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Cleansed: Podcast Transcript

Anita Rao
My skincare journey got off to a good start before I could even speak. As a tiny baby in India, I got a full body massage with coconut oil at least once a day. That princess status didn't last for long, but as a young kid, I was always on top of moisturizing. As a teenager, I dodged acne and terrible breakouts and thought I was in the clear skin wise. And then eczema hit me like a ton of bricks. Dry, itchy patches of skin appeared on my face, head, arms and legs, and in my search for a solution, I found myself down a skincare rabbit hole. And I started to wonder what's the real story when it comes to skincare? And how do we separate the essential information from all of the noise?

This is Embodied: our show about sex, relationships and your health. I'm Anita Rao. The skincare industry has been blowing up in recent years. The global skincare market is projected to reach more than $200 billion by 2026. At the grocery store and down the aisles of pharmacies, we're bombarded by countless cleansers, creams and serums for our skin. But putting a fresh face forward is not as easy as it looks, and we are ready to get to the bottom of it.

Dr. Chesahna Kindred
As an organ, we have to recognize that the skin's job is not to look pretty. The skin's job is to protect us from the outside environment — and pretty much if it's doing its job, we really shouldn't have it at the top of mind.

Anita Rao
Dr. Chesahna Kindred is a board certified dermatologist at the Kindred Hair and Skin Center in Maryland. Our skin is the biggest organ in our body, and she says that reminding yourself of that fact can help you get back to the basics of how to protect and take care of it.

Dr. Chesahna Kindred
This is something I discuss day in and day out. So, number one, particularly for the face is a moisturizing sunscreen, SPF 30 or higher, broad spectrum, water resistant, antioxidants — very important. The second, particularly once we hit our 20s or even 30s, is a really good vitamin A cream or retinoid. And then for the body, a lotion that contains the protein ceramide, which helps to act like a sealant into the skin.

Anita Rao
Moisturizing certainly makes you soft and supple, but it's also how you keep your skin's protective layer working properly.

Dr. Chesahna Kindred
There's several reasons why we want to moisturize. The skin can get so dry that it triggers the skin to make excess oil, and that can be a problem for patients with acne. Patients with overproduction of yeast that leads to a folliculitis — definitely for our kiddos and our patients with eczema — moisturization is very important, and it's also a lot related to which type of climate we're in. We firmly believe you have to moisturize every winter. [It's] very important, but if you live in an area where there's a lot of humidity, sometimes it's not quite as critical. And we kind of switch from saying moisturize to hydration — and what's great, there are hydrating serums that contain hyaluronic acid. So, between moisturizing and hydrating, there's something for everyone, and it helps to prevent certain conditions down the road.

Anita Rao
I take moisturizing very seriously, but I am notoriously bad at what most folks agree is skincare step one. Before you moisturize, you've got to cleanse.

Anay Castro
Every day, you know, we apply things to our skin, so you do have to cleanse it. With makeup products that we apply, cleansing is important, you know, it's kind of like starting fresh and making sure that the canvas is ready to receive whatever you put on it.

Anita Rao
Anay Castro is a certified physician's assistant at the North Carolina Center for Dermatology. I asked her if I really needed to be washing my face twice a day, especially because I'm not a big makeup wearer. Her answer: Yep. Because you have residue from your own skin shedding, sweat and more. Point taken. So, we've got cleansing and moisturizing. Step three, that 11 out of 10 dermatologists recommend, wear your sunscreen and not just outside the house.

Dr. Chesahna Kindred
Sunscreens protect the skin from the sun. Two ways: one, is just physically acting as a shield, and the ultraviolet radiations bounce off of the sunscreen. The second way is chemically. They convert the radiation into a harmless matter such as heat. Sunscreen is that little, tiny bit that we can do every single day that makes a huge difference in the long run. And that's why we just tell everyone to put it into your facial moisturizer. It helps protect from skin cancer. It helps reduce the development of wrinkles. It helps to reduce the breakdown of collagen, so that we don't get the sagging that tends to afflict us after you hit a certain age. It also helps to protect against discoloration and dark spots, etc.

Anita Rao
So, when you start looking into sunscreen it can get overwhelming. Quickly, you hear about mineral or chemical; UVA rays and UVB rays; SPF. So is there kind of a short spiel that you provide to people to orient them to the kind that they should choose, and kind of the bare minimum daily facial sunscreen that most folks should be wearing?

Dr. Chesahna Kindred
SPF 30 and antioxidants is the bare minimum in your moisturizer. If you want to get fancy, you want iron oxides. Iron oxides protect against the blue light that we get from our cell phones, tablets and computer screens.

Anita Rao
Okay, you've got to break down that one, because I did not know until yesterday that blue light from our screens can cause skin damage. So, what on earth is going on there?

Dr. Chesahna Kindred
I don't think it's anything anyone anticipated. It's something we're aware of from cell phones — when we start to see a peculiar type of discoloration on some of our patient's skin, particularly patients with skin of color. The blue light can really damage the collagen and age our skin, and it appears as though it may be the case more so in patients with skin of color than our patients with lighter skin, believe it or not. It's a thing we have to pay attention to, so another reason to reduce our screen time.

Anita Rao
Anay, when we talk about sun exposure, one of the questions that comes up is: Okay, like I get that I should be wearing daily moisturizer on my face that has SPF, but I still want to get vitamin D — I know vitamin D is good for me. So, does wearing sunscreen change if and how our skin absorbs vitamin D? Is that a question that you get often?

Anay Castro
No, not typically. But, you know, if you are walking outside, you know, I don't know for 30 minutes and you use sunscreen, I mean you still absorb vitamin D. Sunscreen doesn't protect you absolutely, you know 100%. So the answer is: Yes. You can wear your sunscreen, and you will still absorb your vitamin D.

Anita Rao
So Chesahna, what are your thoughts around vitamin D and sunscreen?

Dr. Chesahna Kindred
While we certainly need the sun to help us make our own vitamin D, the best, best, best source of vitamin D is actually through our foods. The second best source is through vitamin D supplements. The third source is through the sun. And studies have shown that if you're low in vitamin D, and you increase your sun exposure without sunscreen, it does not bring your vitamin D levels to normal, but it does increase the risk of aging and skin cancer, so avoiding sunscreen, simply is not the way to normalize vitamin D levels.

Anita Rao
And should we be wearing sunscreen all over our body everyday if we're not necessarily spending a day sitting out at the beach — we're just, you know, out walking our dog for 30 minutes or an hour? Is that enough exposure that we should be wearing sunscreen on like our arms and our legs?

Anay Castro
Well, it depends, you know. When I ask about sunscreen to my patients, I take into consideration the patient's culture, too. Okay, so, you know there's people that actually wear protective clothing — there are clothes now that block UV radiation. If you wear a hat, if you wear big sunglasses, a person — woman or a man — who are Muslim, they don't show a lot of their body, so I try to be mindful, you know, of other patient's culture, so I don't penalize them all the time for not wearing sunscreen. I do always emphasize that in the areas that usually stick out , you should wear sunscreen as much as possible. If you're walking your dog, I would say that the areas that are not covered, you should wear sunscreen. Is it going to be detrimental if you forgot for like 20 or 30 minutes? I don't think so. But you should make it a habit.

Anita Rao
That's a great point. That it's not necessarily sunscreen or not, but it's: Are you wearing a hat? Are you wearing protective clothing? Are there other layers that are shaping how the rays may get to your skin? And I guess that kind of brings me to this question of one of the misconceptions — which I was subject to as a kid — my father is Indian and never wore sunscreen his entire life and pretty much had the philosophy that we have enough melanin, we don't need to wear sunscreen. So I didn't wear it until probably my 20s, which, I know, is not great. But Chesahna, this is a pretty common misconception that the more melanin you have, the less sunscreen you need. Can you tell me what the truth is in that and what you want folks to know?

Dr. Chesahna Kindred
Absolutely. So, African Americans, for example — I'm not sure what shade your father is —have a natural SPF. Some reports say they're SPF 13. Some say eight, but the minimum is 30. Days when the minimum was 15 [are] long gone. What we're able to get away with is: sun isn't the greatest factor when it comes to skin cancer. Studies show that when Blacks get skin cancer, we get skin cancers on our feet and our nails, and very rarely do we get one say, on the head. Sun protection doesn't play the most critical role there. However, regardless of what our melanin content is, sunscreens prevent the signs of aging, so we all could benefit from sunscreen.

Anita Rao
Both of the professionals agreed that nailing down the basics of cleansing, moisturizing and SPF will take you a long way toward healthy skin. But what products work, how much time it takes and how it makes you feel? That depends on who you are.

Celeste
What I like about my skincare routine is that it wakes me up in the morning, and it works. As soon as I wake up, I have to wash my face and put on my moisturizer. Otherwise, I still feel super sleepy and super groggy. It's like I cannot start my day until I wash my face and put on my moisturizer.

Nick
It makes me feel like I have a routine — like a ritual. And as a guy, I don't feel like there are many opportunities to really pamper yourself, or maybe that's looked down upon in some ways by our broader culture. So, even to have something for my skin on top of shaving — taking the time to really get my face to look the way that I would like it to look is nice and reassuring in some ways.

Michelle
When I finish my routine, I look like I'm glowing from the inside. And I honestly think it's because I just took that time for myself and said: No, I'm doing this. And there are days when I feel so busy, and I can't do it. And then I put my foot down, and I say to myself: Dammit, if you can't take 10 minutes for yourself, really seriously, you need to reprioritize your life.

Anita Rao
That's Celeste, Nick and Michelle. The amount of time and effort I've wanted to spend treating my skin right has ebbed and flowed as I've gotten older. And with each new decade comes new messaging about what I should be doing to keep my skin looking younger. There are definitely some red flags for me around all of the anti-aging skincare messaging and how unwilling we are to let women age in particular. But, aside from the purely cosmetic stuff, Anay told me that biologically, our skin does change over time — and that's important to keep in mind as we're learning how to take better care of it.

Anay Castro
We lose collagen, you know, our production of collagen decreases exponentially. And, you know, therefore we get more wrinkly. In addition to that, you know, we get bone resorption. Our fat pads tend to atrophy. So, you know, those are all kind of like [the reasons] why we look a lot older -

Anita Rao
And hormones, right? Like how much our hormones change?

Anay Castro
Yeah, hormones play a huge role in that. Absolutely.

Anita Rao
Yeah, I mean, it brings me to this question of, you know, beauty standards and how historically — and in so many ways today —clear skin and fair skin are really prized in Western beauty standards. So, I'm curious for you, Chesahna, as someone who sees folks daily who present with various concerns, how do you balance helping people with their skin health, while kind of recognizing the ways that our beauty standards are flawed and racist and really have prioritized a very particular look over time?

Dr. Chesahna Kindred
Such a key point for us to discuss. So, for patients with hyperpigmentation — say they had acne, [which] led to dark spots, or a patient with melasma. I have 101 things that can help from lasers, chemical pills, bleaching creams, etc. But we have a goal, and the goal is to bring their skin tone evenly back to its original color. We do not lighten skin past their original color. What's great is there tends to be more of a embrace of those with skin of color of loving their skin again. So, the battle in certain cultures, as a couple of cultures were still a little bit tough, but most cultures now are embracing it. And so, the battle is milder and sometimes non-existent, compared to about 10 years ago, thankfully.

Anita Rao
Embrace the skin you're in. It's a phrase that somehow makes it into almost every Embodied episode. And here, I mean it literally, because 70% of how your skin looks is genetics and not in your control.

Dr. Chesahna Kindred
I think that helps to set the balance between what treatment needs to be done, right, because they came in for me to help. But, then also that: We have a certain expectation. We have a goal, and we can reach it. And we have to point out that: Nope, this is your skin. This is your genes, and it's beautiful. But, yes, we can clear up some of these dark spots to get you back to the natural you.

Anita Rao
This perspective is even more important when it comes to cost and accessibility. Protecting our bodies biggest organ shouldn't break the bank. One of our listeners, Kathleen, has been wrestling with the high price tag of skincare routines for a while.

Kathleen
My experience, in relation to skincare routines, has been kind of interesting, because that term itself connotes a lot of things about class and gender expectations. A friend I made in graduate school — who was a first generation college attendee — had been asked by other people in her dorm what her skincare routine was. And, of course, she being new to all this, was just a little overwhelmed by the question. And it really points out the class differences, because she needed to afford more than a bar of Ivory soap. Certainly, I experienced the same thing when I went off to boarding school, and it seemed like every other student in the dorm had a full set of Clinique lined up in their bureau. So, [the] skincare routines term, especially, I think in adolescence, becomes a statement itself and through that a reflection of who you are in society.

Anita Rao
I agree with Kathleen. It is important to take a real pause before you take out a line of credit to buy all the products on the shelf. But, I know that as a consumer, it is so confusing. Dove bar soap, for example, is cheap, easy and good for my eczema-prone skin. But then when I try to figure out what moisturizer to put on top of it, I quickly find myself wondering if the drugstore brand is just the same as the thing that seems similar but has a much higher price tag. The medical professionals gave me the insight I needed to feel scientifically informed, but to be an informed consumer and Googler, I wanted to talk with someone deep in skincare product marketing.

Leo Louie
If I had it my way, and I had, I don't know, a fairy godmother. And I had one wish. I would say get rid of all of it.

Anita Rao
Leo Louie is a beauty and skincare industry professional. He's done everything from working as a Sephora brand representative to writing articles for the website Beauty Tap. He started looking into skincare the same way many of us do — because of troubling skin issues of his own.

Leo Louie
I kind of got started off on everything when I was in like high school, and it's very typical story for a lot of us. Like I started breaking out, except my breakouts weren't quite like my friends. Like my friends were like: Oh, I have a pimple. Next week: I have another pimple. And meanwhile my entire jaw line is like exploding moderate cystic acne. And it's like hurting, and it's all red, and it's bumpy. And I was like: If that's a breakout, then what is this? What's going on? So, that's what kind of kicked me off into looking into how to treat my own skin at home. And then it kind of opened up into, I don't know, Alice in Wonderland. I don't know, I fell into this vortex, which is lovely.

Anita Rao
You wrote this amazing piece about your personal skincare journey and various missteps along the way. And one of the things I noticed come up over and over in your piece was kind of your tendency to go all out in hopes of perfection. And I think that's something that I can certainly relate to, you know. You have this problem, and you want to solve it, and you kind of go to the extremes of researching the ends of the internet. So, I'm curious, kind of, as you have come to be this informed consumer and this writer, what are the things about your skin that you've kind of come to accept and not fight to correct? And how do you figure out where to focus your energy?

Leo Louie
You know, that is such a common thing. I feel like when I was working in major beauty retailers, and I'd be doing education and product launches for staff members, VIP events, and then you know, just your typical client walking in on any given day of the week, I would get so much like: What's the strongest thing you have? What's the most effective thing? What is the highest percentage? How do I get this done the most quick way possible? And I understand that want and desire to be like: Oh, I really am not a fan of this. How do I make it go away as quickly as I can? But, I think we kind of all know that there's no quick solution to really anything, and so, it's been a complete 180 for me in terms of just learning to take my time and really get to know how my own skin reacts to certain things, as opposed to taking the advice of someone who wrote an article online, or someone who just decided to have a YouTube video up saying: This is what your skincare routine should be, because you can take advice from other people, but you can't adopt what other people do and expect the same result. You know what I mean?

Anita Rao
Totally. And I want to go to that question of how things are marketed and the ways that gender comes into that picture. My partner, you know, barely wears moisturizer let alone anything else. And I think in part this is because of how skincare is talked about. It's very feminized in our language around it in the marketing, and I know that's something that you have thought about. So, tell me a bit more about what you've noticed about how skincare products are marketed to men and men's relationship with the skincare market.

Leo Louie
The layers are so deep. But, you know, like you said, a lot of skincare is very marketed towards women. And [it uses] a lot of feminine imagery and a lot of feminine marketing tactics, and a lot of it is for women — is what the implication is. And I think that sort of societally because, at least in the West, we're taught to prize masculinity and men for no real reason, in my opinion. It turns into a situation where you have to have this like separate for men line, you know what I mean? There would be so many times where I would have men come in, and they'd be like: Oh, I'm looking for skincare. Or: I'm looking for this. And I'd lead them over to where all the skincare is, and be like: Oh, let's talk about what you've got going on. What brings you in today? And they're like: Oh, no, I'm looking for the men's stuff. I need the men's stuff. And it's like: Skin is skin. There are some studies, and there has been a little bit of evidence, to show that overall men may have slightly thicker skin than women do — just in terms of the outer layers and whatnot. But at the end of the day, a product is a product, and skin is skin, and anything can work for anybody, regardless of what their gender or gender expression or sex is. It really just doesn't play a factor. I'm more concerned about what's actually happening with you as an individual.

Anita Rao
And I mean, do you have any advice for men who are kind of interested in skincare but don't know where to begin dabbling because of the way that products are marketed to them? You know, it's kind of like the shampoo thing. Like, you can't have shampoo and conditioner, you have to do like a two in one. And with skincare, for men, it's like a three in one. So, how can folks step away from that and actually become informed consumers when the market doesn't necessarily treat them as such?

Leo Louie
You know, it's just so different. I live in America, and I grew up here and went to school here for most of my life. My family's Korean. Korean is my first language, and I was born in Korea. And so, even when you look at the difference between the two types of societies — like there's a lot more acceptance of men being interested in beauty and using skincare and makeup in Korea — but, even there, there's like a layer of like: Oh, but you use the three in one like: serum, moisturizer, whatever — all put together. And it's all about simplicity and being quick and being fast. Because I feel like, unfortunately, that there can be a lot of societal consequences for someone who presents as male or a cisgender male. There can be a lot of societal consequences for them expressing interest in beauty, or wanting to engage more deeply with their appearance and the beauty industry. You know, that makes it really difficult to just say: Don't be afraid. Just go try whatever you want. Because there's so much behind that. I think a good way would be to — if you have no idea what what to do with your skin. You have no idea where to even begin forming a skincare routine — I would say, in your own private time, go on social media. You can go on Instagram. You can go on YouTube — like I said earlier: Don't copy anyone's routine. But just look at videos and look at content creators that are of all genders; of all sexes; of all races — and just consume what you can, just so you know what's being talked about. And you can get your bearings a little bit before you start finding your own way.

Anita Rao
The thing about all this, too, is I think it's so easy to get yourself twisted into a pretzel, because you can get conflicting advice from people if you're not an informed consumer. I once got a facial from someone, and she told me that I should only be using things on my skin that I could eat. And I was like: Oh boy, like I'm not going to start eating my moisturizer! So, I mean, I'm curious about that, and now there's all of this — like clean beauty trends and make sure all of your products are clean. So, as someone who kind of does that research, how do you go about deciding what products to use and not use [and] where to draw the line, because there isn't a ton of regulation over skincare products. The FDA doesn't really have a huge role in determining what's on the shelf, so how do you go about determining what to use and not use?

Leo Louie
Yeah, it's such a deeply personal thing. You mentioned food. I also agree — please don't eat your moisturizer. But, you know, it's kind of like food — where that's another area that's really deeply personal in that people have a lot of opinions about what you should and shouldn't be doing. And I kind of approach it sort of the same way in regards to the fact that like, you know, like you just mentioned, the clean, green beauty thing is sort of like the hot topic right now. And even major retailers are putting little stamps on products that are clean approved. And it's like: That doesn't mean anything. Sometimes the lab-made stuff is better than what's natural. And sometimes it's the other way around, you know, so I know that's not like a clear-cut answer that's easy for people at home or just looking at the skincare aisle at Target to digest and apply. But, I think where you really just have to make choices of what you're comfortable with. And just stick to, like I said, a real kind of step-by-step approach of having one goal in mind; finding ways to achieve that one goal; trying one thing at a time, and then slowly adding from there. And realize that, past a certain point, we're here to just have fun. But, nothing is a "must-have you cannot live if you don't do this" type of thing with skincare. Outside of applying sunscreen. I will say: That, you really, really should do.

Anita Rao
That brings me to the fact that the skincare industry really markets to people's insecurities. And that kind of marketing and language can go a long way in shaping consumer choices. So, are there things that you really want to push back on? You said: Yes, SPF, go for that. But, are there kinds of messaging trends and things in the industry that you want to push back on as someone who is in the industry yourself?

Leo Louie
I mean, so much of the marketing stuff gets so harmful, and it can get almost mean. It can get very classist. It can get very elitist. And it just turns into like: Oh, well if you don't have this, then you're not going to have the best skin. And everyone wants the best skin. And, you know, you want pore-less skin. I've always seen: You want glass like skin, which is a term that's been co-opted from Korea and now doesn't mean what it used to at all. The marketing people who are essentially just trying to make money, break down that idea of perfection and chase it in so many different ways. Like you said earlier, whether it's: Oh, this is great. This is clean. This is made from this type of algae that you've never heard of, but you really need it in your routine or else you're going to look old — is basically the subtext that you get. You really need to use this new acne medication, or else your skin's never going to be clear.

And I would say, you know, do your best to insulate yourself from those types of ideas. Of: If I don't do this, I will never achieve this, and therefore I will never be good enough. I will never be satisfied. I will never be pretty. Because it's not realistic. I would say all the time — because one of the most frequent questions I get is: What is the best moisturizer? What's the best retinol I can use? And there is no best. Because there's so many nuances to creating a skincare product and the formula, and so many things can change how it works for you, and your environment, in your age group, with your current skin condition. There's no way to test for all those things, because if there was one 'best,' then you would walk into like a Sephora or an Ulta, and there would be one bottle in the center of the store on one shelf, and everyone would just go buy that. And we'd go home, and we'd all look like supermodels. I think you just have to understand, like: How much of a commitment do I want to make to this? You know, is this something that I personally enjoy? Or is this a utilitarian thing? And figure out where you want it to fit in your life first — and then, hopefully, you know, you have access to a friend or derm — someone like me that spends way too much time doing beauty stuff — that can help sort of point you in directions for things for you to try and see how you feel about.

Anita Rao
Wash your face. Moisturize. Wear your SPF. And if things get too complicated, just take a note out of Leo's book: It's all about making you feel most comfortable.

Embodied is a production of North Carolina Public Radio WUNC: a listener supported station. If you want to lend your support to this podcast and WUNC's other shows on-demand, consider a contribution at wunc.org now. Incredible storytelling like you hear Embodied is only possible because of listeners like you.

Kaia Findlay produced the show with support from our intern Anthony Howard. Amanda Magnus is our editor. Lindsey Foster Thomas is WUNC's Content Director and Jenni Lawson is our sound engineer. Quilla wrote our theme music.

The show is also supported by Weaver Street Market, a worker and consumer owned cooperative selling organic and local food at four triangle locations in North Carolina. Now featuring online shopping with next day pick up: weaverstreetmarket.coop. Follow Embodied on Instagram or Twitter to get a preview of every topic we're going to talk about,and hear the stories that we want to gather from you. We're at EmbodiedWUNC. I'm Anita Rao — taking on the taboo with you.

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