Common Skin Conditions

Varicose Veins

What are Varicose Veins?

Varicose veins are a very common condition in the United States and affect approximately 15 percent of men and approximately 25 percent of women.

Varicose veins are the blue or purplish enlarged veins you typically see bulging out of one's leg. The word "varicose" is derived from the Latin root word "varix," which is translated in English as "twisted." Any vein in your body may become varicose, however, its important to note that this condition or varicose veins exists most often in the legs and feet. Varicose veins occur in the legs and lower extremities because standing and walking increases the pressure in the veins in the lower half of your body.

Is it only a cosmetic concern? For many men and women, varicose veins and spider veins (these are the smaller and more common variation of varicose veins) makes them feel less attractive. However, it's important to note that for others, varicose veins cause aching pain and discomfort. This condition may lead to serious problems if not treated. Moreover, varicose veins may also serve as an indication that the individual is at a higher risk of other disorders of the circulatory system.

As with many other health related issues, self-help measures work well for prevention; compression stockings and changing certain aspects in one's lifestyle.

Pregnancy and Varicose Veins

Pregnant women sometimes complain of developing varicose veins. This is true. Pregnancy increases the volume of blood in a woman’s body, however, it decreases the flow of blood from the legs to the pelvis. This change in circulation is designed to support the growing baby, but it can produce an unfortunate side effects such as enlarged veins in the legs. Varicose veins may appear for the first time during pregnancy. It has been observed that the varicose veins may worsen during late pregnancy because the uterus exerts greater pressure on the veins in your legs.

Hemorrhoids and Varicose Veins?

Some are very surprised to learn that hemorrhoids are actually varicose veins located in and around the anus. Moreover, this condition is very common in the United States. By age 50, about half of adults have had to deal with the itching, bleeding and pain that often signal the presence of hemorrhoids.

Hemorrhoids, also known as “piles”, are swollen veins in your anus and rectum. The causes include straining during a bowel movement or the increased pressure during pregnancy.

Effective medications and procedures are readily available to treat hemorrhoids. Fortunately, in many cases hemorrhoids may require only lifestyle changes.

Symptoms

A number of people do not experience any discomfort with varicose veins, however, certain people do. For those that do experience discomfort, below are some of the symptoms

Achiness or heavy feeling in one's legs; burning, throbbing, muscle cramping and swelling in the lower legs.
Itching around one or more of your veins in the legs.
Skin ulcers near your ankle, which represent a severe form of vascular disease and require immediate attention.

If you have varicose veins, typically prolonged sitting or standing tends to make your legs feel worse. The varicose veins are easy to spot because they are dark purple or blue in color and sometimes appear twisted and bulging. The most common spot they appear is on the inside of the leg or on the backs of calves. But don’t let that fool you, they can form anywhere on your legs, from your groin to your ankle.

Risk Factors that Increase your Chances of Developing Varicose Veins

Standing for long periods of time. Blood doesn't flow as well if you're in the same position for long periods of time because your muscles are not contracting to push the blood back to the heart.
Obesity. Extra weight puts more pressure on your veins.
Age. The normal processing of aging causes wear and tear on the valves in your veins which regulate blood flow. The wear and tear may causes the valves to malfunction.
Sex. Women have a higher chance than men are to develop varicose veins and spider veins. This is attributed to hormonal changes during pregnancy, and also premenstruation or menopause may be a factor. Some researchers have found that female hormones may relax vein walls. Moreover, the use of hormone replacement therapy or birth control pills may increase the risk of varicose veins.
Genetics. Check to see whether your family members have varicose veins, heredity plays a big role.

Screening and diagnosis by a Physician

To locate a physician in your area that specializes in varicose vein and spider vein treatment, please click here. Prior to making a diagnosis, your doctor will most likely examine your legs while you're standing and will look for swelling. Also, he or she may ask you if you have any of the varicose vein symptoms listed above. As an ancillary test, your doctor may do an ultrasound test to see if the valves in your veins are working normally or if there's any evidence of a blood clot. Ultimately, it is smart to see a specialist for varicose veins and spider vein treatment. When doing your research, whether using veindirectory.org or other sites, choose a physician who specializes in the varicose vein removal procedures. Veindirectory.org has made the process simple for you. You can research using this site and learn about the procedures offered by the physicians. To make it even easier for you, we have provided for you the telephone numbers of each facility. If you have any questions, don’t hesitate to call.

Ulcers

Painful ulcers may form on the skin near varicose veins, particularly near the ankles. Increased pressure of blood within the affected veins can cause "water logging" which is a cause of the ulcers. Sometimes there is a brownish pigmentation prior to developing the ulcer. It is important to see a physician immediately if you suspect you've developed an ulcer

Sudden Swelling of the Leg

If you have considerable swelling in the leg (caused by the enlarging of veins deep within the legs) you must see a doctor immediately. Any sudden leg swelling requires urgent medical attention because it may indicate a blood clot — a condition known medically as thrombophlebitis.

Varicose Vein Treatment Options

Most physicians will say that hospital stay was thing in the past. Treatment today usually doesn't mean a hospital stay or a time consuming, uncomfortable recovery. Less invasive techniques are available that can be done fairly quickly.

The use of compression stockings may prove effective for your condition. Learn more about compression stockings...

Prior to getting treatment for your varicose veins, you should ask a physician about the affects of: compression stockings, exercising, losing weight, not wearing tight clothes, elevating your legs, avoiding long periods of standing or sitting. These are helpful in prevention and slowing the progression of the condition.

If you are pregnant and have varicose veins, please note that varicose veins that develop during pregnancy generally improve without treatment within a few months after delivery. However, it is never a bad idea to ask a specialist.

Below are some procedures that your physician may recommend:

Sclerotherapy
This form of treatment is a non-surgical procedure in which a solution is injected into the problem varicose veins or spider veins in order to cause its disappearance. More info on Sclerotherapy »
Endovenous Laser Treatment (EVLT)
EVLT works by heating the inside of the vein, which causes it to seal shut and disappear. This treatment requires that a very thin laser fiber be inserted into the damaged underlying vein. More info on EVLT »
Radiofrequency Occlusion also known as VNUS
This method treats the vein by heating them, causing the vein to contract and then close. More info on RadioFrequency Occlusion »
Laser and Pulsed Light Treatments
This form of vein therapy involves a light beam that is pulsed onto the veins in order to seal them off, causing them to dissolve. Successful light-based treatment requires adequate heating of the veins. Several treatments are usually needed for optimal results. More info on Laser Light Therapy »
Ambulatory Phlebectomy
This procedure involves making tiny punctures or incisions through which the varicose veins are removed. The incisions are so small no stitches are required. More info on Ambulatory Phlebectomy »
Transilluminated Powered Phlebectomy (TIPP)
The TIPP treatment is a minimally invasive procedure for removing varicose veins that is performed using the TriVex® System. Transillumination is a unique feature - much like a flashlight placed under the skin - that allows a surgeon to see, accurately target and remove varicose veins, then visually confirm the extraction. More info on TIPP »
Vein Ligation
During this type of vein surgery, incisions are made over the problem vein and the vein is tied off. This is done in order to cut off the flow of blood to the varicose vein, which in turn causes it to become less visible. More info on Vein Ligation »
Vein Stripping
Vein stripping involves tying off of the upper end of a problem vein and then removing the vein. More info on Vein Stripping »

There are many other varicose vein treatments out there which include laser surgeries, catheter-assisted procedures and endoscopic vein surgeries. Please consult your physician or other medical care provider regarding what type of treatment is best for you.

Please also remember that current treatments for varicose veins and spider veins are highly successful. However, it's possible that varicose veins can recur.

Prevention

There's no way to completely prevent varicose veins. But improving your circulation and muscle tone can reduce your risk of developing varicose veins or getting additional ones. Traditional, common-sense approaches include:

Exercise. Get your legs moving. Walking is a great way to encourage blood circulation in your legs. Your doctor can recommend an appropriate activity level for you.
Watch your weight, and your diet. Shedding excess pounds takes unnecessary pressure off your veins. What you eat makes a difference, too. Follow a low-salt, high-fiber diet to prevent the swelling that may result from water retention and constipation.
Watch what you wear. Avoid high heels. Low-heeled shoes work calf muscles more, which is better for your veins. Don't wear tight clothes around your waist, legs or groin. Tight panty-leg girdles, for instance, can restrict circulation.
Elevate your legs. To improve venous circulation, take several short breaks daily to elevate your legs above the level of your heart. For example, lie down with your legs resting on three or four pillows.
Avoid long periods of sitting or standing. Make a point of changing your position frequently to encourage blood flow. Try to move around at least every 30 minutes.
Don't sit with your legs crossed. This position can aggravate circulation problems.

Alternative Medicine

Some alternative medicine experts have noted that horse chestnut seed extract may be an effective treatment for chronic venous insufficiency; this is a condition associated with varicose veins in which the leg veins have problems returning blood to the heart. The herb may help improve swelling and discomfort caused by varicose veins. Make sure you talk with your doctor before trying horse chestnut seed extract or any other herb or dietary supplement.

Always Be a Cautious Consumer
Before undergoing any procedure, ask your doctor about any health risks and possible side effects.

Unless you fit into the coverage criteria (if you have signs or symptoms such as swelling and bleeding), most insurance companies will not reimburse for a cosmetic procedure. However, for more information, click here to read up on the health insurance coverage information. Even though the treatments are not too costly, they can still add up. It may be wise to inquire about treatment costs, as well.

Facial Veins

Visible facial veins (spider veins, telangiectasias, spider angiomas, benign vascular lesions)

Visible facial veins, which have many different names (see above), are actually dilated blood vessels. They are usually found on the forehead, nose, cheeks, eyelids, neck, and upper chest. Visible veins are most commonly seen in fair-skinned women and usually appear in the fourth or fifth decade. Blood vessel dilation is due to weakening of the elastic fibers in the walls of the blood vessel. Although the exact mechanisms leading to blood vessel dilation are not understood, visible veins are associated with excessive sun exposure, normal aging, steroid use, liver disease, genetics, radiation therapy, and trauma. On the face, visible veins can range in size from the tip of a pencil to bigger than a pencil eraser. Visible veins may be even larger on sites other than the face.

Visible veins are often considered to be a cosmetic issue. However, they can be found in people with rosacea (see rosacea section on this site), liver disease, and more rarely, autoimmune disease. Hormonal changes can be associated with visible veins as well. Your physician can help to determine the cause of your visible veins.

Facial Vein Prevention

Visible veins are often secondary to sun damage; thus, sunscreen use and sun avoidance are recommended.

Facial Vein Treatment

There are many different treatments options available for visible veins:

1. Electrosurgery uses an electric current from a hand held needle. The electric current, when applied to the blood vessel, destroys it. This method is somewhat painful, but is usually tolerated because it is quick. After the procedure, a tiny scab forms which usually heals quickly and with minimal scarring.

2. Lasers are sources of high energy focused light. Certain lasers, called vascular lasers, are designed to target a component of blood called hemoglobin. Vascular lasers destroy the blood vessel and leaving the surrounding tissue unharmed. The side effects of laser therapy can include pain (similar to a rubber band snap) and temporary purpura or purple pigmentation of the skin similar to bruising. The purpura usually resolves in a day or two. The risk of scarring is low.

3. Intense pulsed light therapy is similar to laser therapy except broadband light is used instead of focused light. The procedure itself is similar to lasers, but there is usually less purpura.

Laser treatments and intense pulsed light are typically done at four to eight week intervals. Several treatments may be required. When new vessels appear, patients return for more treatments.

Other Resourse

For more information and specialist in facial veins or spider veins, VeinDirectory.org has an extensive list of spider vein specialist. Please visit www.VeinDirectory.org for information regarding varicose veins and spider veins.

Acne Scars
acne scarring

Acne Scars and Acne Scarring

Acne is a common condition that affects most people at some point in their lives. For reasons that are not understood some people develop severe acne that leads to permanent and sometimes disfiguring scarring. The term "scarring" refers to a process where collagen within the skin is damaged from inflammation, leading to permanent texture changes in the skin. However, many patients refer to scarring when they see color changes that remain for months after an acne lesion has healed. Scarring, color changes, and treatment options will be discussed below.

Types of Acne Scarring

There are different kinds of acne scarring: ice pick scarring, atrophic scarring, and hypertrophic scarring. Ice pick scars are deep pitted scars with steep edges. Atrophic scars are pitted but have smooth borders and are not as deep. Hypertrophic scar, more common on the back and chest, are thick lumpy scars that sit above the surface of the skin.

Color changes in acne in more common than scarring and can resolve but may take years to completely disappear. Color changes come in three basic flavors: post inflammatory erythema (pink and purple patches at the site of acne lesions), post inflammatory hyperpigmentation (brown/black discoloration at the site of the acne lesion), and post inflammatory hypopigmentation (white marks at the site of a healed acne lesion). Post inflammatory hyperpigmentation is very common in those with darker skin tones or in those who tan easily and can significantly worsen the appearance of acne.

Ethnic Skin and Acne Scars

Acne is one of the most common skin conditions in patients with darker skin. African American patients usually have post inflammatory hyperpigmentation and are at higher risk of scarring. Hispanics and those of Middle Eastern descent also commonly have post inflammatory hyperpigmentation. Asians have a lower risk of hyperpigmentation than African Americans, but higher risk than Caucasian patients. The risk of hypertrophic and keloidal scars is 5-15 times higher in African American patients and 3-5 times higher in patients of Asian descent. Thus, treating acne early, before scar formation and discoloration is recommended.

Treatment of Acne Scars

Acne scarring is permanent but can be treated. No treatment is 100% effective and the best result is improvement, not perfection. Treatment of scarring may require many different kinds of treatments, depending on the kind of scarring present. Treatment of acne scarring can be expensive and may not be covered by insurance. It is important that all the acne is clear before treating scarring. Otherwise, new scars form and the procedures are wasted. The most effective treatments are surgical and there are many types.

• Dermabrasion
Mechanical resurfacing of the skin (see section on Dermabrasion) involves the use of abrasive tools to remove the outer layers of the skin to produce an improved appearance. Dermabrasion is primarily used for the treatment of acne scarring. Superficial and deep techniques are available. There are two layers of the skin; the outer layer is called the epidermis and the inner layer, the dermis. Superficial dermabrasion removes portions of the epidermis and deep dermabrasion removes all of the epidermis and portions of the dermis. Deep methods are the preferred method for treatment of scarring. Deep methods are effective but generally require weeks of healing time and carry a higher risk of complications. Improvements continue for months after the procedure as collagen remodels underneath the skin. It is important that the physician performing dermabrasion is experienced in the procedure. Dermabrasion has been proven to improve the cosmetic appearance of the skin, especially in the treatment of acne scarring. However, deep ice pick scars typically do not improve significantly with dermabrasion.

- Motorized dermabrasion is a medium-deep or deep procedure and employs the use of a motorized brush or diamond cylinder. These tools are used to remove the outer layers of the skin in a controlled setting. Local anesthesia is used for pain control during the procedure.

- In manual dermasanding, the physician abrades the skin with silicone carbide sandpaper. This method is usually considered to be a medium depth procedure and is sometimes used in combination with other methods, such as chemical peels, carbon dioxide lasers, and motorized dermabrasion.

- Not everyone is a good candidate for dermabrasion. Those with active acne, infections, and other scarring skin conditions may need treatment before undergoing dermabrasion. Complications are rare but include infection, prolonged healing, hyperpigmentation, and scarring. Dermabrasion may not be recommended for those with darker skin types because of the risk of hyperpigmentation or darkening of the skin. You and your physician need to decide if dermabrasion is the right procedure for you.

• Laser Resurfacing
Laser resurfacing (see section on Laser Resurfacing) has been used for the treatment of acne scarring. All lasers use a high-energy beam of light that targets specific structures in the skin. The CO2 and Erb:Yag lasers used for laser resurfacing are less specific and destroy the epidermis and superficial dermis. Like dermabrasion, laser resurfacing is ablative meaning that it destroys the outer layers of the skin. Ablative techniques are more effective but less popular because they require recovery time. Side effects are similar to dermabrasion and need to be discussed in detail with your doctor.

• Subcision
Subcision is used for atrophic scarring. Local anesthesia is used and a needle is then inserted under the scar and gently moved underneath the skin to release the scar tissue. This method has been tested in recent studies and shown to be effective.

• Punch excision and grafting
For deep ice pick scars, the only effective treatment is complete removal of the scar. A small, round, cookie-cutter-like device (called a punch) is used to cut out the scar and the edges of the wound are then sewn together with a suture. In this case, a deep, large scar is traded for a tiny line scar that can later be treated to further blend into the rest of the skin. Larger scars can be removed and then filled with a skin graft, taken from skin (usually behind the ear). Grafts are later contoured with dermabrasion to blend them into the rest of the skin.

• Fillers
Substances that add volume to the skin (see section on Fillers) can be used alone or in combination with the above procedures. Fillers can improve the appearance of acne scars by flattening the scar but their effect is temporary. To maintain the result, the lesions must be re-injected at regular intervals.

• Chemical Peels
Chemical peels, also known as chemical resurfacing (see section on Chemical Peels), are chemical treatments to produce an improved appearance of the face, including acne scars. Chemical peels produce controlled injury to the skin that promotes the growth of new skin with an improved appearance. Many different chemicals are used including glycolic acid, trichloroacetic acid (TCA), salicylic acid, “Jessners” solution, and phenol. The different chemical solutions produce different degrees of injury to the skin. Medium depth and deep peels produce injury within the dermis and can improve the appearance of atrophic acne scars. The deeper peels are more effective but carry more risks such as infection, scarring, and discoloration, especially for patients with dark skin. However, more studies are being performed in patients with dark skin and certain peels are proving to be beneficial. For example, in one study of Asian patients, glycolic acid peels (which are superficial) improved acne scarring and pore size. Further studies are in progress.

Treatment of Hypertrophic Acne Scars

Although less common, hypertrophic (and keloid) scars can be more disfiguring and harder to treat than other kinds of acne scarring. This type of scarring is more common on the chest and back. For reasons that are not understood, hypertrophic scars tend to recur after removal. Treatment usually involves topical steroids, injected steroids, silicone dressings, and/or cryosurgery. Recently, pulse dye lasers have been employed with some success. More work is needed in this area.

Treatment of Discoloration From Acne

Discoloration from acne (red, purple, brown, black, and white) is less permanent and easier to treat than acne scarring. However, it is also much more common. Both topical medications and surgical methods are employed.

• Topical Medications
Over-the-counter creams contain 2 percent hydroquinone, a bleaching agent. Prescription creams may use single agents, such as Retin-A (tretinoin) or combinations of medications such as hydroquinone with tretinoin plus a cortisone cream. These treatments can be quite effective when used properly. You need to discuss the risks of each medication with your doctor.

• Chemical Peels
Chemical peels are described above (and see section on Chemical Peels). In general, chemical peels are effective for improving discoloration from acne. More superficial peels have proven effective which is beneficial because there is less risk and less recovery time. However, several peels may be needed to obtain the desired effect.

• Microdermabrasion
Often referred to as a "lunch time" procedure (see section on Microdermabrasion), microdermabrasion is a popular procedure which is classified as light, or very superficial dermabrasion. This method employs aluminum oxide crystals that are propelled at the skin and immediately sucked up. Although not scientifically proven to improve the appearance of skin, many patients report that their skin feels smoother. It is used to treat acne, and the hyperpigmentation caused by acne. It is also popular because it is painless and there is no recovery time after the procedure. However, to effectively treat acne discoloration, up to 15 treatments may be necessary which can be very expensive. Newer devices now are crystal-less.

Melasma
Darkening of the Skin

Melasma

Melasma is a common skin disorder seen in men and especially women. It is quite commonly seen in pregnant women and is often referred to as the “mask of pregnancy”. It presents itself as a dark facial skin rash with irregular borders. The rash is usually recognized by its symmetrical presentation on the cheeks, lips, nose or forehead. Skin discoloration can also occur on the upper arms. The skin discoloration can vary in color ranging from a dark brown to a deep grey.

The condition is universal and seen in all cultures and ethnicities; however it is far more commonly seen in Asians, Hispanics, Arabs and North Africans who all seem to have higher levels of melanin in their skin and a tendency to tan. Individuals with fair skin may experience a lighter shade of melasma which is not always recognized.

Causes of Melasma

The cause of melasma remains unknown but is believed to be due to an increase in the production of cells which release the pigment melanin, which is responsible for the dark color of the skin.

What causes the increased production of melanin is not known but some triggers include:

Heredity factors and hormone fluctuation/production: the rash is most common in pregnant females
Prolonged sun exposure
Use of birth control pills
Certain medications like tetracycline and anti-malarial drugs (derived from quinine)

Melasma is not related to any medical disorder and by itself is a harmless skin condition despite the cosmetic concern associated with its appearance on facial skin. Diagnosing melasma in pregnant women is relatively simple, yet in men and women who are not pregnant, drug related skin reactions and other medical conditions may have to be ruled out. A skin biopsy may be performed for diagnosis in some cases.

Melasma is usually a transient skin disorder that may resolve itself. This may occur after childbirth in pregnant women. In cases where the melasma occurs in men or non-pregnant women, it may exist for a few months to a few years and then suddenly disappear. Thus treatment is not always warranted and it is difficult to know if and when the rash will remain and in whom it will disappear.

Melasma Treatment

Over the years, various treatments developed to treat melasma including:

Chemical peels. The most commonly used acid compounds to remove melasma include trichloroacetic acid, azelaic acid, glycolic acid, lactic acid and various fruit extracts. Stronger peeling agents tend to have a higher effectiveness rate than lighter strength peeling agents. Stronger peeling agents may also carry the risk of side effects such as burning, skin peeling, scarring and even worsening the skin discoloration.
Skin lightening agents. There are many skin lightening agents on the market and the most commonly used is hydroquinone. Numerous other agents sold in herbal and nutrition stores may work as skin lightening agents as well, however each patient has a unique skin type and reactions to skin lightening agents vary.
Sunscreens, especially those which are mineral based, such as zinc and titanium.
Laser skin rejuvenation

These treatments do not necessarily cure the cause of melasma and the effectiveness of each will vary from patient to patient. Even after treatment, skin discoloration may not always disappear completely and each patient may have to try various different treatment options to see a satisfactory result. Some treatments may have to be continually performed to sustain results, such as applying a skin lightening agent on a regular basis, combined with effective sunscreen usage and sun exposure avoidance.

To help prevent melasma from worsening, patients may wear sunscreen which contains a mineral based shield from the sun with an SPF at least 20. Protective clothing and wearing a hat may help to prevent melasma from worsening. Protective facial make-up may also be worn to help even skin tone and block out the sun.

Consulting with a local cosmetic dermatologist in your area may offer skin care opportunities for melasma that are right for you. Find a local skin care clinic in your area!

Rosacea
Redness & Flushing

Rosacea - Redness and Flushing

Rosacea is a common condition-- approximately 14 million Americans are affected by rosacea; most of those who suffer from it have never even heard of it. Both men and women are at risk, particularly those between the ages of 30-50 who have fair skin and blush easily.

Rosacea can cause redness, bumps and/or swelling, especially on the nose, cheeks, forehead, and chin and can look similar to acne. Unlike acne, however, people with rosacea don’t get blackheads but do get dilated blood vessels (called telangiectasias).

Rosacea is a chronic condition and rarely resolves without treatment. Mild rosacea can be limited to mild redness of the cheeks. However, in the most severe forms, the skin overlying the nose can become permanently swollen and red (called rhinophyma) because of dilated blood vessels and abnormal enlargement of oil glands. Other potential symptoms of rosacea include eye irritation (burning, stinging, grittiness, and/or dryness) and styes.

Rosacea Treatment and Skin Care

Rosacea treatment options vary widely, depending on symptoms. Facial redness and acne-like lesions are often treated with oral antibiotics and topical medications. Telangiectasias, on the other hand, can be treated with laser therapy. The more severe forms of rosacea also have a variety of treatment options. You need to discuss your individual concerns with your physician.

Rosacea Prevention

The cause of rosacea is still unknown, but there are a number of exacerbating factors that should be avoided. Triggers of rosacea include but are not limited to sunlight, wind, cold or hot temperatures, alcohol, spicy foods, hot drinks, skin care products, rubbing or scrubbing of the face, and exercise. Sun block of at least SPF 15 and hats are recommended.

Acne (Pimples)

Acne affects nearly 100% of the population at some point. For some, acne is mild and transient; for others, it can be severe and long lasting. Scarring from severe acne can be permanent and disfiguring (see section on Acne Scars). Acne usually begins around the time of puberty. Acne may improve after puberty, but for many, acne persists into and during middle age. Acne lesions form when the opening of oil glands (called sebaceous glands) in the skin become blocked. Trapped oil builds up within the gland, causing inflammation. The swelling within the oil gland can become so intense that the oil gland (and associated hair follicle) can rupture, leading to further inflammation. While the surge of hormones during puberty likely triggers this process, other factors such as stress, diet, and the influence of other hormones may also play a role. A bacterium called Propionibacterium acnes that is normally present on the skin likely plays a role in acne, but the precise link is still unclear. Any person with moderate or worse acne should be seen by a physician to discuss treatment options, because of the risk of permanent scarring.

Acne Treatment

Treatment for acne has improved dramatically in the last 2 decades. Effective over-the-counter medications include salicylic acid and benzoyl peroxide preparations. First line prescription acne treatment usually involves a combination of topical treatments, such as one of the retinoids (such as Retin A) and a topical antibiotic (such as benzoyl peroxide mixed with clindamycin). Common side effects are irritation and redness and you and your doctor will decide what is best for your individual needs. For acne that resists topical treatment, or for more severe acne, systemic treatments may be necessary. The tetracycline antibiotics are effective in many people. Erythromycin, Bactrim, and other antibiotics are second-line antibiotic therapies. However, long term antibiotic use can cause bacterial resistance in those who use them and should be used with caution. There are other side effects that must be discussed with your doctor. For women, oral contraceptives (“the pill”) may also improve acne. For adult woman with acne, other hormonal therapies may be considered. For severe acne that is associated with scarring, isotretinoin (Accutane) is prescribed. This drug is very effective and can cure acne but must be used very cautiously because of the risk of severe birth defects when taken during pregnancy. There are other common side effects (dry lips, peeling skin, etc) of isotretinoin that may limit its use as well. Some people believe that isotretinoin can lead to suicidal symptoms. This is controversial and should be discussed with your doctor.

Because of the risks of systemic medications, newer, less invasive treatments have been sought. With the development of new cosmetic treatment modalities such as lasers and light therapy, new acne treatments have also been developed. In general, because these methods are new, they are not as well tested. In the early studies, most of the new treatments have proven to be mildly to moderately effective. The side effect profiles are usually minimal. The specific treatment modalities are discussed below. You and your doctor can discuss the best treatment to suit your individual needs.

Other Acne Treatment Options:

• Light therapy

Blue light therapy takes advantage of the fact that bacteria in the skin produce a product called porphyrin. Porphyrin can absorb blue light, leading to a chemical reaction in the skin that destroys the bacteria. Red light therapy can reduce inflammation in the skin which in turn improves acne. Acne lesions treated with light therapy tend to reoccur over 3-12 months. In one study, patients who had severe acne had no improvement compared to patients who had moderate acne who did improve. There have been no reported side effects.

• Laser therapy

Although there are many different lasers available, only a few of them have successfully been used in the treatment of acne. For example, the pulsed-dye laser was tested in a randomized, double blinded controlled trial (the best kind of trial available) and was shown to significantly reduce acne after a single treatment with no serious side effects. The 1450 nm infrared laser has been used in one uncontrolled study and decreased lesion counts by 83% after three treatments. Temporary pain, redness, and swelling was reported in most patients. In patients with darker skin tones, hyperpigmentation (darkening of the skin) was reported.

• Photodynamic therapy (PDT)

This therapy combines a drug (called a photosensitizer) that is preferentially absorbed by certain kinds of cells and a special light source. When used together, the photosensitizer and the light destroy the targeted cells. For acne, the hyperactive sebaceous glands are targeted. The photosensitizer, called amino-levulinic acid, is applied to the skin and is left on for a variable period of time. The skin is exposed to the light source (blue, red, or laser light) and the photosensitizer is then removed. Side effects include pain during the procedure and discoloration afterwards.

• Radiofrequency therapy

A few studies have evaluated the effect of radiofrequency energy in the treatment of acne. One uncontrolled study reported a 75% improvement in 81% of the patients. Elamax, a topical anesthetic was used during the procedure for pain control.

• Chemical peels

Chemical peels have long been used for facial rejuvenation and to reverse the signs of aging. More recently, they have been used for the treatment of acne. In one study of Asian patients, salicylic acid peels performed twice a week for 12 weeks significantly improved acne.

• Microdermabrasion

In a few preliminary studies, microdermabrasion treatments have reduced acne lesions and improved the texture of the skin in the majority of patients

Freckles

Freckles (also known as ephelides) are small flat brown spots that appear on sun-exposed skin, especially the face and arms. Freckles are inherited and become darker with consistent sun exposure. Ultraviolet rays from the sun activate pigment producing skin cells (melanocytes) to produce pigment (melanin). Increased melanin is manifested as dark or brown spots on the skin.

Freckle Removal - Treatment Options

Although it is not medically necessary to treat freckles, patients often seek treatment for cosmetic reasons. Potential treatments include topical bleaching creams, topical retinoids, chemical peels, liquid nitrogen, and laser or pulsed light therapy.

Although freckles themselves are harmless, it is important to distinguish between freckles and a type of skin cancer called melanoma. If you have freckles, you have a higher risk of melanoma. Also, if your freckles are growing or changing, it is important see your physician for a skin check.

Age Spots, Sun Spots
& Liver Spots

Age Spots, Sun Spots & Liver Spots

Age spots are also known as sun spots, liver spots, lentigos, or lentigines. These lesions are flat, tan, brown, or dark brown spots on sun-exposed skin. As people age, sun spots most commonly appear on the backs of the hands, the forearms, neck, chest, and face. Sun spots are associated with cumulative sun exposure. The pigment producing cells in the skin (called melanocytes) are activated to produce more pigment (melanin) by ultraviolet rays. While these spots are not themselves cancerous, you may be at risk for skin cancer if you have them.

What causes age spots?

Age spots increase with age and with increased sun exposure. They are more common in people who freckle and who burn easily. It is important to know that if you've had enough sun to develop age spots, you have a higher risk of developing skin cancer.

What do age spots look like?

Age spots are flat and vary in size from a small pea to a dime. They usually are somewhat round and have irregular borders. They are found on chronically sun-exposed areas such as the shoulders, upper back, face, forearms, and the back of hands.

What treatment options are available for age, sun or liver spots?

The best treatment for age spots is prevention. The key to preventing age spots is sun avoidance and daily sunscreen use. For example, you won’t find age spots on your inner thigh because of minimal or no sun exposure. However, for most of us, it is too late for prevention, and there are a number of treatment options available.

Sunless Tanning

Sunless Tanning, controversy or safety?

Tanning salons and natural sun tanning have come under intense scrutiny over the last decade. In the 80’s we all were at the beach enjoying ourselves with Coppertone in hand. In the 90’s the incidence of skin cancer sky rocketed and put people on alert, and that is when the increase in tanning salons began. It was a surefire way to get the sun kissed look without putting yourself at risk of skin cancer, or was it? Questions arose as to the safety of the tanning beds, and the long term effects it may have over time. The question remained- what is safe for us to use to get the look we seek without all the fear of cancer, radiation, and over burning in certain situations.

Enter sunless tanning pills. It is an easy and convenient way of achieving the tan without the consequences, right? The FDA has deemed these "pills" unsafe and a possible threat to your health. They are being marketed as the next greatest thing, but in researching their ingredients, it is hard to find what makes up this miracle pill.

The makeup of such a pill to give you a sun baked look would have to include caretenoid pigments or tyrosine, but if neither of these is in the pill, it really is just an over-marketed multivitamin. The effect of the caretenoid pigments or tyrosine is to alter the skins pigmentation, essentially hoping to fake the tan. In documented cases, some have reported their skin to turn orange, and to have uneven blotchiness in areas and no effect in other areas of their body. Each chemical works slightly differently, but the effect is supposedly the same - a tan.

With the caretenoid tanning pill, it behaves in a manner in which it deposits pigment in fat layers just under the skin, coloring it. The amount it takes to get the tan that we seek has been deemed dangerous by the FDA.

The other base frequently found in these pills, tyrosine, is a non-essential amino acid that helps skin cells produce melanin. There is no need to supplement for it; it is a naturally occurring element in our bodies, so it means that pills that claim to contain tyrosine are not up to their manufacturers' claims.

It is a great feeling to have a tan - but at what cost? When the risk outweighs the benefit, it is best to look elsewhere, and this is one of those situations. There are many options to seek out in looking for the perfect method for you. There are a number of other options to consider before putting yourself at risk for a tan. Seek out the advice of your doctor when in doubt, especially when it comes to altering your appearance.