A Dermatologist Answers Your Questions (Part 2)

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A Dermatologist Answers Your Questions (Part 2)

Part two has arrived! As promised earlier this week, here are the rest of the questions that Dr. Joel Schlessinger answered for us. This portion focuses on wrinkles, acne and sunspots.

Part Two: Wrinkes, Ance and Sun Spots

Real Simple: Is there an inexpensive product (for people who are watching pennies in this bad economy) that works well at fading age and sun spots?

Dr. Schlessinger: Sunscreen! This is the least understood and most valuable tool in fading sun spots, bar none. If looking for repair, the Revision Skincare Alpha Solutionis, an 8% glycolic acid with 0.5% salicylic acid, is a great option.

To buy: $22, skin-one.com

RS: In regards to sunspots, is there something worth splurging on that is proven to work time and again?

Dr. Schlessinger: Anything that contains hydroquinone, in various strengths, is going to work. The key is to make sure to use it on an ongoing basis. The problem with most people is that they start it and then give up or never do the tough things like staying out of the sun. My favorite system is the Obagi NuDerm System Starter Kit–use alongside Retin-A for maximum benefits. It is equivalent, if not better, than lasers.

To buy: $370, lovelyskin.com

RS: Is there a product with retin-A that might be more appropriate for sensitive skin?

Dr. Schlessinger: I love the Kinerase Tretinoin product or Refissa, both of which are a kinder and gentler form of Retin A. Many dermatologists and plastic surgeons are now carrying them in their offices, where they can be significantly less expensive than traditional pharmacies for brand-name Retin-A. While there is no form of Retin-A that truly works for sensitive skin, these are in a cream and gel base that tend to be less irritating than the usual forms. If skin is sensitive, it is best to avoid retinoids as a rule.

To buy: $84, skinelite.com

RS: How long does it take for Retin-A to produce noticeable results when the desired results are a smoother complexion (ex: getting rid of mild acne scarring)?

Dr. Schlessinger: Retin-A is a very mild treatment for scarring, but it can produce benefits over months. It takes about 60 days for the skin to grow from the lowest level to the top, so I always encourage my patients to give it at least 60 days before they expect results.

RS: One of our readers is 27 and would like to know what she should be doing now to help prevent wrinkles in the future?

Dr. Schlessinger: I may sound repetitive, but the answer is to use sunscreen, stay out of the sun, and especially stay out of tanning booths. There now exists some great self-tanners, such as Jane Iredale's Tantasia, They don't smell bad and look normal. There is no reason to try to get a tan while causing wrinkles and risking skin cancer in the future.

To buy: $36,shop.janeiredale.com

RS: What is the best way to fade red marks/acne scars?

Dr. Schlessinger: These sorts of marks are often from the repetitive acne that occurs over time. I will commonly see patients who come in to fix the 'scars' of acne, but who don't realize that the first step is to actually control the acne. Without getting the acne under control, it will always be a losing battle. So the first thing to do is to get to a dermatologist to address the acne concerns. Once the acne is under control or treated effectively, then treat the scarring or marks if any remain. It never ceases to amaze me that the face has a huge resilience and ability to cure itself if given enough time and care.

For those patients who have red marks after treatments or minor scars, Intense Pulsed Light treatments can be very effective. I rarely have to resort to these if treatments are started early. The name of the game is coming in early–before scarring is permanent–to get on medications and prevent scars from forming. While laser treatments can help, they are very expensive and never have the benefits that prevention can provide.

RS: Some of our readers who are older than 40 years old expressed seeing breakout recently. Why have they suddenly begun experiencing breakouts? Specifically around the chin and lower face area.

Dr. Schlessinger: This can either be an infection or, if you are a woman, the onset of menopause. The most common reason for a sudden onset of acne is an infection and we are seeing an explosion of staph infections, some of which are the notorious MRSA (methicillin resistant staph aureus). It is a good idea to go in to a dermatologist to have this evaluated.

RS: What is the best laser or treatment for treating wrinkles and sun damage?

Dr. Schlessinger: While I like lasers and own 12 of them, I rarely use them for sun damage. Intense Pulsed Light, which is a variant of laser light, is great for brown spots and red spots/blood vessels. It can be used as an outpatient and has little or no downtime. If there is significant wrinkling on the face (outside the eyes and forehead), then the fractionated CO2 lasers can be very effective. We rarely have to use these any more as treatments now that we have great fillers like Restylane, Perlane and Juvederm, as well as Botox and Dysport for wrinkle relaxing. Much less expensive than lasers is to find a good system, like the Obagi NuDerm System.

RS: Is there anything a person with rosacea can use to exfoliate with?

Dr. Schlessinger: Rosacea patients now have a great option in the Obagi Rosaclear line, which has a gentle cleanser. The truth is that most rosacea patients need a gentle, not aggressive, cleanser. Exfoliation will only make things worse, and if there is evidence of scaling skin most likely needs to be babied not exfoliated. Many rosacea patients have a condition simultaneously known as seborrheic dermatitis, which looks like dry skin, but won't respond at all to exfoliation. It needs treatment by a dermatologist and should be addressed at the time of their appointment for rosacea.

RS: What are good products and practices for women ready to start preventing wrinkles, but still battling acne? Most treatments seem to be too thick or to put them on breakout-prone skin.

Dr. Schlessinger: I like the Obagi ElastiDerm Eye Treatment Cream and Gel for the crow's feet area (the gel is especially good if you have oily skin). Many products that help with acne will also help with wrinkles to some degree as they are all about exfoliating and turning over the layers of the skin. The LovelySkin product line has effects for both and is excellent for sun damage, with kits for both acne and wrinkles. I generally recommend using the kit (either acne care or wrinkle treatment) thataddresses the biggest issue at the time, but to a great extent they treat both conditions quite nicely.