Comedones to Accutane: How did we get here from there?

It's a sign of the times, and by that I mean it's a sign of the hot, sticky Louisiana summer settling in, that I have already seen two beautiful, relatively clear-skinned young ladies this spring whose dermatologists have brought up Accutane to them.  In both cases, thankfully the women were smart enough to know that applying this dangerous, sometimes debilitating medication to their annoying-but-treatable acne breakouts was, in a word, overkill.

If I've said it once, I've said it a hundred times - Isotretinoin is serious stuff!  So serious that we can't even call it Accutane any more because Roche's brand name product, Accutane, was pulled from the market in 2009 due to massive inflammatory bowel disease lawsuits, leaving today's patients with one of the many generic versions such as Claravis, Amnesteem, or Sotret.  And if you're a client of the Skin Studio or have read this blog before, you know that I think acne is serious too.  With its rap for causing preoccupation, social withdrawal, anger, embarrassment, poor body-image, low self-esteem, reduced self-confidence, and even affecting job and relationship success, you'd want to be rid of it too!

Despite all its terrifying side effects (mine were vision complications and full-body hives, leave yours in the comments!), I still think that isotretinoin has a place in acne care. However, unlike some of the dermatologists I have heard about (not even looking at a patient's skin under a lamp? Really?), I stand firmly with the American Academy of Dermatology's Position Statement on Isotretinoin: that it is "the most effective treatment for severe recalcitrant nodular acne." If you don't have a sensitive stomach, you can see what an image search for that type of acne turns up here.

I'm absolutely not trying to be glib about a condition I suffer from and care a lot about helping others overcome, but guys, "severe recalcitrant nodular acne" accurately describes a very tiny number of acne sufferers.

More importantly, I think there are a LOT of acne-clearing steps that can and should be taken before resorting to a dangerous and potentially life-altering drug!  You've heard me say it before, but nutritional Vitamin A absorption, a topical exfoliant home care regimen, and effective skincare treatments, when combined with education and consistent application, can clear up most acne.  And when the possible alternatives are IBS, Crohn's disease, ulcerative colitis, severe depression, suicidal thoughts or actions, birth defects, liver damage, joint pain, muscle pain, and/or vision changes?  Here's hoping that other acne sufferers out there try it my way first!

At the end of the conversation, unlike many estheticians out there, I don't think that isotretinoin should be outlawed.  For some individuals suffering unthinkable, disfiguring acne, it's a reasonable risk.  But I do think that dermatologists need to think long and hard about prescribing it, and I hope this round of client anecdotes is the last I hear of frivolous Accutane prescriptions.

Oops, I'm Peeling!

Successful acne-clearing and anti-aging routines revolve around exfoliants, as we've discussed in previous posts here, here, and here. For the most part, exfoliating treatments are super-predictable, often down to the day and time of day that you are likely to start peeling. But what happens when your skin doesn't stick to a schedule? And what can you do to minimize peeling when you weren't expecting it?

Peeling on purpose, but you get the picture

Lunchtime peels are not intended to produce visible peeling. The acids are light enough to break apart only the most superficial dead skin cells, allowing them to release cell by cell, without perceptible peeling. Occasionally, lunchtime peels (including microdermabrasion and dermaplaning) may produce some unexpected peeling, especially in the following cases:

• Dry weather
• Increased absorption from pretreatment
• Vigorous exfoliation after treatment

Medium peels are designed to slough off the whole top layer of the skin, while sparing the pink, juicy "live" skin underneath. The exfoliated skin generally peels in small, flaky bits, which are easily removed with gentle cleansing and a washcloth. With medium peels, a few unusual responses sometimes observed are:

• Darkening of the skin, especially over areas of hyperpigmentation
• Starting to peel early, or continuing to peel beyond the usual five days

Intensive and double peels are intended to exfoliate the entire top layer of the skin, while allowing some acid to stimulate collagen production in the underlying dermis. Skin is expected to darken, harden, and peel in large sheets, like a sun or wind burn would(although blistering, scabbing, and oozing, which would indicate a medical-strength peel, are not expected). As with medium peels, skin sometimes peels outside of the usual range of five to seven days, which may be inconvenient for work or social reasons.

In any of these cases, it's a great idea to contact your esthetician if you think you may be experiencing something out of the ordinary. Generally, as long as you are at least two days post-treatment, it is safe to use an ointment. We like Vivant's Recovery Ointment, available at the Skin Studio*, which blends aloe vera juice with the standard occlusive petrolatum. Other good options are Aquaphor and Elizabeth Arden's Eight Hour Cream (the original balm formula, not one of the spinoff cremes). When you find yourself peeling unexpectedly, avoid scrubbing with all your might! Scrubbing at this juncture will leave you with raw, red skin that is almost impossible to conceal. Instead, slather on one of these occlusive preparations. You are essentially gluing down the peely skin. Go as long as you can in the day with just balm on your skin before you need to apply makeup. Then, tissue down the occlusive ointment to the bare minimum needed to keep the peely skin glued down, and apply makeup with a minimum of friction (this is not the time to perfect your blending technique). If prior to applying makeup, the peely skin is reeeaally obvious under the ointment, then you have my permission to wipe your face gently, one time, with a warm washcloth, but proceed with caution - peely skin is always easier to cover than raw skin!

Hopefully these instructions will help in the event that you experience "bonus peeling." Do you have any post-peel photos? Share a link in the comments section below!

*This ointment is available in our online store to existing studio clients when logged in.

Hormonal Acne: Myth vs Fact

I am surprised how often I am asked, "does your studio help people with hormonal acne?"  And my answer is a resounding "Yes!"

The question reflects a widely-held but scientifically inaccurate assumption that somehow "hormonal acne" is different, and that there is nothing topical or nutritional that can be done to clear it up.

In reality, all acne is influenced by hormones.  Acne is the proliferation of comedones (blackheads or whiteheads) leading to pustules, papules, and sometimes cysts or nodules.    Comedone formation is subject to many factors, among them sebum thickness.  A predominance of androgens or male hormones thickens the sebum, while lower proportions of those hormones result in less viscous sebum.  For some women who are both struggling with acne and who wish to be on oral contraceptives, simply using a pill that is higher in estrogen and lower in androgens* can go a long way towards clear skin.  Likewise, certain hormonal birth control, especially those advertised as being low in estrogen**, can be responsible for thickening sebum enough to cause a problem for women who may not otherwise consider themselves acne-prone.  If acne breakouts begin while taking these hormonal contraceptives, in my opinion it's worth a phone call to the prescriber to find out if there might be a more suitable choice of hormonal contraceptive.

Despite what you may have heard about "hormonal acne," though, hormones are not the only factor.  Furthermore, I often see clients who do not want to or cannot take hormonal medications for a variety of personal and medical reasons, and clients for whom the main androgenic hormones acting on the thickness of their sebum are likely to be stress hormones like adrenaline and cortisol.  Unfortunately, I have observed instances in which dermatologists and gynecologists lump these people into a "hormonal acne" header and tell them they have to take birth control pills if they want their acne to clear up.  I know from experience that this does not have to be true, so I think it's important to shrug off the notion of hormonal acne and work on the causes of acne that we can control.  While hormones exert a very important influence on the thickness of the sebum, hormone levels are never the whole store behind an individual's acne.  A comedone forms in a pore when there is a combination of factors present, of which thickened sebum is only one.  The other factors in the development of a comedone (and progression from comedone to pustule or cyst) are:

• the rate at which stratum corneum (dead skin cell layer) cells detach and shed off the skin surface as a whole and the pore lining in particular (determined by genetic and nutritional factors but primarily topical skincare routine)
• the presence of acne-causing bacteria (which can sometimes proliferate excessively as a result of overscrubbing) 
• the overall health of the skin (which can be compromised by exposure to comedogenic substances, UV light, oxidation from sources like cigarette smoke and pollution, and nutritional factors)

The reason that we don't treat "hormonal acne" differently from any other acne at the Skin Studio is that for our purposes, they aren't different!  Our treatment approach does include some minor nutritional adjustments, but is primarily topical, and it's been our observation that even skin that is breaking out under an onslaught of hormonal aggrivators (for example, when corticosteroids have been prescribed after an injury or for an episode of a chronic illness) can remain clear with pro exfoliating treatments and skincare.

*Some examples of birth control pills in this category are Yaz and Yasmin, Ortho TriCyclen, Diane35, and Desogen (Apri).
**These include the Nuva Ring, DepoProvera, Loestrin, and Estrostep FE.

The Skin Studio Now Offering Luxury Body Treatments!

Services Include Mineral Wraps, Scrubs, Cellulite Treatments and Therapeutic Massage

The Skin Studio, located at 725 Joseph St at the corner of Magazine and Joseph in uptown New Orleans, is proud to announce the expansion of its body services menu. The same team of experts you have trusted to give you smooth, glowing skin now brings you deluxe spa body treatments in our beautiful Uptown loft. In the serenity of our indoor garden, you or a loved one can experience blissful relaxation while receiving New Orleans’ most customized care.

Having offered traditional and classic massage therapy in the past, the Skin Studio now offers a range of indulgent body treatments, such as the Body Glow with Relaxation Massage. With this treatment, clients choose one of three professionally formulated scrubs for gentle exfoliation, stimulation and custom results: the Tumeric Neem Glow (for brightening and clarifying); the Lavender Sugar Glow (for deluxe hydration); or the Coffee Salt Body Polish (for brightening and slimming). The treatment includes up to a full hour of relaxing therapeutic massage.

Results-oriented treatments include the exclusive Cellulite Buster with Ultrasonic and Infrared therapy, which targets problem areas with a special kneading massage technique and a cellulite-busting formulation of powerful active ingredients (including caffeine, guarana, carnatine and amino acids). These ingredients penetrate deep into the skin using ultrasonic technology, firming skin and reducing the appearance of cellulite; in addition, clients enjoy a relaxing scalp massage during infrared light therapy.

The Skin Studio’s licensed massage therapists are trained in a wide range of modalities, which are used in combination to best address client needs during each session. Massages can be upgraded to include deep tissue and hot stone therapy.

The Skin Studio’s services also include clinical skincare and cosmeceutical treatments, facials, waxing, lash and brow tinting, and more. For more information, or to schedule an appointment, please call or text 504-717-4466, or email reservations@skinstudioneworleans.com.

The Mother-in-law Request: Free Esthetician Advice?

On a recent visit to my in-laws, my husband's mom had series of anti-aging questions which I think are best answered together.  She asked:

"I have hereditary dark spots on my face.  My dermatologist is willing to freeze them off when I go in for my cancer screenings, so I have had many of them on my cheeks and the sides of my face removed this way.  I am nervous about asking him to remove one that is located on my upper lip because it will look like like I have a sore there.  Is there any other option?  Also, I have some broken capillaries.  Could he do those with a laser, and if so, do you think he could get the dark spot with the laser, and would that prevent it getting scabby?" 

I think this is a great line of questioning because it reflects the concerns many women have about the best approach for the health and beauty of their skin!

I told my mother-in-law that she's thinking along the right lines by endeavoring to consolidate treatments and minimize downtime.  Unfortunately, like the experience she has had with liquid nitrogen, the mechanism by which lasers lighten dark spots always results in the spot darkening, scabbing, and falling off (just like laser hair and tattoo removal, where the pigment molecules are broken apart by the therapeutic light, and must be expelled or reabsorbed), so a laser would not be the best solution to solving the pigment problem without scabbing.

Since my mother-in-law is using a retinoid but not a skin lightener, I recommended that she incorporate Bleaching Cream, from the Skin Studio.  It is a blend of the active retinoid retinyl propionate and 2% hydroquinone, plus citric and kojic acids to provide additional brightening benefit, and aloe to prevent irritation from the active ingredients.  Once skin is preconditioned with a retinoid/lightener/hydroxy acid regimen, great results are possible from peels.  Preconditioned skin will peel and heal even better, with rapid healing time and more complete spot removal.



As for the broken capillaries, lasers can be a great option, but treatments come at a risk of burns or scars.  The risk is minimized by having any treatment performed by someone who has substantial hours logged on the device they are using.  In addition to traditional laser light (in which the light is collimated or focused into one tiny laser point), there are also intense pulsed light treatments, including the noninvasive Radiancy Facial at the Skin Studio, which offer a very low-risk means of reducing redness and homogenizing pigment, especially when you can schedule treatments twice a week for five weeks.

Finally, as mentioned in the previous post, peptide technology can be a great adjunct to traditional means of lightening pigmentation, and can also stimulate skin repair during traditional bleaching treatments.