Dr. Dray Rejects Indoor Sunscreen Claims and Vitamin D Epidemic

Dr. Dray驳斥室内防晒说法与维生素D缺乏“流行病” 标准窗户玻璃会阻隔室内合成维生素D所需的UVB射线，而实验室更高的诊断门槛则人为制造了大范围的缺乏“流行病”。 在这场全面的问答环节中，Dr. Dray澄清指出，由于窗户玻璃会阻挡UVB射线，在室内不涂防晒霜并不能促进维生素D合成，同时她也对维生素D普遍缺乏的主流说法提出了质疑。她详细阐述了应对色素沉着、润色防晒霜氧化变色以及利用乳酸铵改善皮肤结构的实用方法。此外，她还针对应对DSAP、绝经后面部毛发生长、预防健身房真菌与葡萄球菌感染、挑选有效唇膜以及优化IPL、BBL等疗程与针对性指甲护理，提供了切实可行的医学指导。 室内不涂防晒霜无法促进维生素D合成，因为普通窗户玻璃会阻挡合成所需的UVB，而透入的UVA反而会加速降解皮肤中现有的维生素D。 (0:26) 大众认知中的“维生素D缺乏流行”很大程度上源于实验室人为提高的诊断阈值与无症状过度筛查；且维生素D属于负急性期反应物，在慢性炎症与脂肪堆积时循环水平会自然下降。 (2:01) 有色防晒霜中的氧化铁能物理阻隔诱发色沉的可见光，但与酸性活性成分或皮肤油脂接触易发生氧化变橙，建议留出吸收间隔或使用散粉定妆控油。 (5:42) 临床研究显示，每天两次涂抹12%乳酸铵（如AmLactin）持续3个月才能有效促进真皮增厚，降低使用频率或浓度通常仅能改善表皮层。 (7:07) 预防健身房真菌感染需遵循“先穿袜子再穿内裤”的更衣顺序，避免将足癣真菌带至腹股沟引发股癣，易发毛囊炎者可选用过氧化苯甲酰洁肤产品。 (11:58)

Dermatologist Dr. Dray examines common misconceptions surrounding vitamin D synthesis and routine supplementation, arguing that shifted laboratory thresholds have artificially engineered a deficiency epidemic. Alongside systemic health, she outlines evidence-based protocols for managing hyperpigmentation, gym-acquired pathogens, genetic skin conditions, and targeted post-procedural care. The Realities of Vitamin D and Sunscreen (0:00) Dr. Dray asserts that staying indoors without sunscreen does not boost vitamin D synthesis, as standard window glass blocks the UVB rays necessary for production while allowing UVA rays to penetrate and degrade existing skin stores. While evidence indicates that normal sunscreen use does not significantly lower vitamin D levels, Dr. Dray notes that existing studies primarily evaluate beachgoers in high-sun environments rather than residents of low-sunlight regions utilizing high-SPF products. More broadly, Dr. Dray challenges the widespread diagnosis of vitamin D deficiency, attributing it to elevated clinical cutoffs and excessive screening of asymptomatic adults. She highlights that vitamin D functions as a negative acute phase reactant, naturally falling during chronic inflammatory states such as diabetes, hypertension, and cancer. Furthermore, because vitamin D is fat-soluble, it is sequestered within adipose tissue—a relevant factor given that an estimated 43% to 70% of US adults have obesity. She warns that blind supplementation carries clinical risks, including hypercalcemia and vascular calcification. Managing Hyperpigmentation, Acid Layering, and Skin Architecture (5:42) Tinted sunscreens containing iron oxides offer critical photoprotection by physically blocking visible light, a primary exacerbating factor for melasma and post-inflammatory hyperpigmentation in deeper skin tones. When tinted formulas oxidize and turn orange, Dr. Dray explains that surface sebum and acidic actives accelerate the chemical breakdown of iron oxides. To counteract this, she advises allowing 5 to 10 minutes for acidic serums (such as L-ascorbic, alpha hydroxy, or salicylic acids) to absorb before applying tinted SPF, followed by a mineral setting powder. Regarding structural skin changes, Dr. Dray addresses the efficacy of ammonium lactate lotions. Clinical trials have demonstrated that applying a 12% concentration twice daily for three months successfully induces dermal thickening to reverse skin thinning, whereas a 5% concentration only thickens the epidermis. She notes that less frequent regimens, such as three times weekly, have not been evaluated in clinical literature. Clinical Management of DSAP and Menopausal Hair Growth (7:57) Disseminated Superficial Actinic Porokeratosis (DSAP) is an autosomal dominant condition linked to abnormal localized cholesterol synthesis within the skin. Because UV exposure triggers flares, strict sun protection is essential. While predominantly benign, lesions carry a small risk of transforming into squamous cell carcinoma and indicate an elevated baseline risk for skin cancers. Dermatologic therapies include topical 5-fluorouracil (which induces pronounced inflammatory peeling), imiquimod, topical statins, and destructive modalities like cryotherapy or resurfacing lasers, though lesions frequently recur. Addressing postmenopausal chin hair, Dr. Dray explains that declining estrogen levels shift the follicular androgen-to-estrogen ratio, triggering genetically sensitive follicles to convert fine vellus hairs into coarse terminal hairs. Recommended interventions include tweezing for sporadic growth, electrolysis to achieve permanent localized follicular destruction, or laser hair removal, which requires monitoring to avoid paradoxical hypertrichosis in adjacent fine hairs. Gym Sanitation and Preventing Fungal Auto-Inoculation (11:58) To prevent common gym-acquired infections caused by Staphylococcus aureus and dermatophyte fungi, Dr. Dray recommends tailored hygiene strategies. While regular soaps cleanse surface dirt, benzoyl peroxide washes penetrate deeply into hair follicles to suppress recurrent staph folliculitis without generating antibiotic resistance. Hypochlorous acid sprays provide anti-inflammatory relief for post-workout redness but do not replace targeted antimicrobials against established fungal or staph pathogens. To prevent fungal transmission, Dr. Dray stresses never walking barefoot or in socks in fitness facilities. She details the 'two feet, one hand, and jock itch' auto-inoculation sequence, in which fungal spores from athlete's foot are dragged across the groin and hands when putting on underwear before socks. Putting socks on before undergarments breaks this cycle. Preventative protocols also include wiping shared equipment before and after use, showering promptly, and considering intranasal mupirocin under medical supervision for chronic staph carriers. Procedural Light Therapies and Localized Barrier Treatments (17:30) When addressing post-acne marks, Dr. Dray distinguishes between Intense Pulsed Light (IPL), which uses broad-spectrum light to target melanin in post-inflammatory hyperpigmentation, and Pulsed Dye Lasers (PDL), which target vascular erythema. Pre-treating skin with tretinoin before Broadband Light or resurfacing procedures can reduce hyperpigmentation risks and accelerate wound healing, though exact treatment pauses depend on provider protocols. For localized barrier care, Dr. Dray recommends petrolatum-based ointments with hyaluronic acid for overnight lip repair, advising patients with active cheilitis to stick exclusively to plain petroleum jelly. To treat brittle, splitting nails, humectants such as urea and lactic acid enhance the water-binding capacity of nail proteins. Targeted ointments and lacquers provide superior adhesion and active ingredient penetration through the dense nail plate compared to standard body lotions. Dr. Dray emphasizes that safe dermatologic and systemic health practices rely on understanding physiological mechanisms—such as inflammatory acute phase responses, light spectra, and follicular biology—rather than responding to uncalibrated laboratory screening trends or unverified skincare routines.

Dr. Dray 指出，公众对日常防晒导致维生素D缺乏的担忧在很大程度上源于人为提高的诊断标准与对生理机制的误解；同时，她结合临床证据与药理学机制，针对色斑防护、健身房感染控制、特定角化性皮肤病及光电术后护理等常见疑难给出了循证建议。 维生素D假象与防晒霜的真实影响 (0:00) Dr. Dray 指出，室内不涂防晒霜并不能促进维生素D合成，因为普通窗户玻璃会完全阻隔合成所需的紫外线B（UVB），而穿透玻璃的紫外线A（UVA）甚至会降解皮肤内现有的维生素D。关于户外涂抹防晒霜是否降低维生素D水平，现有研究通常表明防晒霜不会削弱其水平，但以往试验多基于短暂的海滩暴晒，缺乏对高倍防晒（如 SPF 50 及以上）的充分测试。部分学者推测防晒霜通过过滤具有降解作用的 UVA 可能间接保护甚至促进维生素D合成，但该假说尚未得到证实。 针对所谓的维生素D“缺乏流行病”，Dr. Dray 联合内分泌学及流行病学观点指出，这主要是由于检验医学系统性调高了缺乏判定阈值，导致数百万健康人被机械地划入“缺乏”范畴，且伴随无症状群体的过度筛查。在生理机制上，维生素D属于负急性期反应物，在糖尿病、自体免疫疾病及癌症等慢性炎症状态下会自然下调，其降低常是炎症的结果而非病因；此外，作为脂溶性物质，它容易被体内脂肪组织隔离，而美国约有 43% 至 70% 的成人患有肥胖症。Dr. Dray 警告健康人群盲目大剂量补充维生素D并无明确健康收益，反而存在高钙血症及血管钙化风险。 色素沉着鉴别与有色防晒氧化管理 (5:42) Dr. Dray 说明老年斑（日晒斑）与黄褐斑在临床上属于不同实体，二者与炎症后色素沉着（PIH）同归于皮肤色素沉着大类。有色防晒霜中所含的氧化铁能够形成阻挡可见光的物理屏障，对肤色较深群体的色斑防御尤为关键。针对有色防晒霜带妆后逐渐变橙的现象，她解释这是氧化铁在皮肤表面发生化学氧化的结果。 为预防氧化变色，Dr. Dray 建议在护肤流程中精细化管理酸性活性成分：果酸（AHA）、水杨酸或左旋维生素C等酸性精华会加速氧化反应，应在涂抹后等待 5 至 10 分钟使其充分吸收干燥，再叠加有色防晒霜。此外，在防晒霜表层扫上一层控油矿物散粉或防晒定妆粉，能够吸附促进氧化反应的皮脂和汗液，从而维持色泽稳定。 汗孔角化症诊疗与乳酸真皮重塑 (7:07) 对于需要逆转皮肤变薄的群体，Dr. Dray 引用临床研究指出，5% 与 12% 浓度的乳酸铵（如 AmLactin）虽均能增加表皮厚度，但唯有 12% 浓度在每日使用两次且持续 3 个月的试验条件下成功诱导了真皮增厚；目前尚无证据支持每周仅涂抹三次能否建立或维持这种深层改善。 针对浅表播散型光化性汗孔角化症（DSAP），Dr. Dray 阐明该病为常染色体显性遗传病，由局部皮肤胆固醇合成缺陷引起，好发于四肢且紫外线为主要诱因。DSAP 病灶偶可直接恶变发展为鳞状细胞癌（SCC），且患者本身具有更高的皮肤癌基线风险。在治疗上，外用 5-氟尿嘧啶（5-FU）因靶向清除异常细胞常引发剧烈的红肿脱屑反应，外用咪喹莫特或新兴的外用他汀类药物亦可作为备选，冷冻、光动力疗法或激光剥脱虽能暂时破坏顽固皮损，但复发率依然偏高。 健身房病原体防御与真菌感染阻断 (11:58) 健身房共用器械与地垫主要潜伏两类病原体：金黄色葡萄球菌（引发脓疱疮和毛囊炎）与皮肤癣菌（引发体癣、足癣等）。针对易发葡萄球菌毛囊炎的人群，Dr. Dray 建议使用过氧化苯甲酰（Benzoyl Peroxide）沐浴露，其能深入毛囊杀灭细菌且不会诱发耐药性；普通沐浴露仅能清除表面污垢，而次氯酸喷雾仅适用于运动后舒缓泛红瘙痒，无法替代针对深层病原体的抗菌治疗。 为杜绝真菌传播，Dr. Dray 警告切勿在健身房光脚或仅穿袜子走动，并提出了“先穿袜子后穿内裤”的更衣准则。她解释了临床常见的“两足一手伴股癣”自体接种现象：患者若先穿内裤，脚部的足癣真菌极易黏附在内裤边缘并随提拉转移至腹股沟诱发股癣，同时污染主导操作的手部导致手癣。先穿袜子可在物理上阻断真菌转移链。此外，共用垫子务必在前后使用消毒湿巾擦拭，运动后应尽快洗澡或至少更换汗湿衣物。 痤疮印痕光电干预与毛发屏障护理 (17:30) 针对痤疮后遗留印痕，Dr. Dray 区分了强脉冲光（IPL）与脉冲染料激光（PDL）的适应证：IPL 覆盖宽光谱，更适于改善炎症后色素沉着（PIH）；而 PDL 专一靶向血管，是解决红斑（PIE）的首选。在日常清洁中，水杨酸洁面通常足以发挥辅助溶解粉刺的作用，但重度炎性痤疮仍需驻留型产品。对于宽光谱光（BBL）术前使用维A酸，虽有助于减少色沉并促进愈合，但具体用药浓度与停复工周期必须严格遵循施术医生的方案。 针对绝经后女性下巴突发粗硬毛发的困扰，Dr. Dray 澄清这通常是衰老过程中雌激素水平下降、毛囊局部雄激素受体相对兴奋导致的正常生理反应，可通过电解脱毛（破坏毛囊）或激光脱毛（需警惕反常性多毛）改善。此外，针对脆裂指甲，乳酸与尿素均可提升甲板保水力，膏状或甲油状配方因渗透附着力更强而更受推荐；夜间唇部修护则首推成分单纯的凡士林或含透明质酸的修护软膏，皮炎发作期应彻底远离复杂配方。 Dr. Dray 强调，许多日常护肤困惑与健康恐慌源自对检验指标和皮肤病理机制的片面解读。无论是面对维生素D水平、光电术后护理还是顽固皮损，消费者均应建立在严谨的生理学机制与临床试验设计之上审视风险收益，避免在缺乏适应证的情况下盲目补充或过度护理。

[10:28] Dr. Dray: Do one... no, do it the other way around! [7:57] Dr. Dray: wants to say F-you [11:58] Dr. Dray: two feet, one hand, and jock itch

[0:00] Well, hey guys. Happy Sunday. We are [0:02] back for part two of the weekend Q&A. If [0:04] you missed yesterday's Q&A, go ahead and [0:06] check it out. It's in the skincare Q&A [0:09] playlist where I keep all of these [0:10] videos. If you ever miss one or you're [0:12] like, "Oh, I don't know. Did she answer [0:13] my question?" You can go back and watch [0:15] them and they all have timestamps in [0:17] them. So, you don't even have to watch [0:18] the whole thing. You can just scan the [0:20] chapters breakdown and find out what [0:22] questions were asked. You can skip [0:23] around, but let's get into this Q&A. I [0:26] live in the Northeast and am at risk for [0:29] osteoporosis. If I don't wear sunscreen [0:31] when I'm spending the day at home, will [0:33] that theoretically help to increase [0:35] vitamin D levels? No. So, when you're [0:37] indoors, your skin is not going to be [0:40] synthesizing vitamin D from the sun. In [0:42] order for your skin to produce vitamin D [0:44] from the sun, you need the sun's UVB [0:47] rays, which are blocked out by window [0:49] glass. In fact, a lot of people argue [0:51] that because we spend so much time [0:53] indoors, we get mostly UVA, which [0:56] compromises actually skin levels of [0:59] vitamin D. It degrades it. Now, the [1:01] question becomes, when I'm outdoors [1:03] then, will wearing sunscreen in what [1:05] limited sun exposure I do get, will that [1:08] compromise my vitamin D? The research [1:09] that we have today does not suggest that [1:12] wearing sunscreen lowers vitamin D with [1:14] a few caveats in that. We don't have [1:17] studies looking at your specific [1:19] circumstance. Most of the studies [1:21] looking at sunscreen and vitamin D [1:23] levels showing, "Oh, yeah, it doesn't [1:25] seem to make a difference." Um, are done [1:27] like at for people at on the beach, [1:29] which you know, it could be very [1:30] different for people who are getting [1:33] such little sun exposure due to where [1:35] they live. Also, those studies don't [1:38] look at high SPF sunscreens like SPF 50 [1:41] and above. People theorize that wearing [1:44] sunscreen can actually improve skin [1:46] synthesis of vitamin D because [1:49] sunscreens can block out that UVA piece [1:51] which degrades vitamin D. But, that's [1:53] never been proven before either. So, I [1:56] would not overemphasize that per se, but [1:58] it is compelling. I tend to be a little [2:01] bit skeptical of all of the vitamin D [2:03] pearl clutching in general. I think we [2:05] have overblown and misrepresented the [2:08] plot, so to speak, of vitamin D. Vitamin [2:11] D is critical for bone health, for [2:13] overall health, absolutely. However, [2:15] where we have run into, I believe, [2:17] problems, and I'm not alone, there are a [2:19] lot of experts in endocrinology to [2:22] likewise agree, epidemiologists, that we [2:24] have created an epidemic of low vitamin [2:26] D by raising what we consider to be low [2:31] vitamin D levels. So, what do I mean by [2:33] that? Well, when you raise the threshold [2:35] value required to trigger a label of low [2:38] vitamin D, you're going to label more [2:41] people with low vitamin D. Couple that [2:44] with the fact that there has been a mass [2:47] increase in the demand for vitamin D [2:51] testing, despite the fact that research [2:54] shows that in an otherwise healthy [2:56] adults, screening for vitamin D is not [2:59] helpful. So, we're screening more people [3:03] because they want to be screened, and we [3:05] have raised the level of vitamin D [3:08] needed to trigger that. So, as a result, [3:11] higher vitamin D levels now get you [3:12] labeled as having low vitamin D. And [3:15] those labels don't take into account a [3:17] lot of nuance when it comes to vitamin [3:19] D. For example, almost no one in this [3:22] discussion ever mentions the fact that [3:24] vitamin D is a negative acute phase [3:27] reactant. What do I mean by that? Well, [3:29] maybe you have heard of acute phase [3:31] reactants like your CRP. That is [3:33] something that gets raised, elevated. [3:35] It's a marker that is high when you have [3:38] some sort of chronic inflammatory state, [3:40] such as diabetes, autoimmune disease. [3:43] The flip side of that is a negative [3:44] acute phase reactant will drop in the [3:47] setting of an inflammatory disorder. So, [3:49] is it any wonder that low vitamin D is [3:52] associated with chronic inflammatory [3:55] disorders. But does that mean that [3:57] that's what caused those disorders or is [4:00] it low because they are chronic [4:01] inflammatory disorders and it is a [4:03] negative acute phase reactant? That's [4:05] something that is almost never brought [4:07] into the vitamin D conversation. Then [4:10] the other thing is that your vitamin D [4:13] levels will appear low if you have [4:16] excess body fat because it is a [4:18] fat-soluble vitamin and it will get [4:19] sequest questioned in adipose tissue. [4:22] And is it any wonder that when 43% by [4:25] newer estimates actually up to 70% of [4:28] the US population, I will say, qualifies [4:31] as having obesity, is it any wonder that [4:33] you're seeing this epidemic of low [4:36] vitamin D? We have more fat to sequester [4:38] the vitamin D. We have more chronic [4:40] inflammatory conditions, both the result [4:43] of more people having excess body fat, [4:46] diabetes, hypertension, cardiovascular [4:48] disease, more cancers. So we have the [4:51] negative acute phase reactant aspect of [4:54] things like that. Plus now what was once [4:56] a normal vitamin D, because we've [4:57] changed the threshold on lab tests to [5:00] trigger oh that's low vitamin D. Because [5:02] we've changed that, now almost everyone [5:03] appears to have low vitamin D and it's [5:05] resulted in this frenzy of vitamin D [5:08] supplementation and it's largely fueled [5:11] overuse, in my opinion, of vitamin D [5:13] supplementation, which I'm sure, you [5:15] know, there's some evidence actually [5:16] that in certain groups, certain [5:18] situations, vitamin D supplementation [5:20] absolutely makes a difference. But for [5:22] otherwise healthy adults, the research [5:24] suggests that just supplementing with [5:26] vitamin D doesn't actually move the dial [5:28] and it puts you at risk for excess [5:30] calcium absorption, calcification. So [5:32] it's not without harm. I think it's just [5:35] a narrative that fuels excess [5:36] consumption of vitamin D supplementation [5:39] without any real understanding of its [5:41] clinical relevance. Are age spots the [5:43] same thing as melasma and [5:44] hyperpigmentation and will it be helped [5:47] by a tinted sunscreen? Are there tips [5:50] then for not having your tinted [5:52] sunscreen turn orange? So, age spots are [5:54] not the same as melasma, but melasma, [5:56] age spots, and post-inflammatory [5:58] hyperpigmentation are all types of [6:00] hyperpigmentation. So, when it comes to [6:02] the tinted sunscreen piece of things, [6:04] clinical evidence suggests that using a [6:06] tinted sunscreen because of the iron [6:09] oxides in the tint, that can offer you [6:11] some protection against the visible [6:13] light from the sun that plays a role in [6:16] hyperpigmentation, especially in deeper [6:18] skin tones. So, tinted sunscreens are [6:20] recommended for people who have melasma [6:23] and post-inflammatory hyperpigmentation, [6:25] and they likely can benefit sunspots, [6:27] age spots as well. As far as the tinted [6:30] sunscreens turning orange, that has to [6:31] do with, I believe, the oxidation of the [6:33] iron oxides. There are certain [6:35] ingredients in your skin care routine [6:37] that might make that more of a problem, [6:39] like your alpha hydroxy acids, your [6:41] salicylic acid, your ascorbic acid [6:44] vitamin C serums. Um, so, if you're [6:46] using those things, you might wait 5 to [6:48] 10 minutes, make sure they're fully [6:49] absorbed and dried down and everything [6:51] before applying your sunscreen. Some [6:53] people also find that applying a matting [6:56] powder or mineral powder or one of the [6:58] SPF powders over can also cut down on [7:01] the oxidation because part of it is [7:03] related to the sweat and the oils. So, [7:05] that powder might help to absorb some of [7:07] your oils. Do we need to use M-Lactin [7:09] daily to obtain the deeper skin layer [7:11] benefits, or would three times a week be [7:13] sufficient? So, no one's looked uh the [7:15] three times a week regimen, and the [7:17] studies that we have on uh 12% ammonium [7:20] lactate, which is what is in the [7:21] M-Lactin daily, um it's not like we have [7:23] a ton, but the ones that we have that [7:25] show that it can reverse epidermal and [7:27] dermal um thinning. Um namely, one of [7:30] them that compares 5% to 12%, and shows [7:33] that both 5 and 12% result in epidermal [7:35] thickening, but 12% results in the [7:38] dermal thickening. And that study, the [7:40] patients were applying the um lactic [7:43] acid, the ammonium lactate twice a day [7:46] for 3 months. So, that's what the study [7:49] looked at as far as frequency, and it's [7:52] not clear then if using it less [7:54] frequently gets you the same results, [7:56] does it maintain the results? We don't [7:58] know. Please educate us on DSAP and [8:00] treatments. DSAP stands for disseminated [8:03] superficial actinic porokeratosis, a [8:06] complicated name for a chronic [8:08] hereditary skin condition where you have [8:11] these little round, scaly, rough spots, [8:15] usually on the arms and the legs. It's [8:17] thought to be related to a genetic [8:18] mutation that is inherited in an [8:20] autosomal dominant fashion in which the [8:22] skin has some sort of problem with [8:24] cholesterol synthesis. It is triggered [8:26] by sun exposure. It's brought out often [8:28] times in the summer months. So, sun [8:30] protection is really important. Very, [8:32] very rarely, squamous cell carcinoma has [8:34] been known to arise in a lesion of DSAP. [8:38] It's It's very rare, but it's something [8:40] that has been known to happen, and so [8:42] ongoing sun protection and and [8:44] monitoring is necessary. If you notice [8:46] any changes, that's really important. [8:47] But as far as therapies, unfortunately, [8:49] nothing really works great. You can try [8:52] to As far as topicals, there is [8:55] 5-FU. I call it 5-FU. It stands for [8:59] 5-fluorouracil, but I call it 5-FU [9:01] because when you use it, the patient [9:03] wants to say "F you" because it can be [9:05] pretty uncomfortable to use. I mean, you [9:06] guys think that tretinoin uglies that [9:09] they talk about are bad with the dryness [9:10] and the peeling, Efudex will really jack [9:13] you up because it's like really buzzing [9:16] around [clears throat] in there with the [9:17] abnormal cell population. So, that can [9:19] be effective. Also, the immunomodulator, [9:22] a topical imiquimod, which is what we [9:23] also use for like genital warts. It's [9:25] called Aldara, that's a brand name. [9:27] Interestingly enough, a topical statin [9:29] can help quite a bit. [9:31] You know, that shows promise as well, [9:32] but nothing really like erases it or [9:34] gets rid of it, and you do want to keep [9:36] protecting your skin from the sun. Now, [9:38] there are some destructive therapies [9:40] that can kind of help. I personally have [9:42] never had good success with those like [9:44] cryotherapy or um photodynamic therapy [9:47] can be helpful for some people, but it [9:49] it often comes back. So, if you're [9:51] wondering about photodynamic therapy, I [9:53] have a video that details that and you [9:55] know, it's it's it's something that I [9:57] think is worthwhile for a lot of people. [9:59] So, check that video out, but yeah, that [10:01] can be helpful and then um of course [10:03] resurfacing lasers can get in there and [10:05] try and zap them. Uh but really it's you [10:08] know, unfortunately not not a straight [10:10] shoot. Like I said, you can develop skin [10:12] cancers and people who make this, they [10:14] tend to have a greater risk for other [10:16] skin cancers. So, it just kind of buys [10:18] you some perhaps more frequent visits to [10:20] the dermatologist for skin checks and [10:22] just something to be aware of. But yeah, [10:24] sadly we we just don't have like a great [10:26] slam dunk treatment for that. It can be [10:28] pretty tough. Postmenopausal woman here, [10:30] why do I grow tough spiky chin hairs [10:33] now? I get new ones daily, no joke. [10:35] Anything to prevent or my hormones out [10:36] of whack? So, no, your hormones are not [10:38] out of whack. Um for whatever reason, we [10:41] will have hair follicles on our body, on [10:43] our face that are like hyper responsive [10:46] to androgen hormones and to to hormonal [10:49] signals. And so, as you go through [10:51] menopause, the natural decline in [10:53] estrogen that happens is a natural [10:54] phenomenon that happens with aging and [10:56] responsible for a lot of the symptoms of [10:58] menopause, but when you have that [11:00] decline in estrogen, well, at the level [11:02] of the follicle, there's more of a [11:04] presence if you will of [11:06] non-estrogen hormones. All of a sudden [11:08] it's like, all right, well, I've got [11:10] this one follicle that's very [11:12] responsive. So, it's just going to go [11:15] from being a vellus hair to a terminal [11:16] hair. It's brutal because like the same [11:19] process that does that on your face, [11:21] these chin hairs, is the same process [11:24] that does the complete opposite more or [11:26] less on your scalp, miniaturizes. Like, [11:28] do one, no, do it the other way around. [11:31] But to get back to the rogue chin here, [11:33] a lot of women just tweeze that. Um but [11:36] that's a situation where electrolysis [11:38] can come in clutch cuz it'll create just [11:40] a focal scarring alopecia there. But you [11:42] know, if you just have one or two, it [11:43] can really, you know, take that off your [11:45] plate, quite literally. Laser hair [11:47] removal if you've got a ton, but uh you [11:49] know, sometimes you get paradoxical [11:51] hypertrichosis with laser hair removal. [11:54] So, like I said, it kind of depends on [11:55] how much you've got, the color, and you [11:58] know, what you want to do. What's the [11:59] best way to prevent skin infection from [12:01] shared mats and equipment? Rinsing off, [12:03] toweling off, then using hypochlorous [12:05] acid spray before getting dressed to go [12:06] back to work, showering with benzoyl [12:08] peroxide face wash, or showering with [12:10] regular body wash. The concerns around [12:12] shared equipment in the gym largely are [12:14] around staff skin infections, common, [12:18] all right? Like, for example, if you're [12:19] a wrestler, they commonly get all kinds [12:21] of impetigo because they're sharing, you [12:24] know, their bodies are often coming in [12:25] contact with one another, mats, all that [12:28] kind of stuff. And um various forms of [12:30] ringworm, dermatophyte skin infections, [12:32] athlete's foot, um ringworm proper, uh [12:35] tinea gladiatorum, it's even called for [12:38] the wrestlers. And so, what should you [12:40] do? Well, when it comes to the staff [12:41] thing, that's really where the benzoyl [12:43] peroxide acne washes are super helpful [12:46] because if you're someone who deals [12:47] especially with recurrent staff [12:49] folliculitis, impetigo, the benzoyl [12:52] peroxide targets the surface, but it [12:54] also gets down into the follicle to kill [12:57] that bad staff bacteria off and keep it [12:59] at bay. And there's no uh concern for [13:02] antimicrobial resistance to benzoyl [13:04] peroxide like some other anti-infectives [13:06] that you might uh pursue. Regular body [13:09] wash is still helpful because it's going [13:11] to remove sebum, dirt, and bacteria from [13:14] like the surface, but it doesn't have [13:15] that treated staff-specific disinfecting [13:18] thing. The benzoyl peroxide isn't [13:20] necessarily that helpful though for [13:23] preventing ringworm per se. Hypochlorous [13:25] acid is fantastic to spray on the skin [13:28] to reduce inflammation, to reduce itch, [13:30] for some antimicrobial activity, but [13:32] it's definitely not a treatment for [13:33] staph or for preventing staph. It's not [13:36] a treatment for dermatophyte infections [13:38] or preventing them. So, it may help cut [13:40] down on workout-related skin irritation, [13:43] but it's not truly a treatment for those [13:45] things. Now, the other thing that's [13:46] really important is wiping down the mats [13:48] with like a disinfecting cloth, any [13:50] shared equipment, very important. Don't [13:52] share towels, washcloths, the gym [13:55] towels, you know. Be real careful with [13:57] those because they harbor staph. And the [14:00] the thing about not only the staph, but [14:03] the thing about ringworm is that it [14:05] makes these little spores. So, in [14:06] addition to wiping stuff off, do not go [14:08] barefoot or, you know, in just socks [14:11] even in the gym. I see people lifting [14:13] weights in the weight room take their [14:16] shoes off. And I guess it's so they have [14:17] a good grip with the floor or whatever. [14:19] I don't know. I'm not going to pretend [14:19] to be some weightlifting expert. I don't [14:21] recommend doing that because you can [14:23] easily get toenail fungus, foot fungus. [14:26] And then, if you pick it up on your [14:27] feet, the other thing that can happen is [14:29] the two feet, one hand, and jock itch [14:32] phenomenon where basically most people [14:34] put their underwear on when they get out [14:36] of the shower before their socks. But, [14:38] if you have ringworm on your If you have [14:39] a athlete's foot, which is ringworm [14:41] basically, on your feet or toenail [14:43] fungus, you can inoculate that You know, [14:45] the fungal spores can get on your [14:47] underwear, transfer onto your hand as [14:49] you pull your underwear up to your [14:50] groin, so you get jock itch, and you'll [14:52] get tinea manuum of the hand that you've [14:54] been pulling your underwear up with. So, [14:56] in those situations, it's recommended to [14:58] put your socks on first reduce the risk [15:00] of that. But, yeah, [15:02] don't walk around barefoot or wear in [15:04] the gym would be the other thing. Get [15:06] out of your gym clothes ASAP. Change [15:09] into, you know, take a shower. You don't [15:11] necessarily, you know, it's a good idea [15:13] to do the benzoyl peroxide wash thing if [15:15] you're at a, you know, a high-traffic [15:18] gym, I would say. I mean, you can get it [15:20] It only takes one or one person with [15:22] staff to to create a problem. So, but [15:24] it's going to be more likely if you're [15:25] in a high-traffic situation. If you're [15:27] someone though who already is getting [15:29] recurrent staph infections, then yeah, [15:31] absolutely. Some people have the staph [15:33] bacteria that colonizes their nose. They [15:35] have to undergo um treatment with [15:37] mupirocin into their nose episodically [15:39] to cut down on recurrences. It's really [15:41] It's really a a burden for them. So, if [15:43] you're one of those people, then yeah, [15:44] then the benzoyl peroxide thing comes in [15:46] handy. But, if you don't have a lot of [15:48] time, you're otherwise not getting skin [15:50] infections at the moment, well, then you [15:51] can at least just just rinse the skin [15:54] off, get out of the sweaty clothes, and [15:56] put dry clothes on to leave. But, [15:58] ideally you are taking a shower. I'm [16:00] looking for a new lip mask for bedtime. [16:02] What are your favorites? CeraVe healing [16:04] ointment, cuz it's got a little bit of [16:06] something extra, I find, as far as [16:08] especially for the lips. That hyaluronic [16:10] acid in there, I guess, really offers [16:12] some kind of plumping effect. I mean, it [16:14] really It really works above and beyond. [16:16] My second uh favorite, which is just [16:18] plain petroleum jelly, aka Vaseline. [16:20] Love that. Like, if I have an active lip [16:22] dermatitis, dry cracked lips, I'm not [16:24] using any kind of product. I am using [16:27] plain petroleum jelly. That's what I'm [16:29] using. The other one I love, actually, [16:31] that I like to keep in my travel bag, [16:32] and it's great for the dry climate like [16:35] in the hotels and stuff, is the [16:37] Neutrogena Hydro Boost Hydrating [16:39] Overnight Lip Sleep Mask. It has [16:41] hyaluronic acid, no fragrance. I also [16:43] really loved the COSRX Ceramide Lip [16:47] Butter Sleeping Mask. That is wonderful. [16:50] using Illiyoon's Intensive Ceramide Lip [16:53] Mask with ceramides and murumuru butter. [16:56] I really like that. I think I mentioned [16:57] I ordered it when I reviewed their uh [17:00] lotion and their toner for you guys in a [17:02] video a while back, and I I've really [17:04] liked that product quite a bit. It's [17:06] quite good. I I would recommend that as [17:08] well. The one that surprised me, because [17:10] I've never used anything from this brand [17:12] that I thought was worth a fart, and [17:14] it's super overpriced, but this product [17:16] was good. Um the Tatcha Kissu Lip Mask, [17:19] that I bu- I want to say it has [17:20] fragrance. I loved that. I've gone [17:22] through like two, maybe three jars of [17:25] it. I I have not gone back to it in [17:27] several years, simply because it's very [17:29] expensive, so it's kind of a splurge. [17:31] Which works better for post-inflammatory [17:32] hyperpigmentation following acne? Is it [17:36] IPL or PDL? So, intense pulse light is [17:39] IPL. Uh, it's not technically a laser as [17:42] a reminder. It's actually a better [17:43] choice for post-inflammatory [17:45] hyperpigmentation than pulse dye laser. [17:47] Pulse dye laser is very good for [17:49] targeting vascular things, so it's a [17:51] great choice for post-inflammatory [17:53] erythema. And, you know, following acne, [17:55] for example, you might Many people have [17:57] both things going on. So, both can [17:59] certainly be beneficial. Intense pulse [18:02] light uses like a more of a broad [18:03] spectrum of light, so that's why it's [18:05] not a laser, okay? Cuz it's using more [18:07] than one wavelength of light. But then, [18:09] you know, more pigment-specific lasers [18:11] like, uh, Q-switch laser, for example. [18:13] Can you use a salicylic acid face wash [18:15] for acne-prone skin? Is that enough, or [18:17] do we need a separate BHA [18:18] serum/exfoliant [18:20] in our routine? Um, for a lot of people, [18:22] that's more than adequate, um, because [18:24] they get the benefits of salicylic acid [18:26] in their routine, and, you know, that's [18:27] all that they need. Some people find [18:28] that they don't respond as well to the [18:31] wash forms, and they do better with a [18:33] leave-on, especially people who have [18:35] more inflammatory, stubborn acne. I [18:36] mean, salicylic acid is helpful for [18:38] acne, but I've never found that by [18:40] itself it moves the dial much for acne. [18:43] It's kind of just like play it has a [18:44] supporting role. I think probably in [18:46] helping to get better penetration to the [18:48] follicle of stuff that actively treats [18:50] acne, cuz it is comedolytic, and it does [18:52] localize fairly well into the pore. But, [18:54] you can get that in there with a wash. [18:57] But, I think people my just experience, [18:59] people who tend to have more [19:00] inflammatory, thicker, stubborn acne [19:02] tend to do better with a leave-on form [19:04] of salicylic acid, but it varies a lot [19:06] from person to person. There's no like, [19:08] this is the best gold standard version [19:10] of it. Should I take a break from [19:12] tretinoin before or after BBL, aka [19:15] broadband light treatment? Pretreatment [19:17] with tretinoin is is actually helpful. [19:19] It's thought to not only significantly [19:21] cut down on the risk of [19:22] post-inflammatory hyperpigmentation, but [19:25] for light-based devices that are [19:26] resurfacing, it's thought to aid in [19:29] wound healing. Unfortunately, there's no [19:31] consensus on the like regimen of [19:33] starting it in advance and stopping it [19:36] and what the best percentage is. You [19:37] don't want to do anything that's going [19:38] to increase irritation. They might tell [19:40] you to stop it. Do whatever they tell [19:41] you, okay? Always prudent to minimize [19:44] risk. And then how long after the BBL [19:46] should you resume? You know, that's [19:48] another one that's kind of provider [19:50] dependent. And it's also going to depend [19:52] to like on your overall skin tone and [19:54] other things that you're dealing with. [19:55] So again, I would I would ask them, but [19:57] do know that there's not like a solid [19:59] consensus on starting and stopping [20:01] topical retinoids around different [20:03] light-based devices. Does lactic acid [20:06] hydrate the nail plate in a similar way [20:08] to urea, which is more effective in this [20:10] way? So both are humectants, and they [20:12] can improve the water binding sites in [20:14] the nail plate and cut down on the risk [20:16] of the proteins in the nail getting [20:18] dehydrated from exposures to water and [20:21] surfactants and detergents and things. [20:22] Ultimately, that can really help with [20:24] brittle nails. As far as which one is [20:26] better than the other, we don't really [20:27] have like head-to-head comparison [20:29] studies between the two. Now, they also [20:31] are very helpful for softening, [20:33] hydrating, and improving the health of [20:35] the skin around the nails, the cuticles [20:37] as well. And ultimately for cutting down [20:40] on nail splitting. You can use both. You [20:42] know, for example, people use AmLactin [20:45] lotions on their hands, get benefits to [20:47] the nails that way. But like the the [20:49] thing I like for nails is either the [20:52] lacquer from Kerasal, which has urea and [20:55] not lactic acid, salicylic acid. I like [20:57] the lacquer, and I also like the [20:59] ointment because those have real good [21:01] staying powder [21:03] staying power on the nail. Like they'll [21:05] last a lot longer. They'll they'll [21:06] adhere. and they really allow for good [21:08] penetration of those ingredients as [21:10] well. Especially like ointments we know [21:12] enhance penetration of things. And nail [21:14] plate penetration is a lot more [21:16] challenging than getting stuff to [21:18] penetrate other skin [21:20] you know, other surfaces of the body for [21:21] example. All right guys, that about [21:23] wraps up the weekend Q&A. I hope you [21:25] guys are having a fantastic weekend. And [21:27] again, if you have any questions that [21:29] you want me to answer in upcoming videos [21:31] that are skin care, hair care, or nail [21:32] related, please leave them in the [21:34] comments of this video because that's [21:36] where I'm going to come back and check [21:37] for the upcoming Q&A, which will happen [21:40] next weekend, 11:00 a.m. Central [21:41] Standard Time. But if you guys enjoyed [21:43] today's video, please give it a thumbs [21:45] up, share it with your friends, and as [21:46] always, don't forget sunscreen and [21:48] subscribe. I'll talk to you guys [21:49] tomorrow. Bye. [21:51] >> [music] [22:05] [music]