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Maskne is the new Acne

12/1/2020

This pandemic had brought a lot of “new normal” and “MASKNE” is one of them. Since Melanin Aesthetics and Laser Clinic re-opened in May, we started seeing a lot of acne cases secondary to face mask. This is not a new skin condition, this is actually called Acne mechanica.

In a journal published by Mills and Kligman (1975), they defined Acne mechanica as local exacerbations due to pressure, friction, rubbing, squeezing, or stretching. The physical trauma brought about by the mask stimulates acneiform eruptions in many patients. Mask causes friction against the skin and this constant rubbing may lead to skin irritation. In addition, the humidity, sweat, oil and saliva trapped inside the mask serve as a good breeding ground for yeast or bacterial organism.

Anyone may be affected by maskne but those with sensitive skin, atopic dermatitis and rosacea are at greater risk. In this pandemic, wearing a face mask is really a must. Masks along with proper handwashing and social distancing will protect us from the invisible enemy. While maskne is really troublesome, it is important to note that it can be prevented. I always tell patients to make their skin care routine as simple as possible. I believe that less is more so the less you wear make up the more your skin breathes.

Here are my suggestions to prevent maskne:

Wash your face twice a day. Overwashing dries your skin and removes its natural protective barrier so it makes your skin more prone to acne .
Use hypoallergenic face wash because they do not contain harsh ingredients that may irritate your skin.
Use fragrance-free moisturizer.
Use light colored mask as this contain less dye. Dyes used in clothing may bleed and may cause irritation.
Wear mask that is made out of natural fabrics such as cotton and linen. When making your own mask avoid those that are “non-repellant or “non-iron” as they usually contain Formaldehyde resins to make them wrinkle-resistant.
Wash your new mask 3x before initial use to remove formaldehydes, dyes and additives used in textile processing as this can cause irritation.
If you start getting acne wash face with cleanser or gel containing 2.5- 5 % Benzoyl Peroxide.
If you can take a break from wearing mask, then do so when it’s safe to remove it.
Use products like retinol, glycolic or salicylic acid only at bedtime.
If the lesion is swollen, red and itchy, it is probably not acne.This may be contact irritant dermatitis so do not DIY your treatment and consult your physician or skin care provider.

If all else fails, then it’s time to seek advice from a skin expert. For stubborn acne, over the counter acne preparations alone might not work, so patients are prescribed oral antibiotics or Isotretinoin which at times cause severe side effects. At Melanin Laser Clinic, we achieve excellent results by using a combination of topical treatment and Intense Pulsed Light (IPL) therapy with the Dermalase IPL. IPL acts as photodynamic therapy that causes thermal damage of P.acnes porphyrins after exposure to the light source. This is done every 2-4 weeks and usually takes 4-6 treatments.

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Do we need to wear sunscreen indoors?

5/4/2020

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Do we need to wear sunscreen indoors?

Yes, we need to wear sunscreen even inside our homes, offices or cars in order to protect our skin from the harmful effects of UVA rays. While glass windows can protect us from UVB it does not protect us from UVA rays unless these windows have UV blocking films. UVA rays penetrate deeper into the skin and while we don’t see the effects right away, long term exposure to UVA rays are harmful to the skin. Even at low doses UVA rays can result to decreased skin elasticity, increased wrinkling, skin roughness and sagging.

The amount of exposure to UVA is continuous throughout the year, whereas UVB exposure occurs more in the summer. UVB is most commonly associated with darkening of the skin (hyperpigmentation) during summer.

Is it true that sunscreen can cause skin cancer?

There are no evidence that link sunscreen to melanoma or other skin cancer. The development of skin carcinoma may be secondary to improper application of sunscreen or prolonged duration of intentional sun exposure. Sunscreen especially those with higher SPF give some people a false sense of security so they exposed themselves longer without re-application thus increasing chances of skin carcinoma.

Should I still apply sunscreen after summer

Yes, we need to apply sunscreen all year round because exposure to UVA is continuous throughout the year, this may lead to loss of skin elasticity and wrinkling. American College of Dermatology asserts that snow, sand, and water increases the need for sunscreen because they reflect the sun’s rays.

Here’s The American Academy of Dermatology’s (AAD) guideline for sunscreen use:

Choose a sunscreen that has an SPF of 30 or higher, is water resistant, and provides broad-spectrum coverage from UVA and UVB rays.
Apply sunscreen generously 15 minutes before going outdoors.
Use enough, most adults need at least one ounce of sunscreen, about the amount you can hold in your palm, to fully cover your body.
Remember your neck, face, ears, tops of your feet, and legs. If you have thinning hair, either put sunscreen on your scalp or wear a wide‐brimmed hat. Use a balm with an SPF of at least 15 for your lips.
Reapply sunscreen at least every 2 hours, or immediately after swimming or sweating. People who get sunburned usually didn't use enough sunscreen, didn't reapply it after being in the sun, or used a sunscreen that was expired.

In addition, seek shade especially when sun is strongest between 10AM-4PM, wear wide brimmed-hat , use light weight clothing that covers exposed areas, avoid tanning beds. Please keep newborns out of direct sun since their skin is extremely vulnerable. Sunscreens should be used on babies over the age of six months. Children are very sensitive to ultraviolet radiation- one severe sunburn in childhood doubles the chances of developing melanoma later in life.

Titanium dioxide and zinc oxide are safe however those with additional contents such as PABA and Trolamine salicylate are not considered safe. Please read label for ingredients which should be on the front of the product. You can post your questions on our Facebook page or email us directly at [email protected].

Let’s continue to socially distance and wash our hands frequently. Stay safe and will see you soon at Melanin!!

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Skin Dryness due to Frequent Handwashing: Cream or Lotion?

4/22/2020

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What is the best way to avoid skin dryness due to frequent handwashing?

First of all, we want to encourage you to keep washing your hands for at least 20 seconds as it removes harmful virus and bacteria.

While soap and water rinses bacteria it also strips the natural protective oil in your skin. Make sure to avoid hot water but instead use lukewarm water.
Do not rub hands with towel when drying your hands as it may irritate your skin. Instead you can air-dry and pat it with soft cloth or paper towel.
While your hands are slightly damp apply hand cream or ointment (you want to seal the moisture so leave a little bit of dampness in to your skin after washing). Creams that are fragrance-free and those that contain petrolatum or mineral oil are better.
We prefer hand cream than lotion because cream has higher percentage of oil therefore it’s a better choice for dry or very dry skin.
If you’re using hand sanitizer, let it dry first and apply hand cream immediately after. British Columbia Centre for Disease Control (BCCDC) recommends alcohol based hand rubs and sanitizers which causes the skin to dry therefore you need to moisturize after applying sanitizer or hand rub.

Hope this helps.We will answer more of your questions in the coming weeks.

Keep safe and hope to see you very soon at Melanin!!

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The Alphabet of Melanoma, A Skin Cancer Tutorial By Gloria Vergara-Octaviano, M.D.

5/19/2016

15 Comments

Image property of the American Academy of Dermatology.

We were taught the alphabet when we were in pre-school but
do you know there’s this very important alphabet that many
of us need to be aware of? Since May is skin cancer
awareness month I decided to talk about the alphabet of
skin cancer and how crucial it is in the early detection of
skin cancer. Skin cancer is the most common form of
cancer diagnosed today with 3.5 million cases in more than
two million people diagnosed yearly. The most common types
of skin cancer are basal cell and squamous cell skin
cancer, they are the so called non-melanoma skin
cancer (NMSC). The other type is melanoma which accounts
for less than 2% of all skin cancer cases, but the
largest majority of skin cancer deaths. It is therefore vital
for everyone to know the ABCDE of melanoma because if
this cancer is detected and treated early the cure rate is 100%. So let’s check the alphabet of melanoma:

A for Asymmetry
If you draw a line through the mole, the two halves will not match. If one half is different from the other then it is asymmetrical which means it can be melanoma.

B for Border
A poorly defined, uneven or scalloped border maybe a sign of melanoma.

C for Color
Most non-cancerous moles have one color. If you notice a variety of colors or different shades of brown, tan, black it might be melanoma. It can sometimes be red, white or blue.

D for Diameter
Non-cancerous moles usually have a smaller diameter than malignant ones. Melanomas have larger diameter than the pencil erasers which is about 6 mm.Some melanomas may be smaller when detected.

E for Evolve
If the mole is different from all your other moles in the body, if there is any change in color, shape, and trait or if it evolves in some way then it can be malignant. Also watch out for itching, crusting or bleeding.

Now, that you know the ABCDE of skin cancer let me share with you the prevention guidelines recommended by The Skin Cancer Foundation. Seek the shade, especially between 10 AM and 4 PM when the sun is strongest. An extra rule of thumb is the "shadow rule." If your shadow is shorter than you are, the sun's harmful ultraviolet (UV) radiation is stronger; if your shadow is longer, UV radiation is less intense.Do not burn. A person's risk for melanoma, the deadliest form of skin cancer, doubles if he or she had had five or more sunburns at any point in life. Avoid tanning and UV tanning booths. UV radiation from tanning machines is known to cause cancer in humans. Indoor UV tanners are 74 percent more likely to develop melanoma, the deadliest form of skin cancer, than those who have never tanned indoors.Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses. Clothing can be your most effective form of sun protection, the more skin you cover, the better, so choose long sleeves and long pants whenever possible.Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher. Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.Keep newborns out of the sun since their skin is extremely vulnerable. Sunscreens should be used on babies over the age of six months. Children are very sensitive to ultraviolet radiation- just one severe sunburn in childhood doubles the chances of developing melanoma later in life. Examine your skin head-to-toe every month. While self-exams shouldn't replace the important annual skin exam performed by a physician, they offer the best chance of detecting the early warning signs of skin cancer (Skin Cancer Foundation, 2016). Once melanoma spreads it could lead to death so it’s best to detect it early, know the warning signs and remember the alphabet of melanoma.

References

The Skin Cancer Prevention (2016). Prevention. Retrieved from http://www.skincancer.org/prevention

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Adult Acne: On the Rise by Manuel Octaviano Jr.

4/29/2016

6 Comments

Gone are the days when acne is just for teens, the reality is that there is an increasing incidence of adult onset acne not only in North America but all over the world. Acne is one of the most common skin conditions and it can occur at any age even in newborn babies. More and more adults especially women from their 30’s and beyond suffer from this frustrating skin problem. Some adults who never experienced acne as teens can have it for the first time. Maybe the world is getting too stressful that our hormones cannot handle it any longer. In a recent clinico-epidemiological study of adult acne they found out that stress is a common factor because it stimulates production of androgens ( also known as male sex hormone) which makes our oil glands active therefore clogging the hair follicles which may lead to acne. Just like in teenagers genetics and hormones may still play a role in adult onset acne. Adult acne is also commonly seen in women in their perimenopausal and menopausal stage because of the fluctuating hormonal levels. Also, comedone (blackheads and whiteheads) is rare compared to teen acne which is composed mostly of blackheads and whiteheads . Acne in adults is more swollen, red and cystic and affects the cheeks and lower half of the face. Facial scarring is also prominent in majority of cases. One piece of advice, when buying any skin and hair products consumers should read the label and make sure it’s non comedogenic hypoallergenic and oil free. Creams sometimes cause the skin to break out so try looking for water based moisturizers. Acne is a chronic condition so your dermatologist or skin care provider will try to find an acne plan that best suits your skin. What is good for one patient may not be effective for you so try to be patient since acne may be triggered by several factors. Treatments are available for adults experiencing acne and this include several acne preparations and procedures like photodynamic therapy (PDT), facial iontophoresis, intralesional injection for cystic acne. American Academy of Dermatologists suggests some tips for clearer skin:

Wash face twice a day and after sweating .Perspiration can make acne worse, so wash skin as soon as possible after sweating.
Use your fingertips to apply a gentle, non-abrasive cleanser. Using washcloth, mesh sponge can irritate the skin.
Be gentle with your skin. Use gentle products, such as those that are alcohol-free. Do not use products that irritate your skin, which may include astringents, toners and exfoliants. Dry, red skin makes acne appear worse.
Scrubbing your skin can make acne worse so do not attempt to scrub your skin.
Rinse with lukewarm water
Shampoo regularly because oily hair can irritate skin
Let skin heal naturally
Keep your hands off your face
Stay out of the sun and tanning beds
If all else fails consult a skin expert

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Non Surgical Alternatives for Wrinkle Reduction and Skin Tightening by Gloria Vergara -Octaviano

3/9/2016

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They say wrinkle signifies wisdom, but who would like to welcome this sign? Wrinkles are inevitable part of ageing because as we get older our skin produces less collagen and elastin, therefore it loses elasticity so we end up with dry, loose and sagging skin, Elastin and collagen are proteins found naturally in the body that maintains skin elasticity and tightness. Sun exposure is the most common cause of wrinkles however other factors like Ultraviolet, smoking, free radicals, hormones, genetics and repeated facial movements may also cause wrinkles. If you’re looking for ways to tighten your skin without the extended healing time, pain, and expense of cosmetic surgery, you may want to consider the following non invasive procedures:

Multipolar radio frequency (RF) This procedure, which is relatively new, is a non-surgical option for people who want to treat wrinkles, sagging, and other signs of aging. Multipolar Radio frequency uses electric energy to treat the skin of the face , neck and other parts of the body by heating up the superficial and deep layer of the skin thus stimulating collagen production. New collagen produced by the body will then smoothen and lift the skin. This procedure requires no incisions and has less chances of side effects.
Another option for wrinkle reduction is Laser treatment. Syneron- Candela, a leading laser company,developed a technology called Elos (Electro opical synergy) that combines the power of Diode laser and bipolar RF. This combination directly heat the second layer (dermis) of the skin and stimulate the production of collagen therefore achieving youthful, firm and toned appearance without downtime. Lasers and Lights are ideal for targeting signs of ageing including sagging under eyes, saggy brow lines and nasolabial folds.
A non-invasive lifting procedure that has been in the market longer is Galvanic Iontophoresis. Galvanic Iontophoresis Facial is the therapeutic introduction of soluble salts into tissue by means of electric current.It increases penetration of drugs into surface tissue without the pain of injections. This helps reduce wrinkles, buff and tone up the skin and reduce puffy eyebags. For wrinkle iontophoresis ,retinoic acid. hyaluronic acid, or vitamit C serums are pushed into the skin to fight the free radicals that causes the skin to sag or wrinkle.
Ultrasonic Facial is another non-invasive, powerfully effective treatment that rejuvenates skin. It emits low frequency sound waves that are used to deliver products more deeply and breaks down oily deposits thus removing imperfections, softens the skin and irons out wrinkles.
Prevention is always better than cure so to avoid photoageing , use a good hypoallergenic sunscreen with at least SPF 30. Sunscreen must be applied 20-30 minutes before sun exposure and must be reapplied every 2-3 hours. Avoid smoking as it has been proven to cause premature ageing. Ultraviolet exposure through the use of tanning bed is also discouraged because not only will it cause premature wrinkles it will also increase the chances of skin cancer (melanoma ) especially among young girls.

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MICRODERMABRASION AND BEYOND........ by Manuel Octaviano Jr.

2/17/2016

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Microdermabrasion is a non- invasive mechanical exfoliation treatment for superficial skin resurfacing. Other skin exfoliation used in today’s cosmetic market are chemical exfoliants like glycolic and tricholoacetic acid peels and laser treatments.The depth of resurfacing achieved with microdermabrasion is moderately superficial as compared to the more aggressive laser resurfacing procedures. The target depth for most microdermabrasion procedures is removal of the stratum corneum and this is achieved based on the principles of wound healing. By wounding and removing the uppermost layers of the skin in a controlled manner, cell renewal is stimulated with regeneration of a healthier epidermis and dermis. Histological evaluation of facial skin after repeated Microdermabrasion treatments demonstrate a reparative wound-healing process leading to cell regeneration and ultimately a smoother epidermis. Skin hydration increases with improved epidermal barrier function, and fibroblast stimulation increases dermal thickness through production of new collagen and elastin.

Microdermabrasion is commonly used to treat sun damaged skin and is proven to improve skin texture, large pores, blackheads/whiteheads, and hyperpigmentation such as melasma and solar lentigo. It also improves fine lines and superficial acne scarring. Microdermabrasion devices use crystals or diamond tips as the abrasive element . Negative pressure draws the skin to the hand-piece tip then the crystals or diamond tips superficially abrade the skin's surface as they pass across the epidermis. Used crystals and cellular debris are aspirated and collected in a sterile container to be disposed after each treament. Each pass of the hand piece removes approximately 15 μm of skin, and two passes of most microdermabrasion devices fully removed the stratum corneum. The depth of resurfacing achieved with microdermabrasion is the same as superficial chemical peels however microdermabrasion offers minimal discomfort and has generally no downtime hence it’s usually called “lunch time peel”.

Recent advances in microdermabrasion technology includes “Hydrafacial” and “Silk Peel” which combines exfoliation with dermal infusion . During this process, topical products like hyaluronic acid or salicylic acid, etc. are delivered into the skin at while doing exfoliation. These systems take advantage of the transient disruption to the epidermal barrier that occurs with removal of the stratum corneum to better deliver medications into the deeper dermal layers. Dermal infusion can enhance results for conditions such as dehydration, hyperpigmentation, acne scars, and rosacea depending on the products used.
Microdermabrasion treatments are most commonly performed on the face, neck and chest. It is usually done in 6-8 treatments every 2-4 weeks. Single treatment is not enough to see results therefore follow up is normally recommended depending on the skin problem. It is usually combined with other treatments such as IPL skin rejuvenation or lasers for better results. Patients typically experience redness or superficial skin peeling after the procedure. Moisturizer as well as sunscreen protection with SPF 30 or greater is recommended after each procedure. It is best to talk to your skin care practitioner so you will be better informed about this treatment.

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WHAT IS MELASMA? By: Gloria Vergara-Octaviano

2/5/2016

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Have you ever noticed dark brown patches on your cheeks, forehead or chin recently? Well.it could probably be melasma. So, what exactly is Melasma. Melasma sometimes called chloasma or “mask pregnancy” is a skin pigmentation more commonly seen in Asians and Hispanics. The exact cause of melasma is unknown but it could be trigerred by several factors and the most common is sun exposure. Women who are pregnant can also develop melasma that fades after pregnancy thus it is also called “mask of pregnancy”.Other risk factors are oral contraceptives (Progesterone), Hormone Replacement Therapy (HRT),cosmetics or products that makes the skin sensitive to light and hypothyroidism (low level of thyroid hormone). Uncontrolled sunlight exposure is considered the leading cause of melasma, especially in individuals with family history of melasma. Clinical studies have shown that individuals usually develop melasma in the summer months, when the sun is most intense. In the winter, the hyperpigmentation tends to be less noticeable. Melasma presents as symmetrically distributed hyperpigmented macules in areas that receive maximum sun exposure, including the cheeks, the upper lip, the chin, and the forehead, however, melasma can also be seen in other sun-exposed areas of the body. Melasma is more common in women than in men; It generally starts between the age of 20 and 40 years, but it can begin in childhood. Melasma is more common in people that tan well or have naturally brown skin (Asians and Hispanics) compared with those who have fair skin (Caucasians). Melasma is one of the skin pigmentation I find hard to treat especially if it has been present for a longer period and since it responds to treatment gradually there’s always the tendency for patients to resort to other over the counter topical creams that might cause hypersensitivity resulting to more skin damage. Each of us has different skin types so what is effective for your friend might not work for you so it is always better to seek help from experts. Melasma can improve with microdermabrasion, Intense Pulsed Light (IPL) or laser treatment, a machine that destroys the melanin pigment by means of heat and light. Topical depigmenting agent can also help like Hydroquinone, Azelaic acid and Vit. C. I find the combination of Hydroquinone, Retinoic Acid and Hydrocortisone (Kligman’s formula) more effective than other creams. Oral medications that are currently under investigation includes Tranexamic acid (also used to stop bleeding) and Glutathione but both are not recommended at this time. Melasma can improve in time but there are no overnight treatments. There is no hard and fast rule in treating melasma it is always a case to case basis. Ask your skin practitioner/dermatologist about your options.

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Flat Warts, Filiform Warts and Skin Tags by Manuel C. Octaviano Jr.

1/25/2016

3 Comments

Flat Warts (Verruca Plana) is a common benign skin condition . They are caused by a virus known as Human Papilloma Virus (HPV) and they can be seen anywhere in the body. Flat warts can affect all ages and are common in both men and women. While common warts are more frequently seen in children and immunocompromised individual more cases of flat warts are seen in in adults especially women who just gave birth. With men, we usually noticed warts on their faces especially the bearded area. Flat warts are slightly raised, smooth, light brown pinpoint papules that are usually mistaken for moles. It often takes a few months for warts to grow large enough to be noticed. They are usually self limiting and can go away even without treatment however it tends to grow in large numbers of 20-100 pieces at a time. There are times when new warts appear as fast as old ones go away because old warts shed virus cells into the skin before it gets treated. Filiform warts, on the other hand looks like long thin fingers that stick out and grow quickly. They often grow on the eyes, around the mouth and nose. Since warts are viral in origin it can spread from person to person or by touching someone’s body or by sharing towels or personal items. Warts can return on the same site or appear in a new spot later. Another common benign skin lesion seen among Filipinos is skin tag (Acrochordon) ,these are soft, skin-colored growth that hangs from the surface of the skin attached on a thin piece of stalk. They easily move or wiggle back and forth. A skin tag is painless but can bleed and become irritated by frequent touching or rubbing. Warts and skin tags are usually treated by methods like electrocautery, cryotherapy, excision , lasers or Cantharidin paint.We don’t recommend treating flat warts or skin tags on the face with topical solutions like Salicylic acid since it destroys the surrounding normal skin hence burns and pigmentation may occur. If your warts or skin tags hurt, bleed, become bothersome or multiply fast then it is time to see your skin practitioner.

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Do facials really work? By Gloria Vergara-Octaviano

1/17/2016

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You’ve probably asked this question to your aesthetician or dermatologist and I bet they gave very different answers. I have heard some aestheticians claim that dermatologist do not have enough knowledge with facials because they are only trained to treat skin diseases while dermatologists say that there are not enough scientific studies to back up claims that facials really work.
If your face is too dry or too oily, or you're always looking for ways to cover up unsightly facial blemishes, a facial may help. A facial is usually defined as deep cleansing treatment applied to the face, designed to eliminate clogged pores, blackheads, and other skin imperfections. It includes several steps that can include the use of creams, masks, peels, steam, exfoliation, extraction and massage. However, there is no “ one size fit all” technique in facial treatment, everyone has a specific skin type thus it cannot be the same for all the clients. A spa facial is soothing and relaxing and is done to pamper yourself but not to treat the skin problem. On the other hand, medical facials start with skin assessment and consultation so that the skin problem can be properly addressed and treated. Proper skin assessment is important so as not to aggravate the skin condition, There are so many horror stories about “Facials gone wrong” and this is because there is no proper skin assessment or the facialist does not have enough knowledge about the client’s skin condition. For example, some skin care providers do comedone extraction because it is included in the facial package even if it is not needed. The facialist will try pricking the skin until it bleeds, it will then end up with scars which are harder to treat in the end. Additionally, too much massage may cause bruising and sometimes may lead to skin inflammation and acne breakouts. Some “organic” products are too harsh that it causes severe hypersensitivity reaction or allergies (contact dermatitis) so their skin will end up worse than before.
As a dermatologist, I believe that facials can help clear your skin provided: it is customized for patient’s skin type, it is combined with other clinically proven procedures like microdermabrasion or galvanic treatment and done by a certified skin care provider. If you want to treat and pamper yourself, by all means go to a spa for facials. If you want your skin problems treated then make time to research and find a good skin care provider. Do not trust your skin to just anyone, you only have one face and you don’t want it ruined by just one facial treatment.

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Author

Gloria Octaviano is a Physician-Dermatologist in the Philippines, she is a member of the International Society of Dermatology and a diplomate of The Philippine Academy of Clinical and Cosmetic Dermatology.

Manuel Octaviano is a Physician in the Philippines, he is a Fellow of the Anti Ageing Medical Society and a member of Philippine Academy of Clinical and Cosmetic Dermatology. Manny is a Skin and laser consultant/educator.

Do we need to wear sunscreen indoors?

Is it true that sunscreen can cause skin cancer?

Should I still apply sunscreen after summer

What is the best way to avoid skin dryness due to frequent handwashing?

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