I always try to avoid a skin decision that will turn out badly

Over the years I have seen and heard quite a few things that have caused me to raise my eyebrows and utter one of my stock answers--"I see." I really like this all purpose term because it allows me to acknowledge in a noncommittal manner that I have heard and understood what I was told, without making a verbal judgment as to the wisdom of the act in question. The following are a scattering of things that I have seen and heard over the years, that warrant an "I see." If you don't want to hear those words come out of my mouth, avoid skin decisions that will turn out badly, and don't do these.

Over the years I have seen and heard quite a few things that have caused me to raise my eyebrows and utter one of my stock answers—“I see.” I really like this all purpose term because it allows me to acknowledge in a noncommittal manner that I have heard and understood what I was told, without making a verbal judgment as to the wisdom of the act in question. The following are a scattering of things that I have seen and heard over the years, that warrant an “I see.” If you don’t want to hear those words come out of my mouth, avoid skin decisions that will turn out badly, and don’t do these.

1) Waxing after using a retinoid

We have information for our patients on our skin care usage instructions: “Discontinue the retinoids: Refissa, Renova, Retin-A, Differin, or Tazorac to affected area 1 week before waxing or bleaching, or before other procedures as directed.”

Why do we say this? Because if you don’t discontinue them and then you wax, when they pull the wax off, your skin will come off with it. Most memorable was the bride to be who went to the nail salon and had her eyebrows waxed three days before the wedding and was left with nice little red oozing strips above and below her eyebrow on one side. At least they stopped after the first eyebrow. This will also happen if you are on isotretinoin (Accutane and generics) for severe acne. Anyone who waxes any part of your body should ask if you are using a retinoid, or taking isotretinoin. You certainly don’t want your skin ripped off “down there” because they neglected to ask, and you neglected to tell them, you are on isotretinoin.

Related to this issue, I was called about a patient who had surgery while on isotretinoin and when the tape that held the endotracheal tube in place during anesthesia was removed, the skin came with it. It’s not often dermatologists get emergency calls from the recovery room, but this was one of those times

2) Soaking in weird stuff

I once had a patient come in with redness, rash and blistering on her whole body. Usually in dermatology one look is worth a thousand words, but occasionally we have to take a history. Turns out she decided to soak in the bathtub in straight Chlorox so “my skin would peel”.

It did.

3) Using prescription topical steroids on the face

This one is often iatrogenic (caused by the doctor), although it is not uncommon for people to use a prescription cream that was prescribed for one condition on something else, or on another part of the body. If you use topical steroids on the face, and they are anything stronger than very mild, you are likely to get into trouble. The problem is that it works at first, reducing rash and redness. Your skin becomes addicted to them if you use them longer than a few days, and when you stop, the rash comes back worse than it was in the first place. Over time, topical steroids thin the skin on the face, cause lots of broken and dilated blood vessels, chronic redness and pimples.

This can be a real mess. Don’t assume you can just put any prescription cream on your face. All the topical steroids have very long names, sound alike, and there are about a hundred of them. If this happens, you will need a good dermatologist to help you wean off of it over time.

4) Not telling the truth about sun exposure before IPL treatment

Intense Pulsed Light is a great treatment for the treatment of sun damage, brown discoloration and spots, broken and dilated blood vessels, and redness. We do it all day long. But effective, safe treatment relies on exploiting the difference in color between the thing you want to treat—the target, and the thing you don’t—the normal skin. Sun exposure, even if you don’t think you are tan, stimulates your natural melanin and reduces this difference in light (and therefore heat) absorption. And if your physician or nurse doesn’t know about this, you will get burned.

So if you don’t want crusted rectangles all over the treatment area, tell the truth. Just because you have taken a day off for treatment, or you don’t believe us when we tell you that it will matter, is not a good reason to risk it.

5) Unfortunate permanent eyebrow tattoo

We used to do permanent makeup application in the office, which is a tattoo applied as eyebrows, eyeliner or lip liner. In general it turned out well, and certainly helps many women who have problems applying makeup because they have difficulty seeing close up or have arthritic hands. By far the trickiest one to do right is permanent eyebrow makeup. Women are very specific about what they consider to be the right shape and appearance for their eyebrows. Unfortunately, they are often wrong. Eyebrows, if done correctly, have a specific starting, stopping, arch, angle and placement that is pretty well defined. When it is right, it is great, when it is not, it really detracts from the face. As many of you already know, funky eyebrows are one of my pet peeves, so there will be a column on it in the near future.

But suffice it to say, if your technician “does it your way” and it is not the right way, you may be sorry. Sometimes permanent makeup really is permanent, sometimes not, but you have to assume it will be. And don’t even get me started here on jarring color choices, or the color shift that the tattoo may undergo over time. Or the fact that your hair color may change and no longer compliment your eyebrow color.

If you are going to put a permanent tattoo in the middle of your face, do it right.

Next: More skin mistakes to avoid