Acne

What is Acne ?

Acne is a common skin problem that starts during puberty and can continue into adult life. In women, it is not uncommon for acne to start after puberty. In men, acne can be more severe than in women b... [more]

Acne is a common skin problem that starts during puberty and can continue into adult life. In women, it is not uncommon for acne to start after puberty. In men, acne can be more severe than in women but it tends to resolve earlier. Acne can be a stressful disease leading to low self esteem and low confidence level. On the other hand, stressful situations, menstruation, the application of cosmetics on the skin and the intake of certain medicines (Cortisone, Lithium, anti-epilepsy medicine) can worsen acne.

What does acne look like? 

Black heads/ white heads

Papules/ pustules

Nodules / cysts

How to treat acne?

The treatment of acne can be in the form cream, tablets, or a combination of both. Your dermatologist will choose the best treatment suited for you. This will depend on the following factors:

- Your age.

- Whether you are a man or a woman.

- The severity of you acne and whether you have scars.

- Whether you are pregnant or breastfeeding.

- If you have medical problems.

- If you are taking medications for another health problem.

Acne can last for years. It is important to see your dermatologist on a regular basis to ensure that your face is always clear and to avoid complications such as scars.

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Herpes Simplex

What is Herpes Simplex?

Herpes simplex is a skin infection caused by the herpes simplex virus (HSV). There are two type of HSV virus, Type 1 and Type 2. Both types of HSV cause similar looking skin lesions, however type 2 is... [more]

Herpes simplex is a skin infection caused by the herpes simplex virus (HSV). There are two type of HSV virus, Type 1 and Type 2. Both types of HSV cause similar looking skin lesions, however type 2 is more commonly involved in the genital area.

Herpes simplex is a contagious disease that is transmitted by direct contact to the blisters.

What does herpes simplex look like? 

Herpes simplex type 1

The skin lesions are usually preceded by localized itching, stinging, burning, or tingling sensation. This is followed by the appearance of small blisters that crust and heal in 10-14 days. HSV infections typically recur at the same site. Recurrence is triggered by several factors:

• fever

• menstruation

• sun exposure

• trauma

If there are active sores on your face, it is best not to:

• Kiss anyone.

• Share your cups or lipstick with anyone.

• Share towels with anyone.

Herpes Simplex Virus Type 2

This infection occurs around 2-20 days after sexual contact with an infected person. Sores appear on the genitals and/ or on the buttocks. This could be associated with fever and burning upon urination.

If there are active sores, it is best not to avoid sex. Once the lesions are healed it is advisable to use a latex condom to avoid spread of the virus which is possible even when there are no visible lesions.

For women who are pregnant and have herpes simplex of the genital area or have a partner with herpes simplex, it is important that they contact their gynocoloist. They may need to take medicine before the delivery of their baby.

How is HSV diagnosed?

The dermatologist can diagnose HSV infections by looking at the lesion. However, sometimes it is necessary to take a swab from the sores and send it to the lab.

How to treat herpes simplex infection?

Herpes simplex infections are self limited. However, anti-viral tablets such as Acyclovir, Valacyclovir, or Famciclovir may be used to shorten the duration of the skin lesions and also help to prevent frequent recurrences.

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Psoriasis

Psoriasis

What is Psoriasis?

Psoriasis is a chronic inflammatory disease of the skin that can occur at any age. Psoriasis is not a contagious disease. Its cause is not known, but it is partly genetic and could be triggered by ext... [more]

Psoriasis is a chronic inflammatory disease of the skin that can occur at any age. Psoriasis is not a contagious disease. Its cause is not known, but it is partly genetic and could be triggered by external factors such as stress, infections, and medications. Psoriasis is characterized by the appearance of red patches covered with a thick silvery scale.
 


 The affected areas are mainly located on the elbows and knees, but lesions may also involve the scalp, palms, and soles. Body folds such as axillae and inguinal areas when involved can simulate a fungal infection.

 


 What does psoriasis look like?

 

In psoriasis, the skin has an excessive inflammatory response. In normal skin, the upper layer (epidermis) is renewed every 28 days. In psoriasis this period is reduced to 5 days or less. Thus epidermal cells accumulate over each other causing the appearance of the thick silvery scale.
 
 How does psoriasis behave?

 

Psoriasis is a chronic disease. The evolution of the disease is unpredictable. Psoriasis can regress and disappear with treatment but can recur after stopping treatment or can flare after a stressor.

 

What factors can trigger psoriasis?

 

There is a familial predisposition in 30% of cases.
 
 Triggers include:

 

• Medications.
 • Skin trauma.
 • Sunburn.
 • Stress, fatigue, emotional shock.
 
 Obesity, alcohol consumption and smoking are aggravating factors.

 

Are additional tests necessary?

 

The diagnosis is done on physical examination by your dermatologist. In case of doubt, your doctor may decide to perform a skin biopsy. In addition, your doctor may want to take your blood pressure and weight since both of these could be abnormally high in patients with psoriasis.

 

How is psoriasis treated?

 

Currently there is not cure for psoriasis, but there are treatment options to stop the symptoms of the disease as well as maintain the good results. Your dermatologist will discuss with you the best option suitable for you. This will depend on the severity of psoriasis and the extent of the areas involved and whether you have joint pain (psoriatic arthritis).

 


Localized psoriasis

 

Your doctor may prescribe one or more of the below options. These can lead to rapid improvement of your skin; however, you need to use them for prolonged periods of time. It is very important to follow the advice of your doctor.

 
  • Cortisone based creams.
  • Vitamin D based creams.
  • Salicylic acid, urea and alpha hydoxy acid based creams.
  • Moisturizers to keep the skin from cracking.
 

 

Extensive psoriasis

 
  • Ultraviolet light radiation (UVR) is effective for extensive psoriasis. It consists of UVA or UVB light emitted by special light bulbs. This type of light is available in several hospitals in Lebanon. The number of sessions needed will be specified by your dermatologist depending on the extent of your psoriasis and on your response to the therapy. Usually you will be asked to come in for treatment 2-3 times weekly for several months. With exposure to UVA, you will take a medication called Psoralen. This is taken two hours before each of your light treatments. On the other hand, UVB light therapy does not require any medication intake.
 

Attention: Solarium is not a medical device and is considered as a major risk factor for skin cancer in case of uncontrolled use.

 
  • Systemic medications come in pill form or injections and are reserved for extensive psoriasis with or without joint pain. The pills include methotrexate, cyclosporine, acitretin, and isotretinoin. The injectable forms include adalimumab, etanercept, infliximab, and ustekinumab.
 

It is very important to understand that the currently available treatments reduce and even clear symptoms, but they do not cure the disease. This means that the disease can recur after stopping the treatment. Therefore, your dermatologist will put you on a prolonged treatment plan called maintenance.

 
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Seborrheic Keratoses

What are seborrheic keratoses?

Seborrheic keratoses are common benign skin growths that appear with advancing age. They can occur anywhere on the skin and can be single or multiple. The cause of seborrheic keratoses is unknown but... [more]

Seborrheic keratoses are common benign skin growths that appear with advancing age.

They can occur anywhere on the skin and can be single or multiple. The cause of seborrheic keratoses is unknown but sun exposure, pregnancy, estrogen intake and hereditary factors could contribute to their appearance.

What do seborrheic keratoses look like? 

Seborrheic keratoses start as small flat skin lesions that thicken and become warty with time.

Their color can range from light brown to black. Also their size can range from a few millimeters to several centimeters in diameter.

Seborrheic keratoses can resemble moles and warts. Your dermatologist will be able to differentiate a seborrheic keratosis from other conditions by examing the lesion under a magnifier or by using a dermatoscope. However, if in doubt, he or she may elect to remove the lesion or take a piece of it to examine under the miscroscope.

How to treat seborrheic keratoses?

Treatment is not necessary because seborrheic keratoses are benign and do not become cancerous if left untreated. However, many patients are bothered by their cosmetic appearance.

Treatment options include the following:

- Liquid nitrogen, a very cold liquid, is applied to each lesion with a cotton swab or spray gun. The treated lesion will dry up and fall off around a week later.

 -Electrosurgery uses an electric current to burn the growth. A local anesthetic is injected under the lesion before it is burnt.

 -Curettage uses a metallic instrument called a currette to scrape off the lesion. A local anesthetic is injected under the lesion before it is removed.

If many new seborrheic keratoses appear all at once, it is important to seek the advice of a dermatologist, because this could be a sign of a serious health problem.

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SKIN CANCER

What are the types of Skin Cancer?

Three types of skin cancer occur most commonly in humans: - Basal cell carcinoma. - Squamous cell carcinoma. - Malignant melanoma. The good news is that all of these skin cancers are curable if de... [more]

Three types of skin cancer occur most commonly in humans:

- Basal cell carcinoma.

- Squamous cell carcinoma.

- Malignant melanoma.

The good news is that all of these skin cancers are curable if detected and removed early.

Who gets skin cancer?

Anyone can get skin cancer. However, some people are more predisposed to develop skin cancer because they have certain risk factors. These include:

- Age after 60 years.

- Blonde hair, blue/green eyes, light complexion.

- Long hours of sun exposure for years such as tanning on the beach or working under the sun (farming, fishing).

- Regular exposure to tanning beds.

- Sunburns in childhood.

What does skin cancer look like? 

Skin cancer does not have a specific look, especially when it is still very small. In addition, not every new growth on the skin is a skin cancer. Therefore, it is important to see your dermatologist if you notice a new lesion on your skin that does not resolve after two weeks or if you notice any change in color or shape of older lesions on your skin.

How to treat skin cancer?

Most skin cancers are removed surgically. However, other options exist such as electrosurgery or cryotherapy or topical cream. The type of treatment depends on the type and size of the skin cancer.

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VITILIGO

WHAT IS VITILIGO?

Vitiligo is a disease that makes the skin lose its normal color. Our skin color depends on a pigment called melanin. Melanin is produced by melanocytes which are cells living in the skin. Vitiligo oc... [more]

Vitiligo is a disease that makes the skin lose its normal color. Our skin color depends on a pigment called melanin. Melanin is produced by melanocytes which are cells living in the skin.

Vitiligo occurs when melanocytes stop producing melanin.

Vitiligo is not contagious and does not cause health problems. However, it can be cosmetically devastating, especially in darkly pigmented individuals. We are not sure what causes vitiligo, but it could be related to a disorder in the immune system or genetic factors.

What does vitiligo look like? 

Loss of normal color of the:

- Skin.

- Hair.

- Mucous membranes.


There are several types of vitiligo:

- Unitlateral or segmental vitiligo appears on one side of the body, usually during childhood.

- Non-segmental vitiligo, which is the more common type, appears in a symmetric fashion on both sides of the body.


How to treat vitiligo?

There is no cure for vitiligo. The goal of the treatment is to stop the progression and to

repigment the affected areas. Options include the following:

 

- Special coloring creams can be applied to the light areas and make them blend in with the surrounding normal skin.

- Cortisone creams alone or in combination with calcitriol are helpful in new onset vitiligo.

- Exposure of the skin to natural sun or to ultraviolet radiation in a specialized cabinet stimulates the normal skin to produce melanin pigment in the light areas.

- Surgery consists of transplanting light areas with skin from the dark areas.

- Depigmentation of the entire skin with a special whitening cream is reserved for patients who have more than half their body involved with vitiligo.

Your dermatologist who will recommend the best suitable treatment depending on your age, location of the vitiligo as well as extent.

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VITILIGO

WARTS

WHAT ARE WARTS?

Warts are benign growths of the skin. They can appear anywhere on the body including the genital area. Warts are caused by a virus called Human Papilloma Virus (HPV). This virus can be present on the ... [more]

Warts are benign growths of the skin. They can appear anywhere on the body including the genital area. Warts are caused by a virus called Human Papilloma Virus (HPV). This virus can be present on the human skin as well as on inanimate objects. Once there is a cut or injury in the skin, the HPV can enter the skin through the cut and grow there to cause the wart. Warts can also spread from person to person by direct contact or from one location to another in the same person. Genital warts appear after sexual contact with an infected person.

What do warts look like? 

The appearance of a wart depends on its location on the body.

- On the face they can be flat or fingerlike.

- On the hands and fingers they are skin-colored, elevated, and feel rough to touch.

- On the soles they can be painful. It is important to differentiate them from callosities.

- On the genitalia they can assume large sizes.

How to treat warts?

The treatment of warts depends on the type of wart, age of the patient, and the location of the wart.

- Salicylic and lactic acid preparation is applied locally to the wart, everyday for around a month. This method is ideal for children who cannot tolerate pain. It should not be used on the face nor on the genital area.

- Liquid nitrogen, a very cold liquid, is applied to each lesion with a cotton swab or spray gun. The treated lesion will dry up and fall off around a week later. This method can be used for all types of warts.

- Electrosurgery uses an electric current to burn the growth. A local anesthetic is injected under the lesion before it is burnt. This method can be used for all types of warts including genital warts.

- Aldara is a special cream that is applied to genital warts and is particularily useful for warts around the nails.

- Bleomycin or 5-FU which are chemotherapy type of medication, can be injected into the warts. This method is reserved for cases that do not respond to the above measures.

Warts can recur despite treatment. Patients with lowered immunity such as transplant patients or cancer patients can have numerous warts that are resistant to therapy.

How to prevent warts from appearing or recurring?

- Do NOT touch another person’s wart.

- Do not walk barefooted in public toilets and showers, lockers, or around the pool. Always wear shoes, sandals or flip flops.

- Do not engage in unprotected sexual activities.

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alopecia areata

What is alopecia areata?

What is alopecia areata?   Alopecia areata (AA) is a type of hair loss that occurs in people all around the world. AA affects men and women equally. More than half of the patients have their fi... [more]

What is alopecia areata?

 

Alopecia areata (AA) is a type of hair loss that occurs in people all around the world. AA affects men and women equally. More than half of the patients have their first episode before the age of 20. The exact cause is still unknown, however, some studies reveal the possibility of a genetic predispostion. This is why one may encounter AA in family members of patients with the disease.

 

How do we recognize alopecia areata?

 

Patients with AA usually report sudden hair loss. A hairdresser or family member may first notice the hairloss. The lesion of AA is commonly a round totally bald patch involving the scalp or any hair-bearing area on the body. The bald skin is usually pale and normal in appearance, with no crusting or scaling. Occasionally an itching or creeping sensation may be noticed prior to the hair loss, but in most people the condition comes on without warning.

 

How many types of alopecia areata are there?

 

There are three types of alopecia areata:

 

  1. AA, patchy type: partial loss of hair on the scalp
  2. Alopecia totalis: loss of all the hair on the scalp
  3. Alopecia universalis: loss of all hair on the scalp and body.

 

Several conditions of hair loss may resemble AA. It is thus important to seek the help of a dermatologist to correctly diagnose the condition and administer therapy accordingly.

 

Does the hair grow back in alopecia areata?

 

The progress or regrowth in alopecia areata is unpredictable. The recovery from hair loss may be complete, partial or none. When hair is confined to one discrete area, the likelihood of total hair regrowth is good. The initial regrown hair is frequently white followed by dark hair.

 

In patients with more severe hair loss, the chance of recovery without treatment is little. In addition, a family history of AA as well as presence of asthma, seasonal allergies, or atopic eczema may make the disease harder to control.

 

It is important for patients to realize that despite full recovery, the disease may still be active and manifest as new bald spots. Therefore, treatment  is warranted for as long as the disease is active.

 

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Fat Transplantation

Fat Transplantation

Fat Transplantation What is Fat Transplantation? Fat transplantation is the removal of fat from one body area and injecting it into another area of that same person. Many consider fat transplantatio... [more]

Fat Transplantation

What is Fat Transplantation?

Fat transplantation is the removal of fat from one body area and injecting it into another area of that same person. Many consider fat transplantation as the optimal filler, because it is cheap, technically easy to collect, and it comes from one’s own body. This means that it does not require the introduction of foreign material into the skin.

What are the advantages for this procedure?

(1)   There is no chance of developing an allergic reaction to the transplanted fat.

(2)   There is a lot of fat in our bodies.

(3)    The transplanted fat can survive for many years.

What are the disadvantages for this procedure?

(1)   It does not correct fine lines/ wrinkles or small scars.

(2)   The fat removing process is time consuming.

(3)   The doctor cannot predict how much of the transplanted fat will survive.

What happens during the procedure?

On the day of surgery, anesthesia is in injected in the areas from where the fat will be taken. These include the abdomen, knee, or buttocks. Once the anesthesia kicks in, fat is harvested following the classic liposuction technique. When all fat is collected, it is left to stand in the container. This helps to separate it from blood. The fat floats to the surface, while blood and plasma sink to the bottom. The fat is then put in syringes and injected into the desired areas of the face or body. Your doctor may not inject all the fat that was collected but may leave some in the refrigerator to be injected at a later time.

Some doctors inject the fat deep into the muscles of the face with a technique called FAMI (Facial Autologous Muscular Injection). Others still prefer to inject it into the skin.

Is one injection session enough?

Prepare yourself to be injected more than once. In order to maintain the desired results, and because around 50% of the fat injected will dissolve, you may need to undergo this procedure more than once.  

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Fillers

Fillers   Fillers are used to fill in hollow spaces or depressions present in the skin. They are mainly used on the face, however, they can also be injected in other areas of the body such as t... [more]

Fillers

 

Fillers are used to fill in hollow spaces or depressions present in the skin. They are mainly used on the face, however, they can also be injected in other areas of the body such as the dorsum of the hands, the chest, and depressions caused by scars or aging. Fillers are either resorbable and non permanent (dissolve slowly with time) or permanent.

 

Resorbable Fillers

 

Hyaluronic Acid

Hyaluronic acid is naturally present in our skin. Its hygroscopic property allows it to attract and trap water molecules, thus giving the skin a plump look.  Hyaluronic acid in the skin decreases with age as well as with smoking and excessive sun exposure.

 

Hyaluronic acid fillers are of synthetic origin (non-animal) and come in pre-filled sterile syringes. They come in different strengths of viscosity depending on where in the body they are injected and how deep they are to be injected. Your dermatologist will decide which viscosity to use and how deep to inject the filler.

 

Fillers are used to treat fine wrinkles around the eyes and mouth. They are classically used to correct the nasolabial folds (line extending from the nose toward the corner of the lips) as well as the marionette lines (line extending from the corner of lips toward the chin). Fillers are also used to increase the size of both upper and lower lip as well as fill in hollow cheeks.

 

 

Before the procedure

Your dermatologist will ask you about your past medical and surgical history, including previous esthetic procedures, intake of medications especially blood thinners as well as allergies. Then the treatment plan will be discussed in regards to the sites of injection, the estimated number of syringes you will need, and whether you will one or more sessions. The cost of the procedure will depend on all of these factors.

 

During the procedure

Your face will be first cleaned from all make-up followed by cleansing with an anti-septic solution. This is followed by the use of and anesthetic cream or injection. Your dermatologist will decide which one to use depending on the type of injection you will undergo and depending on how sensitive you are to pain. Many filler syringes now come with an anesthetic medication incorporated with the filler material. Therefore, you may not need to have anesthesia applied to the skin before the injection.

 

After the procedure

Your dermatologist may apply ice packs to the injected areas, followed by an antibiotic cream. If you have some bruising, you may be given an Arnica based gel to apply to the affected areas. Over the next 3-5 days you may experience some redness, swelling and bruising. Do not apply any make-up for the next 12 hours after the procedure. Avoid vigorous exercise 24 hours to reduce the risk of bruising. Avoid direct sun exposure and hot environment for the next 7 days.


Caution

If you have had previous injections, you have to inform your doctor. It is important to know what type of material was injected every time. You should always keep a note of the date and the name of the injectable that was used each time. If you have had a permanent filler injected in the past, your dermatologist may refuse to inject you with resorbable filler because of the possibility of side effects such as formation of bumps at the new sites of injection.

 

If you are a woman who is pregnant and breast feeding you should NOT undergo a filler procedure.

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Fillers
Botox

Botox

Botox What is Botox? Botox or botulinum toxin type A is a purified protein derived from the bacterium Clostridium botulinum. It was first used in 1989 to treat strabismus. By coincidence, the doctor... [more]

Botox

What is Botox?

Botox or botulinum toxin type A is a purified protein derived from the bacterium Clostridium botulinum. It was first used in 1989 to treat strabismus. By coincidence, the doctors noted that the lines on the forehead of treated patients improved. This is how botulinum toxin became the new treatment for facial expression lines.

What are expression lines?
Expression lines are wrinkles that appear when the muscles of the face contract. Our facial muscles contract when we speak, laugh, frown, talk, smoke, drink, eat, masticate. Each facial expression uses a different set of muscles.  Each set of muscles will cause lines to appear when they contract.

For example, smiling and squinting leads to lines around the eyes called crow’s feet; frowning leads to vertical lines in the area between the eyes. When we are surprised, we get horizontal lines on our forehead. Chronic smokers and nargila users get little vertical lines around the mouth. All these lines become less apparent when our facial muscles relax.

On the other hand, exaggerated and prolonged contraction of the muscles will lead to permanent expression lines, even when the face relaxed. The aging process, smoking and excessive exposure to sunlight make these expression lines deeper and more evident with time.

How does Botulinum toxin work?
Acetylcholine is a chemical produced by nerves. It enters into the adjacent muscles and allows them to contract. Botulinum toxin blocks the transport of acetylcholine from the nerves to the muscles. Therefore, Botulinum toxin causes a chemical type of muscle paralysis. This paralysis is not permanent and lasts only 4 months after which muscles resume their natural activity.

How often should I get Botulinum toxin injections?
During the first year, you may need one treatment every 4 months. In the subsequent years, you may need less frequent treatments, around 2-3 per year.

 

What happens before the procedure?

Your dermatologist will ask you about your past medical history, allergies, surgical history, including previous esthetic procedures and intake of medications such as blood thinners. Then the treatment plan will be discussed in regards to the sites of injection and the estimated amount of Botulinum toxin you will need. The cost of the procedure will depend on these factors.

 

What happens during the procedure?

Your face will be cleansed from all make-up followed by cleaning with an anti-septic solution. This is followed by the use of an anesthetic cream. Your dermatologist will decide depending on how sensitive you are to pain.

 

What happens after the procedure?

 

Your dermatologist may apply ice packs to the injected areas. If you have some bruising, you can apply an Arnica based gel to the affected areas.

 

The botulinum toxin needs at least 6 hours to bind to its site of action. Your doctor will ask you to smile, frown and elevate your forehead once every 15 minutes for the next three hours. This will encourage the Botulinum toxin to attach to the sites of action. Try to stay in the upright position. Try not to lie down or stoop and do not massage your face. This may displace the Botulinum toxin to unwanted zones of the face.

 

You dermatologist may choose to have you come in again after 2 weeks for a touch up session to improve the results.

 

What are the side effects of Botulinum toxin injections?

You may experience mild pain at the injection sites, some redness and bumpiness, or some bruising. However, these will disappear within hours to a few days.

Headaches are rare.

What are the contraindications to Botulinum toxin treatment?

If you are pregnant or breast feeding, you should not receive Botulinum toxin.

If you have myasthenia gravis, amyotrophic lateral sclerosis, or multiple sclerosis you should not receive Botulinum toxin.

If you have a family member with myasthenia gravis, amyotrophic lateral sclerosis, or multiple sclerosis you should consult a neurologist before receiving Botulinum toxin.

 

What are other indications of Botulinum toxin?

Botulinum toxin is used to treat migraine headaches, strabismus, tics, muscle spasticity, and anal fissure.

In dermatology, Botulinum toxin is also used to treat excessive sweating of the armpits, palms and soles.

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Chemical Peels

Chemical Peels What is chemical peeling? Chemical peeling is an exfoliation of the skin. This is achieved by applying a chemical solution to the surface of the skin. Many skin conditions improve wit... [more]

Chemical Peels

What is chemical peeling?

Chemical peeling is an exfoliation of the skin. This is achieved by applying a chemical solution to the surface of the skin. Many skin conditions improve with chemical peeling. These include acne, acne scars, sun spots, melasma, and wrinkles.

 

What are the chemicals used in peels?

There are many different chemical molecules used in chemical peeling. However, the most commonly used are alpha hydoxy acids (AHAs), salicylic acid, tricholoacetic acid (TCA), and phenol.

How many types of chemical peels are there?

Chemical peels are classified into superficial, medium, and deep peels. This depends on the depth of their penetration into the skin. Our skin is divided into 3 layers, the epidermis, the dermis, and the fat layer. The same peeling agent can serve as a superficial peel as well as a deep peel depending on the concentration applied and on the time it is left on the skin.

Superficial peels do not penetrate deep into the skin. They reach the uppert part of the epidermis leading to a light peeling effect. This leaves the skin smoother and more glowy. It can also be used to unroof pus filled pimples and to lighten the color of freckles. The most common agents used for superficial peels are AHAs, salicylic acid and TCA. 

In medium depth peels, the chemical agent penetrates all through the epidermis and reaches the upper parts of the dermis. The peeling in this case will be more intensive leading to an improvement of the skin tone, some tightness of the skin, and improvement of very fine lines. The most common agent used is TCA.

In deep peels, the chemical agent crosses the whole epidermis and reaches the deep parts of the dermis. The peeling here will be very intensive leading to tightening of the skin, improvement of scars and deep wrinkles. The most common agent used is Phenol or TCA.

 What happens before the procedure?

Your dermatologist will ask you about your past medical and surgical history, including previous esthetic procedures, intake of medications, allergies, exposure to radiation therapy, chemotherapy,  and history of herpes blisters on the face. 

 

If you are known to have recurrent herpes blisters on the face, you dermatologist will give you instructions to take anti-herpes pills before and after the chemical peel.

 

Your doctor will discuss the treatment plan with you in regards to the depth of the peel, the improvements that are expected, and the estimated number of sessions you will need. The cost of the procedure will depend on these factors.

 

Depending on the type of peel, your dermatologist may choose to put you on a Skin Conditioning Program. This means that you will be given a set of creams to use on the skin 2-6 weeks before having the chemical peel done. Skin conditioning is important to make the chemical peel more successful and to avoid complications such as hyperpigmentation.

 

The Skin Conditioning creams may include the following:

 

Retinoid cream helps the skin to exfoliate allowing the chemical peel to penetrate into the skin in an even fashion. It also stimulates the skin to produce collagen leading to better healing after the chemical peel and avoiding scarring.

 

Hydroquinone cream decreases theproduction of dark pigment in the skin. It is used in patients with darker skin tones to avoid hyperpigmentation of the skin after the chemical peel.

 

Alpha Hydoxy Acid cream are used for patients with oily skin. They help in allowing the peeling agent to penetrate into the skin in an even fashion. 

           

 What happens during the procedure?

First the skin is cleaned from all make up. This is followed by degreasing the skin with alcohol or acetone pads to remove all the oil. Then the chemical peel agent is applied with a brush or a piece of gauze or sponge. Your dermatologist may apply more than one layer depending on the depth of the chemical peel that is desired.

 

Your doctor may give you an electric fan to hold against your skin to reduce the sensation of burn. For deep peels, nerve blocks and/or sedating medicines are administered to control the pain.

 

What happens after the procedure?

Your dermatologist may apply a neutralizing solution to the skin to stop the action of the peel. This is commonly used for AHA peels. However, also water can be used to clean the skin from the peeling agent.

 

Before being discharged home, your doctor will give you a set of instructions to follow at home. This will include a mild skin cleanser, an emollient cream to be used several times a day, and a sunscreen to be used every time you go out.

 

If you have been started on anti-herpes medicine, you will continue taking it for 5-7 days after the peel.

 

You should not pick at your skin, and you should not remove any scales that could be bothersome. These will fall off alone with the help of the emollient cream.

 

 In case of pain, excessive redness or fever, you should immediately contact your doctor.

 

After complete skin healing, your doctor may put you a maintenance skin program that consists of creams to maintain the results of the peel and to avoid recurrence of the initial problem.

 

When are chemical peels contraindicated?

Pregnancy and breast feeding:

If you are pregnant or breast feeding it is advisable not to have a chemical peel.

 

Active skin infection:

You should not undergo a chemical peel if you have active herpes or a bacterial infection on the skin. A chemical peel on infected skin can lead to spread of this infection to the whole skin surface.

 

Broken skin:

If you have broken or fissured skin from eczema, waxing or depilation, it is better to wait until your skin is intact again before undergoing a chemical peel. In addition, if you have undergone a recent chemical peel or a laser resurfacing procedure, it is better to ask your doctor when it is safe to have a chemical peel.

 

Keloids:

If you are a keloid former or have keloids from previous surgeries or piercings you should avoid chemical peels.

 

Isotretinoin:

If you are taking isotretinoin, you should not undergo a chemical peel. You have to wait at least 6 months after finishing the treatment.

 

Recent radiotherapy and/or chemotherapy:

If you have had either radiotherapy to the skin or chemotherapy, it is better to ask your doctor when it is safe to undergo a chemical peel.

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Chemical Peels
Photosensitivity

Photosensitivity

What is photosensitivity?  Photosensitivity comprises a group of disorders in which the skin launches an abnormal response to ultraviolet radiation or visible light (both of which are found in t... [more]

What is photosensitivity?

 Photosensitivity comprises a group of disorders in which the skin launches an abnormal response to ultraviolet radiation or visible light (both of which are found in the sun’s rays which reach the earth). Photosensitivity can be caused by agents applied to the skin from outside or agents ingested by the body or inherited genetic disorders. The most common photosensitivity is to ultraviolet light A (UVA). Although the sun is brightest in the summer, the winter sun on a cloudy day can also exacerbate photosensitive skin. Even fluorescent light bulbs can sometimes worsen the condition.

 

 

What does photosensitivity look like?

 On clinical exam, red and itchy patches occur on sun exposed areas. On the face they will be more on the nose, ears, and forehead, while on the rest of the body they will be on the outer parts of the arms and hands. Areas covered by clothing will be spared. Lesions can occur anywhere from 30 minutes to days after sun exposure.

 

 

 What factors trigger photosensitivity?

Different factors may trigger the rash.

- Medications.

- Contact with foods, chemicals, fragrances, dyes…

- Time spent under the sun.

- Genetic disorders resulting in a metabolic defect, imbalance of a body chemical, or absent protein that is essential for skin protection and renewal.

 

 

How is photosensitivity diagnosed?

A dermatologist may be able to diagnose the condition by examining the skin or by taking a biopsy of the affected skin. In some cases, photosensitivity may be confirmed by patch testing unaffected skin with the suspicious agent to see if the rash is reproduced.

 

 

How is photosensitivity treated?

Since photosensitivity is worsened by light, it is generally recommended to:

- Avoid exposure to light between 10 am and 5pm, even on a cloudy day.

- Wear protective clothing such as shirts with high collars and long sleeves, long trousers, long skirts, socks, shoes, and wide-brimmed hats.

- Ensure skin is always covered with sunscreen cream, even on a cloudy winter day.

- Apply protective shields on car windows.

 

It may also be necessary to:

- Stop offending drugs.

- Avoid triggering agents such as certain chemicals or food products.

- Treat with topical or oral cortisone to heal the rash.

- Treat with oral antioxidants.

- Begin phototherapy, for preventative as well as curative measures.

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Skin Biopsy

What is a skin biopsy?  A skin biopsy is a simple 10-15 minute procedure during which the dermatologist removes a lesion of affected or unaffected skin to send to the lab for processing and exam... [more]

What is a skin biopsy?

 A skin biopsy is a simple 10-15 minute procedure during which the dermatologist removes a lesion of affected or unaffected skin to send to the lab for processing and examining under the microscope. It can give valuable information and allow the dermatologist to diagnose a condition or exclude possible diagnoses.

 

Why is a skin biopsy done?

 A skin biopsy can diagnose a skin condition, such as psoriasis, or a skin cancer, or a skin infection.

 

From where is the biopsy taken?

 When there are multiple skin lesions, the dermatologist will decide based on:

 - Location: The least visible location is selected. The legs are preferably avoided, because healing in this location is slower.

 - Stage of the lesion: It is preferable to pick the earliest lesion and avoiding crusted and pigmented lesions.

 

Are there different types of biopsies?

- Incisional biopsy: an ellipse of the skin is removed using a scalpel.

- Excisional biopsy: the skin lesion is removed completely.

- Punch biopsy: a small circular disc of the skin is removed using an instrument that looks like a cookie cutter. The diameter of this instrument is small and can vary from 2-6mm in diameter.

- Shave biopsy: protruding skin lesions are leveled and removed using a blade.

 

 

What does the procedure involve?

In all 4 types of skin biopsies, the dermatologist will apply a local anesthetic to the site of the biopsy. The anesthetic is usually an injection administered under the skin. However, it can also come as a cream that is applied to the skin for around one hour. After testing the area to make sure there is no pain sensation, the dermatologist will remove the skin sample using either a small knife or punch tool. Depending on the size of the skin sample taken, the area may require a few stitches or may just be covered with sterile bandage.

 

What to expect after the biopsy?

Over the next few days, the biopsy site may be sore or bleed slightly. If bleeding is excessive, or the biopsy site becomes swollen, painful, or if there is a fever, the dermatologist should be contacted.

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Skin Biopsy

Community Service

On May 30, 2013, Dr. Abd-el-Baki, member of the Executive Committee of the Lebanese Dermatological Society, was invited to present at a Children’s Day Care Center, Dash Club, in the Hamra area. ... [more]

On May 30, 2013, Dr. Abd-el-Baki, member of the Executive Committee of the Lebanese Dermatological Society, was invited to present at a Children’s Day Care Center, Dash Club, in the Hamra area. The aim of this presentation was to educate children and their guardians how to be sun-safe during the summer season.

Around 10 children, 5-10 years old, with their mothers attended the event in addition to 3 assistants working at the club. Dr. Abd-el-Baki approached the theme of her subject by telling the children the story of a small boy who got a sun burn while playing on the beach, and how he had to wait to heal before being able to enjoy again the summer with his friends. This was followed by practical instructions to the children on how to prepare them before heading to the beach. These included applying a sunscreen at home, repeating applications after each swim, sitting in the shade, and wearing a T shirt, a hat and sunglasses. Dr. Abd-el-Baki underscored the importance of drinking a hefty amount of water to avoid dehydration. Power point images accompanied the story telling and made the event easier to follow by the children.

After the presentation, the children had a crafts session in which they cut out sunglasses and hats from cardboard paper and colored them before wearing them. This event was sponsored by La Roche Posay, Avene, and Bioderma who provided sunscreen samples and colored beach bags to all children and their mothers.

In line with the role of the Lebanese Dermatological Society towards the community, Dr. Abd-el-Baki was also engaged more recently in another activity at the Moadieh Evangelical Center, an assisted living center for the elderly in the Hamra area.

Following a brief introduction of Dr. Abd-el-Baki to the residents of the center and its team of nurses, caretakers and administrators, a power point presentation entitled “Skin Tips for Mature Skin” was given in which Dr. Abd-el-Baki talked about the skin, its normal physiology and function, and the skin changes that accompany aging. Tips on how to take care of the skin in the elderly as well as in some disease conditions such as diabetes in which skin changes may be observed, were also improvised to the audience. Dr. Abd-el-Baki interacted with the occupants of the nursing home and answered their questions. She then concluded her educational community service by distributing goody bags filled with moisturizers and sunscreens – courtesy of La Roche Posay.

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