Is skincare for teens harmful? Parenting SOS with Dr. Emma Craythorne

0:01Coming up on Happy Mum, Happy Baby, Parenting SOS. I see the children coming into clinic because of irritation, sensitivity, new diagnoses of conditions like rosacea or perioral dermatitis as a consequence of these skincare routines. I probably shouldn't name these names, but, you know, I can think of a few where you'll see a before and after picture of somebody with pretty severe acne and the acne is better. Yeah. And it's touted as being, you know, this cream has done this. The cream hasn't done that. And in fact, I know the cream hasn't done it because the patient that you have up there is actually my patient.

0:34And I know what treatment I give that face of. No! You don't need a morning one and evening one. You don't need an eye cream. You don't need 20 million series. Do you not need an eye cream? No, just use your moisturiser.

0:52Hello and welcome to another episode of Happy Mum, Happy Baby, Parenting SOS. Now, I don't know about you, but over the last few years, I've noticed a big shift. Skincare routines aren't just for adults anymore. Our kids are getting in on the action too. From multi-step regimes to splurging on fancy skincare products, it seems children are becoming increasingly invested in skincare. But how young is too young to start a skincare routine? And what should our children actually be putting on their faces? Here with hopefully all the answers is consultant dermatologist, Dr. Emma Craythorne. Now, Dr.

1:28Emma hosts the hit TV series, The Bad Skin Clinic. She is also the host of the After Hours Skin Clinic podcast and is basically the most qualified anyone can be in skin. Hello, Emma. Hi, and thanks for that lovely introduction. How are you? I'm really good, thank you. I mean, it just feels like so many people are talking about this at the moment because it's been such a massive shift, I guess. And things like TikTok and Instagram, they're playing such a massive part in younger kids wanting these things much sooner. It's quite interesting that children have always been marketed to, particularly teenagers, whenever it comes to their skin.

2:04So even whenever you think back to the days of the Clearasil adverts where they were marketing to them, you know, almost giving a sense of fear. If you don't use this, you're going to have acne and your skin's going to be terrible and no one will like you and no one will be your friend. So it has always been something that has been marketed to you. But even then, those were teenagers. It was a one bottle is going to fix your life. You know, whereas now, you know, children as young as 10 are using anti-aging products. Yeah. And then I think what has happened then is that as kind of like time has gone by, and I'm speaking as well, not just as a dermatologist, but also I'm a mother of two teenage girls and a boy, but he's too young for this.

2:42But I think that really what's happened is, especially during the whole kind of COVID time and after COVID, where so much pushing of skincare products was happening on all kinds of social media to adults as well as to children. And people were getting more and more invested in these kind of routines. And there was a shift towards people just generally paying more attention to what their appearance was like. And for those tweens and teens, they almost were trying to get and be part of that. And that is where their sense of belonging then came. You know, it wasn't what jeans you were wearing or what trainers you had on.

3:17It was what skincare you were doing. And it wasn't really that they're initially setting out to think, OK, I need to do an anti-aging routine. It was more about setting out to go, well, I want to do this because this very cool influencer is doing it and my friend's doing it. And, you know, I'm not doing anything else at nighttime because, you know, children spend more time in their bedrooms now than they did 20 years ago or 30 years ago. They spend more time on their phone now. And that is the world they live in. So that's how they can have this kind of sense of belonging. And I see it now speaking as the dermatologist that's in clinic.

3:47I see the children less so, I have to say, over the last few months, but certainly the two years before that, coming into clinic because of irritation, sensitivity, new diagnoses of conditions like rosacea or perioral dermatitis as a consequence of these skincare routines. That's crazy, isn't it? I know. Also, you're just putting so much on your skin before your skin's even had a chance to live. Yeah, I mean... To go through the teenage acne phase or whatever that's going to be. Exactly. You know, most children do not need a skincare routine that's convoluded or extensive like this. Most children need to have, and they're very lucky then, you know, thinking about this, because there are many children who have chronic skin conditions like eczema or psoriasis, but have to do all of these convoluded skincare routines.

4:33But for most children who don't have that, Really, you just need to learn how to cleanse your face properly. Maybe if your skin's a bit dry, put on a moisturiser. And maybe if you're somebody who's got sensitive skin in terms of the sunlight, you're going to make sure you're putting your SPF on properly. But that really is it for most children. The rest of it is very, very unnecessary. And in all honesty, actually causing some harm. And not just on their face, but also their mental health. Like if you spend so much of your time worrying about how you look, and, you know, all of that stuff, then I don't know, there's got to be a knock-on effect mentally.

5:09Yeah, I think there is. There is this unrealistic expectation of what people's skin should look like. And I think as adults, you can start to work that out. You know, whenever you see a before and after picture as an adult, you're like, oh, my God, like, do I really need to look at that? What a load of nonsense. That doesn't happen. And you hear these claims that companies make and you can at least use your critical brain thinking, you know, that's never going to work. But that's quite different to somebody who's never learnt those skills or who thinks, oh, my goodness, all I need to do is get that and that's going to make my skin much better or glowy or I'm going to have no pores like that girl in the picture.

5:47You know, everyone has pores. And for most people, you can see them. Yeah. On Parenting SOS, I always ask you for your three most asked questions. So we're going to dive in with those. So the first one is what age should children start using skincare? So I'll make this comment based on somebody who doesn't have a skin condition. So if you have a skin condition, you need to see the GP or your dermatologist, get that skin condition diagnosed and then start on the appropriate medical treatment. That's definitely the first piece of advice. But other than that, what age should they start using it? It's really whenever they start to feel a little bit interested in doing something.

6:26And at that point, it's the advice, OK, well, this is how you cleanse your skin properly. and we have a discussion about the right kinds of soaps that you can cleanse your skin with because that very traditional soap is not great for the skin. You really don't want to be using that. You can feel it, it's a bit squeaky. It's a bit squeaky and anything that's squeaky clean, your skin barrier is disrupted. So there's lovely gentle things like cream cleansers. You can actually get bars of soap and I'm putting my little quotation marks up there called synthetic detergent bars. So Dove do a really great one of these.

6:59It's formulated to be the right pH for skin. So something gentle and cream and cleansing is a really good place to start. And then following that with a moisturiser, because usually if we're washing our face with something that's disrupting the skin barrier, it's a good idea to put a moisturiser on afterwards. And even that's for children who have oily skin, often going into their teenage years. But just a nice, light moisturiser. And that is really kind of it. There's a group of people, I suppose, who would be much more sensitive to the effects of the sun. And if they are going to burn more easily or if they're going to freckle a lot more easily or if they've got patchy bits of pigmentation, they don't want to get worse.

7:41So even as children, then it's kind of important to incorporate an SPF to the face every day. But other than that, it shouldn't be any more complicated. And really, that's probably from around about every kid is different. And I'm going to say as young as 10 you could go to. But, you know, every child is different. But I would say around about that age. OK, your next most asked question is, what products are gentle enough or too strong for kids? So, again, when it comes to things like washing your face and moisturising your skin, it's all about being gentle. It's all about not disrupting the skin barrier.

8:16So the skin barrier is our kind of like very outermost part of the skin. and it's made up of dead skin cells. If you think of it like a brick wall, the dead skin cells are the bricks and then in between it, it's the mortar and that's made up of things like cholesterol and free fatty acids and ceramides, these softening agents. And that barrier is the thing that's responsible for keeping all of the good stuff in. So things like water and all of the bad stuff out. So things like pollution in the environment, you know, pollen might irritate your skin. It keeps all the bad things out and it keeps all the good things in.

8:51And the more that barrier gets disrupted, the more of those other things can kind of happen. So your skin can get dry or irritated if the barrier gets disrupted. So in children particularly, your skin barrier isn't as strong as an adult's would be and you do want to have that protected. So if you're washing the skin, you would never ever want to use just a regular soap, just like the one we said. Or things like bubble baths. you know, they're really not great for kids' skin at all. They're very good for cleaning the bath. Yeah. But they're not good for kids' skin. Which is also hard, isn't it?

9:26Because bubble time, you know, it's seen as the fun thing for, I know we're talking much younger, but, you know, all of my three have had to have a different type of, you know, thing in the bath because it dries out their skin. Yeah. Yeah. You can get things that bubble up now that are much softer than the old traditional kind of SLSs. And you can use those quite nicely. And sometimes you can get almost like something where you bubble the bath, you push air into it and that bubbles the bath up. Right, okay. So you can get little bits and pieces like that that kind of stimulate it. And you've also then got these kind of gentler bubble alternatives.

9:59Right. But those very traditional, like the Métis bubble baths that we had to have when I grew up. Gosh, I mean, no. You used to beg for my mum and dad to let us have those. I know. Do you remember how much we loved those? But no, never use that. No, no. Okay. So it's really all about the very gentle cleansers. Things like the Cetaphil do lovely gentle cleansers. Dove do those synthetic detergent bars. Aven do lovely gentle cleansers. Aveno do beautiful gentle cleansers, especially for little babies and young children. So it's more sticking with things like that. And then usually, even if you put water on your skin, you've disrupted that skin barrier.

10:40So that's why moisturizer after cleansing is usually a good idea. And again, it's just gentle things. So again, the Aveeno range, the Roche-Posay Lipicarbon range, I love. The CeraVe range, the Avene again. So these are all super gentle kind of barrier protecting skin care. And I would say that is the area to kind of stay in. What to stay away from. Yes, equally as important. So and there's lots of these. So I'm thinking particularly now to those tweens who might have been doing all of the the drunk elephant trends or the multiple other trends that you can get from the big companies, Sephora, et cetera, is really staying away from things that have very active ingredients in it.

11:24So alpha hydroxy acids, beta hydroxy acids, you know, retinols, retinols. These are all really good for older skin because our skin barrier actually becomes a bit thicker as we get older. And it gets a bit dull and the skin cells turnover is a bit poor and we don't scatter light so well. So using these ingredients on that kind of skin barrier gives everyone a skin of glow back. It's brilliant. Young people really don't need that. So they're the real things that you want to stay away from. And then things like the sodium lauryl sulfate that causes bubbles. You want to stay away from those kind of things too.

11:59What can having those ingredients, like the retinol and stuff, what effects can that have on young skin when it doesn't need it? How retinols work are they increase the skin cell turnover. so it increase how much of that dead skin is kind of coming away and they do that as well by being irritant so it is an irritant treatment that's obviously great if you've got adult skin but if you don't and you've got very young skin trying to stimulate that to turn over more quickly it will end up making the skin go red and dry and a little bit scaly in itself what is interesting is that if you had acne as a teenager or a tween you would go to your GP and they would give you a prescription-grade retinoid.

12:44And you would go home and you would use it and you would not like it because it would do all of those things I've just described. But the wonderful thing about it is it's also the most effective treatment that we have topically for acne. So it's very effective. And then it will clear things like blackheads and whiteheads and those red spots and pussy spots. It takes about 12 weeks until you start to see the difference and you get through all of the redness and horribleness. so it's very effective in the medical form of the treatment but these over the counter treatments like the retinols and retinals they have no indication for acne whatsoever there's no studies to show that they're going to be beneficial for acne so you wouldn't be using them to treat acne there's no guidelines to say that you would use it to treat acne you just don't use those to treat acne you go and get the prescription drug to treat the acne so unfortunately a lot of them are then using these and just getting the side effects and not any of the actual benefits of what they would have been intended for.

13:39So hard, isn't it? Because I imagine if someone goes to the doctor and they get this medicalised version of it, it doesn't look pretty. It doesn't, exactly. But it is, but that also just amplifies the fact that these are children. You know what I mean? There are children using it because they want to go for the thing that looks pretty. Well, maybe we're all a bit like that, but want to have the thing that looks pretty rather than this white bottle that just has a sticker on it. I mean, that's exactly right. I actually, so my two daughters are now 14 and 16. And so the kind of, they got all consumed in this probably around about three years ago, I would say, would have been the time.

14:13And they had every kind of these products. I mean, all of them, because obviously I'm their mother and they didn't listen to me. But then did you really like, no, no, don't do that. Of course I did. Did they listen? No. Did they get side effects? Yes, a lot. But then this will make so many other mums feel great that, you know, this is your area. Like I feel as mums, we all get ignored. It's always like, oh, shush, mum. But for you, this is your area that you are an expert in. And yet still your children were like, no, thanks. We've got this. Their godmother gave them a voucher to go to Sephora.

14:44OK. And I was like, oh, my gosh. And they go, go, it'll be so nice. And so you go and there's lots of mothers with their daughters in, you know, buying things. And obviously I was walking around like the Grinch at Christmas going, this is ridiculous. It's so expensive. and my two daughters were like, oh, mum, you know, just this is so embarrassing, come with you, Lou, just enjoy it, just enjoy it. So I said, can we get this? I said, this is not going to work, this is not going to be helpful, but, you know, if you find your way. Yeah, yeah. Anyway, of course, they both got the things and within a week, within a week, they were, one of them had a perioral dermatitis, the other one had all red blotches on her face.

15:23Did they come to you then? They did come to me then. Did I fix them? Yes. Let them sweat a bit. God, that's so hard. And are they better not eye and listen to me? Well, yes. I mean, I imagine most children wouldn't go into a shop and turn, you know, wouldn't look at ingredients. And I think it's only certain, you know, skin fluences, I guess, or, you know, influencers who do talk about that, the scientific side of it. Like, I know, Caroline Hirons has been amazing for me looking at things like that and kind of actually breaking down what things are and just like, that's a no go. you know, you don't.

15:57Because sometimes it's just, they're all just massive words I can't break down or just letters. I think that's right. They're not looking at the ingredients to see what's in it. And also, even if they do look at the ingredients and write down the ingredients or can say the ingredients, they don't really know what it means, nor do they even know, okay, well, that ingredient with that ingredient, what that means, you know, because it's all about the formulation in its entirety rather than just individual ingredients. And so it's too complex. It's too much. So you'd never expect them to know it. But what do they know?

16:31Well, they know what it looks like, how pretty it is, how to do the kind of dance routine of applying it to their face. They learn and know all of those things. And the thing is, that's what sells the product. Yeah. I mean, I can imagine you just walking around and just wanting to slap things out of their hands. No, not that one. Not that one. That was it. Your third most asked question is, what is the emotional effect of acne on teenagers and how do you treat it? Acne is something that all teenagers almost expect that they are going to get at some point in their lives. And also, if they are lucky enough and they don't have problems with it, one of their friends will have.

17:11And I think it's about understanding even how to help or talk to somebody if they do have particularly bad acne, even if you don't have it yourself. because people feel different whenever they have acne that's particularly severe. Not even if it's particularly severe, but if their perception of it is severe, then we know in terms of the psychological effect that this, you know, increases their risk of things like depression, anxiety. It doubles the suicide risk in that group for, you know, all other cases controlled. So this is not something that is, you know, just to be taken lightly or ever dismissed.

17:49is, God, it's just a few spots, which does still happen. It may well just be a few spots, but for the teenager on the inside, it really is a huge big deal. And I think increasingly becoming more of a problem pretty much just because of what we talked about. Really? So, you know, you've got these beauty ideals that people struggle to get to because they're not real. They don't exist. They don't exist. And then you've also got a lot of the things that people do to fit in is sharing their get ready with me videos. Now, unless you're going to embrace your acne and show people what you do with your acne to get ready, most people don't.

18:27And they kind of avoid those kind of situations. So it does have a very significant negative impact on how teenagers view themselves. And then the other problem that goes alongside it is that acne itself can be treated. Right. However, if it's not treated appropriately or treated quickly and it goes on to develop scarring, then that scarring can actually be very, very long lasting and is much more difficult to treat. And, you know, then it just means that that stigma is carried on in your 20s and your 30s and your 40s and your 50s. You know, I see patients now in their 70s and 80s still with their significant acne scarring and still affected by it, you know, in their 80s.

19:09So I think the key is understanding this condition and treating it nice and early because we have brilliant treatments for acne. Has that changed a lot over the decades? Not really. I suppose how we discuss the treatments is better and we help people understand how to use them better. And I think that has probably been kind of better done. The treatments, to be honest, have remained pretty much stable. We understand that it is a little bit more about personalised care now. So for some people who have acne, particularly young women, a lot of it can be related to their menstrual cycle or conditions like polycystic ovarian syndrome and we're understanding that a lot more so you know treatments for conditions like that are much more targeted so I think that understanding that and understanding and getting in with the right treatment quickly then kind of sorts out the problems with the scarring that might go on further down the line also then whenever you see these before and after pictures and I mean I can think of a few you know I probably shouldn't name these names But, you know, I can think of a few where you'll see a before and after picture of somebody with pretty severe acne and the acne is better.

20:18Yeah. And it's touted as being, you know, this cream has done this. And, you know, the cream hasn't done that. Yeah. And in fact, I know the cream hasn't done it because the patient that you have up there is actually my patient. And I know what treatment I gave that patient. No. Oh, yes. Oh, my God. I think the message about the acne is, is that there's really good treatment. And the really good treatments are not usually the things that you will go in and buy off the shelf, usually in a beauty store. It's usually medical treatment can get these things better. So is that the best way of helping sort of teenagers with their acne is to get them to the doctors or to a dermatologist?

20:58Definitely. If you want to kind of buy something that's, you know, over the counter, then things like the gentle cleansers that we talked about, the gentle moisturizers we talked about. There are some really nice ranges that do have a few gentle actives in it. So like salicylic acid, there's a company called Bare Essentials. And they do a lot of very gentle kind of skin supporting routine for people who've got early acne. Even some of the Claracil, you know, it's nice and gentle. But inevitably, you will need more of a kind of medical treatment. And that's then best to get into the GP and get in early.

21:33because, you know, if you're then going to have to go on to a dermatologist, that takes a long time. Does it? Yeah. If you're someone who has a child who's really into these skincare routines, is there any one that you would kind of go, well, this person actually does stuff in a slightly different way or is a gentler approach? Or is there anywhere that kids can enjoy doing bits of skincare? I mean, I can think of lots of skincare ranges that are targeted to them that I quite like. So there's things like the bubble range is all done just to be about skin barrier protecting and that's really nice.

22:11Aveeno, I think, for teenagers, they've targeted that all beautifully and the CeraVe for teenagers. That's all, you know, very nice.

22:26Let's talk makeup. My mum told me I was allergic to makeup until I was 16 and then I started using a little clear mascara. and be like, nothing is happening. That is a good trick, mum. I know when I've got an older sister. I don't know whether maybe I just had sensitive skin as a kid and she just kept it going, but I didn't touch anything until I was 16. I hear parents say this to their children, that they're allergic to make-up. If they were, say, for example, doing lots of theatre work or doing lots of dance routines and dance shows and competitions. I was part of my local amateur dramatics.

22:59That was thick make-up. There you go. So when this really thick makeup goes on and your glands are, you know, a little bit oily and they get a little bit blocked up by this very old fashioned theatre makeup, it does irritate them. And so you will see a lot of kind of teenagers, young teenagers, maybe even like 11 and 12, coming in because their parents think that they're allergic to makeup. But actually, it's not a true allergy. It's just an irritation and inflammation because the makeup has been kind of too heavy and cloggy. So I think that I just wonder, is that maybe what's happened to you?

23:36Or maybe she just really didn't want me to go near it. Either way. It worked, though. It worked. I still think makeup will always be there. I mean, you know, just even putting a tiny little bit of mascara on or a tiny little bit of, you know, coal at the edges of your eyebrows or a tiny little bit of lipstick, even if it's like the colour of your lips when it's cold so your lips don't look blue. You know, I think that that will always make people feel a little bit better or express or change who they are. Yeah. Yeah, the makeup part of it kind of bothers me less. Does it? Yeah. That's really interesting.

24:13I like that. So we asked the Happy Mum Happy Baby community to send us some questions. Someone has said, I'm still unsure how to care for my own skin. How can I teach my kids what's good for their skin? Getting to grips with your own skin is really key. So full disclosure here, I have a prescriptive skincare company called Clara, K-L-I-R-A. And the whole mantra of that is, is that everybody's skin is very different. So your skin is entirely unique to you. So it doesn't matter what algorithms you're being served, that cream is not necessarily going to be the cream that is the cream for you. So if you go to that website, it's free and you can complete quite a detailed questionnaire.

24:54It's 51 questions. And it goes through just helping you think a little bit about what your skin is like in terms of things like how we think of as a dermatologist. So what the skin barrier is like, what the redness of your skin is like, what the pigmentation is like, what the wrinkle collagen level is like. And it's a very detailed questionnaire. And you just answer it honestly. It's not asking you complicated questions. and then it will help you understand a little bit more about what your skin likes. So you can say, well, actually, yes, I've got oily skin that pigments very, very easily. And, you know, I've not been so good in terms of my genetics or what I've done and I need to start boosting my collagen.

25:31And then we kind of give some guidance. So the first thing is to understand that your skin is so different to everybody else's and you kind of need to understand a little bit more about your own skin. The second thing is, is that it really isn't that complicated unless you have a medical problem. It is not complicated. In the morning, you wash your face, you put on your moisturiser and you put on an SPF. Most people over about the age of 25 would do well to put an SPF on their face and neck every day. And so that is it. And then at night time, you wash your face. And if you need to do active treatment of the skin, then you would put the active treatment on and maybe a moisturiser.

26:16And that is it. It really is not overly complicated or difficult or you don't need 20 steps or any of these things. It's really, really simple. And as a mum, it has to be really simple because you've only got those two seconds. And it does not need to be expensive at all. Would you use a different moisturiser in the morning and in the evening? No, I don't. I use the same moisturiser morning and evening, but I would use a slightly thicker moisturiser in the winter compared to the summer. So in the winter where the air is much, much drier and colder, we lose water from our skin to the environment.

26:52And so our skin dries out a little bit more. And the converse is true in the summer. And so I would just have a thicker moisturiser in the winter and a slightly lighter one in the summer. Because again, as adults, we have that thing where people are telling us, this is the morning one and this is the evening one. You're like, well, I must get the morning and the evening because, you know, that's what they've told me to do. You don't need a morning one, an evening one. You don't need an eye cream. You don't need 20 million series. Do you not need an eye cream? No, just use your moisturiser. So what is...

27:24Why? Because eye creams are often a different... They're almost thicker, right, usually? Well, they're kind of designed to make you spend money. Yes, OK. They are designed actually to have ingredients that are going to be less irritating to the eye itself, the eye area. and they're not always thicker but usually they're thicker to try and avoid anything running into the eye. That's the kind of idea for it. But you don't need a separate eye cream. You know, keep it really, really simple. Good, because I always forget the eye cream. It's there. That's fine. But I never have time to put that on. Okay, this makes me feel better.

27:58Just washing the face. Just washing the face. Okay, another question. What is necessary in a child's skincare when they have eczema? That's all back to that skin barrier that I talked about at the beginning. So it means that it's not working so well and you are losing water through that. And as soon as you lose water through your skin barrier, it becomes a bit cracked. And that's why you see, if you look really closely at the skin of somebody with eczema, it does look like cracked pavements. And when there's a crack in the skin, it just means then that irritants that are on the outside are going to get in and irritate.

28:31So if you then happen to be a child who's got eczema, but also allergic to cats or to dust house dust mite or whatever, then that's also going to get in and irritate. so the main aim is to restore and protect that skin barrier and so when washing the skin it should be fairly quick lots of long baths or really really hot showers are not a good idea it should be just nice quick cleansing with some of these synthetic detergents and then putting the moisturiser on afterwards there's a couple of tricks that you can do if you've got a baby who has eczema there's a study that's shown that when they come out of the bath if you wait 10 minutes before applying the moisturiser, then it's more effective.

29:13But for children, as soon as they come out of the bath or the shower and their skin is still wet, at that point, if you just grab a whole load of the moisturiser and just cover them in it really quickly when the skin is still wet and then use the towel to pat them dry, then they actually quite like that because they hate the feeling of having a big thick cream on their skin. They hate it. So at least if you get them out, just cover them super quickly, then use the towel to pat them dry then they don't feel that horrible sticky way so I think that would be the things to do with somebody with eczema and if the eczema is not under control and you're getting these red patches still flaring up then you do need to put a topical steroid onto those areas because the aim of controlling eczema is to essentially I would say think of the red areas like a fire and you really do need to put the fire out because what just happens is other bits nearby all, you know, start to get affected.

30:07And, you know, then what happens is, is the child doesn't sleep so well. You don't sleep so well. The child gets tired. They don't learn so well. Eczema gets out of control. They don't grow so well. And then you get this thing called the atopic march where you're then more prone to things like asthma or food allergies because, you know, the child is then meeting these environmental allergens through their skin because their skin's out of control. So that's the importance of kind of getting on top of eczema nice and early. but it's all about that skin barrier. Are there any moisturisers that you would recommend using?

30:40I love, love the La Roche-Posay Lipicarbon AP Plus M. I love it. I just think it's brilliant. It's got a 48R moisturising capability. So if you've got it on the child and even if you're not washing them the next day, there is still evidence to show that it will stay moisturised. You can also use the other study that was done. The University of Nottingham did a big study at this. this is why I can tell you these, is CeraVe. So CeraVe do a big thick cream and that came out one of the top ones. Another company called Uriage do one called XeroSe, X-E-R-O-S-E. I don't know how to say that properly.

31:19And that's also lovely. And then the Aveeno Dermexa Baby Range. In fact, that's what I used on my own child. I really had eczema from being a little baby. Except we used to get it in from America. It was called Aveeno Eczema Baby Therapy. and they didn't sell it here. This was 16 years ago. So we used to bring it over by the caseload. It's so hard though, isn't it? Because you know how much pain that must be. Yes. Like my six-year-old gets really bad eczema on their bottom and, you know, it's that thing of constantly phoning the doctors, sending in photos because you never get an appointment and them just saying, just moisturise.

31:55But I moisturise, then it gets under control and we're still moisturising, but it will find its way back. Yeah, that's right. You know, there will be something else that is driving it. And the key is whenever we then talk about these steroids are that using the steroids to get it. So you apply them topically to get it under control and you do it kind of every day for a couple of weeks. And then you step it down until maybe for some children, you're just applying it once every 10 days, just once. And that's enough to keep it under control. And most children just grow out of this anyway. And it's just about getting them to the stage where the skin barrier has developed enough that they have essentially grown out of it.

32:34For anybody who hasn't had eczema, it is so, so distracting and irritating. And it feels almost like little hot pins being stuck into different parts of your body where it gets itchy. And it's really, really upsetting for them. And then at nighttime, you get this kind of like natural cortisol drop. That's your kind of body's natural steroid dropping. And the problem is then that's actually quite anti-inflammatory. So then your skin gets more itchy at night time. And then so you're scratching it and you break the skin and then it gets infected. And yeah, it's really hard. It's really hard. So the key is protecting that skin barrier and not being afraid of appropriate use of topical steroids.

33:18They are there for a reason and to not be frightened of them if they're used properly. Absolutely. Another question. How do you know when a rash is something to be concerned about? I imagine all of us have Googled various rushes at certain points. Yeah. I know my second daughter, whenever she was only three months old, actually had a rash of great concern because it was, you know, the rash that whenever you put a glass against, it's called a purpuric rash. And she had been unwell in the day. And it's just, you know, her heart rate was up and she was, you know, just a little bit kind of tachycard.

33:53her heart rate up and her breathing rate was up and she was off her food and she had a bit of a temperature and I just thought she was a child. I was bathing her and I saw this rash on her legs. I was like, oh my gosh. So we went down to the hospital where I work as a consultant and they saw her. Anyway, she was kept in and it turned out she had streptococcal infection and that can cause a similar kind of infection. Anyway, all fine. And that was 14 years ago, so she's all good. But as a parent, it's really hard to know what is a bad rash and what is a good rash. I suppose the warning things to look out for is it's not just about the rash.

34:30It's about what else is going on with the child. So, you know, if the child is completely well and they happen to have a rash, you know, likelihood is it's probably something either maybe post-viral or they've been irritated by something or allergic to something or whatever. But the rashes that you worry about is whenever it's attached to a child who has also got a high temperature, they're not eating, their heart rate's up, their breathing rate's up. They're the kind of rashes that you would want to worry about. But other than that, rashes are normally a sign on our skin of something that's perhaps happening, something else on the inside or we've been in contact with.

35:08And children get lots of rashes. Absolutely. Just because their skin barrier doesn't work very well. That makes everything make so much more sense, just thinking about their skin barrier. Yeah. I've never heard of it like that. My eldest is 11, so I've been doing this a long time. What recommendations do you have to transition skincare as their skin changes, for instance, going into puberty? So normally until puberty, most people don't need any skincare routine at all. It's just not necessary. And for going into puberty, what typically happens is that we get hair in places that we didn't have before.

35:40Our sweat glands, especially in our armpits, they start to develop and be a bit smelly. We make more sebum in our hair. So dandruff comes along at that age. And then obviously we're making more sebum on our faces and acne can come along. So normally that's a quite nice transition and, you know, skins get a bit oilier. But if it's manageable and hasn't gone into any of those kind of pathological states of dandruff that's quite severe or acne, then just again that nice gentle skincare routine is fine but for other people who are starting to get a little bit more oiliness it's a problem then you might want to start making adjustments to the skincare routine so unless you're going to go for medical treatment adding in a cleanser that's designed specifically for oily skin or a moisturiser that's designed specifically for oily skin or things like shampoos that are designed specifically for dandruff so thinking of things with selenium sulfide in it or sometimes there's a Nisoral shampoo is very good for these.

36:44Is it almost waiting for certain things to happen rather than acting before something actually happens? Is it better to wait for something to happen and then react to it because otherwise you could be putting loads of stuff on your face that you simply don't need? Yeah, exactly. So just always sticking with a gentle skincare routine. It's all about supporting that barrier for many different things even conditions where the skin has a lot of acne. you still want to support the skin barrier. So that is the baseline skin routine. And then only if there is a problem arises or something changes within it, only then would you want to make an adjustment.

37:18Going back to the bathing earlier, you said about how even water can have an effect on that skin barrier. I remember when our kids first started having problems with their skin when they were younger, how the doctor would say, just water, just water. Is it better when they're younger the skin. Is it better to have just water and a quick bath or is it better to have just water with a bit of gentle soap? So I think it's probably better to have the water with a bit of one of these synthetic detergents that are kind of barrier safe for the skin. And the reason for that is that, you know, kids get really grubby and water just doesn't often get a lot of that off.

37:58And if you're then scrubbing it hard to try and get it off with the water, then actually that's going to be quite irritating for the skin as well. Whereas if you have a gentle cleansing agent, they work by having these little things called surfactants in them. And the surfactants kind of wrap around the bits of dirt and help to soften them off the skin. So it's coming off chemically as opposed to coming off with you physically scrubbing it. So I would say more using a gentle kind of cleanser would be better than just using water. Brilliant. Someone has written sunscreen. For a child with eczema or a teenager with acne slash oily skin.

38:35Are there certain sun creams that we should be using for different types when it comes to kids? We're so lucky now in living when we do in terms of the amount of availability of various formulations of sun creams. So there is absolutely no excuse for not being able to find one. It might take a little bit of trial and error, but everybody will find the sun cream that's the right one for them. There are ones for children, for example, if we think about that group and there's there's formulations that are specifically designed so that kids will like them and use them. So it's things like they're in, you know, like these pistol kind of like gun dispensary things.

39:15So you can like run after them and like play games shooting them. You can there's some that come out in like bubbles and foam. Yeah. And then there's other ones that dry in very quickly so they don't leave a tacky sensation on the skin. Children with eczema often struggle with SPFs. And so if the child, if you're going on a beach holiday, for example, and if the child has eczema, then I actually normally suggest that you don't really use a whole lot of sun cream and instead think of other ways to protect their skin. And so wearing a lot of these UPF clothing, that's clothing that has SPF in it.

39:51So swimwear, where the swimwear goes right down to the ankles and it goes right down to the wrist. And you find one that's in a nice light colour because if you get a dark colour, they end up overheating. That is usually a lot better to do rather than chasing after them and making their skin uncomfortable with sun creams. The kind of go-to ones that I recommend are Aveeno do an SPF for children, which people really like. La Roche-Posay and Thelios do one for children that they really like, although it is a bit annoying because it does dye a lot of things yellow. You know that. And then the Altruist, you make an SPF 50, a huge big tub of this.

40:34Right. And children seem to get on very well with that, even children with eczema. So they would probably be my go-to just a trial to begin with. But I would think of using other methods of sun protection. For a teenager with acne, there is so many. Really? Yeah, there are so many now. You look at something that will say oily skin on it and they will typically have things like mattifiers in them. So yes, it will kind of protect your skin from the sun, but also it tends to have these kind of little balls within it that soak up excess oil so the skin appears matter. So you can use it almost like as a cosmetic agent as well as, you know, incorporating it into your SPF routine.

41:11I like that. This has been so informative. I feel like I've learned more from you than I have learned in my 40 years of life. Oh, thank you. Thank you so much. We end the podcast with you completing three sentences. The first one is if I could tell you one thing, it would be. If I could tell you one thing, I suppose, I mean, I can only give advice as to the person that I am. So I do have that slight disclaimer. So I've always been a working mum, always. And my husband is also a very working husband. He leaves the house at six o 'clock. He's home at six o 'clock. So my lived experience, if anyone is in that particular situation, is that my one piece of advice is to outsource as much as you can that is to do with the running of the house so that you can spend those times with your children.

42:08Next sentence, being a mum means? Well, I think being a mum, certainly in my household, means being the person who just has to know the answer to everything. How's that going, Emma? And if I don't know the answer to everything, I make it up. I like this. So I think you seem to have to know the answer to everyone's questions. You have to know where everything is. You have to know what everyone's timetable is. You have to know when all the dentists are. You have to know when all of these things are, even though other people could do that. So I would say maybe the emotional thermometer, the captain of the house.

42:46That's what it means. I like that. And finally, I'm happy when? I think I'm probably most happy whenever, and it is a bit corny because it is when I'm with my family. And it's probably whenever we're doing some kind of new experience together. So something that perhaps me and my husband have never done and we're doing it with our children for the first time. So last year we did a trip around Colombia and we went and learned how coffee was made and we went and picked coffee beans. And, you know, whenever I read the question, I kind of thought what was a really good time. It was stuff like that or quad biking with them, just doing stuff, doing something with them.

43:26Also that thing of your kids seeing you explore. So that's a really key part in that, isn't it? Yeah. So it's not just you watching them do something. It's you all collectively doing it. Yeah, I never thought of that actually because I think sometimes you think that your parents have done everything or their life is kind of like finished. They're at the end. But I think that that must be quite nice as well for them to see you actively engaging and getting enjoyment out of something completely new. Yeah, absolutely. Emma, thank you so much. Honestly, I've absolutely loved this. I've found it so insightful.

43:59And if you've enjoyed this as much as I have and want to learn more, then don't forget that you can go and listen to the After Hours Skin Clinic podcast, which Emma hosts. Thank you so much for having me on. I loved it too. Thank you.