Common Birthmarks, Dysplastic Nevi and Congenital Nevi

A birthmark is a colored mark on or under the skin that’s present at birth or develops shortly after birth.Some birthmarks fade with time; others become more pronounced. Birthmarks may be caused by extra pigment in the skin or by blood vessels that do not grow normally. Most birthmarks are painless and harmless. In rare cases, they can cause complications or are associated with other conditions. All birthmarks should be checked by a doctor.

See  the slideshow here:   http://www.medicinenet.com/birthmarks_pictures_slideshow/article.htm

Former Soviet President Mikhail Gorbachev has a port wine stain.

Salmon Patches

Salmon patches are nests of blood vessels that appear as small, pink, flat marks on the skin. They occur in 1/3 of newborn babies. Salmon patches can appear on the back of the neck (“stork bite”), between the eyes (“angel’s kiss”), or on the forehead, nose, upper lip, or eyelids. Some fade as baby grows, but patches on the back of the neck usually don’t go away. Salmon patches require no treatment.

Port Wine Stains

A port wine stain begins as a flat, pinkish-red mark at birth and gradually becomes darker and reddish-purple with age. Most will get bigger and thicker, too. Port wine stains are caused by dilated blood capillaries. Those on the eyelid may increase the risk of glaucoma. Port wine stains may be a sign of other disorders, but usually not. Treatment includes laser therapy, skin grafts, and masking makeup.

Mongolian Spots

Mongolian spots are flat, smooth marks that are present from birth. Frequently found on the buttocks or lower back, they’re typically blue, but can also be bluish gray, bluish black, or brown. They may resemble a bruise. Mongolian spots are most common on darker-skinned babies. They usually fade by school age, but may never disappear entirely. No treatment is required.

Cafe-Au-Lait Spots

Cafe-au-lait spots are smooth and oval and range in color from light to medium brown, which is how they got their name, “coffee with milk” in French. They’re typically found on the torso, buttocks, and legs. Cafe-au-lait spots may get bigger and darker with age, but are generally not considered a problem. However, having several spots larger than a quarter is linked with neurofibromatosis and the rare McCune-Albright syndrome. Consult a doctor if your child has several spots.

Strawberry Hemangiomas

Hemangiomas are a collection of small, closely packed blood vessels. Strawberry hemangiomas occur on the surface of the skin, usually on the face, scalp, back, or chest. They may be red or purple; they can be flat or slightly raised, with sharp borders. Strawberry hemangiomas usually develop a few weeks after birth. They grow rapidly through the first year before subsiding around age 9. Some slight discoloration or puckering of the skin may remain at the site. No treatment is required, but when desired, medicines and laser therapy are effective.

Cavernous Hemangiomas

Present at birth, deeper cavernous hemangiomas are just under the skin and appear as a bluish spongy mass of tissue filled with blood. If they’re deep enough, the overlying skin may look normal. Cavernous hemangiomas typically appear on the head or neck. Most disappear by puberty. A combination of cavernous and strawberry hemangioma can occur.

Venous Malformation

Venous malformations are caused by abnormally formed, dilated veins. Although present at birth, they may not become apparent until later in childhood or adulthood. Venous malformations appear in 1% to 4% of babies. They are often found on the jaw, cheek, tongue, and lips. They may also appear on the limbs, trunk and internal organs, including the brain. They will continue to grow slowly, and they don’t shrink with time. Treatment — often sclerotherapy or surgery — may be necessary for pain or impaired function.

Pigmented Nevi (Moles)

Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. They can appear anywhere on the body, alone or in groups. Moles are usually flesh-colored, brown, or black. Moles may darken with sun exposure and during pregnancy. They tend to lose color during adulthood and may disappear in old age. Most moles are not cause for alarm. However, moles may have a slightly increased risk of becoming skin cancer. Moles should be checked by a doctor if:

* They change size or shape
* They look diffrent from other moles
* They appear after age 20

Actress Eva Mendes sports a “beauty mark” on her check.

Congenital Nevi

Congenital nevi are moles that appear at birth. The skin texture may range from normal to raised, or nodular to irregular. Congenital
nevi can grow anywhere on the body and vary in size –from a small 1-inch mark to a giant birthmark covering half of the body or more. Small congenital nevi occur in 1% of newborns. Most moles are not dangerous. But congenital nevi, especially large ones, should always be evaluated by a doctor since they may have an increased risk of becoming skin cancer.

Dysplastic Nevi (Atypical Moles)

Atypical moles are generally larger (one-quarter inch across or more) than ordinary moles and have irregular and indistinct borders. They may resemble cancerous moles. They may have a mix of colors including pink, red, tan and brown.These moles tend to be hereditary. Atypical moles have an increased chance of developing into melanoma skin cancer. Have a doctor evaluate all moles that look unusual, grow larger, or change in any way.

Nevus, Keratosis, Skin Spots, Warts, Benign Growths and Moles

BENIGN GROWTHS & MOLES

Everyone has skin growths. The dermatologist is the expert on determining which are harmless and which should receive attention.
This article is not a substitute for a medical exam. If you have any serious skin issues or concerns, you need to consult your physician.

Moles

Everyone has moles, from a few to several dozen. Most people think of a mole as being a dark brown spot, but moles have a much wider range of appearance. They can be raised from the skin and very noticeable, or they may contain dark hairs. Having hairs in a mole doesn’t make it more dangerous.

Moles can appear anywhere on the skin, alone or grouped. They usually are brown in color and can be various sizes and shapes.  Special cells that contain the pigment melanin cause the brown color.  Facial moles are probably are determined before a person is born. Many of those that form in childhood and early adult life are now thought to be due to sun damage. Some may not appear until later in life, but moles that appear after age 50 should be regarded with suspicion. Moles may darken, which can happen after exposure to the sun, pregnancy and sometimes during therapy with certain steroid drugs. Moles can be safely removed for cosmetic or medical reasons.

Blood Moles

These are benign growths that consists of small blood vessels. These tumors can be located anywhere on the body. Some of the different types include spider angiomas, cherry angiomas, and angiokeratomas. We do not know the cause of most types of angiomas.

Age Spots

Multiple small brown spots that may appear on wrists, backs of the hands, forearms, and face could be solar lentigos. These are also called “liver spots” or “age spots” and occur later in life. The are flat and evenly colored.

Keratosis

After a person reaches middle age, he or she may acquire other dark areas that are not moles. The brown, wart-like growths that appear on the face or trunk and look as if they have been stuck to the skin may be seborrheic keratoses. Seborrheic keratoses are non-cancerous thickenings of the outer layer of skin. They may be just one growth or clusters. They are usually brown but can vary in color from light tan all the way to black. They’re different sizes as well –anywhere from a fraction of an inch in diameter to larger than a half dollar. A main feature of seborrheic keratoses is their waxy, pasted-on, or stuck-on look. They sometimes look like a dab of warm brown candle wax that has dropped onto the skin. Others have a rough surface.

Actinic Keratoses, also called solar keratoses, are caused by sun damage. They occur on body areas that have been heavily exposed to sunlight or exposed a little bit often for a lot of years. The face, hands, forearms and the V of the neck are the most common areas for actinic keratoses. They may get sore a times. These growths are more common among pale-skinned, fair-haired, light-eyed individuals. They are flatter, redder and rougher than seborrheic keratosis. Actinic keratoses are pre-cancerous, which means they may become skin cancers. The risk has been estimated at 1% per spot, per year,

WARTS
Warts are caused by a viral infection of the cells found in the top layer of the skin. The name of this virus is the human papillomavirus HPV). Warts are skin-colored and feel rough to the touch. Hand warts are usually found around the nails, on the fingers and on the back of the hand. They are more common where skin has been broken and in the areas where fingernails are bitten or hangnails picked. Foot warts are usually on the soles of the feet. These warts are called plantar warts (this has nothing to do with farming-the bottom of the foot is called the plantar side by doctors). Flat warts are much smaller and are less rough than hand or foot warts. They tend to grow in great numbers — 20 to 100 at any one time. They can occur anywhere, but in children they are most common on the face. In adults they are most often found in the beard area in men and on the legs in women. Skin irritation from shaving probably accounts for this.

Watch out for…

Melanoma is a serious form of skin cancer. Melanomas are often, but not always, very dark brown to bluish-black growths. Melanomas may be confused with seborrheic keratoses or moles because both can become very dark. It is wise to have any growth that turns dark or becomes irritated checked by a dermatologist. Early detection of skin cancer is the best way to assure successful treatment.

Information by : Dermatologist, Robert M Rosen, D. O.

Skin Tags and Seborrheic Keratoses

Nuisances You don’t have to put up with. As time goes on, we all acquire tiny bits of extra skin called skin tags. These can range in size from 1-10 mm, and are flesh colored or brown.

Skin tags can be found on any part of the body, but are most common on the eyelids and neck, and in the armpits and groin, and under the breasts.  While skin tags are benign they can be annoying if they become irritating or rub on sporting equipment, and skin tags can interfere with shaving and can detract from one’s appearance and self-image.

Fortunately, we don’t have to put up with skin tags. These little annoyances can be easily removed in an office visit with little or no discomfort. Skin tags can almost always be removed without needing stitches, and the treated areas usually have healed completely in a week or two.

The cost of removing skin tags is quite reasonable - ranging from about $80 for a few tiny ones to about $200 for a larger number scattered over several areas.

Seborrheic keratoses are firm flat or raised, sometimes scaly or crusty flesh-colored, brown or black “barnacles” which accumulate (usually on the face and trunk) as time goes on. Some people start to develop seborrheic keratoses in their thirties, and most people have at least a few by the time they are sixty. To look at pictures of different types of moles, click on www.SkinCancerGuide.ca .

Seborrheic keratoses are usually just a nuisance, but - like skin tags — they can rub on clothing and equipment, and their appearance can sometimes be so distressing that they interfere with choice of clothing, sports like swimming, and intimacy.  Because seborrheic keratoses grow above the skin (but not down into the skin) they can be easily scraped off, and the treated areas heal up nicely within a few weeks. Sometimes the healed area remains pink for a few months after the seborrheic keratosis is removed.

The cost of removing seborrheic keratoses is similar to that for removal of skin tags: about $80 for one or two, with the cost gradually increasing depending on the number and size of seborrheic keratoses to be removed.

The cost of removing skin tags and seborrheic keratoses is a tax-deductible medical expense, just like things like dental bills.  So, if you are annoyed by skin tags or seborrheic keratoses you can be confident that it is simple and inexpensive to rid yourself of these nuisances.

By Kevin C. Smith MD FACP FRCPC

Using Anticoagulants During Cutaneous Surgery

Anticoagulants and Blood Thinners During Cutaneous Surgery: Always, Sometimes or Never?

C. F. Schanbacher, MD

Dana-Farber Cancer Institute, Brigham and Woman’s Hospital, Harvard Medical School, Boston, MA, USA

ABSTRACT

There is no consensus with regard to perioperative blood thinner management in patients undergoing cutaneous procedures. The rationale and problems associated with blood thinners during cutaneous surgery are examined and the preoperative screening and surgical management of patients taking anticoagulant medicines discussed. There are many studies that support continuation of blood thinners during cutaneous procedures supporting the conclusion that blood thinners should not be discontinued for cutaneous procedures.
Key Words: blood thinners, cutaneous surgery

Anticoagulant medicines are used to treat individuals at risk for primary or recurrent thromboembolism. During major procedures, such as intraabdominal, intracranial, orthopedic or cardiothoracic, blood thinning agents are usually discontinued or at least modified in an attempt to prevent undue intraoperative and postoperative bleeding. Subsequent to such procedures, blood thinners are reintroduced to treat the underlying thromboembolic disorder. This process of manipulating the level of anticoagulation can be time consuming, requires multiple blood tests and exposes patients to increased risk of thromboembolism, hemorrhage or both.

Patients at risk for thromboembolic events include those with mechanical heart valve(s), valvular heart disease, underlying coagulopathy, atrial fibrillation, history of stroke, pulmonary embolism, myocardial infarction, or deep venous thrombosis. Commonly prescribed anticoagulant medicines include antithrombin agents such as warfarin or heparin products, and antiplatelet agents such as aspirin, thienopyridines or glycoprotein IIb/IIIa inhibitors (Table 1). Patients at risk for thromboembolism typically take one or more of the aforementioned anticoagulants under the guidance of the primary care provider.

Class	Subclass	Compound/Trade name
Antiplatelet agents	Aspirin	——
	ADP induced platelet activation inhibitors	Clopidogrel (Plavix®) Ticlopidine (Ticlid®)
	Platelet glycoprotein IIb/IIIa antagonists	Abciximab (Reopro®) Eptifibatide (Integrilin®) Tirofiban (Aggrastat®)
Antithrombin agents	Unfractionated heparin	——
	Direct thrombin inhibitors	Bivalirudin (Angiomax™) Hirudin (Refludan®) Argatroban (Novastan®)
	Low molecular weight heparin	Enoxaparin (Lovenox®) Dalteparin (Fragmin®) Ardeparin (Normiflo®) Danaparoid (Orgaran®) Tinzaparin (Innohep®)
	Coumarin	Warfarin (Coumadin®)
	Factor Xa inhibitor	Fondaparinux (Arixtra®)
Thrombolytic agents	Plasminogen activators	Streptokinase (Streptase®) Alteplase (Activase®) Reteplase (Retavase®) Tenecteplase (TNKase®)

Table 1: Antithrombotic agents approved in the U.S. Modified from Alam M, Goldberg LH.¹

Historically, dermatologic surgeons have implemented general surgery practice guidelines in managing blood thinning medicines prior to and during cutaneous procedures. Based on advice given for previous surgery, some patients undergoing cutaneous surgery stop anticoagulation medicines themselves without consulting a physician. Other patients stop anticoagulant medicines on the advice of their referring physician, surgeon or both. Frequently patients on long-term anticoagulation arrive for their cutaneous procedures without the protection afforded by their vital blood thinning medicines. Thromboenbolic events have been reported in cutaneous procedure patients whose anticoagulants were stopped in order to limit ostensible perioperative bleeding.² A recent survey of 168 Mohs micrographic surgeons reported 46 patients who experienced thromboembolic events, including three deaths and 24 strokes after brief perioperative blood thinner cessation.3 Fifty-four percent of the thromboembolic events occurred after warfarin was discontinued and 39% had thromboembolism after aspirin was withheld.³ Discontinuation of newer blood thinners such as ticlopidine, clopidogrel and ardeparin has also been associated with thromboembolism.¹

A retrospective study of 653 patients undergoing cutaneous procedures was performed by Otley, et al in 1996. Some of the patients had their blood thinners (antiplatelet agent or warfarin) discontinued preoperatively. The risk of severe intraoperative and postoperative bleeding in patients taking blood thinners was found very low, not significantly reduced by preoperative blood thinner discontinuation.⁴ Several recent studies have documented that cutaneous procedure patients taking aspirin have no significant risk of postoperative hemorrhagic complications.^5-7 Others have reported no significant risk of postoperative hemorrhage in cutaneous surgery patients taking therapeutic doses of warfarin.^8,9 Furthermore, successful procedures in patients taking therapeutic levels of warfarin without undue postoperative bleeding have been documented in many surgical subspecialties, including cardiothoracic, gastrointestinal, urology, oromaxillofacial, vascular, and ophthalmology.

Cutaneous surgeons may cite anecdotal experience as grounds for blood thinner discontinuation. Some surgeons believe blood thinners cause undue intraoperative bleeding, which interferes with operative dissection. Perceiving undue intraoperative bleeding, the surgeon may inquire as to whether the patient has recently taken blood-thinning medicines. A recent study by West, et al showed that cutaneous surgeons are unable to accurately predict blood thinner status of the patient based on intraoperative oozing.¹⁰ This study helped to dispel some of the myths associated with blood thinners in the setting of cutaneous surgery.

I do not advise my patients undergoing cutaneous procedures to discontinue any blood thinner used to treat a thromboembolic disorder. The following techniques may prove helpful in screening and treating cutaneous surgery patients, many of whom take one or multiple blood thinning medicines.

Preoperative Screening

1. Ask patient about bleeding complications from past procedures (dental extraction, teeth cleaning, invasive surgery). Inquire if they have experienced spontaneous bleeding (GI bleeding, epistaxis) or a large hematoma after relatively minor trauma. Does the patient bleed for a prolonged period after minor cuts and scratches?
2. Routine preoperative INR, bleeding time, and prothrombin (PT) are not usually helpful in predicting operative and postoperative bleeding. Determine if patient has had erratic International Normalized Ratio (INR) values in the past. If values are supratherapeutic (INR>5), the risk of postoperative bleeding increases significantly.
3. Inquire about other conditions that may contribute to bleeding: alcoholism, liver disease, inheritable coagulopathies (hemophilia, Von Willebrand’s disease), acne rosacea, and the use of other anticoagulants that could potentiate bleeding such as vitamin E, Ginko biloba, and nonsteroidal anti-inflammatory drugs.
4. Some patients take empiric aspirin and have no obvious underlying risk of thromboembolism. Many of these patients take aspirin at the advice of friends, family or primary care provider. It is reasonable to temporarily stop such empiric aspirin intake.
5. If patient has a history of severe postoperative bleeding complications, consider non-surgical modalities such as radiation.

Operative Techniques

1. Meticulous homeostasis is vital in managing cutaneous surgery patients taking blood thinners. Make sure to have excellent lighting and wound retraction to assist isolating arteriole bleeding. Use a hemostat to grasp and close the vessel. Secure vessel closed with absorbable ligature. Employ electrocoagulation. If automatic implantable cardioverter defibrillator (AICD) or pacemaker is present, use bipolar forceps to stop small vessel bleeding.
2. Simplify wound reconstruction. Discuss simplifying the reconstruction with the patient. Review the risks of a more noticeable scar vis-à-vis the need for continued anticoagulation. A flap, which may mobilize large amounts of skin, is probably at greater risk for hematoma and wound necrosis. Pursestring closures may work well to minimize postoperative hemorrhage. A purse-string closure does not require undermining and serves to tamponade peripheral wound bleeding. The center of the wound remains open and acts as a drain.
3. Limit subcutaneous undermining. In severe cases, when patients have repeatedly soaked through the dressing whilst in the waiting room, I have closed wounds primarily without any undermining, limiting potential bleeding foci. Close the wound meticulously with multiple layers of absorbable suture to minimize dead space.
4. Second intention healing is also a reasonable choice for wound management. In addition, one may apply Gelfoam® to the wound and secure a pressure dressing over the Gelfoam®. In severe cases, the surgeon can also run absorbable suture such as 5-0 Monocryl®‚ continuously around the wound edges.
5. Fenestrated full thickness skin grafts with a tie-over bolster provide wound tamponade and a collagen substrate for hemostasis.
6. During wound repair, consider using local anesthesia without a vasoconstrictor, such as epinephrine. Vasoconstrictors provide helpful operative bleeding reduction, prolong anethesia duration and reduce total anethetic dose. However, reactive vasodilatation in the postoperative period may predispose to hematoma because potential bleeding points, such as arterial bleeding, are not recognized at surgery.¹¹
7. Drains: in cases where refractory bleeding may continue as a generalized slow oozing, often seen in underlying coagulopathies, I will place a Jackson-Pratt or Penrose drain into the wound prior to repair and withdraw the drain after 48 hours.
8. Prescribe analgesics. This not only keeps the postoperative period more restful but also reduces anxiety, pain and elevated blood pressure. High blood pressure increases intraoperative and postoperative bleeding.
9. Place the wound at rest. Have patient avoid stooping, bending or lifting anything heavier than a 12oz. soda for 72 hours. Have them elevate the site and keep the area dry. Avoid any strenuous activity for 1 week. Emphasize that NSAIDs and aspirin are not to be taken for pain. Give written instructions.

Conclusion

Evidence continues to mount favoring blood thinner maintenance during cutaneous surgery. The risk of life-threatening thromboembolism associated with even brief cessation of blood thinners is significant. Unfortunately, primary care providers will remain unaware of the bleeding risks associated with cutaneous procedures such as Mohs excision and wound repair. The cutaneous surgeon should be aware of the various techniques and tools to reduce the risk of intraoperative and postoperative bleeding in patients taking blood thinners. Notwithstanding, bleeding complications carry far less morbidity and mortality than that of thromboembolism.

Can You Tell if Your Mole is Cancerous?

By Paul J. Weber, M.D., P.A. | Moles can be good or bad, sometimes even experts have difficulty agreeing about which moles are good and bad. However, knowledge of moles is important because, among other reasons at least one out of every three melanoma skin cancers arises in a mole. Because melanoma is lethal if untreated, improved public knowledge of moles and melanoma can and will save lives. The chances that an American will develop melanoma are rapidly rising. If current trends continue, one in every one hundred Americans born today will eventually develop melanoma. One in every five patients who develop melanoma will die from it.

The terms mole and nevus (plural: moles and nevi) mean the same thing and can be used interchangeably. In this article we will use lots of parentheses to indicate that these words that can mean the same thing. Even the experts in the field of dermatology do not agree on the use of all of these terms.

Melanoma tends to occur in adults in the prime of their family and professional lives. Traits and factors associated with melanoma include having many typical (normal) moles, any atypical moles, familial atypical mole syndrome, familial melanoma syndrome, disorders of DNA repair, excessive sun exposure (for your genetic background), freckling, history of severe sunburn, ease of burning, inability to tan, blue eyes and light hair.

Nevi (moles) can look like beauty marks (e.g., Cindy Crawford) or they can protrude like a bump on a witch’s chin (common nevus). Most people have between 10 and 40 moles. Darker skinned persons frequently have darker colored moles. Moles can range in color from pink to tan to brown to black to blue to normal skin tone. Nevi are made of cells called nevo-melanocytes. Nevo-melanocytes, as the name suggests, are cells that exist along the spectrum between nevus (mole) cells and melanocytes. These nevo-melanocyte cells can be totally benign in nature (common nevus cells) or they may become or appear more abnormal, resulting in atypical (dysplastic) moles and even melanoma.

The true behavior of a nevo-melanocytic mole is usually best determined by biopsying (cutting a sample of) the mole and examining the biopsy specimen under the microscope. The website author believes that a microscopic result is more important than the doctor’s clinical naked-eye diagnosis.

However, the dermatologist’s clinical examination by eye is also important because it sets up the biopsy in which the true nature of the mole can be discovered. The medical importance of nevi (how they can affect our health) rests in knowing that some nevi can signal or develop into melanoma, a deadly from of skin cancer. Knowing the A, B, C, Ds of pigmented lesions can help save a life by finding and curing a melanoma.

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Asymmetry	=	not regularly round or regularly oval
Border	=	notching, scalloping or poor definition at the edges
Color variation	=	shades of brown, tan, red, white, blue or black, alone or in any combination
Diameter	=	6mm (or a pencil eraser)
This author disagrees with “D” and advises the public to be wary of the smallest of spots with A, B, and C characteristics.

Fortunately, the A, B, C, Ds have made teaching patients about “bad moles” and melanoma inspection easier, but the A, B, C, Ds are not foolproof or even “expert proof.” They may not be as simple as they sound, or maybe not enough doctors understand them. For example, it has been well shown by many studies and quizzes given to doctors of all specialties using a biopsy-proven, obvious, everyday smattering of important pigmented skin lesions (good and bad moles and melanomas) that most non-dermatologists have a high failure rate at correct diagnosis.

All removed moles, even benign-looking ones, should be sent to pathology for microscopic examination, just in case. The microscopic examination helps to tell us whether the mole is harmless. Sometimes moles that are textbook examples of benign or “good” moles turn out to be serious melanoma, discovered incidentally on a 1 of 1000 chance. If a typical doctor’s practice sees several thousand such patients every 3 to 5 years, that may be a chance save a life.

10% of melanomas may not fit the classic dermatologists’ rules for malignancy. Since early detection and removal is the best way to cure melanoma, the patient can participate actively in his/her own care by self-examination. Signs of concern include a mole’s recent change in appearance, size, shape or color, irregularity in color, loss of a uniform border, asymmetry, bleeding and notching of a border. Moles with any of these signs should be brought immediately to the attention of a dermatologist for close scrutiny of the lesion.

Paul J. Weber, M.D., P.A.
5353 North Federal Highway, Suite 400
Fort Lauderdale, FL 33308
Tel: 954-489-9800 | Fax: 954-489-0401

Maintaining Healthy Skin

The skin serves numerous functions - detoxifying, protecting, regulating - but the primary protective or barrier function is the most obvious. The top layer of skin cells has the most important function in maintaining the effectiveness of the barrier. Here the individual cells overlie each other and are tightly packed, preventing bacteria from entering and maintaining the water-holding properties of the skin.
Fatty substances (lipids) are secreted by the cells during the course of their journey from the base layer of the skin to the top. These lipid molecules join up and form a tough connecting network, in effect acting as the mortar between the bricks of a wall.

The cell wall barriers are simply layers of fats that surround the watery contents. Therefore, the communication mechanisms must operate through these fatty cell walls. In fact, many of the substances that are involved in this communication process are various fats since it is easiest for fats to move within the fatty layers that comprise the cell walls. Despite its bad reputation, proper fats and cellular fats are of major importance in our body’s biochemistry and physiology.

Damage to the skin barrier can result from a combination of genetic predisposion and exposure to sensitizing chemicals and other substances. That is why avoiding irritants is as important as using products that help. In skin care, the most common irritants are usually perfumes and preservatives.

Fatty substances control the majority of our body’s physiology through receptors that activate many important genes. Likewise, our skin barrier is comprised of a supporting structure of collagen, a protein that contains fats that serve a critical function. These fats prevent the excess loss of water through our skin and prevent the cells of our body from becoming dehydrated and dying.

A major sign of a defective skin is the dryness that results from excessive water loss. This water can not be applied topically but must be ingested. To prevent the excessive water loss and the resulting dry skin, we must repair the skin barrier. We find that the skin composition in individuals with dry skin is due to an improper mixture of the skin fats. This is commonly due to a deficiency in our diet of the correct fats, those contained in natural olive oils, avocados, and healthy nuts, etc. On a nutritional basis, we can provide these necessary fats through the skin sometimes through topical treatments containing natural butters or oils, like Shea, olive and cocoa butter. The epidermis is not a usual means to acquire nutrition but it can absorb enough fatty substances to correct the fat imbalances that are the cause of the defect in the skin’s barrier function and thus correct the dry, itchy skin or sensitive skin problem. Try to be aware of chemical preservatives in any topical products you do use.

Although many products today are labeled “fragrance free,” that is really a misnomer. Nearly all products contain some fragrance to mask their chemical odor; so-called fragrance-free products may just contain fewer chemicals than others. What’s more, the fragrances used in many products (even pricey perfumes) are commonly synthetic. For sensitive individuals, this chemical brew can be a problem To make matters worse, many natural fragrances are now extracted using harsh solvents rather than old-fashioned distillation methods, in which fewer chemicals come into contact with the essential oil of the flower. Unless you can determine the extraction method used, be cautious. This is one reason many individuals react negatively to the essential oils used in aromatherapy massages and related products – many are of a synthetic, chemical composition.

According to several studies, various preservatives including formaldehyde, parabens, and others commonly used in skin, hair, and beauty products can also provoke allergic reactions. Although the preservatives are needed to maintain product shelf life and only minute amounts are present in any given product, many products contain these same chemicals, including skin care products, makeup, medications, antiperspirants, toothpaste, and foods. Many of these products are used on a daily basis, causing a higher reaction rate. As a result, the overall exposure to these harmful ingredients is higher than would occur if only a single product were used. Studies show that massage therapists have more contact dermatitis – or skin inflammation - due to exposure to these extracts.

Until recently, few studies investigated the cumulative impact of repeated exposures to preservatives in a variety of products and ingredients. For the majority of people, these product preservatives are an additional benefit, not a problem. But, as the chemical compositions increase, so do the allergic reactions.
If you suffer from sensitive, allergic skin or severe dry skin, you may be among those who will have a problem or reaction to these chemical-laden products. In this case, it is your role as an informed consumer to carefully read labels for all products that come into contact with your skin - internally or externally- to assure that they don’t contain the listed ingredients that you must avoid. Your skin barrier does a lot to protect you naturally, help it out when you can and feed it nourishing chemical-free products whenever you can.

Understanding Skin Care

Skin Care is the first step towards achieving a healthy body. Skin care is an essential part of most people’s daily routine.

Skin care specialists say any imbalance in the protective barrier that envelops the human body provides a perfect breeding ground for bacteria, resulting in many types of skin irritations and accelerating the aging process.

Natural skin care is the care of the skin (the largest organ of the body) using naturally-derived ingredients (such as herbs, roots, essential oils and flowers) combined with naturally occurring carrier agents, preservatives, surfactants, humectants and emulsifiers (everything from natural soap to oils to pure water).

Skin care treatment is going green, but you still have to make sure you read the labels. Skin care treatment may be the least of your problems if you’re a middle-aged male, but many dry skin remedies will also raise testosterone levels. The latest craze in skin care is also the oldest: herbal products.

Natural skin care has its roots in the 4th millennium BC in China and the Middle East. Natural body lotion has become a big business in recent years as more and more consumers seek a gentler, healthier alternative for their skin care needs.

The best skin care beauty tips are not only the right products but also healthy diet. People who use natural skin care products are less concerned with artificial beauty enhancements, as they feel that natural beauty is healthy beauty.

Healthy skin care for skin problems is part of overall good health. Healthy Skincare store sells skin care products that are effective anti-aging treatments for aging skin.

Acne is a common skin care problem for many individuals of all ages and all skin types. Acne Skin Care, no matter what kind of acne treatment you select, an outbreak can still emerge even after all blemishes have vanished.

The skin on your face needs more attention than the rest of your body because it has more oil glands. It is important to not just put sunscreen on your face, but also on your body as well.

Some women are seen with bangs but these bangs look very natural with the face, not a blunt cut style look. Most skin is a combination of skin types, with different areas of the face having different conditions that fluctuate with factors such as weather, diet, stress, health, and travel.

Organic and natural ingredients are healthier and more effective then the harmful chemically based products on the market today. Skin care is becoming increasingly more high tech but at the same time there is growing popularity in natural and organic products.

The single most important breakthrough in skin care is understanding that the only Way to truly moisturize your skin is to get water into it. Proper skin care is important to maintaining health, and is an integral part of overall wound management.

While skin care products in the 1990s were almost exclusively focused on wellness and simple body care lotions, today, skin care is one of the most dynamic and technologically advanced segments of the beauty market.

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.

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.

Healthy Diet Helps Dry Skin

There are lots of things you can do with your diet and supplements that can help your dry skin. To combat dry skin, your body needs fats to build fat-rich cells that hold on to moisture. Saturated, monounsaturated and omega-3 fats are key components in the cell membranes . Vegetarians (who eat eggs and dairy products but not meat) eat about one-third less saturated fat than the average meat eater. Vegans (who eat no animal products of any kind) only receive about one half as much saturated fat as the average meat-eating American. As a result, they obtain from their diet much less cholesterol than omnivores.

Although cholesterol has received a bad name due to concerns about its connection with cardiovascular illness, recent studies show that it does have benefits, particularly for some post menopausal women. Cholesterol is needed for key body functions within the cellular membranes that impact the skin. For example, studies show that cholesterol-lowering drugs can lead to dry skin, while decreased levels of essential fatty acids have been associated with dry skin, dry hair, and brittle nails. If you have these symptoms and you are a vegetarian you may want to speak to your doctor to see if you may suffer from an essential fatty acid deficiency.

The best way to assure you get a healthy diet of skin-enhancing  fats is by eating a wide variety of whole plant foods. You can get fats from nuts, seeds, olives and avocados Use olive oil, replete with monosaturated fat, for cooking and salad dressings. Coconut oil is also an excellent alternative for it retains its stability at high temperatures. Try to avoid processed  foods and deep-fried foods that are rich in trans fats and omega-6 polyunsaturated fats. These fats contribute to the production of free radicals, the by-products of oxidation, which is a skin aging process that antioxidant vegetables help tame. Although for many years polyunsaturated vegetable oils, like canola, corn, safflower, and soy were recommended, canola oil is actually unstable when heated and the processed used to stabilize it turns a certain percentage of the oil into a trans fat.

Eating the undesirable fats found in these oils (as well in trans-fat containing foods such as margarine, most baked goods, fried foods, processed foods and sweets )may increase both wrinkling and the risk of developing skin and other cancers including melanoma. Vegetarians can eat eggs and dairy to obtain saturated fats while vegans can obtain them from coconut oil.

Fish oils are good sources of omega-3 polyunsaturated fatty acids which can increase the lipid content of your cells. They can be obtained from fish like salmon, as well as supplements with Omega-3 or Cod Liver Oil capsules. Omega-3s help your skin by providing essential fats needed for cellular integrity while they also prevent inflammation which can lead to the formation of dark spots in pigmented skin types.
Antioxidants are helpful in fighting free radicals - renegade oxygen molecules that cause cellular aging and wrinkles.

Also look for products that contain ingredients that help your skin retain moisture, such as essential fatty acids along with ingredients like lecithin to strengthens kin cell membranes. Look for products that are also third party tested to ensure they are free of environmental toxins. It is important in purchasing essential fats to ensure that you find a pure, well-tested source, free of environmental contaminants.

Several studies have suggested that it is better to get antioxidants through natural food sources instead of supplements, but if this is not possible or additional vitamin intake is needed, supplements can be a valuable help.

SUPPLEMENTS
The following oral supplements that contain the below nutrients can all be helpful to your skin:

Selenium is a powerful antioxidant mineral. Selenium. Some scientific evidence suggests that consumption of selenium may reduce the risk of certain forms of cancer. However, FDA has determined that this evidence is limited and not conclusive. Vitamins A, C, E, B5, alpha lipoic acid, and grape seed extract,  Ester-C , CoQro, lutein, as well as zinc, selenium, copper, and lycopene. Take these supplements according to the manufacturer’s directions.

Taking glucosamine supplements increases hyaluronic acid production. Hyaluronic acid (also called Hyaluronan) is a component of connective tissue whose function is to cushion and lubricate.  Vitamin C can be especially beneficial,  although it is tough to get ample quantities from supplements, every little bit helps. Be cautious of a laxative effect from vitamin C. take small doses at first then build gradually to endure to reaction has occurred. Buffered vitamin C is also available for those with sensitive digestive tracks. Complementing your daily skin care regimen with skin supportive supplements can boost the benefits to your skin.

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