Skincare for Teen Boys: Advice from a Top Pediatric Dermatologist with Dr. Sheilagh Maguiness

About this Episode

Why are there so many skincare products marketed to tween and teen girls but so few for boys? What should teens look for on a label—and what should they avoid? How much do hormones, diet, stress, and age play a role in acne? What are the latest treatments for acne, eczema, and psoriasis? If you’re curious to learn how to help your tween or teen prevent or treat acne, or whether things like Accutane, toners, retinols, or sunscreens are recommended by skincare experts, tune in and take notes! On this episode, one of the country’s top board-certified pediatric dermatologists, Dr. Sheilagh Maguiness, joins Dr. Amy and Sandy to offer straight-forward advice on all things skin related. From babies and kids to teens and adults, Dr. Sheilagh is engaged in the most cutting-age science behind products we use to clean, treat, moisturize, protect, and beautify our skin—and she’s “clearing up” the misconceptions that many of us have believed for years.

About Dr. Sheilagh Maguiness

Dr. Sheilagh Maguiness is Associate Professor of Dermatology and Pediatrics at the University of Minnesota. She has a busy academic practice in Minneapolis and serves as the President for the Society for Pediatric Dermatology this year. Dr. Sheilagh is also co-founder of Stryke Club, a personal care brand for boys, and she is mom to two tween boys herself.

Connect with Dr. Maguines

Website: www.StrykeClub.com

Instagram: @Dr.ghgh.M

TikTok: @DrSheilagh

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Read the transcript for this episode:

DR. AMY: Hi, smart moms and dads. Welcome to another episode of the Brainy Moms Podcast, brought to you today by LearningRx Cognitive Skills Training Centers. I am your host, Dr. Amy Moore, joined by my co-host, Sandy Zamalis. Hi, Sandy.

SANDY: Hello, how are you guys?

DR. AMY: I’m fantastic today. Sandy and I are really excited to bring you a unique conversation on a topic that we have not addressed before. So our guest today is Dr. Sheilagh Maguiness. Dr. Sheilagh is a double board-certified dermatologist and pediatric dermatologist and associate professor of dermatology and pediatrics at the University of Minnesota. She has a busy academic practice in Minneapolis and serves as the president for the society at for pediatric dermatology. Dr. Sheilagh is also the co-founder of Strike Club, a personal care brand for boys. And she’s also a mom to two tween boys herself. She strives to educate the next generation of dermatologists and pediatricians in her practice and teaches families and caregivers through content created for national pediatric and dermatological societies and her social media presence. And we are super excited to have Dr. Sheilagh with us today to talk specifically about skin care. And we’re going to focus on boys, but I think it’s applicable to girls too. So welcome, Dr. Sheilagh.

SHEILAGH: Oh, thank you, Dr. DR. AMY and Sandy for having me. It’s great to be here.

SANDY: So, skincare is my sort of like a rabbit-hole topic that I go into all the time because I have autoimmune issues with skin. I’ve dealt with skin issues my whole life. So I’m really excited about this conversation. Let’s start with you though. How did you get involved in skincare? Where did you start?

SHEILAGH: Well, being a board-certified pediatric dermatologist, I guess, is really the start. I am board certified in both dermatology, and then in pediatric dermatology there’s extra training to do to become board certified in skin care related to teens and children and babies. Basically babies all the way through to young adults. And pediatric dermatology is a small but kind of underserved area actually. There’s only about 400 board certified pediatric dermatologists in the entire country. And we’re working to increase our, our workforce because of course we are passionate about kids of all ages and how their skin conditions or disorders show up a little bit differently in childhood than they do in the adult world. And that’s why you need that extra training, that extra year of a fellowship to really get comfortable with how skin disease shows up in children and also how to make children feel comfortable. You know, dermatology is a field where there are procedures and we need to make sure that we can do those things safely and calmly in children. So pediatric dermatology is such a great career. I’ve been so blessed to, you know, to really make this my focus. But, as you mentioned, I’m also mom to two tween boys and more recently, in the last four years, I was co founder and, and still am co-founder of Strike Club, which is a personal care brand for boys.

DR. AMY: So I have three boys. They’re older now, they’re 19 to 25, but we have wrestled with acne, specifically, with two of my boys. And really kind of ran the spectrum of, you know, dermatological treatments with them. In fact, one of them actually ended up on Accutane. But talk to us a little bit about acne and kind of like what causes it? And what are some of those myths surrounding what causes it or doesn’t cause it? Why are boys more prone? Just let’s just talk about acne.

SHEILAGH: Absolutely. So acne is so common and you know, 90 percent of everyone is going to get a blemish, a pimple. 90 percent of all teens get acne. There is a little bit more severity in boys because one of the factors that contributes to acne is hormones. And testosterone or androgens are actually the male type of hormones can really drive acne and make it worse, both in males and females. And you’re right, Dr. DR. AMY, there are a ton of myths about acne. And we can certainly go down that myth-busting, you know, conversation, because a lot of times parents will come into the office and they’ll say, “He’s eating too much chocolate.” You know, what about diet? Who does diet contribute to acne? And that, you know, for the most part is mostly a myth. But there are a couple of things that have been shown to worsen acne with respect to diet and that is, number one, high-glycemic-index foods. So really those foods that really spike your insulin, those really simple sugars. So staying away from that can help. There’s also been some studies about milk and whey protein, that protein in milk. So skim milk in particular, if you’re drinking a ton of it as a teen, and sometimes many teens and boys especially are drinking a lot of milk, that might be some, an area to cut back in and just limit it to one to two servings a day. Cause over consumption seems to be another factor in contributing to acne with respect to high glycemic index and then that skim milk. But for the most part, diet doesn’t really contribute to acne, which is good news for the teens, but maybe makes it harder for parents to try to control the diet.

DR. AMY: So let’s talk just a little bit about high-glycemic-index foods. We, I mean, we know that teens ingest a lot of carbs and sugar and sweets. And so what is the mechanism there? Like, why do high-glycemic-index foods contribute to acne?

SHEILAGH: I think it is thought to be the insulin growth factor pathway. You know, those again, you’re spiking that pathway. Downstream from that is also serum cortisol. So cortisol levels when they’re raised cannot can also work worse than acne and even drive male hormones. So I think that it does come back a little bit to those types of hormonal imbalances on the skin.

DR. AMY: Okay. So if cortisol levels contribute to acne, does that mean that stress contributes?

SHEILAGH: I think you’re right. It definitely doesn’t make anything better. So yes, rises in cortisol and actually conditions where you have cortisol excess can make acne a lot worse.

SANDY: You had mentioned hormonal things kind of triggering that as well. Is it a myth that, you know, depending on where you’re getting those acne breakouts and they kind of can let you know where if it’s a hormonal issue. Like, for example, if you Google on the internet, I know they say like, if you get it around your chin, that’s typically more of a hormonal acne situation. Is that true?

SHEILAGH: Sandy, that is true, especially in girls. So that mandibular area, that’s so-called beard distribution, you know, is really sensitive to androgens. And so in females, especially in females that might have underlying conditions like polycystic ovarian syndrome or conditions where you do have androgen excess, you will often see acne along the jawline. And that’s actually a nice clue for dermatologists because it kind of opens up other different ways to treat acne, especially in girls in with, you know, directing those therapies at the hormonal excesses.

SANDY: So let’s talk about treatments then for acne, especially for teens. Where do you start? How do you know what avenue or path? Do you have to try different things? I know sometimes with medications, you’ve got to try a couple of different things because people react to things differently. What your approach?

SHEILAGH: Well, whenever a teen or even a tween, you know, acne can start as young as 8 or 9 years old these days, you know, especially in young girls, you can even start to see it around 8. And acne shows up first as what I would say blackheads and whiteheads. We call those comedones. And you might start to see comedones like on the forehead, on the nose, in the ear even, and that can be the first sign that of adrenarche, that hormonal burst right before puberty is starting. That’s when things are really starting to change. And so early, early on, acne doesn’t necessarily look red, inflamed, inflammatory. And that’s a really big differentiator in how you approach acne because the treatments are a little bit different if you’re focusing on blackheads and whiteheads or versus inflammatory acne. So one of the first things steps in being a dermatologist and pediatric dermatologist is looking at that patient and saying, “Okay, what am I dealing with here? Is this mostly comedonal acne, the blackheads and whiteheads? Is this mostly inflammatory? Or is it a combination of both?” And that really kind of leads us down the pathway of what we’re going to choose in terms of a treatment.

DR. AMY: So where do you start? So you’re a mom, you’re worried about your son or daughter’s emerging, you know, skin problems. What does that conversation look like? How do we talk to our kids about it before we even come to you?

SHEILAGH: This is a great question. I really like the idea of using these opportunities to open a great conversation with your tween or teen about healthy skin habits early. First, it’s really important to normalize it. “Hey, you know, acne is normal. Almost everybody gets it.” Even related back to how you dealt with your own acne struggles. And that’s a really nice time to say, “Look, you know, I see that maybe you are breaking a little bit here. How are you feeling about that? What are you doing? How are you starting to take care of yourself? Are you washing your face?” That’s a really important question because you might find that your teen is not washing their face or they don’t know how to wash their face or they don’t know what to wash their face with. So just that first step, honestly, you can look at some clinical studies and they will indicate that just the act of removing dirt and debris from the skin that washing your face twice a day will help improve your complexion. So honestly, when you ask me, what’s the start? That really is the start. You know, you’re 9  years old. It’s probably time that we start. you know, developing really healthy habits and washing our face regularly.

DR. AMY: Yeah. So it’s really just a part of the conversation, “Hey, we brush our teeth at night. I bought you this toothpaste, you know, make sure that you wash your face in the morning and evening. So I bought you this face soap.” Right? Like you, it becomes part of those normal hygiene conversations that we have probably even before their problems is what I’m hearing you say.

SHEILAGH: Exactly. It’s always great to start before there really is a huge concern. And wouldn’t it be fun if, if parents and caregivers took that opportunity to say, “Let’s go to the store together. Why don’t we walk the aisle? See what resonates with you. Give them a little bit of that autonomy to make the choice, see what resonates with them, what would they like. And in doing so, you can really kind of find out a lot about what they might be seeing or hearing from friends or social media or all these kind of areas that teens are really getting new information about skincare. It seems to be a big trend lately, which we can dive into as well. But wouldn’t that be great if we can say, “You know what, I am noticing that that your skin is changing. And you know what? This is the perfect time. Let’s go to any one of those big retailers. Let’s walk the aisle or maybe even do an internet search together.” A lot of people are buying more things and more online or through Amazon. But I think that would be a wonderful way to start the conversation about healthy hygiene early and also give a little bit of that power to your child so that they are part of the decision and a part of the process.

SANDY: I know this probably applies whether you have a son or a daughter, but I know in my house, this is a way harder conversation with my son than it would have been with my daughter. My daughter would go to the drugstore and walk around with me. No questions asked anytime of the week. It’s her favorite place to be. My son, however, not so much. Why is this such a tough conversation for boys? And I would say it’s also harder too, cause there’s not in the store, there’s nothing really geared for them, right? Like things are really more geared towards, you know, female aesthetics, the smell, the textures, all that kind of stuff. So chime in on that.

SHEILAGH: Oh my gosh, you really hit the nail on the head because all you need to go do is walk through Target and all you will see in the skincare aisle are kind of pink, fruity scented things that really are marketed to girls. And I think you’ve brought up a great point, Sandy, because as moms, what are we doing? We’re taking care of our skin. We’re modeling for the girls what to do and how those habits are, you know, look and what they’re, you know, what we’re supposed to do. And then it’s easier through that role modeling for the girls to, you know, really join in and see what their mom is doing. And, you know, that’s a great thing that I think that moms and daughters can share.

SANDY:  I was going to say if my husband was in charge, it would be a bar soap, literally just a bar soap.

SHEILAGH: And you know, I think it’s partly just the way that we’re socialized and the way that boys are socialized a little bit differently. I don’t think that in most households, the dads are having this conversation early or modeling a skincare routine for their sons necessarily. But wouldn’t it be great if they did? Because I think that right now the boys are being left out of this conversation, but it’s so important that we bring them in and give them the tools they need to take care of themselves and establish good habits early on.

DR. AMY: So let’s say we’re standing in the aisle and there are 100 choices. What should we be looking for? And how can we encourage, you know, our boys to look in that direction, right? Because they’re going to go, I know that my youngest goes with whatever smells the best. And so if it’s got that evergreen scent or that forest, right? Like he’s going to choose something that smells really good, but that might not be the best choice. So what should we be encouraging them to look for?

SHEILAGH: I agree. I mean, I think it would depend on whether or not your aim is like a body wash or a head to toe or for face. But let’s talk about someone with just kind of normal skin, maybe a blemish here or there, like that first teen cleanser that you’re going to buy. A lot of times I’m recommending for face specifically, something that is gentle, hypoallergenic, fragrance free with gentle surfactants, the foaming agent, kind of gentle. We don’t want them to over cleanse and strip and dry and become irritated. We want to do something gentle. And you know, there are great options available over the counter for this. But you’re right. A lot of them look more, let’s say medicinal, or are from the like ‘80s and ‘90s. There’s been lack of innovation in that area. I would say not necessarily for the girls. I think the girls have a wider set to choose from, but for sure for the boys. And you know what? That’s one of the motivating factors that led myself and three other moms to start Strike Club to really address this need for boys to have something that was safe, gentle, effective, and fit easily into their lifestyle. Because you’re absolutely right. A lot of times a boy is not going to do a 10-step skin regimen. They’re not going to be wanting to use the toner and a mask and have all this complicated regime going on. Like girls are seeing and doing, you know, from social media or from their moms, et cetera. Sometimes what’s great for boys is a wipe, throw it in your backpack, bring it to the gym, wipe your face after you work out and then wipe your helmet, you know? Just something that can multitask and be easy for them, but yet feel like a point of pride. We like to call our products at strike club locker-room worthy because we don’t want them to be embarrassing or medicinal. We want them to be easy and fun, just like, you know, giving for them what the girls have already had and what seems to be still exploding on the shelves at Sephora.

DR. AMY:  So I want to go back to that locker room where the wipe-after-sweating idea in just a second. But talk to us a little bit about natural versus chemical. Does it matter? Why is natural not always best? Talk to us about that.

SHEILAGH: Yeah, I think that’s, you know, those are really big catchphrases in all of skincare. You know, is it clean? What does clean beauty mean? Well, actually that’s kind of a made-up marketing term. It really doesn’t mean anything and I think for moms out there listening to this podcast, one thing I’d really love for you to take home is that the health wellness and beauty industry is not very regulated. The FDA has almost no say over what’s on the shelf and what you’re putting on your skin to improve your appearance, to beautify, to cleanse, etcetera. And so your question is really on point, DR. AMY, because natural does not always mean better. And I think there’s been just this huge move towards things that are plant-based, natural, essential-oil based. But we have to remember that those things can also lead to significant irritant and contact allergies. We’re really not meant to be spreading essential oils all over our skin. That’s a great way to get irritation and to sensitize yourself to becoming allergic to something. So you may not know this, but of course, in baby products, lavender is in just about everything because there were, you know, very weak, very poor data about lavender scent helping babies relax. There’s really no good clinical trial to support that, yet it’s everywhere. And now the two components in lavender, which are, you know, basically components of the fragrance or essential oils, limonene and linalool. Those are the fastest-rising contact allergens in children under five. So natural is not always better. Poison ivy is totally natural, right?

DR. AMY: Hemlock!

SHEILAGH: But we couldn’t be, you can’t be putting that on your skin. And the same is true for so many products out there that have all of these excessive amounts of botanical extracts, essential oils. I think people have been very well meaning about it, but if you don’t have that scientific, science-backed background to know how to formulate a product properly, you can go down the wrong path really quickly with those type of ingredients.

DR. AMY: Yeah, I’m highly allergic to lavender. And so it’s in everything, not just baby products, but it’s in all of the natural, you know, adult products as well. Like I have to read every single one of the hundred ingredients on every single bottle so that my throat doesn’t close up when I … so I get that.

SHEILAGH: Yeah, I’m sure you do firsthand. Yeah. So natural is not always better. And that type of marketing, I think is really kind of based on fear mongering. You know, everything is a chemical at the end of the day. Right? And so, you know, saying something is “totally natural” really isn’t, that isn’t quite the truth, you know? So I love that you brought this up. I think it’s really helpful for your listeners to really understand that. The best thing that you can do when you’re searching out a product, especially if you have sensitive skin prone to eczema or if you’re just starting your child or your baby on something, is to look for fragrance- and essential-oil-free. Right? Because if we start exposing our skin to essential oils early, like somehow along the way, Dr DR. AMY, you got sensitized to lavender. How does that happen? Repeated application of an allergen onto the skin can ultimately, in those who are prone to it, cause a contact allergy. And as you know, that’s not just a little irritation here and there. A contact allergy is for life. So these babies who were putting lavender all over their body right from day one, we could be inadvertently sensitizing them and unfortunately, just like you, to a lifelong contact allergy.

SANDY: You mentioned Sephora earlier, and I know there are a couple trends out there, especially for teens, right? I think Sephora has kind of just opened wide the …

SHEILAGH: They’re making a lot of money.

SANDY: They are! Let’s talk about some of those trends you’re seeing, you know, that kind of involves Sephora, but it could be, you know, just with teens with using products on children younger than really need those products. What are you seeing?

SHEILAGH: Oh, we’re seeing exactly that. Sandy. It’s like the Sephora baby trend. And we’ve, you know, as a dermatologist, I think many of us have even been asked to comment about it. And to, you know, really kind of try to figure out why this is happening. And, you know, I think there’s a combination of factors, you know, we talked about the modeling from Mom, but also there’s a huge social media influence, right?

We have the children of celebrities with millions and millions of views performing these really complicated multi-step skincare routines, sharing it on social media, using really expensive products that are not meant for children’s skin. You know, when you’re looking at a product in Sephora, a lot of what you’re seeing is for mature skin where anti-aging concerns are really, you know, at the top of the line. Those kinds of products are really not meant for tween or even, you know, for the most part teen skin where we don’t need, you know, to be applying aggressive exfoliating acids or retinols in tween and teen skin. It can only lead to irritation, disruption of the skin barrier and, you know, a whole host of problems. So really, I think there needs to be a little bit more of a, not necessarily regulation, but an intention on the companies that are seeing this problem. Like, you know, I don’t want to name names, but there are many different companies out there with bright and fun packaging that, of course, are really attractive to especially teen girls. But really I think stating the intended use of the product and what the skin type it’s meant for would be really helpful so that moms can look at a product and know, “Oh, this is for mature skin, or this is not appropriate for sensitive skin.” You know, those are things that I think we need to start asking of these companies so that we can have a better, you know, just a better approach overall. And then I think that we just don’t want to be feeding into an unhealthy focus on appearance or anti-aging. I think that, you know, on the one hand, this trend seems kind of harmless where, you know, “Look at these girls, they’re taking care of their skin, they’re doing all of this.” But at the same time, this is a really focused, you know, anti-aging, appearance-improving trend that I think could maybe lead us down the wrong path.

SANDY: Are you seeing some skincare products that are specifically being overused right now? Things that we really maybe shouldn’t be using as quite as regularly as we do. Like you mentioned, like the retinols. I feel like those things are in everything.

SHEILAGH: Oh, my gosh, yes. So Sandy, the teen girls will come into the clinic with a whole big bag full of products. And so I am sifting through, “Do you need a toner? Not usually.” Children and teens don’t need a toner. That’s really drying. A lot of times the toners have alcohol. It can, you know, it’s not necessary and it’s not useful. And then you’re seeing like exfoliating acids, alpha hydroxy acid, beta hydroxy acid, really like high concentrations. And, you know, children at that age, unless they do in fact have significant acne. They don’t need to exfoliate to that extent. So in the girls, I’m taking this bag of goodies and I’m paring it down. I’m saying, “Here’s what we need. Here’s the basics.” So moms who are listening, the basics for a teen skin care regimen are really just a cleanser, a moisturizer, and a sunscreen. If we can get that going early, especially those healthy habits with sun protection, that would be a win.

DR. AMY: So, are you a fan of a combination sunscreen and moisturizer, or do you like those to be separate?

SHEILAGH: Typically most dermatologists will favor them being separate because you don’t often apply enough of the product to really achieve the SPF on the label anyway. So I would say anything in teens that they’re going to use regularly is better than nothing. But an SPF 30 or greater in the morning and being able to reapply it if they’ve, you know, been outdoors or it’s been longer than a couple hours or if they’ve been sweating or swimming.

DR. AMY: And what about oil-free moisturizers?

SHEILAGH: Oil free, or non-comedogenic, or non-acnegenic, is a nice claim that products can make after they have done additional testing to ensure that the product did not worsen acne in a number of people who have volunteered for that testing. So that’s a nice extra claim, you know, especially for teen skin that might be prone to breakouts. That is a nice claim to look for. So something fragrance free, hypoallergenic and non-comedogenic would be three things to look for on the label for a teen sunscreen.

SANDY: I know for some—

DR. AMY:: Yeah, go ahead.

SANDY: I was just going to say that I know for some, so sunscreen in my family talk is an allergy-prone product for us. Like we have to scour the drug store to find one that we don’t react to in some way. And there are a couple of brands that have been okay. But it’s been so hard to find that mix, I think, for us of good coverage, but also not igniting, you know, an autoimmune response. So are there, not to name brands per se, but like, do we need to look for those same kinds of things in sunscreen as well? Like hypoallergenic, you know, take, get the fragrances out, that kind of stuff.

DR. AMY: Like zinc-oxide based versus like, do you …

SANDY: When you say that, I think of like, in the ‘80s, what we used to put on our nose.

SHEILAGH: Yep. So, Sandy, when you’re looking at a sunscreen, flip the bottle over and look at the labeling. It should say active ingredient. And for the most part, I do recommend the mineral-based sunscreens. And so those are going to be the zinc oxide and titanium dioxide. The reason for that is that they give great broad coverage against UVA and UVB, and they tend to be less irritating. They are also a little bit safer for our younger kiddos and babies because they really kind of sit on the surface and reflect the UV rather than the chemical sunscreens that have actually been shown to not only have a bit more irritation and allergy proneness to them, just in terms of their structure, but they also do get absorbed into the bloodstream. And so that’s been a hot topic since 2019, when there were two different randomized controlled trials that looked at six chemical sunscreen ingredients and found that even after one application, there was absorption into the bloodstream. And that led the FDA to kind of change their recommendation on what they generally recommend as safe and effective in a sunscreen. And they really dialed it back and they, they basically, you know, just chose zinc and titanium as their recommended agents. Now I’m not saying that chemical sunscreens are all bad, not at all. But I do think additional testing is going to need to be done before we really feel more comfortable, say putting it on a newborn baby or a 6-month-old baby. Now having said that. I will tell you that any sunscreen, whether mineral or chemical, is better than nothing and far better than getting a sunburn. So if all you can tolerate, or are all you really like in a sunscreen or those chemical agents, they’ve been around for a really long time. We don’t want to fear monger at all about those ingredients. So yes, definitely use your sunscreen no matter what it is to prevent a sunburn. But if you want to be a little bit more choosy about ingredients and formulations, I think you’ve basically kind of said it. Choose something that is mineral based, that is hypoallergenic and fragrance free. Those are three great things to look for on the labeling of a sunscreen.

SANDY: What about SPF number?

SHEILAGH: 30 or greater, I think would be really kind of the bottom rung.

DR. AMY: So I, I worked for a department store beauty brand in college and we were taught to describe the difference between a mineral-based sunscreen and a chemical-based sunscreen as one is a physical barrier, one is a chemical barrier. And it really kind of brought that home for me. And Sandy, just to dispel the myth that it’s the white cream on the nose, I’m wearing a zinc-oxide-based sunscreen right now. And so it’s clearly not white.

SANDY: They’ve gotten better. I just always think about that.

SHEILAGH: They have gotten so much better. They really have, I think. And I really love, especially for my skin of color patients, they have tinted versions now that actually go on and they look quite good. So I think that we’ve come a long way and they can be safely used, you know, by just about anyone. Now, certainly some companies do a better job. I really do like some of the tinted versions. But for the most part, almost everyone should be able to find a mineral-based sunscreen that works for them.

DR. AMY: All right, so we need to take a break and let Sandy read a word from our sponsor. When we come back, I want to do two things. I want to revisit the locker-room-worthy product idea, and then I also want you to walk us through treatment. So like when we do have a problem with acne, what do you start with? What do you try first? Then what do you try? Then what do you try? What can parents and teens expect from that process? When we come back.

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DR. AMY: Thank you, Sandy. Okay, so we’re continuing our conversation with dermatologist Dr Sheilagh Maguiness. So Dr. Sheilagh, talk to us a little bit about that idea of carrying wipes in your, you know, locker room bag to wipe your face after you’re sweating. Is that important to wash your face after a workout?

SHEILAGH: Yes, it is. Because the more that sebum, dirt, and debris build up on the skin, the more you can, you know, end up with clogged pores, et cetera. And that can, you know, be one of the gateways to developing blackheads, whiteheads, then ultimately even inflammatory acne. So even just being able to wash your face on the go, I think for many teens and especially boys, they really love the idea of a wipe. One and done. Just, you know, throw it in the backpack. You don’t need a sink, you don’t need to foam up your, you know, with water. At least it’s definitely something they can take with them, use on the go and better than not washing their face at all or waiting hours and hours before they’re able to do so.

DR. AMY: And what about hair? So can dirty hair or greasy hair contribute to breakouts too?

SHEILAGH: It sure can. Yep. A lot of times I’m seeing some of that blackhead and whitehead comedonal acne on the forehead. When, when teens are using, you know, a bang or cutting their hair with a strong bang that’s occluding onto the forehead, and certainly that can be a cause of buildup because your hair certainly makes natural oils. And then we add more to it with styling products. And then boom, we’ve got, follicular occlusion, we call it. So those hair follicles are, you know, occluded with that oil and sebum. And that can be the start of a problem with acne in that area, too.

DR. AMY: So we need to encourage our teens to keep their hair washed as well.

SHEILAGH: And sometimes the teens I’ll say, “You know what? Wear your hair back at night. Put in like a little clip, or like a headband and just get those bangs off your forehead at night.” If they really, really enjoy and like their hairstyle, they don’t have to, you know, move away from it entirely, but just being mindful about it and making sure they’re washing properly under the bangs, et cetera.

DR. AMY: And what about, how often should you change your pillowcase? Does that contribute to, to breakouts?

SHEILAGH: It can, yeah. So a dirty pillowcase built up with oil, et cetera, never a good idea. Most of the dermatologists would recommend at least weekly washing, changing out of the pillowcase I think would be a great rule of thumb. And then the silk material pillowcases have gained favor recently just to reduce friction, et cetera. I think there’s probably something to that. Not a big clinical study that I can point to, but I think it’s probably something that many women and girls especially are leaning towards. I think the fabric can be helpful too.

SANDY: What about washing your hair? So I feel like, we have come full circle to my grandmother’s time where you only wash your hair once a week, whereas I grew up and you wash your hair every day. What is the right amount of washing we should be doing of our hair?

SHEILAGH: Oh my gosh. So Sandy, I have the really good fortune of working with two world-class experts in hair and hair disorders. So the department chair at the University of Minnesota is very well known for her hair research. And especially if you have a scalp concern, like you have dandruff, we also call that seborrheic dermatitis. Or you may have psoriasis of the scalp. Or you may just really have excessive oil production in your scalp. Washing your hair daily is the best thing that you can do then to kind of take all that oil out. The microbes that naturally live on our skin and contribute to that. Some yeast forms like pityrosporum, et cetera, washing that out is really important. So I would say that you’re right. A lot of times I’m seeing teens, they’ll come in and they say they don’t wash their hair very regularly. But especially if they have a scalp concern, it is recommended to do daily or every other day.

DR. AMY: What if you have dry hair but not a scalp concern? So if you have dry hair, you may want to be using a bit more conditioner or a detangling spray afterwards. That is a really good way to help with the dryness. You also want to be wary about how the heat styling. I’m sorry. This is a blooper reel. I think my dog is barking. I’m really sorry.

DR. AMY: He just wants to participate in the conversation about hair.

SHEILAGH: You know what? She’s really due for a groom right now. So maybe she’s upset about that.

DR. AMY: That’s funny.

SHEILAGH: Sorry guys.

DR. AMY:  That’s okay. Dr. Sheila’s dog. What kind of dog is it?

SHEILAGH: She is a little 8-pound Yorkie poo, but she definitely needs a haircut. So I think she wasn’t exactly happy with our conversation.

DR. AMY: Okay. You can catch a shot of Dr. Sheila’s Yorkie poo.  if you’re watching this on YouTube, by the way, listeners.

SANDY: So I’m glad you brought up psoriasis, especially of the scalp. I mentioned before we got on this discussion that I am a lifelong chronic battler of psoriasis eczema. So we could probably do a whole show on that. I know probably doing our listeners a disservice, but let’s talk about that a little bit. Let’s talk about, you know, what can kickstart things like eczema and psoriasis for kids and adults?

SHEILAGH: So why don’t we start with psoriasis since it’s something that you’ve been battling, Sandy. So 2 percent of the population has a tendency for psoriasis and luckily it doesn’t tend to show up in the early, early years, like in infancy, very often. But it can. And so the way that it shows up can differ based on ages. So in young children, toddlers, when I see psoriasis starting up, a lot of times it’s on the face and in the diaper area, two areas where irritation can lead to the psoriasis plaques coming out on the skin. And then in mid-childhood, psoriasis can sometimes come out all over the body after a strep throat infection. And that type of psoriasis looks kind of like little raindrops all over a little red skin  bumps. That’s called guttate psoriasis. Guttate is actually Latin for raindrop. And then in the late teens and early twenties, that’s another spike when people who are prone to psoriasis can start to show signs. And that’s typically more of the plaque-type psoriasis where you have, you know, red, scaly, well demarcated plaques on the elbows, knees, and you can get some in the scalp too. So psoriasis is less common than eczema. So eczema is in 20 percent of kids. Psoriasis is just 2 percent and less likely to happen during those like early ages. But you know, the good news about psoriasis especially, and to a certain extent, eczema too, is that in the last 10 to 15 years, we have come so far in terms of unraveling all of the different biological pathways and different inflammatory things that are elevated with both psoriasis and eczema, and we have just a ton more treatments in our toolbox than we ever had before.

SANDY: Where do you start?

SHEILAGH: Well, I would say for psoriasis, if we have a, say, a young person in clinic who might have a strep throat, I would always check for strep. And then we would start usually with topical therapies. So a lot of times we are still using the topical steroids and we can certainly make a good improvement with topical therapies, especially if it’s a milder presentation, like less than 10 percent of the body surface area affected. But once you’re starting to see multiple areas and a high proportion of the body surface area affected, then you’re starting to think about other treatments, either whether that be light therapy, phototherapy, like narrow band UVB, where a patient would go a few times a week and be treated with a light therapy, or we’re starting to think about systemic agents too. And those are, you know, kind of older agents where we use like by mouth and then newer agents, which are injection therapies, biologic therapies that are very targeted to the inflammatory pathways that are upregulated in psoriasis.

SANDY: That’s fascinating. I know I get, so like I said, I’ve been dealing with my own issues with psoriasis for a really long time. And I always laugh because I’m one who has it full body and I’d never have heard anybody mentioned the viral connection. So now I’m going to have to rabbit hole that. Thank you.

SHEILAGH: It’s more common in childhood after a stress throat. And sometimes those kids want to heal completely and they won’t show signs of psoriasis again, but a lot of times that’s the first sign that they’re predisposed. And then maybe in their twenties, they’re going to start to show more signs.

SANDY: But the bio biologic injections I hadn’t heard about. I know sometimes the internal medications, they like scare the, you know, the jeebies out of you and any of those ads on that you see on television. But what do they do? What, so what did those kinds of treatments help to get that eczema and psoriasis under control? What are they doing in the body?

SHEILAGH: So we have reached an age, Sandy, of really big sophistication when it comes to these biologic therapies. So for psoriasis, we now really understand what inflammatory cytokines, these are little molecules that are elevated in your bloodstream when you have psoriasis. And there are certain numbers like 17, 23, and we know exactly what cytokines are elevated. And these biologic therapies for, you know, many of them are antibodies, they are monoclonal antibodies that bind to these cytokines and flush them out of your system. And in many cases, they’re very, very targeted. So some of the psoriasis treatments today really will just bind one or two of these molecules and kind of flush them out and in doing so reduce the inflammation, reduce the skin involvement and, you know, psoriasis is associated with inflammatory arthritis, which can be destructive to joints. And these new biologic therapies can prevent that arthritis, prevent that joint destruction. So we’ve really come a long way. And yes, you know, you will see, you know, commercials about psoriasis treatments and or read about them in magazines. And, of course, you’re going to see every bad side effect listed because that’s due diligence on the part of the manufacturer. But for the most part, these biologic therapies are very well tolerated and not as immunosuppressive, as the older kind of generation treatments that we had for psoriasis were. So I see that, you know, as a huge advancement because it can really change the life of someone who’s struggling, you know, with like, say, 40 percent body surface area, not wanting, you know, kind of isolating themselves, not wanting to go out or if they have a bad arthritis and they’re having joint pain every day, it’s really life changing. The same is now true for eczema. If you had told me 10, 15 years ago that we would have an inside-out treatment for atopic dermatitis or eczema, I would have said, “No way.” I wouldn’t have believed you because my entire career, when children and teens have eczema or atopic dermatitis, my entire career has been spent, “Let’s optimize the skin barrier. Let’s heal the skin barrier. Let’s reduce inflammation topically. Reduce the bacteria on the skin topically. Moisturize and trap that water in all topically.” But what we found out in the last 10 years is that those inflammatory cytokines that, similar to psoriasis, are elevated too in patients that have eczema or atopic dermatitis. And in fact, there are two cytokines that are really, I would say the underpinning of all allergic diseases. And those are interleukin 4 and 13 and just these two little inflammatory cytokine molecules. Well, guess what? There’s now a biologic therapy, a monoclonal antibody that can bind to these two cytokines, flush them out, and it’s unbelievably life changing for patients.

DR. AMY: That’s fascinating, especially so I suffer from eczema, especially on my hands, and so it can become so inflamed that I will slather my hands with prescription lidocaine and then cover it with Tegaderm so that I can function without clawing my skin off, right? I mean, and so the thought of being able to have a treatment like that from the inside out kind of is, well, that’s super exciting.

SHEILAGH: So it really is exciting. It was FDA approved for adults in 2017, and it’s now FDA approved for 6 months and up. So, I mean, even using it in younger babies who are really struggling. And, you know, of course, being a pediatric dermatologist, my wait list is pretty long. Because as I mentioned, there’s just a few of us in the country, 400. And when I see these children coming in, they’re so itchy. They’re so uncomfortable. They’re not sleeping. Their parents aren’t sleeping. Their skin is red, open, oozing with infection head to toe. 90 percent of their bodies is affected. So to be able to say now, “You know what? We have something that is going to make this so much better. It’s going to be really life changing for you. It’s going to stop the itch. It’s going to help your skin barrier heal.” That is so amazing. And you know, I never would have expected it because my whole life had been kind of, well, not my whole life, my whole career in dermatology, had really been about eczema is a skin barrier defect. It’s a problem with your skin barrier. You can’t hold water in your skin like you should. You’re more prone to allergies like your contact allergies, Dr. DR. AMY, because you have atopic dermatitis. And so to have the understanding now of how these cytokines mediate all allergic diseases like asthma, allergic rhinitis and even now they’re looking at it for food allergies. It’s a really exciting time actually to be interested in caring for patients with eczema.

DR. AMY: So by the way, listeners, I was not advocating for you to slather your skin with lidocaine and cover it up. My doctor shakes his head and goes, “Really? Like, really?” when I say I do that. So don’t do that. I was just saying, “Hey, how exciting for me because I’m doing these crazy, dramatic things.”

SHEILAGH: Yeah. And I like that you said about the saran wrap, because that is true. You know, sometimes occlusion and, you know, one of the best things that you can do when you have dry sensitive skin prone to eczema is what I like to call the soak and smear technique, where we do a bath, a soaking bath, you don’t even need soap, get out, pat dry and cover yourself in a layer of the blandest moisturizer you can find, which for me is petroleum jelly, right? Plain petroleum jelly. And then in kids, like I mentioned, who are red head to toe, oozing infected, we will do wet wraps. So very similar, like the saran wrap. We’ll do that even for sometimes, you know, patients who are older, but we’ll do a wet pajama on top for kiddos. And it, it works really nicely to cool down, you know, a big flare.

DR. AMY: Okay. So I’m not as crazy as it sounded.

SHEILAGH: No, it’s not crazy. You’ve developed your own technique, which is definitely evidence based.

DR. AMY: Okay. So I want to get back to acne and teens, walk us through step one, step two, step three. Like what are those, you know, phased treatment What’s that process look like? Because I know there are so many options that can be overwhelming.

SHEILAGH: It definitely can be overwhelming. And when we, when we kind of come back to this conversation, it really is about what type of acne. Is it just comedones? Is it inflammatory? Is it a combination of the two? And, you know, for comedonal acne, that really is a sign that those pores and that skin is not, you know, basically overturning in the right way, leading to occlusion of those little pores and hair follicles. So in that case, you really want to use something that helps the skin turn over more efficiently. So then you’re thinking about, “Okay, what about, a basic cleanser?” Maybe one with a little bit of beta hydroxy acid, which is salicylic acid, a 1 percent or 2 percent that can be helpful. And then if the comedones are a little bit more severe, that’s when you might be needing a prescription-strength retinoid. And so in my office, one of the big heroes for, for teen acne, especially comedonal acne, are the topical retinoids. So tretinoin cream is a great option. Now, It can be fraught with difficulty because teens will tend to use more than you like them to or try to use it more frequently or, you know, put too much on, but if you use it in the right way, which is a tiny little dab, a pea-sized amount is enough for the whole face. You take that one little pea, dab, dab, dab, rub it in right after you cleanse your face at night. In the morning, you do not need to reapply it. You just you know, wash again and apply a moisturizer. That is a really nice first step for comedonal acne. The retinoids also are helpful for inflammatory acne too. So a lot of times, no matter which pathway I’m really trying to focus on, getting that teen to tolerate a topical retinoid is really the first step. And it can take up to three months. And sometimes teens don’t have the patience, but when they do, it really makes a big difference. And sometimes that’s all you need. Sometimes that’s the hero for teen acne is a gentle cleanser and a topical retinoid. Now, when you need something else, when you start to see inflammation and, you know, gosh forbid, early scarring, that’s when you know you have to really kind of go up your treatment ladder. And for moms listening at home, honestly, that is the time when you want to see a dermatologist, a board-certified dermatologist, or your pediatrician, just to get that entry step to talk about, Hey, you know, this is more than just we can deal with over the counter now. Let’s talk to the pediatrician. Maybe we need to start that topical retinoid and something else. And so there are so many different treatments for acne, really depending on what the presentation is. You know, Sandy, earlier we talked about hormonal acne. You know, if it’s really related to a young girl’s menstrual cycle and it’s in that beard area, we might be thinking about doing some hormonal therapy for her acne. But if it’s more inflammatory and, you know, big red inflamed pustules, we might be thinking about temporarily using maybe an oral antibiotic for its anti-inflammatory properties. Not forever, because I know Dr. DR. AMY, you mentioned that your own son had to, you know, had an acne journey and ended up taking Accutane, which we do use regularly and is an excellent medication for severe scarring acne, and it works.

SANDY: Why don’t you take a moment, let’s go back to the Stryke Club. We mentioned it at the beginning of our podcast. Tell us more about that. It’s your baby, right? Let’s talk about the Stryke Club. Tell our listeners about it.

SHEILAGH: Oh, well, Stryke Club was founded by four moms. I’m one of them with two tween boys myself realizing that, you know, like we talked about earlier, you know, in this conversation. You just need to walk down the aisle at Target and realize that boys don’t have a lot of choices when it comes to skin care. They either borrow from mom, borrow from sister or are using something that’s really too harsh or inappropriate for them. Or something from the 80s that’s still there, like Noxzema pads, Oxy pads. It’s all still there, you guys. It’s really, I mean, it was time for innovation. And as a doctor, that really excited me because I knew exactly what I wanted to see in the product and how I wanted it to perform. I wanted it to reduce bacteria on the skin with a good ingredient that’s effective, but also gentle. I wanted it to fit easily into lifestyle so really intentional about the types of products. Like one body wash, head to toe, one and done. You know, because a lot of times in my practice, I’ll ask my teen patients who are boys, “What are you doing in the shower? What are you washing with? What’s soap?” And you have to ask the question moms, because you might be surprised to find out that your teen is using shampoo, Pantene, head to toe, over everything. They’re so irritated. Their face is red. You know, I mean, it’s a great time to have that conversation with your teen and be like, “So tell me how you’re, you know, cleaning up in the shower. Like what are you using? What tools can we, can we get together?” And so the Stryke Club was really born out of a need to give boys better tools and to show them, you know what, let’s take the stigma out of self-care for boys. You know, it’s or it doesn’t exist for girls. Girls are just so happy to take care of their skin.  Teens are busy, but we need to role model for them. “Hey, this is okay. This is really important. It’s great that you’re taking this step to take care of your skin.” Because obviously you to know better than everyone how much inflammatory skin conditions like acne are related to mental health issues like anxiety and depression. So telling boys, “This is okay. Remove the stigma. This is cool. It’s great that you took care of your skin today. Good for you.”

DR. AMY:  So why should they not use shampoo all over their body?

SHEILAGH: So a lot of times the shampoo has really harsh surfactants because it’s really meant to be in an area that the skin on your scalp, I would say, is a little bit more oily and a little bit more durable and you need to kind of get all that dirt out. So a lot of times you’re seeing a shampoo foams like crazy. That’s because it’s got a really, you know, exuberant surfactant or soap in there. And that’s not really appropriate, especially to the fragrance. There’s always a lot of fragrance and shampoo to be rubbing all over sensitive areas. You know, contact allergies to fragrances, to the surfactants in shampoos are well documented and it’s certainly not a good idea to be rubbing that on thin areas like the eyelids, for example.

DR. AMY: Okay, so the Stryke Club is a set of boy-friendly skincare products, right? Like you, you sell it in sets, you sell it individually. You do have really cool wipes, you have a stick just for, you know, individual breakouts. portable, yeah, right? You have like a little bit of everything for. For boys, right? Yeah. Girls can use it too. Adults can.

SHEILAGH: Oh, yes. It’s for, you know, it’s for teens. I mean, I even use it every day cause I’m a little bit prone to rosacea. So for me, that’s another time to use a product that’s kind of acne-focused, but yes, anybody can use the product. I formulated it specifically to reduce bacteria, but be very, very gentle. So while the product, you know, doesn’t contain say benzoyl peroxide, it still will reduce bacteria on the skin.

DR. AMY: Well, speaking of benzoyl peroxide, there’s some recent news coverage of a study that showed some danger in benzoyl peroxide products when they’re exposed to heat. Talk a little bit about that. Should we be concerned? I noticed that your products don’t contain it. Is that why? Or just talk a little bit about that so that moms know what to do.

SHEILAGH: So benzoyl peroxide is, you know, an old ingredient. It’s been around for ages, decades, and it is on the FDA monographed as being like a treatment for acne. And so many cleansers, washes, spot treatments contain benzoyl peroxide. And in general, it is actually a good treatment for acne. It really is. It can reduce bacteria, reduce inflammation. It’s helpful. And that’s why it’s been around for so long. Now, the group in the lab called Valisure, who has done some independent testing of things like sunscreens in the past, actually finding some contamination with benzene in those cases as well, has really kind of identified for us that the benzyl peroxide is probably not as stable as we were hoping and that it can break down into benzene, which is a concern. That’s a known carcinogen. It’s doesn’t have any place in any of our skincare. But the thing about the study is that it really did use extremes of temperature. So really high temperatures, where you would maybe keep the product locked in your car on a hot day, or really, really not real-life scenario. So a lot of people have criticized some of the methodology in the study, but at the same time, there is a concern that during transport or storage, which you don’t know what happened to the benzoyl peroxide, could there be an issue there? I suppose there could. So most dermatologists are not advocating for people to throw away their benzoyl peroxide, but we are saying, you know what, use caution, stored appropriately in a cool, dry place. For example, don’t have it out in the bathroom if you’re having a steDR. AMY hot shower, you know, put it in a cool, dry place. And maybe, you know, don’t keep it around as long as, you know, two years, for example. Definitely look at the labeling in terms of expiry date. And just be mindful about it. So yeah, I think there are some issues with the benzoyl peroxide. I think more will come in the, you know, coming weeks or months as, hopefully, other manufacturers will try to do some of the same assays and duplicate results. I’m hoping. But for now, really no need to throw it away, but definitely need to be mindful of how we store it and, you know, issues with transport, etcetera.

DR. AMY: Okay, so what have you not gotten to say to our listeners that you still want to say today?

SHEILAGH: Boy, you guys did a great job covering so many topics. I mean, I think I would say don’t be afraid to see a dermatologist for any skin condition. You know, I think sometimes people may not even know that pediatric dermatologist is a subspecialist and that we’re here to help with anything that your kids might be going through with respect to the skin. Seeing a board-certified dermatologist is always really important. If you do have, you know, a skin condition that’s inflammatory, if you have a concerning mole, et cetera. I just want people to know that dermatology is a huge field. We’re here to help and that there are pediatric dermatologists who have extra specialized training to take care of your baby’s, kid’s and teen’s skin.

DR. AMY: Okay. And Stryke Club is S-T-R-Y-K-E Club.com. That’s how they can find it.

SHEILAGH: Yep. You can get us on, yeah, our website or Amazon, et cetera, if you’re looking for something for your teen.

DR. AMY: And how can listeners find you on social media?

SHEILAGH: So I am Dr. Sheilagh at TikTok. That’s another thing that I’ve kind of dipped my toe into lately, education on a new platform. Cause I think it’s really important since people are spending so much time on social media to get that good evidence-based education out there. And so I’m also on Instagram at Dr.Sheilagh.M.

DR. AMY: Fantastic. Well, we are out of time. This has been a phenomenal conversation on a topic that we have not covered in the past. So listeners, I hope that you got a lot of great tips from Dr. Sheilagh Maguiness. Thank you so much for sharing your wisdom and your knowledge with us and our listeners. We appreciate you taking time out of your busy clinical schedule to be with us today. Listeners, thank you for joining in. If you liked our show, please follow us on Instagram at The Brainy Moms. Do it now before you forget. If you love us, we would love it if you would give us a five-star rating and review on Apple Podcasts so that we can find more smart moms and dads like you. Hey, you can find Sandy at the Brain Trainer Lady on TikTok. As Dr. Sheilagh was saying, it’s a great way to get educated on important topics. And so Sandy spends a lot of time talking about the brain and cognitive skills and why our children struggle to learn and what we can do about it. So you can find her there at the brain trainer lady. All right. Look, that is all the smart stuff that we have for you today. We’re going to catch you next time.

SANDY: Have a great week.