Skin Care Tips, Tricks and Trends with Melissa Piliang, MD

Podcast Transcript

Speaker 1: 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, Melissa Piliang, about skin care tips, tricks and trends. Skin care is one of the hottest topics on social media with sites like TikTok and Reddit full of advice and ideas about what you can do to get smooth, glowing, ageless skin. But it can feel nearly impossible to wade through all of the options to sort fact from fiction and to figure out what's actually best for you and your skin type. Dr. Piliang is here today to walk you through some of your most pressing skin care questions. Dr. Piliang, thanks so much for joining us today.

Dr. Melissa Piliang: It's my pleasure to be here. Thank you for having me.

Kate Kaput: Yeah. So I always like to start by asking our guests to tell us a little bit about themselves. So if you could just tell us, what kind of work do you do here at the Cleveland Clinic? What kind of patients do you typically see?

Dr. Melissa Piliang: Yeah, so I'm a dermatologist. I see primarily outpatients. So patients who just come in for routine things and go home at the end of our visit. I take care of patients from birth to the very elderly. But my special interest is in patients who have hair loss, patients who have hormonal abnormalities and women's skin health.

Kate Kaput: OK, great. So, this is, like I said, a topic that is all over the internet, super popular on social media and people have a lot of questions, right? It's tough to figure out what's what. So this is one that I'm personally really interested in and I'm looking forward to digging in with you. So I want to start with a basic question, and this is a phrase that we hear all over the place in every skin care story and not totally clear to all of us what it is. What can you tell us about the term “skin barrier?” What is the skin barrier and what does it do?

Dr. Melissa Piliang: So the skin barrier is the... basically the outer layer of the skin. It's dead. It's not alive. It's dead cells and lipids and proteins and fats that help protect our skin from the environment. So it works to keep water in and it works to keep chemicals and infectious bacteria and things out. So it's very important for our skin health.

Kate Kaput: And so what kind of conditions can impact your skin barrier and how do you know if your skin barrier is damaged? What does that mean?

Dr. Melissa Piliang: Yeah. So, many things can impact your skin barrier. So, using harsh chemicals or soaps, using too much exfoliant, scrubbing your skin too much, not using a moisturizer can all really break down that skin barrier and make it not work. There are conditions that are associated with having a poor skin barrier. Things like eczema or atopic dermatitis. In Rosacea or adult acne these can be problems with the skin barrier. With psoriasis or other diseases where the skin barrier is damaged or not working properly, you can recognize that your skin barrier is broken down because your skin may feel dry, irritated. It may sting when you put on products. The skin may be flaky or tender.

Kate Kaput: So basically if you're having issues with your skin, there's probably some sort of damage to your skin barrier. Is that right?

Dr. Melissa Piliang: Likely so. Yes.

Kate Kaput: Got it. I know that you just mentioned a few things. Are there any other basic rules and tips for protecting and restoring your skin barrier?

Dr. Melissa Piliang: Yeah, you want to be very gentle when you care for your skin. Warm water, not scalding hot. So, you can think about the lipid... The skin barrier is like a layer of fat on the skin. And the way I like to think about it is if you have butter on a knife and you put it under cold water, the butter doesn't go anywhere. You put it under hot water and the butter melts away instantly. If you add soap, even with cold water, soap, all that butter goes away. So think about that when you're doing things to clean your skin. Hot water's going to wash all that natural oil away and same with harsh soaps. So my suggestion is use warm water and mild cleansers. Look for soap-free cleansers, things that are formulated for sensitive skin and are fragrance free.

Kate Kaput: That is, I feel, such a great analogy, like to be able to mentally make that connection. I think that's really helpful. You want to maintain the butter that is your skin. So let's talk about some ingredients that are particularly trendy right now, making waves on social media. Some of those things that people have a hard time sorting through like what are these and what do they do. One that I want to start with is ceramides. What are ceramides and what do they do for the skin?

Dr. Melissa Piliang: So ceramides are fats; fatty acids and lipids that naturally make up a large percentage of the skin barrier. So these are put into products to help moisturize our skin and help replace that skin barrier and keep it healthy.

Kate Kaput: And so ceramides are then an ingredient in other products, or do they stand alone as a product?

Dr. Melissa Piliang: They are ingredients included in other products with other moisturizing substances and oils. So you will see it on the label, if it contains ceramide. Usually they put it front and center because it's a very important thing. So it's a product name, active ingredients, ceramides, and the other place to look would be in the ingredient list, if you don't see it on the front.

Kate Kaput: OK, perfect. Another ingredient is squalane. What can you tell us about squalane, and what is the difference between squalane and squalene?

Dr. Melissa Piliang: So, again, squalene really is another chemical that makes up that skin barrier. It's a lower percent than the ceramides, but still very important. So it helps to maintain the barrier of the skin, it helps keep the skin protected. Squalene is the more natural way that it exists. And when we add hydrogen to it, it becomes squalane. The benefit of the hydrogen is it makes a lighter oil. So it's not quite so heavy and occlusive. And it also gives the product a longer shelf life because the squalane doesn't break down as quickly as the squalene.

Kate Kaput: And when you say occlusive, that's a word... another word that we hear a lot when we're talking about skin care. Can you just explain that term really quickly for our listeners?

Dr. Melissa Piliang: Yeah. Occlusive is something that is very heavy, often an ointment like petrolatum that is very heavy and sits on the skin and blocks anything from going through. Blocks oxygen or air from going through and really occludes the skin.

Kate Kaput: So, it really keeps all the good stuff in there. It's sort of like a barrier.

Dr. Melissa Piliang: It can, yes. Things that are too occlusive can also plug the pores and lead to acne. So it's a very delicate balance.

Kate Kaput: It seems like all of skin care is a very delicate balance. OK. So back to squalane and squalene. What products have them? Who should use them? And is there anyone who shouldn't?

Dr. Melissa Piliang: Yeah. So they're in things like moisturizers and cleansers. And you can, again, find them on the ingredient list, is how to know if they're there or not. And really anybody with sensitive skin — skin that's prone to irritation. Dry skin would all benefit from using it. It also has some anti-aging properties. So if you're worried about skin aging, that’s another reason to use that.

Kate Kaput: And so it sounds like all of these ingredients that we've just talked about are things that exist in your skin already, and you're putting them back in or putting more of them into your skin. Is that a correct way to think about it?

Dr. Melissa Piliang: It is a correct way to think about it. And as we age, our skin barrier does not replace itself as well or as quickly. So, a young person can take a shower three times a day with hot water and harsh soap, and that barrier will replace itself in six or seven hours enough that they don't dry out their skin. But somebody who's in their 50s, 60s or 70s, their skin barrier does not replace itself as quickly. They may not be able to use it more than once a day without significantly drying out their skin.

Kate Kaput: There's an internet meme about that, right? That says, if you want to get glowing skin, first, be young and start with perfect skin. So, yeah, that makes a lot of sense. What can you tell us... Another thing that's been all over the place just conceptually is talking about the skin's pH. So I've read that you should cleanse your skin with a product that's close to your skin's natural pH, but what does that mean and how do you figure it out?

Dr. Melissa Piliang: It's very hard to know by looking at the product. So the skin's normal pH is about 5.5. So just a little bit acidic. And if you get, make it, if you get the pH too high or too low, then that disrupts the natural microenvironment on the skin. Our normal, healthy bacteria don't grow as well. The skin barrier doesn't work as well. Those lipids break down. It's very hard to know on a product, unless some products will say pH balanced, and that's a good clue that that's a product that you would want to use. Also, look for things that are mild or are categorized as mild, marketed for sensitive skin. Those are also going to be much more pH balanced.

Kate Kaput: And is that something that a dermatologist can help you with, figuring out your skin's pH balance? I would imagine that it's a little bit different for everyone, if you're having some particular issues.

Dr. Melissa Piliang: It is. And if you're somebody who has oily skin, then you might be able to tolerate or even need something that's a little bit of a harsher wash than somebody who has sensitive skin and needs something that's more mild or more pH balanced. So really talk to your dermatologist, see what they recommend in terms of skin care.

Kate Kaput: Perfect. So, speaking of cleansing, a skin care tip that's been popular lately on social media, and I'm curious whether it has any reality behind it, is what people are calling the 60-second rule, which says that you should cleanse your face for one full minute before rinsing off your cleanser. So is there any truth to this, and how long do you usually recommend that people cleanse?

Dr. Melissa Piliang: The ideal way to cleanse is put your soap on massage it in and rinse it off. No benefit by leaving it on longer or massaging it in longer. And in fact, you may do more damage to that skin barrier that we've been talking so much about because the longer the soap is in contact with those fatty layer, the more it can break it down.

Kate Kaput: So I've read, people saying, oh, after 30 seconds, you start to feel like grime or like little kind of like balls under your skin. It sounds like that's not actually maybe necessarily a good thing. That's you breaking down your skin.

Dr. Melissa Piliang: That's correct. And if your goal is to exfoliate your skin, then using something that is a gentle skin exfoliator would be a better choice. You can find this in moisturizing creams and lotions, and you can find it in soap. So look for things like glycolic acid, alpha hydroxy acid, lactic acid, are all good ingredients, if you want to have gentle exfoliation of your skin.

Kate Kaput: This is probably incorrect, so I would love your input. When I think of exfoliants, I think of like in the 90s, remember those very harsh exfoliants that had the micro beads in them. And it was like, you use them and you hurt, your face stung a little bit. I imagine those are probably out of fashion and not what exfoliants are meant to be these days. Can you speak to that at all?

Dr. Melissa Piliang: Yes. Those are not good for your skin. So they make little micro tears in your skin, which can let bacteria in and disrupt that barrier. You're basically scrubbing it off and that's not healthy for your skin. The other thing, those little plastic beads get in our water supply and get into our fish and are really bad for the environment. So really a chemical exfoliant with a mild, alpha hydroxy acid is your best bet. And use it regularly over time. If you use it regularly, then that slowly exfoliates the skin and releases your glow underneath.

Kate Kaput: Got it. And is exfoliating something that you should do once a day, multiple times a day? It sounds like probably just once, right?

Dr. Melissa Piliang: Yeah. It depends how sensitive your skin is. Some people who have tougher, less sensitive skin might be able to use it every day. If you're somebody who has more sensitive skin, then once or twice a week might be enough for. You have to experiment a little bit with your own skin type. It will also depend a little bit on the product that you're using and how strong that product is, how much acid is in it.

Kate Kaput: Yeah. So it sounds like I know that the 90s are back fashion wise, but maybe the weird exfoliants are a 90s trend that we can leave in the 90s.

Dr. Melissa Piliang: Please do.

Kate Kaput: We've evolved. OK. So another ongoing trend in skin care is using facial oils. And I know that this stumps a lot of people, because it feels like, oh, if your skin is... Nobody wants their skin to be oily. So it seems counterintuitive to put facial oils on your skin. What can you tell us about facial oils? Whether they work, what they do, which ones are best?

Dr. Melissa Piliang: So in general, we think about oils as improving that barrier and helping with the moisture management on our skin. And these oils can absolutely do that. They also often have antioxidants in them and can help with oxidative stress in the skin. Oxidative stress can come from sun or the environment, pollution. It can just happen as part of the way our normal skin metabolism works. And so these antioxidant effects from these things can actually help the skin. They can also have some anti-inflammatory properties.

Kate Kaput: OK. So that sounds great. Are there specific oils? We hear a lot about Argan oil. What are the differences between some of the oils? Which ones are good, which ones might you want to avoid?

Dr. Melissa Piliang: Whichever one you choose, you need very little for your face, and they tend to melt into the skin better than we were talking about those occlusive type ointments that are thick and really greasy. These tend to melt in better, so patients often prefer them. Argon oil is a good option. Again, it has anti-inflammatory and antioxidant properties and can help balance the skin's oil production. Two others to look at. One would be Hoba oil, which again has anti-inflammatory, antioxidant effects. It can actually mimic the skin's oil... the oily layer on the skin, and can help balance that amount of oil on the skin.

Kate Kaput: And then when you're picking an oil, is it like, do you choose one of them? Do you use multiples? Is there any way to decide which one is the right one for you?

Dr. Melissa Piliang: I would try to find one that meets your skin needs. If you're somebody who's more dry or more acne prone, and I would use a few drops. You can even mix them in with your moisturizer and then try a little bit before you go whole hog on it, or you might end up with problems.

Kate Kaput: Great. So test it out a little bit. OK. Another recent trend, which is actually, it seems like a pretty age old trend is slugging, or what people are calling slugging, which is basically just putting petroleum jelly on your face overnight. So I know that you mentioned petrolatum earlier when we were talking about occlusives. What can you tell us about slugging and putting this occlusive on your face overnight? What does it do?

Dr. Melissa Piliang: My first instinct is that it's really not very good for your skin, especially if you're somebody who's at all acne prone, because we look for products that say non-comedogenic. These occlusive ointments like petrolatum are comedogenic. So they plug the pores and lead to acne.

Kate Kaput: And so comedogenic means they plug your pores?

Dr. Melissa Piliang: Correct.

Kate Kaput: OK.

Dr. Melissa Piliang: Nobody wants that. And even somebody who's not acne prone, if they put this on, they may develop acne from doing this. If you're going to try it, I would especially avoid the oily and acne prone areas of our skin. Central face, nose, chin, central forehead, and be very careful with this one.

Kate Kaput: So now I'm nervous because this is something that I have been doing and I have just been putting it like on my, like under eye area, right? Where it's like dry, a little bit thin, super not oily, and then on my lips overnight. Should I stop doing this? Is it OK to put it on your driest parts?

Dr. Melissa Piliang: I think if you're somebody who's very dry, it's OK to put it on your driest parts. And under eye and lips are not acne prone areas. And if you find that you've been using it, done this a few times and you start noticing breakouts, then time to stop using this.

Kate Kaput: Stop doing it. It also sounds like depending on where you live, right? You and I are in the Cleveland area. It gets pretty cold here in the winter. We're coming out of the very cold season when our skin is really dry. So it sounds like this might be the kind of thing, right, where during the winter, my under eyes are really dry, and so maybe putting a little bit of petroleum jelly there works. And then once it gets warmer, my skin's not so dry anymore. Maybe it's time to stop. Is that thinking correct?

Dr. Melissa Piliang: That is absolutely the way I would think about it. And there are other areas on your skin that also get very dry, especially in the winter. During COVID, when we're washing our hands all the time. So, putting petrolatum on your hands, putting your hands in socks. You could do white cotton socks or gloves on your hands. Same thing with your feet, if you tend to have dry feet. That can be very moisturizing and very nice for those areas.

Kate Kaput: So, those dry elbows, places where you're not going to break out, but you do have super dry skin seem like safe places to lock in some moisture.

Dr. Melissa Piliang: Absolutely.

Kate Kaput: Got it. Let's see. Something I've always wondered about is putting toothpaste on a pimple. I feel like, is this an old wives' tale? I'd heard probably in high school that putting toothpaste on a pimple is a quick way to dry it out overnight. Does this work?

Dr. Melissa Piliang: This is not a good idea. And I think it comes from being in high school and not having anything else to do for your pimple. What can I put on? Well, I'm put some toothpaste on it. But probably what will happen is that you'll end up with a redder, more irritated pimple than you started with, because there's really nothing in toothpaste that is going to help acne.

Kate Kaput: That makes sense. It seems like another one of those things that's like we've progressed in terms of skin care products. You can probably snag something, even something inexpensive from a drug store that will do a better job than toothpaste.

Dr. Melissa Piliang: Exactly. There are very good over-the-counter spot treatment options for acne. Look for ingredients like benzo peroxide or salicylic acid. They're easy to come by, they're cheap, they're in the drug store and those are much better, more effective spot treatments for an acne pimple.

Kate Kaput: And so those are the ingredients for spot treatments. So things that you're just going to dab on overnight when something's coming up and you're worried about it coming to a head or just it's already come to a head maybe.

Dr. Melissa Piliang: Yes, exactly.

Kate Kaput: You have to be careful about, if you have a pimple that has already come to a head, right? So it's like a little bit open or weepy. I hate that word. Do you have to be careful about putting product on something that's open on your skin?

Dr. Melissa Piliang: Yeah, that skin is going to be drier and a lot more sensitive. So many of the products you put on might sting when you put it over that. So you do want to be careful once it's already drained, what we call drain. So come to a head and the puss has come out. Then you're really thinking about more gentle skin care and just letting it heal. Backing down on your acne treatments.

Kate Kaput: OK, perfect. So, skip the toothpaste. Another home remedy that I have some questions about is on social media, on TikTok, people are claiming right now that rubbing a banana peel on your face can be good for your skin. Is there any benefit to rubbing a banana peel on your skin?

Dr. Melissa Piliang: So there's no scientific evidence to suggest that rubbing a banana peel on your face is going to help. That being said, bananas are very rich in antioxidants. We've been talking about antioxidants. So I suppose in theory, you could get some antioxidant from that, as you rub the peel on, maybe there's some antioxidant residual effect. I think you're going to be much better to find one of the antioxidants that we've been talking about and applying that to your face and eat your banana.

Kate Kaput: Sounds good. So get a product that has the antioxidants and then consume the antioxidants from your banana.

Dr. Melissa Piliang: Exactly.

Kate Kaput: Great. OK. So, let's move into talking about aging. You mentioned it a little bit. People are always in search of the holy grail of skin care products and ingredients that can slow signs of aging. What ingredients and products do you typically recommend?

Dr. Melissa Piliang: Yeah, the two I start with that have the best evidence are sunscreen and what we call retinoids. So there are studies that have shown that women who used a broad spectrum sunscreen on their face every day for a year looked younger at the end of that year. And these women were compared to women who didn't use the sunscreen and they looked older at the end of the year. So if you want to look younger, prevention is key, use your sunscreen. The second type of ingredient that I recommend is something called a retinoid. These are vitamin A derivatives. They come in a prescription form and an over-the-counter form. So the prescription forms are tretinoin and tazarotene. You could, if you're worried and want to try a prescription form, see your dermatologist and let them talk to you about it.

The prescription forms can be a little harsher and require a little more extra skin care. There are over-the-counter versions. Adapalene, which is marketed for acne, but is also retinoid and can have anti-aging effects and the retinol, which is a form of a retinoid that turns into a more effective retinoid once you put it on your skin. It's like converted into tretinoin-type product. So those are two over-the-counter products that are also very effective for anti-aging.

Kate Kaput: Do I remember correctly that retinols make your skin sensitive to sun, that you should put your retinols on at night? Am I remembering that right?

Dr. Melissa Piliang: Yeah. So retinoids definitely make your skin more sensitive to the sun. So if you're using these, you want to be good with your sun protection. You want to wear your sunscreen, wear your hats and be careful. Again, this is just magnifying your anti-aging effects. Some retinoids actually break down during sunlight, so that's why some of them say to go on at night so that the sun doesn't break them down. Then you can get the most effect if they're on overnight, when you're in the dark.

Kate Kaput: OK, great.

Dr. Melissa Piliang: So you remember correctly.

Kate Kaput: I was going to say, I'm glad I remember that one right. OK. So, speaking of sunscreen and sun damage, as summer approaches, people are always looking for the best sunscreen options. Nobody wants that thick, greasy feeling on their face, especially what kind of sunscreen do you recommend?

Dr. Melissa Piliang: So look for one that's marketed for face, and for daily wear look for one that's marketed as a daily moisturizer. Those often go on very nicely under makeup and can be seamless and very nice on your skin and also provide some moisturization. If you're going to go out in the sun, I like the sticks for face. They're a little bit greasy, but they go on very thick and very nicely. My husband will use them, my kids will use them. They're going to provide the best protection like if you're at the beach for the day, when you really want good protection for your skin, and maybe you care less if your skin looks a little greasy.

Kate Kaput: Got it. So when you're in direct sunlight, you're probably not wearing makeup. You're out having a day at the beach and the sun is on you as opposed to a day when you're running errands and looking done up, maybe. Can you explain the difference between mineral and chemical sunscreens?

Dr. Melissa Piliang: Chemical sunscreens undergo a chemical reaction with your skin and they act like a sponge and absorb that ultraviolet light so that it doesn't damage the skin. Both can be very effective. Chemical sunscreens may be a little more irritating. So if you have somebody with sensitive skin, then you really want to look for the physical blockers or the mineral blockers. There's two that fall into this category. One is titanium dioxide and the other is zinc oxide. Every other sunscreen ingredient is a chemical ingredient.

Kate Kaput: And what about talking, not about your face, but about your body. Is there a discernible difference between using the sunscreen that you slather onto your body? Like a sunscreen lotion consistency and the kind that you spray on?

Dr. Melissa Piliang: So both slather on sunscreens and spray on sunscreens are very effective. Whichever one you choose, you have to make sure you put enough on. So it takes an ounce of sunscreen that's the amount in a shot glass to cover your whole body. And if we think about it, most of our sunscreen bottles contain 6 or 8 ounces of sunscreen. So that's six or eight applications on an adult. So if you go to the beach and your sunscreen lasts more than a couple of days, you're not putting enough on. And we know most people don't put enough on.

Kate Kaput: Right. And so on those days when you are say at the beach, how often should you be reapplying your sunscreen?

Dr. Melissa Piliang: You want to reapply your sunscreen every 90 minutes or so. And if you've been in the water and you get out and you towel off, you want to reapply then also because you've washed off quite a bit of it when you got out of the water.

Kate Kaput: So if you're a real outdoorsy person in the summer, you should be going through a substantial amount of sunscreen, if you're doing things right.

Dr. Melissa Piliang: That's correct. If you are an outdoorsy person, you should be using a lot of sunscreen. Now, the other option, if you say, I just don't want to buy all that sunscreen, I don't want to put all that sunscreen on my skin. I don't like sunscreen. Look for SPF clothing. So SPF clothing, it really says UPF on the label. But these are designed to block the sun from your skin. You might think, well, I don't want to put on a long sleeve and pants. It'll be really hot. I wear these all summer and I do not find them hot. They're usually light fabric that lets the breeze flow through and that shade on the skin can be somewhat cooling. So I really like those. You don't have to think about it. You don't have to reapply. You just are out in your clothes and you're protected.

Kate Kaput: OK, great. And so are there any places on your body that you're most likely that you see as a dermatologist that people frequently forget to put sunscreen? Any hot tips of places not to miss?

Dr. Melissa Piliang: So people often miss the areas around their clothing or their swimsuits. So where your short ends, you may not get all the way up underneath that short. And then as you're moving around, the shorts bottom moves up and down and hits different spots on your legs. And so there can be a band of sunburn, same thing with a swim trunk or a swimsuit. So I suggest putting your sunscreen on before you get dressed, because then you can make sure you hit all the spots under your swimsuit and the chemical sunscreens need a little time to work on your skin. So you really want to put them on 15 or 30 minutes before you go in the sun. So again, if you do that at your house, you can make sure you hit all the spots and then you put your swimsuit on and you know you're well covered.

Kate Kaput: Perfect. I remember as a kid, my dad was bald and he used to wear a big sun hat and must not have put enough sunscreen on his head that day. And he got a checkerboard burn through the straw hat. So that's always my main recommendation to friends who are losing some hair.

Dr. Melissa Piliang: Yes. So it is definitely important to remember to put sunscreen on your head, on the tops of your ears, backs of the knees, backs of the hands, those are all places people frequently forget.

Kate Kaput: So I want to back up for a moment and talk about another anti-aging ingredient again. And that's vitamin C serum, which we've been hearing a lot about. What are the benefits of using vitamin C on your skin?

Dr. Melissa Piliang: So there's good scientific evidence to show that vitamin C has antioxidant effects and anti-aging effects. So it's a very good thing to include in your skin regimen. There are studies showing that when you combine vitamin C with sunscreen, that you get even better sun protection and sun aging protection because they work together. So if any of the sun gets through that sunscreen causes a little antioxidant, or it causes a little oxidative stress in the skin, the vitamin C is there as an antioxidant to take care of it.

Kate Kaput: So it's like a backup to your sunscreen. It's there as a security guard to help remedy anything that gets through.

Dr. Melissa Piliang: Absolutely.

Kate Kaput: And how often can you use the vitamin C serum or how often should you use it?

Dr. Melissa Piliang: So you can use vitamin C daily. I suggest putting it on in the morning because it works in synergy with your sunscreen and it takes about three months to really see the effects. So use it and be very patient. I suggest taking a picture of yourself with no makeup or anything on your face, and then maybe photograph every month and then see if you can see the effects.

Kate Kaput: So that's actually a really good point, right? That I think when people start using any skin care product, they hope to see an immediate result. Can you speak a little bit to the value of being patient, figuring it out, tweaking your routine as you go, right? Some of these things don't work right away.

Dr. Melissa Piliang: So it can be a little frustrating because you want to see the effects of your treatments immediately. Maybe you invested a lot of money in it, or you're putting a lot of time. You really want to see immediate results, but remember it took a long time for your skin to get to this point. So you have to be patient and give these things time to work. It really does take a few months, maybe three or four months for most of our products to really see the most benefit.

Kate Kaput: Got it. And I would imagine that talking to a dermatologist can help you figure out which products you should be trying, which ones you shouldn't bother spending your money on, and yeah, which ones are going to be the most effective, ideally for you and for your specific skin.

Dr. Melissa Piliang: I think your dermatologist is a great place to start for recommendations. They know products. They can talk to you about your skin and help you figure out which ones are most likely to be beneficial for you.

Kate Kaput: Perfect. OK. So I want to talk a little bit about at home tools and practices that we seem to be seeing again all over social media. Some that seem OK. Some that seem pretty unsafe. So I'd love for you to weigh in on them. One is home microneedling. Can you explain what microneedling is and why this is something you probably shouldn't do on your own?

Dr. Melissa Piliang: So microneedling uses little tiny needles to poke holes in the skin, essentially. And as these holes heal, the collagen gets remodeled and it can help with things like acne scars or wrinkles, or maybe even pigment changes on the skin. The at-home units have short needles, so they don't go very deep in the skin. The needles that your dermatologist would have are longer and they go deeper and can have much better effects. When you use microneedling, you can have risks. So you could get an infection, because remember you're making those little tiny holes in the skin. You can have bruising, you can have dry skin, flaky skin, irritation redness afterwards. So really it's best to do this under the care of a dermatologist.

Kate Kaput: OK, great. Another one that people seem to be trying at home that again, seems to be fairly unsafe is lip plumping using hyaluron pens. Well, can you tell us about them and the danger of using them at home?

Dr. Melissa Piliang: These are unsafe and should definitely be avoided. So these pens use high pressure air to force this hyaluronic acid under the skin. And you might think it's the same hyaluronic acid that your dermatologist would use. But actually these pens have non-medical grade hyaluronic acid in it. That means it might have other chemicals or other substances in it that can cause inflammation under the skin and lead to problems. The other thing with this is when your dermatologist injects hyaluronic acid, they use a needle and they put it very precisely exactly where it needs to go. If you're just shoving this in with this air pressure, it goes all over and you can really end up with lumpy bumpy, irregular uneven lips. So I would really advise against this.

Kate Kaput: And are in-office lip fillers a safe thing to try, right? Dermatologists do them. You can get them done in an office safely?

Dr. Melissa Piliang: Yes. Lip fillers can be very safe when provided by a dermatologist, but you really want to make sure that the person who's giving them to you is experienced, is trained, knows what they're doing. Look for a board certified dermatologist as a good resource if you want lip fillers.

Kate Kaput: Sounds good. Dermaplaning is the act of using a straight mini razor to remove peach fuzz from your face and TikTokers say that it can lightly exfoliate, make your skin look smoother. What can you tell us about dermaplaning? And is it OK to do on your own?

Dr. Melissa Piliang: Dermaplaning is one I think is fine to do on your own. You can buy these, they're on a little plastic handle and it's a single blade and they're easy to find. You just lightly rub them over your skin. And when you do it, then you can look at the blade and you see that there is a little bit of dead skin cells and a little bit of peach fuzzy hair. Your skin will feel very smooth after doing it. Again, though, it does disrupt that skin barrier. So you may feel a little irritated for a day or so after you do it. So make sure you moisturize well, and then I would not do it more than once a week, just so your skin has time to recover in between.

Kate Kaput: Got it. So this isn't something that you should be doing every day. To keep your peach fuzz from ever growing in, you want to give it a little bit of recovery time.

Dr. Melissa Piliang: Right. And peach fuzz is so fine that when it grows in, you don't really see it.

Kate Kaput: So that was actually one of my next questions for you, is I think that we've all heard the old myth that shaving your face for women makes the hair on your face growing thicker. Is there any truth to that?

Dr. Melissa Piliang: So this is an old wives' tale. I just talked to a patient about this this week. But it's a very commonly held misconception. So, I think part of it is because as our hair grows, it gets very narrow and tapers at the end and feels soft. So if you cut it off blunt, like you shave it, then all of a sudden it can feel a little thicker and coarser, but it's really just because you cut it. And one way I think about it is trimming your hair on your head does not make that hair grow faster. It does not make it grow thicker, darker. We know this. So just trimming off the hair above the surface of the skin has no effect on how the hair grows.

Kate Kaput: That makes a lot of sense. And yeah, I think that's a very pervasive belief. People who are like, oh, I could never shave off my little bit of mustache hair around my mouth, that will make it worse. So I'm glad to hear that that one's not real. One that is pretty universally agreed upon to be dangerous, that I would love your input in, and your warning on is the recent trend of using what people are calling nasal tanning spray. This is when you snort a product that is made with an ingredient called Melanotan. I want to say, although you can correct me if I'm wrong there, it's said to give you a fake tan from the inside out, but it seems to be really unsafe. What can you tell us about this product?

Dr. Melissa Piliang: Yeah. Let's start with anything that you're going to snort into your nose is probably not a good idea unless your doctor tells you to do it and it's FDA approved. These nasal tan things are not FDA approved or regulated. Then inside of your nose is mucosa, not skin. So it doesn't have that same barrier. Things will absorb much quicker through your nose. And so if there's bad chemicals in there, they're going to go right into your body. And they don't tan on their own. They make you more sensitive to the sun. So you get more tan when you go into the sun. So you still need that unsafe sun exposure to get tanned. So these are not safe. I strongly advise against them. If you want a tan look to your skin, many people think it makes them look healthier and they may desire that look, then use a spray tan or the tans that are gradual that come in a tube or in a cream or a lotion. These work by changing the color just on the outer layer of the skin, they don't soak into the skin. They're very safe.

Kate Kaput: OK. So it sounds like there are multiple unsafe things happening with the nasal tanning spray. And yeah, like you said, the fake tan technology has come a long way. You can go get a whole body spray tan that is fake and safe. Perfect. And finally, I want to talk about how to store your skin care products. Skin care fridges have become really popular. They're little mini fridges specifically for storing your skin care products. Is there a benefit to storing your skin care products in cool temperatures and are there some that you should and some that you shouldn't? What can you tell us there?

Dr. Melissa Piliang: They're cute, aren't they, those little mini fridges. And it can feel very nice to put something cool on your face on a hot day, or maybe you got a sunburn and you want to put aloe vera on your skin. If that comes out of the fridge, it feels so much nicer on your sunburnt skin. So there are times that it can be nice to have something that's cooled, maybe a soothing mask if your skin is irritated can feel good. But generally it doesn't change the ingredients of the product. It doesn't make them more or less effective. It's more about how it feels.

Kate Kaput: And are there any products that are made worse by being stored cold? Anything where it's going to disrupt the product?

Dr. Melissa Piliang: So I would not recommend storing your makeup cold. So makeup is meant to be at room temperature or body temperature to be able to go on the skin smoothly and spread evenly. So if it's cold, it may not spread as nice. And you may have uneven skin tone from it.

Kate Kaput: Got it. Any other tips for storing your skin care products, things that you should or shouldn't do?

Dr. Melissa Piliang: So you want to store your skin care products in a cabinet, in a temperature controlled room, so in your house to keep it at a nice temperature. You don't want to put it on a window sill, for example, in the sun, because ultraviolet light can make products break down. You wouldn't want to leave it in your hot car. I'm sure we've all experienced that we accidentally leave something in the car and you come back and it's like all goopy and clumpy and falling apart, it’s super gross. So you don't want to store it in someplace very hot. You want to store something that's just room temperature, 60 to 80 degrees Fahrenheit so that it stays nice.

Kate Kaput: Got it. And is sunscreen an outlier there? Is it OK to carry around sunscreen in your very hot beach bag?

Dr. Melissa Piliang: Yes. I carry sunscreen in my car and in my beach bag and everywhere I can. So those usually actually don't break down from the heat and you use them and they work fine. So that is an exception.

Kate Kaput: OK, great. And how do you know when it's time to throw something out, be it makeup or another skin care product? How often should you rotate through those products?

Dr. Melissa Piliang: So some products have an expiration date. If it's past the expiration date, it's probably time to think about getting rid of it. Sunscreen has a three year expiration date from the time it's made. So you have a little time to use it, but I'd say if you're using sunscreen that's been in your cabinet for three years, you're not using enough sunscreen.

Kate Kaput: Seems like a good rule of thumb.

Dr. Melissa Piliang: Other clues that your product might be bad is if it smells funny, if it looks funny, if it's changed color, if it starts to separate like oil and water and salad dressing, then those are all signs that it’s time to put that in the trash can.

Kate Kaput: Gross. That sounds like a good tip. Is there anything that we haven't discussed today? I feel like this is a topic that we could probably go on forever. There are so many questions out there on the internet and in my own head, but anything that we haven't discussed today that you think is particularly important for our listeners to know about skin care products or how to figure out what's best for them?

Dr. Melissa Piliang: One last thing about sunscreen, because I think sunscreen is so important for people to use. The best sunscreen that you can get is the one that you'll actually put on your skin. So you can buy expensive sunscreen and be afraid to put it on, because it's too expensive and you don't want to waste the product. You can buy something that's real sticky and thick and maybe it's a very good sunblock, but it's not going to go on your skin. You're not going to like it. So find a product that you will use that you can afford and actually put it on your skin.

Kate Kaput: That is great advice and always telling my husband, well, if you don't like this sunscreen, we can find one that you do like so that you wear it. So experiment a little, find the one that you're going to stick with and stick with it. Great. Dr. Piliang, thank you so much for being here with us today and for speaking with us on this helpful topic. This is really helpful to me and I think that it will be helpful to a lot of our listeners. So we really appreciate it.

Dr. Melissa Piliang: Thank you so much, Kate. I’ve enjoyed myself very much.

Kate Kaput: To all of our listeners, if you'd like to schedule an appointment with a Cleveland Clinic dermatologist, please visit clevelandclinic.org/dermatology, or call 216-444-5725. Thanks for joining us today.

Speaker 1: Thank you for listening to Health Essentials, brought to you by Cleveland Clinic and Cleveland Clinic Children's. To make sure you never miss an episode, subscribe wherever you get your podcasts or visit clevelandclinic.org/hepodcast. You can also follow us on Facebook, Twitter, and Instagram for the latest health tips, news and information.