How do I choose a moisturizer?
What can I do about splitting nails?
Is there anything I can do to get rid of brown spots?
How do I choose a sunscreen?
What can I do about my scars?
Q. How do I choose a moisturizer?
A. The ideal moisturizer contains ingredients with multiple properties: “occlusives” that coat the top layer of skin to decrease water evaporation, “humectants” that penetrate the underlying skin and help absorb water, and “emollients” that soften and smooth rough skin texture. Petrolatum is a simple occlusive that covers the skin, preventing water loss. By itself, the product may feel greasy and risk leaving the skin looking soggy, but by adding humectants, like glycerin, urea, or propylene glycol, skin moisture content is improved without looking “water-logged”. The humectants work by absorbing water, allowing cells to fill out and diminish the appearance of fine lines and wrinkles. They improve appearance and texture but do not provide any long-term anti-wrinkle benefit.
Sometimes the perception of dry skin is present even if water and lipid content are normal because the individual notices rough or scaly skin. In such instances, emollients or smoothing agents will improve both the appearance and texture of the skin.
No single moisturizer meets the needs of all people. Common agents can work wonders for some people, but irritate and inflame the skin of others. Your symptoms and physical findings need to be considered in the choice. Professionals at Island Dermatology can assist you in evaluating over-the-counter products that are reasonably priced or specialized products available in our office to meet specific needs. Back to Top
Q. What can I do about splitting nails?
A. Nail splitting (onychoschizia) is a common disorder, particularly in adult women. The most significant cause is prolonged or repetitive water exposure, which makes the nail brittle leading to splitting, breaking and ridging. Other important causes include repetitive trauma, frequent use of polish remover, and exposure to cold, dry weather.
Treatment begins with the avoidance of constant wetting and drying or protecting the nails by wearing cotton lined rubber gloves when performing household tasks that involve contact with water or cleaning agents. It is also important to protect the hands by wearing gloves since cold weather exposure can enhance drying and weakening of the nail plate. We would also recommend the use of protective moisturizers, which should be rubbed into the nail and cuticle before and after wet work or exposure to cold.
Trauma to the nails can be avoided by keeping them cut short and well-shaped. A fine file can be used to round the tips in a gentle curve. Do not use instruments to push back the cuticle. This removes the protective membrane that covers the nail and its growth center. Nail polish, particularly those containing nylon fibers, may add strength and protection to fragile nails. You cannot maintain beautiful nails and also use them as tools. Elegant nails need to be protected as though you were caring for wet nail polish. Dial phones with a pencil, not your nail and use the pad of your finger, not the nails, to pick up and manipulate objects. Do not peel or scrape off nail polish.
In general, nail abnormalities are not caused by diet unless you suffer from severe nutritional deficiencies. Some studies suggest, however, that Biotin (a vitamin) at 2.5 mg per day as beneficial for nail health and strength.
The professional staff at Island Dermatology can review your nail findings, take a history of occupational and environmental exposures, and rule out infections caused by fungus, yeast, or bacteria. We can also guide you in selecting appropriate protective agents to apply to nails and fingers when avoidance of water, chemicals and minor trauma cannot be totally avoided. Back to Top
Q. Is there anything I can do to get rid of brown spots?
A. Pigmentation disorders such as brown spots on the skin are a common source of concern to many people and may cause significant stress and embarrassment. The primary pigment within the skin is melanin, which evolved to protect us from harmful ultraviolet radiation. However, like many biologic mechanisms, the system can be over stimulated, causing a variety of disorders such as lentigines (age or liver spots), melasma, and post inflammatory hyper-pigmentation.
Sunlight exposure is a major source of environmental damage to skin. When our skin is exposed to sunlight, “melanogenesis” is stimulated (making more pigment) and represents the skin’s primary defense against further sun damage. With continued exposure to sunlight, brown spots such as solar lentigines and freckles appear on the skin. These spots often continue to increase in number and get darker with ongoing exposure. No one knows why the pigmentation is uneven, and why the damage shows up so many years later. Most sun spots occur only years after the provoking sun exposure occurred.
Melasma is a common condition that is usually seen in women of childbearing age. It presents as irregularly shaped blotches of light to dark-brown pigmentation on the face that is either superficial (epidermal) or deeper (dermal) in location. A special light (Wood’s Lamp) can be used to determine the depth of pigmentation and is useful in guiding treatment strategies. Post inflammatory hyper pigmentation presents as irregular, darkly pigmented spots arising in areas of previous inflammation. It can appear in any part of the skin, but is a particularly significant source of distress to a patient when it occurs in the face. Post inflammatory hyper pigmentation appears most frequently among patients with darker skin types, but it also can affect people of lighter skin type as well.
The treatments for these pigmentation abnormalities can vary, and are largely dependent on the type of disorder, its causes, and location within the skin (epidermis vs. dermis). Some of the treatments include high quality sun protection and topical treatments. The topical treatments may include creams such as low-potency steroids, hydroquinone which blocks pigment synthesis, or retinoids (Vitamin A derivatives). Other treatments might include technology that is light based such as laser, Intense Pulsed Light or chemical peels. Therapy for abnormal skin pigmentation is often challenging but good results are possible and very gratifying.
The professionals at Island Dermatology will be able to assist you in diagnosis of your pigment problem and selecting appropriate and successful therapy. Back to Top
Q. How do I choose a sunscreen?
A. To protect your skin from risks of skin cancer and signs of premature aging, we recommend rational and consistent protection against excessive sun exposure. Sunlight, the source of ultraviolet radiation, is the primary risk factor for most skin cancers and the most significant cause of skin aging including wrinkles, brown spots, dilated vessels, and blotchy pigmentation.
Sunlight contains a broad spectrum of ultraviolet radiation encompassing UVA (ultraviolet A) and UVB (ultraviolet B). UVB exposure is responsible for the initial redness of sunburn and induction of precancerous growths and skin cancer many years later. UVA, once considered the “safe tanning rays”, has now been shown to be a promoter of skin cancers as well and, because of its deeper penetration, causes the breakdown of skin’s elastic properties leading to wrinkles, easy bruising and blotchy color changes.
Overall protection from the ultraviolet radiation should include a regimen that consists of wearing protective clothing, avoidance of midday sun, and the proper use of an adequate sunscreen. The common term “SPF” refers to the Sun Protective Factor. This term represents the ability of the sunscreen to delay skin reddening by the sun. For example, a person who applies an SPF-10 sunscreen on uncovered parts of the body could stay in the sun 10 times longer without having visible skin redness. There are two problems with the current SPF measurement system. First, it is a system based mainly on UVB exposure (responsible for immediate skin redness). The delayed skin redness and long-term damage caused by UVA exposure is not accounted for in the SPF terminology. Second, most people do not apply the sunscreen as thickly as it is applied in the SPF testing of sunscreens. In fact, a recent study demonstrated that most users achieve an average SPF that is only 20 to 50 percent of that expected from the product label because it is inadequately applied.
Sunscreens contain either chemical barriers that absorb ultraviolet radiation or physical agents that block sun rays. Historically, the physical blocks were only thick and white, a product we recognized on the noses of lifeguards. These agents can now be manufactured in more cosmetically acceptable forms that initially appear thick and white but blend in quickly. They have the advantage of being able to protect against both UVA and UVB light, but are not irritating. Chemical barriers can contain any of a number of molecules that absorb different portions of the light spectrum, and generally contain multiple chemicals. They can be manufactured with a number of different properties and may vary in their protectiveness. If you are in and out of water, you may want to choose a brand promoted as “water-proof” or “sweat-proof”. If your skin is oily or acne prone, then choose a gel or light lotion. If your skin is dry and easily irritated, consider using a thicker cream. If you have a history of reacting to sunscreens with irritation, burning or breakouts, consider applying a small amount of the cream on the inner skin of your arm one or two days before you use it on your entire body or face to evaluate its effects and avoid an uncomfortable, more extensive reaction.
There are many different sunscreen products on the market. It is important to find the sunscreen that is most suitable to your needs and skin type, in order to increase the likelihood of compliance with a daily sunscreen regimen. The professionals at Island Dermatology have the knowledge and experience to assist you. Back to Top
Q: What can I do about my scars?
A. A scar can result from wounds caused by accident, disease, or surgery. Scarring is a natural part of the biologic healing process. Skin scars occur when the deeper layer (the dermis) of the skin is damaged. To mend the damage, the body lays down new collagen fibers (a naturally occurring protein) which “bond” or “fill” the wounded edges of the skin together. This process results in a tissue which will have a different texture and quality than the surrounding normal skin.
The way a scar forms is affected by an individual’s age, skin type, and the location on the body or face. Younger skin tends to make strong repairs and may overheal resulting in larger, thicker scars. Thicker scars are more common on darker skinned people. Skin over a jawbone is tighter than skin on the cheek and will make a scar easier to see. If a scar is indented or raised, irregular shadows will be seen, giving the skin an uneven appearance. A scar that crosses facial expression lines or is wider than a wrinkle will be more apparent because it does not look natural. Scars that are directed similarly to natural wrinkle lines tend not to stand out or be that noticeable. Scars caused by trauma or infection may have random shapes that do not conform to natural facial or body lines. Surgical scars can often be planned and made to look more natural.
The more the skin is damaged and the longer it takes to heal, the greater the chance of a noticeable scar. Typically, a scar may appear redder and thicker at first, and then gradually fade. Many actively healing scars that seem unsightly at three months may heal nicely if given more time. It is often not possible to judge the appearance of a scar until twelve to eighteen months have passed.
No scar can ever be completely removed. There are no magic techniques that will return the scar to a normal uninjured appearance, but scars can be managed or modified to improve their appearance. Unfortunately, there is no scientific data to support the claim that vitamin E either locally applied or taken orally as a supplement will lessen the appearance of any scar, though we do not believe that such compounds hurt the appearance of the skin in any way.
There are a number of reports that suggest that occlusive, smooth dressings like silicon sheets can modify and improve a scar’s appearance. New topical medications (Imiquimod) may reduce the probability of a thick, hypertrophic scar if used early and in a person with a medical history of significant scar formation. Scar appearance can be modified with laser or light treatments to reduce their redness, or surgically revised to reduce size or conform better to one’s natural anatomy.
The most important first step in the treatment of scars is a careful consultation between the patient and the dermatology professionals at Island Dermatology. We can help you decide if your scar is treatable and how we might work to improve its appearance. Back to Top
