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May 2018

PIE vs PIH – Or “why did this acne spot leave a mark?”

Perhaps the worst part about acne is not simply having the spot itself, but that the spot remains red or brown for a long period of time after the initial spot has been… ahem… dealt with.

For many, these spots of discoloration hang around for weeks or even months after, and depending on the severity of the initial breakout, can be pretty bright or noticeable. My skin is still fading three or four marks from my last big breakout around Christmas (jaw and upper lip acne is so flattering during the ‘Happiest Time of the Year’) and I still have a dark red spot on my left cheek from an over-ambitious romp I had with a cleanser back in March.

So what is it that causes these spots? What are they? And how do we fade them?


PIE vs PIH

When our skin erupts into an acne spot, it inflames and causes trauma to the skin around it (this is why it is even more important not to pick or squeeze spots hard – you’re causing even more damage to occur). This trauma in the skin results in an erythema — a superficial reddening of the skin as a result of dilation (or increased blood flow) of the capillaries.

Skin erythema can occur with infections, rashes (such as Lyme’s disease), sunburns, allergic reactions, allergies, and yes, you guessed it — acne. This reddening of the skin after an acne spot is referred to as post-inflammatory erythema or PIE.

It generally occurs in people with fairer skin tones (I’ll get to darker skin tones in a second!) and appears red or pink — not brown. Over time, these pink or reddish spots can turn brown, which is post-inflammatory hyperpigmentation or PIH.

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Post-inflammatory erythema

The primary difference between post-inflammatory erythema (PIE) and post-inflammatory hyperpigmentation (PIH) is that the redness disappears (called blanching)  once pressure is applied to the area.

Post-inflammatory hyperpigmentation is more common in people with darker skin tones, and occurs when the body produces melanin as a result of inflammation or injury.

pih-acne-marks-skinney-medspa

Post-inflammatory hyperpigmentation

This is why treatments for resolved acne spots for darker skin tones does not typically work for people with lighter skin tones and vise versa. However, PIE can become darkened, as I said above, and turn into PIH. This usually happens when the skin is exposed to UV (sun), especially in short does over long periods of time (such as driving to work).


Treatment Options

Both PIE and PIH usually disappear on their own, but can take weeks, months, or even years. There are a couple options to speed up the process.

PIE Treatment

  • Pulsed Dye Lasers. Similar to IPL (or Intense Pulsed Light), PDL aims intense light at blood vessels beneath the skin. This light is absorbed by abnormal blood vessels and converts to heat, which destroys the vessels without damaging the surrounding skin. It can cause bruising, and can take multiple sessions if lesions are larger or very numerous. PDL is usually recommended for severe spots, and can be used to treat a variety of conditions, from stretch marks to port wine stains. [PHOTOSTW: Images of self-harm scars and burns]
  • Coverage and wait. Protecting PIE spots from UV damage shortens their lifespan and ensures they don’t turn into PIH. Anecdotally, I have had better luck with PIE spots when I do not pick or pop the spot and keep the area moisturized before, during, and after resolution of the spot.

PIH Treatment

  • Topical Vitamin C. Since PIH is hyperpigmentation, most antioxidant treatments that are formulated to target hyperpigmentation will help resolve post-inflammatory hyperpigmentation. Topical vitamin C products are great for this, and L-AA (L-Absorbic Acid, a form of vitamin C) serums especially. Timeless is a trustworthy brand that can be found on Amazon.
  • AHAs and Azelaic Acid. I’ve made a longer post on hydroxy acids (how they work, what they require for efficacy, et cetra.). You can read about them here. More specifically, glycolic, lactic, mandelic, and azelaic acid are all effective for fading PIH marks.
  • Skin brighteners. Arbutin, licorice, and niacinamide are wonderful skin brightening ingredients that are found in a plethora of products these days, particularly products created for the Asian skincare market. They are typically non-irritating (though niacinamide can irritate some sensitive skins in higher percentages, such as 5-10%). Some product examples:

Sources:

  1. Easy as PIE
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Skincare Oils: Sea-Buckthorn Oil

by Kristen
Skincare Oils: Sea-Buckthorn Oil

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Not too long ago, it was thought that oil was bad for skin and the primary cause of acne. Oil-free moisturizers dominated the market, and everyone I knew with acne (myself included) scoured, scrubbed, toned, and moisturized their acne-prone skin with oil-free products and astringents.

Fast-forward to the 2010s and oil-based products and luxury facial oils are everywhere.

Today though, I wanted to talk about an oil that seems to be getting more attention in the skincare world: Sea-Buckthorn Fruit Oil.

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Sea-buckthorn oil sounds like it is comes from a creature in the sea, but it is actually derived from the fruit of the sea-buckthorn berry. The oil is typically cold-pressed from the whole berries or the seeds of the berries, and is used in several types of products, from skincare to dietary supplements. [1]

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It is advertised as having multiple benefits – from anti-aging to anti-bacterial – and is rich in omega-7 (palmitoleic fatty acid) and omega-3 (oleic fatty acid). It contains a large amount of beta carotene, which gives it the deep reddish-orange hue.

While it varies by distributor, Rose Mountain Herbs gives their sea-buckthorn oil the following analysis:

Odor– Fatty/Characteristic
pH– 3.43

Fatty Acids and Constituents
Beta Carotene– 254 I.U./100 g
Vitamin E– 123 mg/100g
Lycopene– less than 1%
Linoleic– 6.8%
Oleic– 28.4%
Palmitic– 31.3%
Palmitoleic– 29.7%
Stearic– 1.1%

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Unfortunately, there aren’t a ton of studies about the benefits of topical sea buckthorn oil, though the studies that do exist show that sea-buckthorn oil is a promising ingredient, with potentially some wound-healing [2] and UV protection [3] properties.

For use, I recommend diluting it with other facial oils or products, as it is indeed a very red/orangey oil and can make fairer skins look very fake-tan orange once applied. Some people also recommend sleeping with a towel on your pillow overnight when using it, though I’ve never noticed long-term staining of fabrics due to sea-buckthorn oil.

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I’d recommend it for skin that is acne-prone due to its wound healing properties, though anecdotal evidence seems to point to it having value for rosacean skin types. It may also do well with you if you’ve successfully used macadamia nut oil, as both contain a large amount of palmitoleic fatty acid.

I would also recommend heavy spot testing for people with malessezia folliculitis, fungal acne,  atopic dermatitis, or seborrheic dermatitis, as they are all conditions that can be caused by M. furfur yeast, which oleic and palmitic fatty acid can all cause to grow quickly. [4]

Sea-buckthorn oil can be purchased fairly easily online (it is much more difficult to find in stores) from a variety of retailers, such as The Ordinary, Mountain Rose Herbs, and Amazon.


Sources

  1. Wikipedia – Sea-buckthorn oil
  2. Influence of sea buckthorn (Hippophae rhamnoides L.) flavone on dermal wound healing in rats.
  3. Sea buckthorn products: manufacture and composition.
  4. Improved Detection of Malassezia Species in Lipid Supplemented
    Peds
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Blackheads on the Nose: Are they “sebaceous filaments”?

When you hang out in skincare communities as much as I do, you eventually see lots of questions about totally normal skin features, such as the one I want to talk about today: the blackheads on your nose. These are frequently described as “sebaceous filaments,” though this is not a medical condition or diagnosis and only gained popularity in the 2000s through skincare boards and communities. It is also important to note that they are not oil glands (sebaceous glands), which are deep in the dermis and excrete sebum along the hair follicle, which finds it’s way to the surface of the skin.

Cosmetic chemist KindofStephen notes:

The term sebaceous filament likely originates from around 1912 by French dermatologist Sabouraud quoted in the Journal of Cutaneous Diseases Including Syphilis where it is quoted as “seborrhoeal filaments” and presumably translated to sebaceous filament.

It’s then referenced 12 years later as sebaceous filaments in a paper by Rulison in the Archives of Dermatology and Syphilology.

These of course are looking at seborrhoel or sebaceous filaments of the scalp, but a German paper published in 1976 under Follikel-Filamente examined ones found in the skin. Sebaceous filament was then mentioned by David Whiting in his 1979 review on acne, before making its way into a book by Plewig and Kligman in 1993.

In many textbooks microcomedone, impactions, follicular casts, follicular filaments or just the contents of the infundibulum (the pore opening above the sebaceous gland) are also used to describe them.

If you do a Google Scholar search for the term “Sebaceous Filament” you only get about 15 hits, a University of Toronto literature search only returns 7.

While they are not explicitly comedones, they are usually found in places rich in microcomedones, which can turn into open comedones (or blackheads). Perhaps the most common location for them is the nose, chin, and forehead, where people tend to feel the most self-conscious due to the central location. They frequently appear as an open pore with oil enveloping a vellus hair (the fine, baby hair all over our body that appears during puberty). When extracted, cylindrical tubes of sebum are expressed, which contain all of the makeup of your hair follicles – sebum, dead skin cells, bacteria, microflora, and sometimes the small vellus hair.

The primary difference between these “sebaceous filaments” and blackheads is that they are not inflammatory in nature, are typically uniform in size, and don’t extract as a hard plug or “grain.” On some people, they can appear larger, while on others they may be smaller.

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No one is ever this close to your nose.

These openings never quite go away, though they can appear smaller or lighter.

 

 

Regardless of what you want to call them, many people are uncomfortable with this feature of the skin. If you’re bothered by their appearance, here are some guidelines to follow to do just that:

  • Try a BHA. Paula’s Choice 2% BHA Liquid is my weapon of choice, as it is oil-soluble and can break down sebum sitting inside of our pores, effectively “cleaning them out.” Adjust this as needed — some people need AHAs instead of BHAs, and some people can tolerate much higher percentages of AHA on areas like their nose than the rest of the skin. It is okay to apply products to only one area of your skin. I do this all of the time with my actives, since my rosacea makes my skin a lot more sensitive in some places as opposed to others.
  • For a quick fix, try a clay mask. If you have an event coming up, try a mild clay mask to soak up some of the sebum on your skin. Depending on the strength of the mask (Aztec Indian Clay Mask is very, very strong and can actually be a bit uncomfortable to wear), do this up to a night before so your nose isn’t red before the big event. I recommend being careful with clay masks if your skin is very sensitive, such as people with rosacea or dehydrated skin.
  • Keep pore strip usage to a minimum. While frequently recommended against due to the idea that they can “stretch the pore, making it larger,” there is no scientific literature that confirms that this occurs. Instead, make sure you keep usage to a minimum – KindofStephen recommends only once a week – and that your skin is in top shape before use. This means avoiding use shortly after introducing an AHA or retinoid into your routine, or scrubbing your skin or masking.
  • Try a moisturizer with urea and/or HA. Many people have good luck with low percentage urea moisturizers and HA serums, finding that they reduce the size and appearance of the filaments. I recommend several in my dehydrated skin post.
  • Gently massage your oiliest areas a little longer with cleanser at night. I always spend a couple extra seconds gently working cleanser into my oily areas, like my nose, chin, and forehead.
  • Breathe. No one is looking at your nose when they talk to you, nor are they as close to your skin as you’re probably getting when you’re staring at yourself in front of a mirror. If you’re feeling worried, stand back 3 – 6 feet from a mirror. This is how close most people will be to you.

 


Sources:

  1. Sebaceous filaments
  2. Why your dermatologist or that sales person may not know what a ‘sebaceous filament’ is
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Review: Laneige Water and Lip Sleeping Mask

by Kristen
Review: Laneige Water and Lip Sleeping Mask

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My relationship with Asian Beauty has been a mixed bag. I’ve had great results with some products, like the My Beauty Diary Black Pearl sheet masks, but I’ve also had tragic results with others, such as the Scinic Honey AIO.

When I first bought the Laneige Lip Sleeping Mask, I had just gotten back from Christmas in Buffalo, New York, where wind chill was -19’F (-28’C) and lake effect was in full swing. My lips were practically falling off of my face in bloody, peeling sheets, despite my constant application of lip balms and creams and ointments — literally anything that resembled relief. It was that type of chapped where your lips burn, even when perfectly exfoliated, because the air hurts your face.

Likewise, when I bought the Laneige Water Sleeping Mask, I was deep in dry skin territory. I needed something — anything  to soothe away the dry skin around my nose and boost the moisture in my skin.

I purchased both of these masks at Sephora and they came neatly packaged with spatulas that I promptly misplaced.  C’est la vie.

Both products are advertised to boost the hydration levels of your skin while you sleep and supposedly hold the power to do so without making every piece of fur, hair, or pillowcase in the area stick to you like Vaseline does.

As a frequent Vaseline user, this was incredibly appealing. As much as I love Vaseline for my skin, that initial sticking that happens when you lay down at night is… well, it’s just uncomfortable.

So let’s get into it, starting with the Lip Sleeping Mask!


First Impressions: Lip Sleeping Mask

Review: Laneige Water and Lip Sleeping MaskReview: Laneige Water and Lip Sleeping Mask

 

Ingredients: Diisostearyl Malate, Hydrogenated Polyisobutene, Phytosteryl / Isostearyl / Cetyl / Stearyl / Behenyl Dimer Dilinoleate, Hydrogenated Poly(C6-14 Olefin), Polybutene, Microcrystalline Wax / Cera Microcristallina / Cire Microcristalline, Butyrospermum Parkii (Shea) Butter, Synthetic Wax, Euphorbia Cerifera (Candelilla) Wax / Candelilla Cera / Cire de Candelilla, Sucrose Tetrastearate Triacetate, Butylene / Ethylene / Styrene Copolymer, Ethylene / Propylene / Styrene Copolymer, Mica (CI 77019), Astrocaryum Murumuru Seed Butter, Titanium Dioxide (CI 77891), Dimethicone, Fragrance / Parfum, Polyglyceryl-2 Diisostearate, Dehydroacetic Acid, Methicone, Copernicia Cerifera (Carnauba) Wax / Cera Carnauba / Cire de Carnauba, Polyglyceryl-2 Triisostearate, Yellow 6 Lake (CI 15985), Red 6 (CI 15850), Polyhydroxystearic Acid, Water, Potassium Alginate, Propanediol, Glycerin, Alcohol, Lycium Chinense Fruit Extract, Vaccinium Macrocarpon (Cranberry) Fruit Extract, Fragaria Chiloensis (Strawberry) Fruit Extract, Rubus Idaeus (Raspberry) Fruit Extract, Sapindus Mukorossi Fruit Extract, Vaccinium Angustifolium (Blueberry) Fruit Extract, Rubus Chamaemorus Seed Extract, Coffea Arabica (Coffee) Seed Extract, Chenopodium Quinoa Seed Extract, Magnesium Sulfate, Calcium Chloride, Sodium Hyaluronate, Beta-Glucan, Manganese Sulfate, Zinc Sulfate, Ascorbyl Glucoside.

The Laneige Lip Sleeping Mask smells like strawberries. Or maybe it’s strawberries and pears? In any case, it smells sweet and almost candy-like. It is neither unappealing nor extremely artificial smelling, but it is also not completely natural either.

When I was looking at other reviews on the Lip Mask, I had always heard that it didn’t take much, and man were those reviews right. My initial serving of the Lip Mask was far too much — an ample, pea-sized amount that I ended up massaging into the back of my hand after coating my lips.

The Lip Mask has a creamy but waxy texture that spreads easily. It is an opaque baby pink in the jar, but goes on clear.

It has a slight taste to it which I can only describe as “as it smells.” It isn’t at all unpleasant, and it is very faint but present.

It does not dry down, remaining waxy and emollient once applied. I didn’t find this to be a problem, especially since I apply it only before bed and sleep on my side, but I can see it being less than pleasant for people who sleep on their stomach.

In the morning, there was a slight, waxy residue left over on my lips, but they felt very soft and the dead skin removed easily with a warm washcloth.

Lipstick applied easily and my lips remained soft throughout the day in a way that Aquaphor doesn’t quite create. It was like the Sleeping Mask was lotion for my lips, as weird as that may seem.


First Impressions: Water Sleeping Mask

Review: Laneige Water and Lip Sleeping MaskReview: Laneige Water and Lip Sleeping Mask

Ingredients: Water, Butylene Glycol, Cyclopentasiloxane, Glycerin, Cyclohexasiloxane, Trehalose, Sodium Hyaluronate, Oenothera Biennis (Evening Primrose) Root Extract, Prunus Armeniaca (Apricot) Fruit Extract, Beta-Glucan, Chenopodium Quinoa Seed Extract, Ascorbyl Glucoside, Magnesium Sulfate, Zinc Sulfate, Manganese Sulfate, Calcium Chloride, Potassium Alginate, Ammonium Acryloyldimethyltaurate / VP Copolymer, Polysorbate 20, Dimethicone, Dimethiconol, Dimethicone / Vinyl Dimethicone Crosspolymer, Propanediol, Ethylhexylglycerin, Stearyl Behenate, Polyglyceryl-3 Methylglucose Distearate, Hydroxypropyl Bispalmitamide MEA, Inulin Lauryl Carbamate, Alcohol, 1,2-Hexanediol, Caprylyl Glycol, Carbomer, Tromethamine, Disodium EDTA, Phenoxyethanol, Fragrance, Blue 1 (Ci 42090).

The Laneige Water Sleeping Mask smells like a salt water-scented candle. It is a bit beachy and herbal — very refreshing.

The texture of the Water Sleeping Mask is like a light, gel-cream. Like with the Lip Sleeping Mask, a little goes a long way.

Once applied, it takes a couple minutes to dry down to a slight tacky feel. By morning though, I felt like I had rubbed most of it off of my face.

My skin felt soft, but not particularly more moisturized than when I slept with Vaseline on it.


Consensus

I really enjoy using the Lip Sleeping Mask, and while the pot may seem small, I can imagine it will last me for several months or even a couple years. It made my lips extremely soft and made my lips a fantastic canvas for makeup the following day.

I am a bit torn on the Water Sleeping Mask. While it is inoffensive and doesn’t break my skin out, it doesn’t seem to do much for me, either, which is a shame for $25.00 USD. I brought it with me on the flight to New York City (5.5 hours) and felt like it was helpful, but not so imperative that I would be crushed if I forgot it on my next trip.

 

 

 

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Review: Ialuset Hyaluronic Acid Cream

by Kristen
Review: Ialuset Hyaluronic Acid Cream

When I was in New York City, I purchased a lot of things: Marvis toothpaste, blue foundation (for uh, STAR WARS cosplay), a tube of Embryolisse, sheet masks, and some French skincare favorites. More specifically, Hexomedine, a topical acne medication, and Ialuset, a hyaluronic acid cream.

My skin loves hyaluronic acid. I’ve gone through numerous bottles of Hada Labo Lotion, which despite it’s name, is a watery hyaluronic acid-based serum. Despite this, I’m always looking to try new things, especially things that have cult followings.

First Impressions

I purchased Ialuset in store at New London Pharmacy for $34.00 USD. The ingredients were not listed on the box in English, so I went off of some cursory Googling on efficacy to make my decision. Here is the ingredient list I have found online:

Sodium hyaluronate, surfactant, oleic acid decyl ester, emulsifying wax, humectant, glycerol, methylparaben, propylparaben, dehydroacetate, acidifier, fragrance, water.

It comes in two forms: Cream in a metal tube and pressurized bottle. I purchased the cream version.

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My tube of Ialuset

Ialuset is an opaque, white cream that has a very slight fragrance that I can’t quite put my finger on. In fact, when I first used it, I thought it had no fragrance because it just smells like a non-fragranced cream.

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Excuse my dry hands

It feels extremely emollient when applied. It spreads easily, but needs worked into the skin a little before it settles in completely. This texture makes it feel fairly luxurious and moisturizing right off of the bat.

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Iasulet half-way massaged into the skin

Once worked in, it dries down to a kind of dry, waxy feeling. Skin feels plumper and moisturized immediately.

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Ialuset completely massaged into the skin

The first time I used Ialuset, I didn’t give it a fair chance. My skin was a bit irritated from breaking out, travel, and some aggressive BHA and Finacea usage. Upon application over my topical actives, my skin lit up, turning red, hot, and uncomfortable.

I immediately suspected the fragrance listed in the ingredients and felt discouraged that I had found yet another product that my skin didn’t get along with. Instead of washing it off of my face, I applied some ice and waited to see how my skin felt in the morning (anything for science, right?).

Surprisingly though, it looked and felt plump and happy in the morning, despite the previous evening’s snafu. So I decided to try again once my skin was less irritated.

Days later, I applied the Ialuset once more, fresh out of the shower, while my skin was still damp.

And I waited… and waited…

My skin looked and felt great. It was not irritated at all, nor was it red. My rosacea didn’t flare or get bumpy. Everything was just fine.

Over the next couple of days, I used it in place of my Hada Labo Lotion, skipping the days when I was using topical actives like my Paula’s Choice 2% BHA Liquid or my Finacea.

Consensus

Ialuset has great reviews on Avibon’s site, and I understand why. It is considered one of the few pure hyaluronic acid products on the market, and it delivers in making skin feel and look more hydrated than it would with a moisturizer alone.

It is not a replacement for your moisturizer, and I would not recommend treating it as such. Based on my experience, I’d also be cautious about using it with your actives (AHAs, BHAs, topical prescriptions) or when your skin is irritated.

Will it replace my Hada Labo Lotion though? Probably not. It feels luxurious and emollient for sure, but my Hada Labo is a tried-and-true, inexpensive addition to my routine that just works.

You can purchase Ialuset for $34.00 USD on New London Pharmacy’s website.

Note: Ialuset is available on Amazon.com as well, but I did not recommend it here because I have received fake products from Amazon, such as fake Embryolisse that smelled very strongly of perfume. If you decide to purchase from Amazon, proceed with caution and only purchase from sellers you know and trust.

 

 

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Become a Patron

by Kristen
Become a Patron

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For the last ten years, I have been a part of the video game industry — working on titles like STAR WARS: The Old Republic, Marvel Heroes, and more recently League of Legends. Over that time, I struggled with skin issues and became a regular contributor in skincare and beauty-centric communities, such as MakeupAlley and Reddit, in my spare time.

I recently left my job for my own mental health and began exploring sharing my long-time passion of beauty and skincare with others. I’ve invested countless hours in researching and understanding the science behind skincare, and I want to teach others what I’ve learned so that they can have a better understanding of their own skin.

Together, we can embark on a journey to change what people see in the mirror. As someone who has suffered severe mental illness, I know how painful it can be to not be greeted by a reflection of who you feel like on the inside.

Let’s change that. Your support means I can keep doing what I want to do: writing content multiple times a week here on Skinolog.ist, buying new products to give you honest reviews, paying for my web hosting, and buying new equipment so I can create content in more ways than one.

Thank you so much!

– Kristen

 Become a Patron!

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I Visited Glossier in Los Angeles

by Kristen
I Visited Glossier in Los Angeles

Glossier smells like the color pink. It is warm, powdery, with notes of rose and delicate musk — like the way we imagine our grandmother’s vanity smelled. It wafts out of the store and into the sunny, Los Angeles street corner, inviting you to step in.

Glossier opened their store in Los Angeles on Tuesday, in West Hollywood off of Melrose Place. I visited the store on Wednesday and was struck with how uniquely different it was from the New York City store.

I Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los Angeles

It has a very warm, down-to-earth vibe, reminiscent of the desert that grasps at the mountains that cradle the basin of Los Angeles. Desert grass and yellow flowers dot the millennial pink landscape, giving way to counters with neatly organized makeup and skincare. The stations are lined with mirrors roughly the size of a cell phone, and gave me a very distinct Hollywood vibe, as if you’re checking your lipstick in your rear-view mirror before heading off to a fancy dinner.

In the back is a small canyon escape, lit with alternating LEDs, humming with soothing, ambient noise, and dressed with a mirror.

The store carries the full collection of Glossier’s products, from the ever-popular Boy Brow, to the cult favorite Milky Jelly Cleanser that I reviewed, to the newly released mascara, Lash Slick.

There are plethoras of sample products and one-time-use tester applicators, encouraging you to try out everything without the usual fear of product tubes full of germs.

I Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los AngelesI Visited Glossier in Los Angeles

To order, you find one of the lovely Glossier representatives that walk the floor in their pink coveralls, iPad in tow. This does feel a bit more chaotic and disorganized than the procedure in NYC, where you’d simply take a sheet, marked with the items of your desire, to the front desk, where you’d pay and wait to have your name called.

I took loads of photographs while I was visiting, and it didn’t feel intrusive or discouraged. In fact, like most modern makeup brands, it feels encouraged to take a selfie here or there, or pose with a friend for Instagram. There are even decorations on the mirrors as well as a decorated wall facing a mirror, which I can only assume is designed with an almost-singular purpose in mind.

I Visited Glossier in Los AngelesI Visited Glossier in Los Angeles

Overall, the Glossier store is quite a beautiful, Los Angeles experience that is worth checking out if you’re in town.

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Evaluating Your Routine: Hydroxy Acids

When I was younger, I spent almost every waking moment browsing skincare communities. Most posts in those communities boils down to routine help, selfies, or general questions, but sometimes, skincare routines in popular media come up. One such routine was displayed in the film American Psycho with Christian Bale. You can do a quick Google search and find numerous articles, blog posts, and videos about Patrick Bateman’s infamous daily routine and people who’ve tried to follow it.

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In the film, Patrick Bateman — a man with deep, anti-social behaviors — details his morning routine:

“I live in the American Gardens Building on W. 81st Street on the 11th floor. My name is Patrick Bateman. I’m 27 years old. I believe in taking care of myself and a balanced diet and rigorous exercise routine.

“In the morning if my face is a little puffy I’ll put on an ice pack while doing stomach crunches. I can do 1000 now.

“After I remove the ice pack I use a deep pore cleanser lotion. In the shower I use a water activated gel cleanser, then a honey almond body scrub, and on the face an exfoliating gel scrub. Then I apply an herb-mint facial mask which I leave on for 10 minutes while I prepare the rest of my routine. I always use an after shave lotion with little or no alcohol, because alcohol dries your face out and makes you look older. Then moisturizer, then an anti-aging eye balm followed by a final moisturizing protective lotion.”

Showing the audience this routine reveals to us how much emphasis Bateman puts on his outwards appearance — a central theme to the film.

Most people care deeply about their appearance, whether they’re following a Bateman-esc routine or trimming their brows. After all, glowing skin is typically a sign of health.

Bateman’s routine puts particular emphasis on a youthful appearance, with multiple scrubs, peels, and moisturizers; and indeed it is exfoliation and skin-cell turnover that keeps your skin looking younger and healthier, but how do we get there from here? What should a good exfoliation routine look like? Where do you even start?

In this post, I’ll be breaking down some of the things that can keep us looking younger: AHAs, BHAs, and LHAs.


Introduction to Hydroxy Acids

You may remember from my post on moisturizers that skin cells (keratinocytes) begin deep in the stratum basale — the deepest layer of the epidermis — and work their way upwards, flattening out, hardening, dying, and eventually flaking away.

Stratum+corneum,+top+layer+of+skin,+graph

However, some skin cells are not quite as good at this as others. They will build up, stick together, or get “stuck” in the pores (hair and oil gland openings) of skin. Hydroxy acids are what is called an “active” skincare ingredient — basically something that performs an action on the skin. In this case, rejuvenation and exfoliation. They are largely found in botanical sources, which is why they are frequently referred to as fruit acids, and are divided up based upon the hydroxyl groups on their molecular structures. Hydroxy acids posses the ability to separate skin cells from the stratum corneum, which can be hugely beneficial to skin diseases that are characterized by a build up of dead skin (or hyperkeratosis), such as acne. Many also have the ability to stimulate the growth of collagen in the deeper layers of the skin, resulting in the reduction of fine lines over time.[1][2][3][4][7]

If you want to think of it in a more simple way, hydroxy acids are solutions that break down the “glue” that holds skin cells together (not the skin cells themselves), but like with anything that performs an action on the skin, this can be very irritating. Whether or not it is irritating to you depends on your needs and the formulations as well as the concentrations of the exfoliants you pick.


AHAs

The term AHA is short for “Alpha Hydroxy Acid.” It is the most common of the chemical exfoliants you can find. They’re usually associated with creating glowing, youthful skin due to their ability to exfoliate away the upper layers of the stratum corneum so effectively.

They work best around a pH of 3.5, which allows for better absorption. The higher the pH, the lower the amount of acid that is absorbed by the skin. To demonstrate this, one study compared the effects of glycolic and lactic acid on the skin when applied at different pH values. At a pH of 3, the total absorption of a 5% glycolic acid cream in 24 hours was 27%. When increasing the pH value to 7, that absorption tanked to a mere 3.5%. Similarly, 5% lactic acid had a total absorption of 30% over 24 hours at a pH of 3, which dropped to 10% when the pH was boosted to a value of 7. [5]

They are water-soluble, meaning that they work best directly on clean, dry skin. Some even have humectant properties, allowing them to draw moisture into the upper layers of the skin.

All AHAs create photo-sensitization — or sensitivity to the sun — due to their ability to exfoliate the stratum corneum.

AHAs are also generally not recommended for rosacean or eczema-prone skin, as they can worsen the inflammation that is common in these conditions. Additionally, avoid using AHAs in combination with other forms of exfoliation (such as physical scrubbing) or prescription topicals given to you by your dermatologist, especially tretinoin/Retin-A.

There are multiple types of AHAs, and they come in various forms, differentiated by molecular size and source. The most common types of AHAs are glycolic, mandelic, and lactic.

Glycolic

The most common form of AHA is glycolic, and it’s found in nearly every AHA product you can find these days. It has a small molecular structure, meaning it can penetrate the upper layers of the skin more easily and quickly, but it is also the most irritating due to these properties. It’s usually found in products in concentrations of 8-10%. Some examples of popular products with glycolic acid:

Paula’s Choice 8% AHA Gel – Recommended

Water (Aqua), Glycolic Acid (alpha hydroxy acid/exfoliant), Sodium Hydroxide (pH adjuster), Chamomilla Recutita Matricaria Flower Extract (chamomile/skin-soothing), Aloe Barbadensis Leaf Juice (hydration), Camellia Oleifera Leaf Extract (green tea/antioxidant/skin-soothing), Sodium Hyaluronate (skin replenishing), Panthenol (hydration), Sodium PCA (skin replenishing), Propylene Glycol (hydration), Butylene Glycol (hydration), Hydroxyethylcellulose (texture-enhancing), Polyquaternium-10 (texture-enhancing), Phenoxyethanol (preservative), Sodium Benzoate (preservative).

Pixi Glow Tonic

Aqua, Aloe Barbadensis Leaf Juice, Hamamelis Virginiana (Witch Hazel) Leaf Extract, Aesculus Hippocastanum (Horse Chestnut) Seed Extract, Glycolic Acid, Ammonium Glycolate, Glycerin, Butylene Glycol, Hexylene Glycol (and) Fructose (and) Glucose (and) Sucrose (and) Urea (and) Dextrin (and) Alanine (and) Glutamic Acid (and) Aspartic Acid (and) Hexyl Nicotinate, Panax Ginseng Root Extract, Phenoxyethanol, Sodium Benzoate, Biotin, Polysorbate 20.

Nip + Fab Glycolic Fix Daily Cleansing Pads

Aqua (Water), Glycerin, Glycolic Acid, Polysorbate 20, Sodium Hydroxide, PEG-12 Dimethicone, Hamamelis Virginiana (Witch Hazel) Water, Phenoxyethanol, Benzyl Alcohol, Alcohol Denat. (SD Alcohol 40-B), Disodium EDTA, Globularia Alypum (Blue Daisy) Extract, Panthenol, Lactic Acid, Parfum, Limonene, Ethylhexylglycerin, Dehydroacetic Acid, Sodium Hyaluronate, Linalool, Geraniol, Citral.

CosRX AHA 7 Whitehead Power Liquid

Pyrus Malus (Apple) Fruit Water, Butylene Glycol, Glycolic Acid, Niacinamide, Sodium Hydroxide, 1,2-Hexanediol, Panthenol, Sodium Hyaluronate, Xanthan Gum, Ethyl Hexanediol.

Lactic Acid

Lactic acid is the second most common of all AHAs, and can be frequently found hanging out in the ingredients with other AHAs or BHAs , though it is a fine exfoliator on its own. It has a larger molecule than glycolic, making it slower to act and less irritating — ideal for more sensitive skin. It is usually derived from milk, and has the best humectant properties out of all of the acids. Some examples of popular products with lactic acid:

Sunday Riley Good Genes All-In-One Lactic Acid Treatment

Opuntia Tuna Fruit (Prickly Pear) Extract, Agave Tequilana Leaf (Blue Agave) Extract, Cypripedium Pubescens (Lady’s Slipper Orchid) Extract, Opuntia Vulgaris (Cactus) Extract, Aloe Barbadensis Leaf Extract & Saccharomyses Cerevisiae (Yeast) Extract, Lactic Acid, Caprylic/Capric Triglyceride, Butylene Glycol, Squalane, Cyclomethicone, Dimethicone, Ppg-12/Smdi Copolymer, Stearic Acid, Cetearyl Alcohol And Ceteareth20, Glyceryl Stearate And Peg-100 Stearate, Arnica Montana (Flower) Extract, Peg-75 Meadowfoam Oil, Glycyrrhiza Glabra (Licorice) Root Extract, Cymbopogon Schoenanthus (Lemongrass) Oil, Triethanolamine, Xantham Gum, Phenoxyethanol, Steareth-20, Dmdm Hydantoin.

The Ordinary Lactic Acid 10% + HA

Aqua (Water), Lactic Acid, Glycerin, Pentylene Glycol, Arginine, Potassium Citrate, Triethanolamine, Sodium Hyaluronate Crosspolymer, Tasmannia Lanceolata Fruit/Leaf Extract, Acacia Senegal Gum, Xanthan Gum, Trisodium Ethylenediamine Disuccinate, PPG-26-Buteth-26, Ethyl 2,2-Dimethylhydrocinnamal, PEG-40 Hydrogenated Castor Oil, Ethylhexylglycerin, 1,2-Hexanediol, Caprylyl Glycol.

AmLactin 12% Alpha-Hydroxy Therapy Daily Moisturizing Body Lotion – Recommended (for body)

Water, Lactic Acid, Light Mineral Oil, Glyceryl Stearate, PEG 100 Stearate, Propylene Glycol, Glycerin, Magnesium Aluminum Silicate, Laureth 4, Polyoxyl 40 Stearate, Cetyl Alcohol, Methylparaben, Propylparaben, Methylcellulose.

Mandelic Acid

Mandelic acid has only just begun to appear on the scene, though it has been around for awhile. It is one of the best choices for very sensitive skin, and great for acne-prone skin due to its anti-bacterial and anti-microbial nature. It is derived from almonds and has moderate humectant properties, floating somewhere between glycolic and lactic. An example of a popular product with mandelic acid:

Stratia Skin Soft Touch AHA with 10% Mandelic Acid – Recommended

Water (Aqua), Mandelic Acid, Propylene Glycol, Polyacrylate Crosspolymer-6, Panthenol, Aloe Barbadensis Leaf Juice, Matricaria Recutita (Chamomile) Flower Extract, Glycerin, Sodium Hyaluronate, Allantoin, Sodium Hydroxide, Diazolidinyl Urea, Iodopropynyl Butylcarbamate.

There are also plenty of products that combine several alpha hydroxy acids together, such as:

Drunk Elephant TLC Framboos Glycolic Night Serum

Water, Glycolic Acid, Butylene Glycol, Glycerin, Sodium Hydroxide, Salicylic Acid, Lactic Acid, Citric Acid, Vitis Vinifera (Grape) Juice Extract, Aloe Barbadensis Leaf Juice, Opuntia Ficus-Indica Extract, Aesculus Hippocastanum (Horse Chestnut) Seed Extract, Camellia Sinensis Leaf Extract, Rubus Idaeus (Raspberry) Fruit Extract, Saccharomyces Cerevisiae Extract, Buddleja Davidii Meristem Cell Culture, Sclerocarya Birrea Seed Oil, Sodium Hyaluronate Crosspolymer, Allantoin, Hydroxyethylcellulose, Galactoarabinan, Propanediol, Disodium EDTA, Xanthan Gum, Hexylene Glycol, Phenoxyethanol, Caprylyl Glycol, Ethylhexylglycerin, Sodium Nitrate, Potassium Sorbate, Pentylene Glycol, Sodium Benzoate.

Dr. Dennis Gross Skincare Alpha Beta Extra Strength Daily Peel

Water (Aqua), Alcohol Denat., Glycolic Acid, Potassium Hydroxide, Hamamelis Virginiana (Witch Hazel) Leaf Extract, Salicylic Acid, Polysorbate 20, Lactic Acid, Mandelic Acid, Malic Acid, Citric Acid, Salix Alba (Willow) Bark Extract, Menthyl Lactate, Camellia Sinensis Leaf Extract, Achillea Millefolium Extract, Chamomilla Recutita (Matricaria) Flower Extract, Soy Isoflavones, Copper PCA, Zinc PCA, Disodium EDTA, Fragrance (Parfum), Sodium Benzoate.


BHAs

BHA is short for “Beta Hydroxy Acid.” These acids are slightly more complex than AHAs due to their oil-solubility. They are able to penetrate not just the skin, like AHAs, but also the pores of the skin. This is what makes them an ideal choice for acne-prones, who tend to have lipid-rich sebaceous glands.

BHAs work best around pH values of 3, and in concentrations of 1-2%. They’re frequently found with AHAs, but can be found in formulations without the addition of other hydroxy acids.

BHAs are not as photo-sensitizing as AHAs [6], but it is still frequently recommended that you wear a sunscreen when using any hydroxy acid.

There are two major types of BHAs: salicylic acid and lipohydroxy acid.

Salicylic Acid

When discussing BHAs, the ingredient that is usually being discussed is salicylic acid, which is derived from salicin — the same stuff in asprin. Due to this origin, salicylic acid should be avoided if you have an asprin allergy.

Salicylic acid has no humectant properties, and can cause drying of the skin. Though if formulated correctly, this can largely be avoided which can make BHA a much more effective acne treatment for some than harsher, more drying topicals such as benzoyl peroxide.

It can also be soothing to some skin types, such as rosacean skin or acne skin, and is pretty well-tolerated overall.

Some examples of popular products with salicylic acid:

Paula’s Choice 2% BHA Liquid  – Recommended

Water (Aqua), Methylpropanediol (hydration), Butylene Glycol (hydration), Salicylic Acid (beta hydroxy acid/exfoliant), Polysorbate 20 (stabilizer), Camellia Oleifera Leaf Extract (green tea/skin calming/antioxidant), Sodium Hydroxide (pH balancer), Tetrasodium EDTA (stabilizer).

Stridex Triple Action Pads, Alcohol Free (Red Box)

Salicylic acid 2.0%, Ammonium lauryl sulfate, ammonium xylenesulfonate, citric acid, DMDM hydantoin, fragrance, menthol, PPG-5-Ceteth-20, purified water, simethicone, sodium borate, tetrasodium EDTA.

Lipohydroxy Acid

Lipohydroxy acid is a derivative of salicylic acid, with unique properties. It has a higher molecular weight and an added fatty chain, making it more lipophilic (oil loving) than its parent SA.

First developed by L’Oreal in the 1980s, it penetrates the skin less easily due to it’s lipophilic properties. This slower penetration means that it breaks down the glue of the skin cells slower, but it is still unclear whether or not this results in less irritation.

Like other hydroxy acids, LHA thins the stratum corneum, but has dermal thickening properties. In one study, it was shown to be as effective as tretinoin, due to it’s stimulation of structural skin proteins and lipids. [7]

It is excellent for acne skin due to it’s lipophilic nature, and in one study, showed a decrease of 85% in follicular plugs over 14 days. [8]

It is only available in products made by L’Oreal, so it is difficult to get your hands on a wide variety. Some examples:

SkinCeuticals LHA Cleansing Gel

aqua / water / eau, coco-betaine, propylene glycol, peg-120 methyl glucose dioleate, sorbitol, glycerin, glycolic acid, triethanolamine, sodium laureth sulfate, sodium chloride, disteareth-100 ipdi, phenoxyethanol, salicylic acid, capryloyl salicylic acid, menthol, methylparaben, disodium edta, steareth-100.

La Roche-Posay Effaclar Duo

Water, Isostearyl Alcohol, Glycerin, Pentylene Glycol, Silica, Carbomer, Capryloyl Salicylic Acid, Potassium Hydroxide, Tocopheryl Acetate, Acrylates/c10-30 Alkyl Acrylate Crosspolymer, Disodium EDTA, Epilobium Angustioflium Flower/leaf/stem Extract.

SkinCeuticals LHA Toner

Water / Eau, Alcohol Denat., Glycolic Acid, Sodium Hydroxide, Capryloyl Salicylic Acid, Salicylic Acid.


All Together Now

  • If you’re sensitive, avoid AHA and BHA used together. Multiple hydroxy acids in one product increase your likelihood of a reaction. It’s better to start low and slow when introducing skin to a hydroxy acid.
  • Lower concentrations for beginners. If you’ve never used a hydroxy acid, go for lower concentrations, such as 1% BHA (Paula’s Choice makes a 1% variety of BHA) and 4-5% glycolic acid. If your skin is sensitive and generally reactive, look for larger molecules, like lactic or mandelic acid.
  • If you’re oily-skinned, rosacean, or acne-prone, try BHA. I cannot understate enough how great BHA is. It is generally soothing and can break through oils on the skin, making it ideal for acne.
  • Do not use physical exfoliation like scrubs, towels, or a Clarisonic when using a chemical exfoliant. Your stratum corneum thins when using a chemical exfoliant, so you shouldn’t need to be physically scrubbing your skin, which can just create irritation.
  • Use hydroxy acids infrequently. Unlike Patrick Bateman, most people do not need daily exfoliation. Use a hydroxy acid two to three times a week. Tweak this based on how your skin reacts.
  • Back off if you’re breaking out. Skin irritation can occur with hydroxy acids, usually in the form of breakouts. If this occurs, discontinue use until your skin clears. Re-introduce the product slowly and use fewer days per week. If the reaction re-occurs, discontinue use entirely.
  • Use a sunscreen during the day. Except for salicylic acid, hydroxy acids thin the stratum corneum and photo-sensitize the skin. You must use a sunscreen during the day to prevent damage and sunburn.
  • Be careful when using BP/retinol/retinoids with AHAs/BHAs if you are very sensitive. If you’re very sensitive with conditions such as rosacea or eczema, be cautious when using other actives in addition to AHAs/BHAs. This can be too much for some skin.
  • Use at night. As I said above, hydroxy acids photo-sensitize you. Use them at night for this reason.
  • Use hydroxy acids as close to the skin as possible. Applying any skin “active” right after you cleanse is ideal. This ensures it is as close to the skin as possible, and does not need to penetrate any additional products to work.

Sources

  1. Effects of alpha-hydroxy acids on photoaged skin: a pilot clinical, histologic, and ultrastructural study.
  2. A review of skin ageing and its medical therapy
  3. Epidermal and dermal effects of topical lactic acid
  4. Glycolic Acid Treatment Increases Type I Collagen mRNA and Hyaluronic Acid Content of Human Skin
  5. Labmuffin – Why does pH matter for AHAs and BHAs
  6. The effects of topically applied glycolic acid and salicylic acid on ultraviolet radiation-induced erythema, DNA damage and sunburn cell formation in human skin
  7. The Use of Lipohydroxy Acid in Skin Care and Acne Treatment
  8. Comedolysis by a lipohydroxyacid formulation in acne-prone subjects.
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Review: Glossier Milky Jelly Cleanser

by Kristen
Review: Glossier Milky Jelly Cleanser

Last month, I spent a week in New York City. While there, I visited the beautiful showroom for Glossier.

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Every product is laid out neatly for visitors to test, organized roughly by function. Moisturizers, primers, serums, and balms at one; powder, foundation, and concealer at another; and lip, cheek, and eye products at another.

At the back of the showroom, there is a washbasin, surrounded by their skincare products. One such product is the infamous Milky Jelly Cleanser.

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Of course, by the time I got a chance to test out the cleanser, I had quite a collection of swatches on my hand.

First Impressions

First, the ingredients:

Water/Aqua/Eau, Rosa Damascena Flower Water, PEG-7 Glyceryl Cocoate, Propanediol, Isohexadecane, Poloxamer 184, Acrylamide/Sodium Acryloyldimethyltaurate Copolymer, Xylitylglucoside, Betaine, Allantoin, Glycerin, Panthenol, Symphytum Officinale Root Extract, Sodium Hyaluronate, Anhydroxylitol, Polysorbate 80, Xylitol, Ammonium Polyacryloyldimethyl Taurate, Isopropyl Myristate, Benzoic Acid, Ethylhexylglycerin, Sodium Hydroxide.

Right off the bat, you’ll notice that there is no fragrance added. It does smell faintly of roses due to the inclusion of the rose water (Rosa Damascena Flower Water), so be aware of that if you are very sensitive to fragrance or just really dislike the scent of roses.

The cleansing aspect of it is performed by the addition of a polymer (Poloxamer 184), which helps water to mix with oils and other products on the skin, letting them be rinsed away.

The product feels… well… very jelly-like. It’s a really unique-feeling cleanser in that way. I can’t think of any other cleanser that has its texture. It is more viscous that typical cleansers, which are more runny, but spreads easily and feels very “clean.” In that way, it’s more like a silicone makeup primer, but without the powderiness that usually accompanies primers due to the addition of silica (for oil-absorption).

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The consistency of the Milky Jelly Cleanser. From Glossier’s Instagram.

I used it for about a week in place of my normal makeup remover, and I must say — it lives up to the claim of being a pretty effective remover. It spread easily and worked just like all of the videos that Glossier has posted on their social media, removing my concealer, eye makeup, lipstick, and most of my mascara with ease. I did not try it with more waterproof formulas, like MAC Face & Body or a waterproof mascara.

A post shared by Glossier (@glossier) on

 

After use, it left my skin smooth, soft, and clean-feeling. It did not feel stripped, even after multiple days of usage. It also did not bother my rosacea or make me pinker than usual.

Consensus

 

The Milky Jelly Cleanser has been a bit of a cult favorite for awhile now, and with good reason. It removes makeup pretty well (though I’d still use a makeup remover for any makeup beyond the light, concealer/mascara/lipstick days), cleanses great, and doesn’t leave skin stripped. Bonus: it lacks fragrance and typical surfactants that can leave skin stripped and tight.

Unfortunately, it broke my skin out after a couple of days usage, but I am also incredibly acne-prone. After just a couple days, my skin had closed comedones all over. Paula’s Choice 2% BHA cleared this up within just 2-3 days of nightly usage.

This doesn’t make me less likely to recommend it however, as it is a great, no frills cleanser and I imagine that a bottle would last about 2-3 months of daily usage.

You can purchase Glossier Milky Jelly Cleanser on their website for $18 USD + tax and shipping.

Note on Glossier’s returns: Glossier’s customer service is amazing. After I contacted them to let them know that I purchased this product in store, but was back home in LA without a way to return it, they responded with a friendly note to let me know that they had passed my feedback along and issued me a full refund, no returning of the product needed. 

 

 

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A Life With Eczema – Michael’s Routine

When I first met Michael, he revealed to me that he had pretty severe eczema. From head-to-toe, he had suffered since he was a child with the itchy, scaly patches of dry skin. It had left him scarred in unusual places, like his ankles and elbows. Carrying around a bottle of Aveeno was a must, as uncontrollable itches and dryness consumed every waking moment of his life.

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Michael

It was shortly after I met him that I began recommending products to him — things he still uses today that have, according to him, “controlled his eczema eighty-percent,” or as many doctors have told him, “probably as good as it can get for eczema this severe.”

Eczema is an immune disease, where the skin almost completely lacks the ability to hold onto moisture naturally. I’ve always described it as a deficiency of the moisture barrier of the skin. It is characteristically dry and thus, inflamed at virtually all times. It usually appears as a rash that can crust and scale and itches to all hell. Without treatment, skin can be traumatized, thickening and scarring into what is called lichenification. Treatments are typically corticosteroids, which over long-term use can permanently thin the skin.

It is the most common type of dermatitis and typically starts in childhood. In the US alone it affects 10-30% of people. It’s twice as common in women than men. It’s occurs about three times more frequently in individuals with celiac’s disease, and about two times more frequently in relatives of those with celiac’s disease. [3]

It is frequently confused with sebhorrheic dermatitis.

There are some factors that put you at higher risk for eczema. The American Academy of Dermatology Association lists them as family history of eczema, asthma and allergies, as well as living in cities or heavily polluted areas.

Most people with allergies experience contact eczema (or atopic dermatitis) at some point in their lives. For many, it is due to an allergen they are exposed to regularly, like a pet, sweating, dust, soaps, wool, or laundry detergent with fragrance. For the unlucky few, it is a disease that begins in their youth and continues into adulthood. Michael is one of those cases.

For this post, I asked him to talk a little bit about his eczema: what has worked for him as well as what’s next, and what his day-to-day routine looks like. Hopefully those of you with eczema will be able to find some value in this, as well as some comfort in your discomfort.


When did your eczema start? How did it present?

My eczema has been around since I can remember. I know that at least by age of 4 I was scratching at myself and had some pretty intense patches of dryness. I’m not sure if I exhibited symptoms from birth, but I definitely remember being very itchy from the beginning.

When I first noticed it (and when my parents noticed) it was in the form of dry, inflamed patches. Not scattered bumps, but a child’s hand-sized patch. As I grew older, wider swaths of skin became dry and irritated, and it has remained persistently patchy for as long as I can remember. While the expanses of my skin were always itchy, areas around my joints became especially dry, red, and raised due to sweat, friction, or other environmental factors. On the whole, I was dry, but it worsened on the insides of my elbows and knees, my neck, arm pits, ankles, and anywhere a crease naturally occurred. As I entered into the later single-digits, anywhere my skin folded would develop a sore or a patch of eczema.

It became the worst around the ages of 9-12. It was nearly impossible to control. As a kid, I didn’t have discipline in terms of moisturizing and proper care. I scratched non-stop, so much that my eyebrows disappeared for about two years. In pictures I have of that time, my skin is almost purple with the abuse it was suffering at my own hands. It was at that time that my parents started taking me to a dermatologist in earnest. I was told it was one of the worst cases he had ever seen, which mirrored what my pediatricians had said in the past. Often I would have to go on a burst of prednisone in order to come back from a flareup.

Eczema is a pretty genetic disease. What is your family history surrounding skin conditions?

Apparently, the men on my father’s side had patchy eczema as children, but it had gone away in pre-teen and teenage years. My hope as a child was that my condition would similarly have abated.

However, I wasn’t so lucky. Allergies, eczema, asthma and other disorders seem to be semi-prevalent on that side of the family, at least in the early years of the other men.

What has it been like to live with eczema? Has it created complications in your life?

When I entered my pre-teens and teens — probably with the onset of puberty — it began to improve slightly, but also migrated and manifested in different ways. I no longer had dark patches everywhere — from my eye sockets to my armpits — but I did have a lot more general dryness and extremely painful symptoms such as skin thickening, scaling, weeping, cracking, scabbing, inflamed sores, and crusting. I was a little better with a routine at this point, since I was getting up every day and moisturizing. In the past it had been just my parents lotioning me up after showers and baths.

By my teenage years, I had managed to get a decent moisturizing routine going, but I didn’t really know the specifics about how I should be bathing, at what temperature, for what length, and I probably did a good job of irritating it even more due to my love (at the time) for long hot showers. I remember exiting the shower bright red and tearing at myself, even after moisturizing. I was using some corticosteroids at the time (triamcinolone mostly) but didn’t really use them in the capacity I should have been.

Being a child with eczema, I was teased pretty bad. No other children understood my condition. As I moved into young adulthood, the teasing began to subside, but it definitely hit me in the self-confidence area. Luckily, I had a pretty developed enough sense of self that it didn’t affect me as much socially, rather it just made me uncomfortable in my own skin, so to speak.

Typically, children’s eczema presents differently than adult eczema. Has it changed at all over the years?

When I entered college, I had something resembling a normal routine. I didn’t take as long of showers, I was using more gentle soaps and shampoo, and I was always putting on moisturizer after showers as well as when I woke up. When I moved to New York City for college, the water was a little less harsh than it had been in my hometown of Buffalo, so that also helped. At that point however, friction was my enemy. Doing a lot of walking in NYC changed the dynamic into a highly localized sort of eczema, in severely itchy and damaged skin patches. Due to years of scratching, I now had significant lichenification (traumatized, thickened skin) of the affected areas which were prone to further dryness and often receiving the brunt of my scratching, leaving me with open lesions most of the time. However, I was now using my triamcinolone regularly, which had it’s benefits and detriments. I was more able to manage eczema patches and dryness, but it caused significant skin thinning in areas where my skin creased or folded.

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Traumatized skin with lichenification (not Michael’s skin)

When I left college, my skin was about 60% under control, I feel. I was using Aveeno lotion on the regular, and had learned to use steroids effectively. I had learned how to shower effectively (hilarious how long it takes as a kid to figure this stuff out) and I learned I could wrap inflamed patches/lesions with gauze or bandages. Layering triamcinolone on the skin itself plus a mixture of lotion and Vaseline on a bandage significantly helped localized symptoms.

By the time I had left NYC and moved to Los Angeles, I had gotten to about 70% control, but new problems started to emerge as some of my historically bad symptoms had receded. I didn’t get patches quite as bad (though overall I was still very dry) since I was decent with my daily routine and shower protocol. I did however start developing very painful, acne-like symptoms from the overuse of steroids. My face especially started to develop almost cystic breakouts which eventually produced a pustule, but not after being a visible and inflamed mass for a week or so.

As I moved into my late 30s, I feel I’ve gotten things about 80% controlled, at least as much as I can do with with topicals and shower care.

What kind of advice did your doctor’s give you?

Unfortunately my doctors weren’t a huge help. Eczema largely still has a fair amount of mystery around it to this day, and it seems to tie in with other over-active immunological responses, such as allergies. There was often debate between my different practitioners. My primary care physician would just okay my prescription medications and leave me be. My dermatologists would emphasize moisturizing and give me steroid bursts when needed. They didn’t focus too much on daily care aside from that, which left me in the dark for quite a number of years before I figured out a healthy routine. Allergists I saw felt my skin’s problems were largely a result from environmental factors but this conflicted with the opinions of the dermatologists. It was a lot of back and forth for quite some time.

One thing I learned is that most of the medical professionals I saw didn’t give any real advice for daily care or healthy routines aside from moisturizing and avoiding irritants. There were a lot of home remedies prescribed, and intense steroids, but nothing about how to wash my skin, how to repair the long-term damage, or how to bring the skin up to a manageable baseline. Not until later did I understand that a daily routine of gentle cleansing and layering all of my topicals could do me wonders and reduce the need to be reactive in my treatment.

What are some of your triggers? What do you have to avoid?

Most everything is a trigger, especially the standard allergies of house pets, grass, trees, dust, dust mites, and tons of other environmental factors. Humidity and heat are extremely problematic since I tend to overheat easily, sweat a lot, and itch profusely as a result. I have trouble with anything but 100% cotton clothes, and even some specific sorts of cotton weaves, since some levels of softness, or sheen, tend to feel very uncomfortable. I avoid harsh laundry detergents, dryer sheets, cologne, and other additives to fabrics.

Water can also be extremely problematic depending on what’s coming out of the shower head. Hard water absolutely destroys me, and requires me to use at least 30% more topical medications/moisturizers when I’m somewhere water isn’t soft. I avoid any chlorinated water, from pools to waterparks. The only way I can go to a pool is if it uses Baquacil, a water treatment that uses bisbiguanides and peroxide rather than chlorine. Saltwater can sometimes still irritate me, but it’s been the most cooperative of any water. I’ve used pools which use salinated water and getting into the ocean isn’t really a problem as long as I have some moisturizer on hand after I get out.

Stress is also a problem. I’ve had a general heightened level of anxiety my whole life and the onset of agitation, frustration, or panic can cause my skin to itch more than usual, drawing increased scratching.

What other things have you noticed as a result of eczema?

Cyst-like acne tends to be a common problem since I’ve used corticosteroids most of my life. This has left me with an increased risk for skin infection and caused other more long-term deficiencies in my skin, which need time to be repaired. Staph infections, at least in a minimal sense, can be common, especially with my facial pores. My forehead, neck, and nose can also pretty easily develop very deep, not-quite-pimples which take a while to either form a head or decrease in severity. Thinned skin and excessive topical steroid use also tends to leave my pores fairly clogged which creates a sort of paradox. I need to keep my face clean to avoid infection, but I need the topicals to keep my skin properly moist. However, those topicals seem to clog my pores and can create issues with blackheads, hardened oil, and irritated hair follicles.

I was exposed to cold sores early in life and therefore have the herpes virus hanging around my system until I die. Since physically touching a sore can make it possible to transplant the virus somewhere else on the skin, there is pretty much nowhere on my face (aside from my forehead) where a cold sore can’t pop up. I have pretty hefty medications that can deal with it, but it is still a nuisance and something I have to be extremely careful with when an outbreak occurs.

Shaving can be difficult, as shaving too close too often will create irritation and sometimes cuts, but having facial hair too long can cause a different sort of irritation. I mainly shave with a trimmer that touches the skin rather than an electric razer.

What has helped you the most?

A daily gentle cleansing routine in the morning and especially at night have done wonders. Going to bed having cleaned my face and applying 3 layers of topicals sets me up to not wake up completely dried out and lets my skin heal overnight. Using an even gentler cleansing routine when I wake up ensures I’m not stripping away moisture I’ve regained from the night. Adhering to the morning and night cleansing/application makes me need to use topical steroids less and makes me less prone to the acne-like symptoms.

The introduction of a daily bleach bath in a bottle with CLn has made the act of disinfecting my skin much easier. Sometimes it’s hard to see what inflamation is a result of eczema or bacteria. Using the CLn has taken a lot of the bacteria out of the question.

What would you tell someone living with the disease currently?

Daily gentle cleansing and moisture are a must. Specifically, cleansing with something that will actually reduce bacteria but in a way that’s not stripping/damaging to the skin. Quickly following up with not only a moisturizer, but something which can lock in topicals and promote healing goes a long way to making the day-to-day less miserable. It’s all about finding a balance where healing is part of the equation. Giving the skin more time to heal, and lessening the prevalence of micro-cracks, abrasion, and lesions will eliminate at least some need to be reactive with steroids.

Not using hot water is essential. While it can feel nice, gently bathing and washing is preferable to heat and scrubbing. You’re doing yourself a great deal of damage if you’re scrubbing, making up for a cleanser that’s sub-optimal for you. I currently feel that the cleanser should do it’s job just sitting on the skin, rather than having to be worked in too much.

Things can get easier over time, but if you’ve got something acute and atypical like me, routine is super important. With the right routine, you can be more comfortable over the long haul but you still have to maintain some level of vigilance. It’s not easy, but it can be manageable. You can do yourself a favor by keeping gentle, daily care of your skin’s cleanliness and moisture rather than having to nuke an area with steroids when something flares up.

In terms of treatments, what is next for you?

I’ve realized that I’m probably in about 80-90% control of my eczema at this point. I can always do better, but I’m probably as controlled as I can get with just topical treatments and cleansing.

I’m going to be trying Dupixent, which is a new injectable treatment for eczema. The allergist I’m seeing has high hopes for it, so if the absolutely terrible American health insurance system approves my prescription maybe I’ll get my miracle cure!

In addition to the new injectable, I’ll be getting allergy shots from the same allergist, who has identified that I’m still allergic to pretty much everything in life. This should go some way in making environmental triggers less potent and will hopefully have a splash effect on my asthma.

Aside from that, I’m going to continue to try new, proven products, especially ones which are mild, to improve my daily routine. I’ll get as far as I can with topicals and focus on getting my skin in a state where it can more effectively heal. After all, I’ve done a fair amount of abuse to it my whole life, it’s about time I give it a break.


Michael’s Routine

Michael has a pretty simple routine that is about killing the bacteria on the skin that exacerbates eczema, maintaining and preserving moisture, and ultimately repairing his skin barrier. He has to be very careful with most products and spot tests new products on his forearm prior to application on his face, and even then only applies to one portion of his forehead for a few days, eventually moving to half of his face, and then full face.

I’ve worked with him to find additional products that help him, but one of the biggest issues is that so many thick creams feel really sticky and thick on the skin. This makes adding another product that is by itself sticky and thick, like a sunscreen, difficult. He has had good luck with my sunscreen (CoTZ Sensitive SPF 40 with 20% Zinc Oxide), and I feel like it soothes his eczema, but he still does not wear sunscreen regularly as much as he simply avoids the sun, only using sunscreen when we go out for long periods of time, such as Disneyland or the beach.


Cleansing

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CLn Body Wash, CeraVe Hydrating Facial Cleanser. Not pictured: CeraVe Hydrating Body Wash.

CLn Body Wash

WATER (Aqua), SODIUM LAURETH SULFATE, COCAMIDOPROPYL BETAINE, COCAMIDE MEA, DISODIUM EDTA, SODIUM HYPOCHLORITE.

I found CLn Body Wash for Michael while looking for more comfortable solutions for bleach bathing. It is essentially a bleach bath in a bottle, which is much more comfortable for a majority of people than soaking in a warm bath for twenty minutes. In studies, it was shown to be as effective as bleach baths and significantly easier to use. [1] Best part: it is easily purchased on Amazon.

It is also recommended for use with follicullitis or acne, though neither of us can speak to the efficacy of it for these conditions.

Michael has credited CLn with virtually clearing his skin of eczema and has made a huge difference for him since he began using it a year or so ago. I cannot understate how valuable it has been for him. It simply works.

To use, he adds some to his hands and works it over his body gently (sans legs — he notes that it dries out his legs, so he uses CeraVe in those locations). To get his back, he uses a sponge on a stick. He lets it sit while focusing on other areas, such as inside of his ears, and then rinses it away after a minute or so. He uses it every shower and at night time on his face.

CeraVe Hydrating Facial Cleanser

Purified Water, Glycerin, Behentrimonium Methosulfate, Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Polyoxyl 40 Stearate, Glyceryl Monostearate, Stearyl Alcohol, Polysorbate 20, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Cetyl Alcohol, Disodium EDTA, Phytosphingosine, Methylparaben, Propylparaben, Carbomer, Xanthan Gum.

A creamy cleansing staple, CeraVe Hydrating is what Michael uses on his legs and on his face every AM. It is creamy (and extremely mild) enough to not dry him out, and is easy to obtain at every major grocery store or drugstore chain when we go out of town.

To use, he pumps a bit into damp hands and works it over his face gently, rinsing away with cool (almost cold) water.

CeraVe Hydrating Body Wash

Water, Cocamidopropyl Betaine, White Petrolatum, Lauric Acid, Sodium Cocoyl Glycinate, Glycerin, Glycine Soja (Soybean) Oil, Urea, Stearic Acid, Sodium Cocoyl Isethionate, Sodium Hydroxypropyl Starch Phosphate, Sodium Lauroamphoacetate, Sodium Methyl Cocoyl Taurate, Sodium Chloride, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Phenoxyethanol, Guar Hydroxypropyltrimonium Chloride, Sodium Hydroxide, Sodium PCA, Ophiopogon Japonicus Root Extract, Tetrasodium EDTA, Ethylhexylglycerin, Sodium Lauroyl Lactylate, Phytosphingosine, Cholesterol, Carbomer, Xanthan Gum.

A fairly new addition, Michael left this at his parent’s across country on a recent trip, and was incredibly heartbroken to discover it missing from his bag.

It is creamier and spreads a little easier for the body than the Hydrating Facial Cleanser.

When he has it, he uses it in place of the Hydrating Facial Cleanser on his legs.


Moisturizing and Treating

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Aveeno Daily Moisturizing Lotion, CeraVe Moisturizing Cream, CeraVe Healing Ointment, Triamcinolone .1% (prescription), Stratia Liquid Gold

Aveeno Daily Moisturizing Lotion

Active Ingredient: Dimethicone 1.25% Inactive Ingredients: Water, Glycerin, Distearyldimonium Chloride, Petrolatum, Isopropyl Palmitate, Cetyl Alcohol, Avena Sativa (Oat) Kernel Flour, Benzyl Alcohol, Sodium Chloride.

A staple in his routine since the beginning. This was the only real lotion around when Michael was diagnosed with eczema, and he has used it ever since. It is not quite moisturizing/sealing enough for his skin and must be used with other products to really be effective, but it is the base of his moisturizing routine every night due to it’s soothing oat.

To use, he applies it liberally to freshly cleansed skin after every shower, and first thing to dry skin every morning. It goes on both his face and his body. He isn’t shy about the amount, and frequently goes through a bottle of Aveeno every two or three weeks. It is also his go-to lotion during the day when he is feeling dry or itchy.

CeraVe Moisturizing Cream

Purified Water, Glycerin, Ceteareth-20 And Cetearyl Alcohol, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate And Cetearyl Alcohol, Cetyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide I, Hyaluronic Acid, Cholesterol, Petrolatum, Dimethicone, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Disodium EDTA, Phenoxyethanol, Methylparaben, Propylparaben, Phytosphingosine, Carbomer, Xanthan Gum.

CeraVe has become a staple in Michael’s routine since I met him. It is the second layer in his routine, and has done wonders to soothe, seal, and moisturize his skin in ways that Aveeno could not, most likely due to the inclusion of petrolatum versus dimethicone (remember: dimethicone acts as an occlusive to non-broken, non-irritated skin, but is water permeable, so it is not the most ideal of occlusives).

To use, he applies it liberally to his skin, after Aveeno, immediately after a shower and first thing to his skin every AM. It also goes on both his face and his body.

Triamcinolone .1%

1 mg of Triamcinolone Acetonide per gram in a base containing Emulsifying Wax, Cetyl Alcohol, Isopropyl Palmitate, Sorbitol Solution, Glycerin, Lactic Acid, Benzyl Alcohol and Purified Water.

Triamcinolone is Michael’s topical corticosteroid, which shares anti-inflammatory, anti pruritic (itch-inhibiting), and vasoconstrictive actions.[2]

Due to the severe nature of his eczema, he used to use it each day, sometimes twice a day. It has resulted in skin thinning, particularly around his joints (elbows and knees especially). Unfortunately, it is what works, and without it, the itching returns.

To use, he applies to bare skin, before Aveeno or CeraVe. He avoids using it on his face as much as possible, and due to the CLn, is able to use it only after showers instead of daily.

Stratia Liquid Gold

Water (Aqua), Propylene Glycol, Ethoxydiglycol, Niacinamide, Polyglyceryl-3 Methylglucose Distearate, Rosa Mosqueta (Rose) Hip Oil, Hippophae Rhamnoides (Sea Buckthorn) Seed Oil, Hippophae Rhamnoides (Sea Buckthorn) Fruit Oil, Panthenol, Dimethicone, Glycerin, Squalane (olive-derived), Cetyl Alcohol, Vaccinium Macrocarpon (Cranberry) Seed Oil, Tocopherol, Camellia Sinensis Leaf Extract, Ceramide NP, Ceramide AP, Ceramide EOP, Phytosphingosine, Cholesterol, Sodium Hyaluronate, Sodium Lauroyl Lactylate, Carbomer, Xanthan Gum, Diazolidinyl Urea, Methylparaben, Propylparaben, Disodium EDTA.

While he has only been using it for a couple of weeks, I can say for sure that Stratia has vastly improved his facial skin, particularly his inflammation.

Michael’s facial skin is particularly prone to inflammation around the edges, like next to his ears, or in his nasolabial area. Using Stratia Liquid Gold has soothed these areas, bringing his skin more in line with what is “normal.”


What His Routine Looks Like

AM:

  • Wash my face very gently with cool/lukewarm water.
  • Apply steroids only where there may be localized irritation, no widespread use.
  • (Face) Apply ample amounts of Aveeno.
  • (Face) Apply Stratia Liquid Gold.
  • (Face) Apply CeraVe cream.
  • Apply a light coat of Aveeno on the rest of my body, mainly on dryer areas like joints.

PM:

  • Wash my face gently with lukewarm water and CLn cleanser.
  • (Face) Apply ample amounts of Aveeno, followed by CeraVe creme, followed by CeraVe ointment.
  • Apply a light coat of a Aveeno on my back and some joints (I don’t like to go to bed too greasy).

After Shower Care:

  • Wash in lukewarm/warm water only, not spending too long in the shower.
  • CLn cleanser on my face, neck, upper body (light scrubbing on my back), and arms.
  • CeraVe body wash on my legs — they tend to get a little more dry after a shower.
  • Plain Dial soap in the armpits, crotch, butt, and feet for a slightly heavier clean.
  • T-Sal shampoo since I tend to get something akin to dandruff or light eczema on my scalp.
  • After the shower, application of triamcinolone cream only on problem spots, sometimes using a light coat on my face since I’ve just used CLn to disinfect.
  • Heavy amounts of Aveeno all over the body, followed by CeraVe cream all over and CeraVe ointment on my face and any problem spots.
  • Stand and let things soak in. I don’t get dressed immediately since that can scrape away the topicals. Also, I make sure I’m in loose-fitting cotton after soaking in a bit as to not lose any of the topicals.

 

Enormous thanks to Michael for lending his experience and time to making this post a possibility. <3

 


Sources:

  1. Novel Sodium Hypochlorite Cleanser Shows Clinical Response and Excellent Acceptability in the Treatment of Atopic Dermatitis
  2. TRIAMCINOLONE ACETONIDE
  3. Celiac Disease and Dermatologic Manifestations

 

 

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