Recently I was at an outdoor event and walked by a temporary tattoo stand. It looked like fun and was “temporary” so many people were lined up to get inked. These temporary tattoos are also known as black henna tattoos and vendors typically explain that they will wear off over several weeks.
Interestingly, as a dermatologist I have seen many reactions to these tattoos that range from mild itching to severe blisters. Those with the most severe reactions can actually heal with scarring. When I first saw these reactions I was surprised because henna is a natural vegetable dye and has been used for centuries; however, the truth is that black henna tattoos also contain para-phenylenediamine (PPD) which is a black dye. Authentic natural henna tattoos are actually orange/brown in color and need to be left on for hours to stain the skin. They rarely cause any type of allergic reaction.
Vendors often add PPD, to the natural brown henna because it stains the skin more quickly (within ½ hour) and looks darker like a real black tattoo. This black dye is the same ingredient in black hair dye and is a common cause of contact dermatitis in people who are allergic. In hair dyes, the FDA requires that the concentration of PPD is less than 6% due the significant risk of allergic reactions to this ingredient. In some of the black henna pastes used for tattoos, the concentration of PPD can range from 10%-80%.
So how can you know if a temporary tattoo has PPD? It is simple… if a paste stains skin black in less than ½ hour, it has PPD in it. Also if the paste is mixed with peroxide, or if peroxide is wiped over the design to bring out the color, it has PPD in it. It is best to avoid these temporary tattoos unless you are 100% sure they do not contain PPD…otherwise, if you are allergic, these tattoos may not be so temporary after all.
Ingrown hairs in the underarms and bikini area are very common after shaving. They are especially common after a close shave, and for people with curly hair; the shaved tip of the hair is very sharp and curls back into the skin to form an ingrown hair. In darker or tan skin these “razor bumps” often heal with a dark mark, leaving and unsightly spotted mess in the bikini area.
The best treatment for ingrown hairs is laser hair removal. Lasers work by heating up the hair at the root to destroy the hair follicle. With repeated treatments, up to 80% of the hair can be permanently removed. Lasers are always my first choice for this condition, but of course this treatment is not covered by insurance and can be costly. Prices for the underarms and bikini range from $250 to $400 per treatment, and you need a series of five treatments to get the best results. If laser hair removal is not an option, the following tips may help to prevent this problem: First, shave in the direction of hair growth, which is usually downward. After shaving, treatments with salicylic or glycolic acid can be helpful to remove dead skin cells and exfoliate so that the hairs do not get trapped under the skin. Gentle exfoliation with a loofah can also help to release trapped hairs. Avoid aggressive exfoliation and tweezers because this can lead to significant hyperpigmentation or dark spots. Waxing is also an option but be careful, because waxing can make ingrown hairs worse for some. If you have dark marks use moisturizers that contain skin brighteners to help even out the skin. Follow these simple steps, and smooth skin can be all yours!
People with multi-hued skin tones (tan/olive/brown skin) have a higher risk of scarring after surgery. There are a few things you can do to prevent this unwanted side effect. First and foremost, it is important to understand your risk of scarring. If you have had surgery in the past without any problems, it is less likely that you will develop a bad scar or keloid. Unfortunately, some people who have no history of scarring after surgery can still develop a keloid or hypertrophic (thick) scar. This is because not all skin on the body is the same. For example, facial skin tends to heal better than skin on the body.
The areas that have the highest risk of scarring are those with a lot of tension. The chest, shoulders, and back are typically the worst locations for scars for that reason. If you know you have a personal or family history of bad scars, plan to see a dermatologist within 3-4 weeks of surgery. Preventative treatment options include steroid injections, steroid tape, and silicone sheets. Also it is imperative to wear sunblock on new scars to prevent hyperpigmentation or darkening of the scar. If you do develop a thick scar, dark scar, or keloid, there are treatment options. Bleaching creams can help with dark scars and some lasers can be used in lighter skin types to help with red scars. It can also be helpful to see a dermatologist before your surgery so that you have a treatment plan in place ahead of time. Surgical scars can be significantly minimized with an organized approach to scar prevention so plan ahead!
Scars are a big challenge in my practice. Every patients always asks, “Isn’t there a laser that can remove this scar?” Well we do have effective treatments for scars but very rarely can we make them go away completely. First of all, it is important to know that they are many different types of scars. I treat a lot of keloids which are thick raised scars. These often occur on the earlobes after piercings or anywhere on the body after surgery. Keloids can be injected with cortisone to help shrink and flatten them. The injections work well to make keloids flat but they do not make keloids go away completely. Once flat, keloids can be either red or darker than the surrounding skin. In lighter skin, lasers can sometimes be used to improve redness. In darker skin, we can use fade creams to lighten the scar.
If a scar is already flat, like a scar from a burn or a simple cut, there are a few treatment options that have been proven to work. Sunscreen, of course, is key to prevent hyperpigmentation or darkening of the scar. As mentioned earlier, lasers can be used for redness and fade creams for dark discoloration. Silicone gel sheets are thin clear sheets of silicone that have proven to improve the appearance of slightly raised scars. Cordran tape is a prescription clear tape that conatins a steroid that can also help with scars. There are no topical creams that have been proven to work for scars so don’t waste your money on these over the counter products.
If you have a bad scar, don’t forget that there are excellent coverage makeups that can hide scars. Cover FX and Dermablend are two options that provide excellent coverage. The good news is that scars are a big area of research in dermatology and new treatments are on the way. I will keep you posted!
Hydroquinone is a naturally occurring chemical that inhibits the enzyme that makes pigment in our skin. When used appropriately it offers a safe and very effective therapy to treat hyperpigmentation and dark spots. In my practice I use hydroquinone frequently for many of my patients that complain of uneven pigmentation, dark marks from acne, and melasma.
So you might ask, why does hydroquinone have such “bad press”. Well there are many reasons for this, some are valid and some are not so valid. The main problem with hydroquinone is that with continued long term use, hydroquinone has been associated with a paradoxical darkening of the skin. This condition is called ochronosis and is more common in other parts of the world where hydroquinone is used extensively without regulation. To avoid this rare but significant side effect, I educate my patients on its use.
First and foremost, hydroquinone should not be used for long periods of time. I try to limit treatment to 1 to 3 months. Then I switch to an alternative therapy to maintain results. Secondly, hydroquinone must be used with sunscreen. Many dermatologists believe that sun exposure (without sun protection) may be implicated in ochronosis. Last but not least, I always emphasize to patients that if there is any significant irritation they should discontinue use. Some patients mistakenly believe that if the skin needs to be red or peeling for the product to work, however, with hydroquinone this could represent an allergic reaction that can heal with dark patches.
Following these simple rules, one can safely use hydroquinone to treat dark marks and hyperpigmentation. The good news is that new treatments are being developed that may offer the benefits of hydroquinone without all of the side effects. This is a big area of research in dermatology right now. I will keep you posted!