Rosacea case study: Suzanne

Suzanne was diagnosed with rosacea over five years ago. Her dermatologist has her on a program of MetroCream®, which is a topical medication, and the oral antibiotic tetracycline. She has tried to go off each medication separately, but whenever she does, the rosacea returns almost worse than before. She called to ask me where in her skin care program should she apply her MetroCream—before or after her moisturizer?

Whenever you are incorporating topical medications into your regular skin care regime, you want to get the medication on your skin first before you put your moisturizing cream on. If you put the medication over your moisturizer, it will have less contact with your actual skin. So the order of Suzanne’s product application would be:

• Cleanse with her regular milky cleanser
• Apply MetroCream and let it settle on her skin
• Next, use her spray-on toner
• And finally apply her moisturizer last 
• If she is going to be outside, sunscreen is a must due to her rosacea, which goes on over her moisturizer (or, for oilier skins, sunscreen can be your moisturizer for day) 

I wondered why Suzanne had been on an tetracycline for five years. She did question her doctor about the long-term use of this medication, and he told her it was OK to take these low-dose antibiotics even over a long period of time. My question to the doctor is how long can or should she take them? Forever? Was the dermatologist ever going to end Suzanne’s use of tetracycline? In the meantime, I highly recommended she start taking acidophilus to help her colon increase the healthy bacteria that had no doubt been affected from all those years of oral antibiotics.

I asked Suzanne if she knew her triggers (the foods and lifestyle habits) that caused her rosacea to flareup. She said, “Hot and cold, right?” Yes, extremes in temperature definitely exacerbate any redness in the skin and especially rosacea. But there is so much more to know about what causes your own rosacea to pronounce itself. I felt that if she could educate herself a bit more, she might be able to lessen the rosacea and potentially go off the oral antibiotics.

I encouraged her to read Rosacea: Your Self-Help Guide. There are several books on the subject, but this is the one I found most helpful. I asked Suzanne to stay in touch so I could track her progress and find out if she discovered anything new from reading the rosacea book.

For more information, see:

• Treating Rosacea: Eliminate? Control? Fix? Cure? + Q & A
• What causes rosacea to flare up? Rosacea triggers
• Acidophilus 4-1-1

Zinc Oxide: the ultimate sunscreen

Zinc oxide is an ingredient used in sunscreens as a reflective or physical block against UV rays. As a kid, you probably remember seeing (or even wearing) zinc oxide on the nose—it is pure white and very noticeable. Nowadays it is used as a key ingredient in sunscreens.

Zinc oxide is one of only a few ingredients that are currently used to block the damaging UVA rays. Parsol 1789 (avobenzone) and titanium dioxide are the among some others. Please don’t misunderstand: in a sunscreen, zinc oxide is not a complete block—nothing short of being inside will keep all the sun’s radiation off your skin. But zinc oxide, along with avobenzone and titanium dioxide, are ingredients to look for in your sun products.

If you are a skier, a sailor, or are doing any number of activities that cause you to be out in the sun for long periods of time, consider using zinc oxide to protect your skin. There are even zinc products that are available made in wild and fun colors, so you can protect your skin and make a fashion statement too!

For more information, see:

• SUNSCREENS: The WHAT & WHY plus the importance of REAPPLYING
• Top 10 reasons for not wearing sunscreen: What’s your excuse?
• A Small Sunscreen Lecture

OK—this is not necessarily the norm!

Tend Skin Lotion for problems with ingrown hair

Tend Skin is made to help reduce the pain and inflammation of razor bumps, ingrown hair, and razor burn. The main active ingredient in Tend Skin is aspirin (acetylsalicylic acid). Aspirin, of course, is an analgesic (pain reliever) as well as an anti-inflammatory agent.

Next on the ingredient list is isopropyl alcohol. This, as you hopefully know, is the “bad” kind of alcohol. Isopropyl alcohol is very drying to the skin. Water is the next ingredient, so the fact that alcohol comes before water means this product is almost entirely made of alcohol. (Ingredients are listed by weight.)

However, many people have seen results with their ingrown hair by using Tend Skin. Sometimes even I have to bypass the information I know to be true in lieu of getting results, as long as there are no adverse effects to the skin when using this product. In other words, if you can use Tend Skin successfully without experiencing any problems as a result of using it, you may be able to help your ingrown hair problems. But if you use Tend Skin and it causes reactions or just doesn’t help your problems, I don’t recommend using it. This is a specialized product and because of the alcohol content, it won’t be for everybody.

For more information, see:

• What are razor bumps?
• Ingrown Hair—Men’s Edition: Q & A
• Alcohol in Products: The good and the bad

Yonka-Paris LAIT APRES-SOLEIL—After-sun repairing cream

From Yonka Headquarters:
LAIT APRES-SOLEIL is an after-sun hydrating lotion that is repairing and soothing for face and body. From the first application, this cream for all skin types cools the sun’s fire and provides a fresh feeling to the skin. Quickly absorbed, this milky lotion soaks in as it relieves the hot feeling of extended sun exposure. Apres-Soleil leaves your skin soothed, supple, fresh and silky.

This product is kind of an unknown gem from Yonka, which is really too bad. Apres-Soleil is a wonderful moisturizer and really helps to soothe and rehydrate skin after sun exposure. Although Yonka suggests using it on your face—and there is nothing wrong with that—I still like to use my facial products for face and Apres-Soleil for my body. Experiment for yourself and see what you prefer.

There are many products you can use for after-sun exposure or simply to keep the skin on your body soft and supple, but if you haven’t ever used Apres-Solieil: Try it—you might just fall in love!

Essential ingredients:

• Cornflower, calendula, Roman chamomile, German chamomile, linden flower—soothing 
• Pro-vitamin B-5—hydrating, repairing
• Allantoin—soothing, calming
• Vitamin A—regenerating
• Cucumber extract, milk proteins—hydrating, soothing
• St. John’s Wort—rejuvenating, moisturizing
• Yonka “Quintessence” (essential oils of thyme, lavender, cypress, geranium, and rosemary)—vitalizing, balancing

Directions for use:

• Apply generously after any sun exposure to body (and/or face)
• If you received a sunburn, I recommend my Sunburn Relief Cocktail (see link below). Here you can use Apres-Soleil as one of the 3 ingredients listed in the article
• Not only for after-sun exposure, you can use this silky body moisturizer all year round as your preferred body cream

For more information, see:

• SUNBURN RELIEF COCKTAIL: Important TIPS & help for healing a sunburn—updated
• HUILE CORPS—aromatic body oil
• The BEST Self-Tanner! Lait Auto-Bronzant

Post-inflammatory hyperpigmentation: Q & As

Can you suggest something regarding scars (dark spots) that have been left by past pimples? I was thinking about either microdermabrasion or using products containing kojic acid* that promises to lighten scars. Any thoughts on these?

*Kojic acid is a skin lightening ingredient. It can inhibit the formation of melanin.

You could try microdermabrasion. It is expensive, but it may work for you. You could try kojic acid products and see for yourself if their promises are well-founded. As I have said, no product or procedure is for everyone. And many things out on the market may work for you. My belief, however, is that many will not.

True scarring from blemishes is a tissue-related problem. I think the scarring this reader is talking about is really post-inflammatory hyperpigmentation. Because the dark spots never seem to go away, it probably seems like a scar, but in reality it is an overaccumulation of melanin at the site of the blemish. This caused the dark spot and sun- light is helping it to remain there. What I know is that if you become diligent and hyperaware about sun exposure, your “scars” will lighten and go away—as long as you keep sun off your face.

I am in need of a spot lightener. Basically I suffered from acne when I was pregnant, and the blemishes caused dark spots on my face. I need something to make the spots lighten up. Do you have a product that will reduce the darkness? PS: Why did these dark spots appear in the first place?

When you have breakout, especially deep cysts or pustules loaded with infection, the spots are like tiny wounds, and this wounded tissue is subject to variations in pigmentation. For example: One summer I tripped on my office patio as I was leaving work. My right foot caught the fall, but I ended up deeply scraping the top of it. Once a scab had formed, I stopped wearing Band-Aids; when the scab came off, scar tissue was left in its wake. Since it was summer, the area received all kinds of sun exposure due to wearing flip flops and sandals, leaving the injured tissue full-on exposed to sunlight. When I thought about it, I would put sunscreen there, but for the most part I was a “bad client” and just forgot about protecting it from UV light.

Due to the amount of sun that area received, and the extent of the injury with its resulting scar tissue, a large dark spot existed where the scrape occurred. Some people even thought it was a tattoo! But in actuality it was hyperpigmentation around the outside edge of the injury along with pigmentless scar tissue inside. Had it been winter, the area would have received little or no exposure to the sun, and no doubt it would be less discolored. Now the scar is barely noticeable, but when summer rolls around the darkness will probably reappear and then fade again in the winter. This example is of a foot; imagine how much sun your face is getting in the summer (or winter), subjecting your “injuries” to the potential for hyperpigmentation.

One way to avoid some of the darkness of post-inflammatory hyperpigmentation is to stop picking at your skin! It’s a bad habit and can cause damage to the area. With that said, a picker is going to pick. I can’t change your predilection for doing this; you believe you are helping your skin by picking. Perhaps when you can install a different belief, you can change your behavior. Try the belief: “When I pick at my skin, I am causing further damage. And it will take my skin longer to heal. Picking does not help.” Adopt this, and you are on the road to recovery.

I am not saying that extracting the infected mass from a spot isn’t advantageous. It is. However, in my experience, most people have little or no restraint when it comes to self-extraction. And sometimes tools are needed to properly get to a plug; the use of which is best left to an aesthetician in the course of a facial treatment. If you can’t get a facial, at least put healing products on the blemishes (geranium, for instance) and know this will go a long way to getting rid of the spots faster. Picking will only prolong the healing process and create the potential for post-inflammatory hyperpigmentation.

In conclusion, as long as you are experiencing breakout and receiving sun exposure (even limited amounts), you have the potential for causing dark spots where the blemishes are located. So, don’t pick at your skin, always wear sunscreen when you are out, and find ways to heal the blemishes without causing further damage. Many tools for having healthy skin are listed throughout this blog.

For more information, see:

• What is Post-Inflammatory Hyperpigmentation?
• Hyperpigmentation: A reader’s question(s)
• A Note to All Pickers—you know who you are!!! (Please read!)