Stress acne is a thing

Dr. Benjamin Barankin is a dermatologist practicing in Toronto and is the medical director and founder of the Toronto Dermatology Centre. Often skin care lines have an in-house dermatologist to talk about their respective brand but Dr. Benjamin Barankin is brand agnostic. He has shared best practices for picking sunscreenmosquito protection and healing dry skin.

And now, acne.

Between physical makeup stores and pharmacies and the seemingly endless supply of beauty brands online, it’s hard to decipher which skin care products could work for you. When it comes to acne, there are all sorts of underlying causes.

It’s so interesting and incredible how connected the mind and body are – asides from when our minds are stressed and then we get acne. Way to kick us when we’re down, bodies. But turns out, we’re not imagining things. Stress acne is a thing.

Also, why do we get acne on our chests and backs? Or “trunks,” as dermatologists call them. We learned a bit of the profession’s jargon, how to treat acne and fun (not fun) facts like adult acne is more common in women.

Q: What causes acne?

A: Acne is due to many factors including stress and diet and genetics, but ultimately there is a hormone-mediated drive resulting in increased sebum(oil) production, as well as plugging up of pores, inflammation and C. acnes bacteria.

Q: Do adolescence and adult acne have the same cause?

A: Generally speaking. Adult acne is much more common in women and is typically due to hormonal factors.

Q: Can you treat adolescence and adult acne the same way?

A: Treatment is similar, except that adult skin tends to be less oily and more sensitive and more often hormonal.

Q: What are the differences between face and body acne in terms of cause and treatment?

A: Face and trunk are similar.

Q: How do you prevent acne?

A: Prevention includes gentle cleansing, avoiding picking and popping and minimizing exfoliating of the skin. A low-glycemic diet and reduced dairy (skim milk especially) are helpful for some people. A benzoyl peroxide body wash can be quite useful for those with body acne. Keeping athletic gear (e.g. hockey or football equipment) clean and washing right after sport is important for body acne prevention.

Q: How do you treat acne?

A: The type of acne (e.g. hormonal, comedonal, inflammatory etc.) and extent of acne (face only, or also trunk) are important determinants of treatment options. 

Over-the-counter (OTC) options mainly include benzoyl peroxide and salicylic acid-based products, although retinol, tea tree oil, glycolic acid and azelaic acid or other acids are available and great places to start.

(Benzoyl peroxide helps treat acne by killing the bacteria that cause the skin condition. It also helps by removing excess oil from the skin. You can get OTC products in benzoyl peroxide strengths from 2.5 per cent to 10 per cent. Often the 2.5 per-cent-strength option works just as well as more potent options, so start with a lower concentration to manage side effects. Of course, read the instructions of any product before you use it, but general side effects could include dry, irritated or stinging skin.

Salicylic acid unclogs pores and breaks down oils, like sebum. It also decreases how much skin produces sebum, which can reduce future acne.)

Q: What if OTC treatment isn’t working?

A: If acne is not responding sufficiently to OTC options or the acne is severe or scarring, or having an impact psychologically or socially, then best to see your doctor and ideally a dermatologist for expert skin care and prescriptions, which include topical or oral antibiotics, combination creams and gels and/or hormonal therapies or isotretinoin, chemical peels or lasers.

If acne affects much of the chest or back, or scarring is present on the trunk, then generally one requires oral therapies such as antibiotics, hormonal treatments in women (oral contraceptive or spironolactone) or isotretinoin. Photodynamic therapy may also be considered.

Credit: Randi Mann, Nationalpost.com

When it comes to one’s skin health, the consultation process is equally as important as the actual treatment. With the right tools we can better demonstrate our knowledge and expertise on skin, find the source of your skin’s problem, and present a treatment plan fit for you. 

Skin analysis technology allows us to better understand patients’ skin problem therefore this allows us to recommend proper treatments and the right skincare to help you reach your optimal skin goals.

Cherry Imaging System

It is the first device that can precisely and accurately deliver objective patient data before and after an esthetic or medical treatment.

The innovative, handheld camera scans over one thousand micro 3D images and stitches them together into one composite 3D model. Each scan captures the finest subtleties in texture and smallest changes in volume.

Artificial Intelligence based measurements to automatically identify esthetic problems and trace them over time. Dozens of analytical tools designed for real-time evaluation of skin condition:

  • Volume of fillers
  • Area and volume of moles and scars
  • Elevation/Depression
  • Skin roughness
  • Pigment & redness
  • Cellulite
  • Acne scars

Applicable for:

  • Fillers and Botox volume and wrinkles to monitor treatment effectiveness
  • Skin Rejuvenation – wrinkles length, depth and skin roughness
  • Pigmentation and Redness
  • Scars – elevation, depression volume and area
  • Body – Measuring volume changes, cellulite and stretch marks.           
Dr. Benjamin Barankin’s dermatologic expertise was recently quoted in The Chronicle of Skin & Allergy discussing the latest developments in psoriasis treatment. 

S pecific interleukin pathways have been identified in addressing numerous skin conditions such as plaque psoriasis, atopic dermatitis (AD), and IL inhibitors have emerged as effective agents to treat these conditions. IL inhibitors are also being examined for conditions that have had few or no biologic options available such as generalized pustular psoriasis, prurigo nodularis, and hidradenitis suppurativa (HS).

Psoriasis and generalized pustular psoriasis

“Tildrakizumab is the newest anti-IL-23 biologic agent to be approved [forpsoriasis], and it gives physicians yet another tool to help patients with severe psoriasis to improve quickly, effectively, and safely,” said Dr. Jaggi Rao, a dermatologist in Edmonton and Clinical Professor of Medicine at the University of Alberta. “Tildrakizumab is delivered via a subcutaneous injection, and its unique feature is that it requires the fewest number of injections compared to other anti-IL-23 agents.”

Dr. Rao noted six injections are needed in the first year, and four yearly injections thereafter. Dr. Ben Barankin, a dermatologist, Medical Director and Founder of the Toronto Dermatology Centre in Toronto, agreed that the launch of tildrakizumab represents a new anti-IL player in psoriasis management that will offer convenient dosing. “The frequency of injection is nice, as it is every three months,” he said. “This is the third IL-23 [for psoriasis] to be approved and join the family of risankizumab and guselkumab.”

A new development in the IL-23 inhibitor family is the recent approval of risankizumab for psoriatic
arthritis, noted Dr. Barankin. Another IL-17 inhibitor now approved for psoriasis is bimekizumab.
“Ongoing studies demonstrate amongst the fastest and most complete psoriasis clearance rates ever
seen with it, more so than the currently available IL-17 inhibitors on the market,” said Dr. Rao.

Dr. Catherine Zip, Clinical Associate Professor, Division of Dermatology, University of Calgary, agreed
that bimekizumab, an IL-17A and IL-17F inhibitor, will offer strong efficacy and its side effect of concern
can be well managed. “In head-to-head trials, it was shown to have superior efficacy to adalimumab, ustekinumab, and secukinumab,” said Dr. Zip. “Oral candidiasis can occur, but it’s mild-tomoderate
in severity, rarely recurrent, and responsive to typical anti-candidal therapies. It [bimekizumab] is
also being studied for treatment of psoriatic arthritis and hidradenitis suppurativa.”

Dr. Barankin described bimekizumab as a distinctive IL-17 inhibitor because of how it works. “As
an IL-17 inhibitor, it is unique because it binds to both A and F,” said Dr. Barankin. “With respect to safety
and efficacy, it will be one of the best IL-17 inhibitors, but it presents a higher candidiasis risk.”

The enthusiasm around the expected availability of bimekizumab is shared by other dermatologists including Dr. Kerri Purdy, Division Head and Assistant Professor in the Division of Clinical Dermatology & Cutaneous Science, Department of Medicine, Dalhousie University, Halifax.

“I am most excited about bimekizumab coming out,” said Dr. Purdy. “I am looking forward to having another option in the IL-17 class. I think that is a great class of agents.”

Generalized pustular psoriasis is a condition for which there is a dearth of effective therapies, noted Dr. Barankin

“We have never had a specific therapy for generalized pustular psoriasis,” said Dr. Barankin.

“Spesolimab is an anti-IL-36 inhibitor which reverses GPP quickly, and most patients attain dramatic improvement within the first week. It’s not a common condition that we see, but when we do see patients with it, it can be very serious and even life threatening. Unlike spesolimab, the medications we currently
use act slowly and do not have as good a side effect profile.

IL inhibitors for AD

Dr. Kyle Cullingham, a dermatologist in Saskatoon and medical director of Saskatoon Dermatology Centre, said dermatologists can potentially look forward to using biologic agents for conditions such as HS. “IL-17 molecules, such as secukinumab or ixekizumab, are being studied for the treatment of HS,” said Dr. Cullingham. “Bimekizumab, which is a new molecule that [has] become available for treating psoriasis, is also being trialled for HS. That is really exciting.”

IL inhibitors are also being explored for their ability to manage conditions such as prurigo nodularis
and notalgia paresthetica, conditions in which itch features prominently, noted Dr. Cullingham. “They
[prurigo nodularis and notalgia paresthetica] are conditions that work on similar pathways as
eczema. Often times, these [conditions] can be the result of chronic eczema. If we can treat them upstream [of the pathway], then we can possibly obtain great results.”

Another biologic option now available in Canada for AD is tralokinumab, a biologic agent that targets
IL-13. It received approval in 2021 and will be available for prescription for moderate-to-severe AD, expanding biologic options beyond dupilumab for AD. “No head-tohead trials vs. dupilumab have been
conducted,” noted Dr. Zip.

Dr. Cullingham added he will be taking part in a Phase IV study on tralokinumab. “It’s exciting to have
another biologic for atopic dermatitis,” he said. “We will get patients on the medication and see how they
fare over the next year. This is an opportunity for real-world data.”

The exploration of many molecules as potential treatments for HS is very encouraging, according to Dr. Cullingham. “There are quite a few molecules being studied for HS,” he said, noting the only approved
treatment to date is adalimumab.

“We haven’t had a lot of new options, so it’s exciting to see.”

Non-proprietary and brand names of therapies: tildrakizumab (Ilumya, Sun Pharma); risankizumab (Skyrizi,
AbbVie); guselkumab (Tremfya, Janssen); bimekizumab (BIMZELX, UCB Canada); adalimumab (Humira,
AbbVie); ustekinumab (Stelara, Janssen); secukinumab (Cosentyx, Novartis); spesolimab (not approved
in Canada); imsidolimab (not approved in Canada); ixekizumab (Taltz, Lilly); tralokinumab (Adtralza,
LEO Pharma); dupilumab (Dupixent, Sanofi, Regeneron).

Credit: Louise Gagnon, Correspondent, The Chronicle

Seeking individuals for a research study testing an investigational injectable product for cheek augmentation in adults.

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  • Participants will receive an investigational product (active study treatment) or a comparative product, in the form of an injectable gel.
  • Study treatment and study-related assessments will be provided at no cost.
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  • Study participation could last about 20 months and involve about 12 visits to the study centre, plus 4 follow-up phone calls.

If interested, please contact our research coordinator 416-633-0001 x4 or e-mail [email protected].

Sweat is impossible to avoid, but for the most part it isn’t damaging to skin. “As long as you’re washing your face once or more per day, sweating will not clog up pores sufficiently to cause acne,” says Dr. Benjamin Barankin, a Toronto dermatologist and the medical director of Toronto Dermatology Centre. However, it can result in skin irritation, particularly in those already prone to dry skin, eczema, rosacea or odour.

That said, there are plenty of benefits to sweating, the primary one being perspiration’s ability to cool the body and maintain a proper body temperature. It’s also typically a marker of a good workout. “The fitter you are, the more easily you sweat – big surprise to most people,” Barankin says. However, the idea that sweating can detoxify skin is pure myth, Barankin says.

My recommendation: Although not a traditional beauty product, a good hat can go a long way to protecting your skin from the sun and helping you keep cool on a muggy day. Bucket hats have been my favourite for years — they’re fashion forward, flattering and provide coverage to ears and the back of the neck as well. You can drop a small fortune on a designer version (I’ve had my eye on Prada’s), but they don’t call it Tilley Endurables for nothing.

Credit: Caitlin Agnew, theglobeandmail.com

Tips and products to safeguard yourself from harmful rays

May is Skin Cancer Awareness Month.

Melanoma is one of the most common types of cancer among Canadians aged 15 to 49 with excessive sun exposure leading to the majority of diagnosed cases.

Although there are several types of skin cancer, melanoma is the deadliest form. With early detection, however, the five-year survival rate is 99 per cent.

Melanoma is on the rise, especially in women under 40. In the 1930s, it affected about one in 1500 people, according to the Melanoma Network of Canada — less than 100 years later, that number has ballooned to one in 63 people.

How to protect yourself 

We asked Dr. Monica Li, a double board-certified dermatologist and clinical instructor at the Department of Dermatology and Skin Science at the University of British Columbia to weigh in.

She said the most widely available SPF products are ‘broad-spectrum’ which protect against ultraviolet A (UVA) and ultraviolet B (UVB) radiation. She said that is “critical and highly recommended,” given both contribute to signs of premature skin aging and the development of skin cancer.

SPF (sun protection factor) is simply part of a comprehensive strategy that can include seeking shade, avoiding direct sun exposure during peak hours of 11 a.m. to 3 p.m. and using sun-protective clothing like a wide-brimmed hat which can protect the scalp, ears and lips from sun damage and sunburns, and wraparound sunglasses, she said.

“Easily exposed sites are most likely to get sunburnt, particularly the head and neck region. The shoulders, upper back, lips and ears are also common areas to get a sunburn because of the reach of UV radiation and they can be sites where individuals may also forget to apply SPF,” Li said. “The tops of feet are often forgotten as well until we see the tan from the sandal straps, and this often lasts well past the summer months.”

“Over time, with cumulative sun damage, signs of premature skin aging will appear,” she added. “These include fine lines, a dull skin tone and uneven pigmentation such as sunspots. Skin cancers may also arise, and these do not necessarily appear only on sun-exposed sites.”

Think a pre-tan will keep you safe? Think again.

“Getting a base tan also does not protect an individual from getting a sunburn afterwards. A ‘”base tan’” is simply not healthy. UV radiation is a known human carcinogen and there is no safe dose of UV light,” Li said.

She said a sunless tanning cream, lotion or spray that temporarily dyes the cells at the skin’s surface is a safe alternative to direct sun exposure for those who want some colour.

If you are outside for a while, reapply sunscreen every two hours and opt for a water-resistant SPF if you are spending time in the water.

For those interested in the science behind it — “SPF, or sun protection factor, is a measure of how much UV radiation is needed to produce sunburn on protected skin after applying sunscreen, relative to the amount of UV radiation needed to produce sunburn on unprotected skin with no SPF,” Li explained. “For instance, SPF 30 means the skin will have 30 times longer before developing a sunburn for an individual who wore sunscreen versus someone who did not.”

Assess your risk and get sun savvy

Neutrogena partnered with Melanoma Canada for the month of May to spotlight Canadian on Instagram impacted by melanoma and focus on the importance of sun safety and early detection.  

This skin self-exam tool is a great resource for those wanting to know more about their risk.

Which sunscreens to use

Dr. Benjamin Barankin, Toronto dermatologist and medical director of Toronto Dermatology Centre, answers said sun avoidance, when possible, is best and he recommends reapplying sunscreen after towelling/getting wet/sweating or every three to four hours if out and about. Most people put on about a half of what they need, so be generous when screening up, he said.

Credit: Nadia Moharib, Financialpost.com

Once again, as a cutting edge dermatologist, Dr. Benjamin Barankin was recently asked to update what’s new in dermatology for The Chronicle of Skin & Allergy.

Congratulations to Dr. Anatoli Freiman for being nominated as one of the Top Dermatologists in Toronto by his physician colleagues in streetsoftoronto.com by Post City Magazine. Read the full article here.

Face Skin Care. Closeup Of Woman Face Cleansing At Cosmetology

Interested in improving your skin, but don’t have the time to recover from more invasive treatments? There are plenty of options available at Toronto Dermatology Centre (TDC) that require little to no down-time and their benefits can be surprising.

Ranging from instant but shorter results to treatments that take a little longer to see results, but have extended benefits, there are undoubtedly multiple services that suit even the busiest of lifestyles.

One of our newer services, the Bela MD, is a combination of the Silk Peel microdermabrasion and Hydrafacial. Utilizing dry diamond microdermabrasion, hydrogen water infusion, ultrasonic cleanse and extraction, neuromuscular stimulation, BELA MD serum infusion, and electroporation, your skin will be exfoliated, hydrated, lifted and toned. In just one hour, with the most relaxing treatment at TDC, your skin will be revived and renewed. My patients tell me they can see the benefits for up to a month post-treatment!

People are sometimes afraid to try chemical peels for fear of extreme redness, peeling and even looking like they have a sunburn. There are so many types of chemical peels, and depending on the ingredients, the pH and the buffers, some of even the more advanced peels offer little to no peeling. I love the GlycoAge Peel!  A great peel for anti-aging, but with no visible peeling, it can be performed on a lunch hour and have you back to work without skipping a beat. Removing dead skin cells helps your homecare to penetrate the skin better and keep the skin looking smoother, lessening fine lines and wrinkles.

Even our customized facials can be so beneficial for the skin. Sure there may be a little redness after an acne facial, but for someone with dry skin or rosacea skin, hydration and softness as well as irritation relief can be felt and seen immediately. Some of my patients even leave the clinic less red than when they came in, which in itself can be a big relief.

Some minor invasive treatments also have next to no downtime too. Microneedling alone or microneedling with PRP will often leave the skin a little pink or red right afterwards. However, in most cases, by the next day the skin is usually back to normal. With the ability to stimulate collagen and improve acne scarring, you can imagine the benefits these treatments have on the skin.

Finally, one of our newest services, the Forma, works with radiofrequency to tighten the skin, both immediately and cumulatively. This is one of the best options for the neck, where the skin is so distinctly harder to treat than the face for skin tightening. Feeling like a hot stone massage, the face, the neck, or both can be gently tightened for short or long term results and without downtime.

So, there you have it! Not all services have to have downtime, not all services have to be uncomfortable. Some provide immediate results and some take some time, but all benefit the skin and can help you in achieving the goals your skin deserves.

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