Oily or dry? Solve your skin care dilemmas

Erin Wilson, 30, online advertising executive
Her self-diagnosis: Combination. “My face is dry, and I have rosacea, eczema, and occasional pimples. I wash with the same salicylic acid acne cleanser I’ve used since sixth grade, and during the day I use Cetaphil Daily Moisturizer SPF 15 — it’s one of the few SPF formulas that doesn’t make me break out.”

What the saleswoman told her: “The Clinique adviser at Saks Fifth Avenue in New York City recommended a cleanser and an oil-free moisturizer from the Redness Solutions line, designed to minimize flushing. Both felt cooling, which the saleswoman said would help my rosacea. She also recommended an SPF 40 sunscreen, adding that the SPF 15 I had been using was not enough.”

What the dermatologist says: “Erin’s main problem is actually her sensitive skin,” says Day. “She has some acne, and her eczema and rosacea are made worse by products that dry and break down the skin’s barrier, so I suggest products without fragrances, dyes, or potential for allergic reactions. A salicylic acid cleanser will help her breakouts and shouldn’t aggravate sensitive skin as long as she doesn’t use it every day in the winter. But she should switch to a 0.5 percent concentration of salicylic acid every other day or even once a week. All other times, I recommend a gentle cleanser like the Clinique one. Erin’s combination of acne and eczema warrants something stronger than OTC products. That’s why at night, she should first apply prescription EpiCeram, which will soothe her eczema by repairing her skin’s barrier, then a gentle prescription retinoid, such as Atralin. Follow that with a rich, creamy moisturizer on top.”

Mary-Katherine Ream, 22, recent college graduate
Her self-diagnosis: Changes seasonally/sensitive. “My skin turns warm and red when I use a new product, and it gets very dry when it’s cold and oily when it’s hot. Right now, I’m using a creamy cleanser, a rich moisturizing cream, and a firming eye cream to prevent wrinkles. Once a week, I do an exfoliating peel.”

What the saleswoman told her: “At the Lancôme counter at Macy’s in Chicago, the consultant demonstrated the Diagnôs Expert machine, which took close-up pictures of my face and gauged how my pore size, brown spots, oil production, fine lines, and firmness compared to that of other women my age. The machine said that I had very small pores, no sun spots, an oily T-zone, extremely oily cheeks — and the lines and wrinkles of a 37-year-old! I would’ve freaked out, but my consultant explained that my skin is dry and that’s why my wrinkles look worse. She recommended a deep-cleansing oil that she said wouldn’t upset my sensitive skin, an alcohol-free toner to reduce redness, an antioxidant serum, and a rich SPF 30 moisturizer with antioxidants to prevent further aging. She also suggested a home microdermabrasion kit, which she claimed would even out my skin tone and make my face glow.”

What the dermatologist says: “The fact that Mary-Katherine’s skin changes seasonally means she has to change her products accordingly,” says Waldorf. “I really like the Lancôme cleansing oil for winter and a milder cleanser like Cetaphil for the warmer months. It’s very important that any day cream she use contain sunscreen, especially since it looks like Mary-Katherine may have early rosacea. A product like Aveeno Ultra-Calming Daily Moisturizer SPF 15 will help even out her redness. I don’t think that she has the significant wrinkling that the Lancôme machine said she did, and I wouldn’t recommend a toner or a scrub, which could actually make her face more red.”

Serena Berra, 36, advertising brand planner
Her self-diagnosis: Sensitive with breakouts. “I’m allergic to the fragrance in many skin-care products, so I spend a lot of time in stores reading through all the ingredients. I’m amazed how many products are labeled ‘sensitive’ but still include a fragrance. I used to take Accutane for acne, and though it has mostly cleared up, I sometimes get breakouts, so I cleanse with a foaming wash and occasionally use a home alpha hydroxy acid peel. I also still have a lot of hyperpigmentation left over from previous acne.”

What the saleswoman told her: “I went to Sephora in New York City and told the skin-care expert that I like my cleanser but that it never quite gets all my makeup off, and she recommended a foaming cleanser from Cosmedicine. She suggested Ole Henriksen Skin Insulator SPF 15 moisturizer because it has sunscreen, and an Ole Henriksen pigment-lightening serum with vitamin C and mulberry to gently lighten my acne spots. She also led me to a Fresh clay mask, which she said would detoxify my skin — whatever that means — and an Ole Henriksen acne spot treatment that contains zinc instead of benzoyl peroxide, which she said was too drying for me. She really seemed to know what was fragrance-free and what wasn’t, and when she wasn’t positive, she offered to look up the products’ ingredients.”

What the dermatologist says: “Serena’s skin is probably not truly sensitive, but she does have a fragrance allergy that can leave it irritated,” says Day. “The allergy also makes it tough to treat her acne, scarring, and hyperpigmentation because the majority of products contain scented ingredients. Her current products are fine, but if she wants to combat breakouts and pigmentation more dramatically, I’d recommend applying prescription Tri-Luma every other night under her current moisturizer. Tri-Luma contains the pigment blocker hydroquinone, tretinoin to exfoliate, and a gentle cortisone to prevent irritation. Exfoliating with her home peel once a week will also keep her skin clear, and of course sun protection is key to keeping her hyperpigmentation from worsening. I liked the regimen Sephora recommended because it addresses both acne and excess oil. And the Skin Insulator’s grape-seed oil and vitamin C may help even out her skin tone and prevent future damage.”

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