What You Need to Know about Blackheads

You know a blackhead when you see one.  The center of the blackhead is the dark grey, brown or tan material which is stuck inside a pore.  They can range from being as tiny as a point to being much much larger.  You might have found it irresistable to try to give it a good squeeze to get the material out from between your fingers and nails. But be careful!  You don’t want to do more harm than good.

Here are some FAQs I often get about blackheads.

What makes a blackhead black?

While not truly black, the center of the blackhead is often dark in color.  This darkening occurs when the debris which is normally whitish or ivory is exposed to the air and oxidizes.  This oxidation process darkens the debris.

What is that material inside a blackhead anyway?  What is a blackhead made of?

The material inside a blackhead is a mix of a variety of substances normally made and shed through your pore.  They may include sebum as well as dead skin cells.

How do I get rid of  blackheads?

You may have heard of people extracting blackheads or you may have tried it yourself as well.  In general, it’s best to leave this to a trained professional to minimize the risk of scarring, inflammation, infection, and further skin damage.

There are medications which can also shrink pores and the blackheads.  Retinoids are a type of medication that could be used for this.  There are over the counter retinoids such as retinol and adapalene/Differin as well as prescription retinoids.  These can be irritating so start slowly at first and slowly increase until you can tolerate it.  If you’re pregnant or trying to get pregnant, your physician may advise you to hold off on using retinoids.

Differin (adapalene) Gel is now at your local pharmacy!

Differin (adapalene) gel is now available over the counter.  This is great news since it means you no longer need a prescription for it.  Also, the prices over the counter (e.g. at your local Walgreens or CVS) have been quite reasonable. Or you can purchase online also.

So what is Differin (adapalene) used for?

Differin is marketed for acne.  It can be used in combination with other products or on its own depending on the type of acne you have and the severity of your acne.  It is also particularly good for comedonal acne (eg whiteheads or blackheads) which other types of medications might not address.

Differin is also a topical retinoid and as such it may be helpful for reducing appearance of wrinkles, and helping with skin texture and pigmentation issues.  (You may have heard of using retinols for anti-aging.)  There are a lot of topical retinoids out there though so definitely consult with your dermatologist if you’re wondering whether Differin is right for you.

Are there side effects to using Differin?

Any medication has potential side effects.  Most commonly, people will report dryness, redness, or flaking. This is actually to be expected to a degree. We recommend spacing out use to every other night or mixing with some moisturizer if you need to.  Your skin tends to get used to the medication after a month or so.  You may also need to take it easy on other products you are using (eg benzoyl peroxide or salicylic acid which can also be drying and irritating)

Also, if you are pregnant or trying to get pregnant, you should discuss with your obstetrician before using this medication (it is still a medication after all!)  Many/ ?most will recommend that you stop your topical retinoid.

Seborrheic Keratoses – Bothersome Barnacles of the Skin!

Seborrheic keratoses of the back. Photo by James Heilman MD

One of the most frequent growths that brings patients into the office are seborrheic keratoses.  Frequently mistaken for moles, they are most commonly brown “stuck-on” growths that can occur essentially anywhere on the body.  They tend to arise in adulthood and have a likely genetic inheritance.  Most of my patients refer to them as barnacles, nuisance growths, age spots, or “moles.”

So now the important question… how do you get rid of them?

Seborrheic keratoses can be frozen off by a process called cryotherapy, scraped (curetted) off, cut out (not usually optimal), or burned off with an electric needle if small.  If they are pretty flat, lasers can be used to remove them as well.  Be careful how you get them removed though. I have seen patients left with bad darkening or lightening of the skin as well as scarring after removal.  As with most cosmetic procedures, it’s best not to be tan in general during the procedure as that could increase risk of pigmentary change of the skin.  If you are concerned about a particular growth or interested in removal, schedule an appointment with a dermatologist who can evaluate the growth to 1) make sure it is indeed a benign growth, and 2) counsel you on the best way to remove the growth.

What are those red spots on your body?

Photograph of a cherry angioma
Photograph of a cherry angioma

Patients often ask me about bright pink dots that they’ve noticed cropping up on their skin.  These little spots can be flat or raised, and are usually relatively small and only millimeters wide.  These spots are called cherry angiomas, aka cherry hemangiomas.  They are asymptomatic and benign, and do not need to be treated unless desired cosmetically.  They most often crop up in adulthood and those who develop one are more likely to develop others.  The majority of my adult patients have these growths.

If they are of cosmetic concern, pulsed dye laser treatment is a great way to remove these growths.  Otherwise, nothing has to be done!

What is the difference between a keloid, hypertrophic scar and normal scar?

Photo by Dr. Andreas Settje. SKIM-Hospital, Nepal. Source: Wikipedia
Photo by Dr. Andreas Settje. SKIM-Hospital, Nepal. Source: Wikipedia

You may have heard the terms keloid and hypertrophic scar thrown around.  Both are types of scars, but they are not the run-of-the mill normal scars.  Keloids tend to be bulky and “spill over” the footprint of the wound.  A hypertrophic scar is also larger than normal, but its edges do not “spill over” the footprint of the wound.  Instead, it is raised upwards.

Scars including large scars such as keloids or hypertrophic scars follow injury to the skin, and this injury may be seemingly minor (e.g. ear piercing, acne, or a minor cut).  An exuberant scar response ensues, leading to a keloid or hypertrophic scar.

Who is more likely to develop keloids and hypertrophic scars?

Certain ethnicities are more likely to develop these big scar, especially those of African or Asian heritage.

So what can be done to treat keloids or hypertrophic scars?

First, prevention is key.  If you can prevent unnecessary trauma, this would prevent the keloids or hypertrophic scars from forming. However, sometimes the trauma is not preventable. In this case, many treatments exist.

Injections may be performed on keloids and hypertrophic scars.
Injections may be performed on keloids and hypertrophic scars.

When patients see me in the office for these large scars, I offer to inject these scars with a corticosteroid solution if appropriate.  Several injections are often necessary.  Many other treatments exist as well, and are outlined in this article.  Regardless, these large scars can reappear, even after flattening out after treatment.


Pesky leg veins? They can be treated!

PregnantWomanThe wear and tear that comes with time shows up on our skin.  For many of us, adulthood and various stages of life (eg pregnancy) come with skin changes.  I’ve recently had several patients ask me about pesky spider veins and varicose veins.

These are veins that become dilated or “loose” over time. They lose their elasticity and like old panty hose, become loose and wider.  They become more visible through the skin and this becomes a cosmetic concern for many.  Like leaky pipes, they also become functionally deficient.

So how can varicose veins and spider veins be treated?

A number of treatments exist for each type of dilated vein.  The varicose veins can be removed or “stripped” surgically, or a laser device can be inserted up the vein to destroy the vein.  Sometimes special solutions can be injected that will also lead to destruction of the vein, a procedure called sclerotherapy.  Sclerotherapy can also be done for spider veins.  Spider veins are called such because the appearance of the reddish or purplish veins can resemble legs of a spider.  A special laser can also be used to get rid of these spider veins, although this treatment is sometimes less effective than sclerotherapy.

If you are interested in removal, find a surgeon who is experienced in spider vein and varicose vein removal. Dermatologists often perform sclerotherapy and laser treatment for the smaller spider veins, whereas vascular surgeons or interventional radiologists often take care of varicose vein removal.

Additionally, ask your physician about compression stockings.  These are stockings that can be bought both off the shelf and are also available by prescription.  Your physician can determine how much compression is appropriate for you and prescribe these socks for you.  As someone who is on her feet a lot at work, I have found these compression stockings to be very helpful in preventing leg and foot fatigue and preventing the appearance of dilated veins.  During pregnancy, the legs often swell, and this becomes a time when women develop these dilated veins.  It would be a good idea to talk to your obstetrician about compression stockings if you are experiencing the swelling or dilated veins.

Split earlobe? Enlarging pierced ear hole? You can fix it!

Stretched ear piercing.
Stretched ear piercing.

Have your earlobes split?  Or is your pierced ear hole enlarging and you don’t like it?  Or did you purposefully stretch our your ear hole and now regret it?  Not to worry, you can get these issues fixed.

Earlobes can split if you’ve worn heavy earrings for a while, if someone pulls on an earring (ouch!), or if you’ve had an infection or rash around this earring area.  Big earring holes can happen with time from the weight of the earring or with trauma to the area.  If you opted for a larger gauge ear piercing in the past or purposefully stretched out your ear piercing with tunnels or plugs, this can be reversed as well.

So what can you do to fix a split earlobe or enlarged piercing hole?

Arrange for a consultation with a plastic surgeon or dermatologic surgeon who performs earlobe repairs.  These procedures are usually done under local anesthesia and you can go home afterwards.  The surgeon will fix the split earlobe or wide ear hole, cutting out a small part of skin that is affected and reassembling.  You will likely have small stitches after the procedure.  After the repair is completely healed, you can choose whether you want to re-pierce your ears.

Sunscreen helps keep your skin young

Bahamas_beachRecently published research shows that diligent use of daily sunscreen helps keep the skin young.  Researchers in Australia followed patients for 4 and a half years.  At the end of that time, they looked at the back of the patients’ hands, assessing for evidence of skin aging by making molds of the back of the patients’ hands.

They found that those who used sunscreen at least 3 to 4 days a week showed less skin aging than those that stuck to their usual habits of sunscreen use.

The researchers also studied whether beta-carotene ingestion by supplementation would make a difference in skin aging. It did not.

So what’s the take home lesson? As dermatologists have encouraged for some time, sun protection and sunscreen use is important for decreasing risk of skin cancer, but also to keep you looking young!  If you need to see a picture to convince yourself, just look at the photo here of a trucker whose left side of the face was exposed to sun while driving.

Physician and layman perceptions on the preferred provider for skin surgery and cosmetic procedures

In a presentation at this year’s 2012 annual American Society for Dermatologic Surgery (ASDS) meeting, Dr. Omar Ibrahimi presented his Cutting Edge Research Grant project. Dr. Ibrahimi studied physician and layman perceptions on the most optimal provider for cutaneous surgery, Botox injections and filler injections.  He conducted two internet surveys: one assessing the lay public’s preference for providers of certain procedures and one assessing primary care residents’ (physicians in training) on their preference of providers for certain procedures. Choices of preferred provider included dermatologists, plastic surgeons, and non-physician  providers.

Dr. Ibrahimi found that for skin cancer surgery, both the lay public as well as the primary care physicians preferred dermatologists to perform the surgery.  For Botox botulinum toxin injection, the primary care physicians preferred dermatologists although the lay public preferred plastic surgeons.  For fillers, again the primary care physicians preferred dermatologists although the lay public’s preference for dermatologists and plastic surgeons was roughly equivalent.

Dermatologists receive in-depth training on cutaneous surgery, botulinum toxin injections and filler injections, and Dr. Ibrahimi concludes that it is important to make the public aware that dermatologists are the experts in skin cancer surgery and other cutaneous surgical procedures .

What are cosmeceuticals?

You may have seen or heard the term cosmeceuticals on the web, on TV, in your local department store or in beauty product store like Sephora or Ulta.  So what does the term cosmeceuticals refer to?  The word was coined to reflect products that have aspects of cosmetics and pharmaceuticals by Dr. Arthur Kligman. These are products that are applied to the skin, but unlike cosmetics, are meant to do more than to simply mask or color the face.  Unlike pharmaceuticals, these products do NOT need to be FDA approved and thus do not undergo the rigorous testing that the FDA requires to show that they have some biologic effect.  Additionally, they do not need to undergo testing that the FDA requires for drugs.

You’ve probably seen skin care lines that fall under cosmeceuticals; many of these lines were developed with or by physicians.  These products may include anti-aging products, sunscreens, or lightening products.

So now the next time you see the term cosmeceutical, you’ll know what it means!

What is your favorite cosmeceutical product?