595-The Ultimate Guide to Skincare from Acne to Anti Aging-Sandra Lee-Health-2018
Barack
November 16, 2025
*The Ultimate Guide to Skincare from Acne to Anti-Aging*, first published in 2018, presents the world of this popular dermatologist in a fun and engaging way, offering a wealth of skincare knowledge that will benefit you whether you're in your teens or middle age. It covers acne treatment, anti-aging advice, step-by-step tutorials, fun quizzes, prevention techniques, and practical tips. Whether you're naturally beautiful or plagued by skin problems, everyone needs an effective skincare routine.
Sandra Lee was born in New York City, US in 1970. She attended the University of California, Los Angeles (BS) and Drexel University (MD). Also known as "Dr. Pimple Popper," she is an American dermatologist and YouTuber. She is best known for her online videos and television series, "Dr. Pimple Popper."
In 2010, Lee began uploading videos to YouTube, but didn't start posting content extensively until 2015, after noticing the popularity of her skin-cleansing videos on Instagram. Lee records and posts content only after obtaining written permission from clients and offers patients discounted or free treatments. In 2018, Lee signed with TLC to have her own television show, * Dr. Pimple Popper*, which premiered on July 11. A Christmas special of *Dr. Pimple Popper*, titled "The 12 Pops of Christmas," aired on December 13, 2018. Season 2 of *Dr. Pimple Popper* premiered in January 2019, and Season 3 premiered in the US on July 11, 2019. Season 4 premiered on December 26, 2019.
Table of Contents
Chapter 1: Dr. Pimple Popper 101
Chapter 2: Thanks for Popping In!
Chapter 3: Acne: An Issue for the Ages
Chapter 4: Time Won't Tell
Chapter 5: Prescription for Beauty
Chapter 6: Sack the Lies, Hack the Truth
The author first introduces some dermatological terms. The first category is lesions with color changes, called macules. These are small, less than one centimeter in diameter, and only involve a change in skin color. They have no elevation or bumps and are imperceptible to the touch, such as freckles caused by sun exposure. Patches, on the other hand, are larger, exceeding one centimeter in diameter, but also involve only color changes, such as café-au-lait spots, vitiligo, and large patches of pityriasis rosea. The second category is "raised lesions," which are actually palpable and can cause anxiety. Papules are less than one centimeter in diameter, have a firm texture, and are small bumps that you can easily feel with a light touch, like the pimples that first appear on a teenager's face. Plaques are larger than one centimeter in diameter, formed by the fusion of multiple papules, spreading shallowly with a flat surface, like psoriasis. Nodules are large, hard lumps that penetrate deep into the dermis or even subcutaneous tissue, such as erythema nodosum. The main difference between them lies in their size and depth: papules are small and shallow, plaques are broad and shallow, and nodules are deep and firm. The third category is fluid-containing lesions : vesicles are less than one centimeter long, located within or beneath the epidermis, and contain clear fluid, such as the small blisters that appear from chickenpox or contact dermatitis; bullae are larger than one centimeter, like enlarged versions of vesicles. Pustules, while varying in size, are identified by the pus (white blood cells and necrotic tissue) they contain. The fourth category is surface changes, such as crusts, which form hard shells when fluid, serum, or pus dries, like the yellow scabs that appear after squeezing a pimple; scales are dry, thin flakes that slough off after the stratum corneum thickens, like the silvery-white flakes of psoriasis. Sometimes, our skin cracks. Fissures refer to linear cracks, commonly seen in angular cheilitis or cracked heels. Erosion involves partial loss of the epidermis without penetrating the dermis, so it doesn't leave a scar. Ulcers, on the other hand, penetrate the entire thickness of both the epidermis and dermis, often leaving scars after healing, such as diabetic foot ulcers. Excoriation is epidermal damage caused by mechanical scratching, often accompanied by bleeding or crusting, forming a continuous process from scratch to erosion to ulcer. The last category is atrophy and thickening. Atrophy makes the skin thinner and more translucent, with clearly visible blood vessels, similar to skin changes caused by long-term use of hormones. Conversely, lichenification occurs due to prolonged scratching, resulting in thickened epidermis, deepened skin lines, and rough skin, such as in chronic eczema.
Different skin conditions have different causes. For example, freckles are often small, light brown spots that most commonly appear on the bridge of the nose and cheeks. The cause is often genetics or UV-induced melanin deposition. What can really prevent them from darkening further is consistently applying broad-spectrum sunscreen with SPF ≥ 30 and avoiding strong sunlight as much as possible. If you want to improve your appearance, chemical peels, laser treatments for fading spots, or whitening serums such as Vitamin C can also help. Next is dermatosis papulosa nigra (DPN), a common type of small, multiple, brownish-black papules on dark skin, distributed on the cheeks or neck. It is benign but bothers many people . It is actually similar to seborrheic keratosis and is more related to genetics, especially common in people of African descent. There are almost no effective prevention methods for it. The only way to improve it is through cryotherapy, electrocautery, or laser removal, which is purely for cosmetic purposes. The third type is solar lentigos, which are commonly known as "solar lentigos" or "age spots." They have clear borders, are larger than freckles, and look quite alarming. Ultraviolet radiation causes localized proliferation of epidermal melanocytes and melanin deposition, thus fixing the spots. Prevention hinges on one core principle—sunscreen, ideally applied 30 minutes before going outdoors. Treatment options include photofacial rejuvenation, laser therapy, chemical peels, and topical whitening agents such as hydroquinone or azelaic acid. The fourth type is seborrheic keratosis, a benign epidermal hyperplasia common in middle-aged and elderly individuals, appearing as waxy or brownish patches on the skin. Its occurrence is related to age, genetics, and UV exposure. There are no specific preventative methods; the only solutions are avoiding excessive sun exposure and maintaining skin cleanliness. Unless it affects appearance or is caused by friction, treatment is often unnecessary; cryotherapy, scraping, electrocautery, and laser therapy can resolve the issue. The fifth type is fibrous papules, typically appearing on the nose or face as small, firm, skin-colored or light red raised bumps. This lesion is essentially a localized proliferation of fibrous tissue, resembling a miniature benign tumor. Prevention is virtually nonexistent, and treatment primarily involves laser therapy, electrocautery, or minor surgical excision. Next is xanthelasma, soft, flat, yellowish patches that appear on the inner side of the eyelids, often associated with cholesterol deposits. Xanthelasma is sometimes related to hyperlipidemia or metabolic problems, so prevention focuses on controlling blood lipids, adjusting diet, and regular checkups. Treatment options include cryotherapy, electrocautery, or laser therapy, but recurrence is almost inevitable if blood lipids remain high. Then comes syringoma, which often appears under the eyes and is formed by the excessive proliferation of sweat gland duct cells, resulting in small papules. Genetics and abnormal sweat gland development are the main factors. There is no clear prevention method, and treatment often relies on laser, electrocautery, or chemical peels. Because it is located in the superficial dermis, scarring may occasionally occur after the procedure. Following that is melasma, also known as chloasma or the "butterfly mask," which is a symmetrical light or dark brown patch on the face, particularly common in women, and often appears during pregnancy or when using birth control pills. Causes often include multiple factors such as elevated estrogen levels, UV exposure, and genetics. The key to prevention remains sun protection, and avoiding irritants and the misuse of hormonal drugs. Treatment often employs a "combination therapy," including hydroquinone, kojic acid, azelaic acid, retinoids, laser therapy, and oral antioxidants. Rosacea, the ninth type, is a chronic inflammatory skin disease characterized by flushing, telangiectasia, papules, and pustules. Its causes are related to abnormal vascular regulation, a weakened skin barrier, Demodex mites, and irritating foods. Prevention involves avoiding strong sunlight, hot and cold stimuli, alcohol, and spicy foods, and using mild skincare products. Treatment options include metronidazole, ivermectin, azelaic acid, and doxycycline; severe cases may require pulsed laser therapy. Finally, telangiectasia manifests as tiny, red, linear blood vessels on the skin's surface. Causes typically include sun exposure, skin aging, chronic inflammation, or long-term topical steroid use. Prevention remains sun protection, avoiding friction and hot and cold stimuli; treatment relies on pulsed dye laser therapy, intense pulsed light, or electrocoagulation.
Acne is a way for the skin to send out warning signals. The whole process can be roughly divided into three stages. The first stage is comedones, which include blackheads and whiteheads. The formation of comedones is like a blocked alley: sebum secreted by the sebaceous glands and keratin at the opening of the hair follicles get stuck together, forming small papules. Whiteheads are caused by completely closed hair follicles, like a small white grain of millet hidden in the skin; blackheads are caused by open hair follicles, where sebum is exposed to air and oxidizes, turning black. Excessive sebum secretion, puberty, stress, irregular sleep patterns, elevated androgen levels, abnormal keratinization of hair follicles, imbalance of skin flora, overly oily skincare products, incorrect cleansing methods, and irregular diet and lifestyle can all lead to clogged pores step by step. Essentially, clogged pores are the starting point of the entire acne chain . Comedones are not a small problem; they are the first drumbeat of the entire battle. Prevention naturally starts with controlling oil production and maintaining normal keratinization. For example, using salicylic acid (BHA), low-concentration retinoic acid, or retinol will show improvement with consistent use. However, it's crucial to avoid overuse of cleansers, which can damage the skin barrier and worsen the condition. Another factor is staying up late. The body perceives this as stress, increasing cortisol levels. Cortisol disrupts androgen levels, which in turn stimulates the sebaceous glands to produce more oil, resulting in clogged pores. At night, the skin performs three tasks: repairing the barrier, renewing itself, and clearing inflammation. Staying up late is like forcing your skin to continue driving while it's repairing the road; the result is a thickened stratum corneum, clogged pores, and continued acne inflammation. Acne then enters its second stage: inflammatory papules and pustules. Papules are small, painful red pimples, while pustules have a white pustule at the top. The pus isn't due to an increase in bacteria. The real "out-of-control" issue isn't bacteria, but the immune system. When the immune system is weak, the body exaggerates minor blockages into significant inflammation, turning small pimples into painful red pimples, and then into pustules. Worse still, staying up late is often accompanied by other bad habits, such as eating high-sugar and high-fat foods late at night, prolonged sitting, poor circulation, slowed skin metabolism, and greater blood sugar fluctuations—all of which contribute to worsening acne. So what can be done? The main preventative measure is to break the chain at the pimple stage by continuing with retinoic acid and salicylic acid treatments, avoiding heavy, oily products, and especially avoiding squeezing pimples. If the pimples have become red, swollen, and painful, topical benzoyl peroxide (BPO) can be used for anti-inflammation, or topical antibiotics such as clindamycin can be used, but they must be used in combination with BPO to avoid antibiotic resistance. If the condition has progressed to a moderate stage, a doctor may prescribe oral antibiotics such as doxycycline to prevent the inflammation from spreading or leaving pigmentation. The third stage is the most frightening: cysts and nodules, also known as cystic and nodular acne. Nodules resemble large, hard lumps buried deep in the skin, so painful to the point of making you question your existence; cysts, on the other hand, are formed when hair follicles rupture, allowing oil and inflammation to penetrate deep into the skin. While the surface may appear soft, the inside is like a small, deep-seated bomb ready to explode at any moment . This type of acne isn't just "bigger"; its true danger lies in damaging the dermal structure, leading to permanent pitted scars if repair fails. Reaching this stage often involves a combination of severe blockage, a strong immune response, genetic factors, high androgen levels, stress, or irregular sleep patterns. Prevention still relies on timely intervention in the first two stages: maintaining a stable lifestyle and reducing the impact of high-glycemic diets. If it has already progressed to the cyst stage, the most effective treatment is oral isotretinoin, but close management by a doctor is required; oral antibiotics are suitable for moderate cases; cysts can be treated with injectable corticosteroids for rapid inflammation reduction. Never squeeze them impulsively, as this will only deepen the damage and worsen the scarring. The most crucial strategy is "prevention," not scrambling to address the problem after it erupts.
The core meaning of skincare lies in anti-aging. Therefore, we need to understand why skin ages and how it ages. Aging can be divided into two main categories. The first is intrinsic aging, which is like a silent clock, influenced only by genes, hormones, and time. This is also known as clonal logic aging, and the changes occur deep within the dermis. The synthesis of collagen and elastin fibers decreases, their arrangement becomes disordered, and the matrix, such as hyaluronic acid, decreases, causing the skin to become thinner, drier, and looser. Cell division slows down, the keratinocyte renewal cycle lengthens, and the skin naturally becomes dull and rough, even wound healing becomes slower. As we "get older," hormone levels decline; reductions in sex hormones, GH, and IGF-1 also quietly cause the skin to lose elasticity and moisture. The second category is extrinsic aging, which is like a rough hand that puts the normally slow process on fast-forward. External factors such as sunlight (especially ultraviolet rays), visible light, tobacco, air pollution, poor diet, stress, and lack of sleep all continuously accelerate aging. UV radiation is the most severe culprit, even giving external aging its own name—photoaging. It causes deep wrinkles, age spots, roughness, enlarged pores, and yellowing skin, much like leather that has been over-sun-exposed. Most external aging follows the same path: increased free radicals → oxidative stress → inflammation → collagen degradation → DNA damage, thus accelerating aging. The four major culprits of skin aging are: free radicals, glycation, ultraviolet radiation, and chronic inflammation. Free radicals are like a knife that steals electrons . Just as a cut apple turns yellow quickly when exposed to air, our skin is constantly oxidized by sun exposure, pollution, stress, smoking, and a high-sugar, high-fat diet, though we don't usually see it. The second culprit is glycation. The author gives a particularly vivid example: the golden-brown, hardened surface of toast is because the protein has been "aged" by sugar. Collagen in the skin undergoes a similar process. When blood sugar is high, sugar reacts with collagen in a non-enzymatic way, forming AGEs (Advanced Glycation End Products). Collagen then becomes hard and brittle, difficult to degrade and rebuild, resulting in sagging, yellowing, and loss of elasticity. Sometimes, after eating sweets late at night, our faces look "older" the next day. We used to think it was just our imagination, but now we understand it's a warning from our bodies. The third culprit is ultraviolet radiation, the core of photoaging that's emphasized in almost every dermatology textbook: UVB causes sunburn and direct DNA damage, while UVA penetrates the dermis, destroying collagen, causing age spots, and activating MMPs (matrix metalloproteinases) to further break down collagen, making wrinkles and sagging irreversible. The fourth culprit is chronic inflammation. If free radicals are sparks, inflammation is a long-burning fire. It won't burn the house down immediately, but it keeps the skin in a constant state of "endless damage" and "repair being dragged down." Sources of aging include ultraviolet radiation, pollution, microbial imbalance, repeated scratching, over-cleaning, barrier disruption, high-sugar and high-fat diets, obesity, lack of sleep, and chronic stress. Since the mechanisms of aging are so complex, the anti-aging strategy is clear and simple: the first priority is always sun protection, and it must be consistent, applied adequately, and daily, even if you're just sitting by the window, even on a cloudy winter day. What truly sets you apart from others isn't whether you buy a 200-yuan or 400-yuan sunscreen, but how many days in the next ten years you will diligently apply sunscreen. The second priority is vitamin A derivatives, antioxidants, and a moisturizing and repairing system. Vitamin A derivatives (retinoic acid, retinol, retinaldehyde) can promote renewal, stimulate collagen, and metabolize pigments, but initial dryness, itching, and stinging are inevitable; tolerance must be built gradually. Antioxidants such as vitamin C, vitamin E, niacinamide, and polyphenols help neutralize free radicals and reduce oxidative stress caused by pollution; some can also brighten skin tone and reduce inflammation. Moisturizing and repairing rely on ingredients such as ceramides, cholesterol, fatty acids, hyaluronic acid, and glycerin to help restore the skin barrier. If you want a simple routine, then in the morning it's gentle clea