Posts Tagged ‘ azelaic acid ’

Oscars 2015 – How to Approach Beauty for THE Event of The Year

rosamund pike BAFTASAttending the Oscars:for a nominee, this may well be the pinnacle of  their career and the world is watching. Its also the perfect opportunity for an emerging talent to showcase themselves so putting their best face forward is vital. At the BAFTAS earlier this month, I got to see the nominees firsthand, where Rosamund Pike was a real standout for me. Her skin looked extraordinary, her presence was both commanding and womanly; she completely owned her beauty. Subtle and deft make-up was of course in evidence, but you could tell the ‘canvas’ was in tip-top form.  Getting skin into impeccable condition is a beauty fundamental for every actress – this is not the time for blemishes. So here’s my 12-week timeline to getting the kind of skin that light loves and you can’t take your eyes off. This is a great approach for brides approaching their big day – their own personal red carpet experience.

  • Take a light-handed approach to injectables. This is not the time to try something new. If you get regular treatments, do them well in advance. Many patients like the results of Botox right at the end of their treatment period because they have all the smoothness without any restriction in facial movement. So plan anything like this with military precision, and communicate your timetable clearly with your doctor! We like to know.

  • Peace of mind comes from planning in advance. Most effective skincare ingredients take 2 skin cycles to really make an impact so start radiance- delivering products containing retinoids and niacinamide (an amazing combination that work in synergy, making retinoids easier to tolerate) a minimum of 2 months beforehand.

  • Get problem skin under control. You will undoubtedly start to feel stressed as you enter the last few weeks when pressing issues like dress fittings start to infiltrate every waking thought so ensure your skin stays calm under pressure with gentle but effective azelaic acid – a fantastic multi-tasker that calms blemishes, but also works on clogged pores, dark marks and redness.

  • As the big night approaches focus on hydration. Skin acts like a mirror, reflecting light, when its water content is optimal; so this is key. One of the best ways to do this is with an occlusive paper face mask, one of my favourite quick fixes for lackluster skin. They feel like a proper treatment but with much less risk than a facial. This is ideal for the last 3 nights, as it makes sense to discontinue any more potent actives at this point to avoid any pesky dry patches from irritation.

  • On the day, keep it simple. The hard work is over. Use a non-foaming cleanser and a hydrating moisturiser and that’s it; no scrubs, brushes or other possible irritants. Your skin likes it calm. Keep make-up textures sheer, glossy and allow the beauty of your skin in its best possible natural state to be displayed – skin looks its best when it looks like skin. Then go forth and shine like the star you are, remembering to actually enjoy your moment in the spotlight.


Q:When is acne not acne? A: When it’s perioral dermatitis

I’ve had a cluster of patients presenting with a troublesome facial eruption that’s been mislabelled and thought I’d blog about it because it’s very pleasing to sort and responds rapidly to correct treatment – woo-hoo!

So the common scenario is a female (like melasma, only about 10% of sufferers are men) who has spots near the mouth – within the nose-to-mouth creases and around the chin.

This has a very classic appearance – lots of tiny bumps that look the same, often joining up – but they tend to spare the skin directly next to the lip edge. The skin may be dry and flakey. The bumps on the chin are what tend to lead to the misdiagnosis of acne, as it bears similarity to the distribution of adult female-pattern acne. It can also appear around the eyes (and is then termed periorificial dermatitis) and if severe, spread onto the cheeks. Importantly, clogged pores or comedones are not a feature; this is one of the key features that distinguishes it from acne.

No-one really knows what causes this annoying problem – but the ‘wrong’ type of skin care aggravates it and topical steroids, especially the stronger variants are a common trigger.

When someone presents with this, the first thing I do is to suspend the current skincare regime (and frequently impose a make-up cull). A non-comedogenic regime is the order of the day (I know…I sound like a broken record). We have an excellent choice of soothing, non-clogging products to choose from, courtesy of French pharmacy brands like Bioderma and La Roche Posay and sometimes this will be enough to solve the problem. If topical steroids are the cause, occasionally things get worse before they get better, but stopping them is essential so stick at it.

More severe cases will benefit from prescription medication – my preferred approach is topical (azelaic acid 15-20%) and oral tetracyclines. Usually treatment for 6-8 weeks will sort things out. So satisfying.

A good skin care regime to try if you suffer from perioral dermatitis is as follows  :

Cleanse : La Roche Posay Physiological Cleansing Gel (one of my all-time favourites, non-foaming but effective at removing make-up)

Treatment product – if using a prescription product like Finacea (15% azelaic acid) apply it now, to clean skin morning and night.

Moisturise : Bioderma Sebium Hydra ( a lightweight non-clogging moisturiser for oily skin that’s dry or irritated)

Protect : Obagi Nu Derm Sunshield SPF 50 (lightweight matte finish, excellent physical block without the whitish cast)

Image : courtesy of

What to do when acne and wrinkles co-exist, Part 2!

Ok, so we’ve cleaned up the canvas. Now we need to get our glow on (like the effortlessy gorgeous Eva Green, left). Assuming regular use of a Vitamin A-derivative at night, and sunscreen during the day, most people with mild acne will be much better controlled after about 3 months.

Now, at this stage we need to buff and polish, evening out skin-tone and texture, encouraging the hasty exit of post-inflammatory hyperpigmentation. This is essentially an epidermal intervention-it should already be turning over nicely in response to the retinoid-but the great thing is, everything else you now apply will absorb more easily. So we want to improve pigmentation: uneven, dark patches absorb the light and stop our skin from ‘popping’.

There are any number of ways to improve this-my favourite approach is a multi-tasking one. I find that AHAs+pigment suppressors+retinoid=GLOW. The Obagi Nuderm system remains the gold-standard for me-combining prescription-strength hydroquinone, tretinoin, Vitamin C and glycolic acid; but you can equally use azelaic acid, arbutin or kojic acid to tackle pigmentation. Skinceuticals Pigment Regulator is a great alternative, as is La Roche Posay Pigment Control (in stores in January)-both are based on kojic acid and AHAs. Again, improvements occur over the course of weeks. At this stage I will suggest switching to a gentle cleanser (Cetaphil Gentle Cleanser or Avene Extremely Gentle Cleanser….they’re both….quite gentle!), using moisturiser when needed and sticking with the broad-spectrum sunscreen (minimum SPF30).

Once established on this, I might add in a home medical needling device, to significantly enhance product penetration and improve epidermal turnover. Its important to note that all of these steps might cause a bit of irritation in the first instance-so its important to go slow with any new intervention and support your skin’s barrier function with a non-comedogenic emollient along the way.

With a bit of diligence, your skin should now be posh and polished-looking. Next time-addressing deeper, dermal issues….

What to do when acne and wrinkles co-exist? Part 1!

This is the commonest scenario I face on a day-to-day basis: a distressed late 20’s career girl with lower face acne (and maybe an early nose-to-mouth line), upper face fine lines (usually around the eyes and between the brows…..), combined with an -over-all lack of radiance and glow…..and almost invariably, a heavy coating of foundation. In fact, I think you’ll find that this describes most of the female members of the recent cycle of The Apprentice down to a T. What to do???

The approach is simple-we make a plan. What to fix now, and what to do in the medium to long-term. The priority is always getting any disease process under control. And acne is a disease. It amazes me how many people just get used to having break-outs on their chin and jaw-line and think its something they have to live with, because they have done so for so many years. Not to mention the consequences of spots, with their pigment-depositing potential and general co-existence with rough texture, excess oil and big pores. No, no, no! These things are eminently improvable, with a bit of time, patience and persistence.

A combination of the following will make a big difference in any acne-sufferer’s skin:

1) A BHA wash (containing 1-2% salicylic acid)

2) A topical anti-inflammatory-2.5% benzoyl peroxide (despite historical associations with the nasty, bleaching products of ones’ teens) works well, and there’s no need to use a higher percentage. Seek out those with a moisturising base, like dimethicone, which will help minimise irritancy.

3) A non-comedogenic moisturiser-to preserve barrier function and to help improve tolerability of the acne ‘actives’ in the early stages of treatment.

4) A non-comedogenic sun protection product (minimum SPF 30)-with broad-spectrum cover, which you’ll need as you must use a retinoid (unless getting pregnant).

5) A retinoid-like Differin or Retin-A. In very mild cases, a more gentle Vitamin A-derivative might be sufficient, like retinaldehyde. But you probably need a prescription product if your spot and comedone count is greater than 10-15 lesions. If pregnancy is an issue, azelaic acid is a safe alternative (and will incidentally help tackle your pigmentation). The acne may well get worse before it gets better-do not stop! Retinoids do tend to push out micro-comedones which weren’t previously visible, a process of cutaneous catharsis, if you ask me. It had to come out at some point, so best to get it over and done with. Always use at night, as the molecule is not stable when UV-exposed.

Give it time, be kind to your self in this challenging part of the process…and if your acne is significant, see a doctor to get oral treatment as a holding measure whilst the topicals kick in-but remember, everyone needs an anti-comedonal agent, so a topical retinoid (or azelaic acid) is essential. You must give it at least 8 weeks….so there’s no rush, go slow and build up frequency of application and amount of product used slowly. Your skin is a remarkably adaptable organ, and if you give it time and support it, it will accomodate to the new order of things.

Next instalment…..what  to do once the acne is under control…

The Red Face of Rosacea

One of the commonest inflammatory disorders, it spares no-one, from famous comedians (WC Fields) to world-leaders (see left), frequently chronic…..and is the cause of tremendous distress and embarrassment on a day-to-day basis. It’s commonest in those between 30 and 6o and typically affects us light-skinned Celts. It can be surprisingly tricky to eliminate altogether, but with a few simple tips, should become a lot easier to handle.

The earliest signs are often subtle-a tendency to a prolonged blush after a hot drink or spicy food; this may then progress to the erythemo-telangectatic phase, with fixed central facial redness, typically on the nose and cheeks that doesn’t go away. Acne-like lesions with red spots and white-headed pustules may be superimposed upon this-but what is distinct about rosacea as opposed to ordinary acne, is the absence of blocked pores or comedones. Also the inflammatory spots themselves are often dome-shaped, rather than ‘pointy’ (if that doesn’t sound daft!), which is what you typically see with whiteheads in acne.The sebaceous glands of the nose and chin may over-grow, resulting in a condition called rhinophyma-but this is more common in men. Finally, a symptom that is often overlooked is that of dry,gritty, red eyes, which may be part of the disorder-ocular rosacea. It can affect as many as 1 in2 patients so is an important aspect of the condition.

The exact cause of rosacea is unknown but we know genetics are important, and the trigger may well be immunological, possibly due to over-production of a protein involved in protecting us against bacteria called cathelicidins. Topical steroid use on the face (for conditions like eczema) can also trigger rosacea, and given that redness is also a feature of this condition, can make diagnosis challenging.

I think one of the most important aspects of managing rosacea is knowing what to avoid and using the right type of skincare, something busy physicians often forget to discuss. Know your dietary triggers, be very cautious about sun exposure and take care with environmental extremes of temperature like saunas. Certain ingredients like alcohol will often sting, due to a defect in the barrier function of skin afflicted by rosacea; similarly, oil-free, water-based cosmetics and sunscreens are better tolerated. Cetaphil Gentle  Cleanser and Moisturising Lotion (which are non-comedogenic) are generally well-tolerated and soothing. I also find patients like Avene and Eucerin’s anti-redness ranges.

Medically, oral anti-inflammatory agents like Efracea (which is a low-dose of Doxyxcycline, avoiding its anti-bacterial effect) and Finacea (15% azelaic acid) tend to be effective at managing the ‘spotty’ aspect of the disease. Treatment is usually needed for 8-12 weeks, sometimes longer. Finally, for persistent redness and broken capillaries, light sources like IPL are invaluable (and really the only sucessful option for this aspect of the disease).

As with most inflammatory skin problems affecting the face, unpredictability is one of the most vexing aspects of this condition-so know your triggers, avoid irritants like aggressive scrubs and astringents, use gentle skincare/broad-spectrum sun protection and medicate when needed….life should get a little less testing.

Melasma: The Curse of Summer

Summer…..ah, yes. Lazy  sunny days in the park/at a festival, glamorous white linen separates, glowing,clear skin (see impossibly leggy Alexa for a sickening example)….except that so often it isn’t clear. Its completely ruined by big, muddy, brown splodges on the forehead, cheeks, upper lip and chin-the so-called mask of pregnancy, melasma. In fact, it may well present itself at a time when you’re not remotely pregnant-it occurs in those who are genetically susceptible (commonly affected races include Asian, Hispanic and African-American)and is triggered by UV exposure; hormonal influences may also play a role but men do suffer from melasma too, so its not the whole story by any means. Similarly, whilst melasma may develop during pregnancy or after starting the oral contraceptive pill, it rarely disappears once the pregnancy ends or the pill is stopped. I think of this condition as one of melanocyte instability-those pesky pigment-laden cells (which are there to protect our epidermis from damage due to sun exposure) are all-too-easily tickled into dropping melanin in an untidy fashion leading to the aforementioned splodges.

Treatment is a challenge-the first step is sun protection. All year-round. Skin  biopsies of patients with melasma typically show evidence of damage to the elastin fibres which is associated with sun exposure. So don’t sun-bathe. Please. And wear proper amounts of broad-spectrum SPF 50 sunscreen every day, re-applying if in direct sun-light (but please, avoid sunlight during peak hours of 11-3pm).

The next step is to use a skin-lightening agent. This will work best for those with melasma in just the upper layer of the skin, the epidermis; however it can affect either the epidermis or the dermis, and sometimes both. Just to be tricksy. Skin-lightening agents attract a lot of controversy-but they are an essential part of the armementarium in treating melasma.

Options include:

1) Hydroquinone

A highly-effective bleaching agent, and used in concentrations of 2-4%. It received negative publicity because of cases of ochronosis largely reported in South Africa-but these cases used higher concentrations of non-prescription hydroquinone without physician supervision for many years. Treatment response plateaus after 6 months so its important to use it cyclically to maintain its effects.

Its often combined with other agents-retinoic acid and sometimes topical steroids-for maximum efficacy. Downside-it can be irritant.

2) Azelaic acid

This useful ingredient is a pigment suppressor, rosacea tamer and a comedone-preventor….so a real multi-tasker. Its effect is probably better than low-strength hydroquinone  when used twice daily.

3) Arbutin

Derived from the bearberry plant, this has a similar structure to hydroquinone.

4) Kojic acid

It’s limitation is its tendency to irritate-but again, a good alternative to hyroquinone and again, probably equivalent to using 2% strength.

Peels and lasers can be used……but caution! Any form of injury or trauma can potentially ‘shake’ the volatile melanocyte and trigger a melanin-spill. If you do embark on these treatments (and they can work well in those with deeper melasma), only do so with someone who is experienced at the procedure in this difficult clinical setting. And stabilise your melancytes first with appropriate bleaching creams. The Obagi Nuderm system is my preferred weapon, but the Epionce system (based on azelaic acid and botanical agents) works well too.

Or you could become nocturnal. It’s a thought…..