-So I got a surprisingly large number of questions about skincare.
-Yeah, weird.
-Yeah. So I thought I would get a true expert on skincare. And I read your book “Skintelligent”, which is great.
-Thank you.
-Evidence based skincare. I didn’t know it existed, but now I do.
-Now you do!
-And…
-Not just is fitness evidence based.
-Yes. I was mortified…
-Mortified?

-Mortified to learn, seemingly, that I have two options in life. Either I am going to be pale now, but then have good skin later, or I can be tanned now, would have bad skin later.
-Correct.
-That’s basically the gist of it with sunscreen and sun exposure?
-Pretty much.
-Right. So there’s… Is there no level of sun exposure where you get the benefits, some anti-inflammatory effect, but no skin damage? You can maybe get a tan, but there’s no… there’s no wrinkling going on later on?
-No. Because it’s… it’s chronic exposure over time. So even like low level sun exposure… Tan is already your skin cell saying “this is too much.” So you’re trying to protect yourself. So yeah, no, there’s no level… I’m trying to think if there’s a way I can nuance this to make it, make you feel better about it. But there is no low level sun exposure where you’re going to be able to get a tan and kind of keep that going over time while not incurring the damage, which is going to make you look like a wrinkled prune when you’re older, but also the risk of skin cancer, so don’t forget that.
-Yes.
-With our skin types, you know.
-That’s mostly related to ultraviolet radiation.
-Correct. UV-A and B.
-And then more concerned with head and neck, you’re more concerned about non-melanoma skin cancer. So basal cell carcinoma, squamous cell carcinoma. And you might think oh that’s not a big deal, it’s just skin cancer, just cut it out. But cutting out a facial skin cancer can be deforming to the face. So yes. Okay. We don’t want to, you don’t wanna look old, but you also don’t want to see me in 20 years because you need to have something removed from your nose. You know, you have a small nose, it would be a difficult…
-Yeah.
-…closure. So, you know, so that’s the other reason. I mean, I guess it also depends on, like, what your priorities are. If you, you, you know, want to look your best in your 30s and you think having a slight tan will do that for you, which I’m trying to move people away from that culture where, you know, having pale skin is still beautiful, and attractive. But if you did, I mean, you’d have to just sacrifice the risk of skin cancer. But also, like, looking like a prune.
-Yeah.
-Yeah.
-I actually read about some research that people don’t think being tanned particularly, in particular, is more attractive, but it’s more the healthy… …I think it’s more of a yellow tone that comes from beta carotene intake and the like that people like more. And a tan is more the socio-cultural association in first world countries kind of, that, you know, you can afford to holiday and everything. So it’s more of a socio-cultural distinction.
-Yeah, yeah, I get you. Yeah.
-But basically, health wise, you could say that being tanned is kind of like the equivalent of spending a lot of money or not taking care of yourself physically early on in life. It’s like the short lifespan strategy, where you get a lot of the benefits early on, but then you’re not investing into the future very well.
-Yeah, but I think it’s also important to remember that the majority of the sun damage that you incur that lead you to have problems when you’re older, you get in your early years, like we’re talking your teen years and before the age of 12. So it’s that’s what… I mean nowadays we’re not going to see that in kids because kids right now are so heavily packed with sunscreen, which is great. So they’re not going to have the problems that we are going to have, because I know I’m older than you. But so… He’s had surgery. But the problems that we may have, because when, like, you were younger, how much sunscreen did you wear, and where you protected? Did you get a tan when you went on holiday?
-Yeah. And no sunscreen, I think.
-Well, no, because you’re Dutch, right? And so am I, so we have that in common. So. And like, you remember the summers you just go to the beach. I don’t know if you went to the beach in Holland, because I did.
-Barely, but.
-Okay, fine.
-We did, and… we didn’t travel much. But you know, everyone was encouraged to get a tan, and, like, my uncle had a sunbed in his home because Dutch people like to be tan, you know? So then we lived in that culture when you’re younger, not dissimilar from the UK or this country, but, so the damage done to our skin then is what’s going to show up when we’re in our 60s and 70s. So even though you’re protecting yourself now, you know, you messed up young.
-So how serious should most people be about sunscreen? Is it like.. say your the average office worker. Should you apply it just every morning, like?
-Yeah, pretty much. So, I mean, there’s so many different sunscreen formulations where you can get an SPF 50 that is comfortable for daily use. So and that for men, for example, that is mattifying or doesn’t have a white cast to it and so on. And for women that can be like makeup primers you want under your makeup. We do know that if you apply an SPF 50 in the morning and you’re in your in an office between 8 and 6, and you just spend less than one hour outside in sunlight, that sunscreen is still 84% active by the end of the day when you leave work, so you don’t have to reapply sunscreen during the day obsessively every 2 to 3 hours, like you would if you were at the beach all day for example, when you’re inside. So, that’s really important to remember. So because people are like, I can’t reapply, can’t reapply. You don’t have to reapply sunscreen during the day if you’re inside for most of the day.
-Okay. Is there anything people can do if people really insist on getting a tan, is there any particular like the time of day is a better to tan midday because you have the UV-B that’s highest of midday, right? And there’s less UVA or is it the other way around the tanning bed, which I think is more UVA? Is it better to go with the tanning bed and just, you know, a few minutes, get it over with? Is it better to tan longer with sunscreen or shorter without?
-Oh my God. So I… the simple answer to this, which is also a little annoying for you, is that there is no such thing as a healthy tan. So no matter how you go by…
-Is there a less healthy tan?
-No.
-Okay, it’s just the tan.
-The tan itself, yes. No matter how you do it, whether it’s a some better UVA, whatever. You know, whether it’s between three in the afternoon or ten in the morning. If you’re getting a tan, that means you’re exposing yourself to enough UV light to cause your cells to react in a way that they’re trying to protect themselves from damage. So there, I think the mantra for most dermatologists is there is no such thing as a healthy tan. Sorry.

-What about the, is there any benefit to… Well, there’s vitamin D, of course, but you can supplement that.
-Correct.
-Which is probably more efficient.
-Efficient.
-Because most people don’t get enough sun exposure to maintain optimal vitamin D levels. Right?
-Yeah. So the, the BAD, the British Association of Dermatologists and most dermatology associations throughout the world, our basic guidance is do not use the sun as an excuse to get vitamin D, supplement and that’s all you need. Yeah, yeah, it’s sufficient. Yeah.

-Right. Can you still get tanned behind a window or if you’re on an airplane?
-Yes. You can technically still get tan through a window because there’s still UV light penetrating glass. The effect of the window is going to also be based on its tinting. I don’t know about the plane, though. I don’t think there’s enough… I don’t know, I guess if you… If you were glued against the window and there was sun going through it for eight hours, then yeah, you would get burned through that.
-Right.
-Probably.
-Because I’ve never heard of anyone getting tan in the window. But I’ve heard some people say that the because you’re so high up,
-Yeah.
-the UV exposure even through the plane supposedly is still high, but you know, like I said, I don’t see anyone getting out of the plane of a long flight like “I’m tanned”.
-All right on one half of their face.
-Yeah.
-I would have to check that out because I don’t know the answer to that. So I’m going to have to look, that’s an interesting question. The thing with glasses also a bit confusing to me sometimes, because the tinted thing does change a lot. So I can’t give you an exact figure for how much how that affects people. Yeah.

-So let’s move on to skincare more generally.
-Okay.
-Is there… Well, let’s start with the the skincare industry in general, because if you go to a shop, it seems like there are tons of products and they all do separate things. And we have to be worried about exfoliating, moisturizing and to worry about all of these, all the other things. And, there seems to be a lot of products. Some people say, you know, there’s like seven products everyone should be using. What’s your general feel about the skincare industry? Is it like pharma where you have to be really skeptical? Is it like supplements where there’s a lot of fraud and stuff as well? Or is it more like nutrition, where even if there’s sponsorship bias, most of the research is actually kind of legit. And the claims made by at least government agencies and stuff are not too far off from evidence? Can you trust, like the average label in a… you take a product off the shelf and it says anti-aging. Can you trust that that will be anti-aging?
-100% no.
-Right.
-No. So it’s not like nutrition. Definitely not. Where… whatever you just said, it’s not like that. Big pharma, I call it big skincare, reminiscent of big pharma, except the… with at least with big pharma you have to do these large randomized controlled trials, FDA approval and so on. So a it’s a lot more regulated. Skin care is the most unregulated field. I mean it’s not the most unregulated field, but to me it feels like that because I’m submerged in this industry. I call it big skincare. Yeah. That’s yeah, that’s how I view it. But no, absolutely not. You can’t trust what you read on these labels. I mean, there are some legal things you have to have on labels like expiry dates, you know, date of packaging or, you know, ingredients list. But even with the ingredients list if something is less than 2% or less than 2% of that ingredient in that product it doesn’t have to be listed, so you still don’t know what’s in there. You know, that doesn’t give you any like percentages of stuff. So if you’re buying a vitamin A derivative product like a retinol and retinol is listed somewhere in the middle of like 50 ingredients you have no idea, like, what’s happening there. They might say on the packages “retinol 0.1%”, but God knows, you know…
-Homeopathic almost.
-It’s… I mean, it’s certainly… I mean, over-the-counter vitamin A derivatives are certainly homeopathic. But, but you just can’t trust it at all. So there’s so much marketing hocus pocus around everything. You know, basically all moisturizers are the same thing. They’re just they have the marketing value added ingredients thrown in there. Like shea butter or like, I don’t know, you know, broccoli extract, chickpea flour. You know, it’s crap thrown in there to jazz it up and to sell it for a higher price. So people make up molecules like TGFβ skin-something, and they create a whole product line around that. And it’s just a bunch of crap.
-So is there are there certain things that someone with no real problems in their skin should just do on a daily basis, other than use sunscreen?
-So, no.
-So basically, if you don’t have real skin problems, then your skincare routine can just be eat healthy, live healthy, and you’re good?
-Yeah, pretty much. I mean sunscreen, yes, if you are outside, you know, if you go outside. Generally UV light is everywhere, even if it’s cloudy. So yeah, sunscreen is useful. It’s not, I mean, if you don’t care about aging and you’re not so bothered about skin cancer then it’s not essential either. But we want to, you know, stay looking good and don’t get skin cancer. So that’s why it’s recommended so heavily, and it’s like kind of a general prevention thing. But if you don’t care, you don’t care, you know? So there is no such thing as essential skincare. Nothing is required. If you have a skin problem. Yes. Okay. We need to look at that. But even with people with skin problems, I don’t have essential skincare for them. If I could get my patients who have skin problems to not use any skincare except what I prescribe… …great. Because oftentimes the other skincare products just cause problems and get in the way of treating the actual problem. So, and I have that happen all the time, just constantly. So skincare causes so many problems for people and it causes skin problems, skin disease that, or worsens it, that I have to like get people to understand that there is no such thing as essential skincare. There’s nothing you need to be using. You know, if you have great healthy skin, you’re better off using nothing.

-Right. So if someone does have a skin issue, let’s say it’s dry skin…
-Yeah.
-Do you moisturize?
-Yes. So if you have drier skin, you could probably get away with teaching your skin not to have to use moisturizer if you’ve been using it before. But yes, if someone has dry skin, because there are genetic problems like filaggrin deficiencies that, you know, subject people to having, like genetically dry cell ichthyosis vulgaris, which is a common dry skin, looks like fish scale, So there are conditions like that, that which, which are also predispose you to eczema. So having inflamed itchy red skin. So in those patients, yeah, moisturizer. But moisturizer is not something that really imparts anything onto skin. It stops water loss because hydration is water. So it’s water in the skin. And we lose water through our skin all day long. So to protect that from happening you can use a very occlusive moisturizer. And obviously the prototype for this would be something like Vaseline. That really blocks 98% of trans epidermal water loss, and that will keep the hydration in the skin very effectively.
-So all of these claims of stuff going into the skin, most of that’s not true, is it?
-Correct. Yeah. To impart hydration.
-Right. So there’s nothing physiologically more effective than something that just provides a good barrier that prevents the water from going out.
-Correct. Like you could also use plastic wrap.
-Right. Even plastic wrap?
-I mean, putting on your face… But that’s where a lot of those hydration masks come into play. If you’ve ever seen the ones that people like, you know, you peel them off, you put them on. They’re essentially just trapping water in the skin, and so when you take it off, you feel like your skin looks more plump and, you know, dewy. But that’s just because you’ve trapped water in there for the past hour. And rather than letting it evaporate.

-What if someone has the opposite problem? They have very oily skin.
-Yeah, so oily. This is a totally separate issue. So oiliness is overactive oil glands in the skin which is usually, and this comes down into your field, the more androgen related… So that doesn’t mean you have high androgens or something wrong with you, in most cases, but it’s that for some reason, genetically or whatever, your oil glands are more sensitive to androgens in your bloodstream. So then when the engine attaches to the receptor in there, it makes the oil gland produce more oil and become bigger. So the bigger it is, the more oil producers, and then that drives oily skin. And that’s an inherited trait for most people. You can have oily skin with no acne, but you can never have acne without oily skin. So oil fuels the acne flame. So if we take the oil away from someone who has acne, their acne goes away.
-Right. So let’s say if someone has acne and they want a simple over-the-counter solution?
-Oh, God.
-They can’t all consult with you and get the good stuff.
-The magic stuff.
-But they want something over-the-counter that actually works. What are the things that people can actually use? And in most countries, just get over-the-counter and use for acne. Let’s say they don’t have, you know, those particularly sore, they have like a normal mild moderate amount.
-If it’s, if it’s relatively mild acne the topical treatments can be effective. So the one I go for, especially the younger people is salicylic acid. you can buy 2% salicylic acid, basically anywhere from any brand. 2% salicylic acid can be good. It can unstick some of the sticky cells that are blocking the follicle and help clear that. So that’s quite… Salicylic acid also has an antibacterial component. So that can be quite an easy and mildly… effective thing for mild acne or like young people with acne. Other things you can buy are like benzoyl peroxide, 2.5%, 5%. That is an antibacterial, but it’s very drying, so you don’t really want to dry out acne. That’s not how you treat it, but it does have antibacterial property. I use benzoyl peroxide normally for people who have back acne, because the face can be really reactive. It’s really quite strong. In a lot of countries you can buy vitamin A derivatives. So something like retinoids. But proper retinoids like adapalene or differin, which is the same, which is a kind of targeted for acne. And that can have an oil reduction effect. But it’s not as dramatic as something like roaccutane which you take orally. So retinoids, not retinols, but proper retinoic acid.
-So that would be tretinoin, adapalene, differin.
-Yep. Tazarotene… So there’s different… depending on where you are in the world, there’s different like kind of classes a bit. So to tazarotene tazorac is one you can get in the United States easily. And there’s a couple other names that have come out, I can’t right now recall, but tretinoin would be your most common one. And adapalene is the one that’s used specifically for acne.
-Yeah. So tretinoin I think is the first generation and then…
-Yeah, so many generations.
-Are they better? The third generation stuff? Or is tretinoin still the GOAT?
-I think the tretinoin is still the goat.
-Right.
-It hits all the retinoic acid receptors on the cell while adapalene, for example, is a third generation. I believe it is…
-I think so…
-Please check that, I should know that. I do know that, I just can’t remember, but that only, hits like two of the retinoic acid receptors, which are considered the ones that are specific for acne. So I use tretinoin for everyone. I don’t really use adapalene. I think tretinoin is still going to be the best retinoid we have. And I use it for compounding. I use it for everything. I understand how tretinoin works. So I know how it reacts to people’s skin, so I feel really confident knowing what strengths to provide for people and how their skin is going to react to that.
-Is there anything people should know when used one of these products? Because I think benzoyl peroxide, it bleaches, right?
-Yes, it can bleach clothing if it’s wet. Yep. So sheets and clothing. Yeah.
-So you have to apply it, make sure it’s completely dries.
-Yes.
-And then if I wear this shirt it’s fine.
-Yes, should be fine.
-Should be fine?
-Just test it first. It should be fine, it should be fine. If it’s dry it shouldn’t bleach your clothing.
-Okay. Right. And tretinoin makes you more susceptible to sun damage, no?
-Not sun damage, it actually is protective of sun damage over time.
-Okay.
-So it doesn’t… It doesn’t, it increases your risk of potentially of burning. It makes you slightly more sun sensitive initially, but that again reverses after 6 to 12 months of consistent treatment. So that sun sensitivity is as a temporary effect of the use of the topical treatment as it kind of adjusts in your skin. Not a long term effect.
-Okay. What about salicylic acid? Anything the people should know?
-No, it’s pretty mild. Yeah.
-All right,
-Topical clindamycin, you can also buy them.

-If someone has a red skin, is there any way people can do something about that themselves without a diagnosis?
-Red skin?
-Yeah. So there are the issue where just someone has a red skin somewhere. Is that…?
-On the face?
-Yes.
-Yeah. Can, can they… Is there anything they can do without consulting somebody to actually check what it is?
-No, I don’t think so because that’s really vague. The “red skin”. Yeah.
-What does it mean if the skin is red?
-It means there’s some inflammation happening or some, so some reason is increased blood flow.
-Right.
-So, it can be acute, like flushing, blushing. Or it can be more chronic, which would indicate more of a chronic inflammatory problem or just lots of vascularity in the skin. The vascularity thing tends to happen as you get older, and in Caucasian people primarily, blushing is quite common, so the acute, if you flush and blush chronically for many, many years, you can get, consistently dilated capillaries in the skin, which can lead to chronic redness and inflammation, and we’re thinking mainly rosacea and like acne because both of those conditions cause chronic inflammation of the skin. And that can lead to long standing redness until the inflammatory condition is treated.
-Right.
-So not really…

-Going back to acne for a moment. Is acne the result of bad hygiene?
-No! You know that you just ask me to make me upset. No, actually not. So acne is very, very much not related to hygiene, but also not related to things you do to yourself. So. And I always need to stress, especially my younger patients who come in, they blame themselves for having acne. My pillow’s dirty, my hair gets in my face when I sleep, I don’t wash my face properly, I don’t use enough skincare products, I eat too much dairy… Like, people blame themselves for acne every day. And it’s terrible because it has nothing to do with what you’re doing. You can blame your parents, that’s a good one to blame. You know, blaming your genetics, always worse than blaming your parents. Blame the parents for everything. You blame your genetics, but you certainly cannot blame yourself for it, as in what you’re doing because you’re not causing your acne.
-Right. But there are things you can do to get rid of it.
-Yeah.
-Which you just told.
-So yeah. Don’t blame… You can blame the pregnancy, you can blame the hormones, you can blame the menopause, puberty… Yeah.

-Right. You said that acne is related to sebum, right?
-Correct.
-So if you get… You lower the sebum production you get rid of the acne.
-Yeah.
-Does that mean that oil… because you said you can also use oil, or oil based products for either sunscreen or for general skincare for moisturization…
-Yes.
-Does that mean that those products are comedogenic?
-Oh, I hate that word. You know I hate that word! Yeah, I hate that word. So comedogenicity, which it refers to a product’s ability to clog pores and therefore, “clog pores”, and therefore stimulate the occurrence of acne. So that’s a really misunderstood topic. Like, it’s probably one of the worst words ever in my field. It’s really a research term, and that’s really where it comes from. So it’s not really, really it’s like real life. Only a few things are comedogenic, per, as per, like the very complicated research that went into this like 50 years ago. You know, things like, i don’ know, coal, tar infused stuff. Almost nothing that’s available on the market today, I’m going to say almost nothing, I don’t know everything, but almost nothing is comedogenic at all. Whether it’s Vaseline, Vaseline’s certainly not comedogenic. Vaseline, olive oil based products, oily products, oils. You know, none of these products are comedogenic, and they never have been and they never will be. So Vaseline is actually used as a negative control for comedogenesy testing. Vaseline is because we know it does not cause clogged pores.
-So it’s not like the stuff you put on your face and it goes into the pores and there it causes…
-Yeah, correct. That doesn’t happen. So you can put Vaseline on your face all day long and it’s not gonna give you pimples. You also can’t judge that either because a spot doesn’t form overnight. So people say, oh, I used Vaseline last night, I got pimples this morning. Yeah, that’s not how this works. You know, it takes weeks and weeks and weeks for pimples to form. And it first has sort of as comedone and that has to grow into like an acne.
-So if they do notice something that’s acute irritation, inflammation but not actually that that got into the skin and that’s caused acne to form.
-Yes. Correct. You cannot form a pimple overnight.
-Right.
-So you can’t eat chocolate today and then think that the pimple you’re getting tomorrow is from the chocolate you ate.
-If you have a breakout the next day, it’s more inflammation, irritation?
-Yes. If you used a product or had a treatment or something and the next day you had like an acneiform eruption, so that’s like an irritant reaction. So acneiform eruptions don’t look like acne, at least not to me, but they can to like normal people. Yeah, the average person will be like, oh my God, I have pimples. It’s a totally different process. So you can irritate a hair follicle and create an acne type lesion. But it’s not true acne. So that’s an irritant problem. So that’s what some people see when they have treatments or facials or lasers or skincare. They use some funky skincare, exfoliant or mask, and then they get this kind of acneiform eruption the next day.
-Are there any particular foods that are particularly acne flaring for people?
-Not that I can say there’s evidence base to support. So patients or people often have their own impression of, like every time I eat X food, I get a pimple. I mean, it can be anything from like macadamia nuts all the way to like you know, cottage cheese. And it just has no rhyme or reason to it, like there’s just nothing. But we all make associations with things that which are incorrect, and that’s quite common to do, especially when you have something that you can’t control. So when you have acne, you have no control over this, basically pretty much. So then you’re trying to find ways to control it, and you’re trying to look for things that you can control. And that’s normal behavior. So I don’t ever argue with people, with patients when they come and say, well, every time I have a, you know, I don’t know, Kit-Kat again spots, like maybe, you know, they’re like, I just don’t eat Kit-Kat, so cool, well, that’s not that bad. So, you’re not telling me I don’t eat broccoli because you’re getting pimples. So I just go with it and I’m just like, yeah, fine. You know, like. And you can’t argue with that.

-What about whey protein supplementation? Anecdotally some people have issues with that.
-There’s never been any evidence to support that. So and I get that question a lot actually. Whey protein, protein shakes don’t cause acne, creatine does definitely not does not cause acne. You know, these things are not acnegenic at all. I usually, when I try to explain to people like, well, people who are getting acne from protein shakes are usually using other stuff that gives them acne. So it’s not the protein shake.

-Right? And, so let’s say you do get acne. You have a pimple. Should you pop it?
-So the answer to that is no. But if it’s like this evil looking like pus filled thing, you’re not going to walk around with this volcano in your head right? So I’m like, okay, if you’re going to do that, then, you take a… I just… take a sterile needle… This is sounding like terrible advice, but I write about this in the book. There’s a little box about this. Take a sterile needle if you have one, just puncture it very gently, like with a tiny little needle, and then take cotton buds, not your fingers, because you’re just going to damage the skin if you use your fingers, take on buds and really gently just press on it, just get that purulent stuff out and then that’s it. And don’t put like.
-Try not to make it bleed and…
-Try not to make it bleed, try not to make it red. If it’s a deep under the skin pimple, you never… You don’t get pimples. You’ve never had pimples.
-Not really.
-Yeah. The painful… the people will know, the deep under the skin ones that don’t have the head, just leave that one alone. Because you’re never going to be able to get anything out of that.
-You don’t want to dig deeper?
-No. Dig deeper with the needle, my God. And if you do, you’re going to make a worse abscess there, because is already an abscess. It’s a micro access. You’re just going to make that more terrible because you’re going to spread all that crap into the skin and you get more inflammation into the skin. So just leave it alone. It will go on its own.
-The issue is the damage that you do,
-Yeah.
-and on top of that you create an open wound which just gets more bacteria.
-But you’re driving more inflammation because a pimple, an active exploding acne lesion isn’t red and inflamed because it’s a pimple or because of some inherent thing to do, the hair follicle, it’s your body’s immune system reacting to all this rubbish being in your skin. So if you continue to spread that into the skin, you’re going to drive that immune system more and get more inflammation, more redness. A pimple takes on average 13 days to go on its own. You’re going to prolong that process and leave yourself with worse marking by driving more inflammation there. So leave it alone. Leave it alone. It will go on its own.

-Speaking of which, many people have gotten pimples, they have popped them, they’ve gotten acne scars because of it. Anything you can do against the acne scars?
-It depends on what kind of acne scars. So if it’s just a mark, like a flat, dark or red mark, the red marks go on their own, so you can’t do anything. Dark marks we can treat as pigmentation because it’s post inflammatory pigmentation, but a pitted scar.
-And how do you how do you treat it? So anything over the counter people can use?
-For pigmented scars if you can get hydroquinone over the counter in whatever country you live, then yes, most places you can’t anymore.
-It’s just a bleaching agent, right?
-It’s not a skin bleaching cream. It reduces pigmentation.
-Right. What’s the difference? Cause it doesn’t bleach skin. It doesn’t make it white like the wall.
-Right. Okay.
-So it just lightens your skin to its natural level of lightness.
-Right. So it reduces pigmentation.
-Correct.
-Okay.
-Yes. By direct affect on the conversion of tyrosine into melanin.
-Right.
-So hydroquinone, there’s a… tyrosine is an inhibitor. So it inhibits the enzyme that converts it. So you’re reducing the overactivity overactive production of melanin. But you’re not bleaching. Different concept. Because bleaching skin sounds terrible. But it’s the wrong mechanism. But yeah. So you can use hydroquinone and if for any kind of pitted acne scar, you need a resurfacing agent for that, like a laser.
-Okay. So that’s yeah, that’s not something people can, just get a cream for.
-Yeah, you can’t just get a cream for that.

-Yeah. What about acne, like blackheads that doesn’t have a pimple or anything? Especially blackheads, many people have on their nose. Is there anything you can do against that specifically? Do you also, you just use, retinoids, tretinoin or is it’s different?
-Yeah, so for actual comedone, so blackhead is a comedone, so a non inflammatory acne lesion which is a plug at the top of the follicle, that… tretinoin can help clear comedones. What you have on your nose, I don’t know if you have them…
-I have them too.
-Do you have them too?
-Yeah.
-Yeah you do. He does have them. Yeah. So those are called sebaceous filaments. So they’re not blackheads. So you have so the skin on the nose is slightly different from the facial skin because of the cartilage and stuff. So, the way it’s kind of, the hair follicles are a bit more open, and so what you’re seeing in the follicle is the tube of oil that lines the follicle. So have you ever squeeze out your sebaceous filaments?
-Yeah. Actually, even as a kid I went to, a derm at one point and they left it all red and everything.
-Yeah. They went in and…
-Yeah.
-You might have had blackheads, but didn’t have acne as a teenager, did you?
-Not really.
-No.
-Not on the skin, I only got bacne.
-Oh you got bacne, okay. So they went around and they did this. So basically what happens if you do that yourself you’ll see that what comes out is a little tube, a little yellow yellowy tube of, of oil of debris. So that’s the lining of the follicle. So that’s a physiological thing. So it helps to allow… that little tube allows the oil from the oil gland to go onto your nose surface. The only reason you can see it as a black dot is because it’s exposed to air, it oxidizes and becomes a black dot. So those are not blackheads. And those are physiological. They’re not pathological. Some people have more prominent ones because they have a lot more oil production.
-So you should not treat them?
-You should not treat them. Yeah. So these, follicles appear more dilated and are more visible in some people. So something that will shrink the oil glands down will also reduce the amount of oil coming out. So large oil enlarged pores look enlarged because there’s too much oil coming out chronically. So if you have a lot of oil coming out onto the skin surface all the time, it will dilate the follicle and that will look like an enlarged pore. So to turn that around, you slow down the oil production. You take the oil production away, follicles look smaller.

-Right. So last two topics, actually, the people are also often concerned about hair loss.
-Yeah.
-Much of my audience is male, they get hair loss…
-And they use things which could participate in their hair loss.
-Yes, yes. Also yes. A lot of… Well some of the audience uses anabolic androgenic steroids and that accelerates hair loss. Right. What’s the mechanism there? Because I actually find it interesting that… because DHT I think is implicated a lot.
-Yeah.
-Thyroid testosterone.
-Yeah.
-And it actually increases hair growth in most places.
-Yes.
-But not on the head.
-Yeah.
-What’s the deal there?
-Yeah, I can’t explain that.
-Right.
-I’m sure there is an explanation, I just haven’t found it. Do you have an explanation for that? I read one theory, which sounds contentious, but that it’s to do with gravity…
-Okay, that’s a no.
-Yeah. Yeah, the theory was something that it creates, increases the pressure on the follicle and combined with gravity that makes it fall out, even though it grow faster or something.
-But why it still miss the beard and stuff, facial hair? Yeah, that’s crap, no. I don’t think anyone really understands this, but I haven’t done…
-Because it’s a certain pattern usually… It’s on the top where men get the balding.
-I haven’t done a deep dive into this for a while, but I do need to do that. So I will do that and I will get back to you. I’ll do it this week. If there is an answer to that question, because I have a feeling that there is no good answer or a good explanation, but I’m sure someone’s done biopsy studies and stuff to have a look at the actual follicle and look at the receptors and stuff, working on there. I mean, even though we might not know the mechanism, luckily we do have some treatments, so we don’t know how the treatments work either for all the time. But, yeah, it’s annoying. What’s funny about hair is that you have hair all over your body except in your palms and soles, and it’s like everyone’s life goal is to have no hair on everywhere else, but to have a lot of hair on their head all the time. So you want a hair grow on your head, you want the hair on your head, but you don’t want it to grow in all the other areas you don’t want it to grow. And the irony of that is obviously like we’re talking like here to here. So, or women want lashes, eyebrows, hair, but no hair anywhere else. So the treatments for hair growth.
-Don’t you want my beard?
-Yeah, I don’t want your beard, no. So most women don’t, but, but the so the medications or treatments we use will always, if you take an oral medicine for hair growth, it will always make potentially hair grow everywhere. And with my patients I’m like well it’s a good thing if you’re noticing a bit of fuzz somewhere because that means it’s growing on your head. But it’s a lot harder to see that, especially if you’re long hair to see the hairs growing on your head. So you won’t notice it as quickly. But yeah. So what are you going to ask about hair? Sorry.
-Let’s say people have hair loss or they’re worried about hair loss. Anything they can do, especially over the counter or readily available?
-Yeah. You can buy minoxidil over the counter. So you can buy topical minoxidil. In some parts of the world you can buy oral minoxidil and oral finasteride over the counter, or online or whatever. Topical minoxidil is still going to be the best introduction to using stuff for hair growth, though it is a pain in the butt to use because it is something you apply to your scalp every day. Which can be a bit of a faf, especially if you have a lot of hair. But it does work really well, and it works consistently in everyone who uses it, which I know someone watching is something like I did too, but it didn’t work for me. Yeah, no, it would have worked if you use it long enough, or it did work, you just did notice. About one third of people don’t have enough of the enzyme in their hair follicles to convert minoxidil to its active drug form, and that’s quite unusual. And one third is plenty over again, this is an exaggeration here. And those people need more than 5% minoxidil for efficacy. So if I see a patient who was using 5% for 3 to 6 months and they come back and they’re like, I really had no response to this, which is very rare, then I will I could because I can have things made, I compound them like a 10% minoxidil. So there’s a small subset of patients, I would say one third, like I said, is an exaggeration, but it’s a small set of patients who need a little bit more for it to work effectively. But it works consistently across the board, as most medicine should do. If you have a pathology or a disease, you treat them with the medicine. The medicine fixes the problem.
-Right. I think it was… It was even the… …discovered, right, because it was originally meant for something else.
-Blood pressure.
-Yeah. And then they noticed like everyone’s getting hairy.
-Yeah. So they, it was used for like the 50s and 60s. It’s not really used now as a blood pressure medication, but oral minoxidil is used as a blood pressure medicine. And then they just they saw, they doctors, whoever it was saw that these patients were also growing a lot of hair. Just like with the, with the, the eyelash treatment we have that it’s a glaucoma drug. Patients with glaucoma were found to have really long eyelashes. So now you can use that glaucoma drug as a topical for eyelash growth. Same thing.
-And basically it’s the minoxidil just increases the hair growth by stimulating blood flow and nutrition? That’s what we think. So it’s not been well established.
-We just know it makes your hair grow.
-Correct, everywhere. If you put it everywhere.
-Rright. Where you put it, it will grow.
-Correct. The topical. Yes.
-And oral it will grow everywhere.
-Not in everyone to the same extent.
-So are we talking about Sasquatch?
-Yeah. Pretty much. Like, you can really make hair grow everywhere where there’s hair follicles. Like I said, you have hair follicles everywhere.
-But you can also use it in beard loss for men?
-Yes. Yeah. Yeah, yeah. Or minoxidil I mean, I, I find that it makes hair grow much more obviously in patients who are of an ethnicity where they have it hairy, more hairy, more hairy or hairier, or. Yeah. Or people, they’ve had problems with hair growth in the past like excess hair growth. But in some people who’ve never had hair issues or never had excess hair, they don’t get that problem.
-What about the people on androgens? They may be able to obtain compounds not over the counter, and they want something that slows down the hair loss.
-Yeah. Then I would still give them probably, because they like take oral medications, which is generally, don’t want to faff around for serum. I would give them oral minoxidil and I often also give them oral finasteride, though there is this issue, and I was going to ask you this too about oral finasteride as a DHT blocker. Does that have any anti anabolic effect? And would it…
-It does not.
-It does not. Right. It does not, does it?
-It inhibits the conversion of testosterone to DHT, so you get less DHT, but as a result of that you get more testosterone which means that the anabolic effect, the net anabolic effect is still the same.
-Yeah. That’s what I figured. Something like that.
-Yeah. So yeah.
-Not quite exactly that eloquently, but I was like, this must not be a problem. But so I do treat a fair amount, and especially in younger guys who want to prevent hair loss, they come in and say, I don’t wanna look like my dad. I give them oral minoxidil, oral finasteride compounded into one tablet from a younger age, like in their 20s. And it seems to I mean, I’ve only been a consultant for ten years, so I don’t have patients who have been using it for more than ten years, but they seem to be, doing very well on that. And it’s not they’re not having hair loss. So can you use as prevention? Yes. Though it’s not really licensed for that. But it seems to, it works as prevention in my little population patients.

-Okay. Last topic that many people are interested in: anti-aging, wrinkles and the like. We’ve already established one of the best things you can do is daily sunscreen. Make sure you don’t get the wrinkles, you don’t get the DNA damage and everything. Is there anything else people can do to prevent wrinkles or if they already have them to get rid of them?
-Okay, so don’t smoke. I mean, that’s like your number one…
-Probably in this audience, not a…
-If you smoke, you’re screwed. You might as well just know. So give up. I mean, if you think about what smoking does to your lungs in someone with emphysema, it destroys elastin. I mean, it’s doing this to your skin. So smoking is the worst thing you could ever do for aging. But okay, if you. Especially if you sit in the sun and smoke like this, it’s like a double whammy of like. And I remember my youth of…
-Sit in the sun and smoke, can I just take some collagen supplement?
-Yeah, that’s totally fantastic. Don’t get me started about collagen supplements, but…
-Not a fan?
-Not a fan.
-Not even for skin? Because there are a lot of people in fitness that are kind of convinced that indeed, it doesn’t do anything for you. You only get your protein, you get your vitamin C, then the body makes its own collagen for injuries. It’s the same issue for the skin?
-Yeah, don’t buy collagen supplements.
-So the really, the key to prevent wrinkles and anti-aging and or aging and wrinkles is prevention rather than any cure.
-Well, yeah. So, choose your parents, don’t smoke, don’t go on the sun. If you’re going to have wrinkles already, which most of us will, the best prevention to to delay them from getting worse or delaying them from really appearing is Botox so… or neurotoxin. So Botox is a brand name.
-Botox is evidence based?
-Oh 100%. Yeah. So I should refer to as neurotoxin. You can say Botox. That’s a brand I use. So that is definitely a brand name.
-It’s neurotoxin?
-We call it, we should refer it to as neurotoxin or anti-wrinkle injections.
-That doesn’t sound great.
-No, it sounds terrible. Yeah, it is a neurotoxin.
-So is it safe?
-Yes. It’s 100% safe.
-Okay.
-Yeah, yeah. 100%. So there’s no systemic.. There’s very little of any systemic absorption in the Botox when it’s injected.
-You inject it and it shuts down all the muscles and therefore you don’t wrinkle and therefore they don’t…
-Correct. So wrinkles are for my, we can use your forehead as demonstration. So wrinkles are formed by the movement of your muscle. So if you move your eyebrows up,
-There’s literally like, a piece of paper and just, it gets wrinkled or like your clothes.
-Yeah. Correct. So move your eyebrows up, very good. And you can see all has wrinkles. Yeah. Very good. Excellent. So. And now what happens, you have dynamic lines, so they’re there when you move your eyebrows up, but you also have static lines. So I’m sitting close enough where I can see little etchings of your lines that are there.
-Botox.
-Yeah. So that’s… so someone came to me and said, when am I ready for Botox? No one needs Botox. There’s no like, correct time. But I do say when you start to see the static lines, case right here, case number one, relax, cytokines, they’re there. Then you want to start doing Botox because you’ll stop, you’ll prevent those from becoming more deeply etched in the face.
-Right.
-So, and when you have Botox in your forehead, you will not be able to move your eyebrows up. So, like, I can move them a little bit.
-If you look at research, if that impacts, sociocultural perception and the like?
-That has been research actually. And yes, it does, but not… So you try to frown and you’re like…
-Terrible. You can’t frown. Yeah. Like I can’t really frown. So you have to have different ways of frowning.
-Like, I’m frowning.
-Yeah. Like, I’m frowning. So children respond to that differently. Pets as well, because they don’t see, or see… they don’t kind of get that vibe a frown of, like, anger. When you start to see the etched lines, then you want to think, okay, do I need to do something…
-So it’s a cosmetic trade off. You don’t get the wrinkles, but your facial expression will be a bit altered.
-Yeah. I mean if that matters to you. Some people… You don’t really talk with your face. Does that make sense? Yeah. You don’t. That’s just weird when you do that, there’s a reason why you don’t do that. That looks weird, but you don’t really talk with your forehead. So people, some people do. And you’ll see that that’s usually very animated. So you’re not very animated. That’s probably your Dutchness. Very animated… So and so…
-We are serious people.
-Yeah, exactly, we’re serious people. So you’re not going to be creating a lot of those lines, but you have just by moving your… I mean, I think for you, sorry, can I let me just yeah, I think for you where I would suggest putting a little smidge Botox would just be around the eyes.
-Right. Forehead and eyes?
-I think your foreheads okay right now because you’re… are we allowed to talk about how old you are?
-I’m 36.
-You’re 36. Yeah. So you’re young, but like, you’re on that side towards 40. So I think, you’re I was what I’d want to do if you’re like, what can I do to like, look younger is I want to soften these a little bit, just a little bit because they’re becoming, you have more lineage happening here than you do on your forehead. And you don’t really frown much, can you frown? You don’t really do that, do you?
-Not really.
-Not really. So I think just a little bit here, if you wanted my advice, if you asked me, which you didn’t, but I’m going to give it anyway.
-It doesn’t that, make my eyes weird? They’re not smily.
-You’ll still be able to smile. You just won’t create…
-Even with the eyes?
-Even with your eyes.
-So you do have a Duchenne smile, even with the Botox?
-Yeah, because… But you have the lines there all the time. So, I think they can just be a little bit, like, toned down.

-Speaking of my eyes, most people’s eyes: eyebags.
-Yeah.
-Can you do anything about?
-No.
-All right.
-You have to see a surgeon for that.
-Okay.
-Oculoplastics.
-So no amount of creams, there’s nothing in the store that… because a lot of products will say it gets rid of all the wrinkles.
-With the little rulers. Vitamin C? No, bullshit, bullshit Vitamin C does nothing for anybody. So, except irritate.

-Right. Last one. Cellulite.
-Okay. Oh, God.
-Other than losing fat, which doesn’t eliminate its but reduces its appearance, is there anything people can do?
-No, and I don’t… I know you did a post on this, and I think I might have even sent you an email or something about this when you did a post. Yeah, there is actually no treatment for cellulite, but I think in your post it was interesting because you did go through like the pathogenesis of cellulite, and how it happens, even the skinny people have it, and the kind of the hormonal connection and what we think might be happening. There was a really interesting drug that was available, hopefully will come back on to market, that was looking really promising because I don’t know if… Have you heard something called Dupuytren’s contracture? No? So that’s a neurological disease where people get contractions of the I guess tendons… tendons in the hands so that they have like a claw hand. So these contract and they go like this, it goes like this. So, in that condition, a drug was being used to almost like dissolve that those contracted tendons so that the hand would open. Don’t ask me about any specifics about that, but that drug had a funky name, but it was called “Qwo”, and it was used being used for cellulite. QWO. And it was being injected into the areas of cellulite and it was dissolving the netting holding the fat in place, which was getting rid of the cellulite. And it was extremely effective, super effective. It was taken off the market after about a year because it was found to be causing bruising and some post inflammatory pigmentation in those areas. So it was taken off the market, which is a shame because people would have dealt with that. I never got a chance to use it myself because it hadn’t gotten that far into the market. It had only been in the United States, so I never got to use in the UK or here. And so, but that was the, the only ever seen promising thing for cellulite. And I do think it will come back at some point. They’ll tweak it and then come back again. But what you really need to do with cellulite is you need to get rid of that netting that’s holding the fat in place.
-What you would have to do.
-What you would have to do to get rid of it, because there’s no other way, any kind of liposuction or anything. You ruin the fat doesn’t really do it. It’s that net that’s the issue. And everyone has, you know, unless you’re like a 8% body fat, you know, bodybuilder, you’re going to have that fat there.
-Right. And it’s not it’s purely a cosmetic issue. It’s just a relatively normal, or it’s the majority of people, so it is actually by definition normal presentation of the skin. Especially for women.
-Especially for women. I mean, I haven’t really seen it in men, but I know it can happen to men. You did mention that in the video as well. It can happen in men. So yeah, yeah, yeah.

-All right. Great.
-Cool.
-If people have any other skin issues that we have not covered in this video, they can read your book.
-They can.
-And if they want to get in touch with you, how can they? So they can, check out my Instagram @drnataliaspierings and all my information is there.
-Perfect.

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About the author

Menno Henselmans

Formerly a business consultant, I've traded my company car to follow my passion in strength training. I'm now an online physique coach, scientist and international public speaker with the mission to help serious trainees master their physique.

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About the author

Menno Henselmans

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