April has been designated Rosacea Awareness Month for good reason. The common but poorly understood skin condition affects more than 16 million Americans, yet most of them don’t know it. That doesn’t keep them from suffering from the condition, especially the emotional pain of a chronically red and/or sometimes broken out face.
In a recent survey of 1,675 rosacea patients conducted by the National Rosacea Society, 90% said that the condition’s effect on their appearance has lowered their self-confidence and self-esteem. Eighty-eight percent reported suffering embarrassment, not to mention a whole range of other negative feelings, including, frustration, anxiety, helplessness, depression, anger, and isolation. In fact, 52 percent of the respondents reported that they had avoided face-to-face contact because of the disorder.
Although the cause of rosacea is unknown, a vast array of lifestyle and environmental factors can trigger flare-ups, including sun exposure, hot or cold weather, wind, alcohol, and spicy foods.
“There are different versions of rosacea so each treatment is tailored to that patient’s needs,” said New York City dermatologist Lori Brightman. “But for all rosacea sufferers, you want to avoid triggers such as sun, alcohol ,extreme hot or cold weather, stress, spicy foods, fragrance or menthol, and hot beverages.”
In addition to trigger control, medical treatments range from topical creams and ointments to in-office light or laser treatments, depending on the severity of the condition. The different types of rosacea encompass subtype 1 (moderate to severe redness on the face), subtype 2 (pumps or pimples on the face), subtype 3 (thickening of the skin), and subtype 4 (watery or irritated eyes).
“Obviously, the redness is from ‘leaky, abnormal’ blood vessels so the best treatment would be to get rid of those faulty vessels,” said New York dermatologist Cheryl Karcher. She recommends treatment with Intense Pulsed Light or a KTP or Cutera Excel V Laser. “We also use BOTOX to decrease flushing by relaxing the muscles that dilate the vessels in both the face and chest,” she added.
For topical, temporary control of redness, many doctors recommend the newly popular prescription Mirvaso Gel from Galderma. “The new topical Mirvaso Gel is amazing for redness. Use it in the morning and it will keep redness away for twelve hours,” said New York City dermatologist Lisa Airan.
Oral and or topical antibiotics can be prescribed for the anti-inflammatory benefits—not their anti-bacterial action. In addition, topical sulfur based, azeleic acid, or antifungal-based medicines can help control the redness and pustules. “For some with severe cases of flushing/burning, oral cardiovascular medicine can help reduce the blood vessels from dilating,” Dr. Brightman said.
Many physician-dispensed skin care or cosmeceutical lines feature products specifically formulated to target rosacea. “Rosaliac AR Intense by La Roche-Posay is a light serum that is great for patients with oily-normal skin and wears well under makeup,” said Maryland dermatologist Valerie Callender, who is also president of the Women’s Dermatologic Society. For dry/sensitive skin, she recommends CalmPlex by SkinMedica, an emollient cream that can be used at night.
The ZO Medical® rosacea protocol involves products to control oiliness and breakouts. Cebatrol™ Oil Control Pads feature 2% salicylic acid and anti-inflammatory agents. Beverly Hills dermatologist Zein Obagi also recommends using ZO Medical’s Glycogent™ for rosacea prone skin, which is an exfoliation accelerator engineered to reduce inflammation.
Another popular choice is PCA Skin Anti-Redness Serum which contains aldavine, capparenols, and bisabolol to reduce inflammation, redness, and hypersensitivity. It also works wonder for relieving sunburn. Clinical results show a 50 percent reduction in redness over an eight-week period.
Exuviance by NeoStrata has just launched a new serum as well. Exuviance AntiRedness Calming Serum contains Canadian willow herb, tripeptide, and brown and red algae extracts to help calm redness-prone skin. Follow with Exuviance Ultra Restorative Crème, which relies on gentle polyhdroxy acids to soothe dry and easily irritated skin.
Even cleansing rosacea-prone skin must be handled with a lot of TLC. The gentle CLn Facial Cleanser is formulated with glycerin and skin conditioners to wipe away dirt while soothing and helping skin retain moisture.
For covering up, mineral makeup, such as the Jane Iredale brand, treats red and inflamed skin gently and with titanium dioxide for UV protection. Omaha dermatologist Joel Schlessinger also recommends Phytomer CC Crème Skin Perfecting Cream, a blend of skin care and makeup that offers coverage plus broad-spectrum sun protection.
Although it can’t be cured, rosacea can be controlled. If you are dealing with mild redness, try over-the-counter treatments that contain green tea, licorice/licorice root extract, chamomile, feverfew, and mushroom extract for relief. And remember to stay out of the sun to minimize future UV exposure which also causes flare ups.
Elizabeth Arden unveiled its newest skincare range—Elizabeth Arden Rx—at the AAD in Denver in March 2014, effectively entering into the race for professional skincare domination. The range is based on an innovative topical skin protection product, Triple Protection Factor Broad Spectrum Sunscreen SPF 50+, or TPF 50, that is the hero formula featured in the comprehensive skincare line designed for exclusive distribution in physicians’ offices.
Uber cosmetic chemist Joe Lewis is the brains behind the new skincare range. Lewis first partnered with Elizabeth Arden, Inc. in 2005 to launch Prevage®, which has gone on to win more than 160 international beauty awards. He is well known for discovering mega cosmeceutical ingredients including alpha-hydroxy acid in 1983, idebenone in 2004 (found in Prevage®) and CoffeeBerry® (found in Revaleskin®) in 2007. This new collaboration marks another win for Lewis’ unique formulations.
TPF 50 contains a triple cocktail of key skin saving ingredients—broad spectrum SPF 50, an Antioxidant Complex, and a DNA Enzyme Complex- in a lightly textured, silky moisturizing base. In a recent study in March 2014 in Journal of Drugs in Dermatology, the DNA Enzyme Complex was proven to be more effective in reducing the risks associated with premature signs of aging and skin cancer than other commonly used products in head to head comparisons. The authors concluded that, “Taken together, our results indicate that TPF50 improves the genomic and proteomic integrity of skin cells after repeated exposure to UV radiation, ultimately reducing the risk of skin aging and non melanoma skin cancers.”
According to study author, James M. Spencer, MD, Professor of Clinical Dermatology at Mt. Sinai School of Medicine, “Sunscreens prevent DNA damage but they do not have the ability to repair DNA damage. In the first study done in St. Petersburg, FL, subjects were applying this product topically for eight weeks and doing skin biopsies before and after and stained for pyridime dimers—a signature mutation—which is only caused by UV light. We also looked at P53, a tumor suppressor gene. After eight weeks, there was a significant decrease in pyridime dimers, and mutated P53. If you already have sun damage, TPF50 can repair the skin. It has SPF in it so it combines prevention with repair enzymes. You can’t take back damage that was done twenty years ago. This is actually repairing the skin. We also compared it to other products on the market that contain DNA repair enzymes in them, but TPF50 was superior.”
The line is categorized into four regimens—Anti-Aging, Brightening, Clarifying, and Hydrating—each includes a pre-treatment cleanser and Triple Protection Factor Broad Spectrum Sunscreen SPF 50+ (TPF 50). There are seven products in all; two cleansers, Anti-aging Serum, Brightening Serum, Clarifying Serum, Hydrating Cream, and the signature TPF50. The addition of Elizabeth Arden Rx Mineral Skincare, a loose sheer mineral powder in five wearable shades with SPF27, plus one Finishing Touch, completes the collection.
For physician use only, there are also four peeling systems that complete the treatment selection, for Clarifying, Hydrating, Anti-Aging, and Brightening skin. The peels are designed as an in-office treatment to be administered by a trained medical professional, and the selected products are to be used at home, as well, for maintenance.
Look for the Elizabeth Arden Rx Skin Optimizing Platform™ coming next, a clever little handheld device with interchangeable treatment heads for cleansing, skin smoothing, and the infusion of topical agents all in one.
To find a physician near you—visit elizabethardenrx.com
Do you show a lot of gum when you smile? Dentists have a name for that—it’s called a “gummy smile.” Think Miley, Gwen Stefani, and Beyonce in the early days without Photoshop®.
According to New York City Cosmetic Dentist Brian Kantor, “Gummy smile refers to an excessive display of gum tissue when smiling. The causes can range from overgrowth of the upper jaw, a short upper lip, hyperactive upper lip, as well as an overgrowth of gum tissue.” If you put your hand over your mouth when you laugh or are self conscious about smiling too broadly to avoid showing too much of your gums, BOTOX® can be an easy temporary fix for the problem of a gummy smile. A small injection of BOTOX® in the upper lip can reduce the lifting action of lip muscles, which reduces the amount of gum tissue that shows. The treatment lasts about 3-4 months.
In an off-label study published in the Aesthetic Surgery Journal March 2014 issue on the application of onabotulinumtoxinA (BOTOX® Cosmetic, Allergan) for treatment of excessive gingival display, also known as “gummy smile,” researchers found that this injectable treatment offers an effective, minimally invasive, and safe alternative to surgery, yielding a significant improvement in smile aesthetics with high patient satisfaction. The findings are presented in the article, OnabotulinumtoxinA for the Treatment of a ‘Gummy Smile’.
According to lead author Tampa Plastic Surgeon Jessica Suber, MD, “Approximately 14% of women and 7% of men have excessive gingival exposure upon smiling.” The study showed that participants had significant improvements in their smile aesthetics, and the vast majority indicated high satisfaction levels and interest in repeat treatments.
Participants in the study had a minimum of 2mm of gingival or gum tissue exposure above the central incisors upon smiling naturally, a trait often considered aesthetically unappealing. All patients were initially classified as having a “cuspid smile,” where elevator muscles raise the upper lip—like a window shade—to expose the upper teeth and gingival scaffold, contributing to a “gummy smile.” OnabotulinumtoxinA was bilaterally injected into participants’ lip elevator muscles at three sites. Two weeks after treatment, all patients showed a significant decrease in gingival show, with an average reduction of 85% over the central incisors and 83% over the canines. In addition, all but one patient was highly satisfied with their post-treatment smile.
“The smile is such a meaningful facial expression, and it is very important for the overall aesthetics of patients,” said Foad Nahai, MD, Editor-in-Chief of Aesthetic Surgery Journal.
If BOTOX® is too temporary for your tastes, Kantor says, “An alternative to correcting a gummy smile is to have a gum lift followed by porcelain veneers to get the total smile transformation.”