2008 Skinnies Awards

In “National Treasure: Book of Secrets,” actor Nicolas Cage struggles to retain the integrity of his family name. In real life, Cage battles to preserve the integrity of his mane. The hairs of his scalp, that is. Over the years, Cage's hairline went from full in "Moonstruck"... ...To full retreat.

In the 1990’s, this versatile thespian’s career advanced with a variety of challenging roles. At the same time, the hairline of his scalp receded. Slowly, the troops of hairs along his brow retreated, surrendering in the war against male patterned hair loss. For a Hollywood leading man, thinning hair can affect available movie roles. At one point, Cage was considered to star in a remake of “Superman.” This version did not move forward, and it is rumored that Cage was turned down because of his sparse scalp coverage. After this, Cage’s hair loss pattern changed.

Recent photos show that over the years a frontal tuft of hair has remained steadfast, despite the natural tendency for some men’s front and central scalp hair to signal the white flag. Somehow Cage’s hair has not done the way of boldly bald action stars like Bruce Willis and Jason Statham. And candid shots show that Cage is not wearing a wig. How has Cage preserved this national treasure?

Now is as good a time as any to clarify: Dr. Reese does not treat any of the individuals listed at skinema.com. So we can only speculate what treatments may have been used. First of all, there are two medicines approved by the US FDA to slow and stop male hair loss, fortifying the follicular troops in the baldness battle. Rogaine (minoxidil) is topical, available over the counter, and can be used as long as a dandruff-like reaction does not occur. Propecia (finasteride), is a prescribed pill. It is only for men and usually free of side effects. Occasionally the libido is suppressed, which most film heroes would like to avoid. Both Rogaine and Propecia can resuscitate the entire scalp, especially the central portion.

Yet occasionally a candid photo shows a thinning patch behind Cage’s frontal forest. This would raise the possibility that Cage has undergone a hair transplant procedure. The most common technique is to surgically remove hair follicles from the back of the scalp and implant them in the central or frontal scalp. Genetically, these follicles resist the effect of testosterone over time and retain their strength in the face of adversity. Images that show a thinning pate behind Cage’s frontlines are consistent with hair transplantation.

Would Cage’s career differ if his dome were as hair-free as his “Ghost Rider” character? Would he still play the hero, following Bruce Willis' deforested lead? Or would he opt to play the villain, as relatively hairless Ed Harris does in the “National Treasure” sequel? Perhaps the answer lies in the presidential "Book of Secrets.”

Runner-up, Back in Theaters: Brad Pitt’s acne scars in “The Assassination of Jesse James by the Coward Robert Ford.”

Whew! It takes more time to read this indie flick’s name than it spent in movie houses. After being concealed with makeup and lighting in blockbusters like “Ocean’s 13,” Brad Pitt’s pitted acne scars are on full display as he plays the criminal gunslinger Jesse James. Back in those days, lasers weren’t available to clear deep facial scarring. But aren’t those devices available today, claiming to eradicate facial defects? Perhaps they don’t work as well as promised!

She sang that she wanted “More,” and she got it in 2007. Attention, that is. Celeb tsunami Britney Spears single handedly saved a faltering US economy by driving up sales of paparazzi flash bulbs, tabloid ink, and worn out laptop screens. With so much nightlife lovin’ skin exposed, it should not surprise anyone that at the tender age of 26, Britney has already had a lifetime worth of skin issues. Her persistent acne is the stuff of legend. Many are prone to teen acne and outgrow the disheartening condition by their early 20’s. Others are blemish free in adolescence, and are shocked to begin breaking out in college. Spears is one of the rare few to be zit prone starting in her Disney pop tween years as well as her multiply divorced 20’s. We’ll forego the usual comments about the contribution of a stressful lifestyle on problem pores, and remind Brit and all of you, that many treatments for acne exist and there is hope (see Skinnies award winner Will Smith for more details).

Growing back hair is a lot easier than preventing pimples. The question, why would a women shave her scalp in the first place? Hair represents a potent symbol of health, beauty and fertility. Not every woman requires locks as luxurious as American Idol’s Sanjaya, but substantially thinned tresses can be seriously distressing.

Severe physical and emotional stress can cause telogen effluvium (TE), where all of the scalp’s follicles get set on the same schedule and release their hairs together. Hairs rain out of the scalp like water in a Rihianna video, but fortunately sufferers don’t need an “umbrella ella ella.” For most, this type of hair loss resolves within a few months. Spears did not have a flare of TE, but voluntarily achieved the same result by shaving her head. We are dermatologists, not psychiatrists, but you don’t need a degree to see skin health is not Britney’s only issue.

Britney knocked out this year’s Skinnies competitors by appearing to undergo a final cosmetic procedure, lip enhancement. Full lips are a universal sign of hotness. Angelina Jolie has them naturally, and her fellow starlets covet them as much as Beowulf wanted to get busy with Jolie’s she demon self. With photos showing a suddenly swollen pout, it appears that Spears was either stung by a bee (ouch!), or Speared with a cosmetic doctor’s needle (also uncomfortable, we recommend anesthetic). Whether Spears’ lips were injected with collagen (old school), restylane (last year’s model), or juvederm (new volumizer in town), the problems are the same. Unfortunately, puffed up lips rarely look natural. Eventually, Brits lips will return to their attractively normal state, where we recommend they stay. This is not the time to break out with a karaoke version of “Oops, I did it again.”

S'up with Brit's lips? Attacked by a bumblebee? Hmmm, doubt it.

We should note that Britney’s epidermis is not entirely tabloid territory. Her tattoos are small and discrete, no “Prison Break” roles for her. Her controversial MTV awards appearance revealed that while she no longer sports cgi-style Spartan “300” abs, she is luckily free of stretch marks and only shows a sprinkling of cellulite after delivering two kids. Will her sister, Jamie Lynn, fare so well?

And despite getting too much sun (see last year’s Skinnies), she has not yet developed craggy pruny wrinkles. Our recommendation for Britney's handlers: Stock her shelves with sunscreen and sunless tanners. Take the batteries out of her electric razor. And give those lips a rest, or risk even more attention at skinema.com.

Runner-up, Lifetime Achievement Award: President George "W." Bush

Though our 43rd president got nowhere near as much press as his pop music fan, “W” only narrowly lost the epidermal award to Spears.

In addition to sun damage, stress zits, abrasions, and a unibrow, it was also reported that the sitting prez was diagnosed and treated for Lyme disease in the last year. He noted a rash on his leg, prompting the diagnosis. Caused by a bacteria spread by deer tick bites, this is one bioterror scare we can’t blame on Al Queda. Lyme disease appears to be a common cause of chronic forms of arthritis and nervous system symptoms. When caught early, as in Bush’s case, a round of antibiotics knocks it out. As long as “W” can steer clear of his VP’s birdshot, he may make it through 2008 blemish-free.

In “I Am Legend,” a cure for cancer goes awry, killing most of mankind. Will Smith is one of the few remaining survivors. Sometime before the film was shot, Smith appears to have found an effective treatment for his condition, acne. He is this year’s acne survivor.

In film after film, Hollywood’s breakout star kept appearing broken out. His complexion issues were Legendary. In “Ali,” he was KO’d by pimples.

In “Men in Black,” he was covered in Blackheads.

He had rows of blemishes in “I, Robot.” In “Bad Boys”...you get the picture.

Yet in these high def publicity pics from “I Am Legend,” Smith appears to have healthy pores. Not a blackhead as he tackles infected zombie vampires. No inflamed cysts as battles loneliness accompanied by a courageous canine. How did he kick this disturbingly common condition? Since he is not our patient, we can only speculate. Did he undergo a course of the powerful Vitamin A pill, Accutane (Isotretinoin)? Jessica Simpson proudly reported her success with the prescription. That is before she was hired to shill for an over-the-counter product in ubiquitous infomercials. Retin-A creams can reduce breakouts, but tend to cause dryness and sun sensitivity. Many benefit from topical forms of azelaic acid. Available in the US in prescription forms Azelex cream or Finacea gel, this ingredient can gradually return facial pores to their normal state. It evens the skin tone, particularly helpful in African Americans like Smith. Yet unlike Retin-A, azelaic acid does not usually dry the skin or increase the risk of sun burns. Retin-A is to be avoided before facial waxing or pregnancy, but azelaic acid is considered safe in those situations. And while the cancer cure in “Legend” had the pesky side effect of turning people into cartwheeling corpses, we are certain that azelaic acid has never shown that risk. Or did Smith just outgrow his zits? Adult acne can strike, and just as quickly as our hero lashing out at a grumpy ghoul, it can recede. We can’t be sure about Smith’s situation, yet we applaud it nonetheless.

Runners-up, Action-packed Acne Survivor: Keira Knightley, Orlando Bloom, and Johnny Depp “Pirates of the Caribbean, At World’s End”

These three co-stars have found adult acne their adversary. Their battle against their blemishes, like their war with magical buccaneers, appears won.

Audiences are enraptured by this post-modern take on fairy tales and a large part of the appeal is bubbly actress Amy Adams. As Giselle, the naïve and charismatic cartoon princess come to life, Adams lights up the screen. Particularly striking is that Adams was awarded this role, which could easily gone to an ingénue in her late teens or early 20’s. Despite her youthful looks, Adams is 33 years old, playing a character that could be half that age. Adams is naturally quite pale, so to appear this wrinkle and freckle-free in her 30’s confirms a lifelong devotion not necessarily to the literary works of the Brothers Grimm, but to sun protection.

Any princess knows that a good parasol is worth its weight in SPF.

Once upon a time, (in the 1960’s and 70’s), young royalty would knowingly lie out in the sun for a “healthy” tan. For the fair-skinned, exposure to sun early in life creates sun damage in the form of wrinkles, splotchy sun spots, and dilated blood vessels. That these effects can only result from sunburns caused by UVB sunlight is a misleading myth. The magic mirror didn’t tell the evil queen that the UVA range of light, the so-called “tanning” rays, also speed skin aging. So those with sparse skin pigmentation should use broad spectrum sunscreens that also block UVA rays. In 2007, the US FDA established a new requirement for sun block to be rated not just by UVB protection (the SPF system), but also for UVA.

Also this year US damsels celebrated the FDA approval of mexoryl. Long available in Europe (and presumably in Giselle’s fairy tale home), mexoryl effectively blocks the UVA range of sunlight. Featured in the “Anthelios” line, substances like mexoryl and sun avoidance can make looking into any mirror a magical moment.

The moral of this story is that fair-skinned princesses can stave off becoming sun damaged step sisters with materials like mexoryl.

Runner-up, Sun Protected Princess: Susan Sarandon in "Enchanted."

Okay, so Sarandon’s not the tale’s princess, but she still looks darned good for her age. Like Adams, she’s a fair-skinned femme. And she had the added challenge to remain tan-free through the sun-exposed 1970’s.

In the last year, a singing sensation brought us all the best of both worlds. Was it Destiny? Was it Hope? Actually, it was both, because quadruple threat singer/songwriter/actress/grinner Miley Cyrus was born Destiny Hope Cyrus, daughter of Country star Billy Ray Cyrus. She is known for playing blond wigged pop star Hannah Montana on TV screens and in sold out music concerts. Other than the hair color change, there is one other derm difference between Miley and her platinum alter ego: A facial scar.

On Miley’s forehead, a distinct scar can be seen. We don’t know the cause, but if any of her fans are aware of what injury left her with this mark, we are an e-mail away. Check with your parents before e-mailing and please explain to them that skinema.com is not as bad as it sounds.

Perhaps this is why the Hannah Montana wig forms bangs over her brow. Though not the first choice of hairstyle favored by most teens, bangs are not quite the fashion mistake of Papa Cyrus’ 1980’s era mullet.

While most over-the-counter scar reducing creams have more claims than actual benefit, some treatments can be used to minimize scars. Raised, keloid scars can be injected with cortisone medicine (see below). Red scars can be lasered to reduce the appearance of blood vessels. Plastic surgeons can also “revise” scars, removing the scar surgically and closing the wound with techniques that better mask the mark.

No one wants a facial scar, especially a teen. But a small scar clearly has not stopped Miley’s sky rocketing career. So if you have a facial defect, consider wearing it proudly. Or get a blond wig.

Runner-up, Vanishing Act: Benjamin Bratt's chest scars are gone in “Love in the Time of Cholera”

Movie actor Bratt used to have large lumpy keloid scars across his chest. Now that they have cleared (possibly with injections of cortisone medicine), romance can resume. Early in his career, Benjamin Bratt had... ...a chest full of raised keloid scars. In "Cholera," they have vanished--but how?

There is one villain that is terrifying celebrities this season. What is the foe that filmdom's famous feverishly fear? Is it Beowulf's ectoplasmic enemy Grendel? Is it the airgun-toting pale-skinned psychopath seen in "No Country for Old Men?" Or Johnny Depp as a blade-brandishing cannibal sweetly singing for the holidays in "Sweeney Todd?" None of these cinematic enemies pose any true threat to Tinseltown's titans. If the heroes in those films don't dispatch them, then at least the movies' end credits will. No, we are talking about a nemesis that seems infinite and omnipotent. We are talking about...cellulite. In 2007, the net was abuzz over paparazzi pics of actress and underwear spokesmodel Jennifer Love Hewitt. The images show Love Hewitt's hips dimpled with the dermatological divots known as cellulite. For those genetically prone, fatty tissue in the thighs and buttocks is tethered by fibrous bands that create the bumpy appearance. Unlike previous episodes where potentially unflattering photos have been ignored by their superstar subjects, the ghost whispering actress chose to shout, urging society to re-examine our perspective on women's bodies. But an equally important question was not been addressed: Why wasn't her condition treated in the first place?

A simple online search will reveal any number of hyped treatments for cellulite. Supposedly the full bore of technology has been harnessed to defeat this enemy. Mechanical interventions like endermologie purport to flatten the bumps. Lasers combined with radiofrequency blasts promise to reduce the rolls. Studies of mesotherapy in particular show minimal transient benefit after several sessions. Makers of topical non-prescription lotions actually have the audacity to use the term "cure" in their marketing.

Apparently, Love Hewitt is not the only celeb dealing cellulite. Rasputia, seen here in "Norbit," also battles bulges. From supplements to laser treatments to mesotherapy, stars who share Love Hewitt's heartbreak of cellulite could certainly financially afford an intervention. TV actors like Mischa Barton, film femmes like Sharon Stone, tabloid royalty like Britney all share an incentive to eradicate the thigh bumps and regain cobble-free contours. The reason these photos exist at all? Because none of the above treatments have been proven to make a significant impact. If it was as simple as buying a cellulite banishing balm, the celeb photogs would not have so much material to publish.

So keep checking back here for updates. If a breakthrough occurs in the battle against Hollywood's most hated foe, we'll let you know.

Runners up, Hollywood's Greatest Villain: Paparazzi and HDTV

True enemies of any skin challenged celeb.

Ever since his initial movie role as a vicious prisoner, ex-con turned actor Danny Trejo has been on the casting director speed dials. With his severe facial scars, acne scarring, and extensive tattoos, Trejo has found steady work for a certain kind of role. Complexion problems are often used to identify cinematic criminals, so we aren't shocked that Trejo usually portrays thugs, drug dealers or convicts. Imagine our surprise to see that Trejo has broken this trend in the last year.

Caption: One of these actors plays a counselor, while the other is an addict. Which is which?

In “Sherrybaby” glamazon Maggie Gyllenhaal and Danny Trejo meet to talk about the terrors of drug dependency. Usually, an attractive actress like Gyllenhaal would be cast as an understanding social worker tending the issues of an unstable addict played by a scarred tattooed actor. This indie flick's surprise reverses the usual Hollywood stock characters. Maggie is doping while Trejo’s gruff exterior hides a sympathetic soul as a drug counselor. The film’s realism is heightened: Addiction is not limited to those with problem skin.

The greater step for Trejo is the graduation to action star. Though it was seen only as a phony trailer accompanying the high end B-movie “Grindhouse,” “Machete” stars Trejo as a Mexican American betrayed by corrupt officials who then exacts his revenge.

He turns the tables on his bosses, rallying hordes to his side, and attracts the women, James Bond-style. The preview was such a hit that “Machete” may actually be released as a full feature film in 2008.

Will Trejo relish his sympathetic side? To promote his new leading man status, he could undergo extensive laser tattoo removal. Though this would take many sessions, his blue black tatts can be faded without adding to his scars. Many claim that skin tightening fractional lasers can reduce acne and traumatic scars, though Trejo may need a Hollywood A-list paycheck to complete the process. Yet perhaps all this cosmetic effort is not necessary.

In “Sherrybaby” and “Machete,” Danny Trejo breaks free of the chains of Tinseltown stereotyping, establishing a chance for other tattooed and scarred character actors to play that are roles morally, if not dermatologically, pure.

Runner-up, Stereotype Shredder: Timothy Olyphant in "Hitman"

Assassins that are bald and tattooed usually aren’t film protagonists. That said, we doubt that Olyphant’s bar code look is going to be the hot fashion trend of 2008. It would be confusing at the Walmart checkout line.

In the latest installment of the “Ocean’s” series, George Clooney and his band of gangsta pranksters take revenge on a hotel mogul. One of their tricks is to sabotage the stay of a snooty travel critic. They sneakily coat the fellow’s hotel bed with bed bugs. The next day, the critic is covered head to toe with itchy red bites and welts. There goes the five star review.

The following paragraph contains spoilers about the film, “Bug.” Rent it quick before you read on!

In the dark psychological thriller, “Bug,” Ashley Judd hooks up with an odd fellow convinced that bed bugs have invaded her home. In their attempts to eradicate the alleged insect invasion, Judd and her man lose their fragile sanity. Destroying themselves and the shack in a blazing inferno may end up as the new Webster’s definition of “overkill.”

In reality, bed bugs cause both physical and emotional distress. Outbreaks in NYC caused an understandable panic. Carried into homes and hotel rooms, they typically do not live in mattresses. Usually, the tiny pests hide in walls and crevices, coming out to feed nightly on sleeping humans, causing characteristic bites. While extensive swollen spots can occur, the usual pattern is a smaller group of bites in a row or line. The welting is an allergic reaction, so not every bedmate may end up with an itchy rash.

Unlike their creepy cousins scabies, bed bugs do not remain on the skin and so are not contagious. Treating the reaction usually involves prescription strength cortisone creams, but exterminators are needed to insure the bedroom is no longer a cafeteria for critters. Setting the entire domicile aflame may make for a dramatic movie ending, but shouldn’t be necessary to become bed bug free.

Runner-up, Skin-festation: MRSA

While not making an appearance on movie screens in 2007, a pesky superbug called MRSA (short for Methicillin Resistant Staph Aureus) was likely infecting the skin of some audience members during any given movie showing this year. This strain of staph bacteria has developed resistance to certain existing antibiotics and can rarely spread to internal organs. Hand washing and cleaning up after gym workouts can limit its spread. Prompt attention by a physician for tender boils or spreading sores can also tackle it. Sounds like a horror movie? Watch for it onscreen (or even in the lobby!)