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Dr. Kathy Fields and Dr. Katie Rodan are Stanford-trained, board-certified dermatologists. Dr. Fields is a clinical instructor of dermatology at the University of California at San Francisco. Dr. Rodan is an assistant professor of dermatology at Stanford University School of Medicine.
Both doctors have medical and surgical practices that include disorders of the skin, hair and nails, including the removal of unsightly or malignant skin growths. They also specialize in liposuction, laser and chemical peels, and sclerotherapy procedures for varicose veins. Dr. Fields practices in San Francisco, and Dr. Rodan practices in Berkeley. Welcome to PlanetRx.com, Drs. Fields and Rodan.
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| Dr. Katie Rodan : |
Thank you for having us!
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| PRx Host : |
Dermatology hasn't been considered the most glamorous of medical fields. What drew you to your specialty?
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| Dr. Katie Rodan : |
We were drawn to this specialty for selfish reasons: we each had skin problems that we wanted to fix. And beyond that, we wanted to try to "control" the aging process. Today dermatology is the most glamorous of all the specialties. Please look at all your magazines and see the results of our hard work.
Another thing I would like to mention is that skin is the only visible organ of the body. So, when we have a disease, everybody is aware of it and it is distressing for the patient who is suffering from it.
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| PRx Host : |
Who is most at risk for skin cancer?
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| Dr. Kathy Fields : |
The people at risk for skin cancer usually are the fair skin types and have had sun exposure since early childhood. All the childhood burns and tans result in damage and over time, cancer.
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| Dr. Katie Rodan : |
Another thing that increases a person's risk for skin cancer is their genetics. A family history of skin cancer is particularly important, especially if there is a history of melanoma. Beyond genetics, there are other risk factors such as occupational exposures and smoking. But in essence all of us are at risk for skin cancer unless we have extremely dark complexions.
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| PRx Host : |
How draconian are your anti-sun prescriptions? Some dermatologists recommend wearing sunscreen every moment you are out and long sleeves when exercising. What do you recommend?
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| Dr. Kathy Fields : |
Katie and I are totally draconian. We glow in the dark. Every photon of light that your skin receives over a lifetime is cumulative and not reversible. So everything counts. Sunscreen in the winter and the summer is for aging protection and cancer protection.
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| Dr. Katie Rodan : |
What most people don't realize is that sunlight, particularly Ultraviolet A light, penetrates through window glass so you are receiving those damaging rays when you are least aware -- when you are sitting at your desk, driving your car. To further that point, I can always tell what side of the car my patient sits on by looking at their face and seeing which side is most damaged. So, if you want to look your best and keep your skin healthy, it's imperative that you wear a broad-spectrum sun protection.
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| PRx Host : |
What do you think of studies that show that the more sunscreen people apply, the more likely they are to get skin cancer?
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| Dr. Kathy Fields : |
Phony. The reality is, people are not applying sunscreen adequately. FDA requires 2 milligrams per centimeter squared of sunscreen. That equals one teaspoon for your face alone. Nobody does that. We apply a quarter of what is needed, so an SPF 15 is only a 4. Consequently, nobody is overapplying. In fact, they are underapplying, staying out longer, and getting burned.
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| Dr. Katie Rodan : |
To amplify the question on the connection between sunscreen and skin cancer, the sunscreens mainly block out Ultraviolet B light which is the burning ray. When people are using these sunscreens, they are spending more time out in the sun than they should. Until recently, there has not been a good Ultraviolet A protection. So if you are using a sunscreen that only blocks the B light, you are receiving a higher amount of the A light, which is also connected to skin cancer, especially melanoma.
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| PRx Host : |
Others have suggested that peeling is the body's natural mechanism for protecting against skin cancer and sunscreens block that mechanism. Could that be a factor?
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| Dr. Kathy Fields : |
No. The burn, the tan, the brown, all of this is evidence that the skin is in trouble. These are the warning signs that the skin is trying to recover from all the DNA damage. Peeling is a sign of damage. Peeling is the ultimate insult of sun damage and is not protective in any way. A healthy tan is an oxymoron. There is no such thing as a tan being safe.
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| PRx Host : |
What kind of sunscreens do you recommend?
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| Dr. Katie Rodan : |
We recommend that your sunscreen contain either invisible (micronized) zinc or parsol-1789. These are excellent Ultraviolet A-blocking agents. Sunscreens that contain them, also have Ultraviolet B sunscreens, such as methoxy-cinnamate, benzophenone. So, you need to cover the full-spectrum of Ultraviolet A and B by using sunscreens that block each of these rays.
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| PRx Host : |
Acne is the scourge of adolescence, but adults have it too. Is there a difference between adult and adolescent acne?
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| Dr. Kathy Fields : |
The process of acne is the same in both cases. Genetics and hormones influence the hair follicle to induce plugging, bacteria growth, sebum production, and inflammation. However, adult acne, particularly in women, has large, painful nodules, generally in the chin and jaw location. Women tend to cycle, with breakouts every menstrual cycle.
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| PRx Host : |
Some people with acne swear some foods exacerbate their condition. Are there any studies that show that certain foods trigger acne?
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| Dr. Katie Rodan : |
I agree. As a general statement, food does not cause acne. People believe that chocolate, greasy foods, and the like promote breakouts. However, dietary studies have shown that there is no strong link between what you eat and the pimple you form tomorrow. I tell my patients, however, that if they notice that they break out by eating certain foods, then common sense should dictate that they should avoid those foods.
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| PRx Host : |
Are there any vitamins, minerals, or herbs that can help people with acne?
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| Dr. Kathy Fields : |
Yes. Vitamin A can be helpful with acne. The doses have to be high -- 20,000 units a day. Over time, this can be toxic to the liver. Iodine and bromides can trigger acne. Medications like lithium can trigger acne.
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| Dr. Katie Rodan : |
A patient of mine recently told me that a new supplement called Cellasene used for cellulite contains 500 times the daily recommended dose of iodine. So, fans of this thigh treatment should be aware if they are acne-prone -- because their thighs may look better but their faces won't!
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| Dr. Kathy Fields : |
Sadly, a simple diet and lots of water are not the secrets for curing acne. It's a far more complicated disease than that.
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| PRx Host : |
What are the most important things you can do to control acne?
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| Dr. Katie Rodan : |
There are several things you can do and while acne is not curable, it is preventable, treatable. First of all, you can look for medicated products which contain benzoyl peroxide, sulphur, or salicylic acid, and use these on a daily basis over the entire acne-prone area: chest, face, or back. Do not try to spot treat a pimple -- this is not a long-term remedy for your acne problem. The pimple that you are trying to treat today actually started two or three weeks before it was visible. The only way you can get ahead of the problem is to treat the entire area with the medications that I mentioned. If your acne is very serious, your best bet is to see a dermatologist, who can help you with appropriate treatment. Don't let your acne scar before you seek treatment.
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| Dr. Kathy Fields : |
P.S. Once your skin is under control, continue your combination of medications. If you stop, over the course of time, the acne will return. This is the secret of prevention.
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| PRx Host : |
Isabel Allende, who is 58, was recently complimented on her youthful-looking skin. She credited her dermatologist and Retin-A. Can you talk about Retin-A and other products like it?
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| Dr. Katie Rodan : |
We LOVE Retin-A! While it is an acne medication, I think its main benefit is that in skin rejuvenation. Just as Isabel Allende described, if you use Retin-A over a period of time on your most sun-damaged areas, you can reverse the effects of photo-aging (i.e. brown spots, fine lines and wrinkles and poor skin texture).
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| Dr. Kathy Fields : |
As we age, the skin slows down in its turnover process. An example, it takes 30 days for the skin to renew itself. This is ongoing. As we reach 40, the process takes 60 days, and further declines. Retin-A seems to reverse or normalize this process. The problem with Retin-A is that it can be irritating to use and therefore should be started just two nights a week and increase as tolerated. Redness and scales can be completely avoided and anyone can get benefits from this product. There is new evidence (not FDA-approved yet) that Retin-A may actually reverse early pre-skin cancer and even more, may protect the skin from tomorrow's burns.
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| PRx Host : |
Do you also use collagen-replacement therapy to counteract the effects of aging on the skin?
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| Dr. Katie Rodan : |
It depends on what type of wrinkling we are treating. For very fine lines, collagen can be an excellent way to spackle the skin. For example, it can be an excellent "filler" substance for delicate lines on the cheeks, or between the nose and mouth, but it is not a perfect agent for filling in deep furrows. For that, you need a layered approach. This may include the use of fat transferred from one part of your body where you would like to lose it (think of your thighs) to another part of your face where you would like to gain a little more fullness (such as your cheeks). When we treat skin aging, we also look at a combination approach that may include many agents, and collagen is one of them.
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| PRx Host : |
I'm going to turn to some interesting questions from the audience.
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| Sandyrichardson : |
Are those "pore cleaning" strips good for your skin? My teen-aged daughters want to use them, but I can't see that they are any more than an expensive piece of tape.
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| Dr. Kathy Fields : |
The pore strips remove a very superficial layer of oil and skin cells. Those cells and oil build up immediately the next day. Consequently, there is no long-term benefit. The pore strips on the market are not medicated. Therefore, there is nothing being put into the pore to prevent the process. It feels good, and temporarily the skin is smooth, and people do like that.
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| Ellynmeyers : |
Is there really anything on the market that can help reduce wrinkling in middle-aged women? I have spent a fortune on creams, lotions, treatments, etc., and am still getting deeper lines on my face. Is there something out there or do I need to save for plastic surgery?
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| Dr. Katie Rodan : |
My #1 recommendation is to find an excellent sunscreen that contains zinc or parsol to prevent further wear and tear on your face. Other products for anti-aging, which you can find in your salons, drugstores or here on PlanetRx.com, include glycolic acid in a concentration of 8-10% and a pH of 3.5 to 4.5. You can also use Retinol-containing products. There are several on the market by Neutrogena and RoC. The other thing that you can do, which is very low-tech, is to learn to sleep on your back. When you sleep face-down into a pillow, you are spending 7-9 hours a night helping to create your own wrinkles!
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| Ellynmeyers : |
Can the beauty expert recommend something to cover those unsightly red dots that appear on my face -- a result of aging!
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| Dr. Kathy Fields : |
Those red dots may be angiomas. These are tiny blood vessels. Some people get stringy (or broken blood vessels) over the cheeks, nose, and chin. All of this is caused by the sun and some genetic predisposition. Dermatologists can use lasers to remove them or burn them off. They can be covered with green concealer with beige on top. Please check with PlanetRx.com.
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| PRx Host : |
Can laser treatment cause discoloration of the skin?
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| Dr. Katie Rodan : |
If you have a dark complexion, any injury to the skin such as a mild burn from a laser can result in deepened pigmentation. Usually this resolves within 3-4 months.
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| rose100 : |
Hi Drs. Fields and Rodan! I use your product and am quite pleased with the results for acne. I have a question regarding wrinkles and fine lines around the eyes. Are there any products you suggest? I use sunscreen whenever I know I'll be outdoors.
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| Dr. Kathy Fields : |
Thank you. We're pleased to hear your acne is no longer a problem and you're turning your attention to aging gracefully. As Katie mentioned, glycolic acids, retinols, and antioxidant vitamins such as Vitamin C all have been shown to slow the process and perhaps improve the fine details.
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| Beautybabe : |
Is there anything you can do about hereditary bags under the eyes? Not puffy bags, but indentations under the eye area that even with concealer cannot be filled in. I'm wondering if there is a way to surgically lift the under-eye skin upwards?
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| Dr. Katie Rodan : |
There are a number of ways to approach this problem. Sometimes, with my patients I will inject collagen to lift up this minor indentation. Fat may also be injected into the area. And a final solution is a surgical blepharoplasty (which is an eye-lift).
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| Jenndb : |
I have a lot of moles on my skin and some are slightly raised. Will this cause me problems in the future (e.g., cancer)?
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| Dr. Kathy Fields : |
Your moles should be checked by a dermatologist. Raised or flat is not the deciding feature regarding cancer. Irregular borders, weird colors, like blue, black, red, and even white can be signs of cancer. However, any new mole or changing mole should be seen and documented. It's impossible to know without looking.
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| rose100 : |
Do acne products "wear out" over time? Does your skin get used to the products and reject their potential?
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| Dr. Katie Rodan : |
That is an excellent question! Topical and oral antibiotics are known to produce resistance so their benefits will end over time. Other products such as benzoyl peroxide and salicylic acid never lose their effectiveness because the body does not become immune to them. Acne does ebb and flow, so over the course of months no matter what you're using you may see your acne suddenly worsen or improve.
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| Boardie : |
Can your products help rosacea? If not, what can be used?
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| Dr. Kathy Fields : |
Rosacea is the flush blush reaction seen on the cheeks and nose. It is further complicated with pimples in some people. The best example is our hero Bill Clinton. The products in ProActiv can improve the acne component (pimples) and the sulfur of the mask may improve some of the redness seen in the cheeks.
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| DrStrangelove : |
I have darker skin, and I don't really burn. Do I have a lesser risk of contracting skin cancer?
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| Dr. Katie Rodan : |
Yes, you have a decreased risk of contracting skin cancer but unfortunately, lots of the aging changes such as brown spots and poor skin texture caused by the sun still appear in darker-complected individuals. I frequently am asked by my Asian and Hispanic patients to remove tiny brown bumps over their cheeks and neck which are probably caused by a lifetime of sun exposure. So, no matter what your skin type is, it is still important to protect your skin daily from the sun if you want to look your best.
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| Dacedi : |
I've heard that fluorescent lights emit UVA rays. Is this true?
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| Dr. Katie Rodan : |
No, that's not true.
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| LittleKahuna : |
What are some new hair-removal options?
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| Dr. Kathy Fields : |
There is great excitement with hair removal today. Four laser therapies have been proven effective for black hair on white skin. These therapies are the ruby, the alexandrite, diode, and multi-light laser systems. With dark hair, after approximately 3-6 sessions, there can be near to perfect hair removal. Touch-up procedures will always be needed but an 80% reduction in hair will be seen.
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| Dr. Katie Rodan : |
These lasers have not been around for as long as we would like to collect data and give people a reliable expectation. I have treated patients as many as 10 times with the laser and seen only moderate hair reduction. Because these procedures are very expensive, it's important to see a doctor with the current technology and not get your hopes up too high that in three sessions your bikini area hair will no longer be visible.
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| Dr. Kathy Fields : |
The hair on the upper lip, chin, armpit, legs, groin, and back all have different depths and growth cycles. There is lots of excitement to look forward to as our laser technology advances. We are definitely getting closer to unlocking the secret to hair removal. Brown, blonde, and white hairs are not effectively removed at this time. Stay tuned. New technology is appearing every day.
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| whitt12770 : |
Do vitamin C and alpha hydroxy really help improve the look of your skin?
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| Dr. Katie Rodan : |
They can, but the benefits are subtle. You will not see deep lines and wrinkles and very dark brown spots removed by these topical products. They will give you a healthy glow, a more youthful complexion, and when used over time, there is some belief that vitamin C may decrease the risk of skin cancer and slow down the skin aging process.
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| Bjosephf : |
I am inherently impatient when it comes to skin care and I understand that long-term healthy skin care is a better approach to skin care than dab therapy. Could you please advise me for which skin conditions can I use dab therapy versus long-term healthy skin? Thanks. By the way, I think you guys are terrific. I've even ordered the ProActiv acne solution which you invented.
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| Dr. Kathy Fields : |
Dab therapy isn't very effective for any problem. Prevention is always the key. For the infrequent breakout, we recommend spot treatment with the mask overnight, but as Katie said, it's better to prevent the whole problem than chase the random blemish. ProActiv can be used long-term, is very safe, and will leave the skin looking healthy and smooth.
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| Pumpkin99 : |
I heard Retin-A is very dangerous to use if you plan on being in the sun. Is that true? Also what is the difference between retinol and Retin-A?
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| Dr. Katie Rodan : |
I never prescribe Retin-A to my sun-worshipping patients as Retin-A may increase one's sensitivity to the sun. Since I mainly prescribe it for reversal of skin aging, it makes no sense to use Retin-A and then subject your body to the aging rays of the sun. In other words, you can't have your cake and eat it too!
The difference between retinol and Retin-A is this: Retin-A is a drug. It is known to penetrate into the deeper layers of the skin where it can affect collagen synthesis and cell turnover. Retinol is a form of Vitamin A and is sold without a prescription. It is a precursor to Retin-A and may be converted to Retin-A by the skin. But there are no studies to prove this. The dosages in the skin from Retin-A are significantly higher than can be achieved from retinol.
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| Jenndb : |
I have been using glycolic products for 4 years now and it seems that it is not keeping my pores as unclogged as it used to. Can you build up a tolerance??? What can I use if my glycolic is not as effective?
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| Dr. Kathy Fields : |
Yes, you can build a tolerance to these products. The good news is there are many glycolic products on the market. They vary in strength, and acidity. Please check with PlanetRx.com to see the various products they carry. You should feel a mild tingling sensation and the skin should feel smooth, hydrated, and shiny. When this effect wears off, switch to a different product.
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| Dr. Katie Rodan : |
Or, go to a higher strength. Remember to look for concentrations of at least 8-10%. Dermatologists prescribe AHAs that are significantly (12-20%) higher.
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| Sucharna : |
Can you recommend an over the counter cream to help lessen the appearance of brown spots and acne scars?
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| Dr. Kathy Fields : |
Yes. To lessen the effect of brown spots, we suggest a hydroquinone product of 2%.This would be the Porcelana brand or others. Kojic acid, which is found in some cosmetic creams, is also a minimal lightening agent. Strict sunscreen is crucial to help fade the brown spots and prevent new ones. Specifically use zinc or avobenzone sunscreens.
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| Dr. Katie Rodan : |
Glycolic acid will also help your hydroquinone product to work more effectively.
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| whitt12770 : |
I am in my late twenties...since I was about 18, I get a dark coloration above my upper lip whenever I am in the sun...I thought only older women/pregnant women got this? Can you explain why I started getting this so young and what I can do to fade it...I have fair skin, so it really shows up!
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| Dr. Katie Rodan : |
What you are describing is a condition called melasma. While it is known as "the mask of pregnancy," it happens in women (rarely men) due to circulating estrogen hormones, which, in the presence of the sun, elicit the brown spots on the upper lip, cheeks, lips, and nose. Age is not a critical factor. Women from their late teens to their early 40s are affected by this problem. You can fade it by using over-the-counter bleaching creams which contain hydroquinone or getting stronger products from your dermatologist. So that the problem doesn't return, you need to use a sunscreen daily, because even small amounts of sun will cause the problem to resurface.
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| Pumpkin99 : |
I heard there is a "sand-paper"-like dermatological treatment that sands away wrinkles on the forehead is this true?
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| Dr. Kathy Fields : |
There is a new procedure called microdermabrasion. We are using vacuum suction and sand, literally to sandblast 15 microns of skin with each pass. It is virtually painless and when done weekly, can subtly improve fine lines, texture, pore size, and even shallow acne scars. The process is not perfect, but it is an effective answer for people who cannot have down time with large procedures, but would like to see some improvement in a true "lunchtime" scenario. Your glycolics, retinols, and antioxidants will now penetrate better following these procedures and they will be better for the skin in the long term.
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| PRx Host : |
We've run out of time, though we haven't run out of questions. Many thanks Drs. Fields and Rodan for provoking such a lively discussion at PlanetRx.com. We hope to have you back soon!
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| Dr. Katie Rodan : |
Thank you very much for having us! We really enjoyed the hour!
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| Dr. Kathy Fields : |
We wish you all clear and healthy skin. Thanks for having us.
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| PRx Host : |
Drs. Fields and Rodan's website is www.proactiv.com.
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