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The developers of the popular acne treatment system, Proactiv® Solution, challenge myths about acne while outlining a three-step approach to treating and preventing blemishes on a range of skin types using over-the-counter methods. 75,000 first printing.
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Katie Rodan, M.D., is an associate clinical professor of dermatology at Stanford University School of Medicine. Kathy Fields, M.D., is an assistant clinical professor of dermatology at the University of California-San Francisco. Both have been profiled in Best Doctors in America, and their work has been featured in numerous national magazines and television shows. For more information, you can visit the authors' websites at www.unblemished.com, www.rodanandfields.com, and www.proactiv.com.Excerpt. © Reprinted by permission. All rights reserved.:
Chapter One: skin under siege
"My little nephew, who's only two, turned to me and said, 'Auntie, can I connect the dots on your face?' He didn't know what he was saying, but I was totally humiliated.No matter what your skin color or type, whether you're eight, eighteen, thirty-eight, or sixty-eight, you can get acne. You may have one pimple or a hundred, but the process is the same. Acne vulgaris is the most common and often the most debilitating skin disease that exists. Over 90 percent of all people on earth suffer from it at one point or another. So even if you didn't get it as a teenager, chances are extremely high that you'll experience it later in life. It's a rare human indeed who manages to get through life without a single zit!
I used to wake up crying because I'd feel a new lump on my face every morning."
Amanda, age thirty-one
Before we explore acne in detail, let's learn a little bit about the organ it affects: the skin.
all about skin
Even when it is covered with acne, your skin is still a marvelous organ. It reflects who you are and how you feel, and it keeps you safe. It has an almost magical ability to repair itself, and we certainly almost always take it for granted. (Except, of course, when plagued by acne.) Constantly replenishing itself, the skin covers a whopping twenty square feet and constitutes 15 percent of our total body weight. In the three layers of one square inch of skin you'll find:
· 19 yards of blood vessels
· 65 hairs
· 78 yards of nerves
· 100 sebaceous glands
· 650 sweat glands
· 1,300 nerve endings
· 20,000 sensory cells
· 129,040 pores
· 9,500,000 cells
Epidermis -- Top Layer
The first living layer of the skin is the epidermis. This microscopically thin layer is seven to ten cells thick and in a young adult completely renews itself every twenty-eight days. Nearly 95 percent of the epidermis is composed of new cells called keratinocytes. The remaining 5 percent is made up of the cells that produce melanin, the substance that gives skin its color, and the all-important Langerhan cells, which work with the immune system to help fight infections.
As keratinocyte cells age, they flatten out and eventually lose their nucleus, becoming horn cells. These horn cells create the stratum corneum, the outermost layer of skin. Even though the stratum corneum consists of dead, overlapping horn cells, like shingles on a roof, it serves a vital function as our first line of immunological defense between the outside world and our bodies. The renewal rate of the epidermis diminishes with age. As a result, the stratum corneum becomes thicker and the pores pack up with dead skin cells, which makes them look larger.
Dermis -- Middle Layer
Most of the skin's volume is found here. The dermis is composed of collagen and elastin fibers; nerve endings that sense temperature and pressure; blood vessels supplying nutrients to keep everything replenished and renewed; sweat glands, which function to cool you down, and erector pili muscles, which contract, causing you to shiver and making your hairs "stand up" (these functions keep you at a stable 98.6 degrees Fahrenheit); hair follicles; and those pesky oil glands, which produce the sebum that keeps skin soft, pliable, and waterproof. However pesky they are, you can't live without those oil glands (although when your acne is bad, you certainly wish you could!).
Subcutaneous -- Bottom Layer
Here lie lots of fat cells. These fat cells are good fat cells. Without them, you'd lack insulation and protection for your fragile organs. Also rooted in these fat cells are most of your hair follicles. The hair follicle and the attached sebaceous, or oil, gland share the space known as the pilosebaceous gland (pilo means hair and sebaceous refers to the sebaceous, or oil, gland). The pore is the passageway from the base of the hair follicle to the surface of the skin. Sebum, an oily substance composed of free fatty acids, cholesterol, triglycerides, and wax, is released from the sebaceous, or oil, gland into the pore and travels to the skin's surface to keep it pliable and protected. Without sebum, your skin would look as dry as dust.
what kind of skin do you have?
From a dermatologist's viewpoint, contrary to all those surveys published in women's magazines, just about everybody has combination skin. Human bodies are constructed with the greatest density of oil glands in the T-zone -- the nose, cheeks, chin, and forehead -- so that even if you have dry spots, you will most likely also have oily spots.
The texture, pore size, and oiliness/dryness of your skin is in large part determined by your genes and regulated by your hormones. There's nothing you can do about your body's natural inclination to be dry or oily. You can, however, do something about how the environment in which you live affects your skin. For example, it's easy enough to humidify (or dehumidify) the air inside your home.
Equally important is the fact that your skin changes as your body ages. You can have oily skin as a teenager and dry skin as an adult. Be aware that as these changes take place, your skin care needs change, too. We often see women still using the same products after age thirty, which may not be the optimal treatment plan for their skin.
What if your skin is mostly dry?
You can still have dry skin even when it's covered with acne. If you look at the surface layer of the dead cells in the epidermis (the stratum corneum), they're superhydrated in high-humidity environments and desiccated in dry ones. Drinking gallons of water won't necessarily plump up your skin in Arizona -- you'll just be spending much more time in the bathroom. And as you age, circulation naturally slows down, hormones dwindle, oil production diminishes, and the surface dead cell layer thickens and fissures, allowing water loss from the skin. The result is that your skin won't be as moist as it was when you were younger. Some medications also dry out skin, most notably Accutane.
Using humectant agents (moisturizers) can help relieve dry skin. So can humidifiers. Air conditioners and forced-air heating systems tend to zap the moisture out of the air, so be judicious with their use.
What if your skin is mostly oily?
"My skin's too oily -- make it stop!" We hear that all the time from our patients. Unfortunately, there's no little faucet we can turn off or on to decrease or increase oil flow. Oil production constantly changes. For instance, one month your skin might be oily the week before your period; the next month it might not. And, you may have oily skin and terrible acne or oily skin and no acne. Oily skin is not a life sentence for acne or even necessarily a symptom of acne.
Living in a hot, humid climate will stimulate oil gland production. Exercise, stress, and androgenic (masculinizing) hormones, such as testosterone or DHEA-S, will also increase oil flow.
Oily skin generally needs no moisturizers except on the eyelids. Oil absorb- ers; loose, oil-free powders; and medicated, clay-based masks will help absorb excess oil. However, frequent facial washing (in excess of two to three times a day) may eventually result in increased oil production, because when the surface of the skin is excessively stripped of lubrication, the oil glands' response to perceived dryness is to produce additional oil.
Why Is Dryness/Oiliness So Important?
Knowing that the layer of dead cells (the stratum corneum) in the epidermis is crucial to healthy skin, we became interested in trying to stabilize, protect, and repair the barrier function it provides. Any assault to this top layer increases the skin's susceptibility to infection and environmental irritants. This can produce a range of skin conditions, from impetigo to herpes eczema to contact allergic dermatitis.
One enduring myth about acne is that the best form of treatment is to strip all the oil off your skin. Drying the skin's surface with ingredients like rubbing alcohol leaves the skin parched and irritated, with greater susceptibility to infection while failing to treat the acne process. Perhaps you've even tried to clean your skin with harsh scrub soaps that contain apricot or walnut pits, which can tear your defenseless cells. You look raw and red. Your skin peels. It itches. It doesn't heal properly, and your acne doesn't go away. As a result, your acne may take longer to heal and leave scars behind.
In chapter 5, you'll see how an acne treatment program can be gentle yet effective, maintaining a healthy balance of dryness and oiliness in the epidermis.
Do You Really Have Sensitive Skin?
Many of our patients tell us that they have sensitive skin. In truth, the vast majority of people do not have sensitive skin even though they think they do. The clinical definition of sensitive skin is skin that has a noticeable reaction with product application. It turns red, itches, tingles, or burns. Or all four.
There are two causes of sensitive skin: environmental and genetic. Environmental factors causing sensitive skin are usually product-derived. Most people tend to use more than one product on their face, and in each of the products there are often ten to twenty different ingredients. The more products you layer on, the more ingredients you are exposed to, and the more likely you are to create a sensitive skin response. When you strip your skin of its barrier function, irritated skin often follows.
Then there is the genetic factor. Twenty percent of babies develop eczema, also called atopic dermatitis, within the first six months of life. Atopic dermatitis is often accompanied by allergies, asthma, and hay fever. By the time children are twelve, most outgrow atopic dermatitis. However, because the skin of people with atopic dermatitis...
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