Ashlee Williams, MD (Host): Did you know that your skin is an organ? It's the largest organ in your body and it's important to keep it healthy. But how do you sort through the endless trends and products to find the best routine for you?

Welcome to the Healthier You podcast. I'm Dr. Ashlee Williams. And today, I'm joined by Dr. Randa Khoury, a board-certified dermatologist at Kaiser Permanente, about the secrets to a healthier skin. Thank you so much, Dr. Khoury, for joining me today.

Randa Khoury, MD: Thank you for having me, Dr. Williams.

Host: I really appreciate it. This is such an exciting topic. Okay, so let's just start with the basics. What should a skincare routine look like regardless of skin type?

Randa Khoury, MD: Absolutely. Good skincare is not complicated, regardless of your age, your aesthetic goals. Everyone needs a gentle cleanser, a good sunscreen, and a good sunscreen is one that's between SPF 30 and 50, and a gentle moisturizer that is light and won't clog your pores. These are great skincare basics for everyone.

Host: Wow. It sounds pretty simple. We hear so much everywhere about different things we need to be putting on your face, and I love that you've simplified everything for us.

Randa Khoury, MD: Absolutely. Skincare can be really fun. And I think sometimes with things that can be really fun, they can also be really challenging. To sort through the aisles and aisles of products. At any store you go into, from your grocery store to your drugstore to your dermatologist's office, there are so many products available. But like many things in life, sometimes we just need to get back to the basics. Gently cleanse your face morning and evening, a broad spectrum sunscreen SPF 30 to 50 in the morning, and a light moisturizer at night is going to cover your bases for general healthy skin.

Host: Yeah, that's a great point. It's like when you go to the store, there's so many options. Like, what should we be looking for when we're looking at ingredients in some of these options that are on the shelves?

Randa Khoury, MD: Such a great question, and I love that because it sort of leads into the next step. Clearly, there are so many things on the market other than gentle cleansers, sunscreens, and light moisturizers. There are so many things with active ingredients that are addressing specific skin concerns. So if you are someone who is struggling with acne, for example, when you choose your cleanser, you may choose one that has an active ingredient that's specifically going to target that concern. Some things to look for are ingredients like benzoyl peroxide, which I know has been in the news lately for some not so great reasons, and we can touch on that a bit, or salicylic acid. These are tried and true ingredients that are going to be effective against most types of acne. If you're not struggling with acne and you have a drier skin type, looking for a moisturizer that contains ceramides, glycerin, hyaluronic acid. These are all going to be great products that are going to add a lot of moisture to dry skin.

So as far as what are you looking for in general, if you're trying to target a specific concern, be that acne and dry skin or something more like addressing the signs of photo damage and aging, brown spots, fine lines, wrinkles, these are areas where you can strategically use some additives to increase the efficacy of your skincare routine in reaching those goals. But just for basic skincare, looking for a moisturizer that says non-comedogenic, which means won't clog your pores, looking for a sunscreen that says broad spectrum, SPF 30 to 50, and looking for a cleanser that is just a gentle non-exfoliating cleanser are great things to look for just for everybody.

Host: So it sounds like it's really important to actually know what skin issues that you have before going to the store to look for these products.

Randa Khoury, MD: Yes. So if we're thinking about this in a pyramid-style schematic, at the bottom of the pyramid, the base, the foundation of our pyramid is going to be just those three steps. Your gentle cleanser, your moisturizer, your sunscreen. As we take the next step up, we start to consider targeting specific skin concerns. If you have none, you are great at the foundation. You have excellent foundational skincare that's going to keep your skin healthy by not doing anything harmful and by doing everything gentle and protective.

Once we start moving up those rungs, then we start talking about what specific things are you concerned about? Are you having something that you don't love when you look in the mirror? Are you having something that's making your skin feel uncomfortable? Eczema, psoriasis, acne? And in that case, that's when you start partnering with your dermatologist to choose the right products to add to your routine to make sure you're looking and feeling your best.

Host: I love it. So, you talked about a little bit about the concerns about benzoyl peroxide. Can you talk about that a little bit?

Randa Khoury, MD: Absolutely. This is such a challenge, because benzoyl peroxide is a workhorse in the dermatology community. It is an additive that does so many excellent things for patients who struggle with congested skin, acne, even folliculitis or hair bumps from shaving. benzoyl peroxide is an ingredient that can help to gently chemically exfoliate dead skin cells. It acts as an antibacterial, and it also acts as an anti-inflammatory. So if you picture, you know, sort of acne-prone skin, folliculitis, hair bumps, what a gift that we have an ingredient that can do all of those things gently and effectively.

However, there was a study that came out recently, it was a very small study from a private lab that showed that if benzoyl peroxide is stored at very high temperatures for longer periods of time, it can break down into its component parts and including a chemical compound called benzene, which is a known human carcinogen. And the FDA places fairly strict regulations on how much benzene can be contained in cosmetic formulations.

What I have been doing myself, for myself, my family, and also advising my patients, is that while we should not dismiss this outright, it's important information. I think context matters and if you are storing your benzoyl peroxide-containing products appropriately, not leaving them in a hot car for long periods of time, we believe that they are still safe and effective and there is no reason to completely discontinue use. However, I think that using this as an opportunity to look at our storage and manufacturing practices around benzoyl peroxide is certainly something that we should look to. But in the meantime, if you are using a product with benzoyl peroxide, keep an eye towards how you're storing it, but there's no reason to discontinue use of this.

Host: Okay. That's really good to know. And thank you for touching on the point about hair bumps, because that's one of the issues that come up in my primary care clinic a lot. So, do you have any advice on how to prevent razor bumps, hair bumps, razor burns?

Randa Khoury, MD: Absolutely. As we're moving into the warmer season, I think all of us are going to start thinking about the aesthetic challenges around hair removal practices. Essentially what happens when we remove hair, whether we are waxing, shaving, threading, plucking, essentially anything other than a more permanent method of hair removal like laser hair removal, what we are trying to do is take the visible portion of the hair shaft, away from the surface of the skin. When we shave, we're doing that by kind of chopping its little head off by decapitating that little hair follicle. And when we wax or thread, what we are doing is removing the hair follicle from the shaft in its entirety including the root.

So if we picture that process, let's start with shaving. I first recommend that you use a single-blade razor. You can throw away all of those fancy five-blade razors. Because when you're using a multi blade razor, the reason it gives you that perception of a really smooth, lovely shave is that each blade is lifting and the subsequent blade is cutting and lifting and cutting and lifting so that when you are done, that hair has retracted underneath the skin's surface. Imagine, if you will, that you are that little hair follicle and your skin now feels very, very smooth. But as the hair follicle tries to regrow, it's going to meet a cap of skin that has now keratinized over the opening of that hair follicle. So, that little hair, which now no longer has a tapered point, it's blunt, is going to meet that resistance and be much more likely to turn in on itself and create an ingrown hair or a hair bump. When we use a single-blade razor, yes, it's true, we may not get the perception of as smooth or as long lasting of a shave, but the reason for that is we are giving that little follicle a fighting chance to stay near the surface of the skin, where the skin will not epithelialize or keratinize over it, so you're much less likely to get an ingrown hair.

Host: Interesting. And those have to be cheaper too, right? The single blade versus the fancy one?

Randa Khoury, MD: And I'm so glad you said that because that leads me to my second point, use it once and throw it away. It is no longer in service to you because the surface of our skin is alive. We have yeasts and bacteria that are normal and healthy. They're part of our healthy skin biome. They are part of our ecosystem. But when we shave, we are going to seed our razor with all of those organisms, which are going to be in a lovely environment to thrive on that razor. And if you use it, again, on your skin, even if you're using it on clean, dry, properly prepared skin, which we'll talk about in a minute, the likelihood that those bacteria and yeast colonies have had a chance to grow on that razor and that you could create small micro-tears in your skin environment and seed those into the deeper part of the skin where they don't belong, causing a skin infection is actually pretty high. So, I recommend a fresh, new, super inexpensive, single-blade razor every time.

Host: Oh, that's great. Are there any lifestyle changes that we can make to help better our skin?

Randa Khoury, MD: Yes. I often say that our skin is an outside reflection of what's going on on the inside. So, things that we generally think of as good for us for our health. Things like reducing our stress, getting eight to ten hours of good quality sleep every night, which as a working mom of young kids, I know how ridiculous those two things sound, getting good quality sleep and reducing our stress. But really, it makes the biggest difference in the overall health and appearance of our skin.

Other things like being mindful of healthy diet choices, lean proteins, green leafy vegetables. There's a lot of emerging research in the field of Dermatology that high-glycemic pro-inflammatory foods can contribute to a lot of inflammatory skin disorders like acne or hidradenitis, for example. Some patients who have made dietary modifications to kind of eliminate those really sugary, overly processed foods have seen great benefits in their skin health.

And finally, avoiding things like exposure to ultraviolet light, smoking. All of these are things that not only weaken our body's immune system and our ability to fight back against environmental damage, they also can really age our skin by creating a reduction in collagen production, contributing to the development of brown spots, fine lines, and wrinkles. Really, the best offense is a good defense.

Host: This was so much great information, Dr. Khoury. Thank you so much for joining us today. We learned a lot about how to build a simple and effective skincare routine, what ingredients to look for in skincare products and lifestyle changes that impact skin health. Here are the top takeaways.

One, there are four important steps to every skincare routine: cleanser, toner, moisturizer, and sunscreen. Clean, tone, and moisturize every morning and every night. Two, look for skincare products that contain ingredients to serve your skin's specific needs. If you need help determining your skin type, a dermatologist can help. Three, be sure to exfoliate your skin before hair removal and use a moisturizer afterward. This will help prevent ingrown hairs and razor burn. Four, drink plenty of water and eating healthy foods like whole grains, lean meats, and lots of fruits and vegetables can help promote a healthy complexion. And five, wear SPF 35 to 50 sunscreen every day. For more information about skincare from our experts and other health advice, visit kp.org/doctor and listen to more episodes of Healthier You wherever you get your podcast. If you enjoyed this episode, be sure to share it with others who may find it helpful. Thank you from all of us at Kaiser Permanente. Be well.