Dr. Niamtu’s Weblog

….on cosmetic facial surgery

Can Retin A Kill You?

retina

Sounds like a headline from the National Enquirer!  After decades of safety of use in millions of patients (including this author!), a recent report has raised some eyebrow when a recent study made some alarming claims.  Relax, you are not going to die, but read on to learn some interesting facts that could affect your health.

Retin A (generically known as tretinoin), a Vitamin A analogue that is a popular acne medication and has been used by physicians to prevent skin cancers, treat wrinkles, and prevent skin aging, has been criticized in a recent study for increasing the risk of death in some patients.

Even though these products have been used safely and effectively for many years, a recent study by Weinstock MA et al, published in the Archives of Dermatology, showed that 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.

The researchers looked at 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.

This finding goes along with a study looking at an oral form of Vitamin A called isotretinoin that showed that isotretinoin may be harmful to current smokers.

It is important to realize that this is the first sign of a risk of harm from using tretinoin after decades on the market, so this study’s results may not hold up when more testing is done. However, it is prudent to take this advice: If you use tretinoin (retinol, adapalene, tazarotene) or take Vitamin A or beta carotene supplements, please do not smoke. Smoking is known to age your skin prematurely and to cause lung disease and heart disease. It now looks as if using popular anti-aging products in addition to smoking may increase your risk of death.

To find out more about cosmetic facial surgery in Richmond, Virginia click on www.lovethatface.com.

 

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

February 18, 2009 Posted by | acne, Retin A | , , | Leave a comment

Dealing with Acne

blogacneAcne is a condition that is misunderstood by many patients and doctors.  First let me say that I am not a dermatologist and anyone with severe acne should see a dermatologist for their unique expertise.  Having said that, I see (as do most cosmetic facial surgeons) many patients with active acne.  In some cases patients may outgrow the acne, but a large percentage of patients may end up with permanent scarring.  This is very unfortunate, especially for young patients who don’t know better.  If any adult is reading this and they have a child with active acne, I implore them to seek treatment for their child.

Acne has little to do with what we eat and the other associated wife’s tales.

·         Myth:

Washing your face more often will help clear up acne

Reality:

Facial blemishes are not caused by dirt. Contrary to what you may have seen in commercials, pores do not get blocked from the top down due to “impurities”. Rather, the walls of a pore stick together within the skin, starting acne formation. Far from preventing acne, frequent washing may actually irritate pores and cause them to become clogged. A washcloth can add even more irritation. The best bet is to wash very gently with bare hands, and only wash twice a day.

·         Myth:

Stress causes acne

Reality:

Stress may have an effect on hormones and theoretically can promote acne. However, an effective acne treatment regimen is more powerful than a bout of stress any day. Some psychiatric medications may have acne as a side effect, but stress itself is no big deal. Your time is better spent determining the right course of acne treatment rather than feeling guilty about stress.

·         Myth:

Masturbation or sex causes acne

Reality:

This antiquated notion, originating as early as the 17th century to dissuade young people from having premarital sex, is just plain wrong. Don’t believe the hype.

·         Myth:

The sun will help get rid of acne

Reality:

The sun may work in the short-term to hasten the clearing of existing acne while reddening your skin, thus blending your skin tone with red acne marks. However, a sun burn is actually skin damage. Sun exposure causes irritation which can make acne worse. People will often notice their skin breaking out as it heals from sun damage. The sun is a short-term band-aid which will often bite back with more acne in the weeks following exposure. Having said that, I don’t want to give the impression that the sun is evil. It is not. We get our vitamin D from the sun for instance. Limiting sun exposure on acne prone areas of your body is most likely prudent, but some exposure from time to time is not only unavoidable, but is perfectly okay.

·         Myth:

Diet and acne are related

Reality:

The bottom line is we need more research. We do know that people in some indigenous societies do not experience acne whatsoever across the entire population. This is in stark contrast to the widespread presence of acne throughout all modern society. It leaves us to ponder the question of whether the indigenous people’s diet contributes to their acne-free skin. Discovering a dietary way of preventing acne may be a future reality, however, we may live so differently from our hunter/gatherer ancestors that it has become close to impossible to replicate our ancestral diet. But, let’s see if we can work together to come to some consensus from our own experiences. If you feel that you have cleared your acne using a particular diet, or if you are planning on attempting a diet of some kind, please post your method on the Nutrition & Holistic health message board.

(above taken from www.acne.org which is a very valuable resource for patients)

 Acne is a condition that is a result of a bacterial skin infection.  The bacterium P. acnes lives in the pores and with an increase in sebum (oil gland) production it causes the pustules and sometimes cysts that we call zits.  Some acne is associated with comedones (blackheads) while cystic acne is more of an inflammatory process.  Severe acne requires treatment with such medications as Accutane and is essential to have a qualified dermatologist when using this type of drug.

For the more garden variety acne cases that I see in cosmetic patients or their children, the treatment includes numerous factors.  Skin care is one of the most important.  Very few patients take a serious approach to medically based skin care.  Simple skin care with cleansers, toners, a retinoid (such as Retin-A) can assist acne prevention and treatment.  Oral antibiotics such as Minocycline are frequently used once a day and topical antibacterial wipes (1% cleocin) used twice a day have worked well in my practice.

Ancillary treatments such as microdermabrasion can assist exfoliation.  A recently approved LED single wavelength light treatment has also been useful with a nonsurgical, nonprescription treatment regimen.  I have one of the few Omnilux LED devices in the area.  This FDA approved acne treatment involves the patient sitting in front of an LED device for 20 minutes, twice a week for about a month.  This simple treatment has benefited many patients in my practice.  This treatment is more beneficial for inflammatory acne than “blackhead” type of acne.  Although some patients do not respond to the Omnilux, most do and it is an affordable option to more aggressive treatments.

Finally, for patients that have acne scarring, multiple options exist to improve the scars.  The CO2 laser is the gold standard for acne scarring and can produce dramatic improvement.  Other treatments for acne scars include injecting fillers under the scar, subcision (undermining the scar with a special needle) and surgically removing the scar.  I perform all of these treatments for acne scarring and frequently combine these treatments, depending upon the severity of the acne scars.  Acne patients need to be careful not to be taken advantage of.  There are many devices, new lasers and practitioners that promote or promise miracle cures.  If a miracle cure existed for acne, no one would have it.  Although the newer lasers such as the fractional lasers may show promise, the results have been disappointing in my experience.  I have yet to see any treatment that can compete with the CO2 laser.  Although the recovery a hassle, the results are predictable and reliable.

If you have a loved one, friend, or coworker with acne, encourage them to seek treatment before they develop scars.  For those patients that already have acne scars, an experienced cosmetic facial surgeon can improve their appearance and self confidence.

Joe Niamtu, III DMD

Cosmetic Facial Surgery

Richmond, Virginia

April 9, 2008 Posted by | acne | , , , , , | Leave a comment