Fully Exposed


Posted on: February 21, 2015

Many people have them, those dark circles under the eyes. They make the face look tired and older. They affect our self-esteem. Dark under eye circles can be seen with any skin type but are definitely more common in individuals with darker complexions.  

There are few scientific studies about the cause of this condition. Some blame fatigue, and for some, a few good nights of sleep does seem to remedy the situation. But for others, even getting 8 hours of sleep regularly doesn't seem to help. For some, it runs in the family, "mom has it" and "grandma had it."  As we age, the skin thins, the fat under the skin atrophies allowing the blood vessels around the eyes to become more obvious. As a consequence the skin appears darker.  Dark circles around the eyes are often accompanied by puffiness under the eyes and are a mere result of shadows that are cast due to the puffiness. Disorders that increase lower lid sagging, by increasing water retention, can worsen the appearance of dark circles (thyroid disease, kidney disease, and heart ailments.) Sleeping in a more upright position using pillows to elevate the head seems to improve puffiness for some, but for others, it seems to make no difference. Eczema sufferers often have inflammation around the eyes. This inflammation may leave a footprint of pigment around the eyes called Post-inflammatory Hyperpigmentation. Constant rubbing or scratching the area exacerbates the problem. Treating the eczema may often lighten the dark circles around the eyes. Sun exposure may induce the production of pigment around the eyes. When outdoors, always wear sunscreen and UV protective sunglasses.

Since there are many causes of dark eye circles, there is no real consensus on treatment. The following recommendations, however, may improve the condition:

  • Get adequate sleep (8 hours/night)
  • Sleep with extra pillows elevating the head
  • Wear broad spectrum sunscreen daily (SPF 30+)
  • Wear sunglasses with UV protection
  • Apply cool compresses to relieve puffiness
  • Moisturize the area twice a day
  • Cover up with a concealer

Seek medical attention to manage allergies and eczema and to rule out any underlying medical cause.

Note: Various treatments available from your dermatologist include topical depigmenting products, chemical peels, injectable fillers, and various light and laser therapies.


Posted on: February 21, 2015

  1. Apply prescription medication to a clean face first.
  2. Moisturizer
  3. Sunscreen (if moisturizer does not contain sunscreen)
  4. Facial Foundation
  5. Powder
  6. Blush and other colored cosmetics.


Posted on: February 19, 2015

Acne is a chronic condition caused when hair follicles become plugged with dead skin cells and oil (secreted from an attached sebaceous gland.) Although acne most commonly appears in puberty, it can be experienced in adults, as well. Acne typically appears on the face, chest, back, and shoulders, the areas with the largest number of oil glands. Acne can take several forms.

Noninflammatory lesions:

Comedones (whiteheads and blackheads) form when hair follicles become clogged and blocked by oil secretions and dead skin cells.

  1. When the clog has an opening at the skin's surface, the clog appears dark and "blackheads" form.
  2. When the clogs are closed at the skin's surface, the clogs appear white or skin color and "whiteheads" are formed.

Inflammatory lesions:

  1. Papules: are small red and often tender raised bumps indicating inflammation or infection in the hair follicle.
  2. Pustules: are small red and often tender raised bumps with white pus at the tips of the lesions.
  3. Nodules: are larger, painful bumps with a component beneath the surface of the skin. These are due to a build up of secretions deep within the hair follicle.
  4. Cysts: are red, painful, pus-filled lesions, occurring beneath the surface of the skin. These lesions may result in scarring of the skin.

Acne treatments aim at reducing the production of oil from the sebaceous glands, reducing bacterial infection, reducing the inflammation and normalizing skin cell turnover.

Treatment for very mild acne sufferers may include the use of over-the-counter (OTC) products containing benzoyl peroxide or salicylic acid that help dry up facial oil and help slough dead skin cells.  These ingredients are found in leave-on lotions, creams and gels, and wash-off cleansers. Although these ingredients may be beneficial for those with mild acne, they can cause irritation, redness or flaking. Benefits may not be seen for four to eight weeks after beginning OTC acne therapy products.

Individuals with moderate acne or for those where OTC products are ineffective, a dermatological evaluation is recommended. The dermatologist may prescribe a topical vitamin A derivative like tretinoin (Retin-A) or adapalene (Differin) that aims at normailizing cell turnover and decreasing oil production to minimize clogging of the hair follicles. Topical antibiotic creams are also used to decrease skin bacteria. A combination of topical products is often prescribed to treat acne. 

For moderate to severe acne sufferers, a dermatologist is more likely to prescribe systemic antibiotics to reduce skin bacteria and minimize inflammation. Combination therapy with topical vitamin A derivatives and/or topical benzoyl peroxide may also be prescribed to maximize therapy and minimize antibiotic resisitance.

For severe cases of scarring acne and for those resistant to other forms of therapy, systemic isotretinoin therapy is an option. This powerful medication can be very effective but due to potential side effects, is reserved for the most severe forms of acne.

Tips For Acne Sufferers

  • Wash the face with a mild cleanser twice a day to remove excess oil from the skin surface.
  • Moisturize the face with a fragrance-free, oil-free moisturizer as frequent facial washing can remove the lipids and proteins that maintain a healthy skin barrier.
  • Eat a healthy diet rich with fruits, vegetables and lean protein. Obtain carbohydrates from low glycemic index foods like whole grains, beans and vegetable. Limit high glycemic index foods like white pasta, bread, cakes and cookies.
  • Get adequate nights of sleep. Sleep deprivation has been shown in several studies to increase stress and may exacerbate acne.
  • Exercise. Studies have shown that moderate exercise can reduce stress and may  minimize acne formation. Be sure to hit the showers after heavy sweating to remove the excess oil from the skin's surface.


Posted on: February 18, 2015

Mycotic Conditions are those caused by yeast and fungus. A lipid dependent yeast that is normally found on the scalp, called Malessezia, feeds on the lipids from sweat glands and likely plays a role in dandruff and seborrheic dermatitis.

  • Dandruff: up to 50% of the population experiences dandruff at some point in their lives. Usually seen in individuals from adolescence to about age 50 when the sebaceous glands are most active. Fine white or gray scales are found diffusely in the scalp. Most people experience itching.
  • Seborrheic dermatitis: this itchy scalp condition lasts beyond 50 years of age and is usually chronic and recurring. Red patches, with large yellow greasy scales that may form crusts, commonly occur in the scalp, on the face (eyebrows, nasolabial folds, and eyelid margins), ears, armpits, groin and mid chest. MIld itching is common. It is most common in immunocompromised patients and in patients with neurological illnesses like Parkinson's and stroke patients.

Treatment: antifungal shampoos with the following ingredients may be helpful, pyrithione zinc, selenium sulfide, cicloprox, and ketoconazole. Both over-the-counter (OTC) and prescription products are available depending on severity. Sometimes coal tar or salicylic acid shampoos are beneficial. In severe cases, topical corticosteroids are used.

Itchy scalp caused by true fungal infections or "ringworm" (dermatophytes) is called tinea capitis

  • Tinea capitis: certain fungal organisms can infect the hair shaft itself, while others infect the hair follicle. This contagious condition is most commonly seen in pre-pubescents but can be seen in anyone. It is spread by contact with people, animals, and found in soil. Sharing pillows, hairbrushes and clothing (hats) may spread the condition. There are inflammatory (with pustules, abscesses, and often, lymph node swelling) and non-inflammatory infections (round patches of hair loss with fine scale).

Treatment: Prescription oral medication including griseofulvin, iatroconazole and terbinafine are most effective. Anti-fungal shampoos are prescribed, as well. Family members of infected individuals should be treated with antifungal shampoos and family pets should be checked for infection.

Parasitic Conditions: Head lice, also known as Pediculosis humanus capitis, is the most common parasitic infection to cause an itchy scalp. This infestation is seen most commonly in school aged children. Lice and their eggs (nits) are frequently seen in the posterior auricular scalp (area behind the ears) and occiptal scalp (lower posterior).  Lice (3 mm) and nits (0.8mm) can be seen with the naked eye. Nits, yellow to white oval encasings, usually attach to the hair shaft closest to the scalp. Lice prefer straight hair to curly hair. Lice are transferred from head to head by clothing, hairbrushes and pillows. Itching is very common. Sometimes secondary bacterial infection is seen due to scratching. Lymph node swelling and fever can also be seen in more severe infections.

Treatment: Pediculocide shampoos, lotions, and creams containing the ingredients permethrin or malathion applied once and repeated 6-7 days later is the most effective therapy. Nits can be removed with a fine-toothed comb. Bedding should be washed in hot water, clothing that has been worn should be washed and all family members should be inspected for possible infestation and appropriately treated.

Inflammatory Conditions: the most common cause of inflammatory scalp itching is psorasis. Psoriasis is a chronic, recurring condition that affects 2% of the populaton (a half of whom have scalp involvement.) There is often a family history of the disease. Red areas with silver-gray scaly patches are seen anywhere on the scalp, but especially along the hairline.

Treatment: Mild cases may improve with tar shampoos. Keratolytic shampoos (salicylic acid) are often helpful removing the scales. Topical steroids are the mainstay of treatment. In severe cases, oral medication (methotrexate, cyclosporine) is prescribed. Injectable immunobiologics are also an option for patients with severe psoriasis.

If persistant scalp itching is experienced, seek medical attention.


Posted on: February 02, 2015

Millions of Americans will take to the outdoors this winter. The health benefits of winter sports are numerous. The release of endorphins elevate mood and help ward off "cabin fever." Engaging in winter sports burns more calories than equivalent warm weather activites as it takes more energy for the body to maintain its body temperature in colder environments. But exposure to cold temperature, wind and wet weather may lead to freezing of the skin and underlying tissues, a condition called "frostbite."

Frostnip, the mildest form of frostbite, most often affects the face, nose, ears, fingertips and toes. It presents with numbness and a bluish or whitish skin color for a short period of time. After re-warming, normal skin color returns and the numbness resolves. Frostnip does not leave any permanent damage.

Deeper forms of frostbite may turn the skin red and blue. The skin may feel hard and swelling of the affected area often ensues. Fluid filled blisters commonly appear and with more severe cold injury, blisters may fill with blood. Stinging, throbbing, and burning can occur and discomfort with re-warming of the skin is not uncommon.

Full thickness frostbite is a very serious condition as damage to the skin is accompanied by cold injury to underlying muscles, tendons, and bone. This often leads to permanent loss of tissue, nerve damage and infection.

Prevent frostbite. Limit the time spent oudoors in cold, wet or windy conditions. Wear layered clothing as air trapped between the layers act as an insulator against the cold. Wear waterproof and windproof gear to protect against wind, snow and rain. Remove wet clothing as soon as possible. Wear protective headgear that covers the ears and wear mittens (which provide better protection than gloves.) Stay hydrated and eat a healthy meal before going out in the cold. Avoid alcoholic beverages.

All forms of frostbite require medical attention except frostnip, which can usually be treated at home by re-warming frostbitten areas in warm water soaks (99-107 F) for about 20 minutes. Remove any jewelry, especially rings on fingers, that could tighten as swelling develops. Avoid further cold exposure. Over-the-counter anti-inflammatory medication like Advil or Motrin may be beneficial for throbbing or discomfort.

Seek medical attention if:

  • Skin appears white or pale.
  • Numbness or blistering occurs.
  • Pain, swelling or redness of the affected area develops.
  • Fever occurs.
  • Or other new unexplained symptom develops.



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I've been a New York based dermatologist for over 25 years. I love music. I love triathlons. I love chemistry. (I love petroleum jelly.) I study skincare ingredients and product formulation. I listen to skincare "advice" from self-proclaimed ......Read More

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