Simple way to healthy skin!

Skin Health and Stump Hygiene (part 2)

2010-11-30T11:30:00.000-08:00

Conduction, the transfer of heat between two media in direct contact, is of great impor¬tance to the amputee. As the socket becomes warmed to skin temperature, it acts as an insu¬lator against further dissemination of heat from the surface of the stump. It appears prob¬able also that in the vicinity of principal load¬ing, especially along the medial, anterior, and posterior segments of the socket rim, heat is generated by the friction resulting from shear¬ing action between the skin and the socket rim. The insulating effect of the socket would, of course, tend to maintain any such local eleva¬tion of temperature. We are initiating a clinical study of this question, employing thermistors for the direct reading of skin temperatures while the prosthesis is being worn under vari¬ous conditions of normal use.
Just how significant increased local heating of the skin may be in adversely affecting skin hygiene and metabolism over a long period of time we cannot say at present. It is known that an increase in environmental temperature elevates the oxygen and nutritional require¬ments of most tissues. At the same time, the blood supply to the skin of a lower-extremity stump, if changed at all by the active use of a prosthesis, is probably reduced. One might speculate here whether the predilection of these weight-bearing sites for the development of recurrent "pressure sores" may not be re¬lated to increased local heat plus diminished nutrition, as well as to mechanical damage and to maceration from sweat. Certainly this area of stump hygiene merits further investigation.

REFLEX SWEATING
If, in the normal person, the environmental temperature is raised above a critical level between 31° and 32°C (88° and 90°F), there is a sudden, visible outbreak of sweating over the whole body. A similar response, termed "reflex sweating," may be observed when only a portion of the body surface is heated. When¬ever there is excessive heating of the stump, the conditions favor reflex sweating, even though the environmental temperature of the rest of the body is below the critical level nec¬essary for visible sweating. Certainly a valu¬able contribution, both to the comfort of the amputee and to the improvement of his stump hygiene, would be the development of new socket materials and designs which would pro¬vide for more rapid heat transfer by conduction and radiation to the outside air.
Loss of heat by evaporation from the stump is negligible in the case of the suction socket. Where the conventional socket is worn with a wool stump sock, however, the wicking action of the sock may well provide an avenue for evaporation and consequent cooling. A light stump sock for use with the suction socket may prove feasible. If so, the cooling effect, as well as the added support and protection afforded the stump skin, would be of benefit in main¬taining a healthy stump.
According to Rothman (15), sweating which is elicited by exercise begins at a lower skin

temperature than does sweating produced by external heat. Bazett (2) suggested that there may be, deeply situated near vascular plexuses, thermal receptors which are warmed by the working muscles. These receptors may in turn activate the sweat glands of the skin. What¬ever the true explanation may be, the com¬bination of excessive sweating (Fig. 5) and increased energy requirements for locomotion is all too familiar to the lower-extremity amputee.
Visible sweat secretion and heat loss can also occur independent of thermoregulatory needs. For example, sweating can be elicited with ease at air temperature below 31°C (88°F) by the ingestion of hot drinks, probably through a viscerocutaneous reflex. A variety of other nervous impulses unrelated to heat control may produce sweating. One of the most important of these is "emotional sweat¬ing," which may at times affect most of us to some degree. In dermatologic practice, we sometimes see patients in whom this condition has become so severe as to be almost incapaci¬tating. Serious limitations affecting social con¬tacts and employability result. The same disturbance of sweat mechanism may be ex-perienced by amputees. Although the emotional factor may be important in some amputees who have a troublesome hyperidrosis, it is apparent from some of the known physiologic mechanisms for sweating that there may be other reasons for such an increase.

STUMP HYGIENE AND GERMS
It has been a matter of frequent observation that the normal skin is not a sterile skin. Such a condition simply does not exist. Normal skin teems with immense numbers of unseen organ¬isms, some harmless and some pathogenic, that is, capable, under the right combination of circumstances, of causing an infection of the skin. Normally, the harmful bacteria and fungi are held in check by a number of different forces. Most of the time we live in some meas¬ure of harmony with this enveloping horde. But when resistance to infection is lowered by local skin damage, the presence of some gener¬alized disease, a metabolic disturbance such as diabetes, or any one of numerous other causes, then this harmonious balance is de¬stroyed and the avenue of invasion is opened. Two different classes of bacteria exist on nor¬mal skin under average conditions—the resident bacteria, which remain fairly constant, and the transients, which may be almost any¬thing (Fig. 6). In addition, a variety of fungi come and go, chiefly members of the yeasts and molds, although other types, such as those which cause ringworm of the feet and body, may be present.
Evans et al. (11) have studied the resident bacterial flora in 146 sample scrapings from the skin of 17 adults over an eight-month period. They found that the anaerobic bacteria (those which grow in the absence of free oxy¬gen) outnumbered the aerobic bacteria (those which require free oxygen) by a ratio that ranged between 10:1 and 100:1. In most of the cases, one species of anaerobic bacteria pre¬dominated, the so-called "acne bacillus," Propionibacterium acnes . Of the aerobic bacteria, two species were observed regularly: Micrococcus epidermidis and Staphylococcus albus {Micrococcus pyog-enes), the latter a skin pathogen The ob¬servation was made that, at least in cultures, some types of bacteria inhibited the growth of others. This finding might constitute one explanation for the overgrowth of certain bac¬teria, especially the acne bacillus, at the expense of the others. It was also found that the sebaceous glands were the major site of growth of bacteria on the skin and that exer¬cise with sweating caused a transient minor increase in skin flora.
What effect might the wearing of an occlu-sive prosthesis be expected to have on common skin pathogens trapped under the socket? How might the normal defenses of the skin be affected by the conditions attendant upon the use of a prosthesis? To answer these questions, let us consider four common groups of organ¬isms which are likely to cause skin infections in the region of the amputee's stump—the gram-negative organisms like Escherichia coli, the staphylococci, the beta hemolytic strep¬tococci, and Proteus, some strains of which are secondary wound invaders.
We know that the normal skin surface has two important natural defenses against bac¬terial invasion—first, the ordinary drying action on the surface, facilitated, where the skin is uncovered, by the movement of air currents; second, the presence of unsaturated fatty acids (particularly oleic acid), which are components of the sebum, or oily secretion from skin oil glands.
Gram-negative organisms, that is, those organisms which do not retain the selective blue dye used in the Gram staining technique, are particularly sensitive to drying. This alone is effective in killing or inhibiting their growth. Unfortunately, the dry state never exists for any length of time over the stump skin during the use of a prosthesis.
Both the drying and the action of the fatty acids are slightly to moderately inhibitory against the staphylococcal organisms. In other words, neither factor offers sure protection against invasion by this group of germs, but both have deterrent value in the normal skin. Again, the moist state which usually exists under the socket tends to encourage the growth of staphylococci.
Although the beta hemolytic streptococcus is unaffected by drying, it is destroyed by oleic acid. But streptococci will grow in serous exudate, such as may be seen in a weeping eczematoid dermatitis of the stump, because the albumin in the exuded serum neutralizes the oleic acid, the chief natural antagonist of the streptococci. This relation of exudative lesions of the skin to secondary infection under¬lines the importance of adequate hygienic care in routine management of minor abrasions and irritations of the stump area. Further¬more, it should be apparent that there are times when the continued use of a prosthesis on a stump which is the site of a dermatitis, especially where a serous discharge is present, will prevent healing and is almost certain to invite a secondary infection.
The Proteus strains—the fourth group of organisms mentioned—multiply rapidly in a moist environment. Any occlusive dressing or cover, such as the socket, which tends to increase local moisture on the skin will favor a heavy overgrowth of Proteus.
Thus we see that, in all four of the examples cited, the use of a prosthesis may be expected in some measure to interfere with the defensive mechanisms of normal skin in its resistance to disease. This interference is augmented by prolonged or strenuous use of the prosthesis and by the presence of any pre-existing lesions, however minor they may seem to the amputee.

ELECTRICITY AND THE SKIN
The electrical behavior of the skin plays an important part in the preservation of good health. Normally, there is a negative electrical charge in the superficial layers of the skin. When an alkaline condition prevails, this electrical negativity is increased owing to adsorption of negatively charged hydroxyl ions. An acid condition of the skin, however, causes a discharge of this normal negativity, which is complete between pH 3 and pH 4. As the relative acidity of the skin increases, there is eventually a reversal of the charge, the skin surface becoming electrically positive. Fur-thermore, investigators have reported that scarring of the epidermis (14) and prolonged soaking in water or concentrated salt solutions (13) tend to cause a discharge of the normally negative charge of the skin. Both of these ab¬normal conditions may develop over the stump as the result of use of a prosthesis.
Just what effect socket wear has on the nor¬mal electrical behavior of the stump skin, or how significant this may be in maintaining a healthy condition in the stump area, we do not know at the present time. This is, however, another problem that should receive further investigation. We do know that the negativity of normal skin can be a factor in the defense of the body against pathogenic organisms, which are also negatively charged and which tend to be repelled from, or bound to, the sur¬face of the skin according to variations in the electrical charge on the latter (Fig. 7). It is of interest, incidentally, to note here that in muscle the relationship of negative-positive electrical charges to normal and damaged tissue, as here described for the skin, is just reversed.

STUMP HYGIENE AND LOCAL pH or THE SKIN
Blank has confirmed earlier observations that the pH of healthy skin is always on the acid side, falling usually between 4.2 and 5.6. Furthermore, both eccrine sweat and apocrine sweat are normally acid. These facts have given rise to the concept of the so-called "acid mantle" of the skin, which is cited by some investigators as one of the body's natural defenses against disease. Schmid (17) found a significant shift toward the alkaline side in the surface pH of the skin in cases of eczema and in seborrheic dermatitis, an inflammatory disorder involving especially the hairy and more oily regions of the skin. In general, an even greater shift toward the alkaline side takes place in these inflammatory diseases if the intact skin is broken and neutral in charge or if alkaline extracellular fluid diffuses through, as in any acute, weeping dermatitis of the stump. With healing, the original acid pH returns.
BUFFERING ACTION OF NORMAL SKIN
Another important property of the skin is its buffering action. If the skin surface is exposed to dilute acids or alkalies, there is normally a corresponding shift of the pH locally; but this is temporary, and the former acid pH is rapidly restored. This behavior represents the neutralizing capacity of the skin. Probably the most important agents in this neutralizing property are the sweat constitu¬ents, especially the lactic acid-lactate system and the amphoteric amino acids. Any local damage to the sweat mechanism, such as might be caused by socket irritation, could conceivably impair this important function of the skin in the involved areas. Burckhardt {7,8) and others have established that there is a definite correlation between the acid and alkali neutralizing capacity of the skin and its tolerance for acids and alkalies.
Pursuing a discussion of acid-base balance brings to mind several unanswered questions with regard to the amputee's problem of stump hygiene. We would like to know, for example, what happens to the normally acid pH of stump skin during the daily wearing of an airtight socket. Does stump skin possess the same pH and buffering properties as the skin of an intact limb? What effect do different socket materials have on the pH of stump skin? Does an interior finish which gives an alkaline reaction necessarily cause more damage to the skin than does one with an acid reaction? These are questions which should receive further investigation in the light of their vital relationship to stump hygiene.
It might seem from the foregoing that the cutaneous surface which gives an acid reaction denotes a healthy skin, resistant to invasion and disease, while an alkaline-reacting skin surface denotes the presence of some disease state. Unfortunately it is not quite so simple. Some organisms grow readily on an acid medium. Pathogenic fungi, for example, flourish on certain media at pH 4.9. None¬theless, in general, it is desirable to maintain the surface of the skin at least slightly on the acid side.
Washing, even with plain water, causes moderate hydration of the horny layer, with a drop, according to Szakall (21), from pH 6.3 to pH 5.3 in 30 minutes. This information may also have some application to lower-extremity prosthetics, since the stump skin becomes soaked with sweat in most cases shortly after the prosthesis is put on. Further¬more, a single washing with soap removes about 50 percent of the surface lipid film, thereby facilitating the outward diffusion of carbon dioxide, the acid reaction of which helps to neutralize an alkaline state on the surface of the skin.
SURFACE pll AND DEGERMING OF THE SKIN
Control of surface pH is also important in degerming the skin. Blank, Coolidge, and others (4,5,6), in an extensive study of the surgical scrub, have investigated many differ¬ent germicidal agents and techniques of cleans¬ing. Among the agents studied were the quaternary ammonium compounds, like Ceep-ryn® and Zephiran,® which are widely used in surgical cleansing of the skin. While these compounds do exert a bacteriostatic or bac¬teriocidal effect, Blank et al. found that they also have the property of binding the bac¬teria to the skin. It was demonstrated that, at a pH a little higher than the isoelectric point of keratin, the quaternary ammonium com¬pounds change the normally negative charge on the surface of the skin to positive. Since the bacteria are negatively charged, they are attracted to the skin. If the pH is then in¬creased considerably, for example by rinsing with an alkaline soap, the charge on the skin will revert to negative and the bacteria will be released from the skin, as has been confirmed experimentally by analysis and culture of the rinse water.

Another germicidal agent commonly used in disinfecting the skin is G-ll,® or hexa-chlorophene. Chemically it is 2,2'-methyl-enebis (3,4,6-trichlorophenol):
This compound has the double advantage of accumulating on the skin when used daily and of not being inactivated, as most germicides are, when combined with a detergent. If used only at infrequent intervals, G-ll is no more effective as a disinfectant than any nonmedi-cated soap. If used regularly, however, within five to seven days there will develop in the skin a concentration sufficient to cause a definite reduction in the bacterial flora. One contraindication to the use of this agent is the presence of a serous ooze, such as we see not infrequently on the stump in various types of eczematous skin conditions. Seastone (19) has reported that as little as 1.0 percent of sterile serum will reduce the bacteriostatic effect of this agent.
Hexachlorophene is available commercially in combination with various soaps and liquid detergents, in strengths varying from 0.75 to 3.0 percent. These include such brand names as Dial® soap, Gammaphen® soap, pHisoHex,® and Septisol.® Another useful preparation of G-ll is an alcoholic solution containing 0.1 percent of G-ll, with 0.5 percent of cetyl alcohol added as an emollient. This solution may be used as a two-minute rinse following soap-and-water cleansing of the stump.
A useful cleansing agent for stump skin has been found to be pHisoHex, especially where superficial infection is a problem. It consists of an emulsifying agent known as pHiso-derm,® to which 3 percent of G-ll has been added. Chemically, pHisoderm is sodium octylphenoxyethoxyethyl ether sulfonate, plus lanolin cholesterols, lactic acid, and petrola¬tum. Its pH is 5.5, approximately that of nor¬mal skin. It lowers the surface tension of water and is an active emulsifier.
There are many other agents for degerming the skin, many of which are too irritating for the type of regular use necessary to routine stump care. One of the more readily available of these is alcohol, which remains a useful bac¬teriocidal preparation. Isopropyl alcohol, for example, is germicidal up to 50-percent dilu¬tion. Too-frequent use of such solvents, how¬ever, will dry the skin excessively and may do more harm than good. Furthermore, any marked depression of bacterial flora over the stump skin cannot be maintained for long during use of the prosthesis.
SELECTIVE ABSORPTION AS A PROTECTIVE BARRIER
The healthy cutaneous envelope of the body is constantly active as a physicochemical bar¬rier against the outside world, retaining some substances and passing others through (Fig. 8). As early as 1904, Schwenkenbecher (18) showed that the intact skin is permeable to fat-soluble substances and to certain gases but is practically impermeable to water and most electrolytes. Most substances which are soluble in both water and lipids penetrate the skin and pass into the general circulation at rates comparable even to gastrointestinal or subcutaneous absorption. Phenolic compounds, lipid-soluble vitamins, and hormones pene¬trate rapidly. This property of the skin con¬ceivably could be of serious import in the indiscriminate use of socket materials or fin¬ishes capable of liberating absorbable toxic fractions which could be taken up by the stump skin.
In rare instances, individuals have demon-strated a peculiar sensitivity, known as an "idiosyncrasy," on first exposure to certain drugs and chemicals applied to the skin. Alex¬ander (1) described a case of iododerma, a form of iodine reaction, resulting in the death of a 37-year-old woman following routine pre-operative cleansing of the surface of the skin over the abdomen with iodine. This is not intended to suggest that any similar hazard exists in the use of present-day, conventional socket materials. It does, however, emphasize the fact that the skin may be, in certain rare cases, an open portal to the systemic circu¬lation.
Transfer of gases across the skin barrier may take place with ease in either direction. The biological significance of the movement of oxygen and carbon dioxide through the skin, which was once thought negligible, is given more importance now. Shaw and others (20) found that oxygen was given off through the skin when the oxygen content of the am¬bient air was reduced to about 2 percent and that it was absorbed more rapidly when the skin was surrounded by a gaseous mixture containing about 37 percent of oxygen than when surrounded by air. According to Cham¬bers and Goldschmidt (9), if the total skin surface is surrounded by nitrogen gas instead of air, there may be a compensatory, increased uptake of oxygen by the lungs.
Hediger (12) reported that, from a water chamber containing the dissolved gas, carbon dioxide passed into the skin as long as the water contained more than 4 percent of carbon dioxide. When the concentration dropped below 4 percent, carbon dioxide diffused out¬ward through the skin, as it does constantly under physiological conditions. Measurements cited by Rothman and Schaaf (16) showed that over a 24-hour period 7 to 9 grams of carbon dioxide escaped from the total skin surface, less that of the head, of an adult male. The amount suddenly increased when the temperature was raised to the critical tem¬perature of visible sweat secretion.
Cleansing of the skin with organic solvents such as ether, benzene, and, to a lesser degree, alcohol, enhances percutaneous absorption, that is, absorption across the skin barrier. Since such solvents are used frequently in the cleansing of the stump, as well as of the inte¬rior of the prosthetic socket, this effect upon the skin's absorption should be borne in mind. Moisture, almost constantly present in the wearing of a prosthesis, also promotes trans-epidermal absorption by an unexplained mechanismю

SUMMARY
Through the use of improved prostheses, many amputees have been able to return to relatively normal physical activity and to take again their rightful place in business and social life. It must be remembered, however, that the use of a prosthesis places upon the leg amputee new and heavy demands, includ¬ing not only muscular and emotional readjust¬ments but also the infliction of unaccustomed wear and tear upon his stump skin. Daily, for the rest of the amputee's life, his stump will be subjected to an abnormal environment that combines heat, moisture, and darkness with chemical and mechanical irritation. It becomes imperative then, in restoring the amputee to full activity, to make certain that he under¬stands the importance of systematic skin care. An adequate appreciation of the necessary requirements for good stump hygiene must be based on a knowledge of the functions and limitations of normal skin.
The skin provides for the other tissues a highly effective, tough and elastic outer cover¬ing, which has a great capacity for strengthen¬ing itself at points of stress and for repairing itself after injury. But this capacity of the skin for mechanical protection, the limits of which are of special interest in prosthetics design, is only one of its many important functions. The skin possesses, in addition, a variety of ana¬tomical structures, including the eccrine, apocrine, and sebaceous glands, the normal function of which is necessary for the preserva-tion of good skin hygiene. The eccrine glands are indispensable in the heat control of the body. All of the glands produce secretions, some of which are exceptionally copious. This normal function poses an important sanitary problem for the amputee and makes routine cleansing of both the skin and the prosthesis essential.
The natural defenses of the skin against germs depend upon good hygiene. Conditions inside the socket tend to impair the resistance of the skin to infection, but through adequate cleansing, frequent airing, and intelligent care of early lesions, serious infection may be avoided.
Knowledge is increasing concerning the electrical and chemical buffering properties of the skin and their role in the maintenance of skin health. There is usually a negative charge in the superficial layers of normal skin. It is, however, discharged by injury or by prolonged soaking in water or salt solution. Similarly, normal skin is slightly acid, but in the presence of inflammation of the skin a shift to the alkaline side usually occurs. The sweat con-stituents contribute largely to the capacity of the skin to neutralize or buffer dilute acids and alkalies to which it is exposed. Whether or not these properties are retained intact by the stump skin of amputees and, if so, how they are affected by the conditions of use of a prosthesis are important areas for further research.

Although the skin serves as a protective barrier, it is readily penetrated by certain substances. For this reason the stump should be protected from contact with materials potentially toxic. Similarly, the stump skin may be subject to a variety of local injuries— mechanical, chemical, or allergic in origin. Again the importance of early and close attention to minor lesions and to good pre¬ventive hygiene must be emphasized.
There have been two chief aims in this discussion of basic principles. The first was to impart an awareness of the complex nature of the problem of stump hygiene and the second to emphasize that good stump hygiene, far from being an academic matter, is one of the utmost importance to the amputee. Like the proverbial dispatch rider whose horse was crippled for want of a horseshoe nail, the amputee may suffer discomfort and serious disability because of neglect of a seemingly insignificant lesion or failure to follow a simple cleansing routine.

Skin Health and Stump Hygiene (part1)

2010-11-30T11:29:00.000-08:00

Literally the word "hygiene" connotes a state or condition of health. But adequate hy¬giene, or good health, of the human skin pre¬sents a complex problem involving much more than a casual acquaintance with soap and water, the concept which usually comes to mind when hygiene is mentioned. The func¬tional state of our human integument is pretty much taken for granted by most of us. We know that this two-square-yard covering will, in most cases, repair itself in event of local injury, provided infection is avoided. Cheer¬fully we dissolve it in strong chemical solu¬tions. We broil it in the summer sun until it peels off like old birch bark. We allow it to be rubbed and blistered in tight shoes for vanity's sake. As a nation, we spend millions of dollars on elaborate sun-tan lotions guaranteed to produce in it the beautiful brown of the abo¬rigine and at the same time an equal fortune on lotions and creams which promise to bleach it out to the shade of a sheltered lily.
Even though the skin has remarkable powers of restoration, the conditions of use are occa¬sionally too damaging, or the opportunities for healing between periods of use are too brief for repair and maintenance. In such in¬stances, there may be an acute breakdown of the skin with a severe inflammatory reaction, or the process may be a gradual one, with a progressive deterioration of the skin and a loss of its protective properties. Among indi¬viduals in certain occupations, we frequently see both manifestations of such skin reaction. Housewives, mechanics, laboratory workers, and others whose work exposes certain areas of the body, particularly the hands and arms, to prolonged soaking in solutions and solvents, or even in plain water, are prone to recurrent skin irritation and breakdown. In such cases, the chemical and physiological properties of the skin are altered to such a degree that the skin's built-in protective functions are no longer effective. Even in the absence of pro¬longed soaking, the skin may be injured locally by contact with an irritant, such as a strong acid, or with a sensitizing agent, such as poison ivy.
All of these considerations similarly pertain to amputees who wear some type of prosthesis (Fig. 1), most of which are attached to the stump by means of a snugly fitted socket which excludes circulating air and traps the accumulated sweat against the skin. In the lower-extremity amputee, the effect is aggra¬vated by the added factor of weight-bearing and uneven loading on localized areas of the stump skin, especially in the adductor region of the stump and at other points of contact with the socket rim. Weight-bearing is at¬tended by other mechanical stresses, espe¬cially intermittent stretching of the skin and friction from rubbing against the socket edge and interior surface. The latter results in two important and harmful effects on the skin— heat, and abrasion of the skin surface, which in time can, by steady attrition, become highly destructive. Over a long period of time, heat alone may be capable of causing profound changes in the metabolism of living tissues. The stump skin of the amputee is especially vulnerable to the possible irritant or allergic
action of various materials that compose the socket of the artificial leg.
In this situation, then, the state of health of the stump skin is of the utmost importance in determin¬ing whether or not the prosthesis can be tolerated. If the skin can-not be maintained in a good func¬tional condition in spite of daily wear and tear, then the weight-bearing prosthesis cannot be worn, no matter how accurate the fit of the socket may be.
It is the purpose of this article to review some of the basic prin¬ciples of skin biochemistry and physiology concerned in the main¬tenance of good hygiene in the stump area. Included are some re¬marks relative to the use of certain disinfectant agents in skin cleans¬ing, and to some of the natural skin defenses against bacterial in-vasion, because these topics also are germane to the principal subject with which this article is concerned.

THE SKIN AS A VITAL ORGAN

Man cannot live without his en¬velope of skin any more than he can exist without his heart or his liver. It might seem at first thought that the cutaneous covering of the body performs about the same function as the leather cover of a baseball —and very little more. Actually, the biochemical and physiological activities of the skin are every bit as complex as are those of the liver. The respiratory rate of the main cellular portion of the epidermis, based on oxygen-uptake studies and glycolysis measurements, has been computed to be from two to ten times as high as the rates of other body tissues.
The skin possesses many properties vital to health and life itself. Of particular interest to us from the standpoint of prosthetic design and use is the part it plays in mechanical sup¬port of the soft tissues of the stump. It pro¬vides a tough, elastic outer covering with a tensile strength of up to 2 kg. per sq. mm. Fur¬thermore,   this   covering has   a   tremendous capacity for repairing itself after injury and for strengthening itself at points of mechanical stress, such as those occurring on the lower-extremity stump in association with the wear¬ing of an artificial limb. A familiar example of this is the "lichenification," or leatherlike thickening of the skin over the ischial tuber-osity and in the adductor region of the thigh. We know that "calluses," or localized thick¬enings of the horny outermost layer of the skin, will form at points of repeated pressure. Sometimes a BB-shotlike condensation of horny material will develop over a pressure point, producing the well-known "corn." All of these thickening processes illustrate the defensive reaction of the skin to abnormal mechanical stress by elaborating a natural cushion from its cellular elements.
Mechanical protection, however, is only one of many important services which the skin performs. Its function in the conservation of water and electrolytes, those ionized salts which constitute an essential part of the body fluids, is nearly as indispensable as is the func¬tion of the kidneys. The skin is extremely important in the regulation of the body tem¬perature within relatively narrow limits. It possesses certain important electrical and chemical properties. It is also the first barrier, and one of the chief defenses of the body, against infectious diseases.
Many other properties of the skin that are of less immediate importance to the problem of stump hygiene nevertheless have a bearing on human health and welfare. For example, we rely on the sensory organs of the skin for a good part of our information about the world around us. Through nerve endings at or near the surface, the body receives the outside en¬vironmental stimuli of heat, cold, pain, and touch. Also important to health is the role of the skin in maintaining a highly complex sys¬tem of pigment metabolism and in providing a source of vitamins important for growth and nutrition.
Although there are other vital functions of the skin, those cited serve to illustrate the im¬portance and variety of the services the normal skin performs. Some of these are described at greater length in the following portions of this paper.
THE ANATOMY OF THE SKIN
Plate I shows in semidiagrammatic form the principal structures of the skin concerned in stump hygiene. The skin is seen to consist of two distinct layers—the epidermis and the dermis, or true skin. These two layers are joined by a system of fingerlike projections, the rete pegs, which protrude down from the epidermis and interlock with the papillae, which project up from the dermis. This device furnishes a relatively large surface area at the dermal-epidermal junction, thus providing a strong bond between the two layers.
The most superficial layer of the epidermis is the so-called "horny layer," consisting of a material called "keratin," which is very simi¬lar to animal horn. Scattered over the surface of the skin are numerous deep pockets, called "follicles," into which sebaceous, or oil, glands discharge their contents. From the follicles protrude the hairs of the skin.
Two other types of glands in the skin have an important bearing on the subject of stump hygiene. They are the eccrine, or small sweat glands, which lie in coils near the base of the dermis, and the apocrine, or large sweat glands (not shown in Plate I), which are simi¬larly situated but are more localized in dis-tribution than are the eccrine glands. The watery sweat secretions pass to the surface of the skin by way of the sweat ducts, dis¬charging on the surface through the sweat-duct opening, or pore.
Deep to the dermis lies the subcutaneous zone. Here, cushioned in masses of fat cells, are the large blood vessels which serve the skin. From the arteries, smaller vessels rise, becom¬ing narrower as they branch, until they ter¬minate in fine capillary nets in the papillae of the dermis. Blood from the papillary nets returns again by a venous collecting system to the large veins in the subcutaneous tissue.

RELATION OF SKIN STRUCTURES TO DISEASE

All of these structures are vulnerable to damage from prolonged wear of a prosthesis. Injury to each different anatomical site results

in a specific disease complex of the skin. For example, excessive heat and moisture may result in a local blocking of the sweat-duct pores. We are familiar with this condition in the form of what is known popularly as "prickly heat," a common malady in warm, humid climates; and the same disorder can occur over stump skin under similar environ¬mental conditions.
Prolonged use of negative-pressure sockets, and to a lesser degree of conventional sockets, may lead to engorgement of the small blood vessels of the skin, resulting in local areas of rupture and extravasation of blood into the surrounding tissues. The dark pigmentation often seen on the terminal end of the stump is the result of this bleeding under the skin. It is usually accompanied by some degree of edema, a state in which there is an abnormal collection of watery fluid in the soft tissues. Thus the skin disorder here is essentially focused in the circulatory system, whereas the previously cited condition of sweat-duct blockage affects primarily one of the glandular systems of the skin. It follows, then, that the over-all hygiene or good health of the stump skin reflects, among other things, the func¬tional state of each of the anatomical com¬ponents of the skin.
SKIN GLANDS AND STUMP HYGIENE
In the skin of the lower extremity, three different types of glands produce secretions that are discharged on the surface of the skin. These are the eccrine glands, the apocrine glands, and the sebaceous glands (Plate I). During daily use of a prosthesis, their secre¬tions accumulate inside the socket, where they may become a serious hazard to local stump hygiene.
The Eccrine Glands
The eccrine glands, or small sweat glands, are distributed over the entire surface of the body. They are accessory structures that develop from the epidermis. They are true secretory glands, producing a clear, aqueous fluid, and their functioning is vital to the heat regulation of the body, since these glands are the principal source of sweat. It has been esti¬mated that there are over two million of these glands in the skin of a normal adult and from
500 to 600 per sq. in. over the skin of the thigh and lower leg. It has been reported that the capacity for sweating is considerably less for females than for males. According to Weiner {23), roughly 50 percent of heat sweat comes from the trunk, 25 percent from the head and upper limbs, and 25 percent from the lower limbs.
Sweat Deposits. Eccrine sweat is a clear, watery solution containing 0.5 to 1.0 percent of solids. These solids play an important role in stump hygiene because, in the absence of adequate daily cleansing, their accumulation on the surface of the stump and in the socket interior may serve as a source of irritation and to some extent as a culture medium for the growth of harmful organisms. The eccrine sweat solids include urea (in at least twice the concentration found in blood plasma); creatine and creatinine in minute quantities; uric acid; a variety of different amino acids; ammonia; free choline; occasional traces of glucose; lactic acid and lactate (to the extent of more than 2 grams in 90 minutes of heavy physical labor); many of the water-soluble B-vitamins; traces of dehydroascorbic acid; and the minerals sodium, potassium, calcium, magnesium, sul-fates, phosphates, and iron. In addition to the sweat solids, there are the secretions of local oil or sebaceous glands, plus a quantity of nitrogenous material made up of keratin shreds and other cellular debris which has been des¬quamated from the surface of the skin.
This is the residue which collects on the skin and in the socket under normal conditions. If the skin has been damaged by abrasion against the socket wall, or if an eczematous skin con¬dition is present, there may be "weeping" or oozing of serum over the surface, where it mixes with the sweat, oil, and skin debris. This serous material is deposited on the inte¬rior wall of the socket, where it dries and sets almost like glue. Successive laminations are added from each day's accumulation, until a considerable thickness may be attained (Fig. 2). Constant wearing and rubbing against the skin may produce a polished, glassy finish on the surface. In the interests of good hygiene, this deposit should be cleaned out of the socket interior regularly.
The innervation of eccrine sweat glands,pharmacologically speaking, is parasympa-thetic or cholinergic. Dale and Feldberg (10) demonstrated that the postganglionic nerve fibers liberate acetylcholine at their endings on the receptor cells of the sweat glands. Where excessive perspiration, or hyperidrosis, has been a serious problem, clinical application of this finding has been made by treatment of the patient with an anticholinergic blocking agent to diminish sweating. Drugs like methantheline bromide (Banthine®) and diphemanil methyl sulfate (Prantal®), which are anticholinergic, have been tried.
Such treatment has proved sometimes very helpful, sometimes of slight benefit, and often discouraging. Even though excess perspiration may be reduced, there are not infrequently unpleasant side-effects, such as a sensation oi heat, dryness of the mouth and throat, head¬ache, and urinary retention. In the amputee, who often has an overheating problem in the first place, any further impairment of his cool¬ing mechanism may not be tolerated. In some cases, however, an effort to control excessive sweating may be worth a try; certainly any drying effect that such drug therapy may exer¬cise in the stump area will contribute to the hygienic state of the stump skin.

Eccrine Sweat Retention. In pro¬fuse sweating, the sweat is expelled from the eccrine glands onto the surface of the skin at intraductal pressures ranging as high as 250 mm. of mercury. If the outlet at the surface of the skin becomes blocked by masses of keratin, local inflammation, or other obstruction, this pressure may be sufficient to cause rupture of the duct (Fig. 3). If the rupture takes place near the surface at the level of the horny, or keratin layer, the sweat collects in this layer in a raindroplike configu¬ration of little blisters. If the rupture is deeper in the skin, there may be local inflammation, charac¬teristic of "prickly heat." Where the duct is ruptured still more deeply, symptoms are few or none, and the only surface sign consists of small, noninflammatory eleva-tions, or "papules." Sweat retention may involve most of the skin surface of the body and may be accom¬panied by pronounced generalized symptoms of fever, headache, and exhaustion, a con¬dition usually confined to tropical climates. More commonly it affects only a localized part of the body. It has been reported in many different types of eczema and in a variety of healing inflammatory lesions. Preliminary investigations of eczematous eruptions of the stump suggest that sweat retention occurs in this area also. The heat and humidity which prevail over the stump skin during use of a prosthesis are factors which encourage the development of sweat-duct blockage and local¬ized sweat retention.
The Apocrine Glands
The apocrine glands, unlike the eccrine glands, develop from the follicular epithelium of the hair, as do the sebaceous glands. Apo-crine glands are much larger than eccrine glands, and they are limited in their distribu¬tion to the underarm area, the breasts, the midline of the abdomen, and the anal and geni¬tal areas. Modified apocrine glands are also found in the external canal of the ear and in the vestibule of the nose.

The apocrine secretion is a turbid, whitish-to-yellowish fluid which dries like glue to form a light-colored plastic. The total number of apocrine glands is greater in women than in men, and axillary sweating starts earlier in adolescent girls than in adolescent boys.
The apocrine glands in the groin and axilla are occasionally the site of a chronic, extremely stubborn disease of the skin called "hidraden-itis suppurativa." This disease is characterized by large, burrowing, painful cysts which are filled with a foul discharge. These periodically break down and drain, then heal with scarring, and the process may be repeated indefinitely. Frequently the condition is so severe that sur¬gical extirpation, followed by skin-grafting, affords the only means of controlling it. Rarely, hidradenitis suppurativa is encountered in amputees. In such cases it can cause a really serious handicap, making the use of a pros¬thesis or crutches impossible.
Innervation of the apocrine glands is exclu¬sively adrenergic, as compared with the cho-linergic innervation of the eccrine glands. The apocrine system re¬sponds sluggishly or not at all to heat. How¬ever, it does respond promptly to emotional or painful stimuli. In the management of this aspect of the amputee's hygiene, therefore, it is important to bear in mind that pain or ten-derness in the stump, or an emotional disturb¬ance, may aggravate any existing skin disor¬ders in the groin or un¬derarm regions through stimulation of this spe¬cialized glandular sys¬tem.
Unfortunately, the apocrine glands occur in the areas upon which the amputee must depend for sup¬port in the use of a crutch   or   an   above¬knee prosthesis. The apocrine glands can be a source of considerable grief, if, through poor hygiene, infection, or other cause, these areas are allowed to become unserviceable for weight-bearing.

The Sebaceous Glands
The sebaceous glands occur wherever there are hair follicles. In addition, there are scat¬tered, free sebaceous glands which are inde¬pendent of the follicles. Their secretion is an oily liquid composed of fatty acids, alcohols, hydrocarbons, and certain vitamin precursors. This material, called "sebum," becomes solid at about 30°C (86°F), the prevailing skin-surface temperature.
A unique feature of sebaceous-gland secre¬tion is the capacity of the glands to secrete very rapidly onto a defatted skin surface, but at a rate which gradually declines until the new fat layer of the surface reaches a certain critical thickness. When this occurs, sebum production stops or falls to a minimum. If, however, the fat layer is removed, rapid secre¬tion starts again. The more viscous the sebum becomes, the earlier the sebum expulsion is stopped. As a result, more oil is secreted per unit time at a high environmental temperature than at a low temperature.
Presumably, the counterpressure of the oil film on the surface prevents further production by back-pressure in the gland. There is an interesting fact, however, which is not entirely explained by the back-pressure theory: if the duct of the gland is blocked by sebum only, no pathologic change takes place in the secre-tory cells of the sebaceous glands, but if the obstruction is caused by masses of keratin or other foreign matter, as in the case of come¬dones ("blackheads") and various types of follicular keratoses, degenerative changes in the gland set in relatively early.
This phenomenon of controlled oil produc¬tion is one in which a normal physiologic proc¬ess appears to work with the amputee rather than against him in the wearing of a pros¬thesis. Here, the accumulating lipid film under the socket will serve as its own shut-off valve for further secretion, without damage to the sebaceous glands in the stump skin.

HEAT   CONTROL   AND   THE    HEALTHY   SKIN
Healthy skin exercises a vital role in the thermoregulation of the body, a function in which the skin of the lower extremities nor-mally has an important share. This surface control supplements the central heat-regula-tory center in the hypothalamus of the brain. At basal conditions, the heat balance of the normal body is maintained by cutaneous vaso-motor adjustment through an environmental temperature range of 25° to 31°C (77° to 88°F), the so-called   "zone of vasomotor control."
Above this range, at 31° to 32°C (88° to 90°F),
when cutaneous blood flow has reached its maximum, sweating sets in—the "zone of evaporative regulation." Between 31° and 36°C (88° and 97°F) and at low humidity, evaporative heat loss easily maintains normal temperature. Below the zone of vasomotor control, the skin temperature falls, and body temperature is maintained chiefly by chills (the "zone of cooling"). If environmental tem¬perature is maintained below a critical level of 31° to 32°C, there is generalized, but grossly invisible, periodic sweating known as "insen¬sible sweating." Consequently, although the principal thermoregulation in this temperature range is vasomotor, there is still an assist from the sweat glands in cooling the skin surface.
The values cited are those reported for the normal. In the amputee, significant areas of cooling surface, along with the component sweat glands, have been subtracted from the total reserve of functional skin surface. In addition, the complex and important system of vascular shunts and arterioles in the ampu¬tated limb or limbs has also been lost from the total heat-regulatory mechanism. As a result, a number of characteristic and troublesome disturbances of temperature and heat control are associated with amputation.
Among these is the phenomenon of the poikilothermic stump, which has been studied by staff members of the University of Cali¬fornia Medical School (22). In this condition, the surface temperature over the distal part of the stump, and over a considerable portion of the stump proximally as well, tends to be¬come stabilized at the temperature of the sur-rounding air, more or less independently of any vasomotor control. Thus it is seen that, in a lower-extremity amputation, not only is part of the original heat-control surface per-manently lost but the remaining stump surface is no longer normally effective as part of the heat-control mechanism. Nevertheless, it is important to maintain the hygiene, or good health, of this remaining skin area in order to preserve whatever function it may still possess for heat regulating, and particularly for cooling.

MECHANISMS of HEAT LOSS
Heat loss from the normal skin takes place by radiation, convection, conduction, and evaporation. All of these mechanisms are interfered with, if not entirely abolished, over the stump area when a tightly fitted socket is worn, Excessive local heating of the stump can result (Fig. 4), particularly during warm, humid weather, and a major hygienic problem can arise under such conditions.
Heat loss from the skin by radiation takes place in the form of infrared rays in the range of 5 to 20 m/u. Under normal conditions, radia¬tion accounts for about 60 percent of total heat lost from the body. In the amputee, it
seems probable that loss of heat from the stump area by this mechanism is greatly re-stricted by the socket of the prosthesis. We do not at present, however, have any data to con¬firm this supposition.
Convection depends upon the transfer of energy by means of moving air and thus is negligible as a means of heat loss from the stump when a prosthesis is worn.

The Physical, Economic and Emotional Benefits of Healthy Skin

2010-11-30T10:57:00.000-08:00

Skin is the frontline of the body’s immune defenses. Simply put, if skin is breached—through a cut, sore or change in its protective barrier—bacteria, fungi, viruses and allergens can get in, which can affect your overall health.
Maintaining the strength of the top layer of skin is vital. This strength relies in part on lipids that are made by the skin and also on perspiration and water from deeper layers that help to keep skin moist, prevent the growth of fungi and bacteria, and maintain the protective barrier. However, this barrier is quite fragile and factors large and small—from ultraviolet light exposure to sweating and harsh skin products—may pose potential harm.
Healthy skin is moist, clear and glowing. Maintaining skin health requires a healthy diet, regular exercise, adequate sleep and stress management. Smoking and sunlight are two of the most damaging elements, resulting in poor circulation, brown spots and wrinkles, and significantly increasing the risk of skin cancer.
At any given time, one out of every three people in the United States is suffering from a skin disease. Unhealthy skin not only poses a threat to one’s physical health, but can also affect mental health and self esteem, and costs more than $60 billion in direct healthcare expenses, lost productivity and intangible effects on quality of life.

The Physical, Economic and Emotional Benefits of Healthy Skin

PART I: YOUR SKIN – THE FRONTLINE TO GOOD HEALTH
You may not think about your skin as an organ but in fact it’s the body’s largest, accounting for about one-sixth of your total weight. Taken off your body and stretched out on the floor, it would measure approximately 18 square feet, about the size of a dining room table.1, 2
Unlike other organs, your skin has direct contact with the outside world and its primary function is to protect the internal body organs from injurious external elements. It’s exposed to more potentially life-threatening infectious agents, toxins, environmental factors like pollution and temperature change and gene-damaging radiation than any other organ. Because of its protective barrier properties, your skin serves as the first line of defense for your systemic immune system.

In addition, your skin has its own fairly complex immune system, providing a defense against the outside world.3 Your skin also helps to regulate body temperature, provides insulation, stores energy and lets you perceive the outside world through touch and sensation.
Before you can understand what’s required for healthy skin, you have to understand the structure of skin itself.
Digging Into Skin’s Structure
Skin is composed of two main layers, the epidermis and the dermis, with an insulating layer of fat below, called the subcutis (subcutaneous fatty tissue):
3
1 Epidermis
2 Dermis
3 Subcutis
4 Hair follicle
5 Sebaceous gland
6 Sweat gland

Epidermis. The epidermis has several layers. The outermost part is the protective horny layer, or stratum corneum. This is the part of the skin we lavish with lotions and creams, paint with cosmetics and slather with sunscreen. Composed of dead cells that have migrated from lower levels, this layer is filled with the protein keratin and valuable lipids, forming a barrier against the external environment and internal water loss.
The dead cells are constantly being sloughed off in a process called desquamation, with about 10 grams of skin—about four teaspoons—lost each day. In this way, you create a new epidermis, or top layer of skin, about every month.

Dermis. The dermis is about three times thicker than the epidermis. This layer provides a network of collagen and other connective tissue elements that act like a scaffold that helps to maintain firm, flexible skin. The collagen and its surrounding matrix form a gel-like sponge, able to soak up or release water. The younger and more extensive the collagen network, the more water it can bind, providing the firm skin of youth. As you age, the collagen network is diminished and your dermis holds less water, causing sagging and wrinkles.

The dermis is also where the sweat glands, lymph and blood vessels, smooth muscle and hair follicles reside, as well as nerve endings and cells that transmit sensations of pressure and touch to your brain. 1
Subcutaneous tissue (hypodermis) This underlying layer is composed primarily of fat. It also contains the base of the hair follicles, sweat glands, blood and lymph vessels, as well as sebaceous glands which produce oily sebum that helps maintain moist skin and hair.

The Skin as Immune System
Now that you understand the skin’s structure, let’s focus on its immune-protecting functions. It begins with the stratum corneum—that top layer of dead cells that is constantly being renewed. Think of it as a kind of biological “Saran Wrap,”3 providing a defensive shield that is a major part of the innate immune system.5
Critical to the barrier function of the stratum corneum is the layer of fatty acids, lipids and cholesterol on the skin surface. Combined with sweat and secretions from sebaceous glands, this hydrolipid film inhibits the growth of fungi and bacteria.

This defensive hydrolipid film is slightly acidic with a normal pH between 4.0 and 5.5 (water is neutral, neither acidic nor alkaline, with a pH of 7). The acidity of the barrier is important in inhibiting the growth of alkaline-loving bacteria.5, 6
However, this first line of defense is fairly fragile. Strip away or weaken the protective covering, and the body may be subject to infection.3 Environmental factors like pollution and temperature change, exposure to ultraviolet light, as well as sweating and skin products, can all change your skin’s pH, increasing the risk of damage. That’s why it is so important to keep skin moist and to cleanse and treat it with products designed to maintain an ideal pH.

Water, Water, Everywhere
Water is critical to keeping skin supple. The stratum corneum is about 30 percent water, with younger skin containing 10 to 20 percent more. Without the balance of lipids (fats) and natural moisturizing factors that make up the biofilm, the water bound in the skin would soon evaporate leading to dry and cracked skin, a breach of its natural defenses.
Now that you understand the structure, it’s time to take a look at just what makes—and keeps—skin healthy.
PART II: KEEPING SKIN HEALTHY
Healthy skin is required for a healthy body, yet we tend to think of skin in terms of beauty and appearance. It’s important to realize the very things that work to keep skin beautiful also help maintain its health.
5
The three words that best describe healthy skin are moist, clear and glowing. Moist, well-hydrated skin means the hydrolipid film is doing its job of maintaining the right moisture balance. Clear skin is free of blemishes, clogged pores, sun damage, discolorations and broken blood vessels. Glowing skin has a healthy blood supply carrying lots of oxygen and other nutrients to skin cells.

Healthy skin looks beautiful, no matter what your age. Most wrinkles are caused by sun exposure and smoking. By avoiding both, your skin will appear much younger and healthier than a smoker or sun-worshipper 10 or more years your junior.

Smoking and Your Skin
Next time you’re around a smoker, take a good look at their skin. Note the excessive wrinkles, dryness and sallow complexion. Heavy smokers are nearly five times more likely to have wrinkles on their face than nonsmokers, no matter how much sun they were exposed to. Combine smoking and sun exposure, and the net result is much worse than either alone. Smoking attacks skin in several ways: Constricting blood vessels, limiting the amount of oxygen and other nutrients skin receives. Dehydrating the stratum corneum, leading to dry skin. Depleting levels of antioxidants, which are necessary to neutralize skin-damaging free radicals. Decreasing skin firmness and increasing skin sagging. Interfering with the ability of cells called fibroblasts to manufacture collagen and the extracellular matrix, the structural framework for your skin’s tissue that is vital for repairing skin injuries. Interfering with your immune system, one reason that smokers are 50 percent more likely to develop squamous cell skin cancer than nonsmokers, regardless of sun exposure.

When your skin is healthy, you are unaware of its existence. It doesn’t itch, break out or get irritated, and you don’t need to cover up its flaws with heavy makeup.
Healthy Skin from the Inside Out
Consumers today spend approximately $8 billion a year on over-the-counter skin products.8 However, the most important components of healthy skin come from within. How you eat, how much you exercise, how much ultraviolet light you’re exposed to and your level of stress can all affect your skin’s health.

Eating Right for Healthy Skin
Your diet directly affects your skin’s ability to bounce back from environmental insults such as ultraviolet light. Such exposures trigger the production of free radicals, rogue molecules that seek to steal electrons from healthy molecules, damaging cellular DNA. This is called oxidative damage, and it’s the same process that results in a cut apple turning brown when exposed to air, or a piece of metal rusting when left outside.

To protect cells, your body produces antioxidants designed to neutralize these free radicals. You can increase this supply by following a diet high in antioxidants.
Limit your consumption of low-fiber, high-sugar carbohydrates. They lead to spikes in blood glucose, which can, over time, contribute to the formation of advanced glycosylation end-products, or AGEs. These free radicals can damage collagen and elastin, proteins that help maintain skin’s elasticity and tone.9 AGEs are also more likely to develop (and in greater amounts) in people who are overweight and/or have diabetes, metabolic syndrome or other glucose/insulin related dysfunction.
A diet composed of fruits and vegetables, lean protein, high-fiber grains, low-fat dairy and poly- and monounsaturated fats that is low in saturated fats, red meat and sugar, will help maintain your skin’s health.

Exercise and Skin Health
If you needed another reason to hit the gym, here it is: your skin. Physical activity maintains the health of tiny blood vessels in the skin so they can supply adequate blood and oxygen. This helps provide skin with a healthy glow and also aids in the production of collagen.
Exercise helps you maintain a healthy weight and normal insulin/glucose metabolism, reducing the production of damaging AGE molecules. Exercise also reduces your risk of atherosclerosis, in which cholesterol, calcium and other substances build up on the walls of blood vessels, impeding blood flow.

Exercise helps balance out hormones like testosterone that contribute to acne. In fact, the stress-reducing benefit of exercise is beneficial to maintaining and improving skin health.

Stress and Your Skin
If you’ve ever awakened the morning of an exam, your wedding or the first day of work/school, then you know the effects of stress on your skin. If you have rosacea, psoriasis, eczema or acne, then you know that even the most benign stressful condition can trigger a flare.14 There’s even a new area of medicine focused on this phenomenon: psychodermatology, the study of the interaction between mind and skin.

Stress is more than simply feeling overwhelmed. It’s a biochemical reaction involving the release of numerous hormones, particularly cortisol, which increase inflammation and oil production. One study in graduate school students found that those under stress took longer to recover from a minor skin injury than those who weren’t stressed.16 Other studies found that one-third of psoriasis flares are stress related. Stress-relieving approaches like hypnosis, meditation and therapy improved healing and reduced flares.

Light and Your Skin
The most crucial factor in healthy skin is avoiding the sun’s rays. These rays (or ultraviolet light from tanning booths) are as toxic to your skin as cigarette smoke is to your lungs. This kind of light increases production of free radicals and spurs oxidative damage, triggering cellular changes that can lead to wrinkles, brown spots, sunburn and dryness, or serious diseases like cancer.
There are two types of damaging ultraviolet light:

UVA rays, which can penetrate into the dermis of the skin. These rays are the primary cause of immunosuppression and chronic sun-induced damage (such as premature skin aging). UVB rays, which can reach as far as the deepest layers of the epidermis. These rays are the main cause of sunburn, DNA damage and skin cancer.
Given how damaging sunlight is, it is imperative that you protect your skin through daily use of sunscreen. Unfortunately, just one-third of Americans regularly apply sunscreen.20
Keep in mind that a higher sun protection factor isn’t necessarily better. The American Academy of Dermatology notes that while an SPF of 30 screens 97 percent of UVB rays, an SPF of 15 still screens 93 percent of UVB rays (Figure 2).21 Most dermatologists recommend using an SPF of 30 for the face. Also keep in mind that the SPF only measures UVB protection, not UVA protection.

MAINTAINING HEALTHY SKIN
Clean Skin = Healthy Skin
The first step to healthy skin is keeping it clean. Choose the wrong products and you risk stripping away protective lipids and moisture. In fact, improper skin washing is the most common cause of skin disease!6
Water removes only water-soluble dirt, not the oily residue that clogs pores. Surfactants like sodium laureth sulfate and potassium cocoate dissolve fat-soluble dirt and oils so they can be washed away. However, they also remove important skin-protecting lipids or fats and your natural moisturizing factors, leaving your skin feeling tight and dry. Over time, harsh surfactants can damage the skin barrier itself.1, 24
Certain products can also change the skin’s pH, destroying the barrier function of the epidermis. This can lead to irritation and contact sensitivity, also called contact dermatitis.1
Since most skin cleansers contain surfactants, it’s important to choose products with lipid-replenishing ingredients such as vegetable and fruit oils. Also look for products that use less irritating surfactants such as cocamidopropyl (coconut oil), amphoteric surfactants , alkyl ether sulfates and alkyl glyceryl ether sulfonate.

Choosing the Right Cleanser
Soap Most soaps are alkaline, which can be irritating to unhealthy skin and lead to a condition called alkali eczema, resulting in itching, redness, small bumps and flaking.26 If you wash with
hard water, soap can leave calcium deposits that prevent oil replenishment, causing roughness. To reduce their drying properties, many soaps contain added fats like lanolin and paraffin and/or lactic or citric acid.6
Oil-free liquid cleansers leave a thin, moisturizing film. While often recommended for people with sensitive skin, many still contain propylene glycol and sodium laurel sulfate, both of which can irritate the skin’s top layer.
Cleansing creams simultaneously clean and moisturize. In lieu of surfactants, they use ingredients like beeswax and mineral oil to dissolve oily dirt.

Body washes contain cleansing agents or surfactants. Some may contain a significant amount of petrolatum (better known as petroleum jelly or paraffin), or other lipids which provide moisture.
What Do You Wash With?
Since the top layer of skin is composed of dead cells, it makes sense to think the harder you scrub, the clearer and younger your skin will appear. Such scrubbing can occur with washcloths or through the use of products that contain aluminum oxide particles or ground fruit pits, so-called exfoliants.6
These products can irritate sensitive skin. In most instances, warm water, cleanser and your fingers are all that’s needed. (Stay away from very hot water: it makes your skin absorb cleanser and lose lipids). Or use a soft, disposable cloth with your preferred cleanser. Since you throw it out after each use, it won’t develop bacterial growth.

Don’t over clean your skin! Too much contact with water can make even healthy skin more permeable, weakening its barrier function and leading to transepidermal water loss (TEWL), in which water from deeper layers of the skin is lost to evaporation. This, in turn, can increase your exposure to irritants, pathogens and allergens.

Moisturizing Your Skin
Moisturizers bind water to the skin so it doesn’t evaporate as quickly.1 Think of them as the lid topping a pot of simmering water. The result: a softer and more elastic stratum corneum with optimal protective properties.

There are several types of moisturizing ingredients:
Occlusives such as petrolatum, beeswax, lanolin and oils (think olive oil) form a protective barrier between your skin and the outside environment, keeping moisture in. Humectants such as amino acids, lactic acids, alpha hydroxy acids, propylene glycol, glycerine and urea draw water from the dermis into the stratum corneum, increasing skin’s resistance to drying elements. Emollients fill in the spaces between the cells in the stratum corneum, smoothing the skin like a skim coat of plaster smoothes a wall before paint is applied. Thicker emollients such
as castor oil and almond oil are found in night, eye and facial creams. Those that spread most easily (isopropyl stearate, isopropyl palmitate, isopropyl myristates, hexyl laureate, and dioctyl cyclohexane) are found in body lotions, hand creams and lotions and bath additives. Natural moisturizing factors include citrate, various minerals, urea, lactate and amino acids. When used properly, these factors can help heal the stratum corneum. Many have other health benefits and are used in topical products. However, an overload of these ingredients can cause irritation.

Cosmeceuticals

Designed to improve both skin appearance and health, cosmeceuticals contain commonly used ingredients ranging from natural botanicals (chamomile, curcumin, aloe, green and black tea) to synthetic compounds (ceramide, fluocinonide, retinoids and hydroxy acids). Some examples follow:
Retinoids. One of the most commonly used cosmeceuticals, retinoids are vitamin A derivatives with strong antioxidant and skin-repair properties. Even those found in non-prescription products can improve sun damage.
Hydroxy acids. The second most-common cosmeceutical, hydroxy acids include glycolic acid, lactic acid, citric acid, mandelic acid, malic acid and tartaric acid. They exfoliate dead skin cells to improve the appearance and texture of the skin.

Antioxidants. These include vitamins C and E, panthenol (a B vitamin), lipoic acid, ubiquinone (coenzyme Q10), niacinamide (another B vitamin), dimethylaminoethanol (DMAE), glutathione, superoxide, glucopyranosides, polyphenols and cysteine.
Depigmenting agents. These compounds help lighten skin and brown patches related to sun damage. They include hydroquinone, kojic acid, glycyrrhetinic acid, and N-acetylcysteine. Some products also contain glycolic acid, resorcinol or salicylic acid to induce chemical peeling, which can assist in depigmentation.

PART III: SKIN CONDITIONS AND DISEASES
At any given time, one out of every three people in the United States is suffering from a skin disease.29 In this section, we examine a few of the more common diseases, their underlying causes and treatments.

Dry Skin
Affecting up to 20 percent of the population, dry skin is a major risk factor for bacterial, viral and fungal infections.

Dry skin can occur when your skin is exposed to temperature changes like dry, cold or windy weather, ultraviolet (UV) light, or harsh skin products or chemicals. Many people have chronically dry skin because their skin isn’t “binding” water. This can be related to deficiencies in levels of the skin’s natural moisturizing factors.
Other causes of dry skin include genetics, aging, hormonal influences and skin diseases. One type of dry skin is called atopic dry skin, thought by some to be related to altered ceramide metabolism.
Signs of dry skin problems include mild scaling, roughness, tightness and itching. Signs of extremely dry skin include frequent itching and the formation of calluses, scaling and chapping.
Extremely dry skin needs skin care products designed to supply natural moisturizing factors, like urea and amino acids, to increase your skin’s water-binding capacity and prevent the loss of moisture from the deeper skin layers.

Don’t Forget Your Hands
Many of us focus only on the skin of our face and neck. But your hands deserve just as much, if not more, attention. Your hands get into everything, from scalding hot water in the kitchen sink to freezing cold water in the ocean. Overburden your hands and you can quickly “overtax” your skin’s protection and repair systems. Damaged, cracked and dry hands are more likely to develop dermatitis, or eczema, a condition marked by red, itchy rashes. An estimated 5 to 10 percent of the total population has hand eczema, 15 to 30 percent of working adults. In fact, hand eczema is the most commonly reported occupational disease.
Protect your hands by:
• Choosing washes and moisturizers designed to replace lost lipids, maintain the physiological
pH of your hands’ stratum corneum and promote skin cell regeneration1
• Wearing gloves when outside in cold weather
• Using protective gloves when washing dishes and using cleaning products
• Avoiding excessive exposure to water and liquids

Diabetes and Your Skin
More than 23.6 million children and adults in the United States - nearly eight percent of the population, have diabetes, according to the American Diabetes Association (ADA). Most have type 2 diabetes, in which cells become resistant to insulin, resulting in high blood glucose levels. People with diabetes are much more likely to develop fungal and bacterial infections, as well as dry, itchy skin.31 In fact, the ADA estimates that up to a third of all people with diabetes may develop a skin disorder caused or affected by their disease.31
Even dry skin can be dangerous for someone with diabetes, since scratching can increase the risk of infections. Many people with long-term diabetes have nerve damage in their legs and feet, and a simple cut or foot ulcer may go unnoticed until it becomes infected. Sadly, infections in the extremities can lead to ulcerations that are difficult to heal, which sometimes lead to amputation of the affected limb.
It is imperative that people with diabetes check for skin breaks and maintain the protective barrier of their skin with moisture-rich cleansers and lotions.
Atopic and Contact Dermatitis (Eczema)
Atopic dermatitis is a form of eczema, a chronic inflammatory skin disease marked by excessive dryness, lesions and severe itching. Those with the condition often have other allergy-related disorders such as asthma and hay fever. Atopic dermatitis also increases the risk of contact dermatitis, in which the skin becomes irritated from contact with fabrics, chemicals or clothes washed in certain laundry detergents.32
One reason for atopic dermatitis is low levels of ceramides, a component of the skin barrier lipids. These barrier lipids are found in the spaces between cells on the stratum corneum, and help to prevent water loss. Without their protection, the skin becomes more susceptible to infiltration by pathogens and allergens which, in turn, stimulate an immune response and inflammation.

Various studies have demonstrated urea-containing moisturizers can help with dry skin conditions such as contact and atopic dermatitis. They can reduce the risk of relapse and transepidermal water loss, protect against irritation, and strengthen overall skin barrier protection.What is Sensitive Skin?
Sensitive skin is skin with a lower resistance to irritants. Today, about 50 to 60 percent of the population reports having sensitive skin, compared to about a third in the 1980s. Although the causes of sensitive skin are not completely understood, both internal hereditary factors as well as external factors such as climate, UV exposure, frequent contact with water, alkalis or solvents, and skin peels can make skin more sensitive. Medical conditions such as diabetes or chronic kidney disease can also make skin more sensitive.
Sensitive skin tends to show redness, swelling and scaling when irritated. It may also prickle or burn, feel tight or itch. However, using mild cleansers and moisturizers formulated for sensitive skin—as well as sunscreen—can significantly improve overall skin health.
Rosacea
Rosacea is a condition marked by flushing, persistent redness, dilated blood vessels and/or papules and pustules on the face. In the late stages of the disease, an overgrowth of the sebaceous glands can occur, resulting in thick, horny skin on the nose or other parts of the face. Roseacea occurs more often in women but is more severe in men, generally occurring in middle age.

There is no cure for rosacea, although proper skin care can help reduce flares. That includes the use of mild cleansers and moisturizers, protecting the skin from the sun as well as avoiding extreme weather, alcohol, spicy foods and hot drinks. There are several prescription medications available to treat rosacea, although some can have serious side effects.

Psoriasis
Psoriasis is a chronic skin disease that affects other parts of the body, including the eyes and nails. It is an autoimmune disease, meaning that the immune system attacks a person’s own skin cells. This triggers a rapid proliferation of skin cells that collect at the skin surface, leading to the characteristic thick, scaly patches that develop on various parts of their body.

Psoriasis affects between 2-5 percent of the US population and its prevalence, like that of many autoimmune conditions, may be increasing.45, 46 While it has a strong genetic component, with up to 40 percent of people reporting a family history of the disease, environmental factors such as stress, sunlight, alcohol consumption, certain medications and infections also trigger outbreaks.

The disease is typically treated with prescription medications—oral or topical—and/or light therapy. Daily moisturizing is an important part of skin care for people with psoriasis. Studies have shown that some urea-containing moisturizers can improve the moisture barrier of the stratum corneum twice as much as treatment with a non-urea moisturizer, reducing epidermal overgrowth by a third and epidermal thickness by 50 percent.

Acne
An overproduction of lipids in the skin can promote the growth of P. acnes, a bacterium that causes acne.1 Acne is characterized by pustules and pimples on the face, chest, shoulders and back. Other factors that promote acne include hormonal changes, clogged hair follicles and bacterial infection. Processed foods and certain dairy products may lead to and/or exacerbate acne, as can stress.Although most people develop acne as teenagers, the number of people experiencing adult acne is on the rise. One survey found that between 30 and 35 percent of adults in their thirties said they had acne, with 12 to 26 percent of those in their forties reporting the condition.Treatments for acne include over-the-counter products containing salicylic acid and benzoyl peroxide. Oral or topical antibiotics such as tetracycline or erythromycin and vitamin A derivatives (retinoids) may also be prescribed.
Clean acne-prone skin with liquid cleansers instead of soap, and use skin care products that contain antibacterial additives. An anti-acne regimen should include a salicylic acid-containing cleanser, and a benzoyl peroxide topical product. When you use moisturizer, make sure it’s noncomedogenic, meaning it won’t block your pores.

PART IV: PHARMACOECONOMIC BENEFITS OF PUTTING YOUR SKIN HEALTH FIRST
The costs of skin diseases—in direct medical costs and lost productivity—are staggering, reaching nearly $40 billion a year.29 Another $20 billion is estimated to be lost in intangible costs, such as the effect on quality of life. In fact, skin disease is one of the top 15 medical conditions in the US in which prevalence and spending increased between 1987 and 2000. Both rose more for skin disease than for diabetes, stroke or cancer.51
A 2004 report from the American Academy of Dermatology and the Society for Investigative Dermatology found that the 22 most common skin diseases cost the country $29.1 billion in direct medical costs (including $2.2 billion spent on over-the-counter skin products) and $10.2 billion in indirect costs such as lost productivity. Consider that Americans spent about $1.2 billion on medical treatments for psoriasis in 2004, 40 percent of which were spent on over-the-counter products,29 and you can get an idea of the huge economic problem of skin conditions.

Direct and Indirect Medical Costs for Common Skin Conditions (2004)
Skin Disease
Direct Medical Costs (millions)
Prescription Drugs (millions)
Over-the-counter products (millions)
Indirect costs (lost productivity) (millions)
Intangible cost because of quality of life impact (millions)

One of the most commonly treated skin conditions—and most expensive—is actinic keratosis, i.e., sun spots. A precursor of skin cancer, actinic keratosis is common across the globe, particularly in fair-skinned people and those with suppressed immune systems. Overall, direct medical costs for topical medications, cryotherapy, photodynamic therapy, excision and a combination of treatment modalities used to manage this condition are $1.2 billion a year. Another $295 million is spent on indirect costs, such as lost productivity. However, if we can prevent actinic keratosis by limiting exposure to UV light, using sunscreen and wearing protective clothing, we can dramatically reduce the costs associated with skin cancer.52
Protecting the skin of people with diabetes could also save billions, since skin-related infections and ulcers are a major contributor to limb amputation. Each foot ulcer costs between $7,400 and $20,000 to treat, with many people ending up in the hospital as a result. Overall, diabetes-related amputations cost the US about $3 billion a year in direct medical costs.

Skin and Quality of Life
Unhealthy skin can play havoc with more than your physical health. It can devastate you emotionally. When researchers ask people what part of their body is most important to their body image, skin comes in third behind hair and nose. When something’s not right with skin, it shows!
That’s one reason researchers find that people with bad acne, psoriasis and other skin diseases often experience depression, anxiety and lowered self esteem, as well as overall poorer quality of life and even increased thoughts of suicide.

Studies find that people with skin itching, rashes or pimples were significantly more likely to have “mental distress” and to have experienced negative life events, such as illness or injury to themselves or a close relative, the death of a close relative, separation or a major financial crisis.57 One study found that atopic dermatitis, acne and psoriasis each had a greater negative impact on quality of life than chronic asthma, angina or high blood pressure.

Skin problems, such as psoriasis, are particularly devastating. One study found that psoriasis affects physical and emotional function as much as cancer, arthritis, hypertension, heart disease, diabetes or depression.59 Skin conditions can even negatively impact the quality of life of the family members of those with the condition, causing emotional distress, increasing the burden of care and affecting social life, finances and sleep.The condition of your skin affects every aspect of your life, from how good you feel about yourself to your physical and mental health.

Part V: COSMETIC PROCEDURES AS SKIN SOLUTIONS
Medical procedures are no substitute for maintaining healthy skin, yet they are one of the top solutions for skin problems. The number of cosmetic procedures has increased 162 percent since the collection of plastic surgery statistics began in 1997, according to the American Society for Aesthetic Plastic Surgery. The use of wrinkle fillers such as Restylane and Juvederm, the injectable botulinum toxin (Botox), chemical peels and laser skin resurfacing have become the top nonsurgical skin procedures, with Botox being the most frequently performed nonsurgical procedure. Botox is also the top nonsurgical procedure for patients ages 35 and up. Taking care of your skin with daily use of moisturizers, non-abrasive cleansers and sunscreen can help you delay or avoid these expensive cosmetic interventions.

Skin Cancer

2010-11-30T10:42:00.000-08:00

When I am outdoors, I wear a hat. The reason is simple: exposure to
the sun can increase your risk of skin cancer.

Risk reduction is fairly simple, but to get the word out I am launching NASA’s
skin cancer prevention program as one more health facet in the overall Agency Safety
Initiative (ASI). The program focuses on reducing risks, early detection, and health
education about skin cancer.

Skin cancer is the most common type of cancer and is responsible for one-half of
all new cancers. Approximately one million cases of skin cancer will be diagnosed in the
U.S. this year alone. About 38,000 people in the United States will develop malignant
melanoma annually, and one in five of those that develop this disease will not survive.
People in the U.S. die of skin cancer every day, yet these cancers are the most easily
detectable, curable and preventable of all cancer types.
Since the majority of NASA sites are located in the Sunbelt, our employees have
an increased risk of excessive and prolonged sun exposure. There are also additional
personal risk factors such as fair complexion, history of a blistering sunburn in childhood,
family history of skin cancer and presence of large numbers of skin moles that increase
the likelihood of developing skin cancer. Measures such as limiting outdoor activities
during peak solar exposure hours, wearing protective clothing and using sun blocking
agents are all very effective in reducing sun exposure.

Minimizing the occupational and personal risk factors for developing skin cancer
is a priority in protecting the health of the NASA workforce. Providing health education
and skin cancer screening and reducing exposure to the sun can help us avoid these
troublesome and often deadly diseases.

Principal Center

• Discuss need for skin cancer prevention program and actions with Medical Directors--
completed
• Develop Solar Safe plan--completed
• Support all Centers on initial efforts—in progress
• Implement recommendation for total body screening every 3 years before age of 40
and annually over age of 40—in progress
• Adopt plans for enhancing outdoor shading availability and flexible hours for outdoor
fitness activities--TBD
NASA Centers
• Offer skin cancer screenings to the NASA workforce through Center clinics
• Offer health education to the NASA workforce utilizing a variety of media sources
• Provide protective methods to reduce risk of sun exposure
• Utilize administrative controls to reduce the amount of sun exposure, such as avoiding
outside activity between 11:00 AM and 1:00 PM
• Collaborate with the American Cancer Society, the American Academy of
Dermatology and the Melanoma Research Foundation to maximize educational efforts
for the NASA workforce.

Background

Skin cancer is the most common type of all cancers and is responsible for one-half of all
new cancers. Approximately 1,000,000 new cases of skin cancer will be diagnosed in the
U. S. this year. Skin cancer is the most easily detectable, curable and preventable of all
cancer types. Between 0.7 and 2.2 cases per 100,000 people will develop malignant
melanoma, and one in five affected will die. Every hour, one person in the U. S. dies of
this form of cancer.

The major risk factor in the development of skin cancer is overexposure to the sun.
Centers, especially those in the Sun Belt, need to explore whether work must be
accomplished around the peak sun exposure time. Between 20 to 30% of our daily
exposure occurs between 11 AM and 1 PM. I’m requesting that work outside, between
11 AM and 1 PM be rescheduled or reduced whenever possible. If work cannot be
rescheduled or reduced, those employees should cover up with light colored clothing,
wear a hat and sunglasses. They should apply sunscreen (with a SPF of 15 or higher)
thirty minutes before Sun exposure and reapply every two hours. These simple steps to
avoid overexposure should be used even on cloudy days and wherever possible, provide
shade.

Skin cancer is a disease caused by the abnormal growth of cells. Cells that make up the
skin usually divide and reproduce in an orderly manner replacing worn-out tissue and
repairing injuries. When cells get out of control and divide more than they normally
should, they form skin cancers.
Two types of ultraviolet radiation (UVB and UVA) can start cancer and promote its
growth. UVB affect the production of melanin that helps protect our skin. UVB rays
make our skin tan, but are also responsible for causing skin cancer. Unlike UVB, skin
damage caused by UVA rays may not show for years. UVA rays also contribute to
wrinkles and loss of skin firmness.

Individuals have an increased likelihood of developing melanoma if they have had one or
more blistering sunburns during childhood; have a family history of skin cancer; or have
more than 50 moles, five large moles or were born with moles. An additional personal risk
factor that increases the likelihood of developing skin cancer includes having a fair
complexion. We have no control over personal risk factors, but we do have control of our
exposure to the sun.

The most common types of skin cancer are basal cell, squamous cell and melanoma. The
first two appear primarily on skin surfaces exposed to the sun. Basal cell cancer accounts
for 80% of all skin cancers. It is a slow growing cancer and does not usually spread to
distant parts of the body. However, left untreated it can spread to nearby areas and
invade the bone and other tissues beneath the skin. Squamous cell cancers account for
16% of all skin cancers. This is a more aggressive skin cancer and is more likely to spread
to distant parts of the body and to invade structures beneath the skin.

Melanoma is by far the most dangerous type of skin
cancer. Melanoma accounts for only 4% of skin cancers, but about 85% of the deaths.
Melanoma is much more likely to spread to other parts of the body. However, if
detected in its early stages it is very curable. Unfortunately, family history and personal
risk factors play a major role and only 20% of melanomas occur on exposed skin surfaces.
However, even these odds can be reduced by a regular and thorough screening program.

Skin and Hair Health

2010-11-30T10:38:00.000-08:00

How our skin and hair look is important to many of us. At the same time, your skin and hair are organs that do special jobs that support life. Skin protects your inside organs from injury, bacteria, and viruses. Your skin, hair, and sweat glands help control body temperature. Body hair also alerts you to heat and touch. You can take steps to keep your skin and hair healthy. You can also look to your skin and hair for clues to your overall health. And, as a bonus, good skin and hair care will help you to feel your best, too.

Caring for your skin and hair
Good skin and hair care involves:l eating a variety of healthy foods rich in vitamins and nutrientsl keeping physically activel managing stressl practicing sun safetyl limiting alcoholl not using tobacco and other recreational drugsl drinking plenty of waterUnhealthy behaviors can take a toll on skin and hair. For instance, habits like smoking and sunbathing dry out skin and cause wrinkles.

Caring for your skin
Follow this simple skin care routine to keep your skin healthy and radiant:l Bathe in warm—not hot—water using mild cleansers that don’t irritate. Wash gently—don’t scrub.
l Keep skin from drying out by drinking plenty of water and using gentle mois-turizers, lotions, or creams.
306 The Healthy Woman: A Complete Guide for all Ages

l Practice sun safety to prevent skin cancer. Sun exposure puts you at great-er risk of skin cancer, whatever your skin color or ethnicity. To protect your skin: • Limit exposure to the midday sun (10 am-4 pm). • Wear protective clothing, such as wide-brimmed hats and long sleeves. • Use sunscreen with a sun protection factor (SPF) of 15 or higher and with both UVA and UVB protection. • Avoid sunlamps and tanning booths.l Check your skin for sun damage. Tell your doctor about changes on the skin, such as a new growth.

Age Spots
Years of sun exposure can cause flat, brown spots called “liver” or age spots to appear on your face, hands, arms, back, and feet. They are not harmful. But if the look of age spots bothers you, ask your doctor about skin-light-ening creams, laser therapy, and cryo-therapy (freezing). Use sunscreen to prevent more age spots.
doesn’t heal, or a change in an old growth. Ask your doctor how often you should have a clinical skin exam to check for signs of skin cancer. (See pages 53 and 54 of the Cancer chapter for more information.)l Ask your doctor if the medicines you are taking can affect your skin. For in-stance, blood thinners and aspirin can cause you to bruise more easily. Some antibiotics and vitamins make skin sunburn more easily.
Skin and hair: Clues to overall health
Healthy skin and hair are signs of good overall health. Some skin and hair changes can signal a health problem. For instance, a “butterfly” rash on your face can be a sign of lupus. Distinct rashes appear with some viruses, such as the measles and chicken pox. An allergic reaction can cause hives, redness, and itching. Diabetes and thyroid disease can cause hair loss. Knowing how your skin and hair normally look and feel will help you notice changes to ask your doctor about.

Skin and Hair Health

Nail Health

Healthy fingernails and toenails are smooth, with an even color. Keep your nails clean, dry, and trimmed to prevent
ingrown nails. If you wear artificial (fake) nails, check around the base and sides of the nails for redness, pain, and infection. Bacteria and fungus
can grow between the artificial nail and your natural nail. Tell your doctor if you notice nail changes, which also could be the result of health problems, such as diabetes or heart disease.
Common skin complaints

Sensitive skin
Women with sensitive skin may have itching, burning, stinging, or tightness after using products such as soaps or makeup. Women of color are more prone to sensitive skin. Look for products made for sensitive skin. Talk with your doctor if these products don’t help.

Pimples (acne)
Pimples form when hair follicles under your skin clog up. Although most common
in the teen years, many women get pimples into their 50s. Acne also is common
during pregnancy and menopause, when hormones are changing. Medicines,
such as birth control pills, can also lead to breakouts.
The cause of acne is unclear. We do know that dirt, stress, and foods do not cause acne. But stress and certain foods, such as chocolate or greasy foods, can make acne worse. Acne also appears to run in some families.
To care for acne, use mild soaps, avoid touching your skin, and wear oil-free makeup. Your doctor may also suggest an acne medicine. If so, ask about the side effects. Do not take isotretinoin (eye-soh-trih-TIN-oh-in) (Accutane®) if you are pregnant or trying to get pregnant—it can hurt your baby.
Dry skin

Skin can dry out and become rough, scaly, and itchy for a number of reasons. Dry skin (xerosis, zih-ROH-suhss) can be caused by:
l dry air
l overuse of soaps, antiperspirants, and perfumes

The Healthy Woman: A Complete Guide for all Ages
l not drinking enough waterl stressl smokingl the sunDoctors report a higher rate of dry skin in African Americans. Try the skin care routine on pages 305 and 306. If dry skin does not improve, talk to your doc-tor. Sometimes, dry skin signals a health problem, such as diabetes or kidney disease.
Cellulite
Cellulite is fat that collects just below the surface of your skin, giving it a dimpled look. Women of all sizes can get it. Once formed, you cannot get rid
of cellulite. No amount of weight loss, exercise, or massage reduces cellulite. Spa wraps, creams, and vitamins also do not help. Liposuction can make it look even worse. To prevent cellulite, try eating well, being active, and not smoking.

Stretch marks
Rapid growth and weight gain, such as with puberty and pregnancy, can stretch your skin, leaving pink, red, or brown streaks on your breasts, stomach, hips, buttocks, or thighs. Medicines, such as cortisones, and health problems, like diabetes or Cushing’s syndrome, also can cause stretch marks. Creams that claim to prevent stretch marks are of little value. Yet stretch marks often fade over time

The Darker Side of Tanning

2010-11-30T10:32:00.000-08:00

Public health experts and medical professionals are continuing to warn people about the dangers of ultraviolet (UV) radiation from the sun, tanning beds, and sun lamps. Two types of ultraviolet radiation are Ultraviolet A (UVA) and Ultraviolet B (UVB). UVB has long been associated with sunburn while UVA has been recognized as a deeper penetrating radiation.

Although it's been known for some time that too much UV radiation can be harmful, new information may now make these warnings even more important. Some scientists have suggested recently that there may be an association between UVA radiation and malignant melanoma, the most serious type of skin cancer.
What are the dangers of tanning?
UV radiation from the sun, tanning beds, or from sun lamps may cause skin cancer. While skin cancer has been associated with sunburn, moderate tanning may also produce the same effect. UV radiation can also have a damaging effect on the immune system and cause premature aging of the skin, giving it a wrinkled, leathery appearance.
But isn't getting some sun good for your health?
People sometimes associate a suntan with good health and vitality. In fact, just a small amount of sunlight is needed for the body to manufacture vitamin D. It doesn't take much sunlight to make all the vitamin D you can use certainly far less than it takes to get a suntan!

Are people actually being harmed by sunlight?
Yes. The number of skin cancer cases has been rising over the years, and experts say that this is due to increasing exposure to UV radiation from the sun, tanning beds, and sun lamps. More than 1 million new skin cancer cases are likely to be diagnosed in the U.S. this year.
But aren't the types of skin cancer caused by the sun, tanning beds, and sun lamps easily curable?
Not necessarily. Malignant melanoma, now with a suspected link to UVA exposure, is often fatal, if not detected early. The number of cases of melanoma is rising in the U.S., with an estimated 38,300 cases and 7,300 deaths anticipated this year.

Why doesn't the skin of young people show these harmful effects?
Skin aging and cancer are delayed effects that don't usually show up for many years after the exposure. Unfortunately, since the damage is not immediately visible, young people are often unaware of the dangers of tanning. Physicians and scientists are especially
concerned that cases of skin cancer will continue to increase as people who are now in their teens and twenties reach middle age.

But why is it that some people can tan for many years and still not show damage?
People who choose to tan are greatly increasing their risk of developing skin cancer. This is especially true if tanning occurs over a period of years, because damage to the skin accumulates. Unlike skin cancer, premature aging of the skin will occur in everyone who is repeatedly exposed to the sun over a long time, although the damage may be less apparent and take longer to show up in people with darker skin.
Who is at greatest risk in thesun?
People with skin types I and II are at greatest risk. Which skin type are you?
Skin Sunburn and Tanning History

According to Skin Type
I
Always burns; never tans; sensitive ("Celtic")
II
Burns easily; tans minimally
III
Burns moderately; tans gradually to light brown (Average Caucasian)
IV
Burns minimally; always tans well to moderately brown (Olive Skin)
V
Rarely burns; tans profusely to dark (Brown Skin)
VI
Never burns; deeply pigmented, not sensitive (Black Skin)

Since most sun lamps and tanning beds emit UVA radiation, doesn't that make them safer than natural sunlight?
No. It's true that most sun lamps emit mainly UVA radiation, and that these socalled "tanning rays" are less likely to cause a sunburn than UVB radiation from sunlight. But, contrary to the claims of some tanning parlors, that doesn't make them safe. UVA rays have a suspected link to malignant melanoma, and, like UVB rays, they also may be linked to immune system damage.
What's the government's position on using sun lamp products found in tanning parlors and in homes?
The Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) encourage people to avoid use of tanning beds and sun lamps.
You can get a fact sheet on the hazards of indoor tanning from FDA's Facts on Demand system by calling 18008990381; the information will be faxed to you on the same day (select 2 and then Division of Device User Programs and Systems Analysis or
DDUPSA). You can also go to the FDA Home Page on the World Wide Web at http://www.fda.gov. At this point, click on the Medical Devices and Radiological Health icon, click on Program Areas, then Research Areas and choose Radiation Injuries.
Information on skin cancer is available on the American Academy of Dermatology (AAD) Home Page on the World Wide Web at http://www.aad.org.
What do medical professionals say about tanning?
The American Medical Association (AMA) and the AAD have warned people for many years about the dangers of tanning. In fact, AMA and AAD have urged action that would ban the sale and use of tanning equipment for nonmedical purposes. Doctors and public health officials have recommended the following steps to minimize the sun's damage to the skin and eyes:

• Plan your outdoor activities to avoid the sun's strongest rays. As a general rule, avoid the sun between 10 a.m. and 4 p.m.
• Wear protective covering such as broadbrimmed hats, long pants and longsleeved shirts to reduce exposure.
• Wear sunglasses that provide 100% UV ray protection.
• Always wear a broadspectrum sunscreen with Sun Protection Factor (SPF) 15 or more, which will block both UVA and UVB when outdoors and reapply it according to manufacturer's directions.
For more information on the levels of ultraviolet radiation reaching your area at noon, you can get the Ultraviolet Index (UVI) from local newspapers, radio or TV in many cities. The UVI is a number from 0 10. The higher the number, the more intense the exposure. Call the EPA Hotline for more information on the UVI at 18002961996.
If you believe that some damage has already been done:
• Seek immediate medical attention if you receive skin or eye damage from the sun or if you experience an allergic reaction to the sun.
• See your dermatologist or personal physician if you develop an unusual mole, a scaly patch or a sore that doesn't heal.
• Always wear a broadspectrum sunscreen with Sun Protection Factor (SPF) 15 or more, which will block both UVA and UVB when outdoors and reapply it according to manufacturer's directions.
Developed and produced by the American Academy of Dermatology in cooperation with the Food and Drug Administration.

CAUSES OF SKIN AGING

2010-11-30T10:27:00.000-08:00

There are between 25 and 30 different theories of aging recognized by the NIH. Although some of these
have much credible scientific support, they are still classed as “theories” because none have been
irrevocably proven. There is no unified theory of aging. If there were, one ingredient in one skincare
product would serve to treat aging skin. As it is, aging must be approached from the standpoint of
multi-factorial causation with multiple ingredients and products. We are still learning about aging and
how it affects the individual.

This article will discuss 4 key processes of aging. These processes apply to the entire organism and
every cell within it. Of course, they also apply to skin. However, skin is unique in that is the organ that
shields the interior of our body from the environment and all types of environmental assaults including
solar damage, injury, pollution, and others.

T h e o r y 1 — O x i d a t i v e S t r e s s

This theory is more commonly known as the free radical theory of aging. All cells need energy to perform
their particular function. This energy is a very “hot” process and uses free radical generation to burn fuel.
In this process, extra free radicals are created. These extra free radicals bounce around inside the cell,
damaging all cellular structures they contact. Over a lifetime, these free radical “hits” gradually
accumulate leading to a physiologic decline in structure and function. We label this decline “aging.”
Skin cells being metabolically active are subject to the same free radical damage as other cells of the
body. In addition, skin cells are damaged by energy packets of solar rays termed photons. Photons are
themselves very high-energy particles that are free radicals. Depending on whether the sunscreen
chosen is physical or chemical, these solar free radicals can be blocked or neutralized.
Antioxidants are helpful because they combine with free radicals and prevent the ongoing cascade of
free radical damage. Only about one percent of oral antioxidants reach the skin so topical antioxidants
are also critical.

Suboptimal health states such as severe burns, diabetes, critical illnesses, infections, vascular diseases,
endocrine diseases and others are associated with excess free radical generation. Smokers have huge
amounts of free radicals floating about in their bodies.

All life forms must deal with free radical damage from internal metabolism and from the sun. It is not
surprising that plant substances usually have some amount of antioxidant activity. Some plant
substances such as Centella asiatica are especially potent antioxidants. The 3 most active components
of C. asiatica are madecassic acid, asiatic acid and asiaticoside.

T h e o r y 2 — I n f l a m m a t i o n
A certain amount of inflammation is required for health. Through its inflammatory response the body
combats infections, clears away damaged tissue and heals sunburn and other oxidative processes.
Excess inflammation results in accelerated rates of aging, scarring and destruction of normal tissue
architecture.

Oleuropein is an anti-inflammatory substance found in the olive tree, Olea europaea. More antiinflammatory
activity is contained within the olive leaf than in other parts such as olive oil.

T h e o r y 3 — G l y c a t i o n
The process of attaching a sugar to a protein is called glycation. Oxidative damage is an intracellular
process, i.e. occurs inside the cell whereas glycation is an extracellular process and occurs outside the
cell. Glycation occurs in protein-rich tissues that contain large amounts of the protein collagen.
Collagen-rich tissues include the skin, blood vessels, joints and lens of the eye. Glycated collagen is
damaged collagen and less able to respond to physical stress by stretching. Glycated collagen has much
less deformability and resilience.

Persons most subject to glycation have excess amounts of extracellular sugar (glucose). In this group are
diabetics, the obese and the elderly. These 3 groups are all relatively “insulin resistant”; that is, they do
not respond to insulin in a normal way by moving glucose inside the cell. The excess extracellular
glycose will glycate collagen and damage tissues containing large amounts of it. This illustrates why
“tight glycemic control” or keeping glucose at a normal level is so important in preventing the complications
of diabetes. Excluding diabetics, before the age of 40, the level of obesity is most important in
determining the rate of glycation. After age 40, chronological age is more important than the amount of
obesity.

As we age, our ability to synthesize cellular products such as collagen decreases. This makes it more
difficult for us to repair collagen damaged by glycation and other types of injury.
Resveratrol is an anti-aging substance found within red wine that prevents vascular disease. Resveratrol
is found in the outer covering of the grape seed. Grape seed extract also contains resveratrol.

T h e o r y 4 — D N A D a m a g e
DNA is contained in the helical structure inside chromosomes in the nucleus of the cell. This DNA
contains our genetic material and also directs the function of the cell in which it resides. A cell with
damaged DNA cannot properly function and may even become cancerous. Increased DNA damage in
skin occurs with photoaging and high oxidative stress. Not as much DNA damage is found with glycation
because DNA is protected from glycation within the cell. Most glycation occurs extracellularly.
Genetic defects such as Werner’s Syndrome illustrate the importance of DNA repair. Werner’s Syndrome
is one of the progerias, the diseases manifesting greatly accelerated aging. Persons with Werner’s
Syndrome lack the helicase enzyme required for DNA repair. In the teen years, these individuals look
much like everyone else. By the age of 30, they look many, many decades older and have an accompanying
high rate of disease and decreased lifespan.
DNA is subject to free radical damage so antioxidants improve rates of DNA damage. Some growth
factors such as EGF (Epidermal Growth Factor) or HGF (Hepatocyte Growth Factor) can direct the DNA
of fibroblasts to synthesize more collagen.

Improving Aging Rate and Surgical Outcome. Improving any of these 4 processes decreases the rate of
aging and also improves surgical outcome. Individuals with excess free radical damage, glycation,
inflammation or DNA damage have decreased healing capacity.
Certainly, attacking the processes of aging in younger years is preferable. But even though “younger is
better”, any time is better than never. This is illustrated by experiments on rodents the equivalent of 60 in
human years. These rodents, prior to their rodent age of 60, lived a life full of stress, free radical damage
and high carbohydrate diets. At 60, they were put on high doses of antioxidants. Their lifespan significantly
increased even at this late age. Similarly, when anticipating a procedure, “sooner is better” for
instituting good skincare practices. If begun just prior to surgery, then 2-4 weeks is a good estimate of
the minimum time required to begin a skincare regime.

Anti-Aging Tips

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When it comes to staying young, there are so many guidelines and rules. There are some basic
tips for anti-aging. These anti-aging tips cannot only help keep you young, but can also protect
you against a variety of age-related diseases and complications:

Exercise
This is one of the most important things you can do for your health. Keeping your body in good
shape helps to prevent many diseases and disabilities and may also significantly slow down the
aging process. Exercise strengthens the heart muscle, lowers blood pressure, and helps to
maintain weight. Exercise also strengthens your bones, and reduces the chances of getting
osteoporosis. It also builds endurance, flexibility, and boost your metabolism. There are many
simple and effective workouts like walking, jogging, biking, and even dancing. Effective strength
training can be done with the use of light weights a few times a week.
Natural Skin Care
Though there are countless skin care products available today, most of them are not necessary
for maintaining youthful skin. Regular cleansing, exfoliating, and moisturizing are all important
for keeping your skin in good shape without resorting to extreme treatments such as surgery or
Botox injections. There are many natural products available, and natural ingredients, which are
beneficial to the skin, such as honey, oatmeal, lemon juice and almond oil, which can be used in
homemade treatments.

Some other anti-aging tips for healthy skin include the following:

- Avoid excessive use of cosmetics, as many products can contain potentially dangerous
chemicals. Wearing too much makeup can also clog pores and prohibit the skin from
being able to breathe.
- Drink eight glasses of water a day. Hydrated cells are plump and healthy.
- Take cool showers as too much heat can damage the skin.
- Eat a diet rich in fruits and green leafy vegetables that contain many natural antioxidants.

Diet
The best anti-aging diet is one that is high in antioxidants and low in sugars, fats, and artificial
ingredients or other additives. One popular method is a restricted calorie diet, where caloric
intake is limited in order to slow down aging. The only difficulty in a restricted calorie diet is
maintaining sufficient intake of other nutrients at the same time.

Oral Supplements
One of the best tips for anti-aging is to use a vitamin/mineral supplement. The vast majority of
Americans are not able to get the nutrients they need through their diet alone. Taking a
multivitamin cannot replace a bad diet, but it can provide a valuable boost.
Antioxidants
Antioxidants are nutrients, which protect your cells against oxidation. Oxidation causes the cells
to become old. Since this deterioration of cells is responsible for many of the effects of aging,
antioxidants are especially important as an anti-aging treatment. Some of the best nutritional
antioxidants are Vitamins C and E, beta-carotene, alpha-carotene, selenium, Coenzyme Q10,
and flavonoids. These are available in many anti-aging nutritional products or vitamin
supplements.
Wk 12: 20 Anti-Aging Tips.doc
Healthy Habits
Healthy daily habits are the groundwork of an effective anti-aging regimen. Regular exercise,
plenty of sleep and a balanced diet are all important too. Even simple things such as eating
smaller portions at meals and being more active instead of spending too much time watching
television can make a difference in your health.
De-stressing
Your emotional health can also have a large effect on your physical condition. Too much
unhealthy stress can lead to a number of problems, including unstable emotions, exhaustion,
inability to concentrate, lack of sleep, digestive problems, stiff muscles, headaches, allergy or
asthma attack, frequent colds, infections, and skin problems. There are many things you can do
to de-stress.
Physical activity is one way to release stress. Even simply taking a break from stressful activity
to relax can be helpful. Talking to someone and having the support of family and friends can
also help you to reduce stress and maintain a positive attitude.
Active Lifestyle
Staying active is very important for maintaining good health and keeping up energy. A
sedentary lifestyle can lead to many health problems like heart disease. Doctors recommend an
average of 60 minutes of physical activity a day, which can include anything from running on the
treadmill to simply doing yard work.

Laughing
Part of being healthy is having a healthy outlook on life. Keeping humor in your life is an easy –
and funny way. Laughter can keep your body more open to healing. Research has also found
that laughter can lower blood pressure and relieve fear in uncertain situations.

Yoga and Meditation
Yoga is designed to exercise and soothe both your body and your mood. It can help to slow the
effects of aging by loosening the spine, firming the skin, releasing tension from your body,
strengthening your muscles, and correcting poor posture. Yoga may also increase resistance to
disease, increase vitality, and rejuvenate the glands. Similarly, meditation can help to
rejuvenate the system and reduce stress.

Resorting to Herbs
Herbs are one of the most popular forms of alternative health treatments today. Many types of
herbs have been found to have many anti-aging benefits. Popular anti-aging herbs include
ginseng, gingko, and grape seed extract. They should always be used with extreme care, as
many can cause negative side effects when used incorrectly or when mixed with other
medications.

Hormones
As you become old, your body slows in its production of many important hormones. Though
hormone replacement therapy is one method of treating a hormone deficiency, there are risks
involved with introducing any foreign chemical into your body. There are natural ways to boost
your body’s hormone production with less risk – and less cost. One method is to have
treatments using natural or bio-identical (non-synthetic) hormones. There are also some herbs,
amino acids, and homeopathic medicines which can naturally encourage hormone production
without needing a procedure done by a doctor.

Chocolate
One of the best anti-aging secrets is chocolate as this can actually be good for you. Studies
have found that cocoa may help to lower your blood pressure, as well as help in keeping your
blood flowing and your heart healthy. Chocolate also contains large amounts of flavonoids,
plant compounds which can prevent blood clots. Chocolate also promotes the secretion of
endorphins, which makes us feel good, and contains serotonin, which acts as an antidepressant.

Socialization
Humans are social creatures, and how much you interact with others can have profound
influence of your physical health, mental health, and emotional well being. Interacting with other
people provides a sense of community and purpose and can help to prevent depression.

Getting a Pet
Studies have shown that owning a pet can greatly contribute to your mental and physical health.
Individuals who own a pet are statistically less likely to visit a doctor and are slower to decline
physically and mentally as they age. Pet owners are more active, as the routines of pet care
keep people moving around.

Avoiding Alcohol and Cigarettes
It is a well-known fact that tobacco use and extensive alcohol consumption can be very
hazardous to your health and can greatly accelerate the aging process. While wine, like
chocolate, contains flavonoids, which can be beneficial in small amounts, consuming too much
alcohol or smoking cigarettes is very risky. It can lead to problems like heart disease, liver
problems, and a number of other complications. Nicotine use can also lead to heart disease,
poor blood circulation, kidney damage and stroke.

Avoiding Caffeine
Caffeine is widely used in our society, though many people don’t even think of it as a drug.
Caffeine increases blood pressure and heart rate, causes stress, and can aggravate or even
lead to cardiovascular disease. Many vitamins and minerals are also adversely affected by
caffeine.

Green Tea
Green tea has been used in China since ancient times to treat everything from headaches to
depression. It can also help to prevent or ease rheumatoid arthritis, high cholesterol, heart
disease, and other infections. It also has many anti-aging benefits, and is included in many skin
care products.

The maintenance of good health as you get older requires a combination of many
different factors. Follow these excellent anti-aging tips, which are easy to follow, and
which can be invaluable to your health!

What is Acne?

2010-11-30T10:16:00.000-08:00

Acne is a skin disorder resulting from the action of hormones and other substances on the
skin’s oil glands (sebaceous glands) and hair follicles. Skin pores become blocked resulting in
outbreaks of lesions known as zits or pimples. Acne usually occurs on the face, neck, back
shoulders and chest. Normally acne not a serious health problem, severe acne can result in
permanent scarring.

How does Acne develop?
Doctors describe acne as a disease of the pilosebaceous units (PSUs). Found over most of the
body, PSUs consist of a sebaceous gland connected to the canal (a follicle) that contains a fine
hair. Sebaceous glands produce an oily sebum that normally empties onto the skins surface
and blocks the pores.

What causes Acne?
The exact causes of acne are unknown however doctors believe it results from several factors.
Which are as follows:

• Increase in hormones called androgens (male sex hormones)
• Hormonal changes related to pregnancy.
• Genetics or heredity
• Greasy cosmetics (clog the pores)
• Sweaty sports equipment such as a sports helmet
• Pollution and humidity
• Stress
• Hard scrubbing of the skin

Acne Myths?
Greasy foods are often blamed for acne but there is little evidence to link this to acne in most
people. Another common myth is that dirty skin causes acne however acne lesions and
blackheads are not caused by dirt. Stress does not cause acne, however research suggests that
for people who have acne stress makes it worse.

Who can get Acne?
People of all ages and races get acne though it is most common in young adults. An estimated
80% of all people between the ages of 11 and 30 have acne outbreaks at some point. For
most, acne will stop by the time they reach their thirties.

Dermatology and Laser

2010-11-30T10:12:00.000-08:00

SkinCare Physicians offers a variety of treatments by world-class physicians including the following cosmetic procedures:
- Improving your complexion: basic skin care program, Glycolic acid and TCA chemical peels, as well as microdermabrasion and Vibraderm for facial, hand, neck and chest rejuvenation, Photorejuvenation and Gentle Wave treatment
- Laser skin resurfacing and non-ablative resurfacing
- Laser treatments for red and brown spots and tattoos
- Fraxel-fractional laser resurfacing
- Laser treatment of broken blood vessels and leg veins
- Laser hair removal in patients with all skin types ranging from light to dark skin
- Liposuction and liposculpture using cutting edge techniques
- Neck liposuction and jaw line re-contouring
- Fat transplantation to eliminate wrinkles and restore youthful facial features using the patient’s own donor material
- Blepharoplasty (eyelid lift)
- Hair transplantation utilizing the latest in natural appearing follicles, micro and mini grafting techniques
- Breast reduction with liposuction
- Rhinophyma repair
- Scar revision and the treatment of acne scars with novel excision and subcision techniques and laser therapy
- Botox® injections for facial wrinkles, frown lines, brow lifts, crows’ feet, neck rejuvenation and excess sweating of the face, hands and underarms
- Botox® injections for migraine headaches, blepharospasm, and other facial disorders.
- Soft-Tissue Augmentation procedures with Restylane, Collagen, Sculptra and Radiesse, as well as other latest fillers and methods
- Sclerotherapy for superficial leg veins and surgical removal of varicose veins
- Thermage radiofrequency treatments for tightening of forehead, face and neck and other parts of the body.
- Acne treatments with state-of-the-art lasers
- Contour Thread Non-Surgical Facelift
Dermatology Services
- General Dermatology – diagnostic and therapeutic services for common and complicated cutaneous disorders in patients of all ages.
- Pediatric Dermatology
- Women’s skin care and evaluation program
- Mole and skin cancer evaluation and treatment
- Clinical diagnosis and treatment of malignant lesions
- Minor surgical procedures including treatment of warts, skin tags, and moles
- Removal by excision, cryosurgery, electrosurgery or other methods of benign and malignant growths including basal cell and squamous cell carcinomas and melanoma
- Mohs micrographic skin cancer surgery and facial reconstruction
- Preventive skin care
Laser Services
Lasers or light devices in use at the SkinCare Physicians include the following:
- Q-switched Nd:YAG, Q-Switched Alexandrite and Q-Switched Ruby lasers for the removal of pigmented spots, freckles, age marks, and tattoos
- Pulsed-Dye (Vbeam) and Gemini lasers for the removal of port wine stain birthmarks, “broken blood vessels”, spider veins, leg veins as well as for treatment of scars, stretch marks, and warts
- Intense pulsed light therapy (Photorejuvenation) to remove “broken blood vessels”, freckles and lentigines on the face, and spider veins on the legs, as well as for hair removal
- Long-pulsed Alexandrite (GentleLase), Nd:YAG (GentleYAG, Gemini) and intense pulsed light for removal of unwanted facial and body hair
- Carbon dioxide lasers for the treatment of warts, moles, and other skin growths
- CO2 UltraPulse and Er:YAG lasers for resurfacing aged and photo-damaged skin, and eliminating lip lines, crows’ feet, and facial wrinkles. Lasers are also used to smooth scars caused by acne, past surgery or chicken pox.
* Photorejuvenation with intense pulsed light (Quantum) or photopneumonic therapy (Aesthera PPx) which improves skin tone and texture, reduces fine wrinkles, diminishes pore size, lightens unwanted brown sunspots and decreases broken facial blood vessels.
- Laser treatment for active acne and acne scars
- Photodynamic therapy (PDT) with lasers and pulsed lights for photodamage and for acne.
- CoolTouch III and Smoothbeam near infrared lasers for non-ablative resurfacing to smooth skin, decrease facial scarring and diminish lines and wrinkles from photodamage.
Skin Care Services
- Skin Care Services involve personalized consultations with our award-winning medical aestheticians. This includes everyday make-up advice, as well as camouflage techniques for pigmentation problems, scars, and for our laser resurfacing patients.
- Cleansing medical facials, microdermabrasion, Vibraderm
- Extractions, skin hydration therapy, exfoliation
- Enzyme Peels, oxygenating and vitamin C treatments
- A complete skin-care and make-up line is available to address your skin care needs and concerns
- LED treatments with GentleWaves
About SkinCare Physicians
SkinCare Physicians is a comprehensive state-of-the-art center for cosmetic and laser surgery, dermatology, dermatologic and skin cancer surgery, and medical aesthetics. The center’s founders and their associates are internationally renowned innovators and leaders in all of these fields. They are authors, or co-authors, of more than 700 articles in scientific publications, authors or editors of more than 50 books, editors of 18 medical journals and serve on editorial boards of 14 additional periodicals. Our physicians have been elected or appointed to senior leadership positions in dermatology, cosmetic surgery, laser medicine, and surgery organizations, and have been awarded honorary memberships in many national and international medical and scientific societies.
Our commitment to excellence, along with the credentials of our skilled physicians and staff, are what make

Acne Self-Care Handout

2010-11-30T09:46:00.000-08:00

Patience. Give the acne products enough time to do their job.

Picking. Picking or "popping" your acne lesions can make the acne worse. The lesions can become more inflamed or infected and increase the risk of scarring.

Cleansing. Acne is not caused by dirt. Washing too frequently or too vigorously can make your acne worse. In most circumstances, you should simply wash your face gently with mild soap and warm water twice a day. Remove any cosmetics every night before going to bed.

Shaving. Soften your beard thoroughly with soap and warm water before applying shaving cream. Shave lightly to avoid nicking acne lesions. Always use a sharp blade.

Diet. There is no scientific evidence that foods are responsible for causing or worsening acne. If you think that certain foods make your acne worse, you may want to avoid them, but it is more important to maintain a well-balanced diet.

Cosmetics. Look for skin care products that are oil-free and described as "non-comedogenic" or "non-acnegenic." Avoid heavy foundation makeup. Remove your cosmetics every night with soap and water. Applying a green undercover cosmetic over red lesions may help to hide acne lesions.

Sunlight. Sunlight can temporarily "hide" the acne, but it can lead to hyper pigmented spots on your skin that can take even longer to fade. Since sunlight ages the skin and can cause skin cancer, it is best to use a sunscreen when exposed to sunlight. Select a sunscreen that is oil-free and protects from both UVA and UVB radiation.
Certain acne medications can make you more sensitive to sunlight. It is important to avoid direct sunlight by wearing protective clothing and using sunscreen on areas that cannot be covered. Tanning booths should also be avoided because the ultraviolet light can react with the medication, causing burning or a rash.

Medications
• It is important to take your medication exactly as prescribed by your dermatologist. Using more medication or adding doses will not make the acne go away any faster and it may result in skin irritation or other side effects. Taking too little medication or skipping doses may allow the acne to continue.
• Medications applied to the skin are meant to be used on the whole area affected by acne. For instance, if you have acne on your face, you must apply the medication to your whole face. Placing the medication only on the acne lesions that you see today will allow new acne lesions to appear on skin that now appears normal.
• To avoid forgetting a dose, take your medication the same time every day. Take it while performing other routine tasks, such as brushing your teeth.
• Talk to your dermatologist before stopping your medications.
• Give the medications enough time to do their job. This may take 6 to 8 weeks.