Extra Oxygen? Will It Help You?

I've decided to take a risk on you, my readers. I've decided that this post, which I've been thinking about writing for a long time, is not too complicated for you. You deserve to know the reasons behind why I think you don't need extra oxygen delivered to your tissues, unless you are ill.

I'm definitely not the only doctor who thinks this, check out this great post from Dr. Benabio's Derm Blog. While I'm not a dermatologist, I'm perhaps even better suited for this discussion than Dr. Benabio. I'm an intensivist. So, I spend my days in the ICU trying to deliver oxygen to tissues basically. I can alter how you breath (I can put you on oxygen or on a ventilator if I need to), how your heart works (I have a huge selection of infusions to increase or decrease your heart rate, blood pressure, etc), and I can give you blood if I need to. While I might have a myriad of reasons to do all of these thing, it all boils down to one thing. My whole day is nothing but oxygen delivery!

I've made a little series of graphics that I think really simplify the whole oxygen delivery process and how oxygen delivery in a normal, healthy person works. Read through the graphics in order and I think you'll understand the whole process!




So, obviously how much oxygen you deliver to your body is determined by how much is in your blood and then how fast you get it there. We are talking about delivering oxygen for you, the person sitting at home right now. So, I'm supposing that your heart is healthy with a normal rate and pumping a normal amount. So, we're going to ignore your heart. People aren't changing their heart rate in "heart rate spas" in the airport, nor are they getting facials with this to improve their skin. We're talking about oxygen.

So, we're looking at that equation at the bottom, it's the one that describes how much oxygen is in the blood. There are a few things in this equation that you can't change (such as the 1.34 and 0.003) because they are based on all sorts of things like barometric pressure. Even in the ICU this is the equation I use, we ignore changing all of those factors. If you lived in Denver we might take that slightly into account, but I really don't care about that right now, so we'll move on to looking at what you can change about the content of oxygen in your blood.


So, it should be pretty obvious now that really the amount of oxygen bound to your red blood cells determines how much oxygen is in your blood. The amount dissolved into the blood (the PaO2) makes a very, very small contribution once it gets multiplied by 0.003.

When blood leaves healthy lungs, the saturation is almost always 100%. In the rare cases that it is not exactly 100% it is in the high 90's. Lung disease can decrease your saturation number, this is when a doctor will put you on oxygen.

So, now I've shown you that it's basically impossible for a healthy person to increase the amount of oxygen in their blood to an extent that the increase is actually substantial.

Let's see why even if you did manage to dramatically increase the amount of oxygen, your body actually won't even notice the difference.


The best thing to look at is how much oxygen your tissues actually use. In order to directly measure that you need to do all sort of crazy calculations, measure how much heat your body puts off, how much water you breath out, etc. Much too complicated for me. We intensivists are simple people, so we look at how much oxygen each tissue takes out of the blood.

It's even easier to look at the amount of oxygen in the blood returning from a tissue. Compare that to the amount of oxygen in the blood you delivered and you can see how much oxygen the tissues are taking out. Each tissue is different, the hard working organs like the heart and brain take out more oxygen, while organs like your lymph nodes and skin take out less. Actually, a lot less. There is a huge amount of oxygen delivered to the skin that it doesn't even take out of the blood. Deliver more oxygen to those tissues and they frankly won't care. They already have 2-3 times more oxygen than they need.


So, why am I mentioning oxygen delivery to tissues? Because people pay a lot of money for extra oxygen. It's delivered a couple of different ways:

1) Inhaled Oxygen: You go to a spa, they put a nasal cannula under your nose for $20 and you pick the flavor you want to smell. They may tell you that it is 100% oxygen (minus that orange scent of course), and that is in fact what is in their tanks. However, in a nasal cannula you are also breathing in the regular room air (21% oxygen) around those little plastic prongs. No matter how fast that nasal cannula is flowing it's pretty tough to get over 30% oxygen with a cannula. We even have special masks that prevent you from "rebreathing" air. They can't get much above 40% oxygen.

So, paying to have a mask or cannula put on for extra oxygen really doesn't make a difference because you aren't breathing enough oxygen. You'll only increase your PaO2 up into the 500 range with 100%, and you would NOT be going to a spa to have them sedate you and put you on a ventilator for that. It's too risky.

As well, ignore all of that bunk about extra pollutants in the air and such making oxygen spas necessary. The air in incredibly polluted areas is still 21% oxygen, that's all that matters.

If you want to go all out via MJ and pay someone to stick you in a hyperbaric oxygen chamber then more power to you. I wish I had that much extra money! Truthfully this will increase that PaO2 number to the ~1000 range, but multiply that by 0.003 and you'll see that you didn't really increase the overall amount of oxygen in your blood by much. Then when you remember how much extra oxygen is in your blood and goes unused by tissues you'll feel pretty ripped off.

2) Topical Oxygen: The final way that people pay for extra oxygen is via facials. Your skin can't absorb oxygen. We aren't frogs. It can't diffuse or filter down into your skin (the epidermis is too tightly bound to itself), and there are no receptors to let it in. Oxygen from facials at best just sits on the surface of your skin. At worst it might increase free radicals in the very outer surface of the skin. The skin is designed to get it's oxygen supply from all of the blood delivery options I've already mentioned above.

I hope that this incredibly long and scientific review has helped you understand why oxygen isn't something you need to include in your skin care routine. Frankly, I think it's a waste of time and money. You would be much better served by making sure your heart, lungs and blood are all healthy.


Images: Oxygen, Vascular Man, Red Blood Cell, heart

Note: I just wanted to say quickly that there are very legit reasons that us doctors will put you on oxygen or even into Michael's hyperbaric oxygen chamber.
• Usually we'll put you on oxygen when something is wrong and the blood leaving for your body isn't 100% saturated. Typically this is in the case of a lung problem (like infection) or a heart problem (if you have a congenital heart disease with extra holes in your heart).
• Hyperbaric oxygen we use not to increase your PaO2 but to compete for those 4 binding sites on each red blood cell. Carbon Monoxide for example really loves being bound to RBCs and will push oxygen off of the cells. Then you have no spots for oxygen, and you can quickly see how very little oxygen is delivered to your organs. So, we aren't trying to raise PaO2, but to compete for those spots.

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Aquacurrents: What's The Deal With The Moving Of The Water?

You may have seen ads for Procter & Gamble's new moisturizer technology, Aquacurrents. I've seen mentions of it in magazines, on TV and even on-line. Many brands are featuring Aquacurrents, including Olay, Pantene, Secret and Cover Girl.

It sounds like a huge break through in moisturizing, but what exactly is it?


Actually, Aquacurrents is basically just increased use of a humectants. Rather than relying on the use of emollients and occlusives, P&G has decided to capitalize on Aquaporins.

Aquaporins? Huh?

Let me explain. In the epidermis and dermis cells are very tightly bound together, forming a great barrier for your body. It was thought that the only way water could move throughout the layers of the skin was in conjunction with ions and nutrients, but recently Aquaporins were discovered. These channels allow just water through the cell membrane as needed.

Meanwhile, a humectant is a moisturizing ingredient that will draw water towards it. To the point of even pulling moisture from the air if needed. In the past it was thought that humectants would not draw enough moisture to help skin. Actually, it turns out that you can over do it with humectants, drawing too much water into one area leaving another area dry.

So, you can definitely moisturize and hydrate skin with humectants. You just need balance. This allows less reliance on ingredients like occlusives and emollients, which can sometimes make skin feel greasy or clog pores.


In order to create the right balance P&G did a lot of high tech moisture mapping, similar to what you see here. Niacinamide is the main humectant used in the Aquacurrents skin products. You can see that the moisture level in the outer levels of the skin (towards the bottom here) gain moisture without sacrificing moisture in the deeper layers of the skin.

Niacinimide has also been found to help fight oxidants (it isn't an anti-oxidant on it's own as far as I can tell, but it helps anti-oxidants to work better), fights hyperpigmentation and sallowness of the skin and has even been shown to help increase collagen in the skin. So, while it is used primarily for it's humectant properties in these products, it is also a great anti-aging ingredient!

I've tried out a few products that use Aquacurrents technology from Secret and Olay already (watch for reviews), and I'm starting trials of products from Pantene and Cover Girl as well. So far I have liked the products, though I admit I miss the greasy feeling of all the usual emollients and occlusives on my skin.

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The Environmental Working Group's Sunscreen Report: Are They Right?

Today the news media is abuzz with the Environmental Working Group's Sunscreen Report. I'm not quite sure why this is suddenly news since I've seen it on their website for quite a while, but I definitely thought that I need to address the report and let you know my take.

First, a little bit of background on the Environmental Working Group. The Environmental Working Group is one of the founding partners of the Campaign for Safe Cosmetics. They run a website called Skin Deep, which is a nice website about ingredients in cosmetics. I like this website for a few things, primarily the fact that they often have a list of ingredients for many products (which saves me time from typing things in) and they sometimes will tell you what an ingredient does (which is something I can have problems finding on-line when I'm analyzing ingredient lists for my reviews).

The issue that I have with Skin Deep is the information that they supply for safety. (You can read more about how they compile this information here) I'm not really sure who they have reading studies to determine the validity and how well a study was performed, but I often find myself disagreeing with the EWG's conclusions. Studies that are not well done with major flaws, not performed in humans, and with levels of a substance much higher than can ever be achieved in a human may often grossly overstate their findings. I've found that the EWG then even more overstates the importance of these findings and concludes that by using a product with said ingredient you will be causing major health risks.

While I do agree that we need more information about many ingredients, I think that overstating the findings of poorly controlled studies is also dangerous. The preservative class known as parabens is a classic example of such gross overstatement of findings. I'm not going to get more into that here, but just know that many people disagree with their conclusions regarding ingredient safety.

Having said all that, the EWG's report came with some highlighted major points, so I'll discuss them one at a time.


Many products lack UVA protection.
Our analysis found that 7 percent of high SPF sunscreens (SPF of at least 30) protect only from sunburn (UVB radiation), and do not contain ingredient combinations known to protect from UVA, the sun rays linked to skin damage and aging, immune system problems, and potentially skin cancer. FDA does not require that sunscreens guard against UVA radiation.

This is incredibly true. SPF only refers to protection from UVB and a large number of US sunscreens do not protect against UVA rays at all. Many of those that do protect from UVA only protect from short-wave UVA and ignore the long-wave UVA waves. Really, this is rather inexcusable and I recommend looking for only sunscreens that provide broad spectrum UVA/UVB coverage.



I also think that you can't rely on the bottle to tell you if something is broad spectrum. Frequently the bottle just doesn't tell you the whole truth, and you need to analyze the ingredients yourself. Luckily, the US FDA currently has only approved 17 ingredients to act as sunscreens, and they are easily found under "Active Ingredients" on each product.

To help things along I developed this handy chart above. All 17 ingredients are on this, but they are currently randomly scattered around to allow space for all of them to show up. It isn't hard to line ingredients up though, notice that each UV range has it's own "width" (UVB is 3 boxes, Short UVA 2 boxes and Long UVA is 6 boxes) as well the colors become darker with increasing wavelength. Each ingredient is easy to "plug in" to the correct coverage so you can see if broad spectrum coverage is provided, like I do for each of my sunscreen reviews (check out this example, Kiehl's Vital Sun).


Sunscreens break down in the sun.
Paradoxically, many sunscreen ingredients break down in the sun, in a matter of minutes or hours, and then let UV radiation through to the skin. Our analyses show that 48% of products on the market contain ingredients that may be unstable alone or in combination, raising questions about whether these products last as long as the label says. FDA has not proposed requirements for sunscreen stability.

This is also true. There are some combinations of sunscreens that are much more stable while some combinations are well known to be very unstable once exposed to the sun. The best way to test stability has yet to be agreed upon, so there is often conflicting information about how stable an ingredient/combination is.

One well known example of this is Avobenzone with either Octocrylene or Octinoxate. There are quite a few studies looking at these combinations (just do a quick Medline search to find them), and they are mostly conflicting. There was one study in particular that found the Avobenzone/Octinoxate combination to be very unstable, lasting just a few minutes. However, the stability was tested differently than many other studies and subsequent studies have not confirmed these results. But, other studies about this same time did find that the Avobenzone/Octocrylene combination (much rarer in US sunscreen formulations but rather common in European formulations) to be more stable. The result? No one knows for sure what the best combination is. We know that Avobenzone/Octocrylene is stable, but we don't know for sure that Avobenzone/Octinoxate is unstable. I know the girls over on the Makeup Alley Skin Care board are likely shaking their heads at me (they are firm believers in the OctiNOxate mantra), but the studies are there.

Truly, we need a Gold Standard for testing stability. We need to have more published data about these combinations. We also likely need the FDA to regulate this.


Questionable product claims are widespread.
Many products on the market bear claims that are considered "unacceptable" or misleading under FDA's draft sunscreen safety standards. Claims like "all day protection," "mild as water," and "blocks all harmful rays" are not true, yet are found on bottles. Until FDA sets an effective date for these standards, industry is free to use hyped claims. Companies' decisions to inflate claims has spurred class action lawsuits in California.

Very true. All sunscreens should be reapplied every 2 hours, it doesn't matter what you've been up to. Reapply everything after swimming. Very few products on the market actually block all wavelengths in the UVA/UVB spectrum and even then even the highest SPF products only block about 95-99% of the rays. Really companies shouldn't state these things since it only makes the less educated consumer confused.


Many sunscreens contain nano-scale ingredients that raise potential concerns.
Micronized and nano-scale zinc oxide and titanium dioxide in sunscreen provide strong UVA protection, and are contained in many of our top-rated products. Repeated studies have found that these ingredients do not penetrate healthy skin, indicating that consumers' exposures would be minimal. Powder and spray sunscreens with nano-scale ingredients raise greater concerns, since particles might absorb more easily through the lungs than the skin. Studies of other nano-scale materials have raised concerns about their unique, toxic properties. FDA has failed to approve effective UVA filters available in Europe that, if approved here, could replace nano-scale ingredients.

Many physical sunscreens on the market today are smaller particles of Titanium Dioxide and Zinc Oxide, which allows them to create a finer film on your skin which is much more pleasant. (No more chalky white nose!) But, it does seem very reasonable that if you're spraying it on or applying powder all over that it might aerosolize into the air and you could breathe it in. We don't know how that affects your lungs.


The U.S. lags behind other countries when it comes to products that work and are safe.
FDA has approved just 17 sunscreen chemicals for use in the U.S. At least 29 are approved for use in the E.U. FDA has approved only 4 chemicals effective in the UVA range for use in the U.S., and has failed to approve new, more effective UVA filters available in the E.U. and Asia.

This is why it was such a big deal when Ecamsule was approved, it was the first in an incredibly long time. The Europeans are much more progressive than the US when it comes to sunscreen. Let me know if there is a cult sunscreen that people are importing now (I'm really not sure) and I'll pick it up to review when I'm in Paris in October!

Some sunscreens absorb into the blood and raise safety concerns.
Our review of the technical literature shows that some sunscreen ingredients absorb into the blood, and some are linked to toxic effects. Some release skin-damaging free radicals in sunlight, some could disrupt hormone systems, several are strongly linked to allergic reactions, and others may build up in the body or the environment. FDA has not established rigorous safety standards for sunscreen ingredients that fully examines these effects.

I think I've already addressed this concern above. I frequently don't agree with the EWG's conclusions about a product's safety, I think they have misinterpreted many studies.


Overall Results
Only 15% of 952 products analyzed met EWG's criteria for safety and effectiveness, blocking both UVA and UVB radiation, remaining stable in sunlight, and containing few if any ingredients with significant known or suspected health hazards. Our assessment is based on a detailed review of hundreds of scientific studies, industry models of sunscreen efficacy, and toxicity and regulatory information housed in nearly 60 government, academic, and industry databases.

I think that the EWG may be discounting many great sunscreens due to their ingredient safety analysis. Personally, I still think that there are a lot of great sunscreens available at many price points. I recommend analyzing the active ingredients for yourself for UVA/UVB coverage, applying 1 ounce of sunscreen per application and reapplying every 2 hours when you are out in the sun. Oh, and hope with me that the FDA finally completes their sunscreen regulation, which was mandated by Congress to be complete by 2006. This should give us standards for stability and hopefully some more approved ingredients as well as improved regulations for UVA coverage.

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Aging Tips from Dr. Patricia Wexler!

I can not even begin to tell you how exciting it is to have tips straight from Dr. Patricia Wexler appear in 15 Minute Beauty Fanatic.

Dr. Wexler has appeared in pretty much every beauty magazine available in the US, hardly a month goes by without a quote from her in my beauty bible, Allure. She’s even developed her own skin care line (available nationwide at Bath and Body Works and on QVC) with revolutionary ingredients like MMPi’s (they stop skin from being broken down basically). She's a huge proponent of sun screen, and I really think of her all covered up on the beach (as in this NY Times article) when I pick out my sunscreen for vacations (this prompts me to buy SPF 70 instead of SPF 30, not to mention my tunic cover-up).

In our 20’s, sun exposure may have already caused freckling, pigmentation and fine lines most obviously around the eyes.
• Tip: A good skincare regimen including daily exfoliation and moisturizing with an SPF of 30 will ensure youthful skin and thwart wrinkles from developing.
Try: Patricia Wexler, M.D. Dermatology Universal Anti-Aging Moisturizer SPF30
• Tip: Use at least one anti-aging product to prevent further damage to collagen and elastic tissue.
Try: Patricia Wexler, M.D. Dermatology Universal Anti-Aging Cleanser


In our 30’s, etched lines become more exaggerated especially around the eyes, and forehead. Stress and hormone manipulation may require adult acne relief. Men are particularly prone to follculitius of the beard, which can be treated with topical salicylic acid, exfoliation, and topical antibiotics.
• Tip: Avoid smoking, wear large sunglasses with UVA and UVB protection to protect the delicate eye area.
Try: Patricia Wexler M.D. Dermatology Intensive 3-in-1 Eye Cream
• Tip: Use antibacterial but not drying solutions. It is vital to incorporate your acne regimen into your anti-aging routine.
Try: Patricia Wexler M.D. Acnescription Exfoliating Acne Cleanser and Overnight Acne Repair Lotion


In our 40’s, lines previously only seen with movement become visible at rest.
• Tip: Use products that contain peptides for immediate relaxation of lines while promoting long term collagen and elastic stimulation. In addition, line fillers containing dermaxyl and polysilicone will give immediate improvement in the appearance of lines and wrinkles.
Try: Patrica Wexler M.D. Dermatology Fastscription No-Injection Line Filler for Lips and Eyes
• Tip: Pigmentation and dull sun damaged skin can be treated with glycolic peels, micro dermabrasion, and skin brightening moisturizers with peptides like Haloxyl and botanical brighteners.
Try: Patricia Wexler M.D Dermatology Resurfacing Microbrasion System and Skin Brightening Daily Moisturizer SPF30



Dr. Wexler will be appearing on the TLC program 10 Years Younger, where she'll be sharing her anti-aging recommendations with everyone! Check out the program guide and tv schedule for info on when to tune in!

images: QVC.com

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The New Science of Perfect Skin: A Must-Read for the Skin Obsessed!

For years many in the "business of skin" have known who Daniel Yarosh is. While you may not recognize his name chances are that you have a product he formulated in your bathroom right now. He's formulated for Estée Lauder, L'Oréal and Shisheido, all known for great skin care products. Currently he is the president and chairman of AGI Dermatics, where the products he formulates are so amazing that rather than being featured primarily in Allure and Elle (which I love) are published in The Lancet.

His new book truly is amazing. I've spent the last week or so reading this book and I have to say that it really is like a mini-course in cosmetic dermatology. He starts with Skin 101 (the chapter is excerpted so you may read it if you want).

Actually, this book is likely a very good companion to this blog, as we have many of the same goals. There are mini-reviews on the skin's anatomy and physiology in both, explanations of how ingredients work in both, and we both rely on medical literature and actual science to let us know if a product is over rated. I like that he discusses the optimal conditions for a product to work and even recommends specific products (in both the prestige and mass market areas) that contain this ingredient. There's even a chapter that discusses many of the laser treatments available today for skin resurfacing and treatments. So, if you want more information on those definitely pick up this book because I'm never going to discuss lasers here.

I do think that the amount of information contained within this book could be very easily overwhelming, with the end result that you are simply more confused after reading the book than before. It might be best to use the specific ingredient information as a guide after skimming through it and with the aid of the "Daily Regimens" chapter in the back of the book.

The bottom line is that this book is very informative and I think very accurate. I agree with pretty much everything Dr. Yarosh has to say and his unique perspective as the formulator of products is interesting.

The New Science of Perfect Skin by Daniel Yarosh

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Sunburn: A (Sometimes) Inevitable Problem That You Can Treat

In an effort to take advantage of living in California, my husband and I drove down to San Diego to check out the Padres' stadium (very nice). Did you hear about that absurdly long Padres Game on Sunday? Well, I took that picture from my seat, at that game. No, we did not stay for all 18 innings, luckily we left at the beginning of the 7th.

Unfortunately, I forgot my new Murad Sunscreen at home on the counter. Turns out that sunscreen doesn't work so well when it's still in the tube a hundred miles away rather than on your skin. So, I spent about 3 hours in direct sunlight with only my SPF 15 daily lotion to protect me! My husband (a real keeper) noticed I was "getting pink" and recommended heading for home. Unfortunately, the damage was already done and my nose and forehead turned a bit pink over the next few hours!

Fortunately, there are a few things that can be done to help ease the pain (and decrease the damage) of a sunburn!


First, you'll need to understand the different phases of a sunburn:
• Immediate Redness: Occurs within minutes and fades
• Delayed Redness: Occurs after the immediate redness has faded and lasts for days
• Desquamation (peeling): Usually starts within the week

Note that all of these phases can be accompanied by different degrees of vascular permeability (basically, leaky blood vessels) that can result in swelling and blisters.

In addition, the UV damage induces actual DNA damage within the skin cells (the keratinocytes) which either then needs to be repaired by the skin or may result in cell death. The cell can never truly "fix" its DNA so this damage can build up over time and result in problems such as photo-aging of the skin or even cancer.


Things that help:
• Nonsteroidal Anti-Inflammatory Medications (Advil, Motrin): May decrease some of the early redness and decrease the degree of damage caused by the burn
• Ease the Pain & Itching: Itching can definitely make a bad sunburn much more uncomfortable! Try cool compresses or baths (avoid anything hot, either luke warm or slightly cool will be much more soothing), even cool lotions and creams will feel great, such as that aloe vera gel your mom used to keep in the fridge all summer long!
• Anti-histamines such as Benadryl will help with the itchiness but not the underlying issue.
• Moisturize! Applying lotion very liberally and frequently can help with itchiness and decrease peeling
• Vitamin E also helps to decrease redness and damage from a sunburn, but note that it needs to be applied pretty much as you are burning in order to see the effects. Perhaps make a ritual of applying a cream with Vitamin E after each sun exposure?
• Oral Vitamins have been shown to make a difference! Studies have shown that the combination of 2g (2000 mg) of Vitamin C with 1000 IU of Vitamin E will decrease the sunburn reaction while Carotenoids (25 mg/day) and 500 IU Vitamin E will protect you against the development of redness with sun exposure. Vitamin C also will decrease both damage from the sun as well as redness after exposure. Bottom line? Vitamins that have anti-oxidant activity are good! Eat your veggies or take a vitamin daily.

Things that don't help:
• Steroids, both oral and topical: Studies have shown that if the burn is bad enough it might be worth a try under a doctor's supervision, but usually only have very small effects on the degree of redness
• Never unroof any of the blisters. They are protecting the fragile skin beneath from infection, so allow them to slough off on their own over time.


Most Important Tips!
Your skin is much more prone to another burn in the week after a sunburn. Please take extra precautions to decrease your sun exposure during this time period!

Remember, any change in your skin's color means that damage has been caused! This is regardless of whether that color change is a tan or a burn. There is no such thing as safe tanning. Remember your sunscreen!

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Photoimaging Analysis: A Scary but Informative Picture

As much as I talk about sunscreen on this blog, I haven't always been so sun aware. I distinctly remember my mom slathering me with sunscreen when I was trying to play in the backyard or at the beach as a kid. In high school I would occasionally lay out in our back yard to get some color, though I was afraid of turning red and usually still wore SPF 15. In college I decided that the reason I had never been tan not because of my pale Irish skin but because of the sunscreen. So, for one summer I worshipped the sun with my roommate and without sunscreen. I finally was "tan" with the aide of sunless tanner. I have regretted that summer for years, and while I have good skin now I'd like to stay that way!

So, I took advantage of the complimentary photo-imaging analysis available at Calidora. They have quite a few locations, so check them out, there might be one near you!

Anyways, it was quite and painless and was quite a bit like the image above (not me, that's from their website). You put your head inside of the white box pictured on the left and a high tech camera takes a picture of the left side of your face (the "drivers side" that gets more sun exposure and therefore usually is worse than the right).

From that single image they can do a huge amount of analysis! First I saw a greatly magnified image of my face, then a UV filter that showed the "hidden damage" and even an image that aged me by 10 years! The software even analyzed my face for wrinkles, pore size, brown spots and smoothness of skin. That info was given to me as a comparable number against other females my age and skin type.

I'm proud to say that I did not have a single wrinkle, therefore I was in the 99th percentile, but my freckles dropped me down to 76th percentile for spots, pores had me at 60 and my texture was a disappointing 51. When I aged by 10 years I stayed wrinkle free but I did become one giant freckle, which really was rather alarming. They did tell me which treatments would help my issues (microdermabrasion for the texture and pore issues, a series of 5 laser treatments for the freckles/spotting), but there was absolutely no pressure to sign up for anything. I'm not quite ready to start lasering and having microdermabrasion treatments, but in a few years I might be. In the meantime seeing that image of me in 10 years was definitely enough to keep me slathering on high SPF sunscreen!

Calidora Skin Clinic

As an aside, in the past few days I have seen commercials from Coppertone promoting their DermaPhoto Booth, which does similar UV analysis. If you're interested the booth is on tour across the US, but the dates are very limited so I would show up early or check out a local skin clinic for analysis instead.

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The Skin, Retinoids

Retinoids are one of the most popular cosmeceuticals you can buy. They are all cousins of Vitamin A, and help in growth and development of many tissues, but for our purposes just know that it helps your skin to behave like healthy, young skin. It can take >12 weeks to see any initial improvement in the skin with retinoid treatment, maximal effects won't be seen until 6-9 months. The best improvements are seen in skin roughness, hyperpigmentation and fine lines, but you will see some improvements in coarse wrinkles and freckles as well.

Tretinoin (aka- retinoic acid) is the active component, retinol is converted into this form within the skin.

There are 2 ways which Vitamin A functions:
1. Antioxidants- Protection of tissues from damage from oxygen scavengers
2. Gene Activation- Retinoic Acid (aka- tretinoin)

The net result of these mechanisms is that the epidermis thickens, cells increase in their turnover and the number of cells that produce sebum decrease. There are even changes in the anchoring tissues around the skin cells, making everything more stable. Atrophy of the epidermis is reduced, more collagen is made and with increased cell turnover pigmentation issues are improved because keratinocytes that have accumulated too much melanin are shed.

It is important to note that the retinoid you use needs to be stable in the form you bought it, and active. There are a lot of different forms of retinoids, but they can be easily inactivated in certain creams/gels and with exposure to the sun. So, look for a retinoid that comes in a package that doesn't let in sunlight.

Another concern that many have regarding use of Retinoids is combination with other products. While it is true that Retinoids are less stable when in the same product as some ingredients (such as Alpha-Hydroxy Acids), there should be no issues with combining them on your face. In fact, many dermatologists suggest that using both will improve the efficacy of the the retinoid as it will be able to penetrate your skin more easily.

In addition, many suggest applying retinoids at night. I was unable to find any evidence that they work better at night versus morning. However, they should be started slowly (a few times a week) and increased in frequency as your skin is able to handle them. Don't be surprised if you have some redness, peeling or even stinging with use. These problems will decrease with time, allowing you to increase your use of the product.

One final note- retinoids will make your skin more sensitive to the sun. This makes your daily use of a broad spectrum sunscreen even more important!


Retinoid Picture

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How to Get Rid of Crow's Feet

Today's Skin post is a guest post from Nicki, over at Future Derm. Nicki is currently in school, planning to attend medical school in just a few short months and then I'm sure that this girl is eventually going to conquer the world of dermatology! She publishes daily posts that are extremely in depth about a huge array of cosmetic dermatologic issues!





To quote Meg Ryan in You've Got Mail, "Fight, fight, fight!" Start each day off with a multivitamin that contains vitamin C and linoleic acid, which has been recently reported in a study amongst 4000 women to reduce wrinkles. Next, apply an antioxidant serum and sunscreen or moisturizer with sunscreen, concentrating on the area around your eyes. Be careful that the formulations are tolerated well around the delicate eye area. My well-touted favorites are Skinceuticals CE Ferulic ($107.00, Amazon.com) and NIA 24 Physical Sunscreen SPF 30 ($42.95, Amazon.com), but I also love the new Neutrogena Ultra Sheer Dry Touch Sunscreen SPF 85 ($8.99, Drugstore.com) for ultima supremo sun protection (the most photostable out there, according to some reports). During the day, Dr. Perricone also recommends that you eat a diet rich in fruits and vegetables (for antioxidant activity), salmon (for omega-3s), healthy fats (think almonds and olive oil), and full of water and green or white tea to keep skin glowing. After all, nutrition and skin care together have better results than skin care alone.



At night, use a retinoid cream, followed by a moisturizer with DMAE, niacinamide, or antioxidants, provided your skin can tolerate it. The retinoid treatment is easier to choose: there is 0.5% retinol in Skinceuticals Retinol 0.5 ($32.95, Amazon.com), 0.6% retinol in Green Cream Level 6 ($42.95, Amazon.com) 0.9% retinol in Green Cream Level 9 ($49.95, Amazon.com), and 1.0% retinol in Skinceuticals Retinol 1.0 ($52.00, Amazon.com). You may want to start with a lesser concentration of retinol, applied every 2-3 nights, and gradually work up to nightly use.



As for a nightly moisturizer, Dr. Nicholas Perricone recommends using DMAE, which has been found and reported in two independent studies in The Textbook of Cosmetic Dermatology and Skin Research and Dermatology to significantly firm skin in the undereye area. A product with a high concentration of DMAE is NV Perricone Vitamin C Ester Amine Face Lift ($95.00, Sephora.com), and another designed for around the eyes with slightly less DMAE is NV Perricone Advanced Eye Area Therapy ($95.00, Sephora.com). (P.S.: Free shipping is also available for a limited time on orders of $50 or more from Sephora with the code SHIPPING50 at checkout!)

If DMAE is too harsh for your skin, niacinamideand antioxidants have also been found to have beneficial effects against wrinkles, in various studies. My favorite moisturizer with niacinamide is Olay Regenerist, while my favorite antioxidant moisturizer is RevaléSkin Night Cream.


Once a week, in lieu of your usual nightly routine, use a glycolic acid treatment, provided again that your skin can handle it. (Consult your dermatologist if you are unsure.) Two of my favorite glycolic acid peels are MD Skincare: Dr. Dennis Gross Alpha Beta Daily Face Peel ($75.00 for a thirty-day supply, Sephora.com) and Peter Thomas Roth UnWrinkle Peel Pads ($45.00, Amazon.com). Click here for a full review of the Dr. Dennis Gross peel; click here for a review of the Peter Thomas Roth Un-Wrinkle Peel Pads.

Then go see your dermatologist to look even better.

In the Journal of Plastic and Reconstructive Surgery, amongst many other sources, Botox injections have been found to make a dramatic difference in wrinkles. According to Dr. Jeffrey Benabio, M.D., in this month's Oprah magazine, Botox injections partially paralyze the orbicularis orbis muscle to prevent it from contracting, which causes further wrinkling (and shows off the wrinkles you already have).

Benabio also recommends injectable fillers, like Restylane, to fill up the lines. Injections generally last 6-12 months, and are usually redone every 6 months. The cost is generally upwards of $500 per injection, but this varies by practitioner.

Last but not least, Benabio recommends dermatologist-strength chemical peels and lasers to stimulate collagen production, keeping the skin firm and crow's feet production down in the future.

Yes, you can do it!

Always keep in mind that dermatology today is a lot more powerful than in years past. You can improve and prevent wrinkles, but, like everything else, it takes time, patience, knowledge, funds, and dedication.

Let me know what works for you! I love hearing feedback!

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Sunscreen Active Ingredients

In preparation for a lot of sunscreen reviews, here's a bit of information about the acitve ingredients in sunscreen. While not the most exciting post (been stuck at work, this is the only post I have completed right now.... Sorry... expect me to spend all day Saturday writing!), I'll be referring to this post frequently in the near future!


There are two main types of Active Ingredients, which you should familiarize yourself with before you buy your next sunscreen.

Chemical
Chemical sunscreens absorb the UV rays, preventing them from reaching your skin.
examples: PABA (paraminobenzoic acid), oxybenzone, cinnamates, and butyl methoxydibenzoyl methane.

Physical
These ingredients actually reflect the UV rays off of the skin.
examples: zinc oxide and titanium dioxide.

In addition to considering the type of sunscreen, you need to consider what UV Spectrum you will be covering. You want broad-spectrum UVA and UVB coverage, which generally will take at least 2, usually 3 active ingredients. Look on the back of the sunscreen, legally they need to be listed there.

Short Wave UVA
• Benzophenones
- Oxybenzone
- Sulisobenzone
• Dioxybenzone
• Ecamsule (Mexoryl)

Long Wave UVA
• Avobenzone (Parsol 1789)
• Ecamsule (Mexoryl)

UVB
• p-Aminobenzoic acid (PABA)
- Padimate O: FDA approved as a photo-protectant, this ingredient has quite a bit of debate about it. There is some evidence that when it is activated by the sun it actually directly causes DNA damage to cells, making sun damage worse, it also protects somewhat into the short wave UVA spectrum.
• Salicylates
- Homosalate
- Octyl salicylate = Octisalate
- Trolamine salicylate
• Cinoxate
• Octylmethoxycinnamate = Octinoxate
• Octocrylene
• Ensulizole: This also protects into the short range UVA range

Broad Spectrum UVA and UVB
• Titanium dioxide
• Zinc oxide


Update, 4/10/08
See this cool new chart? It will show you more visually which parts of the UV spectrum each sunscreen covers! I spent a lot of time figuring this out, but really, those are all of the FDA approved sunscreen active ingredients, I'll be customizing this graphic for each sunscreen review!

The Skin Cancer Foundation's Seal of Recommendation
While I'll be reviewing quite a few sunscreens soon (and referring to this post often), I doubt that you'll bring a list of ingredients with you to Target. (I do hope you'll read the reviews and do a bit a research before you buy your next tube of sunscreen.) But, one of the easiest thing to do is to look for the Seal. The Seal has some requirements, companies seek it out and they can't buy it.

• A sun protection factor (SPF) of 15 or greater (note that they don't require broad spectrum UVA and UVB coverage, you'll need to check that out on your own)
• Validation of the SPF number by testing on 20 people
• Acceptable test results for phototoxic reactions and contact irritation
• Substantiation for any claims that a sunscreen is water- or sweat-resistant

You can view a list of all the products that have this Seal at The Skin Cancer Foundation's Site

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The Beauty Bowl: Combating Cold Weather

In celebration of the big game this weekend, a few beauty bloggers decided to get together for themed posts! Inspired by those freezing games recently (and a lot of e-mails regarding winter skin), I thought I'd discuss my favorite winter skin products! Even in Southern California things have gotten chilly! A drop in temperature and humidity wreaks havoc on my skin!


I think that the most obvious tips are the ones we all hear over and over, yet never follow. You need to find a way to keep moisture in you skin (and mucus membranes, you sinuses will thank you), and one of the easiest is to use a humidifier. Make sure you clean it often and buy one sized appropriately for the room it will be in.


Take shorter showers, use warm water instead of hot, and be sure to apply moisturizer right after your shower to seal in moisture.


Increase the intensity of your moisturizers, for both body and face. Earlier this year I tried out Lancome Aqua Fusion Lotion, and at the time it was a tad too moisturizing. I took it to Michigan with me over the Holidays and my suspicions were confirmed- in drier, colder air, this lotion was perfect for my combination/dry skin!


I have eczema on my legs, which requires heavy moisturizers in the summer and only gets worse in the winter. My favorite body wash is Olay Complete Body Wash due to the high proportion of oils and other moisturizers, as well as the gentle surfactants. Once out of the shower I slather myself with huge amounts of Cetaphil Moisturizing Cream (it's a good thing they sell this stuff by the vat at Costco!), usually within about 2-3 minutes of drying myself off. I'm also really enjoying Bioelements Vitalization as an alternative to Cetaphil.

I tend to reapply moisturizer at night, and since I'm not trying to seal in moisture I like to use a moisturizer that will sooth my skin. Lately I have especially loved Aveeno Skin Relief Moisturizing Lotion since the oatmeal and menthol both help to decrease my itchiness.

For my hands, I need intensive treatment! I do like both Gloves in a Bottle and Become's Hand Cream for their barrier effects. However, if my skin is anything less than perfect, I use Kiehl's Ultimate Strength Hand Salve, which has many of the same barrier properties but also has a great tingling/cooling feeling during application which I find to be incredibly soothing.


Images- Humidifier from Amazon.com, Lancome-USA.com


Check out posts from these other Beauty Bloggers!
A Touch of Blusher
Beauty411
Canadian Beauty
For the love of beauty
Grayburn
Steeping Beauty
The Beauty of Life
Urbane Girl

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Why We Should All Wear More Sunscreen... Part 2

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Why We Should All Wear More Sunscreen... Part 1

I'm starting a massive review of sunscreen, just in time for all of us to think about sunscreen for our winter vacations!

Here's just a tiny video, I think how she looks by the end is reason enough, if the mention of skin cancer isn't already making you nervous...

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The Skin- Have Dark Circles?

Well, for months I've had a half finished post about under eye circles and what causes them. Then, suddenly a post popped up over on Beauty Brains from a Dermatologist which said all the same things I was going to, and it was written in much more understandable language! Run on over and check it out!

image-Real Simple.com

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