Dr. Dray Dismisses Salicylic Acid Cleanser Myths

Dr Dray

Topical salicylic acid cleansers successfully deposit active ingredients onto the skin via coacervation even when rinsed off immediately.

AI-assisted summary of Do Salicylic Acid Cleansers Actually Work? | Dermatologist Q&A — original source. Check the original for full context.

Source published: 2026-09-05

Key ideas

Salicylic acid cleansers effectively treat acne and rough skin despite brief contact times, relying on a formulation process called coacervation to deposit active ingredients while surfactants wash away debris. (0:00)
Topical retinoids and chemical exfoliants cannot eliminate established sebaceous hyperplasia lesions because the enlarged lobules sit deep in the dermis, requiring in-office procedures like electrodessication or cryotherapy. (6:12)
Severe eye stinging from US sunscreens is driven largely by high concentrations of older chemical UV filters restricted by FDA delays, making waxy sunscreen sticks a safer option around the eyes. (2:50)
Small bumps that erupt over eczema flares are not true acne breakouts but rather intraepidermal fluid-filled vesicles caused by intense inflammation. (11:39)

Detailed notes

## Background This skincare Q&A was published on YouTube by board-certified dermatologist Dr. Dray on September 5, 2026. According to the video description, Dr. Dray addresses viewer questions covering salicylic acid cleansers, Cool Peel CO₂ lasers versus IPL, sunscreen-induced eye stinging, chalazion resolution, topical retinoids for sebaceous hyperplasia, post-inflammatory hyperpigmentation on the legs, collagen-boosting limits, and vesicular bumps in eczema.

## TL;DR Dr. Dray debunks the myth that rinse-off salicylic acid cleansers are ineffective, explaining that coacervation allows actives to deposit onto the skin with minimal irritation. She contrasts Cool Peel fractional CO₂ laser resurfacing with IPL and validates the severe ocular burning caused by older US chemical sunscreen filters, recommending sticks or mineral formulas near the eyes. She also clarifies that established sebaceous hyperplasia cannot be exfoliated away with topical retinoids, distinguishes melanin hyperpigmentation from hemosiderin staining, explains the biological plateau of collagen-stimulating routines, and details why acute eczema manifests as serous blisters rather than true acne.

## Atmosphere & style The session carries Dr. Dray's signature candid, clinically grounded, and no-nonsense tone. She blends rigorous dermatological explanations with wry humor and vivid imagery—such as joking about users turning into an over-collagenated Kirby bubble or recounting the universal terror of sunscreen stinging while driving on the interstate. Listening feels like an intimate, educational, and reassuring consultation that cuts through skincare marketing hype to deliver realistic, evidence-based guidance.

## Bulletin - [00:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=0s) Salicylic acid cleansers effectively treat acne and rough skin despite brief contact times, relying on a formulation process called coacervation to deposit active ingredients while surfactants wash away debris. - [06:12](https://www.youtube.com/watch?v=9QdcZWQObDY&t=372s) Topical retinoids and chemical exfoliants cannot eliminate established sebaceous hyperplasia lesions because the enlarged lobules sit deep in the dermis, requiring in-office procedures like electrodessication or cryotherapy. - [02:50](https://www.youtube.com/watch?v=9QdcZWQObDY&t=170s) Severe eye stinging from US sunscreens is driven largely by high concentrations of older chemical UV filters restricted by FDA delays, making waxy sunscreen sticks a safer option around the eyes. - [11:39](https://www.youtube.com/watch?v=9QdcZWQObDY&t=699s) Small bumps that erupt over eczema flares are not true acne breakouts but rather intraepidermal fluid-filled vesicles caused by intense inflammation.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=0s) Active ingredients in cleansers are not wasted down the drain; coacervation allows actives like salicylic acid to adhere to the skin while dirt and excess sebum are rinsed away. - [00:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=0s) Salicylic acid cleansers offer a gentler, lower-irritation alternative to leave-on treatments, making them ideal for sensitive complexions and body breakouts. - [01:17](https://www.youtube.com/watch?v=9QdcZWQObDY&t=77s) Cool Peel is a brand name for a low-energy, short-pulse fractional CO₂ laser that micro-resurfaces skin and stimulates neocollagenesis, whereas IPL uses broad-spectrum visible light to target redness and pigment. - [02:50](https://www.youtube.com/watch?v=9QdcZWQObDY&t=170s) Severe ocular stinging and transient blurred vision from sunscreens are exacerbated in the United States due to the limited catalog of FDA-approved UV filters, forcing formulators to use higher concentrations of older chemical agents. - [02:50](https://www.youtube.com/watch?v=9QdcZWQObDY&t=170s) Using water-free sunscreen sticks around the orbital rim and opting for mineral filters (zinc oxide and titanium dioxide) significantly reduces the likelihood of sunscreen migrating into the eyes. - [05:28](https://www.youtube.com/watch?v=9QdcZWQObDY&t=328s) A hard chalazion resolving at around six months is due to the natural timeline of the immune system reabsorbing the trapped lipogranuloma, not the bright light of an eye exam. - [06:12](https://www.youtube.com/watch?v=9QdcZWQObDY&t=372s) Topical retinoids like tretinoin and tazarotene cannot eliminate existing sebaceous hyperplasia, as surface exfoliation cannot reach deep dermal sebaceous gland overgrowths. - [06:12](https://www.youtube.com/watch?v=9QdcZWQObDY&t=372s) Effective removal of established sebaceous hyperplasia requires targeted procedural interventions, including electrodessication, cryotherapy, or ablative lasers. - [07:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=420s) Dark marks from compression sock irritation may be either melanin-driven post-inflammatory hyperpigmentation (PIH) or hemosiderin staining from ruptured micro-capillaries. - [07:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=420s) Topical brightening ingredients cannot eliminate hemosiderin staining, which acts like an internal rust deposit and only clears with time or pigment-targeting lasers. - [08:58](https://www.youtube.com/watch?v=9QdcZWQObDY&t=538s) Skincare routines hit a biological ceiling where stacking multiple collagen stimulators yields diminishing returns and increases barrier irritation rather than producing indefinite collagen growth. - [08:58](https://www.youtube.com/watch?v=9QdcZWQObDY&t=538s) Antioxidants like CoQ10 do not directly synthesize new collagen; instead, they protect existing collagen by neutralizing free radicals and curbing inflammation pathways. - [11:39](https://www.youtube.com/watch?v=9QdcZWQObDY&t=699s) The microscopic hallmark of acute eczema is epidermal edema (spongiosis), which manifests clinically as fluid-filled blisters (vesicles) rather than true acneiform pustules. - [11:39](https://www.youtube.com/watch?v=9QdcZWQObDY&t=699s) Dyshidrotic eczema presents with deep-seated, tapioca-like vesicles on the palms and soles that release clear, intensely pruritic fluid upon rupturing.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=0s) Are Salicylic Acid Cleansers Effective?

Dr. Dray kicks off the weekend Q&A by tackling a common skincare myth: the idea that because cleansers sit on the face for only 30 to 60 seconds before being rinsed away, active ingredients inside them are useless and consumers should stick to basic cleansers and put their money toward serums instead. She rejects this outright, explaining that active ingredients like salicylic acid in a cleanser formulation "absolutely can help your skin."

Formulators utilize a process called *coacervation*, which enables active ingredients to deposit directly onto the skin's surface during washing while the remaining product, dirt, excess sebum, and debris are rinsed away with water. While leave-on treatments deliver a stronger, more prolonged exposure, cleansers offer a much gentler, lower-irritation alternative that many people tolerate significantly better.

```mermaid flowchart LR accTitle: Coacervation mechanism in cleanser formulations accDescr: Flowchart illustrating how active ingredients deposit on skin during cleansing while dirt and excess vehicle rinse away. A["Cleanser Applied"] --> B["Coacervation Phase"] B --> C["Actives Deposit on Skin"] B --> D["Surfactants Bind Dirt & Sebum"] D --> E["Rinsed Away with Water"] C --> F["Gradual Therapeutic Benefit"] ```

- Salicylic acid cleansers are particularly useful for targeting blackheads, whiteheads, rough texture, and keratosis pilaris. - Although results may take slightly longer compared to leave-on products, tolerability is far higher for sensitive complexions. - Body washes containing salicylic acid are especially valuable for treating acne on the trunk and back.

---

[01:17](https://www.youtube.com/watch?v=9QdcZWQObDY&t=77s) Cool Peel Laser Treatment at 75

Responding to a 75-year-old viewer from Phoenix who has maintained smooth skin after decades of sunscreen, hats, tretinoin, and IPL treatments, Dr. Dray breaks down what a "Cool Peel" laser actually does. She emphasizes that "Cool Peel" is simply a brand name for a low-energy, short-pulse fractional CO₂ laser, comparing the naming convention to patients knowing brand-name pharmaceuticals without understanding the actual drug class.

Unlike intense pulsed light (IPL)—which utilizes scattered wavelengths of visible light to target redness, dilated blood vessels, and uneven pigmentation—the fractional CO₂ laser directly ablates microscopic zones of the skin to trigger resurfacing and neocollagenesis.

---

[02:50](https://www.youtube.com/watch?v=9QdcZWQObDY&t=170s) Sunscreen in the Eyes and Blurry Vision

A viewer shares an alarming experience where sunscreen migrated into their eyes while driving, requiring them to pull over. The irritation was severe enough that an optometrist later diagnosed chemical-induced dry eye syndrome and prescribed medicated eye drops, prompting the viewer to ask why this hazard is rarely discussed. Dr. Dray validates the severity of the problem, admitting that it has happened to her multiple times and describing it as "brutal" and genuinely dangerous:

> "It almost always, for whatever reason, seems to happen when you're in the middle of driving on the interstate. Never when you're just like in the comfort of your own home... It is the worst and you're absolutely right. It's a US sunscreen specific thing."

Dr. Dray highlights that this intense stinging, excessive tearing, and transient blurriness are heavily tied to United States sunscreen formulations—specifically chemical filters, though mineral zinc oxide formulas can occasionally trigger it as well. When she has questioned skincare brands about what exact agent causes this severe ocular burning (whether an active UV filter, solubilizer, stabilizer, or film-forming polymer), they look at her like "deer in the headlights" without answers. She suspects the root cause is the heavily restricted list of FDA-approved UV filters in the US: because American manufacturers cannot access modern international filters, they are forced to use high concentrations of older chemical filters to achieve broad-spectrum protection.

- **Practical Workarounds:** - Sunscreen sticks around the orbital area are far less likely to migrate or drip because they lack the high water content found in standard lotions and creams. - Pure mineral sunscreens (zinc oxide and titanium dioxide) generally cause less severe ocular irritation if migration occurs.

---

[05:28](https://www.youtube.com/watch?v=9QdcZWQObDY&t=328s) Can an Eye Exam Make a Chalazion Resolve?

A viewer asks whether the bright light utilized during a standard slit-lamp or ophthalmic exam could have triggered the spontaneous disappearance of a hard chalazion that had persisted for six months. Dr. Dray clarifies that the light had nothing to do with it; rather, six months is the classic natural timeframe for a chalazion to run its course.

A chalazion is a deep lipogranuloma caused by chronic inflammation around a blocked meibomian gland. Even when it hardens into a dense nodule, the body's immune system will slowly break down the entrapped lipid material and reabsorb it over several months, resulting in spontaneous resolution.

---

[06:12](https://www.youtube.com/watch?v=9QdcZWQObDY&t=372s) Tretinoin vs. Tazarotene for Sebaceous Hyperplasia

When asked whether tretinoin or tazarotene works better for clearing sebaceous hyperplasia, Dr. Dray offers a blunt, clinically grounded reality check: topical retinoids simply do not get rid of existing lesions.

While long-term retinoid use may theoretically help reduce the *formation* of brand-new enlarged oil glands, neither prescription retinoids nor exfoliating acids like salicylic acid will reliably shrink or eliminate lesions that have already formed. Because these lesions are benign overgrowths of sebaceous lobules located deep in the dermis, you cannot "exfoliate them away." Dr. Dray does not bother recommending topicals for established lesions, noting that procedural interventions—such as electrodessication, cryotherapy, or targeted ablative treatments—are required for actual removal.

---

[07:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=420s) Dark Pigmentation After Compression Sock Irritation

Addressing an inquiry about patchy brown discoloration left behind after compression socks irritated the lower legs, Dr. Dray explains that finding the right treatment depends entirely on identifying the underlying pigment:

- **Post-Inflammatory Hyperpigmentation (PIH):** If the marks are caused by excess melanin produced in response to friction and dermatitis, body moisturizers formulated with niacinamide, retinol, or alpha hydroxy acids (AHAs) can help accelerate cell turnover. However, because vascular circulation in the lower extremities is sluggish, leg PIH clears very slowly, relying primarily on the "tincture of time." - **Hemosiderin Staining:** If capillaries ruptured under the compression sock, red blood cells leak into the surrounding tissue and break down. The remaining iron deposits create hemosiderin staining, which appears coppery or light brown, sometimes featuring tiny cayenne-pepper-like petechiae. Topical skincare ingredients cannot eliminate hemosiderin; it behaves like an internal "rust stain" and can only be cleared over extensive time or broken down using pigment-targeting lasers.

Regardless of the cause, keeping the lower legs well-hydrated helps minimize ongoing barrier irritation while plumping the stratum corneum to diffuse light, making the discoloration appear less noticeable.

---

[08:26](https://www.youtube.com/watch?v=9QdcZWQObDY&t=506s) Can You Max Out on Collagen-Boosting Ingredients?

The discussion shifts to whether a routine can hit a ceiling of diminishing returns when stacking multiple anti-aging ingredients—specifically whether adding CoQ10 is worthwhile if one already applies prescription adapalene daily. Dr. Dray begins by noting that rigorous, independent clinical studies evaluating whether multiple distinct anti-aging actives have additive or redundant effects on collagen synthesis are practically nonexistent. Most published skincare studies are funded by cosmetic manufacturers and test proprietary finished formulas rather than comparing single actives side-by-side.

[08:58](https://www.youtube.com/watch?v=9QdcZWQObDY&t=538s) Can You Max Out on Collagen-Boosting Ingredients?

Addressing whether stacking multiple collagen-stimulating skincare actives yields diminishing returns, Dr. Dray clarifies how clinical studies are designed and why there is logically a ceiling effect to topical results. Clinical trials typically examine a single product formulation containing a couple of targeted ingredients while controlling the rest of the routine—instructing participants to use only a mild cleanser and a designated sunscreen. Researchers are not routinely evaluating complex, layered routines involving multiple separate brands and actives. As a baseline principle, layering more products simply elevates the likelihood of barrier irritation. Logically, skin cannot stimulate collagen indefinitely without an upper boundary: otherwise, everyone using these ingredients would end up "all puffed up in the face from like exuberant collagen," turning into a walking "collagen bubble" resembling the video game character Kirby.

```mermaid flowchart TD accTitle: Direct Stimulators vs Antioxidants for Collagen Support accDescr: Flowchart contrasting direct collagen stimulators with supportive antioxidants like CoQ10 in topical skincare.

subgraph Direct["Direct Stimulators (e.g., Retinoids, Peptides)"] D1["Direct Collagen Induction"] D2["Cellular Signaling in Dermis"] D1 --> D2 end

subgraph Protective["Supportive Antioxidants (e.g., CoQ10)"] A1["Scavenge Free Radicals / UV Stress"] A2["Reduce Degradation & Inflammation"] A1 --> A2 end

Direct --> Combined["Comprehensive Dermal Support"] Protective --> Combined Combined --> Outcome["Preserved Matrix without Barrier Overload"] ```

While nobody knows the exact biological threshold, combining complementary actives might lead to faster collagen synthesis or offer a more comprehensive shield against breakdown. Dr. Dray highlights CoQ10 (coenzyme Q10) as an illustrative example: because it is an antioxidant, it does not directly stimulate fibroblasts to manufacture collagen. Instead, it mitigates oxidative stress, offsetting the downstream pathways that trigger collagen degradation, unwanted hyperpigmentation, irritation, and sensitivity. Pairing broad-spectrum anti-inflammatory antioxidants with targeted direct stimulators is a logical clinical approach.

She notes that including antioxidants in daily sunscreen is similarly sound, as no sunscreen blocks 100% of ultraviolet radiation, and environmental pollution generates additional free radicals. Although one early study suggested that film-forming agents in sunscreens might hinder antioxidant penetration, subsequent data demonstrated noticeable effects, indicating that specific formulation adjustments dictate success. With hundreds of thousands of individual products available on the market, predicting how separate formulas penetrate when applied over one another remains full of unknowns.

- **Clinical trial limitations**: Topical studies evaluate isolated, controlled formulas rather than complex consumer regimens. - **The "Kirby" threshold**: Biological endpoints prevent skin from continuously swelling with runaway collagen production. - **Role of CoQ10**: Acts as an antioxidant to curb oxidative breakdown, pigment upregulation, and inflammation rather than directly synthesizing new collagen fibrils. - **Antioxidants in sunscreen**: Neutralize free radicals from the UV rays that penetrate sunscreen films as well as daily pollution exposure.

---

[11:39](https://www.youtube.com/watch?v=9QdcZWQObDY&t=699s) Why Do Pimples or Bumps Appear on Eczema?

A viewer with chronic eczema since childhood asks why clusters of small to medium surface pimples appear over their red rashes. Dr. Dray breaks down the origin of the term: "eczema" literally translates to "a boiling over." Under microscopic examination during an acute, revved-up flare, the epidermis becomes severely edematous, saturated with inflammatory fluid so intense that the tissue resembles a pot on the stove about to boil over its lid.

What patients frequently interpret as acne breakouts are actually vesicles—tiny fluid-filled blisters that characterize an acute eczema flare rather than true acne lesions. She points specifically to dyshidrotic eczema (dyshidrosis), a subtype that appears on the palms of the hands and the soles of the feet. This condition typically presents with firm, itchy, deep-seated blisters resembling "tapioca beans." When these delicate vesicles rupture, they weep a clear fluid that causes intense localized pruritus.

```mermaid flowchart LR accTitle: Dermatological Distinction Between Vesicular and Acneiform Rashes accDescr: Chart outlining the morphological differences between vesicular eruptions like eczema and acneiform eruptions.

subgraph Vesicular["Vesicular Morphology"] V1["Intraepidermal Edema / Spongiosis"] V2["Clear Fluid-Filled Blisters"] V3["Small = Vesicles / Large = Bullae"] V4["Examples: Acute Eczema, Shingles"] V1 --> V2 --> V3 --> V4 end

subgraph Acneiform["Acneiform Morphology"] A1["Follicular Plugging & Sebum"] A2["Pimples, Papules & Pustules"] A3["Inflammatory Pus"] A4["Example: Acne Vulgaris"] A1 --> A2 --> A3 --> A4 end ```

In dermatological terminology, an eruption presenting with blisters is categorized as a *vesicular rash*, whereas eruptions made of inflammatory pimples and pustules are classified as *acneiform*. Other classic examples of vesicular rashes include viral infections like shingles (herpes zoster). Dr. Dray also distinguishes blister terminology by size: small fluid-filled lesions are named *vesicles*, whereas larger fluid collections are designated as *bullae*.

- **Etymology**: Eczema originates from the Greek concept of "boiling over," reflecting the intraepidermal edema present during acute flare-ups. - **Dyshidrotic eczema**: Distinctive subtype localized to palms and soles, creating tense, tapioca-like vesicles that ooze intensely pruritic, clear exudate upon rupture. - **Morphology distinction**: Vesicular lesions (vesicles, bullae) are driven by serous fluid collections; acneiform lesions (papules, pustules) arise within the pilosebaceous unit.

---

[13:22](https://www.youtube.com/watch?v=9QdcZWQObDY&t=802s) Outro

Dr. Dray closes out the Q&A session, encouraging viewers to return for the second installment scheduled for the following day. She reminds her audience that this recording, along with previous entries, is archived within her ongoing Q&A playlist for anyone wanting to catch up on missed topics. After wishing everyone a wonderful day, she delivers her signature send-off, reminding viewers to give the video a thumbs up, share it with friends, subscribe to the channel, and never forget their sunscreen.

## Notable quotes > [00:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=0s) absolutely can help your skin. — Dr. Dray

> [02:50](https://www.youtube.com/watch?v=9QdcZWQObDY&t=170s) It almost always, for whatever reason, seems to happen when you're in the middle of driving on the interstate. Never when you're just like in the comfort of your own home... It is the worst and you're absolutely right. It's a US sunscreen specific thing. — Dr. Dray

> [02:50](https://www.youtube.com/watch?v=9QdcZWQObDY&t=170s) deer in the headlights — Dr. Dray

> [06:12](https://www.youtube.com/watch?v=9QdcZWQObDY&t=372s) exfoliate them away. — Dr. Dray

> [07:00](https://www.youtube.com/watch?v=9QdcZWQObDY&t=420s) tincture of time. — Dr. Dray

> [08:58](https://www.youtube.com/watch?v=9QdcZWQObDY&t=538s) all puffed up in the face from like exuberant collagen — Dr. Dray

> [08:58](https://www.youtube.com/watch?v=9QdcZWQObDY&t=538s) collagen bubble — Dr. Dray

> [11:39](https://www.youtube.com/watch?v=9QdcZWQObDY&t=699s) a boiling over. — Dr. Dray

> [11:39](https://www.youtube.com/watch?v=9QdcZWQObDY&t=699s) tapioca beans. — Dr. Dray

## Mentioned Dr. Dray, American Academy of Dermatology, FDA, Cool Peel, Kirby

## Video description In this skincare Q&A, dermatologist Dr. Dray answers questions from followers about salicylic acid cleansers, Cool Peel CO₂ laser treatments, sunscreen getting in the eyes, chalazion, sebaceous hyperplasia, post-inflammatory hyperpigmentation, collagen-boosting skincare, and eczema bumps.

Dr. Dray discusses whether salicylic acid cleansers can actually work despite being rinsed off, what to know about Cool Peel laser treatments compared with IPL, why sunscreen can be particularly uncomfortable when it gets into the eyes, and whether an eye examination could cause a long-standing chalazion to resolve.

She also explains why topical retinoids may not be particularly effective for removing sebaceous hyperplasia, what ingredients may help dark spots left behind after irritation, whether it is possible to "max out" the collagen-boosting benefits of skincare ingredients, and why some people with eczema develop small, fluid-filled bumps on their skin.

TIMESTAMPS

0:00 Intro 0:13 Are Salicylic Acid Cleansers Effective? 1:17 Cool Peel Laser Treatment at 75 2:50 Sunscreen in the Eyes and Blurry Vision 5:28 Can an Eye Exam Make a Chalazion Resolve? 6:12 Tretinoin vs. Tazarotene for Sebaceous Hyperplasia 7:00 Dark Pigmentation After Compression Sock Irritation 8:26 Can You Max Out on Collagen-Boosting Ingredients? 11:39 Why Do Pimples or Bumps Appear on Eczema? 13:22 Outro

Salicylic acid is an established acne ingredient and can be effective in cleanser formulations, although leave-on products may provide a stronger or more prolonged exposure.

For sunscreen around the eyes, the American Academy of Dermatology specifically recommends sunscreen sticks as an option because they are less likely to drip into the eyes.

#Skincare #Dermatologist #SkincareQandA #SalicylicAcid #Tretinoin #SebaceousHyperplasia #Sunscreen #CoolPeel #LaserTreatment #Eczema #Chalazion #Hyperpigmentation #DrDray

FTC: This video is not sponsored. Links are commissionable, meaning I may earn commission from purchases made through links.

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Disclaimer: This video is not intended to provide diagnosis, treatment or medical advice. Content provided on this Youtube channel is for informational purposes only. Please consult with a physician or other healthcare professional regarding any medical or health related diagnosis or treatment options. Information on this Youtube channel should not be considered as a substitute for advice from a healthcare professional. The statements made about specific products throughout this video are not to diagnose, treat, cure or prevent disease.

[Source](https://www.youtube.com/watch?v=9QdcZWQObDY)

中文简报

Dr. Dray辟谣水杨酸洁面产品的常见误区即使立即冲洗，外用水杨酸洁面乳也能通过凝聚作用将活性成分成功沉积在皮肤上。 Dr. Dray澄清了关于需冲洗的水杨酸洁面产品无效的误区，解释称凝聚作用使得活性成分能够沉积在皮肤上，且刺激性极小。她对比了Cool Peel点阵CO₂激光焕肤与IPL（强脉冲光），并证实了美国较老配方的化学防晒成分会导致严重的眼部灼痛感，建议在眼周使用防晒棒或物理防晒配方。她还指出，已形成的皮脂腺增生无法通过外用维A酸类药物去角质来消除；区分了黑色素沉着与含铁血黄素沉积；解释了刺激胶原蛋白生成的护肤流程存在生理平台期；并详细说明了急性湿疹为何表现为浆液性水疱而非真正的痤疮。尽管停留时间较短，水杨酸洁面产品仍能有效治疗痤疮和粗糙皮肤，这依赖于一种称为凝聚作用的配方工艺，在表面活性剂洗去污垢的同时让活性成分沉积下来。 (0:00) 外用维A酸类药物和化学去角质剂无法消除已经形成的皮脂腺增生病变，因为肥大的小叶位于真皮深层，需要通过电干燥法或冷冻疗法等院内诊疗手段解决。 (6:12) 美国防晒霜导致的剧烈刺眼感主要是由于FDA审批滞后所限、浓度较高的老一代化学防晒成分引起的，这使得质地偏蜡状的防晒棒成为眼周更安全的选择。 (2:50) 在湿疹发作部位爆发的小疙瘩并非真正的痤疮粉刺，而是严重炎症引发的表皮内充满液体的水疱。 (11:39)

Reading summary

In a clinical Q&A session, Dr. Dray addresses common skincare misconceptions, detailing the therapeutic mechanics of rinse-off cleansers, the realities of collagen stimulation, and the diagnostic differences between common cutaneous lesions. Active Ingredient Delivery in Cleansers (0:00) Dr. Dray rejects the notion that active cleansers are ineffective due to short contact times of 30 to 60 seconds. Formulations rely on a process called coacervation, which allows therapeutic agents such as salicylic acid to deposit onto the stratum corneum while surfactants bind dirt and sebum to be rinsed away. Although clinical results manifest more gradually than with leave-on treatments, cleansers provide a lower-irritation alternative beneficial for sensitive skin, blackheads, keratosis pilaris, and trunk acne. Limits of Retinoids and Stacking Actives (8:26) Addressing collagen stimulation and lesion removal, Dr. Dray notes there is an inevitable biological ceiling to topical treatments, cautioning that endlessly stacking actives primarily increases barrier irritation rather than yielding runaway collagen production. Most clinical studies evaluate single formulations under controlled conditions rather than layered consumer routines. Furthermore, while direct stimulators like retinoids signal fibroblasts, antioxidants such as CoQ10 function protectively by neutralizing free radicals that trigger collagen breakdown. Differentiating Cutaneous Lesions and Pigmentation (6:12) Dr. Dray emphasizes that anatomical depth dictates treatment efficacy across various skin concerns. Topical retinoids and exfoliating acids cannot eliminate established sebaceous hyperplasia because the benign glandular overgrowths reside deep in the dermis, requiring procedural interventions such as electrodessication or cryotherapy. Similarly, post-inflammatory hyperpigmentation on the legs responds slowly to cell-turnover topicals due to sluggish circulation, whereas hemosiderin staining from pooled red blood cells acts as an internal iron deposit that topical skincare cannot clear. Morphological Differences Between Eczema and Acne (11:39) Patients frequently mistake acute eczema flares for acne eruptions, but Dr. Dray clarifies the morphological divide between acneiform and vesicular rashes. Derived from the Greek term for 'boiling over,' eczema involves intense intraepidermal edema that produces small, fluid-filled blisters termed vesicles, or larger bullae. Subtypes such as dyshidrotic eczema present with firm, tapioca-like vesicles on the palms and soles that weep clear pruritic exudate, contrasting sharply with true acneiform pimples and pustules that originate within the pilosebaceous unit. Chemical Sunscreens and Ocular Irritation (2:50) Severe stinging, tearing, and transient blurriness from sunscreen migration are particularly prevalent with United States formulations. Dr. Dray attributes this issue to the limited catalog of FDA-approved UV filters, which compels domestic manufacturers to use higher concentrations of older chemical filters compared to international formulations. To minimize ocular migration and risks such as chemical-induced dry eye, she recommends using pure mineral formulations containing zinc oxide and titanium dioxide or water-free sunscreen sticks around the orbital area. While topical formulations offer significant protective and exfoliating benefits, their efficacy is constrained by biological ceilings, ingredient depth penetration, and formulation chemistry, leaving structural dermal lesions and specific pigment types reliant on procedural care or natural clearance over time.

Source quotes

[0:00] Dr. Dray: absolutely can help your skin. [2:50] Dr. Dray: It almost always, for whatever reason, seems to happen when you're in the middle of driving on the interstate. Never when you're just like in the comfort of your own home... It is the worst and you're absolutely right. It's a US sunscreen specific thing. [2:50] Dr. Dray: deer in the headlights [6:12] Dr. Dray: exfoliate them away. [7:00] Dr. Dray: tincture of time. [8:58] Dr. Dray: all puffed up in the face from like exuberant collagen [8:58] Dr. Dray: collagen bubble [11:39] Dr. Dray: a boiling over. [11:39] Dr. Dray: tapioca beans.

Original transcript

[0:00] Hey guys, welcome back to the weekend [0:02] Q&A. Let's get into it. If you missed [0:04] last weekend's Q&A, it is saved in the [0:06] Q&A playlist. And of course, all of [0:08] these videos have timestamps, so you can [0:10] check to see which questions I am [0:12] addressing. Are salicylic acid cleansers [0:14] useful, or should I use basic cleanser [0:17] and invest in serums? I've heard that [0:18] cleansers only stay on skin for 30 [0:20] seconds to 1 minute, and using actives [0:22] in a cleanser doesn't do much to your [0:24] skin. Salicylic acid in a cleanser [0:26] absolutely can help your skin, as can [0:28] other active ingredients in cleansers. [0:30] It's not true that they barely stay on [0:32] the skin and don't do anything. There's [0:34] something known as coacervation in the [0:36] formulation of cleansers, which [0:38] essentially allows for active [0:39] ingredients to be deposited on the skin, [0:42] and then the remains of the product [0:44] along with oil, dirt, debris, via [0:46] cleansing, are removed with water. [0:49] Salicylic acid typically helps when used [0:52] in a cleanser for blackheads, [0:55] whiteheads, dry rough skin texture. It [0:57] can be helpful for keratosis pilaris. In [0:59] contrast to a leave-on product, it's [1:01] milder, gentler, if you will, and may [1:03] take a little bit longer to see results, [1:06] but some people tolerate the wash form [1:08] much better than a leave-on, and so it's [1:10] definitely a wonderful option. They also [1:12] make salicylic acid body washes, which [1:14] can be particularly useful in the [1:16] treatment of acne on the trunk. Can you [1:18] comment on the benefits of cool peel [1:20] laser treatment? I'm a 75-year-old woman [1:22] and I have few wrinkles because of 30 [1:25] years of tretinoin and other laser [1:26] treatments like IPL. I've worn sunscreen [1:29] and a hat for 50 years. That's [1:31] wonderful. I live in Phoenix, and the [1:33] sun is relentless. So, cool peel laser [1:36] is a fractional CO2 laser. It can [1:38] resurface the surface of the skin and [1:41] improve collagen production. It [1:42] typically has about 1 to 3 days of just [1:45] like mild redness after the treatment, [1:48] maybe some peeling. You can return to [1:50] normal activities fairly quickly. It has [1:52] that collagen improving effect, [1:55] ultimately helping to cut down on [1:56] wrinkles. Cool peel is just a name for a [1:58] type of laser. It's kind of like drug [2:00] names versus the actual brand names. [2:03] Most people just say the brand names and [2:05] they have no idea what the drug is. It's [2:06] the same thing with lasers, like Cool [2:08] Peel fractional CO2 laser. The reason [2:11] that that is important is because it [2:12] kind of tells you what it is is exactly [2:15] the treatment that you're going after. [2:16] Fractional CO2 laser uses low energy [2:19] short pulses to resurface the skin and [2:22] again improve collagen production as [2:24] opposed to intense pulse light which [2:26] uses a few different wavelengths of [2:27] visible light that can target surface [2:30] texture, uneven skin tone. You get a [2:33] little bit of something different, but [2:34] IPL can be really helpful for visible [2:36] redness, prominent blood vessels, uneven [2:38] skin tone, just evening out overall skin [2:40] complexion. Whereas fractional CO2 laser [2:43] is more the really rough skin texture, [2:45] the sun damage, the wrinkles. It can [2:47] improve the appearance of pores through [2:49] the collagen induction effects. I got [2:51] sunscreen in my eyes about a week ago [2:53] and it was so bad that I had to pull [2:54] over while driving. I did rinse my eyes [2:57] out with water when I got home, but the [2:58] next day I noticed that one of my eyes [3:00] was slightly blurrier than the other. I [3:02] went to the eye doctor who let me know [3:03] that the sunscreen was the culprit and [3:05] that it caused me to develop dry eyes. [3:07] He prescribed me eye drops to take, but [3:09] my question is why do dermatologists not [3:11] talk about the dangerous effects that [3:13] this can have on affecting the eyesight [3:15] and why do you really hear about this [3:17] problem in other countries outside of [3:19] the US? Yes, that has happened to me so [3:21] many times. It's brutal, it's miserable [3:23] and you're absolutely right. It is [3:25] dangerous. It almost always, for [3:27] whatever reason, seems to happen when [3:29] you're in the middle of driving on the [3:30] interstate. Never when you're just like [3:32] in the comfort of your own home. Never [3:34] when you're about to hop in the shower [3:36] at the end of the day where you have a [3:37] convenient way to rinse it out right [3:39] away. Oh, no, no, no, no, no. Nothing [3:41] like that. Or right when you're going to [3:42] take a photo and now your makeup's all [3:44] messed up because your eyes are watering [3:46] and and you're basically unable to see [3:48] anything. It is the worst and you're [3:50] absolutely right. It's a US sunscreen [3:53] specific thing. Usually the chemical [3:55] sunscreens, although some people [3:56] encounter it with the zinc. I have no [3:58] clue what exact ingredient is that does [4:01] this. If it's one of the actual [4:03] sunscreen active ingredients or it's an [4:05] inactive ingredient used like in the [4:07] solubilization, the stabilization, the [4:09] film forming, I have no idea. It is [4:12] miserable. And I've even asked brands [4:14] about this like what the heck is going [4:16] on with chemical sunscreens that causes [4:18] this? Like why is no one cautioning [4:21] about this? Cuz it is really hazardous. [4:23] And usually they're just like deer in [4:24] the headlights. I mean they don't have a [4:26] good answer for me. But I will say when [4:28] it comes to using sunscreen around the [4:30] eyes, here's a situation where I think a [4:31] stick can be particularly helpful [4:33] because they're much less likely to run [4:35] into your eyes cuz they don't have that [4:36] water component like a lotion or cream. [4:39] You might choose a mineral sunscreen. [4:40] They tend to be less likely to do this. [4:43] Dermatologists, I think, will tell you [4:45] to avoid getting sunscreen in your eyes, [4:47] but I'm sure every dermatologist has [4:49] different subtle talking points. So I'm [4:51] not really sure about that. But yeah, [4:53] it's brutal. It It's really brutal. Not [4:55] enough people talk about it and it's [4:57] definitely one of those things about [4:58] American sunscreen formulations that [5:00] really needs reevaluation for sure. Like [5:03] other countries, I think that if we're [5:06] able to have more UV filters at our [5:08] disposal that this issue will go away [5:10] cuz I suspect they have to use a high [5:12] concentration of something when they're [5:14] dealing with a more limited number of [5:16] ingredient filters to work with to [5:18] develop a broad spectrum sunscreen. I [5:20] suspect it has something to do with that [5:22] and that if they were allowed to use [5:23] these other filters then they wouldn't [5:25] necessarily have to formulate products [5:27] in such a way that they're doing this. [5:29] Is it possible that the light used [5:30] during a routine eye exam can cause [5:33] hardened chalazion to spontaneously [5:35] resolve after 6 months? No, it's highly [5:37] unlikely that the light caused that. In [5:39] fact, 6 months is kind of normal course [5:42] for spontaneous resolution of a [5:44] chalazion. It's is of their natural life [5:47] cycle even if it was very hard. [5:49] Basically, this is a granuloma, like a [5:50] type of chronic inflammation, and the [5:52] body can clear that out eventually. The [5:55] immune system can come in. It takes [5:57] several weeks, of course, but it [5:59] definitely can happen, and it gets [6:01] reabsorbed, and and that's that. It [6:03] slowly breaks down that hardened lipid [6:06] lipid. But, it wasn't the light, most [6:08] likely. I mean, that that wouldn't make [6:10] much sense, and it's normal for them to [6:11] do that, to go away. I know there are no [6:13] studies that compare tretinoin and [6:15] tazarotene for the treatment of [6:16] sebaceous hyperplasia, but which one [6:18] have you seen to be more effective? I [6:21] don't find topical retinoids or any [6:23] topical, for that matter, to be [6:24] effective. Maybe, perhaps, they cut down [6:27] on their formation, but I have never [6:29] reliably seen a sebaceous hyperplasia go [6:32] away, resolve with the use of topical [6:34] anything. Not topical retinoids, not [6:37] topical salicylic acid. Like, you can't [6:39] exfoliate them away, and so, I don't [6:41] even really bother recommending topicals [6:44] for existing sebaceous hyperplasia. Um, [6:47] you know, you you can try a topical [6:50] retinoid, and I do think, potentially, [6:52] they cut down on their formation, but I [6:54] I've not reliably seen a topical do [6:56] anything for sebaceous hyperplasia. [6:58] They're removed with procedural [7:00] interventions. Best product to use on [7:02] leg skin that has dark pigmentation [7:04] around a compression sock, really [7:06] irritated my skin. All the skin is [7:08] healed, but there are light brown [7:09] splotchy areas that I dislike. So, it [7:12] really depends on what the heck the [7:13] brown splotchiness is. If it's [7:15] post-inflammatory hyperpigmentation, [7:17] your body moisturizers with niacinamide, [7:19] retinol, alpha hydroxy acid can help [7:21] hasten the clearance of it, but it's [7:23] really tincture of time. When we're [7:24] talking about the leg, that is [7:26] slow-moving, cuz of the nature of the [7:28] blood supply down there. But, another [7:30] kind of cause of patchy brown [7:31] pigmentation is not actual melanin [7:33] pigment, but rather something known as [7:35] hemosiderin. It tends to give this kind [7:37] of almost coppery appearance to the [7:39] skin, as far as the brown patches. [7:41] Sometimes has this cayenne pepper type [7:43] appearance to it of little petechiae, [7:45] blood rupturing out. It's basically [7:47] blood that has leaked out and is now [7:49] degraded. And so, really what you're [7:51] seeing is almost like the equivalent of [7:53] a rust stain from the iron. And it takes [7:55] a very long time for that to resolve and [7:58] to resolve. A skin care product doesn't [8:00] touch hemosiderin. In order to hasten [8:02] its clearance, light-based lasers would [8:05] be needed to target and break that up. [8:07] Um and again, on the lower leg, it's all [8:10] a very slow-moving process, for sure. Um [8:13] moisturizing the skin can [8:15] help cut down on dryness and irritation [8:17] that would cause these things to linger. [8:19] And also, can make them appear less [8:21] obvious just by hydrating up the stratum [8:23] corneum and through light scattering [8:25] make them a little more subtle. Is it [8:27] possible to max out on the benefits from [8:29] ingredients? I'm wondering if CoQ10 for [8:31] collagen boosting is worth it since I [8:33] use adapalene daily. I understand not [8:35] layering products with the same [8:37] ingredient, but I'm wondering if we [8:39] should not use two or three products in [8:41] the same routine that work on the same [8:42] issue but with different ingredients. [8:44] There are no real studies out there [8:46] examining this question at all. And most [8:49] studies look at Rarely do they ever [8:51] actually look at just a single single [8:53] cosmetic ingredients. But often times, [8:56] really what it is is an industry-funded [8:58] study where they have some product that [9:00] has a couple of different ingredients in [9:02] the product and they're only looking at [9:03] that. And then, you know, maybe having [9:05] the users wash their face with a mild [9:07] cleanser and or use [9:09] um a sun you know, a specific sunscreen [9:11] during the day that they've given them. [9:12] But no, they're not routinely studying [9:14] these things. In general, the more [9:16] things you put on your skin, the greater [9:18] the likelihood of irritation. There's [9:20] definitely some sort of threshold [9:22] because you can't just boost collagen [9:24] indefinitely. Like there needs to be [9:25] some sort of end point, logically. [9:27] Otherwise, you're just We're all going [9:29] to turn into Kirby, right? All puffed up [9:31] in the face from like exuberant [9:33] collagen. We're going to be like one [9:35] walking uh collagen bubble. And you just [9:38] don't That's just not a reality. [9:39] Therefore, it is likely that there's [9:41] some kind of a threshold thing. What [9:43] that is, no one knows. To what extent [9:45] com- uh combining different ingredients [9:47] or different ingredient combinations [9:49] leads to more collagen production, I [9:51] suspect it may help to lead to collagen [9:54] production maybe more rapidly, have kind [9:57] of more of a comprehensive collagen [9:58] protective effect. It's specifically [10:00] CoQ10 because that's an antioxidant. It [10:02] doesn't directly stimulate collagen [10:05] production, but rather helps cut down on [10:07] oxidative stress in the skin. So, that's [10:10] going to kind of help offset Yes, [10:11] something that ultimately leads to [10:13] collagen degradation, but also leads to [10:15] other issues in the skin like the [10:17] upregulation of unwanted pigment [10:19] production, irritation, sensitivity, uh [10:22] worsening of underlying skin conditions. [10:24] So, antioxidants I always think makes [10:27] sense to pair in with other ingredients [10:29] that have more specific direct effects [10:32] on, you know, a given outcome like in [10:34] this case, collagen induction because [10:36] they do kind of do that overarching [10:38] anti-inflammatory thing. Similarly, I [10:41] think they could be helpful in a [10:42] sunscreen because no sunscreen is going [10:44] to block out 100% UV. There's still [10:47] going to be some. You're still going to [10:48] get some oxidative stress in there. [10:50] Plus, you're going to get environmental [10:51] exposures, pollution that lead to [10:53] oxidative stress. And so, having an [10:55] antioxidant in sunscreen has always made [10:57] sense to me. Early on, there was like [10:59] one study that suggested in a sunscreen, [11:01] the antioxidants couldn't get in because [11:04] of the film formers, but then there are [11:05] other studies that say, "Well, it looks [11:08] like there's an effect here." So, [11:09] there's likely formulation tweaks that [11:11] need to be made in order to optimize [11:13] penetration of multiple ingredients. So, [11:15] you may be using multiple ingredients [11:17] that technically could work really well [11:19] together, but the formulations that you [11:20] happen to be using cuz again, any given [11:22] ingredient, there's going to be 200,000 [11:25] products with that ingredient for you to [11:27] choose from. So, predicting how any [11:29] given product penetrates when used with [11:31] another product or if you should only [11:33] try and use products that have the exact [11:35] ingredients all in them that you want. [11:37] Lots of unknowns for sure. I have [11:40] chronic eczema and I've had it since I [11:42] was a child. My question is why do I get [11:44] small to medium clusters of surface [11:46] pimples over the red rash? So eczema [11:48] literally means a boiling over. If you [11:51] look at eczema during the acute stage, [11:53] like when it's all starting up, getting [11:55] revved up, oozy, red, rashy, what you're [11:57] going to see is very interesting in that [12:00] epidermis is full of fluid, edema. It [12:03] literally looks like it's about to burst [12:05] with boiling over. It's like a pot with [12:07] a lid on on the stove. It's, you know, [12:09] about to boil over and you're about to [12:11] have a mess. And so what you may be [12:13] saying, I can't tell you for sure, um, [12:15] is it's not uncommon actually for the [12:18] subtype of eczema known as dyshidrosis, [12:21] typically happens on the palms of the [12:22] hands, the soles of the feet, to have [12:24] these firm, tapioca bean-like [12:26] fluid-filled vesicles. They can kind of [12:28] look like pimples for sure, but they're [12:30] not they're not acne lesions, they're [12:32] vesicles. So they're little bubbles [12:35] filled with fluid. And those are very [12:37] itchy and they rupture and leak out this [12:40] clear fluid that is also very itchy. And [12:43] so that might be what you're dealing [12:44] with there is, uh, the little vesicles. [12:47] It's a [12:48] It describes a vesicular rash. Vesicular [12:51] is not the same as acneiform in terms of [12:53] your, you know, if you want to get [12:54] technical as far as how dermatologists [12:56] describe things and the language that [12:58] they use, acneiform is going to refer to [13:00] like pimples, pustules. Vesicular is [13:03] going to refer to the presence of [13:05] vesicles. Like for example, shingles is [13:07] a vesicular rash cuz you get these [13:09] little blisters. Eczema is also a [13:11] vesicular rash in the acute stages [13:13] because you have this boiling over, [13:15] where you get little fluid-filled [13:16] blisters. Fluid-filled blisters, the [13:18] small ones are known as vesicles. Large [13:21] fluid-filled blisters are known as [13:22] bullae. All right, guys, that about [13:24] wraps this Q&A up. Come back tomorrow [13:26] for part two. I hope you all enjoyed [13:28] this one. Again, it'll be saved in the [13:30] Q&A playlist, so check there if you [13:33] missed other videos and you want to [13:34] catch up, but I hope you all are having [13:36] a fantastic day and if you enjoyed [13:38] today's video, give it a thumbs up, [13:40] share it with your friends, and as [13:41] always, don't forget sunscreen and [13:42] subscribe. I'll talk to you guys [13:44] tomorrow. Bye. [13:53] >> [music] [14:02] [music]