FEBRUARY NEWSLETTER

What... Injure my skin to make me look better?

This newsletter will be part one of a three part series discussing the various resurfacing technologies available to repair damaged skin. Our discussion today will cover what the human eye sees when someone looks at your skin; topical medications and cosmeceuticals, and lastly chemical peels.

Why do our eyes focus on the wart on a witch’s nose?

There are two conditions that the human eye notices when looking at skin. One is color variations compared to the surrounding skin (dyschromia). This can show up in the form of lighter pigmentation (hypopigmentation), darker pigmentation (hyperpigmentation), or redness (erythema). Among these three items hypopigmentation is probably the most difficult to correct. Hypopigmentation is usually due to an injury process that results in permanent damage and many times can only be corrected by permanent make-up or hidden by camouflage make-up. The second condition that the human eye notices is unevenness in the skin manifested by shadows. This can show up in a lesion that sticks out above the level of skin or a lesion that is below the level of the skin. Light striking the lesion head on will make it less noticeable compared to light striking the lesion at an angle which causes shadow formation. This is why lighting is so important to a photographer. Sunlight with its resultant photo damage and acne are two common causes of dyschromia and scarring. Basic things you can do to prevent damage to your skin include avoiding sunlight, not smoking, and drinking six glasses of water daily.

Improving your skin with topical medications and cosmeceuticals.

Aging skin is a dynamic process, caused by intrinsic and extrinsic factors. Intrinsic aging is related to genetics while extrinsic factors can be avoided. Sunlight exposure and smoking are the most significant extrinsic factors responsible for age related changes in the skin. Changes in photo-aged and smokers’ skin include increased roughness, mottled hyperpigmentation, loss of elasticity, and wrinkling.

Darker skin types are fortunate because their skin is naturally more protected from sun damage than lighter skin types. The disadvantage of having a darker skin type is that treatment of sun damage may result in more complications.

The primary way to avoid damage to your skin is to not let the damage occur. To avoid photo-damage and photo aging you need to use a sunscreen daily whether you are indoors or outdoors (see our November Newsletter and December Newsletter on sunscreens). In addition, when outside, add protection by wearing a wide brim hat, gloves, long sleeved shirt and sunglasses.

There are many topical products that you can put on your skin to protect it and improve the texture, dyschromia and line formation. These products fall into the following categories: medications, cosmeceuticals and over the counter preparations. Medications are drugs regulated by the Food and Drug Administration (FDA). Drugs that are FDA approved have undergone extensive testing and trials to prove that the drug is effective for the condition being treated and the risk/benefit ratio is acceptable for public use. The FDA, on the other hand, does not regulate cosmeceuticals. A cosmeceutical may or may not be effective. The concentrations of the active ingredients in cosmeceuticals are less than that of medications.

Several topical medications can help improve your skin with consistent use. One of the better known medications is tretinoin or Retin-A. Tretinoin improves skin by thinning and compacting the outer most layer (improves texture), thickening the epidermis (improves skin hydration and helps to smooth out fine lines), dispersing melanin throughout the epidermis (evens out pigment), stimulating dermal collagen deposition, and increasing glycosaminoglycan deposition which helps slow down volume loss. Tretinoin is usually applied nightly. Drawbacks to tretinoin include increased redness or spider veins in one’s skin, especially on the face. Tretinoin is available via prescription and many cosmeceuticals contain various forms and concentrations of tretinoin.

Hydroquinone is a medication that can improve pigmentation in the face. Over the counter it comes in strengths up to 2%, while prescription strength is 4%. It works by blocking a protein that contributes to the formation of the pigment melanin, thus evening out pigmentation in the skin. Hydroquinone must be used daily. When discontinued, exposure to sunlight results in recurrence of pigment changes. Hydroquinone contains the preservative sodium metabisulfite (common food preservative), which can cause an allergic reaction. In rare cases hydroquinone can result in permanent hyperpigmentation with prolonged use. Kojic acid is an alternative treatment if hydroquinone is not tolerated.

Alpha hydroxy acids (AHAs) and beta hydroxy acid (BHA) (the only beta hydroxy acid is salicylic acid) improve the skin in a manner similar to tretinoin. Salicylic acid can penetrate the oil in pores so it may act as a better exfoliant for acne prone or oily skin. Many over the counter preparations and cosmeceuticals contain AHAs and BHA in various concentrations.

Many of these skin care products can be used together but they should be instituted in a stepwise fashion. This makes it easier to eliminate a single product that may be causing irritation or sensitivity. It is important to learn to “read” your skin when using these products. These products can also increase your sensitivity to sunlight so sunscreen use is a must. Expect to see improvement in your skin in the following order over a period of 2 to 24 weeks: texture, pore size, pigmentation, and wrinkles.

 

Chemical Peels… Burn & Turn.

Chemical peels are an excellent method to treat sun-damage. Chemical peels achieve optimal results with pigment and textural changes in the skin. In our Clinic, we use ultraviolet light to assess how well an individual’s pigment changes will respond to a chemical peel. A chemical peel can improve lines and scars but their results for these conditions are limited and this usually requires a deeper peel, which can result in more complications. Chemical peeling is an accelerated form of exfoliation, and essentially induces injury to the skin to stimulate inflammation and healing. Chemical peels improve the skin through three mechanisms: stimulation of epidermal growth through removal and renewal of the outer most layer of dead skin cells, destruction of specific layers of damaged skin, and the induction of an inflammatory reaction deeper in the tissue than the damage induced by the peel.

Chemical peels are usually classified as superficial, medium or deep. The depth that the peel reaches in the skin is important because deeper peels increase the risk for complications and increase healing time. Resurfacing the skin whether it involves a chemical peel, dermabrasion, or a laser peel depends on skin structures for the healing process. When upper layers of the skin are damaged, the replacement skin grows out of or covers the injured skin from hair follicles, oil glands and/or sweat glands. If the resurfacing goes below the level of these accessory structures, scarring will result. Facial skin is ideally suited for resurfacing techniques due to the preponderance of these accessory structures.   

Prior to undergoing a peel, the physician may make suggestions to “prime” the skin. Priming the skin is an attempt to reduce complications and speed up the healing process. This usually involves using a combination of topical agents including tretinoin, alpha or beta hydroxy acid, and/or hydroquinone. Priming should occur for a minimum of two weeks for the process to be effective.

The discomfort associated with a superficial and medium depth peel can usually be controlled with a fan and by taking two aspirin prior to the peel. Superficial peels involve about 15 to 30 minutes of discomfort at most. After the peel you will have a specific set of instructions to follow. The instructions mainly concern sun avoidance, cleansing and dressing the skin, no picking or peeling of the exfoliating skin, and avoiding the direct spray of a showerhead to the peeled skin. Avoidance of sunlight and tanning are mandatory for a period of three to four weeks prior to the peel. Make-up can’t be worn until the skin quits peeling.

In summary we have discussed some of the methods available to improve texture, dyschromia and lines in your skin. Next month we will discuss the resurfacing technique of MicroDermabrasion/Dermabrasion and the following month we will discuss laser peels.

 

February Special

See Additional News below!

 

Additional News

Newsflash--- In the month of February Integrated Skin Solutions will be hosting two special events. Discount pricing on products and services will be offered at both events. Due to the great deals to be had, Integrated Skin Solutions will not have a traditional Special for the month of February.

The first event is Thursday February 9^th starting at 6:30 PM and ending at 9 PM. This will be our “Love the Skin You’re In” Demonstration Night. We will have live demonstrations this evening on patients including Botox injection, Restylane injection, Sciton MicroLaserPeel, and Sciton Broad Band Light (BBL) Facial Rejuvenation. This event will be limited to the first twenty five people who RSVP. Leave your spouse and/or kids at home, bring a friend and have some fun! We’ll give you the real scoop, just like Oprah.

The second event is an Open House on Saturday February 11^th from 10 AM until 6 PM. Stop by and see what services we have to offer, meet our staff, and get your skin questions answered!

At both events refreshments and hors d’oeuvres will be served. Be present at either event to enter a drawing for a free Botox treatment as well as prizes and free samples. Don’t miss out on the discount pricing. Plan to attend, resistance is futile!

That concludes our monthly newsletter. We hope you enjoyed the information. Check out our website at www.integratedskin.com. If you would like to be removed from our mailing list notify us at info@integratedskin.com (send your email address in a separate message- a reply to this Newsletter will not contain your email address).

Sincerely,

John Carter, MD, Julianne Mazurek, MD, and Donetta Taylor

Integrated Skin Solutions- “Where looking good is understood!”

7424 NW River Park Drive (Hwy 9)

Parkville, MO 64152-5028

816.505.5550 Fax 816.505.4550

www.integratedskin.com

Questions or comments- info@integratedskin.com