Wednesday, April 16, 2014

Q&A Uncovering The Cause Of Armpit Irritation

Cosmetic Dermatology
Dermatology Times January 2014

Zoe Diana Draelos, M.D., is a Dermatology times editorial adviser and consulting professor of dermatology, Duke University School of Medicine, Durham, N.C.

Q: Why do antiperspirant/deodorant cause skin irritation?

A: Antiperspirants and not deodorants are the culprit in skin irritation. The antiperspirant decreases sweating while the deodorant simply provides a pleasant scent to the armpit.
   The active ingredient in all widely marketed antiperspirants is an aluminum salt possibly mixed with a zirconium salt. The aluminum salt is very irritating to the skin, especially in high concentration. As a matter of fact, the aluminum salt functions to decrease the release of perspiration from the armpit by coagulating protein in the eccrine and apocrine sweat ducts, and it may also coagulate the stratum corneum protein lining the armpit as well. More modern antiperspirant formulations minimize this irritation by incorporating dimethicone, listed on the skin protectant monograph.
   For patients that experience irritation from antiperspirant/deodorant and wish continue using these products, it is possible to offer some advice. The antiperspirant/deodorant should be applied at night since the armpit is at rest with less sweat and will work better. In the morning, a thin dimethicone-based moisturizer could be applied to the armpit. This provides a compromise between sweat reduction and skin irritation.

Q: Do lipsticks protect against lip sun damage?

A: Lipsticks provide excellent photo protection if they are completely opaque. As a matter of fact, opaque lipsticks provide better photo protection than SPF- containing lip balms because they have an unlimited SPF and excellent substantivity. Substantivity is the ability of the lipstick to remain in the place on the lip. Products that stay on better provide superior longer-lasting photo protection. The best lip sunscreen for female patients with actinic cheilitis is an opaque lipstick.

Q: Do lipsticks contain lead?

A: The presence of lead in lipsticks has created a stir on consumer websites. Indeed, there are some dyes, especially red dyes, which are used in lipsticks that may contain trace amounts of lead. Remember that the government regulates the pigments used around the mouth, where ingestion may occur. This regulation is necessary to prevent safety issues. The trace amounts of lead that may be found in lipsticks are not felt to be health issue and indeed the amounts are very small compared to the lead contamination possibilities from old lead based paints.

Q: Which sunscreens are more likely to cause acne?

A: Many patients claim that they do not wear sunscreens because they cause acne. I do not believe that it is the organic and inorganic filters that cause acne, but rather the vehicle in which the sunscreens are suspended. It is even unclear that the vehicles contain ingredients that cause acne.
  Most patients that complain of acne within 48 hours of applying sunscreen probably are not experiencing true acne with follicular contact dermatitis or possibly miliaria rubra and miliaria pustulosa. The irritant contact dermatitis could be due to the emulsifier in the formulation and the miliaria rubra or miliaria pustulosa could be due to occlusion of the ecrrine sweat units with the sunscreen film.
  It is hard to generalize as to which sunscreen formulations are more likely to cause acne-like skin problems, but thicker creamier products are probably the culprits. It may be worthwhile to suggest to patients who claim that sunscreens cause acne-like eruptions to consider a spray formulation.

Don't Worry, Get Botox

The New York Times
March 2013

Don't Worry, Get Botox

FEELING down? Smile. Cheer up. Put on a happy face. No doubt you've dismissed these bromides from friends and loved ones because everyone knows that you can't feel better just by aping a happy look.
      Or perhaps you can. New research suggests that it is possible to treat depression by paralyzing key facial muscles with Botox, which prevents patients from frowning and having unhappy-looking faces.
      In a study forthcoming in the Journal of Psychiatric Research, Eric Finzi, a cosmetic dermatologist, and Norman Rosenthal, a professor of psychiatry at Georgetown Medical School, randomly assigned a group of 74 patients with major depression to receive either Botox or saline injections in the forehead muscles whose contraction makes it possible to frown. Six weeks after the injection, 52 percent of the subjects who got Botox showed relief of depression, compared with only 15 percent of those who received the saline placebo.
     (You might think that patients would easily be able to tell whether they got the placebo or Botox. Actually, it wasn't so obvious: Only about half of the subjects getting Botox guessed correctly. More important, knowing which treatment was received had no significant effect on treatment response.)
     Other studies over the past several years have found similar effects of Botox on mood. Micheal Lewis at Cardiff University reported that non depressed patients at a cosmetic dermatologist clinic receiving Botox injection about the eyes frowned less and felt better than those who did not receive this injection. And M. Axel Wollmer at the University of Basel Found that Botox injection was superior to a placebo in a group of depressed patients.
     Is paralyzing the muscles involved in frowning truly enough to make depressed patients feel better? The notion that your expression can exert a powerful influence on your mood turns our sense of psychological causality on its head. After all, we smile because we feel happy, and cry because we feel sad, not the other way around, right?
    Not necessarily. The idea that facial expressions may feed information back to our brain and influence our feelings goes back to a theory of emotion first proposed by Charles Darwin. In "The expression of the Emotions in Man and Animals, " Darwin posted that the control of facial expression causes a liked effect on subjective emotions. William James took the idea further and proposed that emotions were the result, not the cause, of various bodily sensations, suggesting that "we feel sorry because we cry, angry because we strike, afraid because we tremble, and not that we cry, strike, or tremble, because we are sorry, angry, or fearful, as the case may be."
   We are used to thinking of the brain, not the body, as the prime mover of our emotional states. Consider the field of so called psychosomatic medicine, which emphasizes a mischievous flow of information from brain to body: hence, the psychosomatic stomachache, headache and the like. You can literally worry yourself sick.
   The Botox studies, by contrast, suggest a circuit between the brain and the muscles of facial expression in which the brain monitors the emotional valence of the face and responds by generating the appropriate feeling. (Obviously, information flows in both directions, as you can think yourself into practically any emotional state and then have the face to match it.)
   There are other treatments for depression that appear top use facial feedback in a similar way. Light therapy stimulates the retina and excites the optic nerve, which sends signals directly to the brain and effectively treats seasonal depression. And the direct electrical stimulation of the brain's vagal nerve has antidepressant effects.
   Botox for depression is part of a long tradition of "outside-in" somatic therapies- many of dubious efficacy- that manipulate the body with the aim of altering the brain and mind, for instance by using cold wet sheet packs to treat severe agitation or acupuncture for anxiety.
  In a broad sense, these Botox studies underscore one of the biggest challenges in treating people with depression. They might think that the reason they are depressed is that they have little interest in the world or their friends- a mistaken notion that is the result, not the cause, of their depression. They insist that only once they feel better will it make sense for them to rejoin the world, socialize and start smiling. Their therapists would be well advised to challenge their invested sense of causality and insist that they will start feeling better after they re-engage with the world.
  Whether Botox will prove to be an effective and useful antidepressant is as yet unclear. If it does prove effective, however, it will raise the intriguing epidemiological question of whether in administering Botox to vast numbers of people for cosmetic reasons, we might have serendipitously treated or prevented depression in a large number of them.