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Dr. Tarbox: Hello, and welcome to "Skincast," the podcast that teaches you how to take the very best care of the skin you're in. I'm Dr. Michelle Tarbox. I'm a dermatologist and dermatopathologist at Texas Tech University ÐÇ¿Õ´«Ã½ Sciences Center in beautiful sunny Lubbock, Texas. And joining me is . . .

Dr. Johnson: Hey, everybody. My name is Dr. Luke Johnson. I'm a pediatric dermatologist and a general dermatologist with the University of Utah.

Dr. Tarbox: So today, we thought we would take on a multi-part episode about how to improve the appearance of your skin, and what you can do at home for that, and what you can do in the office for that.

Dr. Johnson: This is called "Cosmetics." There are a lot of people in the world who are very interested in cosmetics, and many of them are dermatologists, because we take care of the skin, take care of skin disease, and we can also improve its cosmetic appearance.

Michelle does a lot more cosmetics in her practice than I do. Full disclosure, I really don't do any. But if you live in Salt Lake City and you are interested in some cosmetic stuff, I certainly know some basics, but the University of Utah has a great cosmetics division. Michelle, however, will probably be doing most of the talking for this episode.

Dr. Tarbox: So we have a broad array of things that can be done at home, habits that you can start to implement, and procedures that can be performed that can help improve the appearance and health of the skin. One of the most important things is to have a good basic skincare regimen. So where do you usually start with that, Luke?

Dr. Johnson: Well, if you guys want to know exactly what Michelle and I do for our personal skincare routines, we have a whole episode about it. That's Episode 6.

Well, what I do, which I'll just give you guys in a nutshell here, is make sure I wash my face in the morning. And then I put on sunscreen, generally a moisturizer with sunscreen. So there are a lot of products out there referred to as daily facial moisturizers, which are moisturizers for your face that also tend to have sunscreen in them. Those are nice because they're formulated for the face. They won't clog up your pores and give you acne, and they usually have SPF at least 30.

And there's evidence that even just visible light, so the light wave just striking our skin from you having lights on in your home or at your place of work, can cause some aging appearance of the skin. So I always put on sunscreen, whether I'm going to go outside or not.

Dr. Tarbox: I think that's a really good habit to have, and you never really know how you're going to run into the sun in your day-to-day activities. So we are recording this episode in the middle of December, and in the wintertime, there are even more considerations for good skincare health.

So I like to tell patients to avoid foaming agents in the wintertime. One of the most common ones that's in over-the-counter products is called sodium lauryl sulfate. So if you look for sulfate-free cleansers or gentle cleansers, that's often going to be a good place to start.

My very favorite cleanser for the skin is the CeraVe Hydrating Cleanser. Here on "Skincast," we're not sponsored by anything. We don't have any relationships with any of these companies that make these products. These are just ones that we found that are helpful for our patients.

So the CeraVe Hydrating Cleanser and the Neutrogena Ultra Gentle Daily Foaming Facial Cleanser are the two that I like.

Dr. Johnson: And the reason that winter tends to be tough on the skin is because the world is drier. It's dry because usually just outside, there's less humidity, but even more importantly, it's cold in our houses, and we don't like that, so we turn on our heaters and the heaters are also quite drying. They kind of take the moisture out of the air as well.

So you may have noticed that your skin tends to be drier in the winter, that your eczema, if you have some, tends to flare in the winter. That's very common. And these ingredients like sodium lauryl sulfate that tend to make a cleanser foam, because people like things that are foamy, they associate that with cleanliness, can be extra irritating to skin that might be already a little bit more irritable in the winter.

How do you feel about sodium laureth sulfate?

Dr. Tarbox: It's very similar in terms of its foaming capabilities and ability to sort of strip the barrier from the skin, the moisture that's natural really there. So, if you can stick with a product that doesn't foam and cleanse your skin very gently, your skin will thank you.

Dr. Johnson: And by the way, the party line among dermatologists for just a general soap is white Dove bar soap. Just tends to be a good low-cost option for use in the shower, for example.

Dr. Tarbox: Especially the unfragranced one.

When it comes to sunscreens, you want to look for a good broad-spectrum sunscreen. If you have sensitive skin, sticking to a mineral-based sunscreen is best. The ones that I personally prefer include the Cetaphil Sheer Mineral Sunscreen, which is a broad-spectrum. The CeraVe Hydrating Sunscreen, which contains niacinamide, which is a skin-healthy ingredient. And we'll talk about some of those in our next episode. The EltaMD UV Clear Facial Sunscreen, which is SPF 46 and is very gentle for rosacea or acne-prone skin.

If you want to use a CC cream, I like the Supergoop! CC cream that has a 100% mineral base and has an SPF of 50.

And then if you want to actually get really aggressive with your anti-aging, there's a product I like that's called Eryfotona Actinica. So two words. Actinica is the second word. And this is a mineral sunscreen that actually has something in it called DNA Repairsomes. These are enzymes that are made to help repair existing sun damage. So I really like those sunscreen products.

How about you, Luke?

Dr. Johnson: Well, you said if you want a CC cream, what's a CC cream?

Dr. Tarbox: Ah, so CC creams and BB creams are very similar. CC creams take things a little step farther and they have a color correction in them. So color-correcting creams have a little tint to them, which can be helpful for blocking those visible wavelengths of light. And then they also tend to have skin-healthy ingredients and sunscreens in them.

So color correcting creams, I think, is what the CC part stands for. It's similar to the BB cream. Those are just something you can use on a daily basis to help improve your skin quality and protect it from the sun.

Dr. Johnson: So, if CC stands for color correcting, what does BB stand for?

Dr. Tarbox: I think it's like beauty basic. I don't actually know what that stands for.

Dr. Johnson: I didn't know any of this stuff. See, that's what I get for being a pediatric dermatologist. But I do know that the tinted sunscreens are better at blocking out visible light, and visible light can also play a role in making dark spots on your skin even darker. So especially if you're a woman, a tinted sunscreen with an iron oxide component can be helpful.

And as you would hear in my skincare routine episode, I use a La Roche-Posay Toleriane product as a daily facial moisturizer with sunscreen in it.

Dr. Tarbox: I do like that product too.

Dr. Johnson: I found it reasonably priced and it feels good when you put it on and claims to have sunscreen.

Dr. Tarbox: And it is very gentle. So CC is for color correcting. BB is for beauty balm. Both of them have some coverage and hydration. The CC creams are usually a little bit more lightweight with fuller coverage and have anti-aging ingredients, things like the little ribosomes and things like that. So that's kind of cool.

I also think that most people can benefit from a retinoid. What do you do for your retinoid, Luke?

Dr. Johnson: So a retinoid is a vitamin A derivative, and our cells have little receptors within them that can bind to these vitamin A derivatives. And that makes our genes turn on and turn off. The overall net effect is that it's good for the skin. They're good for wrinkles. They're good for dark spots. They're good for acne. They're good for what ails you.

There are some people who think they can even help prevent skin cancer. Sometimes I have patients say, "Well, is it safe for me to just use this forever?" And I say, "Why yes, it's beneficial to use it forever. I've been using one for the last 25 years and look how handsome I am."

Dr. Tarbox: There are some myths about retinoids. Some people think that retinoids thin the skin. This is probably because some people, when they first start using a retinoid, have some skin peeling. And so people can perceive that and assume that their skin is thinning, but actually, retinoids are stimulating collagen production, which thickens the skin. The peeling is just one of the responses of the skin cells having increased cellular turnover.

Dr. Johnson: There are a lot of these different retinoid products and a lot of them will make you dry and flaky when you start, but most people's skin will get used to them. So I often recommend that you start just every other day or just go every night until you start seeing yourself get a little peely, and then stop and give yourself a break for a day or two. But then come back to them because your skin will probably get used to them.

Those that are available over the counter, there's a product called Adapalene. The brand name is Differin. And that's basically just a pure retinoid. You can certainly use that one.

And then there are a lot of products, especially those that claim to be anti-aging, that have retinol or retinoic acid in them. And that can also be effective, though it can be hard to tell which product is actually stronger than another.

Dr. Tarbox: Yeah, they will often have a percentage on them, but the way that the skin absorbs the ingredients can vary based off of the formulations of the different products. So you may have to experiment a little bit to find the one that really agrees with your skin the best.

A couple of good, easy-to-find, over-the-counter products that aren't too terribly expensive include the Neutrogena Rapid Wrinkle Repair Retinol Pro, which is a 0.5% retinol over-the-counter. That's put together very well and works very nicely for some patients.

Another one that's a reasonably priced option is Paula's Choice 1% Retinol Treatment. These are something that I can have patients use on a really regular basis, and it helps with a lot of skin issues. So retinol is generally useful for most patients.

What are other things we can do to make sure the skin looks its best?

Dr. Johnson: Well, before we move on from retinols, if you are using a retinol product over the counter and it's not drying your skin out, you might be ready for a prescription strength. So dermatologists and other doctors can prescribe you stuff called tretinoin or even tazarotene. That's stronger versions of all of that stuff. And I think the strongest version that your skin can tolerate will give you the best results.

Dr. Tarbox: That's a really good point, Luke. Well, in the time of the pandemic, we also have to think about an extra dimension of skincare, and that's caring for the things we put on our skin, which can include, in this day and age, the masks that we might wear every day. So what are some good tips for patients who are having to wear masks?

Dr. Johnson: You can use a disposable mask where you just throw it out afterward and you say, "Take that, Mother Nature." That's what I do. If you're using a fabric mask, you want to wash it. Try not to re-wear it more than one day in a row.

Dr. Tarbox: Yeah. And then anything that touches your face, you want to think about its cleanliness as well. So if you're using brushes to apply makeup, you want to think about how often you're cleansing those.

Anything that is heavily immersed in a liquid-based makeup, like a foundation makeup brush, needs to be washed at least once weekly and then allowed to dry in an upright position or laying off the side of the counter depending on the type of the brush.

Eyeliner brushes that go kind of close to the eyelid margin also should be washed once a week. Eyeshadow and powder brushes should be washed about twice monthly.

And the way that you cleanse these can be done with a gentle soap or brush cleanser, or if you use facial cleansing wipes, which some patients really like. And I tend to sometimes use those as well, especially when I'm traveling or if I'm doing a lot of theater stuff. Those are very helpful to cleanse your makeup brushes as well. You can actually kind of gently swipe the makeup brush on the facial cleansing wipe until the residue of the makeup comes off.

Dr. Johnson: That's not what I do for my makeup routine, because I don't wear makeup. But after our episode, again, about our personal skincare routines, you recommended something called micellar water to clean the skin. So my wife immediately went out and bought the brand that you recommended, which is Simple, and now she uses it every evening to wash her face off and she keeps telling me I should use it too.

Dr. Tarbox: It's a great product. It's very gentle. It's not fragranced. It helps to encapsulate the oil droplets that can be on the skin that can make makeup hard to remove or can make skin oil hard to remove. And it's a very nice, gentle way to cleanse your skin. You can also use that micellar water to cleanse the makeup brushes.

Dr. Johnson: This was the first part in our cosmetic series that we thought we'd cover stuff everybody should be doing. In the next episode, we'll talk about things you can do for specific concerns.

Michelle, anything else you want to hit here that everybody should maybe be doing?

Dr. Tarbox: Well, when you really think about it, skin is a fabric you live your whole life in, so you want to care for it gently. A lot of us tend to be a little aggressive with our skincare sometimes. I know it's frustrating when you have a blemish and you just want it to go away, but as much as you can, try not to pick or squeeze at the skin. Anything that creates any kind of redness or bleeding can potentially cause scarring. And if it's not done in a safe and controlled manner, like would be done in an office procedure, then it can leave a scar that's undesirable.

So remember, you live your whole life in your skin. Be gentle to it and take good care of it.

Dr. Johnson: I'm also suspicious of products that seem especially harsh, like astringents and exfoliators. I think most people, if they're doing this other stuff . . . A retinoid, for example, is like an exfoliator, but a much more slow and gentle and medically proven way to do it. So I generally think people shouldn't be using products like astringents, and exfoliators, and cleansers with little beads in them.

Dr. Tarbox: And the microbeads are actually being phased out of production because of environmental damage that they do. But other exfoliating cleansers, like the one that contains the walnut shells, which are basically just randomly ground up bits of walnut shell, that's a very unregulated kind of angular particle that you're rubbing aggressively against your skin, which could scratch up the skin and cause irritation. So generally, that product is not something dermatologists like.

Dr. Johnson: Well, that's what we've got for these cosmetic basics tips, friends. Thanks for listening. Thanks, of course, to our institutions. Thanks to the University of Utah for supporting the podcast and thanks to Texas Tech for lending us Michelle.

And if you are a super dermatology nerd, you might be interested in our other podcast. Michelle, you want to tell them about "Dermasphere"?

Dr. Tarbox: So "Dermasphere" is a podcast that's engineered more for dermatologists and people who are dermatologically interested. A lot of people listen to it, including medical students, residents, and industry partners. This is a longer podcast with more scientifically-based discussions about different issues that affect the skin. And it's a lot of fun, takes about an hour each time, but if you're a real dermatology nerd, you might love it.

Dr. Johnson: There are also a lot more puns, for better or worse. We'll see you next time.