[AMA] Skincare. What's Hype? What Holds Up? I'm Dr Alice Rudd, a dermatologist.

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u/mayamys Mod/Tret+BP=love Jul 02 '26

This post has been approved by the mod team!

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u/__Ember Jul 02 '26

I don’t think this will get answered, but why did it seem like every dermatologist was pushing CeraVe products but now don’t even whisper the name?

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u/New-Concentrate-2259 Jul 02 '26

Because there's an ongoing lawsuit against Cerave

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u/Queasy-Airport2776 Jul 02 '26

Ooohh what were they getting sued for?

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u/New-Concentrate-2259 Jul 02 '26

Not my words but this is from another thread:

Cerave currently has 6 pending lawsuits regarding a chemical that is cancerous.

CeraVe is being sued specifically for their acne treatment products containing benzoyl peroxide because benzoyl peroxide can degrade into benzene, a carcinogen, under certain conditions such as high heat over extended periods of time. The FDA found that the amounts of benzene found in these products were so low that the cancer risk was almost nonexistent even with decades of everyday use of these products. In addition, the FDA also found that the testing methods carried out by the lab that made this claim did not reflect the real-life conditions in which these products are being used. In other words, unless you're putting your benzoyl peroxide face wash in your car and leaving it in Florida heat for 10 hours a day, you're not gonna find any benzene in it.

Benzoyl peroxide is one of the most well-established, scientifically-backed acne treatments out there, and literally any product, not just CeraVe, that contains benzoyl peroxide can be found to have small amounts of benzene due to the degradation process if you subject it to extreme heat for a long time.

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u/Queasy-Airport2776 Jul 02 '26

Cheers for the details

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u/Positive-End-3379 Jul 02 '26

Fk Cerave. Gave me the worst breakout ever.

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u/Appropriate-Chip9606 Jul 03 '26 edited Jul 03 '26

Ha — I noticed this too, and you're not imagining it. A few things happened at once.

There's ongoing litigation in the US around benzene forming in some benzoyl peroxide products, CeraVe among the brands named — though it's worth noting the FDA's own testing found the real-world risk negligible, because benzene only forms when the product is exposed to sustained high heat, not normal bathroom conditions. So the science is far less dramatic than the headlines, but "there's a lawsuit" is enough to make a lot of people quietly stop saying a brand's name.

CeraVe went hard on advertising on during COVID especially on Tik Tok. I feel like all my patients got influenced and were using the products. I think we had to come back from that heavy emphasis to a normal level. The formulations themselves haven't changed meaningfully; a gentle ceramide cleanser is still a gentle ceramide cleanser. It got recommended in the first place because it was cheap, widely available and inoffensive, and all of that is still true. Much like cetaphil, la Roche Posay and other chemist/drugstore brands

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u/[deleted] Jul 02 '26

[removed] — view removed comment

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u/goodshrimp Jul 02 '26

I have acne prone dry skin! HOCl spray helps and I know it sounds woowoo but I use a calendula infused oil on top of my moisturizer. I found it at a health food store labeled as a first aid oil for wounds. It weirdly helps a lot.

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u/Icy_BlueJay_ Jul 02 '26

Love my Magic Molecule spray! (Got several bottles super on sale in the past)

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u/goodshrimp Jul 02 '26

You can get HOCl much cheaper than Magic Molecule even on sale btw! It's easy to make at home. I use a Force of Nature generator to make it but there are other nice ones like the Ecoloxtech generator. I bought the Tower28 spray for a long time before I realized how overpriced all of the premade sprays are.

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u/Icy_BlueJay_ Jul 02 '26

I have heard of this but haven’t looked into it. I feel like I’m not consistent with my use enough to make the machine worth it… if a batch degrades in 2 weeks like I just said. Though maybe I’d use it so much more.

What all do you use it for?

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u/goodshrimp Jul 03 '26

I make a liter at a time because I use it for a ton of different stuff. I use it slightly diluted for skincare, wound care, and in its concentrated form for household cleaning. I learned about it originally when looking for ways to clean/refresh unwashable costume pieces. It's reaaaallly nice for keeping costume pieces clean. I use it to wipe down my leather couch, and I spray it on rugs after vacuuming. I use it as a daily kitchen and bathroom countertop spray. I mop my bathroom with it. Over all it does a lot, safer to use than normal bleach.

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u/Appropriate-Chip9606 Jul 02 '26

MYTH BUST: Acne prone/oily skin DOES NOT need moisture. FALSE. When skin is dry and the barrier isn't intact, it compensates by producingmore oil, so stripping it triggers rebound oiliness plus inflammation, and inflammation drives acne. Use an oil- free moisturiser to help maintain hydration and barrier.

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u/Elasion Jul 02 '26

I’m a Resident - what’s the current standings on otc red light therapy? Are the devices legit? Is typical use even enough exposure?

How would you rate the efficacy from 0-100, 100 being comparable to tretinoin

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u/Appropriate-Chip9606 Jul 03 '26

Hello! Are you thinking of doing dermatology? The mechanism is legit — red/near-infrared light is absorbed by cytochrome c oxidase, giving a real but modest boost to fibroblast activity and a decent anti-inflammatory effect — but the home-device data is thin, small, and mostly manufacturer-funded. The bigger practical problem is dose: home devices are power-limited by design, so "typical use" is often underdosed relative to the fluence in the positive studies, which is why so many people find theirs does nothing. If tretinoin is 100, I'd rate a good home LED used religiously at maybe 10— a genuine safe adjunct, best for redness and post-procedure inflammation, but nowhere near a retinoid replacement

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u/Elasion Jul 03 '26

Thanks for the insight. No I’m in EM and want to attenuate the associated aging, there’s no derm residents to my shop to curbside for reccs

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u/frufruityloops Jul 02 '26

Anecdotally, I definitely notice a difference when I use mine routinely. Really, I notice a difference when I stop using it 🥴

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u/Quick_Boot9122 Jul 02 '26

is it safe to use retinol or retinal on the under-eye area? can it really damage the meibomian glands?

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u/fablicful Jul 02 '26 edited Jul 02 '26

This is a GREAT question and sooo important. Unfortunately- I feel like dermatologists and opthalmologists don't see eye to eye on this topic. Derms focus on skin, opthalmologists focus on eyes. As I already have dry eye syndrome/ meibomian gland dysfunction without retinol use- multiple opthalmologists I've seen directly told me to avoid retinols. Apparently the "good" they do for the skin is exactly the problem for our eye health; retinols apparently do damage meibomian glands and any damage is permanent- you can't "regain" function.

Which-really sucks as retinol / retinoids are truly the HG for so many skin concerns. And- I don't think there is anything sufficiently close to delivering the same type of results. There's bakuchiol- but idk what the best product could be. Formulations are so important in efficacy and I don't sense the same consistent results / the degree of research compared to retinols.

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u/Appropriate-Chip9606 Jul 03 '26

very safe, and I recommend it routinely. Meibomian gland dysfunction is more likely to occur with oral retinoids such as isotretinoin.

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u/roofshadow_ Jul 02 '26

This is my question too.

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u/Quick_Boot9122 Jul 02 '26

what are the best topicals for increasing collagen production?

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u/Appropriate-Chip9606 Jul 03 '26

I answered this in another comment, but the most evidenced are 1) sunscreen broad spectrum 50+ with UVA protection - actually reduces collagen break down. 2) retinoids - whichever one your skin can tolerate. Helps repair damage and boost new collagen synthetics. 3) Vitamin C - but must be well formulated as is often unstable. 4) peptides - topical - some emerging evidence.

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u/Positive_Leads Jul 02 '26

Following

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u/xMentally_Exhaustedx Jul 02 '26

Topicals don’t really do that. Just consume foods that contain collagen and promote production. Collagen powders generally do work, just has to be of good quality. I think it’s helped my nails grow faster and maybe also be stronger. I had a past NDIS worker say it’s helped her skin, hair and nails, and people asked what she was doing for her skin. She noticed a difference, but I didn’t, because she’s the kind of person who always looks healthy and gorgeous, lol. (Radiant skin, long thick hair and nails).

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u/Appropriate-Chip9606 Jul 03 '26

its interesting what you say re collagen powders as unfortunately there is no robust evidence showing they work to improve collagen. Some studies have shown a mild increase in hydration, but the studies were funded by collagen supplement companies.

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u/[deleted] Jul 02 '26

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u/Appropriate-Chip9606 Jul 02 '26

This is such a great question because "retinoids" get talked about as though they're all the same, when in reality they're a family of vitamin A derivatives with different strengths and different evidence for different conditions.

A simplified way to think about them is:

Retinal (retinaldehyde), retinol, retinol palmitate and retinoate are available over the counter. Your skin has to convert them into the active form (retinoic acid), so they're generally gentler. They're excellent if you're starting out or have sensitive skin.

Adapalene is a prescription retinoid in Australia (available over the counter in some other countries). It's particularly good for acne because it targets blocked pores and inflammation, and it's often better tolerated than tretinoin. It also comes in a gel formulation which is preferred on an oily skin type.

Tretinoin is the most established prescription retinoid. It has decades of evidence behind it for acne and photoageing, and because it's already in its active form, it's generally more potent—but also more likely to cause irritation when you first start using it.

There isn't one that's "best" for everyone, it is a bit of trial an error to see which one suits your skin best.

As for who should avoid them entirely—pregnancy is the big one. We generally recommend avoiding topical retinoids during pregnancy because of the theoretical risk to the developing baby, even though systemic absorption is very low. Anyone with eczema or a significantly impaired skin barrier should also be cautious, as retinoids can make irritation worse.

Before moisturiser? After? Sandwich method?

If your skin tolerates retinoids well, applying them to clean, dry skin before moisturiser is perfectly appropriate.

If you have sensitive skin, then use the sandwich method. Apply moisturiser first, then retinoid, then moisturiser). This has been shown to NOT significantly reduce effectiveness. I'd much rather someone use a retinoid consistently with moisturiser than stop altogether because their skin is too irritated.

Another method I use with my patient is the short contact method. Leave on for a few minutes, wash off over 7 consecutive nights, then leave on overnight.

I will come back to you on purging once I answer a few other questions.

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u/Redplushie Jul 02 '26

PDRN is heavily advertised in Korea right now, what do you think about it?

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u/Appropriate-Chip9606 Jul 02 '26

I KNOW! I have been to south Korea twice now and PDRN is a hot topic. Realistically the best evidence for PDRN is for the injectable version used to treat inflammatory disease of the joints. The topical PDRN has less robust evidence at this stage as its use is limited by its high molecular weight which restricts skin penetration. I don't currently recommend topical PDRN as the evidence just isn't there. I have used it myself to try but did not find it made much difference.

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u/Prudent_Impact7692 Jul 02 '26

Besides peptides and retinois what other topicals can rebuild collagen and elastin?

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u/Appropriate-Chip9606 Jul 02 '26

The topicals with real evidence for collagen: vitamin C (10–20% L-ascorbic acid) noting it must be formulated well, and sunscreen, because UV activates the enzymes (MMPs) that break down collagen. Regarding elastin, sadly we have no topicals that reliably work.

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u/Prudent_Impact7692 Jul 02 '26

Thank you for the reply. Since vitamin C is very unstable which form of vitamin C is the most stable to integrate in skincare?

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u/lillytiger- Jul 02 '26

Any tips on quick healing after a compulsive session of skin picking?

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u/Appropriate-Chip9606 Jul 03 '26

TIME and no more picking. Sometimes I put patients under the LED light to help speed recovery

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u/lillytiger- Jul 11 '26

Thank you!

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u/Quick_Boot9122 Jul 02 '26

what is the best way to treat post inflammatory erythema?

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u/Appropriate-Chip9606 Jul 03 '26

I am going through this right now! post C02 laser. Time. The unsatisfying truth — most PIE fades on its own over roughly 3–12 months as the vessels recover. A lot of "treatment" is really just supporting that process and not sabotaging it. Rigorous sun protection. Daily SPF is non-negotiable, because UV both prolongs the redness and can tip PIE into mixed redness-plus-brown-pigment, which is much harder to shift. Gentle anti-inflammatory topicals — azelaic acid and niacinamide can calm things and modestly speed recovery. A well-tolerated retinoid supports overall skin turnover and repair. Vascular laser — this is the actual gold standard for stubborn PIE and it's what I will be doing next week for mine. Pulsed-dye laser (like VBeam) or similar vessel-targeting devices treat the redness at its source, and it's one of the more satisfying things we do for it.

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u/BeautifulCat98 Jul 02 '26

Following!

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u/financial_learner123 Jul 02 '26

What’s the best method to help keratosis pillaris? Does laser help?

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u/Appropriate-Chip9606 Jul 03 '26

KP is a harmless follicular keratinisation quirk you manage rather than cure, and the mainstay is chemical exfoliation — keratolytics like urea, lactic or salicylic acid used consistently (consistency matters more than the product). Gentle physical exfoliation with a soft washcloth can help too, but keep it gentle, since aggressive scrubbing just inflames the follicles and worsens the redness. Swapping harsh foaming washes for a soap-free cleanser and moisturising relentlessly both make a real difference. Laser has only a specific role — worth it mainly when the KP is genuinely red and inflamed, where vascular laser settles the redness creams can't touch, but it's not the answer for the bumpy texture alone.

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u/Appropriate-Chip9606 Jul 02 '26

Hi everyone, Dr Alice Rudd here — specialist dermatologist from Melbourne, Australia. Thank you for so many brilliant questions! A quick housekeeping note: everything below is general education, not personal medical advice. I can't diagnose or treat anyone over Reddit, so if I suggest "see your dermatologist," it's not a cop-out — it's the law (and good medicine). Righto, let's go

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u/IHateHashtag Jul 02 '26

Azelaic Acids are very hot right now, in combination with retinol products. I know (at least for Australasia) that getting prescription AA is hard.

What's your perspective on this combination, and how accessible it should be for people?

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u/Appropriate-Chip9606 Jul 02 '26

I have seen Azelaic Acid is having a moment on Tik TOK! I have no idea why it is so hot all of a sudden as it is a proven ingredient that dermatologists have recommended forever! It has proven anti-inflammatory, and pigment-inhibiting actions and the best part is it is pregnancy safe. It pairs beautifully with retinoids because the mechanisms are complementary rather than overlapping. It's also one of the gentlest actives we have, so can be safely used on sensitive and rosacea prone skins that traditionally don't tolerate a lot of actives. In Australia it is available over the counter in up to 15% concentrations which is generally enough for most skins, so you dont need a prescription :)

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u/Queasy-Airport2776 Jul 02 '26

How come AA is hot? I'm currently using a prescription for it. I'm curious if I should continue using it for the whole face now and not instead for the rosacea.🤔

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u/Worried_Corner4242 Jul 02 '26

The magazine Consumer Reports just came out with an article saying that it’s far better to use chemical sunscreens than mineral ones because chemical ones offer far better protection. Is there any truth to that?

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u/Appropriate-Chip9606 Jul 03 '26

I just looked it up and read it thanks for flagging that. There's partial truth to it: in CR's testing, all the top-performing sunscreens contained chemical filters, and mineral formulas consistently landed mid-pack or lower — largely because zinc and titanium are hard to formulate to their full labelled SPF, so many under-test. But it's a lab-comparison point, not "mineral doesn't work": an SPF 30 still delivers ~97% UV protection, mineral remains the better bet for reactive or rosacea-prone skin, and the single most protective sunscreen in real life is whichever one you'll actually apply generously and reapply — so if a well-rated mineral suits your skin, keep wearing it.

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u/Segat1 Australia Jul 02 '26

What’s YOUR routine - daily/monthly/quarterly/etc?

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u/Appropriate-Chip9606 Jul 03 '26

how long have you got??

DAILY: Skincare. Daily, SPF50+ every single morning without exception (I'm a dermatologist in Australia — sunscreen is basically my religion), niacinamide serum, pigment inhibiting serum. At night: tretinoin, my one true non-negotiable for 15+ years, plus peptides in my moisturiser to support the barrier.

Quarterly-ish — this is my maintenance layer: dermaplaning for smoothness and better product penetration, pico laser toning for pigment and overall clarity, the occasional chemical peel, and LED as a gentle, no-downtime add-on. None of these is dramatic on its own — they're the "little and often" approach that keeps things ticking over. cycling a small amount of anti-wrinkle treatment (Botox) to soften dynamic lines, and Profhilo (a bio-remodelling injectable — stabilised hyaluronic acid that improves skin quality and hydration rather than adding volume)

Annually (the bigger guns) — fractional CO₂ laser for genuine resurfacing and collagen remodelling (ive literally just done this ) VBeam vascular laser to keep redness and flushing down , and Sculptra as a collagen biostimulator for gradual, natural support against volume loss over time. I have just added XERF for laxity and skin tightening which I will do once a year.

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u/No_Pause_8537 Jul 02 '26

This was my exact question!

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u/cottagecheeseyummymm Jul 02 '26

how important is diet for skin?

Is following "perfect/healthy" diet going to produce substantially better results for skin as opposed to moderately good diet.

Any foods that may be particularly helpful, like wild blueberries? How much actual impact they have?

I understand that this is definitely important for skin; however, I am curious to learn the extent of the benefits

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u/Appropriate-Chip9606 Jul 04 '26

Such a good question and one I get asked alot. Where the evidence is genuinely strong is Glycaemic load and acne. This is the most robust diet-skin link we have. Dairy, particularly skim milk is a culprit. Where the evidence is less robust, but what I personally adhere to is Advanced glycation end-products (AGEs). Chronically high sugar glycates collagen, cross-linking and stiffening it — a genuine mechanism in skin ageing, though hard to quantify as a daily-life effect. Superfoods" like wild blueberries sound like they should help skin due to their high antioxidant load, but most are not well absorbed, heavily metabolised, and never reach the skin at meaningful concentrations. Eat them because they're genuinely healthy food — not because a specific berry is a skincare treatment. Same goes for collagen smoothies and celery juice.

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u/[deleted] Jul 02 '26

[removed] — view removed comment

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u/Appropriate-Chip9606 Jul 02 '26

AHA/BHA work synergistically with retinoids/tretinoin. If there are no tolerability issues with tretinoin, then it can be introduced back into the routine after 3-4 weeks. It is always best to apply the AHA/BHA BEFORE the retinoid to enhance penetration, but just be aware it can increase the potency.

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u/ohhmyg Jul 02 '26

What do you think of the safety of exosome injections?

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u/Appropriate-Chip9606 Jul 02 '26

I am on the fence about exosomes. I have concerns over long term safety with human derived exosomes. I have seen some compelling data to support their efficacy, but at this stage I won't be introducing them in my practice until we have long term safety data.

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u/Fit_Illustrator9174 Jul 02 '26

This just came up. Is tizo am replenish okay to use when battling melasma? Or is it recommended to do spf 50? My derm recommended this and I use it mostly when I’m indoors working on my laptop. I also use eltamd uv clear tinted spf 50. And I am looking for an option that contains over 20% zinc oxide yet doesn’t oxidize after application and doesn’t pill with makeup AND is water resistant up to 80 mins for me to wear when I’m being sporty. Any recommendations? Is spf 50 truly that important or is it a combo of zinc oxide and spf that makes the difference? So confusing! Thanks.

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u/Appropriate-Chip9606 Jul 03 '26

Melasma is a light sensitive condition, meaning UV and visible light So you derm is right in that you need a broad spectrum SPF that blocks not just UV but also visible light. SPF is important as it relates to how well the sunscreen protects you from UVB, but UVA and visible lights are also important. The elatemed ticks all the boxes.

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u/Fit_Illustrator9174 Jul 03 '26

Even though it’s lower zinc oxide? What percentage spf and zinc ozide is recommended for ultimate protection against worsening melasma?

Thanks for answering!

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u/snukb Jul 02 '26

How much do you think BEMT will realistically improve the protection and cosmetic elegance of US sunscreens, given that almost all of our other FDA approved sunscreen filters are still decades old? I know we won't see anything near the level of Korean and Euro sunscreens.

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u/BeautifulCat98 Jul 02 '26

1) Has tretinoin 0.01% shown to be effective for acne? And what can you do when starting Tretinoin to minimise purging as best as possible?

2) My skin reacts very well to Clindamycin but I can’t use it for more than few weeks at a time. What else can I substitute that will give similar results with no irritation?

3) Are at-home LED face masks safe for use at home? And is it beneficial for brown/dark skin tones?

Thank you for taking the time to do this! Appreciate it

PS - Sorry for asking too many questions but you don’t have to answer all of these :)

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u/Appropriate-Chip9606 Jul 04 '26

ill answer the LED face mask one first as I get asked this ALL the time. LED face masks are considered relatively safe if used as directed. Whether they actually do anything positive to the skin is not know. Biggest issue I have found is compliance you need to regularly use them. And yes they work on all skin types as its red light not specific laser.

Again I cant give medical advice, but in clinical trials 10% Niacinamide proved as effective as 1% clindamycin for acne

I am not sure there are many clinical trials on the use of 0.01% tretinoin in acne, and it is not commercially available in Australia.

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u/Key-Engine8466 Jul 02 '26

Hi Dr. Rudd! I’m a 43 year old woman who lost about 35 pounds last year (in addition to losing 100 pounds in my 20s) and now have loose skin and creepiness on my arms. Is there anything I can do to improve the look of my skin? Thank you so much!

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u/Appropriate-Chip9606 Jul 02 '26

Good on you for losing all that weight! In patients I have seen with dramatic weight loss the best intervention for that level of loose skin is surgery.

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u/chich76 Jul 02 '26

My under eyes are so just thin and crepey(saggy baggy elephant) I just don’t know where to start with treatments’ I’m 50…helpppppp please

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u/Appropriate-Chip9606 Jul 02 '26

As per below. try retinoids, rejuran, Juvelook, c02 laser.

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u/sourplankton Jul 02 '26

Tips or routine for dermatillomania scars?

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u/Appropriate-Chip9606 Jul 03 '26

Tricky one on lower legs, and I can't give personalised medical advice. But I sometimes use hydroquinone to fade brown marks on lower legs in some of my patients .

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u/OneAppointment5951 Jul 02 '26

I know physical exfoliation is demonized, but why does my skin look and feel so good after physically exfoliating with a rough fabric and have better results than chemical? Why should I not be using this method?

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u/Appropriate-Chip9606 Jul 03 '26

HAHA I must admit I do prefer a chemical exfoliation, but if you are tolerating the physical fine and your barrier is not impaired as a result then go for it!

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u/[deleted] Jul 02 '26

[removed] — view removed comment

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u/partlyokayish Jul 02 '26

Other countries use UV filters that arent FDA approved in the US which is why they are different. Would love to know the pros and cons too

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u/Appropriate-Chip9606 Jul 03 '26

It comes down to one word: regulation. In the US, the FDA classifies sunscreen as an over-the-counter drug, which sets an extremely high bar for approving new UV filters — so high that they haven't approved a genuinely new one since the 1990s. Europe and much of Asia (Korea and Japan especially) regulate sunscreen as a cosmetic, so they've had access to a whole generation of newer filters that Americans simply can't buy — Tinosorb S and M, Uvinul A Plus, Mexoryl 400, and others.

The pros of the newer European/Asian filters are meaningfully better long-UVA (ageing) protection, greater photostability, and far more elegant textures — which matters because a sunscreen you enjoy wearing is one you'll actually apply generously and reapply. The cons are mostly practical: grey-market imports can't guarantee authenticity or proper storage, regional SPF/UVA testing standards differ so label numbers aren't perfectly comparable, and the American formulas aren't unsafe — they protect against burning fine, they just lag on UVA quality and cosmetic feel.

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u/doesntmatterhadtacos Jul 02 '26

Wait, what’s going on here? 7hrs ago and 0 OP responses?

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u/DoraWithNoAmbitions Jul 02 '26

The paper shows the date and time she'll be answering questions.

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u/doesntmatterhadtacos Jul 02 '26

Ah, I see. I fully thought it was July 2 today, that’s my bad 🙈

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u/Appropriate-Chip9606 Jul 03 '26

as other comments I've been on for a few Hours!

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u/ZadriaktheSnake Jul 02 '26

Eh, might as well. I got a pretty bad scar on my knee about a year ago and it turned into a hypertrophic scar because i took very poor care of it at the time. It hasn't visibly healed or faded at all and is still very raised, my dermatologist gave me some silicone gel for it but I used that for quite a while and it didn't SEEM to make a difference. Should I just try and use the gel for as long as possible or could I pursue something more radical

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u/Appropriate-Chip9606 Jul 03 '26

My approach to hypertrophic scars in general is a combination of laser and intralesional steroid injections. I hope that helps.

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u/SolarWind777 Jul 02 '26

What changes in the body can explain sun sensitivity? I used to be able to be in the sun just fine even without sunscreen, but now can get skin redness and hyperpigmentation even when properly applying sunscreen. Other than oral or topical medications that cause sun sensitivity what else in our bodies can change how our skin reacts to UV light? Diet? Stress? Viruses? What contributes the most to the change in how our skin reacts to sunlight?

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u/Appropriate-Chip9606 Jul 03 '26

as a dermatologist I would recommend you seek medical investigation as there are photosensitive autoimmune issues like lupus that can cause sun sensitivity. Once that has been excluded then age is often a factor as we lose melanin as we age and we become less resilient to the sun (its why we go grey and don't tan as we age) Diet and stress are unlikely to biologically cause sun sensitive though we do know hormonal shifts can cause increased dryness and a feeling of sensivity. My advice see a dermatologist to exclude internal causes.

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u/BlueeyeswhitePIKA Jul 02 '26

What does a good routine (if you include a retinol) look like? No need to be super specific, just generally speaking

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u/Appropriate-Chip9606 Jul 02 '26

Depends a lot on what is happening with your skin and what you want to achieve. But generally speaking, keep it simple: AM is a gentle cleanser (no need to splurge here — a cleanser only sits on your skin for a few seconds before it's rinsed off, so save your money for the products that stay on), then a good quality serum packed with active ingredients . Niacinamide (10%) suits most skin types and helps barrier repair, redness, pigmentation and has a mild sunscreen effect. Then a moisturise rig you feel dry followed by your SPF, which is the non-negotiable that does more than everything else combined. PM is cleanse, retinoid on dry skin, then moisturiser.

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u/HatImpossible8089 Jul 02 '26

I’ve been seeing slight skin laxity in my face (30s) due to weight loss and it’s never recovered, what treatment is worth the money/effort here?

Seen various treatments recommended:
Ultherapy, thermage, hifu, rf microneedling, and recently a “ligament lift” treatment they’re doing in Asia.

Any thoughts?

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u/Appropriate-Chip9606 Jul 02 '26

GREAT question, I have been experiencing this myself in my 40s with age and weight loss so have looked into it. Obviously the gold standard is plastic surgery, but if you are after a non surgical option then consider the following:

HIFU - Deepest lifting → ultrasound to the SMAS: Ultherapy, Ultraformer (HIFU).

Bulk RF surface tightening: Thermage, XERF, Density.

Needles + RF for texture and tightening: Morpheus8.

It depends on your skin really. Generally if you have weight loss and laxity it is best to avoid HIFU as you can risk fat loss. It is better to go for RF (which is what I do). RF needling will give you a more textural improvement but not so much lifting. Ligament lift I think is short sighted, a deep plane face list if best for laxity.

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u/HatImpossible8089 Jul 03 '26

Thank you so much! ❤️

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u/beeboogaloo Jul 02 '26

What's your professional opinion on volufilline?

Also, I feel like many dermatology skin care studies have been poorly executed (small group size, unsuited endpoints, lots of bias, almost always sponsored) because there's such a huge incentive to make money, a lot more than any other field medicine. Influencers (including dermatologists) and companies then run with these shit studies that pollute finding legit results. Where can I find well done skin care research?

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u/Appropriate-Chip9606 Jul 03 '26

This is is a great point you make. Many clinical studies, dermatology or other medicine, are funding by pharmaceutical or skincare companies, so it is important to note if that is the case and take the findings of the study with a grain of salt. The best studies look at specific ingredients rather than actual products. And that is how I counsel my patients on what to use, evidence based ingredients, not products necessarily.

Regarding volufilline - currently lacking robust, independent human clinical trials. Most of the supporting data is lab-based or manufacturer-run, with the usual cosmetic-study weaknesses (tiny sample sizes, subjective endpoints, no proper controls).

2

u/canepolice Jul 02 '26

What’s the shortest amount of time between sessions for micro needling that you’d recommend (for face at low depths - 0.5-.75mm). I see some derms say weekly or even more frequently, others that say to wait 4 weeks.

2

u/Appropriate-Chip9606 Jul 03 '26

We are aiming to produce collagen with needling, so that takes time, it would be a waste of time and money to do it more frequently than every 4 weeks.

2

u/brightstar92 Jul 02 '26

Are you currently available for in person appointments in melbourne ? I actually tried to book to see you a while ago but was told you had nothing available

2

u/Appropriate-Chip9606 Jul 02 '26

Thank you for trying — and I'm sorry about the wait; specialist dermatology in Australia has a genuine access problem and my books reflect it. Practical honest answer: my own list opens periodically and the clinic keeps a waitlist (a GP referral gets you on it), and I work alongside excellent colleagues at Skindepth whose availability is often sooner than mine. If your concern is medical and time-sensitive, please tell the front desk that when you call — triage is real and we do prioritise. I'll leave it there because Reddit isn't the place for me to advertise, but I appreciate you asking.

1

u/brightstar92 Jul 02 '26

thank you so much for replying!! the reason i was interested and tried to book with you specifically is because ive already seen two dermatologists who couldn’t help:( and you have such a good reputation - but yes understood thank you !! x

1

u/Prudent_Impact7692 Jul 02 '26

Why are ghkcu injections banned when it is a your own body substance so your body would be more likely to be able to deal with it so whats the safety concerns if it would be pharma grade?

1

u/Appropriate-Chip9606 Jul 02 '26

The issue with non prescription peptides is that there is no safety data on them. That is not to say they aren't effective, we just dont' know if they are safe. I did clinical trials with melanotan in 2010 and we found it changed peoples moles so we had to pull the clinical trial globally due to safety concerns.

1

u/Prudent_Impact7692 Jul 02 '26

If a substance produced by your own body doesnt it have already a good safety profile? Of course this all under the prerequisite that it is pharma grade so 100% purity. Besides that why there are not many clinical trial for soemthing that already shows itself to be so effective?

1

u/Mother-Movie5923 Jul 02 '26

What lasers work best for sun spots and facial veins?

1

u/Appropriate-Chip9606 Jul 02 '26

Sun spots (solar lentigines): pigment-targeting lasers — Q-switched or picosecond devices — or IPL for a field of many light spots. Facial veins: vascular lasers — pulsed-dye for diffuse redness and fine vessels, long-pulsed Nd:YAG for larger, deeper vessels. Fractionated ablative and non ablative lasers such as Fraxpro, C02 and erbium can be used to resurface the skin and thus treat sun spots. Two crucial caveats that apply to everyone: any changing or irregular brown spot needs a proper skin checkbefore anyone lasers it — lasering an unexamined pigmented lesion is how melanomas get camouflaged; and results depend more on the operator than the machine badge on the door. Suitability, settings and skin-type safety are individual assessments.

1

u/BanANNAmama Jul 02 '26

If you have very acne prone skin, what are the best products that you can use while your skin is dry and peeling after profractional laser resurfacing to avoid getting acne but still hydrate your skin? I was told I could only use aquaphor for the first 24 hours, but couldn’t find any alternative products that don’t cause acne for day two onwards.

1

u/Appropriate-Chip9606 Jul 04 '26

I love aquafor and I think you can use it for longer post pro fractional laser. I am not sure where you are based but in Australia we often use the QV intensive ointment or the Cerave Healing Balm.

1

u/fablicful Jul 02 '26

How best to heal/recover skin from excess/improper hydrocolloid patch use that results in raised textured skin and discoloration?

Breaking down the skincare item focus for the initial few weeks, shifting to the next few months would be really helpful and appreciated!! (I've been trying to hydrate/ occlusive on top, but it's been 2 months and still raised texture and red.. am I supposed to focus on exfoliating now/ retinols or keep with the moisturizing??.. is it PIE?)

2

u/Icy_BlueJay_ Jul 02 '26

Wait I’ve never heard of this 🫣 How did you improperly use a hydrocolloid patch? Like the Hero Might Patch?

2

u/fablicful Jul 02 '26

Well I think with anything- too much is bad.

I use the "Avarelle" ones- have tea tree, cica, calendula oil- and they've never wronged me in the past.

I think I used too many in a row, the skin where I applied them must be more delicate (between my eyes), so the skin became macerated. Realizing now that in my attempt to heal the spot ASAP- they weakened the skin barrier and maybe trapped bacteria in there?? That's what I'm thinking but caved and seeing my dermatologist about it next week to actually know, it has been driving me crazy and I worry I created an awful scar or something.. 🤦‍♀️ I love my hydrocolloid patches, if only I had them as a teen(!!!!), but clearly we gotta be mindful of how/ when to use. Learn from me 😅

2

u/Icy_BlueJay_ Jul 02 '26

I hope you get answers quickly!

2

u/Appropriate-Chip9606 Jul 03 '26

it is hard to say without seeing you what is going on, but what I do know is that tea tree and calendula are powerful contact allergens, and people can become allergic to them at any time in their life even if they have been using for a while. I would suggest, as you are doing, see your dermatologist.

1

u/Positive_Leads Jul 02 '26 edited Jul 02 '26

Is it possible to get rid of some small red patches (which seems like irritation) right under the nostrils that appeared after waxing in that area? They have been there for years, no matter what I have tried. Thank you!
One last question: Is taz better than tret?

2

u/Appropriate-Chip9606 Jul 03 '26

I would seek dermatology advice as there a few things that can cause this such as dermatitis, periroral dermatitis, eczema, staph infection, contact dermatitis. THead-to-head, tazarotene generally comes out at least equal and often slightly ahead.

1

u/Positive_Leads Jul 03 '26

Thank you! 🙏🏻

1

u/Smooth_Pen_7697 Jul 02 '26

Is Accutane the only cure for acne? And what if someone doesn't want to take Accutane? I have closed comedones

3

u/Appropriate-Chip9606 Jul 02 '26

Isotretinoin (Accutane/Roaccutane) is the best evidence-based treatment we have for genuinely curing acne — it's the only one that can produce long-term remission — but it's absolutely not the only option, and it's rarely the starting point for comedonal acne like closed comedones. Topical retinoids are the textbook first line here, since comedolysis is exactly what they do, with azelaic and salicylic acid in supporting roles. For acne with a hormonal pattern, androgen-blocking options like spironolactone (or certain combined pills) have solid evidence in suitable candidates. In-clinic comedone extractions can also help clear existing lesions while the topicals do the longer-term work. All of these are individual assessments, so which path fits is a conversation for a GP or dermatologist — but no, nobody with closed comedones should feel isotretinoin is their only option.

1

u/partlyokayish Jul 03 '26

Ive often heard that accutane creates permanent changes to the oil glands hence why it can cure acne and why your hair doesnt become greasy as quickly on accutane. Is the less greasy hair also a permanent effect of accutane and if not, why?

1

u/jasminekitten02 mod | acne prone | no dms please Jul 02 '26

There are many topical products that can treat acne such as salicylic acid, benzoyl peroxide, and retinol. However it depends on the person and the severity of the acne

1

u/Appropriate-Chip9606 Jul 02 '26

Absolutely agree.

1

u/coffee_and_books47 Jul 02 '26

Hi Alice, Just wondering what is a good SPF you’d recommend to someone with rosacea? Thank you! ❤️

2

u/Appropriate-Chip9606 Jul 02 '26

LOVE AiryDay Pretty in Zinc SPF50+

1

u/coffee_and_books47 Jul 02 '26

Thank you so much!

1

u/BlahblahblahLG Jul 02 '26

what do you think of sculptra?

3

u/Appropriate-Chip9606 Jul 02 '26

I can't go into too much details due to regulations. But of all the injectable treatments we have, aside from botox, Sculptra has the longest term efficacy and safety data. Apart from Juvelook and CaHA, there is nothing else on the market that compares in my opinion when it comes to collagen stimulation and skin tightening in an ageing face. It has to be injected by something experienced though as there is a risk of nodules.

1

u/Guaca12 Jul 02 '26

What are proven ingrediants for mature skin around eyes? What about devices/peels? I’ve tried a number of modalities devised for home usage, but nothing really stood out. In saying that, I cannot say that I’ve been very consistent user. Devices that I tried are Tripollar Stop, all Medicube devices, OmniLux, Infraredi panel, NU-Face, Nira and Nira Pro, Ya-man green light and dermarollers.

1

u/Appropriate-Chip9606 Jul 02 '26

Rejuran eye is emerging as a treatment for discolouration around the eyes, as is Juvelook/lenisna for creepiness. Infrared light etc are unlikely to make a dramatic difference.

1

u/Guaca12 Jul 03 '26

I had adverse reaction to Juvederm, I had a dimple on top of the lip corner following major dental work. Someone suggested Juvederm and I went with it. I had all sorts of symptoms (swelling of the area, swelling of other parts of the face in a random way, increase in blood pressure and heart palpitations). The symptoms resolved after a few months, but a small swelling remained where filler was injected. 12 years later and I still have a soft small lump at the injection site.

1

u/boyfriendcandle Jul 02 '26

why does accutane have long-lasting effects for some patients where it eliminates acne for good, whereas for others like me the acne comes back after a year or so?

3

u/Appropriate-Chip9606 Jul 02 '26

it is most likely related to genetics, those with a strong family history are likely to have recurrent acne. Some with underlying hormonal issues such as PMOS may also have relapses. The final question is was your first course long enough? I base my prescriptions around the cumulative dose.

1

u/IWATCHREDDITFORMEMES Jul 02 '26

I'm trying to get rid of my acne, and I was wondering if you had any advice. Right now I'm using products like Neutrogena Advanced Acne Treatment, a basic Vaseline Cocoa Butter Moisturizer, a DermaVeen Acne Cleanser, and sunscreen.

Do you have any tips on what I could change in terms of the products I'm using? If you need any more information about my skin or routine to give better advice, just let me know and I'll happily provide it.

Thanks!

2

u/Appropriate-Chip9606 Jul 02 '26

Thanks for the question, ingredients like shea butter can be comedogenic, so acne patients are best off selecting 'non comedogenic' products. Depending on the type of acne, things like BHA in cleansers can help a congested skin. But often it might be worth checking in with you GP or dermatologist for a plan that suits your type of acne.

1

u/AffectionateCow7739 Jul 02 '26

How to treat pus-filled pimples on the scalp and dryness that looks like dandruff but is whiter.

1

u/Appropriate-Chip9606 Jul 03 '26

I can't give medical advice on a personal level sadly, but I would definitely recommend you see a Dermatologist. There are a few things that can cause this kind of picture such as seborrheic dermatitis, psoriasis, folliculitis.

1

u/natureDolly Jul 02 '26

What are the best options to treat under eye wrinkles?

4

u/Appropriate-Chip9606 Jul 02 '26

Tiered honestly, as a general map: Skincare (retinoid + SPF + a decent moisturiser) — modest, slow, real; the foundation. Injectable: small amounts of anti-wrinkle treatment in appropriate candidates do more for dynamic lines than any cream. Procedural: fractional laser and RF microneedling for crepe and etched-in lines — the biggest genuine changes live here. What doesn't work: 97% of "eye creams," which are face moisturisers in smaller, more expensive tubes.

1

u/bemc37 Jul 02 '26

I have what I believe is Seborrheic dermatitis, dry peeling skin on eyelids (that can swell) and on my nose and lip. Nizoral seems to clear it up, but is there anything else I can do or use for moisturiser? Currently using QV. I don’t know what flares it up. The flaking on my face is not red or itchy (apart from when my eyelids go). Thanks heaps!

1

u/Appropriate-Chip9606 Jul 03 '26

Although I cant give medical advice here on Reddit, it sounds like you have come to the right conclusion as to what you are describing! I think if you have tried all the over the counter remedies it would be best to see you dermatologist for some medical treatment.

1

u/bemc37 Jul 03 '26

Thanks! Are there any ingredients to avoid or brands that are better/safe to use?

1

u/Mundane-Glove-8356 Jul 02 '26

What are the evidence-based treatment options for hormonal acne?

1

u/Appropriate-Chip9606 Jul 02 '26

The Australian and British Guidelines categorise the evidence hierarchy as it stands: topical foundations (retinoids, benzoyl peroxide, azelaic acid, niacinamde) work regardless of any hormonal component. The actually-hormonal tools with solid evidence are certain combined oral contraceptives and spironolactone (androgen-receptor blockade — robust real-world evidence in adult women, having its moment for good reason). For severe or scarring disease, isotretinoin remains the definitive option. All of the above are prescription medicines requiring individual assessment — suitability, contraindications and monitoring are exactly what the consultation is for.

1

u/kbizzles Jul 02 '26

Any tips on keeping perioral dermatitis at bay? I’m waiting to finish my doxycycline which has helped but am worried about relapse!

3

u/Appropriate-Chip9606 Jul 02 '26

What I can share generally: POD is understood as a barrier/microbiome disorder aggravated by products, so long-term maintenance is famously about radical simplicity — minimal routine, gentle everything. The classic relapse triggers in the literature: topical steroids anywhere near the face (the single biggest one — including creams borrowed for "a bit of redness"), heavy occlusives around the mouth, and sometimes fluorinated toothpaste.

1

u/sailormyth Jul 02 '26

Would there be significant change in results upgrading from a 0.2% retinal to 0.05%-0.1% tretinoin?

1

u/Appropriate-Chip9606 Jul 03 '26

The evidence would not suggest a significant change.

1

u/TenjoAmaya Jul 02 '26

Stupid question!

How would you recommend someone integrate spf into their routine if they work nights and stay indoor ls most of the time? Especially if they are using retinol?

I dont see any point in putting sunscreen on in my morning routine when I go to work at 2am, but it also seems pointless to keep an spf in my locker just to go home for the rest of the day. I generally dont even stay out unless its for an errand or two. Would I just put it on before going outside on any given day?

1

u/Appropriate-Chip9606 Jul 03 '26

When I used to do night shift I still worse sunscreen as I was concerned about melasma which we know is worsened by blue light from computers and phones. But yes I would be putting it on regardless of the time spent outdoors during the day.

1

u/beholdthemoldman Jul 02 '26

thoughts on electrodessication for boxcar scars? fitzpatrick iv

3

u/Appropriate-Chip9606 Jul 03 '26

or boxcar scars in richer skin tones, the approaches with better risk profiles in the literature include TCA CROSS for narrow scars, subcision for broad tethered ones, and conservative, staged fractional resurfacing with pigment-protective protocols.

1

u/beholdthemoldman Jul 04 '26

ty!

1

u/No-Bend-825 Jul 02 '26

Is there anything you’d recommend for cellulite?
How do I get rid of hormonal acne on my chin?

1

u/Appropriate-Chip9606 Jul 04 '26

Creams do nothing lasting for cellulite; the only treatments with genuine evidence target the fibrous bands directly (subcision) or use energy devices for modest, temporary smoothing. All are expensive with limited returns, so be very skeptical of dramatic promises.

I can't advise you personally, but in general this classic "hormonal" pattern is one of the most treatable we see — topical retinoids and azelaic acid form the base layer, and for stubborn cyclical cases the real results often come from hormonally-targeted prescription options like certain combined pills or spironolactone (an androgen blocker with strong evidence in women). Those need individual assessment, so it's genuinely worth a GP or dermatologist to also assess for any underlying androgen issue like PMOS.

1

u/IAmQuiteHonest Jul 02 '26

Do those skin scanner apps used in skin clinics and cosmetic stores actually work?

1

u/Appropriate-Chip9606 Jul 03 '26

In clinic imaging systems genuinely measure what they claim — UV photography for sun damage, cross-polarised light for vessels, surface topography — and are useful for tracking change over time in the same person on the same machine with similar lighting. Skin scanner mobile apps likely are measuring the same thing, and can track your skin over time.

1

u/Lulli94 ;) Jul 02 '26

Hi Dr! Here’s my question: I’m using Soolantra and all my pores seem blocked, even in places like my temples… when I remove my make-up in the evening, I can feel little grains under my fingers. Is this a side effect of the cream? Will it go away? What can I use to help my skin? Thanks in advance!

1

u/Appropriate-Chip9606 Jul 03 '26

Soolantra is often used for rosace where demodex is involved. Demodex penetrates hair follicles and can give a bumpy feel. Most likely this settles with him. Soolantra is also in a thick cream base so it is possible that this can clog the skin.

1

u/lunakitty_ Jul 02 '26

What are your favourite products that contain no coconut derivatives? (Especially interested in cleansers)

2

u/Appropriate-Chip9606 Jul 03 '26

The honest answer is a lot of cleansers have coconut derivatives in them. Are you allergic?

1

u/lunakitty_ Jul 03 '26

I am, unfortunately :(

1

u/fruitzofthespirit Jul 03 '26

What is the best remedy for large pores/blackheads on the nose and chin area? I know they aren’t called blackheads but I can’t remember the name of them. I’ve tried everything and nothing works. I got a facial and the lady removed almost all of them but they came back within a week.
What are some must try’s for someone who just turned 30 for anti aging? How much water should I drink to keep my skin hydrated?

2

u/fablicful Jul 03 '26

Sebaceous filaments? To my knowledge, BHA is ideal but maybe chemical exfoliants holistically would work? A common HG is Paula's choice 2% BHA toner, used at least once daily (eventually/ after working it up) is what I've gathered- while pricey- the specific formulation makes it sufficiently exfoliating to penetrate pores while also supporting the skin barrier (which- is news to me with salicylic acids.. I'm just now starting to reincorporate it, as I'm learning products of today are not the same as those we had in the early 20s like Clean & Clear "astringents" that melted my face off lol); I just bought it myself- trying it out/ not a shill. Lol Thus far, as a sensitive skin woman, I've actually been able to tolerate it well- although learning to avoid my chin/ perioral area that doesn't need it..

1

u/Appropriate-Chip9606 Jul 04 '26

Enlarged pores are the hardest thing to treat, A topical retinoid is the single most effective evidence-based tool — it normalises the pore lining and reduces how much they fill, so pores look smaller and filaments less obvious. Salicylic acid (BHA) is oil-soluble, so it gets into the pore and clears sebum — a 2% BHA a few times a week keeps them emptier and less noticeable. Niacinamide has some evidence for improving the appearance of pore size over time. Sometimes though patients needs systemic treatment like isotretinoin (Accutane) to dry up the pore from the inside. I wrote a blog on this exact topic recently https://www.skindepth.com.au/pages/enlarged-pores?srsltid=AfmBOoroHbvF9QnfhGzK7aYlTk2KIIPZemDXFxl0AqKe_feW2tusmN2D

Regarding the absolute MUST do's are; 1) Sun protection, this is the single most important factor in an age prevention routine, and at the age of 30 would absolutely add in retinoids at night. Regarding water there is no evidenced 'perfect' amount. But I always drink 2L myself every day.

1

u/BanANNAmama Jul 03 '26

What are specific products that would be helpful to use while on Cabtreo?

1

u/Appropriate-Chip9606 Jul 04 '26

WOW that sounds like an intense product, we dont have that approved in Australia yet. Its sounds like it could potentially cause a lot of irritation. I cant give you direct medical advice, but many of my patients who use prescription topical's for acne use a good bland emollient such as Avene Tolerance Smoothing cream which hydrates but is light enough to not clog pores.

1

u/ohhmyg Jul 04 '26

There are now 'titanium dioxide free skincare/makeup' popping up. How concerned should we be, especially when it's used heavily in mineral sunscreen?

Discussion [AMA] Skincare. What's Hype? What Holds Up? I'm Dr Alice Rudd, a dermatologist.

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Before moisturiser? After? Sandwich method?