Your Skin Health Questions Answered

We asked Dr. Tieraona Low Dog, member of Pharmaca’s Integrative Health Advisory Board, to weigh in on some of our customers skin health questions. Here’s what she has to say about creating a clearer, more radiant complexion.

What can I do to minimize wrinkles?
The two most important things you can do to prevent wrinkles: Avoid excessive sun exposure and don’t smoke. I always recommend sunscreen on the face, neck, ears and top of head (especially for balding individuals) if spending more than 10 minutes in the sun. Though we need some sun exposure for creation of vitamin D, too much can damage the skin and increase our risk for skin cancer.

Next, hydrate, hydrate, hydrate. A pure, clean moisturizer (i.e. without all the nasty chemicals) is your very best friend when it comes to reducing the appearance of wrinkles. At the same time, make sure you don’t overdo face washing, as it can strip away the natural oils in the skin. I always recommend using a soap with moisturizer or a natural skin care cleanser that is designed for sensitive skin, as these are usually less harsh and drying.

As far as nutrition, make sure you’re getting those omega-3 fatty acids in your diet, either by eating cold-water oily fish or taking 1,000 mg of fish oil (EPA/DHA) every day. And a diet rich in vegetables and fruits (with a low glycemic load) will provide you with all the antioxidants you need for healthy skin.

Retinoids are one of the most common treatments to reduce the appearance of fine lines and wrinkles. Tretinoin (RetinA) is the only FDA-approved treatment for wrinkles, but can be highly irritating to the skin. In its place, retinol, a natural form of vitamin A that’s available in many over-the-counter products, can also be highly effective and is usually better tolerated on the skin. Tretinoin and retinol increase the skin’s capacity to hold water by stimulating the synthesis of glycosaminoglycan and collagen.

Other options include alpha hydroxy acids, natural fruit acids that remove the top layer of dead skin cells, reducing the appearance of fine lines and wrinkles and stimulating the production of collagen. Topical vitamin C may also be helpful.

What are the most important things I can do to maintain youthful-looking skin?
In addition to the above recommendations (don’t smoke, protect your skin from excessive sun exposure, etc.), make sure you use a gentle cleanser and moisturizer every day. Look for a moisturizer that meets the needs of your skin (e.g. dry, sensitive). In addition, a gentle exfoliant once a week can remove older skin cells and brighten/freshen the appearance.

It’s also critical to focus on your diet if you want to look beautiful both inside and out! There is very strong evidence that all the sugar in our diet contributes to the formation of advanced glycation end-products (AGEs), which bind and damage the collagen and elastin in skin. This is what makes the skin sag, lose tone and take on a lackluster hue. You can see early signs of this process when you look at the skin of a 45-year old who’s smoked for 25 years.

If you want your skin to remain healthy and youthful in appearance, I recommend a low-glycemic load diet. The New Glucose Revolution by Jennie Brand-Miller is an excellent way to learn how to change your diet to reduce your risk of obesity, diabetes, heart disease and even certain cancers. This dietary pattern will also keep your skin radiant!

What are the best treatments for acne?
Acne is caused by hormonal imbalance, which leads to an overproduction of sebum that plugs follicles, creating an environment conducive to the overgrowth of bacteria. Plugged pores (blackheads and whiteheads), pimples and even deep cysts can develop on the face, neck, chest, back, shoulders and upper arms. Acne is often present in teenagers due to fluctuating hormones, and many women complain of acne during the menopausal transition. Sometimes chaste tree berry (Vitex agnus castus) can be useful for reducing acne at doses of 300-500 mg taken each morning.

There are several vitamins that are very important for skin health when it comes to acne. Niacin (50 mg) and zinc (30 mg/d) reduce inflammation and have been shown to reduce inflammatory acne. Because zinc can deplete copper, make sure to add a supplement that provides 1 mg of copper per day.

On a daily basis, wash the skin gently and thoroughly. If you wear makeup, use products that are hypoallergenic and fragrance free to reduce irritation and outbreaks. Topically, tea tree oil has been shown to be equivalent to benzoyl peroxide and better tolerated. Another of my favorite topicals is neem oil/cream. As a potent antibacterial, it often works when other topicals fail. And salicylic acid is often added to topical products as it can also reduce acne breakouts.

Blue light therapy is an FDA-approved treatment for acne and is quite safe. The blue light destroys the bacteria inside your skin pores. This therapy is painless and is done in eight sessions of 10-15 minutes each at a dermatology clinic over a period of four weeks.

If these types of therapies don’t work, a physician/dermatologist can prescribe tretinoin and/or antibiotics, depending upon the severity of the acne. Isotretinoin (Accutane) is extremely potent, effective and also dangerous. Women must be extremely careful not to get pregnant while taking the drug as it can cause birth defects.

What can I do to minimize or erase liver spots?
What are often called “liver” spots are actually areas of hyperpigmentation on our skin—they have nothing to do with our liver. These dark spots are most commonly a result of a condition known as post-inflammatory hyperpigmentation (PIH). When inflammation occurs in the skin, a melanocyte-stimulating hormone is released, which then releases the enzyme tyrosinase, which converts tyrosine to L-DOPA, which then stimulates melanocytes to release melanin. That’s why many of the skin-lightening products for PIH contain ingredients that block tyrosinase, thus preventing the continued release of melanin, the pigment found in skin that causes it to darken upon exposure to ultraviolet light. PIH can occur in anyone, but is more common in individuals with darker skin because of their skin’s enhanced ability to produce melanin.

Treatments that have been shown to lighten dark spots include topical agents like hydroquinone, mequinol, azelaic acid, kojic acid, licorice extracts, niacinamide, and retinoids. Some natural products also contain soy protease inhibitors, which have been clinically shown to lighten skin (though whole soy and soy isoflavones have not been shown to be effective).

The best way to prevent hyperpigmentation is to avoid excessive inflammation and irritation. That means protecting the skin from sun damage, and eating an anti-inflammatory diet low in sugars, processed foods and rich in vegetables, nuts and fruits. Also consider taking omega-3 fatty acids (1000 mg EPA/DHA) and other herbal anti-inflammatories like turmeric and holy basil.

Ultimately, your best strategy for skin health is a low-glycemic diet, good sun protection and not smoking. A daily multivitamin can fill in any nutritional gaps in your diet. If you are struggling with a skin condition that is not responding to over-the-counter treatments, make an appointment to see a dermatologist who can offer more in-depth guidance.

Dr. Low Dog is an internationally recognized expert in the field of herbal medicine and integrative approaches to women’s health. She is currently the Fellowship Director at the Arizona Center for Integrative Medicine and Clinical Associate Professor of Medicine at the University of Arizona Health Sciences Center. Find out more at

1 Comment

  1. Very complete post as it gives good advice at several levels, from diet to topical creams. To treat acne, you can also use homeopathy which is very safe. For example, I have seen great results with “Kalium bromatum” in teenagers. Thank you!

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