From acne and rosacea to simply not knowing where to start with a good skincare routine, we turn to dermatologists for all manner of skincare concerns. Given that they have seen, done and experienced it all when it comes to the skin, what are the questions they get asked most often? And what advice do they give? British Vogue sat down with three experts to find out.
Does your diet affect acne?
“For the vast majority of people, acne purely comes down to your hormones and genetics,” says Dr Anjali Mahto. “That said, there is a small, select group of people that may be sensitive to dairy and refined sugars. I don’t recommend people cut things out of their diet at random because I think that can lead to issues around food restriction and disordered eating. But if you are noticing that your skin is breaking out when you eat dairy – and I’m not talking about a splash in your coffee, but huge amounts or taking whey protein supplements – there is probably some benefit in switching to a plant-based alternative that’s got a low GI index. Think unsweetened soy milk or almond milk, which are both better than oat milk.” Dr Justine Kluk agrees, stating that dietary changes alone are not enough to control acne. “They can form part of the management approach alongside prescription treatment, but don’t replace it in most cases,” she says.
Is the SPF in moisturiser equivalent to the one in sunscreen?
“The SPF in your moisturiser is tested the same way as an SPF in sunscreen, so an SPF 30 moisturiser should provide an SPF of 30,” explains Dr Justine Kluk. “The main issue is that these formulas are less likely to be rub and water resistant and may be applied a lot more thinly than sunscreen. It’s for this reason that they may not offer the same level of protection. It is also worth noting that moisturisers containing an SPF may not contain any UVA protection and, as a result, will not protect against UV ageing.”
Do collagen supplements actually work?
“If you look at the majority of data, at this moment in time, there isn’t any really good evidence that collagen supplements actually work,” says Dr Mahto. “That’s essentially because collagen is a protein – just like eating a piece of steak or tofu is protein. All that will happen is your gut breaks it down into constituent amino acids and doesn’t think, ‘I need to send it to the skin’, so it gets passed around the body. Also, if you’ve got enough expendable cash to be buying collagen supplements – they’re not cheap – you’re probably also the kind of person who is wearing sunscreen and following a good, healthy diet and using a retinol, so it becomes tricky to figure out whether it’s the collagen supplement working or the other things. I’m sceptical, but if you can show me good data that works, I’m willing to change my position on it.”
Will my breakouts ever go away?
“They might, but the reality for many women is that they often continue into the thirties and beyond,” says Dr Sam Bunting. “The good news is that the right anti-acne skincare routine will often be a highly effective plan for tackling premature ageing too, so your skin may well look better and better as time goes on.”
What is the right age to start having injectables?
“Lots of people ask if they’re too young or too old for injectables,” says Dr Mahto. “Generally, people that are in their mid-thirties onwards have figured out whether it’s a reasonable time to get started. Usually what I say in this scenario, is that it’s not actually about your age, it’s more about how your skin is ageing. That depends on your individual genetics – how your parents age – as well as how much sun exposure you’ve had, your diet, how stressed out you are and how you sleep. You can have somebody in their late twenties who’s had very little sun and their skin is ageing beautifully and they don’t need any injectable treatments. On the other hand, you could have a 28-year-old who has a really expressive face, they’ve enjoyed sunny holidays and outdoor sport, and they’re starting to get lines when their forehead is at rest or noticing a loss of volume in fat in their face. For someone like that, it might be a reasonable time to start. Different ethnic groups also age differently – somebody who has really fair skin, blonde hair and blue eyes will start to get wrinkles more quickly than somebody who has Asian or Black skin, because their melanin will protect them. The flip-side is that those with Asian and Black skin tend to start losing volume in their faces more quickly, so they tend to need filler before they need Botox.”
Is my skincare routine working?
“I think there is still a basic lack of understanding around what you actually need in a skincare routine and what you don’t,” Dr Mahto says. “People buy into the buzz about the latest ingredients – whether that’s niacinamide or tranexamic acid – but actually the average person does not need to be using every single one of those ingredients. What you’re trying to do is use as little as possible on your skin, and to look for ingredients that target multiple things. Vitamin A is anti-ageing, good for acne and pigmentation – so why use niacinamide and tranexamic acid and retinol when you’ve got one ingredient that will do a really good job of that? I spend a lot of time stripping back people’s routines, rather than adding things in.”
Will anyone be able to tell if I’ve had Botox?
“Not if it’s done well,” points out Dr Bunting. “I talk to patients about softening strong expression lines and releasing the tension from the face nowadays – it’s a far cry from the frozen faces of the ’90s. Microdosing means no one else ever has to know.”