Pictured:  A vial of Lavender essential oil

Recently, I have been receiving numerous e-mails requesting reviews of lavender essential oil.  Like any other skin care product, consumers often tend to be lead astray by the fact that essential oils are “natural”.   As I have noted before, natural products – not just chemical-based or synthetic products – are also capable of causing skin irritation, allergic reaction, and even in exhibiting cytotoxicity in some cases.

Reported Benefits

With that said, lavender essential oil is one of the most commonly used essential oils.  First used by the ancient Greeks and Romans, lavender oil is generally believed to be antibacterial, antifungal, carminative (smooth muscle-relaxing), sedative, anti-depressive, and effective for burns and insect bites, according to a 2002 review in Phytotherapy Research.  In addition, many enjoy lavender’s aromatic properties, finding it to be calming and soothing.

In the skin, lavender has been shown to exhibit some antioxidant activity, effectively diminishing UV-induced reactive oxidative species generation (ROS) in the skin of rats.  Interestingly enough, in the study (published in the journal Photochemistry and Photobiology), it was demonstrated that lavender oils from England and France exhibited greater antioxidant activity than did lavender oils from Japan, which goes back to how important it is to recognize the specific type and concentration of the lavender oil at hand.   Other reported benefits of lavender oil include a reduction in symptoms of eczema and moderate psoriasis, though the evidence of this is somewhat limited.   Similarly, while lavender oil has long enjoyed the reputation of promoting wound healing and scarring, there is little scientific backing for this as well, as pointed out in Phytotherapy Research.

Potential Detriments – It’s Not Pretty

Unfortunately, what lavender oil does have scientific backing for is a history of inducing skin irritation and allergic reactions, like the one featured in this case study in Contact Dermatitis.  To lavender’s defense, many beneficial ingredients in skin care - from AHAs to zinc oxide - have been shown to induce such reactions in certain patients, so this alone does not mean that lavender oil is necessarily worse than many other skin care ingredients.

A more recent alarming study regarding lavender was featured in Cell Proliferation in 2004, which demonstrated that lavender oil consisting of 51% linalyl acetate and 35% linalool was cytotoxic in vitro (i.e., in culture), most likely through damage of the cellular membrane.  The authors of the study attributed the damaging cellular activity to linalool.  However, this effect has not been demonstrated by other studies as of yet, nor has it been demonstrated in cells in vivo (at least to the best that I could research!), and therefore more research needs to be done.

Another potential – and very alarming – effect of lavender oil is potential breast development (gynecomastia) in pre-pubertal boys.  Published in the highly reputable New England Journal of Medicine in 2007, breast development was found to occur in three different patients, all pre-pubertal young men, only when they used a combination of lavender and tea tree oils.  Indeed, when use of the lavender-and-tea-tree oil was stopped, the boys’ gynecomastia stopped.  It is believed by the studies’ authors that both lavender and tea tree oil have hormonal (androgenic and estrogenic) activity that influences in vivo cellular activity.

Lastly, lavender oil increases photosensitivity.  As such, although it is already crucial to wear a broad-spectrum SPF of at least 15 every day (or higher if your dermatologist recommends), it is even more essential to do so when using products that contain lavender oil in the morning.

Conclusions and Comments

Due to very effective marketing, most consumers seem to believe that “all-natural” or “organic” ingredients are necessarily better for your skin, which is definitely not always the case.  Take, for instance, the lavender oil at hand.  If more consumers were aware that having a pre-pubertal boy use lavender-and-tea-tree oils could potentially trigger his breast development, would we still be reaching for the lavender bubble bath over, say, Mr. Bubble?  (I personally don’t use Mr. Bubble anymore because it contains irritating sodium lauryl sulfate, but that’s another blog entry.  Literally – click here.)

Don’t get me wrong  – there are definitely some great natural-based products out there, just like there are some great traditional ones too.   I think that our best bet in this world is not to get too hyped up on one trend (all-natural!  only organic!) or on one alarming study.   The best tool of all is education:  Know that a natural ingredient can be as harmful or irritating as a synthetic one, and be reserved before making rash decisions about ingredients.  As yourself some crucial questions:

• Has this ingredient been demonstrated to have this effect been demonstrated in multiple studies?
• Is this research in a highly-reputable, peer-reviewed scientific/medical journal?
• Are the ingredients in the study being used in plausible concentrations?  (for more on how to evaluate a skin care study, click here for an earlier blog post).

And always remember, check back on this site, .  I have a lot to learn too, but I will certainly get my best information to you.  Let me know your thoughts in comments below!

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Every year, men and women worldwide spend approximately $2 billion on skin care products, most notably on cleansers, lotions, and creams. However, customers may do better if they choose to invest in supplements as well: according to this 2007 study in The Journal of Skin Pharmacology and Physiology,eating an ingredient is more beneficial than topically applying it, while getting the ingredient both orally and topically is most beneficial. 

Company Promises 

With that said, Hirsana Capsules for Skin, Hair, and Nails ($30 for 30 capsules or $72 for 90 capsules; HirsanaUsa.com) promise to provide more lustrous skin, thicker hair, and healthier nails with just three months’ of two-capsules-daily use, followed by one capsule per day thereafter.  The company asserts that the supplement is suitable for long-term use.  

“Does It Work?” |  Ingredient Analysis

The main ingredient in each 200-mg Hirsana Capsule is 59.7% golden millet oil.   According to this article by GeneCampaign.org, golden millet oil is genetically engineered from two lines of high-nutrition pearl millet bred from Zambia as a part of a project by the International Crops Research Institute for the Semi Arid Tropics (ICRISAT).  The chief purpose of golden millet oil is to deliver very high concentrations of beta-carotene, a lipid antioxidant.  Although other antioxidants have been shown to be chemopreventative and/or anticarcinogenic, it was found by a study in The New England Journal of Medicine that beta-carotene does not prevent against both basal-cell and squamous-cell skin cancers, and further established in a study in The Lancet that supplementation with beta-carotene does not help to prevent or treat skin cancer.

So what is the potential benefit of taking Hirsana?  One potential benefit is that beta-carotene ingestion leads to the production vitamin A in vivo via the action of the intestinal enzyme beta-carotene 15,15′-monooxygenase, which specifically cleaves beta-carotene into two pro-vitamin A molecules.  Given that retinoids (a form of vitamin A) are considered by many dermatologists to be a “gold standard” in anti-aging, using beta-carotene supplementation to increase serum levels of vitamin A may be solid way to reap the benefits of the fat-soluble vitamin.  In fact, according to Juergen Erhardt, a researcher at the University of Hohenheim in Germany, who collaborated on the ICRISAT project, “To have a staple food with a naturally high content of beta-carotene would be the easiest way to alleviate vitamin A deficiency.”   

Therefore, given that beta-carotene is a proven in vivo precursor of vitamin A, it is very plausible that daily supplementation of beta-carotene could lead to some (or all) of the benefits provided by vitamin A, including prevention of collagen loss, stimulation of collagen production, and increased cellular turnover rates.  In fact, daily supplementation of beta-carotene in the prescription treatment Lumitene® has been found to be effective in treating the symptoms of erythropoietic protoporphyria, a rare inherited genetic disorder of porphyrin-heme metabolism that often results in photosensitivity (painful skin sensitivity to sunlight), as well as gallstones and liver dysfunction.  However, more research needs to be done before the benefits of golden millet oil supplementation can be deemed conclusive.

Other ingredients in Hirsana Capsules include 100% of the FDA Daily Value of vitamin E (primarily an antioxidant), vitamin B6, thiamin, riboflavin, and biotin, as well as 50% of pantothenic acid and zinc.  Of these, vitamin E and biotin supplements have been shown to have the most conclusive evidence supporting benefits for the hair, skin, and nails.   

Are There Potential Risks?

Beta-carotene supplementation is often questioned because high doses can lead to carotenodermia, a harmless condition that presents as a conspicuous orange skin.  (This is due to the deposition of pigment in the epidermis, or top layer of the skin).  Because carotenodermia is harmless, the FDA does not provide an established upper level (UL) for beta-carotene.  However, proper usage of Hirsana should not cause carotenodermia in normal healthy individuals, as the average 150-lb (68 kg) adult requires approximately 1800 mg beta carotene/day to maintain adequate vitamin A levels, and each capsule of Hirsana contains only 200 mg golden millet seed oil, of which only part is directly converted to beta-carotene.  

According to the NIH, beta-carotene supplementation in combination with selenium (not in Hirsana), vitamin C, and vitamin E may also decrease the effectiveness of a combination of simvastatin (Zocor®) and niacin.  Talk to your physician if you have any concerns.

When taking any new supplement, I also like to sign up for a nutritional database so I can make sure I am not receiving any toxic levels of any vitamin from my combined supplement and food intake.  Free services are available at CalorieCounter.com or FitDay.com.

As always, talk to your physician before starting this or any other supplement.

Personal Use & Overall Opinions

After using the capsules for two weeks, I have noticed that my nails seem to have grown faster, but it will be awhile before I can honestly tell a difference in my hair (it’s pretty long) or my skin (it’s already very ‘antioxidized’ and moisturized!).  One caveat:  the capsules do leave a bit of a grainy, cereal-like aftertaste (it’s hard to explain), so I recommend taking them with food.     

I personally like combining oral supplements and topical ingredients for skin care. And I like Hirsana Capsules for Skin, Hair, and Nails due to their very high concentration of golden millet oil (which in turn provides a high concentration of beta carotene) and the fact that they provide 100% of the daily value of antioxidant vitamin E and biotin, which have both been shown to have benefits for the skin, hair, and nails when ingested via supplement.  While I feel as though more research needs to be done before the benefits of golden millet oil can be deemed conclusive, I still like this product, and will continue to use it for a while.  Product Rating: 7/9 (= 7.8/10).  (High concentration of proven-effective ingredients: 2.5/3.  Value for the money: 2/3.  New technology or original formulation: 2.5/3.  Sunscreen: 0/0 (N/A).)

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According to Dr. Patricia Wexler, M.D. on Vogue.TV, “You have to select your [skin] problems…and act to treat those problems.”  That said, with Dr. Wexler’s new MMpi 20 Skin Brightening and Pore Refining Serum ($55.00, BathandBodyWorks.com) & Daily Defense Anti-Oxidant Tinted Moisturizer SPF 30 ($29.50, BathandBodyWorks.com), expect to treat hyperpigmentation and lackluster skin (increased brightness occurs with soy extract, acetyl glucosamine, vitamin C, and the serum’s Melaclear tyrosinase inhibitor), as well as prevent signs of future damage (with the patented Niacyl complex,as well as antioxidants and sunscreen). 

MMpi 20 Skin Brightening and Pore Refining Serum (shown above)

MMpi 20 Skin Brightening and Pore Refining Serum ($55.00, BathandBodyWorks.com) is a very solid product.  My favorite ingredient in the formulation is Melaclear,  a patented ingredient designed to treat hyperpigmentation by Sederma.  (A sister product is called Melaslow).  Like arbutin and hydroquinone, Melaclear works by inhibiting tyrosinase, the rate-limiting enzyme in melanin production.  Although a publicly available, non-company-affiliated study has not compared the efficacy of Melaclear to other hyperpigmentation treatments, my best hypothesis (and this is only a hypothesis!) would be that it has similar effectiveness to arbutin, and is most likely less effective than 4% hydroquinone.  

Still, MMpi 20 Skin Brightening and Pore Refining Serum also contains N-acetyl glucosamine, the patented Niacyl complex, soybean extract, and new stable form of vitamin C to increase skin’s brightness.  N-acetyl glucosamine has been established to make a statistically significant difference in hyperpigmentation, as reported in the Journal of Cosmetic Dermatology in 2009.  In addition, the potent combination of N-acetyl glucosamine (NAG) and niacinamide was recently shown to reduce facial hyperpigmentation in Japanese and Caucasian subjects with facial hyperpigmentation in two double-blind, vehicle-controlled, split-face, left-right randomized clinical studies.   It is likely that the patented Niacyl complex in this product has similar efficacy to the niacinamide used in the study, as niacinamide is simply the basic form of niacin.  The soy extract also treats hyperpigmentation and brightens: in this 2000 study in the journal Dermatology, human trials demonstrate lightening of hyperpigmentation after use of realistic concentrations of soybean extract for just two weeks.  Finally, the BVOSC vitamin C used in the product (tetrahexyldecyl ascorbate) has been proposed as a more stable form of vitamin C than the traditional L-ascorbic acid.  Vitamin C runs the gamut in benefits – from decreased hyperpigmentation to increased antioxidant protection to increased collagen production – and BVOSC has been shown in a double-blind, half-face study in Dermatologic Surgery to provide statistically significant benefits.  In other words, this product is a huge thumbs-up for treating hyperpigmentation.  

So what’s the problem with MMpi 20 Skin Brightening and Pore Refining Serum?  My only issue is with this or any other product that says “pore-refining.”  From what I have learned from dermatologists, it is not possible to change the size of your pores (hence, I guess why the product doesn’t say “pore-reducing.”)  At any rate, please do not use this or any other product expecting to see a change in the size of your pores.  While certain products may clean out your pores to make them appear smaller (try 2% salicyclic acid) and others may use alcohol to inflame the skin cells to make the pores appear smaller by contrast, nothing will actually reduce the size of your pores.  Just a side note.   

Daily Defense Anti-Oxidant Tinted Moisturizer SPF 30

My favorite ingredient in the Daily Defense Anti-Oxidant Tinted Moisturizer SPF 30 ($29.50, BathandBodyWorks.com) is the antioxidant concentrate NDGA.  Like Dr. Perricone consistently defines his products by inclusion of DMAE, Dr. Wexler appears to be the only dermatologist (at least that I know of) that is including NGDA in her products.  According to the journal Mutation Research, NGDA has potent antioxidant, antimutagenic, and anticarcinogenic activity.  NGDA exhibits its antioxidant activity by lipooxygenase inhibition, in a similar fashion to the antioxidant quercetin.  Unfortunately, it has been reported that some patients develop contact dermatitis after use of NGDA, so talk to your dermatologist to ensure your skin’s tolerance of the ingredient.  (Perhaps this is why the product includes Symcalmin, a patented ingredient to treat inflammation of the skin).  

Wexler Daily Defense Anti-Oxidant Tinted Moisturizer SPF 30 also contains other antioxidants (apple extract for one), soy extract, and the Niacyl complex.  My only wish for the product was that it contained more photostable forms of sunscreen: while Helioplex (avobenzone and oxybenzone) and Mexoryl SX/XL are touted by this excellent 2007 review for their photostability, it is unknown at this time how the combination of sunscreens in this product compare (i.e., homosalate 8.0%, octinoxate 7.0%, octisalate 6.0%, oxybenzone 6.0%, and titanium dioxide 1.0%).  Still, it is undoubtedly true that the product does contain reasonable sun protection.  

Overall Opinions

I’m a huge fan of Dr. Wexler, and I think that these two products are a testament to her knowledge, training, and willingness to incorporate new technology and rarely-used ingredients into effective and original formulations.  I give these very high marks!  Product Rating (Serum):  8.5/10.  (High concentration of proven effective ingredients: 3/3.   New formulation or technology: 3/3.  Value for the money: 2.5/3.  Sunscreen:  0/1.)  Product Rating (Moisturizer):  9.0/10.  (High concentration of proven effective ingredients: 3/3.  New formulation or technology: 3/3.  Value for the money: 3/3.  Sunscreen: 1/1).  

Also, if you wish to order Wexler products, sign up for EBates.com and receive 3% cash back from your order!  (Cash back is typically delivered as a check in 6-8 weeks.  Please visit EBates.com for more info.)

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Love-Renaissance is a beautiful store at the Royal Hawaiian Shopping Center.

Recently, while on vacation in Hawaii, I came across a lovely skin care store called Love-Renaissance.  Established and quite popular in Japan, Love-Renaissance is relatively new to the American seaboard, having set up a U.S. shop in only Hawaii thus far.  And while I visited many skin care stores and spas during my visit to Hawaii, I must say, this was by far my favorite find.

Love-Renaissance is not the typical skin care system you will see getting high marks on this website.  For one, Love-Renaissance is significantly more expensive than most drugstore brands, and it has never been conclusive that there is a statistically significant difference between the performance of most department store and drugstore brands of skin care.  Second, Love-Renaissance does not contain what are arguably the five most proven effective ingredients in anti-aging skin care today: sunscreen, retinoids, niacinamide, antioxidants, or alpha hydroxy acids.  Lastly, proper use the complete Love-Renaissance system requires four steps: cleansing (a cleansing oil, $47.00-$57.00), moistening (a cleansing foam or soap, $33.00-$57.00), supplementing (with a serum-like product called milk, $57.00-$65.00), and protecting (moisturizing gel or cream $76.00-$95.00) – a multitude of steps some experts would say is excessive.  

However, Love-Renaissance still manages to deliver high-performance results with its inclusion of very high concentrations of all-natural, but scientifically proven, ingredients.  (The salesperson informed me that the main ingredients were included in concentrations up to 80%, but I could not find documentation online verifying this statement).  Love-Renaissance has four separate lines, each concentrating on one specific ingredient:  Verdi (olive leaf and royal jelly); Noe (olive leaf); Sakuyahime (cherry leaf extract); and Swaness (brown rice extract).  The cherry leaf extract in Sakuyahime has been demonstrated in published scientific journals to have anti-oxidant and anti-carcinogenic activity, with the additional inclusion of vitamin C, which helps to fight hyperpigmentation by controlling melanin production.  The brown rice extract in the Swaness line has been shown to be anticarcinogenic and anti-inflammatory, with the potential to also inhibit portions of the free radical pathway that lead to oxidative damage.  Lastly, olive leaf (in Verdi and Noe) has perhaps the least independent scientifically published data behind it, with one study demonstrating its antiviral activity.

I personally have been using the Sakuyahime line for the past three weeks, and I can honestly say my skin looks smoother and feels softer.  However, I am only using the entire system at night, as I will not forgo my ultra-effective morning routine (Skinceuticals CE Ferulic, Neutrogena Ultra Sheer SPF 85 (or 100) OR NIA 24 Mineral Sunscreen SPF 30), at least until conclusive published research shows there are more effective products for ultimate sun protection.  

And while I miss my nighttime prescription retinoid and Revale Skin’s coffeeberry moisturizer, for a short while, I am pleased with the results of Love-Renaissance and will continue to use it.  I look at it like my skin is still on vacation: maybe not the most productive use of my time, but definitely relaxing and soothing…and I am definitely enjoying the luxurious pampering experience!  :-)

With that said, I really love these products.  To order, please see information below.  Product Rating: 7.0/10.  High concentration of proven ingredients: 2.5/3.  New technology or unique formulation: 3/3.   Value for the money: 1.5/3.  Sunscreen: 0/1.  

Take care!  :-)

Ordering information for Love-Renaissance:
2301 Kalakaua Avenue, Honolulu HI 96815
Tel: 808.923.0991
http://www.love-renaissance.com 

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Photo Credits:  Skin Care Tips Originally uploaded by suzaned (flickr) 

Recently, it has been found that using retinoids and an AHA (like glycolic acid) or BHA (like salicyclic acid) diminishes the effectiveness of both ingredients.  So how can a patient still benefit from the potent anti-aging effects of each ingredient?  To find the answer, I consulted with the site of Dr. Leslie Baumann, M.D., a practicing dermatologist and the co-founder and chief of the Cosmetic Dermatology department at the University of Miami School of Medicine.  According to Dr. Baumann:

“Your question about order is a great one. Retinoids should not be mixed with BHA (i.e., salicylic acid) or AHA (i.e,. glycolic acid) because the BHA and AHA can inactivate the retinoid. Always use retinoids at night because the sun can also make the retinoid less effective.” 

Dr. Baumann then proposes a skin care regime in which AHA/BHA products are used exclusively in the morning under a broad-spectrum UVA/UVB sunscreen, while retinoids are used exclusively at night.

Of course, as would be expected from Dr. Baumann, this makes perfect sense.  

Daytime AHA/BHA Products

Please note that AHA/BHA do make your skin more sensitive to the sun, and hence more susceptible to UV damage.  With that said, always use AHA/BHA under a broad-spectrum UVA/UVB sunscreen with SPF of at least 15 (I prefer 50+ myself), reapply frequently, and practice sun avoidance between 10 AM and 4 PM.

Some AHA or BHA products I like include MD Formulations Daily Peel Pads (with 10% of the AHA glycolic acid, $35.00, DermaDoctor.com); DermaDoctor Ain’t Misbehavin’ AHA/BHA Acne Cleanser ($35.00, DermaDoctor.com); and Paula’s Choice Exfoliating 2% BHA Lotion ($18.95, Paula’s Choice.com).  

For more on AHA, please click here; for more on BHA, please click here.

Nighttime Retinol Products

Some nighttime retinol products to try include Neutrogena Healthy Skin Night Cream (with approximately 0.025% retinol, if I had to take an educated guess; $13.99, Drugstore.com); Afirm 2x (with 0.3% retinol, $35.00, Dermadoctor.com); Green Cream Level 6 (with 0.6% retinol, $43.00, Dermstore.com) and Skinceuticals Retinol 1.0 (with 1.0% retinol, $52.00, Drugstore.com).  

Please note that the higher the concentration of retinol, the higher the risk of skin irritation.  With that said, start with a small application every 2-3 nights, gently working up to nightly tolerance.  And, of course, it is always best consult with your dermatologist before starting use of retinol or any other new skin care ingredient.

For more on the benefits of retinoids, please click here (Dr. Baumann’s blog).

Take care!  J

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Photo Credits: ~ It’s A Long, Long Way to Machu Picchu! (Apologies to Jack Judge and Harry Williams) Originally uploaded by Mackeson

According to a recent press release by DermaNetwork.org, more than 20 states currently have legislation pending about restricting tanning bed usage. Of these states, two – Arkansas and Mississippi – signed into law new legislation to restrict access for minors under 14 to tanning salons in March of 2009, and one – Montana – failed to get such legislation passed in May 2009.

Tanning beds do in fact pose a substantial risk to minors, even more so than to adults. According to the American Academy of Dermatology, an estimated 80 percent of sun damage occurs before age 18. Given the fact that the average tanning bed (or other artificial UV light source) provides approximately three times the DNA-damaging long-wavelength UVA rays (192.1 W/m² on average) than the sun, it is easy to see why use of tanning beds in youth is particularly alarming. In addition, this 2005 study in Cancer Epidemiology, Biomarkers, & Prevention confirms that use of tanning beds prior to age 18 significantly increases a patient’s risk of malignant melanoma later in life. In the study, it was confirmed that both earlier use of tanning beds and regular use of tanning beds throughout youth substantially increased cancer risk. With approximately 10,500 American lives lost to skin cancer each year, it is no wonder that restrictive legislation looks so promising.

Yet the legislation may fall flat if parents and guardians do not recognize the risk of using tanning beds themselves. According to a 2002 study in Pediatrics, youth (age 11-18) were significantly more likely to use artificial UV light sources for tanning if their parent/guardian did so, with 30% of the youth with artificially tanning parents/guardians doing so themselves. (Other factors that make a young patient more likely to use tanning beds include female gender, age 15-18 as opposed to 11-14, and the belief that tanned skin is more attractive).

A second problem with the impending legislation is the fact that most youth using tanning beds are in the 15-18 range, whereas the legislation is primarily targeting children 14 and under. In fact, according to this 2002 study in Pediatrics amongst 10000 youths using tanning beds, tanning bed use increased from 7% among 14-year-old girls to 16% by age 15, and more than doubled again to 35% by age 17. Although earlier exposure does correlate to higher risk of malignant melanoma later in life, it is still haunting that legislation restricting tanning bed use under age 14 will ultimately not save as many lives as legislation affecting the 14-17 age range.

With that said, I personally believe that the only effective legislation will be that which sets advisory guidelines for UV exposure, concurrent activities, and sun protection, which has also been proposed in the journal Photochemistry and Photobiology. Governmental legislation needs to inform parents and guardians of the true risks of sun exposure for their children and adolescents. There are simply too many erroneous beliefs circulating in our society about the sun – “the sun is good for you,” “a little base tan protects you in the future,” “everyone looks better with a tan,” etc., and it is no wonder parents are confused. With that said, the American Academy of Dermatology’s current sun exposure guidelines are available here, and the organization maintains that this amount of exposure is adequate for the body to synthesize enough vitamin D.

For the original press release by DermaNetwork.org about the impending legislation, please click here.

Let me know your thoughts in comments below!

Editor’s Note: This entry was entered on June 15, 2009 in the “Make a Difference” Blog Contest, sponsored by Dermanetwork.org. The contest awards either a donation to the Melanoma Research Fund or a gift card to the winning blogger.  I decided to enter the contest because I thought the topic was relevant to my readers’ interests, as well as for the opportunity.  While not necessary, I wanted to disclose that this entry was entered in a contest in order to maintain the trust of my readers. -NZ

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Recently I was honored with the privilege to interview Dr. Jeanine Downie, M.D., about the treatment and prevention of melasma.  Although Dr. Downie is an expert in many realms of dermatology, she specializes in pigmentary disorders, and is particularly passionate about the topic, having been personally diagnosed with melasma in her early twenties.

Dr. Downie is a practicing board-certified dermatologist of Image Dermatology in Montclair, New Jersey; author of Beautiful Skin Of Color: A Comprehensive Guide for Asian, Olive and Dark Skin; as well as a professional lecturer, wife, and mother. Dr. Downie has been featured in numerous sectors of the public arena as well, including onThe View, Good Morning America, The Rachael Ray Show, and In Style andO magazines, amongst many others.  Thank you for taking the time to talk toFutureDerm.com, Dr. Downie!

Nicki Zevola:  How common is melasma in your patients?

Dr. Jeanine Downie:   Melasma is very common amongst patients, and I have seen numerous patients with it lately.  One type I have seen a lot of recently is intense heat fluctuation melasma.  [...]It is upsetting, how common melasma is amongst patients.

NZ:  What can be done to prevent or eliminate melasma?

Dr. D:  To prevent or eliminate melasma, don’t necessarily get off of hormonal contraceptives.  Put sunscreen on, reapply every 2 hours, and watch heat.  Patients don’t often consider how much heat aggravates melasma.  Even waxing the upper lip can exacerbate the condition.

NZ:  What can be done to treat melasma?

Dr. D.:   Three major factors:  sunscreen, Tri-Luma, and chemical peels/Fraxel.  

To treat melasma, first use sunscreen.  The prescription Tri-Luma is the only FDA-approved treatment for melasma.  With the Tri-Luma, you may also wish to do chemical peels to help to even the skin out.  Also, laser treatments like Fraxel are useful if the patient has had very deep-seated melasma for many years.  In summary, sunscreen, treatment cream (with Tri-Luma being the best, but a cosmeceutical may be used) and chemical peels or Fraxel.  

NZ:  A lot of attention has been drawn to potential safety issues [i.e., ochronosis] with Tri-Luma, particularly for patients of darker skin tones.  Has this been an issue for you in your practice?

Dr. D:  My practice consists of approximately 60% white patients, 40% black/Latino/Asian, in that order.  Regardless of race, I advise my patients to only putTri-Luma on the dark patches themselves.  I tell them not to put Tri-Luma all over the face, or else patches may evolve that look like a bull’s eye!  Of course, these bull’s eye-like patches may not be a problem, but as a safety precaution, I do not advise puttingTri-Luma all over the face.

Recently, I was giving a lecture at the Cosmetic Boot Camp in Aspen, CO, where approximately 250 dermatologists, plastic surgeons, and facial plastic surgeons attended to learn about cosmetics.  I happen to specialize in pigmentary disorders, especially melasma.  And when a question about Tri-Luma was raised, I explained this:  the tretinoin in Tri-Luma thickens collagen and elastin over time, and the tiny drop of steroid is balanced by the retinoid in the product.  In addition, it has been proven that there is no problem with using Tri-Luma for an extended period of time. The product has been FDA approved for seven years.  

NZ:  Is there a difference between treatments for melasma, dark spots from acne scars, and sunspots?

Dr. D:  Yes.  For dark spots from acne, I advise use of fade creams, the laser treatmentsFraxel or Lyra, and sunscreen.  Sunspots are solar lentigines – I say these are like the ones that appear on Grandma’s hands – are best treated with the laser Gentle-Laze.  Sunspots are an entirely different modality from melasma – don’t use Tri-Luma for sunspots!  In fact, Tri-Luma doesn’t work swimmingly well for sunspots.

NZ:  Melasma often develops during a woman’s pregnancy.  Is there any way to prevent melasma from occurring during pregnancy?

Dr.D:  In terms of being preventative during pregnancy, melasma can occur anywhere – even the arms – particularly if the patient has a family history.  The patient must be very stringent about sun protection, must use sunscreen every 2 hours [for sunscreens that are permissible during pregnancy, please click here].  A patient can also receive peels all through her pregnancy, which can be helpful.  However, I absolutely do not give Tri-Luma to pregnant or nursing women [due to tretinoin/retinol/vitamin A].  

NZ:  In summary, what is the best advice you can give to patients regarding melasma?

Dr. D:  The bottom line is that people need to realize that they should get their irregular spots checked.  Patients need to get melasma diagnosed by a board-certified dermatologist.  Often patients with dark spots cannot tell the difference between melasma, sunspots, dark acne spots, and even skin cancer, so it is vital to have a board-certified dermatologist make the proper diagnosis – it could save your life! In addition, avoid too much sun exposure.  While the sun is not a statistically significant factor in the development of melasma, it makes already-developed melasma patches worse, and can aggravate acne spots and worsen sunspots.  

Have a skin care regime….once you are diagnosed with melasma, sunscreen, Tri-Luma, chemical peels, and/or Fraxel lasers are the best!  Even after [dermatological] surgery, I tell patients they can keep the area covered, use Fraxel, and then use Tri-Luma to help eliminate scarring.  

NZ:  Thank you very much, Dr. Downie, for taking the time to do this interview!  It was very useful and I feel privileged to have learned so much directly from you.

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Cosmetics Alford&Hoff

Flickr: Originally uploaded by Manisfive

As we all know, Father’s Day is rapidly approaching, and if your dad is anything like mine, he has probably gotten enough toolsets, colognes, ties, and sweaters to fill a garage.  With that said, looking into skin care gifts for your father may be just the ticket this Father’s Day.

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This month, I am proud to announce that Curél and FutureDerm.com have teamed up in support of the “Share the Gift of Caring” campaign, which supports the American Red Cross, one of my all-time favorite organizations.  Since 1881, the American Red Cross has provided domestic disaster relief; support and comfort for the military and their families; the collection, processing and distribution of lifesaving blood and blood products; CPR, first aid, and other life-saving training; disaster preparedness education and international relief and development programs.  For more on the American Red Cross and its programs, please click here.  

About the contest:  Five lucky winners will receive a full-size bottle of Curel Continuous Comfort Original Formula Lotion (currently $9.68 on Amazon.com) just for entering!  Five lucky winners will be drawn from random number generation on July 15, 2009 at midnight EST.  

To enter, please put your name and e-mail address in Comments below!  One entry per person, please.  

More About the “Share the Gift of Caring” campaign:   Collaborating for the second time, Cynthia Nixon (shown above) and Curél are proud to launch the “Share the Gift of Caring” campaign in support of the American Red Cross.  Curél has made a contribution of $250,000 to the American Red Cross, and has pledged to donate $10,000 more.

How You Can Help the American Red Cross (for free, and in 5 minutes or less!):  Through the “Share the Gift of Caring” campaign, you can make a donation without spending a dime!  Just log on to www.curel.com and click to donate $1 of the additional $10,000 Curél is donating in a friend’s name. Your friend will receive a message from Curél letting her know, and she will be invited to share the gift of sharing with someone else—creating a chain of donations from Curél and you!

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Quite simply, patients don’t use their antifungal dandruff shampoos regularly, which allows recurrence to occur.  In addition, patients tend to use the antifungal dandruff conditioner on their scalp, but the conditioner can remove the antifungal ingredients the shampoo leaves behind.  Instead, according to Jim Schwartz, a research fellow at Procter and Gamble, it is best to apply the dandruff conditioner to the hair ends only.

The fact that dandruff shampoos don’t work due to inconsistent use is a new concept.  According to writer Kristin Sainani in the June 2009 issue of Allure magazine, a recent survey of 722 dermatologists revealed that 64% believed that patients experienced dandruff recurrence because response to the antifungal shampoos diminished over time.  However, Sainani reports that a 2009 Procter and Gamble study (headed by Schwartz) found that no dandruff recurrence occurs when a 1-2% pyrithione-zinc-based product (like Head & Shoulders) is used regularly for 24 or 48 weeks.  In the study, two groups of 337 patients total using either a 1-2% pyrithione-zinc based product (like Head & Shoulders) or a placebo for 24 or 48 weeks showed that those using the anti-fungal shampoo experienced no dandruff symptoms or recurrence relative to patients in the placebo group.  This indicates that the popular belief that dandruff shampoos diminish their effectiveness over time is false, and instead, patients who tend to get dandruff should consistently use their antifungal dandruff shampoos, even after the dandruff seems to have been treated.

Have any additional advice for dandruff or any other hair care tips?  Let us know in Comments below! 

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