Skin Care Advice Dr. Ghohestani's interview with San Antonio Express News

Skin Care Advice


New Study Suggests that Some Sunscreens Are Not As Safe As People Think
About half of the 500 tested sunscreen products may cause or spread skin cancer because they contain vitamin A or its derivatives, according to an independent research group.
The sunscreens might prevent sunburn but they may not efficiently prevent the ultraviolet light from destroying your skin cells and additionally, they may cause tumors and lesions, according to researchers at Environmental Working Group.
According to the EWG, only 39 of the 500 tested products are considered safe and effective to use.
The report cites these problems with bogus sun protection factor (SPF) numbers:
  • The use of the hormone-disrupting chemical oxybenzone, which penetrates the skin and enters the bloodstream.
  • Overstated claims about performance.
  • The lack of needed regulations and oversight by the Food and Drug Administration.
But the most alarming disclosure in this year's report is the finding that vitamin A and its derivatives, retinol and retinyl palmitate, may speed up the cancer that sunscreen is used to prevent.
Vitamin A products are added to the sunscreen formulations because it is an anti-oxidant and they may slow skin aging. However, researchers found out that vitamin A products can be photocarcinogen, meaning the possibility that it results in cancerous tumors when used on skin exposed to sunlight.
"In that yearlong study, tumors and lesions developed up to 21 percent faster in lab animals coated in a vitamin A-laced cream than animals treated with a vitamin-free cream," the report said.
These data confirmed the previous data that were obtained by the FDA researchers about 10 years ago. "Retinyl palmitate was selected by (FDA's) Center for Food Safety and Applied Nutrition for photo-toxicity and photocarcinogenicity testing based on the increasingly widespread use of this compound in cosmetic retail products for use on sun-exposed skin," according to the October 2000 report by the National Toxicology Program.
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Is there any safe sunscreen?
An ideal sunscreen would completely block the UV rays including UV A and B that cause sunburn, immune suppression and damaging free radicals. It would remain effective on the skin for several hours and not form harmful ingredients when degraded by UV light. Typically, they should not contain oxybenzone or vitamin A. Dont buy spray or powder based sunscreens.
But in the U.S., there is currently no so many ideal sunscreens that meets all of these criteria. There are either "chemical" sunscreens, which have inferior stability, penetrate the skin and may disrupt the body's hormone systems, and "mineral" sunblocks zinc and titanium dioxide that provide a physical barrier to UV lights. While the mineral sunblocks are better, the industry is increasingly using nanosized titanium dioxide which may have serious health implications. The nano particles absorb easily through the skin and may cause problems.
"There is no doublt that an effective sunscreen can prevents sun damage, but people should be aware of potential side effects of chemicals that can be found in some of those products," said Dr. Reza F. Ghohestani, Director of Texas Institute of Dermatology. "People should depend on Hats, clothing and shade rather sunscreens for protection from the sun."
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Below, you may find some sunscreens receommended by us (we dont have any conflicts of interest with any of these companies)

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Skin, Sun and Sun Block

Dr. Ghohestani's interview with San Antonio Express News (Updated by TID)

No SPF? UVA and UVB will leave you RED.
Dr. Reza F. Ghohestani, of the Texas Institute of Dermatology, recommends that people wear at least SPF 30 every time they step outdoors.
If there is one thing Dr. Ghohestani wants people to know about the sun, he emphasizes that sun protection needs to start at an early age.
Dr. Ghohestani said recent studies show that people who were sunburned as children are three to five times more likely to get skin cancer as an adult.
It's very, very important to emphasize sun protection for kids, Dr. Ghohestani said. Most people think that's not a big deal and then they end up having cancer 20-50 years later.
According to the National Cancer Institute, skin cancer is the most common form of cancer in the U.S. Every year, more than 1 million Americans are diagnosed with skin cancer.
Ultraviolet rays cause cancer by damaging the cell's center, which controls the proliferation of cells. These rays are subdivided into three categories according to their wavelength: UVA, UVB and UVC. Research and studies show that UVB rays directly cause these mutations in the DNA. Ghohestani said that to avoid these harmful changes, it is important for people to protect their skin from the sun.
Dr. Ghohestani encourages people to use sunscreens that block both UVA and UVB rays every day.
We know recently that UVA is damaging to skin and chronic exposure is harmful to the skin as well, he said. We see sun-damaged skin on the left side of drivers from the windows in their car windows only block out UVB rays, not UVA rays. He said people who do not put on sunscreen every day, especially those who spend a lot of time driving, tend to have more wrinkles on the left side of their face because of sun damage.
Ghohestani recommends that people wear at least SPF 30 every time they leave their home, even on cloudy days and road trips. An adult should apply about two tablespoons of sunscreen on their face at least 30 minutes before going out. Sunscreen should be reapplied every two hours.
He explained that without sun protection, a fair-skinned person turns red after about 10 minutes in the sun. If that same individual uses sunscreen with an SPF of 30, it will take approximately 150 minutes for his or her skin to turn red. In general, he said it is not necessary to apply sunscreen with an SPF higher than 50. However, people should consider waterproof sun protection when they are swimming because UV rays can still be harmful through one or two feet of water.
He recommends that people buy hypoallergenic sunscreen that offers protection from the sun's harmful rays. Stores typically sell a mixture of sunblock that physically blocks UV rays and sunscreen that contains chemicals, which absorb the rays. He recommends the sunblock that physically blocks UV rays.
He suggests people also protect themselves by wearing protective clothing, finding shade, and avoiding direct sun exposure from 10 a.m. to 4 p.m. during summer months. Hats and clothing with high UPF factors help decrease UV exposure. All fabrics have different UPF factors: closely woven fabric, dark colors, and dry cloth have high UPFs.
Dr. Ghohestani urges taking precautions against sun exposure.
We discourage people to go out and expose their skin to any ultraviolet radiation either through sun or tanning salons; he said there is a correlation between tanning and wrinkles.
Instead of tanning, he recommends sunless tanning products commonly sold as creams gels, lotions and sprays. However, in the event that sunburn has already occurred due to tanning or sun exposure, he suggests waiting until it goes away or applying hydrocortisone if it is not blistered. If a burn blisters, does not disappear after a few days, see a dermatologist.
Source: Samantha Hensley | 210SA contributor (with some modifications)

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There is a link between diet and acne.
For years, the common belief was diet had absolutely no effect on acne. Turns out, it may have been wrong.
A study completed by the Australia's RMIT University and Royal Melbourne Hospital Department of Dermatology have discovered what is being hailed as a "solid link" between diet and acne development.
Associate Professor Neil Mann, from RMIT University's School of Applied Sciences, led the research team which spent more than two years studying metabolic changes in glucose and insulin levels due to diet and the resulting changes on the skin.
Researchers believe carbohydrates with a high glycemic index, which cause glucose and insulin levels to spike, may influence the development and severity of acne. Conversely, a diet high in protein and carbohydrates with a low glycemic index seemed to improve acne breakouts.
So, is diet alone going to clear your acne? Probably not. However, a healthy diet will certainly improve your overall health. Instead of highly processed foods, try incorporating more whole grains (such as whole wheat bread, wheat pastas, brown rice, oatmeal, etc.) into your diet, as well as plenty of fresh vegetables, fruit, and lean protein. Limit the amount of soda, sugary snacks, and other "junk foods" whenever possible. You have nothing to lose, and a healthy body to gain. And possibly clearer skin, too.
Smith R., Mann N., Braue A., Mäkeläinen H., Varigos G. "The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial." Journal of the American Academy of Dermatology (2007); 57 (2): 247-256.
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Nutrition makes a difference in skin rejuvenation.
It would be naive to believe that changing your nutrition is going to wipe out all your wrinkles or completely stop skin aging. But it is just as naive to think that you can eat (or neglect to eat) whatever you want without any effect on your skin. What you eat affects every organ in your body and skin is no exception. You may think that as long as you are using an expensive skin cream with a bunch of ingredients with scientific-sounding names, your skin will be properly nourished. Nothing can be further from the truth. While a skin cream may provide a number of important substances, it is never enough to ensure a proper, all-round skin nutrition.
Advantages of nourishing the skin from within:
  • Every cell in the human body needs dozens and dozens of nutrients and metabolites. Some, like vitamins, minerals and essential amino acids need to come from food. Others are produced by the body provided it is healthy and properly nourished. No skin cream can replace that.
  • Applying a cream with nutrients to the surface of you skin does not ensure that those nutrients actually penetrate into your skin cells. They may just "sit there" until your next shower. How much of the active ingredients actually get into your skin cells depends on the skin's condition, concentration of the ingredients, manufacturing technology and many other factors. This doesn't mean that all topical preparations are useless -- but they are often unreliable. On the other hand, when the nutrients are ingested and absorbed into your bloodstream, they are sure to be delivered to your skin cells.
  • Nutrition has some effect on the mechanisms of aging of the body as a whole. Inhibiting these mechanisms slows down the overall aging process, including the aging of the skin.
  • Nutritients and foods that benefit your skin also tend to benefit other body systems and overall health.

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Botox and hydrosol are effective in treating axillary hyperhidrosis (sweating).

There is a new topical product (Hydrosal, Valeo Pharma) that contains 15% aluminium chloride in a 2% salicylic acid gel base. A recent open-label study on 30 patients with primary axillary hyperhidrosis showed a significant improvement in patients' symptoms. Previous products that contained aquous alchohol seemed to be too irritating for patients.
Botox is another option and it is considered a very effective treatment for hyperhidrosis. Botox lasts for about 6 months.
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Be aware of skin cancer danger signs
Malignant Melanoma is a fatal skin cancer characterized by abnormal proliferation of melanocytes. Dr. Ghohestani encourages the use of the "ABCDE rule" to detect malignant melanoma. Finding any of these danger signs, on your skin, should prompt you to see a Dermatologist.

A (ASYMMETRY): when one part of a mole or birthmark does not match the other side.

B (BORDER): The edges are irregular, ragged, notched or blurred.

C (COLOR): The color is not the same all over and may include shades of brown or black, sometimes with patches of red, white or blue.

D (DIAMETER): The spot is larger than 6 millimeters across (about ¼ inch – the size of a pencil eraser) or is growing larger.

E (Evolution): There is a rapid growth of a mole.

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What are the Top Antiaging Breakthroughs?
Wanting to look young is not exactly a new idea -- the search for the fountain of youth has been going on for centuries. Some beauty products that are on the market, may not truly deliver their promise. Here are our a list of recent breakthroughs:
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Fractional CO2 Laser Skin Resurfacing
The antiaging breakthrough of the decade, according to many doctors, is a skin-resurfacing treatment known as CO2 fractional laser therapy. Combining the effectiveness of traditional carbon dioxide lasers -- long thought to be the gold standard in wrinkle removal -- with a new application technique, it delivers powerful results without the traditionally harsh side effects.
"Essentially, you are getting all the benefits of laser resurfacing, still the best way to remove wrinkles, but you’re getting it without the downtime and without the horrendous complication rate,".
How does it work? The natural aging process, combined with exposure to sun and pollution, destroys collagen -- the main protein of connective tissue that keeps skin plump and line-free. Laser resurfacing uses beamlets of energy light to bore tiny holes in the skin, which works to put the body’s natural collagen production on fast-forward. Here’s what’s new: Fractional CO2 laser resurfacing does this in a way that prevents damage to the top layer of skin, offering maximum results with minimal recovery time.
While laser resurfacing doesn’t come cheap -- the procedure will cost you about $3000 -- it is quick, accomplished in one or two sessions, with about four days downtime, effects are thought to last about 10 years.
According to the American Society for Dermatologic Surgery, patients with darker complexions may be at risk for pigmentation loss with any laser surgery. Common minor side effects for fractional laser resurfacing include redness and swelling that lasts about two to fourteen days.
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The New Fillers for Wrinkles
With fillers, you can really sculpt a lifted, youthful look without surgery. Wrinkle injection technology soared to new heights by launching several fillers to the market: Perlane, Juvéderm Ultra, Juvederm XC, Juvederm Ultra Plus, Prevelle, Restylane, Artifill, and Radiesse. Each uses a slightly different substance to fill wrinkles and volumize skin anywhere on the face.
Unlike a face-lift, which pulls the skin taut and tight, volumizing plumps up the skin so the look is youthful but more natural.
Interestingly, studies conducted by Frank Wang, MD, at the University of Michigan Medical School found that those containing hyaluronic acid (such as Restylane and Juvéderm) led to "robust collagen production" while also interfering with collagen breakdown. So not only do you get a filling effect, but you also have an actual increase in natural collagen production.
Currently, most fillers last up to one year, or longer. Only one -- Artifill -- offers permanent results, but not without concern. According to a published report by the FDA, it increases the risk of granulomas, bumps that form under the skin and may be permanent, as well as an increased risk of allergic reaction.
All currently approved wrinkle injections have been used in Europe for several years, and the track record on safety is generally good. Most often, side effects are mild, usually limited to redness or swelling at the site of injection, she adds.
The cost of wrinkle-filling volumizers is between $600 and $8,00 per syringe.
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Antioxidants
Topping the list of over-the-counter antiaging ingredients making the most noise these days are antioxidants. These skin-care nutrients fight aging by destroying free radicals, the unstable molecules that occur from sun exposure or pollution and that can literally gobble up the skin’s collagen supply.
"Antioxidants are nutrients that, when topically applied, disarm and neutralize free radicals before they harm skin -- so they can play an important role in antiaging skin care."
Scores of studies demonstrate the power of topical antioxidants (particularly CoQ10 and vitamins C and E) to rejuvenate and protect skin. However, the ingredient generating the loudest buzz in 2007 was clearly coffee berry, which some experts now believe is the single most powerful antioxidant discovered to date.
Two independent studies found that the same plant that gives you your java jolt in the morning is ready to provide a powerful antiaging boost to your face. The research conducted by David McDaniels, MD, at the Institute of Anti-Aging Research in Virginia, and Zoe Draelos, MD, at Dermatology Consulting Service in North Carolina, reported that coffee berry extract significantly improved the appearance of fine lines and wrinkles without allergic reactions or skin irritations. It will be a few years before the full extent of coffee berry’s rejuvenating properties is known, he adds that it is "so powerful in its antioxidant rating that even if 1/1,000th of what’s applied gets into the skin it’s probably going to have an effect."
Other cosmeceuticals with new and powerful antioxidants include:
  • Prescriptives Super Line Preventor Xtreme with seven antioxidants (1 ounce, $48)
  • Neutrogena Antioxidant Age Reverse Day Lotion and Night Cream (1.7 ounces, $17.99 each)
  • Lumene Vitamin + Energy Cocktail (1 ounce, $17.99)
  • Clinique Continuous Rescue Antioxidant Moisturizer with eight time-release antioxidants (1.7 ounces, $39.50)

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Peptides
Small proteins that stimulate the production of collagen, peptides have been on the cusp of antiaging skin care for a while. The excitement began several years ago with NIH-backed research on the ingredient Matrixyl (palmitoyl pentapeptide-3), showing its ability to stimulate collagen production in skin. Today, further studies on additional peptides continue to generate research news.
According to Jamal, studies on formulations such as Argireline (acetyl hexapeptide-3) show they can produce a mild, Botox-like effect, inhibiting the release of neurotransmitters that keep facial muscles from forming wrinkles. Even newer peptide formulations act like growth factors, stimulating skin cells to make a quicker turnover, much like young skin.
What’s new for peptides? Formulations that seem to yield overall improved results. "They are really getting the science down now, learning how to stabilize the peptides and at the same time inhibit collagenase [the breakdown of collagen] so we have better, more tailored peptide products," says Beer.
Products containing the newest versions of that peptide technology include:
  • Olay Regenerist Micro-Sculpting Cream with amino peptide complex (1.7 ounces, $29.99)
  • Lumene Premium Beauty Rejuvenating Instant Serum (1 ounce, $29.99)
  • Avon Anew Clinical Eye Lift (0.5 ounce, $28)
  • Osmotics Blue Copper 5 Face Lifting Serum (1 ounce, $75)
  • Emerge Bio-Peptide Night Repair Cream with 10% peptides (1.12 ounces, $43)

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Vitamin A
Among the most medically studied topical antiaging treatments are the retinoids -- derivatives of vitamin A. They are offered as prescription treatments such as Retin A or Renova, but also available in weaker strengths in over-the-counter products, listed as the ingredient retinol.
Retinoids are "thought to work on aging skin by increasing collagen production and decreasing collagen breakdown," says Jamal -- and a ream of studies backs her up.
But while many doctors believed only the prescription-strength retinoids were powerful enough to cause significant change in the skin, 2007 was the year that idea changed. In a study published in the Archives of Dermatology in May, researchers from the University of Michigan found that 0.4% retinol lotion applied three times a week for 24 weeks yielded significant difference in skin wrinkling when compared with a similar lotion without retinol used on a separate group of people in the study.
Even more surprising: The average age of study participants was 87, meaning it’s truly never too late to look younger.
A prescription-strength Retin A product can produce measurable antiaging results.
Products containing retinol include:
  • Vichy Reti-C Intensive Corrective Care (30 milliliters, $31)
  • Neutrogena Healthy Skin Anti-Wrinkle Intensives with retinol and antioxidants (Serum, 1 ounce, $16.99; Eye Cream, 0.5 ounce, $16.99)
  • Clinique Zero Gravity Repairwear Lift with retinol, antioxidants, and peptides (1.7 ounces, $52)
  • L’Oreal Advanced RevitaLift Double Lifting Gel (1 ounce, $16.99)
  • RoC Retinol Correxion Deep Wrinkle Serum (1 ounce, $19.99)

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Antiaging Sunscreens
Among the most exciting new ways to fight skin aging are two dramatic breakthroughs in sun protection: Helioplex, a new technology that makes current sunscreen ingredients more effective, and Mexoryl SX (ecamsule), a new protective agent. Representing the first innovation in skin sun protection in more than 20 years, each is specifically designed to defend against the aging effects of short UVA rays.
Most of us know about the dangers of burning UVB rays, but you might be less aware of the damaging and aging effects of UVA. "These are the ones that go deep -- UVA rays cause the deep collagen and elastin damage that contributes to aging skin.
While most sunscreens effectively protect against UVB rays, protection from UVA was mostly limited to the "long" waves, with ingredients that were unstable and frequently degraded in the sun.
But Mexoryl SX (ecamsule), a UVA-blocking sunscreen developed by L’Oreal, and Helioplex, a technology created by Neutrogena to stabilize traditional sunscreen ingredients avobenzone and oxybenzone, are proving not only to protect against the damaging short UVA rays, but to offer long-lasting protection without the need to constantly reapply.
They have been available in Europe for some time now, and there is no question they work -- and from an antiaging standpoint, they can be your best friend.
Even more exciting: In 2007 these sunscreen advances were combined with antioxidants and other antiaging ingredients in moisturizers and day creams that offer Fort Knox-level protection against the aging effects of the sun.
Products containing the latest Helioplex technology include:
  • Neutrogena Healthy Defense SPF 45 Daily Moisturizer (1.7 ounces, $11.99)
  • Neutrogena Ultra Sheer Dry-Touch SunBlock SPF 70 (3 ounces, $9.99)
Products containing Mexoryl SX include:
  • Vichy Capital Soleil SPF 15 Sunscreen Cream (3.4 ounces, $29.99)
  • L’Oreal Revitalift UV Moisturizer and Sunscreen (1.7 ounces, $22)
  • LaRoche-Posay Anthelios SX (3.4 ounces, $29)
  • Lancome UV Expert 20 (3.4 ounces, $35)

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SKIN CARE ADVICE

Resting your face on the pillow in the same way for a long period of time can lead to wrinkles. These sleep lines eventually become etched on the surface of the skin and no longer disappear. They are most likely seen on the chin and cheeks. These wrinkles can be avoided, if you sleep on your back.

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A MESSAGE FROM THE DIRECTOR

Welcome to the Texas Institute of Dermatology, Laser and Cosmetics website. I hope you will find our site easy to use and informative. Our mission is to serve as a leading center for understanding and treating skin, hair and nail diseases in Texas through excellence in patient care, research and education.

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PRESS RELEASE

The Texas Institute of Dermatology Team Finds Easy-to-Apply, Topical Drug Just as Good as Injectable Compound for a Disfiguring Skin Infection.


SAN ANTONIO, March 5 - A plentiful, inexpensive, topical compound is as effective at treating the.....

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