Skin Health; Key Q&A

NWHRC Health Center - Skin Health, March 16, 2005

* What causes acne?

Acne is caused by genes and male hormones called androgens, which women have, too. Hormones are a major influence on acne. That's why you usually don't see acne before puberty. Bacteria contribute to acne--which is why either oral or topical antibiotics help. Greasy ointments, perspiration, headbands and other things that can plug up pores make acne worse. Stress may also make it worse. What you eat is generally not a major contributing factor to developing acne.

* Are tanning beds safer than the sun?

No. Tanning beds not only inflict the same type of skin and eye damage as the sun, but also may be as much as 20 times stronger than natural sunlight. Tanning beds typically use UVA rays. Although UVA rays are milder than UVB rays--the main cause of sunburn and sun cancer, UVA wavelengths are longer and they penetrate deeper through the skin's layers. UVA rays contribute to wrinkling the skin, as well as to the development of skin cancer. Some diseases, such as discoid or systemic lupus, and some oral medications, such as those containing sulfur, are aggravated by light exposure, especially in the UVA range.

* Can dermabrasion, chemical peels or laser treatments get rid of wrinkles? What are the risks and benefits of each and how long do the effects last? What other treatments are available?

Yes. Although the improvements can last many years, they are usually not permanent and may have to be repeated at periodic intervals. Dermabrasion and medium-depth chemical peels have both been used for many years to improve the appearance of superficial wrinkling, eliminate sun-induced pigmentation and keratoses and to improve the overall surface texture of the skin. In the past decade, laser resurfacing has become very popular because it may be easier to control and therefore produces a more predictable outcome. Laser resurfacing, however, is usually more expensive and frequently involves longer healing times, possibly requiring the patient to remain at home until healing is complete. All three procedures, if done correctly, are relatively safe, although localized scarring and pigment alterations can occur in a small percentage of patients.

Botox[R] (botulism toxin type A) has been approved by the U.S. Food and Drug Administration to temporarily (up to six months) smooth moderate to severe facial frown lines. Small doses of a purified, sterile form of the toxin are injected into certain facial muscles, which temporarily paralyzes and weakens them. When the muscles can't contract normally, frown lines disappear. The treatment worked for up to approximately six months in clinical studies of the drug. According to the FDA, Botox treatments should not be injected more frequently than once every three months, and the lowest effective dose should be used. The most common side effects following injections included headache, respiratory infection, flu syndrome, nausea and droopy eyelids. Less frequent adverse reactions (less than three percent of patients) included pain in the face, redness at the injection site and muscle weakness. These reactions were temporary but could last several months.

* If I have dandruff, does that mean my scalp is dry?

No! Mistakenly attributed to dryness because of the flaking it causes, dandruff is actually caused by inflammation of the scalp. Medicated shampoos can help this condition.

* Do Renova and Retin-A work to reduce acne and wrinkles?

Yes. Retin-A was developed about 20 years ago as an acne treatment. It works on acne mainly by altering the growth of the top layer of the skin to unplug pores. Retin-A can be irritating for some people. Retin-A is typically used at night. Several years ago, researchers found that Retin-A had a beneficial effect on the dermis and worked for wrinkles as well. Truthfully, it doesn't work for the deeper wrinkles on the face, but does have an effect on the more superficial wrinkles. Recently, the company that makes Retin-A developed Renova cream, which is basically a less irritating form of Retin-A.

* What type of SPF should I look for in sunscreen?

Look for a sunscreen with and SPF of 15 or higher that blocks both UVA and UVB rays. The SPF number only relates to the UVB protection. Zinc oxide and titanium dioxide preparations provide good protection and little problem with skin rashes.

* Should I avoid the sun altogether?

No! Who wants to stay inside all the time? Bright, beautiful days should be enjoyed. Sunlight isn't entirely bad, but tanning (and long-term exposure) is. Learn how to protect your skin, and protect it whenever you're outside. Certain companies sell specialized sun-protective clothing and hats providing additional protection to the skin. These are also good for children. Ask your dermatologist about these, or look for them on the Internet.

* Does sunscreen prevent sunburn?

While sunscreen helps to minimize damaging sunburns, it doesn't completely prevent burning. You still need to avoid the sun between 10 a.m. and 4 p.m., when its rays are strongest; wear a large-brimmed hat and sunglasses to protect your scalp and eyes; cover other sun-exposed parts of your body; stay in the shade when possible and limit the time you spend in the sun.