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Soaps and Cleansers
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Soaps & cleansersWhy wash?Everyone likes to feel clean; it's refreshing, invigorating, relaxing
and enjoyable. Washing your skin removes excessive oil and unpleasant odours as well as make-up, sunscreens and dirt. How to wash: wet your skin. Apply soap or cleanser to your hands, add warm water and work
into lather. Massage gently. Rinse thoroughly. Gently pat dry. Do I have normal, dry, oily or sensitive skin?These
terms are most frequently applied to facial skin, but may apply to other sites as well. To determine your skin type, wash
your face and pat dry. Wait for an hour, then press a tissue to your forehead, cheeks, chin and nose. If your face is not
shiny and there's no oily residue on the tissue, you have normal skin. If your face looks/feels tight or is flaky and
there is no oily residue on the tissue, you have dry skin. If your face is shiny and the tissue reveals an oily residue, you
have oily skin. Many people have combination skin: the T-zone (forehead, nose, chin) is oily but the cheeks are normal or
dry. Normal skin has a correct balance of moisture and oils. It is slightly acidic at a pH of 4.5-5.75 (6.5 under your
arms). A variety of harmless (commensal) bacteria and yeasts live in low numbers on the skin surface, and may help protect
your skin from infection (invasion by more harmful bacteria such as staphylococcus or streptococcus). Sensitive skin
is skin that stings easily, especially during or just after cleansing. Sensitive skin is more likely to be dry and is hyper-reactive,
i.e. prone to develop dermatitis (itchy bumpy skin). Sensitive skin may be inclined to be red, flush easily or have broken capillaries (telangiectasia). There
is often an underlying skin problem such as: Oily skin, or seborrhoea, predisposes to acne. If you have an oily complexion, you may be tempted to scrub twenty times a day: don't! You might dry your skin too much
and rather than preventing infection, you may even increase the number of harmful bacteria. Just gently wash affected areas when you wake up, post-exercise and at bedtime. What cleanser should I use?Pure
water alone is not quite enough: removing dirt, which is fat-soluble (lipophilic) and sticks to the skin, requires a surfactant.
Surfactants are active cleansing substances that consist of a fat-soluble (lipophilic) part and a water-soluble
(hydrophilic) part. The lipophilic part sticks to oil and dirt, and the hydrophilic part allows it to be washed away. Surfactants
may be a soap, a synthetic detergent or a combination The choice of cleaning agent helps determine the product's lathering
characteristics, feel on the skin and how easily it rinses off. There is a wide range of products designed for washing,
available as bars, liquids, gels, creams, shampoos, scrubs, masks, cloths and wipes. Manufacturers consider mildness, biodegradability,
low toxicity, cleansing ability, emulsification, moisturization, skin appearance and feel, smell (fragrance) and lubrication
to be important aspects of their products. Cleansers may contain: - Water to remove water-soluble (hydrophilic)
components of dirt.
- A mixture of detergents or surfactants (surface-active agents) to remove oil-soluble (lipophilic)
dirt, by loosening particles from the skin surface. Surfactants often have an electrical charge:
- Anionic (negatively
charged) surfactants to foam (lather) such as sodium lauryl sulphate, sodium laureth sulphate and sodium sulphosuccinate.
Anionic surfactants rinse off easily.
- Cationic (positively charged) surfactants include trimethyl dodecyl ammonium
chloride.
- Amphoteric surfactants are both negatively and positively charged to leave a pleasant sensation on the
skin and reduce the irritant action of anionic surfactants. An example is cocamido propyl betaine; betaines are derived from
sugar beet.
- Non-ionic surfactants include polyethylene glycols (PEGs) and acyl-polyglycoside (APG).
- Emulsifiers
such as diethanolamine (DEA) to prevent separation into layers of different chemicals.
- Moisturisers to replace skin
oils and retain moisture in the skin.
- Fragrances to provide a pleasant smell.
- Preservatives to prolong shelf-life
and prevent mould.
- Colours, humectants, thickeners and solvents such as glycerine to improve texture and appearance.
- Biocides (antiseptics) such as triclosan and para-chloro-meta-xylenol (PCMX), to reduce bacterial count on the skin.
They can reduce body odour and help certain skin disorders such as atopic dermatitis and acne. These products, depending upon
their formulation and application, may also kill or inhibit the growth of bacteria that cause intestinal illnesses and other
community infections. But there is concern that common household use may increase resistant organisms and actually make such
infections more likely and more serious,
- Scrubs i.e. abrasive substances to smooth out rough skin (face) or remove
stubborn dirt (industrial hand cleansers).
- Antioxidants, vitamins and alphahydroxy acids (fruit acids) to smooth
skin and reduce photoaging changes.
- Botanicals to soothe, heal, moisturise, for their astringent properties or to
act as natural antiseptics.
- Exfoliating (peeling), keratolytic (skin-dissolving) or comedolytic (whitehead-removing)
additives such as salicylic acid or benzoyl peroxide to reduce acne.
What are the complications of skin cleansing?Soaps
and cleansers can irritate and result in skin problems. These are rare with modern synthetic detergent products made by reputable
manufacturers, if they have been designed for sensitive skin and are used appropriately. Over-washing may have the following
effects: - The pH of the skin may change. Water alone has a neutral pH of 7. Soaps are alkalis pH 7-12, which damage
the skin barrier function.
- The number and type of bacteria may change. Alkalis may even increase the number of Proprionibacterium acnes (the acne bacteria).
- The surface oil film (sebum) is removed, allowing greater water loss through the epidermis to the skin surface, from where it evaporates. This may lead
to dermatitis.
- The de-fatted skin may become excessively dry.
- The surface horny cells may be loosened, disturbing barrier
function and allowing more water loss. The skin becomes more permeable to chemicals.
- Dry skin is more prone to infection with Staphylococcus aureus, resulting in impetigo.
- Irritant contact dermatitis (red, dry, chafed skin) may develop. This may be provoked by the dry skin itself, or by a particular surfactant in the cleanser.
Sodium lauryl sulphate is more irritating than sodium laureth sulphate for example. Cleansers designed to treat acne should
be used with caution if leave-on acne products are used as well: too much treatment will result in excessive dryness and irritation.
- Stinging is particularly likely with alcohols, gels, alphahydroxy acids or other additives
- Contact urticaria (immediate redness, itching and swelling) may arise due to fragrance, preservative
or benzoyl peroxide.
- Some formulas are comedogenic (clog the pores), aggravating acne.
- Scrubbing may break open comedones (blocked pores) forming inflamed acne pimples.
- Applying a thick moisturiser to compensate for dryness could also aggravate acne.
- Allergic contact dermatitis (a delayed but persistent reaction) may develop to a component of the cleanser. Because they are rinsed off, true contact
allergy to soaps and cleansers is rare. However it may result from:
- Protein contact dermatitis, a rare mixture of contact
urticaria and allergic dermatitis, due to a protein component such as peanut or oatmeal.
SoapSoap has
been made since ancient times, but has been particularly popular for cleansing the body since the mid-eighteenth century when
modern manufacturing processes were discovered. Soap is an anionic surfactant. Soap is made from fats and oils mixed
with alkali, forming glycerine and the sodium salt of the fatty acid. The fats required for soap making come from a combination
of tallow, grease, fish oils, and/or vegetable oils. In ancient times, the alkali came from ashes but today the alkali for
soap formed into solid bars is sodium hydroxide. Liquid soaps are made with potassium hydroxide. The hardness, lathering
ability, and transparency of soap vary according to the combination of ingredients. Disadvantages of soap
- It is alkaline, which irritates sensitive skin, which is normally acidic.
- It forms scum when used with
hard water (water that contains a high amount of calcium in solution). The scum stops the surfactant properties, so one tends
to use more soap.
- Soap leaves deposits of carbonate salts on the skin. This irritates the skin.
- Soap deteriorates
on storage.
SyndetsSynthetically produced detergents (syndets) were developed in the 1950s and are widely
available. They are made from a variety of petrochemicals (derived from petroleum) and/or oleochemicals (derived from fats
and oils). These hydrocarbon chain sources are used to make the lipophilic end of the surfactant molecule. Chemicals, such
as sulphur trioxide, sulphuric acid and ethylene oxide, are used to produce the hydrophilic end of the surfactant molecule.
Compared with soap: - Syndets can be set to the normal skin pH of 5.5
- The number of Proprionibacterium
acnes (acne bacteria) is reduced
- No scum is produced so they rinse off well
- Washed skin is less dry
- Sensitive skin is less irritated
- They are more expensive.
Hypoallergenic products
The manufacturers of hypoallergenic skin cleansers have tried to avoid using substances that are likely to cause contact
allergy. Their products are often "fragrance-free" (low levels of masking fragrances are permitted), "mild"
and "non-irritating". If you have acne, choose products that are labelled as "oil-free" and "non-comedogenic".
However, even hypoallergenic products may still be irritating to those with very sensitive skin, and they may still
rarely cause contact allergy. Labelling in the USAFor the US, the FDA states: "If a cosmetic claim is made on the label of a "true" soap or cleanser, such as moisturizing or deodorizing,
the product must meet all FDA requirements for a cosmetic, and the label must list all ingredients. If a drug claim is made
on a cleanser or soap, such as antibacterial, antiperspirant, or anti acne, the product is a drug, and the label must list
all active ingredients, as is required for all drug products."
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Care. I personally see every new patient who visits our office. I am not just a physician, I am a Board Certified Dermatologist. This is the type of 5-star care and service that our patients expect, deserve and receive. I treat every patient the way
I would want to be treated: with courtesy, dignity and respect. I carefully listen to their skin-care concerns and offer a
variety of options including a treatment plan that I believe will give them the best results. We also support our patients
with a very fine medical staff . Please take a moment to explore our top of the line winning website. My philosophy is simple…Experience
Counts and Quality Matters. Please allow me to solve your skin problems. After all, at NYC
Dermatology , our philosophy is if you look great you will feel great with gorgeous skin.” Best Regards, Dr. Rothfeld
Years
of squinting and frowning can leave deep wrinkles that form between the eyebrows and may extend to the bridge of the nose. Wrinkles and frown lines also may appear
across the forehead and at the corners of the eyes ("crow's feet"). Dermatologists can quickly and safely inject
botulinum toxin during an office visit to diminish these wrinkles and lines that create an angry or sad look and detract from
a pleasant facial appearance. What is botulinum toxin? Botulinum
toxin type A and botulinum toxin type B are purified substances, derived from a bacteria, that block muscular nerve signals. Injecting very small amounts into specific facial muscles blocks
the muscle's impulse. This temporarily weakens the muscle and diminishes the unwanted lines. Botulinum
toxin has been used since 1980 to treat many muscle disorders such as lazy eye and uncontrolled blinking. It was pioneered by dermatologic surgeons for cosmetic use in 1987. Botulinum toxin type A is specifically indicated for the
lines between the eyebrows, and it also can be effectively used for "off-label" indications in other facial areas.
Once the muscle is weakened and relaxed, it cannot contract. Since there is no way to make the undesirable
facial expression, the lines gradually smooth out from disuse, and new creases are prevented from forming. Other muscles such
as those needed to raise the eyebrows are not affected, so a natural expression is maintained. For optimal results, botulinum
toxin therapy may be used in combination with other cosmetic skin procedures such as chemical peels, laser resurfacing, and
dermal fillers. Combination therapy also can help prevent the formation of new lines and wrinkles. Botulinum toxin is less
useful for the smile lines around the mouth because muscle action in this area is needed for important functions such as eating
and talking. Botulinum Toxin Therapy Before treatment, the
dermatologist obtains the patient's medical history, including any medications taken. Treatment involves injecting very
small amounts of botulinum toxin directly into the underlying facial muscles to relax them. A tiny needle is used; the procedure
is well tolerated and takes just a few minutes with no "down time" or prolonged recovery period.
Botulinum
toxin takes effect about 3 to 7 days after treatment. The improvement generally lasts about 3 to 4 months; the effect gradually
fades as muscle action returns. Patients require re-injection at various intervals. With repeated treatments, atrophy (thinning)
of the muscle may occur. This usually produces longer-lasting results. Treatment
Areas Vertical lines between the eyebrows and on the bridge of the nose - Squint lines (crow's feet) at the corners of the eyes
- Horizontal lines on the forehead
- Muscle bands visible on the neck, commonly known as "turkey neck"
Are
there any side effects? Side effects are generally minimal, temporary, and typically relate
to the local injection. Soreness or mild bruising, while uncommon, may occur around the injection site. Makeup may be applied
after the treatment, but care should be taken to avoid pressing or massaging the area for several hours. A temporary headache
is not uncommon after injections in the forehead area, especially after the first treatment. In rare instances, patients may
develop weakness of the neighboring muscles leading to a temporary droopy brow or eyelid. All of these possible effects are
mild, reversible, and self-limiting. Other Applications Hyperhidrosis
(excessive sweating) can be treated with injections of a highly diluted form of botulinum toxin which is superficially injected
directly into the underarm skin, skin on the palms of the hands, or on the soles of the feet. This weakens the action of the
skin's sweat glands which are responsible for excessive perspiration. A single treatment session can provide months of
relief, and injections can be repeated when the excessive perspiration returns. Twitching muscles also can be treated by injecting
botulinum toxin into the appropriate muscle.



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At NYC Dermatology, our goal is to provide compassionate, medically-sound patient care. We respect the trust
our patients and referring physicians place in our opinions.
We provide a complete range of dermatology
services including the most advanced treatment for skin cancer, the most up-to-date treatment for acne, psoriasis, eczema
and work related skin conditions.
We also offer many cosmetic services to reduce the effects of aging on the skin,
including Botox, chemical peels, laser treatment to remove facial veins, sclerotherapy to remove spider veins on the
legs, dermal fillers, cosmetic excisions and repair, and hair removal.
Trained in Dermatology, NYC Dermatolgy by Board Certified Dermatologist NY Dermatology Dr. Gary Rothfeld
possesses the special knowledge, skills and professional capability that distinguishes him as an outstanding Dermatologist
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in Manhattan, New York has treated many patients in the entertainment and music industry is caring, detailed and meticulous
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As an expert in the field of dermatology and cosmetic dermatologic
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and Cosmetic Surgery Center in Manhattan, New York. Dr. Rothfeld, Dermatology Director of NYC Dermatolgy is a Board
Certified Dermatologist at NYC Dermatology who has treated many patients in the entertainment industry. Schedule an appointment at
our office which provides top of the line expert skin care, dermatology, cosmetic dermatology services,
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During
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- Botox® - Botox® for Hyperhidrosis - Cellulite - Cool Laser - Cosmelan Depigmentation Treatment - Glycolic
Acid Peel - Fat Transfer - Fotofacial / IPL Fractionated Resurfacing Laser - Hair Loss - Laser Hair Removal - Liposuction
- - Surgery - Minimal Scar Technique - Photodynamic Rejuvenation Radiance® - Restylane® - Sclerotherapy
- Sculptra - Smoothbeam - Stretch Marks - SunFX - TCA Peel - Tattoo Removal - Titan Laser Facelift - V-beam Laser Treatments
- Velasmooth Our cosmetic surgeon includes Dermatologist Dr. Gary Rothfeld Board Certified Dermatologist
at NYC Dermatology. Our NYC dermatologist offers advanced dermatology laser treatments for cosmetic needs and medical
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