Cosmetics have been used for years to help women (and men) look and feel younger, but for those with sensitive skin using cosmetics can be an expensive challenge of trial and error.

These tips can help you find the best cosmetics for sensitive skin:

   1. Choose powder when possible.
      Powder cosmetics are not only great at removing shine, they have very few preservatives and contain minimal ingredients that can cause skin irritation.

   2. Avoid waterproof cosmetics.
      Waterproof cosmetics require a solvent to remove them that also removes sebum, the oily substance made by the sebaceous glands in the skin. Without this oily barrier, skin is exposed to potential irritants.

   3. Do not use old (expired) cosmetics.
     
   
   4. Check sunscreen ingredients.
      For women or men with sensitive skin, look for sunscreens that contain the physical sunscreen ingredients zinc oxide or titanium dioxide.

   5. Use products that contain no more than 10 ingredients. Simply stated, the fewer ingredients in a product, the less likely it is that the product will cause a problem.

   Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Dismorphophobia or Body dysmorphic disorder (BDD) is an obsessive preoccupation with a perceived defect in one’s physical appearance which the individual persistently seeks medical attention to correct surgically.

Any body part can be the focus of concern (most often, the skin, hair, and nose), and most patients engage in compulsive behaviors, such as mirror checking, excessive grooming, or excessive skin make up.

Approximately half are delusional, and a majority experience ideas or delusions of reference. Nearly all patients suffer some impairment in functioning as a result of their symptoms, some to a debilitating degree. Psychiatric hospitalization, and suicide attempts can occur. BDD often goes unrecognized and undiagnosed, due to patients’ reluctance to divulge their symptoms because of secrecy and shame.

Much remains to be learned about BDD, it is important that doctors screen patients for this disorder and accurately diagnose it. There is need for interdisciplinary interactions between the dermatologist and the psychologist. Referral to a psychiatric to clarify the diagnosis.

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic dermatologist

www.dermatologia.com.br

Reloxin is a botulinum toxin type A (NBTX-A ) that is a potent neurotoxin derived from the bacteria Clostridium botulinum.

Botulinum toxin is one of the most poisonous naturally occurring substances in the world. Though it is highly toxic, it is used in minute doses both to treat muscle spasms, and as a cosmetic treatment for facial dynamic lines and wrinkles.

In Brazil, we have three reliable products: Botox, Dysport and Prosigne, and we have Xeomin and Neurotox pending for approval.

Dysport and Reloxin are exactly the same product but they are sold commercially under different brand names.

Botulinum neurotoxin type A is one of the most important cosmetic procedure performed today. Although  NBTX-A  treatment can be combined with other procedures, it can produce impressive results when used alone. We have been using Dysport/Reloxin for several years and we have published papers demonstrating that NBTX-A  Dysport injection is safe, satisfying and well tolerated treatment for dynamic facial wrinkles.

We have similar results using both Botox and Dysport/Reloxin.

This is a clinical trial using Dysport/Reloxin for facial lines:

http://www.cibersaude.com.br/revistas.asp?fase=r003&id_materia=3907

Now that you know more about Reloxin, you have a new option to treat facial wrinkles!

Best wishes from Brazil!

Dr. Érica Monteiro

Cosmetic Dermatologist - Brazil

www.dermatologia.com.br

Desquamation is the natural process in which skin cells are sloughed away and replaced. New skin cells are created in the deepest layer of the epidermis (stratum germinativum). From this layer, the cells begin their migration to the skin’s surface. Once the cells reach the uppermost layer of the skin ( stratum corneum ) they are essentially dead. These tightly packed cells of the stratum corneum continuously fall as newer cells push their way to the surface. The entire process, from cell birth to sloughing away, takes approximately 28-30 days. In pathologic desquamation, the stratum corneum becomes thicker (hyperkeratosis), imparting a "dry" or scaly appearance to the skin, and instead of detaching as single cells, corneocytes are shed in clusters, forming visible scales.

There are many dermatological diseases when we can see descamation: psoriasis, seborrheic dermatites, eczema and other inflammatory skin diseases.

If you have this condition, see your dermatologist.

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Freckles or ephelids or lentigines orbrown spots that appear on skin areas that have been exposed to the sun (example: face, hands, chest). Freckles are common in lighter skin who sunburn easily.

Freckles and brown spots are among the many signs of photoaging. Photoaging occurs when chronic and excessive sun exposure accelerate the skin’s natural aging process. In addition to freckles and brown spots, photoaged skin may also show signs of mottled pigmentation, surface roughness, fine lines and wrinkles and dilated blood vessels.

Treatments for freckles and brown spots include cosmetic foundations, sunscreens, bleaching creams including alpha hydroxy acids, retinoids, hidroquinone and more. Usually we include freezing them with liquid nitrogen, and/or procede a chemical peels, and/or laserand IPL (intense pulsed light) treatments. Results from a full series of treatments usually last for a year or more with good sun protection.

If you have freckles and/or brown spots and light skin type it is better schedule an appointment with your dermatologist to check them every year cause you must prevent problems with skin cancer in the future.

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Hi everyone!

Last week I went to the American Academy of Dermatology meeting.  It is the largest dermatology meeting in the world.  I have seen my friends from University of Miami International Cosmetic Center, including Dr. Baumann. It was a very busy Congress and we discusses a lot of botulinum toxins such as Botox and Dysport/Reloxin, dermal fillers (hyaluronic acid, collagen, and many others), cosmetics and new cosmeceuticals, sensitive skin, aged skin and much more. In fact, I will discuss many informations in the BLOG!

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Sometimes, not always, oily skin can benefit from the use of moisturizers. But the wrong moisturizer can cause greasy feeling, blackheads and acne. Choosing the right moisturizer is very important. Here are some tips that will help you to find the right one.

- Creams are heavier than moisturizing lotions, if you have a oily skin choose a lotion or serum.

- Choose a moisturizer labeled oil-free and noncomedogenic. Oil-free products don’t have oils that can leave a greasy feel to the skin. Noncomedogenic products are much less likely to clog the pores and cause breakouts.

- Look for SPF. Many moisturizers contain SPF, and using a sunscreen daily will protect your skin from aging and skin cancer. This is especially important if you are using acne treatments that cause photosensitivity, or increase your sensitivity to the sun.

- Some moisturizers contain exfoliating ingredients, as alpha hydroxy acids (AHA), salicylic acid (BHA), retinol or other exfoliating ingredients. These ingredients are helpful to control oily skin and in improving acne.

- If you are a sensitive skin, choose a hypo-allergenic formulation.
  
- If you have oily skin and acne, it is better consult your dermatologist and follow his/her recomendations.

- Remember you do not need to have a bad day with your oily skin!

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Tretinoin is a retinoid drug (vitamin A analogue) that has been used to treat many dermatologic conditions (“label” and “off label”) as acne, wrinkles, photoaged skin, melasma, stretch marks, and to prevent non melanoma skin cancers. 
The recent study published in the January 2009 by Weinstock in the Archives of Dermatology was very perturbing for all dermatologists and consumers. The study showed that elderly men patients treated in a VA hospital with 0.1% tretinoin topically to prevent skin cancer had a higher risk of death than those not using tretinoin. The veterans in this study were predominately elderly men.
Various factors in the study to try to determine the explanation for the increased number of deaths among tretinoin users. It is difficult to know for sure because the study was not designed to look for risk of death, but it seems that it is smokers who are at greater risk.
There were many limitations to the study since the information was obtained from VA databases which might have been incompletely filled, and also commorbidities and smoking incidence were not matched equally for both groups thus failing the comparison between the groups.
Smoking causes lung disease, heart disease and cause deep folds and wrinkles. We are not really sure that retinoid topic products in addition to smoking may increase the risk of death, but I totally agree with Dr. Baumann to inform all the patients that are using retinoids as tretinion, retinol, adapalene, tazarotene or taking vitamin A or beta carotene supplements to not smoke. 
Adverse drug effects, side effects, drug interactions are manifold and heterogenous.The detection of unknown and unexpected connections between drugs exposure, commorbidities and adverse events is one of the major targets of pharmacovigilance. Pharmacovigilance serves to detect previously unrecognized adverse events associated with the use of the drugs but this is only possible if the drug is rigid controlled. In Brazil we have a very important problem; patients do not go to the dermatologist to ask for a retinoid topical cosmeceutical or drug as they proceed to use a systemic one. If we control the topic retinoid use, it will be possible to understand the connections (or not) and mechanisms involved in the detection of adverse drug effects or increased risk of death in using topical retinoid.  There are papers describing risks in using beta carotene and develop lung malign disease, but I do not remember papers linking systemic retinoid intake and lung cancer. Better than limited phase IV clinical trials, rigid retinoids´ pharmacovigilance may elucidate retinoids and death connections.

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatology

www.dermatologia.com.br

Eyelash is the hair that grow at the edge of the eyelid. Eyelashes protect the eye from fragments and they are sensitive to being touched, thus providing a warning that an object is near the eye, which is then closed reflexively.The follicles of eyelashes are associated with a number of glands known as the Glands of Zeis and the Glands of Moll.Long eyelashes are considered a sign of femininity in many cultures. Modern eye makeup includes mascara, eyeliner, fake eyelashs and eye shadow to emphasize the eyes. For safety reasons it is important to choose dermatologic and ophtalmologic tested products to prevent alergic reactions and some diseases.

Diseases - there are a number of diseases or disorders involving the eyelashes:

    - Madarosis is the loss of eyelashes
    - Blepharitis is the irritation of the lid margin where eyelashes join the eyelid. Eyelids are red and itching. The skin often becomes flaky. The eyelashes may fall.
    - Distichiasis is the abnormal growth of lashes from certain areas of the eyelid.
    - Trichiasis is ingrown eyelashes
    - Eyelashes may become infested with crab louse parasites
    - An external hordeolum, or stye, is a purulent inflammation of infected eyelash follicles and surrounding sebaceous (Zeis) and apocrine (Moll) glands of the lid margin.
    - Trichotillomania is a disorder that urges the sufferer to pull out scalp hair, eyelashes, and other hairs.

Take care of your eyelash!

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Although there is no cure for eye´s dark circles, it is possible improve their appearance:

- Make-up can be used to disguise the dark color.

- Sunscreen and sunglasses: the more you are exposed to sunlight, the more natural pigmentation that is affected. This contributes to the appearance of dark circles.

- Do not scratch the under eye skin.

- Sleep well. Sleep for sufficiently long hours.

- While you are sleeping, you can use an overnight facial masque or eye cream that help reduce the appearance of puffiness and discoloration. These products can be vitamin A, retinol, vitamin C, vitamin E.

- Eat healthy foods full of vitamins and anti oxidants that protect our skin from free radicals.

- Laser treatment to treat the vessels and the dark pigment (ask your dermatologist).

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br