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What Dermatologists Want You to Know

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I talked with two experts, Margaret Brown and Jennifer Comiskey, both certified physician assistants in dermatology, to get the real story behind the skin we’re in.

Is it ever okay to be out in the sun?
We need sunlight to help us produce vitamin D, so we don’t need to avoid it completely, but we should always wear sunscreen. Both experts recommend applying sunscreen (SPF 30+) before going out and reapplying it every two hours. If you have a problem with sunscreen getting into your eyes, Ms. Brown suggests a stick formulation that is waxier and more likely to stay in place or a product like Neutrogena Ultra Sheer that goes on feeling dry, not greasy. Additionally, sunscreens that contain either zinc oxide or titanium dioxide tend to offer more of a “mechanical” barrier versus a chemical one. And, if you can, avoid being in the sun from 10 a.m. to 2 p.m.

Can we really fight aging and wrinkles?
While we can’t turn back the clock, there are treatments and products that mask the signs of aging. You can lighten brown spots (solar lentigos) with bleaching agents like hydroquinone, though the spots may reappear when exposed to the sun. Ms. Brown recommends Aveeno’s Positively Radiant, which helps diffuse the appearance of the irregular pigmentation. It has an SPF 30, it’s oil-free, and it’s noncomedogenic. Chemical peels and lasers are also used to treat spots. If you have a new spot that is changing (getting bigger, darker, or fading), see a dermatologist because malignant melanoma can appear similarly.

And those wrinkles? There are many options to choose from including injections such as Botox (which paralyzes the muscles) or fillers such as Restylane, Sculptra, and Juvéderm. You can also treat wrinkles with laser procedures like Fraxel, chemical peels, and topical solutions that contain tretinoin, retinol, or alpha hydroxy acids.

What’s the best treatment for keratosis pilaris (KP) and psoriasis?
Ms. Brown stresses that both of these conditions are chronic and have no cure. KP is very hard to treat, but the experts say to avoid scrubbing or exfoliating, because the little bumps will become more irritated and inflamed (and more noticeable). It’s also best to avoid scratching or wearing tight, occlusive clothing. Dermatologists may use an acid cream to try to smooth the bumps. Ms. Brown suggests Lac-Hydrin (a moisturizer containing lactic acid), AmLactin (an over-the-counter moisturizer), or a product that contains urea like Vanamide (a tissue softener).

The latest treatments for psoriasis include the use of biologics, a class of medications that are produced through biological processes involving recombinant DNA technology. These treatments are for patients who have a large percentage of their body surface affected or who suffer from psoriatic arthritis. They can also be used to treat difficult areas like the hands, feet, face, and genitals. For less severe cases, Ms. Comiskey suggests vitamin D derivatives, topical steroids, intralesional steroid injections, topical keratolytics, light therapies, and oral medications.

What’s a good daily routine for people with adult acne?
To begin with, Ms. Brown recommends finding out whether you suffer from acne or rosacea. They are in the same family, but rosacea is triggered by things like alcohol, spicy foods, caffeine, and excessive sun exposure. Products that reduce the redness in both conditions are Purpose Redness Reducing SPF 30, Eucerin Redness Relief, or Aveeno Ultra-Calming with Feverfew (a natural ingredient related to chamomile, known for its soothing properties). Using makeup that has a green tint can also reduce the appearance of a red face.

Wash with a mild cleanser that is oil-free, noncomdeogenic, and hypoallergenic (don’t wash too much, as it can overstimulate your oil production). You can apply some type of anti-acne cream that contains salicylic acid, benzoyl peroxide, or retinoids. Some people respond to oral antibiotics or oral contraceptives. Last of all—don’t pick! It leaves scars, opens you up to infection, and may cause deeper lesions.

What’s a good daily routine for people with no skin problems?
Both experts recommend washing with mild cleansers and avoiding extremely hot water. Moisturize when the skin is wet and clean with products that are free of harsh perfumes or dyes (Ms. Comiskey recommends Dove’s sensitive skin products). Use sunscreen!

How many times a year should we check moles?
According to Ms. Comiskey, if you have a history of melanoma, the schedule is every three months for the first year, every six months for the next year, and if all is clear, then yearly. If you have a family history of melanoma and have many moles, you should be checked every six months. If you have no history, get a yearly exam. Monthly self-checks are highly recommended; use the ABCDE process to do your self-exam.

What’s one thing you wish people understood about skin/skin care?
Ms. Brown: Skincare is “all-encompassing.” Genetics, hydration, good nutrition, smoking, the tanning bed, protection with clothing and sunscreen, and oily makeup all factor into whether you have good skin or not.

Ms. Comiskey: Not all creams treat all conditions. For example, antifungals are not good for all rashes and hydrocortisone is not the “cure all” cream. And—sunscreen works!

A Few Quickies:

  • If you don’t have much money, use Vaseline; it’s the best moisturizer there is
  • The most common spot women get skin cancer is the back of the leg/thigh
  • It is possible to wash too much; every time the skin is wet, the natural protective oils are washed off and your skin is exposed to dryness

Skin is our largest organ and we’re pretty much stuck with it, so we should keep it healthy. Skincare is like a diet—what works for someone else may not work for you. There are many options out there and your dermatologist will work with you to find the right treatments for your specific needs.

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