Ask Dr. Herschenfeld
BY RACHEL HERSCHENFELD, M.D. - DERMATOLOGIST
Sooo many questions were submitted for November's Skin Sense online discussion that Dr. Herschenfeld couldn't answer them in just an hour. So, for December, she chose the ones readers expressed the most concerns about and came up with solutions, including what sunscreens people with really sensitive skin should use, which moisturizers perk up fair, dry black skin and when it's time to go for a laser treatment.
Fairfax, Va.: Hi, Dr. H. I'd like to find cleansing and moisturizing products that will work with my dry skin. What I'm specifically looking for is something that will "perk up" my skin. I have very clear skin but I feel that it looks dull and tired. Any recommendations in the $20-$30 range? If it helps, I'm 20 years old and a very fair black woman. Thanks!
Dr. Herschenfeld: You would probably benefit from some good moisturizers, particularly products incorporating ingredients that can exfoliate and smooth your skin, such as glycolic acid. Some affordable and good products containing glycolic acid include Aqua Glycolic Facial moisturizer, Neutrogena Healthy Skin face lotion, night and MD Formulations Daily Peel Pads. It is also a good idea to incorporate a retinol-containing cream for exfoliation and treating fine lines. Consider Neutrogena Healthy Skin Anti-Wrinkle Intensive Night Cream.
Washington D.C.: I'm a 50-plus white woman with very sensitive, reactive skin -- I've had eczema on my legs for more than 30 years and I get dermatitis from such things as scented detergent and the adhesive on bandaids. Some sunblocks that I've used on my arms have also caused dermatitis; do you know of one that is very non-reactive? Thank you for any help.
Some sunscreens are formulated specifically for people with sensitive skin or multiple allergies. Try Vanicream sunscreen. It comes in different SPFS and with either mineral sunscreens (zinc and titanium) or formulas containing both mineral and organic active ingredients. The entire Vanicream line is designed to be hypoallergenic.
Sterling, Va.: I have a mole on my cheek. I have no desire to remove it, but it does sport a few unsightly, stiff hairs. Sometimes when I pluck them, the mole or the area around it becomes irritated. Is it safe to pluck hairs growing out of a mole or should I try another method, such as laser hair removal by a doctor?
It is safe to pluck hairs from a mole, but it can be irritating. Options for more long lasting removal of these bothersome hairs include electrolysis and laser hair removal. Electrolysis can be challenging if you have been plucking for a while since this can distort the hair follicle and make it difficult for the electrologist to insert the needle to destroy the hair root. Also, most electrologists will not treat hair in a mole without a note from a physician stating that it is safe to do so. Laser hair removal is a good option only if the hair is dark.
Boston, Mass.: I am 44 years old and have very nice skin. I am not interested in Botox because I think it looks too fake or plastic. I am interested in having some laser treatments around my eyes and forehead to reduce some of the smile lines I have. Is there a laser that you can recommend that helps to stimulate collagen production and will work on reducing the wrinkles when I smile?
There are lasers that can improve wrinkles on the forehead and around the eyes, and they work best on fine lines. Lasers improve wrinkles by tightening collagen and stimulating collagen formation. Fractional resurfacing lasers, such as Fraxel Re:store and Re:pair, are more effective than many of the older lasers used for wrinkles. In addition to treating fine lines, Fraxel lasers can even out pigmentation and reduce redness. However, laser treatment does not address the dynamic component of lines and wrinkles, meaning that it may not reduce the lines that are formed when you smile or frown. Botox is often better for this.
Potomac, Md.: Hello Dr. Rachel. I'm from India and suffer from under-eye dark circles, which increase or reduce in darkness but never go away. Is it hereditary? Or is it just pure inflammation? Can you recommend a good concealer which is good for the skin as well? Otherwise my face has pretty even skin tone. Thanks for your advice.
Heredity certainly plays a role in under-eye circles. They seem to result from a combination of factors including increased pigmentation in this area in some people, and also from shadows in the hollow area that develops under the eyes with age as the skin and tissue underneath it thin. Concealers are somewhat helpful, but filling in the hollow area with a product such as Juvederm or Restylane is often more effective.
Washington, D.C.: Hello Dr. Rachel! I'm so grateful that you're having this chat! I am 28 and have noticed that the wrinkles on my forehead have become more pronounced, even when I put on extra moisturizer (Clinique brand) and try to stay more hydrated. It's not working. I have fair skin and use a daily sunblock (SPF 40). Is there a way to combat this? I feel like I'm too young to already be developing wrinkles this pronounced. Thank you so much.
There are effective topical treatments for fine facial wrinkles that you can add to your regimen. Sunscreen and moisturizer are a good start. I would consider adding moisturizer with glycolic acid, as I mentioned above, as well as a night cream with retinol. You may also want to consider seeing a dermatologist to get a prescription for a cream containing tretinoin. Also, avoid too much sun exposure. If these interventions don't do enough for you, it may be time to consider a laser treatment such as Fraxel, or Botox for your forehead.
Bethesda, Md.: I recently saw a dermatologist who wanted to prescribe the Obagi (http://www.obagi.com/article/homepage.html) system. I have a few dark spots and freckles, but overall I think my skin is OK. Is there a less expensive alternative? I asked the dermatologist and she said there is nothing commercially available to rival the Obagi or an expensive anti-age serum she sells. Or should I seek another dermatologist's opinion?
Well, here's another dermatologist's opinion! There is nothing unique about the Obagi system. The two main active ingredients it uses can be found in other products. Hydroquinone is present in many fading creams; prescription products generally containing a more effective, higher concentration than over-the-counter products. Tretinoin is the active ingredient in RetinA and Atralin and is also available as a generic product. You could certainly use creams containing these active ingredients without purchasing the entire Obagi system, but you would still need to obtain prescriptions, and the creams tend to be expensive. There are even creams available, such as TriLuma, that combine these ingredients in one product. As for the anti-aging serum, it is hard to comment without knowing the active ingredients, but chances are alternatives are available.
Baltimore, Md.: Is there an affordable anti-aging skin product for young women of color, such as African American women?
There are effective over-the-counter anti-aging skin products, and I recommend the same ingredients for young women of color as for lighter skinned women, since these are the ones that have been proved most effective. Retinol, or its relative, retinaldehyde, can be found in over-the-counter products. Some of my favorite retinol-containing products include LaRoche Posay Biomedic and Skin Medica Retinol Complex. Retinaldehyde, which may be more gentle, can be found in Avene Eluage or Retrinal creams. I also recommend glycolic acid products, such as Skin Medica AHA/BHA cream, and Aqua Glycolic facial moisturizer.
Boston, Mass.: I am a fair-skinned woman in her 30s and I'm already seeing little red veins around my nose! I can typically cover them with makeup but is there any treatment to get rid of them?
Laser treatments are usually very effective for veins around the nose. I would recommend considering treatment with a laser such as the VBeam or KTP, which are both ideal for targeting blood vessels.
Washington, D.C.: What's your take on Radiesse? I've read somewhere that since it doesn't dissolve naturally, you can be left with big lumps and bumps after treatment.
Radiesse is a filler that contains small spheres of a mineral called calcium hydroxylapetite. Radiesse provides a long-lasting effect because the tiny mineral particles stimulate collagen formation. It can do a great job filling folds between the mouth and the nose, and is also used to provide volume in the cheeks and around the chin. When it is injected properly by an experienced injector it is very unlikely to lead to the formation of big lumps. I would recommend seeking treatment only from a physician with experience using this filler. Unfortunately, no filler product is perfect, and it is possible to get lumps from any filler product that is not injected properly, and even sometimes from products that are used properly.
More questions? Send an e-mail to Dr. Herschenfeld.
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