April 17 Weekly Skinspiration

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Weekly Skinspiration April 17, 2017

weekly skinspiration

Dermatology Pearl

Hormonal Acne

Credit: The cat and the coffee drinker

Let’s talk about acne for a second. Acne is on my mind since I’m presenting my research on hormonal acne this Friday, so it’s fitting that I share some information with you guys on this topic. Women can get hormonal acne, a type of acne that appears in characteristic locations like the jawline and the chin, and flares around your periods. These can also be sometimes accompanied by other signs of androgen excess like excess hair growth on the chin or even hair loss on the scalp. Androgens like testosterone and DHT in excess quantities can be responsible for this type of acne. If you suffer from this type of acne, definitely see a dermatologist because there’s a lot of things we can try for you! One way to regulate the hormone craziness is to try birth control pills, which tell the ovaries to make less androgens. You should know that birth control pills are contraindicated in anyone who smokes or has a history of blood clots. It can also cause breast tenderness, headaches, increased risk of blood clots or heart attack, especially if you smoke. Just because you’re on birth control it does NOT mean you are protected against STD’s, so you still have to use protection if you’re going to be sexually active!

Another pill is called spironolactone, and it is an androgen blocker that also prevents conversion of testosterone to its more potent form that also acts on the skin, called DHT. This pill can also help with hormonal acne, but it may involve blood tests and can cause side effects like urinating more (it’s actually designed to be a diuretic initially) or breast tenderness.

As dermatologists we like to mix and match things for acne, so in addition to systemic medications, you may also receive a topical regimen. I like using an antibiotic like topical clindamycin, plus something like benzoyl peroxide, plus a retinoid at night to get rid of any comedones (blackheads and whiteheads). You may have to be a little patient while waiting for this regimen to work; usually I tell my patients to wait around 6 weeks before expecting a huge change.

If you’re interested in reading more about how to treat acne, check out my post about my acne treatment algorithm here or about the REAL link between food and acne here.

Beauty Review

La Roche-Posay Anthelios 50 Mineral Tinted Ultra-Light Sunscreen Fluid

La Roche Posay Ultra Light Sunscreen Fluid
Price: $$

Coverage: 4/5

SPF: 5/5

Scent: N/A

Texture: 5/5

Overall: 5/5

*Each $ is approximately $20

Now that the sun is shining brightly in NYC (YES! SPRING IS HERE!) I have been lathering on my sunscreen, paying special attention to SPF and reapplication. I reviewed a bunch of sunscreens here but I hadn’t yet tried one of my favorite sunscreens of all time yet, the La Roche-Posay Anthelios 50 Mineral Tinted Ultra-Light Sunscreen FluidI received a bottle of this c/o La Roche-Posay at a dermatology conference last year and I have been buying it ever since. In fact I not only bought extras for myself, I purchased it for my mom and my aunt too! There are so many things I love about it. It is formulated for sensitive skin, so it never makes me break out, and it is also ultra light so you don’t feel like you’re putting on anything heavy or greasy the way other sunscreens feel. Its active ingredient is titanium dioxide, which is a physical blocker (not sure what that means? click here) that works by reflecting off UV radiation from your skin. You won’t get any of that chalky white pasty residue here though; this sunscreen provides enough coverage for my freckles and sunspots while leaving a smooth matte finish. It even contains an antioxidant compound to help prevent free radical damage from the UV radiation! I love using this product when it’s sunny outside and I want smooth pore-less skin without using something heavy. It’s one of my favorite sunscreens and I hope you’ll enjoy it too!

Fashion Find

Madewell Tee and Bag and ShortsMadewell Whisper Cotton turtleneck in XXS
Madewell scallop shorts in XXS (under $30!)
Madewell Transport Crossbody with monogram

I posted before about the Madewell sale, which is going on AGAIN this week with an extra 30% off all sale styles with code DREAMBIG. All of the items are now back in stock! I love the soft mock turtleneck and the scalloped hem shorts which fit perfectly out of the box, but I wanted in particular to post a review of the leather bag since I’m so happy with it. In my opinion this bag is the perfect size for traveling; it’s not too bulky or heavy but can fit all the essentials – water bottle, light jacket, wallet, keys, phone. It’s really light and the color is a nice tan. I also like that the monogram is small and not so obvious; the little detail of extra personalization (which was free! sign up to be a Madewell insider) was a nice touch. The cross body length works well on me and the strap is adjustable to your height. The only drawbacks are that the bag was creased during the delivery* and the crease line has actually darkened with time, and the opening of the bag is a little bit small compared to how deep the bag is. I like being able to see a lot of the contents of my bag through the opening, but with this smaller opening I have to rummage around a bit more to get to my stuff. Overall it’s a really nice, sturdy, and well-made leather tote, and I’ve already gotten quite a few compliments when I use it!

Some other items that caught my eye:

*note: I’ve emailed Madewell customer service about the damage the bag underwent during delivery and I’m happy to report back that their customer service is top notch. Not only are they letting me refund the bag, but they are also giving me a $25 gift card and free overnight shipping on my replacement bag. I’m very impressed with their customer service!

Life Update


Two of my best friends that I’ve known for over a decade visited two weekends ago. Sally, my maid of honor and bestie from Stanford undergrad, and Melody, my bridesmaid and childhood best friend I’ve known since I was born, were both in NYC for various reasons, and it was so awesome to hang out with friends from home! It felt so familiar and relaxing, and we had a great time reminiscing about our lives pre-marriage while eating at all the popular spots throughout the city. Spending time with them really made me feel so happy and rejuvenated but also homesick once they left. I’ve never lived far from home before, so not being able to see my friends I’ve accumulated over two decades of living in the Bay Area has been tough.

I took them to eat at Robata-ya, a cool yakitori restaurant where you can sit in front of these pirate looking chefs who grill everything in front of your eyes on an elevated stage and then deliver it to you on a large wooden paddle. We also hit up Jane for boozy brunch, hit up a Parker sample sale in Soho, did drinks at VNYL (plus late night eating at – what else – the Halal guys chicken and rice AND Artichoke’s pizza), and got Japanese desserts at Chikalicious Dessert Club. I also took Sally and her husband to my favorite sushi place in the city – Domo Domo in the West Village. They have an amazing omakase set with sushi and hand rolls for $55. I can’t believe I’ll soon be living within walking distance to it!

I also visited the Butterfly Conservatory at the American Museum of Natural History last week and I highly recommend a visit! It’s an awesome special exhibit, one of the most popular ones at this museum each year, that allows you to walk through a man-made indoor garden with hundreds of exotic butterflies flying around inside next to you. The butterflies even land on you; I stayed still for a few minutes and I had butterflies on my coat and my boots!

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In terms of work:

  • I’ve been really busy this week (or even, this whole month…) wrapping up research projects, finishing up a draft for submission to a peer-reviewed dermatology journal, and making a research presentation to share with the department the acne research project I have been working on for the past year. Work hard, play hard!
  • In a month I will be presenting at grand rounds about my time at ABC News. For any medical residents who are interested in a 3-4 week internship at the ABC News medical unit, email me! Dan Childs the wonderful medical editor over there is currently RECRUITING for the next year. Email me at teawithMD.com and I”ll connect you to Dan.
  • Last week in cosmetics clinic I injected Sculptra, a filler material made of poly-L lactic acid. This is a long-lasting filler that can stay in place for 1-2 years depending on your frequency of treatments. It was cool learning my attending’s “fanning” technique where you enter the skin from a distance away, inject as you pull out of the tract with a long needle, and without removing the needle from the skin, rethread the needle in a different direction and injecting more. This allows you to place the product in an arc like fashion around the point of entry.

Have a good week!

11 Comments on April 17 Weekly Skinspiration

  1. Jen
    April 17, 2017 at 11:08 am (5 months ago)

    Love your helpful and informative comments on hormonal acne! I tried birth control, Accutane, Retin-A, and spironolactone. Accutane was a total game-changer back in the day, and the spiro / Retin-A is helping me deal with my adult hormonal acne now. I’m getting worried though because I can’t use any of these meds when I get pregnant! What do you recommend for pregnant women who have acne? (I KNOW that I will be a pimply pregnant woman given my history)

    Reply
    • Joyce
      April 17, 2017 at 3:20 pm (5 months ago)

      Hey Jen! Thanks for leaving a comment :) Acne during pregnancy is a bit trickier because many medications like retinoids, spironolactone, and even benzoyl peroxide are class C. I found this great primer on the AAD (American Academy of Derm) website about meds that are safe to use during pregnancy. You want to stick to medications that are class B (there are no FDA approved Class A acne medications), like topical antibiotic solution or azelaic acid (which also helps with brown pigment disorders like melasma). You can also consider light therapies! I know Neutrogena now makes a home light mask, though I haven’t reviewed the evidence into whether it works well or not.

      Reply
    • Betsy
      April 17, 2017 at 8:05 pm (5 months ago)

      IANAD, but Jen, if it is any encouragement I struggle with hormonal acne and I LOVED my skin during pregnancy. My acne disappeared and the extra fat filled in my wrinkles. I stared at my face in the mirror every day – it was a miracle. Maybe you will have the same luck!

      Reply
      • Joyce
        April 17, 2017 at 9:09 pm (5 months ago)

        Many women love the glowing complexion they get during pregnancy! So glad that you experienced that Betsy! 😀

        Reply
        • Jennifer
          September 10, 2017 at 2:10 am (2 weeks ago)

          @Betsy I just saw this and it is making me feel so much better about pregnancy – thank you!

          Reply
  2. kristen
    April 17, 2017 at 1:42 pm (5 months ago)

    Can I ask a question about sunscreen? I layer it on each morning after my serums and moisturizer, but before my foundation, but I always wonder, is it still helping me by the time I leave the house – three hours later? (I work from home.) Since I live in Houston I try to wear a hat, as well, but the sunscreen question always plagues me! 😉

    P.S. I love the transport cross body on you! I have the regular Transport – but I think I love that one even more!

    Reply
    • Joyce
      April 17, 2017 at 3:34 pm (5 months ago)

      Hi Kristen, great question! You typically want to put the sunscreen on 15 minutes before you are exposed to the sun, and you actually have to reapply every two hours! That means that if you’re indoors in a relatively shaded environment you don’t have to put on sunscreen until just before you’re ready to leave the home. The reason why we have to reapply isn’t because the sunscreen breaks down, but rather because people as a rule don’t put on enough sunscreen to begin with. Here’s a link to a NYTimes article quoting a prominent dermatologist in NYC about that issue.

      Also, thanks for your comment about my transport cross body! I was also tempted by the regular transport :)

      Reply
  3. Betsy
    April 17, 2017 at 8:08 pm (5 months ago)

    That Transport crossbody is the perfect size! I think it’s time for an upgrade.

    Question about Sculptra: for what areas of the face is it best? I start with a new derm here in Austin next month and at 47, I am starting to get interested in fillers (see ya, cavernous naso-labial folds) but I want to retain facial movement and not look weird.

    Thank you for such a smart, interesting blog! I love your posts!

    Reply
    • Joyce
      April 17, 2017 at 9:16 pm (5 months ago)

      Hi Betsy, great questions. Sculptra is great for areas where you need more volume and it lasts for longer than hyaluronic acid fillers like Juvederm or Restylane. Sculptra is also great because it promotes new collagen production. It can be used to fill hollow cheeks, temples, the nasolabial folds, and the chin area. I’ve used it mainly for the temples and cheeks, areas where there can be massive volume loss, especially in conditions like HIV lipodystrophy where the fat in the face decreases abnormally quickly due to side effect of antiretrovirals. If you don’t need too much volume you can go for Juvederm or Restylane. Either way, definitely check with your derm to discuss locations to inject for the most natural look and which fillers to use! So glad that you enjoy my posts!

      Reply
  4. Lisa
    May 9, 2017 at 5:53 pm (4 months ago)

    Hello! I am so glad I found your blog! Can you please comment on whether La Mer products are worth the money or not? Does algae really provide benefits to the skin? Thanks!

    Reply
    • Joyce
      May 10, 2017 at 7:43 pm (4 months ago)

      Hi Lisa, great question! I’ll put that on my list of brands to review. I’ve always wondered that myself since I have tried La Mer samples at airport duty free stores and felt that the creams are luxurious but aren’t THAT much different from the other brands I like (which are more affordable).

      Reply

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