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Come Out! (With Your Skin Care)

Come Out! (With Your Skin Care) Emma Carlton!

Introduction:

Emma has very oily skin that naturally, is prone to acne. She experiences ever-present whiteheads and blackheads, with several (2-4 she claims) more severe relatives like pustules making appearances around the jawline and cheek areas. Emma is also very prone to hyperpigmentation scarring that occurs after any breakouts subside. Furthermore, her skin is naturally very pale and red, which only makes her condition look worse than it actually is. She has gone to her general practitioner (GP) for help, and he/she has prescribed what she believes to be two retinoids and an oral antibiotic.

Routine:

Morning:

  • Cleanser: Clinique Liquid Facial Soap, Oily Skin Formula (I’m assuming that the liquid facial soap is used, instead of the bar version. Neither is specified)
  • Moisturizer with SPF: Proactiv Oil Free Moisturizer with SPF 15
  • Acne Treatment: Unknown Benzoyl Peroxide Treatment OR  Adapalene

Evening:

  • Makeup Remover: Simple Kind to Eyes Eye Makeup Remover AND Simple Kind to Cleansing Facial Wipe (Again, I’m assuming that the original version is used, instead of the pad or cream versions for the eye makeup remover. For the facial wipe, I’m assuming that the Kind to Cleansing version is used because it’s from a similar line as the “Kind to Eyes”)
  • Cleanser: Clinique Liquid Facial Soap, Oily Skin Formula (I’m assuming she uses the same cleanser as the morning one)
  • Toner: Clinique Clarifying Lotion 3
  • Moisturizer: Clinique Dramatically Different Moisturizing Gel
  • Acne Treatment: Unknown Benzoyl Peroxide Treatment OR Adapalene OR Tretinoin

Others:

  • Spot Treatment: Soap & Glory Dr. Spot
  • Mask: Proactiv Refining Mask (Used twice per week)

I took the liberty of assuming some of the products’ positions based on common sense, just because they weren’t specified in the submission or were not categorized clearly enough.

Review:

Overall, the routine is decent or in the words of a pessimist, lackluster. I’m not quite a pessimist (yet haha), but I am a realist.

Cleansers: All three cleansers have ingredients that I do not recommend for topical use. The Clinique one contains low amounts of menthol, which as I explained to Mia last week, is a potent irritant even in lower doses. And considering how easily Emma’s skin is irritated, I’d definitely suggest discontinue use of this. The two Simple products, use a type of preservative that may not be safe. It uses something called Bronopol (listed with its IUPAC name 2-bromo-2-nitropropane-1,3-diol), which has been shown to form nitrosamines. For any science buffs interested, Bronopol decomposes in water and forms bromoethanol, which will react with any secondary amides and amines, in this case the amides in the ingredient Disodium EDTA that’s present, to form nitrosamines. Nitrosamine is carcinogenic and should therefore, be avoided. I’m not trying to scare anyone, unlike those paraben claims, because unlike those, the amounts that can form in skin care products, are up to tens of parts per billion, which are significant enough to be considered toxic by various regulating agencies. That’s why this ingredient is rarely used in personal care products anymore. But to put everyone at ease, even ingredients deemed as “carcinogenic” require repeated exposure to manifest any physical effects, so relax. It’s not like we’re talking about plutonium here! However, I’d strongly suggest discontinue use, just to avoid any future problems. 

I also see that the Clarisonic is used. I did a mini-review of this device in Jessica’s routine (here). For Emma, I’d recommend discontinue use of this as well. Physical exfoliation will only aggravate any existing acne, and combined with the irritating menthol in the Clinique cleanser and the alcohol in the following toner, may have largely (but reversibly) wrecked Emma’s skin.  

Toner: As many of my long-time readers hopefully know, I first started out using the Clinique 3-Step. (See the “My Story & Routinepage if you don’t.) The alcohol in this toner was just too intensely irritating for my skin, and will be for Emma’s skin, despite the fact that this contains salicylic acid. As I also said in my second Temptalia post (here), with the exception of blackheads and whiteheads, acne is an inflammatory condition. Anything that promotes inflammation, like drying ethanol, will exacerbate the condition itself. I’d suggest discontinue use of this product as well.  

Moisturizers: The Proactiv Moisturizer with SPF 15 is a decent sunscreen with a combination of physical and chemical sun protection components. However, it may not be the most suitable product for Emma, who has very sensitive and acne-prone skin. One, it contains a high amount of diethylhexyl sebacate, which is a thickener and contains a castor oil derivative (sebacic acid). Castor oil, while great for dry lips, can be quite pore-clogging due to its similarities to sebum, and therefore shouldn’t be used for Emma, who is acne prone. Second, this contains a chemical sunscreen and I’d prefer it if Emma were to use an all mineral-based sunscreen, because physical sunscreens won’t irritate the skin. It’s all about calming Emma’s condition. Also, the 3% zinc oxide in my opinion, is just not enough UVA protection. Third, this contains methylisothiazolinone, which is a preservative that has been known to cause contact dermatitis, or in other words inflammation of the skin. And being a product that’s left on the skin, the chances of irritation are even higher. So away this goes, please!

The Clinique DDMG is a decent moisturizer that contains a tiny amount of vitamin E and the calming cucumber and chamomile extracts. However, that’s all there is to it. I think Emma deserves better than that! It is well-priced though, for a department store product.

Acne Treatments: I don’t know which specific benzoyl peroxide treatment is used, so I can’t comment on the other ingredients present that may be irritating. Benzoyl peroxide in itself however, is quite irritating because it releases ROS species, like I said in my second Temptalia post. Furthermore, because it makes the skin more sensitive to sunlight and therefore its UV rays, please Emma, don’t use this during the day. I’d suggest removing it completely, but dabbing it onto just existing spots is acceptable and effective.

Adapalene, unlike tretinoin, is remarkable in the sense that it doesn’t oxidize under direct light OR in the presence of benzoyl peroxide. This is because of the introduction of aromatic rings in place of the weak double-bonds present in the polyunsaturated carbon chain of tretinoin. This characteristic is what makes adapalene a third-generation retinoid. However, adapalene still makes the skin more sensitive to the sun, so it shouldn’t be used during the daytime. I’m sure Emma’s GP should have told her this… But more on the GP later. And both tretinoin and adapalene are not necessary, especially for concurrent use, unless Emma was instructed to do so. One retinoid of proper strength and target, should suffice.

Spot Treatment: The Dr. Spot product contains lots of alcohol, which I just discussed, and witch hazel, which I discussed in Mia’s routine (here). They are just irritating and not the most beneficial ingredients for Emma’s condition. And while this product contain a nice blend of hydroxy acids (lactic, salicylic), I don’t know the pH, so who knows if it’s even low enough to allow for exfoliation. Finally, there’s the odd inclusion of castor oil, which is completely baffling since this product is marketed as an ACNE SPOT treatment! Again, I’d recommend for Emma to cease use.

Mask: The Proactiv mask is acceptable. Sulfur can be helpful because it breaks down keratin by interacting with the cysteine content in keratinocytes, which are cells on the surface of the epidermis. It can also be irritating, but since this is only used twice a week, its inclusion is like I said, acceptable.

Discussion:

Like I said in Mia’s routine review, many of the ingredients present in the current routine have been documented to be quite irritating. This fact could have caused the redness in Emma’s skin and worsened her acne. However, Emma was brave enough to submit two photos, and while I’m not a doctor by any means, the inclusion of that evidence combined with the written documentation provided, makes me want to say that Emma has rosacea, not acne. Or perhaps she has both. I don’t have the clinical experience or knowledge to make that kind of diagnosis. However, I do know that the two conditions are commonly confused because they are in many cases, similar in symptom and appearance. And because her GP didn’t catch that, I’d strongly suggest seeing a dermatologist. Even if I’m wrong, there are many other reasons to see a dermatologist.

Dermatologists and GPs are vastly different when it comes to training. Both types of doctors have to obtain a four-year undergraduate degree, as well obtain a medical degree from an accredited medical school. Here’s where it becomes different. GPs only need to fulfill a one-year residency and the consequent board examination and certification in order to begin practicing. Dermatologists on the other hand, have to go through a four-year (at least in the United States) dermatology residency program. Furthermore, dermatologists will typically follow that with a one or two year fellowship where they further specialize in fields such as laser therapy, cosmetic surgery, etc… So the knowledge and experience that comes with this kind of training, is invaluable.

One more thing about Emma’s routine. If she does indeed have rosacea, then the use of topical retinoids like adapalene and tretinoin should be stopped. Rosacea has a documented history of not responding well to retinoids just because they are so irritating to the skin. All subtypes of rosacea are the result of inflammation, so glycolic acid chemical treatments probably wouldn’t work either.

There are other reason why I think Emma should see a dermatologist instead of her GP, but that’ll be discussed in the next section.

Recommendation:

First, I will give my own personal and basic topical recommendations that can be used for someone with either acne or rosacea. Then, I will give suggestions as to what kind of questions Emma can ask a dermatologist, if she so chooses. (Please do!)

Cleanser: We need a cleanser that’s stripping enough for her oily skin, but not so harsh to disturb the epidermal barrier and cause irritation. (Duh, John!) I personally enjoy the Paula’s Choice Skin Balancing Oil-Reducing Cleanser. It’s got a mild, but still potent surfactant for my oily skin, along with some nice thickeners like sunflower seed oil and stearic acid, which won’t clog pores in a rinse-off product, but are great at removing makeup. I only suggest this because as someone who has quite a similar skin type, this is one of the best and affordable cleansers I’ve found. Paula’s Choice frequently has sales and make sure, after trying samples to see if it is appropriate, to get the larger bottle since it’s much cheaper per ounce. Like I said, it removes face makeup quite well, and any makeup around my eyes as well. However, I don’t wear eyeshadow or liner, so a separate product may be warranted for Emma. As she seems to enjoy Clinique products, the Clinique Take the Day Off Eye Makeup Remover is excellent.

Toner: To address Emma’s acne or rosacea, something that will exfoliate the skin and not be too irritating, would definitely be salicylic acid. Try the Paula’s Choice CLEAR Extra Strength Toner, which should address the whiteheads and any future blackheads. Salicylic acid doesn’t remove existing blackheads, just because it’s not strong enough of an acid. But it’ll keep the pores clear of future ones. :) Salicylic acid also has anti-inflammatory attributes since it inhibits several cyclooxygenase enzymes, which are responsible for prostaglandin synthesis, which in turn, produce things like cytokines. Anyways, though this is the extra strength version, I don’t think it’ll be too irritating. If it is, try the regular strength or even the 1% versions.

Moisturizer: Like I said above, find a sunscreen that only utilizes minerals like titanium dioxide and zinc oxide. From personal experience it’s difficult to find one that has a light vehicular base just because an emollient one helps disperse the white cast typically seen. Like I said for the other people’s reviews, I don’t know what Emma looks for in a sunscreen under foundation, so just try to keep my recommendations in mind when looking for one. Make sure to check out my recent post about mixing sunscreens here, to see how that can help.

As for a nighttime moisturizer, we need something that’s light, but still contains things like humectants and moderate occlusive agents. Something like a serum would be appropriate. Perhaps Emma would consider trying out one from Clinique’s sister brand Estee Lauder, specifically the Nutritious Radiance Serum. It’s got some fantastic antioxidants and anti-inflammatories like green tea, pomegranate, and soy, combined with water-attracting hydrolyzed proteins and sodium hyaluronate, all wrapped up in a beautifully silky silicone and butylene glycol base.

Here’s what I want Emma’s new routine to look like:

Morning:

  • Cleanser: Paula’s Choice Skin Balancing Oil-Reducing Cleanser
  • Toner: Paula’s Choice CLEAR Extra Strength Toner
  • Moisturizer with SPF: A mineral sunscreen that has a lightweight base (If Emma or anyone has questions regarding a specific product, as always I’m here to help!)

Evening:

  • Makeup Remover: Clinique Take the Day Off Remover
  • Cleanser: Paula’s Choice Skin Balancing Oil-Reducing Cleanser
  • Toner: Paula’s Choice CLEAR Extra Strength Toner
  • *Moisturizer: Estee Lauder Nutritious Radiance Serum**

*If Emma decides to still use her original benzoyl peroxide treatment, she would apply it before the evening moisturizer. Also, after talking to her GP or dermatologist about the issues I raised with rosacea and topical retinoid use, if Emma still decides to use tretinoin or adapalene, they would also be used before the evening moisturizer. Make sure for all three, to wait at least half an hour before serum application. Also, don’t use benzoyl peroxide and tretinoin concurrently, since the former will inactivate (oxidize) the latter.

**The Proactiv mask can still be used twice a week.

Those are all the topical products I’m recommending. Perhaps after Emma’s skin is properly under control and after she sees a dermatologist, we can expand this routine and discuss things like vitamin C and hydroquinone to help rebuild collagen and reduce hyperpigmentation. Right now, the most important things to do is to take care of the acne/rosacea, which leads to my final recommendation.

PLEASE SEE A DERMATOLOGIST! On top of all the reasons that I already discussed, if Emma does indeed have rosacea (with or without the presence of acne, there are several widely used and highly successful laser treatments that a dermatologist can inform her about. There are things like intense pulsed light (IPL) and pulsed dye laser (PDL) that can largely reduce or even eliminate any facial redness. Furthermore, Emma can ask a concern that I have thus far, been unable to address, simply because I’m not a doctor. It’s that she’s curious if her condition may be a hormonal one. I didn’t think so, because she claims that breakouts are aways on her face, and don’t just appear during her monthly cycles. However, let me reiterate that, I am NO doctor whatsoever, which is even more reason to see a dermatologist. Finally, a study has shown that the use of oral antibiotics, specifically minocycline, in conjunction with oral ibuprofen (at 400 mgs and 3 times daily), an example of which is Advil, can largely improve cystic acne in people that have past histories of unsuccessful minocycline treatment. It seems that the cyclooxygenase inhibition abilities of ibuprofen are responsible. However, before Emma or anyone does anything, please consult a medical professional (dermatologist?), because who knows what kind of drug interactions and side effect may arise, especially since Emma does not currently use the antibiotic applied in that particular study. I’m just giving Emma more information to ask a DERMATOLOGIST! ;)

Conclusion:

I feel so lucky to be given the chance to help someone out! I hope Emma gives my words some consideration and that she sees a dermatologist. I’d like to once again thank Emma for being outrageously gutsy in submitting those photos. It must have been hard clicking that submit button!

Feel free to ask any questions in the comments down below. And if anyone would like for me to review his/her routine in a similar fashion, click here.

Like I’ve mentioned before in the Disclaimer, I am not a medical professional of any kind, so if you decide to follow my advise, do so knowing that you bear full responsibility.

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About John

The Triple Helixian is an unbiased science and research-based site that attempts to clarify and elucidate questions about skin care, while aspiring to be the most thorough and complete source of information.

Discussion

4 thoughts on “Come Out! (With Your Skin Care) Emma Carlton!

  1. Hi John, I’m ‘Emma’, and I really and truly cannot thank you enough!

    Since I submitted this I have been on the Yasmin pill in case my problem was hormonal, and it seems you’re in fact right, that it is NOT, because after 10 weeks, my acne has actually WORSENED, I think because I’ve stopped taking the oxytetracyline.

    I’m very interested in your ‘diagnosis’ of rosacea, it’s never been brought up by my GP, and I think it is most definitely time for me to see a dermatologist. I’m not saying all GPs are useless, however I have seen three different doctors in four years and my skin has only worsened. Looking at my skin, it IS reddy-pink underneath the red acne scars.

    I’d be interested, just as a side note, as to what you thought about diet in relation to skin? My GPs have never suggested this, but I’ve heard that cutting out dairy and wheat can see an improvement.

    I will be following all your advice, I just really look forward to the day when my skin no longer holds me back from life.

    Thank you so much.

    Posted by 'Emma' | March 6, 2012, 3:39 am
    • Hi Emma,

      You’re very welcome! And I agree that GPs aren’t useless at all. However, they just can’t help you very much evidently. In my opinion, GPs play the role of treating common aliments and act as “receptionists” when they encounter a problem they don’t know enough about. It’s their job to direct to you the correct “department” or specialist, in your case, a dermatologist! I’d love to get an update on your situation after you’ve seen a dermatologist. But of course, if you don’t feel comfortable, that’s perfectly fine! There’s absolutely no obligation!

      Also, there is a page that I’ve titled “Skin & Nutrition.” I just haven’t gotten around to it. All the pages that are unfinished take considerable time to compile and efficiently write, so that they’re not too boring, but still very informative and clear. Anyways, I plan to discuss all about food and acne and other conditions there. But to give you a quick answer, diet may very well affect acne for certain people. It’s just so difficult to prove specifically what foods because effective studies can’t be done. There are just too many factors to control and indentify. While studies have shown that things like pizza and chocolate don’t directly cause acne, those studies may not be the most accurate just because there are so many different ingredients in pizza and chocolate. And how could someone prove that “dairy” or “wheat” cause acne? Even removing all dairy products don’t prove anything, because that could mean you’re allergic or lactose-intolerant, or it could mean that during that time, you were less stressed and therefore had less acne (think the placebo effect.) Or it could be because your hormones just so happened to be stable during that period of time. There’s SO many different potential causes of acne, and it’s difficult to create a study because people are just so different! I hope that made sense Lol!! The common sense thing is to avoid things that you believe make you break out, until there are more definite answers. Stay tuned for the Nutrition page though! xD

      And it’s so satisfying for me to hear you have that kind of beautiful hope! You will get there, with or without my help!

      Posted by John | March 6, 2012, 3:43 pm
      • Thank you for your reply! Just to clarify, would you advise that I ask my GP to refer me to a dermatologist, or should I go to an independent salon/office?

        I’ll certainly update you – I can in fact update you a bit now. I took advice you gave to other people on this blog and your Temptalia posts and I bought the BHA 2% gel from Paula’s Choice. I wasn’t using it properly for a few weeks, I was putting my products on in the wrong order so they were just failing, but now I’ve been using it for a few weeks after toner, before moisturiser, and I do think that my pores are decreasing in size. I also bought about 4/5 weeks ago a Paula’s Choice toner, not the one you have recommended here, but her Skin Balancing Toner, and I like to think that this toner in combination with the BHA has been helping my pores a bit.

        The main problem I have now is that the amount of blemishes has INCREASED from what I originally told you – from 2/4 to more like 6-8 on average, since I started taking the Yasmin pill. I’m just so annoyed that it’s worsened. I thought, probably naïvely, that I would see a big difference around hormonal times with my acne, but now it’s just really bad for about 3 weeks every month. I’m definitely going back on oxytetracycline, which brings me to my next question – should I be asking for a stronger antibiotic? I’ve read that it’s the most ineffective of all possible ones you can be prescribed. Feel free to send me to another page if you’ve already answered this!

        Sorry to pester you with questions, you’ve already helped me so much with my routine!

        I will absolutely wait patiently for your page on nutrition. I was also given information by my GP that there wasn’t evidence about correlations between diet and wearing ‘greasy’ make-up and acne, but I’m sceptical about everything now! I’m very stressed and sleep very badly so I’m sure that impacts on my skin, but I only drink water (which is supposed to be good for skin apparently??) and I don’t ever eat fast food or butter etc. so I’m just really trying to discover WHY this has happened to my skin. That’s why I’m so annoyed that the Yasmin hasn’t worked (yet, maybe), because I really thought that hormones were behind this.

        Thanks again, for everything!

        Posted by 'Emma' | March 7, 2012, 7:42 am
        • You’re welcome.

          As to your questions about the GP. I think it’d be wise to accept both. Let your GP refer to you someone, and then do a litle digging in his/her background. And why would it hurt to look up your own salon/office as well?

          Now the BHA 2% gel from PC is just a thicker version of the toner that I recommended for you in the routine review. The Skin Balancing Toner is just to hydrate the skin. It doesn’t actually contain any acne-fighting ingredients (though niacinamide may help). The CLEAR toner that I recommended for you contains 2% salicylic acid, and is a lot thinner than the gel version. But they both contains 2% salicylic acid. I think you may have gotten a bit confused about that. And it’s understandable since Paula has so many different types of exfoliants in different vehicles.

          And I’m sorry to hear that your acne as worsened. As you say, it may be from the Yasmin pill. I’d suggest going off it after that fact as been validated by a dermatologist. I’d strongly suggest not just taking yourself off meds and switching around without validation from a medical professional, which is why I’d like for you to see a dermatologist. Same goes for the oral antibiotics. The different times of antibiotics aren’t strictly just categorized by strength. They have various properties that are used to treat different types of acne and they can also vary depending on your physiological characteristics. There’s so many aspects, so once again, please go see a dermatologist about this. I’m sorry to keep telling you this lol! But it’s the truth. Derms just have so much more information that’d we’d be unable to obtain.

          And the GP is right that there isn’t any evidence, but that doesn’t make it true. It just means it hasn’t been discovered yet, just because like I said in my previous responses to you that, it’s so difficult to conduct accurate studies.

          I hope that helped, and good luck with finding a great derm, because unfortunately, they’re not all made equally. :(

          Posted by John | March 7, 2012, 10:24 pm

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