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.

Get ready for spring sandals now!

For many of us, the rough, thick skin on our heels  looks like it belongs on an elephant?  It’s hard to hide cracked, thick heels in sandals and you CAN fix them before spring.

Reclaiming your baby soft feet is easy when you have the right tools for the job.  All it takes is strong exfoliation.  A pumice stone alone doesn’t cut it if you have really thick foot skin.  You need CHEMICAL EXFOLIATION AND PHYSICAL EXFOLIATION to get your feet back into sandal-ready shape.

• Chemical exfoliation means using a skin care product that softens and dissolves the thick skin so that you can actually get somewhere when you try to file it off.  The best product for thick, rough heel skin is Glytone Heel and Elbow Cream*.  This is a seriously strong glycolic acid cream that’s a miracle for rough feet!
• Physical exfoliation is what you do when you file or scrape off your rough thick foot skin. The best foot scraper is the PedEgg, which you can get at www.PedEgg.com.  You could also use a foot file like the pedicurists use, or a pumice stone.

Dr. Cynthia Bailey’s 3 Steps To Treat Thick, Rough Skin on Your Feet

1. Soak your feet in warm water, or take a warm shower for 10-15 minutes.
2. Rub the rough skin off your feet using the PedEgg or a foot file while your feet are wet.  Rub off as much rough skin as possible without hurting your feet.
3. Apply Glytone Heel and Elbow Cream while your feet are still damp.  Towel dry your feet, but you need to apply the cream while they are still damp.  Apply the Glytone Heel and Elbow Cream liberally to the thick areas, including the toes and nail beds if needed.  Put on a clean pair of cotton socks and leave them on for at least 8 hours.

Depending on how thick your foot skin is, this process can take between one week and several months for all the thick, rough skin to come off of your feet.

If irritation develops, let the skin heal before you resume the treatment

Once you have soft, smooth skin on your feet, repeat this process as necessary to maintain the results.  Some people find that once their feet are soft again, they can maintain the results by switching to my Anti Aging Body Rejuvenation Kit products and treating their feet when they treat the rest of their body skin in the shower.

Having baby soft feet that invite a foot massage is easy, and they look so much better in sandals!

*  Glytone Heel and Elbow Cream is a 30% glycolic acid cream and is REALLY strong.  If used in any manner other than I’ve stated above it WILL be too strong and irritate/burn your skin.  It works beautifully for thick skin on the feet, but even though Glytone markets it for elbows, only the thickest, roughest elbows need this strong glycolic acid product. Because Glytone Heel and Elbow Cream is so strong, I do not sell it directly to customers on my web site.  I will sell it by phone if you call my office at 707 829-0937 during the normal business hours (Pacific Time).  This enables us to be sure that you have read this information and understand that you are buying a very strong (and very effective) professional grade glycolic acid skin care product.  You can also order it directly from large retail sites like Dermstore.com without this precaution.

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

Essential Winter Skin Care: 2 Simple Tricks To Healthy Winter Skin

Dermatologist’s Simple Tips for Athlete’s Foot Fungus Treatment

Brilliant Skin Care For The New Decade

Chapped Lips: The Remedy Depends On The Cause

Pandemic Of Dry Hands: Hand Sanitizers, The Swine Flu And Tips To Save Your Hands

Making Sense Of The Vitamin D Dilemma And Sun Exposure

Photo Attribution: Sean Dreilinger

Happy New Year’s Morning!

In my first shower of the new decade I’m struck by the evolution of skin care since I entered dermatology in 1987 and all it’s implications including advances in the products that I use.

This morning, I’m using state of the art products and feeling gratitude for how effective they are!

Today, when I step out of the bathroom, my skin is soft, luminous and healthy all because of my skin care products; in less than 15 minutes I was able to benefit from brilliant medical advances in skin care  and my skin glows with  results.

The ‘play-by-play’ of my New Years Day skin care in 2010:

1.    I used Replenix Scrub in the shower to exfoliate my face for polished and luminous skin today. When I toweled dry, in less than 30 seconds I applied Replenix CF Cream then CRS Vitamin C (to protect and treat wrinkles), hydrated with Glycolix Elite Fortefied Facial Cream and sun protected with Citrix (I plan to go for a walk today even thought it’s raining) Last night I used Retin A for its antiaging benefits and washed with Noble Zinc to control my seborrhea and rosacea.

2.     I have wonderful hydrated, velvety texture to the rest of my skin because in the shower I washed with Glytone Body Wash and the Salux Cloth to polish off any roughness.  I then gave myself an AHA hydrating treatment with Glytone Body Lotion once I had toweled off.

3.     In the shower, I gave my scalp a therapeutic treatment for my bothersome seborrhea by washing with my OTB Cleanser #2 (a medicated shampoo as well as a cleanser) then followed up with my usual hair products.

Hydrated, luminous healthy skin in about 15 minutes max!

Skin Care is Brilliant in 2010!

As I finish blow drying my hair and  look in the mirror, my facial skin has a healthy glow, my arms and elbows are soft, my hands aren’t chapped (that’s another story) and my scalp is healthy and free from itchy scale (another story too). All changes that defy my genetics!

Wishing you a Happy New Year and beautiful healthy skin in 2010.

Now is the best time of the entire year to fix your uneven pigmentation and lighten your age spots, and the most effective home treatment is the Obagi Nu Derm System.

Before Obagi Nu Derm

After Obagi Nu Derm

I love the Obagi Nu Derm results.  I’ve started using it again for the fall and my skin just glows! No other combination of home skin care products can match the ‘wow’ effect that I get with Obagi.

Obagi Nu Derm is a 3 to 4 month home treatment course of powerful skin lighteners, exfoliators and skin penetrators.  You stop using your normal skin care products and use only the Nu Derm products because they work synergistically.  The exfoliators and penetrators allow the skin lighteners to reach down deep into the skin to treat the really stubborn pigment.

In my practice,  patients use Obagi for a total of 3 or 4 months because the powerful skin lightening medicine (hydroquinone) isn’t something I think should be used indefinitely.  Patients are instructed on product use by my two wonderful aestheticians who have been certified and trained in the Obagi System.

The powerful ingredients in the Obagi Nu Derm System can be irritating to skin and my aestheticians are available to help patients troubleshoot product usage.  Calming facials work wonders to soothe the skin during the Obagi Nu Derm treatment process and I highly recommend them given at monthly intervals.  If the skin begins to flake or peel, a gentle microdermabrasion treatment followed by a calming facial can really get the skin looking lovely.

I used Obagi about this same time last year and right now I’m 2 weeks into my current treatment course.  My husband keeps looking at my skin telling me how pretty it looks.   The Obagi company claims that the Nu Derm system is ‘transforming’ and in my experience the results really are.

Here’s the instructions we give patients in our office:

Dermatologist Dr. Cynthia Bailey’s instructions for using Obagi Nu Derm

In the morning:

1. Wash with the Cleanser (step  1) and rinse well
2. Apply the Toner (step 2) with a cotton ball
3. Apply a generous layer of the Clear (step 3)
4. Apply a thin layer of the Exfoderm or Exfoderm Forte (step 4) where tolerated.  See Trouble Shooting Below
5. Apply a generous layer of Healthy Skin Protection Sunscreen (step 6)

In the evening

1. Wash with the Cleanser as above
2. Apply the Toner as above
3. Apply the Clear as above
4. Wait 15 minutes
5. Mix the Blender (step 5) with the tretinoin and apply where tolerated. See Trouble Shooting Below

Nu Derm Kit Products

Trouble Shooting:  The powerful exfoliators and skin penetrators can be irritating and contrary to the official Obagi package information,  you don’t need to let your skin get irritated to get great results.  When your skin begins to get red and sensitive, stop using the Exfoderm or Exfoderm Forte for a day or so until the sensitivity subsides.  The same goes for the tretinoin.  You may find that only certain areas  of your face are sensitive and in that case, I recomment that you just stop using these products in those areas.

The Obagi Nu Derm results really are transformational.  Skin becomes luminous, pigment more even and the skin texture is refined.  The best results are obtained with supervised counseling by knowledgeable skin professionals who are experienced with the Nu Derm program.  The ultimate process is to combine the Nu Derm system with monthly calming facials and if needed, microdermabrasion treatments.

Before Obagi Nu Derm

After Obagi Nu Derm

If you found this post helpful, you may want to read these other posts:

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

Brilliant Skin Care for a New Decade

Dermatologist’s 3 Simple Steps for Sandal Ready Feet By Spring

Now, Between Early Fall and Late Spring, It’s The Best Time To Reclaim Soft Skin and Treat Age Spots and Uneven Pigmentation

It’s  Indian Summer in the redwoods. This is my favorite time of year here in Coastal Northern California. The redwoods are bathed in golden sun instead of shrouded in fog.  There’s a spacious stillness to the air and it’s the most magical season here.  Plus, it’s the time I turn my dermatology focus to helping people remove the ‘foot prints of summer’ on their skin.

The health promoting outdoor activities of summer  have a negative cosmetic impact on our skin; they’re leathering and they darkens age spots and uneven pigmentation.  Most of us also have rough feet after months in sandals and flip flops.  Both of these dermatologic summer remnants  need an exfoliation program.  For the age spots, we need pigment lightening therapy as well, which is best done between early fall and late spring.

In my practice, patients know it’s time to get down to work rejuvenating their skin after summer. Most of my patients have been with me for years.  They know that in the summer we just try to keep the age spots from getting too much darker.  We use a good sunscreen, hats, and clothing to keep the sun off our skin as much as possible.  Many of my patients have to stop using the powerful skin lightener Retin A (tretinoin)  because it makes the skin more sun sensitive and requires really strict sun protection. People often slack off on glycolic acid products in the summer as well because they too create a little extra sun sensitivity, or they just don’t want to be bothered.

As summer winds down, my patients start back on their skin care regimes; they exfoliate, they lighten uneven skin pigment and age spots, they restart their wrinkle treatments.  They also come in for procedures that work best when they are out of the sun.  Here’s some of what we do:

Anti Aging Skin Care Treatment Options for Early Fall to Late Spring in my Dermatology Office

1. Restart Retin A/Renova (tretinoin) therapy on the face, neck and chest.  Sometimes even on the back of the hands
2. Use glycolic acid facial care products either with tretinoin (for the rare few who can handle the combination), or instead of the tretinoin.
3. Use hydroquinoin products if they have a lot of uneven pigmentation and pigmented age spots.  These products are practical for use on the face, neck and chest and the back of the hands.  The most effective are prescription 4% products and include the Obagi Nu Derm system (available in my office by consultation with my aesthetician).  I typically don’t like hydroquinone products used more than 6 months at a time and so late fall, winter and early spring is the most effective time to really lighten pigment with hydroquinone here in California.
4. Consider a monthly microdermabraision program or glycolic acid peel program with my aesthetician.
5. Consider a deeper TCA peel.
6. Start  IPL (intense pulsed light) treatments with my Sciton BBL. These are usually done in a series of 3 to 5 at monthly intervals or a treatment or two for maintenance. These can only be done if a person is not tan. For darker skinned patients, being on a good pigment lightening skin care treatment first is really important to maximizing their results with IPL.
7. Do a single Pro Fractional laser treatment or a series  of treatments (2 or 3 treatments at 2 month intervals to really maximize wrinkle improvement).  The Sciton Pro Fractional laser is state of the art fractionated laser technology to reduce wrinkles and treat acne scars.   Patients have to stay out of the sun after having Pro Fractional treatment, and darker skinned patient get better results if they are on a pigment lightening skin care treatment, so fall, winter and spring are the best times for Pro Fractional laser treatments.
8. For the body, using my Anti Aging Body Kit at least twice a week helps to soften skin and lighten age spots.   Many of the lumpy age spots called seborrheic keratosis are also treated with this kit.  For stubborn age spots we can also freeze them with liquid nitrogen.  We can lighten flat pigmented age spots with  IPL treatments or liquid nitrogen.
9. Rough feet and scaly feet can be treated with Glytone Heel and Elbow Cream (sold through my office to patients, but not on my web site ) if they are really bad (I sent my treatment method out to my email subscribers recently and I will provice it as a blog post in the future as well).  For feet that aren’t so rough, Glytone Body Lotion may be enough to remove the thick scale (along with using a pumice stone).

So for me, the Indian Summer means getting ready for the busiest time of year in my office.  The schedule gets pretty tight and we don’t have much wiggle room. But it’s also a really satisfying time because I get a chance to neaten up peoples skin and I make real headway keeping their skin soft and attractive.

If you found this post helpful, you may want to read these other posts:

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

Brilliant Skin Care for a New Decade

Dermatologist’s 3 Simple Steps for Sandal Ready Feet By Spring