Texas Cosmetic Dermatology Blog

This segment was aired on Friday 6/18/2010 on CBS evening news. I would like to thank my patient, Janelle for volunteering for the video.
Click CBS 11 news link to watch video:

Creams Offering Lighter Skin May Bring Risks. Click to read the entire article in New York Times.

Skin lightening cremes are commonly used to lighten dark spots caused by acne and other inflammatory skin conditions or melasma,

Typically skin lightening cremes contain a combination of Hydroquinone and Topical steroids. These cremes can have potentially dangerous side effects and should always be used under Physician supervision. Long-term use of topical steroids can lead to localized effects on skin such as skin thinning, formation of new blood vessels, increased incidence of localized infection and acne. Long term use of topical steroids especially on larger areas can lead to systemic side effects such as hypertension, elevated blood sugar and suppression of the body's natural steroids.

Some studies link long term use of Hydroquinone 4 percent to increased incidence of skin cancer, it is prescribed for short-term use to lighten skin pigmentation but should be used with Physician supervision. Hydroquinone 4% has been banned in Europe. Over-the-counter versions contain 1.9 percent hydroquinone, but bootleg versions are being sold with 4 percent or even higher concentration.

Another side effect of hydroquinone is blue-black darkening of the skin, more common in individuals with darker skin types.

If you need more information on treatments to lighten dark skin spots or Melasma, call our office 888-210-9693 or visit our website .

LEGAL DISCLAIMER

The information on this Web site is provided by Naila Malik MD for educational purposes only. It is not a substitute for professional medical care, and medical advice and services are not being offered. If you have, or suspect you have, a health problem you should consult your physician. Only your doctor can provide you with advice on what is safe and effective for you. Never disregard professional medical advice or delay in seeking it because of something you have read on the Site!
THE SITE DOES NOT PROVIDE MEDICAL ADVICE.

Hyperpigmentation (darkening) is caused by an increase in melanin deposits in skin. Conditions such as pregnancy or Addison's disease ( adrenal gland dysfunction), may increase melanin production and hyperpigmentation. Exposure to sunlight is a major cause of hyperpigmentaion, and will darken already hyperpigmented areas.

Hyperpigmentation can occur from certain drugs such as malaria medications, anti arrhythmia medications and some antibiotics. skin inflammation such as following eczema, infection , burn or inflammatory acne lesions etc can lead to dark pigmentation especially in Olive skin individuals.

Melasma is characterized by tan or brown patches, most commonly on the face. Melasma can occur in pregnant women. Men can also develop this condition. Melasma frequently goes away after pregnancy. It can also be treated with certain prescription creams (such as hydroquinone).

For my patients with melasma or other hyperpigmentation I suggest general measures such as limiting exposure to sunlight, using a broad spectrum SPF 15 or higher at all times, because sunlight will worsen the condition. Sunblocks containing zinc oxide or titanium dioxide are best.

Hyperpigmentation is difficult to treat and poor response to treatment leads to frustration among patients. I have treated many patients with this disorder and tried different approaches to this skin condition. I use a custom compounded creme which seems to work better that traditional preparations such as Hydroquinone, Triluma and other similar preparations.

I have also noticed some advantage of combining compounded topical bleaching agent with Office treatments like Microdermabrasion or specialized chemical peels. Each patient is unique and the treatment and results vary with individual skin type.

Consult with your doctor before treating the condition yourself.

If you would like to discuss your treatment options, please visit our website or call our Southlake TX office at 888-210-9693 .

LEGAL DISCLAIMER

The information on this Web site is provided by Naila Malik MD for educational purposes only. It is not a substitute for professional medical care, and medical advice and services are not being offered. If you have, or suspect you have, a health problem you should consult your physician. Only your doctor can provide you with advice on what is safe and effective for you. Never disregard professional medical advice or delay in seeking it because of something you have read on the Site!
THE SITE DOES NOT PROVIDE MEDICAL ADVICE.

As winter approaches in DFW Texas more and more of my patients seek the right moisturizer for their skin.
Skin Moisturizing Mechanism
The outermost layer of skin, the stratum Corneum (SC), forms a crucial barrier to prevent water loss and penetration of chemicals, bacteria, viruses and other irritants.

The components of SC, bricks (Corneocytes) and mortar (Lipid bilayers) are easily disrupted by hostile environmental conditions and cleansers.

Our skin produces a hygroscopic "Natural Moisturizer Factor (NMF) to prevent water loss. NMF is sealed within corneocytes by the Lipid bilayer. When the lipid bilayer is breached, the highly soluble NMF is lost on contact with water, (thus the paradoxical drying of skin with water soluble cleansers)

Here a few of the most commonly asked questions by my patients in Southlake TX .

Does everyone need moisturizer?
Yes

What are the key ingredients that MUST be considered?
Traditionally moisturizers are formulated with three types of ingredients:

• Humectants: These replace function of lost NMF. These products attract and hold water in the skin form underlying epidermis and sometimes from the environment depending on the humidity. Examples are Glycerol, Sorbitol, propylene glycol, urea, lactates, and salts of hdroxy acids. Humectants support the hydrated environment required for enzymatic digestion of desmosomes enhancing desquamation (reducing scale associated with dry skin)


• Occlusives: These form a water impermeable barrier on skin surface. Petrolatum is the archetype occlusive agent. I use it liberally for my patients with dermatological skin conditions such as Eczema, Psoriasis and severely dry skin. It is not practical for everyone. Other occlusive agents are Lanolin, mineral oil and silicones like Dimethicone. Dimethicone is suitable for everyday use for most skin types.


• Emollients: These are lipids and light weight oils that keep skin soft and supple by improving hydration. Examples are long chain fatty acids and alcohols such as Stearic, Linolenic, Oleic acids found in Palm, coconut and other natural oils.
  

  Does price matter?
  For a "plain moisturizer" No
  For someone with extremely dry skin, "Aquaphor" or "Eucerin Plus" is great choice at low price. I use these frequently for my patients and for my body.
  For facial use, a lighter weight moisturizer is more suitable (Naila MD Replenish)

  How do you choose moisturizer for Dry vs. Oily skin?
  I usually combine different products to get a well rounded effect. I "layer" products to maximize efficiency. I use heavier products for dryer skin types and light weight products for my patients with oily skin. For acne prone oily skin, I use very light weight moisturizers layered with Alpha hydroxyl acid cleanser or exfoliant pads for better penetration without pore blocking.

  Does the moisturizer routine need to change based on season?
  Yes

  Generally people need heavier/more moisturizer during winter.
  The NMF is composed of free amino acids derived from Filaggrin, a protein in the Epidermis. Filaggrin is converted to NMF when skin hydration is low, thus making Filaggrin-NMF system an elegant regulatory system for maintenance of skin moisture.
  This Filaggrin-NMF system cannot instantly respond to rapidly changing environment that occurs from transitioning between centrally heated buildings and cold exteriors, requiring extra moisturizer in these conditions.

  How does age factor into moisturizing choice?
  First of all as we age the Filaggrin-NMF system becomes less efficient, leading to higher incidence of dry skin requiring extra moisture. We might need more frequent use or a heavier moisturizer with advancing age.

  Secondly, for aging patients, I like multi tasking products like moisturizers with antioxidants, anti inflammatory and other anti aging ingredients (like UGL) that increase skin hydration from within.

  Here are a few additional things I like to consider when treating dry skin:
  

  
  
  • I like use of exfoliation to enhance penetration of moisturizers into the skin. I prefer alpha hydroxyl acid products for gentle exfoliation.
  
  
  • Oral intake of good fats such ad Olive oil, Salmon, Walnuts help retain moisture in the skin in addition to topical products.
  
  
  • Hydration with adequate water intake is equally important in maintaining skin moisture.
  
  
  • Choosing the right cleanser is equally important to keep skin moisture. I like very gentle cleanser like Cetaphil for dry sensitive skin and a non drying deep pore cleanser with Glycolic acid (Naila MD Refresh ) for acne prone/large pore skin.
    
    If you are looking for a new moisturizer, please contact our Southlake Texas Dermatology office 888-210-9693for Naila MD product samples or to make an appointment with Dr. Malik for skin evaluation.

    LEGAL DISCLAIMER

    The information on this Web site is provided by Naila Malik MD for educational purposes only. It is not a substitute for professional medical care, and medical advice and services are not being offered. If you have, or suspect you have, a health problem you should consult your physician. Only your doctor can provide you with advice on what is safe and effective for you. Never disregard professional medical advice or delay in seeking it because of something you have read on the Site!
    THE SITE DOES NOT PROVIDE MEDICAL ADVICE.