Come Out! (With Your Skin Care) Lisa Thompson!

Introduction:

Lisa is middle-aged and blessed with “normal” skin, meaning that she experiences only mild bouts of dry or oily skin; any deviations are likely the result of seasonal changes in the weather. But no extreme climate conditions are experienced as Lisa spends most of her time indoors. However, this doesn’t mean that Lisa has no issues when it comes to her skin. She’s concerned about the hormonal cystic acne that manifest at the jaw line, as well as the chin and cheek areas. This condition typically presents itself once every couple of weeks. However, what concerns her even more is the hyperpigmented scarring that occurs after the cysts have subsided. Her skin is very prone to discoloration, which can last for several months. Finally, she may be allergic or at least highly sensitive to benzoyl peroxide, a common topical treatment for acne relief.

Routine:

A separate morning and night routine was not indicated, so I will assume that they are one and the same.

• Cleanser: Origins Clean Energy Gentle Cleansing Oil (once to remove makeup and once again to cleanse the skin)
• Toner: Paula’s Choice Clear Regular Strength Exfoliating Toner (once a week)
• Moisturizer: Caudalie Vinexpert Radiance Day Fluid (only used during the day as Lisa feels that night cream is unnecessary; her skin feels great when she wakes up)

Review:

I personally am not a fan of cleansing oils because while they easily bind to the oils and makeup on your face (like combines with like), there’s nothing present (like a surfactant such as sodium laureth sulfate or sodium cocoyl isethionate) to remove all of that buildup, which incidentally is greater than what was initially on the surface of the skin before “cleansing.” Furthermore, any residue left behind may prevent any the ingredients in serums and moisturizers from penetrating into the skin. Fortunately, this doesn’t apply to the Origins Cleansing Oil, which contains a blend of olive, safflower, sesame, and sunflower oil to “bind” to the makeup and oil on the skin, and a PEG surfactant that allows for subsequent emulsification of those oils with water, thereby facilitating a smooth and clean rinse. If anyone’s cleansing oil doesn’t contain surfactants, be sure to rinse with a standard water-based cleanser to remove all oils and makeup. Though moderate amounts of several essential oils are present in the Origins cleanser, they’re negligent since this isn’t a leave-on product.

The Paula’s Choice Regular Strength Toner contains 2% salicylic acid without the additional penetration enhancement of methylpropanediol, which is present in the “Extra Strength” version. It’s in an appropriate pH and overall, an effective product.

Unfortunately, the Caudalie Day Fluid is not. Not only is it rated an SPF of 10 (15 is the minimum recommended by dermatologists and medical professionals around the world), it contains hardly any antioxidants to combat UV-induced damage: it only has low amounts of vitamin E and resveratrol, a polyphenolic antioxidant derived from red grapes. Not to mention that this product contains more fragrance than it does resveratrol. I cannot recommend this product and I strongly suggest that Lisa finds another product.

I’d like to point out that, and this may not have been done intentionally on Lisa’s part, but the majority (2/3rds) of the routine are from brands that have a “natural/organic” slant to their marketing. I can wholeheartedly assure everyone that that’s all there is to it! It’s just marketing; it’s another avenue that skin care companies pursue in the hopes that more people will purchase their products. And “natural” ingredients are not necessarily better than synthetic ingredients, if they in fact are “natural.” For example, the Caudalie Day Fluid uses chemical sunscreen actives, which are about as natural as plastic. You’d think that a natural/organic brand would use mineral sunscreen actives… at least those occur in nature. But this is a whole other discussion. I’d just like for Lisa to briefly understand this concept, in case she was drawn by this type of marketing.

Discussion:

As we age, hormone levels will inevitably being to fluctuate. Testosterone in men tends to gradually decrease at a more or less, linear pace. Estrogen in women on the other hand, tends to initially decrease at a similar rate, followed by a sharp plunge, which is known as menopause. As discussed in my second Temptalia post (here), hormonal acne in women can be caused by decreasing levels of estrogen, which unmask the effects of androgens. Androgens prolong inflammation, while estrogens do they opposite: they are anti-inflammatory. Furthermore, androgens stimulate the sebaceous glands to produce sebum. Refer to the Temptalia post again for how acne sebum plays a role in acne formation. 

Now, Lisa is only using the salicylic acid toner once a week and that may not be enough, especially before and during times of acne eruptions. If the 2% concentration is too potent and irritating, products containing lower doses are readily available.

Retinoids are also an option. Since Lisa has sensitive skin, I’d suggest starting off with a retinol product; retinol is a precursor to tretinoin, the active ingredient in Retin-A. Retinoids have so many benefits that address acne and aging, such as normalization of exfoliation and inhibition of the production of several collagen-catabolizing enzymes such as collagenase, to name a few.

Finally, there is of course the option of oral contraceptives or hormone replacement therapy. Not only can it help acne breakouts, but it can slow down the skin’s natural aging mechanisms exemplified by the thinning of the skin, atrophy, and loss of elasticity. In addition, since there are so many hormone receptors throughout the body, it can help prevent bone loss or osteoporosis. Clearly, this is something that needs to be consulted with a doctor and he/she will evaluate what steps to take on a case-by-case basis. Like most drugs, there are downsides and side effects. Never do anything rash when it comes to prescription drugs since there are ways of obtaining them without a prescription…

As for the skin discoloration issues, what Lisa is experiencing is called postinflammatory pigment alteration, which is often seen in people with sensitive skin after a wave of acne or an allergic reaction. What happens is that melanin production increases after damage to the skin occurs. This particular combination of sensitivity and hyperpigementation is difficult to treat because solutions like strong chemical peels or laser therapies will most likely worsen the condition. Therefore, only non-irritating topical ingredients (which are much slower in producing results) can be used. Things like hydroquinone, retinoids, and niacinamide can be quite useful. However, like I said before, the results will not come quick. Unfortunately, there isn’t much Lisa can do about the postinflammatory hyperpigmention, but to prevent future breakouts and effective sunscreen protection. If anyone is curious to see if laser treatments or chemical peels are appropriate for his/her skin types, please see a doctor or qualified professional for more specific information.

Recommendation:

Clearly, Lisa’s skin is sensitive prone to hyperpigmentation.

I’d like for Lisa to discontinue use of the Paula’s Choice Regular Strength Toner since it’s currently only used once a week and also that it contains 2% salicylic acid, which may be too strong. Besides, using a leave-on chemical exfoliator just once is week is pointless because the skin never stops exfoliating. Also, she needs to stop using the Caudalie Day Fluid. It’s expensive, ineffective, and just awful. Sorry!

I’d recommend that Lisa use the Proactiv Dark Spot Corrector, which contains 2% hydroquinone (which will lighten the skin), 4% glycolic acid (which will help with superficial hyperpigmentation and exfoliate the skin, thereby, decreasing the chances of comedones forming) at a pH of 3.3, and also small amounts of vitamins A, C, and E. All of that is suspended in a lightweight lotion formula that will quickly become dry to the touch.This should be used at nighttime. And though Lisa mentioned that she doesn’t use night creams, I think she should start using one. Though her skin feels good in the morning now, as history and her hormones will prove, it won’t be like that forever. It’s best to start with preventative maintenance, which is what skin care is all (okay mostly) about! Plus, we’re starting with a very light formula that won’t feel heavy at all.

She’s not going to like this next recommendation, but I’d like for her to expand her nighttime moisturizer list to two! I know, I know it’s a big change for her, but I know she can do it! I’d like for her to start using a retinol product, such as the Paula’s Choice Skin Balancing Super Antioxidant Concentrate Serum with Retinol, which contains high amounts of two forms of vitamin A (retinyl palmitate and retinol), as well as vitamins C (as tetrahexyldecyl ascorbate, which will alsp help address superficial hyperpigmentation issues because it inhibits the tyrosinase enzyme), and E, in addition to several other antioxidants such as astaxanthin and green tea. It’s a matte serum that dries down nicely.

Finally, with the addition of hydroquinone, glycolic acid, and retinol (and its derivative) into Lisa’s routine, a high SPF and UVA protective sunscreen is absolutely crucial! If any of products containing these ingredients is used, without the concurrent use of sunscreen, any hyperpigmentation will actually worsen! Like I said in Jessica’s review (here), I’m not recommending a particular sunscreen because I can’t know what type of makeup is worn and how well a particular sunscreens sits under makeup. I personally use a Shiseido sunscreen and Lisa can definitely try any of those out, considering her very sensitive skin, because they are all mostly mineral-based sunscreens, which are normally less irritating than their chemical relatives. 

So this is what I would like Lisa’s revised routine to look like (or at least close to):

Morning: 

• Cleanser: Origins Oil Cleanser
• Moisturizer: Sunscreen of her choice, at least with an SPF of 30 and adequate UVA protection

Evening:

• Cleanser: Origins Oil Cleanser
• Moisturizer: (Paula’s Choice Skin Balancing Super Antioxidant Serum OR Proactiv Dark Spot Corrector)*

*Like I said for Jessica last week, these two products need to be alternated every night. Do not layer or combine them as the pH necessary for glycolic acid to function will inhibit retinol’s conversion to tretinoin. (FYI: the skin can only use tretinoin, not retinol).

Conclusion:

I was fortunate enough to actually see Lisa in a photograph. She looks absolutely lovely! I can definitely see the acne scarring, so I want her to be able to wake up and smile and be happy with her skin! Whatever insecurities that she may have, I hope that we can work together to eliminate her skin from that list! Thank you Lisa, for trusting me with your information. I had a great time writing up this short post, and I hope that she and everyone else can learn a little something!

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.