Mature woman admiring her skin after Photocure

Photodynamic therapy is an FDA –approved and very effective treatment for patients with multiple precancerous skin lesions. The treatment involves application of a light activated medication, Levulan, followed by exposure to a medical blue light. The treatment reduces precancerous lesions on the skin by 90%.  After completing this treatment, patients are amazed at the improvement in the texture and appearance of their skin.

We are pleased to introduce Allumera –Photocure, a light activated topical cream combined with a medical light source that produces the same skin improvement as the medical photodynamic therapy with minimal downtime.  

Allumera is a cream that has been scientifically formulated to improve the overall skin appearance, reduce signs of aging and minimize pore size. It is actually a chemically modified version of Levulan, the medication used for treatment of precancers, but with more superficial penetration. The cream is applied to the skin for one hour and washed off. The skin is then exposed to a medical light source in the red or blue color range or treated with IPL or a pulsed dye laser. For 1 or 2 days after treatment the skin has a red or sunburn- like appearance. Sun avoidance is recommended for 48 hours; however patients may go to work using sunscreen. And, women can wear makeup to conceal the redness. Optimal benefits are achieved after 3 treatment sessions.

Allumera has been proven to provide significant skin improvement. The benefits include: decreased pore size, younger  looking skin, smoother skin texture and reduction in the appearance of fine lines. In a clinical trial of 120 patients, there was a statistically significant reduction in pore size and improvement in skin firmness five months after treatment.  Schedule a cosmetic consultation at our office to learn more and to take advantage of our introductory offer. For additional information as well as  before and after photos visit www.allumera.com .

Before and After treatment of smile lines with LAVIV

I just returned from attending the American Academy of Dermatology meeting which was held this year in San Diego. My patients and friends have asked me “What is new in skin rejuvenation?”

The top story for 2011, which is just now coming into clinical practice, is the development of personalized cell therapy for the treatment of “smile line” wrinkles. The treatment, known as “LAVIV”  was FDA approved in June 2011 for improvement  of smile lines or nasolabial folds. The technology involves an advanced process that extracts a person’s collagen producing fibroblast cells from a small skin sample taken in the doctor’s office. The Fibrocell Science Lab multiplies the patient’s own fibroblast cells and processes the cells into a formulation,  ”LAVIV” that can be injected into “smile line” wrinkles. The process of preparing the cells takes 3 months. Any cells that are not used can be frozen for future use over 2 years.

The cell therapy in the physician’s offfice is done over 2 or 3 treatment sessions spaced 3-6 weeks apart. The clinical trial, which was of 6 months duration, showed benefit for at least that time. In my “off the record” conversations with the investigators, several of them have observed benefit for 1 year or more. And, although the trial focused exclusively on the smile lines, as it is an easily measurable area, as LAVIV is in wider clinical use, it is likely that information will emerge about LAVIV’s  benefit in other facial areas.

I think this treatment is an exciting, unique treatment option that will produce natural results while reducing risk of allergic reactions.

Our office will soon be ready to offer this treatment. Save the date, Thursday April 26th, our Night of Beauty to learn more.

If you have been recently pregnant, had surgery, suffered from a serious illness, or lost a lot of weight on a very restricted diet and you are seeing hair falling out in handfuls, don’t panic! In each of these instances, more hair follicles have gone into the shedding phase for a few months. Within 3-6 months the problem should  resolve without treatment.

Are you noticing broken hairs or a receding hair line in front? If so, and you wear your hair pulled back tightly or in braids, it may be time for a new hairdo. Wearing tight braids, bun or ponytail can result in hair breakage over time. And, be careful about frequent chemical straightening or hot combing. If you are noticing breakage of the hair, take a long break from the straightening and with any luck, the damaged hair will grown out.

Have you noticed small, smooth coin shaped bald spots on the scalp? If you have been under stress recently, it is likely that you have alopecia areata. The good news is that dermatologists can offer treatments, such as local injection of cortisone, that will  resolve alopecia areata in a few months.

Have you noticed receding of your hairline?  If you are postmenopause, these changes can be normal.  Not likely that you will be bald, even if your dad had a shiny head!  Talk to your OB-Gyn about hormone replacement therapy early as it may make a difference in minimizing  hair loss. And, give the over-the counter medication Rogaine or minoxidil a try. It comes as a foam or liquid and has been shown to slow down hormonally induced hair loss in women. If the Rogaine for women has no result, try the Rogaine for men. (just wash your hands well after use and don’t rub your face!)

There are some forms of hair loss associated with medical conditions such as low thyroid and low blood count or anemia. If hair loss does not resolve or improve with the suggestions above, a consultation with a dermatologist is the next step.

My hair is falling out

Mederma, Vitamin E , silicone gel dresssings-all promise to reduce scars. Do they really work? Several recent studies in peer reviewed dermatology journals have cast doubt on the benefits of all three. Here is a rundown of what works and what is a placebo.

Mederma:

Although it is often recommended by physicians, this scar gel, which contains an onion extract, has no solid scientific evidence to support its use.

Vitamin E:

Although it is commonly used in anti-scarring products, clinical studies are disappointing. There is little research to support the use of Vitamin E and some studies have shown side effects such as localized allergic reactions.

Silicone Dressings or gels:

These inexpensive products, found at most pharmacies, are often recommended by plastic surgeons. Originally used for burn patients, silicone dressings are thought to soften scars by improving water content and oxygen in the wound. There is little scientific evidence that shows benefit but this treatment continues to be popular due low cost and safety.

Cortisone cream or injections:

Corticosteroids injected directly into raised or keloid scars are effective in flattening the scars in 50% of cases or more (depending on the study). There is a small risk of thinning the skin or lightening of skin color which is dose related and may be reversible. Cortisone creams, on the other hand have shown no benefit as a scar treatment.

Laser therapy;

Several lasers have been used for preventing and treating scars.  The pulsed dye laser reduces redness and elevation and improves texture of keloids or thickened scars.  There is a risk of recurrence of keloids after treatment. 

Fractional laser therapy ( aka Fraxel laser) has been recently used for improving the appearance of surgical scars. There is not a lot of data but results are promising.  Healing after this laser treatment is very quick, which has increased interest in this option. There are some recently published, small studies using fractional laser pre-surgery to minimize scar formation. This is an interesting area for future study.

New therapies:

New agents that target molecules active in the healing process are currently being studied. Several agents that can be injected into surgical scars; avotermin, human recombinant interleukin -10 and insulin have shown promising results.

It may soon be possible to say “Scar be gone”

Hollywood awards season has begun. Those who follow the awards shows will be taking note of the outfits and jewelry worn by the stars as well as their hair and makeup. Without a stylist or makeup artis, here are a few tips for flawless looking skin for your special occasions.

 If you are acne prone, it is important to begin a program of treatment, either over the counter or prescription 2-6 months ahead of the date.  Most topical medications take 8-12 weks for maximal improvement. And, for more severe acne, oral medication which takes several months to work may be needed.

For uneven pigmentation, prescription skin lightening creams will also need to be started 3-4 months in advance of the big event. If improvement is not complete after a few months, peels or laser treatment may be needed for optimal results.

At least a month before the date, start a gentle program of exfoliation to help your skin to glow on the big day. If you chose to use at home products, look for a mild glycolic acid cleanser for at least once daily use. and an evening product with retinol or glycolic acid. If your skin is very sensitive, I suggest using 5% glycolic acid in a moisturizing cream one a day or every other day first and adding an exfoliating cleanser if tolerated.  Then, two weeks before the event, see an esthetician for a superficial peel, or buy a home masque. Use very gentle products without glycolic or retinol while the skin is peeling. The home masque can be repeated one week before the event. On the big day your skin will be smooth and  perfect  for applying makeup.

There are so many brands at different price points it is hard to know which products can be purchased at the pharmacy to save money and which should be purchased at the cosmetic counter. Getting the foundation and blush color right is tricky so having your makeup done at the cosmetic counter or by an esthetician can help you get that right. Some niche products such as under eye concealer are hard to find at the pharmacy. I like Laura Mercier concealer because it is not as light in color as others so it blends better. Don’t forget to apply a light moisturizer as a base to help the foundation go on smoothly. Lipstick and eyeshadows are very similar from brand to brand. In some cases the difference between the more expensive and less expensive brand is in the packaging. L’Oreal, which is the biggest beauty company in the world, makes an inexpensive line of lipsticks and eye shadows that are sold at Target and pharmacies for a reasonable price. I have used them and noticed no difference between those and more expensive brands.

As for your attire and jewelry, take notes on what the stars are wearing tonight at the Golden Globes and at the Academy Awards. There are sure to be knockoffs we all can afford available soon. Whatever your attire, you will exude confidence knowing your skin and makeup look flawless.

Winter and fall bring in dry skin in southern California. Dry, hot Santa Ana winds can make you feel parched inside and out. And, cold weather combined with dry heat indoors zap the moisture from your skin. Medications such as antihistamines and topical acne medications reduce skin hydration or skin oils. Other culprits include thyroid disease, diabetes, menopause and older age (>65).

Here are some tips to treat dry skin from head to toe:

Hair and Scalp:

Dry hair can result from chemical treatments, use of hairdryers and hair straightening irons, and over washing. A hair masque applied for 15-20 min once weekly can hydrate the cuticle and restore brittle hair. Hair oils in sprayer bottles used before or after heat drying or straightening are another good option.  

Scaling and flaking of the scalp is usually a sign of seborrhea, eczema or psoriasis. If it doesn’t clear up with regular use of a dandruff shampoo, it is time to see a dermatologist.

Lips:

Dry winter weather frequently results in dry cracked lips. Keep a tube of Vaseline or a plain lip balm or moisturizing lipstick and apply throughout the day. Avoid lip balms with menthol or flavorings as long term use can result in an allergic reaction with increased redness and dryness. Cracked skin at the corner of the mouth with redness may require the addition of hydrocortisone 1%. Failure to respond may require a visit to the dermatologist.

Hands and Feet:  

The hands and feet often show the signs of dry weather first. Putting the moisture back by using one of the many effective dry skin products usually works. Some of my favorites, available at most drugstores, are: Cerave Cream, Lipikar Balm , Vanicream, and Cetaphil Cream. For extra dry skin try Aquaphor at night with socks or gloves. 

To reduce dry skin on the hands, wear gloves for housework and gardening and use a gentle moisturizer soap. And, avoid the use of alcohol based hand sanitizers which can dehydrate the skin.

Body, arms and legs:

The best tip for all over smooth skin is to apply a moisturizer all over on damp skin after showers. All of these products mentioned above can be used all over the body and reapplied several times a day. If the skin on the arms and leg looks like peeling paint, try a moisturizer that includes urea or lactic acid. These ingredients will exfoliate the dry dead skin cells as well as hydrate dry skin. If the skin is red and very itchy and does not respond to these measures, see a dermatologist for an accurate diagnosis and treatment plan.

Woman getting newfangled facial

I am often asked ” Would having regular facials help my skin?” 

Facials can be especially beneficial for men and women with acne prone skin characterized by lots of comedones (blackheads and whiteheads).  A skilled esthetician can use masques, steaming and mechanical extraction to get rid of the blocked pores, resulting in smoother, clearer skin. Combining regular facials with prescription topical acne medication containing vitamin A, such as Retin A, Differin or Tazarac can maintain the benefits.

For very dry or sun damaged skin, facials can aid in hydrating the skin. Mild exfoliation reduces the dead skin layer, allowing better penetration of the moisturizers and antiaging products applied afterward. After the facial, a good skin care program using cleanser, moisturizer, sunscreen and anti-aging treatment products appropriate for dry skin will help maintain the benefit.

In our fast paced and stressful world, there is psychological  benefit to 45 minutes or an hour of relaxation and pampering. For some the pampering is the main attraction.

What about “oxygen” or “microcurrent” or ” ultrasound” facials. Is there any evidence that the addition of these new technologies will improve your skin? And, is it worthe $125-$400? I think there is little  scientific evidence to support the claims of the device makers. For more information on “new” facials, click here.

Based on current evidence, I  suggest facials for patients with stubborn comedonal acne that doesn’t clear completely with topicals medication. I also recommend facials for patients desiring a non invasive skin smoothing and hydrating treatment.

 Nikki Darlak, the medical esthetician in our practice, performs facials with dermaplaning , a procedure that gently removes fine facial hairs leaving the skin markedly smoother and free of hair. This treatment is especially popular before special events as it allows better application of makeup. This treatment is less costly than an “oxygen” or “ultrasound” facial and provides immediate benefit.

For now it may be better to eat 5 servings of fruit and vegetables and take a multivitamin than to spend a lot on special oral vitamin supplements to improve the health of your skin. No matter how much healthy food and vitamins you ingest, only a small percentage of vitamins  are delivered to the skin.

The best way to prevent and reverse signs of aging is to apply anti-aging vitamins directly to the skin.  Here are the top vitamins to give your skin a healthier glow.

Vitamin A: Best overall anti-age fighter

Available in over the counter retinol creams such as Neturogena Retinol NX as well as prescription strength products such as Renova , Retin A and Refissa.

How to use : Apply topical Vitamin A products or retinoids ( as they are known) at night. All of these products can cause irritation, redness and peeling at first. To minimize that start off 2-x/week and gradually increase to nightly. A moisturizer may  be applied  afterward. All retinoids increase sun sensitivity, making very inportant to use a daily sunscreen. After several months your skin will be smoother, fine lines will be reduced and brown spots will be lighter. These benefits have been proven by more than 700 published research studies.

Vitamin B3: Reduces Redness and Helps Hydration

La Roche Posay Rosaliac Anti-Redness Moisturizer and Olay Regnerist Micro Sculpting Cream both contain B3 or niacinamide.

How to Use

Apply twice daily for best results. Flushing or blushing from rosacea will improve. And, this vitamin increases production of fatty acids in the skin helping the skin to retain moisture.  It can be used with a retinoid to reduce irritation.

Vitamin C: Boosts the Skin’s UV Defense

Skin Medica Dermal Repair ( contains C and E) Active C from La Roche Posay, Skinceuticals Vitamin C Serum. There are many other Vitamin C serums and creams. Look for products with at least 5% V itamin C in the form of ascorbic acid. The bottles should be opaque and able to seal tightly to maintain Vitamin C activity – light will deactivate it.

How to Use :

Vitamin C can be used morning or evening to help repair free radicals generated by sun damage. When used with sunscreen in the morning, it has been shown to prevent sunburn. Vitamin C is often combined with vitamin E, known as alpha tocopherol, in antiaging creams. Vitamin C combined with vitamin E provides 4x the antioxidant activity, helping to repair skin from sun damage.

Using at least 2 of the products mentioned above, combined with a broad spectrum sunscreen will result in younger looking, healthier skin within 3-6 months.

Dark circles under the eyes can make you look tired, unhealthy and older than you really are.  They occur in men and women often as young as the mid 30’s.

What are the causes?

·         Aging : the under eye ligaments get weak resulting in the normal fat pad pushing forward

·         Allergies: sinus and nasal congestion and watery eyes can cause under eye redness and puffiness

·         Heredity

·         Lifestyle factors: Lack of sleep, stress and  smoking all can cause puffiness in the under eye area

·         Pigmentation : more common in Asian, Hispanic and African-American skin

How can it be treated?

Mild or moderate dark circles respond to simple remedies. Getting enough sleep and   stopping smoking can result in improved eyelid appearance. Application of cold used teabags or frozen peas can temporarily reduce eyelid puffiness.  Allergy sufferers should reduce triggers such as pet dander and try a non-drowsy over-the-counter antihistamine such as Allegra or Zyrtec.  Women can conceal pigmentation or the deep trough under the eyes by applying an under eye concealer. It is best to select a color two shades lighter than the foundation color and apply lightly. For more makeup tips click here

Eye creams with anti-oxidants such as vitamin C and E reduce inflammation and can help hydrate the skin. My favorite is TNS Eye Repair from Skin Medica.

When to see a doctor:

·         If allergy symptoms are not relieved by an over the counter antihistamine after a few weeks, a trip to the allergist is in order.

·         If simple measures do not result in improvement, consult with a dermatologist to see if injection of Restylane into the under eye crease or “tear trough” would be helpful

·         If the under eye bags are very prominent , eyelid surgery done by a board certified plastic surgeon or opthalmoplastic surgeon may be the best option

Dermatologists may soon have a new tool to aid in the diagnosis of melanoma. MelaFind, a noninvasive computer-vision system, aids doctors in the diagnosis of pigmented lesions, helping to distinguish melanoma from benign lesions. The device is a computer on a rolling rack with an attached camera. The camera, which is placed on the skin lesion, takes images at various depths. The images are compared with images in the database to help confirm or disprove the likelihood of melanoma diagnosis. The diagnosis then needs to be confirmed by biopsy. In the company sponsored clinical trial, the Melafind was accurate 98.3% in diagnosing melanoma lesions vs.  dermatologists’ diagnoses, which were accurate 80% of the time. (The 80% accuracy in melanoma diagnosis by dermatologists is lower than other studies. One must keep in mind that this was an industry sponsored clinical trial)

The device has not yet passed all the hurdles of FDA approval. The next hurdle will be gaining approval from Medicare and other insurance plans to cover the test. Currently, there is a more cost effective diagnostic tool, the dermatoscope.This is a non-invasive handheld magnifying device that is placed on the surface of the patient’s skin, allowing the dermatologists to identify morphological structures at or below the skin surface that re not visible to the naked eye. There are specific dermoscopy patterns associated with melanoma which can help the dermatologist determine if a biopsy is necessary.  The “gold standard” for diagnosis is still a skin biopsy. The dermatoscope or Melafind can help the dermatologist analyze smaller, suspicious lesions and perhaps avoid doing unnecessary biopsies. Studies have shown that dermatologists who are experienced in the use of a dermatoscope can be 90% accurate or better in the clinical diagnosis of melanoma.

The most important partner in diagnosis is the patient. Those who are at high risk for developing melanoma are: individuals who have used tanning parlors, those with a family history of melanoma and individuals with fair skin who have had a history of severe sunburns. A yearly skin exam is important for patients at high risk. The yearly exam should be coupled with regular self-exams of the skin. If you fall into one of the high risk categories, you should schedule a skin exam with your dermatologist now. And, begin to do self-exams regularly by using the tools on the Skin Cancer Foundation website: http://www.skincancer.org/Self-Examination/ Pigmented or brown/black lesions on the skin which have grown, changed or appear different than other moles should have an evaluation by a dermatologist. And don’t forget about prevention. Apply your sunscreen…SPR 30or better.