Combination Skin Causes and Care

It can be utterly frustrating to deal with combination skin; one day it is dry and tight, the next it is oily and blotchy. Seasonal weather changes only serve to make matters worse. Your skin can wrinkle in some areas and flake in others. If that’s the case, then you may have combination skin - varying skin conditions in different zones of the face. But not to worry; combination skin is quite common. In fact, more people have this skin type than any other.

Combination skin is characterized by a mixture of oiliness and dryness. Typically, the oily areas tend to be the T-zone, consisting of the forehead, nose and chin. The cheeks are normal to dry. The degrees of oiliness and dryness can vary. Pores may be larger in the oily areas - with pimples, blackheads and breakouts sometimes occurring - and dry areas may feel rough and irritated.

The “tissue test” can help you determine if you have combination skin. Take a tissue and hold/press it against your face. If there’s oil on the tissue where it touched your T-zone, but no oil where the tissue touched your cheeks, you most likely have combination skin.

Causes

Many factors can cause combination skin, including hormones, age, genetics, the way in which lipids are organized in our skin and even the weather. Hormonal changes can lead to changes in skin’s oiliness or dryness. Teens and young adults tend to have oilier skin, especially in the T-zone, but with age, hormones change and the oil production may decrease (but unfortunately, acne is still an issue for many adults). Also, hormones change due to menstruation and the birth control pill, which can make skin oilier in certain areas. Lipids also play a role in combination skin: These proteins affect skin’s softness and feel. When lipids aren’t evenly spread throughout the skin, certain areas will feel drier and rougher, while other areas may feel soft but oily or greasy. The organization of lipids in skin is due to genetics and hormones. Finally, weather can exacerbate combination skin. Dry cold weather can cause skin to dry out and become irritated. Conversely, hot humid weather can increase oil production. This can affect your T-zone as well as your cheeks.

Care Plan

Combination skin requires special care to balance the oily and dry areas of the face. Proper cleansing, treatment, moisturizing and sun protection are all necessary.

• Cleansing: People with combination skin often have difficulty finding a cleanser that works for their unique skin needs. Formulas designed for oily skin may leave combination skin too dry, especially in the cheeks, while formulas designed for dry skin may leave combination skin greasy, especially in the T-zone. It’s best to avoid products that are either too drying or too rich. Instead, use a foaming or gel cleanser to get rid of dirt and oil without causing irritation or dryness. A cleanser to try is one that removes excess oil and impurities while still being gentle and not drying out skin.

You should also exfoliate your skin regularly to remove dry, dead, rough skin cells. These cells may be particularly prominent on your cheeks. They can flake off and block pores, causing blemishes and blackheads. Try a product that might include papaya and pineapple juice, olive derivatives and Ginkgo Bilbao.

• Treatments: Treatment products are another important skincare component, helping to balance your skin. One treatment to try is one which moisturizes dry areas but prevents excess oil, especially in the T-zone. This product also contains antioxidants to prevent aging. Another type of treatment is a mask, and you’ll find an array of products for every skin type. Some experts advise using a hydrating/moisturizing mask on dry areas (cheeks) and a deep-cleaning clay mask on oily areas (T-zone). While using two different masks is certainly an option, you can also use a mask specifically designed for combination skin. If you suffer from breakouts, which may occur around the T-zone, use acne treatment products with salicylic acid. For problem skin, try a blemish serum or a spot treatment.
  
  
• Moisturize: Combination skin needs balance, and part of that balance means moisturizing your skin. Moisturizing is especially important for drier areas of the face, but your entire face needs moisture. Some experts suggest using separate moisturizers - a lightweight one for the T-zone and a deeper one for cheeks. You may choose to use separate moisturizers, but you can also use a single moisturizer designed for combination skin. Try a lotion which balances skin with witch hazel and aloe extract to help skin stay soft. Pay careful attention to dry areas, as they may require more frequent moisturizing than oily areas. Generally, experts recommend moisturizing dry areas twice a day and moisturizing oily areas once a day. Keep in mind that your individual skin has unique needs, so you might want to adjust your moisturizer - how often you use it, where you need it and how much you need.
• Sun Protection: Like all other skin types, combination skin needs protection from the sun. UVA and UVB rays can damage skin, so use oil-free sunblock all over your face daily (and on any other exposed areas). Try an oil-free sunlotion or sunblock because it protects your skin from UV rays and won’t make skin greasy.

Natural Treatments

Natural treatments such as aromatherapy oils, home-made exfoliants and masks may help treat your combination skin. For example, try mixing essential oils like chamomile, lavender and ylang ylang (just a few drops) together with your oil-free moisturizer. These ingredients have antibacterial properties and may help to rid skin of dirt or bacteria. However, if your skin is sensitive or easily irritated, or if you’re pregnant, you shouldn’t use these essential oils.

Exfoliating treatments can be made at home by mixing and grinding nuts, seeds or oatmeal along with water. These will slough off dead, dry skin cells - especially common around the cheeks. You can add citrus peels from fruit - like orange or grapefruit - to the mix and apply it to the oily T-zone.

To make a mask for dry areas, use ingredients like yogurt, mashed bananas or avocados to moisturize. On oilier areas, try pureed strawberries and apples.

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)

Are Chemical Peels Right for You?

With so many beauty products, facial treatments and surgical procedures available these days, it can be overwhelming to choose a treatment that is right for you. First off, when trying any new skincare treatment or procedure, it is always important to do your research, seek out reputable sources and never be afraid to ask questions, after all, it is your face – you only have one, so treat it accordingly. Selecting the right specialist or understanding details of a surgical procedure will be time consuming, be prepared to put in the time necessary to make the best choice. Below are some tips to help you get started.

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Choose carefully. The Consumer Guide to Plastic Surgery recommends you:

· Check educational, training, background credentials and experience to ensure that he or she is well-qualified

· Ask how many times they have performed this procedure

· Ask to see before and after photos of patients who have had chemical peels - in some cases offices will give you contact information of previous patients as referrals.

Dermatologists, plastic surgeons, licensed estheticians and registered nurses can all perform chemical peels. However, depending on the type of peel, you might need to see a doctor. Ensure your procedure is both safe and effective.

Schedule a skin consultation. A chemical peel is an aggressive treatment, it’s important that you get an in-depth analysis of your skin beforehand. When at the consultation, make sure the specialist knows your medical history and any prescriptions you may be taking. Be prepared to ask questions, such as what is my skin type? What are my skin concerns? How can chemical peels improve my skin? What kind of peel is best for my skin type?

Become a peel expert. There are three types of chemical peels: superficial, medium and deep. In addition, they increase substantially in cost depending on the peel. The cost ranges from $150 to $300 for superficial peels; $1,000 to $2,000 for medium peels and $2,500 up to $5,000 for deep peels, according to Smart SkinCare:

Superficial: The mildest of chemical peels, superficial peels treat fine lines, discoloration, dryness, roughness and mild acne. Results are subtle and you will need regular maintenance sessions. Estheticians typically perform superficial peels. Common solutions: Alpha hydroxy acids or AHAs (e.g., glycolic acid, lactic acid), salicylic acid

Medium: These peels penetrate deeper into the skin, producing a second-degree burn. Medium peels treat wrinkles, pigmentation problems, sun damage and blemishes. You will need at least a week to recover. You’ll also need several peels to achieve desired results. Common solution: Trichloroacetic acid (TCA)

Deep: These peels target deep wrinkles, dramatic discoloration and skin lesions. Deep peels are the most effective, providing pronounced and long-lasting results. However, they are also riskier with longer recovery time—most people take two weeks off from work. A certified, experienced plastic surgeon must perform these peels. This peel is performed once. Common solution: Phenol

Consider your skin type. Be aware that a chemical peel is not always the best option for your skin type. These are several examples when a chemical peel isn’t appropriate or can be helpful. In most cases, a chemical peel should not be used on dry or sensitive skin. A peel might cause dryness, flakiness, itching and further inflammation. If you have inflammatory acne and deep cysts, you should also consult a dermatologist, as a chemical peel might not be the best treatment for those conditions.

Chemical peels are a good choice if you experience mild to moderate acne or acne scars: The acids in the peel work to both kill active blemishes on the surface and to prevent new blemishes from forming. By accelerating the exfoliation process, a chemical peel delivers clearer, healthier-looking skin.

Become an expert on your chemical peel. Before having the chemical peel, make sure you ask every question possible to ensure you are aware of the entire procedure and its potential complications.

Examples like; what strength is the peel? How many sessions will I need? What are the pros and cons? What kind of discomfort, pain and other reactions can I expect during the procedure? How should my skin react after the chemical peel?

Communication is key in making your chemical peel a safe experience. Clarify you are experiencing normal reactions or seek immediate attention if you think you are not. Remember if something doesn’t feel right, only you can speak up about it.

About two to four weeks prior to your chemical peel, the specialist will ask you to incorporate pre-care products into your daily regimen. These products are designed to thin out the skin’s surface, allowing the peel to penetrate deeper and evenly. Your medical expert might prescribe Retin-A, an AHA product or hydroquinone cream.

When using these new products, you might have to discontinue your old ones. Your specialist will give you specific information about what products to use and avoid.

Depending on the type of peel, your results might be subtle or dramatic. Every skin type reacts a bit differently. Be realistic about the results and fully understand to what degree the peel will improve your skin and whether you will need additional sessions to maintain results.