Q&A with Dr Sam Bunting about facial cleansing
Harley Street dermatologist, Dr Sam Bunting took part in a Q&A about facial cleansing and answered your questions about rosacea, hormonal outbreaks and dealing with teenage skin.
As a cosmetic dermatologist with a busy private practice in Harley Street, Dr Sam Bunting is used to giving out advice on all skin types and giving tips on how to keep skin radiant and youthful-looking. The Q&A was sponsored by Philips VisaPure, a gentle, easy-to-use electronic facial cleansing device that massages the skin to remove make-up, dirt and impurities.
Q. BloodFlower: Which common skincare ingredients should be avoided?
A. Dr Sam Bunting: The key is to match up your skincare routine with your skin type – personalisation is vital for great results. However, in general, harsh cleansers that foam aggressively and leave the skin feeling tight after washing should be avoided, as should excessive use of physical exfoliants - particularly for those with sensitive skin types. Toners containing alcohol are also best left on the shelf.
Q. Roseformeplease: How can I make sure that my very sensitive and eczema-prone skin does not flare up? I use Eucerin and La Roche Posay, which help, but would love to be able to use a cleanser and thus be able to wear some make up. Also, at 45, it has got drier and more prone to red patches, so how can I adapt as I age?
A. Dr Sam Bunting: My favourite skincare brand for dry skin is Avene – they have an Extremely Gentle Cleanser that is well tolerated by those with very dry skin. They also do a range called Tolerance Extreme, which is preservative and fragrance-free and is a real blessing for sensitive, reactive 'stinging' type complexions. I think it's important to have flexibility in your moisturisers – a lighter lotion for the day and a heavier cream at night. Cetaphil Moisturising Lotion and Cream are good options. If despite these measures you still have red, dry patches, see your GP as you may benefit from prescription medication.
Q. UntamedShrew: What is your own skincare routine in morning and evening and which products do you recommend for each stage?
A. Dr Sam Bunting: I use a combination of French pharmacy brand products and prescription based products. I cleanse with La Roche-Posay Physiological Cleansing Gel and I use Obagi Hydrate Moisturiser and Sunshield SPF 50. I also use their Professional C-serum 20% vitamin C serum in the morning and a prescription retinoid at night. Simplicity rules!
Q. Lovecat: Is there any way to actually get rid of blackheads and prevent them coming back once you've got them?
I have tried so many different things over the years and they come back again and again. I don't wear make up and rarely use foundation, I use a blackhead scrub and the Neutrogena Pore Refining Moisturiser, I'm now nearly 48, the rest of my skin is fairly dry but I still have a teenager's nose.
A. Dr Sam Bunting: Blackheads are blocked pores which are open to the air. The best approach is to prevent them by using a topical retinoid – Avene Ystheal is a good place to start and should be used at night (in conjunction with daily sunscreen). In addition, a salicylic-acid based cleanser would be a good product to use in view of your combination skin type, as this helps remove debris from pores, making them appear smaller.
Q. WallyBantersJunkBox: What do you recommend to improve large open pores? I have heard that they happen because cleansing isn't thorough enough, but even after facials they are still visible on my cheeks.
Also, at the change of each season I always seem to suffer with an itchy and flaking forehead for a few weeks. Exfoliating or intensive moisturizing never seem to work. What recommendations do you have?
A. Dr Sam Bunting: Pores don't open and close like doors – large pores appear in the context of oily skin. Their appearance can be improved by using salicylic acid as this gets to the oil element of the pore and removes built up debris and sebum. In addition, it's important to maintain collagen stores and 'prop' the pore up, this means using a broad spectrum sunscreen on a daily basis, all year round, and using ingredients like vitamin C to maintain collagen stores. Again retinoids would also be useful here. Read more on big pores here.
In regards to your forehead, it's important to see your GP in case it's eczema or psoriasis, which may need topical medication.
Q. Ijustworemytrenchcoat: Is there a limit to what products we put on our skin can do to improve it? I have tried so many regimes over the years, but my skin looks like I don't take care of it at all -dehydrated in places, oily in others, hormonal outbreaks and cystic acne.
A. Dr Sam Bunting: You are not alone. Many skincare trends are not suitable for everyone and can actually cause problems, sometimes we women are our own worst enemy. It sounds like you need an intervention. It would be worth having a one-off appointment with a beauty-orientated dermatologist to help you rationalise your skincare. There is no doubt in my mind this could help your skin improve. In most cases, less is more.
Q. mumsbe: Since having my son, I have had really dry skin. Some days it's almost like a layer of dry skin on top of my normal skin, it makes me look 100 years old, is very itchy and drives me mad. It's strange because up until now I have had very oily skin, so oily that my skin looked wet. I think I would rather have the oily skin back, any advice?
A. Dr Sam Bunting: Pregnancy and the hormonal changes that go with it can lead to fluctuations in your skin. On top of that, the subsequent sleep deprivation that goes with having a young child can lead to dryness. You should try using a non-foaming cleanser and nourishing moisturiser – I'd recommend Cetaphil Gentle Cleanser and Moisturising Cream, and use tepid water (not hot) when cleansing. Make sure that your diet supports skin hydration – be sure to get plenty of omega-3 and omega-6 fatty acids from sources such as salmon, avocado and walnuts. If these simple measures don't help then you may need to see your GP or a dermatologist for some extra input.
Q. FabULouse: What would your cleansing recommendations be for an 18-year-old with oily skin, prone to blackhead formation and two to three proper red spots at any one time? The typical 'teenage' products seem terribly harsh and definitely worsen oil production.
A. Dr Sam Bunting: I am a big fan of the Obagi Clenziderm range – their foaming cleanser with 2% salicylic acid is an excellent choice and is less drying that most typical acne cleansers.
Q. mandalee: In the past month, I've suddenly gotten small patches of little bumps on my chin, at the corner of my mouth, next to my nose and even inside my nostrils. They are not pimples, they never come to a head, and spot cream does nothing to them. They don't itch like eczema, either and if anything, they're tender. I've also had patches of eczema on my hands and inner elbows lately, though. I have resorted to Betnovate 0.1% twice a day, which seems to help somewhat, but will it ruin my skin? I'm 42.
A. Dr Sam Bunting: First thing to say is stop the Betnovate topical product. From your description you sound like you could have a condition called perioral dermatitis. Topical steroids can make this condition worse. I'd advise that you stop using products that are not labelled non-comedogenic as this condition can arise from using poorly formulated skin care products. It would be worth getting an expert opinion as a doctor really needs to see a skin problem to make a diagnosis and you may need prescription medication to settle it down fully.
Q. Rosie29: My daughter is starting puberty, she's 10, when should preteens start doing more than just washing their face with a flannel in the bath?
A. Dr Sam Bunting: The key is to take action once oiliness in the T-zone and those first clogged pores appear. At this point a simple salicylic acid-based cleanser can help. Try Neutrogena Visibly Clear Oil-free Wash.
Q. ParsleyTheLioness: What will the electronic cleaning device do for my skin that normal cleansing will not?
A. Dr Sam Bunting: Simply put, the thoroughness of the cleanse. The VisaPure is 10 times more effective than manual cleansing and will make sure there are no remnants of make-up, grime and dirt which might clog up pores. This also helps with the penetration of skincare products after cleansing. This is especially pertinent for those living in an urban environment - it's crucial to remove environmental pollutants from the skin as we now know this plays a key role in the development of hyperpigmentation.
Q. Rexy: Will using this improve my combination skin and pigmentation issues?
A. Dr Sam Bunting: The VisaPure will form a good foundation for an effective skincare regime, aimed at tackling these issues especially if living in a urban environment as mentioned previously. Seek out ingredients aimed at hyperpigmentation – for over-the-counter I like La Roche Posay Pigment Control and Avene D-Pigment. Check out my blog for my top tips to getting the most out of your cleansing brush.
Q. OneLittleLady: What is the best way to deal with hormonal spots that don't seem to come to a head, and what are your top tips for looking after dry skin?
A. Dr Sam Bunting: The first approach is to avoid skincare products on a regular basis that exacerbate the problem. You'll need to seek out non-comedogenic skincare – brands like La Roche-Posay and Bioderma are great options. You then need to utilise an agent that prevents spots and the ideal product would be a vitamin-A derivative at night. In addition, it's worth having an anti-inflammatory product to tackle inflamed spots – benzoyl peroxide 2.5% strength would work. It should be possible to take care of dry skin using products which support skin barrier function at the same time as tackling blemishes with this approach. In fact good barrier support ensures more rapid resolution of blemishes – so the notion that you have to 'dry spots out' is an outdated one.
Q. Mobbsey: With teenage boys with spots/acne, is it what they eat or how and what they cleanse with? How should my son keep his spots at bay?
A. Dr Sam Bunting: The approach to spots should be the same as mentioned in the last question. Teenagers may be better off with a salicylic acid-based cleanser, to help manage the excessive oiliness that typically occurs at this age. Key dietary tips which may help when managing acne are:
- Stick to low GI carbs – ie avoid any refined/unnaturally white carbs.
- Make sure there is plenty of zinc in your diet. Good sources are cashew nuts and shellfish.
- Moderate dairy intake.
I don't believe in excluding things from diets but a balanced diet including fresh fruit and vegetables, based on these key principles, will make a valuable contribution to an acne management plan. Read more on acne truths here.
Q. Leedscatgirl: What's the best treatment for whiteheads?
A. Dr Sam Bunting: There are many different types of lesions that can be described as whiteheads – common ones are milia - small, raised, pearly white non-inflamed bumps often around the eye or on the cheeks. These can be triggered by using oil-based products, like eye make-up remover which can clog the delicate glands in the eye area. The use of a non-oily eye make-up remover is recommended and stick to non-comedogenic skincare as general as a rule. Individual lesions can be extracted in-office by a dermatologist.
Q. kasbah72: My nine-year-old son is already suffering from breakouts. He gets white heads and large spots around his hairline and deep blackheads and raised spots on and around his nose.
We are currently washing his face with teen washes and using a Dermalogica spot treatment but nothing is working.
My husband and I both had terrible acne as teens and I have various hormone-related issues. I feel so bad that he has inherited something like this. What do you recommend as a skincare routine and any other products?
A. Dr Sam Bunting: I would recommend seeing a GP – your son is likely to need a prescription-grade retinoid at night to tackle the blackheads and also benzoyl peroxide for the inflamed spots. I recommend tackling acne earlier rather than later for teens, to limit the damage to the skin and perhaps, just as importantly, the psychological scars acne can leave on self-esteem.
Q. lazypepper: What is your view on using Roaccutane for mild but persistent acne? I am 46 and have very oily skin still. I have had acne since being a young teen and I am currently taking Trimethoprim which keeps the spots to a minimum, but my face feels like an oil slick.
When taking no medication I get some large spots on my face, neck, chest, shoulders and back. I wouldn't say it is cystic, but there are enough to upset and embarrass me. I have been to see a dermatologist privately and I am to return for a repeat visit to see how the Trimethoprim is working. However, I can't keep taking it forever, can I?
A. Dr Sam Bunting: I am very sympathetic to your story – I see a lot of patients who suffer in the same way with chronic ongoing acne which destroys quality of life. In my opinion, it's important to consider Roaccutane in the context of patient's history and background medical condition. But yes, I feel it does have a place in cases such as yours where other treatments aren't working, assuming you are also using a topical retinoid at present. Spironolactone would also be an option. Here's a useful website discussing the various treatment options.
Q. cakelover75: Which cleansers do you recommend for rosacea sufferers? I have the small, bumpy, red spot type of rosacea. I'm in my late 30s and have fair, celtic skin.
A. Dr Sam Bunting: I like La Roche-Posay Rosaliac Cleanser. I also like Cetaphil's Gentle Cleanser which tends to be well tolerated by most patients with sensitive skin. I would avoid physical exfoliation in those who suffer from rosacea.
Q. Grey24: I have daily acne and very over-oily skin even though I'm now 40. Combined with this, I have also had rosacea and redness since I was 25. Balancing and treating them both is very difficult as most products and treatments for one, exacerbate the other. Any advice?
A. Dr Sam Bunting: Interestingly there are some ingredients that can be used in patients with acne and with rosacea. Salicylic acid is a useful ingredient as it's helpful to those with excessive oil, acne and rosacea due to its anti-inflammatory properties. Involving your doctor might be sensible – azelaic acid (available on prescription) could be beneficial in both conditions. It's important to emphasise the need for sunscreen. A non-comedogenic sunscreen (like Avene SPF 50 emulsion) is really key in preventing rosacea flares. Read more on rosacea here.