Ask the Dermatologist

My skin shows signs of age, but I often react to harsh products. Would you recommend at-home microdermabrasion? What else should I try?

At-home microdermabrasion kits aren’t too harsh on your skin, but I don’t find them much help in making your face look younger. Instead, try sunscreen. It’s the best anti-aging medicine out there. In the winter, wear at least a daily moisturizer with SPF 15. If you’re looking for some extra help, you could try products with vitamin C. It’s an anti-oxidant and has been shown to increase collagen production. Stick with La Roche-Posay’s Active C Facial Moisturizer for normal to combination skin or SkinCeuticals C E Ferulic, which do not have other irritating ingredients such as fragrance or botanicals. For people with ultra-reactive skin, I recommend the Kinerase line, which contains a plant-based antioxidant. It’s very gentle, fragrance-free, and the science behind its anti-aging claims is reputable. You could try products with Retin-A, such as RoC Retinol or Neutrogena Ageless Intensives which have high concentrations of stable retinol and are fragrance-free. Many anti-aging products contain glycolic acids (also called AHA or alpha hydroxy acids). These should be avoided as they will irritate.

(Winter 2010, Allergic Living magazine)

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I have mild rosacea. I wash my face with unscented goat’s milk soap, wear mineral makeup and use an unscented moisturizer. What do you suggest to calm the redness and flushing? Would essential oils help?

Patients who have a genetic predisposition toward rosacea, a chronic skin disorder characterized by facial redness, bumps and broken capillaries (blood vessels) will have more sensitive skin and react more easily to products used on the face. Many patients who get rosacea have always had a tendency to flush or blush more readily. You are doing all the right things by using a mild, fragrance-free soap and mineral makeup, which is usually free of irritating perfume and preservatives. Treatments for rosacea such as topical or oral antibiotics can help with pimples or bumps associated with the condition, but they do not generally reduce the flushing and resulting redness. If you are very red all the time, the prescription treatment Metronidazole may help a bit, although as I mentioned, it does work better on the bumps. Persistent facial redness can be reduced by lasers, such as Intense Pulsed Light (IPL) and Vbeam lasers. In my opinion, topical antiredness creams, including essential oils, aren’t helpful.

(Fall 2009, Allergic Living magazine)

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I have food allergies (nuts) and facial skin that’s highly sensitive and prone to facial breakouts in the sun. What should I look for in a sunscreen, and do I use something different on my face/body?

People with food allergies often have a genetic predisposition toward atopic eczema. You say you have sensitive skin: what you probably have is mild eczema which will get irritated with various cosmetics and toiletry products. Most people don’t have trouble on their body with sunscreens but if you do, a good option is Neutrogena Sensitive Skin SPF 30. It’s only active ingredient is titanium dioxide, and it doesn’t contain any chemical sunscreens. (I don’t recommend it for the face QI have food allergies (nuts) and facial skin that’s highly sensitive and prone to facial breakouts in the sun. What should I look for in a sunscreen, and do I use something different on my face/body?” though – it can look white when applied.) Always look for at least SPF 30 with UVA and UVB coverage. Ombrelle, La Roche-Posay and Neutrogena have the best sunscreen molecules and do not break down in the bottle or in the sun. Consider using alcohol- or gelbased sunscreens for your face if you are acne prone. I often recommend Neutrogena Ultra Sheer Body Mist Sunscreen SPF 45 or 60 and Neutrogena Ultimate Sport Sunscreen Spray SPF 45 or 60 (spray onto your hand then pat on your face). Also, La Roche-Posay Anthelios Spray in SPF 30 is fairly light and fragrance-free and Ombrelle Clear Gel Sport can be used on the face. (The above can also be used on your body.)

(Summer 2009, Allergic Living magazine)

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Occasionally I wear eye pencil, but lately I’ve gotten redness on my lower lid. I’ve had contact dermatitis before: could an ingredient in the makeup be causing this problem?

In most cosmetics, it is the fragrances, preservatives and sunscreens that are the major allergens, and eye pencils do not usually have many of these ingredients. Also, dyes in makeup rarely cause allergic contact dermatitis; they are the same dyes used in food. Most makeup does not cause allergic contact dermatitis but rather irritant contact dermatitis. This is likely the root of your problem. Stick with matte colours, which do not contain mica, an ingredient that gives makeup shimmer and can be an irritant. I suggest you also stay away from colours such as blue, green or purple. They can contain cobalt, which is an allergen. Brown and black are usually safe. Also, refrain from using liquid liners. The liquid needs to be preserved and emulsified and will therefore contain many more allergens. If you adhere to these suggestions but are still having problems, you can be tested to see if you’re allergic to something in a particular pencil.

(Spring 2009, Allergic Living magazine)

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I get severe skin breakouts to parabens. They seem to be in so many cosmetics, body creams and sunblocks. Can you tell me what causes this and what I can do to avoid them?

Parabens are one of the most commonly used preservatives in the cosmetic and toiletry industry as well as in the food industry. They are so widely used because – contrary to what most people believe – they are one of the best and least reactive preservatives.

With the new wave of using everything natural, they get a bad name because they are synthetic preservatives. The actual incidence of true allergic contact dermatitis to parabens is very low, less than 2 per cent. They are also not very irritating. So it is unlikely that the skin reactions you are having are related to parabens.

The one area where parabens can cause problems is with inflamed skin. This is known as the “Paraben Paradox”. In essence, parabens almost never cause a problem on normal skin, but can cause allergic dermatitis when used on active skin disease, such as wounds or eczema. This is why parabens are never used to preserve topical hydrocortisone creams or antibiotic ointments.

What is more common to cause both allergic and irritant skin reaction or dermatitis is the fragrance added to toiletry products. Fragrance is still the number one cause of allergic contact dermatitis to toiletry products, with an incidence of about 4 per cent within the North American population. It would be wise to see a dermatologist to figure out whether fragrance is behind your breakouts.

(Summer 2007, Allergic Living magazine)

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I recently used a new shampoo and it caused my scalp to go bright red, itchy and flaky. My doctor said this was a reaction to sulfates in the shampoo. Can you tell me more about what happened?

Most shampoos today contain fragrance, and fragrance that includes botanical ingredients is the number one cause of allergic contact dermatitis for all cosmetics and toiletry products. On the scalp, allergic contact dermatitis can manifest as itchy and dry, red patches. You may also experience irritation rather than true allergy, with immediate burning on the scalp, itching or redness.

Troublesome shampoo ingredients are:

Fragrances
Botanicals such as mint, rosemary, lavender, ylang-ylang, tea tree oil and chamomile
Surfactants, which create foam or lather

The most important one to avoid is cocoamidopropyl betaine, derived from coconut. Dermatologists are seeing many cases of allergic contact to this ingredient. Patients don’t always react to it on the scalp, but get dry patches on the eyelids, face, ears and neck.

There is really only one shampoo available in Canada that does not contain fragrance or cocoamidopropyl betaine, and that is Cliniderm Gentle Shampoo.

My advice to patients who may be getting irritation rather than allergy is to avoid the shampoos that have the extras like ylang-ylang or lavender. Plain but mildly fragrant shampoos are a good start. Sulfates are not an issue and remember, botanicals are not safer.

(Spring 2007, Allergic Living magazine)

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I’m a 40-year-old woman with sensitive skin, and I get some flaking around the eyes. What anti-aging products would you suggest?

The best anti-aging product is still sunblock. Unless you’re spending a lot of time outside, a moisturizer with added SPF 15 is enough for the winter. Steer clear of products that contain glycolic acids and Retin-A, which can be irritating.

I like the fragrance-free Kinerase line, which has some good science behind its anti-aging promises. In terms of ingredients, matrixyl is non-irritating and has scientific data to support its anti-aging claims. (Look for it in StriVectin and Olay’s Regenerist line.)

Stabilized vitamin C, found in Active C by La Roche-Posay, is also gentle and proven to decrease fine lines, increase collagen production and reduce pigmentation.

(Winter 2006-07, Allergic Living magazine)

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My teenage daughter just found out she has a sun allergy. Can you explain what this means, and what type of sun products she should be using to best protect herself?

Many patients develop itchy, red, raised lesions while on a sun holiday, or during the spring in Canada. Though this reaction is often referred to as a sun allergy, it’s not a true allergic reaction. The correct medical term is Polymorphous Light Eruption, and it’s characterized medically as an abnormal cutaneous (skin) reaction to ultraviolet light.

Lesions usually occur on the second or third day of prolonged sun exposure, with reactions lasting about seven days. The condition improves after repeated sun exposure as the skin “hardens” and the abnormal reaction to the sun decreases – which is why it occurs during the spring in Canada and improves over the summer months.

The best treatment is prevention. Happily, the newer sunscreen technology is enough to block most reactions. I recommend Ombrelle SPF 45 for kids as it contains titanium dioxide, stabilized Parsol 1789 and Mexoryl SX – all ingredients that block the longer UVA wavelengths, thought to be the primary cause of Polymorphous Light Eruption. I also like La Roche-Posay Anthélios Lait SPF 45, which is fragrance-and preservative-free, and the Anthélios L SPF 60 sunscreen, for heavy-duty protection.

Remember to apply sunscreen 30 minutes before sun exposure and reapply every two hours.

(Summer 2006, Allergic Living magazine)

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In the spring, the skin around my eyes seems easily irritated, and becomes flaky and peels when I wear most eye shadows or use certain moisturizers. What causes this, and what do you suggest?

Because the skin around the eye is the thinnest on the body, it’s easily irritated by toiletry products, cosmetics, ophthalmic medications, even the elements. If you have a genetic tendency towards eczema or dermatitis, you’ll also be more prone to developing irritation around the eye.

Don’t use creams meant for the hands or body on the face because they’re formulated differently, and might have concentrations not meant for the more delicate face and eye areas. Make sure you choose products that are fragrance-free and that list their ingredients, such as Marcelle and Clinique. Olay has a great eye cream for sensitive skin, too. Remember that many lines labelled “sensitive skin” or “hypoallergenic” might still have allergens or irritants in their formulations, so look for a complete list of ingredients.

If flaking and itching continue, see a dermatologist, because you may have developed allergic contact dermatitis (flaky, red, itchy skin resulting from a reaction to a chemical) to an ingredient. Only about 3.4 per cent of North Americans have allergic contact dermatitis to fragrance – so it’s more likely that you’re experiencing irritation to chemicals in your skincare and makeup products.

Common irritants include perfume, sunscreen and many botanicals. Remember, just because it’s natural doesn’t mean it will work for you – poison ivy is natural!

(Spring 2006, Allergic Living magazine)

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My eczema always flares up during the winter. What can you suggest?

Characterized by inflamed, scaly and red skin, eczema is a problem that those with asthma, allergies and/or hayfever are particularly prone to developing. The good news is that eczema can be managed.

Here’s how:

1. Avoid fragrance. It’s an unnecessary additive and a potential irritant. I suggest using unscented laundry detergents such as Tide Free and Cheers Free, and unscented dryer sheets like Bounce Free.

2. The same goes for beauty products. Facial and body soaps should be mild and unscented, like the bars from Dove, Cetaphil and Allenbury. Stay away from body washes, which are often scented and contain irritating ingredients.

3. Moisturize the entire skin daily. Go unscented with moisturizers like Vaseline Creamy Problem Skin Therapy Unscented, Glaxal Base and La Roche Posay Lipikar Baume.

4. Take short showers. Too much water can dry out the skin, so keep showers and baths to between 10 and 15 minutes, and make sure the water isn’t too hot. Pat dry – don’t rub, and always moisturize after bathing. Moisturizer is most effective when applied to damp skin.

5. Cool down. If you don’t have much control over your central heating, a cool mist humidifier can add moisture to your air.

6. See a doctor. Painful or inflamed areas should be treated by a dermatologist.

(Winter 2005-06, Allergic Living magazine)

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I’m a busy mother of two, and I recently found out that I have rosacea. Can you suggest a daily cleansing routine that will fit my skin and lifestyle?

Rosacea, or acne rosacea, is a condition characterized by facial redness, flushing, pimples and broken blood vessels. The most important thing to remember regarding skin care for rosacea is that less is more. Avoid scented cleansers and moisturizers, which can aggravate. Also steer clear of cleansers that strip the skin, and those that contain sodium lauryl sulfate, a harsh ingredient used to make cleansers foamy.

A product line that I often recommend to rosacea patients is Toleraine, made by La Roche-Posay. The brand is made specifically for people with intolerant skin – it’s unscented and contains few irritating ingredients.

In terms of a routine, I suggest using Toleraine Dermo-Cleanser, a milk cleanser that does not foam, twice daily. (A less expensive alternative is Spectro-jel.) The next step is to use a moisturizer – I usually don’t suggest a toner for those with rosacea, as it is drying. I like moisturizers from the Toleraine line and other unscented lines such as Marcelle and Clinique. With this condition, it’s best to pick moisturizers without anti-aging ingredients.

If you do apply makeup, try to buy unscented lines. I like Clinique, Marcelle, Almay and some MAC products. For more information, I recommend visiting www.rosaceainfo.com.

(Fall 2005, Allergic Living magazine)

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Dr. Sandy Skotnicki-Grant answers...