Staff Report

Winter Skin Problems and Treatments

Crow's Feet: Prevention and Treatment
Crow's feet — the wrinkly imprints that appear along the corners of your eyes — are often one of first signs of aging. Learn what you can do to prevent them and how you can minimize their appearance with home or medical treatments. In adolescence and young adulthood, crow's feet — also known as squint lines or worry lines — usually aren't a concern. That's because youthful skin has a lot of elastic fibers called elastin and a protective protein called collagen. Over time, however, skin loses elastin and collagen, and the inevitable result is wrinkles. For many women, the appearance of crow's feet — radiating lines that form along the corners of the eyes — is the first distressing sign of aging.Fortunately, there’s a lot you can do to prevent these unwanted bird tracks from forming, and to minimize their appearance with home or medical treatments.

The Causes of Crow's Feet
You're more likely to develop crow's feet if you:
• Spend a lot of time in the sun.
• Smoke cigarettes.
• Not only do both of these factors prematurely age the skin, but they force you to squint to avoid either excessive sunlight or irritating tobacco fumes, a muscle motion that promotes the formation of crow's feet.
• Other factors associated with crow's feet include a family history of early wrinkling, dehydration, and even sleeping on your face.

Prevention of Crow's Feet
Most dermatologists agree that you're unlikely to develop crow's feet if you don't tan your face, smoke, or squint. So, starting early in life, the best prevention strategies include:
Applying a broad-spectrum sunscreen before going outdoors.
Wearing sunglasses and hats.
Either not starting smoking, or quitting smoking.
Drinking an adequate amount of fluid.
Using skin moisturizers. Because skin around the eyes contains very few oil glands, it's especially likely to be dry.
Adopting other healthy lifestyle habits. A diet rich in fruits, vegetables, and whole grains can improve skin elasticity. Technicolor fruits such as cranberries, blueberries, strawberries, and raspberries contain high concentrations of antioxidants that may protect skin. In addition, regular exercise helps relieve stress, which promotes the formation of crow's feet and other wrinkles.

Home Remedies for Crow's Feet
Over-the-counter eye creams tout their ability to reduce fine lines and facial puffiness. Although these products are unlikely to make crow's feet disappear, some of them may minimize their appearance. Look for products containing either glycolic acid or tretinoin (Retin-A), which encourage wrinkled cells to slough off and promote formation of smoother skin. Some dermatologists also recommend eye creams that contain topical anti-inflammatory agents such as alpha lipoic acid, DMAE, and vitamin C ester.

Medical Treatments for Crow's Feet
If crow's feet are cramping your style, your doctor or dermatologist may recommend procedures such as: Chemical peels, which remove the skin's outer layer and promote the formation of new skin.
Wrinkle fillers, which include injections of temporary, absorbable fillers such as collagen, hyaluronic acid gel, calcium hydroxylapatite, and poly-L-lactic acid; and the permanent, non-absorbable filler PMMA (polymethylmethacrylate beads). Laser resurfacing , usually with a non-ablative or non-wounding carbon-dioxide laser that stimulates collagen growth and tightens underlying skin.
Botox. A favorite of seemingly ageless celebrities, this therapy relies on injections of purified botulinum toxin type A or B to temporarily paralyze the muscles that cause squinting and diminish the appearance of crow's feet.
Plastic surgery . Severe crow's feet — and other signs of aging — may be corrected with procedures such as a face-lift.
Bear in mind that all of these procedures have potential side effects, may be only temporarily effective, and are usually not covered by insurance because they're considered cosmetic.
There's no question that crow's feet are an unwanted sign of aging. By making some common-sense changes to your lifestyle, you may prevent the formation of these all-too-common tracks of your tears. If they do appear, you may be able to minimize their effect on your looks with over-the-counter remedies or medical treatments.

Eczema
The most common type of eczema is atopic dermatitis, a chronic disease that usually affects babies and children but also strikes adults. It often causes dry and itchy rashes on the:
• Face, neck, and scalp.
• Hands.
• Insides of the elbows.
• Skin behind the knees.
• Buttocks.
• Other types of eczema include allergic contact eczema, contact eczema, dyshidrotic eczema, neurodermatitis, nummular eczema, seborrheic eczema, and stasis dermatitis. Because all types of eczema cause an intense urge to scratch, they're often associated with skin irritations and damage that increase the risk of infection.

The Causes of Eczema
Atopic dermatitis is an allergic condition in which the immune system attacks healthy skin tissue. Although its exact cause is unknown, it's more common in families that have other allergic conditions such as hay fever and asthma.
Allergic contact eczema is a delayed reaction to an allergen such as poison ivy or nickel. Contact eczema is a direct reaction to an irritant such as a detergent, acid, cleaner, or other chemical, and is the most common occupational skin disease.
In some cases, eczema is a consequence of dry skin, insect bites, infections, nutritional deficiencies, or medical conditions such as celiac disease.

Preventing Eczema Flare-ups
If you have eczema, certain triggers may make your condition worse. Keeping an "eczema diary" may help you identify these triggers so you can avoid or minimize your exposure to them.
Flare-ups of atopic dermatitis may be associated with allergies to certain foods, especially eggs, peanuts, milk, fish, soy products, or wheat; or to other allergens such as dust mites, mold, pollen, or dog or cat dander. Flare-ups may also be associated with exposure to irritants such as wool and synthetic fibers, soaps and cleaners, perfumes and cosmetics, dust or sand, cigarette smoke, substances such as chlorine, mineral oil, or solvents such as gasoline and turpentine.

Other common triggers include:
• Stress.
• Upper respiratory infections.
• Low humidity in winter.
• A dry year-round climate.
• Long and frequent hot baths and showers.
• Not using a moisturizer after bathing.

Medical Treatment of Eczema
If you have persistent eczema that can't be managed by avoiding or minimizing exposure to allergens or irritants you've written in your eczema diary, see your doctor, dermatologist, or allergy specialist. After examining your skin and taking a medical history, he or she may recommend other avoidance strategies, help you develop a good skin-care routine, and prescribe treatments to reduce symptoms.

An effective eczema-control regimen includes:
A daily bath or shower. Use only mild soaps such as Dove, Basis, or Oil of Olay; keep water cool or lukewarm; and limit bathing time to 15 to 20 minutes.
Moisturizing. Within three minutes after bathing, and then throughout the day, use a plain, fragrance-free ointment or cream to seal in moisture and protect skin from allergens and irritants. Many dermatologists recommend a thick, oily moisturizer such as petroleum jelly (Vaseline). Newer alternatives include barrier-repair creams that not only moisturize the skin but help rebuild it with an ingredient called ceramide.
Using topical medications exactly as directed. These include over-the-counter or prescription creams containing corticosteroids, antibiotics, or antihistamines. Generally, you'll see the best results if you apply a topical medication before applying a moisturizer.
If you don't respond to such therapy, your doctor may recommend:
Phototherapy, which involves exposure to ultraviolet light.
A combination of phototherapy and a drug called psoralen.
Oral antihistamines.
Tar treatments, which use itch-reducing chemicals.
Although no complementary or alternative therapies have proved effective for eczema, some evidence suggests that acupuncture, hypnosis, and relaxation therapies may be helpful in relieving stress, which is a common eczema trigger. There's no question that eczema can cause excruciating itching and inflammation, affecting both your looks and your mood. But you can control even the most stubborn case of eczema and reduce the risk of flare-ups by avoiding allergens and irritants, practicing good skin care, and using medications as directed.

Keratosis Pilaris:"Chicken Skin"
Keratosis pilaris is a common skin condition that usually affects the thighs, upper arms, and buttocks. Since keratosis pilaris also can affect the face, it’s sometimes mistaken for acne.
Keratosis pilaris results from excess production of keratin, a cream-colored protein. When keratin builds up in hair follicles, it forms hard plugs, resulting in a proliferation of hard white or red bumps the size of a grain of sand. Although these bumps resemble acne, they don’t contain pus but can occasionally become inflamed and itchy. In some cases, keratosis pilaris also appears as dry, rough patches.

The main types of keratosis pilaris include:
• Keratosis pilaris rubra, which causes red, inflamed bumps.
• Keratosis pilaris alba, which causes rough, bumpy skin with no irritation.
• Keratoris pilaris rubra faceii, which causes a red rash on the cheeks.
• Also known as “chicken skin” because of its goose-bump-like appearance, keratosis pilaris affects as many as 80 percent of teenagers and about 40 percent of adults. It is more common in women and may be more severe during dry weather. Although it’s not known why excess keratin production occurs, it may be related to heredity. You’re more likely to develop keratosis pilaris if you have a family history of skin conditions such as atopic dermatitis.
• Although keratosis pilaris can be persistent, annoying, and difficult to treat, it usually doesn’t cause pain, itching, or other complications, so it’s considered a benign condition. If you’re concerned about its effect on your appearance, self-care measures can make it less noticeable. If these measures don’t work, your doctor or dermatologist may recommend medical treatments.

Self-Care Strategies for Keratosis Pilaris
Most doctors recommend an initial regimen of intensive moisturizing, which involves application after bathing and reapplication several times a day. Products that may help loosen keratin plugs and soften rough, dry skin include Acid Mantle, Vaseline, and Complex 15. Others include medicated creams containing ingredients such as:
Urea (found in Carmol, Vanamide, U-Kera E, Ultra Mide, Nutraplus, and others).
Alpha hydroxy acids (found in Aqua Glycolic, LactiCare, and others).
Other recommended self-care measures include using humidifiers during dry, winter months. Experts differ on washing techniques. Some recommend soaking in hot baths and vigorous scrubbing of affected areas with a coarse washcloth or stiff brush. But others caution that such measures may irritate skin and worsen the condition.

Medical Treatments for Keratosis Pilaris
If intensive moisturizing and other self-care measures fail to work, consult your doctor or dermatologist. He or she may recommend prescription medications such as:
Topical retinoids, which include cell-turnover-promoting vitamin A derivatives such as tretinoin (including Retin-A Micro and Avita) and tazarotene (including Tazorac).
Topical corticosteroids. A short course of low-potency corticosteroids is often recommended for keratosis pilaris on the face or on widespread patches elsewhere on the body.
Carmol and Keralac, which contain prescription-strength urea.
Lac-Hydrin, which contains a 12 percent solution of ammonium lactate.
Be aware that over-the-counter and medical treatments often provide only temporary benefits. Once treatment is stopped, keratosis pilaris has a tendency to recur.
Although keratosis pilaris can be annoying and persistent, you may be able to wait it out because it often subsides after age 30. If it’s a cosmetic concern, however, self-care measures and medical treatments can minimize the appearance of “chicken skin” and boost your self-confidence when you venture outside the coop.