Friday, May 28, 2010

Twitter Q & A "Oily skin?"


I know its been long over due for me to answer the second part of the twitter question that was submitted to me a while ago "Oily skin?"
I myself have oily skin and that makes me more of an insider expert on how to care for it because I suffered and still suffer from it. But now as a dermatologist and from personal trial and error as a patient my self I learned how to manage it or even learn how to live with it at times. I have used many products over the years to try to deal with the constant shine especially while living in a very humid hot weather city like Jeddah, which makes it worse.

In this post I will not discuss the skin care regimens on caring for oily skin during harsh winter seasons which we do not experience here in Jedddah. My focus for this post will be for the group living in these areas or in similar weather. But I will place more references that you can look up at the end of the post with a link.


In my posts I usually try to tackle it the way I explain things to my patients in my clinic. I usually start with daily regimens, including possible prescription medications that I might add to it, then weekly regimens, last but not least what can be done in a medical office and medical skin care spa.


Daily regimens


Cleansers:
I have noticed in the past that many of my patients have fallen into the assumption that excessive cleansing with drying facial washes is whats needed to control oily skin, that the more the better, right?.. wrong!.. After I became a dermatologist I learned that the more you try to dry your oily skin the more your skin will try to compensate for it by increasing the sebum production ( which gives the oily complexion and shininess). So with that we stop right here. Minimize cleansing your face to only twice daily routine, morning and night unless you got splashed with dirt on your face then don't say DrLillian told me not to :) It should be enough with a cleanser that is especially labeled for oily skin something with low pH to neutral PH (this has been debatable to exactly which one as mentioned in some resources) what I use and prescribe is a diluted form of a cleanser with very low concentrations of AHA, Glycolic acid ,1% Salicylic acid (maximum concentration in very humid hot weather 2% salicylic on mornings only if the patient is not been given a drying topical treatment which then I would use a more Neutral PH), or a non-oily and non-drying cleanser which to me is the ideal cleanser. Try to avoid soaps as much as possible, most try to strip away the natural fat barrier that our skin has which we all need.

Matting/Anti-shine Lotions:
I have used and suggested a matting lotion or fluid that is available in some of the over the counter cosmeceutical companies products. Some are even tinted to act as a base for makeup or as a foundation (tints range from green which help to reduce the facial redness if present in some people, and others are tinted with skin tones). I usually prefer suggesting these matting lotions and fluids more than toners and astringents which I found some that are especially made for oily skin can a bet too drying.

Astringent and toners:
It can help control oily over production during the hot humid day. I recommend using it not more than twice through out the day and it doesn't necessarily has to be used right after cleansing as suggested by beauticians it can be used later on in the day as needed. These especially can be used on the T-zone area of the face as its is the most oily and shiny. It removes excess oil, tightens pores and smooth the appearance of the skin.


Moisturizers:
Oily skin type people should minimize using topical moisturizers even if it is oil free. It should only be used if the person has combination skin and only to the areas that are dry. Because how ever light the moisturizer is in my personal opinion and from personal experience it has caused clogging of pores and development of comedones in acne prone skin types if used regularly. I use moisturizers when my topical treatment has gone a little too drying and only till my skin is re-hydrated again and then I would stop. I recommend using it as needed and only to rough dry patches till they resolve.


Sunscreens:
If you will not be exposed directly under the sun (or indirectly through a window, glass, or as a reflection from sand, sea, or other surfaces) I would try to minimize its use, but there are some really good ones out there that are suitable for oily skin that are noncomedogenic. Choose a fluid or liquid base form labeled specifically for oily skin, never use the ones that are excessively cream base.


Make up and foundation:
The new makeup in the market for oily skin mostly have a matting effect it addresses the shine problem (I have to mention that they mostly do, but it doesn't mean it goes along with the different make up trends of each fashion session, as of this spring the glowing complexion is more the trend than a matted complexion as has been mentioned in People magazine style watch periodic), I recommend using a powder foundation with a SPF of at least 15-20 which has been integrated in many formulations of make up. It will substitute according to the patients extent of exposure to the sun from using added sunscreen in most cases. Jeddah is a sunny city but with the cultural habits we have, sun exposure to most women (not so much for men especially while driving their cars) on a daily bases isn't a real problem.
Blotting powdered paper is a quick rescue that a person can carry around even in their wallet that can be used as a quick fix for that extra shiny nose, forehead, and chin.

Weekly regimens:

Masks and scrubs:
Clay and mud masks can be done once to twice weekly it helps with reducing oily skin by absorbing excessive oil and clearing out pores. There is also a new mask that contains sulfa, it can be helpful to patients that also have acne or rosacea.
Scrubs have to be really gentle or you will run the risk of damaging the skin. I never recommend harsh scrubs only gentle dissoluble beads types that don't damage the skin. It can be used once to twice weekly to clean up oily pores and decrease clogging.


Prescriptions by dermatologist

Topical treatment:
Vitamin A derivative topical creams such as adapalen, tretinion cream or gel, isotretinoin, even OTC creams with retinol that can be suggested by a dermatologist can help. These are all off label uses that have shown to help in some practices by experience.


Oral prescriptions:
Another possible prescription is Tretinoin (Roaccutane) which has to be strictly prescribed and monitored by a dermatologist, it can be given in small weekly doses and sometimes daily doses, but that can only be decided by the physician. You can discuss that option with them and they will explain the risks and benefits of its use.

Clinic treatments:

Peels:
AHA or Glycolic acid peels have helped in my own practice. Also Salicylic acid peels have been used in other practices. Peels removes dead skin, uncloggs pores, and generates new skin production.


Medical facial treatments:
Sessions can be done by the beautician in which they can use a much lower concentration preparations of GA or AHA in small percentages. They can perform deep cleaning and toning of the skin with special techniques. Finish of with a proper mud or clay mask. This gives an instant satisfactory result to the patient of glowing skin after removal of the dead skin and cleaning up of the pores and absorbing the excessive oiliness on the skin.

Laser:
There has been reports in the literature as well as discussions among dermatologist regarding the effectiveness of using laser or light treatments specifically for oily skin to shrink the sebaceous gland and thus decreasing sebum (oil) production. Two types have been mentioned ALA PDT treatment with a 1450nm diode laser that targets the dermis where the sebaceous glands lie causing its shrinkage. Other mentions are pulsed light and heat energy therapy,and photopneumatic therapy. Other wise laser and PDT have been used most effectively to treat Acne as it destroy es the P. acnes organism that contributes to the flares of acne but not specifically to reduce oily skin by it self.

Diet


People with oily skin should be careful to avoid too much oil or fat in their diet as this can create excess sebum. I always recommend for healthy skin to increase the intake of green leafy vegetables, fruits and lots of water at least 8 glasses a day especially in our hot weather because they supply vital nutrients and help flush toxins from the skin.

Mentioned but not widely practiced in Jeddah

Taken from www.webmd.com
Oily Skin: Solutions That Work -- No Matter What Your Age
"One very new remedy for oily skin uses topical preparations containing the B vitamin niacinamide.  Early studies have found that these preparations reduce oil production, but the results have been modest to date.
In still another study, a group of Japanese researchers found that topically applied spironolactone (the oral version is available in this country and is used to treat high blood pressure) was also found to reduce the rate of oil production in young women. This product is not available in the United States, however."

Summary
The list that you should take with you when go to over the counter pharmacy section:

Daily:
1- Cleanser for oily skin low-neutral PH gel form (look for Salicylic acid 1% (Max 2%), AHA, Glycolic acid in the wash) avoid soaps. Wash twice daily.
2- Matting/ anti-shine gel, fluid or lotion in the morning after wash or mid day. Especially to the T-zone area.
3- Astringent/ toner for oily skin once -twice per day as needed.
4- Sunscreen for oily skin in liquid form for oily skin (SPF 30-50) if there is daily direct exposure to the sun
5- Water base moisturizer noncomedogenic for oily skin only to rough patched and dry areas on the face as needed. Avoid the T-zone area.

Weekly:
1- Mud or clay home care mask for oily skin. Once to twice weekly.
2- Di-solvable beads non irritating exfoliating scrub for oily skin and unclogging pores. Once or twice per week.
Instructions:
Once-twice per week wash face with gentle exfoliating gel wash rubbing very gently. Do not scrub harshly so that you don't damage the skin. Wash off with luke warm water. Pat dry. With cotton pad apply a toner. Finish off with mask. Leave on as suggested by the package which usually ranges from 10-20 min. Beauticians always suggest applying the proper moisturizer at the end, I don't unless there are some dry areas or rough patches.

At the make up counter:
1- Foundation has to be oil free and non comedogenic.
2- Preferable powder base foundation with SPF at least 15. Mineral base is better.
3- Blotting powder paper packets to keep with you for a quick fix when you are on the run.

To discuss with a dermatologist at the clinic:
Topical vitamin A derivative creams or gels, oral medications, peels, medical facial treatment sessions, lasers, and light therapy.

With that I come to the end of my post. I hope that it is helpful.

The information in this post is strictly for educational purpose only. Any skin condition and proper skin care regimens should be evaluated by a dermatologist and then according to their evaluation of the skin can a proper suitable regimen be advised.

If you are pregnant, breast feeding, or have any medical condition you should check with your doctor before using any medication.

If you have any questions and comments please leave them at the end of this post.... till then...

Write to you soon...
 
References:
Bookmarked in this link:
DrLillian delicious "Oily Skin" references bookmarks link






Saturday, May 8, 2010

سؤال و جواب تويتر ... ماهو علاج الرؤوس السوداء؟


أحصل على العديد من الأسئلة على حسابي في تويتر @ DrLillian و أحاول دائما الإجابة على أكبر قدر ممكن. جلب لي هذا فكرة هذه المدونات القادمة. سأبدأ بنشر سؤال وجواب على المدونة كمرجع لها.

 سأبدأ مع احدى الأسئلة الذي وصلتني على تويتر عندما سألت المتتبعين على الموضوع الذي أرادوا لي أن أتحدث عنه. وكان هذا السؤال من احدى الردود "رؤوس سوداء والبشرة الدهنية؟"
في هذه المدونة سوف أناقش كيفية التعامل مع الرؤوس السوداء والتي هي في معظمها في المصطلحات الطبية يعني مصطلح "كوميدونس" هم إما سوداء أو بيضاء. ليس هناك فرق في طريقة علاجها، انها اساسا نفس العلاج ما لم تكن هناك بثور بصديد التي لن تكون مناقشتنا هنا.

واحد من الأسئلة الشائعة التي أحصل عليها في الممارسة السريرية هو ما إذا كانت هنالك حبوب عن طريق الفم يمكن ان تتخلص منها ، وجوابي هو أنه في الغالب لا يستجيب إلا للالعلاجات الموضعية التي هي "Comedolytics" والتي تعني حل الرؤوس السوداء أو البيضاء (أي ، التخلص منهم). وسأذكر هنا ما وجدته مفيدا في ممارستي الخاصة وما وجدته فعالا.

سوف أقسم نظام علاجاتي لثلاثة فئات :
1 -- العلاج الذي يمكن أن تجدوه على الأرفف في الصيدليات من غير وصفة طبية هنا في جدة ، المملكة العربية السعودية.
2 -- علاجات التي يجب وصفها من قبل طبيب أو طبيبة (وهذا وفقا لممارسات الطبية التي مقرها في المملكة العربية السعودية ، في البلدان الأخرى قد تختلف)
3 العلاجات التي تتم في مراكز عيادات الجلدية التجميلية الطبية.

علاجات دون وصفة طبية :
هناك بعض العلاجات الفعالة التي يمكن أن توجد في محلات السوبر ماركت المحلية مثل "هيبر بندة" و "الدانوب" في جدة في ارفوف العناية بالبشرة والمكياج مثل Neutregena ، كلين اند كلير ، و Clearasil هي الأكثر شعبية في منطقة الخليج.
معظم هذه العلاجات اذا نظرتم الى العنصر النشط مكون من"حمض الصفصاف" او بالانجليزية "Salicylic Acid "في بعض التركيزات التي قد تصل إلى 2 ٪ في شكل الصابون ، وغسول هلامي ، كريم ، و تونيك. هذا الحمض جيد comedolytic لكن في نفس الوقت يكون لها تأثير على تجفيف الجلد عند استخدامه كثيرا.
الخوض في مزيد من الأشياء التي هي خارج الوصفات الطبية متوفرة في الصيدليات. كما أنهم عادة تحتوي على حمض الصفصاف ، AHA، وحمض الجليكوليك. كلهم لهم أثر comedolytic فضلا عن مستوى معين من تقشير سطحي. بعض هذه تأتي في مجموعات علب علاج للمرضى في المنازل. من أمثلة Rexol ، DDF Skin care ، NeoStrata ، و فيشي .

الوصفات الموضوعية للرؤوس سوداء أو البيضاء أدوية لحب الشباب :
عندها يتم إضافة كريمات مشتقة من فيتامين (أ) معالجة موضعية فعالة، تساعد على التخلص من الرؤوس "الكوميدونس" المتواجدة حاليا وتساعد من التقليل من ظهور جديد منها . هم" ، Adapelen، الايزوتريتنون (على سبيل المثال ، Isotrexine) ، وترتينوين (على سبيل المثال ، ريتين ألف). من الآثار الجانبية المزعجة التي تجعل معظم المرضى مستائين منان يستمرو بالعلاج، هي اولا لها تأثير في تهيج في الجلد ، واحمرار ووفي بعض الحالات باحساس بحرقان طفيف. هذه الآثار الجانبية عادة ما تستمر 3-4 أسابيع ، ثم الجلد تتكيف مع العلاج ويصبح متأقلم به.
مرة أخرى يمكن  اضافة استخدام comediolytics مثل مادة تقشير بعناية فائقة مع تعليمات مشددة لتركيزات أعلى أكثر التي تحتوي على حامض Salicylic أيضا ، و AHA.
ذكرت في بعض الموارد العلمية ايضا اضافة الى العلاج بحامض Azalaic في الكتب  الطبية التي يمكن أن تضاف للمساعدة في علاج حب الشباب comedonal ، وكذلك إضافة مادة بنزيل بيروكسايد في النظام العلاجي.

العلاجات التي تتم في مكتب الأمراض الجلدية :
نبدأ بأشياء بسيطة مثل جلسات تنظيف البشرة لعلاج حب الشباب  بمواد طبية التي تستخرج  الرؤوس الكوميدونس من قبل أخصائية التجميل باستخدام البخار لفتح المسام والسماح للطرد  المكونات في الرؤوس بسهولة يدويا. ولا يجب أن يتم بقوة ، ثم تتنتهي بأقنعة خاصة مجففة حب الشباب.
ثم هنالك طرق لاستخراج الرؤوس السوداء والبيضاء comedonal التي يقوم بها طبيبة الامراض الجلدية بطريقة من نوع معين وأداة خاصة.
أخيرا جلسات التقشير الطبية ااشبة عميقة التيتساعد في الاستجابة للعلاجات المعطاة للمريض وهنالاك أنواع مختلفة من جلسلت التقشير في العيادة التي تحتوي على مكونات مختلفة ومجتمعة في بعضها. أساسها حمض الصفصاف ، AHA ، TCA. التي لابد من تطبيقها فقط من قبل الطبيب أو من قبل ممرضة مدربة تحت اشراف طبيب في العيادة.

 لدي دائما كلمة الأخيرة من المشورة للمرضى مع جميع  من يعانون برؤس الأبيض او الأسود هو أنه يجب أن تكون حذرة للغاية بما يوضع على بشرة وجوههم والمناطق المتضررة. يجب دائما التأكد من أن أي مستحضرات التجميل ، أو التي يمكن وضعه cosmecutical ماكياج ، مسحوق ، كريم ، ومحلول ، هلام السائل ، أو حتى الصابون لابد من وصفها بأنها "Non-Comedogenic" غير "،غير مسبب انسداد المسام " ، أو "غير مسبب لحب الشباب" "مكتوب بشكل واضح في العلب أو أنها لا ينبغي أن توضع على البشرة على الإطلاق ، وذلك لأن البشرة المعرضة comedonal حساس جدا للمستحضرات الموضعية ، إذا سميكة جدا ، أو غير مناسبة لنوع بشرتهم بعد ذلك يجعلهم عرضة لتطوير المزيد من الرؤوس السوداء أو البيضاء كوميدونس.

هكذا وصلت للردعلى هذا الجزء من السؤال : "رؤساء الأسود؟" سيتم  في النشر المقبل الرد على الجزء  "البشرة الدهنية؟".

أمل ان يكون هذا مفيدا. 

وهذه المدونة هي فقط لأغراض تعليمية. مشاكل الجلد بما فيها حب الشباب يجب أن يتم تقييمها أي كان نوعها من قبل الطبيب وذلك لجعل التشخيص السليم ثم التعامل وفقا لذلك.

أكتب إليكم في وقت قريب...

Friday, May 7, 2010

Q & A Tweets: "black heads?"

 
I get many questions on my Twitter account @DrLillian that I try to answer as much as possible. That brought me to the idea of these upcoming posts. I will start posting these Q & A's here on my blog as a reference to those micro-blogging posts as they are also great topics for this blog.

So here goes.. I'll start with one of the question that I received on twitter when I asked my followers on which topic they wanted me to talk about. This question was one of them "black heads and oily skin ?"
In this post I will discusses how to deal with black heads which is mostly in medical terms mean the term "comedones" they are either black or white. There is no difference in their treatment, it is basically the same unless there are pustules which will not be our discussion in this post. 

One of the common questions I get in my clinical practice is if there are pills that can get rid of them and my answer is that it mostly only responds to topical treatments that are "Comedolytics" which means dissolving of black or white heads (i.e, getting rid of them).  I will mention here what I found useful in my own practice and what I found to be effective. 

I will divide my treatment regimen into 3 categories:
1- Treatments you can find over the counter here in Jeddah, Saudi Arabia.
2- Prescribed treatments by a Dermatologist ( This is based according to a dermatological practice based in Saudi Arabia, in other countries it may differ)
3-Treatments that are done in a Cosmetic Medical Spa.

Over the counter (OTC) treatments:
There are some effective treatments that you can find in your local Hyper supermarkets like "Hyper Panda" and "Danoub" in the skin care and make up ails like Neutregena, Clean & Clear, and Clearasil are the most popular in the gulf region.
Most of these treatments if you look into their active ingredient its mostly based on "Salicylic Acid" in some concentrations up to 2% in the form of soap, gel washes, cream, and toners. Now salicylic acid is a good comedolytic but at the same time it has a drying effect on the skin when used too much.
Going into more things that are available OTC in pharmacies. They also usually contain Salicylic acid, AHA, and Glycolic acid. Which all have a comedolytic effect as well a s some level of superficial peeling. Some of these come as home treatment kits. Examples of these OTC's are Rexol, DDF skin care, NeoStrata, and Vichy.

Prescription topical black and white heads acne medications:
This is when its time to add a vitamin A derivative topical treatment, they help expulsion of present comedones and pervent formation of new ones. Which are adaplene (eg, differen) , isotretinoin (eg, Isotrexine), and tretinoin (eg, Retin A). Their disturbing side effect that makes most patient find it unpleasant to continue with it, is its initial irritation effect on the skin with flaking, redness and in some cases slight burning sensation. These side effects usually last 3-4 weeks, then the skin adapts to it and becomes less irritated when applied.
Again we can use comediolytics such as peeling agent very carefully with strict instructions to higher concentrations more than OTC also containing Salicylic acid, and AHA.
Azalaic acid has been mentioned in textbooks which can be added to help with comedonal acne treatment, and well as adding benzyl peroxide in the regimen has been reported to help.

Treatments that are done in a dermatological office:
Ill start with simple things like acne treatment medical spa facials which extracts comedones by a specialized beautician with application of steam to open up the pores and allow easy expulsion manually. It shouldn't be done forceful, then its finished with special drying masks.
Then there is the comedonal extraction procedure done by the dermatologist with a certain kind of technique and instrument.
lastly application of professional peels that fastens the response to the treatments given for the patient to apply at home. There are different types of professional peels containing different components and some are combined. Mainly they are salicylic acid, AHA, and TCA. Which has to be applied either by the doctor or by a trained nurse under the supervision of a doctor in the office.

My usual last word of advice to all my patients with black and white heads is that they have to be very careful with what they apply on their face and areas affected. They always have to make sure that any cosmetic, or cosmecutical which can be makeup, powder, cream, lotion, fluid, gel, or even soap has to be labeled as "Non comedogenic", "Non pore clogging", or "for acne prone skin" written on the box clearly or they shouldn't apply it at all, because comedonal prone skin is very sensitive to topical applications, if its too thick or not appropriate for their skin type then it makes them prone to develop more comedones.

With that I come to the conclusion of this part of the question "Black heads?" next post will be to answer the part of "Oily skin?".


Hope that this was helpful. There will an Arabic translation post on same topic in the next post.

This post is purely for educational purpose only. Any kind of skin problems including acne should be evaluated by a physician in order to make the proper diagnosis then treat accordingly. This I strongly advice.


Write to you soon...