My Blog
By Cindy Hoffman Dermatology
July 03, 2018
Category: Skin Care
Tags: Cold sores  

Cold Sores can appear on the outside of the lipWhat are cold sores and what can you do to relieve your symptoms?

Most people who have had cold sores often know when they are about to appear. The tingling and burning sensation around the mouth is often the first indicator that a cold sore is imminent. Approximately 80 to 90 percent of Americans have been exposed to the herpes simplex virus type 1 (HSV­1), which causes cold sores. If you have cold sores then you are probably wondering more about this condition, how to treat it and what it means for your health.

What are the symptoms of cold sores?

Symptoms often stick around for about two to three weeks. Besides experiencing oral sores around the mouth, people may also experience flu­like symptoms such as fever, muscle aches and fatigue. These oral sores will often appear as tiny blisters that break open and scab over.

When should I see a doctor about cold sores?

While cold sores often don’t warrant a trip to the dermatologist, there are certain times when it might be advisable. These sores can be painful, so if you find it difficult to eat or talk then you will want to talk to your doctor about the best ways to alleviate the pain to make eating easier. The last thing you want to deal with is dehydration on top of an outbreak.

If these oral sores look different from other cold sore outbreaks, then it’s also worth seeing your dermatologist to receive a proper diagnosis. Those with weakened immune systems due to chronic illness or chemotherapy should also see their dermatologist to prevent further complications.

What treatments are available for cold sores?

While many cold sores will go away without the need for treatment, if you are experiencing pain we may prescribe a topical anesthetic to reduce your discomfort. There are also over­the-counter treatments that speed up healing and reduce pain. However, for those with severe infections your dermatologist may also prescribe an oral antiviral medication.

Those with weak immune systems and those who become dehydrated as a result of cold sores may need to go to the hospital to prevent further problems and to receive oral antivirals.

While you cannot cure the virus that causes cold sores, there are certainly ways to reduce your symptoms. Talk to your dermatologist to find out more!

By Cindy Hoffman Dermatology
June 04, 2018
Category: Skin Care
Tags: Birthmarks   Skin Blemishes  

Port wine stains are just one type of birthmarksLearn some fun facts about these common skin blemishes.

Birthmarks are extremely common, appearing on about 80 percent of babies at birth. Even if you don’t have a birthmark, chances are good that you know someone who does. However, how much do you actually know about these dermatological markings? There are a lot of facts and folklore surrounding birthmarks and why they appear. Find out how much you really know!

Your Birthmark Is Not Caused By Your Mother!

There are many folk tales surrounding the expectant mother’s influence on whether or not her child has a birthmark. Some cultures believe that a birthmark is associated with the mother’s unfulfilled want or need, while others believe that certain foods that the mother eats or activities that she participates in can cause birthmarks to appear on her newborn. However, many doctors believe that birthmarks actually form before the child is even born.

Does a Birthmark Tell You Who You’ll Be?

Are you always looking for the next amazing adventure? Do people revel over all your successes? If so, some people might believe your birthmark has something to do with it. A birthmark on the back is believed to signify that the child is open­minded, while a birthmark on the right foot means you are born to be a traveler. While there is certainly no scientific evidence to prove any of this, it’s a fun superstition nonetheless.

All lore aside, many birthmarks are benign; however, it is best to see your dermatologist to have it evaluated and to make sure it isn’t malignant. There are several different kinds of birthmarks:

  • Congenital melanocytic nevus: This more rare birthmark can be found anywhere on the body and is usually light brown or sometimes black, depending on the person’s skin color.
  • Mongolian spots: A bluish­gray marking that may look similar to a bruise.
  • Port wine stain: A purple or red blemish that often appears on the face.
  • Telangiectatic nevus: Sometimes referred to as a “stork bite” or “angel kiss”, these slightly red patches are often found on the face or back of the neck.
  • Hemangiomas: A raised, red mark sometimes referred to as a “strawberry mark”
  • Café au lait spots: This birthmark is characterized by circular, light brown spots
  • Silvermark: A silver or white streak in the hair.

If you are unhappy with or embarrassed by your birthmark then you may also want to talk to your dermatologist about having it removed. Both surgery and laser treatments may be options for having your skin blemish removed.

By Cindy Hoffman Dermatology
April 26, 2018
Category: Skin Care

Sun DamageToo much exposure to sunlight can be harmful to your skin. Dangerous ultraviolet B (UVB) and ultraviolet A (UVA) rays damage skin, which leads to premature wrinkles, skin cancer and other skin problems. People with excessive exposure to UV radiation are at greater risk for skin cancer than those who take careful precautions to protect their skin from the sun.

Sun Exposure Linked to Cancer

Sun exposure is the most preventable risk factor for all skin cancers, including melanoma. To limit your exposure to UV rays, follow these easy steps.

  • Avoid the mid-day sun, as the sun's rays are most intense during 10 a.m. and 4 p.m. Remember that clouds do not block UV rays.
  • Use extra caution near water, snow and sand.
  • Avoid tanning beds and sun lamps which emit UVA and UVB rays.
  • Wear hats and protective clothing when possible to minimize your body's exposure to the sun.
  • Generously apply a broad-spectrum, water-resistant sunscreen with a Sun Protection Factor (SPF) of at least 30 to your exposed skin. Re-apply every two hours and after swimming or sweating.
  • Wear sunglasses to protect your eyes and area around your eyes.

Risks Factors

Everyone's skin can be affected by UV rays. People with fair skin run a higher risk of sunburns. Aside from skin tone, factors that may increase your risk for sun damage and skin cancer include:

  • Previously treated for cancer
  • Family history of skin cancer
  • Several moles
  • Freckles
  • Typically burn before tanning
  • Blond, red or light brown hair

If you detect unusual moles, spots or changes in your skin, or if your skin easily bleeds, make an appointment with our practice. Changes in your skin may be a sign of skin cancer. With early detection from your dermatologist, skin cancers have a high cure rate and response to treatment. Additionally, if you want to reduce signs of aged skin, seek the advice of your dermatologist for a variety of skin-rejuvenating treatment options.

Platelet Rich Plasma: A Novel Hair Loss Therapy

PUBLISHED ON August 3, 2016  Dimensional Dermatology

https://dimensionaldermatology.com/2016/08/03/platelet-rich-plasma-a-novel-hair-loss-therapy/

Lacey Elwyn, DO & Paul M. Graham, DO

Platelet rich plasma (PRP) is a new and exciting treatment option for hair loss currently being offered by many dermatologists across the country. Patients that have failed a variety of treatment options for hair loss are now seeing incredible results with PRP therapy. Historically, hair transplants were seen as the only definitive option available for near total hair restoration. The costs of a typical hair transplantation ranges from $3500-$15,000 per session, depending on the experience of the surgeon, the complexity of the problem, and the number of grafts involved. This option is often cost-prohibitive and has prompted the search for new therapies for hair loss, specifically PRP. Taking a more conservative approach, that is using PRP, will give modest results at a fraction of the cost of hair transplantation.

Platelet rich plasma (PRP) has been used in the medical community for many years, mainly in the specialties of orthopedic and plastic surgery, as it has shown great effectiveness in the process of wound healing and tissue rejuvenation. PRP has now made its way into dermatology as another treatment option for those suffering from hair loss.

Hair loss can be a very frustrating and extremely challenging problem to treat. It is important to see a dermatologist so that the exact etiology of hair loss can be investigated. A dermatologist will thoroughly evaluate exactly why you are losing hair. Hair loss is often variable and can be caused by a number of different etiologies, some more problematic than others. A detailed history and physical exam will be performed, as well as obtaining the appropriate blood work to evaluate the hair loss. This blog focuses on the use of PRP for male and female pattern hair loss and diffuse hair thinning.

Is PRP an option for you?

If you are a man with male pattern or a woman with female pattern balding, or suffer from diffuse thinning with no identifiable cause, then PRP may be a great option.

What is androgenic alopecia?

Androgenic alopecia, also known as pattern hair loss, is a condition that is often associated with genetic factors and elevated androgenic hormones.  This occurs when hormone-susceptible hair follicles shrink in size giving the appearance of hair thinning/loss in a classic and reproducible pattern. Male pattern baldness is the most common type of hair loss and affects 70% of men and 40% of women.

      Signs of male and female androgenetic alopecia

  1. Gradual onset
  2. Increased hair shedding (normal = 100 hairs lost per day)
  3. Distinct pattern hair loss (as shown above): Men develop a receding hair line and thinning at the vertex scalp; Women develop thinning at the crown and widening of their part
  4. Hair goes from being dark, having a large hair shaft diameter, and thick coverage to lighter, smaller hair shafts with thin coverage.

What is the cause of androgenic alopecia?

Hair growth occurs in 3 phases: anagen, catagen, and telogen. During the anagen phase, the hair shaft grows in length and diameter over the course of 2-4 years. In catagen phase (2-3 weeks), all growth stops and the hair shaft slowly looses its connection from the follicle. The telogen phase, otherwise known as the resting phase, last approximately 2-3 months and is characterized by shedding of the hair from the follicle. Androgenic alopecia is both genetic and androgen-dependent, hence its name androgenetic alopecia. Androgens are hormones such as testosterone and dihydrotestosterone (DHT) that when elevated, increase hair shaft miniaturization. Patients with androgenic alopecia also have elevated numbers of telogen hair, leading to increased shedding in the patterns depicted above. Dihydrotestosterone (DHT) is the androgen thought to be directly responsible for this increased shedding that occurs. Testosterone is converted to DHT by the enzyme called 5-alpha-reductase. Patients with a genetic predisposition to develop androgenetic alopecia have increased activity of 5-alpha reductase, increasing the level of circulating DHT.

Minoxidil (Rogaine) is the only FDA-approved topical treatment option for men and women suffering from androgenic alopecia. On the other hand, Finasteride (Propecia or Proscar) is the only FDA-approved oral medication for the treatment of androgenic alopecia in men. Other commonly used treatments include oral contraceptive pills and spironolactone for their anti-androgen effects, hair transplantation, and now PRP.

Rogaine works by dilating the blood vessels that supply the hair shaft. This increase in blood flow directly prolongs the anagen phase. Rogaine can take up to 4 months for noticeable improvement to occur, so patience is key. This medication is ideally started as soon as hair thinning in observed. It is highly recommended for both men and women to use the 5% solution as this will provide the most beneficial effects. Rogaine may increase facial hair development, which is not ideal in women using this product. Many believe that if this medication is stopped, all the new hair growth will be lost. This is not an entirely accurate assumption. When Rogaine is discontinued, the hair follicles slowly depart from the anagen phase and resume normal progression through telogen and catagen phases. It is important to remember that although an increase in hair loss may occur, this does not signify the loss of pre-existing hairs prior to starting this medication. Rogaine ideally should be continued indefinitely to increase the ratio of hairs that are in the growing phase and decrease the amount of hairs that are in the resting phase. Add this product to your daily routine to help slow down the process of hair loss.

Propecia works by blocking an enzyme called 5-alpha reductase, therefore decreasing the conversion of testosterone to DHT. It is thought that by decreasing DHT, this will slow the progression of hair follicle miniaturization, leading to retention of pre-existing terminal scalp hairs. Propecia does come with several side effects, which include erectile dysfunction, decreased libido, breast tenderness and gynecomastia (breast enlargement). Be sure to have a detailed discussion with your dermatologist before starting this medication.

Androgenic alopecia is highly associated with numerous genetic factors, but PRP therapy may halt genetically pre-determined hair loss. Deactivated stem cells are present in hair follicles of patients with androgenetic alopecia. PRP contains the growth factors necessary to activate these stem cells, leading to an increase in hair growth. Recent studies support an increase in number of hair follicles and hair density after undergoing PRP treatment, as demonstrated on biopsy specimens 2,3,4.

How does PRP work?

PRP is derived from whole blood. Blood is drawn into a test tube and placed into a centrifuge to separate out the components. Plasma appears as a yellow serum at the top of the test tube, separated from the red blood cells at the bottom. Separating these two components is a layer called the “buffy coat”. The plasma directly above the buffy coat layer is the richest in platelets and immune cells responsible for the beneficial effects of PRP.  The remaining plasma is considered platelet poor plasma. PRP contains a high level of both cytokines and growth factors, which function to stimulate inactive stem cells within the hair follicles, promoting increased hair growth.

PRP Protocol: What to expect (Slight variations in protocol depending on your dermatologist and PRP system)

Eclipse PRP System is an efficient and high quality system for healthcare professionals to harvest and prep PRP. The procedure is designed to take less than 30 minutes and only a small amount of the patient’s blood is required. 

  • Three treatments, 4-6 weeks apart
  • Maintenance every 6-12 months
  1. A topical anesthetic mixture will be applied to your scalp to minimize pain during injection
  2. Blood will be collected in a test tube
  3. The blood will be placed in a centrifuge to induce layered separation of whole blood
  4. The topical anesthetic will be rinsed from the scalp and antiseptic solution will be used to disinfect the area prior to the procedure
  5. (Optional*) Platelet poor plasma will be applied to the scalp during a microneedling treatment to the target area.
    • Microneedling induces the formation of tiny columns within the epidermis and superficial dermis, facilitating increased penetration of activating cytokines and growth factors contained within PRP.
  6. Platelet rich plasma will be injected into the target area of the scalp.

Eclipse MicroPen is a cordless, medical grade micro-needling pen. It comes with sterile, single-use disposable tips to ensure both patient and provider safety.

What are the side effects?

The side effect profile of PRP is relatively mild with only erythema and swelling which last less than 12 hours. PRP is a natural substance derived from the patients whole blood, preventing the risk of developing an allergic reaction. Clean or sterile technique is often used to prevent the risk of infection. Although pain is minimized with topical anesthesia, it is not entirely eliminated. Tylenol is often recommended prior to the procedure to limit discomfort.

In summary, there are many options for the treatment and management of hair loss. PRP appears to be a promising therapy for the restoration of male and female androgenic alopecia. Although PRP is relatively new in the field of dermatology, many dermatologists are seeing excellent results with minimal downtime, as compared to more invasive procedures such as hair transplantation. Many etiologies exist that may contribute to hair loss and a thorough evaluation is necessary. Make sure to ask your dermatologist if PRP is right for you!

 

 

I would like to inform all of you about a brand new blogging website called Dimensional Dermatology, founded in May 2016 by Dr. Paul M. Graham, St. Joseph Mercy Dermatology in Ann Arbor, Michigan. This website provides concise, up-to-date, easy to read articles on varying topics in general, surgical, and cosmetic dermatology as well as aesthetic medicine, cosmeceuticals, and plastic surgery. This blog is built upon the concept of digesting complicated research data, technologies, procedures, and innovative treatments into succinct, easy-to-read articles with the target audience focusing on the general public, consumers, patients, medical staff and providers. I welcome all of you to check this out at https://dimensionaldermatology.com/.

References

  1. Yim, Elizabeth; Nole, Katherine L. Baquerizo; Tosti, Antonella (December 2014). “5α-Reductase inhibitors in androgenetic alopecia.”. Current Opinion in Endocrinology, Diabetes, and Obesity (Review) 21 (6): 493–8.
  2. Headington JT, Novak E. Clinical and histological studies of male pattern baldness treated with topical minoxidil. Curr Ther Res Clin Exp. 1984, 36:1098-106.
  3. Goldberg, J, Lynne J, Singh B. Autologous platelet-rich plasma for the treatment of pattern hair loss. Amer Jour Clin Derm. 2016. 1-9.
  4. Gentile, Peitro. Et al. The effect of platelet rich plasma in hair re-growth: A Randomized Placebo-Controlled Trial. Stems Cells Translational Medicine. 2015;4:1317-1323.
  5. Cervelli, V. Et. al. The effect of autologous activated Platelet Rich Plasma (AA-PRP) Injection on Pattern Hair Loss: Clinical and Histomorphometric evaluation. BioMed Research International. 2004; 9 pages.

 

Photographs

http://erhhairrestoration.com

http://drshellyfriedman.com/hair-loss/

https://disqus.com/home/channel/talkshop/discussion/channel-talkshop/hair_loss/

http://orlandohairtransplant.org/platelet-rich-plasma-prp-hair-growth

http://alluremedicalspa.com/services/skin-hair-dermatology/platelet-rich-plasma-prp-acell-matristem/

http://www.mededge-inc.com/micropendown.jpg

http://www.rogaine.com/home.do

Coming soon.

 

What’s Our Secret: Your Guide to a Seamless Skincare Regimen

PUBLISHED ON May 16, 2016 https://dimensionaldermatology.com/

Lacey Beth Elwyn, DO

SKINCARE HAS NEVER BEEN EASIER. USE THESE SIMPLE TIPS TO DESIGN YOUR PERSONALIZED SKINCARE REGIMEN. GET READY TO UNLOCK YOUR SKIN’S FULL POTENTIAL!

Secret #1 – Back to the basics with a gentle face cleanser

Face Cleansing for Anti-Aging

Stop spending countless dollars on over the counter (OTC) anti-aging products. OTC products may have some benefit, but looking at the big picture, they don’t work. Vanicream cleanser is free of dyes, lanolin, fragrances, masking fragrances, parabens, and formaldehyde; all ingredients that could be potentially harming your skin! However, if your face tends to be more on the dry side, CeraVe hydrating cleanser is the right choice for you.

Basic Cleanser: Vanicream bar soap, Free and Clear liquid soap, CeraVe hydrating cleanser

Face Cleansing for Acne

Soaps and face washes with salicylic acid, exfoliating beads, or sand are really harsh on your skin, very drying, and should not be used. One OTC acne product that I like to recommend in my acne patients is benzoyl peroxide (BP) face wash. I recommend a 4-5% BP wash for the face and a 10% BP wash for the chest and back. Benzoyl peroxide is also

very drying, so always follow with a moisturizer. Be sure to rinse well, as BP can bleach towels and clothing. BP wash should always be used as your facial wash if you are using a prescription topical antibiotic. It helps prevent antibiotic resistance. Only wash with benzoyl peroxide in the morning if you are using a tretinoin topical at night. Benzoyl peroxide can deactivate your tretinoin and should never be used at the same time.

Basic Cleanser: PanOxyl Creamy Face Wash, 4% BP

Secret #2 – Don’t underestimate the benefits of an electric brush

The Clarisonic Skin Cleanser is awesome! Research supports that it improves the cleansing
of your face, removing more dirt and oil than regular washing. Therefore, it is great for helping to prevent breakouts! It also increases the efficacy of your topical prescription products up to 80%! Meaning, it will make your morning acne products and nighttime anti-aging products work better! It can also help decrease pore size and improve the overall smoothness of your skin! The Clarisonic system is the best. It

is the only one with patented sonic technology. When you first start using, you may only tolerate washing with this cleanser once a day, recommended at night. However, after repeated use, you may use twice a day to wash your face, both morning and night.

Secret #3 – Moisturizers are a must

A wonderful brand to use for facial moisturizing is CeraVe Facial Hydrating Lotion AM and CeraVe Facial Hydrating Lotion PM.

The AM facial lotion has broad spectrum SPF 30 to start your day off right! CeraVe is formulated with ceramides, which help to protect and build your skin barrier as well as provide optimal hydration for your skin. Ultraviolet damage from the sun is the number one contributing factor to accelerated aging, fine lines, and wrinkles. Moreover, most acne treatment regimens are slightly irritating and drying to your skin and some may even induce a slight photosensitivity. CeraVe facial hydrating lotion AM is the perfect moisturizer. CeraVe facial hydrating lotion PM is for nighttime use, as it lacks the SPF needed during the day.

Basic Moisturizer: CeraVe Facial Hydrating Lotion AM and CeraVe Facial Hydrating Lotion PM

Secret #4 – Vitamin A is not just for nutrition

Everyone, starting as early as their teenage years, should use a topical retinoid (tretinoin), prescribed by their dermatologist, on their face at night! Retinoids are vitamin A derivatives. They normalize follicular keratinization or teach our skin to shed appropriately. Tretinoin is FDA approved for the treatment of acne and the ONLY FDA approved product to decrease and prevent fine lines and wrinkles. Because it is teaching our skin to shed appropriately, it is like giving yourself a micro-peel every single night. It can help erase dark spots on your face from sun damage or acne spots, which will give your skin a smooth, even color. It helps prevent breakouts and can also improve pore size. Topical tretinoin tightens and brightens your facial skin! With the exception of sun block, tretinoin IS the miracle cream for your face. It is the product on the market that ALL the other products WANT to be. There are many vitamin A derivative retinol creams available OTC, but the BEST is prescription tretinoin! Why? Well, the over the counter anti-aging creams are RetinOLs. Retinols are still vitamin A derivatives, but they are not as strong or effective as the retinOIDS, which is the tretinoin prescription from your dermatologist. When you first start using topical tretinoin, it will be irritating. It can cause redness and drying/flaking. This should only last for about a week. The trick to help prevent excessive drying is to use CeraVe facial lotion PM in conjunction with the tretinoin at night. Always put on the moisturizer. It will not decrease the efficacy of your tretinoin. You want to use only a pea size amount, dab onto your forehead, nose, both cheeks, and chin. Don’t waste your product or your money. Using more of your product will not make it more effective. A pea size amount of the tretinoin is sufficient and then you can use your moisturizer to help

spread it evenly over your face. After using consistently, your skin will achieve that beautiful, smooth, creamy glow that you have always wanted! Tretinoin may not be covered under your insurance plan and can be expensive, but think of all the money you have spent on OTC product lines for acne and anti-aging purposes, none of which worked… This WILL work and IS worth it! Your skin is worth it!

Secret #5 – Acne is not your enemy

You should stop using all OTC washes and lotions for acne and let your dermatologist treat your acne! A basic face cleanser and moisturizer, as described above, is all you should use. The standard of care in treating acne involves specific treatment modalities targeting the dominant pathogenic mechanism. For example, hyperkeratinization is targeted in the treatment of comedogenic acne (white heads and black heads), inflammation in inflammatory acne (red pimples and cysts), and androgen induced sebum production in hormonal acne (lower face acne in females or acne that worsens around your menses). White heads and black heads are best targeted with topical tretinoin. Remember, tretinoin normalizes follicular keratinization and is therefore the best topical for comedonal acne. Inflammatory acne is treated with topical and/or oral antibiotics. Topical clindamycin is a common first choice, and should always be used in conjunction with a benzoyl peroxide to prevent antibiotic resistance. If topical antibiotics are not working, an oral antibiotic will typically be prescribed. Oral antibiotics from the tetracycline class, such as minocycline or doxycycline are the antibiotics of choice for treatment of inflammatory acne. They are pretty specific to the skin. They are lipophilic drugs, which means oil loving, so the oil glands in the skin absorb the medicine like a sponge! It works great to clear up the acne. These antibiotics must be taking with food, or they will cause significant gastrointestinal upset. It is also important to be aware that these antibiotics will make you more sensitive to the sun, yet another reason to remember your SPF daily. Acne spots left behind, after your acne has cleared, can stay on the skin for up to 6-9 months. Spots can be faded away with the topical tretinoin that you use at night. If you have severe nodulocystic acne, oral isotretinoin, is the answer for you. It is a last resort, but if nothing else is working, it is worth it to go through with the treatment, as failure to effectively treat your acne will result in the possibility of permanent acne scarring. Isotretinion is a retinoid (Vitamin A derivative) that is systemic, so it works from the inside of the body outward. There are many side effects associated with isotretinoin which has prompted a mandatory enrollment and monitoring via the iPledge system. Your Dermatologist will see you monthly to check blood work and ensure adequate contraception. About 20% of patients will relapse and require a second treatment course.

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Secret #6 – Mineral makeup matters

The make up that we use is very important! We should be using a mineral makeup that has titanium dioxide and zinc oxide. It is very good for the skin and looks so amazing on! Zinc and titanium are actually what is used in creams for diaper rash in babies, so it is very soothing for the skin and great for preventing and helping acne. My favorite mineral makeup is by Jane Iredale.

Mineral Makeup: Jane Iredale liquid minerals foundation and the amazing matte loose finishing powder

Secret #7 – Always be keen on the sunscreen 

SO, the miracle for anti-aging, besides your retinoid, is broad spectrum SUN BLOCK!!! Now, notice I say BROAD SPECTRUM. You need to use a broad-spectrum physical sun block on your face, which blocks out both the UVA and UVB rays from the sun. UVB rays are the rays that cause your skin to burn! UVA rays go deeper into your skin, causing DNA damage, leading to skin cancer and are also the ones that most contribute to your brown age spots!

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My favorite broad-spectrum physical sun block for the face is called TIZO.

Sun Block: Solar protection formula TIZO facial mineral fusion SPF 40 UVA/UVB very water resistant sun block

 It is an AWESOME product! It has this creamy, very light consistency so you can use it as your moisturizer on your face in the morning. Moreover, it actually comes in a tinted color so you can use in replace of makeup if desired!

Powdered Sun Block:  Colorscience Pro loose mineral powder brush sun protection SPF 50

This is a loose mineral powder brush sun protection SPF 50 tinted color to carry in your purse to re-apply your sun block in powder form through out the day! It is also great for shine and oil control. You can also brush on your hands and left side of your face while driving in your car to prevent those age spots!

Skin Regimen, The Basics

Morning

Night:

1. Wash, Clarisonic Cleansing system (optional)

1. Clarisonic Cleansing system to wash

2. Prescription topical antibiotic for acne if needed

2. Prescription topical tretinoin

3. Moisturizer with sun block

3. Moisturizer

4. Mineral foundation (Optional)

 

5. Mineral powder (Optional)

 

6. Re-apply sun block throughout the day

 

I would like to inform all of you about a brand new blogging website called Dimensional Dermatology, founded in May 2016 by Dr. Paul M. Graham, St. Joseph Mercy Dermatology in Ann Arbor, Michigan. This website provides concise, up-to-date, easy to read articles on varying topics in general, surgical, and cosmetic dermatology as well as aesthetic medicine, cosmeceuticals, and plastic surgery. This blog is built upon the concept of digesting complicated research data, technologies, procedures, and innovative treatments into succinct, easy-to-read articles with the target audience focusing on the general public, consumers, patients, medical staff and providers. I welcome all of you to check this out at https://dimensionaldermatology.com/.

 

*The information contained in this publication should not be used as a substitute for the medical care and advice of Dr. Hoffman. There may be variations in treatment that Dr. Hoffman may recommend based on individual facts and circumstances.





This website includes materials that are protected by copyright, or other proprietary rights. Transmission or reproduction of protected items beyond that allowed by fair use, as defined in the copyright laws, requires the written permission of the copyright owners.

 

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