Queries Related to Skin & Beauty

— Marcia, Illinois

Sandals can be really hard on your feet. Tight straps can cause blisters and scabs, while open toes and open heels expose your skin, leading to calluses and dry, cracked patches. I suggest using bandages or pieces of moleskin to cushion your skin against chafing and dark marks. Try using Band-Aid Blister Block Cushions under tight straps or buckles, or on any areas where you feel pinching or rubbing. You may need to trim the bandages to fit, especially if your feet are petite or your sandals are very strappy.

To keep your feet looking their best (and to avoid having to throw out your shoes), try this routine every night before bed:

  1. Soak your feet in warm water for five to ten minutes to soften calluses.
  2. Use a foot file or pumice stone to remove dead skin. My current favorite is the PedEgg (available at drugstores), a foot file that collects the dry skin as it's being removed so you can neatly empty it into the trash.
  3. Rub in a foot cream containing glycolic and/or salicylic acid, such as Vaseline Intensive Rescue Healing Foot Cream or Philosophy Soul Owner. This will help soften rough skin and seal any cracks or calluses. The acids will also help remove the top layers of dead, discolored skin. Be sure to wash your hands immediately after applying, and be careful not to touch your eyes.
  4. Slip on a pair of thin white cotton socks or Moisture Booties by the Body Shop. This will help the foot cream penetrate more deeply and keep it from rubbing off on your sheets.

Q2. I've been trying to grow my nails, but they keep splitting and cracking. I try "nail-grow" polishes, but they don't seem to work. What can I do to have longer nails?

— Bess, Iowa

Nails are made of a protein, keratin, so make sure your diet includes an adequate amount of protein. Patients of mine who go on crash diets or make sudden dietary changes often notice that their nails get thinner and brittle. Because nails are not made of calcium, taking calcium supplements and drinking gelatin will not make them grow faster. On the other hand, some research suggests that taking a daily supplement of biotin (a B vitamin) may help strengthen brittle nails. One study showed that taking 2,500 micrograms a day of biotin for two months helped heal dry, splitting nails in two-thirds of the participants.

To prevent splitting in the first place, try to be gentle on your nails. Avoid using your nails to open packages or pop the tops of soda cans. If you do see a split or crack in a nail, resist the urge to peel the nail off; instead, immediately file the ragged edges with a nail file or emery board and buff the surface smooth with a nail buffer. This will prevent the split from getting longer and weakening the nail. Filing your nails into a soft rounded shape (instead of straight across) will also help make them stronger and less likely to split.

Since frequent hand washing can dehydrate the nails and predispose them to splitting, be sure to moisturize your nails after they've been in water. You can use hand cream or cuticle oil. To further protect your nails, wear gloves when you're doing the dishes, gardening, or working with any chemicals or solvents.

If you wear nail polish, avoid acetone-containing polish removers, which can dry out the nail. Instead, look for "acetone free" products. Consider taking a break from nail polish and just buffing your nails for a shiny, natural look.

Many of my patients have also had success with topical nail products containing acetyl mandelic acid. While these products won't make nails grow faster, this alpha hydroxy acid helps smooth out splits on the nail surface, so nails have a chance to grow longer before they break off. Try DermaNail Nail Conditioner or NeoCeuticals Nail Conditioning Solution.

Q3. Can you tell me the differences among lotion, body cream, and body butter? I don't know which one I should use! Is one better than another?

— Jessie, New York

All body moisturizers consist of a combination of water and different types of oils and other emollient ingredients. For best results, select a body moisturizer according to how dry your skin is, the climate you live in, and what part of your body needs moisturizing.

Lotions have a thinner consistency, are less greasy, and absorb quickly, so they’re perfect when you need lightweight, all-over moisture. They’re also the most convenient since they often come in a pump dispenser. Because they leave little residue, you can apply a body lotion in the morning and get dressed without having to worry about your clothes sticking to you. Choose a lotion if you live in a humid climate or when the weather gets warmer. Try Vaseline Total Moisture Conditioning Body Lotion.

Creams are thicker than lotions and contain more moisturizing oils. So, they’re best for extremely dry skin and areas that tend to be drier than others, like the arms and legs, which have fewer oil glands than the chest and back. If you get acne on your chest and/or back, your skin is producing enough natural oils, so skip the body cream in this area. Use a body cream if you see flaky skin or still feel dry despite using lotion. You may also want to switch to a heavier cream in the winter months or when you travel to a drier climate. To seal in moisture, apply body cream immediately after showering. Try Eucerin Dry Skin Therapy Original Moisturizing Cream.

Body butters have the highest proportion of oils, so they’re very thick and rich, with the consistency of margarine. Common ingredients include shea butter, cocoa butter, and coconut butter. They can be greasy and hard to spread, so they’re best for small areas of very dry, cracked skin, such as elbows, knees, and heels. You may want to use these at night only to avoid leaving a greasy residue on everything you touch. Try Palmer’s Cocoa Butter or Body Shop Body Butter.

Q4. Someone in our household has been diagnosed with MRSA, and he's been successfully treated with several antibiotics. We don't share towels, razors, or other personal care items, but what else can I do to prevent the disease from spreading? Also, how long after the treatment will he be free of the infection? Can a blood test determine whether it's gone or dormant?

MRSA, or methicillin-resistant Staphylococcus aureus (the name of the organism), is a particularly difficult infection to treat.

Approximately 25 percent of people in the general population are colonized — but not actively infected — with these bacteria. Of these people, approximately 1 percent are colonized — but not necessarily sick — with the methicillin- resistant variety (that is, the strain of bacteria that are resistant to the antibiotic methicillin).

MRSA, if it's contracted in a health care setting — a hospital, for example — can be resistant to many antibiotics. If it was contracted in the general community, however, it might be easier to treat. This second type of MRSA, called community-associated MRSA, tends not to be as resistant to other antibiotics, and there are a variety of drugs that can successfully treat it.

By not sharing any personal items, you are doing the correct thing to decrease the likelihood of transmission to other family members. If your loved is being treated for a single, nonrecurring community-associated MRSA infection, a follow-up with a doctor is usually a good idea, but the doctor probably won't do any additional screenings. However, this is not the case in hospitals, where there are often aggressive programs in place to eliminate the sources of infection completely.

Only after repeated community-associated MRSA infections do we typically try to completely eradicate all colonization with MRSA, even if it's not actively causing illness, although the effectiveness of this approach isn't clear. To test for colonization, a doctor will typically take cultures in the nose and other areas of the body. Generally, blood tests are not helpful in detecting MRSA if your loved one isn't actively infected.

Q5. Ever since I stopped taking HRT (hormone replacement therapy) my skin has gotten thin, I've lost connective tissue, and I'm losing skin pigment. Is there anything I can do to address these problems? Are there any supplements I can take?

Surprisingly, there is little research on how hormone therapy affects the skin. While there is some evidence that estrogen increases collagen in the skin and increases the skin's thickness, these observations were made in small clinical studies, and no large-scale, rigorous studies support this link. Even if a lack of estrogen does negatively impact the skin, I don't recommend that you start hormone therapy again solely for the purpose of improving your skin. Skin problems aren't considered an indication for estrogen use.

Instead, you may want to talk to a dermatologist about over-the-counter and prescription creams, such as Retin-A, that may help skin look younger. Some of these topical treatments are said to increase the collagen in your skin, slightly minimize wrinkles, and enhance the appearance of youth.

In addition to this, there are things you can do on a daily basis to help protect your skin. Use a moisturizer, guard against UV rays by applying sunblock (look for protection against both UVA and UVB), use a mild, nondrying soap, and quit smoking if you are a smoker. You can also eat more fish, take multivitamins, and eat lots of fruits and vegetables (these contain antioxidants). There are no supplements, however, that have been conclusively linked to improving the skin. Though there's been some talk about vitamin E, there's no good evidence that it helps with skin dryness.

Finally, if you're losing skin pigmentation, you could have a condition called vitiligo. Although there's no treatment for this particular condition, you may want to discuss pigmentation with your dermatologist to rule out other, possibly preventable causes.

Q6. I am 51 and would like to improve my skin. I have some sun damage, and I live in an arid climate, so my skin often feels dry. I also have a lot of blackheads in my T-zone, but when I tried a few exfoliating agents, my skin became irritated and inflamed. What do you suggest?

— Tina, Nevada

Blackheads are caused by the accumulation in pores of dead skin, oil, and bacteria. While many over-the-counter acne medications and exfoliating scrubs can help reduce blackheads, they can also irritate sensitive skin.

Because your skin is dry, it's more likely to be sensitive, so avoid products that contain salicylic acid and benzoyl peroxide. Although these ingredients can help dissolve blackheads, they can be too harsh for dry skin. Instead, look for nonirritating scrubs, like Aveeno Skin Brightening Daily Scrub, which contains smooth round granules to gently loosen blackheads, and soy extract to soothe sensitive skin. Start by using the scrub once or twice a week, and gradually increase to everyday use as tolerated. Avoid scrubs that contain crushed walnut shells or apricot pits, which have sharp edges that can scratch delicate skin. You can also try using a product that contains retinol a few times a week.

Retinol is a milder version of Retin-A — both help unclog pores. As an added benefit, retinol stimulates collagen production, which helps fight fine lines and sun damage. You can find retinol in many drugstore products; one of my favorites is RoC Retinol Correxion Deep Wrinkle Serum.

Because dry skin can magnify wrinkles, it's important to keep your skin hydrated. Heavy, greasy moisturizers can aggravate your blackheads, so look for ingredients like glycerin and hyaluronic acid, which help hold moisture in your skin without clogging pores. Try CeraVe Moisturizing Lotion, which contains ceramides, compounds that replenish your skin's natural protective barrier and help minimize fine lines.

Q7. I have severe rosacea that won't go away. I have seen two dermatologists but have not made much headway in controlling the problem. Can you help me?

Rosacea is a skin condition involving the "flush/blush" area of the face, predominantly the nose, cheeks, central forehead, and chin.

Rosacea may be seen in both sexes and in all races; however, it occurs more commonly in middle-aged females of fair-skinned complexion. The symptoms of rosacea are varied, ranging anywhere from a slight flush of the skin to a more permanent redness, broken blood vessels (telangiectasias), and acne-like lesions to rhinophyma (think W.C. Fields's nose).

It is important to be aware of the factors that can trigger rosacea: alcohol, especially red wine, hot beverages, spicy foods, steam baths or saunas, hot baths, exposure to extreme heat or cold — all of which dilate your blood vessels.

Rosacea tends to be a chronic condition, with periods of lesser and greater activity. It is important to differentiate rosacea from other skin conditions and systemic diseases that may result in a central redness of the face. Successful treatment for your rosacea may involve several therapeutic approaches based on your individual symptoms:

  • Avoidance of the triggers that exacerbate flushing.
  • Use of topical antibiotics such as clindamycin, erythromycin, and sulfur-sulfacetamide and topical metronidazole and azelaic acid.
  • For more severe cases, oral antibiotics such as tetracycline, minocycline, doxycycline may be given for both antibacterial and anti-inflammatory effects.
  • Topical immunomodulators as well as topical antifungals may be effective.
  • In severe cases of rosacea, a course of cis- retinoic acid (such as Accutane or Sotret) may be advisable.
  • Broken blood vessels may be treated by electrodesiccation or laser.
  • Redness may be treated by intense pulsed light (IPL) or laser.

Q8. I have severe dry skin on my hands — the skin and cuticles crack. What are some possible remedies?

— Susan, Maine

Dry, cracked hands can be quite uncomfortable — they can also be painful, itchy, and unsightly. The cuticles around the nails can also be affected. Dry skin can be caused by a number of things, including environmental conditions, genetic disorders, and undiagnosed diseases. The most common factors that trigger dryness are:

  1. Low humidity (lack of moisture)
  2. Exposure to cold temperatures
  3. Exposure to caustic chemicals at home or work

Treatment involves avoiding trigger factors as well as using topical products on the hands that can relieve the dryness. Consider these tips:

  1. Avoid harsh soaps and detergents.
  2. Wash your hands only when necessary.
  3. Wear gloves to protect your hands from caustic chemicals in household or occupational activities, as well as outside in cold weather.
  4. Apply creams to hold in moisture, especially after washing your hands. Products with alpha hydroxy acids (such as glycolic acid), lactic acids, and beta hydroxy acids (salicylic acid), and those that are urea-based, can be exceptionally beneficial. Eucerin Plus and AmLactin, in either cream or lotion form, are readily available and quite effective. If something stronger is required, your physician may prescribe products such as Keralac, Lactinol-E, or Carmol creams. However, there is a risk of irritation from these products. Products that provide a physical barrier on the skin, one example being Mimyx cream, may also be prescribed.
  5. A great technique at nighttime is to apply an alpha hydroxy acid cream or lotion followed by Vaseline and then put on white cotton gloves.

Q9. I recently had a facial, and a woman told me I should exfoliate my skin and then tried to sell me a $70 exfoliating cleanser. I'd like to try this, but is it a good idea? Are there ways to exfoliate that cost less than $70?

— Laura, New York

I personally love and recommend a gentle exfoliation of the skin. Exfoliation allows for the removal of dirt, debris, and the superficial layers of the skin, which results in a smoother, brighter complexion. Exfoliation is particularly beneficial in individuals with clogged pores, as well as those who have comedonal acne — that is, acne with blackheads and whiteheads.

The cost of a product is not necessarily commensurate with its effectiveness. Many exfoliating products can be found relatively inexpensively at your local drugstore, such as Neutrogena Fresh Foaming Scrub, Aveeno Skin Brightening Daily Scrub, Clean & Clears Morning Burst and Oxygenating Facial Scrub, and Oil of Olay Warming Deep Purifying Cleanser and Daily Regenerating Cleanser. Or make your own exfoliant by adding steel-cut Irish oatmeal to your liquid cleanser.

Q10. I'm thinking of having some cosmetic surgery, but I'm not sure how to find the right doctor. Should I just ask a friend or my internist? Must I get a second opinion, since the surgery is completely elective? Is it important to have the surgery in a hospital setting, or is it okay to have it in the doctor's office?

First things first: With any surgery, it's very important to find a qualified practitioner, so a professional referral is a must. This is especially true since cosmetic surgery has exploded — and changed — in the past decade, with many more practitioners performing the procedures. While a friend may absolutely love her nose job or tummy tuck, remember that her knowledge is limited only to her own experience, so she shouldn't be your sole source of information. Ask your internist, gynecologist, or specialists who have cared for you, especially those affiliated with university medical centers. These physicians have probably all had multiple experiences with many plastic surgeons, so their feedback is invaluable.

Next, second opinions can be as valuable for elective surgeries as they are for nonelective operations. The main purpose is to elicit information about the different approaches that are feasible and the advantages and disadvantages that exist. For example, there may be advantages to breast augmentation done with certain types of implants, and soliciting several opinions from seasoned practitioners will help you understand the choices.

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