Welcome back to viewer question week and today’s questions come from DermTV.com viewers. But first, in last week’s episode on whether your skin gets used to the effects of skincare products, I promised you that the first three viewers to answer my question correctly would receive a free BeautyRx Skincare product. And the question was, which is the only skincare or skincare related products whose beneficial effects can stop working because you can get used to them? There were three winners, who correctly responded, that your shampoo can stop working if you use the same shampoo and in order to avoid shampoo failure, occasionally you need to use a different shampoo approximately every week or every other week. So with that answered, lets move on to the questions from DermTV.com viewers.
The first questions from Lisa. “Hi, I’ve been breaking out since im fourteen, I’m 27. Nothing has worked for me and I’ve tried everything. I’m considering Accutane, do you think it’s a good choice? Does it really work for someone like me who’s been prescribed everything else?” Lisa, YES. The whole point of Accutane is that’s what we use when nothing has worked and if you’ve had lots of antibiotics, you’ve tried birth control pills and none of these things have been able to help your acne, it is time to move on to Accutane, which I believe is one of the 4 or 5 miracle drugs, of the twentieth century. Accutane, when used as directed, is safe and very effective, so good luck with your Accutane.
The next question is from Malcolm. “Can I use antioxidant vitamin-C facial serum first and then apply a 10% glycolic acid serum?” Malcolm, vitamin-C and exfoliants are compatible so there’s no reason you can’t use those two products together. As to which you use first, it really depends on the relative weight of the two products. So, you mentioned that you’re using a vitamin-C serum and a glycolic serum; since they’re both serums what I would suggest is just try a little experiment. Put a little on the back of your hand a see which feels lighter. Whichever feels lighter is the one you should apply first and then apply the other one on top.
The next question is from Jay and she asks, “Many over the counter lotions and creams contain retinols or vitamin-A, are they safe to use in pregnancy?” and Jay, the answer is, they’re probably not safe to use in pregnancy. The problem is, retinol becomes in the skin, Retin-A and all of these retinoids in laboratory tests have been shown to cause birth defects in certain laboratory animals. Obviously there’s been no studies done to see if they cause birth defects in humans but our fear is that because we know that oral retinoids in humans can cause birth defects in the form of Accutane, we are concerned that we don’t want to use any, even topical retinoids in pregnancy. So please, make sure if your trying to get pregnant or you are pregnant, that none of your skin care products contain any retinoid derivatives, retinol, differin or any of the other topical retinoids that we use for acne or facial rejuvenation.
Next question comes from Sarah, “I’m 23 with blotchy skin, I need to wear foundation everyday. I mostly have pigmentation from previous pimples and occasional breakouts. How often should I do a glycolic peel and what concentration?” Sarah, I really discourage people from doing glycolic peels at home because today through the internet all different sorts of very concentrated glycolic products are available, 40%, 50% and the reality is these peeling solutions can do a lot of damage if you don’t know how to use them and if you don’t use them properly. In terms of glycolic products that you can use safely at home, most of these products vary from 8-15% and we don’t really consider them to be peels, they’re either in serums or lotions or creams and they can be used everyday or every other day depending on where you’re up to with your exfoliation and how sensitive your skin is. But my recommendations to both my patients and all my DermTV viewers is that, please use exfoliation, use it regularly. I love glycolic, I think it’s the gold standard for chemical exfoliants, but just use safe concentrations between 8% and 15% and use it according to the tolerance of your skin, but please, don’t purchase glycolic peeling solutions from the internet or any place else because im afraid your going to get in trouble with it.
Laura asks, “In what order do you apply exfoliating products? At night I use a cleanser, toner, eye cream, moisturizer, when should I use my glycolic acid? And by the way, I’ve been taking your advice to exfoliate more frequently; do I use my glycolic before or after toner? And would toner effect the pH of the glycolic acid?” Well Laura, you really have two or three embedded questions here and they’re all very important, so I’m going to answer all of them. First of all, at night you would use your cleanser and toner first, and the whole point here is that cleanser and toner prepare your skin for all of the active ingredients you’re going to use. So you certainly wouldn’t use your toner after your glycolic product because the toner would them remove it, just the way your cleanser and toner are used to remove all the dirt, debris or oils on your skin and any other impediments that would prevent your glycolic and other active ingredients from working. Second of all, would toner affect the pH of the glycolic? Really not, because after you’ve used your cleanser and you’ve then used your toner to help remove any residual cleanser or debris left by your cleanser, the toner is going to evaporate, its volatile, there won’t be any toner left on your skin when its time to put on your glycolic. So, after your cleaner and toner, the first product we usually recommend, but of course it depends on the relative weight of the product, the first product is usually your glycolic, after that you would put on your eye cream and then your moisturizer, so thanks for a great question.
The next question comes from Jordan, and Jordan says, “Age spots, sunspots have started to show up on my face now that I’m 37, is the best treatment for this: a) IPL, b) peels or c) patience plus a regimen of vitamin A and other exfoliants?” Sort of expecting to see what other treatment is behind door four? Jordan, and by the way Jordan says, “thanks to you I exfoliate and wear sunscreen everyday”, Jordan thanks. Well, the best treatment for age spots and sunspots depends on how many you have and what your tolerance is for a little bit of downtime from treatment because if you use the best treatment for sunspots, actually it is the YAG laser or alexandrite laser because these lasers will work the first time every time in destroying the age spots or brown spots. But, when you use those treatments they cause a little bit of black and blue or purple on your facial skin for anywhere from 5-7 days. The advantage of IPL treatments (which means intense pulse light) is that they usually don’t cause the black and blue darkening so there’s usually very little downtime from that but IPL you often have to do two or three times so it’s more visits and its more expensive. Now both of those are, whether it’s the laser or the intense pulse light they’re both very effective and both work either first time or first couple of times. If your going to use peels to try and treat your age spots or sunspots, it’s not as effective, you need lots and lots of treatments and it takes a longer time. But the peels that you should be using should be gentle peels like glycolic peels but you need them in conjunction with both a very effective sunscreen to make sure your not causing any additional darkening from the sun or allowing additional darkening from the sun as your going through the process and you also need to use a bleach on a regular basis. The peels will help take off the dead cells that have too much pigment in them that are contributing to the brown spots and the bleach will help prevent the new cells from making additional extra brown pigment. Your third choice was patience plus a regimen of retin-A and other exfoliants, I find that just using exfoliants without actually doing chemical peels doesn’t remove these brown spots completely and if you want better results and faster results, don’t want to go the laser intense pulse light route, I would recommend the peels with the bleaches and the sunscreens.
Our next question is submitted by an anonymous user, “I always apply sunscreen underneath my make-up every morning and it is almost impossible to reapply sunscreen on top of the make-up without messing it up. I’d like to ask Dr. Schultz, what’s the best way to reapply sunscreen while having make-up on?” Well, this is a very important question and actually it became the subject of a DermTV episode and the answer here is very simple, if you apply your sunscreen first and then you apply your make-up, if your make-up is still there a few hours later, then undoubtedly the sunscreen is still there because its underneath your make-up. The reason we need to reapply sunscreen every two or three hours is when your very active or sweating or when your swimming but if your going to work and your putting on sunscreen and then your putting on make-up and the activities aren’t removing your make-up then there’s a good chance that those activities aren’t removing the sunscreen either so there’s no reason to reapply your sunscreen and mess up your make-up. When its time for a make-up change when your make-up is wearing off, or you just want to change your make-up, that’s the time to reapply your sunscreen and obviously then it’s not inconvenient to do.
The last question for today is from Joanna, and she asks, “I heard from your video that I should use sunscreen before my moisturizer but the problem is when I do this, the moisturizer on top messed up all the sunscreen underneath, sunscreen flakes off my face too. My face became a total mess. Please kindly advise me a feasible way of applying both to my face. Thank you.” Joanna, it sounds like you may be putting too much sunscreen on because when you apply your sunscreen in 20 or 30 seconds it should be set and it should be matte and it shouldn’t still be liquid after you’ve applied it so that when you’re then applying your moisturizer, there shouldn’t be any fluid sunscreen left for the moisturizer to effect and if there is perhaps you’re putting just a little bit too much sunscreen on. So next time, try putting a little bit less sunscreen on, gently spreading it around and if after 20 or 30 seconds it doesn’t feel like the sunscreen has set, then just take a tissue and tissue off the extra sunscreen before you put your moisturizer on. Well that’s it for today’s episode of answering questions from viewers, don’t forget the subjects from so many DermTV episodes come from your questions which are great, so please keep sending them in and I’ll keep answering as many as I can.