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Needling and Rollers for Scar Reduction by Dr. Phillipa McCaffery

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General Scar Removal

Most scars can be removed or greatly improved. Scars develop when the wound repair process is incomplete and collagen and elastin are improperly deposited. Most scar repair involves stimulating the skin's healing mechanism to reorganizes and rebuild the collagen and elastic tissue. The process often involves removing the damaged area and stimulating skin repair. Techniques include the use of chemical peels, lasers, and covering the scar with silicone sheets.

However, any skin lesion that is infected or appears to be dark and have irregular borders or just seem "too" bothersome should be checked by a physician or dermatologist.
 

Exfoliating creams, and their stronger versions used as "chemical peels" have long been used to reduce scars. Likewise, Retin-A (retinoic acid) reduces scars but can be quite irritating to the skin.

At Skin Biology, we have had many customers report very good results on skin lesion removal or reduction of scars, sun damage marks, skin tags, acne scars, some types of moles and flat warts and stretch marks of pregnancy. Most often the SRCP products are used in combination with the hydroxy acids and/or retinoic acid (Retin-A). This is a much lower cost method than laser treatments or silicone sheets and less irritating than retinoic acid alone. This is a very simple, low cost, safe and painless method that often works surprisingly well.

Dermatologists have long used both hydroxy acids and retinoic acid to reduce scars and skin imperfections. The addition of SRCPs improves the overall process.

Deep chemical peels are often recommended for scars, but if the dermatologist or aesthetician is not highly skilled, this is often unsatisfactory and can produce further scarring. Many people who have had deep chemical peels for scars and end up with worse scarring than their initial scars and laser treatments often leave permanent burns.

Use of SRCPs with Salicylic Acid

To use this method to reduce skin lesions, apply the salicylic acid product in the morning to the lesion. In the evening, use the SRCP. Results should be evident in about one month as a reduction in the area and thickness of the lesion. After a week, you may also notice a slight flaking of skin around the periphery of the lesion. This is usually followed by a shrinking and thinning of the skin lesion which is significant after one month.

For facial acne scars, either use a mixture of Super CP Serum and Exfol Serum.

In addition to SRCPs and Hydroxy Acids, scar and blemishes can also be reduced with abrasive methods. The key is to go slow and only remove a small amount of tissue during each abrasion.

Exfoliating brushes and pumice stones often help.

Scrapers or dull knives can work well. Just do not break the skin.

Microdermabrasion units work well on scars and blemishes that are weakened by hydroxy acids and SRCPs.

Many aestheticians also use subcision on depressed scars. In this procedure, a needle (such as tattoo needle) disrupts the disorganized collagen in the scar and stimulates replacement of newly formed collagen. Best results are achieved with several sessions. This often used on pitted acne scars or at the margins of face lifts. Some scars may be too deep and too hard for hydroxy acids to effective loosen.

Some estheticians tell us that they use CP Serum or Trireduction P&R after the needling and see a much better and faster clearing of the scars.

Sometimes things look briefly worse after clearing a damaged skin surface

Deeply buried scar tissue is often covered over with normal skin. For example, cystic acne can form hard scars under the skin. These scars often are later covered over by superficial skin cells. But as skin is exfoliated, this old buried scar tissue becomes visible. As such deep damage becomes visible, you can focus more usage of SRCPs and hydroxy acids on these specific problem spots.

More Aggressive Methods for Severe Scars - But Nothing is Fast

The natural and gentle methods outlined above may not always work for very severe scars. But keep in mind that nothing is fast. More vigorous procedures such as laser and surgery are usually followed by 6 to 12 months of post procedure healing.

Deep Acne Scarring

Depressed severe scars are often improved by laser resurfacing procedure. First, the individual scars are first resurfaced with several passes of a laser, then later the complete area, such as the cheeks of the full face is resurfaced . With very depressed scars, the depression is often first to be corrected by the dermal-collagen graft procedures to fill the area, then followed by laser resurfacing after a  few months.

For severe "ice pick" scars, often a prior surgical procedure surgically is used removes the scar tissue. Then punch grafts are taken from behind the ears, and inserted into the above defects and allowed to heal. After three to six weeks, these areas is laser resurfaced. This has been compared to patching and sanding all cracks and gouges in a wall, before applying the coat of paint.

Some physicians use very fine needles to inject 70% glycolic acid into the acne pits to loosen the scar tissue.

Removal of Stretch Marks

Stretch marks are the result of thinning of the collagen bundles and loss of elasticity and often accompany pregnancy, obesity, and weight lifting. During pregnancy, stretch marks usually develop about 6 months into the pregnancy that begin as as purplish or reddish marks that eventually form shallow, white scars on the abdomen, hips, buttocks, thighs, and breasts. Athletes may develop stretch marks after exceptionally vigorous exercise.

Stretch marks occur in the dermis, the middle skin layer which contains the skin's elastic proteins that allowing the skin to stretch and return to its original shape. Continuous stretching of this layer over an extended period breaks down the elasticity of the skin. The body tries to reinforce the over-stretched and weakened layers of skin increasing collagen fiber production in that affected area, which produces the little scars called stretch marks.

Many people have reported removing old stretch marks with hydroxy acids and strong copper peptides. See www.scar-reduction.com/stretchmarks.html.

Retinoic Acid Treatment of Stretch Marks

Topical tretinoin (retinoic acid or retin-A) reduces stretch marks. Archives of Dermatology. Sewon Kang, M.D., from the Department of Dermatology, University of Michigan Medical Center, Ann Arbor, and colleagues studied the effects of topical 0.1 percent tretinoin cream on 22 patients with established stretch marks.

The individuals in the study had established stretch marks that had evolved into white scar like lesions. Ten were treated with the tretinoin cream and 12 applied a placebo on the effected areas. After two months, most patients treated with tretinoin showed significant reduction in the severity of their stretch marks compared with those who received the inactive cream. After six months, 80% of the tretinoin-treated patients had marked improvement 8% placebo-treated patients.

The length and width of the stretch marks treated with tretinoin decreased by 14 and eight percent respectively, while the control group's placebo-treated lesions increased in length by 10 percent and in width by 24 percent. Half of the tretinoin treated patients experienced side effect such as dry and itchy skin.

Many of our clients combine the use of our SRCPs and retinoic acid for scar reduction.

Laser Removal of Stretch Marks

David McDaniel, M.D., of the Eastern Virginia Medical School has recently reported success with lasers to remove stretch marks after pregnancy. He said, "The laser passes through the upper layer of the skin leaving it undamaged and then triggers new elastin production in the deeper layer ...which causes the stretch marks to soften or disappear".

He used a pulsed-dye yellow beam laser that causes the skin to bruise for a couple of weeks. The laser removes new pink stretch marks in one treatment but if the scar is old and deep, multiple treatments are required. Lasers were previously tried on stretch marks years ago but the laser settings were not correct and the patients weren't followed for a long enough time. In some persons, scar improvement requires several months to become apparent and the healing process can take as long as six months.

The laser treatment has no side effects and costs about $300 a session. About 200 centers in the USA use lasers to remove stretch marks. For more information contact the American Society for Dermatologic Surgery at 1-800-441-2737.

Keloid Treatment

A keloid is an enlarged scar that projects above the skin surface. Normally, after healing of a skin wound, its scar becomes flat. Unfortunately, sometimes scars enlarge to form firm, smooth, hard growths called keloids. The cause of keloids is poorly understood. Most persons never form keloids, while others develop them after minor skin injuries. Keloids are a cosmetic problem but never become malignant.

While there is no satisfactory treatment for keloids, the best treatment is to inject a long-acting cortisone into the keloid once a month. After several injections with cortisone, the keloid normally  becomes less noticeable and flattens in three to six months time.

One new treatment for keloids is to apply a silicone gel preparation over the keloid scar. The gel should be covered with a bandage, cloth wrap, or tape and changed every 7-10 days based upon need. After two to 12 months, the keloid will become flatter and smoother.

Strong hydroxy acids (such as 30% glycolic acid) and Super Cop slowly reduce keloids but be cautious of excessive irritation. It take several months to remove a keloid scar this way.

Silicone and Mineral Oil Sheets for Scars

ReJuveness sells medical grade silicone sheets that speed scar removal. The sheets have clinically proven to be effective in the reduction of existing hypertrophic and keloid scars. The sheets, which are FDA approved, are worn 24 hours a day for two months and can result in permanent improvement of some resistant scars. The sheets softens and flatten scars, and restore a more normal skin color. ReJuveness is widely used by plastic surgeons and burn centers. Prices range from $43.50 for a sheet of 1.57 x 3.15 inches to $163.50 for a sheet 5.9 x 7.9 inches. They can be found at www.rejuveness.com or in the USA at 1-800-552-0085,  in Australia at 1-800-350-510, and in Canada at 1-800-361-0778. They have specialized sheets for use on curved areas of the body such the chin and the breasts. While the sheets are expensive, a single sheet can be used until the scar is reduced. The sheets are reusable and washable.

DuraSil also sells silicone sheet for scars. Their Sil-KTM Silicone Occlusive Sheeting helps flatten and shrink hypertrophic scars and keloids over a period of time varying from a few weeks to a few months. Continuous contact with the skin by the silicone sheets should be maintained until the desired results are obtained, usually in 10 to 12 weeks. The sheets should be removed and cleaned at least weekly, then reapplied. Their address is: The S.F. Group, Inc., 304 West Main Street, Grand Junction, Colorado 81505 USA,  telephones are 970-243-0660, 800-324-7455 [Toll Free] and 970-256-9861 [Fax].

Mineral oil gels developed by Dr. Patrick Hudson for scar treatment are an alternative to using silicone sheets. These sheets slowly dissolve onto the skin. The gel provides protection from friction and pressure and seems to moisturize the skin with the mineral oil. These gels are washable and can be reused.

Skin Rips of Gymnasts

Gymnastic exercises often produce rips on the hands which can be especially difficult to heal because of continuing exercise.  Rips should be cleansed in soapy water, dried to prevent infection, then covered with a sterile bandage. Many recommend also applying a triple antibiotic ointment such as Neosporin to the wound surface.  For normal skin protection and healing, some gymnasts cover their hands at night with a hand lotion or vitamin E then put gloves or socks over their hands before sleeping.

For workouts, products such as Preparation H and Bag Balm help numb the rip and provide some protection. Sometimes a small balloon is taped over bandages on the hand to help reduce friction on the wounded hand.  The Gibson company  (800-275-5999) sells a series of three ointments. There is a callus stick to be used before workouts to help toughen calluses, a conditioning  stick for night use to soften skin, and a rip stick to use on fresh rips. Another company “10.0” (800-241-9249), sells “Rip Kits” with a hydrogel dressing, “2nd Skin”, for use to prevent and protect rips along with pressure foam pads and a knitted skin adhesive.  Dunlap sells a skin protector called “Compeed” which is used in practice to protect the fresh rips. G.A. Deitch (717-697-3107) sells lanolin protective gloves to be worn underneath the regular grip as an “undergrip.”  Many gymnasts use Johnson & Johnson’s Elastikon elastic tape to protect a rip.

One effective way to speed up the healing of rips is, after cleaning the rip in soapy water, to apply  DuoDERM Extra Thin CGF Spot (from Convatec) dressing over the rip. The DuoDERM dressings adhere to the skin and form a moist gel over the wound that speeds healing.  DuoDERM dressings give wound up to five times lower than gauze bandages (Hutchinson J.J. Prevalence of wound infection under occlusive dressings: A collective survey or reported research. Wounds. 1989; 1:123-124).  With the Extra Thin DuoDERM, some wounded gymnasts can swing bars with the bandage beneath the grip. Some prefer the use of thinner barrier bandages such as Bioclusive or Op-sight.

Any rip that shows signs of infection should be promptly seen by a physician. Signs of infection include a foul order, pus or yellow discharge, redness and swelling.

Tattoo Removal

Tattoo removal is often difficult. Successful removal of the professionally applied tattoo depends on the number of inks and technique used as well as the size and area of the body.

Very small tattoos on "hidden" areas of the body often best treated by simple excision and closure. A scar will result, but the scar is may be less objectionable than the tattoo itself. Lasers removes the skin to below the level of the tattoo ink. Carbon dioxide lasers are used to selectively vaporize of the entire tattooed. The problem is that such methods may leave objectionable scars.

Newer YAG laser have improved the procedure. With this laser, the color of the laser light is chosen dependent upon the color of the ink. Some colors, like fluorescent yellow are difficult to remove. The goal is to, as selectively as possible, vaporize the pigment while producing minimal damage to the skin. This laser fires a very intense light into the tattoo in a very rapid burst which heats the pigment and triggers its eruption from the skin.

The procedure time varies about 30 to 45 minutes, depending on the tattoo size and the area. Topical anesthesia may be used depending on tattoo location and size. After treatment, the wound must be covered with a dressing for 24 hours and maintained in a moist environment for the next week. The risks of scarring with this laser treatment are low, but the tattoo may not be completely eradicated. Multiple treatments are usually required to obtain a further lightening of the tattoo.

Removal of Spider Veins and Varicose Veins

Vein surgery is one of the most performed cosmetic procedures performed, about 500,000 yearly, in the United States. The results are better looking and healthier legs. Many patients are satisfied with even a partial improvement - such as a 70 percent reduction in visible veins. Improved technology and advances in surgical methods are increasing the popularity of the procedure. Vein treatments simply eliminate damaged veins, and the blood they carried is easily shifted to the many extra healthy veins.

Spider veins are small, dilated, superficial veins appearing on the skin are tiny blood vessels in the skin that have enlarged to the point that they have become visible. They can be short, unconnected, and about the size of a large hair and have a red or bluish color. Sometimes they also look like a spider web or a tree with branches. They appear primarily on the legs, and occasionally on the face. Their treatment is usually best classified by their location.

Larger unwanted blood vessels called varicose veins are often raised  above the skin surface and may occur along with spider veins. The veins may cause occasional pain, ranging from dull throbbing pain to a burning sensation.

Though these unwanted blood vessels carry blood, they usually are not necessary for tissue health. Varicose veins and spider-veins are caused when valves inside veins weaken or become damaged. Gravity then causes blood to pool in the vessels of the legs, resulting in blue, bumpy, ropelike veins.

Sclerotherapy for Spider Veins on the Leg

The usual treatment for spider veins of the leg is sclerotherapy or vein injection. These veins are a common problem, particularly in women after a pregnancy. While  large varicose veins are most often treated surgically, small superficial veins are best treated with sclerotherapy, which involves injecting a solution into the vein to cause inflammation and subsequent disappearance of the vein.

Sclerotherapy is performed as an outpatient procedure and requires about 30 minutes depending on the number of areas being treated. No anesthesia is required although local anesthesia may be used. The patient may experience a temporary cramping sensation during injection for a few minutes as the solution enters the vessel.

The physician injects a small amount of mild sclerosing solution (a salt solution) directly into the spider veins or into the "feeder system" of veins underneath the obvious spider veins by using a very small needle, magnifying glasses and a strong light. This causes the veins to be absorbed by the body. There is no bleeding but the injection sites are covered with gauze and the legs are wrapped with an elastic ace bandage or a compression stocking. Several injection sessions usually are required to obtain optimum results. After treatment, the veins disappear or become smaller over the following month.  Sclerotherapy is effective in 95 percent of patients. The most common complication of sclerotherapy is the development of a brownish pigment in the treated area, which usually disappears within two to six months. Occasionally patients develop matte-like telangiectasias (small sunburst-like blood vessels) at the injection site. Patients may occasionally develop a small scab at the injection site. There is little risk of infection or bleeding after sclerotherapy.

Sclerotherapy may be performed in conjunction with treatment for large varicose veins, but is usually performed after treatment of large veins

Laser Photothermolysis for Facial Spider Veins

Dilated veins on the face, which may be called telangiectasias or spider angiomas, are best treated with yellow-light laser therapy. This therapy is rapid and the effects may range from minimal discomfort, consisting of a brief burning pain when the laser is fired and some itching afterwards to the treated areas becoming dark and bruised for a seven to 10 days. During this time, the small blood vessels begin to slowly disappear over the ensuing months. The risk of scarring is low. Complete resolution of the unwanted veins may require two to three treatments. Each laser treatment may cost $300 to $400, depending on the length of time required to treat the skin.

Super CP Serum has often been reported by our clients to remove spider veins.

Laser Treatment of Leg Veins

Generally sclerotherapy is used on leg veins but specialized lasers are now also used to vaporize unwanted leg veins. One difficulty is that veins may be arterial or venous in nature and vary in size from 0.1 mm up to 4 mm in diameter. The Mayo Clinic (Rochester, Minnesota) has reported good results using a new Long Pulsed Neodymium YAG laser operating at 532 nm, which is green light. They report that patients can expect to achieve over 75% of their leg veins successfully treated in one or two treatments. The Long Pulsed Alexandrite Laser appears promising for the treatment of leg veins greater than 0.5 mm in size.

Microsurgery (ambulatory phlebectomy) for varicose veins

In about about 20 to 25 percent of people with varicose veins, some veins require the removal of  a damaged vein through minute incisions under local anesthesia.

"Vein hooking" is the somewhat unfortunate term for modern methods of removing varicose veins. However, it is a great improvement over previous methods of treating the veins. Under localized anesthesia, a small "hooking" instrument is used to remove small segments (up to 6 inches long) at a time, instead of the older methods of removing the entire vein at once. Since the removed vein was dysfunctional, the blood circulatory system easily compensates for its removal by re-routing the blood through the thousands of other healthy veins.

The procedure takes between one and three hours, and there is little patient pain or discomfort. After surgery, the leg is covered with a bandage and compression stocking. Mild physical activity, like walking, light bike riding, and housework, is recommended after surgery to help keep the blood flowing.

Exercise and Vein Health

Walking, swimming and other forms of physical exercise helps strengthen the muscles in your legs that push blood toward the heart. For large varicose veins, dermatologists recommend exercising with graduated elastic (support) stocking.

Laser Treatment of Other Pigmentations by Blood Vessels

More than 10 in 100 babies have some type of vascular birthmarks. These are made up of blood vessels bunched together in the skin. They can be flat or raised, pink, red or bluish discoloration's. Certain of these disfiguring disorders of blood vessels are helped by laser treatment.

Port-Wine Stains is a type of vascular birthmark that is also called nevus flammeus, or capillary hemangioma, but should not be confused with a hemangioma. Port-wine stains are flat, pink, red or purplish discolorations and are found mostly on the face, neck, arms or legs. Over time, port-wine stains may become thicker and develop small bumps or ridges. Laser treatment of port-wine stains is performed on an outpatient basis with several treatments over two month intervals. About one-fourth of port-wine stains are totally cleared by lasers and seventy percent will look much better.

Hemangiomas include strawberry hemangiomas and cavernous hemangiomas. The term "hemangioma" is used to describe many types of blood vessel growths. Strawberry hemangioma is slightly raised, and red because the abnormal blood vessels very close to the surface of the skin. Cavernous hemangiomas have a blue color because the abnormal vessels are deeper under the skin. Laser treatments of these conditions have reported to be promising.

Congenital and acquired pigment conditions often respond to laser surgery. Both light brown birthmarks (cafe au lait) and blue facial birthmarks (nevus of ota) usually are removed by laser surgery.

Wart Removal

Warts are non-cancerous skin growths caused by a viral infection in the skin or mucous membranes. Warts are usually skin-colored and may feel rough to but other types can be dark, flat and smooth. The lesions are caused by a virus "family" called the Human Papilloma Virus (HPV) and may appear on any part of the body. Warts seem to start from injured or broken skin and people with a weakened immune system are more prone to a wart infection.

There are several kinds of warts:

Common warts grow around the nails, on fingers and on the back of the hands. They commonly grow where skin has been broken, such as where fingernails are bitten or hangnails pulled.

Foot warts, normally on the soles of the feet, are called plantar warts. Most plantar warts are flattened by the pressure of walking. Plantar can be painful and can feel like a small stone in the shoe.

Flat warts are small and smooth, but tend to grow in numbers of 20 to 100 at any one time. In children, they are most common on the face. In adult men, they are often in the beard area and on the legs in women. Skin irritation from shaving lets the virus invade the skin.

Genital warts (called condyloma), are common and tend to be small and flat but can also be thin and tall. These are soft and can occur on the  genitalia, within the vagina, on the cervix in women, and around the anus or within the rectum.  The viruses causing these warts rarely affect the hands or feet but can spread in the mucous membranes of the mouth. Such warts should be regularly checked by a physician and women with genital warts should have regular PAP tests.

The most common treatments are by cryosurgery (freezing with liquid nitrogen),  the CO2 laser or the pulsed dye laser. However, there are many other treatments and and a recent review listed 19 methods used for wart removal. The application of salicylic acid pads which are available without prescription is usually helpful, but a slow method. Chemical peels with an acid such as trichloroacetic acid or a blistering agent such as cantharidin may work. The warts may be injected with cancer chemotherapeutic drugs (such as bleomycin) or interferon, which causes an immune system attack on the wart.

Immunotherapy treatments attempt  to cause the body to attack the wart. One method paints chemicals that bind to proteins in the wart and cause a mild allergic reaction around the wart. This often causes the disappearance of the wart.

Some warts spontaneously disappear and forty percent of  untreated patients will be free of warts after 2 years.

One surprisingly treatment that is often successful for wart removal is hypnosis. In some persons, the power of subconscious suggestion is able cause a regression of warts when other treatments have failed. A book describing these methods is Clinical Hypnosis: Principles and Applications by Harold B. Crasilneck, Ph.D. and James A. Hall, M.D. ISBN # 0-205-10082-1.

Moles

There are many varieties of moles which are clusters of pigmented cells growing on the skin. Most moles are raised, pigmented lesions but they may be flat or raised flesh-colored lesions. Technically moles are called nevus cells that form into nests in the upper portion of the skin.

Although some moles are referred to as beauty marks, many others are removed for cosmetic reasons and others are removed for medical reasons, such as their potential to become melanoma cancers. A melanoma appears like a growing mole with a spreading, but often often notched margin and varies in color. It may thicken and may bleed. If in doubt have your dermatologist check any suspicious moles.

Different techniques are used by dermatologists to remove the various types of moles. Lasers are increasing used for mole excision. Skin tags or polyps, and other wart-like skin growths are treated by either cryosurgery (freezing with liquid nitrogen) or the CO2 laser. Scarring is minimal.

For people facing the chronic development of new moles, retinoic acid (vitamin A acid, Retin A®, Tretinoin) is often prescribed. In addition to its uses in treating acne and for improving skin quality, retinoic acid has has anti-tumor effects and causes the regression of many types of non-uniform pigmentation (such as the start of moles) and precancerous lesions.

Some moles can can be removed with the combination of alpha hydroxy acids and copper peptides. A mixture of a strong copper peptide cream and a strong alpha hydroxy acid cream is rubbed into the mole daily. After about one to three months, some moles  flatten and diminish in size or are totally removed. See www.scar-reduction.com.

Age Spots and Freckles

Lentigenes, known as sun spots or age spots, are benign, darkly pigmented lesions on sun exposed skin areas such as the face, upper chest, arms, and hands. Some lasers such as the ruby laser destroy the pigment in the skin but do little damage to the skin. Six to eight weeks after the initial treatment, the response is evaluated to determine if further treatments are needed.

Age spots are hard and removal is slow - over several month. Many age spots can can be removed with the combination of strong SRCPs such as Super Cop and strong hydroxy acids (you may need a 30% glycolic acid). The mixture of Super Cop and the strong hydroxy acid cream is rubbed into the age spot daily. After about two to four months, many age spots flatten and diminish in size or are totally removed. See www.scar-reduction.com.

Skin Tags and Sun Damage Marks

Skin tags and sun damage marks (actinic keratosis or solar keratosis) are unwanted or extraneous pieces of skin that protrude from the surface of the skin. In general, they are innocuous, but can be esthetically offensive. Dermatologists usually remove them with lasers, surgically, with liquid nitrogen as the dermatologist deems best.

Many skin tags and sun damage marks can be removed with the combination of hydroxy acids and SRCPs. The SRCP and the hydroxy acid are rubbed into the skin lesion daily. After about two to four month many tags and marks will either turn brown and fall off the skin or sometimes they redden and swell for a few days, then also fall off. See www.scar-reduction.com.

Skin Lightening Chemicals

Increased melanin deposition resulting in hyperpigmentation may be a sign of hormonal changes, pregnancy, chemical exposure, or some pharmaceutical drugs

Skin lightening treatments often use 2 to 4% hydroquinone in an alcoholic glycol or cream base that is applied daily. Hydroquinone decreases melanin production by deactivating tyrosinase. It is usually most effective when applied over the entire face rather than specifically at hyperpigmented sites. Hydroquinone is effective for only as long as it is used. After stopping treatment; normal levels of tyrosinase will be present within two or three days and treatment is  required indefinitely to maintain results.

Retinoic acid (tretinoin, Retin-A) has melanin-blending properties and the combination of retinoic acid and hydroquinone gives more even distribution of pigmentation. The ratio of retinoic acid and hydroquinone can be adjusted to achieve the desired balance of bleaching and blending. In persons with vitiligo (the appearance of de-pigmentated patches of skin), physicians use a higher ratio of retinoic acid to hydroquinone, to achieve the maximum blending with minimum skin bleaching.

Before use, the hydroquinone patch tested for a week before using to determine a person's tolerance of the chemical. When outside, a reflective sunscreen of SPF 15 or greater should be used to avoid suntanning.

Other products that are also used for skin lightening are kojic acid, arbutin, ascorbic acid, botanical lighteners, and glycolic acid.

Rosacea

Rosacea ( also called " The Curse of the Celts" ) is a common, treatable skin disorder that occurring most often among fair-skinned individuals of northern European descent. The ailment afflicts approximately 1 in 10 adults, who are usually in their 40s or 50s. A person with classic rosacea has many tiny, visible red blood vessels in the central part of the face. Rosacea starts as a tendency to blush easily. Facial and neck flushing may accompany the blushing. With time the redness begins to persist, creating a constant, rosy glow created by dilated blood capillaries near the surface of the skin. After the redness appears, pimples may break out. As time goes on, the affected skin of begins to swell and thicken. The condition is not caused by alcoholic intake.

The cause of rosacea is unknown but is is primarily a disorder of blood vessel growth patterns. The disease is most prevalent in fair-skinned individuals who have extensive sun damage to their skin. Women are more likely to get rosacea on the cheeks and chin, while men are more affected on the nose. For most people it tends to get better and then worsen (flare up). Condition that seem to worsen rosacea include sun exposure, hot drinks, alcohol, spicy foods, and extremes of hot or cold temperature.

There are effective medications for rosacea. Oral drugs include antibiotics and, in rare cases, isotretinoin (Accutane). Topical agents used for treatment include MetroGel® is a topical antibiotic and Sulfacet-R® which is also used for seborrheic dermatitis. In addition, a water-based Color Blender can be mixed with the Sulfacet-R® which eliminates the need for other color make-ups. It usually takes about two months to eliminate or reduce rosacea, then the dosage of drug is reduced.

If medications are not effective, laser therapy may be used to destroy the small blood vessels in the face. This laser treatment seems to decrease acne as well as the skin redness.

Gentle skin care is is highly recommended and the use of very mild soaps.  Persons with rosacea should avoid abrasives, scrubs, astringents, and other agents that irritate the face. For women, a green-tinted concealer under makeup dampen the redness of rosacea.

Some women have found that the use of CP Serum and Emu Oil for Skin plus use of a very mild skin cleanser such a Liquid Gentle Clean alleviates the symptoms of rosacea. Sometimes this works better than MetroGel.
 

A Non-drug Procedure That May Help Reduce Rosacea

Procedure		Click to Order
Step 1	Use Gentle Clean for cleansing or another very mild cleanser
Step 2	Apply a light coating of Emu Oil in the morning
Step 3	Apply a light coating of CP Serum before bedtime

The National Rosacea Society publishes a periodic newsletter called Rosacea Review. For information, contact:

               National Rosacea Society
               800 S. Northwest Highway
               Suite 200
               Barrington, IL 60010
               Telephone: 1-888-662-5874 (toll-free)
               Website: http://www.rosacea.org
               E-mail: rosaceas@aol.com

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