We are not sure of the exact cause of this worsening, but hormonal changes during pregnancy undoubtedly play a significant role. Some studies indicate that the worsening is greater in the third trimester, as a result of increased androgens, while other studies found that acne was more severe mainly in the first trimester.

Whatever the situation, whether you didn’t have acne before pregnancy and it has appeared, or you already suffered from it and it has worsened, it’s normal to try to find a solution. The problem arises when, during pregnancy, it is impossible to use the most effective treatments for acne in adult women: retinoids (either in cream form, such as adapalene or retinoic acid, or orally, such as isotretinoin) and antiandrogens (contraceptives, spironolactone).

Despite this, there are certain options that we can use during pregnancy to control acne. I’ll tell you about them below.

What topical treatments can be used for acne during pregnancy?

AZELAIC ACID:

Marketed at 15 or 20%, this product has an effect on pimples (keratolytic, cleanses pores), is antibacterial and anti-inflammatory, and also slows down skin pigmentation, which can help prevent spots on the face as a result of pimples, especially if you have dark skin.

Azelaic acid may cause slight irritation when first used, but the skin gradually becomes accustomed to it.

BENZOYL PEROXIDE:

When applied topically, it has antibacterial, comedolytic, and anti-inflammatory effects. It has a “bleaching” effect on fabrics, discoloring them, so be very careful after using it (wash your hands and use a white pillowcase).

Some time ago, I wrote an article about benzoyl peroxide (in Spanish) where you can learn more about it.

ANTIBIOTICS:

The most commonly used are erythromycin and clindamycin. Both are suitable for use during pregnancy, but are not recommended for prolonged periods of time in order to avoid the development of bacterial resistance.

It has been shown that combined use with benzoyl peroxide helps reduce the risk of resistance, so antibiotics are not recommended as the sole treatment for acne.

SALICYLIC ACID

Found in cosmetic products (gels, creams, tonics), it helps dissolve keratin in the pores, producing a comedolytic effect. It is clear that salicylic acid alone will not cure acne, but it can be useful as a supplement.

What oral treatments can be used for acne during pregnancy?

We will reserve oral treatment for acne outbreaks that are not adequately controlled with topical products and are highly inflammatory, which can result in persistent marks or scars.

ANTIBIOTICS:

For these situations, we can use antibiotics from the macrolide family (erythromycin or azithromycin) or cephalexin. Once again, in order to prevent the development of bacterial resistance, it is advisable not to prolong treatment for more than 3 months and to combine it with benzoyl peroxide. If more than one course of antibiotics is required, it is preferable to always use the same one, which also minimizes the risk of resistance.

ORAL STEROIDS:

We would only use them in very severe cases where the acne is highly inflammatory, such as acne fulminans. As I said, this is exceptional, but it is certainly good to know that we have tools available to treat severe cases with a lot of inflammation and pain.

Are you pregnant and have acne? What treatment have you used?

The post How to treat acne while pregnant? first appeared on Dra. LOREA BAGAZGOITIA.

Before looking at how to prevent or improve skin aging, it is important to understand how it occurs.

On the one hand, the skin undergoes an intrinsic aging process, which is due to the passage of time, whereby the skin becomes drier as the production of skin lipids decreases. In addition, the connection between the dermis and the epidermis flattens, making the skin’s surface more fragile.

On the other hand, most of the changes in our skin are the result of extrinsic aging, which is conditioned by external factors, the most important being sun exposure through ultraviolet (UV), infrared, and visible light radiation. Other factors that play a role in the aging process include pollution, smoking, lack of sleep, an unbalanced diet, and heat. All of these external elements that influence our skin on a daily basis are collectively referred to as the exposome.

Many of these factors, given that they generate significant oxidative stress in the dermis, increase the activity of MMPs (matrix metalloproteinases), enzymes that break down collagen, leading to a reduced support capacity of the dermis, which makes the skin’s surface appear more wrinkled.

There are two different types of skin aging (atrophic and hypertrophic), which I discuss in another article on this blog.

Now that we have touched on how and why our skin ages, let’s move on to what we should look for in an anti-aging cosmetic product. At this point, it seems sensible to emphasize that any of the active ingredients discussed below will be meaningless if their application is not accompanied by sunscreen. Knowing that the sun is the main cause of aging, any cosmetic routine must be accompanied by sunscreen, ideally on both sunny and cloudy days.

To review the most effective active ingredients in this field, in addition to my own professional experience, I will draw on a recently published article in the British Journal of Dermatology, which provides a good overview of the ingredients with the most scientific evidence currently available.

Retinoids

The retinoid family includes retinol (vitamin A) and its derivatives: retinoic acid, retinaldehyde, and esters. Retinoic acid (also called tretinoin) is the most scientifically studied and has robust evidence regarding its ability to improve fine wrinkles, hyperpigmentation, and texture. It is the most potent retinoid used at concentrations between 0.01% and 0.1%, with 0.025% and 0.05% being the most commonly used.

In addition, retinoic acid has been shown to have a positive effect on regulating the balance between collagen degradation and synthesis in the dermis. It does this by activating fibroblasts, the cells responsible for collagen production. Furthermore, MMP activity is reduced.

For all these reasons, we consider retinoids to be the star anti-aging molecules.

Antioxidants

Antioxidants are beneficial both orally (especially when consumed through a healthy diet rich in fruits and vegetables) and topically.

Niacinamide, in addition to its antioxidant effect, can help with barrier function, reduce pigmentation, and control skin sebum production. In any case, its potency is lower than that of retinoids.

Vitamin C also has beneficial effects on skin aging. It has been shown to increase collagen expression and reduce skin pigmentation.

Peptides

Peptides are short chains that group together certain amino acids. Some of these molecules (such as PKEK) applied topically can reach the dermis and stimulate collagen synthesis. Others (Argireline) appear to be able to slightly reduce the depth of certain wrinkles by having a neuromodulatory effect, causing the superficial muscle fibers to contract with slightly less force.

In conclusion…

Skin aging is inevitable. However, we can adopt certain measures in our daily routine, while always maintaining realistic expectations, to help us keep our skin healthy and youthful-looking. Choosing products that provide adequate sun protection, hydration, barrier function restoration, and a certain stimulus for collagen synthesis will help us as we age.

If you are unsure about which anti-aging product to choose, ask your dermatologist (either online or in person) for advice on the most appropriate products for your particular situation.

Which cosmetic product do you like best for preventing aging?

The post What should an anti-aging or anti-wrinkle cream contain? first appeared on Dra. LOREA BAGAZGOITIA.

As you may know, retinol is one of the most scientifically proven anti-aging active ingredients. In recent years it has gained much popularity and its use has spread considerably. Products with concentrations of 0.2% to 1.5% are currently available.

High concentrations of this molecule (which in the skin is transformed into retinoic acid, the really active and most effective molecule) can cause irritation, redness and flaking in the first applications. Also, if the use is not adequate and is done without control, it can lead to an irritative dermatitis that may require medical treatment in some cases. However, to my surprise, the new retinol regulation does not claim these arguments for the reduction of the maximum allowed concentration, as you will read below.

Is retinol banned in cosmetics?

Contrary to some rumors, retinol will not be banned. It has simply been regulated differently so that retinol, retinyl palmitate and retinyl acetate will be included in cosmetics at lower concentrations than hitherto.

• Body lotions may not contain more than 0.05% concentration.
• Facial products may not contain more than 0.3%.

It appears that the regulation does not affect retinal (a molecule related to retinol, also a precursor of retinoic acid).

Why has the new retinol regulation been implemented?

Retinol, chemically speaking, is vitamin A. Apparently, it has been found that up to 5% of the population includes in their diet more vitamin A than the maximum recommended daily amount. This occurs both as a result of food and food supplements (those containing carotenes). The EU is considering that the cosmetic supply of retinol could increase the possible (and very remote!!!) toxicity of vitamin A in that percentage of the population.

For this reason, a warning should be included on packaging to inform consumers already exposed to vitamin A in foods and food supplements of the possibility of overexposure from the use of such compounds.

Does the new retinol regulation affect retinoic acid?

Retinoic acid is considered a drug, so this measure would not affect it.

When does the new retinol regulation come into force?

As of February 1, 2025, no more products with concentrations above those permitted may be launched on the market, and as of November 1 of the same year, they may not be marketed.

Is it dangerous to continue using the product I have?

No. You can use it. Given the new recommendation, make sure that you do not take more vitamin A than is desirable because you abuse vitamin supplements. However, the absorption of cosmetics into the blood is very low and it is unlikely that using a cream with retinol at more than 0.3% concentration will cause you any real health problems.

What do you think of the new regulation of retinol in cosmetics?

The post New retinol regulation first appeared on Dra. LOREA BAGAZGOITIA.

WHAT IS a dermatofibroma?

Dermatofibromas are very common benign tumors (again, meaning by “tumor” simply “lump”, without meaning it is malignant or anything similar), which are usually harder than normal brown skin. It is not uncommon for a person to have more than one on their legs or arms.

More images of dermatifibromas

They are firm to the touch and in many cases are not bothersome, although some people find them slightly painful, especially when squeezed. They are usually less than a centimeter in size, although sometimes larger dermatofibromas occur.

They appear more frequently in adults, usually on the legs. They are twice as frequent in women as in men.

WHY do dermatofibromas occur?

Traditionally, they have been blamed on small wounds, bites, or ingrown hairs. If you have any, you have probably thought that was the cause. However, as with so many things in dermatology, the cause is still not entirely clear.

Are dermatofibromas RISKY?

No. Dermatofibromas are benign and have no chance of turning into something bad.

How are dermatofibromas DIAGNOSED?

They are usually diagnosed with a simple examination. Dermatofibromas characteristically show what is called the pill sign. This means that when they are squeezed from the side, they become depressed and sink into the skin, as you can see in the picture.

When pressed laterally, dermatofibromas are slightly depressed.

In any case, dermatofibromas can have very varied aspects and colors, so sometimes it can be difficult to differentiate them from melanocytic nevi, basal cell carcinoma, certain scars or even melanoma. To differentiate them, the dermatologist will use the dermatoscope and if this is not enough, he/she may indicate that they should be removed to confirm the exact diagnosis.

How are dermatofibromas TREATED?

From a medical perspective, once the diagnosis is confirmed, no treatment is needed for dermatofibromas. They are usually removed under two circumstances: if they are painful or for cosmetic reasons. In rare cases, as I mentioned earlier, they may need to be removed to confirm the diagnosis.

To remove them, local anesthesia is used; small punctures are placed in the area of the dermatofibroma to render the skin insensitive. After removal, stitches are usually given. It is important to keep in mind that in the area where the dermatofibroma was, there will be a scar, so it is not always compensated to remove them for aesthetic purposes.

The post Dermatofibroma: a hard mole on the leg first appeared on Dra. LOREA BAGAZGOITIA.

However, around this age and beyond, some of you will notice the appearance of new brown spots that are sometimes raised, rough, and may be itchy. If you notice such a spot or bump, chances are it is a seborrheic keratosis. Although it never hurts to consult a dermatologist to confirm this…

What are seborrheic keratoses?

These are tumors (keeping in mind that the word “tumor” in medicine means nothing more than “lump”) that originate from the most superficial layers of the skin (epidermis) and are benign. They are usually brown in color, although some are very dark, almost black, and others are almost skin-colored. They are usually lumpy and their surface is rough; it is not uncommon for them to occasionally peel off or even break off a small piece. They are often confused with warts, but although they look similar, they are not exactly the same.
They may itch or bleed after a slight rubbing.

More pictures of seborrhoeic keratosis

Why do they appear?

We can consider seborrheic keratoses as part of skin aging. It is thought that the amount of sun we get throughout our lives influences their appearance, but this is not entirely clear because they also appear, although less frequently, in areas that are not exposed to the sun. Some people are more susceptible to their appearance than others, so there is probably some genetic predisposition.

Is there any risk?

Seborrheic keratoses are by definition benign and are unlikely to progress to skin cancer. Even if they grow, they remain benign.

How are they diagnosed?

The most common is that with a simple examination, using a dermatoscope, we can differentiate a seborrheic keratosis from other types of patches. In this sense, the most important thing is to distinguish it from a melanoma, which, as you know, is one of the most aggressive skin cancers. In rare cases, in order to make this distinction, we need to perform a biopsy of the lesion to confirm that it is a seborrheic keratosis.

How can they be treated?

Seborrheic keratoses can be treated with cryotherapy (liquid nitrogen), laser (usually CO2 laser) or they can be removed. Occasionally, a lighter or darker spot may remain in the area of the seborrheic keratosis after removal.

In conclusion…

Seborrheic keratoses are completely benign and pose no risk. However, it is always important to differentiate them from moles or even melanoma, and it is advisable to see a dermatologist for this. If they are not aesthetically pleasing, they can be easily removed with treatments such as cryotherapy.

The post Rough, brown spots on the body first appeared on Dra. LOREA BAGAZGOITIA.

Melasma is difficult to treat, but in recent years we have a new therapy that can help us in this regard: tranexamic acid.

What is tranexamic acid?

Tranexamic acid is an antifibrinolytic agent. It reversibly binds to a molecule called plasminogen, preventing it from being converted into plasmin, which reduces bleeding. On the other hand, it interferes with the formation of new blood vessels in tissues.

It has traditionally been used by surgeons to prevent bleeding during surgery. It may also be used to reduce menstrual bleeding in women. It is considered a safe medication.

Why is it used for melasma?

Plasmin (by binding to epidermal cells and inducing these cells to release a molecule called prostaglandin E2) has the ability, when exposed to UV radiation, to activate the enzyme tyrosinase, which produces melanin (skin pigment).

Blocking the formation of plasmin by tranexamic acid reduces skin pigmentation by decreasing tyrosinase activation.

In addition, the vascular component is important in some cases of melasma. Thus, tranexamic acid’s ability to reduce the formation of small cutaneous blood vessels may also be helpful.

Is tranexamic acid effective for melasma?

To date, no fully controlled clinical trials (the most rigorous scientific studies) have been published. However, there are large series that show the efficacy of tranexamic acid in lightening melasma.

The largest study was conducted by Lee et al. They followed 591 patients with melasma who took the drug twice daily for 4 months. 87.9% of them improved and only a quarter of them had a recurrence of melasma.

Is tranexamic acid a safe treatment for melasma?

Yes, it is safe. Adverse effects reported in studies are rare and generally mild. However, there are some situations in which it should never be given:

• Pregnancy
• Personal or family history of thrombosis
• Coagulation disorders
• Severe renal insufficiency
• Impaired color vision

There are certain situations in which it is generally better not to take it, but it can be individualized and assessed on a case-by-case basis:

• Breastfeeding
• Renal or hepatic insufficiency
• Use of oral contraceptives.

How should tranexamic acid for melasma be used?

Tranexamic acid is taken twice daily. It comes in 500 mg tablets. It is advisable to divide it in two, taking half in the morning and half in the evening.

If you prefer not to take drugs or if you have any of the above-mentioned medical contraindications to their use, there is a possibility of administering them by mesotherapy (through small punctures in the area of the blemish). Some studies show an efficacy comparable to hydroquinone (the most effective depigmentation cream) with hardly any side effects.

In conclusion..

Tranexamic acid is another alternative that we can add to the usual depigmenting treatments that we use in the complex management of melasma.

The post Tranexamic acid for melasma first appeared on Dra. LOREA BAGAZGOITIA.

What do we know about anti-ageing products?

We know that a large proportion of skin ageing (up to 80%) is caused by the sun. For this reason, the use of sunscreen is a must if we want an anti-ageing routine.

In an anti-ageing routine, sunscreen is a must.

In addition to this, the most proven active ingredient in terms of anti-wrinkle and anti-spot effect is retinoic acid.

Are there any oral anti-ageing options?

It is clear that a healthy diet contributes in many ways to maintaining a healthy body and therefore beautiful skin. Fruits and vegetables, which are rich in antioxidants, help to combat oxidative stress caused by the sun, pollution and other factors. If you eat well, you don’t need miracle vitamin supplements to fight ageing.

A healthy diet, rich in antioxidants, helps fight ageing

However, knowing the proven effects of retinoic acid, and knowing that isotretinoin (the famous Accutane ® for acne) is a derivative of it, it is reasonable to think that taking isotretinoin orally could have similar effects to retinoic cream, which could be more convenient. In addition, I recently told you that we generally use low doses of this drug, and that these have been shown to be very convenient and safe.

What does the science say about isotretinoin and ageing?

There is some research that has tried to establish whether taking low doses of isotretinoin (lower than we use for acne) has any effect on wrinkles or collagen synthesis.

Some of them find favourable effects; others do not. Relevantly, one article finds that the effects of isotretinoin may be noticeable, but that they are not better than 0.05% retinoic acid and a good sunscreen.

Although isotretinoin is safe, there is insufficient scientific evidence in favour of its use as an anti-ageing agent.

Isotretinoin is a safe drug, but it is important to weigh the benefits against the risks of using it to prevent ageing. Many of its users are women of childbearing age, and the most serious adverse effect of this drug is the risk of foetal malformation in pregnant women. This is why isotretinoin treatments are so tightly controlled.

In conclusion…

It is possible that isotretinoin could help prevent skin ageing. However, there is not enough good-quality scientific evidence to recommend isotretinoin for this use. The trials that have been done are inconclusive. It is important to assess the risk-benefit ratio.

Would you like to have an oral anti-ageing option?

The post Isotretinoin: an oral anti-wrinkle treatment? first appeared on Dra. LOREA BAGAZGOITIA.