Testing our Sun Smarts

Misconceptions abound about sun exposure. Here are the five biggest—and the reality behind them:

  • Getting a “base tan” is a good way to avoid sunburn (and sun damage).
    “Trying to save your skin through preemptive tanning is an exercise in insanity”, says Dr. Fox. “A tan gives the equivalent of an SPF 4—not a lot of protection, and certainly not worth the damage and risk. The base tan itself causes skin damage.” Repeated exposure to UV radiation—even if it’s done with good intentions—leads to wrinkling and possibly cancer later in life.
  • You need sun exposure to get the Vitamin D your body needs.
    A big part of this misconception comes from news reports on sunlight’s role in producing Vitamin D, which the body uses to help build bone. “But these reports are misleading”, Dr. Fox says.  “Vitamin D is essential,” he says, “but sun exposure is not essential for Vitamin D production.”  “Instead”, he says, “you should eat a healthy diet, with plenty of natural and fortified foods, and take a supplement of up to 1000 units of Vitamin D to make up for any dietary shortfalls.”
  • Tanning beds have gotten a bad rap, but they’re still better than natural sunlight.
    Nearly 30 million Americans visit tanning salons every year, and only about one-third of adults realize they’re unsafe. “However, indoor tanning is associated with a seventy-five percent increase in the risk of melanoma, the deadliest form of skin cancer”, says Dr. Fox. Many states have recently put restrictions on tanning beds for people under age 18 – some states now require parental consent and other states are considering banning tanning beds altogether for minors.
  • Sunscreen with SPF 30 gives twice the protection of SPF 15. And SPF 90 delivers three times as much as SPF 30—enough to keep you safe on the planet Mercury.
    “There are a few things wrong with this theory”, says Dr. Fox. First of all, the sun protection factor, or SPF, refers to UVB rays. To get UVA protection, you need a sunscreen labeled ’broad spectrum‘ or one that contains a physical block like titanium dioxide. Secondly, UVB protection doesn’t increase proportionately with the SPF number. For example, SPF 30 screens about ninety-seven percent of the UVB rays, whereas SPF 15 screens ninety-three percent (SPF 2 stops about only fifty percent).  “The difference in protection between SPF 30 and anything higher is relatively negligible”, reports Dr. Fox.
    “Another factor here is application”, adds Dr. Fox. Using too little or reapplying too infrequently effectively reduces a product’s SPF—and leaves you exposed to sun damage. “The rule is to apply about an ounce—an amount equal to that which would fill a standard shot glass—over your body and to reapply it every two hours, more often if you’re swimming, sweating or playing sports,” he advises. “Don’t let an astronomical SPF number give you a false sense of security.
  • Let’s face it: You look better—and healthier—with a tan.
    Many associate a suntan with wealth and success. “But a tan is nothing more than a record of sun damage”, says Dr. Fox. “It’s the evidence of all the ultraviolet radiation that your skin has been exposed to—and had to protect itself against.” Dr. Fox suggests using a self-tanner (with sunscreen, of course). “You’ll get that tanned look, but without the damage”, recommends Dr. Fox.

Joshua L. Fox, M.D., F.A.A.D., is a New York-based dermatologist and founder/director of Advanced Dermatology, PC with offices in Roslyn Heights, Fresh Meadows and NYC. 516-625-6222. www.advanceddermatologypc.com.

Tackling the Issue of Teen Acne


Tackling The Issue of Teen Acne

While there have been big advances in the way we treat teenage acne in the past few years, there is no single approach that works for every patient. For the best results, dermatologists need to match the treatment to the teen.

Dr. Valerie Goldburt, a leading expert on teen acne and dermatologist at Advanced Dermatology and its Center for Laser and Cosmetic Surgery, said there’s more to finding the best treatment than just examining the patient’s pimples.

“If you want to see results, you need to consider a teen’s active lifestyle,” she says. Despite the fact that today’s therapies can effectively treat the problem, patient compliance is often as important as the therapies themselves.

Acne often causes serious social, emotional, and psychological problems, she adds, and its symptoms can vary dramatically with age, heredity, habits, and beliefs. “Lots of teens have misconceptions about the causes of acne and unrealistic treatment expectations. They often have trouble incorporating the treatment into their daily lives or sticking with it long-term after they start to see results.” Doctors and patients need to discuss the patient’s lifestyle, family history, and habits—as well as his or her expectations—and then decide together which medicines are best, she explains.

Treatment Options for Teens
Dermatologists most often recommend topical medications for teens with acne. The most common nonprescription options are benzoyl peroxide, mild acids like salicylic acid, and sulfur-based products. Prescription-strength topical medications include topical antibiotics, sulfer based products and retinoids (derivatives of Vitamin A) such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac). All of these medicines are available as gels, lotions, creams, soaps, liquids, and pads. They require compliance, meaning the teen needs to be consistent in using them. Goldburt says, “I always ask teenagers, if I prescribe a topical medicine, will you use it? Half the time, the answer is no.” She believes that, especially among the young male population, there is a stigma associated with cream use. “Liquid soaps are sometimes a better topical choice, because the soaps can be used in the shower, where there is already an activity (the shower) in progress.”

Additionally, many a teen has heard their dermatologist tell them that sometimes things get worse before they get better. “That’s because the medications speed up the life cycle of all the pimples, including the little baby pimples that would have taken a lot longer to come to a head without medicine.” Also, topical acne medicines can easily be over-used, especially by teenagers who follow the more-is-better mantra, because they are often desperate to get an instant clear complexion. Most acne medications need to be used in small amounts so this approach can cause side effects like dryness, irritation, burning, or redness. This will force patients to stop using the medications before they’ve had a chance to work. Some medications may interact with the sun. Goldburt said the dermatologist needs to talk with the patient about ways to minimize and manage the side effects.

Stronger options include prescription oral medications: antibiotics, isotretinoin (Sotret, Claravis, Amnesteem, formerly sold as Accutane), and hormonal therapy (birth control pills and spironolactone). These pills could interact with medication or birth control pills, so care must be taken. As with any pill, these drugs need to be taken as prescribed, meaning a teen who’s less-than-perfect at sticking to a schedule may not do very well on them. However, many teenagers prefer pills to creams, since there is a perception that they are easier to use. Frequently, the teen who won’t use topical medications will be extremely compliant with oral medicines. Occasionally, Dr. Goldburt comes across a teen who hasn’t learned how to swallow pills.

“Most pills are smaller than the bites we take out of food, so there’s definitely a psychological barrier. You can get practice with tic tacs, and once you swallow those little pills, you realize the other pills are only slightly bigger and go down easily with some water,’ she said.

She recommends teenagers discuss how to take pills properly with their dermatologist.

In addition, dermatologists can use in-office procedures such as laser or light therapy, acne surgery and corticosteroid injections for large or painful pimples and to permanently fix the acne scarring. These procedures don’t require compliance (with the exception of making it to the appointments), and as a result are usually a good option for teen patients.

Valerie Goldburt, MD, PhD, is a dermatologist with New York & New Jersey-based Advanced Dermatology and the Center for Laser & Cosmetic Surgery. www.advanceddermatologypc.com

Banish the Bags Under Your Eyes


Banish the Bags Under Your Eyes

Tired of being told you look tired? Here’s how to get rid of eye bags, puffiness, dark shadows, and circles.

By Shelley Levitt, April 2012
WebMD Feature

Reviewed byHansa D. Bhargava, MD

Bags or dark circles under your eyes can make you look exhausted after a solid eight hours of sleep; stressed while you’re in the middle of a yoga class. Where once people commented that your eyes were the color of the sky, the sea, caramels, or butterscotch, now all they say is, “Tough night?”

Dermatologists and plastic surgeons say that laments about under-eye baggage are common. “I hear patients voice complaints several times a day,” says Valerie Goldburt, MD, PhD, a clinical assistant professor of dermatology at NYU Langone Medical Center.

Brent Moelleken, MD, a Beverly Hills plastic surgeon, agrees. “Under-eye issues are a huge concern for patients,” he says, “because they make you look older and they make you look tired.”

People often don’t make the distinction, Goldburt says, between pouches, puffiness, bags, and shadows. They just know they don’t like what they see.

There are new fixes for under-eye flaws — and old ones that still work. The first step, however, is figuring out just what the problem is.

Morning-After Puffy Eyes

Seasonal allergies, a cold, a sinus infection: These are some of the things that can lead to water building up under the eye.

“We have the thinnest skin around our eyes, so it’s the area that’s most influenced by the in-and-out flow of fluids,” Goldburt says.

A dinner heavy with salty food or a night of crying while watching a tearjerker movie can also cause morning-after puffiness. The reason is osmosis. “Water always travels from areas in the body where there’s low salt concentration to tissues where there’s more salt, Goldburt explains. That principle holds true whether the salt comes from tears or from soy sauce.

Simple Fixes for Under-Eye Bags

Addressing the underlying cause will help treat these temporary eruptions of puffiness.

Here are steps to try:

· Treat hay fever, if that’s the problem. There are non-sedating, over-the-counter allergy medications that may help. If you have or suspect hay fever, talk with your doctor about how to treat it (whether or not it’s affecting your eyes’ appearance).

· Try a neti pot. Irrigating the nasal cavity with a neti pot — a traditional device that looks like a small teapot — can help relieve fluid buildup caused by allergies, sinus congestion, or a cold.

· Switch your sleep position. Your sleep position may be contributing to under-eye bags. Thanks to gravity, sleeping on your side or stomach can encourage fluids to collect under your eyes. If you’re a side sleeper, you may notice a heavier bag on the side you sleep on. Goldburt advises her patients who wake up with puffy eyes to sleep on their back and add an extra pillow under their head.

That switch can be hard to get used to, says Goldburt, a self-described “former eye-bag sufferer” and stomach-sleeper herself. Still, she says, “The earlier you start changing your sleep position, the better, because after a few years under-eye bags can became permanent.”

Other everyday habits, including rubbing your eyes frequently, going to bed with makeup on, and excessive drinking, can contribute to under-eye bags, too. “Sleeping in eye makeup can irritate your eyes, causing fluids to pool,” Goldburt says. Heavy alcohol drinking causes dehydration. That weakens the delicate skin around the eyes, making it more likely to sink into a pouch.

Eye bags might also be a sign of an underlying medical condition. If your bags appear suddenly and you’re not suffering from allergies, a sinus infection, or a cold — and they don’t ease up when you try the lifestyle steps mentioned above — it’s a good idea to see your doctor. Craig Austin, MD, a New York dermatologist and dermatopathologist (a doctor with special training in analyzing skin biopsies) says that some thyroid or kidney problems can cause under-eye fluid retention.

Dark Circles

When dark shadows or bags linger, the cause typically is not something temporary, like a few too many cocktails. It might be something you’ve inherited. Pigmentary issues that cause under-eye discoloration are common among people of Asian or African descent. Age also contributes to dark circles. With age, the skin around the eye thins, exposing the tiny blood vessels that lie just below.

If you pull the skin sideways and the darkness turns blotchy, that’s evidence the problem is caused by excess pigment in the area, says Joseph Eviatar, MD, a New York ophthalmic plastic surgeon.

Most often, dark circles aren’t about changes in the color of the skin at all. Instead, they’re created by a loss of volume in the area around the eye. That exposes the orbital bone, creating a hollow trough that shows up as a dark circle. With the delicate eye area one of the first spots to reveal signs of aging, this can happen as early as the late 30s or 40s.

Makeup can help conceal dark circles. Hiding dark circles with concealer is simpler than you may think, says New York makeup artist Kimara Ahnert. Choose a concealer that matches your skin tone. If you have mild discoloration, pick a liquid formula. If your shadows are more prominent, go for more coverage with a cream or cake concealer. Lightly pat the concealer on from the inner corner of your eye to just past the outer corner.

Other, more expensive options, including treatment with certain lasers such as IPL or intense pulse light, can help by destroying those pigment cells and smoothing the skin. A series of four IPL treatments, at about $200 each, is typically needed to see improvement. Skin lightening creams that contain hydroquinone or kojic acid may also diminish the darkness.

These fixes are less successful when the dark circles are caused by extremely thin skin. “That’s really difficult to treat,” Eviatar says. “Eye creams that contain caffeine may help a bit because they constrict the underlying blood vessels.”

Prevention and Quick Fixes

There’s a lot you can do — without surgery — to help keep your eyes looking youthful.

1. Don’t smoke, and always apply a sunscreen around the eye area. Smoking and exposure to UV rays both weaken collagen and cause premature wrinkling and sagging.

2. Apply a moisturizer to the eye area nightly. “You don’t need to spend a lot,” says Goldburt. “Almost any drugstore moisturizer will provide the hydration you need.”

3. Add a prescription retinoic acid — the vitamin A cream that goes by the generic name “tretinoin” — to your daily skin care regimen. “It’s the single best thing you can use to prevent wrinkles and improve existing lines,” Goldburt says.

4. To calm puffy eyes, place cold spoons, slices of cucumbers, chilled tea bags, or even a package of frozen peas under your eyes. The cool temperatures — rather than any special properties of cucumbers or peas — reduce swelling. And, yes, placing a hemorrhoid cream under your eyes might help get rid of puffs, too. “We have patients who swear by it,” Moelleken says, “but we suggest a retinol eye cream instead.”

Fillers for Hollow Eyes

Some people choose to gethyaluronic fillers, such as Juvederm or Restylane, injected under their eyes. “Fillers mimic a youthful look by correcting the contours of the eye socket,” Eviatar says.

Injecting dermal fillers under the eye is, Moelleken warns, a very “technique-dependent” procedure. The filler needs to be injected deep under the muscle rather than into the superficial layers of the skin. An inexpert job can lead to puffiness. If you’re considering this treatment, seek out a skilled, board-certified dermatologist, plastic surgeon, or ophthalmic surgeon who is experienced in under-eye injections.

The procedure costs about $500 to $700. Results last about eight months. Ask your doctor about side effects, such as minor swelling and bruising that can last for a week or two. Your doctor may suggest injecting Botox, Dysport, or Xeomin (wrinkle-smoothers that erase crow’s feet) at the same time. But it’s up to you how much, or how little, you want to do.

Eyelid Surgery Gets a Makeover

Some people choose to go further to address sagging skin that creates pouches under their eyes.

Today, eyelid surgery, or blepharoplasty, is done through incisions made in the eyelid. Doctors may remove a little bit of fat, reposition the fat, or even add fat grafts, depending on what’s needed. Lasers are used to firm up loose skin. These procedures cost between $2,500 to $5,000, and recovery from bruising and swelling takes 10 days to two weeks.