6 Skincare Resolutions for the New Year!

  6 Skincare Resolutions for the New Year!

 

 

With the holidays behind us it's time to gear up for the New Year - the one time of year when we put pen to paper to outline all our resolutions. While losing weight and saving money may top your list this year, don't forget about your skin. Here are some quick and easy resolutions your skin will love in 2012:

 

Protect your skin from the sun everyday: Make a commitment to protect your skin from UV damage and wear sunscreen under your makeup or purchase makeup that has at least SPF 15. If you don't know what’s right for your skin type ask your doctor what they recommend. UV damage can cause premature wrinkles and sun spots. By protecting your skin from UV rays you will continue to look more youthful throughout the New Year!

 

Throw away outdated skincare products: Make-up that hasn't been used in a while and outdated skincare products may be hosting bacteria and can cause breakouts. Open the medicine cabinet and empty your make-up bag. If you haven't touched that skincare product or piece of makeup in a few months it’s time to say goodbye. Your skin will thank you later. 

 

Sleep without make-up: Not removing your make-up is one of the worst don'ts when it comes to your skincare routine. Makeup clogs pours and can leave your complexion looking dull. Wash, tone and moisturize your skin every night before bed this year. 

 

Exfoliate: This is the step most people skip as part of their skincare routine. Try exfoliating at least once a week with an at home facial scrub – you will see an immediate difference. If you can make it into the office, try microdermabrasion, a chemical peel or hydrafacial. Peels in particular can take years off your face. 

 

Consult a trained professional before pursuing aesthetician services (Botox, dermal fillers): Minimally invasive procedures including Botox® and dermal fillers such as Artefill®, Juvederm® or Restylane® continue to grow in popularity.  But not every physician is trained to perform these procedures. Make sure you check the physician's credentials and validate they have extensive experience using the products they have recommended. 

 

Manage stress: Stress affects your health and over time can cause over-production of oil and inflammation which results in bad skin. Relieve stress this year by taking a walk, going to a yoga class or taking up a hobby. You will stay happier, your health will improve and it will be reflected on the outside.

 

For More Questions and Answers, Contact: Las Vegas Laser and Lipo at 702-360-6686

MRSA sanitizers largely a myth, FDA warns

A New Article from:

Washington — The Food and Drug Administration is warning consumers that several companies are making unproven claims that their products will prevent methicillin-resistant Staphylococcus aureus infections, the McClatchy-Tribune News Service reports.

Makers of some hand sanitizers and other products are saying their products kill MRSA bacteria. “Don’t believe them,” the FDA warning states.

Deborah Autor, compliance director for the FDA’s Center for Drug Evaluation and Research, said in a news release, “Consumers are being misled if they think these products you can buy in a drugstore or from other places will protect them from a potentially deadly infection.”

The FDA reportedly is cracking down on companies that are breaking federal laws by promoting products as being able to prevent MRSA infections.

By: Bill Gillette

Scar treatment protocol creates synergism between fractional lasers, corticosteroids: Part 2

Part 2 from:

PROMISING RESEARCH Dr. Waibel cites Rox Anderson, M.D., and colleagues with publishing the concept of harnessing the microthermal zones created by the fractional ablative laser to serve as a drug-delivery channel. The research involved a preclinical, controlled study and showed enhanced skin penetration of the topically applied photodynamic therapy drug, methyl 5-aminolevulinate (Metvix, Photocure), following fractional ablative laser treatment (Haedersdal M, Sakamoto FH, Farinelli WA, et al. Lasers Surg Med. 2010;42(2):113-122). 

Dr. Waibel says she also recognized in 2009 the potential for synergistic benefit in combining ablative fractional laser resurfacing with corticosteroid treatment, when she was treating a set of identical triplets for extensive scarring resulting from severe burn injuries sustained when they were in a house fire at age 17 months. 

All of the young women were being treated with fractional ablative laser resurfacing, but one of the sisters also underwent tumescent anesthesia of her upper arms and developed severe edema over the first 24 hours secondary to poor lymphatic drainage. Topical corticosteroid was applied to manage the edema, and it was noted coincidentally that the burn scars of this sister healed significantly better and faster than her identical siblings', Dr. Waibel says. 

Intrigued by this finding, Dr. Waibel undertook a proof-of-concept prospective study including five patients with multiple severe acne scars. Scars were treated with the fractional ablative laser only; intralesional triamcinolone acetonide 10 mg/cc only; fractional laser plus intralesional triamcinolone acetonide; shave excision; fractional ablative laser treatment plus shave excision; or they were left untreated. In all patients, the best outcomes were achieved with the combination of the fractional laser resurfacing and intralesional corticosteroid, she says. 

FUNCTIONAL BENEFITS While the endpoints in Dr. Waibel's prospective and retrospective studies focused on cosmetic outcomes, experience with the combination laser-corticosteroid regimen shows it also has a valuable and remarkable effect on patient function, enabling improved range of motion that was previously restricted by scarring. 

Dr. Waibel tells the story of a woman who initially ran out of a house fire without injuries, but went back inside when she remembered her dogs were still there. In leading her pets outside to safety, the woman's clothes caught on fire and she sustained severe burns on more than 50 percent of her body. After the burns healed, she was left with contracture scars that limited movement of multiple joints. 

"The patient is right-handed and had a scar over her right wrist that prevented its flexion. After a series of three treatments, she regained almost full range of motion," Dr. Waibel says. 

The cosmetic and functional benefits of advances in laser treatment for severe burn scars are also having a dramatic impact in the rehabilitation of wounded military personnel who have experienced severe burns caused by improved explosive devices. Recently, Dr. Waibel participated in a military symposium on burn-scar treatment in which she worked with military dermatologists Chad Hivnor, M.D., Peter Shumaker, M.D., and Nathan Uebelhoer, D.O., to train military physicians about advances in scar treatment. 

"These military physicians have already been using the fractional CO₂ laser for early intervention with great results in improving scar appearance and symptoms of pain and severe itching, as well as function. In some dramatic cases, soldiers with severe burn injuries on their lower extremities are achieving improved gait after a single treatment," Dr. Waibel says. 

"I shared with them my experience, including combination treatment with corticosteroids, and I learned that starting treatment before the scar matures may be particularly valuable for limiting functional morbidity," she adds. 

FUTURE DIRECTIONS Although the outcomes achieved with the combination treatment approach provide compelling evidence about efficacy, Dr. Waibel says she believes further study is needed to understand the mechanism of action. Working with University of Miami colleagues Evangelos Badiavas, M.D., Ph.D., and Stephen Davis, Ph.D., she is conducting controlled pharmacokinetics studies in preclinical models to quantify the effects of the laser-assisted drug-delivery technique on corticosteroid bioavailability and systemic absorption. 

By: Cheryl Guttman Krader  

Scar treatment protocol creates synergism between fractional lasers, corticosteroids: Part 1

A New Article from:

Same-session therapy that incorporates topical/intralesional corticosteroid and multiple-wavelength laser treatment, including the fractional CO₂ ablative laser, shows promise as a safe and effective protocol for providing aesthetic and functional improvement for patients with challenging cutaneous scars, says Jill Waibel, M.D. 

A patient before (left) and after three treatments with fractional ablative laser and injected Kenalog 20 mg/cc. (Photos credit: Jill Waibel, M.D.)

Dr. Waibel reports results from a retrospective study including 15 patients treated for hypertrophic or keloidal scars secondary to third-degree burns or surgical or traumatic injuries. First, a nonablative laser was used to treat any vascular and pigmented components of the lesion. Then a fractional CO₂ ablative laser (UltraPulse TotalFX, Lumenis) was used to achieve scar resurfacing and to improve bioavailability of triamcinolone acetonide suspension (Kenalog) that was applied immediately after the laser procedure. 

All scars were treated for a total of three sessions at one-month intervals. Results were graded six months after the last treatment by three blinded observers who used a 0 to 3 quartile scale to rate improvement in four areas: overall, dyschromia, hypertrophy and texture. The mean score for overall improvement was 2.73; all scars received a score of 2 or higher for improvement in texture, and 14 (93 percent) were rated with a score of 2 or higher for improvement in hypertrophy. 

A patient before (left) and after three treatments with fractional ablative laser and topical Kenalog 10 mg/cc.

While dyschromia showed the least improvement among the three characteristics rated, all scars were judged to have some improvement in color, and the change was rated with a score of 2 or higher for 60 percent of the scars, says Dr. Waibel, Miami Dermatology & Laser Institute, Miami, and clinical voluntary professor, department of dermatology and cutaneous surgery, University of Miami Miller School of Medicine. 

"We have come a long way in treating severe cutaneous scars in the past few years, and in my opinion, the fractional ablative laser has emerged not just as the new gold standard for scar resurfacing, but the platinum," Dr. Waibel says. "However, cutaneous scars can present a complex problem, and in that situation, the treatment approach should also be complex.
"Use of a multimodal protocol combining various laser wavelengths and corticosteroid treatment is based on that principle, because it addresses multiple features of the scar while also taking advantage of the variable depth ablation zones created by the fractional ablative laser to assist drug delivery," she adds. "These channels, which reach 500 to 800 microns into the dermis, allow for synergistic efficacy by enabling dermal penetration of the corticosteroid deeper than can be achieved even with intralesional injection, and thereby optimize its efficacy in breaking down scar tissue." 

The combination laser and corticosteroid treatment is performed under topical anesthesia using a compounded cream containing benzocaine 20 percent, lidocaine 8 percent and tetracaine 4 percent. The triamcinolone acetonide is applied or injected immediately after the fractional ablative laser treatment is finished with the chosen concentration (10 mg/cc, 20 mg/cc or 40 mg/cc) and method of administration (topical and/or intralesional), based on scar severity and thickness, Dr. Waibel says. 

"We know the inflammatory cascade initiated by the laser treatment begins within just two minutes, and by delivering intralesional steroid we can decrease inflammation and simultaneously diminish collagen synthesis. Application of the corticosteroid immediately after the laser treatment aims to maximize inhibition of this process," Dr. Waibel says.

The Multifunctional Value of Sunscren-containing Cosmetics: Part 3

Multifunctional SPF Rated Cosmetics

Multifunctional SPF rated cosmetics are increasing in the marketplace. Lipsticks, lip balms, facial serums, and eye creams are all commercially available formulations that can possess an SPF rating. Increasing patient compliance with sun protection through the inclusion of sunscreen filters in many commonly used facial products can be a synergistic effect. Patients do not wish to purchase or use multiple products that are expensive and time consuming to apply. The multifunctional cosmetic is an important dermatologic advance. This trend is expected to continue with extensions to male skin care, such as sunscreencontaining after shave preparations. Sunscreen filters are also finding their way into hair care products that claim to prevent color fading. Protection from UV exposure improves color purity and retention, lengthening the time a hair dye can be worn until repeat dyeing is required.^[5] This is a positive trend for dermatology as it reinforces our safe sun message to our patients.

Conclusion

With the widespread emergence of sunscreen-containing moisturizers, foundations, and various lip treatments, it is apparent that the cosmeceutical industry has embraced the importance of photoprotection. These multifunctional products have the potential to encourage patient adherence to regimented sunscreen use by facilitating ease of application, thus minimizing the need for any significant behavioral modification, particularly during the morning routine.

By:  Zoe Diana Draelos, MD

The Multifunctional Value of Sunscreen-containing Cosmetics: Part 2

Sunscreen-containing Facial Foundations

If a sunscreen-containing moisturizer is tinted to match the skin, it can then be classified as a facial foundation. Facial foundations are another category of multifunctional cosmetics that can be helpful in encouraging sun protection compliance. There are four basic facial foundation formulations: oil-based, water-based, oilfree, and water-free forms. The most popular facial foundations are liquid oil-in-water emulsions containing a small amount of oil in which the pigment is emulsified with a relatively large quantity of water. The primary emulsifier is usually a soap, such as triethanolamine or a nonionic surfactant. The secondary emulsifier, present in smaller quantity, is usually glyceryl stearate or propylene glycol stearate.

Facial foundations are designed to color, blend, and camouflage the underlying skin and create an illusion of perfect complexion beauty. The ability of a foundation to conceal or cover the underlying skin is known as "coverage." Higher coverage products deliver better photoprotection while lower coverage products deliver less photoprotection. In this case, the photoprotection is due to inorganic filters in the formulation, which commonly include titanium dioxide, zinc oxide, talc, kaolin and precipitated chalk. Even coloring agents, such as iron oxide, can function as inorganic filters.

Sheer coverage foundations with minimal titanium dioxide are almost transparent and have an SPF around 2 while moderate coverage foundations are translucent and have an approximate SPF of 4 to 5. Thick, waterproof cream facial foundations that are used for camouflage purposes or post-surgically completely obscure the underlying skin and have an unlimited SPF because they function as a total physical block. For persons with severe photosensitive facial skin disease, such as lupus, these waterproof cream facial foundations offer superior photoprotection.

In addition to the normal photoprotective constituents of a facial foundation, other inorganic and organic filters can also be added. The most commonly added organic filter is octyl methoxycinnamate. It is an excellent UVB filter with no aesthetic issues and limited allergenicity.^[1] It may be combined with other filters, such as oxybenzone, to increase coverage in the UVA range.^[3,4] Some of the newer facial foundations even add avobenzone that has been photostabilized with octocrylene and oxybenzone. Selecting the proper mixture of sunscreen ingredients is key to providing superior photoprotection and aesthetics while offering a high broad spectrum SPF.

New sunscreen-containing facial foundation formulations are available in a variety of forms: liquid, mousse, water-containing cream, soufflé, anhydrous cream, stick, cake, and shake lotion. Liquid formulations are most popular because they are the easiest to apply, provide sheer to moderate coverage, and create a natural appearance. As previously mentioned, they contain mainly water, oils, and titanium dioxide. To this basic formulation, sunscreen filters can be added. For most patients, this type of sun protection through a facial cosmetic is the best way to increase compliance.

Other formulations of facial foundations can also be created. If the liquid is aerosolized, a foam foundation known as a mousse is produced. A cream foundation has the additional ingredient of wax, which makes a thicker, occlusive, more moisturizing formula. These thicker cream facial foundations also deposit more pigment on the skin surface and obscure more of the underlying skin. Cream formulations typically offer better photoprotection than liquids. Whipping the cream produces a soufflé foundation. Finally, an anhydrous cream with no water in its formulation provides enhanced occlusion and exceptional long-lasting coverage. These products resist water removal better and can be used with greater success in persons who need superior photoprotection when perspiring heavily.

There are three final forms of facial foundation that have been adapted for sun protection. These include stick, cake, and powder facial foundations. Adding more wax to the cream facial foundation results in a stick that can be stroked across the face. These facial foundation sticks are also water-free and provide water resistant photoprotection. This is in contrast to the cake and powder facial foundations that are dusted over the face. A cake foundation is a compressed powder consisting of talc, kaolin, precipitated chalk, zinc oxide, and titanium dioxide compressed into a cake that is applied to the skin with a sponge. If the ingredients are not compressed into a cake, they can be left loose in a jar with a brush attached to one end. This loose powder facial foundation is sometimes called a mineral makeup.

Mineral makeup are some of the newest sun protective cosmetics. They are dusted onto the face and can be just easily dusted off the face. Powders do not provide water resistance characteristics, making them only appropriate for day wear with casual sun exposure. Also, the powder does not provide an even film over the face, allowing for uneven photoprotection. For the patient with serious sun protection needs, it is best to apply a sunscreencontaining moisturizer followed by a mineral makeup. The moisturizer will allow the powder to stay in place and offer increased photoprotection due to layering. It is important to note that the SPF rating of the powder and the moisturizer are not additive. For example, an SPF 15 sunscreen-containing moisturizer and an SPF 15 mineral makeup do not combine to confer SPF 30 photoprotection. Each product application will make a more even sun protective film, allowing closer approximation of the SPF 15 rating.

The Multifunctional Value of Sunscreen-containing Cosmetics: Part 1

Introduction

Sunscreens are perceived as gooey, sticky, uncomfortable products that are difficult to apply and distasteful to wear. This accounts for dismal compliance when dermatologists ask patients to use daily sunscreen. Since the time delay between accumulated sun exposure and skin cancer can be more than 20 years, patients do not receive a short-term benefit from photoprotection. Any marketing genius will tell you that compliance requires both self-perceived short- and long-term benefits in order to reinforce positive behavior. This insight into the human psyche led skin care companies to develop the concept of the "multifunctional cosmetic," which by definition delivers several benefits in one bottle. Currently, popular multifunctional cosmetics include sunscreen-containing moisturizers and facial foundations.

 

Sunscreen-containing Moisturizers

Sunscreen-containing moisturizers have dramatically improved photoprotection compliance. These products can provide moisturization by decreasing transepidermal water loss through creation of an environment that is optimal for barrier repair. Through the use of occlusive agents such as dimethicone, petrolatum, and mineral oil, as well as the use of humectants such as glycerin, propylene glycol, and hyaluronic acid, a therapeutic moisturizer can aid in the restoration of the corneocyte and intercellular lipid organization. In addition, a sunscreencontaining moisturizer can deliver effective ultraviolet B (UVB) and ultraviolet A (UVA) photoprotection, thereby contributing to the prevention of sunburn, photoaging, and skin cancer simultaneously. Through the inclusion of active ingredients such as retinol, niacinamide, and/or green tea, additional antiaging benefits may be achieved. In short, one bottle of sunscreencontaining moisturizer can be designed to moisturize the skin, repair the barrier, stop sunburn, prevent skin cancer, minimize photoaging, and potentially reverse oxidative insults.

Most sunscreen-containing moisturizers are formulated at a sun protection factor (SPF) between 15 to 30. SPF 15 products can be designed with little UVA photoprotection and they may or may not be labeled as broad spectrum. SPF 30 products must contain both UVB and UVA photoprotective ingredients and are therefore preferred. This logic encouraged the American Academy of Dermatology to restate its sun protective recommendations and raise the minimum recommended SPF to 30. For most formulations, SPF 30 is a nice compromise between photoprotection and aesthetics. Once the SPF raises much above 30, the product becomes sticky. Many highly effective sunscreen filters, such as octocrylene, are thick oils and increasing their concentration in the final formulation leads to poor aesthetics.^[1] Yet, for casual limited sun exposure, SPF 30 provides excellent daily photoprotection.^[2]

 

by: Zoe Diana Draelos, MD