Rosacea During the COVID-19 Crisis

by Jennifer Deaver Peterson, MD, FAAD
The Pearl Dermatology, Houston, TX

April is Rosacea Awareness Month. Rosacea, also known as acne rosacea, affects 16 million Americans. It occurs in men, women, all skin tones, and is characterized by facial redness, flushing, sensitive skin, broken blood vessels (telangiectasias), and/or acne-like lesions. Rosacea is best controlled with a combination approach of gentle skincare, prescription medications, laser/light therapy, and minimization of triggers.

Treatment

Many rosacea patients also have sun-damaged skin in the form of brown spots (lentigines). The Lumenis M22 intense pulse light (IPL) uses a spectrum of wavelengths of light to simultaneously reduce facial redness, telangiectasias, and lentigines. These treatments have the benefit of minimal to no downtime and are performed in a medical office. Not all IPL devices are created equally and not all can be used safely in patients with Asian, Hispanic, Brazilian, Mediterranean, and olive skin tones. The Lumenis M22 has enhanced safety features such as contact cooling, multiple sequential pulsing, optimal pulse technology, and longer wavelength filters to allow for treatments in patients with a variety of skin tones.

Choosing the Right Skincare Products

Sensitivity to facial skincare products is a common trigger in rosacea. Those suffering from rosacea should use a mild, non-abrasive cleaner such as CeraVe Hydrating Cleanser or Caudalie Gentle Cleansing Milk and gently pat dry. Some may be tempted to try at home peels, scrubs, or masques; however, these have the potential to worsen facial redness and cause burning, stinging, and irritation. For patients looking for home treatments, we recommend soothing and calming masks such as SkinCeuticals Phyto Corrective Masque and Avene Antirougers Calm Soothing Repair.

Don’t Forget Your Sunscreen!

Although we are staying at home during the COVID-19 crisis, most of us are still getting outdoors for fresh air, exercise, and/or playing with our children. The sun is a trigger for the majority of rosacea patients and results in increased facial redness. Therefore, sunscreen must be an essential part of the skincare regimen. Mineral (zinc oxide and/or titanium dioxide) sunscreens are preferred as they provide broad-spectrum UV coverage and are less irritating than chemical sunscreens. New, cosmetically elegant mineral sunscreens in cream, lotion, powder, and stick based formulations are available and blend beautifully into the skin. Some excellent options include Colorescience Sunforgettable Total Protection Brush-On Shield SPF 50, Colorescience Total Protection Face Shield SPF 50, and Coola Mineral Sun Silk SPF 30.

Other Triggers

There are many potential triggers for rosacea. Heat can exacerbate facial redness. Therefore, it is important to keep cool and limit activities such as saunas and hot yoga. Food and alcoholic beverages such as spicy foods, chocolate, caffeine, red wine, beer, bourbon, gin, vodka, and champagne are common triggers but vary from person to person. Fumes from some household chemical cleansers can also act as exacerbators for many rosacea patients. Finally, stress can trigger a flare of rosacea. Taking a careful rosacea diary for a week can be helpful to pinpoint triggers. While it is not possible to eliminate all triggers from a daily routine, limiting exposure to triggers will aid in the management of rosacea.

Treatment During COVID-19 Crisis

At certain times during the COVID-19 crisis we have been unable to perform cosmetic procedures. However, we can still help control our patients’ rosacea by utilizing gentle skincare, continuing prescription medications via telehealth, and minimizing triggers and stress. While there is no cure for rosacea, there are a variety of effective topical and oral prescription medications available to control and manage rosacea. Many of rosacea treatments are directed towards reducing the acne-like (aka papulopustular) lesions of rosacea and require long-term usage. Another class of topical medications called alpha-adregeneric agonists work to reduce the facial redness of rosacea for up to 8 hours.

Soon we will be back in our offices and have the capacity to re-establish our combination treatment protocols. In the meantime, with gentle skincare, minimization of triggers, prescriptions, and telehealth we can help our rosacea patients navigate the COVID crisis with success.

Spring Skin Care and Rehydrating Your Hands

Spring Skin Care and Rehydrating Your Hands

It’s a new season, so it’s time to talk about new skincare! Spring is a time of renewal, and after months of alternating between hot and dry indoor air and the wash cold outside your skin is ready for a change. Your skincare needs to change every time the weather or season changes, so we have put together some tips on how to achieve your most glowing, radiant, and healthy skin this spring.

Our Top 3 Spring Skin Care Tips

1. Remember to exfoliate 

The winter often makes our skin feel dry, flaky, and dull. You’ll want to get rid of that feeling and the dead skin cells before spring arrive, and for that we recommend exfoliating. Exfoliating helps to remove the dead surface skin cells and reveal fresh layers of skin. Not only do you achieve healthier and clearer skin, but your skin is also better prepared to absorb products more effectively allowing you to achieve that flawless spring look.

For your body skin, use an exfoliating body scrub in the shower or bath once or twice a week paying close attention to those areas that are prone to developing rough patches such as your arms, elbows, hands, feet, and back.

Remember that most body scrubs are too rough to use on your face, so use a gentle product designed specifically to exfoliate your face and always remember to follow-up with a moisturizer after exfoliating.

2. Lighten up

While the winter required us to slather on thick, heavy products and moisturizers from head to toe, using the same products during the spring can leave you with greasy skin and clogged pores. Choose lighter skincare products such as lotions and gels to keep your skin healthy and hydrated without weighing you down. Look for products that contain hydrating ingredients which will help to add a natural glow to your complexion.

3. Protect your skin

UVA rays penetrate through windows, so make sure to apply sunscreen every day and remember to reapply.  We recommend using an SPF of at least SPF 30 on a daily basis. For patients interested in antiaging and sun protection, we love Neocutis Journee SPF 30 and MicroDay SPF 30. Both products contain ingredients to boost collagen and antioxidants to repair the damage.

Look for using a sunscreen with SPF >45 if you have a history of melasma and/or if you will be in the sun for longer periods of time.  For patients with melasma, Colorescience EvenUp SPF 50 is a great option. It contains mineral-based sunscreen, antioxidants, and skin brighteners. Remember to stay hydrated, wear loose clothing as well as hats and sunglasses, and reapply sunscreen every 1.5-2 hours if you are outdoors.

Keeping Your Hands Hydrated


Though we understand many of us may not be spending a great deal of time outside enjoying the spring weather due to certain circumstances, we would still like to offer our help this season. Many of us are washing our hands more often now that the Center for Disease Control and Prevention (CDC) has continued to emphasize that washing our hands can greatly reduce the spread of COVID-19. However, the constant washing and bathing of our hands in soaps and sanitizers can lead to dryness and even deep cracks in our skin allowing bacteria to freely enter our bodies. Fortunately, there are many ways to help keep your hands clean, hydrated, and healthy this season!

When we wash our hands, the natural barrier of protective oils on our skin is washed away by soap and as a result, leaves our skin unprotected and dry. With over-washing your hands, the effect can be tenfold causing people to experience redness, bleeding, scales, itching, flaking, and cracks or fissures in the skin. Those with pre-existing dermatologic conditions such as eczema can develop worsening symptoms.

How to combat dry hands from frequent washing

  • Use a mild, fragrance-free soap.  While antibacterial soaps and harsh sanitizers seem like great options, in overuse they can be severely damaging to your skin.
  • Wash your hands with warm water for at least 20 seconds each time. Not only is hot water uncomfortable but it can dry out your hands even more.
  • After patting your hands dry, apply a moisturizer. Your hands don’t have to be completely dry as moisturizing slightly damp hands is best and it helps to lock in that extra moisture.
  • We recommend using thicker hand creams with the key ingredients of ceramides and hyaluronic acid. Ceramides are a type of lipid in our skin which helps maintain our skin barrier and seal in moisture. Hyaluronic acid works to bind water and increase skin moisturization. Some of our dermatologists’ favorites include CeraVe cream, Aveeno eczema care cream, Aveeno intense moisture repair, Avene Cicalfate, and Neutrogena Norweigan formula hand cream.
  • If possible, treat your hands overnight by applying a thick moisturizer to your hands and then wearing cotton gloves as you sleep. This will help your hands absorb the moisture and heal them as you sleep.
  • Using a humidifier is also helpful to reduce overall dry skin.

For more information on spring skincare or how to combat dry hands from frequent washing, contact The Pearl Dermatology today.

Preparing Your Skin for Wedding Season

Wedding season is almost here, and our dermatologists at The Pearl Dermatology have put together a plan to help you look your best for your special day. Ideally, it is best to meet with your dermatologist at least 6 months before your wedding day, as some treatments may take longer than others to achieve your desired result. During your initial consultation, it is important to address all of your skin concerns with your doctor as well as the goals you would like to achieve from treatment. This will help us to create a plan & timeline as to when you should come in for each specific procedure. Over the years we have helped so many brides achieve their fairytale look, and we have compiled a list of the most common conditions that women like to have corrected or treated before their big day. Below you will find examples of the treatment we can provide to help you look and feel your best depending on your specific goals and skin condition.

1. Wrinkles in the Upper Face

Regardless of how old you are, wedding planning can age you. Between the stress of planning all the last minute details and the anticipation of your big day, you may be looking in the mirror and feeling less like a glowing bride and more like a tired woman. Whether you have lines between your eyebrows or unwanted crows feet that you would love to get rid of, we have you covered. We typically recommend Botox or Dysport for these skin imperfections, and treatment should be performed 2-3 weeks before your big day. These products are especially effective in treating wrinkles in the upper face as well as relaxing and smoothing lines on the forehead and between the eyebrows. Results tend to last 3-4 months (depending on how fast your body metabolizes the product), so you will still be looking fresh throughout your honeymoon! If this is your first time trying Botox or Dysport, we recommend coming in 3-4 months before your wedding for a “test drive” of the product so that we can determine how your body responds to the treatment and how much product you need to achieve your desired result.

2. Excessive Underarm Sweating

Between the stress leading up to your big day and the excitement, dancing, and even the weather during your wedding and reception, sweating can quickly become an unwanted issue. Sweating under the arms can be particularly bothersome as it can cause staining on your gown as silk repels water rather than absorbing it. It also retains body odors more than other types of fabric, which could make dancing and socializing in close quarters a little uncomfortable and embarrassing. Fortunately, Dysport and Botox can be beneficial treatments for this condition as well. Botox injected into the underarms can help reduce sweating in the area for up to 6 months. Our board-certified dermatologists recommend you come in 2-3 weeks before your wedding for optimal results. There may be a slight risk of bruising and swelling that can last up to 3-7 days, but will be long gone before your big day.

3. Dull Skin

Everyone wants that newlywed glow on their wedding day, and often you need more than just makeup to achieve this look. The Spectra “Hollywood Laser Peel” is our go-to treatment to help remove dead cells that accumulate on the top layer of the skin which can often create a dull appearance. Within hours, your skin can appear softer and more radiant. Not only does the Spectra treatment help to create a radiant and healthy glow, but each treatment can also help improve the appearance of melasma, acne, acne scarring, reduce pigmentation, pore size, fine lines, and wrinkles. We recommend coming in a week before your event to prepare your skin for your big day and more importantly, your makeup artist. Give your skin a fresh new glow that will make all the difference on your big day, and come in for a Spectra Hollywood Laser Peel!

4. Submental Fullness or Double Chin

Having a double chin in wedding photos can be a fear for many brides, especially if you have a stubborn pocket of fat under your chin. With the help of Kybella, Coolsculpting, or AccuTite products and a skin tightening treatment such as Ultherapy or Morpheus, we can get you in picture-perfect shape in no time. During your consultation, you can discuss the various products and treatment options with your dermatologist so that together you can create a customized treatment plan. Usually, this needs to happen 6 months prior to the wedding, but specific treatment options will vary and are listed below.

  • Kybella– Kybella is injected in a series of treatments ranging from 2-5 treatments. These results of fat reduction with Kybella are permanent; however, the final results can take 2-3 months after the final treatment to be seen. ⠀
  • Coolsculpting– CoolSculpting is a noninvasive, innovative way to contour your body by freezing unwanted fat away with no surgery, scalpels or downtime. It can take anywhere from 6-12 weeks to see results, so it is recommended that treatment be done 3-4 months prior to the wedding.
  • Accutite– This treatment option is minimally invasive and is able to address hard to reach areas of the face and body without the need for surgery or unwanted scarring. It is great for precision fat reduction and skin contraction and can be done quickly in our office. Results can take 6 to 8 weeks to be noticeable, so it is recommended to come in 3 to 5 months prior to the wedding for treatment.

For patients with skin laxity, we recommend adding Ulthera, Morpheus, and/or AccuTite to your treatment regimen to produce a skin tightening effect. Talk to your dermatologist about which options are right for you.

5. Brown Spots

Similar to redness, pigmentation and sunspots on the face and body can be treated using IPL, also known as Photofacials. For more intense pigmentation and/or photodamage, your doctor may recommend a fractionated 1927 nm thulium laser (LaseMD, Fraxel DUAL, or the Clear and Brilliant Permea) alone or in combination with IPL. It is often necessary to have multiple treatments depending on the desired result. As discoloration or brown spots can occur commonly present on the face, neck, and chest we recommend treating all three areas to create a smooth, even appearance. This is something very important to consider if you’ve chosen a strapless gown! Treatment should occur 3-4 months before your big day, so be sure to keep that timing in mind when scheduling your consultation.

6. Redness and Wrinkles

Redness on the face can be difficult to cover up with make-up alone for women. Men can find it even more challenging as coverage and concealing options are more limited. Whether it is caused by stress, heat, or a skin condition called rosacea, redness can be reduced significantly by using laser & light treatments such as those used a Photofacial. We typically recommend a series of 3-5 treatments spaced 4-6 weeks apart depending on the amount of visible redness. It is important to consider visiting your dermatologist at least 3-5 months in advance to allow plenty of time to squeeze in a few treatments and achieve your best results before your big day.

Do you have more than one issue that needs to be addressed? No problem! Many of our patients seek to simultaneously reduce redness, fine lines, and/or shallow acne scars. To address all of the issues, we offer combination therapy with Photofractional therapy. During this treatment, an IPL is performed using the Lumenis M22. Immediately afterward, a light resurfacing laser called the Resurfx is performed to stimulate collagen. Downtime is minimal with a few days of mild redness and swelling.

There are many options when it comes to rejuvenating your skin before your magical day. In addition to the treatments already mentioned, we also offer fillers that can help restore volume and reduce facial lines. Fillers need to be injected 3-4 weeks before the wedding for the best results. These may be an appropriate form of treatment depending on your specific skin type, condition, and goals, which you can discuss with your dermatologist during your consultation. Contact The Pearl Dermatology today for more information and to schedule a consultation!

Summer Skin Rehab

Pearl Dermatology skincare for fair skin

As summer comes to an end, it’s time to start focusing on how to repair sun damage and pigmentation that has accumulated over the past few months. It is also time to rehydrate our skin as the cooler temperatures begin to bless us with their presence. So, where do we even start? Our board-certified dermatologists here at The Pearl gives us the inside scoop on what to look for, where to begin, and what products to consider.

First things first, start by revamp your skin care regimen.
During the summer months, most of us tend to use products that help us control oil and shine and commonly contain active ingredients such salicylic acid, glycolic acid, and other neutralizing agents. These products can still be used as part of your regimen, but should be alternated with a more calming cleansers or products. These products will keep your skin looking hydrated and dewy instead of matte and dull.

We recommend having a daily regimen that consists of the following products: gentle cleanser, antioxidant/vitamin c, moisturizer, skin brightener, and a powerful facial sunscreen. If needed, switch your daily cleanser from a normal gel base to a cream cleanser to help restore moisture and protect your skin from the weather changes that can cause dry skin. We recommend always using an antioxidant such as SkinCeuticials Phloretin or CE Ferulic. These two antioxidants serums protect your skin from harmful UVA/UVB rays, blue light from our screens, heat, and helps diminish the appearance of discoloration, fine lines, and wrinkles.

It is also a great idea to transition to a thicker moisturizer in the fall and winter months. Look for active ingredients such as peptides, hyaluronic acid, ceramides, and fatty acids. These ingredients help rehydrate, soothe, and replenish dry looking skin. We love combining SkinCeuticals HA Intensifier followed immediately by their Triple Lipid Repair.

If you have developed some pigmentation from repetitive sun exposure, it may also be beneficial to consider using a skin brightener. Skin brightners work to lighten the appearance of these new sun spots. Two of our favorite skin brighteners include Neocutis Perle and Glytone Brightening Complex. Skin brighteners are also a great way to begin prepping your skin for future laser treatments. By using skin brighteners before laser treatments, pigmentation can be further diminished than using just lasers alone. Consult with your doctor on which skin brightener would best suit your individual needs.

Consider lasers to help lighten pigmentation.
Our Doctor’s prefer to recommend procedures such as Photofacial, Photofractional or LaseMD. Patients typically need about 3-5 treatments spaced 4-6 weeks apart to improve the appearance of pigmentation, sunspots and photoaging accumulated over the summer months. If needed, these lasers can also be used to treat other areas of the body such as the neck, chest, arms, hands and legs. Some patients notice that as we begin to treat the face, their neck and chest become more noticeable aged. By treating multiple areas at the same time, we can create an even appearance with less pigmentation, improved texture and tone as well as an overall healthier appearance.

Don’t forget your SPF
A common misunderstanding in skin care is that you only need to wear sunscreen when you are out in the sun. This couldn’t be further from the truth. Most of our sun damage is accumulated from daily commutes and outdoor activities. We recommend using a sunscreen with an SPF of 40 or higher on the face and an SPF of 50 or higher on the body. Some of our favorite brands include EltaMD, Revision, and Neocutis which offer daily facial sunscreens with tinted options and built in moisturizers.

Stay Hydrated
Drinking plenty of water every day helps keep your skin looking hydrated from the inside out. Even as the temperature drops and the air becomes drier, our bodies require us to rehydrate ourselves. A humidifier in your room at night is also beneficial. Remember, the secret to achieving radiant and healthy skin is having a good, consistent regimen that you use daily. If you would like to have one of our board-certified dermatologist take a look at your current skincare regimen or create a custom skincare regimen, contact our office at 713-497-1417. To learn more about the different services we offer, please visit our website at www.thepearldermatology.com.

Skin Concerns: How Age Plays a Role

Teens

During our teen years, coming of age often brings along with it many skin concerns. Our teenage years are when many of us develop acne and along with that comes oily skin. The T-zone is of particular concern and may seem to produce a never-ending supply of blackheads. This is when washing our face twice a day is introduced and teens often peruse the drug store isles seeking out the nicest smelling face wash. When good skin care advice comes from a dermatologist, teens tend to pay attention and start to make good decisions for themselves. Your dermatologist may also recommend a light chemical peel or treatment with a light source for an in-office approach to acne treatment. Acne scarring may also be of concern as a teen. Our dermatologists are experienced in both laser resurfacing and micro needling for the treatment of acne scars, in addition to several other procedures that can improve the skin’s texture. Hearing about the importance of sunscreen from a dermatologist can ease the pressure a parent may feel in educating their children about sun protection. Establish care with a dermatologist as a teenager and watch your skin concerns evolve over the years.

our 20’s

In our 20’s, life is busy and we have a lot going on! We may not appreciate the nice smooth, tight skin we have. If we start a good routine early, good skin habits are ingrained in us and become less of a chore down the road. If you are not already using sunscreen daily, then it is time to start. For routine daily usage we recommend using a sunscreen with at least SPF 30. This is the time to add a topical vitamin C serum into your skin regimen, which works as an antioxidant and reduces inflammation caused by UV rays, infrared rays, and ozone pollution. IPL (photofacial), chemical peels, and micro needling can all exfoliate, clean out pores, and stimulate low levels of collagen.

After puberty, our skin may still suffer from hormonal acne and be on the oilier side, thus finding a daily sunscreen may be a challenge. Even though wrinkles are usually not of big concern, this is the time getting in a good routine, sun protection, and daily sunscreen will make all the difference in the years to come. Many of us don’t realize skin cancer is the most common type of cancer for people in their 20’s, making it ever so important to have a dermatologist you trust early on.

our 30’s

Our 30’s is when reality sets in…we will not stay young forever. This is when some insecurity may begin. This is the time when the aging process of the skin begins to speed up. Did you recently notice your first wrinkle? While the skin is still producing collagen and elastin, some wrinkles may become evident, skin texture may begin to change, and skin care concerns shift. Our eyes are usually the first place we start to notice signs of aging. Dark circles under eyes and crow’s lines become evident as our bone structure begins to change and we may think we look “tired”. Brown spots may accumulate if we weren’t great about sun protection as a child or teen.

Regular use of a retinoid slowly builds collagen and starts to bank it for later. Topical antioxidants (Vitamin C & E) and sunscreens are essential to our skin care regimen. IPL (photofacials) are a nice low-down time procedure to eliminate brown spots and help any rosacea that may be brewing. A touch of neurotoxin (Botox or Dysport) is also a good idea, as we now know neurotoxin can prevent the formation of deep lines down the road. Fillers, such as Restylane or Juvederm, can correct under eye dark circles, plump lips, and maintain good facial volume. This is the time when focusing on prevention is key, aka prejuvenation. The time is now to create a reservoir of collagen in our skin with procedures such as Ultherapy, which is safe in all skin tones.

our 40’s

Our 40’s is when we really start to feel like we look our age. Wrinkles become deeper, volume loss is more obvious, skin texture changes, and skin laxity starts to creep in. Thus, by our 40’s we should be using a good anti-aging skin care regimen with a retinoid, antioxidant, peptides, and growth factors. Laser skin resurfacing and injectable fillers (Sculptra, Voluma, Restylane, and Juvederm) can really help to refresh our look and neurotoxins continue to play an important role in further prevention and correction of lines. Regular skin tightening procedures such as Ultherapy are optimal for prevention of skin laxity. Fractionated CO2 laser resurfacing can be used to tighten skin on the upper and lower eyelids. Maintenance is key!

our 50’s

Our 50’s are a time of direction and comfort; however, we may feel the need to look as good as we feel. We may also feel insecure in the work place and want to keep up appearances with our younger colleagues. Some concerns in our 50’s are deeper lines, volume loss, skin laxity on the face and body, and leg veins. With these concerns thankfully come solutions. We can offer the best of facial re-volumization with fillers such as Sculptra, Voluma, Restylane Lyft, and others. Skin tightening with Ultherapy and pairing Ultherapy with Sculptra can turn back the clock on the aging décolletage, face, neck and even the buttock, thighs, and arms. Neurotoxins continue to be effective and can be injected into the neck’s platysmal bands for smoothening. More aggressive laser resurfacing with a CO2 laser may also be appealing starting in the 50’s.

Our 60’s & 70’s

In your 60’s & 70’s you may be delighting in the joy of retirement. But just because you are taking it easy, doesn’t mean you want to look retired. In your 60’s, your skin is noticeably lax, thinner and drier than in years past. The natural aging process takes a more visible toll on the body, but with the help of experts, you can rejuvenate your skin and take years off your appearance! It is a great feeling to look in the mirror and feel good about yourself.

Some of the most frequent concerns expressed by patients age 60 and older are saggy, creepy, dull sallow skin. Wrinkles, thin lips, eye bags, and volume loss are continued concerns. Full face fractionated CO2 lasers can literally iron out wrinkles and give you back creamy healthy looking skin. Ultherapy tightens the face and neck and lifts the brows. Fillers and neurotoxins continue to keep you looking fresh. Our board certified dermatologists can skillfully select a combination of services to give you the best possible outcome in the shortest period of time. A long-term plan with maintenance is the key to keeping you looking great in the years to come.

Please contact our offices for more information or to schedule your appointment.

 

Tropical Travel Tips from Your Derms

The Pearl Dermatology tropical travel tips

Are you beginning to plan for your next tropical getaway? Before you go make sure to pack your bag with some of our favorite derm picks to keep your skin safe and protected. Let’s think of what our skin might encounter as we head south … sun, water, citrus, & insects. Some of the most popular winter getaway vacations for those of us in the States include Hawaii, Costa Rica, Belize, southeastern Mexico, and the Caribbean islands. Not only do these destinations share gorgeous sandy beaches, water, and wildlife, they are also located close to the equator. The closer your vacay spot is to the equator, the more intense the sun’s rays become. Thus making it easier and faster for your skin to become burned.

First things first, sunburns increase the risk for skin cancer and skin aging, so make sure to come prepared with plenty of sunscreen! We recommend our patients use mineral based sunscreens, ie those containing zinc and/or titanium aka physical blockers. Physical blockers are preferred as they are less likely to cause skin irritation vs chemical based sunscreens (avobenzone, oxybenzone, or PABA). Look for physical blockers with nanotechnology, such as micronized zinc, which reduces the white chalky appearance of sunscreen and gives the sunscreen a more cosmetically elegant feel. Apply sunscreen 15-20 minutes before heading outdoors as it will need time to form a barrier to protect your skin. Make sure to apply a thick enough layer. A “shot glass” size of sunscreen is the amount needed for an average adult. Reapply every 90-120 minutes and/or after getting wet.

For the face, avoid aerosol sunscreens as they can cause eye and airway irritation. Instead choose oil-free creams, lotions, or sticks. My favorite is Elta MD Clear SPF 46, it great for acne, sensitive, and pigment-prone skin. It goes on white, rubs in clear in seconds, feels silky, and will not yellow your white swimsuit or clothing. If you have acne, consider using Elta MD Clear on other acne-prone areas such as the neck, chest, and upper back. For your body, reach for aerosols, creams, or lotions . Don’t forget to protect your lips with a sunscreen containing lip balm. We wear Colorescience Sunforgettable Lip Shine SPF 35.

Now lets turn our attention to the water. Whether your snorkeling, deep sea fishing, surfing, playing in the pool, or running along the beach your skin is directly exposed to the sunrays from above and those reflecting off the water. Some of the worst sunburns I have seen in my patients occurred while snorkeling. If you are planning any of these fun activities, consider getting a SPF surf shirt (aka rash guard) before you go. SPF fabrics have come a long way and chic versions with SPF 50 are readily available. Check out Shopbop, Lululemon, Roxy, J. Crew, & Letarte. Also remember to pack are your favorite Jackie O shades and a fabulous sunhat. Look to Eugenia Kim, Eric Javits, and San Diego Hat Company for a broad brimmed sun hat or create your own inspired by some pinterest ideas.

Let’s imagine you have been beachside for a few days relaxing, having some tasty margaritas, and practicing your best safe sun techniques. Then, you notice numerous little red dots have appeared on the back of your left hand and wonder what might be happening? It is could be phytophotodermatitis (phyto=plant, photo=light, dermatitis = skin inflammation), and your dermatologist sees this condition quite frequently in patients coming back from beach vacations and cruises. Phytophotodermatitis occurs when the oils or juice of lemons, limes, or oranges gets on your skin followed by sun exposure. It results in an intense inflammatory skin reaction leading to an intense red rash, which may blister, 24-48 hours after the exposure to the citrus juice or oils. The rash can be arranged in a line or curvy shape if the juice ran down your arm or little dots if the juice was sprayed on the skin while squeezing the fruit. If the juice was on the palm of hand and fingers it can produce a handprint-shaped rash if you touch another part of your body. A few days later, the redness fades and the skin turns brown.

So how can you prevent phytophotodermatitis? Enjoy your favorite cocktail, but remember to wash your hands if consuming drinks or handling fresh citrus fruit while in the sun. If you think you accidentally touched your skin with a citrusy hand, then go wash both areas with soap and water. Seek medical attention for any severe pain, itching, swelling, or blistering. The brown pigmentation that remains after the redness has resolved can be improved with a prescription skin brightener and/or laser procedures from your board certified dermatologist back in the States.

Finally, don’t forget many of these tropical locals have insects such as no-see-ums, sand flies, and mosquitos. When traveling to areas containing mosquitos capable of transmitting viruses like Zika, Dengue fever, & Chikungunya, make sure to pack insect repellant. The CDC recommends insect repellents containing DEET, picaridin, or lemon eucalyptus oil. Just remember to apply your insect repellant on TOP of your sunscreen, keep windows and doors closed at night, and if your hotel room is not well sealed/screened, then consider sleeping under bed nets.