Tag: treatments

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The light side of pigmentation

Hyperpigmentation is the darkening of areas of skin compared to the surrounding skin colour leading to uneven skin tone or large darker patches. It occurs when melanocytes are stimulated to produce increased pigment called melanin. Melanocytes can be stimulated by sunlight, hormones, trauma, inflammation, medication and a constantly growing list of other factors. It was recently discovered that vascularisation (increase in blood vessels) also has a role to play in melanocyte stimulation and hyperpigmentation.

Hyperpigmentation is a common and intensely distressing condition. The commonest forms seen are melasma, solar lentigenes (sun spots) and post inflammatory hyperpigmentation (PIH).

What causes hyperpigmentation? – new evidence!

Melasma and sunspots mostly occur on sun exposed areas, particularly the face, while PIH can occur in any area of skin trauma or skin conditions like acne, eczema or insect bites.

All forms of hyperpigmentation worsen with sun exposure. It is well established as the greatest contributor, with the condition worsening during summer and improving in winter when ultraviolet exposure is less intense.

Melasma is also strongly influenced by genetic and hormonal factors and is often precipitated by pregnancy or the use of the contraceptive pill.

The influence of other environmental factors is only recently being examined, and other causative factors have now come to our attention as contributing to skin ageing and hyperpigmentation.

The solar energy spectrum is composed of ultraviolet radiation (A, B and C), visible light and infrared. The visible light spectrum is the light that we see. It has longer wavelengths than ultraviolet A and B and therefore actually have a deeper penetration into the skin, though they have never been regarded as potentially harmful.

Recent studies have found that visible light stimulates melanocytes to produce pigment. This is especially significant in darker skinned individuals and it seems that repeated long term exposure to visible light may cause hyperpigmentation. In addition, visible light may also cause inflammation and induce reactive oxygen species causing DNA damage, though it has not yet been established as a cause of skin cancer.

Important to note that most traditional sunscreens do not adequately protect against visible light. Fe oxide in sunscreens and antioxidants offer protection from visible light.

Infrared or heat represents the longest wavelength of solar energy and hence penetrates even further than visible light. IR activates matrix metalloproteinase and causes the breakdown of collagen causing skin ageing. Infrared also causes hyperpigmentation by inducing inflammation and vascularization (production of blood vessels). There is currently no effective way of protecting against infrared and only topical antioxidants have shown to offer some protection.

Traffic related air pollutants including a harmful form of ozone called tropospheric ozone and polycyclic aromatic hydrocarbons cause the formation of free radicals which depletes our skins antioxidant reserve. This leaves the skin vulnerable to further insult including DNA mutations and melanocyte stimulation.

Treatment for hyperpigmentation

Hyperpigmentation is treated with a combination of topically applied creams, and skincare procedures like chemical peels and dermal needling.

A complete treatment regimen should:

  • Protect against factors that cause melanocyte stimulation
  • Inhibit the production of melanin by inhibiting the enzyme tyrosinase
  • Improve the turnover of cells that have accumulated pigment

Maintenance treatment is critical to ensure that results are lasting as hyperpigmentation should be seen as a chronic condition that requires constant management.

The gold standard skin lightening agent is hydroquinone which has come under scrutiny as it was used to lighten skin generally, not just for treating hyperpigmentation.

Hydroquinone works by inhibiting the enzyme tyrosinase. This medication can be prescribed where appropriate by a dermatologist in various combinations and works well when used responsibly.

Kojic acid is an effective and well studied skin lightening agent. It is an ingredient in numerous creams and generally well tolerated

Neoretin Booster Serum is a lightweight serum containing Kojic Acid and other active ingredients which inhibit melanin synthesis.

SkinCeuticals Metacell Renewal contains Kojic Acid and other active ingredients to target the early signs of ageing and hyperpigmentation.

NeoStrata Enlighten Pigment Gel contains Kojic Acid, Liquorice extract, citric acid and multiple other active ingredients to target hyperpigmentation.

Arbutin is a glycosylated hydroquinone extract and has been considered one of the safest and most effective skin lightening agents. Its effects may also be optimised when combined with other substances like vitamin c, liquorice, glycolic acid and kojic acid.

Arbutin inhibits the enzyme tyrosinase decreasing the production of melanin pigment.

The active ingredient is slowly released making it suitable for those with sensitive skin.

Obagi Nu-Derm System

The Nuderm system combines Arbutin and exfoliating ingredients to inhibit melanin production and remove cells containing pigment. Arbutin is a smaller molecule that penetrates deeper into the skin reaching the basal layer of the epidermis and inhibiting the enzyme tyrosinase.

Obagi C Clarifying Serum combines 10% Vitamin C and Arbutin to protect against sunlight and environmental aggressors and inhibit production of melanin. This product targets early ageing and hyperpigmentation.

Vitamin C is a potent antioxidant which indirectly inhibits the enzyme tyrosinase leading to decreased melanin production

The anti inflammatory effect reduces cell injury and pigment production.

SkinCeuticals CE Ferulic and SkinCeuticals Phloretin CF are patented combination antioxidant formulations. Vitamin C is combined with other antioxidants for a potent synergistic effect that protects against ultraviolet light and visible light and offers some protection against infrared (IR) and air pollutants.

Obagi Professional C serum 10%, 15% and 20%.

The Obagi Professional C range contains different concentrations of Vitamin C to suit different skin sensitivities.

Ellagic acid

Is a natural phenol antioxidant that inhibits the transfer of melanin to skin cells.

SkinCeuticals Advanced Pigment Corrector contains ellagic acid, niacinamide , vitamin and salacylic acid. It lightens dark spots by gentle exfoliation and prevents the formation of new pigment spots.

Tranexamic acid reduces pigmentation by its effect on the plasminogen activator pathway.

SkinCeuticals Discoloration Defense

Combines tranexamic acid (inhibits the UV induced production of melanin by melanocytes), Kojic acid , niacinamide and HEPES which work synergistically to inhibit melanin production and remove epidermal cells containing pigment.

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Note from Dr. Kesiree

HYPERPIGMENTATION should be regarded as a chronic condition that needs to be constantly managed. Be consistent with your treatment regimen. Treatment protocols generally combine intense phases of prescription treatment and procedures with maintenance regimens.

No treatment regimen for hyperpigmentation would be complete without strict daily sunscreen use.

Book an appointment with your dermatologist or skincare professional for advice on how best to treat your hyperpigmentation

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Living with Rosacea

What is Rosacea?

Rosacea is a skin condition characterised by redness and flushing of the skin of the face, affecting mainly the cheeks and nose.
People who have Rosacea complain of a red complexion with dilated, broken blood vessels (telangiectasias), but sometimes have papules and pustules that can be mistaken for acne.

One less common form leads to an enlarged, red nose with thickened skin, large sebaceous glands and large pores. This form is called Phymatous Rosacea and occurs mainly in men, who are often wrongly thought to be alcoholics.

Ocular Rosacea presents with redness and irritation of the eyes.

Rosacea is common in fair skinned individuals but can occur in skin of any colour. Patients with Roscaea also complain that their skin is dry and ‘sensitive’, and ‘stings’ on application of skincare products.
For this reason there are numerous ranges of skincare that cater for those with Rosacea.

What causes Rosacea?

The cause of Rosacea is mainly unknown, there are however genetic and environmental influences and people with Rosacea have a 20% chance of having a family history of the condition.

Rosacea may start from an early age with frequent flushing and redness of the face. This is due to abnormal reactivity of blood vessels caused by dysregulation of the nervous system. This vascular hyper-reactivity worsens into adulthood. At first it is reversible, but in time there is persistent dilatation of the blood vessels and leaking of fluid into the tissue. The face may become tense with fluid (oedematous), leading to the formation of papules and pustules similar to acne.
In addition the skin is dry and sensitive due to a damaged skin barrier and there is a defective immune response further contributing to the inflammation seen in Rosacea.

Rosacea may also be caused by sun damage to the skin with damage to the dermal connective tissue and blood vessels and resultant leakage of fluid from blood vessels into the surrounding tissue.

Demodex mites, which seem to contribute to the development of Rosacea, are part of the normal skin flora and are found in large numbers in the skin of Rosacea sufferers

A secondary form of Rosacea can be caused by using steroids on the skin, often seen with inappropriate use of steroid creams on the face when treating conditions like eczema.

What triggers Rosacea?

A trigger is anything that causes Rosacea to flare up.
These may be anything from food and drinks, medication, medical conditions, physical activity, emotional factors, to weather and temperature changes and personal care products.

Identifying and avoiding trigger factors is an important part of the management of Rosacea but may not always be possible.
Most patients have multiple triggers and the list of reported triggers is exhaustive.
The most common trigger for Rosacea is heat and temperature changes, while other common triggers are alcohol, hot or spicy foods, emotional stress, wind and cold exposure, smoking and menopause.

Can Rosacea be cured?

Rosacea cannot be cured.
It is important for patients to understand what their possible triggers are and to try to avoid them.
Medical treatments are aimed at controlling signs and symptoms and the condition may then go into remission for some time.

What are my treatment options?

Treatment options are medical and surgical and an individual will probably go through a variety of different treatment options in their lifetime.
Rosacea requires continuous management and the foundation for this is a good skincare regimen including a gentle cleanser, moisturiser and suitable sun protection. There are also various ingredients in skincare that successfully reduce redness and calm inflammation.
In addition, this is combined with a prescription treatment depending on the type of Rosacea.

Erythematotelangiectatic Rosacea is characteristised by redness and broken veins.
This type is best treated with topical metronidazole or topical azeleic acid. Laser may be helpful to improve redness.
Topical oxymetazoline is used in the United States, but is not available in South Africa

Papulopustular Rosacea is treated with a combination of topical antibiotics eg metronidazole, erythromycin, or clindamycin and oral antibiotics eg tetracyclines and erythromycin.
Other treatments including benzoyl peroxide, tretinoin, pimecrolimus and permethrin are also sometimes prescribed.

Isotretinoin may be prescribed for Rosacea that is severe and unresponsive to other treatment.
It is also used for a type of Rosacea called solid facial oedema in which the skin is tense with inflammation.

Are there any procedures to treat Rosacea?

Laser or light treatment can reduce redness, shrink blood vessels and remove thickening of the skin.
Laser is particularly useful for Erythematotelangiectatic Rosacea or Phymatous Rosacea.

Some chemical peels may also be suitable to calm skin and reduce redness and inflammation. An example of this is SkinTech Easy Phytic peel.
This chemical peel is specifically designed for sensitive skin like Rosacea. It is useful for those that have an acute flare-up of their Rosacea.

General measures

Identify and avoid your triggers.
Sun protection is essential, as sun damage may precipitate or worsen Rosacea.
Use a sunscreen for sensitive skin. These are usually mineral sunscreens contains zinc oxide or titanium dioxide.
Wash the face twice daily with a gentle soap-free cleanser suitable for sensitive skin.
Avoid products with alcohol, menthols, camphor, witch hazel and fragrances.
Avoid toners and facial scrubs.
Use your prescription topical treatment after washing the face.
Use a moisturiser with ingredients that reduce redness and calm the skin.
Avoid heavy occlusive makeup or greasy cosmetics as these are difficult to remove without scrubbing the skin.
Patients with Rosacea often complain that products ‘sting’ their skin. This is because of a damaged skin barrier.
It is sometimes necessary to try a few skincare products before finding a suitable one.

Rosacea is a condition that develops over time and patients are initially unaware of their symptoms. If you are experiencing some of these symptoms and believe you may have Rosacea, visit your dermatologist to confirm your diagnosis and receive prescription treatment suitable for your skin.

To book an appointment with our skin specialist email [email protected]

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All About Acne

 

What is acne?

Acne is a common disorder of the pilosebaceous unit (hair follicle). There are two main types of acne lesions:

Inflammatory lesions consists of papules and pustules, more commonly referred to as ‘pimples’, as well as nodules and cysts which can be found in severe acne.

Non-inflammatory lesions called open and closed comedones are better known as ‘blackheads’ and ‘whiteheads’.

Acne mainly affects the face, neck, back and chest and can affect a localized area or all these areas extensively, acne can therefore vary greatly in appearance and severity.
Mild acne is characterised by comedones, while severe acne can be disfiguring with large nodules and cysts.
Rarely patients may have a systemic form of acne called Acne fulminans which can leave them feeling very unwell.

Whether mild or severe, acne can still have a huge psychological impact and lead to significant permanent scarring.

Who gets acne?

Acne is primarily a disease of adolescence and affects about 85% of the young between 12 and 24 years. However it can also affect any other age group from infants to adults. It is not uncommon for acne to develop in the 30’s and 40’s and 50’s without any prior teenage acne. We call this type of acne ‘late onset acne’ and it is particularly challenging to manage.

What causes acne ?

While there are many factors that play a role, the four main pathogenetic mechanisms are:

– A defect in keratinisation at the hair follicle opening which causes keratinocytes (skin cells) to block the opening of the hair follicle

– Androgens (male hormones) which cause the sebaceous glands to produce more sebum. Androgen production increases around puberty as the adrenal glands mature which results in oiliness of the skin, causing the higher incidence of acne at this age.

– Propionibacterium acnes proliferate in the hair follicle and contribute to triggering an inflammatory response and worsening acne.

– An inflammatory response that leads to the formation of papules and pustules in response to the blocked follicle.

Other possible contributing factors:

The use of oral or topical steroids on the face for prolonged periods can lead to steroid induced acne. Many prescription drugs can cause acne as a potential side effect. Examples are epileptic medication and injectable progesterone containing contraceptives.

Greasy face creams or hair products may further block follicles and worsen acne. We call this type of acne Pomade acne.

High humidity contributes to a kind of acne found in the tropics known as Tropical acne.

Pinching and scratching acne lesions can worsen acne, particularly acne scarring. This type of acne is called Acne excorie.

Is acne genetic?

Acne may be considered genetic as one is more likely to get acne if either parent has had severe acne. The incidence of both identical twins having acne is high, supporting a genetic link. The size, number and activity of sebaceous glands which is directly related to acne is genetically determined and can’t be altered.

What is hormonal acne?

All acne can be considered ‘hormonal’ as the major contributing factor to developing acne is androgen (male hormone) induced stimulation of sebum production from the sebaceous glands. In most case the hormone levels are normal. There are however some conditions in which there is an increase in androgen production. An example of this is Polycystic ovarian syndrome.

Late onset acne is thought to be partly because of an increased effect of androgens on the sebaceous glands even at normal blood levels.

Late onset acne is usually distributed on the lower face of women. We often refer to this as ‘hormonal acne’.

How do I treat my acne?

The acne guidelines have been developed to provide a guide to treating acne.

The guidelines divide acne into mild, moderate and severe and treatment is based on the grading of acne.

Mild acne with open and closed comedones (‘blackheads’ and ‘whiteheads’) is treated with topical benzoyl peroxide and topical retinoids.

Moderate acne is treated with antibiotics (either topical or oral) in combination with topical benzoyl peroxide or topical retinoid. It is very important to combine antibiotics with topical treatments as it prevents resistance to the antibiotic.

Severe acne usually warrants prescription of isotretinoin (Roaccuatane, Oratane, Acnetane) which is the most effective treatment for this type of acne.

In addition to this oral contraceptives can be used by women as this counteracts the effects of androgens.

In all forms of acne the first lesion is the microcomedone. For this reason no treatment regimen is complete without a topical treatment to prevent the formation of new comedones.

Some other treatments that have some success are usually recommended in combination with prescription treatment.

These include:

Chemical peels

Peels help to decrease the amount of dead keratin blocking the follicular unit, reducing the amount of blackheads and whiteheads and calming down inflammation.

Chemical peels assist with mild acne scarring and post Inflammatory hyperpigmentation which is often more emotionally disturbing than the acne.

Photodynamic therapy

Red and blue light with or without topical aminolevulinic acid can decrease the amount of propionibacterium acnes in the follicle and in this way improve acne.

Home-care

A carefully tailored home-care regimen can help reduce oiliness and moisturise skin that has been left dry and sensitive from prescription medication. Ingredients like salacylic acid, lactic acid and glycolic acid can also help shed dead surface skin cells and reduce the amount of blackheads.

Does diet affect acne?

This is still a controversial topic as there is still not much evidence available. In general dairy and high glycaemic index foods may worsen acne. This does not mean that they are causing acne, nor does it mean that you don’t need acne treatment if you control your diet.

My acne has cleared, how do I treat the scars?

In most cases untreated acne will eventually resolve. The problem with this is the resultant scarring and post inflammatory hyperpigmentation which is often permanent. It is therefore important to start treating soon and to continue treatment.

Management of the acne will prevent scarring.

Treatment of scars starts with topical retinoids in the treatment phase.

After acne has cleared options for scarring include chemical peels, dermal needling and laser therapy.

Dermal filler may also be injected to fill up pits caused by acne scarring.

General measures

Keep the skin clean by washing twice daily with a gentle cleanser suitable for your skin type.

Avoid harsh soaps or scrubs which traumatize the skin and worsen inflammation.

Very oily skins may benefit from a cleanser with added salacylic or glycolic acid.

Toners may be used to reduce oiliness after cleansing.

Use a suitable moisturiser.

Use your prescription topical treatment regularly. The results will not be quick but regular treatment helps prevent new acne and assists with maintenance of a skin condition that often fluctuates in severity for many years.

Wear sunscreen in the day as most acne treatments make the skin sun sensitive.

Sunscreen will also help reduce post inflammatory hyperpigmentation.

Avoid heavy occlusive makeup or greasy cosmetics which block the follicles and worsen acne.

Seek treatment early to avoid scarring.

Visit your doctor or dermatologist for prescription treatment, and a home care regimen that can be tailored to suit your skin.

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Everything Eczema

What is eczema or dermatitis?
The terms Eczema or dermatitis can be used interchangeably and are used to describe an inflammation of the skin – the suffix “-itis” means inflammation.
Another example is “arthritis” which means inflammation of a joint.

Atopic eczema is the most common type of eczema that affects up to 30% of children and 10% of adults. Rarely, one can develop eczema for the first time even after the age of 60. Atopy means a genetic predisposition to develop eczema, asthma and hayfever and we find that these conditions run in families, children also have a greater risk of developing eczema if one of their parents have had it.

A few other common types of eczema are:

Seborrhoeic eczema – a mild form of eczema occurring most commonly on the scalp, ears, face and mid chest and  ‘Cradle cap’ is a variant of seborrhoeic eczema which affects babies. Malassezia yeasts are thought to contribute to the cause of seborrhoeic eczema.

Allergic contact eczema is a variant of eczema that occurs from contact with chemical substances that the skin is allergic to.
A common example is contact allergy to nickel in earrings and clothing studs leading to an eczema around the area of contact.
People may also develop allergies to various other allergens including plant materials (eg poison ivy), hair dyes and ingredients in personal care products.

Asteatotic eczema occurs mostly in elderly patients and starts with a very dry skin that cracks and becomes red and inflamed. This kind of eczema occurs mostly on the lower limbs and flanks.

Stasis dermatitis occurs particularly on the lower limbs in patients with varicose veins and is due to the pooling of the circulation beneath the skin.

What does eczema look like?
The inflamed skin of eczema can look red, wet and weeping if the eczema is acute and severe.
The skin is leathery with varying redness, scaling and crusting if the eczema is subacute, or thickened and nodular if the eczema is chronic.
The distribution of eczema may vary with age.
Babies generally have eczema on the face, neck and scalp, outer arms and front of the legs.
Childhood eczema is typically in the folds of the elbows and knees, the wrists, ankles hands and feet, we call this flexural eczema.

The distribution may alter yet again in adults who have a higher incidence of hand eczema. It is important to exclude allergic contact eczema in adults with hand eczema.

What causes Eczema?
As with most disease there is a genetic predisposition and contributing environmental factors. These vary with different types of eczema.

The skin in Atopic eczema has an impaired skin barrier function and a defective immune response.
Mutations in a gene called fillagrin is a strong predisposing factor which weakens the skin barrier and allows allergens to penetrate and trigger the immune response.

There are multiple potential environmental triggers; irritants like detergents, soaps and fragrances contribute to weaken the skin barrier, as well as synthetic fabrics and wool which irritate the skin and worsen itching and scratching.
Allergens like house dust mite, pollen and animal hair have also been shown to trigger atopic eczema.

Is eczema contagious?
No. You will not get eczema from touching an area of eczema on another person. Similarly you can’t make your eczema ‘spread’ over your own skin by touching it.

Can you outgrow eczema?
Yes. As many as 50-60% of sufferers can outgrow their eczema around puberty.
Regular moisturizing of the skin can control asteatotic eczema. Avoidance of the offending substance in allergic contact allergy may resolve this condition.

What are the treatment options?
Treatment consists of maintenance treatment and treatment of the acute flare up.
Maintenance is exceptionally important as it can help keep the eczema in remission for prolonged periods of time and reduce the need for topical steroids .
Avoid soap on the skin as it has an ingredient called sodium laurel sulphate which weakens the skin barrier, also avoid perfumed products, bubble baths and other environmental triggers.
Use soap free products to wash with and a suitable emollient to moisturise the entire skin at least twice a day.

Topical treatments
The first line treatment for the ‘acute flare-up’ of eczema are topical corticosteroids which range in strength or potency. There is much controversy regarding the use of ‘steroids’ leading to ‘steroid phobia’ in patients with eczema. Topical corticosteroids remain the most potent anti-inflammatory agent for a condition that is characterized by varying levels of inflammation.
As a dermatologist I am constantly educating my patients on the correct and responsible use of steroids to prevent occurrence of known steroid side effects.

Topical calcineurin inhibitors pimecrolimus and tacrolimus are used in ongoing maintenance of atopic eczema. They may sometimes be used as first line treatment in suitable patients.

A new topical therapy for atopic eczema, crisaborole has recently been approved by the United States food and drug administration.

Systemic treatments
These include oral steroids, steroid injections, and oral immuno-suppressive drugs which include include azathioprine, cyclosporine and methotrexate. These treatments are indicated for severe flare-ups of eczema, or eczema that cannot be managed with topical treatment.

A new biologic injectable drug called dipilumab was recently approved by the United States Food and Drug Administration and has shown promising results in clinical trials.

Phototherapy (light therapy)
Light therapy with narrow band UVB light has been shown to improve inflammation in eczema and the associated itch. Light therapy is generally combined with other treatment options.

Are there certain foods I need to avoid if I have eczema?
Food avoidance is only recommended if there is a proven food allergy.
Atopic eczema, food allergy, asthma and hay fever are genetically linked. If you have one of these conditions, then you may be predisposed to develop any of the others. However it does not necessarily mean that avoiding certain foods will have any effect on the eczema. If you believe that a certain food is worsening your eczema, keep a food diary to establish whether this is consistent. Food allergies can be investigated and tested by an allergologist. This will prevent you avoiding food that you are not actually allergic to.

Does stress worsen eczema?
Yes. Psychological factors including emotional stress can certainly trigger worsening of eczema. Flare ups of eczema are commonly seen in students around exam time.
Another reported example of stress triggering eczema, is the occurrence of first onset of atopic eczema in pregnant women.

Can I use sunscreen if I have eczema?
There are sunscreens suitable for sensitive eczema-prone skin. These are usually the physical or mineral sunscreens and those that are free of perfumes and fragrance.

Dermatitis or eczema can be a frustrating condition to live with particularly if it is chronic.
It’s also difficult to accept the first onset of a chronic skin condition later in life and with such a wide variety of washes and emollients available, patients are often overwhelmed for choice.  It’s always best to contact your dermatologist if you are suffering with eczema or feel you may be developing a similar skin condition.

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Troubleshoot Your Sunscreen

With summer in full swing, we thought this would be a great time to share some of our helpful tips for keeping your skin well protected from those damaging rays.

Seriously… there are very few reasons not to wear sunscreen, and we thought we would share the
complaints we have heard numerous times, with our recommended solutions.

1. I DON’T LIKE TO WEAR SUNSCREEN BECAUSE IT LEAVES A WHITE RESIDUE ON MY SKIN 
The “white cast” from sunscreen comes from the physical UV filters, titanium dioxide and zinc oxide.
Newer sunscreens are formulated with microfine particles of zinc oxide and titanium dioxide which don’t leave a white residue.
Some sunscreens contain smart colour adaptive particles that blend with most skin tones.

We recommend:
SkinCeuticals Sheer Physical UV Defense SPF 50 which is a broad-spectrum protective fluid with a weightless matte finish.
Or SkinCeuticals Physical Fusion UV Defense SPF 50 with translucent colour spheres to enhance your natural skin tone. It’s also water resistant for up to 40 minutes.

2. WEARING SUNSCREENS GIVE ME BREAKOUTS
Oily or cream formulation sunscreens can occlude the pores and cause acne breakouts. Go for ultrafluid sunscreens or those advertised as “non-comedogenic”.

We recommend:
La Roche Posay Anthelios XL 50+ Ultrafluid provides sun effective protection but with a soft, non-greasy light texture suitable for normal to combination skin.
Or SkinCeuticals Sheer Physical UV Defense SPF 50 offers broad spectrum sun protection with a sheer mattifying texture that is ideal for sensitive, rosacea-prone and post-procedure skins.

3. MY SKIN BECOMES SHINY WHEN I USE SUNSCREEN 
Mattifying or dry touch sunscreens contain ingredients that absorb oil on the skin surface leaving a matte finish throughout the course of the day. This is perfect for those with an oily skin or a humid environment.

We recommend:
SkinCeuticals Physical Matte UV Defense SPF 50 which offers maximum broad spectrum protection in a comfortable oil absorbing base with colour adapting tint.
Or Heliocare 360 Gel oil free contains antioxidant formula Fernblock FC and Bioshield technology in a unique oil free dry touch formulation. It protects against damage from UVA/UVB, infrared and visible light.

4. MY SKIN IS TOO SENSITIVE FOR SUNSCREEN
Sensitive or eczema-prone skin can develop irritation and itchiness with the application of sunscreen. It is mainly the chemical filters or added ingredients in the sunscreen that can cause contact allergy.
If you tend to have a sensitive skin or suffer from rosacea or eczema try mineral sunscreens which are chemical filter free.

We recommend:
Heliocare 360 Mineral. An innovative mineral fluid ideal for sensitive, acne-prone skin types, atopic dermatitis, post-procedure use and children.

5. I DON’T REAPPLY SUNSCREEN DURING THE DAY AS IT WILL MESS UP MY MAKE-UP
Solution 1
Brush on powder sunscreens are available in different shades to suit your skin.
Simply reapply over your make up as you would powder.

We recommend:
Colorescience® Sunforgettable® brushes are a unique self-dispensing powder sunscreen that make re-application simple throughout the day.
These are one of the few effective SPF products that can be applied over make-up.

Solution 2
Tinted sunscreen or sunscreen ‘make-up’ compacts.
Some sunscreens are conveniently available in different shades to blend easily with your skin tone, making them suitable to double up as make-up and easy to reapply.

We recommend:
Heliocare Gelcream which comes in brown and light shades Or Heliocare Compacts oil-free, which are also perfect to throw in your handbag.

6. I DON’T WEAR SUNSCREEN ON MY FACE BECAUSE IT MAKES MY EYES BURN
Sunscreens may run into the eyes with sweating, causing burning and irritation.
Try sunscreens with safe eye technology.

We recommend:
ISDIN Fotoprotector Fusion Water SPF 50+ is a unique high protection facial sunscreen that is quickly absorbed into the skin providing an invisible layer of silky, matte protection. Safe-Eye Technology ensures it does not sting the eyes, making it perfect for cycling, running and other sports.

7. IT’S DIFFICULT TO REAPPLY SUNSCREEN AFTER BEING IN THE WATER OR ON SWEATY SKIN 
It can be bothersome to completely dry your skin after a swim, or to properly reapply your sunscreen during sport.
Try sunscreen that can be effectively applied to damp or wet skin.

We recommend:
ISDIN Fotoprotector® Transparent Spray Wet Skin is a unique and revolutionary water-friendly sunscreen. It can be applied directly to wet or dry skin without the white emulsion effect derived from oils found in most sunscreens.

8. IT’S TOO LATE TO USE SUNSCREEN AS I ALREADY HAVE SUN DAMAGE
It is never too late to start protecting your skin! If you already have sun damage there is now a solution for you as well. New sunscreen technology includes DNA repair enzymes to help prevent and treat sun damage.

We recommend:
Heliocare 360 AK FLUID contains unique key ingredients Fernblock FC and Roxisomes  prevent to repair DNA damage caused by solar radiation.
It is an elegant oil free formulation that feels light on the skin.
Or ISDIN Eryfotona AK-NMSC with Repairsomes to prevent DNA damage caused by sun exposure

So, this season, whilst enjoying the warm summer days, there is no excuse not to take the best care of your skin and limit sun damage by using the right products – all available on www.skinsmart.co.za. Happy Holidays!

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The best anti ageing ingredients to use

What ingredients should you look out for in anti ageing products?
With ongoing research more and more molecules are proving beneficial.
Here we talk about a few with the best evidence.
Hydroxyacids
Glycolic acid is part of the alpha hydroxy acid group. This acid is widely used for anti ageing skincare, but can also treat hyperpigmentation, acne and rough skin texture.
How does Glycolic acid work within the skin? Glycolic acid penetrates the epidermis and help loosen the bonds that prevent dead skin cells from shedding. Glycolic acid has great exfoliating efficacy, but may also cause irritation and burning of the skin.

Retinoids
Retinoids are the gold standard anti-ageing ingredient and have been an integral part of a comprehensive anti ageing regimen for decades. Retinoids improve cell turnover and help repair damaged cells.
In this way they help to even out dark marks/hyperpigmentation and assist in treating acne lesions. Increased cell turnover improves dullness and rough texture and reduces the appearance of fine lines and wrinkles.
Retinoids also inhibit the production of collagenase thus slowing down the breakdown of collagen and promoting collagen production resulting in a firmer healthier-looking skin . With long term regular use you see renewed radiance, a remarkably smoother appearance, and a noticeable feeling of firmness.
Though retinoids are generally applied at night, remember that they do sensitise your skin to sun, so it very important to wear a sunscreen in the daytime.

Antioxidants
The use of antioxidants prevents damage from free radicals related to photo ageing and other cellular processes. Antioxidants reduce oxidative stress by neutralizing free radicals – unstable atoms that have an unpaired electron in their outermost shell. The antioxidants act by binding with the unstable electron and preventing attack on collagen, elastin and other elements of the skin’s architecture.

Stem cells
Stem cells are capable of self renewal. Their role is to replenish dying cells and regenerate damaged tissue. Studies show that topically applied stem cells activate regeneration of human stem cells, protect the cell from oxidative stress, and in this way decrease the appearance of wrinkles. Stem cells prevent premature skin ageing and assist with wound healing.
Skincare products with stem cells help reverse pre existing damage and protect against further environmental assault.

Hyaluronic acid
This complex sugar is a natural substance that is found in the skin. Hyaluronic acid acts as the skin’s natural “super-sponge” locking in moisture for a plumper, softer and more supple skin.
Hyaluronic acid has become quite a buzz word in the cosmetic industry over the past few years. The natural occurring form declines with ageing. It is therefore a key ingredient in skincare products to rejuvenate dehydrated skin and reduce the appearance of fine lines and wrinkles.

…And of course the number 1 anti ageing ingredient is sunscreen. No anti ageing regimen would be complete without optimal sun protection. Remember the best sunscreen is the one you are happy to use!

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Winter Skincare tips

So we know that winter really does leave us with a compromised skin barrier, and dry and sensitive skin. How can we remedy the situation?

Here are some useful tips on how to change our skincare and winter behavior to help keep our skin hydrated and comfortable!

Cleansers : Most of us make use of the same cleanser throughout the year, no matter the season. During a harsh, dry winter season one could consider avoiding cleansers with high concentrations of sodium lauryl sulphate (soap), as well as those with high concentrations of acids, like salicylic acid and glycolic acid. While these are useful to control an oily skin type, they can strip away essential moisture, leaving the skin dehydrated and sensitive. Rather opt for a milk or gel cleanser in winter that will gently cleanse the skin of make-up and impurities, without leaving the skin dehydrated or vulnerable.

Moisturisers : Change your daily moisturiser during the colder months to one that is more nourishing, and provides a protective barrier to environmental elements. Hyaluronic acid in moisturisers is a natural moisturising ingredient that nourishes the skin while also having a plumping effect. If you enjoy your current daily moisturiser, and do not want to change, you could supplement your daily regimen by adding a hydrating or antioxidant serum underneath your moisturiser. A good tip when applying your daily moisturiser is to do so immediately after your bath / shower, when the skin is still warm and slightly damp. This will allow for better penetration.

Sunscreens : Do not stop applying your sunscreen during the winter months. Although there may be less UV exposure, due to cloud cover, you will still be exposed to UV damage, particularly UVA, which causes free-radical damage. Sunscreens containing antioxidant ingredients also protect against exposure to atmospheric and environmental aggressors, such as UVA, UVB, Infra-red, and ozone pollution, which may lead to dehydration, pigmentation and ageing.

Humidifier : Indoor fires and heaters, underfloor heating and air conditioning dries the air and worsens dry skin problems. Before you invest in bulk quantities of lotion and lip balm to rehydrate your skin, think about rehydrating the air. Use a humidifier to add moisture to the air and to prevent dryness of the skin, nose and throat.
While you will still need a good moisturiser, humid air is a great first step toward lessening dry skin issues.

Should you exfoliate?

When the skin is overly dry or dehydrated, it becomes less efficient at sloughing off dead skin cells which build up on the surface of the skin resulting in a dull, flaky appearance. Gentle exfoliation of the skin on a regular basis will help to improve the appearance of dull skin. Superficial to medium peels gently break the bonds between these dead skin cells, removing them and exposing healthier, more youthful, glowing skin. This exfoliation also allows for better penetration of hydrating ingredients into the skin.

Microneedling: This treatment technique is designed to address poor skin quality by creating a controlled injury to the skin so that it regenerates and repairs itself naturally. Microneedling is also referred to as ‘collagen induction therapy’. The principle behind microneedling is that it breaks down old collagen and stimulates certain growth factors to promote the production and deposition of new collagen and elastin.

Dr Kesiree Naidoo offers a range of non-invasive procedures including Microneedling, to book your appointment contact her practice on 021 531 1107 or via email on [email protected]

If you are not sure what product would be best for your winter skin, take our free Skin Assessment or email our medical skin therapist Annika on [email protected]

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Essentials for winter skin

Dry, dull looking skin in winter is distressing and well as uncomfortable. If you are distressed by winter skin concerns we have good news!
Skinsmart has a variety of skincare products that will not only help to hydrate and plump up the skin but also target other concerns such as fine lines and wrinkles.

Cleansers
Obagi Gentle Rejuvenation Soothing Cleanser:
This calming gel cleanser offers relief from inflammation and irritation. It effectively removes makeup and impurities without disrupting the skins natural moisture barrier.

Neostrata Facial Cleanser:
Facial Cleanser is a gentle soap-free, fragrance-free formulation which effectively cleanses and exfoliates without drying or stripping the skin. This product is suitable for all skin types including sensitive skin and is gentle enough to use twice a day.

Serums:
SkinCeuticals B5 Hydrating Serum:
Hydrating B5 Gel replenishes nutrients the skin needs to create a supple, smooth textured, younger-looking skin. This oil-free moisturiser combines vitamin B5 with hyaluronic acid, the body’s natural hydrator, to help prevent moisture loss from the skin.
It can be used alone or underneath a daily moisturiser to provide extra hydration, and is ideal for all skin types.

Neostrata Skin Active Tri Therapy Serum:
This exciting new product from Neostrata is formulated with a triple anti-ageing complex to help volumize and sculpt skin, improving the appearance of deep wrinkles and skin laxity while hydrating the skin without causing sensitivity.

Obagi Professional C serum 10%:
This oil-free antioxidant serum is suitable for dry and sensitive skin types. It stimulates collagen synthesis, reduces inflammation, suppresses pigmentation and helps the skin to retain hydration. Vitamin C enhances UV protection for anti-ageing and skin cancer prevention.

Moisturisers:
SkinCeuticals Epidermal Repair:
Epidermal Repair is a barrier cream specifically formulated for application after non-ablative professional resurfacing procedures such as chemical peels, IPL and microdermabrasion. Applied immediately following these procedures, this product repairs the skin’s barrier function, soothes sensitised skin, and can also be used to treat conditions such as eczema.

SkinCeuticals Triple Lipid Restore:
Triple Lipid Restore 2:4:2 is formulated with optimal concentrations of reparative lipids to restore the skin’s barrier function, which may have become compromised due to the natural ageing process. 2% pure ceramides restore the skin’s barrier function, 4% natural cholesterol restores skin elasticity and promotes self-repair, and 2% fatty acids assist in replenishing lost lipids due to ageing. This unique lipid correction cream has been clinically proven to improve skin smoothness, laxity, pore appearance and overall radiance.

Obagi Gentle Rejuvenation Calming Cream:
This non-irritating moisturising formulation contains plant-derived growth factors Kinetin and Zeatin. It effectively calms and soothes a sensitive and irritated skin.

Eye cream
Obagi Ultra Rich Hydrating Eye Cream:
Obagi Ultra rich hydrating eye cream: This eye cream containing a blend of plant-based extracts is deeply hydrating for sensitive and dry skin.

Treatments
Neostrata Bionic Face Serum:  
Lactobionic acid reduces fine lines and wrinkles and provides excellent antioxidant benefits to the skin. The combination of Vitamins A, C and E; and Lactobionic acid provide intense moisturisation, refines pores and improves skin laxity and mottled pigmentation to restore an even-toned radiant complexion.

SkinCeuticals Phyto Corrective Mask:
Phyto Corrective is an oil-free soothing and hydrating mask for irritated and sensitive skins. It contains cucumber for its anti-inflammatory properties; thyme, which is anti-bacterial and antiseptic; and hyaluronic acid for its hydrating benefits. Often referred to as the ‘green ambulance’, it is ideal for sensitive, red and irritated skins, acne and rosacea-prone skins and as a post-sunburn treatment.

Sunscreens
Heliocare 360 Mineral:
This mineral fluid sunscreen is ideal for those with sensitive, acne-prone skin and atopic dermatitis. It is safe for use in children.

Neostrata Sheer Physical Protection
Neostrata Sheer Physical Protection is a lightweight, translucent fluid providing broad spectrum UVA and UVB sun protection, while its sheer tint and texture provide a mattifying finish that blends beautifully with the natural skin tone. It is formulated with physical filters, titanium dioxide and zinc oxide, along with potent antioxidants, green tea extract, Lactobionic Acid and Vitamin E, to neutralise free-radicals and preserve healthy DNA.

If you are still not sure what product would be best for your winter skin, ask your Dermatologist or email our medical skin therapist Annika on [email protected]

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Pregnancy Skin Conditions

Pregnant women are still susceptible to everyday skin concerns that plague other women, though the treatment may need to be tailored to suit the changes of the skin and body in pregnancy and take into account the effects on the developing fetus. Here is some of our advice followed by a few product recommendations for common pregnancy concerns.

ACNE BREAKOUTS


Higher levels of hormones called androgens are at least partly responsible for pregnancy breakouts because they prompt the sebaceous glands in your skin to get bigger, and boost production of sebum. This often occurs during early pregnancy and may make the skin appear or feel oily. Acne during pregnancy may be mild, moderate or severe. It may be of new onset or an exacerbation of a pre-existing problem. It is important to remember that not all treatments and products are safe to use during pregnancy and if you were on a treatment regimen before you fell pregnant this may need to change. Consult your doctor, dermatologist or skincare professional to make sure you are on the right medication.

Product recommendations:

Neostrata Sheer Hydration-Sheer Hydration is a light, oil-free ,daily hydrator formulated with NeoGlucosamine to gently exfoliate the skin, promote cell turnover and help with minor acne problems.


Obagi NuDerm Foaming Gel – This foaming gel cleanser cleans the skin thoroughly of makeup and impurities. This product is safe to use during pregnancy.

MELASMA / CHLOASMA (PREGNANCY MASK)


Hyperpigmentation can occur for the first time during pregnancy as a result of hormonal and genetic factors, together with increased sensitivity to sun exposure The melanocytes in pregnant women are more sensitive to increased levels of melanocyte stimulating hormone(MSH), oestrogen and progesterone. Hyperpigmentation is one of the most common skin changes during pregnancy, and is also very hard to treat as options are few. It is often very distressing for pregnant women to deal with, in addition to all the other changes that come with pregnancy.
It may gradually improve or disappear after childbirth (normally 3-6 months after) but may persist in some women. There are numerous ingredients in cosmeceutical products that work synergistically to lighten and control pigmentation, but many of these are not suitable for use during pregnancy.

Product recommendations:

Heliocare 360 mineral – This innovative mineral fluid sunscreen is ideal for sensitive skin.


Neostrata Brightening cleanser – The Neostrata Enlighten range is clinically proven to treat and control pigmentory disorders, dark spots and signs of sun damage, while also reducing the appearance of fine lines and wrinkles.
Please note that not all products in the Enlighten range are safe in pregnancy.

DRY SKIN


Dryness of the skin is a common skin complaint and may occur for the first time during pregnancy or part of an ongoing problem. The skin feels tight and uncomfortable and may appear rough and dull. Pregnant women often look for more hydrating creams during pregnancy as their regular moisturiser may not provide enough hydration.

Product recommendations:

Neostrata Bionic Face Serum – Bionic Face Serum is a concentrated oil-free serum with 10% Lactobionic Acid designed to work synergistically with other Neostrata anti-ageing products in your regimen to improve radiance, skin texture and the signs of ageing.
It provides comfort and hydration for dry skins.


Neostrata Bionic Face Cream– Bionic Face Cream is an ultra-rich, anti-ageing emollient cream which provides intense hydration and skin smoothing effects without irritation.

SENSITIVE SKIN


Some pregnant women have the impression that their skin in more sensitive than before pregnancy. This may mean different things to different people, but in general, the skin is easily inflamed and irritated and reacts to numerous cosmetic products. Sensitive skin is a common complaint among pregnant women and is most likely due to changes in hormone levels. Pre-existing skin conditions such as eczema and rosacea may improve or worsen and your regular skin care regimen may no longer be suitable.

Product recommendations:


Obagi Soothing Cleanser – This calming gel cleanser offers relief from inflammation and irritation. It effectively removes make-up and impurities without disrupting the skins natural moisture barrier.


Obagi Skin Calming Cream– This non-irritating moisturising formulation contains plant-derived growth factors Kinetin and Zeatin. It effectively calms and soothes a sensitive and irritated skin.

Can I continue with my anti-ageing treatment during pregnancy?

A well-tailored anti-ageing skin care regimen can help slow the process of ageing. While you are pregnant you may need to change your existing regimen for one that doesn’t contain ingredients that are unsafe or have high irritation potential. In general vitamin A and its derivatives, including retinol, are not safe for use during pregnancy.
Please take our Skinsmart Skin Assessment to see our recommendations for anti-ageing skin care that is safe to use during pregnancy and while breastfeeding.

If you would like our advice on whether you can still use any of your existing creams, please email us on [email protected] or alternatively book a consultation with our medical therapist or dermatologist on 021 521 1107.

 

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What is Pseudofolliculitis?

Pseudofolliculitis is a common chronic skin condition which typically affects the beard area of men who shave.
It is then referred to as pseudofolliculitis barbae or more commonly called ‘shavers rash’.
It typically occurs in men with tightly curled hair and of African descent. ‘Barbae’ refers to the beard area though pseudofolliculitis can occur in any shaved area and could even affect women and other race groups. It occurs where hair is coarse and abundant and subject to shaving, waxing or plucking
In all cases it is a cosmetically disfiguring condition which is difficult to treat and often recurrent.

How does it occur?

 

Paeudofolliculitis is caused when hair grows parallel to the skin surface rather than perpendicular to it such that the sharp tip of the newly cut hair curls back and pierces the skin causing trauma, inflammation and ultimately an ingrown hair.

A newly cut or plucked hair shaft may pierce the follicular wall to enter the dermis without ever leaving epidermis (upper layer of the skin) once again resulting in an ingrown hair and inflammation

While this process occurs mainly in curly hair, skin folds or scarred skin may cause the condition in straight hair.

Pseudofolliculitis barbae is essentially a chronic foreign body reaction to an ingrown hair shaft.

What does it look like?

Pseudofolliculitis barbae typically presents with firm papules and pustules in the beard area. For some reason it does not occur on the moustache area. The appearance of the disorder can be cosmetically distressing for affected patients. Postinflammatory hyperpigmentation, secondary bacterial infection, scarring, and keloid formation are potential complications.

How can you prevent it?
Use good shaving techniques.
Cleanse the skin thoroughly and wet the skin and hair before shaving. Wetting the hair softens the keratin making it easier to cut. Applying a warm wet towel for a few minutes before shaving may also be helpful.
Shaving preparations provide additional hydration and cushion the blade against the skin to minimise trauma.
Use a clean,sharp blade and shave in the direction of hair growth where possible.
This may be difficult as the hair in the beard area tends to grow in different directions.
Cleanse the skin thoroughly after shaving, as residual shaving preparation left on the skin surface may cause irritation.

How do you treat Pseudofolliculitis?

Stop shaving
The first step is to stop shaving in the area till all inflammatory lesions and ingrown hairs have cleared.
You may trim the hair to a minimum length of 0.5 cm with a scissors or electric clippers

Release ingrown hairs on a daily basis
Apply a warm water compress to the affected area for 10 min to soften the epidermis ( upper layer of the skin). Then release the ingrown hairs with a sterile needle or toothpick.

Topical corticosteroid
Apply a mild topical steroid to the area to decrease the inflammation and reduce burning and itching.

Systemic antibiotics
Some patients may need an oral antibiotic for secondary infection or for anti inflammatory effect.

Other treatments
Other treatment options include topical retinoids, alphahyroxyacids and benzoyl peroxide.
Chemical depilatory creams may be used for hair removal.
Laser hair removal is sometimes recommended for those with resistant and recurrent pseudofolliculitis.

Once the condition has resolved, adopt good shaving techniques as described above, and invest in a suitable skincare regimen as recurrence is common.

Skincare recommendations for Pseudofolliculitis.

Neostrata Foaming Glycolic wash

– This is a potent, foaming facial cleanser with glycolic acid and lactobionic acid to resurface and hydrate the skin with minimal irritation. The special formulation exfoliates and unclogs congested pores.

Obagi Clenziderm pore therapy

This liquid treatment contains salicylic acid which helps unclog pores and remove dead surface skin cells.

NeoStrata Ultra Smoothing Lotion 10 AHA


– Ultra Smoothing Lotion is an antioxidant-rich, exfoliating moisturiser. This is a lightweight formulation which is suitable for use on the face and body and may be preferred by men. The exfoliating action of alphahydroxyacids removes the surface dead skin cells and helps unclog pores.