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Fabulous Tips for Your 40s: Ask the Dermatologist

Dec. 15, 2010. Dermatologist Susan Evans, MD, answers questions about skin care and make-up for your 40s.

Question:
I am getting more and more tiny blood-red spots all over; on my forehead, chest, arms, legs ... everywhere! They don't bother me at all, except a larger one on my face. But that's only because it's on my face. I have very fair skin and have avoided the sun for decades! Can you explain what these spots are and what I can do to get rid of them?
Answer:

Blood-red spots may be attributed to dilated small vessels on your face, or telangiectasia. The majority of these "red spots" are benign. However, on occasion, they are associated with other medical conditions such as acne, rosacea, scleroderma, and birthmarks. Your first step is to exclude any underlying medical conditions. Then your physician may recommend a topical product or laser treatment.

Question:
I've been diagnosed with hypothyroidism and dry skin is one of the symptoms that I have, especially around the eyes. I am on medication to regulate it. But I wonder what beauty routine I should follow. What products are recommended?
Answer:

Dry skin associated with hypothyroidism requires more hydration and added moisture than normal or oily skin. If your skin is itchy, consider using calamine lotion or over-the-counter cortisone cream.

Implement hydrating solutions that contain natural oils such as avocado or almond oil, which will hydrate the skin without causing an allergic reaction.

Question:
I am a woman of color with acne scars. What can I get to help remove the scars that are left from flare-ups? Over-the-counter or prescription, I don't care. I just want something to help clear it up.
Answer:

Post-acne scars can leave a variety of changes to your skin, including hyperpigmentation and pitting. People of color are especially prone to have post-inflammatory hyperpigmentation or dark marks after acne flare-ups. Your physician should implement a program that uses a combination of salicylic acids (to penetrate the dark marks) and brightening agents to improve the color. You physician can prescribe prescription-grade formulations.

Question:
I have very, very dry hands that are cracked. What should I use on them?
Answer:

Your first step is to exclude any underlying medical causes such as a thyroid condition, connective tissue disease, or an infectious process. When you wash your hands, avoid cleansers that contain alcohol. This will further dry your hands. Your next step is to focus on moisturizing and hydrating your hands.

Question:
I'm 45 and have quite a lot of sunspots and age spots on my face. Is there any over-the-counter product or homemade concoction that I can make to fade them? I'm on a tight budget and cannot afford microdermabrasion or chemical peels.
Answer:

The No. 1 cause of premature aging and sunspots is sun damage. Avoid direct sunlight during peak hours, 11 a.m. to 2 p.m. Most sunblocks that contain titanium dioxide will help. Compounds that contain salicylic acid will resurface your skin. Compounds that contain tretinoin will help rejuvenate your face by encouraging collagen production.

Question:
I’m a man with healthy, somewhat oily skin. I'd like information about using abrasive skin scrubbers or loofahs to remove dead skin. What are your thoughts?
Answer:

Overly aggressive scrubbing of your skin may damage the top layer of your skin. If your objective is to remove dead skin cells, consider using gentle exfoliating agents that contain salicylic acid, glycolic, or papaya-based products.

In addition, use cleansers that contain jojoba beads. Jojoba beads are gentle, spherical exfoliants that do not scratch the skin's surface.

Question:
I am 46 years old. What would be the best toner for my age? I have been using witch hazel since I was a teen, because it’s 100% natural. But it seems that it’s not enough sometimes. I have oily-combination skin.
Answer:

I suggest that you cleanse your face twice daily with soap and water. Pack a pre-moistened cleansing pad if you won't be around a water basin throughout the day. Shower or bathe in tepid water, rather than steaming hot water. Hot water can strip your skin of needed moisture, while cold water can shock your skin. Avoid using cleansers or toners that tend to over-dry skin or have high alcohol content. This over-drying actually causes your skin to produce even more oil than usual.

Use only noncomedogenic moisturizers and sunscreen products. This means they're oil-free and won't clog pores. Use vitamin A derivatives or retinoids, which reduce production in oil glands and shrink their size.

Question:
I would like to receive laser hair removal on my chin and upper lip area. I am plucking the hair now. But it is very time-consuming. I previously had maxillofacial surgery, so I currently have metal plates in my face. I have one titanium plate on the chin area where I also have extra hair growth. Can I still receive laser hair removal on these areas?
Answer:

Your prior history should be taken in to account. A thorough exam of your face by your maxillofacial surgeon should exclude any potential problems (infection or loose plates) below your skin surface.

Once this information is determined, you should be able to proceed with laser hair removal. For extra caution, first laser only a small test area.

Question:
What's the best treatment for large, deep pores on cheeks?
Answer:

Proper skin care is your first approach towards large facial pores. Pores appear enlarged when they are clogged, dilated, or infected, and that's why the best way to keep your pores small and less visible is to keep your skin clean all the time. Often the pores get clogged with dead skin cells, dirt, and oil, which makes them appear more prominent. That’s why regular skin exfoliation is essential, in order to remove the dead skin cells and to allow your skin to produce newer, healthier cells.

Question:
I am wondering how to prevent the lines I have from getting worse. They are pretty deep already and I'm only 46.
Answer:

Sun damage is the primary cause for premature aging. Incorporate sun block in your daily skin regimen. Avoid outdoor activities between 10 a.m. and 2 p.m. when the sun's rays are the strongest. Twice per week, incorporate an exfoliating regimen for your skin to remove surface dead skin cells.

Question:
Is there any nonsurgical procedure to get rid of my eye bags?
Answer:

A lot depends on how extensive the eye bags are. If the underlying causes are medical or from lack of sleep, these issues should be addressed first. Next, consider discussing the use of fillers with your dermatologist. Properly placed fillers along the lower eyelid and cheek junction can mask the presence of eye bags.

Question:
What is the best solution for pimples that do not come to a head? They just stay visible under my skin. I'm 40 and I thought I was past the stage for pimples.
Answer:

Adult acne may be attributed to hormonal changes. The most important thing is to wash your face twice a day with a gentle soap. There is no need to wash your face more than twice a day unless you are sweating profusely or have a very dirty job.

Salicylic acid is found in a number of acne products and this works to dissolve the sebaceous oils, helping to remove any skin debris that is clogging your pores. Rinse this off. Find a very mild benzoyl peroxide cream, something that is 2.5% or less. This is applied directly to the skin at night to help unclog you pores as you sleep. Try this every other night at first.

Question:
I would like to make my crow's feet less noticeable. Is there a product I can use or something I can do to help with this issue?
Answer:

Many factors contribute to crow's feet, including sun exposure, squinting, and menopause. Solar radiation damages the elastic and collagen in your skin, which leads to "lax skin" rather than tight skin that is adherent to the underlying muscles. Sun exposure is probably the easiest to address.

You should incorporate sunblock in your daily skin regimen. Squinting results in contraction of the muscles around the eyes. Years of squinting can lead to hypertrophy or enlargement of the underlying muscles, which will lead to the noticeable grooves on the skin surface. Menopause affects estrogen levels, which is critical for maintaining collagen levels and skin hydration.

Question:
I am a 47-year-old woman with the worst skin! My entire body gets boils and they leave marks all over. I am at my wits' end. I am pretty but the scars left because of this condition make it difficult for me to go out in public. Do you have any ideas for me?
Answer:

Your condition sounds quite challenging. Boils all over the body may be secondary to an altered immune system, an opportunistic staph infection, or a hereditary condition of the sweat glands referred to as hidradenitis suppurativa. Your first step is to undergo a complete examination by your internist, including a comprehensive blood panel to determine if there are any underlying medical causes for your skin changes.

Question:
I've been dealing with seborrheic dermatitis for about a year, with periods of remission and flare-ups. Do you have any advice on how to further control seborrheic dermatitis and prevent it in the future?
Answer:

Seborrheic dermatitis is thought to be a combination of over-production of oil glands and yeast on the skin's surface. Unfortunately, seborrheic dermatitis can be a lifelong problem characterized by prolonged inactive periods and flare-ups. If you suffer from seborrheic dermatitis, consider using selenium- or ketoconazole-containing shampoos at least once per week. When you wash your hair, also apply a small amount of the shampoo on the problematic areas on your face and then rinse your hair and face simultaneously.

Over-the-counter corticosteroids will control minor flare-ups. More severe reactions should be evaluated by your dermatologist.

Question:
I am 49 years old and going through menopause. I'm experiencing extremely dry skin, particularly on my back. I'm guessing it's eczema, but I don't know for sure. I just know it itches like crazy. I also get little red bumps on my arms and legs occasionally. But they don't itch, so I'm not sure what that is. In any case, I'm wondering if there is any cream or other possible solution you could recommend.
Answer:

Menopause can effect estrogen production. Estrogen is critical in the production of oil glands and collagen. Estrogen levels are also associated with your cells' ability to maintain hydration.

To help your skin cells, avoid hot showers, because they tend to further dry out your skin. Consume foods rich in essential fatty acids. These will help your cells with natural oil production. Finally, use sun protection. Sun damage is the No. 1 cause for premature aging of the skin.

Question:
How do you prevent freckles and dark patches or age spots on the face? Are there any special skin treatments you'd suggest?
Answer:

Avoid direct sunlight between the peak hours, 11 a.m. to 2 p.m. Sunblock is probably your best approach to avoid premature aging and dark spots. Your skin regimen should include steps to exfoliate and get rid of dead skin cells, hydrate, and rejuvenate with natural amino acids, or peptides.

Question:
I was wondering if you could please recommend the best skin care products for antiaging, including moisturizers.
Answer:

Your first step is to educate yourself. You should look for products that contain salicylic acid, AHA (alpha-hydroxy acid), or papaya-based enzymes to help exfoliate and remove unwanted cells. Your next step is to focus on rebuilding and hydrating your skin. Compounds containing tretinoin will work towards improving collagen synthesis. Last, and most importantly, your daily skin care regimen needs to contain sunblock. Sun damage and smoking are the primary causes of premature aging.

Question:
I have dark circles under my eyes. What should I do?
Answer:

Hyperpigmentation, discoloration, or post-inflammatory hyperpigmentation (PIH) on your skin can be attributed to a variety of disorders. I like to begin with excluding any medical reasons that may result in hyperpigmentation. Hyperpigmentation may be attributed to renal disease, diabetes, or peripheral vascular disease.

PIH arises from an acquired excess of pigment related to an inflammatory process, such as infection, an allergic reaction, a reaction to medication, or a trauma. PIH often occurs as a consequence of inflammatory skin disorders, including acne, drug-induced eruptions, and eczema.

Once you have excluded medical causes, there are multiple options to regain your even skin tone. A combination of glycolic acid, AHA, and tretinoin-based products -- along with a traditional topical skin care regimen -- will work for skin brightening. Hydroquinone-based products work well. However, there are other alternatives, such as bearberry, kojic acid, licorice extract, and niacin. These compounds will work towards brightening your skin and correcting your skin tone.

The key is to work with a physician that is very familiar with your skin type and color because incorrect use of these agents can lead to further hypo- or hyperpigmentation. I tell my African-American patients in particular that in order to get your skin in shape it has to be a gradual process, similar to exercising. You would not attempt to lift 250 lbs on the first day of your workout; this attempt may lead to injuring yourself and disastrous results. The same holds true with your skin regimen, a gradual approach is always best. Once you get your melanocytes in shape and under control, you can improve your skin tone.

Question:
I have worn my wedding ring for the past 17 years without a problem. In the past two weeks, a small amount of eczema has appeared on my finger where the ring touches, but not all the way around. I have cleaned the ring and applied cortisone to the area. But each time I put my ring back on it returns. Is there anything that I can do or am I now allergic to my wedding ring?
Answer:

Delayed hypersensitivity to the metal in your ring is not uncommon even after several years. The most common allergy is nickel. Most 14k to18k gold rings contain a small amount of nickel. A quick fix is to apply a small amount of clear nail polish on the inside of the ring so that the metal is not in direct contact with your skin. Typically, platinum rings cause less of a reaction.

Also, if you are wearing your ring continuously while washing your hands and doing other chores, the accumulated grease and oil will cause a reaction. Simply try removing the ring throughout the day and allow the skin underneath to get some air.

Question:
I have puffy eyebrows and would like to know how to cure them. Can I use a cream?
Answer:

Your first concern should be to exclude any underlying medical issues that would lead to any sudden weight gain or fluid retention.

Question:
I am 49 years old now and my skin is getting dry. I have pimples in the jaw line and dark circles. Please suggest an effective remedy.
Answer:

You may be suffering from hormonal acne. Up to 50% of all women experience some form of adult hormonal acne the week before their period. Some women are even more prone to adult acne because they have larger problems with androgens. These are women with polycystic ovarian syndrome. Because the overabundance of androgens throws their monthly cycles completely off kilter, they never know when they'll experience an acne breakout.

Most women who suffer from adult hormonal acne experience their worst breakouts on their chin and around their lips. Adult hormonal acne typically begins after age 25 and occurs on and off during the course of adulthood. The bad news is that when a woman begins to go through menopause, her female hormones begin to dwindle, and those androgens become even more dominant. Here comes the acne, yet again.

Try washing your face twice a day with a gentle soap. There is no need to wash your face more often unless you are sweating profusely or have a very dirty job. Salicylic acid, found in a number of acne products, works to dissolve the sebaceous oils, helping to remove any skin debris that is clogging your pores. But be sure to rinse it off thoroughly. Also, find a very mild benzoyl peroxide cream, something that is 2.5% or less. When applied directly to the skin at night, it can help unclog you pores as you sleep. Try this every other night at first.

Question:
Do you have any advice for melasma?
Answer:

Melasma is acquired hyperpigmentation of sun-exposed areas. Common locations are the face, cheeks, upper lip, and chin. The exact cause if melasma is unknown, though it is thought to be a combination female hormonal activity and solar photosensitization, which leads to the increase in the production of melanin.

Therefore, your first approach to control melasma should be to avoid direct sunlight, especially during peak sunlight hours. Your next steps should include a skin care regimen that includes sun block, a combination of chemical peels with natural fruit acids, and skin-brightening agents.

Question:
I have skin tags in both underarm areas. How many skin tags can typically be removed in one office visit?
Answer:

Skin tags are common, acquired, benign skin growths that look like a small piece of soft, hanging skin. Skin tags are harmless growths. Some individuals may be more prone to tags -- between 50-100 tags. Males and females are equally prone to developing skin tags. Obesity and being moderately overweight (even temporary increases) dramatically increase the chances of having skin tags. Normal-weight individuals with larger breasts are also more prone to skin tags under their breasts.

Some small tags spontaneously rub or fall off painlessly and the person may not even know they had a skin tag. Most tags do not fall off on their own and stay around once formed. The medical name for a skin tag is acrochordon, or fibroepithelial polyp.

Skin tags can occur almost anywhere on the body where there is skin. However, the top two favorite areas for skin tags are the neck and armpits. Other areas include the eyelids, upper chest (particularly under the female breasts), buttock folds, and groin folds. Tags are typically thought to occur in high-friction locations, where skin rubs against skin or clothing most often.

In general, there is no limit to the number of skin tags that can be removed at one office visit, as long as your overall health permits the in-office procedure.

Question:
Is surgery the only way to get rid of stretch marks?
Answer:

Stretch marks occur from disruption in the underlying dermal support of the skin. Topical medications that contain tretinoin are designed to increase cell turnover and encourage new collagen deposition. Lasers work by targeting and subsequently tightening the dermis and encouraging new cell growth. A combination of topical products and lasers may improve less severe stretch marks. But more severe stretch marks are less likely to respond to nonsurgical approaches.

Stretch marks are weaknesses in the supporting structure of the skin, causing layers of the skin (dermis) to separate, and leaving the skin grooved and discolored. Stretch marks develop when the skin is excessively stretched during pregnancy, weight gain, or growth spurts. They are most common during pregnancy and the teen years, when growth spurts and increased levels of steroid hormones cause significant changes throughout the body. Stretch marks can also be brought on by obesity. Genetic factors, including inherited defects of connective tissues, also play a role.

Prevention is the key. To avoid stretch marks, avoid rapid weight gain or loss. Moisturize daily when pregnant. There is no exact cure for stretch marks; however, products containing glycolic acids, tretinoin, or vitamin C help towards rebuilding the structure of your skin.

For a more invasive option, consider laser resurfacing. Lasers work by stimulating collagen synthesis. For severe stretch marks, you may want to consider evaluation by a plastic surgeon for surgical removal.

Question:
I have many dark spots on my legs. Is there a cream or a type of acid to bleach these spots? They look like freckles but they are not from the sun. Why do I have these dark spots on my legs? Where do they come from?
Answer:

Hyperpigmentation or dark spots will respond to a combination of chemical peels that contain salicylic acid, alpha-hydroxy acids, and skin-brightening agents such as hydroquinone, licorice extract, or bearberry. Your physician will be able to implement a skin care regimen once any underlying medical causes are excluded.

Question:
I'm 48 years old. I have adult acne -- blackheads and whiteheads. I have tried many products, but none have worked. Also, the skin around my nose flakes. Can you recommend what to do about these two issues?
Answer:

You may be suffering from a combination of acne and seborrheic dermatitis (SD). Typically, SD sufferers will have flaky skin around the nose and hairline in combination with dry patches. There is usually an underlying fungal component (with SD) that can be treated with an antifungal cream and/or shampoo. Flare-ups can be controlled with over-the-counter corticosteroids.

Once this component is under control your acne will be easier to treat. Your acne prevention regimen should include an antimicrobial facial wash that contains benzoyl peroxide acid or alpha-hydroxy acid, a mild exfoliating agent, and salicylic acid to help clear your clogged pores.

Question:
For about 12 years I have been suffering with itchy toes. None of the doctors I’ve seen have been able to help. As I type to you now my toes are all inflamed from scratching. What can I use to get rid of the itch?
Answer:

Your condition sounds quite complex. Usually "itchy" toes are a result of athlete's foot (tinea pedis), which is a fungal infection. You may want to seek advice from an infectious disease specialist who will evaluate you and possibly obtain a biopsy or culture in order to exclude any other underlying medical conditions or ongoing infections.

Question:
What I can I use to brighten my elbows? They are very dark, they itch sometimes and I have been using cocoa butter, vitamin E oil, and lemon and lime to try and brighten them. People always make comments about my elbows because it’s such a noticeable contrast to my actual skin color. I've had this problem all my life. Can you give me some advice?
Answer:

Hyperpigmentation or dark spots will respond to a combination of chemical peels that contain salicylic acid, alpha-hydroxy acids, and skin-brightening agents such as hydroquinone, licorice extract, or bearberry. Your physician will be able to implement a skin care regimen once any underlying medical causes are excluded.

Question:
At age 40 I have both oily and dry skin problems. What kind of cleanser and toner do you recommend?
Answer:

A change in your skin type may be caused by your skin care regimen. Make sure that you are not using products that are over-drying your skin because that will lead to increased oil gland production. You should exclude any underlying skin conditions such as eczema, psoriasis, or seborrhea that may alter your skin’s oil production.

You may also have combination skin (elements of dry and oily skin). Because the nose, chin, center of the forehead, and the cheeks all have more oil glands than any other part of the face, it is not surprising that those areas tend to be oilier and may break out more frequently than other areas. At the same time, the areas that lack oil glands can become dry and flaky. Problems occur when you attempt to treat combination skin as one specific skin type. Many ingredients that are appropriate for the T-zone (the area along the center of the forehead and down the nose where most of the active oil glands on the face are located) won't help the drier parts of cheeks, eyes, or jaws -- and vice versa. More often than not, separate products are required to deal with the different skin types on your face because different skin types, even on the same face, must be treated differently to truly feel and look better.

Once you accept this fact and adjust your routine, combination skin can be brought into balance, at least to the extent that using the right products allows. If anything, using overly abrasive or irritating skin-care products on oilier areas will only worsen combination skin's dual nature by making dry areas drier and creating a rough, reddened appearance over oily areas. Plus, treating skin harshly does not correct or improve oiliness in any way because combination skin should be viewed and treated as separate skin types.

Thank you for joining us for WebMD Ask the Dermatologist. Be sure to come back on Jan. 19 at 1 p.m. ET when we will discuss beauty shortcuts for busy women, sleeping in makeup, waxing, new ingredients, and healthy routines. Sign up if you'd like an email reminder the day before our next event.

WebMD Ask the Specialist Transcript

Reviewed by Susan Evans, MD on December 15, 2010

The opinions expressed in this section are of the Specialist and the Specialist alone. They do not reflect the opinions of WebMD and they have not been reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance or objectivity. WebMD is not a substitute for professional medical advice, diagnosis, or treatment. Never delay or disregard seeking professional medical advice from your doctor or other qualified health provider because of something you have read on WebMD. 

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