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

Periorbital hyperpigmentation is the official name for this condition. It occurs when there is more melanin produced around our eyes than usual, giving them a darker colour.

Eye dark circles around the eyes has many causes, such as: 

- Heredity: dark circles under the eyes run in some families.

- Vascularization: inherited eye blood vessel condition.

- Aging

- Dehydration

- Pallor - the paleness of the skin may accentuate the dark rings.

- Sleep difficulty - you can see many causes of sleep difficulty symptoms, e.g. stress, depression, sleep disorders, etc.

- Allergies (atipic dermatites, eczema,…)

Next post: dark circles treatment.

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist

www.dermatologia.com.br

Here are common Foot Problems:

Fungal and Bacterial: fungal and bacterial conditions, including athlete’s foot, occur because our feet spend a lot of time in shoes - a warm, dark, humid place that is perfect for fungus to grow. Fungal and bacterial conditions can cause redness, blisters, itching, scale, pain. To prevent these infections, keep your feet clean and dry - mainly between your toes.

Callosity: they are caused by friction and pressure when the bony parts of your feet rub against your shoes. Wearing shoes that fit better can solve the problem.

Warts: warts are skin growths caused by viruses. They are sometimes painful and can spread. If you have warts see your doctor. These are some treatments performed by dermatologist to treat warts: topical medicines (acids), freeze the wart off (criotherapy), lasertherapy, and surgery in some cases.

Ingrown toenail: it occurs when a piece of the nail breaks the skin and can happen if you don’t cut your nails properly. A dermatologist can remove the part of the nail that is cutting into the skin. Ingrown toenails can often be avoided by cutting the toenail straight across and level with the top of the toe.

Osteophytes or spurs: It is calcium growths that develop on bones of your feet. They are caused by muscle strain in the feet. Things that can make it worse include: standing for long periods of time, wearing badly fitting shoes, being overweight. Sometimes spurs can be very painful. Treatments for spurs include using foot supports or heel pads. Surgery can be performed in some cases.

Best wishes from Brazil and happy New Year!
Dr. Érica Monteiro - Cosmetic Dermatologist
www.dermatologia.com.br

Foot care may prevent many foot problems. Problems with our feet can be the first sign of more serious medical conditions such as: arthritis, diabetes, nerve disorders, circulatory disorders.

Practice Good Foot Care: Check your feet regularly, primary care doctors (internists and family practitioners) are qualified to treat most foot problems, but sometimes the special skills of an orthopedic surgeon or dermatologist are needed.

Circulation
It also helps to keep blood circulating to your feet as much as possible. You can do this by: putting your feet up when you are sitting or lying down, stretching if you’ve had to sit for a long while, walking, having a gentle foot massage, taking a warm foot bath.

Other Foot Care Tips: avoid pressure from shoes that do not fit right, try not to expose your feet to cold temperatures, do not sit for long periods of time (especially with your legs crossed), do not smoke, wearing comfortable shoes that fit well.

Have a nice weekend with your foot.

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist
www.dermatologia.com.br

No matter how thick or strong it looks, the hair is actually very delicate. So we cannot just tug and pull at it, or else it would break.

Is there a right way of washing the hair?

Yes! First you should comb the tangles out of the hair before you wet it so the hair would wash easily and the tangles would not worsen. And then, wet your hair thoroughly under the shower. You can wet your hair with warm water to open the scale-like cuticles of the hair and wash all the oil and dirt off. And then, you can rinse your hair with cold water afterwards to close the cuticles and add to the shine of your hair.

Rinse your hair under the shower to rid it of the leave-on conditioner and styling aids you have used previously, using gentle strokes of your fingertips. Then, pour a dollop of shampoo in the palm of your hand. Rub your hands together, and then apply the shampoo to your scalp. You should put the shampoo on your scalp and not at the ends of your hair, as the shampoo would dry your hair’s ends and cause it to weaken and split. After this, rinse the shampoo off. If you have a delicate or a damaged hair avoid to shampoo our hair for a second time. The first shampoo will clean the oil and dirt off; the second shampoo can dry your hair. Rinse the hair completely after this.

To get the excess water off your hair, just squeeze the water out. The hair is mainly delicate when it is soaked. When the excess water is out, apply a conditioner - mane event - and apply it along the hairline, the nape and the ends of the hair. Pile your hair then inside a shower cap and let the conditioner stay there for around ten minutes. And then, rinse it off completely.

The process described is time-consuming, but having great hair takes time…

Best wishes from Brazil!

Dr. Érica Monteiro - Cosmetic Dermatologist
www.dermatologia.com.br

The colour of skin depends primarily on a pigment called melanin. Melanin is a pigment produced by cells called melanocytes that manufacture the melanin and transfer it to the skin cells of the epidermis.

Melanin pigmentation in humans is of two types. The constitutive colour is that which is genetically determined without the effect of sunshine. The other is inducible skin colour or tan as a consequence of sun exposure. Other factors can darken skin, some hormones e.g. in pregnancy can make the skin darken, blod flow through the skin and others.

Melanocytes are found throughout the skin. Melanin helps protect the skin against the effects of ultraviolet light, and tanning of the skin on sun exposure acts to increase that protection. The number of melanocytes in the skin is the same in all races. The difference in colour between Caucasoid and Negroid skin is due to the number and arrangement of the melanosomes in the keratinocyte.

The superior sun protection of the black skin is therefore not due to more melanocytes but more melanosomes within the epidermis. How well their skin tans and how easily it burns is related to your risk of skin cancer from sunshine.

Protect the skin you are in!

Best wishes from Brazil,

Dr. Érica Monteiro - Cosmetic Dermatologist
www.dermatologia.com.br

What makes a face attractive and why do we have the preferences we do?

Since the beginning of humanity, man has sought to define beauty. Whether by philosophy, mathematical constructs, social studies, or biology, the fascination with and the study of beauty has consumed our emotions and intellect. Averageness, symmetry and sex-specific traits have been associated with attractiveness. Recent studies are shaping a new reality of beauty, one founded on evolutionary and biologic findings that link our fascination with beauty to our reproductive success.
It is proposed that beauty can be external or internal or both. External or physical beauty is immediately visible. Internal or inner beauty is not always immediately visible. Ideally both types of beauty are connected. The dermatologist needs many clinical skills, including an understanding of psychology, when addressing skin-related problems - appearance-related problems in particular.
Beauty is in the eye of the beholder and cosmetic dermatology is the science of beauty.

Best wishes from Brazil!

Dr. Érica Monteiro
Cosmetic Dermatologist
www.dermatologia.com.br

Soap is one of the most important cosmetic and personal care product. Soap is a product used in conjunction with water for washing and cleaning. It can comes in a solid form (bar soap) but may also come in the form of liquids. Soaps typically contain surfactants that, when applied to a soiled surface in combination with water wet the dirt and effectively holds particles in suspension so it can be rinsed off with clean water. But some soaps today are much more sophisticated and they can also serve as a deodorant, cleanse and moisturize, to treat acne and bacterial infecction and much more.

My tip: choose not so detergent soap and always moisturize your skin after bath.

Best wishes from Brazil!

Dr. Érica Monteiro
Cosmetic Dermatologist
www.dermatologia.com.br