CHICAGO (Aug 5, 2010) — For many people, the phrase “tough as nails” doesn’t apply to their own nails. Instead of strong nails, their nails may be brittle and break or split easily. Or, nail fungus might cause nails to look unattractive and unhealthy. Fortunately, dermatologists can help people improve the health and overall appearance of their nails with proper diagnosis and treatment.

At the American Academy of Dermatology’s Summer Academy Meeting 2010 in Chicago, dermatologist Phoebe Rich, MD, FAAD, adjunct professor of dermatology at the Oregon Health & Science University in Portland, discussed the most common nail ailments and how to prevent and treat them.

Brittle Nails Require Handling with Care
Brittle nails affect millions of people and are characterized by peeling, splitting, fracturing and chipping, often causing aesthetic and functional problems. While no segment of the population is spared, brittle nails are more commonly seen in women, and the incidence increases with advancing age in both women and men. People who work in certain occupations with exposure to irritating substances and water also are more at risk for brittle nails.

Dr. Rich explained that brittle nails are caused by both internal and external factors. Internal factors that contribute to brittle nails include genetics, aging, or other nail problems such as nail psoriasis and nail fungus. On rare occasion, certain internal disorders such as thyroid abnormalities, anemia, or the effects of chemotherapy may be responsible for brittle nails. However, external factors – including exposure to harsh irritants, such as chemicals and solvents and even excessive water exposure – are far more likely to cause brittle nails.

“Brittle nails can sometimes be painful to the point of making it difficult to do simple activities like buttoning a shirt,” said Dr. Rich. “The nail plate itself is not living, which is why we can cut and file our nails without discomfort. But if a nail split or chip goes into the live nail bed tissue to which the nail plate attaches, it can be painful until the nail plate grows out and covers the exposed nail bed.”

While treatment of brittle nails can be challenging in some cases, Dr. Rich explained that a three-pronged approach is always recommended. The first step is to rule out any underlying medical conditions or correct those that are contributing to the problem. The second step is to protect the nails from environmental exposure in daily activities in order to prevent conditions that can cause brittle nails. For example, a good line of defense is wearing gloves to do chores that expose the nails to harsh chemicals, limiting exposure to water and avoiding excessive hand washing.

“Using mild soaps to wash hands, washing primarily the palm side of the hands, drying hands well after washing and avoiding waterless hand sanitizers that contain a high alcohol content will help control brittle nails in most cases,” said Dr. Rich.

The third step is to treat the nails by several methods known to strengthen the nails. The correct water content in the nail must be maintained to keep nail cells properly hydrated and flexible. Dr. Rich recommends “greasy” products, such as plain petroleum jelly to provide a protective barrier over the nail. High water content moisturizers that shake or pour should be avoided, as the water actually evaporates and leaves little protection behind. In general, thick hand creams found in a tube or jar are more effective than watery ones.

“Hand lotions that contain humectants, such as urea, which attract and hold water in the nail can be helpful in keeping the nail flexible and less likely to fracture,” said Dr. Rich. “A dermatologist can help patients find the best therapeutic moisturizers to keep brittle nails adequately hydrated.”

While foods rich in calcium help strengthen bones, they do not help strengthen nails, but adequate protein in a well-balanced diet is helpful in improving nail health. However, Dr. Rich cautioned that the old data on protein-rich gelatin as the magic bullet for weak nails is not scientifically significant.

Similarly, the known health benefits of vitamins do not always translate into improving nail health. For example, Dr. Rich added that too much vitamin A may actually make nails brittle and fragile and should best be avoided. But there also is some suggestion that the B vitamin biotin at doses of 2.5 mg per day may improve brittle nails in some cases, but it may take four to six months to notice an improvement.

Nail Fungus Could be Here to Stay without Proper Medication
The prevalence of fungal infections, known as onychomycosis, is high and reported to be as high as 30 percent in the senior population. Since the infection occurs under the nail plate in the nail bed, it can be difficult to treat. Dr. Rich explained that the same fungus that causes athlete’s foot and ringworm is responsible for nail fungus as well, which is why people with nail fungus are susceptible to athlete’s foot and should try not to walk barefoot in public places. They also should wear water sandals or flip flops if they must use public showers.

While topical antifungal medications are readily available to treat nail fungus, Dr. Rich said that most of these over-the-counter formulas don’t work very well because these products are only applied on the surface of the nail and do not penetrate deep within the nail bed under the nail plate – where the fungus lives. Dr. Rich added that systemic medications can work well in clearing nail fungus and target the affected nail bed by way of the bloodstream.

“How fast the nail grows will determine how quickly the nail fungus will clear, but in most cases this can take up to a year,” said Dr. Rich. “The nail has to grow healthy from the base up in order for the fungus to clear completely.”

In addition, several new systemic medications and topical preparations currently being studied in clinical trials hold promise as future treatments. “There is a lot of exciting research being conducted in treating nail fungus, including creative vehicles to deliver antifungal medication to the nail such as patches, lacquers, and gels,” said Dr. Rich.

It is important to remember that nail fungus most likely will not subside on its own without some type of prescription treatment. While there is no harm in trying over-the-counter treatments or home remedies, patients should see a dermatologist if the condition does not improve or worsens.

Headquartered in Schaumburg, Ill., the American Academy of Dermatology (Academy), founded in 1938, is the largest, most influential, and most representative of all dermatologic associations. With a membership of more than 16,000 physicians worldwide, the Academy is committed to: advancing the diagnosis and medical, surgical and cosmetic treatment of the skin, hair and nails; advocating high standards in clinical practice, education, and research in dermatology; and supporting and enhancing patient care for a lifetime of healthier skin, hair and nails. For more information, contact the Academy at 1-888-462-DERM www.aad.org.

Compliments of the American Academy of Dermatology

These no-nonsense tips from dermatologists can help people living with psoriasis ease their discomfort and maximize the effectiveness of treatment.

Follow the basics of good health. Eating a balanced diet, drinking plenty of water, and getting enough sleep are all steps patients can take to avoid feeling tired and overstressed. This also can help the body fight off infections that can aggravate the skin.

Learn the triggers. Research shows there are known triggers for psoriasis — certain infections, some medications, skin injury, stress, and winter weather. Smoking also may trigger psoriasis. While it is not always possible to avoid every trigger, knowing what triggers psoriasis can help you make informed decisions. To learn more, see Psoriasis Triggers.

Keep track of flares. This can be an especially helpful technique for managing psoriasis. When a flare-up strikes, write down when it occurred and include information about what was happening at the time that may have triggered the psoriasis. Was there a stressful event in your life? Did spending a summer evening outdoors result in numerous mosquito bites? Keep in mind that psoriasis may not flare for 10 to 14 days after the skin is injured. This information can reveal facts about how psoriasis affects you and offer insight to help you and your dermatologist better manage the condition.

Quit smoking. If you have psoriasis or a family history of psoriasis, don’t start smoking. If you do smoke, here’s another good reason to quit. Research continues to suggest that smoking may trigger psoriasis. It appears that localized pustular psoriasis, which occurs on the palms and soles, can be aggravated by smoking and that in some cases, quitting smoking clears the skin. Research also suggests that severe psoriasis may be linked to smoking.

If you are trying to quit, do not use a nicotine patch before consulting a dermatologist. Nicotine patches can aggravate psoriasis.

Limit alcohol consumption. Research indicates that heavy drinking may trigger psoriasis and even prevent treatment from being effective. Studies also are finding that there may be a link between severe psoriasis and heavy drinking. Dermatologists recommend that their patients who drink should do so in moderation. However, people taking methotrexate, a medication used to treat moderate to severe psoriasis, should not drink alcohol. Mixing methotrexate and alcohol can have serious side effects.

Reduce stress. Many people with psoriasis say they experience flare-ups during stressful times. While stress cannot be prevented, there are a number of healthy ways to reduce stress. Some people find that joining a psoriasis support group helps. Others find comfort in psychological counseling. Exercise and a number of relaxation techniques also can effectively reduce stress.

According to the National Psoriasis Foundation, stress reduction works best when combined with medical treatment.

Take good care of your skin:

Apply emollients and moisturizers. Emollients soften the skin. Moisturizers lock in the skin’s own moisture to prevent dryness and cracking. One of the best ways to lock in moisture is to apply moisturizer after bathing. Regular use of moisturizers can help prevent the itch and pain of dry skin and reduce scaling and inflammation. People often get good results by applying a lotion during the day and a cream or ointment, which are thicker than lotion, at night.

Avoid scratching. There is no doubt about it, psoriasis itches. In fact, the word “psoriasis” derives from the Greek word for itch, “psora” The thought of not scratching can seem maddening. However, scratching can puncture the skin, allowing bacteria to enter and cause an infection. Scratching also causes the skin to bleed and worsens psoriasis. After scratching, lesions can appear on previously clear skin. To alleviate the itch, dermatologists recommend:

Treat the psoriasis. Dermatologists say that one of the most effective ways to stop the itch is to treat the psoriasis. When the psoriasis clears, the itch usually disappears. In the interim, these can curb the itch:

Apply a cold compress. Applying a cold compress can reduce inflammation and lessen the desire to scratch.

Apply a menthol-based ointment or topical steroid. These can help manage the itch until the psoriasis clears.

Moisturize. Moisturizing, especially after bathing, can help relieve the dry skin that causes itching.

Soak in a warm oatmeal bath. This relieves itching for some people. A dermatologist can recommend an appropriate oatmeal-bath preparation.

Once lesions clear, it is important to continue using emollients and moisturizers. Regular use can help soften skin and prevent the dryness that causes the skin to itch.

Bathe in warm, not hot water. Dermatologists recommend that patients with psoriasis take short, warm showers and use fragrance-free cleansers.

Never pick at lesions. Like scratching, picking at lesions can cause bleeding, infection, and a worsening of the psoriasis. Dermatologists recommend treatment to clear the psoriasis and regular use of emollients and moisturizers to help soften skin and prevent dryness.

Pat your skin dry; rubbing can irritate it. Rubbing, or irritating the skin in any way, can cause psoriasis lesions to form. Developing a habit of gently patting your skin dry can alleviate this problem.

Use sunscreen. While sunlight can help treat psoriasis, many treatments make the skin sun-sensitive. Anyone using a topical or systemic retinoid or PUVA therapy must protect their skin from the sun. Patients using retinoids should apply sunscreen 15 to 20 minutes before going outdoors and wear protective clothing. Additionally, sun exposure can cause sunburn, which can trigger psoriasis.

Wear cotton clothing next to your skin. Cotton is less likely than other fabrics to irritate the skin or cause overheating.

Compliments of the American Academy of Dermatology; www.aad.org

Psoriasis is a persistent, inflammatory skin condition. Some cases of psoriasis are so mild that people don’t know they have it. Alternatively, severe psoriasis may cover large areas of the body. Dermatologists can help even the most severe cases.

Psoriasis is not contagious, so it cannot be passed from one person to another. Psoriasis does, however, have a tendency to run in families, meaning it can be an inherited condition.

CAUSES OF PSORIASIS

While the cause is unknown, research indicates that the immune system plays a key role.  It is believed that the person’s immune system mistakenly activates T cells, a type of white blood cell. Once activated, the T cells trigger inflammation, which causes the skin to grow too rapidly. Normally, the skin replaces itself about every 30 days. When the process speeds up and the skin replaces itself in three to four days, psoriasis develops.

A “trigger” is usually needed to make psoriasis appear, whether for the first time or the twentieth. Psoriasis can be triggered by stress; an infection, such as strep throat; and by taking certain medicines, such as interferon and lithium. Cold, dry winter weather and lack of sunlight also can trigger psoriasis. Others see psoriasis flare 10 to 14 days after their skin is injured, such as by a cut, scratch, or severe sunburn. This is known as Koebner’s phenomenon.

TYPES OF PSORIASIS

There are five major types of psoriasis, each with unique signs and symptoms:

Plaque psoriasis

The most common type, plaque psoriasis appears as patches of raised, reddish skin covered by silvery-white scale. Patches frequently form on the elbows, knees, lower back, and scalp, but can occur anywhere on the skin.

• Guttate psoriasis

Appearing as small, red spots, guttate psoriasis usually affects children and young adults. It often starts after a sore throat, and frequently clears up by itself in weeks or a few months.

• Pustular psoriasis

Characterized by white pustules surrounded by red skin, pustular psoriasis tends to confine itself to certain areas of the body, usually the palms and soles. Dermatologists call this “localized pustular psoriasis.” When widespread, the condition is known as “generalized pustular psoriasis,” which is a rare and severe form of psoriasis that can be life threatening.

• Inverse psoriasis

This type occurs when smooth, red lesions form in the skin folds. Lesions can appear in the armpit, under the breasts, and around the groin, buttocks, and genitals.

• Erythrodermic psoriasis

Causing widespread redness with severe itching and pain, erythrodermic psoriasis can be life threatening.

Psoriasis frequently develops on the scalp and the nails. When psoriasis occurs on the scalp, psoriasis often causes silvery-white scale, which may be misdiagnosed as dandruff. Psoriatic nails frequently have tiny pits. The nails may loosen, thicken, or crumble. These signs may be misdiagnosed as a nail infection. Both scalp psoriasis and nail psoriasis can be difficult to treat.

PSORIATIC ARTHRITIS

Between 10% and 30% of people who develop psoriasis get a related form of arthritis called “psoriatic arthritis,” which causes inflammation of the joints. Psoriatic arthritis is a lifelong condition that causes deterioration, pain, and stiffness in the joints. Medication can help prevent joint deformities and disability if used early. Without treatment, permanent joint degeneration and destruction can occur.

DIAGNOSING PSORIASIS

Dermatologists diagnose psoriasis by examining the skin, nails and scalp.  A skin biopsy may be taken to confirm the diagnosis.

TREATMENT OF PSORIASIS

While psoriasis cannot be cured, a number of treatment options can help control psoriasis.

A patient’s health, age, lifestyle, and the severity of the psoriasis determine which treatment options are appropriate. Gaining control over psoriasis may require different types of treatment and several visits to your dermatologist.

To help patients control psoriasis, a dermatologist may prescribe medications to apply to the skin.  These medications may contain cortisone compounds, retinoids, tar, or anthralin.  These may be used in combination with natural sunlight or another ultraviolet (UV) light treatment. The more severe forms of psoriasis may require oral or injectable medications with or without UV light treatment.

TYPES OF TREATMENT

TOPICALS

• Corticosteroids (cortisone)

Cortisone is a medication that reduces inflammation.  Cortisone creams, ointments, and lotions may clear the skin temporarily and control the condition in many patients.  Weaker preparations should be used on more sensitive areas of the body such as the genitals, armpits and face.  Stronger preparations will usually be needed to control lesions on the scalp, elbows, knees, palms, soles, and parts of the torso. Dressing may be applied to enhance the effectiveness of the medication.  Corticosteroids must be used cautiously and with your dermatologist’s  instructions.  Side effects of stronger cortisone preparations include thinning of the skin, dilated blood vessels, bruising, stretch marks, and skin color changes. Stopping these medications suddenly may result in a flare-up.

When used for many months, psoriasis can become resistant to the corticosteroid. Difficult-to-treat spots may be treated with an injection of a corticosteroid.

• Anthralin

Often effective on tough-to-treat thick patches of psoriasis, anthralin decreases the skin’s rapid growth rate and reduces inflammation. Newer preparations and treatment methods minimize the traditional side effects of skin irritation and staining.

• Calcipotriene

Useful for individuals with localized psoriasis, calcipotriene may be combined with other treatments. Be sure to apply calpotriene as instructed by your dermatologist to avoid side effects, such as skin irritation.

• Retinoids

This medication may be used alone or in combination with topical corticosteroids for treatment of localized psoriasis. Women who are, or may become, pregnant should not use topical retinoids.

• Coal Tar

For more than 100 years, coal tar has been used safely and effectively to treat psoriasis. Today’s products are greatly improved and less messy. Stronger prescriptions can be made specifically to treat difficult areas.

• Light Therapy

Ultraviolet (UV) light, which is found in sunlight, slows the rapid growth of skin cells. Patients with psoriasis may receive light therapy treatments at a dermatologist’s office, psoriasis center, or hospital. Psoriasis patients who live in warm climates may be directed to carefully sunbathe. Under a dermatologist’s care, light therapy offers many patients a safe and effective treatment option. Seek the advice of your dermatologist before self-treating with natural or artificial UV light.

Patients who receive light therapy at the medical facility may receive UVB light therapy, PUVA, or Goeckerman treatment.

• Ultraviolet B (UVB) Light

This treatment exposes the skin to a wavelength of UV light called UVB.  The therapy may be used alone or in combination with topical or systemic treatments.  To receive UVB therapy, a patient either enters a light box that surrounds the patient or stands in front of a light panel.  About 24 treatments over a two-month period are needed for clearing. Although UVB is very safe and effective, it does have possible side effects that include burns, freckling, and premature aging.  Risks of skin cancer appear to be no greater than the risk caused by sun exposure.

• PUVA

An acronym, PUVA stands for “psoralen + UVA,” which are the two components of this treatment. Used to treat widespread psoriasis and psoriasis that has not responded to other therapies, PUVA is effective in approximately 85% of cases. To receive PUVA, a patient is given a drug called psoralen, which may be taken orally or applied to the psoriasis. The patient is then exposed to a carefully measured amount of a special form of ultraviolet A (UVA) light. Because psoralen remains in the lens of the eye, patients must wear UVA-blocking eyeglasses when exposed to sunlight from the time the psoralen is taken until sunset that day. Clearing usually occurs after approximately 25 PUVA treatments, which are given over a two- or three-month period. Keeping psoriasis under control requires about 30 to 40 treatments a year. PUVA treatments over a long period increase the risk of premature aging, freckling, and skin cancer. Dermatologists and their staff monitor PUVA treatment very carefully.

• Goeckerman Treatment

Named after the Mayo Clinic dermatologist who first reported it, this treatment combines coal tar dressings with UV light. Used to treat patients with severe psoriasis, Goeckerman treatment is performed daily for a prescribed amount of time.  UV exposure times vary with the type of psoriasis and the sensitivity of the patient’s skin.  Access to this therapy is limited because only a few specialized centers in the United States offer it.

SYSTEMIC THERAPIES

• Methotrexate

This anti-cancer medication can dramatically clear psoriasis. Because methotrexate can cause serious side effects, particularly liver disease, it is reserved for treating moderate to severe psoriasis that has not responded to other therapies.  Patients taking methotrexate receive regular blood tests. Chest x-rays and occasional liver biopsies may be required.  Other side effects include upset stomach, nausea, and dizziness.  Methotrexate should not be used by pregnant women, nor by men or women who are trying to conceive a child. Conception should be avoided for at least 12 weeks after stopping methotrexate.
Patients who take methotrexate should not drink alcoholic beverages.

• Retinoids

An oral retinoid may be prescribed alone or in combination with ultraviolet light  for severe cases of psoriasis.  Side effects include dryness of the skin, lips and eye; elevation of fat levels in the blood (cholesterol and triglycerides); and formation of tiny bone spurs.  Oral retinoids can cause birth defects and should not be used by pregnant women, or women who intend to become pregnant during or within three years of discontinuing therapy.  Patients taking oral retnoid require close monitoring, which includes regular blood tests.

• Cyclosporine

This medication suppresses the immune system and is used to prevent rejection of a transplanted organ, such as a liver or kidney. While cyclosporine proves extremely effective in treating psoriasis, it is generally reserved for patients with severe psoriasis who have not responded to other therapies. Due to potential side effects, kidney function and blood pressure must be checked before the drug can be prescribed. Patients taking cyclosporine require close medical monitoring, which includes regular blood tests.

BIOLOGIC AGENTS

Biologics are systemic medications that are given by injection or infusion.  What makes biologics unique is that these drugs pinpoint  precise immune responses involved with psoriasis.  For this reason, careful consultation with your dermatologist is important as there are a variety of treatments and combinations of treatments to consider and many medical tests to undergo before finding the most appropriate biologic treatment. The biologics used to treat psoriasis are:

• Alefacept

By blocking the over-activated T cells, alefacept can treat moderate to severe chronic plaque psoriasis. A medical professional must give each treatment of alefacept by an intramuscular injection (IM), which is used to deliver medication deep into large muscles of the body. The patient typically receives one injection per week for 12 weeks.

• Etanercept

For the treatment of psoriasis and psoriatic arthritis, this biologic agent blocks tumor necrosis factor-alpha (TNF), a messenger in the immune system that directs cells to cause the inflammation that leads to psoriasis. Given by subcutaneous (under the skin) injection, which patients can learn to give themselves, etanercept is typically used as long-term therapy.

• Infliximab

For the treatment of psoriasis and psoriatic arthritis, this biologic blocks tumor necrosis factor-alpha.  It is given as an infusion, so the treatment must be given in a medical office.

• Adalimumab

This biologic blocks tumor necrosis factor-alpha and is effective in treating psoriatic arthritis.  Patients can learn how to give themselves adalimumab which is given by subcutaneous injections.

A dermatologist is a physician who specializes in treating the medical, surgical, and cosmetic conditions of the skin, hair, and nails. To learn more about psoriasis, log onto www.aad.org, www.skincarephysicians.com/psoriasisnet, or call toll-free (888) 462-DERM

Compliments of the American Academy of Dermatology; www.aad.org

Plaque (pronounced plak) psoriasis is the most common type of psoriasis. This type of psoriasis can develop anywhere on the skin. When it develops on the scalp, people call it “scalp psoriasis.”

Who Gets Scalp Psoriasis?
Psoriasis is common on the scalp. Researchers estimate that at least half (50%) of the people who have plaque psoriasis will have at least one flare-up on the scalp.

Signs and Symptoms of Scalp Psoriasis
Scalp psoriasis can appear anywhere on the scalp. Sometimes one small patch develops, which can be easy to hide with hair. Scalp psoriasis also can cover the entire scalp. It can even creep beyond the scalp, appearing on the forehead, back of the neck, or behind the ears.

When scalp psoriasis develops, people have one or more of these signs and symptoms:

· Reddish plaque on the scalp. Plaques range from barely noticeable to thick and inflamed.

· Silvery-white scale. This often develops on the scalp and can be mistaken for dandruff.

· Dandruff-like flaking. This is common due to the continual shedding of the new skin cells. Unlike dandruff, scalp psoriasis causes a silvery sheen and dry scale on the scalp.

· Dry scalp. The scalp may be so dry that the skin cracks and bleeds.

· Itching. This is one of the most common symptoms. For some the itch is mild; others have intense itching that can interfere with everyday life and cause them to lose sleep.

· Bleeding. Because scalp psoriasis can be very itchy, almost everyone scratches. This can cause the scalp to bleed. Scratching also injures the skin, which tends to worsen the psoriasis. This is why dermatologists tell their patients “Try not to scratch your scalp.”

· Burning sensation or soreness. The scalp can burn. It can feel extremely sore.

· Temporary hair loss. Scratching the scalp a lot or forcefully removing scale can cause hair loss. Once the scalp psoriasis clears, hair usually re-grows.

These signs and symptoms can come and go. Some people have only one mild flare. Others experience flare-ups that range in intensity, with some flare-ups being milder than other flare-ups. Many things can trigger a flare-up, including stress, cold, and a dry environment.

Scalp Psoriasis can be Controlled
Scalp psoriasis causes many people to feel uncomfortable and embarrassed. There are many safe and effective treatments. A dermatologist can tell you what can help control your scalp psoriasis.

Reference:
Van de Kerkhof PCM and Schalkwijk J. “Psoriasis.” In Bolognia JL, Jorizzo JL, Rapini et al. [editors]. Dermatology. Spain. Mosby Elsevier; 2008. p. 122.

Compliments of the American Academy of Dermatology; http://www.skincarephysicians.com/psoriasisnet/scalp_psoriasis_overview.html

Yes, scalp psoriasis can be controlled. There are many treatments for scalp psoriasis. Some people get relief from a medicated shampoo or solution that can be purchased without a prescription. But scalp psoriasis can be stubborn. Many people see a dermatologist for treatment.

Diagnosis: The First Step in Successfully Treating Scalp Psoriasis
Before prescribing treatment for scalp psoriasis, a dermatologist will examine your scalp. Usually a dermatologist will simply look at the scalp and make the diagnosis.
Sometimes scalp psoriasis can look like another skin condition, and a dermatologist will remove a bit of skin and send the skin to a lab. The lab report will tell the dermatologist whether the condition is scalp psoriasis. Your dermatologist may refer to this process as a biopsy. A dermatologist can safely and quickly perform a biopsy in the office.

Scalp Psoriasis Treatments
The treatments that dermatologists prescribe for their patients who have scalp psoriasis can be divided into these categories:

• Medication applied to the scalp. This is the most commonly prescribed treatment for scalp psoriasis. Your dermatologist may call it a “topical.” These medications include:
  • Corticosteroid (may be called a steroid
  • Calcipotriol/calcipotriene
  • Tazarotene

• A corticosteroid that can be applied to the scalp is the mainstay treatment for scalp psoriasis.
  Studies show that a corticosteroid is more effective than any other treatment that you can apply to the scalp. It is prescribed for a short period of time and works quickly to clear the scalp.

  Topical corticosteroids are safe when used as directed. Because side effects can occur with long-term use, other medications may be used to keep the scalp clear. These medications includecalcipotriol/calcipotriene and tazarotene.

• Treatment Tip: When applying the medication, be sure to lift your hair away from the scalp so that you can apply the medication directly to your scalp.

• Medicated shampoos. A shampoo may be part of your treatment plan. For people who have moderate to severe psoriasis on their scalp, a dermatologist may prescribe a psoriasis shampoo that contains clobetasol propionate. While clobetasol propionate is a strong corticosteroid, studies show that when used in a shampoo, it can provide safe and effective treatment for scalp psoriasis.In studies, patients have been able to use a psoriasis shampoo containing clobetasol propionate daily for as long as 4 weeks. If the scalp responds, the shampoo can be used once or twice a week to maintain the results.

• Treatment Tip: When shampooing, be gentle. Rubbing, scrubbing, and scratching your scalp tends to make scalp psoriasis worse.

• Scale softeners. Psoriasis can be thick, which makes it difficult for topical (applied to the scalp) treatment to work. Applying a scale softener to the psoriasis can help. A product that contains salicylic acid can soften the thick, stubborn patches of psoriasis. Studies show that topical corticosteroids can produce better results when a patient also uses salicylic acid.

• Injections. Some patients receive injections of corticosteroids. Your dermatologist may call this treatment an “intralesional corticosteroid” because the corticosteroid is injected into the psoriasis.

• Light treatments. When scalp psoriasis does not clear with treatment that is applied to the scalp, light treatments may be an option. Your dermatologist may call this type of treatment “phototherapy.”Until recently, light treatments were not useful for scalp psoriasis unless the person was bald or had very thin hair. Thanks to recent advances, even people with thick hair can have light treatments on their scalp. Some patients are treated with a UV comb. Others receive laser therapy.

• Biologics and other medicines that work throughout the body. Scalp psoriasis can be stubborn. Sometimes it does not respond to topical (applied to the scalp) medicine or light treatments. When a patient needs aggressive treatment, a dermatologist may prescribe a medication that works on the immune system. Some of these medications come in pill form. Others require self-injections. Sometimes the medicine is given by infusion, which requires the patient to go to a hospital or psoriasis treatment center.

• Medication that may be prescribed for aggressive treatment of scalp psoriasis includes:
  • Oral (taken by mouth) retinoids
  • Methotrexate
  • Cyclosporine
  • Biologic (medicine that works on the immune system and is given as a shot or intravenously)

Most cases of scalp psoriasis can be effectively treated. Sometimes treatment requires using more than one treatment option. Dermatologists have the expertise required to combine these treatments and minimize side effects.

References:
Bovenschen HJ, Van de Kerkhof PC. “Treatment of scalp psoriasis with clobetasol-17 propionate 0.05% shampoo: a study on daily clinical practice.” Journal of the European Academy of Dermatology and Venereology; April 2010; 24: 439-44.

Chan CS, Van Voorhees AS, Lebwohl MG et al. “Treatment of severe scalp psoriasis: from the Medical Board of the National Psoriasis Foundation.” Journal of the American Academy of Dermatology June 2009; 60: 962-71.

Krell J, Nelson C, Spencer L et al. “An open-label study evaluating the efficacy and tolerability of alefacept for the treatment of scalp psoriasis.” Journal of the  American Academy of Dermatology April 2008; 58: 609-16.

Poulin Y, Papp K, Bissonnette R et al. “Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of moderate scalp psoriasis.” The Journal of Dermatological Treatment; May 2010; 21: 185-92.

Poulin Y, Papp K, Bissonnette R et al. “Clobetasol propionate shampoo 0.05% is efficacious and safe for long-term control of scalp psoriasis.” Cutis; January 2010; 85: 43-50.

Compliments of the American Academy of Dermatology http://www.skincarephysicians.com/psoriasisnet/scalp_psoriasis_treatment.html

]]> http://www.vashonorganics.com/education_center/treatment-scalp-psoriasis/feed/ http://www.vashonorganics.com/education_center/what-is-sebaceous-carcinoma/ http://www.vashonorganics.com/education_center/what-is-sebaceous-carcinoma/#comments Mon, 02 Aug 2010 17:25:25 +0000 Steve Reed http://www.vashonorganics.com/education_center/?p=532

Sebaceous carcinoma (SC) is a rare type of skin cancer. It only develops on skin that has sebaceous glands. These glands, which help keep our skin moist, are found throughout the body. They are most plentiful around the eyes.

About 75% of SCs develop on an eyelid. The face and neck also contain many sebaceous glands, and this is where most other SCs develop. SC also can develop on the torso, leg, arm, inside the mouth, in the ear, on the genitals, and even on top of the big toe.

What Causes Sebaceous Carcinoma?
Scientists believe that the sun plays a key role in causing SC. Having a weak immune system or receiving radiation treatments for a medical condition also seems to increase the risk of developing SC.

Who Gets Sebaceous Carcinoma?
Anyone can develop SC, but some people have a greater risk:

Middle age or older. It is very rare for SC to develop before 30 years of age. Most people are 60 years of age or older, and the risk continues to increase with age.

Weakened immune system.

People who have a weakened immune system have a much greater risk. A weakened immune system may be caused by a medical condition or medication. Medical conditions that weaken the immune system include human immunodeficiency virus (HIV) and cancer. Medication taken after transplant surgery to prevent the body from rejecting the new organ and some medications used to treat psoriasis or arthritis also weaken the immune system.

Received radiation treatments for a medical condition.

People who received radiation treatments as a child have been diagnosed with this rare skin cancer in their 60s and 70s. SC also develops in children who receive radiation treatments for retinoblastoma, a cancer that develops in the eye.

Muir-Torre syndrome (MTS).

This is a rare medical condition. People get MTS from the genes that they inherit from their parents. MTS greatly increases the risk for developing several cancers. The risk is greatest for a type of colon cancer. Other cancers that a person with MTS has an increased risk of developing are SC, cancers of the uterus, stomach, ovaries, intestine, urinary tract, liver, and bile duct.

SC is often the first sign that a person has MTS.

Signs and Symptoms of Sebaceous Carcinoma
SC often appears as a small, slowly growing, firm, deep-seated mass on the upper eyelid. SC is 2 to 3 times more common on the upper eyelid than on the lower eyelid. It tends to look like a sty and to be painless.

As the cancer progresses, the affected eye may look like a person has a case of pink eye. Left untreated, SC can cause the affected eyelid to turn inward or outward. The eyelashes may fall out, and the person’s eyesight may become distorted.

When SC develops elsewhere on the body, the skin cancer looks like a slowly growing mass that is pink to reddish yellow in color. The mass may bleed.

How is SC Diagnosed?
When a dermatologist suspects skin cancer, the dermatologist performs a biopsy. This procedure can be safely performed during an office visit. To perform a biopsy, the dermatologist will remove the suspicious lesion, or part of it, so that it can be examined under a microscope. This is the only way to know whether a patient has skin cancer.

If the biopsy confirms that the patient has SC, the dermatologist may also:

Perform a full-body skin examination to check for other skin cancers and check the patient’s lymph nodes for swelling.

Ask if the patient or anyone in the patient’s family has MTS.

Request that the patient have a thorough eye exam from an ophthalmologist if the SC occurs on an eyelid.

Write orders for additional medical tests. These tests may include a chest x-ray, blood tests, urinalysis, and colonoscopy. Women may get an order for a mammogram. The purpose of these tests is to check for other cancers that are common in people who have MTS.

Refer the patient to a medical geneticist. A medical geneticist can provide information about genetic testing and cancer screenings that may be appropriate.

Treatment for Sebaceous Carcinoma

A dermatologist considers many factors before determining which treatment will be best for the patient. These factors include the patient’s age, health, and where the SC is located on the body. Treatment options for SC include:

Mohs micrographic surgery (Mohs).

Mohs allows the surgeon to remove one layer of skin at a time. Each layer that is removed is placed under a microscope so that the surgeon can look for cancer cells. This process continues until the surgeon no longer finds cancer cells. Mohs often can be performed in a dermatologist’s office while the patient remains awake.

Excision.

Mohs may not be appropriate for every patient. If a tumor is large, SC may be treated with a surgical procedure called “excision.” This involves surgically removing DFSP and a portion of normal-looking skin. This procedure may be performed in a dermatologist’s office. Sometimes it needs to be performed in an operating room.

Lymph node dissection.

If the cancer has spread to nearby lymph nodes, the lymph nodes may be surgically removed.

Radiation.

This treatment is usually only an option when a patient cannot have surgery. If the cancer has spread to other parts of the body, radiation may be part of the treatment plan. It can help kill cancer cells and ease discomfort.

Follow-up Essential
When detected early, survival rates are good for people who have SC. But SC can return or spread to other areas of the body, so follow-up is essential. The dermatologist will tell you how often you should return for check-ups. It is essential to keep all of these appointments.

More Information
Sebaceous Carcinoma: What Does It Look Like?

References:
Blake PW, Bradford PT, Devesa SS et al. “Cutaneous appendageal carcinoma incidence and survival patterns in the United States: a population-based study.” Archives of Dermatology. June 2010, 146: 625-32.

Martinelli PT, Cohen PR, Schulze KE et al. “Sebaceous Carcinoma.” In Nouri K. [editor]. Skin Cancer. United States. McGraw Hill Medical; 2008. p. 240-9.

Nelson BR, Hamlet KR, Gillard M et al. “Sebaceous carcinoma.” Journal of the American Academy of Dermatology. July 1995; 33: 1-15; quiz 6-8.

Compliments of the American Academy of Dermatology

http://www.skincarephysicians.com/skincancernet/whatis_sebaceous_carcinoma.html

Dermatofibrosarcoma protuberans (DFSP) is a rare type of skin cancer. It is considered rare because for every one million people, about 5 to 8 will develop DFSP.

While this skin cancer tends to grow slowly, it can be aggressive. DFSP can grow deeply into the skin. It can invade the fat, muscle, and bone. DFSP rarely spreads to other parts of the body. This gives DFSP a higher survival rate:

5-year survival rate = 99.2%

15-year survival rate = 97.2%

What Causes DFSP?
It is not clear what causes this type of skin cancer. A scar that develops after a burn or surgery may increase the risk for developing DFSP. More research is needed to learn whether this is true.

Who Gets DFSP?
This skin cancer develops in people of all races and ages. Some people seem to have an increased risk:

Between the ages of 30 and 50 years.

While DFSP can develop at any age, most people develop it between these ages. DFSP is rare in children.

Had skin trauma.

A scar left by a surgery or burn may increase the risk of developing DFSP.

Women.

One large-scale study found DFSP to be more common in women. Other studies have found that it tends to develop equally in men and women.

African Americans.

One large-scale study found that DFSP might be more common in African Americans. Other studies have found that it develops about equally among races.

Signs and Symptoms of DFSP
The first sign is generally a flat or slightly raised patch of skin that feels hard to the touch. It often looks like a scar or wrinkled patch of skin. The patch may be violet, reddish brown, or skin colored. As DFSP grows, a tumor may appear. Sometimes more than 1 tumor appears. The tumors also tend to be violet, reddish brown, or skin colored. By the time a tumor appears, the cancer is usually growing more rapidly. As the cancer starts to grow more rapidly, a tumor may open up, bleed, or become painful. But in many cases, DSFP does not cause any discomfort or pain.

A rare form of DFSP, called a Bednar tumor, contains cells that produce melanin. Melanin is the substance that gives skin its color. Because of this, a Bednar tumor may contain various colors, including red and brown. The Bednar tumor occurs more frequently in blacks than in whites.

How is DFSP Diagnosed?
When a dermatologist suspects skin cancer, the dermatologist performs a biopsy. This procedure can be safely performed during an office visit. To perform a biopsy, the dermatologist will remove the suspicious lesion, or part of it, so that it can be examined under a microscope. This is the only way to know whether a patient has skin cancer.

Treatment for DFSP
While slow growing, treatment is important. DFSP can grow deeply into the skin. A dermatologist will consider this and other factors before deciding which treatment(s) is most appropriate. Other considerations include where DFSP is located on the body and the patient’s health. Treatment options include:

Mohs micrographic surgery (Mohs).

Because DFSP can grow deeply into the skin and even into the fat and bone, this surgical procedure is often used to treat DFSP today. Mohs allows the surgeon to remove one layer of skin at a time. Each layer that is removed is placed under a microscope so that the surgeon can look for cancer cells. This process continues until the surgeon no longer finds cancer cells. Mohs is often performed in a dermatologist’s office.

Because treatment continues until cancer cells are no longer found, Mohs reduces the risk that the DFSP will return.

Excision.

Mohs may not be appropriate for every patient. If a tumor is large, DFSP may be treated with a surgical procedure called “excision.” This involves surgically removing DFSP and a portion of normal-looking skin. This procedure may be performed in a dermatologist’s office. Sometimes it needs to be performed in an operating room.

Treatment for Advanced DFSP
When a patient has advanced DFSP, the cancer has grown deeply. It may have reached the muscle or bone. It may have spread to other parts of the body. In these cases, more than one treatment may be used to increase the likelihood that all of the cancer is killed or removed. Treatment options for advanced DFSP are:

Chemotherapy.

One medication, imatinib mesylate, has received approval from the U.S. Food and Drug Administration (FDA) for the treatment of DFSP. This medication targets and turns off proteins that allow cancer cells to grow. This medication is not meant to treat everyone who has DFSP. It has been approved to treat an adult who has DFSP that cannot be removed with surgery and DFSP that keeps returning or has spread to other parts of the body.

In some patients with advanced DFSP, imatinib mesylate may be taken before surgery. It may help reduce the size of the tumor, which can make surgery more effective. Using both the medication and surgery to treat advanced DFSP has been shown to greatly reduce the risk of DFSP returning.

Radiation therapy.

Because DFSP can return after treatment, radiation therapy may be prescribed. Radiation therapy is usually only given after surgery when the risk of DFSP returning is high. Radiation may be a treatment option for a patient who cannot have surgery.

Follow-up Essential
DSFP is a type of skin cancer that has a tendency to return after treatment. Continuing to see a dermatologist is essential. When DFSP returns, it often does so within 3 years of treatment. This is why dermatologists recommend that during the first 3 years, patients return for follow-up examinations every 3 to 6 months. If DFSP does not return within the first 3 years, dermatologists recommend that a patient return once a year for a thorough exam. Anyone who has had DFSP should have these yearly exams for life.

More Information
Dermatofibrosarcoma Protuberans (DFSP): What It Looks Like

References:
Cooper JZ, Brown MD. “Tumors and Hyperplasias of the Dermis and Subcutaneous Fat.” In Wolff K., Goldsmith LA, Katz SI et al. [editors] Fitzpatrick’s Dermatology in General Medicine, 7^th edition. United States. McGraw Hill Medical; 2008. P. 1159-61.

Criscione VD, Weinstock MA. “Descriptive epidemiology of dermatofibrosarcoma protuberans in the United States, 1973 to 2002.” Journal of the American Academy of Dermatology June 2007; 56: 968-73.

Gloster HM, Jr. “Dermatofibrosarcoma protuberans.” Journal of the American Academy of Dermatology September 1996; 35: 355-74; quiz 75-6.

Halpern M, Chen E, Ratner D. “Sarcomas.” In Nouri K. [editor]. Skin Cancer. United States. McGraw Hill Medical; 2008. p. 217-8.

Kamino H, Meehan SA, and Pui J. “Fibrous and Fibrohistiocytic Proliferations of the Skin and Tendons.” In Bolognia JL, Jorizzo JL, Rapini RP et al. [editors] Dermatology, 2^nd edition. Spain. Mosby Elsevier. 2008. p. 1825-7.

Love WE, Keiler SA, Tamburro JE et al. “Surgical management of congenital dermatofibrosarcoma protuberans.” Journal of the American Academy of Dermatology. December 2009; 61: 1014-23.

Young CR, Albertini MJ. “Atrophic dermatofibrosarcoma protuberans: case report, review, and proposed molecular mechanisms.” Journal of the American Academy of Dermatology. October 2003; 49: 761-4.

Compliments of the American Academy of Dermatology

http://www.skincarephysicians.com/skincancernet/whatis_dfsp.html

A rare type of skin cancer, Merkel cell carcinoma (MCC) often looks like a cyst, pimple, or stye. It can even be mistaken for an insect bite. While this red to violet-colored growth may look harmless, it is very aggressive. MCC tends to spread quickly. Learning the signs and symptoms can help you spot MCC early when it is most treatable.

Signs and Symptoms of Merkel Cell Carcinoma
Until recently, common signs and symptoms of MCC were not defined. To identify common characteristics of MCC, a team of physicians studied 195 patients diagnosed with MCC between 1980 and 2007. These common characteristics emerged:

Where Merkel Cell Carcinoma is Most Likely to Appear
Like other types of skin cancer, MCC is most likely to appear on skin that has received years of sun exposure. About 50% of MCCs occur on the head and neck. The eyelid is a common site as is the rest of the skin around the eye.

MCC is not limited to the head and neck. It can appear anywhere on the skin. A tumor may develop on an arm, leg, or buttock. MCC has even been found inside the mouth and on the genitals.

Who is Most at Risk?
People 50 years of age or older who have fair skin and did not protect their skin from the sun are most at risk. Research also suggests that men are twice as likely as women to develop MCC.

It is rare for MCC to develop in someone under 50. If MCC develops before then, the person usually has a weakened immune system. Medication taken to prevent organ rejection after a transplant operation weakens the immune system. The risk of MCC increases 10-fold in people taking this medication. Illnesses that weaken the immune system such as HIV and chronic lymphocytic leukemia (a cancer of the blood and bone marrow) also increase the risk. While a weak immune system increases the risk, age and fair skin are still greater risk factors.

Exposure to arsenic, infrared light, and certain medications also increase the risk. One such medication is methoxsalen (meth-OX-a-len). This medication is used in UV light therapy. Some patients who have psoriasis or vitiligo receive methoxsalen during their PUVA therapy.

Rare . . . But Cases Increasing
Cases of MCC tripled between 1986 and 2001. About 1,500 cases are now diagnosed in the United States each year, so MCC is still a rare skin cancer. Researchers believe that the increase may be due to the growing number of people over 50 years of age who had years of unprotected sun exposure. As this population grows, cases of MCC may rise.

Early Treatment Offers Best Prognosis
Research suggests that early detection can improve the patient’s prognosis. If the cancer has not spread, the patient may have a greater than 90% chance of surviving.

If you believe you may have a growth on your skin that could be MCC or any other type of skin cancer, see a dermatologist. These doctors regularly diagnose and treat skin cancer.

The AEIOUs of Merkel Cell Carcinoma
The Lesion

Asymptomatic. Growth does not feel tender or painful. (88%)

Expands (grows) rapidly. The lesion/spot grows quickly. (63%)

The Person

Immune system may be weakened. The person’s immune system can be weakened from taking medication that helps prevent organ rejection or a medical condition such as HIV. (7.8%)

Older than 50 years of age. Most cases are diagnosed in people aged 50 and older. (90%)

Ultraviolet (UV) exposure. MCC tends to develop on skin that has received years of UV exposure. (81%) When the skin is fair and has had years of UV exposure, this percentage jumps to 98%.

Source: Journal of the American Academy of Dermatology, 2008 Mar;58(3):375-81. Heath M, Jaimes N, Lemos B et al. “Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features.”

Related Link
Merkel Cell Carcinoma: What it Looks Like

References:
Brewer JD, Appert DL, Rognigk RK. “Merkel Cell Carcinoma.” In: Nouri K, “Skin Cancer.”China. McGraw Hill Medical; 2008. p. 181-94.

Heath M, Jaimes N, Lemos B et al. “Clinical characteristics of Merkel cell carcinoma at diagnosis in 195 patients: the AEIOU features.” J Am Acad Dermatol 2008; 58:375-81.

Nghiem P, Jaimes N. “Merkel Cell Carcinoma.” In: Wolff K, Goldsmith LA, Katz SI, et al. editors. Fitzpatrick’s Dermatology in General Medicine, 7^th ed. United States of America, McGraw Hill Medical; 2008. p. 1087-94.

Compliments of the American Academy of Dermatology http://www.skincarephysicians.com/skincancernet/whatis_merkel_cell.html

By Simon Pitman, 24-Jun-2010

Nanoparticles commonly contained in zinc oxide sunscreen formulations could prove potentially toxic if inadvertently taken orally, a peer reviewed report claims.

Particles smaller than 100 nanometers are marginally more toxic to colon cells than conventional-sized zinc oxide particles, the report in the ACS’ Chemical Research in Toxicology states, documenting a study conducted at the University of Utah.

“Manufactured nanoparticles are being marketed as having unique properties due to their size, shape, surface area, and composition as compared to bulk material, but there remains concerns regarding toxicities associated with these novel materials,” the report states.

The team of six researchers led by Philip Moos also found that solid zinc oxide was more toxic than equivalent amounts of soluble zinc and that direct particle-to-cell contact was required to cause cell death.

Eating nano sunscreen endangers colon cells

Direct contact with colon cells is likely to be triggered even if a small amount of zinc oxide nanoparticle containing sunscreen is inadvertently consumed orally.

The scientists said their report particularly flags up the dangers of children eating sunscreen containing zinc oxide nanoparticles, particularly as smaller infants often experiment by orally testing all kinds of substances as part of their development process.

“Unintended exposure to nano-sized zinc oxide from children accidentally eating sunscreen products is a typical public concern, motivating the study of the effects of nanomaterials in the colon,” the report states.

The scientist’s experiments compared the effect of conventional zinc oxide powder on a culture of colon cells compared to the effect from a zinc oxide nanoparticle formulation.

Nano formula had twice the toxicity

This procedure found that the nanoparticle formulation was twice as toxic to the colon cells as that of the formulation with the larger cells.

Likewise, the experiments also concluded that the concentration of nanoparticles that were toxic to the colon cells was the equivalent of eating 2 grams of sunscreen, an amount that would normally provide enough sun protection for the face.

The scientists say that the next stage of the research will be to take the experiments beyond cell cultures to discover the effects of zinc nanoparticle toxicity on both laboratory animals and humans.

Compliments of CosmeticsDesign.com http://www.cosmeticsdesign-europe.com/

Dermatologists say it pays to be an educated consumer

When it comes to skin care products that can help us look younger, it is difficult to know what to use. There are so many choices, and promises of instant results or looking 10 years younger can be alluring. So alluring, in fact, that Americans spent more than $7 billion on these products in 2008.

While alluring claims sell products, the products do not always deliver. To select effective age-fighting topicals, dermatologists say, you need to be an educated consumer. The following tips from dermatologists can help you become an educated consumer:

1. Do your homework. Understanding what products can and cannot do before you buy can save you a lot of money and minimize disappointment. Your dermatologist can be your best source of information. A wealth of information exists, and it often takes expertise to evaluate this information. Too many patients, dermatologists say, feel that they have wasted a lot of money on useless products by the time they ask for product recommendations.

If you want to consult additional sources, look for sources that provide unbiased information. These include books, blogs, and Web sites written by dermatologists and other doctors; Web sites such as this one (leading dermatologists review all content); and other sources that do not exist simply to sell products. News releases from the American Academy of Dermatology offer unbiased information. Dermatologists are regularly interviewed for these releases, and some of the releases feature information about treating aging skin.

2. Pick your #1 concern. While it can be tempting to go shopping and bring home many products to sample, this approach generally will not help you find an effective product. Using several products on your skin, especially anti-aging products, in a few days or weeks tends to irritate the skin. When skin becomes irritated, signs of aging such as wrinkles, age spots, and blotchiness become more noticeable.

To start, dermatologists recommend that you pick your #1 concern such as adult acne, age spots, fine lines, or a blotchy complexion. Then look for a product that addresses this concern.

3. Use sunscreen and moisturizer. Protect by day and repair by night is what dermatologists recommend. Two products that science has shown can protect the skin are:

· Sunscreen (offers UVA and UVB protection and an SPF of 30 or higher)

· Moisturizer

Dermatologists agree that sunscreen is by far the most beneficial age-fighting product on the market. When applied daily, a broad-spectrum (offers UVA and UVB protection) sunscreen helps protect the skin from damaging ultraviolet (UV) rays that can cause age spots, deep wrinkles, and a leathery texture. With daily use, a broad-spectrum sunscreen also may allow the skin to repair some of the damage.

Moisturizer is another essential. A good moisturizer can plump up fine lines and make a complexion look brighter and younger. In fact, moisturizer is the secret ingredient in many products that promise visibly reduced fine lines in 24 to 48 hours.

Some people prefer a moisturizer that has sunscreen. That’s fine. Just be sure the product offers UVA/UVB protection and has an SPF of at least 30. If you will be spending the day outdoors, a broad-spectrum sunscreen must be re-applied approximately every few hours.

At night, you want to apply products that repair the skin. Sunlight inactivates many of these products or causes skin irritation.

How to Evaluate Products as You Shop
Now that you know what you want to treat and what you absolutely should use (sunscreen and moisturizer), it is time to look for products. As you shop, the following tips can help you evaluate products:

4. A claim that sounds too good to be true generally is. The saying, “If it sounds too good, it probably is,” applies to skin care products that promise younger-looking skin. It is not possible to get the results of a facelift from a jar. Nor it is possible to look 10 years younger overnight. And a cream cannot flatten your tummy. Exaggerated claims such as these do sell products though.

It also is important to keep in mind that one product can effectively treat the many signs of aging from age spots to wrinkles. Be sure to pass on products that make exaggerated claims.

5. Expensive does not mean better. Consumers often equate more expensive with more effective, but this is not always the case with age-fighting products. There are some very effective, affordable over-the-counter products.

Moisturizer, an essential in any age-fighting skin care plan, is one such product that need not be expensive to be effective. The most expensive components of any facial moisturizer are the fragrance, bottle, and packaging. None of these makes the moisturizer more effective.

6. No one product works for everyone. While a friend may swear by a product, it does not mean you will be as pleased. People have different skin types and different skin concerns. Some people’s skin is more sensitive. As such, one product cannot effectively treat everyone’s mature skin.

7. Product should contain a proven active ingredient. Only a handful of active ingredients have the scientific studies to prove that they can effectively treat signs of aging. This does not mean that other ingredients do not work. It just means that the studies have not been done to back up the claims.

Active ingredients that have some evidence of effectively treating signs of aging include retinoids (may appear as retinol, retinyl, or retinoic acid on the label), alpha hydroxy acids, azelaic acid, growth factors (some), hydroquinone, kojic acid, peptides (some), and salicylic acid.

As new knowledge emerges, this list will grow. A dermatologist can tell you which active ingredients have proven effective.

8. “Clinically proven” does not necessarily mean the U.S. Food and Drug Administration (FDA) found the product effective. If the FDA does not classify the product as a drug, “clinically proven” usually means the product was given to a group of people for a few weeks to try and then report whether or not they saw improvement. The FDA does not review such reports.

9. “Preservative free” is a misleading term. All products must contain preservatives or they could not sit on store shelves without spoiling. Some preservatives are antioxidants such as ascorbic acid (vitamin C), tocopheryl acetate (vitamin E), and retinyl palmitate (derived from vitamin A). These prevent the product from becoming rancid. Preservatives that inhibit microorganisms such as bacteria include parabens and phenoxyethanol.

10. “All natural” is another misleading term. People often interpret “all natural” to mean that a product contains pure plant extracts. Most plant extracts cannot be added to a skin care product in their natural form. Even if they could, adding pure plant extract would make the product cost prohibitive and unappealing. Imagine a product that contained ground up leaves or chunks of mushroom. Most plant extracts undergo extensive processing in which they are modified and chemically synthesized to create a pleasing form.

If these guidelines still leave you yearning for specific product recommendations, talk with your dermatologist. No one product is right for everyone. That’s why this site does not recommend anti-aging products. A dermatologist can examine your skin and medical history. With this information, a dermatologist can recommend products that can address your concerns. Keep in mind that creams, gels, and serums cannot effectively diminish all aging-skin concerns.

References:
American Academy of Dermatology. “Cosmeceuticals” (fact sheet), Issued November 2008. Last accessed May 13, 2009.

Draelos, ZD. (editor) 2005. “Cosmeceuticals.” 1^st ed. China:Elsevier Saunders.

United States Food and Drug Administration (FDA). “Is it a Drug, a Cosmetic, or Both?” Frequently Requested Information, issued July 8, 2002. Last accessed May 14, 2009.

Compliments of the American Academy of Dermatology (http://www.skincarephysicians.com/agingskinnet/age_fighting_selecting.html)

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