A DERMATOLOGIST’S GUIDE TO PREGNANCY SAFE SKINCARE INGREDIENTS

Our Principle Dermatologist Dr Hope Dinh recently shared her expert skincare tips for pregnant or breastfeeding mothers with beauty editor Joanna Fleming from Adore Beauty.


Just found out you’re expecting? Congratulations! Along with the excitement of falling pregnant comes a few lifestyle changes – so we asked Dr Hope Dinh, principle dermatologist and director of Hope Dermatology and mum of two, to give us her advice on pregnancy-safe skincare.

 

Which ingredients do you typically recommend women steer clear of while pregnant, and why?

If you are newly pregnant you may be noticing some big changes in your skin! Changes in hormones can result in an increase in oil, sweat, and increased circulation.  If you’re one of the lucky ones, this all results in the “pregnancy glow”. For the rest of us, increased oil and sweat = pimples and breakouts, and improved circulation = splotchy and red!  Pregnancy can also wreak havoc with your barrier protection, leading to dry, irritated or sensitive skin.

It’s important during pregnancy to review any prescription creams you may have been prescribed pre-pregnancy and check with your doctor if it is safe to continue their use.  As a hard and fast rule, ANY prescription Vitamin A product should preferably be stopped throughout pregnancy and breastfeeding. Rest assured though, studies have shown these products are often poorly absorbed through the skin and broken down quickly and have demonstrated no adverse effects to baby with accidental exposure.

Any prescription fading product containing ingredients such as Hydroquinone should also be stopped as these do have a higher rate of absorption through the skin.

Some women think they need to switch to completely natural skincare and body products during their pregnancy, is this true?

Absolutely not.  In most cases, you can continue your regular skincare regime and tweak it depending on the changes you experience and your skin’s needs.  Dry skin may require more hydration or barrier protection (hyaluronic acid, vitamin B) whilst conversely increased oil production with pregnancy may benefit from the addition of an AHA (alpha hydroxy acid such as lactic or glycolic) or BHA (salicylic acid).

Skin can become more sensitive during pregnancy and many “natural” skincare products contain plant-based ingredients which can feature quite high on the list of skin allergens and can actually irritate the skin further.

What’s the most common myth around pregnancy-safe skincare?

You’ll often hear that you should stop any skincare containing Salicylic acid (BHA, commonly found in acne or brightening serums or washes).  The rationale behind this is that regular use of these products can lead to a systemic build-up of salicylates, which can have a toxic metabolic effect.   Salicylic acid is chemically related to aspirin which when medically indicated, can be used in low doses. The amount of salicylate that is absorbed through the skin via topical skincare is negligible and risk during pregnancy is low.

Contrary to popular opinion in both the public and medical fields, over-the-counter Vitamin A products (retinol) can be used safely during pregnancy under the guidance of your doctor.  We know that oral isotretinoin medication does cause birth defects and so I advise patients using prescriptions topical tretinoin to cease use, however, widely available over-the-counter skincare containing the much less potent forms of Vitamin A such as Retinyl Palmitate, Retinol or Retinaldehyde pose very little risk when used during pregnancy.  These forms are significantly weaker, are poorly absorbed through the skin and are usually found in low concentration in skincare.

Care should certainly be taken to avoid skin irritation and I would generally recommend a low dose and titrate up in strength if well tolerated. Always consult your doctor if you have any concerns.

Pigmentation is a common skin concern that can arise during pregnancy, which ingredients are safe to use to help manage pigmentation while pregnant and breastfeeding?

Pigmentation can be such a tricky condition to treat and often requires the full arsenal of home care, prescription therapy and cosmetic procedures.  The most important thing you can do for your skin pre-pregnancy, during and post-pregnancy is to incorporate the use of a high quality, daily SPF 50+ into your skincare regime.

Pregnancy-safe products that can help reduce pigmentation include Vitamin B, antioxidants such as Vitamin C, Azelaic acid, and exfoliants like your AHA/BHA products. Some treatments, such as skin needling (without topical anaesthetic!) and lactic peels are safe both during pregnancy and breastfeeding and are an effective way to address both pigment and minor breakouts.

Tell us, what are your own skincare go-to’s when pregnant or breastfeeding?

Sunscreen. Sunscreen. Sunscreen.  And an active AHA/BHA serum to target breakouts, with a hydrating, non-occlusive moisturiser at night to prevent sensitivity.

I tend to switch my moisturiser during pregnancy as I find my skin becomes more oily. And I slow down with some of my active skincare (alternate nights) as I find I get slightly more sensitive.

Hope Dermatology Dr Hope Dinh

Dr Hope Dinh is the principle Dermatologist/ Director at a busy dermatologist practice, Hope Dermatology in South Melbourne

She has a 2-year-old and a four-year-old (and her skin breaks out with pregnancy every time!)

Molluscum Contagiosum

Molluscum Contagiosum

You may have experienced a bumpy rash like condition but unsure what it was or if it has been diagnosed incorrectly. Molluscum contagiosum is a common and stubborn viral infection that causes a mild skin rash. It is important to get the correct diagnosis to ensure the best treatment quickly for fast results. The rash looks like one or more small growths or wart-like bumps that are usually pink, white, or skin-coloured. The bumps are usually smooth and shiny or pearly-looking, and may have an indented centre.

We treat these similar to how we treat warts; we apply topical solutions or pastes to the skin. Sometimes we can also use cryotherapy where we freeze them off.

With the topical medications you keep the medication on overnight ideally, if the patient can tolerate. Expect the skin to blister and go red, this is what we want as this means it is doing something!!!

We will also give you home treatment to use every night as much as you can tolerate. Home treatment is extremely important as we normally only see patients every 3-4weeks with Molluscum, so attacking the virus daily at home helps to stop the spread and keeps killing it!

There are four main types of how it can be spread:

  • Direct skin-to-skin contact
  • Indirect contact via shared towels or other items
  • Auto-inoculation into another site by scratching or shaving
  • Sexual transmission in adults.

Molluscum is most commonly seen in children, although we see this virus in adults as well. The most important thing is to treat this condition as early as possible! This is to avoid it spreading to the whole body. Your child may just have one or two bumps on the arm or leg, this can spread quickly so prompt treatment is needed to stop the virus as quickly as we can.

It can be a big confidence issue for some children as it is quite visible to others, so that’s why we like to treat when we just see a couple of lesions.

Once we start treatment the immune system is woken up and kicked into gear to start erasing this virus. So we don’t have to necessarily treat every single spot for all of them to disappear, as the body will start to mop up any ones we miss. The immune system is an amazing thing!! Sometimes it just needs something to kick start it and refresh it and get back to its normal self!!

Contact Dermatitis- Patch Testing Techniques

Contact Dermatitis

If you have ever experienced dry, red or itchy skin, you know how frustrating and debilitating it can be.

Whether it is a small rash on your face or a rash covering your entire body, it is possibly due to Contact Dermatitis.

 

We recently attended the Melbourne Dermatology Conference in May 2019 and the Skin and Cancer Foundation patch test training day, where we got to learn more interesting information about Allergic Contact Dermatitis and refine our skill in patch testing. Patch testing is the way forward in allowing out patients to find out what they are allergic to!

Allergic Contact dermatitis (also called contact eczema) refers to a group of skin disorders in which the skin reaction is due to direct contact with the causative agent. The term dermatitis implies that the outside layers of skin are affected. It can be acute (a single episode) or chronic (persistent). Dermatitis is nearly always itchy.

Allergic Contact dermatitis is the most common cause of occupational skin disease, and is particularly common in cleaners, healthcare workers, food handlers and hairdressers due to the sheer numbers of chemicals these professionals come into contact with on a daily basis with work.

What does it look like?

  • Redness (erythema)
  • Blisters that are small (vesicles) or large (bullae)
  • Swelling (oedema)
  • Dryness or scaling
  • Cracks (fissuring)
  • Lichenification (thickened, lined skin)
  • Pigmentation increased (hyperpigmentation) or reduced (hypopigmentation).

What will patients complain of?

Itchy, dry skin in a patterned distribution. So for example, with hair dye allergy, it will come up as a scalp rash but also a rash and swelling around the eyes. For nail cosmetics allergy, this may come up as a rash around the eyelids. For allergies to clothing textiles and dyes, the rash might outline the exact pattern of the clothing (eg socks, gloves etc).

How is the diagnosis for contact dermatitis made?

The dermatologist will take you through a thorough consult, taking down all history carefully and making note of all possible irritants and exposures. Once the dermatologist can clearly identify what is causing your rash, it is important to avoid direct contact with those irritants.

  • Avoid soap – use a pH-balanced cleanser suitable for sensitive skin
  • Dry skin carefully after washing

The rash can be treated with a short course of topical corticosteroid steroid. Apply emollients/moisturiser frequently while the rash is active and for some weeks afterwards as the normal skin barrier function is restored. Severe contact dermatitis may be treated with a short course of systemic corticosteroids, e.g. oral prednisone. Occasionally, for chronic contact dermatitis, phototherapy may be tried, or immunosuppressive agents such as methotrexate,ciclosporin or azathioprine may be prescribed.

 

Patch Testing

If the dermatologist can’t determine the exact cause of your dermatitis straight off sometimes we have to do a bit of detective work to get to a diagnosis, that’s where patch testing comes in!

 

Patch testing is a simple and non-invasive way of detecting what your body is allergic or reacting too. We are looking for a diagnosis to help narrow down how your skin reacts to certain stimulants when placed on your skin for a certain amount of time. The first appointment will be a history taking exercise and thorough examination to narrow down potential allergens.

 

After the allergens for patch testing are then ordered (which can take 1-2 weeks), we will bring you back for an appointment to place allergen strips on your back. You will then come back 48 hours later to have your first reading; the second reading will be a further 48hrs to see if you have had a late reaction. Hence, we find doing a Monday-Wednesday-Friday cycle the most efficient way of conducting the readings.

 

We do a very thorough testing and can test for a range of different irritants such as

-Sunscreens                     -Airborne Allergies                -Tapes/dressings

-Fragrances                     -Textile dyes                          -Metals/nickel

-Cosmetics                     -Corticosteroids                     –Car Fragrance/air fresheners

-Hairdressing products

 

Once we get a diagnosis, we can then look at removing these from your routine and start treatment for you. These results can be positive OR negative, all leading to a diagnosis. If not allergic contact dermatitis then possibly irritant contact dermatitis could be the diagnosis.

Just remember to be patient, it is a process to get to a diagnosis, but it can be life changing once we get a diagnosis for you!

To start your skin journey and for patch testing appointments with one of our dermatologists please call our clinic on 9039 5644.

IN THE MEDIA – Rosehip Oil

Read Dr Hope Dinh’s full interview with the Australian Women’s Weekly (May 2019 issue) on her thoughts on Rosehip oil and is it as good as it smells?!

Here is the interview excerpt with Dr Dinh (in Q & A form!)

What solid benefits do they have for skin?

Rose hip oil is good for pigmentation issues, scars and fine lines. This is because in addition to nourishing and moisturising omega-6 essential fatty acids and antioxidants, it also contains vitamins A and C which help to increase cell turn-over; producing a retinol-like effect.

Plant oils are commonly used for cosmetic purposes and have been found to have many benefits . Rosehip oil is rich in antioxidants including Vit C, E, B and abundant in unsaturated fatty acids (linoleic) which are shown to reduce transepidermal water loss (TEWL) and reduce irritation through barrier repair.

Rosehip oil can also help with acne due to its high concentration of linoleic acid, allowing for an anti-inflammatory effect.

Are there any drawbacks (from my understanding so far, the fragrance component of rose oil is irritating and inflammatory)?

Fragrances in general are high on the list of allergic contact dermatitis.  Rosehip oil is widely available as a pure oil and so irritation from fragrances as such is not necessarily an issue.  Care should be taken in sensitive skin when using products containing Rosehip oil as other additives can cause irritation, particularly because of the high concentration of antioxidants such as Vitamin C and Tocopherol (Vitamin E), can be an allergen.

Anything used in high quantities and without regard to how the individual persons skin is reacting can potentially cause irritant contact dermatitis. You don’t necessarily have to use it daily to reap the benefits. By using the oil less frequently, there may be less risk of skin irritation for those who are prone to sensitivity.  End message I give most of my patients is to start at low frequency application e.g. every 2-3 days and then after a while can slowly titrate up frequency, carefully looking for irritation or other side effects.

When a skin boil is more serious….could this be hidradenitis?

Hidradenitis Suppurativa (HS) – the latest information from the recent Melbourne Dermatology Conference May 2019.

Every year the Australasian College of Dermatologists holds an annual scientific meeting to update us all on the latest advancements in the diagnosis and management of dermatologic diseases. This year it was held in Melbourne (YES – my home town!). After 4 days of absorbing all this amazing information, my head is bursting with ideas for managing our existing patients. One session that really got my attention was the hidradenitis suppurativa lecture. Mainly under-diagnosed and sub-optimally managed, the prevalence of this condition is 0.67% (so, it’s more common than you think!). It was pleasing to hear that dermatologists lead the list of the medical specialists diagnosing this condition but there is STILL a LONG delay of MANY YEARS to patients being formally diagnosed with this condition.

WHY?

There can be many factors leading to diagnosis delay including embarrassment from the patient about the condition and so they never speak up about it, sub-optimal education of other medical specialties about the condition, patients thinking it is just a “simple boil” in the groin etc  ……in order to diagnose HS earlier, the public needs to be more aware that a condition like HS even EXISTS…..

We really should be asking our patients –Do you suffer from sore painful lumps or boils under your armpits or groin area?? Do you mind if I have a look? As it could be hidradenitis suppurativa.”

“SEEK and YOU WILL FIND”

_____________________________________________________________________________

Hidradenitis suppurativa is an inflammatory skin disease that affects gland-bearing skin in the underarms, in the groin, and under the breasts. It is characterised by recurrent boil-like nodules and abscesses that culminate in pus-like discharge, difficult-to-heal open wounds (sinuses) and scarring. Hidradenitis suppurativa also has significant psychological impact and many patients suffer from impairment of body image, depression and anxiety.

Hidradenitis often starts at puberty, it is most active between the ages of 20 and 40 years, and in women, can resolve at menopause. It is three times more common in females than in males. Risk factors include:

  • Other family members with hidradenitis suppurativa
  • Obesity and insulin resistance/metabolic syndrome
  • Cigarette smoking
  • Acne
  • Inflammatory bowel disease
  • Rare autoinflammatory syndromes

Signs and Symptoms

HS can affect single or multiple areas in the armpits, neck, sub mammary area, groin and inner thighs. Anogenital involvement most commonly affects the groin and vulva (in females), sides of the scrotum (in males), buttocks and perianal folds.

  • Open and closed comedones (white heads and blackheads)
  • Painful firm papules, larger nodules and pleated ridges
  • Pustules, fluctuant pseudocysts and abscesses
  • Draining sinuses (like “tunnels” under the skin) linking inflammatory lesions
  • Thick (hypertrophic) scarring

Hidradenitis can be associated with inflammatory bowel disease and so it is important for your dermatologist to also consider screening for your risk of this condition too. HS can also be associated with acne, psoriasis and hirsutism.

General measures you can do at home

  • Loose fitting clothing
  • Avoiding too much friction in affected areas (being careful with the types of exercise pursued). It may be worth considering the High Intensity Workout regimes which get your blood pumping quickly but minimise too much frictional irritation.
  • Reduction in weight (to lead to decreased friction in the skin fold areas); dietician advice may be helpful
  • Daily un-fragranced antiperspirants
  • If prone to secondary infection, wash with antiseptics or use dilute bleach baths
  • Apply simple dressings to draining sinuses
  • Analgesics, such as paracetamol (acetaminophen), for pain control
  • Seek help to manage co-existing mood issues such as anxiety and depression
  • Seek GP advice about weight loss, mood issues, quitting smoking etc. Also GPs can act and possibly come up with Team Care Arrangements which then allow patients to access some allied health services for FREE (like dietician consults and psychological support).
  • Join a support group so you can receive tips and support from people who going through the EXACT same issues as you!

We are here to help you manage your disease!

The dermatologist may prescribe local therapies such as –

  • anti-septic washes (such as Phisohex or Chlorhexidine),
  • antibiotic cream (such as Clindamycin 1% cream),
  • injections of steroid solution into the inflamed lumps.
  • Topical vitamin A creams (retinoids) to help unblock the blackheads and whiteheads

Oral medications include –

  • Oral contraceptive pill or hormonal treatments such as spironolactone (for females).
  • Oral antibiotics to clear any infection and reduce inflammation (must be taken for a few months to see the outcome).
  • Vitamin A tablets such as isotretinoin or acitretin
  • Metformin (a diabetic medication) which can help with the insulin resistance pathway which can drive HS
  • Oral immunosuppression tablets

Injectables

  • There are the new injectable “biologic” medications which have recently been approved under the PBS for eligible patients with hidradenitis.

Surgery

  • Simple surgery that can be done at the dermatologist without general anaesthetic. This is the technique of de-roofing the very inflamed lesions to allow for healing.
  • More complex surgery can be done in hospital via Plastics and usually done with consultation with the Dermatology Team.

Key points to remember

– Get the correct diagnosis from a professional such as a dermatologist EARLY, don’t mistake it just as a pimple

– Early treatment can mean less chance of scarring

– There are simple home measures you can do to prevent them from flaring

– With appropriate treatment you can stop this disease from returning

Want to know more? Here are some online resources

https://www.hs-online.com.au

https://www.dermnetnz.org/topics/hidradenitis-suppurativa/

http://anzvs.org/patient-information/hidradenitis-suppurativa/

http://hidradenitissuppurativasupportgroup.org/