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My Routine: June 2018

by Kristen
My Routine: June 2018

I’ve made some changes to my routine since I wrote my first routine post back in May, and I feel like my skin has been much better for it. Certainly I’ve tried some new products, which I will be reviewing in the coming days, but I have landed on something so simple and so bland that I never would have imagined it would work for me.

If you are curious about the plethora of ingredients I cannot use, want to know some back-story on my skin, or read mini-reviews (plus ingredients!) of each product, please check out my first routine post.


DSC_1641

Products

My routine has largely remained the same, but I’ve jostled products around, removed many, and added jojoba oil (Trader Joe’s brand, which was the cheapest I could find).

Product List

  • HadaLabo Goku-jyun Premium
    • Water, butylene glycol, glycerin, PPG-10 methyl glucose ether, hydroxyethyl urea, sodium acetylated hyaluronate (super hyaluronic acid), sodium hyaluronate, hydrolyzed hyaluronic acid (nano hyaluronic acid), hydroxypropyltrimonium hyaluronate (skin absorbent type hyaluronic acid), sodium hyaluronate crosspolymer (3D hyaluronic acid), aphanothece sacrum polysaccharide (sacrum), hydrogenated starch hydrolysate, glycosyl trehalose, diglycerin, sorbitol, pentylene glycol, triethyl citrate, carbomer, polyquaternium-51, PEG-32, PEG-75, ammonium acrylates crosspolymer, disodium EDTA, potassium hydroxide, diethoxyethyl succinate, disodium succinate, succinic acid, phenoxyethanol, methylparaben. 
  • Trader Joe’s Jojoba Oil
  • Trilogy Rosehip Oil
  • Clinique Take the Day Off Balm
    • Ethylhexyl Palmitate, Carthamus Tinctorius (Safflower) Seed Oil, Caprylic / Capric Triglyceride, Sorbeth-30 Tetraoleate, Polyethylene, PEG-5 Glyceryl Triisostearate, Water / Aqua / Eau, Tocopherol, Phenoxyethanol.
  • CoTZ Sensitive SPF 40 Broad Spectrum UVA-UVB
    • Active: Zinc Oxide 20% (Sunscreen). Inactive: C12-15 Alkyl Benzoate, Caprylhydroxamic Acid, Caprylyl Glycol, Cetyl PEG/PPG 10/1 Dimethicone, Cyclohexasiloxane, Cyclopentasiloxane, Dimethicone, Dimethicone Crosspolymer, Dimethicone/Vinyl Dimethicone Crosspolymer, Dimethiconol, Disodium EDTA, Glycerin, Methicone, Microcrystalline Wax, PEG-10 Dimethicone, PEG-30 Dipolyhydroxystearate, Polyglyceryl-4 Isostearate, Polyhydroxystearic Acid, Polysorbate 20, Sodium Chloride, Stearyl Dimethicone, Tetrahexadecyl Ascorbate, Triethanolamine, Triethoxycaprylylsilane, Water.
  • Finacea 15% Gel
  • Tretinoin .025% Gel

Cleanser

Since writing my last post, I’ve finished a tub of Clinique Take the Day Off Balm and re-purchased. It is my stand-by, my forever cleanser.

Since my skin is dry, I’ve begun only cleansing PM with this cleanser and one of the microfiber towels resting atop the HadaLabo that is pictured above. I wipe away most of the excess cleanser with the towel, but very lightly. This exfoliates my skin lightly, and doesn’t irritate me.

Moisturizer

Swapping out my Cheryl Lee MD Lotion for a simpler routine, I add 3-5 drops of Hada Labo Premium to my palm, along with 3-5 drops of jojoba oil and 2-3 drops of the Trilogy Rosehip Oil (which I am almost out of). I massage my hands together, which creates this lovely, slippery emulsion, and spread it across my face, down my neck, and across my chest. It’s lovely, hydrating, and doesn’t leave me as dry in the AM as when I was using traditional moisturizer or when I use do steps separately (example: applying the Hada Labo, then the oil).

I feel like the real game-changer for me in this was the addition of jojoba oil. I actually wasn’t sure if jojoba oil was going to work for me, but I picked up a bottle of it on one of my last Trader Joe’s visits and began slathering it on unapologetically. To my surprise and delight, my skin took to it immediately, looking less red and feeling softer, plumper, and less flaky.

I definitely owe a whole post to jojoba in the future. I’m a convert.

Sunscreen

Still the same ol’ same ol’ (CoTZ Sensitive SPF 40 Broad Spectrum UVA-UVB). I think I’m about halfway through this tube, and it is still one of my favorite sunscreens around, instantly soothing my skin.

It can settle into my fine lines, such as around my nose and the 11s on my forehead, but this isn’t a huge deterrent for me. It just means I need to make sure to make sure to wipe it away at night with a cleanser (especially since I’ve missed the creases of my nostrils before, which has created a build-up of dead skin and sebum).

Treatments

I am still using Finacea (15% Gel), possibly until the day I die, and have added tretinoin .025% gel every third or fourth day. I only apply it to my forehead and chin (my cheeks and rosacean areas are simply far too sensitive) so it is way too early to tell what benefit this has had on my skin, but this is absolutely the most I’ve ever been able to use it successfully, without breakouts or even excessive peeling.

What My Routine Looks Like

My routine is still heavily based around what my skin looks like or feels like. Since I started to include tretinoin back into my routine, I notice slightly more peeling, for instance, so I try to keep that in check.

AM

  • Mix HadaLabo Premium with Jojoba Oil and massage into face, down neck, and onto chest.
  • Apply sunscreen
  • Apply eye makeup
  • Follow with powder, face makeup, and then more powder to set.

PM

  • Work in Clinique Take the Day off Balm
  • Lightly wipe away with a makeup removing microfiber towel and rinse with cool water until water runs clear off of my face.
  • Mix HadaLabo Premium with Jojoba Oil and massage into face, down neck, and onto chest
  • Apply Finacea to flushed spots.
  • Apply tretinoin .025% to neck and chin area every third or fourth day.
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Visiting Riley Rose, Los Angeles

It wasn’t the first time I had visited Riley Rose. I had stumbled upon the place about a month earlier, when going for a facial appointment at Skin Laundry.

Initially, I walked right past the store, with it’s cheery pink neon sign and friendly cursive, discounting it as another Claire’s wanna-be. As I walked past it a second time, I noticed a Lime Crime display at the front, and thought to myself, “Wait, like the brand you can only buy online?”

I went in.

Visiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los Angeles

The center of the store is lined with well-lit vanities, and the cheery pink and white displays are lined with products from Internet cult-favorites, both makeup and skincare alike.

Lime Crime, Winky Lux, Sigma, CosRX, Banila Co., Tony Moly, Missha, and many more call the store it’s home. Each display has samples for you to try, and the multiple sitting spaces urge you to try on a new look with the products offered there.

Visiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los Angeles

Riley Rose, launched by the daughters of the Forever 21 founders, is a fun concept store for the savvy Internet beauty consumer. Not to be limited by skincare or makeup, it also offers shoppers a variety of haircare (both Asian beauty choices as well as western favorites) and lifestyle pick-ups, like headbands (I almost bought at least five pairs of cat-eared headbands), notebooks, pens, coffee mugs, and cute phone cases.

Visiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los Angeles

There is even a space for you to buy drinks and snacks, like green tea or Hi-Chews.

There’s a space near the back of the store that seems to be entirely dedicated to the 10-step Korean beauty routine, with suggestions for every skin type as well as beautifully displayed samples to use.

Visiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los Angeles

Whenever I visited, employees were passing out 20% off coupons for the Friends and Family sale, and it didn’t seem to have any limitations. Prices were on par to Amazon, if only a little higher, but you’re guaranteed authenticity and there are frequent coupons online, if that is where you prefer to shop.

Visiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los AngelesVisiting Riley Rose, Los Angeles

Overall, Riley Rose is a really fun experience if you’re a skincare fanatic, and akin to Disneyland if you use mostly Asian beauty products.

You can find Riley Rose online or in-person at the Glendale Galleria in Los Angeles.

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Rosacea: The Curse of the Celts

Rosacea is a frustrating skin condition. Despite how long I’ve knowingly had the condition, I’ve struggled with it. Some days are good days, and some days are not so good. There’s rarely a single reason I can pinpoint for the bad days, and at times my skin can flare from occurrences so benign that they don’t even deserve a note.

This seems to be the universal problem with rosacea. It is confounding, chronic, and difficult to treat. There is no universal treatment, and for some, the recommended cures can turn into the cause.

Compounding that is the fact that rosacea frequently looks like other skin conditions, such as acne, and the prescriptions for acne can also aggravate the rosacea, undoing any benefits. To make matters worse, rosacea is frequently misdiagnosed and under-treated, leaving sufferers with worsening symptoms that are difficult to reverse.

My mom had always battled with it, and for decades she was misdiagnosed with acne. By the time she was properly diagnosed with rosacea (subtype 2), she had suffered from broken capillaries and flushing that was difficult to cover with make-up, as well as frustrating breakouts that did not respond to typical acne treatments.

Her story is one that is pretty common with rosacea-sufferers. It’s frustrating, painful, and sometimes just embarrassing.

As I was researching for this article, I uncovered so much that challenged my initial ideas around rosacea. It is without a doubt that skincare and lifestyle habits are the most important things for rosaceans, and hopefully, once you’re done with this post, you will be left with answers to some of the questions you started with.


The Curse of the Celts

Rosacea afflicts nearly 30-50% of the Caucasian population, particularly those of European descent. In one genome-wide study conducted in 22,952 individuals whose genomes were >97% European ancestry, they found that 2,618 individuals answered “yes” to whether they had been diagnosed with rosacea (roughly 9%). This was consistent with the population data of European countries, where the prevalence of rosacea has been reported as affecting upwards of 10% of the population¹. This link has earned it the nickname of “the Curse of the Celts.”

It is most common in women, but frequently the most severe in men. It also tends to run in families, and researchers have discovered two genetic variants that may be associated with the disorder.

According to the National Rosacea Society, nearly 90% of rosacea patients say the condition lowers their self-confidence and self-esteem, and 41% report it causing them to avoid public contact or social engagements. For patients with severe rosacea, nearly 88% said their condition negatively affected their professional interacts, and nearly 51% missed work due to the condition.²


The Subtypes of Rosacea, Defined

The National Rosacea Society Expert Committee has identified four major types of rosacea, though subtypes 1-2 are the primary major subtypes that can be accompanied by symptoms in subtypes 3-4.

The two primary subtypes of rosacea (1-2) are Erythematotelangiectatic Rosacea (ETR) and Papulopustular Rosacea (PPR). The common link between all types of rosacea is the constant blush or flush — called erythema — that remains present in the central portions of the face. It is the other symptoms, such as flushing, papules or pustules, ocular symptoms, phymatous changes, and telagiectasias, that determine the subtypes.

rosacea-forms

Subtype 1 ( Erythematotelangiectatic or ETR)

Facial-redness-cropped

Subtype 1 (ETR)

ETR presents as erythema with some visible blood vessels (telangiectasias). It has an abscense of papules, pustules, or nodules. ETR patients report a flush that lasts longer than 10 minutes, and usually involves the center-most part of the face, but can also involve the peripheral regions. The episodes can occur from emotional stress, spicy foods, hot baths and showers, hot weather, or with no cause at all. People with ETR frequently describe themselves as extremely sensitive and dry, sometimes accompanied by tightness, itching, and burning or stinging, even with topicals meant to soothe discomfort and redness.

Subtype 2 (Papulopustular or PPR)Bumps-and-pimples-cropped

Formerly “acne rosacea,” PPR presents with erythema (the common link between all types of rosacea) and can also display visible blood vessels. It is accompanied by papules and pustules, and sometimes swelling (edema) can occur, particularly in the cheeks. It can be dry, scaly, and even itchy, but not respond to heavy moisturizers or creams. A history of flushing and irritation from external stimuli can occur in PPR patients, but the symptoms are usually much milder than ETR patients and are generally less common. Due to the presence of papules and pustules, it is frequently misdiagnosed as rosacea, but generally responds very little to conventional acne treatments, and can sometimes worsen.

TABLE 1. Findings in patients with Subtype 2 Rosacea prior to treatment. ¹ n=patients
CHARACTERISTICS GROUP 1 (n=457) GROUP 2 (n=127) GROUP 3 (n=331)
Skin Dryness 65% 66% 69%
Scaling 51% 58% 57%
Itching 49% 51% 52%
Edema (Swelling) 36% 32% 38%
Burning 34% 33% 36%
Stinging 29% 34% 29%
Discomfort 17% 14% 21%

Patients with both ETR and PPR report hyper-reactivity to skin products (82% in a survey by the National Rosacea Society), even those meant for sensitive skin types, and UV (sun) exposure plays a large role in both conditions, but especially for patients with ETR.

rosacea-telangiectasia

Visible veining (telangiectasias)

Disruption of the skin barrier (the stratum corneum permeability barrier) plays a large part in rosacea, and all rosacean patients experience increased trans-epidermal water-loss (TEWL), particularly in the areas of the face most effected, such as the cheeks and along the sides of the nose. This disruption plays a large part in why rosacean skin is so hyper-reactive. In a study involving 7 ETR patients and 25 PPR patients, 100% of ETR patients responded positively to a “sting test” (discomfort, flush, stinging sensations) of 5% lactic acid, while 68% PPR patients responded potively. Only 19% of the control group responded in the same manner.

Subtype 3 (Phymatous)Skin-thickening-cropped

Subtype 3 is defined by thickening of the skin, enlarged pores, and surface nodules. It oten presents with bulbous nose (rhinophyma), lumpy, swollen areas (particularly in the cheeks). It can occur in women, but is most prevalent in men. In the past, it was confused for alcohol abuse (the “gin blossom”). In 50% of cases, it can cause irritated, bloodshot eyes, which is associated with subtype 4.

Rosacea: The Curse of the CeltsRosacea: The Curse of the Celts

Subtype 4 (Ocular)

Ocular-Rosacea4

Ocular rosacea with PPR

The white part of the eye (sclera) has persistent burning, grittiness, dryness, discomfort, and visible blood vessels. Sties are common in sufferers of ocular rosacea. Inflammation of the eyelid is also common, and pink eye (conjunctivitis) can be recurring. Eye makeup can become painful and increase the symptoms.


Causes of Rosacea

There is a lot of debate around what causes rosacea, and nothing is for certain. Researchers have discovered two genetic variants that may be associated with the disorder, and fairly recent research suggests that the facial redness is likely the start of an “inflammatory continuum initiated by a combination of neurovascular dysregulation and the innate immune system.”² Beyond this, mites have also been considered a contributing factor to the condition (particularly the demodex folliculorum mite). While this mite is present on all people’s skin, it was found to be even more abundant in the facial skin of rosaceans.


Other Considerations

Rosacea is frequently accompanied by other conditions. In a study across 6 million people (nearly 83,500 with rosacea), aged 18 and above, researchers in Denmark found that people with rosacea seem to be at higher risk for dementia, particularly Alzheimer’s, compared to people without the disease³. It has also been linked to a progressive form of  hair loss in women.⁴  As if this isn’t bad enough, according to the National Rosacea Society, 26% of patients reported seborrheic dermatitis (SD) of the face, and 28% had SD of the scalp⁵.

Rosacea is also a highly inflammatory disease, and some patients may see mild to moderate improvement by adopting a healthier lifestyle that reduces inflammation in the body, such as eating probiotic rich foods (particularly ferments) and turmeric and ginger.

Smoking, drinking, and eating too much sugar can all cause inflammation in the body. Additionally, one study found that women taking birth control pills are at an increased risk of developing rosacea⁶.

Caring for Rosacea

The most important thing you can do if you have rosacea or think you have rosacea is visit a dermatologist, particularly one that specializes in rosacea (the National Rosacea Society has a physician finder to help get you started). There are many treatments that can create immense improvement. If you lack insurance and live in the US, Curology, an online dermatology service, is an option.

Beyond that, there is no magic bullet, but skincare (particularly cleansers, moisturizers, and sunscreen) seems to be the most important. Everyone’s skin is very different, and rosacean skin is especially individual.

TABLE 2. Skin care products and skin sensitivity in rosacea. Female respondents. n=patients
PRODUCT % (n=1,023)
Astringents and Toners 49.5%
Soap 40%
Makeup 29%
Perfume 27%
Moisturizers 25.5%
Hairspray 20%
Shampoo 12%
TABLE 3. Skin care products and skin sensitivity in rosacea. Male respondents. n=patients
PRODUCT % (n=1,023)
Soap 24%
Cologne 19%
Shaving lotion 24%
Sunscreen 13%
Shampoo 12%

Cleansers

One of the key parts to success when treating rosacea is the skincare routine you build for yourself, particularly gentle routines that do not further aggravate or inflame the skin. The cleanser is what you build the foundation of the rest of a skincare routine upon. I wrote a long post about cleansers that I encourage you to read, and indeed, all of the same rules apply.

Rosacean skin is particularly prone to being stripped, with “true” soaps (saponified soaps) being the worst, as they have a pH of 9 to 10. True soaps are excellent at removing dirt and debris, but in the process they strip the lipids of the skin, causing increased TWEL, dehydration, altered desquamation (shedding), and increased penetration of topically implied substances.

Syndet cleansers (or synthetic detergent cleansers) are usually less than 10% soap and have a more neutral to acidic pH (5.5 to 7), which makes them minimally stripping. They’re made from oils, fats, or petroleum, but are not processed like true soap. These are the gentle cleansers of old, before creamy cleansers were so widely available. These are recommended if you are unable to use creamy cleansers.

In one experiment on arm skin, the ultra-structural skin changes were monitored after washing with a true soap as well as a mild syndet bar. Electron microscopy revealed changes in the skin structure, including uplifting of cells and an increase in surface roughness after washing with true soap. In contrast, the syndet-washed skin had well-preserved proteins and lipids. Some examples of syndet cleansers recommended for rosacea:

Aveeno Moisturizing Bar

Ingredients: Oat Flour Avena Sativa, Cetearyl Alcohol, Stearic Acid, Sodium Cocoyl Isethionate, Water, Disodium Lauryl Sulfosuccinate, Glycerin, Hydrogenated Vegetable Oil, Titanium Dioxide, Citric Acid, Sodium Trideceth Sulfate, Hydrogenated Castor Oil.

Dove Sensitive Skin Unscented Beauty Bar

Ingredients: Sodium Lauroyl Isethionate, Stearic Acid, Sodium Tallowate, Sodium Palmitate, Lauric Acid, Sodium Isethionate, Water, Sodium Stearate, Cocamidopropyl Betaine, Sodium Cocoate, Sodium Palm Kernelate, Sodium Chloride, Tetrasodium EDTA, Tetrasodium Etidronate, Maltol, Titanium Dioxide (CI 77891).

Combination bars are another type of cleanser and are typically antibacterial soaps that are quite literally a combination of true soap, syndet, and antibacterial agent. This gives them a pH of 9 to 10. They are not recommended for rosacean skin due to their propensity to strip skin of essential flora.

Lipid-free cleansers are what most of us are familiar with. These are the liquid, creamy cleansers that cleanse without soap formations and are designed to leave moisture in the skin. They are some of the most studied cleansers with rosacean patients, and also some of the most recommended. Examples of lipid-free cleansers recommended for rosacea:

Aquanil

Ingredients: Water (Purified), Glycerin, Cetearyl Alcohol, Stearyl Alcohol, Benzyl Alcohol, Sodium Laureth Sulfate, Xanthan Gum.

CeraVe Hydrating Cleanser

Ingredients: Purified Water, Glycerin, Behentrimonium Methosulfate And Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide I, 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.

Moisturizers

Hydration is integral to the function of skin in all people, but is very important in rosaceans, who have impaired skin barrier function and increased TEWL, regardless of subtype. I’ve written a full post about the classes of moisturizers, which you can find here.

Occlusive ingredients are very important for this reason. Examples include petrolatum, mineral oil, caprylic/capric triglycerides, silicones (such as dimethicone), lanolin, ceatyl alcohol, and stearyl alcohol. Unfortunately, while petrolatum can reduce water loss up to 98%¹, it can also diffuse into the intercellular lipid domain of the skin, interfering with barrier recovery. This may make it a poor choice for patients with ETR and PPR¹.

Note: This was new information to me and very surprising, as petrolatum is recommended for virtually all skin with impaired barrier function virtually everywhere in skincare communities, and I use it myself. I’ve done some additional digging and it seems like studies are mixed. There are a fair number of studies that cite that petrolatum products (specifically Vaseline) do not interfere with barrier recovery, while others dispute that occlusive-only coverings (such as Vaseline only as opposed to a product with petrolatum mixed in) are the problem, not petrolatum itself. 

Lanolin is also not recommended for rosaceans due to inducing allergic or irritant reactions. Another ingredient to look out for is propylene glycol, which can pose issues for hyper-sensitive skin, even in very low concentrations (<2%).

The benefits outweigh the downsides though, and rosaceans are encouraged to experiment with products until they find one that works.

While not inherently harmful, stearic acid and palmitic acid are some other ingredients commonly found in moisturizers that have the most potential to interact with skin lipids, and thus create reactions in rosacean skin.

Menthol, alcohol, acetone, sodium lauryl sulfate, benzalkonium chloride, benzyl alcohol, camphor, urea, and fragrance (parfum) are all common skin irritants for rosacea.

In general, rosaceans are encouraged to use products containing lipid-restoring ingredients, such as cholesterol and ceramides. Examples of recommended products:

CeraVe Daily Moisturizing Lotion

Ingredients: Purified Water, Glycerin, Caprylic/Capric Triglyceride, Behentrimonium Methosulfate and Cetearyl Alcohol, Ceteareth-20 and Cetearyl Alcohol, Ceramide 3, Ceramide 6-II, Ceramide 1, Hyaluronic Acid, Cholesterol, Dimethicone, Polysorbate 20, Polyglyceryl-3 Diisostearate, Potassium Phosphate, Dipotassium Phosphate, Sodium Lauroyl Lactylate, Cetyl Alcohol, Disodium EDTA, Phytosphingosine, Methylparaben, Propylparaben, Carbomer, Xanthan Gum

Paula’s Choice MOISTURE BOOST Hydrating Treatment Cream

Ingredients: Water (Aqua), Ethylhexyl Stearate (texture enhancer), Simmondsia Chinensis (Jojoba) Seed Oil (emollient plant oil), Butylene Glycol (texture enhancer), Glycerin (skin-replenishing ingredient), Petrolatum (emollient), Cetearyl Alcohol, Dipentaerythrityl Hexacaprylate/ Hexacaprate, Tridecyl Trimellitate (texture enhancers), Sodium Hyaluronate, Ceramide 3, Cholesterol (skin-replenishing ingredients),Tocopherol (Vitamin E/antioxidant) Squalane (emollient), Magnesium Ascorbyl Phosphate (stabilized Vitamin C/antioxidant), Dimethicone (texture enhancer), Niacinamide (Vitamin B3/skin-restoring ingredient) Polysorbate 60 (texture enhancer), Hydrolyzed Jojoba Protein, Hydrolyzed Wheat Protein (skin conditioning agents), Avena Sativa (Oat) Kernel Extract (soothing agent), Hydrogenated Lecithin (skin-restoring ingredient), Whey Protein (water-binding agent), Tridecyl Stearate, Neopentyl Glycol Dicaprylate/Dicaprate, Phenyl Trimethicone, Myristyl Myristate (texture enhancers), Linoleic Acid, Linolenic Acid, Decarboxy Carnosine HCI (skin-restoring ingredients), Hydroxyethyl Acrylate/Sodium Acryloyldimethyl Taurate Copolymer, Acrylates/C10-30 Alkyl Acrylate Crosspolymer (texture enhancers/water-binding agents),Cetearyl Glucoside, Cetyl Alcohol, Polyglyceryl-3 Beeswax (texture enhancers/emollients), Aminomethyl Propanol (pH-adjustor), Disodium EDTA (chelating agent), Benzoic Acid, Chlorphenesin, Sorbic Acid, Phenoxyethanol (all preservatives).

In short, avoid harsh skin care regimes that contain astringent (stripping) toners, abrasives (such as washclothes or cleansing tools like the Clarisonic), and sensory stimulants (menthol, camphor, and other things that “tingle”).

This proper care and grooming preps the skin for treatments. One study I read literally called it “priming the skin.” This is because once set into motion, the inflammatory reaction of rosacea is a domino effect that makes any topicals (either prescription treatments or basic skincare) even more challenging. Rosacean skin is incredibly delicate, and even once seemingly under control, the dominoes can begin to fall once you add products that were once too irritating.

For example, when I first began treating my rosacea, I could not use anything outside of my basic moisturizer. Years into treatment, I have begun to experiment. Every now and then though, I get cocky and try to introduce something to my routine too quickly after playing with harsher products, such as when I tried to use ialuset so shortly after using a BHA. My skin lit up and felt like it was on fire.

This is common with rosacea, and is called “status cosmeticus” (cosmetic intolerance syndrome).

Priming the skin — aka giving it time to rest and recover — mitigates the risk of this occurring.

When skin is this flared up, it is recommended to wait before applying even the most bland of moisturizers. In some cases, delaying up to 30 minutes may be necessary. This reduces risk of irritation. Once tolerability improves, you can reduce the wait time by 5 minutes per week until you are able to moisturize right after cleansing.

Sunscreens

Sun exposure plays a large part in the erythema of rosacea, particularly in ETR, and was cited as the number one trigger for redness and flushing by the NRS. For this reason, it is incredibly important to wear sunscreen or a hat daily. I’ve done a larger post on sunscreens that you can read here.

In general, zinc oxide sunscreens seem to do well with rosaceans due to the soothing effects of the zinc. Zinc oxide can be a bit drying though, so wear a moisturizer underneath if it feels uncomfortable.

Organic sunscreens (chemical filters) may cause stinging and irritation, particularly if the skin is more sensitized or irritable.

Prescription Topicals

Prescription topicals have become more and more common for treating rosacea, especially when considering the growing prevalence of antibiotic resistance (though some oral medications, like Oracea, have shown promise due to the lower prescribing level it is prescribed at, and is typically prescribed in combination with topicals for treating PPR).

Metronidazole

Metronidazole is known under the brand names MetroGel, MetroLotion, and MetroCream. It has been well-studied and has impressive results at killing some of the microbes that are considered responsible for rosacea.

Azelaic Acid

Approved by the FDA in 2002, azelaic acid (AzA, brand names Finacea and Azelex) is usually prescribed to treat mild to moderate ETR or PPR in concentrations of 15-20%. It is a dicarboxylic acid, and usually sits at a higher range of the pH scale (4.8-5). This is potentially what makes it less irritating.⁷ In one study, it was shown to be potentially as effective as metronidazole, but tolerated much better by patients.

It should also be noted that in another study involving AzA (15%), waiting until after moisturizing to apply AzA resulted in greater penetration of the AzA. This did not occur with all moisturizers however, and was only seen in moisturizers that lacked large amounts of occlusives.

It should also be noted that in a small study, gluconolactone (PHA) was shown to be helpful when combined with Azelaic Acid 15%.

Azelaic acid can be found in some over-the-counter products and in mixtures from Curology (US only, 4%+).

Oxymetazoline Hydrochloride

Oxymetazoline hydrochloride (brand name Rhofade) is an extremely new topical for treating the redness that is characteristic of rosacea. The mechanism of action is vasoconstriction — quite literally meaning it constricts the blood vessels involved in rosacea. You may recognize a different form of oxymetazoline from nasal sprays, such as Afrin.

Oxymetazoline hydrochloride was approved for topical use by the FDA in January 2017 and became available for prescription in May 2017. Unfortunately, it’s so new that I can’t find a ton of literature on it that wasn’t part of the initial literature and studies submitted to the FDA for approval.

However, according to the last study submitted by the parent company (Allergan) to the FDA for approval: “The FDA’s approval was based on data from two identical randomized, double-blind, parallel-group, vehicle-controlled studies involving a total of 885 patients with moderate or severe disease who were treated with oxymetazoline cream or vehicle. In study 1, the proportions of patients with reduced erythema at hours 3, 6, 9, and 12 on day 29 were 12%, 16%, 18%, and 15%, respectively, for oxymetazoline cream (n = 222) compared with 6%, 8%, 6%, and 6% for vehicle (n = 218). In study 2, the corresponding values were 14%, 13%, 16%, and 12% for oxymetazoline cream (n = 224) compared with 7%, 5%, 9%, and 6% for vehicle (n = 221).”¹¹

Brimonidine Gel

Approved by the FDA in 2013, Brimonidine gel (brand name Mirvaso) was one of the first topicals approved for vasoconstriction.

Unfortunately, it can cause severe rebound erythema if it does not do well with you.

Retinoids and Adapalene

For sufferers of PPR, tretinoin (such as brand names Renova and Retin-A) as well as adapalene (brand name Differin) may be an option. In a small study of 25 patients with mild to severe PPR who were treated with .05% tretinoin, 80% had complete or excellent resolution of their papules and pustules, with only one patient showing no improvement. In 40% of patients, it also resulted in a resolution of their visible blood vessels.¹² It is thought that tretinoin’s ability to suppress inflammation may be a factor in this.¹³

In some patients with rosacea, tretinoin may be very difficult to incorporate into their routine due to the irritation that tretinoin can cause. For these people, adapalene (Differin) may be a gentler option.

Other Combinations

Some doctors can also prescribe combination ingredients that may be more commonplace for acne sufferers, but can work in some PPR. These combinations usually include benzoyl peroxide (BP) and erythromycin.

Other Ingredients

Niacinamide

There have also been small studies that show the benefits of niacinamide in PPR⁸, though anecdotal evidence seems to be that the higher the percentage of niacinamide, the greater chance of reactivity. You can find niacinamide serums that are made to be added into products. Some examples:

The Ordinary Niacinamide 10% + Zinc 1%

Ingredients: Aqua (Water), Niacinamide, Pentylene Glycol, Zinc PCA, Dimethyl Isosorbide, Tamarindus Indica Seed Gum, Xanthan gum, Isoceteth-20, Ethoxydiglycol, Phenoxyethanol, Chlorphenesin.

Paula’s Choice 10% Niacinamide Booster

Ingredients: Water (Aqua), Niacinamide (vitamin B3, skin-restoring ), Acetyl Glucosamine (skin replenishing/antioxidant), Ascorbyl Glucoside (vitamin C/antioxidant), Butylene Glycol (hydration), Phospholipids (skin replenishing), Sodium Hyaluronate (hydration/skin replenishing), Allantoin (skin-soothing), Boerhavia Diffusa Root Extract (skin-soothing), Glycerin (hydration/skin replenishing), Dipotassium Glycyrrhizate (skin-soothing), Glycyrrhiza Glabra Root Extract (licorice extract/skin-soothing), Ubiquinone (antioxidant), Epigallocatechin Gallate (antioxidant), Beta-Glucan (skin-soothing/antioxidant), Panthenol (skin replenishing), Carnosine (antioxidant), Genistein (antioxidant), Citric Acid (pH balancing), Sodium Citrate (pH balancing), Sodium Hydroxide (pH balancing), Xanthan Gum (texture-enhancing), Disodium EDTA (stabilizer), Ethylhexylglycerin (preservative), Phenoxyethanol (preservative).

Vitamin C

In my experience, vitamin C – a powerful antioxidant – may also prove to be tricky for rosaceans. I’ve never been able to successfully use vitamin C for long periods on my skin, though some rosaceans may find success with it.

There are many derivatives of vitamin C. Refer to table 5 below.

TABLE 5. Derivatives of Vitamin C
Sodium Ascorbyl Phosphate
THD
Ascorbyl Glucoside
Magnesium Ascorbyl Phosphate
Ethylated L-Ascorbic Acid
L-Ascorbic Acid

L-Ascrobic Acid (L-AA) and Ethylated L-Ascorbic Acid (EL-AA) are the most irritating forms of vitamin C. Magnesium Ascorbyl Phosphate is typically considered the most gentle and recommended for sensitive skin types.

Salicylic Acid

Salicylic acid (BHA) is usually recommended to rosaceans over AHA due to it’s anti-inflammatory properties (it is related to asprin and both are salicylates). This means that it can reduce redness and swelling. Conclusive evidence of it’s efficacy with rosacea is lacking, but it can work for some. When shopping for a product, you’ll want to find a BHA product without alcohol or menthol.

Natural Oils

In anecdotal cases, natural plant oil can benefit rosacean skin, particularly rosacean skin that is troubled by many moisturizer ingredients.

In my case, I do better with oils that are high in linoleic acid and low in oleic acid. Knowing how your skin does with one oil may guide you in choosing the next. Refer to table 6 below for more information on linoleic vs oleic content in common oils.

TABLE 6. Linoleic vs Oleic Content in Common Skincare Oils
OIL LINOLEIC % OLEIC %
Mineral Oil 0 0
Grapeseed 73 16
Flaxseed 67 20
Sunflower 62 25
Hemp 55 11
Rosehip 48 14
Sesame 42 42
Rice Bran 39 43
Argan 37 43
Apricot Oil 29 58
Sweet Almond 24 62
Hazelnut 12 79
Neem 10 40
Olive 10 70
Coconut 2 60
Jojoba 0 10

Licorice

Licorice root and licorice extract are both considered skin brighteners due to their ability to inhibit or slow melanin synthesis, but it can also be very soothing and anti-inflammatory.

Green Tea

Green tea (Camellia Sinensis Polyphenol) is an increasingly common anti-inflammatory and soothing ingredient. It stars in many anti-inflammatory serums and moisturizers, such as the Replenix Power of Three products.

Snail Mucin Extract

Collected from happy snails (snails are not harmed for the collection of their mucus and are usually fed diets of organic greens), purified snail mucus is more common in Asian beauty products, but has already shown promise for wound healing and may have anti-inflammatory properties for some people. It is the star in many KBeauty favorites, such as CosRX Snail Mucin Extract. Not all rosaceans respond to snail mucin extract, but some (particularly with PPR) find it to be nearly magical.

Propolis

Another rising star in the Asian beauty world, propolis or “bee glue” is a mixture of bee saliva and beeswax. It can be very soothing and similarly to honey, anti-bacterial.

Aloe Vera

Aloe is renown for its ability to soothe and heal. It is found (at least in part) in every post-sun product you can get your hands on, and may have been recommended to you by a family member to slather on a wound, directly out of the stem of the plant. It can be extremely soothing to both ETR and PPR rosacea. It also may contain some humectant (water-binding) qualities and helps with wound healing.

Tranexamic Acid

While I do not know much about tranexamic acid, in a small study of 30 rosacean patients over two weeks, involving 3% tranexamic acid, it was shown to improve the skin barrier.⁹ According to Paula’s Choice ingredient dictionary, tranexamic acid is a “synthetic amino acid that functions as a skin-conditioning agent and astringent. Research has shown that amounts of 3% can work as well as gold standard skin-lightening ingredient hydroquinone for discolorations; however, hydroquinone has considerably more research attesting to its effectiveness. Other research has looked at skin improvements from tranexamic acid via administration by microneedling.”¹⁰ It seems to be more common in Asian beauty products, such as UNT EX WHITE LASERWAVE (also contains mandelic acid, a mild hydroxy acid).

Hydroxy Acids (Glycolic, Lactic, Mandelic)

Hydroxy acids are tricky for rosacea. In virtually every study I read, lactic acid preparations in 5-10% were used for sting tests in rosaceans (from above: In a study involving 7 ETR patients and 25 PPR patients, 100% of ETR patients responded positively to a “sting test” (discomfort, flush, stinging sensations) of 5% lactic acid, while 68% PPR patients responded potively. Only 19% of the control group responded in the same manner). The permeability barrier dysfunction, characterized by an increase in TWEL, is an integral feature of rosacea and would explain why hydroxy acids are so tricky for rosaceans.

Mandelic acid seems to be the acid of choice for most rosaceans who can use hydroxy acid at all, but only once skin has stabilized over the course of a couple of months and not immediately following other treatments. If you find that you cannot use hydroxy acids at all without redness and discomfort, you are not the only one.


Laser and Light Treatments

While it is one of the more expensive ways to treat rosacea, it can be highly effective and very helpful for stubborn cases.

The most common laser and light treatments for rosacea are pulsed dye lasers (PDL) and light-emitting devices (IPL or Intense Pulsed Light), though CO2 lasers are used for thickened skin.

While not a laser, IPL helps to break down the structures in the skin that cause redness. The output is broad spectrum, and can be modified.

PDL is more intense, and aims light at blood vessels beneath the skin. This light is then converted to heat, absorbed by abnormal vessels, which destroys the vessels without damaging the surrounding skin. This can cause bruising, and is usually recommended for severe cases.


Hopefully this post has been helpful to many people. Do you have rosacea? Let me know what has helped you in the comments below!

Sources

  1. A Guide to the Ingredients and Potential Benefits of Over-the-Counter Cleansers and Moisturizers for Rosacea Patients
  2. NRS – All About Rosacea
  3. Alzheimer’s risk higher in people with rosacea
  4. Study Finds Potential Link between Hair Loss and Rosacea
  5. NRS – Seborrheic Dermatitis
  6. Reproductive and hormonal factors and risk of rosacea in US women
  7. Disruption of the transmembrane pH gradient–a possible mechanism for the antibacterial action of azelaic acid in Propionibacterium acnes and Staphylococcus epidermidis
  8. Cosmeceuticals and rosacea: which ones are worth your time
  9. Topical tranexamic acid improves the permeability barrier in rosacea
  10. Tranexamic acid
  11. Drug and Device News – Mar 2017
  12. Topical tretinoin resolves inflammatory symptoms in rosacea, in small study
  13. Topical tretinoin for rosacea: a preliminary report
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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.

Seabuckthornoil-113

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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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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My Routine – May 2018

I have sensitive skin. I’ve spent years and thousands of dollars on my skin. Following a rough bout with tretinoin in my early 20s, I really began to dig in deep on what I could and couldn’t use as well as what worked for me.

I won’t lie to you: This has taken me years, and I am still changing it here and there on occasion. Sometimes I switch out my trusty Vaseline for a more comfortable sleeping mask, or I try out a new hyaluronic acid serum, but much of the time, I land right back where I was.

To give you an idea of how sensitive my skin is, I know for certain that I cannot use the following ingredients:

  • Polymethylsilsesquioxane
  • Cetareth-20
  • Argan oil
  • Sunflower seed oil
  • Macadamia nut oil
  • Almond oil
  • Squalane
  • Coconut oil
  • Virtually all essential oils
  • Most products with fragrance

Despite knowing all of this, some things I’ve used still give me grief for unknown reasons. If you’d like a full list of the products (that I remember) that I cannot use, I’ve created a Google Sheet full of the products with the name and ingredients which you can view here.

As such, I’ve become very stringent about reading ingredient lists. In fact, I avoid most oils and ferments, and I won’t even touch squalane (which has become very popular in recent years, much to my frustration).

With that in mind, I have learned that I can use ingredients I previously ruled out, including:

  • Fatty alcohols like cetyl alcohol
  • Rosehip seed oil

Every time I add an ingredient to my list of “things I can use that I thought I couldn’t,” it feels like a little bit of a celebration.

So now that we’ve talked a little bit about what I cannot use, let me show you what I can (and do!) use every day and give you a mini-review of each.


Cleansers

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Bioderma Sensibio H2O, Lancome BiFacil, HydraLight Face Cleanser, Clinique Take the Day Off Balm

Bioderma Sensibio H2O

Water, Peg-6 Caprylic/Capric Glycerides, Propylene Glycol, Cucumis Sativus (Cucumber) Fruit Extract, Mannitol, Xylitol, Rhamnose, Fructooligosaccharides, Disodium Edta, Cetrimonium Bromide

My bottle of this has the old label of “Crealine” but it is the same formula as the Sensibio. It has a fairly bland ingredient list and minimal scent. I’ve used it for years to remove makeup mistakes, cleanse my eyelids to prep for eye makeup, and give my skin a once-over before makeup application between my AM and PM washings.

To use, I soak a Japanese cotton (MUJI Unbleached Cotton) and just wipe away. For makeup mistakes, I just stick a q-tip (or cotton bud) into the dispenser and soak it. It’s perfect for cleaning up wings or lipstick application mistakes this way.

It does leave my skin feeling a little dry (but not tight) when used all over, and it does not feel as “clean” as if I washed it with my normal cleansers, but it is an excellent remover nonetheless. I’ve used it for years and would have no problem recommending it to anyone else.

Lancome BiFacil

Water, Cyclopentasiloxane, Isohexadecane, Sodium Chloride, Poloxamer 184, Hexylene Glycol, Dipotassium Phosphate, Benzyl Alochol, Potassium Phosphate, Quaternium-15, Benzalkonium Chloride, Fragrance, Citronellol, Geraniol.

This is my eye makeup remover for days when I’ve worn a budge-proof liquid liner, false lashes, or mascara. It is also really good at removing matte liquid lipstick formulas that don’t remove with Bioderma Sensibio or my Clinique remover.

It needs shaken up, and is pretty oily on the skin, but is honestly the best eye makeup remover I’ve used. I’ve tried the Target Up&Up knock-off as well as the Neutrogena dupe, and they all went into the trash. This is it for me: The best eye makeup remover I’ve ever used.

To use, I simply soak a Japanese cotton and then press it to my closed eyelid, letting it soak away the makeup. *Chef’s kiss*

Paula’s Choice Hydralight One Step Face Cleanser

Water, Glycerin (skin-replenishing ingredient), Sodium Laureth Sulfate (gentle cleansing agent), Sodium PCA (skin-replenishing ingredient), Sodium Lactate, Glycine, Fructose, Urea, Niacinamide, Inositol (water-binding agents), Sodium Benzoate (preservative), Lactic Acid (water-binding agent), Allantoin (soothing agent), Sodium Hyaluronate (skin-replenishing ingredient), PEG-7 Glyceryl Cocoate (texture enhancer), Sodium Hydroxymethylglycinate (stabilizer), Sodium Methyl Cocoyl Taurate (gentle cleansing agent), Xanthan Gum (texture enhancer), Triethanolamine (pH balancer), Carbomer (texture enhancer), Benzophenone-3 (stabilizer),Methylparaben, Propylparaben (preservatives).

There are a lot of feelings out there for Paula’s Choice products, and I have used several of her products (some with success, some with not-so-much success). However, this has been an old standby.

As a teenager, I used an Aveeno Oatmeal Bar on my face, but it became increasingly hard to find, and before long, I wanted to use a liquid cleanser. After much searching and sampling, I landed on this one, and I haven’t changed it since. Sure, I’ve had flirtations with other products, but I always return to the Paula’s Choice. I’ve repurchased it maybe five or six times, and always the 16oz. bottle (which is HUGE — the last one took me two years to finish).

It is clear, unscented, and non-offensive. A basic, no-frills cleanser, it barely suds and leaves my skin feeling clean but not parched. Creamy cleansers break me out, and other forms of foaming cleansers have been too foamy, stripping my delicate skin of essential moisture.

To use, I squeeze about a dime’s worth in my dampened palm, working it together first before applying to my face. I work in gentle, circular motions all over, running my hands under the (cool — not cold or hot) water occasionally, and then going back to massaging. This way, I am diluting my cleanser more and more, slowly removing it but ensuring it has a chance to work off all of the oils and dirt on my skin. It takes me about ~1 minute to wash my face this way, and it always feels clean but not at all dry after.

Clinique Take the Day Off Balm

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Ethylhexyl Palmitate, Carthamus Tinctorius (Safflower) Seed Oil, Caprylic / Capric Triglyceride, Sorbeth-30 Tetraoleate, Polyethylene, PEG-5 Glyceryl Triisostearate, Water / Aqua / Eau, Tocopherol, Phenoxyethanol.

Ever used a product only to realize that this is it — this is the one that you’ll never be without? That this is your product soulmate? That is me and my Clinique Take the Day Off Balm. In fact, I love it so much that I took a photo of it — lid off — to show you what it looks like inside.

I’ve used this remover for years. I’ve had my bag swabbed by the TSA because I refused to be without it. I’ve dragged my girlfriends across a mall in Las Vegas to buy this product because I forgot to pack it. I’ve probably been through ten or fifteen tubs of it, and start to panic when I run low.

It is the perfect makeup remover for me. It is a balm, so it travels great and doesn’t spill out of my hands; it has a simple ingredient list; it is unfragranced; it feels luxurious when massaged into the skin; and it rinses perfectly clean, leaving my skin supple and moisturized.

To use it, I run my finger along the inside, scooping out a small amount, and working it in my hands a little. From there, I simply massage it into my face, taking care to sweep it over my eyes to loosen up pesky mascara. I even massage it into my lips to remove lipstick. After my makeup feels sufficiently loosened, I rinse it away. It does take a good couple rinses to remove, but you’ll know once it is off because the water will run clear. Some days I follow this with my Paula’s Choice cleanser, but most days I don’t.

On days where my skin is particularly dry, I actually swap this in as my normal cleanser and just use a smaller amount. It is that moisturizing to my skin.

The only caution I have for you is to not get caught up massaging this in for too long if you have very sensitive skin like me. The nonstop rubbing and friction tends to irritate my skin (not the product, just the massaging).

To speed up removal of it, I’ve used soft makeup removing microfiber towels (not washcloths — microfiber towels for the face are much softer). Just damp the towel and gently wipe. Rinse out the towel and splash your face until the water runs clear.


Moisturizers

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Avene Thermale Water, HadaLabo Gokujyun Premium, Cheryl Lee MD Hydrate, Correct & Perfect Lotion, and plain Vaseline Jelly

Avene Thermale Water

Water (Aqua), Nitrogen.

I feel almost ridiculous giving ingredients for this product, but I am nothing if not consistent.

While I know that this product is, essentially, fancy distilled water, it is convenient and it does seem to soothe my skin, especially after a shower in Los Angeles tap water. While it is not technically a moisturizer, I use it in conjunction with the HadaLabo to “boost” the moisture in my applications.

To use, I spritz some of this fancy French water on a Japanese cotton and then drizzle a little HadaLabo on it. While I know I could apply this with my hands, the little bit of extra friction from the cotton seems to give my skin just the right amount of exfoliation.

Adding water to the HadaLabo step has given it a bit of extra “oomph” and something to hold onto from the start.

Alternatively, you could apply your HA serums right out of the shower, before patting your face dry.

HadaLabo Gokujyun Premium Lotion

Water, butylene glycol, glycerin, PPG-10 methyl glucose ether, hydroxyethyl urea, sodium acetylated hyaluronate (super hyaluronic acid), sodium hyaluronate, hydrolyzed hyaluronic acid (nano hyaluronic acid), hydroxypropyltrimonium hyaluronate (skin absorbent type hyaluronic acid), sodium hyaluronate crosspolymer (3D hyaluronic acid), aphanothece sacrum polysaccharide (sacrum), hydrogenated starch hydrolysate, glycosyl trehalose, diglycerin, sorbitol, pentylene glycol, triethyl citrate, carbomer, polyquaternium-51, PEG-32, PEG-75, ammonium acrylates crosspolymer, disodium EDTA, potassium hydroxide, diethoxyethyl succinate, disodium succinate, succinic acid, phenoxyethanol, methylparaben.

For years I’ve used the classic HadaLabo Gokujyun Lotion — the watery toner classic. Whenever the Premium came along, I knew I had to try it.

It is much stickier and thicker than the original, and it does moisturize my skin much better. My skin is dry and I live in a drier climate, so it is perfect. I frequently wear it AM and PM under sunscreen and makeup as the first step in my routine. It just locks in moisture and plumps up my skin, making it instantly look healthier and glowier.

One thing I will note is that when I took this product with me on a trip back home to Houston, I looked moister than an oyster for days and had to back down on using it only at night. Indeed Houston is much more humid than Los Angeles, and this product did it’s job at sucking up all of the outside moisture. Unfortunately for me, I spent the week looking slimy and oily until I realized that it was probably a bit too much during the day. Just something to think about if you live in a humid climate.

Cheryl Lee MD Hydrate, Correct, and Perfect Lotion

Water, Caprylic/Capric Triglyceride (Coconut), Neopentyl Glycol Diheptanoate, Polyglycery l-10 Pentastearate, Behenyl Alcohol, Sodium Stearoyl Lactylate, 1,3 Propanediol (from Corn), Glyceryl Stearate, Cetyl Alcohol, Glycerin, C10-30 Cholesterol/Lanosterol Esters, Ceramide 3, Phytosphingosine, Euphorbia Cerifera (Candelilla) Wax, Niacinamide, Glycyrrhetinic Acid (Licorice Root), Xanthan Gum, Disodium EDTA, 1,2- Hexanediol, Caprylyl Glycol, Gluconolactone

For years, I used Elta MD PM — an objectively great product but not enough moisture for my skin — and then I found Cheryl Lee MD products. In fact, introducing more hydration to my routine with these products cured a majority of my acne. Yeah — it shocked me too. Imagine my surprise when I started to slather products on my face that contained ingredients that I thought were problematic for my skin (namely cetyl alcohol) and my acne actually got better. I haven’t been without a tube since, and have found nothing that works as well for my skin. 

I alternate between the Lotion and the Ceramide+ Cream at any given time. Both are great for me, though the lotion is noticeably lighter and preferential at times when I don’t feel so parched.

I’ve used both for years now, as does my mom, and have found them to be a real treasure that I couldn’t be without. To use, I simply dispense about a dime-sized amount into my hand and pat in.

I do feel the need to say that I am unaffiliated with Cheryl Lee MD in any way though, as there was a debacle a couple years back on Reddit with a team of moderators spreading affiliate links for this product and doing their best to benefit from their position within the community.

Vaseline Jelly

White Petrolatum, USP (100%)

Vaseline has been with me since almost the beginning. Bland, boring, beautiful. When I am dry, it is the last thing to grace my face, and when I am irritated, it is the first and only thing to go on.

I can’t really say much more than that. It is a beautifully simple product that just works. My skin looks and feels plump when I use it on top of my moisturizers, though I do stick to pillows a bit at night.

To use, I take a small glob and work it between my hands to warm it up before patting it into my skin. I use it mostly after all of the steps in my routine, but also immediately after a shower (right after stepping out, still in the steam) on lazy days.


Sunscreen

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CoTZ Sensitive SPF 40 Broad Spectrum UVA-UVB

 

Active: Zinc Oxide 20% (Sunscreen). Inactive: C12-15 Alkyl Benzoate, Caprylhydroxamic Acid, Caprylyl Glycol, Cetyl PEG/PPG 10/1 Dimethicone, Cyclohexasiloxane, Cyclopentasiloxane, Dimethicone, Dimethicone Crosspolymer, Dimethicone/Vinyl Dimethicone Crosspolymer, Dimethiconol, Disodium EDTA, Glycerin, Methicone, Microcrystalline Wax, PEG-10 Dimethicone, PEG-30 Dipolyhydroxystearate, Polyglyceryl-4 Isostearate, Polyhydroxystearic Acid, Polysorbate 20, Sodium Chloride, Stearyl Dimethicone, Tetrahexadecyl Ascorbate, Triethanolamine, Triethoxycaprylylsilane, Water.

You may notice that sunscreen stands alone as a single item in its category, and that’s because this single sunscreen has made me neglect all others.

CoTZ sunscreen is 20% Zinc Oxide and has an estimated PPD value of 10, which is pretty good for a US sunscreen. For perspective, one of the highest PPD value sunscreens you can obtain in US sunscreens is La Roche-Posay Anthelios SX Daily with SPF 15 which has an estimated PPD value of 10.5.

This sunscreen is fairly thick and definitely produces a white cast upon application. I would not recommend this for darker skin tones or oilier skin unless you plan to wear makeup over it, but for fairer skins it is excellent. The zinc soothes my rosacea, and it leaves a dewy, luminous finish. Since I began wearing it, the acne on one side of my face cleared up and the hyperpigmentation left behind by Christmas zits is finally disappearing. Take that as you will.

To use, I apply it after my HadaLabo Premium, in place of a moisturizer. I eyeball a quarter teaspoon, dot it all over, and then work it in, making sure to coat my entire face evenly (sans eyelids).

While it sets a bit, I do eye makeup and eye brows, and then dust my face all over with transluscent powder. This dries down the sunscreen, which can otherwise look a bit greasy. Then I apply my usual foundation with a beautyblender-esc sponge, as to not shift the sunscreen around too much.

To remove, I use my Clinique TTDoB. I have run into some trouble with removing it, even with this method, as it is a pretty oil and waterproof sunscreen. To combat this, I simply work in my Paula’s Choice cleanser and then gently wipe away with a microfiber cloth. I usually follow this with a very gentle second cleansing, just to make sure the product has been removed from my skin.

As an anecdote, I’ve also had my boyfriend use this sunscreen on his eczema-prone face and not only does it work for him, it seems to soothe his eczema and hydrate his skin.


Treatments

 

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Paula’s Choice 2% BHA Liquid, Paula’s Choice 5% Benzoyl Peroxide, Finacea Gel, 15%

Paula’s Choice 2% BHA Liquid

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).

This bottle is old. I don’t use it often, but when I break out from a product or travel, out it comes. An oldie but goodie, this product is sold in two lines on Paula’s Choice’s website. It is the same formula for both the Skin Perfecting liquid (pictured here) as well as the Extra Strength CLEAR Anti-Redness Exfoliating Solution.

It is an excellent zit-buster, and even better clog-buster for me. It dries my skin out very minimally, and even seems to soothe the spots I have. It will dry me out if I use it very frequently, but I only tend to use it for four or five days in a row, and only at night.

One note is that I do not use this on my rosacean areas. For whatever reason, BHA products make my rosacea look blotchy and flushed. Finacea only for those regions.

The texture of this product is watery but almost a bit… slimey? Oily? Slippy? It’s hard to describe. I would not recommend wearing it under makeup and allocating it to “night time only.”

To use, I dump a small amount of product out in my palm — no cottons required here. I then wipe it onto my forehead, pat it into my cheeks, chin, and my nose.

Paula’s Choice 5% Benzoyl Peroxide

Active Ingredient: Benzoyl Peroxide 5% (anti-acne)
Inactive Ingredient: Water (Aqua), Propylene Glycol (hydration/penetration enhancer), Bisabolol, Allantoin (skin-soothing), Acrylates C10-30 Alkyl Acrylates Crosspolymer (texture-enhancing), Hydroxyethylcellulose (texture-enhancing), Sodium Citrate (stabilizer), Laureth-4 (stabilizer), Caprylyl Glycol, Hexylene Glycol (preservatives), Sodium Hydroxide (pH adjuster), Disodium EDTA (stabilizer), Phenoxyethanol (preservative).

A fairly new addition to my routine, this product is simply around to zap hormonal zits. You know the ones — those big honkers that sit under the skin on your chin until they rise up to turn into double-headed monsters that refuse to go away quietly.

It is bland (all things considered) and very effective. Best part is that it goes on clear as opposed to other BP spot treatments that create a weird, white film.

To use, I dispense the tiniest amount to the back of my hand and then dot it onto the spot with a Q-tip. I only use this at night.

Finacea Gel, 15%

Each gram of FINACEA Gel, 15%, contains 0.15 gm azelaic acid (15% w/w) as the active ingredient in an aqueous gel base containing benzoic acid (as a preservative), disodium-EDTA, lecithin, medium-chain triglycerides, poly-acrylic acid, polysorbate 80, propylene glycol, purified water, and sodium hydroxide to adjust pH.

Finacea is my favorite product to combat my rosacea. Well, that and moisture.

When I first began to use Finacea, it tingled and felt itchy. Anyone who has used azelaic acid knows what I am talking about here. It just feels like little pin-pricks on your skin.

Fortunately, I am past this stage of rosacea, and now it only seems to happen when my skin is well-exfoliated. In fact, at this point, I take the pin-pricking itches as a sign that I may have gone too far and irritated my skin a bit, hence the pin-prickly goodness.

Finacea soothes my rosacean flushing and controls the flat pustules that always accompany my flush. When my skin is doing particularly well, it doesn’t even get the characteristic dryness in those rosacean spots.

To use, I simply dab a less-than-pea-sized (usually about half a pea?) on the back of my hands and apply to the places where I flush, which in my case is by my nose, where cheek-meets-nose. I don’t apply much — just enough to feel like I have some “slip” under my fingers, but not enough to have excess that I am wondering what to do with.


What My Routine Looks Like

So for me, my routine is pretty based around what my skin feels or looks like. If it is troubled, I’ll use more of my actives (BHA, BP, Finacea) , but if it is doing okay, I’ll use just my Finacea as an active. Most days though, it looks like this:

AM:

  • Apply Avene Water to cotton, drizzle on HadaLabo, and massage into skin, especially dry areas.
  • Apply my sunscreen.
  • Apply eye makeup.
  • Follow with powder, face makeup, and then more powder to set.

PM

  • Work in Clinique Take the Day Off Balm.
  • Lightly wipe away with a makeup removing microfiber towel (I am currently using Ulta’s Removing Towels) and rinse with cool water until water runs clear off of my face.
  • Gently work in Paula’s Choice Cleanser, if needed
  • Apply Avene Water to cotton, drizzle on HadaLabo, and massage into skin, especially dry areas.
  • Apply BHA, if needed, to outer perimeter of face.
  • Apply Finacea, if needed, to flush spots.
  • Apply Cheryl Lee MD Moisturizer (Lotion or Cream).
  • Apply BP, if needed, to spots, and allow to dry.
  • Pat in Vaseline on dry spots or over whole face, if needed.

On lazy days, this is what my PM routine looks like (especially if straight out of a shower, when my skin is moist, clean, and supple):

  • (In shower) Work in Clinique Take the Day Off Balm.
  • (If not in shower, otherwise let the shower just rinse it away) Lightly wipe away; rinse away with cool water until water runs clear.
  • Apply Vaseline

And that’s about it! My skin has remained in pretty good shape due to this routine, and I don’t make many tweaks to it. I’ve used a majority of these products for years, and they are old standbys that I feel fairly safe recommending to most sensitive-skinned folk.

 

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Evaluating Your Routine: Sunscreen

Big sigh.

Sunscreen. The product that is touted as liquid gold among skincare enthusiasts, but neglected among… well, virtually everyone else.

There’s a lot I could explain on the topic of sunscreen, but being as much of it is pretty deep in the weeds, I will attempt to cut through a lot of the extra in this post and give you the simplified “how it works” version, as well as attempt to convince you why you should give sunscreen a try if you aren’t using it already.

First though, I’d like to alleviate some feelings I have on the topic.

Frequently, on skincare blogs and in skincare communities, sunscreen is touted as such a necessity that it is considered a pearl-clutching offense to even leave the house without it. Most sun damage is cumulative, and absolutely no one should be mocked for avoiding actual cancer, but there is a point where the insistence of some encroaches on the comfort of others. That is to say that while sunscreen is incredible, I am by no means pushing the usage of sunscreen on everyone. I understand that the filters bother some people, can aggravate existing conditions, and that sometimes… life happens. We don’t always have a bottle of sunscreen around when we need to dash out of the house. We don’t always want to slather it on before sitting outside to read a book. I certainly don’t.

And that’s okay. 

Do what makes you comfortable, and live your life. Just be reasonable and safe about it.

Whew.

With that out of the way, let’s dive right in, shall we?


Introduction to UV Radiation

You may remember the electromagnetic spectrum from science class and learning about radiation, such as light, heat, and radio waves. In short, it’s energy that’s moving. Leaving out a large portion of the electromagnetic spectrum for relevancy’s sake, there is light that we can see (known as the visible spectrum) as well as ultraviolet radiation.

uv-color-spectrum

The sun emits three types of invisible ultraviolet radiation known as UV-A, UV-B, and UV-C. UVC is filtered out completely by the ozone layer of the Earth’s atmosphere, but both UVB and UVA can reach the surface. While that may not seem so bad, climate change and depletion of the ozone layer has lead to an increase in UV radiation at the surface.

As you may remember from the previous post, the epidermis is comprised of several layers, including the stratum basal. This layer is enriched with epidermal stem cells (cells that can give rise to other cells of the same type), and give life to all epidermal structures, including sweat and oil glands as well as hair follicles. The layer beneath the stratum basal — the dermis — is also composed of stem cells that give rise to collagen and immune cells. These stem cells are essential to the skin as one of the systems of the body with a high rate of cell turnover.

When UVB radiation reaches our skin, our skin cells absorb the photons from the radiation, warping the DNA, rearranging nucleotides, and ultimately leading to defects. This damage causes a depletion of the epidermal stem cells, and ultimately, skin aging. [4] UVA can reach deeper into the skin, causing the most damage to our stem cells responsible for elasticity. This is why UVA damage is sometimes referred to as UV-Aging (with UVB as UV-Burning).

The skin attempts to counteract this damage by creating melanin (the pigment responsible for the color of our hair, skin, and eyes). Think of melanin as little umbrellas, attempting to shade the skin cells from the sun.

As sun exposure continues, the skin eventually begins to burn — the cells so damaged that they flake away and are discarded by the skin. The inflammation that follows is the presence of blood flow to the effected regions.

This is why even tanning — whether sun or tanning bed — is skin damage.

Surprisingly (or perhaps unsurprisingly), this damage begins to add up.


Visualizing Sun Damage

You may have seen the photo of the truck driver or even the video of what skin looks like in ultraviolet.

 

The epidermis thickens as a result of long-term exposure. The dermis loses elasticity. Inflammation occurs, parching the skin of essential moisture. This cascade of effects not only shows up later as wrinkles, but also can worsen eczema, acne, rosacea, or any other condition aggravated by dryness or inflammation.

trucker

And if we burn more than five times in our lives, our risk of skin cancer is doubled. According to the American Academy of Dermatology, 95% of melanoma cases are attributable to UV exposure. It is the most common type of cancer in the United States, with current estimates at 1 in 5 Americans developing skin cancer in their lifetime (or 9500 people every day). [1] You’re at an even higher risk of skin cancer on the driver’s side of your body, due to exposure while driving. [3]

If this isn’t enough, we can see changes in the structure of skin and it’s cells. According to a blog post by KindOfStephen, a group of researchers (with the funding of La Roche Posay) looked at the effects of UVB exposure on skin protected with high SPF (sun protection factor) and UVAPF (UVA protection factor) sunscreen as well as skin that was not protected.

sunscreen2

To quote directly from KindOfStephen’s post: “What they found was that doses of UVB that caused long-lasting erythema (redness) caused morphological changes in the skin. Changes observed were spongiosis (abnormal accumulation of fluid), microvesicles, sunburn cells, and blood vessel dilation. None of these were observed in skin that was protected by the sunscreen.” [2]

sunscreen2-1.jpg


Sunscreen Filters

So now that you know how ultraviolet radiation affects skin cells and you want to dip your toe into the sunscreen world, where do you even start? There are so many filters, so many ingredients, and you’ve even heard about sunscreen causing coral bleaching. Don’t worry, I’m going to get into these things, but first let’s break down the filters.

There are a large number of sunscreen filters available across the world. In the US there are only 16 approved filters, but only 8 are used, and out of that, only 2 of those protect from UVA.

Now you might be asking, “Wait, only two protect from UVA? I thought all sunscreen just protected me from the sun’s UV rays?” You wouldn’t be alone in this assumption. Even I thought this up until about 10 years ago.

Unfortunately, the United States doesn’t really have guidelines around UVA protection, unlike many other countries. In Asian sunscreens, the level of UVA protection is usually denoted by a PPD (persistent pigment darkening) rating, represented with plus symbols, such as ++++. In the EU and Canada, this is is simply a number. The higher the number (or the higher the number of plus symbols), the better the protection from UVA rays. Some sunscreen brands in the EU list their SPF along with the PPD value, ex. SPF 100/PPD 40. In the United States, we largely have to guess based on the percentage of listed filters or simply import them from other countries. I generally recommend sunscreens with high percentages of zinc oxide and titanium dioxide for this reason.

Below I’ve created a chart with the most common sunscreen filters you can get your hands on, along with their range, and some additional notes. For a more complete list of sunscreen filters, please refer to Skinacea’s UV Filters Chart [5]. I’ve also included two of the sunscreens implicated in the killing or bleaching of coral. For a more complete list of that, please check out this BadgerBalm article [6].

Sunscreen_list

Now I know what you’re thinking: why inorganic and organic? And furthermore, I thought zinc oxide and titanium dioxide were organic sunscreens and not the chemical variety.

The difference between these types of filters can be defined by chemistry. Titanium dioxide and zinc oxide do not contain carbon — they’re made of metal and oxygen, thus classified as inorganic. [7] However, both inorganic and organic filters work roughly the same — by absorbing the energy, bending, and eventually relaxing. Some filters do this better than others. For instance, avobenzone, as I noted above, must be stabilized by other filters. Instead of relaxing, avobenzone changes structure and breaks down, becoming more irritating to the skin. This is generally referred to as photostability, and while it is not typically harmful to wear a sunscreen that is unstable, it is just a bit of a pain, requiring re-application often and correctly to keep getting the amount of protection on the bottle.

Speaking of that protection, how do you know you’re even applying sunscreen right, or how much you should be using? Thankfully, science has an answer for just about everything.


Sunscreen Application and Care

Most sunscreens need to create a film over the skin in order to work effectively. This is particularly important for inorganic sunscreens, which are particle suspensions. This means you should be applying them evenly to get the best coverage and protection. Wait before applying any makeup to allow the sunscreen to dry down a bit and form a coating.

You also need to be applying the right amount to get the protection listed on the bottle. Yes, this even means your foundation or BB cream (which you should not be relying on makeup for sunscreen in the first place). Here’s a general guideline on how much you should be using on each portion of your body:

quarter-teaspoon-sunscreen-comparison

1/4″ teaspoon of sunscreen

  • Face: 1/4 teaspoon of sunscreen
  • Neck (front and back)1/4 teaspoon of sunscreen
  • Arms: 1/2 teaspoon of sunscreen per arm
  • Legs: 1 teaspoon of sunscreen per leg
  • Chest: 1 teaspoon of sunscreen
  • Back: 1 teaspoon of sunscreen

Applying less gives you less protection than listed on the bottle. For spray sunscreens, you need to apply several thin layers. Make sure to rub in each layer to avoid the streaky sunburn.

Sunscreens also have a shelf life of only about 3 years. Anything older than that should be tossed. Also be sure to keep your sunscreen in a cool place — even when at the beach. High temperatures of cars or direct sun will break down your sunscreen and render it less effective.

Lastly, re-apply your sunscreen when you are sweating or swimming. I know this is a pain, but if the two times I’ve burnt extremely bad in my life have taught me anything, it’s that the inability to sleep due to pain from sunburns can make the healing period one of the longest sets of weeks in your life.


Sunscreen Myths

  1. Darker skinned people don’t need sunscreen because they don’t burn. While it is true that caucasians have a higher risk of developing melanoma than the general population, skin cancer can affect anyone, regardless of skin color. In fact, skin cancer in patients with skin of color is often diagnosed in its later stages, when it’s more difficult to treat. They’re also less likely than Caucasian patients to survive melanoma, and are more prone to skin cancer in areas that aren’t commonly exposed to the sun, including under the nails. [1]
  2. Inorganic reflect sun rays, while organic filters absorb them. Both classes of filters work much the same, stretching, absorbing, and eventually releasing the energy. There is very little that is “reflected,” though inorganic sunscreens do have flashback (white cast under flash photography) due to their ability to reflect energy above the UV spectrum. [7]
  3. Inorganic sunscreen sits on the skin while organic sunscreens absorb. KindOfStephen put this best: “… if we want to protect ourselves from the rain we need to hold the umbrella above our heads. Sunscreens work the same way, you want them to absorb the energy before they can reach our skin cells, particularly the living cells. The most effective way for this to be done is to have them on the surface of the skin in a continuous and even layer.” [7]
  4. Sunscreens need time to activate on the skin. Sunscreens absorb UV due to their chemical makeup, not due to a chemical reaction that takes place on the skin.
  5. If I wear sunscreen, I won’t get adequate vitamin D. Vitamin D is very important to our bodies, and many people are deficient in it. However, thanks to the many well-formulated vitamin D supplements on the market today, we can get D3 just as efficiently as if we were sitting in the sun for an hour. Check with your doctor before taking any supplements. 
  6. Glass blocks all UV. Glass only filters UVB rays, so you still must wear sunscreen to be protected from the most harmful rays — UVA.

General Sunscreen Guidelines

  1. Apply your sunscreen after moisturizer and before makeup. Think of it as the barrier that protects your skin from the outside. I typically apply my sunscreen as the last step in my AM routine and do my eye makeup while I wait for it to sink in.
  2. Apply your sunscreen under your eyes. Avoid the top of the lid, which can get oily and cause the sunscreen to “run” into your eyes later in the day. Protection of the delicate undereye area prevents darkening that can look similar to undereye circles, as well as premature aging and wrinkles.
  3. Wear sunscreen, not moisturizer with SPF or makeup with SPF. As I mentioned above, sunscreen in moisturizer or makeup is not adequate.
  4. Don’t neglect your driver’s side. It’s easy to forget about our bodies, but as I mentioned, skin cancer is especially common on the driver’s side of the body. Avoid this with sunscreen, UV protective clothing, or special UV tinting.
  5. Wear at least SPF 30, but don’t worry about trying to wear SPF 100. There is very little difference between the amount of protection that SPF 30 provides versus SPF 100, when applied correctly. For example, SPF 30 blocks nearly 97% of UVB rays, while SPF 50 blocks an estimated 98% of UVB rays. [10] On top of this, higher SPF values mean more filters, which can irritate some skin. Good guidelines are at least SPF 30 but no more than SPF 50.
  6. Wear the highest amount of SPF you can tolerate. For some, this is SPF 15, and that’s okay. Whatever your skin can tolerate is better than nothing at all.
  7. When in doubt, wear a hat. There are plenty of UV-protective clothing options (and UV-blocking umbrellas!) on the market today. When I know I am going to be out in the sun for a long period of time, I will frequently bring a hat with me in addition to my sunscreen.
  8. Wear sunscreen and avoid the sun if you’re especially sun sensitive. This means skin with acne, rosacea, eczema, psoriasis, or under the treatment of photo-sensitizing (sun sensitivity) ingredients like retinol, retinoids, isotretinoin (Accutane), benzoyl peroxide, AHAs like glycolic acid or lactic acid, and topical steroids (such as triamcinolone).

Sources

  1. American Academy of Dermatology – Skin Cancer
  2. Kind of Stephen – Visualizing how a daily sunscreen can protect the skin from UV damage
  3. Study: Driving May Contribute to Left-Side Skin Cancers
  4. Ultraviolet Radiation-Induced Skin Aging: The Role of DNA Damage and Oxidative Stress in Epidermal Stem Cell Damage Mediated Skin Aging
  5. Skinacea – UV Filters Chart: Sunscreen Active Ingredients
  6. BadgerBalm – Coral Reef Friendly / Reef Safe Sunscreen
  7. Kind of Stephen – “Physical” vs. “chemical” sunscreens and other sunscreen myths
  8. Skinacea – How much sunscreen should I apply?
  9. The Derm Blog – Is that sunscreen in your car still good?
  10. Skin Cancer Foundation – Does a higher SPF sunscreen always protect your skin better? 
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Evaluating Your Routine: Moisturizers

Welcome back! It’s been a couple days since my last post in this ongoing series. I’ve had family visiting and have been busy giving the tour of Los Angeles.

This post will be a bit long, and with good reason — moisture is extremely important to skin health.


An Introduction to Moisturizers

“Moisturizer” is a bit of a vague marketing term. Moisturizers do not necessarily add moisture to the skin as much as they reduce or slow the amount of water that skin loses. They’re important to everyone who cleanses their skin, whether with water or a cleanser, but even more critical for those with conditions that cause the skin to lose moisture more easily, such as eczema. In short, moisturizers provide a barrier against moisture loss by creating a soothing, protective film.

But let’s slow down a little. Why does the skin lose moisture in the first place, and where does it even get moisture? To answer this, I present to you a helpful diagram of the skin’s epidermis.

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

Epidermal_layers.pngYou may remember from Health or Biology class that skin is generally broken into three major layers: Epidermis (or the upper most layer — what we can see with our eyes), the dermis (the middle layer — where most of the nerve endings, oil glands, hair follicles, blood vessels, and collagen hang out), and the hypodermis or the subcutaneous layer (where our fat lives).

There are multiple layers of each of these three basic layers, but we will be focusing on the layers of the epidermis, particularly the stratum corneum.

The epidermis is composed of thousands of cells known as keratinocytes. They begin life deep in the stratum basale, where they slowly make their way upwards, propelled by the growth of new cells below. As these cells get closer to the surface, they flatten down, harden, die, and eventually flake away. Some skin does this well, some not so well (dry skin, acne skin, etc.).

This process is generally referred to as skin cell turnover, and as we get older, this process gets slower and slower. In children, this only takes about two weeks, and in teens it is three to four weeks. Once you’re into your adult years, this slows down to a month, and by the time you’re over 50, it’s closer to 45 to 90 days.

Nowadays, we have ingredients that can speed this process up when applied topically, but that’s another post for another time.

The water that keeps these skin cells happy and healthy comes from deep within the epidermal layers and works its way upwards, until it is eventually lost to evaporation, but just like any organ of the body, it functions best with moisture. When skin is broken or it’s natural processes disrupted by wounds, burns, exposure to surfactants (cleansers), or extreme dryness (winter), it loses water quicker. That’s why doctors tell you to keep wounds moist and covered and you feel the desire to use richer moisturizers in the winter. When you keep even the upper most layers of the skin hydrated, the cells aid in elasticity and the enzymes within the skin are able to function more efficiently.

In short, moisturizing helps to repair the skin, increases water content, reduces trans-epidermal water loss (water evaporating out of the skin), and maintains the appearance of the skin. They do this by acting as humectants, occlusives, emollients, and rejuvenators.

Occlusives

Occlusive is a fancy word for a sealant — a compound that is generally hydrophobic and prevents water from evaporating.

They’re not typically very appealing because they can feel heavy or greasy, but they are the most effective ingredient at reducing trans-epidermal water loss. This property makes them particularly effective when used immediately after a shower or cleansing, while the skin is damp.

The most effective occlusive agent is petrolatum — a bland little ingredient with a bad reputation. It is the most commonly used ingredient in skin care and reduces water loss by 99%. It’s able to initiate production of lipids by penetrating into the upper layers of the stratum corneum (“sealing the cracks” in the skin, so to speak), and can reduce the appearance of fine lines and dryness caused by dehydration.

The second most common ingredient is dimethicone, though it is permeable to water vapor, which makes it less ideal for compromised or damaged skin.

Occlusives, when used alone in a skin care routine, are the last step. I personally apply a touch of Vaseline on the driest parts of my face after applying moisturizers and prescription medications.

Other common types of occlusives include squalene, paraffin, lanolin, cetyl alcohol, beeswax, and cholesterol.

Humectants

Humectants are kind of like the hydrators of skin care ingredients. They’re hydroscopic, meaning they are able to attract and hold onto water molecules. However, due to their water-loving way, they can pull water away from the dermis and cause excessive water loss. This is why humectants are almost always combined with occlusives, like petrolatum.

The most common humectants are glycerin or glycerol and hyaluronic acid, but there are also hydroxy acids (another post, another time), propylene glycol, and urea.

Emollients

Emollients are the ingredients that serve the primary function of filling in the cracks between skin cells. Many times, occlusives can be used and function as emollients. These ingredients are what make your skin feel soft after applying a moisturizer, and are commonly natural oils like rosehip seed oil.

While simple, these ingredients can assist in the inflammatory response of the skin, and are very individual. For example, you may notice that your skin seems to act better when you use rosehip seed oil, thanks to the linoleic acid (an omega 6) within the oil.

Rejuvenators

Rejuvenators replenish the proteins in skin, and include ingredients such as collagen, keratin, and elastin. These ingredients have limited permeability due to their large molecular size, but they can fill a similar role as emollients, filling in fine lines and smoothing the skin.

A Note on Ceramides

Ceramides are a fairly new breakthrough in cosmeceuticals. They’re naturally found in the lipids of the skin, and help to maintain the skin barrier (the function of the skin that holds onto moisture and keeps out unwanted chemicals). In a 1990 study, “it was found that the level of ceramides was greatly reduced in the stratum corneum in patients with atopic dermatis. It was subsequently concluded that an insufficiency of ceramides in the stratum corneum is an important factor in atopic dry skin. Subsequently, ceramides have been added to many moisturizes used in the treatment of both atopic and normal skin.” [1]

You can find ceramides starring in many creams and lotions now, and even at your local drugstore in brands like CeraVe.


All Tied Together

When I first began resolving my own skin issues, the greatest barrier (and what finally solved my acne) was finding a moisturizer that worked for me. I have several sensitivities and am unable to use a handful of common ingredients as well as a large number of uncommon ingredients. Skin needs are unique and individual in this way. You may find that you need to try many products to find what works best for you, but here are some guidelines to get you started.

  • Look for simple ingredient lists. Ingredient lists proven by the science are the best kind. Try to find something without fragrance, essential oils, and if you have particularly sensitive skin, without natural nut or plant oils, such as jojoba, rosehip, marula, or almond oil. This also makes it easier to rule out what causes your skin problems, so you aren’t fluttering from one product with an exhaustively long ingredient list to another, just hoping.
  • Use an occlusive on your driest parts. Vaseline (brand name for petrolatum) is one of the most bland products on the market, and is comprised of one of the most boring molecules around. It is incredibly non-reactive and well-tolerated. Pat it on after a shower, after your moisturizer, on damp skin.
  • Moist skin heals best. Keep cuts, scrapes, and scratches under a bandage with a glob of Vaseline. Same for acne spots with an open wound. Moist skin also scars less.
  • Seek out ceramides. These crown jewels are amazing for all skin types, but especially skin that is dry or acne-prone.
  • Don’t be afraid of moisture if you have acne. Many times, we fear moisture and oil as the cause of acne, but as I’ll start to explain, skin that is prone to acne tends to lack a lot of the moisture and good fats that keep it healthy.
  • Hydrated skin absorbs ingredients better. Remember when I said that skin that is hydrated functions more efficiently? Skin that is hydrated also uses other ingredients more effeciently. This means that you may experience more irritation from topical prescriptions like tretinoin/retinoids, AHAs, BHAs, LHAs, etc. Simply back down on how much you use of these products and celebrate — your skin is healthy!
  • Use a humidifier if it’s dry in your home. I have a simple digital humidity gauge in my bedroom so I can track the humidity of the room at any given time. Ideal humidity levels are between 40-60%. When humidity levels dip below this, such as in the winter when the heat is running frequently, I use a humidifier to boost the humidity levels. This is fantastic for your skin and prevents humectants from “pulling” too much moisture out of the deeper layers of your skin.

 

Sources:

  1. Nolan, K. and Marmur, E. (2012), Moisturizers: Reality and the skin benefits. Dermatologic Therapy, 25: 229–233
  2. Chemistry of skin: Trans-epidermal water loss (TEWL)
  3. SkinTherapyLetter

 

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Evaluating Your Routine: Cleansers

So in my previous post, “Evaluating Your Routine: The Very Basics,” I posed the following question:

What does your skin feel like after you cleanse? Does it feel dry – parched and tender? Does it feel dry but quickly become oily? In my experience, this is usually a cleanser issue. It’s generally recommended that everyone should use “creamy” cleansers (these are usually cleansers that do not suds due to lacking the sudsing ingredients of sodium lauryl sulfate or sodium laureth sulfate), and are advertised as “gentle,” “hydrating,” and “creamy”), and there are more options than ever within this category, from CeraVe to Skin Laundry.

However, if you find that creamier cleansers give you problems, you may need something that is a bit more translucent in appearance (meaning less moisturizing agents). These can be a bit tougher to find that fit within the usually-strict guidelines of no SLS/SLES (sodium lauryl sulfate or it’s gentler cousin, sodium laureth sulfate), so I usually advise people to experiment with what works. For me, this is Paula’s Choice Hydralight Cleanser, but there are also options like La Roche Posay Effaclar or Glossier’s Milky Jelly Cleanser.

In this post, I’ll be breaking down general cleansers as well as oil cleansers (or the oil-cleansing method aka OCM) and micellar cleansers. Let’s dive right in!


Cleansers work by dissolving or binding to things on the skin that aren’t normally rinsed away by water, such as the waxes or oils produced by our skin.

Without getting too into the weeds, they are able to do this with surfactants  (or “the thing that makes cleansers sudsy”). The most common surfactants, and the ones you may have heard of are SLS and SLES (sodium lauryl sulfate and sodium laureth sulfate). These ingredients work by binding to the lipids (oils such as jojoba oil or silicones like dimethicone) and then being whisked away by their water-loving properties. Once mixed with water, surfactant molecules cluster together into little spheres known as micelles. Some surfactants molecular size allows them to penetrate deeper into the skin (namely SLS), where they can bind to skin cells. As you can imagine, this is very irritating to skin, and is what causes the eventual drying that you may experience after using some products.

501_Structure_of_the_skin

So by increasing the size of these molecules or adding additional ingredients, we get a gentler cleanser.

If you’ve hung out in any beauty circle, you’ve probably also heard chatter of pH – “What is the pH of that cleanser? Have you tried the CosRx Low pH Cleanser?”. The pH value of a cleanser can have an impact on how harsh your cleanser is on your skin as well, and simply put, it’s because the surface of your skin is naturally pretty acidic.

Going back to Chemistry class really quickly, you’ll probably remember something called the “pH Scale.”

ph-scale

Things on the left side of the scale (1-6) are considered acidic. Things on the right side (8-14) are considered basic or alkaline. And of course, there is what is considered neutral, or pH 7. Skin has a pH of around 5.5, but becomes more basic the further down into the dermis you go, reaching a pH of about 7. Why is this important, you may be asking? Well, if you think back to your high school Chemistry course, you may have remembered the good ol’ baking soda and vinegar reaction. When this reaction — called an acid-base reaction — occurs, the baking soda and vinegar exchange atoms and form different compounds, namely water and carbon dioxide. This is because bases are compounds that generally want to donate atoms and acids are compounds that generally want to accept atoms.

As skin comes in contact with other ingredients, even water, the pH temporarily raises and other compounds are created. Fatty acids (read: acidic components) of the skin are removed.

Healthy skin can usually re-balance itself within an hour or so. Some skin takes longer to do this, especially skin that is prone to irritation, such as skin with acne, rosacea, eczema, or psoriasis. This is why your boyfriend can cleanse his face with a Dial soap bar and have glowing skin an hour later, while you’re busily slathering on layer after layer of moisturizer.

Using a cleanser that is closer to our skin’s natural pH is the obvious solution to this problem, and most modern cleansers are formulated much better than those of the past.

So now you’re probably asking yourself: Well, how can I test the pH of the cleanser I would like to buy? And how do I know the surfactant isn’t going to irritate my skin?

A general rule of thumb is to look for mild surfactants, such as decyl glucoside, or multiple surfactants, like decyl glucoside, coco-glucoside, disodium cocoyl glutamate, disodium laureth sulfosuccinate, cocoyl methyl glucamide, sodium cocoyl isethionate, and lauryl lactyl lactate.

You should also look for moisturizers, like oils, ceramides, cholesterol, and humectants (water-binding ingredients such as glycerin, hyaluronic acid, or squalane). Avoid saponified oils (please don’t use Dr. Bronner’s on your skin) and bar soap.

Now I know you’re asking: What about oil cleansers then?


What if I told you that your grandmother was ahead of the game?

Nearly all of us have seen a tub of Pond’s Cold Cream hanging out in our grandmother’s bathroom or on her vanity. You might’ve seen her dab some all over her skin and wipe away all of her makeup with a tissue. She may have sworn by it as the thing that kept her looking young, and she’s not entirely wrong.

I like to think of oil cleansers as being broken down into two types of cleansers — wipe-off cleansers like your grandmother’s Pond’s, and emulsifying cleansers like the translucent oil cleansers that come in a pump or tub.

The former — wipe-off cleansers — are the most common mixtures in the cosmetics industry. They are usually simple mixtures of oil and water, and are high in water content, which makes them inexpensive.

cold_cream

They spread easily and often leave an oily or richly moisturized feeling behind. They’re typically purchased by people with mature skin, but are a great alternative for people with dry skin.

The latter — emulsifying cleansers — are also mixtures of oil and water, but are higher in oil content, which makes them more expensive. They contain emulsifiers that bind well to water, which allows them to rinse away in water.

oil_cleansers

The benefit of these cleansers is there is no real “sudsing” action on the skin. Indeed many of them can actually feel “moisturizing” due to their ingredient makeup. They are also excellent for breaking down make-up and other waterproof things, such as mascara, due to the high oil content.

When picking out an oil-cleanser, look for shortened ingredient lists. Don’t be swayed by extracts or other frills that will wash away. The oil itself will be the biggest point of irritation (or not) for your skin, so don’t be afraid of “boring” oils like mineral oil or petrolatum, which is one of the blandest, most non-reactive molecules around.

Just one more to go…


Micellar water is quite literally made up of micelles, or the molecular bunches of surfactants that group up, their water-loving butts faced outwards. These larger bunches of molecules, diluted in combinations of water and hydrating ingredients (such as glycerin), are the most mild of cleansers.

The percentage of surfactant to other ingredients is generally so low that micellar water does not need to be washed away. This allows the hydrating ingredients, such as glycerin, to stay on the skin after the debris has been removed.

bioderma

This makes micellar water ideal for sensitive skin or prepping the skin for product application, when cleansing with a standard cleanser and water will be too drying.


So what does this all mean? Here are some general skin cleanser guidelines to follow:

  • Cleanse your skin at least once a day. At the end of the day, your skin not only has a build-up of oils, but also debris and particulates in the air.
  • Don’t pile it on. Your non-sudsing cleanser does not need to suds to work.
  • Two-step cleanse for removing make-up. Most make-up is waterproof and does not easily cleanse away. Use an oil cleanser to break down the make-up and remove it.
  • Use cottons to remove cream cleansers like Pond’s. The friction will help to remove grime and dirt. Splash with water after to remove any leftover emulsifiers.
  • Use cool water when cleansing. Hot water can make surfactants penetrate deeper by reducing the size of the micelles, which is why your hot shower is more irritating and drying to your skin than the less-fun cooler shower.
  • Moisturize. Even water strips away the valuable fatty acids in your skin. Using a moisturizer on your skin after will help your skin to re-balance itself quicker.


Sources and Further Reading:

 

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