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© 2019 Savvy Derm Diva

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Dear Savvy Derm Diva,

I am noticing more facial flushing that started in my mid-20s.  Should I be concerned? 

-Lisa A. Always Blushing.  

Dear Always Blushing,

You could be at the beginning stages of something called Rosacea, which is a skin condition that affects approximately 16 million people in the US.  April is Rosacea Awareness Month created to educate the public of this frustrating skin disorder. Symptoms include flushing and blushing that can be exacerbated by certain triggers such as UV exposure, alcohol, spicy foods, and even alcohol-based skincare products.  Rosacea can appear at any age with different symptoms but usually presents itself in your 30s, according to the National Rosacea Society.   Unfortunately, if left untreated, it can continue to worsen and cause increased dryness, itch, and even acne-like bumps to the face. Your best bet is to get an evaluation by your Board-Certified Dermatologist or their Dermatology PA-C or NP to confirm the diagnosis and make sure there is not an auto-immune component to your symptoms.   They will be able to start you on a treatment right away, teach you how to practice good skincare for your skin type, as well as rule out any other diseases that can cause facial flushing.

Diva Tip:  Start keeping a journal of your triggers and bring in all the products you are using to your appointment. 

Dear Savvy Derm Diva,

I have red bumps on my face, specifically my nose, that never resolves.   I tried everything from OTC topical remedies, to facials, to trying to extract them myself, but nothing works!  They do get smaller at times, but never completely go away. Sometimes, they get very inflamed and painful, especially after I have some wine.  Should I be concerned?

-Gina L.  Forever Breaking Out 

Dear Forever Breaking Out,  

Rosacea is an inflammatory condition of the skin that can cause resistant pimples and pustules to the face.  You are probably experiencing some dryness and background redness along with broken blood vessels to your cheeks and nose as well.  As I mentioned before, there are many triggers that can exacerbate this condition, and alcohol is one of them. There are terrific RX treatment options that can help get it under control, such as topical medications, oral antibiotics, supplements, as well as laser treatments known as photofacials that work quite well.  The key is to be compliant with your routine, monitor and avoid triggers, and make sure you continue to follow up with your Board-Certified Dermatologist/Derm PA-C or NP for routine check-ups.  The sooner you control your Rosacea, the better.


Diva Tip:  April is Rosacea Awareness Month and to learn all about Rosacea please visit 

Dear Savvy Derm Diva, 

Now that spring is around the corner,

should I be changing up my skincare routine? 

- Looking Forward to Spring. Kerri S. 


Dear Looking Forward to Spring,

This is a great question, and the answer is yes, you may want to consider it.  As the temperature increases, so does the humidity, and therefore, the air is not as cold and dry once it becomes warmer outdoors.  You can probably back off using thick heavy creams to the body and start incorporating lightweight water-based moisturizing lotions instead.  Another tip is to start getting that springtime glow by gently exfoliating the skin to your body and face one time a week to remove the dead skin cells that can contribute to skin dullness.  Lastly, you may want to incorporate a mask 1-2X/week to help remove the impurities from the skin, such as pollution, dirt, etc.  Lastly, don't forget to continue to wear SPF daily! 


Diva Tip:  Not all skincare products are created equal; make sure you are familiar with your skin type when choosing exfoliants and masks.









Dear Savvy Derm Diva,

Because of my skin experiencing increased dryness during the colder weather, should I discontinue my retinol in my routine during this time of the year?

- Curious about Retinols. Val K.

Dear Curious about Retinols,

I am so glad you asked as I have a lot of patients curious about this as well.  It’s proven that retinol is a perfect product to use to up the ante of your anti-aging defense.  That said, it can at least 3 months of use to reap the rewards of this magical potion. Because of this, I say no unless you are experiencing any side effects with the product, such as stinging, burning that is not resolving. You may experience more dryness or some transient mild forms of these types of side effects in which you should make sure you are using a good moisturizer two times daily in addition to possibly adding a hyaluronic acid.  You may even want to decrease the use every other day or even replace your current retinol with a milder form. Some Tips: Discontinue when side effects are not improving and contact your Board-Certified Dermatologist for an appointment because you may be experiencing something known as Irritant Contact Dermatitis.  

Diva Tip: Retinol from mild to most potent includes retinyl palmitate, retinol, retinaldehyde (AKA retinal), and retinoic acid (AKA Tretinoin).

Dear Savvy Derm Diva,  

I am so excited for Spring Break and am considering a few indoor tanning sessions, so I have some color before my trip to Florida.  I always sunburn, so I thought a base-line tan would be best to decrease my risk.

- Seeking a Base Tan. Terri H. 


Dear  Seeking a Base Tan,

Indoor tanning is dangerous and significantly increases your risk of developing melanoma, the most deadly form of skin cancer.   The UV radiation from indoor and outdoor sources causes damage to the skin, which can lead to premature aging, immune-suppression, eye-damage, and even other forms of skin cancer.  Though sunburns can increase your risk, even more, you would still have a risk of getting a sunburn and skin cancer even with a base-tan. That said, no UV exposure is safe, and therefore, you should always avoid indoor tanning beds, wear SPF of at least 30 or more with reapplication every 1-2 hours when you are outdoors.  Finally, make sure you have a Total Body Skin Exam (TBSE) scheduled every year with your Board-Certified Dermatologist to make sure there are no suspicious moles or growths.


Diva Tip:  You increase your risk of developing melanoma by 75% if you start indoor tanning before the age of 35.






Dear Savvy Derm Diva,

I keep seeing moisturizers with the terms “humectants” and “emollients.”  Why are these two ingredients so important?

- Wanting to know. Karen T.

Dear Wanting to Know,  

I love this question because it helps define the importance of the reason we use moisturizers in the first place.  Natural humectants such as hyaluronic acid, glycerin are necessary because they moisturize the skin by attracting water from the environment into the skin.  Examples of emollients include “oils” or “lipids” such as mineral oil, coconut oil, and shea butter to name a few.  They are responsible to soothe and soften the skin by replacing oils (lipids) and preventing water loss.  Both synergistically help strengthen the barrier of your skin.

Diva Tip: Gold Bond Healing with Aloe Fragrance-Free Lotion, Gold Bond Eczema Relief Lotion/Cream, or Amlactin Daily Moisturizing Body Lotion.  

Dear Savvy Derm Diva,

What cleanser do you recommend for oily sensitive skin that won’t be too drying in the winter?  I’ve been struggling to find a good one if you have any suggestions.

- Seeking a Good Cleanser.  Jen G.

Dear Seeking a Good Cleanser,

This can be quite the challenge as the balance is vital for optimal skin function.  The harsh winter months can wreak havoc in all skin types. Despite your skin type, it is crucial to utilize the correct cleanser as it is a great way to remove the debris of our skin that has collected throughout the day, such as make-up, pollution, and even excess oil and dead skin cells.    The pH of our skin is more acidic at about a pH of 4.7. For oily complexions, I do recommend more of a foam type of cleanser with a higher pH.

Diva Tip: Epionce Lytic Gel Cleanser, La Roche-Posay Effaclar Purifying Foaming Gel Cleanser, you can even use a 5% Benzoyl Peroxide by Topix if you are acne-prone.  Just don’t forget your moisturizer and SPF.

Dear Savvy Derm Diva,

I note more dryness to my skin during the winter months, I know the weather can affect it but are there other things I should be aware of that can contribute to the dryness? 

- Feeling Dry. Mark M.

Dear Feeling Dry,  

Dryness can result from any number of things that can remove water from the skin.  Dryness contributors include skincare products, weather, and bathing habits, to name a few. The cold, dry weather causes the skin to lose moisture, and to chap or crack.  Products with alcohol such as skin toners, aftershaves can dry and irritate the skin. Lastly, hot water and prolonged bathing, which feel fantastic during the cold months, but can lead to increased water loss and dryness.  It would be best if you also stayed away from things that can cause increased aggravation, such as scrubbing brushes, granular, or antibacterial soaps. Make sure you use a moisturizer at least once a day and apply within 3 minutes of getting out of the shower to lock in the water that your skin has soaked up.

Diva Tip: Thick creams are better than lotions. I love Avene Xeracalm cream, Epionce Renewal Calming Cream, and Cerave cream

Dear Savvy Derm Diva,

I travel a lot for work,  is it alright to use the skincare products I get from the hotel?

-Traveling Girl, Amy W.

Dear Traveling Girl,

Though the hotel skincare items are convenient, I recommend only use for emergencies.  It is always best to travel with your essentials, such as cleanser, moisturizer, and SPF.  The hotel products are often full of fragrance and can wreak havoc on your skin. For simplicity, I have sample sizes of my essentials in a mandatory travel bag, so they are not forgotten. 

Diva Tip: You may even want to keep a folded pillowcase as the detergents used to wash hotel sheets may be irritating.

Dear Savvy Derm Diva,

Is chocolate terrible for my skin (i.e., acne) or is this just a myth, I love indulging during the Holiday Season?

-A true chocoholic, Tammy L.

Dear True Chocoholic,  

The excellent news is that “chocolate” per se is not harmful, but it is the SUGAR in the chocolate that can be problematic.  A diet with a high glycemic intake from sugar or refined carbohydrates can cause an inflammatory response, which can lead to acne flares. Refined carbohydrates include everything I love during the holidays:  pastries, sodas, snacks, white bread, and can also be found in processed foods. Enjoy in moderation, and make sure you are on a good skincare routine and get plenty of zzz’s to control your flares somewhat!

Diva Tip: Diet is an adjunct to proper skincare, and sometimes the holidays get the best of us. Be sure to have your Derm on speed dial just in case!

Dear Savvy Derm Diva,

I use a 0.5 retinol and vitamin c every night, but my dark spots are now visible WITH makeup on. Help! 

-Katie M, Dark Spots and Makeup

Dear Dark Spots & Make-up:

Thank you for inquiring!  I love this question! You are missing the most crucial piece, which is using a Broad Spectrum SPF in your routine.  Make sure you get a mineral-based one with SPF 30 or more and reapply every two hours and after sweating or swimming.  SPF in makeup is NOT enough to protect you. Another problem is our smartphones and computers are contributing to the discoloration, so make sure you have an SPF with Iron Oxide.  Lastly, you may even need a prescription to help lighten them in addition to what you are already using. I would strongly recommend getting them checked out by a Board-Certified Dermatologist to make sure they are benign first and don’t delay.  

Diva faves: EltaMD Tinted UV Clear Broad-Spectrum SPF 46 and Epionce Daily Shield Tinted SPF 50.

Dear Savvy Derm Diva,

I would love to learn how to fix under eye blueness! 

-Melissa R, Feeling Blue.

Dear Feeling Blue,  

Yes, such frustration!  Let’s talk undereye circles in general.  There can be several causes of under-eye discoloration that may be happening synergistically:  sleep deprivation, dehydration, genetics, allergies (hay-fever), aging, dry skin. That being said, all can contribute and accentuate the problem.  With under-eye “blueness” tells me it is more vascular, which may be a genetic component. Aging makes it worse. As we age, the skin thins even more due to the loss of collagen, and the discoloration is more prominent.  Aging also causes a loss of fat and bone, which can also contribute. An option for you you may be a topical that has caffeine. Lasers can help improve the elasticity of the skin and may target the hemoglobin contributing to the discoloration, and finally, fillers or fat transfers in an option which can be expensive and have increased side effects but worth the results if done correctly.  All three would be optimal for the best results.

Diva Tip: I always recommend starting with a good eye cream.  Though it will not be a miracle treatment, it is still important to have whether you do additional therapies or not.  A Diva Fave is Teamine by Revision.

Dear Savvy Derm Diva,

Now that summer is over, and my tan is fading; I am noticing a lot of discolored patches on my face that are not going away.  What is it, and what can I do to get rid of it?

-Anna B, Concerned in Chicago.

Dear Concerned in Chicago,  

It sounds like you may have a condition known as melasma, which is caused by cells known as melanocytes.  These cells make pigment in your skin and are usually stimulated by sun exposure, but hormones can also play a role.  Your best bet is to make sure a Board-Certified Dermatologist evaluates your skin to make sure there are no concerns.  There are several RX treatments available, and good results are paired with in-office procedures. All vary in cost, so make sure you choose something you can afford as full treatment will give you the best results.  In the meantime, make sure you pick up SPF 30 + with Iron Oxide as the Blue Light from our personal devices may be contributing as well.


Diva faves: Epionce Daily Shield Lotion Tinted SPF 50, Avene Tinted SPF 50. 

Dear Savvy Derm Diva,

I am noticing a white patch under my chin along with a splotchy discoloration surrounding it.  Should I be concerned?

-Diana N, Looking Splotchy.

Dear Looking Splotchy, 

What you have described is something called “Poikiloderma of Civatte,” which is a condition caused by chronic sun exposure (aka photodamage).  You can appreciate that white, “normal skin” under your chin secondary to the shade it is providing to the area. Always make sure you wear an SPF 30 or higher all year round.  Though it can be tough to treat, please make sure you have the area evaluated and monitored for any concerning growths because of the chronic sun damage.

Diva Tip: Your computers and personal devices may contribute to the discoloration of your skin, protect your skin with Diva SPF Faves.

Dear Savvy Derm Diva,

I am hearing that my personal devices, such as my cell phone, laptop, etc. are contributing to the pigmentation on my face, chest, and neck. Is this true?

-Cary W, Seeking the Truth

Dear Seeking the Truth,

Yes, unfortunately, it is true. All personal devices emit High Energy Visible Radiation (HEV Light) or Blue Light. This form of light is responsible for regulating our circadian rhythm but can contribute to pigmentation produced by melanocytes, cells that makes up our skin color. It has also been found to be instrumental in causing damage to your skin (aka photo-aging = wrinkles). Your best bet is to start wearing an SPF 30+ with iron oxide. 

Diva Tip - SPF with iron oxide are usually found in a tinted version.

Dear Savvy Derm Diva,

Do I need to wear SPF every day? I work at home and rarely go outside during the day unless I am getting the mail or walking the dog which doesn’t take long. Am I getting that much exposure to the sun?

-Brittany M, Keepin it Indoors

Dear Keeping it Indoors,

The answer is an absolute yes! The UV radiation from the sun is potent and can even penetrate windows, causing the skin to damage. Also, if you go out for a few minutes daily, all of that accumulation of sun exposure can wreak havoc on your skin years later. Start wearing SPF now, and you will thank me years from now. Promise!

Diva Tip - Make sure you choose an SPF 30 or higher and reapply every 1-2 hours or after sweating or swimming for the best results.

Write your skin related questions or your favorite finds to Savvy Derm Diva and your request may be featured in our monthly column.  Your name will be kept in confidence (if requested) as the goal of this column is to assist everyone with proper skin care. MUAH!

Dear Savvy Derm Diva,

What should I do to get glowing skin?

- @rachelmichella

Dear @rachelmichella,

Thank you for writing to the Diva!  Glowing skin is as easy as 1, 2 3!  1. Washing your face with a glycolic acid cleanser to exfoliate the skin gently.  2. A moisturizer with SPF to offer protection and hyaluronic acid to add hydration.  3. Nightly retinols for anti-aging and gentle exfoliation. This nightly for a few months will help aid in a naturally glowing skin!  It is always best to see a medical provider so he or she can help guide you to the correct products for your skin type.

Diva Tip - Just start this routine slowly, because it may cause irritation in the beginning.   MUAH!

Dear Savvy Derm Diva,

How do I combat major dry skin?

- @peplumnbubblegum

Dear @peplumnbubblegum,

We all know that winter time can be rough on the skin, but now that spring has finally arrived it is so important to take care of your skin all year around!  My tips are to wash your body with a gentle cleanser like Dove bar or CeraVe bar and only cleaning “dirty” areas such as the groin and armpits. Do not over-scrub with a loofah or washcloth.  Within 5 minutes of getting out of the shower to apply a moisturizer and make sure you do this EVERY single day, I love any of these three LaRoche Posay Lipikar Balm, Gold Bond Eczema or Diabetic Cream, and Avene Xeracalm during the tough winter months, but I do have many patients using them year round.  Now that spring is here; you can easily transition to a lotion and keep up the same routine. Restart your cream based moisturizers in the fall. If your skin is not improving, make sure you make an appointment to see your Board Certified Dermatologist to rule out any other causes.  Best of luck and please keep me posted.

Diva Tip - Stay away from hot showers! MUAH!