DR JAISHREE SHARAD

SKIN RULES
Your 6-Week Plan to Radiant Skin

PENGUIN BOOKS
 Contents

A Note on the Author

Introduction
How to Read This Book

WEEK 1

1. Know Your Skin

2. What Is Your Skin Telling You?
3. Your Skincare Ritual
4. Acquainting Yourself with Labels

WEEK 2

5. Twenty Skin Myths

6. Acne
7. Hyperpigmentation
8. Serums

WEEK 3

9. Exfoliation
10. The Make-up Removing Ritual
11. All about Anti-ageing

WEEK 4

12. Food for Skin

13. Exercise and Your Skin
14. Home Remedies

WEEK 5
15. Lifestyle and Skin

WEEK 6

16. When Should You See a Dermat?

17. Skin Treatments
18. Latest Advancements in Skin Technology

Epilogue: The Way Forward

Footnotes
5. Twenty Skin Myths
6. Acne
12. Food for Skin
13. Exercise and Your Skin
14. Home Remedies
15. Lifestyle and Skin
Acknowledgements
Follow Penguin
Copyright
 A Note on the Author

DR JAISHREE SHARAD is the author of Skin Talks. She is India’s

leading celebrity cosmetic dermatologist, who has been practising for
nineteen years. She is the only Indian on the board of directors of
the International Society of Dermatologic and Aesthetic Surgery. She
is also the international mentor of the American Society of
Dermatologic Surgery. Jaishree is the founder and medical director
of Skinfiniti Aesthetic Skin and Laser Clinic in Mumbai.
She is also the editor-in-chief of a cosmetic dermatology textbook
called Aesthetic Dermatology: Current Perspectives, published in
August 2018. She has been the vice president of the Cosmetic
Dermatology Society of India for eight years. She was one of the ‘50
Outstanding Women in Health Care’ at the World Health Congress
Annual Awards in Mumbai in 2017.
 Advance Praise for the Book

‘This gem of a book is a comprehensive compilation that will take

you from the essentials of self-preservation to the most complex
layered technology services available, and everything in between’—
Amitabh Bachchan, actor

‘Dearest Jaishree, you continue to make me proud with your many

accomplishments and the admiration of your colleagues. You have
always been my favourite student’—Stephen Mandy, renowned
cosmetic dermatologist, Miami

‘Your skin at times can be your arch-nemesis, working against you

and becoming something you constantly need to be aware of and
wary of. When someone like Jaishree enters your life, you feel like
you have won the skin battle! She makes the cure painless and
immediately effective—it’s an “ageless” bond and your skin’s BFF for
life’—Karan Johar, director

‘As the largest organ of the body, the skin is literally a window into
the type of lifestyle you are living. Healthy skin not only makes you
feel more youthful but also signals your vibrancy to others. Dr
Jaishree Sharad is a well-respected colleague and internationally
recognized skin expert. I have personally learnt so much from her
and it is wonderful that her tricks are now in print for everyone to
keep looking their best’—Kavita Mariwala, renowned cosmetic
dermatologist, New York

‘Dr Jaishree Sharad sums up the take-home points on the daily

skincare routine, making it easy and very doable. Her book sheds
light on the esoteric and makes taking care of your largest organ
accessible to all. A must-read’—Hassan Galadari, renowned
cosmetic dermatologist, Dubai

‘You are an international derm diva!’—Heidi Waldorf, renowned

cosmetic dermatologist, New York

‘Dear Jaishree, I am very happy to witness your success as a

teacher. There is no more happiness for an old teacher like me than
seeing my trainee carry on my mission. Congratulations on your
success, my daughter from India’—Dr Niwat Polnikorn, renowned
cosmetic dermatologist, Bangkok

‘I am an old man but I look more presentable and younger than I did
twenty years ago! The complete credit goes to none other than my
darling Dr Jaishree Sharad! She believes in care and cure and not
commercial viability, and that makes her one in a million!

बरसते रहो सावन सरीखे खेत में

महकते रहो चंदन सरीखे देश में
लोग तो मिट्टी से सोना ही निकालें
और तुम मोती उगाओ रे त में
—Annu Kapoor, actor

‘Jaishree is so knowledgeable about the latest developments in

skincare that makes it easier for you to look younger and fresher.
There is no one better than her to write a book on skincare because
we want our outer beauty to match the inner beauty’—Farah Khan,
director

‘I get dark circles when I don’t sleep . . . I get sunburnt and my skin
peels when I spend the day on the beach . . . I break out into pimples
and acne when I’m stressed . . . But as a film star, I’ve gotta always
look like I’ve walked out of a magazine cover! That’s when I realized
great skin doesn’t happen by chance, it happens by appointment . . .
Dr Jaishree is my one-stop shop. Forget the camera, she’s the
reason I look into the mirror!’—Ranbir Kapoor, actor

‘I have been going to Dr Jaishree for several years and there is no

one I trust more to take care of my skin. She always has apt advice
and a fantastic bedside manner that makes the treatment painless
and stress-free. She does not overprescribe and makes sure you
take care of your health through food and fluids. My husband tells
me that I see her more often than my best friend, but I always go to
her for the best and the right advice’—Sonam Kapoor, actor

‘As an actor, I am always on the move, working with few hours of

sleep and a schedule which is not skin-friendly. Jaishree is my
instant cure for any skin problem. Whether I get any scar or pimple
or mark, she is “Dr Solve It” for me’—Varun Dhawan, actor

‘One thing I have noticed is that the oxygen facials at Dr J’s Skinfiniti
work well when you drink a lot of water, get good sleep and take
vitamin C. Ghee in my coffee has also helped in making my skin look
naturally moisturized’—Jacqueline Fernandez, actor

‘I had pimples and scars on my face all my life and I struggled with
them. Then I met Dr J and she did her magic. Now I smile and have
dimples instead of pimples. I also have the pleasure of knowing this
beautiful being personally’—Amit Sadh, actor

‘Jaishree is undoubtedly one of the best in the business. She is not

of those who constantly highlight the flaws in our features and lure
us into trying new treatments. She will do only what is necessary and
knows when to stop, so I feel completely safe in her hands. I have a
very sensitive skin, so I do not like doing too much to it, but her
mesotherapy treatment once a month is a must for me. Being good
at work is great, but for me being a good human always comes first
—and Jaishree is one of the nicest, most genuine, caring and
positive souls I have come across, and I love her even more for that.
I am so proud of all her achievements’—Shamita Shetty, actor

‘I’ve been visiting Dr J’s clinic for several years now . . . and there’s
no one else I trust with my skin. She doesn’t believe in extreme and
radical treatments. She is so quick and accurate with her diagnosis. I
have sensitive skin and face various skin issues. I make it a point to
keep her in the loop and see her twice a month. With very little
downtime and the lack of appropriate treatments, as well as spot-on
advice, she is the best. Instead of self-medicating and trying to find
solutions on the Internet, try and make an appointment with your
dermatologist. Otherwise you could permanently damage your skin.
Sometimes a healthy diet and lifestyle aren’t enough. You need a
qualified professional to look at your skin and an equally skilful pair
of hands to do your skin treatments’—Harshvardhan Kapoor, actor

‘I have always taken my skin for granted and treated it like an

outward part of my body. Jaishree taught me the importance of
loving my skin and nourishing it—that less is always more. She is my
go-to person in times of panic because she can cure with immediate
effect and calm my nerves too’—Athiya Shetty, actor

‘Dr J has been my skin saviour. Before every shoot, I consult her on
the best possible skin routine to follow depending on the weather
conditions I am shooting in. I remember calling her after I got badly
sunburnt during a particular schedule and was in tears and she
sorted me out immediately. I have sensitive skin and it reacts to
changes in weather and my diet a lot. Thanks to her, my skincare
routine has become really easy!’—Huma Qureshi, actor

‘I’m yet to come across a more passionate and well-informed doctor.

The medical profession is perhaps one of a kind where the process
of learning never stops. That’s where I think Dr Jaishree Sharad
scores the most. I know her now since 2009, and as we have
evolved in age, she has evolved in methods and techniques’—Nikhil
Dwivedi, actor and producer

‘I’ve been Dr J’s patient since 2015. I used to suffer from pimples
and dull skin. Today my skin glows and is pimple-free thanks to
Jaishree and her easy procedures. The peels she has done on my
skin have worked wonders. More importantly, the stem cell PRP hair
treatment has really helped me battle my hair loss issues’—Amyra
Dastur, actor

‘As a guy in his early twenties, I never really thought of going to a

dermatologist. But after my first session with Dr Jaishree, I realized
how much I could and should take care of my skin. From the word go
she made me comfortable and confident in my own skin. The
“Skinfiniti Signature clean-up” is my personal favourite. I always
leave the clinic feeling revitalized and rejuvenated’—Aadar Jain,
actor

‘I make sure that I drink lots of water and eat plenty of fruits because
it keeps my skin fresh and hydrated. Applying aloe vera on my skin
also works like magic! Sleep is important too but when sometimes
work does not give you the sleep your body requires, break-outs or
skin reactions do happen. But the good thing is that Jaishree will
always be available and ready to help’—Elli Avram, actor

‘You’re the best doc, and thank you helping me out with my skin’—
Karan Kapadia, actor

‘For someone who backpacks often and is not diligent with skincare
or beautification, it was a blessing to meet Dr Jaishree. She
simplified things and helped me understand the essence of skincare
through the most essential and non-fussy of regimens. I deeply
admire her positive energy and warmth. She is a slice of home’—
Sobhita Dhulipala, actor

‘It has been more than ten years and Jaishree is the only
dermatologist I trust with any skin issue—not only me but my family
and friends too. Today, she is a world-renowned doctor and that is a
huge achievement’—Ehsaan Noorani, music composer

‘Healthy and glowing skin is very important for a person’s

confidence. I try to be as natural as I can and always vouch for home
remedies like besan or yogurt packs once in a while. I believe in
cleansing my skin well and getting rid of all the make-up before sleep
and letting it breathe overnight. Also, drinking water to keep your
skin hydrated is really important. Skin tips from Dr J and basic peels
and face packs at Skinfiniti have also changed the way my skin looks
and feels’—Priya Banerjee, actor

‘Love J! She is the best’—Shekhar Ravjiani, musician

‘I always had a decent skin—clear with occasional break-outs. But

when I started with my first film, my face suddenly broke out. Every
doctor I visited gave me hundreds of expensive products—my skin
only got worse. It was then that I met Dr Jaishree. She took time to
understand what my skin was like before I started acting and
immediately realized that the new make-up was the culprit. It was so
simple yet no one else before had realized it. I switched make-up
brands, stopped using all the unnecessary products and saw an
immediate improvement. She gave me a simple routine (cleanser
and moisturizer) and with regular clean-ups at her clinic, my skin has
been better! I love her because she never pushes products on you
and only addresses your concern in simple and effective ways. The
fact that she is one of the sweetest people is also a plus!’—Kalyani
Priyadarshan, actor
‘What can I say about Jaishree Sharad? As a person she is one of
the loveliest people I know. She is kind and gentle. She has a lovely
smile. She’s always happy and full of life. Even when she is not, she
appears to be. As a doctor she is someone whom I can trust
wholeheartedly. There are lots of times when I want to do treatments
but she doesn’t let me because she says I don’t need it. I think that is
one of her best qualities—that she doesn’t force you to do anything.
She looks at your face, evaluates it and then decides what kind of
treatment is needed. She doesn’t sell you anything. I can tell you that
my face has never looked better and it’s all thanks to her. Thank you,
doctor. I love you’—Yasmin Karachiwala, celebrity fitness expert

‘She is the best doctor in the world! I wouldn’t go to anyone else.

Fantastic dermatologist, an amazing person and my best friend’—
Namrata Dutt Kumar, social worker

‘Jaishree is my best friend, guide and go-to person for everything.

She is one person I can truly trust with closed eyes. She is also a
fantastic doctor. Thank you, Jaishree, for always putting up with me.
I am so proud of you’—Riddhima Kapoor, designer

‘J is not only my go-to person when I need skin advice, she is a dear
friend too. I wish her all the best for Skin Rules’—Poorna Patel

‘When you feel good, you look good. That happens when you meet
Dr Jaishree. She is such a warm and positive person, her smile and
kindness makes you feel good even before you start the treatment. I
have the confidence that she will guide me to choose the right
treatments for my skin’—Iulia Vantur, singer

‘I leave my skincare routine to Dr Jaishree. Whether it is hydration,

diet or oxygen facials, Jaishree knows best. As a doctor, she has no
shortcuts to a good and healthy life’—Jitesh Pillai, editor
‘JS is not just a skin doctor. She is also a skin and mind healer. She
heals her patients not just physically but by even instilling self-
confidence and happiness in her clients. She is a real-life heroine—a
beautiful, giving, caring, compassionate, intelligent and extremely
hard-working being whose aura is what I seek when I feel under the
weather’—Shalini Sharma

‘My experience with Dr Jaishree has been a kind of revolution for my

skin! It completely changed my perception and understanding of
skincare! When I met her for the first time, I had plenty of skin issues
being a teenager. After going through several vigorous skincare
routines as prescribed by different dermatologists, her guidance was
refreshing! She gave me a very simple, basic routine to follow
without any heavy medication or treatments and it worked magically!
I have a sensitive skin . . . My profession involves travelling to
different places, late-night shoots, being under the light for hours and
that leads to frequent skin emergencies. Whenever I call her with a
skin crisis (break-outs and such), she just tells me, “Calm down,
Palak, I’ll sort it out.” Her expertise, warmth and concern make me
feel relieved about any skin problem I may have. My skin is in its
best form today and it’s only because of her! My skin saviour!’—
Palak Muchhal, singer

‘Your expertise and knowledge are always up to the mark and the
results prove it each time! I’ve known you for years now and have
always had a great experience! And not to forget, your staff is as
sweet and nice as you are’—Gaurie Pandit Dwivedi

‘Expert hands with a human touch! She’s as personal as she is

professional. Dr Jaishree is one of the most passionate, honest and
sincere doctors I have come across. I completely trust her with all my
worries and concerns and she takes care of them perfectly’—Prithvi
Hatte, actor
‘I took my husband to Dr Jaishree Sharad and now he looks younger
than me. Dr J has magical hands! She is truly the best!’—Anupama
Kapoor
 To my daddy—an engineer par excellence, an amazing artist, a
fabulous teacher, a genius in every way. He was the strong, silent
pillar behind every milestone in my life. I sat in his room and wrote
this book. I am sure he was sitting next to me and giving me all the
ideas. Dear Daddy, I am sorry I read your diary without your
permission. You said I did you proud. I hope this book will do you
more proud even up there in heaven.

I miss you.
 Introduction

I completed my MBBS in 1995 and went on to do my post-graduation

in dermatology. Apart from dealing with problems related to skin, I
was also trained in dermatologic surgery, which involved chemical
peels, lasers, vitiligo surgery, acne scar reduction and so on.
I was the first dermatologic surgeon to start practice in Navi
Mumbai, in January 2000. At that time, my husband was a junior
surgeon in one of the reputed hospitals of Navi Mumbai. I wanted to
do a fellowship in cosmetic dermatology somewhere in the US
because I needed to fine-tune my Botox and filler injection skills. But
that would involve heavy costs, which we couldn’t afford. So I started
to visit five different polyclinics and one hospital as a consultant
dermatologist, my working hours being from 10 a.m. to 10 p.m.
In June 2004, I got the opportunity to do a fellowship in cosmetic
dermatology in Bangkok. By now I had saved up a little money to
sustain my added expenses in a different country. It was my first-
ever international trip, at the age of thirty. That is where my journey
as a cosmetic dermatologist began. Later I also underwent training in
cosmetic dermatology in Miami, North Carolina and Los Angeles.
June 2006 saw the birth of Skinfiniti, one in Vashi and one in
Bandra, and there has been no looking back since. Through my
journey, I realized how people lacked knowledge about skin. It used
to bother me when I saw people giving importance to all the organs
of the body except the skin. Not only that, most rashes, pimples,
pigmentation are treated with home remedies which further ruin the
skin.
So when Milee Ashwarya, the publisher of Random House India,
asked me to write a book, I decided to take the plunge. My first book,
Skin Talks, was published in 2014. This book has a detailed
description of the anatomy of skin, nagging skin problems, product
ingredients, skin in different climates, etc. Though the book has been
a bestseller, a few of my younger patients said it was too elaborate
and they’d rather come to me and take a prescription. In 2017 when
Milee coaxed me into writing another book, I decided to adapt to the
changing world and cater to the generation which functions at a fast
pace.
They say, when in Rome, do as the Romans do. So I decided to
write a more simple, illustrative book which a teenager could enjoy
as much as an eighty-year-old could.
My editor Gurveen came up with the brilliant idea of six weeks to
radiant skin. ‘It is impossible! One would need at least three months,’
I told Gurveen. We were playing tug of war with no outcome. Around
the same time, a patient—let’s call her Mickey—came to my clinic.
And guess what, she wanted flawless skin in six weeks! Perhaps it
was God’s way of telling me to take up Gurveen’s challenge.
‘Dr J, I want my skin to be radiant and glowing. Not just six weeks
from now, but for ever after. I can’t be sitting with make-up at home,
especially when my mother-in-law-to-be is the most stylish lady I
have seen. So please do some magic,’ Mickey said. Obviously, she
had come to me with a lot of hope and there was no way I could let
her down. I examined her skin with my magnifying glass, and then
my skin analyser. (A skin analyser comes with a powerful camera
and functions which help to peep into the deeper layers of the skin
and analyse skin irregularities, levels of pigmentation, as well as
fungal and bacterial infections of the skin.)
Mickey’s skin was dull and blotchy. She had a few whiteheads on
her forehead and blackheads on her nose. Her eyes looked tired and
she had just about started to develop dark circles.
We had an elaborate chat about her eating and drinking habits,
her lifestyle, work and stress levels and, of course, her skincare
regime. Mickey was a super-busy entrepreneur. She worked late
nights, slept very little, partied hard, smoked occasionally, ate
whatever she could lay hands on (though she claimed she ate
healthy), barely exercised because she did not have the time. And
skincare was alien to her.
To top it all, she was stressed and running around in the sun for
her many last-minute wedding preparations. I took a deep breath as I
spoke to her, as if convincing myself that I could meet this flawless-
skin challenge only if she cooperated. I had to make sure that by the
end of six weeks, Mickey had an even skin tone, i.e. her skin had a
uniform colour. Her skin texture had to be smooth and supple. Her
skin had to be devoid of blemishes or pimples. She had to have no
dark circles, fine lines or open pores. And of course she had to look
like a million bucks. A few skin creams wouldn’t do the trick, nor
would a laser work like a magic wand. I made her promise she would
follow my instructions to a T and carefully chalked out a plan for her.
That night, I went home and wrote an email to Gurveen—Six
weeks to radiant skin it is!
Skin Rules, we called it, and here it is in your hands. Mickey is
representative of every patient of mine who yearns for clear skin.
She is the face of every individual, male or female, who wants to
look good but is tired of searching for answers on the Internet or in
beauty shops. In an era where cosmetic and pharmaceutical
companies make billions of dollars on skincare products, the Internet
doesn’t have honest or relevant answers all the time. Packaging,
marketing and advertisements have a strong influence on sales of
any skincare product or even skin treatment.
Mickey is every individual who does not want to get deceived but
wants genuine guidance. I know of a lot of boys who use their
sisters’ creams and a lot of men who empty their wives’ closets
because they are uncomfortable buying skincare products in the
store. That skincare is vanity and only for women is but a false belief.
Mickey is every guy’s voice too because glowing skin is not a
‘female’ thing.
 Finally, I am not a writer. I am just another dermatologist who
wants to spread awareness about skin and skincare. I must have
edited each sentence five times just to make you understand the
context better. I have pondered over all the common skin issues my
patients face in their day-to-day lives. And I have tried to find some
simple solutions and put them in my weekly programme.
Though an ideal pathway to glowing skin, especially if there are
problems such as acne or pigmentation or post-acne scars, would
take at least three to six months, six weeks are good to begin with.
Once you get into the routine, sow the seeds and reap the benefits,
there will be no looking back.
 How to Read This Book

Skin Rules presents a six-week plan to blemish-free, radiant skin. It

does not cater to one symptom at a time. Right from identifying your
skin type, skincare routine and skin treatments to changes in diet
and lifestyle, the approach needs to be holistic. Let me unfold the
plan for you week by week.

Week 1: This week is all about learning to know your skin. Often you
are confused about your skin type. You don’t know which products to
use and what to include in your daily routine. Some people don’t
even have a daily ritual. They just use a random cold cream off the
shelf. You need to prep your canvas if you want your creams to work
their magic on your skin. Learn the correct art of cleansing and the
right way to use moisturizers and sunscreens, which are armaments
for your skin’s defence.

Week 2: Imagine waking up to dull, lifeless skin every day. If you

want a fresh start, do your skin a favour by removing all your make-
up before hitting the bed the previous night. This week is about
getting into the habit of removing your make-up every single day.
A lot of us are plagued with pimples, or at least whiteheads, at
some point in our life. Many have flawless skin until the thirties and
presto, enter the hormones to show how mighty they are and how
they can inflict us with acne, open pores and cause blemishes at
thirty. Discover ways to tackle pimples, sun spots, dark circles, dark
lips, dark underarms—practically everything that leaves your skin
dark.
One pimple or dark patch on your face and the world will be ready
to give you advice. Some will be generous enough to tell you about a
magic cream they used and how their dark spots vanished, not
knowing that it was probably a harmful steroid. Others will give you
remedies from the kitchen. And some will simply pour out their
sympathies, pushing you further down the rabbit hole, as if this was
the end of the world for you. Beware of all these benevolent advisers
because there are too many fallacies and misconceptions floating
around which could do you more harm than good. Sometimes things
are accepted without raising eyebrows because they seem to make
sense. For example, gulping down gallons of water and over-
cleansing your gut will detox your skin . . . Now don’t raise your
eyebrows when I say both are not true. This week is also about
avoiding common blunders and doing a reality check.

Week 3: This week is not about the CTM drill. It is about adding the
icing to your cake of skincare. There is an influx of new skincare
lines and anti-ageing lotions and potions. Amid this constant buzz,
one may find it difficult to distinguish hype from reality. So get ready
to feel confident when you walk down the beauty gallery and pick the
most suitable serums and anti-ageing products for yourself.

Week 4: If you think rubbing a cream on your skin for six weeks is
going to make you Prince Charming or Snow White, you are wrong.
Your skin also needs nourishment from within. We are all aware that
a healthy diet and exercise can help us beat diabetes, heart
diseases, gut, kidney and liver issues. This week is to make you
aware that food and exercise can also work wonders on your skin.
We shall also discuss a few home remedies which have been
passed down for generations and are good for your skin.

Week 5: This is probably the toughest week. It’s about challenging

your lifestyle. Your skin cells work overtime while you sleep, in order
to overcome the agony they have undergone during the day. So
when I say you need beauty sleep, it is not a fairy tale. Factors like
pollution, stress, smoking, alcohol, sedentary hours in front of your
computer are not only malignant for your internal organs, but also
corrupt your skin. People feel meditation and yoga are only for
spiritual seekers or the distraught. I say they are a way of life, a way
of taking care of ourselves and respecting our body and our skin. So
get ready for some serious mandates on skin and lifestyle. I’m sure
you will thank me later.

Week 6: Do you wake up in the morning and look into the mirror to
find some pits on your face, reminiscent of the acne you had when
you were in high school? Do the red patches on your face or dryness
on your body keep flaring up, ruffling your feathers way too often?
Sometimes you cannot escape a dermatologist’s appointment. This
week is about seeking help from ‘skin doctors’. It is also about
understanding the pros and cons of various skin treatments rather
than blindly following advertisements. New anti-ageing gizmos and
skin-brightening gadgets are introduced every day.
The beauty and laser industries are growing bigger than one could
have ever imagined. From gold-infused skincare to bee’s venom,
claims to make you younger or fairer are rising by the second.
Indeed, there are age-defying innovations which help attain what
was once considered impossible. But the credibility of these
machines, lasers and treatments need to be researched before you
sign up. This week, learn about what’s latest in the field of cosmetic
dermatology, what is really worth the buck and what is snake oil.
Now that the plan is made, it is time for execution. Mickey and I
have pledged to work hard for the next six weeks. I invite you all to
join us in our endeavour to achieve radiant skin. Follow your weekly
skincare programme with passion, honesty, patience and
enthusiasm.
WEEK 1
 1
Know Your Skin

‘A journey of a thousand miles begins with a single step’

—Lao Tzu

Mickey had no clue about her skin type. She said her mother gave
her good genes and so her skin did not need any extra care. ‘Doc,
why don’t you tell me about all skin types if it is important. That way, I
can help my family and friends buy the right products too. I want
them all to glow on my big day.’ Mickey was rather generous, I’d say.
I sat with her for almost two hours, describing the various skin types.
When thirty-two-year-old Mrinal, an HR executive, went on the
hunt for a night cream, she got thoroughly confused. There were a
multitude of creams by innumerable brands. All of them looked
tempting and promised miracles. But these creams were specially
tailored for different skin types and would work best if we chose the
right one. Mrinal’s first hurdle was to identify her skin type. She
sought help from the salesgirl at the desk. The salesgirl was sweet
and helpful and Mrinal thought she had bought the best night cream
for herself. However, within two days of applying the cream, she
broke into a rash.
‘I bought the cream the girl suggested!’ she told me. What Mrinal
didn’t realize was that the salesgirl was neither a trained aesthetician
nor a pharmacist. She was only selling her product. It is important to
either consult a dermatologist or learn to identify your own skin type
before buying a skincare product.
Like Mrinal, there are many people who do not know their skin
type—and Mickey was no exception. There are many others who do
not know what creams to buy for themselves. So let’s start by
learning to identify our skin type.

Know your skin

Skin is made up of the upper epidermis and lower dermis. The upper
epidermis has many layers of cells. The topmost layers, composed
of dead cells, lipids, keratin, urea, salts and 30 per cent water,
together form the stratum corneum. They also make up the skin’s
natural moisturizing factors (NMF). The stratum corneum forms a
barrier that protects the skin and prevents toxins from entering.
The epidermis consists of five layers. The lowermost layer of the
epidermis, known as the stratum basale, is of significance to us. It
comprises cells called keratinocytes and melanocytes. Keratinocytes
form the factory that produces new cells. From this layer, old cells
gradually travel upwards to reach the surface of the skin and are
then shed in twenty-eight days. Melanocytes produce the pigment
melanin that gives skin its colour.

The other layers

The lower part of skin is known as the dermis. The dermis contains
an important molecule called hyaluronic acid—a polysaccharide
glycosaminoglycan—that builds moisture in the skin. It has the
unique capacity to bind and retain water molecules. It helps maintain
the resilience and smooth texture of skin.
The dermis is also comprised of collagen fibres that give skin
structural support and elastin fibres that give skin its suppleness and
elasticity.
Sweat glands that secrete sweat, sebaceous glands (the oil glands
of the skin) that secrete an oil called sebum, hair follicles (hair roots),
blood vessels, lymphatics and nerves all lie in the dermis.
 Below the dermis lies the subcutaneous or fat layer, followed by
fascia, muscle and bone.

What does our skin do?

Apart from adorning us and making us look beautiful, our skin also
forms the protective wall around our internal organs. It protects us
against the scorching heat, the bitter cold, the swarm of microbes
and the layers of pollution. It produces vitamin D. It acts like a
warehouse which stores fat, water and metabolic products. It allows
us to feel pain, touch, heat and cold. It also acts as a thermostat
because it regulates temperature and protects us from too much cold
or heat.

The skin diagram

Normal skin type

Normal oil and sweat production, a balanced moisture content of

skin and a normal cell cycle with proper cell shedding together form
normal skin.
 You may not have flaky skin and your skin may not seem like an
oil factory, but that does not mean you do not have to take care of it.
You need as much skincare as a person with oily or dry skin.

How does one identify it?

Normal skin is neither too dry nor too oily.
The pores are barely visible.
The skin is free of blemishes.
The skin is smooth and radiant.
There are hardly any imperfections.
The skin does not react adversely to any product.

Causes

Your genes!

How does one take care of it?

Use a cleanser, moisturizer and sunscreen in the morning.
Use a cleanser, an anti-ageing serum and a moisturizer at night.

Dry skin type

Skin that produces less sebum than normal skin is termed as dry
skin. Normally, lipids, such as ceramides, cholesterol and fatty acids,
present in the stratum corneum retain moisture and build a protective
barrier against external agents. NMFs such as lactic acid, amino acid
and urea help to bind in water. Dry skin lacks adequate lipids and
NMFs, resulting in an impaired barrier function. This makes the skin
more susceptible to allergies and dullness.
Skin loses water constantly, either by perspiration or through
trans-epidermal water loss (TEWL). TEWL is the natural mechanism
of passive water loss from the skin by diffusion from the deeper
layers of the skin. Excessive perspiration or TEWL also increases
dryness.

How does one identify it?

The skin feels dry and rough to touch.

There are no visible pores.
The skin is less elastic.
The skin appears lustreless and blotchy.
The skin may be flaky and when you run your nails over it, it
turns white.
Fine lines may be visible.
The skin may feel itchy.
After washing your face, the skin feels stretched and tight.
Extremely dry skin can result in calluses and cracks.

Causes
Dry skin may be a result of your genetic composition. A result of
which is that you have inherently less lipids in your skin and
therefore your skin produces less oil.
The oestrogen hormone can increase hyaluronic acid in the
skin, to maintain fluid balance and structural integrity. During
menopause, oestrogen is reduced, resulting in dryer skin.
In people who suffer from hypothyroidism, the thyroid
stimulating hormone (TSH) level is high. This can lead to
dryness.
Diabetes can also result in insulin alterations and dry skin.
Just as the body goes through changes while ageing, so too
does the skin. Chronological ageing occurs as a natural
process. The skin’s ability to produce more collagen or
hyaluronic acid or to retain lipids reduces due to cellular DNA
damage. Hence, skin becomes drier and thinner. Extrinsic
ageing is a result of external wear and tear and sun damage.
Interestingly, this results in dry skin too. Water is lost from the
 keratinocytes in dry weather and during low temperatures, as in
cold climates, leading to dry skin.

How does one take care of it?

Slather your skin with a rich moisturizer while it is slightly damp in

order to trap the moisture. Look for ingredients such as shea butter,
cocoa butter, vitamin E, squalene, coconut oil and geranium oil in
your moisturizer. Use the moisturizer at least twice a day.
Most of the time, moisturizing adequately will solve the problem
and reduce itchiness, flakiness, dull skin and fine lines.
Keep your baths short and do not bathe more than once a day.
Being in the water for long hours causes the skin to dry as the skin
cells are depleted of water in the bargain.
Bathe in cold or lukewarm water. Hot water evaporates easily from
the skin and takes away the moisture, leading to dryness.
Use mild cleansing lotions or shower gels. Avoid soap bars. Soap
alters the pH of the skin, changing it from acidic to alkaline. This,
again, results in dryness.
Do not use scrubs and loofahs. Scrubbing can damage the lipid
barrier layer of the skin and result in dryness.
Do not remain in an air-conditioned environment for long hours at
a stretch. This dehydrates the skin. More so if you are sitting in front
of the blower. Try to keep the temperature at 24–25° C if you are
working in a centrally air-conditioned office. Take a ten-minute break
and leave the air-conditioned room. Moisturize your skin at least
thrice a day, once before leaving for work, once at bedtime and once
during your lunch break at work.
Use a humidifier at home if you use room heaters in winter. Indoor
heaters are as bad as air conditioners. They zap the moisture from
the skin.
Wear gloves when working with detergents and solvents.
Detergents and solvents damage the lipid layer of the skin.
 Do not use alcohol-based toners and make-up removers. Alcohol
strips moisture off the skin and increases dryness. Use oil-based
make-up removers, balms, micellar water or rose water instead.
Do not use fruit or vegetable juices and packs on the skin.
Remember, most fruit and vegetable juices are acidic. Acids can
cause irritation and dryness of skin.
If you are undergoing treatments for acne or pigmentation, you
may be given medicines and creams, both of which cause dryness.
Isotretinoin, retinoic acid, glycolic acid, salicylic acid, adapalene and
benzoyl peroxide will cause dryness. Chemical peels and some laser
treatments may also do the same. Do not forget to balance the
dryness with the help of moisturizers.
Anti-ageing creams with retinaldehyde or retinoic acid can also
cause dryness. Use them thrice a week, alternating with a good
hydrating cream containing hyaluronic acid. Make sure you use a
sunscreen during the day.

Oily skin type

When sebaceous glands in our skin are hyperactive and produce

excessive sebum, the skin is oily. The face and scalp are usually
oilier than the rest of the body due to the concentration of sebaceous
glands in these areas of the body.
Shoulders, chest and back can get oily too.

How does one identify it?

The skin feels greasy all the time.

There is oil on the face within an hour of washing. There are
large pores on the surface of the skin.
The skin is more prone to developing blackheads, whiteheads
and large pimples.
The skin looks shiny all the time.
Causes

You may have inherited your parents’ genes and so you have
more oil glands in your skin, especially your face and scalp. So
your skin produces more oil, typically on the face and scalp.
Polycystic ovaries in females and increased dihydrotestosterone
hormone in males can result in oily skin. Hormonal changes in
the form of raised androgens during puberty will also result in
oily skin.
Stress can increase cortisol hormones leading to increased oil
production in the skin.
Certain medicines, such as steroids, can increase the oiliness of
the skin.

How does one take care of it?

Wash your face at least twice a day.

Use a cleanser containing salicylic or glycolic acid at least once
a day to unclog the pores and cleanse the skin.
Use gel or matte sunscreens.
Use water-based moisturizers.
Do not use oil- or cream-based products on the skin. Look for
products which say ‘non-comedogenic’—this means they won’t
clog the pores.
Avoid using milk, cream or high-fat yogurt on the skin.
Strictly avoid popping your zits.
Avoid scrubbing your face often. By doing so, you will strip the
skin of its natural oils and damage the lipid layer protecting your
skin. Also, the oil glands will produce more oil as a defence
mechanism.
Avoid massaging the skin. The oil glands will secret more oil
when you do so.

Combination skin type

Combination skin comprises of an oily T-zone while the rest of the
skin is either normal or dry. The oily T-zone is caused by an over-
secretion of oil sebum. Lack of sebum or oil, and a corresponding
lipid deficiency in the cheeks and chin cause dryness in the
remaining parts. If the skin is normal in the cheeks and chin, it only
means that there is adequate oil secretion in these areas.

How does one identify it?

The skin feels normal or dry on the cheeks but is oily in the T-
zone.
Acne or blackheads occur on the forehead, nose and chin.
Large pores are visible on the nose.
T-zone is shiny.

Causes

You have more oil glands in your T-zone. The rest of your face
has an optimum number of oil glands.

‘Bingo, that’s my skin type, doc. I have blackheads on my nose all

the time like black spots on my rather clear face,’ said Mickey. So we
crossed the first step. At least Mickey identified her skin type.

How does one take care of it?

You will have to use a cleanser which is neither drying nor

hydrating. A neutral soap-free cleanser works best. Avoid
alcohol-based cleansers and toners.
You could even use separate products for the oily and dry areas
of the face.

Sensitive skin type

Sensitive skin is easily irritated by different factors, such as climate,
skincare products and cosmetics, that are generally tolerated by
normal skin.
The lipids in the upper stratum corneum of the skin are like the
‘mortar’ to the skin cells, which are the ‘bricks’. Lipids provide
permeability and stability and regulate fluids in the skin.
The effectiveness of skin lipids is dependent on enzyme activity,
which is often weaker in sensitive skin. Thus, the protective function
of the barrier is compromised in sensitive skin. This leads to
excessive TEWL and allows irritants and toxins to penetrate the skin.
The protection from chemicals, UV rays and pollutants is also
compromised.

How does one identify it?

The skin may turn red at the drop of a hat.

There may be swelling, scaling, flaking, roughness or rashes.
There may be itching, burning or a pricking sensation.
One may develop a rash if there is a change in climate or
environment.
One may get eczemas too often.
Most skincare products and cosmetics rarely suit people with
sensitive skin.

Causes

If one has genes where the lipids are deficient or defective from
birth, one develops sensitive skin.
In the case of females, hormone fluctuations due to the
menstrual cycle, pregnancy and menopause can all affect the
skin’s resistance to irritants.
Inadequate sleep and stress are both known triggers for
sensitive skin.
Low humidity, prevalent in centrally air-conditioned offices and in
aeroplanes and central heating, dehydrates the skin and
 increases its sensitivity.
Heat increases sweating and evaporation of moisture from skin.
Cold climates dry the skin. Both can result in sensitive skin.
UV radiation and environmental pollutants increase free radicals
in the skin, weakening the natural defence mechanisms of the
skin and making it sensitive.
Creams, oils, lotions and cosmetics containing harsh chemicals,
alcohol and preservatives can make the skin more sensitive by
damaging the protective barrier layer of the skin.
Fragrance is known to cause allergies in sensitive skin.
Some surfactants that remove dirt can also remove skin lipids
and harm the skin.
Medicinal creams, especially steroids, damage the lipids, NMFs
and keratin in skin and make it extremely sensitive.

How does one take care of it?

Have a diet rich in antioxidants such as vitamins A, C and E and

omega-3 fatty acids.
Make sure to use sunscreen throughout the day.
Avoid perfumes, deodorants and any other fragrance-based
products.
Do not forget to moisturize your skin at least twice a day.
Avoid products with heavy synthetic dyes and harsh chemicals.
Avoid products with alcohol and parabens.
Stick to basic ingredients like aloe vera, coconut oil, glycerine,
pantothenol, vitamin B5 and ceramides.
Avoid wearing synthetic clothes.

‘Just knowing your skin type is not enough,’ I told Mickey. ‘You also
need to know about certain skin conditions and buy products
accordingly. Let us run through them quickly.’ From the corner of my
eye, I could see her yawn but an incomplete tutorial was not an
option for me.
The common skin conditions are:

Acne-prone skin

Gia tells me she has sensitive skin. I ask her what makes her say so.
‘I get whiteheads with whatever cream or cosmetic I use,’ she
replies. My dear Gia, you do not have sensitive skin. You have acne-
prone skin. Samir’s doctor told him he had dry skin. But when he
bought a moisturizer for dry skin, he developed whiteheads. So
Samir should have ideally bought a product for dry, acne-prone skin.

Pigmented skin

Arin feels his skin is completely tanned. He has dark patches on his
face and arms. The rest of his body is fair. This has been so for four
to five years. Arin, a tan disappears within one and a half to three
months. It does not remain for five years. You have developed
pigmentation on the exposed parts of your body due to years of sun
exposure.

Mature skin

Skin that is thin, dry, wrinkled, saggy and has a lot of blemishes and
sun spots can be termed as mature or ageing skin. This is seen in
people above the age of fifty-five.
My friend Marissa tells me her skin is weird. It gets oily sometimes
and dry at other times. Well, Marissa, with age, your skin has been
subjected to changes in climate, environment, medicines, creams,
skin treatments and hormonal imbalances which can change the way
it behaves.
Skin can also become dry as one ages. This is because the oil
glands shrink in size with age and the lipid bilayer, which protects the
skin, becomes thinner.
 Skin also becomes thin due to the thinning of collagen and elastin
fibres and damage of the lipid barrier layers of the skin.

‘Hmm, so my mom and dad have mature skin now,’ mumbled

Mickey, beginning to understand the complexities of skin and its
types.

Take a skin test

Step 1: Wash your face in the morning with a gentle cleanser.

Step 2: Pat it dry with a soft napkin and leave your skin bare.
Step 3: Do not apply anything on your skin for an hour.
Step 4: After an hour, take a tissue and spread it over your face
evenly. Dab your skin.
Step 5: Look at the tissue and feel your skin as well.

If the tissue is clear, your skin is normal.

If the tissue has oil in the shape of a T, you have combination skin.
If the tissue is stained and oily, you have oily skin.
If the tissue has some fine flakes, you have dry skin.
 Tissue paper test

Identify your skin type

An hour after washing

An hour after washing my face, My skin
my face, the tissue
my skin feels type is
looks
Normal, not oily, not dry Clear Normal
Blurred and smudged
Greasy and shiny Oily
with oil
Looks clear but
Tight and dry, sometimes flaky sometimes tiny flakes Dry
are stuck to it
Feels greasy on the T-zone, the
An oily or smudgy area
nose shines, the cheeks are normal Combination
in the form of a T is seen
or dry

‘Mickey, now keep in mind, you cannot use the same cream at all
times. The cream you use will depend on your skin type, your skin
condition and the climate you are in. Why don’t you do a skin check
for all your family members this week and identify their skin type?
Trust me, you would be doing them a big favour.’
 2
What Is Your Skin Telling You?

‘Beauty is of the great facts in the world like sunlight, or

springtime, or the reflection in dark water of that silver shell we
call the moon’
—Oscar Wilde

‘My skin is not too bad, doc, but my nails are chipping away to glory,’
wailed Mickey.
‘Mickey, nails can become weak due to frequent use of nail polish
or nail polish remover containing acetone. Gel nails and artificial
nails are indeed in vogue but too much exposure to UV rays can
damage the nail. If you are in contact with chemicals constantly due
to your profession and you often don’t wear gloves, your nails can
become brittle. If you have OCD and wash your hands with soap
every other hour, your nails can become weak.’
‘But, doc, I do none of that. No gel nails, no frequent washing, no
chemicals. I fail to understand this. Help me, doc. I do want my
natural nails to grow long so I can shape them well and apply a nail
polish to match every outfit I wear for my various functions.’
‘Mickey, do you know our skin often gives us signals about what is
going on inside our body? We must learn to listen to our skin. And
when I say skin, I mean nails and hair too because hair and nails are
a part of skin. So, there is a hidden reason behind your brittle nails.
Your nails are telling you that you are deficient in protein and biotin.
Nails comprise of keratin, which is nothing but protein.’
Other deficiencies can also manifest as skin, hair or nail disorders.
For example, if your knuckles are turning black, it’s time to check if
your vitamin B12 levels are low. If you develop dark circles despite
sleeping well, your haemoglobin may be going down.
Skin is the largest organ of our body. We think of it simply as an
outer covering of the body, like an orange peel, which we can abuse
as we please. But it is a vital part of the body. It shields our internal
organs, provides vitamin D, regulates body temperature and, most
importantly, gives us signs of any internal problem.
We all look at ourselves in the mirror every day. Why not take a
few moments to carefully examine our skin? To feel it and see if
there is anything abnormal or different. Does it feel dry or oily? Does
it look dull, oily or radiant?
If your skin feels dry, you have not moisturized it well. ‘But I did
apply a moisturizer before sleeping,’ said a friend who works at a
corporate office. You may have done so, but then you sat in your air-
conditioned office for twelve hours. That is enough to dehydrate you.
Your skin is asking for more. So please moisturize in the morning as
well. My friend answered, ‘I am in such a hurry in the morning.
Where is the time to moisturize?’
Well, you could keep a bottle of moisturizer in your car and apply it
on the way to work. If you travel by public transport, just keep one in
your office drawer. You may be in the air-conditioning for long hours
or in a place where the temperature is very low. This zaps the
moisture from your skin and makes it dry. You need an extra amount
of moisturizer. If you are using it only once a day, switch to twice a
day now. And do not forget your arms, legs, hands, feet, neck and
back.
If you suffer from frequent pimple outbreaks and are losing hair as
well, it’s time to find out if you have polycystic ovarian syndrome
(PCOS) or raised androgens (male hormones which females also
have in small quantities). This is an extremely common condition in
girls who have attained menarche. Small cysts appear in the ovaries
due to a hormonal imbalance in the body. This leads to a series of
problems like acne, hair fall, hair growth on body parts like the face,
weight gain and sometimes irregular periods. If you have any two of
these symptoms, you should get an ultrasonography of your ovaries
and do some blood tests during your menstrual cycle.
This will help you find out if you have PCOS or any other hormonal
imbalance. If you happen to suffer from PCOS, make sure your
weight is under control. And make sure you consult a gynaecologist.
Sometimes all your efforts to treat acne will fail or you will end up
doing twenty-odd sessions of laser hair removal and still suffer from
disastrous pimples and hair growing on the body. But treat the PCOS
—and lo and behold! Your acne will disappear, and so will your body
hair suddenly respond to laser.
At a party one day, my friend said she was noticing some
pigmentation on her back and arms. She was using double the
amount of moisturizer and yet her skin felt dry. I asked her to get her
blood tested for thyroid hormones. Sure enough, she had high levels
of thyroid stimulating hormone (TSH). This signified that she was
suffering from hypothyroidism. I asked her to consult an
endocrinologist (a doctor who specializes in disorders of hormones).
Hypothyroidism is an autoimmune disorder and it can cause dryness
of skin and even pigmentation on the skin.
My father once developed pus-filled boils on his legs. I remember
going to the local dispensary with him where Dr Singh told him that
boils occur because of a bacterial infection called staphylococcus.
‘You must be scratching your legs and your nails must be infected
with bacteria,’ he told my dad. I used to admire Singh Uncle. He was
a doctor, after all. Something I would also be when I grew up.
‘Oil your legs, they won’t get dry and you won’t keep scratching,’
my granny would tell my dad. She was certainly not wrong. And she
didn’t have a post-graduate degree in skin to diagnose dry-skin
woes. But that didn’t work and Dad developed boils yet again. This
time Singh Uncle asked dad to get his blood sugar tested. Dad was
around thirty-five years old and he wouldn’t believe that he could be
suffering from diabetes at such a young age. But Singh Uncle was
very strict. Dad couldn’t possibly overrule his instructions. Besides,
who would treat his wounds? So his blood tests were done. One
blood sample was taken early in the morning after he fasted for
twelve hours. Another blood sample was collected two hours after
his lunch. Singh Uncle was in shock. Dad’s reports showed that both
his fasting and post-meal sugar levels were high. Singh Uncle must
have cursed himself for not asking for these blood tests four months
earlier, when Dad first got those boils. It happens with all doctors
sometime or other. But all’s well that ends well. At least the diagnosis
was made. Dad was immediately put on anti-diabetic medicines and
his wounds healed as if a genie had performed some miracle.
Diabetes can manifest in the form of bacterial infections like pus
boils or itchy fungal rashes in the body folds. Sometimes wounds as
simple as a scratch on the skin will either take ages to heal or be
stubborn and just not heal. Sometimes there is excessive itching on
the arms and legs without any visible skin rash. Another common
condition seen both in diabetes and hypothyroidism is speckled
pigmented patches over arms, legs and upper back. This condition,
often mistaken as sun tan, is called cutaneous macular amyloidosis.
It sometimes itches but most of the time it may be symptomless.
‘Cutaneous’ means skin, ‘macular’ means flat spots or patches,
‘amyloidosis’ means deposition of a protein-containing pigment
called amyloid.
My friend Naina’s nineteen-year-old son has a thick band of
pigmentation on his neck. It looks like a layer of dirt. ‘He doesn’t
bathe well, J, he is very unhygienic,’ Naina said when she brought
him to me one fine day after months of coaxing. The pigmentation
didn’t bother him as much as it bothered her. She had even
scrubbed his neck a couple of times but the stubborn dirt did not
budge. I told Naina that the stubborn dirt was not dirt at all.
Darkening and thickening of skin, almost like thick rugosities on the
neck, arms and armpits is known as acanthosis nigricans. It is
usually a sign of insulin resistance or diabetes. But it may also be
seen in obese people.
One must get a blood test done to check both fasting and post-
meal insulin levels as well as blood sugar levels to know if there is
insulin resistance. Insulin resistance can eventually lead to diabetes.
Insulin is a hormone produced by pancreas. It regulates the sugar
level in the blood. Whatever sugar or carbohydrates we eat are
utilized for energy with the aid of insulin. The excess sugar, however,
is converted into fat. If you have insulin resistance, your cells do not
respond to the insulin, and sugar gets accumulated in the blood,
raising the blood sugar level. So it eventually leads to diabetes.
I get hives quite often. It is the body’s way of fighting against
something I am intolerant or allergic to. It could be allergy to food,
pollen, fungi, dust, mites, etc. The condition is called urticaria. The
only way to find out which one you are allergic to is by doing the skin
allergy test or the prick test. However, if the allergy is acute and you
have a lot of hives coming frequently, avoid doing the test. Your skin
will be hyper-reactive in such a state and the test will show a lot of
false results.
Finally, if you see a mole growing rapidly, you should get it tested.
It could be heading towards skin cancer.
‘Whoa, doc, the skin is indeed a mirror of what’s going on inside
our body,’ said an amused Mickey.
‘Yes, your skin is constantly trying to tell you something. Every
mole, every dark or light spot, every growth tells you a story. It is like
litmus paper telling you about a disease you may have. Do not
ignore the messages your skin is relaying to you. Take your skin
seriously.’
 3
Your Skincare Ritual

‘To accomplish great things, we must not only act, but also dream;
not only plan, but also believe’
—Anatole France

Mickey has no skincare routine. She uses any soap that is lying on the
shelf in her bathroom. On some days she remembers to wash her face
before going to sleep. On other days, she grabs a bite and hits the
sack as she is too tired. She never uses moisturizers because she has
never felt the need. However, she makes sure she uses a sunscreen
on holidays. But she has a complaint. She still comes back tanned.
Does she reapply every two hours? Most certainly not! And that’s the
catch, the reason behind the sunscreen not working on most holidays.
Having said that, Mickey knew about the CTM (cleansing, toning,
moisturizing) routine.
‘I am glad you are familiar with the CTM regime, Mickey. But let me
tell you, I like to do away with toners. Toners are nothing but extended
cleansers. They are needed if you do not cleanse your skin well or do
not manage to remove your make-up properly. You can completely do
away with them unless you have extremely oily skin. If you have
normal or dry skin, toners may actually increase dryness.’
I believe what our skin actually needs is the CHP (cleanse, hydrate,
protect) ritual in the morning and the CCH (cleanse, correct, hydrate)
ritual at bedtime. This means, in the morning, you clean with a
cleanser, hydrate with a moisturizer and then protect with a sunscreen.
You may apply make-up over your sunscreen.
At night, you must cleanse again. This means removing your make-
up with a make-up remover, cleansing with a face wash and then, if
your face still feels oily or clogged, using a toner or a scrub. Then you
can apply a corrector. A corrector could be an anti-acne cream, a
cream for pigmentation or an anti-ageing cream. Finish with a
moisturizer for hydration.
Let us understand this regime in detail.

Cleansers

We don’t realize the magnitude of particles that collect on our skin’s

surface at every moment. The stratum corneum of the skin sheds its
cells daily. This is not visible to the naked eye. The skin produces
sebum. This attracts dust which attaches to the skin’s surface as dirt.
Cosmetics, creams, make-up, external pollutants, soot and grime can
also settle on the skin and clog the pores. There’s so much for
microorganisms to feast on, so don’t you think cleaning all the muck is
important? Cleansers remove all the dead cells, sweat, salts, grime,
dirt, dust and make-up from the skin’s surface, and help maintain skin
hygiene.

Cleansing
 Make sure to cleanse your face once in the morning and once at
night. You must use the right kind of cleanser for your skin type.
When on the hunt for a cleanser, do not base your decision on the
look of the cleanser, the fragrance or the packaging. Choose your
cleanser based on your skin type and any existing skin condition such
as acne. Also keep in mind the climate.

Normal skin

A cleanser that leaves your skin feeling fresh and clean is all you
need. You can choose any cleanser for normal skin, from Himalaya to
LaMer. You can even use syndet bars. Syndet bars are synthetic
detergent-based cleansers that contain less than 10 per cent of soap
and typically have a more neutral/acidic pH (5.5–7), similar to the pH
of normal skin.

Some examples of face washes for normal skin:

Crème Lavante face wash

Saslic foaming face wash
Sebamed liquid face and body wash
Episoft cleansing lotion

Dry skin

If your skin feels dry all the time, you should use a gentle cleanser. It
should have added moisturizers and super fatty acids such as
petrolatum, lanolin, mineral oil, cocoa butter, glycerine, shea butter
and ceramides. Natural ingredients like jojoba oil, aloe vera, coconut
oil, soybean oil and olive oil are also found in cleansers for dry skin.
These cleansers clean the skin and leave a thin film of moisture on the
surface, giving it a supple feel. If you have dry skin, you should avoid
antibacterial soaps. They will indeed keep your skin germ-free but will
also make it dry. Avoid cleansers with exfoliants such as salicylic or
glycolic acid. Also avoid using basic soaps on facial skin. Basic soaps
have a high pH and are irritating to the skin as a result of their
damaging effects on the skin barrier.

Some examples of face washes for dry skin:

A-Derma soothing foaming gel

Cetaphil gentle skin cleanser
D-wash face wash
Sebamed olive face and body wash

Oily skin

An oily face can be very annoying, especially when you have

meetings, presentations or outdoor work. ‘I can fry an egg on my face,
do something, doc,’ is a common phrase most people use when they
come to me with oily skin. Oily skin is prone to acne, both blackheads
and whiteheads. This is a result of androgen hormones which signal
the oil glands to produce oil (sebum) in excess. There is no need to
get frustrated. Let us first pick the perfect cleanser for you. Choose a
cleanser or face wash that foams gently. Too much foam can be harsh
on the skin while a little foam will remove the oil and leave the skin
free from any greasy residue. You can use a cleanser with salicylic
acid in it to help unclog the pores. Botanicals such as aloe vera or tea
tree oil balance oil production and support clarity. Alpha hydroxyl acid,
such as glycolic acid or lactic acid, present in cleansers will help to
gently exfoliate skin and can be used too.
However, your cleanser should not leave your skin feeling dry and
tight. So make sure your cleanser does not have alcohol in it.

Some examples of face washes for oily skin:

 Sebamed clear face foam face wash
Sebium gel moussant
Ahaglow advanced face wash
Saslic face wash

Combination skin

A cleanser for combination skin must be neither extremely

moisturizing nor too drying. Alternatively, one can use a face wash for
oily skin on the T-zone and a face wash for dry skin on the rest of the
face.

Some examples of face washes for combination skin:

Hyséac cleansing gel

Cetaphil oily skin cleanser
Episoft OC cleansing gel
Ethiglo face wash

Acne-prone skin

Mallika says she cannot use any face wash or cream. Whenever she
does, she breaks out. She has acne-prone skin. Those with acne-
prone skin should use antibacterial cleansers. They help decrease the
load of Propionibacterium acne, a particular microbe which causes
acne or pimples. Salicylic acid-based cleansers unclog pores and
reduce oiliness. They are a very good option for those who tend to
break out easily.
If you are on any oral medication or topical creams for acne, such
as isotretinoin, tretinoin, retinol, adapalene, benzoyl peroxide or even
chemical peels, antibacterial or salicylic cleansers should be avoided.
They can irritate and dry up the skin. So gentle cleansing with a non-
soap cleanser (names mentioned in face washes for sensitive skin) is
important for this group of patients.

Some examples of face washes for acne-prone skin:

FCL Alpha Beta acne cleanser

Acmed face wash
D’acne face wash
Avene cleanance gel

Sensitive skin

Do you develop a rash with any face wash you pick off the shelf? You
need a cleanser for sensitive skin. I would advise you to stick to
medicated ones. Stay away from the fancy, fragranced face washes,
however chic they may seem. You should look for a cleanser with zero
fragrance and alcohol. It should be neutral to acidic pH and have
emollient properties, to keep the stratum corneum hydrated. Micellar
water is best for sensitive skin. Micellar water is a mixture of thermal
waters which are rich in minerals and have skin-healing properties,
non-ionic surfactants, which are not harsh on the skin unlike soaps,
and some form of glycerine to keep the skin soft. Micellar water
absorbs all dirt and impurities and cleanses the skin thoroughly. It
does not lather or change the skin pH. Hence, people with sensitive
skin now have a cleanser to look forward to without having to worry
about the perils of a face wash or a cleanser.

Some examples of face washes for sensitive skin:

Sebamed olive face and body wash

Bioderma Sensibio H20 micelle solution
Uriage Thermal Micellar Water
Aquaderm face and body wash
Now let us look at the other forms of cleansers available in the market.

Scrubs

Scrubs help remove lodged dirt through abrasive physical action

imparted by natural or synthetic particulate ingredients. Natural
particles include fruit seeds (e.g. peach, apricot or apple), nut shells
(e.g. walnut or almond), grains (oats, wheat), sandalwood and sugar.
Synthetic particles include polyethylene or polypropylene beads and
aluminium oxide or sodium tetraborate decahydrate granules. They
help in mechanical skin exfoliation and remove dead skin cells. Of
these, aluminium oxide and fruit pits are the most abrasive. Their
sharp edges may lead to irritation for those with dry or sensitive skin.
Those with normal skin and oily skin can use scrubs once a week to
exfoliate and unclog pores.

Cleansing creams

As the name suggests, they cleanse and moisturize. Therefore, they

are better suited for dry skin. They can contain wax, mineral oil,
petrolatum or detergents such as borax. Long lasting oil-based make-
up can be effectively removed with these cleansers.

Cleansing milk and lotions

They are the water-based counterparts to cleansing creams. They can

be used to remove water-based make-up with a cotton ball or a wipe.
They can also be rinsed off with water.

Toners

They are best suited for oily, acne-prone skin and areas like the T-
zone that produce excess sebum. They are also used to remove
make-up. They can be applied directly to target areas with a cotton
ball or a tissue. It is better to avoid alcohol-based toners. Rosewater or
any micellar water is a better option than a harsh menthol– or
camphor-based toner. Those with dry or sensitive skin need not use
toners at all.

Motorized brushes

Motorized brushes, such as clarisonic brushes, have become popular

as home skincare tools. They are battery-operated brushes with
bristles that move back and forth in a circular motion. The bristles help
remove make-up and dirt from the skin’s surface. They are a good
option for those who work outdoors, sweat a lot or use a lot of make-
up. People with normal, oily or combination skin can use them. Those
with dry or sensitive skin should avoid using them.

Face packs

Packs made of fuller’s earth, fruit extracts and green clay are known to
reduce oil from the skin’s surface. Fuller’s earth, or multani mitti, can
be mixed with rosewater and applied on the face. It should be left on
for about ten minutes and then rinsed off. It can be used once a week.
Those with dry or sensitive skin should not use this. Some face packs
contain sea mud and algae, and are said to have anti-ageing benefits.
They are better suited for mature skin, to prevent fine lines and reduce
pores. They can be mixed with water or honey and then applied on the
skin. Those with sensitive skin should not use any packs.

Masks

I am amazed at the number of pictures of charcoal masks that flood

my Instagram. Charcoal masks are said to kill germs, remove oil from
the skin and clean the skin thoroughly. The mask contains charcoal
and a kind of glue. It is applied to the entire face and neck and allowed
to dry for fifteen to twenty minutes. The mask is then pulled off. The
pulling action removes fine hairs too, leaving the skin smooth and
radiant. However, if used too often, the skin’s natural lipids may get
damaged and result in rashes or itchy skin. Do not use these masks if
you have dry or sensitive skin.
The other masks that are quite popular are the skin-brightening
masks, which contain ingredients such as arbutin, bearberry,
niacinamide, liquorice and other botanical extracts known to lighten
the skin. They brighten up the skin temporarily and are great to be
used before a party. They are usually safe for all skin types. However,
those with sensitive skin must always use masks with caution.
Yet another mask that floods the current market is the gel sheet
mask made popular by the Koreans. These are left on the skin for
twenty to thirty minutes, during which the solution in the mask gets
soaked into the skin and brightens it. There is no added benefit.
Honestly, it is just another before-party mask.
Have you heard of sleepover masks? You actually apply them on
the skin and leave them overnight, allowing the active ingredients to
gradually get absorbed into the deeper skin layers, working their way
towards cleansing and brightening the skin.
Ingredients you could look out for if you have oily skin are charcoal
and clay. If you have dry skin, look for glycerine, hyaluronic acid and
aloe vera in your mask.
If you have sensitive skin, I’d say it is best to avoid using any masks
available in the shops. Instead make your own mask without using
lemon or tomato or any fruit containing citric acid, which can irritate the
skin further. Look up chapter 14 for some safe DIY masks.

Moisturizers

Why do we need to moisturize at all? Let us understand the skin better

to be able to answer this.
The stratum corneum has cells which overlap to form a protective
barrier. There is also a lipid bilayer which comprises free fatty acids,
cholesterol and ceramides. In addition, the cells have NMFs which are
made up of amino acids, urocanic acid and minerals. All these
together have the ability to retain water in the epidermis and limit the
loss of NMFs, as well as loss of water from the skin, through TEWL.
Cold weather, low temperatures, air conditioners, room heaters, lack
of humidity, steam, sauna, bubble baths, hot-water showers, bar
soaps, foaming washes and scrubs all strip the lipids from the skin,
disrupting the skin barrier.
In order to replenish the lost water and prevent the skin from
becoming dry and flaky, we need to moisturize.
Always apply a moisturizer on slightly damp skin, ideally within three
to five minutes of your bath or washing your face. This locks the
moisture within the skin and keeps it hydrated.
How do you know which moisturizer is good for your skin type?
Well, this might help.

Normal skin

You can use a moisturizing cream for your face and a lotion for your
body. Moisturize at least once a day.

Oily skin

Opt for lotions or water-based moisturizers. Look for lactic acid as an

ingredient. It has both exfoliating and hydrating properties.
Dimethicone and hyaluronic acid are great ingredients too. My patient
Chris has very oily skin and hates using creams, especially when it is
hot. I gave her the option of using sunscreen in the day and skipping
the moisturizer. I also gave her a lightweight hyaluronic acid–based
lotion for the night. What she really loved was the micellar water that I
had asked her to use during the day when she was sweaty. She felt
refreshed each time she sprayed the water on her face, her make-up
stayed put and her skin felt hydrated.

Dry skin
You should choose a cream as it has more oil and will hydrate better.
Use a thicker cream at night. Remember, the greater the oil content,
the better the absorption through the barrier layer of the skin and the
moisturization. Look for ingredients like dimethicone, hyaluronic acid,
glycerine, vitamin E, shea butter, cocoa butter and squalene. If your
skin is extremely dry and flaky, you should use an ointment base at
bedtime. While a moisturizer gets absorbed, an ointment leaves a
much-needed oily film on the skin surface. You must moisturize at
least twice a day in summer and thrice a day in winter.

Combination skin

Use a light moisturizing cream or lotion. Moisturize at least once a day.

‘This is for you, Mickey,’ I emphasized.

Sensitive skin

Avoid using essential, aromatic oils. Stick to fragrance-free creams or

natural oils like coconut, safflower or almond. Oil your skin at least
twice a day.

Mature skin

Now this is not really a skin type but I’d like to mention it because
people above the age of fifty usually develop dryness. The skin
becomes thinner and wrinkled. So you need heavy moisturizers. If
your moisturizer has hyaluronic acid or olive oil or coconut oil in it, it’s
the right one for you.

Common concerns about moisturizers

‘I have oily skin but it becomes dry every time I go to Germany on my

business trips,’ says Mihir. Like Mihir, a lot of you must be getting
confused trying to figure out your skin type. You must remember that
the temperature of your surrounding impacts your skin. So if you go to
places which have cold, dry climate, you will need a thicker moisturizer
than what you normally use on a day-to-day basis. If it is hot and
humid, you should either use a lightweight moisturizer or a gel
formulation.
Forty-nine-year-old Kashmira had never used a moisturizer as she
felt her skin was always oily. But her skin was now becoming dry and
she didn’t know what to use. Like Kashmira, each and every one of us
will face this issue as we age. Don’t forget: as we age, our skin ages
too. The skin becomes dry as the epidermis becomes thinner, the
lipids are lost and the sebaceous glands secret less oil. Hormones
also change. Lack of oestrogen makes the skin dry and dull. So we
will need to moisturize more often, use thicker creams and avoid hot-
water showers and soaps which can dehydrate the skin.
Trisha said her face was oily but the skin on the rest of her body
was very dry. This is quite possible. A moisturizer that is suitable for
one’s face need not suit their body. In such cases, you will need to use
different moisturizers for the face and body. When you go to buy a
moisturizer, you must know a little bit about the ingredients in order to
choose the right one.
The three types of moisturizers are emollients, humectants and
occlusives.
An emollient increases the water content of the stratum corneum
and makes it supple and soft. The effect of an emollient lasts for four
to five hours. Emollients have an anti-inflammatory effect, so they
repair the skin. They also reduce itching and have a soothing effect on
inflamed or damaged skin. Dimethicone, cyclomethicone, castor oil,
jojoba oil, propylene glycol, octyl stearate, isopropyl palmitate and
isostearyl alcohol are some examples of emollients.
Humectants such as glycerine, hyaluronic acid, sodium hyaluronate,
sodium PCA, propylene glycol and heparan sulphate attract water and
add moisture to the skin. Glycerine also modulates aquaporins, which
are the water channels in the skin. It is a good ingredient to look for in
a moisturizer. Hyaluronic acid is another great ingredient as it has the
ability to attract and retain more than 1000 times its weight in water. It
plumps up the skin and helps in new collagen formation. It also gives
the temporary appearance of smoother skin with fewer wrinkles.
A word of caution regarding humectants: In dry weather they can
suck the moisture from within the skin. So always pick moisturizers
which contain both occlusives and humectants.
Occlusives are oily substances that coat the skin and prevent water
from evaporating from the surface. They function like a plastic wrap
that protects food and form a shield only as long they are there. When
the occlusive is washed off, its effect is gone. The skin will lose its
moisture due to evaporation and become dehydrated. Oils, lanolin,
stearyl alcohol, cetyl alcohol, lecithin, squalene, mineral oil, petrolatum
and silicones are occlusives. Mineral oils have been used for many
years. However, industrial mineral oil was found to be carcinogenic.
And petroleum jelly, when tested, had some amount of petroleum
distillates. Hence, a lot of manufacturers do not use mineral oil and
petrolatum any more and instead opt for natural ingredients such as
shea butter, cocoa butter, sesame seed oil, etc.
There are various fatty acids that repair the skin barrier. I love
palmitic acid, found in palm oil, and stearic acid, found in shea butter.
These oils help to repair the skin barrier and keep the skin hydrated.
Your skin barrier can also be repaired by taking omega-3 fatty acid
supplements, evening primrose oil, fish oil, borage seeds, flax seeds
and salmon.
Mustard oil can irritate the skin. Those of you who are fond of oils
need to pick the correct ones for yourself. Borage seed oil, safflower
seed oil and jojoba oils aid in skin barrier repair as they have anti-
inflammatory properties. Apricot kernel seed oil and cranberry seed oil
are doing the rounds now as they are rich sources of essential fatty
acids. They can be taken orally and applied on the skin as well.
Frieda wanted to know if she and her husband could use the same
moisturizer. Honestly, men do not need heavy moisturizers. Men’s
sebaceous glands secrete more oil. And men do not use numerous
cosmetics on their skin or indulge in many facial treatments. Hence
there is minimal trans-epidermal water loss. What men need is an
emollient which makes the skin soft and smooth. Dimethicone is the
most preferred ingredient. It is found in creams and after-shave
lotions. However, men with dry skin eczemas or atopic dermatitis need
thicker moisturizers. Females need a combination of occlusives,
emollients and humectants. Not just to moisturize and protect their
skin, but also to prevent fine lines and wrinkles which appear due to
dryness.
Some medicated moisturizers contain lactic acid or urea. Lactic acid
and urea increase the water-holding capacity of the skin and also act
as mild exfoliants. Look for these ingredients when you have calluses,
thick dead flaky skin or cracks on the soles of your feet.
Restoring your pH balance

Normal skin has an acidic pH of around 5 to 5.5. This pH is maintained

by the acid mantle of the skin. It forms a protective barrier, blocking
harmful bacteria, micro-organisms and toxins and restoring moisture
to the skin. Dry skin has an alkaline pH, i.e. pH above 7. Hence it is
more sensitive and prone to allergies and eczemas. pH-balanced
products help restore the acid mantle and the protective lipid layer of
the skin. They are available in the form of moisturizers and aid in
repairing dry, flaky skin, and even skin wounds. Soaps and detergents
make the skin more alkaline and increase dryness.

Sunscreens

Sunscreens are products which prevent ultraviolet rays from being

absorbed by the skin. They are available in the form of creams, gels,
lotions, sprays and now even capsules.
Let us first understand these rays. Solar radiation comprises UV
rays, visible light and infrared rays.

Sun protection

UV rays that reach the earth’s surface comprise UVA (320–400nm)

and UVB (290–320 nm) rays. Visible rays are at about 400–800 nm
and infrared rays are anything above 800 nm.
Wavelengths less than 320 nm are absorbed by the upper layers of
the skin, namely the stratum corneum and the epidermis. Wavelengths
greater than 320 nm enter the deeper part of the skin, the dermis. All
rays cause the breakdown of cell membrane, lipids, structural proteins
and DNA of the skin.
Exposure to UVA rays can cause suntan, wrinkles, pigmentation,
sun spots and even skin cancer.
UVB rays are responsible for sunburns and skin cancer. Visible rays
and infrared rays are said to increase pigmentation (any dark patches
on the skin). To protect the skin from all these rays, we need to use a
sunscreen every single day.
Always look for sunscreens which say ‘broad spectrum, non-
comedogenic, hypoallergenic’. Broad spectrum means they offer
protection from both UVA and UVB rays. Non-comedogenic means
they are less likely to cause whiteheads. Hypoallergenic means they
are less likely to produce allergic reactions or rashes.
Physical ingredients are zinc oxide, titanium dioxide and iron oxide.
These ingredients form the main constituents of mineral sunscreens.
Safe chemical ingredients are cinnamates such as octinoxate, octyl
methoxy cinnamate; ecamsule such as mexoryl, benzophenones,
avobenzone; anthranilates such as methyl anthranilate; and
salicylates such as octisalate, homosalate.
For best results, opt for a sunscreen which has both physical and
chemical sunscreen ingredients. Some of the newer ones even protect
from infrared rays. So if you are cooking most of the time or exposed
to harsh indoor lights, use these sunscreens which protect from visible
light and infrared rays as well as from UVA and UVB rays.
Now it’s time to understand the SPF game.
SPF or sun protecting factor is a measure of protection from UVB
rays. A higher SPF is recommended for Caucasian skin as it is more
prone to skin cancer.

Table 1
SPF Proportion of UVB blocked (per cent)
15 93
20 95
30 96.7
40 97.5
50 98.3

For Indian skin types, it is essential to look at the PA value which

indicates protection from UVA rays.

Table 2

PA Protection from UVA rays

+ Fair
++ Moderate
+++ Good
++++ Excellent

For regular use, one should opt for a sunscreen with SPF 30 and PA
+++
If you have dry skin, use a cream-based sunscreen. And if you have
oily skin, use a gel-based or matte sunscreen. For larger surface
areas, use a lotion or a spray.
Having said that, the effect of even the best sunscreen will last for
only two hours if outdoors. Ideally, therefore, it should be reapplied
every two hours. And more frequently during outdoor activities when
you sweat.

How much sunscreen should one apply?

The current US Food and Drug Administration (FDA) standard

recommends 2 mg/cm2 of skin surface. Remember to apply it on the
back of your neck, ears and hairline.

Table 3

Face and neck ½ teaspoon (3 ml) of sunscreen

Each arm ½ teaspoon (3 ml) of sunscreen
Each leg 1 teaspoon (6 ml) of sunscreen
Feet 1 teaspoon on both feet
Chest 1 teaspoon
Back 2 teaspoons to full back

The most common questions asked about sunscreens:

1. ‘My grandma never used sunscreen, yet her skin is flawless,’

said Kriti when I asked her to apply sunscreen every day.

Kriti, our grandparents were living in a better environment. The air was
less polluted and the ozone layer wasn’t as depleted as it is now.

2. Sunscreens are so sticky, I cannot use them.

Not any more. The market is flooded with new easy-to-use sunscreens
that are not greasy. Ask your dermatologist or refer to the table at the
end of this chapter.

3. Sunscreens make my face look white.

The older sunscreens made the skin look chalky and white. Zinc oxide
and titanium dioxide, essential physical ingredients in a sunscreen,
were responsible for this. Haven’t you seen cricketers paint their faces
white? This is zinc oxide, the best barrier from sun rays. However, one
can’t wear a white mask and go out on a regular basis. But now, zinc
oxide and titanium dioxide are broken into micronized nanoparticles
and incorporated into sunscreens. So you get the benefits without the
white look.

4. I break out when I use sunscreen.

You are not using the appropriate sunscreen. Choose a gel-based

sunscreen or a matte one with ecamsule. Oil or cream-based
sunscreens can clog your pores, causing blackheads and whiteheads.
Look for sunscreens which say ‘non-comedogenic’, ‘gel’, ‘oil-free’, ‘dry
touch’, ‘for acne-prone skin’ or ‘matte finish’.
Matte finish sunscreens contain silicones that ensure the pores are
not clogged. They also reduce oil secretion and stickiness. They are
best suited for people with oily skin.
Water-resistant sunscreens are occlusive and may clog pores.
Avoid using them. Do not wear sunscreen for long hours if you tend to
break out. If you work indoors and have no exposure to rays, you may
wash your face an hour after reaching your office.

5. My skin turns dark when I use sunscreen.

All you have to do is change your sunscreen. Avoid ingredients such

as avobenzone and titanium dioxide in your sunscreen. Sometimes
you may be allergic to these ingredients. Using these could result in
darker skin.

6. I don’t step out into the sun; I just sit in my car and reach office.
Why should I use a sunscreen?

UVA rays penetrate the glass in automobiles. Laminated glass used

on windows offers some UV protection. However, rear side windows
are made of non-laminated glass and transmit a significant amount of
UVA rays. For adequate UV protection, all your car windows should
have dark, protective UV shields which are available as laminated or
tinted glass or film. However, as per traffic regulations, these tinted
glasses are no longer allowed unless you have special permission. So
the bottom line is that even if you travel by car, your skin still needs
sunscreen.
Similarly, if you are working in chic glass buildings which do not
have curtains, you are being exposed to UVA rays.
My friend Karishma loves to sit by her French windows on Sunday
mornings and sip her coffee. She is indoors, yet she gets exposed to
UV rays. So she does need a sunscreen, even at home. My aunt
thinks she has zero sun exposure as she is a homemaker and does
not step out of the house during the day. So she doesn’t use a
sunscreen. What she doesn’t realize is that she is exposed to sun rays
while making her trip to the balcony to water her plants, to the terrace
to dry wet clothes and to the bus stop to wait for her kid’s school bus.
The short walk from our car to the office door or a walk to the café next
door during a break is enough to do the damage.

7. Aditi is an actor and feels that her make-up has enough SPF.

Foundation make-up provides SPF 3 to 4, because of its pigment

content, for up to four hours after application. BB creams offer up to 40
per cent of the sun protection claimed by them. It is always better to
wear a sunscreen first and then layer on make-up that has SPF. There
are tinted sunscreens and sunscreens with primers available. These
allow the make-up to blend well without making the skin appear
patchy.

8. Ashfaq says he doesn’t like to use a sunscreen because his face

becomes sweaty on applying a sunscreen.

Sunscreens which have more chemical ingredients change UV rays

into heat. This causes sweat. To avoid this problem, opt for
sunscreens with more physical ingredients like titanium dioxide and
zinc oxide.

9. Marissa recently had a fabulous holiday in the Alps where it was

snowing heavily. Yet, she came back tanned.
Snow reflects 80 per cent of the sun’s rays; sand reflects 25 per cent
and 80 per cent of the UVA rays that pass through clouds. So you
must apply a sunscreen even on a cloudy day or when it is snowing.
Remember to apply your sunscreen on all the exposed parts of your
body.
Physical protection helps a lot when outdoors. Full-length trousers,
long skirts, full-sleeved shirts and kurtis provide protection from UV
rays. If you tend to tan or pigment easily, it is advised that you wear
such clothes. Clothes made from tightly woven fabric offer better
protection than loose ones. Also, darker-coloured clothes offer better
sun protection than lighter ones. Wide-brimmed hats, umbrellas and
scarves can also be used when outdoors.

10. Rishabh says he leaves for work before 10 a.m. when the sun
is not very bright. So he doesn’t apply a sunscreen.

Well, Rishabh, you are only partly correct. UVB rays are most intense
between 10 a.m. and 4 p.m. However, as long as you see daylight,
UVA rays are present with a fairly constant intensity. So there is no
such ‘safe time’ unless it is before sunrise or after sunset.

11. How will I get my vitamin D if I don’t step out in the sun?

This is a common question. Most people get more than enough

vitamin D through regular, incidental sun exposure. And even if you
always wear sunscreen, some UVB rays will still penetrate your skin,
stimulating vitamin D production. Furthermore, after a limited amount
of sun exposure, vitamin D production reaches its maximum and
stops. UV exposure beyond this actually breaks down vitamin D.
The US FDA recommends a balanced diet and a daily 600 IU
vitamin D3 supplement, along with 1 g calcium to obtain adequate
vitamin D. A diet rich in vitamin D includes fortified milk, cereals,
mushrooms, eggs, liver, cod liver oil and fish such as salmon, tuna
and mackerel.
12. Rimi’s seven-year-old plays soccer and she feels he has turned
two shades darker.

This is the effect of UV rays. Sunscreen can be applied on children

above the age of six months. It is advisable to plan indoor activities
between 11 a.m. to 3 p.m. Avoid sun exposure during these hours
because rays are the harshest at this time. It also helps to be fully
clothed. Caps and hats should be worn. Preferably, use a physical
sunscreen with SPF 15. Make sure to use a sunscreen before and
after a swim or an outdoor sport.
Oral sunscreens: Supplements containing polypodium leucotomos,
β-carotene, lycopene, vitamin C (ascorbate), vitamin E (tocopherol),
nicotinamide, afamelanotide, grape seed extract and ubiquinone are
known to protect the skin from visible light and infrared rays. Visible
light is known to increase facial pigmentation, such as melisma, and
sun-induced pigmentation. Infrared rays cause the skin to age by
reducing skin elasticity and firmness and facilitating wrinkle formation.
Further photo protection can be achieved by applying a facial
foundation. Facial foundation contains iron oxide, zinc oxide and
kaolin, all of which block UV rays. Many of them now contain organic
sunscreens as well, using octyl methoxycinnamate and oxybenzone,
to provide an SPF rating.
Facial powders, applied on top of the facial foundation, provide even
more sun protection. They allow the facial foundation to remain in
place, while coating the skin with an additional layer of kaolin, talc and
iron oxide. Powders are also excellent at absorbing sweat and sebum
that can destroy the facial foundation film and literally float the photo
protection right off your face. The face powder can be dusted with a
loose brush over the facial foundation that has been applied over the
sunscreen-containing moisturizer. Never forget to wear a hat, scarf,
umbrella and big sunglasses, in addition to cosmetics, to protect
yourself from the sun.
Skin type Examples of sunscreen
Avene VHP SPF50 Sunscreen, UV Smart Daily Sunscreen,
Normal
Sebamed Multi Protect Sun Cream
La Shield lite, Isdin Fotoprotector Gel, Suncros Matte Finish Soft
Oily
Gel
Sebamed Sunscreen Lotion, Shadowz SPF 50, Rivela
Dry
Sunscreen Lotion
Combination Avene Dry Touch, Photostable sunscreen, Suncros Tint
Sensitive Isdin Fusion water, Coola Mineral sunscreen, Z Block Sunscreen
For Suncros Aquagel, Neutrogena Beach Defense, Isdin Fotoultra
swimming Unify Lotion

Now Mickey has clearly understood what her skincare ritual should be.
I hope you all have too.
 4
Acquainting Yourself with Labels

‘Genes and family may determine the foundation of the house,

but time and place determine its form’
—Jerome Kagan

Every time Mickey’s sister is at an international airport, she cannot

resist the temptation to buy a range of skincare products. However,
the products only adorn her dressing table because she doesn’t
know how to use them or finds the labels difficult to understand.
Mickey thinks it’s a complete waste of money and I agree with her.
Once you know what the labels on these products mean, you will be
able to buy your basic skincare products easily and not end up
wasting money on those that don’t suit you.
I shall help you get familiar with some common terms and labels.

1. Normal skin, oily skin, dry skin, combination skin, sensitive skin:
This has been described already and it only means the product
is apt for the skin type mentioned on the label.
2. Hypoallergenic: This means the manufacturer claims that there
are less chances of an allergy with this product. However, this
does not mean that the product is sure not to cause any rashes
or allergies.
3. Non-comedogenic: A comedone is a whitehead or a blackhead
in medical jargon. Non-comedogenic indicates that the product
does not cause comedones. People with oily or acne-prone skin
could use this product. However, it does not completely stop
acne from occurring. US FDA does not define any ingredient as
non-comedogenic or hypoallergenic. And there aren’t any
 standardized tests to determine whether a product is really
hypoallergenic or non-comedogenic. But referring to these
labels will at least give you some direction.
4. Date of manufacturing and date of expiry: This doesn’t need
explanation but please do not be stingy and use products way
past their expiry date just because you spent a bomb on them.
Check the date of manufacturing and the date of expiry. If the
date of expiry is close and you think you won’t be able to finish
using the cream, do not buy it. Once a product crosses the date
of expiry, its quality begins to deteriorate.
5. PAO: This stands for ‘period after opening’. Some skincare
products and cosmetics carry a PAO symbol (a number followed
by an M and an open jar icon). The PAO tells you when the
product needs to be thrown away once opened. For example, a
‘6M’ would mean you should discard the product six months
after you have opened it. Again, this is not 100 per cent reliable
but it is better to follow it.
6. Fragrance-free: Manufacturers are allowed to call their products
fragrance-free if the ingredients are not included only for the
sake of emitting an aroma. However, some fragrant ingredients
are used as preservatives or just to give a cosmetic effect to the
product and the product can still be called fragrance-free.
7. Preservative-free: Do not go by this term. A preservative is used
to protect just about any product from mould and bacteria. Any
product with water in it has to have a preservative as well,
otherwise it is sure to decay. Do not be afraid of preservatives.
There are many natural preservatives such as vitamins,
turmeric, rosemary, thyme, oregano, salts, silver citrate,
potassium sorbate and essential oils that can be used safely in
products. Products with natural preservatives can last for up to a
year. Synthetic preservatives such as isothiazolones, urea
derivatives, halogen-organic actives and EDTA are safer than
parabens.
8. Paraben-free: Parabens have been the most common
preservatives in any product since the 1950s due to their
excellent antibacterial and antifungal properties. However, it was
 found that parabens mimic the hormone oestrogen by binding to
oestrogen receptors. It was thus hypothesized that the use of
paraben-based products could cause early puberty, breast
cancer and low fertility in males. It has since been proven that
for parabens to have effects similar to oestrogen, the dose of
the preservative has to be 25000 times more than what is
currently used in a preservative. And the link between parabens
and breast cancer has also been discredited due to insufficient
scientific evidence. Nonetheless, the concentration of
propylparaben and butylparaben is limited to 0.4–0.14 per cent
in products manufactured in Europe. It has also been banned in
diaper products. US FDA has claimed that the current low
amounts used as preservatives are safe. There is no cumulative
effect of parabens used over a period of time. The percentage
used is so small that it gets washed away with cleansing.
However, some people are allergic to parabens and develop
rashes when using paraben-based moisturizers or anti-ageing
creams. There are other preservatives which are safer than
parabens and one can opt for these if the skin is allergic or
sensitive to them.
9. Dermatologist-approved: This does not mean it is FDA-
approved. The approval of any one dermatologist, who may
even be working for the manufacturing company, is enough to
label the product as ‘dermatologist-approved’. So do not go by
it.
10. Clinically tested: No doubt most of the branded products
undergo a lot of research. However, there are no regulations as
to how the trials are done. We don’t know whether all the
ingredients are tested or just one or two active ingredients.
Consumers should not be misled by this term.
11. Organic: If 75–94 per cent ingredients in a product is organic,
the product can be termed so, according to the US Department
of Agriculture.
12. Natural: By calling a product natural, the manufacturer may
mean that the active ingredients are obtained from plants. But
the product can still contain chemicals and preservatives to
 sustain it. Think about it, how can you use a papaya extract for
days without it decaying? Home-made or freshly prepared
products from extracts of a fruit or plant can be termed natural.
However, they cannot be used for more than three or four days,
even if refrigerated.

For basic selection, stick to the following rule:

Skin type Label to look for

Oily or acne-prone
Non-comedogenic, oil-free
skin
Dry skin Hypoallergenic, should not be oil-free
Hypoallergenic, paraben-free, soap-free, fragrance-
Sensitive skin
free

An excited Mickey said she would not only look out for the right
labels for herself but educate her sister too. Her father, she said,
would be the happiest because her sister would then not be wasting
money any more.
WEEK 2
 5
Twenty Skin Myths

‘If you fuel your journey on the opinion of others, you are going
to run out of gas’
—Dr Steve Maraboli

During our first meeting, Mickey emphasized on natural products

only. She had never used anything on her skin before and so she
didn’t want anything with chemicals, especially before her wedding.
All-natural wouldn’t work in such a short span of time. There are
many popular beliefs and myths regarding skincare. They may have
been told to you by your grandmother when you were a teenager, or
friends who subscribe to many blogs on the Internet, or those who
gather at kitties and discuss skincare. Although they may all have
been well meaning, there is no scientific evidence to that side of the
story. Some of those advices are proverbial old wives’ tales, others
courtesy of Dr Google. Let us bust some of these myths.

1. All-natural products are better for the skin.

Natural is the ‘in’ thing. The question is: are the products really
natural? Can you keep fresh orange juice in the refrigerator for over
a week? It will decay, won’t it? In order to keep natural things well
preserved, preservatives are required. And preservatives are
chemicals too. Quite often natural ingredients can cause irritation
and allergies. I have seen reactions to some of the most common
ingredients such as aloe vera and tea tree oil in people with sensitive
skin. Firstly, the plants and trees whose leaves, bark or fruits are
used should not be chemically treated or infused with pesticides. The
soil in which they are grown should be organic too. Thirdly, the
extracts must be pure. Then, the preservatives must also be natural.
So always check the authenticity of the product and the
manufacturer and do not forget to check the ingredients.

2. You’ll eventually outgrow acne.

It is a popular belief that acne is a normal teenage problem. This is

not true at all. Acne occurs due to hormonal changes in the body,
especially when your androgen hormones increase. There can be
many triggers for acne, such as stress, oil-based cosmetics, etc.
(refer to the next chapter on acne for more details) irrespective of
age. Acne can occur right from the teens to even the sixties. Adult
acne is on the rise and just because you have never had a pimple
during your teens does not mean you cannot have a pimple when
you grow older.

3. Expensive cosmetics are better than inexpensive ones.

This is not true at all. A basic 30 g retinol cream which costs Rs 150
is as good as its branded equivalent which costs Rs 6500. Similarly,
a basic cold cream is as good a face moisturizer, and Boroline a
better lip cream than most of the fancy lip balms. Do not get lured by
the packaging and do not be a victim of the fancy-looking skincare
boutique. What is important is to look at the ingredients (common
important ingredients have been mentioned in detail in chapter 3 and
chapter 11), the date of manufacturing and expiry, whether the
company which manufactures the product is authentic enough and
finally whether the product is suitable for your skin.

4. Hot water open pores, ice closes pores.

I am sorry, pores do not open or close like a tap on their own, nor are
they temperature-sensitive. A pore is an opening of the duct which
carries sebum from the sebaceous gland to the surface of the skin.
When the sebaceous glands secrete more oil or sebum, the ducts
enlarge, giving the impression of an enlarged pore. Elastin fibres
which hold the duct in shape lose their elasticity due to sun exposure
or ageing. This can also cause the pores to become larger. While
some anti-ageing serums and creams containing retinoids or
peptides help in firming the elastin fibres, fractional lasers or micro-
needling may help a bit more. However, there is no 100 per cent
solution to open pores.

5. Blackheads need to be scrubbed away.

When too much oil or sebum is secreted by the sebaceous glands,

the channels which take oil from the gland to the skin’s surface get
blocked just like a jam due to excess traffic. When this clogged oil,
mixed with dead skin, reaches the surface of the skin, it gets
oxidized and becomes a blackhead. It isn’t dirt at all, so you cannot
scrub it away completely. All you can manage to do is remove the
upper part of the blackhead, and so it returns very soon. You need to
use a salicylic acid– or lactic acid–based lotion or facewash which
will exfoliate the lining of the pore and dissolve the oil, thus removing
it completely. Scrubbing vigorously will only disrupt the protective
layer of the skin, giving way to more microorganisms to enter the
skin and cause more havoc.

6. Drinking a lot of water will prevent acne or dryness and make

the skin radiant.

I often have these troubled patients who guzzle tonnes of water and
yet have dry skin or acne. They are so distraught that water isn’t
doing the trick for them while it does wonders to people on the
Internet. The good part about water is that it is extremely essential
for our body to function well and remain hydrated. So we do need six
to eight glasses of water a day. But water plays a small role in acne
and dryness. It is the oil inside your skin, produced by the sebaceous
glands (endogenous), and outside, in the form of moisturizers
(exogenous), which is responsible for how dry or oily your skin
actually is. So if your skin is dry, make sure to use moisturizers
rather than simply drinking four litres of water a day. And if you have
acne or oily skin, use products to reduce the oil or get to the root
cause and treat it. Do not expect water to be a miracle worker. Our
liver does all the detoxing and the digestive system or the urinary
system flushes out the toxins. Water certainly aids them to function
better. So drink water for their sake.

Drinking gallons of water

7. Any cream or serum if applied for long stops working because

the skin gets used to it.

‘Doc, the serum you prescribed was fab the first two months and
then it stopped working,’ is something I often hear from my patients.
The truth is, your skin has its requirements depending on the
climate, the environment, your hormones, the products you put
together for your skin ritual. So how will a cream which was amazing
in summer, when you were sweating most of the time, work in winter
when your skin is cracking up? Don’t forget that your skin is an
organ; it will change with time and age. So you do need to change
products. You may go back to the ones you have used in the past,
depending on the skin condition.

8. Skincare is a girl thing.

I wonder why so many people believe this. Skin is something that

men possess too. They can also have eczemas, rashes, pimples,
wrinkles, blemishes. So why should skincare be a girl thing? I often
see my brothers splash some water on their face, shave and use an
aftershave lotion. That’s the beginning and end of their skincare
regime. They love to talk about fitness, protein and other
supplements. But if you have a good body and a dull face, would
they complement each other? Yes, men have slightly thicker skin,
more sebaceous glands, more collagen. So they need different
products. Men needn’t keep a bunch of flowery or pink products
which exude sweet fragrance in the bathroom or on the dressing
table. I tell my husband to do me a favour by just using a sunscreen
in the day and a moisturizer at night. Even this is more than enough.
And if you follow the entire skincare ritual, you will surely have
radiant, blemish-free skin.

9. I will grow hair like a gorilla if I shave my hair.

When you shave, you snip hair from the skin’s surface. The hair
follicle is not plucked from its root. So what you see are blunt edges
of the hair when your hair begins to grow after a shave. These blunt
edges give you an illusion of thicker hair but the reality is: there is no
difference in the density or diameter of the strand. Imagine chopping
the stem of a plant halfway—won’t you find a rough edge? If you
remove the entire plant from its roots, the surface of the earth is
smooth. That’s the case with hair too. When you wax, you remove
hair from its root. So it regrows at a slower pace and the tapered
ends of the hair are thinner, and the hair appears to grow thinner.
 Shaving

10. If I pluck one white hair, I will grow many strands of white hair
back.

I wish that were true—I would pluck the few strands of grey hair from
my brother Nikhil’s scalp, so they would grow back in larger
numbers! At least then he wouldn’t bother about his receding
hairline. White or grey hair is a result of the loss of a pigment called
melanin in the hair roots and the skin around it. So if you pluck one
grey hair, the new hair which grows will grow back white or grey
because the melanin-producing cells in the hair root and its
surrounding area have died. Which is why, sometimes, more hair
which grow from this portion of the scalp will all grow white or grey.
Remember that frequent plucking will damage the follicle, and hair
may not grow back at all. You may even develop scarring and
infection. So it’s best to refrain from plucking your hair.

11. I won’t develop wrinkles or pigmentation because my mom’s

skin at sixty is still so radiant and youthful.

It’s true that genes play a big role in how your skin and facial
features are. But ageing is based on both intrinsic and extrinsic
factors. Your genes are the intrinsic factors but sun exposure, poor
lifestyle, smoking, alcohol, stress and pollution play a huge role in
shaping your skin, especially after you cross the forty mark. No
matter how good your mom’s skin is at sixty, you could still look like
you are fifty at forty if you don’t take care of your skin. Sun
protection, healthy food, exercise, beauty sleep and no addictive
habits are the key to good skin even in later years. Of course, you
will need a little support from dermatologists in the form of a fruit peel
or a non-surgical skin tightening once you cross forty-five or fifty.

12. Regular facials are a must once I turn thirty to prevent ageing.

Amid the humdrum of daily routine and busy schedules, facials can
be stress-relieving and have a relaxing effect. The radiance on the
face is a result of thorough cleansing but it’s at best temporary and
can also be achieved at home. Facial massages have a calming
effect, but science has proved that massages neither improve
circulation nor cause any lymphatic drainage. A study done in
University of Wisconsin-Stout, USA, showed that massage therapy’s
effect on the stress hormone called cortisol is ‘generally very small
and, in most cases, not statistically distinguishable from zero’ as
opposed to the claims that massages can reduce cortisol levels.*
Secondly, nothing can be massaged into the skin to the point that
it reaches the liver and detoxes it. This is more voodoo than truth.
Applying things that enter blood circulation would be considered
drugs and would have to be regulated by the FDA. Also fluid build-up
on the face cannot be reduced by facials. That is a function of the
kidneys. Sun protection is the single most important thing to ensure
your skin looks good for a long time. Facials are a feel-good factor.
Neither are they a compulsion nor do they stimulate collagen or
tighten your skin or cause any lymphatic drainage or body detox. I do
not discourage facials because it is nice to relax once in a while and
have your skin cleansed too.

13. I sleep well but I have dark circles.

Yes, inadequate sleep is hugely responsible for the dark circles
under your eyes but there are various other reasons too. Low
haemoglobin, allergy to cosmetics or creams, dust allergies resulting
in constant rubbing of eyes, asthma, hay fever, genes and certain
medication can also cause dark circles in spite of you having your
eight hours of beauty sleep every day. So try to find out the cause
and get it treated accordingly. Your dark circles will certainly reduce.

14. Oiling the hair is important for hair growth.

When I look at all my childhood pictures, I wonder what my mom and

my granny thought as they oiled my hair. I never really ended up with
Rapunzel’s hair but I surely looked like this nerd with oily hair tied up
in a ponytail. Oil is a very good conditioner for hair. It helps reduce
frizz and nourishes the hair shaft. However, coconut oil, almond oil or
mustard oil will stimulate the hair follicles to grow new hair or make
the hair shaft thicker. Some of the newer oils claim to have medicinal
benefits but they have no scientific data to back them up. Oiling your
hair (not the scalp), once a week for about two hours before
shampoo, conditions it well and is a healthy hair practice as long as
you are clear that it will neither stop your hair fall nor promote hair
growth.
15. I will develop wrinkles if I do not apply moisturizer and
foundation in upward strokes.

This is completely untrue. You cannot rub wrinkles into your face, nor
can you alter your muscles or fat just by using your make-up in
upward strokes. In young people, the skin is more elastic. So when
you stretch it, it bounces back. In mature skin, the elastin fibres are
weaker and the skin is not so supple due to the loss of elasticity. So
when you sleep with the same side of your face squished into the
pillow every day, you will develop more wrinkles and sagging on that
side of the face. Instead of focusing on the movement of your hands
while applying make-up, train your mind to sleep straight on your
back rather than curling up on one side.
16. I will be able to get rid of my wrinkles with facial exercises.

Exercise does help to tone your body and is extremely good for your
skin and overall health. But facial exercises have to be taken with a
pinch of salt. Constant movement of muscles will cause more lines
and wrinkles rather than reducing them. Actors and people who
emote more as they speak always end up with more wrinkles. A
report in the Aesthetic Surgery Journal published in 2014 showed
that facial exercises do not play a role in facial rejuvenation. Hence it
is better to stick to squats in the gym than exercising your face in
front of your dressing mirror.*

17. Toothpaste is the quick fix to my pimple.

Most teenagers who consult me for their acne have already tried
dabbing toothpaste on their pimple in the hope that it will disappear.
This is an old hack which won’t work now. The older formulations of
toothpaste contained an ingredient called triclosan, which killed
acne-causing bacteria. So it did help to dab toothpaste on your acne.
However, triclosan was found to reduce the immunity in children who
were exposed to antibacterials at an early age. Hence, newer
toothpastes stopped including it as an ingredient. As a matter of fact,
some of the current ingredients may lead to irritation and rashes. So
stop applying toothpaste on your pimple a day before your prom
night. You don’t want a rash on your face which you can’t even
conceal with make-up.
 Toothpaste on a zit

18. Wine and dark chocolate are great for the skin.

While red wine has resveratrol, a powerful antioxidant, having it

every day in the name of beauty can actually be detrimental to your
skin. It can leave your skin dehydrated, sallow and wrinkled. You
could also end up with puffy eyes. A glass of red wine once in a
while is good enough. You might as well gorge on cranberries,
blueberries, dark grapes, pistachios and peanuts to get your
resveratrol.
Dark chocolate has cacao which contains resveratrol and
polyphenol antioxidants. But you should look for 80 per cent dark
chocolate with minimum sugar if you want to actually benefit from it.
You can’t have any chocolate considering it to be good for your skin.
On the contrary, sugar causes glycation, which results in early signs
of ageing.

19. I will become fair if I take glutathione injections.

Glutathione is a powerful antioxidant used for the treatment of liver
disorders. It can be taken in the form of tablets or aerosol sprays for
its antioxidant benefits. The dose is 600–1200 mg/day and not more.
Skin lightening is a side effect of glutathione, as it depletes the
pigment melanin from the skin. However, not everybody develops a
side effect. Moreover, for the side effect to persist, you will need to
continue taking glutathione. Once you stop it, your colour may go
back to what it used to be within a year or so, sometimes even
earlier. And if you do not develop a side effect to glutathione, it will
not make your skin lighter unless you overdose yourself. It is not yet
US FDA approved.

20. A body detox will keep my skin allergies and pimples away.

We abuse our body day in and day out with unhealthy food, stress,
pollution, sun exposure, poor sleep, sedentary lifestyle and so on. It
is good to give the body some rest and take a break from all the
abuse. You can detox your body by living on greens and natural
food, drinking a lot of water and taking ample rest. This is easy on
the gut and helps clear a lot of waste which accumulates in our
intestines for days. It is also good for the liver and intestines;
however, it will not have much of an effect on your hormones or on
the immune system of your body. Hence you may still break out into
acne or develop a rash as there is no correlation between detox and
the skin.

‘Oh my God, doc! You’ve busted so many myths that were stuck in
my head too. Incomplete knowledge is so dangerous,’ Mickey
exclaimed.
There are a lot of myths when it comes to skin and beauty. No
doubt the Internet is a well of knowledge but one must only trust
authentic websites and articles written by qualified doctors when it
comes to skin.
 6
Acne

‘It is not only for what we do that we are held responsible, but
also for what we do not do’
—Molière

‘I don’t get pimples or acne, doc. But blackheads take no time to find
a lace on my nose. No amount of nose strips help,’ Mickey
complained. Well, Mickey, blackheads are a form of acne too. Let me
give you a little insight into acne.
One of the most distressing things that can happen to you is an
eruption of an unsightly pimple on your face right before your
birthday party or before that important presentation you have to
make.
In my eighteen years of practice, I have seen how acne can have
a depressing psychological impact on people. If we doctors help
these youngsters get rid of their acne, we actually help them gain
confidence and start a new life.
Take the case of twenty-seven-year-old Maitri who was brought to
my clinic by her parents. At her age if her parents have had to bring
her to a skin clinic, something must be surely amiss. I soon learnt
that Maitri has been suffering from acne since the age of fifteen and
was always disturbed about it. Initially her parents thought it was
normal, so they did not take her to a doctor. After a couple of years,
Maitri went to beauty parlours to seek help. She even applied home-
made packs her friends and relatives suggested. She started eating
healthy, chewed neem leaves and had dudhi (green gourd) in every
meal since she had read on the Internet that these help in combating
acne.
When nothing helped, she started to withdraw into a shell of her
own. Worried, her parents took her to their family doctor, who
prescribed anti-acne medicines. Maitri started improving, to her
parents’ delight. But as soon as she stopped the medicines, the acne
came back. Her parents then took her for alternative therapies since
allopathy wasn’t working for their daughter.
By then, Maitri had developed big pimples, deep pits and dark
blemishes, leaving her devastated. She did not want to meet
anyone. She didn’t go to college. She had become a complete
recluse. She wasn’t willing to get married because she was
embarrassed to show her face in public. I got Maitri investigated for
PCOS, and, as I had suspected, it was positive. I sent her to a
gynaecologist to get the PCOS treated. Simultaneously, I started her
on anti-acne treatments. Her acne settled completely within four
months. Then I began my combination of chemical peels and
fractional laser. In another six months, her scars had reduced by 70
per cent.
One day, almost after a year of treatment, Maitri walked into my
clinic with a cake and a huge smile on her face. She was dressed
well, had lipstick on (I had never seen her wear make-up before) and
exuded a kind of confidence I had never seen in her. The cake was
for two reasons, she said. First, it was her birthday. Second, her
marriage was fixed and she would be married within three months.
Today, Maitri is happily married and has a twelve-year-old kid, and I
am her child’s dermatologist too. And guess what her child comes to
me for? Treatment of acne. Maitri says she doesn’t want her
daughter to go through the same mental trauma that she had
undergone due to her problem. My profession certainly gives me a
lot of gratification and joy and I thank God for this every day.
Acne is estimated to affect 9.4 per cent of the global population,
making it the eighth-most prevalent disease worldwide.*
 According to the Global Burden of Disease (GBD) study
conducted in Seattle University, Washington, in 2013, acne vulgaris
affects 85 per cent of young adults aged twelve to twenty-five. Acne
persists into the twenties in around 64 per cent of individuals and
into thirties in 43 per cent of individuals. It is seen that 15–20 per
cent females in their forties and fifties suffer from acne and 7–12 per
cent of males have acne in their forties and fifties.
In my own practice, I see about forty to fifty patients a day and
almost 40 per cent of them suffer from acne.
But first we need to understand what the difference between
pimples and acne is. I often have youngsters come to me and say, ‘I
don’t get pimples or acne but I do get blackheads and whiteheads.
So I keep scrubbing my face to get rid of them. But they keep
popping up again and again.’
Let’s clear this common confusion in our minds. Acne is a medical
term for blackheads, whiteheads, pimples, pustules, cysts, nodules
(pimples that don’t come out on the surface but just seem like hard
bumps inside the skin).
If you have blackheads and whiteheads, in medical terms it will be
called grade 1 acne. This is the mildest form of acne. If you have tiny
pus-filled pimples, they are grade 2 acne. Grade 2 is a more severe
variety of acne. Large, painful pimples, some of which look like cysts,
are grade 3 acne. This is obviously more severe than grade 2 and
will need stronger medicines for a longer duration. And if you have a
mix of all of these and those red bumps which never come out, you
have grade 4 acne. This is the most severe form and usually there is
a severe hormonal issue in such cases.
Now that this has been clarified, let’s talk about who can get acne.
My friend Mehek, who is my age, came raging to me one day and
said, ‘Why am I suddenly getting pimples? Jawani ab kyon aa rahi
hai, I never had them in my teens!’
Well, my dear friend, there is no age for this notorious thing called
acne. Yes, they are more common during teenage because of the
natural process of puberty and hormonal changes in the body—you
have heard that a million times—and it’s androgens, or the ‘male’
hormones, that are responsible.
Male hormones in females? I am not kidding. Females have a bit
of male hormones and males have a bit of female hormones for
proper functioning of the human machine. These hormones never
leave us. When women get pregnant, or are heading towards
menopause, their hormones go haywire. Irrespective of our sex,
when we are stressed, our hormones go haywire. So when
androgens increase—whether in males or females—pimples can
occur even in the thirties and forties.

Why does this happen?

As I mentioned, the most common cause of acne is a hormonal

imbalance in the body. It could be a natural result of teenage both in
males and in females. In females it can also occur before
menstruation, during pregnancy or before menopause or as a part of
PCOS.
Stress is the second most common cause. Stress causes an
increase in cortisol levels. This sends signals to our brain and the
brain then gives signals to the oil glands to secrete more oil and
result in acne.
Another reason for acne could be the intake of drugs such as
steroids, body-building supplements and other hormones.
Acne can also appear if your pores get blocked due to application
of creams and lotions which have an oil base. These creams and
lotions are easy to identify as they leave a layer of moisture on the
skin’s surface and are greasy to the touch. Also, upon sweating due
to exercise or running, the water in the sweat evaporates, leaving
behind sweat salts on the skin which could also block the pores.
When our pores get clogged, the natural oils cannot flow out
through the normal pores. They collect in the oil glands as a white
cheesy substance called sebum. Now the normal bacteria called
Propionibacterium acnes feed on sebum and multiply. Just like
human population, anything in large numbers is bad, isn’t it? So, the
quiet and peaceful Propionibacterium acnes become notorious after
having fed themselves well and are ready to attack the skin.
That’s when pimples form.
Did you know that pollution and humidity have a huge role to play
in the formation of pimples too? Studies have shown that presence
of particulate matter from vehicles and industries can cause acne.*
And finally, the million-dollar question:

What about junk food?

There is research documenting that dairy as well as food with high

glycaemic index have a role in acne. So those of you who suffer from
pimples and zits and want to get rid of them have to divorce those
chocolates, ice creams, milk shakes, smoothies, cheese, pizzas,
burgers, cakes, pastries, potato chips and the like.
Kucharska and others reviewed scientific literature and found that
dairy and chocolate do aggravate acne.*
Acne is more common in people who are genetically pre-disposed,
which means if your parents or grandparents suffered from acne,
chances are you will have them too.

Why do people get acne on the shoulders and back?

Twenty-year-old Myrah’s mom was traumatized by the fact that her

daughter was getting these tiny eruptions all over her back. At the
same time, thirty-two-year-old Anmol who was going to get married
in a couple of months couldn’t figure out why his chest was full of
these ugly, painful boils. When I examined them and told them that
they were suffering from acne, both had a similar reaction, ‘Doc, how
can acne occur on the chest and back?’
 Acne can sprout on all the parts of the body which are rich in oil
glands or sebaceous glands. While the face is the most common
area, it can also erupt on the chest, back, shoulders, upper arms,
buttocks and thighs.
Back, chest and shoulder acne are more common in people who
work out and sweat more. They can also occur if you have dandruff.
They are also more likely to occur if you take anabolic steroids or
body-building growth hormones. It can even be a result of a very
relaxing oil massage on the body. So next time you want an oil
massage, you will have to think twice if you have had acne on the
back anytime in the past.
Not just that. Your hair conditioner too can cause acne on the
chest and back. Most conditioners contain oil-based ingredients such
as jojoba oil, petroleum, shea butter or silicone which clog the pores
and cause acne. After rinsing the conditioner off your scalp, use a
shower gel to wash your chest and back thoroughly, making sure
there is no residue of the hair conditioner left on your body. Also
make sure you wash your face.
Aman had the issue of hairline acne. He was so fond of his hair
gels and sprays that he was just not ready to part with them when I
pointed out that they could be causing the hairline acne. Finally, I
gave him a little tip. I asked him to look for hair products which did
not contain myristyl myristate. Myristyl myristate used in hair
products and isopropyl myristate in creams and lotions can cause
acne and should be avoided if you have acne-prone skin or are
suffering from it.

Should teenagers be taking medicines for acne?

Most parents come and complain that since their boys don’t wash
their faces often, eat all the wrong food and don’t sleep on time, they
get pimples. ‘Doc, Virat is just seventeen, please don’t prescribe
medicines but just tell my son how to take care of his skin so that he
doesn’t get acne,’ a mother said to me.
Parents, I completely agree with you on the fact that a proper
skincare routine should be followed. But whether medicines be
prescribed or not depends on the severity of the acne and the
hormonal imbalance. If there are large cysts, they will leave scars on
the face. In such cases, oral medication is necessary.
So all you buddies who have zits, pimples, blackheads, breakouts,
acne—whatever you call them—let’s begin with your skincare routine
first.
Make sure you wash your face at least twice a day. If you have
really oily skin, you need a facewash which has salicylic acid in it.
Salicylic acid is obtained from willow birch trees. It is a beta hydroxy
acid which unclogs the pores and reduces the oils. It also helps in
gentle exfoliation of the dead skin. However, if you have acne and
are using anti-acne creams which contain retinoids like tretinoin,
adapalene or even benzoyl peroxide, or taking some oral medication
like isotretinoin, you may have to think twice before using salicylic
acid. These ingredients make your skin dry and flaky. Using salicylic
acid on dry skin can increase the dryness and irritate the skin. In
such cases what you need is a mild cleansing lotion which has no
soap.
Never overdo the cleansing routine. Washing twice a day is more
than enough. However, if you sweat due to exercise or after playing
a sport, you will have to cleanse your face even if it’s for the third
time.
Over-cleansing is harmful to the skin. The protective barrier layer
called the lipid bilayer as well as the skin’s natural moisturizing
factors get ripped off by washing too much or too frequently.
‘What about clarisonic brushes and scrubs?’ asked Mickey,
amused with the idea of brushes for the face.
Clarisonic brushes are great if you have oily skin and a lot of acne.
But don’t use them every day. Scrubs and clarisonic brushes can be
used once or twice a week if you have acne-prone skin.

What about multani mitti and home-made packs?

Multani mitti or fuller’s earth can be mixed with water or rose water
and applied on the face for ten minutes and rinsed. It dries the face
and removes oil and grime. However, do it only once a week or else
it will rip away the moisture from your skin.
Not everything that you read on the Internet is safe. Avoid using
milk, yogurt, milk cream (malai), facial oils, limes, lemons, tomatoes
or potatoes on your skin. Oils, milk and milk products can lead to
more whiteheads, while tomatoes and lemon can irritate the already
irritated skin.

So what can you use?

Make a coarse powder of oats, add a spoonful of honey to it to

make a paste and use this as a scrub.
You can also use mashed papaya.
A fine powder made out of masoor dal can be mixed with rose
water and used as a scrub too.
Finally, a paste of tulsi and neem leaves with a pinch of pure
turmeric can be mixed with water and applied on the face for ten
minutes.

Never leave any of the packs, however natural they may be, for
more than ten to fifteen minutes.
Kiara has normal skin and her brother has oily skin. Take a guess.
Kiara never forgets her skin toning ritual while her brother never
bothers to use a toner. Which of them is doing the wrong thing?
Well, neither of them is wrong.
A toner cleanses deeper, unclogs pores and removes make-up. If
you have normal or dry skin, you really do not need a toner. If you
have oily skin, you could use a toner in addition to a cleanser
especially if you use a lot of make-up. Avoid alcohol-based toners.
Pure rose water can also be used as a toner instead of synthetic
preparations.
Yamini thinks it is not important to use a moisturizer. She calls her
face an oil factory because it secretes too much oil.
Yamini is wrong. Even oily skin gets abused throughout the day
because of exposure to UV rays, heat, dust, pollution and stress. It
does need a little comfort in the form of an oil-free moisturizer. There
are plenty of water-based, oil-free moisturizers available and should
be used at least once a day. Whether you apply it during the day or
night doesn’t matter.
Kunal hates sunscreens. Sunscreen makes his face sticky and
white, and he thinks it causes his acne problem to rise. I hate to say
this but Kunal is wrong. When acne heals, they may leave behind
their traces in the form of blemishes. These blemishes may stay for
months together if you do not protect yourself from the harsh UVA
rays. So you must use a sunscreen with SPF 30. There are gel-
based sunscreens, or matte sunscreens which are neither greasy
nor leave a white film on your skin. Pick any one of them and apply
fifteen minutes before stepping out in the sun.

What about anti-acne creams?

If you have pus-filled yellow zits, you may use a clindamycin gel at
bedtime. If you have blackheads or whiteheads, try 2.5 per cent
benzoyl peroxide gel once a day. However, if your acne does not
subside or if you develop large cysts or nodules, you must consult a
dermatologist.
All females above eighteen years of age must do their blood
hormone tests and ultrasound of the ovaries to rule out PCOS.
These should be done between the second and the fifth day of the
menstrual cycle for accurate results.
 Krisha is an actor who needs to use cosmetics every day. She has
grade 3 acne too. So I asked her to use an oil-free moisturizer with
SPF, followed by a stick concealer instead of a cream-based one,
and then a water-based, light foundation. She made sure all her
cosmetics read non-comedogenic, meaning they don’t cause
comedones. However, be cautious, not every product which says
‘non-comedogenic’ really prevents acne.
Zubin has been banned from meeting me unless and until he
stops picking at his acne. When you pick at or squeeze a pimple (I
know it is very tempting), you actually damage the deeper layers of
your skin, resulting in scarring and dark spots. These dark spots do
not go away so easily. Days of creams and series of chemical peels
are the only solution. Not only that, at any given point of time, we
have thousands of germs on our skin, even if our hands are washed.
When we squeeze a pimple, there is a direct gateway for these
germs to enter the skin and cause more havoc. So please do not
pick at your skin.

Popping a zit is a strict ‘NO’

Britney had this strange problem. She would break out only on one
side of the face. I inquired a little about her profession and lifestyle.
She was a marketing executive and had to be on the phone every
day. Her phone would be sticking to her right cheek whenever she
used it. She had to travel quite a bit for her many meetings. And she
would sleep on the right side of her face. She would break out into
pimples on the right side of her face. Now this right-sided pimple
puzzle was solved. Her cell phone could be carrying a lot of dust
particles and microorganisms which can clog pores. The grime, soot
and pollution due to her outdoor activities was only making her skin
worse.
And finally, her maid would change pillow covers only every
Sunday. Your face rests on the pillow for six to eight hours every
night. So the pillow cover receives all the pore-clogging oils from
your face as well as your skincare products if you haven’t washed
your face well before hitting the sack. This makes it a great breeding
ground for bacteria. Your towels and face napkins can also harbour
dirt and bacteria. I asked Britney to change her pillow covers every
alternate day and use fresh face towels daily. I also advised her to
clean her cell phone cover and keep it a little away from her face as
she spoke, so that the phone did not touch her skin. In addition, I
gave her a mild anti-acne cream, and magic happened. Her one-
sided acne cleared up completely within five weeks.
Another common cause of acne is PCOS. Nayanika is a twenty-
two-year-old MBA graduate looking for a job. She is tall, slim and
very intelligent. However, she didn’t have the confidence to face
people who interviewed her because she felt they were only looking
at the pimples on her face. By the time she came to me, she had
used all the anti-acne creams that had been prescribed to her. But
nothing had helped. Nayanika’s periods were normal and I had little
reason to suspect PCOS. Yet I decided to get her hormones
checked. And guess what? Her reports showed raised androgen
levels. An ultrasonography of the uterus and ovaries revealed
multiple cysts in her ovaries. She is a classic case of lean PCOS.
While 60 per cent females suffering from PCOS are obese or
overweight, 40 per cent are actually lean and their diagnosis is often
missed. Thirty per cent suffering from PCOS have normal periods.*
 There is an explosion of PCOS in the last decade. When I had
started my practice in the year 2000, I would see one patient with
PCOS in three or four days. Now, one in every four females who
walks into my consulting room has it. PCOS may be genetic or
purely a lifestyle disorder. It presents itself differently in different
individuals. According to a study conducted in 2011, prevalence of
PCOS in Indian adolescent girls is 9.13 per cent.*
Some women suffer from PCOS without a hint until they find
themselves struggling to get pregnant.
Approximately 40 per cent of patients with PCOS—both obese
and lean—have insulin resistance. These women are at increased
risk of type 2 diabetes mellitus and consequent cardiovascular
complication. Insulin resistance is a condition in which the fat,
muscle and liver cells do not respond properly to insulin and thus
cannot absorb sugar from the blood. The body being an intelligent
machine tries to produce more and more insulin to facilitate the
absorption of glucose (sugar). This excess insulin sends signals to
the ovaries to produce more testosterone, which is a male hormone.
This leads to PCOS and even interferes with ovulatory cycles,
leading to reproductive disorders. Ninety per cent of females
suffering from PCOS have resistant or recurrent acne, 60 per cent
have hirsutism (excessive hair growth on body), 20 per cent have
acanthosis nigricans (thickened and dark skin folds) and 12.5 per
cent have hair loss.

What about the cure?

While gynaecologists and endocrinologists prescribe certain

medicines, lifestyle changes stand tall in the treatment of PCOS. Eat
right, exercise regularly, sleep on time, stress less, avoid alcohol and
smoking and see the difference. Really tough in today’s times of late-
night parties, social media activity and WhatsApp chats at night! But
if you want to have clear skin and suffer less, you have to lead a
healthy lifestyle. There is no permanent cure for PCOS, but if you eat
healthy and reduce weight such that your BMI drops to around 22–
23, you will find your symptoms disappearing and your androgen
levels going down to normal again.
High-fibre foods such as sprouts, beans, lentils, cauliflower, red
leaf lettuce, bell peppers, broccoli, tomatoes, spinach, almonds,
walnuts, olive oil, fruits such as blueberries and strawberries, and
fatty fish high in omega-3 fatty acids, such as salmon, are great food
options for those suffering from PCOS. Sugar, dairy and refined flour
are a strict no.
So, my acne-prone friends, my honest advice to you is: Eat
healthy, sleep early and for six hours, stay happy and stress-free.
Meditate if you have to. Yoga helps too. This is your sure-shot way to
clear skin.

Table 1

Labels to look for when you buy skincare products or cosmetics

Non-comedogenic
Oil-free
Water-based
Hypoallergenic
Matte

Table 2
Mickey is confident she can deal with her blackheads now. She has
realized that acne is indeed not just a hormonal but also a lifestyle
disorder. The dermatologist can prescribe medicines, give you
certain advice and do some treatments. Your acne will surely clear
up but thereon remember, the ball lies in your court. Not only will you
have to follow a proper skin ritual, you will also have to make certain
lifestyle changes in order to see that you do not develop pimples all
over again.
 7
Hyperpigmentation

‘When the clouds clear we shall know the colour of the sky’
—Keorapetse Kgositsile

I met Mickey after almost ten days. She said she had been
religiously following my instructions. ‘Doc, we forgot my underarms.
They are really dark,’ she said at the end. Dark underarms would
need immediate attention because even if you try to conceal dark
skin with a foundation, it will not stay when you get sweaty. And
Mickey had spent a bomb on her chic halter blouses to match her
saree and lehengas for the sangeet, mehendi and wedding.
Moreover, she was flying to the Maldives for her honeymoon and
would be wearing bikinis. ‘Mickey, usually it takes about eight to ten
months for dark underarms to be fixed. But we do not have time. So
please get ready to undergo some laser treatments ASAP.’
With this we started discussing pigmentation, a huge issue in India
among both sexes.
What is a pigmentary disorder?
Our skin has cells called melanocytes which contain a pigment
called melanin. Melanin gives skin its colour. If there is increased
melanin in a particular area of the skin, that area looks darker than
the rest of the skin and is called hyperpigmentation. People also call
them blemishes and dark patches on the face and body.
If there is less melanin in a particular part of the skin, that patch
looks lighter and is called hypopigmentation.
Hyperpigmentation is a very common problem faced by millions of
Indians. We have type 3 to type 5 skin, which means we always tan,
never burn. This has its good side and bad side. The good side is
that the melanin in our skin acts like a warrior protecting us from the
harsh UV rays and preventing our skin from developing deep
wrinkles or skin cancer. The ugly side, however, is that we tan easily
and are prone to increased pigmentation.

Common types of hyperpigmentation

Dark underarms
The skin over our axillae (underarms) can get dark due to several
reasons. It could occur as a result of a fungal infection which leaves
behind dark patches. Another very common reason is allergy to
deodorants and perfumes. Mickey literally pounced on me when I
told her this. You may not wear perfumes in your underarms, but you
do spray on to your clothes, and perfume being an aerosol, does
manage its way to the skin through the clothes. Constant friction and
pull due to hair removal as well as allergy to the soap that you use
can also cause darkening of the underarm skin. If the underarm skin
is dark as well as thick, it could be acanthosis nigricans, which is
seen in PCOS, diabetes, obesity, hypothyroidism, etc.
While Mickey complained of dark underarms, Harita said she was
embarrassed to wear a bikini because her groin (skin between her
thighs) and her butt are very dark. This again is a result of a fungal
infection or allergy to soap or constant friction due to rubbing of
thighs or due to sitting for long hours (more so if you are a little
overweight).

Solution

If dark underarms have become a menace, you need to stop all

deodorants and perfumes and opt for some antifungal powders
instead. Opt for laser hair removal to prevent more friction-induced
hyperpigmentation. Lose weight if you are obese or even plump.
Switch to a soap-free shower gel for bathing. Consult a
dermatologist to see if you have a fungal infection. Investigate for
diabetes, PCOS, etc. Apply a pigment lightening cream containing
kojic acid. Salicylic acid peels and Q-switched Nd Yag laser are good
treatment options.

Dark circles
One day I happened to drop by my friend’s place. She was busy
trying to teach her twenty-one-year-old son how to use an orange
corrector under the eyes. He had a prom night and he certainly didn’t
want to look like a raccoon with his prominent dark circles. Dark
circles are a common concern—from teens to those in their
seventies. Anyone can have them, no one loves to have them, but
no one has been able to do anything about them. The most common
cause of dark circles is lack of sleep. But there can be other reasons
too. Low haemoglobin, smoking, poor lifestyle, excessive sun
exposure or even liver disease can result in dark circles.

Dark circles

Rehmat has dark circles and so does her mother and

grandmother. It runs in the family, she says. Yes, dark circles can be
genetic too. Arjun is constantly sneezing and rubbing his eyes, as a
result of which he has dark circles at the age of fifteen. Allergies to
dust, pollen and even cosmetics can lead to itching and watering of
eyes. You must seek help from a doctor. Rubbing the eyes frequently
will cause darkening of skin around the eyes. Your mascara,
eyeliner, kohl, eye shadow and even your make-up remover could be
possible culprits. Dark circles can also be a part of the ageing
process. As one ages, the skin becomes thinner, there is loss of fat
and blood vessels under the eyes become more prominent. They
become sunken and hollow, casting a shadow under the eyes. This
could sometimes be seen as tear trough in youngsters due to their
bony formation from childhood.

Solution

First of all, bring discipline into your life. Stop scrolling through
Instagram and Snapchat posts a million times to see how many likes
you have got to the pic you posted in the evening. Avoid your late-
night WhatsApp chats or watching your Amazon Prime videos. In
fact, I would say, just switch off your cell phone at 10 p.m. Maybe 11
p.m. if I may be liberal. I do that every single day.
Sleep for a minimum of six hours every day. The eyes need rest
and so does your skin. Quit smoking and drinking. Trust me, it isn’t
cool to be indulging in either. Alcohol can result in puffy eyes over
time. So beware. Get your haemoglobin checked. If you have
anaemia, make sure you take iron supplements and include food rich
in iron such as spinach, okra, sweet potato, whole grains, brown rice,
prunes, raisins, figs, fortified cereals, tofu and soybean in your diet.
Avoid rubbing your eyes and consult an allergy specialist if you
suffer from allergies and sneezing.
Moisturize under your eyes at least twice a day and do not forget
to apply a sunscreen too. Avoid cosmetics which could be
responsible. At bedtime, clean your face, remove all make-up and
gently dab an eye cream containing vitamin C, vitamin K and
hyaluronic acid. If you suffer from severe dark circles, lactic and
glycolic acid peels do help. You will need ten to twelve sessions at
two-week intervals. If there is dark pigmentation under the eye, Q-
switched Nd Yag laser treatment works best to get rid of the
pigmentation or reduce it. I have explained more about this laser in
chapter 18. Eyes should be protected while doing an under-eye laser
treatment.
 If you have sunken eyes and are above twenty-five years of age,
you could consider getting a hyaluronic acid filler done. It is US
FDA–approved, safe and lasts for a year, sometimes more. Never
opt for permanent fillers in this area. (FDA gives approval for any
medical product, be it medical equipment, lasers, injections,
medicines or anything related to public health. The US FDA rules are
extremely stringent and only safe, high-quality products receive
approval.)

Dark patches on the cheeks

Every morning before leaving for work, Grishala closely inspects her
face in the huge mirror on her bathroom wall. She comes back and
does the same thing at night. Although she has no issues with her
eyesight, she goes closer to the mirror and stretches her skin and
looks on as if she would be able to gauge the depth of the dark
patches on her cheeks. She has applied every possible cream and
tried every home remedy that even the person sitting next to her in
the train during her commute to work recommended, but her
pigmentation only got darker, as if in revolt. As she looks in the
mirror, she hopes that someday a genie would work his magic on her
and when she wakes up, her cheeks would look rosy and radiant
with no patches whatsoever.
There are millions like Grishala who suffer from a pigmentary
disorder called melasma. This is seen most commonly on the cheeks
and nose as if a butterfly has laid an imprint of its wings on the
cheeks and its body on the nose of the face. It appears brownish in
colour and may spread to the forehead, lower face as well as upper
lip gradually. Grishala told me her melasma has a mind of its own. It
increases on certain days and looks very light on certain days.
Melasma looks darker just before one’s menstrual cycle in females,
or with the slightest of sun exposure or with stress. The latter is true
in case of males too.
 Melasma occurs as a result of sun exposure or due to hormonal
changes in the body, for example, during pregnancy. It is very
commonly seen in pregnant ladies and is often called the pregnancy
mask. It can be genetic too.

Solution

Unfortunately there is no treatment which guarantees a permanent

solution. Melasma will disappear if it is epidermal but may only
lighten if the increased melanin is sitting deeper in the dermis. The
most important treatment is protection from UVA, UVB rays, visible
light and infrared rays. Use a broad-spectrum sunscreen, wear wide-
brimmed hats, scarves, and carry an umbrella whenever possible.
There are skin-lightening creams containing hydroquinone which
form the gold standard. However, prolonged use of hydroquinone
leads to blotchy skin and a condition called ochronosis. Tranexamic
acid-based creams are found to be better and safer. They have no
adverse effects even when used for a long period of time. We
dermatologists also do microneedling with tranexamic acid and
glycolic acid peels to lighten melasma. Some doctors like to use
lasers to treat melasma but I personally refrain from it. I have seen in
my practice that melasma always returns no matter how good the
laser is.

Dark lips

I have always seen my neighbour Lavie wear bright red, maroon or

orange lipsticks. Her latest favourite is violet. The dark colours look
very sexy on her too. However, my son wondered why she wore
lipstick at home too while I did not. I told him it was rude to say that
and we should leave people to their choices and not have an opinion
about everything. One day Lavie came to my clinic distressed. She
removed her lipstick to unveil her dark, almost black lips. She was
fed up of camouflaging them 24/7. Smoking is the most common
cause of dark lips. Nicotine constricts the blood vessels, reducing the
blood supply to your lips, causing them to dry and darken. Also
tobacco is deposited on the lip mucosa and causes discoloration of
the lips. Caffeine can have the same effect, which means too many
cups of black tea and coffee can also be a reason.
Another very common cause of dark lips is lip licking. By pursing,
biting or licking your lips constantly, you increase the chances of lip
discoloration. Your own saliva becomes your enemy and damages
your lip mucosa, making it dark and chapped.
An allergy to the silver coating on sweets and condiments or to
colour in toothpastes, high content of lead in dark-coloured lipsticks,
poor-quality lip balms, lip glosses and lipsticks can all result in the
darkening of lips. Some drugs like amiodarone, daunorubicin, gold,
methotrexate, psoralens and 5-fluorouracil given for autoimmune
disorders can also cause the same effect.

Solution

First, stop smoking. Second, no more licking your lips or pursing

even though they may feel dry as a bone. A lot of times, you lick your
lips out of sheer habit, without even realizing it. You have to tell
yourself time and again not to do so. That is the only way to train
your subconscious mind and get out of the habit. Another solution is
to carry a lip cream with you and keep applying it every two hours.
Drink a lot of water so that you are not dehydrated. Avoid using dark
shades of lipsticks and unknown brands. Avoid fragrance-based lip
glosses and lip plumpers. Fragrance can induce pigmentation of lips.
Use good old white-coloured toothpastes. Avoid having menthol and
silver-coated sweets and condiments after your meal. Non-flavoured
pure fennel seeds are good digestives instead of cloves and betel
leaf.
 Certain lip-lightening creams containing kojic acid, liquorice
extract, niacinamide, arbutin, bearberry extract, mulberry extract,
vitamin C and vitamin E help in reducing the lip colour.
Lactic and glycolic acid peels as well as Q-switched Nd Yag lasers
are other options, albeit it takes many sessions and almost a year to
get rid of the dark colour.

Dark patches on face (forehead or chin or entire face)

Thirty-five-year-old Vikrant has a dark patch on his forehead, almost

like a band. On probing, he confessed to using a lot of balm during
his teens as he suffered from migraines. Dark rough patches on the
forehead and sides of the cheeks can also occur due to sun
exposure, constant friction due to wiping of sweat or even in those
who have insulin resistance or diabetes. Blotchy pigmentation can
also be seen on the entire face and neck due to consumption of
Ayurvedic bhasmas which contain heavy metal.
My cousin Rishabh came to me two months before his wedding
wanting to get rid of his tan. His face, arms, hands and neck were
four shades darker than the rest of the body. In fact, his chest and
back looked like someone else’s because they were so much fairer!
Rishabh has a marketing job and travels most of the time. He has
been doing this for eight years and before that he was a soccer
player in school and college. Rishabh thought his skin was badly
tanned. He was partially correct. When the skin is assaulted by
repeated exposure to UV rays, the tan gets converted into hardcore
deeper pigmentation. It doesn’t remain the superficial tan which is
supposed to regress on its own within three months of sun exposure.
UV rays also increase freckles and cause sun spots.

Solution
Avoid sun exposure. I tell my patients they may forget to brush their
teeth on a certain day but they should not forget to use a sunscreen
365 days of the year if they have any kind of pigmentation on any
exposed part of the body.
Balms which claim to relieve headaches are counter-irritants. They
contain menthol, camphor, peppermint, cajaput oil and clove oil
which can irritate the skin and cause pigmentation. Stop using all
balms if you have pigmentation or even the slightest family history of
pigmentation.
Avoid wiping your sweat with thick Turkish napkins. Dab your face
with dry tissues instead. Spray thermal water mist to wipe the sweat
away. This will keep your skin cool and hydrated too.
A lot of powders, bhasmas and lotions claiming to be Ayurvedic
contain heavy metals such as mercury and lead. Do not take them
without consulting a qualified Ayurvedic physician. Hair colour or hair
dyes have paraphenylenediamine (PPD) in them which is the key
ingredient in dark colours such as black and brown. A lot of people
may be allergic to PPD and they develop either blisters on the scalp,
an itchy scalp, or pigmentation along the hairline which gradually
spreads to the rest of the face. If you have such symptoms, you must
use an organic hair colour or a vegetable dye. Henna is another
option but it may leave a reddish tinge and even make the hair dry.
So you will need to condition your hair well. Finally, foundations,
essential oils and perfumes can cause or increase existing
pigmentation. Avoid using them. Opt for a mineral powder if you
have to use a foundation. Spray perfumes on to your clothes and
wear them after ten minutes if you think you cannot do away with
your perfumes.
Very importantly, you must consult a dermatologist. Firstly,
because your skin may be trying to tell you something you do not
know. These pigmented spots are like warning flags trying to tell you
that you may be under attack. Hypothyroidism, diabetes, PCOS,
hormonal imbalance, liver disorders, kidney disorders could all
manifest with increased pigmentation in the beginning and should
not be ignored. Secondly, your dermatologist will make a diagnosis
and treat the cause rather than prescribing random skin-lightening
creams which are available over the counter. Specific chemical peels
and laser treatments can be performed to reduce or get rid of
pigmentation, provided they are done by qualified dermatologists.
Read chapter 18 to know more about these peel and laser
treatments.

Dark neck

Twenty-year-old Sumaira yearns to wear noodle-strapped tops for

parties like her friends do but ends up wearing turtleneck tops all the
time because she is embarrassed to show her neck. The skin on her
neck is thick, rough and dark. She keeps herself very clean but that
really doesn’t help. The thing to remember here is that the moment
one says thick, dark, rough skin, a bell should ring—it could be
insulin resistance, hypothyroidism, diabetes, PCOS, Cushing’s
disease or just obesity. This can happen on the neck, especially the
nape. It can also be seen in underarms, groin and under the breast.

Solution

You must consult an endocrinologist and get your hormones

checked. Work towards losing weight as well and stop rubbing your
skin because friction will increase the pigmentation.

Dark elbows, knees and ankles

This occurs due to constant friction.

Solution
You must make a conscious effort to avoid sitting in a particular
position which leads to friction of these parts of your body. Also
make sure you always moisturize these areas at least twice a day.
Keeping them hydrated will prevent friction and subsequent
darkening of the skin. If they persist, you could opt for phenol and
TCA peels. About six to eight sessions at three-week intervals will
reduce the discolouration.

Dark patches on upper back and forearms

Apart from a sun tan, dark, mottled, pigmented spots appear most
commonly on the forearms, upper back and shin due to months of
UV exposure or friction or autoimmune conditions such as
hypothyroidism and diabetes. This condition is called macular
amyloidosis and is more common in females. The female to male
ratio has been found to be 3:1. My friend Kiara, her mom and her
aunt suffer from macular amyloidosis. Upon investigation, both her
mom and aunt were found to have hypothyroidism. While Kiara was
spared thyroid disorder, the culprit in her case was the loofah with
which she used to scrub her back every day, not realizing that this
was the cause of the hyperpigmentation.

Solution

Always wear a sunscreen with SPF 50 on all exposed parts. Never

use nylon loofahs or scrubs. Wear full-sleeved clothes from sunrise
to sunset. Get your thyroid hormones tested to rule out
hypothyroidism. Also, do a blood test for glycosylated haemoglobin.
This is a test to detect diabetes in its early stage. Salicylic acid and
TCA peels have shown some improvement in this condition.

Dark spots on the skin after injury

Tatiana is always anal about the slightest scratch or boil on her body
or even a small pimple on her face. ‘Even if I don’t touch them, they
leave a dark mark,’ she says. Some people have the tendency to
hyperpigment with every little scratch, acne, injury or boil, or even
with an allergic reaction. That is the tendency of their body. This is
called post-inflammatory hyperpigmentation (PIH). PIH can also
occur due to picking at the skin if there is a boil or acne or if the
patient has got any skin treatment such as a chemical peel or
microdermabrasion or laser done and stepped out in the sun
immediately without using a sunscreen.
Also beware if a cream or lotion makes your skin look abnormally
red. This could be a sign of skin irritation leading to a sure-shot PIH.

Solution

Always protect your skin from UV rays if you have got any skin
treatments done. Use a broad-spectrum sunscreen liberally. Avoid
picking at, scrubbing or peeling your skin.
As a child, I often saw my aunts slather their face with a skin-
lightening cream. They probably thought they would get fair sooner if
they applied loads of the cream. Do not apply more than a pea-size
of any anti-ageing, pigment lightening or even anti-acne cream at a
time on the face. If you see that your face has become red, consider
it a warning signal. The only two products you can slather on your
skin as much as you want are sunscreen and moisturizer. Consult a
dermatologist to get your PIH sorted. Various pigment-lightening
creams which are steroid-free are prescribed under supervision.
There is an array of chemical peels available, such as glycolic acid,
mandelic acid, arginine, kojic acid, lactic acid, salicylic acid, etc., for
the treatment of PIH.

The seven sinisters

If you don’t want to be plagued by hyperpigmentation, you must
avoid the 7 Ss.
1. Sun exposure: Don’t step out in the sun without wearing a
sunscreen. Full-sleeved clothes, darker-coloured fabrics, wide-
brimmed hats and scarves are also helpful.
2. Swimming: Avoid swimming, especially in outdoor pools.
Chlorine and UV rays are a lethal combination for people who
have pigmentation or for those who are prone to skin darkening
or tan.
3. Smoking: Not only does nicotine constrict blood vessels and
reduce blood circulation, it deposits free radicles in the skin and
depletes the fighter antioxidants, resulting in darkening of skin
and formation of wrinkles.
4. Scrubs: Do not scrub your skin vigorously or frequently. Much as
it feels cleaner after scrubbing with fruit pits, nut fragments or
polyethylene scrubbing beads, you could end up with increased
pigmentation. Aggressive exfoliation damages the lipid layer of
your skin, making it dry and prone to the detrimental effects of
UV rays.
5. Stress: Stress can cause an increase in cortisol, leaving your
skin vulnerable to pigmentation, acne and rashes. It is best to
get into the zen mode. Keep calm and this will surely prevent
increase in pigmentation.
6. Steam and sauna: Heat will rip the moisture off your skin and
make it dry. Dry skin is more prone to damage from UV rays.
Yes, it does feel relaxing to take steam or get into the sauna
after a heavy workout but is it more precious than getting rid of
your pigmentation? Think about it.
7. Scent: Allergies to any form of fragrance, be it perfumes,
deodorants, fragrance used in preservatives, body talc,
cosmetics, soaps, shampoos and even incense sticks, have
been proven with research time and again. The most common
way of allergy manifesting itself is through increased skin
pigmentation. So you will have to give up all your lovely
 fragrance-based toiletries and cosmetics and make do with
fragrance-free products.

Scrubbing

Remember, hyperpigmentation can occur to anybody but is more

common in those who are genetically prone to it. For example, you
and your friend may both be pregnant but she may develop melasma
while you may not. This does not mean you can bask in the sun for
hours together without bothering about a sunscreen. Extrinsic factors
such as sunlight, drugs, allergies and smoking can cause
hyperpigmentation even if you may not be genetically prone to it.
You must consult a dermatologist, who will identify the cause of your
increased pigmentation or what’s triggering it and then treat it
accordingly in order to minimize or get rid of it. There is no single
magic potion which would do the trick. But proper care and a
committed holistic approach can make your skin look way better.
As for Mickey, I asked her to use an antifungal powder in the
morning over her axillae to prevent any fungal infection from sweat. I
also gave her a cream containing kojic acid and arbutin to use at
night. I planned biweekly Q-switched Nd Yag laser treatments so that
the pigmentation would reduce by at least 50–60 per cent. We still
have five weeks to go. So am hoping to see some positive results.
 8
Serums

‘Everything has beauty, but not everyone sees it’

—Confucius

Mickey wanted to know if she should be using serums too. She was
now gearing up to look her best on her big day. I usually prescribe
serums to people as a part of their routine skincare after the age of
thirty. But if people have dull skin or pigmentation, I do not hesitate to
prescribe a vitamin C serum even if they are in their late teens or
twenties.
When I was in my teens, I grew up watching my mom and aunts
use Emami or Pond’s cold cream every winter and Fair & Lovely or
Vicco Turmeric almost like a ritual every night. Sunscreens became
the next big thing when I turned twenty-one. When I entered my
thirties, serums started doing the rounds. And now in my forties, I
see the big hullabaloo about face oils.
What exactly is a serum? Just like the smartphone which has
many functions and great power but is pocket-sized and light weight,
serum is a lightweight, power-packed skincare product. A serum has
highly concentrated formulations as opposed to a cream or a lotion.
It is a more focused and target-oriented product, designed to cater to
specific needs of the skin.
Serums have a fluid texture, they feel smooth on application and
are much lighter than creams and lotions. They have a smaller
molecular structure, due to which they can penetrate deeper into the
skin, targeting specific skin needs at the cellular level. Serums can
deliver higher concentrations of active ingredients such as vitamin C,
peptides, etc. as they penetrate more easily into the skin due to their
nanoparticle size. Secondly, serums are devoid of heavy
moisturizing ingredients such as petrolatum, seed oil or mineral oil.
Hence, they do not leave a thick layer on the skin. They are usually
targeted towards issues like fine lines, pigmentation, open pores,
blemishes and dull skin. They can even be incorporated in your
routine skincare ritual to prevent fine lines, pigmentation and give
your skin that extra sheen.
‘Is it compulsory to use a serum?’ asked Marissa who hates
applying layers on her face and is always short of time. Well,
cleansing, moisturizing and using a sunscreen are a compulsion as
far as your skincare routine is concerned. Serums are for those who
are looking to go that extra mile and want to have radiant, blemish-
free skin.
‘Are serums and face oils the same?’ asked Samira, who got very
confused when she went to a beauty store which showcased a
plethora of products and the salesgirl tried to sell her almost every
product, saying it was good for her skin. Yes and no! While traditional
serums are water-based and are applied before applying a
moisturizer, face oils are thicker molecules and they can replace a
moisturizer. But if you have very dry skin, both serum and face oil
may be needed. Face oils are marketed as oil-based serums too.
What about essence? Is it different from a serum? Actually, they
are quite similar. Both need to be applied after cleansing, before
moisturizing. Both are meant for targeted treatments. Both have
microsized particles and penetrate deeper into the skin. But serums
are a little gooey, while essences are more watery.
So to make it easier, if you have normal or combination skin, you
can use a serum. If you have oily skin, opt for an essence. If you
have dry skin, opt for an oil. Having said that, serums can go with all
skin types but if you have sensitive skin, it is better to consult a
dermatologist before splurging on a serum.
How do I know which serum is right for me?

Dry skin

Look for serums which contain hyaluronic acid, vitamin E,

niacinamide, essential fatty acids, amino acids and ceramides.
Hyaluronic acid is a natural moisturizer which keeps the skin supple
and soft. Vitamin E is hydrating and is an antioxidant which protects
the skin cells from oxidative damage. Niacinamide increases
ceramide levels in the skin and prevents dryness. Lactic acid is a
natural moisturizer. Essential fatty acids, ceramides and amino acids
strengthen the skin’s barrier layer and help build strong cell walls.
They replenish naturally occurring skin lipids, aid in retaining
moisture in the skin and protect the skin from pollution and
environmental toxins.

Pigmented skin

Your serums should target the pigment cells and reduce the pigment.
Glycolic acid, lactic acid, vitamin C and niacinamide are excellent
ingredients when you have blemishes or a tan or pigmentation and
you want to use a serum. Glycolic acid gently exfoliates and lightens
the skin. Lactic acid is a mild skin-bleaching agent. Niacinamide or
vitamin B3 has both hydrating and skin-lightening properties. Vitamin
C fights environmental assault with its potent antioxidant properties.
It also protects the skin from UV rays. In addition, it fights the bad
enzyme tyrosinase, which is responsible for increasing pigmentation,
thus preventing darkening of the skin.

Acne-prone or oily skin

You should look for retinol, salicylic acid, aloe vera or zinc-based
serums. Salicylic acid unclogs pores; retinol reduces inflammation,
kills germs and increases collagen production. It also helps in
exfoliation and makes the skin luminous. Zinc regulates oil
production and soothes the skin. Aloe vera is an anti-inflammatory
agent. It prevents zits from turning into big pimples, it soothes and
heals the skin and hydrates it too. You must opt for water-based,
non-greasy serums.

Ageing skin

Your best bet would be a serum containing peptides, resveratrol,

ferulic acid, vitamin C and vitamin E. All these ingredients are
powerful antioxidants. They promote cell repair and new collagen
formation, thus making the skin radiant and youthful. Peptides are
known to boost elastin and collagen formation and restore the
firmness of the skin. Grape-seed extract and pomegranate extract
are also fabulous antioxidants which fight against free radicals and
prevent fine lines from forming.

Where does a serum fit in my CHP routine?

A serum comes immediately after cleansing. Apply a moisturizer

over the serum and then top it with a sunscreen. You can even use a
serum before going to bed. If you want to use any other cream, layer
it over the serum.
Serums are heavily concentrated. So a little goes a long way. Take
two or three drops of serum and pat it on your face with your
fingertip. Then gently massage it into your skin. This will be enough
for your entire face. Too much of anything is bad and if it is a
concentrated product, then certainly too much will cause irritation. So
always remember to use very little serum, and refrain from using it
altogether if you suffer from chronic skin conditions like rosacea or
eczema.
Indication Ingredient Examples
Skin- Vitamin C,
Flavo C by Auriga, Revibra C10 by Dr
lightening niacinamide,
Reddy’s, VC 15 by Cipla
serum liquorice
Peptides, retinol,
Anti-ageing Ureadin anti-wrinkle serum lift by Isdin,
vitamin C,
serum VCx serum by Cipla
hyaluronic acid
Hyaluronic Acid Intensifier by
Hydrating Hyaluronic acid,
SkinCeuticals, Cutisera intensive
serum glycerine
skincare serum by Cipla
Serum for
Retinol, salicylic Revibra A15 by Dr Reddy’s, VC 20 by
acne-prone
acid Cipla
skin

Serums feel light on the skin and are easier to use since they don’t
leave a thick film on the face. They can be doubled up as a
moisturizing primer before make-up, and because they are enriched
with vitamins, antioxidants and moisturizing agents, they are safe to
use. So if you too are getting married soon like Mickey, do not
hesitate to ask your dermatologist which serum to use. And all those
who are already married, I am sure that by just reading the chapter,
you would be able to pick the right serum for yourself.
WEEK 3
9
 Exfoliation

‘Simplicity is the ultimate sophistication’

—Leonardo da Vinci

Now we were into week three and Mickey wanted to know why I
hadn’t asked her to exfoliate. All her friends believed in using scrubs
almost every day for a fresher-looking skin.
Let us find out if Mickey’s friends were doing the right thing.
Our skin is constantly working, even while we rest. Old cells
migrate to the skin’s surface from the deeper parts of the skin as a
part of the normal cell cycle, which is twenty-eight days long. These
old cells are dead and are shed through a process called
desquamation or natural exfoliation. Skin begins to function more
sluggishly as one ages, resulting in the piling-up of dead cells on the
skin’s surface. When light falls on this surface, it gets absorbed
instead of getting reflected. This results in dull and unhealthy-looking
skin. Exfoliation becomes important here.
Exfoliation is the process of removing dead skin cells from the
upper layer of your skin. Not every individual can exfoliate. It can be
detrimental if you suffer from eczemas, atopic dermatitis, inflamed
skin, psoriasis and even sensitive skin.
Exfoliation can be done at home or at a skin clinic. Dermatologists
will exfoliate your skin either by microdermabrasion or chemical
peeling.
At home, you can use mechanical or chemical exfoliation
techniques. Chemical exfoliation is done using alpha and beta
hydroxy acids that are available in the form of creams and lotions.
These acids gently dissolve the dead cells, making the dead skin
peel off. Mechanical exfoliation is the fun part. It is done using scrubs
with fruit pits or beads, with tools such as sponges or loofahs,
clarisonic brushes and even a pumice stone.
Always select an exfoliation method that suits your skin type.
If you have oily skin, use scrubs with fruits, plant extracts or non-
plastic beads. Plastic beads were banned in July 2017 as they go
down the drain and pollute larger water bodies, harming aquatic
creatures.
Pomegranate seed powder, jojoba bead granules, apricot scrubs,
oatmeal scrubs, papaya enzyme scrubs, rice and wax are gentle
mechanical exfoliators that can be used once or twice a week on oily
skin.
If you have dry skin, opt for a mild AHA exfoliating lotion such as
lactic acid or mandelic acid. This will remove the flakes that prevent
the proper absorption of a moisturizer. Avoid physical exfoliators.
If you suffer from acne, opt for chemical exfoliators like glycolic
acid or salicylic acid. These not only remove the grime, but also
break down the pore-clogging dead cells. Physical scrubs are too
harsh and can also irritate the inflamed skin, causing more break-
outs and redness.
If you have sensitive skin, consider using a cleansing milk or an
alcohol-free, enzyme-rich cleansing lotion instead of exfoliating the
skin. Do not use gritty scrubs as they can damage the lipid layer of
your skin.
Some exotic scrubs consist of blueberry extract, along with
cranberry and raspberry enzymes. All of these are powerful
antioxidants. They help slough away the dead skin to reveal the
brightness underneath.
Another scrub I found has chrysanthemum extract, caffeine, sage
and rosemary extracts. These deep-cleanse and have a calming
effect on the skin.
Avoid exfoliation if you are using retinol-based creams or anti-acne
preparations that dry up the skin. Exfoliating while using these
products can worsen dry skin or even cause break-outs.
 Never overdo the exfoliation ritual. It can cause more harm than
good. Sometimes you may even end up with blemishes or
pigmentation due to over-scrubbing.

How do you use an exfoliator?

First cleanse your face, removing all the make-up, sweat and grime
that may have formed a layer on your skin. Then pat the scrub on
the entire face. Using gentle, circular strokes, exfoliate for about
thirty seconds. Rinse your face with lukewarm water. If you have
open cuts or wounds or if your skin is sunburnt, do not exfoliate till
the skin has healed completely.
After exfoliating, always use a moisturizer on slightly damp skin to
keep it hydrated.
If you have very oily skin, you can exfoliate twice a week.
Exfoliating once a week is enough for those with normal skin. If
you have dry or sensitive skin, do not exfoliate more than once a
month. Exfoliating strips the skin of its natural moisture and makes it
more sensitive and prone to rashes. It can also throw your natural oil
production off balance and overcompensate, leading to acne.
Always listen to your skin. If it burns or turns red easily, it is telling
you that it has had enough and you should stop scrubbing.
After listening to my lecture on exfoliation, Mickey decided to go
the natural way.
She decided to make her own scrubs from kitchen ingredients as
described in chapter 14 and exfoliate once in two weeks. Mickey had
little time and I also wanted to do a bunch of treatments for her. So
exfoliating frequently wasn’t a great idea.

My advice

Seek a dermatologist’s opinion on whether you should exfoliate or

not and the type of exfoliation to pursue.
 10
The Make-up Removing Ritual

‘The purpose of art is washing the dust of daily life off our souls’
—Pablo Picasso

Mickey had appointed a fabulous make-up artist who would make

her look like a million bucks at her wedding. But obviously, the make-
up artist would not accompany her to the post-wedding parties and
on her honeymoon. So I decided to conduct a tutorial on cosmetics
and make-up removal. Mickey was really excited as she loved to buy
cosmetics and stack them on her dressing table. But I am sure that
after this lesson, she would not just pile things, she would make the
most of them and use them till the last bit.

When you go to buy cosmetics, ask yourself these questions:

What is my skin type?

Is the product suited for someone my age?
Do I have any skin concerns, such as acne, pigmentation, fine
lines or flaking skin?
What is the temperature of the place where I am going to use
these cosmetics?

Teens and twenties

These days, I see a lot of young girls wearing heavy make-up to

college to hide their pimple marks. This can clog pores and make
pimples worse. Too much make-up can cause tiny break-outs even
in normal or dry skin types. For those with a family history of
pigmentation, it is better to keep it simple as foundations and
concealers can cause pigmentation as well.
If you are in your teens or twenties, colourful lip glosses, tinted
moisturizers and tinted sunscreens are your best bet for daily wear.
This is the age when your oil glands are functioning well and your
skin is hydrated. However, this is also the age where your skin easily
breaks out into zits. So for special occasions, opt for a non-oily,
lightweight liquid foundation. This will give you a sheer, natural cover.

Cosmetics for mature skin

Once you cross thirty, your skin starts to mature. You should now
look for anti-ageing ingredients in your make-up products. Look for
antioxidants, like niacinamide and vitamin C, and moisturizers like
ceramides, in your foundation. Peptides and vitamin E are also good
for anti-ageing. If you have dry skin, you should opt for a mousse or
a cream or oil-based foundation. This will make your skin look
smoother and more even. Foundations with SPF are even better as
they will protect you from UV rays as well.
Most anti-ageing ingredients degrade on exposure to light and air.
So look for products that contain anti-ageing ingredients and not just
those that are labelled ‘anti-ageing’. After thirty, the skin becomes
drier. It is best to use cream-based concealers or sticks. Rich,
creamy blush-ons are good alternatives to powders.

Acne-prone skin

If you have acne-prone skin, look for a non-comedogenic foundation

with salicylic acid. Another ingredient to look for is dimethicone. It
does not dry the face or clog the pores. In fact, it smoothens the fine
scales found around drying pimples. Matte-finish liquid foundations
are also suitable options. They provide good coverage, do not clog
pores, last longer and reduce unwanted shine on the face. Thick
make-up products, like stick or creamy compact foundations, provide
high coverage but also cause great damage to the skin. They can
trigger new zits or exacerbate existing acne.
One day, a twenty-three-year-old walked into my cabin with what
looked like clear skin. After I removed all her make-up, all I could see
were big black spots all over her face. These were caused by
squeezing blackheads and whiteheads. To hide them, she used a
thick concealer stick. This clogged her pores, causing more zits.
If you have oily or acne-prone skin and hate stepping out with
blemishes, use a liquid concealer. Creamy and stick concealers only
magnify the appearance of the pores, increase whiteheads and add
an oily shine to the face. Powder blushes and bronzers are better
options than gels or creams. Gels and creams can pool in enlarged
pores and make acne worse.

Sensitive skin

Power foundations, especially those with silicon, are best for those
with sensitive skin. Powder or cream concealers are safe bets. Mica
and bismuth oxychloride add a sheen to the face and are usually
found in mineral make-up. However, these two ingredients can
cause irritation and itching. They should be avoided by those with
sensitive skin.
Do not use fragrance-based make-up. It feels refreshing but does
more harm than good. Avoid make-up with ingredients such as SD
or denatured alcohol. Alcohol-based make-up is particularly harmful
for acne-prone and sensitive skin. Avoid waterproof make-up,
particularly for the eyes.
Removing eye make-up requires extra cleansing that can further
irritate the skin. Use eye pencils instead of liquids, gels or kohls.
Dark blue and grey eye shadows have more irritating chemicals and
are avoidable. Opt for beige, cream and light pink shades instead.
The wisest thing to do is to check ingredients and select brands that
have fewer than ten ingredients.

Primers

Primers form a perfect canvas for foundation or concealer to set

evenly on. They also help your make-up last longer. Opt for primers
with an SPF 30 sunscreen. Also look for antioxidants such as coffee
seed extract, apple fruit extract, green tea, green algae and soothing
agents such as aloe vera, chamomile, liquorice and bisabolol. A
combination of these ingredients helps shield the skin from sun
damage, pollution, free radicals and toxins in the environment. Steer
clear of alcohol- and fragrance-based primers.

BB creams

BB stands for beauty balm. These are essentially lightweight tinted

moisturizers, usually with SPF. Newer BB creams contain
antioxidants too. They have a creamy texture and are better for
people with normal or dry skin.

CC creams

CC stands for colour correcting. These creams are meant to address

issues like sallowness and redness. They are good for people with
acne or oily skin.
BB and CC creams are not must-haves. A BB cream can be used
instead of a moisturizer and foundation. But it does not provide
adequate sun protection because it does not have adequate
concentrations of the sunscreen ingredients. Besides, no one applies
half a teaspoonful of BB cream on the face and neck, which is the
required quantity for adequate sun protection.

Mineral make-up
Mineral has been the buzz word for the last couple of years. Since
mineral cosmetics are solid powders, there are no oil- or water-
soluble phases. This makes it possible to eliminate the emulsifier,
the most irritating ingredient in cream or liquid facial foundations.
Mineral cosmetics are fragrance-, paraben- and preservative-free,
making them safe for sensitive skin. They soak up oil and give a
natural finish. That is why they are good option for those with oily
skin too.
Another advantage of mineral make-up is that it contains zinc, iron
and titanium oxide. These provide some protection from UV rays.
However, mineral make-up isn’t all natural the way we are made to
believe. Some products may have ingredients like bismuth
oxychloride, a byproduct of lead and copper processing, that are not
minerals. They can aggravate acne, irritate the skin and cause
rashes. If you have sensitive skin, avoid mineral powders that
contain bismuth oxychloride.

Lip cosmetics

Most of us opt for long-lasting, matte lip cosmetics because we do

not want to reapply the lipstick. But lips have no pores or oil glands.
Air conditioners, room heaters, low temperatures and our own saliva
can dry the lips. So if you are going to wear lipstick to work, and your
work entails sitting in the AC for twelve hours at a stretch, choose a
moisturizing lipstick.
If you have chapped lips, opt for glossy lipsticks. Choose lighter
colours. Darker shades have more chemicals in them and make the
lips drier. Avoid flavoured and coloured lip balms. Opt for colourless,
odourless ones instead.
Often when you are getting ready for a party, you reach for a
smudge-proof lipstick. After all, who would want their lip colour to
slide on to their wine glass or coffee mug? Having said that,
smudge-proof lipsticks do not contain oils and certain emollients that
hydrate the lips. Hence, it would be all right to wear them on special
occasions, but not as a part of routine wear. And if you have dry or
chapped lips, smudge-proof, long-lasting lipsticks should be a big
no-no. Long-lasting lipstick contains bromo acid that interacts with
the mucosa (the wet lining in the inner part of the lip) and stains the
lips red. This allows the colour to last longer, but also causes the lips
to dry.
Dry lips also occur with the two-part lipstick that has an automatic
cylinder with a sponge-tipped brush. One end of the cylinder
contains a clear, unpigmented or lightly pigmented lip gloss. The
other end has a thin coloured liquid polymer that binds to the lips for
long-lasting colour. This polymer can block UV rays and is great
when you want sun protection for your lips. The flip side is that it can
cause irritation and dryness. One way out is to top it up with a
moisturizing lipstick that not only adds colour, but also prevents
dryness.
Can wearing lipstick every day cause cancer? This is a question I
often get from concerned mothers whose daughters refuse to leave
the house without painting their lips red. A couple of years ago, there
was a big buzz about lipsticks containing lead. This was thought to
be carcinogenic and toxic to the body.
The red pigments in lipsticks do contain lead. But the amount of
lead is too small to cause any harm to the lips, except for staining
them. In 2010, Frontier Global Sciences, Inc., under a contract with
the FDA, tested 400 lipsticks from different brands. They found that
only two lipsticks—Pink Petal Colour Sensational by Maybelline
L’Oréal USA and Volcanic Colour Riche by L’Oréal USA—contained
7.19 ppm of lead. The remaining 398 lipsticks had less than 2 ppm
lead in them. You would have to eat thousands of tubes of lipsticks
every year to get lead poisoning!
However, to prevent lips from staining or turning dark, you should
avoid wearing dark red or maroon shades every day. And if you still
fear lead poisoning, you can opt for products coloured with fruit and
other natural pigments.
What about lip plumpers? Lip plumpers are becoming increasingly
popular. However, their use should be restricted to very specific
occasions. Most lip plumpers contain capsaicin, menthol, cinnamon,
ginger, niacin and even chilli pepper. These ingredients increase the
blood flow by dilating the blood vessels in the lips. This causes the
lips to swell, creating the illusion of plumper lips for a few hours. This
can dehydrate the skin and harm the lip mucosa in the long run.
Frequent use or overuse can cause scaling, dryness and even cuts
on the lips. If you really want to use lip plumpers, look for ingredients
like hyaluronic acid, peptides, marine collagen and human growth
factors.

Eye cosmetics

The skin around the eyes is the thinnest and there are almost no oil
glands here. This is why, for most people, the skin around the eyes
can be dry, itchy and sensitive. The skin under the eyes also ages
the fastest due to the structural anatomy in this region and facial
movements. It is imperative to use a moisturizer around the eyes
before applying make-up. Avoid waterproof make-up on a regular
basis. It may be difficult to remove, resulting in under-eye puffiness
and irritation the next morning. Eyeliner, kohl and mascara have a
greater chance of entering our eyes as we toss and turn in our sleep.
It is therefore important to remove eye make-up before going to bed.

False lashes

They are made up of natural or synthetic hair. They come in various

shapes, sizes and colours. You can fix them to your own lashes with
the help of a special glue. Make sure the angle of your false lashes
and real lashes is the same so that they look natural. To remove
them, use an oil-free eye make-up remover to soften the glue and
then gently slide the false lashes off. Be careful not to remove some
of your normal lashes. Store them in a clean plastic container for
reuse. Some of you may be allergic to the glue and could develop
allergic contact dermatitis. Always do a patch test with the glue and
never use it if you have any eye infection.

Eyelash extensions

Eyelash extensions are a gorgeous, albeit expensive, way to

enhance your natural eyelashes without mascara or false lashes.
The lash extensions are made up of natural or synthetic hair. Each
one is fixed to our own eyelashes with surgical glue. Extensions
must be done by professionally certified and trained aestheticians.
Lash extensions can cause allergies, dry eyes, itchy and swollen
eyelids and eye infections. So one has to be extremely careful about
the hygiene of the place, the sterility of the lashes and the expertise
of the aesthetician.

Tips

1. Always cleanse your face well before applying make-up.

2. Apply a moisturizer on your entire face, don’t forget the skin
around your eyes.
3. Use a good primer if you want your make-up to last longer.
4. Avoid holding your phone against your face. It is full of
microorganisms that can cause zits or tiny eruptions.
5. Avoid touching your face throughout the day. Your hands are not
the most sterile things on earth.
6. Carry blotting papers with you to dab off sweat or excess oil that
can cause make-up to slip and dissipate on the face.
7. Do not use expired products.
8. You need to discard products from time to time, even if they
happen to be your favourite. Pay attention to the expiry dates.
 Make-up

How long you can keep

Make-up product
once opened
Mascara and eyeliner Three to six months
Cream, liquid or stick foundations and
Six months to one year
concealers, cream blushes
Lip balm One year
Lipstick, lip gloss and lip pencils Two years
Powder-based products (e.g. blush, bronzer,
Two years
highlighter, eye-shadow)

Make-up Removers

You are doing your skin a big favour by removing your make-up
before going to bed. Not only do you allow your skin cells to repair
themselves at night, you also wake up with glowing skin. Sleeping
with make-up on can result in puffiness, rashes, itchy skin, milia and
acne.
Now, let’s see what can be used to remove make-up.

Wipes
Wipes are the easiest to use when it comes to removing light make-
up. Gently massage the wipe over your face and eyes. Avoid
scrubbing too hard. Once done, discard the wipe and use a second
one. Be sure to rinse your face with water after doing this. Most
make-up-removing wipes contain surfactants that dissolve make-up
and also emulsifiers that remove oil, dirt and make-up. Hence the
residue can be drying and irritating, particularly for those with
sensitive or dry skin.
Avoid wipes that contain alcohol. They can cause a stinging
sensation and dehydrate the skin. Opt for oil-based wipes, especially
if you have dry or sensitive skin. They are gentle and usually free of
phthalates, silicones, parabens and sulphates.

Micellar water

It isn’t a fad. It is the real deal. Micellar water is almost like a water-
based cleanser with barely any surfactants. It is made up of micelles,
tiny balls of oil molecules suspended in soft water. These micelles
attract oil and dirt and remove them without drying the skin. Micellar
water is great for oily, acne-prone skin. They are usually alcohol-,
paraben- and fragrance-free. So they are excellent for people with
sensitive or flaky skin as well.

Cleansing lotion

If you have normal or dry skin and wear a lot of make-up, opt for a
cleansing lotion. They do not contain soap or surfactants. They
should be massaged gently on to the skin, left on for a few seconds
and then wiped off with cotton pads. You may develop zits if you
have oily or acne-prone skin.

Cleansing oil
You could use a cleansing oil from the beauty store, baby oil or even
fresh almond or coconut oil from your kitchen. They all do the trick
and remove highly resistant make-up such as glitter, bronzer and
shimmer. But oils can seep into your pores and cause break-outs. So
if you have oily skin, cleansing oils are not for you.

Eye make-up

Leaving eye make-up on overnight can result in eye infections, eye

irritation, styes and broken eyelashes. A good eye make-up remover
is one without alcohol, alpha hydroxyl acid and any kind of soaps or
surfactants. Micellar waters remove eye make-up that is not layered
or waterproof. But for waterproof or thick eye make-up, you may
need baby oil or a special eye make-up remover. Baby oils do a
great job at removing eye make-up. Soak a cotton pad in oil or
make-up remover solution and gently press it down against your eye
area. This helps the make-up to dissolve easily and reduces the
amount of rubbing. Massage in a light, downward motion without
pulling or tugging. You may end up pulling out your lashes or
abrading the fragile skin around your eyes by rubbing too hard.

Tips

Do not forget to remove every bit of your make-up before you hit
the sack. You may have returned late from a party, wanting to
crash immediately. But don’t forget about your skin.
I keep my cleansing pads by my bedside table. This always
reminds me to remove my make-up before passing out.
Soak a cotton pad in the make-up remover and then wipe the
face gently. Allow it to sit on your skin for a few seconds in order
to absorb all the make-up and grime. Now the make-up will
come off easily without you having to scrub vigorously.
Do not forget the eyebrows, eyelashes, lips, skin behind the
ears, below the chin and the hairline.
 Do not rub hard to remove your make-up.
Splash water on your face after removing your make-up. This
will ensure no residue is left on your skin.
Do not save on your make-up remover by trying to rub off all
your make-up in one go. One cotton pad may not be enough.
Use a second and a third one if required. Make sure you use a
fresh side of the cotton or wipe every time you swipe. Otherwise
you’ll just redistribute the make-up particles.
To kiss your long-lasting lipstick goodbye, spread a good
amount of ghee or coconut oil all over your lips and leave it on
for about fifteen seconds. Wipe this off with a cotton ball. The
lipstick will come off without damaging the lip mucosa.
Soak all your make-up brushes and sponges in a mug of soap
water for at least half an hour every Sunday. Rinse them
thoroughly. Make-up brushes, when not washed regularly, can
collect microorganisms and dirt, leading to skin infections and
allergic rashes.

Restoring your pH balance

Normal skin has an acidic pH of around 5 to 5.5. This pH is

maintained by the acid mantle. It forms a protective barrier on the
skin, blocking harmful bacteria, microorganisms and toxins, and
restores moisture. Dry skin has alkaline pH, i.e. above 7. Hence it is
more sensitive and prone to allergies and eczemas. pH-balanced
products help restore the acid mantle and the protective lipid layer of
the skin. They also help repair dry, flaky skin and skin wounds.
Those with dry skin should avoid soaps and detergents as they
make the skin more alkaline and increase dryness.
So now, when you wait in transit at various airports and end up
visiting the lucrative cosmetic stores, make sure you buy the right
stuff for yourself. And always remember, make-up isn’t bad if you
use the right products and, more importantly, remove it before going
to bed.
 Mickey has a lot of shopping to do and I am sure she is going to
bless me for this tutorial. I hope you do too.
 11
All about Anti-ageing

‘What spirit is so empty and blind, that it cannot recognize the

fact that the foot is more noble than the shoe, and skin more
beautiful than the garment with which it is clothed?’
—Michelangelo

One day a beautiful lady who seemed to be in her late forties

entered my clinic. She inquired about anti-ageing products. In my
clinic, when a patient comes in, they have to fill out a form with
details like name, age, address, etc. This lady had left the age
column blank. ‘I want you to guess my age, doc,’ she said. After
examining her, I said, ‘Fifty?’ I was close, she was forty-eight. But
she was devastated that I proclaimed her to be two years older than
she actually was. Although her skin wasn’t sagging and she didn’t
have wrinkles, this lady had dilated pores and some fine lines. After
going through her skincare ritual, I added a few anti-ageing creams
and serums to her routine. At the end of the consultation, the lady
revealed she was none other than Mickey’s mother.
Don’t get worried by the term ‘anti-ageing’. It’s not always about
Botox. Let us understand ageing before getting into age-defying
products.
Anti-ageing means turning the clock back a few years. None of us
can defy the process of ageing. But we can slow it down and age
elegantly.
A young face is usually convex with full lips, a sweeping jaw line,
full temples and cheeks. An aged face, on the other hand, is more
concave with flat lips, sunken temples and cheeks, scalloped
mandible and more shadows.
Ageing is a degenerative process caused by both intrinsic and
extrinsic factors.
While the intrinsic or natural ageing process is genetically
programmed and occurs evenly on all skin surfaces, superimposed
changes at both the physical and the microscopic level occur
because of environmental or extrinsic factors. These include
sunlight, smoking, alcohol, weed, stress, pollution, irregular sleep,
unhealthy diet and lack of exercise.
Intrinsic ageing normally begins in the mid-twenties. As a part of
the physiological process, the cells in the lower part of the epidermis
reach the surface within twenty-eight days in children and young
adults. This cell renewal cycle slows down to forty to sixty days in
those above the age of forty-five. What actually happens is, as we
age, dead skin cells shed more slowly and there is a build-up of old
cells on the skin’s surface. The turnover of new skin cells decreases.
This leads to dull, flaky skin. The moisture content in the skin
reduces due to disruption in the protective lipid layer of the skin and
reduction in hyaluronic acid content in the skin. Therefore, the skin
becomes dry and dehydrated. The production of new collagen fibres
slows down and older fibres shrivel up. The elastin fibres lose their
spring too. Together, they result in loose, sagging skin and wrinkles
in the form of furrows on your forehead, crow’s feet, smile lines and
turkey legs on the neck. Next to go as we age is the subcutaneous
fat from under the eyes, temples, cheeks and even the chin. The
bone and cartilage from the eye sockets, cheeks and nose is eaten
up as well. Loss of fat and bone together results in hollow sockets
under the eyes, hollow temples, hollow cheeks and a flat chin. Some
of the fat gets redistributed to the lower face and leads to jowls,
double chin and folds over the laugh lines. The nose begins to droop
and so do the eyebrows and eyelids.
 The signs of intrinsic ageing are fine wrinkles, thin and transparent
skin, sagging skin, dry skin, inability to sweat sufficiently to cool the
skin, greying hair, hair loss and unwanted hair.
Intrinsic ageing is responsible for 20 per cent of ageing changes.
However, a whopping 80 per cent of the changes that we see in our
skin as we age are due to extrinsic factors. So an anti-ageing regime
involves a completely healthy lifestyle and a proper skincare routine.

When to start

Ritwik and Ayesha had just returned from their honeymoon. They
completed their entire pre-marriage skin glow treatment package at
my clinic and were now back with a new concern. They wanted their
skin to continue looking radiant and not age! ‘When should we start
using anti-ageing products?’ twenty-seven-year-old Ayesha asked.
During the teens and twenties, the skin turnover is excellent and
needs no extra support. The skin is capable of repair and can
withstand the wear and tear.
What you need in your teens and twenties is protection and
prevention. How do you do that? By using a broad-spectrum
sunscreen. A broad-spectrum sunscreen is one that provides
protection from both UVA and UVB rays. Occasional bursts of sun
exposure while on vacation can be harmful. However, I believe that
most sun damage occurs from daily sun exposure. Sometimes sun
exposure is just incidental. You swear you are never in the sun but
that daily walk from your car to the office door, the short trip to your
terrace to dry clothes and the brief coffee break where you stare out
of a glass window and watch the outside world are all enough to
cause changes in your skin. The other important thing is to use is a
good moisturizer, particularly at bedtime.
In your thirties, your skin is still doing well. It feels smooth and is
pretty elastic. However, you suddenly notice that the skin tone is
slightly uneven. A few fine lines may appear around the eyes. This is
the decade where you should add vitamin C and retinoids to your
skincare tool box. Vitamin C is a powerful antioxidant and prevents
collagen degradation and pigmentation. Retinoids have been there
forever. They are time-tested molecules that help speed up the cell
turnover, build new collagen, reduce acne, shrink pores and even out
the skin tone.
Retinoids, however, cause dryness and should be used in small
quantities. Initially, use them on alternate nights. Then gradually
incorporate them into your daily night routine. Retinoids should not
be used by women who are planning to conceive or are pregnant or
breastfeeding. They should also be stopped before a peel or laser
treatment.
When you hit the forties, you need to focus on correction, along
with protection and prevention. Pigmentation begins to set in in the
form of melasma, freckles and pigmentary demarcation lines seen as
dark patches on the sides of the cheeks. Fine lines become more
prominent. You may see wrinkles in your mid or late forties even
when you don’t emote or talk. The oestrogen level drops around this
time too and the skin starts to lose its radiance and firmness. The
jowls and laugh lines become more noticeable. By the time you
reach fifty, your neck and hands also begin to look wrinkled. Dryness
sets in and sagging becomes a major issue. Now, along with your
sunscreen, moisturizer, vitamin C serum and retinoid, you must use
an anti-ageing cream too. Do not forget your eye cream and a cream
for your neck and hands.
 Skin at twenty

Skin at fifty

What to use

Just as the body needs a well-balanced diet, the skin needs a

mixture of ingredients to maintain itself. A cleanser, sunscreen and
moisturizer are must-haves. But once you turn thirty, you need to
nourish the skin further.
Every skin type requires three categories of ingredients every day
—skin-replenishing ingredients, skin-restoring ingredients and
antioxidants.

Ingredients
Skin-replenishing ingredients

These help moisturize the skin and revive the protective skin barrier.
They fortify hydrating foods to the skin, making it smooth and supple.
Some of the skin-replenishing ingredients that you should look for
in your moisturizers, day creams and night creams are hyaluronic
acid, ceramides, fatty acids, cholesterol, glycerine,
glycosaminoglycans, amino acids, sodium hyaluronate, sodium PCA,
sphingolipids, glycolic acid and lactic acid.

Skin-restoring ingredients

These are ingredients found in most anti-ageing creams. They help

tighten the existing collagen and elastin fibres, build new collagen,
reduce unnecessary pigment in the different layers of the skin and
improve skin roughness. Hence, they make the skin appear firm,
youthful and blemish-free.
Skin-restoring ingredients are the anti-ageing superstar retinol,
peptides, coenzyme Q10, resveratrol, grape seed extract, coffee
berry, niacinamide, linoleic and linolenic acids, epigallocatechin-3-
gallate (found in green tea) and adenosine.

Antioxidants

Free radicals are toxins in the body that can damage the DNA,
proteins and lipids in the skin and cause cell damage. Our body is
exposed to free radicals through pollution, soot, smoke, chemicals,
digestive byproducts and even certain medicines. These free
radicals are scavenged by antioxidants. Antioxidants can be
obtained through food or supplements. They are also available in
anti-ageing serums and creams.
Vitamin C, E, ferulic acid, some minerals such as selenium and
chromium, flavonoids found in herbal teas and berries are powerful
antioxidants. Blackberries, cranberries, blueberries, beans,
artichokes, pecans, walnuts and hazelnuts are foods thought to be
the richest in antioxidants.
Also look for antioxidants in your anti-ageing serums and creams.
Vitamin C serum is the most popular serum as of today. It gives your
skin an extra boost by improving the immune system of the skin,
preventing pigmentation, improving skin elasticity, decreasing
wrinkles and preventing environmental damage. Choose a vitamin C
serum that has L-ascorbic acid and is formulated at a pH range of
around 3.5. It should also be packaged in an opaque, air-tight
container as vitamin C tends to destabilize on exposure to light and
air.

Type Example
Skin- Isdin Ureadin anti-wrinkle melting cream, Avarta anti-ageing
replenishing cream
Skin-restoring Sebamed age defense Q10 cream, Yugard cream
Antioxidant Revibra C10, Flavo C cream

Rapid fire
Question Answer
What is the right
age to start anti- Forty
ageing products?
When do you
In your twenties. Be regular with sunscreen and
start anti-ageing
moisturizer.
skincare?
What about
Sunscreen, moisturizer and vitamin C or retinoids.
thirties?
Five anti-ageing Sunscreen, moisturizer, retinoid, vitamin C and any anti-
products that are ageing ingredient such as peptides, coenzyme Q10,
important green tea extract, coffee berry, grape seed extract, etc.
Will my skin look
like a million
Not unless you also eat well, avoid smoking and lead a
bucks if I strictly
healthy lifestyle.
follow the five-
product regime?
Yes. Every child above the age of one should be made to
Is it true that
wear protective clothing. They should also be moisturized,
skincare should
be it through a daily massage with baby oil or otherwise.
begin during
Sunscreen can safely be applied on a one-year-old child
childhood?
when outdoors.

When to start treatments

A question I am often asked is, ‘When is the right age to start getting
Botox or fillers done?’ There is no ‘right age’ for this. Botox is given
to children with cerebral palsy and to older people with migraines
and eye paralysis. As far as the US FDA is concerned, there is no
age restriction for these treatments. The determining factors for anti-
ageing treatments are the symptoms, skin conditions and lifestyles of
patients. Every doctor has his or her own protocol. To treat a square
jaw I inject Botox into the masseter muscle, even for people in their
thirties. For wrinkles, I start Botox at thirty-five. I usually give
hyaluronic acid fillers for anti-ageing to men and women above forty.
But HA fillers for lip plumping or sunken eyes can be given to girls in
their late twenties as well. I believe less is more.
Mesotherapy and platelet-rich plasma can be started in one’s
thirties.
Non-surgical skin tightening with HIFU or radiofrequency can be
started as soon as you see your skin beginning to sag. This could be
in your late thirties or early forties.
Chemical peels can even be done in your twenties.

Let’s see some examples:

1. Karuna is thirty-five years old. She is beginning to notice laugh

lines. Her skin is supple. It can be oily at times. Her pores are
looking more prominent. What does she need?

A.M. routine: An oil-free moisturizer and a sunscreen.

P.M. routine: Antioxidant, like vitamin C serum, at night, followed by
a skin-restoring cream, such as a retinol cream, on alternate nights.

2. Rohan is forty-eight years old. His skin is dry. He has

developed a dark band of pigmentation on his forehead. What
does he need?

A.M. routine: A moisturizer and a sunscreen.

P.M. routine: A skin-replenishing cream at night for the full face and
an antioxidant cream for his forehead.

3. Shrividya is fifty-three years old. She is developing lines and

wrinkles on her face. Her skin looks blotchy and feels dry.
What does she need?

A.M. routine: A moisturizer and a sunscreen.

P.M. routine: A skin-replenishing cream (e.g. a cream with hyaluronic
acid) and a skin-restoring cream (a cream with peptides or
coenzyme Q10) at night.

4. Triveni is gorgeous at sixty-seven years of age. She has no

pigmentation. But her skin seems thin and a little dry. She has
prominent jowls, neck bands and crow’s feet around her eyes
and some forehead wrinkles. What does she need?

A.M. routine: A skin-replenishing cream and an antioxidant, followed

by a sunscreen.
P.M. routine: A skin-replenishing cream and a skin-restoring cream
at night.

Mickey’s mother realized that there was more to a skin routine than
cleansing, toning, moisturizing and using a sunscreen. ‘Will I look
forty-five in four weeks, doc?’ she laughed and got up to leave.
Adding a few anti-ageing creams that I had prescribed to her
otherwise perfect skin routine and healthy lifestyle would surely
make her skin look younger, I assured her.
WEEK 4
 12
Food for Skin

‘Your diet is a bank account. Good food choices are good

investments’
—Bethenny Frankel

‘I think I am a fairly healthy eater,’ Mickey said. ‘I eat everything

that’s available at home and rarely eat out.’ She worked ten hours a
day and I was impressed she carried a lunchbox to work. But her
lunch was comprised of two rotis and a little vegetable. Her dinner
again was rice, dal and a few veggies. No wonder she complained of
hair fall and brittle nails. There was hardly any protein in her
supposedly healthy diet. So we discussed diet.
You can eat your way to healthy skin. Skin and hair are indeed a
manifestation of your overall well-being.
How you feed your body affects your skin too. So if you want
radiant, healthy skin, you better eat right. The moment your eyes
look tired, you develop dark circles or your cheeks look sunken, your
family and friends will say you look ill. ‘Whenever I have submissions
in college, it shows on my skin first,’ says twenty-one-year-old
Ruchika. She works late nights and does not follow a healthy diet. A
good diet combined with some dietary supplements can make your
skin glow and look younger as well.
‘I drink four litres of water a day, but my skin doesn’t glow,’ says
Mona. The skin needs water, proteins, amino acids, vitamins, iron,
minerals and fat to function well and look healthy. Human skin is 70
per cent water, 25 per cent protein and 5 per cent fat. This does not
mean that if you drink four litres of water, it goes straight to the skin
and perks it up. Skin gets its water supply both from inside the body
and from the environment outside. Of the 70 per cent water, the
outermost layer of the skin, known as the stratum corneum, should
contain 10 per cent. This 10 per cent is not obtained from the deeper
layers of the skin, as the cells in this layer are dead. They absorb
water from the environment. So moisturizing the skin will give the
stratum corneum its 10 per cent of water. The remaining 60 per cent
is obtained through the intake of about 1.5–2 litres of water a day.
Tender coconut water, lemon juice, buttermilk, fruits and vegetables
that contain water, such as oranges, grapefruits, strawberries,
apples, sprouts, watermelons, lettuce, spinach, cucumbers and
tomatoes, also add to the water content of the skin.
Revamping your eating habits can make your skin feel and look
like a million bucks. Let us understand the skin nutrients better.

Proteins
‘Protein is King’—Dr Spencer Nadolsky

Collagen fibres are the pillars of our skin. They give it its basic form.
Collagen is made of fibrous protein and comprises 30 per cent of the
total body protein. Our hair, nails and dead skin layer are made up of
a protein called keratin. Our muscles and bones are also made of
protein. With age, the collagen fibres shrink and degenerate. This
results in wrinkles and loose skin. Along with that, muscles and
bones are almost eaten up due to loss of protein. This makes the
face look like an inverted pyramid, or a bulldog. ‘Doctor, I feel like my
entire face is drooping,’ say my patients who are in their mid-forties
and above. So if you want to delay the process of ageing on your
face and want your hair to be your crowning glory and your nails to
be strong, make sure your protein intake is adequate. Proteins also
keep your muscles and bones strong, preventing early ageing.

Sources
Chicken, eggs, lean meat, tofu, soy, Greek yogurt, milk, cheese,
French beans, kidney beans, mushrooms, almonds and pure oats.

Daily requirement

An average male with a sedentary lifestyle needs 60 g and an

average female with a sedentary lifestyle requires 55 g of protein per
day.

Essential fatty acids

Fats are not always the bad guys. I love my teaspoon of organic
ghee every day. I just feel it makes my skin googly woogly woosh!
‘But, doc, won’t it make me put on weight? They are fats after all,’
ask most of my patients. Not at all. Essential fatty acids are the good
fats. The last thing they would make you do is put on weight. They
comprise of two groups, omega-3 fatty acids, which originate from
linolenic acid, and omega-6 fatty acids, which originate from linoleic
acid.
Omega-3 fatty acids are the soldiers who prevent inflammation
and fight against it. They help the skin heal faster for those who
suffer from acne, eczema or rosacea. Omega-6 fatty acids are the
guardian soldiers. They form a protective barrier on the skin’s
surface. As it is the cell membrane that holds water in, the stronger
that barrier is the better your cells can hold moisture. So omega-6
fatty acids make the skin look plump and radiant.

Sources

Omega-3 fatty acids, as well as omega-6 fatty acids, are found in

nuts, seeds, oils such as flaxseed oil, canola oil, hemp seed oil, and
cold-water fish like salmon and trout.

Daily requirement
There is no official recommendation but a healthy adult usually
requires 250–500 mg of essential fatty acids per day. Higher
amounts, up to 1500 mg, are recommended for dry skin, eczemas,
heart disorders and other health conditions.

Vitamins

‘If you don’t eat vegetables, you won’t get your vitamins!’ All of us
have heard this in school when we refused to eat our greens. It is, in
fact, true. Let’s look at the vitamins that are essential for our skin’s
well-being.

Vitamin C

It is a powerful antioxidant, most prevalent in the skin. It is easily

leached away by environmental stress. Exposure from the ozone of
city pollution can decrease the level of vitamin C in skin by 55 per
cent. Sun exposure and smoking can reduce it by 30 per cent. When
taken orally in the form of L-ascorbic acid, vitamin C nudges the skin
cells to produce more collagen. It helps heal wounds and prevents
discolouration. It functions as an antioxidant by scavenging and
quenching free radicals and regenerating vitamin E from its radical
form. So if you want to combat pigmentation, tanning and fine lines
with one vitamin, this is your superstar.
Oral vitamin C is necessary to prevent scurvy, a disease with
many manifestations including gingivitis (swollen and bleeding
gums), skin fragility and corkscrew hair, often noticed as dry and
splitting hair.

Sources

Oranges, limes, lemons, kiwis, strawberries, raspberries,

gooseberries, blueberries, cranberries, cherries, pineapples,
mangoes, grapefruits, papayas, guavas, lychees, cantaloupes,
tomatoes, kale, broccoli, cauliflowers and red and green peppers.

Daily requirement

For men, 90 mg a day, and for women, 75 mg a day. Smokers need

35 mg more vitamin C per day than non-smokers. However, in cases
of pigmentation or skin conditions, an adult would need 1000 mg of
vitamin C per day.

Who should not take vitamin C

In a study published in the Journal of the American Medical

Association, taking more than 7000 mg of vitamin C per week can
increase the risk of kidney stones if one has a medical history related
to it. Kidney stones are often composed of calcium oxalate. And
when excess vitamin C is excreted by the body, it is usually in the
oxalate form. This may lead to the formation of stones in the kidney.
The caution applies only to vitamin C supplements and not to vitamin
C found in food.*

Vitamin E

Vitamin E is a lipid-soluble vitamin that stabilizes the cell membranes

of skin against damage by the harmful free fatty acids and
phospholipids. It regenerates its antioxidant capabilities in the
presence of vitamin C. Hence, vitamin C and E work synergistically
to fight free radicals. When I go out on holidays, I always take my
vitamin C and E supplement; together they fight the harmful effects
of UV rays better. In fact, those with skin allergies and eczemas
should also opt for this combination because together they have
better skin repair capabilities too.
Several studies have shown that vitamin E, when applied on the
skin, can reduce damage caused by sun exposure and limit the
chances of skin cancer.
If your nails feel lustreless or chip away, just break a vitamin E
capsule and apply a few drops of the oil from the capsule on your
nails. You can do the same for chapped lips. Vitamin E hydrates and
protects your nail cuticle much as it hydrates chapped lips.

Sources

Wheat germ oil, safflower oil, palm oil, sunflower seeds, wheat germ
oil, hazelnuts, almonds, pistachios, peanuts, spinach, oats, sweet
potatoes, avocados and dairy products.

Daily requirement

One needs 15 mg of vitamin E per day. The most active form of

vitamin E is alpha tocopherol. When taken orally, it is known to
reduce wrinkles, prevent sun damage and improve skin texture. To
be in the safe zone, stay within 400 IU per day or less.

Who should not take vitamin E

Vitamin E can increase the tendency to bleed in an individual. So

people on aspirin and other blood thinners should avoid taking it on a
daily basis.

Vitamin A

Just like cracks that develop in an old wall or a poorly made

foundation, elastin and collagen fibres get damaged due to UV rays,
smoking and other unhealthy lifestyle habits. The skin begins to
loosen and wrinkles develop. Vitamin A is like a mason who repairs
the skin. It helps promote new collagen formation and repairs the
skin tissue. Skin tends to get dry and flaky when vitamin A levels are
low. So if want your skin to smoothen and your fine lines to reduce,
make sure you take enough vitamin A in your food. Vitamin A also
protects us from UV rays and infections. It is used to treat skin
conditions such as eczema, psoriasis, acne and lichen planus
pigmentosus. Lack of vitamin A results in thick, dry skin that is often
compared to toad skin.

Sources

Carrots, sweet potatoes, kale, pumpkins, mangoes, spinach, greens

and tomatoes.

Daily requirement

2000–3000 IU per day.

Vitamin B3 (Niacinamide)

My mother had pigmentation on her cheeks and she would try every
cream that promised to make it disappear. The most popular one in
those times was a cream which had niacinamide as its main
ingredient.
Niacinamide is another name for vitamin B3 and it has anti-
inflammatory and healing properties. It helps the body perform
critical functions like DNA repair and is a cellular energy precursor. It
decreases water loss through the epidermis and protects the skin
barrier, thus keeping the skin supple.
Vitamin B3 also regulates sebum formation in the skin and is
known to reduce pigmentation. It can be taken as a supplement
orally. It is popularly used in creams to reduce blemishes,
pigmentation, fine lines and wrinkles, and to hydrate the skin.

Sources

Legumes, nuts, grain products, mushrooms, chicken, pork and fish.

Daily requirement

One needs 14–16 mg of vitamin B3 per day.

Vitamin B7 (Biotin)

Everybody who has hair loss thinks biotin is the miracle supplement
which will arrest the hair fall and make it grow back abundantly. This
is not true, because there can be many reasons for hair loss.
Nutritional deficiency—in the form of lack of iron, biotin, vitamin D3,
proteins, minerals—is only one of the reasons for hair fall.
Nonetheless, biotin forms the basis of hair, nails and skin cells, and
its deficiency can result in hair loss, brittle nails and itchy, scaly skin.

Sources

Bananas, eggs, oatmeal and rice.

Daily requirement

One needs 5 mg of biotin per day.

Minerals

Most of us don’t need to supplement our mineral intake, particularly if

we already take a multivitamin. And those who drink spring water,
which often contains a natural supply of important minerals, meet
their requirement easily. Studies show that washing your face with
mineral water can help reduce many common skin irritations. Plus
the mineral content helps the skin cells absorb moisture better. The
top three minerals needed for skin are selenium, zinc and copper.
Chromium and magnesium are needed for people with insulin
resistance and PCOS.
Selenium

This is a super antioxidant mineral. It plays an important role in DNA

synthesis and repair.
Selenium protects the skin from the harmful effects of UV rays,
and also preserves tissue elasticity and slows down the hardening of
tissues associated with oxidation.

Sources

Wholegrain cereals, seafood, garlic and eggs.

Daily requirement

55 µg for men and women nineteen years and older.

Zinc

Zinc is an essential trace element in the skin’s dietary defense

squad. It reduces the formation of free radicals, improves skin
immunity, reduces inflammation and helps in the normal healing of
wounds. Zinc also regulates cell turnover and reduces the amount of
natural oil produced by skin. It is often given as a supplement to
improve eczemas, acne, alopecia, scaly skin and seborrheic
dermatitis.

Sources

Nuts, beans, fortified cereals, oysters, meat.

Daily requirement

One needs 8 mg of zinc per day.

Copper
This is a trace mineral found naturally in soil. Copper has
antibacterial and anti-inflammatory properties. It aids in the repair of
wounds and skin that has been cut, abraded or infected. It also
rejuvenates the skin by contributing to the formation of new skin
cells.

Sources

Seafood, meat, grains, nuts and seeds.

Daily requirement

900 µg per day for men and women above nineteen years of age.

Iron

Iron deficiency can result in hair loss, dark circles and pale skin.

Sources

Eggs, meat, fish, whole grains, dried apricots, prunes and raisins,
nuts, seeds, fortified cereals, spinach and beetroot.

Daily requirement

18–20 mg per day.

Beyond vitamins and minerals: The new skinnutrients

Some of the newer, more exciting skin research looks beyond

vitamins and minerals. It talks of other nutrients that, when taken
internally or applied topically, can have remarkable effects on the
skin.

Alpha-lipoic acid
This is a powerful antioxidant for ageing skin which helps scour free
radicals from your blood. With the ability to penetrate both oil and
water, affecting skin cells inside and on the surface, it is a vital
nutrient. Alpha-lipoic acid helps neutralize skin cell damage caused
by free radicals. It also helps other vitamins work effectively to
rebuild skin cells damaged by environmental assaults, such as
smoke and pollution.

Polyphenols

Curcumin

The first time I learnt to ride a bicycle, my excitement knew no

bounds. Confident of being able to ride it without support, I went
down a slope one day, not realizing that I would end up in the gutter.
I got abrasions all over my arms and legs. My mom was extremely
worried, but my grandma simply made a paste of turmeric and tulsi
leaves and applied it on all my skin wounds. I remember howling as
the turmeric paste was being applied because it stung the hell out of
me. But it worked like magic. All my wounds healed within two to
three days and there was not a scar anywhere on my body. Turmeric
has been an integral part of our ancient home remedies. It has
existed in Ayurvedic and Chinese medicine for more than 4000
years.
Curcumin is an antioxidant derived from turmeric. It is an anti-
inflammatory and anti-carcinogenic polyphenol. It helps to repair skin
and heals wounds. It helps prevent lines and wrinkles and makes the
skin look youthful.

Sources

Turmeric.

Daily requirement
2–8 g per kg of one’s body weight daily.

Green tea

Green tea contains epigallocatechin gallate (EGCG), the most potent

tea polyphenol. Again, it is a powerful antioxidant that helps delay
the signs of ageing in skin. Green tea does contain caffeine and can
affect your sleep. Hence it is better to take it during the day. I love my
iced green tea. I add a quarter teaspoon of honey, half a lemon and
a few drops of juice extracted from ginger to the tea. Lemon not only
gives it tanginess, it also has vitamin C. Honey compensates for
sugar and ginger adds the zing and is antibacterial too. It is a perfect
replacement for drinks which contain caffeine, sugar and milk.

Sources

Camellia sinensis plant.

Daily requirement

300 mg EGCG per day (4–5 large cups of green tea per day).

Who should not take green tea

If you are pregnant or breastfeeding, you should limit your caffeine

intake to less than 200 mg per day. If you are suffering from high
blood pressure, heart conditions, bleeding disorders, anaemia,
glaucoma or are taking oestrogen or birth control pills, or
amphetamines, you should avoid drinking green tea.

Resveratrol

Also known as the fountain of youth, resveratrol is a polyphenol that

is produced naturally by several plants either in response to injury or
when the plant is under attack by pathogens such as bacteria or
fungi. It has potent anti-inflammatory, antioxidant, anti-ageing, anti-
acne and skin-lightening properties. It also helps prevent skin
cancer. ‘If you do not want wrinkles, drink a glass of red wine every
day,’ said my friend Yashita on a girls’ night out. While red wine does
have the benefits of resveratrol, it also has the perils of sugar on the
skin. So you will have to take Yashita’s advice with a pinch of salt.

Sources

Abundant in Vitis vinifera (grapevine) and its derivatives (e.g. red

wine, purple grape juice), various berries, peanuts, jackfruit and
pomegranate.

Daily requirement

100–200 mg of resveratrol daily.

Polypodium leucotomos

A robust antioxidant, it also provides protection against sun rays.

Take it on a trip to the beach and I promise you, you will not tan,
provided you also apply your sunscreen. It is a perfect oral
sunscreen. It is also used to treat skin disorders such as psoriasis,
atopic dermatitis, polymorphic light eruption and melasma.

Source

It is an extract obtained from a species of fern called Polypodiaceae

available in Central and South America. It is not found in food.

Daily requirement
The regular dose is two capsules, one in the morning—thirty minutes
before sun exposure—and one before midday. During a vacation, it
is better to take two capsules of 300 mg in the morning and two
capsules three hours after the morning dose.

Glutathione

It is a fabulous antioxidant that is also used to treat liver toxicity. It

prevents melanin formation and reduces its presence in the skin,
resulting in lighter and brighter skin. It has been studied for the
treatment of autoimmune disorders, such as psoriasis, lichen planus,
alopecia areata and polymorphic light eruption, with positive results.

Sources

Tomatoes, avocados, oranges, walnuts and asparagus.

Daily requirement

20–40 mg per day.

Red flag

Glutathione has been doing the rounds for the past couple of years
as a skin-whitening agent. People think of it as a wonder drug that
can turn you into Cinderella overnight. Of late, large doses of
glutathione have been given orally or intravenously without any
safety studies or research. Although the recommended dose is 20–
40 mg for every kg body weight per day, there are pharmaceutical
companies claiming to manufacture up to 50,000 mg of glutathione
per injection. This sounds impossible. Safety is also a big concern,
as there are no relevant studies involving such large doses of the
drug. And don’t forget that anything in excess is unsafe and can be
toxic to the liver or kidneys.
Carotenoids

Carotenoids are a large family of red, orange and yellow substances

found in plants that perform vital antioxidant roles when ingested.
They are the original antioxidants and the most potent free radical
scavengers. They protect the skin from damage by skin saboteurs
such as sun, stress, pollution, environmental toxins, nicotine,
alcohol, etc. Humans and animals cannot synthesize carotenoids, so
they must obtain them via ingestion of foods or supplements. The
four major dietary carotenoids are carotene, lycopene, lutein and
zeaxanthin.

β-Carotene

β-Carotene is a precursor to vitamin A.

Sources

Carrots, bell peppers, mangoes and papayas.

Lutein and Zeaxanthin

These two fighters prevent sun damage. Studies have shown that on
ingesting oral supplements of these two carotenoids every day for
twelve weeks, there was a significant improvement in skin tone,
luminance and colour. Other studies have shown that lutein and
zeaxanthin protect keratinocytes from UV radiation–induced skin
ageing.

Sources

Green leafy vegetables, such as spinach and kale, and egg yolks.

Daily requirement
6–10 mg a day of lutein and 2 mg a day of zeaxanthin.

Astaxanthin

This carotenoid is said to reduce inflammation and oxidation in the

skin. Its cell membrane is composed of two external lipid layers,
making it a stronger antioxidant than vitamin E. It is both water and
oil soluble, only produced by algae when exposed to intense UV
radiation.
There is not enough research on this carotenoid yet, but it is
unsafe to take during pregnancy. It should also be avoided by people
with hormonal issues, low calcium and osteoporosis.

Sources

One of the largest sources of astaxanthin is certain types of marine

algae. It is also found in seafood such as salmon, rainbow trout,
shrimp and lobster.

Daily requirement

2–4 mg per day.

Lycopene

This is a potent carotenoid found in most red-coloured fruits and

vegetables like tomatoes, watermelons, pink grapefruit, papaya, red
bell pepper and pink guava.

Daily requirement

About 5–6 mg per day is sufficient for an adult.

Antioxidants
Everybody talks about them. On asking people what they understand
by the word antioxidant, you will get answers like ‘They help detox’
or ‘They purify the blood.’
The body produces free radicals due to internal release of toxins
and external agents such as pollution, smoking, alcohol, sun
exposure and smog. Free radicals speed up the process of ageing
internally in the body organs and externally on the skin’s surface.
They gobble up collagen and elastin, the fibres that support skin
structure. This causes wrinkles and other signs of ageing.
Antioxidants protect against DNA damage and prevent free radicals
from harming cells in the body and the skin. To sum up, skin plays a
major role in the immune system of our body. It is like the head
bouncer which protects any attack on the body from pollutants,
germs, bacteria and allergens. Antioxidants are the junior bouncers
who aid the head bouncer in its work.
Vitamin C and E and selenium are amongst the top three
antioxidants found in food and food supplements. They help the skin
look youthful.
Role Common sources
Antioxidants Blackberries, blueberries, strawberries, plums
Anti-ageing Grapes, purple grape juice, berries, jackfruit, pomegranate
Skin- Sunflower seeds, hazelnuts, almonds, pistachios, peanuts,
replenishing spinach, oats, sweet potato, avocado
Skin- Chia sees, flax seeds, sunflower seeds, pumpkin seeds,
hydrating walnuts, fish
Oranges, limes, lemon, kiwis, strawberries, raspberries,
Skin-
gooseberries, blueberries, cranberries, cherries, pineapple,
brightening
mangoes, grapefruit, papayas, guavas, lychees, tomatoes, kale
Skin Nuts, green leafy vegetables, beans, fortified cereals, oysters,
fighters meat
Acne- and
blackhead- Bitter gourd, green gourd, turmeric
minimizing
Sunscreen Carrots, all berries and pomegranate
Building Chicken, eggs, kidney beans, chickpeas, sprouts, mushrooms,
blocks lentils

Now that we know who the good guys are, it is important for us to
know the bad ones too.
My grandfather passed away when he was eighty-six years old.
He was fit as a fiddle till his last day. At eighty-six, he barely looked
seventy. He had salt-and-pepper hair, few wrinkles and a fairly
chiselled face. Except for some joint pains, my grandfather had no
ailments. He ate vegetables, fruits, legumes, eggs, yogurt, nuts and
ghee every day. And I never saw him eat sweets, bread, butter or
red meat. He did not smoke or drink alcohol. He went for a walk
every morning and evening and was in bed by 10 p.m. every night.
He had no bad guys to damage his skin. His good guys were whole
foods.
 On the other hand, my friend Anna went to Atlanta for further
studies after twelfth grade. She studied for sixteen hours a day, did
no exercise, lived on pizza, chocolate and burgers, and barely slept.
Anna is thirty-five years old now but looks fifty-five. High carb foods
coupled with a sedentary lifestyle are the reasons for this. Our
parents always discouraged us from having junk food. And now I
know why.

Sugar and skin

This is an obviously unhealthy combination. Chocolates, ice creams,

cakes, sweets, pastries, biscuits, doughnuts, sweetened drinks and
alcohol can be delectable to the palate. But they are good for neither
the waistline nor the skin. Sugar triggers a process called glycation.
Here, sugar molecules bind to collagen and elastin fibres and form
advanced glycation end-products (AGEs). This destroys the collagen
and elastin fibres, resulting in premature wrinkles, fine lines and
uneven skin tones. So think carefully the next time you reach for
your sugar fix.
AGEs also increase with grilling, frying, and roasting food.
Methods of preparation that are water-based, such as boiling and
steaming, produce smaller amounts of AGEs.
Some spices, like cinnamon, cloves, oregano, ginger and garlic,
inhibit the endogenous production of AGEs and are worth adding to
your food to prevent early skin ageing.

High glycaemic index food

Food with glycaemic indexes above seventy increase the production

of insulin in the body. High insulin levels result in inflammation,
resistance to insulin’s ability to store sugar and weight gain. This
elevates hormones that increase the activity of sebaceous glands in
the skin and the formation of acne. White bread, white rice cakes,
instant oats, white potatoes, most crackers, bagels, cakes,
doughnuts, croissants, biscuits, sweets and most packaged
breakfast cereals are foods with high glycaemic indexes. They
should be avoided.
Avoiding sugar is understandable. But why do most dermatologists
and nutritionists ask you to forgo dairy as well?
Presently, milk is sourced from pregnant dairy cows who have
been pumped with antibiotics and hormones to secrete more milk.
The milk produced has high levels of circulating progesterone,
insulin-like growth factor and other hormones which, when ingested,
convert into dihydrotestosterone (DHT). These hormones send the
oil glands into overdrive, triggering acne in susceptible people. They
can also give rise to hives and allergies.

Subtract the bad and add the good food to look youthful

Probiotics

Considering the high usage of pesticides in agriculture and the

reduction of the normal protective bacterial flora in our gut, probiotic
has become a fast-emerging dietary recommendation.
Probiotics are a group of microorganisms living within our bodies
and on our skin. There are over 10,000 different types of
microorganisms living inside us. They are essential for the proper
functioning of our body and skin. Each of us have our own complex
array of probiotics. This is called our microbiome.
It was recently discovered that skin has its own microbiome. It is
primarily composed of bacteria, but also includes fungi, viruses and
protozoa. A microbiome protects our skin from allergens, oxidative
damage and harmful bacteria such as Staphylococcus aureus and
Group A streptococcus. It also inhibits inflammation and stimulates
the production of antimicrobial peptides that kill harmful bacteria,
fungi and viruses.
Yogurt, yakult, kimchi, kefir fermented food and apple cider vinegar
are probiotics that we take orally to keep our gut healthy. They keep
the bad bugs away and ensure that the good bugs stay. Our skin
microbiome plays the same role of determining which bacteria is a
friend and which one a foe. However, when the bad bacteria are
higher in number than the good bacteria, they wreak havoc on the
skin. They also stimulate the good bacteria, making them multiply.
And as you know, anything in excess is bad. So these good bacteria
can now result in rosacea, acne, etc.
Probiotics are now available in cream formulations too. However,
due to their inherent instability, light and air cause them to break
down faster. Hence, they should not be packaged in jars. A probiotic
cream should contain a mix of probiotics, lysate ingredients and
prebiotics (to fuel the probiotics). These help improve the immunity
of the skin. Lactobacillus, Bifidobacterium, Vitreoscilla and various
prebiotic sugars such as xylitol and fructooligosaccharides are
ingredients you should look for in probiotic creams.
Probiotic creams restore the pH balance of the skin. They keep
the skin hydrated and protect it from environmental threats.
There is so much about food and skin that I could go on writing
pages. But this was the essential gist of it all. Mickey said it was an
eye-opener for her as she had always been under the impression
that she ate healthy. She said she would now add a fair amount of
protein to her diet. She would drink two litres of water every day and
eat all the brightly coloured fruits and vegetables. ‘Not the artificially
coloured ones, doc, I shall only buy organic stuff,’ she said aloud
while getting into her car. ‘Yes, and don’t forget the best diet is a
protein-rich, sugar-free, low-salt diet with a small amount of carbs
and a little bit of essential fats too,’ I hollered back.
 13
Exercise and Your Skin

‘To enjoy the glow of good health, you must exercise’

—Gene Tunney

‘I don’t have time for exercise but I do walk for about ten minutes
from my house to the bus stop every morning and evening,’ Mickey
said. Exercise is essential and twenty minutes of routine walk was
certainly not enough for Mickey. I asked her to try going for a brisk
walk or a jog for at least half an hour every day. An even better
option would be to join a dance class. It would be like killing two
birds with one stone—get the daily exercise and become party-ready
too.
While some people exercise to lose weight, others exercise to
keep fit and increase their stamina. Exercise also helps the heart
and other organs to function well.
A stealthier pay-off to why you should stick to your New Year’s
resolution of hitting the gym every day is healthy skin. Haven’t you
noticed how your skin looks when you are blushing and how it glows
after a run? This is because exercise improves circulation. This
allows more nutrients and oxygen to reach your skin, while removing
toxins and waste products more efficiently.
Skin cells contain organelles called mitochondria. Mitochondria are
the work engines that generate energy. They help the skin repair
itself from sun damage and other external assaults. They also help
build collagen. Research has shown that exercise boosts these
mitochondria, along with toning the skin and making it tauter. It also
inhibits the villainous free radicals and improves the activities of
antioxidants in the skin. It also prevents the process of glycation in
the cells. Together, this helps prevent premature ageing of the skin.*
Exercise also ensures better sleep, thereby benefitting the skin
indirectly. Unhealthy sleep patterns and insufficient sleep cause early
ageing of the skin, resulting in dark circles, fine lines and dullness.
In addition, exercise reduces the level of cortisol and releases
endorphins. This in turn can lower stress and fight skin aliens such
as hives, acne, dullness, etc.

Exercise

Pre-workout skincare
Wash you face well. Remove all make-up. It is a bad idea to wear make-up
while exercising. Sweat infused with make-up clogs the pores and gives rise
to acne or whiteheads.
Apply a good moisturizer. You sweat as you exercise. This dehydrates the
body as well as the skin. So you need to hydrate your skin in advance. If you
take spinning or hot yoga classes, use a thicker moisturizer.
If it’s an outdoor workout, do not forget to use sunscreen on your face, neck
and arms.
Carry wet wipes with you. Clean the workout equipment you plan to use to
prevent bacteria from infecting your skin.
If you are swimming, use a waterproof sunscreen and a moisturizer.
During your workout, wipe off sweat with a clean towel.
Drink a lot of water.
Use a thermal water mist while doing weights or cardio. This will clean your
skin, clear the sweat and purify it with rich minerals.

Post workout

First wash your hands. They must be dirty with a mixture of sweat, dirt and
microorganisms from all the equipment you have used.
Next, splash water on your face.
Take a shower. Cleanse well to remove all the sweat, bacteria and grime
from your scalp and body. This will prevent acne and body odour.
Change into a fresh pair of clothes. Dump the sweaty clothes and socks in
your washing machine. Do not wear them again without washing. Dirty
clothes harbour fungi and bacteria.
Apply a generous amount of moisturizer on your face and body.
Have a protein-rich diet to prevent hair loss.

One of my close friends is a renowned Pilates instructor. She has

never had the need to do any skin treatments on her face. All she
does is use a sunscreen in the day and a vitamin C serum and
retinol cream at bedtime. Sometimes she teases me saying I
purposely don’t inject Botox and fillers into her face because I want
to look younger than her. At any given time of the year, her skin
looks amazing. The rewards of exercise are not just a healthy body
but also radiant skin.
So instead of ditching your workout because you don’t have the
time, make time for it!
 14
Home Remedies

‘Beware of false knowledge. It is more dangerous than

ignorance’
—George Bernard Shaw

‘My granny’s skin is still so smooth and beautiful, doc. You know, she
is eighty years old but she doesn’t look a day older than seventy,’
said Mickey. Genes, lifestyle and good skincare is the secret.
My granny used to apply coconut oil on her face and entire body
every day after her bath. She was using a natural organic
moisturizer. Coconut oil is rich in lauric acid and has antibacterial
properties. Hence it keeps the skin moisturized and germ-free. I’m
sure she didn’t know the significance of trapping the skin moisture
after bath but she did it right. She had her own set of home-made
packs. I think she applied every leftover raw vegetable and fruit on
her face. In other words, she was doing her own peels at home. Fruit
and vegetable extracts have a lot of acids like glycolic, citric, lactic
acids which must have worked on her skin to destroy the bad
pigment and keep her collagen fibres strong. And what better
exfoliant than the powdered pulses she used to scrub her face with.
Even today, herbs, flowers and fruits play a big role in skincare.
‘Ghee in my coffee has also shown a huge improvement in making
my skin look naturally moisturized,’ says actor Jacqueline
Fernandez. Actor Richa Chadha swears by natural packs. ‘I have
always tried to be as natural as possible, given that our profession
demands we use a lot of make-up at all times. I use besan and
multani mitti packs for instant lifts,’ she says.
 Let us look at some do-it-yourself tricks to keep your skin radiant
and healthy.

Home remedies

For tan removal

Our skin has its own defence mechanisms. Melanin, the pigment
which gives skin its colour, protects the skin from UV rays. This is
why dark-skinned people rarely get sun burns or skin cancer. When
we are out in the sun for long hours, UV rays trigger the melanocytes
present in the skin to produce more melanin. It’s the body’s way of
protecting the skin. This results in a tan. A tan goes off by itself in
about eight to twelve weeks. But if you continue to be out in the sun,
a tan could persist. Sheets of melanin are laid down, leading to
pigmentation.
Tips from the kitchen

The Chinese apply cooled black tea on sunburnt skin for ten to
fifteen minutes. Tannic acid, theobromine and catechins repair skin
damage, fight free radicals, cool the skin and prevent the formation
of melanin.
Once tanned, apply yogurt with honey to your skin for ten to fifteen
minutes and rinse. Yogurt has lactic acid, which is a natural skin
bleach and moisturizer. Honey is a soothing agent and will prevent
any inflammation.

For dark circles

We have discussed the cause and medical remedies in chapter 7.

Let’s take a look at Granny’s solution for dark circles.

Tips from the kitchen

Take two almonds and crush them to make a paste. Add three to
four drops of milk and apply this paste under the eyes for fifteen to
twenty minutes daily. Almonds contain vitamin E, which hydrates the
skin. Both milk and almonds help lighten the skin.
Prepare fresh cucumber juice. Drink some of it and keep the rest
in the freezer for fifteen minutes. Place soft cotton soaked in chilled
cucumber juice under the eyes for a few minutes. Cucumber juice
contains ascorbic acid oxidase, which makes it a good astringent. It
is also a mild diuretic when taken orally. Hence, it soothes the skin,
reduces puffiness and makes the dark circles appear less prominent.
Apple, again, can be effective against dark circles. Cut thin slices
of the fruit and leave them under the eyes for a few minutes. Apple
contains tannins that help diminish dark circles. In addition, it has
potassium and water-soluble vitamins like B and C that restore lost
nutrients to the under-eye skin.
For acne

I often see girls and boys applying lemon juice, tomato and even
garlic paste on their pimples. These are highly acidic and can cause
irritation. They can also leave burns, blemishes and ugly scars on
the skin.
Toothpaste can also cause an irritant reaction.

Tips from the kitchen

Make a paste of neem leaves. Add half a teaspoon of honey to it.

Apply this on the pimples for ten minutes. Rinse with cold water.
Honey has been used topically for centuries to heal wounds and
burns. In vitro, honey has been found to carry out antibacterial and
antifungal activity against organisms that commonly infect surgical
wounds. Neem leaves have antimicrobial effects and will kill the
germs that cause acne. They also help cleanse the skin.
Tea tree oil, an essential oil extracted from the leaves of Melaleuca
alternifolia, a small tree indigenous to Australia, is also beneficial. It
reduces blackheads and whiteheads as well as dryness, itching and
burning. It can be applied once a day and left on for about four hours
and should then be washed. Tea tree oil is also used as an
astringent or a toner.
Witch hazel (Hamamelis virginiana) bark extract is considered very
safe for topical use as an acne treatment.* A decoction can be made
with 5 gm of the herb in one cup of water, and then applied on the
affected area. It should be left for about twenty minutes and then
rinsed. Green tea bags can also be applied on acne. Tannins present
in green tea and witch hazel have natural astringent, anti-
inflammatory and antiseptic properties.

Dark elbows and knees

Constant friction, like when we rest our elbows on the table while
sitting, while kneeling down, even in our denims, can result in the
darkening of elbows and knees.

Tips from the kitchen

Take two teaspoons of chickpea and make a paste. Add a pinch of

turmeric and a tablespoon of yogurt. Apply this mixture to the
elbows, knees, knuckles and ankles. Leave this on for thirty minutes
and then wash thoroughly. Immediately dab a moisturizer on slightly
damp skin. Do this every alternate day for a couple of weeks to
reduce the dark colour. Make sure you do not wear clothes that are
tight on your elbows and knees. Chickpea is a good cleanser, yogurt
is a moisturizer and skin lightener, and turmeric is an antiseptic.
Make a paste of masoor dal (orange lentil flour). Add half a
teaspoon of lemon juice and one teaspoon of tomato juice to one
tablespoon of the masoor dal paste. Add a pinch of turmeric, and
apply this on the elbows and knees. Leave it for fifteen minutes and
then wash it off with cool water.

For cracked feet

My mom always had cracks on her heels. At times, they would

bleed. Cracks occur on the feet if you walk barefoot, stand for long
hours or wear ill-fitting shoes. They also happen if you use harsh
soaps that strip your skin of natural oils.

Tips from the kitchen

Add a tablespoon of almond oil to half a bucket of lukewarm water.

Soak your feet in the water for not more than five to seven minutes.
Scrub the dead skin with a pumice stone. Apply fresh aloe vera gel
to your feet after rinsing them. Aloe vera gel is obtained from the
central core of the leaf and has been used topically for centuries to
treat wounds and burns. It is anti-inflammatory, hydrating, and also
helps cracks heal fast. You can leave the aloe vera on for an hour.
Wipe it off instead of rinsing it away. ‘Applying aloe vera on my skin
also works like magic,’ says actor Elli Avram.

For instant glow

When you have a party to attend and no time to visit a skin clinic or
get a facial, don’t worry. Your skin can still look like a million bucks
with a simple home-made mask.

Tips from the kitchen

Pomegranate mask: Prepare fresh pomegranate juice. Drink the

juice, but don’t throw the pulp away. Instead, add honey and yogurt
and make it into a paste. Use this as a face pack after cleansing your
skin. Leave it on for twenty minutes and rinse. Your skin will look
bright and beautiful with this instant-glow pack. Pomegranate is
loaded with antioxidants like flavonoids and phenolics. It also has
high levels of vitamins A, E and C. Thus, it delays premature ageing
and lightens the skin tone.
Papaya mask: Take a small piece of ripe papaya and a quarter of
a cucumber. Make a puree of both. Add a tablespoon of yogurt.
Refrigerate this mixture for an hour so that it thickens. Finally, add a
teaspoon of honey. Apply it to your face and neck. Leave it on for
fifteen minutes and wash. Your skin will look bright and fresh.
Papain, the main enzyme in papaya, dissolves the dead skin cells
and works as an antibacterial to fight infection. It brightens the skin
and makes it more even.

For chapped lips

Dry, chapped lips can be irritating and painful.

Tips from the kitchen

Apply ghee or butter as often as possible. Do not lick your lips.

Almond paste or malai can also be applied thrice a day to reduce
dryness.
Mix sugar with honey and use it as a gentle scrub to exfoliate dead
skin on the lips. Apply coconut oil after exfoliating to lock in moisture
and help the lip mucosa heal.

What should one keep in mind before home remedies?

Know your skin type.
If you have dry or flaky skin, or are on acne medication, do not use fruit
extracts, potato, tomato juice or lime juice on your skin. These will dehydrate
the skin and make it more sensitive. They could even lead to irritation and
burns.
If you have oily skin, avoid using malai, milk and oils on your face. These will
clog the pores and give rise to more whiteheads.
Ensure that your ingredients are not old. And that the containers as well as
the applicators are clean. Otherwise you may develop boils or an infection.
If you have sensitive skin and break into rashes easily, do not try home
remedies without consulting a dermatologist. I have seen people break into
hives or itchy skin even with aloe vera, honey or yogurt.
Do not try home remedies without having your doctor examine your skin first
and give you the green signal.

Now that I have given you some tips, you should also know the
pitfalls. People usually love to experiment with home remedies for
any ailment, let alone on the skin. With the Internet easily accessible
and hundreds of websites providing information on such remedies,
the risk of skin allergies, scarring, irritant contact dermatitis and post-
inflammatory hyperpigmentation have gone up. People love anything
natural even if it is as caustic as lime (calcium hydroxide).
 I present to you five cases where people have used home
remedies for their skin and developed scars and rashes. These
patients used:

Toothpaste on acne.
Garlic paste for acne and post-acne pigmentation.
Calcium hydroxide for earlobe repair.
Tomato and lemon overnight for dark circles.
Cinnamon and honey paste for glowing skin.

It is important to know that not every home remedy is safe and not
everything you read on the Internet should be believed.
‘What should you do if you have an allergic reaction?’ Mickey
asked.
Apply ice. Take an anti-allergic tablet like Avil. See a dermatologist
immediately.
Every skin is unique and will behave differently with the same
products or even home remedies. It is best to try the DIY recipes on
a small patch first and leave it for at least an hour. If you do not
develop any reaction, you can go ahead and use the ingredients on
your entire face. Home remedies do help in achieving radiant skin
when used the right way for the right skin type. However, you need
to understand that not everything is holy grail—a lot can be snake oil
too.
WEEK 5
 15
Lifestyle and Skin

‘The creation of the world did not take place once and for all
time, but takes place every day’
—Samuel Beckett

Although we had had a serious discussion on lifestyle on the very

first day, when I met Mickey at the beginning of week five, I checked
on her to make sure that she had not touched a cigarette in the past
four weeks.
Mickey, I remember, had told me at the beginning that she led a
healthy lifestyle but was an occasional smoker. When she was
stressed, she smoked more. She also drank a glass of wine twice or
thrice a week. It seemed like she was a happy person with no
enemies. But hold on, she did have some skin enemies and needed
to be aware of them. So I told Mickey a story about my childhood
neighbours.
Riyan and Kian were our neighbours for almost twelve years and
were identical twins. When they were in school, no one could tell one
from the other. To make it more complex, their parents even dressed
them alike. As they entered their teens, their interests began to differ.
Riyan became a sports lover. He played outdoors all day long—
soccer, cricket, hockey—and was a champ. His mom had to scream
and yell at him for not bathing even after a game of sweaty soccer.
Kian on the other hand was a computer whiz. He worked on
scientific projects over weekends and through his vacations. He was
also very particular about his skin and hair. He made sure he used a
sunscreen every morning and oiled his hair every Sunday. He even
watched his mom apply malai and besan on her face and tried it on
himself sometimes. He had read in a magazine that it was not a girl
thing because men had skin too.
As they entered the work sphere, Riyan quit sports and became a
party lover after work. With parties came smoking and alcohol. Kian,
on the other hand, loved his sleep and never partied after work. Now
both are in their early forties. And you know what, anyone can tell
one from the other. Riyan has grey hair, his face looks permanently
tanned, he has racoon eyes with wrinkles around them. At forty, he
looks fifty-five. Kian, however, looks barely thirty. He is a fairly well-
built, tall, fair and handsome guy with dark hair, no wrinkles, no dark
circles. Both had the same genes, so what went wrong?
 Enemies of the skin

Smoking and skin

One inhalation from a cigarette contains more than 3800 different

harmful, chemical substances, notably nicotine, carbon monoxide,
tar, formaldehyde, cyanhydric acid, ammonia, mercury, lead and
cadmium.*
An immediate effect of smoke inhalation is reduced blood flow to
the skin and nutrient deprivation in skin tissues, with a maximum
effect after the first two minutes of consumption, regardless of the
nicotine concentration.†
Chemical substances from cigarette smoke activate trans-
epidermal water loss, making the skin dry. They also cause
degeneration of connective tissue in the skin, leading to wrinkles and
sagging. They increase substances called matrix metalloproteinases,
which degrade the collagen and elastin fibres. They are also
responsible for pigmentation, lines, wrinkles and dilated pores.‡
Seventy-nine pairs of twins were identified during the Twins Days
Festival in Twinsburg, Ohio, 2007–10, in which only one twin smoked
or where one twin smoked at least five years longer than his or her
counterpart. Their facial features were studied by three unknown
judges and photographs were also taken for documentation. It was
seen that the group which smoked had worse scores when it came
to wrinkles around eyes, laugh lines, under-eye puffiness, dark
circles and lines around the lips.*
In another study, a significant decrease in oxygen content and an
increase in temperature were observed in the skin after smoking.†
In Mickey’s case, she had a few fine wrinkles, and dark circles had
begun to appear since she was an occasional smoker. I have seen
many patients looking older than their age, all thanks to nicotine. Eric
was another groom who came to me just ten days before his
wedding and wanted his dark lips to be lightened. It was an
impossible task and I had no choice but to let him down by refusing
his ten-day challenge. He was a chain-smoker for over three years
which had resulted in dark lips and dark gums. I would need at least
six to eight months to resolve his issue, provided he quit smoking.
I met my friend Katie for lunch after almost five years. She was my
batchmate in college and was this beautiful girl with lovely features.
But now she looked haggard and at least ten years older than me.
Her face and neck were blotchy, there was a grey tinge to her skin,
and her eyes were sunken and dark. Who was the culprit? Cigarette.
Katie was a chronic smoker and puffed at least eight cigarettes a
day. But now that her daughter was going to get married in seven
months, she realized she couldn’t look like this. I thought it was my
duty as a friend and a dermatologist to make the bride’s mother look
youthful and resplendent at her daughter’s wedding. All her skin
problems were due to smoking and bad eating habits. For the
mornings, I gave her a hyaluronic acid–based cream followed by a
sunscreen to apply. At bedtime, I told her to use a vitamin C serum
and a cream containing niacinamide, and also prescribed some
antioxidant supplements. The most difficult part was convincing her
to quit smoking. I had to counsel her for an hour. It wouldn’t be easy,
I told her, but nothing is impossible if you make up your mind. I
asked her to reduce the number of cigarettes she smoked every day
gradually, and switch to e-cigarettes, use zero nicotine patches and
basically be determined to divert her mind. Katie had seven months,
so she could do it. I called her every two weeks to do a yellow peel.
Once we finished six peels in three months, I switched to Spectra
Revital once a month, which is a laser treatment for pigment
reduction. I strictly monitored her smoking habits. One month before
the wedding, Katie and her daughter Victoria came in to see me.
What a change there was! Both looked like two gorgeous sisters.
Katie’s sallow skin had now turned into radiant, blemish-free skin.
There was hardly any pigmentation and her eyes sparkled and
looked bright. ‘All my friends want to know what I have been doing
because my skin has taken a 180-degree turn to look like this,’ Katie
said.

Smoking leads to:

Dark circles
 Dark lips
Crow’s feet (wrinkles around eyes)
Fine lines and wrinkles around the lips
Dull and pale skin
Stained gums
Discoloured nails
Thinning and premature greying of hair
Hair fall
Other effects: delayed healing, exacerbation of psoriasis,
eczemas, skin cancers, oral cancers and other skin disorders

So the next time you light a cigar, just remember what it’s going to do
to your skin. It’s a war between youthfulness and those few minutes
of feeling good and a false perception of stress release.

Alcohol and skin

How can alcohol be bad for skin? Isn’t wine an antioxidant?

Not all alcohol is wine, and not all wine is good for the skin.
So let’s peep into this relationship between alcohol and skin.
One day, a tall, dark, not so handsome guy walked into my clinic.
He was forty and was going to relocate to Australia. He was also
looking at marriage proposals. When I asked him about his skincare
ritual, he said he had none. He did not smoke, nor did he have sugar
or fried food. But he enjoyed his whiskey every night—a kind of ritual
for the past four years. No wonder he looked dehydrated, pale and
shrunken! And his eyes were so puffy, they almost looked like frog
eyes. Even small doses of alcohol every day can have a cumulative
effect on the skin.
Alcohol hinders the production of vasopressin, an antidiuretic
hormone. Hence, one tends to pee more, which dehydrates the skin,
leaving it dry and lustreless. Dry skin in turn leads to rashes, itching,
wrinkles, fine lines and loss of resilience.
Alcohol also causes the blood vessels to dilate, causing flushed
skin and broken capillaries on the face.
Not only that, alcohol contains destructive molecules called
aldehydes, which cause inflammation and cellular damage to the
skin cells. This results in enlarged pores, fine lines, sagging skin and
discolouration.
Puffy eyes, again, are a result of drinking too much alcohol.
Cocktails have another flipside: sugar. Mojitos and alcohol mixed
with sweetened aerated drinks are loaded with sugar, which causes
cell damage and skin ageing.
Margaritas taste great but are a double whammy, with both the
sugar and the salt in them leading to inflammation as well as bloating
and puffiness of eyes or sometimes the entire face.
Different alcohols have different effects on the skin, but as a
general rule: the clearer, the better. Vodka, tequilas and gin get
flushed out faster. So if you have to drink occasionally, these would
be better if you do not want your skin to get damaged, provided you
drink in small quantities.

What about wine?

Red wine is rich in antioxidants but causes inflammation too. So it is
good in limited quantities. It should be had with a meal to avoid the
rapid rise in blood sugar. Red wine can also cause increased
flushing due to histamine release in some people. Seventy-six per
cent of the people who drink red wine have a flair of their rosacea,
versus 56 per cent who drink white wine, 41 per cent who drink beer
and 21 per cent scotch drinkers. But the bottom line is, any alcohol
will exacerbate rosacea.*
Alcohol contains chemical substances called congeners, produced
during the fermentation process. Congeners not only contribute to
liquors’ unique smell and tastes, but they are also responsible for
hangovers. So next time you have had a hangover in spite of having
less alcohol, blame it on the congener. And of course, the more the
hangover, the more haggard the look.
The best way to combat the ill effects of alcohol is to drink plenty
of water. Squeeze an entire lemon into a glass of water and have it
as a shot. This will surely neutralize the hangover.
For good skin, train yourself to be a sophisticated party drinker
who holds a glass of wine from the beginning of the party to the end.

Stress

When my uncle developed a rash all over his body and we found no
cause for it, I said it could be stress-induced. My uncle laughed and
said, ‘You dermatologists have one common reason for every
ailment. Stress is a part of everyone’s life, it is easy for you to blame
stress.’
‘Srini uncle, it is not a blame game, there is science behind this
theory,’ I told him.
 When we say ‘stress’, it is always attributed to mental stress and
worry pertaining to family or work. A painful situation, fear of
something either in college or in office, a remark which feels like a
knife piercing through the heart, all these can lead to stress. But
what we do not realize is that stress to the body can also be caused
due to illness, exertion, overwork, lack of sleep, injury and even
extreme temperatures.
When one is stressed, epinephrine and norepinephrine are
released from the adrenal glands—the tiny glands sitting on top of
our kidneys.
Our body releases cortisol under any stressful circumstance.
Cortisol increases the sugar in our blood, which in turn leads to the
process of glycation. Glycation damages the collagen and elastin
fibres present in the dermis of our skin. When collagen fibres are
damaged, the skin becomes lax and fine lines as well as wrinkles
appear. When elastin fibres are damaged, the skin loses its ability to
bounce back, i.e. it loses its elasticity and suppleness.
 Effect of stress on cortisol

I found some interesting studies where stress due to exams or an

interview resulted in raised cortisol levels in blood and a reduction in
the skin immunity, as well as a delay in the skin barrier function
recovery.*
Another study showed that stress due to marital disruption
significantly delayed skin barrier recovery.†
This indicates that stress can also cause dryness, itching, acne
and even exacerbate existing skin disorders such as eczemas,
psoriasis, atopic dermatitis, urticaria, etc.
In various other studies, chronic stress such as childhood
adversity, nursing elderly dementia parents, special children or
chronically ill children, exposure to partner violence, depression can
all lead to shortening of telomeres, resulting in premature ageing.
Telomeres are present at the ends of DNA strands, like plastic caps
at the end of shoelaces, protecting the DNA. As the telomeres
shorten, DNA gets damaged and can no longer do their job well,
thus leading to early ageing. Telomeres shorten as we age, but can
also be shortened by stress, unhealthy diet, lack of exercise,
smoking, obesity and pollution.‡
Stress also increases the formation of free radicals in the body,
including the skin.
If you go back to your chemistry class in eighth grade, free
radicals are those unpaired electrons which lie free and fly around
looking for another particle to bind with. Once they bind to particles
in the skin, they cause oxidation. Oxidation corrupts the skin cells
like how iron rusts on exposure to oxygen. Free radicals are formed
due to pollution, stress, nicotine, UV rays, alcohol, unhealthy diet,
dust and smoke, to name a few.
Has it started sounding like jargon? Well, the long and short of it is
that stress can:

Cause dark circles and baggy eyes

Cause acne
Make the skin more sensitive by releasing inflammatory
neuropeptides in the skin. This could lead to itching, redness,
hives, etc.
Exacerbate existing skin problems such as psoriasis, eczemas,
rosacea, seborrhoeic dermatitis, atopic dermatitis, pruritus and
alopecia areata
Increase oil production, leading to clogged pores, whiteheads
and blackheads
Cause fine lines and wrinkles
Cause excessive hair loss by speeding up the hair cycle and
moving the hair to the telogen (rest) phase
Speed up greying of the hair
‘Who does not have stress?’ asks my patient Ritwik. Stress is indeed
a part of our lives but the way we deal with it is what matters.
I am neither a motivational speaker nor a wise guru but from
experience and practice, I have certainly learnt a few ways to deal
with stress:

No stress is big if you look at the bigger picture. My husband

says, stress about something for a day and then leave it,
because it is not worth taking the stress if stress isn’t the
solution to your problem!
Laugh. Keep away from people who give you stress. Keep away
from negativity. Learn to say ‘no’ when required and do things
that make you laugh. The American Journal of the Medical
Sciences reported a study where participants who watched a
comedy video were found to have lower levels of the stress
hormones ACTH and cortisol than a control group. So
sometimes your WhatsApp forwards may actually do you good
by making you laugh.
Meditate. Ever since I started meditating for twenty minutes
every morning, I have been able to cope with stressful situations
better. I find myself calmer and do not get agitated or worried
over little things. In a study published in the Journal of Clinical
Psychiatry in 2013, it was seen that mindfulness meditation
lowers anxiety and reduces cortisol levels. Yoga has a
meditative component that is particularly effective for reducing
stress and lowering cortisol levels.

Meditation
Exercise. Weight-bearing exercise such as lifting weights can
lower blood sugar levels by making tissues more sensitive to
insulin. So they help prevent premature ageing. Exercise also
releases a lot of endorphins and norepinephrine, both of which
make you feel good.
Unplug from technology. I have gone off WhatsApp for the past
three years and it feels like my biggest achievement. I have also
made a rule at home: whenever we go to family dinners, movies
or outings, I do not let my family members take their phones. I
leave my phone at home too. It is good to unwind and spend
some quality time with your family and yourself. Believe me, it is
a big stress buster.
Manage your time. There should be a work–life balance and this
comes with discipline and time management. Make sure to keep
some leisure time for yourself too. Do not over-schedule your
appointments. Do not try to do everything yourself. Learn to trust
your staff and colleagues and delegate work. Prioritize your task
in such a way that if you leave something out, it doesn’t stress
you.
Sleep. A sleep-deprived person looks haggard, fatigued and
less attractive than a person who is well rested. Lack of sleep is
indirect stress to the body and has its adverse effects on the
skin. In a study conducted to check the effects of sleep
deprivation, it was seen that people who had a poor quality of
sleep showed increased signs of skin ageing such as dark
circles, uneven pigmentation, fine lines and reduced elasticity.
They also recover much slower if their skin barrier gets
disrupted due to other factors.*
 Beauty sleep

Once you are stress-free, you will find that your radiance is back,
your hair stops falling, your dark circles reduce, your pimples
disappear. It just works like magic.
 Pimples disappear with reduced stress

Pollution

Environmental toxins

I live by the creek of the Arabian sea. Earlier I’d wake up in the
morning to the clear blue waters and the stretch of greens. At the far
end, I would be able to see the bridge connecting Navi Mumbai to
Mumbai and the vehicles would look like tiny toys moving slowly.
One look outside my window and there would be happiness on my
face. But these days, all I see is a sheet of smog.
For those few hours in the morning, it feels like the sea and the
marsh have all migrated to another place and the sky and earth have
become one huge mass of grey. This is the pollution from the
surrounding industries and the soot from the vehicles.
When I see a man with a band of dark colour on his forehead, I
know he is either working as a traffic police officer or spends most of
his time either on the streets or in chemical industries.
Do you know that the polluted air we breathe in contains harmful
chemicals such as polycyclic aromatic hydrocarbons (PAH), nitrogen
oxides, particulate matter, volatile organic compounds, cigarette
smoke, arsenic and heavy metals?
When we expose ourselves to pollution for a prolonged period of
time or repeatedly, the fighter antioxidants such as vitamin C, vitamin
E, superoxide dismutase and glutathione reductase get depleted
from the skin. This results in the production of more free radicals and
reactive oxygen species which are the villains that damage the DNA
of the skin and disrupt the skin’s barrier function.
This can lead to dryness, discolouration, fine lines and wrinkles.
Long-term exposure to air pollution can also cause skin allergies,
eczema and even acne.
PAH are formed in any burning, waste incineration, metal
production, fuel and wood combustion. Exposure to PAH can result
in acne-like eruptions on the face, chest and back. PAHs have also
been implicated in the development of skin cancer.*
Particulate matter in the air consists of mixtures of various sizes
and compositions from factories, power plants, refuse incinerators,
automobiles, construction activities, fires and natural windblown
dust.† What is more appalling is that the most harmful components
of particulate matter are nanosized particles from traffic pollution.
Particulate matter penetrates the skin either through hair follicles
or through the skin’s pores and exerts its detrimental effects,
contributing to skin ageing, pigment spots, wrinkles, lax skin and
spider veins.*
A study published in the Journal of Investigative Dermatology
showed that increase in soot and particles from traffic was
associated with 20 per cent more pigment spots on the forehead and
cheeks.†
Further, a study in Korea has shown that symptoms of atopic
eczema increases in children who have shifted to a new building due
to an increase in exposure to volatile organic compounds.‡
Closer home, you will be surprised to know that there are 1.3
million deaths in India each year due to poor indoor air quality. The
most common reason for indoor pollution is the use of firewood, cow
dung cake, coal, charcoal, kerosene for cooking. Among the 70 per
cent of the country’s rural population, about 80 per cent of
households rely on biomass fuel, making India top the list of
countries with the largest population lacking access to cleaner fuel
for cooking. Tobacco smoke, organic solvents in paints and
varnishes and exhaust from cars in the garage are some of the other
causes for indoor pollution.*

Skincare and protection from pollution

Always cleanse your skin well after returning from any outdoor place.
Use a facewash which can unclog your pores and remove all the dirt
and grime from the skin’s surface as well as the pollutant particles
which sit on the skin.
Next, make sure you apply a good moisturizer. Pollution
dehydrates the skin, leaving it dull and more exposed to
environmental damage. A moisturizer will protect the lipid barrier
layer of the skin.
Do not forget to apply a sunscreen with both UVA and UVB
protection. Choose physical sunblocks which will also form a
protective layer on the skin, making it difficult for the smog particles
to reach the deeper layers of the skin.
At night, make sure you apply a serum or cream containing
vitamin C and E, which will detox your skin.
Do not forget to wear a mask which not only covers your nose and
mouth but also your entire face except the eyes. Physical protection
is the best method of protection from pollutant particles. This is
extremely important for people with high occupational risk, such as
traffic policemen and sweepers.
Make sure you drink enough water, a minimum of two litres every
day, and have a lot of bright-coloured fruits such as berries,
pomegranates and dark grapes that are rich in antioxidants.
You may also take vitamin C, E and A supplements to protect the
skin. Supplements of polypodium leucotomos, a potent antioxidant,
prevents cellular damage from exposure to harmful rays.
In extreme conditions, you must have an air purifier at home so
that at least in your safe haven you are breathing clean air.
Good lifestyle
Aye Nay
Cleanse Sleep with make-up on
Moisturize Smoking
Sunscreen Alcohol
Make-up removal Pollution
Sleep Late nights
Healthy food Junk food, sugar
Exercise Lazing
Meditate Stress

Leading a healthy lifestyle from the time you are old enough to
understand the nitty-gritty of life—in my opinion, that’s the age of
sixteen—will help you stay young and healthy even as you battle
age. Don’t wait till the damage is done. As goes the old adage,
prevention is always better than cure. At the same time, if the
damage is already done, do not give up. Antioxidants, skin therapies
and, most certainly, a change in lifestyle can turn back the clock. It’s
never too late.
WEEK 6
 16
When Should You See a Dermat?

‘Three things are needed for success in painting and sculpture:

to see beauty when young and accustom oneself to it, to work
hard, and to obtain good advice’
—Bernini

‘Doc, I never had pigmentation issues earlier and my skin was

flawless,’ said Mickey’s forty-one-year-old cousin Sheela, whom
Mickey had dragged to my clinic after seeing the changes in her own
skin. ‘My lifestyle is the same. My diet hasn’t changed. But now, I
see these dark patches on my face suddenly. And people even tell
me that I have started to look tired and old.’ Sheela was an athlete in
college. Running was her passion, whether in the hot summers or
cold winters. She never used a sunscreen because it would get
washed out with her sweat. After marriage, she quit sports but led a
hectic life. I explained to Sheela that the damage was inflicted during
her teens and twenties when she ran in the sun for hours together,
had no set pattern for food or sleep and barely got time to relax. The
effects start showing only in our late thirties and forties. With age, the
ability of our skin cells to repair themselves slow down. This makes
things worse and problems such as pigmentation, adult acne,
sagging skin, wrinkles and eczemas start manifesting. It is better to
start skincare early, in your teens, and see a dermatologist in order
to understand you skin.
My patient Vivian used to play cricket for his college but now
works indoors in a bank. When he came to consult me, he said he
had given up on sunscreens. He had tried every sunscreen available
in the shops because he thought he was getting permanently tanned
—he had developed sun-induced pigmentation on the face. After
examining him, I gave him a water-based sunscreen which did not
leave his skin white. Additionally, I also gave him a three-month
sunscreen challenge to make him believe in the benefits of using
one. Fortunately, he was sporting and obedient enough to take up
the challenge. And in three months, he saw his skin looking clearer
and vowed never to forget to apply a sunscreen on all the exposed
parts of his body before stepping out. Had Vivian consulted a
dermatologist right at the beginning, his tryst with sunscreens
wouldn’t have begun in the first place. In my opinion, one should
meet a dermatologist once you hit sixteen and again at thirty and at
forty-five. Your skin changes according to age, hormones, lifestyle,
climate and pollution, and only a dermatologist can help you with the
correct skincare routine.
There are a myriad creams and lotions available to the consumer
in the market, making it tough for a person to choose the right
product for himself or herself. Hence a visit to a dermatologist
becomes important. One also needs to see a dermatologist for
certain skin conditions which may not seem severe but don’t seem to
abate despite efforts. For instance, severe acne or pimples will not
improve with over-the-counter products. If after a month of using an
anti-acne cream you still see no results, it is time to see a
dermatologist. You may be suffering from hormonal imbalances or
PCOS. Similarly, if you have developed scars or blemishes, you
should not try out treatments on your own. Let your dermatologist do
the peels and lasers suitable for you.
If you see a mole or an abnormal growth on your skin which keeps
growing, you must seek help. The mole could be turning cancerous
or the growth could be an infected cyst.
Eczema, psoriasis and other types of dermatitis are accompanied
by itching and rashes. They may subside temporarily with an over-
the-counter steroid cream or an anti-allergic pill but will only worsen
once you stop the medication. Make sure you consult a
dermatologist for any rashes on your body.
Dandruff—a common problem—may also need a dermatologist’s
attention. If you have used all kinds of anti-dandruff shampoos with
no results, and tried all anti-dandruff treatments in salons, it could be
possible that your problem is something else altogether. For all you
know, you may be suffering from scalp disorders such as
seborrhoeic dermatitis or psoriasis which mimic dandruff but are
seen as thicker, stickier scales on the scalp. They need medical
attention. Scar-reduction creams may help if the scars are
superficial. However, if they are raised, thickened scars or keloids,
you must consult a dermatologist as you may need injections into the
keloid or cryotherapy with liquid nitrogen. Similarly for depressed
scars, you may need fractional laser treatment. So don’t just rely on
microdermabrasions and other treatments at your local beauty
parlour.
Brown skin discolouration and pigmentation reduce with over-the-
counter skin-lightening creams. However, the pigmentation returns
when you stop using these creams. Sometimes, long-term use of
these creams causes thinning of the skin, visible veins and sensitive
skin due to a steroid present in the cream. Other times they can
cause more pigmentation due to the presence of hydroquinone in the
cream. Hence, do not try over-the-counter skin lighteners.
And of course, if you have an important occasion like Mickey’s,
you must consult a dermatologist at least six weeks in advance. If
you have skin problems like severe acne, pigmentation, etc., then
you need to see the dermatologist not six weeks, but six months in
advance. Having said that, don’t panic if you don’t have six months.
We dermatologists always have quick fixes for you.
 17
Skin Treatments

‘The true work of art is but a shadow of the divine perfection’

—Michelangelo

Mickey had a few days left and I had to do some behind-the-scenes

magic to make her skin even-toned, more radiant and blemish-free.
Sometimes creams may not be enough for certain skin problems
such as acne scars, pigmentation, sagging skin and wrinkles. At
other times, you may need to spruce yourself up for an important
event. There are various skin treatments available to aid this pursuit.
When you read about them in the newspapers or online, be careful
not to trip up. Let us discuss some of them:

Skin polishing
Chemical peel
Microneedling
Mesotherapy
Lasers
Radio frequency skin tightening
High-intensity focused ultrasound (HIFU)
Threads
Platelet-rich plasma
Botox
Fillers
Skin boosters

Skin polishing
A lot of people come a day before an event, a party or a wedding
wanting to get their skin polished in the hope that their pigmentation
will disappear like magic. Let me debunk this myth. Skin polishing is
a more sophisticated way of exfoliating your skin. It is done with a
vacuum-operated device which sucks all the dead skin and grime
from the pores. It also has fine aluminium oxide crystals or fine
diamond powder which exfoliates the skin gently. This is an excellent
way to cleanse the skin but do not go for it more than once a month
if you have dry skin and once in fifteen days if you have oily skin.
Skin polishing helps remove tan and very superficial acne marks.
However, one session is never enough. One has to get about four to
six sessions done to get optimum results. The good thing is, after the
session, one comes out feeling cleaner. It does not have any side
effects and is a lunchtime procedure. So you can walk back to your
office without anyone asking you any weird questions. You may
certainly get compliments like, ‘Whoa, you look fresh!’ ‘I realize that
regular clean-ups at a qualified dermatologist’s clinic are better than
facials at your neighbourhood parlour,’ says actor Richa Chadha.

Chemical peel

The moment I suggest a chemical peel to my patient, the answer is

always, ‘No, doc, I do not want to apply chemicals on my face.’
The truth is any cream or lotion that you apply on the face may
have the same chemicals that you apply as a peel—the difference
being, the peel will have a higher concentration. Most of the times,
these so-called chemical peels are extracts of fruits, tree barks,
seeds or leaves. They are called ‘chemical’ because of their
chemical formula and the preservatives added to the peel solution.
You will understand better when you look at the sources of most of
the chemical peels. Glycolic acid, for example, is an extract of sugar
cane, lactic acid is a milk extract, mandelic acid is derived from bitter
almonds and kojic acid from Japanese mushrooms, salicylic acid
from willow bark.
‘Doc, I cannot do a peel. Lying down on a treatment bed for an
hour is just not my thing,’ said Sandeep, a patient. Who said it will
take an hour? You walk in, your face is cleansed and degreased.
The peel solution is applied for five to ten minutes and then
removed. A sunscreen is applied and you are ready to go back to
work. Some peels are cream-based; they are applied to the skin and
left on for four to eight hours. So it is the quickest skin treatment you
can think of.
Miraya had been refraining from doing a peel for a long time
because she saw her friend shed skin like a snake after having done
a peel. Well, chemical peels are classified as superficial, medium
and deep, based on how deep into the skin the peel solution
penetrates. Medium peel solutions cause peeling of skin for three to
four days. They are usually done for acne blemishes, pigmentation,
fine lines, open pores and even pimples. Deep peels cause peeling
for up to ten days but are not recommended for Indian skin.
Superficial peels do not cause visible skin peeling. And they work
wonders when it comes to radiance and glow.
‘Doc, I have heard skin becomes sensitive after doing a peel,’ said
Ruhi, another of my patients. Choosing the right peel for your skin
along with proper post-peel care will certainly never make your skin
sensitive.
A word of advice: Make sure you do not step out in the sun after a
peel. Also, some peels such as TCA, retinol and phenol cause
peeling of the skin. Let this happen naturally. Do not try to remove
the skin which looks like snake skin, however tempted you may be.

Microneedling

Microneedling is a procedure whereby tiny channels are created in

the skin with very fine medical-grade stainless steel needles, which
are either fixed on a roller or a pen-like device. ‘I read that
microneedling is popular with celebrities like Jennifer Aniston, Kim
Kardashian, Angelina Jolie, Brad Pitt and Demi Moore. May I also do
microneedling for my face?’ asked thirty-year-old Ashwin, who was
troubled with the pits on his face that pimples had left behind. He
wanted to be an actor but the tiny scars on his face were acting like
speed breakers to his confidence. Yes, Ashwin could do
microneedling along with a couple of other treatments to get rid of
his acne scars. Microneedling is also done to reduce pores, stretch
marks, accident scars and also to get radiant skin.
The instrument used for microneedling is called dermaroller or
dermapen. A dermaroller is a plastic handheld device with a drum-
shaped head which has 192 needles all around it. These needles are
0.5–3 mm long. A dermapen is a motorized device with similar
needles attached to a pen-like structure. The patient’s skin is
cleansed and a numbing cream is applied for about an hour. The
skin is cleaned with sterile aseptic solutions. The roller is then rolled
on the skin in four directions. The skin is cleaned and a vitamin C
serum or hyaluronic acid is applied on it. The patient is then sent
home. The procedure feels like a sting but is bearable. The redness
and swelling persists for a day or two at the most. The skin looks
radiant and taut after microneedling. Acne scars reduce over a
period of time. The dermatologist decides on the type of roller, i.e.
the number of needles and their length, depending on the condition
and area to be treated. For example, a 0.5 mm needle length is used
for the under-eye area because the skin here is very thin. For the
treatment of acne scars, 2 mm needles are required.

Mesotherapy

Actress Jennifer Aniston and singer Katy Perry have endorsed this
celebrity trend of injecting minerals and vitamins directly into the skin
in order to nourish it and make it more youthful. One of my celebrity
clients says that it reduces blotchiness, makes the skin look young,
soft and radiant. Mesotherapy involves infusing vitamins, minerals,
amino acids, enzymes and hyaluronic acid into the mesoderm, i.e.
the middle layer of the skin, either with a dermaroller or a mesogun
or even micro-injections, directly into the skin. It is painless and often
qualifies as a lunchtime facial. It is done once in two weeks for six to
eight sessions. The discomfort is bearable, akin to having your arms
waxed.

Lasers

Talk about lasers and some of my patients want to scoot from my

clinic like I have asked them to commit suicide! But you will certainly
regret it if you get a laser treatment done from a person who doesn’t
have sound knowledge of the device but has enough money to buy
the machine. The word LASER is an acronym for ‘light amplification
by stimulated emission of radiation’. When we say radiation, it is not
the radiation energy which can harm your DNA or your cells. Some
people ask me if laser can damage internal organs. Well, laser
energy can only penetrate up to a certain layer in the skin and not
beneath. So there is no question of harming internal organs. The
only part of the body which can get affected is the eye. Hence, one
must use protective eye shields before performing any such
treatment.
When Abimanyu came to me with a lot of stubborn pigmentation
on his forehead, I suggested doing a laser treatment. ‘But I don’t
want my hair gone, doc,’ he said. Well, laser treatment doesn’t just
involve hair removal. There are several types of laser with specific
wavelengths and they can be used for different treatments. A long
pulse diode or a long pulse Nd Yag, an Alexandrite laser are
excellent for removing hair on skin like ours, the Indian skin.
‘Doc, tell me some other method to get rid of my hair. My friend
has done twenty sessions of laser hair removal and it’s still growing
back long,’ said one of my patients, Pritika.
Hair regrowth can happen if you have a hormonal imbalance in the
body. Usually, a female needs eight to ten sessions of laser to get rid
of the hair and a male needs twelve to fifteen. But if a girl has
polycystic ovaries, raised prolactin levels or raised androgen levels,
or even insulin resistance, her response to laser will be extremely
slow and the laser sessions may go on and on. Similarly, if the guy is
taking supplements such as anabolic steroids or growth hormones or
similar stuff, his response to laser will be very slow or even zero. So
one must get all hormones checked before going for laser hair
removal. Get the hormonal imbalance treated, lose weight and then
expect fabulous results. Otherwise be prepared to do multiple laser
sessions.
A Q-switched Nd Yag laser is used to remove tattoos, reduce
pigmentation, cause skin brightening. It is also used to remove
certain types of birthmarks and even reduce freckles.
Resurfacing lasers such as Fractional CO2 or fractional erbium
lasers are used to treat scars or depressions which occur after acne,
accident scars, scars which remain after burns or surgeries. They
are also used to reduce fine lines, open pores and stretch marks.
Pulsed dye lasers are used to get rid of those spider veins or thin
pink veins which are visible through the skin. They are also used to
treat bigger problems like blood vessel malformations since birth.
Indian skin tends to pigment during the healing process after
undergoing any peel, laser or even surgery, if one does not take
proper care after the treatment. This pigmentation, known as post-
inflammatory hyperpigmentation is indeed temporary but can be
bothersome and stay for up to six to eight months. So it is better to
take some basic pre- and post-treatment precautions.
Whichever laser you do, you must avoid direct sun exposure for at
least seventy-two hours after the treatment. Avoid using scrubs or
swimming, bleaching, body scrubs, massages for at least a week
after a laser.
Radio frequency and HIFU

‘Dr J, I want to look ten years younger but I do not want to go under
the knife,’ said fifty-six-year-old Manjula. Had Manjula said this to me
twenty years ago, I would have had little to offer her. But today,
technology has given us fabulous anti-ageing weapons which are
harmless and efficacious.
Non-surgical skin tightening can be done using radio frequency
energy or high-intensity focused ultrasound. Both technologies are
used to tighten collagen fibres which tend to loosen and wither with
age or even poor lifestyle. Both treatments involve passing heat
energy to the dermis of the skin which is home to collagen and
elastin fibres. This heat energy tightens collagen and elastin and
also stimulates new collagen formation over three to four months.
Now, only a dermatologist can decide whether your skin will respond
to radio frequency or HIFU. So if you want to treat irritating jowls,
wrinkles and folds on the face and saggy skin on the face and body,
consult your dermatologist without fearing to go under the knife.
While radio frequency skin tightening will have you walk out of the
clinic as if nothing has happened, with HIFU, be prepared to be a
little swollen for four to five days after the treatment. Since there is
no light energy involved, there are no chances of burns or
pigmentation after treatment. Hence, these treatments are extremely
safe. These treatments may not show very satisfactory results in
people who are very chubby, hence lose a little fat and then go for
tightening procedures.

Thread lifts

‘Doc, you’ve got to be kidding. Threads into the face? Are you going
to sew my face with a needle and thread?’ asked forty-eight-year-old
Meher when I suggested a thread lift as the best option for her
sagging face. Meher has a lean and pretty face but her jowls are
now prominent. The chiselled jawline she once flaunted is now like a
small hill-and-valley. It bothers her the most. She had consulted a
plastic surgeon who advised a facelift surgery. But she wasn’t ready
to go under the knife yet. She had decided to undergo a facelift as a
sixtieth birthday gift to herself. She did not want to battle a sagging
jaw for twelve more years and that is when someone recommended
her to me.
Thread lift is an office procedure where the thread is inserted into
the skin along vectors to tighten the skin, be it in the jowls or neck or
even cheeks and forehead.
The two types of threads commonly used are polydioxanone
threads and silhouette threads.
These are fine threads which are inserted into the skin after
applying a numbing cream. They stimulate new collagen formation
within two to three months of inserting them in the right plane, and
this helps tighten the skin. The threads dissolve over three to four
months. In this, two sessions are usually done at an interval of one
month. Thereafter the procedure needs to be repeated after a year. If
you are in your late forties or fifties and have loose skin under your
chin, a sagging jawline or if you feel your cheeks are sagging, this
could be a good option for you. There is a little swelling on the face
for three to four days after the treatment. However, there are no
other side effects. You can walk into the clinic, get your treatment
done and walk back to work after two hours.

Platelet-rich plasma (PRP) or the vampire facial

Kim Kardashian made headlines when she posted a video of herself

getting PRP injections all over her face way back in 2013. She called
it the vampire facial, not because it would be done at night (it is
pretty much done during the day) but because it is bloody and looks
gory. The process involves collecting one’s own blood, putting it
through an incubator followed by a centrifuge to draw out plasma
rich in platelets and growth factors. This plasma is reinjected into the
skin of the same person, on the face, neck, hands or whichever part
of the body that needs to be treated. Treated for what? Well, for fine
lines, wrinkles, dullness, large pores, blotchy skin, acne scars or
even stretch marks that you hate. It is done in all age groups from
twenty to sixty and is absolutely safe. Bruising may be the only side
effect but this too is temporary and lasts for four to five days.
The latest trend is to do a round of microneedling and then just
pour the PRP on the skin surface which has many channels opened
up due to the microneedling. We also add hyaluronic acid to the PRP
for more hydration and better stimulation of fibroblasts, cells which
produce collagen.

Botulinum toxin (Botox)

‘Doc, I watched myself on Instagram stories today and I could see

one thousand lines on my face. And it makes me look old,’ said
Abigail, a thirty-seven-year-old home-maker. These lines and
wrinkles on the face which come with emoting are expression lines.
They occur due to constant movement of the muscles as our face
emotes a thousand different expressions. Every time we laugh, cry,
talk, worry, get angry, look surprised or feel sad, the muscles, the fat
above the muscle and skin move in particular directions. Over time,
this constant movement results in wrinkles or lines. ‘Abigail, you
must be a very expressive person, but don’t worry. It is good to let
your face speak,’ I told her. Since she was thirty-seven, and the lines
were bothering her so much, I decided to soften a few lines. I told
her I would inject a few units of Botox to get rid of her crow’s feet
around the eyes and reduce the frown lines between her eyebrows. I
would then do some hyaluronic acid filler injections to reduce her
laugh lines.
Just as the word Xerox is used for photocopy, a neuromodulator
injection comprising of botulinum toxin has become synonymous
with the word Botox. Botox is a natural, purified protein available in
the form of an injection. Upon injecting into the muscle, it relaxes the
wrinkle-causing muscles and creates a rejuvenated and youthful
appearance. It is US FDA approved, well researched and safe to
use.
Let’s understand the uses of Botox. Botox is used to soften or
erase:

Frown lines between the eyebrows

Crow’s feet around the eyes
Forehead wrinkles
Bunny lines on the nose
Downturned corners of the lips (sad lips)
Neck bands also known as turkey neck
Horizontal lines on neck
Multiple dimples on the chin
Square jaw
Excessive sweating of underarms, palms and feet

Shubha, forty-seven years old, yearned for a good jawline. Her neck
looked like that of a turkey and she hated it. So I injected a few units
of Botox into her neck and jawline to erase the neck bands and
create a nice jawline. This procedure is also called the Nefertiti lift,
named after the beautiful Egyptian queen Nefertiti. I usually
recommend Botox for people above thirty-five years of age and only
if necessary. The results are seen within three or four days but the
effect is best seen after seven to fifteen days of injection. The effects
gradually wear off after four to six months and the treatment has to
be repeated. People who are above twenty-five years of age and
have a very broad jaw or a square face due to strong masseter
muscle (the muscle used for chewing) can take Botox injections to
reduce the size of the jaw and make it more oval or rounded. I
wouldn’t recommend cosmetic Botox for other indications in
youngsters. Botox is also given to reduce excessive sweating on
palms and underarms, and for the treatment of migraine.
A word of caution: If the doctor who is injecting isn’t well-trained,
mistakes may happen. So make sure you go to a qualified and well-
trained dermatologist or plastic surgeon. Do not get obsessed and
go overboard with Botox. Too much can lead to loss of expression
lines and give you a plastic face. The aim should be to soften the
lines and look natural.

Overdose of Botox

Botox is manufactured by Allergan. Other botulinum toxin injections

available are Xeomin and Dysport, both of which are also US FDA
approved.

Fillers

Like I mentioned in chapter 11, as we age, the skin loses its collagen
and elastin fibres, the fat below the skin gets displaced from some
places and lost from the others. The muscles become weaker. The
deeper pockets of fat are lost and the bone shrinks too. All these
changes happen gradually, leading to the formation of laugh lines,
jowls, sunken eyes, thinner lips, retruded chin and even hollow
temples. The skin support system undergoes a failure and the pillars
need to be recreated to give the face its support. This is done with
the help of filler injections. Fillers are not the same as Botox. They
do not have any effect on expression lines or wrinkles.
Fillers are available as pre-filled injections which are injected into
the skin into all the hollow areas of the face to recreate the
youthfulness. They may be temporary or permanent, depending on
the substance injected. Temporary fillers made of hyaluronic acid
(HA) last for about a year. HA fillers are safe and they form the
body’s natural moisturizer too. Permanent fillers, on the other hand,
are synthetic and though they last longer, there is a rare possibility of
infection or granuloma. In my clinic, I use HA fillers to:

Fill sunken eyes to make them look youthful, and not tired or
haggard
Fill brows to lift them
Fill the temples, which become hollow with age
Fill the cheeks, which become flat with age
Recreate cheekbones in younger women
Create a sharper nose without surgery
Fill thin lips or create a subtle pout in order to make one look
attractive. Lips can be filled beautifully without making them look
huge and artificial. The key is to keep it natural and not have the
lips walk into a room before the person herself.
Make laugh lines less prominent
Recreate a sharp jawline
Create a nice chin in those with small chins. This improves the
contour of the face.
Fill thin earlobes so that earrings can be worn without the lobe
sagging down
Fill hands which look wrinkled and old

Why do I consider it better than surgery?

It’s cheaper.
 If one doesn’t like the way the face looks after the injection, it
can be dissolved with another injection called hyaluronidase
within two hours. So you don’t live with it for life.
You don’t have to go under the knife.
Lunchtime procedure, no hospitalization.
No anaesthesia given. Just ice or a topical anaesthetic cream
applied.
No downtime or recovery period, you can go back to work
immediately.
Safer as there is no risk of surgical complications.
Results are seen instantly, as opposed to a surgery where it
takes six to ten months.

I love to inject fillers to bring back the youthfulness in a male or

female face. I inject fillers to recreate the emotions of joy. I inject
fillers to instil confidence in the person by getting rid of those tired
eyes and hollow cheeks. I inject fillers to enhance one’s facial
features to make them more attractive, not overdone. I inject fillers to
improve the overall facial contour to replicate one’s youth and not
make a person look like someone else. It is a combination of a lot of
study of the human anatomy coupled with the art of sculpting a
beautiful face. The key lies in the art of injecting the right way and
having an eye for natural beauty.

Overdone lip filler injection

Skin boosters

The skin is injected with tiny doses of hyaluronic acid, a natural

constituent of the skin lost with ageing. Hyaluronic acid has a
property of binding and holding water in the skin. Hence it improves
skin hydration, giving a glowing complexion by naturally
smoothening the skin from within. In this, multiple tiny injections are
given to the skin after numbing it with a cream, thereby reducing the
discomfort. Injections are spaced at three to four weeks for three
sessions and repeat sessions are needed no earlier than six months.
With just three sessions, the skin looks and feels supple and radiant.
These injections are available as Belotero Hydro and Restylane Vital
in India.
There is no one-size-fits-all when it comes to aesthetic treatments.
Every individual has unique skin with different requirements.
Treatments have to be mixed and matched according to the need of
the individual. As I mentioned earlier, one may need a combination
of chemical peels, laser resurfacing and microneedling to reduce
deep scars which are formed due to acne. Similarly, to make the
face look tighter and younger, one may have to undergo a
combination of radio frequency tightening and HIFU, and sometimes
fillers and Botox injections too. You must also remember to follow
your skincare ritual along with these treatments for better results.
Furthermore, none of these procedures are permanent. So have
realistic expectations and take care of your skin every single day.
Consistence is the key to beautiful skin.
I did one yellow peel and one session of laser toning for Mickey. I
also scheduled a photo-facial for her a week before her wedding to
give her skin that final zing.
 18
Latest Advancements in Skin Technology

‘Some painters transform the sun into a yellow spot, others

transform a yellow spot into the sun’
—Pablo Picasso

When it comes to skin and beauty, technology is advancing at a

rocket speed. A lot of research has been going on in the field of
cosmetic dermatology and aesthetic medicine. A number of people
are now keen on non-invasive cosmetic procedures to look better
and younger. With a few game-changing innovations, one can now
have clearer, tighter and more radiant skin. Not only that, the body
can be brought back to shape without having to go under the knife.
The American Society of Plastic Surgeons revealed that 15.7 million
non-invasive cosmetic dermatology procedures were performed in
the United States in the year 2017. Non-invasive fat-reducing
procedures using CoolSculpt increased by 7 per cent, non-invasive
cellulite treatment increased by 19 per cent and non-surgical skin-
tightening treatments increased by 9 per cent. So the market is
booming and people are certainly getting more aware of their skin
and body.
Let me throw some light on some of the happening treatments and
regimes.

CoolSculpting

CoolSculpting is the hottest trend in Hollywood right now and India is

not far behind.
 While Kris Kardashian was seen undergoing CoolSculpting in the
television series Keeping up with the Kardashians, Khloe Kardashian
has spoken about it on her social media accounts. American model
and actress Molly Sims shared her CoolSculpting experience with a
popular magazine, saying that it helped her get rid of her unwanted,
stubborn belly fat post pregnancy.
Over 6 million CoolSculpting treatments have been done all over
the world with successful outcomes. And these people are not just
celebrities; they are people like you and me who want to look good
and feel confident without having to be concerned about the
abnormal bulges on their body. CoolSculpting is the only US FDA–
approved treatment for non-surgical fat reduction. One does not
have to be hospitalized or given anaesthesia, and there are no cuts
and stitches on your body. You can walk out of the clinic comfortably
on your own once your treatment gets over. CoolSculpting uses
cryolipolysis technology to destroy fat cells which lie beneath the
skin. The procedure freezes fat cells and destroys them. These fat
cells get eliminated from the body over the next eight to twelve
weeks. The device used in the treatment has an in-built safety
mechanism that ensures no harm is done to the skin above the fat. A
muffin top, the ugly underarm puff, love handles, back fat, little
bulges on the thigh—not much, but just enough to show through a
snug-fitting T-shirt or blouse or jeans—can be made to disappear
with cryolipolysis. Remember, CoolSculpting is not a weight-loss
treatment. It’s for people who are healthy but have bulges that refuse
to budge, no matter how healthy a diet they follow or how many
kilometres they run or swim. Your BMI should be between 20 and 30
if you want to go for CoolSculpting. If you are obese or even
moderately overweight with BMI above 30, please do not consider
this treatment.
Armanda, my thirty-four-year-old manager, told me one day that
no matter how healthy she ate or how regularly she exercised, she
always had a few areas on her body where the fat just wouldn’t
budge. She had developed these bulges after her pregnancy. I
asked her to undergo liposuction but she was afraid of surgery.
‘Besides, I am no model or actress, doc,’ she said. Nonetheless,
these stubborn love handles and back fat bothered her all the time.
She yearned to wear a perfectly fitted dress someday but was afraid
her bulges would show. Finally, CoolSculpting came to her rescue.
At my clinic, we use the CoolSculpting machine by Allergan, the
original cryolipolysis device approved by US FDA. It has a paddle-
like applicator attached to a hose that provides the cold. Applicators
come in various sizes to suit the area to be treated. For example, the
cool mini applicator is meant for the double chin, the cool advantage
applicator is meant for love handles and so on. This applicator
securely pulls up the area to be treated between its two panels and
the fat cells crystallized for about forty-five minutes. You may feel a
slight stinging or a sensation of cramping once the treatment is
complete. You may also see a temporary whitening or reddening of
the treated area, which may also feel stiff. Otherwise, you’re free to
resume normal activity immediately after the treatment. Men and
women can both opt for the treatment. In fact, many men are now
looking at ripped bodies and go regularly to the gym. They still have
some stubborn bulges. We help them get rid of these bulges with
this treatment.
For many, a single session is enough to produce great results,
provided you keep your expectations realistic. On an average, most
patients see 20–30 per cent fat reduction. That may not sound like a
lot, but visually it can mean the difference between a flat stomach
and a paunch.
The most common side effects, all of which are typically resolved
within one to three weeks, are redness, swelling and bruising.
Cryolipolysis with CoolSculpt does not harm the skin or muscle
tissue; rather, the cold temperature specifically targets fat cells. What
you need to keep in mind is that for any treatment to sustain,
maintenance is the key. So make sure you keep a check on your diet
and don’t go binging once you have lost those bulges. Exercising for
at least half an hour every day would do you wonders.

Fat lipolysis injections

‘Can you melt my double chin away? I always have to try different
angles to make sure my double chin doesn’t make me look like a
toad in my selfies,’ said Ivana, who hated her double chin. Ivana did
not have a big double chin. So I did not suggest CoolSculpting which
would have been otherwise great. There was a small lump of fat and
I knew the easy way out. It’s called Kybella or Geolysis. This is a US
FDA–approved injection containing sodium deoxycholate which is
injected carefully into the fat layer. It actually breaks down the fat
cells which are then excreted through the lymphatics. The downside
is, there is visual swelling in the area of injection for five to seven
days. It does subside and the chin looks like it was always flat and
well shaped. For larger pockets of fat under the skin, I would suggest
the CoolMini cryolipolysis. It just works like magic in a single session.

Micro-Botox

In this, Botox is diluted ten times and tiny droplets are injected into
the superficial skin instead of the muscle. Micro-Botox reduces
oiliness, closes pore size and makes the skin appear taut. It is given
once in three to four months all over the face and neck. It also gives
a nice sheen to the face. Women who are tired of crinkled neck,
micro-Botox is for you. There are no precautions for micro-Botox
injections as they are really miniscule doses.

Non-surgical nose jobs

‘Really? Can my nose look sharper without getting a nose job done?’
Anupriya was gorgeous but always complained about her nose being
flat. It bothered her especially when she had to face the camera. But
she wasn’t allowed to undergo any surgery. ‘Anything non-surgical,
doc,’ said her mom. So I decided to give her filler injections to create
a sharper nose. HA filler injections are given into the nasal bridge to
create a well-defined, sharp nose. The effect lasts for up to two
years. Non-surgical nose jobs can’t make the nose smaller, but they
can help correct imperfections and camouflage areas that are
bothersome. Anupriya loved her nose job. She didn’t have to take
leave from work nor did she have to worry about swelling, pain and
bruising, and most importantly, no one could tell. But almost
everyone who saw her commented on how beautiful she looked.

Filler injections for the body

Aunty Akshara looked gorgeous at fifty-eight. It was her thirty-fifth

wedding anniversary, and she had worn a bright red Kanjeevaram
silk saree, flowers adorning her hair, which was tied in a bun. She
was bedecked from head to toe but her ears were bare. Her
earlobes had thinned with age, and to top it, the hefty earrings she
routinely wore dragged her earlobes down. I also noticed her hands.
They looked shrivelled and wrinkled like a dry raisin. I asked her to
see me at the clinic. ‘I am going to give you the best anniversary gift,’
I whispered into her ears as I left the party.
She was promptly there at my clinic at 10 a.m. the next day. She
knew I do not make false promises. I told her my aesthetic-
dermatology eyes noticed her ears and hands at the party and I
certainly didn’t want my precious aunt to have any telltale signs of
ageing. I applied a numbing cream on her earlobes and hands and
gave her some magazines to read as she sat with the cream on her
skin for forty-five minutes. Then, I plumped her earlobes by injecting
HA fillers. I also injected calcium hydroxyapatite–based fillers into
the top layer of her skin on the hands. Her earlobes were ready to
bear the brunt of her earrings again and her hands looked smooth as
that of a twenty-year-old. She was thrilled beyond words. Fillers
made of hyaluronic acid, calcium hydroxyapatite, poly lactic acid and
poly methyl methacrylate are now being used to fill thin earlobes,
wrinkled hands and feet. Koreans like fuller calves and Brazilians
love big butts. So fillers are even being injected into calves, buttocks
and breasts. It is always safer to use temporary HA fillers or semi-
permanent fillers such as Radiesse made of calcium hydroxyapatite
and Scupltra made of poly L-lactic acid. Avoid permanent fillers as
there may be chances of infection, granulomas or disfigurement over
the years.

Vaginal skin tightening

This is not something to shy away from. After childbirth and with age,
the lips of the vagina do get thin and lax. HA fillers can be used to
reshape the lips. Vaginal skin tightening can also be done using
radio frequency skin tightening devices and lasers. The treatment is
similar to the radio frequency treatments described in chapter 17.
Always opt for US FDA–approved devices only. Also make sure you
go to really hygienic and reputed clinics.

Cellfina

‘Doc, do something about these dimples on my thighs. My entire butt

and thighs look like hills and valleys,’ said Niharika, my twenty-nine-
year-old patient. She had tried all possible creams which claimed
they were the miracle cures for cellulite but nothing worked. Cellulite
occurs when swollen fat cells get trapped in the skin and the
lymphatic drainage is impaired. It is seen in both slim and obese
females and becomes more prominent with age. The condition has
been extremely difficult to treat in spite of diets, loss of weight,
exercise and even skin-tightening or fat-reduction procedures.
Cellfina is a US FDA–approved breakthrough treatment which can
actually improve the appearance of cellulite. A needle-sized device is
used to break the fibrous bands amid which the fat cells are trapped.
This evens out the fat cells and smoothens the dimpling. Results are
seen in a week and last for up to three years. Though the treatment
is done using local anaesthesia, it is done as an office procedure.

Cryotherapy

Cryotherapy has been around for decades at dermatology clinics for

the treatment of warts, acne scars, skin growths and even skin
cancer. But it is being propagated for anti-ageing in recent years and
is popularly known as Frotox. In this procedure, liquid nitrogen is
sprayed on the skin’s surface. The freezing of the skin causes
constriction of blood vessels, thereby reducing flushing, redness and
inflammation. It also causes mild exfoliation and helps in reducing
acne as well as superficial acne scars. It stimulates collagen
formation which leads to tightening of the skin. There are full-body
cryo chambers where a person exposes the entire body to the
freezing liquid nitrogen, which has a temperature of about -90°C, for
two to four minutes. The extreme cold stimulates new collagen
synthesis and reduces inflammation in the cells. While the long-term
effects are skin tightening, the bonus is an instant glow. This is
because the extreme cold causes blood vessels to constrict, and
when you step out, they open up again. So the blood gushes back to
the skin, making it flush with radiance.

LED

Scroll through Instagram pictures of Hollywood celebrities and you

will find most of them wearing these well-lit ghostlike masks. No,
they are not celebrating Halloween. These are LED masks which
may have blue or red light. LED stands for ‘light-emitting diode’. If
your blackheads and whiteheads are turning into a menace, use a
blue light to kill the bacteria which cause acne. And if you want your
skin to look firm and pores invisible, red LED is the right choice for
you. Red light speeds up healing and stimulates collagen production
and is a perfect ten-minute anti-ageing facial. Results are temporary.
However, you will see results after four to five sessions. It is
painless, non-invasive and there are no telltale signs.

Stem cell injections

After the vampire facial, this is going to be the next big thing. It is still
undergoing a lot of research and does not have US FDA clearance
yet, but a lot of clinics in Europe boast of doing stem cell therapy for
anti-ageing. In this, adipose tissue or fat cells are removed from the
person’s abdomen or buttocks. These fats cells are sent to a
laboratory where stem cells are obtained from the fat cells. These
stem cells are then injected into the face to create a youthful,
wrinkle-free face. Stem cells are also obtained from the bone marrow
should the person not have adequate fat deposits at the donor site.

Anti-pollution skin products

I recently read in the newspaper that thirteen most polluted cities in

the world are in India. This level of pollution, whether in the form of
soot from vehicles, smog from industries or smoke from coal used to
cook food in villages, cause a lot of damage to the skin. Blue light
from computers, bacteria from heaters and air conditioners are other
skin aggressors. There is a lot of research going on into the making
of products which will protect the skin from pollution. Anti-pollution
skincare range is going to sweep the markets.

Gel sheet masks

Dry sheet mask is applied to the face as is. It allows all the
ingredients such as vitamins and hyaluronic acid to get absorbed
into the skin and the mask is then removed after twenty minutes.
These masks are easy to carry, easy to use and safe too. Gel sheet
masks are used for an instant glow. Avoid if you have sensitive skin
or a history of any allergy.

Charcoal masks

Charcoal masks contain bentonite clay and charcoal, which help in

deep cleansing. These are good for people who have oily skin or
pimple-prone skin or even combination skin. They reduce
blackheads and whiteheads and also unclog pores. Charcoal masks
make the skin dry, so people with dry or sensitive skin should not be
using it.

Charcoal mask

Glass skin

Glass skin, a term made popular by Korean beauties, is not a

miracle. Glass skin is referred to crystal clear, blemish-free,
translucent and radiant skin which looks like a piece of clear glass.
One cannot achieve glass skin overnight. It takes months of
following a regular skincare regime to make your skin look like glass.
But it is not impossible to achieve.

Steps to achieve glass skin—the K skincare

 At bedtime, remove all make-up from your face with a hydrating
make-up remover or baby oil.
Cleanse your face with a facewash that suits your skin type.
Now apply a hydrating serum containing hyaluronic acid or
vitamin C and vitamin E.
Hydrating sheet masks (there are plenty of Korean brands to
choose from) can also be used instead of serums.
The serum or sheet mask is left overnight, allowing the skin to
soak in the solution and enhancing complete absorption of the
ingredients into the skin.
In the morning, cleanse your face with plain water or a soap-free
cleanser. Follow this with a moisturizer suitable for your skin
type. Top it with a sunscreen which protects your skin from UVA
and UVB rays.
Make sure you avoid alcohol, nicotine and sugar.
Sleep for at least six hours daily.
Repeat this simple regime every single day for at least six
months and you will see the transformation in your skin texture
and tone.
The results will be gratifying but the key is to maintain it by
following these steps routinely.

The J skincare

Most people call me Dr J, so J skincare sounds like my skincare but

it’s not. It stands for Japanese skincare regime. J skincare is said to
overpower the K (Korean) skincare by the end of 2018. The classic
principles of Japanese aesthetics, kanso, shibui and seijaku—
simplicity, understated beauty and energetic calm—take a natural
course of skincare. Japanese skincare products, unlike the
razzmatazz of Korean products, basically cater to everyday
prevention. According to the Japanese, K beauty is more about
trends and quick-fixes, while J beauty is more about technology-
driven, holistic, traditional, preventive treatments. Time will tell us
which is more powerful. Whatever it is, the basic skincare regime will
not change.
Very often, my patients read about the latest treatments either on
the Internet or in magazines, or hear it from friends and colleagues.
Most of the time, however, these are not new treatments. They are
simply old recipes in a new jar. Sometimes they are not even
clinically proven treatments but are over-hyped and advertised.
‘Doctor, my friend does Venus viva for her face, do you have it in
your clinic?’ my patient Rachel asked me once. Well, I have
Endymed and Secret, both of which are devices using the same
technology as Venus viva. Just as there are many cars in the market,
from a Tata Nano to a Lamborghini, there are many lasers, radio
frequency machines, HIFU devices and fat-freezing machines. While
the underlying technology is the same, the make is different, hence
the different names. So don’t always check out what’s new, check
out what works. Before you follow the tribe and spend your hard-
earned money on treatments that may not be necessary for you at
all, do some research. Consult your dermatologist and let them
decide what’s best for you.
‘Thank God for this lesson, now I won’t get influenced by what
people around me are doing to their skin. I’ll just come and you do
what’s best for me. But don’t forget to incorporate the newer
technologies,’ Mickey said at the end with a wink and a naughty
smile on her face.
 e pi lo g ue
The Way Forward

‘Genius is eternal patience’

—Michelangelo

Happiness speaks through the eyes and the skin too. Mickey looked
like a fairy descended from heaven on her D-day. Her eyes emitted
graciousness, her lips oozed charm, her beautiful skin seemed like it
was radiating powerful positive energy from within and the joy on her
face made her look ethereal. When I went up to wish her, she gave
me the tightest hug and whispered, ‘Thank you, Dr J. You are my
angel.’ Mickey had followed my advice and done all the treatments I
had asked her to do like an obedient child.
Two months after her wedding, I saw her name in my appointment
list. Had she spoilt her skin by eating all the wrong things or basking
in the sun without sunscreen during her honeymoon, I wondered. But
when she walked into my chamber, she looked as radiant and
gorgeous as ever, with not a speck on her skin. She had even
carried all the supplements—sunscreen, moisturizer—to her
honeymoon as I had asked her to do. ‘Doc, I came to ask you if I
needed to continue my skin routine. My skin never looked so good
and I didn’t even tan as much on my holiday,’ she said. ‘Mickey, you
are a good child. Yes, of course you need to follow your routine. Skin
is lifetime maintenance. Pollution, sunlight, stress and other
aggressors aren’t going anywhere. They are right here to spoil your
skin if you don’t take care.’
I gave Mickey a list of products to be used in summer and another
list in winter. ‘Always remember, your skin requirement changes
according to the climate you are in,’ I told her. We made a checklist;
her must-use products were:

Cleanser
Make-up remover
Moisturizer
Sunscreen
Vitamin C serum
Under-eye cream
Body lotion

We revised the skincare drill she had to embrace—from healthy

food, good sleep and exercise to meditation and yoga. ‘Doc, I do eat
a lot of fresh fruits and green vegetables, drink more water and
coconut water. I have given up sugar and processed food. I can
already see the difference not just in my skin, my body feels lighter
too. I have begun brisk-walking for half an hour in the morning but I
sleep on Sundays. I also make sure I get my six hours of sleep,’ she
said. Superb, now all you have to do is follow this discipline for the
rest of your life.
‘Mickey, you will have to steer away from all the skin aggressors.
Remember, the repercussions are not worth the momentary thrill. I’ll
be honest, it isn’t going to be all that simple. It takes a little more
than slathering sunscreen or eating right. The modern-day dramas of
late-night parties, stress and pollution have to be tackled too. Make it
a rule to avoid alcohol, or drink occasionally and only if necessary.
Do not overindulge in smoking or drinking. Weed is not a fashion
statement, it kills you and your skin.’ Mickey and I went on a head-on
agreement.
These six weeks, my friends, were not just Mickey’s journey. It’s
the journey each one of us who desires to look beautiful from within
and on the outside should take. And please do not take care of
yourself to look good to others. You must look good to yourself and
exude confidence. I hope you will take baby steps and gradually
seep into the adulthood of flawless, graceful skin. An ounce of
prevention is worth a pound of cure. This dictum of life holds true for
our skin too. It is never too late for anything. Just like it is never too
late to begin a new venture, never too late to say sorry, never too
late to tell someone you love her, it is never too late to begin taking
care of your skin, even if you are a guy. You will be amazed at what
just a six-week routine can do to your skin. I do believe that we must
age gracefully. But ageing gracefully does not mean sun spots,
sagging skin and a haggard face.
I love to quote Coco Chanel in this context. She said, ‘Nature
gives you the face you have at twenty; it is up to you to merit the
face you have at fifty.’
Don’t wait for the assaults of pollution, stress and ageing to leave
their trail on the skin. You should make skincare part of your routine.
Just as you brush every day, bathe every day, comb your hair every
day, you must cleanse, moisturize and use a sunscreen every day
too. If you are good to your skin, it will remain loyal to you. Don’t
make it a few days’ wonder like the gym you joined and quit after
shedding those few pounds. You don’t need exotic treatments and
expensive creams. Trust me, committed holistic skincare will make
heads turn even when you are seventy. Let the beauty in your heart
and the beauty of your skin amalgamate to create a new ethereal
you.
My love and best wishes to all.
* C.A. Moyer et al, ‘Does Massage Therapy Reduce Cortisol? A
Comprehensive Quantitative Review’, Journal of Bodywork and
Movement Therapies 1 (15 January 2011): 3–14.
* Van Borsel et al., ‘The Effectiveness of Facial Exercises for Facial

Rejuvenation: A Systematic Review’, Aesthetic Surgery Journal 34,

no. 1 (1 January 2014): 22–27.
* J.K. Tan and Ketaki Bhate, ‘A Global Perspective on the
Epidemiology of Acne’, British Journal of Dermatology 172 (July
2015): 3–12.
* A.E. Nel et al., ‘Enhancement of Allergic Inflammation by the

Interaction between Diesel Exhaust Particles and the Immune

System’, Journal of Allergy and Clinical Immunology 102 (1998):
539–54; J. Krutmann, et al., ‘Pollution and Acne: Is There a Link?’
Clinical, Cosmetic an Investigational Dermatology 10 (2017): 199–
204.
* Alicja Kucharska, Agnieszka Szmurło and Beata Sińska,

‘Significance of Diet in Treated and Untreated Acne Vulgaris’,

Advances in Dermatology and Allergology 33, no. 2 (2016): 81–86.
* Alicja Kucharska, Agnieszka Szmurło and Beata Sińska,

‘Significance of Diet in Treated and Untreated Acne Vulgaris’,

Advances in Dermatology and Allergology 33, no. 2 (2016): 81–86.
* Nidhi R. et al., ‘Prevalence of Polycystic Ovarian Syndrome in

Indian Adolescents’, Journal of Pediatric and Adolescent

Gynecology 24, no. 4 (August 2011): 223–27.
* L.D. Thomas et al., ‘Ascorbic Acid Supplements and Kidney Stone
Incidence among Men: A Prospective Study’, JAMA Internal
Medicine 173 (2013): 386–88.
* C. Couppe, R.B. Svensson, J.F. Grosset, V. Kovanen, R.H. Nielsen,
M.R. Olsen et al., ‘Life-long Endurance Running Is Associated with
Reduced Glycation and Mechanical Stress in Connective Tissue’,
Age (Dordrecht, Netherlands) 36 (2014): 9665.
* A. Peirce, ed., The American Pharmaceutical Association Practical
Guide to Natural Medicines (New York: Stonesong Press Inc.,
1999).
* H. Bartsch et al., ‘Black (Air-cured) and Blond (Flue-cured) Tobacco
Cancer Risk IV: Molecular Dosimetry Studies Implicate Aromatic
Amines as Bladder Carcinogens’, European Journal of Cancer 29A
(1993): 1199–207.
† G. Monfrecola et al., ‘The Acute Effect of Smoking on Cutaneous

Microcirculation Blood Flow in Habitual Smokers and Nonsmokers’,

Dermatology 197, no. 2 (1998): 115–18.
‡ L.N. Jorgensen, et al., ‘Less Collagen Production in Smokers’,

Surgery 123, no. 4 (April 1998): 450–55; D.P. Kadunce et al.,

‘Cigarette Smoking: Risk Factor for Premature Facial Wrinkling’,
Annals of Internal Medicine 114 (1991): 840–44.
* H.C. Okada et al., ‘Facial Changes Caused by Smoking: A

Comparison between Smoking and Nonsmoking Identical Twins’,

Plastic and Reconstructive Surgery 132, no. 5 (2013): 1085–92.
† G.B. Fan et al., ‘Changes of Oxygen Content in Facial Skin before

and after Cigarette Smoking’, Skin Research and Technology 18,

no. 4 (2012): 511–15.
* H. Alinia et al., ‘Rosacea Triggers: Alcohol and Smoking’,

Dermatologic Clinics 36, no. 2 (April 2018): 123–26.

* A. Garg et al., ‘Psychological Stress Perturbs Epidermal

Permeability Barrier Homeostasis: Implications for the

Pathogenesis of Stress-associated Skin Disorders’, Archives in
Dermatology 137, no. 1 (2001): 53–59; M. Altemus et al., ‘Stress-
induced Changes in Skin Barrier Function in Healthy Women’,
Journal of Investigative Dermatology 117, no. 2 (2001): 309–17.
† N. Muizzuddin et al., ‘Impact of Stress of Marital Dissolution on

Skin Barrier Recovery: Tape Stripping and Measurement of Trans-

epidermal Water Loss (TEWL)’, Skin Research and Technology 9,
no. 1 (2003): 34–38.
‡ E.S. Epel et al., ‘Accelerated Telomere Shortening in Response to

Life Stress’, Proceedings of the National Academy of Sciences of

the United States of America 101, no. 49 (2004): 17312–15.
* P. Oyetakin-White et al., ‘In Effects of Sleep Quality on Skin Aging

and Function’, Journal of Investigative Dermatology (2013).

* A.O. Fernandez and A. Banerji, ‘Inhibition of Benzopyrene Induced
for Stomach Tumors by Field Bean Protease Inhibitors(s)’,
Carcinogenesis 16 (1995): 1843–46.
† U. Pöschl. ‘Atmospheric Aerosols: Composition, Transformation,

Climate and Health Effects’, Angewandte Chemie International

Edition in English 44, no. 46 (2005): 7520–40.
* A. Vierkötter et al., ‘Airborne Particle Exposure and Extrinsic Skin

Ageing’, Journal of Investigative Dermatology 130 (2010): 2719–26;

N.L. Mills et al., ‘Combustion-derived Nanoparticulate Induces the
Adverse Vascular Effects of Diesel Exhaust Inhalation’, European
Heart Journal 32 (2011): 2660–71.
† A. Vierkötter et al., ‘Airborne Particle Exposure and Extrinsic Skin

Aging’, Journal of Investigative Dermatology 130 (2010): 2719–26.

‡ R. Dales et al., ‘Quality of Indoor Residential Air and Health’,

Canadian Medical Association Journal 179 (2008): 147–52.

* E.H. Kim et al., ‘Indoor Air Pollution Aggravates Symptoms of

Atopic Dermatitis in Children’, PLOS One 10, no. 3 (2015).

 Acknowledgements

‘People who uplift you are the best kind of people. You don’t
simply keep them. You have to treasure them’
—Dodinsky

I want to first and foremost thank Shri Amitabh Bachchan from the
bottom of my heart for his golden words of appreciation for the book
and for being my sole inspiration in life.
I am eternally grateful to all the wonderful friends who have non-
hesitantly given testimonials for my book. It means a lot to me.
To Milee Aishwarya for reinstilling my faith that doctors can
become authors too.
To my lovely editor Gurveen Chadha for being the empathetic cop
who guided me patiently all along my tenure as the author. This book
would not have been possible without you.
To all those at Penguin Random House India who poured their
blood, sweat and tears into the making of Skin Rules.
To Pooja Mertia for being the amazing creator of the book cover.
To my patients for being my biggest inspiration. And for being
patient with me whenever I told them it would take more than six
weeks for their skin to recover.
To my friends for always standing up for me and being my genuine
ringmasters.
To my husband for being my punching bag for every snag and for
standing tall like my Tower of Pisa I can always lean on.
To my father-in-law, Pinky, Chetan, Archit and Piyali for being my
supporters all along.
To my sister who took over as brigadier of the Skinfiniti army and
wing commander in my kitchen at home. While I had no time for
anything but patients and this book in the last four months, she left
no stone unturned in making sure my new Skinfiniti clinic has the
swag. I moved in yesterday like a freshly appointed consultant.
To my adorable babies, Aarav and Giana, who were my sources of
periodic entertainment when I felt my brain going kaput.
To my brother Sai Karun and sis-in-law Mili for being the perfect
broadcast technicians whenever I wanted to chat with Giana just to
overcome my mental blocks while writing this book.
To my staff for building Skinfiniti cooperative association; they
have made sure I remain oblivious of any hiccups occurring at the
clinic.
A big, heartfelt thank you once again. I promise to treasure all of
you for the rest of my life.
 THE BEGINNING

Let the conversation begin…

Follow the Penguin Twitter.com@penguinbooks
Keep up-to-date with all our stories YouTube.com/penguinbooks
Pin ‘Penguin Books’ to your Pinterest
Like ‘Penguin Books’ on Facebook.com/penguinbooks
Find out more about the author and
discover more stories like this at Penguin.co.in
EBURY PRESS
UK | Canada | Ireland | Australia
New Zealand | India | South Africa
Penguin Books is part of the Penguin Random House group of companies
whose addresses can be found at global.penguinrandomhouse.com.

This collection published 2017

Copyright © Dr Jaishree Sharad 2018
The moral right of the author has been asserted
Jacket images © Pooja Mertia
ISBN: 978-0-143-44472-5
This digital edition published in 2018.
e-ISBN: 978-9-353-05326-0
This book is sold subject to the condition that it shall not, by way of trade or
otherwise, be lent, resold, hired out, or otherwise circulated without the
publisher’s prior consent in any form of binding or cover other than that in
which it is published and without a similar condition including this condition
being imposed on the subsequent purchaser.