Cutting through the crap (on your skin) part 1 - science and cleansers

First things first, the most important step to your skincare is cleansing your face. 

1)      1f you leave make up on your skin, that means you are leaving oil, silicone, chemical spf (my nemesis) along with all the rubbish from the environment that has become trapped in it throughout the day - namely your own oils, pollution (blow your nose after spending a day in the city and see if you'd want that left on your skin) , and bacteria particularly from phone surfaces or touching your face. None of this is beneficial to good skin. 

Yes some people may be blessed - we all know the story "ooo my friend has slept in her make up for 50 years and she still looks 12". Unfortunately "she" is a myth 

Not only will this dirt lead to problems such a blocked pores and spots, it will also increase the appearance of fine lines and wrinkles. Think of painting a wall, imagine continuously layering and layering more and more paint. Is that last layer going to look smooth and shiny? No. Its going to crack. Do you want this for your face?

This leads to issue number…

2)      If you do not remove the make up, dirt and debris and dead skin, whatever product you put on next, whether it costs £2 or £200 will be completely pointless as it will not be absorbed. You will effectively just be paying to apply nice treatments to your finger tips, which fine if all you’re hoping to do is ant age your finger prints.

Now consider you have a good habit with cleansing, are you doing more damage that the above 2 points would cause? You may well be if you are using the wrong cleanser.

Generally if you have a “normal” skin. That means, not prone to skin conditions such as acne, rosacea, eczema etc you can use pretty much anything you like…..EXCEPT foaming cleansers. Would you shampoo your face? No (and if you would, you are probably not the target audience of this blog).

I will explain the reasons behind this. Foaming cleansers contain products such as sodium laureth/lauryl sulphate as well as some new fangled derivatives of these that they like to disguise but generally end in sulphate. These strip the skin of oil. Surely this would be beneficial for acne? The answer is no. The body wants to maintain equilibrium and so if you remove oil, your body will work to make more. Just as when you pluck that pesky chin hair, 2 more will come to its funeral.

In this way, foam which strips is counter intuitive to pretty much everyone except those with a clinical oily skin, which is pretty much no one, and even for those people, there are better options.

It is a similar case with physical exfoliating cleansers. As an acne veteran I used to have an obsession with all things scrubby. I felt if I could just remove the top 500 layers of my skin, the dirt would be able to release and maybe I would find a layer that didn’t have acne. This was not the case. Acne is an inflammatory process. If you scrub and weaken the barrier of the skin, not only does this inflame it, it leads to bacteria being able to enter and boom, spots ahoy.

Similarly, if you scrub and have any dryness of sensitivity you will be left with more of it.

You are best to stick to chemical exfoliants – which I will discuss in a separate post.

It is worth noting at this point that make up wipes are banned in my skin religion. They do not effectively remove make up. They mostly contain a load of crap. They have no place in a skin care routine unless you are a drunk student and you use one whilst hugging the toilet. This is a similar case for micellar waters. A lot of them contain alcohol or other nasties. They should be used for eye make up removal only prior to a proper cleanse.

So…that’s a lot of what not to use…what SHOULD you use.

Bear in mind ALL skin is sensitive. If you use the wrong product or abuse it, it will flare up. It can also become sensitised to ingredients at any point. My skin used to be like a rhinoceros, I could put anything on it and it not cause a reaction. Now, I can’t use fragranced products, go in the sun etc. Just in the same way you can develop food allergies, the same can occur with skin.

Skin type	Cleanser type	My faves
Dry. No rosacea or acne	Anything nourishing, you are some of the few that can use a cleansing balm or oil	EMMA HARDIE Moringa Cleansing Balm https://www.cultbeauty.co.uk/emma-hardie-amazing-face-moringa-cleansing-balm-with-cleansing-cloth.html This is a solid form of balm, you scoop out a 50p size, warm it in your hands and it transforms into an oil SARAH CHAPMAN SKINESIS ULTIMATE CLEANSE https://www.lookfantastic.com/sarah-chapman-skinesis-ultimate-cleanse-100ml/11165911.html Botanics Organic Hot Cloth Cleansing Balm 97% Organic 70ml This one is pretty much undistinguishable from the significantly more expensive elemis pro collagen cleansing balm. http://www.boots.com/botanics-organic-hot-cloth-cleansing-balm-97-percent-organic-70-ml-10231452
Combination. Dry in some patches, get the occasional spot around the time of the month, maybe the odd blackhead around the nose but no whiteheads	Cream cleansers The reason why I say you should not be prone to regular blocked pores, is that a lot of these cream cleansers contain shea butter or other emollients which can cause serious cloggage problems on those prone to closed comedones. It is ok for blackheads as these are solely caused by poor cleansing habits. If the oil is exposed to the environment (which is what makes it go black), the it can easily be removed.	Lixirskin Electrogel Cleanser https://www.cultbeauty.co.uk/lixirskin-electrogel-cleanser.html Liz Earle Cleanse & Polish Hot Cloth Cleanser – oldie but goodie http://www.boots.com/liz-earle-cleanse-and-polish-hot-cloth-cleanser-100ml-10189830 MONU Gentle Cleanser https://www.lookfantastic.com/monu-gentle-cleanser-180ml/10555374.html
Oily Acne prone Closed comedones Rosacea Sensitivity Post procedure or after too much product application	Basic, fragrance free gel cleansers	CeraVe Hydrating Cleanser  http://www.boots.com/cerave-hydrating-cleanser-236ml-10246701 I only link one, as there is only one that I have found which is oil free, fragrance free, and works.
	Bear in mind, any of the other skin types can also use a generic gel cleanser too. It covers all bases, will remove the dirt from your skin but cause no irritation. The other benefit is that these are CHEEAAAPPP. So, save with your cleanser, spend on your treatment products.
People with bulletproof make up	Make up remover oil. You can use the cleansing balms or oils mentioned in the dry skin row, but you are only using it to wash off make up so I do not see the point of spending a lot of money to waste it. Similarly if you are broke to blocked pores – even blackheads – in any form, these balms will be too heavy. So à	L'OREAL PARIS DERMO EXPERTISE SKIN PERFECTION 15 SECOND MIRACLE CLEANSING OIL - ALL SKIN TYPES https://www.lookfantastic.com/l-oreal-paris-dermo-expertise-skin-perfection-15-second-miracle-cleansing-oil-all-skin-types-150ml/10766071.html This turns milky once you massage into the skin and add water. As the name suggests, it takes seconds, and you look like a hilarious panda in the process which is always a joy. You then follow with the appropriate cleanser for your skin type LA ROCHE-POSAY RESPECTISSIME WATERPROOF EYE MAKE-UP REMOVER https://www.lookfantastic.com/la-roche-posay-respectissime-waterproof-eye-make-up-remover-125ml/11355388.html

Tune in for part 2 to discuss how to get the most out of your lovely new cleanser!

The long and painful journey of Roaccutane (isotretinoin)

When I first started on Roaccutane, I searched for various peoples experiences on the drug.

The problems I found were:
1) The writers or youtube videos were mostly from people the the USA. Anyone above the poverty line in America will have been seeing a dermatologist since they were about 5, and the FDA approvals and drug doses of Roaccutane are vastly different to the UK. Both these factors meant that whilst they could be helpful, they also had to be taken with a pinch of salt.
2) The writers or youtube "stars" were all about 12. They therefore had no other skin care concerns beyond the acne. No aging to worry about. Yes I wanted to fix my acne, but I also don't have teenage skin that bounces back from anything. Similarly 99% of them had oily skin which can tolerate the same force of product as a rhino, I do not.
3) It was almost impossible to find any advice one what skincare you GENUINELY can and can't use whilst taking the drug, because they just recommend moisturiser and lipbalm...oh and the wondrous cetaphil. As a 28 year old product junkie, this was not going to cut it.

For this reason, I feel this blog post might be helpful to some thinking about starting the medication.

So, lets start on a bit of education about why acne occurs, because then the understanding of how to fix it will make more sense.

The cause of acne on a skin level has a number of facets.
1) Generally more oil is produced. This may be all over the face or in certain areas. In reality, only a very small percentage of the population have a true oily skin, and these are the only people that should be using skin care lines dedicated to acne.
2) The oil is stickier than in someone without this problem.
It is worth noting that testosterone boosts the product of oil which is why during pre menstrual or menstrual times you can get spots, particularly along the jaw line.

3) The skin cells around the "pores" - pores being the area around a hair follicle - are sticky and lazy. This means that rather than the body natural exfoliating and losing these skin cells, they stick, layer up, block the oil which naturally occurs around a hair, and cause a big blockage.

This blockage can present as a blackhead or white head (closed or open comedones)

The trapped oil as discussed above, becomes trapped and forms a white blocked area. If exposed to the air this discolours and turns dark - making a black head.

If the area becomes infected with bacteria, which is mostly likely will be as nice sticky skin cells and oil are an ideal breeding ground for bacteria, the area becomes red, inflamed, and will often contain pus. This is your spot.

I am now going to insert a few photos. Please be nice. This is my skin at its worst and at its regular slightly less than awful state.

This was at a calmer time, however you can still see all the bumps under the skin waiting to arise,
and the spots that are present are the typical ones I would get

Comedones ahoy

So I started taking my Roaccutane in October 2017. I was started on a low dose. All dermatologists do things differently, some blast you with the max dose from the start, but considering the list of side effects of isotretinoin is as long as your arm, and is powerful enough to cause foetal abnormalities, I was quite happy to start slow.

By January I was on the max dose of 60mg. In the UK Drs are only allowed to give a max of 1mg per kilo body weight, in the USA the doses can go up to double.

I noticed in the first month a bit of a "purge" of my skin. Roaccutane reduces keratin in the skin, switches off your oil glands and causes your skin to "turnover" (shed and replace itself) more quickly. Therefore all the crap that was lurking in the pores ready to give months of hell, instead gives the hell in a shorter faster burst.

That being said, I did not have a single cystic spot for the whole time I was on the medication unless it was self caused by the dreaded picking.

Very soon on, my lips felt like they were going to fall off, and I don't mean the bit of dryness you get from going out in the cold, I mean crack-until-they-bleed dry. Fortunately I had products on hand to deal with this, to the point where the dermatologist was concerned I was not metabolising the drug as my lips did not appear dry (score). Despite this, every smile or yawn caused another split and even wiping with a towel would cause a layer of skin to come off.

I used many products I probably shouldn't have which led to extreme chemical burns, then flaking like a shedding snake, then finally peeling.


My body skin did not suffer at all except for a slight bit of dryness on my knees.

Beyond the more superficial side effects, I had a constant upset stomach, my knees ached to the point I could not run for the last month of treatment and are only just recovering a month post finishing it. My feet and ankles were also extremely painful which, as someone who spends most the day on their week, was unpleasant. Whilst I had no back pain I did spend a fortune on physios to fix the various neck and shoulder pains I had. Also, your eyes will be dry, and your nose will feel like the Sahara desert but with added bleeding. Be prepared for your tissues to be blood stained for the next 6 months.

So...back to the superficial stuff.

I have made a table of things I found helpful, and REALLY not helpful as well as links to the products. Feel free to shop around for better prices.

Product	What for	Outcome
Snowfire ointment https://www.amazon.co.uk/Snowfire-Ointment-Stick-emollient-ointment/dp/B002YIXRRO	Lips, cuticles	This is the only lipbalm I have ever used at night but it became a necessity to have one in every bag, every room of the house, my car, because every other lip balm , at worst – burnt , at best – did nothing. They are also reaalllyy cheap. Bear in mind there is absolutely nothing glamourous about it. It smells funny and makes your lips a bit white. 3 months into roaccutane you wont care.
Cereve hydrating cleanser http://www.boots.com/cerave-hydrating-cleanser-236ml-10246701	Facial cleanser	Nicer to use than the bog standard Cetaphil, but is fragrance, soap, preservative etc free. This one also contains ceramides which are crucial for restoring the skins barrier which is destroyed by the sun, air con, heating, roaccutane and products you shouldn’t use when taking roaccutane…
The ordinary advanced retinoid 2% http://theordinary.com/product/rdn-advanced-retinoid-2pct-30ml	If you are concerned about aging or skin texture	Whilst I knew the roaccutane would clear the acne from the pore level, as a product junkie I was unprepared to give up the lovely smooth even skin you get from using a topical retinol. I – stupidly – tried using my usual beloved Neostrata retinol NAG and woke up looking like a beetroot with intense burning painful skin, this progressed to skin so flaky it looked like I had painted PVA glue on my face which then dried, then it all peeled off. This one by the ordinary is wonderful and causes no irritation at all.
La Roche-Posay Effaclar Duo+ 40ml http://www.boots.com/la-roche-posay-effaclar-duo-40ml-10169551 The ordinary Niacinamide 10% Zinc 1% http://theordinary.com/product/rdn-niacinamide-10pct-zinc-1pct-30ml	While your skin is still purging the crap and you have a few spots or still have the fear of getting them	The effaclar duo contains the beloved benzoyl peroxide and salicylic acid (2% - the only percentage that actually works). It vastly improved my skin before even considering roaccutane and caused no irritation whilst still on it. The Niacinamide and zinc work in a plethora of ways to hydrate, limit inflammation and calm the skin. Niacinamide also has anti-aging benefits
Skinoren 20% azelaic acid cream – prescription only https://www.pharmacy2u.co.uk/skinoren.html	Bumpy skin	Whilst the roaccutane cleared my spots and any comodones (clogged pores/bumps) on the majority of my skin, I still suffered with them on my chin. Not only is azaleic acid great for exfoliating the poor it is also a great anti-inflammatory, so much so that it is one of the front line treatments for rosacea which is about the most inflammatory cosmetic skin condition out there . It also works in preventing melasma, which I also suffer from so this was a triple winner.
Dermalogica active moist https://www.dermalogica.co.uk/active-moist/14,en_GB,pd.html La roche posay toleriane fluid http://www.boots.com/la-roche-posay-toleriane-ultra-fluide-40ml-10189529 toleriane rich LIMITED AREAS OF THE FACE ONLY https://www.lookfantastic.com/la-roche-posay-toleriane-riche-soothing-protective-cream-40ml/11091889.html	Oil free moisturisers that actually moisturise	It is beyond a struggle to find oil free products that are moisturising enough to use during the drying process of roaccutane. Similarly, if you are anything like me, I became sensitive to EVERYTHING, so fragrance was also a no no . Also be prepared to use 2 different moisturisers for different areas of your face. I do not suffer with black heads, comodones etc around my eyes and cheek bones but these dried the most so I used Toleriane rich in these areas
Hyaluronic Acid 2% + B5 http://theordinary.com/product/rdn-hyaluronic-acid-2pct-b5-30ml If you want to be fancy.. NIOD Multi molecular hyaluronic acid complex http://niod.com/product/multi-molecular-hyaluronic-complex-15ml	If a moisturiser alone is not enough	My skin has now become used to having an oil free moisturiser over the whole face, with maybe an added top up with something heavier just around the eye/cheek bone area, however there are days it needs something more. These products do not clog. Hyaluronic acid and glycerine are “humectants” i.e. they attract and hold water, up to 100’s of times their weight in water in fact. They are therefore very helpful in products to keep the skin hydrated and less like a snake shedding itself.
Vaseline body moisturiser worked perfectly fine for me. It has a slight fragrance but I believe they do a fragrance free and even with my prolonged chlorine exposure I felt moisturised even until the end of the day https://www.superdrug.com/Vaseline/Vaseline-Intensive-Care-Essential-Lotion-400ml/p/320602	Body moisturiser	I swim every day, so I was fully prepared at the start of treatment for my body skin to crack into a million pieces and fall off. I did not experience any issues. I also had waxing done on my body with no problem, but you would have to check this.
Ren evercalm ultra comforting face mask https://www.renskincare.com/uk/evercalm-ultra-comforting-rescue-mask.html	Emergency situations where you have used one of the products below that you shouldn’t have and have burned yourself like a sun dried tomato.	This was the only thing that took down redness that wasn’t a leave on product. I did not want a cream that was left on because all the healing ones are packed with oil, shea butter etc so this mask was a good compromise, particularly for times when I needed my skin to look ok, e.g. parties where I just needed it to CALM THE F*** DOWN.
SkinCeuticals Protect Sheer Mineral UV Defense SPF 50 https://www.amazon.co.uk/SkinCeuticals-Protect-Sheer-Mineral-Defense/dp/B005GK7C64 You can also get this in the tinted form as this does leave a white cast on the skin, which can be hidden by make up if needed EltaMD UV Clear Broad-Spectrum SPF 46 TINTED https://eltamd.com/product/uv-clear-broad-spectrum-spf-46/	Sunscreen	I used to HATE sunscreen. I would use it and immediately or post holiday get more spots. I realise now that the sun has a temporary anti inflammatory effect so will, whilst exposed, reduce the spot size. It also however increases oil production, increases the thickness of the skin and increases the cells clogging the pores. Therefore as soon as you come home BOOM even more spots than you had before which is enough to render that lovely golden tan completely pointless. Of course the sun is also extremely damaging, increasing lines, wrinkles, dark spots and cancer risk. Physical sunscreen is a must. This one caused absolutely no break outs at all. Yay
Eye drops	For dry eyes	I was prepared for hellish dry eyes, especially considering I immerse myself in diluted bleach at the pool most days, so I used these for the first month of my treatment, and didn't seem to need them beyond that! They also do some with hyaluronic acid which are meant to hydrate longer but I found these perfectly fine.
DO NOT USE  - mistakes I made
Chemical peeling agents. Glycolic acid, neat salicylic acid, retinols. This is the burn I had an several occasions...		JUST DON’T DO IT. Retinoids however I have found to be fine, see above. I would not start using them if you have never used them before however. My skin was tolerant to the much higher levels prior to taking Roaccutane
Micro needling		JUST DON’T DO IT.
Foaming face wash		Unless you want your morning and evening routine to sting like hell and for it to not matter what you put on top because the skin surface is so dry it won’t absorb anything…don’t do it.
Facial hair removal		JUST DON’T DO IT.
Oil		I realised this quite late on. It is extremely confusing to know what to do with all the beauty press urging people with oily or acne prone skin to make sure they are hydrated. Whilst an oil like the clarins lotus oil might do wonders for an unbalanced skin, a clear skin that just gets spotty due to hormones etc , on a skin with true acne it will just lead to blocked pores. It is beyond a struggle to find oil free products that are moisturising enough to use during the drying process of roaccutane
Spot squeezing		Do not do it. Do not do it with your nails, do not do it with a tool. All that happens is you peel off the layer of skin over the spot leaving a red oozy mess with the spot still happily in tact underneath

Hope this helps !! This is where I am now. I still have a bit of bumpyness on my chin however it has gone from 1000 comedones to maybe 20 and is decreasing daily.

I could have filtered this or done my hair but I wanted to show my face, in A LOT of daylight, no make up.
There is still some redness and scarring but no spots and smooth skin!

http://skinspecialistinrajendranagar.com/what-causes-acne-whats-the-difference-in-a-normal-skin-and-a-skin-with-acne/
https://www.amazon.com/Cliganic-Blackhead-Remover-Extractor-Instructions/dp/B013P26K9O

"Nice to meet you....you're the one that knows about skincare right?"

So....after the relentless pestering of all my poor colleagues who have listened to me drone on about skin care for the lengths of time that they have known me...I have decided to go ahead and do a few skin care posts. P.s. the title of the blog is the genuine opening line of a colleague I had just met, apparently my reputation proceeded me.

I am a dentist, as hopefully you all know, this mostly means I'm a massive science geek and spend 8 hours a day looking at peoples faces under a bright (and hideously unflattering) dental light.

Trust me, if you think you are having a good skin/make up day, have a look in a mirror in a dental surgery and you will see you were deluded by your softly lit vanity mirror at home. 

I have therefore spent a lot of time mentally diagnosing skin conditions, and whilst my degree only ethically warrants me giving patients advice about medical skin concerns, e.g. referrals for potential skin cancers, treatment for angular chelitis (cracked mouth corners), I have come to learn and see the vast issues people have with their skin. 

At the same time, I am an absolute skin care obsessive. Ask my parents and more recently my boyfriend, and they will advise you that my bathroom storage takes up more space than my wardobes (well not quite, I do also have a bit of a primark addiction but that's a separate matter).

I am a bona fide skin care product junkie. A day rarely goes by when I am not trying a new product or routine, and unlike all the make up plastered, ad smattered, youtube "gurus", I do not get sent anything for free nor am I paid for it.

It all comes from having acne for the last 15 years.

It started when I was 11 and there was no stop to it. I tried EVERY product on the market, I tried every course of antibiotics, contraceptive pill and every potion from the doctors. Nothing worked and the side effects - the burnt and dry skin, the lack of money - were just not worth the effort.
 It was around 2 years ago I simplified my routine and stopped looking for products for "acne" and my skin started to settle. However there were many times - and not just limited to the time of the month - when my face would erupt in boils.

Now by acne, I mean AARRGGGHHHCNE. I do not mean the odd little white headed spot on the chin that appears for a few days each month and disappears not leaving a mark.
I mean volcanic, deep rooted, cystic acne lumps which would come up and be agonizingly painful.
My fellow acne suffers will understand the slightly pyschotic routine on first waking up in the morning, of moving and stretching their face in various directions to feel where a new monstrosity has appeared so we are somewhat mentally prepared for what might meet us in the mirror.
These lumps stay for around a week, go down, leave a hard raised area, which is often purple, they remain dormant and then re erupt at a moments notice. If said lumps aren't present, hundreds of bumps would be sat under the skin waiting to grow into their adult larger sized selves.

It was in September last year that I had had enough. I had my skin under control for the most part, but my skin care dos and dont's list was a mile long.

I couldn't fall asleep with my face in contact with skin, even if I rested my head on my hand or my partners shoulder, the next day there would be a crop of spots in the area. If I ate dairy in any form, the same would occur bang on 48 hours after consumption. I had to wash my face immediately after exercise for fear the sweat bacteria would cause the same issue. It was all too much.

So..... I took the plunge and paid a small fortune to see a dermatologist. I wish with all my heart I had done it sooner, because this small fortune was probably only the cost of the 10 "miracle"products I would buy a month to "fix" my acne.

In October I started on Roaccutane, I finished it the second week of March and will do a separate post on my Roaccutane journey.

I am now in a position where my acne is in control, but like any good skin obsessed woman, it is now time to move onto all the other issues. Sun damage, aging, wrinkles, thread veins, scarring.

All this being said, I feel I am in a pretty good position of knowing and understanding ingredients and the science behind them, as well as having tried pretty much every product in existence from Boots to La Mer.

I have also now experienced every skin type. I have been oily in my teens, combination in my late teens and early 20s, and through the sheer joy (not) that is Roacctane I have had skin so dry it cracks like a dried up river bed on every facial expression.

And for all these issues...there is a product that will genuinely help.

For that reason, I decided to start this blog to bust some skin care myths, from a science basis, and try and help people solve their problems in a real way, because I have no beauty company funding, no sponsorship, this is not my job so I can give honest answers. I am also not an "it" girl or Daddy-funded socialite so I can recommend products from a fiver to a hundred quid.

So...let us begin. Enjoy the ride and please ask any questions.