Dear Paula Q & A

Skin Care

 

Dear Paula,
I started using Revlon's Eterna 27 with Progenitin on the recommendation of a friend. Then I read in your book that it may contain estrogen. I am a breast cancer survivor taking Tamoxifen because my cancer was estrogen-receptive. Should I stop using this product because I may absorb estrogen from it? I really look forward to your answer. I asked my doctor about this and he didn't know what to tell me.

Kathleen, via email

Dear Kathleen,
Given your situation, I wouldn't continue using this product without talking to a physician who knows about this ingredient or checking back with your current physician after you give him the information I'm providing here. The active ingredient in this Revlon cream is pregnenolone acetate. Pregnenolone is a steroid hormone involved in the production of progesterone, androgens, and estrogens. It is considered a precursor hormone or a prohormone. Whether or not the acetate version has this effect is unknown, but all hormones can be absorbed through skin. Personally, as someone who has a family history of breast cancer, I would think twice about using any hormone-generating substance, whether bio-identical, synthetic, or plant-based, and definitely not without checking with a physician. If you are not satisfied with the information your current physician is providing based on your concerns, I would strongly encourage you to seek a second opinion, especially from a doctor that is better informed on this topic.

Hair Care

 

Dear Paula,
I've read so much about all sorts of hair-care products that can repair split ends. Is there really something out there that can get rid of my raggedy looking ends, other than cutting them off?

Terry, via e-mail

Dear Terry,
There are products that can help split ends look better, and if the damage isn't terrible, can actually make it look like they don't exist. However, making split ends look like they don't exist isn't the same as getting rid of them. To eliminate the problem, the ends need to be cut off; they can't be repaired. Hair is dead and can't be restored. Pomades are the perfect product for just this sort of problem and many of them can work brilliantly, particularly the new forms of pomade, which are less waxy and greasy and have a far lighter texture and silkier feel than some of the traditional versions. There are many to choose from, but Got2B Playful Texturizing Creme Pomade ($5.99 for 2 ounces) or TRESemme Hydrology Smooth & Shine Moisture Pomade ($4.49 for 3.5 ounces) will get you started on the right track. The trick with pomades is to apply them after your hair is dried and styled, and then apply only the tiniest, thinnest amount, just on the ends of your hair. You can always add more product if needed to get the effect you want.

Dear Paula,
I have a question in regard to shampoo for people that have sensitive skin or allergic skin. Right now I am using Cliniderm shampoo and conditioner and I find that it works but it is very expensive--is there another alternative to this?

BMJ, via email

Dear BMJ,
Cliniderm Shampoo and Cliniderm Conditioner are indeed unique. These two hair-care products leave out dyes, perfumes, fragrances, plant extracts, parabens or formaldehyde-based preservatives, and polyquaterniums. Those can be significant to people with sensitive skin. If you aren't using these products to avoid special sensitivities, you could look for products that are otherwise formulated the way these are, though the only other brand I am aware of that has products similar to Cliniderm is Free & Clear from Pharmaceutical Specialties. For more information about these products (they offer shampoo, conditioner, hairspray and styling gel, plus skin care items), visit www.psico.com. For more information about Cliniderm, visit their Web site at www.canderm.com.

Breakouts / Acne

 

Dear Paula,
I’ve trusted you for years, ever since first reading your Blue Eyeshadow Should Be Illegal (who could forget your first title?) book and reading every product review for acne-plagued skin since. After four separate rounds of Accutane, I’m still struggling with bad skin at age 49. When I had a recent horrible flare-up I found an interesting regimen on the Internet at www.acne.org (Daniel Kern authored it). His advice is so close to what you’d say, but lacks any BHA or an appropriate warning about sunscreen. Have you come across it? What do you think? I would love to know for my three teens and my own menopausal self if Kern’s routine may actually be helpful.

Kelly, via e-mail

Dear Kelly,
Believe me, I would love it if there were one or two slam-dunk routines people with acne could follow and be assured of great results. Alas, that’s not the case. You’re not alone in still dealing with acne, that’s for sure. It remains one of the skin issues my readers (of all ages) ask about most. I admire your perseverance for going through the Accutane treatment four times; what a shame it didn’t work for you, though I suspect you’ve noticed some incremental benefits, hopefully at least less frequent breakouts and less oiliness.

The Web site www.acne.org was envisioned and is maintained by Daniel Kern, a regular guy who suffered with acne for years before he figured out a routine that finally provided clear skin. His routine, which he recommends to others who visit the site, includes merely a cleanser, a 2.5% benzoyl peroxide product, and a moisturizer. Nothing new here, that’s about as standard and basic a treatment for acne as eating a salad is to dieting. Kern believes the key to the success of his routine is applying plenty of benzoyl peroxide twice per day, at least 12 hours apart. How much is plenty? Kern urges people who want to follow his routine to begin with a dime-sized amount or less, then work up to an index finger’s worth of product, per application. That amount of benzoyl peroxide may indeed prove more effective than applying a superficially thin layer. However, not everyone’s acne responds to benzoyl peroxide (which is well documented in the research).

It’s good that Kern stresses not irritating skin and using the lowest strength of benzoyl peroxide; but the fact remains that, for some people with acne, any amount of benzoyl peroxide can be irritating. Whether or not Kern’s routine will be helpful for you and your teenagers depends on how well your acne responds to benzoyl peroxide. I assume you’ve tried it in the past, given its availability and that it’s generally recommended as a starting point by dermatologists (and me) for those with acne. Did it work well? If so, applying more of it more often may prove helpful. If it did not work well, I am skeptical that slathering on more of it will have much benefit for you, especially given your skin’s response to several rounds of Accutane.

I urge anyone considering Kern’s routine to also consider adding a BHA (salicylic acid) product as well. When well-formulated (meaning pH-correct and without needless irritants such as alcohol and mint), a salicylic acid product can play a powerful role in helping to improve the manner in which the pore lining functions. And if blackheads accompany your acne, salicylic acid is a must. Benzoyl peroxide, as effective as it is, has no impact on blackheads because they are not caused by bacteria.

By the way, on his Web site Kern offers a gentle, well-formulated cleanser and a benzoyl peroxide gel, which are simple but effective products that are priced lower than many options at the drugstore. He now has a moisturizer in the works, too, as well as a sunscreen. The cleanser is not fragrance-free due to the sage and cucumber extracts, but the Benzoyl Peroxide Gel is 100% fragrance-free.

One more point: Remember that benzoyl peroxide can bleach hair and dyed fabric, especially cotton. If you or your children decide to try Kern’s routine, be sure to sleep on a towel or a white pillowcase to avoid stains, and take care to avoid getting the peroxide on your eyebrows or near the hairline.

Dear Paula,
I am 23 years old and have a problem with blackheads. I have combination skin, and the blackheads are worst on my T-zone, especially on my nose. I've tried just about every scrub and facial mask on the market, in all price ranges, and nothing seems to work. It appears the only way to remove them is either to manually squeeze them out, which people tell me is bad for my skin, or to go for weekly facials, which I can't afford to do. I recently saw an advertisement in a magazine selling a device that removes blackheads by "soft suctioning," using a "vacuum-air" method of some kind, or at least that's what the ad implied. It supposedly entails no squeezing and will not puncture the skin. What are your thoughts on this? If this device is just a gimmick, what do you recommend?

Traci, via e-mail

Dear Traci,
I have seen that same device advertised in magazines since I was a teenager. Like you, I was enticed by the promise; the difference is I bought it. What a huge disappointment. Not only didn't it work, it left small red marks on my face. I believe that was one of the first times I was angry at the beauty industry. I was all of 16 years old. What I learned back then was if devices like that worked, who would ever complain about blackheads? It doesn't work, but it stays on the market, advertised in miscellaneous magazines for other unsuspecting consumers.

The good news is that squeezing is absolutely a viable option for removing blackheads, and exactly what you would be paying a facialist to do. You already have spent a lot of your hard-earned money searching for the perfect scrub and mask, which means you now know those don't work. In essence, the most important thing you can do to get rid of blackheads is routine use of a well-formulated beta hydroxy acid (BHA) product. These contain salicylic acid and, when the pH of the product is between 3-4, it can penetrate the follicle lining of the pore, dislodging blackheads and restoring a free flow of oil to the skin’s surface. Blackheads are unrelated to dirt; you cannot wash or scrub them away. But routine use of a good BHA product coupled with occasional, gentle squeezing should keep them under control. Paula’s Choice, Olay, Clearasil, and Neutrogena all offer effective, leave-on BHA products.

Dear Paula,
What Is Accutane? I constantly hear about this, but am confused as to what it is.

Mark, via e-mail

Dear Mark,
Accutane is a synthetic drug made to resemble the molecules in vitamin A, and is taken orally. It stops the oil production in your sebaceous glands (the oil-producing structures of the skin) and literally shrinks these glands to the size of a baby's. This prevents sebum (oil) from clogging the hair follicle, mixing with dead skin cells, rupturing the follicle wall, and creating pimples or cysts. Oil production resumes when treatment is completed and the sebaceous glands slowly begin to grow larger, but rarely as large as they were before treatment.

In 85% of patients who complete a four-month treatment with Accutane, acne is no longer considered to be clinically significant. In other words, for all intents and purposes, their acne is cured!

What about the remaining 15% of patients who do experience recurrences? Typically three to six months after treatment, when the breakouts return, they are milder, easier to treat, and can generally be cured with a second round of Accutane. By the way, dosage and duration depend on the severity of the patient's acne, but treatments generally last 16 weeks. If a second treatment is necessary, an eight-week rest period is required in between.

If you are curious about whether Accutane could work for you, talk to your dermatologist and be sure you understand the all of potential side effects, some of which are quite serious but short-term in nature and a major concern is not an issue for men because, of course, they cannot become pregnant.

Dear Paula,
When I start a new skin-care routine, should I expect my face to break out badly? In the past, for example, I tried Clinique and my skin got so bad for two to three months, I finally quit. Everyone tells me "It has to get worse before it gets better."

Laurie, via e-mail

Dear Laurie,
The notion that skin has to get worse before it gets better is generally not true. It is also fiction that the skin is breaking out because the new products are purging toxins lurking in the pore or under the skin, making skin worse before it can get better. Women have heard this repeatedly from cosmetics salespeople. This long-standing myth puts women in a position to tolerate bad or ineffective skin-care products longer than they need to.

Typically, breakouts occur from a new skin-care routine because it is just bad for the skin and probably contains ingredients that trigger blemishes, or are ineffective or irritating, causing a rash-like breakout. However, the most common cause of breakouts from a new skin-care routine is really one of coincidence that has nothing to do with the new products you are using. If you have a skin type that tends to break out, you could very easily start a new skin-care regime at a time when you may be going through a normal breakout phase, even if your skin was perfectly clear before the new products were used. Remember that effective acne products can take two to three weeks to show results, so there wouldn’t be time for them to have an impact on the new cycle of breakouts you just happened to be going through.

For some skin types, it is true that an effective skin-care routine can cause breakouts. This is particularly true when you are using disinfectants, exfoliants, and Retin-A. It may be due to the initial effect of the active ingredients, which can be irritating and cause breakouts (not true acne but rather what’s referred to as an irritant contact dermatitis), and then the skin may need awhile to adapt.

Dear Paula,
I am prone to developing bumps or milia (as my facialist calls it) under my eyes. What causes milia and how can I prevent them from forming? What ingredients should I look out for when shopping for eye-care products to prevent more from coming up? How do I get rid of them? Everyone I've spoken to at the cosmetics counters seems to have different and conflicting explanations. You're the only one I can rely on, for an honest answer at this point.

Lynn, via e-mail

Dear Lynn,
Milia are difficult to get rid of but there are options. Renova, Retin-A, BHA, or AHA can actually improve the appearance of milia. If you want to try a moisturizer for the eye area, a lightweight gel serum is your best option to not further clog pores.

From there, the other options you have are microdermabrasion, AHA or BHA peels, and laser resurfacing. You may also want to see a dermatologist for more pronounced milia. He or she can lance these bumps and drain the contents which, with proper at-home care, should diminish quickly.

Dear Paula,
After visiting my local doctor to discuss my 18-year-old daughter's acne problem I was amazed that I was given a scenario that taking the contraceptive pill would be the 'cure' for it. So I recently looked into natural alternatives and discussed the problem with the staff at my local health store. He came up with 'Silver Colloid' – a clear liquid taken orally and also externally. It seems to have helped but due to the cost, I wandered if you think these natural remedies are plausible. My daughter does have an excellent diet and exercises regularly, and feels this product has helped but is it a figment of our imagination?

Mary, via email

Dear Mary,
Colloidal silver is indeed used for acne as well as other ailments (both topically and orally) including rosacea, fungal infections, and bronchitis. However, there is concern over silver toxicity. Most of us get enough silver via our daily diets (and it is not considered an essential nutrient). The problem is that silver accumulates in the body, and if your daughter’s medication exceeds the maximum recommended daily dosage, it could cause permanent problems. The following information about colloidal silver is from www.naturaldatabase.com, and succinctly details the inherent problems with using silver (especially in a medically unsupervised manner):

Colloidal silver is likely unsafe when used orally, topically, or intravenously. Total daily silver intake should not exceed 14 mcg/kg/day (980 mcg/day for a 154 pound person). Combining colloidal silver supplements with regular dietary intake of silver would likely result in exceeding this amount of silver. Silver accumulates in the body and can lead to an irreversible bluish skin discoloration known as argyria. Neurological deficits, diffuse silver deposition in visceral organs, renal damage, and metal flume fever can occur. The U.S. Food and Drug Administration (FDA) does not consider colloidal silver products to be generally recognized as safe (GRAS).

Orally or topically, colloidal silver can lead to an irreversible bluish deposition of silver in the mucous and skin membranes known as argyria. Argyria typically first appears in the gingival (gum tissue) with a slate-blue silver line. Toxicity may also present as blueish-gray discoloration of the fingernails. Colloidal silver can also stimulate melanin production in skin. Areas exposed to the sun will become increasingly discolored.

In short, advise your daughter to stop taking silver supplements immediately and see her physician for an exam to determine if any damage was caused by her regimen. This is another example of how seeking a natural remedy can backfire. Natural doesn’t always equal safe or even superior to other treatments.

Anti-Aging

 

Dear Paula,
I made an appointment with my old dermatologist who I went to 10 years ago for Accutane. She has since changed focus to cosmetic dermatology and I thought finding out what cosmeceuticals she recommends would be a great thing to do to as well as get a prescription for Renova. The visit taught me how naive I was about today’s dermatology business. I could have saved myself the trouble and found out what cosmeceuticals she recommends by just walking into her office and seeing what brands she sells (TNS and Kinerase). As for Renova, it was like pulling teeth to get her to talk about it; the emphasis was on the products she sold. I thought Renova is still state of the art, but I guess the difference is that the doctor’s office can’t profit from it. No question really, just wondered what your thoughts are.

J., via email

Dear J.,
I am sorry to learn that your latest dermatology visit was so disheartening. It’s disheartening for me to learn that any dermatologist today would eschew tretinoin (the active ingredient in Renova) for their own products, and especially for overpriced less-than-stellar products. Given the mounds of published research pertaining to tretinoin’s efficacy and benefit for aging skin, it’s almost shocking that your dermatologist would seemingly downgrade it in favor of other nonprescription products. Sadly, that’s a trend I suspect will continue as dermatologists continue to sell skin-care products and blur the line between medical professionalism, scientific proof, and cosmetics puffery. From a consumer perspective, this is frustrating because we generally don’t expect dermatologists to be salespeople, or for there to be any pressure to buy products during an office visit. The best dermatologists balance nonprescription product recommendations, at a variety of price points, with prescription treatments when needed. For example, a prescription for Renova coupled with daily use of an antioxidant-rich serum and sunscreen is smart combination therapy for aging skin.

Renova is still a state-of-the-art option for skin types that can handle it, and I encourage you to seek a dermatologist who both understands this and will at the same time be glad to recommend over-the-counter products that benefit your skin type and condition, whether they’re retailed by the dermatologist or available elsewhere.

Dear Paula,
Over the last few years of reading your books, newsletters, and Beauty Bulletins I have learned so much about skin care. Above all else you have taught me to recognize claims about a product that sound too good to be true and investigate its validity. My alarm bells are going off after my first visit to an aesthetician and I need your help to discover the truth.

I'm 39 and extremely fair skinned. I have avoided the sun and used sunscreen most of my life. An aesthetician examined my skin under a "Woods light" and pronounced that I have suffered extreme sun damage especially on the left side of my face. She recommended several courses of a "Jessner peel" until the sun damage had been significantly reversed.

I don't really see much of a problem with my skin. I have no discoloration aside from a bit of redness on my cheek and some fine lines on my forehead along with age-related developing of crow's feet. Can a Woods light really show this sun damage? Will a course of Jessner's peels reverse sun damage? The whole thing sounds suspect to me.

Susan, via email

Dear Susan,
A Wood's lamp uses a certain wavelength of ultraviolet light to pinpoint and map various underlying problems in skin, from fungal infections to pigmentation issues. It can reveal pigment problems (from sun damage or another factor) that may not be visible on the surface yet (and you may never see them or won't see them for years). Given your adherence to sunscreen, it is likely you've stopped this pigmentation in its tracks. However, being fair-skinned, you are more vulnerable to sun damage even when exposure with protection is intermittent. What your esthetician saw under the lamp may be the cumulative damage from childhood sun exposure (most of us didn't wear sunscreen as kids or teens).

A Jessner's peel is a rather strong option that you shouldn't consider just yet. This solution consists of a salicylic acid, lactic acid, and resorcinol in an alcohol base. Some dermatologists consider it a light peel, while others classify it as medium depth (the classification status often depends on how long the solution is left on skin). The resorcinol component is what’s most irritating, especially compared to standard glycolic or salicylic acid peels. I'd suggest trying a series of IPL treatments (also known as PhotoFacials) or a series of AHA or BHA peels. Both are less problematic than Jessner's and, over time, can produce comparable results with less initial irritation. Your esthetician may not offer such procedures or services, which would explain why she suggested a Jessner’s peel. In general, it is best to have IPL treatments or peels done by a physician or at an accredited facility with a doctor on staff. The IPL treatments will also address the superficial redness you noted, as well as stimulate collagen production to make your fine lines less noticeable. I wouldn’t say your esthetician was wrong to suggest a Jessner’s peel; rather, it’s not the best initial choice or the only option at your disposal.

Dear Paula,
In your September 2005 newsletter, you described the Fraxel laser as "intriguing" but [said] to give it a year to see if the results were as good as claimed without damaging the skin. I was wondering if you could give an update on this treatment. Also, I was in a laser clinic recently for hair removal and they have a laser skin treatment for wrinkles called the Profile ThermaScan. The description sounds like it could be the same as Fraxel laser; are you familiar with this one?

Holly, via email

Dear Holly,
If I said to give it a year to see what new studies would show about the Fraxel then I apologize because a year is too short a time to make an assessment of any new procedure, particularly an expensive one that could have long-term risks or disappointing results. There are only a handful of studies available about the Fraxel and most of those involved only a small group of women (six in one study, seven in another). And most of the studies were done by doctors paid to do the research by the company selling Fraxel. At this time there still isn’t enough information to warrant excitement or the expenditure of your hard-earned money.

ThermaScan is quite different from the Fraxel. The ThermaScan laser is a nonablative 1319 nanometer light wave that heats up the skin without causing injury and is supposed to reorganize and regenerate collagen. The Fraxel is a semi-ablative laser that does cause injury to the skin, and is said to give similar results, but it is done in a way that is supposed to produce the benefits of more injurious (ablative) lasers with less problematic results. There is definitely not enough research about the Fraxel to believe that claim and I have not been able to find any research about the ThermaScan—so consider it a potentially advantageous but still nascent technology.

Body Care

 

Dear Paula,
I am 35 years old, and for as long as I can remember I have had old-looking hands. My mother says that as an infant, I had very dry, wrinkly hands. I now use sunscreen daily on my hands to help prevent further lines and wrinkles, but I am wondering if there is anything I can do to make the skin on my hands look smoother. What about AHAs? If so, what percentage should I use, and which products and how often? Should I follow that with hand lotion? I ordered a foot cream through the mail; would you recommend this for my hands?

Kelly, via e-mail

Dear Kelly,
A dermatologist can do nothing topically for your hands beyond the things you are already considering. Now it is just a matter of experimenting until you find the right combination. The foot cream you bought could be an option, but I suspect it may be a tad bit too strong for hands and much better for callused feet. Hands rarely ever require the same thing as the feet. The "secret" in the foot cream you ordered isn't really a secret. It contains urea, which, like AHAs, exfoliates the skin and also works as a water-binding agent, plus lactic acid, for additional exfoliation. You may want to consider an 8% AHA product in an emollient base to see if it creates a smoother appearance for your hands. You can try Alpha Hydrox Lotion or Cream 8% AHA, which can be found at the drugstore. However, you still need to use sunscreen on your hands to prevent any damage. Apply the sunscreen after you apply the AHA product. One more consideration: Be sure that any time your hands are in water or you are using cleaning products, you are either keeping them protected by wearing rubber gloves or applying moisturizer immediately afterward. Curel Ultra-Healing Lotion ($7.99 for 13 ounces) works great for dry hands and is not greasy. They also make a 2.5 ounce size that fits well into most purses or for at the office.

Dear Paula,
I am having trouble with sunless tanning lotions. When I use them, my legs break out in an itchy rash from my knees to my ankles. This does not happen anywhere else on my body. I am getting frustrated with trying different brands and then being miserable with the rash. We spend a lot of time doing sports in the water. At age 45, my skin is starting to show its age and a fake tan helps hide some imperfections. I sweat easily, so I am worried about bronzers washing off plus the maintenance of applying a bronzer every day. I have not read about this problem in any articles. Can you help?

Deb, via email

Dear Deb,
You may be experiencing an isolated contact dermatitis to dihydroxyacetone (DHA) the most common ingredient found in self-tanners. Although rare, it does occur. Try applying a thin layer of hydrocortisone cream (Aveeno makes a good one that has a nice texture) to legs the night (or a few hours) before applying the self-tanner. Another issue that may be causing this rash is shaving immediately before application of self-tanner. Shaving can make skin more sensitive, so try to separate this from application of self-tanner (for example, shave legs in the morning, apply self-tanner at night). Last but not least, look for a self-tanner that's fragrance-free, such as Paula's Choice Almost the Real Thing Self-Tanning Gel ($12.95 for 5 ounces). Other good fragrance-free self-tanners include Dr. Denese Glow Younger Clear Self Tanner for Face & Body ($25 for 3 ounces) and Clinique Self-Sun Body Quick Bronze Self-Tanner ($17 for 4.2 ounces). Before using the self-tanner, apply a dab to your leg, blend in, and leave undisturbed for 24 hours. If no signs of rash or irritation develop, proceed with application to the entire leg.

Skin Conditions

 

Dear Paula,
I have lost some eyebrow hair, and I believe it's due to hypothyroidism, and I can't seem to grow it back. I have tried Talika products but nothing seems to work. Is there anything that you would suggest?

Kimberly, via email

Dear Kimberly,
I would encourage you to see your doctor to be sure you have the correct diagnosis for the cause of your hair loss. When you are at your doctor's office, take the opportunity to ask about using over-the-counter minoxidil (Rogaine is the brand name, but it's available as a generic for less money), as there is anecdotal evidence that it can work for helping to grow eyebrow hair.

Another option is topical application of latanoprost, a drug commonly prescribed in eyedrop form and used to manage glaucoma. It has been shown to stimulate growth of eyelashes* and there is potential it could do the same for eyebrow hair. However, using this drug for such a purpose would definitely count as off-label use, so it may be somewhat difficult to get a physician to prescribe it for you. Still, it doesn't hurt to ask the question of your physician to see if he or she agrees with this experiment.

*Source: