Dermatitis

First and foremost if you think that you are suffering from seborrheic dermatitis go see a dermatologist before trying to treat yourself.  The doctor can determine if you need prescription products or not to keep your condition under control.  Some skin conditions simply cannot be treated with over the counter products but with seborrheic dermatitis it depends on the severity of the condition.

The Mayo Clinic explains further how to treat this condition:

Seborrheic dermatitis tends to be chronic, and there’s usually no strategy that stops it permanently. But treatments — including many you can try at home — may control your signs and symptoms during a flare-up. The best approach for you depends on your skin type, the severity of your condition, and whether your symptoms affect your scalp or other areas of your body.

Creams and lotions that you apply to affected body areas and medicated shampoos are all mainstays of treatment. In very severe cases, physicians may prescribe oral medications with whole-body effects. Products are available with several kinds of active ingredients. Some preparations include active ingredients from more than one category.

The following over-the-counter treatments and self-care tips can help you control and manage seborrheic dermatitis.

  • Wash your hair with a medicated anti-dandruff shampoo according to the recommended schedule. If you don’t see results, try a shampoo with a different active ingredient.
  • Use an over-the-counter antifungal cream. Application of nonprescription-strength ketoconazole may be helpful.
  • Apply an anti-itch cream or lotion to the affected area. A short course of a nonprescription hydrocortisone cream containing at least 1 percent hydrocortisone can temporarily relieve itching.
  • Avoid harsh soaps and detergents. Be sure to rinse soap completely off your body and scalp.
  • Wear smooth-textured cotton clothing. This will help keep air circulating around your skin and avoid irritation.
  • Shave off your beard or mustache. Seborrheic dermatitis can be worse under mustaches and beards. If this is the case for you, shaving might ease your symptoms.
  • Avoid scratching whenever possible. Scratching can increase irritation, making you more uncomfortable and increasing your risk of infection.

What else can you do at home to keep your condition under control?  Dr. Thornfeldt recommends in his book using a gentle facial cleanser that doesn’t strip the skin’s pH.  He recommends that the homecare products that:

… contain ingredients such as low concentrations (<2%) azelaic acid, salicylic acid, zinc pryrithone and/or willow bark extract to help kill surface bacteria, reduce redness and scaling, and smooth skin texture.  (Page 87)

The American Academy of Dermatology recommends the following:

Adolescents and adults: Skin

  • Wash the skin daily with a soap that contains 2% zinc pyrithione.
  • Soften scale by:
    • Wetting the skin thoroughly before washing.
    • Applying a moisturizer after bathing.
    • Applying a tar cream, letting it sit on the skin for several hours before rinsing.
    • Applying a cream containing salicylic acid and sulfur.
    • Do not use petroleum jelly to soften the scales. It tends to worsen seborrheic dermatitis.

 

Bottom Line:  In adults seborrheic dermatitis is a chronic condition without an actual cure.  Proper home care coupled with prescription medications can help keep this skin condition under control.

 

Sources and Further Reading:

 

Image from http://www.aad.org

 

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:

 

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 

 

*  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.

 

 
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