Back in July, I sat down with chemist, organic skincare founder and former rosacea and acne sufferer, Marie Veronique, and in-demand Bay-area facialist, Kristina Holey, to pick their brains for answers to my biggest skincare questions: Is candida linked to perioral dermatitis? Are some people predestined to develop rosacea? Does retinol thin your skin? Can you use retinol if you have rosacea or PD? Do lasers cause premature aging with consistent use? And more. The answers below will make you cringe and gasp as you recall everything you’ve done in opposition to this sage advice.
Marie: It’s interesting and timely you bring this up. We don’t know for sure that there’s a link but it is something to research and in fact it’s one of the things Kristina and I have been talking about doing a research project on with my daughter Jay, whom is a physicist professor at PSU. Kristina sees many people with perioral dermatitis, and we want to study the perioral microbiome to address that very question. Barrier malfunction is a part of the cause but micro organism imbalance is certainly a part of it too. It’s too early to say what is the exact cause of perioral dermatitis.
Kristina: It’s easy to oversimplifying it and say it’s caused solely by candida, but I think it’s far more complex than that. Unfortunately, “PD” is a combination of multiple things. What we know right now about yeast and candida is that it manifests in different ways depending on what your vulnerabilities are and what’s happening in the entire picture: your immune function and your constitutional weaknesses, how you overcome transition points, the health of your endocrine system and what your topical skincare habits are, the strength of your skin’s barrier and immune function.
When I see clients with yeast overgrowth in the skin, it could be PD, but not necessarily. Sometimes it manifests as jawline hormonal acne – it’s so complex. Ten years ago when candida became trendy, it was an umbrella term for people to say “cut out sugar to combat the yeast and it will cure it.” But cutting out sugar will always be good; it will cut down inflammation and make your body more resilient, but that doesn’t mean your skin issues were due to candida. So this is why we are trying to do a research project so we can get hard evidence.
Marie: Candida is one microorganism that we know of that can cause skin issues. It’s like saying “oh, acne is caused by p acnes.” But actually when you look at the whole picture of acne it’s so much more complex than that. What we do know is that the skin microbiome has a thousand different species and a trillion microorganisms that live on it. And it’s still early days to figuring it all out.
Kristina: The reason why people overgeneralize is to create shortcuts towards fixing the problem. So they come up with these solutions like benzoyl peroxide as the sole answer for any sort of breakout on the skin oversimplifying the problem and the solution. But doing that has caused a lot of problems. We are trying to move away from oversimplifying by saying there is no one size fit all solution and no one size fits all causality.
Kristina: Anti-fungal creams can work really well. We just had a client who had dermatitis that was diagnosed as acne, then PD, then rashes, and it kept manifesting a little bit differently. I thought it was yeast, so we did swabs and found out it was different bacterial strains causing the outbreaks. That took us down this rabbit hole and coming up with a totally different solution where anti-fungals worked for her. But the point being, finding a solution is complex. Anti-fungals might work for some and might not work for others even if the symptoms look the same.
Marie: There is this whole study of rosacea that’s been going on for thirty years and it’s just stalemated at ‘we don’t know, we think it’s this, but it could be that.’ Now finally, the consensus is that it’s human demodex; a mite that lives in the hair follicles and comes out to eat at night feeding off of the sebum on skin – it’s on everyone’s skin. The mites don’t have anuses so they only live for about two weeks, then they come out on your face and when they die they just sort of burst. As they die, all of this bacterial waste explodes on your face and that’s what causes the immune system to go into over drive creating inflammation.
Kristina: The mites have a two week life span so they can make you think it’s cyclical or corresponding to your cycle when it’s not.
Marie: So you might try a product or treatment and think it’s working, but really it’s just that their life span cycle is every two weeks. They do say that people with rosacea tend to have defective immune systems which is why they encounter this bacteria from the mites and can’t handle it.
Marie: Firstly, anybody who has any kind of compromised skin, PD or rosacea, has a barrier function that is impaired. Using our Barrier Restore Serum is a good first step. If you can improve barrier function, you have gone a long way towards reducing inflammation and you can start dealing with some of the other components.
I think we have seen such a rise in these dermatitis type skin issues because people are using too many products on their skin which disrupts the microbiome of the skin. Dermatitis is a modern skin disease caused by too much washing, too much this, too much that, and using moisturizers with synthetic preservatives and irritating fragrances. It’s a constant assault on the microbes on the skin that are there to help keep your skin’s microbiome balanced.
Kristina: The more we can move away from over stripping, over cleansing, antibacterial this and that the better supported the skin microbiome can be. And moving away from antibiotics, pesticides and preserved foods that disrupt the gut balance internally – even better. It’s so important to eat a well balanced whole foods diet, and make sure you are digesting and assimilating these nutrients as well as getting enough good fats.
Marie: Your whole skin barrier layer is made up of fats: ceramides, fatty acids, and cholesterol. Your skin needs fat. If you are depriving yourself of fats, that barrier will be compromised. I’m not surprised you noticed a drastic change to your skin.
Kristina: I think what happens is a lot of people confuse inflammation with skin cell build up. They see rough texture and assume they need to exfoliate a lot. Usually, the roughness is inflammation and it’s made worse with exfoliation. I’ve never seen a single client where I was like “you need a lot of exfoliation.” Usually, it’s that there is so much inflammation I am like we need to cool it with all the exfoliation.
Marie: The point of exfoliation is to compensate for the slow down of your cellular turnover rate. Exfoliating two or three times a week when you are in your twenties is not necessary. It would be very rare if you were having turnover that slow and a build up of dead skin cells.
Peels were created to instigate the healing process of the skin and give a nice fresh look to the skin, but doing that consistently to the skin can cause micro traumas to the skin over and over again. It might confuse the skin’s microbiome and also it breaks down your barrier which acts as a protective shield. So if you are exfoliating like that three times a week, then it’s going to cause problems.
Exfoliation is recommended for older women because they say this speeds up your cell turnover rate and you get fresh new cells. But only up until a point that may be true. We don’t have the same resiliency in our skin as we do when we’re younger and too much exfoliation is just going to beat your poor fibroblasts to death and pretty soon drive them into premature senility.
Marie: The fibroblasts just start producing skin cells that are defective. You can send a message to a particular fibroblast in your skin for it to produce new skin cells, and so you figure the lifetime of a fibroblast and as many times as it can receive that message is about 50, but if you are continually at it with this message “make new skin cells” because you are harming the skin to encourage repair, you can force it into senility.
You are constantly replacing fibroblasts but as you are getting older everything slows down and you aren’t replacing the old fibroblasts with new fibroblasts in enough time to make up the difference, so you get a higher proportion of defective fibroblasts. It’s like they sort of get the message but they have become deaf.
Marie: Laser treatments and exfoliation treatments have at their core one theme: if you wound the skin, you are rejuvenating it in a sense that when you wound the skin, it sends a message to the fibroblasts to make more skin cells. This is what exfoliation is about and it’s what lasers are about and all those other treatments like chemical peels and microdermabrasion. I think that mechanism of repeatedly imposing that type of trauma on skin ultimately accelerates the aging process because you do have a limit on how many times you can trigger that response. Your skin is not built to take constant assaults.
Kristina: Delay it as long as you can. I try to dissuade clients as much as possible from these types of treatments until they are older. But if they are going to do it, I make sure they know the risks, how to alter their lifestyle afterwards and have the right protocol to heal post treatment.
Marie: But I would suggest before they go that route to try retinoids. Retinoids actually improve skin deep down and so if anybody wants to embark on some program for anti-aging they should start with a good retinol.
Kristina: Yes, but if you’re worried about being sensitive you can start with our Barrier Restore Serum before to strengthen the barrier. There may be some initial irritation but over time it should be a very positive thing. Retinoids can be really good for dermatitis.
Marie: Vitamin A derivatives are anti-inflammatory, but you do have to go through an adjustment period called facial retinization. Start with our Barrier Restore Serum, then use retinol two or three times a week and just feel it out to see how your skin is responding. If the retinol is too strong, then you can slow down the frequency depending on your needs. I recommend starting on a retinoid when you turn thirty, that’s when you start aging and everything goes downhill.
Marie: No, it doesn’t. It develops healthy new skin cells. It deposits more skin cells into the dermis. When you’re young your skin has a thin epidermis and a thick dermis, but as you get older your epidermis thickens and your dermis thins. This is why you get a build up of dead skin cells and why exfoliation will give you the look of a nice thin epidermis. Vitamin A derivatives reverse this process; they make your epidermis thinner and your dermis thicker which is what you want.
Kristina: It’s all under the umbrella of a retinoid but it’s a different form.
Marie: You start out with beta carotene which converts to retinol palmitate which converts to retinol which converts to retinaldahyde which converts to retinoic acid. So retinol is not the pen ultimatum conversion, meaning it’s much gentler, but your skin converts retinol to retinoic acid as you need it.
What the dermatologist can give you is retinoic acid which is the end stage and it’s very strong and can be irritating. When your skin gets retinol it converts and uses about 10-15%, but if you are getting straight up retinoic acid you can see where it would be very strong and potentially irritating. The trade up is you do get results faster. This is why I tell people to start with retinol. You’re going to get the same results as you would with retinoic acid but it just takes longer – three months versus one month.
Curious to read more from Marie Veronique? Read this interview where Marie shares her thoughts on how to combat adult acne. Or read how her products helped heal my perioral dermatitis naturally.
as told to BOND EN AVANT; photographed by Wing Ta