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Skin Care

Our guest experts in November 2009 were Dr. Nowell Solish and Dr. Christian Murray, dermatologists at Women’s College Hospital in Toronto.

Dr. Solish is a recognized specialist in the fields of cosmetic dermatology and dermatologic surgery, an assistant professor of dermatology at the University of Toronto and past-president of the Canadian Society for Dermatologic Surgery. In addition to being the co-director of dermatologic surgery at the University of Toronto, Dr. Solish is co-director of the Non-Melanoma Skin Cancer Clinic at Women's College Hospital. He has also published in peer-reviewed journals, and lectures regularly on dermatologic surgery techniques at local, national and international medical meetings.

Dr. Murray is board certified in dermatology in Canada and the United States, and completed an accredited fellowship in Mohs Micrographic Skin Cancer Surgery. As assistant professor of medicine at the University of Toronto, he teaches resident physicians at Women’s College Hospital’s Dermatology Centre. Dr. Murray is often invited to speak at national and international conferences and universities, and also publishes journal and textbook articles. His key areas of research and practice are skin cancer, treatment of excessive sweating and aesthetic dermatology.

Here are their answers on Skin Care.

Q: I have been told by my doctor that I have skin cancer on my face. It is not melanoma. What is the most effective therapy?

A: The most common types of skin cancer are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and malignant melanoma (MM). All are curable if caught early. For BCC and SCC, the most effective therapy is Mohs Micrographic Surgery (MMS). This technique is reserved mostly for facial cancers. Mohs is a surgical technique that ensures the cancer is removed by using a microscopic method. During the procedure the patient is awake and everything is done the same day. Women’s College Hospital has the only Mohs surgery unit in Toronto and sees patients from all across Ontario. Patients are usually referred by their dermatologist.


Q: I'm in my early 50s and have developed some milia (tiny white bumps or small cysts on the skin) on my cheeks. How do I get rid of them? What skin care regimen should I follow? I normally use a facial cleanser followed by toner and moisturizer.

A: Milia can occur on their own or be caused by creams with too much oil (too rich) for your skin. Your family doctor or dermatologist may extract them with a small needle. Some estheticians also treat these by steaming and extraction. If they continue to form, topical tretinoin (available by prescription) can help treat and prevent them.


Q: What is more important for healthy aging skin: good nutrition or good skin care using creams (moisturizers, cell renewal creams, etc.)? Can wrinkles be minimized by appropriate skin care or are they genetic and inevitable?

A: Although proper nutrition is very important for all aspects of health, including skin, targeted creams are usually more beneficial for specific concerns like skin aging. There are many reasons wrinkles develop. The most important factors include: sun damage, genetics and repetitive facial muscle movements. Although many age-defying creams are on the market, most are less effective than sunscreen at preventing wrinkles. Some creams can minimize fine wrinkles and texture changes, such as those that contain vitamin A, vitamin C, peptides and glycolic acids, to name a few. For wrinkles that are caused by repetitive muscle movements (like frown lines), Botox® is often very effective at treating and preventing these lines from forming.


Q: What is the best way to fight teenage acne without prescription medication?

A: A good skin care regimen which includes regular skin cleansing, avoiding oily creams, and using over-the-counter benzoyl peroxide preparations.


Q: What is the best way to minimize pore size?

A: Although many treatments have been tried, no therapies seem to be consistently effective in reducing pore size. Pore minimizing creams seem to reduce the appearance of pores, but do not actually reduce their size. Even aggressive laser therapies seem to only have minimum benefit.


Q: What is the best way to care for dry skin? My skin peels and scabs when the seasons change. Are there inexpensive ways to maintain healthy, moist skin?

A: Moisturizing the skin, particularly during the dry winter months, is the most effective way to ensure healthy and moist skin. Avoiding dry heat, by using humidifiers, can reduce such winter dryness. Moisturizers that are more oily, or richer, seem to work better than watery products. Some people also develop dry skin from excess heat in the summer or too much sun. In these cases, avoiding such situations can help.


Q: Since menopause I have experienced darkening of the skin on my throat similar to the "mask of pregnancy" on one's face during pregnancy. My only medication is Ranitidine to treat gastroesophageal reflux disease. I am extremely embarrassed by what others perceive as a dirty neck. Is there any safe method of removing or lightening this discolouration?

A: You should see a dermatologist to get a specific diagnosis. Although sunlight is the most likely cause, other things can mimic this and need to be ruled out to ensure you are treated properly.


Q: I am 38 and for as long as I can remember, I've had heat rash on my upper back. The last several years (after two pregnancies) it has gotten worse with increased coverage on my back. It now appears around my neck and on my stomach and chest. I have always taken showers, and find that if I use moisturizer daily it helps relieve itching and redness. I even tried a prescription steroid cream – using it sparingly – but it doesn't make much difference. It just never clears completely! I've never gone to a dermatologist but think I ought to just to see what can be done, if anything. It's frustrating and affects how I'm feeling about my body. Thanks for any help or suggestions.

A: You should see a dermatologist to get a specific diagnosis. Many conditions can mimic this presentation and need to be ruled out to ensure you are treated properly. Sometimes a skin biopsy is necessary to confirm the cause.


Q: I have very sensitive skin. I recently used a costly product for sensitive skin to brighten and re-energize my skin. I have also tried the new day and night creams with peptides that claim to reduce wrinkles and build collagen. Honestly, I can't tell the difference between the two products. I am really in a quandary about which moisture/wrinkle cream works best. What do the experts say?

A: Each person’s skin responds differently. It is often trial and error, particularly if your skin is sensitive. If you continue to have a lot of problems you may need to see a dermatologist.


Q: Is there any way to keep the face firm, rather than sagging with age?

A: Sagging skin is often genetic. For some people, avoiding sun damage can help, but if the sagging or loose skin is excessive it may require medical treatment with tightening cosmetic therapies or surgery to reduce the sagging.


Q: I have extensive vitiligo and hyperpigmentation all over my skin. Is there any remedy to decrease the pigmentation or to eliminate vitiligo?

A: You should see a dermatologist for a specific treatment plan and to discuss the new therapies available. There are no quick solutions for this complex problem.


Q: What's the best and easiest way to take care of eczema? Mine gets worse in winter. It never goes away. It drives me crazy. Please provide advice for a lazy person who does not put cream on twice a day. Thank you.

A: Typically, good skin care and moisturizing aggressively is effective for simple eczema. Your eczema does not sound simple and may require prescription therapy from your doctor.


Q: I had a lot of brown areas on my face treated with electrodessication. They are now a lighter colour but still very visible. Recently I've been applying 4 per cent hydroquinone cream twice a day without much result. Anything else I could do? I'm a fair-skinned 83-year-old woman.

A: You should see a dermatologist for a specific diagnosis and treatment plan. Although sunlight is the most likely cause of brown spots, other things can mimic these and need to be ruled out to ensure you are treated properly.

Q: I’m 50 years old, menopausal and I've just finished a round of five IPL (intense pulsed light) treatments and three microdermabrasions due to some brown spots (sun damage) and spider veins on my cheeks. The improvement is minimal and I am disappointed. All the brown spots are still present, albeit somewhat lighter, and my pore size is the same. I have brown hair and eyes and fair skin. I didn't expect porcelain skin, but I'm at a loss as to what to try next. It took me a while to save money for these procedures. All these treatments were done at a hospital dermatology clinic by an experienced quantum operator. What's next for me?

A: You need to talk to the people you saw to ask for more options. There are creams and other lasers available, but it is important to understand why the IPL you used did not meet your expectations. Most people do very well with IPL, so determining why your situation may be different could be helpful for you.

Q: Since February I have had a distressing skin rash all over my face and neck, and itchy and swollen or red eyes. Allergy tests and ENT scans for sinus problems have been negative and I am desperate to find dermatological help. My family doctor will not refer me to a dermatologist. Can I see a dermatologist without a referral? I am on disability and wasting lots of money on over-the-counter pills, lotions, cosmetics and herbal potions that my health insurance does not pay for. The embarrassing state of my face prevents me from participating in everyday activities.

A: If you are not improving and would like a second opinion, I suggest you seek out another physician, perhaps at a walk-in clinic. That physician may be able to help you or refer you to a dermatologist. Most dermatologists require a referral for medical concerns.

Q: I am 46 years old and have had acne outbreaks since I was a teenager. I thought my skin would have calmed down by now, but I continue to have large pimples on my cheeks, chin and neck area. They are painful – like little lumps or balls under the skin. I would like to find a way to improve my skin and be happy with what I see in the mirror. Do you have any general skin care tips for someone in my age range who has oily to combination skin with acne breakouts?  I'm also approaching menopause and am getting concerned about aging skin. I don't want to take any prescription medication for the acne and want to use a natural approach. I've used an over-the-counter product for a few years with varied results. Right now I'm just washing my face with soap and using a natural moisturizer and hardly any makeup. I would like to look beautiful one day. My acne makes me very sad most of the time. Thanks for listening.

A: You should see a dermatologist for a specific diagnosis. It could be rosacea and many effective treatments are available for this disorder.

Q: How do you tell if moles on the skin are pre-cancerous? What method should be used to get rid of them? Is it effective to burn them off, or will they return even worse?

A: You should see your doctor to get your moles checked to ensure they are not cancerous and to discuss what things to look for in your moles. Changes in size, shape and colour are the most common signs of concern. Your doctor can also tell you which moles can be removed and in what way, because some techniques that are effective for certain types are ineffective for others. Making the correct diagnosis is the key to proper treatment.

Q: I’ve been suffering from chronic idiopathic urticaria since July. Are there products with histamine that will help relieve the itch?

A: Histamine makes urticaria worse. Antihistamines are typically first-line therapy and are available over-the-counter both in sedating (nighttime) and non-sedating (daytime) versions. Your pharmacist can help you choose. If this fails, you should see your doctor to ensure that an underlying problem is not making the hives worse.

Q: I suffer from plaque psoriasis and guttate psoriasis. Can you recommend a good hydrating agent that will not irritate my skin?  Should I stay away from vitamin E supplements and vitamin E enhanced lotions?

A: Each person’s skin responds differently to different creams. It is often trial and error, particularly if your skin is sensitive. Vitamin E in creams or pills has not shown particular use in psoriasis, but likely will not hurt either. If you continue to have a lot of problems you may need to see a dermatologist because there are many very effective prescription products available for psoriasis.


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