Treatments for Common Birthmarks, Dysplastic Nevi and Congenital Nevi

A birthmark is a colored mark on or under the skin that’s present at birth or develops shortly after birth.Some birthmarks fade with time; others become more pronounced. Birthmarks may be caused by extra pigment in the skin or by blood vessels that do not grow normally. Most birthmarks are painless and harmless. In rare cases, they can cause complications or are associated with other conditions. All birthmarks should be checked by a doctor.

See  the slideshow here:   http://www.medicinenet.com/birthmarks_pictures_slideshow/article.htm

Former Soviet President Mikhail Gorbachev has a port wine stain.

Salmon Patches

Salmon patches are nests of blood vessels that appear as small, pink, flat marks on the skin. They occur in 1/3 of newborn babies. Salmon patches can appear on the back of the neck (“stork bite”), between the eyes (“angel’s kiss”), or on the forehead, nose, upper lip, or eyelids. Some fade as baby grows, but patches on the back of the neck usually don’t go away. Salmon patches require no treatment.

Port Wine Stains

A port wine stain begins as a flat, pinkish-red mark at birth and gradually becomes darker and reddish-purple with age. Most will get bigger and thicker, too. Port wine stains are caused by dilated blood capillaries. Those on the eyelid may increase the risk of glaucoma. Port wine stains may be a sign of other disorders, but usually not. Treatment includes laser therapy, skin grafts, and masking makeup.

Mongolian Spots

Mongolian spots are flat, smooth marks that are present from birth. Frequently found on the buttocks or lower back, they’re typically blue, but can also be bluish gray, bluish black, or brown. They may resemble a bruise. Mongolian spots are most common on darker-skinned babies. They usually fade by school age, but may never disappear entirely. No treatment is required.

Cafe-Au-Lait Spots

Cafe-au-lait spots are smooth and oval and range in color from light to medium brown, which is how they got their name, “coffee with milk” in French. They’re typically found on the torso, buttocks, and legs. Cafe-au-lait spots may get bigger and darker with age, but are generally not considered a problem. However, having several spots larger than a quarter is linked with neurofibromatosis and the rare McCune-Albright syndrome. Consult a doctor if your child has several spots.

Strawberry Hemangiomas

Hemangiomas are a collection of small, closely packed blood vessels. Strawberry hemangiomas occur on the surface of the skin, usually on the face, scalp, back, or chest. They may be red or purple; they can be flat or slightly raised, with sharp borders. Strawberry hemangiomas usually develop a few weeks after birth. They grow rapidly through the first year before subsiding around age 9. Some slight discoloration or puckering of the skin may remain at the site. No treatment is required, but when desired, medicines and laser therapy are effective.

Cavernous Hemangiomas

Present at birth, deeper cavernous hemangiomas are just under the skin and appear as a bluish spongy mass of tissue filled with blood. If they’re deep enough, the overlying skin may look normal. Cavernous hemangiomas typically appear on the head or neck. Most disappear by puberty. A combination of cavernous and strawberry hemangioma can occur.

Venous Malformation

Venous malformations are caused by abnormally formed, dilated veins. Although present at birth, they may not become apparent until later in childhood or adulthood. Venous malformations appear in 1% to 4% of babies. They are often found on the jaw, cheek, tongue, and lips. They may also appear on the limbs, trunk and internal organs, including the brain. They will continue to grow slowly, and they don’t shrink with time. Treatment — often sclerotherapy or surgery — may be necessary for pain or impaired function.

Pigmented Nevi (Moles)

Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. They can appear anywhere on the body, alone or in groups. Moles are usually flesh-colored, brown, or black. Moles may darken with sun exposure and during pregnancy. They tend to lose color during adulthood and may disappear in old age. Most moles are not cause for alarm. However, moles may have a slightly increased risk of becoming skin cancer. Moles should be checked by a doctor if:

* They change size or shape
* They look diffrent from other moles
* They appear after age 20

Actress Eva Mendes sports a “beauty mark” on her check.

Congenital Nevi

Congenital nevi are moles that appear at birth. The skin texture may range from normal to raised, or nodular to irregular. Congenital
nevi can grow anywhere on the body and vary in size –from a small 1-inch mark to a giant birthmark covering half of the body or more. Small congenital nevi occur in 1% of newborns. Most moles are not dangerous. But congenital nevi, especially large ones, should always be evaluated by a doctor since they may have an increased risk of becoming skin cancer.

Dysplastic Nevi (Atypical Moles)

Atypical moles are generally larger (one-quarter inch across or more) than ordinary moles and have irregular and indistinct borders. They may resemble cancerous moles. They may have a mix of colors including pink, red, tan and brown.These moles tend to be hereditary. Atypical moles have an increased chance of developing into melanoma skin cancer. Have a doctor evaluate all moles that look unusual, grow larger, or change in any way.

Common Bacterial Infections of the Skin

Our skin is host to a number of bacteria, most of which are beneficial. Including the friendly flora in our gut, more than 200 species of bacteria reside within the tissues exposed to the external environment. Skin infections result from these bacteria when the integrity of the skin breaks down or when the immune defense system is weak.

Skin infections can occur on the skin surface or deeper within the skin tissue. The most common bacteria that infect the skin are Staphylococcus aureus and Streptococcus pyogenes. Read more about bacterial infections on www.skincareguide.ca/conditions/bacterial_infections

TYPES OF BACTERIAL INFECTIONS:

Impetigo and Ecthyma

Impetigo begins with a redness of the skin and progresses to blisters that fill with fluid and itch, and then produce honey-colored crusts. Lesions usually form around the nose and face. Ecthyma is a deeper version of impetigo that usually forms on the legs. It causes large boils, crusts, and deep sores that leave scars.

Folliculitis

Folliculitis is an infection of the hair follicles. It produces pimplelike skin bumps and small blisters with pus. Folliculitis occurs on the face, upper trunk, arms, and buttocks. When the infection goes deeper, feels tender, and produces more pus, it is furunculosis. Carbuncles are furuncles that have fused.

Abscess

An abscess is a deep infection that appears like a closed blister or an open hole with pus. It is usually tender and becomes sore and painful as the infection progresses.

Erysipelas and Cellulitis

Erysipelas is a superficial infection that tends to occur in young children and the elderly. It is also seen in those who have chronic swelling of the limbs, are addicted to alcohol, have diabetes mellitus, or have experienced trauma. Erysipelas mostly occurs on the face or legs. A fever occurs abruptly, the cheeks become red, and the skin feels hot, tense, and swollen. Cellulitis is a deeper form of this infection.

TREATMENTS:

Bacterial skin infections are treated according to their severity. Your physician may incise and drain deeper infections and abscesses, and recommend that you apply warm compresses. Creams such as Fucidin® or Bactroban® are prescribed for mild stages of:

* impetigo
* ecthyma
* folliculitis
* abscess

If the infection is more extensive, oral antibiotics such as Cloxacillin or Cephalexin are used as well as those in the erythromycin family. Penicillin is often used to treat for strep.

Antibiotic resistance is an increasing problem so it is best to have early adequate proper treatment to minimize risk of exposure to antibiotics and lower the risk of transmission to others.

During treatment, remember to wash your hands daily with an antibacterial solution such as Trisan®, Tersaseptic® or Hibitane®, or use a product like Safe4Hours® (www.invisicare.com) which kills bacteria for four hours. Hand washing is the most important thing you can do to minimize the spread of infection.

If you suspect a bacterial skin infection, see your doctor before it becomes severe. Due to the increase of bacterial resistance to drugs in general, it is important to take the full course of your prescribed medicines.

Treatment of Anogenital Warts

Safety, Efficacy & Recurrence Rates of Imiquimod Cream 5% for Treatment of Anogenital Warts

Imiquimod 5% cream (Aldara™, Graceway Pharmaceuticals) is an immune response modifier used for the topical treatment of anogenital warts in non-HIV-infected patients. Several randomized controlled trials have demonstrated that imiquimod 5% cream is a safe and efficacious treatment. Current data regarding efficacy shows that complete clearance of warts occurred in up to 50% of patients treated with imiquimod 5% cream applied once-daily, 3 times per week for up to 16 weeks. Recurrence rates ranged from up to 19% at 3 months to 23% at 6 months. Imiquimod 5% cream showed an acceptable safety profile; local inflammatory reactions were the most frequent adverse effects, with local erythema being the most common.

Imiquimod is an immune response modifier that was approved by the US FDA in 1997 for the topical treatment of anogenital warts in individuals 12 years old and older. An estimated 30%-50% of sexually active adults in the US are infected with human papillomavirus (HPV), and approximately 1%-2% of this same population have clinically evident genital warts.¹ This review will focus on studies that evaluate the safety, efficacy, and recurrence rates of imiquimod 5% cream in the treatment of anogenital warts in non-HIV-infected men and women. Local inflammatory reactions were the most frequent adverse effects, with local erythema being the most common. Overall, imiquimod 5% cream is a safe and efficacious treatment for anogenital warts.

Using Imiquimod

Imiquimod cream is supplied in individual packets. Each gram of the 5% cream contains 50mg of imiquimod in an off-white oil-in-water vanishing cream base.² The US Center for Disease Control recommends that imiquimod 5% cream be applied once daily at bedtime, 3 times per week for up to 16 weeks. The product should be washed off with mild soap and water 6-10 hours following application.^2-4 Many considerations exist when using imiquimod. Some of these are listed in Box 1. The US FDA provides a full list of considerations.³

Mechanism of Action

Imiquimod is a Toll-like receptor agonist that induces the production of local cytokines from predominantly T helper (Th) 1-type cells, thus stimulating both acquired and cellular immunity, which is important for fighting virus-infected and tumor cells.^5-7 Cytokines such as interferon (INF)-á, tumor necrosis factor (TNF)-á, interleukin (IL)-1, -6, -8, -10, and -12 stimulate tissue-specific apoptosis of virus-infected keratinocytes, thus leading to a viral load reduction of HPV types 6 and 11 with subsequent wart regression and normalization of keratinocyte proliferation.^5,6,8 Regression of warts after treatment with imiquimod is strongly associated with evidence of tissue production of INF-á, -â, and -ã and TNF-á as well as a decrease in the presence of HPV DNA and in the expression of mRNA for both early and late viral proteins.⁹

Points to consider when using imiquimod:

It is common for patients to experience local skin reactions and treatment can be resumed after the skin reaction has subsided. Sexual (genital, anal, oral) contact should be avoided while the cream is on the skin. Imiquimod may weaken condoms and vaginal diaphragms, therefore concurrent use is not recommended. Imiquimod is pregnancy category C and it is not known whether topically applied imiquimod is excreted in breast milk. New warts may develop during therapy, as imiquimod is not considered a cure.

Box 1: Information for patients being treated for external genital warts3

Safety

In all the randomized controlled trials (RCTs) examined, topical imiquimod 5% cream showed an acceptable safety profile. Local skin reactions are associated with a local inflammatory reaction including itching, erythema, burning, irritation, tenderness, ulceration, erosion, and pain.¹⁰ In several studies, local erythema was the most common reaction.^11-13 There were no differences in adverse systemic reactions or flu-like symptoms among treatment groups.^10,12,13 The optimal dosing regimen is 3 times per week. With more frequent applications (up to 3 times daily), wart clearance does not improve significantly and is associated with an increase in local adverse events, such as erythema, vesicle formation, ulceration, and excoriation.¹⁴ Imiquimod 5% cream is effective for up to 16 weeks of treatment for external anogenital warts and is well-tolerated for up to 32 weeks.¹¹ Imiquimod is contraindicated in individuals with a history of sensitivity reactions to any of its components and should be discontinued if hypersensitivity to any of its ingredients is noted. Overall, patient-applied imiquimod 5% cream is an effective treatment for external genital warts and has a favorable safety profile.

Efficacy and Recurrence

Several randomized controlled trials demonstrated that imiquimod 5% cream is an efficacious treatment for external anogenital warts when applied 3 times per week for up to 16 weeks. Complete clearance of warts occurred in up to 50% of patients treated with imiquimod 5% cream applied 3 times daily. At the end of 16 weeks, recurrence rates ranged from up to 19% after 3 months and 23% after 6 months.11 See Table 1 for comparisons. The recurrence rates of external genital warts were found to be similar at both 3- and 6-month follow-up, suggesting that after 3 months, the risk of developing recurrence is low.¹⁵

The studies that follow were chosen to evaluate imiquimod 5% cream for the treatment of anogenital warts because of sufficient data on efficacy, recurrence rates, and safety.^10-13 Studies that did not include this data were excluded. Several other studies focused on the treatment of anogenital or vulvar warts in the female population; however, the efficacy rates are generally higher for this population, ranging from 71%-77%.^12,16-18 To maintain continuity, this review focuses on comparing studies that include treatment of anogenital warts with imiquimod 5% cream in non-HIV-infected men and women.

Detailed Findings of This Study Can be Found Indexed by the US National Library of Medicine and PubMed

Monotherapy Compared with Combination Therapy: Imiquimod + Surgery

Carrasco et al.¹⁹ showed that treatment with imiquimod 5% cream followed by excision of remaining warts resulted in a lower recurrence rate compared with surgery alone. This strategy represents a viable option for those with residual lesions and may provide long-term clearance of anogenital warts in patients for whom imiquimod monotherapy is insufficient.¹⁹

Conclusion

Patient-applied imiquimod 5% cream is a first-line topical treatment for anogenital warts that is both safe and efficacious, and yields complete and partial responses in the majority of patients. Various studies demonstrate complete clearance rates of up to 50% and partial responses manifest as a 50%-90% reduction in baseline wart area.^12-14 Recurrence rates range up to 19% at 3 months and 23% at 6 months. More studies are needed to compare the efficacy of combination therapies vs. monotherapy vs. other treatment modalities. Longer follow-up is also needed to evaluate recurrence rates after monotherapy, as well as in combination with other treatments for anogenital warts.

M.L. Diamantis, BS¹; B.L. Bartlett, MD²; S.K. Tyring, MD, PhD³

1. The University of Texas Medical School at Houston, Houston, TX
2. Center for Clinical Studies, Houston, TX
3. The University of Texas Health Science Center at Houston and Center for Clinical Studies, Houston, TX

Skin Tag Removal at Home

If you are embarrassed or irritated from a funny little piece of extra skin somewhere on your person, you may have a skin tag.

Skin tags (medical name: acrochordon) as it turns out are a common condition, basically a benign tumor, or growth of skin, on various part of the body–most commonly the eyelids, nose, cheek, neck, armpits, upper chest and groin.   More women (especially pregnant women) than men get skin tags, and skin tags increase in both genders with age, diabetes, and obesity.  Skin tags usually don’t cause any serious health problems, but are unwanted for aesthetic reasons or because of the minor irritation they can cause.

Getting rid of a skin tag is relatively simple, as the suggestions below show.

Removing skin tags with a scalpel or scissors is a common and easy way to get rid of skin tags at home. Make sure the blade you use is sharp and sanitized (use an open flame, rubbing alcohol, or hydrogen peroxide), and cut as quickly and closely to the healthy skin as you can. Some bleeding may occur, but shouldn’t last for more than a minute. Tweezers may also be used to pull the skin tag off. Getting rid of skin tags this way will likely be painful, and you might want to numb the area first with an ice cube, or other cold substance.

Remove skin tags by freezing them off with liquid nitrogen (cyrotherapy).  Liquid nitrogen is a common treatment for skin growths. When applied to a skin tag, liquid nitrogen will destroy the cell tissue quickly and efficiently. Getting rid of skin tags with cyrotherapy may cause some minor pain and scarring, and the liquid nitrogen should not be applied to the same area of skin more than once a week.
Electrosurgery, or electrolysis, is an effective way to get rid of skin tags. This procedure is usually performed by a professional, who will use an electric needle to destroy the skin tag growth, as well as any additional growth beneath the skin. Electrolysis is usually fast and permanent, with minor scarring.

You can also remove skin tags by cutting off their blood supply. Use thread or string to tie off the skin tag close to the healthy skin to cut off the blood supply, which will eventually cause the skin tag to fall off (usually after a day or two). Depending on the location of the skin tag, you may either need help tying the string tight enough to be effective, or be unable to use this method (unless you don’t mind having a piece of string
hanging from your nose) to get rid of skin tags.

Cover skin tags in certain areas with a band aid to avoid further irritation before treatment, or to avoid treatment. Skin tags in areas like the armpits, the groin, the chest, and the back (basically any area that rubs against clothing or other skin on a frequent basis) are prone to irritation, which can cause skin tags to worsen, and in turn cause getting rid of skin tags to become more difficult or painful.

Treating Skin Conditions
If you don’t feel confident about diagnosing skin tags, see a dermatologist before attempting to treat yourself. There are numerous other, more serious, skin problems that may require more serious attention and different treatment than skin tags.These include moles, warts, freckles, and general skin damage from sun or chemicals.

Birt-Hogg Dube syndrome is a rare genetic disorder characterized by skin problems, especially noncancerious tumors occuring in hair follicles on the face, neck and chest. The presence of this syndrome can increase a person’s risk of other internal cancerous tumours and cysts. While it’s highly unlikely that you have this disorder, something like this is a good reason for you to consult a health professional if you are at all unsure about or unfamiliar with diagnosing or treating skin tags, or any other skin disorder.

Acne Treatments

Anti-acne drugs are medicines that help clear up pimples, blackheads, whiteheads, and more severe forms of acne.

Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Clear By Design, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician’s prescription; others require a prescription. Tretinoin (Retin-A) is available only with a physician’s prescription and comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician’s prescription. Only physicians who have experience in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.

Acne is a skin disorder that leads to an outbreak of lesions called pimples or “zits.” The most common form of the disease in adolescents is called acne vulgaris. Antiacne drugs are the medicines that help clear up the pimples, blackheads, whiteheads, and more severe forms of lesions that occur when a teen has acne.
Different types of antiacne drugs are used for different treatment purposes, depending on the severity of the condition. For example, lotions, soaps, gels, and creams containing substances called benzoyl peroxide or tretinoin may be used to clear up mild to moderately severe acne. Isotretinoin (Accutane) is an oral drug that is prescribed only for very severe, disfiguring acne.

Acne is caused by the overproduction of sebum during puberty when high levels of the male hormone androgen cause excess sebum to form. Sebum is an oily substance that forms in glands just under the surface of the skin called sebaceous glands. Sebum normally flows out hair follicles onto the skin to act as a natural skin moisturizer. The glands are connected to hair follicles that allow the sebum, or oil, to empty onto the skin through a pore.

Sometimes the sebum combines with dead, sticky skin cells and bacteria called Propionibacterium acnes (P. acnes) that normally live on the skin. The mixture of oil and cells allows the bacteria to grow in the follicles. When this happens, a hard plug called a comedo can form. A comedo is an enlarged hair follicle. It can appear on the skin as a blackhead, which is a comedo that reaches the skin’s surface and looks black, or as a whitehead, which is a comedo that is sealed by keratin, the fibrous protein produced by the skin cells and looks like a white bump.

In addition, pimples can form on the skin. Types of pimples include:
•    papules, which are small, red bumps that may be tender to touch
•    pustules, which are pus-filled lesions that are often red at the base
•    nodules, which are large, painful lesions deep in the skin
•    cysts, which are painful pus-filled lesions deep in the skin that can cause scarring

Pimples form when the follicle is invaded by the P. acnes bacteria. The damaged follicle weakens and bursts open, releasing sebum, bacteria, skin cells, and white blood cells into surrounding tissues. Scarring happens when new skin cells are created to replace the damaged cells. The most severe type of acne includes both nodules and cysts.

Acne cannot be cured, but antiacne drugs can help clear the skin and reduce the chance of scarring. The goal of treating moderate acne is to decrease inflammation and prevent new comedones from forming. Benzoyl peroxide and tretinoin work by mildly irritating the skin. This encourages skin cells to slough off, which helps open blocked pores. Benzoyl peroxide also kills bacteria, which helps prevent whiteheads and blackheads from turning into pimples. Isotretinoin shrinks the glands that produce sebum. It is used for severe acne lesions and must be carefully monitored because of its side effects. Antibiotics also may be prescribed to kill bacteria and reduce inflammation.

Eliminating Allergens and Chemicals for Sensitive Skin

If you suffer from sensitive or dry, delicate skin, you already know how difficult it can be to find a skin care product that does not cause a negative reaction. However, have you considered many other kinds of chemicals you are exposed to every day? Many unsuspecting products, like household cleaners, air pollution and even industrial chemicals in your furniture can induce inflammation in susceptible individuals. If you suffer from dry or sensitive skin, you are more at risk for reactions, especially if you are already experiencing extreme dryness or eczema symptoms.

To repair your natural skin barrier, you must first take active steps to build it up by eating healthy fats – like olives, avocados and raw nuts or butters and engaging in a natural healthy diet to start. To further help your condition, review the dermatological list below to identify, and where possible, eliminate allergy-causing ingredients. Whether what you experience is merely a sensitivity or full-blown allergic reaction, try to eliminate anything that causes inflammation and can degrade your skin barrier – and its ability to protect you from harmful irritants. Give your skin a chance to heal by protecting it from things that may cause a reaction.

1. Eliminate chemical ingredients in skin care and perfumes – including parabens and all manner of chemical substances until you have narrowed down your reactions.

2. Eliminate problem ingredients in soaps, shampoo, bath, body care, dental, shaving, and conditioning products and medications. Avoid products that foam or contain detergents. Always rinse thoroughly after cleansing and shampooing. Protect your skin with moisturizer afterwards.

3. Avoid direct contact with dish and laundry detergents, household cleansing products, paints, strippers, furniture polishes, and other ingredients containing harsh chemicals. Wear gloves, moisturize, or avo: altogether. Studies show that residual detergent remaining in launderei clothing may be a prime contributor to eczema. Rinse your clothing twice if your washing machine allows.

4. Notice whether fabrics in clothing, furniture, or bedding are irritating your skin due to their rough texture or chemicals treating them. Use hypoallergenic protectors on mattresses and large furniture if this is the case.

5. Pay attention to contact allergies from jewelry, flatware, and coins or metals containing nickel, a common allergen. Some are allergic to gold, so always be aware of unsuspecting culprits.

6.  Only use quality filtered water and avoid hard water when possible. Chlorinated water, excessively hot water, or long soaks in baths, showers, or hot tubs, can strip precious oils from your skin.

If you consider all these factors and use them diligently, your skin barrier can be restored and you may be able to withstand common irritants and practices. But for now, notice what chemicals irritate you and avoid contact with them at all costs in order to give your skin a chance to rebuild itself. If you are unable to address your symptom on your own, ask a professional dermatologist about patch testing, which can help you determine exactly what your allergies may be.

Acne Treatments

Acne treatment consists of reducing sebum production, removing dead skin cells, and killing bacteria. Treatment methods differ depending on how serious the acne is. Topical drugs are applied directly to the affected areas of the skin. They are available in the form of creams, gels, lotions, or pads. They are used primarily to treat mild forms of acne in which there is little or no inflammation.

One group of topical drugs used for acne includes antibiotics. These drugs kill the bacteria that contribute to the disease. Another group of drugs is called comedolytics (pronounced KO-mee-do-LIE-tiks). These drugs loosen hard plugs and open pores. Still another group of drugs works by increasing the rate at which new skin cells form. These drugs prevent the formation of new comedos.

Topical drugs are applied once or twice a day after washing with mild soap. Treatment may have to continue anywhere from a few weeks to a few months to a few years. Side effects such as mild redness, peeling, irritation, dryness, and an increased sensitivity to sunlight may occur.

Oral Drugs

Oral drugs are taken by mouth. Doctors sometimes prescribe oral antibiotics for moderate cases of acne. These antibiotics prevent the formation of new comedos and reduce inflammation. They are usually taken once a day
for two to four months. Side effects may include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.

A drug that is used for severe cases of acne is isotretinoin (pronounced i-so-TRET-uh-no-un, trade name Accutane). This drug reduces the production of sebum and the stickiness of skin cells. It is used when cysts and nodules are present. The drug may be used alone or with other topical or oral antibiotics.
Isotretinoin treatment usually lasts for four or five months. It is effective in about 60 percent of all patients. If the acne reappears, another course of treatments may be necessary. Some side effects that may accompany the use of isotretinoin include nosebleeds, dry skin, a temporary worsening of the acne, vision disorders, and increased production of liver enzymes, blood fats, and cholesterol. It may also cause birth defects and cannot, therefore, be used by pregnant women.

Women who do not respond to any of these treatments may be given another type of oral drug, an anti-androgen. Anti-androgens reduce the production of androgen and therefore reduce the formation of comedos. Certain types of oral contraceptives are also effective as anti-androgens.

The most serious forms of acne require other types of drugs, including oral corticosteroids, or anti-inflammatory drugs. These drugs are often used for the treatment of a form of acne known as acne fulminans, which occurs mostly among adolescent males. They are also used with acne that produces numerous deep, inflamed nodules that heal with scarring.

Acne Treatments

There are two main methods of acne treatment that you can follow: topical treatment and oral treatment.

Before selecting a treatment, you must have a solid understanding about acne, and determine the exact type of acne that you have. In addition to this, it is also important to set goals for your acne treatment. Here are some points to keep in mind when thinking about acne, and when selecting the best acne medication for yourself.
Goals of acne treatment:

* You should understand how much acne and what type of acne you have.
* To stop new acne blemishes from developing with appropriate treatment.
* To treat acne scars and prevent new scars from forming.

Points you should remember:

* You can control and cover the visible lesions and avoid embarrassment.
* Treatment is available that can prevent acne scarring.
* You should get help for your acne as soon as you notice it. Early treatment minimizes the severity of acne. This is important especially if one of your parents had severe acne.
* Treatment may last for months and often years.
* You should understand that improvement can be slow, and will often take months (not weeks) to work. There may even be an initial flare of your acne.

Points To Remember For Selecting Your Best Acne Treatment:

* The severity level of your acne
* Your personal goals for therapy
* The effectiveness of the treatment and possible side effects
* Your personal preference.

Other Circumstances Specific To Girls And Women:

* Pregnancy: is it possible you could become pregnant during treatment, or are you already pregnant?
* Breastfeeding: Will you be breastfeeding during treatment?
* Are you in the childbearing age range?
* The acne treatment that you select will depend on the factors listed below:

* The severity of your condition
* The type of acne (comedonal vs. inflamed) lesions you have
* Any previous experience you have had (and your skin’s response) to other treatments
* The degree of oiliness or sensitivity of your skin
* Any history you may have of sensitive skin or extreme irritation to specific products.

Note: Acne may flare in the initial stages of treatment. However, this is not necessarily an indication of unsuitable treatment. On average, you’re likely to see about a 20% improvement per month.

Chemical Peels and Aging

Chemical peeling is emerging as one of the most effective ways to combat skin aging. Chemical peels are one of the most frequently performed aesthetic procedures in North America. Its popularity continues to grow because of the versatility of conditions where chemical peels are of significant benefit. In addition to the topical preparations such as over-the-counter and prescription creams, chemical peels are one of the earliest forms of treatment adopted by many patients. At the same time, there is much confusion and misunderstanding surrounding chemical peels that prevents more of us from enjoying their undeniable benefits. Let’s go through the important facts about chemical peels and their uses in modern skin care regimens.

Categories of Chemical Peels:

1. Superficial chemical peels:

Broadly speaking, chemical peels can be divided into several categories based on the depth of penetration in the skin. Superficial chemical peels create an injury to the epidermis - the outermost layer of the skin. As such, they are recommended for the treatment of skin conditions that primarily affect the epidermis. Conditions such as acne, actinic keratosis, superficial (epidermal) melasma, mottled skin pigmentation, superficial wrinkling as well as mild photo-damage can greatly benefit from properly selected and applied superficial chemical peels.

* AHAs

Some of the most common examples of superficial chemical peels include a variety of alpha-hydroxy acids
(AHA,) salicylic acid as well as low concentration trichloroacetic acid (10% - 25%.) The most commonly used superficial chemical peels are members of AHA. Alpha-hydroxy acids is a group of compounds derived from food products including glycolic (from sugar cane,) lactic (from sour milk,) malic (from apples,) citric (from fruits) and tartaric acid (from grape wine.) Glycolic acid (GA) is a clear winner amongst the AHA as its small molecular weight allows it to penetrate into the skin and exert its influence on living and non-living (outermost layer) cells. These properties account for the popularity of this product in both cosmetic as well as medical preparations.

In low concentrations, 5 - 10%, GA reduces cell adhesion in the top layer of the skin. This action promotes exfoliation of the outermost layer of the skin accounting for smother texture following regular use of topical GA. This relatively low concentration of GA lends itself to daily personal use as a monotherapy or a part of a broader skin care management for such conditions as acne, photodamage, wrinkling as well as selected cases of melasma.

In higher concentrations, between 10 and 50%, the benefits of GA are more pronounced but are limited to temporary skin smoothing without much long lasting results. This is still a useful concentration to use as it can prepare the skin for more efficacious GA concentrations (50 - 70%) as well as prime the skin for deeper chemical peels such as higher concentration trichloroacetic acid.

At higher concentrations, 50 - 70% applied for 3 to 8 minutes under the supervision of a physician, GA promotes separation between the cells and can be used to treat acne, photodamage (such as mottled dyspigmentation, superficial melasma or fine wrinkles) as well as superficial scars. The benefits from such short contact application depend on the pH of the solution (the more acidic the product [lower pH,] the more pronounced the results,) the concentration of GA (higher concentrations produce more vigorous response,) the length of application and prior skin conditioning such as prior use of topical vitamin A acid products. Although single application of 50 - 70% GA will produce beneficial results, multiple treatments every 2 to 4 weeks are required for optimal results.

* Salicylic Acid

Salicylic acid is a member of beta-hydroxy acid group. Because of its improved lipid solubility compared to the AG, it is particularly effective in the treatment of acne. In addition, it is not as inflammatory and some physicians use it extensively for the treatment of melasma. Low concentration trichloroacetic acid (10% - 25%) can also be used to treat the conditions affecting superficial epidermis but its use is limited to experienced physicians as more detailed patient selection and application care is required. As such, physician supervision is required for all peels except low concentration glycolic acid (up to 35%) and salicylic acid peels (below 20%.) This precaution is necessary to prevent inadvertent worsening of the skin condition as well as scarring.

Although in some instances only one superficial peel can accomplish desired effects, in most cases a series of peels is recommended to achieve optimal results. Superficial peels are an excellent way to introduce oneself to the rejuvenating power of these common aesthetic procedures. Done properly and with care, superficial peels are very safe treatment options for some of the most common conditions affecting facial skin.

It is important to understand that superficial chemical peels are peels with similar risks and side effects as other peels. Some of the side effects of superficial chemical peeling can include hyper- or hypo-pigmentation, persistent redness, scaring as well as flare up of facial herpes infections (”cold sores”). Caution needs to be exercised with some patients, particularly those suffering from rosacea or eczema. These patients are prone to skin irritation and even the mildest peels can cause injury to the skin. Fortunately, in most instances, such injury can resolve with time and optimal skin care. In cases of melasma, extreme caution needs to be taken, as it is possible to worsen this common and unforgiving skin condition. Any significant redness of the skin must be avoided.

Author: Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Are Chemical Peels Right for You?

With so many beauty products, facial treatments and surgical procedures available these days, it can be overwhelming to choose a treatment that is right for you. First off, when trying any new skincare treatment or procedure, it is always important to do your research, seek out reputable sources and never be afraid to ask questions, after all, it is your face – you only have one, so treat it accordingly. Selecting the right specialist or understanding details of a surgical procedure will be time consuming, be prepared to put in the time necessary to make the best choice. Below are some tips to help you get started.

­

Choose carefully. The Consumer Guide to Plastic Surgery recommends you:

· Check educational, training, background credentials and experience to ensure that he or she is well-qualified

· Ask how many times they have performed this procedure

· Ask to see before and after photos of patients who have had chemical peels - in some cases offices will give you contact information of previous patients as referrals.

Dermatologists, plastic surgeons, licensed estheticians and registered nurses can all perform chemical peels. However, depending on the type of peel, you might need to see a doctor. Ensure your procedure is both safe and effective.

Schedule a skin consultation. A chemical peel is an aggressive treatment, it’s important that you get an in-depth analysis of your skin beforehand. When at the consultation, make sure the specialist knows your medical history and any prescriptions you may be taking. Be prepared to ask questions, such as what is my skin type? What are my skin concerns? How can chemical peels improve my skin? What kind of peel is best for my skin type?

Become a peel expert. There are three types of chemical peels: superficial, medium and deep. In addition, they increase substantially in cost depending on the peel. The cost ranges from $150 to $300 for superficial peels; $1,000 to $2,000 for medium peels and $2,500 up to $5,000 for deep peels, according to Smart SkinCare:

Superficial: The mildest of chemical peels, superficial peels treat fine lines, discoloration, dryness, roughness and mild acne. Results are subtle and you will need regular maintenance sessions. Estheticians typically perform superficial peels. Common solutions: Alpha hydroxy acids or AHAs (e.g., glycolic acid, lactic acid), salicylic acid

Medium: These peels penetrate deeper into the skin, producing a second-degree burn. Medium peels treat wrinkles, pigmentation problems, sun damage and blemishes. You will need at least a week to recover. You’ll also need several peels to achieve desired results. Common solution: Trichloroacetic acid (TCA)

Deep: These peels target deep wrinkles, dramatic discoloration and skin lesions. Deep peels are the most effective, providing pronounced and long-lasting results. However, they are also riskier with longer recovery time—most people take two weeks off from work. A certified, experienced plastic surgeon must perform these peels. This peel is performed once. Common solution: Phenol

Consider your skin type. Be aware that a chemical peel is not always the best option for your skin type. These are several examples when a chemical peel isn’t appropriate or can be helpful. In most cases, a chemical peel should not be used on dry or sensitive skin. A peel might cause dryness, flakiness, itching and further inflammation. If you have inflammatory acne and deep cysts, you should also consult a dermatologist, as a chemical peel might not be the best treatment for those conditions.

Chemical peels are a good choice if you experience mild to moderate acne or acne scars: The acids in the peel work to both kill active blemishes on the surface and to prevent new blemishes from forming. By accelerating the exfoliation process, a chemical peel delivers clearer, healthier-looking skin.

Become an expert on your chemical peel. Before having the chemical peel, make sure you ask every question possible to ensure you are aware of the entire procedure and its potential complications.

Examples like; what strength is the peel? How many sessions will I need? What are the pros and cons? What kind of discomfort, pain and other reactions can I expect during the procedure? How should my skin react after the chemical peel?

Communication is key in making your chemical peel a safe experience. Clarify you are experiencing normal reactions or seek immediate attention if you think you are not. Remember if something doesn’t feel right, only you can speak up about it.

About two to four weeks prior to your chemical peel, the specialist will ask you to incorporate pre-care products into your daily regimen. These products are designed to thin out the skin’s surface, allowing the peel to penetrate deeper and evenly. Your medical expert might prescribe Retin-A, an AHA product or hydroquinone cream.

When using these new products, you might have to discontinue your old ones. Your specialist will give you specific information about what products to use and avoid.

Depending on the type of peel, your results might be subtle or dramatic. Every skin type reacts a bit differently. Be realistic about the results and fully understand to what degree the peel will improve your skin and whether you will need additional sessions to maintain results.

Next Page »