Skincare
Paula Bourelly
Professor of Dermatology
Wednesday, March 02, 2005; 2:00 p.m. ET
Cosmeceutical creams -- a combo of cosmetics and pharmaceuticals -- that promise anti-aging abilities with glycolic acid and dermabrasion treatments are the latest news in an industry that spans the spectrum from the basic Neutrogena to the elite and pricey La Prairie.
Join Dr. Paula Bourelly, assistant clinical professor of dermatology at Georgetown, and washingtonpost.com Fashion and Beauty editor Janet Bennett to discuss what's happening in skin care -- from which sunscreens to use to the safety of the uber-popular Botox to the latest wrinkle in wrinkle reduction.
Submit your questions, comments and rants before or during the show.
Editor's Note: washingtonpost.com moderators retain editorial control
over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
washingtonpost.com:
Hi, everyone, and welcome to our discussion about the dos and don'ts of skin care with dermatologist Dr. Paula Bourelly. I know there are lots of questions out there, so let's get started.
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Washington, D.C.:
Hello!
Do the lotions that claim to deliver whole collagen into the skin and thereby remove wrinkles actually work? There is one that advertises a lot on the web. Are they worth the price--$55/month? Also, should the thin skin below the eyes be treated differently? I'm a 46-year-old caucasian male. Paula Bourelly: Great question, but I'll have to give you a cautious reply. It is very unlikely that you can apply whole collagen to ones skin, and expect to maintain enough potency and activity to achieve wrinkle reduction. Similarly, some of the other anti-aging essentials may be of benefit in one form (for example L-ascorbic acid and Vit C), but be less stable, thus less effective once placed in a bottle that is not light reflective, on a shelf for months. Is it worth the $55 - you'll have to decide. There are, however, some agents that have proven efficacy in the medical literature - many are sold in doctor's offices.
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Chicago, Il.:
Hi Dr. Bourelly,
Are there one or two ingredients that you
would recommend searching for when looking for an
inexpensive ( i.e. available at drugstores as opposed to
cosmetic counters) night time moisturizer?
Paula Bourelly: This depends on your need. If you are just looking for an emollient (moisturizer, and have no great interest in "anti-aging" products, I think looking for the term "non-comdeogenic" on the label is important. This means that it won't cause to develope acne, which can be a problem with some of the heavier, night creams. If you are interested in over-the-counter anti-aging ingredients, look for retinol, vit c or kinetin. The problem there will be no assurance that the one you choose is the one with the most "activity".
The single most important feature of your daytime cream, by the way, is SPF 15 or higher UVA/UVB block. It may help you save on the aformentioned in your nightcream later.
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Pittsburgh, Pa.:
I am an African-American woman who needs some skin care/repair advice. I have a couple of places on my hands and arms where I got a small cut or burn and when it healed, left a dark discoloration in its place. Is there any topical ointment or cream that can fade these dark patches? What causes these, anyway? And, for future reference, is there something I can put on my skin while the area is healing to reduce the likelihood of developing this type of discoloration? Paula Bourelly: What you are describing is "post-inflammatory hyperpigmentation", often times the result of minor scrapes or even blemishes in skin of color. The problem is this type of discoloration can linger for months, sometimes even years.
Hydroquinone(HQ) is the active ingredient in many over-the-counter bleaching aids. It is usually too weak to be of significant benefit, however, in these non-prescription formulas. A prescription strength HQ 4% or higher can have dramatic results, limited primarily by irritation. Protect the areas from the sun, because sun exposure will only make dark spots darker. If this is not helping, I sometimes will treat focal areas with chemical peeling agents to lighten stubborn spots. You are in good company. I see a many people for just this problem.
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Washington, D.C.:
A couple of years ago, I experienced a disorder that caused my face to swell up - a condition called "moon face." Since returning to "normal," my face has sagged somewhat. I was wondering whether, short of surgery, is there anything I can do to "tighten" or "lift" my face? Paula Bourelly: Depending on the areas of laxity, and the extent, you may be pleased with the improvement offered by injecting a safe, FDA approved substance into the folds alongside the lines connecting the corner of your nose to the corner of your lips. There is also a new, non-invasive facial tightening procedure called "thermage". The results, and benefits are still being monitored, but the treatment is being performed in the offices of dermatologists and plastic surgeons. An in-office consultation for you would be very worthwhile.
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Vienna, Va.:
Hi, my daughter who is 4 has pimples/blackheads on her entire forehead only! I've tried Clinique's 3 step treatment (soap, face wash, cream), did not work. What's the best solution? Paula Bourelly: We can treat the acne with standard acne meds (topical antibiotics +/- benzoyl peroxide), but I would be more concerned about why she is having acne so early. I trust that her pediatrician has no concerns about "precoccious puberty", a premature hormonal surge that may need correction by an endocrinologist. Please have her checked by her primary MD first. Let's also make sure that what you are seeing is truly acne. There are other types of skin lesions that can mimick acne in children, and I want to be sure that your daughter is getting the best possible care.
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Washington, D.C.:
First, I am 36 and have extremely oily skin. I use 10% glycolic on my face twice a day and my face looks great. No breakouts, but I cannot control the oil. I can use blotting papers every hour on the hour. Makeup looks awful after an hour. What can I do? I don't wear makeup every day but I do use an oil free sunblock in SPF 30. I am ready to pay any price for something that can control this. My dermatologist is at a loss.
The other issue I have is that I also have acne on my back that I can't get cleared up for anything. I use a 20% glycolic wash followed by a mild scrub. I have been on antibiotics, oral and topical, and the pill. I stopped using fabric softener on my clothes. I am at my wits end. I don't want to use Accutane because I am going to get pregnant soon, but I would like to be able to wear a tank top or a bathing suit during the summer. The acne extends to the tops of my arms (shoulder cap area)
Thanks for any suggestions. Paula Bourelly: If you are happy with your facial regimen as it relates to controlling your acne, but unhappy with the amount of oil that you produce try the following:1. Seban oil control pads (active ingredient = perfluoroalkyl surfactant, Cooper Labs 800-645-5048) - you may need to apply just after you wash in the morning, and again midday. Although topical Retin-A (gel or solution) may be helpful for you, its use is not approved in pregnancy.
2. Switch to a gel based sunscreen ("oil free" may not be enough).
3. When you are wearing make-up, use loose powder in place of foundation - once your oil starts to increase through out the day the powder will absorb it and give you "foundation - like finish" - works great.
4. You may be able to tolerate a higher concentration glycolic acid - check with your derm to avoid irritation.
Back acne can be quite resistant. You are a little bit limited because of your impending pregnancy, but talk with your derm about salicylic acid chemical peels for your back. They can be very effective at helping with the marks left once the acne has cleared.
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Washington, D.C.:
Is the prescription acne drug Tazorac effective at preventing the development of wrinkles in people who don't yet have wrinkles (say, mid-30s) but who are heading in that direction? Paula Bourelly: Tazorac (aka Tazarotene) is commonly used to treat acne vulgaris. There is literature now that demonstrates Tazorac's ability to diminish fine lines and wrinkles. There is every reason to think that starting early may help prevent the common signs of skin aging, even in one who has not yet displayed them. Don't forget your sunscreen - that is the single most effective preventative measure you can take.
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NE:
Dr. Bourelly - I have quite a few deep acne scars that are pretty obvious. Is there any skin care treatment I can use to help them heal? Or at least get smaller? Thank you. Paula Bourelly: Acne scars are classified according to their shape and depth. For some of the more common "crater like" scars, there are a number of in-office procedures including chemical peels, laser resurfacing, and dermabrasion that may lessen their appearance. For deeper "ice-pick" scars, surgical removal with or without grafting of healthy tissue may be indicated. For very superficial depressed scars one may be adequately satisfied by the results of using an at home topical regimen i.e. a retin-a type cream, alpha-hydroxy acids, etc.
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Suitland, Md.:
Hello,
I have a question for Dr. Bourelly thats a little off topic from skin care per se. I went to a dermatologist last year for a prescription anti-perspirant. He prescribed Drysol. It seems to help, but do you have any tips for proper application for maximum effectiveness? Is it safe to use in places other than the underarm?
Also, he prescribed Robinul for entire body perspiration. I didn't really feel a difference with it. Should I give Robinul Forte a try?
Paula Bourelly: Hyperhidrosis (excessive sweating)is a problem that plagues many. Drysol has a slightly higher concentration of aluminum chloride (the active ingredient) than some of the over-the-counter products. For that reason it is frequently prescribed "for application every 3rd day". If this is how you are using it you may receive greater benefit by trying it every other day, or even everyday (if not irritated). I usually have patients shower at bedtime, dry the affected area, and apply. The next a.m. you may apply your regular anti-perspirant/deodorant, since Drysol is not deodorizing.
I personally have no experience with Robinul, the active ingredient of which is glycopyrrolate 1mg. The Robinul Forte is twice the dose (glycopyrrolate 2mg), and although this may be more effective, the potential "anticholinergic" side effects may be more pronounced. Check with your doctor.
I have had great results by treating patients with difficult hyperhidrosis with Botox, if the areas in question are appropriate for Botox injections.
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Washington, D.C.:
I want to use a lightening cream, but I understand that Hydroquinone is temporary. If I fade some spots, then am exposed to sun they will come back. Is there a product that permanently removes spots? Paula Bourelly: In the proper concentration hydroquinone can be a very effective agent for lightening dark spots. That effect can be permanent. The sun can be a major cause of creating or exacerbating dark spots. There is nothing that will remove the dark spots, and prevent their reappearance if you are not protecting yourself from that which caused them initially i.e. the sun, acne blemishes etc.
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Woodsville, N.H.:
I have read that face oils are better
moisturizers than lotions or creams for
dry or normal skin, is this true? I am
not familar with face oils. Thank you for your response.
Paula Bourelly: If you suffer from dry skin then you want to keep in mind that the vehicle of your moisturizer has alot to do with how effective it may be. The from the least moisturizing to the most moisturizing we recommend: gels, lotions, creams, ointments. Some of the "oils" can probably be placed in between creams in ointments, but my experience is that although they look great, they often time don't penetrate dry skin very well. Nothing is better than an ointment (i.e vaseline like) product on exceptionally dry skin. These ointments, however, can cause clog pores and produce acne in susceptible locations.
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Washington, D.C.:
Over the years (I am now 33), my skin has been developing increasing dryness. Also, I have noticed a few wart-like bumps (a cm in diameter) on my face, especially around the eyes. Any suggestions?
Paula Bourelly: There are a number of topical agents that may help you with your dry skin issue, but remember that dry patches can sometimes be a manifestation of sun damage. If all that you truly have is dryness make sure that you are using cream based products rather than lotions. Avoid astringents, a wash with a mild cleanser (cetaphil is one brand of many over-the-counter). The growths that you refer to may be simple benign keratoses, but probably worth having your dermatologist check out to be safe
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Silver Spring, Md.:
Critics used to say that skin could not absorb vitamins like vitamin A and E. Well, new cosmeceuticals continue to profess that they contain vitamins like alpha lipoic acid that are good for your skin. Has anything changed?
Paula Bourelly: We are continuing to monitor the scientific based research to see if what we know happens "in vitro" (in the lab) is reproducible "in vivo" (in the human). There is some data with respect to some of the vit C and retinol products that is very promising.
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Columbia, Nd.:
Hello, Dr. Bourelly. So what works? I (age 44) have been using Alpha Hydrox (10% glycolic acid) and recently added the Neutrogena facial peel product. What would be a logical next step? Are salons any good or do I need to go to a dermatologist? When I did go to a dermatologist a few years ago she just looked for cancer and told me to use sunscreen. I am very confused by everything that is available. Thanks.
Paula Bourelly: I think that the focus of dermatology has changed significantly in the last few years. Although we are still diligently on "the hunt" for skin cancer, many of us are also performing procedures and making recommendations to address the anti-aging needs of our clientele. I think that you may be happy with a higher level glycolic (or other type) chemical peel performed in a medical office. Many salons and aestheticians do a nice job, but there is a limit to what can be done without the supervision of a medical doctor. Since you are already "in the process", you would probably benefit from the expertise of someone who can advance your regimen more quickly.
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Washington, D.C.:
I am 50+ with firm skin and no wrinkles on the face but have large dark areas on both cheeks from sun damage. What over the counter or prescription remedy would you recommend that might remove them? Or what procedure do you think might be suitable should I decide to seek professional help?
Paula Bourelly: There are products over the counter that can be of help, but my suggestion is that you see a dermatologist. This will allow you to receive a regimen tailored to your skin type and needs, and not spend money unnecessarily on products that may not be well suited for your condition. Your dermatologist may suggest a topical regimen with bleaching aids, chemical peels or laser treatment. Go in for a consult.
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Washington, D.C.:
Hi Paula and Janet,
As a twenty-something with combination skin, I'm wondering if it is really "worth it" to use expensive skin care products? I use a daily cleanser, moisturizer with spf 15, acne spot treatment w/benzoil peroxide and under-eye cream. But I mostly stick to drug store brands (neutrogena and oil of olay). What makes pricier brands better and would my skin be much better if I used them? I have some cheek redness, get occasional breakouts and sometimes my skin is flaky, but overall my skin is OK. If I was going to invest in just one expensive product, what would you recommend? Sorry, I know there are a lot of questions in here.
Paula Bourelly: I think for many people, without special skin issues, over-the-counter products work just fine. I particularly like the fact that you are using sunscreen in your 20's - you will be ahead of the game. The occasional breakouts, facial redness, and dryness you described may represent the very early stages of Acne Rosacea. If this is the case a dermatologist can save you some money at the drugstore by prescribing a regimen suited for this condition. It might be worth having a quick consultation to see if this diagnosis applies to you.
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Washington, D.C.:
What other anti-aging ingredients would you recomment for someone with very fair, sensitive skin which is allergic to Vitamin C?
Paula Bourelly: With fair skin your best defense against premature skin aging is your sunscreen. Make sure that it says "UVA/UVB block, and has atleast an SPF of 15. Many people who cannot tolerate retinol products have found the ingredient "kinetin" useful. It is available in some professional lines (sold in MD's offices), but also in the drugstore. Always test your new product on your forearm a few consecutive days before you apply to you entire face - hopefully your allergic reaction will be limited to the Vit C products.
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Western Michigan:
I was wondering what your thoughts were regarding dealing with a small keratosis above the upper lip (tied into hormonal changes related to menopause, I've been told. I did have a biopsy and it is benign. I am an African American woman who lives in an area where there are limited dermatologists familiar with black skin. I've read that various procedures which may be helpful for Caucasians may be detrimental for black skin. Various articles suggest dealing with someone who has experience with black skin.
Paula Bourelly: Benign keratosis can often times be treated with "electrocautery". This a technique that essentially burns them off, but usually leaves little to no permanent scarring if done by "the right hands". I have people apply an anesthetic cream prior to the procedure so that the discomfort is minimal. It may be worth a drive to Detroit if you are not comfortable with the derm care for skin of color in your area. I have a great group for you if you need help locating a doctor.
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Charlottesville, Va.:
Hi Dr. Bourelly,
Thanks for the chat. I have a large scar on my leg from an accident with some boiling water. Can you recommend anything affordable I can use to minimize the appearance. If it helps, I'm a medium-toned Asian girl. Any key ingredients I should look for in a scar-reducer?
PS - A dermatologist I met told me that Asians never get skin cancer and I don't have to worry about it or an SPF. Is this true?
Paula Bourelly: I would like to know more about the age, and description of your scar before I give you a well thought out answer. I what you have is primarily darker pigmentation perhaps a bleaching cream (prescription strength hydroquinone) would help. If what you have is smoothe, and shiney (like a true scar or keloid) then your treatment options would change.
One of the most virulent forms skin cancer, "acral-lentiginous melanoma", affects Asians and African Americans more commonly than their caucasion counter-parts. Its is true that Asians do not get skin cancer at the same rate of frequency than Caucasians, but you can get it. Wear your sunscreen.
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Sterling, Va.:
Are retinols and Retin-A the same thing? Also, is Retin-A still considered a good wrinkle preventative measure?
Paula Bourelly: Both are vitamin A derivatives. Topicas Retinoic Acid is considered a very effective agent for wrinkle reduction, and possibly even skin cancer prevention in certain settings. Retin-A is the brand made by Ortho-Neutrogena.
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Washington, D.C.:
I am a light-skinned black woman with several small moles on the face. What can I do to remove them? Skin lighting cream? Chemical peels? Facial?
Paula Bourelly: If what you have are moles that are raised (i.e. you can feel them when you brush your hand along your face), you would probably get great results with "electrocautery" removal. This is a technique of "burning" the individual mole with an electricity delivering probe. In the right hands it can be done quite painlessly, with little to no scarring.
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Washington, D.C.:
What is a cheap and effective way to remove cherry angiomas? I have several on my face, chest, and torso, and I'd like them gone.
Paula Bourelly: Electrocautery - see your dermatologist. OTC creams are not going to be useful.
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Arlington, Va.:
I have been using high-end skin care products for a while now, but I'm just not sure if what I'm using is right for me. Would going to a dermatologist help sort this out for me and how does one go about choosing a dermatologist? I've seen ads for medical spas - are they any better or worse than a traditional doctor's office?
Paula Bourelly: I think that going to a dermatologist is exactly what you need to do. The medical spas serve a definite purpose, but there is not always a doctor on site. Also, many of the medical spas these days are being run by medical doctors without skincare or dermatology training.
Ask around to see who is good in your area. Make sure that you are seeing someone who also has an interest in the kinds of questions that you will be answering i.e. there are still some derms who prefer not to deal with "cosmetic" issues.
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Another scar question:
About a year ago I had a general surgeon remove a cyst from my back. It's sort-of in the shoulder blade area and I'm an active person to begin with...needless to say it's left a red scar (which stands out on my very pale skin). Someone mentioned getting the scar fixed by recutting, etc. but I'm not so sure I want to deal with that again. What are your thoughts on over-the-counter products that aim at minimizing scars? Is it too late at this point?
Paula Bourelly: At one year your scar is probably still fading in terms of the redness. If what you have is itching, painful or raised you may benefit from cortizone injections or silicone gel sheathing. If the redness of your scar is your only complaint, laser therpay can help to reduce this.
I agree with your instincts. I would be shy to have someone cut the scar out to give you a "better one". The second scar usually has to be longer than the first in order to remove the entire lesion. Good luck.
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Western Michigan:
I just wrote to you regarding the "benign keratosis" problem. Would greatly appreciate any group you could recommend in the Detroit area or possibly Grand Rapids ? (That's probably a long shot..)
Detroit is 3 hrs away, but I may be able to get there. If not, I'll just wait it out until I get to the DC area.
Thanks, again.
Paula Bourelly: I would love to see you in D.C. or Maryland. Until you get here look for Dr. Karen Heidelberg in Detroit. She is worth the drive.
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Columbia, Md.:
Hello,
What can someone do with really dry feet do to soften and moisten them? Thank you.
Paula Bourelly: Make sure that your dryness is not fungus - it can present as dry, sometimes itchy feet that does not respont to traditional creams. Once you know that all you have is dryness, try to use the thicker emollients ie. aquaphor, vaseline, eucerin cream. They can be messy, but they work. You may need to apply twice a day, and sleep in a cotton sock at night to enhance the penetration in the beginning.
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Md.:
I have really dry, flaky skin on my face that just won't stop falling off -- like facial dandruff. I have tried a couple of presciption creams but they don't generally work. People swear by Cetaphil and that too doesn't work, but I continue to use it anyway because I'm tired of 1/2 empty bottles of various products. Any other suggestions? I also have eczema and have had it since I was about 3 -- I'm now 31.
Paula Bourelly: Sounds like you have Seborrheic Dermatitis. Your description of facial dandruff is perfect. This condition may wax and wane with your level of stress or if you have been ill. Seek treatment with a dermatologist because there some very effective creams that will help you keep it at bay.
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Washington, D.C.:
My 2-year old son suffers from eczema. His pediatrician prescribed Elidel but with all of the bad publicity I will no longer use it on my son. Can you suggest anything over the counter that may relieve the itchiness and redness of eczema outbreaks and is appropriate for use on a young child? Thank you.
Paula Bourelly: For a 2 year old with eczema the best thing you can do is keep him "greased up". I think there is nothing wrong with vaseline, and aquaphor for a 2 year old who is not worried about his clothes being ruined.
I must tell you that most of us in the dermatologic community have no changed our prescribing habits with respect to protopic and elidel based on the recent media coverage. Many of the longterm literature on these meds have given us comfort that their use in eczema, as steroid-sparing agents is still quite important.
Lastly, cortizone creams/ointment in moderation under the supervision of a doctor will probably keep the flares to a minimum.
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washingtonpost.com:
Thanks, everyone. Great questions out there. We'll have to do this again soon. Bye for now.
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Hypopigmentation:
I have hypopigmented scarring and have read about an FDA-approved "laser" treatment - that is really not a laser, but concerntrated light. I have found little when I tried to research this. Are there any safety concerns - for example, is the "light" safe or is it like "light" from a tanning booth (potentially cancerous). How many doctors do it and how effective is it?
Paula Bourelly: There is a light base treatment now gaining some press in the medical literature. The treatment is mainly described for vitiligo. There is something different about hypopigmented scars (the components ultrastructurally are different). I am not sure if this would be of benefit for you, but check out google scholar - to read more about the recent literature.
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Laser Hair removal:
Does it really work? I'm fair skinned with dark hair, and have lots of "5 o'clock (underarm) shadow" not long after shaving. Waxing is not for me. So, it's shaving or laser - but who wants to spend all that money for nothing?
Paula Bourelly: laser absolutely work, and the ideal candidates are fair skinned with dark hair. The issue is how many treatments you will need in order to achieve an acceptable result. Consult a derm in your area with the expertise. You may be pleasantly surprised by the cost these days, with so much competition.
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Baltimore, Md.:
How can I get rid of blackheads? I don't have any other acne. I have tried 2% salycic (sp) gel at night, but it does not seem to do anything.
Paula Bourelly: Retinoid base products (retin-a,tazora,differen etc.) are geared towards the treatment of blackheads, and are quite effective. In addition, extractions by a dermatologist or aesthetician would enhance your results.
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Dandruff?:
Hi Paula,
I have what seems to be very persistent dandruff - almost to the point of small scabs on my head. There seem to be a million dandruff shampoos out there - what key ingredients should I be looking for?
Paula Bourelly: Selenium sulfide, zinc pyrithione, tar and salicylic acid are the ingredients most anti-dandruff shampoos have. If you are not improving with the OTC products see a dermatologist who may prescribe for you a cortizone preparation to minimize the scabbing and flakes. They now come in solutions, mousse, oints, and shampoos. Take your pick.
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Washington, D.C.:
What's a good gel-based oil-free sunscreen?
Paula Bourelly: pre-sun has a decent product on the market - spf30
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Tysons Corner, Va.:
Hi there! You are fast with these questions!
I am 41 and have been on Renova for 2 years. I'm also scrupulous about wearing an SPF 30 moisturizer at all times. In general, my skin is pretty good, except for the long days of winter when it starts to flake , peel, get red, erupt, crack and bleed in patches (nb, my skin is pretty much used to Renova). Right now I've tapered Renova off to every other day, but it's still breaking out.
A friend of my husband's (a guy) said that his skin did the same thing, that it ended up being psoriasis, and he cured it by washing with dandruff shampoo. This sounds wacky, but I'm close to desperate.
Paula Bourelly: If you are not able to control the dryness of your skin using traditional moisturizers I schedule a derm visit. It is true that sometime these eruptions that seem to merely be dry skin are something a little more - any you could save yourself alot of aggravation,and money by getting the right therapy early. Good luck.
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