Should I use an AHA or BHA?


Combination 

Glycolic acid, an AHA, is a good choice for combination skin. Glycolic acid has the smallest molecule of all the AHAs, so it is able to penetrate without encouraging more sebum production. This acid is derived from fruit sugars. AHAs are water soluable, so they also work well for areas that are not as oily. 

For a mild nightly cream that is inexpensive and highly rated, I really like Reviva's 10% cream. Lots of people rave about this. I've also found this at Ulta on sale occasionally.

For a bi-weekly or monthly peel, I like Skin Obsession's 40% Glycolic Acid Peel. This peel really works well, but it stings and itches A LOT. I use this about once a month.

Be cautious when performing superficial chemical peels; acne can, ironically, be a side effect. [1] Avoid occlusive moisturizers if possible, which will help.

Acne Prone

Salicylic acid is the only BHA available; it encourages skin exfoliation and penetrates deeper than AHAs, so it's a good option for acne-prone skin. This acid is oil soluble, so it's a great option for oily skin that is plagued by acne. 

Beware with BHA: this can increase sun sensitivity by 50%, which can easily result in hyper-pigmentation. Salicylic acid also seems to cause more irritation. 

When to Use

Do NOT choose a daily moisturizer with BHA since it increases sensitivity to sun. Also, avoid cleansers with BHA because the acid must have time to penetrate the skin, and the cleanser will be rinsed too quickly. This is best used in a night-time moisturizer or serum--or monthly chemical peel. Remember to use sunscreen regularly with BHA. 

Dr. Heather Brannon recommends solutions with BHA at 1-2% and pH of 3-4. [2] This 2% Salicyclic Acid by Refresh Skin Therapy is well rated and is naturally derived.

Glycolic acid, an AHA, is another good choice for mild acne-prone skin. See Combination above for more.

Dry and/or Aging

Lactic acid chemical peel  is better suited to aging and/or dry skin because it encourages sebum production, among many other benefits, such as reducing age spots, freckles, sun spots, hyperpigmentation, and wrinkles. This acid is derived from milk sugars. For peels, I like the Lactic Acid by Perfect Image. It has high ratings at a descent price.

For a daily lactic acid lotion, I like AmLactin 12% Lotion. This is also a great body exfoliation lotion that will help retain moisture while increasing cell turnover.




Gloss Chemical Peel

The Gloss peel is the first generation of “non-wounding” chemical peels designed to retexturize the skin without harming it. This chemical peel is reported to contain restorative acids at levels that work symbiotically to restore a healthy, reflective glow to the complexion with little down time.

Before and After:
This is a "before and after" gloss peel picture from Dr. Steven Hopping's website:


It's difficult to see if she achieved HER desired results with this size and resolution.

Purpose:
This peel seems to be most effective in reducing large pores and retexturizing skin that may not seem smooth. The combination of acids indicates (to me) that it would also help reduce acne, fine lines, and hyperpigmentation or dark spots.

Ingredients:
This peels contains TCA, Salicylic acid, Azelaic acid, and a retinoid (vitamin A). It’s touted as gently exfoliating the skin as it delivers anti-inflammatory, anti-bacterial, and anti-aging benefits to the skin.

It’s a combination of 17% Trichloroacetic acid (TCA),  17% Salicylic acid, Azelaic Acid, and varying amounts of vitamin A, in a phenol-free,  anhydrous gel vehicle that limits ionization of the free acids. This results in limiting the pain and cellular injury associated with conventional TCA aqueous solutions. It also allows a longer contact time of the peel solution with the skin, thus enhancing efficacy.

Prep:
To prepare for this peel, one week before the treatment, avoid electrolysis, waxing, sunless tanning, spray tanning, or UV free tanning, depilatory creams, laser hair removal treatments, cosmetic facials, Botox, Retin-A, Renova, Differin, Tazorac, Avage, retinols, alpha hydroxyl acids, beta hydroxyl acids, benzoyl peroxide, or any other exfoliating products that may be drying or irritating.

Application:
After a 10-minute contact period, the peel solution is wiped from the skin using a solvent containing 1% retinol. The remaining residue is left on the skin an additional period of time before washing it off, adding retinoid benefits to the keratolytic effects of the peel solution.

After the Peel:
Most of these peels include a take-home kit consisting of a gentle, fragrance-free cleanser, emollient physical sunscreen, additional retinoid treatment pads and niacinamide-containing moisturizer.

I’ve read that the normal reaction is redness for 2-5 days but minimal peeling if at all. Results will vary, but generally users will see smoother skin texture, and revived appearance. Remember to use sunscreen every day after a peel since this new skin is especially vulnerable to hyperpigmentation.
It’s recommended to use this peel only two times per year, or at 6-month intervals.

Costs:
I haven’t been able to find this peel combination for purchase to use at home, but for treatment by a professional, I’ve seen it listed from about $200 to $600, depending on location.

If you've seen this available online for purchase, please let me know. I want to try it to post pictures and give a review.


FDA Approves First Dermal Filler for Acne Scars

The U.S. Food and Drug Administration approved the first dermal filler to treat scarring caused by acne, the most common skin disorder in the United States afflicting 40-50 million people.
Many plastic surgeons and dermatologists have used other fillers, off label, to help fill acne scars, including ice-pick, pitted, atrophic scars (flat, thin, or depressed), and hypertropic or keloid scars, those that are thick or lumpy. 
While many of us experience the slow actualization of our mortality through those wrinkles we often see as scars from living life, imagine how a young, vibrant person feels going through the onslaught of pain from not only from the appearance of nodular acne but also the resulting scars. My brother experienced this, and I can share that it affected his entire being. My parents had him put on Accutane, but it was too late to avoid the scarring. 
Bellafill, developed by privately held Suneva Medical Inc, has been developed to treat moderate to severe acne scars on the cheeks of patients over the age of 21.
A cure for acne has long eluded drug developers. And from topical gels to lasers, nothing so far has satisfactorily treated scarring that affects up to 95% of acne sufferers.
The U.S. Food and Drug Administration cleared a laser treatment for acne scarring in July, but adoption for this kind of therapy is limited by its high cost, associated pain, and the need for repeat treatments.

FDA Approves Ivermectin Cream for Rosacea

Published 12/24/14:

FDA Clears Ivermectin Cream (Soolantra) for Rosacea

Megan Brooks
DisclosuresDecember 24, 2014
The US Food and Drug Administration has approved 1% ivermectin cream (Soolantra, Galderma Labs), a once-daily treatment for the inflammatory lesions, bumps, and pimples of rosacea.
Rosacea is a common chronic skin condition affecting an estimated 16 million Americans, predominantly women, aged 30 years and older. The exact cause of the characteristic facial redness, pimples, and bumps of rosacea is unknown, but research suggests multiple triggers, including exposure to sun, alcohol, spicy food, and exercise. Recent evidence also suggests that rosacea may be caused by the overproliferation of Demodex mites in the skin.
Ivermectin, the active ingredient in the cream, has both anti-inflammatory and antiparasitic activity. The basis for the cream is Cetaphil moisturizing cream, a dermatologist-recommended formula that is fragrance-free, mild, and nonirritating, the company says.
The approval of ivermectin cream was based on two pivotal phase 3 randomized, double-blind, 12-week, vehicle-controlled studies involving 910 patients with rosacea.
In both studies, ivermectin cream applied once daily met each of its primary efficacy endpoints of treatment success, as defined by an Investigator Global Assessment rating of clear skin and change in inflammatory lesion count.
Beneficial effects were observed as early as week 2, with continuous improvement, the company says.
Rosacea is a "challenging condition to manage as it tends to vary from patient to patient, often requiring a tailored approach," Linda Stein Gold, MD, Galderma consultant and clinical investigator for the phase 3 studies, said in a company statement. "While some rosacea treatments for the common bumps and pimples of the condition may take more than 4 weeks to show effect, Soolantra Cream may provide initial results as early as week 2," she noted.
In long-term extensions to the 12-week studies, ivermectin cream was safe and well-tolerated for an additional 40 weeks (up to 52 weeks in total), although some patients reported skin burning and skin irritation.

Nose Mole Removal - Update

I wanted to post an updated picture of my nose-mole removal (over a year since my last peel to remove it), and I'm including the photos and information from my previous posts.

It was small, but it bothered me, so I saw my dermatologist first for the move removal; he burned off the mole with a laser, only for it to return within about 6 months. Did I get my $250 back when the mole returned? NO.

Since my dermatologist's laser wasn't successful in permanent mole removal--it came back--I'd been trying to remove it with 50% TCA mole removal treatments.  Here are the before and after pictures of my MULTIPLE 50% TCA chemical peel mole removal treatments:


BEFORE:

Mole Before Mole Removal Treatments

AFTER:
A year later - click to enlarge

Although my dermatologist didn't perform a successful mole removal, I still think it's a good idea to have any suspicious mole checked by a doctor.

Mole Before Mole Removal Treatments

There are several products to use for mole removal, but they're all very strong.

I attempted mole removal myself a couple of months ago, but I quit after two sessions, and it came back. I applied a solution of 50% TCA Chemical Peel for mole removal, on two separate occasions. The mole peeled twice.

Mole Peeling After TCA Mole Removal Treatment

The mole did get smaller, but the mole removal wasn't successful with the strength and number of applications. I lost interest since I’d gotten the mole down to a size that I couldn’t see it without my makeup mirror.


3rd Mole Removal Treatment

It kept growing. I decided that the solution strength wasn't high enough for mole removal, and I was washing it off (thanks to one reader who suggested leaving it on overnight). So I applied a 50% TCA chemical peel solution to the mole, and I left it on. 

Mole Frosting after TCA Chemical Peel Mole Removal

It's interesting to me that as soon as I applied the solution, the mole seemed to get smaller when it frosted. It actually didn’t hurt when I applied the mole removal solution and left it on. I did feel the solution on the mole, but not like the normal chemical peel sting and burn. It felt more like a pinprick, and as quickly as the pain came…it disappeared.

The frosting stayed visible on the mole much longer since I didn’t rinse it. After about 10 minutes, I applied my CU3 Copper Peptide Lotion, yet the mole remained white for about an hour.


Mole 2 Days After Treatment

This is the mole two days after the mole remover treatment.  As you can see, although it's smaller, this single treatment was NOT enough.
4th Mole Removal Treatment

Here's the 4th mole removal treatment, applied again only THREE days after the last treatment. I'm trying to be more aggressive with it this time!
Mole Frosts after 3rd Mole Removal Treatment
I left the mole removal treatment on overnight again but applied CU3 copper peptide lotion
about an hour after the treatment.

This picture is three days after the application:
4th Mole Removal Treatment
The scab is starting to form, and I can see where I accidentally got a drop of the solution above the mole; fortunately, I saw it when it happened and put a cream on it immediately. Although there's a slight dryness there, it didn't penetrate as deeply as the area on the mole.

Day 4 after the 4th mole removal treatment. The slight scab fell off.

Day 4 after Treatment
I ended up doing one last application several days after the photo above, although I'm not sure if I needed to or not, but after having it come back twice, I didn't want to take a chance.

Here's my nose more than a year after the last application! So happy I persisted with this mole removal, although I can see from this picture that I need to work on blackhead removal (yuck).

One year + after last TCA application