The sun exposure we get on our skin early in life determines how many wrinkles and age spots we’ll get as we age, and boy did I have a lot of sun exposure!  Even if we sun protect our skin now, that early exposure can never be undone entirely.  The fairer our skin, the more vulnerable we are to this early life sun exposure, and that’s my situation.  I’m blond, fair skinned and had a lot of California sun exposure in the first 25 years of my life.  This means that I’m really likely to develop a lot of brown liver spots and uneven pigmentation on my skin as I age.  Because I’m a dermatologist I see and hear all the latest and greatest treatment options to even skin pigmentation, reverse sun damage and lighten liver spots (age spots).    I’ve tried most of the age spot treatments and non invasive procedures, and have settled on an effective regimen that works well for me.   I’m busy  and don’t have a lot of time so I rely on products that I can use at home, plus a few quick treatments that I can do in the office.

Here’s what do I personally do to keep my skin color even and prevent age spots :

1. Sunscreen with zinc oxide every day on all non-covered parts of my skin. I’ve done this since I entered my dermatology training at the age of 28.  For about the last 10 years, the products I use are Citrix on my face, neck and chest every day, and Solbar Zinc on my hands or on any exposed skin when I am going to be sweaty or in water while I am outdoors.
2. Physical exfoliation.  For my face I do this at least twice a week with either a Facial Buf Puf or the Replenix Scrub. Sometimes I have my aesthetician do a microdermabrasion treatment on my face for a quick glow.  For the rest of my skin I use my Anti Aging Body Skin Care Kit.
3. Retin A: since 1987 in fact.  I slack off every now and then, but I use Retin A at least 3 times a week and usually more.  I have all 3 strengths in my bed side table and mix and match according to my skin’s sensitivity.  I love Retin A (tretinoin) big time and can’t emphasize enough how integral it is to include in your skin care regimen!  It’s tricky to use and some people just can’t tolerate it, but it’s worth a try.  Retin A is prescription so talk with your dermatologist about it.
4. I used Obagi Nu Derm for 3 months in the spring when we started carrying it in the office.  It worked great.  My husband kept commenting on how radiant my skin looked.  Obagi Nu Derm has hydroquinone prescription products in it to lighten brown uneven pigmentation.  Because I only like hydroquinones used on a daily basis for a maximum of 3 or 4 months, this is an intermittent treatment in my office.  I may decide to repeat the Obagi Nu Derm treatment on my face again this winter, we’ll see.
5. Between the age of about 32 to 45 I used professional strength glycolic acid skin care products on my face every day.  My favorites were the Glytone Mild Gel Wash Cleanser and Glytone Exfoliating Lotion. When I was about 45 I developed rosacea and seborrheic dermatitis and my skin would not tolerate the daily use of glycolic acid product so I had to rely on monthly peels in order to reap the benefits of glycolic acid on my skin.  I still use glycolic acid products on the rest of my skin.  I developed my Anti Aging Body Skin Care Kit for myself for my 40^th birthday when I found a barnacle (age spot) on my arm.  Since then,  glycolic acid body skin care products combined with physical exfoliation (like you get with the Salux Cloth in the Anti Aging Body Skin Care Kit)  has become more mainstream and popular.
6. Glycolic acid peels: I’ve done these mini peels on myself every month or so for years.  My skin is really sensitive and I do the peels carefully so that I don’t get irritated from the glycolic acid and have no redness or ‘down time’ ever.  I’m biased and think that glycolic acid peels are best supervised by physicians because they are acid peels that can burn sensitive skin.  There are spa level glycolic acid peels however and many aestheticians do them in their offices.  Be careful if you have sensitive skin, dark skin or are prone to post inflammatory hyperpigmentation (healing from injuries by forming brown marks on your skin).
7. IPL:  I just bought the Sciton BBL in December of 2008 and I love it!  I have to say that I think I finally got into laser/light technology  because I turned 50 and discovered that I needed more age spot intervention than ever before.  I love IPL on my skin!  My freckles turned dark and fell off in a week  after my first treatment. In addition my rosacea and facial seborrheic dermatitis also went away, my pores and skin texture look finer and my skin has been SO SOFT!  I love IPL!  I’ve had a treatment on my face once a month since the spring and love the results!

I’ve settled on a very manageable and not too expensive or time consuming set of products and procedures to treat my sun damaged skin and control my age spots (liver spots, sun freckles) and uneven pigmentation.  There’s been a lot of advances in anti aging skin care during the almost 25 years that I’ve been in dermatology.  Many of the advances are easy to work into a busy life; they improve both the look and the health of the skin and I’ve settled on the best and most effective options for my skin.   I just had a birthday, and all in all, for 51 I think I’m holding my own!

I’m outdoors whenever I can be. My skin is fair, and as a dermatologist I know how important it is to limit my sun exposure. I’m almost never outside without a hat, sunscreen and sun protective clothing………except mornings on my patio.

Today it’s 10:30 in the morning and I’m still out here. I’ve gotten caught up on my computer, I’m in my bathrobe writing this and I don’t have on sun screen. My patio faces west and technically I’m in the shade, but I know that doesn’t always mean I’m sun protected. Am I ‘throwing caution to the wind’? Am I going to end up with darker age spots because I’m out here unprotected (not to mention skin cancer, but that’s a less immediate consequence)? I’ve done this for years and I think I’m getting away with it, but the act of writing my blog entry makes me think I should know my sun exposure for sure. I’m going to test it right now.

I go get my key chain, where I keep a ‘Detecto Ring’ and bring it outside. It’s an old Detecto Ring and the beads are almost worn out. The uv sun exposure detecting beads barely color up.  I compare that to the beads color in full sun and there is a big difference so I know the sun intensity is a lot less on my patio.

Detecto Ring in shade on the patio at 10:30am

Detecto Ring Full Sun 10:30am

Boy am I glad! I love sitting outside on my patio at 7:30am every morning in the summer, have my tea, read the paper and work on my computer. I’m not a real morning person and I sure don’t want to wash my face and put sunscreen on before I’ve had my tea. Today I’m still out here at 10:30 and the California summer sun is getting intense. I have trees and wisteria over the patio and I’ve always assumed that I’m fairly sun protected, but honestly I’ve never tested my assumption until today.

Plastic UV detecting beads are a great trick for checking uv ray sun exposure. They’re plastic beads made of uv sensing material and they will turn color 50,000 times in response to uv sun rays. I’ve used them to test a lot of situations where I wondered about my sun exposure. I can test fabric on garments, and in fact, one of the sun protection shirts I had been using for about a year did not fully block the sun, the beads turned color and I knew the shirt needed to be replaced. I’ve tested my exposure to reflected sun light at an outdoor café, through my tinted windows at the office etc. I keep the little beads on my key chain so they ‘re handy. I call the combination of the beads and ring the Detecto Ring and it’s available on my web site. Of course the beads aren’t a medical device that can promise total accuracy, but I find that they’re a great tool to test my assumptions about my sun exposure. (Kids really get a kick out of them too.)  Certainly if they color up I know I’m being exposed to uv sun rays and there have been times where I thought I was sun safe but I wasn’t.

Sun exposure does more than increase our risk of getting skin cancer, it also causes most of the age related changes on our skin like wrinkles, liver spots, sun freckles and the brownish red color on the sides of the neck and mid chest. For the past 20 years, I’ve been seriously committed to sun protection and preventing more sun damage and liver spots from forming on my fair skin. I had way too much sun as a kid and young adult. As a teen, no blistering sun burn ever kept me from trying to tan. Unfortunately, neither did my grandmothers good advice or the scary skin tumor that grew on my leg when I was 15.

I started getting wrinkles and age spots in my 20’s and in my early 30’s I got serious about sun protecting my fair, Fitzpatrick type 2 skin . Now, I’m nearly perfect about sunscreen and sun protection. The one exception is in the mornings on my patio. Glad my Detecto Beads didn’t color up! Now, at 11am, the beads are starting to color up a little, time to go inside and put on sun screen.

Detecto Ring at 11am

On my next post, I’ll describe my own personal skin care program to lighten and prevent age spots (aka sun freckles, liver spots, solar lentigos), and treat uneven pigmentation on my middle age, sun damaged skin. I’ve tried just about everything available and I’ll tell you what I’ve found that works the best.

New Dawn

Welcome Dear Reader to my first post.

I am a practicing dermatologist and my blog is to be the Journal of a Practicing Dermatologist covering both the professional and personal topics that come up in the course of my dermatology career.

I’m an unlikely blogger. I’ve never gravitated towards writing, I’ve been tech phobic and I’m a bit reclusive outside of the office. Yet after writing all of the text for my web site, I seem to have found my web voice, and oddly, I like using it.

Much to my surprise, I want to blog.

• I want to blog about skin care because I’m a Skin Care Geek.
• I also want to use blogging like a dermatology diary or journal because I live and breath deratology and running my small business.

I don’t intend for my blog to be another of the encyclopedic medical information sources widely available on the web.  My blog will be an account of my experiences, both in my practice and in my life. The things that I think readers might be interested in.

Being a dermatologist is a wonderful career for me and I  enjoy ‘talking’ about it.  I love my time with my patients; what I learn from them about life and about dermatology.    I love our shared human experience and I’m  constantly enriched because of it.  I’m blessed to be a physician. Of course I can’t ever share anything that would breach patient/physician confidentiality. But the insights, the lessons, the ‘how’ of what my patients and I observe and decide regarding their skin issues, and how this effects life in general may have relevance for readers. And, typing and writing about it will allow me to savor it.

In my blog entries I don’t intend to recreate the many excellent reference web sites and blogs that are already on the net. When needed for completeness, I’ll reference ones I think the reader may want to visit in order to more fully understand a diagnosis or treatment that I’m covering in a blog entry. But, the fact, numbers, statistics, lists don’t hold juice for me at this point in my life. I use that stuff as part of the data that sits behind every decision I make for patients, but I’m not interested in writing about it.

For me, my writing interest lies in the human experience of being a practicing dermatologist. I love my medical practice and I work at it full time at it doing general medical and surgical dermatology. I also do some cosmetic dermatology. That means that in the course of my day, I diagnose and treat skin cancer and skin disease, and I help people to improve the health and appearance of their skin. I help patients one at a time to get the best possible outcomes for their skin problems.

What makes me different as a skin care advice blog on the web is that I’m a full time practicing physician and I’ve been so for years. My perspective is that of a dermatologist ‘in the trenches’. I’m not a professional writer who does research on a medical or scientific topic and then writes on it. Nor am I a physician who has transitioned from medical practice to a writing or administrative medical career. I practice medicine and I’m interested in writing about my experience doing just that. In addition, I own my own small medical practice and run it as a small business. That’s also an interesting experience and full of stories.

So, life (and blog content) from my vantage point: I’ve practiced medicine nonstop, full time since I graduated from Medical school in 1985. I own my own practice, I live and breathe dermatology, I love my career, it’s a huge part of who I am, and my blog content will focus on just that.

So, I’m going to use my blog to accomplish the following goals:

1. Provide information about skin care solutions and treatment recommendations for skin problems. I’ll cover what I use in my office for my patients, and what I do for myself and my family. My focus will be on what I’ve learned over the years, and it will be practical.
2. Talk about skin problems of interest to readers. Please send me things you would like to see me address!
3. Reflect on life in general from my vantage point as a practicing, dermatologist career woman in middle age.
4. Have fun blogging.

Please see my bio on my web site if you would like more information about me or my background.

So, I invite you to send topics that you would like to see me address. Please stay tuned as blog content emerges from my life.

I appreciate every reader who finds me, and I look forward to this new blogging adventure.

Warm Regards, Cynthia Bailey MD, Dermatologist/otbskincare.com

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