Acne Care List for the Holidays and Beyond

Do you get an occasional pimple or are you dealing with full blown acne? With the help of our in house acne expert, Nancee Daly, we have comprised a list to keep your skin clear and healthy any time of the year.

No HOT yoga when dealing with acne. Yoga practice is great for keeping the mind and body de-stressed which in turn controls hormonal activity. But HOT yoga, where there is excessive heat and sweating can cause more break-outs and irritate an already unbalanced skin. Heat also ages the skin so keep it cool.

Probiotics, as already mentioned, help to restore some of the healthy bacteria (Microbiota) that antibiotics can wipe out. The Microbiota are essential for maintaining our immune systems so find a probiotic formula that contains at least 50 billion cultures and as many bacteria strains as possible.

Cleanse thoroughly every night – if necessary two to three times before toning and make sure that the cotton pad you use to tone is completely clean before moving on to the rehydrating and rebalancing phase.

Add a holistic approach with Reishi mushrooms, red clover, peppermint, saw palmetto, black cohosh and green tea. These all control the presence of androgens and can reduce the severity of acne.

Watch the sugars in your diet. Simple sugars in particular are highly inflammatory. Candy, sodas, ice cream, alcohol and white foods are the main culprits. Dairy foods can also exacerbate acne and check that any supplements that you are taking do not contain iodides.

We recommend that our male clients sterilize their razors after each use and that our female clients make sure that every trace of make-up is washed off at the end of the day. This often means several cleansing steps and plenty of toning.

Make-up brushes should be washed every week and most important NO PICKING!! Check out my post “Stop picking on me”. When a painful break-out begins to erupt, ice it for 15 minutes 2-3 times a day. This will not only help to reduce the severity but also the scarring.

Change pillow cases at least twice a week and wipe off smart phones with an antiseptic wipe after each use.

Finally make sure you hydrate inside and out. Plenty of water keeps the system flushed and healthy and a light topical serum or hydrating lotion will help to rebalance the skin. Don’t eliminate moisturizers. The right one will help, not hinder, the healing process.

Acne and How to Treat It

Part I

Hormones and acne:
Puberty is often associated with acne break-outs and at SkinSense we regularly counsel teenagers about skin hygiene and sensible dietary choices as we clean their skins. But many male and female clients develop acne later in life after navigating puberty and pregnancy without any problems. This can be due to excessive stress and in women it frequently signals approaching menopause, as estrogen levels drop allowing more free testosterone to take control.

Tip: Spironolactone (Aldactone) is an effective oral androgen blocker that helps to control this kind of late onset acne. (For women only.) Ask your doctor for details.
The formation of an acne lesion occurs when the skin is oily and begins to shed excessively, clogging the pores and supplying a food source for Propionibacterium (p. acnes). This creates inflammation and an immune response.

Identify the type:
Comedonal, Inflammatory and Cystic acne are the main categories used to define this condition. For the first two, a mix of topicals including salicylic, lactic and glycolic acids, with tea tree and camphor for spot treatment is very effective. Sometimes oral antibiotics are necessary to treat inflammatory acne but don’t stay on these for too long and always take a good probiotic at the same time. The redness and scarring is easily treated with an over the counter or prescription retinoid. Build slowly – one or two nightly applications a week – to avoid irritation and always wear a sunscreen during the day.
With both Comedonal and inflammatory acne regular cleaning and rebalancing facials are really helpful to bring the breakouts under control. At SkinSense, we often use a Mandelic Acid peel and an enzyme treatment that incorporates Niacinamide and Pumpkin extract to get rid of scarring. Oxygen facials are also great for a deep clean, killing bacteria, calming and revitalizing the skin.

Cystic acne is a more serious type of acne with deeper inflammation and a higher risk of scarring. It needs to be tackled quickly. If after three months oral anti-biotics don’t do the trick then Accutane is often recommended. Aczone is a topical medication that is non-irritating, reduces inflammation and can be used along with Accutane. Accutane does have some potential risks for certain individuals so make sure your dermatologist explains these to you and monitors you closely while you are on the medication. Gentle cleaning facials are useful in these cases to clear the skin and calm any redness.If Accutane is not a choice you would make, then there are other options and lifestyle plays an enormous role in how you can rebalance and correct acne.

Look for Lifestyle and Acne: Part II – up next.

Twelve Steps to Healthy Skin, Day by Day

Great skin requires commitment and discipline – two words that can strike terror in a lot of peoples’ hearts. But the benefits always outweigh the effort. Follow these twelve tips and you will be beaming from ear to ear.

Have regular ( preferably monthly) customized facials and take care of your skin AM & PM.

Use sun screen.

Don’t smoke.

Drink half your body weight in water.

Take your vitamins AM & PM.

Eat at least three fruits and five vegetables a day and keep your diet 80% alkaline and 20% acidic.*

Get to bed by 10.30 pm at least five nights a week.

Exercise at least four times a week for an hour.

Don’t pick your skin.

Don’t drink sodas.

Hang upside down for fifteen minutes every day. (Yoga counts).

Laugh LOTS.

*Read “Stop Aging, Start Living” by Jeannette Graf, M.D.

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As we all know, oxygen is essential for life. It makes up about 20% of the air we breathe, depending on where we live. It is important when discussing skincare treatments to differentiate between oxygen entering the body through respiration versus the benefits of topically applied oxygen. When applied in too large amounts to the skin, oxygen can have a detrimental effect and produce free radicals.

At SkinSense, however, we use a controlled and measured delivery system that enhances penetration without forming free radicals. This solid state oxygen treatment uses no hydrogen peroxide or gas wands and all the activity is generated by enzyme action which suits a wide variety of skin conditions.

Here are the main benefits of oxygen facials:

Stimulation of cellular activity which reduces the appearance of fine lines by increasing metabolic function. Reduction of redness and bacterial activity associated with Rosacea.

Leaves the skin calm and even.

Soothes inflamed skin and acne.

Provides a calming follow-up treatment after laser, acid peels and microdermabrasion.

Increases the absorption of active ingredients applied after treatment. Improves the appearance of scarring and lightens sun damage.

Tightens the skin surface and leaves the skin glowing and refreshed.

Oxygen facials can be performed as regularly as once a week, but the results are evident after just one treatment. In other words, oxygen facials are the equivalent to a brisk mountain walk in clean, fresh air. Living in Los Angeles that provides all of us a welcome opportunity to have a continually healthy and radiant complexion.

I have written about many different ingredients over the years, particularly the new ones as they come on to the market and seem to be the next best thing! And following on from my last blog, “The Discipline of Great Skin Care” there really are some effective products and ingredients available today that have stood the test of time and have made a huge difference to how our skins age.

One I have not addressed yet is stem cell extract. Just to be clear, there is no relationship between human stem cells and plant stem cells that are used in skin care. I want to avoid any misunderstandings for ethical, political and philosophical reasons.

The advantage of plant-derived stem cells is that they are unspecialized or meristematic, until they receive a signal from the host plant to differentiate or change. Meristematic cells are generated from a defense response from the plant when it is cut. The responding callus contains stem cells that are now neutral. As they carry the entire DNA gene expression of the plant, they can turn themselves into any particular cell that is needed to heal or regenerate. At this stage these cells are cultured in the laboratory, become a usable active ingredient that eventually, when applied topically can trigger cell renewal and repair. The first research into plant stem cells was done on a variety of apple in Switzerland in the 18th century which seemed to have the ability for long-term self-preservation.

More recently, other plant extracts have been tested including edelweiss, gardenia, sea fennel, grape and lilac. The role of these plant derived ingredients in skin care products is to protect against free radical damage caused by pollution, UV exposure, inflammation and photo-aging. And the results can be dramatic. Smoother, toned skin with improved elasticity and firmness.

Stem cell harvesting does not damage or endanger the plant because a very small amount of tissue is needed and easily replaced by the host plant.

I have been in the skincare industry for many years and this is one of the most significant partnerships between nature and science I have used to date. Add some of the other great ingredients we now have at our disposal – ATP, peptides and hyaluronic acid to mention three – and we can seriously delay the effects of gravity!! Plant stem cell extracts offer us a promising and earth-friendly anti-aging tool that deserves serious examination.
Reference:

Sam Dhatt, Skin Inc. magazine, October 2012. “Plant Stem Cells: The Next Generation of Skin Care Technology.”
Ivana Veljkovic, Skin Inc. magazine, January 2012. “The Science Behind Today’s Anti-aging Ingredients.”

The skin sheds about one million cells a day – most of your house debris probably consists of dead skin.

Shedding slows as we age, so extra sloughing on a regular basis helps to keep skin healthy, youthful and vibrant. And there are lots of options available to get rid of those cells more quickly. Here are the three main categories: mechanical, digestive/chemical and proliferating.

Mechanical methods include nut scrubs, polyethylene balls, micro-fine pumice and more aggressive protocols like microdermabrasion, dermaplaning and skin resurfacing.

Chemical methods include digestive fruit acids like AHA and BHA’s, enzymes from papaya, pineapple and pumpkin and deeper peeling protocols like TCA (trichloroacetic acid) and enhanced Jessner’s solutions.

Proliferators speed up the cell renewal process as well as encouraging the production of collagen and elastin. This includes the retinoid family derived from Vitamin A – and used regularly, these products can really improve the appearance of fine lines and wrinkles.

TIP: The products in these categories degrade quickly in sun and when exposed to oxygen so use at night only and if irritation occurs stop using until the skin is calm again.

All these methods work really well and make a difference to the appearance of the skin. Ask your facialist what would be best for your skin condition.

Many of my clients pick their skin. This is an addictive habit exacerbated by extreme or chronically stressful situations and the worst of it is that there is more to pick when we are stressed! Psoriasis, eczema, acne and dry flaky skin can all be partially attributed to the excess cortisol that is produced as a stress response. Hormones, neuropeptides and other signaling molecules also released during these times can be as aging as sunlight because they break down proteins and DNA. All this disruption drives many clients into the bathroom in a quest to somehow fix or ’cleanse’ the situation.

I recently had a client tell me that she ‘prepares’ her bathroom for a picking session. She brings in a magnifying mirror, comfortable chair and box of Kleenex and then works at her skin for an hour or more. She told me it gives her a sense of control, relief, and emotional release. It is also the opinion of Ted Grosshart, an assistant clinical professor of psychology at Harvard Medical School, that the compulsion to pick can be intensified by drugs taken for ADD and ADHD. Of course, after picking and the ensuing irritation and scabbing, most clients feel shame and less social because of their appearance. This form of isolation severely affects their self-esteem. It is a deeply psychological problem and needs to be handled with patience and compassion.

So how can we begin to break the cycle? Keeping the skin surface smooth with exfoliants and regular facials that include the use of AHA’s, BHA’s and other light peeling agents will get rid of little bumps and surface unevenness that might tempt fingers to go to work. Become aware of when you pick – at your desk, in the car, at home when you are watching television, when you have to deal with new environments? Iona Ginsburg, associate professor of psychiatry in dermatology at Colombia University has a useful tip. She suggests her patients put a Band-Aid around the fingers that do most of the picking. We encourage our clients to wash their skins’ by candle-light and time themselves in the bathroom. No more than five minutes to cleanse, tone and hydrate.

We also offer complimentary zaps in between spa visits to keep the skin and the client under control. Once the skin begins to clear and the client is no longer ashamed of how she/he looks, their demeanor and confidence grows. Confucius once claimed: ”True quality of life comes from a lasting harmony between body and mind.” Clear skin is that, plus a great facialist to guide the healing and an easy to follow home care regime that keeps the skin clear and healthy. Then there is no need for picking.

Dealing with pigmentation continues to be a struggle but as we learn more about the condition, we are adding some useful tools. Here are some of them.

An estimated six million women throughout the US are currently affected by melasma (also known as chloasma). This is a specific type of pigmentation problem thought to be caused by stimulation of the pigment-producing cells (melanocytes), and by the hormones estrogen and progesterone, when exposed to the sun and/or heat. Melasma is often referred to as the “mask of pregnancy” as the skin often darkens at this time, but the birth control pill and HT (hormone therapy) can also trigger a response. Other factors implicated in this annoying skin condition are certain medications that can cause photosensitivity, and cosmetics and fragrances that contain alcohol.

There are actually two kinds of melasma: epidermal, which is the most common and treatable type, and dermal, which is seen less often. Dermal melasma is light brown in color and has ill-defined borders. It is best treated topically with mandelic acid (an AHA derived from bitter almonds) and can often turn darker if treated with IPL (Intense Pulsed Laser) or laser protocols. Epidermal melasma generally has well defined borders and is dark brown in color.

There are several popular topicals currently being recommended for this type of melasma, primarily tyrosinase inhibitors but including bleaching and lightening agents. Tyrosinase is the enzyme responsible for catalyzing melanin, so inhibiting the action of tyrosinase is quite effective in reducing pigmentation issues.

The tyrosinase inhibitors are:

Kojic acid, derived from fungus

Arbutin, derived from the leaves of uva-ursi, the bearberry plant

Liquorice extract, taken from the root of the plant

Rumex extract, derived from the field dock

Niacinamide, also known as Vitamin B

Mulberry leaf extract

Other topical agents:

Vitamin C, a skin lightener and antioxidant derived from ascorbic acid

Tretonin, a skin exfoliator prescribed as Tazarac or Retin-A

Azelaic acid, a bleaching agent derived from barley, wheat and rye grains

Hydroquinone is still the most single effective bleaching treatment for melasma, but there are side effects attributed to this topical and some countries have banned its use. In fact, the FDA is now considering banning the sale of 2% OTC (over the counter) hydroquinone in the US and making it available by prescription only. If you are using it to treat melasma, watch for any irritation, redness and unusual discoloration.

The advantage of using topicals on the above list is that when combined properly, they can outweigh the benefits of hydroquinone and they have no side effects when used correctly.

Spa Treatments:

At SkinSense, we have found that ultrasound used with some of these topicals, particularly Vitamins C and A, during a facial treatment, helps to fade the pigmentation more rapidly by aiding penetration. Modified chemical peels alternated with regular applications of AHAs also speed results.

The client needs patience and persistance when tackling this condition because results are gradual. We recommend postponing spa treatments until the cooler weather sets in. As mentioned earlier, heat alone can cause pigmentation, so wait until fall and winter to start treatments. During the summer, we recommend deep-cleaning facials, lots of sunscreen, shade and wide-brimmed hats.

When consulting with clients on their visits to my spa, lifestyle takes up a big part of our initial conversation, particularly what they are eating on a daily basis. It is no secret at this point, that consuming a blend of fresh fruits, vegetables and clean protein, plus drinking the right amount of water does translate into a clear and vibrant skin most of the time.

However, two additional recommendations I have been making to my clients more recently to keep their skins youthful and healthy are to try and keep their overall food intake as alkaline as possible and to take regular courses of probiotics.

Ph Balancing:

In the skin care business, it is not unusual to talk about the pH of a product. The letters pH stand for potential hydrogen, as hydrogen is the element that controls the levels of either alkalinity or acidity in a formulation. Acidic products range from 0 – 6.9 and are often used to exfoliate or peel the skin; alkaline products range from 7.1 – 14 and can be used in cleansers or to neutralize acidity and very often moisturizers are formulated to be neutral (a pH of 7) to bring the skin back into balance. Too much acid or alkalinity is irritating for the skin so the pH is always carefully calibrated.

More recently, the principle of pH balancing has been applied to our bodies. This holistic approach believes that the foundation of a strong digestion is built on a simple eating system that maintains an ideal acid/alkaline (pH) balance in the body.

How do we do that?

The suggested pH ratio would be a diet of two-thirds alkaline and one-third acid-forming foods. This takes some adjustment. So, to take a step in the right direction, let’s outline a few alkaline foods that we can incorporate in greater quantities and some acidic foods we can eliminate.

Raw, green leafy vegetables like chard, kale and spinach are all excellent at maintaining a more alkaline system. So are avocados, celery, cucumbers, tomatoes, peppers, broccoli, coconut, cherries, grapefruit, lemons and watermelon. Obviously, exercise and relaxation are essential and as already mentioned, drinking the right amount of water.

Men need more water than women on a daily basis, but if you eat plenty of the above listed vegetables and two or three fresh fruits a day, you can fill half your required fluid quota. A healthy way to start and end each day for example, would be with a cup of warm water flavored with half a fresh lemon.

Things to avoid would be white flour, red meat, processed food, coffee, too much alcohol and artificial sugar. These create a lot of acidity in the body. Too much acidity triggers eczema, acne, cysts, rosacea and wrinkles – so all of these conditions could be greatly improved by a diet that contains alkaline-rich foods.

At this point most of us have heard the term probiotic or have noticed the words lactobacillus and acidophilus listed on our dairy products – particularly yoghurt containers. But did you know that about two hundred trillion of these microscopic organisms- bacteria, viruses, and fungi – are swarming inside you right now and are part of a vast organism called a microbiome?

A microbiome is, in essence, the sum collection of all the microbes found in or on people. Currently, about 9 million adults in America are taking probiotics in one form or another. It has built up to a billion dollar industry. Results are as difficult to predict as the actual microbiome is hard to understand and unravel but some tests have shown dramatic results. In the Intensive Care Nursery at Duke University Medical Center, the Preemie Microbiome Project has become an important step in understanding how we achieve a healthy, balanced microbiome in the first place. Researchers know that infants acquire about 100 species of microbes in the birth canal and others come from the mother’s skin after birth. Microbes can also be found in the mouth, lungs, between our toes and eyelashes, and even living in and around our tummy buttons. Our nose, mouth and eyes are also obvious entry points for germs. Tears and mucus contain an enzyme (lysozyme) that breaks down the cell wall of many bacteria. Saliva is also anti-bacterial. Since the nasal passage and lungs are coated in mucus, many germs not killed immediately are trapped in the mucus and soon swallowed. So your body has a regular artillery of defenses that it would seem logical to support as much as possible.

Scientists feel that understanding and controlling the diversity of our germs could be the key to a range of future medical treatments as well as maintaining our general health – diversity provides resilience in our bodies as it does in our environment and our local communities. Biologists at Washington University in St. Louis have done studies that suggest that the microbiome may play a significant role in affecting the ability of the body to digest properly, extract energy from food and to deposit it as fat and it has long been thought that the gut is the seat of the immune system. Imbalances in the microbiome in this part of the body might be linked, for example, to allergies, IBS, Krohns, diabetes, obesity and generally poor digestion. So it is becoming clear that managing the microbiome might be far more preferable to pummeling it with antibiotics. Which of course brings up the issue of the increased use of antibiotics not only through prescription but also in our food chain – especially in chicken and cattle feed. It has been established that continued use of antibiotics will eradicate certain strains of friendly bacteria that never fully repopulate certain areas of the body. So buy organic as much as possible. In the fullness of time we will understand how our genetic make-up, lifestyle, health and disease, influence the metabolic composition of our gut, and how this in turn influences, and is influenced by, our gut microbiome. And perhaps the next time you feel yourself getting hungry, or are feeling lethargic, you might ask yourself whether it’s really you, or is it the residents of your gut? As scientist Lynn Margulis commented in the April edition of Discover magazine,”We couldn’t live without bacteria. They maintain our ecological physiology. There are vitamins in bacteria that we can not live without. The movement of gas and feces would never take place without bacteria. There are hundreds of ways our bodies wouldn’t work without them. Bacteria are our ancestors.”

As any good aesthetician knows, the skin is an important part of the body’s immune system and will reflect inner stress and poor lifestyle. Topically, the skin produces antimicrobial peptides that keep bacteria in check. But when certain conditions are present, like psoriasis, acne, atopic dermatitis and rosacea, the skin’s defenses are over ridden and bacteria and fungi proliferate. Harsh cleansers, highly acidic formulas and prescription medications, both oral and topical, often exacerbate the problem, so correct analysis and product recommendations at this stage are vital. At SkinSense, we take a two step approach to skin health and wellness.

After counseling the client about diet and lifestyle we suggest a spa routine that is corrective without being too aggressive. Skin that is dehydrated or broken out won’t respond well to immediately aggressive peels or exfoliating treatments so we balance the skin with enzymes and aromatherapy before attempting anything more advanced. Meanwhile the client uses a home care routine that is also gently re-balancing including vitamins A, C, and B5 with plenty of ceramides and hyaluronic acid to calm and hydrate. Consistent and diligent morning and evening routines are always important but never more so than at this particular stage.

It is also interesting to note that probiotics have now started showing up in product formulations for topical use where they can encourage cell renewal, improve barrier function and retain surface moisture. This builds new tissue and gives the skin a glow. We also have a list of alkaline foods compiled from “The Acid Alkaline Food Guide” by Dr. Susan Brown that many of our clients find very useful and we recommend specific brands of probiotics that are easily purchased locally.

The secret to staying healthy and keeping skin youthful it seems, might be in keeping your germs healthy and your bodies pH balanced too. This way we can reflect both inner and outer health on a daily basis.