The ModernÜ

Hormone imbalances can play a huge role in adult onset acne, especially in women. Often times it is characterized by cystic, painful nodules around the chin and jaw areas. These nodules will flare up around the time of your menstrual cycle and then linger long after. If you’ve experienced irregular menstrual cycles, random facial hair, fatigue, head hair loss, pelvic pain, weight gain and acne, then all signs may be pointing in the direction of (PCOS) polycystic ovarian syndrome. I strongly urge any female client who’s had persistent acne through their teens and past the age of 25 to get tested. One study found that 27% of women with acne were diagnosed with PCOS.

What is it?

PCOS is a metabolic disorder that alters the endocrine system. “Poly” means many, and “cyst” means egg. The name of the disorder translates simply: several immature eggs are being produced in the ovaries. As part of a healthy cycle, one egg is produced at a time, matures and gets released. It either becomes fertilized or imbeds itself in the lining, resulting in a period. This doesn’t happen when you have PCOS and causes disruption to ovulation. Many times, insulin resistance is at the root of this disorder, which is why many women who have this condition can develop diabetes. The pancreas produces insulin but the cells don’t use it efficiently, so too much sugar builds up in the blood. When there’s excess insulin and sugar in the blood, this increases testosterone production in the ovaries and in turn causes excessive facial hair growth and acne.

If you have some of the symptoms listed, it would be smart to get your hormones checked. You can do an easy saliva test which measures androgen/testosterone levels. A pelvic ultrasound can give further insight and assess the number of follicles on each ovary.

The good news: PCOS is a cyclical condition, meaning it can change greatly depending on how you treat your body each month! Genetics play a role, of course, but making proper diet and lifestyle changes can have a profound influence on how those genes are expressed, and can improve or even reverse the cycle! Incorporating a diet low in sugar, grains, dairy and no soy will help reset biochemical pathways, regulate hormones, and slow down sebum production which feeds the p. acnes bacteria. Consistent exercise can help tremendously by switching insulin receptor sites “on” so that the body regulates blood sugar correctly. Natural supplements such as Vitex, maca, licorice root, and fish oil have been shown to help a lot, too. 

Isn’t it strange that only humans are affected by acne? I’ve been reading “Acne Rx” by James E. Fulton, MD. He describes how we came to be the only species prone to acne and discusses the skin’s modern uses of sebum:

“When we had course hair all over our bodies, the follicles with their sebaceous glands had plenty to do busily oiling and waterproofing these hairs. In the evolutionary process over millions of years, our skin, becoming more and more complex, took over various protective functions once served by scales, feathers and fur. Loss of dense hair and the skin’s resulting greater diversity was an important step in our metamorphosis into the complex animal we are today. However, the oil glands still producing have not yet caught up with our altered state. As humans grew less hair, the stage was set for the uniquely human disease of acne.”

Is sebum useful for the skin?

“Scientists suspect at this point in human history, sebum has no function at all. Like the appendix, sebum appears to be biologically useless in humans. That said, for a trait (or organ) to be retained over time, ie. oily skin, it doesn’t need to be beneficial. As long as it’s not disadvantageous, the trait will stay. Some speculate that oil moisturizes the skin. “Moisture” is in fact the water content of the skin, and an oil film on the surface could slow down evaporation of water.”

Since our body hasn’t quite caught up with our modern day selves, we need to be ahead of our skin instead. As an acne specialist, I notice similar traits among my clients who have moderate – severe acne. About 95% of them are very oily. How I gauge that is I ask how long they begin feeling oily after washing their face in the morning. This is always a good indication of excess oil production. Anything within 1 – 3 hours is too much in my opinion. The goal with treatment is to use an oil stripping cleanser and wash whenever their skin feels greasy. As long as the skin is producing oil, people who are genetically predisposed to acne will likely breakout. I always recommend if you’re struggling with acne to keep your skin as much on the ‘dry’ side as you can, and this in turn keeps you one step ahead of future breakouts!

Exfoliating is essential in keeping any skin type looking it’s best! The reason is because an accumulation of dead skin cells contribute to buildup on the skin, causing it to look dull and become congested. By exfoliating regularly, you keep your skin in a constant state of rapid movement, encouraging cells to turn over at a faster rate and not allowing time for buildup to collect in the pores. Not only is it beneficial in helping the skin look more bright and youthful, but it can also help your moisturizer work better. Ever wondered why it seems like your moisturizer doesn’t do the trick anymore? It’s possible you could be continuously hydrating a thick layer of dead skin cells sitting on the surface, and this blocks the moisturizer from reaching healthy living tissue underneath. By removing that dead cell layer, it allows the skin to soak up what it needs.

How often you exfoliate is dependent on your skin type. Someone who is oily/acneic can take much more than someone who has mature/dry skin. If exfoliating is new in your routine, start slow by using it 1-2 days per week, and then you can increase each week. Gauge where the happy place is for your skin, so that you don’t become overly dry or irritated. Some people can only take exfoliating 1 day per week, while others need to exfoliate 3 times a day. Do what works for your skin – it will take some paying attention to at first.

It’s also important to note that over-exfoliating isn’t healthy either. Our skin is meant to serve as a protective barrier. The more we break down that barrier by over-stripping the skin with chemicals, the less efficient it’s able to perform and you put yourself at risk for being more vulnerable to pathogens.

There are many different types of exfoliation that work best for addressing specific skin concerns. In this blog I’m going to solely focus on chemical exfoliation, and the differences between each.

Alpha Hydroxy Acids (AHA) – water soluble

[Note: the smaller the size, the more “work” ie. shedding, will be done]

Glycolic:

Smallest AHA molecule – can penetrate skin deep and do it’s work quickly

Source: sugar cane

Best for: decreasing oil production, stimulating collagen, reduces the depth of fine lines and wrinkles

Lactic Acid:

Source: milk, yogurt, fermented fruit

Best for: smoothes the skin and improves texture, antimicrobial, keeps skin hydrated

Malic Acid:

Source: apples, cherries, pears

Best for: hydration, increases oxygen supply to cells

Tartaric Acid:

Souce: grapes, berries, red wine

Best for: aging skin – contains powerful antioxidant properties!

Citric Acid:

Source: orange, tomato, lemon, lime

Best for: brightening dull skin, anti-aging, neutralizes free radicals

Mandelic Acid:

Source: almonds

Best for: age spots, discoloration

Beta Hydroxy Acids (BHA) – lipid soluble

Salicylic Acid:

Source: white willow bark

Best for: oily, acne-prone skin – helps to unclog congestion

Note: if you’re allergic to Asprin, do NOT use this!

*If you’re working on discoloration or scarring, glycolic, lactic and salicylic are best due to their small molecular size and ability to shed fast!

 

Polyhydroxy Acids

Ok, this category is new in skincare and not used much yet, at least in the US. But of course, Korean skincare is one step ahead of the game and already using these.

PHA’s are ingredients such as gluconolactone and lactobionic acid. They are chemically and functionally similar to glycol and lactic acids, except their molecular structure is large. This means it takes time for the acid to do it’s work of shedding skin, and is more preferably used on skin that’s main concern is aging or is too sensitive to use regular AHA’s/BHA’s. These are packed with antioxidants which make them a great anti-aging exfoliant.

Vitamin A

There are many derivatives out there – Tretinoin, Retin-A, Retinol, and Retinoids to name a few.

Vitamin A has a large molecular weight, so it takes much longer to do it’s shedding work, compared to the performance of AHA’s/BHA’s. Many clients I see with acne were put on a Vitamin A topical by a doctor and I rarely see results, because it’s primary function isn’t so much to shed quickly but to thicken the skin by increasing cell metabolism. Vitamin A is a great choice for agin/dry skin as it tends to be thin, but not so great for acne/oily skin. Acne-prone skin is typically thick, which creates a sound environment for dead cells, bacteria, and oil to collect. My goal in clinic and for home care is to essentially ‘thin out’ the skin by using AHA’s/BHA’s. These acids are more preferable since their only job is to break apart dead cells and slough them off.

Applying skincare products in the correct sequence is super important! It ensures you’ll get the most benefit from each one. For instance, if you put a serum on after applying moisturizer, the serum won’t get absorbed as deeply as it should. Time is also something to consider. Think about it: benzoyl peroxide, for example, has a 1 to 3 hour “working time.” So anything else you put on after, like a moisturizer, may interfere with the efficacy of the medicated product.

I’ve broken it all down for you here. The easiest way to remember this is to apply your products first from the thinnest viscosity to thickest! I’ve also included advice I give to my clients on the types of products to look for and how to apply them correctly.

1. Cleanse

Removing dirt and oil buildup from the day is an important step for anyone and everyone! Ladies: if you like using makeup wipes, use one first and then do a double cleanse. I always recommend double cleansing when wearing makeup, or when you’re excessively oily. Washing with tepid water in the sink with your hands or in the shower is ideal. If you prefer to use a washcloth to cleanse, make sure to use a clean one every time. It’s also important to be using the correct cleanser for your specific skin type! You don’t want something too stripping if you’re dry. I advise using a cleanser that’s only job is to clean your skin really well, and help control oil if that’s an issue. Opt for something non-medicated.

2. Exfoliate

Alright, we have many choices when it comes to this. Of course I have my own opinion on what’s best and so I’ll explain.

There’s mechanical exfoliation – this includes scrubs, Clairisonics, microdermabrasion. These work by abrasiveness, and more often than not, we’re more aggressive than we need to be. If your scrub has large granules, use it on your body instead and opt for something with granules that has the consistency of sugar. The key to using mechanical exfoliation is to use them very gently. If you don’t, over time collagen and elastin will breakdown and that can lead to wrinkles.

Then there’s chemical exfoliation. What more do I need to say – this is obviously the winner. Reason is, because it’s such a clean way of removing dead cells without the consequence of mechanical exfoliators. The way acids work is they just break apart the peptides that hold skin cells together and get them to shed. Make sure to let the acid completely dry, or set, before going on to the next step if you’re using an acid that stays on overnight. There are many types of acids such as glycolic, which is from sugar cane. Lactic, from milk. Salicylic, from willow bark, and mandelic from almonds. There’s many others too!

Exfoliation is such an important step to having healthy skin! It removes dead cell buildup on the surface, which in turn speeds up new cell turnover. Removing that dead cell layer before applying any products is crucial in allowing active products to go deeper into the skin and work more effectively.

3. Tone

I tend to skip this step because my feeling is this: if your cleanser is doing it’s job well, there won’t be any left over residue on the skin and it’ll be pH balanced… so, no need for a toner. However, some people love them and they’re certainly not doing any harm so if you like to add this step, go for it! Also, skip this step if the exfoliator you use has to stay on the skin, like acid pads for example. In that case you’ll want to use a toner before exfoliating.

4. Medicated Treatment

Medicated products, like benzoyl peroxide, need to be applied as closely to the skin as possible. That’s because it’s job is to kill bacteria and dry up oil, so you need it right at the source. A lot of people love to do spot treatments when they start breaking out but don’t realize that products like these are very strong, and applying them in such a concentrated area will likely burn the skin and can cause a ring of hyperpigmentation or scarring. I advise applying a super light thin coat all over the skin, that way it’s blended. Always use a small amount, apply to the forehead first, and then go from the perimeter of your face to the inside, avoiding the eye, nose and mouth corners from burning. The skin is thickest on the outer areas and thinnest towards the middle of your face. Another medicated product could be Retin-A, which you would apply in the same manner.

4. Serum

These are nutrient-dense, ultra concentrated, and meant to be “active” on the skin. Serums are always tailored to your main skin concern. Someone who is working on hyperpigmentation may be using a lightening serum, as opposed to someone with acne may use one with acids. These are great for anti-aging and hydrating benefits!

5. Eye Cream

If you love using eye creams, this is when you’d apply.

6. Moisturize

Apply this last, as it tends to be the thickest of them all and helps to lock in hydration! I think of moisturizer in the same way as how we use chapstick. The more you apply it, the more your skin needs it to feel balanced. Use common sense here – if you’re oily, your skin is already producing enough hydration. If you feel dry, apply it. If you don’t then skip it.

7. Sunscreen

Look for mineral sunscreens which contain zinc and/or titanium. These will give you maximum protection, are great for sensitive skin types and you won’t have to reapply as often.

 

This is a general guideline, and of course, not every skin type needs all of these steps! We can get sucked into thinking we need to have excessive routines and expensive products to get our skin to where we want it to be. Let me just say, expensive products do not necessitate higher value to something less expensive. And do we really need to over-complicate our lives with having 20 extra steps to do in the morning before work? I say no way! Just keep it simple and know what works for you.

Traveling somewhere new is always exciting! That is, once you get there. The whole part in between with security checks, hauling heavy bags, airplane food, and recycled air… not so much. It’s very common to breakout once you arrive at your destination. I’ve got some tips on how you can keep your skin looking and feeling it’s best!

How Flying Affects the Skin

In-flight air quality is extremely dry. In low humidity, moisture gets pulled from the deeper layers of skin, causing it to become extra dehydrated. People who have naturally dry skin (like me!) will be able to see and feel this dryness in their complexion. The skin may look a bit leathery and fine lines will stand out more. If you tend to have oily or combination skin, you might experience even more oiliness. This is because the skin is trying to compensate for the moisture being lost, and sebaceous glands go into overdrive. Sebum is a perfect environment for propionibacterium acnes (the bacteria that causes acne) to flourish. With a spike in oil production, dead cells building up on the surface, a lack of sleep, the stress of traveling and hopping time zones, it makes sense as to why so many of us breakout. Here’s what you can do!

 

Pre-Departure

• Exfoliate more. Removing dead cells off the surface prevents them from stacking up and allows topical products to get absorbed deeper. Peter Thomas Roth Max Complexion Pads are my favorite acid exfoliation. If you like scrubs, opt for one with a sugar-like consistency. SkinCeuticals Micro Exfoliating Scrub is the best!
• Lather on the moisturizer. Use what’s best for your specific skin type! After a good exfoliation, your moisturizer should work even better.
• Go makeup-less. If you can, having a bare face will decrease buildup and make it easier for you to take care of your skin while flying.
• Bring a hydrating mask. Do this the night before, and during the flight if you’re able to. It will make a huge difference! Dermalogica’s Colloidal Base Mask is my favorite gel mask and is great for any skin type.
• Get in your antioxidants. Flying exposes us to free radical damage. Load up on vitamin A and/or C, and this will help keep skin clear and vibrant.
• Bring your usual products – traveling is not the right time to try out your new Sephora samples!

 

During

• If it’s a longer flight, remove your makeup in between and keep the skin clean.
• Apply a thick moisturizer or hydrating mask
• Spritz with a moisturizing mist. Dermalogica’s Antioxidant Hydramist works great. I also recommend Rose Water Mist by Heritage Store.
• Load up on water, and skip alcohol/caffeine.
• Avoid excess salt and sugar

 

Upon Arrival

• Wash off the airplane grime and get to EXFOLIATING! Removing the accumulation of dead cell buildup will leave skin feeling refreshed.
• Opt for a moisturizing mask to push hydration back into the cells. If you still feel oily that night, apply a clay mask to pull out excess oil, then moisturize.
• Use your usual products in the same routine you do at home, and remember to apply sunscreen!