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One of the questions I’m frequently asked is “what is your favorite treatment?” Well, anyone who knows me knows I can go on for hours and hours about anything that stimulates collagen. I understand the necessity of creating new collagen cells for anyone suffering from acne scars to aging skin, and that it is as important for your skin as eating fruits and veggies are for your body.

Most of the time, I come back with one of our microneedling treatments for my answer (more on that next time) but recently I took stock of my patients who have been coming to the clinic for years. What I noticed is that the patients who regularly do Laser Genesis have, without a doubt, the best skin overall.

So, what is Laser Genesis and what can it do for your skin? Technically it is a 1064nm Laser that works in Hertz, which is the speed that the energy travels into the skin. It creates a bulk heating as opposed to most lasers. It is attracted to the colour red and to water in the skin. So, in essence, we are mainly targeting vascularity deep in the skin along with collagen. Collagen? Well, yeah, collagen is about 70% water, so the energy will hit cells in the dermis, absorbing into the water in the collagen, & thus stimulating new cells.

Ok, so what does all of that mean? For rosacea patients or those with a flushed skin, it goes deep enough to help alleviate those vessels that most lasers can’t reach. Its energy goes in so quickly that it doesn’t cause thermal damage, therefore it is safe for all skin types. It means that, by creating new cells, we get more volume, tighter skin and an overall smoother appearance.

Oh, and did I mention it treats nail fungus, acne, and is used in conjunction with our Excel V Laser to treat red scars, Port Wine Stains and a multitude of other skin conditions?

The best part for me, is that once you get used to the feel of this Laser, and once you understand that due to the speed the energy travels, it can’t cause a burn, it is actually quite comfortable for most people. I actually have fallen asleep having it done. I kinda love the feel of it, so maybe I’m weird???

So, back to the beginning: I have found that patients of mine who have been doing the Laser Genesis as their maintenance treatment 3-6 times a year overall have the best skin. There is no downtime, they are not red when they leave the clinic, and although collagen takes time to be created and visible on the surface, that tightening effect can sometimes be seen as early as a day after treatment.

Who is the right candidate for Laser Genesis? Everyone!!! It is safe, effective, and probably the easiest laser to tolerate, even for those who have a lesser pain tolerance. It takes some time for long term results due to it treating so deeply in the skin, but for those who are in it for the long haul, there is no treatment I believe in more than Laser Genesis. In fact, I think I am going to see if I can book myself in now for another session!

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre

An essential step in every good skincare routine is washing your face. Sure, you’ve got products targeted at remedying your problem areas and protecting your skin, but the simplest step in your routine could be the culprit behind your skin issues. Careless cleansing could lead to dull skin, clogged pores and aging. But how do you wash your face correctly — and how do you treat any issues caused by improper washing?

We tapped Dr. Monica Li, a Vancouver-based dermatologist and clinical instructor in the Department of Dermatology and Skin Science at the University of British Columbia, and Dr. Benjamin Barankin, a Toronto-based dermatologist and medical director of Toronto Dermatology Centre, for their tips on how to wash your face properly.

Signs you’re not washing your face properly: you still have makeup on

One of the notable signs that you’re not washing your face properly is if you see traces of makeup remaining once you’re through with your wash. Removing stubborn makeup is undoubtedly tricky, but the residue can cause damage to your skin. “Makeup residue can cause irritation to the skin, as well as clog pores which may lead to acne formation,” Li explains. She recommends double cleansing — using a makeup-removing product before washing your face to remove your makeup thoroughly. “Ideally, use a micellar water which is well-tolerated [for most skin types]. Some makeup removal cloths seem to be helpful and preferred for others,” Barankin adds.

Signs you’re not washing your face properly: dull skin

If your skin lacks radiance and looks lacklustre, you’re dealing with dull skin. “Makeup not adequately removed from the face over time can cause skin dullness,” Li says. When you wash your face correctly, the dead skin cells on the surface of your skin are washed away, leaving the natural glow in your skin to show. That’s why Barankin recommends washing your face twice a day, especially if you have naturally oily skin, are physically active or coping with summer heat. Using a gentle exfoliant can also help dissolve dead skin cells, but those with sensitive skin should proceed with caution as it can cause irritation.

Signs you’re not washing your face properly: early aging

Although improper face washing may not directly speed up the aging process, the products you use and how you wash your face can lead to advanced signs of aging. The general rule of thumb is not to scrub your face when washing. Treat your skin with some TLC and delicately wash your face in circular motions. “In general, harsh cleansers should be avoided,” Li advises. Barankin agrees, explaining that cleansers with “fragrances and SLS (sodium lauryl sulfates) may be irritating to some people” and should be avoided.

Signs you’re not washing your face properly: clogged pores

When dead skin cells and makeup are not removed from the skin, they can get trapped in your pores and clog them. Blackheads are challenging to get rid of, so preventing them is critical. Barankin recommends washing your face for 20 to 30 seconds to allow the cleanser to penetrate your pores and clean your skin properly. “Remember the purpose of washing the face is to remove makeup, debris, topical medications or skincare products, so the face really should be washed for the time it takes to remove these layers,” Li says.

Signs you’re not washing your face properly: acne

“[Makeup residue can] clog pores which may lead to acne,” Li cautions. Although you can implement products into your skincare routine to treat acne, a simple way to include acne-fighting ingredients into your regimen is through your cleanser. “You can have salicylic acid or glycolic acid in your cleanser. Still, use a cleanser, not soap,” Barankin says, as it can cause dryness and irritation that can potentially make the acne worse. Li recommends using acne-fighting ingredients, but keep in mind the tolerability and sensitivity of your skin to avoid irritation.

Signs you’re not washing your face properly: irritation and inflammation

Irritation and inflammation can be caused by under-washing and over-washing your face. Barankin says over-washing your face “can damage the natural skin barrier.” A healthy skin barrier keeps your skin healthy and hydrated while also protecting you from external threats like air pollutants and possible dirt from your hands. “Be gentle when you wash your face because you’re not scrubbing pots and pans!” Li says. She recommends using gentle cleansers and looking for products with calming ingredients like colloidal oatmeal and glycerin.

Signs you’re not washing your face properly: skin texture

Washing your face literally removes all the dirt, debris and dead skin cells from your face. But when you wash your face incorrectly, too quickly or too long, those elements either do not get removed or build up over time. This can lead to a change in skin texture that may leave you with bumpy, irritated skin. Cleansers with chemical exfoliants can help flatten texture and even out your skin, but Li says they should generally be used no more than two to three times per week to avoid irritation.

Signs you’re not washing your face properly: dry skin and flaking

Dry skin is difficult to deal with. Makeup clings to it, and staying hydrated may not totally treat it. But the ingredients in your cleanser may be at fault for your dryness and flaking. Li recommends shying away from cleansers with fragrances as they can trigger underlying inflammatory skin conditions (like rosacea) in those with sensitive skin. Barankin recommends using a gentle foaming cleanser and immediately moisturizing right after.

Signs you’re not washing your face properly: oily skin

A common myth about oily skin is that you should avoid moisturizers. But moisturizing could be the best thing to do to combat the oil. If you wash your face too frequently or with a product that has ingredients that cause dryness, your skin may be overcompensating for the lack of moisture in your skin by overproducing oil. On the flip side, if you do not wash your face enough, sweat and dirt will stay on your face and cause irritation. “I recommend a gel or foamy cleanser for oily skin types. For the moisturizer, a lotion or gel would be appropriate,” Li suggests.

Signs you’re not washing your face properly: sensitivity

Some people have naturally sensitive skin, but others can develop sensitive skin by not cleansing properly. This can escalate to irritation, soreness and redness. It’s important always to use gentle products that will soothe the skin and keep it healthy and balanced. Barankin says, “Niacinamide, ceramides, hyaluronic acid are good ingredients to look for,” when shopping for a cleanser. He also recommends putting a humidifier in your bedroom to keep your skin hydrated and calm.

Credit: Julia Paolercio, slice.ca

Botox, or Botulinum toxin, a medication derived from a bacterial toxin, is commonly injected to ease wrinkles, migraines, muscle spasms, excessive sweating and incontinence. Researchers at Skaggs School of Pharmacy and Pharmaceutical Sciences at University of California San Diego, in collaboration with two physicians from Germany, may have found a new use thanks to the U.S. Food and Drug Administration (FDA)’s Adverse Effect Reporting System (FAERS) database, in which nearly 40,000 people reported what happened to them after Botox treatment for a variety of reasons.

The study, publishing Dec. 21, 2021 in the journal Scientific Reports, found that people receiving Botox injections at four different sites — not just in the forehead — reported anxiety significantly less often than patients undergoing different treatments for the same conditions.

“A large number of diverse adverse effects are being reported to the FDA and the main objective usually is to find those harmful side effects that had not been identified during clinical trials,” said Ruben Abagyan, PhD, professor of pharmacy. “However, our idea was different. Why don’t we do the opposite? Why don’t we find beneficial effects?”

Abagyan and his team scoured the database for the absence or reduced frequency of anxiety and anxiety-related disorders as a health complaint, compared to a control group, when taking Botox. Then the team applied a mathematical algorithm to look for statistically significant differences between Botox users and patients who received different treatments for the same conditions.

What they found was that the reported anxiety risk was 22 to 72 percent lower in Botox-treated patients for four of eight conditions and injection sites: facial muscles for cosmetic use; facial and head muscles for migraine; upper and lower limbs for spasm and spasticity; and neck muscles for torticollis. (For the other four injection sites, there was not enough data for statistically significant confidence intervals, according to Abagyan.)

Anxiety disorders are the most common class of psychiatric disorders, according to the National Comorbidity Survey Replication, a survey of the prevalence and correlates of mental disorders in the U.S. carried out between 2001 and 2003. According to the survey, 32 percent of the U.S. population are negatively affected by anxiety at some point in their lives, and treatments are ineffective for nearly one-third of them. That’s why clinicians and researchers seek other therapeutic options.

To be clear, the data used in this study was not collected for the purpose of exploring the association between Botox use and anxiety exclusively. In addition, the FAERS data represents only the subset of Botox users who experienced negative side effects. While the team excluded reports in which a person was also taking antidepressants (often used in treating anxiety) or anxiolytic medications, the use of other prescription and over-the-counter medications could have been underreported in some cases.

Abagyan and his team published a similar study — in Scientific Reports in July 2020 — in which, using the same database, they found that people who received Botox injections reported depression significantly less often than patients undergoing different treatments for the same conditions. Both studies found a decrease in reported symptoms regardless of injection site, thereby casting doubt on speculation that patients may have felt happier because they had fewer wrinkles, or because Botox prevents frowning. But the researchers believe the specific molecular mechanisms by which Botox reduces depression and anxiety — while not known — may be different.

“They may be related, but there are different pathways responsible for anxiety attacks versus depression,” he said.

Abagyan and collaborators hypothesize a few possible mechanisms worth investigating: Botulinum toxins could be transported to the regions of the central nervous systems involved in mood and emotions. Alternatively, the Botox-affected neuromuscular junctions may directly communicate with the brain. Finally, since Botox is commonly used to treat chronic conditions that may contribute to anxiety, its success in relieving the underlying problem may indirectly also relieve anxiety.

More research is needed to determine the mechanism by which Botox reduces anxiety, Abagyan said, and clinical trials will be necessary to work out the best site and dose to administer the medication specifically for anxiety.

Abagyan led the study with Tigran Makunts, PharmD, a former research fellow at the FDA who has joined UC San Diego as a research scientist, and German psychiatrists Marc Axel Wollmer and Tillman Kruger.

Funding came in part from the National Institutes of Health (grant R35-GM131881) and the National Institute of General Medical Sciences.

Disclosures: Ruben Abagyan is co-founder of Molsoft, LLC and has equity. M. Axel Wollmer has consulted for Allergan pharmaceuticals.

Credit: UC San Diego, scienceblog.com

If you haven’t been diagnosed with actinic keratosis (AK) or acne, you might not have heard of photodynamic therapy (PDT) which treats pre-cancerous cells and significantly reduces acne. While modern photodynamic therapy has been around for over 20 years, the beginnings of PDT can be traced to the year 1900!

First, what is actinic keratosis and how is it diagnosed?

Actinic keratosis (AK), sometimes called solar keratosis or, is a pre-cancerous area of rough, scaly, or crusty skin (“feels like sandpaper”). Lesions may have symptoms like being sensitive, or more commonly don’t have any symptoms at all. Actinic keratosis is a disorder of epidermal keratinocytes that is induced by chronic ultraviolet (UV) light/radiation exposure. These growths are more common in fair-skinned people and those who are frequently in the sun due to work (e.g. farmer) or hobbies (e.g. gardening). If left untreated, a small percentage of them will turn into a type of skin cancer called squamous cell carcinoma (SCC) which can be locally destructive, but also has the potential to spread (“metastasize”) leading to death.

Assessment and treatment by your dermatologist is recommended. Many times, a few individual lesions will simply be treated with liquid nitrogen (“cryotherapy”) which creates a localized controlled frostbite to kill the bad cells. For those with more extensive involvement, and where lesions are frequently recurring, “field therapy” should be considered to treat the entire area (e.g. scalp, or face, or both; or chest, or forearms or legs) so as to both treat lesions that are present, and also prevent new lesions from forming. Field therapies include photodynamic therapy, ablative laser resurfacing (e.g. ProFractional laser), medium-strength chemical peels (e.g. TCA), as well as home chemotherapy treatments such as 5-FU (EfudexÒ) or Imiquimod (e.g. ZyclaraÒ or AldaraÒ). Often a combination of these therapies will be used over the years to control these lesions. Your doctor may also recommend you take Niacinamide supplements to help prevent AKs too.

Let’s move on to acne!

Ok, so we all know what acne is, but I feel that cystic or hormonal acne, with or without inflammation seems to garner the greatest results. With that said, even those who experience a significant amount of oil production, even without papules, will find relief with PDT when oil production quickly reduces to a minimum.

PDT consists of two parts: medication and activation. Metvix is now the favored topical medication in dermatology due to its ability to treat deeper and more efficiently than its previous counterparts; it is also activated by the deeper red light spectrum, as opposed to the original more superficial blue light. First, the skin is quickly & easily prepped, Metvix is applied and then it has to “ incubate” for 2-3 hours, at which time the patient feels absolutely nothing from the medication. Metvix is light-activated, so until the patient is exposed to a light source, be it the Aktilite device, IPL/BBL, or even just the sun, the Metvix sits securely in the skin grabbing onto only the cells it needs to “fix”.

The patient needs to stay in low level lighting for the next two days and avoid going outside during the daytime. When treating either AKs or acne, there may be some crusting where the lesions were, but they fall off leaving the skin healthier, smoother and far more attractive (both medical & cosmetic benefit!).

What is awesome about PDT is it is typically only 1-3 sessions per year (varies ofcourse between people), may be fully or partially covered by your drug plan or benefits, and that it has a very high success & satisfaction rate. We have extensive experience treating countless patients over the past decade.

If you think you may have AKs or acne that you are frustrated with, a visit to TDC to see if PDT is right for you might just be the best decision you have ever made!

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre

Our esteemed dermatologist, Dr. Benjamin Barankin, joins other reputable experts in dermatology to offer valuable advice on winter skin care. Read below to learn more.

As temperatures dip, check your products for these skin-saving ingredients

Cold air outside, hot air inside, and dry air everywhere can disrupt the skin’s barrier in the winter. And that can mean dry, itchy skin for everyone, but especially for those who deal with conditions like eczema and psoriasis.

Here are some products that can help your skin look and feel its best throughout the colder months. Some of the ingredients are tried-and-true skin superstars, while others are relatively new additions to the winter skin care arsenal.

Facial cleanser

“You want to make sure your cleanser puts moisture into the skin, rather than taking it out,” says Joyce Davis, MD, FAAD, a board-certified dermatologist practicing in New York City.

Look for: Products that specifically say “gentle” and “moisturizing” on the label. Avoid products that contain alcohol, as these can dry your skin.

Body cleanser

Your skin below your neck needs just as much care as your face.

Look for: Cleansers—liquid, gel, or mousse—the creamier the better. “Also look for products labeled ‘fragrance-free,'” advises Benjamin Barankin, MD, FAAD, a board-certified dermatologist in Toronto.

For patients with eczema, Dr. Davis says products that contain petrolatum, shea butter, and silicones are good choices.

Facial moisturizer

Lighter lotions may not be enough to protect your skin from the elements in colder, drier climates.

Look for: Creams, oils, or balms. “Hyaluronic acid is popular lately,” says Robert Anolik, MD, FAAD, a board-certified dermatologist in private practice in New York City. This ingredient is moisturizing rather than exfoliating, like other acids such as glycolic or salicylic acid. “Jojoba oil is another good hydrating ingredient. Notably, some lactic acid moisturizers are able to walk the fine line of exfoliating dry, flaky skin while helping to maintain skin hydration.”

Body moisturizer

Moisturizing your body while your skin is still damp after a shower or bath is an effective way to keep skin hydrated. This is because moisturizer traps existing moisture in skin. Why not use the same moisturizer on your face and body? Facial skin is thinner and more sensitive, so many face moisturizers are designed to be a bit thinner and less likely to cause acne. They may also have more expensive anti-aging ingredients added to them. Keep in mind that more expensive skin care products are not necessarily more effective.

Look for: Ointments and creams that you squeeze from a tube or scoop from a tub, as opposed to ones you pump from a bottle, as thicker formulations typically pack more moisture. Hyaluronic acid is recommended, because it works as well for the body as it does for the face. “Using hyaluronic acid in body products is new,” says Dr. Davis. “Hyaluronic acid absorbs 1,000 times its weight in water, but until recently it was primarily used in products for the face.” Other ingredients that work well for dry skin are glycerin, lanolin, mineral oil, petrolatum, and shea butter.

Rejuvenating products

Many dermatologists recommend minimizing the use of products containing anti-aging ingredients such as glycolic acid, salicylic acid, or retinol in winter. “You can use them less often, or at a lower concentration,” says Dr. Barankin.

Look for: Products or brands you like with a lower concentration of harsh ingredients. “If you use prescription retinoids regularly, but find them too drying in the winter, you can consider over-the-counter retinols before going back to your prescription in the spring,” suggests Dr. Anolik.

Sunscreen

Yes, you should be wearing sunscreen year-round on areas not covered by clothing, like the face, neck, ears, and hands.

Look for: More moisturizing sunscreen products, such as creams instead of lotions or sprays. “Or use a moisturizer and then apply sunscreen on top,” recommends Dr. Barankin. Your sunscreen should offer broad-spectrum protection, water resistance, and have an SPF of at least 30. You can also protect your skin from the sun in the winter by seeking shade and donning smart accessories, such as gloves and sunglasses with UV protection.

Credit: American Academy of Dermatology Association

November is Eczema Awareness Month and the Eczema Society of Canada (ESC) is asking Canadians to “live the itch” of atopic dermatitis (AD), commonly known as eczema, to help raise awareness around this burdensome symptom.

The itch of AD is frequently rated as the most bothersome symptom of the condition, and intense itch can bother eczema sufferers day and night. According to ESC’s recent survey report Itch in Atopic Dermatitis, 44% of adults with severe AD feel itchy all the time. The report highlighted how itch impacts sleep, work, and relationships for both adults and children who live with the condition.

ESC’s itch report also revealed:

• 46% of adults with moderate or severe AD describe their itch as debilitating
• 87% of adults with severe AD have scars or marks on their skin due to scratching
• 76% of children with moderate or severe AD are woken from sleep due to their itch

To raise awareness, ESC invited their Eczema Ambassadors – a group of dedicated volunteers who live with moderate and severe forms of AD — to challenge their friends and family to “live the itch” of AD for 24 hours. Participants were asked to set an alarm to sound off once an hour for 24 hours to replicate the interruption of itch. They would experience the frustration and disruption throughout their day and even overnight; the challenge aimed to provide a small glimpse of what it is like to live with the condition. 

ESC Eczema Ambassador Allie challenged her family to take the itch challenge. She shared with ESC: “Eczema runs in my family, and the challenge made us all stop and think about how itch impacts our lives. The Live the Itch Challenge is a great way for people to understand the persistence of the itch from eczema and the interruptions itch causes to daily life.” 

Allie added: “While I wouldn’t wish feeling itchy on anyone, I’d like people to understand how frequent and bothersome itch can be. I hope that by participating in this challenge and having these conversations, we can raise awareness around AD and why sufferers deserve better care and understanding.”

To follow the “Live the itch” challenge, or to participate follow @EczemaSocietyofCanada and use the hashtag #Livetheitch. To learn more about the itch survey visit www.eczemahelp.ca/itch.  

About Atopic Dermatitis

AD is a chronic, inflammatory skin condition. It is characterized by periods of dry, itchy, inflamed skin that can crack, ooze, and bleed. These periods of worsening symptoms are known as flares. It is estimated that 11% of children and 7% of adults live with AD.

About the Eczema Society of Canada:

The Eczema Society of Canada is a registered Canadian charity dedicated to improving the lives of Canadians living with eczema. Its mandate is to provide education, support, awareness, advocacy, and research. To learn more, visit www.eczemahelp.ca.   

SOURCE Eczema Society of Canada

Credit: www.newswire.ca

Dr. Barankin recently published a case about acne vulgaris in the medical journal Drugs in Context.

Abstract

Background: Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress. This article aims to provide a narrative updated review on the management of acne vulgaris.

Methods: A PubMed search was performed with Clinical Queries using the key term “acne”. The search strategy included clinical trials, meta-analyses, randomized controlled trials, observational studies and reviews. The search was restricted to articles published in English.

Results: Treatments of acne include proper skin care, topical medications, oral medications and procedural therapies. Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne. Systemic therapies are usually prescribed for the initial treatment of moderate-to-severe acne as well as for acne that is refractory to topical therapies.

Conclusion: Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris. Depending on the severity of the acne, topical retinoids may be used alone or in combination with benzoyl peroxide and topical or oral antibiotics. Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy. Neither topical nor oral antibiotics should be used as monotherapy. Oral contraceptives and/or spironolactone are useful for many women with acne. Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris but is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant or other treatment modalities have failed.

Click here to download the full article.

Credit: Drugsincontext.com

CBC: The National spoke with our very own Dr. Anatoli Freiman amongst other leading dermatologist. Doctors are concerned some Canadians missed opportunities for skin cancer screening during the pandemic because they didn’t make in-person visits to their doctors that could’ve caught illnesses when they are more treatable.

Our microdermabrasion treatment has had a spectacular update. Introducing Bela MD+ a solution to your skin concerns that falls somewhere between a hydra facial and a silk peel. With this in mind, we are able to target a plethora of concerns all within one device.

Skin health is at the forefront of what Bela MD+ stands for. As skin ages, we lose density, especially in the upper layers of the skin, leaving it looser, duller and more prone to dehydration. Lines develop leaving an uneven texture and our inability to produce the oil we once did, prevents our skin from bouncing back to a healthy, full and glowing state.

This all-in-one treatment is comfortable, showing immediate results and without the associated downtime we would normally expect from most treatments. The surface layers of the skin are exfoliated with two separate modalities, followed by a deep penetrating hydration and finally infused with customized ingredients that are able to get deeper into the lower layers of the skin. There is even a hand piece to target firming and lifting!!

The skin may have a slight rosy glow post treatment for a few hours, but is otherwise capable of giving that instant gratification we all dream of. Although you will see visible results after just one treatment, for best results 3-6 treatments about a month apart is suggested.

The Bela MD+ is suitable for almost all skin conditions from dry and dehydrated to acne prone, and from sun damaged skin to mild rosacea. Extremely reactive acne or rosacea should be controlled first before considering the Bela MD+. There is no age limit to whose skin works best with Bela MD+. From teenage acne to post-menopausal dry and dehydrated skin, a series of treatments followed by regular maintenance may be all your skin needs to get it back on track.

The Bela MD+ takes about 60-75 minutes in total, and you receive treatment on both the face and neck. I for one, am very excited to introduce my patients to this new, relaxing all-in-one skin-correcting treat!

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre