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Welcome to Listen to your Skin by Moon and Skin, the podcast where science meets nature to celebrate the story of your skin.
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Your skin is a living canvas, ever evolving, deeply personal and uniquely yours.
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Each week, we'll dive into the science of healthy skin, share empowering stories and uncover transformative self-care rituals.
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We're here to help you embrace every phase of your journey with confidence and care.
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Hey everyone, welcome back to this week's episode of Listen to your Skin by Moon and Skin, and I am your host, dr Jen Haley, a board certified dermatologist, and I'm so grateful to be here today because I love answering your questions.
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So, as the channel grows, we're getting so many great questions and this is what I love I eat this stuff up.
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So keep sending your questions because I want to serve you and I'm so grateful to have been partnering with Moon and Skin.
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They're doing some great things and great educational content, so any part of it that I can be, I am happy to be here.
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Okay, so we're going to start with the questions what are the best ingredients for treating acne-prone skin?
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So it's such a loaded world we live in, where there's so many products out there.
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It's so overwhelming and with marketing and names of products, there's so much false and misleading information.
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So I want you to start looking at your skincare like you look at your nutrition labels, turn it around and look for certain ingredients.
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Okay, so, when it comes to treating acne-prone skin, we want to know what type of acne we're dealing with and this will determine what ingredients you want to look for.
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So the first ingredient that I universally love for most skin types is salicylic acid.
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Salicylic acid has been around a long time.
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Encapsulated salicylic acid is really nice because it tends to be less irritating, but salicylic acid it's a beta hydroxy acid.
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Actually, scientifically it's a polyhydroxy acid, but you'll see most labels call it a beta hydroxy acid.
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And the reason I love it for acne prone skin is because it's drawn to oil glands.
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So, unlike alpha hydroxy acids, it this beta hydroxy either the salicylic acid, it's drawn to oil glands so it will penetrate into your pores where the clogging happens and your pores get plugged up.
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And the other thing about salicylic acid it is a keratolytic, so keratoidic being a an acid that basically breaks apart and loosens up dead skin cells.
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So if you imagine it's drawn into oil and it's attracted to the pores in the oil gland and basically what happens is.
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It loosens up all of those clogged and plugged up oil glands and then it exfoliates it off and it helps your pores look smaller.
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It helps prevent acne from forming and it removes all the dead skin cells that are plugging your pores.
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So it's really best for people who struggle with blackheads, whiteheads and clogged pores, not as good for inflammatory papules or pustules the big red juicy ones.
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It's not going to hurt those areas, but it's not going to be the hero ingredient for those type of acne lesions.
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And while salicylic acid tends to be anti-inflammatory, overuse of it which means you're using it too often or too high of a percentage can certainly be irritating to the skin.
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So I recommend most people start with a 2% formulation and you can use it in the form of a cleanser, a toner or a serum.
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So either way, if you do want to use it in a cleanser, make sure you apply it to your whole face and massage it into the pores and let it sit for two full minutes, because otherwise it's not going to do anything if you don't let it have contact with your skin for a full two minutes.
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So, salicylic acid being the first ingredient to look for if you have acne prone skin.
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The second ingredient is going to be benzoyl peroxide, so benzoyl peroxide is effective at killing the acne causing bacteria, and it works a little bit better for the inflammatory papules and pustules the red juicy bumps that we get for acne.
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I also like it if someone is prone to shaving bumps Men who get shaving bumps on their neck it's a nice product to reduce the bad bacteria that cause the shaving bumps that can lead to significant scarring.
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The thing about benzoyl peroxide, though, is that it can bleach your towels and it can bleach your eyebrows, and it can bleach your clothing and your hair.
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So just keep this in mind, and that's one of the reasons why I like it as a cleanser as well, because then it gets off your body and it doesn't soak into those areas like a serum or a gel might, so you could use it once a day or twice a day.
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So if you're someone who struggles with blackheads and whiteheads and juicy red pimples, you can use a salicylic acid cleanser once a day, a benzoyl peroxide cleanser once a day.
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Those would be really nice combinations.
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And the thing about benzoyl peroxide, though, is higher concentrations can be quite irritating to the skin and can cause a lot of dryness, redness and irritation.
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So keep in mind that higher concentrations is not necessarily more effective, it's just more irritating.
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So look for a product that contains 2.5 to 5% benzoyl peroxide.
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You don't need 10% benzoyl peroxide.
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So that's the second ingredient.
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And the third ingredient I want you to look for, which is really essential, I think, for all skin types, especially if you're struggling with acne or discoloration of your skin or looking to reduce the rate at which you age or reverse some sun damage and fine lines and wrinkles, is retinoids.
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So retinoids is it's a global term that we use for vitamin A derivatives.
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So these vitamin A derivatives, which come from nature, they can be in the form of over-the-counter, different, which used to be a prescription, called a dapoline.
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It can be in a retinol, which you can find over the counter, or it can be in prescription strength tretinoin and basically the precursors of these vitamin A derivatives turn into retinoic acid in the skin and I usually have people start with a retinol because it tends to be the least irritating and then you can graduate over time if you tolerate it.
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But retinoids are the most scientifically studied ingredients in pretty much all of skincare and they work very effectively for acne.
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They help unclog pores.
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They help reduce inflammation and they enhance cell turnover.
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They also even out skin tone and they stimulate collagen at the cellular level.
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But this enhanced cell turnover turnover.
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If you're using retinoids too much and too often and too high of a percentage, it can make your skin really inflamed and peeling and dry and it's hard to tolerate.
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So less is preferred.
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Start low and go slow.
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With retinoids, they work through nuclear cell receptors.
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So what does that mean?
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So basically, with retinoids, they work through nuclear cell receptors and that means that you don't need to have full coverage of an area in order to get benefits.
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You have to trust the science.
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You only need a small, pea-sized amount and you dot your forehead, each cheek, chin and massage it in.
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Avoid the creases around your nose, avoid the creases around your eyes and avoid the creases around your lips, because these areas the retinoids will pool and they'll enhance cell turnover to the point where it's irritating.
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The nuclear cell receptors are going to be signaled from these retinoids and help enhance cell turnover, unclog pores, stimulate collagen and lift off pigmentation more adequately than applying it everywhere.
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So the other thing about retinoids is that you don't want to use it at the same time as a benzoyl peroxide, because they counteract each other and they're not effective if you're using both of them at the same time.
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All the more reason why I like benzoyl peroxide in the form of a cleanser.
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You apply it for two minutes, let it do its job and then rinse it off, and then you can apply your retinoid at night.
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Use your salicylic acid in the morning.
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The other thing I wanted to mention about retinoids is there's a form of retinol that tends to be a hero ingredient called liposomal retinol, and this liposomal retinol it goes through the bilipid membrane of the skin without causing the peeling and the irritation to the epidermis, like a lot of traditional, less elegant formulations of retinol cause the irritation.
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So look for a liposomal retinol if you can find one in your ingredient list, and the retinol that Moon and Skin is producing has this technology in it, which is why I love it so much.
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Okay, the fourth ingredient I want you to look for is niacinamide.
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Niacinamide known as vitamin b3.
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It helps regulate oil production, it improves the skin barrier and it reduces inflammation.
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So, morning and night, it's very good at reducing inflammation, and the nice thing about niacinamide is it's tolerated by pretty much all skin types and it's great for sensitive and inflamed skin.
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The thing you should know about niacinamide is that it works with most ingredients typically, although you want to avoid using it with highly acidic products.
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So if you're applying an AHA, bha serum, you're not going to want to apply your niacinamide at the time.
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But if you are cleansing with a salicylic acid cleanser, then you can apply your niacinamide afterwards and you can layer it.
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When we layer skincare we always go from thinnest to thickest, so you start with your cleanser, then your toner, then your thinnest serum and then your moisturizer is last before sunscreen, and then the last ingredient for acne to look for is azelaic acid.
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So azelaic acid it's kind of cool.
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Azelaic acid is a natural acid that's produced by malassezia, a yeast that grows on the body, and when it's out of balance with all of the other microbiome on your body, it can produce something called tinea versicolor.
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If you've ever seen that or experienced that, it's fairly common and it can show as pink areas or white patches on the skin of the trunk and the oily areas of the body.
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And this malassezia yeast.
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It produces azelaic acid and the azelaic acid bleaches the skin white and that's why, if you've ever experienced tinea versicolor, you will notice that when you get tan, those areas don't get tan.
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And that's usually the biggest complaint I'll get when somebody comes into the office with tinea versicolor is they notice it in the summer when they're getting tan outside and that area doesn't get tan.
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So we've used this azelaic acid, this special acid produced by natural yeast, and it works actually very well for acne and it reduces redness and it also helps fade and lighten acne marks that happen after acne goes away.
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So ingredients you look for salicylic acid, benzoyl peroxide, retinoids especially your liposomal retinol niacinamide to reduce inflammation and azelaic acid.
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These are the top ingredients that you should look for if you're someone who struggles with acne.
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And before we move on to the next question, the only thing I really really want you to know as a takeaway because we live in a society where there's always going to be a new TikTok video and a new trend of somebody saying something's the best is you must stick with a plan for six to eight weeks.
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When I grab my skin, there's pimples formed deep in those layers.
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It's going to take six to eight weeks for those to purge and surface up.
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So we need to stick with the same regimen for six to eight weeks before moving on and adding anything else.
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So be patient and you will get the skin that you deserve, okay, so that's the first question.
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Now listen, if you are listening to this and you have other questions, you keep sending them to me.
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We will get to every question, because if you're wondering something, somebody else is wondering something out there.
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Okay, so the second question I got and we're going to stay in this topic of acne is should I use a moisturizer if I have oily and acne-prone skin?
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My initial response is yes.
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There's a caveat there, though, because we don't live in an absolute world, right.
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There's times that it's going to work for you, in time that it's not, but basically it's a.
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It's a common misconception that oily skin doesn't need moisturizer, when in fact it does, because skipping moisturizing can lead to increased oil production and cause even some dryness in some areas, which can cause clogging of the pores and inflammation.
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This is is why I love the Moon and Skin Moisturizer, because it has hyaluronic acid and kojic acid in it.
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What you want to look for is you want to look for something that's oil-free, you want to look for something that's non-comedogenic, and if you're very oily in the T-zone, just apply moisturizer to the periphery of your face.
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If you find that your cortisol runs a little high during the day, like mine does, you may not need moisturizer during the day, maybe just the periphery or face, or skip it but you always, always, always need to use a moisturizer at night.
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When we're sleeping at night, our body is in the regenerative and renewal phase, and this is when we really lose a lot of water.
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There's something called trans epidepidermal water loss and our skin is evaporating all of that moisture and it's a great opportunity to add hydration to the skin.
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So it pays dividends during the day.
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So you must use a moisturizer at night, but not everyone needs to use it during the day.
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So I want you to listen to your skin.
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Do you need it everywhere?
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Do you need it just on the periphery of your face?
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You just need it on your neck and your chest to help minimize the rate at which you're aging and the appearance of fine lines and wrinkles.
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So these are all things you ask yourself when you're determining if you need a moisturizer twice a day.
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But even if you're oily, even if you're acne prone, you do need a moisturizer at night.
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You just want to choose the right moisturizer that's going to be oil-free and non-comedogenic.
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So the other thing I want to bring up is that many people will notice that they'll only break out during a certain time of month.
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So in our podcast episode about skin sinking, I discussed in detail your infradian cycle and working with the infradian rhythm of your body and how your skin's needs will change throughout your monthly menstrual cycle and there are certain times a month you may need more moisturizer and there are certain times a month you might need less.
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So I want you to listen to that episode if you want the small nuances on how to take care of your skin.
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The other thing is is our skins needs are going to change through the seasons.
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So in the winter, someone who may have oily or normal skin will be more dry in the winter and someone who has drier skin is going to be more moist in the summer.
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So we will be discussing how to rotate your skin care with the seasons, and that's a great opportunity because, as I mentioned before, with acne giving it about six to eight weeks to take effect, we really want to re-address our skin care every season, every 12 weeks, and adjust it accordingly to get the best skin that we deserve.
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Let's jump into a question about foods.
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I find that the questions I get on foods are so triggering.
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So anything with nutrition is always up for debate and it's just triggering for people.
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It's fascinating to me and all I'm doing is I'm a medium, I am a channel to share scientific information with you.
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You can choose to receive this information and do with it as you please.
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Okay, I mean, even with the knowledge I have, I'm not perfect.
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I ate carrot cake the other day and I paid for it with two pimples.
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So you know you, you have the information and it will hopefully help guide you into the direction to give you beautiful skin.
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But nobody is perfect.
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So if you don't have to be perfect, you just have to do the best you can.
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So this question leans into foods.
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So what are or can certain foods trigger breakouts?
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Was the question.
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Can certain foods trigger breakouts?
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Was the question.
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Can certain foods trigger breakouts?
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When I was in medical school many, many years ago, we were told that food plays no role.
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Food plays absolutely no role in your skin health, in whether or not you get acne or anything like that, and that's not true.
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So it just makes absolutely no sense that you could take medicine in your mouth and it could magically know where to go to make you heal, but the food that we are taking in every day is not going to play a role.
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It absolutely does.
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The what we drink, what we eat, even who we kiss, determines our microbiome and the health of our gut.
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So be discerning with what you put in your mouth, and it's going to represent itself and show itself on your skin.
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So what do we know about acne, though?
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There's things we know, and there's things that you might know affect you but don't affect everyone.
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So this is an evolving area of medicine, and it's really hard to prove a lot of things with scientific studies, because when you're doing a study, you have to control for every little thing, except for that one variable to prove that it is making an effect on the skin.
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So, with acne, though, there are a few things that we do know for sure.
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High glycemic foods, high glycemic foods, foods that turn into sugar rapidly in your body are linked to acne Absolutely.
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So what does this mean?
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It's not just sugar.
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So if you go to Starbucks and you get a Frappuccino, yeah, that's high sugar, and it's going to bump up your glucose levels in your body and you're going to be more likely to get acne.
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It's also processed carbohydrates like instant oatmeal or rice or pasta or breads.
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These things convert into your body into a glucose molecule and your body identifies it as sugar, even though it's not sugar.
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When you put it in, when it's broken down by your gut, it turns into sugar in your body and goes into the bloodstream as high sugar.
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So it's really processed carbohydrates and processed foods that raise your blood glucose levels rapidly and processed foods that raise your blood glucose levels rapidly and that leads to increased inflammation and more likely to get acne.
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So I mean, I have two boys during their teenage years when it was Halloween and they binged, they'd always break out a couple days later.
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And this is just part of it and the evidence was right in front of me.
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I had patients over the years that were very well controlled.
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Their acne was well controlled and they would go home for the holidays and then they would come back and they'd have breakouts.
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So now we have good science and many studies showing that high glycemic diets, high sugar diets, high processed carbohydrate diets do cause acne.
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So if you're struggling with acne, start by going lower carb and eating real whole foods.
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You're never going to go wrong by eating real whole foods that have one ingredient Okay.
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Second thing is dairy consumption.
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This is a little less consistent, so I wouldn't say that everyone has a problem with dairy not in my experience.
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The studies do show that dairy does cause a lot of inflammation and acne in adults.
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I find it to be variable and I think that there's something going on genetically with how we're metabolizing dairy, or how the dairy can increase insulin-like growth factor one IGF-1, in the bloodstream, or how it increases insulin levels in the bloodstream as well, and it varies depending on person to person.
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There was a 2018 study in the Journal of the American Medical Association of Dermatology and it found that participants that drank skin milk so you think you're being healthier by drinking skinim milk the skim milk had a higher rate of acne.
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Skim milk tends to cause more acne than those who consumed whole or no milk, and we think that's because the lack of fat in the skim milk changes how the hormones are absorbed, causing higher IGF-1 levels and a greater insulin response with the skim milk consumption.
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So the fat actually in whole milk will reduce the rate at which the blood sugar spikes, and I'm not saying eat whole milk instead.
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Really, the only way to know if dairy is a problem for you if you struggle with acne is to stop it completely for six to eight weeks and then wait till your skin is clear and then, when you reintroduce it, you'll know if it's a problem for you.
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That's really the only way to know if it's a problem for you.
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Also, some people have more of a problem with the casein protein in dairy than the whey protein in dairy.
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So I do have some patients that they have a lot of acne and they have to avoid dairy in general, yet they have no problem with whey protein.
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So the only way you're going to know if it's going to be beneficial for you is for you to completely eliminate it.
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Do an elimination diet for six to eight weeks and then, when you're clear, reintroduce it slowly, watch for about two weeks and see if it plays a role.
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The third thing I want to mention about diet with acne is we notice that adults that have fattier and sugary processed foods basically have higher insulin levels, higher IGF, more metabolic syndrome, basically more inflammation overall, overall, and they're going to have more predisposition to acne, whereas people that have a diet that's rich in whole foods fruit, vegetables, real foods fish that has is correlated with less acne, so I want you to focus on anti-inflammatory diet, a whole food, and omega-3 fatty acids and antioxidants.
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Okay, this question is something I'm so passionate about.
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So when I was a resident, I was the only woman resident, so every woman over the age of 20 that had acne wanted to come to me.
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They didn't want to see the man doctors, they wanted to come to the female doctor.
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So I have been seeing adult hormonal acne since the 90s, and I've see I see it get more and more prevalent over time, and I know it's the environment, because I asked my mentor did you used to see this much acne in 20, 30, 40, 50 year olds?
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And he said and this was 25 years ago, and now we see even more.
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So this question has to do with hormonal breakouts, so let's talk about what hormonal breakouts are.
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So the question is how do I deal with hormonal breakouts?
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And there's ways to treat it.
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At the end of the day, though, I want you to ultimately take agency over your own health and prevent it right.
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So take agency over your own health and prevent it right.
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So, short term we treat things.
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Long term, we prevent things.
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That's the take I have on all of this.
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So what is hormonal acne?
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It's different than regular acne.
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So if a teenager has acne they might have blackheads, whiteheads, they might have big red juicy pimples, inflammatory papules and pustules.
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What I see with hormonal acne it's typically around the jaw and the chin area and they're deep, tender red cysts that happen in this sort of mask area on the chin and the jaw and they're usually pretty tender and they last a long time, like three or four weeks and when they go away they often leave discoloration afterwards that can last many, many months.
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If you're fair-skinned, it will leave a pink area and if you're dark-skinned or medium skin tone it will leave a dark area like a brown spot, sort of like what you get after you get a cut, and that post-inflammatory hyperpigmentation can often be more scarring than the acne itself.
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So the one thing is is don't pick these type of pimples, because you usually don't get anything out of them and it causes more scarring if you pick them.
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So just don't pick them.
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As far as treatment options, if you're in the office seeing a dermatologist, you can be prescribed a medication called spironolactone that basically helps block the receptors from higher circulating hormone levels in the body.
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It's not something that you should ever take without a prescription if you can get access to it on the internet nowadays, but it is something that works very effectively and I use it in the office while I give people lifestyle recommendations, because when you change your lifestyle, it takes three, four, five months to really see an effect.
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But we're playing the long game here.
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We're playing the long game of beautiful skin for life.
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So, short-term, okay to take these medications.
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Long-term, I want you to get off the medications and use lifestyle as your treatment.
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The other things we can do for hormonal acne we discussed the retinol at night and you can use benzoyl peroxide or salicylic acid in the morning.
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This is really an internal condition, though it's not so much external.
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So while the skincare can certainly help because it's going to help, especially with the retinoids, to lift off the pigmentation and prevent pigmentation from forming after the pimples go away we need to address the hormonal imbalances inside the body.
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So there is some evidence actually showing that supplementation in addition to all the dietary stuff I just answered from the previous question there are some supplements that can help with this hormonal acne in adult women, particularly around the jaw and the chin that we mentioned.
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So the first is Saw Palmetto.
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So Saw Palmetto is a prescription and not a prescription.
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It's a supplement that men often take for BPH or prosthetic hypertrophy, like in a large prostate, basically, and it works by blocking 5-alpha reductase, which is an enzyme that converts testosterone into dihydroxy testosterone, and this is a major trigger for adult hormonal acne.
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And one of the other things that the saw palmetto does is it reduces sebum or oil production.
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So sebum is basically oil production from the pores, and the saw palmetto can help reduce the sebum and make it especially useful for oily or acne prone skin or when somebody has pcos and they also have, like, hair growth in areas that they don't want.
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There was a study back in 2012 in the journal of cutaneous aesthetic surgery that found that saw palmetto helped reduce sebum or oil production and acne in individuals with oily skin, and there's another study in 2010 in complementary therapies in medicine that suggested that saw palmetto reduced androgenic activity, which can also help treat hormonal acne, and the dosage for saw palmetto is between 160 to 320 milligrams per day in these studies of the standardized extract.
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The thing is is that saw palmetto can cause digestive issues in some individuals and it's definitely not recommended during pregnancy or breastfeeding, and if androgen activity is not the cause of your hormonal activity, that's not going to be the best treatment for it.
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So you do want to have an individual evaluation to determine if this is the right supplement for you.
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Another supplement that I use a lot is called DIM, d-i-m, and it stands for diindylmethane, and this works by balancing estrogen metabolism, and this works by balancing estrogen metabolism, so this can help to reduce breakouts as well that are caused from hormonal imbalances.
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And the nice thing is that DIM is found in cruciferous vegetables like cauliflower and broccoli, and I actually love broccoli sprouts for this purpose.
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I want you to look at medicine as food, so I usually will keep some broccoli sprouts in the refrigerator and I just take a little chunk and eat them a couple times a day, and it helps with liver detoxification, so that's really, really beneficial, and there was a study back in 2011 showing in the BMC dermatology that found that DIM helped reduce acne in women with hormonal imbalances.
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The dosage is around 100 to 200 milligrams per day.
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I don't like people to be on DIM for long periods of time.
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I'll often cycle them through for three months to kind of rebalance things and then instill good lifestyle measures, and part of the lifestyle measures are reducing exposure to endocrine disrupting chemicals.
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So there's plastics, there's phthalates, there's all sorts of ingredients or chemicals in our environment that are causing us to have endocrine and hormonal disruption.
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They mimic estrogen and we want to eliminate our exposure on that, and I'm going to do a deep dive on that in the future episodes, so stay tuned for that.
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But DIM may be helpful in this category.
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There's another supplement which I I find that a lot of people can tolerate pretty well.
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Whereas the saw palmetto and the dim, it's really a case-by-case basis of who uses which supplement.
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Myo-inositol is one supplement I find I can utilize in most people with benefits, and the way myo-inositol works is it helps balance insulin levels.
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So we talked about how dairy and sugar can boost your insulin levels and cause inflammation and lead to acne.
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So the myo-inositol helps to balance this, and then it also helps to reduce insulin resistance, which is a major, major trigger for PCOS and hormonal imbalance.
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So in people who especially struggle with PCOS, I love myo-inositol.
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It can lower testosterone, it can improve ovarian function in women with PCOS and reduce hormonal imbalance and hormonal breakouts, even if you struggle with it certain times of the month.
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Myo-inositol also helps with oil production and prevent clogged pores, and it's great that they're doing studies behind all of these.
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So there's a study back in 2017 in the International Journal of Endocrinology that found that myo-inositol significantly reduced testosterone levels and insulin resistance in women with PCOS and it led to fewer acne breakouts.
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There's another study in 2016 in gynecological endocrinology that found that myo-inositol improved metabolic and hormonal imbalances, which helped reduce acne in PCOS patients.
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So what's the dosage?
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It's around 2,000 to 4,000 milligrams per day, divided in two doses, and I actually have a powder that I mix with my coffee every morning.
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So there's ways to take this.
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You could do capsules, you could do powders, all sorts of things and the best form, as I mentioned, is myo-inositol.
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It's often combined with D-chiroinositol in a 40 to 1 ratio for PCOS, but you want to look for that myoinositol form.
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It's generally very safe.
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It can cause a little bit of stomach digestive issues at high doses, so stick with the lower doses.
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The doses in the studies were 2,000 to 4,000 milligrams a day, divided into twice a day, and just start slow, start low and go slow, and the digestive issues typically happen at higher doses and the myo-inositol, unlike the DIM, tends to work better the longer you use it.
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So with the DIM, I like it for shorter periods of time of two to three months, but with the myo-inositol I like it longer term.
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For acne reduction it tends to work a little bit better.
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Okay, so those are the three supplements that I look at adding and incorporating into the lifestyle modifications for my patients that have hormonal acne.
