Skincare advice

Apart from acne, what are the biggest skin concerns you see in your clinic?

The most common reasons for coming to see me in clinic after acne include rosacea, pigmentary disorders such as melasma and post inflammatory hyperpigmentation, sun damage and for advice about slowing the signs of skin ageing.

Are there any obvious signs or quick visual tests that people at home can do to know what sort of concern or skin type they have?

Classifying skin into set types is often unreliable and unhelpful. I am yet to meet someone who has “normal skin.” The skin is a dynamic and reactive organ so what is true on one day or during one particular time of year, might not be true the next. Our skin might also behave differently at different sites. For example, you might have breakouts on your chin and dry patches around your nose, eyebrows, scalp and ears. Putting our skin in a pigeon hole doesn’t reflect its’ changing needs and may lead to inappropriate product selection. I often find it more helpful to look at skin goals rather than skin types. 

That said there are some clues that might help you understand your skin a little better… 



Dry skin often feels tight after cleansing. Skin surface markings or lines may appear exaggerated, for example below or around the eyes. The skin might flake or appear red and rough in texture.

Oily skin manifests with excess shine. This is most likely to affect the nose, but sometimes also the forehead, hairline and the chin. Hair might get greasy very soon after washing. Blackheads and breakouts are more likely to be a concern. Makeup tends to slip earlier during the day.

Pigmentation can affect any part of the face. It tends to becomes darker after exposure to sunlight so is typically most pronounced in Spring and Summer and after sunny holidays. Areas protected from the sun, for example behind the ears and underneath the chin, may be spared. Melasma, a common cause of hormonal pigmentation, is typically symmetrical, affecting both sides of the face.

All skin types will be subject to features of ageing at some point. Fine lines are one of the earliest signs and the most common place for these to appear initially is around the eyes. These lines, referred to as crow’s feet, are accentuated by smiling and squinting. Apart from fine lines and wrinkles, dark spots (sun spots) are another characteristic hallmark of skin ageing.

Why are antioxidants best worn during the day?

It’s not actually clear which time of day is best to apply your topical antioxidant, however as the intention is to protect from free radical damage that accumulates throughout the day, it would seem logical to apply it in the mornings.

Is retinol something that the majority of skin types could benefit from?

It would be nice if we could all use topical retinoids as the anti-ageing benefits are well proven. There are certain groups of people who find them more difficult to tolerate though. This includes people with an existing skin concern, like eczema or rosacea, and those with very sensitive or reactive skin that reddens or flushes easily. If you have one of these skin conditions, you may be better served by a different option, such as peptides, if the aim is to slow the signs of ageing.

When introducing retinol in more sensitive skin types, start with the lowest strength you can find and phase it in very gradually. I typically suggest applying the product at night after cleansing on 2 non-consecutive evenings per week for the first 2-4 weeks, then alternate evenings for 2-4 weeks and then every evening if tolerated.

If you’re comfortably able to apply a low strength retinol every evening e.g. 0.3%, you can start to think about moving onto a higher strength product, but remember to phase it in gradually once again to reduce the risks of redness, dryness, flaking and irritation.

Apply retinol in the evenings after washing your face. Place a pea-sized amount of retinol on your forehead or chin and with clean fingers spread it in an even layer over your whole face, avoiding your eyes and lips. Wait 15 minutes before applying moisturiser so the product has time to be absorbed without dilution. Apply moisturiser again in the morning after cleansing and follow with sunscreen.

You can treat your hands, forearms and neck in the same way, but be mindful that the skin on the neck and upper chest is very thin and may be even more prone to irritation thus slower ramping-up may be needed at these sites.

Retinol also has a bad rep – why is that?

Retinol formulas have come on a long way and advancements such as encapsulation and timed release, mean that products are easier to tolerate than previously. It is, however, still fairly common to develop a “retinoid reaction” when introducing retinol. This causes skin peeling and redness for around four to eight weeks after introduction. For most people, this is just an adjustment period and the irritation goes away. 

The best thing you can do throughout this period is to use a moisturiser twice daily (or more) to keep the skin feeling comfortable, and if necessary reduce the frequency of retinol application temporarily until your skin has had a chance to accommodate. Apply sunscreen every morning too.

Why is SPF important?

Excessive exposure to sunlight leads to sunburn, skin cancer, premature ageing and hyperpigmentation. Much of this damage is attributable to UV radiation, but pigmentation, for example, may be influenced by other wavelengths of light too e.g. high energy visible light.

UVB levels are lower in British winter so the risks of sunburn, tanning and skin cancer are lower too, although not zero. UVA rays, which contribute to skin ageing, dark spots and skin cancer, are also highest in Spring and Summer, but levels don’t drop as much in Autumn and Winter. It seems logical, therefore, to protect your skin with sunscreen every day of the year.

I would suggest that anyone looking for a sunscreen should choose a broad spectrum product which protects from both UVA and UVB. The SPF should be 30 or higher for the best levels of protection. For pigmentation problems, I would pick a product that offers extended protection from visible light as well as UV and would always go for the highest SPF I can find.

For dry or dehydrated skin, you can choose a thicker or creamier formulation. If your skin is very prone to sensitivity and you experience irritation following application of a chemical sunscreen, consider using a mineral or physical formulation instead.

For oily skin, look for a lighter lotion or fluid. If your skin is prone to breakouts, pick a non-comedogenic formulation.

What are the main excuses you hear about why people don’t wear SPF every single day? Do you think those excuses are valid?

The two reasons given most often for not wearing sunscreen in the mornings are not having enough time or that the products are too thick, greasy, white or don’t sit well under makeup. This certainly used to be true 10 years ago, but there is such a multitude of different textures, weights and compositions these days that I don’t believe this to still be the case. I am constantly on the hunt for new sunscreens to recommend to patients.