If you spend a small fortune on skincare every month, if you go for regular facials, use expensive eye cream and buy all the latest luxury products, then you might want to hear what Dr Natalia Spierings has to say about it.
The straight-talking consultant dermatologist at Kings College Hospital splits her time between Dubai and the UK, appears on Britain’s Channel 5 program Skin A&E and has just released an evidence-based skincare guide called Skintelligent: What You Really Need to Know to Get Great Skin.
She wrote the book to counter everything she sees on social media, explaining:
I was like, ‘hold on a second. Where are we getting this information from? Who is providing the consumer with this information regarding these products? Is there anything that’s not biased? I couldn’t find anything that wasn’t biased. Then when I started looking at the literature myself and really started, like I said, unpicking things, it became very clear to me that most of the skincare stuff that’s being sold to us is basically a scam’.
Can you talk a little bit about the relationship between dermatologists and products?
Skincare companies really love doctors and dermatologists promoting their products. This has been studied. This has been shown as evidence that when a dermatologist who has a title like a consultant dermatologist or board-certified dermatologist, if they say, ‘Yes, this product is good,” it will sell out much more quickly.
The power that I have because of my title is something that I think a lot of doctors don’t even realize they have. To me, if I find a product that I really love… if I think something’s good, I shouldn’t have to be paid to tell you. That’s what I took oath about. That’s why I went to medical school, so that I can give you that information for free. It’s my job. For a dermatologist to go around and say yes, the serum is amazing, anti-aging, anti-pigment but they’re getting paid to say that, their credibility is shot to crap. I don’t trust you. Would you trust that? No.
What you see out in the media from these sorts of doctors that people need to be aware of?
One of the big ones is vitamin C as the magic panacea for all things skin. That is total nonsense. Vitamin C does basically nothing for skin that’s useful, at least in the form it’s sold as a serum. Vitamin C, when it comes down to the science, is extremely important for skin health as a cofactor in the production of collagen. Yes, yes, yes, I understand that. It’s an antioxidant. Yes, I know, I know. The utility of it being applied to the skin as a lotion or potion or serum, that is total crap. That is the biggest one because for a doctor to go around be like, yes, vitamin C, vitamin C. These Vitamin C products are not cheap. Pretty much a chapter in the book I wrote because I had to unpick this Vitamin C story and it is very difficult to unpick it because there’s a lot of bias and there’s a lot of stuff written all over the place about Vitamin C because there’s many industry-sponsored studies that the methodology is crap, the way they do it is crap, everything’s crap, but the headline’s great.
You mentioned the industry-sponsored studies; can you just talk about that a little bit?
An industry-sponsored study basically means that the company that makes the product also puts together the study or funds the trial and also chooses the outcome, if you will. I say that very loosely because yes, they have to show that the outcome comes from somewhere, but they can manipulate the numbers to show whatever you want. An industry-sponsored study means that the company that makes the product is paying for the trial of the product. Generally speaking, that product will come out shining and amazing because the researchers are being paid to show that. I’m not saying they’re doing it intentionally. It’s usually different people. The researchers are different from the company, but there’s a lot. You just never know. If you don’t understand how to read clinical trials, which the majority of people, even doctors don’t really know, then you can just read the abstract and be misled down a whole rabbit hole of confusion.
So what do we need to know about products?
All the products are the same. Pretty much all brands are the same in terms of what the product is. The feel of the products are different. Something is foaming, something is not foaming. Something feels softer on your skin than another thing, but the bottom line is all these products are made of the same couple of ingredients anyway. They’re all based on water, they have emollient in them. There’s some type of emulsifier, there’s some type of a preservative. They’re, basically, all the same, so the idea that you can’t mix different brands in a skincare regime is also total nonsense, but it also looks prettier in your bathroom if they’re all the same.
What about SPF in sunscreen?
SPF is about how long you can stay out of the sun without burning if you were not wearing sunscreen. If it’s an SPF 50, you can stay out of the sun 50 times longer than if you weren’t wearing sunscreen. The number itself does have a meaning and it is something that’s calculated in a lab setting, but, of course, a lab setting isn’t human life. Really in fact if you’re wearing SPF 50, you’re probably only wearing enough to get an SPF 25. You’re only protecting yourself half as much as you think you are from the sun. In the States, you can buy an SPF 100. In the EU that’s not been recognized as being a true sunscreen.
Sunscreen regulation is actually quite a complicated area that changes in every country. I just say stick with SPF 50, use a mineral, reapply as you can, but more importantly than that, just sun avoidance is more important. I encourage my patients to wear a hat, wear long sleeves if you’re going to be gardening. Don’t rely on sunscreen. Sunscreen should be your third line because of all these issues of application and with chemicals and stuff, people are scared. I’m like, ‘well, don’t rely on sunscreen. Use it as your third line. Stay out of the sun, use protective clothing and then use your sunscreen’.
Some people are saying that should now wear sunscreen while you’re using the computer…
The blue light. That’s not true. People are also selling from your phone as well. Apparently you can get UV damage from your blue light from your phone. I’m on my phone, on the screen. The intensity of the light coming from your screen is so much lower than that done in a trial setting, that it’s almost certainly totally irrelevant. It has to do about the intensity of the light and the intensity of the screen light is just like zero. There is just no impact at all on your skin, zip. You shouldn’t worry about that. You don’t need a special sunscreen.
How much of skincare is about what you eat?
I think strongly your genetics. How you live, what you eat and your genes, that will decide what your skin ultimately looks like. This is me just ballpark figuring it, but I think the amount of control we and as individuals have over the way our skin looks is would probably be like 2 percent in terms of what you’re applying to your face. It’s largely genetic, environmental, lifestyle related, and then maybe 5 percent, what you actually do to your face, unless you have a skin problem and then what you do is going to be relevant.
For the majority of people, you could use the most expensive creams, LED mask, light mask, get a facial every week and God knows what else for a year and your skin probably won’t look any different than it did at the beginning of the year.
What can we stop doing?
I think the first immediate thing I would get anyone to stop is exfoliating with a scrub. Ditch the exfoliating because you treat your face gently. Your facial skin needs to be treated gently. Don’t exfoliate your face. You’re going to lead yourself down to more problems. I would skip the toner. That does nothing at all. I don’t see the point of using a toner. Definitely ditch that. No masks, also pointless. Don’t understand it. That’s just drawn in through your skin. Anything where you’re leaving water on your skin for an extended period of time is not a great idea. Skin doesn’t like water. Just like if you’re in a bathtub for a long time, your skin gets a little bit shrivelly, same with your skin dry.
What’s your take on collagen peptides?
I think if we go down to very basic science here, collagen is a very big protein molecule and it’s found in most animal or all animal things you eat. When you eat collagen or protein, it goes into your gut, it gets broken down into individual amino acids, and it gets absorbed in your gut as amino acids. That’s the only way you can absorb collagen or any protein if it’s broken down into the individual amino acids and then you absorb it and it goes and does whatever it needs to do in your body.
The idea that if you drink collagen supplement and that collagen will go directly to your skin and do something magical to your dermis is complete fantasy. To me, the collagen industry is a hugely profitable industry, but it’s also one of the biggest scams I have ever come across in skincare because it’s just so nonsensical. The studies that are done of this are so crap that I can’t believe they even get published in peer review journals. It is horrifying. No, stay away from collagen.
What are the best treatments for pigmentation, wrinkling and other aging concerns?
My first would always be to do a topical retinoid, a Vitamin A derivative called tretinoin, because, in terms of stuff we know has an evidence base and is recognized to actually do something for skin, nothing beats topical retinoids, or tretinoin. They have the license, they’ve been tried and tested, and they’ve been around for decades and decades. That is for maintaining collagen in the dermis, helping with surface, like with creepiness, also helping with acne, helping with overall appearance of skin and glow.
You can’t get better than a topical retinoid. In the UAE, you can buy over the counter without a prescription. I can prescribe it as well in the UAE, but that’s all women after they’ve had their children and are no longer breastfeeding, should almost certainly be on a topical retinoid to help maintain their skin health over time. The over-the-counter tube costs Dh14. The brand is called Acretin, it’s tretinoin 0.025 percent or 0.05 percent. You have to ask the pharmacist for it. It’s not on a shelf. That’s the one you want and use it every day, once a day at night. That would be the first best topical treatment by far in this patient population. For pigmentation, the most evidence-based and effective treatment, or the only effective treatment for pigmentation is topical hydroquinone [10 percent] with the tyrosinase inhibitor and that is the gold standard treatment for pigmentation.
When combined with tretinoin or vitamin A derivative, it is the blockbuster cream. That will clear melasma, it will clear solar pigmentation. It will just make your skin all one color. Whether you’re Caucasian or Indian or whatever type, hydroquinone combined with tretinoin will absolutely do what we want it to do, which is give you that glow, smooth everything out, and remove the pigmentation. That combination is the best you can do when it comes to cream. Hydroquinone is definitely a prescription only.
• This is an edited version of the interview. Go here to listen to the full podcast.
Ann Marie McQueen
Ann Marie McQueen is the founding editor-in-chief of Livehealthy and host of The Livehealthy Podcast. She is a veteran Canadian digital journalist who has worked in North America and the Middle East. Her past roles include features editor for The National, trends writer and columnist for the Canadian newspaper chain Sun Media, and correspondent for CBC Radio.