Squamous Cell Carcinoma Treatments

Most squamous cell carcinomas may be treated by one of the following methods. More healthy tissue around the lesion is removed than for basal cell carcinomas because of the potential of squamous cell carcinomas to spread. Nearby lymph nodes are also examined carefully. The choice of treatment is influenced by:

* size, location, grade, and type of tumour
* whether the tumour is primary or is recurring
* person’s age and health
* people with organ transplants are at a high risk of aggressive squamous cell carcinoma, which is considered in their treatment plan
* availability of the treatment

Surgery (Wide Excision)

# used for:
- most small lesions that are less than 2 cm
- superficial or SCC that has not spread
- verrucous carcinomas (slow growing and less aggressive)
- tumours that have previously been treated with radiation therapy
- lesions on the eyelid, forehead, scalp, lip, penis, vulva and anus

Mohs Micrographic Surgery

* used for all types of squamous cell cancer
* commonly used for:
- areas that are at high risk of recurrence (eyelids, nose, ears, forehead, scalp), as well as areas that have - already recurred
- areas where it is important to keep function and appearance
- lesions that are larger than 2 cm, and lesions with poorly defined borders
- aggressive tumours, and invasive lesions that have spread to nerves, cartilage or bone
- tumours that have been left untreated for a long time
- lesions that had not been completely removed with prior surgery it involves a meticulous study of tissues removed by a  pathologist at the time of surgery

Radiation Therapy

* used after surgery for:
- elderly individuals
- ensuring cancer free margins
- treatment of involved lymph nodes
- squamous cell carcinoma that has recurred after surgery
- to relieve or control the symptoms of very large tumours
- for people who are unwilling or unable to undergo surgery
- tumours on the eyelid, cheek, earlobe and nose not used for verrucous carcinomas (slow growing and less aggressive)

Chemotherapy

* systemic chemotherapy is used for squamous cell cancer that has spread to other parts of the body
* drugs used most often in chemotherapy:
- cisplatin
- doxorubicin
- bleomycin

Curettage And Electrodesiccation (C & E)

used for
- small areas that are less than 2 cm
- lesions that haven’t spread
- squamous cell carcinoma with distinct margins in Actinic Keratosis should not be used for:

- larger lesions that are greater than 2 cm
- recurrent tumours
- aggressive squamous cell carcinoma
- lesions with poorly defined borders
- hairy areas like the underarms, scalp, and the pubic area
- areas where it is important to keep function and appearance uncommonly used

Management and Treatment of Pruritus

Pruritus, or itch, is a common sensation that causes a person to want to scratch. It is a complex process that may negatively impact quality of life and commonly occurs with skin disorders such as atopic dermatitis and urticaria. It could also be a symptom related to an underlying disease process such as cholestasis or hyperthyroidism, or simply be caused by dry skin, especially in the cold, winter months. Therapy is often aimed at eliminating the underlying cause first, followed by the management of the itchy sensation. Treatment may include prescription and over-the-counter (OTC) medications, herbal remedies, hydrotherapy, phototherapy, and ultraviolet therapy. This overview provides information regarding the various management and treatment options for pruritus.

Pathophysiology of Pruritus

Pruritus is a complex process that involves the stimulation of free nerve endings found superficially in the skin. The sensation of pruritus is transmitted through the C-fibers in the skin to the dorsal horn of the spinal cord, and then, via the spinothalamic tract to the cerebral cortex for processing. Many chemicals have been found to be pruritogenic, therefore causing the itch sensation, including histamine, serotonin, cytokines, and opioids. There are six categories of pruritus: dermatologic, systemic, neurogenic, psychogenic, mixed, and other. Various treatment and management options exist depending on the category or cause.¹

Treatment

Treatment of pruritus can be categorized in several ways. A common method of grouping the various options is causative vs. symptomatic treatment. Causative treatment involves finding the underlying disorder and then correcting it, thereby eliminating the itch sensation. Symptomatic treatment involves substituting another sensation for the itch, using methods such as cooling, heating, or counter irritation (e.g., scratching). Symptomatic treatment can be used in addition to treating the underlying disease process in order to provide earlier relief. Most of the available treatment options are categorized under symptomatic therapy and management.

Prescription Medications

Prescription medications include topical and systemic antihistamines, corticosteroids, local anesthetics, and topical immunomodulators, among others. Some lower concentration preparations of these medications are available OTC.

Antihistamines

Itching occurs when histamine is released, causing redness, swelling, warmth, and consequently itchiness. Antihistamines, or H1 antagonists, act by blocking the histamines, and are the most widely used medications for this condition. They take approximately 15–30 minutes to be effective and can be short- or long-acting.²

Topical antihistamines are available in prescription as well as nonprescription forms. Camphor (Caladryl^®, Pfizer) is a common diphenhydramine preparation that has both antipruritic and anesthetic properties. This traditional therapy carries with it a small risk of contact dermatitis and allergic sensitization.³

Corticosteroids

Local Anesthetics

Calcineurin Inhibitors

Cholestyramine

Rifampicin

Naltrexone

Ultraviolet (UV) Light Therapy

UV phototherapy is used to treat various pruritic conditions including chronic renal failure; AD; HIV; aquagenic pruritus; solar, chronic, and idiopathic urticaria; urticaria pigmentosa; polycythemia vera; pruritic folliculitis of pregnancy; breast carcinoma skin infiltration; Hodgkin’s lymphoma; chronic liver disease; and acquired perforating dermatoses, among others. It is often undertaken after multiple attempts to treat stubborn itch, and can offer relief without many of the side-effects and risks of systemic medications. UV-based therapy utilizes UVB and UVA in both broadband and narrowband, as well as PUVA (psoralen UVA). Cost and side-effects can be a prohibitive factor for patients. Erythema is common in UVB, as is premature aging and photocarcinogenesis with both UVA and UVB. Side-effects associated with PUVA include redness, burning, headache, and nausea.^16,19

UVA, UVB, and PUVA light therapies have been especially useful in the treatment of pruritus in HIV patients, as well as in those patients with systemic mastocytosis and cutaneous T-cell lymphoma. It localizes the effect on the superficial nerve endings, sparing the remaining helper cells, and relieving the pruritus. Because of its more superficial penetration, UVB is believed to be safer than UVA. UVB also spares the remaining helper cells in HIV patients and may localize the effect on the superficial nerve endings, thus relieving pruritus. Systemic mastocytosis and cutaneous T-cell lymphoma also respond to UV therapy and because destruction of the proliferating CD4 clone is desirable, UVA is usually the preferred modality over UVB, although Millikan suggests that the relief of pruritus is more predictable with UVB than with UVA.3

Cutaneous Field Stimulation (CFS)

CFS, which electrically stimulates thin afferent fibers, including nocireceptive C-fibers, was reported to inhibit histamine-induced itching. The reduction in itching is accompanied by degeneration of the epidermal nerve fibers. In one open trial, localized itching responded to CFS treatment, and pruritus was reduced by 49% at the end of 5 weeks. Itch relapsed gradually after the discontinuation of CFS, which led the researchers to conclude that nerve fibers regenerated into the epidermis.20

Over-the-Counter Treatments

In addition to the nonprescription medications mentioned above, there are other OTC treatments that can be helpful for treating and managing pruritus. Moisturizing after a bath is extremely important, and emollients such as white petrolatum, or petrolatum depositing moisturizing body washes, and in-shower moisturizers (e.g., Olay^® Ribbons^®, Procter & Gamble; emulsifying ointment USP) can be helpful when applied while the skin is still wet.²¹

There is new evidence to show that moisturizers containing niacinamide and glycerin (e.g., Olay^® Quench^®, Procter & Gamble) not only hydrate the skin, but improve the skin’s resistance to external factors and improve the barrier function. Glycerin is required for moisturizers to work quickly and add moisture to the skin, but the niacinamide helps to sustain that benefit over a longer period of time.²¹

Alternative Therapies

Several alternatives to traditional treatment of pruritus have been proposed. Often these therapies can be used in conjunction with prescribed or OTC medications to relieve symptoms quickly. Compounds that have been found to be effective for pruritus by depressing cutaneous sensory receptors include menthol, camphor, and phenol.⁷ Some other alternative therapies that have been suggested include herbal remedies, nutritional therapy, reflex therapy, and hydrotherapy.³

Herbal Remedies

Several herbs have been proposed as corticosteroid-sparing agents and may provide a viable alternative to topical steroids and their side-effects. Oatmeal baths appear to be most useful because of its colloidal protein and high mucilaginous content. Other herbs have been suggested because of their high mucilage content as well, including flax, fenugreek, English plantain, hearts ease, marshmallow, mulberry, mullein, and slippery elm.3 More extensive research needs to be conducted regarding their possible use and effectiveness for the treatment of pruritus.

Tannins, also derived from herbs, may be helpful as well. The exact mechanism of action is unclear, but may perhaps be related to the coagulation of proteins in the skin. The most common tannin-containing herb is witch hazel, but others include oak bar, English walnut leaf, goldenrod, Labrador tea, lady’s mantel, lavender, and St. John’s wort.

Other possible herbs that may be advantageous include chamomile, which has shown to be equivalent to low concentrations of hydrocortisone, aloe vera, and capsaicin.3 Some side-effects may include irritant or allergic contact dermatitis. Some herbals can be toxic if ingested as well. Some of the oldest group of medications used to soothe and cool pruritic skin is menthol and camphor, which are both considered low risk and safe to use topically. ^3,4

Nutritional Therapy

Nutritional therapy, despite not being sufficiently researched as a monotherapy for pruritus, may be helpful in combination with other anti-itch treatments. Vitamins D and E, and linolenic acid have shown some efficacy in the treatment of psoriasis and atopic eczema.³

Reflex Therapy, Acupuncture, and Hydrotherapy

While they are not traditionally used, reflex therapy, acupuncture, and hydrotherapy are three treatments that may be beneficial as adjunctive therapy, however further research is needed. There is little research available regarding the effectiveness of reflex therapy and hydrotherapy. These options may be considered in difficult-to-treat patients where traditional approaches have been unsuccessful. Acupuncture is based on the gate theory of neurotransmission, however it is infrequently used in the Western world, and therefore has insufficient evidence to fully support its use. ³

Management

The management of symptoms is paramount in the treatment of pruritus. Patients should be educated regarding the self-care aspects of this condition. Eliminating the use of irritating or tight clothing is recommended, as well as maintaining a cool environment. Patients should avoid the frequent use of soap, topical irritants in clothing, dry environments, and vasodilators such as caffeine, alcohol, and hot water. Patients should be advised to take brief, tepid or lukewarm baths using mild cleansers with a low pH. Soap film should be rinsed off completely and skin should be patted lightly, followed by the generous application of a moisturizing lotion or cream.^4,7,22

Conclusion

Pruritus is a common complaint, but one that can often be a challenge to treat. It can be a major quality of life issue for patients, so it is important that both the underlying disease and associated symptoms are treated as quickly and effectively as possible. Health teaching regarding the prevention and management of pruritus should be included in the overall treatment of the cause and symptoms.

P. Lovell, RN, BScN1; R. B. Vender, MD, FRCPC²
1. Michael DeGroote School of Medicine McMaster University
2. Dermatrials Research, Hamilton, ON, Canada

Identifying Skin Lesions - Warts, Moles and SebKs

By Van Le |  While freckles can add to a person’s beauty and uniqueness, other skin lesions such as large moles, skin tags, warts, and seborrheic keratoses can be unsightly and embarrassing. Most lesions are malignant (non-cancerous), however, it is important to be aware of and track any skin abnormalities on your body as a preventative measure.

Freckles

Freckles are irritating for some and embraced by others. They are pigment cells that retain within the skin to form light brown spots, and individuals with lighter complexions are more susceptible to freckles since their skin contains less melanin. Freckles, also known as ephelides, can appear on the face, arms and other sun-exposed areas. Excessive and continued exposure to harmful UV rays can cause more freckles and cause them to appear darker. While they are harmless, it is important to distinguish between freckles and symptoms of melanoma, a type of skin cancer that can grow from an existing freckle. Consult your doctor if you notice any change in freckle size, shape and color.

Skin tags

Skin tags are pieces of skin that hang from the surface of a surrounding area. Like freckles, they are benign, but can cause irritation if located on an area that is exposed to constant contact, such as the eyelids or areas where they can be snagged by jewelry or clothing. Skin tags can vary from a small pin-point size to a large grape size. While some can fall off on their own, there are several ways to medically remove skin tags, including freezing and burning. There are home remedies as well as creams available on the market to remove unwanted and embarrassing skin tags.

Seborrheic keratoses

Seborrheic keratoses, another benign skin lesion, can form anywhere on the body, but is commonly found on the chest and back. They can be distinguished from other types of lesions due to their waxy, stuck-on-the-skin appearance and often described as brown candle wax stuck on the skin. While the cause is still unknown, scientists have found that they can be hereditary and not affected by sun exposure.

Warts

Most warts are skin infections caused by viruses of the human papillomavirus (HPV) family. Basically, warts are benign tumors of the epidermis (outer layer of skin), and can occur in people of all ages, but are most commonly found on children and teenagers. There are different types, including flat and plantar warts. Flat warts are small in size but can be high in quantity, can spread to other areas of the body by shaving or scratching, and can be transferred person-to-person by physical contact. Plantar warts grow on the heel, ball or sole of the foot, and pressure from standing or walking pushes them into the deeper layers of skin.

Skin lesions like warts, seborrheic keratoses and skin tags are often harmless, but they can be embarrassing. While they can be surgically removed, there are creams and ointments available on the market to remove and reduce their appearance. If you have further questions about a particular skin lesion, consult your doctor or pharmacist for proper diagnosis and treatment.

Van Le is a staff writer for the CSU Daily Titan and writing intern for Vivoderm Laboratories in Los Angeles, California. She is currently pursuing a Journalism degree at California State University, Fullerton.

For the latest findings on skin lesions and treatments, you can also link to http://www.dermatosispapulosanigra.net

Seborrheic Keratosis or Seborrheic Verrucas

A seborrheic keratosis (also known as “Seborrheic verruca,” “Senile keratosis,” and “Senile wart” [1,2]  is a noncancerous benign skin growth that originates in keratinocytes. Like liver spots, seborrheic keratoses are seen more often as people age.[3] In fact they are sometimes humorously referred to as the “barnacles of old age”. [1]

They appear in various colors, from light tan to black. They are round or oval, feel flat or slightly elevated (like the scab from a healing wound), and range in size from very small to more than 2.5 centimetres (1.0 in) across.[4] They can resemble warts[3], though they have no viral origins. They can also resemble melanoma skin cancer, though they are unrelated to melanoma as well.

Because only the top layers of the epidermis are involved, seborrheic keratoses are often described as having a “pasted on” appearance. Some dermatologists refer to seborrheic keratoses as “seborrheic warts”, however these lesions are usually not associated with HPV, and therefore such nomenclature should be discouraged.

* 1 Classification
* 2 Variances of Seborrheic Keratosis
o 2.1 Dermatosis Papulosis Nigra
o 2.2 Stucco Keratosis
* 3 Diagnosis
* 4 Treatment
* 5 Cause
* 6 Etymology
* 7 References
* 8 External links

Classification

Seborrheic keratoses may be divided into the following types:[1]

* Common seborrheic keratosis (Basal cell papilloma, Solid seborrheic keratosis)
* Reticulated seborrheic keratosis (Adenoid seborrheic keratosis)
* Stucco keratosis (Digitate seborrheic keratosis, Hyperkeratotic seborrheic keratosis, Serrated seborrheic keratosis, Verrucous seborrheic keratosis)
* Clonal seborrheic keratosis
* Irritated seborrheic keratosis (Basosquamous cell acanthoma, Inflamed seborrheic keratosis)
* Seborrheic keratosis with squamous atypia
* Melanoacanthoma (Pigmented seborrheic keratosis)
* Dermatosis papulosa nigra

Also see:

* The sign of Leser-Trélat
Variances of Seborrheic Keratosis or Dermatosis Papulosis Nigra

Often are small papules. Pinpoint to a few millimeters in size. More commonly found in dark-skinned persons.[5]

Stucco Keratosis

Often are light brown to off-white. Pinpoint to a few millimeters in size. Often found on the distal tibia, ankle, and foot.[6]

Diagnosis

Visual diagnosis is made by the “stuck on” appearance, horny pearls or cysts embedded in the structure. Darkly pigmented lesions can be hard to distinguish from nodular melanomas. [7] If in doubt, a skin biopsy should be performed. Thin seborrheic keratoses on facial skin can be very difficult to differentiate from lentigo maligna even with dermatoscopy. Clinically, epidermal nevi are similar to seborrheic keratoses in appearance. Epidermal nevi are usually present at or near birth. Condylomas and warts can clinically resemble seborrheic keratoses, and dermatoscopy can be helpful. On the penis and genital skin, differentiation between condylomas and seborrheic keratoses can be difficult and may require a skin biopsy.

Treatment

When correctly diagnosed, no treatment is necessary[3]. There is a small risk of localized infection caused by picking at the lesion. If a growth becomes excessively itchy or is irritated by clothing or jewelry, it can be removed by cryosurgery.  Small lesions can be treated with light electrocautery. Larger lesions can be treated with electrodessication and curettage, shave excision, or cryotherapy. When correctly performed, removal of seborrheic keratoses will not cause much visible scarring except in darkly colored persons.

Cause

The cause of seborrheic keratosis is unclear[3]. Because they are common on sun-exposed areas such as the back, arms, face, and neck, ultraviolet light may play a role, as may genetics.[8] A mutation of a gene coding for a growth factor receptor, (FGFR3), has been associated with seborrheic keratosis.[9]

Etymology
The term “seborrheic keratosis” combines the adjective form of seborrhea[10], keratinocyte (referring to the part of the epidermis that produces keratin), and the suffix -osis, meaning abnormal.[11]

References

1. ^ a b Freedberg, et. al. (2003). Fitzpatrick’s Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0071380760.
2. ^ James, William D.; Berger, Timothy G.; et al. (2006). Andrews’ Diseases of the Skin: clinical Dermatology. Saunders Elsevier. ISBN 0-7216-2921

-0.
3. ^ a b c d Moles, Freckles, Skin Tags, Benign Lentigines, and Seborrheic Keratoses from the Cleveland Clinic website
4. ^ Seborrheic keratosis: Symptoms, from the Mayo Clinic website
5. ^ http://www.emedicine.com/derm/topic99.htm
6. ^ http://www.emedicine.com/derm/TOPIC407.HTM
7. ^ http://www.dermadoctor.com/article_Seborrheic-Keratoses_91.html
8. ^ Seborrheic keratosis: Causes, from the Mayo Clinic website
9. ^ Hafner C, Hartmann A, Vogt T (2007). “FGFR3 mutations in epidermal nevi and seborrheic keratoses: lessons from urothelium and skin”. J.

Invest. Dermatol. 127 (7): 1572–3. doi:10.1038/sj.jid.5700772. PMID 17568799.
10. ^ Seborrheic, from Merriam-Webster’s online medical dictionary
11. ^ Suffix “-osis” from the Merriam-Webster website

Skin Rashes - Where Do They Come From?

A skin rash shows up as an area of inflammation or change in the texture, and/ or color of your skin. It can be caused by a number of different things including irritation, disease, or allergic/ non-allergic reactions to foods, chemicals, plants, animals, insects or other environmental factors.

So many rashes appear because the skin is an active player in the immune system. Antigens are things like viruses or proteins that we react to. These antigens need to be presented to our immune system in a very controlled way; otherwise we would react to too many things. The skin is the site at which antigen presenting cells introduce the antigens to lymphocytes. These lymphocytes are in a sense the paratroopers of our body. A complicated process of making sure that we are not overreacting takes place. All of this occurs in the skin once these lymphocytes have been activated they produce many chemicals that cause inflammation. When we become allergic to an antibiotic or other drug, the action takes place mainly in the skin as well as in the lymph glands. Viral infections also frequently produce rashes as viral particles are presented to our immune system in the epidermis. In a sense the skin is like the schoolyard which is where many of the fights occur.

Rashes can appear on your entire body or be limited to a specific area, and what it looks like and how it feels can vary depending on the cause and type of rash. Some common types of rashes include:

* eczema (also called atopic dermatitis), which is commonly seen in children. It can cause dry, chapped, bumpy areas around your elbows and knees, and can be very itchy. It can sometimes become very serious causing red, scaly and swollen skin all over your body. (Visit Eczema Guide.ca for more information)
* irritant contact dermatitis, which is caused by your skin coming into contact with something that irritates it, such as a chemical, soap or detergent. This type of rash can be red, swollen and itchy.
* allergic contact dermatitis is caused by your skin coming into contact with something you’re allergic to, such as rubber, hair dye or nickel (which is a metal that is found in some jewelry). A nickel allergy can show up as a red, scaly, crusty rash wherever the jewelry touched your skin. Urushiol, which is an oil or resin that’s found in poison ivy, oak and sumac, can also cause this kind of rash.

If you develop a rash, don’t scratch it! If you do, the rash can take longer to heal and you might develop an infection or scar. There are a wide range of over-the-counter products available to treat rashes, but it’s important to see your doctor first and determine what’s causing the rash and the most effective treatment.

* If the rash is caused by an allergy, then treatment will focus on identifying and avoiding the allergen.
* It it’s caused by eczema, your doctor may suggest special moisturizers (emollients) to help retain the water in your skin; not only will this help to keep your skin soft and smooth, it will help reduce the itching. Short, cool showers are also a good idea because hot showers and baths can dry out your skin more. Also use a mild soap (read more on Mild Cleanser.ca ) and be sure to apply more emollients after you’ve showered.
* For poison ivy, cool showers and calamine lotion often help and if the rash is severe, your doctor may prescribe an antihistamine to reduce the itching and redness.

It’s important to try to find out what’s causing the rash because the best way to prevent it is to avoid the problem food, substance, medicine or insect. If a poison plant is your problem, learn what it looks like and avoid it. It may also help to wear long sleeves and pants when you go camping or hiking. If insect bites are causing your rash, then consider applying insect repellant before going outside. For eczema, stay away from harsh soaps that may dry out your skin, and make an effort to moisturize with creams or lotions.

By SkinCareGuide.ca

Oil Production in the skin

The skin has many oil (sebaceous) glands, which secrete oil that contains wax esters, triglycerides, and squalene - a hydrocarbon that is an intermediate in the formation of cholesterol. These fats (or lipids) form a film that helps keep moisture in the skin. While increased sebum production results in oily skin, the opposite is not always the case, as dry skin can also arise from an impaired skin barrier. Oil production can be affected by diet, stress, and hormones-as well as genetics. In a study of twenty pairs each of identical and nonidentical same-sex twins, identical twins had virtually identical amounts of oil production, while the nonidentical twins had significantly different amounts.

No amount of blotting and scrubbing will “remove” the skin’s oil production, and many of us unknowingly destroy the natural beauty of the skin in pursuit of clarity. The skin’s own sebum mechanism is there to regulate own moisture. Drying your skin profusely with oil-stripping, foaming cleansers, detergents and de-greasers like soap and sulfates, or alcohol-based toners that leave the skin feeling tight (always a sign it’s been stripped), will only cause the skin to “rebound” with excess oiliness and destroy its protective and anti-bacterial “matrix,” leaving it sensitized. By stripping the natural acid mantle of the skin, these deep cleaning products actually make skin more vulnerable to bacteria and inflammation. Dabbing benzoyl peroxide often destroys the beauty of the skin by causing flaking, while more aggressive treatments, such as antibiotics or Accutane can cause a cascade of side-effects.

How Facial Masks Work

A mask for your face should be applied once or twice weekly. You don’t want to use them too frequently as they can upset the balance of your skin. The way that most facial masks work is that you put them on your face and wait for a specified period of time until you feel it dry and your skins starts feeling a little tight. Don’t worry, this is a normal part of the process and it is not harming your face. After this you usually will give it another few minutes and then rinse your skin. Some people choose to use water by itself and others like to remove the mask with a wash cloth, it’s entirely up to you. Afterwards you should dry your face totally and moisturize it because masks remove some moisture from your skin.

There are also full body masks available that can treat all of your skin at the same time. These work in exactly the same way as the ones for your face and they can help renew the look of your skin all over. It is not possible to do this properly at home so you will have to have one of these applied by a professional. Thankfully, there are many full service salons that offer this service and it is a real treat to have done. When you schedule yourself for one of these be sure to drink lots of water before and after to help remove toxins, help replace lost moisture, and re-hydrate you body. Water is crucial because just as with a facial mask these also remove moisture but on a much larger scale.

Educating yourself about different types of lotions and masks will help you keep your skin clear and give you the healthy glow you want. Water is a beauty secret that many women overlook. The key to beautiful clear skin is adequate hydration and water is crucial in this process as it not only helps your skin hydrate itself but also helps to remove toxins. Utilize what you have learned here and you will have beautiful and radiant skin that others will envy.

The Mediterranean Diet

We all know how important diet is to building healthy, beautiful skin. But did you know eating the right foods and avoiding the wrong ones can actually help prevent wrinkles and minimize the signs of aging?
According to a recent article in the UK’s Daily Telegraph, “Eating a Mediterranean diet can halve the risk of the most dangerous form of skin cancer, research suggests.” The recent study may eventually prove regular intake of fruit, vegetables, nuts and fish may protect against malignant melanoma.

The” Mediterranean diet,” which features plenty of vegetables, legumes, and olive oils, may be a catalyst for the body to absorb and benefit from fat-soluble antioxidant vitamins and phytochemicals, such as vitamin E, lycopene, and isoflavones. In this light, organic produce has been shown to contain a higher level of beneficial antioxidants than conventionally raised fruits and vegetables.

So, what does all this mean if you suffer from dry skin or sensitive skin? With dry skin issues, it is important to get the right types fats into your diet. But what are the right types of fats? For example, increased intake of saturated fat and monounsaturated fat in the diet has been associated with a decrease skin hydration. So consuming some saturated fats but not too many, seems to be best.
Countless studies show that an omega-3 fat deficiency is associated with dry skin and skin problems like eczema. That’s why it is important to consume adequate amounts of these essential fats, found in fatty fish, fish oils, flaxseeds, flaxseed oil, etc.

Be aware of the difference from the omega-6 polyunsaturated vegetable oils (including corn, canola, and safflower), formerly hailed as healing for the heart. Meaning, most need to eat more omega-3s and less omega-6 oils.
The dairy products you eat (and avoid) can also make a difference in skin aging. Butter, full-fat milk, margarine, and sweets should be minimal, while yogurt, cheese, and reduced-fat milk are neutral in their aging effects.

The epidermis (upper layer of the skin) is composed of 25 percent monounsaturated fatty acids. In the cell membranes, both monosaturated fats and saturated fats resist oxidation, a key process in cellular aging. Omega-6 polyunsaturated oils, on the other hand, contribute to the production of free radicals, the by-products of oxidation - also the cause of the skin aging process. This would increase both wrinkling and the risk of developing skin and other cancers, including melanoma. Polyphenols, found in fresh fruits, vegetable and herbs can protect the body’s cells against the damaging effects of oxidative stress, a process by which oxygen-rich molecules can attack and destroy cells in much the same way as rust rots a car.
Therefore, it is beneficial to eat more olive oil (a monounsaturated) while avoiding omega-6 polyunsaturated oils, such as corn, canola, safflower and others. Included in this list of foods to avoid, are the trans fats, present in margarine, most baked goods, fried, processed foods, and sweets, which are oxidized polyunsaturates, making them even more detrimental. In certain studies they have been shown to block healthy Omega -3 fats. High trans-fats content may interfere with the hormonal pathways needed for healthy fat metabolism and preventing inflammation.

Consuming the omega-3s and avoiding unhealthy oils that block them will help the body absorb the vital lipids needed in the skin cells and improve the hormonal actions. Since skin aging is caused by hormonal shifts that occur naturally in the aging process, it’s best to eliminate the polyunsaturated and trans fats as much as possible.

Fish oils and fish are the purest sources of omega-3 fatty acids,which can increase the lipid content of your cells. These fats have been shown to improve psoriasis and other severe dry skin conditions. If you are pregnant or nursing, please be aware of the mercury content in your fish - which has been shown to cause detrimental effects to mothers, and young children, so supplements may be the best way of obtaining these fats vital to skin health.

Dry, sensitive, and wrinkled skin can also be helped with a diet rich in antioxidants obtained from fresh fruits and vegetables, such as spinach, kale, collard greens, turnips, romaine lettuce, broccoli, leeks, corn, peppers, peas, and mustard greens. Egg yolks and oranges contain the antioxidant lutein. Lutein is an important natural antioxidant that may help your eyes stay healthy while maintaining the health of your skin.
So, to recap your skin-healthy diet should include:
•    Fats from whole foods-nuts, seeds, olives, and avocados
•    A wide variety of whole plant foods
•    Monounsaturated fats, such as olive or nut oils
•    Good sources of omega3 oils (never heated) or in capsule form
•    Moderate use of omega-6 oils (corn, safflower, canola and soy oils)
•    Limited amounts of processed foods and deep-fried foods
•    Pure sources of omega3 fats, including a source of essential fatty acids (EFA)

Chemical Peels and Aging

Chemical peeling is emerging as one of the most effective ways to combat skin aging. Chemical peels are one of the most frequently performed aesthetic procedures in North America. Its popularity continues to grow because of the versatility of conditions where chemical peels are of significant benefit. In addition to the topical preparations such as over-the-counter and prescription creams, chemical peels are one of the earliest forms of treatment adopted by many patients. At the same time, there is much confusion and misunderstanding surrounding chemical peels that prevents more of us from enjoying their undeniable benefits. Let’s go through the important facts about chemical peels and their uses in modern skin care regimens.

Categories of Chemical Peels:

1. Superficial chemical peels:

Broadly speaking, chemical peels can be divided into several categories based on the depth of penetration in the skin. Superficial chemical peels create an injury to the epidermis - the outermost layer of the skin. As such, they are recommended for the treatment of skin conditions that primarily affect the epidermis. Conditions such as acne, actinic keratosis, superficial (epidermal) melasma, mottled skin pigmentation, superficial wrinkling as well as mild photo-damage can greatly benefit from properly selected and applied superficial chemical peels.

* AHAs

Some of the most common examples of superficial chemical peels include a variety of alpha-hydroxy acids
(AHA,) salicylic acid as well as low concentration trichloroacetic acid (10% - 25%.) The most commonly used superficial chemical peels are members of AHA. Alpha-hydroxy acids is a group of compounds derived from food products including glycolic (from sugar cane,) lactic (from sour milk,) malic (from apples,) citric (from fruits) and tartaric acid (from grape wine.) Glycolic acid (GA) is a clear winner amongst the AHA as its small molecular weight allows it to penetrate into the skin and exert its influence on living and non-living (outermost layer) cells. These properties account for the popularity of this product in both cosmetic as well as medical preparations.

In low concentrations, 5 - 10%, GA reduces cell adhesion in the top layer of the skin. This action promotes exfoliation of the outermost layer of the skin accounting for smother texture following regular use of topical GA. This relatively low concentration of GA lends itself to daily personal use as a monotherapy or a part of a broader skin care management for such conditions as acne, photodamage, wrinkling as well as selected cases of melasma.

In higher concentrations, between 10 and 50%, the benefits of GA are more pronounced but are limited to temporary skin smoothing without much long lasting results. This is still a useful concentration to use as it can prepare the skin for more efficacious GA concentrations (50 - 70%) as well as prime the skin for deeper chemical peels such as higher concentration trichloroacetic acid.

At higher concentrations, 50 - 70% applied for 3 to 8 minutes under the supervision of a physician, GA promotes separation between the cells and can be used to treat acne, photodamage (such as mottled dyspigmentation, superficial melasma or fine wrinkles) as well as superficial scars. The benefits from such short contact application depend on the pH of the solution (the more acidic the product [lower pH,] the more pronounced the results,) the concentration of GA (higher concentrations produce more vigorous response,) the length of application and prior skin conditioning such as prior use of topical vitamin A acid products. Although single application of 50 - 70% GA will produce beneficial results, multiple treatments every 2 to 4 weeks are required for optimal results.

* Salicylic Acid

Salicylic acid is a member of beta-hydroxy acid group. Because of its improved lipid solubility compared to the AG, it is particularly effective in the treatment of acne. In addition, it is not as inflammatory and some physicians use it extensively for the treatment of melasma. Low concentration trichloroacetic acid (10% - 25%) can also be used to treat the conditions affecting superficial epidermis but its use is limited to experienced physicians as more detailed patient selection and application care is required. As such, physician supervision is required for all peels except low concentration glycolic acid (up to 35%) and salicylic acid peels (below 20%.) This precaution is necessary to prevent inadvertent worsening of the skin condition as well as scarring.

Although in some instances only one superficial peel can accomplish desired effects, in most cases a series of peels is recommended to achieve optimal results. Superficial peels are an excellent way to introduce oneself to the rejuvenating power of these common aesthetic procedures. Done properly and with care, superficial peels are very safe treatment options for some of the most common conditions affecting facial skin.

It is important to understand that superficial chemical peels are peels with similar risks and side effects as other peels. Some of the side effects of superficial chemical peeling can include hyper- or hypo-pigmentation, persistent redness, scaring as well as flare up of facial herpes infections (”cold sores”). Caution needs to be exercised with some patients, particularly those suffering from rosacea or eczema. These patients are prone to skin irritation and even the mildest peels can cause injury to the skin. Fortunately, in most instances, such injury can resolve with time and optimal skin care. In cases of melasma, extreme caution needs to be taken, as it is possible to worsen this common and unforgiving skin condition. Any significant redness of the skin must be avoided.

Author: Mariusz J.A. Sapijaszko, MD FRCPC (Dermatology)

Understanding Acne and Hormone Levels

Most of us have at one stage or other sought an acne remedy when suffering from that troublesome and common acne problem that first appeared in our early teen years. Many more have continued to suffer into our adult life. A rare few have avoided the embarrassment of pimples appearing at the worst possible time – knocking self-esteem to its lowest - usually when we are trying to make a good impression. A fast and effective remedy is what we want if acne is a problem.

Acne is caused by hormonal changes that occur during adolescence when oil glands in the skin become hyperactive. This additional oil combined with dead skin cells that block hair follicles and skin bacteria infect the hair follicles producing a breakout of the skin. Result? Clear skin is marred and embarrassment can follow.

There are many acne remedies available from natural home varieties to potent pharmaceutical drugs. Modern preferences are to avoid drugs because of their side effects and rather find a natural acne remedy. One acne remedy is to cut a raw potato in half and rub the flat section over the affected areas in an attempt to neutralize the bacteria that is causing the trouble in the pores. If it works for you, great.

The truth is acne comes second only to premature aging in the charts for skin disease. If you are a sufferer you will likely be aware that flare ups will always occur before a special event. You can put all the blame on testosterone produced by the adrenal glands which are trying to help you deal with the stress of that interview, wedding or important presentation.

Another acne remedy is to go on a fast for several days and to change the diet to healthier eating of mainly raw food. No doubt there is an element of truth in following this acne remedy but it does require some discipline as fasting and a strict diet regime is often too much like hard work for the majority.
High in iodine foods, shellfish, leafy vegetables including spinach and cabbage, and peanuts are other potential problem foods. If you have an acne problem, experiment with your diet. If you crave certain foods that may aggravate this problem curtail consumption to see it there really is a difference in acne activity
If you have a special sensitivity to a food, small amounts of anything - even soft drinks, chocolates will not make a major difference.

One of the more widely spread (and often believed) myths about acne is that it is caused by dirt or grime. It’s more likely to be because of oily skin, in which case simply washing regularly with either a mild soap, special acne skin cleanser or even antiseptic soap and warm water can make a big difference to controlling and managing oily skin. And don’t forget to keep your hair clean - again, depending on your skin type, your hair can also become extreme oily if not cared for properly.

The bad news is that acne cannot be cured, but the good news is that it can be treated. If you’re suffering with only mild acne, then some form of non prescription (over the counter) acne medication will no doubt have a positive impact for you. If you have bad or severe acne you will definitely need to see a doctor to get some professional advice.

A vitamin A deficiency can lead to skin problems. Not all cases of acne call for professional attention. An occasional blemish or pimple could be called “drugstore acne”. Topical antibiotics prevent about fifty per cent of blemishes, and are a significant breakthrough for treating average acne.

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