What you didn’t expect when you’re expecting

Aah, the joys of pregnancy. You are basking in the glory of carrying your bundle of love. Your hair is more lush and plentiful, you have that “glow”, you can indulge your every craving guilt free, and you can finally fill out that low-cut top you’ve coveted without any er, um…supplemental padding. But alas, you discover that the “Girlfriend’s guide to pregnancy” left out a few significant details about what could happen to your skin over the course of those nine months. Well, girlfriend, I’m here to tell you ugly truth. Your skin is your window to what’s happening on the inside. With a baby growing inside of you, your body is functioning in overdrive and all that growth and change happening for the baby translates into a lot of growths and changes with your skin, hair and nails. Having gone through this process a few times myself, I have had the unfortunate pleasure of experiencing a few of these lovelies and the good news is that most of the changes I’ll detail below do go away after pregnancy, and those that linger can be “taken care of” shall we say, by your local dermatologist. So even though you didn’t expect these things when you found out you were expecting, don’t worry, I’m here to guide you through it.

Lumps, bumps and tags oh my!

photo credit: skincare-service.com

photo credit: skincare-service.com


a.Common benign growths during pregnancy include skin tags also known as acrochordons or fibroepithelial polyps which love to occur in all the inconvenient places like crevices and skin folds for example around your neck, in your armpits, along your bra line and groin. They also like the face, especially around the eyes. Skin tags are typically skin colored or hyperpigmented(darker)lesions 2-5mm in size that may be smooth or irregular in appearance and are often raised from the surface of the skin on a fleshy stalk. They are usually asymptomatic unless they get irritated or itchy from being rubbed by clothing or jewelry. Other than being seen during pregnancy, skin tags may have a causal genetic link as well as a link to metabolic syndromes such as diabetes. These lesions can easily be removed if desired or warranted via cauterization, cryosurgery, excision or surgical ligation.

b. Seborrheic keratoses:

photo credit: finantempleton.com

photo credit: finantempleton.com


These benign lesions are raised thickenings of the skin that typically appear as variable shades of brown and can appear black at times raising concern for a differential diagnosis of melanoma and therefore are likely to be biopsied for confirmation. Some refer to seborrheic keratosis as “barnacles on the ship of life” as they typically appear later in adult life. I personally refer to them as “gifts of maturity”. Now granted, it’s like the gift from your Aunt Minny, you really don’t want the gift, you have no need for it and it’s downright ugly, but you can’t give it back and you can’t exchange it, so you might as well make the most of it and give it a nice name right? Just like tags, they don’t need to be removed, but if they become irritated or bothersome the same methods of removal for tags can be used for seborrheic keratoses.

c. Pyogenic granuloma:

photo credit: procedureclinic.com

photo credit: procedureclinic.com


These lesions are also referred to as granuloma gravidarum, eruptive hemangioma, granulation tissue-type hemangioma, lobular capillary hemangioma, and tumor of pregnancy. I had the distinct displeasure of having one of these in my mouth during pregnancy, a common location, and in this location it is coined an “epulis of pregnancy”. A pyogenic granuloma or epulis is essentially granulation tissue which appears as an overgrowth of tissue due to irritation, physical trauma or hormonal factors. Because they are composed of groups of blood vessels they are extremely friable and can bleed significantly with minor trauma. The good news is that they often resolve spontaneously. The caveat is that if a lesion doesn’t resolve on it’s own and removal is performed but incompletely so, the lesion can recur with “friends” i.e. multiple lesions can occur. Again, being a benign lesion this is not a long term concern, but acutely it can raise false alarm for more concerning skin conditions including malignancy if you don’t inform your doctor of your prior procedure.

d. Cherry angiomas:

photo credit: byebyedoctor.com

photo credit: byebyedoctor.com


Who doesn’t like a cherry on top? Well, when it comes to having them all over your body you may not. Cherry angiomas are another vascular benign neoplasm that can occur at all stages of life from childhood to adulthood, but it seems that during pregnancy they like show up even more. These lesions range from 2-5mm and may be flat or raised. The larger the lesion, the more likely that it may bleed with minor trauma. An important thing to know about these lesions that if they do become traumatized they take on a blue/black appearance which similar to seborrheic keratoses, can mimic melanoma and prompt a biopsy to rule out this possibility. Unlike pyogenic granulomas and skin tags, cherry angiomas linger long after pregnancy and in most cases become a permanent fixture on your body. Like most other lesions though they can be removed via excision, cauterization or laser therapy.

e.Nevi/moles:

photo credit: hawaiidermatology.com

photo credit: hawaiidermatology.com

These are benign lesions comprised of melanocytes which are your pigment producing cells. They range in color from flesh-colored to shades of brown. Melanocytes are also the cells which give rise to melanoma, the deadliest form of skin cancer. Melanoma can arise de novo, meaning the lesion originates as a cancer, or it can evolve from a pre-existing nevus/mole that undergoes changes in terms of its size, shape and color. During pregnancy it is not uncommon that pre-existing nevi/moles become darker than they were at their onset due to an increase in a hormone called melanocyte stimulating hormone. This darkening effect can be seen in other areas where melanocytes are found including genital skin, breast areolar tissue and that line from your belly button to your pubic area which is referred to as the linea nigra. Following pregnancy, the affected lesions and skin may return to their previous state, though more commonly they remain slightly darker than they were originally. The concern for melanoma is low in these situations unless it is noted that a pre-existing lesion has significantly changed in size, shape as well as color or a new lesion has appeared during pregnancy that stands out from all the other lesions a patient has, both of these scenarios may prompt a biopsy for further evaluation.

There are a host of other issues that may arise during pregnancy including: soft, brittle nails that grow at warp speed; outbreaks of acne; spider veins; stretch marks; melasma (patchy darkening of facial skin: the key is sun protection); new rashes that itch as well as exacerbation and new manifestations of underlying skin conditions like psoriasis and immuno-bullous disease. And if that weren’t enough, that luscious head of hair you acquired during pregnancy is going to start to shed starting around 3 months postpartum and last for about 3 months known as telogen effluvium. Sounds awful doesn’t it? Don’t worry, most women experience a few of these things but not all of them, and most of these issues resolve spontaneously. For all other issues and any lesions that concern you, consult your local dermatologist.

Pregnancy may not be all rainbows and butterflies, but at least now you know what to expect right? Good luck and enjoy the journey!

Advertisements

Orange and chocolate does the body good

Image

 

For those of you who have been reading my posts lately, I realize you may think I am starting to sound like Charlie Brown’s teacher (“whah whah whah, whah,”) since I talk about skin cancer so much ( I am a dermatologist after all), but orange and chocolate are really a great combination for your skin so hopefully you will indulge me. May is skin cancer awareness month and to kick off the month, today is known as “Melanoma Monday.”  Dermatologists across the country will be wearing orange to bring attention to a campaign headed up by the American Academy of Dermatology to promote skin cancer awareness and skin cancer screenings.  We dedicate today to raising awareness about melanoma, because although it accounts for less than 5% of skin cancer cases, it is the cause of the majority of skin cancer deaths. 

Here are top 10 facts you should know about melanoma*: 

  • 1 in 50 men and women in the U.S. will be diagnosed with melanoma of the skin during their lifetime.
     
  • Melanoma is the fifth most common cancer among men and the seventh most common cancer in women in the US and it is the only cancer whose incidence continues to rise nearly 2% annually. 
  •  In 2009, there were approximately 876,344 men and women alive in the U.S. with a history of melanoma. This number continues to rise.
     
  • Approximately 86 percent of melanomas can be attributed to exposure to ultraviolet (UV) radiation from the sun.
     
  • Melanoma is one of only three cancers with an increasing mortality rate for men, in addition to liver and esophageal cancers.
     
  • Survivors of melanoma are about nine times as likely as the general population to develop a new melanoma.
     
  • The vast majority of mutations found in melanoma are caused by ultraviolet radiation.
     
  • Melanoma is the most common form of cancer for young adults 25-29 years old and the second most common form of cancer for young people 15-29 years old.
     
     
  • A person’s risk for melanoma doubles if he or she has had more than five sunburns at any age.
     
  • One or more blistering sunburns in childhood or adolescence more than double a person’s chances of developing melanoma later in life.

So if you see someone wearing orange today, hopefully it will prompt you to check your skin for any new or changing spots. As dermatologists we look for “the ugly duckling” on your skin; the spot that stands out from your “crowd” of spots and the sore that isn’t healing in a timely fashion. This month, and today in particular, is a time we encourage you to do the same with your skin. If you have any concerns or questions regarding your “spots”, it’s always best to seek consultation with a dermatologist in case a biopsy needs to be performed.

Ok, so now that your brain is full of facts that admittedly are a bit frightening and overwhelming, I am here to cheer you up with chocolate! That’s right chocolately deliciousness to bring you back to your comfort zone. The key ingredient in chocolate is cocoa, which is rich in anti-oxidants, richer in fact than red wine or green tea. Recent research* highlighted the group of anti-oxidants known as flavanols (a group of compounds that can be particularly rich in cocoa) and that have been previously reported to improve blood flow and vessel function. The study revealed the potential benefits of consuming flavanol-rich cocoa and how it might actually benefit the appearance of skin from the inside out including: increasing hydration, decreasing skin roughness and scaling, and helping to support the skin’s defense against UV damage.  Good news right? Chocolate without guilt, what could be better?

So to celebrate “Melanoma monday”, put on your orange clothes, check your skin and get in the kitchen to eat some flavanols and cocoa with this chocolate chocolate chip cookie recipe that is kid tested and approved (and I have some pretty picky eaters around here!)
IMG_2002

2 1/4 c unsifted flour (can use brown rice flour for gluten free option)

1 tsp baking soda

1/2 tsp salt

3/4 c fair trade raw cane sugar (or whatever you got in the cupboard)

3/4 c organic light brown sugar, packed

2 tsp vanilla extract

2 eggs 

1/2 c butter

1/2 c pumpkin puree

1/4 c cacao powder

10 oz  chocolate chips ( I used Ghiradelli 60% Cacao bittersweet chips)

Preheat oven to 375F. Combine flour, baking soda, salt and cacao and set aside. Beat butter, pumpkin, sugar and eggs at medium speed until creamy. Add vanilla and eggs, one at a time, mixing on low speed until well blended.

Add your dry ingredients into creamed mixture gradually and then add your chocolate chips. On a cookie sheet drop your preferred size cookie (tablespoon or bigger/smaller) and bake for 9-11 minutes or until golden brown. Depending on cookie size makes about 4 dozen.

Voila! Comfort food that has the potential to be good for your skin and for your soul!

These cookies are a bit more cakey due to the pumpkin. You can use a full cup of butter if you don’t like the consistency. Enjoy!

*References:

1. Skincancer.org

2. Heinrich U, Neukam K, Tronnier H, Sies H, Stahl W. Long-term ingestion of high flavanol cocoa provides photo protection against UV-induced erythema and improves skin condition in women. J Nutr. 2006 Jun; 136(6):1565-9.

 

Ladies, got aspirin?

photo credit: top news

photo credit: top news

Got aspirin?

Perhaps you’ve heard that adding an aspirin to your daily regimen may help prevent heart attacks, strokes and decrease incidence of cancers including lung, colon, prostate and breast (good stuff right?), but I wanted to bring your attention this recent study by the derm folks at Stanford. (click on the link above to check it out)

Ladies, this is worth a read. Researchers found that women who took a daily aspirin had a lower incidence of melanoma compared to women who did not take the drug. They also found that the risk continued to decrease the longer duration the drug was taken. The study had it’s limitations, and additional research needs to be done, but it’s something to think about. Guys….I am really hoping the additional research will include you, but it looks like this research was chivalrous, “Ladies, first.” Sorry.

It’s important to note that taking aspirin is not a safe option for everyone depending on any underlying medical conditions you may have, so please, before you start any medicine consult with your physician.

-See you in the shade

Like a fine wine…..

photo credit: www.trialx.com photo credit: http://www.trialx.com
We have heard the cliché countless times, “Aged like a fine wine.” But what does that really mean? What makes a wine so fine (aside from my rhyming ability)? As with many things, success is achieved through collaboration of multiple factors to produce a better end product. The same principle applies to winemaking. The creation of a fine wine rests upon factors including the varietal of grapes used, the light, temperature and soil conditions affecting the grapes and vines respectively, the length of the fermentation process and yes, you guessed it (this is a dermatology blog after all) the skin. Wine grapes, compared to table grapes, have a thicker skin; a desirable quality as the skin imparts the aroma to wine. Grape skin also contain tannins which produce the color of the wine. These tannins found in the skin help to preserve the wine for a longer period. Recently, it has been found that the skin of black grapes (used to make red wine, a personal favorite) contain a chemical called resveratrol; which is what provides the cardio and chemo-protective health benefits of red wine.

For those of you who love wine, these tidbits are good fodder to keep drinking, yes? Salut! But the point of all this information is not really about wine of course. It’s about skin. Your skin. Like the creation of a fine wine, the health of your skin is a significant contributing factor to the end product of your overall well-being.

Your skin is the largest organ of your body. As such, it is constantly exposed to the elements just like wine grapes, and light, in the form of UV-rays have a significant impact on the quality and appearance of your skin and your health. With regards to appearance, prolonged exposure to UV-radiation directly affects the color and texture of your skin. The acute changes may be a sunburn, followed by a tanned appearance. But what about the chronic changes? Those brown spots on your arms and hands that folks refer to as “liver spots” or “age spots” are in actuality the manifestations of chronic sun exposure and resultant sun-damage. They are irreversible.

For a grape, dried by the sun, the texture and quality of the skin transforms to a wrinkled, flaccid and shriveled form which we call a raisin. Our skin is very similar to the grape. Premature wrinkling, loss of elasticity and leathery feel to the skin (think Magda from “There’s something about Mary”) are direct by-products of extensive sun-exposure. So which would you rather be, a grape or a raisin? In a society where people are paying a premium for a youthful appearance with products like Botox, dermal fillers and plastic surgery, why not save money and be pro-active: protect your skin from the sun everyday!

With regards to health, it is known that UV-radiation suppresses the immune system. Suppression of the immune system leads to cancer. It has been reported that 90% of skin cancers are induced by UV-radiation exposure. 90%! This statistic is a vital reason that I encourage you to seek shade (where your bliss awaits), wear sunscreen and protective clothing on a daily basis.

Now some of you may be thinking, what? How can that be? Maybe Dr. Barr (that’s me) has been drinking too much of that red wine, because I know that phototherapy (delivery of UVB rays in a very controlled and time limited setting) make my psoriasis better! Psoriasis (a chronic skin condition +/- joint involvement) is known to be driven by an up-regulation of aspects of the immune system…so suppression of these “jazzed up” factors so to speak, is the desired end result. This principle applies to several conditions in dermatology, but these are the exceptions not the rule, and most importantly, the exposure to UV-radiation administered in a dermatologist’s office is tightly regulated and controlled to minimize adverse effects of said exposure.

Like a fine wine, your skin will age, but there’s a big difference between chronologic aging and physiologic aging. The latter of which is accelerated significantly by extensive sun-exposure. So the choice is yours, grape or raisin…which would you rather be?

Just the facts ma’am….

just-the-facts-ma'am

Sgt Joe Friday (Jack Webb)

I was recently asked by a new acquaintance if I had been diagnosed with ADHD. My initial response was surprise. Me? Attention problem? As someone who has sat in the same spot for hours on end reading textbooks cover to cover, studying for medical boards and looking at hundreds of slides (one of my favorite parts of dermatology and why I became a dermatopathologist) without getting up to eat, drink or use the loo (that just sounds better than “potty” don’t you think?), it hadn’t occurred to me that I might have a problem staying focused.  I know I have my idiosyncrasies and nuances, and that certain” je ne sais quoi” that I like to think of as part of my charm (aka: a New Yorker without a filter=inappropriate and sometimes vulgar to which I credit  my father: love you Dad ), but I didn’t think attention or focus was a problem. But as I thought about her comment some more, I came to the realization that my issue is not an inability to stay focused when tasked, it’s more that I am perpetually interested in lots of things and often more interested in something other than what I am doing at that moment. Which brings me to the whole point of this post.

I had originally intended to post topics that only had “dermatology” titles: topics relating to the health of your skin, how to manage issues with your skin, and how to protect it, as my passion is educating people about skin cancer and melanoma, but somehow I keep getting side-tracked. Like I said, I am interested in a lot of things, especially eating. Learning new ways to cook (or just learning to cook for that matter) has opened a whole new world for me and I am having fun experimenting and I want to share that with you.

You see, your skin is a window to the overall health of your body. There are many systemic diseases which manifest characteristic skin findings. Therefore, examination of the skin can be key to making diagnoses as well as prompting a more extensive evaluation to pursue the possibility of internal organ involvement. Though not common, skin findings can be the first clue to metastasis of internal malignancy leading to diagnosis, work-up and subsequent management.

So what I am getting at is that what you eat can have a big impact on your skin. For example, those of you with Celiac disease may have experience with dermatitis herpetiformis (DH). DH is a chronic, intensely itchy, blistering skin manifestation of gluten-sensitive enteropathy (Celiac disease) which affects 15 to 25 percent of people with the disease and is found mainly in adults (more common in men and people of northern European descent). A strict gluten-free diet is the only treatment for the underlying disease, though some people may require temporary use of oral medication in order to get relief from their skin symptoms as they transition their diets.

So even though my plan was just to stick to the “derm facts”, there are so many facets of our lives that are intimately linked to the health of our skin: food, fitness, travel (bed bugs, myasis and leishmaniasis, oh my) that you may find my attention wandering in different directions. Feel free to reign me in if you have questions, or jump on board and enjoy the ride it should be interesting!

Chocolate Almond goodness

IMG_1909
These little nuggets of goodness are made from a recipe adapted from an inspiring and beautiful blog I have come across (thank you Caitlin-roostblog.com)  It was originally made as a dinner biscuit, but I tweeked it make it an after dinner treat. Depending on which of my adaptations you try, you can make it more like a biscuit(less sweet) or more like a true dessert….a girls got to have her chocolate right?

Over the last few months, as I have jumped, I mean seriously, like off the high dive right into the deep end of a pool (and I’m afraid of heights mind you…another wonderful bonus of getting older, but I digress) into the gluten-free realm, I have tried to nudge my family, especially the kids into the “shallow water” of gluten-free eating. So when my son, the pickiest eater of us all gives something a thumbs up, believe me, I am going to shout the recipe out to anyone willing to listen. (just turn down the volume if I’m being too loud).

I have now made this 3 ways, using either butter or coconut oil for variety. Choose whichever one sounds good to you!

Chocolate Almond Goodness: Subtle sweetness for a mini-biscuit

  • 2 1/2 cups almond flour
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 2 eggs
  • 1/4 cup melted organic coconut oil or butter (Note: coconut oil will impart a somewhat “tropical” flavor and butter will provide a true biscuit flavoring)
  • 1/4 cup brown rice syrup
    3 Tb organic cacao powder

Preheat oven to 350F. Line a baking sheet with parchment paper or a silpat (or whatever you’ve got so things don’t stick to pan).

In a large bowl, combine the almond flour, salt, cacao and baking soda. In a medium bowl, whisk together the coconut oil, brown rice syrup and eggs. Stir the wet ingredients into the flour mixture until thoroughly combined. With a spoon or if you are willing to get dirty (which is more fun in my opinion) scoop up some dough in your hands and make small/medium blobs (very technical term) probably equivalent to 2 teaspoons or tablespoon size depending on your blob preference.

Bake for 15 minutes (give or take depending on your oven) so that a toothpick inserted into the center of a biscuit comes out clean. Let cool briefly on the baking sheet. Serve warm. ( I have also frozen the leftovers and they keep well!)

Makes about 25-28

The one below is the sweet treat version and my favorite one so far. Not too sweet, but just enough to satisfy my cravings…and hopefully yours too!

Chocolate Almond Goodness: my version of an “Almond Joy”

  • 2 1/2 cups almond flour
  • 1/2 tsp salt
  • 1/2 tsp baking soda
  • 2 eggs
  • 1/4 c organic melted organic coconut oil
  • 1/2 c organic light brown sugar
    1/4 c organic cacao powder

The mixing and cooking directions are the same as above but instead of brown rice syrup use the brown sugar and add it to your dry ingredients. Enjoy!

By the hair of my chinny chin chin….

My dog Beaudi. He graciously agreed to be the model.

My dog Beaudi. He graciously agreed to be the model.

As a kid, hearing about  hair on your chinny chin chin was an amusing part of a fairy tale. As an adult female, having hair on your chinny chin chin is no laughing matter, right ladies? And not to leave the guys out …..having rogue earlobe hairs and feeling like a sasquatch may not be your thing, so the good news is that over the last few decades the options for hair removal have expanded and improved.

There are numerous methods available for hair removal, some of which are very temporary and some of which have the potential to permanently reduce hair growth. Notice I didn’t say permanently remove hair. I am a New Yorker to my core, despite living on the West Coast for many years,  I’m gonna tell it like it is…if it sounds too good to be true, it most likely is…so I’m not going to try to convince you otherwise.  As a dermatologist it is my job to provide facts, details and opinions so that my patients can make informed decisions. So even though this site is not intended to treat, diagnose or cure any disease or ailment, and as readers you are not patients, I am committed to providing clear, concise (well maybe not that concise, I am known to ramble a bit) explanations of issues in hopes of being helpful.

So let’s start with the basics of hair. I am sure many of you have tweezed, shaved, waxed, threaded,  sugared or “been lasered” only to be befuddled by the fact that some hairs stay gone and others rear their wiry heads way too soon. This is due to the fact that hair grows in three phases: the actively growing phase (anagen), which comprises about 80-90% of hairs. On the scalp this phase lasts about 2-6 years, whereas on the arms, legs, eyelashes, and eyebrows the phase is only about 30-45 days which helps explain why hair in these areas is much shorter than the scalp. The next phase or  transitional phase known as catagen comprises 3% of all hairs at any time. This phase lasts for about 2-3 weeks. The last phase is the resting  phase (telogen) which comprises 10-15% of hairs and last approximately 100 days. It is during the telogen phase when “shedding” occurs and about 25-100 telogen hairs are shed each day. The kicker is that hairs are not in sync with each other and while some hairs are growing, others are transitioning or falling out.  Moreover, it’s only when hairs are in anagen (growing hairs) that they are responsive to removal modalities (i.e. electrolysis, laser).

Now that we have the basics down, how do you choose the best hair removal method? There are several factors to consider: convenience, pain threshold (a very subjective factor), cost, goal for temporary vs. more long-lasting results and anatomic location. Most of these factors are intimately intertwined.

For instance, shaving is very convenient as you can do it yourself, in your home, cost is lower (although the cost of razor blades these days is nutty), pain is minimal but the results are very temporary as you have to shave every few days because you are only trimming the hair not removing it.

Waxing/threading/sugaring: convenient as the service is readily available and it’s quick, cost is relatively low, can be done on most if not all external anatomic locations. The downside is that it can be painful and the results usually only last about 3-6 weeks. With repeated treatments the hair follicles may be disrupted/ damaged  which may lead to permanent hair loss (but most likely patchy at best).

Electrolysis: So how does it work? An electric current is applied with a very fine needle-shaped electrode, or metal probe into each hair follicle to destroy the root. The pros are that this method has a good track record for permanent hair reduction and in some cases permanent removal. Since it targets the follicle itself, this method can be used on most skin types. The cons are that it can be painful, requires many treatments (can be upwards of 15-30)  and can be expensive. Also operator dependent so results can vary.

Laser: Laser hair removal is one of the most commonly performed cosmetic procedures in the U.S. A beam of  highly concentrated light penetrates into hair follicles. It is the pigment in the follicles that absorbs the light and this destroys the hair.  The technology of lasers has advanced so that patients of color can safely have laser performed without damaging skin tone. As with other methods, only the anagen follicles are targeted so treatments need to be repeated every 6-8 weeks to capture more and more of the anagen follicles until the desired level of hair reduction is achieved.

The pros are that laser can be done relatively quickly depending on the site treated and the results are long-lasting. Treatments literally can take as little as 5 minutes! The cons are cost, number of treatments required (usually 6-12) depending on body part treated and pain. I can attest to the fact that current lasers are way less painful than lasers used in 2008 even, and that is saying a lot because I am a big wimp. Risks of treatment other than pain , include swelling at treatment site, burns (go to someone with expertise and experience, and have a test spot done first: settings can be adjusted to avoid this). Although with the advances in technology this does not happen as often, but lightening or darkening of the skin in the treated area can occur.  The other issue with lasers are that they are best used on course hair: legs, back, bikini, underarm, men’s beards. Although they are used for women’s facial hair, the light colored, peach fuzz found on women’s cheeks, chins and lips is unlikely to respond as well. Lasers target a color and the lighter the hair the less there is to target.

Topical therapy: A serendipitous discovery of hair loss was noted when using an anti-malarial drug (eflornithine). The medicine is formulated under the trade name Vaniqua which is a prescription cream used to reduce facial hair growth in women. The mode of action is to block the enzyme that leads to hair growth. This ” blockage” is gradual and can take up to six months to take effect, during which time other hair removal methods would need to be continued. It’s a twice daily application and the downside is that once you stop using it…the hair growth is no longer blocked and hair will eventually return.

So as you can see there are many options…this is a good thing. The best expected outcome is permanent hair reduction and in some cases permanent hair removal may occur. Now don’t get me wrong, I’m a glass half full kind of a girl (and if the wine is really good, fill her up’) but when it comes to issues in medicine I am a realist, and I hope armed with this information you will be too so that you can decide which if any of these modalities might work for you and you will not be disappointed with the result. If none of these float your boat, au natural is beautiful too!