Dermatologists know that the vast majority of skin aging changes come from external factors and not simply from chronologic aging. Every time I do a total body skin exam on an elderly person with advanced signs of aging  on the exposed skin of their face, neck, chest, and extremities, I find that buttock skin looks decades younger since it’s free of the unwanted changes we associate with older skin. We've attributed all the signs of aging  on exposed skin to UVA/UVB and we call these changes "photoaging." But I have determined that skin aging is due to multiple other factors that our skin is exposed to, not just UV. All of these factors have been studied and there is excellent published evidence that each contributes significantly to skin damage and the kinds of changes we have been attributing to aging and UV only, including wrinkles and age spots, redness and rough texture.*

At Dr. Loretta we take  a "holistic" approach to skin health, recognizing that the key to skin rejuvenation is addressing the four factors proven to damage skin (as opposed to the more standard teaching that most damage is due solely either chronological aging or to UV).

​​*Krutmann, Jean, et al. “The Skin Aging Exposome.” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161., https://doi.org/10.1016/j.jdermsci.2016.09.015.

*Krutmann, Jean, et al. "<a href="https://doi.org/10.1016/j.jdermsci.2016.09.015"" target="_blank">The Skin Aging Exposome.</a>” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161.

Studies show that people of the same age living in more polluted cities have more wrinkles, deeper creases, and more age spots than people of the same age who live in less polluted areas. This shows us that urban environments and living near highly trafficked roads significantly contribute to age spots and wrinkles, making skin protection from the elements even more important. 

*Krutmann, Jean, et al. “The Skin Aging Exposome.” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161., https://doi.org/10.1016/j.jdermsci.2016.09.015.

*Krutmann, Jean, et al. "<a href="https://doi.org/10.1016/j.jdermsci.2016.09.015"" target="_blank">The Skin Aging Exposome.</a>” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161.

Pollutants often are very tiny particles that penetrate easily into layers of skin where they cause free radical damage. The World Health Organization (WHO) tells us that indoor pollution levels can be higher than that of the outdoors. To protect your skin we recommend the use of  skincare products rich in antioxidants morning and night, whether you're inside or outdoors.

But the major antioxidants on the market only protect from oxygen free radicals and don't protect from nitrogen (from car exhaust and nicotine) or carbon (from paints and cleaning solvents indoors and greenhouse emissions outdoors).

At Dr. Loretta, each of our skincare regimens feature Lipochroman®, the strongest antioxidant to protect skin from all three types of free radicals that harm skin: oxygen, nitrogen and carbon. Additionally, our Gentle Hydrating Cleanser features a marine algin that absorbs microscopic pollution particles from skin surface before they penetrate into deeper living layers of skin where they produce the free radical damage.

Dermatologists know that UVA and UVB cause skin cancer as well as signs of aging like wrinkles, age spots, and sagging. We also know that visible light, the major type of light emitted by the sun as well as  by digital devices, causes skin damage.  This visible light is also referred to as HEV (for High Energy Visible light) or what many know as blue light.  It causes more pigmentation in darker skin tones and more redness in lighter skin tones  than UV.  Also, the damage from visible light is often longer lasting than UVB or UVA. Recent research has also demonstrated that visible light can cause free radical damage to the skin.*

*Krutmann, Jean, et al. “The Skin Aging Exposome.” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161., https://doi.org/10.1016/j.jdermsci.2016.09.015.

*Krutmann, Jean, et al. "<a href="https://doi.org/10.1016/j.jdermsci.2016.09.015" target="_blank">The Skin Aging Exposome.</a>” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161.

*Coats JG, Maktabi B, Abou-Dahech MS, Baki G. “<a href=”https://doi.org/10.1111/jocd.13837” target="_blank">Blue Light Protection, Part I—Effects of blue light on the skin</a>.” J Cosmet Dermatol. 2021;20:714–717.

Of course, using UV protection in the form of an SPF is important. But you also need to avoid all UV sensitizing ingredients, including some of the botanicals that sensitize to UV. We use a non-UV-sensitizing fade ingredient, Chromabright®, that helps protect from the whole spectrum of damaging sun rays, including UV and HEV.

Additionally at Dr. Loretta we incorporate other ingredients that have been shown to protect skin from harmful HEV blue light. Two are Indian Ginseng  in our award-winning Urban Antioxidant Sunscreen SPF 40, and Tetrapeptide 4 in our Dr. Loretta Tightening Detox Mask.

*Coats JG, Maktabi B, Abou-Dahech MS, Baki G. “<a href=”https://doi.org/10.1111/jocd.13854” target=”blank”>Blue light protection, part II – Ingredients and performance testing methods.</a>” J Cosmet Dermatol. 2021;20:718–723.

Fluxes in temperature can cause changes to our skin. Dry, winter weather causes lower levels of moisture trapping lipids on the skin surface making our skin redder, rougher, drier and wrinkles become exaggerated in appearance. Hot, humid weather can cause  exaggeration of blood vessels, increase in oiliness and breakouts.*

*Krutmann, Jean, et al. “The Skin Aging Exposome.” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161., https://doi.org/10.1016/j.jdermsci.2016.09.015.

*Krutmann, Jean, et al. "<a href="https://doi.org/10.1016/j.jdermsci.2016.09.015" target="_blank">The Skin Aging Exposome.</a>” Journal of Dermatological Science, vol. 85, no. 3, 2017, pp. 152–161.

In cooler weather, be sure to replenish skin with lipid-laden products. I suggest our Intense Replenishing Serum. In warmer weather look for products that control oil levels without drying out skin. For that, I suggest Anti-Aging Repair Serum with organic Lilac Stem Cells that regulate sebum production and help with acne breakouts.

When you use skincare, you’re usually aware of the active ingredients in the product but almost none of us can really decipher a full ingredient deck, which contains all the "inactive" ingredients as well. Many of these inactive ingredients will include: denatured/ethyl alcohol, sulfates, artificial dye, artificial fragrance/parfum, formaldehyde releasing preservatives, and parabens.

These ingredients are irritating to the skin and cause redness that is often mislabeled as rosacea or eczema. Also, irritation activates an inflammatory cascade in the skin that starts to break down collagen and elastin, leading to worsening of lines and wrinkles.

The first thing is to become a label reader when it comes to skincare. Avoid the ingredients I've listed above. and when you use something that may irritate, like an AHA or high percentage vitamin C, be sure to apply these sparingly and never apply them to areas that are already a bit red, sensitive or peeling.

Until age 40, I led an incredibly active professional and personal life and truthfully used very little in the way of skincare products. I was fortunate to have pretty clear skin in my teens and twenties so I didn't see much need to "correct" my skin with product. And unfortunately I also had extremely sensitive skin, so I avoided using many skincare products on my face as I'd had way too many bad reactions to products I'd try. I found that avoiding exposure to potential irritants in many of the products on the market would be my safest approach.

Since I'm a dermatologist I'd receive samples and information on a myriad of products. But in the 1970's I'd done lab research at the Harvard dermatology labs, and I had enough insight into ingredients and formulations to find that most skincare products were more marketing hype than true solution. I would use one of several sulfate-free, fragrance-free, non-soap cleansers twice a day and a moisturizer in the cooler months. But I was also very aware of the fact that both of my parents had advanced wrinkling by their fifties, so my inner self sensed that at some point I would need to explore more skincare solutions.

Then came my skincare tipping point moment and I remember it as clear as if it were yesterday. After a long day with patients and helping my four children with their homework, I was pretty exhausted. I looked at myself in my daughter's bathroom mirror which happened to have three big bulbs right over the mirror. I was about to turn forty. My pores were big and looked clogged with a lot of tiny whiteheads on my cheeks, my texture was rough, and lines were starting to show. I was startled not only by what I saw but I was petrified about what this might mean for my face as I aged. I started calling labs that were making some of the new cosmeceutical formulas coming on the scene. I explained that I'd done research on some ingredients they had in their formulas and asked them, based on my recommendations, if they'd make slight tweaks in the formulas. Two of the labs did, and I started to use some of their glycolic and moisturizing products on my face and recommended these products to my patients. But when I asked them if they would be willing to use lipids and peptides at high active concentrations they declined. Encouraged by my husband to branch out, and with interest from a number of plastic surgeons and fellow dermatologists in dispensing products I'd make for them, I began to formulate my own dermatologically advanced products for my own practice and about fifty other doctors in 1993. I started with two cleansers, an at home glycolic peel, a serum, and an SPF. I’ve been making skincare as private label for doctors and spas for 25 years now. And since this time I’ve never used any other products on my face but those I’ve formulated!

As I developed a new understanding of skin aging and how exposure to external factors is responsible for most of our unwanted aging changes, I set out to formulate a line of products that would specifically address these issues to make people feel more confident about their skin at all ages. In 2014, we painstakingly created products that protect skin from the multiple issues that are aging us: pollution, indoor and outdoor light, climate issues, and irritants. With all anti-aging options available to me, I faithfully rely on our own Dr. Loretta products to be the most beautiful and youthful version of myself. And they haven't let me down!

Our products are all created to protect skin from the key external Four Factors that are responsible for aging changes seen on our exposed skin. The factors are pollution, light, climate and irritants. By taking this unique and scientifically-based approach, we want our products to correct skin changes that most of us

assume are the inevitable consequence of aging.

Our research to create new product ideas comes from looking at industry trends, demand and feedback from Dr. Loretta patients, as well as our own personal needs for anti-aging skincare. Based on desired benefits and claims of our new products, we look for the right ingredients and packaging working closely with our vendors, attending conferences and trade shows. We use the highest concentration recommended for desired efficacy. We then work on texture and absorption, viscosity while being careful not to add dyes and synthetic fragrances. We develop blends made from 100% pure and therapeutic essential oils. Once our formulas are ready, we test them on our skin and conduct clinical studies. We never bring a product to market until we have confirmed its efficacy in an 8 to 12 week clinical trial. The formulation process takes anywhere from 6 to 18 months including stability, micro and compatibility and clinical testing.

Consumers are becoming more aware that avoiding toxic ingredients can prevent many health concerns and unwanted skin changes that we sometimes attribute to aging, including redness, rough texture, increased lines and uneven pigment. Science shows that our skin is our largest organ and can absorb and accumulate a lot of toxic chemicals that can be harmful to our health.

However, the natural market is not closely regulated. It is of the utmost importance that sourcing of natural ingredients be done with great care to ensure that the highest quality ingredients are used. We also stress that the natural ingredients combine well with active ingredients, some of which are synthetic in nature, to provide the greatest benefit to the skin. For example, we use some “bio-inspired” ingredients, like Lipochroman®, a synthetic antioxidant that is inspired by vitamin E but which is 1,000 times more potent in its antioxidant benefits than several of the most popular antioxidants.

A common misconception is that natural plant-based products are less effective than science based ingredients backed up by clinical studies.

We know that using the right natural ingredient as a substance can be as active as a synthetic one. But you must be knowledgeable about how to use them in formulation and how to select the right quality and dosage.

Our products actually include many natural actives that have amazing properties for the skin. And the sourcing of these natural ingredients is very important. In my practice, I have seen many patients who have problems from so-called “natural” products that have been adulterated to cause irritation to the skin.

The natural trend is truly a buzzword in skincare as consumers fear the potential harm that may be done by chemicals applied to their skin. We both have a very holistic approach to our lifestyles. But we also strongly believe the goal of all skincare should be to provide the maximum benefit for your skin. So we use many essential oils, marine extracts and botanical ingredients. And we combine them with medically advanced ingredients that have been sourced and proven to specifically protect skin from external aging factors. These ingredients, some of which are synthetic, have been developed to be more effective actives than naturally occurring ingredients. We use the term "bio-inspired" for some of our ingredients, like Lipochroman®, the strongest of all antioxidants available, which was originally inspired by naturally occurring vitamin E but which has been altered to now provide up to 1,000 times the antioxidant protection of other popular antioxidants. All along the way, we never use known irritants.

Natural ingredients provide the perfect balance with science-based ingredients for greater efficacy. They also calm potential irritation and drying effects that can be seen with more potent formulations and can boost the effectiveness of an SPF, vitamin C, and produce a surge in hydration and detoxification of skin.

It is great that many companies are being transparent about the real cost of cosmetic products. With us having long careers in cosmetic manufacturing we have seen a lot of abuse in prices of cosmetic products that are often no more than for marketing purposes.

There is a huge spectrum in the sourcing and cost of most ingredients. We use the highest quality ingredients in all our products. And we also know that simply using vitamin C or Retinol does not define a brand as science-based. We strongly believe that there needs to be true research expertise and clinical science behind not only the individual ingredients used, but the final formulation. This is why our final formulations are clinically-tested to prove the benefits we claim. We have purposely created affordable price points for our dermatologist line since we want to make these products accessible instead of making them seem like a luxury one-time splurge.

I always use products morning and night and I like to layer products on my skin. In the morning, I use our Micro Exfoliating Cleanser. I like this in the morning after I’ve had my face in my pillowcase all night, with the dust mites and other pollutants that are unfortunately inescapable indoors.

Then I apply Intense Replenishing Serum mixed with Concentrated Firming Serum. Depending on the time of year, I will either finish off with Anti-Aging Repair Moisturizer or in drier times of year I prefer to use our heavier-textured Intense Brightening Cream. If I’m going to be outdoors for more than an hour (including time spent driving), I will apply makeup with SPF or use our new mineral sunscreen Universal Glow Daily Defense. And if I am gardening, I always wear a big brimmed hat that I consider to be part of my skincare routine as well.

At night, I use our Gentle Hydrating Cleanser to wash my face and take off all my makeup. I also use our Micro Peel Peptide Pads at least three times a week and then I follow up with the same routine as in the morning. I believe that applying my skincare products is as important as brushing my teeth, so I try never to miss doing it AM and PM.

Hydroquinone (for skin fading), retinoids (for acne, skin fading, anti-aging), benzoyl peroxide (for acne) are all actives that are best to avoid during pregnancy because they haven't had sufficient testing to prove their safety in pregnancy. Two other ingredients that aren't actives but can affect hormones are phthalates (which have more effect on male hormones but please avoid during pregnancy!) and Parabens (common preservatives that go by many names so anything that ends in "-paraben" should be avoided by all women, pregnant or not, since these may affect your hormonal balance).

Ask your own physician about AHAs since these haven't had extensive testing during pregnancy, but most dermatologists and OBs feel safe recommending them after the first trimester.

I love topical vitamin C in pregnancy because it gives some of the same benefits as the ingredients to be avoided and it gives the added benefit of UV protection which is advisable in pregnancy when you’re typically more UV sensitive. 

Vitamin C is safe and is great for anti-aging and evening of skin tone/fading.

Salicylic Acid, up to 2% is great for acne and isn't absorbed into living layers as its main benefit is ungluing dead cells within pores to lessen pore congestion and acne.

Indian Ginseng helps prevent hyperpigmentation in pregnancy and even skin tone, plus provides great protection from HEV/blue visible light from the sun and digital screens.

There is only one BHA (beta hydroxy acid) used in skincare, salicylic acid. It was originally derived from willow bark although it is mostly made in the lab now. There are several AHAs with glycolic acid being the most popular in skincare. It is the acid of sugar cane, but like BHA it is really all synthetic now.

Since BHA is an acid that can penetrate deeply into pores and unglue dead cells that may be clogging pores, it is good for acneic skin.  It can also be included in regimens for photodamaged skin and hyperpigmentation since dead cells add dull appearance to aging skin and they also store excess pigment. It is only available in low percentages, 0.5 to 2% as an over-the-counter (OTC) drug, so when you use a BHA product it is generally milder than AHA products, which are not regulated and are commonly in 5-10% and sometimes even as high as 20% concentrations.

As a general rule, BHA is best for oily and acneic skin, or if you are sensitive and have hyperpigmentation (melasma, age spots) you can start with a BHA product since it is almost always better tolerated than AHA. BHA is also less sun sensitizing, so it's safer for outdoor lifestyles in summer weather.

Like AHAs, BHA will unglue dead cells from each other, but it is more effective at penetrating into pores than the AHA's.

Since all acne lesions, from a simple whitehead or blackhead up to a painful acne pustule or cyst, start with a plug of dead cells that gets stuck in the pore, BHA (aka salicylic) works by ungluing dead cells to resolve the plug and preventing the formation of new plugs/clogged pores.

One of the hallmarks of aging skin is a slowdown in cell renewal, leaving skin with less luminosity and vibrancy. Since BHA literally lifts dead cells off the skin surface, it is a nice and gentle exfoliator to help these signs of aging.  It can also help to slightly fade age spots since the dark pigment (aka melanin) is stored in the dead cell buildup at skin surface that BHA will help lessen microscopically.

Yes, since it is an acid it may cause redness, stinging and even peeling in very sensitive or post-procedure skin. It is also not good for most people with rosacea where it can worsen redness.

AHAs also unglue dead cells from each other, but since they are available in much higher concentrations without a prescription, the higher percentage AHAs have many more benefits than BHA. Glycolic acid, which is the most common AHA, also has specific receptors in living skin that can stimulate collagen and hyaluronic acid.

For AHA: fine lines and wrinkles, especially on the cheeks. The at home AHA products that are most effective are very acidic/have a low pH so you shouldn't use them right up to eye skin since this can cause irritation, redness, swelling and even skin peeling.

For BHA: this is a similar kind of exfoliation benefit but BHA/salicylic is more effective at getting into pores so you want to focus on areas of breakouts and congested pores, more specifically the T-zone or perioral areas, since BHA is beneficial to lessen existing breakouts and prevent new ones. Salicylic, at levels of 0.5-2% is actually classified as an over-the-counter (OTC) drug with the FDA.

This will depend on the specific product you are using and the duration of your problem, your age, and your skin type. A product with a high concentration and low PH,  you can expect:

For BHA: a visible improvement in pores and acne is usually seen in 2-4 weeks, but about 5% of people will get a purging, meaning that there is a slight uptick in lesions as the pores empty out.

For AHA: if you use a product with a low pH of around 3.5, and a concentration of 10% in my experience you will see improvement in texture, fine lines, and evening of skin tone again within 2-4 weeks.

Never use them immediately after you've had a procedure, even waxing, since the acidic nature can potentially burn the skin.

Also, ask your OB about using these products in pregnancy since these two ingredients haven't been conclusively tested in pregnancy, and there is some variation in what OBs recommend when it comes to their use in pregnancy.

They should be used with caution if you suffer from rosacea since there is the potential for worsening in some cases, whereas other rosacea sufferers see improvement. If you have rosacea, please go to the dermatologist to be evaluated before you decide to use these at home or have an in-office peel performed with one of these acids.

​Retinol is a retinoid, meaning it is a type of topical vitamin A. Of all skincare ingredients to date, topical retinoids have the most studies proving their effectiveness in treating skin photo-aging. Retinol has been extensively studied by dermatologists since the 1990's and it has been found to be highly effective but considerably less irritating and better tolerated than the prescription retinoid, retin-A (aka Tretinoin).

Prescription strength retinoic acid (tretinoin, a form of topical vitamin A) is very well documented to deliver anti-aging, pore minimizing and skin brightening benefits. But is not tolerated by all skin types since it can be very irritating, drying, and sun sensitizing. Retinol is a skin friendly substitute that has been a great alternative to the prescription vitamin A. But if you are sensitive skinned, there is still some risk of redness and irritation from retinol products that have a high enough concentration of retinol to produce visible anti-aging benefits. It's helpful to know the strength of the retinol in a product. 0.25 to 0.5% is the ideal range for benefits. Dr. Loretta Concentrated Firming Serum combines 0.5% retinol in a base of moisturizing lipids to enhance penetration and minimize dryness and irritation.

Two other forms of retinoids have been found to be effective. Dr. Loretta Concentrated Firming Moisturizer features retinoic ester. This is well tolerated by sensitive skinned people and has been proven to support collagen, brighten skin and lessen pore appearance.

Another new arrival in the retinoid family of ingredients is Retinoid Hydroxypinacolone. Like retinoic ester, it appears to be less irritating yet beneficial. Consumers should be careful label readers. You may have been sensitive to a retinol product but you can still tolerate this new ingredient. So read the whole ingredient deck if you are not sure which kind of retinoid is in a product that interests you.

The scientific literature shows that over-the-counter retinol is actually at least as effective as prescription retinoic acid, but the retinol is less irritating and more readily available and affordable than retinoic acid. A major dermatology research journal, Journal of Investigative Dermatology, published this research in 1997: "the increased penetration of retinol in comparison to retinoic acid confers on retinol a more effective delivery of a retinoidal effect than (unoccluded) retinoic acid. Retinol at 0.25% may be a useful retinoid for application without occlusion because it does not irritate but does induce cellular and molecular changes similar to those observed with application of 0.025% retinoic acid."*

*J Invest Dermatol. 1997 Sep;109(3):301-5. https://pubmed.ncbi.nlm.nih.gov/9284094/#

Duell EA, Kang S, Voorhees JJ. Unoccluded retinol penetrates human skin in vivo more effectively than unoccluded retinyl palmitate or retinoic acid. J Invest Dermatol. 1997 Sep;109(3):301-5.

Retinol is still a potentially irritating ingredient that is typically not tolerated by people with dry, sensitive, rosacea, or post-procedure skin. Just because it is less irritating than its prescription counterpart, retin-A/retinoic acid, that does not mean that it is good for everyone.

1. Retinol is good no matter the concentration. Because it is found to be less irritating than retinoic acid, many people and even some manufacturers believe that you can use this at any concentration and see benefits without irritation. Not true! Most dermatologists advocate somewhere in the range of 0.25% to 1% to see benefits. But beware of starting with 1% since this is a very concentrated dose and it's very likely to cause some of the same downside as prescription retinoids.

2. The base of retinol doesn't matter: since retinol does produce some degree of exfoliation, it is important to look for a retinol in a moisturizing base. If the base is not hydrating, the skin can get dry, red and irritated with continued use.

3. Retinol cannot dry or redden skin. Retinol needs to be used sparingly to start and then you may well build a tolerance to it. Always apply in front of a well lit mirror and never apply to skin that is pink/red, dry or irritated. Sometimes this means avoiding the bone around the eye as this skin can become sensitive earlier on than most other parts of the face.

​4. Retinol cannot be used twice a day. If you find a product that benefits your skin and you do build a tolerance to it, it can be safe and effective to apply the product twice a day. I have many of my own patients who use our Dr Loretta Concentrated Firming Serum AM and PM. They start just once a day for the first two weeks and then if tolerated, they use it morning and night.

5. If you couldn't use retin-A/retinoic acid, stay away from Retinol: again, I recommend our Concentrated Firming Serum with 0.5% retinol in a very hydrating base for a perfect balance of tolerability and efficacy. If you couldn't tolerate retin-A, start this product just Monday, Wednesday, Friday at bedtime for the first two weeks and then increase to nightly if well tolerated.

Of all skincare ingredients to date, topical retinoids have the most studies proving their effectiveness in treating skin photo-aging. Retinol has been extensively studied by dermatologists since the 1990's and it has been found to be highly effective but considerably less irritating and better tolerated than the prescription retinoid, retin-A (aka tretinoin). Our skin has actual receptors for the retinol molecule which, when activated, stimulate collagen production.

When skin cells are pre-treated with retinoids and then have damaging UV radiation, the retinoid prevents collagen breakdown and pigment production typically seen after UV.*

*Fisher GJ, Datta SC, Talwar HS, et al. The molecular basis of sun induced premature ageing and retinoid antagonism. Nature. 1996;379:335–8. https://pubmed.ncbi.nlm.nih.gov/8552187/

High concentrations of retinol can be irritating, drying, cause skin redness and be sun sensitizing. If you are sensitive skinned or rosacea-prone, there is some risk of redness and irritation from retinol products.

A more gentle version of retinol, called retinoic ester in Dr. Loretta Concentrated Firming Moisturizer, is a great alternative if your skin is sensitive, dry or rosacea-prone.

Always start with nighttime application of retinol. If your skin tolerates it and you want to see more visible improvement, you may be able to go up to twice daily. Always apply a Retinol product in front of a well lit mirror and never apply it to areas that are red, puffy, or feel irritated.

It's not always easy, or cost effective, to schedule an appointment with your dermatologist when you have breakouts. Some more natural at home remedies may work for you. Rosemary essential oil has been found to stop the growth of P acnes, the bacteria that causes acne. It’s certainly worth giving this a try as a spot treatment applied twice a day to breakouts. Another oil that can benefit acne is tea tree oil. This is effective against a wide variety of harmful bacteria and fungus in the skin.

Zinc is certainly worth a try. In a double-blind study comparing Zinc to the prescription oral antibiotic Minocycline, both have comparable results by one month (although continued use of Minocycline was superior as the study progressed). But zinc is available over-the-counter and cannot give antibiotic resistance, dizziness or skin pigment changes that are rare side effects of Minocycline so this is a possible alternative. I haven't found much evidence that fish oil will help acne.

Prevention is extremely important if possible. We know that dairy products set off acne in many cases, so going dairy-free for six weeks is a very good starting point. Sometimes acne is caused by or worsened with certain hair products you may be using. Sulfate-based or heavily fragranced shampoos or argan oil hair products can promote acne in acne-prone people.

Look at the distribution of your acne. If your breakouts are on the sides of your face more than your T zone (mid-forehead and nose) you may be able to clear your skin if you change your haircare. T-Sal shampoo with 3% salicylic acid is a great product to use on your hair that often helps to clear acne on the face as well. Also, if you find that you are holding your cell phone up to your face, and your acne is concentrated on the areas where your cell phone comes in contact with your face, switch to using speaker or headphones/ear buds.

Retinol is an effective anti-acne treatment. But it is wise to find the right retinol product for your skin since there are many on the market. I recommend 0.5% retinol, used every other night to start if you are dry or sensitive skinned, or every night if you have normal to oily skin.

This should be reserved for severe cystic acne that has failed other treatments.

I don’t believe prescription topicals work better than many over-the-counter products. Dermatologists often rely on peer-reviewed studies of products and these expensive studies are more commonly done on prescription products. Hence many derms rely on prescriptions to clear acne. But based on my 40 years of dermatology experience, I use a “functional medicine” approach to acne. This means determining the cause of the problem when possible and using few or no prescription topicals to clear acne.

Here’s an approach I often take:

1. For haircare, use a 3% salicylic acid shampoo like T-Sal Shampoo, three times a week.

2. Eliminate all hair products with artificial fragrance, sulfates and argan oil.

3. Go dairy-free for at least 6 weeks. If your skin clears, continue on a plant-based diet indefinitely.

4. Don’t hold your cell phone up to your face.

5. If you take the birth control pill, see if you can be on the lowest estrogen oral contraceptive. Reflect on any association your acne may have in onset to oral contraceptive.

Absolutely! But please read the full ingredient deck when choosing your skincare products. Remember that your face cleanser should be free of artificial fragrance and sulfates. Also avoid using products with ethyl alcohol which is very drying and can make your skin overproduce acne-producing oils to compensate.

No.  Typically I see acne patients back between 6 & 8 weeks after an initial consultation. If they cleared quickly after following the 5 step approach I outlined above, and they’re doing well with my Dr. Loretta Micro-Exfoliating Cleanser and our at home glycolic pads, I will have them discontinue the prescription antibiotic.

1. Did you recently come off the pill? If so, your body’s in some estrogen withdrawal and you may need to use prescription topical clindamycin twice a day.

2. Is your acne in a pattern? If it is on the periphery of the face it may be that you’re having an acne-like reaction to hair products. Omit products with artificial fragrance, sulfates, and Argan Oil which I see as three leading causes of this pattern of acne. In the majority of my patients who have this patterned acne they clear up without having to take out their IUD.

3. Start to use AHA/BHA which dissolve the plugs of dead cells that get clogged in our pores and are the beginning of acne.

Dr. Loretta Micro-Exfoliating Cleanser sulfate-free, combines 2% salicylic acid with virgin cold pressed organic coconut oil.

Dr. Loretta Micro Peel Peptide Pads combines glycolic with skin calming herbal extracts and hydrating peptides.

There is no absolute cause and effect for dietary intake of any one type of food and acne vulgaris. The best guideline I can give is to know what's been found about dietary acne triggers and monitor if this is relevant to your acne. So, try cutting out foods that have been related to acne and see if you have improvement.

There is good evidence that milk, including low fat and skim, can worsen some cases of acne.  Good news: cheese and yogurt appear to be safe for acne sufferers!  We truly don't know why this is. The evidence for the relationship between sugar and chocolate and acne is less clear. In 2011, dermatologists published a study showing that chocolate worsens acne in many patients, but there was no investigation to know if it was the dairy, sugar, or chocolate itself that may have been to blame.  But I advise it is best to limit your sugar and fatty food intake to help with breakouts.

I advise patients to eat a balanced diet but to avoid milk and substitute it with nut "milk" products. If after six weeks of doing this there isn't improvement, they can go back to dairy.

Alcohol consumption is different in that it is related to inflammation in the skin. If your acne breakouts are red pimples, pustules or cysts you will probably see worsening when you drink alcohol and should try to limit how much you drink. If you have the rosacea variant of acne avoid alcohol, spicy food and hot foods like hot beverages or soups.