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CNN Sunday Morning
Weekend House Call
Aired November 23, 2003 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. From acne to rosacea and wrinkles, we're talking about new skin care treatments that are giving hope to millions of people who struggle with skin problems every day. Our Dr. Sanjay Gupta explains.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Everyday Brienne Pedago (ph) wages a battle against acne.
BRIENNE PEDAGO, ACNE SUFFERER: Most of my friends aren't going through this anymore. That was high school, that was middle school. So at 23, I kind of feel like, OK, enough. I've passed that phase in my life. I'm ready to be done with this.
GUPTA: She's been dogged by skin problems for years. No medications seem to work. The frustration often cropping up on her face.
PEDAGO: It's difficult when -- when there's something causing you to not feel so great.
GUPTA: Now she's receiving a new acne treatment, it's less than a year old; it's called Laser Photo Dynamic Therapy or Laser PDT.
DR. BRUCE KATZ, DERMATOLOGIST: This treatment originally was used to treat skin cancers and actually pre-cancers, as well. What we found when we were treating patients with these pre-cancers that their acne was getting better, too.
GUPTA: First Brienne's doctors apply something called aminolevulinic acid or ALA to the skin making bacteria photoactive and receptive to the laser. The ALA is absorbed for about an hour. Then ten minutes of quick laser bursts later, Dr. Bruce Katz says the bacteria are destroyed.
KATZ: The acne starts to clear after the first treatment. Then they may have two or three more treatments, and then it's gone.
GUPTA: So far, the difference in patient's skin is dramatic. Sude Dellinger's blotchy skin portrayed a lifelong problem with acne and rosacea and she'd just about given up hope.
SUDE DELLINGER, PATIENT: There wasn't a day that I wasn't dealing with some really bad issues. GUPTA: Six months have passed since she got Laser PDT and she hasn't had a problem since.
DELLINGER: It's just so much freer. It's the state of mind of not having to worry about it anymore.
GUPTA: Only a handful of doctors in the country perform Laser PDT, but Dr. Katz says promising early results coupled with minimal side effects may attract a range of acne sufferers to this new treatment option. One that he says is far superior to popular medications like Accutane, which can be dangerous for women who are pregnant or who want to be.
KATZ: We call this treatment Accutane without the side effects.
GUPTA: Patients like Brienne say the best part will be looking in the mirror and at life with a new attitude.
Dr. Sanjay Gupta, CNN, Atlanta.
(END VIDEOTAPE)
COHEN: Now, this new treatment doesn't always work for all kinds of acne and it isn't cheap. It can cost to $500 to $600 a session and patients need up to five sessions. In most cases this laser therapy is not covered by insurance and also the acne can come back even after treatment. Now, more than 80 percent of people are affected by acne at some point in their lifetime. It usually starts when someone's around 10 to 13 years old. Normally it can be handled with over-the- counter treatments, but 40 percent of kids with acne end up going to the dermatologist in their mid-teens. Now, wouldn't it be great if acne just affected you in your teens, but as we know, that's not the case. Adults spend over $100 million a year for over-the-counter acne treatments.
We want to hear from you. If you or someone you know is battling acne, give us a call at 1-800-807-2620, or e-mail us at housecall@CNN.com.
Joining us this morning is Dr. Darrell Rigel, professor of dermatology at New York University Medical Center.
Good morning, Dr. Rigel.
DR. DARRELL RIGEL, DERMATOLOGIST: Good morning, Elizabeth.
COHEN: Thanks for joining us to talk about all these problems. Let's start right off with Veronica from Connecticut who has a question about this new laser.
VERONICA, CONNECTICUT: Caller: hello?
COHEN: Hi Veronica, welcome to WEEKEND HOUSE CALL. What's your question for the Dr. Rigel?
VERONICA: I wanted to know about the laser treatment. Is that good for African-American skin?
RIGEL: Well, Veronica, that's a wonderful question. When you look at acne, there's so many ways to treat it and this is one of the ways to do that. With that older lasers, that actually was a problem because the darker skin absorbed a lot of the energy instead of the acne absorbing the light energy and therefore you didn't get really, the benefit of the treatment. With some of the newer lasers that out there, as well as non-lasers, but also things that use light, like blue lights, for example, you can use this on darker skins and be almost as effective.
COHEN: We also have a phone call from Diana in Pennsylvania.
Diana, welcome to WEEKEND HOUSE CALL and go ahead with your question.
DIANA, PENNSYLVANIA: Yes, hello. I have a 12-year-old granddaughter who is experiencing really bad acne on her forehead and down the side of her face. We've tried everything from astringents to Retinol-A and, need also to say, it's really taking down her self- esteem really bad, and I want to know if there's something you can help us with?
RIGEL: Well, dermatology is very visual, so it's hard without seeing, although you did a very good job describing what the problem was. You know, we as dermatologists are fortunate because we get to do things with medicines, with surgery, and with appearance related things across the board, and there's so many different ways to approach acne. I tend to be, with a 12-year-old, in favor of using less strong things because I don't want, any of the long-term effects of some of the other things being involved. So, I would suggest some of the things you're using topically are fine. There are topical antibiotics you can use, that I don't -- you didn't give on your list that might be helpful. I think a good cleansing regimen, washing the face twice a day, all those things together, would be where I would start. And if those didn't work, I might take it on to the next level.
COHEN: Well, as we head earlier, acne does not just affect teens. We have an e-mail from Susan in Colorado who wants to know: "I'm 36 and I'm experiencing an acne problem for the first time in my life. Why now? I never even had acne as a teenager."
Doctor, is that unusual, for people to just get acne in their 30's when they never had it before?
RIGEL: No actually, it is a fairly common event; it's called Adult Onset Acne. It's acne that appears, not when you're a teenager, but typically about age 30 or so. It happens about ten times more frequently in women than men. Usually the acne tends to be a little more on the mild side, but that's the kind of acne that typically you don't need the intense treatments like Accutane, but you could use the topical treatments or even some of the new light-based treatments that you heard about earlier in the show.
COHEN: We have an e-mail now, from Linda in Pennsylvania, who wrote in asking: "I was wondering if an Erbium laser would permanently remove acne scars and fine lines? How much pain is involved and how much downtime would I need?"
Doctor, exactly what is an erbium laser?
RIGEL: Well, that's part of the fun of being a dermatologist. We're everywhere from mixing medications up to being a physicist with lasers. An Erbium laser is a type of laser that emits a specific wavelength of light that works in a lot of things related to the skin. In terms of scarring, what the Erbium laser actually does is induce the collagen under the skin, not the surface of the skin, but the area below the skin, to re-grow and to fill. The reason you see an acne scar is because it shadows and when the light comes in, you see -- it's almost a little crater. But, in fact what happens is this fills it up so it becomes less apparent. Erbium lasers have been around for a while and there are other ones that work similarly well. But, the point is there are lasers out there that could a pretty good job on helping with acne scarring.
COHEN: Well, millions of people suffer, not just from acne, but from rosacea and psoriasis. Coming up next, we'll tell you about new treatments that can dramatically reduce the redness associated with both of these conditions.
Give us a call, 1-800-807-2620. Dr. Rigel is here to answer your questions. Or e-mail Dr. Rigel at housecall@CNN.com. Stay with us.
(COMMERCIAL BREAK)
COHEN: Hope is on the way for those who suffer from psoriasis, an incurable skin condition characterized by itchy, dry patches. Studies out in the "New England Journal of Medicine" this week show two drugs: Enbrel and Raptiva help fight psoriasis. When people have psoriasis, their immune system starts to run a muck, these drugs tell the immune system to calm down. Enbrel is currently used to treat rheumatoid arthritis, Raptiva is a brand new drug, both reduce inflammation. The downside of these drugs? Researchers are checking to see if by suppressing the immune system you put yourself at a higher risk for cancer.
With us to talk about new skin care treatments is dermatologist Dr. Darrell Rigel.
Doctor, we've gotten lots of phone calls and e-mails on this disease that can be so devastating. Let's start with an e-mail from Paul in California who asks: "Is there anything new in the treatment of psoriasis?"
Now, we've already talked about Enbrel and Raptiva. Doctor, are these drugs just for severe cases or for anyone with psoriasis?
RIGEL: Well, they're primarily for people with fairly severe psoriasis. They're actually a whole new class of drugs. When I get excited about dermatology is because there are so many new treatments that are out there. There are actually four drugs in this category one is -- another one called Amevive, another one called Remicade. But, the whole idea behind these drugs is that they're called biologics because they use the body's own mechanisms to fight disease to help fight this off. So, when we'd been treating psoriasis in the past, we've been just treating the system symptoms, trying to get rid of some of the scaling, some of the redness, but now we have a way to treat it at its source, and that's why it's so exciting.
COHEN: There's another common, but not so well known skin disorder called rosacea. If you notice redness on your cheeks or nose or small blood vessels, bumps or pimples and you have watery or irritated eyes, you may have rosacea. As we mentioned at the beginning of this show, new pulse laser treatments may be able to help you.
Let's take more of your questions. We have a phone call -- or I'm sorry, an e-mail from Manisha -- oh, I'm sorry, it was a phone call from Ingrid in Virginia.
Ingrid, go ahead with your question for Dr. Rigel.
INGRID, VIRGINIA: Hi, doctor. I have rosacea and I have two questions. One is, I know rosacea can go into the eyes. Can you tell me about that, how does that work and is it dangerous?
RIGEL: Well, the first answer to that, basically, is rosacea is an involvement of the oil glands around the eyes sometimes and some redness. It can be when it is extreme, but most of the time it can be controlled in some simple ways.
COHEN: We have an e-mail now from Marcy in New York, also about rosacea. She wants to know: "What do you recommend for rosacea, not in terms of daily treatment, but something like a laser to take away the redness?"
Doctor, can you talk about lasers for rosacea?
RIGEL: Yeah, basically rosacea is the red face that you see on people. The extreme of rosacea would be the W.C. Fields look with the large nose. That's what happens over long periods of time, and not everybody progresses to that. But, when you see the redness around the face, the blood vessels in the corner of the nose, all those things are the spectrum of things you see with rosacea. And basically, it's the redness that's the problem. There are lots of ways to treat it. The simplest ways is to use creams. There area a variety of topical agents that can be used to treat it. But for those with the redness that just doesn't go away, we're fortunate that there are laser and laser-like devices -- intense pulse light devices that, in fact, can be used to treat it and these treatments are nice because five years ago when you had treatments like this, your face would look like raw hamburger for ten days and your face would be red for three months. Now the treatments are such, you can come in at lunchtime and leave and go right back to work in the afternoon and nobody will know you had anything done, there are no after effects. And within a couple of weeks you'll see improvements. So, these whole new sets of treatments are exciting because using lasers, we can treat rosacea much better.
COHEN: Do rosacea or psoriasis ever go away on their own? If you have just have a mild case can you kind of just wait it out?
RIGEL: Well, with psoriasis it might, although it's kind of chronic, it lasts over time. The average person, who has psoriasis, may just have a little bit of redness and scaliness on the knees and on the elbows, but not typically in the other areas. And even using a good moisturizer sometimes will help. With rosacea, it's hard to totally get rid of it. It comes and goes. But, there are a lot of other factors in rosacea including stress, that makes it worse; caffeine; alcohol; a lot of good things, too. So, if you eliminate all those things from your life, your risk goes down for getting rosacea in the future, if you have a tendency towards it. But, the reality is, it doesn't usually just go away on its own.
COHEN: Manisha from Virginia wants to know: "What is the cause of rosacea? Are there any other over-the-counter forms of treatment available?"
Doctor, you were talking about things that you would have to go to the doctor to get. Is there anything over-the-counter for rosacea?
RIGEL: Well, you know, one of the things that can be used, I guess, and some people do use, when have you that redness, is to use a cover-up makeup and what you need is a makeup that has some green in it. Green will absorb the red. That's a common trick that's used to bring that redness down. If you put too much on though, you kind of look like a Martian, you look too green, so that's a balance of what you have to do. But, the other thing is to -- again as I mentioned, to avoid caffeine, avoid alcohol, avoid spicy foods, try to get the stress out of your life. All those things together will, in fact, help rosacea somewhat.
COHEN: Well, next we're going to be talking about winter. It can be especially harsh on your skin. It can get dry and scaly and even though it's cold out, you can still get sun damage. We'll talk -- find out from our doctor the best ways to keep your skin merry this winter are season when we come back.
(COMMERCIAL BREAK)
COHEN: Welcome back to WEEKEND HOUSE CALL. We're talking about taking care of your skin. We're joined by Dr. Darrell Rigel, a professor of dermatologist at New York University Medical Center.
Dr. Rigel, winter has descended in most parts of the United States and many people think the sun is less dangerous, but what's your advice to viewers on wintertime sun protection?
RIGEL: Well, never forget that sun you get any time of the year can cause you problems. And, people don't realize that even in the winter, the amount of sun you're getting, even in the northern part of the United States, is such that you still can hurt yourself. So, my advice is, it always pays to wear sunscreen and protect yourself that way. Again, the less sun that hits your skin when you're -- at least have the protection, the less risk you're going to have in the long run. One in five Americans get a skin cancer of some sort in their lifetime. There will be over a million cases this year in the United States, and in fact, it's totally preventable, basically, with some simple things.
COHEN: Well, the phone calls and the e-mails are lining up on this subject. Let's talk to Ramona in Louisiana. She has a question about wrinkles in the winter.
Ramona, welcome to WEEKEND HOUSE CALL, and go ahead with your question.
RAMONA, LOUISIANA: Ah yes, I'm calling to see what kind of moisturizer you would use for the wrinkles and the dryness in Louisiana?
RIGEL: Well, that's a great question because people usually ask that question in Colorado or Minnesota, but remember even in Louisiana, in the winter, it gets drier. What happens when it's drier outside -- it's always drier everywhere in the winter than it is in the summer that, the moisture comes out of your skin, so therefore, your skin dries, it can get flaky, it can get wrinkly. What you have to do is moisturize, and the way you do that, the best way is when you come out of the bath or come out of the shower, that's the time to put the moisturizer on. Because what it does, it then seals in the moisture that your skin has taken in during the time you are cleansing, so the best time to do it again, is right after you come out of the shower, put that fine layer of moisturizer on and that will protect your skin the best.
COHEN: Doctor, when you go to the drugstore, there's an entire aisle of moisturizers, each claiming to be the best. How do you know which is really the best? What should you look for?
RIGEL: Well, that's also a great question because a lot of it is a difference in marketing or packaging or whatever. The absolute best moisturizer, if you didn't care how it felt, would be Vaseline, because it skin seals the skin surface really, really well. But, I don't think most people want to put just pure Vaseline on their skin. So, it's a trade off. The heavier moisturizers are better from a moisturizing point of view, but they may block your pores, they could cause acne. The lighter moisturizers feel better, but they're not as effective. So, the best way to do it is try a couple and see which works best on your skin. Try on the back of your hand, that's the best way to test it. Use one on one hand, one on the other hand, and those sorts of ways you can really find out which works best for you.
COHEN: We have an e-mail now from Chris in Minnesota who asks: "Now that winter is here, my skin has turned red, dry, and scaly. I have not found an over-the-counter lotion that does not cause a rash. Are there any treatments for extremely dry skin that are safe for people who are allergic to lotions with fragrances?
Doctor, I imagine this is a relatively common problem.
RIGEL: Very common. And there's the question from Minnesota we were talking about, but -- but the reality is in the wintertime this is a problem for several reasons. When you're in a cold, dry area, what happens is you're in a heated building and the air from outside is heated up and if moisture's not added to that air, and it's not in most of the buildings, the air is so dry it's just sucking the moisture out of your skin. Your skin gets red, it gets irritated, it itches, you get rashes. So, you try to use a moisturizer and there are people like me, too, who, in fact, are very allergic to fragrances. So, you put that on and your skin is more moisturized, but you get the rash and the itching. So, the trick is find something that's fragrance free, not unscented, but fragrance free, those are two different things. Try something again, that works on you, and if you're still red try a mild hydrocortisone, the 1 percent hydrocortisone over the counter that's available, when that doesn't work, go see your dermatologist, because there are lot of prescription medications that can be used to really help you in the winter.
COHEN: Doris in Oregon also has a question about dry skin, I think this time, extremely dry skin. "Are there any treatments for eczema other than steroid creams?"
Doctor can you first explain -- briefly explain what eczema is?
RIGEL: Well, eczema basically is the extreme of the dry skin we were talking about, and what it is, it's an inflammation of the skin that's really due to your body's ability not able to produce enough oil causing that kind of dryness. The skin can break down, bacteria can get in, it can become infected. But, it really tends to itch and it tends be primarily on arms and legs, but can be anywhere. The typical way to get rid of the inflammation of eczema is to use an anti-inflammatory, in other words a cortisone, to bring the inflammation down. But, there are other medications beyond that. First of all, a good moisturizer is helpful and there's a whole other class of drugs that are out there: Eladil is one that's very good, Protopic is excellent, these are drugs that are not cortisone related, but can be used to treat eczema, too. So, if somebody has a severe case, again, I suggest they see their dermatologist to really have those drugs available to them.
COHEN: Well, stay where you are, when we come back, I'll give you some Web sites where you can go for more information on all the skin care troubles we've talked about. But first, a look at some medical headlines from this week in today's "Your Health."
(BEGIN VIDEOTAPE)
GUPTA: The CDC sounded the alarm on flu this week saying this year's flu season is starting much earlier than expected. In addition, experts say that many of the cases they've seen so far are not of the strain contained in the vaccine, but that a flu shot will still provide some protection.
Also, green onions are being pulled from Chi-Chi's restaurants across America. According to public health officials, the vegetables were a possible cause of the recent outbreak of Hepatitis-A in Western Pennsylvania. Officials stress though, if they are cooked properly, the onions pose no danger.
"For Your Health" I'm Dr. Sanjay Gupta.
(END VIDEOTAPE) (COMMERCIAL BREAK)
COHEN: Welcome back to WEEKEND HOUSE CALL where we've been talking to dermatologist Dr. Rigel from the New York University.
Dr. Rigel, people are bombarded with all these different sales pitches for different skin treatments. Any words of wisdom for consumers?
RIGEL: Well, I think the bottom line is if the claim sounds too good to be true, it probably is. And, what I would suggest is use your dermatologist as your resource. If you have a question, contact your dermatologist. We really do know or not, what's going on there. See your dermatologist once a year on your birthday. Have your birthday suit examined. If do you that, most of the things we talked about today, really should not be that big a problem.
COHEN: Well, we're out of time for today. Thank you Dr. Rigel. Make sure to watch next weekend's WEEKEND HOUSE CALL, we'll be talking about battling holiday stress, so tune in and hopefully chill out.
Then on Sunday we're going to tackle winter woes from cold and flue to winter depression. That's next Sunday at 8:30 a.m. Eastern, 5:30 a.m. Pacific. I'm Elizabeth Cohen, thanks for watching.
CNN's "Sunday Morning" continues, right now.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired November 23, 2003 - 08:30 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
ELIZABETH COHEN, CNN MEDICAL CORRESPONDENT: Good morning and welcome to WEEKEND HOUSE CALL. From acne to rosacea and wrinkles, we're talking about new skin care treatments that are giving hope to millions of people who struggle with skin problems every day. Our Dr. Sanjay Gupta explains.
(BEGIN VIDEOTAPE)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Everyday Brienne Pedago (ph) wages a battle against acne.
BRIENNE PEDAGO, ACNE SUFFERER: Most of my friends aren't going through this anymore. That was high school, that was middle school. So at 23, I kind of feel like, OK, enough. I've passed that phase in my life. I'm ready to be done with this.
GUPTA: She's been dogged by skin problems for years. No medications seem to work. The frustration often cropping up on her face.
PEDAGO: It's difficult when -- when there's something causing you to not feel so great.
GUPTA: Now she's receiving a new acne treatment, it's less than a year old; it's called Laser Photo Dynamic Therapy or Laser PDT.
DR. BRUCE KATZ, DERMATOLOGIST: This treatment originally was used to treat skin cancers and actually pre-cancers, as well. What we found when we were treating patients with these pre-cancers that their acne was getting better, too.
GUPTA: First Brienne's doctors apply something called aminolevulinic acid or ALA to the skin making bacteria photoactive and receptive to the laser. The ALA is absorbed for about an hour. Then ten minutes of quick laser bursts later, Dr. Bruce Katz says the bacteria are destroyed.
KATZ: The acne starts to clear after the first treatment. Then they may have two or three more treatments, and then it's gone.
GUPTA: So far, the difference in patient's skin is dramatic. Sude Dellinger's blotchy skin portrayed a lifelong problem with acne and rosacea and she'd just about given up hope.
SUDE DELLINGER, PATIENT: There wasn't a day that I wasn't dealing with some really bad issues. GUPTA: Six months have passed since she got Laser PDT and she hasn't had a problem since.
DELLINGER: It's just so much freer. It's the state of mind of not having to worry about it anymore.
GUPTA: Only a handful of doctors in the country perform Laser PDT, but Dr. Katz says promising early results coupled with minimal side effects may attract a range of acne sufferers to this new treatment option. One that he says is far superior to popular medications like Accutane, which can be dangerous for women who are pregnant or who want to be.
KATZ: We call this treatment Accutane without the side effects.
GUPTA: Patients like Brienne say the best part will be looking in the mirror and at life with a new attitude.
Dr. Sanjay Gupta, CNN, Atlanta.
(END VIDEOTAPE)
COHEN: Now, this new treatment doesn't always work for all kinds of acne and it isn't cheap. It can cost to $500 to $600 a session and patients need up to five sessions. In most cases this laser therapy is not covered by insurance and also the acne can come back even after treatment. Now, more than 80 percent of people are affected by acne at some point in their lifetime. It usually starts when someone's around 10 to 13 years old. Normally it can be handled with over-the- counter treatments, but 40 percent of kids with acne end up going to the dermatologist in their mid-teens. Now, wouldn't it be great if acne just affected you in your teens, but as we know, that's not the case. Adults spend over $100 million a year for over-the-counter acne treatments.
We want to hear from you. If you or someone you know is battling acne, give us a call at 1-800-807-2620, or e-mail us at housecall@CNN.com.
Joining us this morning is Dr. Darrell Rigel, professor of dermatology at New York University Medical Center.
Good morning, Dr. Rigel.
DR. DARRELL RIGEL, DERMATOLOGIST: Good morning, Elizabeth.
COHEN: Thanks for joining us to talk about all these problems. Let's start right off with Veronica from Connecticut who has a question about this new laser.
VERONICA, CONNECTICUT: Caller: hello?
COHEN: Hi Veronica, welcome to WEEKEND HOUSE CALL. What's your question for the Dr. Rigel?
VERONICA: I wanted to know about the laser treatment. Is that good for African-American skin?
RIGEL: Well, Veronica, that's a wonderful question. When you look at acne, there's so many ways to treat it and this is one of the ways to do that. With that older lasers, that actually was a problem because the darker skin absorbed a lot of the energy instead of the acne absorbing the light energy and therefore you didn't get really, the benefit of the treatment. With some of the newer lasers that out there, as well as non-lasers, but also things that use light, like blue lights, for example, you can use this on darker skins and be almost as effective.
COHEN: We also have a phone call from Diana in Pennsylvania.
Diana, welcome to WEEKEND HOUSE CALL and go ahead with your question.
DIANA, PENNSYLVANIA: Yes, hello. I have a 12-year-old granddaughter who is experiencing really bad acne on her forehead and down the side of her face. We've tried everything from astringents to Retinol-A and, need also to say, it's really taking down her self- esteem really bad, and I want to know if there's something you can help us with?
RIGEL: Well, dermatology is very visual, so it's hard without seeing, although you did a very good job describing what the problem was. You know, we as dermatologists are fortunate because we get to do things with medicines, with surgery, and with appearance related things across the board, and there's so many different ways to approach acne. I tend to be, with a 12-year-old, in favor of using less strong things because I don't want, any of the long-term effects of some of the other things being involved. So, I would suggest some of the things you're using topically are fine. There are topical antibiotics you can use, that I don't -- you didn't give on your list that might be helpful. I think a good cleansing regimen, washing the face twice a day, all those things together, would be where I would start. And if those didn't work, I might take it on to the next level.
COHEN: Well, as we head earlier, acne does not just affect teens. We have an e-mail from Susan in Colorado who wants to know: "I'm 36 and I'm experiencing an acne problem for the first time in my life. Why now? I never even had acne as a teenager."
Doctor, is that unusual, for people to just get acne in their 30's when they never had it before?
RIGEL: No actually, it is a fairly common event; it's called Adult Onset Acne. It's acne that appears, not when you're a teenager, but typically about age 30 or so. It happens about ten times more frequently in women than men. Usually the acne tends to be a little more on the mild side, but that's the kind of acne that typically you don't need the intense treatments like Accutane, but you could use the topical treatments or even some of the new light-based treatments that you heard about earlier in the show.
COHEN: We have an e-mail now, from Linda in Pennsylvania, who wrote in asking: "I was wondering if an Erbium laser would permanently remove acne scars and fine lines? How much pain is involved and how much downtime would I need?"
Doctor, exactly what is an erbium laser?
RIGEL: Well, that's part of the fun of being a dermatologist. We're everywhere from mixing medications up to being a physicist with lasers. An Erbium laser is a type of laser that emits a specific wavelength of light that works in a lot of things related to the skin. In terms of scarring, what the Erbium laser actually does is induce the collagen under the skin, not the surface of the skin, but the area below the skin, to re-grow and to fill. The reason you see an acne scar is because it shadows and when the light comes in, you see -- it's almost a little crater. But, in fact what happens is this fills it up so it becomes less apparent. Erbium lasers have been around for a while and there are other ones that work similarly well. But, the point is there are lasers out there that could a pretty good job on helping with acne scarring.
COHEN: Well, millions of people suffer, not just from acne, but from rosacea and psoriasis. Coming up next, we'll tell you about new treatments that can dramatically reduce the redness associated with both of these conditions.
Give us a call, 1-800-807-2620. Dr. Rigel is here to answer your questions. Or e-mail Dr. Rigel at housecall@CNN.com. Stay with us.
(COMMERCIAL BREAK)
COHEN: Hope is on the way for those who suffer from psoriasis, an incurable skin condition characterized by itchy, dry patches. Studies out in the "New England Journal of Medicine" this week show two drugs: Enbrel and Raptiva help fight psoriasis. When people have psoriasis, their immune system starts to run a muck, these drugs tell the immune system to calm down. Enbrel is currently used to treat rheumatoid arthritis, Raptiva is a brand new drug, both reduce inflammation. The downside of these drugs? Researchers are checking to see if by suppressing the immune system you put yourself at a higher risk for cancer.
With us to talk about new skin care treatments is dermatologist Dr. Darrell Rigel.
Doctor, we've gotten lots of phone calls and e-mails on this disease that can be so devastating. Let's start with an e-mail from Paul in California who asks: "Is there anything new in the treatment of psoriasis?"
Now, we've already talked about Enbrel and Raptiva. Doctor, are these drugs just for severe cases or for anyone with psoriasis?
RIGEL: Well, they're primarily for people with fairly severe psoriasis. They're actually a whole new class of drugs. When I get excited about dermatology is because there are so many new treatments that are out there. There are actually four drugs in this category one is -- another one called Amevive, another one called Remicade. But, the whole idea behind these drugs is that they're called biologics because they use the body's own mechanisms to fight disease to help fight this off. So, when we'd been treating psoriasis in the past, we've been just treating the system symptoms, trying to get rid of some of the scaling, some of the redness, but now we have a way to treat it at its source, and that's why it's so exciting.
COHEN: There's another common, but not so well known skin disorder called rosacea. If you notice redness on your cheeks or nose or small blood vessels, bumps or pimples and you have watery or irritated eyes, you may have rosacea. As we mentioned at the beginning of this show, new pulse laser treatments may be able to help you.
Let's take more of your questions. We have a phone call -- or I'm sorry, an e-mail from Manisha -- oh, I'm sorry, it was a phone call from Ingrid in Virginia.
Ingrid, go ahead with your question for Dr. Rigel.
INGRID, VIRGINIA: Hi, doctor. I have rosacea and I have two questions. One is, I know rosacea can go into the eyes. Can you tell me about that, how does that work and is it dangerous?
RIGEL: Well, the first answer to that, basically, is rosacea is an involvement of the oil glands around the eyes sometimes and some redness. It can be when it is extreme, but most of the time it can be controlled in some simple ways.
COHEN: We have an e-mail now from Marcy in New York, also about rosacea. She wants to know: "What do you recommend for rosacea, not in terms of daily treatment, but something like a laser to take away the redness?"
Doctor, can you talk about lasers for rosacea?
RIGEL: Yeah, basically rosacea is the red face that you see on people. The extreme of rosacea would be the W.C. Fields look with the large nose. That's what happens over long periods of time, and not everybody progresses to that. But, when you see the redness around the face, the blood vessels in the corner of the nose, all those things are the spectrum of things you see with rosacea. And basically, it's the redness that's the problem. There are lots of ways to treat it. The simplest ways is to use creams. There area a variety of topical agents that can be used to treat it. But for those with the redness that just doesn't go away, we're fortunate that there are laser and laser-like devices -- intense pulse light devices that, in fact, can be used to treat it and these treatments are nice because five years ago when you had treatments like this, your face would look like raw hamburger for ten days and your face would be red for three months. Now the treatments are such, you can come in at lunchtime and leave and go right back to work in the afternoon and nobody will know you had anything done, there are no after effects. And within a couple of weeks you'll see improvements. So, these whole new sets of treatments are exciting because using lasers, we can treat rosacea much better.
COHEN: Do rosacea or psoriasis ever go away on their own? If you have just have a mild case can you kind of just wait it out?
RIGEL: Well, with psoriasis it might, although it's kind of chronic, it lasts over time. The average person, who has psoriasis, may just have a little bit of redness and scaliness on the knees and on the elbows, but not typically in the other areas. And even using a good moisturizer sometimes will help. With rosacea, it's hard to totally get rid of it. It comes and goes. But, there are a lot of other factors in rosacea including stress, that makes it worse; caffeine; alcohol; a lot of good things, too. So, if you eliminate all those things from your life, your risk goes down for getting rosacea in the future, if you have a tendency towards it. But, the reality is, it doesn't usually just go away on its own.
COHEN: Manisha from Virginia wants to know: "What is the cause of rosacea? Are there any other over-the-counter forms of treatment available?"
Doctor, you were talking about things that you would have to go to the doctor to get. Is there anything over-the-counter for rosacea?
RIGEL: Well, you know, one of the things that can be used, I guess, and some people do use, when have you that redness, is to use a cover-up makeup and what you need is a makeup that has some green in it. Green will absorb the red. That's a common trick that's used to bring that redness down. If you put too much on though, you kind of look like a Martian, you look too green, so that's a balance of what you have to do. But, the other thing is to -- again as I mentioned, to avoid caffeine, avoid alcohol, avoid spicy foods, try to get the stress out of your life. All those things together will, in fact, help rosacea somewhat.
COHEN: Well, next we're going to be talking about winter. It can be especially harsh on your skin. It can get dry and scaly and even though it's cold out, you can still get sun damage. We'll talk -- find out from our doctor the best ways to keep your skin merry this winter are season when we come back.
(COMMERCIAL BREAK)
COHEN: Welcome back to WEEKEND HOUSE CALL. We're talking about taking care of your skin. We're joined by Dr. Darrell Rigel, a professor of dermatologist at New York University Medical Center.
Dr. Rigel, winter has descended in most parts of the United States and many people think the sun is less dangerous, but what's your advice to viewers on wintertime sun protection?
RIGEL: Well, never forget that sun you get any time of the year can cause you problems. And, people don't realize that even in the winter, the amount of sun you're getting, even in the northern part of the United States, is such that you still can hurt yourself. So, my advice is, it always pays to wear sunscreen and protect yourself that way. Again, the less sun that hits your skin when you're -- at least have the protection, the less risk you're going to have in the long run. One in five Americans get a skin cancer of some sort in their lifetime. There will be over a million cases this year in the United States, and in fact, it's totally preventable, basically, with some simple things.
COHEN: Well, the phone calls and the e-mails are lining up on this subject. Let's talk to Ramona in Louisiana. She has a question about wrinkles in the winter.
Ramona, welcome to WEEKEND HOUSE CALL, and go ahead with your question.
RAMONA, LOUISIANA: Ah yes, I'm calling to see what kind of moisturizer you would use for the wrinkles and the dryness in Louisiana?
RIGEL: Well, that's a great question because people usually ask that question in Colorado or Minnesota, but remember even in Louisiana, in the winter, it gets drier. What happens when it's drier outside -- it's always drier everywhere in the winter than it is in the summer that, the moisture comes out of your skin, so therefore, your skin dries, it can get flaky, it can get wrinkly. What you have to do is moisturize, and the way you do that, the best way is when you come out of the bath or come out of the shower, that's the time to put the moisturizer on. Because what it does, it then seals in the moisture that your skin has taken in during the time you are cleansing, so the best time to do it again, is right after you come out of the shower, put that fine layer of moisturizer on and that will protect your skin the best.
COHEN: Doctor, when you go to the drugstore, there's an entire aisle of moisturizers, each claiming to be the best. How do you know which is really the best? What should you look for?
RIGEL: Well, that's also a great question because a lot of it is a difference in marketing or packaging or whatever. The absolute best moisturizer, if you didn't care how it felt, would be Vaseline, because it skin seals the skin surface really, really well. But, I don't think most people want to put just pure Vaseline on their skin. So, it's a trade off. The heavier moisturizers are better from a moisturizing point of view, but they may block your pores, they could cause acne. The lighter moisturizers feel better, but they're not as effective. So, the best way to do it is try a couple and see which works best on your skin. Try on the back of your hand, that's the best way to test it. Use one on one hand, one on the other hand, and those sorts of ways you can really find out which works best for you.
COHEN: We have an e-mail now from Chris in Minnesota who asks: "Now that winter is here, my skin has turned red, dry, and scaly. I have not found an over-the-counter lotion that does not cause a rash. Are there any treatments for extremely dry skin that are safe for people who are allergic to lotions with fragrances?
Doctor, I imagine this is a relatively common problem.
RIGEL: Very common. And there's the question from Minnesota we were talking about, but -- but the reality is in the wintertime this is a problem for several reasons. When you're in a cold, dry area, what happens is you're in a heated building and the air from outside is heated up and if moisture's not added to that air, and it's not in most of the buildings, the air is so dry it's just sucking the moisture out of your skin. Your skin gets red, it gets irritated, it itches, you get rashes. So, you try to use a moisturizer and there are people like me, too, who, in fact, are very allergic to fragrances. So, you put that on and your skin is more moisturized, but you get the rash and the itching. So, the trick is find something that's fragrance free, not unscented, but fragrance free, those are two different things. Try something again, that works on you, and if you're still red try a mild hydrocortisone, the 1 percent hydrocortisone over the counter that's available, when that doesn't work, go see your dermatologist, because there are lot of prescription medications that can be used to really help you in the winter.
COHEN: Doris in Oregon also has a question about dry skin, I think this time, extremely dry skin. "Are there any treatments for eczema other than steroid creams?"
Doctor can you first explain -- briefly explain what eczema is?
RIGEL: Well, eczema basically is the extreme of the dry skin we were talking about, and what it is, it's an inflammation of the skin that's really due to your body's ability not able to produce enough oil causing that kind of dryness. The skin can break down, bacteria can get in, it can become infected. But, it really tends to itch and it tends be primarily on arms and legs, but can be anywhere. The typical way to get rid of the inflammation of eczema is to use an anti-inflammatory, in other words a cortisone, to bring the inflammation down. But, there are other medications beyond that. First of all, a good moisturizer is helpful and there's a whole other class of drugs that are out there: Eladil is one that's very good, Protopic is excellent, these are drugs that are not cortisone related, but can be used to treat eczema, too. So, if somebody has a severe case, again, I suggest they see their dermatologist to really have those drugs available to them.
COHEN: Well, stay where you are, when we come back, I'll give you some Web sites where you can go for more information on all the skin care troubles we've talked about. But first, a look at some medical headlines from this week in today's "Your Health."
(BEGIN VIDEOTAPE)
GUPTA: The CDC sounded the alarm on flu this week saying this year's flu season is starting much earlier than expected. In addition, experts say that many of the cases they've seen so far are not of the strain contained in the vaccine, but that a flu shot will still provide some protection.
Also, green onions are being pulled from Chi-Chi's restaurants across America. According to public health officials, the vegetables were a possible cause of the recent outbreak of Hepatitis-A in Western Pennsylvania. Officials stress though, if they are cooked properly, the onions pose no danger.
"For Your Health" I'm Dr. Sanjay Gupta.
(END VIDEOTAPE) (COMMERCIAL BREAK)
COHEN: Welcome back to WEEKEND HOUSE CALL where we've been talking to dermatologist Dr. Rigel from the New York University.
Dr. Rigel, people are bombarded with all these different sales pitches for different skin treatments. Any words of wisdom for consumers?
RIGEL: Well, I think the bottom line is if the claim sounds too good to be true, it probably is. And, what I would suggest is use your dermatologist as your resource. If you have a question, contact your dermatologist. We really do know or not, what's going on there. See your dermatologist once a year on your birthday. Have your birthday suit examined. If do you that, most of the things we talked about today, really should not be that big a problem.
COHEN: Well, we're out of time for today. Thank you Dr. Rigel. Make sure to watch next weekend's WEEKEND HOUSE CALL, we'll be talking about battling holiday stress, so tune in and hopefully chill out.
Then on Sunday we're going to tackle winter woes from cold and flue to winter depression. That's next Sunday at 8:30 a.m. Eastern, 5:30 a.m. Pacific. I'm Elizabeth Cohen, thanks for watching.
CNN's "Sunday Morning" continues, right now.
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