Marys Medicine

TABLE OF CONTENTS Copyright 2013 Guthy-Renker LLC.
All rights reserved. No part of this book may be reproduced in any form without written permission from the publisher. You may have been plagued with pimples in high school and now are watching history repeat itself through your teenage son or daughter. Or perhaps now, as an adult, you are experiencing breakouts for the first time. You are not alone.
Acne affects us all, whether we are among the 85 percent of people who suffer with it at some point in our lives or have loved ones who do. We both were deeply affected by our acne, and know that you can have one pimple and feel as bad as someone with a full face of pimples.
That's why we've made it our mission to help all acne sufferers take control—so that the physical and emotional challenges of acne no longer need to be a fact of life. It's why we developed Proactiv®, which was the first-ever comprehensive three-step program that both treats blemishes and helps prevent them from forming. And it's also why we wrote this handbook.
In the pages that follow, we'll share with you our 17 best anti-acne secrets, straight from our dermatology practices and based on our 40 years of combined clinical experience. You'll learn that achieving healthy, clear, radiant skin requires a lifestyle commitment—a commitment to regular exercise, sun protection, a smart and balanced diet, plenty of sleep, and, of course, sticking to your acne-treatment program each and every day. It is a commitment to treating acne faster, managing stress better, looking fabulous every day, and living longer. Consider this handbook an indispensable roadmap for creating positive change in your life. Use it to educate and empower yourself and others. Share the knowledge with your friends, family members, anyone who suffers from acne. Realize that whether you're aged 25, 45, or 75, you can change your skin's destiny, and in doing so, you can change your life's destiny. —Katie Rodan, M.D., and Kathy Fields, M.D.
YOUR EMOTIONS"I don't go to parties or talk in class because I don't want anyone to notice me." "I don't look in the mirror because I don't want to see myself." "I hate the way I look and feel every single day." Unfortunately, far too many of us can relate. Acne sufferers experience low self-esteem, social withdrawal, and depression—and can carry this negative emotional baggage throughout life.
But as we said in our introduction, the good news is that thanks to topical treatments and medicines, you can achieve a clearer, more glowing complexion.
The overwhelming majority of our patients find that their worries and pain go away when their acne is treated properly. Some, though, still need to be able to talk about these worries. Finding a sympathetic therapist or support group (either online or offline) can be tremendously helpful. We also suggest having a buddy—someone you can talk to about your skin's appearance in confidence when you feel down. Acne is caused by genetics and hormones. According to the American Academy of Dermatology, 85 percent of us will experience acne at some point in our lives.
Acne is not your fault—and you are not alone.
PREvENTING STRESS Mental picking is a lot like zit picking. Once you start, it can be very difficult to stop, especially when you know that stress triggers blemish flare-ups.
Then your acne worsens, making you even more stressed out. Yes, it's a vicious cycle, but one that you can break. here are the doctors' orders: First, start an effective acne-treatment program. You'll gain a sense of control over what had once seemed to be an uncontrollable situation. Your life can—and will—change. Next, begin managing the stress in your life that can set off acne flares. Bring balance to your life. Exercise, go for a walk, or practice yoga; get a full night's sleep; and eat a healthy diet. Also, plan a reward for yourself once the stressful time is over—a massage, a bouquet of flowers, a weekend getaway, something to look forward to. We also recommend that you keep a stress journal. A journal gives you a safe place to purge the volcano of emotions building up inside you, before it has a chance to blow. Finally, and perhaps the most difficult step, learn to let go. If you have stressors that are out of your control—your commute to work, your partner's increased workload, your mother-in-law's temper—let them go. By learning to let go of what you can't control, you can take charge of what you can control. You—and your skin—will be glad you did. Biking. Swimming. Pilates. Weight lifting. Surfing. Kickboxing.
Whatever your exercise pleasure, just go for it. vigorously. At least an hour a day, four days a week (but seven would be great … hint, hint). It'll increase your circulation, deliver vital nutrients to your skin, and likely reduce your stress level. Do we hear any objections so far? Just a couple of words of caution to acne sufferers: To help stave off blemishes while you sweat, stick to workout gear that wicks moisture away from the body—lightweight, loose-fitting cotton or microfiber—and make sure any equipment you're using fits properly. If you're a surfer, that means a wetsuit that's not too constricting, especially under the arms. If you're a cyclist, make sure the chinstrap on your helmet isn't on so tight that it rubs against your skin, triggering a flare-up. And never, ever "stew in your own sweat." That's how bacteria can thrive and breakouts can occur. As soon as you've finished working out, grab your medicated exfoliating cleanser, head to the shower, turn on the warm water, and jump in. Doesn't sound too bad, does it? A firmer, healthier body. A glowing complexion. A more relaxed attitude. That's what exercise can do for you. Now, isn't that worth four hours of your time each week? Do we hear any objections? We rest our case. RESTORATIvE SLEEP Get seven to nine hours of it every night. Yes, you heard that right. A good night's sleep won't prevent acne, but it will help keep your immune system strong to help fight off infection and reduce stress, which can be a key acne trigger. So here are the doctors' before-bedtime orders. No caffeine, no working on your laptop, no bill paying, no distracting clutter on your night table (if you're anything like us, it's there!), and no watching action-packed thrillers. Make yourself a cup of warm milk or hot tea (decaf, of course), read a book (as long as it's not a scary one), or take a warm bath. Keep your bedroom cool, and make your bed toasty with extra blankets. And if you're one of those people (also like us!) who wakes up with your to-do list floating through your brain, be sure to have a notepad and pen handy near your bed. That way you can quickly jot down those urgent, must-not-forget to-dos and middle-of-the-night musings and then go back to sleep.
Now get yourself between those cozy covers and turn off the light. Sleep tight, and pleasant dreams.
Contrary to popular belief, eating chocolate, pizza, and French fries won't give you acne. But eating a healthy diet will help your skin look its best. So skip the fad diets and go for the sensible, balanced kind instead. Simple foods. Easy to prepare. Steamed veggies, broiled chicken or fish, fresh fruits and nuts.
Start reconfiguring your grocery list now. Cross off the simple carbohydrates—the starchy stuff, like flour, bread, potatoes. They all have a high glycemic index, which means they're likely to cause glucose and insulin levels to spike after eating. For your skin, that surge stimulates oil-producing hormones, which can lead to breakouts. The same goes for sugary snacks and drinks. If you're a milk drinker, stay away from skim milk—it has a high glycemic index. Stick to two-percent or whole milk instead.
Fill your shopping cart with high-protein foods—lean meats, poultry, legumes. They all have a low glycemic index. Add in fruits and veggies that are rich in antioxidants, along with nuts, fish, and other foods that are sources of omega-3 fatty acids. Both antioxidants and omega-3s can help soothe and calm the skin. Try to eat hormone-free foods, too. Look for "certified organic" or "hormone-free" on product labels.
If you know that a certain food tends to worsen your acne, common sense says it's best to avoid it.
For the sake of your face and body, eating healthy is the way to go. WISE AND PRACTICAL There's no such thing as a healthy tan.
We'll shout this from every rooftop garden, beach, campground, tennis court, backyard pool, amusement park, and hiking trail you can name—from Manhattan to Malibu, from Crete to Colorado. Plain and simple, sun exposure damages skin, and the pigment you see as a tan results from your body's reaction to this injury. If you think the sun is going to clear up your acne, think again. Yes, a tan might mask the redness of a breakout and help pimples dry up faster. But with every tan, cell turnover increases, building up more dead cells that can block pores and cause additional breakouts. To keep your complexion looking young and healthy, never expose unprotected skin to the sun. Every day, slather on a broad-spectrum UvA/UvB sunscreen. For most skin types, broad-spectrum SPF 30 is perfect. higher SPFs offer very little extra protection and tend to feel heavy and greasy. Most importantly, you should reapply your sunscreen every two to three hours. Wearing Uv-protective clothing, wide-brimmed hats, and sunglasses is a good idea, too. No matter the time of year, your skin tone or ethnicity, whether you're 25, 45, or 75, whether you're sitting on a beach or indoors next to a window, sun protection is a daily necessity. After all, it's much easier to prevent damage than to fix it afterward. Welcome to Face Washing 101. If you don't cleanse and apply products properly, your acne treatments aren't going to work properly. In need of a refresher course on the hows and whys? Then these four lessons are for you.
Remove your long-wearing makeup, grab your cleanser (no harsh soaps that can strip your skin, please!), and let's get started. Lesson 1. Lukewarm water is just right. Contrary to what your grandma might have told you growing up, hot water does not mean better cleansing. hot water does not remove bacteria, and in fact increases blood flow and dilates blood vessels, making an already red face even redder. hot water also will not open your pores. Pores don't open and close like little mouths or windows! Lesson 2. One morning wash + one evening wash = just the right amount. Cleansing more than twice a day can disrupt the skin's delicate moisture barrier, leading to dryness and irritation. Skin can also produce more oil following frequent cleansing, creating a vicious cycle of oil production. Two washes a day are more than enough to remove bacteria.
Lesson 3. Just say no to rubbing alcohol. It's an astringent that strips oil off the surface of your skin. Worse, it breaks down your skin's natural barrier, exposing it to rashes and infections. Stick with safe, skin-friendly toners and astringents.
Lesson 4. Let your fingertips do the washing. Using a mesh sponge or loofah can irritate the skin and lead to breakouts. So use fingertips, please, to apply cleanser in gentle, circular movements. Using a very soft washcloth or a cleansing brush with a rotating head is fine, too. Your homework assignment? You guessed it—follow the lessons above each and every day. Class dismissed.
Do yourself a favor, will you? Stop scrubbing your face with those harsh products—the ones filled with ground-up apricot pits or walnut shells. They can tear your skin and create irritation and redness. Who wants that? You deserve better. Doctors' orders are to use a gentle, safe formula—one with tiny, round polyethylene beads. Strip off those dead cells sitting on the surface of your skin—the ones that make your complexion look dull. Exfoliation can unclog your pores and improve the penetration of your topical acne medicine. It's worth the effort, because you deserve a fabulous-looking complexion.
Keep in mind that exfoliation is not for everyone. If you have rosacea, eczema, or highly sensitive skin, you should not exfoliate. When skin is sensitive, the outermost layer is doing a poor job of protecting your complexion. Removing every last dead cell increases your skin's vulnerability to infectious agents and potential irritants. That's why exfoliating your red face is a big no-no! When it comes to exfoliation, gentle and safe are the watchwords. They're the key to the radiance that you and your skin deserve. PROPERLY PURGING Stop picking.
Better yet, never start picking. We know—easier said than done. Pimples are an invitation to pick! But picking and squeezing—with fingernails, pins, you name it—can cause permanent damage. Picking not only worsens the pimple you're attacking, but also makes the surrounding skin even more irritated and swollen.
A pimple that's bothering you today will go away faster if you just let it be. If you pick and poke and prod and squeeze it, you might be reminded of it forever in the form of a pitted scar. Most importantly, faithfully maintain your acne-treatment routine. When your skin is clear, there's nothing to pick, and that means your acne treatment is working well to prevent breakouts. Now, if you absolutely can't stop yourself from picking at that one juicy whitehead, put a warm compress on the area, use a tissue, and apply very gentle pressure evenly around the zit. If nothing comes out after 15 seconds, stop.
It's time to let your body do the healing. No. More. Picking. There's always the one that got away.
No matter how devoted you are … to your routine of topical acne medicines, that is. Yes, you've got an unwelcome visitor—what looks (to you) to be a 50-pound knot hanging out on your chin. Expected stay: a week, maybe more.
hello, pimple panic! So what can you do to make your unexpected guest go bye-bye—and fast? The gold-standard treatment—often used by movie stars cursed with a big zit during filming—is a cortisone injection delivered by a skilled dermatologist. It typically shrinks pimples by the following morning. But if seeing a dermatologist isn't an immediate option for you, we suggest you give our simple, at-home four-step emergency fix a try: • First, apply ice to lessen the inflammation and swelling along with a drop of visine to "get the red out." • Next, cover the pimple with benzoyl peroxide (a high concentration, 6 to 10 percent) to shrink it. • Then camouflage with a liquid concealer.
• Finally, set with loose oil-free powder. Good news! It looks as though your unexpected guest will be leaving very soon. Now get to work or school. Keep that appointment you thought about cancelling. It's time to face the day with confidence.
NEvER LETTING ThEM have you ever visited the arid deserts of Palm Springs or Nevada and found everything on your body drying up? Or taken a trip to Miami in the summer and found your skin perhaps just a bit too shiny? Maybe the skincare products you use every day feel different on your skin, too. The climate—temperature, wind, humidity, and even altitude—affects both your skin and the efficacy of your skincare products.
Unfortunately, hot weather can create a microclimate where acne thrives because of increased oil production. We're not suggesting that you move, or never visit hot weather locales, to avoid acne flares. Our advice is simply to always evaluate your environment, and adapt your skincare routine to whatever climate or season you find yourself in—hot or cold, dry or windy, high altitude or tropical.
To keep your skin looking fresh, youthful, and healthy in hot, humid locales, doctors' orders are as follows: Use a clay-based cleansing mask weekly to unclog pores, absorb excess surface skin oil, and calm inflamed skin. Apply oil-free moisturizer only to areas of your face that feel tight and dry.
Don't forget that your sunscreen comes off with your sweat, so reapply Carry oil-blotting papers to refresh your face throughout the day and stop your skin from looking shiny. If you adapt your skincare routine to weather and climate, you'll have nothing to sweat about.
Did you know that 90 percent of what people think are acne scars aren't true scars? Instead, they're the pink or brown pigmentation spots that follow a healed pimple. The medical term is postinflammatory hyperpigmentation. These red-to-pink spots can take anywhere from days to weeks to turn brown—and, without treatment, can take anywhere from six months to a year or longer to fade away. That's a long time to wait! Like acne itself, these spots can be treated, but preventing acne breakouts in the first place is always your best bet. Dermatologists consider hydroquinone the mainstay in the treatment of these spots. It's the only FDA-recognized ingredient to fade abnormal discoloration, and it's available over the counter in a 2 percent concentration. Although you can get a greater strength (4 to 8 percent) from your doctor, lower concentrations can work extremely well—especially when combined with exfoliation and sun protection. And speaking of sun protection, the other secret to long-term management of hyperpigmentation is strict, daily, year-round use of a broad-spectrum sunscreen. A single day of sun exposure without protection can undo months of treatment. So sunscreen is mandatory. Forever. One final caution: hydroquinone is a powerful medicine, even at low doses. To get the best results, start a hydroquinone program slowly to give your skin time to adapt—and please also take time to read the product instructions, specific usage guidelines, and any warnings. A little patience will go a long way.
If you're anything like us, there are plenty of things your mother didn't tell you. And we'd like to help set the record straight—at least about makeup. here are our "what we wish our moms had told us" words of wisdom about makeup: • Less is definitely more. The fewer products with the least number of ingredients you put on your skin, the better. Wearing too much makeup can age your appearance and imply that you have something to hide. Our goal for you is clear, radiant skin—always—and with clear, radiant skin, you don't need to hide behind a mask of makeup. • Always begin with a clean, dry face. The correct order for successful application is medicine, moisture, sunscreen, makeup. • Look for the term "noncomedogenic" on product packaging, especially if you're concerned that your makeup may be contributing to your acne. "Noncomedogenic" means the product has been laboratory tested and proven not to promote acne. • Makeup migrates into the pores. For those with acne, medicated makeup that contains salicylic acid or benzoyl peroxide allows this migration to benefit your complexion by treating existing blemishes and helping prevent new ones from forming. • Makeup rubs off. Keep your hands away from your face as much as possible. If you keep rubbing the makeup off, you'll want to keep reapplying it, which sets up a vicious cycle of overuse and irritation. • Applying makeup is an acquired skill. Treat yourself to a lesson from a professional makeup artist who understands acne. A lesson will teach you the "tricks of the trade"—and may even save you hundreds of dollars by steering you away from products that might not work best for you. Most importantly, have fun with your makeup. Makeup should be a life-enhancing exercise, not an obsessive chore.
There are many things you could be afraid of in life, but a moisturizer shouldn't be one of them.
Even if you have acne. Contrary to what many people with acne believe, the right moisturizer will not make your acne worse—and, in fact, can improve the appearance and texture of your skin. Keep in mind that your skin's response to a moisturizer will vary by product. If a cream or lotion triggers a new breakout, discontinue it and try something else. Look for products that are clearly labeled "noncomedogenic." We recommend taking a minimalist approach when using a moisturizer. A dime-sized amount should be more than enough to thinly coat the dry areas of your skin. There's no need to apply moisturizer to oily areas of your face or use more product than can be quickly absorbed into your skin. Remember to always use acne medicines first, allowing them to dry before applying a moisturizer. When acne medicines are used in this order, their active ingredients can penetrate into the skin and work effectively. When it comes to moisturizers and acne, fear not.
SENSIBLY STOCKING Is your medicine cabinet bursting with products—"gift with purchases," free samples, or impulse buys? We bet the majority of these products have been used only once or twice and are long past their expiration date. Taking the Fifth? Well, then, doctors' orders are to clean out your medicine cabinet. Now. Start by taking an inventory of every item you have on the shelves. Check for expiration dates, and toss every sunscreen, moisturizer, lipstick, mascara, and foundation that is past its prime. Rule of thumb—keep creams, moisturizers, sunscreens, and liquid makeup no longer than a year. Lipsticks and powders, including eye shadow, are usually fine for up to two years. Mascara should be replaced every six months. If you notice a change in color, texture, or smell, toss it—no matter the expiration date.
Now check the labels on the remaining products. If the word "noncomedogenic" appears on a label, the product is a keeper. If not, say bye-bye. Noncomedogenic products have been laboratory tested and proven not to cause blackheads and whiteheads. Let's move on to medications. Both over-the-counter and prescription medications can affect the body's chemistry and hormones, leading to an acne flare. Make a list of all the medications in your cabinet to determine whether any could be contributing to your breakouts. The medications most likely to provoke an acne flare are lithium, anticonvulsants, corticosteroids, DhEA supplements, and hormones. Check with your physician to find out if any of your medications or supplements could be contributing to your breakouts. Finally, give the shelves and drawers a good wipe-down to remove dust and any sticky remains. Store your "keepers" in a cool, dry place.
Congratulations! You've taken one more giant leap toward keeping your skin as healthy and radiant as possible.
SOUNDLY DOCTORING Sometimes you do everything right. You explore the full range of nonprescription acne treatments; you follow all the directions, take all the advice, think good thoughts. But still you're seeing no improvements in your skin—at least not at the pace you had anticipated. Don't panic. Don't give up. Be patient awhile longer. Continue to stick to your routine and use your acne treatment as directed. If an extended period of time passes and you're still getting frequent breakouts, then it's time to see a dermatologist.
The number one priority of a dermatologist is to prevent permanent scarring from your acne. Generally speaking, the more advanced cases of cystic and nodular acne*—large, deep, painful bumps filled with blood and pus that can linger under the skin's surface for weeks or months—are the most likely to scar. It's especially critical to take all possible measures to manage this condition. Unfortunately, we have an adage: "Once a scar, always a scar." With this in mind, it's important to remember that prevention is key. Stop the acne, and you'll stop the scars before they've had a chance to form. If you have an advanced case of acne that warrants treatment by a dermatologist, the best way to choose a doctor whose style suits your personality is by word of mouth or recommendation from your primary physician.
Once you find a dermatologist, it's crucial that you share a detailed history of your acne. Set aside time in advance of your appointment to compile a list of any doctors and aestheticians you've seen previously regarding your complexion. Describe the treatment results as well as any side effects you may have encountered. Include a list of any medications and herbal or vitamin supplements you currently take. It's helpful to bring in either a detailed list or a bag full of the skincare products, makeup, and sunscreen you use. Also jot down notes about your lifestyle, including anything that seems to trigger your acne.
The more information your doctor has at hand, the better able he or she will be to plan the right course of treatment and get you on the road to an acne-free future.
*Proactiv+ is designed to treat mild to moderate acne. If you consider your acne to be cystic or severe, please consult a dermatologist.
We always tell our new patients that no matter what state their acne is in now, it will get better. Acne is a complicated condition. It didn't happen overnight, and it can't be successfully treated overnight, either. Acne treatment and control can be a lifelong process. Think prevention. Apply or take your medicines daily. If you don't follow the directions, your treatment is likely to fail. Use your medicines properly—don't use them on Monday and forget on Tuesday, or use them once a day sometimes and twice a day other times. Be consistent, and plan ahead. Try to maintain balance in your life. Exercise, get a full night's sleep, and eat a healthy diet. Think of your daily acne program as a series of small steps, or "tiny habits"—all helping you achieve your ultimate goal of the complete treatment of your acne. So don't feel overwhelmed. This problem isn't insurmountable. You can conquer it.
Give yourself rewards every small step of the way.
Carve out time each day to work on healing your acne. Small steps. Tiny habits. "Consider this handbook an indispensable roadmap for creating positive change in your life. Use it to educate and empower yourself and others. Share the knowledge with your friends, family members, anyone who suffers from acne. Realize that whether you're aged 25, 45, or 75, you can change your skin's destiny, and in doing so, you can change your life's destiny." Katie Rodan, M.D., and Kathy Fields, M.D.


Report cover - forest environment


Biophysical Journal Imaging Cells and Tissues with Refractive Index Radiology Y. Hwu,* W. L. Tsai,* H. M. Chang,y H. I. Yeh,z P. C. Hsu,* Y. C. Yang,* Y. T. Su,* H. L. Tsai,yG. M. Chow,§ P. C. Ho,{ S. C. Li,{ H. O. Moser,k P. Yang,k S. K. Seol,** C. C. Kim,**J. H. Je,** E. Stefanekova,yy A. Groso,yy and G. Margaritondoyy*Institute of Physics, Academia Sinica, Nankang, Taipei, Taiwan; yPandis Biomedical Research Association, Chupei, Taiwan;