1. The doctor is in!
Michelle Henry M.D. is currently a 3rd year Dermatology resident at Mount Sinai School of Medicine. After finishing her residency this June, she will pursue a fellowship in Procedural Dermatology at Harvard Medical School, specializing in skin cancer and cosmetic surgery. Her areas of interest include: skin cancer surgery and prevention, skin of color and cosmetic dermatology.
2. What made you decide to go into dermatology?
I am a visual learner, who pays obsessive attention to details. I think many dermatologists can describe themselves that way. I have a long-standing interest in infectious diseases and I desired a career that would allow for versatility in terms of practice. Dermatology is the perfect collision of medicine and surgery so, for me, it was the best choice of a specialty.
3. Has learning about skin care from a dermatological perspective changed the way you treat your skin? In what way(s)?
It has definitely changed the way I protect my skin. I always had the perception that I was immune to skin cancers and wrinkling because I have dark skin. Now, I am never outdoors without sun screen. I also treat my acne quickly to avoid scarring and hyperpigmentation, which can both be long lasting. If I get a large cyst, I quickly inject it with a low concentration of steroid. Works like magic! In addition, I use the retinoid Tazorac religiously. Tazorac is like retin-A, which helps regulate skin turnover. I strongly believe everyone should use a retinoid daily (if tolerated). That, and regular gentle exfoliation are the most important aspects of my regimen. However, I will admit to being a product junkie, and my newest obsession is Lancome’s Advanced Night Repair serum. It’s like CPR for the skin. It has saved me from looking like a prune after a long work week.
4. What are the THREE tips you’d give to someone struggling with adult acne?
- Avoid the over-application of skincare products. Acne is NOT a disease caused by lack of hygiene. It is a disease of the pilosebaceous unit (the follicle) .This means that over washing will actually cause more harm than help. In addition, over-applying medications can cause drying. Many women, desperate for improvement, become mad scientists, making crazy concoctions and show up in our offices red, with worse acne than before. Keeping your skincare regimen simple is always a recommended strategy for most. I use a good creamy wash with salicylic acid to start. If your skin starts to feel too dry, stop using chemicals/medications for a week to allow your skin to return to its natural balance.
- See a dermatologist. Often times, over the counter treatments are not enough. In particular, patients with darker skin often times should have a lower threshold for more aggressive treatments as permanent scarring and hyperpigmentation may occur more frequently.
- Oral contraceptives can be helpful in maintaining a healthy hormonal balance. Adult acne in women is often a hormonal disease that requires oral treatments in the form of a pill. Oral contraceptives are frequently used to aid in hormonal regulation.
5. What are your views on over-the-counter/online products like Neutrogena or Proactiv? Are some more helpful/less helpful than others? Which skin products do you recommend?
I think that Proactiv is okay for mild acne. Proactiv is micronized benzoyl peroxide. Benzoyl peroxide is available, cheaply, over the counter. I think Procativ’s major benefit is that its texture allows it to serve as an exfoliant. There are many other tools that exfoliate well. I love the old fashioned “buff puff” and use it daily. Many of my patients love the Clarisonic brush for exfoliation. Both are excellent. The Rolls Royce of exfoliation is microdermabrasion, which is safe for all skin types. I love the Neutrogena line, in particular the sun screens. However, my current and favorite sun screens are Aveeno Positively Radiant and Anthelios by La Roche-Posay. They are cosmetically elegant and don’t leave those of us with darker skin looking “ashen”. I would also like to take a second to stress the importance of sun screen in all skin types. Although skin of color is less prone to skin cancer, the risk remains. In addition, sun screen helps prevent uneven skin tone and wrinkles.
6. What skin challenges would you say are specific to people of color? What advice do you have for any readers who might be dealing with those challenges?
- Hyperpigmentation: One of the major concerns I find in my patients with darker skin, is that of hyperpigmentation or uneven skin tone. This is often a consequence of trauma, skin irritation or hormonal influences (conditions like melasma). Your dermatologist can assess the type of hyperpigmentation you have, how deep or superficial it is, and create a treatment plan. We have many topical skin lighteners that can help. Chemical peels and lasers are very effective in more severe cases. Using a good sun screen is very effective in maintaining an even skin tone. The over the counter fade cream by Ambi is effective as well. I would avoid fade creams without addressing them with a dermatologist, because they are often unregulated and may contain unsafe ingredients such as mercury.
- Hair loss: Many women attribute hair to age or poor styling practices, but it may be an indicator of diseases like Lupus (which disproportionately affects African American women), thyroid disease, or scarring alopecias like central centrifugal cicatricial alopecia ( thought to be cause by relaxers, hot combs etc).
- Pseudofolliculitis barbae (razor bumps): Razor bumps plague both men and women of color. Learning to avoid shaving against the direction of the hair, as well as exfoliating the area gently afterwards (manually or with creams), can help. Your dermatologist can also prescribe medications like topical steroids or retinoids which can be helpful.
We have a number of great modalities for scars. If the scar is flat and discolored we can use many different hydroquinone preparations to treat it. For depressed facial scars, such as those caused by acne, retinoids help somewhat, there are several effective chemical peels. Chemical peels that are safe for darker skin types include salicylic acid or glycolic peels, which are gentle but effective. For more severe cases of scarring, there is laser treatment. The Fraxel laser is great for scars and textural improvement. I always tell patients not to worry, if we can’t make you perfect we have enough tools to make your scarring significantly better.
8. Let’s talk about skin cancers/disease. Are any specific signs or markers to look for on your skin that might indicate a more serious skin condition? What are those signs and what advice do you have for readers?
- Acanthosis Nigricans (AN): This is a dark velvety hyperpigmentation often found on the back of the neck or underarms. It can be an indication of insulin insensitivity which can lead to diabetes. Severe cases of AN can indicate an internal cancer warranting a thorough work up.
- Nail pigmentation: Although over 70% of dark skinned patients (over the age of 20) have benign linear hyperpigmentation of the nails, called Melanonychia, patients must be aware that acral melanoma is the most common type of skin cancer in dark-skinned patients and is generally found on the nails, hands and feet. As an interesting aside, Bob Marley died of acral melanoma. If very dark lesions that grow rapidly or distort the nail arise, there is concern for melanoma.
- Yellow skin or eyes: May indicate liver disease caused by medications or infections such as hepatitis.
9. What is your view on Botox? Is it safe? What issues should someone consider before deciding to get Botox?
I love Botox. Few treatments work as well for reducing wrinkles. It works by directly targeting the facial muscles that are causing dynamic wrinkles to form. Dynamic wrinkles are those formed by animating the face. The Botox protein blocks transmission from the nerve ending to the muscle. The muscles relax and the appearance of wrinkles is reduced. This effect lasts an average of three to six months. Botox celebrates its 10 year anniversary for aesthetic use this year (even though it has been used since the 1990’s). The initial indication for Botox was for treating crossed eyes and spasms in the eye muscle so it has been proven to be medically safe for many years. However, there was one study in mice that showed Botox had migrated to the brain, but any safe medication might be harmful to a small animal in ridiculously high doses. Because of this, patients with certain neuromuscular diseases (such as multiple sclerosis) or autoimmune diseases (such as lupus) need clearance from their specialist before having Botox injections.
10. Is there anything else you’d like to add about skin care/health?
Proper hydration, vitamin supplements, getting enough sleep, exercise and reducing stress; these are things that are often overlooked in skincare. Monitor your skin, its needs and condition will change. The weather plays a big role in how your skin behaves. Your winter regimen will likely need to be different than your summer regimen. Exercise can also be good for the skin. By increasing blood flow, exercise helps nourish skin cells and keep them healthy. With regards to diet, there is little evidence of any food being linked to acne; however, a recent article in the Journal of the American Academy of Dermatology, by Di Landro and colleagues, showed that milk may exacerbate (or even cause) acne, but one serving of fish a week might be preventative. So drinking Almond milk and stocking up on salmon may help us all in our quest to be healthy, beautiful and acne free.
*What skin challenges do you face? Do you have any questions for Michelle?*