Healthy Skin Expert Dermatology Advice

Ask a Dermatologist Night Shift: How the skin repairs itself at night.

Cosmetics Magazine: To start, what happens within our skin at night while we sleep? What processes take place?
Dr. Lisa Kellett: Sweating and blood flow in the skin are regulated by certain nerves in the skin at night and these factors differ depending on what stage of sleep you are in. Scientists have identified five stages of sleep that you or I pass through which they call a sleep cycle. A complete sleep cycle lasts an average of 90 to 110 minutes and the stages are called 1, 2, 3, 4 and REM (rapid eye movement) sleep. It’s important to understand that sleep is a naturally recurring altered state of consciousness with relatively suspended sensory and motor activity, characterized by the inactivity of nearly all voluntary muscles. It is, in fact, a heightened anabolic state, accentuating the growth and rejuvenation of the immune, skeletal and muscular systems. It is incredibly important for allowing the body to heal, recover and grow. Sleep dept, the effect of not getting enough sleep, has been proven to cause mental, emotional and physical fatigue.

Cosmetics: Are there any particular ingredients that work better at night?
Dr. Lisa Kellett: There is a paucity of evidence-based medicine that specifically examines this issue as of yet. However, in general, retinoids are best used at night as they can make the skin more sensitive to sunlight. I advise using them at night for this reason.

Cosmetics: How important is cleansing thoroughly before bed? What happens if we don’t?
Dr. Lisa Kellett: Especially with patients who are prone to acne breakouts, it is best to cleanse before bed as makeup and dirt can exacerbate acne.

Cosmetics: Why do night creams tend to be thicker than those used during the day?
Dr. Lisa Kellett: Many night creams are quite thick and thus are not cosmetically acceptable during the day. It really is a comfort issue. We prefer to use lightweight moisturizers during the day especially under makeup.

Cosmetics: What ingredients should we look for in a night cream?
Dr. Lisa Kellett: The most important ingredient is a vitamin A product of at least the strength of 1% retinol. This is what I recommend to patients in my clinic.

Cosmetics: We see many young girls using night creams developed for women in their 50s and 60s. Can this cause problems?
Dr. Lisa Kellett: This is a trend that I am starting to see. Some young women think that if they use really strong anti-aging products designed for older consumers, they will prevent wrinkles and many signs of aging. This isn’t the best approach. Night creams developed for older skin types can be quite thick and oil-based and thus can result in acne breakouts in younger patients. The most important skincare product for younger girls is a good quality broad spectrum sunscreen. That paired with skincare products designed for their particular skin type will offer the best results.

Cosmetics: What order should you apply skincare products at night?
Dr. Lisa Kellett: An ideal serum is a 1 retinol which can be applied either before a moisturizer or can be mixed into a moisturizer.

Cosmetics: What do readers need to know about skin at night?
Dr. Lisa Kellett: Repair processes in the skin are an ongoing process occurring throughout the day. Otherwise, night shift workers would have problem! The most important anti-aging step is a good vitamin A, minimal alcohol and a good night’s sleep.

From Cosmetics Magazine - November/December 2010

Ask a Dermatologist: The Rise of Adult Acne

For years, acne was thought of as a teenage condition - the result of surging hormones and bad diet. Over-the-counter remedies featured smiling teens on the packaging and formulas were aggressively strong in fighting over oily skin conditions. Then, something began to change. Adults began having breakouts into their twenties and thirties in increasing numbers. Scientists hypothesized that stress, pollution and diet had something to do with it. But the trend continues. Today, doctors estimate that 70 percent of North American will suffer some type of acne throughout their life. Here, Dr. Lisa Kellett, one of Canada’s foremost experts on adult acne, explains the condition.

Cosmetics Magazine: How many people suffer from acne?
Dr. Lisa Kellett: According to the Academy of Dermatology, 70 million adult Americans will suffer from acne - more than 50% of women and 25% of men.

Cosmetics: What causes adult acne and where does it mostly appear?
Dr. Lisa Kellett: The cause of adult acne is thought to be multi-factorial including stress, environment toxins, genetics, hormonal changes and the use of anti-aging products. Whatever the reason, it is a painful and frustrating experience. Adult acne often occurs on different parts of the face such as the chin, jaw, and temples. Teenage acne, in the comparison, is found in the oily facial T-zone.

Cosmetics: What adult acne treatments are available?
Dr. Lisa Kellett:  There are many treatments available ranging from over the counter treatments to prescription medications. Unfortunately, many of these aren’t designed for adult skin or sensitive skin and might result in flaking, redness and irritation. Some designed for teenagers are very strong to combat excessive oil production and can seriously irritate adult skin. Oral medications for acne consist of antibiotics and Accutane but these have been associated with a number of side effects including blood, liver and kidney problems. There are also new laser light treatments that can help.

Cosmetics: How do I know if it is hormones causing adult acne?
Dr. Lisa Kellett: A hormone problem is most likely the cause of your acne if you also have problems with scalp loss, an increase of hair growth on your face, chest or back and irregular periods in women. If you have any of these problems, you should see your doctor.

Cosmetics: What happens if you pick acne?
Dr. Lisa Kellett: Often, picking, popping, or picking your acne bumps will cause more scarring than the acne itself. It can even result in an infection. The best thing to do is keep your hands off and use acne products formulated for adults.

Cosmetics: What can be done about acne scarring?
Dr. Lisa Kellett: There are number of treatments available for scarring: laser treatments, intense pulsed light and injectable fillers. In general, glycolic acid peels and Microdermabrasion will result in only minimal improvement in scarring.

From Cosmetics Magazine, September/October 2010

Ask a Dermatologist - A Sun Protection Glossary

In 1938, Chemist Will Baltzer invented what is believed to be the first effective sunscreen called Glacier Cream. Historians believe it had about a factor of SPF 2. And while he was technically they first to develop sunscreen, the first widely used sunscreen was the brainchild of pharmacist Benjamin Greene. He created a physical block made of red veterinary petroleum in 1941 during World War II to protect soldiers fighting in the South Pacific from sun overexposure. Coppertone bought the patent in the early 1950s and soon marketed to North Americans under Bain de Soleil and Coppertone brands.

Today, dozens of companies produce and market sunscreens and blocks. This is carefully regulated by Health Canada with a handful of approved chemical sunscreen ingredients that have been carefully tested. As summer weather approaches, Dr. Lisa Kellett assists Cosmetics in explaining the most common sun protection terms with some interesting facts you might not know.

Cosmetics: To start, what is SPF?
Dr. Lisa Kellett: SPF stands for Sun Protection Factor which measures mostly UVB protection and is calculated as a ratio of the redness caused by UV light in protected versus unprotected skin. SPF can range from 2 to as high as 100. The measurement term was created by Franz Greiter in 1962 which has become a worldwide standard for calculating the effectiveness of sunscreen. It’s based on sunscreen applied at an even rate of 2 milligrams per square centimeter. This measurement factor is currently causing some controversy as many doctors believe it isn’t enough for proper protection. They believe it should be double the amount.

Cosmetics: What is UVA?
Dr. Lisa Kellett: UVA is Ultra Violet A Rays and UVB is Ultra Violet B Rays which coexist on a spectrum of light measured in nanometers. They are produced artificially and also are found in sunlight.

Cosmetics: What does it mean to have broad-spectrum?
Dr. Lisa Kellett: The term “broad-spectrum” usually refers to broad-spectrum coverage of sun protection products whereby the product is composed of ingredients that are effective against both UVA and UVB rays.

Cosmetics: What is melanoma and how does it form?
Dr. Lisa Kellett: Melanoma refers to malignant melanoma which is a potentially life threatening skin cancer arising from pigment producing cells in the skin. There is an association between sun exposure and malignant melanoma development.

Cosmetics: What is an appropriate amount of sunscreen in a single application?
Dr. Lisa Kellett: Ideally, you should use the amount of product you can put in a shot glass for the entire body.

Cosmetics: What is Parsol 1789?
Dr. Lisa Kellett: Parsol 1789 or avobenzone is an oil soluble ingredient used in chemical sunscreens to absorb UVA rays. It’s also known as Eusolex 9020, Escabol 517 or butyl methoxydibenzoylmethane. It’s been proven to absorb ultraviolet light across a wider range of wavelengths than several organic sunscreen ingredients, hence its popularity in sunscreen lotions and sprays. Some studies show it is most effective when paired with titanium dioxide, a physical sun block. Unfortunately, Parsol 1789 has recently been the cause of significant incidence of allergies. For that reason, it’s being used in less and less sunscreens.

Cosmetics: There are more and more products that claim to prolong a suntan. Do these work?
Dr. Lisa Kellett: A tan is the skin’s response to injury. In short, if you have a tan you have damaged your skin. A tan resolves when the damaged dead skin layers with the pigment are desquamated from the skin. Some products moisturize the top of the skin to decrease the desquamation process thus keeping the “look” of the tan longer.

From Cosmetics Magazine, May/June 2010

Ask a Dermatologist – Understanding Cellulite

If you’ve ever stood naked before a full-length mirror and discovered lumpy, “Cottage-cheese-like” fat deposits on your hips or arms, you understand the stress and embarrassment cellulite can create. It’s arguably the number one body care concern with Canadian women. Yet, it’s often misunderstood. We ask our in-house dermatologist Dr. Lisa Kellett to dispel the most common cellulite myth.

Cosmetics: To start, what exactly is cellulite?
Dr. Lisa Kellett: Cellulite is a term used to describe the irregular “cottage cheese-like” appearance of fat in certain areas of the body under the skin. It technically is a kind of fat deposit.

Cosmetics: How does it form and where?
Dr. Lisa Kellett: It forms more commonly in women in areas of increased fat distribution such as the buttocks, hips, thighs, abdomen and arms. It can appear at any age in individuals who are obese but also in individuals with normal total body fat. It is usually associated with an increase in fat deposition in certain areas such as the hips, buttocks, thighs and arms.

Cosmetics: What is the difference between fat deposits and cellulite?
Dr. Lisa Kellett: This is a great question. Many people get them confused. Fat deposits refer to a pathological condition called lipoma. Cellulite refers to a certain appearance of fat.

Cosmetics: Why do few men get cellulite?
Dr. Lisa Kellett: Men have less fat deposited in the above areas and have overall less percentage of body fat than women.

Cosmetics: What is the psychological effect of cellulite? Do you have patients who are very distressed with their cellulite?
Dr. Lisa Kellett: Yes. Many women and men are quite concerned with the appearance of cellulite and find that it can inhibit their activities and affect their quality of life. I reassure them that cellulite is very common and that there are now new ways to improve its appearance. But, cellulite can be very traumatic for some people.

Cosmetics: What factors affect cellulite production? I’ve read that stress may play a role.
Dr. Lisa Kellett: There is no evidence-based medicine to support the role of stress and its effect on cellulite. However, in terms of genetics, if for example your mother had large hips or thighs with cellulite and you inherited them, there is a higher probability that you will have cellulite.

Cosmetics: Many anti-cellulite products contain caffeine. Why?
Dr. Lisa Kellett: Caffeine increases blood flow to the area resulting in local tissue swelling.

Cosmetics: What is the latest way to treat cellulite in a doctor’s office?
Dr. Lisa Kellett: Synergie is technology that helps to improve cellulite by using a balanced mixture of vacuum and massage to reposition fatty deposits under the skin and stimulate blood flow. The result is smoother-looking, more even, less dimpled skin.

Cosmetics: What is the most important thing readers should know about cellulite?
Dr. Lisa Kellett: Readers should know that most women have cellulite…even supermodels! And that there are treatment options available if it is a concern.

From Cosmetics Magazine - March, 2010