Chapter 2

Skin Stressors

Open pores

THIS IS ONE COMPLAINT that everyone has irrespective of their age, and why not? Even if you have absolutely clean complexion, if the pores are wide open, your skin does not look beautiful. The skin actually starts to look dull because it does not reflect light evenly. When this gets linked with oily skin, comedones (bumps on the skin that give it a rough texture), and acne, you end up hating this condition further. It is important you have your pores nice and closed so that your skin looks flawless and bright.

Why do you get open pores?

Sometimes you are genetically prone to have open pore skin, maybe in combination with oily skin. Then as you age, your skin gets relaxed and the pores open up. Excessively steaming your face during a facial or while body steaming and sauna, or the latest craze of hot yoga, can lead to permanently relaxed pores.

How to deal with it?

The simplest thing you can do is use absolutely chilled water from your fridge and splash it on your face. That acts like an instant toner which tightens up your pores. Also, make sure that every time you go to a salon, ask them to use cool mist after they have done the blackhead extraction and deep cleansing. Ask them to put a cold towel on your face while you are in a steam chamber. Splash cold water on your face after a hot shower. You can use ice cubes wrapped in a bit of muslin on your pores as a cooling pack. You can try a mask with kaolin clay or fuller’s earth (multani mitti) to tighten the pores. Apply calamine lotion to calm the skin.

Try mild peels on your own at home. Buy either Kojic Acid 6-20%, Azelaic Acid 10-20%, or Salicylic Acid of around 2%, which are all available over the counter. You can apply them one at a time and leave it overnight and see how your skin takes it. Once your skin gets used to it, you can mix all the three and apply it. Leave it on for a couple of hours and see how your skin reacts. Once it adjusts to the blend, you can leave it overnight. If you have oily skin, use this twice a week, and if your skin is dry, then apply it only once a week. Application of Tretinoin and Retino-A ointments at night over a period of time also helps. Look for pore minimizing creams or serums for wearing under your sunscreen during the day.

At your skin doctor’s

You can also go to your doctor’s to get mild peels done regularly. Ask for Retin-A peels and medium depth peels. You can do mesotherapy wherein Botox is injected underneath your skin to shrink the pores. You can also opt for collagen remodelling laser treatment which shrinks the pores automatically.

Adult acne

Adult acne is a skin problem that you can face between the ages of 40 to 50. So how do identify that you have adult acne? The first sign of adult acne is that it will appear in your C-Zone. Adult acne presents itself as a tenderness that can start 5 to 7 days before you see an actual pimple on the skin. It gets really red and painful. It may not even become a pustule like teenage acne and just remain there for quite some time, hurting you, and then subside leaving behind a dark mark.

Why do you get adult acne?

Hormonal fluctuation is the culprit. It can be stress related as well. Other signs of hormonal fluctuation include breast tenderness, your menstrual cycle going all haywire, and abnormal hair growth on your chin and other facial areas. Then you know that there’s something wrong going on with your hormones. It is usually sporadic.

Alterations in the level of female and male hormones can lead to stimulation of sebaceous glands and hair growth on your face. You might also notice some on your back and chest. These hormones also reduce BMR which increases your tendency to put on weight around your belly. What happens is this—your excess female hormones are converted into male hormones in the peripheral fat which further harms the skin and affects the metabolism of body fat.

The other factor that can trigger adult acne is your thyroid. If you have a family history of thyroid abnormality or going through a stressful situation, then you have higher chances of sprouting pimples. Both these situations can be brought under control; all you need to do is visit your endocrinologist.

Yet another cause could be wrong cosmetic products or make up and any other medication that you may be on. In such a case all you need to do is to stop the application of your beauty product, make up, or medication. Slowly reintroduce them one by one to find out the trigger to the skin irritation. Then go and consult your doctor.

What do you do to deal with it?

You could simply start off with yoga and exercise to make sure that happy hormones are released. It can go a long way in calming you from the inside which then shows on the outside.

At home, start regulating your skincare regime—pick a face wash that matches your needs, regulate your night cream, and check your sunscreen. Start your at-home care with a Salicylic Acid or Benzoyl Peroxide cream. Eat a balanced diet with anti-inflammatory ingredients. You can also take oral anti-inflammatory medication, EFA, and antioxidants.

At your skin doctor’s

First get the right medication to regulate your hormones. Then go for gentle peels. You can also opt for certain lasers and light therapy.

Stretch marks

If I had a magic wand that could erase stretch marks, I would be a millionaire by now. But then I don’t have the wand, and neither does anybody I know. We all know why we get stretch marks—pregnancy, sudden weight loss—there can be so many reasons for it. But can we really do anything about it? Can we prevent those lines? No. All the creams and all the oils that claim to do so cannot prevent stretch marks if your skin is prone to it. Your genetic make up is responsible for it as well. However, you can ease your skin into it and reduce the severity of the marks.

When you are pregnant and putting on and then losing weight rapidly, lubricate your skin with these special potions:

Calendula: Stimulates growth of new skin cells

Celery oil: Eases congestion, puffiness, and swelling of the skin

Camomile: Has a cooling and soothing effect on the skin

Lavender: Soothing effect on dry and itching skin

Vitamin A: Helps improve the skin’s elasticity, texture, and tone

Vitamin E: Increases the moisture content of the epidermis, thereby making the skin softer, smoother, and suppler

But if you have already developed stretch marks, then can you really get rid of them? Sorry, but no, not completely. Though, with care and certain treatments, you might be able to lighten the appearance and reduce the severity.

Here’s what you can do at home

• Regularly apply the special stretch mark potion
• Apply Retin-A creams
• You can use acids and skin lightening creams if you have dark stretch marks

At your skin doctor’s

You can opt for peels, laser skin resurfacing, micro-needling and radio frequency. In fact, I have got super results with a combination of all the above.

Hyperpigmentation

Hyperpigmentation is characterized by a darkening of an area of the skin. This is most often caused by overproduction of a pigment called melanin. This overproduction is due to an increase in the number or activity of melanocytes. Though it can occur to a person belonging to any race, those of Asian, Mediterranean, African or Latin origin are more prone to it.

Why do you get hyperpigmentation?

Here are some common forms of hyperpigmentation and their causes:

Tanning: Sun exposure stimulates the production of melanin.

Melasma: Brownish discolouration of the face, more often across the cheek, nose, forehead, and chin areas. It is more common in women and those with a darker complexion. It is associated with hormonal changes like those that occurs during pregnancy (called chloasma), and by the use of oral contraceptives. It is aggravated due to sun exposure and may become permanent with the lack of timely intervention.

Freckles: Small peppery brown spots arising on the face and other sun exposed areas. They darken and increase in number during summer and get lighter during winters.

Lentigenes: Brown to black spots that occur mostly in sun exposed areas; there is no seasonal variation.

Age spots or liver spots: Small, flat, pigmented spots which look similar to freckles. Most often seen on the sun exposed skin after you cross 40; it usually occurs on the face, shoulders, neck, ear, and the back of the hands. Unlike freckles, these generally do not fade with treatment.

Dermatosis Papulosa Nigra or DPN: Small, 1-3mm sized areas of thickened skin that gradually enlarge with time. They are not pre-cancerous.

Mole (Nevus): Growths on the skin that are usually brown or black. They may appear at birth or later in life. A vast majority of moles are benign but some that may be of medical concern are those that develop due to sudden change in the colour, size, or shape; or if they bleed, ooze, itch or become tender or painful; or if they are very large or asymmetric moles.

Skin tag: A small flap of tissue that hangs off the skin by a connecting stalk. They are not dangerous.

Post Inflammatory Hyperpigmentation (PIH): Pigmentation that occurs after any superficial damage to the skin like pimple, superficial burn, cut or abrasion. This leaves a mark that is darker than the rest of the skin.

Pigmentation on other body parts: Pigmentation on the back or upper arms is common in individuals who have darker skin despite the long-term use of body scrubs or loofahs. Pigmentation may occur in those with some hormonal disorders like Addison’s disease, caused by adrenal insufficiency; Cushing’s disease, those with insulin resistance; Acanthosis Nigricans, hyperpigmentation of intertriginous areas and body folds; Grave’s disease, thyroid disorder. In addition, patients of certain liver or kidney diseases or certain kinds of vitamin deficiencies or some underlying malignancy may also develop hyperpigmentation on various body parts. Certain fungal infections may also cause the skin to look patchy or dry. Chronic friction may also cause pigmentation of certain body parts like the chin or neck due to regular threading, or elbows or knees due to posture.

The pigment cycle

Skin cells that make melanin are in the lowermost layer of the epidermis. With age, melanocyte distribution becomes less controlled, causing dark spots to form instead of clear, even skin.

Name of the pigmentary condition	Melasma	Sunspots/ Age spots/ Liver Spots	Post-inflammatory hyper-pigmentation (PIH)	Freckles
Colour	Light to medium brown	Light to dark brown	Brown to black	Light to dark brown or black
Place of occurrence	On the cheeks, sides of the face, upper part of the nose, forehead, and above the lip	On the face, chest, and hands, not much in darker individuals	Anywhere	On the face, chest and arms
What it looks like	Patches that are inconsistent in shape and size	Small, flat, dark spots	Flat spots or raised	Concentrated small spots, seasonal variation
Cause	A surge in hormones, usually from pregnancy or birth control coupled with sun exposure, may run in the family	The sun	Any skin injury, trauma, friction, pressure, lasers, inflammatory acne etc.	The sun, genetic
How to treat it?	Hydroquinone and Retin-A; Azelic, Salicylic, Lactic or Glycolic Acid peels, Q-switched Nd Yag laser; or hard to treat, may come back with a vengeance	Retinol + IPL fractional laser	Light Salicylic Acid chemical peels; lasers, avoid causing factors	Q switched Nd Yag laser at 532 nm

 

Step 01

Melanin production is triggered.

Sun exposure, inflammation, or a hormonal surge, trigger a signal to the hormones that control melanin production. Once this signal is sent, the enzyme tyrosinase tells the body to start the process of creating more melanin.

Step 02

The melanocyte cells start producing a new pigment.

This newly created pigment is then packaged into little bundles called melanosomes.

Step 03

Pigment is distributed.

Next, the melanosomes disperse the pigment through the dermis up to the epidermis through their dendrites. If the pigment doesn’t make its way up toward the surface and stay in the dermis, they will be harder to erase.

The cause of dark spots

The Sun: UV rays produce excess melanin, which is deposited in the skin.

Inflammation: Trauma to the skin is one of the main causes for hyperpigmentation, and also responsible for sharp, blunt or normal irritation and inflammation.

Acne: The more severe the blemish the more inflammed the skin is, and the more likely it is to pigment. Inflamed areas naturally produce more melanin.

Hormones: Pregnancy, birth control, and menopause can cause a spike in melanin production.

Lasers and peels: Laser and strong chemical peels cause inflammation, and the body may respond with brown patches or stripes.

Medication: Some antibiotics (sulphonamides and tetracyclines) and medications to treat Parkinson’s disease, cancer, diabetes, and heart disease, can lead to dark patches as an allergic reaction or because of increased sun sensitivity.

Regardless of what caused your skin to become uneven in tone, the slightest bit of sun exposure (mere minutes in the sun can be enough for some) can trigger the skin to kick melanin production into overdrive. That’s why wearing sunscreen daily is stressed in almost all the sections.

‘Akshara and I have always believed in home-care from natural ingredients. And now that both Akshara and I are shooting, using make up, and are constantly exposed to the sun, skincare routine—cleansing and protection against the sun—is a must. Sun protection, I feel, is of utmost importance not only to look beautiful but also for protection against skin ailments.’

Sarika, Actress

Surface pigmentation vs. deep pigmentation

When pigmentation is on the top most layer of your skin, the discolouration is more of a light brown colour and is more diffused. It also responds better to treatment. Pigmentation deep within skin takes on more of a dark brown or grey shade and is solid and hence harder to treat.

Chemical peels

These are a series of light ‘chemical’ peels that use Salicylic Acid, Lactic Acid, Glycolic Acid, resorcinol, TCA, Jessner’s solution etc. They can improve skin texture and colour.

Laser resurfacing treatments and intense pulsed light (IPL)

Laser treatments—in which a beam of fractionated energy is delivered to skin to incite a wound-healing response—can work wonders to correct hyperpigmentation or more specifically sunspots and acne scars. When using lasers to treat hyperpigmentation, it is important that a low-energy, non-ablative fractional laser is used. Otherwise, new or more pigmentation can develop. Nd: YAG lasers can also be used to treat spots.

Enzymes

Enzymes are tiny little proteins that accelerate chemical reactions in skin cells and on the surface of the skin, they are responsible for softening it. They also dissolve and digest old, dry skin cells so that you can wash them away easily to reveal healthy, glowing skin.

Enzymes tend to be gentler than acids in chemically loosening the cells of your outer most layer. Enzymes are less acidic and have a pH value closer to the skin’s natural state. Every fruit has an enzyme and all of them can help, so you can simply use the pulp to massage or apply it as a pack and let it stay on for 15 minutes.

The upside

Since many enzymes are derived from fruits, they also up the ante by being antioxidants and having the ability to scavenge free radicals. They also help jump-start cell turnover and boost the metabolism of cells to help keep skin acting young.

The downside

Enzymes can break down very quickly—many of us could be allergic to them. I am allergic to aloe vera. And if you are looking for a specific benefit, you may not really achieve it as the actives may not be potent enough.

Papin (Papaya): Very powerful exfoliator and anti-inflammatory.

Protease (Pumpkin): In addition to its exfoliating ability, it also has anti-ageing superstar vitamin A.

Bromelain (Pineapple): anti-inflammatory

Malic Acid (Green Apples): Although it’s found in several fruits, malic acid is most abundant in green apples.

Actinidin (Kiwi Fruit): A vitamin-C powerhouse that also has the ability to brighten the skin. Kiwi fruit is perhaps the most suitable enzyme for sensitive skin.

For more information on skin, you can visit my webpage http://www.drrashmishetty.com/pages/skin.html