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| Preface | 13 | (4) | |||
| Introduction | 17 | (8) | |||
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| Bibliography | 267 | (7) | |||
| Index | 274 |
The New copy of this book will include any supplemental materials advertised. Please check the title of the book to determine if it should include any access cards, study guides, lab manuals, CDs, etc.
The Used, Rental and eBook copies of this book are not guaranteed to include any supplemental materials. Typically, only the book itself is included. This is true even if the title states it includes any access cards, study guides, lab manuals, CDs, etc.
Patients come to me wanting to know more about their skin. It is a subject that can confuse even the most intelligent person because of the information and misinformation that barrages us every day.
My purpose in writing this book is to help you understand how your skin works, why it looks the way it does and what you can do to improve it, regardless of your age. There are a lot of books available by eminent skin specialists who claim they have the answer to looking young. It's tempting to think there is truly only one way to take care of all your skin problems. But the truth is, no single procedure, no one cream can do everything for everyone. Moreover, all the high-tech treatments and all the money in the world cannot replace what you must do for yourself every day at home. That's where it begins.
In order for you to be effective in caring for your skin, I have created a Skin Profile system. Instead of listing skin by "types," I use the phrase Skin Profile. I specifically chose the word "profile" because of its definition: "an analysis of the history and status of a process or relationship." To me, this is precisely how your skin should be viewed. Your personal Skin Profile is more than a category or type. It is really a process -- a dynamic, fluid and ongoing event. How your skin looks depends on the inner workings of your body, your state of mind, your environment and your willingness to do all you can to improve these interdependent factors. Of course, heredity plays a big role as well, but you can work with the genes that nature gave you to maximize your personal best.
You will be learning whether your skin responds and reacts most strongly to internal forces or external ones. For example, hormonally reactive skin responds to the chemical changes within your body that ebb and flow at various levels, day to day, month to month, year to year. Individuals with stress-reactive skin notice that variable emotions change the appearance of their skin more than anything else.
Other readers will discover that the outside world leaves its mark on their skin. Persons with environmentally sensitive skin experience irritation, rashes, breakouts and other problems when their skin comes in contact with perfumes, dyes and cosmetic ingredients, for example. I will show you how to eliminate irritants and allergens while maintaining a skin care regimen that will bring out the best in your skin. The environment can harm your skin over the long run as well. Too much sun and wind as well as other habits like smoking result in overexposed skin. Finally, I will briefly discuss how to keep hearty skin looking good. People with Hearty Skin look younger than people of the same age and find that using basic inexpensive products works well.
My approach to skin care has always been to ask my patients in-depth questions during each visit. Learning everything about a person makes caring for his or her skin easier. When you read this book, you will be treated like one of my patients. I will ask you many questions -- not just about your skin but about who you are and how you live. Your answers will provide the information that determines how best to care for your skin.
At first you may wonder about the relevance of certain questions when it comes to treating your skin. However, you will soon see that all the answers have a bearing on you, your lifestyle, your health and, by def-inition, your skin.
With that analysis complete, your daily skin care routine will become much simpler. I am committed to saving you time, money and effort. I want to support you in your quest to look great without a doctor's help and without unneeded risk to your well-being.
You will find that I have recommended a number of specific brand-name products. My choices are dependent on my personal experience, patients' suggestions and a review of the ingredients in the product. More than one product is given in each category to give you an opportunity to purchase items at a drugstore for usually under $20 or at a department store for usually over $20. The order in which the product is listed does not indicate preference. I have made an effort to choose items from a variety of sources. I have also limited my list to widely available national brands made by companies that have a long history of standing behind their products.
This book covers all there is to know about skin care. It also helps you decide how to select a doctor (if you choose to see one) who suits your needs.
After you have finished this book, I am sure you will never think about your skin in the same way again. I am also sure that your skin will look and feel better. People will notice, but, more important, you will too.
Copyright © 1999 by Dr. Barney J. Kenet
Introduction
Patients come to me wanting to know more about their skin. It is a subject that can confuse even the most intelligent person because of the information and misinformation that barrages us every day.
My purpose in writing this book is to help you understand how your skin works, why it looks the way it does and what you can do to improve it, regardless of your age. There are a lot of books available by eminent skin specialists who claim they have the answer to looking young. It's tempting to think there is truly only one way to take care of all your skin problems. But the truth is, no single procedure, no one cream can do everything for everyone. Moreover, all the high-tech treatments and all the money in the world cannot replace what you must do for yourself every day at home. That's where it begins.
In order for you to be effective in caring for your skin, I have created a Skin Profile system. Instead of listing skin by "types," I use the phrase Skin Profile. I specifically chose the word "profile" because of its definition: "an analysis of the history and status of a process or relationship." To me, this is precisely how your skin should be viewed. Your personal Skin Profile is more than a category or type. It is really a process -- a dynamic, fluid and ongoing event. How your skin looks depends on the inner workings of your body, your state of mind, your environment and your willingness to do all you can to improve these interdependent factors. Of course, heredity plays a big role as well, but you can work with the genes that nature gave you to maximize your personal best.
You will be learning whether your skin responds and reacts most strongly to internal forces or external ones. For example, hormonally reactive skin responds to the chemical changes within your body that ebb and flow at various levels, day to day, month to month, year to year. Individuals with stress-reactive skin notice that variable emotions change the appearance of their skin more than anything else.
Other readers will discover that the outside world leaves its mark on their skin. Persons with environmentally sensitive skin experience irritation, rashes, breakouts and other problems when their skin comes in contact with perfumes, dyes and cosmetic ingredients, for example. I will show you how to eliminate irritants and allergens while maintaining a skin care regimen that will bring out the best in your skin. The environment can harm your skin over the long run as well. Too much sun and wind as well as other habits like smoking result in overexposed skin. Finally, I will briefly discuss how to keep hearty skin looking good. People with Hearty Skin look younger than people of the same age and find that using basic inexpensive products works well.
My approach to skin care has always been to ask my patients in-depth questions during each visit. Learning everything about a person makes caring for his or her skin easier. When you read this book, you will be treated like one of my patients. I will ask you many questions -- not just about your skin but about who you are and how you live. Your answers will provide the information that determines how best to care for your skin.
At first you may wonder about the relevance of certain questions when it comes to treating your skin. However, you will soon see that all the answers have a bearing on you, your lifestyle, your health and, by definition, your skin.
With that analysis complete, your daily skin care routine will become much simpler. I am committed to saving you time, money and effort. I want to support you in your quest to look great without a doctor's help and without unneeded risk to your well-being.
You will find that I have recommended a number of specific brand-name products. My choices are dependent on my personal experience, patients' suggestions and a review of the ingredients in the product. More than one product is given in each category to give you an opportunity to purchase items at a drugstore for usually under $20 or at a department store for usually over $20. The order in which the product is listed does not indicate preference. I have made an effort to choose items from a variety of sources. I have also limited my list to widely available national brands made by companies that have a long history of standing behind their products.
This book covers all there is to know about skin care. It also helps you decide how to select a doctor (if you choose to see one) who suits your needs.
After you have finished this book, I am sure you will never think about your skin in the same way again. I am also sure that your skin will look and feel better. People will notice, but, more important, you will too.
Copyright © 1999 by Dr. Barney J. Kenet and Patricia Lawler
Chapter Four: Your Skin Profile: Analyzing the "Why" of Your Skin
We have heard it many times before -- dry skin, oily skin and combination skin. Three neat categories aimed at selling products to consumers eager for a quick dermatological analysis -- but, in my opinion, very inadequate to cover subtle and important variations, particularly among women.
Some of my patients don't know whether their skin tends to be oily or dry. Others know which category they fall into but either aren't sure how to care for their skin or are dissatisfied with the results of their regimen. Women with oily skin tend to scrub with soap and avoid anything with oil, but they still break out with pimples and have shiny skin. Women with dry skin tend to purchase dozens of moisturizers but suffer from a parched, older look. Those with combination skin purchase all kinds of products -- exfoliaters, toners, moisturizers and soaps -- but still can't seem to find the right balance. When one of my patients described her skin care routine, it sounded like a full-time job. Another became so frustrated that he quit taking care of his skin altogether -- and it showed.
In order to help these men and women, I began to analyze their skin difficulties using categories other than the standard oily, dry and combination. I realized that the three traditional skin types characterized skin but did not define the mechanisms and reactions that caused the problems. They just described a symptom. It would be like telling a patient that something was wrong with his leg but not explaining whether it was a muscle spasm, a circulation problem or an infection.
After hundreds of discussions with all different types of patients, I discovered that the most important question was not "What type of skin do you have?" but"Whyis your skin behaving this way?" Heredity? Lifestyle? Stress? Diet? Too little sleep? Too much alcohol? The wrong skin care? I also wanted to knowwhentheir skin acted up. Was the change dependent on the weather? Was it linked to emotional troubles or allergy season? When we talked about these issues, a pattern emerged; more important, we identified a way to handle problems with a specific but simple treatment plan.
Once you understand thewhyandwhenof your skin, you will have the key to better care and healthier, more beautiful skin.
Let's review the dry, oil and combination skin types and how this categorization falls short. Then I will introduce you to another perspective -- the Skin Profile.
Dry skinlooks older than it should. It also feels awful -- itchy, flaky and irritated. Skin is continually losing moisture to the atmosphere, especially when humidity is low, such as during winter months. When water is lost faster than it can be replaced from underlying tissue, the outer layer dries out. For the skin to look normal and healthy, the water content of the stratum corneum must be above 10 percent.
In biological terms, dry skin may be the result of a slowdown in the way the skin sheds, causing its outermost layer to become abnormally thick and stiff, inclined to flake or crack. In dry skin the amount of fatty molecules (lipids) within the skin that holds the top layer of cells together is decreased. Lipids also create a barrier to trap and prevent excessive water loss. When these lipids can't perform their job, cells collect on the outermost layer -- the layer that you and everyone else sees. Instead of sloughing off, the cells form hard patches that crack and peel. Microscopic studies show that dry skin has a thick, cracked and disorganized stratum corneum.
Skin can be dry for many reasons, ranging from the way we wash to the condition of our thyroid gland, to the changes that come with aging. If one of your parents had dry skin, you may have a genetic predisposition toward it. If you have dry skin, it is important to evaluate why your skin is the way it is.
For example, in some situations, especially among older persons, a standard moisturizer may not adequately treat dry skin if the roughness is caused by the failure of cells to slough off properly. Products containing alpha hydroxy acid may provide more relief than a moisturizer in that case.
In some situations, people withoily skinmay actually be washing excessively. They may have overactive oil (sebaceous) glands, possibly due to stress, hormonal disorders or genetics.
In your teens and twenties, oily skin may have seemed like a curse as you continually had to powder your nose and blot your face to keep the shine down. You may also have had lots of acne breakouts. As you got older, however, your tendency to be oily became a blessing. People with oily skin tend to have smoother, less wrinkled skin than people with dry skin.
Caring for oily skin presents a challenge because it is subject to acne breakouts. When acne persists beyond a person's teens and twenties, one is faced with fighting both aging skin and blemishes, a difficult task.
The termcombination skin,developed by cosmetic companies, not dermatologists, refers to skin that is oily in the center of the face (nose, forehead) and dry on the periphery. According to so-called beauty experts, persons with combination skin may break out more often on the oily parts while other areas of their face need more moisture. Combination skin describes obvious physical characteristics, but the underlying cause of the problem is not addressed. No cosmetic foundation has been developed that can supply the proper amount of moisturizing to dry areas while absorbing oil from other areas.
Uncovering the reason for overabundant oil production is the first step toward improving combination skin; and the reason for the dryness must be determined as well. In many cases the misuse of various cosmetic products creates combination skin in the first place. Aggressive cleaning with irritating ingredients can stimulate oil production in the central portion of the face and dry out the skin on the periphery. No wonder, therefore, that so many people find their skin both dry and oily.
Department Store Skin Analysis
Have you ever had your skin analyzed in a department store? It's common for many cosmetic companies to offer this service.
Bright lights, shiny glass countertops, exotic feminine fragrances, elegant jars and bottles, and beautiful women with lab coats -- an exciting, sometimes irresistible setting. Always on the first floor, it's hard to miss. And unlike the clerks at the hosiery counter, the sales force is eager to serve you, sometimes leaping from a promotional display to grab your attention. "May I help you?" "Free gift with purchase today!" "Would you like your skin analyzed?" But what are you really getting when you have your skin examined in a department store?
You'll probably end up with very little valuable information. For one thing, you won't be asked to take your clothes off in the middle of Macy's! Because of that, 95 percent of your skin goes ignored. Overlooking body, arm and leg skin is like buying a car based on the condition of the headlights. The skin on the area below your neck reveals important information. Your inherent skin color and texture show up on areas not generally exposed to the sun, such as the inside of your forearm and your buttocks. Without comparing these two areas of skin, the analysis misses an important clue about what type of sunscreen you need. Without the comparison between face and body skin, it's hard to say how much damage has already been done and whether it is sun related or purely chronological.
Consider also that a department store analysis usually takes about three or four minutes. Their mission is to analyze and sell quickly. They can't delve into lifestyle, family history and personal habits. Even if they did, you might not be willing to discuss personal issues with a cosmetic salesperson in front of other people. But that kind of information is critical. A thirty-two-year-old actress, for example, has concerns that are very different from those of a twenty-six-year-old stay-at-home mother. And what about your willingness or ability to comply with beauty routines? Some people have only a limited amount of time for skin care. Others wear lots of makeup and spend hours in front of the mirror.
Additionally, information about what prescription and nonprescription drugs you are taking could explain why a skin condition exists in the first place. Smearing more creams and lotions on a drug-related skin condition will do nothing but waste your money and possibly exacerbate the problem you wanted relieved.
Finally, a department store skin assessment is biased by the motive of the salesperson -- who wants to sell you something! Her opinion will be influenced by the products she can get you to buy. I have spoken to many women who feel intimidated into buying something even when they didn't need it or couldn't afford it.
Of course, other women enjoy the department store experience. I'm not suggesting that they should not have a little fun and pick up a few new products to enjoy. My message is that you should go in with your eyes open. You should know a lot about your skin. You should be able to ask the right questions and obtain answers. A bit of healthy skepticism can be quite empowering.
The Skin Profile Questionnaire
Your skin is as complicated as you are. It changes as the years go by or sometimes as seasons and weather challenge its delicate nature. It reacts to insults. It needs attention. Based on these ideas, I have devised a series of questions that will help you determine your Skin Profile. The answers to the questions below will provide you with a truly meaningful assessment of what you need for your skin. The Skin Profile questionnaire uncovers important physiological and psychological issues that affect your skin.
As stated earlier, the three traditional skin types of dry, oily and combination can be a starting point, and they will be discussed in the context of these skin profiles.
Your Skin Profile will be easy to identify. You will find yourself saying "That's me" with great conviction to one specific category. You will also learn a lot about what you've been doing right and wrong for your skin.
Consider the following Skin Profile questions.
Hormonally Reactive Skin
Stress-Reactive Skin
Environmentally Sensitive Skin
Nonsteroidal anti-inflammatories such as aspirin, or ibuprofen such as Nuprin, Aleve, Motrin or Naprosyn
Diuretics such as hydrochlorothiazide
Sulfa drugs such as Bactrim
Oral contraceptives
Lupus erythematosus
Rosacea
Overexposed Skin
Lifestyle Analysis
Ten to twenty minutes
More than twenty minutes
These are the types of questions I ask my patients in order to determine their Skin Profile. The answers reveal much about what's making their skin look and feel bad. I ask even more specific questions depending on what I learn about the patient. For example, I recently saw a local newscaster who had a mysterious rash on his leg. After seeing an internist who was concerned that he might have lupus, an autoimmune disease, he came to my office. I asked this man many questions, but no single answer gave me a clue. Just as he was getting ready to leave, I inquired whether he ever used a space heater. He said he did. The television studio where he worked on the early morning shift was quite cold, so he put a heater under his anchor desk. That was the information I needed. I diagnosed him with a disorder called erythema ab igne caused by chronic heating of the skin, and his problem was solved. The condition is easily treated by avoiding exposure of the skin to direct heat.
My recommendation is that you reevaluate your Skin Profile every six months or so to determine if it has changed and to adjust your skin care regimen accordingly.
Think carefully about these questions and your answers to them. They are not meant to be judgmental. They are meant to provide you with insight about the dynamic nature of your skin and its reaction to your emotions, external irritants and other factors.
Five Skin Profiles
I have devised a treatment plan for five Skin Profiles, which I will discuss in the following chapters.
If you found that the most relevant questions related to your menstrual cycle or other hormonal changes, you may have Hormonally Reactive Skin.
If you found that the stress-related issues caused your skin trouble, your skin is Stress Reactive.
As their names imply, Hormonally Reactive and Stress-Reactive Skin respond to changes within your body. These changes result from chemicals and hormones circulating within your bloodstream that show up on your skin. Reactive skin types can be oily, dry, combination or even "normal."
If your skin reacts most strongly to outside elements such as heat, weather changes, insect bites, irritating fabrics, soaps, creams or cosmetics, your skin is Environmentally Sensitive. Your skin responds in an exaggerated fashion to contact with the outside world.
Did you find after reviewing the questions that your skin was not truly reactive or sensitive? Instead, your concerns revolved around the aged appearance of your skin -- lines, furrows, brown spots, and rough texture. Most likely, your skin profile is Overexposed. It has been damaged by the environment, specifically ultraviolet radiation. In some cases Overexposed skin has also been damaged by harsh products. This type of skin has begun to show signs of photoaging in the form of wrinkles, dark spots and spider veins. This category of skin is neither too sensitive nor reactive but instead has photo-age-related problems.
A few fortunate people may find that none of the questions apply to them. Their skin may not show any sensitivity to hormones, stress or the environment. Either through sun avoidance or because of good genes, or both, your skin may not be showing any signs of premature aging. If this sounds like you, the category of Hearty Skin fits.
Golden Rules for All Five Skin Types
Some rules hold true for all skin types. They are simple and straightforward, and will produce lasting results if you follow them.
You now have the basic information you need to analyze and understand your skin. The next step is to change the way you care for your skin. This will not complicate your life. In fact, once you recognize the why and how of your skin, your daily skin care routine will be quite simple -- and the results will be truly fantastic.
Copyright © 1999 by Dr. Barney J. Kenet and Patricia Lawler
Excerpted from How to Wash Your Face: America's Leading Dermatologist Reveals the Essential Secrets for Youthful, Radiant Skin by Barney J. Kenet, Patricia Lawler
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
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