Dermatologist Dr. Cynthia Bailey answers your questions about skin care and skin problems

Hi Dr. Bailey,

I am 49 years old. I use Tretinoin 0.5% for sundamage and aging purposes. Is it possible to add Glycolic acid to my routine also?  I am wondering if there is a Glycolic face cream I can add?During the day I am currently using Glycolix Fortified Facial Cream for Dry Skin and the Citrix Antixodant SPF30 sunscreen.

Thanks so much!

Heather

Dear Heather,

I love both tretinoin and glycolic acid for sundamage and anti aging skin care.  Tretinoin and Glycolic acid are both powerful anti aging skin care ingredients that make very noticeable improvements in the appearance of the skin by:

• Lighten age spots
• Smooth and exfoliate the skin giving it a more luminous character
• Work to reverse wrinkles by building new collagen just underneath the surface of the skin.

The ultimate anti aging skin care product combo is to use both of these and throw in a strong professional level vitamin C product every 4th day. Each of these ingredients works to rejuvenate the skin by a different mechanism, and thus combination therapy yields more age reversal that using just one alone.

Unfortunately, all these highly effective anti aging ingredients are irritating.  Only people with really tolerant skin can combine tretinoin and glycolic acid therapy.  People with sensitive skin (especially people with rosacea, eczema or facial seborrheic dermatitis) typically have to pick either tretinoin OR glycolic acid.  People who can’t tolerate using tretinoin with glycolic acid can sometimes tolerate using just one of these ingredient with a topical vitamin C product.  This is because the vitamin C is not exfoliating.  Vitamin C is, however, irritating to exfoliated skin so it’s still a little tricky.

The reason that it’s tricky to combine these wonderful and effective anti aging ingredients is that the glycolic acid and the tretinoin are both very exfoliating.  Exfoliated skin has a more refined and luminous appearance, but also  absorbs things faster.  Because the glycolic acid and the vitamin C both have an acid pH, they can be irritating to exfoliated skin.  In addition, tretinoin causes a ‘break in’ rash (called retinoid dermatitis) when a person first starts using it.  The skin adjusts in about a month and the retinoid dermatitis typically goes away, but skin with retinoid dermatitis gets really irritated from the acid pH of the glycolic acid or the vitamin C products.

When people want to try to combine anti aging home therapy, my favorite method is to start them on the tretinoin at night for at least 2 months. When their skin has adjusted to the tretinoin, we add professional level glycolic acid during the day as I describe below.  When the combination is tolerated and can be applied every day, then we throw in the CRS Vitamin C at least twice a week in place of the glycolic acid.  To help the skin tolerate this powerful anti aging treatment, I add Replenix CF cream twice a day.  I’ve found Replenix to really increase a person’s ability to handle more anti aging skin care products than it otherwise would.

When a person wants to try combining glycolic acid and tretinoin therapy I recommend they start with one first, let the skin adjust for a month or two, then add the second. They use the second product a few days a week to begin with.  Gradually, as their skin adjusts to the new second product, they work up to using the second product every day.  If parts of their face do well with the combination but other areas become irritated, then they don’t put the second product on the sensitive areas.  When their skin gets irritated for any reason, they need to stop both products until the skin is back to normal, at which point they repeat this process over a shorter period of time.

Of course, any exfoliating anti aging treatment means that a person MUST wear a 5% or more microsized zinc oxide sunscreen like Citrix every day, all year, regardless of their planned activities.  Because exfoliated skin allows more damaging sun rays to enter the skin, I also want people to wear hats and try to keep their face out of direct sunlight as much as possible.  This is important for skin cancer prevention, and it’s also critical for their anti aging skin rejuvenation to be effective.

Because combination therapy is complicated and involves layering products on the skin, I write out the order of product application for my patients.  The typical product application regimen that I recommend is:

Morning

1. Wash with a gentle cleanser (eg. Noble Zinc Soap or Toleriane Cleanser)
2. Replenix CF Cream
3. Glycolic acid product (choose based on your skin type) or CRS Vitamin C Cream
4. Moisturizer if needed (eg. Glycolix Ultra Lite or Fortefied, or your favorite non copper containing moisturizer)
5. 5% or more micro sized zinc oxide sunscreen (Citrix is the most popular)

Night time

1. Wash with a gentle cleanser as above
2. Replenix CF Cream
3. Moisturizer of choice if needed
4. Wait 15 minutes then Tretinoin (begin every 3rd night and gradually work up to every night)

If a person finds that they are unable to tolerate both tretinoin and glycolic home therapy, then I recommend they try combining tretinoin at night, CRS vitamin C during the day and have occasional glycolic acid peels done carefully by a skin care professional.  Again, the exfoliation achieved with tretinoin makes the peels tricky and the skin care professional needs to be experienced with this situation.  The risk is that the peel may be go too deep and injure the skin, potentially causing scarring.  Remember, professional skin care is capable of creating powerful skin rejuvenation, but there are risks; professional anti aging skin care products have to be strong in order to overcoming nature, it’s not like buying some fluffy, ineffective products at the department store.

I wish you the best of luck.  Be sure to talk with your tretinoin prescribing doctor about what you’ve learned here. This information is general information and I can’t promise it is appropriate for your specific skin.

I hope you found this helpful and informative.  Thanks for sending me your question.

Warm Regards,

Cynthia Bailey MD, Dermatologist

For more information on anti aging skin care you may want to read:

Dermatologist’s Own Personal Tricks to Control Age Spots, Sun Spots and Uneven Pigmentation

Now Between Fall and Early Spring is the Best Time Of Year To Reclaim Soft Skin and Treat Age Spots

To send me your skin care questions or to ask me to address a specific dermatology topic, please use the  ‘Contact Dr. Bailey page’ on the left sidebar or click here to load the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

This is my fight against my middle age bulge.

I’ve been blogging about my personal diet and exercise programs and want to update my readers on how they’re going.  I’m experimenting on myself, as usual.  I’m having good results and want to share what I’m learning.

My post holiday BMI shocker kicked me into a frenzy to send the new  belly fat packing; having my lifelong pear get joined by an apple, forming what I call a papple, isn’t something I’ll take lying down.

Diet Program

In a January blog post I outlined the Alkaline Mediterranean Diet that I created.  This is the diet I feel best on and have aimed for over the years.  Aiming doesn’t always mean I hit the mark so I fortified my resolve after the holidays when my BMI tipped up to 25.

On my Alkaline Mediterranean Diet, a minimum 60% of foods that are eaten should be alkaline forming foods and a maximum of 40 % of what I eat are acid forming foods.    This is a primarily vegetable and fruit based diet with low glycemic whole grains, lean meats and dairy, and some fish, nuts and oils. I’ve been good at making sure that  60% of my food is low calorie alkaline foods. I also limit the dairy, and protein food portions to 6 oz. serving sizes. I eat all the veggies and fruit I want.  I mostly keep the 40% acid foods healthy, low calorie choices.

The low glycemic, low calorie food choices went well for 5 weeks, steadily sending the papple packing. Valentine’s Day weekend was a bust, however, and for the next 2 weeks decedent gourmet foodie treats became my 40% acid forming foods. I was holding steady weight wise, but boy those foods are hard to kick once they make their way into my diet.  Chocolate, wine even a piece of a lemon tart-argh!

Time for an intervention.  To reset my metabolism for weight loss I decided to use my March week off to do another detox cleansing fast. A detox cleanse also quickly fixes my food driven musculoskeletal aches and pains.   Bodies however have inherent alarm bells that go off when calorie intake falls below calorie usage; a primitive survival mechanism held over from the days of famines, obsolete and not useful in our modern land of abundance.

During the first day of a cleanse my body always complains. I’m hungry and fantasizing about foods. By day 2 I’m in the groove.  Belly fat obviously melts on a cleansing fast, and at day 4, melting it is.  I feel great, pain is just about gone, and Iplan to keep it up for 7 days this time.  After 7 days I’ll taper off the cleanse by slowly going back to the Alkaline Mediterranean diet.

A detox cleansing fast isn’t for everyone.  Anyone in fragile health or with a tendency for diabetes or other metabolic diseases needs to do this under their doctor’s supervision.  There are a number of residential programs that help people do a cleanse. I don’t have time for that so I created my own program and integrated it into my life.  Patients ask me about it so I posted my program in my blog.

Exercise

Adding 150 minutes of cardio per week back to my life boosted my vitality and kept me loosing belly fat in spite of the Valentines diet slide. I added three 50 minute cardio workouts a week to my 4.5 hours of yoga and 3 hours of ballroom dance.  This made a huge difference to  shrinking the papple as well as to my overall quality of being.

Consistent cardio exercise, done every week is a must for anyone working on maintaining good health.  I’ve done regular cardio my entire life until last year when my back forced me to quit my cardio dance class.  I never filled the cardio void and this probably has something to do with the appearance of the papple.

I’m not pushing myself with the cardio while on the cleansing fast.  I do a power walk every other day and continue with yoga, but the spinning and swimming will wait a week.

So…….

My do-it-yourself physical health rehab program.

Created by a doctor and aimed at the middle age obesity and  belly fat that’s become an American way of life.

If you found this information helpful, you may want to read:

Post Holiday BMI Shocker Gets Me Serious About My Middle Age Belly Fat

Why I Do A Detox Cleansing Fast To Improve My Health

Cynthia Bailey MD’s Recommendations For The Alkaline Mediterranean Diet

Photo attribution:

Dermatologist Dr. Cynthia Bailey answers your questions about skin care and skin problems

Dear Dr. Bailey,

I love the information in your blogs.  I have a question about white spots that are on my arms and legs.  They don’t tan, are they a form of skin cancer?

Thank you, looking forward to reading more info on your blog,

Vicki

Dear Vicki,

The most common cause of white spots on the arms and legs is guttate hyopmelanotic macules.  This long name actually refers to a very simple condition-the flat little white spots that start showing up around middle age.  They are smooth surfaced, slightly shiny and don’t itch or hurt.  They are entirely benign and don’t become cancer or anything other than a decorative nuisance.  They don’t tan and they still show up when a person uses fake tanners.

Guttate hypomelanotic macules are usually seen on the outside of the arms and the legs.  They are especially likely to be seen in people who have had a lot of sun exposure during their lifetime, leading us to believe that they are somehow a part of sun damage.  I usually also see the brown sun spots (the age spots that are actually sun freckles due to sun damage) on a person’s skin when I see guttate hypomelanotic macules.

Doctors don’t know why people get these little spots and they are impossible to fix.  They can’t be burned off, scraped off or lasered.  I recommend that people exfoliate their skin with my Anti Aging Body Kit because in my experience it helps a little. I discovered that it seemed to slow how quickly I was developing guttate hypomelanotic macules on my own skin and now I recommend that patients use the kit for the same reason.

Not seeing your white spots I can’t be certain that you have guttate hypomelanotic macules.  The information I’ve just given is inspired by your question, but you need to see your doctor for an exact diagnosis.  There are other causes of white spots on the skin, some are common and some are rare, some have important health implications and others don’t.

Even though I can’t guarantee that this information fits your specific situation, I hope you’ve found it interesting and helpful.

Warm Regards,

Cynthia Bailey MD, Dermatologist

To send me your skin care questions or to ask me to address a specific dermatology topic, please use the  ‘Contact Dr. Bailey page’ on the left sidebar or click here to load the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

If you found this information helpful, you may also want to read:

Early Skin Cancer Detection Saves Lives; You Need An Annual Full Skin Exam

The first time I did a real cleansing fast the results were extraordinary!

I did a 3 week fast as an act of desperation; at the time I was struggling with pain from degenerative joint problems and on the brink of taking time off from my medical practice to figure out what to do.  One of the alternative health practitioners I know here in Northern California (of which there are of course many) encouraged me to try a cleansing fast first.  Instead of phoning my disability insurance agent, I did a 3 week cleanse.  By day 5 of the cleanse, I was absolutely and totally pain free! I slept through the night without being woken up with pain, I could bend over without pain, nothing ached-frankly it was a surprising and welcome miracle.

At that point, I knew my musculoskelatal pain problem was somehow related to my diet.  Apparently my pain was caused by something reversible that was happening around my degenerative joint areas (probably inflammation) and not the structural joint issues themselves.  This was 2 years ago and since then I’ve been able to turn my pain on or off like a light switch with my diet. I’ve worked hard to figure out what dietary choices bother me and what I can tolerate.  Pain is highly motivational and I’m pretty dedicated to maintaining a diet that controls my pain.  (I’ve posted some of what I’ve learned in prior blog posts) I’m not perfect at avoiding foods that trigger my pain however, so doing a shorter cleansing ‘detox’ fast is a good way for me to reset my body. It’s much like how cleaning out my garden shed or cleaning out my email box keeps me focused and productive.  I sustain a cleanse for anywhere from 1 day to 3 weeks.

I do a short cleanse when I feel like my body needs it and I always feel better afterwords.  I’m out of the office this week and I’ve decided to use the time to do a 1 week cleanse.  For the past 5 weeks I’ve been working on upping my cardio work out plus sticking to my Alkaline Mediterranean diet plan and the boost I get from a cleanse will be nice.  See my Post Holiday BMI Shocker post.

These days it’s trendy to talk about ‘detoxing’ and ‘doing a cleanse’.  The terms are loosely used and poorly understood.  As I see it, the necessary components of a detox cleanse are:

1. Consuming nothing that your body is troubled by
2. Eating only simple vegetables that don’t cause spikes in blood sugar, are organic and fresh so that your body can reset itself
3. Adding supporting herbal supplements and treatments to help your body flush out any troublesome byproducts from consuming troublesome things in the past

This last point is highly controversial among my traditional medicine colleagues where the general view is that the liver and the kidneys do just fine at getting bad things out of us.  I think extreme examples of  consumption based diseases like gout and high blood pressure make it pretty obvious that our bodies do vary in how completely we’re able to process and eliminate what we consume.

The cleansing program that I’m doing right now

During my detox cleansing fast I only consume highly concentrated and nutritious organic vegetables.  I use support herbs and a few other products to theoretically help ‘get bad things’ out of my body.  I chose the method and picked the supporting products after investigating many of the resources and products that claim to support the body in cleansing.

The supplies and information resources I use for my detox cleanse are:

• I used The Martha’s Vineyard Diet Detox as a guide and modified their recommendations (I bought the book and recommend anyone thinking about doing a similar cleanse buy it and read it first)
• I chose not to buy the Martha’s Vineyard Detox supplies. Instead I went to my local Whole Foods Market and selected the following items based on reading the labels and talking with the Whole Foods staff about product quality.
• The products I use are:

The actual cleanse schedule:

• First thing in the morning I take one of the CleanseSmart herbal supplement (the morning formula), have a 1 oz. shot of the mangosteen in 12 oz of water and have my usual pot of organic green tea (I try not to have soy milk)
• Midmorning I have a green drink made with a heaping tablespoon of the Barlean’s Green Powder in 12 oz water
• At noon I have 8 to 12 oz of freshly juiced veggies (see below) and an enzyme capsule
• Mid afternoon I have another green drink
• Late afternoon I have another shot of mangosteen in 12 oz water
• For dinner I make a boiled soup (see below) and have an enzyme capsules
• At bedtime I have the evening formula CleanseSmart herbal supplement and 1 tbs of the aloe vera concentrate in 12 oz water
• All day long I have lots of organic herb tea and many glasses of water.

Preparing fresh veggie juice: The veggies I use for juicing always include carrots, celery and kale.  I also juice beets, fresh sprouts, and parsley.  You can juice just about any veggie, but some taste bitter.  Carrot juice is sweet and tastes good, so I always include carrots.  Beets are yummy but have to be cut and the juice will stain so I don’t always do them.  Veggies should always be organic, fresh and washed well.  I always drink the juice fresh.  If I can’t make it myself, I go to Whole Foods and have them make it.  I also occasionally do a separate shot of wheat grass, which I really dislike but it’s apparently good for me.

Preparing the veggie soup: For the veggie soup, I boil about 3 cups of water and throw in whatever veggie I have.  I always use onions, carrots and celery.  Other options include cabbage, kale, beet greens, dakon radish, green beans, or whatever is growing in my garden or looks good in the fresh produce section at the store.  I sometimes add curry powder, herbs or other spices but I try not to add much salt since that’s one of the things that’s nice to clean out of the body.  Towards the end of the fast, or if I’m really getting desperate I’ll add frozen soy beans, dried lentils, potatoes or a low glycemic grain like add rice, quinoa, millet or amaranth to my soup.  I have as much of the soup as I want and I don’t puree it.

Soup ingredients

Additional considerations when doing a cleanse

My cleansing detox fast is very alkaline for the body.  Eating alkaline foods are one of the important ways I keep my body feeling good.  I outlined the benefits of alkaline foods in my posts on the Alkaline Mediterranean Diet.

While I’m doing a cleanse, I don’t have fruit, except to occasionally squirt fresh lemon juice into a glass of water.

I don’t do vigorous exercise while I’m doing a cleanse. Doing an intense cardio workout or maintaining a tough work schedule is difficult with so little food energy so I don’t try to do either.  Fasting is a nice time to rest and spend time in contemplative activities, allowing the body to function on less fuel.

The Martha’s Vineyard Detox Diet book recommends doing some additional alternative therapies during a cleanse to support the detox process.  I do some of these such as having a massage to enhance lymphatic drainage.  The book also recommends enemas and colonic therapy and I’m not going to tell you if I avail myself of those options but there are some good reasons why they would be beneficial.

Of course, no one who is frail or has serious health problems should ever do a fast, cleanse or ‘detox’ without their physician’s supervision.

All of the supplies I list can be found on their companies web sites.  Your natural food store may be able to order them if they don’t normally stock them.  The Martha’s Vineyard Diet Detox book is also called 21 Pounds in 21 Days.  As the name states, you will lose weight doing a detox cleansing fast.   The book is written by Roni DeLuz RN,ND and can be ordered from mvdietdetox.com or from Amazon.

I’d love your comments-please send me your detox cleanse thoughts and your diet/health stories.

Photo attribution:

Dermatologist Dr. Cynthia Bailey answers your questions about skin care and skin problems.

Hi Dr. Bailey,

I always seem to have dandruff – I use good shampoo and conditioner and wash my hair every other day. I dislike wearing black shirts since I feel that I am always “shaking off” the dandruff. Any suggestions?

Thank you,
Donna

Dear Donna,

Thank you for being the first person to take me up on my offer to provide skin care information based on your questions.

Dandruff, also called seborrheic dermatitis, is common and can vary from a mild itch to a severe crusty and scaly rash. Sounds like your problem is mostly scale on your scalp. When I advise people on the care of their scalp dandruff I recommend maintenance care (medicated shampoos) to suppress the problem and interventional care (cortisones and scale removing topical treatments) to control flair ups.

It’s important to know that doctors don’t know what causes dandruff and we can’t cure it. Our goal is to get dandruff into remission and keep it there. It’s easier to maintain a clear and healthy scalp than it is to control a constantly scaling one. That means that you should work really hard to get complete control of the problem by using effective interventional treatments plus shampooing with medicated shampoo every day. Once your scalp is dandruff-free then you can rely on the medicated shampoos for maintenance. Remember that scalp seborrheic dermatitis will flair up from time to time anyway, and you’ll need to go back to the interventional treatments.

In the fall I wrote 2 blog posts with detailed instructions for scalp dandruff. The first outlines my maintenance care with medicated shampoos, the second outlines the interventional care:

Remedies for the Dry Itchy Scalp of Seborrheic Dermatitis

Remedies for Really Stubborn Scalp Seborrheic Dermatitis

To summarize my advice for the treatment of scalp dandruff:

1. I recommend a person get 3 different medicated shampoos, with 3 different ingredients and rotate them (my favorites in the drug store are Nizoril, DHS Zinc and DHS Sal). The shampoos should be used as I describe in the first post. Ideally the medicated shampoos should be used every day until the dandruff is controlled.
2. In addition, interventional care needs to be done using treatments that remove the scalp scale quickly. This means using either the mineral oil or the P&S liquid (or alternate both) scalp treatments that I outlined in the second post as often as possible until the scalp scale is gone.
3. I also recommend using a topical cortisone product like Scalpicin with Hydrocortisone twice a day to the active areas until they clear up. It’s also possible to ask your doctor for a stronger prescription cortisone product.
4. Do this until the dandruff is gone, at which point the interventional treatments can be stopped.
5. I recommend continuing to use the medicated shampoos to suppress a recurrence of the dandruff. Shampooing as often as possible will really help to keep dandruff under control.

Remember, if dandruff does not improve within a few months, or if it gets worse with this treatment, then you must see a dermatologist for a diagnosis. There are other conditions that cause dandruff-like scalp scale including common problems like a scalp fungus infection (which will get worse with cortisone application) and psoriasis (which often needs prescription medicines).

Best Wishes and Warm Regards,

Cynthia Bailey MD, Dermatologist

To send me your skin care questions or to ask me to address a specific dermatology topic, please use the  ‘Contact Dr. Bailey page’ on the left sidebar or click here to load the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.