According to the Canadian Dermatology Association, women make up to 75 per cent of adult acne cases, with hormonal changes like menstruation playing a big role in those numbers.

Why do hormones have such a big impact on acne, how long will it last, and what can people do to care for their skin when they’re experiencing hormonal breakouts? Dr. Jennifer Tran, a Sunnybrook dermatologist, shares her insight.

Understanding hormonal acne

People often anticipate breakouts around the time they are menstruating. What’s less talked about is that acne can be brought on by other hormonal changes, such as starting birth control, pregnancy and menopause.

“There is evidence that hormonal fluctuations in androgens, progesterone and testosterone can worsen acne,” says Dr. Tran. Though, while these changes have been linked to acne, the connection is not so straightforward.

“The exact pathogenesis of acne in these scenarios is unclear,” she says. In fact, she adds, “Some studies have looked at measuring various hormone levels in patients with acne, and in the majority of cases, these levels are within normal range.”

How long will these breakouts last?

Similar to the uncertainty surrounding the cause of hormonal acne, the length of time that these breakouts will stick around is also unclear.

“Timing depends,” says Dr. Tran. “It can be very specific to a patient’s circumstances. For example, if someone is pregnant, it can last the duration of their pregnancy. For some, hormonal acne can last for several years.”

Treatment

To manage these hormonal breakouts, Dr. Tran encourages people to speak with their doctor to discuss options.

“Topical treatments, oral medications such as spironolactone or certain oral contraceptive pills, and even antibiotics and isotretinoin can be used for hormonal acne,” she says.

And while acne is typically harmless, in some instances, it can be indicative of a bigger issue.

“Hormonal acne is sometimes associated with polycystic ovarian syndrome,” she says. “If there are other signs or symptoms of this condition, patients should be screened.”

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Why teens get acne

Puberty causes a surge in hormones that can lead to acne in teenagers.

“Adolescents start to have increased androgen production and that stimulates sebum formation, which in turn leads to the development of acne,” says Dr. Tran, adding it is important to know that other factors do play a role in acne and its severity.

And it’s not just something high school students face: Dermatology Canada says 80 per cent of those struggling with acne are between the ages of 12 and 24, and 25 per cent of teenagers will still have acne at 25.

Treating acne

Dr. Tran says adolescents (and their families) shouldn’t feel as though acne needs to be severe before reaching out to their family doctor for a referral to a dermatologist.

“[Dermatologists] are happy to help our patients manage all types of acne, regardless of severity,” she says.

Treating acne is a personal decision, and every patient is different, says Dr. Tran. It is common and normal and doesn’t necessarily require treatment, but everyone will have a different tolerance.

“What might seem mild or inconsequential to others may in fact be having a big impact on a patient’s self-esteem,” she says. “Generally speaking, I think if your acne is bothering you, it’s worth a visit to your doctor to discuss options.”

Keep the skin care simple

For adolescents who are looking for ways to care for their skin, Dr. Tran keeps the recommendations simple.

“I usually recommend a cleanser once daily, a moisturizer and —if necessary— a prescription-grade topical treatment to start,” she says, adding there are many options for these that patients can explore with their family doctor or dermatologist.

And for those who might be concerned that their acne is caused by not washing their face enough, Dr. Tran says that’s a myth.

“Acne is not caused by poor hygiene or not washing your face enough. In fact, acne can sometimes be worsened by excessive cleansing.”

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Dr. Jennifer Tran is a dermatologist at Sunnybrook Health Sciences Centre.

Did you grow up in an environment where skincare was a priority?

No, I wouldn’t say it was a focus. As a kid, I remember my mom lathering me up with sunscreen when we were at the beach, but at that time it wasn’t widely known to always wear sunscreen and avoid the sun at peak times. All that definitely came into focus when I began to study dermatology

So what would you tell your younger self if you could?

When I was younger, I thought getting a base tan before going away on holidays was a good idea.  I even went to tanning beds a few times.  Like many people, I was told that getting a base tan would help reduce the risk of burning in the sun.  Now as a dermatologist, I would never recommend getting a base tan due to increased risk of melanoma (skin cancer).  If I really feel the need to look tanned, I use a self-tanner and make sure I lather up with sunscreen.

What does your daily skincare routine look like now?

I’m not loyal to one brand and I try to keep things really simple. Dermatologists tend to avoid fragrances and trendy ingredients because they could contain potential allergens.

In the morning I wash my face and apply sunscreen. These days, my foundation contains SPF 50 broad spectrum sunscreen, which offers good protection. In the evening, I use a simple fragrance-free face wash and apply a retinoid and moisturizer.

For my body, I moisturize when I get out of the shower and avoid using products that contain fragrance.

Do you think this routine will change as you get older?

No, I think I’ll use this routine for a long time. What’s always consistent is using a sunscreen in the morning, a retinoid at night and fragrance-free moisturizer for my face and body daily.

When you go to dinner parties, is it a given that someone will ask you about a skin issue?

Some people ask me if my job is anything like Dr. Pimple Popper. (It isn’t.) I do get a lot of parents asking about their kids’ rashes, but not so much their own!  I love dermatology and enjoy answering questions to help ease people’s concerns.

What’s something people would find surprising about your job?

Probably how little my day-to-day work has to do with simply skin care. In dermatology, we treat a lot of sick people dealing with complex conditions, like autoimmune or inflammatory diseases. These sometimes serious conditions may manifest on the skin sometimes with rashes, boils and blisters. Recognizing skin findings that can be related to a serious underlying disease can help determine the diagnosis and treatment. It’s truly fascinating how the skin is a mirror of what’s happening inside our bodies.

The post How to live like the experts: Taking care of your skin with Dr. Jennifer Tran appeared first on Your Health Matters.

Make sunscreen part of a daily routine

It might seem as though sunscreen is unnecessary on cloudy days, or days when you think you’ll only be outside for a short time, but Dr. Pon recommends putting on sunscreen every day, no matter what.

“It’s a good habit, a good routine to get into every day,” she says, adding that weather can be unpredictable, and a day that starts cloudy and overcast could become bright and sunny later on. “You should prepare for the day, not just for that instance when you’re out.”

And while it might seem that sunscreen only needs to be a part of a summer routine, Dr. Pon says people should continue to wear sunscreen in the winter months as well.

“UV rays can bounce off the snow and ice and get reflected, so it’s important to use sunscreen all year round, and every day.”

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Skin cancer: warning signs and symptoms

The COVID-19 pandemic means a lot of our activities and socializing will be outside this summer. While we’re enjoying the warm weather and sunshine, it’s important to remember sun safety, and that includes being aware of any skin changes that could indicate skin cancer.

Melanoma

Pay attention to moles that are asymmetrical, have a diameter of 6mm (larger than a pencil eraser), have an uneven border, have changed colour or have changed rapidly.

Basal cell or squamous cell carcinoma

Typically found on face, upper chest, neck; areas with high sun exposure

Basal cell carcinoma is often a sore that will bleed, scab and bleed again without healing, and it grows slowly over time.

Squamous cell carcinoma is often a crusty sore that won’t heal and can also grow slowly over time.

Early detection is very important for skin cancer, so if you have any of these symptoms, don’t hesitate to contact your family doctor, who can refer you to a dermatologist if necessary.

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Selecting a sunscreen

“The best sunscreen is the one that you like and that you’re going to use,” says Dr. Pon. She says it should be a minimum of SPF 30, but other than that, whether it’s a cream, spray or even tinted sunscreen doesn’t matter as long as you’ll wear it daily.

Dr. Pon does say not to rely on SPF in moisturizers or makeup as the only sunscreen you wear, though.

“Typically, these have a lower SPF than an SPF 30,” she says. “Also, more than half a teaspoon is recommended for the face and neck, and people don’t put that much makeup on their face.”

If you’re going to be outside for the day, plan to reapply sunscreen every two to three hours, and more frequently if you’re sweating or swimming. You should be applying more than half a teaspoon of sunscreen to each arm, and more than a teaspoon to the chest, torso, back and each leg.

Know your skin

In addition to wearing sunscreen daily, it’s important for people to check their skin for any changes that could indicate sun damage. For those who have a lot of moles, freckles or spots, Dr. Pon says an easy way to track any changes is to take pictures of the spots and use them for reference.

“We do recommend people check their moles once a month,” says Dr. Pon. “I always recommend to my patients the first day of the month or the last day of the month, so it becomes routine.”

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Our long winter means I want to get outside ASAP. I know I’m not the only one who wants to shake off the winter cobwebs with some fresh air!

But before we do, remember these tips from a dermatologist to help us protect our skin from the sun.

A history of sunburns increases the risk of skin cancer, including melanomas. Sun exposure can also cause wrinkles, dry skin and age spots.

Dr. Mary McKenzie, dermatologist in Sunnybrook’s Melanoma Clinic, recommends using a sunscreen 30 SPF or higher if you will be outside. Some make-up and face creams now have SPF between 15 and 30 – that’s OK for your daily use. (For example, if you are just going from your house to car to head to the grocery story and back but not spending time outside, that makeup will provide enough coverage.) If you’ll be outside longer — to take a walk, sit in the backyard or wait in line outside of the hardware store, reach for an SPF 30 or higher. If your skin gets irritated after applying sunscreen, try a mineral formula. If you tend to break out after applying sunscreen, try a formula that is made for acne-prone skin.

While skin cancer is more common in people with light or pale skin, red hair or freckled skin, people with other skin types and tones are not without risk. People of all complexions should also wear sunscreen daily and practice sun safety.

Lips are super sensitive, and should be protected from the sun, particularly when you are near water (which reflects the sun). Try a chapstick with 30 SPF or more. And reapply often. Some colour lipsticks also offer SPF protection.

Don’t forget to apply sunscreen to the commonly missed places — your ears, tops of your feet and hands. Wear a hat to protect the top of your scalp (in particular if your hair is thin, fair or if you are bald) or apply sunscreen on the top of your head. Dr. McKenzie says the top of the head is a common trouble spot when it comes to skin cancers.

Cover up or find shade

There are ways to cover up besides sunscreen. Wear light, long-sleeve clothing to protect your skin. Linens are nice and airy. Or there’s sun-protective clothing available too. Wear a hat. Avoid the outdoors mid-afternoon when the sun is at its peak. Seek shade. Carry an umbrella.

And wear shades

Dr. McKenzie doesn’t recommend putting sunscreen on your eyelids – sweat can make the sunscreen run into the eyes and sting. Sunglasses do double duty – they protect the eyeballs and the eyelids. So don’t forget them!

If you find your eyes do sting (often from sunscreen mixed with forehead sweat) try a mineral sunscreen.

Rub it in

Be sure to put a thick coating of sunscreen on your skin (about a shot glass worth) and rub it in. If you are using a spray sunscreen, keep the bottle close to the skin when you spray. “With the spray bottles, it’s a little harder to tell if you’ve missed a spot,” Dr. McKenzie says. “Be sure to still rub it in and use enough sunscreen.” Don’t spray it in the wind – you want to make sure it’s getting onto your body.

After sun

Is there anything we can do to feel better or minimize a sunburn’s effects? Dr. McKenzie says try a mild cortisone cream, available over-the-counter, to reduce the inflammation. But, most importantly, try to avoid the burn by using sunscreen and following the other tips above.

(This post was reviewed and updated April 28, 2023)

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It’s one of the most common questions dermatologists hear: what is the best moisturizer? Two of Sunnybrook’s leading dermatologists, Dr. Neil Shear and Dr. Kucy Pon, weigh in with their advice and expertise on this, and other common queries.

Why is moisturizing important?

NS: The skin has its own natural humectants that keep moisture in, but there are many reasons why that skin barrier can break down. Some of the most common include disease, older age and weather. You need to take steps to keep moisture inside the skin.

What happens if you don’t moisturize properly?

NS: You can get rashes, and itchy scaly skin. And if the skin becomes irritated and inflamed, there is a higher risk of infection and scarring.

What is the best moisturizer?

KP: There’s no such thing as the “best” moisturizer for everyone, and picking the right one depends on your skin type, preference for consistency and what you are comfortable spending. So for more oily skin, an oil-free moisturizer, something noncomedogenic and maybe more lotion-based may be preferred. If you have very dry skin or are prone to eczema, a thicker cream or ointment may be better.

NS: The best moisturizer is really the one you will use every day, and that may be very different for everyone depending on their preference, skin type and budget. There’s no scoring system for moisturizers, so it’s the one you are most comfortable with.

Is it better to moisturize as soon as you get out of the shower?

KP: A good way to make sure your skin is moisturized is to put it on right after your daily shower so that it becomes a regular habit. If you suffer from really dry skin, maybe moisturize one or two more times during the day.

NS: You can really moisturize anytime, as long as you do it regularly. In the long run, your skin will look younger and feel better. Just remember that anytime is better than next time!

If you spend more money, will you get better results?

KP: You can get good results at all price points, so it just depends on what your are comfortable spending. Price does not always dictate quality or results.

Are there any skincare ingredients consumers should avoid?

KP: Generally, we recommend using fragrance-free products because in many cases, fragrances can aggravate skin conditions and can be a potential cause of allergies.

NS: I actually love to read labels, so in a moisturizer, I tend to steer away from known allergens. That’s hard, though, because there are a lot of them out there and for most people, they aren’t a problem. If you are experiencing problems, like rashes or itching, you may be allergic to some of your skincare components. That’s something a dermatologist can test for.

Do you need to wear sunscreen all year long?

NS: Yes, and I would recommend choosing one that contains a Sun Protection Factor (SPF) of 30 or higher.

KP: People should apply an SPF every day. Even in the cold and winter, there can be sunny days and UV rays are present. Also, the snow and ice can bounce the UV rays back, exposing us to reflective UV rays.

What should you apply first: moisturizer or sunscreen?

KP: Moisturizer first, and then sunscreen.  There are also a lot of great two-in-one products that can make the process more convenient. Just keep in mind when applying a sunscreen that you need to use adequate amounts to protect yourself.  We recommend about two tablespoons to cover the whole body, and don’t forget to reapply after a few hours.

Will drinking water hydrate the skin?

NS: Proper hydration is important for overall health, but it’s not going to do enough to moisturize the skin. You need to apply something directly to the skin to do the trick.

Many products claim to reverse aging. Any truth to that?

NS: There’s no reversing aging, but if you keep your skin moisturized well, it will generally look younger and healthier.

KP: Some creams and cosmeceuticals do provide benefits to the skin, like giving it a glow and helping it feel supple. By far the best anti-aging strategy is practicing proper sun protection.

Do you need a separate moisturizer for around your eyes?

NS: The eye cream story is complicated because people have different issues, like puffiness or dark circles. There are also many skin correctors that, if applied too closely to the eye area, may cause burning or irritation to the eyes. I would recommend finding something simple, not too heavy, that addresses your specific needs.

KP: Often a facial moisturizer is good for the whole face, but some people like to have a specific eye cream. It all comes down to personal preference.

Should your skin care routine change as you age?

KP: It might, as the issues you deal with shift at various ages. Even if your products change, though, be consistent with sunscreen at all ages.

What do serums do?

KP: Serums aren’t moisturizers. They are ways to deliver active ingredients to the skin. If you’re going to use one, follow this order: wash your face, then apply your serum, moisturizer, sunscreen and makeup.

Should you change your moisturizer seasonally?

NS: It’s not necessary, but I’d recommend it if you feel your skin needs are different throughout the year.

Are hydrating facial masks effective?

KP: A lot of women like using them because they are relaxing, so there’s value in that. Some facial masks deliver active ingredients to the skin, so as long as they don’t irritate your skin, go ahead and enjoy them.

Any final words of advice?

NS: With online shopping, it’s easy to access products through mail orders from all over the world. Keep in mind, though, that some of these products may contain ingredients that have not undergone proper testing and haven’t been approved for use in Canada, so it’s buyer beware.

KP: In the winter, when many people develop dry, itchy skin, I recommend using a humidifier in your bedroom, opting for gentle cleaners and avoiding itchy fabrics coming in direct contact with your skin.

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If you are taking any medication, there is always a risk of experiencing side effects. Some of these may affect the skin in various ways, says Dr. Shapiro, from fairly banal rashes to more life-threatening reactions. She says antibiotics cause the most skin reactions, affecting between 1-8% of Canadians.

Your physician will need to take a thorough history of your overall health, and consider all medications you are taking. This includes any herbal supplements or naturopathic remedies, as well as all over-the-counter medications. Your doctor may refer you to a dermatologist for more specific sleuthing. As the skin can react in a number of ways – including hives, measles-like eruptions, pustules, blisters and skin shedding – these patterns will definitely provide some important clues.

Your doctor or dermatologist will also need to consider if other health issues may be at play. In some cases, symptoms like fever that accompany a skin reaction can alert your doctor that a serious systemic drug reaction is present. This may have implications on other organ systems, such as the liver or kidneys. Hospital admission may be needed to provide close monitoring and supportive treatment.

A rare but potentially life-threatening condition to be aware of is called Toxic Epidermal Necrolysis (TENS). It can cause widespread skin sloughing and can affect all areas of the body. In the majority of cases, it’s triggered by commonly used drugs for epilepsy or gout, such as carbamazepine and allopurinol. If you are newly prescribed these drugs, a simple genetic blood test can let you know if you’re susceptible to TENS. Those with origins from Southeast Asia are at a particularly higher risk.

This is one example where genetic testing can help avoid medication-induced skin reactions. In other situations your doctor or dermatologist may also recommend skin testing, where a small area of skin is pricked and exposed to the medication and later examined for a reaction. Sunnybrook’s Drug Safety Clinic offers this type of testing.

A skin reaction may also be a sign of a skin allergy or sensitivity to another substance, like a cosmetic ingredient or a drug itself. Sunnybrook’s Department of Dermatology offers patch testing. A number of small discs, covered in various substances that may be causing the reaction, are taped to the back for several days and then evaluated for a reaction.

To listen to Dr. Shapiro’s lecture, or view the entire Speaker Series event, watch below:

Learn more about Sunnybrook’s Division of Dermatology »

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Every day, we are all exposed to countless chemicals in the products we touch and apply. And for some people, that can trigger a skin reaction. But how can you know the exact cause? Doctors at Sunnybrook are helping patients solve the mystery by using patch testing. Take our quiz below to learn more!

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1) Protect your skin

Heading to a patio for a long lunch or mid-afternoon drinks? It’s actually the most important time of day to pay attention to your sun exposure. The sun causes the most harm to the skin when it’s overhead, from 11 a.m. to 3 p.m. between April and September in Canada. At those times, the sun’s rays travel through less atmosphere, making them especially intense.

To be safe, seek shade, avoid direct sunlight during peak UV periods and wear a broad-spectrum sunscreen. An SPF 30 will protect you from about 97% of harmful UV rays. Just make sure you apply enough. You’ll need about a shot glass full to cover your body adequately.

2) Keep your eyes safe

The sun poses a significant risk to the eyes even when it’s low in the sky. In fact, the lower angle gives the sun’s rays a direct pathway into the eyeball. Think of how hard it is to drive on the highway when you’re heading into the rising or setting sun. Furthermore, UV rays can penetrate clouds and reflect off many different surfaces such as snow, sand and water.

Research has shown that to protect your eyes, you should be wearing sunglasses, day-long, year-round and even when it’s cloudy. The best protection is provided by close fitting, wrap-around sunglasses that also block sunlight from the sides. When you’re picking sunglasses, you will want to find a pair that shields against both UV rays and blue light. Wearing a wide-brimmed hat also helps to keep the sun out of the eyes.

3) Stay hydrated

Dehydration can cause a variety of problems from simple thirst to low blood pressure and increased heart rate. At extremes, dehydration can affect your kidneys, which can be dangerous. Water or other calorie free drinks are the best choices if you are trying stay hydrated. Make sure your water glass is replenished often, to remind yourself to keep drinking it.

If you’re planning on drinking alcoholic beverages, it’s recommended that women drink no more than 3 drinks on a single occasion, and that men drink no more than 4 drinks. Following these guidelines will reduce your risk of injury or harm. And if you do drink, arrange for a safe way to get home- don’t get behind the wheel.

4) Pass on the chicken fingers and fries

If you’re heading to a patio, you’re probably going to end up ordering something to eat. Don’t starve yourself all day- have a healthy snack low in sugar and fat before you arrive at the restaurant to avoid overeating. And when it comes to choosing something from the menu, avoid ordering high fat, fried or greasy foods.

5) Clean your hands

Make sure to clean your hands before eating, drinking, or preparing food, and after using the washroom or touching high traffic surfaces like doorknobs. If you can get to a sink, use warm water and rub the soap in your hands for at least 15 seconds. Using very hot or very cold water makes it less likely that you’ll wash your hands for long enough. Remember, the action of rubbing soap on your hands is what lifts dirt and bacteria off your hands, which is then rinsed away by the water. You’re not going to ‘kill’ any bacteria by using scalding hot water to wash your hands!

If you can’t get to a sink with running water and soap, use an alcohol-based hand sanitizer instead. You’ll still need to rub the sanitizer into your hands for 15 seconds to ensure your hands are properly cleaned.

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When caught early, melanoma is a highly treatable form of cancer.

Thank you to Dr. Mary McKenzie, dermatologist, and Dr. Teresa Petrella, medical oncologist, for their tips on prevention and screening for melanoma.

Wear sunscreen.

This ain’t news. But we’ll remind you: We should all be wearing daily sunscreen of 30 to 60 SPF on exposed skin. Add this to your morning routine. While getting a sunburn doesn’t mean you’ll automatically develop skin cancer, a history of sunburns does put you at higher risk.

This means you (no matter your skin tone).

While melanoma is more common in those with fair complexions, red hair or freckling skin, other skin tones and types are not exempt. People with dark complexions should also wear sunscreen daily.

Say “absolutely no” to tanning beds.

No good can come of spending time in a tanning bed. Just don’t do it. The law in Ontario says teens under 18 aren’t allowed. But adults shouldn’t use tanning beds either. According to SkinCancer.org, people who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent. Other studies have found that the risk of melanoma goes up with the hours/sessions/years spent using tanning beds. (More on that here.)

Check yourself and your partner/friend/family members.

You (and sunscreen!) are your best defense against melanoma. Perform self-screening each month. Remember, not all melanoma follow these ABCDEs to a T. So check in with your doctor or dermatologist regularly if you have moles.

Here’s what you are looking for, from Melanoma.Org. If you have moles or lesions with any of these factors, make an appointment with your family doctor or dermatologist. Look for moles or lesions on the skin that are:

A – asymmetrical in shape. (This means they aren’t an even circle or oval.)

B – border. Non-cancerous moles tend to have smooth edges. Melanoma lesions often have irregular edges.

C – colour. A spot that has more than one colour (brown, black, red, tan) or colour that isn’t evenly distributed.

D – diameter. Is the mole wider than 6 millimeters? (about the size of a pencil eraser)

And most important of all:

E – Evolution. If and how your moles change can be the most important thing to consider when screening yourself for melanoma. If your moles look different in colour, size or shape, call your doctor. 

Not just moles.

There are other types of skin cancers that don’t look like moles. Wounds that won’t heal; hard, pink acne-like lesions on your face that don’t go away — these could be suspicious. Make an appointment with your doctor or dermatologist if you have anything like this on your skin.

Melanoma caught early has an excellent prognosis – keep an eye on your skin and your family members’ and talk to your doctor if you see changes.

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