Dr Dray Rejects Claims Tretinoin Outperforms Adapalene on Aging

Dr Dray

Claims that tretinoin possesses superior anti-aging potency over adapalene lack clinical trial evidence, as routine prescribing patterns reflect FDA approval history and insurance requirements rather than pharmacological superiority.

AI-assisted summary of Do Lymphatic Face Brushes Actually Work? Dermatologist Q&A — original source. Check the original for full context.

Source published: 2026-09-12

Key ideas

Claims that tretinoin is inherently more potent than adapalene for photoaging lack clinical evidence, as pharmacological potency requires head-to-head dose-response data that do not exist; prescribing preferences are largely dictated by historical FDA clearances and insurance approval requirements. (11:01)
Lymphatic face brushes provide no physiological benefit for cosmetic aging or morning facial puffiness—which clears naturally through upright posture and gravity—while introducing real risks of mechanical friction and barrier dermatitis. (1:20)
Topical antioxidant serums cannot be assumed to replicate the hyperpigmentation defense of tinted sunscreens, because iron oxides physically absorb and reflect visible blue light, whereas antioxidants only mitigate oxidative stress downstream. (2:35)
Erythema persisting for years following ablative CO2 laser resurfacing points to chronic microvascular dilation and thermal capillary damage rather than standard healing, typically requiring targeted vascular lasers such as pulsed dye laser (PDL) to resolve. (9:13)

Detailed notes

## Background Published by board-certified dermatologist Dr. Dray on YouTube in September 2026, this Q&A video addresses viewer questions submitted through previous video comments. According to the page description, Dr Dray breaks down trending tools and cosmetic concerns, including lymphatic face brushes, Coleman Compound versus hydroquinone, antioxidant serums versus tinted sunscreen, Pond's Cold Cream, and the pharmacological reality of tretinoin compared to adapalene.

## TL;DR In this Saturday skincare Q&A, Dr. Dray dispels common social media misconceptions, explaining that facial lymphatic brushes offer no physiological benefit over natural gravity and risk barrier irritation. She clarifies that while antioxidants combat free radicals, they lack the physical blue-light blocking protection of iron oxides found in tinted sunscreens, and confirms that sun tans cannot be reversed with cosmetic products—only through time and protection. Additionally, she defends classic staples like Pond's Cold Cream while demystifying clinical dermatology practice, and debunks the myth that tretinoin is inherently more potent than adapalene for anti-aging, noting that prescribing patterns stem from FDA indications and insurance constraints rather than clinical superiority.

## Atmosphere & style The video carries Dr. Dray's trademark candid, pragmatic, and slightly exasperated tone, offering sharp reality checks against online skincare fads. Watching feels like having an unfiltered, no-nonsense consultation with a clinician who is amused by marketing hype and unapologetically direct about pharmacological facts. Her delivery blends dry humor—such as dismissing trendy claims as 'talking to a brick wall'—with accessible, grounded science that cuts through cosmetic consumerism.

## Bulletin - [11:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=661s) Claims that tretinoin is inherently more potent than adapalene for photoaging lack clinical evidence, as pharmacological potency requires head-to-head dose-response data that do not exist; prescribing preferences are largely dictated by historical FDA clearances and insurance approval requirements. - [01:20](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=80s) Lymphatic face brushes provide no physiological benefit for cosmetic aging or morning facial puffiness—which clears naturally through upright posture and gravity—while introducing real risks of mechanical friction and barrier dermatitis. - [02:35](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=155s) Topical antioxidant serums cannot be assumed to replicate the hyperpigmentation defense of tinted sunscreens, because iron oxides physically absorb and reflect visible blue light, whereas antioxidants only mitigate oxidative stress downstream. - [09:13](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=553s) Erythema persisting for years following ablative CO2 laser resurfacing points to chronic microvascular dilation and thermal capillary damage rather than standard healing, typically requiring targeted vascular lasers such as pulsed dye laser (PDL) to resolve.

## Key takeaways - [00:00](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=0s) Proprietary brightening formulations like Coleman Compound lack convincing evidence showing superiority over affordable, established alternatives like niacinamide for fading dark spots. - [01:20](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=80s) Unlike the lower limbs where fluid pools against gravity, facial lymph drains downward naturally upon standing, eliminating any physiological need for cosmetic lymphatic brushes in healthy individuals. - [01:20](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=80s) Mechanical bristles dragged across facial skin pose significant friction hazards that can compromise the epidermal barrier and induce irritant dermatitis, regardless of how soft the brush feels. - [02:35](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=155s) Iron oxides in tinted sunscreens provide physical protection by reflecting and absorbing high-energy visible light, an effect topical antioxidants have not been proven to match. - [03:39](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=219s) Pond's Cold Cream remains a functional, cost-effective cleansing balm and occlusive moisturizer, especially in fragrance-free formulas for sensitive skin. - [03:39](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=219s) Clinical dermatology focuses heavily on treating pathological skin diseases rather than curated cosmetic skincare routines, with core cosmetic guidance mostly limited to sunscreen and proven pigment treatments. - [08:11](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=491s) Sunscreen aerosol mists frequently deliver inadequate protection due to wind dispersal, uneven surface coverage, and the necessity of rubbing the product in to establish a continuous film. - [09:13](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=553s) Prolonged post-laser erythema lingering for years signals abnormal vascular dilation from thermal injury, requiring vascular-specific lasers rather than topical cosmetic intervention. - [09:48](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=588s) A tan cannot be actively reversed once melanin has been synthesized; clearing it relies on natural cellular turnover and immune processing over time, though chemical exfoliants can speed surface shedding. - [10:27](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=627s) Body moisturizers formulated with 10% glycolic acid provide dual benefits as chemical exfoliants and hydrating humectants, effectively smoothing keratosis pilaris and hyperkeratotic friction points. - [11:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=661s) Pharmacological potency is defined by the concentration required to achieve a biological effect, meaning tretinoin cannot be declared objectively more potent than adapalene without head-to-head clinical trials. - [11:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=661s) Tretinoin's reputation as the gold standard for anti-aging stems from its multi-decade research head start and specific FDA photoaging label, not verified superiority over newer retinoids like adapalene.

## Detailed walkthrough ### [00:00](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=0s) Coleman Compound for Dark Spots and Hyperpigmentation

Dr. Dray kicks off her Saturday skincare Q&A by addressing questions pulled directly from viewers' comments on previous videos. The first inquiry comes from a viewer asking about Coleman Compound as an alternative to pure hydroquinone for fading dark spots: is it effective, and is it safe for long-term use? Dr. Dray breaks down its formulation, noting that it features a 4% concentration of an arbutase enzyme, effectively an enzyme-activated form of arbutin.

She expresses strong skepticism regarding the compound's performance, pointing out that there is nothing truly convincing to prove it works any better than widely available, proven alternatives like niacinamide. The formula also appears to contain glycolic acid, which offers mild chemical exfoliation to speed up the turnover of unwanted superficial pigment, along with what she playfully terms "la-di-da vitamin C derivatives" aimed at neutralizing surface-level oxidative stress. However, she remains unimpressed by its overall value proposition: - Standard, inexpensive body lotions formulated with niacinamide already work reliably by inhibiting melanosome transfer (the movement of pigment packets within the skin). - Niacinamide can be deployed effectively on its own or alongside hydroquinone without the unpredictability or steep price tag of proprietary blends like Coleman Compound.

---

[01:20](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=80s) Lymphatic Face Brushes: Do They Actually Work?

Moving to a trendy tool flooding social feeds, Dr. Dray responds to a viewer asking about lymphatic face brushes. She vents some exasperated humor regarding the passionate community surrounding lymphatic tools, facial massage, and face yoga: "It's like talking to a brick wall. They want to believe that stuff does all this stuff, but it simply does not." She clarifies that facial aging and everyday facial appearance have practically nothing to do with lymphatic drainage. While genuine medical conditions like lymphedema exist and require clinical lymphatic drainage massage, that is entirely distinct from using cosmetic tools on a healthy face.

```mermaid flowchart TD accTitle: Facial vs Lower Extremity Lymphatic Drainage accDescr: Diagram contrasting how gravity naturally drains facial fluid versus causing pooling in the lower legs.

subgraph Face["Facial Anatomy & Gravity"] F1["Morning fluid accumulation (lying flat)"] --> F2["Upright posture during the day"] F2 --> F3["Gravity naturally drains facial lymph downward"] end

subgraph Legs["Lower Extremities"] L1["Prolonged standing throughout the day"] --> L2["Lymph must travel upward against gravity"] L2 --> L3["Fluid pools, leading to dependent edema"] end ```

Beyond the lack of physiological need, Dr. Dray explicitly warns against these brushes due to the potential for skin barrier compromise: - Claims that the bristles are ultra-soft and gentle do not eliminate the friction hazard; dragging mechanical bristles across facial skin frequently causes mechanical irritation and disrupts the barrier. - Unlike the lower legs—where fluid must fight gravity to return upward, making mild dependent edema common after standing all day—facial fluid drains downward naturally once an individual is upright. - Morning facial puffiness resolves on its own without needing mechanical stimulation, meaning these brushes offer no established benefits while carrying a genuine risk of dermatitis.

---

[02:35](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=155s) Vitamin C, Antioxidant Serums, and Tinted Sunscreen

A viewer with a deeper skin tone asks whether layering a vitamin C or antioxidant serum beneath a standard non-tinted sunscreen can replicate the protective benefits of a tinted SPF or complexion product. The viewer struggles to find a flattering tinted sunscreen shade and prefers not to wear makeup over their clear SPF every day.

Dr. Dray explains that science has not established whether topical antioxidants offer equivalent defense against unwanted pigmentation driven by visible light (specifically high-energy visible or blue light): - Tinted sunscreens and makeup get their coloration from iron oxides, which function as a physical barrier that absorbs and reflects visible blue light. - Topical antioxidants, including vitamin C, are theorized to mitigate blue light damage by mopping up free radicals and neutralizing oxidative stress after exposure occurs. - Because antioxidants address the downstream chemical reaction rather than physically blocking the light rays at the surface, they may not offer the same robust defense against pigment production as iron oxides.

---

[03:39](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=219s) Pond's Cold Cream and Why Dermatologists Recommend Skincare Products

The conversation shifts to a classic staple when a viewer observes that Pond's Cold Cream remains beloved across generations as a makeup remover and cleansing balm, yet asks why dermatologists never seem to recommend it online or in clinic. Dr. Dray laughs, welcoming the commenter to her channel where she has already published multiple videos recommending it. She calls Pond's Cold Cream the "OG cleansing balm," praising its ability to break down heavy makeup while moisturizing the skin, whether used for double cleansing or even left on as an occlusive moisturizer. She notes they make (or at least made) a fragrance-free version, which is ideal for sensitive complexions.

From there, Dr. Dray broadens the topic into a candid reality check about the disconnect between social media perceptions of dermatology and actual clinical practice. She argues that patients drastically overestimate how much headspace dermatologists devote to commercial cosmetic products: - In day-to-day clinics, 99.9% of patients present with medical dermatologic diseases—such as skin cancers, severe rashes, or autoimmune conditions—that require prescription drugs or procedural interventions, rendering drugstore cleansing balms completely irrelevant to the visit. - Dermatologists generally care about two primary cosmetic pillars: broad-spectrum sun protection and evidence-based non-drug cosmeceuticals for hyperpigmentation; outside of those, asking a doctor to navigate cosmetic cleansers is "about as much sense for your dermatologist to chime in on what kind of skincare products you're using as it would be for them to tell you what kind of smartphone you should consider buying." - She finds it almost comical that dermatologists are viewed as natural skincare brand founders, noting that product formulation is fundamentally cosmetic rather than medical. - She compares dermatologists to dentists: an ethical dentist just advises buying an affordable fluoride toothpaste to prevent cavities while ignoring whitening gimmicks; similarly, most dermatologists simply use cheap sunscreen, basic soap, and winter hand cream. - Dr. Dray reveals that across her entire formal dermatology residency, a "skincare routine" was never mentioned even once.

---

[08:11](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=491s) Bioré UV Aqua Protect Mist and Sunscreen Sprays

Addressing a question about the Bioré UV Aqua Protect Mist—a water-like aerosol sunscreen spray praised for its on-the-go convenience—Dr. Dray explains that while she has not tested that exact product, aerosol mists inherently struggle with user error and coverage gaps.

She outlines the fundamental issues with sunscreen sprays and mists: - Sprays produce an ultra-thin, inconsistent film that easily leaves patchy voids on the skin barrier. - Outdoor factors like wind can blow a significant fraction of the product away, leaving it on the ground rather than the face. - To achieve the rated SPF, mists must be held close to the skin, applied in multiple overlapping passes, and physically rubbed in with hands to seal gaps—defeating the appeal for people who use sprays specifically to avoid touching their face.

---

[09:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=541s) Persistent Redness After CO2 Laser Treatment

Dr. Dray turns to a concerning scenario from a viewer dealing with persistent redness nearly two years after undergoing a series of fractional CO2 laser procedures. The viewer wants to know if intense pulsed light (IPL) or a vascular-specific laser could target the lingering red pigment. Dr. Dray prepares to address how to handle prolonged post-procedure erythema and vascular complications following aggressive ablative resurfacing.

[09:13](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=553s) Persistent Redness After CO2 Laser Treatment

Dr. Dray addresses a viewer experiencing redness that has lingered for two years following a CO2 laser procedure. While emphasizing that she cannot offer a personalized medical diagnosis over the internet, she explains that this timeline is deeply concerning for prolonged post-laser erythema. In normal recovery trajectories, standard post-laser redness typically resolves on its own within a few months of treatment.

When erythema persists for years, it strongly indicates that the thermal energy from the laser caused deeper vascular trauma—specifically abnormal capillary stretching and chronic dilation of the blood vessels. To correct this persistent vascular issue, Dr. Dray notes that patients typically need targeted vascular laser treatments, such as a pulsed dye laser (PDL), to collapse and calm the dilated vessels.

---

[09:48](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=588s) Can a Tan Be Reversed?

A viewer living in Australia—where the sun is notoriously intense—asks if there is any way to reverse a tan once it has developed, aside from just practicing sun protection. Dr. Dray laughs frankly and delivers the hard truth: "No, honestly there's not." While alpha hydroxy acids (AHAs) and retinoids can hasten the clearance of uneven, superficial pigment in the upper epidermis by accelerating cellular turnover, true reversal cannot be forced with skincare.

Ultimately, resolving a tan requires what she calls "tincture of time." The body relies on its own immune system and natural cellular cycles to gradually clear out the melanin deposits and normalize the skin. She adds that while topical antioxidants can help mitigate oxidative stress and free radical damage if applied early around the time of exposure, they will not magically undo the tanning response once it has occurred.

---

[10:27](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=627s) Glycolic Acid Body Lotions and Keratosis Pilaris

Asked about the 10% Glycolic Acid Body Moisturizer from the Spanish brand Niche Beauty Lab, Dr. Dray admits she has never personally heard of or used that specific product. However, she breaks down the general dermatological utility of 10% glycolic acid body formulations:

* **Surface Exfoliation and Tone:** Depending on the formula's pH and vehicle, glycolic acid loosens dead surface cells, smoothes texture, and accelerates the fading of unwanted body hyperpigmentation. * **Dual Action as a Humectant:** Beyond exfoliating, glycolic acid functions as an effective humectant, drawing water into the stratum corneum and providing substantial hydration. * **Keratosis Pilaris and Friction Zones:** These lotions are particularly effective for smoothing "rough and bumpy skin" associated with keratosis pilaris, as well as softening thickened, dry, hyperkeratotic patches on elbows and knees caused by chronic friction.

---

[11:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=661s) Tretinoin vs. Adapalene: Dispelling the "Potency" and Anti-Aging Myth

Dr. Dray takes aim at a widespread skincare misconception: the belief that tretinoin is inherently "more potent" than adapalene for anti-aging, or that patients who used adapalene for acne need to "switch" to tretinoin once they care about wrinkles. She is adamant that clinical studies do not support this narrative, stating that anyone asserting tretinoin is demonstrably more potent than adapalene "doesn't understand what potency means or they're just like confused or making stuff up."

In pharmacology, potency has a very strict definition: it refers to the dose required to produce a specific biological effect. If tretinoin were truly more potent than adapalene, a lower concentration of tretinoin would produce the exact same clinical outcome as a higher concentration of adapalene. Dr. Dray highlights that head-to-head clinical potency trials supporting these broad consumer claims simply do not exist. Instead, people routinely confuse a drug’s official FDA indication with its absolute efficacy:

```mermaid flowchart TD accTitle: Retinoid Indications vs Clinical Reality accDescr: Flowchart contrasting tretinoin and adapalene FDA approvals with clinical practicalities.

subgraph Indications["Regulatory Approvals"] AD["Adapalene"] -->|"FDA Approved"| AC["Acne Vulgaris<br/>(Higher tolerability)"] TR["Tretinoin"] -->|"FDA Approved"| PA["Photoaging & Fine Lines<br/>(First retinoid studied)"] end

subgraph Reality["Clinical & Practical Realities"] PR["Practice Constraints"] -->|"Insurance prior auths & off-label risks"| RX["Prescribe strictly by label"] EV["Trial Volume"] -->|"Decades of head-start studies"| BIAS["False equivalence that tretinoin is 'stronger'"] end ```

Tretinoin has far more published literature behind it for photoaging simply because it was the earliest topical retinoid discovered and researched, earning its photoaging FDA clearance decades ago. Adapalene, meanwhile, was developed later, proved far better tolerated, and sought FDA approval specifically for acne. Dermatologists routinely prescribe tretinoin for photoaging and adapalene for acne not because one is fundamentally superior at remodeling collagen, but because practicing clinicians must contend with insurance constraints: "The dermatologist only has so many hours in a day to bicker with the prior auth and all that." Prescribing off-label creates extra administrative headaches and theoretical medicolegal risk. Dr. Dray urges consumers not to equate a drug's routine on-label indication with it being the objectively superior, most powerful active ingredient for a skin concern.

Wrapping up the Q&A, she reminds viewers to return the following day for part two of the series, signing off with her signature farewell: "Don't forget sunscreen and subscribe."

## Notable quotes > [01:20](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=80s) It's like talking to a brick wall. They want to believe that stuff does all this stuff, but it simply does not. — Dr Dray

> [03:39](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=219s) OG cleansing balm — Dr Dray

> [03:39](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=219s) about as much sense for your dermatologist to chime in on what kind of skincare products you're using as it would be for them to tell you what kind of smartphone you should consider buying. — Dr Dray

> [09:48](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=588s) No, honestly there's not. — Dr Dray

> [09:48](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=588s) tincture of time — Dr Dray

> [10:27](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=627s) rough and bumpy skin — Dr Dray

> [11:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=661s) doesn't understand what potency means or they're just like confused or making stuff up. — Dr Dray

> [11:01](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=661s) The dermatologist only has so many hours in a day to bicker with the prior auth and all that. — Dr Dray

> [12:55](https://www.youtube.com/watch?v=t_BYOQcaGOE&t=775s) Don't forget sunscreen and subscribe. — Dr Dray

## Mentioned Dr. Dray, Coleman Compound, Ponds Cold Cream, BIORE UV Aqua Protect Mist, Niche Beauty Lab 10% Glycolic Acid Body Moisturizer, Niche Beauty Lab, hydroquinone, niacinamide, glycolic acid, vitamin C, iron oxides, CO2 laser, pulsed dye laser (PDL), tretinoin, adapalene

## Video description In this skincare Q&A, board-certified dermatologist Dr. Dray answers questions from followers about lymphatic face brushes, dark spots, sunscreen, cleansing balms, laser complications, tanning, glycolic acid, and retinoids.

She discusses whether Coleman Compound is a worthwhile alternative to hydroquinone, whether lymphatic face brushes actually benefit the skin, and whether antioxidant serums can provide the same pigmentation benefits as a tinted sunscreen containing iron oxides. She also explains why Ponds Cold Cream is still a product she recommends and why dermatologists may not be the best resource for choosing every cosmetic skincare product.

Other topics include the BIORE UV Aqua Protect Mist and the challenges of getting consistent sunscreen coverage from sprays, persistent redness following CO2 laser treatment, whether tanning can actually be reversed, and the potential benefits of 10% glycolic acid body lotions.

Dr. Dray also addresses a common retinoid question: is tretinoin actually more potent than adapalene for anti-aging? She explains what "potency" actually means and why claims that tretinoin is inherently more potent than adapalene are not supported by the available evidence.

TIMESTAMPS

0:00 Intro 0:14 Coleman Compound for dark spots and hyperpigmentation 1:20 Lymphatic face brushes: Do they actually work? 2:35 Vitamin C, antioxidant serums, and tinted sunscreen 3:39 Ponds Cold Cream and why dermatologists recommend skincare products 8:11 BIORE UV Aqua Protect Mist and sunscreen sprays 9:01 Persistent redness after CO2 laser treatment 9:48 Can you reverse a tan? 10:27 Niche Beauty Lab 10% glycolic acid body moisturizer 11:01 Tretinoin vs. adapalene for anti-aging 12:55 Outro

PRODUCTS MENTIONED

Ponds Cold Cream https://amzlink.to/az029r3XBq2NV BIORE UV Aqua Protect Mist Niche Beauty Lab 10% Glycolic Acid Body Moisturizer Coleman Compound

In this video, Dr. Dray discusses skincare for hyperpigmentation, dark spots, sunscreen, tinted sunscreen, vitamin C, antioxidant skincare, cleansing balms, Ponds Cold Cream, facial brushes, CO2 laser redness, tanning, glycolic acid body care, tretinoin, adapalene, and anti-aging skincare.

This video is for educational purposes only and is not a substitute for individualized medical advice, diagnosis, or treatment from a qualified healthcare professional.

If you enjoy evidence-based skincare advice from a dermatologist, be sure to subscribe to Dr. Dray's channel and leave a comment with the skincare questions you'd like her to answer next.

#lymphaticdrainage #Dermatologist #DrDray #SkincareQandA #Tretinoin #Adapalene #Sunscreen #Hyperpigmentation #DarkSpots #AntiAgingSkincare #PondsColdCream #CO2Laser

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

💜Shop my Amazon store https://o.bttn.io/0BwiPWFIZLG 💜Follow me on liketoknowit https://www.liketoknow.it/drdrayzday 💜Social media Instagram @drdrayzday Pinterest https://www.pinterest.com/drdrayzday/ Facebook @DrDrayzDay Twitter: @drdrayzday Tiktok: @drdrayzday

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=t_BYOQcaGOE)

中文简报

皮肤科医生Dray驳斥维A酸抗老效力优于阿达帕林的说法维A酸抗衰老效果优于阿达帕林的观点，源于历史上的临床试验资助与监管审批途径差异，而非药理效力更强的证据。在本次问答中，Dr. Dray驳斥了面部淋巴排毒刷的有效性，指出面部组织液会随重力自然排出，而刷拭只会带来破坏皮肤屏障的摩擦。在评估色素沉着应对方案时，她强调外用抗氧化剂无法完全取代氧化铁对蓝光的物理阻隔，且昂贵的小众成分相比基础烟酰胺并没有明确优势。Dr. Dray还肯定了Pond's Cold Cream作为卸妆洁面膏的功效，同时澄清皮肤科医生是接受过系统医学训练的临床医师，而非美容护肤方案的选品策划人员。最后，她解释了二氧化碳（CO2）激光术后长期的红斑为何需要血管激光介入治疗，指出晒黑只能依靠时间与严格防晒慢慢淡化，并通过梳理临床试验历史与监管审批背景，打破了维A酸在生物学效力上优于阿达帕林的迷思。认为维A酸在抗衰老方面天然比阿达帕林更有效的说法缺乏临床证据支持，二者FDA适应症的差异源于当年的试验规划、耐受性设计和医保报销障碍，而非生物学机制上的优越性。 (11:01) 面部淋巴刷无法紧致轮廓或逆转衰老，因为面部淋巴液在直立姿势下会借助重力自然引流，机械刷拭反而存在摩擦、屏障受损和引发刺激的风险。 (1:20) 点阵CO2激光术后持续数年的面部泛红，代表存在外用护肤品无法修复的深层微血管热损伤，需要采用脉冲染料激光等针对血管的靶向治疗。 (9:13) 气雾防晒喷雾形成的防护层薄且不均匀，在户外极易被风吹散，需贴近皮肤多次喷涂并用手手动抹匀才能达到均匀覆盖。 (8:11)

Reading summary

Dermatologist Dr. Dray argues that many viral skincare trends and product hierarchies stem from marketing myths and regulatory designations rather than clinical pharmacology or facial physiology. She cautions against unproven cosmetic tools and proprietary blends, advocating instead for simple, evidence-backed regimens and an understanding of biological limits. The Fallacy of Lymphatic Facial Drainage Tools (1:20) Dr. Dray rejects consumer claims surrounding lymphatic face brushes, facial massage, and face yoga, noting that cosmetic facial appearance and aging are unrelated to lymphatic drainage. While clinical conditions such as lymphedema necessitate medical massage, healthy facial anatomy does not require mechanical assistance to drain fluid. Unlike the lower extremities, where fluid pools against gravity during prolonged standing, facial fluid naturally drains downward once an individual assumes an upright posture. Morning puffiness resolves on its own through normal daily activity. Furthermore, she warns that using mechanical brushes poses genuine dermatological risks regardless of how soft the bristles are marketed to be. Dragging bristles across facial skin generates friction that frequently compromises the skin barrier, risking irritation and dermatitis without offering any proven aesthetic or physiological benefits. Pharmacological Potency Versus Regulatory Retinoid Indications (11:01) Addressing the persistent consumer belief that tretinoin is inherently more potent for photoaging than adapalene, Dr. Dray clarifies that clinical data does not support this claim. In pharmacology, potency specifically denotes the dose required to produce a given biological effect, yet head-to-head clinical trials demonstrating tretinoin's biological superiority do not exist. Instead, consumers routinely conflate a drug's official regulatory approvals with its absolute clinical capacity. Tretinoin possesses extensive photoaging literature because it was the earliest retinoid researched and received clearance decades ago. Adapalene, engineered later with superior skin tolerability, pursued regulatory approval specifically for acne vulgaris. Dr. Dray explains that clinicians predominantly prescribe tretinoin for photoaging and adapalene for acne to navigate insurance coverage and minimize prior-authorization burdens, not because adapalene is incapable of remodeling photoaged skin. Biological Limits in Sun Protection and Pigment Reversal (2:35) Dr. Dray highlights significant gaps between consumer expectations and the physical reality of pigment and sun defense. Topical antioxidants like vitamin C cannot reliably substitute for tinted sunscreens; tinted formulas contain iron oxides that physically block and reflect high-energy visible blue light, whereas antioxidants merely neutralize free radicals downstream after exposure has already triggered oxidative stress. Similarly, sunscreen aerosol sprays are prone to severe user error, as wind dispersion and thin, patchy application leave coverage gaps unless the product is sprayed close and manually rubbed into the skin. For existing hyperpigmentation, Dr. Dray emphasizes biological constraints. Once a tan has developed, no cosmetic ingredient can actively reverse it; chemical exfoliants and retinoids can only accelerate superficial epidermal turnover, while complete pigment clearance requires the immune system and natural cellular turnover over time. She notes that persistent redness lasting years after aggressive ablative procedures like fractional CO2 lasers signals chronic vascular trauma—such as abnormally dilated capillaries—which requires targeted vascular lasers like pulsed dye lasers rather than topical cosmetic remedies. The Gap Between Commercial Skincare and Clinical Practice (3:39) Dr. Dray challenges the assumption that dermatologists are preoccupied with commercial skincare routines or proprietary formulations. Proprietary brightening alternatives like the Coleman Compound (a 4% arbutase blend with glycolic acid and vitamin C derivatives) offer no convincing clinical evidence of superiority over affordable, established ingredients like niacinamide, which reliably inhibits melanosome transfer. In routine medical practice, roughly 99.9% of patient visits involve serious dermatologic diseases such as skin cancers, severe rashes, and autoimmune disorders that demand prescription therapies or procedures. Dermatologists generally focus on two core non-prescription pillars: broad-spectrum sun protection and evidence-based topical treatments for hyperpigmentation. Beyond that, she observes that formal residency training never covers cosmetic skincare routines, comparing dermatologists to ethical dentists who prioritize basic fluoride toothpaste over elaborate cosmetic whitening fads. Dr. Dray concludes that consumers should base their skincare choices on proven, accessible ingredients rather than proprietary claims or mechanical tools. However, individual treatment plans for deep vascular post-laser erythema or persistent pigment disorders still require in-person clinical evaluation rather than universal online advice.

Source quotes

[1:20] Dr Dray: It's like talking to a brick wall. They want to believe that stuff does all this stuff, but it simply does not. [3:39] Dr Dray: OG cleansing balm [3:39] Dr Dray: about as much sense for your dermatologist to chime in on what kind of skincare products you're using as it would be for them to tell you what kind of smartphone you should consider buying. [9:48] Dr Dray: No, honestly there's not. [9:48] Dr Dray: tincture of time [10:27] Dr Dray: rough and bumpy skin [11:01] Dr Dray: doesn't understand what potency means or they're just like confused or making stuff up. [11:01] Dr Dray: The dermatologist only has so many hours in a day to bicker with the prior auth and all that. [12:55] Dr Dray: Don't forget sunscreen and subscribe.

Original transcript

[0:00] Hey guys, happy Saturday. We are back [0:02] for another skincare Q&A. I'm going to [0:04] be answering random questions that you [0:06] guys last left in my other videos. So, [0:10] let's get into it. And these are all [0:11] saved in the skincare Q&A playlist. I'm [0:14] interested in using Coleman compound to [0:16] fade dark spots. I know it's not pure [0:18] hydroquinone, but do you know anything [0:20] more about it? And is it safe to use as [0:22] long as I need it? So, Coleman compound [0:24] is a 4% arbutase enzyme containing [0:27] cream. That's basically an enzyme [0:29] activated form of the ingredient [0:31] arbutin. I haven't seen anything really [0:33] convincing about this to suggest that [0:35] it's going to perform any better than [0:37] like nioinomide for dark spots as a [0:40] hydroquinone alternative. And from what [0:42] I can glean, uh it also has glycolic [0:45] acid which can depending on how it's [0:47] formulated, you know, be helpful for [0:49] exfoliating gently and in doing so [0:51] hasten the clearance of unwanted [0:53] pigmentation up high. And then it's I [0:55] think it's got some lotty daty vitamin C [0:57] derivatives as I call them which may [0:59] help with oxidative stress at the [1:00] surface of the skin. But like I said, I [1:03] haven't seen anything convincing that [1:04] it's going to get you much above and [1:06] beyond what you could get from your [1:07] standard body lotion with nioinamide [1:09] which inhibits the transfer of pigment [1:11] packets around and can give a an [1:13] improvement in unwanted pigmentation [1:14] free of hydroquinone or longside [1:16] hydroquinone. So yeah, unpredictable and [1:19] expensive. I'm wondering what your [1:21] opinion is on lymphatic face brushes. [1:23] I'm seeing them everywhere. You know, [1:24] the lymphatic face brush, facial [1:26] massage, facial exercise group. I mean, [1:30] you can't It's like talking to a brick [1:32] wall. They they want to believe that [1:34] stuff does all this stuff, but it simply [1:36] does not. Facial aging is doesn't have [1:39] anything to do with lymphatic drainage. [1:41] And the appearance of of the face, very [1:43] little to do with lymphatic drainage [1:45] problems. You know, there's a condition [1:47] known as lympadeema. That absolutely can [1:49] happen. and lymphatic drainage massage [1:51] is a treatment for that. But you, first [1:54] of all, I don't recommend these brushes [1:56] because despite what they say about the [1:58] bristles being soft and then being [1:59] gentle, like rubbing a brush on your [2:01] face, it's not generally a good idea [2:04] because it can be very disruptive to the [2:06] skin barrier, irritating. I wouldn't do [2:08] it or I find it, you know, to be [2:10] something I'd recommend. Lymph in your [2:12] face is not having to work against [2:14] gravity like on your lower legs. You [2:16] know, you're more likely to get lower [2:17] leg lympadeema, a bit of it from [2:19] standing all day than you are in your [2:22] face because it's going to drain out [2:24] through gravity. When you wake up in the [2:25] morning, you might be a little puffy, [2:27] but then that all goes out of your head. [2:29] And so, doing this kind of stuff can [2:31] just irritate your skin. It doesn't have [2:33] any established or likely benefits. If I [2:36] use vitamin C serum and other [2:37] antioxidant serums underneath a [2:39] non-tinted SPF, do I still get the same [2:42] benefits of a tinted SPF or a complexion [2:44] product over the top of a non-tinted [2:47] SPF? I have darker skin and haven't [2:48] found a tinted SPF that works for me, [2:50] and I don't always want to use a [2:52] complexion product on top of my [2:54] non-tinted SPF. You know, it's not clear [2:57] whether antioxidants offer the same [3:00] degree of benefit for unwanted [3:03] pigmentation when it comes to addressing [3:06] the blue light aspect. So, with your [3:08] tinted sunscreens or your complexion [3:11] products that have tints, that's coming [3:13] from the iron oxides, which is what [3:15] imparts the blue light protection. [3:17] Antioxidants in skin care are thought to [3:20] potentially offset the negative effects [3:22] of blue light because part of how blue [3:25] light causes problems for the skin is [3:28] through the generation of free radicals. [3:30] So they may help, but they don't have [3:32] that blocking effect that iron oxides [3:34] appear to or at least we don't know if [3:37] they do or not. So hard to say. Hard to [3:39] say. I've noticed that Pawn's cold cream [3:41] used by generations of women as a [3:43] cleansing balm still is much loved [3:45] online. I've never heard it recommended [3:46] by dermatologists, neither online nor in [3:49] person. Welcome to the channel. I have [3:50] like two videos recommending Pon's cold [3:52] cream. Uh derms do recommend Pawn's cold [3:55] cream. It's like the OG cleansing balm. [3:58] Uh and you know, it it works well. It it [4:01] helps to remove makeup and [4:02] simultaneously moisturize the skin. It [4:05] can be used for double cleansing. Some [4:06] people used it as a moisturizer, left it [4:08] on the face, and it works quite well. [4:10] They make a fragrance-free one, or they [4:12] did at one point. Hopefully, they [4:13] haven't done away with that. It's been a [4:15] while since I have have dabbled in it. [4:17] But I will say this in general, I think [4:19] people way way way put too much emphasis [4:22] on the role of dermatologists in [4:24] skincare product recommendations. When [4:26] in reality, yes, dermatologists are [4:29] going to play a role in in talking about [4:31] your skin care, when it comes to sun [4:32] protection, when it comes to the use of [4:35] cosmetic cosmaceuticals as they're [4:37] known, non-drug cosmetic. They're [4:39] cosmetics that can aid in supporting the [4:42] needs of certain skin conditions, namely [4:44] like hyperpigmentation. You know, when [4:45] we're talking about dark spot correctors [4:47] that you might look for, by and large, [4:49] dermatologists don't really put a lot of [4:52] emphasis on skin care products, [4:55] especially non-cossmetic dermatologists, [4:58] because talking about the likelihood [4:59] that Pawn's cold cream is relevant to [5:02] 99.9% of the patients in a dermatologist [5:05] given clinic schedule is like very very [5:08] low. uh unless the patient has some kind [5:11] of allergy to something mold cream and [5:14] they started using it recent something [5:15] like that it's very unlikely that it's [5:17] going to be relevant so that's probably [5:19] why they don't talk about it much uh [5:21] like I said I think people way [5:23] overestimate dermatologists role in in [5:26] in brain occupation we'll say like the [5:30] amount of of time the dermatologist [5:32] spends focused on skinincare products [5:34] you know more you know the names and the [5:37] existence of more skinincare products [5:39] than your dermatologist does because [5:41] it's not really relevant like it's not [5:44] really relevant to a lot of dermatology [5:46] skincare. And so, you know, in most [5:48] cases, it's it's going to make about as [5:50] much sense for your dermatologist to [5:52] chime in on what kind of skin care [5:54] products you're using as it would be for [5:56] them to tell you what kind of smartphone [5:58] you should consider buying because [6:01] they're cosmetics. At the end of the [6:02] day, a dermatologist will probably [6:04] caution you like, "Yeah, try not to use [6:06] too much skinincare. can irritate your [6:08] skin. True. But they're not really, you [6:10] know, necessarily that concerned with [6:13] skin care products because here's the [6:16] thing, dermatology is a dra, you know, [6:18] dermatologic disease is what [6:20] dermatologists do and that's treated [6:22] with procedures and drugs, drugs for [6:25] specific conditions, not cosmetics. Uh, [6:28] so it's it's actually not as relevant as [6:31] people assume it is, which is why I [6:32] always find it comical when people like [6:34] really start to put a lot of emphasis on [6:37] dermatologists as skincare brand owners. [6:40] Like when in reality, I mean, yeah, I [6:42] guess it makes some sense, but I don't [6:44] know that they're even the most logical [6:47] uh profession to to do anything with [6:49] skincare technically. And I know that [6:51] seems counterintuitive, but really it [6:54] doesn't have a whole whole heck of a lot [6:55] to do with the treatment of skin [6:57] diseases. It's kind of like when it [6:59] comes to toothpaste recommendations from [7:01] a dentist, right? Like most dentists who [7:03] are not, you know, trying to sell you a [7:05] toothpaste to gain a little extra [7:06] revenue from for their practice or [7:08] whatever. Most dentists are going to [7:10] tell you just get whatever the cheapest [7:11] toothpaste is. You know, look for [7:13] fluoride for cavity prevention. They [7:15] tell you don't spend a lot of money cuz [7:17] everything else in there is, you know, a [7:18] gimmick or whatever. Like, you know, if [7:21] you go into the dentist and you're like, [7:22] "What are your thoughts on the Crest 3D [7:24] whitening versus the this, that, and the [7:26] other?" They're they're probably going [7:27] to be like, "Huh? Oh, they came out with [7:28] another toothpaste." I don't I don't [7:30] know. Just buy the toothpaste that you [7:31] can afford to use. That's kind of how [7:33] dermatologists are about skincare. Like [7:35] a lot of old school derms, too. They [7:37] don't even like they're like, "What? [7:39] What do you mean? I have no idea what [7:40] you're talking about." They don't even [7:41] do they don't do anything other than [7:43] wash their hands, maybe put hand cream [7:45] on in the winter from washing their [7:47] hands so frequently, and then sunscreen. [7:49] And and that's that's a lot that's about [7:51] it. I mean, you'd be surprised at how [7:53] many dermatologists don't even have [7:55] their own skincare don't have a skincare [7:57] routine. Like the emphasis on a skincare [7:59] routine and dermatology, it it came up [8:02] never in my training. Never once was was [8:06] skincare routine ever mentioned. I think [8:08] people put way too much emphasis on the [8:10] role of dermatologists in in skincare. [8:12] What are your thoughts on Bor's UV Aqua [8:15] Protect Mist, which is like sunscreen [8:18] and water spray form? I'm really curious [8:19] as I find it really convenient. You [8:21] know, I've not used that or tried it [8:23] myself, so I can't comment on the [8:24] product specifically, but generally [8:26] speaking, sunscreen mists and sprays are [8:28] a lot less reliable as far as even [8:30] coverage and protection. They can leave [8:32] gaps in in protection, uneven [8:34] application, inconsistent, too thin, too [8:37] light, and and then if you're in an area [8:39] where you've got wind blowing, you know, [8:41] it might all end up on the ground. So [8:42] that's what I caution with with the [8:44] sprays. Ideally, you want to get them on [8:46] the skin, you know, spray fairly close [8:48] to the skin, multiple passes, and [8:50] physically rub them in so that you could [8:53] coverage where the gap areas, which a [8:55] lot of people don't like to hear cuz [8:56] they're like, I'm using the spray cuz I [8:58] don't want to touch my face. Well, uh, [9:00] you do still need to rub them in with [9:01] your hands. I still have redness after a [9:03] series of fraal CO2 lasers. It's been [9:06] almost 2 years. What can I do? IPL? Any [9:08] lasers that target red pigment? Active [9:10] ingredients in skinincare. Thanks. So, [9:13] persistent redness that's lasting for 2 [9:15] years after CO2 laser. That would be [9:18] more consistent with or concerning, you [9:20] know, not a diagnosis. Okay. But that [9:22] would make me concerned for like [9:24] prolonged post laser athemma because [9:27] typical post laser redness resolves [9:29] within a few months after the treatment. [9:31] But if it persists beyond that, it [9:33] really suggests that the thermal energy [9:36] has caused some kind of deep uh you know [9:38] perhaps vascular capillary stretch [9:40] abnormal dilation of blood vessels [9:42] that's now led to this persistent [9:44] redness. And so that can be treated with [9:46] pulse da you know vascular lasers, pulse [9:48] daser. I live in Australia, so naturally [9:51] the sun is very strong and I get tan [9:53] very easily. Other than the then of of [9:55] course sun protection, is there any way [9:57] to reverse tanning? No, [laughter] [9:59] honestly there's not. Um, you know, [10:01] alpha hydroxy acids or retinol might [10:04] hasten the clearance of u uneven pigment [10:07] of course in the upper epidermis, but [10:10] it's really just tincture of time for [10:12] your immune system to come in and clear [10:13] that stuff out and for stuff to to [10:15] normalize. Um, so no, there's not really [10:18] anything. You know, uh, topical [10:19] antioxidants may help to kind of come in [10:22] there and and help to a certain extent [10:23] with some of the oxidative stress and [10:25] the damage if applied early on. But what [10:28] do you think of the 10% glycolic acid [10:30] body moisturizer from Niche Beauty Lab, [10:33] which is a Spanish brand, not familiar? [10:35] Never used it, never heard of it. Uh, [10:36] glycolic acid lotions in general can be [10:38] helpful depending on how they're [10:40] formulated for exfoliating the surface [10:42] of the skin, smoothing it out, helping [10:44] to hasten the clearance of some unwanted [10:46] uh, hyperpigmentation. They can be very [10:48] hydrating. Uh, cuz glycolic acid is a [10:50] hctant. Um, good for keratossis pilaris, [10:53] rough and bumpy skin. Uh, if you have [10:55] thick uh, dry rough skin on the elbows [10:57] and knees from frictional forces in [10:59] particular, it can help quite a bit [11:01] there as well. Is Trenton more potent [11:03] than adapylene for anti-aging since [11:06] studies show that adapylene is more [11:08] potent for acne whereas for anti-aging [11:10] we should switch? No. No. Studies don't [11:13] really show any of that. And people who [11:15] say there's no evidence that teninoone [11:17] is more potent than adapylene. Anyone [11:19] who says that doesn't understand what [11:20] potency means or they're just like [11:23] confused or making stuff up. Potency [11:25] refers to for example if something is [11:27] more potent than something else. That [11:29] means that you need less drug to get the [11:32] same effect as the less potent drug. [11:34] Okay? So if tininoan were more potent [11:36] than adapylene, that would mean that you [11:38] would need a lower percentage of [11:40] tininoan to get the same outcome as a [11:43] you know a given percentage of [11:45] adapylene. That's what that means. And [11:47] so I I don't understand why people are [11:49] always saying that one is more potent [11:50] than the other when we don't really have [11:52] these potency studies that people are [11:54] are claiming. Uh adapylene is FDA [11:57] approved for the treatment of acne. [11:58] that's what it gets prescribed for. You [12:00] know, I think people are falsely [12:01] equating what certain drugs are commonly [12:04] and routinely prescribed for and [12:06] indicated for the treatment of with most [12:08] powerful for that. Adapine's FDA [12:10] approved for acne and it's a lot easier [12:12] to tolerate. Tininoan is uh FDA approved [12:15] for photoagging cuz why? Well, it's the [12:18] first, you know, earliest topical [12:20] retinoid. The number of studies on [12:22] tininoan for anti-aging far outweighs [12:24] the number of studies that exist for the [12:26] use of adapylene for anti-aging. We just [12:29] don't have as many studies looking at [12:30] that. The dermatologist only has so many [12:32] hours in a day to bicker with the prioth [12:34] and all that. They're going to go with [12:35] what's approved, you know. Plus using [12:37] stuff off label, it just creates more [12:39] work and the potential for uh you know [12:41] medical legal risk in some cases. I mean [12:44] here, no, not so much, but you get what [12:45] I'm saying. Like don't falsely equate. [12:48] We commonly prescribe this for that. [12:51] It's indicated for this and that as this [12:53] is evidence-based is the most powerful [12:55] thing for this. All right guys, that [12:57] about wraps up today's video. Make sure [12:58] you come back tomorrow for part two. I [13:01] hope you are having a wonderful day. [13:03] Thank you so much for watching today's [13:05] video. If you liked it, give it a thumbs [13:06] up, share it with your friends, and as [13:08] always, don't forget sunscreen and [13:10] subscribe. I'll talk to you guys [13:11] tomorrow. Bye. [music] [13:29] >> [music] [13:29] >> Heat. Heat.