Skin Sense

The Most Frequently Asked Questions About Skin Care

Boston-based dermatologist Dr. Rachel Herschenfeld will talk about the most popular questions people ask her.

Dermatologist Dr. Rachel Herschenfeld, talked about the questions patients ask her the most frequently Tuesday, Jan.16, at 11 a.m. ET.

A transcript follows.

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Washington, D.C.: My skin is covered in blackheads throughout my nose, chin and forehead. I have been using Murad products that include salicylic and glycolic acids and retinol for over 6 months, and while there's been some improvement, it's far from ideal. What other options do I have?

Dr. Rachel Herschenfeld: Salicylic acid and glycolic acid will help blackheads, but you should also try something in the RetinA family. These medications are truly the most effective ones for blackheads, or comedones, as they are officially known. Also, a gentle extraction by your dermatologist or a well trained aesthetician can be very helpful.

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Chevy Chase, D.C.: What can you tell me about a TCA peel and what it does for your skin? Also, what's the downtime you can expect after?

Dr. Rachel Herschenfeld: TCA peels are wonderful for the treatment of brown spots and fine lines on the face. It is incredibly important that the procedure be performed by a well trained physician who is experienced with TCA. In th right hands, brown spots can fade, fine lines can smooth, and the skin looks much better, Going too deep, however, can cause scarring, and the peel isn't right for everyone- fair skinned people are the best candidates.

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Washington, D.C. : Somehow ever since I started using prescription Retin-A six months ago, I have noticed the lines around my eyes get much deeper. I am relatively sure it's not just me noticing more about my skin -- is this possible? I'm 30 years old and I use SPF 35 every day. How can I stop the process?

Dr. Rachel Herschenfeld: RetinA is a great anti-aging treatment. However, it can't work miracles, and it won't stop the aging process. It can also be drying and irritating for some people, so perhaps this is what you are experiencing, and it is making your skin look worse. Defnitiely make sure you are using a good moisturizer, and have a dermatologist get a good look at your skin. If the aging process is simply moving along, you mayu need to consider other treatment options for this area, such as Botox.

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Clinton, Md.: Every month around my cycle I get large nasty pimples that are filled with oily white puss. I usually cleanse my face with Neutrogena cleanser and use a Noxzema astringent. Sometimes I use a face mask on that area to dry it out, however it still is quite oily and takes days to clear, only to leave a brown mark. There are the only pimples that I get so, what am I doing wrong?

Dr. Rachel Herschenfeld: It doesn't sound like you are doing anything wrong. Many people have acne that flares around their period. Treating the acne is the way to go. There are many options: RetinA, topical antibiotics, benzoyl peroxide, or even oral contraceptives (which work well for many people). You need a good dermatologic evaluation to decide how to proceed.

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North Potomac, Md.: I am in my early 50s and have very noticeable dark circles under my eyes. It seems as if they've always been there, but have definitely gotten more prominent with age. My skin is fair and freckled. Is there any product or procedure that can noticeably reduce the dark circles? Does Hylexin help? I currently use a yellow-tone concealer that is somewhat effective but doesn't last very long. Also, due to the freckles, heavy makeup looks very unnatural on me. But any cover up advice would be appreciated.

Dr. Rachel Herschenfeld: Dark circles under the eyes are a difficult challenge, but don't despair, there are things that help. Unfortunatley, Hylexin isn't one of them. I haven't yet found a cream that does a tremendous amount for this problem. Concealer is always a good option. Another treatment involves injection of filler such as Restylane or Juvederm, which can smooth the skin and the hollows under the eyes and dramatically improve the appearance of this area.

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Fairfax, Va.: I'm a fair Caucasian female and have a number of spider veins on my face (both cheeks, nose and chin). I've heard that laser treatments can banish them, but I've hesitated for fear of discoloration resulting from the treatment. (I now minimize them -- but can't completely cover them -- with makeup, and I don't want to risk a treatment which could make matters worse.) What type of laser is best used for this treatment and how often do you encounter discoloration when using it?

Dr. Rachel Herschenfeld: If you have fair skin, then you are probably a great candidate for laser treatment of facial veins. My favorite laser for this is the VBeam, a pulsed dye laser that does a great job of clearing up those annoying red lines. One or two treatments usually produces very noticable improvement. Discoloration is very rare when treating fair skinned people for facial veins, but temporary redness and swelling are very common.

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Washington, D.C.: Is there a credible, unbiased source of information that would help me to select skin care products - specifically cleanser and moisturizer? I am overwhelmed by the selections in CVS, department stores and Sephora, and skeptical of salespeople as well as aetheticians who perform facials in spas and salons. I am 34, have large, clogged pores on my nose, chin and jawline, lots of oily shine by 10 a.m. every day, mildly dry cheeks, and periodic breakouts on my chin and neck. Help!

Dr. Rachel Herschenfeld: What a great question! There are credible sources out there for all of us who are interested in learning what works and what doesn't. One great website is written by Paula Begoun- she reviews many products and gives good information about them. Dr. Leslie Baumann published a great book called The Skin Type Solution which also has a lot of good recommendations on products to use. Your dermatologist is also a great source of information if she (or he) is interested in this topic.

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Chevy Chase, Md.: I am 34 and 9 weeks pregnant. I am looking for a new skin care routine that will be easy to follow and safe during pregnancy (I assume peels, etc are out for now). I have combination skin, still break out occasionally in my chin area but dry and getting lines elsewhere.

Dr. Rachel Herschenfeld: I always recommend that people minimize their regimens during pregnancy. Choose a gentle cleanser (like Cetaphil or Cerave) and use sunscreen. If you feel the need to exfolaite, try a gentle glycolic acid cleanse such as AquaGlycolic. Remember, the pregnancy only lasts 9 months, but you can (and should) work on your skin for the rest of your life.

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Washington, D.C.: I'm African-American and have acne scars. How effective and costly would a laser treatment be to reduce acne scarring?

Dr. Rachel Herschenfeld: Acne scarring is a difficult problem, but you do have options. The ideal treament depends on the type of scar, but in general, lasers (such as the Smoothbeam) will help to smooth out scarring but not get rid of it completely. Usually a series of treatments (from3 to 6) is necessary, and each treatment may cost $300 to $500 depending on the laser and the practitioner.

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Alexandria, Va.: What would you recommend for treating brown spots and fine lines -- an IPL laser or a TCA peel -- and why?

Dr. Rachel Herschenfeld: If I had to choose, I would go with the IPL. IPL does a really good job treating brown spots, and it also helps with redness on the face. Also, IPL can help improve the texture of the skin at the same time. The recovery from IPL is also generally easier than the recovery from a TCA peel.

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Clinton, Md.: As an African American woman, what is a good product to use to get rid of marks left behind from pimples?

Dr. Rachel Herschenfeld: You may neeed a cream to help fade some pigmentation. In general, hydroquinone containing creams are best for this. Prescription products such as EpiQuin Micro or TriLuma usually work very well.

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Washington, D.C.: I have a question about finding a dermatologist. In the past, whenever I have tried to seek one out, I have found an almost universal months-long waiting list to see a doctor in D.C. Is there really a shortage of practicing derms in the city? Going to a physician outside of DC isn't really a viable option, since I rely on Metro for transit.

Dr. Rachel Herschenfeld: This is a very timely question. You are not alone in waiting to see a dermatologist. In fact, a recent study that was described in the Boston Globe showed long wait times to see dermatologists across the country. Don't feel too bad, because things are even worse in Boston- the city with the longest time to wait and see a dermatologist. Clearly there are not enough dermatologists around to see everyone who would like to be seen quickly. I would suggest making an appointmant, and inquiring about the possibility of being called for a cancellation. This may get you in sooner if your schedule is flexible.

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Re: Lines and Retin-A: Re: the lines around the eyes of the person using Retin-A -- this happens to me sometimes when I've gotten the Retin-A too close to my eye area and my skin has gotten dry and irritated. I have sensitive skin to start with, and when I'm in overheated, dry rooms in the winter, coupled with getting the Retin-A too close to my eyes, I've been shocked at how the skin there gets so dry and pulls and I look like I'm like 100 years old! But it goes away - here's the solution: I basically just keep the Retin-A away from my eye area and make sure to moisturize obsessively and keep out of the wind and cold. If I'm careful like that, Retin-A keeps my skin looking younger, not older.

Dr. Rachel Herschenfeld: Some helpful comments from another reader- Thank you! The moisturizing is key.

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Maryland: This may not be your expertise, but I am hoping you may be able to help. I'm Caucasian with a Mediterranean complexion, and very dark hair. I am considering permanent laser hair removal but am unsure where to begin. I would like to start with the hair under my arms, at least for now. What do you know of laser hair removal and how do I determine the best place to go for treatment? Thank you!

Dr. Rachel Herschenfeld: Laser hair removal; is great, and it can be done safely for people af all different complexions. Starting under the arems is a very good idea, because you will see gow your skin reacts. Sometimes people with darker skin will temporarily develop dark spots after treatment. I recommend choosing a place where you will be treated by a physician experienced in this procedure. Although this may cost more than a laser center staffed by technicians, it is worth it to be treated properly.

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Eat right = no pimples: I've read a lot about how research hasn't found a correlation between what you eat and acne. I don't see how anyone can think that what we put into our bodies for fuel doesn't affect how our bodies behave. For example, I get breakouts (blackheads and tiny whiteheads) all over my face whenever I eat refined products, especially white bread. When I don't, my skin looks good. Why do doctors keep denying that what you eat has an affect?

Dr. Rachel Herschenfeld: Actually, recent research has shown some correlation with what you eat, but not what most people expect. The Nurses Health Study showed that increased dairy intake was correlated with worse acne, but didn't find a link between acne and soda or chocolate. I think that the jury is still out. Hopefully more research in the future will give us more information.

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Memphis, Tenn.: I get a horrible wind burn on my face when golfing in the winter. Is there anything that can prevent it?

Dr. Rachel Herschenfeld: Exposure to wind and to sun can produce additive damage to the skin, so I would recoimmend using a good moisturizer with sunscreen in it even in the winter. Examples of over the counter products that I like include Aveeno Positively Radiant facial mositurizer with SPF 30, Eucerin Facial moisturizer SPF 30 and Neutrogen Healthy Defense SPF 30. ALso, reapply the moisturizer while you are out, because it will wear off.

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Fairfax, Va.: I am seriously considering laser hair removal for my upper lip and chin. Pricewise, the storefront places like Alase seem to be the most economical choice, but I worry about "getting what I pay for." Am I better off going to a physician? And how effective is the treatment really?

Dr. Rachel Herschenfeld: See my earlier answer about laser hair removal- you definitely get what you pay for. As to whether it works, the answer is yes. However, it works better for some people than for others, and the reasons for this are not clear. Certainly people with dark hair do better- in fact lasers won't work on light hair- but it is not possible to predict exactly how any one person will react. Also, it takes multiple treatments to significantly reduce the amount of hair. For some poeple 4 treatments may work, for others 10 may be necessary. So, be patient.

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Clearwater, Fla.: How effective is Radiesse in diminishing the lines around the lips? Is there another product that would be more effective?

Dr. Rachel Herschenfeld: Radiesse is not my favorite product around the lips- although it is great for the folds between the nose and the corners of the mouth (also known as the nasolabial folds). I prefer Cosmoplast, Juvederm or Scupltra around the lips, and I often combine a filler with some Botox. The product I choose depends on the individual patient: how deep are the lines, how many treatments does the patient want or can they tolerate? An evaluation by a dermatologist experienced with using multiple kinds of filler is your best bet.

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Washington, D.C.: I'm a light-skinned male seeking laser treatment for acne scars. My dermatologist has recommended a series of treatments using a Fraxel laser. Do you have any advice on this? It's much more expensive than the $300-$500/session price you listed earlier for another laser treatment. Thanks.

Dr. Rachel Herschenfeld: Fraxel is a great option for helping with acne scars. As for the price- again it depends on the laser and the practitioner.

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Virginia: Do you recommend regular screenings by a dermatologist for people who have had a lot of sun exposure in their lifetime? Can a family physician give an adequate screening? Should there be increased screening with advancing age? Is there an age threshold when screenings should start or become more frequent?

Dr. Rachel Herschenfeld: I definitely recommend regular skin screenings by a dermatologist for people who have had a lot of sun exposure in their lifetimes. General practitioners just don't have the same training that dermatologists do. For most people I recommend an annual skin exam yearly when they hit 40. However, people who have multiple risk factors for skin cancer (such as a family history of skin cancer, personal history of blistering sun burns, presence of pre-cancerous spots) may need to be seen more frequently and to start their exams at an earlier age.

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Washington, D.C.: I've bought a couple of products lately because they say in large letters on the front that they have alpha and/or beta hydroxy and salycic and glycolic acid. But when I look closely at the ingredient list on the back, those things aren't listed. These are from reputable brands. Any idea of what's up with that? Could alpha hydroxy, for example, be a component of one of the listed ingredients? Or am I just being ripped off? And while I'm at it, is there any way to find out how much of these things are in a product? I have no idea if the cleanser I use is made up of 10 percent glycolic acid, .10 percent, or what.

Dr. Rachel Herschenfeld: It can be very difficult to tell just what is in a product you're using. Often ingredients can be listed under different names, so you may see glyclolic acid on the front, and a different chemical name in the ingredient list on the back. In many cases, there is no percentage listed for most ingredients, so you can't really tell exactly what you're getting. Sometimes this information is available on line, and sometimes the manufacturer won't provide it.

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Washington, D.C.: When is it too early to start using Retin-A? I'm 26, but have no acne -- I only want to use it for anti-aging purposes.

Dr. Rachel Herschenfeld: It is not tooearly to start using RetinA in your 20s. In addition to helping with established signs of aging, there is evidence that RetinA, when used properly in combination with sunscreen, can help prevent some sun damage. So, see your dermatologist for a prescription.

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Arlington, Va.: Thank you for taking my question. I'm getting married in a few months and would like to get facials before then. However, my skin is very acne-prone. In high school I once tried a home facial that left me with a cyst on my chin that stayed for months despite cortisone injections. I'm not ever doing THAT again. What kind of facial would you recommend for acne-prone skin?

Dr. Rachel Herschenfeld: In general, I don't recommend facials because there is no standard defintion of exactly what a facial is. If you would like to improve your skin texture and appearance, consider a series of mild glycolic acid peels or microdermabrasion treatments.

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Vienna, Va.: Since my family has a history of melanoma I know I need to get checked out by a dermatologist. I'm nervous about it, though, since I'm shy. What does the exam involve? Is someone going to look at every single mole on my skin, or shine a special light onto me, or what?

Dr. Rachel Herschenfeld: A skin exam is extremely important if you have a family history of melanoma. It can be a bit embarassing, since the dermatologist has to look at ALL of your skin. However, you should try to find someone who makes you feel comfortable (or as comfortable as you can under the circumstances) and get it done regularly. I use a very bright light during exams, and sometimes a magnifying lens as well. Although the entire skin surface needs to be examined, you don't need to be completely uncovered at all times, since a dermatologist can only look at one area at a time.

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Minneapolis, Minn.: Hi Dr. Herschenfeld, Thanks for taking my question. I have a few of them. First, what do you think of Skinceuticals C and E Furelic? Is it is a good antioxident? Second, what is the best prescription retinol for anti-aging? Tarzoac? Differin? Third, what do you think of Kinerase? Does it work? THANKS so much!!

Dr. Rachel Herschenfeld: SkinCeutical C and E Ferrulic is a very good antioxidant- I like this product a lot. Retinol is not a presription product. The products you mention are retinoids, and I have not seen any good research comparing the anti-aging efficacy of one versus another. So, try to use one regularly: RetinA, Differin, Renova, Tazorac or Avage. There isn' as much data about Kinerase as there is about retinoids, and I don' ususally recommend it.

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Arlington, Va.: My neck is starting to look craggy. Do I have any other option besides plastic surgery?

Dr. Rachel Herschenfeld: Treatments, other than surgery, that can help the neck include Botox, IPL, lasers and Thermage. So, it depends what aboutn your neck is bothering you- schedule an appointment with a dermatologist or a plastic surgeon.

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Silver Spring, Md.: Hi Dr. Rachel - I have fair skin, cheap Irish skin actually, but I am pretty good about using sunscreen everyday. My question is for the last few years I have had some bumps grow on my face. I am 43 and these really bother me (but I have yet to visit a dermatologist). What can I do about these to get rid of them and prevent more?

Dr. Rachel Herschenfeld: There are all sorts of bumps that can grow on the face- moles, small cysts, oil glands, to name a few. MAny of these can be removed easily in the office, but the exact procedure depends on the exact type of bump. So, get into a dermatologist's office to check out your options.

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Topical resolution for PCOS acne: Do you have any recommendations (or references I can consult) on topical management of acne related to PCOS? I would prefer to manage this condition primarily through diet and other resources, and to deal with the skin-related issues without taking spironolactone/aldosterone orally. The acne is not severe, but it is persistent, primarily on my face and upper back. Thanks for any guidance you can provide.

Dr. Rachel Herschenfeld: Here's a thought: spironolactone can be used topically, and it can be used along with other topical acne treatments, such as RetinA and topical antibiotics. In terms of diet, it can help with some issues related to PCOS, but I'm not sure that it will make a huge difference for your skin.

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Central Virginia: I am 50. I have a complexion that freckles, but I can't pass the brown spots on my hands and forearms as freckles any more. They are larger and don't go away in the winter. I don't get a lot of sun exposure and wear a sunscreen when I'm in the sun. What can I do to get rid of these things? Over-the-counter products like Porcelana and Esoterica don't seem to have any effect.

Dr. Rachel Herschenfeld: It may be that you have something other than frackle son your arms. there are skin growths that can be flat and brown, but not respond to fading creams. That doesn;t mean they can't be treated. Depending on what they are, lasers or other treatments may work. See your dermatologist.

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Dr. Rachel Herschenfeld: Thank you for all of the great questions and comments!

Rachel Herschenfeld MD

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