Skincare 101: Hyaluronic Acid

Everyday I get asked about what skincare products are best for acne, anti-aging, rosacea, dark spots… and the list goes on!

My answer is always “there isn’t one answer for everyone.” All skincare lines have great products. I have my favorites (a post for another day), but they may not be right for you. The key to finding great products is to look at the ingredients. If your product contains active ingredients that have been shown to improve the skin, you will see results (regardless of the brand).

The ingredient I am covering today is hyaluronic acid. From now on I will refer to hyaluronic acid as “HA.”

HA is the major glycosaminoglycan in the epidermis and dermis. Picture your epidermis and dermis as the foundation (like a foundation of a house) of your skin and hyaluronic acid is part of the concrete.

HA is key in maintaining the structure of the skin, improving skin hydration and maintaining the barrier function of the skin. It is really important stuff!

Unfortunately, the natural HA content of the skin decreases with age – which is why there are hundreds of serums and creams that contain HA, claiming to replete the HA that is lost during natural aging.

The question is- does topical application of HA actually improve skin quality?

Small studies have shown improvement in skin hydration and increases in both HA and collagen after topical application. There are also studies that have shown that topical HA can decrease sebum production resulting in less oily skin. But these are small studies and many are supported by the companies that make products with HA.

So are HA topicals worth it? I would say yes. Personally, a few of my favorite products contain HA (Skinceuticals Retexuring Activator and Neocutis Journee), however some highly concentrated HA products have caused me to have breakouts. So I look for HA in products, but usually not as the first ingredient.

My recommendation when buying any skincare product is to either try and get a sample or purchase from a retailer who has a good return policy (Sephora, Nordstrom). You shouldn’t return an anti aging product due to lack of results in a short time period (results take months), but you want a good return policy in case you have a bad reaction. These creams are expensive!

Hopefully this post will help you the next time you hit Sephora, Blue Mercury or Nordstrom. One word of caution when purchasing these products- buy from a licensed retailer to ensure you get a pure product.


Girl wash your hair!

I get it, washing your hair is time consuming and it removes color and other treatments faster. My color turns brassy much faster than it should and smoothing treatments NEVER last as long as they claim. And it’s my fault. I wash my hair every day. It needs washing every day. I am a “sweaty mess” when I work out and there is no way dry shampoo will cut it. If I skipped a day (or two or three) between washing my hair would smell and my scalp would start to itch and then start to get flaky. Once- on the recommendation of my hair dresser- I tried washing every other day. Shortly after, my husband (who doesn’t notice much about my appearance) asked why my hair smelled sweaty… back to washing daily for me.

Every day I see multiple people who complain about itchy and flaky scalp. For the minority, this is caused by dry scalp and washing makes it worse. For the MAJORITY, the condition worsens as they get further from wash day. In this situation I try to be gentle but honest that the condition will never improve unless the scalp is washed at least 3-4 times per week. I cannot help you if you wash every two weeks.

Notice I said “unless the scalp is washed.” You don’t have to wash all of your hair, just the scalp and the hair that is directly attached, this is where the yeast, oils and dead skin cells build up to create the flaking and itching.

So how does one wash the scalp and not the rest of the hair? I recommend coating the hair with a cheaper conditioner and then lathering shampoo on the scalp. When you rinse the shampoo the conditioner creates a barrier for the parts of the hair that is drier and more damaged.

Another recommendation- use a medicated or “naturally medicated” shampoo one to two times per week. Medicated shampoos that I recommend: Nizoral (1 percent or 2 percent), Selenium Sulfide (Selsun Blue and others), T-Sal. For those that prefer a more natural feeling shampoo: tea tree oil shampoos are awesome. My own kids use Jason brand tea tree oil shampoo for their dandruff prone hair. You can even add your own tea tree oil to your favorite shampoo (if you want a sulfate free or color safe option). If you add your own oil, start with a small amount and titrate up, some essential oils can be very strong and can burn the skin.

Hoping every day is a good hair day for you!


My skin hates yogurt

My skin hates yogurt. I used to eat yogurt every day for breakfast. I thought Greek yogurt was the perfect food. High in protein and I could add a dab of honey to the plain variety and it tasted like dessert. But my skin didn’t like it. It took me years to figure it out. My skin wasn’t horrible, but I always had a few rosacea bumps and my nose was a little too pink. When I figured it out and changed my breakfast routine, my skin cleared up (with the continued daily medicated creams and gentle products).

Every day people ask whether their skin condition is caused by something they are eating. Everyone (myself included) wants to cut out one food and their skin will magically clear up. It isn’t that easy. I wish it was. Skin conditions (such as acne, rosacea, eczema, psoriasis) are usually not caused by specific foods but they can be triggered or exacerbated by foods. The challenge is figuring out which foods are triggers for you.

My rosacea is not caused by eating specific foods. My rosacea (and yours) is a complex condition caused by genetics, hormones, environment, stress AND nutrition, leading to skin that can be sensitive, reactive and breakout prone.

Nutrition can play an integral role in helping keep your skin healthy and vibrant. In general, healthy diets (whatever that means for you) will result in better skin. But there is not one answer for everyone. A vegan diet may be helpful for one person and cause breakouts or worsening of psoriasis for another. It takes time and an awareness of your skin and body to develop a nutritional regimen that works for your skin. While I never did this myself, sometimes it can be helpful to keep a food diary to determine what foods your skin responds to- positively or negatively.

Some foods that I have found increase inflammation and lead to breakouts for me:

  • Red wine (I switched to white and it was all good)
  • Yogurt (this was a bummer)
  • Too much peanut butter (I can have a little but not too much)
  • Asian food at restaurants- I have not figured out what ingredient it is-. This one is hard living in Seattle with so many great restaurants
  • Too many nuts

This is a list I have compiled over almost 20 years of having acne-rosacea prone skin. I know there are probably additional trigger foods (coffee or chocolate would kill me) and my body is constantly changing. I don’t always avoid these foods. If friends are going out for Thai food- I join them. But knowing I might have a bad skin day is empowering- if I know that my skin is going to be reactive and bumpy the next day and I can be (mentally) prepared.

Hopefully this post will help you optimize your nutrition so that every day is a great skin day. Please post comments of foods that are good and bad for your skin condition so others (myself included) can learn more.

Anti aging

Freshen up for fall!

I’m back- for now. Life is busy now with eight year old twins. It has been so long since my last post I don’t remember my wordpress password, thank goodness for the automatic recall. At least you can be reassured that nobody is paying for my posts (or they would fire me)!

I decided I am going to capitalize on the “waiting” that occurs with so many kids sports and get more blog posts up! Currently I am huddled under an umbrella waiting for a soccer game to start. With four practcies and two games per week I should be able to get at least one post per week (as long as I disable facebook).

So after a record breaking summer of sun in Seattle I realized that I had been a bit relaxed with my hat use (used a baseball camp instead of the goofy widebrim) and my skin had suffered. My usual pale skin had areas of brown “smudge” on my cheeks and upper lip (which is not attractive). There were tiny areas of permanent redness on my cheeks where the sun had created telangictasia. When I had to pull out the (fuller coverage) makeup for family photos I knew it was time for a fall refresher.

My first target was the smudge on my upper lip because a mustache is not a good look! I emailed my colleague and asked her to send in a prescription for Tri Luma. Tri Luma is a medication that combines Hydroquinone, Tretinoin and Hydrocortisone. I have found this commercial product works better than combining the individual creams myself. It is spendy (about $175 with a coupon) but it works well and the tube lasts a long time. I am sure most people have spent more money on ten creams that don’t work. This one is good. I have already noticed a difference in just a week. It is VERY important to avoid the sun when using this medication, luckily the Seattle weather is cooperating.

I plan to use the Tri Luma for at least a month, though it can be used safely for two months before you have to take a break of equal length. My next step will probably be a mini IPL (intense pulsed light also called a photofacial)to target any residual brown spots and the blood vessels. Stay tuned for my post on IPL.

So if you are noticing those pesky sun spots are sticking around after the sun is gone, ask your dermatologist for a plan to refresh your skin before the holidays.

Disclaimer: I was not paid to write this post and did not receive free product. I paid full retail for my tri luma. This blog post is not intended to replace advice from your physician and does not constitute a patient-physician relationship.



Skin cancer


I’m back. I think I just need to accept that blogging won’t happen during November and December. Between family and work those months are a blur. I used to feel a little post holiday blues but now I relish the free weekends of January.

Usually my posts focus on light topics, but this is a heavy one. These past couple months I have diagnosed several melanoma skin cancers, with about half of them in young women. I hate having to call someone and tell them they have a melanoma. Even if it is an early melanoma (which has a good prognosis), telling someone they have a cancer that can kill them is hard.

Melanoma is the least common type of skin cancer but is responsible for nearly all skin cancer deaths. The overall risk for melanoma is low (about 1/40 for caucasians) but it is one of the most common cancers in young adults.

Melanoma usually presents as a new or changing mole. The mole can be a variety of different colors: brown, black, pink, red, blue, grey- or a combination. A melanoma can develop from a mole you have had for many years. An easy way to remember possible features of a cancerous mole: the ABCDE of Melanoma.

A: Asymmetric- one side of the mole looks different than the other

B: Border- the border is jagged and not smoothe

C: Color-more than one color or change in color

D: Diameter- larger than 6mm (or a pencil head eraser)

E: Evolving- a mole that is changing

I recommend looking at your moles every 2-3 months to ensure there are none that look suspicious.

If you have risk factors for skin cancer or melanoma such as tanning bed exposure, history of severe sunburns, fair skin and light eyes, a high number of moles or a family history of melanoma it is advisable to have a baseline skin exam to determine your individual risk.

A few great resources for skin cancer (these url don’t link because I can’t figure out how to insert the link-sorry)

http://www.cancer.org (The American Cancer Society)


So there is my public service announcement for January. I promise my next post won’t be so heavy.







Acne, Uncategorized

Adult acne- what’s the deal with that?

Acne is one of the most common reasons for visiting a dermatologist. Everyday I see several patients with acne, and many of these are adult women. It is a myth that only teenagers suffer from acne. About 35% of women will suffer from acne at some point in their adult life- which just isn’t fair- to be fighting acne and wrinkles at the same time!

Why do we (I say we because I am part of the unlucky thirty five percent) get acne as an adult? The theory is that most adult female acne is related to fluctuating hormones. If you think about it- our hormones fluctuate as adults frequently. There are normal monthly fluctuations and then you add fluctuations due to birth control, pregnancy, post pregnancy, pre-menopause and menopause, it is a wonder that anyone has clear skin! 

Fortunately there are many treatment options for acne. When considering treatments in adult women it is important to remember that our skin is aging and traditional acne medications may be too harsh. 

One category of topical treatment, Retin A (also called tretinoin), is very good for light acne and is also anti-aging, win-win! With Retin A I am very careful to prescribe the appropriate strength, as it can be drying and irritating to the skin. I usually prescribe a low strength and recommend applying a small amount (such as a fingertip) over a moisturizer and starting application every other night (or even every third night).  It is important to use Retin A at night because it is in-activated by sunlight. It is also VERY important to use sun protection if you use Retin A because it will make your skin very sensitive to the sun.

Other topical treatments that are commonly used for acne are topical antibiotics and medicated washes (salicylic and glycolic are my favorite for mature skin).

If your acne is cystic (those big deep, red ones), scarring and more severe then we consider oral medications. Oral antibiotics can be used to clear the skin and then creams are used to keep the skin clear as oral antibiotics are not meant to be used long term. If someone needs a longer term treatment, an oral medication called Spironolactone can be very helpful. Spironolactone is a blood pressure medication that is used off label for acne, it works by blocking the effect of male hormones (women have male hormones too and they are part of the reason we get acne) at the level of the skin. Spironolactone works very well for some women- but it is not a cure- it only works when it is being taken. 

Which leads me to our most powerful medication for acne, Isotretinoin (commonly called Accutane). Accutane is our only cure for acne. Most people who complete a course of Accutane are cured of acne. Accutane can be a difficult medication to take due to lab testing and office visits, but it can be life changing for people whose acne is severe, scarring, resistant to other treatment or just persistent for many years. I prescribe Accutane frequently for both teenage and adult patients.

I recommend calling your dermatologist if acne is a concern for you, there are many treatment options to help you achieve clear skin!


My daily skincare routine

Wow- two posts in one day, a record for me! This post is for Miranda who requested an outline of my daily skincare routine. My routine is fairly simple and it changes depending on the season and if I have had (or planning) a peel or other treatment (microneedling and Resurfx are my go-to maintenance treatments).

The products are in the order of application unless otherwise stated. In general you should apply thinner (serums) products first and use moisturizers last. The exception are medicated products – which should be applied first (except Retin A can be put over other products to decrease intensity).

My Daily Routine

Early AM (Pre workout)

Splash water then Skinceuticals Retexuring Activator serum OR Elta AM Moisturizer

Morning (Post workout)

Splash water in the shower,  Finacea foam (for rosacea prevention), Neocutis Journee Bio-restorative Day Cream with Broad spectrum SPF 30 (workday) OR EltaMD UV Clear SPF 46 (weekend). If my face is feeling dry I will add Neocutis Biocream after the Finacea. If my complexion needs a little smoothing I’ll add a little Chanel Perfection Lumiere Foundation.

My morning routine involves 2-3 products. I wait a few minutes between applying the products. In general you want to put on medicated products or serums first.


Wash with Perfect Cleanser or Cetaphil Gentle Cleanser , Finacea foam, Neocutis Lumiere Eye Cream, Neocutis Biocream.

2-3 days per week I use Skinceuticals retinol (.5 or 1 %) OR Perfect A (prescription strength Retin A with Vitamin C). I apply retinol under the moisturizer because it is not as strong. I apply the Perfect A over the moisturizer to decrease intensity.

For body cream I use Cetaphil (in the tub). For hands I use Cetaphil or Neutrogena Norwegian Hand Formula. I use Cetaphil Gentle Cleanser as body cleanser.

This routine changes occasionally when I am trying a new product or after a treatment (then I use only Cetaphil cleanser and biocream or even vaseline).

If you have seen my purple product sheet in the office- be assured I have tested/used all the products.

Hopefully this is helpful, thanks for the idea Miranda!