This month, we are inaugurating a new section of our newsletter, the "Question of the month." In this section, we will discuss common skin conditions so that our patients can familiarize themselves with disorders of the skin that occur frequently.

Rosacea is a skin disease that causes red patches, bumps, and broken capillaries on the face. Although it can occur at any age, it is most likely to start in fair skinned people in their thirties and forties. Often, the first symptom noticed by people with rosacea is a tendency to blush (facial flushing), which becomes more frequent and noticeable over time. Eventually, the redness of the face becomes permanent, although it can vary in intensity. Small dilated blood vessels, known as telangiectasias, may appear in the affected areas. Small white bumps, called milia, and red bumps may also occur. Although rosacea is frequently mistaken for acne, rosacea does not cause the blackheads and whiteheads that are common in acne. The most likely areas to be affected by rosacea are the nose and cheeks, but in more severe cases rosacea can affect the entire face and neck.

Doctors grade the severity of rosacea on a mild-moderate-severe scale. If left untreated, rosacea may progress over time from mild to moderate disease, and eventually to severe disease. The severe form of rosacea is characterized by intense bouts of facial flushing, swelling, facial pain, and debilitating burning sensations. At this stage, some patients may also develop a rhinophyma (rino-fi-ma), a bulbous enlargement of the nose. It is said that W.C. Fields developed his famous nose as a complication of rosacea.

Some patients with rosacea may also develop eye problems. Commonly occurring symptoms include dry eyes, itchy or burning eyes, gritty eyes, and a sensation of a foreign body in the eye. Redness and swelling of the eyelid may also occur. Rosacea patients with eye involvement should see an ophthalmologist.

Although there are many theories, the cause of rosacea is still unknown. Genetic and environmental factors 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, either taken 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 dilated blood vessels associated with rosacea are best treated with either laser therapy or intense pulsed light. 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.

Remember, there is no way to completely prevent oily skin from occurring, but hopefully these tips will help keep the oil and acne under control:

• Although dirt and oil on the surface of the skin do not cause acne, excessive oil on your skin may exacerbate the clogging of pore openings, so proper washing is often a good way to keep the situation from becoming worse. Most topical acne medications have a drying effect on oily skin.
• Try a mild cleanser that cleanses without drying.
• Do not use any oil-based cosmetics, which will only aggravate oily skin.
• Use water-based, non-comedogenic cosmetics.
• Remove your makeup before going to bed, but avoid cold creams and lotions.
• Eat a healthy well balanced diet.
• Reduce stress. Doctors have seen a connection between stress and acne for a long time. Studies have shown that the body produces more androgens when a person is under stress. The increase may trigger acne flare-ups by stimulating the sebaceous glands to pump out more sebum. Even physical stresses, such as colds, allergies, surgery, or menstration, can trigger break-outs.

Procedures for this problem

• Glycolic Acid Peel
• Classic Facial
• Blue Light

Oily skin Questions & Answers

Why is exfoliation so important for oily skin?
Since small pores are what give the impression of smoothness, oily skin's larger pores can make it appear rough. Excess dead skin cells and blackheads can actually stretch a pore too making it appear even larger. By deep cleansing the pores of this cellular debris, exfoliation makes larger pores appear smaller.

If I have oily skin, do I still have to moisturize?
Yes, absolutely. The biggest mistake is to strip away all oil, because the skin reacts by creating even more oil.

None of the above is not intended as medical advice. If you have a medical concern, please consult your doctor.

Many menopausal women notice changes in their skin-especially increased dryness and wrinkling. These changes are believed to be due in part to the breakdown of collagen in the skin due to decreasing estrogen levels, which also decreases the blood vessel supply to the skin. Smoking and sun exposure also contribute to skin dryness and wrinkles.

Procedures for this problem

• Thermage
• Intense Pulse Light Rejuvination FotoFacial™
• Botox®

Menopause or transition Questions & Answers

Once my menopause is complete, will my skin be different than it was during the transition phase?
Through perimenopause the body still produces skin-enhancing estrogen, though in declining quantities. Once estrogen production stops entirely at menopause, thinning skin, increased facial hair, and possible acne breakouts result.

Without intervention, post-menopausal skin will continue to degenerate. Some studies show that skin loses up to 30% of its collagen in the first five years after menopause. Furthermore, as post-menopausal skin loses thickness by about a percentage point a year, its cell turnover rate drops and leaves increasing numbers of dulling dead skin cells on the surface.

What does the hormone estrogen do for the skin?
Estrogen keeps skin soft, firm, and supple by encouraging collagen production and reducing the potential for acne breakouts. Collagen and the elastic fibers that make up skin's structural support, are responsible for skin thickness and resiliency. Reduced collagen leads to skin fragility, thinness, wrinkling, and, sagging.

None of the above is not intended as medical advice. If you have a medical concern, please consult your doctor.