Dermatologist Dray Clears Azelaic Acid Stacking Across Topicals

Dr Dray

Azelaic acid carries no chemical incompatibilities with skincare actives like dapsone or benzoyl peroxide, making barrier tolerance rather than molecular conflict the sole limit on combination regimens.

AI-assisted summary of Can You Mix Azelaic Acid With Anything? Dermatologist Q&A — original source. Check the original for full context.

Source published: 2026-08-16

Key ideas

Hydroxypinacolone retinoate (HPR) lacks clinical evidence proving it matches standard retinoids like retinol or tretinoin despite cosmetic marketing claims. (1:06)
Azelaic acid has no chemical contraindications preventing combination with actives like dapsone or benzoyl peroxide; barrier tolerance to dryness is the only limiting factor. (15:11)
Both 12% ammonium lactate (AmLactin) and tretinoin stimulate thickening across both the epidermis and the dermis, helping counteract photoaging and steroid-induced skin thinning. (16:18)
Heavy moisturizers do not cause milia; milia are subepidermal keratin cysts tied to skin trauma, genetics, or photoaging rather than cosmetic product weight. (3:30)

Detailed notes

## Background Published on YouTube on August 16, 2026, by dermatologist Dr. Dray, this video is the second installment of a weekend skincare Q&A series. The page description outlines that she evaluates audience questions concerning UltraClear laser treatments, HPR, retinoid alternatives, eyelid care, sunscreen stability, melasma lasers, pumpkin seed oil for hair loss, dandruff, sensitive skin exfoliation, active serums, azelaic acid with dapsone, and AmLactin for skin thinning.

## TL;DR In this comprehensive consultation-style Q&A, Dr. Dray separates dermatological evidence from cosmetic marketing claims across a range of trending treatments and ingredients. She debunks the notion that hydroxypinacolone retinoate (HPR) matches true retinoids or that topical pumpkin seed oil treats hair loss, while clarifying that heavy moisturizers do not cause milia. She provides practical guidance on product layering, confirming that azelaic acid can safely combine with dapsone provided barrier irritation is managed, and that daily gentle washcloth use is acceptable unless water stings. Finally, she clarifies formulation mechanics, explaining that standalone serums offer no clinical superiority over active moisturizers and that both 12% ammonium lactate and tretinoin thicken both the epidermal and dermal layers.

## Atmosphere & style The video delivers a no-nonsense, pragmatic, and educational tone that cuts through commercial skincare hype with clinical authority and dry wit. It feels like an open, candid consultation where Dr. Dray pulls back the curtain on cosmetic labeling, sharing relatable personal experiences with atopic dermatitis and barrier sensitivity to ground her advice. The delivery remains reassuringly steady and accessible throughout, transitioning smoothly from histological mechanisms to straightforward daily routines before wrapping up with her signature reminder to wear sunscreen.

## Bulletin - [01:06](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=66s) Hydroxypinacolone retinoate (HPR) lacks clinical evidence proving it matches standard retinoids like retinol or tretinoin despite cosmetic marketing claims. - [15:11](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=911s) Azelaic acid has no chemical contraindications preventing combination with actives like dapsone or benzoyl peroxide; barrier tolerance to dryness is the only limiting factor. - [16:18](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=978s) Both 12% ammonium lactate (AmLactin) and tretinoin stimulate thickening across both the epidermis and the dermis, helping counteract photoaging and steroid-induced skin thinning. - [03:30](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=210s) Heavy moisturizers do not cause milia; milia are subepidermal keratin cysts tied to skin trauma, genetics, or photoaging rather than cosmetic product weight.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=0s) The UltraClear cold ablative fractional laser smooths fine lines and acne scars with minimal downtime, but clinical outcomes vary widely across patients. - [01:06](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=66s) Hydroxypinacolone retinoate (HPR) is a retinol ester without the robust clinical data necessary to claim equivalence to gold-standard retinoids. - [01:43](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=103s) Over-the-counter retinol and retinaldehyde can cause delayed, cumulative irritation after several weeks, challenging the assumption that they are universally gentler than prescription adapalene. - [01:43](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=103s) Buffered prescription vehicles like Altreno lotion help mitigate dryness, whereas RAR-gamma-selective retinoids like Aklief can still trigger notable irritation. - [03:30](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=210s) Dedicated eye creams are largely marketing fluff; simple facial moisturizers or glycerin applied away from the lash margin effectively hydrate the eyelids. - [03:30](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=210s) The belief that heavy moisturizers cause milia is a myth; milia are keratin-filled cysts resulting from trauma, genetics, or photoaging rather than skincare base weights. - [07:04](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=424s) While facial sebum acts as a lipid solvent that can break down UV filters over time, modern sunscreens rely on film-forming polymers and oil-absorbing powders to maintain stability. - [07:52](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=472s) Vbeam pulsed dye laser can address vascularity in melasma, but its use carries a risk of inducing post-inflammatory hyperpigmentation if not carefully titrated with low fluences. - [08:53](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=533s) Topical pumpkin seed oil lacks credible clinical evidence for reversing hair loss; viral claims stem from a small, limited study on oral supplementation. - [09:39](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=579s) Applying scalp oils does not have strong clinical evidence linking it to worsening dandruff, although patients experiencing flares should discontinue use. - [11:13](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=673s) Daily washcloth cleansing is safe and helps atopic dermatitis patients remove sweat and debris, but should be paused if skin barrier damage causes shower water to sting. - [13:16](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=796s) The term 'serum' lacks a regulatory definition; well-formulated moisturizers containing active ingredients deliver equivalent efficacy to standalone serums. - [15:11](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=911s) Azelaic acid can be paired safely with dapsone and other active ingredients, as long as combined cutaneous dryness and peeling are monitored. - [16:18](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=978s) Ammonium lactate at 12% thickens both the epidermis and the dermis, mirroring tretinoin's structural benefits for thinning skin without being superior to it.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=0s) Introduction and the UltraClear Laser

Dr. Dray welcomes viewers to part two of the weekend skincare Q&A, reminding everyone that all installments are archived in the skincare Q&A playlist and organized with timestamps for easy navigation.

She jumps straight into the first audience inquiry regarding the UltraClear laser. Dr. Dray explains that UltraClear is a cold ablative fractional laser designed for skin rejuvenation. It functions by vaporizing the outermost layers of the skin while concurrently stimulating collagen remodeling deep within the dermis. This makes it a viable candidate for general photo-rejuvenation—smoothing fine lines, improving rough texture, balancing uneven skin tone, and refining certain types of acne scars.

One of its main appeals is that it is safe across all skin types and comes with minimal downtime, allowing patients to heal quickly without having to retreat from public-facing life. However, Dr. Dray emphasizes that individual outcomes vary substantially; while the marketing makes it look widely appealing, not every patient walks away with impressive results.

[01:06](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=66s) Hydroxypinacolone Retinoate (HPR) vs. Retinol

A viewer inquires about the "new HPR," leading Dr. Dray to clarify that hydroxypinacolone retinoate is neither new nor a medical-grade miracle. It is a cosmetic ingredient categorized as a retinol ester. Despite trendy brand marketing, she points out that robust clinical data demonstrating that HPR matches the performance of gold-standard retinoids—such as retinol, retinaldehyde, or tretinoin—simply does not exist.

She notes that while HPR might offer mild antioxidant activity, she finds its commercial positioning frustrating: "it really kind of grinds my gears when that gets marketed as like a retinol." Labeling it as an equivalent alternative misleads consumers into expecting the well-documented collagen-boosting and anti-wrinkle benefits of true retinoids without getting the proven clinical track record.

[01:43](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=103s) Retinoid Alternatives for Sensitive Skin: Adapalene, Altreno, and Aklief

When asked what vitamin A derivative might work if adapalene proves too harsh, Dr. Dray gives a candid, experience-based response. Over-the-counter options like cosmetic retinol or retinaldehyde are the conventional recommendation, but she warns against believing the myth that they are universally gentle. In her personal experience, cosmetic retinols and retinaldehydes can provoke notable redness, peeling, dryness, and sensitivity—often more aggressively than adapalene. With over-the-counter products, irritation often "sneaks up on you" after several weeks of continuous use, whereas prescription tretinoin causes acute irritation almost immediately.

For those who fail to tolerate standard adapalene, Dr. Dray recommends consulting a dermatologist for prescription vehicles designed specifically to offset barrier compromise: - **Altreno lotion:** A formulation containing tretinoin suspended with hydrating vehicles like hyaluronic acid and soluble collagen, engineered to buffer peeling and dryness. - **Aklief (trifarotene):** A fourth-generation topical retinoid marketed for selective retinoic acid receptor-gamma (RAR-$\gamma$) specificity to minimize adverse effects. Dr. Dray notes that despite the theoretical advantages, clinical practice reveals that trifarotene can provoke just as much irritation as traditional retinoids.

```mermaid flowchart TD accTitle: Retinoid Tolerance and Irritation Pathways accDescr: Flowchart detailing patient tolerance routes from adapalene to cosmetic formulations or buffered prescription vehicles.

A["Patient Intolerant to Adapalene"] --> B["OTC Cosmetic Alternatives"] A --> C["Prescription Vehicle Adjustments"]

subgraph OTC ["Over-the-Counter Retinoids"] B --> B1["Retinol & Retinaldehyde"] B1 --> B2["Irritation can sneak up after 2–3 weeks"] end

subgraph RX ["Prescription Formulations"] C --> C1["Altreno (Tretinoin Lotion)"] C1 --> C2["Buffered with Hyaluronic Acid & Collagen"] C --> C3["Aklief (Trifarotene)"] C3 --> C4["RAR-gamma specific, but often still irritating"] end ```

[03:30](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=210s) Eyelid Moisturizers, Application Technique, and Debunking the Milia Myth

Addressing a question about daytime moisturizing for delicate eyelids when petroleum jelly feels too heavy, Dr. Dray explains that almost any gentle facial moisturizer will suffice. Dedicated "eye creams" are predominantly "marketing fluff" and glorified moisturizers in miniature packaging, unless they contain active ingredients that specifically necessitate specialized buffer formulations.

However, patients with sensitive eyelids should steer clear of lotions containing alpha hydroxy acids (glycolic, lactic, or mandelic acid) or salicylic acid, as chemical exfoliants readily inflame the thin periorbital barrier.

To care for the eye area without adverse effects, Dr. Dray outlines specific guidelines: - **Keep away from the lash margin:** Never apply any skincare formula within one millimeter of the lash line to keep product from migrating directly into the eye. - **Use minimal product:** Avoid the heavy globbing often seen in social media tutorials; a tiny "rice grain amount" split between both eyes is plenty to hydrate the upper lid and under-eye area. - **Accessible staples:** Simple drugstore products like Lubriderm lotion or Vanicream moisturizing cream function exceptionally well around the eyes without paying a premium. - **Glycerin solutions:** Pure humectants offer long-lasting relief without heaviness. Dr. Dray recommends using La Roche-Posay Cicaplast Gel B5 (a soothing glycerin-based protectant) or a single drop of Now Foods Vegetable Glycerin patted over damp skin to plump up dehydration lines.

Dr. Dray firmly dispels the widespread myth that heavy moisturizers trigger milia. Milia are keratin-filled subepidermal cysts stemming from trauma, skin injury, genetic predisposition, extensive photoaging, or underlying autoimmune connective tissue diseases—they appear spontaneously even in infants. There is zero clinical evidence linking specific cosmetic vehicle weights to milia formation, and no formulation can accurately be labeled as "milia-safe" or "milia-unsafe."

[07:04](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=424s) Sebum, Sunscreen Breakdown, and Reapplication

A viewer asks whether natural facial sebum degrades water-resistant sunscreen similarly to an oil cleanser, necessitating frequent reapplication on oily complexions. Dr. Dray acknowledges that sebum can indeed challenge sunscreen performance. Sebum acts as a lipid solvent that may dissolve certain UV filters, disrupt polymeric film-formers, and oxidize over the course of the day, compromising the uniformity of the protective barrier.

Nevertheless, cosmetic chemists anticipate these factors. Modern high-performance sunscreens integrate resilient film-forming polymers, oil-absorbing silica, and specialized powders designed to anchor the product even against high sebum output. While midday sebum migration and oxidation do factor into why sunscreen needs regular reapplication, robust formulas prevent rapid dissolution on oily skin types.

[07:52](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=472s) Melasma and Vascularity: The Role of Vbeam Laser

Addressing the relationship between melasma and dermal vascularization, Dr. Dray discusses whether the Vbeam pulsed dye laser (PDL) has utility in treating the condition. Because Vbeam specifically targets intravascular oxyhemoglobin to treat telangiectasias and spider veins, treating the underlying abnormal vascular network in melasma has gathered clinical interest.

While some patients experience positive outcomes, clinical evidence remains mixed, and pulsed dye lasers are neither first-line therapy nor the standard of care for melasma. Lasers can generate heat and post-inflammatory responses that trigger or worsen hyperpigmentation, particularly in darker skin tones (higher Fitzpatrick phototypes). If pursued, the procedure demands ultra-low fluence settings delivered by a board-certified dermatologist who understands the narrow therapeutic window required to treat the blood vessels without irritating the surrounding melanocytes.

[08:53](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=533s) Pumpkin Seed Oil for Hair Loss and Dandruff

Dr. Dray evaluates the viral trend of applying pumpkin seed oil to the scalp for stopping hair thinning and regrowing hair, particularly in individuals with dandruff. She makes a firm distinction between online hype and clinical reality: there is no credible evidence demonstrating that topical pumpkin seed oil stimulates hair regrowth, halts shedding, or treats any clinical hair loss disorder.

Online claims frequently misrepresent a single, small clinical study that evaluated *oral* pumpkin seed oil supplements in men with androgenetic alopecia. While that oral trial demonstrated minor promise, it suffered from severe study limitations and small sample sizes, preventing it from serving as a dermatologic treatment standard. Topically applying plant oils remains unsupported for reversing alopecia, regardless of how often internet influencers promote it as an all-purpose botanical cure.

[09:39](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=579s) Scalp Oiling, Malassezia, and Dandruff Concerns

Addressing the common belief that applying oils to the scalp aggravates dandruff, Dr. Dray explains the theoretical mechanism behind this fear. *Malassezia* is a lipophilic, "oil-loving organism" whose overgrowth drives scalp inflammation and flaking. The traditional logic suggests that putting oils on the scalp essentially feeds *Malassezia*, exacerbating dandruff. However, Dr. Dray emphasizes that there is currently no solid objective evidence proving that topical scalp oiling actually worsens the condition. In fact, many cultures have deeply rooted traditions of regular hair and scalp oiling without demonstrating higher rates or more severe presentations of dandruff.

While Dr. Dray remains open to future research that might prove otherwise, she does not believe current evidence justifies blanket medical advice warning patients against hair oils. She takes a pragmatic clinical stance: dermatologists should recognize that patients oil their hair, and if an individual finds that scalp oiling flares their dandruff, they should simply trial stopping it. Specifically regarding pumpkin seed oil, because there is no convincing evidence that it promotes hair growth anyway, there is zero reason to continue applying it to the scalp if it triggers irritation or flaking.

- *Malassezia* is the yeast responsible for dandruff and feeds on sebum, driving scalp inflammation. - Cultural hair-oiling practices do not show an epidemiological surge in severe dandruff, challenging the theoretical risk. - Pumpkin seed oil lacks evidence for hair growth, making it unnecessary to risk flaking or flare-ups.

[11:13](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=673s) Daily Washcloth Exfoliation and Sensitive Skin

Responding to a viewer asking whether daily body exfoliation with a washcloth and gentle soap is safe for sensitive skin, Dr. Dray notes that the answer hinges on several variables: what product is being used, how "gentle" is defined, how long and hot the showers are, and the baseline integrity of the skin barrier. If a person's barrier is already compromised, aggressive physical scrubbing simply adds "insult to injury" and escalates sensitivity. At the same time, daily bathing with a washcloth is standard practice and often clinically beneficial, even for conditions like atopic dermatitis. Slow epidermal cell turnover in certain body areas can cause rough dead skin, dirt, and irritants to accumulate, which actively destabilizes the barrier and sparks eczema flares.

Dr. Dray shares her personal experience, noting that as someone living with atopic dermatitis, skipping daily showers causes her to be "itching up a storm" because sweat itself acts as a potent cutaneous irritant. Proper bathing introduces crucial hydration into the skin and mechanically clears debris, refuting the outdated advice that atopics should avoid bathing. However, she offers a clear indicator for when to dial back: if shower water stings on contact, the skin barrier is actively inflamed. In that scenario, individuals should pause using washcloths and cleansers for a few days, cleansing gently with only their bare hands until the barrier settles down. Under normal circumstances, gentle daily washcloth use is entirely safe and unlikely to cause harm.

- Bathing hydrates the skin and clears sweat, allergens, and slow-shedding epidermal buildup that irritate eczema. - Stinging from plain shower water is an immediate warning sign of barrier compromise; switch to bare hands and water until it resolves. - Dr. Dray refutes the myth that eczema patients should avoid daily showers, citing sweat as a primary itch trigger.

[13:16](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=796s) Serums vs. Active Moisturizers: The Marketing Myth

When asked whether active ingredients must be applied via a serum rather than a dedicated moisturizer formulated with actives, Dr. Dray pulls back the curtain on cosmetic industry branding. She asserts that "serum is kind of a marketing word." Having tested skincare formulations for over a decade, she observes that the word "serum" provides no real guarantee of a product's vehicle or consistency. A serum can range from a thin, watery liquid to what she candidly describes as "glotion"—a product utilizing the exact same emulsifiers, thickeners, and hydrating agents found in standard lotions, merely packaged with the word "serum" on the bottle.

```mermaid flowchart TD accTitle: Active Ingredient Delivery Comparison accDescr: Diagram illustrating that serums and active moisturizers deliver equivalent ingredient efficacy despite marketing claims. subgraph Formulations["Product Categories"] S["'Serum' Label"] M["'Moisturizer' Label"] end subgraph Bases["Base Formulations"] F1["Thin fluid or thick lotion ('glotion')"] F2["Emulsion with thickeners and emollients"] end subgraph Reality["Clinical Outcome"] E["Equivalent Active Delivery\n(e.g., Niacinamide)"] end

S --> F1 M --> F2 F1 --> E F2 --> E ```

She directly dispels the persistent social media claim that active ingredients require serum formats to achieve meaningful concentrations or superior delivery systems. In reality, there are no cosmetic regulatory standards governing what can be labeled a serum. A well-formulated moisturizer containing an ingredient like niacinamide delivers the exact same efficacy as a standalone niacinamide serum. While Dr. Dray personally enjoys and uses serums, the choice between a serum and an active moisturizer comes down entirely to personal aesthetic preference, texture compatibility, and how smoothly it layers into an existing routine.

- "Serum" has no regulatory definition; formulations range from watery fluids to identical lotion bases ("glotions"). - Social media claims that serums are inherently more potent or concentrated than active moisturizers are purely marketing rhetoric. - Clinical efficacy depends on the active molecule and overall formulation, not whether the bottle says "serum" or "lotion."

[15:11](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=911s) Pairing Azelaic Acid with Dapsone and Other Actives

Addressing whether over-the-counter azelaic acid can be paired in the same regimen with dapsone (Aczone), Dr. Dray confirms that the combination is entirely safe. Whether using a 10% cosmetic formulation or prescription-strength 15% to 20% options (such as Finacea), azelaic acid has no inherent chemical incompatibilities and can be paired with any active ingredient—provided the individual's skin can tolerate it.

The primary limiting factor when layering azelaic acid is dryness and initial cutaneous sensitivity. Because azelaic acid commonly provokes mild flaking, stinging, or peeling upon initiation, combining it with other inherently drying agents increases the risk of irritant contact dermatitis. For example, pairing azelaic acid with benzoyl peroxide for acne is completely permissible pharmacologically, but because benzoyl peroxide is notoriously drying—even at lower 2.5% concentrations—layering them together may overwhelm sensitive skin barriers. Product combinations should always be judged by barrier tolerance rather than fear of chemical contraindications.

- OTC azelaic acid (10%) and prescription formulations (15–20% Finacea) are chemically compatible with dapsone. - Azelaic acid can be combined with any active ingredient, including benzoyl peroxide, provided cumulative dryness is tolerated. - Barrier irritation from stacking drying agents is the sole restricting factor, not product-on-product chemical interference.

[16:18](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=978s) AmLactin vs. Tretinoin for Epidermal and Dermal Thickness

Dr. Dray corrects a viewer's misunderstanding regarding the histological effects of retinoids compared to AmLactin (ammonium lactate). The viewer mistakenly believed Dr. Dray had stated retinoids only thicken the epidermis while 12% AmLactin thickens both the epidermis and the dermis. Clarifying the actual clinical science, Dr. Dray explains that ammonium lactate demonstrates concentration-dependent effects: lower strengths, such as 5% ammonium lactate, have only been shown to increase epidermal thickness, whereas 12% ammonium lactate increases both epidermal and dermal thickness.

```mermaid flowchart TD accTitle: Histological Impact of Ammonium Lactate and Tretinoin accDescr: Flowchart showing how 5 percent ammonium lactate affects only the epidermis, while 12 percent ammonium lactate and tretinoin thicken both epidermis and dermis. subgraph Actives["Topical Treatments"] AL5["5% Ammonium Lactate"] AL12["12% Ammonium Lactate (AmLactin)"] TRET["Tretinoin (Retinoid)"] end subgraph SkinLayers["Target Tissue Impact"] EPI["Epidermal Thickness Only"] BOTH["Epidermal AND Dermal Thickness"] end

AL5 --> EPI AL12 --> BOTH TRET --> BOTH ```

Both the epidermis and the dermis atrophy as a natural part of chronological aging and photoaging. The 12% ammonium lactate formulation is particularly valuable not only for mature skin but also for individuals suffering from steroid-induced dermal atrophy secondary to prolonged topical corticosteroid use. However, tretinoin *also* demonstrably thickens both the epidermis and the dermis. Consequently, 12% ammonium lactate is not "better" than tretinoin in this regard; both therapies are evidence-based, highly effective strategies for countering epidermal thinning and reversing dermal atrophy.

- 5% ammonium lactate improves epidermal thickness only, without impacting the deeper dermal matrix. - 12% ammonium lactate (AmLactin) thickens both the epidermis and dermis, and can help reverse dermal atrophy caused by topical steroids. - Tretinoin robustly thickens both epidermal and dermal layers; it is not inferior to 12% ammonium lactate for addressing structural skin thinning.

[17:41](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=1061s) Outro and Wrap-Up

Concluding the weekend Q&A session, Dr. Dray thanks her audience for their thoughtful submissions and notes that the episode will be added to her ongoing skincare Q&A playlist. She reminds viewers that all of these videos are timestamped so they can quickly jump to the exact questions and topics that interest them. She wraps up with her signature closing sign-off: encouraging viewers to give the video a thumbs up, share it with friends, subscribe, and above all, "don't forget sunscreen."

## Notable quotes > [01:06](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=66s) it really kind of grinds my gears when that gets marketed as like a retinol. — Dr. Dray

> [01:43](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=103s) sneaks up on you — Dr. Dray

> [03:30](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=210s) marketing fluff — Dr. Dray

> [03:30](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=210s) rice grain amount — Dr. Dray

> [09:39](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=579s) oil-loving organism — Dr. Dray

> [11:13](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=673s) insult to injury — Dr. Dray

> [11:13](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=673s) itching up a storm — Dr. Dray

> [13:16](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=796s) serum is kind of a marketing word. — Dr. Dray

> [13:16](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=796s) glotion — Dr. Dray

> [17:41](https://www.youtube.com/watch?v=oyQl5MU3pRQ&t=1061s) don't forget sunscreen. — Dr. Dray

## Mentioned Dr. Dray, UltraClear Laser, Hydroxypinacolone retinoate (HPR), Retinol, Retinaldehyde, Tretinoin, Adapalene, Altreno, Aklief (trifarotene), Lubriderm, Vanicream, La Roche-Posay Cicaplast Gel B5, Now Foods Vegetable Glycerin, Vbeam, Pumpkin seed oil, Malassezia, Dapsone (Aczone), Azelaic acid, Finacea, Benzoyl peroxide, AmLactin (ammonium lactate)

## Video description In this skincare Q&A, dermatologist Dr. Dray answers audience questions about UltraClear laser treatments, HPR, retinoids, eyelid skincare, sunscreen and sebum, melasma lasers, pumpkin seed oil for hair loss, dandruff, body exfoliation, active serums, azelaic acid and dapsone, and Amlactin for skin thinning and aging.

Dr. Dray discusses what the evidence actually shows about these popular skincare treatments and ingredients, including which vitamin A derivatives may be less irritating, whether HPR works like retinol, how sebum can affect sunscreen protection, and whether V-Beam laser can help melasma.

She also explains how to care for sensitive eyelid skin, whether scalp oils can worsen dandruff, how to safely exfoliate sensitive skin, whether an active serum is necessary, and whether azelaic acid can be combined with dapsone.

中文简报

壬二酸可以和任何成分混用吗？皮肤科医生答疑在本期全面的问答环节中，Dr. Dray 评估了热门美容宣称背后的临床证据，将生物学事实与营销噱头区分开来。她探讨了 UltraClear 激光和 Vbeam 等项目应对血管型黄褐斑的实际效用，破除了围绕眼霜、粟丘疹形成以及外用南瓜籽油防脱发的误区，并解释了内源性皮脂是如何分解防晒膜的。此外，她证实只要妥善控制干燥问题，壬二酸即可与氨苯砜（dapsone）叠加使用；阐明了敏感肌肤每日进行机械沐浴清洁的安全性；并解释了 12% 乳酸铵和维A酸（tretinoin）是如何共同增厚表皮层与真皮层的。临床证据表明，12% 乳酸铵与处方维A酸（tretinoin）均能同时增厚表皮层和真皮层，从而对抗皮肤变薄。 (16:18) 无论是 OTC 还是处方浓度的壬二酸，只要妥善管理皮肤干燥及屏障耐受度，均可与氨苯砜（dapsone）及其他祛痘活性成分搭配使用。 (15:11) 专用眼霜在功能上等同于普通保湿霜，普通的无香乳液在眼周使用同样安全，且不会诱发粟丘疹。 (3:30) 外用南瓜籽油治疗脱发缺乏科学支持，且关于头皮涂油是否会直接滋养引发头屑的马拉色菌，现有证据仍无定论。 (8:53)

Reading summary

Dermatologist Dr. Dray contends that skincare decisions must be guided by barrier tolerance and clinical evidence rather than cosmetic marketing categories. She emphasizes that pairing active ingredients, such as azelaic acid, depends on individual cutaneous limits rather than chemical incompatibilities. Retinoid Tolerability, Vehicle Design, and Tissue Remodeling (1:43) Dr. Dray cautions that cosmetic alternatives like hydroxypinacolone retinoate (HPR) lack clinical data matching gold-standard retinoids like retinol, retinaldehyde, or tretinoin, despite marketed equivalencies. Furthermore, over-the-counter retinoids can cause delayed irritation weeks into use, challenging assumptions that they are universally gentler than adapalene. For sensitive skin, she highlights prescription vehicles like Altreno, which buffers tretinoin with hyaluronic acid and soluble collagen, whereas Aklief (trifarotene) often still provokes irritation despite selective RAR-gamma targeting. Addressing histological effects, Dr. Dray clarifies that both tretinoin and 12% ammonium lactate (AmLactin) stimulate structural thickening across both the epidermis and the dermis, making both valuable for photoaging and corticosteroid-induced atrophy. In contrast, lower-strength 5% ammonium lactate only thickens the epidermis. Tretinoin is therefore not inferior to ammonium lactate for deep dermal remodeling. Deconstructing Cosmetic Categories in Serums and Eye Creams (13:16) Dr. Dray explains that terms like 'serum' reflect marketing language rather than pharmaceutical standards. Because regulatory bodies do not define serum formulations, products range from thin liquids to lotion emulsions dubbed 'glotions.' Consequently, active ingredients like niacinamide deliver equivalent efficacy in well-formulated moisturizers, making the choice between serums and active creams a matter of personal texture preference. Similarly, dedicated eye creams are predominantly standard moisturizers in miniature packaging. Delicate periorbital skin benefits from basic drugstore creams or humectants like glycerin applied in a rice-grain amount away from the lash margin, avoiding chemical exfoliants. Dr. Dray also dispels the myth that heavy creams cause milia, clarifying that these keratin-filled subepidermal cysts stem from genetics, trauma, or photoaging, meaning no cosmetic formula is genuinely 'milia-safe.' Barrier Tolerance in Active Layering and Daily Cleansing (15:11) Pharmacologically, azelaic acid—in 10% cosmetic strengths or 15% to 20% prescription formulations—exhibits no chemical incompatibilities with other actives, including dapsone or benzoyl peroxide. The restricting factor in combining treatments is cumulative dryness and irritation. Because azelaic acid and benzoyl peroxide both cause peeling, combining them can compromise sensitive barriers even though no chemical contraindication exists. Dr. Dray applies this barrier-focused principle to physical cleansing. While regular washcloth bathing helps manage conditions like atopic dermatitis by removing sweat, allergens, and debris that provoke itching, mechanical scrubbing worsens active inflammation. She notes that if shower water stings, patients should immediately stop using washcloths and cleansers, cleansing solely with bare hands and water until the barrier recovers. Evaluating Evidence Gaps in Viral Botanicals and Lasers (8:53) Evaluating trending botanical treatments, Dr. Dray states that topical pumpkin seed oil lacks credible clinical evidence for hair regrowth; viral claims misinterpret a small, limited study on oral supplements. Furthermore, while the dandruff yeast Malassezia consumes lipids, evidence that topical scalp oiling worsens dandruff is unproven, though individuals should pause application if flaking occurs. Regarding procedural interventions, Dr. Dray notes that the UltraClear cold ablative fractional laser provides collagen remodeling with minimal downtime across skin types, but individual results vary substantially. Similarly, using the Vbeam pulsed dye laser for vascularity in melasma remains non-standard; procedural heat and inflammation risk triggering post-inflammatory hyperpigmentation, particularly in darker skin tones. Dr. Dray concludes that effective skincare requires prioritizing formulation tolerance and verified clinical efficacy over product labels and viral trends. Key unresolved questions remain regarding optimal laser parameters for vascular melasma and the objective clinical impact of topical oils on scalp microbiology.

Source quotes

[1:06] Dr. Dray: it really kind of grinds my gears when that gets marketed as like a retinol. [1:43] Dr. Dray: sneaks up on you [3:30] Dr. Dray: marketing fluff [3:30] Dr. Dray: rice grain amount [9:39] Dr. Dray: oil-loving organism [11:13] Dr. Dray: insult to injury [11:13] Dr. Dray: itching up a storm [13:16] Dr. Dray: serum is kind of a marketing word. [13:16] Dr. Dray: glotion [17:41] Dr. Dray: don't forget sunscreen.

Original transcript

[0:00] Hey guys, happy Sunday. We are back for [0:02] part two of the weekend Q&A. As always, [0:04] this video along with all of the others [0:06] are saved in the skincare Q&A playlist [0:10] and these videos are time stamped. So, [0:11] if there's a specific question that you [0:13] just want to get right to, you want to [0:15] know the answer, you don't have time to [0:16] watch the whole video, check the [0:18] timestamps. What are your thoughts on [0:20] Ultra Clear laser? So, Ultra Clear is a [0:23] cold ablative fractional laser for [0:25] rejuvenation purposes. It's going to [0:27] work by vaporizing those outermost [0:30] layers of the skin as well as [0:32] stimulating collagen production in the [0:33] dermis. Be helpful in addition to, you [0:36] know, photo rejuvenation. So, fine [0:37] lines, texture, uneven skin tone. It [0:40] also can be helpful for certain acne [0:42] scars as well. It's safe for all skin [0:45] types and it has very little downtime. [0:48] So, it's one of those things that a lot [0:50] of people are interested in pursuing. [0:51] They don't have to, you know, take the [0:53] time away from being forward-facing, so [0:56] to speak, to heal. So, it's popular for [0:59] those reasons, but the results can vary [1:02] from person to person quite a bit. So, [1:04] you know, not everyone gets good [1:05] results. What are your thoughts on the [1:07] new HPR? So, HPR stands for hydroxy [1:12] pinacolone retinoid. It's not new, it's [1:14] a cosmetic ingredient. We don't have any [1:17] data to substantiate the claims that it [1:19] acts as like retinol or retinaldehyde or [1:22] retinoids. It is a retinol ester and [1:25] typically those don't perform like [1:28] retinol. It may act as an antioxidant, [1:30] but it really kind of grinds my gears [1:32] when that gets marketed as like a [1:34] retinol because I think it misleads the [1:36] consumer into thinking that they're [1:38] buying an ingredient that is established [1:39] to improve wrinkles and collagen in the [1:41] same way that retinol. Which vitamin A [1:44] derivative could I use if adapalene was [1:46] too irritating for me? So, you could [1:48] pursue a cosmetic retinol or [1:50] retinaldehyde. Although that being said, [1:52] I've tried many of them over the years [1:55] and despite the widespread belief that [1:58] they are not [clears throat] irritating, [2:00] I have found that just like adapalene, [2:02] in fact, more so than adapalene, some of [2:04] them do in fact cause quite a bit of [2:06] irritation, redness, dryness, [2:08] sensitivity. The thing about it with [2:10] those in contrast to like tretinoin is [2:12] it tends to sneak up on you after you've [2:14] been using it for a while. Like a couple [2:17] of weeks into starting it. So, tretinoin [2:19] I find the irritation came on a lot [2:21] faster. I really never got much [2:23] irritation with topical adapalene to be [2:26] frank. So, in other words, for me [2:28] personally, I found adapalene to be [2:30] pretty easy to tolerate, but obviously [2:32] that's why you're asking the question [2:34] because you did not. And so, I'm telling [2:35] you that because it would generally be [2:37] recommended, well, maybe consider a [2:39] retinol or retinaldehyde, but those are [2:41] not always necessarily less irritating [2:43] than adapalene, but maybe for some they [2:46] are. Now, alternatively, your [2:48] dermatologist might try to prescribe [2:51] other topical retinoids that are in [2:53] vehicles that help to reduce irritation, [2:56] such as Altreno lotion, which contains [2:58] hyaluronic acid and collagen. It is [3:01] often better tolerated. It's a lot more [3:03] moisturizing. It's formulated to really [3:06] address the dryness and sensitivity [3:07] issues. No guarantee with that. [3:09] Allegedly, trifarotene, which is [3:12] marketed as Aklief, allegedly that was [3:14] supposed to be so much less irritating [3:16] because of the receptor specificity, but [3:19] in clinical practice, it bears out to be [3:22] just as irritating as any other topical [3:25] retinoid. But, that might be an option [3:27] as well, but personally, I haven't found [3:29] it to be less irritating. What is a good [3:31] lotion to use on eyelid skin? I can't [3:34] use petroleum jelly there during the [3:36] day. Honestly, any lotion you want. I [3:39] would avoid lotions and moisturizers on [3:41] the eyelids that contain alpha hydroxy [3:44] acids like glycolic, lactic, mandelic, [3:46] or salicylic acid. I would also avoid uh [3:51] containing lotions. Not to say that you [3:53] can never use those ingredients there [3:55] are either in a lotion or some other [3:56] product, but if you expressed that you [3:58] have sensitivity of the eyelids, those [4:00] are more likely to worsen sensitivity [4:02] because they can be irritating to [4:04] delicate eyelid skin. But there's really [4:06] no magic when it comes down to [4:08] moisturizers and their like [4:10] eye-friendliness. And a lot of that is [4:13] just marketing of eye creams, which are [4:15] often glorified moisturizers. Unless [4:17] it's an eye cream that has an ingredient [4:20] that commonly is irritating to eyelid [4:22] skin like AHAs or retinol, then the eye [4:25] cream uh stuff makes a bit more sense. [4:28] But for the purposes of moisturizing [4:30] eyelid skin, there's really not anything [4:32] that formula-specific, you know, with [4:34] the eyelid moisturizers, which is what [4:36] most eye creams are. Now, I will [4:38] caution, you want to make sure you're [4:40] not getting any kind of product within a [4:42] millimeter of your lash line to avoid [4:44] getting it in your eyes. Product should [4:46] not go in your eye, and you really need [4:48] to be very light-handed with the amount. [4:50] I I notice on social media a lot of [4:52] people promoting eye creams. They really [4:54] keep on quite a bit. You You really only [4:56] need like the tiniest little rice grain [4:58] amount to coat the under-eye and upper [5:01] eyelid area for the most part. I haven't [5:04] ever found that I needed like big globs [5:06] of a moisturizer around my eyes. But for [5:09] example, you could use Lubriderm as an [5:11] eye cream. You could use Vanicream face [5:15] or body cream as an eye cream. The idea [5:18] that you need something that is in a [5:20] tiny little tube that says it's an eye [5:22] cream, it implies that there's some [5:24] magic about it that makes it safe or [5:27] safer for eyelid skin. And And that's [5:29] really just all marketing fluff. And no, [5:31] eye creams do not cause milia. Milia are [5:34] due to skin injury, trauma, hereditary [5:37] conditions. They form spontaneously in [5:38] children. They can happen secondary to [5:40] extensive sun damage, so they're more [5:42] common in older adults with age. And [5:44] they also can happen secondary to skin [5:47] changes that happen in certain collagen [5:49] vascular disease autoimmune skin [5:51] disorders, but they don't have any [5:54] established association or nor is it [5:57] ever been shown that skin care products [5:59] cause milia. Milia are little cysts that [6:02] form below the surface of the skin. So [6:04] the idea that a heavy cream could [6:06] trigger that, not to mention the [6:08] implication that there is a milia safe [6:11] cream and a milia unsafe cream. get that [6:14] question like, "There's nothing about a [6:16] cream that gives any kind of indication [6:18] of milia yes or no." There's no [6:20] formulation that's ever been established [6:22] to cause them. There's no formulation [6:24] that's ever been established to not [6:26] cause them. A lot of eye creams are just [6:28] marketing of moisturizers [snorts] for [6:30] around the eyes. But I have found [6:32] personally that glycerin is great around [6:35] the eyes. I love, as many of you know, [6:36] to use the La Roche-Posay Cicaplast Gel [6:40] around the eyes. It's a glycerin skin [6:41] protectant. I also buy a vegetable [6:43] glycerin from the Now Foods brand. I'm [6:45] not sponsored by them or anything. That [6:47] just happens to be the common vegetable [6:48] glycerin brand that shows up when you go [6:50] searching for vegetable glycerin. And I [6:53] found that the tiniest little drop of [6:54] that around the eyes is great. It is a [6:56] little sticky on the face, but pretty [6:58] comfortable and with some time it sinks [7:00] down in and provides long-lasting [7:01] hydration to smooth out those little [7:03] fine dehydration lines. Does sebum break [7:05] up water-resistant sunscreen the same [7:07] way a cleansing oil does? More reason [7:10] for oily skin to reapply maybe? I mean, [7:12] I guess it can because um sebum could [7:15] dissolve certain UV filters and also [7:18] might start to compromise the film [7:21] formers over time. Also sebum on the [7:24] surface of the skin oxidizes, so that [7:26] might have some implications for the [7:28] longevity of sunscreen on the skin. That [7:31] being said, cosmetic formulators and [7:33] sunscreen formulators, they are able to [7:35] overcome some of these issues in the way [7:37] that they formulate. For example, they [7:39] use different polymers and different [7:41] like powders and things like that in the [7:43] formulation so that it will withstand [7:46] even the oiliest of skin types. But, [7:48] that is a contributor over time, I [7:50] suppose, to the need to reapply. You [7:53] always talk about melasma having a [7:54] vascular component. Could Vbeam laser [7:57] help with melasma? So, Vbeam is a pulsed [8:00] dye laser. Pulsed dye lasers are what [8:02] are used to treat vascular things, [8:04] dilated telangiectasias, dilated [8:06] abnormal blood vessels, spider veins. [8:09] And they it work by targeting those the [8:11] the vascular stuff, that the hemoglobin. [8:14] And there is some evidence that they can [8:15] be helpful for melasma given the [8:18] vascular component. The research is kind [8:20] of conflicting. It's not a standard of [8:22] care treatment for melasma. It's not a [8:24] first-line therapy, but some people do [8:26] get good results. However, the devil is [8:28] in the details here because when it [8:29] comes to lasers, they do always offer [8:31] the potential lasers, for example, to [8:34] worsen melasma, especially if the wrong [8:36] settings are used. You want to use a [8:38] real low fluence here. So, in other [8:40] words, the provider is key. You you [8:43] really want to go to a board-certified [8:45] dermatologist if this is something that [8:46] you're entertaining doing, especially if [8:49] you have a deeper skin tone, simply [8:51] because they definitely can aggravate [8:53] melasma. Is it safe to use pumpkin seed [8:55] oil topically on our scalp for hair [8:57] growth and stopping hair loss even if we [9:00] have dandruff? Does pumpkin seed oil [9:02] worsen dandruff? There's no evidence [9:04] that pumpkin seed oil applied to the [9:06] scalp grows hair, is a treatment for any [9:09] hair loss disorder, or slows or prevents [9:12] any type of hair loss. So, just keep [9:14] that in mind. There is one study on [9:15] oral, taken by mouth, pumpkin seed oil [9:18] for androgenetic alopecia that shows [9:20] promise, but it did have a lot of [9:21] limitations. It was very small. So, it's [9:23] not a standard recommendation. That [9:25] doesn't stop people on the internet from [9:27] claiming it is the cure-all for every [9:29] type of hair loss from here until, you [9:32] know, every follicle on earth can be [9:34] saved by pumpkin seed oil. But, uh it is [9:37] a popular and generally well-tolerated [9:39] thing to do. Now, with regards to [9:40] putting oils on the scalp and [9:42] aggravating dandruff, yeah, there's [9:44] always been this concern about that that [9:47] oils on the scalp, scalp oils, scalp [9:49] oiling as a practice can aggravate [9:51] dandruff because Malassezia is an [9:53] oil-loving organism, and overgrowth of [9:55] Malassezia is you know, the cause of [9:58] dandruff. And an aggravation of oil [10:01] production from the scalp drives more [10:03] Malassezia, which drives more [10:06] inflammation and causes dandruff. So, [10:08] the idea has always been like, well, if [10:09] you put oils on the scalp, you're [10:11] feeding Malassezia. Truthfully, we don't [10:13] have any good evidence for that. And a [10:15] lot of cultures um are really into this [10:18] hair oiling thing. We don't see more [10:21] severe dandruff per se in those groups. [10:23] Now, that being said, I would say [10:25] there's like no objective evidence that [10:27] it does or it doesn't. It's kind of [10:28] like, well, it might. Here's a mechanism [10:31] by which it might. Here's a mechanism by [10:32] which it might not. So, should we be [10:35] recommending no hair oils? Or should we [10:37] just be aware that this is something [10:38] patients do and suggest a trial of [10:40] stopping if they find that their [10:42] dandruff is really bad? I'm not [10:44] convinced that putting oils on the scalp [10:47] per se feeds Malassezia, but I'm [10:49] definitely open to data coming out [10:52] showing me I'm wrong and that, you know, [10:54] they should be strictly avoided. But, I [10:56] need to see more research. If you find [10:58] that doing that flares up your dandruff, [11:00] uh there's no need to continue with [11:02] pumpkin seed oil from a hair growth [11:04] health perspective. It's not been shown [11:06] to grow hair, so I wouldn't do it, but [11:09] I'm not going to pretend to tell you [11:10] that it's it's completely bad when it's [11:13] just not clear. Is it safe to exfoliate [11:15] our body using a washcloth along with a [11:18] gentle body wash or soap on a daily [11:20] basis if we have sensitive skin? It [11:22] depends, you know, on a couple of [11:24] factors like what are you using, you [11:26] know, what constitutes gentle. Everybody [11:28] has their own definition of that. Are [11:31] you taking long hot showers? Are you [11:33] using a lot of other exfoliating things? [11:35] How bad is your skin barrier to begin [11:37] with? Adding more insult to injury, so [11:39] to speak, can just worsen the symptoms [11:41] of sensitivity. So, whether or not it's [11:43] going to aggravate your sensitivity or [11:45] not is hard to say, but generally [11:47] speaking, that's how most people bathe. [11:49] You know, the bathing advice around at [11:50] least atopic dermatitis and other dry [11:53] skin conditions is that bathing really [11:55] does help because it mechanically [11:57] exfoliates away dry rough build-up from [12:01] throughout the day um due to you know, [12:03] some people in certain areas of the body [12:05] in particular, the epidermis is just [12:07] like kind of a little slow. And so, [12:09] people get, you know, rough texture [12:11] build-up, dirt, and things like that [12:12] trapped on the surface of the skin. And [12:14] all of that compromises healthy barrier [12:16] integrity and then, of course, can flare [12:18] things like atopic dermatitis. So, [12:20] bathing not only removes that, but the [12:22] the washcloth and and and hygiene, you [12:24] know, just being in the shower in [12:25] general, it does help to get water into [12:28] the skin. And so, it really does have a [12:30] place. Like, telling atopics to not [12:32] bathe is is kind of not logical at all [12:35] and and I think in many cases aggravates [12:36] their disease. Like, for me personally, [12:38] I have atopic dermatitis and if I don't [12:41] shower every day, I'm going to be [12:42] itching up a storm because we know that [12:44] sweat is an irritant. But, you know, if [12:47] you have a lot of sensitivity on the [12:48] body, you'll notice that when you get [12:50] even in the shower, the water kind of [12:52] stings. And so, that's sort of a clue. [12:54] Like, maybe you should back off of using [12:57] a lot of body wash and soap for the day. [13:00] Just kind of use your hand for a couple [13:01] of days. I know that shocks people, but [13:03] I mean, if your skin is uncomfortable [13:05] with bathing, it's kind of a sign that, [13:07] you know, you need to be a little maybe [13:08] a little bit gentler for a bit till [13:10] things get back on track. But, yeah, I [13:12] mean, it's safe to bathe every day with [13:13] a washcloth. You're not You're not [13:15] likely to cause harm doing that. Do you [13:17] think it's better to use a serum with [13:18] actives in it than a simple moisturizer [13:21] or would using only a moisturizer that [13:22] already has the actives in it be enough? [13:24] Thank you so much. Here's the thing, [13:26] serum is kind of a marketing word. Uh [13:29] I've lamented about this in other videos [13:31] and sometimes I don't always adequately [13:33] explain myself, but serum you'll find, [13:35] especially I've been doing this for 10 [13:37] years now trying out different skin care [13:39] products. You never know when you buy [13:41] something that is marketed as a serum, [13:43] you never know what's going to come out [13:44] of that bottle. It could be a [13:46] lightweight, thin, mostly water-based [13:49] product, or it could be glotion, [13:51] frankly. The same exact textures, [13:53] thickeners that are added to lotion to [13:55] be in the quote-unquote serum. It's just [13:57] in a different packaging. It has serum [13:59] on the front instead of lotion or [14:01] moisturizer. But at the end of the day, [14:03] it's a moisturizer. Like it's got the [14:05] same texture, consistency, ingredient [14:07] families, thickening agents to slow [14:09] water. I mean, it's a moisturizer. So um [14:12] I think if you uh the reason I point [14:14] that out is cuz a lot for a long time um [14:16] you would hear this rhetoric on social [14:18] media and you still hear it from time to [14:20] time that in order to um really get a uh [14:23] skin care product that had the [14:25] ingredient in a meaningful uh delivery [14:28] system or concentration, you must use a [14:31] serum. That serums were more potent, [14:33] more concentrated. That's all marketing. [14:35] That is all marketing uh you know, [14:37] jargon. Not at all true. I mean, there's [14:40] no there's no I mean, like I said, [14:43] serum, anybody can call anything a [14:45] serum. There's no rules to what class is [14:48] classified as a serum. So yeah, at the [14:50] end of the day, a moisturizer with say [14:52] niacinamide is as effective as a serum [14:55] with niacinamide, no matter the texture. [14:57] It all depends on, you know, I love [14:59] serums. I'm not saying they're useless. [15:00] I I use a lot of them, obviously. It all [15:03] boils down to what do you like to use, [15:05] you know, as far as the textures and [15:07] what's easy to work into your existing [15:09] skin care routine if you're looking to [15:10] introduce an ingredient. Can [15:12] over-the-counter azelaic acid uh be used [15:15] in the same routine as dapsone? Yes, [15:17] azelaic acid, whether it be [15:19] over-the-counter as a cosmetic at the [15:21] 10% strength or a prescription 15 and [15:23] 20% strength, you can use it with any [15:26] skin care ingredient provided you [15:27] tolerate the combination. So, with [15:29] azelaic acid, it can be a little drying, [15:31] a little irritating. Some people find [15:33] that they get a little bit of [15:34] sensitivity when they first start using [15:35] it, especially the prescription like [15:37] Finacea. Therefore, you you need to be [15:39] mindful that because of the dryness, if [15:41] you use it alongside other stuff, well, [15:43] that just increases the likelihood of [15:45] dryness and irritation. Like I've said, [15:46] the more things you use, the greater the [15:48] likelihood of dryness and irritation. [15:50] Azelaic acid at baseline being something [15:52] that for many people makes the skin a [15:53] little dry at least in the beginning. [15:55] So, you're using that with benzoyl [15:56] peroxide. Absolutely, you can use it [15:58] with benzoyl peroxide say for acne, but [16:00] benzoyl peroxide is notoriously drying [16:03] even at the lower percentages like 2.5%. [16:06] So, if you have some dryness from [16:07] azelaic acid and you have the dryness [16:10] from benzoyl peroxide, that might just [16:11] be too much, give you a lot of [16:13] irritation. It's not a good um approach [16:15] for you, and you might be better off [16:17] with some other way to do it. You have [16:19] mentioned that retinoids only improve [16:21] epidermal thickness while 12% AmLactin [16:24] improves epidermal and dermal thickness. [16:26] So, is the latter better? Um so, that's [16:28] not correct. That's not what I said, but [16:31] maybe you misheard. AmLactin 12%, that's [16:34] 12% ammonium lactate. 12% ammonium [16:37] lactate can improve epidermal and dermal [16:39] thickness. Lower percentages of ammonium [16:42] lactate like 5%, [16:44] with [16:47] those lower percentages, those have been [16:48] shown to just improve epidermal [16:50] thickness, not dermal thickness. Now, as [16:53] part of the aging process, you have [16:54] atrophy of the epidermis and the dermis. [16:57] Either percentage can still give you [16:59] some benefit, okay? But if you're [17:00] specifically looking to improve dermal [17:02] thickness, say you want to not only [17:05] address uh aging skin, but also a lot of [17:08] people might develop dermal atrophy [17:10] secondary to um an adverse event from a [17:13] topical steroid, in which case you'd [17:15] want to try the 12% because that's been [17:17] shown to improve dermal thickness and [17:19] reverse some dermal atrophy. Therefore, [17:22] you know, it's a great option. Now, [17:23] tretinoin [17:25] does, in fact, improve both epidermal [17:27] thickness and dermal thickness, same as [17:29] the 12% ammonium lactate. And either one [17:33] is a great option for reducing both [17:35] epidermal and dermal atrophy as can [17:37] occur with the aging process. And I've [17:39] got videos here about using both [17:41] ingredients. All right, guys, that about [17:44] wraps up our weekend Q&A. Thank you so [17:46] much for all of your excellent [17:48] questions. I hope you enjoyed today's [17:50] video. I will pop it into the skincare [17:52] Q&A playlist along with all of these [17:54] videos, which are timestamped, so you [17:57] can find the questions that have been [17:59] answered and get right to the part of [18:02] the video you're interested in if you [18:03] don't have time to watch the whole [18:04] thing. But, if you enjoyed today's [18:06] video, give it a thumbs up, share it [18:08] with your friends, and as always, don't [18:09] forget sunscreen and subscribe. I'll [18:11] talk to you guys tomorrow. Bye. [18:17] >> [music] [18:28] [music]