Wednesday, 29 April 2015

Confused skin: what do you treat first? And with what product?


Only a very select few have what would be termed 'normal skin'. Which is why I find it odd it is called 'normal'. It's far from the norm for most people!

For the rest of us, there are multiple issues to contend with. Pigmentation, dry, oily, combination, sensitive, rosacea, dehydrated - you name it, you probably have at least one of them. 

But what if you have more than one? What if you have 3 of them? FOUR of them?
It would not be uncommon to see a dehydrated, hyper-pigmented, sensitive, ageing skin with hormonal breakouts. Dr Leslie Baumann wrote about her 16 skin types years ago - and she was spot on, although I think there's more than that..

What do you do in that situation? 

You treat by the potential your issue has to cause pain and/or long-lasting damage such as scarring or broken capillaries.

For that reason, the first thing you do is take care of the sensitivity/rosacea. Inflammation will exacerbate the rest of your issues. For example, if you had rosacea and acne, and used a foaming traditional acne 'wash', your cheeks would scream at you. That's not good. That's not what you need or want for your face.

Sensitivity is King. Best product choice: moisturiser for sensitivity.

Followed by Dehydration. A dehydrated skin drinks anything you put on it, but you have to do it repeatedly. Your anti-ageing serums end up just filling a gap in your skin rather than actually doing their job. 
If you are dehydrated, which 95% of us are, you need to treat the dehydration. You can leave the house in the morning with a perfectly hydrated, bouncy face and be dehydrated to the point of it showing on facial machinery by mid-morning. No matter what you do, what you use, how old you are, and your lifestyle, you can be dehydrated just by waking up. 

Dehydration is Queen. Best product choice: the toning phase - both acid and spritz and serum. Acid on cotton pads to gently strip it back and spritzes and hyaluronic acid serums to follow. Neither of these two products should irritate any of the other issues....

Then you can start to be more general. 

As long as you are keeping your redness under control and your skin hydrated you can tackle anything. But the best product choices for these skin types/conditions are, for the most part...

Dry - facial oils and oil in products including balm cleansers - no foam, ever. Dryness frequently crosses issues with dehydration - if you're both, treat both simultaneously and if you are unsure which you are read this: Cheat Sheet - Dry or Dehydrated
Ageing - targeted serums - think *retinoids* and peptides
Pigmented - dedicated serums for pigmentation and retinoids and SPF (not suggesting you don't use SPF normally, it's just the priority if you scar easily, get sun spots etc)
Oily - acid toners and essences are great as are the right moisturiser. Don't over-embrace oil-free and foaming. 
Acne - acid toning phase is key, as is your moisturiser. Please, please think carefully about how you will go about replenishing the oils in your skin if you use an oil-free moisturiser. If you want to try and keep your oil under control by mid-afternoon, use an oil-free moisturiser if you want to - but use a facial oil dedicated for acne/combination underneath it. I promise a drop or two can make all the difference. We're ahead of the game now, the market has plenty. The old 'foam wash, strip tone, oil-free moisturiser' routine is dead and buried. Or should be.

And finally, a special mention to the sufferers of melasma - or chloasma as it may be called by your midwife if you're pregnant. Melasma and pigmentation are different things. Pigmentation, for example, can be caused by sun damage, acne scarring, picking spots or inflammation and can normally be treated with topical products - glycolic, kojic and azaleic acids, retinoids, and licorice for example with some success.
Your best product choices would be peels, targeted serums containing those ingredients and SPF.
And if you still get no joy, go to a dermatologist before you spend any more cash and see if it isn't in fact...

Melasma can be triggered by those things but is also linked to hormones (hence the link to pregnancy, the pill and peri-menopausal women), illnesses, such as Addison's Disease, Lupus and Celiac disease among many others. Female sufferers outnumber male 9 to 1.
It's basically your melanocytes throwing their toys out of the pram by doing this:


Instead of behaving politely like this:


Something that Into the Gloss managed to misinform its readers of last week by recommending $300 serums to treat melasma:



Sali*, a melasma sufferer, tried to get them to talk about it/correct the piece, to no avail.

You best product recommendation for melasma is time, a laser and sun block. I had mild melasma with pregnancy, it eventually cleared up on its own. Some people aren't that lucky.
Yes, peels (clinical) can help, but if you want it gone, it's a laser. And the bad news is that even if you stay out of the sun and wear a complete sunblock, it will probably come back, because your melanocytes hate you that's what it does. Please make sure you know what you have before you part with your hard-earned cash. 














*I obviously asked Sali's permission to post these screen-grabs and mention her melasma and I refer to the ITG article purely because it led to questions from readers for both Sali and I.
www.salihughesbeauty.com

45 comments:

  1. I'm using Clinique mild & serozinc with facial oils and oil including moisturisers but am still facing mid day shine! Any other ideas as to what else I can do?

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  2. Hi Caroline!;) I was wondering what would be a good treatment for blackheads because they are really annoying and will not go away! Thanks xx

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  3. Hi Caroline. Great post. I've actually made your blog my homepage, it's far more helpful and honest than any other beauty blog / site I've come across. I've tweeted you a few times as I'm SO fed up with my skin and my routine at the moment. After going shopping to give my routine a revamp

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  4. Hi Caroline!

    I know you're a super busy woman! But can you recommend any moisturisers for acne prone skin. I'm currently using the Avene Cleanance Mat Oil Free Moisturiser (please don't kill me!) but I have searched high and low for moisturisers for acne oily skin but haven't found one that doesn't contain ingredients that may cause problems for my acne.

    Thank you so much!

    Kind regards,

    Julie

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    1. I second this request for moisturizers for acne/oily skin. I feel so overwhelmed as I search for one.

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    2. I second the request as well. When I run ingredient lists on cosDNA, the red numbers always scare me into giving up on a product (probably a good thing tho). Could you please recommend both moisturizers for day and oils for night? Thank you!

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    3. (Sorry if posted again but can't find my original reply) I second this list too please! Especially moisturizers for the oily dehydrated acne prone skin for hot weather!! Also, do you still recommend the current Darphin purifying balm for problematic skin? When would you use this (or does it even matter) - right after hydrating toner, before serums or reverse? Thanks so much! You're the best!!

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    4. I have had this same problem for years but i can recommend Hydraluron moisture jelly and Clinique moisture surge extended thirst relief. if you have really sensitive skin Bioderma Sensibio Light is amazing.

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  5. I was assured and promised by a lady on the Clinique counter that a certain cleanser would be fine for my skin which I had mentioned had in the past had a reaction from some if their products. I ended up spending £40 on products, went home and had a horrible reaction. Itchy, red skin and my eyes were actually in pain they stung so much.

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    1. They don't advertise it, but Clinique is one brand whose policy is to accept returns/give refunds for products that provoke an allergic reaction (I'm speaking about the UK). So definitely take it back to that counter!

      ~El

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    2. This also applies to all other brands under the Estée Lauder Companies umbrella btw.

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    3. Thanks so much for the tip :)

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  6. I had to take an antihistamine. So disappointed and fed up now. I would just love it if you could recommend a routine fir me. I have oily / combo skin with hormonal breakouts around chin and jawline. My cheeks have also become super sensitive, redness and fairly reactive, with little red pimples appearing. It's so difficult to try and get a routine together with so many skin concerns and after such a disaster buying products from a beauty hall I really could do with some honest and helpful advice xx

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  7. What kind of laser best treats melasma? I've tried IPL/BBL with no result and certainly don't want to aggravate the situation with the wrong treatment. My daughter is three and a half and I stopped the pill last August, but no improvement yet. I'd trust your word over the person trying to sell me a laser treatment package! Thanks.

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    1. Hi Mary
      I'm not Hirons, obvs, but I wanted to butt in here and say that you absolutely must avoid Fraxel. A good practitioner would strongly advise against its use on skin suffering from melasma anyway, but not everyone is as ethical as they might be. Fraxel is extremely effective on many signs of ageing, but is highly likely to agitate cells and worsen your melasma. That also goes for at home versions of Fraxel, like Philips ReAura.

      As Caroline correctly points out, no topical product will work, ever (even prescription). Save your cash. Only seeing a cosmetic derm will help. They will prescribe the right treatment (laser or otherwise) as every case is different. However, the results will almost certainly not be permanent. And sunblock must be worn to protect positive results as much as is possible (they're not infallible, however. Even if you're super vigilant).

      Things like AHAs and BHAs do not affect melasma, either positively or negatively. The problem is very much below stairs and so you are free to do whatever you want up top at epidermis level. Your skin type / condition will not be affected by melasma either.

      As someone who suffers from melasma (brought on by the Dianette contraceptive pill in my twenties and here forever, with varying degrees of severity depending on the season), I can strongly recommend the Keromask range and Kevyn Aucoin Sensual Skin Enhancer for covering your patches. Pat on and always set with powder.

      Sorry for gatecrashing your blog, The Hirons!
      Love ya.
      Hughes x

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    2. Hi Sali, hope you don't mind me asking, but did your melasma happen when you were on Dianette or afterwards? Just wondering as I took Marvelon ocp for several years in my late teens/early 20's - the same point at which I wore absolutely no spf (as I didn't burn), although the melasma only showed up aged ~28. Thanks.

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    3. Thank you, Sali! Lovely to hear from you directly. I appreciate your advice, and enjoy your articles and Instagram. You've probably saved me a lot of money and wasted product. I do have a prescription retinoid, which I hope doesn't worsen things, and otherwise will use my sunblock and leave it at that, I suspect.

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    4. I have been on Dianette for most of the last 22 years and I now have dark patches on my skin. This has only just happened in the last couple of years, I have a 7 yr old and a 2 yr old. So is it pregnancy related? Is it sun damage and signs of ageing? Is it melasma? I have been looking at retinol products for days, since the Paula's Choice post, but I think I had better find out exactly what the problem is before I chuck loads of money at it. Thank you :)

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  8. You've recommended essences for oily skin but i'm still confused about what they are. I've heard of them before in the asian skincare routine, are they the same as serums or an extra step?

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    1. Essences is a cross between hydrating toner and moisturiser, in many cases, with additional benefit of a serum. Diluted serum so to speak, though not exactly that. Its not a serum with all its benefit, but can use as moisturiser if the usual one is much to heavy.

      If you follow the complete steps of asian skincare, essences is extra step in product layering and usually taken between hydrating toner and serum?

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  9. I always wished that you could do the same thing as in the Leslie Baumann book, like a quiz that would solve your skin type and recommend products. So you could get the consultation experience at home

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  10. Ahhhh this post is so helpful! Thank you!

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  11. Caroline, I love that I can come to your blog posts and learn! I learned more about skin care from reading your posts and watching your videos in the last few months then I ever have anywhere else. Thank you for sharing your vast knowledge with us!

    Kristi
    www.beloverly.com

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  12. A zillion times thank you for the melasma info. I've had it for more than 10 years and have spent a lot of money on peels and potions to try and fix it. My melasma is dermal - diagnosed by a dermatologist, no obvious trigger so probably hereditary - and I've worn broad spectrum spf50 every day for all these years plus a wide brimmed hat in summer but it's still there. I have olive skin which tans in a flash (given the chance; fried as a teenager, now 41) and so it's a huge sigh of relief to know I should focus on a solid anti aging routine for my skin type rather than chasing snake oil 'cures' trying to fix something which probably can't be fixed. Thank you both xxx

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  13. This is perfect, I really struggle with knowing what to deal with first so end up dealing with nothing! I have redness around and under my nose and broken capillaries under my nostrils, I also am dehydrated, have pigmentation marks, blackheads and fine lines (40 next year!). So I’m thinking I need to overhaul my routine – I’m thinking about this, am I missing anything?
    AM & PM cleanse – REN Evercalm/ Pai/Balance Me balm cleanser
    PM pre-cleanse- Superfacialist oil
    AM Tone – FAB Pads or Pixi Glow
    Spritz then serum – La Roche Posay Pigmentation serum or hydrating serum? (Clarins Hydraquench?)
    AM Moisturiser - Ole Henriksen Nuture Me
    PM Serum – Ole Henriksen – Truth Serum
    PM Moisturiser – Nuture Me or something with Retinoids?
    Thank you!

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  14. Thank you, thank you, thank you! This post is so über-helpful!

    But I´m really interested in your opinion about using glycolic acids on pigmentation during summer.
    My dermatologist said something like "never ever during spring and summer" but he was so terribly arrogant and barely looked at my skin... Really confused right now and I don´t want to worse things.

    Have a nice one and thank you once more!

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  15. I have the same :) SPF50 for more then a decade now, winter and summer. But the brown patches never budged; I kept track of the patterns in them (faces, triangles etc). It's a relief to recognise that it can't be fixed with peels and spf, and I'm glad I found out before I pushed my skin too far striving for something which cannot be achieved. Thank you Caroline and Sali!

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  16. This is great! My skin is dehydrated but I have pigmentation issues also, I've always favoured treating the dehydration so at least I know thats right! I'd love some recommendations on topical treatments for pigmentation that actually work. Anything that I've tried have been largely ineffectual.
    Of course I'm pregnant right now and my skin is gone completely crazy and doing things its never done before!

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  17. Re: Into The Gloss, this isn't the first time I've seen them post pseudo-scientific or just plain wrong information. They ran an article about making your own sunscreen(!) last year but took it down when a lot of people called them out on how unsafe that is. I enjoy their Top Shelf articles but I don't think any of their staff writers really know what they're talking about when it comes to scientific skincare advice. So THANK YOU Caroline for this great and informed article.

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    1. I quit reading ITG altogether after the article extolling the virtues of essential oils, where the writer advised applying them neat to the face. Er, no, really not a good idea!

      ~El

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  18. Hi, Caroline!! Txs for a really useful post!! Does this mean that I need to start layering Hydraluron plus Paul's Choice Retinol? Or use one AM and the other PM? Txs a lot!!!!!

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  19. Brilliant post, Caroline! Thank you. I'm wondering if you anticipated the "but what's more important?" avalanche to the previous post, or if that sparked this one off! *g*

    As someone with rosacea, allergies, and generally sensitive skin, I've found your order of importance to be so, so true. Taking proper care of the rosacea often means that the spots sort themselves out pretty quickly, because my overall skin is being adequately nourished. I've also found that even though I have combination skin, the sensitivity factor means that my skin dehydrates really easily, so using comforting moisturisers intended for dry skin actually works well even on my T zone, because it treats the dehydration and then moisturises. And then I add a little extra to my cheeks.

    And about spots, actually, I ran with what I learned from you on the blog here: what works best to calm ALL of my skin, and take down redness, and begin to take down those nasty under-the-skin spots, is a layer of pure sweet almond oil over my entire face and neck. It doesn't work so great under makeup necessarily - depends on the makeup - but as a night treatment, it's fantastic.

    ~El

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  20. Thank you! So many issues, different times of the month. I have been super dry and red on my chin and around my mouth and was having trouble figuring out what I should focus my energy/money/time on to get it under control.
    You are just great!

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  21. Hi!
    Do you have any recommendations for sensitive skin that is dry but also suffers from a lot of closed comedones/milia? I find that moisturisers and eye creams are the most difficult since I need something quite heavy...but then end up really clogged. I've given up on eye creams completely...and I've tried using creams marketed towards "normal" skin instead but that almost always makes me go red and itchy. I also tried a BHA but then my milia went red (??) and all scary looking so I stopped. Ah. The struggle.
    Thank you for a great post as always!

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  22. I just bought an old copy of Dr Leslie Baumann book. It was so empowering to get a better idea of my skin type and how to care for it. I'm so glad you rate her. Her website is currently being updated and hopefully soon as some of the facts in the book are out of date and a lot of the products she recommends are no longer on the market. Great post Caroline!
    I've noticed you don't address eczema that much. I have had eczema all my life, its mostly under control. Instead for the past two years I've been getting irritated cystic spots on my cheeks. The video you made with Dr Sam helped so much with that, thank you. I bought some products she recommended and think the Tri-acneal by Avene is making a huge difference. I suffer with ME so on the rare night I simply can't put it on my skin I really notice the problems returning. Which in a rambling fashion leads me to my question, how long can I keep using this product? Thanks for taking the time to read this!

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  23. Thank you for another great class Prof. Hirons! Really! Very helpful!

    Alina
    www.eclecticalu.blogspot.com

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  24. This post was so helpful!!! Thank you!

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  25. My skin is dehydrated; should I wash makeup off mid-day and reapply hyularonic treatment and moisturizer?

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  26. Thank you!! I needed this so much! I wasn't too far off the mark, except for the moisturizer.

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  27. I'm a teenager and I have these weird spots, not acne, on my chin and forehead. They never seem to go away and when I squeeze them white stuff comes out, which isn't pus, and they keep coming back. How do I get rid of them and are they clogged pores?

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    1. Yes, they are most likely clogged pores. Squeezing them will only aggravate them further and will turn them into nasty acnes. I learnt the hard way, as this was (and still is) I got acnes

      Chemical exfoliation will be your best bet.

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  28. Wonderfuly clear and informative! Thank you, again, Caroline!

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  29. That actually helps a lot for my acne-prone, dehydrated, aging skin...

    LindaLibraLoca: Beauty, Baby and Backpacking

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  30. I have rosacea. Could you please recommend a particular moisturizer that is good for sensitivity? I've tried so many! Thank you!!!

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  31. Thanks, Caroline, what a great cheat sheet!
    I never thought of adding oil to my moisturiser...

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