MEET DR JULIE HARPER – FOUNDING DIRECTOR, AMERICAN ACNE & ROSACEA SOCIETY
Dr. Julie Harper has a very personal reason for finding her way into dermatology. She was an acne sufferer as a teenager. But once under the care of a dermatologist, her quality of life greatly improved and she became inspired to offer that same relief to others. Today, she is director of the Dermatology and Skin Care Center of Birmingham, as well as a Clinical Associate Professor of Dermatology at the University of Alabama in Birmingham.
An expert in rosacea as well as acne, Dr. Harper is a founding director of the American Acne and Rosacea Society. She has extensively written and spoken on acne and rosacea. Some of her writings can be found in journals including Practical Dermatology, Advances in Dermatology and Cecil’s Review of General Internal Medicine 8th edition.
Read on to share her thoughts on acne and anti-aging treatments, as well as some great at-home tips for clear skin.
Tell us a bit about your background. Why did you choose dermatology as your specialty?
I was an acne sufferer as a teenager. While acne is not life-threatening, it can be life-altering. I would spend hours trying to conceal and cover my acne and I did not want to be seen without makeup. Once I was under the care of a dermatologist, my acne and my overall quality of life greatly improved. I thought it would be really gratifying to help people in that same way. By the way, I was right! Whether it is acne, rosacea, eczema, or aging, improving the overall health of a person’s skin is very rewarding.
What’s happening in the area of adult acne treatment?
First of all, I think we are seeing more adult acne, particularly in women. We do have some recent evidence that one of our topical acne medications (Aczone) actually tends to work better in women than in men. It is a topical agent that is FDA-approved to treat acne. Importantly, it is well-tolerated and can be applied under makeup. It does not bleach or stain clothing or other fabrics. Topical retinoids are still an important treatment option for adult acne. Adult females may benefit from hormonal therapies, including oral contraceptive pills and/or spironolactone.
Are there any triggers for adult acne/rosacea that people may not even be aware of?
It’s easier to come up with a list of triggers for rosacea than acne. Rosacea may be exacerbated by sunlight, hot beverages or soups, emotional distress, spicy foods and even hot showers. Keep in mind anything that causes vasodilation ( this is a mechanism of cooling in response to a thermal stimulus) can exacerbate rosacea. While rosacea is centered around small blood vessels in the face, acne is centered around the hair follicle or pore. Acne can certainly be aggravated by stress. The role of diet in acne continues to be controversial. There is some evidence that a high gylcemic load diet may contribute to acne. More studies are needed before this theory is confirmed.
What are some of your at-home secrets and tips for healthy skin?
Don’t ever skip sunscreen!!!! Not even one day!!! Other than that, take it easy on your skin. Don’t overscrub. If you love to exfoliate, pick a gentle product and exfoliate once or twice a week. Find a moisturizer that you like and use it regularly. Look for ingredients like petrolatum, dimethicone, and glycerin.
Are you noticing any trends among the requested treatments by your patients?
People want to look natural. Gone are the days of looking “frozen” or of over-filled lips (thank goodness!!). Botox and filler treatments should make people look rested and more youthful. If someone compliments your Botox or filler, then your doctor did not do a good job!
What’s new in the area of anti-aging treatments? Do you find any new treatments particularly exciting?
I can’t talk about anti-aging without talking about sunscreen and topical retinoids. Don’t waste your money on expensive anti-aging treatments if you are going to tan or smoke. Ultraviolet damage and cigarette smoking promote aging of the skin. On the other hand, everyone who is interested in anti-aging skin care should be on a topical retinoid. From a procedural standpoint, I love Botox and filler. While many of the fillers are FDA-approved to treat the nasolabial folds (the parentheses around the mouth), the trend is to volumize the face in other locations (i.e. the “apple” of the cheek, the temples, the chin).
MEET MOUNT KISCO DERMATOLOGIST DR. DAVID BANK
With his finger on the pulse of the latest cosmetic treatments and procedures, Dr. David E. Bank is the founder and director of The Center for Dermatology, Cosmetic, and Laser Surgery in Mount Kisco, NY – named one of the top ten laser centers in the country by Self magazine.
Dr. Bank has over 20 years experience in the filed of dermatology. A frequent guest on television shows including 20/20, The Today Show, and Good Morning America, he is a go-to skincare expert when it comes to such issues as skin cancer and the newest technologies and treatments. Additionally, he serves as a regular resource for the nation’s top health and beauty publications.
After receiving his M.D. from Columbia College of Physicians and Surgeons, Dr. Bank competed his residency in Dermatology at Columbia-Presbyterian Hospital and Medical center, where he remains a member of the teaching faculty. He is a lead investigator in FDA clinical trials and serves as the President of the New York State Society for Dermatology and Dermatologic Surgery.
Dr. Bank is the author of Beautiful Skin – Every Woman’s Guide to Looking Her Best At Any Age, a comprehensive guide to appearance enhancement for women of all ages and skin types. Here he shares some of his best tips on products, treatments and coping with seasonal weather changes.
What types of treatments do you recommend for a woman who has never had one? Which are the least severe or the most simple?
There are a host of minimally-invasive treatments available for women who have never previously undergone any cosmetic procedures. By far the most simple are Botox injections, which were the most popular treatment in 2010, with five million of these injections performed on women. Other simple procedures include soft tissue fillers, chemical peels, laser hair removal and microdermabrasion – which involves the exfoliation of the outermost layer of skin cells using tiny crystals. This stimulates cell growth and results in healthier-looking, more youthful looking skin.
What are some of the latest products out there that you would recommend for anti-aging?
New Prevage Antioxidant Cream ($155) contains idebenone, which is the most powerful antioxidant cream available. This cream reduces the appearance of fine lines and wrinkles and restores youthful-looking skin. Other facial creams include, 15% Moisturizing Facial Cream by Topix Pharmaceuticals ($25), which exfoliates and moisturizes the skin to improve texture and tone. Kinerase Cream by ICN Pharmaceuticals ($70) is also clinically proven to reduce the signs of photoaging with no resulting irritation. The new Bio-serum Intensive Treatment serum ($199) from Neocutis “teaches” your skin cells to act like young ones. It dramatically reduces fine lines, plumps and tightens the skin.
What can you tell us about future skincare treatments in development and what do you think will be the next big treatment everyone will be asking for?
2012 will bring around more affordable, appealing natural and organic skincare products. We will see products and treatments, which focus on sustainability and green beauty such as less packaging, straightforward ingredients and the evolution of chemical-free claims. Belotero is the hottest new filler for 2012. It is more fluid then the current hyaluronic acid fillers and is used for the fines around the mouth and eyes with dramatic results.
Does diet affect the skin? What foods should we be cautious of to avoid skin reactions like acne, dry skin, etc.?
It is important to try to stay away from refined sugars as these upset the skin’s natural pH balance and are likely to result in acne and pimples. Caffeine has been shown to be a potent diuretic, which removes water from your skin. Alcohol also removes water and water-soluble vitamins from your skin. Dehydrated skin looks older and more wrinkled. Water soluble vitamins such as Vitamin C act as potent antioxidants. Adding more vitamins A and C, zinc and omega-3 to your diet can work wonders for a soft and moist skin. Vitamin C helps to restore collagen in the skin which can help to smooth it out, eliminating puffy eyes or dark circles that can often result from long nights of drinking and eating during this time. Vitamin A is also an important antioxidant. Overall, the main thing to remember is that maintaining a wholesome, balanced diet is the key to supporting both a healthy skin and lifestyle.
What are some basic skin routines everyone can implement to refresh their skin during the winter?
The winter climate can prove very challenging for most skins. The harsh change in weather can result in flaking, cracking dry skin that is very uncomfortable. In the cold months, it is essential to moisturize more. Find yourself a moisturizer that’s oil-based rather than water-based or a cream as these will create a protective layer on the skin that retains more moisture. Sunscreen can also help keep the skin healthy, especially when you are exposed to snow glare. Applying some before leaving home will help you avoid sun damage to your skin. Make sure to keep your hands warm as the skin on them is thinner than on most parts of the body. Lastly, avoid long, hot baths as these break down the lipid barriers in the skin – leading to a loss of moisture. Also, for a more on-the-go treatment moisturizing practice during the winter months, keep a little rose water in your purse. In addition to its anti-aging ingredients a spritz of rose water also won’t smear your makeup. If you’re not a floral person try a Vitamin E mist with cooling agents such as aloe vera. Your best option is also to seek the care of a specialist who can provide you with the best advice on the skincare you should be using if your dryness is severe during the winter. Moisturizing creams that contain hyaluronic acid such as Hyalatopic are excellent ways to bring moisture into the skin. Hyaluronic acid brings and traps water into the skin.
MEET DONNA BILU MARTIN – SOUTH BEACH DERMATOLOGIST
Donna Bilu Martin, MD is a board certified cosmetic dermatologist at South Beach Dermatology in Miami, as well as in Aventura, Florida at Horwitz Dermatology. Her colleague in South Beach Dermatology is Dr Stephen Mandy. A graduate of the Johns Hopkins University and the Johns Hopkins School of Medicine, Dr. Bilu Martin completed her residency at the University of Maryland Medical System. She is the “Make the Diagnosis” editor for Skin and Allergy News online and a volunteer instructor in Dermatology at the University of Miami. Sought frequently by the media, Dr. Bilu Martin is quoted regularly on television and in print on topics in medical and cosmetic dermatology, and has been published extensively in medical journals.
What has been one of the biggest changes in dermatology?
One of the biggest changes in dermatology and medicine in general has been the advent and use of social media to communicate information to the public. Our two offices have facebook accounts that are regularly updated. I am on twitter @drbilumartin, and I also write a blog called “This Derm’s Life.” You tube is also huge. In addition, I follow groups like the American Academy of Dermatology, the Skin Cancer Foundation, and Skin and Allergy News to stay up to date on the latest technologies. Social media gives dermatologists the opportunity to convey not only new happenings and specials at the office, but also information on novel treatments and products, and tips on keeping skin healthy. The patient feels more in touch with the physician. That being said, patient privacy is paramount, and the internet is no exception to that.
What trends are you seeing in South Florida?
In an area where the heat is on and the clothes are off, women and men are very beauty and health conscious, and appearances matter. Most people come in asking for procedures that will not make them look “done.” They want to look rejuvenated, but still like themselves. I like to use a multifaceted approach focusing on skin texture, wrinkling, and pigment changes as well as correcting areas of volume loss.
What procedures are your favorites to perform?
I love to use neurotoxins to create an upper face that is smooth but still has movement, so it looks natural. The precise placement of conservative amounts is key to avoid the “frozen” look. I enjoy using fillers to achieve a pan-facial volumization of the face tailored to each specific patient, rather than just trying to fill a naso-labial fold. That’s where the real art of fillers comes into play. Paying attention to the aesthetic of each specific face is important – every face is unique and has different areas to be addressed. My absolute favorite area to fill is the lips. People are afraid of having the dreaded “duck lips” – a dead giveaway that you’ve had a treatment. I follow the natural contour and anatomy of the lips to stay true to the original shape and proportions.
What three products are “must haves” in any beauty routine?
The number one, non-negotiable, in anyone over 6 months of age is daily sunscreen. My favorites are MD Solar Science mineral sunscreen with tint for the face, SkinMedica Environmental Defense SPF 50, and La Roche Posay Anthelios. I also recommend an antioxidant serum or cream that contains ingredients such as vitamin C, vitamin E, resveratrol, green tea, coffeeberry, and niacinamide. I love the Revaléskin line with coffeeberry, NIA24 intensive recovery cream, and SkinMedica’s TNS Essential Serum. Finally, a retinol or vitamin A derivative helps prevent and reverse damage from the sun and aging. Pregnant or nursing women should not use vitamin A creams.
You must see a lot of sun damage in South Florida. Tell us about it.
Absolutely, and it always amazes me how many people my age and younger are still baking in the sun and using tanning beds, despite all the information and media awareness of how sun exposure is a risk factor for melanoma. Education is so important, especially for the younger generations. If we can stop the sun/tanning addiction from forming, we can save lives. Melanoma is the most dangerous type of skin cancer, but if caught early, it has an excellent prognosis. I speak at elementary schools to teach second and third graders how to protect themselves from the sun, and encourage them to spread the word. Campaigns like The Skin Cancer Foundation’s “Road to Healthy Skin Tour,” in which dermatologists like myself volunteer to conduct free skin exams, helps to raise awareness. Examining your own moles regularly for changes and seeing a dermatologist at least once a year helps ensure early detection.
What ways do you employ to reverse some of the damage?
For brown spots caused by sun damage, Elure Advanced Skin Lightening System by Syneron, a lightening cream that is hydroquinone-free, is highly effective. Retinols, or vitamin A containing creams, as well as creams containing azaleic acid, kojic acid, glycolic acid, and licorice can all lighten spots. Lasers, such as the intense pulsed light and Fraxel Dual Re:Store work well to improve spots with little down time. If there are chest wrinkles in addition to pigment changes, the Active FX laser, a fractionated carbon dioxide laser, can improve the appearance greatly. Remember, any brown spot that is new or changing needs to be examined by a dermatologist for skin cancer. And use sunscreen/sun safe practices to prevent future damage!
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