Correcting Skin Flaws

Last Editorial Review: 6/8/2005

WebMD Live Events Transcript

Whatever your skin flaw -- dark circles, age spots, freckles, moles, enlarged pores, splotches and pigmentation problems, broken capillaries -- you'd like it to go away! Now you can get advice from dermatologists Katie P. Rodan, MD, and Kathy A. Fields, MD. They joined us on May 17, 2005 to answer your questions about correcting skin flaws.

The opinions expressed herein are the guests' alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Welcome back to WebMD Live, Dr. Rodan and Dr. Fields.

Hi everybody out there. Bring us your skin questions.

I have always had dark circles under my eyes. I don't like using the tinted under-eye products because they are so thick and hard to blend. They say yellow is how to disguise them, but I don't feel it is helpful for me. Is there another remedy?

Under-eye circles are common, normal, and genetic and they worsen with age, stress, lack of sleep and a million other factors.

In truth, under-eye creams that claim to completely erase dark eye circles don't work. However, if there is brown pigment it can be lessened with a hydroquinone-bleaching agent. There are advanced eye creams with reflective particles that lessen the look of dark circles and excellent hydrating agents that smooth the area.

Certainly eye concealers are the best for concealing, but painting it yellow is an extra unnecessary step.

"Lasers, like the ruby lasers, which are good for dark circles, may be risky in a person of a dark skin type."

I have dark circles under my eyes, what can I do for that? I am African-American.

First of all your concern is a very common one. These dark circles are more prominent in darker skinned individuals. This is because of postinflammatory hyperpigmentation.

The eyelid skin is very delicate. This skin becomes inflamed or irritated due to allergies or frequent rubbing of your eyelids and the delicate capillary network in the skin becomes damaged and releases red cells. Red cells contain iron, and that dark iron pigment deposited in the skin can make these dark circles particularly difficult to remove.

Lasers, like the ruby lasers, which are good for dark circles, may be risky in a person of a dark skin type. Therefore, camouflage is your best bet. You can use eye creams that contain light diffusing particles, such as mica, and a shade or two lighter than your natural pigmentation.

I'm interested in trying Blue Light Therapy for my acne and oily skin. What should I ask about this procedure? How common is this medical procedure?

Blue light therapy has been available for approximately three years. It is best for mild to moderate, but less satisfying for severe cystic.

It is a tedious procedure where you come in twice a week for a month and you continue topical, over-the-counter or prescription medication before, during and after therapy. The success rate of controlling acne is just fair. It is certainly not a cure. I have a blue light in my office and we're using it infrequently because of this.

There are a lot of new nonablative lasers on the market now for acne and they are all expensive. None of them cure acne, all require multiple treatments at about $500 a session and topical care will be required following the therapy.

The newest light method is where the doctor paints the chemical ALA (aminolevulinic acid) on the full face, the face is exposed to a light, there is a burn on the skin for approximately one week and the acne may stay clear for several months. This is highly investigational and not mainstream yet. It is also not a cure.

I've got a lot of dark scaring from acne problems. How can I get rid of them faster? Also what can be done about craters that have formed due to acne?

The dark marks are a common aftermath from a healing pimple. It's called postinflammatory hyperpigmentation and is not a true scar.

First, you must get control of your acne so that you don't continue to get more of these brown spots once the pimple has healed.

Second, in order to remove these brown spots, a combination approach works best. The use of hydroquinone-bleaching agent in a 2% to 4% range used over the entire face once to twice per day, along with daily exfoliation, will help to gradually fade these dark marks over a period of two to four months. Microdermabrasion (a procedure performed either in an aesthetician's or doctor's office) is a deeper form of exfoliation and will allow the hydroquinone-lightening agent to work a little faster. This procedure must be performed every two weeks for approximately 6 to 8 treatments.

The other part of your question, namely the shallow acne scars, can be a permanent fixture on one's face. Removing them is quite difficult and requires treatments performed either by a dermatologist or plastic surgeon. These treatments include CO2 laser or dermabrasion which creates a wound in the skin following which the skin heals with a less noticeable scar. Another alternative involves plumping up the shallow scars with a filling agent like collagen or Restalyn (or other hyaluronic acid derivative) to minimize the depth of the scar. These injections must be repeated approximately every year to maintain correction.

I have had seborrheic keratoses removed several times by liquid nitrogen at a dermatologist's office. Assuming everything else about my skin is OK and reasonable, is it safe to have this done by someone less qualified, and presumably much cheaper? Could you recommend (generically of course) what kind of professional qualifications I should look for?

"The gold standard of spider vein treatment -- known as sclerotherapy -- is still injections."

Seborrheic keratoses are very common. These tan to dark brown, velvety to course growths, occur commonly on the trunk as well as the face, and can be few or many. After treatment they have the right to grow back and they will pop up.

Dermatologists are most qualified for the treatment of these. Some family practitioners also understand the difference between these growths and melanoma and are able to treat them. Since, however, melanoma can masquerade as these innocent lesions; we really cannot safely refer you to any other specialty.

You may ask your local dermatologist to give you a cash discounted rate to destroy them all instead working with your insurance.

I would like to have my spider veins removed with a laser. I don't have too many yet, but judging by my mother's legs it will continue to worsen. If I have the procedure done now, is there a chance those same veins will come back in the future?

Great question. I've been treating spider veins for many years and I can tell you that while doctors treat the visible ones, new ones are destined to come out years later.

The gold standard of spider vein treatment -- known as sclerotherapy -- is still injections. These veins can be injected with a variety of substances, including concentrated salt solution, and other drugs like Sotradechol. These solutions cause an irritation in the vessel wall which causes collapse of the vessel and eventual death of the vessel. Since these vessels are not important for your circulation and of cosmetic concern only, losing them is no big deal. This sclerotherapy procedure must be repeated several times at monthly intervals for adequate treatment.

You asked about laser treatment. I can tell you from experience, using the laser it is not as good as injection. Many patients ask about it, however, because they believe it is more effective and less painful. Leg vein laser treatment is very painful, expensive, and not as effective in removing the veins as injections, and is also more fraught with side effects, like scarring and permanent pigmentation.

I have large pores that are on my face -- mostly on my cheeks and chin. I've been going to the dermatologist but stopped because it was getting so costly. I was wondering if you could recommend something that could be helpful regarding this matter.

The most common complaint that Dr. Rodan and I hear, both in our offices and out, is "Doctor, I hate my pores, what can I do about it?"

Pores are genetically predetermined, but through aging and hormonal cycles do seem to spread and get larger on our faces. The sebaceous glands under our skin do grow larger as we age, particularly in the nose and forehead regions.

The treatment for pores includes daily exfoliation with either a scrub soap, washcloth, done gently. Next is to apply either a tretinoin product from your dermatologist (Retin A, Tazorac, Differin) nightly. Microdermabrasion by a professional is also helpful if done weekly and used with a prescription grade tretinoin. Daily use of SAL acid in leave-on lotions, as well as retinol over the counter can be helpful for this chronic condition. In all cases, we are unplugging the pore and clearing it of oil and debris, but unfortunately we are unable to shrink the sebaceous gland that lies beneath.

What can I do to hide or get rid of bug bite scars on my legs and broken capillaries on my nose?

The bug bite scars are most likely pigmentation after the bite has healed. The pigmentation on the legs is slow to resolve, compared with other parts of the body like the face, due to poor circulation.

You can try a bleaching/lightening agent that contains hydroquinone. I also suggest to my patients who are going into mosquito-infested areas to get a prescription of a strong topical steroid gel to have on hand. This medicine is helpful to apply immediately to the bite so that it will resolve quickly and be less likely to leave a dark stain behind.

Facial veins, unlike leg veins, respond beautifully to laser treatment. For best results, see a dermatologist who has either the VersaPulse Laser or Intense Pulsed Light (IPL) device. Within one or two treatments, your red facial veins will disappear.

"Melanoma is on the rise. In the 1930s one in 400 people got melanoma and today it's 1 in 70."


Sun-Damaged Skin: See Sun Spots, Wrinkles, Sunburns, Skin Cancer See Slideshow

I have had a light-brown birthmark pigmentation on my right mid-thigh all my life. In the last two years it has changed to bright red in color, has widened in shape and now has a mass-textured feeling to it. Should I be concerned enough to visit my family doctor? What might these changes represent?

Please see your doctor as soon as possible. Moles should not change, and this one certainly has. Call today.

In general, if a mole changes in size, shape or color, it is important to have it checked by your dermatologist. If it's larger than a pencil eraser, if it went from flat to raised (even slightly raised),has gone from a round border to an irregular border or changed any in color (not necessarily black, red is also suspicious) these could all be early symptoms of a melanoma.

While we are talking about melanoma, what are the important things we need to do to avoid melanoma?

First off, be very wise about sun exposure. As much as possible, limit your time in the sun and wear a truly broad spectrum sunscreen containing either zinc oxide or avobenzone.

Never, never visit a tanning salon! In spite of the ads, these salons do not deliver a safe tan.

I also recommend to my fair complexioned patients and those with many moles, to see a dermatologist regularly, at least once or twice a year, to have their moles checked and possibly documented with photography. The key to melanoma is early detection and diagnosis.

Melanoma is on the rise. In the 1930s one in 400 people got melanoma and today it's 1 in 70. Melanoma, when caught early and treated via surgical excision, can be curable. If detected late, it is deadly. Any lesion, including a brown or black pigmented one or even a red bump that is persistent, changing or new, should immediately be evaluated by a board-certified dermatologist.

What can I do for rosacea?

Rosacea is a very common condition whereby the facial skin will flush and blush. The skin will flush with embarrassment, wine, weather changes, exertion and many different kinds of foods. Simple rubbing or cosmetic ingredients can also trigger it.

The condition is also associated with acne, where pimples form primarily on the nose, cheeks and forehead as red bumps without blackheads. The acne component of rosacea can be treated with over-the-counter benzoyl peroxides, sulfur and SAL acids on a daily basis to heal and prevent the problem. Prescription medications include topical metronidiazole, Finacea, benzoyl peroxides, and sulfurs. Oral tetracycline can be used for more severe cases.

The facial redness itself, if it is persistent and consistent with blood vessels across the face, can be improved with Intense Pulsed Light (IPL) light sources by your dermatologist or by using vascular lasers. It does not cure the condition, but after several treatments the baseline color of the skin can be improved with much less facial redness.

I have some age spots on my cheeks and have used NeoStrata HQ Gel 4% for one and a half years with no result. What else can I do? I am light brown and of East Indian descent, 55 years old.

"At this time a facelift is still the gold standard to take away the loose skin in the neck juncture."

The brown spots are caused by chronic daily sun exposure. They're also known as liver spots. Larger patches across the cheeks and nose in women of childbearing age are called melasma. Melasma is caused by the combination of hormones and sun exposure.

You asked how best to lighten these unattractive brown discolorations. In order to do that, you need to accomplish three tasks.

  • First, you must exfoliate daily to remove the scale so medications can better penetrate, and also to enhance cell turnover and lifting of that discoloration.
  • Second, you need to use a hydroquinone-lightening agent over your entire face. The reason being is that the brown spot you may be fixated on is merely the tip of the iceberg. The discoloration may be far more widespread beneath the top layer of skin, causing your skin to look uneven.
  • Third, it is imperative that you use a UVA-protective sunscreen. These sunscreens must contain either zinc oxide or avobenzone. Because it is UVA light that triggers the formation of these brown patches and spots.

By omitting any of these three steps, you will not see results.

Patients often ask me whether lasers can work to remove these brown spots. In some cases they can be quite successful; in others they can be highly risky and darken an already dark mark.

My jaw and mouth areas are sagging. Is there anything I can use or do to tighten these areas without surgery? I have been using StriVectin SD for four to five months, twice per day, and I don't see a difference.

I can relate completely to your question and concerns as a 47-year-old with early sagging in my face.

Unfortunately, laser technology has failed to lift sagging changes. Thermage, which is basically heat energy pumped into the skin, does a minimal if modest improvement in this area for tightening, whereas three out of ten may see visible tightening using this device. Unfortunately, this aggressive heat-generating neck procedure can lead to scarring.

At this time a facelift is still the gold standard to take away the loose skin in the neck juncture. If there is considerable fat in the chin/neck area, liposuction of the neckline can be accomplished with skin tightening for a very satisfying low-risk result.

Topical creams are modestly helpful, but unfortunately will not pull up loose skin. Strict sun avoidance will also help lessen the fall of the skin.

I'm starting to wear turtlenecks, how about you?

Many of my friends are using the new peptide creams for
wrinkles. I would also like to try them but currently use benzoyl peroxide, Differin and a sulfur wash for acne. Would it be unwise to try one of these creams on top of the regimen?

We are also very excited about this new peptide technology.

Peptides are small protein fragments that work by tricking the collagen-producing cells (fibroblasts) into believing that the skin has been injured, so that new collagen is made in an effort to heal the skin. This new collagen helps to thicken up the skin filling in lines and wrinkles.

You can take advantage of this new technology by using it in the morning and it should include a UVA sunscreen with zinc or avobenzone, and continuing your acne medication at night.

Hydroquinone has not worked for me. How long should I use this cream? It costs about $100.00 a jar!

If your pigmentation is not resolving after the methods we described above, we encourage you to see a dermatologist for more advanced therapy.

"The last bit of advice is to avoid the sun, because nothing ages you faster, and use a sunscreen every day, because every day is sun day. "

We are almost out of time. Before we go, do you have any final words for us today?

The best aging remedies you can start with today that are free:

  • Pick your parents carefully.
  • Sleep on your back so there are no sleep crush lines.
  • Remember -- every day is sun day, so wear sunscreen.
  • Never smoke and minimize your alcohol.

The last bit of advice is to avoid the sun, because nothing ages you faster, and use a sunscreen every day, because every day is sun day. That sunscreen must contain either zinc oxide or avobenzone in an SPF 15 or greater.

Wishing you all a lifetime of healthy, gorgeous skin.

Our thanks to Katie Rodan, MD, and Kathy Fields, MD for joining us today. Members, thanks for all of your great questions. I'm sorry we couldn't get to all of them.

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Self-examination is important in the detection of skin cancer. See Answer

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