Anti aging

Freshen up for fall!

I’m back- for now. Life is busy now with eight year old twins. It has been so long since my last post I don’t remember my wordpress password, thank goodness for the automatic recall. At least you can be reassured that nobody is paying for my posts (or they would fire me)!

I decided I am going to capitalize on the “waiting” that occurs with so many kids sports and get more blog posts up! Currently I am huddled under an umbrella waiting for a soccer game to start. With four practcies and two games per week I should be able to get at least one post per week (as long as I disable facebook).

So after a record breaking summer of sun in Seattle I realized that I had been a bit relaxed with my hat use (used a baseball camp instead of the goofy widebrim) and my skin had suffered. My usual pale skin had areas of brown “smudge” on my cheeks and upper lip (which is not attractive). There were tiny areas of permanent redness on my cheeks where the sun had created telangictasia. When I had to pull out the (fuller coverage) makeup for family photos I knew it was time for a fall refresher.

My first target was the smudge on my upper lip because a mustache is not a good look! I emailed my colleague and asked her to send in a prescription for Tri Luma. Tri Luma is a medication that combines Hydroquinone, Tretinoin and Hydrocortisone. I have found this commercial product works better than combining the individual creams myself. It is spendy (about $175 with a coupon) but it works well and the tube lasts a long time. I am sure most people have spent more money on ten creams that don’t work. This one is good. I have already noticed a difference in just a week. It is VERY important to avoid the sun when using this medication, luckily the Seattle weather is cooperating.

I plan to use the Tri Luma for at least a month, though it can be used safely for two months before you have to take a break of equal length. My next step will probably be a mini IPL (intense pulsed light also called a photofacial)to target any residual brown spots and the blood vessels. Stay tuned for my post on IPL.

So if you are noticing those pesky sun spots are sticking around after the sun is gone, ask your dermatologist for a plan to refresh your skin before the holidays.

Disclaimer: I was not paid to write this post and did not receive free product. I paid full retail for my tri luma. This blog post is not intended to replace advice from your physician and does not constitute a patient-physician relationship.




Out Damn Spot!

It is officially fall. Gone are the long days of sun and the summer glow is starting to fade (I never had one of course). As the tan fades, those pesky brown spots become annoyingly obvious.  I probably have at least five people ask about getting rid of brown spots every day. Unfortunately I can never devote the time needed to the topic because insurance companies (who are always watching and auditing) don’t want me to discuss cosmetic issues if they are paying the bill. Now brown spots should be evaluated to ensure they are not cancerous (so making an appointment for brown spot evaluation is ok with most insurance companies), just last week one of those brown spots turned out to be a melanoma. Fortunatley, the majority are not melanoma and represent either solar lentigos (age spots), seborrheic keratoses (another type of age spot) or melasma. All three of these conditions are somewhat cosmetic in nature (if you are looking to remove them).

Solar lentigos (which look like brown spots) and melasma (often looks more like brown blotchy skin) are caused by the sun. They are very sun sensitive and are not prevented 100 % by sunscreen. So before treating, you have to be committed to protecting your skin from the sun with heavy sunscreen and hats.

Now how do you get rid of the spots?

Liquid nitrogen.      This treatment works very well if you have just a few solar lentigos or seborrheic keratoses. It does not work for melasma. The advantages of this treatment are speed and low cost. The disadvatages are possible lasting redness, post-inflammatory hyperpigmentation (a medical word for a brown spot) or even a scar.

Creams.      Creams don’t tend to work well for large solar lentigos, but are first line for mottled brown pigment and melasma. The most effecitive creams are a combination of prescription strength hydroquinone and Retin A. At my office we sell a 4 percent hydroquinone and .1 percent Retin A for $68 each, which is a pretty good deal. There are several commercial prescriptions available from the pharmacy as well. There is a commercial cream (Tri Luma) that adds a hydrocortisone which can help if you have irritation from Retin A tyoe creams. Hydroquinone creams must be used for limited time periods (8 weeks) before taking a break- or they can cause worsening of pigment. Retin A can be used continually but will cause increased sensitivity to the sun. If you prefer to avoid hydroquinone or you are breastfeeding, there are creams that can help lighten skin- though they are not as effective in most cases. Look for products with kojic acid, arbutin, licorice, azelaic acid, soy and vitamin C. We have one called Perle by Neocutis, but there are other brands available.

Peels.  Peels can be effective for brown spots as they contain the same ingredients as the creams above. A benefit is they can work faster than creams.

Laser and light treatments.  IPL (Intense Pulsed Light), is commonly the first light treatment used for dark spots. It has to be used cautiously on melasma (it can make this worse) but works very well on non-melasma brown spots. It can be safely used on the neck, chest and arms. It has low downtime and is pretty affordable ($300-400 for full face treatment). You may need more than one treatment (depending on the level of sun damage) but many have good results in one treatment. Other lasers used for brown spots include non-ablative resurfacing lasers such as Resurfx and Fraxel. CO2 laser is very intense, but does provide treatment for brown spots.

So how long do these treatments last? The great news is that they are long lasting- if you protect your investment. None of these treatments will prevent brown spots if you are out in the sun. In fact, they may make you at risk for more brown spots due to increased sun sensitivity. So if you decide to get rid of your spots, invest in a few good hats and good sunscreen!


Age Spots

Age spots, those sneaky brown spots that show up on your face, hands, arms and chest. The medical term for age spots is a solar lentigo. They are caused by the sun and appear in sun exposed areas. In most cases they are not harmful, though there is a type of melanoma (called lentigo maligna melanoma) that can look similar to an age spot- so if you notice dramatic changes (in color, size or shape) of your age spots please have them evaluated.

Now the real question- how can you get rid of them and how can you prevent them?

Prevention: these buggers are VERY sun sensitive. Sunscreen will not prevent these from popping up. You need to wear a hat and avoid sun exposure if you want to have NO sun spots.  Of course, sunscreen will help, but you need to make sure to reapply every 2-4 hours because it stops working in that time period.

Getting rid of them. It is not easy or quick. The least expensive and least invasive treatment is to use a cream that contains a lightening agent. The most effective lightening cream is hydroquinone and it works best when paired with retin-A. There are several non hydroquinone lighteners with variable results, they often contain Kojic Acid, vitamin C, azelaic acid, soy or a combination of these.

The next level of treatment is a chemical peel- these can be very effective and cost about $150-$300 per treatment. I love peels, they are a good bang for your buck. The downside is you will peel- so be prepared for 3-7 days of peeling. The peeling starts on day 2-3 after the peel. I always get my peels on Wednesday so I peel the most on Saturday and Sunday.

The most expensive and invasive treatment is a laser treatment. There are several types of lasers that can be used: Intense Pulsed Light, Fraxel, Carbon Dioxide (these are general categories listed in order of intensity and expense). If you want dramatic results you may need a laser.

All of the treatments cause your skin to be sensitive to the sun, so you MUST protect your investment or the sun damage will come back and might even be worse. Always wear at least SPF 30 and take a hat if you will be in direct sun.