Diverse Acne and Skincare Needs in Philadelphia

Skincare 101 and when to see the Doctor

Acne is a skin condition that affects almost everyone at some point in his or her life. While many people only deal with the occasional pimple, others have to contend with regular outbreaks that can cause feelings of self-consciousness and misery. Fortunately, there are many effective treatments that can minimize or even eliminate acne problems.

For some individuals, however, home treatments are not successful at treating acne and professional help is necessary. It is important to know when you should see a doctor about your acne in order to prevent long-term problems such as scarring or skin discoloration.
Hormones that lead to increased oil production are the main cause of acne. Bacteria then cause the oil to thicken and clog pores. This problem results in pimples and blackheads that are unattractive and can even be quite painful. Before consulting a doctor concerning your acne, try clearing up your skin with home treatments and remedies.

The first step in acne prevention and treatment is to use a good cleanser, washing your face no more than twice a day, once in the morning and once at night. It is important to use a good moisturizer in order to prevent skin from becoming overly dry, which will lead to increased oil production and more pimples. Once you have applied moisturizer, use an over the counter medication to treat the problem areas where outbreaks commonly occur. One of the best treatments is benzoyl peroxide lotion, which helps clear up the bacteria that causes acne.
Be cautious to use these treatments in moderation in order to avoid drying out the skin too much. Never squeeze or pick at pimples, which will only spread the acne-causing bacteria to the surrounding area and can lead to permanent scars.

If home treatments do not lead to a reduction in symptoms within two weeks, you should consult a doctor about how to best treat the problem. You should see a doctor if pimples become irritated or inflamed or if the problem worsens due to your home treatment. If either of your parents had severe acne or scarring as a result, you should consult your doctor as soon as possible. Your doctor may prescribe antibiotics that will kill the germs and bacteria that cause acne. Another commonly prescribed treatment is medicines that impact hormones amounts, leading to a reduction in the amount of oil the body produces. Your doctor may recommend other topical solutions that are stronger than those you can buy over the counter.

Before deciding on the treatment that is best for you, ask your doctor about the potential side effects of each option. Some hormonal treatments can lead to weight gain or moodiness, while topical solutions can cause skin irritation or allergic reactions. If your doctor recommends the drug Accutane, be sure to inquire about the drug's potential for psychiatric side effects such as depression or thoughts of suicide. Carefully watch for potential problems after you begin using a doctor prescribed treatment and be sure to report any undesired or unexpected results.

Acne can be more than just a minor annoyance for many people. Those with severe acne often experience depression, feelings of self-consciousness, and may avoid social situations due to embarrassment over the condition. It is important to take good care of your skin in order to minimize acne, but home treatments may not be effective for everyone. Consult a doctor for advice and treatment if home remedies are not helping, if your acne is worsening, or if you have a family history of severe acne. A professional can offer treatments that will minimize or eliminate the problem. It is vital to treat acne effectively in order to prevent long-term damage such as skin discoloration and scarring.

To Slow Down Aging: Treat All Three Layers of Skin

TO SLOW DOWN AGING: TREAT ALL THE LAYERS OF THE SKIN

The skin has three different layers to it. To help slow down the aging process of the skin, all three layers of the skin need to be treated. The treatment is different for each layer because the aging process affects each layer differently. To help you understand what is the best treatment for you, read on.

The top layer of skin, the epidermis, regenerates itself every 6-8 weeks, but as we age, the natural exfoliation process of the epidermis begins to slow down. This leaves the skin appearing uneven, dryer and duller. Your skin care products don't work as well because they now have to pass through this thick layer of dead skin for them to have an affect. The best treatment for epidermal aging is microdermabasion or glycolic peels.

The middle layer of skin, the dermis, is where collagen and elastin are produced. After the age of 30, we begin producing less collagen and elastin fibers. This causes the skin to thin, and if you are fair, it may appear more red because the superficial blood vessels under the skin are more noticeable, and skin begins to sag. If you have sun damage, there is an accumulation of abnormal tissue that begins to replace collagen, causing it to further weaken. The skin begins to develop fine lines, deep wrinkles and leathery skin. The best treatment to help rebuild this layer are the fractional resurfacing lasers (the PIXEL). These lasers penetrate deeper in the dermis to build collagen and elastin. If there is more redness, the skin rejuvenation lasers can help decrease the redness. The last layer of the skin is the hypodermis, the subcutaneous fat which provides us the natural fullness seen in young faces. As the dermis thins and atrophies, gravity begins to take its effect and slowly begins to pull the subcutaneous fat down to the jawline. Our facial structure begins to slowly change. In our twenties and thirties, we had an inverted triangle with the fullest part of our face in our cheeks with a natural tight jawline. In our forties and fifties, our face becomes more square or rectangular like as the dermis thins and gravity begins to pull the fat in the cheeks down towards the jaw line. As we approach our sixties, the fat is now at the jaw line causing more of the jowling and sagging effect. The end result is that we have an upright triangle rather than the inverted triangle we started with as a young person. The treatment for this layer is the Accent laser that helps remodel the subcutaneous fat while tightening the skin.

Shanti MedSpa at The Institute for Advanced Skincare and Optimal Health can help you slow down this process with our new 3 in 1 combo: ACCENT, PIXEL, MICRODERM. This treatment procedure helps you rebuild, remodel and revitalize all three layers of the skin to truly slow down the aging process. To see if you are a candidate for this revolutionary anti-aging treatment, please call or email us today!

A Detailed discussion of Acne Treatment Options

Contrary to what your mother may have told you, it’s not what you’re eating that causes acne. Acne has a strong genetic component, exacerbated by hormonal changes (most women already know this!); stress associated with school, jobs and starting families, and sometimes-poor skin care regimens. Everyone knows that acne affects teenagers, but most people do not realize that young adults in their 20´s and 30´s are more likely to develop acne than their teen counterparts.

NOT ALL ACNE IS CREATED EQUAL

There are different types of acne lesions as well as grades of acne severity. Treatment is based upon these possible combinations.

Types of acneiform lesions

· Open Comedone (aka the blackhead)

· Inflamed Papule

· Pustule (aka closed comedone)

· Painful Nodular Cysts

Doctors perform acne grading to help track improvement (or lack thereof) to therapy. Grade 1 is the mildest, with very few lesions. This continues up through grade 4, acne that has the most significant surface coverage.

When a patient presents in my office, I quickly evaluate the overall severity of the acne (the grade) and the types of lesions present. Every doctor has their favorite combinations of treatments that have been successful for their patients, so what I am about to share with you are regimens that I tend to favor. I allow 6-8 weeks for any therapy regimen to show significant (I didn’t say miraculous) improvement. If a patient does not demonstrate this, I will often change their medications. If you have been on the same medicines for a year and you are still breaking out, discuss this with your doctor!

Very mild, grade 1 acne, composed of small, superficial lesions, such as blackheads and pustules often responds well to topical therapy. My favorite prescription topical that shows consistent resolutions of blackheads continues to be Retin A .025% cream. Frequently, patients will tell me they have used Retin A in the past and have experienced quite a bit of irritation. Almost everyone can use Retin A if used properly.

I tell my patients to wait 30 minutes after washing before applying a pea-size amount of Retin A to the face. I also tell them to apply it only every other night when starting out. This minimizes the dryness. If the patient experiences anything more than some mild white flaking, they should back off to every third, fourth, or fifth nights, etc. until they can tolerate its use.

For patients with incredibly oily skin or for those who have innumerable stubborn blackheads, I have been very pleased with the Tazorac Gel that comes in 2 strengths, 0.05 and 0.01%. It is used in the same manner as Retin A or other similar derivatives.

Prescription Therapy For Acne Currently On The U.S. Market*

PILLS

Used to kill the bacteria P. acnes that causes acne flares as well as act as anti-inflammatory agents, reducing the size of acne lesions and helping prevent outbreaks altogether. Spironolactone works for those women with hormonal influences causing acne. BCPs again work at the hormonal level. Accutane works to correctly form the oil glands whose linings are improperly forming, and is the closest to a “cure” we have for acne.

· Tetracycline

· Minocycline

· Doxycyline

· Erythromycin

· Bactrim (Sulfa)

· Accutane

· Birth Control Pills (Ortho Tricyclen)

· Spironolactone

DIETARY SUPPLEMENTS

VitaMedica Healthy Skin is a nutritional supplement that provides internal skin care by enhancing the body´s natural systems for repairing, cleansing and healing. The supplement is intended as an adjunctive therapy to the topical products and/or treatments that skin care professionals recommend for acne patients.

Many topical treatments for the care of acne and inflammatory disorders of the skin are currently available. While effective, these regimens contain products that produce an action primarily on the outer layer of the skin. Although the topical approach represents the foundation of good skin care, it also makes sense to address what is going on internally. That´s because what you put inside your body may be just as important as what you apply externally.

VitaMedica Healthy Skin is indicated for patients with mild to moderate acne. The product is suitable for patients 12 years or older. This nutraceutical is ideal for individuals who do not eat a well-balanced diet on a consistent basis. Certain individuals should seek the advice of their doctor before beginning the program particularly diabetics, pregnant or lactating women. Healthy Skin Formula contains Vitamin A. If you are presently taking Accutane® (isotretinoin) for the treatment of acne, please refrain from taking HEALTHY SKIN FORMULA until the end of the treatment cycle.

TOPICALS

Topical Vitamin A Derivatives
Used to remove blackheads, dry up excess oils and smooth out bumpy acne.

· Tretinoins (Retin A, Avita)

· Tazarotene (Tazorac)

· Adapalene (Differin)

Topical Antibiotics
Used to kill of P. acnes, the bacteria responsible for flaring acne outbreaks.

· Erythromycin (Erycette, Emgel)

· Clindamycin (Cleocin T)

· Azelex

· Benzoyl Peroxide (BPO)

· Benzamycin (a combination of BPO and Erythromycin)

· Clinac BP (a combination of Clinac O.C. and Benzoyl Peroxide)

· Metronidazole (MetroGel/Lotion/Cream & Noritate)

· Plexion Lotion & Cleanser (Sulfa based)

INJECTABLES

The stray cyst can always rapidly be resolved with a small shot of steroid solution known as Kenalog (triamcinolone). The plus side to this is the rapid resolution for those "little emergency" situations like weddings, prom, etc. The draw back is that this is simply not the way to treat widespread recurrent acne. Nor is it pleasant should you experience the atypical "sink" spot where fat atrophy has taken place as a side effect from the shot. Fortunately this is unusual and fills in over several months.

DRYING AGENTS

Drying agents help reduce oils and often contain ingredients to help unplug pores otherwise known as keratolytic activity. Many OTC products contain these 2 activities in addition to some antibacterial properties thanks to Benzoyl Peroxide.

· Sulfur (Sulfacet R)

*This list is not meant to be fully comprehensive.

Non Prescription Therapy Options For Acne*

· Salicylic Acid (a.k.a. Beta Hydroxy Acid)

· Glycolic Acid

· Oil-Absorbers

· Oil-Absorbing Therapeutic Masques

· Combination Products (Peter Thomas Roth Max BPO Gel 10%,

· BPO

· Drying Agents/Keratolytics

· "Scar" therapy

· Discoloration therapy

*This list is not meant to be fully comprehensive.

While there is no single perfect prescription item in the treatment of acne, I still find topical Azelex 20% Cream to be a personal favorite. This medication is great for treating small inflammatory papules and pustules, and also works well for folliculitis and "hair bumps". This product works well in conjunction with Retin A. It is applied twice daily (ideally morning and dinner time), while the Retin A is applied by itself at bedtime.

A few tips when treating acne.

· Blackheads often require some form of prescription topical vitamin A product for eradication. Several agents have been clinically proven to target a variety of factors that contribute to the formation of a blackhead while improving the appearance of pores. It can be used solo or in conjunction with a prescription regimen depending upon the severity of the problem.

· Cysts respond best to pill therapy.

· A corollary: If you’re under 13, nursing or pregnant, tetracycline based medications are off limits as they can permanently discolor the tooth enamel. If you really need oral medication, usually it’s limited to Erythromycin.

· Consistency of treatment is your best asset when trying to get results. Don’t pick, it can lead to scar formation.

· Allow at least 6-8 weeks for every new therapy to kick in before giving up on it.

· Don’t scrub your face or get facials if you’re acne prone. This simply traumatizes the glands and leads to further flare-ups.

· Keep your bangs off your forehead and your hands off your face. This deposits excess oils that can further clog pores.

· Avoid the use of heavy skin care products like cocoa butter, they will smother the skin and flare your acne.

· Don’t apply your acne creams/lotions, etc. heavily like a masque (unless it is one). There is no reason that your cream needs to be seen in order to work.

· Remove your make-up when you’re at home. Let your skin breathe!

Skin care for those who are acne prone can be enhanced by the use of high potency glycolic acids. "Medical grade" should provide at a minimum level of 8%, preferably 12% or higher. Neostrata line of acne agents contains 12% glycolic acid, can be used for removing excess oils and surface debris, thus unclogging pores. For anyone concerned about rejuvenation and acne, Neostrata has a bevy of antioxidants combined with even higher levels of glycolic acid (15% and 20%, respectively), providing an enhanced cleansing experience.

The application of a topical glycolic acid gel or lotion such as Neostrata can also be used in conjunction with other topicals such as Azelex at the same time, it helps to draw the medication in deeper and become more effective.

Many times, patients will also have a great number of inflammatory papules and/or cystic lesions. In this case, oral medication is needed in addition to topical therapy for effective resolution. The tetracycline family is the most effective. Regular tetracycline (aka sumycin), is used in doses of 500mg twice daily. Minocin is a more aggressive member of this antibiotic family. It also is much more expensive. I save this for patients who show no response to tetracycline, or patients with mostly cystic acne. Doxycycline is similar to minocycline, however, I have not had nearly the response rate to this medication as I have to Minocin so I tend to avoid its use. Erythromycin is not nearly as effective for treating acne and tends to cause significant stomach upset. I save this for patients who are younger than 13 (tetracycline products will discolor dental enamel in this age bracket) or for patients who for some reason cannot take tetracycline. If you are on Erythromycin, take it on a full stomach you’ll be more likely to tolerate it.

Regardless of which antibiotic you might be on, here are some things to keep in mind. After you’ve cleared in let’s say 8 weeks, that doesn’t mean you suddenly go off the medication like you have had a sinus infection. If you do, odds are you are going to break out again. Once I have found the best mix of medications that clears a patient, I usually keep them on the same routine for another 3 months. At that time, assuming all is well, I will start to slowly wean them off their oral prescription antibiotics if at all possible. If there is a flare, I go back to the dose before that kept them clear. Some patients come off the meds altogether (this is rare), most are able to take the medicine less frequently (timing will vary with the patient) and a few won’t be able to decrease their dosage whatsoever.

Unfortunately, I still come across many first time acne patients who have very severe cystic acne. These are the grade 4 cystic acne patients for whom aggressive treatment is required right away. Accutane has been a blessing for these patients. Accutane is a drug to be taken seriously. It is the closest drug we have to an acne "cure", however, it can have potential side effects. For this reason it is not offered to patients with mild acne. Occasionally, I will have a patient with significant non-cystic acne unresponsive to accepted aggressive therapy who may be placed on Accutane. Pregnancy must be avoided while on Accutane as well as for 1 month after discontinuing the drug due to the risk of birth defects. It is important to understand that the medication does NOT affect ovaries, eggs or sperm. Only a developing fetus is at risk. Treatment is for only 5 months and has repeatedly shown great results. While on Accutane, blood work is done for screening, every 2 weeks for the first month of use and monthly for the final 4 months of use. This is to monitor potential problems with blood counts, liver and kidney function as well as monitor triglyceride levels that can skyrocket during Accutane use.

Two product candidates in the acne pipeline under study include topical versions of oral medications that have been used to treat cystic acne. Topical Accutane is being used in Canada and Europe. I have had some patients present who have been given "home made" forms of this product which consisted of their pharmacist poking holes in the Accutane capsule and mixing it into a cream base. So far they have reported all it did was locally irritate and dry the skin without helping clear the acne lesions. It remains unclear whether a consistent formulation marketed after FDA approval would be more beneficial. Another medication called Dapsone used to be prescribed for severe cystic acne before the availability of oral Accutane. Dapsone continues to be used in dermatology mainly in the treatment of certain blistering disorders. So far I have heard very little about early study results of its topical use for acne therapy.

Foot Loose and Oil-Free

Finally, it is necessary to avoid the use of routine skin care products that might exacerbate or cause acne. Typically dermatologists try to recommend oil free products right away to their acne patients. Another term for these items is non-comedogenic. Products such as Neostrata are often recommended as appropriate for acne prone patients without the concerns of causing further acne flares. It is important not to dry out your skin in your enthusiasm to try to clear your face. It is natural to want to repeatedly use a helpful item or try one that is quite strong to help speed up the healing process. But overly dry skin or red, irritated, inflamed skin is not meant to be the end point. There are some acne patients who have normally dry or sensitive skin despite the presence of acne. If you fall into this category, try keeping the use of drying items to a minimum. Rarely, some acne patients are unable to use any topical acne therapy as it is simply too irritating and the use of pills again becomes necessary.

Too many acne sufferers go untreated far too long. Acne can have a real impact on an individual’s self esteem. Dermatologists are specially trained to treat skin diseases including acne. We have so many effective therapies that weren’t available in the 70’s when I was growing up. I can’t emphasize enough that NO ONE needs to suffer from acne. If you have acne that doesn’t respond to over the counter treatment, please check with a board certified dermatologist in your area.

Thank you for taking the time to read through this important information. I hope you have found this article informative.

Acne Geography-Treatments for Various Unique Location

Despite its persistence as a facial blight, acne doesn’t necessarily respect bodily borders and confine its geographical reach to the T-zone. Despite winning the overall war against zits, you may still find yourself fighting the occasional battle on your chin, back and butt. Sticking with a good skin care routine that keeps your skin clean, but not stripped, exfoliated, but not raw, and using a topical agent such as benzoyl peroxide or salycilic acid is good practice. However, if your breakouts seem to crop up where you least expect them, a little sleuthing might help you uncover the culprit.

The zone: Jaw and chin

The culprits: your phone or resting your chin in your hand.

Dirty hands cradling your face throughout the day constantly deposit dirt and oil from your hands directly on to your face. Add to that the pressure and you’ve set the stage for a pimple. Telephones, oily from constant use and tucked against your face, create a welcome environment for acne.

The fix: Regularly swab down your home phone, cell phone, work phone, whatever phone you use, with an alcohol soaked cotton pad to cut grease and kill bacteria lingering on these heavy-use surfaces. When speaking on the phone remember not to rest your face on the receiver. Wear an excellent oil-control gel that will be there to absorb the oils, not your skin. Gel can be re-applied throughout the day - even over makeup! We can make recommendations on a gel for your problem

The zone: Hairline, scalp, forehead, and temples

The culprits: So common is this flare-up destination that it even has it’s own name: pomade acne. Many hair products designed to defy gravity and the nature of your hair to get it to mold into the desired style of the day can also clog pores and lead to acne.

The fix: If you can’t forgo using the hair product altogether, try to at least keep it from having direct contact with your skin by limiting the amount that comes into contact with your hairline and scalp. Look for brands that tout their noncomodogenic (won’t clog pores) qualities such as many water-based formulations. Keeping oily hair clean by using a good, grease-busting shampoo. Glycolic acid facial cleansers such as NeoStrata alone or combined periodically with a good facial chemical peel or microdermabrasion can go a long way to keeping skin clean. Add a dab of retinol used solo every other night to stubborn troublesome areas.

The zone: Cheeks

The culprits: Hair, hands, pillows, and makeup.

The fix: Compared to other regions of your face, cheeks generally are less prone to breakouts, so a flare up can be particularly frustrating. Luckily, a little self-discipline may be all it takes to get your complexion back in shape. If your hair is oily and regularly dragging across your cheeks, try using a shampoo formulated for oily hair and then keep your hair tied back, off of your face, to prevent transferring oil from your hair to your skin. Likewise, change your pillowcase frequently. Dirt and oil build-up on bed linens can aggravate acne.

If you are a blush or bronzer user check the label for mica. Mica is a mineral that even when ground finely for cosmetics retains its irregular shape. Its jagged edges can irritate and clog pores leading to acne. We recommend mineral oil based cosmetic line like Glo Minerals as a daily use make-up that is safe and preventative.

A dirty blush brush can harbor disturbing amounts of acne causing bacteria so remember to wash out your cosmetic brushes regularly or switch to a non-comodogenic gel or water-based formula.

Kill skin bacteria and open pores with a well-rounded acne masque such the NeoStrata antibacterial soap and moisturizer used a few nights each week.


The zone: Back and shoulders, chest

The culprit: Sweat and friction.

The fix: Wear workout clothes, especially sports bras, that breathe and wick sweat away from the skin, and aren’t binding or abrading to the skin, both of which can promote an acne-positive environment. Make sure to shower after sweating with a cleanser that will lift grime away from the skin such as Murad Activating Body Scrub and change into clean, dry clothes that aren’t tight fitting.

If you find that you’re breaking out along your bra-strap line, on the shoulder where you carry your handbag, or shoulders that take the weight of your backpack, rethink those items (i.e. use a handbag or tote instead of a shoulder bag) to reduce what is called acne mechanica. This pressure-induced acne can also show up on the chins of violin players and where sports equipment chaffes (like bike helmets).

If you are experiencing acne on your back, Murad allows you to treat this hard to reach area. If after controlling the acute and chronic acne formation, microdermabrasion, chemical peel or pixel laser are all options for eliminating acne scarring, pitting and discoloration.

The zone: Lip line

The culprit: Pore clogging lip balms/lipstick/lip gloss. All those concoctions that make your lips feel slick and silky can also leave you broken out.

The fix: Switch to formulations that don’t have the high concentrations of waxes and petroleum. A Lip Plumping Pencil is a great option; apply to lip line and fill-in. Don´t forget to remove lipstick residue at the end of the day.

The zone: Your, uh, bum

The culprit: Tight clothes that don’t breathe and tough behind skin that doesn’t slough off pore clogging dead skin cells.

The fix: First, ditch tight pants and undergarments, including tights and stockings, for garb which gives skin a little space and a chance to breathe. Then, invest in an exfoliant and use it regularly. Medicated scrub is an ideal way to keep pores "down there" clean and fresh, but remember, that this is delicate skin; don´t over do it!

Health Benefits of Brown Rice

White rice begins as brown rice. Once the outer coating of rice bran is hulled off, however, not a lot of nutrients remain. A thousand years ago, Chinese physicians discovered that eating only refined white rice, devoid of the B vitamins in the bran, led to beriberi, a deficeincy in thiamine (B1). Modern research has identified a wealth of nutrients in the bran coating of brown rice. It is remarkably effective in lowereing high blood sugar and therefore serves as an excellent food for diabetics.

Rice bran contains more than seventy antioxidants, including the well known aging fighters vitamin E, glutathione peroxidase, superoxide dismutase, coenzyme Q-10, proanthocyanidins, and inositol hexaphosphate. It is no wonder that rural farmers in Asia, who eat brown rice because white rice is too expensive, live longer and develop fewer health problems than their city dwelling counterparts, who eat mostly white rice.

Biologic Replaces Ointments & Surgery to Stop Aging

Biologic Replaces Ointments & Surgery to Stop Aging

Sun Smart Cities-Where does Philadelphia rank?

So you think your city got on the list for "sun smart cities", think again. The American Academy of Dermatology released its first-ever ranking of 32 "sun smart" cities and a few states. Washington, D.C. leads the list and Chicago is in last place.
More than 3,300 adults in those areas completed the AAD's online survey, "Rays: Your Grade," in February.
Survey topics included participants' history of sun exposure and their knowledge about tanning, sunburns, skin cancer, and sun protection.
The AAD's rankings are based on the responses of residents in each location. Here is the AAD's list. Locations that tied received the same number.
1. Washington, D.C.
2. New York
3. Miami
4. Tampa, Fla.
5. Los Angeles
6. Dallas
7. Salt Lake City
8. San Francisco
9. Idaho
9. Atlanta
9. Philadelphia
12. Phoenix
13. Portland, Ore.
14. Vermont
15. Providence, R.I.
15. Baltimore
15. Boston
18. Hartford, Conn.
18. Riverside, Calif.
20. Houston
21. New Hampshire
21. Denver
21. St. Louis
24. Cincinnati
24. San Diego
26. Detroit
27. Cleveland
27. Minneapolis
29. Seattle
30. Pittsburgh
31. Maine
32. Chicago
Other poll results include:
Nearly 3 in 4 participants feel that people look more attractive with a tan. Nearly 4 out of 5 participants are concerned about skin cancer. Nearly two-thirds of participants got a tan last year. Half of participants were sunburned at least once last year. Most participants (71 percent) don't use sunscreen on an average day.
Curious about the quiz? You can take it yourself on the AAD's Web site http://www.aad.org/