Ask Jodi

Winter-whipped skin! Now what?

Posted on by Jodi LoGerfo
Question:  I have been using a Retin-A (tretinoin) anti-aging  skin-care regimen but with all this extreme winter weather my skin is chapped, cracked and looks and feels terrible. What should I do? Answer: You may need to adjust your skin-care routine and anti-aging product use during the winter when your skin is exposed to extreme cold, wind, snow as well as extreme drying from indoor heat.
  • Reduce Retin-A use. The great thing about Retin-A is that you can cut down your usage and it still continues to work. Instead of using your Retin-A twice every day (at bedtime) try applying it every other day or even two or three times a week. Experiment with the amount you can use without causing the drying effects.
  • Switch out the Alpha Hydroxy Acid lotion. Instead, use an emollient (thick) cream moisturizer to help avoid cracking, peeling and chapping. You can even apply this over your Retin-A.
  • Leave the long, hot showers.  Hot, hot water irritates skin's top layer and also strips it of its natural oils, leaving it unprotected and open to cracking and peeling. Instead  take a quicker, lukewarm shower, less than 10 minutes tops, and pat skin dry gently (no harsh rubbing on skin or hair). While skin is still damp, apply a  super-rich cream moisturizer for hands, feet and anywhere else you are dry and cracked.
  • Don't forget the sunscreen. Just because it's not summer doesn't mean the sun is not strong. Skin is always vulnerable to the sun's damaging UV rays so I always recommend patients use a daily facial SPF of at least 30. Especially protect skin when doing winter sports such as skiing or ice-skating outdoors - some of the most severe sunburns occur while skiing since snow reflects sunlight (plus the wind-burn). Don't forget to protect lips with a sunscreen, too.
  • Try a humidifier. If the heating air in your home is especially drying to your skin, turn on a humidifier all day and all night to help keep skin and nasal passages from drying out.
How have you changed your skin routine for the winter?

Does minoxidil cause facial wrinkles?

Posted on by Jodi LoGerfo

Question: I have been using Rogaine for 6 months and I have recently noticed several deep wrinkles forming under my eyes, specifically the side I sleep on.  I know there are some testimonies on the internet and on Wikipedia about minoxidil causing collagen depletion so I’m wondering if this is true or just an internet rumor?

Answer:  So, I dug down to the research for your answer. Minoxidil has been shown in cell culture (outside of the body, also called, in vitro) studies to have range of inhibitory effects on skin fibroblasts (a type of cell that produces collagen). It has also been reported that minoxidil hinders collagen synthesis and inhibits the effects of specific growth factors, substances that are capable of stimulating cellular growth, in cultured hair dermal papilla of rats (yes, rats, not humans!) But applying these results obtained in cell culture studies or rats to the use of minoxidil in humans is uncertain.

There are no human studies demonstrating that minoxidil causes collagen depletion or wrinkles as a side effect (and there are many studies of minoxidil effects on humans). Even though there are anecdotal reports online stating this, minoxidil has been used for over 25 years and there are no real complaints or published reports in clinical practice (with patients).

You are smart to ask a professional when faced with internet rumors, especially when it comes health issues, because side effects of medications and even over-the-counter products are largely personal. Also, facial wrinkles are known to form in response to repetitive muscle movements such as facial expressions and patterns over time, such as the side you sleep on. A good idea would be to schedule an appointment with a dermatological practitioner to review your age, medical history, lifestyle (such as sun exposure) and skin and hair loss condition as well as your usage of minoxidil to see if any alterations (a weaker percentage or foam instead of liquid) or additions to your treatment plan need to made.

How to avoid and treat dark spots

Posted on by Jodi LoGerfo

Post-inflammatory HyperpigmentationQuestion:  All I had was a simple pimple – why did it leave such a dark spot and how can I get rid of it as quick as possible? 

Answer:  Of course the answer’s not that simple! Everyone’s propensity to form a dark spot in response to anything that causes skin redness and swelling,  (medically called post-inflammatory hyperpigmentation) varies depending on skin type, ethnicity and racial group as well as the severity of the inflammation and its duration. That’s because the amount melanin (light-absorbing pigment) and type of melanosomes (pigmented skin cells)  have a significant impact on the formation of a dark spot in your skin. To avoid dark spots from forming at all costs, it’s a good idea to first know what skin type you have. Your Fitzpatrick Skin Scale type depends on genetic disposition and your skin's reaction to sunlight and tanning. Dark spot intensity and duration is linked to skin hue and more pronounced in skin of color, especially phototypes IV-VI. Click the link above to take the quiz and find out if you’re more at risk for developing dark spots, then read on. What causes dark spots?

  • Any skin disease, infection or injury-producing inflammation
  • Acne
  • Insect bites
  • Razor bumps (pseudofolliculitis barbae or PFB)
  • Allergic or contact irritation (dermatitis)
  • Surgical or cosmetic procedures

Treat recurring conditions immediately! The darkness, or intensity, of the spot, area or scar left behind depends on the duration of the inflammatory process underneath the skin and whether or not is has a chance to reach deeper tissues and cause damage. In response to a skin eruption or inflammation, melanin is over-produced at the site causing the skin-darkening. The longer the period of inflammation, the darker the postinflammatory hyperpigmentation response so action should be taken to avoid or intervene on any known causes of inflammation such as acne and PFB and treatment should be instituted as quickly as possible to stop the inflammation from damaging skin’s deeper tissues and causing the dark spot response. Skin conditions with a recurring nature such as acne or PFB intensify the hue of dark spots as do skin diseases that disrupt skin's basal layer such as lichen planus, psoriasis eruptions and lupus) Stay out of the sun! In addition to any post-inflammatory response, UVA and UVB exposure also stimulate increased melanin production so limit sun exposure by walking on the shady side of street, wearing a hat, sunglasses and use sunscreen daily  on exposed, inflamed, irritated or healing areas. Sun exposure frequently darkens hyperpigmentation and chronic sun exposure may result in a longer resolution period of any dark spots. Don’t let scabs form! For any skin eruption (acne, insect bite), injury or surgery where the skin is open (no matter what the cause) never let a dry scab form and never pick at, squeeze or further exacerbate the inflammation! Acne surgery can be performed by medical professionals to  help acne heal faster to avoid skin damage and spots. Keep the area covered with antibiotic ointment until there is no crust at all and new skin is formed. And keep that area out of the sun the whole time it is healing and protected with sunscreen at all times until skin has returned to normal. Rx for already-formed dark spots Hydroquinone 4%:  This melanin-inhibitor is the most widley-used  active ingredient to fade dark spots. It is available at 4% strength by prescription only and at weaker concentrations (which you can try first) over-the-counter. Depending on the age and darkness of a dark spot, therapy may be required for 20 weeks, although you may see results much sooner than that.  If only used on one spot, sometimes a light ring of lighter skin surrounds the area like a halo, and this halo effect disappears when the hydroquinone is discontinued.  Do not use hydroquinone if it is a known allergen and watch out for any irritation or further discoloration (called exogenous ochronosis) in which case hydroquinone should be discontinued. Azelaic acid:  An alternate, but slightly weaker ingredient for treatment if you're allergic to hydroquinone. Similarly, kojic acid and glycolic acid are two more ingredients for hydroquinone-intolerant patients. Combinations: We have even found that combinations, depending on your skin type and condition, including hydroquinone , and/or a corticosteroid, retinoid and Combinations are more effective than 4% hydroquinone alone. These can be prescribed if necessary by a dermatologic practitioner. Chemical peels: Chemical peeling agents have been found effective in removing dark spots, but be mindful to start with the lowest concentration and then move upward because you want to avoid any additional postinflammatory hyperpigmentation caused by chemical peeling agents Follow my advice and you will see spots fade and fewer spots form!

Are you at risk for this common spot for skin cancer?

Posted on by Jodi LoGerfo

Question: My hair has been thinning considerably for several years now, and my hairdresser recently found some  strange spots on my scalp. What are they?

Answer: Watch out for basal cell carcinoma (BCC), the most common, treatable form of skin cancer, on your scalp, especially if you are balding or your hair is noticeably thinning.

Think about it:  The top of your head, forehead (and also your nose) is exposed to the sun's harmful rays more than any other part of the body. Once you lose the cover of your thicker hair, your scalp is highly vulnerable.

The tricky thing about BCCs is that those who have had one BCC are at an increased risk for developing more tumors later  in the same area or elsewhere on the body and you may also be at risk for other types of skin cancer. And the recurrence of scalp BCCs is even higher within the first two years after surgery because of the constant sun exposure.

No matter where you (or someone else) notices any type of strange lesion (there are 5 warning signs of a BCC), check in with a dermatologic practitioner regularly so your entire skin surface can be examined, especially in places like the top of your head that you cannot easily see yourself...and wear a hat!

Has anyone else ever found strange spots on you? What did they turn out to be?

Can you mistake skin cancer for something else?

Posted on by Jodi LoGerfo

Question:  I've noticed a small sore like a scab on my left upper arm that will not go away. What could that be? What should I do about it?

Answer:   Your sore could be a Basal Cell Carcinoma (BCC), so don't take it lightly.

Sometimes a BCC can resemble something else like a mole, psoriasis or eczema,  a scar or any irritation. My rule of thumb is to watch it for one month:  If it does not go away or it enlarges or changes get it check out by a dermatologist, for an accurate diagnosis. The reason is because BCC is the most common type of skin cancer we see and anyone with a history of sun exposure is at risk of developing BCCs. A BCC is medically defined as any abnormal, uncontrolled growth or lesion that occurs in the skin’s basal cells (which line the deepest layer of the epidermis, the outermost layer of skin). They can start out as a barely noticeable lesion or rough patch, and while they rarely metastasize (spread) to larger organs beyond the original tumor site, they can be highly disfiguring and destructive to surrounding skin, if allowed to grow.

Who is at risk for BCCs? Aside from extensive exposure to UV sun rays such as in workers or athletes or even those who spend a lot of leisure time outdoors, we consider those with fair skin, blond or red hair, and those with blue, green or grey eyes to be at highest risk.

BCCs have generally been seen in older people but lately it seems the patients we are treating are younger and younger. And men have historically outnumbered women, although the number of women under age 40 diagnosed with BCC has more than doubled in the last 35 years.

There are five warning signs of a basal cell carcinoma; two or more are usually present in one tumor:

  1. Any non-healing open sore that bleeds, oozes or crusts and remains open for more than 3 weeks can be a very early sign of BCC.
  2. Any reddish or irritated area on the face, chest, shoulders, arms or leg which can be patchy or crusty may itch or hurt or may not have any sensation at all.
  3. Any pink growth that is slightly elevated with a rolled border and a crusted indentation in the center. If left to grow, tiny blood vessels may develop on the surface as it enlarges.
  4. Any shiny bump or nodule, often confused with a normal mole, that is pearly or clear, pink, red, white or even tan, black, or brown, especially in dark-skinned, dark-haired people.
  5. A scar-like area that is white, yellow or waxy and often has poorly defined borders or skin that looks shiny and taut, which indicate an aggressive, invasive BCC that is larger than appears on the surface.

BCCs are easily treated when caught early and cure rates are close to 100 percent, so any lesion that has been around for one month should be checked as soon as possible and treated and monitored by a dermatologist.

Do you have a growth that worries you? What does it look like?

Can I use perfume as a deodorant?

Posted on by Jodi LoGerfo
Q.  I ran out of my usual deodorant, so in a pinch I sprayed my favorite perfume under my arms. Is that bad? A. Possibly. Because underarms, especially in the summer, are more sensitive when susceptible to wetness from sweat, humidity, friction and heat. Your underarm skin could have a different reaction to a perfume you normally spray elsewhere like neck, hair and back of knees, so keep perfume away from delicate areas such as armpits and genital areas.

Can antiperspirant/deodorant cause itchy armpits?

Posted on by Jodi LoGerfo
Question: I've noticed that every time I use my antiperspirant/deodorant my armpits start itching the next day and they keep itching even if I stop using the product for a few days. Eventually it stops itching. Could my antiperspirant/deodorant be causing my itchy armpits? Answer: Yes. It's highly possible in both men and women. What it's like to be an armpit on a hot August summer day: There's a thicker-than-usual amount of antiperspirant/deodorant on freshly-shaven skin to avoid sweat marks and odor. As you go rushing about your day, damp armpit skin rubs together along with some sweat, oil and your clothing. But underarm skin is sensitive from the shaving too and sweat glands are mostly blocked by irritating chemicals and perfumes in addition to the fabric, laundry detergent (and possibly chlorine bleach) from your shirt. What if you added sand, salt water and chlorine to that mix? How antiperspirant/deodorant works: Underarm odor is not caused by the watery sweat that wets your shirt which is secreted by your eccrine sweat glands to lower your temperature through evaporation. The odor is caused by bacteria that break down fats secreted by your apocrine sweat glands.  An antiperspirant contains an aluminum salt chemical to block the watery secretion from the eccrine glands which can be a primary irritant, especially when skin is more vulnerable  in the summer or freshly shaven.  But, It's deodorant that controls the odor with perfumes and sometimes an antibacterial chemical to inhibit bacterial growth such as triclosan, also a common skin irritant. You can now see how your antiperspirant/deodorant could be exacerbating an already sticky situation in your armpits! 5 steps to avoid itchy armpits Don't worry. You don't have to wing it like Matthew McConaughey or Julia Roberts, who both reportedly abstain from wearing deodorant. Just experiment with different ingredients and formulas until you find one that does not cause you itchy armpits. 1.  Read labels and switch underarm products, formulas. Many antiperspirant products contain a percentage (14-17) of the highly irritating ingredient aluminum zirconium tetrachlorohydrex GLY. Read product labels looking for a product in the lower percentage or for the least irritating antiperspirant ingredient, aluminum chlorhydrate. If excessive sweat is not your primary problem, switch solely to a deodorant to see if it was the sweat-gland blocking antiperspirant that caused your itching. If the deodorant product still causes itching, try an all-natural brand such as Tom's of Maine which relies on botanicals such as aloe, sage and lemongrass to soothe skin and inhibit odor and irritation. Sometimes it’s the formula that causes the itching due to the drying nature of increased alcohol in a liquid spray, roll-on or clear versus a dry solid. Look for aluminum-free, alcohol-free and fragrance-free products. 2. Shave armpits at night. And don't apply any antiperspirant/deodorant afterwards. Let skin breathe. 3. Go au naturel at the beach. Don't apply any underarm products if you will be at the beach or swimming as excessive skin rubbing, sweating and salt, sand or chlorine can all further irritate sensitive underarm skin. 4. Switch laundry detergent, too. Try a dye- and fragrance-free laundry detergent to reduce exposure to irritants to your underarm area. Steer clear of chlorine bleach on T-shirts. 5. See your dermatologist if rash doesn’t clear.  If you notice bumps, rash or pustules that do not resolve within a few days, see your dermatologist as folliculitis or other bacterial or fungal infection could be at play.  

How to apply sunscreen properly

Posted on by Jodi LoGerfo
Question:  When applying sunscreen, should you rub it in so it's invisible, or leave it as a white coating (not quite as stylish)? Answer: Well, it depends on the type of sunscreen you are using. Most spray-ons will rub in invisibly. But if you are using a white lotion, especially one containing physical UV blockers such as titanium dioxide or zinc-oxide, or any of those labelled "water-resistant," they may go on much thicker (or whiter) no matter how much you rub because they are meant to stay on top and provide a layer of protection. A new online survey of adults nationwide by the American Academy of Dermatology found that most people only apply 25 to 50 percent of the recommended amount of sunscreen. The recommended amount is to apply one full ounce of sunscreen for the entire body, or enough to fill a shot glass. And this amount should be re-applied every two hours. My personal opinion is the whiter it looks the more it's got you covered, plus you can easily see areas you missed like neck, ears, legs and feet. You're right, not quite as stylish now, but you'll be avoiding a painful sunburn, premature aging and that pesky skin cancer! Who's for the "white" look on the beach?

Kids starting camp? Choose sunscreen wisely…

Posted on by Jodi LoGerfo

Question: My son goes to camp all day and I need a good sunscreen because he has sensitive skin and is very fair. I've also heard that there is a certain chemical that kids should not be exposed to because it causes cancer. And, are the sprays as effective as the lotion? Help!

Answer: I know just how you feel and I send my  three-year old Annabelle outside wearing a hat at all times, so send your sun to camp wearing at least a baseball cap to shield his face, or even a broader-rimmed fishing hat to protect his face and back of his neck and ears, if possible. Also, you mentioned he is very fair-skinned, so you might consider having him wear a t-shirt when swimming to help deflect the sun's rays and provide extra protection.

Sunscreen chemicals to avoid:  Recently available data from an FDA study indicate that a form of vitamin A commonly found in sunscreens, retinyl palmitate, may speed skin tumor development when applied to skin in the sun and requires further testing. In addition, according to the Environmental Working Group (EWG), a consumer environmental and health watchdog group, some 65 sunscreens advertised for babies and kids contain oxybenzone, a synthetic chemical that absorbs the sun’s rays but also readily penetrates the skin, more so in children, and can disrupt the body’s natural hormones and also cause allergic reactions. Also, look for glycerol PABA, padimate A and padimate O instead of the original staining, reaction-forming PABA, or para-aminobenzoic acid.

Safer active ingredients include Mexoryl SX (ecamsule),  Parsol 1789, also called avobenzone, and titanium dioxide and zinc oxide, which physically block ultraviolet radiation. Although these sunscreen formulas may go on thicker and appear "whiter,"  they also stay on longer and are gentler to sensitive skins which is a good thing at camp!

Simply make a list of ingredients to avoid and to look for and take it with you to the store. Read labels to make the best choice.

Sunscreen recommendations:  Consumer Reports recently rated sunscreens according to the new FDA labeling requirements and reported that two for kids completely failed  tests so do not choose Alba Botanica and Banana Boat Kids, whose labels claimed broad-spectrum protection and failed the wavelength test. Banana Boat Kids was also poor against UVA rays. Do choose All-Terrain AquaSport Sunscreen Lotion, SPF 30,  recommended by both the EWG and Consumer Reports ratings. I also like the chemical-free Neutrogena Pure & Free Baby, especially for sensitive skins.

You might also speak to camp counselors about how they reapply sunscreens for outdoor activities because sunscreens need to be re-applied after swimming or sweating, or every two hours.

What about spray-on sunscreen?  Stick to the lotions with an SPF between 30-50. Currently, the FDA has requested additional data to establish effectiveness of spray-on sunscreen and to determine whether there is safety hazard if  unintentionally inhaled by children.

Check out the infographic below from EWG which gives a great picture of what to avoid when looking for sunscreen for your child...

Sunscreen Infographic

Are you making these top sunscreen mistakes?

Posted on by Jodi LoGerfo

 Question: I recently went out for a day on a boat with friends and even though I used SPF 50 sunscreen all day, I still got burned. What did I do wrong? Answer: There's a lot of news in sunscreen ingredients and thinking these days so lets update how you buy, use and apply sunscreen so you don't get burned again (or needlessly exposed to the rays that cause aging, wrinkles and skin cancer): Mistake:  Not applying enough sunscreen The current guideline is to apply a shot glass-worth, one full ounce, of sunscreen to your body when spending the day in the dun. And, the most important part, you should reapply this amount of sunscreen  every two hours regardless of the SPF noted on the bottle, so you could go through half of an eight-ounce bottle in one day in the sun! Mistake:  Believing that sunscreens are "water-proof" The FDA, in its new labeling guidelines, has declared that the use of the term "water-proof"  misleading and banned brands from using it. The word will need to be removed from labels by December 2012.  Now, the guideline is that sunscreen is "water-resistant" and only for a tested time limit of 40 or 80 minutes when spending time in the water, after which the product will need to be re-applied. Mistake: Applying the sunscreen when you get there The best way to allow sunscreen to do it's work is to apply it a full 30 minutes before going into the sun, so it has time to bond to skin, instead of getting immediately rubbed off by a towel you lay on or washed off by jumping directly into the water. Mistake:  Not protecting your skin from UVA rays It used to be that sunscreens only protected against UVB (the burning rays) but now a slew of new chemicals can absorb UVA rays (the ones that penetrate deeper to cause aging, wrinkles and skin cancer).  Choose a sunscreen with the new designation "broad spectrum" because these have been tested by the FDA to provide protection against both UVB and UVA rays. Consumer Reports recently tested and rated sunscreens according to the new FDA labeling requirements and found these three top-rated choices:

  • All Terrain AquaSport SPF 30 (for athletes and outdoor workers)
  • Coppertone Sport High Performance Ultra Sweatproof SPF 30 (for athletes and outdoor workers)
  • No-Ad with Aloe and Vitamin E SPF 45 (for the budget minded, every-day body user)

Mistake:  Thinking the higher the SPF, the better the protection… According to Consumer Report's recent ratings, top-rated sunscreens are between SPF 30-45. The new thinking is that higher SPF does not really not afford more protection. Here's why:  an SPF 15 filters out approximately 93% of all incoming UVB rays, SPF 30 filters out approximately 97% and SPF 50 filters out approximately 98%. No sunscreen can block out 100% (which is why the FDA has also banned the use of the word "sunblock" on labels) of all UV rays so after an SPF 30, you can see the difference in filtering is negligible. The old  thinking:  If your skin starts reddening in 20 minutes when exposed unprotected to sunlight, using an SPF 15 should prevent your skin from turning red for 15 times longer (approximately 5 hours). The new thinking: No sunscreen protection lasts more than 2 hours. Choose an SPF 30-45 and reapply one ounce every two hours for real protection. Mistake:  Ignoring your scalp Most people protect their eyes with sunglasses and slather on the sunscreen but completely ignore their scalp. This is very dangerous, especially if you have any hair loss or thinning issues. Apply sunscreen to any areas experiencing hair loss (a widening part-line, bald spot or receding hair line) and definitely wear a hat! Mistake:  Believing that the sun does not affect your face every day I advise everybody to apply a basic "broad-spectrum" sunscreen every day to face, underneath makeup or in makeup for women,  especially to protect against photo-aging and skin cancer that you cannot see happening. One that I personally recommend, that was also recommended by the Consumer Reports Ratings, is La Roche-Posey Anthelios 40 with Mexoryl SX SPF 40. Have you made any of the mistakes on this list recently? Tell us your worst sunburn story in the comments!

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