How to Start a Skin Care Routine with Dr. Kiyanna Williams

Podcast Transcript

Intro:
There's so much health advice out there. Lots of different voices and opinions, but who can you trust? Trust the experts, the world's brightest medical minds, our very own Cleveland Clinic experts. We ask them tough intimate health questions, so you get the answers you need. This is the health essentials podcast brought to you by Cleveland Clinic and Cleveland Clinic children's. This podcast is for informational purposes only and is not intended to replace the advice of your own physician.

Kate Kaput:
Hi, and thank you so much for joining us for this episode of the Health Essentials Podcast. My name is Kate Kaput and I'll be your host. Today we're talking to dermatologist Kiyanna Williams, Section Head of Cleveland Clinic Skin of Color Section, about how to start up a skincare routine. There are so many skincare products to choose from. How do you decide which ones are best for your skin, and in what order do you apply them? It's a lot to try to figure out on your own, so we're thrilled to have Dr. Williams here today to walk us through what to consider and where to begin. Dr. Williams, thanks so much for being here with us today.

Kiyanna Williams, MD:
Thanks so much for having me.

Kate Kaput:
I'd like to start by asking you to tell us a little bit about your work here at Cleveland Clinic. What kind of work do you do, and what kind of patients do you typically see?

Kiyanna Williams, MD:
Sure. I am a cosmetic and a surgical dermatologist. I split my time about 50/50. About half of my time is spent doing Mohs surgery, which is a skin cancer surgery. The other half of my time is spent doing cosmetics and skin of color dermatology, which includes things like lasers, fillers, toxins, and such.

Kate Kaput:
Great. Let's begin with the basics. Can you tell us about some of the ways that race, age, sex, even geographical location plays a role in our individual skincare issues and needs, what should people be keeping in mind as they approach their own particular skincare routine?

Kiyanna Williams, MD:
Sure. Some people are inherently a little more greasy. Some people are inherently a little bit more dry. Some people have more sensitive skin, while others can put anything on their face and skin and really have no issues. It's important that people take that into consideration when they're looking for things. If your face is really dry, you might not want to get one of those washes that's geared towards acne or oily skin obviously, because it's going to dry you out more. In terms of age, as we age, all of us start to lose some of those factors that keep moisture in our skin. That moisture helps obviously, to keep us well moisturized. It prevents us from being dry. It also contributes to the plumpness in our skin. As we get older, we might find that we're starting to need more and more moisturizers and things to replenish what we're starting to lose. In addition, as we get older, our skin can also become more sensitive and we can start to become more sensitive to things that we once didn't have a sensitivity to.

Kate Kaput:
A lot of people want to take care of their skin, but honestly just have no idea where to start. It can be really overwhelming to parse through all of the options and try to figure out how to use all of them. Let's start at the beginning. Can you walk us through the basics of a basic skincare routine and what it should include?

Kiyanna Williams, MD:
Yeah. I agree with you. I think at best, it's best to just kind of whittle it down to the basics, like you said. First, everyone has to cleanse their face and body, so a gentle cleanser for face and body, which often are different. Then a moisturizer and a sunscreen. If we're doing nothing, I always say to my patients, "If you want to do one thing, put on sunscreen. If you want to do more, we can talk about more," but first and foremost, a gentle cleanser and a sunscreen.

Kate Kaput:
When you're talking about cleansers, do those face wipes that you use to take off your makeup count, or should you be using an actual sort of cleanser alongside?

Kiyanna Williams, MD:
If you are on a long flight or something and you have to use one of those cleanser wipes, by all means do that for something, but in general, use water.

Kate Kaput:
Got it. Let's talk about some of those individual steps, if you want to do more. I think that people who are new to skincare routines, don't always know the difference between some of the steps. We talked a little bit about cleansing. Anything else that we should know about cleansing your face? You said use water, anything else about choosing a cleanser?

Kiyanna Williams, MD:
Yeah. I'm not a big fan of those that have those microbeads in it, or that are meant to be kind of harshly exfoliating, just because I find that it can cause more damage, cause more irritation and inflammation than anything. I would steer clear of those that have those microbeads or those other particles that you can feel, that feel gritty on the face. If your face is prone to being more dry, staying away from those that are foaming. If your skin is sensitive, looking for ones that have the word gentle on them or for sensitive skin, would be my recommendations for a cleanser.

Kate Kaput:
Perfect. That's super helpful. What about toner? What is toner and what does it do? I feel like it's one of those products I hear about a lot, but I'm not totally sure of.

Kiyanna Williams, MD:
Yeah. Toners are generally astringents. The thought is that they are helping to shrink pores. Unfortunately, there really isn't anything that's going to shrink your pores that you can apply to your face. They're almost like an additional step in cleansing. You could cleanse your face and then put on the toner. The thought is that you're getting your face kind of ready and prepped to then receive the moisturizer or the subsequent products that you're using. I'm indifferent on them honestly.

Kate Kaput:
Good to know. You talked a little bit about the microbeads in cleansers. What about exfoliating? What does it do? How do you do it? How important is it?

Kiyanna Williams, MD:
Yeah. When we think about exfoliating, you can kind of think about it in two different ways, physical exfoliators, which are those beads or sometimes those brushes or things that you can buy where you're actually physically exfoliating going on. Then there's chemical exfoliators. Chemical exfoliators are going to be products that have ingredients such as glycolic acid in them. Those provide a more gentle, even exfoliation. I would recommend more towards that, rather than one of those physical exfoliators.

Kate Kaput:
Okay. Then moisturizer, we talked a little bit already about moisturizer, but why is it important and sort of, what should you consider in choosing the right one for your skin? There are so many kinds out there.

Kiyanna Williams, MD:
Right. Really when it comes to moisturizer, it's going to be where you're at and how much you need to replace, right? When you're younger, oftentimes we don't need to put on really heavy moisturizers because we have a lot of those components in our skin that are keeping it nice and moisturized. But as we get older like I said, we might notice that our skin is becoming more dry. Then you're going to start to want to replace some of those things that we're losing, so moisturizes that have hyaluronic acids, jeremiads and such, can be helpful to replace some of that moisture.

Kate Kaput:
Okay. Another confusing element of skincare is the order of application, right? Between moisturizers and serums and oils, what orders should we apply our products in?

Kiyanna Williams, MD:
Generally you want to go lightest to heaviest. If you're using something that is a really fine, light lotion, you might start there. If you have a cream, you would follow your cream, and then you can follow up with a serum.

Kate Kaput:
What about if you have multiples of something, right? You have multiple serums or acids, maybe they seem like they're the same weight. How do you know which one of those goes on first? Does it matter?

Kiyanna Williams, MD:
It does matter, but it gets very specific as to what things can be mixed with what. If you have a lot of questions, you should just schedule an appointment with a dermatologist and we can certainly go over it. But in general, there's really no need to have multiple serums or multiple toners or multiple of the same product.

Kate Kaput:
Got it. Good to know. Okay. What about morning versus night? How should a morning skincare routine vary from a nighttime skincare routine? Are there any products that should only be used at a certain time of day? Are there steps that you only need to do in the morning or in the evening?

Kiyanna Williams, MD:
Generally when we're talking about retinoids or retinols, those are applied in the evening, partly because some of them can be deactivated by the sun. It's important that you wear them in the evening. Sunscreens obviously should be applied in the morning. Some people like to have their heavier moisturizers be applied at night, because they just don't like the feeling on their face during the day when they can feel it. Whereas when they're sleeping, they're not as aware of it, which is reasonable and completely fine to do.

Kate Kaput:
Okay. How about seasons? I know that here in Cleveland, we are about to head into a fall and winter. How should our skincare routines change as the seasons change? What do we need to keep in mind in cold weather versus warmer weather and sort of, how should we be switching things up, if at all?

Kiyanna Williams, MD:
Yeah. In the winter, obviously most of us are more dry because we have less humidity, it's colder outside. You might find that you're in more need of a heavy moisturizer or reapplying your moisturizer. You also might find that some of the products that you're using are a little bit more irritating in the winter. If that's the case, such as using a retinol in the evening, if that becomes a little bit more irritating for you during the winter, then generally I recommend to use that product every other night, rather than every single night, to give your skin a break and allow it to catch up.

Kate Kaput:
Great. Let's also go back to talking a little bit about age, which I know you already mentioned. What are some of the other ways that age impacts our skin and what we need to do to take care of it? Do the products that we need change as we get older? Do we need more products, different products, products with different ingredients? Tell us a little bit more about age and skin.

Kiyanna Williams, MD:
Yeah. As I mentioned earlier, as we get older, a lot of those factors that are normally in our skin, we start to lose some of them, which makes our skin more dry. In addition, we start to lose some of that plumpness. A lot of times, I'm seeing patients who are trying to get that plumpness back and almost like that youthful glow. When you're older. Products that are going to increase cellular turnover such as a retinol, is going to help your skin become more, kind of give it that youthful glow. You can think about it almost as preventative. When we're younger, we can use these products, and it's more kind of to prevent some of that expected aging in our skin. Then we become older, it becomes more of a treatment.

Kate Kaput:
How can we decide which products are right for us, especially, if we've decided on a product we like? Is there ever a time when it comes time to switch things up, maybe you're getting older, maybe the seasons have changed, maybe any number of things, right? How do you both decide what's right for you in the moment, and then sort of figure out as things change, whether you should be switching up some of those products to something different?

Kiyanna Williams, MD:
Yeah. That's a good question. I think in the moment obviously, if you're putting on something on your skin just because you were told, or you think that it might be good for your skin, however it's drying you out, you're getting a lot of inflammation, a lot of irritation, or you just don't like the way it feels or the way it smells, then by all means stop using it because there will be an alternative that can be used instead. Certainly if you're having side effects, you're just not liking the product, don't feel as though that you need to use it just for some promise of benefit. That would be first.

Then if you're noticing that your skin is changing where you used to, you've always used the same skincare routine, however now you feel like you're getting more acne or you feel like your skin is a little bit more dry or is greasier or things are a little bit different, that might be a time to kind of reassess and say, "Okay, which part, or which step in my skincare routine might be contributing to this? Which one can I remove? What can I add to help with this problem?"

Kate Kaput:
That makes sense. Basically, if you feel like suddenly you're not getting the results that you were getting or that you want to be getting, maybe it's time to switch something up?

Kiyanna Williams, MD:
Correct.

Kate Kaput:
Okay. Let's talk about some specific products starting with one of the most vital, as you already mentioned, let's talk about sunscreen. Give us sort of the basics of sunscreen. Why is it such an important element of skincare?

Kiyanna Williams, MD:
For sure. This is one of my favorite topics to talk about. Sunscreen, there are chemical sunscreens and physical sunscreens. Chemical sunscreens work by when the sun is penetrating the skin. Essentially, there's a chemical that is in the skin that is able to defend against the effects of sunscreen. Whereas physical blockers, sit more on top of the skin and they serve as a reflectance. They reflect sun off of your skin. Physical sunscreens are much less likely to cause an allergic contact dermatitis or irritation. People who have sensitive skin, I always recommend a physical sunscreen. Also, some of them can have broader coverage than chemical sunscreens. But if you do prefer a chemical sunscreen, either because the way it feels or you just like the way it looks on your face, a chemical sunscreen is certainly better than nothing.

Kate Kaput:
When you say physical sunscreen, we also sometimes hear about chemical sunscreen and mineral sunscreen. Is mineral and physical, are those the same thing?

Kiyanna Williams, MD:
Yes, they are.

Kate Kaput:
Okay.

Kiyanna Williams, MD:
Yeah. Physical sunscreens are those that contain zinc oxide, titanium dioxide, and are traditionally thought as the ones that when you put them on, they're pasty white. Luckily though, there are a lot of companies that have made new mineral sunscreens that really don't have that thick pasty consistency and blend in very well with the skin, including ones that are tinted for people who have a little color to their skin.

Kate Kaput:
Great. That was one of my questions. Does the SPF in your makeup or moisturizer count, or do you need to put it on specifically on its own, right? I'm very pale. I know that the moisturizer that I use in the morning is SPF 25. Does that count, or should I be putting on something else specifically?

Kiyanna Williams, MD:
You should be putting on something else specifically. Oftentimes, the SPF in makeup and other moisturizers isn't quite enough. Oftentimes it's chemical. I recommend SPF 30 or higher every, single day of the year, even in the winter. Then if you know you're going to be out in the sun, golfing. At the beach, whatever, SPF 50 or higher.

Kate Kaput:
I mean, can you kind of talk about why that is, right? People think, "Oh, it's the winter. I'm not going outside today. I don't need to put on sunscreen," or maybe, "I'm very dark-skinned. I don't to put on sunscreen," just to kind of drive home for us, why you really do need to put it on every day, why that's so important for everyone.

Kiyanna Williams, MD:
Yeah. When it comes to the effects of sun, yes, there is a risk of skin cancer. That's part of it. It's also the things that we were talking about before with a skincare regimen, right? When we talk about photoaging and losing some of that collagen, losing that youthful glow, that plumpness, getting age spots, all of that is related to the chronic sun exposure that we get over time. Even though it might be a cloudy day, a cold day, you might be inside most of the day, you are still getting exposure to UV just by a window. There is newer data to even suggest that the light that we get from our cell phones, our computer screens, TV screens, indoor light, also contributes to some of these problems.

There is a common misconception that if you don't burn, or if you have darker skin, then you don't need to use sunscreen. While it's true that those who are darker tend to not have skin cancer at the same rates as those who are lighter, it is important to note however, that one, brown and black people can still get skin cancer. Also, we want to protect from those other things that we talked about earlier as well. That photoaging, hyperpigmentation, melasma, all of these things are things that can be protected with sunscreen.

Kate Kaput:
Wow. Okay. Thank you. I know that I need to get a different kind of sunscreen in addition to my moisturizer now. Onto another product. We hear a lot about retinol and retinoids. Can you explain what they are and what they do for the skin and kind of, how do we know if we should be using them and what kind to use?

Kiyanna Williams, MD:
Yeah. They are all vitamin A derivatives, meaning that they all are essentially a form of vitamin A. What they do is, they stimulate collagen production. Again, getting to that plumpness, that youthfulness of the skin, as well as they increase cellular turnover. The way you can think about it is, normally our skin turns over about every 28 days or so. What retinoids do or retinol does, is it essentially helps to continue that cellular turnover. You can almost think about it as continuing the process of say, exfoliating or getting a facial, where you're kind of starting anew, because it's increasing that cellular turnover. By doing so, stimulating collagen, increasing cellular turnover, it also helps with fine lines and can help with dyspigmentation and just evening out skin tones.

Kate Kaput:
Okay. That sounds pretty helpful. Is there anything to keep in mind or to be worried about? I know that you mentioned sort of, they can be deactivated by the sun, anything in particular that we need to be careful about when using those products?

Kiyanna Williams, MD:
The thing to be careful about them really, is that they can be initially you might find that they're a little irritating. They do cause some drying. They can make you a little bit more sensitive to the sun. If you start using them every single night off the bat, and you're noticing that your skin is really just inflamed, irritated by it, you can either decrease and use it every other night and then it'll still be effective, or you could go down on the dose or change the product.

Kate Kaput:
Okay. That seems like good advice for kind of all of your products, right? If you're getting inflamed, if you're not seeing the results that you want, either back off a little bit or stop using it, try something else.

Kiyanna Williams, MD:
Yeah. Yeah.

Kate Kaput:
A lot of people spend a lot of money and effort on products that say they can do things like prevent wrinkles and get rid of dark circles, kind of what should we be on the lookout for, or be aware of in products like this? Do they work? Should we try some of them? Avoid them all? What can you tell us about these sort of cure-all promises from our skincare?

Kiyanna Williams, MD:
Yeah. I mean in general, most of these cure-alls just, if it sounds too good to be true, then it's probably not true. Obviously, there are products that can help with these things. It's better to be more preventative than it is to be more in the treatment arm of things. If it's making a lot of promises to do things that just don't sound very reasonable, then it's probably not going to work. However, that doesn't mean that there aren't certain things that you can try. A lot of it's going to come down to the active ingredients or the specific ingredients that are in these products. Some things we know are helpful, such as retinoids, sunscreen, certain antioxidants, things like that. If you're really feeling bogged down, then by all means I would recommend making an appointment with a dermatologist and we can go over the specific ingredients that have clinical data to support their use.

Kate Kaput:
Perfect. Dr. Williams, can you tell us about, is there a best place to buy your skincare products from, right? We can find skincare products everywhere from the drug store to the grocery store to sort of upscale makeup counters to our dermatologist office. Does it matter where we buy our products from?

Kiyanna Williams, MD:
Yeah. I think it really depends on the product that you're buying. There are amazing products at the drug store and the grocery store. There are also amazing products that are sold out of the dermatologist office or out of a specialty boutique. It really just depends on the product that you're looking for. In general though, I would certainly say that sunscreen, wherever you get your sunscreen from, is a good sunscreen. Sunscreen specifically have to go through FDA approval to say that they have the SPF that they do. That is something that you can definitely trust. When it gets more into some of those claims that we talked about earlier about fine lines and dark spots, things like that, then it becomes a little bit more tricky. Some of those over the counter products might be boasting more promises than they can actually deliver.

Kate Kaput:
What about those zits stickers that are so popular right now? Are pimple patches effective? Can they actually do anything for you?

Kiyanna Williams, MD:
Most of them, I believe, have benzyl peroxide in them, and benzyl peroxide is a treatment for acne. They can help. Obviously benzyl peroxide, it can be irritating. That's its purpose, is to dry out those acne lesions. I think they're fine. I think they're fine. I don't think it's a long-term treatment. Really, you want something that's going to prevent your acne from ever happening, rather than a reactionary treatment, which those are. But in the meantime, if you have just one or two and you want to pop one on there, I think that's fine.

Kate Kaput:
Got it. In a pinch, doesn't hurt to stick one-

Kiyanna Williams, MD:
Right.

Kate Kaput:
On if you've got a big day coming up or something.

Kiyanna Williams, MD:
Exactly. Exactly.

Kate Kaput:
What about some of the skincare products that we don't use every day, but kind of want to add in sometimes for a little bit of extra benefit or sort of self-care? What about at-home sheet masks? Do they work? How often should we use them? Are some kinds better than others? Et cetera.

Kiyanna Williams, MD:
Mm-hmm (affirmative). I think with those, there's such a broad range of what's in them, so it's hard for me to give a blanket yes or no statement of if they're helpful or not. I do think though in general, what they're aiming to do is to put moisture back into the face, because again, you can kind of think of your skin as a grape versus a raisin. If you put a raisin in water for a while, it'll start to plump up. That's kind of what we're trying to do, and it's kind of what those masks are aiming at. In general, I don't think that they hurt obviously, unless you have a reaction to one of them. How much they help, maybe. To your point, maybe if you have a night out or something and you want to pump up your raisin.

Kate Kaput:
I love that. I really love thinking about it that way. I think that sheet masks are one of those things that you put them on because they feel like nice self care, but I never really think about what they actually might do for my face or not. That's actually kind of a very helpful analogy. If you want to pump up your raisin, they probably can't hurt.

Kiyanna Williams, MD:
Right. Exactly. One person once described it to me as, it's like a glass of water for your face. I remember thinking that makes no sense. Then I think I used them and I was like, "Oh, I get it. It feels like a glass of water for my face."

Kate Kaput:
That's funny. What about acne spot treatment? I know kind of like the zit stickers, you said better to focus on prevention than on sort of dealing with it in the moment, but what if you wake up one morning with a giant zit, you've got a big day the next day, anything to know about acne spot treatment and kind of what kinds actually work and what to look for.

Kiyanna Williams, MD:
Yeah. First thing, don't pick. It's really, really hard not to pick, but don't pick. It'll just make it more angry and more irritated. Obviously, if it's one of those really juicy ones that's just ready to pop. If you have to pick, I say use the flats of your fingers, the soft part of your finger, rather than your fingernails, if you have to pick. Products that have benzoyl peroxide are my favorite. If you just want to get a little benzoyl peroxide cream or a retinoid cream and just dab it on there just to help dry it out, those would be my preferred products.

Kate Kaput:
Perfect. We've talked a lot about skin care products for the face, but what can you tell us about the rest of our body, right? We are covered in skin, there is skin everywhere else too. Is there anything special that we should be doing, or products that we should be using on the rest of our skin?

Kiyanna Williams, MD:
In terms of the skin on our body, it's important that we also are using gentle cleansers or cleansers that can help kind of bring back some of that moisture. You don't want to use the ones that are really, really stripping. I know a lot of people like that squeaky clean feeling when they take a shower or bath, which makes sense. But if you're squeaky clean, that also means your skin is really dry. Staying away from those that are heavily scented. I always say, if it smells pretty or if it looks pretty, you shouldn't be using it if you have sensitive skin. You want it to be more bland. If it does have a scent, be more lightly scented. Then, again, moisturize, moisturize, moisturize. Definitely when you come out of the shower or bath, take tepid showers or baths, so not really hot water. When you get out, pat dry, and then immediately put on a moisturizer. Also, one that's going to be bland, the thicker the better.

Kate Kaput:
Got it. The moisturizer that you used for your body should be different than the moisturizer that you use for your face, is that right? Anything to know about picking out a moisturizer for your body?

Kiyanna Williams, MD:
In general, our faces generally, we have more oil glands and such in our face. Our face usually doesn't need as heavy products because it also can't tolerate such heavy products, right? It's really heavy and thick. It's likely going to clog our pores and it's just going to be too much for our face, but our body is much more rugged. The skin is thicker. It can be much more dry. The thicker the better when it comes to the body. You can lather your body up in Vaseline if you wanted to

Kate Kaput:
Okay, great. I mean, Dr. Williams, I know that this is a huge topic and we could probably talk for another 45 minutes about it, but is there anything that we haven't discussed today that you think is important to the topic of sort of starting a skincare routine, understanding the basics, anything else that people should know that we haven't covered yet?

Kiyanna Williams, MD:
I think we covered most of it. It's really a gentle cleanser in the morning and the evening. Sunscreen in the morning as well. If you wanted to prevent some of that photo-aging, than adding a retinol in the evening.

Kate Kaput:
Great. Dr. Williams, thank you so much for being here today and for speaking with us on this topic. To schedule an appointment with a Cleveland Clinic dermatologist, including a provider in the Skin of Color Center, please visit clevelandclinic.org/dermatology, or call 216-444-5725. Thanks for joining us today.

Outro:
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