Dear Paula Q & A

Skin Care

 

Dear Paula,
I started using Revlon's Eterna 27 with Progenitin on the recommendation of a friend. Then I read in your book that it may contain estrogen. I am a breast cancer survivor taking Tamoxifen because my cancer was estrogen-receptive. Should I stop using this product because I may absorb estrogen from it? I really look forward to your answer. I asked my doctor about this and he didn't know what to tell me.

Kathleen, via email

Dear Kathleen,
Given your situation, I wouldn't continue using this product without talking to a physician who knows about this ingredient or checking back with your current physician after you give him the information I'm providing here. The active ingredient in this Revlon cream is pregnenolone acetate. Pregnenolone is a steroid hormone involved in the production of progesterone, androgens, and estrogens. It is considered a precursor hormone or a prohormone. Whether or not the acetate version has this effect is unknown, but all hormones can be absorbed through skin. Personally, as someone who has a family history of breast cancer, I would think twice about using any hormone-generating substance, whether bio-identical, synthetic, or plant-based, and definitely not without checking with a physician. If you are not satisfied with the information your current physician is providing based on your concerns, I would strongly encourage you to seek a second opinion, especially from a doctor that is better informed on this topic.

Hair Care

 

Dear Paula,
I've read so much about all sorts of hair-care products that can repair split ends. Is there really something out there that can get rid of my raggedy looking ends, other than cutting them off?

Terry, via email

Dear Terry,
There are products that can help split ends look better, and if the damage isn't terrible, can actually make it look like they don't exist. However, making split ends look like they don't exist isn't the same as getting rid of them. To eliminate the problem, the ends need to be cut off; they can't be repaired. Hair is dead and can't be restored. Pomades are the perfect product for just this sort of problem and many of them can work brilliantly, particularly the new forms of pomade, which are less waxy and greasy and have a far lighter texture and silkier feel than some of the traditional versions. There are many to choose from, but Got2B Playful Texturizing Creme Pomade ($5.99 for 2 ounces) or TRESemme Hydrology Smooth & Shine Moisture Pomade ($4.49 for 3.5 ounces) will get you started on the right track. The trick with pomades is to apply them after your hair is dried and styled, and then apply only the tiniest, thinnest amount, just on the ends of your hair. You can always add more product if needed to get the effect you want.

Dear Paula,
I have a question in regard to shampoo for people that have sensitive skin or allergic skin. Right now I am using Cliniderm shampoo and conditioner and I find that it works but it is very expensive--is there another alternative to this?

BMJ, via email

Dear BMJ,
Cliniderm Shampoo and Cliniderm Conditioner are indeed unique. These two hair-care products leave out dyes, perfumes, fragrances, plant extracts, parabens or formaldehyde-based preservatives, and polyquaterniums. Those can be significant to people with sensitive skin. If you aren't using these products to avoid special sensitivities, you could look for products that are otherwise formulated the way these are, though the only other brand I am aware of that has products similar to Cliniderm is Free & Clear from Pharmaceutical Specialties. For more information about these products (they offer shampoo, conditioner, hairspray and styling gel, plus skin care items), visit www.psico.com. For more information about Cliniderm, visit their Web site at www.canderm.com.

Breakouts / Acne

 

Dear Paula,
I’ve trusted you for years, ever since first reading your Blue Eyeshadow Should Be Illegal (who could forget your first title?) book and reading every product review for acne-plagued skin since. After four separate rounds of Accutane, I’m still struggling with bad skin at age 49. When I had a recent horrible flare-up I found an interesting regimen on the Internet at www.acne.org (Daniel Kern authored it). His advice is so close to what you’d say, but lacks any BHA or an appropriate warning about sunscreen. Have you come across it? What do you think? I would love to know for my three teens and my own menopausal self if Kern’s routine may actually be helpful.

Kelly, via email

Dear Kelly,
Believe me, I would love it if there were one or two slam-dunk routines people with acne could follow and be assured of great results. Alas, that’s not the case. You’re not alone in still dealing with acne, that’s for sure. It remains one of the skin issues my readers (of all ages) ask about most. I admire your perseverance for going through the Accutane treatment four times; what a shame it didn’t work for you, though I suspect you’ve noticed some incremental benefits, hopefully at least less frequent breakouts and less oiliness.

The Web site www.acne.org was envisioned and is maintained by Daniel Kern, a regular guy who suffered with acne for years before he figured out a routine that finally provided clear skin. His routine, which he recommends to others who visit the site, includes merely a cleanser, a 2.5% benzoyl peroxide product, and a moisturizer. Nothing new here, that’s about as standard and basic a treatment for acne as eating a salad is to dieting. Kern believes the key to the success of his routine is applying plenty of benzoyl peroxide twice per day, at least 12 hours apart. How much is plenty? Kern urges people who want to follow his routine to begin with a dime-sized amount or less, then work up to an index finger’s worth of product, per application. That amount of benzoyl peroxide may indeed prove more effective than applying a superficially thin layer. However, not everyone’s acne responds to benzoyl peroxide (which is well documented in the research).

It’s good that Kern stresses not irritating skin and using the lowest strength of benzoyl peroxide; but the fact remains that, for some people with acne, any amount of benzoyl peroxide can be irritating. Whether or not Kern’s routine will be helpful for you and your teenagers depends on how well your acne responds to benzoyl peroxide. I assume you’ve tried it in the past, given its availability and that it’s generally recommended as a starting point by dermatologists (and me) for those with acne. Did it work well? If so, applying more of it more often may prove helpful. If it did not work well, I am skeptical that slathering on more of it will have much benefit for you, especially given your skin’s response to several rounds of Accutane.

I urge anyone considering Kern’s routine to also consider adding a BHA (salicylic acid) product as well. When well-formulated (meaning pH-correct and without needless irritants such as alcohol and mint), a salicylic acid product can play a powerful role in helping to improve the manner in which the pore lining functions. And if blackheads accompany your acne, salicylic acid is a must. Benzoyl peroxide, as effective as it is, has no impact on blackheads because they are not caused by bacteria.

By the way, on his Web site Kern offers a gentle, well-formulated cleanser and a benzoyl peroxide gel, which are simple but effective products that are priced lower than many options at the drugstore. He now has a moisturizer in the works, too, as well as a sunscreen. The cleanser is not fragrance-free due to the sage and cucumber extracts, but the Benzoyl Peroxide Gel is 100% fragrance-free.

One more point: Remember that benzoyl peroxide can bleach hair and dyed fabric, especially cotton. If you or your children decide to try Kern’s routine, be sure to sleep on a towel or a white pillowcase to avoid stains, and take care to avoid getting the peroxide on your eyebrows or near the hairline.

Dear Paula,
I am 23 years old and have a problem with blackheads. I have combination skin, and the blackheads are worst on my T-zone, especially on my nose. I've tried just about every scrub and facial mask on the market, in all price ranges, and nothing seems to work. It appears the only way to remove them is either to manually squeeze them out, which people tell me is bad for my skin, or to go for weekly facials, which I can't afford to do. I recently saw an advertisement in a magazine selling a device that removes blackheads by "soft suctioning," using a "vacuum-air" method of some kind, or at least that's what the ad implied. It supposedly entails no squeezing and will not puncture the skin. What are your thoughts on this? If this device is just a gimmick, what do you recommend?

Traci, via email

Dear Traci,
I have seen that same device advertised in magazines since I was a teenager. Like you, I was enticed by the promise; the difference is I bought it. What a huge disappointment. Not only didn't it work, it left small red marks on my face. I believe that was one of the first times I was angry at the beauty industry. I was all of 16 years old. What I learned back then was if devices like that worked, who would ever complain about blackheads? It doesn't work, but it stays on the market, advertised in miscellaneous magazines for other unsuspecting consumers.

The good news is that squeezing is absolutely a viable option for removing blackheads, and exactly what you would be paying a facialist to do. You already have spent a lot of your hard-earned money searching for the perfect scrub and mask, which means you now know those don't work. In essence, the most important thing you can do to get rid of blackheads is routine use of a well-formulated beta hydroxy acid (BHA) product. These contain salicylic acid and, when the pH of the product is between 3-4, it can penetrate the follicle lining of the pore, dislodging blackheads and restoring a free flow of oil to the skin’s surface. Blackheads are unrelated to dirt; you cannot wash or scrub them away. But routine use of a good BHA product coupled with occasional, gentle squeezing should keep them under control. Paula’s Choice, Olay, Clearasil, and Neutrogena all offer effective, leave-on BHA products.

Dear Paula,
What Is Accutane? I constantly hear about this, but am confused as to what it is.

Mark, via email

Dear Mark,
Accutane is a synthetic drug made to resemble the molecules in vitamin A, and is taken orally. It stops the oil production in your sebaceous glands (the oil-producing structures of the skin) and literally shrinks these glands to the size of a baby's. This prevents sebum (oil) from clogging the hair follicle, mixing with dead skin cells, rupturing the follicle wall, and creating pimples or cysts. Oil production resumes when treatment is completed and the sebaceous glands slowly begin to grow larger, but rarely as large as they were before treatment.

In 85% of patients who complete a four-month treatment with Accutane, acne is no longer considered to be clinically significant. In other words, for all intents and purposes, their acne is cured!

What about the remaining 15% of patients who do experience recurrences? Typically three to six months after treatment, when the breakouts return, they are milder, easier to treat, and can generally be cured with a second round of Accutane. By the way, dosage and duration depend on the severity of the patient's acne, but treatments generally last 16 weeks. If a second treatment is necessary, an eight-week rest period is required in between.

If you are curious about whether Accutane could work for you, talk to your dermatologist and be sure you understand the all of potential side effects, some of which are quite serious but short-term in nature and a major concern is not an issue for men because, of course, they cannot become pregnant.

Dear Paula,
When I start a new skin-care routine, should I expect my face to break out badly? In the past, for example, I tried Clinique and my skin got so bad for two to three months, I finally quit. Everyone tells me "It has to get worse before it gets better."

Laurie, via email

Dear Laurie,
The notion that skin has to get worse before it gets better is generally not true. It is also fiction that the skin is breaking out because the new products are purging toxins lurking in the pore or under the skin, making skin worse before it can get better. Women have heard this repeatedly from cosmetics salespeople. This long-standing myth puts women in a position to tolerate bad or ineffective skin-care products longer than they need to.

Typically, breakouts occur from a new skin-care routine because it is just bad for the skin and probably contains ingredients that trigger blemishes, or are ineffective or irritating, causing a rash-like breakout. However, the most common cause of breakouts from a new skin-care routine is really one of coincidence that has nothing to do with the new products you are using. If you have a skin type that tends to break out, you could very easily start a new skin-care regime at a time when you may be going through a normal breakout phase, even if your skin was perfectly clear before the new products were used. Remember that effective acne products can take two to three weeks to show results, so there wouldn’t be time for them to have an impact on the new cycle of breakouts you just happened to be going through.

For some skin types, it is true that an effective skin-care routine can cause breakouts. This is particularly true when you are using disinfectants, exfoliants, and Retin-A. It may be due to the initial effect of the active ingredients, which can be irritating and cause breakouts (not true acne but rather what’s referred to as an irritant contact dermatitis), and then the skin may need awhile to adapt.

Dear Paula,
I am prone to developing bumps or milia (as my facialist calls it) under my eyes. What causes milia and how can I prevent them from forming? What ingredients should I look out for when shopping for eye-care products to prevent more from coming up? How do I get rid of them? Everyone I've spoken to at the cosmetics counters seems to have different and conflicting explanations. You're the only one I can rely on, for an honest answer at this point.

Lynn, via email

Dear Lynn,
Milia are difficult to get rid of but there are options. Renova, Retin-A, BHA, or AHA can actually improve the appearance of milia. If you want to try a moisturizer for the eye area, a lightweight gel serum is your best option to not further clog pores.

From there, the other options you have are microdermabrasion, AHA or BHA peels, and laser resurfacing. You may also want to see a dermatologist for more pronounced milia. He or she can lance these bumps and drain the contents which, with proper at-home care, should diminish quickly.

Dear Paula,
After visiting my local doctor to discuss my 18-year-old daughter's acne problem I was amazed that I was given a scenario that taking the contraceptive pill would be the 'cure' for it. So I recently looked into natural alternatives and discussed the problem with the staff at my local health store. He came up with 'Silver Colloid' – a clear liquid taken orally and also externally. It seems to have helped but due to the cost, I wandered if you think these natural remedies are plausible. My daughter does have an excellent diet and exercises regularly, and feels this product has helped but is it a figment of our imagination?

Mary, via email

Dear Mary,
Colloidal silver is indeed used for acne as well as other ailments (both topically and orally) including rosacea, fungal infections, and bronchitis. However, there is concern over silver toxicity. Most of us get enough silver via our daily diets (and it is not considered an essential nutrient). The problem is that silver accumulates in the body, and if your daughter’s medication exceeds the maximum recommended daily dosage, it could cause permanent problems. The following information about colloidal silver is from www.naturaldatabase.com, and succinctly details the inherent problems with using silver (especially in a medically unsupervised manner):

"Colloidal silver is likely unsafe when used orally, topically, or intravenously. Total daily silver intake should not exceed 14 mcg/kg/day (980 mcg/day for a 154 pound person). Combining colloidal silver supplements with regular dietary intake of silver would likely result in exceeding this amount of silver. Silver accumulates in the body and can lead to an irreversible bluish skin discoloration known as argyria. Neurological deficits, diffuse silver deposition in visceral organs, renal damage, and metal flume fever can occur. The U.S. Food and Drug Administration (FDA) does not consider colloidal silver products to be generally recognized as safe (GRAS).

Orally or topically, colloidal silver can lead to an irreversible bluish deposition of silver in the mucous and skin membranes known as argyria. Argyria typically first appears in the gingival (gum tissue) with a slate-blue silver line. Toxicity may also present as blueish-gray discoloration of the fingernails. Colloidal silver can also stimulate melanin production in skin. Areas exposed to the sun will become increasingly discolored."

In short, advise your daughter to stop taking silver supplements immediately and see her physician for an exam to determine if any damage was caused by her regimen. This is another example of how seeking a natural remedy can backfire. Natural doesn’t always equal safe or even superior to other treatments.

Anti-Aging

 

Dear Paula,
I made an appointment with my old dermatologist who I went to 10 years ago for Accutane. She has since changed focus to cosmetic dermatology and I thought finding out what cosmeceuticals she recommends would be a great thing to do to as well as get a prescription for Renova. The visit taught me how naive I was about today’s dermatology business. I could have saved myself the trouble and found out what cosmeceuticals she recommends by just walking into her office and seeing what brands she sells (TNS and Kinerase). As for Renova, it was like pulling teeth to get her to talk about it; the emphasis was on the products she sold. I thought Renova is still state of the art, but I guess the difference is that the doctor’s office can’t profit from it. No question really, just wondered what your thoughts are.

J., via email

Dear J.,
I am sorry to learn that your latest dermatology visit was so disheartening. It’s disheartening for me to learn that any dermatologist today would eschew tretinoin (the active ingredient in Renova) for their own products, and especially for overpriced less-than-stellar products. Given the mounds of published research pertaining to tretinoin’s efficacy and benefit for aging skin, it’s almost shocking that your dermatologist would seemingly downgrade it in favor of other nonprescription products. Sadly, that’s a trend I suspect will continue as dermatologists continue to sell skin-care products and blur the line between medical professionalism, scientific proof, and cosmetics puffery. From a consumer perspective, this is frustrating because we generally don’t expect dermatologists to be salespeople, or for there to be any pressure to buy products during an office visit. The best dermatologists balance nonprescription product recommendations, at a variety of price points, with prescription treatments when needed. For example, a prescription for Renova coupled with daily use of an antioxidant-rich serum and sunscreen is smart combination therapy for aging skin.

Renova is still a state-of-the-art option for skin types that can handle it, and I encourage you to seek a dermatologist who both understands this and will at the same time be glad to recommend over-the-counter products that benefit your skin type and condition, whether they’re retailed by the dermatologist or available elsewhere.

Dear Paula,
Over the last few years of reading your books, newsletters, and Beauty Bulletins I have learned so much about skin care. Above all else you have taught me to recognize claims about a product that sound too good to be true and investigate its validity. My alarm bells are going off after my first visit to an aesthetician and I need your help to discover the truth.

I'm 39 and extremely fair skinned. I have avoided the sun and used sunscreen most of my life. An aesthetician examined my skin under a "Woods light" and pronounced that I have suffered extreme sun damage especially on the left side of my face. She recommended several courses of a "Jessner peel" until the sun damage had been significantly reversed.

I don't really see much of a problem with my skin. I have no discoloration aside from a bit of redness on my cheek and some fine lines on my forehead along with age-related developing of crow's feet. Can a Woods light really show this sun damage? Will a course of Jessner's peels reverse sun damage? The whole thing sounds suspect to me.

Susan, via email

Dear Susan,
A Wood's lamp uses a certain wavelength of ultraviolet light to pinpoint and map various underlying problems in skin, from fungal infections to pigmentation issues. It can reveal pigment problems (from sun damage or another factor) that may not be visible on the surface yet (and you may never see them or won't see them for years). Given your adherence to sunscreen, it is likely you've stopped this pigmentation in its tracks. However, being fair-skinned, you are more vulnerable to sun damage even when exposure with protection is intermittent. What your esthetician saw under the lamp may be the cumulative damage from childhood sun exposure (most of us didn't wear sunscreen as kids or teens).

A Jessner's peel is a rather strong option that you shouldn't consider just yet. This solution consists of a salicylic acid, lactic acid, and resorcinol in an alcohol base. Some dermatologists consider it a light peel, while others classify it as medium depth (the classification status often depends on how long the solution is left on skin). The resorcinol component is what’s most irritating, especially compared to standard glycolic or salicylic acid peels. I'd suggest trying a series of IPL treatments (also known as PhotoFacials) or a series of AHA or BHA peels. Both are less problematic than Jessner's and, over time, can produce comparable results with less initial irritation. Your esthetician may not offer such procedures or services, which would explain why she suggested a Jessner’s peel. In general, it is best to have IPL treatments or peels done by a physician or at an accredited facility with a doctor on staff. The IPL treatments will also address the superficial redness you noted, as well as stimulate collagen production to make your fine lines less noticeable. I wouldn’t say your esthetician was wrong to suggest a Jessner’s peel; rather, it’s not the best initial choice or the only option at your disposal.

Dear Paula,
In your September 2005 newsletter, you described the Fraxel laser as "intriguing" but [said] to give it a year to see if the results were as good as claimed without damaging the skin. I was wondering if you could give an update on this treatment. Also, I was in a laser clinic recently for hair removal and they have a laser skin treatment for wrinkles called the Profile ThermaScan. The description sounds like it could be the same as Fraxel laser; are you familiar with this one?

Holly, via email

Dear Holly,
If I said to give it a year to see what new studies would show about the Fraxel then I apologize because a year is too short a time to make an assessment of any new procedure, particularly an expensive one that could have long-term risks or disappointing results. There are only a handful of studies available about the Fraxel and most of those involved only a small group of women (six in one study, seven in another). And most of the studies were done by doctors paid to do the research by the company selling Fraxel. At this time there still isn’t enough information to warrant excitement or the expenditure of your hard-earned money.

ThermaScan is quite different from the Fraxel. The ThermaScan laser is a nonablative 1319 nanometer light wave that heats up the skin without causing injury and is supposed to reorganize and regenerate collagen. The Fraxel is a semi-ablative laser that does cause injury to the skin, and is said to give similar results, but it is done in a way that is supposed to produce the benefits of more injurious (ablative) lasers with less problematic results. There is definitely not enough research about the Fraxel to believe that claim and I have not been able to find any research about the ThermaScan—so consider it a potentially advantageous but still nascent technology.

Body Care

 

Dear Paula,
I am 35 years old, and for as long as I can remember I have had old-looking hands. My mother says that as an infant, I had very dry, wrinkly hands. I now use sunscreen daily on my hands to help prevent further lines and wrinkles, but I am wondering if there is anything I can do to make the skin on my hands look smoother. What about AHAs? If so, what percentage should I use, and which products and how often? Should I follow that with hand lotion? I ordered a foot cream through the mail; would you recommend this for my hands?

Kelly, via email

Dear Kelly,
A dermatologist can do nothing topically for your hands beyond the things you are already considering. Now it is just a matter of experimenting until you find the right combination. The foot cream you bought could be an option, but I suspect it may be a tad bit too strong for hands and much better for callused feet. Hands rarely ever require the same thing as the feet. The "secret" in the foot cream you ordered isn't really a secret. It contains urea, which, like AHAs, exfoliates the skin and also works as a water-binding agent, plus lactic acid, for additional exfoliation. You may want to consider an 8% AHA product in an emollient base to see if it creates a smoother appearance for your hands. You can try Alpha Hydrox Lotion or Cream 8% AHA, which can be found at the drugstore. However, you still need to use sunscreen on your hands to prevent any damage. Apply the sunscreen after you apply the AHA product. One more consideration: Be sure that any time your hands are in water or you are using cleaning products, you are either keeping them protected by wearing rubber gloves or applying moisturizer immediately afterward. Curel Ultra-Healing Lotion ($7.99 for 13 ounces) works great for dry hands and is not greasy. They also make a 2.5 ounce size that fits well into most purses or for at the office.

Dear Paula,
I am having trouble with sunless tanning lotions. When I use them, my legs break out in an itchy rash from my knees to my ankles. This does not happen anywhere else on my body. I am getting frustrated with trying different brands and then being miserable with the rash. We spend a lot of time doing sports in the water. At age 45, my skin is starting to show its age and a fake tan helps hide some imperfections. I sweat easily, so I am worried about bronzers washing off plus the maintenance of applying a bronzer every day. I have not read about this problem in any articles. Can you help?

Deb, via email

Dear Deb,
You may be experiencing an isolated contact dermatitis to dihydroxyacetone (DHA) the most common ingredient found in self-tanners. Although rare, it does occur. Try applying a thin layer of hydrocortisone cream (Aveeno makes a good one that has a nice texture) to legs the night (or a few hours) before applying the self-tanner. Another issue that may be causing this rash is shaving immediately before application of self-tanner. Shaving can make skin more sensitive, so try to separate this from application of self-tanner (for example, shave legs in the morning, apply self-tanner at night). Last but not least, look for a self-tanner that's fragrance-free, such as Paula's Choice Almost the Real Thing Self-Tanning Gel ($12.95 for 5 ounces). Other good fragrance-free self-tanners include Dr. Denese Glow Younger Clear Self Tanner for Face & Body ($25 for 3 ounces) and Clinique Self-Sun Body Quick Bronze Self-Tanner ($17 for 4.2 ounces). Before using the self-tanner, apply a dab to your leg, blend in, and leave undisturbed for 24 hours. If no signs of rash or irritation develop, proceed with application to the entire leg.

Skin Conditions

 

Dear Paula,
I have lost some eyebrow hair, and I believe it's due to hypothyroidism, and I can't seem to grow it back. I have tried Talika products but nothing seems to work. Is there anything that you would suggest?

Kimberly, via email

Dear Kimberly,
I would encourage you to see your doctor to be sure you have the correct diagnosis for the cause of your hair loss. When you are at your doctor's office, take the opportunity to ask about using over-the-counter minoxidil (Rogaine is the brand name, but it's available as a generic for less money), as there is anecdotal evidence that it can work for helping to grow eyebrow hair.

Another option is topical application of latanoprost, a drug commonly prescribed in eyedrop form and used to manage glaucoma. It has been shown to stimulate growth of eyelashes* and there is potential it could do the same for eyebrow hair. However, using this drug for such a purpose would definitely count as off-label use, so it may be somewhat difficult to get a physician to prescribe it for you. Still, it doesn't hurt to ask the question of your physician to see if he or she agrees with this experiment.

*Source: http://dermatology.cdlib.org/93/commentary/alopecia/wolf.html

Dear Paula,
Will you please write about the extremely frustrating skin condition called seborrheic dermatitis? My particular questions have to do with how to cleanse facial and scalp skin when I have this condition, as well as how to address issues of acne combined with the seborrhea. I've been a huge fan for years, so I'm really looking forward to your response!

Melinda, via email

Dear Melinda,
I haven't written much about this skin condition, and for that I apologize. Seborrheic dermatitis is a disease that causes flaking of the skin in oily areas of the body, such as the scalp, face (including the eyebrows), and chest. Redness and itching are usually part of the package, making this an all-around uncomfortable disorder. Plain seborrhea is characterized by excessive oily skin with some flaking, but without the redness, itching, or scaling that accompany seborrheic dermatitis.

Its onset can occur as early as infancy (where it is commonly known as cradle cap), but it isn't unusual for it to manifest itself for the first time at puberty and sometimes not until much later in life. Mysteriously, this condition can come and go, sometimes resolving itself without treatment. Seborrheic dermatitis also seems to worsen from winter to late spring, and often goes away completely during the summer months. It affects slightly more men than women.

As with other skin conditions, such as rosacea and eczema, the exact cause of seborrheic dermatitis is unknown. Potential culprits that have been studied and debated among medical professionals include hormonal changes during puberty, neurological disorders such as Parkinson's disease, and the fungus malassezia, an organism that is typically present on everyone's skin in small numbers, but that can create problems if its numbers increase.

Although there is no cure, fortunately there are numerous topical options for managing the symptoms of seborrheic dermatitis. Regarding your question about how to cleanse the scalp, any over-the-counter anti-dandruff shampoo is worth trying. Various active ingredients to look for include selenium sulfide (Selsun Blue), zinc pyrithione (Head & Shoulders), ketoconazole (Nizoral), coal tar (Neutrogena T/Gel), and salicylic acid (Neutrogena T/Sal). Some of these have antifungal and antimicrobial ingredients, while others, like salicylic acid, are designed to break through the oily, scaly buildup, thus allowing the debris to be washed away. The key to achieving satisfactory results with an anti-dandruff shampoo is to massage it directly onto the scalp and leave it on for a few minutes so it has time to work. It also helps to alternate active ingredients, which is known as rotational therapy. For example, use a coal-tar shampoo a couple of days per week and a shampoo with zinc pyrithione or salicylic acid on the other days. If the various anti-dandruff shampoos don't work, your next step is to ask your physician for prescription alternatives. Keep in mind that because the active ingredients in anti-dandruff shampoos can be drying to hair and scalp, you may need a more emollient conditioner to keep your hair manageable and your scalp comfortable.

For your face, you can use any of the above shampoos if the condition is severe and if you are careful to avoid the eye area completely. A gentler facial-care option is to use a fragrance-free cleanser, such as original Cetaphil or Aquanil Lotion, followed by a well-formulated, fragrance-free BHA (salicylic acid) product such as those from the Paula's Choice line. It may also be helpful to use a topical cream with zinc pyrithione along with the BHA product (applying the BHA first); an excellent one is DermaZinc Cream ($20.95 for 4 ounces) available from www.dermadoctor.com.

When acne is thrown into the mix, the protocols for battling blemishes apply, too, and these you can review on my Web site, at www.cosmeticscop.com/learn/art.asp?ID=138 . Once you have a battle plan that works to manage your breakouts, you simply need to modify the routine to accommodate the extra products and/or active ingredients necessary to control the seborrheic dermatitis. Salicylic acid performs a dual role, not only helping to dislodge blackheads and reduce acne inflammation, but also by providing exfoliating action that can help dissolve the scaling, which is seen in most cases of seborrheic dermatitis.

One more point: A surprising number of medications may prompt or worsen outbreaks of seborrheic dermatitis. Such medications include auranofin, aurothioglucose, buspirone, chlorpromazine, cimetidine, ethionamide, gold, griseofulvin, haloperidol, interferon alfa, lithium, methoxsalen, methyldopa, phenothiazines, psoralens, stanozolol, thiothixene, and trioxsalen. If you are taking any of these medicines and you are dealing with seborrheic dermatitis, speak to your physician about alternate medications that hold hope for improving your skin.

Sources: www.aad.org; www.emedicine.com; www.neutrogena.com; and www.familydoctor.org

Dear Paula,
Do you have any hints concerning spidery red capillaries? I have them on my cheeks, nose, chin and under my nose.

Cher, via email

Dear Cher,
Spidery red capillaries that have surfaced on the face can be treated only by a plastic surgeon, dermatologist, or esthetician certified to work with lasers in a medically-supervised facility. A series of Intense Pulsed Light (IPL) treatments often produces great results, but the improvements are incremental, so don’t be discouraged initially. There is nothing that can get rid of them cosmetically (although a medium coverage foundation or good concealer can go a long way in covering them up). However, there are things you can do to keep them from getting worse. Steaming the skin, including in saunas and hot tubs, can make them worse. Scrubs, irritating toners, washcloths, and hot water can also make them more apparent and cause more to appear. The more gentle you are with your skin, the less noticeable they will be. One more note: excess alcohol consumption can also result in broken capillaries due to alcohol’s effect on blood vessels.

Makeup

 

Dear Paula,
I'm interested in your opinion of foundation brushes. I've been using my fingers and a sponge to apply foundation for a long time, but recently have had a couple of makeovers (Prescriptives and Paula Dorf) in which the salesperson/makeup artist used a brush to apply the foundation. It looked very good but I don't like the idea of having to wash a foundation brush every time I use it--sponges are fairly easy to clean and use several times before replacing. Please let me know your opinion.

Langdon, via email

Dear Langdon,
I personally don't prefer foundation brushes because I find the tendency is for the application to look streaky and uneven. Some people work well with brushes, but they are few and far between. I actually have never seen a makeup artist use brushes to apply foundation. I suspect more people are asking about foundation brushes because many cosmetic lines are selling them. While some people may find success with this type of brush, they are not for everyone. If you prefer a sponge to apply foundation, by all means keep using one.

Dear Paula,
You mentioned that liquid and cream-based products should only be kept for one year at most. Powders should be kept for no more than two years. How can this be? Many products last far longer than that. I normally have about six or eight favorite lipsticks on the go at any one time. That means that each one of them is in circulation for more than a year. As for eyeshadows—whoever ran out of eye shadow within a year?

At the moment, I have two favorite powder blushers in my drawer. One is 12 years old and is about two-thirds used. One is nearly two years old and I’ve barely scratched the surface. And I use blusher every single day!

I once bought a little eyebrow powder compact. I know exactly when I bought it because I was on holiday at the time. I used it once a day, every day, to fill in my sparse eyebrows, and it lasted just over ten years. If I were to follow your guidelines, I’d be throwing out masses of practically full products, which seems unnecessarily wasteful. Is it really so important?

Sandra, via email

Dear Sandra,
The short answer is that for many types of cosmetic products, I think it is complete nonsense to discard them on a rigid timetable, especially for powder-based products, basic moisturizers (without antioxidants or other state-of-the-art ingredients), lipsticks, brow pencils, and lip pencils. The risk for microbial growth in nonaqueous or mineral-based products is at best minor and as your description makes clear, there is no evidence that your 12 year old compact was posing a problem or risk of any kind.

Over the years, I have been interviewed more times than I can count by reporters asking me when to throw out a product, how long does it really last, and what are the risks. As far as I am aware, no one really knows for sure, so I quote what I’ve heard ophthalmologists say, particularly for mascara: after six weeks to three months, toss it out.

The European Union recently mandated PAO dates on all products (PAO stands for Period After Opening) to let you know when you should throw it away. Yet there are no studies or standards developed to determine what constitutes an appropriate PAO date. Not to mention that the way a product is used affects its microbial contamination. Clearly, a jar product is more of a problem than a product you can’t touch with your fingers. Leaving a product in your hot car or opened in your steamy, hot bathroom would have an impact, but no one knows what that is, so everyone in the industry is just guessing. If Estee Lauder puts a PAO date of six months on a product and everyone else follows suit, why not? It makes the regulators happy and it fosters more sales. That’s the reality.

What is far more risky than your 12-year-old blush are the tester units at cosmetics counters worldwide. These products are used by hordes of women and who knows whether or not they had infections, diseases, sores, and other gross things I don’t want to think about. There have been studies showing how tester units of cosmetics are teeming with all sorts of bacteria, mold, and the like, but no one is making the cosmetics companies throw those away and the consumer doesn’t seem to mind in the least, in fact I think there would be a female backlash if they took those displays off the counter.

To be perfectly honest, in terms of products like moisturizers with fancy ingredients, the base ingredients will last, but the meaningful ingredients, even in “air-tight” containers, should be out of date after six months to a year of usage. The same goes for well-formulated toners and specialty products such as acne products with benzoyl peroxide. Having said all this, now I have to go on the record stating that it is best to follow the EU guidelines and those voiced by some physicians. Summing up, this throw-away regulation helps cosmetics companies far more than it does the consumer.

Exfoliation

 

Dear Paula,
I have been using an alpha hydroxy acid product on my face at night. But since winter is almost here and I am pale again, I've also started to use my sunless tanner. I want to continue to use my AHA, but it exfoliates the tan right off of my face. Someone suggested I apply my AHA at night and my tanner in the morning, or vice versa. Is it a good idea to put the AHA on in the morning and then sunscreen over that and then to put the sunless tanner on at night?

Alicia, via email

Dear Alicia,
Your dilemma is completely understandable but I'm not sure there's an easy answer. Regardless of when you opt to use the AHA, it will have a negative effect on the longevity of your sunless tan. Self-tanners change the color of the very top layers of skin and AHAs are meant to remove just those layers. Further, if you apply the self-tanner over the AHA or vice versa, the acidity of the AHA will prevent the self-tanner from having its action on the skin cells (or at the very least will result in a blotchy or streaked-looking tan).

I'm not sure what to suggest other than to recommend that you experiment with what works best for you. I would start with the advice you were given, because it is probably your best option. Apply the AHA in the A.M. and the self-tanner at night. During the first two days of your self-tan, avoid applying the AHA product. Try applying it on the third night, then reapply your self-tanner in the morning, avoiding AHA use for two days afterward.

Dear Paula,
I have been looking into the at-home chemical peels on the Internet. I am considering ordering a peel from www.platinumskincare.com/glycolic-acid-peel.htm. This particular peel contains 30% glycolic acid and has a pH of 2.1. In your book The Beauty Bible, the reader is advised against home peels. You wrote that several companies offer home peels, but that the pH is too high for them to be effective. Is this still true of what is offered by all companies today? Would the product that I am considering be effective? Its pH is within the 2-3 level that is recommended for these types of peels, and it is much less expensive than having an AHA peel from my dermatologist.

Jocelyn, via email

Dear Jocelyn,
When I read your letter I was a bit shocked. I thought, if that ingredient list is true, this could be a really, really serious problem for unsuspecting women. Professional glycolic acid peels (AHA peels) are no more an at-home procedure than Botox injections or laser resurfacing. AHA peels with a 30% concentration (or more) and low pH levels (like 2.1) should be administered only by a physician. Side effects from professional peels can range from burns to blisters, scarring, swelling, and long-lasting redness. These are considerable risks and avoiding them takes skill and experience.

I went to the Web site you listed and, sure enough, they are retailing "professional" strength AHA peel solutions that range from 30% and up (and claim a pH of 2.1) to anyone with a credit card. Though they have some warnings that echo my concerns, some of their advice, such as the following, is disingenuous: "When you are at a doctor's office there are professionals who are constantly monitoring your skin for erythema [redness], frosting, and any other telltale signs ... that the acid needs to be rinsed off immediately or you could get a burn. When you are in the privacy of your own home you do not have a professional standing by making sure that you do not burn your skin. Glycolic acid is acid and it can burn you if you are not careful. Our pH levels are 1.0 higher to give you the extra time (SAFETY) you need!" This half-baked caution makes it sound safer than it really is, because a pH of 2 compared to a pH of 1 does not really reduce your risk.

Another confusing caveat on the site, and one that should make you very wary, states (the exclamation marks are from the company's wording.): "Misuse of glycolic acid products can cause injury or burns! Always follow directions exactly! Do not extend peeling times past 15 minutes! Used as directed, our peels and products are safe and effective. By using these products you agree that www.platinumskincare.com and Platinum Skin Care Incorporated assume no responsibility for misuse of this product or for any consequences or injuries as a result of using any of our products." The problem is, it's not necessarily misuse that causes injury or burns, it is merely inexperience.

Please rethink this purchase. You would not only be risking your skin, but if you did have problems (which I think is likely) you would have no recourse because this site has no return policy and warns consumers that the company is not liable for any problems related to using their peels.

General / Myth-busting

 

Dear Paula,
There is an article being circulated over the Internet that certain lipsticks contain lead, which is one of the ingredients, that may cause cancer. Part of the message stated that "The higher the lead content, the greater the chance of causing cancer. After doing a test on lipsticks, it was found that the Yves Saint Laurent lipstick contained the largest amount of lead. Watch out for those lipsticks that are supposed to stay longer. If your lipstick stays longer, it is because of the higher content of lead. Here is the test you can do yourself, 1) Put some lipstick on your hand. 2) Use a 24k-14k gold ring to scratch on the lipstick. 3) If the lipstick color changes to black then you know the lipstick contains lead.

Connie, via email search

Dear Connie,
First, to be absolutely clear, lead is never added to lipstick! And beyond that, it is ludicrous to suggest lead has anything to do with long-wearing lipsticks, or that gold in any form can detect lead. Lead-based house paint, a major source of problems because of its lead content, can't be detected by scratching it with anything. While, Yves Saint Laurent lipsticks are overpriced, they do not contain lead.

The one iota of truth in this offensive and devious Internet email is that a minute amout of lead may be present in some dyes used in cosmetics. According to the Food and Drug Administration (FDA) there are trace amounts of lead in certain FD &C (Food, Drug, and Cosmetic) coloring agents. FDA separates color additives into two categories: (1) colors that the agency certifies (derived primarily from petroleum and known as coal-tar dyes) and (2) colors that are exempted from certification but approved for use (obtained largely from mineral, plant, or animal sources). Only approved substances may be used to color foods, cosmetics, and medical devices.

Dear Paula,
As usual, thank you for mentioning our Age Intervention Hair Revitalizing Conditioner in the July/August issue of your newsletter. I always appreciate the exposure we receive from your publication. However, the review incorrectly states that the product contains a prostaglandin analogue known as Travoprost which is dispensed by prescription for the treatment of glaucoma. Jan Marini Skin Research Age Intervention Hair Revitalizing Conditioner does not contain Travoprost or any other ingredient used for the treatment of glaucoma. Nor does our ingredient appear on any drug label. I truly appreciate your efforts to provide a correction. Thanks Again.

Warmest Regards,
Jan Marini
President & CEO
Jan Marini Skin Research, Inc.

Dear Jan,
Thank you for bringing this to my attention. You are correct and I apologize for the error. Your Age Intervention Hair Revitalizing Conditioner does not contain the drug Travoprost. After your discussion with my assistant, it was clear that the ingredient used in your product is not “technically” a drug but a separate compound altogether. It is not approved by the FDA for medical use as Travoprost is, and as you said, it is a substance “your lab developed” whose effects are intended to make hair appear fuller (a cosmetic claim not a medical one). As explained on your Web site, “Age Intervention Hair Revitalizing Conditioner is not intended to stop, prevent, cure, relieve, reverse or reduce hair loss or to promote the growth of hair.” That meets with FDA’s standards regarding drug claims. I will publish a correction in the next edition of my newsletter.

I still have two concerns. While your product does not contain Travoprost, from our research, it appears that parts of the compound you’ve used is chemically related to prostaglandin analogues (albeit distantly). The good news is that because the ingredient in your product has some faint similarities to Travoprost (but, stated, is not Travoprost), there is some animal research showing that it may be helpful for men or women dealing with androgenetic alopecia (also known as male-pattern baldness). And we do know that prostaglandin analogues stimulate growth and darkening of eyelashes, so it’s not a stretch to presume these drugs would have that effect on scalp hair as well.