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Archive for the ‘Q&A’ Category

QandA3Question:  I’ve had acne since I was a teenager, but now  I’m  37  and its still a problem.  I wanted my doctor to give me Retin A, but she insisted that Differin would work better.  Its not covered by my heath plan and I can buy  Retin A online for a lot less.  Any advice?

Answer: Its sad but true  that acne can remain a problem long past high school.   Differin ( adapalene)  is actually the newest form of Retin A  ( aka  tretinoin).   This new kid on the block  has several advantages than its older cousins.  It is less irritating than traditional  Retin A, yet can be more effective  preventing   blocked-pores.  It also acts both to reduce inflammation and helps the skin shed old dead skin cells.  But what makes adapalene   an anti-acne rock star is its ability to get along well with  other acne fighters.  Both benzoyl peroxide which kills acne causing bacteria and clindamycin  which reduces  inflammation,   reduce effectiveness of  Retin A.  By contrast,  Differin ( adapalene)  works beautifully with other acne medications.  You can layer all three at night and  then use the benzoyl peroxide and clindamycin during the day.  To round out dynamic acne care, wash your face with an oil free cleanser like Neutrogena  Oil-Free Acne Wash   and  be sure to use an oil-free  physical sunscreen  such as  SkinCeuticals Physical Fusion UV Defense  SPF50 during the day.  Keep in mind that  Differin like the original Retin A  increases skin sensitivity. 

This triple threat program is the current  gold standard for acne care and you should see  big improvements in 2-3 months. If  things  don’t get better, you probably have some form of hormonal acne  and will need hormonal therapy.   I agree that its outrageous that most  healthcare plans refuse to cover any form  of tretinoin  much past adolesence.  Retin A is now available in less expensive generic form while newer Differin is  still under patant. Despite the increase in costs,  I think your doctor  made a good call.

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QandA3-smQuestion:  My neighbor  brought me back a small bag of  Dead Sea  Salts  from her trip to Israel.  She says its good for  my skin.  But my cardiologist has told me to cut back on salt to lower my blood pressure.  Who is right?

Answer: While it is certainly true that excess dietary salt   is not good for both your heart and yourskin, Dead Sea Salts  have significant health benefits. How?  One of the reasons  is that rather than just plain sodium chloride, Dead Sea Salts are actually a mixture of beneficial minerals.   The sodium chloride content is actually much much higher in traditional ocean water than in the water in the Dead Sea.

Dead Sea Salts have a payload of healthy minerals including magnesium, iodine, zinc, potassium and sulfur.  A study published  in the International Journal of Dermatology, found that  soaking in a a bath enriched  with Dead Sea Salts relieves the pain of  arthritis.  The skin can absorb some of the minerals to  increase circulation.  The National Psoriasis Foundation recommends Dead Sea Salts because the minerals help the skin retain moisture and reduce inflammation. Researchers believe that the psoriasis  skin care benefits can be traced to the magnesium content in Dead Sea Salts.   This essential mineral is known  to bind water to skin cells, normalize skin cell growth and reduce skin roughness.  All good.

You can purchase  bags of pure Dead Sea Salt as well as  in skin care products  which include the salts in their list of ingredients.   Many commerical Dead Sea Salt products are actually made from the mineral-packed mud that is near and in the Dead Sea.   Mud facials with Dead Seal Salts eg  AHVAVA Time to Clear Purifying Mud Mask are especially effective.  These beauty masks soak up excess oil, lift off dead dry skin cells while the magnesium helps the skin plump up with gorgeous moisture.

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 QandA3-smQuestion:   I’ve tried just about   everything for acne.  I wanted  to try Retin A but   my  doctor  gave me a prescription for Azelaic acid.  Do you think it could help or should I  go to a doctor to give me what I want?

Answer:   Azelaic is one of the newer  acne fighters.   It is found  on a yeast that lives on our skin and  is a natural  anti-inflammatory compound.    It is a triple threat against acne– kills bacteria that provoke  breakouts, decreases the growth of  pore clogging keratin and reduces irritation.   But wait there’s more.  Azelaic acid is effective for  lightening  dark  spots and melasma because it inhibits  the production of melanin.  It  is especially  effective for  darker skin  tones because it avoids  the  problems of irritation  of Retin A and Benzoyl Peroxide.   Azelaic is also  prescribed  for   types of  rosacea breakouts that  resemble  acne eruptions.  Finacea is a 15% Azelaic gel that has been a pproved   for both  mild to moderate acne  and rosacea.

You can also find azelaic acid in over the counter products, but usually the concentration is not listed on the label.  One excellent  example where the this info is  available  is  Acne Gel from PCA Skin that contains 5% Azelaic Acid and 2% salicylic  acid ( Its available online from The Derm Store).  You can also try  to get the  azelaic acid levels in a product by writing to the manufacturer.

One final thought:  Azelaic acid  works for  less severe acne.  If you have  cystic and/or  hormonal acne, Azeleic alone will not get the job done.

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QandA3Question:   Can  Arbutin  help my  acne?

Answer:  Found in both the mulberry and  bearberry  plants, arbutin  is known not  for acne care  but for its ability to lighten skin discolorations.   Arbutin acts by inhibiting production of tyrosinase , the enzyme that promotes  melanin.  In short, less tyrosinease, less melanin.  Keep in mind that Arbutin  converts to hydroquinone in the body, so if you wish to avoid hydroquinone, arbutin is not the lightener  you want.

Arbutin does not directly deal with  the forces behind acne.  However, it may be useful to lighten  darkening or hyperpigmentation that can develop after breakouts.   While laboratory studies  indicate that  arbutin can reduce melanin production it is   often not possible to determine how much  arbutin  is used  in a commerical, non-prescription  products.  With active ingredients like zinc oxide  or salicylic acid, the concentration is listed on the label.  Without this information, you cannot  judge how strong or how weak  an arbutin product is  before you buy it.  With arbutin, this info is just not provided on the package.   Arbutin is often called mulberry extract and the amount of this ingredient is also  not stated on the label.  Like most skin lightening formulations, arbutin is usually combined with other skin brighteners including Kojic acid and even hydroquinone.  

Like most lightening  ingredients, arbutin  has to be used for at least six weeks to see a difference.  Most  work by inhibiting new melanin production so you need to slough off the old darkened  cells before the slow down of melanin will make a visable difference. And whenyou use a lightening agent,  its absolutely imperative to use an effective SPF50 sunscreen to prevent new melanin production.

And to get back to  your original acne problem. You need to look for products that contain proven, measured anti-acne ingredients eg salicylic acid and benzoyl peroxide. You also want to avoid products with  acne triggers such as mineral oil, shea butter, beeswax and lanolin

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Q&A2Question: I am a 45 year old South Asian women. I now live near Chicago  and the weather is  usually  grey and very cold.  My cousin says I still need to use a sunscreen and I think its unnecesary  at this time of year.  Who is right?

Answer: Umm, I tend to stay out of family arguments, but  in this case I have to say your cousin is right.  The UV rays are  hitting our skin all year  round.  While  your melanin rich complexion  provides protection from sun aging and skin cancers,  even weak UV rays  can  provoke  unwanted patches of darker pigmentation known as hyperpigmentation or melasma.    Brown spots and splotches  are an increasing problem  for  skin  of color.  Rather than spend a good part of your beauty dollar on  products that promise to  brighten and even out the skin tones,  prevent hyperpigmentation by investing   in a sunscreen with at least a 30SPF.  In summer a 50SPF is  even better.

Virtually every dermatologist  I  speak to makes sun protection for everyone  their main focus– and they dream of the day when its as automatic  as brushing  your teeth.  Because its so essential for skin health and beauty, its key is choosing the right sunscreen for your skin.  If you have dry skin, a good sunscreen can   boost  hydration.  However if you have oily  or acne prone skin,   the wrong sunscreen can increase  skin problems.  For  best results,  look for  oil free forumulation that provide physical sun protection with zinc oxide or titanium dioxide.  The chemical sunscreens like avobenzone and Mexoryl are effective  but can be irritating– and this irritation can provoke moremelasma and hyperpigmentation  in women of color.  Not what you are looking for.

Use the sunscreen every day  on your face, neck and hands.    There has been  alot of discussion about how much  goo you should put on.  I’ve tried out the   often quoted recommendation of one tablespoon  per face and the results were both funny and disturbing.    To keep up sun protection during the day, use a mineral based powder  like Brush on Block ( $30, free shipping)or Colorerscience ( $50, free shipping).

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Q&A2Question: My hair  salon is now selling  argan oil shampoo.  Is is a good choice for dry hair?  And is it worth  the higher price?

Answer:  Argan oil  is arguably the oil of the year.  It comes from the nut of the argan tree which  is found  primarily in Morocco.  In North Africa argan oil is used  as a dip for bread, in salads as well as in skin and hair care products.     Argan seeds destined for eating are toasted to bring out the nutty flavor.   When seeds are used for  cosmetics, they  skip the  toasting step. 

Argan seeds are a tough nut to crack ( pun not really intended)  They have to cracked by hand and the entire  extraction process is long and labor intensive.   This, plus  the  fact that  the argan tree is now on the endangered list, make argan oil one of the rarest  ( and thus most expensive) oils on the market.

Health Benefits of Argan Oil

Argan oil is packed with  omega six fatty acids.  It is actually almost 40% linoleic acid– theArgan oil and fruit most effective anti-wrinkling oil  according to the NHANES study.  Pure argan oil is also  rich in a range of anti-oxidants including vitamin E, carotenes, and phenols.  Studies done with volunteers found that adding argan oil to  the diet lowered both cholesterol and triglyceride levels.    Other studies suggested that argan oil  could be as heart healthy as olive oil– but at  a much higher price tag.

Beauty Benefits of Argan Oil

Moroccan women have a long tradition of using argan oil to soften  sun dried skin and hair.  Linoleic  acid is  known for its anti-inflammatory properties maknig it an excellent choice for  irritated or sensitive skin.   Argan oil mixes well with other cosmetic ingredients  and softens without excessive oiliness.  In a shampoo and or conditioner this means it can  add shine and flexibility  without making the hair flat or greasy.

The challenge is to find genuine  Argan oil products.   You can find 100% Argan oil in health food stores   while other products have only a drop or two of  this unique oil.    Be  cautious of products labeled Moroccan oil which is often a mixture of some  Argan oil and  who knows what else.

Bottom line:  Argan oil has a lot going for it.  It makes  elegant products and is a welcome addition to your healthy foods list.  Just be sure  you’re getting the real thing.

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Q&A2Question:  My Mom  reads your blog and  has been talking about getting Botox  or the “lunchtime laser.”  I want to get  her a treatment for Christmas but don’t know which one to choose.  I can afford  only one  and I want  her to see the biggest results.

Answer:  What a great question and you’re a great daughter! Both  Botox and  Intense Pulsed Light  laser  ( also known as the lunchtime laser) will make a major  difference in her appearance.  The choice depends on the condition of her skin.  If she has spent many  happy hours in the sun, its likely that she has lots of freckles and dark patches.  An Intense Pulsed Light treatment  will literally vaporize this aging pigmentation and leave her skin younger and refreshed.  The results are permanent but brown spots will return if she goes out without sun protection.  If she was not a beach bunny and  her skin  has   lines along the cheeks, forehead and  and around the eyes, Botox will erase them– for about 3-4 months.   Because lasers leave the skin extra sensitive for a few days,  you can also give her a stocking  filled with a gentle cleanser ( eg Cetaphil), sunscreen ( Neutrogena for Sensitive Skin)  and soothing water spray ( eg Dermalogica UltraCalming Spray).

The Right Tool  at the Right Time

Which anti-aging tool to use  and when to use it  was the fundamental question   behind the No-Nonsense Beauty Blog.   Initially, I planned to start with  Retin A  to reve up the circulation and skin growth, add Botox to reduce lines and polish things up by removing  large freckles and age spots with a laser.  But  as it turned out,  lasers work best on darkest spots, so I started the anti-aging journey  by removing them with a   traditional laser and then continuing with  my  plan. 

But in the past  few years since I started, there have been so  many new options  that  my new plan has become  an exploration  of new forms of Retin A, new lasers and new machines that  deal  both singly and in combination with a slew of aging issues.  At a recent dermatology  conference at Mount Sinai, the experts  came up with an effective anti-aging game plan  that started with   gentle lasers like Intense Pulsed Light  to brighten and Botox to smooth the skin.

I’d love to hear which treatment you chose.  Happy holidays!

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