Management and Treatment of Pruritus

Pruritus, or itch, is a common sensation that causes a person to want to scratch. It is a complex process that may negatively impact quality of life and commonly occurs with skin disorders such as atopic dermatitis and urticaria. It could also be a symptom related to an underlying disease process such as cholestasis or hyperthyroidism, or simply be caused by dry skin, especially in the cold, winter months. Therapy is often aimed at eliminating the underlying cause first, followed by the management of the itchy sensation. Treatment may include prescription and over-the-counter (OTC) medications, herbal remedies, hydrotherapy, phototherapy, and ultraviolet therapy. This overview provides information regarding the various management and treatment options for pruritus.

Pathophysiology of Pruritus

Pruritus is a complex process that involves the stimulation of free nerve endings found superficially in the skin. The sensation of pruritus is transmitted through the C-fibers in the skin to the dorsal horn of the spinal cord, and then, via the spinothalamic tract to the cerebral cortex for processing. Many chemicals have been found to be pruritogenic, therefore causing the itch sensation, including histamine, serotonin, cytokines, and opioids. There are six categories of pruritus: dermatologic, systemic, neurogenic, psychogenic, mixed, and other. Various treatment and management options exist depending on the category or cause.¹

Treatment

Treatment of pruritus can be categorized in several ways. A common method of grouping the various options is causative vs. symptomatic treatment. Causative treatment involves finding the underlying disorder and then correcting it, thereby eliminating the itch sensation. Symptomatic treatment involves substituting another sensation for the itch, using methods such as cooling, heating, or counter irritation (e.g., scratching). Symptomatic treatment can be used in addition to treating the underlying disease process in order to provide earlier relief. Most of the available treatment options are categorized under symptomatic therapy and management.

Prescription Medications

Prescription medications include topical and systemic antihistamines, corticosteroids, local anesthetics, and topical immunomodulators, among others. Some lower concentration preparations of these medications are available OTC.

Antihistamines

Itching occurs when histamine is released, causing redness, swelling, warmth, and consequently itchiness. Antihistamines, or H1 antagonists, act by blocking the histamines, and are the most widely used medications for this condition. They take approximately 15–30 minutes to be effective and can be short- or long-acting.²

Topical antihistamines are available in prescription as well as nonprescription forms. Camphor (Caladryl^®, Pfizer) is a common diphenhydramine preparation that has both antipruritic and anesthetic properties. This traditional therapy carries with it a small risk of contact dermatitis and allergic sensitization.³

Corticosteroids

Local Anesthetics

Calcineurin Inhibitors

Cholestyramine

Rifampicin

Naltrexone

Ultraviolet (UV) Light Therapy

UV phototherapy is used to treat various pruritic conditions including chronic renal failure; AD; HIV; aquagenic pruritus; solar, chronic, and idiopathic urticaria; urticaria pigmentosa; polycythemia vera; pruritic folliculitis of pregnancy; breast carcinoma skin infiltration; Hodgkin’s lymphoma; chronic liver disease; and acquired perforating dermatoses, among others. It is often undertaken after multiple attempts to treat stubborn itch, and can offer relief without many of the side-effects and risks of systemic medications. UV-based therapy utilizes UVB and UVA in both broadband and narrowband, as well as PUVA (psoralen UVA). Cost and side-effects can be a prohibitive factor for patients. Erythema is common in UVB, as is premature aging and photocarcinogenesis with both UVA and UVB. Side-effects associated with PUVA include redness, burning, headache, and nausea.^16,19

UVA, UVB, and PUVA light therapies have been especially useful in the treatment of pruritus in HIV patients, as well as in those patients with systemic mastocytosis and cutaneous T-cell lymphoma. It localizes the effect on the superficial nerve endings, sparing the remaining helper cells, and relieving the pruritus. Because of its more superficial penetration, UVB is believed to be safer than UVA. UVB also spares the remaining helper cells in HIV patients and may localize the effect on the superficial nerve endings, thus relieving pruritus. Systemic mastocytosis and cutaneous T-cell lymphoma also respond to UV therapy and because destruction of the proliferating CD4 clone is desirable, UVA is usually the preferred modality over UVB, although Millikan suggests that the relief of pruritus is more predictable with UVB than with UVA.3

Cutaneous Field Stimulation (CFS)

CFS, which electrically stimulates thin afferent fibers, including nocireceptive C-fibers, was reported to inhibit histamine-induced itching. The reduction in itching is accompanied by degeneration of the epidermal nerve fibers. In one open trial, localized itching responded to CFS treatment, and pruritus was reduced by 49% at the end of 5 weeks. Itch relapsed gradually after the discontinuation of CFS, which led the researchers to conclude that nerve fibers regenerated into the epidermis.20

Over-the-Counter Treatments

In addition to the nonprescription medications mentioned above, there are other OTC treatments that can be helpful for treating and managing pruritus. Moisturizing after a bath is extremely important, and emollients such as white petrolatum, or petrolatum depositing moisturizing body washes, and in-shower moisturizers (e.g., Olay^® Ribbons^®, Procter & Gamble; emulsifying ointment USP) can be helpful when applied while the skin is still wet.²¹

There is new evidence to show that moisturizers containing niacinamide and glycerin (e.g., Olay^® Quench^®, Procter & Gamble) not only hydrate the skin, but improve the skin’s resistance to external factors and improve the barrier function. Glycerin is required for moisturizers to work quickly and add moisture to the skin, but the niacinamide helps to sustain that benefit over a longer period of time.²¹

Alternative Therapies

Several alternatives to traditional treatment of pruritus have been proposed. Often these therapies can be used in conjunction with prescribed or OTC medications to relieve symptoms quickly. Compounds that have been found to be effective for pruritus by depressing cutaneous sensory receptors include menthol, camphor, and phenol.⁷ Some other alternative therapies that have been suggested include herbal remedies, nutritional therapy, reflex therapy, and hydrotherapy.³

Herbal Remedies

Several herbs have been proposed as corticosteroid-sparing agents and may provide a viable alternative to topical steroids and their side-effects. Oatmeal baths appear to be most useful because of its colloidal protein and high mucilaginous content. Other herbs have been suggested because of their high mucilage content as well, including flax, fenugreek, English plantain, hearts ease, marshmallow, mulberry, mullein, and slippery elm.3 More extensive research needs to be conducted regarding their possible use and effectiveness for the treatment of pruritus.

Tannins, also derived from herbs, may be helpful as well. The exact mechanism of action is unclear, but may perhaps be related to the coagulation of proteins in the skin. The most common tannin-containing herb is witch hazel, but others include oak bar, English walnut leaf, goldenrod, Labrador tea, lady’s mantel, lavender, and St. John’s wort.

Other possible herbs that may be advantageous include chamomile, which has shown to be equivalent to low concentrations of hydrocortisone, aloe vera, and capsaicin.3 Some side-effects may include irritant or allergic contact dermatitis. Some herbals can be toxic if ingested as well. Some of the oldest group of medications used to soothe and cool pruritic skin is menthol and camphor, which are both considered low risk and safe to use topically. ^3,4

Nutritional Therapy

Nutritional therapy, despite not being sufficiently researched as a monotherapy for pruritus, may be helpful in combination with other anti-itch treatments. Vitamins D and E, and linolenic acid have shown some efficacy in the treatment of psoriasis and atopic eczema.³

Reflex Therapy, Acupuncture, and Hydrotherapy

While they are not traditionally used, reflex therapy, acupuncture, and hydrotherapy are three treatments that may be beneficial as adjunctive therapy, however further research is needed. There is little research available regarding the effectiveness of reflex therapy and hydrotherapy. These options may be considered in difficult-to-treat patients where traditional approaches have been unsuccessful. Acupuncture is based on the gate theory of neurotransmission, however it is infrequently used in the Western world, and therefore has insufficient evidence to fully support its use. ³

Management

The management of symptoms is paramount in the treatment of pruritus. Patients should be educated regarding the self-care aspects of this condition. Eliminating the use of irritating or tight clothing is recommended, as well as maintaining a cool environment. Patients should avoid the frequent use of soap, topical irritants in clothing, dry environments, and vasodilators such as caffeine, alcohol, and hot water. Patients should be advised to take brief, tepid or lukewarm baths using mild cleansers with a low pH. Soap film should be rinsed off completely and skin should be patted lightly, followed by the generous application of a moisturizing lotion or cream.^4,7,22

Conclusion

Pruritus is a common complaint, but one that can often be a challenge to treat. It can be a major quality of life issue for patients, so it is important that both the underlying disease and associated symptoms are treated as quickly and effectively as possible. Health teaching regarding the prevention and management of pruritus should be included in the overall treatment of the cause and symptoms.

P. Lovell, RN, BScN1; R. B. Vender, MD, FRCPC²
1. Michael DeGroote School of Medicine McMaster University
2. Dermatrials Research, Hamilton, ON, Canada

Taking Elidel Top To Treat Atopic Dermatitis

PIMECROLIMUS - TOPICAL : Pronunciation: (pim-eck-row-LEE-muss) , Brand Name(s): Elidel

Elidel Top is used to treat the following:  Atopic Dermatitis, Eczema Skin Condition Resisting Treatment

Pimecrolimus is used to treat certain skin conditions such as eczema (atopic dermatitis) in people who should not use or have not responded to other eczema medications (e.g., topical steroids). Eczema is an allergic-type condition that causes red, irritated, and itchy skin. This drug works by changing the skin’s defense (immune) system, thereby decreasing the allergic reaction that causes eczema. Pimecrolimus belongs to a class of drugs known as topical calcineurin inhibitors (TCIs).

This medication is not recommended if you have a history of a certain rare genetic disorder (Netherton’s syndrome). Also, this medication should not be used by anyone who has a weakened immune system (e.g., following an organ transplant).

How to use Elidel Top

Read the Medication Guide provided by your pharmacist before you start using pimecrolimus and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist.

Wash your hands with soap and water before using this medication. Apply a thin layer to the affected areas of skin, usually twice daily or as directed by your doctor. Rub the medication into the skin gently and completely. Wash your hands after using this product unless your hands are being treated. If your doctor recommends a moisturizer, apply it after this medication.

Pimecrolimus is for use on the skin only. Avoid getting this medication in your eyes or on the inside of your nose or mouth. Do not apply this medication to open wounds or infected areas. Do not cover the treated area with plastic or waterproof bandages unless directed to do so by your doctor. Do not bathe, shower or swim right after applying this medication.

Use this medication exactly as directed. Your doctor may instruct you to stop using it once your eczema has cleared up and to start using it again if signs or symptoms reappear. Consult your doctor for details.

Inform your doctor if your condition does not improve after 6 weeks of using this medication or if your condition worsens at any time.

WARNINGS

Patients have benefited from use of pimecrolimus when it is used correctly. Long-term safety for this drug is not known at this time. There have been rare reports of cancers (e.g., skin cancer, lymphoma) in patients using pimecrolimus. It is not known whether pimecrolimus caused these cancers when used on the skin. Further studies to determine the long-term safety of this product are ongoing. In the unlikely event that unusual lumps, swollen glands, or growths (especially on the skin) occur, contact your doctor immediately.

The FDA recommends the following: This drug should be used only if other drugs have failed or if other medications are not considered appropriate by your doctor. Pimecrolimus should be used on the skin for short treatment periods only. If needed, treatment may be repeated with breaks in between. Use the smallest amount that will treat your condition properly, and apply only on the affected skin. Also, this medication should not be used in children younger than 2 years. As with all medications, discuss the risks, benefits, and proper use of this medication with your doctor.

Acne Prevention Tips

Acne Prevention

You can possibly prevent acne from affecting your skin or at the very least, moderate the outbreaks. Science has not yet discovered a fool-proof method that will work for everyone with an acne problem, but there are many things you can do to control it. Treating your acne outbreaks properly is something that must be done, especially if you are prone to suffer from severe cases.

Acne is a very common skin condition which produces whiteheads and blackheads on the face and upper torso. It affects people differently, being mild for some and quite debilitating for others. Acne untreated or treated improperly can cause permanent scarring which requires extensive time and expense to effectuate any level of cure.

Proper Cleansing

Acne is mainly caused by bacteria that get into the pores on your skin, and the first and most important thing you need to do is to prevent this from becoming a problem. Bacteria are everywhere, and while there is no way to keep them from getting on the skin of your face or other areas, you can remove them before they cause a problem. There are many good cleansing products on the market today that contain anti-bacterial elements to help you get rid of bacteria on your skin. No matter how thoroughly you think you are washing, in all likelihood bacteria still remain.

A second step you should take to prevent acne is to use an exfoliating product on your skin. The dead skin cells that are always present on your skin can often contribute to acne formation. They do this by blocking your pores. This leads to oil becoming blocked in the pores, also known as follicles, which is one of the major causes of acne. The dead cells are also used as a food source by the bacteria which furthers their breeding. Using an exfoliating product does a good job in removing these dead skin cells.

Both anti-bacterial cleansers and exfoliates can be found in just about any pharmacy or super store at very reasonable prices. There are usually several brands and price ranges from which to choose, so you should be able to find products that suit you.

What To Do When More Care and Treatment Are Needed

For many people, washing their face and skin properly and using exfoliates is enough to manage the acne blemishes they have. For others, however, these two methods do not contain the acne outbreaks. These people should see a dermatologist or some kind of skin specialist. This is the person who can prescribe whatever medication that is needed to get the condition under control.

When it comes to treating and preventing acne, there are many products on the market that can help some, or maybe most, people. When you are using facial/skin cleansers, exfoliating products or topical medications, it is very important that you follow the directions given for them. Most of them should be used regularly if you are to get any benefits.

In conclusion, not everyone can have a clear complexion, but many will find relief in these products for acne prevention and treatment.

Skin Rashes - Where Do They Come From?

A skin rash shows up as an area of inflammation or change in the texture, and/ or color of your skin. It can be caused by a number of different things including irritation, disease, or allergic/ non-allergic reactions to foods, chemicals, plants, animals, insects or other environmental factors.

So many rashes appear because the skin is an active player in the immune system. Antigens are things like viruses or proteins that we react to. These antigens need to be presented to our immune system in a very controlled way; otherwise we would react to too many things. The skin is the site at which antigen presenting cells introduce the antigens to lymphocytes. These lymphocytes are in a sense the paratroopers of our body. A complicated process of making sure that we are not overreacting takes place. All of this occurs in the skin once these lymphocytes have been activated they produce many chemicals that cause inflammation. When we become allergic to an antibiotic or other drug, the action takes place mainly in the skin as well as in the lymph glands. Viral infections also frequently produce rashes as viral particles are presented to our immune system in the epidermis. In a sense the skin is like the schoolyard which is where many of the fights occur.

Rashes can appear on your entire body or be limited to a specific area, and what it looks like and how it feels can vary depending on the cause and type of rash. Some common types of rashes include:

* eczema (also called atopic dermatitis), which is commonly seen in children. It can cause dry, chapped, bumpy areas around your elbows and knees, and can be very itchy. It can sometimes become very serious causing red, scaly and swollen skin all over your body. (Visit Eczema Guide.ca for more information)
* irritant contact dermatitis, which is caused by your skin coming into contact with something that irritates it, such as a chemical, soap or detergent. This type of rash can be red, swollen and itchy.
* allergic contact dermatitis is caused by your skin coming into contact with something you’re allergic to, such as rubber, hair dye or nickel (which is a metal that is found in some jewelry). A nickel allergy can show up as a red, scaly, crusty rash wherever the jewelry touched your skin. Urushiol, which is an oil or resin that’s found in poison ivy, oak and sumac, can also cause this kind of rash.

If you develop a rash, don’t scratch it! If you do, the rash can take longer to heal and you might develop an infection or scar. There are a wide range of over-the-counter products available to treat rashes, but it’s important to see your doctor first and determine what’s causing the rash and the most effective treatment.

* If the rash is caused by an allergy, then treatment will focus on identifying and avoiding the allergen.
* It it’s caused by eczema, your doctor may suggest special moisturizers (emollients) to help retain the water in your skin; not only will this help to keep your skin soft and smooth, it will help reduce the itching. Short, cool showers are also a good idea because hot showers and baths can dry out your skin more. Also use a mild soap (read more on Mild Cleanser.ca ) and be sure to apply more emollients after you’ve showered.
* For poison ivy, cool showers and calamine lotion often help and if the rash is severe, your doctor may prescribe an antihistamine to reduce the itching and redness.

It’s important to try to find out what’s causing the rash because the best way to prevent it is to avoid the problem food, substance, medicine or insect. If a poison plant is your problem, learn what it looks like and avoid it. It may also help to wear long sleeves and pants when you go camping or hiking. If insect bites are causing your rash, then consider applying insect repellant before going outside. For eczema, stay away from harsh soaps that may dry out your skin, and make an effort to moisturize with creams or lotions.

By SkinCareGuide.ca

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.

Combination Skin Causes and Care

It can be utterly frustrating to deal with combination skin; one day it is dry and tight, the next it is oily and blotchy. Seasonal weather changes only serve to make matters worse. Your skin can wrinkle in some areas and flake in others. If that’s the case, then you may have combination skin - varying skin conditions in different zones of the face. But not to worry; combination skin is quite common. In fact, more people have this skin type than any other.

Combination skin is characterized by a mixture of oiliness and dryness. Typically, the oily areas tend to be the T-zone, consisting of the forehead, nose and chin. The cheeks are normal to dry. The degrees of oiliness and dryness can vary. Pores may be larger in the oily areas - with pimples, blackheads and breakouts sometimes occurring - and dry areas may feel rough and irritated.

The “tissue test” can help you determine if you have combination skin. Take a tissue and hold/press it against your face. If there’s oil on the tissue where it touched your T-zone, but no oil where the tissue touched your cheeks, you most likely have combination skin.

Causes

Many factors can cause combination skin, including hormones, age, genetics, the way in which lipids are organized in our skin and even the weather. Hormonal changes can lead to changes in skin’s oiliness or dryness. Teens and young adults tend to have oilier skin, especially in the T-zone, but with age, hormones change and the oil production may decrease (but unfortunately, acne is still an issue for many adults). Also, hormones change due to menstruation and the birth control pill, which can make skin oilier in certain areas. Lipids also play a role in combination skin: These proteins affect skin’s softness and feel. When lipids aren’t evenly spread throughout the skin, certain areas will feel drier and rougher, while other areas may feel soft but oily or greasy. The organization of lipids in skin is due to genetics and hormones. Finally, weather can exacerbate combination skin. Dry cold weather can cause skin to dry out and become irritated. Conversely, hot humid weather can increase oil production. This can affect your T-zone as well as your cheeks.

Care Plan

Combination skin requires special care to balance the oily and dry areas of the face. Proper cleansing, treatment, moisturizing and sun protection are all necessary.

• Cleansing: People with combination skin often have difficulty finding a cleanser that works for their unique skin needs. Formulas designed for oily skin may leave combination skin too dry, especially in the cheeks, while formulas designed for dry skin may leave combination skin greasy, especially in the T-zone. It’s best to avoid products that are either too drying or too rich. Instead, use a foaming or gel cleanser to get rid of dirt and oil without causing irritation or dryness. A cleanser to try is one that removes excess oil and impurities while still being gentle and not drying out skin.

You should also exfoliate your skin regularly to remove dry, dead, rough skin cells. These cells may be particularly prominent on your cheeks. They can flake off and block pores, causing blemishes and blackheads. Try a product that might include papaya and pineapple juice, olive derivatives and Ginkgo Bilbao.

• Treatments: Treatment products are another important skincare component, helping to balance your skin. One treatment to try is one which moisturizes dry areas but prevents excess oil, especially in the T-zone. This product also contains antioxidants to prevent aging. Another type of treatment is a mask, and you’ll find an array of products for every skin type. Some experts advise using a hydrating/moisturizing mask on dry areas (cheeks) and a deep-cleaning clay mask on oily areas (T-zone). While using two different masks is certainly an option, you can also use a mask specifically designed for combination skin. If you suffer from breakouts, which may occur around the T-zone, use acne treatment products with salicylic acid. For problem skin, try a blemish serum or a spot treatment.
  
  
• Moisturize: Combination skin needs balance, and part of that balance means moisturizing your skin. Moisturizing is especially important for drier areas of the face, but your entire face needs moisture. Some experts suggest using separate moisturizers - a lightweight one for the T-zone and a deeper one for cheeks. You may choose to use separate moisturizers, but you can also use a single moisturizer designed for combination skin. Try a lotion which balances skin with witch hazel and aloe extract to help skin stay soft. Pay careful attention to dry areas, as they may require more frequent moisturizing than oily areas. Generally, experts recommend moisturizing dry areas twice a day and moisturizing oily areas once a day. Keep in mind that your individual skin has unique needs, so you might want to adjust your moisturizer - how often you use it, where you need it and how much you need.
• Sun Protection: Like all other skin types, combination skin needs protection from the sun. UVA and UVB rays can damage skin, so use oil-free sunblock all over your face daily (and on any other exposed areas). Try an oil-free sunlotion or sunblock because it protects your skin from UV rays and won’t make skin greasy.

Natural Treatments

Natural treatments such as aromatherapy oils, home-made exfoliants and masks may help treat your combination skin. For example, try mixing essential oils like chamomile, lavender and ylang ylang (just a few drops) together with your oil-free moisturizer. These ingredients have antibacterial properties and may help to rid skin of dirt or bacteria. However, if your skin is sensitive or easily irritated, or if you’re pregnant, you shouldn’t use these essential oils.

Exfoliating treatments can be made at home by mixing and grinding nuts, seeds or oatmeal along with water. These will slough off dead, dry skin cells - especially common around the cheeks. You can add citrus peels from fruit - like orange or grapefruit - to the mix and apply it to the oily T-zone.

To make a mask for dry areas, use ingredients like yogurt, mashed bananas or avocados to moisturize. On oilier areas, try pureed strawberries and apples.

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.

Helpful Hints to Heal Acne

While we all wish to have perfect skin, some days are more important than others - whether it’s a job interview, an important date, or a social gathering where you may be introduced to many new people, looking our best during these special occasions is usually a priority. While acne should be the last thing on our minds, many times the additional stress brought on by these very important occasions can result in just that – unwanted acne.

If you have ever awakened to a big day only to find a BIG SPOT where it shouldn’t be, read the below tips to help prevent and heal acne more regularly to help avoid those nasty last minute acne issues.

Acne Tip #1

Drink plenty of water – plain and simple. This is probably one of the best ways to prevent future acne. Doctors recommend this easy exercise to remember – whatever your body weight is in pounds, divide that number by two to get the number of ounces of water you should consume for optimal skin flushing and overall health. Add a slice of lemon juice to further enhance the cleansing effects. Your goal is to flush all the toxins in your body and cleanse your skin from inside out. This will also help your body run smoothly by cleaning out unnecessary toxins that help build bacteria onto your skin.

Acne Tip #2

Resist the urge to pop - popping your pimples incorrectly is something you don’t want to do. There are dermatologist recommendations how to do this properly, but most folks want the offending item removed much earlier than it is safe to do so. While it can be a quick fix to your acne, the incorrect action could result in a scar that could become very noticeable if you make a habit of popping. Even worse, most dermatologists tell us the majority of the plugged oil creating the acne goes back into the underlying skin layer, which will reform as more acne later. If you really need to pop, try to follow a safe procedure.

Acne Tip #3

Change your bed linens regularly –changing your linens weekly is ideal. Repeatedly placing your skin on the surface of a pillow or sheet will allow bacteria and oil to build up, creating an environment for further outbreaks.

Following these simple actions can help tremendously when it comes to having acne free skin.