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My Winter Skincare Routine

Is winter starting to make your skin dry and your lips chapped? Below is my winter skincare regimen as well as tips for keeping your skin glowing all year long.

The first tool I find extremely versatile is Aquaphor. It is an ointment made of 41% petrolatum that serves as a semi-occlusive barrier on the skin. This keeps water and oxygen from being pulled from the skin by the elements, which helps with wound healing and creates a protective moist environment. It does not contain fragrances, preservatives, or dyes so it is good for even the most sensitive skin. It is non-comedogenic so it won’t clog up your pores. I use it on my face, my lips, my hands, and any other dry areas in the evening.

Vaseline is also made of petrolatum but it is 100% petrolatum, so it forms an occlusive barrier and is a lot thicker and stickier.

Some people prefer moisturizing with a cream or lotion rather than an ointment. The difference is that an ointment contains around 80-100% oil and up to 20% water, so an ointment feels oily on your skin and doesn’t “rub in.” A cream, on the other hand, is about 50% oil and 50% water so you will still have an oily layer that doesn’t fully rub in but it is less greasy. Make note, however, that creams often contain emulsifiers and preservatives which can be irritating to the skin. A lotion is similar to a cream but it is an even lighter or less thick formulation and can sometimes contain alcohols for faster drying. Gels and foams are the lightest, so to speak, and they also dry faster the the aid of alcohols. One cream that I find to be non-irritating to my skin and a great moisturizer is Cetaphil Cream. Some providers recommend CeraVe Moisturizing Cream but when I have tried it myself a felt a stinging sensation on my skin, body and face.

Another part of my skincare regimen that I use at night is Differin Adapalene Gel 0.1%. I had mild acne in college and used adapalene (Differin) gel, which at that time required a prescription (now it is over-the-counter!), along with an antibiotic cream called clindamycin. Differin is a topical retinoid that increases skin turnover and wards away acne including blackheads and whiteheads. Retinoids are also anti-aging (you may have heard of prescription Retin-A). I still use a pea-size amount of Differin gel about once every 3-4 nights to maintain clear skin. However, retinoids can be very drying so be sure to moisturize aggressively. Also, wait at least 30 minutes after applying Differin to apply moisturizer as you want to avoid getting retinoid on the sensitive skin around the eyes.

In the morning, I use a tinted CC cream that contains SPF 50. I am currently using IT cosmetics’ Your Skin but Better CC Cream with SPF 50 Plus (Medium) – 1.08 Ounces. I really like the way it gives me a smooth, even skin tone without feeling heavy at all. I use this in the morning with some Aquaphor on my lips. I even use it at night as my foundation and then use a contour stick over it plus mascara, lipstick, and bronzer or blush. I love the fact that it includes SPF for daytime. Protecting my skin from UVA and UVB rays is a priority in order to prevent skin cancer as well as aging and discoloration (and yes, you do need SPF in the winter time too! You can get your Vitamin D from food or a supplement). I will admit, on rotations where I have to wake up at the crack of dawn, I often roll out of bed, brush my teeth, throw on scrubs, and go to work bare-faced, as evidenced in this photo from my intern year.

However, lately I have been making an effort to effort to wear SPF, and to look a little more polished. Also to floss my teeth nightly, but that’s a story for another day.

Lastly, I am a lifelong user of Dove soap. It is the only soap that does not dry out my skin. Because I use Dove I do not have to regularly moisturize my body skin.

And that sums it up. I like to keep my skincare regimen simple and effective. Moisturize at night, preferably with ointment or a non-irritating cream, and wear SPF in the morning.

Benign Skin Growths and Spots

During my dermatology elective, I encountered countless patients who were concerned about growths on their skin that were, in fact, harmless and very common. There are thousands of lesions that can appear on the skin, but here I will discuss a few of of the most commonly seen benign skin spots and growths. I will also discuss what kind of changes to be cautious of when examining growths and moles. When in doubt, consult with your dermatologist.

Brown Spots

1.freckles-boy-flickr-NoSpareTime Freckles (“Ephelides”): these small, flat light-brown spots are small, multiple, and irregularly shaped. They appear in childhood, darken during the summer months, and lighten during the winter months (waxing and waning in response to sun exposure). They are due to a local, superficial accumulation of melanin, the protein the gives pigment to our skin and protects us from the sun. They are more common in lighter-skinned individuals who sunburn more easily. Sometimes these fade with age. The best way to avoid new freckles is by good sunprotection.

2. “Solar lentigos” (aka liver spots, age spots, or sun spots): these brown spots appear similar to freckles, but have sharper margins and sometimes stand alone. They can be found on the backs of hands, the shoulders, and the head and neck of adults. They are caused by sun damage acquired over time, but their appearance is persistent (they do not darken or lighten with the sun, or with time). They are due not only to a local accumulation of melanin, but also to a local increase in the cells that produce melanin (“melanocytes”). Some consider them to be flat versions of seborrheic keratoses (see below). Though not harmful, they can be treated for cosmetic reasons with freezing (“cryosurgery”), chemical peels, or certain lasers.

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3. Café-au-lait spots: these light-brown “macules” (flat, smaller than 0.5cm) and “patches” (flat, greater than 0.5cm) appear within the first year of life. They are due to a local increase in melanin. If a child has greater than 5 café-au-lait spots >1.5cm, they should be tested for syndromes such as neurofibromatosis.

cafe au lait infantcafe au lait

3. Junctional nevi: these darker brown, sharply bordered, flat lesions are a type of mole (“nevi” = mole). Moles have specific features under the microscope. They do not need to be removed unless there are features concerning for melanoma (see the ABCDE rules below). Removal is by cutting them out (“excision”); be mindful that excisions leave scars.

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*There are many types of flat and elevated moles. Some have more pigment, and some are skin-colored. We will discuss at the end how to monitor moles.

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Signs of Wisdom – seen more commonly in people age 30+

1. Seborrheic Keratoses (SKs): sometimes referred to as barnacles, these light tan to dark brown waxy growths appear to be “stuck on” to the skin, as if they could be peeled off with your fingernail. They have a rough, warty surface, and they can grow up to 1” (2.5cm) in width. SKs are caused by skin cells from the top layer of the epidermis (“keratinocytes” in the “stratum corneum”) sticking together. Some think they may be related to sun exposure. There is no need to remove these growths, as they are completely harmless, but if they become irritated or cosmetically undesirable, they can be removed by freezing (“cryotherapy”), burning with an electric current (“electrocautery”), or scraping.

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2. Skin Tags: these smooth, fleshy growths hang on to the skin by a little stalk. These are commonly acquired in areas of friction. Though they are harmless, if irritated or undesired they can be removed by snipping with scissors or freezing.

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3. Cherry angiomas: the cherry-red raised round bumps (“papules”). They often start out flat and become dome-shaped. They are caused by an abnormal growth within capillaries, the smallest blood vessels. In the rare case that the patient desires removal, they can be burned off with electrocautery or zapped with a laser.

cherriescherry angiomas

Monitoring moles and other growths and spots:

One of the most important rules of thumb in screening for melanoma is the ugly duckling sign: spotting the mole or growth that does not look like the others. A lesion is often not concerning if you have others that look like it on your body.

Monitor your moles by following the ABCDEs. The most important of these is E – EVOLVING—if you notice any change in your moles, or any appearance of new moles, mention this to your dermatologist during your check-up. [*Make note that even benign moles can grow. Not all change is melanoma.]

A – ASYMMETRY: if your mole has become uneven or asymmetric, have it looked it.
B – BORDER: benign moles have nice, regular borders. Dangerous moles have irregular borders.
C – COLOR: benign moles usually have only one color. Dangerous moles can have two or more.
D – DIAMETER: benign moles are usually smaller than a pencil eraser (<6mm).
E – EVOLVING: changes in your moles or the appearance of new moles should prompt examination.

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Sunprotection

Summer is upon us, and that means fun in the sun!  Let’s remember to be safe and smart, taking measures to prevent sunburn in the short-term, and skin cancer, premature aging, and unsightly discoloration in the long-term.

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Everyone, regardless of skin tone, is susceptible to the harmful effects of the sun’s rays. People with lighter skin types who burn easily should be especially cautious.

Ultraviolent (UV) radiation (290 to 400 nm) causes skin damage. Within that spectrum, UVB (290 to 320 nm) is responsible for sunburn (“B” for “burn”), inflammation, skin discoloration, and cancer formation. UVA (320 to 400 nm) is responsible for photoaging (“A” for “aging”), skin darkening, and possibly cancer formation.

The UV Index, on a scale of 0-11, is a forecast of how risky the sun exposure is that day, and is calculated by zipcode here or here. Read this or this to learn how to interpret the UV index.

beach hat

To protect your skin against UV radiation:

A)   Avoid the sun during peak hours: stay inside or seek shade between 11 am and 3pm. This is especially important at latitudes closer to the equator.

B)   Wear sun protective clothing:

  1. Sunglasses: Look for lenses that block 99-100% of UV rays. UV rays can lead to eye damage including cataracts, macular degeneration, photokeratitis (“sunburn of the eye”). For more: Mayo Clinic, All About Vision.
  2. Hats: especially wide-brimmed.
  3. Long-sleeve garments: Fabrics are rated on their ultraviolent protection factor (UPF).

C)   Apply sunscreen: these contain filters that reflect or absorb UV rays. They fall into two categories: organic (aka chemical), or inorganic (aka physical).

kids under tent

Here are some tips for finding and using sunscreen:

1)   Look for “broad-spectrum” on the label: these protect against both UVB and UVA. Make sure it contains at least one of the following in the ingredients list: avobenzone, zinc oxide, or titanium dioxide.

2)   Look for SPF 15 or above, per the FDA (but better 30 or higher). When enough sunscreen is applied, SPF 15 will absorb about 93% of UV radiation; SP 30 will absorb 97%, and SPF 50 98%.

3)   Apply daily, even on a cloudy day. Keep your sunscreen of choice next to your toothbrush so you apply it as part of your morning routine.

4)   Look for cosmetics or lotions with SPF15+. Choosing a moisturizer or a foundation with SPF to use as your daily sunprotective product may help you stick with your sunscreen routine.

5)   Apply 15-30 minutes before going out in the sun. This allows a protective film to form on the skin.

6)   Apply sunscreen liberally before outdoor activities to all sun-exposed areas. For the average adult, this means applying 1 oz (30mL), or one shot glass full.

7)   Reapply often: at least every two hours when out in the sun. Reapply after swimming, water sports, or sweating.

8)   Look for water-resistant sunscreens for days you will be in the water. Continue to reapply, however, after each swim.

9)   If you have sensitive skin, inorganic or physical sunscreens may be best for you, as they are less irritating. These contain mineral compounds such as zinc oxide and/or titanium dioxide. These products are also preferred for use in children.

10) Find the form you are most likely to use. Sunscreens come in a variety of forms: creams (greasier, thicker), lotions (thinner), liquids, sprays, gels, roll-on sticks. Find the vehicle that works for you. The best sunscreen is the one that you will use.

Vitamin D: Some people are concerned that they will not produce enough 25-hydroxyvitamin D if they do not get enough sun. Vitamin D, however, is readily available in certain foods (milk, fortified juices, salmon) or in supplement form. Vitamin D insufficiency is a common problem, but the safest way to combat it is by taking a daily supplement.

Thanks for reading, and enjoy your summer!

-Alex

 More links: Consumer info on Sunscreens, Teacher Resources, SunSmart Australia

References:

Baron ED, Elmets CA, Corona R. Selection of sunscreen and sun-protective measures. UpToDate April 01, 2014. Accessed May 13, 2014.

Young AR, Tewari A, Dellavalle RP, Danzl DF, Corona R. Sunburn. UpToDate May 01, 2014. Accessed May 13, 2014.