Powder cosmetics are the simplest formulation and least likely to cause problems in sensitive-skin patients.
Q: What would you recommend to the patient who is allergic to eyeliner?
These products are sometimes stiff and require a fair amount of pressure to transfer the cosmetic to the skin. For patients who truly have sensitive skin, I recommend black powdered eyeliner. The patient can purchase a matte black eye shadow and a thin sable eyeliner brush. My favorite black eye shadow and brush are available from MAC cosmetics. The brush is wetted with distilled water and stroked across the eye shadow powder to create a paste. The paste is immediately stroked just above the upper eyelashes and below the lower eyelashes to create a black line. Powder cosmetics are the simplest formulation and least likely to cause problems in sensitive-skin patients.
A: Antiperspirants only work as well as the person applying the product. They use aluminum and/or zirconium salts to place a physical plug in the acrosyringium. The plug prevents sweat from being released into the axilla as long as it remains in place. It takes about 10 days of daily antiperspirant application to create the plug, which will remain for about 14 days. Weak antiperspirants, containing only aluminum salts, form the plug superficially in the acrosyringium. The plug is so superficial that aggressive rubbing and shaving can remove it. This is why women who shave their armpits frequently may complain that antiperspirants are less effective.
A combination of aluminum and zirconium salts can create a physical plug deeper in the acrosyringium that is less susceptible to physical removal. Patients who have problems with antiperspirant efficacy may wish to choose a product with this combination. In addition, antiperspirants are more effective when applied at night. This is because the body is at rest and axillary sweat production is decreased. Sweat actually rinses away the antiperspirant before it can form the plug, making it less effective.
For persons with hyperhidrosis, antiperspirants should be applied twice daily, with the nighttime application more important than the daytime application.
The key to excellent antiperspirant performance is twice-daily application of the product - using the proper metered amount - to the entire axilla. All of the eccrine ducts must be touched by the antiperspirant for it to work. Erratic spread of the antiperspirant will result in erratic sweat control. In summary, if the plug in the acrosyringium is not formed, the product will not work.
Zoe Diana Draelos, M.D., is a clinical associate professor of dermatology, Wake Forest University School of Medicine, Winston-Salem, N.C., and primary investigator, Dermatology Consulting Services, High Point,
N.C. Questions may be submitted via e-mail to firstname.lastname@example.org