Heal Your Skin: Fixes for Complexion Complaints

Adult Acne

Now more than ever, the
doctor's office can provide
healing skin options, from
skin-calming injections to
cutting-edge medications.

Acne can strike at any age, and its blackheads, whiteheads, inflamed red bumps, and cysts can be traced to the same culprit: sensitivity to androgens, a group of hormones that enlarge oil glands and induce more oil production. In addition, the hair follicles shed skin cells that combine with the oil, plugging the pores.

What causes this interruption? Usually it's genetics and stress. Bacteria, yeast, and debris accumulate in the blocked follicle. The body's immune system reacts by inflaming the area, hence the redness and swelling. In a word, acne. So there you are, staring at the mirror in disbelief.

A dermatologist can help you devise a regimen that treats all of acne's triggers, with these solutions:

• Retinoids: These vitamin A-based creams and lotions reduce inflammation, kill bacteria and yeast, and kick-start the shedding of skin cells so that follicles don't get blocked in the first place, says Wilma Bergfeld, MD, of the Cleveland Clinic. Retinoids, however, make the skin more sensitive to sun, so be sure to use them only at night.
• Isotretinoin: This version of vitamin A decreases oil production, making the skin less hospitable to bacteria and yeast. Because this drug can cause serious birth defects, women who take it must agree to use two forms of birth control and be carefully monitored for pregnancy.
• Antibiotic and benzoyl peroxide combination: This prescription product attacks bacteria and yeast.
• Hormonal imbalance check: Some dermatologists will also screen for hormonal imbalances, which can cause breakouts -- birth control pills can help with this, as can anti-androgen pills.
• Cortisone shots: "Physicians can shrink deep cysts by injecting a slow-release cortisone derivative," says Caroline S. Koblenzer, MD, clinical professor of dermatology at the University of Pennsylvania.
• Light therapies: Certain lasers unclog closed pores and reduce oil production.

Classic acne fighters, such as benzoyl peroxide or salicylic acid, remain the gold standard. You can find them in everything from cleansers, such as Neutrogena Deep Clean Cream Cleanser, $5.99, to spot treatments, such as Kinerase Clear Skin Blemish Dissolver, $39. And owing to the rise in adult acne, many skincare products now combine these active ingredients with soothing botanicals to help prevent any potential irritation. Also, beware oil-rich moisturizers that can block pores. Remember, the more consistent you are with your antiacne regimen, the less likely you are to have a blemish in the first place.

Rosacea

The exact cause of rosacea, an increasingly common chronic skin condition that affects 14 million Americans, is unknown. Generally speaking, it's characterized by redness flare-ups, bumps, and pimples, which occur in two distinct stages. First, blood vessels in the face become permanently enlarged, bringing on rosacea's typical "flushing and blushing" on the cheeks, chin, nose, or forehead. In the second stage, the skin develops red bumps or inflamed pimples.

Since rosacea is often confused with acne, it's crucial to be diagnosed by a dermatologist. "What we prescribe for acne may be too strong when you have rosacea," cautions New York City cosmetic dermatologist Neal Schultz. Additionally, it's helpful to be aware of triggers that can set off rosacea flushing, such as sunlight, extreme hot or cold weather, wind, hot baths, certain foods, spices, and alcohol.

"The goal in treating rosacea is to prevent its progression," says Zoe Draelos, MD, clinical associate professor of dermatology at Wake Forest University School of Medicine. Treatments include:

• Low-dose antibiotics: These reduce the redness or inflammation. These are ideal for protecting against developing bacteria that are resistant to treatment.
• High-dose oral or topical antibiotics, as well as oral sulfa drugs: These treat rosacea's acne-like symptoms.
• Light therapies: These reduce inflammation, kill bacteria, and shrink enlarged blood vessels; they can be used with antibiotics or instead of them, says Dr. Draelos.

The skincare aisles are now chock-full of rosacea treatments, which can be confusing. According to Dr. Schultz, rosacea sufferers have to be extremely discriminating about what touches their skin. The goal should be to cleanse gently, such as with Eucerin Redness Relief Soothing Cleanser, $8.99. Calm redness with a mild moisturizer (try La Roche-Posay Rosaliac Skin Perfecting Anti-Redness Moisturizer, $30), and keep the skin cool to avoid setting off a flushing episode. Since the sun's rays are another trigger for rosacea outbreaks, using sunscreen is absolutely crucial. A good choice: La Roche-Posay Anthelios SX sunscreen with Mexoryl, $29, an ingredient recently approved by the FDA for its potent UVA protection; it also works against UVB rays.

Eczema

The 15 million sufferers in this country who experience the relentless itching and nonstop scratching that characterize eczema know just how uncomfortable this condition can be. Other symptoms include inflamed, dry, and sometimes cracked skin that is especially vulnerable to infection.

"People with eczema get rashes from things that most other people don't get rashes from," explains Dr. Schultz, adding that seemingly benign objects such as contaminants on paper clips can set off a reaction. Interestingly, people with eczema are also often prone to asthma or hay fever and if one or both parents have these allergic conditions, their offspring are likelier to develop eczema.

"Eczema is a disease we normally associate with infants and children," says Bruce A. Brod, MD, clinical associate professor of dermatology at the University of Pennsylvania. So when adults get it, it's important to have a doctor confirm it's not a drug reaction or mycosis fungoides, an uncommon T-cell lymphoma of the skin that causes a long-lasting itchy rash and slowly spreads. (It's rare but definitely something to rule out.) Here, a few medical options:

• Corticosteroid ointments: These medical mainstays reduce itching and inflammation. Since cortisones can thin the skin, a doctor may also prescribe topical calcineurin inhibitors. Since this alternative has received an FDA black box warning owing to a possible increased risk of lymphoma, discuss your options with your doctor.
• Antihistamines: They can help you get a restful night's sleep by temporarily relieving itching.
• Light box treatments: These treatments help to reduce eczema's symptoms, most likely by reducing the white cells in the skin that contribute to inflammation.

Itching and irritation are the top concerns of eczema sufferers, so it's crucial to stick to facial products that are as free from fragrances and preservatives as possible -- both can inflame sensitive skin. Also, because eczema can affect the whole body, it's smart to be equally wary about ingredients when choosing body products. Lotions that list water or alcohol high on the ingredient listing are detrimental to the skin, as they provide less moisture and may irritate the skin. Most soaps are also no-nos since they dry out the skin's protective upper layer. Instead, try dermatologist-recommended products, such as Dove Sensitive Skin Unscented Beauty Bar, $2.49 for two bars.

The most effective advice is to avoid over-bathing by taking short, lukewarm showers no more than once a day. "The hotter the water, the more likely it is to open the skin's pores and let the water in your skin escape," explains Dr. Schultz. "Also, very hot water will cause the release of histamine, making your skin itchier." After bathing, help your skin hold on to precious moisture by patting dry and slathering a humectant-rich body cream, such as St. Ives Mineral Therapy Advanced Body Moisturizer, $4.99, or Olay Quench Body Lotion for Sensitive Skin, $6.99, all over your body. (Extra-dehydrated spots, such as elbows and heels, will soak up rich balms such as Vaseline Intensive Rescue Heal and Repair Balm, $8.99, while itchy hands will get relief with Cortaid Advanced Long-Lasting Anti-Itch Hand Cream, $8.49.)

Psoriasis

Psoriasis is an inherited chronic skin inflammation that causes cells to grow too quickly, producing thick red patches often covered with silvery scales. These can occur on most parts of the body but are commonest on knees, elbows, scalp, hands, feet, or lower back. Affected fingernails become thickened and pitted.

Psoriasis afflicts between 5 and 7 million people in the United States, according to Mark G. Lebwohl, MD, chairman of dermatology at Mount Sinai School of Medicine and chairman of the National Psoriasis Foundation Medical Board. Psoriasis can't be cured but episodes can be controlled. Here, some options:

• Corticosteroids or calcipotriene (a vitamin D derivative) creams and ointments: They can reduce inflammation.
• Ultraviolet light treatments: Applied three times a week for three months, they can temporarily clear up psoriasis by slowing down the cell turnover process, hence normalizing the skin's appearance.
• Methotrexate (developed to fight cancer), cyclosporine (an immune-suppressing drug), or acitretin (a retinoid similar to isotretinoin, a powerful acne medication): These are reserved for severe cases. All can heal psoriasis outbreaks in days to weeks but carry potentially serious side effects.
• Biologics: This new approach, in which patients inject themselves with drugs, targets the immune system and blocks inflammation. Biologics carry fewer side effects than traditional psoriasis treatments and can be used for longer periods of time.

Over-the-counter products aren't as effective on thick, red psoriatic patches as doctors' treatments, but they still offer great relief. Start with a 15-minute soak with mineral-rich bath salts, which are soothing, and top with rich creams and ointments that help seal moisture in the skin. Try Vichy Laboratoires' Nutrilogie 2 Intensive Nourishing Moisturizing Cream for Very Dry Skin, $24, for the face and Jergens Shea Butter Skin Enriching Moisturizer, $4.29, for your driest body parts.

Healing Products

Queen Helene Mint Julep Masque, $3.29, uses sulfur to kill acne-related bacteria.

For soothing bathing if you have psoriasis, try moisture-rich soap, such as Palmer's Olive Butter Formula Organic Therapy Soap, $2.60; itch-relieving oatmeal bath soaks (good for eczema, too), such as Aveeno Skin Relief Bath Treatment, $7.22; healing oils, such as (4) Kneipp Moisture Bath Oil, $19, and mineral-replenishing preparations, such as AHAVA Dead Sea Bath Salts, $18. Protect your precious moisture supply with a rich emollient, such as Aquaphor Healing Ointment, $5.99, excellent for psoriasis sufferers.

Some research shows omega-3 fish-oil tablets may benefit dry skin. Try Nature Made Fish Oil Supplements, $8.68.

Sufferers now have a new strategy to try: Oracea, the first oral drug approved by the FDA for the treatment of rosacea bumps and pimples (available by prescription).

It does exist -- makeup that heals and nurtures all skin types and helps you look flawless!

Keep pesky blemishes at bay with salicylic acid-based concealer and foundation, such as Clinique Acne Solutions Concealing Stick, $13.50, and Almay Clear Complexion Liquid Makeup, $12.49.

Try Eau Thermale Avene Couvrance Mosaic Powder, $18, and Dermacia MD Lycogel Camouflage, $61.

Mineral makeup is composed of natural substances, such as mica, zinc oxide, and titanium dioxide to deliver as little or as much coverage as you desire. You'll love the formulas' built-in sun protection and fragrance- and talc-free ingredient listing. A few to try: Bare Escentuals i.d. bareMinerals SPF 15 Foundation, $25. Pur Minerals 4-in-1 Loose Mineral Makeup/Foundation, $23.50. Physicians Formula Mineral Wear Talc-Free Matte Finishing Veil, $11.95. L'Oreal Paris Bare Naturale Gentle Mineral Blush, $15.25. Apply with Bare Escentuals Full Coverage Kabuki Brush, $28.

Originally published in Ladies' Home Journal, February 2007.