Rosacea is a common, frustrating and often disfiguring inflammatory facial rash. In spite of years of excellent scientific studies, the cause of rosacea remains elusive.  In the entire 25 years that I’ve practiced dermatology, the standard rosacea therapies have relied on oral and topical antibiotics.  Many of my patients are unwilling to use antibiotics long term so I’ve worked hard to find alternative treatments to help them.

What’s new is that scientists are starting to rethink the significance of mites in rosacea.

• We’ve always known that every person has Demodex mites in their skin pores (yes, it’s unsavory but true).
• We’ve also always known that people with rosacea have even more mites in their pores than normal.

Because everybody has Demodex mites doctors have ignored their presence.  I haven’t.  I’ve been treating Demodex mites for years and my rosacea patient’s skin improves.

Results of recent scientific papers suggest a significant role for Demodex mites in rosacea of the facial skin and eyes.  Even more interestingly, one of the papers suggests that it’s not just the mites, it’s a protein on a bacteria that the mites carry that causes some of the inflammation of rosacea-Wow!

So, what are my current recommendations for my patients with rosacea?

• Wash and rinse the facial skin twice a day because mites can be washed off-sort of.
• Use antimicrobial skin cleansers for skin cleansing and wash the entire face including the eyelids (of course, don’t get cleansers in the eyes!).
  • The amount of mites on the skin goes down with the use of antiseptic cleansers, though many antiseptic cleansers are harsh to sensitive rosacea prone skin.
  • I’ve had patients use prescription antibiotic cleansers that contain sulfa drugs, if they aren’t allergic to this medicine.
  • My favorite antimicrobial cleanser is the 2% pyrithione zinc in Noble Zinc.  Noble Zinc does not dry or irritate sensitive rosacea skin.
• Use the Clarisonic brush with the antiseptic cleanser to really get the cleanser into the pores. (On the facial skin not the eyelids.)
• Apply Replenix CF Cream or Power of Three immediately after washing. I find that it soothes the skin sensitivity and redness of rosacea.
• I have patients apply anti-mite medicines after the Replenix Cream.  This is tricky because there aren’t specific topical medicines to treat human skin mites.  On the other hand, the mites seem to respond to many things.  One study showed that mites died quickly on contact with 100% tea tree oil, caraway oil or dill oil.  I’ve never used those and would expect them to irritate sensitive rosacea facial skin.  I have had patients use Metro Gel and Cream, benzoyl peroxide (this can be very irritating to some people with rosacea) and even permethrin cream (a prescription scabies medicine not usually used on facial skin).  The trick is to keep the mite population controlled and I customize the anti mite treatment for each patient.

The new research results are exciting and I expect that soon we’ll have new treatment medicines for facial Demodex mites, and that these medicines will help to control rosacea.

I’d be curious to know what other treatments have worked for you.  Please let me know by including them as comments below or sending them to me using the email link at the top left of this page.

References

Zhao YE, Wu LP et. al., Retrospective analysis of the association between Demodex infestation and rosacea,  Arch Dermatol. 2010 Aug;146(8):896-902

Elston DM, Demodex mites: facts and controversies, Clin Dermatol. 2010 Sept-Oct;28(5):502-4

Li J, O’Reilly N, et. al., Correlation between ocular Demodex infestation and serum immunoreactivity to Bacillus proteins in patients with facial rosacea, Ophthalmology. 2010 May;117(5):870-877

Gao YY, Di Pascuale MA, In vitro and in vivo killing of ocular Demodex by tea tree oil, Br J Ophthalmol 2005 Nov;89(11);1468-73

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

Dr. Cynthia Bailey’s Tips For Treating Facial Seborrheic Dermatitis

4 Diet Changes That Can Improve Your Acne

5 Steps For Smart Sun Protection

Photo: Thanks and gratitude to XMatt

Rosacea: New Treatment Ideas and Scientific Developments is a post from: OTB Skin Care Blog

What makes the skin folds susceptible to this annoying red skin fold rash?

1. Moisture from sweat
2. Rubbing together of folded skin, causing the dead skin cells to rub off and accumulate
3. Irritation caused by normal skin germs which thrive in this environment
4. Growth of a yeast germ called candida, which occasionally also ‘dog piles’ on the problem making a real mess of the skin

Who gets intertrigo?

Anyone with sweaty skin. In my practice I mostly see adults with intertrigo. People with large breasts or a fold under their belly fat are especially prone to intertrigo. Babies can also develop intertrigo in their little skin folds. Because the skin germs thrive in a sweet and sugary environment, diabetics are particularly prone to intertrigo; they often also get the candidal yeast infection in the folds making their rash particularly severe.

The common risk factor is prolonged moist and warm skin from sweating. I see patients with this skin fold rash all year long. During the summer it’s due to the hot weather. In the winter it’s because of the layers of thick clothing worn to keep warm.

Dermatologist’s Recommendations for Care and Prevention for Intertrigo Prone Skin

These are the recommendations that I give my patients. I’ve found that the trick to treating and preventing intertrigo is to try to keep the skin folds dry and sweat free. Using anti-yeast skin care products also helps. For really irritated skin I add a short course of nonprescription cortisone cream.

Preventative care

• Wash your skin folds with Dial soap. The anti-bacterial ingredient in Dial will decrease the skin germs. Dial also has an ingredient that acts like an antiperspirant and will block your sweat ducts, decreasing sweat in your folds. I don’t recommend using Dial soap elsewhere on your body because it’s simply too drying, and frankly, you don’t need antibacterial ingredients and clogged sweat ducts on the rest of your skin.
• After bathing, towel-dry your skin and then blow dry your folds until they are totally dry.
• Apply Zeasorb AF powder to your dry skin folds. Zeasorb AF contains an anti-yeast medicine. Never ever apply corn starch based-powders to your skin folds because the starch feeds yeast.
• Wear breezy, loose cotton or linen clothing that breathes and allows sweat to air dry quickly. You can even separate your folds with absorbent cotton cloth. Avoid synthetic and thick fabrics that don’t allow your sweat to air dry.
• Stay cool to decrease sweating.

Treatment of Intertrigo

If the red, painful and sometimes even smelly rash of intertrigo flairs up in the skin folds in spite of following the skin care outlined above, then medicine is needed to control it. Luckily there are effective medicines over the counter. In addition to my care instructions above, I have my patients stop applying the Zeasorb AF powder after blow drying their folds and instead apply the following medicine to the affected area twice a day:

• Clotrimazole cream (eg. Lotrimin Cream). Clotrimazole Cream needs to be used for at least 2 weeks because it takes 2 weeks to fully treat a yeast infection.
• If clotrimazole cream alone does not start to decrease the redness within a few days, I then have patients add a thin layer of 1% hydrocortisone cream after the clotrimazole cream. I tell them to stop the hydrocortisone a soon as possible because it can thin the skin. (If you chose to use hydrocortisone, don’t use it or more than 2 weeks without seeing your doctor and having them supervise your treatment.)

Important precautions:

• All cream products have ingredients that can sting damaged skin, including the rash of intertrigo. Of course, severe stinging is a sign you need to see your doctor and have your diagnosis confirmed and treatment supervised by them.
• Don’t use clotrimazole or hydrocortisone creams with other active ingredients like anti-itch medicines (Benadryl, ‘cains’ etc) because you can become allergic to them, and this will make the rash even worse.
• Severe intertrigo can be weepy and very tender. You will need to see your doctor if your rash has gotten really bad.
• Not every skin fold rash is intertrigo, anyone whose rash is not responding within a week needs to see their doctor to confirm their diagnosis.
• Babies’ skin is so delicate that treatment should always start with a doctor’s exam and should be supervised by their doctor as well.
• Diabetics are much more prone to intertrigo than everyone else and so anyone who is continuously troubled by this annoying red skin fold rash needs to be seen by their doctor and tested for diabetes.

Lastly, I recommend that even non-diabetics who are prone to intertrigo consider avoiding foods that raise their blood sugar. This includes high glycemic foods like sweets, refined flour foods and sugary drinks. ‘We are what we eat’ and a low glycemic, veggie-intense healthy diet is ideal for supporting skin health.

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

Stop The Summer Darkening Of Your Age Spots

Cracked, Dry and Splitting Fingernails; Dermatologist’s Tips

Dermatologist’s 3 Simple Steps To Have Sandal Ready Feet By Spring

Photo: Gratitude and thanks to Conorwithonen

Intertrigo: A Red Rash In The Skin Folds is a post from: OTB Skin Care Blog

Solutions for the biggest summer skin problems that I see in my dermatology practice:

Thick, rough and cracked feet: Walking barefoot or in sandals leaves feet thick, rough and cracked. Keep them soft with exfoliation. My ’step by step’ instructions to keep your feet soft and attractive this summer: Dermatologist’s 3 Simple Steps For Sandal Ready Feet By Spring

Athlete’s foot: sweaty athletic shoes and public showers breed fungus. If your feet are scaly, itchy and cracked you may well have picked up this highly contagious problem. Get rid of the fungus before it gets worse by following my instructions: Dermatologist’s Tips For Athlete’s Foot Fungus Treatment.

Chapped and sunburned lips: Sun and wind chap and burn lips fast. You need good sun protection when you’re outdoors, and mineral sunscreen products designed specifically for the lips, such as Lip Cotz, are the best. Some colored lipsticks can also give your lips good sun protection.

For moist, healthy lips you also need constant applications of a really good lip balm like Ceralip or pure shea butter. I recommend avoiding lip balms with a lot of medicated or herbal ingredients because I see so many people whose severely chapped lips are actually due to allergic reactions to these ingredients. I recommend using just the hydrating ointment base in lip balms and skipping all the dicey ‘extras.’

Gardener’s Hands: chapped, rough and cracked hands are a part of summer for you if you’re a gardener (like me). Good hand care is essential to keeping your hands looking even remotely presentable outside of the garden. The same hand care that I outlined in the winter for all the folks with chapped hands from hand sanitizers will fix your gardener-worn hands too.

“Embarrassing” arms and legs!: I can’t tell you how many people are embarrassed to show off their arms and legs; like it or not, summer fashions show more skin. After about our mid-twenties, just about everybody has to put a little work into keeping their arm and leg skin looking good. My recommendations:

At a minimum, moisturizing will help control the dry, flaky scale and give your skin an attractive, dewy look.

Adding sun protection plus alpha hydroxy acid hydration combined with physical exfoliation keeps the age spots from darkening. I give you instructions in my post: Stop The Summer Darkening of Your Age Spots.

On top of that, if you add a sunless tanner, you’ll have evenly bronzed, dewy hydrated skin with a buffed and polished glow! I tell you how in: Use Self Tanners Like A Pro.

Stressed facial skin: In the summer, facial skin care is all about survival; summer sun and environmental exposure will cause permanent damage to your facial skin unless you protect it every day. Sunscreen and antioxidant skin care products are essential for anyone seriously concerned about facial wrinkles and age spots (not to mention skin cancer). The best sunscreens are the mineral-based products. The best antioxidant protection comes from products with high concentrations of vitamin C and products that combine green tea and caffeine. Every day there are new ‘miracle’ antioxidants and sunscreens hitting the skin care market, but in my opinion, the mineral sunscreens and vitamin C and green tea/caffeine antioxidant products have the best scientific evidence proving their benefits; they’re what I personally use and recommend for my patients.

With good skin care you can have soft, healthy and fabulous-looking skin all summer long.

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

How To Get The Most Out Of Your Anti Aging Skin Care

5 Steps For Smart Sun Protection

Photo: Thanks and gratitude to Dystopian

Summer Skin Care…. and Repair is a post from: OTB Skin Care Blog

3 Easy Steps You Can Take to Help Prevent Darkening of Age Spots:

1. Keep the sun off of your skin
2. Exfoliate regularly
   
3. Use skin lightening products to ‘turn down’ your skin’s ability to tan

1. How to best keep the sun off your skin to prevent age spot darkening:

The best way to keep the sun off of your age spots is by covering them with clothing. For areas of your skin that you can’t cover (eg. your face), wear a sunscreen with an SPF of 30 or higher that contains 5% or more micro zinc oxide. I give extensive recommendations on sun protection in some of my recent posts:

Are Your Summer Clothes Good Enough To Be Sun Protective Clothing

How To Apply Sunscreen & Have Healthy, Fabulous Skin Forever

2. Exfoliation to lighten age spots:

Exfoliating lightens your age spots because the dead skin cell layers above them are extra thick and the brown color is carried up through every layer. Because of this, age spots are sort of like little speed bumps and regular exfoliation of the dead skin really lightens up the dark color because they sit slightly higher than the rest of the skin. The best way to do this is with my Anti Aging Body Skin Care Kit that includes both physical exfoliation and strong AHA glycolic acid exfoliation. Over the years, I’ve had many thousands of my patients using this kit and it works beautifully to lighten age spots. I’ve used it myself for at least 10 years and have watched my age spots actually go away just because I’m using these products; I created the kit for my 40th birthday when I got my first age spot on my arm — it went away in a few months after using my new kit, which was a great ‘happy birthday to me’ !

3. Using skin pigment lighteners to fade age spots:

I also have my patients ‘turn down’ pigment production with prescription bleaching creams that contain 4% hydroquinone, and prescription Retin A (tretinoin). There are tricks to using these products and they have side effects so ask your doctor if these treatments would be appropriate for you. One of my favorite skin lightening programs is The Obagi Nu Derm System and I discussed it during a post that I wrote this winter:

Winter: Now Is The Time To Fix Your Unwanted Age Spots and Skin Pigmentation

The good news about age spots is that it really is possible to get through the summer without getting spottier and spottier. Using any one of these steps to prevent age spot darkening will help, and doing all three is even more effective. You might even see them get lighter than they are in the winter!

A final note on age spots:

Remember that not every brown spot is an age spot. Melanoma, a deadly cancer, can often start looking like one of your age spots. If you have age spots, you’ve probably also had a lot of sun exposure in your life and would be well served by getting an annual skin exam by your dermatologist. Early detection of skin cancer really does save lives, I see it every day.

If You Found This Information Helpful, You May Also Want To Read:

How To Get The Most Out Of Your Anti Aging Skin Care

Choosing The Right Make Up For Post Menopausal Skin

Use Self Tanners Like A Pro

Skip The Tan And Eat Your Veggies For Beautiful Skin Color

Photo Mik Hartwell Flickr

Stop The Summer Darkening Of Your Age Spots is a post from: OTB Skin Care Blog

Well, I just had to post a comment on the New York Times!  I’m surprised at what memories came up for me when I read the article and wanted to share my comment with you.  Here is the comment I left on the New York Times online health blog concerning the article:

I’m a practicing dermatologist and was probably addicted to tanning as a teen and young adult. I was unable to stop tanning in spite of having surgery for a skin growth that was at first thought to be a very aggressive melanoma. In the end the growth was not cancer, I did not have the lower leg amputation recommended by my first dermatologist, but the scare did not deter me from tanning.

It wasn’t until my dermatology residency in San Diego that I found the resolve to stop; seeing sun damage and skin cancer in patient after patient was like the shock therapy used to help people stop smoking. For the last 25 years I’ve avidly sun protect my skin. Interestingly, my facial skin texture looks younger now than when I was in my 20’s and tanning. Also interesting is that my family now has a strong family history of melanoma and I’m convinced that if I had continued tanning I probably would not be here today.

As for vitamin D, fair skin makes all it needs in the first few minutes of sun exposure. Continued exposure actually starts to break the vitamin D down. Knowing that sun protection is never perfect, I recommend sun protecting your skin, and the ‘margin of error’ usually lets enough sun into your skin for vitamin D production. To really know what your vitamin D needs are, get it measured and ask your doctor for advice. I find there is very little correlation between patients that sun protect or tan and vitamin D levels. My specific advice and more information on vitamin D is available on one of my recent blog posts.

It’s funny that I didn’t go into dermatology because of this early near brush with cancer.  It’s also funny that it took my residency experiences to get me out of the sun, now I know why.

You may also want to read my sun protection advice:

5 Steps For Smart Sun Protection

If You Want A Nice Sunburn Use Last Year’s Sunscreen

How To Pick The Best Sunscreen

Are Your Summer Clothes Good Enough To Be Sun Protective Clothing

Photo Attribution:

Tanning Addiction; Dermatologist’s Personal Story is a post from: OTB Skin Care Blog

Your nails don’t always stand up to the use you put them to, and when they don’t, they crack!

Just yesterday, an 80 year old patient asked me why his fingernails were dry, brittle and splitting on the ends.  He’d always had strong nails.  He wanted to know if I thought Knox Gelatin Capsules would work for him; it’s what his mother used when she had nail problem. They didn’t work for her, but he didn’t know what else to do.

Almost every day I’m asked by someone for advice to fix their brittle, splitting fingernails because the problem is so common. It can happen at any age, but it’s definitely one of those “as we age” stories. If your nails are splitting, there are things you can do to improve them, but there are also common ‘remedies’ that actually make the problem worse.

THE PROBLEM:

Your nails dry out as you age, losing their natural oils which act as a glue to hold the nail layers together. If you have thin fingernails and dry skin to begin with you can expect this to happen to you ‘sooner rather than later’.  Exposing your hands to harsh soaps, cleaning products, solvents and rough work makes things worse. At first your nails begin to ‘fray’ on the edges, becoming brittle. Eventually the layers split.  Nail hardeners make this worse because the alcohols, formaldehyde and other chemicals in the nail hardeners really dry out your natural oils. (Crazy fact: Nail hardeners actually contain more of these chemicals than nail polishes!  It’s these chemicals that make the nails feel harder at first, but- whammo- after a few weeks the splitting is worse than ever.)

THE FIX:

Dermatologist’s 3 Simple Tricks To Treat Cracked And Splitting Fingernails:

1. Hydrate and add oils.  Use creams, oils and ointments on your nails everyday after they’ve been wet. My favorite is good old Bag Balm with it’s wool alcohol (aka lanolin).  Some of my other favorite hydrating ingredients for nails are Shea Butter, Jojoba oil, avocado oil, or other rich natural oils.  The thicker the cream the better, and oils or ointments are best. The trick is to use something that stays put for awhile and doesn’t just rub off right away.  Plus, you always moisturize skin and nails immediately after water exposure; applying moisturizers to dry nails is a waste of time.  Put your moisturizer on within minutes after your bath or shower, or after washing your hands.  Do it as often as possible.  You can use a hand cream during the day (I love my Intensive Hand Cream, which is non-greasy), but use a thicker product like Bag Balm at bed time. If your nails are really bad, apply Bag Balm to them numerous times a day after washing your hands.
2. Clip and file your nails when they’re wet. Clipping and filing dry nails makes the splits worse so always do it after water exposure.  Towel off the water and then use sharp nail clippers to trim your nails, followed by gently filing the edges.  You can also very gently buff the nail edges to keep the splitting layers from catching on things and progressing down the nail.
3. Wear gloves when you do rough work or get your hands into harsh chemicals. Obviously you want to protect your brittle and splitting nails from the things that make them worse.

Gelatin capsules don’t work but vitamin supplements formulated specifically for nail growth may help. I’ve had patients who feel that their nails grew a lot faster and stronger once they started taking supplements. Nail supplement formulations appear to vary, though most contain biotin.  I tell patients to go to their favorite high quality natural food store and ask the vitamin specialist for their best nail formula.  It’s important to know that many of the ingredients in these supplements are lavishly present in whole foods like fruits, vegetables, whole grains, nuts, natural oils, beans and fish.  Eating a richly nutritious diet is key to supporting healthy nails and vitamin supplements should be used in addition to, not in place of a healthy diet.

Your fingernails grow slowly, about 1mm per month.  As you age, the growth slows down even more.  This means it will take several months for the dry and split portion of your nails to grow out.  Depending on the condition of the rest of your existing nails, it could take as long as a year for proper nail care, good diet and your vitamin supplements to stop the nail splitting, so hang in there and don’t give up.

Lastly, there are internal diseases that can affect your nails, the most common being thyroid problems and anemia.  Some skin diseases affect the nails as well and cause splitting.  If your nails don’t improve, see your doctor.

I’d love to hear any tricks or products you’ve found to improve your brittle and splitting fingernails.

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

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

Natural Skin Health; Dermatologist’s Diet Recommendations For Healthy Skin

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

Photo:

http://www.flickr.com/photos/tonythemisfit/2432720887/ Tony The Misfit

Cracked, Dry, Brittle and Splitting Fingernails; Dermatologist’s Tips is a post from: OTB Skin Care Blog

And, do you know that if you apply it to moist skin, it’s more likely to cause peeling and skin irritation?

Lastly, do you know that some of the common and really good ingredients in other skin care products aren’t compatible with tretinoin?

Used correctly, tretinoin does amazing things for skin. I love tretinoin and have personally used it for over 25 years. My skin looks better now than it did then. I’ve also written thousands of prescriptions for it in that same period of time and I’ve helped the same number of patients integrate it into their skin care treatments.

Just this last month I had interesting conversations with two of these patients, both of whom expressed gratitude for my recommending tretinoin and attributed the healthy condition of their skin to their years of tretinoin skin therapy:

The first patient is a woman in her early 60s with rosacea and a history of skin cancer who said that she had more wrinkles 15 years ago when she started using tretinoin than she does today. Her pores appear smaller and her skin texture is better, and she feels it’s the tretinoin that’s helped.

The second patient just turned 39 and looks like she is in her mid-twenties. She started using tretinoin at 27 and says she, too, looks better now than she did then. While getting a pedicure to celebrate her birthday, the woman giving her the pedicure was astonished when she found out that my patient was over 30.

Tretinoin therapy is well worth the effort in my opinion, but there are tricks to doing it right.

The three key tricks I tell my patients for using Retin A (tretinoin) correctly

1. Always apply it to your skin at bedtime, never use it during the day.
2. Never apply it at the same time you also have products on your skin that contain glycolic acid or benzoyl peroxide .
3. Always wait at least 15 to 30 minutes after washing your skin and applying any other skin care products before you apply tretinoin. I personally keep my tube of tretinoin on my bedside table and read a little to pass the time before I apply it.

My tube of tretinoin sitting on my bedside table

Additional treatment tips to help skin tolerate tretinoin therapy

• Start tretinoin therapy by using the product twice a week (every third night) and slowly increase to every night over a month or two as your skin adjusts. A little scaliness and irritation is normal at first, but if the treated skin becomes really sensitive, back off and wait. Let the skin return to normal then begin treatment again. Slowly try to increase to every night as your skin adjusts.
• Apply a ‘pearl-sized’ portion to the face. Use the same amount for the neck and/or chest.
• If your skin continues to become irritated and just won’t adjust to tretinoin treatment, then switch to entirely non-irritating cleansers like Toleriane Cleanser or Nobel Zinc Soap. Many cleansers are too irritating for tretinoin treated skin.
• If your skin becomes red and irritated for any reason (eg. wind burn, sun burned, harsh skin care products, surgical or cosmetic procedures etc.), don’t apply tretinoin until your skin has entirely returned to normal. This is because tretinoin irritates irritated skin!

Important things to know about tretinoin treatment

• Tretinoin-treated skin is very exfoliated and should not be waxed for hair removal.
• Any doctor or skin care specialist performing a procedure such as a chemical peel, microdermabrasion, laser or light treatments etc. needs to know you are on tretinoin. They may ask you to stop it for a period of time before and after your treatment.
• Anyone who is or may be pregnant should not use tretinoin.
• Anyone using tretinoin must sun protect their skin or they will have more skin sun damage than if they never used tretinoin, again because tretinoin skin is very exfoliated.

Lastly, why bother with this tricky and sometimes inconvenient skin care treatment?

Scientific studies and my medical experience give me so many reasons to be a big fan of tretinoin:

• It has proven itself to reduce, reverse, and prevent wrinkles. The younger a person starts (teens and twenties), the more benefit they receive, but it’s never too late!
• It helps lighten and prevent age spots.
• It builds collagen to thicken and increase the structural strength of treated skin.
• It helps to decrease a person’s risk of developing skin cancer.
• Skin just looks better and younger when they use tretinoin.

I’ve used tretinoin for over 20 years and will continue to do so. I see the benefits every day in the mirror and for me these benefits outweigh the inconveniences. How about you? What are your stories?

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

5 Steps For Smart Sun Protection

How To Get The Most Out Of Your Anti Aging Skin Care

How To Unclog Your Clogged Pores

How To Correctly Use Retin A (Tretinoin) For Acne & Anti-Aging Skin Care is a post from: OTB Skin Care Blog

Strappy sun dresses, tank tops and bathing suits are part of summer. Is your skin ready for you to wear what you want, or do you have to wear clothes that hide pimples on your back and chest?

A lot of people have acne on their back and chest, but you don’t see it because they cover it up with clothes. There’s also not a lot of advice out there for treating back and chest acne which means that I see many of these folks in my dermatology practice.

Most of my back and chest acne patients have the type of acne called pityrosporum folliculitis. This type of acne is caused by a different acne germ than the more common form of acne called acne vulgaris, and it needs different treatment in order to improve. Pityrosporum folliculitis is caused by a yeast called pityrosporum. To treat it, you need to use medicines and skin care practices that get rid of this yeast and most regular acne treatments don’t.

Here’s the 5 step plan I give my dermatology patients to treat their back and chest acne:

1. Wash the back and chest skin with medicated products that specifically treat this type of acne. Products need to kill yeast and unclog the pores. I developed my Back Acne Kit in order to makes this step easy for my patients. It has one cleanser with 2% zinc pyrithione to kill yeast and another with 10% benzoyl peroxide to unclog pores. The cleansers are applied with an exfoliating cloth to help the medicines penetrate into the skin. There are some tricks to using these two medicines and the kit comes with complete instructions.
2. Keep the back and chest skin as sweat and oil free as possible. The yeast germ that causes this type of acne feeds on oil and sweat. Showering at least once a day with the medicated cleansers is important, but so is showering as soon as possible after workouts or any other sweaty activities. If it’s not possible to shower immediately after sweating, I recommend, at least degrease the skin with rubbing alcohol and changing into a clean dry shirt.
3. Special skin treatments such as ‘back facials’ and light skin peels can really help. These are done in the dermatologist’s office or by aestheticians. I usually recommend they be done every month until the skin clears up.
4. Diet matters with back and chest acne. The yeast thrives on sugar rich oily skin. Eating low carb, low fat foods puts the yeast on a starvation diet. My Alkaline Mediterranean diet is perfect for people with back acne; it provides you with nutritionally rich foods while closing the restaurant to the yeast.
5. As an absolute last resort, a little careful sun exposure often helps this type of acne. Sun exposure is highly controversial, and I only recommend it to my patients with severe back and chest acne who aren’t improving enough in spite of doing everything I’ve already mentioned-AND who have a big event where they need clear skin (like prom, a wedding etc.) Then, and only then a little mid day sun unfortunately can help clear back and chest acne in a pinch. Sun works because it suppresses the skin’s immune cells that are fighting the yeast in the pimples. 5 minutes of mid day sun, without a sun burn, can sometimes help heal the pimples pretty fast. Sun of course causes permanent damage to the skin in the form of freckles, wrinkles and skin cancers. The damage can never be reversed, so sun is of course a last resort and only done for the short period of time before the event. Tanning beds are an absolute no-no and should never be used.

Photo Attribution:

Back Acne & Chest Acne: Will They Ruin Your Summer? is a post from: OTB Skin Care Blog

Dear Helen,
I’m so glad to hear that My Antioxidant Kit is helping your post menopausal skin! Thank you for your feedback.

I wonder why your skin is flaky and breaking out.  Common skin conditions that occur as we age and that cause facial skin to flake and break out include rosacea and seborrheic dermatitis.  You may want to see your dermatologist to see if you may have one of these conditions.

What ever the cause of your skin problems, it’s hard to put makeup on flaky skin. Makeup color goes on heavier in the scaly areas and looks uneven.  To create an even skin surface before putting on makeup many of my patients find it helpful to first cleanse and gently exfoliate their skin with nondrying  Noble Zinc Soap and the Facial Buf Puf.

The second issue is that adult skin that is prone to ‘breaking out’ is often actually sensitive and easily irratated.   The goal with makeup is to create the aesthetic appearance  you want without irritating your skin problems. This means figuring out what products flair up your skin and avoiding them.   Look for products that claim to be gentle and hypoallergenic.   Anti aging ingredients in makeup can be irritating so I recommend avoiding them; they won’t be present in therapeutic amounts and you’re already using great anti aging products in the antioxidant kit. This goes for your moisturizer as well.  Your moisturizer and makeup should sooth and support the antioxidant kit products, not irritate your skin; they should ‘dial in’ the moisture and appearance you want- and that’s all!

My favorite type of gentle, hypoallergenic makeup for sensitive skin is mineral make up. I especially like the loose powders. Powders don’t need to be preserved like liquids do and so they have fewer chemical ingredients that could irritate your skin.  There are great foundations, eye shadows and blushes that are loose or compressed powders and that are made with high quality natural ingredients. They look great and the minerals often provide additional sun protection on top of your sunscreen giving you an anti aging bonus. Eyeliners on the other hand have to be moist or waxy which means they’ll need some chemical preservatives.  The good news is that eye products are formulated to be extremely gentle so they are rarely a problem for sensitive skin.

Mineral makeup brands that I or my patients have had consistently good experience include:

1. Drug store brands like Almay and Neutrogena and Physician’s Formula.
2. Department store brands like Clinique and Prescriptives.
3. Spa and boutique brands like Bare Minerals, Glo Minerals and Jane Iredale.
4. Natural food store brands like Dr. Hauschka, Hemp Organics and Mineral Fusion.

There are many other good mineral makeup brands that I haven’t listed.    Try the products before you buy them.   Ideally you want to wait 24 to 48 hours to see if your skin tolerates a product before you buy it.

One last important point about makeup and post menopausal skin is that we often should use less of it as we age. This seems counter-intuitive but unfortunately makeup can accentuate wrinkles and sagging skin.  This is because makeup products migrate into our creases during the day, making them more visible. The lesson here is that there’s no substitute for powerful anti aging skin care and good sun protection, like the Antioxidant Kit that your using.

I hope this helps.

Warm Regards,

Cynthia Bailey MD, Dermatologist

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

Facial Skin Care For Problem Skin With Rosacea, Seborrhea and Clogged Pores

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.

Choosing The Right Makeup For Post Menopausal Skin is a post from: OTB Skin Care Blog

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

Dear Dr. Bailey,

I have facial seborrhea dermatitis, rosacea and clogged pores in the T zone, plus age spots. I am 49 years of age. I recently tried Obagi Blender which caused acne. I have Solbar sunscreen which also causes some breakout and seems a bit heavy/oily. With my skin so problematic and sensitive, I thought to try your green tea cream, zinc soap for the seborrhea, but am unsure about sunscreen and when to work on the congestion and age spots. My dermatologist really isn’t into cosmetic treatments, but does have me on Oracea for my rosacea, but is not approved for long-term use. Complicated, I know, but hope you can help. I though about Rodan + Fields new line, but it has fragrance and is really pricey.

Thanks, Lisa

Dear Lisa,

You sure have the double, triple, quadrupedal whammy of facial skin issues-and your not alone!

I can’t tell you how many patients I see with exactly your combination of skin problems, including myself.  You have tried some good products, you have some good ideas and your on the right track.  Assuming that your doctor has correctly diagnosed your rosacea and seborrheic dermatitis, I totally agree with your idea to try the Noble Zinc Soap and the Replenix CF Cream to quiet these skin conditions.

I have found Replenix CF Cream and Noble Zinc soap to be wonderful skin care products for helping to calm both rosacea and seborrheic dermatitis. These are also the foundational products for many of my anti aging skin care regimens.  They are oil free and should not clog your pores.  Plus, they are non irritating, and in fact very soothing for facial skin rashes.  Both of those are key characteristics for skin care product tolerance in people with sensitive skin.

I also applaud you for your determination to use a high quality, micro zinc oxide sunscreen like Solbar Zinc.  I love this product, but it does have a heavy feel.  It is actually oil free, but the water resistant base feels oily.  I recommend Solbar Zinc for wet, sweaty activities, but most people don’t use it as their every day sunscreen in my practice.  I recommend instead that you try the Citrix Sun Screen. It has a drier feel yet the same excellent UVA and UVB protection as the Solbar Zinc because it too is a micro zinc oxide sunscreen.  Patients find that it is non-irritating, doesn’t sting eyes and won’t clog pores.

I can’t stress enough the need to wear a  5% or higher Micro Zinc Oxide Sunscreen EVERYDAY!

Broad spectrum UVA and UVB sunprotection is critical for anyone who wants to lighten their age spots.  Micro Zinc Oxide is the best sun screen ingredient for complete, broad spectrum UVA and UVB sun protection in my opinion. Sunscreen needs to be applied every day, regardless of what activities are on the adgenda and regardless of what time of year it is.

I tell people to put their sunscreen on with their skin care products first thing in the morning.  I have them wash, put on Repleinx CF Cream followed immedietly by any other products they use. They then finish with Citrix.  Make-up of course goes on top as the last product applied.  No need to wait and let things dry.  Skin products are like the different foods we eat, they all get mixed up when they reach their final destination so they can be applied together.

Your last question is about  products that actually fade age spots.  Picking age spot fading products is tricky for people with rosacea and seborrheic dermatitis because these conditions make the skin sensitive, and age spot lightening products are usually irratating.  You need to chose these with your doctors help.  My favorite anti aging and age spot fading skin care product for patients with rosacea and seborrheic dermatitis is Retin A (tretinoin) at the lowest strength.  I find that if I can really quiet down the 2 rashes, I can sneak up on the skin and get it to tolerate the Retin A (starting twice a week and working up slowly as tolerated).  This is tricky though, so you need your doctors help.  Plus, Retin A is a prescription, Retin A use makes skin more sun sensitive and it can’t be used when pregnant.

Bring this information to your doctor and see what he/she has to say.  Best of luck!

Warm Regards,

Cynthia Bailey MD, Dermatologist

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

Dermatologist’s Tips for Dry Flaky Skin On Your Face and Scalp; Tis the Season for Seborrhiec Dermatitis

Facial Skin Care for Problem Skin with Rosacea, Seborrhea and Clogged Pores is a post from: OTB Skin Care Blog