Female dermatologists are often thought of as the experts on effective, scientific skin care. And that’s because we are. So how does this girl dermatologist, and I use the word “girl” loosely, do skin care? I want to be the best I can realistically be, and that includes my skin. The key to doing the best you can with what you’ve got, it to know what you’ve got. To some degree, you inherit the skin you’ve got. But skin you’ve got is also the result of what you have done, and what you are doing.

Before I became a dermatologist, I always just took my skin for granted and didn’t think much about it. I have moderately sensitive skin, and am “atopic.” Atopic tendencies are genetic, and people who are atopic have skin that is more sensitive than others, gets rashes easier, itches at things others don’t, have little bumps on the upper arms, and often have a family history of asthma or hay fever. If you cut the tags out of all of your clothing, been told you were “allergic” to grass, or wool, or whatever, you are atopic.

Very luckily for me, as a child, adolescent and young woman, I didn’t ruin my skin in the sun. Although I would have loved growing up on the beach, I didn’t. In Oklahoma City, beaches are hard to find. I wasn’t on the swim or tennis team. We didn’t belong to the country club. Many of my friends would lay out in the backyard and tan. However, sticking to the webbed straps of a wobbly chaise lounge, sweating in the hot humid air, swatting the flies that would continually swarm around was not my idea of fun. So I didn’t do it. Later I was too busy with pre-med and medical school to have any fun outside. So I escaped the early sun exposure that shows up as damage twenty or thirty years later.

I never really had acne as a teen or young woman. Only in middle age, which is not fair and I plan to sue someone, as soon as I figure out who to sue. I pigment moderately easily, and had a decade or so dealing with melasma. Caused by a combination of hormones, either birth control pills or devices, pregnancy or just the hormones made by the body, melasma is a brown pigmentation on the face, especially cheeks and above the upper lip. It is often in a pattern, and I had a delightful set of horns above my eyebrows and a brown pigment moustache. Melasma drives women crazy, and is incredibly frustrating. I was no exception. Usually it finally burns out, and mine did.

I always ask patients “where is your family from, the old country?” It not because I am just nosy, it is because it makes a difference. The tendency to make abnormal pigment, to get wrinkling with sun damage, to get broken blood vessels and redness, to have sensitive skin all have a genetic basis and that genetic basis is tied to ethnic background. People who have ancestors that had more natural pigment, Hispanic, Asian, American Indian, Black, Middle Eastern etc, respond to anything that happens to the skin, such as pimples, rashes, procedures, treatments, with increased pigmentation. It is hard to fix, so you want to avoid it. If you have light skin, like most Northern Europeans, especially Irish and Scots, and you get a lot of sun exposure over the years, your skin will get thickened bumpy elastosis, wrinkling, loss of elasticity and skin cancer, and you won’t like that either. The list goes on. My family background is German, Dutch, and a little American Indian, so I don’t get sun damage easily, but can make abnormal pigment.

There are 3 components to coming up with your own skin care plan—quiz—soul searching—reality. Kind of like coming up with a life plan.

1. Quiz—What kind of skin do I have?
2. Soul searching—What kind of results do I want?
3. Reality—How much time and money am I willing to spend?

Dr E takes the Dr E Skin Care Quiz:

• Is your skin very dry, dry, combination, normal, oily, very oily?—Dry
• Do you get breakouts?—Yes, 3-4 per month, painful medium sized pustules and small cysts, and I don’t like it one bit.
• Is your skin sensitive?—get rashy or itchy easily? Yes, didn’t I just say I was atopic?
• If you are out in mid-day sun without sunscreen do you get some immediate darkening of your skin? Yes, a moderate amount
• How much sun do you get daily? Noooooooooooooooooooooooo
• Do you wear sunscreen every day? Duh, yea
• Are you a “soap and water and nothing else”, “I will do 3-4 steps in the morning and same in the evening”, or “as much as it takes” kind of woman? I am a “as much as it takes kind of woman.”
• Are you using any prescription surface treatments like Retin-A, Refissa or for Rosacea? Yes, I have used retinoids in one form or another continuously for the past 30 years.

• Which of the following are a problem—

  • Brown spots—No, see 5 and 6
  • Broken blood vessels—Yes
  • Fine wrinkles—No, see 5 and 6
  • Deeper wrinkles—-No, see 5 and 6
  • White “beads” under the skin—Yes, a few
  • Flaking or peeling—Occasionally, from retinoids

Dr E does some soul searching

• What kind of results do I want? Here is what I want—I want have the very best skin I can have.

• I want smooth, uniformly pigmented skin with small pores, minimal wrinkles, no broken blood vessels, no gross brown crusty things, no pimples, and no reddish brown spots after pimples have gone. I want my skin to be approximately in the same place on my face that it was twenty years ago. When I stretch it, I want it to bounce back in less than 10 seconds. And it should not be oily, not be dry, but just right, like Goldilocks porridge.

What am I willing to do to get it?

• No, I am not willing to do a great deal for hair care and nail care. But I am for skin care. Why you ask? All three are visible to the world. All three can make you look worse, or hopefully, better. But, a very important difference. Taking care of your hair and nails make them look better today, but in general don’t influence the appearance tomorrow. I can fry my hair with bleach, color it blue, get split ends and it will still grow it out fine. I can get fungus under my nails, warts around the cuticles, and significant deformity of the nails after acrylics, etc Although treatment of warts and fungus is difficult and often recurrent, to at least some degree they can be prevented or treated. Preventing nail damage is basically avoiding sharing nail care instruments, whirlpool tubs etc that are contaminated by other customers in nail salons, and not wearing fake nails continuously.
• But skin care is a different story. I can prevent undesirable skin changes, I can improve the ones that are there, and I can change the nature of my skin. In contrast to hair and nails, which are completely replaced when they grow out, skin cells are turned over on the very surface, with lesser turnover under the top layers. That’s why destroyed collagen and elastic fibers, elastosis, scars, pre-cancer, and skin cancer, pigment, broken blood vessels, and brown growths are permanent and don’t “grow out”. Taking care of your skin today makes it look better today and tomorrow. If I don’t take care of it today, it will look worse tomorrow, and some of those changes aren’t fixable.

We all make mistakes in life. It’s just that the consequences of some are worse than others, and some are easier to fix. So the answer to the question “How much time and money am I willing to spend?’’ Whatever it takes.

Next: what it takes for this dermatologist, every day, to take care of her skin