I see a lot of tattoos in clinic. They tend to be of three varities: old men with vintage war-time tattoos, young men with authentic NBA-style tattoos, and women who want to know how they can get rid of their tattoos.

It might be that despite there are increasing numbers of women getting tattoos (some reports claim that 65% of people who get tattoos are women), there is also more social pressure for women to remove them.

A study published in the Archives of Dermatology seems to support this. The study interviewed nearly 200 people. They asked people why they got the tattoo and why they wanted them removed. They compared answers from a study done in 1996 to 2006. In 1996, more men requested tattoo removal than women. However, in 2006 most of the tattoo removal request were in women (nearly 70%).

The researchers found that women with tattoos typically were white, single, college educated, and with moderate to strong religious beliefs. According to the study authors, women got tattoos “to be unique” and liked the sense of both both femininity and power it gave them.

However, they found that women were much more likely to report stigma problems as compared to men. They were also more likely to say that they hid the tattoo and that they felt that they no longer wanted it because they “grew up.” Careers were also a significant reason for women to want their tattoos removed. Other reasons why women wanted tattoos removed were embarrassment, problems with clothes, and negative comments.

It is interesting that historically, tattoos were associated with men, but now more than half of people who get tattoos are women. At the same time, women are more likely to experience negative social consequences and be more likely to want their tattoo removed as compared to men.

Tattoos are an ancient body art. They are often beautiful, and the majority of people who have tattoos are satisfied with them. It is unfortunate that there is more negative social consequences to having a tattoo if you are a woman as compared to men. The fact that a tattoo on a women’s lower back is sometimes referred to as a “tramp stamp” is an example of this stigma. As tattoos become more popular for women, perhaps negative societal stereotypes will fade away.

If you do want to remove a tattoo, see a physicain. Creams and balms advertised to remove tattoos do not work.

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

It is commonly believed that estrogen replacement in addition to relieving hot flashes, also gives the skin a younger, healthier, pre-menopausal appearance. However, studies thus far have been conflicting and there is little research to support these claims. A recent study examined if treating post-menopausal women with hormone replacement therapy would improve their skin.

The researchers took post-menopausal women who had crows feet, jowls, and dry skin and gave some women hormone replacement and some women a placebo. Nearly 500 women were enrolled in the study that lasted about a year.

Unfortunately, they found that there was no differences in skin wrinkling or complexion in women who took hormone replacement as compared to those who took the placebo.

The women in the study were 5 to 7 years past menopause, so it is possible that treatment with hormone replacement right when menopause starts might actually help, whereas it did not in these women. Also, the study used low doses of hormone replacement, which has less risk of side effects like blood clots, but perhaps slightly higher doses would have an effect in the skin.

Hormone replacement therapy in post-menopausal women appears to be safest and most effective immediately after menopause. Future studies will look at hormone replacement and its effects on the skin in these perimenopausal women and it will be interesting to see if there is some improvement in their skin.

Hormone replacement or estrogen therapy is not for all women, talk to your physician about your symptoms and medical problems to see if hormone replacement is right for you.

Reference: Phillips, T et al. Does Hormone Therapy Improve Age Related Skin Changes in Post Menopausal Women, Journal of the American Academy of Dermatology, September 2008.

Photo: Down Town Pictures, Flickr.com

Post written by Jeffrey Benabio, MD

All rights reserved, Copyright The Derm Blog, 2008

The concept of mineral makeup is brilliant in its simplicity.

• Take natural minerals (which are pretty colors).
• Pulverize them.
• Package them in cute containers with brushes.
• Market them as being so good for your skin that “you can sleep with it.”
• Charge $50 for 0.005 cents worth of iron oxide.

While I work on developing Benabio’s Beryllonite Bronzer, let’s take a look at the claims that companies make:

1. Mineral makeup contains only natural ingredients.
2. Mineral makeup will have beneficial affects for your skin.

With regard to the first claim, there is no regulation for what constitutes a mineral makeup. Don’t be fooled by makeups labeled as “all natural minerals.” A company can put artificial fillers, preservatives, or dyes in a makeup, and so long as it contains minerals, they can claim it is mineral makeup.

The FDA does not check to see if the product contains natural minerals; it only monitors the makeup to ensure it is not harmful. There is no requirement for a company to validate claims that its makeup is natural.

Some minerals, such as bismouth oxychloride are actually not natural, but are manufactured (yup, that means artificial); yet, they are often included in natural mineral makeups.

Since mineral makeups usually are powders, they usually do not have the preservatives which are needed for cream or liquid makeups. This might be beneficial since these preservatives can cause irritations or allergies.

With regard to the second claim, there is no published evidence that mineral makeup has health benefits for your skin. Claims that makeups nourish your skin are unsubstantiated and unlikely. Because the minerals in makeup do not penetrate your skin, they cannot have any effect. Imagine it like this: if the minerals were beach sand, your skin would be a sponge. If you dusted some beach sand on the sponge there is no way that sand would penetrate to get to the other side.  It just sits on the surface. If you read carefully, many companies claim their makeup nourishes the skin but also claim that it won’t clog your pores. If the makeup won’t even get into huge pores on your skin, how could it possibly penetrate through skin?

The other thing to consider is that not all minerals are healthy. For example, asbestos, a natural occurring mineral, is carcinogenic and increases your risk of mesothelioma cancer. Talc, which is similar to asbestos, has also been scrutinized for possibly contributing to ovarian cancer and lung disease. Because of inhalation risks, we discourage parents from using talc on babies.

Last, mineral makeup might increase your risk of developing an allergy to metals, such as gold. Though typically unusual, allergy to gold has become more common since mineral makeups have become more popular.

Companies also claim that mineral makeup is a good sunscreen. It’s true that titanium dioxide and zinc oxide, which are often found in mineral makeup, are good physical sunscreens. However, because they’re a powder, they do not adhere to the skin and are easily brushed off. As a result, your actual ultraviolet light sun protection is less uniform and less effective than it would be with a cream.

Mineral makeup might be a great cosmetic — many women love products such as Bare Escentuals and others. They like the look and feel of these products. If you do too, then by all means use them.

If you don’t use mineral makeup, however, then don’t worry, you’re not missing anything.

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

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Now a company has created an eyelash conditioner that doesn’t merely make you look like you have fuller, longer lashes, it actually makes you grow fuller, longer lashes.

But there’s a catch, (isn’t there always a catch?).

The story is that Jan Marini, a skin care company based in San Jose, CA, released a “miracle” eyelash conditioner about a year ago that they claimed made eyelashes fuller. It turned out that the mysterious conditioner really did give you fuller lashes because it made eyelashes grow. However, as I wrote about in an earlier post, this can be a problem for a cosmetic. If a cosmetic actually has an physiologic effect, like making your eyelashes grow, then the Food and Drug Administration (FDA) no longer considers it a cosmetic; rather, it considers the product a drug. This is significant because a drug is subject to much more FDA scrutiny than a cosmetic.

So how did this lash-lengthening liquid work? They used an actual drug, latanoprost (Xalatan®), in their formula. Latanoprost, which lowers prostaglandin levels, is prescribed as a drug in drop form to treat glaucoma patients. It has been known for some time to have the interesting side effect of causing eye lashes to grow. Jan Marini capitalized on this side effect by putting it in their eyelash conditioner.

When the FDA realized that the miraculous eyelash growing conditioner actually contained an active drug, the company had to withdraw the product from the marketplace.

The latest news is that Jan Marini has developed a new eyelash conditioner that does not contain any prostaglandin inhibitors (or probably any other drugs for that matter). According to the company’s website, they have “… uncovered a recently discovered proprietary peptide which when combined with other essential factors produces extraordinary eyelash and brow enhancement.”

Notice that they (wisely) do not claim that their new product causes your eyelashes to grow. I don’t know if it will or not. It is possible though that the original formulation using a latanoprost will be available again as an over the counter eye lash treatment. But, it will have to pass the FDA first.

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Bromelain is a natural substance derived from pineapples. It has been used medicinally for years because of its anti-clotting and anti-inflammatory effects. Like anti-inflammatories, such as aspirin or naproxen, bromelain blocks inflammation from developing and is used to treat sports injuries, arthritis, and sinusitis as well as pain and swelling.

Bromelain might also both prevent blood clots from forming and aid in breaking them down. As such, it has been promoted to reduce the risk of blood clots in conditions such as thrombophlebitis. Thus far, there is good evidence that taking bromelain reduces inflammation, but at this time, there are either few or no good studies on any of its other uses.

Because of its anti-inflammatory and anti-blood clotting properties, it has been suggested that bromelain might be a good supplement to help minimize pain and redness associated with cosmetic procedures and to help resolve bruises that might develop as a side effect.

Unfortunately, most of the bromelain in pineapple is in the stem, not the fruit, so eating lots of pineapple will not give you enough of a dose to have any effect. However, bromelain is available as a dietary supplement.

Although there is no standard recommended dose for bromelain consumption, this substance has been used in different doses ranging from 200 mg to 2000 mg.

Bromelain is considered safe; however, a higher incidence of adverse events including headache, gastrointestinal symptoms and cutaneous rash have been observed with higher doses.

Of course, you should always talk to your physician before starting any supplement, including bromelain. In particular, if you take anticoagulant medications such as warfarin and aspirin or have a history of ulcers, then it might not be recommended for you.

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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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Particularly concerning is new data from the National Cancer Institute which shows that from 1980 to 2004 melanoma rates rose 50% for young women.

A study of this data, published in the July 10th issue of the Journal of Investigative Dermatology, analyzed 20,000 cases of melanoma in young adults ages 15 to 39. The cases were recorded in a large database maintained by the National Cancer Institute.

The authors found the melanoma rate in young women rose from 9.4 per 100,000 in 1980 to 13.9 per 100,000 in 2004. In young men, melanoma rates remained stable at about 7.7 per 100,000 during the same time period.

Why the significant increase in melanoma in women? It is not likely due to improved detection of melanoma because we would expect that melanoma rates would have increased in both men and in women equally. It is more likely due to increased exposure to ultraviolet radiation, a risk factor for developing melanoma. Other studies of the same time period have shown that:

• More and more people in the U.S. are getting sunburned
• Teenagers had a higher incidence of sunburn and reported that they spent more days at the beach in 2004 then they did in 1998.
• More young people in the U.S., especially women, are using tanning beds.

Melanoma is curable when caught early. It is life-threatening when it has spread. Here’s how to find a melanoma:

Do a self skin exam every 3-6 months, at a minimum.  Have a partner help you with hard to see areas such as the scalp and back. If you have a family history of melanoma, have many moles, or have a history of any type of skin cancer, then see your dermatologist regularly for a complete skin exam. It could save your life.

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Photo credit: Michael Cote

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.

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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.

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