Should I Delete That? - Your Skincare Questions Answered with Dr Alexis Granite

Episode Date: October 15, 2023

This week on the podcast, Em and Alex are joined by consultant dermatologist Dr Alexis Granite. She answers all of your questions about skincare: from filler to acne and pimple popping to verrucas! Alexis breaks down what we really need to maintain healthy skin, and how to get a routine you can really stick to.You can follow Alexis on Instagram @DrAlexisGraniteFollow us on Instagram @shouldideletethatEmail us at [e-mail] by Daisy GrantMusic by Alex Andrew Hosted on Acast. See acast.com/privacy for more information.

You don't want to make people worried or feel like they need to do something that they don't need. I mean, when you're young, like, enjoy being young. I don't even like the concept really of pre-rejuvenation. You know, I don't really think, you don't need that. You just need your basics. Hello, and welcome back to should I delete that. I'm Alex Light. And I'm in Clarkson.

How you doing, Al? I am good. My good is that I am away. I'm on holiday. You're alive. I am alive. Well, that's my awkward. We'll get on to that. But I am away. I'm away with all my family. We've come away to celebrate two big birthdays. And there's, there are 14 of us here. It includes two kids, two pregnant ladies. So it's a lot. But it's good. It's really nice. We're missing you. It's not the same. It's hot, though, right? In England. I mean, it's probably not, I'm not in the bikini. it's all right it's kind of hot in the kind of like the planet's getting way too warm and it's a bit distressing but we don't want to talk about that every day so we're just kind of making new okay i keep seeing videos of people like sweating on the tube and it's like oh yeah it's been a lot of that it is raining today though thank god oh hallelujah couldn't come soon enough because like you know me i love the sun as much as the next girl but it does get to a point in mid-october

where i just think nah not having that no fuck that throw it down do you know i my awkward comes off the back of my good because I am away and I have been very bad on social media just because there's so much going on here. And I also don't really know what to post and whatever. Anyway, I went into my DMs last night and like, I think a few people I think I've just died. They're like, where have you gone? Like, are you okay? Because I mean, it's been, actually, it's been almost a week since I posted properly. So a few people think I have passed. I guess I worry less because I know that you are a lot. Like, I see you on WhatsApp, but that's true.

That's a lot. And I see you watching my stories as well. Yeah, I'm here, I'm here. And I'm still watching everyone's stories. I'm just, I'm like, yeah, you're like an ex that ghosted me. I'm like, I can still see her. She's still alive. She's just incognito.

That's my awkward. I am alive. Talk to me. Good or awkward. Okay. Good. Good. Very good.

I ran a half marathon on Sunday. You did. Well done. I did. which yeah honestly I'm so pleased it's done it felt amazing it was so good like I'm really proud of myself like I'm really proud of myself I don't think I realize the toll that training for that so soon postpartum without child care has taken on me um it just took it was just a lot it was just a lot so I'm really really relieved that it's done now because I feel like I can just

not have to run a half marathon for a bit and I think that's probably going to be good for me but I did love it I think that's good yeah I feel like it's gonna be good I loved it so much and I don't want to like you know I've still got like big plans

for challenges next year and stuff but I just think like I just want to focus on just like having a little bit of gym time and just getting back in the good head space and like not having the pressure of like that massive challenge ahead of me because I just didn't know

I feel like I'll probably be fine but I cannot guarantee that so I was just nervous and it was distressful. And obviously, Arlo was poorly, like, so poorly last week. And then the half marathon being on the Sunday on the back of that where, like, when you're breastfeeding and your baby's poorly, they do not stop breastfeeding.

Like, I could not. I don't think I put her down for more than five minutes last week. Like, she couldn't not be on me. Every time she wasn't on me, she was crying. And so I was so physically drained by the time it came to the run. And on Saturday, I was like, I just don't think I could do. I just kept crying. Like, I was not okay.

But, but I pulled through Yeah, my rags to riches I did it and I was really proud and I think I was even more proud of myself in the context of the shittiest week ever So my expectations were in the bin So I just did really well So it's amazing

Well done, well done That's really cool Thank you so much Is it 13 miles? 13.1 yeah Yeah, that's a lot That's no small feet That's a lot

I loved it honestly I loved it Do you want anything bad? My bad is that we didn't win an award. Oh. No. We were nominated for awards. Actually, we've been nominated for two awards recently, and we have one either. We've lost in both.

But we are a podcast, a nominated. We're a nominated. So that is my bad. Award nominated. We're like Leonardo DiCaprio, Al. Yes. Just never getting the recognition we deserve. Funnily enough, I have a photo of Leonardo DiCaprio right next to me, and I don't know why.

Love that. Wait, how long did he have to be? to wait for his Oscar win. I think about 18 years. Okay fab. Okay. So not bad. I'm just to manage expectations. I don't think it's going to be an Oscar or anything of that calibre when it comes. But one day... Oh my God. 22 years. Yeah, I can got that kind of patience. Where are we? So in 2045, maybe we'll have an order under our belt. Maybe, baby. Um, okay, my bad just quickly is that, oh, right, Alex is going flying. My husband, Alex, is flying a plane. on Saturday.

Himself? Yeah. Oh, God. Have you seen him driving a car? I haven't actually, because you tend to drive. Maybe that says everything. I need to know. No, I see what, he's really good at driving and he's good at driving a car.

I think what happened is he only learned to drive a car about five years ago, maybe. When I got to go with Alex, he couldn't drive because he lived in Dublin. And you just don't really, it's kind of, say, for a lot of people who live in a city, you just don't really need a car and you don't really need to know how to drive. and he could just like walk to school and then he could just walk to uni because he was at UCD and he lived in Dublin

so he was like you didn't have to drive anywhere so he never drove and I've got that thing because I kind of taught him how to drive it doesn't matter how good of driving he is in my head he's still shit at driving you know what I mean I remember all those moments

like fucking closing my eyes and just praying to the baby Jesus that we were going to be okay when we went across a mini roundabout without stopping you know what I mean so now he's going in a plane to fly it shit indeed why

because it's his dream and this is his 30th birthday present not from me because I think it's a horrible idea so so it's a little plane right we're not talking like an easy jet plane like an everett's like

he's doing the Dubai the yeah the Dubai well actually no yeah it's a little plane it's a little plane yeah but I'm but there's pilots on board right, obviously. Well, there's him and the pilot.

Yeah. Shit. That's so cool. Shit, yeah. Will you take video footage of it? No, I'm not going. Okay, fine. I don't want the...

Like, God forbid, it goes terribly. I don't want to see that. The call will be horrible enough. But to have the fireball forever imprinted in my mind is not what I want. No, I get that. I can't go.

I hope he has a really nice morning and I pray to coffee he survives because I can't do this alone I am crossing everything this year but you bought this for him right this was your present to him no no no no he told me

he told me it's all I want it's all I want for my worth it's all I want for my birth it's all I want for my birthday and you know what I did with information nothing I ignored it buried it because yes I was like I can't hear you I can't hear you I'm getting you a bag I don't care about your dreams but unfortunately other people in his life listened

Twats. I know. I know. I'm furious. I'm furious. I pray for Alex's safe return from flying. Me too. Me too.

I know. I know. It's not okay. I'm terrified. Have you done you're awkward? No. I've just kind of had a bit of awkward week, to be honest. Randomly, it's been the week of like experiences for my family because last weekend, my

Christmas present from my dad was that all of us kids got a racing day last year. That's cool. Yeah, it was nuts, right? But, like, you have to drive, like, Formula, well, Formula 3 cars was one of them. Kate Trims, the Kate Trim, I was really good at. Like, that was insane. Like, I was doing like donuts. They're, like, little rally cars.

They're so cool. And my mum actually used to rally. Still does, actually. My mum still rallies, obviously, because my mum does everything cool. But she still rallies, Kate Trim. She listens all women rallies. Actually, not all women. She's done some all women, but she does some of men as well.

Anyway. So I was really good at that. I won out of our group. Well done. But the rest of it, the rest of it, how I was so shit at, it was actually embarrassing. This, my awkwardness just how bad I was at it. Like, we did go-karting,

then there was a Formula 3 thing, and there was a few different things, and at one point, I span off when I was driving the Formula 3 car by myself, span off the track, and then I couldn't start the car again. Like, how embarrassing is that? Oh my God, how embarrassing?

How embarrassing? And I was pressing the button, and I remember thinking when they told us what to do if we span off, I remember thinking, I'm not going to spin off, because I'm not going that fast because that seems incredibly reckless.

Like, I'm a slow corner queen. Like, there's no way I'm going to spin off. So I didn't listen to that bit because I was like, it won't happen. Sure enough. And you spun off? Twice. Twice. Twice.

First time I went into the corner too fast. Second time I went in too slow. I didn't even know it was possible. But if you break too hard in one of those cars, you're out of there. I felt like you. Safety Susan. I was going to say, it reminds me of me on your handy when we went on the bumper cars.

All I could do was go backwards. And I couldn't go forwards. God, it was a bit embarrassing, you know? I didn't have the confidence in that. And I wouldn't have mind, you know what, they say about those days, they say that the instructor told me that he prefers teaching women because women listen and they

want to learn. So men come in there with their egos. They go too fast, too soon, spin off and that's that. Whereas women normally come in slowly and they learn, and I'm actually annoyed at the day, because if I'd have had longer, I think I'd have been really good. But as it was, I was constantly in the way.

Everybody overtook me. I was the only, when we got, they got some thing at the end and he went, he was like, so who looked in their wing mirrors and everyone, and all the men were like, I didn't even know I had wing mirrors. And I was like, I, I couldn't not look in my wing mirrors because I literally, every time I looked in there was someone else waiting to get past. It was tragic. Oh my God.

I didn't peg you for, I thought you'd be like Speedy Gonzalez, honestly. My mum described me as a kid and it remained, I am a cautious hooligan. Like, the minute I've got the hang of something, I'm like, speed, speed, speed, Speed, speed, speed. The minute I know it's safe, like roller coasters, I'm like, let's fucking go, go, go, go. They've been safely checked. I am going. With the caterer, the minute I got the hang of it, I was like, and we're out of here. Like, I'm so good at this. But when I'm not good at something, I need to get my bearings. I need to know that it's safe. And then I'll push it. Do you know what I mean? So I didn't have enough time. You just needed longer.

I just needed longer. So I've actually decided with that in mind to completely change my career and I'm heading in the direction of Formula 3. I'm going to be really good. Well, speaking of formula stuff, did you see Mercedes released Toto's AI album, AI yearbook covers? I thought you were going to say nude. That would be nice.

That would be nice. No, we can't say that. We want Susie. We can't say that. It would be nice. That would be nice. Oh, come on, guys. And now, and now we're sex pests, and now we must go into our episode.

We must, we must. Oh, a very informative episode this time, with an, a will have expert. A consultant dermatologist, no less. I outed myself in the first, like, minute of this interview as a disgusting, great human being. As soon as I saw Em's face, I was like, oh, I've made a mistake. You shouldn't have admitted this. So that's good. Anyway, all about skin.

And everything about skin, I hope you enjoy. Here is Dr. Alexis Granite. Hi, Alexis. Hi. Thank you so much for coming in. This is strange seeing you in this context, because normally, I don't know, I've known you for years. I don't even know how long, but I interviewed, I've interviewed you loads for hello.

And actually, very important point of how we know each other and content warning, this could be sexy. You got rid of a very longstanding veruca that I just couldn't. get rid of? Oh, my God. I don't even remember that. That's so funny. I remember. You froze it. You froze it off me. Why did you just put yourself on blast like that? I know. I know. Well, I mean, we've done worse on this podcast then. I feel like Rooka's pretty bad. I had one that I could not get rid of. Oh, wait a minute. It's all coming back now. I do remember. Yeah. That was awful. It was awful. I love that. That's so brave of you. You took your Vruca. I know. I think that's how we first met. It is. Yeah. Yes. Yes. Yes. Yeah. So,

There we go. Are you look horrified? I am horrified. How did that come to be? Was that a work thing? No, no, no, no, not how you got the fruica? I mean, how did you like bring that up to your editor? Like, oh, I just need...

I think I interviewed you for hello. And while I was there, I was like, hey, do you know how I go in this room? Because we've been trying really hard, really, really hard for a long time. And you were like, right, we need to get that nitrogen, the liquid nitrogen on it. Freeze it off. Very, very painful when it gets through the nerve. But it worked. Oh, my God.

Yeah, there you go. God. Well, that's cool. Yeah, I told you. Quite the intro. Sexy content. That was not the intro. I thought we were having. But I think it's funny because I think some people are so used to seeing me in one setting. You know, so when you, sometimes I see patients outside of clinic and they're always a bit, I think, thrown.

Yeah, it's funny, isn't it? I'm just so used to seeing you in the clinic room. I know. It's weird. Whenever I think of skin, I always think of, like, skin on your face. I never think about, like, your whole skin. Like, I never think of, like, a varica being, like, a dermatologist issue or, like, exma or, right. Of course it is, but I don't think about it in that. context. I developed psoriasis when I was pregnant and now it's gone again. Is that normal?

It can happen because of hormones. I've actually seen, was it a kind of psoriasis called gutate seres? Like little tiny ones all over? It's like no, no, no, just one patch on my arm. And I got it and I was like, oh, this is really weird. And then I had it like the whole way through the pregnancy and then right at the end when I went for my six week appointment, I said to the doctor, I was like, oh, I think I developed exma when I was pregnant and he's literally like, no, that's psoriasis. I was like, oh, okay. And then it's just gone again. Yeah. They can look very similar. Yeah, that does sometimes happen. It has to do with hormones, really. And then it, hopefully, it won't happen again if you become pregnant, but it's possible. And then it kind of

fades. Fine. Cool. So that's my personal question. There's some molasma that I've been worried about in pregnant because I've got it anyway. Yeah. That's a big one during pregnancy, unfortunately. Very much out of the sun. Yeah. Oh my God. My skin changed so much when I got pregnant. I've always been able to just tan and tan and tan and tan and tan. And then when I got pregnant, And it was like, like, cooked me. I was like, the color of this seat. Yeah. And melasma is the type of pigmentation.

They call it like the mask of pregnancy, basically. It can come, it can happen to men too. But it's very common in women, particularly if you go on oral contraception or during pregnancy just from hormone changes. And it tends to be kind of dark patches in characteristic areas. So cheeks, forehead, above the lip. I have it. I have it above my lip.

I'm too. Crazy. And it's just tricky because it can be hard to get rid of. It tends to recur. And so. it can be quite frustrating. Yeah. I've got the mustache. I've got the mustache too. My son likes to point it out when

when I go on Sam, he's like, you have a mustache. He's so kind. Thanks. He's just trying to. He's pretty good at last. He's probably not. I haven't actually even said what you do. You're a consultant dermatologist. Sorry, probably this has all been a bit confusing now because I'm like

baruchas and malasma. You're a consultant dermatologist. And you cover, well, everything, right? Yes. And we wanted to speak to you about skin because there are a lot of questions about skin and obviously, and I think there's a lot of confusion about skin specifically skincare since it's become so big online.

And actually, I think because it's become so accessible over the past few years, hasn't it? It's become really affordable and accessible, which it just wasn't before. And there's so many new ingredients that we need and it's become quite confusing and a lot of conflicting information. So we wanted to get you on

and we asked for questions, skin questions. We had an absolute ton of them. Okay. But I have put the main ones, the main ones together, the most common ones together. And I think it's a good place to start with affordable skin care. And what we actually need, what's a fad, what ingredients are fads? You know, we're bombarded with ingredients, nicinamide, vitamin C, retinal, all of them, haleronic acid, like which ones do we actually need?

And what's the best, in your opinion, what is like really? good affordable skin care. Okay, got it. So I would say, I think some of it depends truthfully on age and what you're looking for, but I think the building blocks of any good routine are cleanser, moisturiser, sunscreen. You got to start with those. What about moisturiser that's got sunscreen in it? It's probably, it depends. It could be okay. The issue with that is that, and the same goes for makeup with sunscreen, is that you need to basically put to the good kind of rule of thumb, actually rule of fingers, is to put the first two fingers length's worth of sunscreen on your face. So if you were to take your index finger and your middle finger, put a

strip of sunscreen on each, that's going to be enough to cover your full face. So it's just sometimes, I think you skimp a little bit, particularly with makeup, I think that's nearly impossible to achieve. Okay. But with moisturizer with sunscreen in it, you know, probably if, unless you're really consciously thinking about it, you're not going to be putting that much moisturizer on your face. So it's just putting the amount that you need on to obtain the coverage that, you know, it says on the bottle, SPF 30, SPF 50. Whenever I do that with my fingers, I always think of people who have like big hands on a small face, you know? I'm like, I'm just like drowning. It's true. That's what my

Alex. He's got really big hands and this white is small. Or maybe really small hands and really big face, I guess. But it's a good general rule. Maybe not for everyone. So I think sometimes, again, it can be hard to achieve just with a built-in sunscreen moisturizer. But overall, those are the building blocks for anybody, whether you're a teenager all the way up to your 80s, 90s, and older. And then I think the active ingredients, so all the things that we hear about, whether it's like a TikTok trend or just that you see in skincare and stores, things like vitamin C, hyloronic, retinol, et cetera, those tend to come in more when you're dealing with looking at problem-based skin care.

So skin care where you're trying to achieve something beyond just, you know, your daily moisture and your daily sun protection. So I'd say, you know, it's hard because it's a little bit different for everyone. But I'd say some of my, well, so overall, I think for most dermatologists, one of our favorite ingredients is retinal. I don't know if you guys have ever used retinal before. I just got into it and then I got pregnant. Yeah.

So I'm still breastfeeding. So can you use? Yeah. So I wouldn't use it during pregnancy and breastfeeding. But retinal basically is derived from vitamin A. and essentially it does a little bit of everything. It turns the skin over, it unclogs pores, it helps with pigmentation, helps stimulate collagen.

So to me, that's a great one to use kind of ongoing from a young age all the way through. Two questions about retinol. Yes. First one being, the person that you and I were talking about before we started recording, that it's a very organic skin care person, it's quite anti-retinal.

And I think there's quite a lot of that in sort of natural spaces. And I've heard quite a lot of arguments against it. Yeah. Is there any ground to that? I mean, in my mind, no. I think the main thing that tends to happen with retinol is that it can be quite irritating. So I think for a lot of people, if you jump right in, you're using it, maybe every day you're using a lot of it. It can cause a lot of irritation.

I think there's also a myth that it thins the skin. That's what I've heard. Yeah, which really isn't true. So what it's doing is it's helping to shed the what's called the stratum cornyum, the dead skin cell layer. on top of the skin. So yes, it is thinning that in a sense, but actually it's building collagen. So over time, you're actually improving the quality of your skin and sort of thickening the skin, if you will. So it's really not thinning the skin in the long term. That's so interesting because I just got my husband using retinal, which, and I think he's got a lot of

lot of, like he's, because he's got quite, I don't know, he's got quite a lot of skin. So I kind of, I think he needs a bit more collagen. Yes. He's a big, big face with long skin. No, he's got small face, small face. He's got too much skin. It's weird. Anyway, it's not that skin that you can pull. Yeah, yeah, yeah. Really far out. Yeah, yeah, yeah. Like, weirdly far out for that.

Yeah, well, he may, there is a skin, there is a condition called Ellers Danlos, which is genetic, which can cause that, like, super super stretchy. It does, but there are different variations, so some are much milder than others. So if it's really quite stretchy, it could be that he has very enough that. Oh my God, picture for the Instagram account. Yeah, we need to, we need to see it. He'll be so up for that. Anyway. I digress. I thought retinal would be quite good for him because he is starting to age,

which is all power to him and it's much easier for a man to age, so whatever. But he's starting to get quite like, so I thought retinal would be really good. But then I took him for a facial at the organic place and they were like, it's thinning your skin out, all that. And so now I'm back to square one and he's like, no, I can't use the retinal. Oh, no. I would, I would, yeah, I'm a huge fan and I think most derms, truthfully, are big fans. The one thing I would say as well, it's just, it's a little finicky when you use retinal. So you do have to make sure you're wearing sun protection every day, which hopefully you are anyway. And then the other thing is it does make, because it's loosening up that stratum corneum, it does make the skin more sort of friable. So if you are

going to do procedures like facials or laser, or we generally recommend stopping for several days before that. And that definitely goes with waxing too, because a lot of people learn that the hard way. So if you're using retinal, you need to stop it a few days if you're going to wax anything on your face because it does, I've had that happen where. I'm like, I'm not using it on my eyebrows. will be fine. And then you take the wax off and it's just a big block of red under your eyebrow. Oh, I didn't know that. So is retinal good for anti-aging? 1,000%. Right. I'm so texting Alex right now. We all bringing that back in. So anti-aging, anti-blemish. Wow. Anti-prety much everything. Isn't it the only like the only proven ingredient

for anti-aging? Yeah, pretty much. Outside of like SBF. Yes. So I'd say the other, so I, so retinol, ideally you're using in the evening. And then kind of other ingredients to look for. I think another big kind of category, which I think can be really helpful for skin, particularly for anti-aging, are the antioxidants. So that's things like vitamin C, vitamin E. And the reason for that is because they're going to protect against a few things. So one is against just sun and the damage that comes from sun exposure. What happens when you're exposed to sun is obviously you tan and, you know, that's going on.

But on the other hand, your skin and your body are producing something called free radicals, which basically damage skin. So antioxidants help prevent that. So vitamin C is a great one, and there's a whole bunch of brands, as you know, I'm sure that have vitamin C containing products. And so I think that can be great for the morning. So kind of putting in an antioxidant in the morning

and then some sort of retinal in the evening. And quite honestly, that can be a great routine to start with, you know, with your cleanser, with your moisturizer, with your sunscreen. And it's relatively simple. You really don't need, you know, 10 to 15 steps. It just gets exhausting. And talking about affordability, what are the brands that you'd recommend with that in mind? Yeah. So I think, you know, I think French pharmacy

type brands can be amazing for actives and just general skincare. So I tend to love Avon, La Roche Pose. Saravi is also a great mass brand, which is super popular with teenagers in particular, but for all ages. So those are some of my favorite kind of boots type brands. In the middle category, I would say Medicaid is a great one. That's sort of your mid-priced point, and they have, again, a ton of active. So they're going to have a retinal, vitamin C. They have a whole host of other ones, too, like you mentioned, haleronic acid, and niacinamide. And then in your sort of higher category, I think skin suiticles is one of my favorites still. It's like the old, the OG. It is so expensive. I love C. Brulic, but I can't. I can't.

I can't part with that much money for basically my vitamin C serum. When you can get it at like Garnier for, you know, I just, but it is amazing though. Yes. So I think in any of those ranges, you can absolutely find really great products. And sometimes you can also, I kind of like the concept of a high low. Maybe you're using your Sarajevi moisturizer and sunscreen, but you're splurging on your vitamin C or do you know what I mean? So I think sometimes you don't have to have super high priced in all of the products that

using but if you want to kind of pick one maybe that's maybe you really want to like deep dive into your retinal maybe that's where you splurge and then the rest you kind of mix with what is the best retinal in your opinion two of my favorites probably are skin suiticals and medicate the crystal yeah yeah complex i like that one the medicaid one i think that's what that one's worth paying a bit more yeah radermic retinol from la roche pose is also quite good um serravi uh unfortunately Unfortunately, they make a great retinol, but it's not available yet in the UK. It's only available in the US. So if you happen to be traveling to the US, you grab it from CVS off the shelves.

It might not be long before. No, it will come eventually, I'm sure. But you really can mix high and low, for sure, with your skincare. That's really helpful to know, like, the different brands that you rate in the different markets. It's so difficult, isn't it? Because it's like, vitamin C, there are, like, thousands. so many. And so many say, like, different percentages. Some don't give their percentages at all. Some have different ingredients added to them, like the C, Ferulic, which has got vitamin E and ferudic acid.

What things are like, I guess, red flags when buying skincare for you? Like, do you go for the straight up ingredient? Like, this only contains vitamin C, or do you try and have other ingredients added to it? Have you got any, like, red flags or, like, green flags? Yeah, I think, well, I think, you know, overall, when you're looking at the sort of big, longstanding, trusted brands, I think in general, you can have pretty good confidence that they're putting in what they say they're putting in. When it comes to vitamin C, you generally want to be looking for L-sorobic acid, which is the most active form of vitamin C. And then you're right, some do put the concentration in, some don't. You generally want to hover around anywhere between sort of 10 and 20%. I think it's absolutely fine to combine vitamin C with other ingredients, particularly other antioxidants like a C.

Fruilic, because those are all basically antioxidants in there. So I don't think that's a red flag. One thing that is a red flag, particularly around vitamin C, is that you need it to be an opaque or dark pack, which, because essentially vitamin C is very easily oxidized on exposure to air and light. so if you are putting it in a in a clear like a very clear bottle it's just not going to protect that formulation and you're not going to get the longevity out of it when the liquid goes because it does go darker doesn't it it oxidizes and it just it does go darker is it still effective yes I mean so generally with products you can get usually it'll say it might say on the label like how long you can keep it for once it's been open so you'll see like a little jar and then a little lid coming off with a time frame. I don't know if you ever noticed it on the back. So usually it ranges, the shortest I've ever seen, I think, is maybe six months and then it can go all the way up to 24 months. With something like vitamin C, you kind of have to respect that a little bit because I do think opening, closing it constantly, it can start to, you know, wear in terms of efficacy. So I would say you're

probably going to get, you know, your nine months out of it and then it's going to have to be tossed in the bin. But hopefully by then you've used it all. It's probably hilarious, like watching me do my vitamin C because I try and minimize the time that it's open for, like, to as little as possible. So I'm literally like, open it. I'm going to go back on quickly. No one distract me. Well, that's why you don't see vitamin C a lot in jar, in jar products either, because again, you're like keeping that quite open and closing. It's, it's not going to be potentially as effective over the long run. And what do you think of, like, prescription skincare brands that have become really popular, like Skin and Me, Darmatica? I can't remember.

the one's name, but those kind of, you know, the ones that, yeah, yeah, it's like it's more tailor-made, you know, you send your photos in and you describe your skin type and then a dermatologist will prescribe you your own bespoke. Yeah, no, I think there's a real place for that. I think especially because, as you said, there is so much out there and it can be quite confusing. So, if we were to go through the list of all the ingredients available, you know, that are quote-unquote actives, things like hyluronic acid, peptides, azaleic acid, I mean, the list is sort of endless. So I think it can be really helpful if you don't really know where to start to kind of invest in that, get a sense of what your concerns are. And then you can kind of have a more tailor-made regimen.

So I think truthfully, there's room for both. I think if you're interested in trying a lot of different products and kind of seeing what's out there, you can certainly buy off-the-shelf, you know, skincare that's amazing. But I think sometimes the tailor-made stuff is quite good for people that, A, maybe don't know where to begin and B, maybe have a real specific concern. but then maybe don't have access to a dermatologist, you know, to see in clinic. Yeah. That can be a great, I think, in between, particularly for conditions like molasma or breakouts, things like that. Can I ask about the eye back, eye back, eye bags? I don't look after the skin under my eyes at all because I don't know how.

And I feel like I've finally got the hang of like the rest of my skin. I honestly, when you guys are speaking about acids, pepsides, everything, I really struggle. with it. I find it very overwhelming. I finally got into a good routine, which I cannot fuck with, but I do think I should add something for my eyebags because I'm starting to get wrinkly, which is fine because I have a baby now and I'm getting old and I never sleep. So it's whatever. But it's anything I can do to help, because obviously you can't do retinal while I'm breastfeeding. Yeah. Is there, because I see a lot of products for under eyebags. Is there like actually a need for them? And if so, what's good?

I don't necessarily think everyone needs as dedicated eye product, particularly if you're or it's not like you're not putting those products near the eye. And the truth is that, just to give you a perfect example, when I wax my eyebrows and half the skin came off, I wasn't putting the retinol there. The products do diffuse throughout your skin. It's not like they know where to stop on your cheek and they're not going up to the skin around the eye.

So you are getting benefits when you're using things like retinal, vitamin C, kind of all over your face. I think if people do have a lot of sort of puffiness under their eyes or they're really noticing maybe wrinkling and they want to invest in more of an active-related eye product. Things like caffeine can be helpful, peptides. You can actually, again, if you're not using a retinal in your whole face, but you want to maybe just target the skin around the eye,

they actually do have eye creams that have retinal in them. So I think if you're going to use something for your eyes, it's worth kind of investing in something that has actives in it rather than just a nice moisturizer because you're going to be using that on your skin anyway. Do you know what I mean? They always just look like moisturizers, but more expensive in smaller pots. And I couldn't really work. I just didn't know if there's any merit to them.

And it's a, I find it a fath. Yeah. And they say you have to do it so gently. It's like tap, tap, tap, tap. So I have to be honest, I'm a bit, I'm a bit quick with my skincare and I love to use, you know, good products and lots of actives. But I don't actually use a dedicated eye cream. On that is things like jade rollers. Yeah.

Around, you know, for puffiness and stuff like that, jade rollers and guash, guashas. What do you make of them? I think also can be. great and great tools to kind of supplement what else you're doing. I think with any of those home tools, so whether it's jade rollers, guasha, microcurrent devices, LED, because I recommend those a lot to patients. So LED is where you either use a pen or a mask that has little tiny lights in it that go through different wavelengths. So red, blue, green, et cetera. And all of those lights have different benefits for the skin. Microcurrent is things like Newface, which deliver a little

bit of electrical impulses, essentially, into the skin. And all of those, so alongside things like jade rollers and guasha, they have their benefits. So I would say jade rollers and guasha are to kind of stimulate the circulation, kind of get lymphatic drainage so they can reduce puffiness, just give you a nice glow. But obviously, you have to keep doing them in order to maintain the benefit. So if that's going to be something you're going to do a few times a week or every day, great. If it's something you're like pulling out once a month, you're probably not going to get a huge benefit from. Same goes with something like LED. So LED can be great for stimulating collagen, you know, helping with breakouts. But again, it's something you have to be consistent with.

So I find sometimes, even myself, I'll buy something and then it, you know, I get really excited and then I put it away and I sort of forget about it. So, and that goes for microcurrent too, which is more for lifting and tightening. And I think you can get a subtle benefit. It's just the consistency that matters. Does that make sense? So, and I think those are kind of maybe a spectrum of, you know, when you're quite young and maybe you just want a nice glow and you just want to kind of reduce puffiness. I think a jade roller and guasha can be great. Something like microcurrent maybe is for a slightly older consumer who's really looking more for kind of wrinkles, wrinkle prevention. I've got one from Forio, the Forio Bear.

Yes, that does a combination, I think, of both. So does it have lights on it too? No, no, I've got one that's got light as well. Because I think they do make a combination product also. Oh yeah, I think so. The bare one is just the, and I really rate it. Yeah. Like it was expensive, but it's so good. And I found a really, when I used it long term, I used it before my wedding.

And my jawline is like, it really, I do think can give you a little lift and a little bit of tightening. It's just, it's going to be to some degree temporary. You know what I mean? It's something you have to continue. And things like microneedling at home as well, what do you make of that? That makes me a little more. nervous. Yeah. It makes me a little nervous just because anytime you are creating open channels within the skin, so that's what needling does. It creates tiny little open pores within,

you know, openings within the skin. I just, I do worry that you can cause irritation, potentially infection. So I think that I would say in general, I think needling is best left to the professionals. But anything that's going to give you a nice massage that's non-invasive, they're going to do lights or even, you know, home. microcurrent I think is okay but the needleing I would say it makes me makes me a little nervous to ask okay so I feel like that's okay that's fairly like so it's quite a basic skincare routine like you can't really go wrong you don't really necessarily need all the gimmicky extra stuff that cost so much actually I was looking at guajas yesterday yeah on a website and there was one for

like 40 quits. Yeah, yeah. Well, it's the stone, was it stone? It was, no, it's a metal one. Yeah. Sometimes the stones are quite expensive. I mean, all that stuff, I think, is one of those things that can be great, but I, I guess that's part of why I sort of like to, because a lot of my patients come to me mainly for, they come for lots of skin concerns, eczema, acne, rosacea, etc. But I do treat a lot of, I know, I think we'll get to this later, but, you know, patients who are looking kind of to start their aesthetic journey, whether that's injectables, lasers, et cetera. And I think part of why I like to look at it as sort of like a pro-aging approach rather than anti-aging is just because all those things can be great, but I also think you don't have to use them if you don't want to. So

you can achieve really good results kind of in your own way and you don't need to feel pressure to kind of buy into all these things. Some people love to, they want to spend their kind of extra, you know, their extra pot on beauty. And that's okay. And that's great. They love it. They want to try new things. But some people don't. And so I just feel like you don't have to feel pressure to buy into that, if you will. You can still get really good results without those things. But so I just think it can be really hard because you feel like, oh my God, I'm not gwashing. I'm, you know, I'm going to be behind. But I wouldn't say that's necessarily true. I think that's what it is. It's the pressure. It's the pressure to always like be doing more, especially with TikTok now as well. I've noticed like all these TikTok trends and things that go viral. And you just feel like, oh, I should be adding that into my routine. Why aren't I doing that? She looks great. Why am I doing that?

There's so much pressure. And I've noticed whenever I've gone down those rabbit holes of being like, I need to do that, I need to buy this. Like I bought a microneedling thing at some point years ago and did it every night. My skin never really actually looked any different for it. As when now it's fairly basic because I can't, because I'm lazy basically. Right. And I think some people enjoy the routine and the ritual. and that's, you know, I think that can be great.

But if you don't, I just don't think you have to buy it. I think TikTok is kind of fascinating, to be honest, especially from a dermatologic point of view, because there's so many things that are trends now, but we've been doing them for years. We just didn't have, like, a catchy term. Like, I thought the skin cycling one. Do you remember that was a year ago or maybe two years ago? I just thought it was so funny. It was like, rotate your products, like, as if that was this, like, amazing new concept.

I'm like, we've been telling people to do that for, I don't know. know, I've been a dermatologist for decades now. You know, it's so funny. But they sort of package it in a really fun and interesting way. So by all means, I mean, it's pretty incredible. But it's a lot of those trends in actuality are not that new. They're just kind of repurposed and rebranded in a way. Skin cycling. It sounds good. Yeah, it sounds so good. But I just was telling people for years, like, alternate your products. It's not as sexy. I actually saw a video about that last night. This is like, this is the one thing you need to do to get amazing skin. And then obviously I'm like, Okay, so taking notes.

Well, and it's a good one that comes with retinal in particular because, as you were saying, not everybody, retinal can be quite irritating. So a lot of times when people are starting retinal, I might say, okay, use it one night and then on the next night use whatever it is, hyluronic acid or something else to potentially moisturize. And so that is a form of skin cycling. I just didn't know. Yeah. So in clinic treatments, which is obviously a huge part of what you do, let's go on to them. ask your question. I don't know. I was just wondering how you felt about in general, like what the merit, well, not even merits, but just how you feel about Botox for injectables. Yeah, I mean,

I guess I'm very pro just because it is a huge part of my practice. I would say I mainly do aesthetics. So that's things like neurotoxin, which is Botox and fillers, skin boosters, lasers. And, but again, I think it's also part of that sort of pro-aging concept, which is where you can some people want to do those things and they make them feel better and they make them feel like sort of the best version of themselves but equally if that's not for you then that's completely okay and I think that it's that's just a very personal decision and I don't necessarily think people should be judged for one or the other if that makes so much judgment around Botox it really annoys me yeah and it's really interesting because I have I think it depends a bit on your circle too like your circle of your sort of cohort because I have I do see predominantly women. And I have some women who are all kind of friends. I have lots of groups of friends that come to see me. And some are very open with each other. And they all talk about it. And they all, they're like, oh, so-and-so said she had this. You know, could I try it too? And then I have other groups where they're clearly not telling each other that they're doing anything. And it's so funny. I mean, of course, I'd never say anything. But I'm like, I do want to tell them. So-and-so's doing it too. You don't have to worry. They're so worried about being bruised or that there'll be a sign. You know, that I'm like, just be open with each other. There's no shame. But yeah, I think it is one of those things that there is, you're kind of like, damned if you do, damned if you don't. You know what I mean?

Yeah, it's such a stigma attached to it. Yeah. And I feel as well with, well, how do you feel about filler? Because I've never had Botox for aesthetics, absolutely not ruling it out. To be fair, that it's for a minute I stop breastfeeding, I'll probably be coming to see you. But I've never had it before, but I do have it in my jaw because I, because of the jaw surgery and stuff. And I have TMJ and it's so painful. And I haven't been having it while I'm breastfeeding.

And the second I'm so excited for the pain relief. But it's made me realize. having it as a pain relief that it is temporary because when it wears off I'm back in like agony again so I'm like well obviously it's temporary which is that feels really good for me to kind of know that and it's given me a lot more confidence to want to maybe try it aesthetically because I know that it will wear off yeah but I don't have that confidence with fillers because I just don't know where it goes yes so I think filler I think unfortunately um has gets a really bad rap because when there's many many people walking around who've had filler

you would have no idea, but the ones where maybe it's done overdone or done poorly, that is so it's very, very noticeable. So I think, unfortunately, it gets, it sort of scares people clearly. The majority of filler, the majority of filler is made of hyluronic acid. So hyluronic acid is a sugar molecule, basically, that's, as we know, in skincare. You actually produce hyluronic acid naturally, so it's part of your skin, naturally. So when you inject hyluronic acid into the skin. Basically, ultimately, what happens over time is it gets broken down by the enzymes that you naturally produce to break down your own hyluronic acids. So it's not there forever. One thing that has become very clear is it's there for a lot longer than we thought. So I don't know

if you ever, Alice Hart Davis, she's sort of big in the beauty community, but she did a, she did sort of a whole feature on, she had a scan of her face, basically, and it showed that she'd had filler from, you know, decades previous. And I'm still there. Wow. So there's no danger in that, really. I mean, filler's been around for a long time. So I think health-wise, that's not dangerous.

It's just to be aware that you don't want to be then putting tons of filler on top of that. That's where you start to see that sort of go wrong, if you will. So I think filler is one of those things I definitely use and it can be amazing and you can achieve things with filler that really are very hard to achieve with any other intervention. because what starts to happen as we get older is that as you're aging, unfortunately, you know, when you're young, you have these sort of juicy, they're called fat pads. Essentially, they're juicy sort of bits of fat within your skin and they're in all the right places. And then as you get, as you as you age, unfortunately, they will thin out, they will hollow, they'll start sliding down the face, which is why you start to see jowling and, you know, the things that we tend to associate with aging, sort of fine, the smile lines, what we call marionette lines. So the lines, so the lines. between the corner of your mouth and your chin. And that all has to do with shifting of tissue. And it can be very hard sometimes to improve that,

if that's what someone's looking for, without filler. But I'm just very judicious with my use of it now. I really only, you know, I'll use a very small amount and typically no more than once a year for that, an individual patient, because I do feel like it is one of those things that you can overdo, unfortunately. Okay. And then just before we carry on, just because I'm really interested in like the sort of factual side of things, but then I also feel like for our listeners, I will,

be probably like questions from a like a morality thing when it comes to filler maybe maybe the kind of like marketing of it to young people yeah like what kind of age really because obviously all power to any woman that wants to do anything to herself and with your face and your body and do whatever but for when it's being like marketed to younger people how do you feel about like the morality around that sort of thing yeah it makes me deeply uncomfortable so I I'm just very fortunate in that I don't get a lot of young patients for those types of truthfully, if really any truthfully, which is amazing because I, it makes me, I mean, I'm sure as you feel the same way, very, very uncomfortable. I think there's a very big difference between an sort of older

patient or, you know, looking to maybe just look the best version of themselves, maybe restore something that's been lost that was there before versus a young person who's 18 or 20 who just fundamentally wants to look like a different person. And that makes me really, really uncomfortable. Sadly, I think what's happened with the popularity of all of these things, whether it's skincare or treatments, I think there are great upsides, but I also think from a younger point of view, younger consumer, you know, you don't want to make people worried or feel like they need to do something that they don't need. I mean, when you're young, like, enjoy being young. I don't even like the concept really of like pre-rejuvenation. You know, I don't really think,

you don't need that. You just need your basics. You know, like the people having filler in their cheeks is because the fat pads go. So it's like, you've already. we got the fat parts. Yes. And same with the lip, for example, you know, as we see so many of these just giant lips like smacked on these faces, it just looks crazy. Whereas an older, let's say, an older woman, maybe, you know, perimenopausal in their 40s, you do, and you do start to lose volume in your lip. And so I think restoring that. And truthfully, I think a lot of those women are actually terrified to have filler because they think I'm going to end up with those big giant lips. But that's not what the goal is. The goal is really maybe just to maybe just refresh

what you previously had that you've lost a little bit of. And just give you that boost of confidence. You know, I think, I think Botox and fillers that can give you that sort of same way when you get your hair done or got a great facial or you just, you have a great outfit. You just feel good, you know, brings you confidence versus a really young person coming in. I just think that's coming from somewhere else. And it just makes me very uncomfortable. Do you ever turn patients away?

Oh, yeah. Yeah. And I think it's also, I think sometimes it's very hard for doctors and truthfully probably harder for me when I was first starting out. I maybe didn't have that confidence in myself, you know, to say this, I don't want to do this. Like I said, I am very fortunate in the sense that I don't, for whatever reason, our clinic just doesn't really attract of super young, kind of that type of consumer looking to really just kind of totally alter their appearance. if anything, I tend to have sort of older patients, more sort of my age. I'm 47. Maybe that's not older, but maybe reasonably aged patients for interventions.

And they just want to be subtle and they just, which really goes along with kind of my ethos. And I think sometimes you do end up in your practice kind of you sort of age alongside your patients, which is great. So that sort of happens too. I've had patients for many, many years, the same patients for many years. And so we, you know, we sort of go through it together and we might start out really small and then just build gradually over time rather than just, you know, going crazy from the outset with tons of filler and Botox. Wrapping up Botox quickly, a lot of people wanted to know whether Botox is actually preventative. Yes, it is.

Is it? So, yes. So I think, so just to clarify, because I know regulatory, there's always regulatory around this, but Botox is actually a brand name for neurotoxin. So botulinum toxin. So there are actually other. brands too. We call it Botox. So Botox, there's Bocator, there's Disport, there's Asylore, but they're all essentially the same thing. They're using botulinum toxin, which comes from bacteria. And ultimately, what happens is when you inject the toxin into the muscle, it prevents the muscle from contracting. And that's why you get a softening of wrinkles. So the areas where we tend to use it the most are the frown lines, so between your eyebrows, your forehead and around the eyes, your crow's feet. And so when you do Botox over a long period of time, so whether it's, you know, over several years, for example, that does prevent the lines from worsening. And in some cases, reverses them

because you can think about it. If you're not making those contractions with the muscle, those lines won't deepen. That being said, I'm not a huge fan of like what we call pre. I feel like I'm seeing it a lot like pre-rejuvenation. So I don't think you need to do Botox or any, I need the neurotoxins before you, like, quote-unquote, need it. And generally, we say the time to start would be at the first signs of lines at rest. So what you'll see sometimes as you get older is, you know, you furrow your brow and that line goes away. And then all of a sudden, one day, it doesn't go away. And you're like, ooh.

Do I have lines at rest? No. No. Really? So I wouldn't need Botox now? No. So if you came, I would just say, don't bother yet. Oh.

because again it's just another it's just another thing to add to the list of maintenance do you what I mean and so expensive thing as well it's so expensive yes and I think when you're you know usually unfortunately over time sometimes you do need to do it more frequently so a lot of times people will start with sort of twice a year but over time you may have to do it three to four times a year just to maintain that same result so yeah it's it's I think it's an investment that if certainly lots of people do it and it makes them feel good and it boosts their confidence, but I don't think you need to jump into that

sort of before it's, quote-unquote, necessary. Okay. We have to go into acne because that made up a huge, huge part of the question. As you can imagine, because I don't know, I guess you deal with it. You deal with this a lot, right? Oh, my God.

Like, day in and day out. Loads of questions. What causes it? How to treat it? Will it ever go away? Hormonal acne? Yeah. What, if anything, can people do to treat hormonal acne?

I've just thrown a thousand questions. Yeah, yeah, yeah, no, that's fine. I'm really sorry, but people want to know what it is what they can do about it. It's so hard. So I see acne all day, every day from all ages, so teenagers all the way through 50s, 60s, particularly for women. So with acne, essentially, it's largely genetic. So it's very hard to zero. And it's one of those conditions that we call sort of multifactorial, meaning there are probably many different reasons why that acne is occurring.

It's not like one, you can't isolate one and pinpoint one cause and say, okay, if you don't eat this, now it's going to get better. And that's why things like dietary changes oftentimes, maybe they improve your skin a little, but they're just not enough to get you kind of pass the point of breakouts. So, and actually hormonal acne, we call it, we sort of say hormonal acne, usually when we mean kind of acne along the jaw line, particularly in women in the lower face. But truthfully, all acne is hormonal. It has to do with hormonal changes within. in your skin. So a lot of times when you, when patients come in and they might say, okay, you know, maybe I need blood test to see if there's something like quote unquote wrong with my hormones. That's not, unless there's other signs like, you know, irregular periods and

hair loss and maybe something thinking we, that patient might have polycystic ovarian syndrome or some other underlying hormonal condition. Most of the time, if you were to do someone with acne's blood test, their hormone levels would look in their blood would look absolutely normal. So we aren't able to measure hormones within the skin as of like yet with modern medicine. So most acne, like I said, does come from fluctuations within the hormones within the skin. And it tends to be a lot of times in teenagers, you might find that that's very T zone related because that's where a lot of your oil glands are. But as we get older, sometimes it does shift more to cheeks, lower face.

And it becomes that sort of painful, tender, like bump sort of underneath the skin that even if you squeeze it, nothing comes out. So I think, unfortunately, it can be, for some people, you can use over-the-counter products, things like retinol, things like salicylic acid, glycolic acid, and that can help. But obviously, the patients that I end up seeing have kind of tried a lot of that at-home treatment and haven't been able to kind of see the results that they want. So we do have tons of prescription treatments available. And those range from creams and gels that you apply to the skin all the way to racutane. which is a medication that's derived from vitamin A, and that works to kind of dry up the oil glands to prevent the breakouts. So unfortunately, I think what's happened probably is that there's a lot in our environment that contributes to acne, which is why we're seeing it extend well into adulthood, where maybe it wasn't so much several decades ago. So we're seeing, you know, whether it's chronic stress, whether it's things about the Western diet, whether it's like microplastics that we're exposed to constantly.

I think probably these all do play a role in the change, those subtle changes within our hormones, within our skin that calls acne. Do you think contraceptives affect it as well? Yes. They can do for the better or sometimes for the negatives. Yeah, I said this to my doctor when I was pregnant. When I was on the pill and then I had the coil. Yeah. Marina coil.

And my skin was horrific. Yeah. But I didn't make the connection because I've been on, because I was on hormonal contraception for 10 years, I had written. And I would get them at DMs all the time people saying you have acne. Like, people would be like, oh, have you tried record? And I was like, I don't think I have acne. I just have shit skin. I never thought it was acne.

I just thought I had bad skin. And then when I got the coil out, it changed hugely. Yeah. So with oral contraceptives, there's kind of, or coil, there's two kind of ways that you can go about it with hormones. So you can have what's called a combined pill, which has both estrogen and progesterone. And that tends to be helpful for acne versus the marina coil, for example, is just progesterone. And you can also have that. a pill form. So they're called mini pills. They're just progesterone. And for some women, that

pure just progesterone only contraception can really worsen acne. So unfortunately, I do have a lot of patients who have had a marina coil and have had issues. And then it's a real pain because obviously you have to decide. I'd still choose to have the marina. Yes. So a lot of them have to go through that kind of conversation of do I want to take this out or do I leave it in and kind of faff around with other prescriptions to try to control it? It's frustrating. One more question about my skin. sorry, how much does diet really affect skin? When it comes to acne, I mean, I think, unfortunately, probably not as much as we think it does, which is why, yeah, so things like, yeah, so things like the old school, exactly, you know, candy, sweets, dairy, gluten,

probably don't have as much of an impact as we think they do. The only thing where sort of sugar comes into it is that there is some evidence that very high glycemic foods, So foods that make your blood sugar spike very quickly and then drop can worsen breakouts for some people who are very sensitive. So that's where sugar potentially comes in. But even things like juices and, you know, other things that you might associate with being healthy, if they're going to cause that blood sugar spike, it is possible that they can worsen breakouts. That's so interesting. That is interesting.

My entire teenage life is a lie. I know. Dairy. I thought it was dairy. Yeah. So dairy is a – and it's really interesting because – it tends to flip-flop. I feel like it's sort of like the, you know, the HRT conversation where we're always one decade we're saying HRT is the next best thing and the next decade is don't take it. And so there's been a lot of flip-flopping on diet and acne in particular. The dairy piece, generally it's really only now there's evidence to show that a skimmed dairy can cause potentially a worsening of acne, particularly in females, particularly in younger females like teenagers. And that again, probably has to do with the glycemic index because when you're, so essentially what happens,

when you're taking whole fat milk and you're making it skimmed, you're taking out fat and replacing it with sugar. So it's probably the same. It's not the dairy. It's probably the sugar. Sorry. I was going to say, what about dairy and exma? Is that a different conversation? Again, very minimal. So I'm allergic to dairy. Sorry, it's all about me. I'm allergic to dairy. It gives me asthma. But I always thought it came, made my skin bad too. Yeah. So, The eczema piece is very complicated because, so eczema, as you know, sounds like you have all of them, but tends to go along with something called atapy, which is like a sensitivity. So it tends to be asthma, seasonal allergies and exas and exas and those. If I don't have dairy, I have none of those problems. Oh, interesting. Yeah. So the interesting thing about eczema and food allergies is they do tend to go hand in hand in the same person. But the question is, what's the chicken and egg and are they worsening each other? So we used to think that patients had food allergies. and then they would develop eczema as a result of that. But now some of the thinking has changed where it's possible that patients that have eczema,

because their skin is the barrier is not as healthy as it would be a normal skin, it's what we call a leaky barrier. So it's actually allowing allergens in that wouldn't have normally gone in. And that's causing food allergies. God, how interesting. So it's almost like turned on its head. the thinking. And I think, again, those types of relationships between food and eczema, for example, they tend to be a lot more person-specific and not a blanket. Like, nobody with eczema should eat

dairy. It's more, you notice in particular, that dairy worsens your asthma or your skin. So then I would say, well, you should definitely cut it down. But there isn't a blanket type of food that's known to worsen eczema. That's so good to know for people, I think, because that's the people That's the TikTok thing as well, just like, so diagnostic. Yeah, yeah. Poor dairy. Dairy's always blamed for everything. So I have X-Met and my dad does as well.

And he's always said that citric acid makes it worse. And I love grapefruit, but I don't eat it because of my ex-ma because I'm convinced that it makes my X-O-M-Worse, but is there no link? No, no. And the other thing you, I mean, what you... We're getting you a grapefruit for long-stires. Yeah, and what you can do as well, I mean, it's a bit of a chore, but I do often tell patients who, and sometimes people do have sensitivities to foods, you know, but I think it can be really helpful to keep a like a food journal essentially, which just for a month. And if you really just track, you know, even just on your phone, you know, I ate a grapefruit today and all of a sudden, you know, I had a big flare up. I think that can be super helpful, particularly for individuals because it's very hard to pinpoint, you know, for a group of people what foods could potentially be causing their skin issue, whether that's.

psoriasis, eczema, or acne. I have heard people say things like dairy is so inflammatory and blah, blah, blah, blah. And actually it's so bad. I mean, I know I'm alleged to it, but for everyone else, it's really like. Because that always, like, that always made sense in my head, like, oh, you know, because it's sebum in acne, in spots, right? So I was like, okay, so the more fat you eat, the more sebum you make. Yeah.

But you all know people that eat terribly and have amazing skin. Yeah. And a lot of it's down to genetics, too, unfortunately. But I think that in those kind of situations where it. it could be or could not be. I think doing a food sort of log, even like that for just a month, can be really helpful because you really will notice it a little bit. That being said, things like rosacea, sometimes foods can worsen rosacea, but almost

in an indirect way. So rather than it being, for example, so coffee or spicy foods, it's not so much what it actually is that you're ingesting. It's more the heat or the spice of it that causes the flushing. So again, it's these food. sort of get a bad reputation with these skin conditions, but it's maybe in a different way than you think that they're worsening or causing a flare-up. Okay, I have like five personal questions. Why do I get X-prone random patches? And it never comes anywhere else. It's just

these are these specific patches. I'll always get it in those same ones. Where are the patches anywhere? Yeah, I don't my wrist on my little fingers. And then, I mean, behind my rings, but that makes sense. Yeah. And then behind the back of my knees. Yeah. So I was going to say in childhood, it's very common to have eczema, and we call like the flexual areas, so that's behind the knees, anywhere that things are bending, so the crook of the elbow and then behind the knees, neck, et cetera. As we get older, though, it does sometimes localized to really random places and you just don't have a reason. I find a lot of times in adults, this is maybe just anecdotally, but tends to be hands, eyelids, and around the mouth are just

very common. But the interesting thing about that is particularly with acne, a lot of times people say, oh, it's only on my, you know, my right side of my face. So I think maybe it's from my phone or it's, there's some reason it's because I'm sleeping on that side. And unfortunately, it's just random. It's random. Yeah. We can't talk about X-Men without talking about something that was asked literally a hundred times, which was topical steroid withdrawal. So I think not maybe in the way that they're describing. I guess the thing with topical steroids is I think, unfortunately, there is a lot of negative discussion around And for things like psoriasis and eczema, they can be super helpful.

Sorry, just to for clarity, this is prescribed like hydrochortisone or whatever. Yeah, so typically you can get things like hydrochortizone are sort of the lowest potency, and those are often available over the counter. But then more potent steroids would be available by prescription. Yeah. And I think what sometimes happens with steroids, in particular I see it with patients with eczema, they get afraid to use them because they hear all these sort of negative things. So rather than, so I kind of liken the best way to use steroids.

topical steroids is almost like interval training. So you have a flare-up and you blast the flare-up with the steroids. You use it consistently twice a day for a week, two weeks, and that it goes. Unfortunately, I think what happens is patients are often nervous to do that. So rather than do that, they'll put a little bit on and then maybe like a day later or two days later, they put a little bit more on. So unfortunately, you're never quite getting rid of the rash. It's just sort of simmering under the surface and you're slightly controlling it. And so that's potentially where I think you could see a rebound like that, where it was never really gone to begin with. So then you stop the steroid and all of a sudden it, it flares up. But whether there's a true dependence, I mean, on topical steroids, there's really

no scientific evidence to show that. So it's not like you can use it and then all of a sudden your skin needs it and then you stop it and it goes away. The one thing where I do see it quite a bit, though, and I don't know if anyone asked about perioral dermatitis, that's quite a common skin condition, where you get little red bumps or flesh-colored bumps around the mouth. Sometimes they can also look kind of like eczema, sort of dry and flaky, very, very common in women and particularly common in women who love to play with different skin care products, because I think sometimes what happens is you sort of get a bit of like an irritation from that product.

But what often I see is that for that peri-old dermatitis, someone might be prescribed a steroid or or they'll pick up like a hydrochortosone from the pharmacy. And the problem with that is that it temporarily helps while you're using it. But then the minute you stop it, you really do see. It's not a withdrawal, but it's a rebound. I mean, a crazy rebound. And so then people don't know what, you know, they think, oh, my gosh, I have to use the steroid again because this is making it, you know, now that I've gone off, it's gotten worse. So for perioral dermatitis, you definitely want to avoid topical steroids.

But for eczema and psoriasis, you know, and things like contact dermatitis. there's definitely a role for topical steroids and I think it just has to be how they're used has to be managed rather than all sort of scaremongering that goes on because they are a mainstay of treatment for sure I have to use them all the time I've never been scared of them and now I am sorry I'm just like oh yeah I'll put that on I'll put that on because those videos are so terrifying yeah they're so terrifying and a lot of them are like start out like I had this tiny little rash on my arm and now my face has fallen off yeah exactly I can't even like open my mouth.

Okay, fine. That's good to know. Okay. We've got to wrap it up. We've got to wrap it up. But just quickly, before you go, on a very personal note, I can't let you go without asking you. Do you get to do a lot of pimple popping? Oh, yes.

And I'm so, I'm so, so jealous. Oh, my God. Just yesterday, I had two patients actually who were there for Botox, but they both had these blackheads. And I was like, I just can't let you walk out the door without getting that out. I just can't do it. Oh, yeah. They're amazing. And then I have to, I don't even sure they want to know.

but I show them what I go out because it's just so satisfying. Stunning. It's funny, I haven't watched videos in a long time, but I could just watch those removal ones like set to music for hours. Don't you just love them? Beautiful piano music. I'm like to do it myself. It's so calming.

I don't like watching the videos, but I want to do it. When Alex is doing his teeth, I'm like, oh, you stay still. Have you seen the one where they take, it's like a jelly bear and it has like the fake pimples in it and they pop in? Oh my God, they're amazing. Is it so? Do you use it? So they give you, they give you vitamin E to go into it. You have to warm the vitamin E up in the microwave and then put it in and then so it's an absolute

No, no, no, no. It has to come pre-filled with the pimples. Yeah, yeah, it's so funny. Thank you so much. Sorry, we've thrown like a million questions at you, but thank you. That's been so useful and helpful. Thank you so much. Yeah, thanks.

Thanks. Should I delete that is part of the ACAS creator network.