Got Acne? Other skin problems? Read the live web chat transcript

Welcome! The chat will begin at noon. Feel free to submit your questions now, and we will address them when the chat starts.

Readers: We’re LIVE. Welcome to our weekly Wednesday Web chat. Today’s topic is Acne and other skin disorders. You can ask our experts all your questions about healthy skin and how to overcome the cold weather and its effects too.

Hello, I am Dr. Reginald Henry ( I go by the nickname Buck). I finished college at Duke University, and went to Med School and did my Dermatology training at University of Virginia.

I have been in Dermatology practice here with the Sentara Medical system since 1986.

Please forgive me, I am a very slow hunt and peck typer so you will have to bare with my slowness. I will also make lots of typing errors but will probably not go back and correct them as the point of this is not to correct typing errors, but to be informative in a short period of time. This whole introduction has been pre typed.

I would be happy to try to answer ANY SKIN questions for you. Specific or not.

Before we start, I need to say that there are some questions that I will not be able to answer – rashes are very visual and I more often than not I may not be able to identify a rash only from a description over the internet. Rashes often need to be seen in person, and sometimes even then we have a tough time making a specific diagnosis without a biopsy . There are literally thousands of rashes. So if today a person describes “an itchy rash that consists of bumps and blisters on their legs only in the summer and sort of gets better with a prescription cream”, I will say this could be from hundreds of causes and the rash needs to be seen in person by a DERMATOLOGIST, who knows about those hundreds of rashes.

That being said, I’d be glad to TRY to answer any skin questions that anyone has.

Obviously the internet is loaded with medical information begging to be read. Be sure the source is reputable – careful of websites trying to sell you something. The American Academy of Dermatology (aad.org) is a great starting place for dermatological information.

Any specific questions?

Eczema, or atopic dermatitis (AD), is an extremely complicated problem. Basically patients with AD have very sensitive skin that breaks out with th e most minor insult.

A great resourse is EASE (Eczema Association for Science and education)

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Our experts today are Dr. Reginald B. Henry with Sentara Dermatology and LaDonna Finch, executive director of the Skin Disorders Institute.

Welcome Dr. Henry and thanks for the great introduction.

I have several questions that readers have e-mailed in advance.

Are there creams/ointments that you shouldn’t use for a child’s eczema that you might use for an adult?

regarding AD, moisturizers and topical cortisones are the mainstay of therapy. you need to control the itch because infection can develop in the broken skin.

……

steroid creams that are givento you by an md should be low potency. otc moisturizers are ok for adults and kids

the key to moisturizers is to use them right after bathing when the skin is wet

I am LaDonna Finch, director of the Inflammatory Skin Disease Institute (ISDI) located in Newport News, Va. we do not prescribe or diagnose, however we do supply information. Eczema im infants is fairly common, dry, red itchy skin is classic, it is important to keep the skin moisturized.

I woul ddefinitely suggest getting your grandchild to a dermatologist to get on a specific regimine. very complicated disease, hard to treat over the internet -lots to learn!!!!

Hi LaDonna – Welcome. How would you recommend keeping skin moisturized when it’s sensitive.

Regarding AD, usually cream based (rather than alcohol based LOTIONS) are pretty well tolerated – bath oils are also soothing

People with vitiligo get white spots on their skin. Basically the skin DEPIGMENTS, and all color is lost. Leaving white spots. It is thought to be autoimmune ¿¿¿ the immune system attacks the pigment, causing the problem.

There is no great treatment for vitiligo. Rub on cortisone creams sometimes help, but need to be used for 2-3 years. Light therapy, another immune modulating treatment, also sometimes helps a bit, but again must be done for years and is not all that effective.

Like mentioned earlier apply lotion or cream to moist skin…with in 3 mins. after bathing,

Are there some creams that are better for sensitive skin than others?

Regarding moisturizers, there are lots of brands out htere, CETAPHIL CREAM, CERAVE CREAM are relativel inexpensive and of good quality.

Thew ISDI is a member of the Coalition of Skin Disease-(CSD) they also have a Vitiligo support group that may be helpful. For more infgo you can contact our office at 757-223-0795

Regarding skin cancers, I think as long as you don’t notice any new spots, its perfectly fine to have your GP watch you……….

Readers: We are talking to a dermatologist and the director of a skin disorders institute. They can answer your questions about skin care.

What is VItiligo?

regarding cancers, a dermatologist could tell you more specifically with pix what to be on the lookout for.

people can get acne on the face, ALSO the back, chest , less commonly arms and legs……..

I see you answered the Vitiligo question earlier… sorry.

In regard to creams and lotions there are many over the counter products, what works for some may not work for others. People with dry skin often prefer creams over lotions. The ISDI offers a TRY before you BUY program to sample several types of products,

OK – we have lots of questions about Acne. What is it? And what’s the best treatment? Do you have any opinion on Proactiv which is marketed so aggressively?

hormones affect oil gland activity, there are more oil glands on the face and back and chest than elsewhere. why evolutionarily????? you got me.

First of all it is important to follow up with your doctor if the acne broke out more.

Acne is caused by oil accumulating underneath the skin, stuck behind a plugged up oil gland. It is hormone related (most often seen in teenagers with oily skin whose hormones are rapidly elevating). It often runs in the family. It can be worsened by stress.

Acne cannot be washed off with soap and water, and generally is not felt to be food related. That is not to say that teenagers should not wash their faces or should not eat right, but the cure for acne isn’t simple. Most everyone gets some acne, and most everyone outgrows it by the mid 20’s.

Till acne is outgrown, otc medicated soaps with benzoyl peroxide or salicylic acid can be used as a start. Another over the counter popular medication (with lots of advertising behind it!) is ProActiv. It also contains benzoyl peroxide as the active ingredient ¿¿¿ similar to old fashioned Clearasil. Further than that, there are prescription meds such as RETIN A which are good pore unpluggers. For the deep infected lesions, antibiotics can be used. None of these are 100% effective in getting rid of all acne, but in correct combinations do a good job with keeping it down.

If you can’t get rid of your acne on your own, see a dermatologist who would know the best thing for YOUR SPECIFIC kind of acne.

What do you recommend for face care? How often should you wash? with what?

re acne: you mentioned using a wash – i don’t think washes work well as you put them on and then wash them off – they don’t have time to do anything

Just like other disease treatment everyone does not react the same. There have been many success stories on ProActive. I would suggest once you find what works for you to be compliant and use as directed as often as directed.

re: oily skin, there is really no reason to use a moisturizer if your skin is already oily. you use a moisturizer to MAKE your skin “oily”

For oily skin a lighter lotion may be all you need to moisturize.

Readers: We are talking with a dermatologist and the director of a skin disorders institute. Ask your skin questions now.

For all your health information, go to HealthKey at www.dailypress.com/health every day.

Agree 100% with LaDonna – be compliat with med use. the most common reason pts do not improve on acne therapy is they don’t use their meds – “too much trouble, too time consuming”……

re : acne treatment may be “trouble” but acne is not pleasant either.

I had previously received this question about pityriasis lichenoides chronica (PLC). I wrote this response yesterday again to speed things up.

Since you who have the rash seem pretty interested (or exasperated) by the disease, you probably have already done some internet research and have found out that we know neither the cause nor the cure for the disease.

People who have PLC get patches of dry scaling skin scattered over their trunk and arms. It can look sort of like psoriasis or eczema.

We think the rash is an abnormality of the skin¿¿¿s immune system ¿¿¿ the rash develops from collections of immune cells in the skin. There is nothing wrong with the internal body¿¿¿s immune system, just the skin¿¿¿s immune system.

In any event, because we do not know the trigger for this, we do not know had to cure it. Many skin diseases sort themselves out, in this case the skin¿¿¿s immune system sometimes corrects itself, and the condition MAY resolve spontaneously. Ultraviolet light and topical steroids suppress the skin¿¿¿s immune system, treating the symptoms.

Any answer for Dee?

true adult acne is difficult to treat. it just doesn’t get better like acne in kids. Aldactone is a very clever idea – it is a hormone blocker, often used in women with hormone induced acne . ALONG with BCP’s…..

Yes, I think it might be a good idea to folloup with a dermatologist.

generally, if you have a skin problem that a gp can address, se a dermatologist – this is what we do evrery day

I have just received this email from a reader: Can you ask about winter rashes? All the sudden the doctor tells me I¿¿¿m allergic to soap and lotion and I have to use Dove. Something about dry skin and such and winter.

regarding sue’s comment regarding her sensitive skin, you probably should go back to see your dermatogist – that would be a hard question to answer on the internet without seeing you and talking for a while

Readers: We are being inundated with questions. We will get to everyone as quickly as we can. If you can’t stay for the chat, be sure to check back later at dailypress.com/health and click on Archived Live Web Chats to find the full transcript. Thanks for your interest. We are here until 1 p.m.

ok, another pre written winter itch note……

I have pretyped this short exposee regarding dry skin, so on line time would not be spent with watching me type . Books have been written on this subject, what follows is a brief practical rundown of dry skin care. Below are listed 5 talking points.

Understanding Dry Skin

Normal, healthy skin is coated in a thin layer of natural lipids, or fatty substances. They keep in moisture, leaving the skin soft and supple.

Usually, something in the environment — or something you’re doing to your skin — is stripping away these fatty oils, leaving your skin unprotected.

Just as most causes of dry skin are external, most help for dry skin is external. With careful dry skin care, you can usually help the problem. Obviously dry skin cannot be “cured”.

1) Using moisturizers correctly:

If you have dry skin, you’ve probably already tried a moisturizer. But while moisturizers are a crucial part of dry skin care, we don’t always use them correctly.

The biggest mistake we make is to apply moisturizer to dry skin, when it’s least likely to help. You have to put on moisturizer when your skin is still damp. That way, the moisturizer is trapping the moisture still on your skin. Your skin shouldn’t be sopping wet — just pat yourself dry with a towel and put it on. Let it soak in for a few minutes, and then towel off the excess.

You’ve also got to get the right type of moisturizer. People with dry skin need to use moisturizers that have no perfumes or alcohols. The moisturizer must also be thick and greasy in order to seal in the moisture needed for good dry skin care. Creams (thicker) work better than lotions (thinner).

2) Dry Air

Dry air is probably the most common cause of dry skin, especially during the winter, it draws the moisture right out of the skin. Dry skin during winter even gets its own name: winter itch.

While cold, harsh weather does dry your skin, another big problem in the winter lies indoors — the dry heat churned out by your furnace. (During the summer, air conditioning can have a similar effect.) To counteract the dry heat, start with a moisturizer. Turning down the thermostat a bit in the winter can also help,

3) Long, Hot Showers & Baths

Prolonged exposure to water — especially hot water — can wash away the natural oils that protect your skin. If you get out of the bath or shower and your skin feels tight, it’s dried out.

Try to limit showers to a few minutes, skip the hot water, and unless you are really dirty, there is no need to shower every day. You might want to apply a BATH oil to your skin while it is still wet. Afterward, pat your body dry with a towel — rather than vigorously rubbing it — and put on a moisturizer right away. This is called the SOAK and GREASE method. It traps water in the skin. This idea is also applied to dry hands. Minimize the handwashing, and moisturize afterwards, to prevent the dry cracking.

4) Soap

One of the biggest problems people have with dry skin stems from their soap. Soap removes your skin’s protective oils (that’s what it is for, to remove oil and dirt), and we tend to use way too much of it.

The average person who goes to school or work just doesn’t get very dirty during the day but in the shower many people scrub at their skin like it’s the bottom of their shoes. Unless you’re a child or a ditch digger, the only parts of the body that need any soap at all are the face, hands, feet, groin and underarms. The rest of the body can usually just be rinsed off with water.

While our mothers always told us to wash our hands frequently, that can also lead to trouble. Ironically, while done in the quest to rid ourselves of germs, excessive hand washing can dry out the skin and cause it to crack and bleed, making infection much more likely.

Many of us choose unwisely when we’re in the soap aisle of the supermarket. We go for harsh soaps, such as deodorant or antibacterial soaps, that generate lots of lather and leave us feeling squeaky clean. The bubbling and lathering from soap removes the oils from the surface of the skin and dries it out.

5) AGING

¿¿¿ As we age , our skin dries out because it wears out from chronic environmental insults (sunshine, chemicals, etc), and our oil glands do not produce as much oil because of a drop in hormone levels. As many as 75% of people over 64 have dry skin. Other people, regardless of age, are simply genetically prone to dry skin.

Any answer for the Dove soap question. What does it contain that ‘s good for winter skin?

Dove contains less surfactants, less ingredients to remove oil from your skin

Interesting. Thanks!

sorry dee, BCP’s are birth control pills

Winter and heat in our homes can be tuff on sensitive skin. There are some soap free cleanser on the market, and moisturizers that are free of certain allergens, a dermatologist could help direct you

Sue with “bumps on the face” – again would have to see the bumps to give you a dx. tehy are PROBLY areas of oil gland overgrowth – sebaceous hyperplasia – unfortunately a part of the aging process – nothing to slow that down 🙁

lots of very complicated questions – hard to answer by internet typing…….

LaDonna — Can you answer the sunscreen question?

There is much controversy in regard to ACCUTANE, there are new rules and regulations for its use. It has been on the market for decades and has helped many, a good question about its safty and one that should be dicussed with you doctor.

Readers: We are talking to Dr. Reginald B. Henry 111, with Sentara Dermatology and LaDonna Finch, director of the Skin Disorders Institute. They have the answers to your skin questions.

frances, yes, we can remove small milia (cysts) on the face.

accutane is safe , all meds have very rare side effects – got to be sure any disease is bad enough to “risk” treatment. talk with you r doc

What was the controversy with Accutane about? What were the perceived dangers?

sunscreens- great question – try a chemical free sunscreen…..

Bolck the sun not the fun…if you have problems with sun screen there are other ways to avoid the sun with clothing and beware aware of the hours, the worse time is 10-2

neutragena purpose aveeno all make chemical free sunscreen – no chemicals – just zinc oxide/ titanium dioxide – tiny particles that are inert – block sun by reflecting it back -won’t irritate the skin

Thanks for those specifics on sunscreen, Dr. Henry

regarding chemical peels, I don’t do them – more of a plastic surgery question – sorry

There is also a vanicream sunscreen that is chemical free and is used by many

Dr Henry may be able to address this in regard to chemo. There are benifits with risk

Readers: We have just a few more minutes for you to ask your questions. Dr. Henry has momentarily lost Internet connection but hopes to be back with us soon.

Yes, everyone reacts differently, the internet supplies general info and guidelines.

Again, if you want to see the whole transcript after the chat — and there’s tons of information here, go to www.dailypress.com/health and click the tab Archived Live Web chats.

online

i’m back

The issues with accutane are detailed, Guidelines have to be followed by the patient and the doctor. Birth control during use of accutane is an issue if you are child bearing age.

Thanks for that info on accutane, LaDonna

re plc, diseases don’t read books. books necessarily have to talk in generalizations. all diseases run on bell curves, ther’s always an outlyer

Any advice on acne scars? That would seem to be a very common concern.

re: acne scars, you talking about true thick scars or dark spots?

We are lucky in the Tidewater are to have a SKIN OF COLOR RESEARCH INSTITUTE, it is a part of Hampton University, they may be helpful.

Dr. Henry — could you give advice for both types of acne scarring?

I have some other questions that were e-mailed from readers: A couple about rosacea. Could you tell readers what rosacea is and what the recommended treatment is?

true scars – thick skin or depressed skin- may fade with time -steroid injex may help if they ar very thick. MEDERMA MAY help the thick scars. DARK SPOTS ( NOT SCARS) cwil fade with time bleachinfg creams help……

more pretying:

Rosacea (also known as adult acne) is a very common condition. It looks similar to adult acne except it is generally seen in older individuals, and in addition to acne pus bumps, patients also can develop broken blood vessels.

Maybe 15% of patients with rosacea on the facial skin also can get rosacea in the eye (ocular rosacea) . those patients get red eye (conjunctivitis) and can also get styes from plugged up oil glands around the eyes which can get infected.

Treatment is with topical antibiotics, antibiotic soaps and cleansers, an doral antibiotics. All of these need a doctor¿¿¿s prescription.

Rosacea is a common inflammatory skin disease characterized by flushing,redness usually on the face

yes good point, pts with rosacea FLUSH which worsens th eredness over time

anything you can do to minimize th e facial flush will help decrease the longterm permanent redness……

plastic surgeons have lasers that can help the red broken blood vessls – doesn’t really treat the underlying problem though

There is no cure for Rosacea, there are positive treatment and symptoms can be reduced

Is diet considered to be a factor in any of these skin diseases?

LaDonna, tell me about the Skin of Color Institute

Diet can play a factor, in many diseases,

Any particular foods to avoid with inflammatory skin diseases?

diet and rosacea -caffeine, hot foods, spicy foots, alcohol, all can IN SOME PEOPLE , causing flushing which then worsens the permanent longterm redness

Experts: Please let our readers know how they can reach you for any follow-up questions/information.

other inflammatory diseases – suggestion: EAT RIGHT. avoid fatty foods – makes psoriasis worse. avoid too much alcohol – makes eczema and psorisis worse. TAKE CARE of your body – you’ve only got one for one go around

I had a long e-mail from a gentleman over 80 who wonders if his seasonal skin rash (more than 10 years) on his legs could have to do with contact with Agent Orange? your thoughts?

The Hampton University Skin Of Color Research INstitute is a wonderful resource.

It started in Sept of 2010. Dr Valerie Harvey from EVMS is very involved. I will be glad to send you more info from my office.

Death Becomes Her – great bruce willis goldy hawn marel streep movie about taking care of yourself

LaDonna — that’s great information. I wasn’t aware of it. Could you also tell readers where they can find you at the Skin Disorders Institute and what kind of help you provide.

Dr. Henry — I think that’s the first movie recommendation we’ve had during a health chat!

i’m at sentara dermatolgy specialists on kempsville road.

Dr HArvy at EVMS is a wonderful woman. great help to our derm community – glad she’s helping out over there

Yes, you can call the ISDI 757-223-0795. I am honored to sit on the board of the HUSCRI and can provide more info, per request. Or you can contact them directly.

Any answer for Chuck?I notice we’re getting a lot of adult acne questions.

re: Nature’s cure for acne =- don’t know of that specific product – but if it works , go for it. There are lots of htings that help specific disease, glad you found something that works

skin disease is so odd – so many things work in some people but not in others..

I am not familiar with that either, however, like Dr H says if it works and there are no contrindications

Dr. Reginald Henry and LaDonna Finch — Thank you so much for your expertise in answering the many questions we had today. Readers can access the chat at www.dailypress.com/health under the Tab, Archived Live Web Chats.

I have some pts who swear by one product, other pts cannot believe I gave them that same product for the same disease. “a total waste of money” we try ……

thanks to everyone for attending

Thank you for having me on this web chat

Look for our Live Health Chats every Wednesday at noon and the last Friday of the month at 11 a.m.

Our next chat is on Jan. 26 at noon on the subject of seasonal affective disorder and depression.

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The chat is now closing. Bye!