Welcome to DermTV viewer question week for May 2012. Today’s episode will feature questions from DermTV.com viewers and don’t forget as part of viewer question week I’ll be answering viewer questions over live steaming video at BeautyRxLive.com. So if you have a question, tune in this Wednesday at 2:00 EST.
Today’s first question comes from Isaac, “Hi, I got my ear pierced yesterday just in the normal place and they guy put a bar in it with a ball on the end. He was really vague about how to clean it and keep it fresh. I just need to know how to take it out for a start and whether I should take it out so soon and how to clean it”. Isaac, the care for recent piercings, regardless of where they are, whether it’s the ear or the belly button or any place else really is all the same. Number one, you should be using alcohol and an antibiotic ointment on the post and apply it three, four times a day and each time you apply the alcohol and antibiotic ointment twirl the post and slide it back and forth so the alcohol and antibiotic ointment slide in through the skin that the pierce goes through. You should be doing this for at least 3 or 4 weeks and during that time you shouldn’t remove it at all because if you remove it your probably going to have a problem getting it back in because during those 3 or 4 weeks your making skin in the inside or in the lining that the post goes through and until that skin is mature it’s real hard to reinsert it. After 3 or 4 weeks of regularly twisting or turning and putting on the ointment or alcohol it should be ready to be removed and you should then be training it which means the first time you take it out, leave it out for about an hour, put some antibiotic ointment on it and slide it back in, do that for two days then the next two days remove it for two hours, the next two days three hours and so on until your up to about 8 hours, at that point it’s trained and then you can sleep without it.
Our second question comes from Molly, she says that she’s 50 and she had an abscess in her uterus, she went into septic shock and had emergency surgery, very very serious, she almost lost her life. She had a complete hysterectomy and about 3 months later she started a job with a lot of stress and she started shedding a massive amount of hair. She says that she’s always had a full head of really thick, long, curly hair. Her hair has gotten so thin after losing all of that, that she can almost see parts of her scalp. ”What hair I do have seems to be growing longer but my hair that I lost just doesn’t seem to be filling in. What could be happening?” Molly what your describing is called telogen effluvium and it’s a very common situation after a very stressful situation such as your emergency surgery. It can come from the stress of the surgery or it can also come from the general anesthesia that you had, it could also come from the very high fever that you had. It’s the same thing that happens after women give birth and that is there is a resetting of the synchronization of the hair follicles, normally your losing about 10% of your hairs at any given time, 10% are sleeping, 90% are growing. Under this type of stress, about 30, 40 even 50% become synchronous in all going to sleep at the same time. Well, if they all go to sleep at the same time then 3 to 4 months later they all fall out, so instead of losing 10% on a rotating basis your losing 40-50% which is a very large amount of hair which is exactly what your describing and actually leads to cosmetic hair loss where you can actually see part of the scalp because the hair is so thin. The good news is Molly, you don’t have to do anything because in 4 or 5 months, synchronously all of those hair follicles that went to sleep at the same time are going to wake up and start growing new hairs and I can assure you that almost all of the hair that you lost as a result of this stressful situation is going to grow back.
Our third question comes from Laura, “Hi, does the sun really cause freckles? I really want freckles on my face”. Interesting. “I’m light skinned, dark brown hair and never had freckles in my life but I’ve been researching sun and freckles and it says wearing sunscreen and staying out in the sun 1-3 hours a day will help freckles appear on your face, is this true?” Well, Laura, I understand why freckles may look attractive to you but there are two types of freckles, the type that very fair haired celtic people get as a result of being out in the sun these freckles form and darken when they’re in the sun, during the winter when they’re not in the sun they lighten up, those freckles are genetically determined by the fairness of your skin and by the DNA that you get from your mother and father and you cant induce those freckles to come out no matter what you do unless your genetically preprogrammed for them and judging from the colors that you’ve given for your hair you probably are not preprogrammed to have freckles. The other kinds of freckles that you get from the sun are called sun spots, age spot or liver spots and they come in your 40’s, 50’s and 60’s as a result of chronic repeated exposure to the sun where the sun actually breaks the pigment cells and once they come out they never go away unless removed by a dermatologist. So at your age, if you don’t have freckles it doesn’t matter how much sun exposure you get short term, with a sunscreen, without a sunscreen, you’re not going to induce freckling on your skin but you certainly will without adequate sun protection cause a lot of irreversible sun damage in terms of getting premature wrinkling and setting yourself up for those sun spots in your 40’s and 50’s, not to mention of course the damage that can lead to skin cancer as a result of unprotected sun exposure.
The fourth question comes from Sarah and she says, “Is it okay to exfoliate the under eye area?” Well Sarah it certainly is because the under eye area which has sensitive thin skin still can be improved by exfoliation because you’ve heard me say many times that I believe exfoliation is the single most important therapeutic procedure you can do for your skin. Now when we’re dealing with sensitive skin under the eye the exfoliant has to be tailored for that area, so it has to be lower strength anywhere between 1% and 3% instead of 5-8% and it has to be put in a cream or a vehicle that is specific for the under eye area, so we usually have creams made that have a higher pH, they’re not quite as acidic, again to not be as irritating. Lastly, any proper eye cream will have been tested by the manufacturer for the eye area to make sure that there’s no sensitization. So get an exfoliant that is specific for, that is made for the eye area but by all means include that in your exfoliating routine.
This question comes from a viewer who apparently hasn’t given us her name, and she says, “Can I mix my physical sun block with moisturizer for application in the morning? If I use the same amount of sun block and moisturizer as I would if I were to apply them separately then the sun block won’t be diluted with moisturizer.” Well, that’s not exactly correct. If you mix the sun block and the moisturizer the moisturizer will dilute the sun block number one, number two it will not allow the sun screen to settle directly on the skin as it should so you really still need to apply the sunscreen first, your moisturizer second and if you would like to have them mixed together buy a product that comes as a moisturizing sunscreen with an SPF between 15 and 30 with UVA or broad spectrum protection and if its mixed by the manufacturer you then will get that SPF protection as promised without compromising the protection by your mixing two different products together.
Last question from today comes from Ron and he says, “Hi Dr. Schultz, I saw your video on YouTube, it’s a great explanation about chicken skin which I think I have on my arms but I’ve had it for seven years. The video on YouTube says I can apply any facial cream to remove them but can you suggest a cream?” Actually Ron it’s not just any facial cream, what you need to apply for your chicken skin which is also called keratosis pilaris is an exfoliating cream, something with a percentage of glycolic between 8 and 12% so there are a lot of really good glycolic exfoliants available, creams or lotions, you should start off by using once a day, a small amount on the back of both arms and after a week increase to two applications a day, one in the morning and one at bedtime and within 3-4 weeks you’ll see a meaningful reduction in your keratosis pilaris or your chicken skin.
So that’s it for today and don’t forget the subjects from so many DermTV episodes come from your questions which are great so please keep sending them in and I’ll keep answering as many of them as I can.