Posts Tagged ‘psoriasis’

Question: I’ve seen ads for make-up that claim its dimethicone free.  What is dimethicone and why should I care if  its in my skin care products?  Can  it damage my  skin or cause environmental  problems?

Answer:  Dimethicone is a type of silicone. It is an especially large molecule that stays on the surface of the skin and  form a protective barrier.  Dimethicone is used in practically every type of toiletry including  moisturizers, sunscreens, eye cream, eye make-up shampoo and  diaper ointment.

The FDA has approved dimethicone  as safe and effective for personal care products.  Dimehticone is not on lists of chemicals which are suspected to cause health problems.  In addition, its not been found in human cells  or urine, indicating that it stays on the skin’s surface. Even the Environmental Working Group (EWG) which finds a problem with practically everything, have nothing bad to say about dimethicone- no info on cancer risk, reproductive toxicity,  allrgies,  or contamination to the environment.

Dimethicone seems  to be helpful  for seriously unhappy skin.  Its a frequent ingredient in diaper ointments  and creams for psoriasis and eczema.  Its inherent safety  makes it a popular ingredient in  eye  make-up and  toiletries for babies. The only red flag may be  for acne troubled skin. Its ability to form a water tight shield that  may, in some people block  pores and  increase breakouts.  But this is pretty hypothetical and not based on  published studies or even anecdotal  repots. 

There are definately problem ingredients in  some personal care  products.  Mineral oil, alcohol, steroids  and menthol can provoke different  issues  in different skin  profiles.  But dimethicone is not on that list.  It can be a dangerous world  today, but dimethicone is not  part of the problem.

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Its been almost  three weeeks since my red splotches and breakouts  have been brought under control.  The labor intensive protocol of washing my face 3x/day ( once with Anti-Redness Cleanser and twice with home microdermabrasion), glycolic  peel pads  3 times a week and Metro Gel at night  seems to  be the perfect formula.

I also  have been diligent in following  rosacea dietary guidelines.This meant avoding spicy foods, coffee, alcohol and chocolate.   With my skin so clear, I wondered if I really needed to be as careful with my diet.  I mean,  no coffee for life?  I’m one of those annoying New Yorkers who walk around in summer with a container of ice coffee  glued to my hands.  The answer?  Yes and no.

Over the weekend with friends, I treated myself  to a glass of  my favorite Rombauer Chardonnay– and nothing popped out on my face.  Next, I tried my summer favorite– iced coffee.  Again my skin stayed  clear.  My next two experiments were actually accidental.

I’m a total chocoholic and when  a friend passed a box of  Godiva  chocolates, I popped one in my mouth without thinking.  That night, I woke up with a burning sensation on my chin.  In the morning,  my chin was dotted with red lumps  that looked like  old-fashioned teen age acne.   Dr Lefkovits went into emergency mode with an in-office microdermabrasion and a 70% glycolic peel.  Within hours  the outbreak disappeared along with my passion for chocolate.  There is  a good bit of controversy about the link between chocolate and acne.  Well-respected research has repeatedly demonstrated that chocolate does NOT provoke breakouts.  IRL dermatologists and   patients  report  that chocolate  seems  be  an acne triggerr.   I wonder  if these chocolates related reakouts are actually  part of rosacea rather than  traditional acne vulgaris.   I smell a  nice grant proposal.

My next food test  was a surprise in a bowl of creamy corn chowder.   Instead of a mellow bowl of  summer corn, it turned out to be as spicy as a dish of  Texas Red Chili.   I was famished, late and it  had taken so long to get my order that  I ate about half before rushing  out. The next day my  chin was red and sore.   Home microdermabrasion and MetroGel brought it under control in 48 hours, but each episode  leaves the skin  a little redder with more broken blood vessels.

Both chocolate and spicy foods provoke rosacea, but in slightly  different pathways.  Chocolates  stimulate histamine release which lead to an inflammatory response.  Spicy foods directly stimulate circulation, expanding blood vessels.

I’m really glad that  wine and ice coffee are on back on my menus and I can avoid  food related redness by avoiding chocolate and spicy foods.  Have you found a connection diet and your skin?  I’d love  to hear  how  you  handle  it.

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Unlike rosacea, psoriasis, and eczema, there are no celebrities with seborrheic dermatitis.  There is   no website, no fund raising events , no  online support group for people dealing with  seborrheic derrmatitis.   Yet this  type of sensitive skin affects an estimated 10 million  men and women in the US.

Seborrheic dermatitis, often considered a form of eczema, is a red splotchy rash that pops up the face, hands, scalp and chest.  When it appears along the smile  lines and around the mouth  its also known as perioricular dermatitis.   (That’s  latin for around the mouth).  

The red splotches are the end result of a series of events that starts  with over production of  oil in the skin.   This  oil provokes the overgrowth of  a yeast that is actually a natural organism in the skin.   This yeast  produces a toxin and the overgrowth of yeast  produces high levels of  this toxin.  The result?  It creates an inflammation  which we see as red, raised, itchy areas on the skin. 

Over-active oil glands are a rite of passage of  normal teenage years.  But past age 40 over-active glands  are often the result of stress, exhaustion, lack of sleep, and poor health.  The link between stress and seborrheic dermatis is so strong that it sometimes is called “Wall Street Dermatitis”.  After the crash  of 1928,   many of the ruined financiers developed seborrheic dermatitis,  obviously distressed at the destruction of their wealth.

Treating Seborrheic Dermatitis

Getting seborrheic dermatitis under control starts by cooling  off the oil glands.  Soaps and cleansers compounded with different forms of sulfur encourage the oil glands to calm down.    To  jump start control, mild steroid creams and/or anti microbial gels  are used for 1-3 weeks .  If seborrheic dermatitis is especially persistant,  antibiotics, or even oral anti-fungal medications can be added to the treatment plan.

Seborrheic dermatitis reacts badly to  many  types of personal care  products.  Even water-based  foundations and moisturizers  may trigger  an outbreak.   Needed   sunscreens can be extremely tricky.  While  titanium and zinc oxide sunscreens are generally less irritating then chemical  sunscreens,  even oil free formulations can provoke a shower of red spots.    To avoid wasting your money and irritating  your skin, shop for  beauty care products in stores  like Sephora and CVS  with consumer-friendly return   policies. 

According to  NYC dermatologist Dr Albert Lefkovits, a low fat diet will help keep seborrheic dermatis under control.  This means   eliminating  high  fat  foods like  fried chicken, doughnuts and potato chips  which aren’t healthy for anyone.

Seborrheic dermatis  poses some problems for anti-aging programs.  Moisturizers, even those enriched with goodies like anti-oxidants  and  ceramides seem to  provok eruptions.   While retinoids like Retin A can decrease  oil production, they can be especially irritating.  Dr Lefkovits prefers using glycolic acid cleansers and peels to improve seborrheic dermatitis  as  well as  stimulate  cell growth and  healtheir elastin and collagen.

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Since I started   a series on different types of sensitive skin I have been getting questions about the  role of nutrition in managing red itchy skin.  I started to answer them individually, then realized this topic deserved a big post of its own.

It certainly goes without  saying that a diet rich in nutrients and low in  processed food is the basis for any healthy skin.  But with skin that is prone to redness and eruptions, very specific dietary changes can have a big impact– and whats  important here is that each type of sensitive skin has unique diet needs.

Diet and Rosacea

The triggers for rosacea  are many and varied, but four diet factors  are common  for the  millions of people living with problem.   Alcohol, coffee, spicy  foods and chocolate  are at the top of the list of food factors to avoid to reduce rosacea exacerbations.  These are fairly easy to carve away from a standard diet  and  many people  with rosacea can expect  to see some relief.  FYI  decaf coffee and tea seem to  far less of a problem.

Diet and Hives

The role of diet  in hives is big and complicated.  The raised red hives are triggered by an over-production of histamines and there is a long list of foods that are heavy histamine producers.  Top of the list are shellfish. nuts,  eggs, wheat,  and soy, closely followed by strawberries, wine, cheese preservatives, food dyes and tomatoes.   This is a  long list, but the good  news is that most people  with hives only  have two food allerrgies.  The trick is finding out which two. 

Eczema and Diet

Food allergies  have often been linked to eczema.  Dairy products, coffee, soy beans, eggs, nuts and wheat have been fingered as common eczema triggers. Most of these are nutrient rich foods  and its not good science to cut all of them out of your diet without good reason.  Traditional allergy testing calls for the elimination of all   top  known triggers and then add them back- one by one- into the diet.  This is  difficult to do without  help from a healthcare professional.  An easier, albeit less conclusive approach would be to omit each item individually  for a week to see if  the eczema improves.   

The best  bet would be to start with gluten-rich wheat.  Gluten allergy is at the top of the list of eczema triggers.  Well designed studies have found that people with   celiac disease ( a severe form of gluten intolorance) have  3X  the incidence of exzema.  Even more interesting, close relatives of people with celiac disease have twice the incidence of exzema. 

To  learn if wheat is an eczema trigger for you, try eliminating bread, pasta and cereal for two weeks.  In the past  a gluten-free diet  was pretty grim.   Today there are  so  many wonderful  gluten free foods that its one of the easiest  dietary restrictions to follow.

Psoriasis and Diet

The appearance of  scaly red patches of psoriasis, diet  does  not mean the elimination of foods but the addition of a very specific nutrient.   University-based research has shown that fish oils appear to reduce the inflammation of psoriasis.  Fish oils are rich in two omega-3 fatty acids– EPA and DHA– that reduce psoriasis symoptoms.   Standard advice recommends two servings of fish a week– a goal that can be met by one tuna sandwich for lunch and on salmon dinner.

While there is certainly strong science  between diet and sensitive skin, there are  also many worthless  products and distressing over statements.   I know first hand  just  how desperately  we want to find something- anything-  that will reduce redness and itching.   Staring at a drawerful of   prescription creams and pills that haven’t worked,  it is so  seductive to read about  supplements and serums  that promise to deliver perfect skin.  Caveat emptor.

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What do Kim Kardashian, Leann Rimes and my neighbor Erica  have in common?  Like almost 8  million Americans they all   have psoriasis.  This  chronic skin condition is caused  by  a dramatically increased speed of  skin cell growth leading  to red splotches coverd with  silvery scales.  Itchy, dry and  painful it usually pops up on the torso, hands, elbows,  and legs.  Unlike eczema, its found on the outside rather than on the underside of  joints.

Like so  many health problems, doctors  don’t  really have a good handle on the causes of psoriasis. It seems to be genetically driven and  about 30%  of people with  psoriasis have at least one family member with the condition.  Psoriasis flare-ups  have been  linked to wheat, stress, weight gain, strep infection cold weather, smoking  and heavy drinking.  Psoriasis can also cause joint  pain and swelling and up to 30% of people with psoriasis experience  some degree of psoriatic arthritis. 

A Bounty of Treatment Options 

The three top rules for psoriasis care  are moisturize, moisturize and  of course moisturize. Daily care starts with a lukewarm bath with a mild soap  like Dove or Aveeno Skin Relief Body Wash.  Adding a handful of colloidal oatmeal to the bath will also reduce  itching and inflammation.  After a nice soak, gently towel dry and  apply a simple but heavy moisturizer like Aquaphor.  Apply a light  layer, let it soak in then apply another layer.

Sunlight  which is usually viewed as  skin enemy #1 is actually helpful for psoriasis  But easy does it.  A daily 15 minute exposure will provide the benefits you want without increasing  skin cancer risks.

Stepping up Psoriasis Care

Lukewarm bath, ointments and a little sunlight are the first steps in managing  itchy, scaly  psoriasis skin care problems.  If you need more help ( and most  people do) doctors “step-up” care, progressively adding treatments:

1. Topical Medications

When more than simple moisturizers are needed, salicylic  acid cleansers and gels  can remove scales.  Steroids can also be prescribed  for flare-ups, but  should not usually be used  long term.   Tazorac ( similar  to Retin A) and coal tar  products can be very helpful  if psoriasis  affects less than 10-20% of the body.

2.  Light Therapy

You can crank up the benefits of UV rays by adding  a type of drug  called psoralens.  Either in a pill or cream, psoralens act by slowing down the turbo charged rate of cell growth that is driving psoriasis.  Psoralens have  problems  of their own.  They can cause nausea, headache and  over time have been linked with  an increased risk of skin cancer

3. Systematic Medications

If psoriasis still persists, doctors still have a number of powerful options in their tool  box.   Usually taken in  pill form,  methotrexate, cyclosporine, and retinoids ( like Accutane) all act  by slowing down skin cell growth.

4.  Biologics

The  newest  categories of care are injectables  that act on the molecular level to interrupt skin cell over production.  Given  in an injection or IV infusion,  biologics like Stelera or Enbrel can be life changing  if you have extensive psoriasis  and/or psoriatic  arthritis. Biologics are extremely powerful  and require close medical monitoring.  They have been  linked to increased risk of  infections and worsening of heart failure  and multiple sclerosis.  Effective  but with potential side effects  they are  usually prescribed when other remedies  have not been able to control   psoriasis.

Living with psoriasis can be frustrating.  All the treatments  from oatmeal baths  to  biologic injectables  need to be used in combination and it takes time and supportive  health care to come up with the most effective combo plan for  you.  Don’t  give up.  The best care is out there.

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