Reader E-mails: Benzoyl Peroxide, Skin Purging, Active vs Concentration

I received my first e-mails over the weekend so I thought I would answer it on here. Paraphrasing just the questions here.


"I have been on every acne medication and my prescription just increases more and more. Even my 10% Benzoyl Peroxide cream is not doing anything to hold the breakouts. I'm using maximum strength cleansers, toners, creams but my skin seems to be getting worse. I feel like the only answer is to go on Accutane, what do you suggest?"
From: Jas

I definitely think you should see a dermatologist regarding your acne. Without seeing you in person, I really can't give you a set plan. It does seem like your response to break outs is to up the ante by strengthening your products. I get the logic behind it, but in general I don't advise anyone 'fight' with their body, it never goes well. I'm assuming when you say maximum strength products, your cleansers have exfoliating acids, your toners have astringents and alcohols, and you're using a 10% BP solution. You're declaring chemical warefare on your skin. Instead, I would urge you to try and 'work' with your body by giving it a more gentle regimen.  Try to use a gentle, non stripping cleanser that won't irritate your skin or cause imbalance in sebum level. Switch your toner to a healing one that doesn't have alcohols. I know you probably see the benzoyl peroxide solution as an essential product but try to just let your blemishes go down on their own for 2 weeks. You won't see immediate changes, but I believe helping your skin heal itself will be the best thing you can do at this point. Depending on your severity, a dermatologist might prescribe Accutane but see if you can manage your skin on your own first. Just remember: your skin WANTS to be healthy, help it, don't hinder it.

"I have really sensitive skin and since switching to natural skincare, I have experienced redness and irritation. I am currently using the Marie Veronique Organics line and while I really love the ingredients and philosophy, I find my skin has broken out like never before. I contacted them to ask about it and they said that my skin is just purging, is this normal?"
From: Leah

I haven't personally used any products from MVO but I do like the ingredients list. I also see a lot of good comments for their products and I like the science behind it. What is important to remember is that every one has their own unique skin chemistry so just because the formula of a product is high quality and good, it doesn't mean that it will work with your skin. Purging and 'adjusting' can indeed happen, but if it's been over a month, your skin is no longer 'purging', I think you might be sensitive to a particular ingredient. Natural skincare is often times more potent than the alternative because you're getting less chemical fillers, so this belief that natural skincare is best for sensitive skin isn't necessarily true.

"I have been using Arcona's Night Worker which is a Vitamin C serum. I really like how it makes my skin feel but the active ingredient is ascorbic acid, which I read from La Bella Figura is a lab synthetic derived from GMO corn in China so it is less effective than a product that uses a natural complete form of Vitamin C like the one in their Modern Radiance Concentrate. Is this true?"
From: Elleco

I think using a natural complete form of any vitamin or supplement is a good idea in the same way that getting your vitamins from fruits and vegetables are preferable to getting it from a pill. Let's go beyond the large words for a minute: natural complete form just means a natural ingredient that has vitamin c, of which many ingredients in Arcona's Night Worker all contain, such as Black Currant, Evening Primrose, Borage, and Lemon. So even with all these ingredients, why would a company still choose to use Ascorbic Acid? Because although the natural ingredients do provide Vitamin C, what matters in dermatology is the concentration. Anything less than a certain threshold is not going to produce results when applied topically, and Ascorbic Acid offers a more concentrated dosage that naturals cannot provide. I understand that La Bella Figura has a product to sell and I think based off of the ingredients list, they have a great product. I don't think they mean to be misleading but the conclusion they drew comparing a natural whole source Vitamin C to being an effective topical active is indeed a fallacy. I really wish there was a better system of accountability in the natural beauty industry but as it's still very small with individual who might not have the education or industry experience to understand the intricacies of dermatology and skin care, not every statement is scientifically vetted, which leads to misinformation for the audience.

Any other questions, just e-mail me: greentechderm at gmail dot com

A Word on EWG (Environmental Working Group): Cosmetics Database

The Environmental Working Group is a company that many of you probably heard of especially if you've been on the 'natural' kick for a while now. Their skin deep database holds a lot of clout and the numbers they give out for safety are the human equivalent of a BMI number (the lower, the better). It is a very informative tool that teaches you what to avoid. Anyone who wants to use this should go to this website to see a full safety report using national and international databases.

Dermatologists that I have worked with have told me that more and more of their patients are introducing the EWG into conversation. While this access to information can be empowering, like all things, it's best to keep those numbers into perspective. The way EWG measures safety can at times be questionable and without doing some homework yourself, you might be misled by their report.

Here are some areas where misinformation can arise:

1. Natural & Synthetic

Here's an example of two shampoos who both achieved a ranked of "2" on their report, Terressentials Cool Mint Pure Earth Hair Wash and Giovanni's Magnetic Energizing Shampoo. Terressentials is for most part an all natural herb-infused mud for hair while the Giovanni shampoo uses synthetics such as Cocamidopropyl Betaine (a risk score of 5). So how did they both arrive at the same score? The Giovanni shampoo offsets their chemical with a host of herbs that rate a 0 to pull down the score. The Terressentials shampoo is flagged a '4' for their ingredient 'clay minerals' which is not identifiable to EWG, however similar natural ingredients such as Kaolin clay pass with flying colors. Because the herb-infused mud is purer, there are less ingredients to offset this outlying mark that shouldn't have been given in the first place.

So while on EWG the two look equal, in reality you're comparing a very natural mud shampoo infused with select herbs with a synthetic detergent shampoo that is loaded with herbs.

2. Double check the ingredients list

There are many times that a product will be reformulated or is entered with an error on the database. For example Hylunia recently began reformulating their products to include Phenoxyethanol, but some of the products on their database with low scores do not have this listed.

3. Read the actual concerns cited in studies

EWG relies on a broad system of studies looking for the ingredient as the key word and not the use. For instance, Aloe Vera is listed as having cancer risks yet it is one of the safest most effective skin ingredients that have been used since prehistoric times. The study in question could have been done on intravenous consumption of aloe vera and in high doses (that exceed even abnormally high concentrations) over a prolonged period of time in lab testing environments, maybe it did lead to cell mutation. This would cause it to receive that risk label, but I can assure you that even if you bathed in aloe every day of your life, it will not trigger cancer growth.

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EWG is a wonderful tool but like all tools designed to help us, we have to know how to use it effectively otherwise it could get in the way. It's important to note that EWG is constantly working to improve and tune it's metrics which I applaud.

Vitamin A: Myth vs Facts Retinoic Acid & Natural Retinols

Vitamin A has become the go to source for most skin concerns. Wrinkles? Sagging skin? Apply some Retinols! Acne and breakouts? Tazorac! Indeed Vitamin A can be a very powerful active in improving skin health but many people have become a little unclear due to all the noise out there so this is a list of the most commonly asked questions I get.

Why all the different names?

The most common form of active Vitamin A for topical application is Retinoic Acid. It's what you're most likely to be prescribed by your dermatologist, although it might be branded as Retin-A, Renova, Tazorac, etc. For the most part this branding makes little difference and the formulas are pretty similar. Some skin types will take better to others, and most dermatologists (if they're not contracted with a specific brand) are happy to provide you with samples from different brands to try out. It's worthwhile to ask about insurance coverage as some will cover specific brands which can save you a lot of money in the long run.

What does it do?

Retinoic Acid is used to treat wrinkles, fine lines, age spots, sun damage, and acne, so this is why it's seen as a cure all for most skin concerns. Research has shown that retinoic acid restores elastin fibers, stimulates collagen growth, and increases cell turnover which help renew mature skin, making it firmer and more youthful. For acne, the acid helps breaks down dead skin cells and induce new skin cells which helps remove pore clogging debris and heal the marks that zits can leave behind. Stronger concentrations of retinoic acid can also deplete sebum levels which means acne is less likely to be triggered.

What are the side-effects?

Everyone will respond differently to everything. That's just the nature of the beast. Even with different brands of Retinoic Acid, people will respond differently and it has little to do the actual quality of the product. General side-effects of retinoic acid include photo-sensitivity, skin sensitivity, dry skin/flaking, redness, and some people might experience initial breakouts.

What form of retinoic acid should I use?

The ingredients list is only somewhat different and the active Retinoic Acid will be at most at a 5% concentration (though you will very likely start out on something way less concentrated). For dry and sensitive skin types, ask for a cream formula as they're less drying. For acne prone and oily skin, ask for a gel formula as they'll be lighter on your skin.

Start off on the retinoic acid every other night, applying only to the areas you'd like to treat.

Is it true that long term use will make my skin thinner?

This perception mainly comes from the fact that retinoic acid sloughs off dead skin cells, so people think it will just eat away at epidermal layers. This is incorrect. In fact, retinoic acid has been shown to boost collagen synthesis so if anything, you should notice thicker, stronger skin.

Can I use retinoic acid in the day time?

I wouldn't advise it, but if you do, you should absolutely apply a strong sunscreen and stay out of the sun. Retinoic Acid is instable in sunlight meaning at best it will be rendered ineffective, and at worst it will generate skin damage. The photo-sensitivity caused by retinols is attributed to this quality and also that the skin regenerative properties mean new skin is particularly vulnerable to exposure.

I am using products that contain natural retinols, is this different?

Yes and no. There are companies like Intelligent Nutrients, Pai, Ren, and Yuli who use naturally derived retinols. They have similar benefits as retinoic acid but structurally, these are different from Retinoic Acid which is a synthetic chemical. There are some key advantages to using these:

• More readily absorbed, meaning you won't experience the sensitivity/irritation with naturals as you would with Retinoic Acid because these synthetic chemicals are harsher for skin while the naturals are in a form that skin can break down and utilize. 
• More stable under sun light, meaning your skin will not be as prone to photo-sensitivity because the chemicals that cause Retinoic Acid to breakdown under sunlight and be instable are not present in natural retinols. Natural retinols are not only more stable and resist breakdown, but many are anti-oxidants which protect against sun damage and free radicals. 

Like synthetic retinols, these natural retinols have similar benefits for skin. So your skin will experience increased skin turnover which does mean that it will be more prone to exposure. However this is fairly minimal and is generally not the factor that causes discomfort. Applying a sunscreen of SPF 30+ should be enough to offset this. And in Yuli's case their formula also contains skin protecting ingredients such as avocado oil, so they covered their bases to the degree where I am comfortable recommending these products as suitable for day and night use. The minor setback for many of these naturals are that the trade-off to the irritation and sensitivity is that these naturals are not as concentrated as something like a 10% Retin-A Gel, but you will see gradual improvement that could be even more advantageous over long-term comparison since the natural retinols often carry other "phyto-nutrients" that science is only beginning to untap.

Having a natural version of retinols in a concentrated formula gives you the effective power of retinols that us dermatologists love, but in a safer and less irritating way as your skin can more efficiently utilize this stable form. This is one of the reasons why I am an advocate for doing things the natural way.