Budget Friendly Skin Care

Affordable Skin Care Options

I often get emails from our DesiDerm  readers about affordable skin care regimens. I always like to point out that skin care does not have to be terribly expensive to be good. A few suggestions:

-- Always a moisturizer with sunscreen in the am. As a woman of color myself, I see many patients with brown skin who do not think sunscreen applies to them. Sunscreen is the single most important way to minimize aging, discoloration, and wrinkles. A few inexpensive brands I like are Neutrogena with Helioplex, Anthelios, and Cerave am.

Could my white spots be vitiligo?

Vitiligo, which presents with milky white patches on the skin, is of significant social stigma in the Desi community. It interferes with marriages, jobs, and overall quality of life. Scientiifically, vitiligo is characterized by destruction of melanocytes (the pigment producing cells). It is estimated that up to 2% of the worldwide population is affected by vitiligo- and perhaps even more among Desis!

Help, I have bumps on the back of the head?

Dear Dr Tareen,
Several years ago my barber cut the back of my head with clippers that seemed too sharp. The back of my head broke out and various treatments have only had temporary and minimum affect. I  have tried everything but the bumps always come back with a vengence. Please help


Dear Reader
Thank you for your inquiry. It sounds as if you have developed a condition called acne keloidalis nuchae (AKN). This is more common in ethnic skin and typically occurs after some trauma to the area (such as the cut that you described). The bumps that develop are due to ingrown hairs. They can sometimes be successfully treated with simple acne medications (such as over the counter benzoyl peroxide wash) or prescription acne products (such as Retin-A). Occasionally injections of cortisone or surgical/ laser removal may be necessary. Consult a dermatologist as this may be a recurrent problem.

In addition, please contact the common skin conditions page of desidermatology.com. There you can read about the condition called pseudofolliculitis barbae (PFB) which is the same skin problem as AKN, just located in a different area (beard area). http://www.desidermatology.com/common_skin_conditions.html#Razor_Bumps_in_ethnic_skin

what can I do for depressed acne scars and oily skin (ps I don't have a lot of money)?

Thank you for your inquiry.  Depressed scars are certainly damaging to your self esteem and we can work together to make yours better!

The best method of treatment is with fractional laser treatments. Ablative laser treatments are stronger and require fewer treatment sessions. However, there is some down-time involved while your skin heals. Also, if not done properly there is a small risk of hyperpigmentation or raised scars.  

Non-ablative laser treatments are also very effective. These treatments are less intense, thus requiring more treatment sessions. However, the risk for discoloration and scarring is very minimal.

In terms of oily skin, you should begin to use a retinoid (retin-a, differin, tazorac). This is a prescription vitamin A cream that helps normalize the oil production of your face. The added benefit is that the retinoid cream can stimulate collagen below the skin surface to help heal your scars as well. 
For more information about lasers, please see the "laser" section of desidermatology.com

Since finances are an issue, I want you to know that most of the products out there that claim to help scars ae ineffective -don't waste your money or time. A regimen of retinoid + laser will definitively work for you :)

Sincerely,
Dr Tareen
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Hyperpigmentation after laser hair removal?

Dear Dr. Tareen,I have beige skin and had recently laser hair removal done. It resulted in scabbing and left me with hyperpigmentation aournd my lips and chin. Please tell me what options I have to remove brown patches?

Dear Reader,

That is an unfortunate side effect. There are many things you can do to minimize the discoloration and scarring. I am glad that you wrote to me because the sooner we start, the less discoloration will result!

1. Most importantly, do not pick at the scabs. This will only increase the depth of the skin injury and will result in longer healing time.
2. Keep the skin hydrated (we will talk about which topical options are best) so that it may heal quickly.
3. In terms of topicals, it is important to start a lightening agent immediately. The options include hydroquinone (2% is over the counter and 4% is presciption strength), azelaic acid, or kojic acid.  If the skin is very inflammed, you may opt to mix a small amount of hydrocortisone 1% cream (over the counter) with your lightening agent for 3-5 days (or until the inflammation subsides).
4. Keep the area covered with broad spectrum sunscreen during daylight hours. Even light through the windows can further the discoloration.

Now, lets discuss which factors may have led to your discoloration:
-Your doctor may have not been using the correct laser for ethnic skin tones (for further discussion of which laser is safe, please see the "Laser" section).
-Your doctor may be using the right laser, but may have used too high of energy for your skin tone
-You may have had a slight tan and this may have led to the discoloration

I hope these suggestions help. Please let us know how your are doing :)

Can food cause acne?

For years, people with acne have wondered if their diet affects their skin. Most dermatologists are pretty adamant in saying "No, diet does not cause acne." This is because, until recently, large scale scientific data was lacking. However, new developments suggest that diet may play a factor in causing or influencing the severity of acne.

 A few main foods have come to the forefront:
--Milk: Two large controlled trials found that cow's milk increased both the number of people who got acne and its severity. Milk contains large amounts of testosterone and other androgens. These hormones directly feed into the oil glands that produce acne.

--High glycemic foods: These include simple carbohydrates such as bread, rice, cereal, pasta, sugar, and flour. Other large randomized prospective controlled trials found that people who had higher simple carbohydrate intake had significantly more acne. Furthermore, low-glycemic diets in under-developed parts of the world were associated with reduced incidence of acne.  These simple carbohydrates quickly raise insulin levels, stimulating acne lesions.

So contrary to previously held views, diet may have a role in triggering acne. A good regimen from your dermatologist combined with a balanced diet is a surefire way to insure that clear, glowing skin that you desire!

Does ethnic skin really need sunscreen?

A common misperception among people with ethnic skin tones is that sunscreen is only for whtie skin.  While it is true that darker skin has a lower risk for skin cancer and sun damage, direct exposure to the sun can have a significant impact on ethnic skin -- causing discoloration, premature aging, and even skin cancer.

Skin color is determined mostly by the presence of a substance called melanin. Melanin is what gives skin its pigment. When skin is exposed to the sun, the body stimulates increased melanin production, leading to darkening of natural skin tone.  While many perceive this "bronzing" of skin to be healthy, it is quite the opposite.  The melanin can lead to pathcy discoloration which is often difficult to treat.  More importantly, however, the sun leads to breakdown of the skin's DNA.  These DNA mutations increase ones susceptiblity to skin cancer.  

If DNA damage is not enough to encourage you to wear sunscreen, consider this:  sun damage is the most preventable cause of aging. In ethnic skin, this sun damage manifests as brown spots, deep lines, and sagging of the skin.

We have all heard the cliche "an ounce of prevention is worth a pound of cure."  Literally, an ounce (or more) of sunscreen on a daily basis will save you pounds of money and aggravation when you look fabulous later on in life!

For further questions about sunscreen feel free to contact me via "ask the dermatologist." 

Can laser hair removal actually stimulate hair growth?

The simple answer is yes-- laser can sometimes actually stimulate more hair growth.  A recent article published in The Journal of Dermatologic Surgery reported that widespread use of lasers by a variety of users (nurses, doctors, beauty technician) has led to a surprising yet increasingly common side effect -- stimulation of hair growth.  In fact, this may be as high as 1-10% depending on the type of laser that is used.  In addition, this regrowth is most common among individuals with ethnic skin- particularly South Asians and Mediterranean ethnic groups.

Why does laser actually stimulate more hair?  There are several explanations --  all of which stem from improper use of lasers. 

The most common reasons for failure of laser hair removal reported in Dermatologic Surgery are:

1.  Using inadequate ('too weak') energy on ethnic skin for fear of creating scarring/pigmentation

2.  Not creating a deep enough treatment zone (again for fear of burning/ scarring) which may in turn stimulate new growth  

Fortunately, this side effect is preventable by an experienced physician using the correct laser at the correct depth.  In fact, according to scientific studies, the treatment of increased hair after laser hair removal is actually laser used at proper treatment parameters!

If you have been unfortunate enough to experience increased hair growth after laser treatment, I recommend finding a board certified dermatologist  or other appropriately trained physician to perform your procedure. 

"doctor, I DEMAND to stick with my ineffective cream"

"But can't I just keep using the cream I have at home?"  I get this question all of the time. Suprisingly, from the patients with the worst skin. A patient will come to me covered with severe acne, scars, and discoloration. I will take my time to formulate a treatment plan that encompasses cleanser, moisturizer and sunscreen. Inevitably, as we are about to part, the last question is- "but do I have to stop using what I already have at home?"  As Einstein once said, "the definition of insanity is doing the same thing over and over again and expecting different results."

I never understood why a patient would be so loyal to a cream that clearly is not working. A recent NY Times article sheds light on this. In fact, the less effective a beauty product or treatment, the more likely women are to keep using it!  Researchers recently surveyed 300 women and found they were more loyal to products and treatments when they didn’t work rather than when they did.

The NY Times article theorized that when people don’t feel good about themselves, fear is a more powerful motivator than success. Fears about looking older spur women to keep using the same production -- even when they don’t work. Once they have success however, such as younger-looking skin, their anxiety dissipates, and they stop worrying about it.

Ultimately, we are all creatures of habit.  While I may not be able to convince people to stop buying and using ineffective creams, I can hope that using the correct regimens in combination with their ineffective creams will give them the improvements and satisfaction that brought them to see me in the first place.

http://well.blogs.nytimes.com/2007/12/14/wrinkle-cream-not-working-give-me-two-more-jars/#more-157

Losing the Post C-Section Bulge Today

(HealthNewsDigest.com) - Roslyn, NY, January 2010

With the cesarean section rate on the upswing in the United States, also growing is the number of women seeking ways to reduce the “c-section bulge” that often sits just above the scar. A new safe and fast fat removal technique may be the answer, says Dr. Mohiba Tareen, clinical instructor in Dermatology at Columbia University and cosmetic dermatologist with Advanced Dermatology of New York and New Jersey, who recently used the new laser system herself.

According to the U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, in 2007, the most recent year for which statistics are available, nearly one third (32%) of all births were cesarean deliveries, a number that has been growing steadily for the past two decades. Many women who have had c-sections complain about a bulge or pouch just above their surgical scar that is very resistant to diet and exercise.

Until recently, in fact, the only sure way to remove that extra fat was through surgery, liposuction or a tummy tuck. However, says Dr. Tareen, the Zeltiq cool sculpting system shows promise in helping women regain their pre-pregnancy shape. “As a board-certified dermatologist on staff at Columbia University, I am sometimes skeptical of claims made by manufacturers of the new laser systems for skin tightening and weight loss,” Dr. Tareen says. “However, I am pleasantly surprised by Zeltiq. I underwent a one-hour treatment on my abdominal area, on the area above my c-section incision, and within four weeks I began seeing excellent results.

“It is a ‘dirty little secret’ that women often develop a little pouch of tissue above their cesarean scars due to tissue laxity. This area is quite difficult to treat even after all of the pregnancy weight has been lost. I treated this area and am seeing a great flattening and tightening effect,” Dr. Tareen says. “Zeltiq has accomplished what I could not do with diet and exercise, including weekly two-hour abdominal exercise classes. This new procedure, which is safe, non-surgical and affordable, gives hope to all the other mothers who have had c-sections.”

Zeltiq is one of only two non-invasive fat-reduction methods to be approved by the Food & Drug Administration. The procedure’s CoolSculpting device uses controlled cooling (selective cryolipolysis) to essentially freeze fat cells in the area being treated. The cold causes the fat inside the cells to crystallize, which kills the cells and allows them to be reabsorbed into the body. According to Dr. Joshua Fox, director of Advanced Dermatology, P.C. of NY and NJ and a spokesman for both the American Academy of Dermatology and the American Society of Dermatologic Surgery, fat cells, like all other types of cells in the body, die naturally on their own. “Zeltiq speeds the process, reducing the number of fat cells in the area being treated and reducing the overall mass of fat in that area.” After about three or four months (the time it takes the cells to die and disappear), you’ll see a slimmer bulge, he says.

About the size of a fat paperback novel, the Zeltiq device is attached to a small hose that delivers suction. During treatment, the doctor skillfully places the device over the area to be treated, where it pulls the bulge into place and administers a dose of fat-freezing cold; a treatment lasts about an hour. “Most people report little to no pain or discomfort,” says Dr. Fox. “You’ll feel a slight tug and your skin getting cold, then going numb as the cells are frozen.” Following the procedure patients might see some redness or rarely bruising, but most patients say they don’t see any negative effects. Although most patients get significant improvement with just one treatment, the area can be retreated for more dramatic improvement.

Dr. Fox says that while Zeltiq just may be the answer new moms are seeking to help them look and feel better about their appearance, women should consider the following when considering a Zeltiq removal procedure:

• Do you have a noticeable bulge above your c-section scar that you

would like to reduce?

• Do you want natural-looking results without surgical intervention?

• Do you want a procedure with minimal pain or discomfort?

• As a new parent, do you need a procedure with no downtime?

• Do you prefer a natural process over drugs, chemicals or surgery?

What is the best way to remove unwanted hair?

The pursuit of eliminating unwanted facial and body hair is a challenge for desi skin.  Dark hair and brown skin poses a unique set of challenges.  The most important factors in selecting the best means of hair removal are as follows:

1. Longevity (hopefully permanent) removal of hair
2. Ease of removal (painless, limited number of sessions)
3. No side effects of scarring
4. Price

Below is a brief summary of these four factors.

Threading
This is the least expensive and perhaps one of the easiest means of removal.

1. Longevity:  Threading is only a temporary form of hair removal. Hair typically grows back within 1-3 weeks
2. Ease of removal:  Can be painful. Usually threading is limited to small areas such as upper lip, or eyebrows
3. Side effects:  minimal 
4. Price:  inexpensive 

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Waxing
Similar to threading

1.  Durability:  Similar to threading in that hair typically grows back 1-3 weeks
2. Ease of removal: Typically waxing is less painful than threading and can be done on larger areas (ie leg, back, etc)
3. Side effects:  Minimal although small chance of discoloration/irritation. Unfortunately, waxing may lead to ingrown hairs that may then scar in desi skin.
4. Price:  inexpensive 

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Electrolysis

A permanent means of hair removal but has fallen out of vogue with newer laser treatments that equal permanent nature of hair removal without the large time commitment.

1.  Durability:  US FDA approved as a permanent means of hair reduction
2. Ease of removal:   Painful.  Needle placed into individual follicles.  Requires multiple sessions.  Very time consuming.
3. Side effects:   very safe, there is a small risk of discoloration and scarring if not done properly.  If you opt for electrolysis, make sure your technician is a board certified electrologist.
4. Price:  moderately expensive (from $15 to $100 a treatment) 

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Laser

There are multiple types of lasers. In our next blog we will discuss which laser is best for desi skin tones – stay tuned! 

1. Durability:  if done properly laser can reduce hair growth permanently by 80- 95% 
2. Ease of removal: Quick and relatively painless if done properly. Your dermatologist may use numbing cream or cold air to help minimize pain.
3. Side effects:  If done by an experienced dermatologist side effects should be minimal. However, laser in desi skin is tricky. If not done properly there are many risks of laser- burns, discoloration, and scarring to name a few. 
4. Price: depending on area, can be between $100 (lip) to $400 (back) a session. If done properly, it should only take 4-6 treatments to achieve permanent hair reduction. Thus, laser and electrolysis eventually end up costing the same. 

Meet Dr. Mohiba Khan Tareen

Dr. Tareen is a magna cum laude graduate of the University of Michigan, where she was a member of the Phi Beta Kappa honor society.  She continued her postgraduate studies at the University, where she earned her medical degree and was inducted into the Alpha Omega Alpha Honor Medical Society.  In her senior year of medical school, she received two different and distinct honors.  The Michigan Association of Physicians from India (MAPI) awarded her work with an academic scholarship and the American Medical Women’s Association awarded her as one of the five top female graduates in her class.

Dr. Tareen completed her dermatology residency at Columbia Presbyterian Medical Center in New York, New York.  During this time, she also lectured extensively and has had her work published in the medical literature.  Dr. Tareen is currently a clinical instructor in Dermatology at Columbia where she actively teaches the dermatology residents.

Dr Tareen completed a Cosmetic and Laser Fellowship where she specialized in advanced aesthetic techniques. She is a member of the American Academy of Dermatology, the American Society for Dermatologic Surgery and the Women’s Dermatologic Society.

In her free time, Dr Tareen enjoys spending time with her son.  She and her husband, also a physician, reside in New York City.