Consultant Dermatologist Dr. Hiva Fassihi answers skincare questions received at the Virgin Money London Marathon Expo.
SUN PROTECTION QUESTIONS:
- Ageing skin - what sun protection do you recommend?
As you know, sunscreens are designed to protect the skin from the damaging effects of ultraviolet radiation (UVR) which includes skin aging. However, for optimal protection, sunscreens must be used in conjunction with sensible sun-exposure behavior, specifically avoiding the mid-day sun, and keeping covered with a hat and appropriate clothing. When choosing a sunscreen, it is important to look for a high SPF value, such as 30 or 50+, and good UVA protection. This means that the product will give the best possible protection again sunburn and will also protect against UVA which causes skin aging. I would recommend that you incorporate a sunscreen moisturizer with at least an SPF30, suitable for your skin type, into your everyday routine for the best results. In addition, the amount of protection a sunscreen provides is related to how thickly it is applied onto the skin, so be generous with your sunscreen application.
- What sun protection products should I use for sensitive skin?
It is really important to protect your sensitive skin from the damaging effects of UVR as chronic sun exposure can make the skin even more red and sensitive over the years. I would suggest choosing an SPF50 with no fragrance and minimal ingredients. Those with a higher contents of mineral (physical) sunscreen filters (often found in children’s sunscreens) are tolerated better by people with sensitive skin.
- What is the best sunscreen for the face when running or sweating?
We are all trying to run and bike more, however protecting your skin form excess sun exposure and the cumulative UVR damage caused by this is really important. Regular sunscreen use not only reduces the risk of developing cancer in the future, but also helps to prevent premature aging of the skin. The best way to protect the skin is with UVR protective clothing and a hat. However, for the exposed areas, a light oil-free formulation with a high SPF and broad-spectrum coverage of both UVA and UVB which does not sting the eyes is best. Keep in mind all sunscreens work best with frequent application (every 2-3 hours) if sweating profusely.
- Why am I allergic to my own sweat!!?
Many people find that exercise and sweating can cause the skin to become irritated and itchy. This is more common in individuals who suffer with dry skin and eczema and is not a true allergy. The sweat and friction from overlying clothes during exercise result in irritation which makes the skin feel hot and itchy. It is important to moisturize dry skin and treat any eczema on the skin before exercise to prevent these flares.
Another reason for itchy skin during exercise is a condition called cholinergic urticaria. This is triggered by a rise in body temperature resulting in itchy red raised hives on the skin which resolve after cooling down again. Antihistamine tablets can help with cholinergic urticaria.
- I get red and itchy skin in the sun, and blotchy irritable reaction when go in the water in the sun - what can I do to help?
There are lots of reasons why you may become red and itchy in the sun. The most common is a condition called polymorphic light eruption or ‘prickly heat’. There are also a number of skin conditions such as eczema that can flare and get worse in the sun. Its best to see a dermatologist so that you can be carefully assessed. Once you have a diagnosis then there maybe a number of things you can do to reduce your reactions.
- Can I use Anthelios Ultra if I am diabetic Type 1?
Yes, you can.
- What can I do to remove pigmentation?
There are a several causes for facial pigmentation such as hormone related melasma (often appearing when taking the contraceptive pill or during pregnancy) or pigmentation caused by chronic sun exposure or following inflammation in the skin. Pigmentation is a very difficult problem that will not disappear overnight, its treatment needs persistence and patience. There a number of effective over-the-counter products available for pigmentation - skin lightening serums and pigment correcting creams can be included in your daily routine. However, these should always be used in conjunction with with a broad-spectrum sun protection product of SPF 50. A single day of excess sun can undo months of treatment. If skincare is not enough, then your dermatologist could consider stronger prescription creams, specialist peels or laser treatment for pigmentation.
- What's the shelf life for sun cream?
Most sun creams have a shelf life of about 12 months. Over time the texture of the cream/lotion can change and the efficiency of the UVR filters can decrease making the sunscreen less effective. It’s worth buying a new bottle each spring/summer.
SKIN AGEING QUESTIONS:
- How do I prevent lines and looking old?
Sunscreens are designed to protect the skin from the damaging effects of ultraviolet radiation (UVR). They are important for skin health and are the ‘best anti-ageing product you’ll use’. I encourage my patients to wear a high SPF and broad UVR spectrum sunscreen every morning, regardless of how bright and sunny it appears outside. It is important to remember that UVA, the main cause of skin aging, is present all year round, even on dull days. In addition to the prevention of damage during the day, the evenings are an opportunity to repair any damage using creams containing vitamin A derivatives such as retinal and retinol which should be cautiously applied after washing the skin with a suitable cleanser.
- Which product best suits mature sensitive skin?
Mature skin requires a daily skin care routine with active antiaging ingredients. After cleansing the skin in the morning, a high-grade antioxidant product should be applied to the face, neck, chest and hands. The next crucial step in a broad-spectrum sunscreen moisturiser of SPF 30-50. Once this has soaked in, foundation/make up can be worn on top. In the evenings, after a thorough cleanse, an effective damage-repair formula containing vitamin A derivatives such as retinal and retinol can be applied to the face, neck, chest and hands. There are now many over-the-counter products containing these ingredients. They support collagen production, reduce sun damage, lighten pigmentation and soften lines and wrinkles. However, they can irritate, so should be introduced gradually and only used as tolerated. It’s important to tailor the daily routine to the individual’s skin type and those with sensitive skin must avoid fragrances and other irritants.
- How to stop acne?
If you suffer with breakouts, I would suggest that you see a dermatologist for prescription creams or tables. Although ‘spots’ are very common in teenagers, don’t be tempted to ignore them, thinking they’re a normal part of growing up. Even mild acne can have a significant effect on one’s psychological well-being. Acne is a medical problem with effective treatments. In most cases the prescription creams will be enough to clear your skin, however for more severe cases there are also highly effective tablets. If you suffer with occasional and mild breakouts, a lot can be achieved with the correct daily routine alone, avoiding rich, heavy creams and facial oils, and using light ‘non comedogenic’ lotions. Products which exfoliate the skin (containing ingredients such as salicylic acid) as well as reducing sebum secretion (such as zinc) can also be considered. A light ‘non comedogenic’ high factor and broad-spectrum sunscreen is necessary to prevention pigmentation following breakouts.
- I'm on roaccutane so need to know the best product to use please?
Whilst on roaccutane you should use soothing non-fragranced moisturizing products. Please avoid any active ingredients in creams such as salicylic acid or retinols. You must also use an SPF50 non comedogenic sunscreen, as roaccutane makes you more sun sensitive and more likely to sunburn.
- How can I reduce dryness whilst on medication for acne?
Medication for acne can often leave the skin feeling dry and sensitive. A soothing ‘non comedogenic’ moisturizer, with minimal ingredients and no fragrance, can compensate these side effects. You must also ensure that your cleanser and moisturizer do not contain any active ingredients such as salicylic acid or retinols as they will exacerbate these side effects.
DRY SKIN / ECZEMA / PSORIASIS QUESTIONS:
- What are the best treatments for psoriasis on elbows?
Psoriasis is a common chronic skin condition, which often affects the elbows, knees and scalp. Although it is a genetic condition that can’t be cured, there are various prescription creams, tablets, and more recently injections available to control it. Regular application of a greasy moisturiser to the affected areas such as the elbows is important. This softens the skin and allows any prescription creams to penetrate deeper and be more effective. Calcipotriene is a form of synthetic vitamin D3 that slows skin cell growth and flatten the lesions of psoriasis. This can be combined with a steroid cream to reduce inflammation and itch. If the psoriasis is very thick on the elbows there are also prescription combination ointments containing salicylic acid and steroids which are also very effective. Alternatively, if the psoriasis is more widespread, then second line treatment such as phototherapy or immunosuppressive tablets can also be considered.
- What products are good for dry skin?
It’s important to moisturise body skin daily to maintain good hydration. There are many moisturisers out there and the choice is very much dependent on the preferences of the individual. The best time to apply a body lotion is immediately after showering, when the skin is still slightly damp, to avoid further moisture loss. Exfoliating your skin once per week in the shower prevents flaky skin build-up and helps your moisturiser penetrate deeper into the skin. Don’t forget to moisturise well after a body scrub.
- How can I combat eczema?
The tendency for eczema is genetic and often runs in family. It may be associated with other ‘atopic’ tendencies such as hay fever and asthma. Here are my top tips:
- Moisturize – eczema is caused by problems with the barrier function of the skin and by moisturizing regularly the barrier can be improved, reducing the number of times the skin flares.
- Avoid irritants – irritants such as fragrances (often found in natural products) should be avoided as they can result in a flare of eczema.
- Treat infections – skin affected by eczema can commonly become secondarily infected and this should be treated with antibiotics if confirmed. Bacterial infections of the skin can often drive eczema and make things worse
- Don’t scratch – eczema is very itchy, however scratching the skin can make things worse. Taping the skin instead can give some relief without out damaging the skin.
- Put the fire out - if the eczema has flared then steroids (or steroid-like) ointments should be applied 30 minutes after moisturizing in the evenings to calm things down. At this stage moisturizing alone will not ‘put the fire out’.
- I have eczema around the eye area - what can I do to help?
The skin around the eyes is a common site for eczema. Occasionally this is related to allergic reactions to cosmetic products and allergy testing may be needed, but more often than not, genetic atopic eczema can occur at this site. I would suggest using a fragrance-free moisturizer every day and avoiding any irritants. If severe, then your dermatologist may suggest the use of a very weak steroid cream for a few days to reduce the inflammation. Avoid rubbing the area as this often makes things worse.
- I have dehydrated skin around the eye area - what can I do to help?
It depends on what you mean by dehydrated. Assuming you mean dry and dull – then using an eye cream once or twice a day, carefully massaged into the lower eyelid skin, can significantly improve things. There are many ‘multifunctional’ eye creams available on the market, not only to help moisturize the skin but also promote collagen production, reduce pigmentation, reduce under-eye puffiness, in addition to antioxidant effects. Also, don’t forget to apply your daily sunscreen right up to the lower eye lid margin to reduce the risk of aging caused by UVR exposure.
- What products do you recommend for rosacea?
Rosacea is a common skin problem, more often seen in fairer skin types. It presents with easy flushing, ‘spotty’ breakouts, and redness or broken blood vessels on the face. There are lots of effective creams and tablets that can be prescribed by your dermatologist to keep rosacea under control. You must also try and avoid aggravating factors such as sun, spicy food, alcohol and coffee. In addition, it is very important not to aggravate rosacea with unsuitable skincare. Try to avoid rich, heavy creams and facial oils, and use light lotions with anti-inflammatory ingredients instead. Stay away from any potentially irritating products such as alcohol-based solutions. Moreover, don’t forget to use broad-spectrum, high SPF sun protection in a light, non-oily base every day, as UVR from the sun is a well know trigger in rosacea.