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The rapidly growing field of nanotechnology and its future use in cosmetic products holds both enormous potential and potential concern for consumers. Currently, major cosmetic manufacturers have imposed a voluntary ban on the use of nanoparticles in products while they await a ruling from the Food and Drug Administration (FDA) regarding the safety of this technology. However, these manufacturers know that when ingredients in products such as sunscreens and anti-aging products are converted into nanosized particles, the end product displays unique properties that can benefit the skin in ways that otherwise could not be achieved using larger-sized particles.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Adnan Nasir, MD, PhD, FAAD, clinical assistant professor in the department of dermatology at the University of North Carolina in Chapel Hill, presented an overview of nanotechnology and how nanoparticles may eventually be used in cosmetic products.
“Research in the area of nanotechnology has increased significantly over the years, and I think there will be considerable growth in this area in the near future,” said Dr. Nasir. “The challenge is that a standard has not been set yet to evaluate the safety and efficacy of topical products that contain nanosized particles.”
Nanotechnology: On the Plus Side
Products incorporating nanotechnology are being developed and manufactured at an ever-growing rate, especially among clothing manufacturers that incorporate nanomaterials into fabrics to enhance stain and wrinkle resistance, and water repellence. However, Dr. Nasir explained that a substantial proportion of patents issued for nanotechnology-based discoveries are currently in the realm of cosmetic and consumer skin care products. In fact, the cosmetic industry leads all other industries in the number of patents for nanoparticles, which have the potential to enhance sunscreens, shampoos and conditioners, lipsticks, eye shadows, moisturizers, deodorants, after-shave products and perfumes.
One example of how nanoparticles are being considered for use is to improve some of the undesirable properties of skin care products. Dr. Nasir explained that when certain ingredients are included in micrometer-sized particles, which are considerably larger than nanosized particles, the result is a product than can be cosmetically unappealing.
For example, one common ingredient in broad-spectrum sunscreens, which protect the skin from both UVA and UVB rays, is avobenzone, which can make a sunscreen greasy and very noticeable when applied to the skin. Since titanium, another common sunscreen ingredient, requires an oily mixture to dissolve, a white residue can be apparent on the skin upon application. However, when these active ingredients in sunscreens are converted into nanoparticles, they can be suspended in less greasy formulations – which seem to vanish on the skin and do not leave a residue – while retaining their ability to block UVA and UVB light.
“While widespread use of this technology is currently under evaluation, I think one of the main benefits of nanoparticles used in sunscreens will be that the particles can fit into all the nooks and crannies of the skin, packing more protection and more even coverage on the skin’s surface than microsized particles,” said Dr. Nasir. “Since sunscreen formulations using nanoparticles may be more cosmetically appealing and seem to vanish when applied, consumers may be more inclined to use them on a regular basis.”
Nanotechnology also is generating excitement for its potential use in anti-aging products. When properly engineered, nanomaterials may be able to topically deliver retinoids, antioxidants and drugs such as botulinum toxin or growth factors for rejuvenation of the skin in the future.
In anti-aging products, Dr. Nasir added that nanotechnology may allow active ingredients that would not normally penetrate the skin to be delivered to it. For example, vitamin C is an antioxidant that helps fight age-related skin damage which works best below the top layer of skin. In bulk form, vitamin C is not very stable and has difficulty penetrating the skin. However, in future formulations, nanotechnology may increase the stability of vitamin C and enhance its ability to penetrate the skin.
“Since anti-aging products that contain nanoparticles of antioxidants will be harder to make, we expect that these products will cost more than products using traditional formulations,” said Dr. Nasir. “Once these products are determined to be safe, the consumer will have to decide if the increased costs are worth the added benefits.”
Nanotechnology: Future Melanoma Treatment
Researchers also are reviewing the use of nanomaterials for the treatment of melanoma. In particular, gold, when turned into a nanomaterial called nanoshells, has been shown to be a useful treatment for melanoma in animal studies.
According to Dr. Nasir, gold nanoshells can be engineered to absorb specific wavelengths of light. If the wavelength of light unique to a particular type of gold nanoshell is used on it, the particle generates heat. In one animal study done at MD Anderson Cancer Center in Houston, investigators joined gold nanoshells with a molecule which homes to melanoma. When these gold nanoshells are injected into mice harboring melanoma, the nanoshells accumulate in the cancerous tissue. When mice are illuminated with the proper wavelength of light, their tumors, laden with gold nanoshells, heat up and are effectively killed. The surrounding tissue, which lacks targeted gold nanoshells, is unharmed.
“Nanotechnology holds promise for new non-invasive treatment methods, particularly for challenging dermatologic conditions, such as atopic dermatitis and ichthyosis,” said Dr. Nasir.
Nanotechnology: More Consumer Information Needed
Because the skin is the first point of contact and the first line of defense for newly manufactured nanomaterials, Dr. Nasir noted that many dermatologists have concerns about the potential health risks posed by nanotechnology. “Although nanotechnology is an exciting area that holds enormous potential,” said Dr. Nasir, “we anxiously await the FDA’s review of the safety of nanoparticles which will determine their future role in skin care products.”
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
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For the approximately 7.5 million Americans affected by psoriasis, the thick, red, scaly, itchy plaques it causes only scratch the surface when it comes to the overall implications of this disease. Now, ongoing research linking psoriasis to other serious medical conditions and the incredible toll it can take on a person’s overall quality of life are shifting the way psoriasis is viewed – from a common skin disease to a complex systemic condition.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Alan Menter, MD, FAAD, chair of the Psoriasis Research Unit at Baylor Research Institute in Dallas, addressed the need for psoriasis to be viewed as a serious disease affecting the whole body with significant quality of life issues.
“In the past, psoriasis was viewed primarily as a cosmetic nuisance that was not thought to extend beyond the obvious plaques apparent on the skin,” said Dr. Menter. “With the discovery of multiple genes related to psoriasis, a better understanding of the immune system responses involved in this disease, and the frequent associations with other serious diseases, we know that psoriasis is a much more complex disease that demands continual monitoring and evaluation by a dermatologist and, if necessary, other medical professionals to address related health issues.”
The Link between Psoriasis and Other Serious Medical Conditions
Over the years, multiple studies have found that psoriasis is associated with a number of potentially serious medical conditions, including cardiovascular disease, cancer and lymphoma, obesity and metabolic syndrome (also known as “Syndrome X”), autoimmune diseases (Crohn’s disease and diabetes mellitus I and II, for example), psychiatric diseases (such as depression and sexual dysfunction), psoriatic arthritis, sleep apnea, personal behavior issues, chronic obstructive pulmonary disease (COPD) and even increased mortality. Dr. Menter explained that the majority of these diseases can have a significant impact on a patient’s overall health and affect psoriasis patients in different degrees of severity.
“It is important to note that while we are unsure whether psoriasis causes other diseases or that these other diseases cause psoriasis, the fact that an association exists at all is critically important in treating psoriasis patients,” said Dr. Menter.
One recent observational study of 3,236 patients with psoriasis and 2,500 patients without psoriasis who served as the controls concluded that patients with psoriasis experienced an increased incidence of ischemic heart disease (where the blood vessels are blocked leading to the heart), cerebrovascular disease (where the blood vessels are blocked leading to the brain), and peripheral vascular disease (the obstruction of arteries in the arms and legs), and mortality.(1)
Another study examining the increased risk of mortality in psoriasis patients suggests that patients with severe psoriasis may have shorter life expectancies by an average of three to five years than individuals who are not affected by psoriasis. (2)
In addition, other studies have shown that psoriasis patients are more likely to consume excessive amounts of alcohol and cigarettes, both of which can negatively impact a psoriasis patient’s health. These detrimental behaviors can further aggravate other conditions associated with psoriasis, such as heart disease and COPD.
Impact on Quality of Life from Psoriasis Cannot be Underestimated
Since psoriasis is a chronic lifelong disease that needs to be controlled with a customized treatment regimen, the constant presence of psoriatic lesions
or unexpected flare-ups – at times when patients least expect it – can cause a considerable amount of stress and anxiety. In fact, psoriasis has long been known to cause considerable emotional stress for patients, including low self-esteem and feelings of rejection, introspection, weight gain, increased use of alcohol and tobacco, and depression (which in some cases can be severe).
Another study conducted by the National Psoriasis Foundation examining attitudes and beliefs about contagious diseases among the general population of young adults found that approximately one-third (36 percent) of those surveyed were unsure whether psoriasis was contagious. In addition, when asked their attitudes about dating and skin conditions, more than half (62 percent) of the respondents reported that they take the condition of a person’s skin into consideration when first asking someone out on a date. Dr. Menter added that the findings of this survey lend credence to the belief held by many psoriasis patients that their disease can have a negative impact on their personal lives and affect their interpersonal relationships.
“We cannot underestimate the complexity of psoriasis, particularly the psychological impact the disease can have on young people,” said Dr. Menter. “Even at a young age, psoriasis can affect a person’s relationships at home, work or school, and the disease can contribute to an overall poor body image that can be hard to reverse throughout life.”
Dr. Menter added that studies conducted regarding the effect of newer biologic medications, such as adalimumab, etanercept and infliximab, on psychiatric symptoms have shown that psoriasis patients may experience significant improvement in fatigue and other symptoms of depression. The newest biologic agent recently approved by the Food and Drug Administration (FDA), ustekinumab, also has been shown to improve sexual dysfunction in patients with moderate to severe psoriasis up to 10 fold.
“Although psoriasis is an incurable disease, it is controllable in the majority of cases with proper treatment,” said Dr. Menter. “Over the past several years, there have been a number of newer therapies introduced that are effective in
managing psoriasis, and a patient’s dermatologist can determine which therapy would work best to control each patient’s disease.”
To learn more about psoriasis, visit the PsoriasisNet section of www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of disorders of the skin, hair and nails.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
(1)Archives of Dermatology: Vol 145 (NO. 6), June 2009, Pages 700-703
(2)Archives of Dermatology: Vol 147 (NO. 12), December 2007, Pages 1,493-1,499.
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Acne and rosacea are two seemingly different skin conditions that have one important thing in common: both are chronic and extremely common skin conditions. However, dermatologists recommend that with proper diagnosis, treatment and a healthy dose of good, old-fashioned skin care, acne and rosacea can be less of a nuisance for patients.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Jenny J. Kim, MD, PhD, FAAD, associate professor of dermatology at the University of California, Los Angeles, (UCLA) David Geffen School of Medicine in Los Angeles, discussed the latest treatments for acne and rosacea and how ongoing research into the causes of these conditions holds promise for future therapies.
“Sometimes it is hard for patients dealing with acne or rosacea to understand why, even with ongoing treatment, they cannot get rid of their symptoms forever,” said Dr. Kim. “I explain to them that these conditions are similar to having any chronic disease, like having diabetes – there is no cure yet, but we can control the symptoms. Just like insulin helps maintain a diabetic’s blood sugar, patients with acne and rosacea need to find a treatment regimen that works for them to maintain clear skin.”
Acne: An Equal-Opportunity Skin Condition
It is estimated that 40 million to 50 million Americans are affected by some form of acne. While acne is commonly associated with teenagers struggling with the growing pains of adolescence, this skin condition can strike at any age. In fact, Dr. Kim emphasized that it affects adults in their 20s, 30s, 40s and even in their 50s, especially in women and even in people who never had acne as teenagers. The causes of acne include excess oil production, skin inflammation, skin cells in the hair follicles that shed too quickly and an increased number of the acne-causing bacteria Propionbacterium acnes. However, hormones also influence both oil production and the shedding of skin cells, thereby contributing to the formation of acne lesions. For example, when androgens (the male hormones present in both men and women) over-stimulate the oil glands and hair follicles in the skin, hormonal acne flares can occur.
In the past, most cases of acne were treated solely with antibiotics. While these treatments can be very successful, a growing concern about long-term antibiotic use is that bacteria are evolving to become resistant to these medications. As a result, the development of other effective therapies and combination therapies has evolved.
For example, Dr. Kim noted that some of the newer therapies for acne are anti-inflammatories, which can be used in some cases to lessen the severity of acne. Controlled-release of lower dose doxycycline is a newer anti-inflammatory oral medication that some dermatologists use to reduce the redness and swelling of acne. Combination therapies, which may include an anti-inflammatory and antimicrobial effects that can decrease resistance and are more convenient to use for patients, has made combination therapeutics increasingly common treatments used to manage acne.
Another newer approach to treating acne is the use of lasers and light-based technologies as a complementary treatment to traditional medical therapies. Dr. Kim noted that these technologies include the pulsed-dye laser, red and blue light, and photodynamic therapy, which target the sebaceous (or oil) glands and can reduce acne flares. While Dr. Kim does not recommend lasers and light-based technologies as first-line therapies for acne, she believes it is a promising new area of research.
“Patients are becoming increasingly concerned about the long-term use of oral medications to fight acne, so lasers and light sources appeal to them,” said Dr. Kim. “The problem is that there are limited large, prospective, well-controlled studies that demonstrate the effectiveness of laser and light technology at this point, so that will be
an area we need to explore in the future.” “It’s very likely that with the advancement in dermatologic research, we will see sebaceous gland targeting lasers in the future that will be effective for the treatment of acne.”
Dr. Kim added that many patients are concerned about scarring that can result from acne, and many acne scars can be very aggressive and difficult to treat. For mild scarring, retinoids, chemical peels, microdermabrasion, and lasers can give mild improvement. In addition, fillers can be used successfully to fill in depressed areas and improve the appearance of scars.
Another therapy that is approved by the Food and Drug Administration (FDA) for acne scarring is fractional laser resurfacing. This laser technology works by targeting damaged skin in columns of microscopic treatment zones, which include the outermost and underlying layers of skin known as the epidermis and the dermis. Fractional laser resurfacing thermally damages the tiny columns of scarred skin while the surrounding healthy skin is left intact.
“One of the main benefits of fractional resurfacing is wound healing and increased collagen production that reduces acne scars,” said Dr. Kim. “However, most patients will notice only a modest improvement in acne scarring and multiple treatments are required. For more severe scarring, such as deep ‘ice pick’ scars, several acne surgical procedures can be used – including punch grafting or punch excision – to remove, raise, fill or separate the scar tissue from the underlying skin. These surgical procedures in combination with other therapies, including lasers and fillers, can produce improvement for severe acne scarring.”
Rosacea Triggers and Treatments
Rosacea, another chronic skin condition, affects an estimated 14 million people in the United States and is characterized by redness, flushing and prominent blood vessels on the face. Dr. Kim explained that rosacea commonly occurs in older people, and there are many known triggers for this bothersome condition – including sunlight, alcohol, spicy foods, caffeine, heat, citric acid, and stress.
While the exact cause of rosacea is not fully understood, Dr. Kim noted that a recent study suggests that the presence of an abnormal peptide (a small protein) in the skin of rosacea patients may contribute to the disease.
“There is some evidence to suggest that the peptide cathelicidin within the skin is processed differently in rosacea patients than in individuals not affected by rosacea and induces inflammation that may contribute to rosacea,” explained Dr. Kim. “These findings are encouraging, as we can identify better treatments for the disease if we have a better understanding of what the cause might be.”
Over the years, lasers have been shown to be effective in treating the symptoms of rosacea. For example, Dr. Kim mentioned that pulsed-dye lasers work well for rosacea patients with lots of broken blood vessels, and both pulsed-dye laser and intense-pulsed light treatments are effective at treating redness on the face and flushing associated with rosacea.
“Patients undergoing laser therapy for rosacea will likely need multiple treatments. However, I have found lasers and light treatments to be very effective and produce long-lasting results,” said Dr. Kim.
In addition to oral treatments, a number of topical medications have been introduced to treat rosacea, and Dr. Kim explained that metronidazole and azeleic acid are two topicals that are tolerated well and effective in reducing the symptoms of rosacea.
Good Skin Care: Good for All
For patients with acne or rosacea whose skin is often sensitive, Dr. Kim emphasized that proper skin care is very important as part of their overall treatment regimen. In addition to avoiding products or behaviors that tend to make acne or rosacea worse, patients may find that gentle skin care can help alleviate some of the redness or irritation common with these conditions.
“I advise my patients to use a mild cleanser and sun protection that is non-irritating to the skin every day, particularly a moisturizer that contains sunscreen,” said Dr. Kim. “While skin care products containing too many acids can be irritating to sensitive skin, I find that products containing salicylic acid are useful for some acne patients. Separating treatments, such as using salicylic acid or benzoyl peroxide in the morning and a retinol-based product at night, might be helpful for patients with sensitive skin.”
Dr. Kim also noted that while over-the-counter products containing salicylic acid or benzoyl peroxide may help control mild acne, patients should avoid using too many products at once on their skin to try to manage acne.
“The old adage ‘less is more’ applies to patients with sensitive skin,” said Dr. Kim. “The best advice is to discuss your skin care regimen with your dermatologist who can recommend products based on not only your specific skin condition, but your individual skin type as well.”
To learn more about acne and rosacea, visit www.skincarephysicians.com, a Web site developed by dermatologists that provides patients with up-to-date information on the treatment and management of conditions of the skin, hair and nails.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
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If simply the thought of bedbugs, scabies and head lice makes you feel a little itchy, imagine how those affected by these common infestations feel when they learn what has been creeping around them and causing symptoms such as intense itching, red bite marks or irritated scalps. Even less comforting is the fact that some parasitic infestations are on the rise, and can strike adults and children in unsuspecting places.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Albert C. Yan, MD, FAAD, chief of dermatology at the Children’s Hospital of Philadelphia and associate professor in the departments of pediatrics and dermatology at the University of Pennsylvania, addressed the prevalence of bedbugs, scabies and head lice, and the latest treatments for the skin and hair problems they can cause for their unsuspecting prey.
Don’t Let the Bedbugs Bite: Infestations are on the Rise
In recent years, infestations of Cimex lectularius (commonly referred to as bedbugs) have become a significant health nuisance. These nocturnal, reddish-brown wingless insects are visible to the naked eye, measuring between 3-5 mm in size, have three pairs of legs and feed on blood. Dr. Yan reported that the increased incidence of bedbugs is likely due to a rise in international travel and the elimination of the pesticide DDT, which had been highly effective in destroying this insect. In fact, studies have shown that the resistance to currently available pesticides has contributed to a 500 percent increase in the population of bedbugs in the past few years alone.
“In the United States, bedbugs frequently infest hotels and homes and, once established, can spread rapidly and be difficult to eliminate,” said Dr. Yan. “For example, New York City reports hundreds of complaints of bedbug infestations every year, and these numbers have been steadily increasing. In addition, in two separate surveys of hotels done by extermination companies, reports have emerged indicating that 14 percent of hotel rooms and up to 25 percent of hotels show evidence of bedbug infestation.”
Bedbugs are hardy insects and can go as long as six to 12 months between feedings in times when their food supply is scarce. They commonly are found along the seams of mattresses or box springs, behind headboards, or in other small dark spaces. When bedbugs bite, people may experience intense itching that can be hard to relieve.
“About one-third of people bitten by bedbugs will develop juicy bite reactions that are often clustered in groups, which dermatologists refer to as a ‘breakfast, lunch and dinner’ pattern,” said Dr. Yan. “However, bedbugs have not thus far been associated with any serious health threats nor have there been any documented cases of diseases being transmitted from bedbugs.”
Dr. Yan noted that topical corticosteroids are effective in reducing the itching and redness of bedbug bites, and warm compresses applied directly to the bites can help ease itching.
To avoid bedbugs, it is recommended that individuals check their hotel room before unpacking, especially along the seam of the mattress and in the bed sheets and linens. Never put your suitcase on the floor and if you are using the luggage rack in the room, check it thoroughly for signs of bugs. Once home, wash or dry clean your items immediately and check your suitcase for any signs that you have brought the bugs back with you.
Itching for Relief from Scabies
Scabies is another common infestation caused by a tiny, round eight-legged mite that burrows in the skin and can cause intense itching. Little red bumps similar to hives, tiny bites or pimples usually appear with scabies and, in some cases, the skin can become crusty or scaly, especially between fingers and toes. Some people also can develop nodular lesions from a hypersensitivity reaction, which can be seen in the armpit or genital areas.
Dermatologists estimate that more than 300 million cases of scabies occur around the world every year, and it is easily transmitted from person to person by close contact. Although everyone is susceptible to scabies, crowded living conditions and poor hygiene are two of the most common associations.
“Dermatologists can diagnose scabies by doing a thorough examination of the patient, and sometimes the diagnosis can be confirmed by scraping the lesions to identify the scabies mites or its eggs,” said Dr. Yan. “Recently, use of epiluminescence microscopy (dermatoscopy) also has demonstrated good sensitivity for identifying mites by looking for a specific pattern that indicates the pigmented areas of mites, as well as looking for corroborating air bubbles associated with the mite’s presence.”
The gold standard treatment for scabies remains topical 5% permethrin cream for most patients who are three months old or older. For younger children or pregnant women, sulfur compounds in petrolatum can be effective in treating scabies. Dr. Yan added that the oral medication ivermectin also has been shown to be effective, particularly for resistant cases or those with extensive infestations, but should not be used for pregnant women or young children. New therapies on the horizon focusing on the use of terpineols and tea tree oil have shown promise in early studies.
Not having close skin-to-skin contact with someone who has scabies or with their personal items (such as clothes, towels, and brushes) will help avoid contracting the condition.
Head Lice: Treating Parasites That Go to Your Head
According to studies, 6 million to 12 million people a year suffer from head lice infestation, and it is estimated that more than $100 million is spent annually to combat this problem. Head lice tend to affect younger, school-aged children, and girls tend to get head lice more than boys due to their longer hairstyles.
The most common sign of head lice is an itchy scalp, and red bumps and small tears in the skin in the affected areas. Dr. Yan noted that close examination of the hair and scalp will show evidence of the egg casings (or nits) attached to the hair shafts, as well as live lice. The nits hatch within seven to 10 days and live about 30 days, during which they reproduce to spread the infestation.
Traditional treatments for head lice include the over-the-counter topical treatments permethrin and synthetic pyrethroids. However, Dr. Yan pointed out that resistance to standard pyrethroid treatments has become widespread and is well documented in the United States, the United Kingdom, Israel and the Czech Republic. In addition, one study found that patients using the standard instructions for both permethrin and synthetic pyrethroids – in which patients are instructed to leave the products on the hair for 10 minutes and then wash it out – only killed 5 to 7 percent of head lice.
To help children avoid lice, they should not share combs, brushes, hats, barrettes or any other personal care items with anyone else, regardless of whether they have lice or not. Also, it’s important to examine everyone in the household when there is a case of head lice, just to be sure that the bugs have not been transmitted.
“Due to the mounting resistance of head lice to traditional treatments, promising alternative therapies have emerged, including the use of trimethoprim-sulfamethoxazole combined with topical therapies, products that can suffocate the lice, and novel agents or devices that work to physically destroy the lice,” said Dr. Yan. “The specific alternative therapy used will depend in large part on the dermatologist’s assessment of the safety and efficacy of available therapies and the degree of infestation.”
Dr. Yan added that people who experience any unusual rashes, especially those accompanied by itching or inflammation, should consult their dermatologist for proper evaluation and treatment.
For more information about skin, hair and nail conditions that affect children, please visit the Academy’s new Web site www.KidsSkinHealth.org.
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
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According to projections from the United States Census Bureau, people with skin of color will comprise approximately half of the U.S. population by 2050. This group, which includes African-Americans, Asians, Latinos and other ethnicities, are more prone to certain dermatologic problems than those with lighter skin tones due to their genetic make-up and in some cases cultural practices. For that reason, dermatologists – who understand the nuances of different skin tones – are poised to help patients of color by diagnosing and treating these conditions.
Speaking today at the 68th Annual Meeting of the American Academy of Dermatology (Academy), dermatologist Andrew F. Alexis, MD, MPH, FAAD, assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons and staff member at St. Luke’s-Roosevelt Hospital Center, both in New York, discussed the leading medical and cosmetic dermatologic concerns in darker-skinned populations.
“Although people of color have more natural protection from ultraviolet (UV) radiation due to the increased amount of melanin in their skin, the cells that make melanin pigment tend to be more reactive to inflammation and injury, and therefore pigmentation problems are more common in skin of color,” said Dr. Alexis. “These natural genetic factors, coupled with cultural differences in their skin and hair care practices, can result in differences in the appearance of common dermatologic conditions and the frequency in which they can occur.”
Treating Pigmentation Disorders Takes Patience
The most common pigmentation problem (dyschromia) of the skin that can occur in people of color is post-inflammatory hyperpigmentation (PIH), which refers to increased pigmentation or dark spots at the sites of inflammation. Acne is one trigger for PIH, and the resulting dark spots often can be of equal or greater concern than the original pimples.
Dr. Alexis explained that although there are several effective treatments that can be used for PIH, none of these treatments are quick fixes and each requires time to take effect – from several weeks to several months in most cases. Common treatments include retinoid creams (vitamin A derivatives), bleaching creams (containing hydroquinone) and chemical peels.
“While in-office procedures, such as chemical peels or any skin resurfacing cosmetic treatment, can help correct pigmentation problems, they have to be administered with caution due to the higher risk of inducing other pigmentary abnormalities,” stated Dr. Alexis. “That’s why it is important to consult a dermatologist with an expertise not only in using these procedures, but in treating darker skin tones as well.”
Melasma, often referred to as the “mask of pregnancy,” is the second most common pigmentation problem occurring in skin of color patients. More women than men are affected by melasma, but the condition can occur independent of pregnancy and is commonly seen in people in their 40s, 50s and 60s. The cause of melasma is a combination of genetic and hormonal factors and UV exposure. Dr. Alexis added that melasma can be treated with the same topicals and in-office procedures used for PIH, and in some cases, lasers can be effective.
Since sun exposure can worsen dark spots, Dr. Alexis stressed that year-round sun protection is extremely important. “I recommend that my patients wear a moisturizer with sunscreen every day to protect their skin from further damage,” said Dr. Alexis.
Solving Hair Problems Can Require Changing Habits
One common follicular problem that affects a disproportionate number of dark-skinned patients, particularly African-Americans, is pseudofolliculitis barbae (also known as razor bumps). Dr. Alexis noted that several studies have reported that pseudofolliculitis barbae affects an estimated 45 to 83 percent of African-American men. The cause of this condition stems from the structure of the hair follicle, which is curved in people with skin of color. Pseudofolliculitis barbae is aggravated by shaving, as it can cause the sharp tip of shaved hair to grow back into the skin and results in a bump.
Dr. Alexis advises patients affected by pseudofolliculitis barbae to discuss ways to modify their shaving habits with their dermatologist. He also noted that there are several effective treatment options available. For example, lasers have evolved over the years and can now be safely used to reduce and remove hair in skin of color patients. Two lasers Dr. Alexis recommends for use with darker skin are the 810 nanometer (nm) diode laser and the 1064nm Nd:YAG laser. Topical creams and gels also are effective in treating pseudofolliculitis barbae, including topical retinoids, topical antibiotics, topical steroids and the topical prescription medication eflornithine.
“Women of color also can be affected by pseudofolliculitis barbae, as they often wax or shave unwanted hair on their chin and neck that can cause these bumps and skin discoloration,” said Dr. Alexis. “Many of these women are finding laser hair removal to be an effective treatment option for this problem.”
Hair loss is another dermatologic concern in patients with skin of color. Traction alopecia is a form of hair loss caused by hairstyles (such as braids) that put tension on the hair and is most common in African-American women. “The majority of cases of traction alopecia are reversible, but patients must be willing to style their hair differently to stop and reverse hair loss,” said Dr. Alexis. “Dermatologists also can administer injections of steroids into the affected areas, which we find can be quite effective if started early in the course of the condition.”
Another form of hair loss common in dark-skin individuals that can be more difficult to treat is central centrifugal cicatricial alopecia (CCCA). Although the cause of CCCA is unknown, it also is thought to be related to common hair care practices in African-American women. Often referred to as “hot comb alopecia”, this type of hair loss begins on the crown of the scalp and gradually spreads out to other areas of the scalp.
Dr. Alexis noted that once a hair follicle is scarred, it cannot produce hair any longer, but if caught early, hair loss can be treated with a variety of anti-inflammatory therapies, including injections into the affected areas of the scalp, topical steroids and oral antibiotics. Dr. Alexis added that minoxidil can be used in conjunction with anti-inflammatories to try to stimulate hair growth in healthy hair follicles.
Reversing Cosmetic Dermatologic Concerns Can Be Done Safely
Dr. Alexis explained that the water content of the skin decreases with age, especially when people enter their 60s. For people of color, this change in the water content of their skin can create an ashen look if they do not use moisturizers to help counteract the water loss. Other changes in the skin include textural irregularities, such as roughness, enlarged pores and dullness.
To help reverse some of these telltale signs of aging in darker-skinned individuals, a variety of topicals and non-invasive procedures can be used safely and effectively – including retinoids and other cosmeceuticals, chemical peels, and non-ablative laser resurfacing. Fillers can be used to correct nasolabial folds (lines around the mouth) and botulinum toxin is effective in softening wrinkles.
“It is important to note that injections of both fillers and botulinum toxin can be performed safely in darker-skinned patients, and these procedures are increasing in popularity with these patients to address aging skin,” said Dr. Alexis.
Another skin condition that is common in African-American patients as they age is dermatoses papulosa nigra (DPNs), also referred to as flesh moles. These small, brown moles are especially common in the cheek area and can be removed by a dermatologist who carefully will remove these skin growths to minimize any injury to the skin.
“While people of color are prone to many unique medical and cosmetic skin conditions, dermatologists are well equipped to treat them using a variety of safe and effective treatment options,” said Dr. Alexis. “The key is to seek treatment early.”
Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM (3376) or www.aad.org.
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Dr. Simon Ourian, Medical Director of Epione Medical Corporation, revealed his method for determining the physical age of a client’s skin. By using a special machine, he can examine data from a number of different readouts to tell the client exactly how much skin damage they have suffered.
According to Dr. Ourian the Complexion Analysis System shows “more detailed specifications of aging.” The system can detect early stages of discoloration, UV ray damage, fine lines, and even enlarging pores. By using this data in combination with his extensive training and experience, Dr. Ourian can give patients valuable information on the health of their skin. “I look at the textural changes which shows me if a person is getting hollowness in their face…so I use all this information…that helps me with determining with how I’m going to address a person’s aging,” he said.
Indeed, many clients discover that the physical age of their skin is often much older than their chronological age. For some, the difference can be as much as ten years. Some are sun worshipers from years past; some have medical conditions that cause damage, while others have merely neglected to take care of their skin as they should. Clients come in all ages, shapes, sizes and colors.
Dr. Ourian points out that avoiding skin damage is fairly simple at its core. Wearing sun block daily, no matter what the melanin count or weather is, is mandatory. Staying out of the sun is very important, since sun block can only provide a limited amount of protection. Lastly, large hats and long sleeves help shield the skin from UV rays.
Once the damage has been identified, the next phase is treatment. Dr. Ourian has options for his patients, such as dermal filler injections with Radiesse or Juvéderm to get rid of hollows under the eyes and Coolaser laser resurfacing treatments to get rid of fine lines and wrinkles. Laser resurfacing before and after photos and laser resurfacing side effects information can be found on www.epione.com.
The cosmetic procedures recommended by Dr. Ourian are very popular due to their swift results. “If you have a lot of sun damage and discolorations on your skin the best treatment that we have found is a Coolaser or a fractional laser that removes the top layer of the skin and gives you brand new baby skin,” he said. Both procedures target the damaged areas only, which allows skin to heal much faster than previous laser treatments. The procedures also take very little time; many of them can be done during a lunch hour, with little to no visible scarring or side effects.
Epione offers a free consultation including an evaluation with the Complexion Analysis System. Radiesse before and after photos and Juvéderm before and after photos can be seen on www.epione.com. Information on Radiesse side effects and Juvéderm side effects can also be found there.
Epione Medical Corporation, located in Beverly Hills Golden Triangle, is among the most comprehensive and state-of-the-art laser and aesthetic surgery centers. Dr. Ourian has been a pioneer for laser technology and non-invasive aesthetic procedures including Restylane, BOTOX, Juvéderm, Radiesse and Sculptra. These treatments are used for correction or reversal of a variety of conditions such as acne, acne scars, acne scar removal, skin discoloration, lip enhancement, wrinkles, stretch marks, varicose veins, cellulite, and tens of others. Laser hair removal and laser tattoo removal are offered too. Epione also carries Doctor Ourian’s Signature Series skin care products. For further information please contact 310-271-6506 or visit: www.epione.com.
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Did you know that one in five children suffer from eczema? Paediatric research has confirmed that a new born baby’s skin is 5 times thinner than an adult therefore making a baby’s skin more prone to dryness and irritation which can lead to eczema.
Finding an easy and cost effective therapy you can implement into your baby’s daily skin care routine is often not as easy as it seems.
Walk down the aisle of any supermarket, chemist or baby boutique and the choice in skincare is overwhelming. You are inundated with soap, shampoo, moisturising lotions, creams, ointments, bubble bath, bath oil, powders – the list is endless. And while there are good, natural, organic options available, there are limited products available that are also free from essential oils.
Until now
Available from April 2010 - Nature Within has a divine range of unscented, natural, organic skin care specifically developed for baby’s sensitive skin.
Created by Queensland aromatherapist and mother of two children with eczema, Nadine Hall
“My daughter’s skin was so sensitive, even the mildest essential oils would irritate her skin. I also found that by applying a rich moisturiser which I had formulated using Shea Butter, Avocado and Vitamin B5 to her skin 3 times a day, reduced the number and severity of her eczema outbreaks”. Nadine explains
Nadine noticed that most of the baby products on the market tailored to sensitive skin contained essential oils or synthetic fragrances. “babies’ under 3 months should have a very simple skincare routine and shouldn’t use products containing essential oils”. Nadine explains
Over 3 years Nadine researched this growing problem in children and developed a range of skin care that is Ph balanced and contained hypoallergenic ingredients rich in essential fatty acids, vitamins and minerals to soften, soothe and protect baby’s skin while being completely unscented.
Future products due for release in May will include the much anticipated TGA listed Soothing, Moisturising Eczema Cream and some beautiful Bamboo & Organic Cotton Rompers that are wonderfully silky soft on baby’s skin.
Nature Within products are free from the following:
- Artificial colours, fragrances and essential oils
- Petrochemicals and mineral oils
- Sulphate surfactants and paraben preservatives
- Pesticides and fertilizers
The products are not tested on animals and only recyclable packaging is used.
Nature Within – Keeping baby skincare simple
Nature Within Product Range
Baby Bath & Hair Cleanser 250ml – RRP: $15.99
This gentle low foaming, Ph balanced, fragrance free blend is specially formulated to cleanse and nurture your baby’s skin and hair using a nourishing blend of certified organic Avocado, Evening Primrose oils and Aloe Vera.
Suitable for sensitive, dry, itchy and eczema prone skin
Baby Body Moisturiser 200ml – RRP: $18.99
A nourishing blend of certified organic shea butter and avocado oil, combined with the nurturing properties of calendula and evening primrose, this rich moisturiser will leave your baby’s skin feeling simply divine.
Suitable for sensitive, dry, itchy, and eczema prone skin
For best results use within 2-5 minutes of baby’s bath to help protect baby’s skin from moisture loss.
Baby Bottom & Barrier Balm 50gm – RRP: $13.99
A rich nourishing balm of Shea butter, beeswax, calendula and vitamin E will provide a light barrier and protect and soothe little bottoms.
Suitable for nappy rash and cradle cap
Baby Bath & Massage Oil 125ml – RRP: $16.99
Specially formulated with a rich blend of Apricot Kernel and Safflower Oil combined with the skin softening properties of calendula, evening primrose oil and vitamin E this blend will ensure your baby’s next massage is sheer bliss.
Suitable for sensitive, dry, itchy, and eczema prone skin
Tip: To help the oil disperse in bath water add an equal amount of full cream milk to the water.
Beautiful Baby Gift Pack – RRP: $59.00
This gorgeous pack is the perfect gift for the new baby and contains:
1 x 250ml Baby Bath & Hair Cleanser
1 x 200ml Baby Moisturiser
1 x 50gm Baby Bottom
1 x 125ml Baby Massage & Bath Blend
Web: www.naturewithin.com.au.
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