Depressed? Maybe Your Psychiatrist Will Prescribe Botox.

Botox makes you happy. So does a new Lexus, but I can’t prescribe that.

Botox® temporarily freezes dynamic lines such as crow’s feet and forehead wrinkles. When Botox is done well, it can raise your eyebrows and make your face appear well rested, younger, happier. Botox also makes it difficult to furrow your brow or frown.

Too much Botox freezes your face, making it expressionless (which could be seen in both winners and losers at the recent Golden Globes: Were they happy? Sad? Shocked? Who could tell?).

Because Botox can make people look better, it’s no surprise that people who get Botox are happier afterwards. A review in the Journal of Drugs in Dermatology actually looked at the cost of treating depressed patients with Botox. Here’s the reasoning: If you cannot frown because of Botox, then your mind will interpert this as you feel less angry or sad. Preliminary studies showed that people treated with Botox had more positive emotions and felt less depressed after their treatment.

While the logic is easily followed (and is emphatically supported by people who ordinarily pay cash for their Botox), the science is absent. There are no studies that show Botox improves depression as compared to placebo, therapy, or antidepressants. Much more research would have to be done to show that there is a real benefit (it would be  interesting to compare Botox to simply giving people $500 in cash and teaching them to frown less).

Depression is a disease and is never fixed quickly. Treating depression always requires effort, often requires therapy, and sometimes requires medication. I doubt that medication will be Botox. Or a new Lexus.

Photo: Geekadman Flickr.com

Weak, Split, Torn, Brittle, Frustrating Fingernails

Ever have a beautiful woman walk up to you, thrust her fingernails in your face and say, “Why do my nails keep splitting like this??” I have.

One of the rare hazards of being a dermatologist is being accosted with skin, hair, or nail questions at social settings. Broken, split, weak, or brittle nails are common, so I get this question a lot.

Nails are an appendage of skin and are made up of protein. Nails need moisture to stay healthy and pliable. They dehydrate much like your skin dehydrates. Dry nails are brittle: instead of flexing, they fracture and split from the tips backward. Once a nail is split, it is difficult to stop the split from spreading. Nail splitting occurs more frequently in winter when your skin and nails are  dry.

Nail polish can help protect your nails; however, nail polish remover worsens dryness. Therefore, the more frequently you paint and remove polish, the more your nails dry out. If you paint your nails, then touch up chips rather than remove the polish frequently. Keep the polish on for as long as you can before removing.

What else can you do to strengthen weak nails?

Apply to your nails a moisturizer with urea, like Eucerin Hand Creme. This puts moisture back in the nails and keeps them pliable.

Avoid excess washing. Soap and water dry your skin as well as your nails. (I can write you a doctor’s note that says you are not allowed to wash the dishes. If you must, then wear gloves).

Remember that once a nail is split, it cannot be repaired. The key is to keep the base of the nail healthy so when it grows out to the tip, it stays strong and intact. Fingernails grow 3 mm each month, so a 2-3 mm split will take a month to grow out.

There are lots of products that promise to strengthen or harden nails. Most of them are a waste of money, for example,  gelatin tabs. Gelatin tablets are animal collagen derived from bone. The collagen is broken down into protein by your digestive system. As such, taking gelatin tabs is no better than eating a piece of chicken or any other protein. Eat plenty of protein as part of a complete diet, but don’t bother with supplements.

Don’t waste money on calcium or other “mega-nail” vitamins. There is no calcium in nails and loading up on vitamins will not make nails grow faster or stronger.

There is some evidence that taking biotin, a B-complex vitamin, at 2.5 mg each day can help weak nails by improving protein synthesis. Remember though, if you start taking biotin today, it will be June before you see improvement because you can only improve nail that hasn’t yet grown.

Just like trimming dead ends can help your hair, trimming split ends can help your nails. Try to clip off the split part, but avoid being too aggressive because you can spread the split farther. With a little effort and a lot of patience your nails will be hard as nails.

Oh, and next time, a least buy me a drink.

Photo: KW Sanders (flickr)

Brown Skin Spots

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Ever notice brown spots on your skin after a rash or an injury? Brown spots on your skin are often blamed on the sun, but any damage to your skin can result in skin spots.

Skin color is caused by pigment-producing cells called melanocytes. Anything that excites these cells will cause them to release brown pigment into your skin. Sun causes them to release pigment, but so can an infection, a  rash, and even acne.

When you have an infection, injury or a rash,  inflammation develops to protect your skin from harm and to repair damage. This inflammation is apparent as redness, scaling, swelling, pus, pain, or even itching.  Inflammation triggers the melanocytes to make brown pigment which is dispersed and sinks into the deep layers of your skin.

Long after the inflammation is gone, the pigment remains and the brown spots stay visible. People with darker skin tones release more pigment when their skin is inflamed, which leads to more noticeable brown skin spots.

Brown spots such as these are called post-inflammatory hyperpigmentation because they appear after inflammation resolves. Unfortunately, once that pigment is deposited in the skin, it is very slow to fade. Over-the-counter bleaching creams such as hydroquinone 2% can lighten brown skin when used for weeks to months. More potent prescription creams such as Tri-Luma® can remove brown spots, but are expensive and generally are not covered by health insurance.

It is much easier to prevent than to remove brown skin spots:

  • Minimize inflammation as quickly as possible by treating the underlying problem
  • Avoid sun which could make the spots even darker
  • Be patient — some brown spots can last for years and treating them excessively can lead to inflammation making the problem worse.

Photo: Pat Hensen

School Stress, Hormones, and Acne

Dear Dr. Benabio,

OMG, my face is a disaster! My acne is worse than ever. PLZ help me!

Desperately,

Your Patient

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Many of my patients email me; this is the most common email I am getting this week. Why is everyone’s acne flaring up all of a sudden? It’s because of this simple formula: [High School Stress + Hormones = Acne].

Acne results when your pores clog, trapping sebaceous oils and bacteria deep in the skin. When you’re under stress, your body releases cortisol, a hormone that helps you stay alive in life or death situations. High school, however stressful, is not usually life or death, but your body doesn’t know that, and it reacts as if it were.

Two side effects of increased cortisol are increased sebaceous oil production and increased inflammation in your skin. The result: big, red pimples in the middle of your face that make you now wish you were dead.

If you have painful, cystic acne bumps, then your dermatologist can inject the worst ones with steroids to reduce the inflammation and to flatten them out quickly — “Nurse! Give me a syringe with Kenalog. Stat!” (Who said I don’t do emergencies?) Steroid injections can, however, cause atrophy or dimpling in your skin, which can last for months — much longer than the original pimple.

  • Spot treating acne is difficult at home. Tretinoin products such as Retin-A, Differin, or Tazorac do not work if applied to acne spots.
  • You can pop a pimple; however, unless it has a white head, squeezing usually just makes a little pimple into a big pimple.
  • Apply a spot acne treatment such as Neutrogena Rapid Clear Fight and Fade Gel. The mild acids in it help dissolve a pimple when applied directly.
  • Use a spot cover-up or concealer that has salicylic acid in it. Yes, guys, it is OK for you to apply a dab of cover-up. Use your sister’s.
  • If you have a little extra cash lying around (humor intended), then acne zappers like Zeno can help. They apply heat directly to the pimple killing the bacteria and hastening recovery. Or just use your iPhone, (I’m sure they will have an app for that soon, right?).

Remember that school is stressful, so eat well, sleep well (preferably not in calculus class), and exercise regularly. These will decrease your stress hormones and help keep you acne free.

Disclaimer: I did not receive any free products or reimbursement from any products mentioned in this post; these are my unbiased suggestions.

Photo: John Steven Fernandez

What You Need To Know About Adult Acne

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Argh! You cleaned out your high school locker years ago and now you have acne pimples on your jaw this morning. You’re not alone — 1 in every 5 women over 25 has acne.

Adult acne, in contrast to the teenage type, occurs more often in women. For some women, this is the first time they had acne; we call this late-onset acne. For other women, their acne never stopped from childhood into adulthood; we call this persistent acne. Many of my women patients have other names for adult acne, but they cannot be printed here.

It Must Be Hormones

We like to blame everything on hormones. In the case of acne, hormones contribute, but they are not the only factor. Stopping birth control pills causes a change in hormones and is  a cause for acne in adult women. Similarly, using progestin-only birth control pills affects hormones in such a way as to cause breakouts. Pregnancy is a time of dramatic hormone fluctuations and for some women, dramatic acne. Similarly, menopause can trigger outbreaks. Despite these known hormonal triggers, most women who have acne do not have hormonal imbalances (they are normal fluctuations in hormones). Foods or supplements that claim to balance women’s hormones don’t. So save your time and money, they won’t help your acne.

You Can’t Scrub Acne Away

Exfoliating to open pores can help, but only when done in moderation. Harsh scrubs or repeated microdermabrasion will irritate the skin and make acne worse. Instead, use mild chemical exfoliators such as salicylic acid or glycolic acid which are found in many women’s cosmetics and in acne treatments. Products that contain benzoyl peroxide also help to exfoliate and will treat adult acne.

Don’t Give Up Your Scharffen Berger Chocolate

Although myths of chocolate and pizza causing acne have been disproved, it is true that consuming cow’s milk (which contains hormones) as well as eating a diet high in carbohydrates (which causes inflammation) can contribute to acne. Eating chocolate once and a while, especially good chocolate, will not cause or worsen your acne.

Cosmetics Cause Acne

Many skincare products contain ingredients that clog your pores, triggering acne. Pantene shampoo as well as many hair conditioners have been known to cause this problem. Also, sunscreens are notorious for causing acne. If you notice that your acne is worse around your hairline or that it has flared since you started sunscreens, then try changing your products; it might be all you need to clear up your face.

Photo: Foundphotoslj (flickr)

Post written by Dr. Benabio Copyright The Derm Blog 2009

Poison Ivy and Poison Oak Treatment

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There are some lucky people who don’t get poison ivy or oak. If you’re like me, you do. Here are some poison plant pointers:

Ivy block cream prevents poison ivy or oak, but only if it is applied 15 minutes before exposure. It doesn’t work after you’ve been exposed.

The intensely itchy, sometimes frighteningly-bubbly rash is an allergic reaction to oil, urishiol, found on poison ivy, oak and sumac plants.

You can wash off the oil with soap and water. Do not use laundry detergent, alcohol, or expensive poison ivy soap — any ordinary bar of soap will wash off the oil. However, the oil is quickly absorbed into your skin, like olive oil into nice piece of Italian bread, so time is of the essence. Once the oil is absorbed in your skin, you cannot get it out no matter what you use.

  • You can wash off 50% of the oil within 10 minutes
  • You can wash off 10% of the oil within in 30 minutes
  • After 1 hour, no amount of washing will make any difference. Nothing will prevent the soon to be rash.

Whatever you do, don’t touch your groin in the first hour or so. You could end up in the hospital; I’ve seen it.

After one hour, you cannot spread poison ivy to someone else. Scratching or breaking the water blisters does not spread the poison ivy or the rash.

The rash lasts for 2 weeks, sometimes less if it is not severe. No cream or treatment, however expensive, can shorten the duration. The rash must run its course.

Once your arms and face turn into wet tapioca pudding, use a drying astringent like Domboro soaks to dry it out.

Once the blistering dries up, apply a topical steroid like hydrocortisone 1% cream or anti-itching lotions like topical Calamine or Benadryl. Cool baths with collodial oatmeal will also help. Super hot showers will relieve the itching, but only temporarily, and in the end, only makes it worse.

If you have a severe case of poison ivy, defined by your mother doesn’t recognize you or you are unable to sit, stand, or lie down, then see a dermatologist for prescription drugs to help.

Photo: Jim Frazier (flickr)

Post by Dr. Benabio, copyright The Derm Blog 2009.

Blue Light Therapy for Acne – Is It Worth It?

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Everybody is talking about the blue light. It is the latest gadget for treating acne (and admit it, we LOVE gadgets).  But can you really treat acne by simply shining a blue light on your skin? Continue reading