Consultant Dermatologist Dr Justine Hextall answers skincare questions received at the Allergy Show London
How many times a day should you apply moisturiser?
Usually twice a day. If you are having to apply more frequently and are reaching for the moisturiser as soon as you have cleansed your skin it suggests that the skincare regime is too harsh and may be stripping the skin barrier. If the skin barrier is unbalanced (e.g. the naturally acidic skin pH is changed with harsh cleansers), increased water loss is common and as such we try to counteract this with using stronger and more frequently applied moisturisers. Look for a very gentle cleanser and you will be surprised at the improvements.
What products do you recommend for hyper sensitive skin?
I would say the Toleriane Ultra range by La Roche-Posay. It is preservative and perfume free (some of the most common skin allergens) and contains neurosensine, a neuropeptide that reduces skin irritation.
What products can I use on my child's sensitive skin?
Firstly make sure that bathing is kept to a minimum as over washing and damaging a child’s sensitive skin barrier can cause a myriad of problems. I like La Roche-Posay’s Lipikar AP+ Balm as it contains shea butter that is very similar to the fat naturally occurring in our own skin barrier, and as such will help to repair it. It also promotes a heathy skin microbiome, again changes in which are now being studied as it is believed they play a significant part in inflammatory skin conditions such as eczema.
What do you recommend for itchy skin?
It depends on the cause of itchy skin. If there is inflammation then reducing this will help. Dry skin tends to be itchy and as we get older our skin barrier loses key ingredients that maintain it, such as ceramides. Topical creams that repair the skin barrier can help hydrate the skin and as such reduce itching. Look for humectants such as hyaluronic acid and glycerine that attract water to the skin. Shea butter and ceramides help repair the skin barrier. Regular moisturising as you get older is also highly recommended.
My skin is prone to redness, what products can I use to control this?
Look for anti-redness moisturisers that also hydrate the skin. If your skin is sensitive and tends to sting as products are applied I would recommend the Toleriane Ultra range from La Roche-Posay.
What do you recommend to treat psoriasis?
Psoriasis usually needs specific medicines to treat it, but hydrating skincare plays a very important role. I would recommend looking for creams that hydrate the skin but also promote a healthy microbiome. I like Lipikar Balm AP+ by La Roche –Posay.
What should I use to manage dry skin?
As mentioned above, I would recommend looking for creams that hydrate the skin but also promote a healthy microbiome. I like Lipikar Balm AP+ by La Roche –Posay.
What is the best treatment for eczema?
I am not keen on petroleum based creams as they can trap heat and make itching worse. I like hydrating creams that will not irritate the skin. Try La Roche-Posay’s Lipikar AP+ Balm. There is also a Lipikar AP+ Stick that contains a natural anti-inflammatory: madecassoside. If your child wishes to scratch, encourage them to rub this soothing stick on the site, this can help break the itch-scratch cycle.
My son has multiple allergies resulting in eczema flare-ups. What products would
be safe to use?
Try to find preservative free creams without perfume.
What do you recommend for skin with rosacea?
I recommend using products that are going to be extremely gentle as the skin barrier is very vulnerable with rosacea. Using a cleanser that isn’t going to strip the skin and a soothing hydrating moisturiser that will preferably reduce redness and inflammation is important. UV is a common trigger in rosacea so using a high factor 50 sun cream with UVB and UVA cover is important.
Is the La Roche-Posay Rosaliac range suitable for someone with severe nut allergy?
I am not aware of any risks with this range and nut allergy. A patch test if you are concerned may be the most sensible approach.
OILY, BLEMISH-PRONE SKIN:
What routine do you recommend for acne-prone skin?
We know that inflammation plays a key role in acne so, counterintuitive as it may sound, gentle non stripping products are so important. There is a lot of misinformation out there encouraging so-called deep cleansing regimes that in fact leave the skin dry inflamed and vulnerable and unable to tolerate anti-acne topical treatments.
What do you recommend to treat adult acne, including on the back and neck?
It is important to make sure this is acne. I often see individuals with a diagnosis of acne who in fact have folliculitis or inflammation of follicles in these areas exacerbated by heat, exercise etc. Using a gentle antiseptic cleanser after exercising will help with this. If there is true acne, then topical creams like La Roche-Posay’s Effaclar Duo+ that reduce inflammation can help, and prescription topical treatments such as benzyl peroxide and a retinoid can also help. I try to avoid antibiotics in acne now if possible, not only because of bacterial resistance but also because of the risk of changing the gut microbiome.
What do you recommend to manage hormonal acne?
Usually a combination of the right skincare products to reduce skin inflammation, topical active treatments such as a combination of benzyl peroxide and a retinoid. Also I would be looking at hormonal influences that may be affecting the skin e.g. an implant, or specific type of oral contraceptive pill. Some pills contain anti-androgens that can help in this type of acne. Diet and exercise will also have an effect with this type of acne.
What products can I use to prevent and reduce acne scarring?
In order to prevent acne scarring it is important to get the acne under control and also to be careful about squeezing or picking any active acne lesions. It is difficult to affect acne scarring until the acne itself is switched off. Seek medical help to optimise acne management firstly, then once under control there are many treatments available to help with the scarring.
How can I best manage combination skin (oily with dry patches)?
I often feel combination skin is a result of over stripping/cleansing oily skin. It sounds counterintuitive but choosing a more gentle wash (so the skin does not feel tight afterwards) will leave the skin soft and hydrated without dry patches. Do not be afraid to use a light moisturiser with combination skin.
What do you recommend for enlarged pores?
A cold water rinse can help after cleansing and primers can minimise the appearance of enlarged pores. IPL laser and micro-needling are two of the best treatments in my view to reduce pore size.
What treatment do you recommend for pigmentation, including on the under-eye area?
Under the eye area, pigmentation is not always the issue. Dark rings are often because the skin is getting thinner and under eye blood vessels are becoming more visible. If the skin is red and itchy and getting darker this may suggest post inflammatory hyperpigmentation and as such using the gentlest products here is important. Look at the Toleriane Ultra range by La Roche-Posay. Remember hands (e.g. nail products) can cause under eye allergies as we are always touching this area.
What can I do to prevent and reduce age spots?
Wear a high factor sun cream with SPF 50 and good UVA cover. In these situations I favour light reflective mineral sun creams (e.g, zinc oxide). Use topical vitamin C products that help mitigate against the free radical damage from UV exposure which results in pigmentation. The active version of vitamin C suppresses enzymes in the pathway of pigmentation. Finally cleanse at night to help remove pollution particles that contribute to so-called age spots and collagen damage.