Archive for June, 2014
The eyelids are one of the most common places for skin cancer and the first place we see the signs of aging. Skin cancer in this area is especially dangerous and hard to detect. Luckily, there are products that can protect the delicate skin around the eye.
The eyelids are very susceptible to skin cancer and the aging effects of UV exposure. About 10% of skin cancers occur on the eyelids, which is kind of shocking when you consider that the face/head accounts for less than 5% of the total body surface area. There are many additional concerning factors regarding skin cancers on the eyelid. There is a significant risk for tissue damage to nearby vital ocular structures and even blindness. Tumors in this area can also spread into the nasal and orbital cavities (the area behind the eye). Let not forget that the skin of the eyelid serves to protect the eye and when that skin has to be removed we are presented with a host of issues such as preventing infection and reconstruction of the eyelid is very difficult. Early detection can be challenging because these tumors tend to grow inward toward the deeper layers of the skin and bone, before they are seen on surface of the skin. The appearance of this type of cancer varies and looks different than other types of skin cancers, making detection even more difficult. Reoccurrence of skin cancer on the eyelid is among the highest. It is important to take measures to prevent skin cancer, and become an established patient of a good dermatologist before you think you need one.
As if cancer was not enough, photo-aging of the eyelid is another concern. Photo-aging is a term used to describe sun damage and premature aging caused by UV exposure. Consider that the skin is a direct reflection of health and that sun damaged skin is not healthy skin. Photo-aging goes beyond vanity, it really is about skin that is not functioning properly or at a healthy state.Sun damaged skin will have lowered immunity against infection and impaired wound healing ability. Furthermore, UV rays age skin cells, damage DNA, break down collagen, elastin and damage pigment producing melanocytes. All of this equals unhealthy skin that is thin, lax (loose), with lines wrinkles and skin discoloration. There are products and treatments that can be done to improve these issues, but it will take time, money, and a little work.
Prevent the damage and reduce risk of cancer
The first line of defense is a broad spectrum sunscreen SPF 30 or more. The eyes and the skin around the eyes are sensitive to chemicals in sunscreen so you should look for a physical sunscreen, meaning the only two active ingredients are Titanium dioxide and Zinc oxide. I like Physical Eye UV Defense SPF 50 by Skin Ceuticals, it is a non-migrating, high protection sunscreen designed specifically for the upper and lower eyelids. This is a pure physical sunscreen that you apply like and eye cream. The formula is tinted to enhance tone, however it will nor provide coverage like a cosmetic. I like to say it’s tinted for a man. It blends right in and doesn’t settle into fine lines or make your eye area appear dry/cakey. the ceramics in it will nourish the skin, but I still recommend using your usual eye cream first then SPF.
For additional protection I recommend using a topical product with vitamin-C, every morning. While sunscreens absorb or reflect out UV radiation, antioxidants such as vitamin-C neutralize the UV rays. Photoprotective topical antioxidants work by the inhibiting the UV-induced biochemical changes that lead to photoageing and DNA mutations.
Studies show that sunglasses do help protect eyes from UV damage, however some UV light can still get to the eye area, depending on the type and style of sunglasses. Look for sunglasses with UVA/UVB protection and remember that sunglasses do not eliminate the need for sunscreen.
The Eyelids: Highly Susceptible to Skin Cancer / Skin Cancer Foundation
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The eyes are the focal pointe of the face and one of the first places we start to age. A professional chemical peel to treat the skin around the eyes, may be just what the doctor ordered.
A Medium Depth Peel will..
– Treat skin laxity, fine lines, “stretchable” wrinkles and scars.
– Improve skin texture, reducing roughness
– Treat hyper-pigmentation Brown spots and Melasma
– Tighten large pores
– Increase collagen and skin density
The skin around the eyes is thin and with age begins to show fine lines and take on a crepey texture. Treating the delicate skin around the eye can be tricky. Lasers can damage the eye, so this limits how we treat this area. Laser resurfacing can be done, if special laser eye shields are placed inside the eye. Chemical peels are another option for treating the skin around the eye, and when done by a skilled professional can be done up to the lash line.
Chemical peels that penetrate to the appropriate depth in the skin, can improve texture and tighten skin. A TCA peel that penetrates beyond the papillary dermis, just to the Immediate Reticular Dermis (IRD) will provide skin tightening effect, this is called a Medium Depth Peel. I am choosing not to mention the strength of TCA used, because I read too many horror stories online about people who attempted to do a professional peel at home. Skin care professionals are trained on how to determine where we are working in the skin, this is a medical grade peel and should be done by an experienced professional.
Aging Skin and Chemical Peel Intervention
Skin care professionals often talk about “skin cell turn over”. Skin cell turnover is the process of a new skin cell being produced, working it’s way up to the surface and replacing old skin cells which have been sloughed away. In young healthy skin this process takes about 6 weeks, however aging and sun damage slow this process. Chemical peels increase skin cell turnover, which in turn improves skin texture.
The production of growth factors, collagen, elastin and hylaraunic acid all slow with age, so the goal in anti-aging is to preserve and increase the production all of these things. Collagen is a protein that gives skin it’s volume strength and structure, while elastin is what gives skin it’s elasticity or ability to snap back. Hyaluronic acid is a key molecule involved in skin moisture, as it binds and retains water. Hyaluronic acid is also needed to bind collagen to elastin. When we do chemical peels and laser treatments that penetrate beyond the skins epidermis, we are benefitting from the skins own wound healing ability to up regulate growth factors and stimulate the production of collagen, elastin and hyluranic acid. The result is a thicker dermis, smoother surface and skin tightening.
What to expect
The day of the peel is considered day 1. On days 1 and 2 your skin looks okay, but it may look dry and slightly older. By day 3 skin begins to look dark or bronze, this will vary depending on your natural skin color, skin discolorations and depth of peel. Skin usually begins to peel on day 4 and is usually done by day 5. After the skin has peeled of it may be pink for a couple days. The healing process does vary for each person. Healthy skin will always recover more quickly with less inflammation.
During the peeling process you will need to follow the post peel instructions given to you by your skin care professional. This usually includes using a gentle cleanser, a hydrocortisone cream and mild moisturizer. An occlusive ointment such as Vasoline or Aquaphor may be recommended. It is VERY important to not pick or pull off the skin, let it peel in its own time! (seriously… don’t do it) You should also avoid sweating during the pealing phase, because it will create sweat beads under the skin that will cause it to peel of prematurely and thats bad. The skin should be protected with a totally physical sunscreen, I like Physical Eye UV Defense SPF 50 by Skin Ceuticals.
After the old skin has peeled off, it instantly looks and feels smother. The collagen production will continue to increase and the skin will continue to feel tighter. To keep the skin renewal process un regulated and functioning more similar to young skin, I usually recommend having around 4 TCA chemical peels around the eye area per year. Treatments should be scheduled over 6 weeks apart.
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Throughout my career in medical aesthetics, Pseudofolliculitis and ingrown hair has been a common concern. Often times it’s men who mistake the condition for acne, other times it’s someone who has had an infection and a doctor recommended they get laser hair removal. The bad news is, that it can be more serious than you might think. The good news is, it can be treated!
What is Pseudofolliculitis?
Pseudofolliculitis commonly known as “razor bumps” or “ingrown hair” is an inflammatory condition in the skin and hair follicle caused by shaving, waxing and ingrown hairs. Pseudofolliculitis can occur anywhere on the body hair grows, however it most commonly occurs on a mans beard and for women on the bikini and underarm area. It tends to be more common in those with curly or coarse hair.
There are two types of Pseudofolliculitis, extrafollicular and transfollicular. Extrafollicular pseudofolliculitis or “razor bumps” occur when curly hair grows back into a hair follicle. Transfollicular pseudofolliculitis or “ingrown hairs” occur when the hair never leaves the follicle, this can happen if the hair grows at an angle. The hair keratin causes inflammation in the skin, usually seen as pustules that look similar to acne.
Concerns and complications associated with Pseudofolliculitis?
Pseudofolliculitis can be painful, embarrassing but more concerning is that it can lead to scars, secondary infection or become abscessed. You may not think that an ingrown hair is a big deal, but it has been associated with serious secondary infections such as MRSA. When there is damage to the skin, it becomes more susceptible to bacteria such as Staphylococcus. It is not unusual for an ingrown hair to become infected with “staph” or become abscessed. In extreme cases, if left untreated staph can lead to a very serious blood infection known as sepsis. These infections can spread and be contagious. If you suspect an infection, you need to seek immediate medical attention.
Laser hair removal remains the best treatment option for Pseudofolliculitis. A series of treatments will be needed, generally spaced 4-6 weeks apart. Another option is to quit shaving, waxing or tweezing and let the hair grow, but if that doesn’t work for you there are some things you can try. When shaving, start with cleansing the area with an exfoliating cleanser that has glycolic acid or some type of an AHA. I also recommend the Clarisonic cleansing brush, which will help to lift the hair. Before you shave place a steamed towel over the area, being careful not to burn your self. For sanitary reasons, I prefer a new razor. Avoid shaving too close, do not stretch the skin or shave against the direction of growth. If you have pustules, you may also be prescribed a topical antibiotic.
Chemical peels and skin care products that contain chemical exfoliant can help with skin discolorations and help to prevent hair from becoming ingrown. - ” the reducing properties of glycolic acid may reduce sulfhydryl bonds in the hair shaft, resulting in straighter hair growth, and thereby may potentially reduce the chance for re-entry of the hair shaft into the epidermis. Salicylic acid peels offer exfoliation and lightening in cases complicated by PIH. Reduced numbers of PFB lesions have been observed with both glycolic acid and salicylic acid peels.” Expert Rev Dermatol. 2009;4(6):595 Dermatologic Conditions in Men of African Ancestry by Marcelyn K Coley, Andrew F Alexis
Laser hair removal for skin of color, is challenging, but possible. If you have dark skin, be sure to find a laser technician that is also a skin specialist and has experience treating your skin type. Your specialist may recommend preconditioning the area prior to having laser treatment, it is important to comply with all instructions. We make these recommendations to prevent you from getting a burn. They may also suggest doing a test spot first to see how you respond to the laser treatment.
Treating the scars
Pigmented scars are the most common and can be treated consecutively with laser hair removal treatments. Pigmented scars can usually be treated with prescription strength skin care products, and chemical peels. Depressed scars require a deep treatment such as micro-needling, fractional laser resurfacing or dermabrasion. It is best to treat depressed or raised scars when the condition is well controlled. Keloid scars are very complicated and need to be diagnosed and treated by a dermatologist. I want to specify that keloid scars need to be diagnosed by a dermatologist, because raised scars are sometimes confused with keloid scars.
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