Superficial Chemical Peels

Chemical peeling is emerging as one of the most effective ways to combat skin aging. Chemical peels are one of the most frequently performed aesthetic procedures in North America. Its popularity continues to grow because of the versatility of conditions where chemical peels are of significant benefit. In addition to the topical preparations such as over-the-counter and prescription creams, chemical peels are one of the earliest forms of treatment adopted by many patients. At the same time, there is much confusion and misunderstanding surrounding chemical peels that prevents more of us from enjoying their undeniable benefits. Let’s go through the important facts about chemical peels and their uses in modern skin care regimens.

Categories of Chemical Peels:

1. Superficial chemical peels:

Broadly speaking, chemical peels can be divided into several categories based on the depth of penetration in the skin. Superficial chemical peels create an injury to the epidermis - the outermost layer of the skin. As such, they are recommended for the treatment of skin conditions that primarily affect the epidermis. Conditions such as acne, actinic keratosis, superficial (epidermal) melasma, mottled skin pigmentation, superficial wrinkling as well as mild photo-damage can greatly benefit from properly selected and applied superficial chemical peels.

* AHAs

Some of the most common examples of superficial chemical peels include a variety of alpha-hydroxy acids
(AHA,) salicylic acid as well as low concentration trichloroacetic acid (10% - 25%.) The most commonly used superficial chemical peels are members of AHA. Alpha-hydroxy acids is a group of compounds derived from food products including glycolic (from sugar cane,) lactic (from sour milk,) malic (from apples,) citric (from fruits) and tartaric acid (from grape wine.) Glycolic acid (GA) is a clear winner amongst the AHA as its small molecular weight allows it to penetrate into the skin and exert its influence on living and non-living (outermost layer) cells. These properties account for the popularity of this product in both cosmetic as well as medical preparations.

In low concentrations, 5 - 10%, GA reduces cell adhesion in the top layer of the skin. This action promotes exfoliation of the outermost layer of the skin accounting for smother texture following regular use of topical GA. This relatively low concentration of GA lends itself to daily personal use as a monotherapy or a part of a broader skin care management for such conditions as acne, photodamage, wrinkling as well as selected cases of melasma.

In higher concentrations, between 10 and 50%, the benefits of GA are more pronounced but are limited to temporary skin smoothing without much long lasting results. This is still a useful concentration to use as it can prepare the skin for more efficacious GA concentrations (50 - 70%) as well as prime the skin for deeper chemical peels such as higher concentration trichloroacetic acid.

At higher concentrations, 50 - 70% applied for 3 to 8 minutes under the supervision of a physician, GA promotes separation between the cells and can be used to treat acne, photodamage (such as mottled dyspigmentation, superficial melasma or fine wrinkles) as well as superficial scars. The benefits from such short contact application depend on the pH of the solution (the more acidic the product [lower pH,] the more pronounced the results,) the concentration of GA (higher concentrations produce more vigorous response,) the length of application and prior skin conditioning such as prior use of topical vitamin A acid products. Although single application of 50 - 70% GA will produce beneficial results, multiple treatments every 2 to 4 weeks are required for optimal results.

* Salicylic Acid

Salicylic acid is a member of beta-hydroxy acid group. Because of its improved lipid solubility compared to the AG, it is particularly effective in the treatment of acne. In addition, it is not as inflammatory and some physicians use it extensively for the treatment of melasma. Low concentration trichloroacetic acid (10% - 25%) can also be used to treat the conditions affecting superficial epidermis but its use is limited to experienced physicians as more detailed patient selection and application care is required. As such, physician supervision is required for all peels except low concentration glycolic acid (up to 35%) and salicylic acid peels (below 20%.) This precaution is necessary to prevent inadvertent worsening of the skin condition as well as scarring.

Although in some instances only one superficial peel can accomplish desired effects, in most cases a series of peels is recommended to achieve optimal results. Superficial peels are an excellent way to introduce oneself to the rejuvenating power of these common aesthetic procedures. Done properly and with care, superficial peels are very safe treatment options for some of the most common conditions affecting facial skin.

It is important to understand that superficial chemical peels are peels with similar risks and side effects as other peels. Some of the side effects of superficial chemical peeling can include hyper- or hypo-pigmentation, persistent redness, scaring as well as flare up of facial herpes infections (”cold sores”). Caution needs to be exercised with some patients, particularly those suffering from rosacea or eczema. These patients are prone to skin irritation and even the mildest peels can cause injury to the skin. Fortunately, in most instances, such injury can resolve with time and optimal skin care. In cases of melasma, extreme caution needs to be taken, as it is possible to worsen this common and unforgiving skin condition. Any significant redness of the skin must be avoided.

Author: Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Non-Comedogenic Cosmetics

Non-comedogenic cosmetics are products which have been tested on the oily skins of human volunteers or inside
rabbit ears. These products are less likely to cause blackheads (open comedones) or whiteheads (closed comedones) in patients. However, no single product is non-comedogenic for everyone.

For example, a person with very oily skin may still get skin breakouts from products that another person with mildly oily skin may find non-comedogenic. A better term may be non-acnegenic rather than non-comedogenic, but this is not so widely used. It is important to test a new product on your own skin rather than rely on the label, before using it freely.

Moisturizers:
There are moisturizers labeled oil-free which have a very thin consistency. These have been tested in old animal models and have been proven to be oil-free. Most people who are acne-prone or who have oily skin do not even need these products. There are moisturizers labeled non-comedogenic which are usually thicker than the oil-free products, these may
be suitable when the ambient humidity is dry. When the patient is exercising or if the air is hot and humid, these moisturizers may be comedogenic.

Cleansers:

There are some products, which are suitable for oily skin, most liquid cleansers are not as helpful for oily skin as bar soaps or synthetic detergents. Some deodorant soaps or cleansers may be helpful for oily skin. Care must be taken not to over dry the skin with a strong cleanser for fear that the skin will re-bound with extra oil. Often a good gentle face bar soap, or gentle cleansers such as will be more likely to allow for patient satisfaction.

When the patient actually has acne and not just oily skin, many acne cleansers are available and many companies have cleansers made specifically for acne. There are benzoyl peroxide cleansers in the form of 5 and 10 % bar soaps and liquid cleansers, which are very effective in controlling acne breakouts.

Foundations:
Foundations for acne prone skin are often formulated to be like a shake lotion the color contents settle on the bottom while the opaque or clear solution is on the top. The bottle is shaken before the foundation is applied, these are the least elegant oil free cosmetics. Most foundations remain mixed together but are not heavy or thick. It is not necessary to have poor coverage in foundations for oily or acne prone skin. Titanium dioxide is the ingredient which allows for better coverage, and that ingredient is not oily, varying amounts of starch and kaolin will thicken up the products without causing acne.

For those who actually have acne prone skin, the addition of 1-2% salicylic acid may be partially therapeutic. For patients who need a blotter for the excess oil in their skin, extra amounts of starch, kaolin, and polymers which absorb sebum may be added.

Sunscreens:
The active ingredients of sunscreens UVB blockers such as Cinnamates, Octocrylene, Salicylates, and UVA blockers such as Benzophenones, Parsol 1789 (avobenzone), micronized zinc or titanium dioxide, are not themselves comedogenic. These ingredients can be incorporated into foundations, non-comedogenic moisturizers, and oil-free bases. The least comedogenic sunscreens are usually formulated into gel formulations.

Moisturizers - Are they really needed?

The truth is that moisturizers are a growing component of daily skin care and account for one of the most common over the counter products sold in the world.

This growth is partly due to the fact that what started as a simple moisturizer has become a sophisticated vehicle for delivery of complex nourishment and regulatory molecules to the skin.

The moisturizers are mostly used for one of the following reasons:

1. To repair the skin’s ability to provide effective barrier against outside pollutants, toxins, bacteria, viruses, fungi and to prevent the essential components of our skin and tissues from escaping our bodies.
2. To increase the water content of the skin in both dermis and epidermis.
3. To reduce skin vulnerability against trans-epidermal (through the skin) water loss.
4. To rebalance the skin’s composition of lipids (fats) both inside and outside the skin cells.
5. To deliver nutrients and regulatory substances to the viable portion of the dermis and epidermis.

The anatomy of most moisturizers encompasses at least one of the following components: emollients, occlusive agents, humectants as swell as additives designed to add extra benefits to the traditional functions of the moisturizers.

Emollients improve the visual aspect of the skin by sealing the tiny splits between the components of stratum Occlusive agents block trans-epidermal water loss. Because of the powerful occlusive properties, these agents have to be used carefully on the face as acne related to the use of cosmetics can result. Humectants are designed to attract water either from the environment or from the underlying dermis to the epidermis.

The era of newer, much more sophisticated moisturizers is upon us where scientifically formulated delivery systems can offer additive benefits of supplementing and modulating skin cells for their optimal function and differentiation. As such, these new moisturizers offer a cutting edge frontier where therapeutic benefits are combined with the moisturizing qualities of topical products. Vitamins, minerals, growth factors, peptides, enzymes and co-enzymes are some of the few categories of molecules currently in use in the latest fight to prevent skin deterioration and optimize its functioning.

About the author:
Mariusz J. A. Sapijaszko, MD FRCPC is the Director of the Western Canada Dermatology Institute located in Edmonton, Alberta. He is also the Clinical Assistant Professor at the Division of Dermatology, University of Alberta, in Edmonton. His areas of expertise include cosmetic and laser surgery.

Skin Care Myths (part2)

According to leading dermatologists, most of the cosmetic and skin care information out there is misleading. For example, do you buy into any of these common beauty myths?

Myth #4:

Pure soap is good for sensitive skin. Any product that vigorously suds and foams contain detergents, a strict no-no for dry skin. The best-known example is a certain soap, marketed with the buzz phrase “so pure it floats.” Advertising featured pictures of delicate babies and fair-skinned blonde-haired people, along with the recommendation that since it was “pure, and fragrance free,” it was designed “for sensitive skin.” Read more

Benzoyl Peroxide and Tretinoin

When applying antiacne drugs to the skin, people should be careful not to get the medicine in the eyes, mouth, or inside the nose. They should not put the medicine on skin that is wind burned, sunburned, or irritated, and not apply it to open wounds.

Because antiacne drugs such as benzoyl peroxide and tretinoin irritate the skin slightly, users should avoid doing anything that might cause further irritation. They should wash the face with mild soap and water only two or three times a day, unless the physician says to wash it more often. They should also avoid using abrasive soaps or cleansers and products that might dry the skin or make it peel, such as medicated cosmetics, cleansers that contain alcohol, or other acne products that contain resorcinol, sulfur, or salicylic acid.

If benzoyl peroxide or tretinoin make the skin too red or too dry or cause too much peeling, the user should check with a physician. Using the medicine less often or using a weaker strength may be necessary. Benzoyl peroxide can irritate the skin of people with skin of color and cause darkened spots called hyperpigmentation on the skin. Benzoyl peroxide may discolor hair or colored fabrics.

ORAL DRUGS. Oral antibiotics are taken daily for two to four months. The drugs used include tetracycline, erythromycin, minocycline (Minocin), doxycycline, clindamycin (Cleocin), and trimethoprim-sulfamethoxazole (Bactrim, Septra). Possible side effects include allergic reactions, stomach upset, vaginal yeast infections, dizziness, and tooth discoloration.

The goal of treating moderate acne is to decrease inflammation and prevent new comedones from forming. One effective treatment is topical tretinoin, used along with a topical or oral antibiotic. A combination of topical benzoyl peroxide and erythromycin is also very effective. Improvement is normally seen within four to six weeks, but treatment is maintained for at least two to four months.

Special Conditions

People who have certain medical conditions or who are taking certain other medicines may have problems if they use antiacne drugs. Before using these products, the physician should be informed about any of the following conditions.

ALLERGIES. Anyone who has had unusual reactions to etretinate, isotretinoin, tretinoin, vitamin A preparations, or benzoyl peroxide in the past should let the physician know before using an antiacne drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.

PREGNANCY. Teens who are pregnant or who may become pregnant should check with a physician before using tretinoin or benzoyl peroxide. Isotretinoin causes birth defects in humans and must not be used during pregnancy.

OTHER MEDICAL CONDITIONS. Before using antiacne drugs applied to the skin, people with any of these medical problems should make sure their physicians are aware of their conditions:
• Eczema. Antiacne drugs that are applied to the skin may make this condition worse.
• Sunburn or raw skin. Antiacne drugs that are applied to the skin may increase the pain and irritation of these conditions.

In people with certain medical conditions, isotretinoin may increase the amount of triglyceride (a fatty-substance) in the blood. This may lead to heart or blood vessel problems. Before using isotretinoin, adolescents with any of the following medical problems should make sure their physicians are aware of their conditions:

• alcoholism or heavy drinking, currently or in the past
• diabetes or family history of diabetes (Isotretinoin may change blood sugar levels.)
• family history of high triglyceride levels in the blood
• severe weight problems

Using antiacne drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.

Home Toner Recipes

Blueberry Toner
Make this mask the day you plan to use it, and do not store.

3 tablespoons steamed, crushed blueberries
1/2 C. sour cream or plain yogurt
Purée ingredients in a blender at low speed until well mixed and fluffy. Apply to face and neck.  Let penetrate for 15-20 minutes. Rinse off with tepid water.  If you find the mask is too runny after blending, you should refrigerate for one hour or until of the consistency you desire.

ALMOND FACIAL MILK
The herbal waters are antiseptic and toning. Grapefruit seed extract is available in health food stores, and is included in the recipe as a preservative.
•    1/2 cup rose, lavender, or distilled water
•    1 teaspoon pure vegetable glycerin
•    1/4 to 1 teaspoon cold pressed organic almond oil
•    12 drops grapefruit seed extract
Make the rose or lavender water by placing a small handful of dried organic rose petals or lavender in a pint mason jar and adding boiling water to cover. Let steep overnight, then thoroughly strain. Combine the remaining ingredients in a glass jar and shake to blend. Dab some on your fingers or a cotton ball and massage into your skin. Rinse with warm water. Keep stored in the refrigerator for no more than a month or so. Discard at the first sign of mold.

Apple Face & Neck Gelee

Yield: Approx. 2 applications
Ingredients:
4 teaspoons hot distilled water
1 teaspoon freshly juiced apple juice
1 teaspoon aloe vera gel
4 teaspoons vegetable glycerin
1 heaping teaspoon powdered pectin

Add the glycerin to the water/juice/gel combination and stir to fully incorporate.  Add the pectin while the liquid remains quite warm (if it cools, place it in the microwave or a double boiler to raise the temperature) and use a hand held electric mixer to blend, or stir vigorously to dissolve the pectin. Once the pectin has fully dissolved, a light gel will begin to form. This may take from 15 minutes to 1/2 hour. Once the gel sets, Apple Face & Neck Gelee is ready to use. Apply the gel in a layer to your clean, damp face and neck. Rest for 15 minutes. Rinse with warm water and follow with a light moisturizer if desired. Leftover product can be stored in the refrigerator for about a week. Enjoy!! The shelf life of this product is necessarily limited by the fresh apple juice. It should be used within a few days after it is made.

APPLE SKIN TONER

Intended for slightly oily skins, we’re told by our skincare team that Apple Toner is an excellent substitute for rubbing alcohol (a real no-no, as it actually stimulates the oil glands to produce more oil).
Combine 2/3 cup witch hazel,
1/3 cup of apple cider vinegar,
and several drops of Lavender Essential Oil (or essential oil of your choice).

Mix, and add to clean bottle. Shake bottle well before using, and then dampen a cotton ball or pad saturated with your toner, and swab over face. Witch hazel is a gentle astringent, apple cider vinegar will help restore your skin’s natural ph balance, and lavender soothes sensitive skin.

BASIL ACNE TONIC

Basil is known for its “soothing and toning” properties.
2 to 3 teaspoons dried basil leaves
1 C. boiling water
Steep basil leaves in water for 10 to 20 minutes. Cool, then apply to face with a white cotton ball.   Keep tonic refrigerated.  Recommended shelf life: 90 days.

Skin Care for Men

When men start buying skin care products, they may not pay much attention to the ingredients of the product in front of them. Men have been known to glance over the shelves and read general features, such as “anti-aging,” “no more wrinkles”, “bye bye greasy skin” and think that is all they need to know. While these “advertising tags” are beneficial to help pick a skincare product, in recent years another more prominent skin care feature is gaining attention, “organic product.”

Organic skin care or natural skin care refers to the use of all-natural ingredients to take care of our skin. These products are generally made of more than one type of herbs and seeds, that combined are able to bring the same results as a chemical based products. Organic lifestyles and the rediscovery of ancient herbs are making organic skin care increasingly popular in men skin care products, and have put chemical based products under the spotlight.

Chemical skin care became popular thanks to its sometimes incredible results in correcting skin problems. In addition, that was the reason they had a higher price too. However, as years had passed, medical investigations had shown that some of these components are not safe. Components such as Aluminum, Propulene Glycol and Imidazolidinyl urea, have been proved to be harmful to people. Their effects include links with breast cancer, contact dermatitis, ototoxicity, kidney damage and more. Most of the products with these components have been banned, but there are some that not, even with all the research to back that up. There may be also other components not YET found harmful.

Unfortunately, men are in contact with many of these chemicals on a more regular basis than women, due to higher instances of exposure at work or industrial areas. An average woman uses 12 beauty products a day, this adds up 168 chemicals!However, with all that, consumers shouldn’t rely so blindly in organic skin care without more personal experience.

Organic products are notoriously under-regulated and some of these so-called “all-natural” products can contain manufactured chemicals, and chemical processes to blend the components. The best advice here is to know what you are using. Be well informed, once your skin is damaged it is much more difficult to repair it than prevent the damage in the first place. You may think if you are a man, your skin is tougher, but that is not true. Facial skin is more sensitive in men due to constant bad shaving habits. Do a search on Internet
for the ingredients on the product you are about to buy and if possible ask a doctor for advice.

Skin Care Myths (part1)

According to leading dermatologists, most of the cosmetic and skin care information out there is misleading. For example, do you buy into any of these common beauty myths?

Myth # 1: The way find the right skin care product is by buying many different products until you find one that works for you (if you are lucky). Actually, this approach works well for the cosmetics industry, but it’s not so good for you, unless you happen to have loads of money, tons of free time, and a desire to experiment on your skin. Yet, that’s the way most people purchase skin care products and services. Without knowing your skin type and being directed to the range of products that work well for it, you are at the mercy of marketers and advertisers.

Because of the way that they are regulated by the FDA, cosmetic companies cannot lay claim to any biological activity - meaning they can’t say a cream will repair your wrinkles. If they did, their products would be regulated as drugs, with costly clinical trials needed to validate their claims. Instead, they make vague marketing statements. No wonder people are confused. However, a dermatologist can reveal the biological effects of different products to cut through the hype.

Myth #2: The more expensive a product, the better it will work.
What does the high price tag on that designer skin cream buy you? Not the ingredients in the bottle. Instead, most often you are footing the bill for the marketing and bottling of that product. In fact, if tomorrow someone invented the world’s best skin cream, they could sell the rights to market it to different segments of the skin care marketplace, and very likely the only difference between the drugstore item, the department store brandname version, and the special edition sold by dermatologists would be - you guessed it - the packaging and price. However, the creams contained therein could well be absolutely identical. Maybe some day, the high-end lines will really be worth the extra expense because they are packed with ingredients that can deliver real results.

Myth #3: Fragrance-free products contain no perfume or fragrance.
People with sensitive skin often buy products with this misleading labeling, hoping to avoid ingredients they react to. “Fragrance-free” is no guarantee that the product does not contain perfumes or fragrances. It means that no fragrance is detectable by the average person’s sense of smell. In fact, fragrances are added to most face creams to neutralize their bad odor. Have you ever noticed that your old makeup foundation smells funny? That’s because over time the fragrances evaporate, leaving the unpleasant smell unmasked. For most people, this doesn’t matter so much, but if you have sensitive skin, you may need to find roducts completely free of these sensitizing ingredients.

Facial Toners

Alcohol-free Facial Toner

Facial toner should not be confused with astringent, which can strip the skin of its vital acid balance due to higher concentrations of alcohol. Alcohol-free toner helps to instantly restore the natural PH level of your skin. Toning is a step usually taken after cleansing and before moisturizing. It works best to help balance the skin, remove residual cleanser, clear the pores and soothe the skin.

“Alcohol-free facial toner is a vital transition between cleansing and treatment. The Vivoderm toner, for example, is enriched with minerals and natural herbal astringents to purify hydrate and normalize the skin. The grape seed and green tea extracts soothe and tone the skin preparing it to readily receive the maximum benefits of skin care to follow,” reports Dr. Noushin Adhami, Vice President of Vivoderm Laboratories.

Natural facial toner that combines herbal ingredients, like grape seed or green tea extract work more holistically than alcohol-based astringents. Grape seed contains “oligomeric proanthocyanidin” or OPCs showing medicinal and pharmacological properties against oxidative-caused cellular stress. Radical-scavenging effects have also been reported. The bioflavonoids in grape seed are water-soluble and have antioxidant and ‘adaptogenic’ or stress-resistant properties, which help defend against a number of negative environmental factors, including smoke, radiation and chemicals. Green tea extract has been reported act as a protective agent of skin from ultraviolet light.

What all this means is, in order to achieve optimal health, your skin needs sufficient blood supply, hydration, moisture, oxygen and thickness. The natural facial toner is also a complementary part of the anti-aging prevention tools. Facial toner should promote skin health and vitality by toning the skin and retaining the skin’s natural moisture.