From Acne To Hyperpigmentation, Dermatologists Solve R29's Skincare Concerns

Illustrated by Anna Sudit.
We all have a particular skincare issue we'd like to fix. We're not talking about changing the way we look, but the way our skin behaves. An oily T-zone that looks more like a mirror than a forehead come lunchtime? We've been there. Scarring left from a nasty bout of hormonal acne? We understand.
Skin is a very temperamental thing, subject to change whenever we switch up our environment, hormones, lifestyle or the products we use. It can often feel like a constant battle (when a dry patch clears up, blackheads might appear), which is why we went to the best in the business to put our skin concerns under the spotlight.
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Ten Refinery29 staff, all with a plethora of skin tones and types, asked 10 dermatologists to help solve their issues. Read on to find out what they advised.
1 of 10
Meg O'Donnell, Photo Assistant

"I really neglect my skin..I use micellar water and moisturiser in the evening and repeat that (lengthy) process again when I wake up. So I'd like to find a skincare routine to benefit my combination skin. I am often quite oily yet dry on my nose, and have random patches of dry skin on my cheeks. Also, I have quite big pores and small pimply skin and would love to hear what I can do to exfoliate in a delicate way without using a harsh scrub."

Abigail James, celebrity facialist

“For a combination skin, just using a micellar water and moisturiser is not going to be enough, and may well be contributing to small pimples on the face. It may also cause the skin to sway from oily to dry.

Micellar water is a mix of water and minute oil particles. I only really see it as a quick way to remove makeup rather than cleansing your face. You are likely to be leaving product on the skin then applying your moisturiser on top of this, clogging pores. This means the skin is not able to breathe, which, in turn, slows cell turnover resulting in dull and patchy skin.

Using a micellar for a quick remove of makeup is fine but I would suggest also using a gentle wash to properly cleanse the skin morning and night. Starting the day with a gentle cleanse allows your moisturiser and makeup to sit on a fresh, clean base. This should also help keep pores clean even if they are slightly large. Nivea Daily Essentials Refreshing Face Wash Gel or Cosmedix Benefit Clean Gentle Cleanser are both good to begin with.

Exfoliating with something gentle 2-3 times a week will also help the skin. You could use a Clarisonic, or an AHA face mask which would gently remove dead skin cells while adding some hydration to dry skin. I would recommend a vitamin C mask or a night / morning combo, too. I love the way Nivea have done this with their Q10 Plus Vit C Skin Sleep Cream. It's a great nighttime boost for dry skin. Try Nivea Q10 Plus C Energy Day Cream with SPF 15 in the morning for a pick-me-up and sun protection.

To further support large pores, you could look to include a derma roller in the evening once a week as an additional step. That said, I would make the other changes first, see how skin responds over a two-month period, and then look to progress.”
2 of 10
Samantha Yu, Brand Director

"I have hyper-pigmentation on either side of my face as a result of acne. I've had it for about 10 years, since breaking out in high school. I've tried so many things, from natural products to treatments like microdermabrasion and glycolic peels to light therapy. Help!"

Dr. Justine Hextall, consultant dermatologist at The Harley Medical Group

"Firstly I would wish to assess the depth of the pigmentation as this is crucial to assess appropriate treatments. It may be that although acne inflammation triggered the pigmentation, other factors may be exacerbating the situation. Topical treatments such as Kligman's cream (with hydroquinone, hydrocortisone and retinoid) may help to reduce the pigmentation and is probably advisable to use before any active treatments, such as a peel. As the latter in itself can cause post-inflammatory pigmentation, I always advise caution with any peels in the context of hyper-pigmentation. After a course of Kligman's cream, Derma FNS may help. This can target pigmentation and any possible acne scarring. Finally, ongoing treatments to reduce recurrence would include a high factor sun cream, preferably with a physical block such as zinc oxide, and I advise topical vitamin C. It blocks the production of melanin, and has antioxidant properties that protect against free radical damage from UV and pollution that can cause unwanted skin pigmentation."
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3 of 10
Rose Lander, International Coordinator

"I've had milia around and under my eyes for around 10 years. I once had them removed during a facial but they came back. In the past I've used exfoliating scrubs, but my skin is too sensitive. Now I use an overnight exfoliator and sometimes they come away on their own while I wash my face – but nothing I've tried has really worked."

Dr. Frances Prenna Jones, cosmetic anti-ageing doctor

"It is important to differentiate milia from fatty deposits under the skin (they can often look the same), as the treatment of these is often different. Milia are essentially trapped calcified secretions under the skin which are often caused by using too greasy a moisturiser and not using glycol-type products, which slough away the top dead layer of skin cells. Paradoxically, if you physically scrub the area though it will make them worse! So prevention is better than cure: use a product that contains glycol. They need to be removed by an experienced professional otherwise, as they can scar if you try and remove them yourself."
4 of 10
Alice Casely-Hayford, Fashion & Beauty Director

"I have dark skin that scars very easily. Even the smallest, most inoffensive spot can leave a dark mark that can take weeks, if not months, to fade. What would be your advice for hyperpigmentation? Are there any products I should try or a change to my routine or approach to skincare? I'm so bored of pinpoint concealing each morning in order to make my skin tone appear more even. Please help!”

Dr. Nyla Raja, cosmetic dermatology GP

"Hyperpigmentation can be treated by two different methods, either clinically or topically. In terms of clinical treatments, I would recommend the M22 laser, or the Ultrapulse laser, both of which are suitable for darker skin tones. M22 and Ultrapulse treat pigmentation on a cellular level by breaking down the excess melanin which causes hyperpigmentation.

Topically, it is important that skincare to help with hyperpigmentation contains the correct actives, as this is how you will see the best results. Ingredients such as azelaic acid and arbutin are effective in treating pigmentation on darker skin tones. A skincare range such as Universkin, which contains medical-grade actives, made into a bespoke formulation for the individual, would be my personal recommendation."
5 of 10
Natasha Slee, Social Media Manager

"My issue is sebaceous filaments. I rarely get spots but in the last 18 months or so I noticed these tiny, hard grey bumps filled with a drop-shaped hard bead. In the last month they have increased. I get them on my chin and between my brows. I haven't tried any products on them, but I'm obsessed with squeezing them out! How can I stop them or slow down their appearance?"

Dr. Anita Sturnham, GP, dermatologist, and founder of Nuriss Clinics

"Sebaceous filaments are often under-diagnosed and mistaken for blackheads or whiteheads. While their origin is the same as those pesky pimples – the pilosebaceous unit (pores) – their characteristics are very different.

A sebaceous filament is a tiny collection of sebum (oil) and old dead skin cells, which accumulate around a hair follicle. They usually take the form of a small, white or yellowish, hair-like strand. Sebaceous filaments are usually only found around the thin skin of the nose, unlike blackheads and whiteheads, which can form anywhere on the face.

If you analysed the histology of a sebaceous filament, you would see that they are composed of a skeleton structure of up to 30 horn-like cell layers. These are mixed with a blend of skin bacteria, sebaceous oils, corneocytes and a single hair. The reason I like to break down the structure of these filaments is that it enables us to select the best treatments to break the structures down.

To target the filaments you can add some fantastic skin ingredients into your daily skincare routine. Adding in a combination alpha and beta hydroxy acid cleanser will help, thanks to its double-action cleansing mechanism. The lactic and glycolic acid will help to exfoliate and remove dead skin cells, while the salicylic acid will seep into your pores, reduce bacteria, oil and pilosebaceous inflammation. Start off by using this at nighttime, which in my opinion should always be the more intensive cleanse in your regimen.

Dehydration can trigger an internal ‘skin repair’ mechanism, whereby the sebaceous glands try to rehydrate the skin, by switching on faster sebum production. This will undoubtedly increase the rate of pore clogging. The key to prevent this is to ensure that you have adequate skin hydrators in your skincare but to also take care to avoid those pore-clogging facial oils and comedogenic moisturisers. High molecular-weight hyaluronic acid in your morning and night serums will be your skin saviour. This natural skin hydrator hydrates and nourishes the epidermal and dermal layers, without pore-clogging.

Adding in a retinoid (vitamin A) serum or night cream will be a great asset for your skin. This multitasking skin nutrient will reduce sebum, bacteria, inflammation and improve epidermal turnover. There's no need to blitz your skin with high doses of retinoids to address this skin concern. 0.5-1% of a second or third generation retinoid works wonders and I find products with additional hyaluronic acid in the formula help to counteract any dryness or irritation that one may see typically after using these types of products.

To take things up a gear you can also seek advice from a dermatologist. There are numerous treatments that can assist, such as salicylic acid peels and professional extractions. I also like to add in Q-switch high-powered clearlift laser treatments too, which can really enhance the efficacy of your topical treatments."
6 of 10
Sadhbh O'Sullivan, Social Media Assistant

"I've had hormonal, cystic acne for least a year and a half now. I've tried everything and am currently using Differin and Acnecide which has sorted out the acne for the most part but big pores, redness, hyperpigmentation and easy inflammation are still a problem. I have pared back my skincare routine and use various masks and peels to soothe and calm. My skin is extra-sensitive to sodium laurel sulphate which can make me break out in painful whiteheads, and harsh acids like salicylic acid dry me out and don't work. Help!"

Dr. Sajjad Rajpar, consultant dermatologist at Belgravia Dermatology

"The good news is that it sounds as though your active is under control. You have redness and sensitive skin because both the treatments you are using cause irritation as a side-effect. It may be time to cut down Acnecide to alternate nights or even to twice a week. It may also be helpful to introduce a light non-comedogenic moisturiser which contains vitamin B3 to help restore the skin barrier. These measures will improve redness and sensitivity.

There are other reasons you may have redness too. When acne spots resolve they can leave a localised area of redness which can last for several months. This is because inflammation in an acne spot causes new blood vessels to form in the skin. The redness can be quite deep in colour and, fortunately, usually lessens with time. Laser treatment or IPL can help reduce the level of redness very effectively. Inflammation in an acne spot can also cause pigmentation by disturbing pigment-producing cells in the skin. Again, pigmentation will usually resolve naturally but this can take several months or even years. Tixel therapy, a fractional resurfacing treatment in which a hot plate with tiny probes is applied to the skin, works wonders to reduce pigmentation."
7 of 10
Louise Whitbread, Editorial Intern

"I suffer from acne, which is mostly hormonal, on my chin, and I have a very oily T-zone. I always take my makeup off before bed, double cleanse when I've worn makeup, and try to avoid anything with SLS, mineral oil, shea butter and typically stick to fragrance-free cleansers. What else can I do?”

Dr. Sarah Tonks, cosmetic physician, facial surgeon and dermatologist

"As someone with oily skin too I know how they feel. I have my patients use Skinceuticals Simply Clean, which is a cleanser containing AHAs. I find if wearing makeup it’s also important to tone, so again I tend to go with Skinceuticals Equalizing Toner or Obagi C-Rx Exfoliating Day Lotion, both of which contain witch hazel. I tend not to bother if I’m not wearing makeup. Then daytime I'll use SkinCeuticals C E Ferulic which is great for oily skin, then Alumier AHA Renewal Serum again because I like to layer these AHAs. Alumier Matticlear Solution is great to soak up any excess oils. I then like the Oxygenetix Oxygenating Foundation Acne Control SPF25 because it doesn't clog my pores. At nighttime I go with the same cleanser and toner followed by the Alumier Retinol Resurfacing Serum, and every other night I'll go with the Skinceuticals Resveratrol B E."
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8 of 10
Sarah Raphael, Editor-at-Large

“I get spots after having my eyebrows threaded. Is there any way to avoid this?”

Dr. Stefanie Williams, dermatologist and author of Look Great, Not Done! The Art and Science of Ageing Well – How Aesthetic Treatments Can Work for You

"‘Breakouts’ after eyebrow threading are usually one of two things – irritation or folliculitis. If you develop some minor redness and a few tiny little ‘bumps’, this may be a simple irritant reaction. For mild irritant reactions, a soothing aloe vera gel might be all you need (wash your hands before applying it!). I would always recommend combining this with application of a non-irritant antiseptic such as Clinisept+ Solution to avoid bacterial contamination.

However, if this doesn’t help, a couple of days of a mild steroid cream, best in combination with an antibacterial ingredient (eg. prescription Fucidin H cream from your doctor), is usually very effective. However, proper breakouts with acne-like spots or pimples can be bacterial folliculitis, which means bacteria have entered the hair follicle during or shortly after the threading and are causing the ‘breakouts’.

To help prevent this, hygiene prior to and around the threading procedure is very important, so make sure you are visiting a reputable salon, your therapist doesn’t reuse thread and works as cleanly as possible. Also, avoid touching the area with your hands for a few hours after the threading. It’s also a good idea to dab a good, non-irritant antiseptic solution (eg. Clinisept+) onto the skin, prior to and after the treatment. If despite all precautions you still develop folliculitis, you might need topical antibacterial treatment from your doctor (eg. prescription Dalacin T lotion or Fusidic acid cream)."
9 of 10
Chemmie Squier, Branded Content Manager

"I've been suffering from hormonal acne for the past year and although it's finally clearing up (thanks, Differin!) I'm left with red marks/scarring on my skin where the spots once were. What's the most effective way to get rid of them? I regularly use acids in my skincare routine but I wonder if I should incorporate something else as well?"

Andrea Pfeffer, founder of Pfeffer Sal

"When it comes to reducing acne scarring, there are a few avenues that you can take but it’s important to ensure that the active acne is totally cleared – so be patient! This will ensure you don’t accidentally aggravate the breakouts whilst trying to target existing scarring.

In clinic, treatments such as our Great Skin Peels will reduce the pigmentation dramatically by deeply exfoliating and resurfacing the skin. Our peels are a series of controlled, lighter peels to achieve effective and safe results. This careful and delicate approach means that any down time and redness after treatments is minimised, a definite win when you have a real life to get on with.

If there are any textural changes, we would recommend a course of medical needling. This needling works on the principal of controlled trauma to the skin in order for it to start releasing growth factors, and puts the wonderful fibroblasts to work, leading to the right type of collagen being produced, which will then be remodelled, reducing the appearance of pitted scar.

At home, incorporating acids into your regimen is a great step towards reducing scarring so keep it up! Another must is to wear SPF every single day. Sun protection will prevent the scarring from becoming further pigmented or sensitised. No excuses! Apply, apply, apply – even on the cloudiest of days!"
10 of 10
Georgia Murray, Fashion & Beauty Writer

"I have very oily skin. I've tried every cleanser, moisturiser and primer under the sun, and piling on makeup makes my skin look cakey. Help!"

Dr. Murad, founder of Murad skincare

"There are several factors which may contribute to oiliness, such as environmental damage, not cleansing properly, hormonal changes and even stress. Topical skincare products can help improve your skin dramatically but it’s important to remember to also nourish your skin from within (orange-coloured foods like sweet potatoes, carrots and oranges are great because they help normalise cell production), as well as taking time to nurture your own wellbeing. If you can, take 10 minutes each day to look up from your phone, which I call going ‘Eyes Up’, to appreciate the world around you and spend time dedicated to you.

On another note, if you’re noticing your skin is oily or becoming more oily at certain times of the day, ensure you’re cleansing thoroughly every night and cleansing again in the morning with a cleanser formulated for an oily skin, such as Murad Time Release Blemish Cleanser or Daily Cleansing Foam. It’s important to choose products targeted to your skin concerns.

Also check that your moisturiser is working hard enough for you; ideally it will be suitable for oil-prone skin but it’s important to keep oily skin hydrated and protected too. Just because your skin is oily it doesn’t mean it’s hydrated, and a hydrated skin is a great base for healthy skin. Murad Oil-Control Mattifier SPF 15 hydrates skin, protects from UVB and UVA damage while controlling oil for up to eight hours.

You may also wish to use an intensive clay-based mask, such as Murad Pore Extractor Pomegranate Mask, once or twice a week – this will help keep oily skin at bay as it helps keep pores clean and clear, as well as helping absorb excess shine."

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