Having pores that are too big on the nose and forehead is a common complaint from men in clinic. Men have a higher density of sebaceous glands than women and sometimes have excessively oily skin with wide, deep pores. Excess oiliness and big pores can be difficult to treat. Surgical treatments such as lasers, microdermabrasion, and chemical peels can be used to improve the appearance, but results are often not satisfactory. Topical retinoids such as Retin-A® and Tazorac® can also effective in some people, but require applying the medication daily.

A cosmetic physican in Chicago has published a study using Botox to treat oily skin complexion and large pores. He found that 17 of 20 patients who received Botox in the skin reported a reduction in the oiliness and the pore size in the treated areas.

Botox works by blocking the release of a neurotransmitter, acetylcholine. Acetylcholine controls sweating, which is why Botox works so well to treat excess perspiration (hyperhidrosis), and can effect production of sebum. Botox injected into the skin then can block excess sebum production leading to less oily skin and to smaller pores.

The study did not compare Botox to other treatments and did not have scientific measures of pore size or of oiliness, but it did find that the majority of patients who were treated with the Botox specifically for oil problems felt that the treatment worked.

Women are more frequent users of Botox than men, but studies like this might give men another reason to try Botox to improve their appearance.

If nothing else, it can make you seem cool and collected as you watch your stocks plummet in the market.

Post written by Jeffrey Benabio, MD. All rights reserved, The Derm Blog 2008.

Photo: riNux, Flickr.com

In theory, eating foods high in antioxidants like blueberries or acai berries, or applying topical antioxidants like vitamin C should soak up free radicals. However, in reality, consumed antioxidants do not concentrate in the skin (no matter how much Mona Vie you drink) and topically applied antioxidants degrade too quickly to have any effect (despite what they tell you in the infomercial).

To make matters worse, most antioxidants applied to the skin don’t penetrate the dead, outer skin and so cannot have any effect on the living skin below (sort of like trying to clean a window that is dirty on the outside by applying cleaner on the inside). That may change soon.

A group of physicians at Duke University is working to find a way to apply potent topical antioxidants which are stable, penetrate the skin, and have measurable damage-protecting abilities. Through years of research, they found that popular antioxidants such as vitamin C and vitamin E do not live up to their claims, and have little if any actual antioxidant properties when tested on the skin. Recently, however, they found that when vitamins C and E are combined with a special antioxidant derived from ferns called ferulic acid, the antioxidants stabilize each other and really do work.

By combining ferulic acid with the vitamin C and E, the researchers found that the antioxidants remain stable when applied and do not break down quickly. They then put their cream to the test; they applied the cream to people’s skin and fired a beam of skin-damaging ultraviolet light (a form of sunlight) at it. They then measured how red the skin got and biopsied the skin to see if the antioxidant cream did indeed protect cells from the ultraviolet radiation.

They found that the skin treated with the ferulic antioxidant cream had much less redness, many fewer damaged skin cells, and had less DNA damage as compared to the skin that was treated with a placebo cream.

Although there are countless creams that claim to make you look younger and protect you against damage, there are very few studies to support these claims. This study examined the actual antioxidant effect of a highly engineered cream and found that the combination of vitamins C, E, and ferulic acid does protect the skin from damaging oxidation.

Look for creams containing this triple combination of vitamins C, E, and ferulic acid, which I am sure will be available soon. They are probably filming an infomercial right now.

Foot blisters can be a minor inconvenience or can keep you from walking, hiking, running, and otherwise enjoying your summer vacation. If you are in a remote area camping or if you have a medial condition like diabetes, they can be quite serious. So what can you do to avoid them?

• Wear socks that minimize friction and moisture. Blisters form when moisture builds up and your feet slide, causing friction. A study done by biological engineering students at the University of Missouri-Columbia tested ten popular brands of socks and found that the material they are made from is a major determinant of whether feet will develop blisters. They found that cotton socks held moisture and were the worst for blisters while nylon socks wicked moisture away and were the best. Higher priced socks did not test any better than the inexpensive brands.
• Wear quality, well fitted sandals or flip-flops. Poorly made or ill-fitting sandals or flip-flops allow your foot to roll inward, causing the strap to cut across your foot and creating a blister on the arch behind the bunion bone.
• Use moleskin, a soft, felt material, that can be stuck on the inside of shoes or a strap, to protect your skin. Petroleum jelly (Vaseline®) or Aquaphor® can also serve as lubricants beneath hard leather straps.

If you do develop a blister, resist the (powerful) urge to pop it. The dead skin and fluid provide a sterile dressing for the underlying wound. If the blister does break, then do not remove the layer of skin covering the blister. This can lead to more pain and possibly infection, which will certainly ruin your vacation. Just keep it clean, cover it with a Band-Aid®, and leave it alone.

And if you go to Sea World® with your niece, wear sneakers.

Post written by Jeffrey Benabio, MD. You might also like:

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Photo credit: Laura Hamilton

Athlete’s foot or foot fungus and toenail fungus affects people of all ages. It is itchy and ugly and can destroy your toenails. Here are six tips to keep your feet fungus-free and beautiful.

1. Foot fungus can be hard to treat — the best strategy is to keep your feet from getting fungus in the first place. Always wear flip-flops in places like public showers, locker rooms, and pools (walking on your tip-toes across the locker room floor won’t protect you). Don’t share towels, shower sponges, shoes, or socks. Wash your socks in hot water every time you wear them.
2. Keep your feet dry. You should wash your feet everyday, including between the toes (you know you don’t). Then dry your feet completely, including between the toes (you know you don’t); you can even use a hair dryer before putting on your socks. If you have sweaty feet, consider using a foot antiperspirant to minimize wetness. Wear loose fitting, synthetic socks that allow your feet to breathe and wick moisture away.
3. Apply an antifungal foot cream to your feet and toes everyday. Any over the counter antifungal cream will work; I recommend generic clotrimazole cream because its effective and a lot less expensive than other antifungals. If you don’t like applying cream, then try antifungal foot sprays such as Tinactin® (tolnaftate) or antifungal foot powders such as Desenex® (miconaozle). Spray antifungal spray powder like Oder Eaters® (tolnaftate) directly in your sneakers or sandals to block the growth of fungus.
4. The best treatment for nail fungus is oral antifungal pills. However, pills, such as Lamisil® (terbenifine) or Nizoral® (ketoconazole), can have serious side effects and require blood tests to monitor for complications. Combining oral antifugals with a topical antifungal cream everyday gives you the best chance of a cure. If you want to treat toenail fungus at home, then consider applying Vicks VapoRub® to your nails everyday. You can also try soaking your feet in a solution of one part Listerine with one part white vinegar. The alcohols in the Vicks VapoRub® and in the Listerine® might help eliminate the fungus. A third option is to try applying tea tree oil to your nails everyday. None of these home remedies are likely to cure toenail fungus, but they can help improve the appearance of your nails and are relatively harmless. Unfortunately, if your toenails are completely infected with fungus, there is less than 50% chance you will have a complete, long-lasting cure. Even with the strongest antifungal treatments available, only 50-70% of people clear their toenails; and those who are cured become reinfected 50% of the time!
5. Keep your toenails clean and trimmed short. You can scrape the crumbly material from under your nails, but do it gently. Vigorous scraping won’t clean out nail fungus and will cause your nail to lift off your toe or to fall off all together. Remember to wash your hands after every time you touch your feet or nails and to clean your toenail clipper and nail files with alcohol before using them again.
6. If you have successfully eliminated your foot fungus or toenail fungus, remember that you still are at risk of getting the fungus again. Consider getting new sneakers, sandals and socks, and apply an antifungal foot cream or powder to your feet everyday to prevent a regrowth of fungus on your now fungus-free feet.

Post written by Jeffrey Benabio, MD. You might also like:

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Photo credit: Randen Pederson

There are few conditions that evoke anxiety in my patients (men and women) more than hair loss. Hair is an important part of our appearance. We are biologically programmed to view it as a marker for a person’s suitability as a mate; this is probably because it’s an obvious indicator of a person’s youth and health.

Good hair suggests you are well nourished and healthy. As we age hair thins naturally, so a full head of hair also indicates the owner is young (and likely fertile).

It is no wonder that billions of dollars are spent every year to darken it, lighten it, grow more of it, and style it.

Like other physical characteristics such as body shape and skin complexion, the hair you have is the hair you are genetically programmed to grow. For some it is dense and thick. For others it is thin and sparse.

Patients often ask me what they can do to grow thick, luxurious hair. Here are five tips to have hair that says: “Yes, I’m dreamy.”

1. Eat well. Your hair reflects your overall health. If you eat healthfully, your hair will be healthy. Consume a diet based on whole foods such as fresh fruits and vegetables, whole grains, lean protein, nuts, and low-fat dairy.
2. Take your biotin. There are countless vitamins touted to make your hair grow faster, stronger, and longer, including prenatal vitamins. Don’t believe it. If you eat a good diet (as above), then you don’t need vitamins. The only one I recommend supplementing is biotin at 1,500 mcg each day. Otherwise, leave the prenatal vitamins for pregnant women.
3. Moisturize. Shampoos are often potent soaps and can strip your hair’s natural oils, leaving it dry, dull, and brittle. Use the shampoo at the scalp only, not at the ends which can be months to years old and have endured countless washes. Use a conditioner everyday (or at least 3-4 times a week if your hairstyle can’t tolerate daily conditioning) to help lock in moisture. This will help your hair be thicker, shinier, and healthier.
4. Try carnitine. A recent study showed that at least in the laboratory, L-carnitine (found in red meat) stimulated hair growth. Maybe that’s where the expression, “Eat this. It’ll put hair on your chest” comes from….
5. Cut it. Because your hair can be years old, it reflects all your body has been through in that time. For instance, if you were sick a few months ago, then the hair that grew during that period can be thin and brittle and will remain that way until it is sheared. If your hair is damaged or frayed, then there is little you can do to repair it. Sometimes the best thing to do is to cut off all the damaged areas and focus on taking better care of the hair that is still healthy.

Post written by Jeffrey Benabio, MD. You might also like:

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Genital or venereal warts appear as skin colored or brown bumps in the genital area of men and women. They can be small or large and can look bumpy or cauliflower-like.

They are easily spread from person to person by contact with the wart. Some people fight off the virus quickly and the warts go away. However, most people have the virus for months or years and sometimes never clear the virus. Once genital warts have taken hold, they can be difficult to treat.

Most wart treatments rely on destroying the skin where the virus is living. The fastest way to treat them is to freeze them with liquid nitrogen. Freezing the wart destroys the skin and incites your immune system to finish off the job. Other treatments like electrocautery, surgery, tricloracetic acid, and using podophylin all destroy the skin in a controlled manner to eliminate the wart. Usually multiple treatments are needed.

An interesting study published in Obstetrics and Gynecology has added green tea extract to the list of treatments. We know that green tea is a wonderful antioxidant; this current research shows us that it has potent antiviral activity as well.

Researchers from Argentina found that sinecatechins, extracts from green tea, were an effective and well tolerated treatment for external genital and anal warts.

• They randomly assigned 502 adults with genial warts to either a green tea sinecatechins ointment or to an inactive, placebo ointment for up to 16 weeks or until the warts cleared.
• In the sinecatechins groups, warts cleared completely in about 60% of patients compared to about 35% of subjects in the control group. (The 35% cleared the warts because the warts do sometimes go away on their own).

Sinecatechins ointment, sold as Veregen, is approved for the topical treatment of genital warts in adults.

Unfortunately, this research does not mean that either drinking green tea or applying green tea bags to your warts will treat them. It will not. Nor will onion extract, vinegar, vitamin E or any other do-it-yourself therapy.

Because genital warts are common and are embarrassing, there are countless home remedies and internet sites touting cures. Buyer beware. These treatments are unproven; they usually fail to treat the wart, and in some instances can be harmful, causing burns to your skin and scarring.

Not properly treating the wart can also be dangerous. Certain strains of genital warts can develop into penile cancer in men and cervical cancer in women. If you have warts, then it is important that you see a physician for evaluation and for treatment.

Women should also consider getting the genital wart vaccine, Gardasil. This might not completely prevent you from getting genital warts, but it can protect you against the strains of the HPV virus that are known to cause cervical cancer in women.

Post written by Jeffrey Benabio, MD. You might also like:

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Photo credit: Kanko

A razor with 5 blades instead of 2 or 3 will give you a closer shave (although they feel like you’re shaving with a tiny vacuum cleaner head). Each blade cuts the hair another fraction of an inch as you pull it across your skin, actually finishing below the surface, which is why it feels so smooth. You can get a similarly close shave by shaving against the grain.

But how smooth is smooth enough?

In some cases, a super-close shave is not desirable. Many men have thick or curly hair in their beards. Shaving too close causes the tip of the hair to get trapped beneath the skin, so when the hair grows, it grows back inward, trapped under the skin. This creates a tender (and unattractive) acne-like razor bump called pseudofolliculitis barbae.

A similar problem occurs in women when they shave their bikini area. If you have this problem, then be sure to soften the hair well with warm water and shaving cream first, then shave in the direction that the hair is growing.

Shaving closer also does not make the hair grow back more slowly. This is true for men and for women’s legs as well — the hair grows at the same rate no matter how close you shave it. Women, though, can try Aveeno’s Positively Smooth Shower and Shave Cream or Moisturizing Lotion which have soy proteins that can inhibit hair growth, keeping your legs smoother for longer.

If you have problems with razor bumps, consider scaling down to a two blade razor and shaving only in the direction the hair is growing. In most instances, the difference in closeness will not be noticeable, and you will be much happier without the ingrown hairs. Plus with the money you’d save (up to $3.50 ea. for cartridges), you might just be able to afford a full tank of gas for your car this month.

Post written by Jeffrey Benabio, MD

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Photo credit: Saintbob Flickr.com

There are 250,000 sweat glands in each foot, producing half a pint of moisture per day. People with excess sweating, called hyperhidrosis, can sweat much more than that, leading to scaling, fungus infections, and overall sandal-unworthy feet.

If you have mild to moderate excess sweating:

• Wash your feet every day with antibacterial soap, such as an antibacterial hand soap. Then dry them completely, including between the toes (you know you don’t).
• Use a hairdryer on the cool setting to get your feet completely dry.
• Apply a foot powder (powder is better than corn starch, which tends to absorb the moisture, leaving a wet paste on your skin). Try Lamisil AT defense with tolfnaftate, an antifungal, if you have a tendency to get athlete’s foot, or try Dr. Scholl’s Deodorant Foot Powder with Zinoxol (zinc oxide and baking soda) if you have smelly, sweaty feet.
• Wear synthetic socks, instead of cotton. Synthetic socks wick moisture away instead of trapping it like a sponge. Try Adidas’ Clima Cool socks.
• Use a spray antiperspirant such as Gold Bond Maximum Strength Foot Spray. Your regular underarm antiperspirant will work as well, but the aluminum chloride concentration is much lower, so it is less effective.

If you have seriously sweaty feet or hyperhidrosis:

• See your physician. He or she can prescribe a prescription-strength antiperspirant (Drysol ®). After one week of applying Drysol nightly, most patients have a significant reduction in foot sweating. It can, however, be irritating and some people cannot tolerate using it every day.
• Botox®. Yup, Botox. When injected into your feet, it blocks the signal from the nerves that turn on your sweat glands, stopping sweating. The downside: getting stuck with little needles about a hundred times on the bottom of your feet. The upside: a marked reduction in sweating that lasts many months.

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Hollywood’s golden boy, Matthew McConaughey, likes going au naturel. Yup. He doesn’t wear deodorant.

Lets be clear on something guys, even if you look like Matthew McConaughey, unless you are Matthew McConaughey, you’re not going to pull this off. (Well, not here in the States anyway).

So what causes underarm odor anyway? It’s not the watery perspiration that soaks your shirt; this is from your eccrine glands which secrete water and salt in an effort to lower your temperature. The odor is caused by bacteria breaking down fats secreted by your apocrine glands. These glands are located primarily in your underarms and groin and do not develop until puberty, which is why kids don’t have adult body odor.

Antiperspirants primarily block the secretion of the watery perspiration from your eccrine glands. They contain anhydrous substances like aluminum chloride and can be used anywhere you have eccrine glands such as underarms, hands, and feet. Antiperspirants do not control odor.

Deodorants do not stop perspiration, but they do control odor. They contain antibacterials like triclosan or other chemicals that inhibit bacterial growth. They also contain perfumes that mask the odor.

Most products labeled antiperspirant have both antiperspirants and deodorants in them; some products labeled deodorant have only a deodorant and not an antiperspirant.

And though this may seem obvious, don’t apply deodorant to a smelly arm pit. It won’t work because the bacteria are already there producing odor; it’s better to shower and dry thoroughly before applying.

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OK boys. Face it, women sometimes like a manly beard. But do you have what it takes? It requires patience, persistence, (and just enough testosterone) to pull it off.

• The first step in growing a beard is deciding to grow one. This is no trifling matter. Growing a beard takes at least 4 weeks including enduring an uncomfortable itchy period and having to answer ridiculous questions like: “Are you trying to grow a beard?” from your friends and colleagues.

• Don’t shave. Despite the popularly held belief, shaving will not make your beard grow faster or thicker.

• Pick a time when you can get a running start like at the beginning of a vacation or even a long weekend.

• Resist the urge to trim or shape the beard. Let it grow as much as possible before shaving, even if you are going for the “goatee” look. The hairs on your face will be in various stages of growth; not all are actively growing at the same time, so you have to be patient to see where it will fill in and where it won’t.

• What if your beard is spotty? Unlike your scalp, the hair on your face will not cover every inch. Some men will have hair from their eyeballs to their neck. If you’re this guy, then feel free to shave areas to shape it. Most men will have some areas that are spotty or thin, like on their cheeks and chin. This is determined by genetic and hormonal factors. There is little you can do about it, so work with what you’ve got.

• What about applying Rogaine (minoxidil) to your face? Minoxidil is a drug that was used to lower blood pressure until it was found it also grows hair. In topical form, it causes hair growth on the scalp of men and women with hereditary hair loss. Why it works is not really known. In theory, Rogaine could help you grow a beard, but this is never been shown in studies, nor is it FDA approved for facial hair. Applying Rogaine (minoxidil) to your face would likely be irritating and can also cause acne. If ingested or if applied in excessive amounts, it could cause serious side effects like a drop in your blood pressure.

• Biotin is a dietary supplement known to help with hair and nail growth. Consider taking 2.5 mg of biotin each day.

• You might find that growing a beard gives you an itchy, red, scaly rash on your face. Try using a little dandruff shampoo like Head and Shoulders on your beard two or three times each week. You can also apply a mild over the counter steroid cream like hydrocortisone 1% once a day.

• When your beard starts growing, the hairs are often stiff at first; they will soften over time. Consider using a mild steroid like hydrocortisone 1% everyday to help with the itching.

• After 4 to 6 weeks you should have a good idea what your beard will look like. If after 6 weeks you find people saying: “Oh, are you trying to grow a beard?” consider the clean-shaven look.

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