How-To Transition Your Skincare For Fall, Vitamin C For Sensitive Types and Hyperpigmentation SOS with Dermatology PA, Amy Koberling, AKA The “Skinthusiast”

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25:45What about dark spot correctors? I feel like this is another area and we've gotten this question from our listeners as well, where there's just been, the market has been flooded with options where people are just confused and they're like, I don't know what actually works, what's actually good. So I have the same question for you about that. I do know that vitamin C helps with dark spots, of course, but is there anything else that is sort of like a go-to for you that you would recommend? And also I love the, that you gave us a budget option as well. Yeah, absolutely. So it can be tricky because I think it's one of the areas that people see the least improvement.

26:24So they're very quick to say like, it doesn't work. I don't like it. And I think one thing to keep in mind is that it takes really at least 12 to 16 weeks to see an improvement in most types of hyperpigmentation. So that's often enough to get you through a bottle or even more. So it's not uncommon to go through a bottle of something and not see a difference when it comes to dark spot correctors. And that's just because of the nature of hyperpigmentation. There's many different types of dark spots and a lot of them are very stubborn. And it's really about a comprehensive routine, right? Your sunscreen matters, your exfoliant matters, your retinoid matters.

26:55But when it comes to the actual serums, there are a lot of exciting ones that have come out in the last few years. For budget options, I really like the La Roche-Posay Melaclear. That's like a really new, interesting new ingredient that they're using with great data. I'm trying to think in clinic, the ones that I use, I really like the one by Isden. I like the one by Elastin. Those are going to be your higher price points. Dr. Brandt has a dark spots, no more serum that I like. Dr. Shreen I just, her whole line is really based around hyperpigmentation. So that's a good option, but it can be tricky.

27:30And a lot of these are a blend of different ingredients. So I find that they can sometimes be irritating on sensitive skin. So it's, it's a little bit of trial and error, but what I will say is consistency is key. Like I said, you might go through a whole bottle and not see a difference. You number one, you need to make sure the rest of your regimen is in check, you need to make sure you're wearing a daily sunscreen every day and a tinted one because we know that dark spots are made worse by visible light and tinted sunscreen protects from visible light. We always tell our patients, like you can be using the best routine.

27:58You could be using prescription products, but if you go walk your dog for 20 minutes in the sun, it's going to come back. So really like that's the most important thing is being super diligent about sun exposure. And then the last thing I said again would be to really give it, give it two bottles before you're judging it truly because it takes a long time for these things to improve. Right. I've never heard that about tinted sunscreen before, that it's more effective than untinted other than I just thought it was put in there because mineral sunscreens have that white cast. So they need to kind of neutralize that.

28:33Yes. The iron oxide is what gives it its tint. So that's like what they use in makeup and things like that. So actually, if you're someone who's like, I love my non-tinted sunscreen, but you wear foundation every day, you're getting the benefit of both. So normal sunscreens gives us UVA, UVB protection. The tint, the iron oxide gives us visible light protection. And we know visible light can make light sensitive conditions worse. So that's some things like melasma or other types of hyperpigmentation, post-inflammatory hyperpigmentation after an acne marker, scratch, rosacea can be made worse by visible light.

29:04So that's one of the first changes I make in my patients' routines is switching them to a tinted sunscreen. Oh, that's good. And what's your fave? Oh gosh, there's so many good ones. Right now I'm using Isden. I think they just have really cool technology. But the tint, it's, you know, it's very personal because the tint can really, most of these things have one tint and one tint only. So you have to really find which one works for you because there's not a lot of shade variation. I kind of am one that I just use them all, blend them in really nice. And then if I need to put a skin tint on top, I do.

29:35I think because I come from such a skin forward place, I don't really care, to be honest. if it's a little off when I'm doing my day-to-day stuff. But I know a lot of people who are very makeup forward obviously would care about that. So it's about finding your tint. But I love ISDIN. I love PCA Sheer Tint. For really dry types, I love Elta Elements. It's like really nice and dewy. Notarium has a nice tinted one. I really like the Kosas Tinted. It's really like gives you like almost a filtered look, especially if you wear it underneath the skin tint because it's so reflective. So one's like the top of mind.

30:06Awesome. Can I ask you, because you are working in clinic every day, let's say people are, they've gone through their two bottles of serum and they're going, damn it, it's still there. What laser treatment do you think is like the best investment if you're going to go there to try to help with hyperpigmentation? This is a really fantastic question. And in our clinic, we almost never employ lasers for hyperpigmentation. And the reason is because some of the most common forms like melasma can actually be made worse by the inflammation that the laser causes. So you guys probably know this if you're familiar with Dr.

30:39Bauman, but half of our clinic is a research center. So we do a lot of the FDA trials when new devices, new fillers, new toxins come out. And so in those three, you know, the three months that they're following the patients after they get these lasers, the hyperpigmentation looks great. But then when we're following them in clinic, we see it come back even worse because of the underlying inflammation from the laser. So because I was trained by Dr. Bauman and she, that's like her stance. She does not laser anybody with melasma. For me, I'm comfortable doing some lasers if we're targeting something else, as long as I pre-treat them.

31:11Like if they're in a really good place with their melasma and we've pre-treated with a hydroquinone, I'm comfortable lasering, you know, for something else, but I never really laser melasma for treatment. But there's other types of hyperpigmentation, right? There's things like post-inflammatory erythema. For those, I would do something like a vascular laser to bring down the redness, but for actual like sun spots, like the more isolated ones that don't look modeled like melasma, an actual true laser is the most effective way. So like there's BBL, there's IPL, those are light therapies. But for those isolated spots, I prefer a true laser, like an alexandrite or something like that to actually target it.

31:48I know that those LED masks have gotten super popular and we're kind of sold on them now because we had Dr. Dennis Gross on the show and he just went deep on the technology behind it. Is that something you use in your practice? I do. I use it myself like daily. Yeah. It's so great. So just maybe you could just recap what some of the main benefits are really quickly. But my question for you actually is if you found an affordable at home option, because we've talked about it many times on our show, but typically they're all like around $500. And, you know, I think there is this perception that if you're just buying one on Amazon that might be less expensive.

32:28It might not be like as effective. It might not be legit. So I'm just curious if you've found one that's more affordable. Yeah. So the most affordable one that I've found is like the 380 range. So still not affordable, right? For most people, but they can go up to 500, 600. I mean, there's some of these devices are thousands of dollars, but I haven't found anything that's super affordable. I do really like the benefits. I think, you know, with red light, we know it reduces inflammation. It can help increase collagen production. Blue light, we know it reduces acne-causing bacteria. So great for those who are dealing with breakouts.

33:04But if it's not in your budget, I think there's this notion that it's something that people have to invest in. And the fact is that if you go, again, it always comes back to the basics. If you're wearing daily sunscreen and your Renoid and your vitamin C, that's going to take you further than any of these devices. So don't get upset if it's something that's not within your budget. I think that as a technology becomes more and more available, we will start to see those budget friendly options because all these brands are going to be trying to one up each other on the on the price tag. Right. So I do think eventually we will have it.

33:33I just don't think it's there yet. Yeah. I think the wands might be less expensive, which are, you know, obviously it's more of a targeted approach. But if we can find a more affordable wand. We'll link to that guys in our, on our website. Yeah. I mean, I think the thing is it's with the mask with SoGenius, it's one and done. And you're actually getting that physical, the contact all over your skin versus the, the solo wave or whatnot, where you're kind of moving it around. I think that's good structure. But if you're someone who's like, I have this stubborn line and I'm interested to see what red light could do for me, then potentially, you know, you can hold your wand there for three minutes or whatever it is.

34:14But I think for most people, yeah, they're not the most practical. I don't usually recommend them for that reason. But yeah. Or, but just if, if you have just like acne only or acne, the thing is with the blue light is that the benefit, is it preventing new lesions, right? Because you're reducing the acne bacteria. Once the lesion, once the pimple is already there, there's not a ton you can do. So it could be helpful to reduce bacteria in the area, but is it going to really make your pimple go away much faster, probably not. But if you're someone who's like, I always break out in the same spot and you do that daily, that might be helpful.

34:47Yeah. I wanted to ask you, my daughter has been working out all summer. She's like, she's a fanatic. She does Muay Thai and she's sort of training at the gym. And so now she's 14 and she, her acne has been flaring up more. And so she, We were like both wondering, what is the ideal skincare routine post or pre-gym that you could do? Is it the hydrochlorous acid? Is it important not to wear makeup? What can you tell us? Sure. Is it mostly on the face that she's dealing with or anything on the body? Mostly the face. Okay. So I always recommend go with a clean face or just your sunscreen. If you're going to be working out during daylight hours and she has a commute and things like that, just her sunscreen, No makeup, obviously, is going to be the best beforehand.

35:36Afterwards, if she can cleanse quickly, then using a cleanser with something like salicylic acid that really penetrates the pore and will help dissolve the dirt and oil in the pore is helpful. If she can't work out right away, I do think the sprays are helpful. I think that for this particular issue, that probably a salicylic acid spray is most helpful. We know hypochlorous acid can help with redness and soothing, really, mostly soothing. The data isn't quite there on acne. Maybe we'll have it eventually enough to be able to say that it treats acne. But I think right now, from a clinical standpoint, I think a cell slick, I would pick a cell slick acid spray over a hypochlorous acid spray.

36:15What would be a good one? I know Diffrin has one that I've personally used because I tend to break out on my back after working out. So something I spray in the car right, you know, on my way home. So I would say Diffrin. And then any salicylic acid spray that she uses or salicylic acid cleanser that she uses is helpful. Just lather it on the skin for 30 to 60 seconds before she rinses. And then go from there. And that really should be, if it's mild, that should be enough to take care of it. But if that doesn't take care of it, an adaption is available over the counter, which can be really, really helpful.

36:45It used to be only available by prescription, which you guys know. But now it's available at CVS, Target, all those places. Yeah. And then sunscreen. Of course, sunscreen.

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39:13out. I'm so curious, Amy, because you have a blog, which not all content creators these days have blogs. So you're actually out here writing these articles and whatnot. What's the biggest search term that brings people to you? Oh, that's such a good question. You know, I get a lot of traffic from people searching about dermatology PAs, people who want to become one. Interesting. Which is funny because I feel so secluded in the skincare space. Like I'm not as involved in my profession as probably I should be because it's just such a broad profession, right? And I'm so in my little bubble of skincare.

39:48But it seems to be a super popular area of interest. So that seems to bring a lot of people to me. Also, pregnancy skincare is huge. I try to write about that as much as I can just because I know that there is a lot of confusion, a lot of misunderstanding, a lot of fear around what's safe in pregnancy. So that's definitely a common one. And actually what your question earlier, transitional seasons bring a lot of traffic to the law. People trying to figure out how to make their routine for the season. What's a skincare trend that you are excited about or that you would recommend to people? Oh, that's a great question.

40:24You know, there's some ingredients that I think get a bad rap, especially now, like things like hyaluronic acid and niacinamide, right? We see this kind of natural trajectory of these ingredients where they get really popular and then people start to give them hate. And I think we're kind of on that, on that downward slope for both of those ingredients. But I think, you know, use properly. Yeah. HA, yuck. That's like so 2021. It's funny because we've all been using it for years. We just didn't think about it. You know, it's in most of our moisturizers. It's in a lot of our serums already. So I am glad that we're kind of moving away from like a separate HA serum or a separate niacinamide serum.

41:00However, I'm glad that we're not getting rid of them in our skincare because I do think that they're trendy for a reason. They have good merit. We just need to know how to use them. And, you know, I am on board with the trend because I love those ingredients, but I'm happy that we're kind of getting away really from single ingredient skincare in general. But I think that those trends have merit. I want to ask you, so first of all, congratulations on your podcast, which is almost celebrating its one year anniversary. That's coming up in October. I understand. So yeah, podcaster to podcaster, what guest have you had on your show who taught you something new that you didn't know that maybe you're using in your own routine or in your practice?

41:44And who was it? Oh my gosh, that's a great question. I've had so many great guests on. Shawnee Darden was a favorite. She's just like so funny and straightforward. I loved having her. Vanessa Lee from LA, from the things we do. She's incredible. She gave me so much insight on like facial balancing and how she approaches cosmetic patients. Can I ask you, because you're like, now I'm getting personal, but you're, you're working in Miami. Let's get real. Is the Ozempic face real? And what are you doing about it when people come to see you? Are they coming to you and saying, I've lost a lot of volume in my face.

42:16And how do you go about tackling that? So restoring volume after any sort of weight loss. So Ozumbic face is weight loss face, right? Restoring volume is so difficult. I see this not only with people who have lost weight, but also new moms who are then back to their pre-pregnancy weight. The face just looks different. And it's something I see all the time. And it has to be done very artfully and intentionally because this is when you're putting a lot of volume back in the face, this is when things can start to go awry. So I think it's a little mixture of things like Sculptro, which is a biostimulator that helps your skin make its own collagen, things like filler strategically placed to help give volume back.

42:57Really, other than those two things, there's not a ton that's going to give volume back to the face. Sometimes it's so extreme that it really is a surgical issue, especially if If they are going to try to maintain that weight, if it's surgical, I'll tell them, you know, I don't think that you're going to be happy. You're going to spend a lot of money and it's not going to give you the result that you're looking for. But restoring volume in the face after weight loss can be very, very tricky. Very tricky. Yeah. Are you actually seeing more of it? Yes. Oh my gosh. There's so much of Zempick in Miami.

43:26So much. Yeah. When my patients come in, I can usually always tell that that's kind of, you know, I've seen them for years and then all of a sudden they're 10 pounds. Yeah. It does age the face. it ages the face. Yeah, it absolutely does. I want to ask you, so I think it's funny because as sort of a dermatologist patient, I feel like, or just a regular skin enthusiast at home, it's like when we get a reaction to something or we notice something with our skin, we're always like reaching for a product. We want easy solution, like what can we put on it? Or we have like signs of irritation. But with dermatologists, it's more like, what are you using?

44:03Let's take it away. I feel like is more of the approach. Like you've likely done something to yourself here. So I'm curious, what's the biggest irritant you're seeing lately that people should maybe be aware of? The biggest irritant. It's funny because I said this is a trending ingredient that I love, but I do see irritation with niacinamide and I think it comes back to just it being in everything. So that's something I have people pull back on a lot. Overdoing it on the peel pads. I think Like people think you're supposed to use them five to seven days a week and most skin types can't handle that.

44:38So I see that quite a bit. But you kind of hit the nail on the head. I always joke, like if you think your skin needs something, it probably needs less. Like that's if you're like, oh my God, what do I put on to make this go away? It's probably something you need to pull back on. So what does it look like if you're ODing on niacinamide? What are you seeing? You can see breakouts. You can see redness. You can see irritation. It's kind of these like little monomorphic breakouts. that don't look like the regular pimples that you get. Kind of similar to like what a rosacea breakout would look like.

45:07It's very classic. I see it all the time with people who are using too much or too high of a concentration of niacinamide. We know like two to five percent is really the sweet spot in the data, but brands are doing 10, 20 percent. So you can start to see some irritation. Okay. That's what I like. Yeah. She likes to push it to the limit. Hey, if your skin can handle it. Yeah. That's super helpful. Okay. And our last question for you, what is a fundamental skin truth that you wish you knew earlier besides sunscreen? Everybody knows. I was going to say that's hard. I think that everything is temporary and that our skin naturally goes through changes as we age.

45:49And that just because you have clear skin at one point doesn't mean you'll never have breakouts. So be kind. And just because your skin is broken out now doesn't mean that it won't honestly clear up. I've seen it. It happened to me like it just when I was a teenager just kind of cleared up on my own. So I think just understanding that everything is temporary because especially with things like acne, it can be really, really tough on your mental health. I see it all the time with my young patients that we know that there's a connection with mental health and acne or really any forward facing skin condition, right?

46:20Our skin, when we're speaking to someone, they're looking at our face. So if we have a skin condition on the face, it can be really, really disheartening. And so I think just understanding that everything is temporary and there are options. I think I felt so lost when I was young, thinking that I was going to have to deal with these things forever. And, you know, now I know. And that's really why I have such a special place in my heart for acne patients, because oftentimes it's such an easy tweak that we can make to their routine. Even those who have, quote unquote, failed other medications or gone to other providers, it's usually like a lack of education or a lack of like education from the provider to the patient.

46:55They're not understanding because their provider is not taking the time to discuss it with them. And that's where I see the most issues. So I think that if I could go back and tell myself one thing at that age, it would be like, this is temporary. Yeah, I love that. Well, thank you so much, Amy. Her handle is the underscore skin enthusiast on TikTok. And you guys have to rush over there right now because I'm looking at a video where she's got some kind of helmet thing on her head. I'm not entirely sure what it is. I told you I love L &D. I'm on the LED train. She is wearing the LED helmet. Wow.

47:31She's also doing a full face of drugstore beauty on there. So many great, insightful videos. And we appreciate you sharing your expertise with us today. Well, thank you so much for having me. Thank you, truly. And everybody go check out our episode over on the Skin Enthusiast podcast, which just came out. Yes, doing a little pod swap. Yes, so fun. Thanks, Amy. Thank you.

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