Acne Treatment: What’s Safe During Pregnancy and Breastfeeding?

                                             

While bringing a precious little one into the world is a joyous occasion, there are also the not-so-joyous effects of those pregnancy hormones, including acne. During the first few weeks of pregnancy, there is a rise in progesterone and other androgens that can increase oil production and formation of acne.  For many women, acne improves in the second trimester and onward, but for others (myself included!) breakouts can persist throughout pregnancy and into the postpartum period. While several traditional acne treatments are contraindicated during pregnancy, thankfully there are several safe treatment options available to help you get that pregnancy glow.

Over-the-counter topicals and washes

·      Alpha-hydroxy acid (eg. Glycolic acid) containing peels, washes, and creams

o   These are essentially fruit acids

·      Benzoyl peroxide washes and creams (eg. Panoxyl wash)

Topical prescriptions

·      Azelaic acid (Finacea) gel or foam

o   This may also be helpful for that pesky pigmentation (melasma) that occurs during pregnancy.

·      Clindamycin or Erythromycin topical lotion, gel, or solution

o   Topical antibiotics that help reduce the amount of acne-producing bacteria on the skin

Oral Antibiotics

While we typically try to avoid oral medications during pregnancy if possible, there are a few safe options if acne continues to worsen despite topical treatments.

·      Azithromycin

·      Erythromycin

·      Cephalexin

Light Therapy

Blue light therapy or photodynamic therapy is an in-office therapeutic option for acne, which involves shining a blue light on the face for several minutes at regular intervals. This is often not covered by insurance but provides a safe option during pregnancy.

 What isn’t safe?

Acne medications such as isotretinoin (Accutane), doxycycline, minocycline, and spironolactone are absolutely contraindicated during pregnancy due to a risk of birth defects. While absorption is likely quite low, topical retinoids, including tretinoin, adapalene, retinol, and tazarotene are also not recommended. As several of these medications can come in combination prescription drugs and over-the-counter creams, make sure to check the ingredients on your prescriptions and moisturizers to avoid these. Additionally, products containing salicylic acid and sodium sulfacetamide are discouraged, both of which can be found in over-the-counter acne products.

The recommendations while breastfeeding are typically similar to those during pregnancy, but when in doubt, please consult your doctor first.

If you are one of the many of us that struggle with acne during and after pregnancy, we would love to help you get on a safe and effective regimen!

I Scream for Eye Cream

When I was younger and crow's feet had yet to appear around my eyes, I often wondered why there had to be a special cream for the eye area in particular.  Then, it hit me when one day someone, a close acquaintance, said I "looked tired."  Well, indeed, maybe I was tired.  There are only so many hours in a day and well, no, I had not had eight hours or sleep or had eight glasses of water and the recommended exercise, but she said I "look tired."  That's code for, "you look really bad and old and maybe need to do something about it."

That's when I scream for eye cream!  The eye area is one of the first areas to show signs of age.  The eyes can get little fine lines under and around them where the skin has a fine, wrinkled appearance.  This same area can show puffiness, pigmentation, hollowing, you name it.  There are also many choices when it comes to eye cream, and it may be hard to pick from all the options.  I like to define my choices by what the worst problems are. 

If the problem is mostly puffiness and pigmentation, pick a cream that helps promote circulation in the area, reduction of pigment, and hydration.  These creams may contain ingredients like caffeine or coenzyme-A to promote circulation to reduce the puffiness.  They have natural lighteners and brighteners to help reduce pigment production and also help scatter light to mask the appearance of dark circles.  There are often potent antioxidants to reduce any further damage to the area and hydrating agents to keep the skin well-moisturized.  Any dry skin in the area will make the skin look more wrinkled and aged.

If the problem is more related to aging and wrinkling of the skin, pick a cream more geared to anti-aging.  The main ingredients to look for in this category are retinol and peptides.  Retinol is particularly known for helping boost new collagen production, but the formulation must be mild in this area of particularly sensitive skin.  Peptides also work to increase collagen production.  These creams will also need good hydrating agents to keep the skin well-moisturized, and there are often anti-oxidants in the mixture to further prevent aging.

If you are a little (or a lot) tired but don't want the world to know, or if you see the first signs of aging around the eyes, let us help you with an eye cream best suited to your needs!  Several eye creams are on special this month at Trinity Vista Dermatology. 

What is a wattle, and why do I care?

     What is a wattle?  It's the fleshy piece of soft tissue that hangs down from a turkey's chin.  As we have just finally finished our Thanksgiving leftovers, we turn from turkey wattles to the equivalent in humans, the dreaded double chin.  Anyone who's taken a selfie in the last ten years knows this is a problem area for many adults and not easily fixed once it develops. 
     In this season of gratitude, I am thankful for many things, and one of them is Kybella, the new permanent fix for double chins.  Kybella is a non-invasive, in-office injectable that dissolves fat cells and permanently gets rid of them.  It is FDA approved for the area under the chin where the so-called "double chin" occurs.  Most people need two to four treatments total, one month apart, and after that, the result is expected to be permanent. 
     Side effects are generally well-tolerated and include swelling, bruising, and tenderness in most patients.  A rare side effect that was described in the original trial included nerve damage that resulted in a droopy smile, but this effect was temporary and did self-resolve. 
     It is important to assess whether a patient is a good Kybella candidate.  Patients with too much loose skin may need different therapies such as face lift or neck lift.  If there is only subtle skin laxity, Kybella could be combined with skin tightening (Ultherapy) of the lower face and neck, performed on separate visits, for maximum effect.
     Trinity Vista Dermatology is ready to answer any and all questions you may have regarding Kybella.  Don't let your wattle get in the way.  Call us today at 817-885-8222.

Ultherapy-An Unexpected benefit for Rosacea patients

By now you've probably heard the buzz about Ultherapy, the skin tightening device that uses ultrasound energy to tighten the skin.  We have been using this therapy successfully for over two years here at Trinity Vista and have seen some great results. 

What's news this month is that Ultherapy may also improve redness in addition to tightening skin.  A study by Dr. Joel Schlessinger showed that two-thirds of patients with type 1 rosacea (mainly redness) improved with Ultherapy.  More studies will be performed to validate the results with greater numbers of patients, but in the meantime, these results look promising for offering another treatment to patients with a previously hard to treat condition.  

Rejuvenation of the Chest, a multimodality approach. Sculptra, Ultherapy, and BBL.

The rejuvenation of the décolletage has been a hot topic lately.  I have often observed that this area is a tell-tale sign of aging.  Since many patients have already addressed aging of the face, their faces look youthful, but there are other areas that show their age, namely the chest and hands.  Some new combination therapies to address the décolletage in particular have come about and show lots of promise.

There is often a fine, wrinkled appearance where skin has lost elasticity.  This is often worst in the center of the chest right above the cleavage.  The combination of Sculptra plus Ultherapy is what works best to address this texture change.  Sculptra is a filler that works gradually to stimulate new collagen production.  It works with your body's own cells and stimulates them to go to work to form new collagen.  Since Ultherapy is used to tighten the skin and form new collagen, we perform the Ultherapy immediately after Sculptra injection to multiply the effects.  The Sculptra can be diluted with a little bit of lidocaine added into the mixture.  This lidocaine has the added benefit of making the Ultherapy much more comfortable.  Patients say the procedure is very easy to tolerate.  There is no downtime, and since results are achieved gradually, it will not be obvious to others that any work was done, but gradually the area looks smoother, as if someone ironed the skin smooth.  Results should last up to two years. 

The other common concern is discoloration.  For brown spots and redness on the chest we often do BBL treatment to specifically target sunspots and dilated blood vessels that cause diffuse redness.  A series of three treatments is usually needed, and is best performed in the fall or winter when there is not much sun exposure to the area.  I suggest doing the Sculptra + Ultherapy combination in summer and then BBL in the fall or winter for a perfectly timed approach. 

To maintain the best effects, careful attention to sun protection is needed as this area is easily sunburned.  An added benefit can be attained by use of topical antioxidants such as a Vitamin C and E combination serum.  Multiple antioxidant products exist, so be sure to ask me or my staff about options. 

Trinity Vista is here to help you put your best self forward, so don't forget to rejuvenate this highly visible area!

Feeling Red??? April is Rosacea Awareness Month

April is rosacea awareness month!  I usually don't buy into "insert problem" awareness month or awareness day, but since several new treatments have emerged recently for rosacea, we could all stand some updating and overall awareness.

If you have easy flushing and redness and don't have an underlying medical disorder, you may have rosacea.  Other symptoms can include pimples or enlargement of the nose or a dry, scratchy feeling and redness in the eyes.  Not everyone has all of these symptoms, and a fair number of people just have redness and easy flushing. 

The tried and true treatments (topical antibiotics, topical azelaic acid, and oral antibiotics) as well as avoidance of triggers such as hot and spicy foods or alcohol do help a fair number of patients.  If you are left still feeling red, there are two new options.  Mirvaso came out last year and is a topical vasoconstrictor that works for several hours, in other words, it can get you through the day so that you don't have redness while you are at work, at school, taking photos, giving a presentation, etc.  It does wear off at the end of the day, but people who are very red and embarrassed by their redness have benefitted by this, and it can be lifechanging for those individuals.  Another new topical just out is Soolantra.  It is a topical ivermectin which decreases some of the pimples and redness that rosacea causes.  There are tiny little mites that live on everyone's skin, the Demodex species of mite, and for some people, they are likely the trigger for inflammation in rosacea.  Eliminating the Demodex mite is showing really impressive results in terms of reduced redness and inflammation in the skin.

Lastly, we can do a series of photofacials/broadband light treatments to help decrease redness.  Topical antioxidants may also help and may be preventive if used on a daily basis.  As always, keep in mind that daily sun protection with an SPF containing zinc as an active ingredient is very important and should be used by every rosacea patient.  My favorite sunscreen for rosacea patients is Elta MD UV Clear. 

If you need any additional information the National Rosacea Society is a great source!  www.rosacea.org

Texas Heat means it's time for a MiraDry Miracle

"Texas weather sure turns quick," or so the saying goes.  We have gone from a week of ice storms to sleeveless weather in less than a month, which can only mean one thing for people who are prone to excess sweat...worry over wet clothing and what others think of them. 

A few years ago we didn't have as many options for people bothered by sweat, but today there is a wonderful new device that permanently reduces excess underarm sweat.  I call it the miracle of MiraDry.  Most people only need one treatment with our new treatment protocols, and we are able to change their lives for the better and increase their confidence in almost every social situation. 

Over 90% satisfaction rates over this procedure speak for themselves.  The procedure typically involves numbing up the area under the arms with lidocaine and then using the device to heat up the area of skin to just the precise depth where the sweat glands reside.  This is usually accomplished in one to one and a half hours in the office setting.  There is minor discomfort as the anesthetic wears off and some swelling under the arms that can last about a week.  For most patients, using some ice packs and taking a break from working out for a few days is all that is required.

If you or someone you know could use a confidence booster and a drier future ahead, particularly in time for summer, don't hesitate to call Trinity Vista Dermatology at 817-885-8222.