Dr. Whitney Bowe shares her expertise on acne – how to treat it, how to prevent it, and whether popular social media posts offer a one size fits all solution.
Research shows clean skin still has trillions of microbes on it, and these bugs play a major role in our skin’s health. “Our skin is covered with trillions of microorganisms you can’t see, primarily bacteria, that are essential to healthy and beautiful skin,” says Whitney Bowe, MD, a dermatologist in New York City and author of The Beauty of Dirty Skin. “These microbial critters are part of your skin’s health and behavior, and many of them provide vital functions for your skin that the human body actually can’t perform on its own.”
Dr. Bowe explains that over-cleansing will not only strip away the skin’s natural oils, but it will also upset its sensitive microbial balance. “The bacteria on our skin exist in a very delicate equilibrium—a delicate balance or harmony even—that keeps our skin functioning at its optimal level,” she says. “When the bacterial balance is maintained, our skin is pumping out collagen, sealing in moisture with ceramides, and telling our immune systems to calm down. But when we upset that delicate balance by rubbing and scrubbing with loofahs, buff puffs, wash cloths, harsh soaps with a high pH, or antibacterial soaps with biome-sabotaging ingredients like triclosan, our skin begins to suffer.” This can lead to a number of skin issues, including eczema, acne, dry skin, and premature aging.
Healthy bacteria also acts as a protective shield. In fact, researchers recently found that Staphylococcus epidermidis produces a molecule called 6-N-hydroxyaminopurine (6-HAP) that may provide natural protection against skin cancer. “The presence of this strain may provide natural protection, or it might be used therapeutically to inhibit the growth of various forms of cancer,” Richard Gallo, a co-author of the study from the University of California, San Diego, writes in the journal Science Advances.
When the strain was introduced to mice with melanoma cells, the tumors were over 60 percent smaller than those that had not received the strain. “Not only did this substance appear to slow the growth of melanoma cells, but it also appeared to reduce the number of pre-cancers formed when mice were exposed to UV light,” says Dr. Bowe. “In my opinion, this science is truly groundbreaking, and represents a revolution in the field of skin care and dermatology. Scientists are turning towards probiotics to fight infections, fight chronic skin diseases such as acne and rosacea, and now even to fight cancer.”
To keep your bugs in check, steer clear of harsh, anti-bacterial soaps or cleansers with a high a pH. Instead, Dr. Bowe says to look for words like gentle, pH balanced, and hydrating. She recommends La Roche Posay Toleriane Cleanser ($15; ulta.com), which is formulated with prebiotic thermal spring water to help restore that healthy balance. Use only your fingertips when cleansing—no instruments or tools—and moisturize immediately after. “Moisture is critical to microbial growth on the skin, and moisturizers preserve the skin’s physical barrier and maintain the normal composition of the microbiome,” she explains. “If your skin feels tight or dry after you cleanse, you are not respecting your microbiome.”
Before you hit the pillow, apply an overnight-focused formula as the last step in your p.m. regimen. “Skin cells grow faster when you’re asleep, so a nighttime treatment can add nutrients that help to repair and restore even better, says NYC dermatologist and The Beauty of Dirty Skin author, Dr. Whitney Bowe.
The top 20 pantry staples to get a glowing complexion, one bite (or sip) at a time. “Greek Yogurt – Probiotics do more than just heal your gut, says Whitney Bowe, NY-based dermatologist and author of The Beauty of Dirty Skin. They boost the production of ceramides (healthy fats in skin) and aid with recovery from exposure to UV rays.
Rosy cheeks, chapped lips, hands which burn from the cold . . . sound familiar? Winter is the time when playing outside often makes our skin honestly hurt and crack from the cold, dry air. This is only compounded by the warm, dry heated air indoors. We take hot showers to warm up and this only further exacerbates all of this dryness!
What should you use to heal and protect your skin’s barrier and what is safe to use on your children that won’t burn when applied? I have been borderline obsessed with Doctor Rogers RESTORE Healing Balm, developed by my friend, Seattle dermatologist Heather Rogers. It is made with 100 percent plant based ingredients and is made without lanolin, parabens, phthalates, sulfates, fragrance and common allergens.
The key ingredients are glycerin, which promotes healing, restores your skin’s healthy barrier function, and reduces irritation, and castor seed oil, which is hydrating and has been proven to reduce skin inflammation.
I have been using the Healing Balm all winter on my cheeks, lips and hands, and also on my daughter’s lips and cheeks, which get very chapped when she is playing outside in the snow or ice skating. My sister and her kids now use it all the time, too, and swear by it. The $30 price tag is completely justified by how well this product works.
Stress is a good thing, at least from an evolutionary and survivalist perspective. It serves an important function: to protect us from real danger by equipping us with the means to either escape a life-threatening situation or face it head-on. But our physical response doesn’t change according to the type or magnitude of a perceived threat. The body’s stress response is the same whether you’re facing a life-or-death emergency, a packed to-do list, or an argument with a friend or family member. Acute stress comes on suddenly and doesn’t last long. When you’re under the gun of taking a test, having to give a public speech, or about to get into a car accident, that’s acute stress. You’ll feel it physically with that adrenaline rush and may even have some gastrointestinal issues as digestion slows and diverts blood away from your stomach. But acute stress isn’t the kind that will have a long-term negative impact on your skin. It’s the prolonged stress, especially the kind rooted in our psyche, that’s the most damaging to our skin. Acute stress goes away relatively quickly. The slow boil of ongoing, unremitting stress from life in general, however, is a whole other ball of wax. It’s the big time skin villain.
At the heart of chronic stress’s impact on skin is its relationship with your endocrine-hormonal-system. Prolonged stress of any kind, be it from chronic sleep deprivation or the pain of going through a divorce, can do a number on your endocrine system. And if, as a result, your hormones are not optimally balanced, or they are not working effectively, you will eventually begin to notice it. Your skin will not escape these challenges. Any of the Big Four skin conditions – acne, eczema, rosacea, and psoriasis – can be part of this picture.
The body’s counterattack on stress does not just involve surges in stress hormones such as cortisol and the subsequent breakdown of tissues such as collagen. In addition, two other players are often involved in direct skin damage: inflammation and oxidation.
Inflammation is the body’s protective mechanism against harmful stimuli. It’s the process by which our bodies can effectively kill an invader or deal with an illness. But, like cortisol, it has a downside-over time, it can cause everything from skin problems such as acne and rosacea to autoimmune disorders.
Oxidation results from the action of free radicals-a term you’re probably already familiar with. Free radicals are the biological equivalent of wayward bullets. They are indeed radical and free-highly reactive forms of oxygen that can damage cell membranes and other structures in the body. But their wrath is especially brutal on the skin. Free radicals can come from anywhere-from inside our bodies, where they are produced as part of our normal physiological processes, to pollution and UV rays, just two of the external sources of stress on the skin.
So, to achieve your healthiest, most radiant skin, you’ve got to dial down the long-term, nagging stress that so many of us deal with on a daily basis. How can we tame that inner psychological beast that keeps us agitated, anxious, worrisome, and feeling overwhelmed?
Before I focus on the single tool I have found to be most impactful, here is a list of 5 of my favorite ways to dial down persistent stress, which you can start acting on immediately:
- One of the things I love to do to calm my very active mind is to wake up 20 minutes early and set my intentions for the day. I make a list of my priorities for that particular day and then, I feel more at peace and focused as I move forward.
- I have started to keep a gratitude journal and to share it with my daughter. I think it’s a good practice for both of us to maintain a healthy perspective.
- I believe that mindfulness about the influx of information from social media and the constant pull of it can be very helpful in stress management. We have a barrage of constant information coming our way. At night and in the morning, I think it’s important to turn these things off and to focus on the moment. I think taking time to simplify our environment, even for a short period, and to breathe can be very restorative.
- I have started to incorporate essential oils into my bedtime ritual. I think the fragrances can be transporting and soothing and can assist with dialing down that sense of urgency that can lead to generalized stress.
- This is one that I am working on, but I think it’s healthy to consider indulging in a relaxing and restorative spa treatment every few months to allow yourself to have time to focus on you. It will help you take better care of others in the long run.
Now, I will turn to the one simple lifestyle intervention can do more good than any cream, lotion, or dermatological procedure: meditation. A few short years ago, if someone started talking to me about the benefits of yoga or meditation, I would immediately stop listening. I was a multitasker, a type A powerhouse. I was a sweater, a runner, a trampoline jumper, not a deep breather. Relax? That was just not in my vocabulary. But people who are crazy-efficient multitaskers actually need to read this section more than anybody else. In fact, meditation is a shortcut to a calm mind-and, in turn, to calm skin. I try to meditate once daily.
What makes meditation so powerful? It has the goal of triggering what’s called the relaxation response, a term popularized by Dr. Herbert Benson at Harvard Medical School. During the relaxation response, the body releases chemicals and brain signals that relieve tension in your muscles, slow down your organs, and increase blood flow to your brain. This response can reduce the pain, discomfort, and anxiety that often manifest themselves in skin conditions (among other things). Scientists now theorize that the biological events taking place during the relaxation response essentially prevent the body from translating psychological worry into physical inflammation. The experience of the relaxation response appears to change cellular connections in areas of the brain associated with reactions to stress. And the good news is that nurturing a daily practice that turns on your relaxation response can help you more easily cope with stressors in your life that persist or even worsen.
You can engage in an activity that triggers the relaxation response simply by stopping for a moment to be fully present (mindful) with your breathing and controlling your inhalations and exhalations. Deep breathing can be done anywhere, anytime. If you’ve never meditated before, a deep-breathing practice twice daily will get you started and give you a foundation for working up to more advanced techniques. There are apps on your phone like Headspace or Breethe that many of my patients use and love. Restoring your skin’s balance, and your overall wellness, doesn’t have to be overly complicated. This is one simple change that can make a world of difference for your health, which will be reflected in your healthy glow from the inside out and the outside in.
I am so excited to share this brand new page with you guys!
Part of my job as a dermatologist and media expert is to know which of the trending products really work and deliver the results they promise! As a research scientist, I look at the science and the studies behind product claims. I want to see proof that the products that I am recommending do what they say they will do for your skin! I want to see proof that the product is safe. I am all for trying a new trend or an exotic ingredient, but only if I am confident it will not harm my skin’s barrier and my overall health.
I am asked for my product recommendations all the time – so here they are! I will update my top picks on a monthly basis so you always have the opportunity to learn about something new and exciting! I will share recommendations for women, men, and children – something for everyone. I look forward to sharing my favorite products and brands with you to help you achieve your skin goals and stay sun safe and radiant!
Many of my patients find facial oils confusing. Are they a replacement for day cream, night cream, serum? Should you apply them before your face cream or after? I’m here to answer all of these questions and more.
Oils are emollients, so they do not hydrate your skin’s deeper layers. Rather, they stay closer to the top layer of your skin and hydrate the surface of your skin while providing protection for your skin’s barrier. They act as a sealant which locks moisture in the skin and that can be very beneficial for your skin’s overall health, provided that the oils are not too heavy. So, I do not recommend swapping out your hydrating moisturizer for a face oil altogether, but they can be very effective if used several times per week at night to seal in your skin’s moisture after cleansing or for oily skin to trick your skin into producing less sebum. Many of my patients swear by facial oils, so I think the key is trying different brands and different amounts to find the formula and quantity that works best with your skin.
We are also learning so much right now about the skin microbiome – the millions of invisible bacteria that live on the surface of the skin and help the skin to function. Just like we have bacteria in our gut, we are covered with bacteria on our skin! And we need those bacteria to maintain the health of our skin. Some of those healthy bacterial strains feed off of our skin’s natural oils, called sebum. This can be a good thing—in the case of promoting the growth of bacterial strains that boost our natural collagen or ceramide production! But this can be a bad thing if we are feeding bacteria that cause breakouts. We are just learning about this area right now, but it’s possible that certain oils you might be adding to your skincare regimen might also act as food for the healthy strains of bacteria, a “prebiotic” if you will. I cover the microbiome and how it affects our skin in my new book, The Beauty of Dirty Skin.
How to use oils on your face: I recommend mixing a few drops of oils with your regular moisturizer. If you apply oils first, then you will block the anti-aging ingredients in your moisturizer from penetrating into the skin.
Oils and acne prone skin: take it slow and use only 1-2 drops of oil mixed into your moisturizer at first. If you notice that you break out more when you use the oil, then save the oil only for days when your skin feels tight or dry, or the weather is harsh and cold (like whipping winds).
QUESTION 1: What helps with acne scarring?
ANSWER: When it comes to acne scarring, there are many options that can smooth out those scars, but they usually work best when used as part of a personalized treatment plan. Topical retinoids are key to use at home, as they help to rebuild the collagen especially in atrophic scars (ones that appear depressed or have a shadow). If scars are raised (so called hypertrophic scars), then cortisone shots can make a huge difference. For ice pick scars, and many types of rolling scars, I usually combine lasers with microneedling and fillers. I use lasers like the Fraxel laser to resurface the skin. Microneedling is amazing for acne scars as well. I can combine microneedling with your own plasma (the so-called Vampire Facial), or I can combine microneedling with radiofrequency energy (the Endymed Intensif). Last, chemical peels can also help to slowly even out the tone and textural changes associated with acne sequelae. (more…)
There are so many popular myths about Melasma! I am here to help you get the FACTS you need to keep your Melasma under control.
FIRST, no lemon juice. If you google “home remedies for Melasma” you will find pages of home remedies listing lemon juice as one of the key ingredients. this is a MYTH!!! Do NOT use lemon juice on your Melasma! Citrus fruits can irritate the skin, which can make Melasma worse. AND lemons in particular actually make your skin much more vulnerable to the sun. I’ve seen these remedies make Melasma 10x worse in just 24 hours.
SECOND, no heat! Anything that causes too much heat or irritation in the skin can make Melasma worse! When it comes to Melasma, your doctor has to be gentle and you have to be patient. Trying to rush that process will only set you back. This means:
- NO Hot yoga
- NO saunas
- NO steam rooms
- NO sunbathing
- NO tanning salons
THIRD, what should you look for: look for serums, lotions and creams that contain Vitamin C, kojic acid, licorice, or soy. Those are brightening ingredients that have been shown to gently lighten Melasma patches over time.
FOURTH, sun protection!! This is critical to your Melasma treatment!
FIFTH: I wanted to share the regimen that I provided to Ginger to treat her Melasma for your ready reference:
- cleanse with a gentle cleanser (Purpose, Dove, Cetaphil all good) fingertips only
- pat dry using a clean towel
- put a few drops of SkinCeuticals CE Ferulic antioxidant serum into La Roche Posay sunscreen
- rub all over face and neck. CE ferulic has Vit C (skin brightener) AND acts as an antioxidant, neutralizing free radicals that are thought to trigger Melasma.
HAT– wear a hat when outside!!! I’m serious
I mixed a Melasma Emulsion for Ginger. Less is more to start. I recommended that she use it every other night for the dark areas ONLY. Key ingredients here are Hydroquinone (which acts to block the enzyme that makes melanin and is the MOST powerful depigmenting topical ingredient for Melasma) and Tretinoin (prescription strength vit A) which increases skin cell turnover, bringing the stained cells to the surface where they ultimately slough off.
Alternate nights: dr. brandt DNA Night Cream (loaded with antioxidants) or a gentle moisturizer like Cetaphil or CeraVe.
4 nights before each PEEL: STOP the Melasma emulsion.
Check out the segment right here:
Share your thoughts and questions about Melasma with me on social media! My handle is @drwhitneybowe on FB, TW, and IG!