Sep 23, 2021

TRANSCRIPT

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 Michelle Tarbox. I'm an associate professor of dermatology and dermatopathology at Texas Tech University Health Sciences Center in beautiful, sunny Lubbock, Texas. And joining me is . . .

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

Dr. Tarbox: We had a great idea for an episode that actually came from the inestimable Lindsey Johnson, who is Luke's wonderful wife. And she suggested that we actually talk about our personal skin care routines.

Dr. Johnson: That's right. So I'm more interested in yours, Michelle, because I already know what mine is.

Dr. Tarbox: All right. So I'm going to kind of go through a weekday skin care routine. I wake up in the morning, and of course the first thing I want to do is cleanse my skin because over the night you have potentially a little bit of perspiration and it's good to start the day with a nice, fresh, clean face. So I like to wake up and kind of gently cleanse my face. One of the ways I like to do that is with my micellar cleansing water. That's much more gentle than any kind of detergent to your skin. It doesn't strip the natural oils as much, but still provides a nice, clean face.

And so I like the simple product line because they're very hypoallergenic. They don't have a lot of complex chemical ingredients. They are not fragranced. So I'll use that micellar water to cleanse the skin on either a little cotton like pad or on a little cotton ball. If I'm running late and I don't have time for my normal, I will actually grab one of their pre-moistened facial towelettes that's also made by that same company, that simple cleansing wipe and kind of cleanse my face off before I put on my morning moisturizer.

Dr. Johnson: We should say that nobody is paying us. We're not sponsored by any of these products. We just thought it would be nice for you guys to know the specific things that we used. And Michelle, I'm sorry that I don't know the answer to this, but what is micellar water?

Dr. Tarbox: Micellar water actually is water that has little tiny, micelles that help sort of encapsulate and remove particles of like, you know, soil from the face. They help to improve the skin health and cleanse sort of deep down into the pores without really chemically or severely stripping the skin of their oils. So it's a very nice, gentle way to cleanse the skin. And micellar water can be found from lots of different manufacturers.

Garnier makes a really nice one. There are, you know, different products available similarly from La Roche-Posay as well as Philosophy. But I just like the simple product because it's not terribly expensive, it's easy to find, and the ingredients are nice and well put together. So I really do like that product line. And I think it's a very nice way to cleanse the skin. Micellar water has also got some benefits in terms of leaving the normal skin barrier intact and not causing a big change in the skin's pH that could cause irritation. So I do like to use that to cleanse the face in the morning.

And then I like to put on a gentle moisturizer that contains a sunscreen. So one of my go-tos is CeraVe AM. It's a product that has hyaluronic acid as a facial moisturizer, along with some niacinamide and some gentle sunscreens.

So after all of that in the morning, sometimes I'll put on a little bit of makeup if I want to look extra special. I have a couple of different ones that I really like. But most of the time I'm using something along the lines of the bareMinerals powders. I like those a lot. They don't tend to cake or leave any kind of heaviness on the skin, and they give a nice, gentle finish.

The other products I'll use in the morning, you know, I usually use just a little bit of mascara. There's a very nice hypoallergenic one made by Neutrogena that I like quite a lot. During pandemic times, I'm not really doing a whole lot of other makeup because no one would see it. And so I'm trying not to leave a whole bunch of stuff under the mask to get sort of just pushed into my face. So my mornings are pretty straightforward and simple.

Dr. Johnson: Do you have a specific mask that you wear? Do we need to talk about mask routines and hygiene in this episode?

Dr. Tarbox: Well, the biggest thing about masks is that I use a clean one. You've got to have a clean mask every single day, because if you're reusing masks, if you're reusing a sort of paper mask, you might be putting oils and contaminants onto the face from the previous day. If you're wearing fabric masks, you want to make sure that they're clean and that you're using a gentle skin detergent.

So when I get home after wearing that mask all day long, I'll also cleanse my face again, often using that micellar water or a facial wipe, just depending on how much I need to do and how much I need to get on with my evening. After that, if I'm not going to be out in the sun again, I like to use my nice, gentle moisturizer. One of my favorite ones is by La Roche-Posay, which sounds very bougie, but it's actually a very reasonably-priced skincare line.

So it's La Roche-Posay's Toleriane Double Repair Face Moisturizer. I really like this moisturizer for a couple of reasons. It's called Double Repair because it actually has some really healthy skin ingredients in it, including ceramides and niacinamide and glycerin. So ceramides are the type of oil our skin makes to hydrate itself. It's very natural to our skin. It doesn't cause any inflammation. It doesn't alter our skin barrier in any way. It's sort of replacing what we might be missing. Niacinamide is skin healthy B vitamin that helps our skin recover from sun damage as well as decreasing redness and irritation and dyspigmentation. And then glycerin, for most people, is a great humectant. It kind of pulls moisture into the skin. It helps to retain that moisture. I like the Double Repair because it actually gives up to 48 hours of hydration. It's lightweight, and it doesn't plug your pores.

So I like to have that on, on the evenings when I'm kind of relaxing at home, and then possibly before bedtime, I'll put a little bit of night cream underneath my eyes just to hydrate those extra, especially to help them to look their best and brightest in the morning.

Now in the kind of interim, I do have to say that one of my big skin care secrets is, of course, that I have worn sunblock religiously since I was actually about 14 or 15 years old and I was actually, in my dark days, a lifeguard as well as a water safety instructor. So I got to teach people about how to be safe around a pool, and one of the modules we had for our rainy days, so if we had any rain and especially any lightning, of course, we couldn't go in the pool, so we would teach different kind of safety things. And one of those modules was about sun safety.

That's one of the reasons I'm a dermatologist was learning about that and teaching about that and kind of becoming fascinated about it. So I've actually used sunscreen every single day, anytime I'm out in the, since I was a young teenager, and that's given my skin a lot of protection over time and protected it from some of the early aging you might get in beautiful, sunny Lubbock, Texas.

My other big secret for my skin is that I do love and use Botox. I consider that as part of my like wardrobe budget and makeup budget. I would rather have four months of Botox active on my face than a pair of shoes that looks beautiful in the closet, but hurts my feet. So I use that every three to four months in areas that I make over-expressive facial expressions, especially in my forehead. I was kind of taught a young lady who is always politely and intensively listening to people expresses it on her face by raising her eyebrows constantly. So I actually had very deep, horizontal lines on my forehead back all the way when I was 10 or 12 years old. And so that is one of my can't do without products is Botox.

Dr. Johnson: So overall your routine sounds fairly simple, this micellar water a couple times a day, some good moisturizers and sunscreen, and not a lot of makeup.

Dr. Tarbox: Not a whole lot of makeup most of the time. Now, sometimes if I'm doing something like, every once in a while, I'll go on television to talk about skin cancer prevention or skin impacts of certain things that are happening in the sort of zeitgeist. And then I'll actually put on more makeup. And one of the things that I'll use for television appearances is something called HD powder. HD powder makes your skin look really good on HD camera. It's designed to sort of blur and make the skin not look terrifyingly real when you're looking at a camera that has a very intensive lens that can pick up every little detail of the skin.

But HD powder as amazing as it is at making your skin look great for short periods of time can really break you out if you leave it on for any significant period of time. So if you are using HD powder, you only should have it on for the event or whatever that you're using it for. And then you do need to cleanse your skin carefully because it's not made to sit on the skin like some other skin powders are.

Dr. Johnson: Well, my routine largely centers around the fact that I've had acne for a long time. And even though I mostly don't have it anymore, thanks in a large part to a medicine called isotretinoin or Accutane, I still get the occasional pimple. So I've got some topical products that help me not get so many pimples.

So in the morning in the shower, I wash my face with a benzoyl peroxide containing cleanser. Benzoyl peroxide comes in a lot of different strengths, about 2.5% to 10%. They all seem to be about equivalent in terms of their benefit on your acne, but the higher the percentage, the more likely they are to be irritating to your skin. My skin doesn't seem very sensitive, so I just buy the generic, like 10% benzoyl peroxide cleanser, you know, from Kroger or Kirkland or Equate or whatever. So I wash my face with that in the morning.

Once a week, in the shower, I also use an anti-dandruff shampoo because I occasionally get some dandruff. The medical term for this kind of dandruff is seborrheic dermatitis. So massage that into my scalp, let it sit for five minutes before rinsing it off once a week, just seems to be enough to keep my occasional dandruff under control.

Then after I get out of the shower, I put this medicine called clindamycin lotion on my face. Again, that's to help prevent acne. You need a prescription for that. And then I also put on a "daily facial moisturizer." Those called daily facial moisturizers usually have some sunscreen in them. I actually like the same ones that you have discovered, Michelle. So I use CeraVe AM sometimes. And then the same La Roche-Posay Toleriane Double Repair thing. There's a version with sunscreen and a version without. So I, of course, use the version with sunscreen in the morning. And that's all I do in the morning, but I do put on sunscreen every day, even if I only expect to be in the sun if I I'm walking from my car into the office or something.

And then in the evening, the only thing I do is put on this medicine called tazarotene. Tazarotene is a type of medicine called a retinoid, and retinoids are very good for the skin. They help prevent acne. They're good for scars. They're good for wrinkles. They're good for blemishes. They're good for pigment alterations. They're good for what ails you.

There's over-the-counter versions. They're called retinols and retinoic acid and adapalene, and they're in a lot of over-the-counter products that have names like anti-wrinkle or anti-aging, and then there's prescription strength versions of them as well. And this tazarotene that I use is just the strongest prescription strength that's out there to help me with, you know, acne and also all those other things.

Dr. Tarbox: Now as a dermatologist, Luke and I also sometimes do other things to our skin to help erase marks from the past or help to rejuvenate it a bit. So some of those things can sound and look a little bit scary, but help our skin to look its best by engaging something called the wound healing response in the skin. So what are some adventures your skin has been on in the past, Luke?

Dr. Johnson: Well, one of the benefits of doing a dermatology residency is you get access to a bunch of fun toys. So I think four times, over the course of my three-year residency, I was treated with the CO2 laser for acne scarring. So the CO2 laser works by punching a bunch of little holes into your skin. And then as your skin repairs, it supposedly looks better than it did beforehand, especially if you had some acne scars. And I think that's really helped out with some acne scarring. I also got some microneedling done in residency, which again works via a similar principle, except instead of using lasers to poke holes in your skin it uses needles, but otherwise kind of a similar concept.

Dr. Tarbox: So I actually have also had some focal CO2. I've never had the downtime to do my full face, but I've had some focal areas that I've treated. I have a scar on my nose from having a cyst removed there when I was a child, and I have actually used the CO2 laser on that area. Sometimes I do microneedling as well. I think microneedling is a great way to help renew the skin and utilize that wound healing response. It helps with acne scars and pigment irregularities, and it's also very helpful for fine lines and blemishes.

And after that, your post-care can be very important because you don't want use anything that's too harsh or too irritating. So one of my post-procedure products that I really like is also made by La Roche-Posay. It's called Cicaplast Baume. It's kind of fun. Cicaplast Baume, it has a B5, which is a vitamin in there that helps the skin to heal. And then sometimes I will also use a little bit of like pure hyaluronic acid potentially. Or I might use a product I really like actually called Vanicream healing ointment. That's pretty gentle and inert and doesn't cause any significant irritation. There's a French company as well that has a similar product. I'm going to probably really not do a great job of saying the name of this product, but it's called Cicalfate. And I also like that product post-procedure.

I of course, like we talked about, we do the Botox and the chemical peels, which I love. All of those things can help our skin look its best over time.

Dr. Johnson: I do like Botox. It over-performs. I know it's a little bit pricey, especially since you need like 50 units, 4 times a year, and it's whatever it is, $15 a unit or something. So it is kind of pricey. But if you have the money, it's definitely worth it, in my opinion. Again, nobody is paying us.

Dr. Tarbox: Yeah, I think that, you know, you get to try a lot of things as a dermatologist. You get to see how different topical products are made. One of the most fun things I ever got to do at one of our big meetings was actually work with some of the chemical scientists to put together some of these skincare products, where they actually show you what each different additive does, why it's a part of a lot of products, what its function is, and how things go right and how they can go wrong with that different type of product line. So all sorts of different ways that these things are put together.

Simple is always sometimes better for people, especially if you have irritated skin, and you always want to add one product at a time. So it's very tempting to go out and buy like an armamentarium of brand-new skin care. But the problem is if you do that, then you might react to something, and you won't know what product you're reacting to. So adding one product at a time can be judicious as well as cost effective.

Dr. Johnson: Sometimes people will say, "You dermatologists all have such great skin. You must know all the secrets." Well, we do, but really the secrets are fairly simple — sunscreen in the morning, retinoid at night, and occasionally stuff like Botox.

Dr. Tarbox: I love Botox.

Dr. Johnson: All right. Well, that's enough Botox love for today. Thanks for hanging out with us, guys, and thanks to the University of Utah for supporting the podcast and to Texas Tech for lending us Michelle. And if you would like to listen to more, you can certainly find our archive on the University of Utah's web page among other places. And if you would like to listen to more of Michelle and I talking about much more nerdy things, we do another podcast called the "Dermasphere," where we talk about some of the latest research in clinical dermatology with an eye toward educating dermatologists, but hopefully other people would find it cool as well. We'll see you guys next time.