I have learned so much from your blog. Thank you for starting this blog and sharing your knowledge with us. I am 29 years old and still fighting with acne. As my age is getting older I have started to worry about anti aging skin issues too. How can I a set up a regimen both for ‘acne and anti aging’ at the same time? In your last post you set up a skincare routine, can you also do it for acne+anti aging? With your own recommended products?  Is Retin-a one of the elements that should be used in this regimen?  Or would it be benzoyl peroxide with some other ingredients, or would glycolic acid be enough? I will be very glad if you enlighten me Which path should be followed?

Thank you thank you thank you very very much in advance.

I hope you never give up this blog, it’s a real treasure for skin care problems.

Best regards,

Ayse S

Hello Ayse,

My favorite anti-aging and acne treatment combination skin care regimen is based on glycolic acid.  This combination of skin care needs is exactly why I made my Glycolic Acid Kits.  These kits are designed to fit the different skin types and become the key active ingredient to address both skin problems.

Click here to see my Glycolic Acid Facial Skin Care Kits

You then build on top of this regimen to meet your other skin care needs such as 1.  Sun protection (a key anti-aging step), 2.  Additional collagen building products, 3.  Skin hydration as needed.

For sun protection, my SunSavvy Daily Wear Kit has a great oil free products.  There’s Citrix for every day use and Solbar Zinc for those wet and sweaty outdoor activities.

Click here for my SunSavvy Daily Wear Sun Protection Kit

Glycolic acid is a great anti-aging ingredient that helps skin build collagen if you use only products that are strong, professional strength products – like mine!  I’ve written an article explaining the science of how glycolic acid can benefit skin health for anti-aging, wrinkle fighting skin care.  Click here to read it. 

For additional anti-aging, collagen building, anti-wrinkle skin care treatment products (phew!), the best results (in my opinion) come from professional vitamin C products or prescription tretinoin cream (Retin-A).

CRS is the product that I think is the best Vitamin C skin care product made.  It has liposome encapsulated, stable L-ascorbic acid vitamin C in a wonderful base that feels fantastic on the skin.  I usually have patients use it during the day under their sunscreen.  They then use their glycolic acid product at night.

Click here to see CRS

To read about how I combine glycolic acid and tretinoin skin care regimens read my post How Do You Combine Retin A and Glycolic Acid for Anti-Aging Skin Care? In that post you will also find a link to my very specific method for using tretinoin; there are some really helpful tricks for successfully combining this tricky combination.

Whether you chose CRS or tretinoin as your additional collagen boosting skin care ingredient, I recommend adding Replenix CF Cream (or Replenix Power of Three) to your regimen too.  In my dermatology practice,  I have my patients use this ultra-high concentration green tea antioxidant product twice a day after washing their skin, and before applying their other skin care products.  I’ve found that it helps quite any irritation that may develop from either of these combination regimens.  It also has anti-oxidant benefit and the key ingredients in this product (caffeine and green tea antioxidants) have also been shown to reduce skin cancer formation in the lab, which is a fantastic benefit that I love to incorporate.

Click here for Replenix CF Cream

The easiest way to get all the benefits of this skin care regimen is to combine one of my Glycolic Acid Facial Kits and my Antioxidant Kit.  You’ll also get Replenix Scrub this way which is a wonderful exfoliating scrub for that ‘instant gratification’ glow you get from exfoliating twice a week.

Click here for my Anti-Aging Antioxidant Skin Care Kit

If you still need additional skin hydration, chose one of the Glycolix Face Creams to ‘dial in’ the right skin hydration for those drier areas of your facial skin.

Click here to see the Glycolix Face Creams

So there you have it!  Combining the right Glycolic Anti Aging Kit for your skin type with my Antioxidant Kit gives you ‘state of the art’ anti-aging skin care for both your acne and anti-aging skin care needs.

BTW, thank you for your lovely comment about my blog.  Writing it has become a passion for me and, god willing, I’ll do it as long as I’m able.

Cheers,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

What’s The Best Anti-Aging and Acne Skin Care Product Regimen? is a post from: Dr. Bailey's Skin Care Blog

I suffer from rosacea and acne, and I’m not sure which to treat.

Acne medications and regimes irritate my sensitive skin.  On the other hand, rosacea treatments burn or clog pores.  I’m at a loss.  I have seen numerous dermatologists and they all prescribe the same thing, my face only gets worse. It’s really embarrassing.

Thank you,

Jenn

Hello Jenn,

Acne vulgaris and rosacea can coexist, unfortunately.  My usual approach is to treat the rosacea, which is trickier, and to aim my acne vulgaris treatments very precisely at what I think the biggest driver of the acne is for a particular patient.

One of my favorite regimens for this combination of skin problems is the product combo in my Facial Redness Kit.

This skin care kit included Calming Zinc ® soap which has an ingredient that helps to decrease a skin yeast that causes a form of acne called pityrosporium folliculitis, and that’s also overgrows the pores in rosacea.  The other product in the kit is either Replenix CF or Power of Three Cream.  These products are very soothing for rosacea.  They also act to moisturize acne prone skin WITHOUT pore clogging oils.  They have one more benefit and that is to help relieve the redness from acne lesions.

If the acne is mostly due to clogged pores and blackheads (comedones) then I try to sneak in a little tretinoin, which is a fantastic prescription medicine for comedonal acne.  When we use the Facial Redness Relief products I find that the rosacea is usually so well controlled that we can get the tretinoin into the skin care regimen without irritating the rosacea.  I typically stick with the lowest strength of tretinoin, and I start with it just twice a week.  I have many rosacea patients who successfully use tretinoin, so it is possible. I’ve included a link below to a post that explains my tretinoin use tricks.

If hormonal factors are driving the acne then I may try hormone regulating treatments such as birth control pills, but this is usually a last resort in my practice.  I always look for a bacterial infection too because bacteria may be ‘dog-piling’ on a case of mild acne or rosacea and really making big, tender, inflamed pustules out of what would otherwise be little ones.  The goal is to trying to figure out why the acne lesions are present and then very precisely address the cause while at the same time providing a supportive skin care regimen to calm the rosacea.

I know that is not a simple answer but I hope it gives you some idea of how I approach a patient with your combination of skin problems.  It’s actually a fairly common combination in my dermatology practice.

Warm Regards,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

The Best Skin Care Products For Rosacea and Acne is a post from: Dr. Bailey's Skin Care Blog

I’m 17 years old and lately I’ve had a remarkable amount of acne breakouts, or more like a really massive breakout.  I’ve had many breakouts in the past but lately it has been worse.  I want my skin to recover quickly and would like to know what I can do to speed the natural healing process?  Also, what can I do to eliminate acne scars from the past breakouts?

Hope you can help,

Irvin S

Hello Irvin,

To speed the skin’s natural healing process after a big acne flare I recommend:

1. Avoid using skin care products with mineral oil or petrolatum. These ingredients can cause new acne lesions to form.  Once the original acne flare-up is quiet it’s wise not to provoke a new bout of acne by using the wrong skin care products.

2. Start using skin care products that treat and help prevent acne such as my OTB SKIN Acne Treatment Kits.  OTB Acne Kits contain high levels of the best non-prescription acne treatment medicines available for topical acne treatment.

3. Make diet changes that help to prevent acne such as:

• cutting the carbs and junk food
• eating more fruits and veggies
• cutting down on dairy
• loading up on omega-3 rich foods like salmon, walnuts, spinach and flax seeds

These changes will allow acne prone skin to calm down and the active lesions to heal.

It takes time for the marks to fade though.  To help stop acne lesions from leaving brown marks on your skin (called post inflammatory hyperpigmentation) I always recommend avoiding the sun.  Even casual sun exposure can worsen the risk of post inflammatory hyperpigmentation.  This means that wearing an oil-free, mineral zinc/broad spectrum sunscreen everyday in place of a moisturizer can really help. The product I have my acne prone patients use is Citrix.

Also, using glycolic acid products can help to prevent and lighten hyperpigmentation from acne lesion.  My favorite glycolic acid skin care regimen for acne prone skin is my Glycolic Acid Skin Care Kit.

Acne scars are tougher to treat than post inflammatory hyperpigmentation.  Many scars will naturally fade over time, but others require treatment.  Laser treatments, IPL treatments (a special kind of light treatments done in the doctor’s office) and topical prescription tretinoin are three of my favorite treatments for acne scars.

A massive breakout of facial pustules may not just be acne. It may be time to get a specific diagnosis because not every skin whitehead or pimple is caused by acne.  When I see a real upsurge in pimples I look for a cause.  One really important cause to consider is a bacterial infection; bacteria such as staph can ‘dog pile’ on a mild case of acne, infecting what would otherwise be small pimples and causing them to be deeper, redder, more tender, and really dramatic big zits.  There are different types of bacteria other than staph that can do this too.  Different types of bacteria are treated with different oral prescription antibiotics.  The bottom line is that the best treatment starts with the correct diagnosis.  If acne isn’t responding to acne skin care products, good non comedogenic skin care practices and an acne diet then it’s time for a doctor’s appointment.

I hope that helps.

Warm Regards,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

How To Heal Acne Naturally is a post from: Dr. Bailey's Skin Care Blog

Hope you’re having a wonderful summer!

I wanted to ask if the Replenix Power of Three Cream can be used before tretinoin and what the benefit is? I’m also wondering if a moisturizer can be applied either before or after using tretinoin?

Thanks!

Robin

Hello Robin,

Layering skin care products is an important way to customize your skin care. It’s also the best way to accurately address your unique skin problems because strong, professional skin care ingredients don’t all live well together in the same container.  Product layering is tricky though and you need to do it right! Application timing and product combination can make or break results and often you won’t know thing aren’t working for weeks or months. It’s why I’m so specific about the products and regimens that I recommend.

Tretinoin cream (tretinoin is the generic name for Retin A or Renova) is one of the best skin care products you can use to reverse the signs of skin aging, sun damage, uneven pigmentation and treat acne.  It also is one of the most complex skin care products to add to your regimen.

Tretinoin cream is applied at night.  It breaks down on exposure to light so it’s best to put it on right before you turn out your light to go to sleep.  It also causes irritation if you apply it to skin that is damp.  Because of these two particular tretinoin ‘issues’, the steps of my night time skin care regimen for tretinoin users are as follows:

1. Wash
2. Apply any other skin care products
3. Wait at least 15 or 30 minutes
   
4. Apply tretinoin right before turning out the light

This means that in step 2 I would recommend applying Replenix Power of Three and then a moisturizer if needed.  This is followed by step 3, which is to wait at least 15 minutes before step 4, the application of tretinoin right before ‘lights out’.

The benefit to nightly application of Replenix Power of Three is all get all the antioxidant and anti inflammatory effects that it offers.  Replenix Power of Three and CF Creams are simply the best antioxidant green tea skin care product made, in my opinion, and they work best when applied twice a day.  (Click here to read more about these Replenix Creams.) Moisturizer gets applied next because moisturizers are always applied within 3 minutes after toweling dry or else they don’t work.  Yes tretinoin is in a moisturizing base, but because it causes irritation if applied to damp skin, it can’t be your moisturizer!

For more information on Retin A (tretinoin) use and what I tell my patients, click on the links below:

Does Light Break Down Retin A?

Layering Skin Care Products With Dimethicone

How To Correctly Use Retin A For Acne and Anti Aging Skin Care

Tretinoin is a tricky product but the results are so worth the trouble. I’ve been using it since I was 27 years old (and I’m just about to turn 53) and I think my skin looks better now than it did when I was 26.  In fact, my office staff found my Dermatology Residency application photo in a file drawer and they were shocked at the difference!

Precise and powerful skin care directed at exactly your skin problems can transform your skin. Keep up the good work and thanks for a great question, I hope my answer helps.

Warm Regards,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

How do you layer skin care products with tretinoin? is a post from: Dr. Bailey's Skin Care Blog

Recently a reader sent me this question as a comment to one of my blog posts.  It’s such a great question, and one patients often ask me, so I decided to make an Ask Dr. Bailey post out.

You may think that you don’t need to worry about sun damage when you’re indoors, but that’s not true if you’re sitting in front of a window…..

John asked:

Hi Dr. Bailey,

I work in a “trendy” office with floor to ceiling windows on all the outside walls. I know many commercial buildings now have UV window film that appears untinted to the human eye but block almost all UV radiation. Is there any way to tell if the window next to me has this type of filtering in place? It would save me from reapplying sunscreen at my desk every 3-4 hours!

Best Regards and love the blog!

John

Hello John,

This is a really important issue for anyone sitting in direct sunlight that comes through a window. Normal glass blocks all of UVB but allows UVA to come through. Both of these rays are harmful.  Remember:

UVB

• UVB is considered the main sunburn ray
• It causes skin cancer and sun damage
• The SPF in a sunscreen tells you how well the product protects you from UVB

UVA

• Is the UV ray in tanning beds
• It penetrates the skin more deeply than UVB playing a big role in sun damage including wrinkles
• It can cause skin cancer
• The SPF on sunscreens tells you nothing about whether the product protects you from UVA.  Look for sunscreens labeled ‘broad spectrum’, but even then full UVA protection is more complex.  Bottom line, I recommend mineral sunscreens for the best, most reliable UVA protection (click here to read more) or Mexoryl SX if you really don’t like mineral sunscreens.

As you point out, some modern windows block most all of the UV rays including UVA. Finding out which windows were used in the construction of your building might help answer that question. It’s possible to block up to 99.9% of UV waves with today’s modern technology. The Skin Cancer Foundation has information on window UV film, click here to see it. In general, you can add sheets of UV blocking film to windows, or purchase glass that includes technology to block UV rays.

The Skin Cancer Foundation also has a list of window films that they have investigated and whose reliability they approve of.  Click here to read more. They also have a a glass manufacture that’s passed their muster too, click here see it. Beyond that, the only way to accurately test how much UV passes through your windows would be to finding someone with a radiometer that measures the UV transmittance.

For my patients who sit in direct sunlight coming in through window glass, I recommend wearing a mineral sunscreen and clothing that blocks UV rays (click here to read about sun protective clothing). If their windows claim to block UV rays I point out that a very tiny amount of UV still gets through.  As I mentioned above, it’s possible to block 99.9% of UV rays, but even if their windows are that good, the 0.1% can add up at 8 hours a day, 5 days a week.  Wrinkles, age spots and skin cancer just ain’t worth it!

For exposure through windows that don’t claim to block UV rays I definitely tell my patients to reapplying mineral sunscreen every 2 hours if they can’t move out of the direct sunlight.  It’s also time to get creative about trying to create shade too. That would be pretty tough in a ‘trendy’ office building with floor to ceiling windows, which is what makes this question such a challenge.

You’ve asked an excellent and important question. Best of luck.

Warm Regards,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

Do UV Sun Rays Go Through Windows? is a post from: Dr. Bailey's Skin Care Blog

I have seborrheic dermatitis and have found your website tips and information extremely helpful. I was hoping that you’d consider adding some information about the prescription shampoo Loprox to the site.  I just started using this shampoo and am wondering how it fits in with your other advice (for example, should it be rotated like the other dandruff shampoos or must it be used for a uninterrupted period in order to be effective). If you have particular tips about the use of Loprox, I’d love to read your thoughts on your website or blog.  Thanks,  Sue K

Hello Sue,

The challenging thing about dandruff is that there are as many variations on what works for it as there are people with it!  This means that when I’m helping a patient we ‘test’ treatment regimens to find what works  When I’m integrating prescription Loprox into a regimen some of the variations I use are:

Shampoo everyday and have my patient rotate the Loprox with their other shampoos. I especially do this if the dandruff is really severe.  The more frequently a person shampoos the better the treatment works.  To really get control of severe scalp dandruff we want to initially hit is hard, and shampooing everyday is important to getting the rash under control.  It can be a little hard on fine or colored hair because the shampoos can be harsh so I counsel patients to pay particular attention that they apply the medicated shampoo primarily to the scalp skin only (it will rinse-off over the rest of the hair, but it will be diluted at that point).

Since I have patients use Loprox twice a week, and since I ideally want patients to use 3 other medicated shampoos for rotation, this is perfect.  They use the Loprox one day, then their first over-the-counter shampoo the next, then their second over-the-counter shampoo the next, then their third over-the-counter shampoo the next then back to the Loprox (there are supposed to be 3 days between Loprox applications).  They do this for the 4 week use limit on Loprox (or as directed by a treating MD).  Over-the-counter medicated shampoos need to be continued until the scalp dandruff is controlled plus at least a few weeks.  They can then taper down on their shampooing frequency if they would like.  Eventually they even taper off the medicated products once their dandruff has been controlled for a few months or more (see below).

Shampoo every other day or every third day and rotate the Loprox with one or two other medicated shampoo. Some people just are not going to shampoo everyday.  If their dandruff is mild then this regimen may work.  Loprox is ideally used twice a week, and so they would pick one or two other shampoo to rotate with it.  I try to encourage them to shampoo every other day initially.  If this treatment is not working, then I recommend they ramp up to the daily shampoo with the 3 product rotation to jump start things, and then diminish shampoo frequency to every other or every third day once things are improved.

Loprox as ‘mono-therapy’ used twice a week. This is the ‘low maintenance’ approach and can actually work well if the dandruff isn’t too stubborn.  If it’s not working then ramping-up to the two or three shampoo rotation and more frequent shampoo intervals can jump start improvement.  Once the dandruff is under control treatment can be reduced to this mono-therapy.

A word about scalp dandruff maintenance treatment: Dandruff will come and go, there unfortunately is no lifelong cure.  I therefore like to give my patients varying treatment options that they can use as their rash waxes and wanes.  If they are using a prescription shampoo like Loprox I don’t want them to use it as maintenance treatment.  I like it to be the ‘big surprise’ for the scalp when it’s really misbehaving.  That means I have them put it away after the rash has been controlled for a few months.  They then use over-the-counter shampoos for a while, and, if the rash stays quiet they can even stop those.  Their dandruff will of course flare-up at some point and then they get out the over-the-counter products.  If those don’t work, out comes the Loprox.  If that doesn’t work, up goes the shampoo frequency to everyday etc…

Remember, with dandruff, I find that my patients are more likely to have treatment success if they jump on any little flare-up early; if the dandruff gets really bad again then we start over from scratch to get it under control.  Also Loprox is a prescription product and to use it a person must be under the care of a treating, licensed physician, plus there are limits on it’s use.  Please read my disclaimers below!

For more information on over-the-counter dandruff shampoos and how exactly I tell my patients to use them for maximal results, click on this link to see my post titled: Remedies For The Dry Itchy Scalp Of Seborrheic Dermatitis

For more of my dandruff posts click here to check out the Dandruff category page on my blog.

Warm Regards,

Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

How To Use Loprox Shampoo With Other Dandruff Shampoos To Treat Seborrheic Dermatitis is a post from: Dr. Bailey's Skin Care Blog

In your recent blog, (which was great by the way) you recommended products for hydrating oily skin, which products to you recommend for hydrating dry skin? Even though we do not have a dry climate in Hawaii we are constantly battling dry skin. Most of my friends are menopausal and curious as to what you suggest for our age group.

Much Aloha,

Devra

Hello Devra,

This is such a great question that I decided to devote an entire blog post to my answer!

The bottom line is that best moisturizers for people with dry skin have:

1. Water holding ingredients
2. Rich oils or oil-like ingredients that prevent the loss of water through evaporation

Remember, moist and well-hydrated skin is skin that’s loaded with water.  Your body is made up mostly of water.  The inside of your body regulates your water content for optimal health.  Your skin tries to do the same thing but it’s on the outside and it’s constantly exposed to air and harsh chemicals (including some soaps!).  People with dry skin need to help their skin hold water if they want it to look fabulous by today’s standards. That means using the right skin care for your dry skin, and figuring this out is the fun part that I love.

To understand your goals, the easiest analogy is to think of your skin like a sponge.  You wet it when you expose it to water making it soft and pliable.  Just like a sponge, that water will dry out, leaving a hard rough surface, unless you do something.  That’s where moisturizer comes in.

Water Holding Ingredients In Moisturizers:

These are ingredients that use cleaver chemistry reactions to keep water inside the layers of your skin.  Some of these ingredients are the result of modern scientific advances.  Others are actually natural substances that the the ‘old wives’ have known about for years.  These ingredients do things like draw water into the skin or bind it there with chemical bonds etc.

I think that the best and most effective water holding ingredients in facial skin creams include:

1. Hyaluronic acid (also called sodium hyaluronate)
   
2. Glycerin
   
3. Lanolin (and wool alcohol), which you can’t use if you’re allergic to wool
   
4. Alpha Hydroxy Acids (lactic acid and glycolic acid are the best AHA water binders)

Oil and Oil-like Ingredients In Skin Care Products

Oils in your skin care products layer on the skin, gradually entering the outer layers.  They trap water by preventing evaporation.  If you have dry skin you don’t naturally produce large amounts of your own oil meaning it’s a good idea to use a moisturizer that offers the right amount of oil to fit your skin’s needs. Dry skin will soak up some amount of oil without leaving an oily or shiny film, but oils can still clog pores even if you have dry skin.  This is easy to fix and I have good advice on deep pore cleansing in my post How To Unclog Your Clogged Pores.  If you’re one of us ‘lucky’ ones that are really prone to both dry skin and clogged pores then consider regular deep pore cleansing facials and products with glycolic acid or tretinoin that help keep pores cleaner (I personally need these tricks to keep my dry post-menopausal skin looking its best!).

There are many great oils that are added to moisturizing facial creams and lotions.  The creams and lotions contain other ingredients that can be of value, or can actually cause problems like allergy or irritation.  For this reason, people with really dry skin may want to use a pure oil from time to time (I often do this on nights when I’m not using my tretinoin/Retin A).

Some of my favorite skin oils to use directly on the skin or to look for as ingredients in facial moisturizers include:

1. Jojoba oil
   
2. Shea butter
   
3. Extra virgin coconut oil (one study showed it has some antibacterial properties)
   
4. Extra virgin olive oil (also has some antibacterial properties)
   
5. Canola oil (surprisingly, scientific studies have found that canola oil is a uniquely effective oil for skin hydration!)
   
6. Sesame oil
   
7. Almond oil

Other oil-like ingredient options include dimethicone, ceramides and squalene among others.  Mineral oil and petrolatum (also called petroleum jelly or Vaseline) are petroleum products that contain oil (derived from the refining of petroleum) as well as some other components.  They have been added to products for years and are highly effective moisturizing ingredients proven to by scientific studies to benefit dry skin.  They are currently not so popular because they are petroleum products.  I also find that petrolatum/Vaseline can actually sting some sensitive skin types.

With the natural oils, the less refined the better.  These oils are complex, with mother nature’s brilliant balance of different components.  Refining the oil or extracting a particular component will alter this balance and it’s my opinion that you want them all.  Some of the components impart additional benefits when you apply the oil to your skin such as killing germs and helping to control inflammation.   Olive oil, coconut oil, canola oil and shea butter in particular have interesting compositions that I like to see used in their entirety.

Specific product recommendations for facial moisturizers

I actually find this difficult because there is no ‘one size fits all’ here.  I tell patients to take this list of my favorite active ingredients to the store and try different products.  Find one that fits your budget, feels good on the skin and that you would enjoy using.  Some people like drug store brands, others department store products, others want entirely natural products and others like boutique store products.

I find that Glycolix Elite Fortified Facial Cream works beautifully for my patients with dry skin, combines well with all the products I recommend and is reasonably priced.  It’s what I use when I’m not using pure Jojoba Oil or testing a new product.

Other reliable facial moisturizing products for dry skin that either I or my patients have liked and that have a nice combination of ingredients include:

Cetaphil Moisturizing Cream and Lotion

Eucerin Daily Replenishing Lotion or Original Moisturizing Cream

DML Forte Cream and Moisturizing Lotion

Dr. Hauschka’s Rose Day Cream Light or any of their other facial moisturizing creams or oils

Weleda Pomegranate Firming Day Cream or their other facial moisturizing creams or lotiions

Estee Lauder facial moisturizers like Verite Moisture Relief Cream

Clarins Multi-Active Day Early Wrinkle Correction Cream

Glytone Face Creams (with glycolic acid)

Final notes on dry facial skin care

Aside from trapping water, the most important point about your facial moisturizer is that it needs to work well with the therapeutic products you’re using for your skin problems (ie antiaging, rosacea, facial dandruff, acne).  Where does your moisturizer fit into your skin care regimen? I tell my patients to apply their moisturizer after applying their therapeutic products and before their mineral sunscreen.

Remember, dry skin care starts with the cleansing step of your skin care regimen; it’s important not to use a cleansing product that strips too much skin oil or irritates your skin causing a break in your skin barrier function.  That’s the reason that I recommend people with dry skin avoid the sodium laurel sulfate family of ingredients in cleansers.  These are the main cleanser foaming agents. They can irritate sensitive, dry skin and they just remove too much oil.  Instead use a non-foaming cleanser like Toleriane Cleanser, which I love.

References

Verallo-Rowell VM, Dillague KM, Syah-Tjundawan BS, Novel antibacterial and emollient effects of coconut and virgin olive oils in adult atopic dermatitis, Dermatitis, 2008 Nov-Dec;19(6):308-15

Loden M, Andersson AC, Effect of topically applied lipids on surfactant-irritated skin Br J Dermatol. 1996 Feb;134(2);215-20

Huang ZR, Lin YK, Fang JY Biological and pharmacological activities of squalene and related compounds: potential uses in cosmetic dermatology. Molecules 2009 Jan 23;14(1):540-54

What Are The Best Moisturizers For Dry Facial Skin? is a post from: Dr. Bailey's Skin Care Blog

A lot of skin care lines carry different products for dry skin and so called dehydrated skin. What is the difference between dry and dehydrated? Can the skin be oily and dehydrated? Can skin be dry and not dehydrated? Or is dehydrated skin only a marketing buzzword?

Thanks a lot for giving great answers to great questions on your blog! I really like reading your answers and skin care advice.   and thanks a lot for this answer too.  Judith

Hello Judith,

I like this question!  Yes in this context it’s a marketing term but we can use it as a great jump off point for an interesting discussion about moisturizers and skin hydration.

Skin moisture is actually water, not oil and this is why the topic is both confusing and fun.  There are different ways to trap water in the skin.  There are also some conditions that cause the skin to lose more water than is good for it, causing it to become overly dry and irritated.  So, the long and fun answer:

Moisturizers traditionally work by utilizing an oil, which when applied right after washing/wetting the skin will trap water by sealing over the skin and  preventing evaporation.  Skin with adequate trapped water is considered hydrated. Some of my favorite moisturizing oils are shea butter, jojoba oil, coconut oil, and sesame oil.  Mineral oil works really well too, in spite of the fact that it gets a bad rap for being a petroleum product.

Oily skin will hold more moisture because it produces its own moisturizing oil, which is very efficient and wonderful until the oily shine becomes annoying.  Harsh soaps will remove the oil and it takes time to reproduce it so any absorbed water from washing may have evaporated by the time the oil begins to re-coat the skin.  That said, people with oily skin usually don’t like oil containing moisturizers because they have enough oil and oily shine already.

There are non-oil ingredients in skin care products that can bind water too. These are especially great for oily skin moisturizing, but every skin type benefits from them. Some of my favorite oil free moisturizing ingredients are

• hyaluronic acid (sodium hyaluronate)
• glycerin
• squalane
• alpha hydroxy acids.

These ingredients are capable of holding water in the skin without needing oil to do it. They’re that brilliant bridge between science and nature that I love so much! Products with these ingredients would be my choice for hydrating oily skin.  Products I rely on and have a lot of experience with include: Replenix CF Cream and Power of Three which contain hyaluronic acid.  Glycolix Elite Ultra Lite and Glycolix Elite Face Cream with 15% glycolic acid which contain glycerin and squalane (and the 15% is an AHA concentration of glycolic acid).

Skin can have suboptimal water content and be considered relatively dehydrated.  This is most likely to happen when your skin is irritated to the point that it’s barrier function is compromised and moisture escapes. Conditions that harm the barrier strength of your skin  include:

• Repeated contact with harsh soaps (for sensitive skin this can include products with the sodium laurel sulfate family of ingredients) or harsh chemicals (like rubbing alcohol or household cleaners).
• Rashes such as facial dandruff that can cause a compromised barrier and water loss.
• Having a genetic tendency for eczema, asthma and allergies that means you may also have an inherently vulnerable skin barrier and are one of the classic ‘sensitive skin’ people.
• Exposure to harsh environments such as windy, cold climates, or simply going between cold outdoor temperatures and heated indoor environments which can irritate the skin and cause water loss.

So, yes, it’s possible to have oily skin that is also dehydrated!

Understanding this and knowing whether your skin is oily and/or dehydrated can help you pick appropriate products, but I wouldn’t count on a products marketing spiel to accurately guide you.  Look at the product ingredients to see if they contain oils or one or more of the non-oil water binding ingredients.

Thanks for sending me a fun question, I’ve been meaning to cover this information and you gave me the perfect reason to do it now.

Warm Regards,

Cynthia Bailey MD, Dermatologist

If you have questions about skin care or skin health please send them to me using the Contact Dr. Bailey button at the top of the page.

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

What is dehydrated skin? is a post from: Dr. Bailey's Skin Care Blog

After many years, I now know that I have seborrheic dermatitis and it’s in my ears as well as on my scalp, nose, eyebrows, and eyes (blepharitis). Through the years I have been prescribed various drops for my ears, and they are only temporarily effective.  Of all the body parts affected by my seborrheic dermatitis, the ear canals are the worst area to treat and they itch the worst.  Also, the dandruff started in my ears years before the other areas of the body. Do you know of anything that might help?  GW S.

Dear GW,

Dandruff in your ear canal can cause an absolutely insatiable itch that’s impossible to reach! Patients are so appreciative when I fix it for them; it’s one of those little things that really makes a big impact on someone’s life.

I’ve found that my patients usually experience relief when they use the recommendations that I published for crusty ears affected by seborrheic dermatitis. The trick is that they have to be sure to carry this treatment down into the opening of the ear canal.

I have my patients use a baby wash cloth and dandruff shampoo to wash their ears. These wash cloths are thinner than normal wash cloths so it’s possible to reach into the ear canal opening a little.  They leave the shampoo on the skin for 5 minutes in the shower before rinsing it off.  It’s important to rinse all the shampoo off of the skin because shampoo residue is irritating.

I then have them apply a very small amount of lotrimin (clotrimazole) solution, using a cotton tipped applicator or their fingertip, just into the opening of the ear canal.  (Cotton tipped applicators should not be inserted down into the ear canal!)  The lotrimin product will melt down into the canal as it heats to body temperature.  If the itch and inflammation does not begin to improve after about a week then we add a little 1% hydrocortisone cream or solution, applied twice a day after the lotrimin.  If after about 6 to 8 weeks things are not improving then it’s time to come back to see me and possibly for me to refer them to an ear/nose/throat doctor for an exam.

I recommend that my patients maintain control of their ear canal dandruff by using the dandruff shampoo indefinitely to wash, and by occasionally applying the lotrimin the minute the itch begins to return.  Hydrocortione can be added too if needed.  The important point is to never let the dandruff get really bad again because it’s much harder to regain control of a bad flare-up, than it is an early one.  I find that it’s also important to control all the areas of skin involved with dandruff; when dandruff is active somewhere, other areas are more likely to ‘misbehave’ too.

Ear canals are tricky because they have a unique group of bacteria and yeast germs living in them and sometimes these germs play a role in the problem.  I’ve seen some interesting and unusual infections of the skin of the ear canal that required treatment with antibiotics. Because the germ population there is unusual, I often have to use antibiotics that I don’t normally use for skin infections.

The take home message is that dandruff in the ear canal is more complex than dandruff on other areas on the skin.  Sometime there’s just no substitute for getting the help of a dermatologist or ear/nose/throat doctor for this really frustrating problem-and sometimes that doc needs to think outside the usually treatment options if the problem isn’t improving.

Lastly, and very importantly, I tell my patients to try not to scratch down in the ear canal, even if the itch is intense. Scratching will break open the skin of the ear canal and increase the chances of this rash getting infected with those unusual bacteria and yeast.

Warm Regards,

Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

For more of my information on dandruff, you may want to read:

Dermatologist’s Tips For Dandruff Of The Eyelash Line (seborrheic blepharitis)

Dermatologist’s Tips For Dry, Flaky Skin On Your Face and Scalp; ‘Tis the season for seborrheic dermatitis (the first of a series of articles)

Dandruff In The Ear Canal; How To Treat An Itch That Can’t Be Scratched is a post from: Dr. Bailey's Skin Care Blog

Do you have any advice how to get rid of perioral dermatitis?  I am dealing with gluten/allergy and leaky gut issues and take supplements for that, because I’m sure they are related.  Also, is it common to get it not only around the mouth, but on the forehead?  I get itchy pimples in clusters that won’t go away for anything!

Thanks, Lori

Hello Lori,

Typically perioral dermatitis happens on the face and involves the perioral and periocular (around the eyes) skin.  It can move out from there, but I have not seen it jump to the forehead.  That said, an inflammatory rash like this can present differently on every person.

Perioral dermatitis usually manifests as red itchy pimples and little red blisters around the sides of the mouth. The rash may start subtly at first but gradually revs-up.  The skin can get really red, inflamed and blotchy-looking. The rash typically extends onto the chin, up the crease to the nose and can move to the skin around the eyes.  The pustules and blisters ultimately become very red, large and ‘juicy’ looking.  Perioral dermatitis can be mistaken for acne, rosacea and facial dandruff (aka seborrheic dermatitis).

This is unfortunately one of those frustrating and fairly common rash that we don’t understand. Doctors and scientists have no clue about what causes it.  There is a link between perioral dermatitis and chloride or fluoride exposure in dental products, strong prescription (halogenated) cortisone creams/ointments and asthma inhalers.

Treatment of Perioral Dermatitis:

Tetracycline is the usual treatment for perioral dermatitis. In my experience it needs to be used for at least several months, or else the rash comes back quickly.

Supportive topical prescription products help the skin heal faster. I really don’t like putting patients on oral antibiotics and so I also combine a broad topical approach in the hopes that it will allow me to stop the tetracycline as soon as possible.  I usually combine the oral treatment with three topical medicines.  Patients layer the medicines on their rash.  The topical prescriptions I usually recommend include:

1. An anti-bacterial topical (metrogel, erythromycin or cleocin topical prescriptions),
2. An antifungal such as ketoconazole or clotrimazole creams
3. A mild, non-halogenated cortisone cream.

Key points are that all topical medicines need to be non-irritating and all except the cortisone need to be continued for at least a month after the skin has cleared.

I usually also have my perioral dermatitis patients wash with my Calming Zinc Soap (formerly Noble Zinc Soap).  This naturally hydrating and soothing soap contains medicated pyrithione zinc to help control skin yeast germs that may play a role in this rash.  For years pyrithione zinc cleanser was only available as a harsh soap called ZNP, or in harsh dandruff shampoos.  Now it’s available in this hydrating, naturally anti-inflammatory bar soap.  I have my perioral dermatitis patients use Calming Zinc indefinitely because I find that it helps prevent recurrences too.

Also, continued exposure to fluoride and chloride containing medicines and products needs to be avoided.

There is a high relapse rate with perioral and periocular dermatitis.  Patience is important and if medicines are stopped too soon the rash comes right back.  In my experience, patients who are prone to perioral dermatitis typically go through a ‘spell’ where they get it several times over a 2 to 5 year period.

I hope that helps. Please remember I can talk generally about perioral dermatitis but, of course you need to follow up with your dermatologist regarding your diagnosis; I cannot in any way make a diagnosis or give specific advice for your particular treatment over the internet. Take this information into your treating dermatologist to be sure you have the correct diagnosis because your description is not classic for perioral dermatitis.

Warm Regards,

Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

If you found this skin care information helpful, you may also want to read:

Trying To Buy ZNP Soap Online and In Stores

What Are Milia and What Causes Them

Pityrosporum Folliculitis; Could This Be Why Your Acne Won’t Go Away?

Tips For Treating Perioral Dermatitis is a post from: Dr. Bailey's Skin Care Blog