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Skin Creams: What's Worth It?

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Dr. Rachel Herschenfeld
Dermatologist
Thursday, June 22, 2006; 11:00 AM

Dr. Rachel Herschenfeld talked about the claims some skin creams make and which ones live up to their promises.

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Rachel Herschenfeld: We've all seen the ads for moisturizers and skin serums claiming amazing powers for some new product. This one is even "better than Botox" or that one will smooth all of your wrinkles and prevent any more aging changes. Although these claims seem too good to be true, who wouldn't want to try something that sounds so good? What about StriVectin, Freeze 24/7, and all those antioxidants? Let's chat about what skin creams can really accomplish, which ones are worth trying, and which ones are better left on the shelf.

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Maryland:

I'm 25 years old with fairly decent skin that still experiences the occasional breakout. My current routine is to wash my face morning and night with Cetaphil, then in the morning I apply a thin layer of Duac cream (which contains benzoyl peroxide and clindamycin), followed by Kiehls Ultra Facial Moisturizer with SPF 15. At night I apply Differin Cream before going to bed. Does this sound like a worthwhile routine to you, or would you suggest changes?

Rachel Herschenfeld: This sounds like a very reasonable regimen. You may want to consider using a moisturizer with a higher SPF, especially during the summer. Some of my favorite facial moisturizers with sunscreen include Olay Complete Defense SPF 30, Eucerin Extra Protective Moisture Lotion SPF 30, Neutrogena Health Defense SPF 30 and Aveeno Positively Radiant SPF 30.

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Washington, D.C.:

Thanks for this topic. Cosmetics aisles are loaded with dubious stuff at high prices. I asked a dermatologist for a particular ingredient to look for what was effective in a moisturizer and he suggested urea. But when I asked a pharmacist, she said not to apply it to the face. What is urea, is it recommended, and why NOT put it on the face? It's just skin.

Rachel Herschenfeld: Urea is an ingredient that is added to moisturizers because it helps exfoliate and also binds water. It can be found in over the counter products such as Carmol moisturizer, and also in prescription products. There is no inherent reason not to use it on the face, but I would recommend choosing a low concentration for the face, since higher concentrations may be irritating. So for the face, try the Carmol 10.

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Alexandria, Va.:

I am 32 and have combination skin. But now I'm starting to have wrinkles, too -- especially those lines that go from the bottom of my nose around to the corners of my mouth! Is there a skin cream that can help prevent these? Thanks for any help you can give me.

Rachel Herschenfeld: The lines from the nose to the corners of the mouth often need more help than a cream can provide. These lines are caused by loss of tissue volume in that area, and also by repetitive motion, and usually respond best to injectable fillers such as Restylane. All the creams that claim to erase all of your lines are usually overstating the case, and don't work that well in that area.

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Anti-aging creams and sun exposure:

Hi, There are a million products out there that contain agents that supposedly slough off dead skin and remove fine lines for younger- looking skin, e.g. retinol and alpha hydroxy. I've heard, however, that those products can increase the effects of sun exposure. Is this true, and can you recommend any product or active ingredient that is effective but not harmful?

Rachel Herschenfeld: There are so many products to choose from, but there sre definitely some ingredients that are better than others. The two that you mention are actually very good choices for anti-aging effects. Alpha-hydroxy acids can help to exfoliate and even out pigmentation. They do thin the top layer of the skin a little bit, and so there have been concerns about whether this makes you more sun sensitive. I recommend using products with alpha hydroxy, and also using sunscreen. Retinol is another ingredient that helps smooth fine lines. In either case, adequate concentrations of the ingredient need to be in whatever formula you choose. Here are some recommendations: MD Formulations makes excellent alpha hydroxy moisturizers. In terms of retinol containing products, try Neutrogena Health Skin Anti Wrinkle Cream or Roc Retinol Actif Pur.

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Washington, D.C.:

Hello Dr. Herschenfeld., I was wondering if La Prairie face creams are as good as everyone says. I started to use them a couple of years ago (at 30) and loved them til I got pregnant and now I find it makes my skin greasy. Lancome Hydra Zen is always a winner, but I'm wondering if I'm buying into the marketing too much and there's something cheaper/better I should be using? I have normal skin and am 32 years old.

Rachel Herschenfeld: La Prairie is a good line, but you don't have to spend that much to get a good moisturizer. In terms of specific products, the caviar containing creams won't do much more than creams that don't contain this ingredient. Some of their sunscreens are good, and many of their moisturizers contain anti-oxidants, which can be found in good drugstore brands such as Olay Regenerist.

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Fairfax, Va.:

Two pregnancies in three years have left me with all sorts of exciting new skin issues, but the two that are driving me nuts are the dark blotches across my cheeks and nose, and facial hair that my OB/GYN promised would disappear when my hormones settled down (he lied). Is there anything over the counter that would reduce either of these issues?

Rachel Herschenfeld: There are over the counter creams that can help with pigmentation. First of all, creams containing hydroquinone work to fade spots. Over the counter preparations usually contain 2% hydroquinone. An example is Porcelana. Otherover the counter ingredients that can help to fad pigmentation include: alpha hydroxy containing creams such as AquaGlycolic face cream, and possibly products containing soy extract, which is found in many products including Aveeno Positively Radiant moisturizer. I would recommend checking with your doctor if you are pregnant or nursing before starting new products. You couls also always seek help froma dermatologist for stronger prescription treatments.

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Adelphi, Md. :

I have very fair skin (usually use SPF 50). How many times a day should I be putting on sun screen? How long do I have to wait before I go out into the sun after applying?

Rachel Herschenfeld: Ideally, you should reapply your sunscreen about every 2 hours to make sure you don't lose any protection. Once you put it on, you're good to go. You don't really have to wait to get the protection, but it may help to let a product dry on so it won't rub right off.

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Reston, Va.:

We had a health fair at work last week and one of the vendors said that my skin was dry (based on a screening by a machine that indicates dry skin by glowing purple). Is there a brand or type of moisturizer that will keep my face from being dry but won't make it oily (I have a T-zone complexion)?

Rachel Herschenfeld: You should probably choose a light moisturizer, such as Olay Complete Defense. You may also want to try an alpha hydroxy conatining formula such as AquaGlycolic. If your skin tends to get a little oily, stick with lotions, rather than thicker creams.

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Washington, D.C.:

Hi and thanks for taking my question. I am 30 years old and fortunately, have no wrinkles except for a few small lines right under my eyes. I want to help maintain this so here's my question. What is your opinion of the Oil of Olay Total Effects line? I've been using the eye cream and it's actually helped soften some of the finer lines I've had underneath my eyes. I am finishing up a bottle of a different moisturizer, but once it's done I'm going to start using the total effects daily moisturizer with sunscreen. Is it worth trying?

Rachel Herschenfeld: Olay Total Effects has a good blend of moisturizers and anti-oxidants, which will help the skin look better, but won't actually reverse aging changes. The anti-oxidants may help slow some age-related changes by helping to prevent damage from sun exposure. The moisturizer with sunscreen will do even more to prevent UV damage, so I would recommend trying it.

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Bethesda, Md.:

How about the Kinerase line? And La Mer? They cost a fortune; do they produce the results they promise?

Rachel Herschenfeld: So, are these products really worth it? I don't think so. In terms of La Mer, the supposedly magical active ingredient is seaweed extract. I do not know of any well conducted trials which have been published that show this to be an effective treatment to reduce facial lines and wrinkles. Kinerase contains kinetin, which also hasn't yet been proved to reduce lines and wrinkles in any well conducted trials. There are some ingredients that have been shown to make a difference in aging skin by reducing fine lines and evening out pigmentation. Retinoids such as tretinoin, which is found in RetinA and Renova, are among the most effective.

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Washington, D.C.:

I have used the Bath and Bodyworks Dr Wexler system and it works but is highhly expensive. What is the "best" system for a woman in early forties, fair skin with many freckles and some sun damage?

Rachel Herschenfeld: Some of the products in Dr. Wexlers' line are good, and some aren't. I think this is the case with most product lines. For fair skin, early 40s, some freckling, there are a few key recommendations. First of all, broad spectrun sunscreen with an SPF of 30 or greater every day. UVA even comes through window glass and contributes to aging changes. I think anti-oxidants are a good idea; these include vitamin C, vitamin E, green tea extract, alpha lipoic acid and others. Then if your skin can tolerate it, use a retinoid such as Retin A, or a retinol containing product over the counter.

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Retin-A (renova):

Is there any better cream to use than this for anti-aging? I have used that, and sunscreen daily for over ten years and am 40 but most folks think 28-30. Am I on a good path or is there something better.

Rachel Herschenfeld: Renova is the gold standard for anti-aging creams. That being said, there are other related creams that you may want to try. Top on my list is Avage or Tazorac, which contains Tazarotene. if you haven't added any exfoliation to your regimen, I woudl try that as well. Either an alpha hydroxy or beta hydroxy cream (MD Formulations, Skin Medica, Neutirogena Age Defying) would be a good choice. Also, anti-oxidants. They won't get rid of your wrinkles, but the evidence suggests that they'll help prevent some UV mediated damage. Olay Regenerist has some, SkinCeuticals makes great antioxidant products such as C E Ferulic.

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Baltimore, Md.:

What, if anything, can I expect from a series of six 50 percent gylcolic acid treatments performed at a day spa? Thanks.

Rachel Herschenfeld: Hard to know what to expect. The results depend on the strength of the peel, which depends not only on the concentration of AHA, but on the pH of the solution, it's other ingredients, and how it's administered. In general, I recommend getting such treatments under a doctor's supervision. You'll probebly get a stronger treatment and better results. When done properly, these peels can smooth the skin, and help fade brwon spots. But be patient! Usually it takes a series to get results.

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Fairfax, Va.:

I am 30 and recently started to see broken capilliaries on my face, especially my cheeks. Are there any over-the-counter products I could use to prevent them or reduce their occurence? What causes them? I was wondering if I should see a dermatologist?

Rachel Herschenfeld: Broken, or more accurately, dilated capillaries, are one of the things that don't respond well to creams. See a dermatologist to discuss laser or intense pulsed light treatments.

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Rockville, Md.:

Hello, Dr. Herschenfeld, and thank you for taking my questions. Shiseido sells a compact powder that offers sun protection (I use one with SPF 45). Can their powder work as advertised in terms of protecting the skin from the sun? Is it better to stick with a moisturizer with SPF protection? Currently, I apply Olay's moisturizer of SPF 15 followed by the Shiseido compact powder. Also, what do you think of Neutrogena's Ultra Sheer sunblock?

Rachel Herschenfeld: If you apply enough of the powder, it can provide an SPF of 45. I always prefer a sunscreen first, to make sure that all areas get good sun protection. Then you can apply the powder so it looks good, instead of in a thick uniform layer to get the sun protection. I really like Neutrogena's Ultra Sheer sunblock. Excellent broad spectrum protection from both UVB and UVA, not too greasy, and not too expensive.

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Washington, D.C.:

Olay Daily facials (they look like a soft $4 gauze pad). Worth it, or would a face flannel do just as well?

Rachel Herschenfeld: The face flannel is probably just as good, but if you like the feel of this product, there's nothing wrong with it.

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Washington, D.C.:

What about Strivectin? Does it work for stretch mark? wrinkles?

Rachel Herschenfeld: The whole StriVectin thing is hard to understand. There is no good data to support the assertion that the active ingredient, palmitoyl oligopeptide, greatly decreases facial lines and wrinkles or reduces stretch marks. Despite this, it seems to be wildly popular. Until we have that data, I don't recommend it, unless you like the feel of the product- then go ahead and use it as a moisturizer, but not more than that. Don't expect any miracles.

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Woodbridge, Va.:

I have crow's feet near my eyes, and a line above my nose in between my eyes that I'm pretty sure I got due to being in the sun and having to squint (or wearing glasses and not having the proper shades). Are there any creams I can use to make these imperfections not as noticeable? I'm 32, fair skinned, and I wear sunblock religiously (although, admittedly that wasn't always the case).

Rachel Herschenfeld: The crow's feet and the frown lines are what we call dynamic lines- produced by repetitive motion. Creams may help a little with mild crow's feet- in particular I would recommend retinol or a prescription retinoid such as Renova or Avage- but not with the frown lines. You're heading towards Botox territory to be truly effective.

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Start Early?:

I'm 26 and am fortunate to have a nice complexion, no real problems or blemishes. Currently I just use an Origins face wash and Dove moisturizer with SPF 15. Should I be using more creams to help with wrinkles now? What I'm doing now works great for me, but I imagine there will come a time when I should do more.

Rachel Herschenfeld: Prevention is so important when we talk about aging changes in the skin. You're doing great if you're using a facial moisturizer with sunscreen every day. Yes, even in the winter! But I prefer an SPF of 30. Also, think about anti-oxidants: they probably help prevent damage too. Look for vitamin C, vitamin E, green tea extract, soy isoflavones, ubiquinone (or CoQ10) and others.

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Washington, D.C.:

How about Idebenone? Is this as effective as Retinoid?

Rachel Herschenfeld: Idebenone is a good anti-oxidant that is found in Prevage. It is a derivative of ubiquinone, which is also used as an anti-oxidant in many skin creams. I recommend anti-oxidants as part of any daily skin care regimen, and this one is great, but there isn't any compelling evidence that it is better than all the other ones out there.

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Washington, D.C.:

There are a number of over-the-counter microdermabrasion products available now. From your perspective, what are the benefits and negative effects (if any). I have used one, and my skin looks great that day. However, I wonder if it is too harsh?

Rachel Herschenfeld: Many of these products have small beads in them that can gently exfoliate your skin when they are used properly. Just follow the directions to avoid irritation from over use. Also, remember your sunscreen after.

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Washington, D.C.:

Do you think Philosophy moisturizers (Hope in a Jar, When Hope is Not Enough) are worth the price, or is Olay just as good?

Rachel Herschenfeld: I think Olay is just as good.

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Paul, Tex.:

Do products with elastin really help with skin elasticity? For instance, the skin below my eyes.

Rachel Herschenfeld: In a word, No. Any elastin that you apply topically can't get into the skin where it might help.

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Arlington, Va.:

Can you please recommend a good all-around eye cream? I have fine lines, dark circles, and puffiness in the morning.

Rachel Herschenfeld: There are several eye creams that I like: PrimaC eye balm, Matis eye balm, Skin Medica Illuminating eye cream and Vichy RetiC.

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Montgomery County, Md.:

I'm 28 with dry, fair skin, not really prone to breakouts. I've found that my skin looks the best when I don't use any soaps (but do wash my face in the morning with warm water and a washcloth), and use Cetaphil cream twice a day and Kiss My Face spf 30 in the mornings. I don't wear makeup, so there's nothing to take off at night. Is it ok for me to not use a facial cleanser? I can't seem to find one that doesn't dry my skin out and make it flaky; even Cetaphil is too strong. But I don't want to harm my skin in the long run just to have it look nice now.

Rachel Herschenfeld: There is no magic in a cleanser, so if water and a washcloth work well for you, that's fine. You're not depriving your skin of anything essential.

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Baltimore, Md.:

Can you recommend a product or a regimen that includes all of the ingredients you've been recommending; SPF, Retin-A, antioxidants, etc.? What do you use? I like to take care of myself, but I would also like to take care of my family.

Rachel Herschenfeld: There's no one product that does it all. here are some things I like: Renova or Avene Retrinal(a little gentler)at night, along with Aquaglycolic facial cream or SkinMedica AHA/BHA cream. During the day, antioxidants such as Prevage or SkinCeuticals C E Ferulic with a sunscreen such as Aveeno Positively Radiant or Neutrogena Ultra Sheer SPF 55 or LaRoche Posay Anthelios.

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Facial waxing w/ Retinol products:

For how long should I discontinue using Retin-A prior to getting my eyebrows waxed? In the past, when I have not discontinued use, the waxing resulted in some loss of skin (ouch!) where my brows were waxed, along with prolonged redness.

Rachel Herschenfeld: This is key: stop RetinA or Renova or Avage 1 week before waxing on the face to avoid burns.

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Washington, D.C.:

Have you heard of Frownies, which look like little pieces of cardboard that you stick to your face at night? I got the ones for mouth-nose lines. I'm 22 but I have recently started seeing those lines. Can they be caused by sleeping on your side?

Rachel Herschenfeld: I actually think the Frownies aren't too helpful, but they won't hurt you. The lines are probably not from the way you sleep: sun damage, genetics, and early aging changes have more to do with this.

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Washington, D.C.:

Thank you very much for your straight answers. It is rare to get such objective no-nonsense advice.

Rachel Herschenfeld: You are welcome!

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Fargo, N.D.:

I just wrote in. I am 33 and I have been using Neutrogena Copper Night cream (not the right name -- I can't think of it), Vanicreme soap for my face (mild, no irritants) and a mild scrub. I also use a broad spectrum, SPF 30 lotion for my face every day. Does green tea work to reverse signs of aging? What do you think about that for people with roseacea?

Rachel Herschenfeld: Copper peptide, found in Neutrogena's Visibly Firm line, has been shown in one study to increase some collagen synthesis. Whether or not it will really reverse any aging changes is an open question. Again, no good data on long term anti-aging effects. I would prefer a retinoid at night to get some real results.

In terms of green tea- it contains great anti-oxidants. These will not reverse aging changes, but can probably help prevent some UV related skin damage, so I would recommend products containing these ingredients. Just be realistic in terms of your expectations. I think green tea extract is a good choice for people with rosacea because it doe not tend to be irritating.

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Alpha-hydroxy:

I use a Neutrogena face cream daily that contains alpha-hydroxy and is SPF-15, but I'm confused by the fact that the product recommends also wearing sunscreen, even though it is sunscreen! Do I need an additional sunscreen with this, do you think? I'm 30 years old.

Rachel Herschenfeld: I think it's fine as it is. The point about AHAs and sunscreen is that there's been some concern that AHA's may increase sensitivity to sunlight, so if you use one, you should use a sunscreen. Just remember to re-apply sunscreen. The exfoliating effect of the AHA may last all day, but the sunscreen won't.

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Boston, Mass.:

Is the retinoid in Differin an effective anti-aging agent? Also, are the claims that Differin can help reverse some of the effects of sun damage true?

Rachel Herschenfeld: Differin is a retinoid- same class as Renova and Avage- and retinoids all have anti-aging effects.

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Washington, D.C.:

What's the best thing for pouchy under-eyes? I don't have dark circles, but do have bags.

Rachel Herschenfeld: Creams probably won't help very much. When there are truly pouches under the eyes, surgery is usually the best option. I would recommend consulting a plastic surgeon.

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Woodbridge, Va.:

I'm 54 and have noticed that my pores have gotten larger over the years. What do you recommend to help shrink them and keep them clean?

Rachel Herschenfeld: Pores are so hard to treat! There isn't any cure in a jar, but there is some data that suggests that Avage- a prescription retinoid- may help. So see your dermatologist to discuss it.

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Washington, D.C.:

I have read that long-term use of retinols like Retin A can undo past sun damage at the cellular level? Is there any truth to this, or is this just wishful thinking for those of us who had a few too many sunburns in our youth?

Rachel Herschenfeld: There is some truth to this, but no retinoid can undo all past sun damage. Retinoids can reverse some aging changes and improve fine lines and pigment irregularity. There is also evidence that they may prevent some ongoing UV damage and help prevent precancerous lesions on the skin. I strongly recommend using retinoids, particularly for people with a lot of sun damage.

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Annapolis, Md.:

I cannot use anything with paraben. I use La Mer because it does not have paraben. Do you know of any other lines, less expensive, that are paraben free?

Rachel Herschenfeld: Vanicream is a great product line that is free of parabens and a lot of other irritating and sensitizing ingredients. Check out their website: www.psico.com .

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Washington, D.C.:

Kiehl's makes a great face cream with lycopene, which I love. But it is very expensive. Do you know of any lower-cost alternatives?

Rachel Herschenfeld: You can try one of the facial creams by Paula Begoun- her Paula's Choice line tends to be very good.

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Washington, D.C.:

How long does restylane last? Is it safe? No after-effects?

Rachel Herschenfeld: Restylane can last 6 months and sometimes longer. But it's not a cream! It works great for lines around the mouth and between the nose and corners of the mouth. It's very safe, and after effects are usually limited to transient swelling, mild redness and mild bruising.

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Tyson's Corner, Va.:

Does drinking water actually prevent wrinkles? Some of my coworkers swear by this but I am skeptical.

Rachel Herschenfeld: Drinking water doesn't really prevent wrinkles. Although getting totally dehydrated can make the skin temporarily slack.

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Boston, Mass.:

Dear Dr. Herschenfeld, I am a skin cream skeptic. With a typical red-head's complexion, I've settled on Dove unscented soap and Oil of Olay sensitive skin lotion for my face's "beauty" regimen. I don't like the idea of alpha hydroxy or other acids on my skin, and I really don't like spending a lot of money for water plus glycerin plus the latest fad ingredients. Is there really any justification for trying anything other than sunscreen, good diet, exercise, and sufficient water (and NO SMOKING)?

Rachel Herschenfeld: The measures that you mention are crucial to maintaining good health and keeping your skin looking good. As I've mentioned already, there is good data for some other creams as well. In particular, the retinoid family truly helps reverse some aging changes in the skin including fine lines. Ingredients such as hydroquinone, soy extract, and alpha hydroxy acid can truly help fade brwon spots. Anti-oxidants also add another layer of protection to prevent sun damage. That being said, you don't need to spend a fortune on these things if you don't want to. You may be blessed with good genes (never under estimate the importance of this!) and your skin may look great if you just keep up what you are already doing.

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Boulder, Colo.:

Because I live at high altitude and am often outdoors, I choose not to use my Retin-A during the summer months. However, my chin always ends up breaking out (this is my tough zone). What do you recommend I do during summer months?

Rachel Herschenfeld: I would use the RetinA and also apply a good sunscreen, such as Neutrogena Ultra Sheer SPF 55, and keep re-applying it during the day. If your chin is the only problem area, maybe you could just use the RetinA there in the summer. Talk to your dermatologist and see what he or she thinks.

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Alexandria, Va.:

I've been wearing La Mer lifting serum, followed by its moisturizing lotion. But when I stopped using it for a week last month, my skin quickly became dry and started to break out. This might sound funny, but is there such a thing as skin addiction to a certain product after a long period of use?

Rachel Herschenfeld: You didn't become addicted, but your skin may need regular moisturizing. I expect that if you substitute another moisturizer, your skin will improve again.

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Washington, D.C.:

I was wondering about those moisturizers that allow you to self tan. I use a Retin-A product and metrolotion on my face. Can I still use a self-tanner like these? Do they actually work?

Rachel Herschenfeld: Self tanners do work, and can be used along with the products you mention. Self tanners contain dihydroxyacetone, which binds to skin proteins to produce its color. This is really the only safe way to tan. Also, it provides a tiny bit of sun protection, but not enough to replace sunscreen.

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Arlington, Va.:

I understand that the new sunscreens with Helioplex really do provide longer protection, maybe 4 hours instead of 2, since they don't degrade as quickly. But I just picked up some Sea and Ski sunscreen that claimed to last 8 hours! Is this really possible?

Rachel Herschenfeld: No sunscreen is going to provide 8 hours worth of protection. They all rub off at some point, and need to be reapplied.

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Bowie, Md:

Do scar removal creams with Vitamin E work? My toddler son fell over a year ago and he still has a slight scar on his chin. The scar tissue doesn't have pigment, I assume, so that's why it's lighter than the rest of his skin.

Rachel Herschenfeld: Vitamin E does not work to improve scars. It is a good anti-oxidant.

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New York, N.Y.:

Hi, Dr. Herschenfeld. I'm not sure if this is the type of issue you are covering today, but my question is: I have tiny blackheads across my nose and the cheek area right around my nose. I've tried "pore refining" cleansers, hoping to get rid of them that way, but with no luck. It's the only place on my face that I can actually see my pores, and it drives me crazy. Is there anything I can do to eliminate them? Thanks.

Rachel Herschenfeld: You'll never get rid of those pores, but they may be more obvious if they're clogged. Here's what may help: try a retinoid such as RetinA or Differin- you'll need a prescription from a dermatologist. Also, most pore refining products contain salicylic acid, which can help to decrease balckheads, but not get rid of them. It may also be helpful to have a gentle extraction done by a licensed esthetician, preferably under a doctors supervision.

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Rachel Herschenfeld: Thank you for all of your questions. I hope that all of this information will make it a little easier to choose products that will help keep your skin looking great.

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