Q: I want to take very good care of my skin to keep my skin looking young and healthy. What types of skin care products would be best for me?

A: Everyone should have a good skin care regimen to treat, nourish, protect, and moisturize his or her skin. In recent years, skin care products have been significantly improved. Outstanding moisturizing, anti-aging, skin calming, and pigment reducing products are now available. Because these products contain ingredients that influence the physiological functioning of the skin, these products are referred to as cosmeceuticals.

There are many different types of ingredients used in cosmeceuticals today. Antioxidants remove the free radicals resulting from excessive sun exposure and other environmental factors that can cause injury to normal skin cells. Botanicals are plant extracts and they form the largest category of skin care ingredients in use today. An appropriate botanical can be chosen to reduce inflammation, sooth the skin, or act as an antioxidant. Retinoids are derivatives of vitamin A that act as antioxidants, increase cellular turnover, stimulate a beneficial thickening of the epidermis, and promote the removal of excessive skin pigment. Alpha hydroxy acids increase cellular turnover and improve the color and texture of the skin; they have been shown to produce younger looking skin. Depigmenting agents are skin-lightening ingredients that remove excessive brown pigment from the skin. Peptides are protein fragments that can be used in cosmeceuticals to either increase the production of collagen or to reduce the breakdown of collagen; this is important because loss of collagen in the skin is one of the causes of wrinkles. Matrix Metalloproteinase Inhibitors are substances that also block the breakdown of collagen.

The best cosmeceuticals combine many different types of ingredients in one product. Because there are literally thousands of skin care products in the marketplace from which to choose, it can be quite confusing as to which products would be best for a particular person. For this reason, it is best that each person have his or her skin care program designed by a skin care expert. These professionals are able to customize a skin care program by selecting from the large number of skin care products available those products that would be best for each individual person.

Q: I have noticed that as we head into winter, my skin is feeling dryer. How should I take care of my skin during the winter months?

A: Winter is hard on skin because cold temperatures, harsh winds, and low humidity remove moisture from the skin and dry the skin out. These environmental factors impede the proper functioning of the skin's lipids (fats), which normally help to keep the skin hydrated. The following tips will help you keep your skin healthy and looking its best during the winter months.

• First, don't overheat your home. Heating the air will reduce the humidity level in your home and lead to drier skin.
• Try to limit washing the face to twice a day, as more frequent washing will tend to dry the face excessively.
• Take shorter showers, no longer than ten minutes, using lukewarm water. This will help preserve the natural moisturizing lipids (fats) in the skin. If you prefer a bath, you may add soothing oils to the bath water to moisten and help hydrate the skin.
• After your shower or bath gently pat the skin until almost dry, then apply a good facial moisturizer and body moisturizer. In general, the drier the skin, the thicker the moisturizer you should use. We generally advise our patients to apply their moisturizers twice a day, but women with very dry skin might want to apply their moisturizers more frequently.
• Remember that dry winter air will make the skin more sensitive to many anti-aging products. For this reason, women who use Retin-A, Renova, Tazorac, glycolic acid, or salicylic acid might have to reduce the frequency of application during the winter.
• It is important to continue to protect your skin from the sun's ultraviolet rays, so use a sunscreen with an SPF of at least 15 on your face and exposed skin. In addition, use a lip balm with sun block on your lips throughout the winter.
• Finally, make sure you eat a well-balanced diet, drink plenty of water, and moisturize, moisturize, moisturize!

Taking care of the skin during winter months often requires some changes in the normal skin care regimen. By taking these basic steps, you can keep your skin looking healthy and beautiful all winter long.

Q: I recently began having flushing on my face. What is causing this and what can I do about it?

A: Flushing is defined as a sensation of warmth accompanied by visible reddening of the skin. Flushing results from an increase in facial blood flow, which in turn is caused by dilation of the blood vessels in the face.

There is a long list of medical causes of flushing, but the most common causes are an emotional reaction, certain foods and beverages, alcohol, and rosacea. Emotional flushing is an easy diagnosis to make; it is characterized by flushing which occurs when an individual is emotionally upset or has a feeling of embarrassment. If certain foods, beverages, or alcohol cause flushing, their avoidance will usually cure the flushing.

Rosacea is another very common cause of flushing. Rosacea is characterized by symptoms of facial flushing and a collection of other clinical signs such as facial redness, broken capillaries (medically called telangiectasias), coarseness of the skin, and an inflammatory eruption that may be similar to acne. The most likely areas to be affected by rosacea are the nose and cheeks, but in more severe cases the entire face and neck can be affected. Eventually, the redness of the face becomes permanent.

Rosacea is most likely to start in fair skinned people in their thirties and forties. Although there are many theories, the cause of rosacea is still unknown. Genetic and environmental factors such as sun exposure probably play roles in the development of rosacea.

The treatment of rosacea begins with sun protection. Patients who have rosacea should carefully monitor their exposure to the sun and routinely use sunscreen. Antibiotics, taken either orally or applied topically to the affected areas, are also regularly used to treat rosacea. Topical azaleic acid may also be used, especially if antibiotics do not give sufficient improvement. The redness and broken capillaries associated with rosacea are best treated with either laser therapy or intense pulsed light. These treatments have no downtime and lead to amazing improvement in the skin of rosacea patients. The good news is that by combining several skin care modalities, an experienced skin care professional will be able to control nearly every case of rosacea.