Dr. Sunil Dhawan skin care interviewDr. Sunil Dhawan is a popular dermatologist who has been practicing for 20 years.   I see him for skin and hair concerns and we visit the same gym.   There is a friend-like relationship besides being doctor and patient.  Yet still it took a while to book a slot with him when I requested to interview him,  as he is always so busy.

Finally today I got to sit down with him for 30 minutes.

Q:  Could you tell me the main skin problems Asian women face?
A:  1) Acne, acne scarring; 2) pigmentation – usually too much, not too little; 3) sensitive skin to all kinds of things (red and irritated skin reaction); 4)  eczema; 5) brown bumps on face called dermatosis papulosis nigra.

Q:  What about Caucasian women?
A: They have sun damage – brown spots, skin cancer, more fine lines and wrinkles. They tend to have acne too, but they don’t scar that much.

Q: And both of them have acne?
A: Yes it’s not Asian unique, but Asian’s skin tend to have scarring after the acne is gone.

Q: If Asian women don’t pick at the acne, do they still scar afterward?
A: It will be lesser brown if you don’ pick at it, but still you can have scar.

Q: I sometimes have breakouts other times not, I can’t well predict when it happens.
A: A woman’s period can have an effect on it. It happens more before and after the period. Other things that can affect it are hormones, stress, etc.

Q:  Which group has dryer skin?
A: Asian.

Q:  Then why Caucasian women tends to have more wrinkles?  Isn’t wrinkle related with the dryness of skin?
A: Wrinkle is more related with the level of sun protection. The darker your skin is, the less wrinkles you get. Many wrinkles are from sun damage.  Caucasian women has less natural protection from sun because the light color of their skin. Asian women have some natural degree of sun protection due to the pigment in their skin.

Q: Both Asian and Caucasian grow brown spots due to sun damage?
A: Yes, but Caucasian has more individual spots, while Asian tends to have brown patches, more diffuse- called melasma

Q:  What are the effective methods to treat brown spots or patches?
A:  There are multiple ways.   Fading creams, peel (chemical), microdermabrasion, lasers.   I normally recommend my patients to start with fading creams, which usually contain a compound called hydroquinone. This compound is effective, though it can be irritating. Also retinoids like Retin-A, and Tazorac are effective as well.

Q:  Are the intensity/risk level go up following the order you gave?
A:  Microdermabrasion is very mild.  For others,  from creams to peels to lasers the risk and intensity go up. I have some Asian patients who used fading cream then microderm and peels their skin just looked amazingly different, look lighter, fresher, and more youthful.

Good fading creams include Tri-luma and Obagi. If you are only concerned of brown patch both can work well, if you are concerned of both brown patch and wrinkles, use Obagi.

Q:  I looked a bit into Obagi.  My impression is it causes skin to be thin and very sensitive.  I won’t have as much freedom going to the beach or under the sun after I use it.
A: That’s not true.   For some people who didn’t get proper training or knowledge it may not have worked well with them.  My wife first used Obagi in 2000, and she didn’t like it, because she was not trained properly by someone outside our office.  Later she got better training from one of our trained medical aestheticians and started using again since 2003 till now, and she loves it.   Her skin looks pretty good.

Q:  But she cannot stop using it.
A:  Yes if you stop using it your brown patches could come back.   But you only need to use it twice or 3 times a week to maintain the effect.

Hundreds of my patients used Obagi.  10% of them couldn’t use it because their skin was very sensitive.  A couple stopped because they were concerned of the side effect.  The only side effect I am aware of is irritation and probably just 5-10% run into that.

Its just like brushing your teeth- you can do it once, and get some effect, but usually you have to maintain it, because the causes of pigmentation like hormones and sun do not go away on their own.

Do some fading first, you can use tri-luma/ Obagi/ other fading creams to start. After using fading creams, laser is good for individual spots, and microdermabrasion/ peels is good for diffuse pigmentation like melasma..

Q:  What percentage of your patients are Asian?
A: About 30%.   Among them, Vietnamese, Japanese, Chinese, Korean women are close genetically, they have similar skin.

Q: Over the years during your practice, has there been a trend that people are seeing you more for cosmetic purposes instead of dealing with real issues such as skin cancer etc.?
A:  Yes there has been this trend, from the demands/needs of women mostly, though men are also asking.

Q:  For women who have given births, there will be some loose skin on the tummy area, how to improve that?
A:  Tummy tuck surgery.

Q: It will leave scar isn’t it?
A:  Yes but usually light scar under the bikini line.   Asian women could have a condition which causes more visible scar called keloids, though this can be treated.

Q:  Is there any other non-surgery method for someone whose condition is not that bad?
A:  We have an equipment called Skintyte from the Sciton Company, could help improve it.  We use it on face, neck, and tummy areas, and 70% of the time it works well..

Dr. Dhawan has offices in Fremont and Milpitas in the Bay Area (http://www.centerforderm.com).