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Acne Treatment Options

Hi Dr. Reichel, I'm a student & trying hard on a research task I've been given to ask world's best Dermatologists about the best practices to get rid of acne in few concise sentences. Hope you'll take a few minutes to help me in completing my research.



I don't know that I would be considered a world expert on acne - as my practice focuses on Skin cancer surgery and Cosmetic Surgery. However, I would say treatment for acne depends on the type of acne that an individual has, and how severe the acne is. For mild cases, topical medications such as Retin-a, Benzyl Peroxide, and Clindamyacin can be very effective. For more severe cases, oral medications are indicated. The front line for oral meds would be antibiotics such as minocycline or doxycycline. For females with acne that tends to be hormonal, a medication called spironolactone works very well. For really severe cases, and those that are scarring, then Accutane would be indicated. This is a difficult medicine to take, and does have side-effects, but is absolutely imperative to use in patients with scarring cystic acne. Non-medications such as chemical peels and intense pulse light can also be used to treat acne effectively.
Jennifer Reichel MD
Director, Pacific Dermatology & Cosmetic Center
Seattle, WA and Renton, WA

Dr. Jacobson on KOMO radio

It's skin cancer awareness month and KOMO's Art Sanders talks to leading dermatologist Dr. Laurie Jacobson about the danger even here in Seattle


Does Your Neck Need Special Anti-Aging attention?

There is a cream for everything these days. From your under eyes to your feet—no area of the body has been neglected by beauty brands looking to sell you a new way to look your best. But do all these areas actually need their own skin-care regimen? We wanted to know, especially when it comes to the neck—a lesser-known area of the body that can really tattle tale our true age.

Anti-aging creams and serums designed specifically for the neck are popping up everywhere, and it's true that this area and the décolletage are commonly neglected areas of the body when it comes to maintenance and care. "One of the largest mistakes I see women make in their skin-care regimens is neglect of the neck and upper chest," says Dr. Jennifer Reichel of Pacific Dermatology & Cosmetic Center. And it turns out, the neck is just as susceptible to damage and aging as the face. "Over the course of a lifetime, necks and chests are exposed to as much UV light as faces, but don't get the same good consistent skin care routine that most women establish for their faces," she says.

Over time, neglect of the neck leads to mottled red and brown pigmentation with sagging and wrinkling of the skin. But that doesn't mean you have to run out and purchase a cream designed specifically for the skin of the neck if you already have one for your face.

"In general women do not need specific different products for their necks/upper chests, but it is important to remember that this can often be more sensitive skin (thinner with fewer oil glands) that can become irritated more easily by aggressive topical products," says Dr. Reichel.

That means that the best rule of thumb for neck care is to give it the same treatment you give your face. When exfoliating or applying moisturizer, don’t stop at your jawline. Antioxidant protection and sunscreen are of utmost importance as well. "I encourage my patients to think of their neck as an extension of their face to ensure it gets the benefit of daily sunscreen and other skin maintenance products; we are big fans of Skinceuticals A.G.E. Interrupter as well as their vast line of zinc-oxide sunscreens." she says.

And if you have neglected your neck over the years, it's not too late to reverse the sagging and wrinkling. When treated early, neck wrinkles can be softened with neurotoxin injections, such as Botox, to help release constricting muscles. Slack skin on the neck can also be treated with Ultherapy, this FDA-cleared device used in the procedure utilizes the safe, time-tested energy of ultrasound to stimulate the deep structural support layers of the skin.

If the wrinkling and sagging is really bothering you, Seattle Dermatologist Jennifer Reichel, says you "can tighten the skin using nonsurgical treatments such as Fraxel Dual or Fractional CO2."  Call our office to schedule your consultation, and get the results you've always wanted.

Is Mixing Skin-Care Products Dangerous?

Every dermatologist and skin-care professional has their own opinion when it comes to combining ingredients. Some doctors say strong ingredients should never be mixed together and should be used solely on their own, while others disagree, saying it’s safe to use them together as long as they’re applied at different times of the day. Before you layer product on top of product, seek out the advice of your dermatologist to reduce your risk of irritation.

Don’t mix vitamin C with:

1. Alphahydroxy Acids (AHAs): Overloading your skin with too many acid based-ingredients (both vitamin C and AHAs are acid-based) increases your chances of redness, peeling and irritation. “Some AHAs come with instructions to wash it off after a certain amount of time so that the skin can accommodate and tolerate it,” says Seattle dermatologist Jennifer Reichel, MD.

2. Copper Peptides: Copper peptides help to encourage elastin and collagen formation, making it necessary for wound healing. But when used with vitamin C, the effects of each are cancelled out, rendering the benefits useless.

3. Retinol: Many experts will say that super-strength concentrations of vitamin C and retinol shouldn’t be applied to the skin together, or only with extreme caution, since both are very powerful and can cause the skin to become dry. However, there are some topical products that contain both ingredients, but chances are they contain low concentrations of each, making them safe to use.

Don’t mix retinol with...

1. Benzoyl Peroxide: Retinol and benzoyl peroxide can ward off acne and prevent the formation of new blemishes, but when used simultaneously, they can counteract each other’s benefits. “Both are drying, exfoliating, peeling agents, and when they’re mixed together, they can cause excessive peeling, unwanted pigment, lasting redness and even blistering and scarring,” explains Dr. Reichel.

2. AHAs: Both retinol and AHAs can help to generate new collagen, but be careful when using them together. “It’s okay to use both as long as you are not too sensitive to the combination,” says Dr. Reichel. “Women with sensitive skin need to alternate, applying the AHA in the morning and retinol at night for the first few weeks so tolerance can be built.” If you’re using either a retinoid or AHA, it’s essential to use a daily sunscreen as well, since both cause UV sensitivity.

Fall is Coming...Peel Your Way to Flawless Skin

Credit: Harry Vorsteher/Corbis

There’s no better way to perk up dull skin than with a chemical peel. A beauty staple since the days of Cleopatra (who was said to bathe in spoiled milk, the basis of lactic acid), the formulations and peeling agents used today may have been adapted to meet modern-day beauty standards but the basic principle of exfoliation for an immaculate complexion remains a steady constant.

Light Peels - alphahydroxy acids (AHAs) and betahydroxy acids

Good for:  Lightly refreshing the skin

You’ll notice:  Subtly smoother, more evenly toned skin and less blemishes

Medium Peels- trichloroacetic acid (TCA)

Good for: Correcting moderate wrinkles, lines and sun damage

You’ll notice: Significantly smoother skin that’s more even in tone with fewer lines and spots

Deep Peels - phenol acid

Good for: Extreme resurfacing

You’ll notice: Drastically smoother skin sans wrinkles and pigmentation

Understanding the Strengths: Just like how ingredients, such as retinoids and vitamin C, are available in different strengths, so are the peeling agents used in chemical peels.

On the Low End: Each acid ranges in strength—single digits and 10 percent concentrations are on the more gentle side; 20 to 70 rank on the higher end.

Stronger Peels Offer an Advantage: The higher the percentage of the acid used in a chemical peel, the more damage reversal it can do for your   skin.

Formulation Counts: “The different percentages are like the difference between using an over-the-counter product versus a prescription-strength version,” says Santa Ana, CA, dermatologist Tony Nakhla, MD. Take, for example, glycolic acid. “It can come in different strengths and pH levels, or combined with other ingredients. These factors help to determine how efficacious the product is, and how deep it can penetrate,” says Boca Raton, FL, aesthetician Cheryl Staurowsky.

Skin Basics: Every 28 days or so our skin sheds—a natural healthy process that is essential. “Stimulating the natural exfoliation cycle purposely removes the outer layer of cells to improve the texture of your skin faster,” says Dr. Nakhla. That’s where exfoliating chemical peels come in. “Superficial peels act as a means of exfoliation, but at a stronger level than what can be achieved with a manual exfoliator or scrub,” says Dr. Nakhla.

How deep a peel can go:

Light peels reach just the epidermis, the outermost layer of the skin to lighten discoloration, transform texture and fight breakouts

Medium strength peels work on the middle dermis or the layer of skin between the epidermis and the dermis for more serious resurfacing.

Deep peels get down to the dermis, the lowest layers of the skin, to dramatically soften lines and wrinkles

Something to keep in mind as we watch the 2012 Summer Olympics!

Skincare Advice for Athletes
Every four years we look forward to cheering on Team USA. These Olympians are the best of the best – swimming, diving, volleyball, running, you name it. But whether you are athletic or an athlete you sweat and sweating decreases your skin's natural protection against the sun’s harmful rays. You might not have as much skin in the game as Team USA but here are some tips to help you achieve fresh, glowing skin.
Slow it down … A recent study conducted by Berlin researchers showed that strenuous physical exertion actually produces oxidative stress that depletes the skin of antioxidants and makes it more vulnerable to skin damage. They found mild to moderate exercise actually has the opposite effect.
Cover up … If you can't give up your run or walk outside invest in some sun-protective clothing and always wear a hat and sunglasses. Also avoid working out during peak hours (10-2pm).
Go liquid … Liquid sunscreen has a high alcohol content and can keep you pimple free. Also stick with sunscreens that are hypoallergenic and oil-free. Prickly heat (otherwise known as heat rash) is a common disorder in athletes so avoiding certain types of SPF’s should help you avoid these types of skin complications.
Hydrate … Drink plenty of water and moisturize daily. Cetaphil® is a great everyday moisturizer that you can buy over the counter. If you are looking for something that can hydrate your skin and slow the aging process Skinceuticals is a great product line that will help turn back the clock.
Wash Off … Shower after working out. It helps cleanse your skin of bacteria, oil and dirt. We recommend using a mild soap to open up the pores and prevent breakouts. Exfoliating a few times a week will also give you that added glow.
It’s never too early to start thinking about your fall treatment plans including non-invasive procedures such as chemical peels or photofacials or a dermal filler like Restylane or Juvederm. Call us at 206.859.5777 to schedule a consultation or book your next treatment.



Enjoy the rest of your summer!

Is sugar affecting our skin?

Fight the Negative Effects of Sugar in Your Skin

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Fight the Negative Effects of Sugar in Your Skin

Posted Monday, July 02, 2012 by Anjelle Ruppe, Contributing Writer

Sure, you know that sugar isn’t exactly the best ingredient to consume on a daily basis, after all, it's bad for your figure and can also cause wrinkles.

That's because sugar molecules in your system attach to fats and proteins in a process called glycation, which leads to advanced glycation end products, commonly called AGEs, that cause protein fibers to become stiff and malformed.

Unfortunately, the proteins in your skin that are most prone to glycation happen to be the same ones that make a youthful complexion plump: collagen and elastin. During the process, they become discolored, weak and less supple, which then shows up on the skin as wrinkles, sagginess and a loss of radiance.

What's worse, these external signs start to show up around the age of 30 to 35, when sun damage, environmental oxidative stress, hormonal changes and the development of AGEs begins to result in fine lines.

It’s important to note that refined sugar is not the only culprit. Whole grains, fruits and vegetables also turn to glucose when digested, although there is less damage and these foods are necessary for our health. So, we shouldn’t completely eliminate all types of sugar from our diets. Thankfully, there are some options to fight off the unwanted results of glycation.

With regards to your diet, stay away from white sugar and high-fructose corn syrup, which studies have found increase the rate of glycation by 10 times, along with simple carbs. You can also take supplemental carnosine, an amino acid that has been shown to protect against AGE buildup.

Skin care is also important to slow glycation. Products that contain viable AGE fighters began to appear five years ago. Now that glycation is widely known as a major cause of aging, there are plenty of anti-aging creams containing AGE fighters, too. Green tea has been proven to significantly interfere with the glycation process, while it also stimulates collagen synthesis. So, use a product that contains this antioxidant-rich ingredient, or drink it regularly, to protect your skin from glycation.

“Anything that stimulates the fibroblasts to build new collagen is going to help eradicate damage,” says New York dermatologist Fredric Brandt, MD, who also notes that retinoids and some dermal fillers fall into this category as well.

A couple of products that fight glycation in the skin are SkinCeuticals A.G.E. Eye Complex ($86) which targets advanced glycation end products with blueberry extract and Amore Pacific Time Response Skin Renewal Serum ($500), which harnesses the antioxidant and collagen-restoring powers of green tea stem cells.

Great Beauty Finds for Mom

Finding the best gift for mom is no easy task, but look no further! We have identified some of the best beauty finds for Mother’s Day this year. These aesthetic products and treatments will help mom look even younger and more beautiful than she is today and make for the perfect gift. Here are our top picks.

In-Office Options: Some of our most popular anti-aging treatments are Photofacials and glycolic peels.  Each can soften fine lines and wrinkles, help smooth textured skin, decrease the appearance of scarring, reduce pore size, and reduce those age spots.  These are great gifts to help mom rejuvenate and re-discover that younger looking skin.  If you think mom might need a little extra help to turn back the clock, injectables like Botox® and Restylane® have little to no downtime and are great ways to reduce those lines and wrinkles. Mom will instantly erase a few years off her appearance after one of these treatments.

At-Home Options: There are several new anti-aging products on the market today to smooth fine lines.  Skinceuticals has an award-winning line of serums, CE Ferulic and Phloretin CF, as well as A.G.E. Interruptor that are formulated to help repair aging, damaged skin caused by daily sun exposure, irritants and pollutants while shielding the skin from damaging ultraviolet light.   A great product to help exfoliate and deep cleanse the skin is the Clarisonic® Sonic Skin Care System (this is the same company that developed the Sonicare tooth brush). The electric skin brush can remove 6x more makeup and 2x more dirt and oil than a wash cloth and will make mom’s skin look and feel beautiful.

Let Mom Choose: Gift cards are a great option if you aren’t sure what direction to go. Make it even more enjoyable for mom and see if one of her friends might want to join in. Our office can customize a great package to meet your needs.   If you have questions about any of these gift ideas call us at 206.859.5777 or email us at

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Thank you for choosing Pacific Dermatology & Cosmetic Center, we look forward to providing you with the very best skin care.