Author: Dermoiatry of Athens Dermatology Clinic

What it is and what causes it 

Adult acne is acne that occurs after the age of 25. For the most part, the same factors that cause teenage acne play a role in adult acne. The four factors that directly contribute to acne are: excess sebum production, clogged pores, bacteria and inflammation. 

There are also some indirect factors, including hormones, stress and the menstrual cycle in women, as well as skin care products and makeup, which can clog pores. In some people, consumption of sugar and dairy products is associated with flare-ups. Certain medications, including corticosteroids, anabolic steroids, and lithium, can also cause acne.

Acne and underlying conditions

Many skin disorders, including acne, can be signs of various diseases. For example, hair loss, excessive hair growth, irregular menstrual cycles, rapid weight gain or loss, combined with acne without a previous history, may be signs of an underlying disease such as polycystic ovary syndrome or endocrine disorders. Let your doctor know if you experience additional symptoms, as proper diagnosis is of utmost importance in treating the problem. 

Treatment of acne

There are many treatment options for adult acne. Consult your Dermatologist as treatment depends on the type and severity of acne. 

He can prescribe you local medicinal preparations or recommend specialized treatments, such as chemical peels, laser treatments, etc. which will help with acne treatment.

Prevention

Some things you can do to reduce your risk of acne:

• Never go to bed wearing makeup, but clean your face thoroughly every night. 
• When shopping for cosmetics and skin care products, look for the phrases “non-comedogenic” or “non-pore-clogging”. 
• Avoid face oils and hair products that contain oils
• Wear sunscreen with SPF 50+ daily 
• Finally, there is evidence that specific dietary changes may help, such as reducing dairy products and foods with a high glycemic index (those that cause blood sugar levels to rise more quickly). 

Wear sunscreen

Even in winter you need sunscreen to avoid the sun's harmful rays. A broad-spectrum SPF 30 or higher should be applied daily. Just reapply every two hours, especially if you sweat.

Take care of your lips

In the cold, the lips may appear chapped and tingling. Use a lip balm with moisturizing ingredients such as natural coconut or jojoba oils, vitamin E, beeswax and shea butter. For an added bonus, try getting a lip sunscreen with SPF. Lips can also burn from the sun or during winter sports in snow that reflects solar radiation.

Stay hydrated

Since it's not hot outside and we don't sweat, often in winter we consume less water than we should, leading our skin to become dehydrated. A well-moisturized skin is also important in winter.

Also, sometimes the moisturizers and treatments we use in the summer months are not enough for the skin in the winter, especially in older ages. As the weather changes, the skin becomes drier and shows redness and peeling. This is due to the colder and drier weather which makes the skin more susceptible to moisture loss. Maybe you need to change your moisturizer. Moisturizing gels and lotions are commonly used in summer as they are lightweight and contain a high water content. Richer textures in creams and serums are better for cold, dry weather because they provide a stronger barrier to "lock" moisture into the skin.

Also, very hot showers and baths strip the natural oils from the skin, drying it out. For this, after the hot shower, it is advisable to apply a good moisturizing cream to the body, such as e.g. products with hyaluronic acid that will retain moisture in the skin.

Choose natural fabrics

If you have sensitive or intolerant skin, it is recommended to wear natural fabrics, such as wool, cotton, etc. Fabric allergies are mainly caused by synthetic ingredients that make fabrics waterproof and wrinkle-resistant. Even some natural fibers are treated with formaldehyde resins, so it's important to know the composition of the fabrics you wear.

A common dermatitis is that caused by an allergy to polyester, a very common fabric. Polyester fibers may cause skin irritation.

Contact allergy may also be caused by chemical additives used to treat or clean the fabric. This can include laundry detergent and dye used by textile manufacturers.

Use antioxidants

Incorporating products with antioxidants into your skin care routine is a good idea for any time of year. After summer, you may notice signs of damage to your skin such as freckles, dark spots, uneven skin tone, fine lines and wrinkles. These signs of damage are also caused in part by free radicals resulting from UV exposure.

Antioxidants are the body's defense mechanism against free radical damage and work by neutralizing free radical molecules. Those with the greatest benefit for the skin are vitamins C, E and B3 (niacinamide), because they have small molecular weights, which allow them to easily penetrate the surface of the skin, making topical application effective.

Invest in "winter" skin treatments

Winter is a great time of year for dermatological treatments. Peels and laser treatments are not recommended for the summer months, as there is a greater risk of unwanted post-inflammatory hyperpigmentation. Winter is an opportunity to do treatments that will beautify and strengthen the skin, such as skin scraping to stimulate new collagen and restore skin radiance. Likewise, now is the time to start treating unwanted hair with laser hair removal.

For photoaging skin, winter is suitable for treatments that target the signs of photoaging, such as antiaging laser or the peels.

Winter skin is often dull, so a professional facial every four weeks is recommended. That's how long our skin needs to go through the entire life cycle of skin cell growth. The regulars facial cleansing they will help you keep your skin clean, shiny and hydrated.

Consult your dermatologist for the right combination of treatments for healthy, firm and clear skin.

What is psoriasis?
Psoriasis is a chronic, non-contagious disease that occurs on the skin, joints and nails. It is an autoimmune disease, that is, it is caused by an overstimulation of the immune system.

The exact cause of psoriasis is not known, but it is linked to heredity. Of course there are triggering factors, such as skin injuries, infections and viruses, endocrine factors or taking certain medications, alcohol abuse and even stress.

Symptoms
Psoriasis causes the skin cells in the top layer of the skin to overproliferate, resulting in psoriatic plaques—red patches covered in silvery or white scales—hard-to-the-touch, flaky or scaly patches. It appears anywhere on the body but most often on places like the elbows, knees, head, and even the palms and soles of the feet. The skin is hard and cracked and often itches. Sometimes the patient may develop psoriatic arthritis, which causes pain, swelling and stiffness of the joints. It can also affect the nails.

Living with the disease
As with other chronic autoimmune diseases, psoriasis can affect emotional health, interpersonal relationships, and the way one handles stress. For some people, living with psoriasis can be a challenge, especially in the summer when we dress lightly or in swimwear. As there is a false stigma attached to psoriasis, in the minds of many it is associated with scabies and there is a fear of contagion. As a result, patients with psoriasis often experience feelings of anxiety, shame, beach shyness, depression, isolation or fear.

However, there are several ways to manage the disease so that the patient suffering from psoriasis can have a quality life and the support they need. It is important with proper information to consolidate the perception in society that it is not a contagious disease. Many patients consult a psychologist if they feel they need more help with the psychological part of disease management.

It is especially beneficial for the psoriasis sufferer to find the right communities and talk with fellow sufferers, because in this way different stories are heard in the light of the common experience of the disease and understanding is broadened. The psychological support one receives by participating in patient groups offers hope and solidarity. There are patient networks that offer information and support, such as the Panhellenic Association of Patients with Psoriasis and Psoriatic Arthritis, "Epidermia".

Types of psoriasis and treatment
There are different types of psoriasis and it is possible for someone to have more than one type at the same time - as well as more than one type in their lifetime.

Monitoring the course of the disease by a dermatologist experienced in psoriasis is the key to finding the right treatment to keep the symptoms of psoriasis under control. It is important to make regular appointments for re-evaluation of the treatment you are following to discuss with your doctor how the particular treatment is working and how the body is reacting to it.

As it is a chronic disease, it is important that the patient has - in addition to an excellent Dermatologist - patience, valid information and the support of family and friends, which can be invaluable.

The sun may cause well-being, but the photodamaging effects of solar radiation on the skin cause photoaging. 

What is photoaging? 

Photoaging affects the appearance, texture and elasticity of the skin. Photoaged skin is rough and dry, due to the destruction of the hydrolipidic film and thickening of the stratum corneum.

Wrinkles appear caused by the loss of collagen and elastin as well as dehydration. We also observe discolorations and panades, i.e. brown skin lesions which are noticeable to the eye. Discolorations are due to the increase of melanocytes or the excessive production of melanin in the specific part of the skin. 

In cases of chronic, severe sun damage, larger 'blackheads' appear on the oiliest areas of the face, such as the nose and forehead. Sun marks (or hyperkeratosis) are caused by DNA damage of cells that have absorbed radiation and are associated with skin cancer.

Another symptom of photoaging is the sagging, either of the skin of the face, which is exposed to the sun every day, or of the skin of the neck, where we often forget to apply sunscreen. Especially in the skin of the neck, elasticity occurs, a phenomenon called 'turkey neck' or 'goosebumps' and is seen on the neck and décolleté.

Finally, the color of the skin may turn yellow and appear pale, as it has a deficiency in blood vessels, due to the damage they suffered during exposure to the sun.

Treatments for photoaging

The repair of sun-damaged skin is done with the appropriate treatment that the Dermatologist will indicate to you. There are various treatments that treat photoaging, with great results, but there is no one-size-fits-all treatment as it depends on your skin type. 

Consult one of them Our dermatologists, who have many years of experience in the repair sun damage and they will design the right personalized treatment protocol for you.

How should we take care of our skin during menopause?

Four different issues matter in menopausal skin care. Cleansing, moisturizing, antiaging and protection.

Estrogen plays an important role in hydration, in how much moisture our skin retains. When their levels drop, the skin becomes drier, thinner and more sensitive. In addition, they play an important role in how much collagen we synthesize. Collagen is an essential protein in our skin that gives support and firmness. When it decreases the skin changes... We see it thinner, with more wrinkles and sagging. We know that in the first 5 years after menopause we lose about 30% of our skin's collagen.

So how should we take care of our skin during menopause...

 

1. The cleanser should be gentle. After all, common alkaline soaps in combination with hot water significantly dry the skin, even at young ages. So we need to use non-drying cleansers, without fragrances and agents that in other decades might be useful, such as salicylic acid, lactic acid or fruit acids.
2. The hydration. Its purpose is to improve dryness and repair the skin's barrier. Here we use lipids (for example ceramides) and ingredients that retain a lot of water such as hyaluronic acid and glycerin. At menopause we also have a decrease in estrogen and a relative increase in androgens – so some women have a tendency to suddenly develop pimples. It is therefore of great importance that our moisturizers provide the necessary lipids but not be food-borne.
3. To apply anti-aging products. What does this mean; Products whose ingredients activate collagen production. Such are retinol or other topical retinoids that may belong to drugs, and vitamin C. Another approach is to apply substances or replacement complexes that mimic estrogen (without being) because their chemical structures are similar.
4. It's never too late to start applying sunscreen daily – there's a significant window of prevention in the 60s-70s-80s. Sunscreens protect us from discolouration, gradual thinning from wrinkles and relaxation caused by UV rays.

 

Finally, skin care has to do with other issues that are generally related to a life with good quality – well-being. Proper nutrition, enough sleep, no cigarettes, stress reduction – everything matters in the good condition of our skin

Immediately below our epidermis, in the second layer of the skin, there are the proteins collagen and elastin. Collagen forms a network, a mesh that supports the skin, gives it firmness. Elastin is a protein that gives elasticity, which enables the skin to return to its position when stretched. As the years pass these proteins are produced at a lower rate and are broken down more quickly. So when they are reduced, sagging and wrinkles appear on the skin. Some people show more sagging, others more wrinkles. This depends on our genes.

Menopause, i.e. the significant decrease in estrogen, significantly accelerates this process. Consider that women in the first 5 years from its onset we lose approximately 30% of our skin's collagen. And skin elasticity in postmenopausal women decreases by 0.55% per year.

What external factors increase relaxation during menopause?

Also, it is very important the role of the environment in this reduction of the substances that give a youthful image to our skin. Diet, smoking, sleep clearly have a role in skin aging. However, the most aggravating factor from the environment remains the exposure to the sun. Ultraviolet radiation it destroys the elasticity of the skin in the areas that have been exposed for decades, and it is the main factor responsible for sagging and wrinkles on the face, neck, hands as well as the sagging of the skin on the body.

Skin relaxation can also be affected the big weight loss and the redistribution of fat that occurs with age. It is a myth that running causes relaxation and that relaxation is linked to how we sleep.

What do we do for relaxation?

1. Prevention by avoiding the sun.
2. Long-term application of topical retinoids, antioxidants, peptides.
3. In addition, our dermatologist advises us on possible in-office treatments aimed precisely at preventing or correcting sagging.

Over the years brown or black marks appear on the face, mainly in the areas exposed to the sun, on the face and hands. These marks may have different names but they are all darker than the surrounding skin which is why they are called “spots" the "discolorations». The most common are the melasma (or panada) and the solar lenses.

How do these come about? In our skin, we all have melanocytes, i.e. cells that produce a substance, melanin, which is responsible for our color. Darker-skinned people have more active melanocytes that produce more melanin, while lighter-skinned people have less. The melanin is then distributed evenly to the keratinocytes, the main cells of our skin. When our skin is significantly exposed to the sun, at some point the melanocytes produce more melanin in certain places and this causes solar lentils and melasma. As for melasma, it is also often triggered by hormonal changes such as pregnancy, contraceptives or replacement therapies that we may take at menopause. It gets worse with UV light, but we know visible light and infrared from devices also affect it.

So what can we do about dyschromias?

First thought is always the prevention. It is never too late to prevent our discolorations from getting worse or new ones appearing. We know that the sun is to blame for their appearance and of course when we avoid it they decrease. Even when the weather is not good, ultraviolet rays (mainly UVA) penetrate the clouds and reach our skin to stimulate melanin production. It is also known that both visible and perhaps infrared light can induce melanin production, especially in dark skin. That is why it is very important to apply sunscreen every day 365 days a year and for darker skin choose sunscreen products with special natural filters or pigments that also protect against visible light. It's never too late to get the right behavior in the sun, seek the shade, wear a hat and apply the right sunscreen every day.

They also have a role in the prevention of discoloration antioxidants, and this is because it has been proven that oxidative damage from exhaust gases in cities increases the possibility of discoloration. Antioxidants neutralize this risk to a certain extent.

Then, next step after prevention is trying to eliminate dark marks, spots. This might be done with creams containing bleaching substances which reduce melanin production by melanocytes. Such substances are hydroquinone (which has restrictions on its use in Europe and is prescribed by dermatologists), azelaic acid, kochic acid, cysteamine, tranexamic acid and other substances. Another approach is the substances that prevent the transfer of melanin to keratinocytes, for example niacinamide. We can also apply substances that cause keratolysis, that is, they remove from the skin keratinocytes that have increased pigment and thus the color of the skin is more uniform. For example fruit acids, topical retinoids or salicylic acid. Ideally, when we talk about skin whitening with creams, we deal with the problem from many sides, we combine different substances with different actions for a better result.

Our dermatologist suggests which combination is best for each person. Of course, the dermatologist's job during the examination is also to confirm that the discoloration is harmless to our health and that it is not a cancerous or precancerous lesion. Also, the dermatologist may reinforce the whitening effort with creams with special treatments that are done in the doctor's office.

When estrogen drops greatly at menopause, the skin produces less collagen and elastin. The collagen forms a network, one support mesh below the surface of the skin. THE elastin is one protein that gives elasticity, which enables the skin to return to its position when we pull it. When these proteins are reduced, wrinkles and sagging appear. What can we do about it? There is certain routine that we should follow at home, daily and long-term, which delays the signs of aging. There are also procedures that one does in the dermatology clinic, which depending on the case give anti-aging results. Regarding the work that we recommend someone to do at home, it concerns:

 

• Application of topical retinoids at night. Retinoids are derivatives of vitamin A and are the substances with the most evidence for antiaging action. Epidermal cells usually need a month to complete their life cycle, that is, to reach the outer parts and fall off. With retinoids, this happens faster, in 2 weeks the rate of their multiplication is accelerated. Retinoids also prevent the breakdown of collagen and aid in the synthesis of new collagen, thus fighting wrinkles.
• Application of appropriate antioxidants, such as vitamin C or ferulic acid or other molecules. These help to neutralize the oxidant radicals produced by sun exposure, may also help with discoloration and make the skin brighter and more radiant.
• To treat wrinkles we can also look for products that they contain peptides in their composition. Peptides are small protein molecules that help produce collagen.
• Of course it is good moisturizer containing hyaluronic acid, glycerin to retain a lot of water and lipids to strengthen the skin's barrier cannot be missing from daily care
• We do not forget that the 90% of the signs of aging that we have on our face are due to exposure to the sun. So dealing with antiaging requires that we use some form product with sun protection (which also provides protection against skin cancers).

 

At the dermatology clinic there are many options and they are personalized according to the needs of each person. They target either the enhancement of collagen production diffusely in the skin or specifically at wrinkles and relaxation.

Many menopausal women describe a change in their skin from oily or combination skin to dry. This is because when estrogen decreases the skin produces less sebum (i.e. lipids) and has less ability to retain water. Care must therefore be adjusted accordingly.

1. Firstly, The cleaning must be done with suitable gentle products. Common alkaline soaps combined with hot water significantly dry the skin, even at young ages. So we must use cleansers that are not drying, without perfumes and agents that in other decades when we may have acne or oiliness are useful such as salicylic acid, lactic acid or fruit acids. A wrong cleanser can remove fat molecules or sebum from the skin that we need, otherwise the skin becomes drier and may show irritation and redness.

2. Secondly, has role one good moisturizer. But what does this mean? What is a good moisturizer? The outer part of the skin, the one we touch, has rows of cells closely stacked on top of each other and between them are lipids. Such, for example, are the tiles. When we touch our skin and it feels dry we are practically grabbing the edges of the keratinocytes that are about to fall off and that have peeled off, or folded because they are not held in place by the lipids – the skin barrier is not working properly. Then the skin's water content is not ideal, i.e. between 20-35%. The role of a good product in menopause is twofold:

1. 1. To give enough lipids to the skin and to restore the ratio of Omega 3-6-9 fatty acids.

• a. The goal is to replace their loss and their ratio, so that the skin barrier works properly.

1. 2. Moisturizers are a must also contain hygroscopic agents, i.e. substances that can hold a lot of water, such as hyaluronic acid and glycerin.

 

In addition, some menopausal women they complain that their skin suddenly became sensitive. In other words, things that did not bother them in the past, suddenly the skin does not tolerate them, they have the feeling that they it stings, pulls or displays redness and pimples. For example, they are bothered by woolen clothing or products that were previously tolerated without problems. This is because when we don't have estrogen we synthesize less lipids and in that the skin becomes thinner. We have a lower rate of proliferation of the outer cells (keratinocytes) but also less collagen in deeper layers of the skin. So we need gentle cleansing and the right moisturizers without fragrances or irritants.

What is Cryolipolysis?

It is a painless and safe method and reduces local thickness without surgery or anesthetic, in a single session. With special electrodes, a very low temperature is applied to selected areas. Fat cells are particularly sensitive to cold, unlike other cell types. Controlled cooling has the effect of destroying fat cells, which the body then gradually removes naturally.

When will I see results?

The first results are visible in 4 weeks but the final results are visible after a few months (injured fat cells are gradually eliminated from the body up to 4 to 6 months after treatment), with 25 to 35% fat reduction. The lost centimeters create a slimmer silhouette.

In which areas does it apply?

On abdomen, sides of abdomen, buns, inner thighs, arms, above knees.

How many reps are needed?

More often than not one application gives satisfactory results, in which significant problems a second session offers more improvement.

How long is the session? What should I do next?

The session for each area lasts approximately one hour. Immediately afterwards you can return to your daily activities.

Unwanted actions;

Bruising rarely occurs in the treatment areas and lasts for a few days. The treatment should not be done by patients sensitive to cold (cryoglobulinaemias, cold urticaria, paroxysmal cold haemoglobinaemia).