Prescription vs Over the Counter Skincare: Is Reale Actives Actually Worth It?

Not around here, partner. Not around here. — All right. I'm trying to read all the products in this video, but what we have here is very clinical, very prescription over here, and they're saying they're not going to buy Alex Earl's new skincare line. So, for those of you who don't know, Alex Earl is one of the most popular influencers online, and she just dropped her own skincare line, which we'll be talking about in this video. But we're also going to be just talking about clinical skincare, prescription skincare versus what you're buying over the counter available at your drugstore. Does the drugstore stuff have any value if you're going to see a dermatologist and getting prescriptions? We'd argue that it does have value, but we'll see in this video how it all fits together and why we still recommend drugstore products every time you see us as dermatologists. So, drugstore versus prescription versus Alex Earl. Here we go. So on this counter, we really have three categories of products. We have your prescription, we have your over-the-c counter, and we have medical grade. And we're going to walk you through where each one lives and what is the purpose of each one of these categories. So when you come to see me as a dermatologist, you're coming with some type of problem. Now, this person seems to have acne. They have lots of acne ingredients that are coming in here, but they may be coming with a rash. dark spots. And our goal is to really treat this. And so the first thing that we're going to do is we're going to evaluate the skin. So for acne, is it mild? Is it moderate? Is it severe? Is it cystic? Is it scarring? Is it something that's inflammatory or more comedonal and dry looking? This is all going to determine what type of prescription I'm going to use. And the prescription honestly is going to do most of the heavy lifting. So tininoan at night and maybe in this case, and then azelleic acid in the morning. This is doing the heavy lifting for your acne treatment, but you still need the rest of the routine to support this. And this is where your quote unquote medical grade or over- the-counter or cosmaceutical products come into play. And so whether it's for acne or for aging, your prescription ingredient probably will be the most effective thing for you. And then we can transition to this idea of medical grade skincare. This category has evolved a lot over time. And what it used to be is perhaps some of the best ingredients that were in a dermatologist friendly formula. And some of them do marry prescription ingredients with over-the-counter accessible compliments. Now, many brands also call themselves medical grade and they're all over-the-counter ingredients. And what that typically equates to is a higher price point for the same results. So I would exclude this category altogether from your consideration when you're building a skincare routine. And that's both me as a professional, as a dermatologist, and also as a consumer and a human who needs skincare for healthy skin. So when it comes to this quote unquote medical grade, which has the same ingredients that you can find over the counter in any cosmaceutical product, these are going to have no additional benefits and you're just paying this additional price tag. And so it's not something that you would really consider in an acne routine, for example. So when I'm diagnosing patients with acne, getting them a prescription, I'm often recommending a complimentary routine from the over-the-counter cosmaceutical brands that are much more affordable and more widely acceptable. So if I'm looking for a benzyl peroxide cleanser, I might recommend Caravee or Penoxil, for example, and that's going to be less than $20. And it's going to be widely available so anybody could get it instead of potentially a benzel peroxide from one of these medical grade brands. it's going to cost $50, $60 or $80. — And when you look at how you build a skincare routine, we always say cleanse, treat, protect. Now, it's modified allegedly to cleanse, treat, moisturize, protect. But the interesting thing is prescription lives in the treatment phase almost exclusively. Now, that leaves you with the cleanse, moisturize, protect, which all can be relegated to over-the-counter. So, yes, benzyl peroxide as a cleanser can treat, but just because you have a prescription strength doesn't mean it's more effective, which is why over-the-counter is acceptable and probably optimal from an irritation standpoint. Similarly, you move on, skip treatment, go to moisturizers, and you look at moisturizers. These all the goals is to soothe the skin barrier, help, repair, hug, heal, whatever. Over the counter, great. There's no irritation threshold. There's no side effects to worry about, so it doesn't live in the prescription space. Lastly, is sunscreen. Definitely Over the counter is regulated as a drug. It's as effective as anything prescription or you'd get from your dermatologist. So, all three of those steps purchased at your drugstore. Over-the-counter medical grade is in the same category. Prescription just lives as a treatment. Finding a new doctor that accepts your insurance is accepting new patients is actually quite difficult. And if you're a doctor and you're looking for patients in a new city that you just moved to, this can also be quite difficult. This is the reason why we use ZDOC at my practice in New York. And this video is brought to you by Zachdoc because not only can it help you find the right doctor, it also can help you find whether they have open appointments, whether you want to be seen virtually or in person. And you get to see verified reviews from real patients so that you know this is a good fit. You can search by specialty or you can even search by your symptoms to find the right doctor for you. Like Dr. Shaw mentioned, this not only helps the patient find a doctor, but helps the doctor find a patient. And if you are a patient, you do get to see the real reviews from those patients. Now, this helps you find if this relationship is a good fit for you. Maybe you have something in common. It could be interest. It could be language spoken. It could be history. And it could be something as simple as personality. So, using doc adds the person, the humanity back into that relationship between the physician and patient. Now, if you think about anything else that you book, whether it's a restaurant, a hotel, an

airline, a ride share service, you usually have an idea of what you're getting into and ZDOC gives you that opportunity to see real reviews from real patients on the doctor that you're about to see. So, if you need care today, you can just use Zachdoc. The information is in the description below. So, there's really three main reasons these cosmaceutical brands even exist. Whether it's the world, the dermocsmetic brands, the remedies of the world, or Alex Earls line. So, first reason would be to support a prescription skincare routine that's prescribed by your dermatologist. You still need the cleanser, the moisturizer, the sunscreen. Or if you're somebody who has no access to a dermatologist, for example, you're not going to ever see a dermatologist in person. You still need to build a skincare routine that's going to maybe treat mild or moderate acne. There are some products that are available that are widely available out there that you can use even before you see a dermatologist. And third, simply some people don't have skin issues and they just look at skincare as a way to maintain and something that they enjoy doing. And so they'll choose these brands that are maybe more fun like Glow Recipe for example because they enjoy the process and the experience of doing skincare. And so these brands exist for multiple reasons. Some are supportive, some are treative is treative treat therapeutic and finally uh some are just because people enjoy doing skincare and they enjoy the process of applying things to their skin. — And now let me introduce you to the conflict. It is drugstore versus prescription, prescription versus drugstore. Your dermatologist thinks all over the counter products are trash. Your esthetician thinks all prescription products are a waste of your time. This is actually not real. This is like a false controversy. This is should be actually a harmonious relationship. And as a dermatologist, I'm also speaking to my colleagues. I think it's a disservice when we are not educated on what people are purchasing to round out the rest of their routine because every step matters and everything that you were doing over the counter in your daily routine complements what we're prescribing as a prescription, right? And then the value of like for example an influencer that maybe you like or maybe you trust and we all watch and trust and like different people, right? So we're not even telling you who to like or who to watch or who to trust. But the thing is that if you enjoy using the product and it's something that you actually think is going to work and you're actually going to use it consistently over time, you're going to see more results of that. So if you buy Alex Earl's cleanser cuz you like Alex Earl and you have acne and you already got Tino and you decide to use her cleanser and you like it and you're going to use it every day, you're more likely to see results from that from a cleanser that you hate the way that it feels on the skin like the Caravee hydrating cleanser. I hate the way that product feels on my skin. It feels like I'm rubbing lotion on my skin with no foam. It's not something that I enjoy. And if a patient buys that and doesn't use it, they're not going to see results with that either, right? So, you do have to find things that you like and want to use. And that's the value of some of the influencers who testing many different products and recommending things to their followers that their followers might actually like and actually use and may actually see results with. And that takes us into this relationship with Alex Earl and her skincare line. Now, it's been a really interesting product launch. I candidly didn't know who she was, a neutral opinion of her entirely. But the feedback that I was seeing unfold was one that she had been on Accutane. The assumption was that this skincare line was supposed to give you Accutane like results. She never said that to be clear, but that somehow she was crediting this skinincare for her skin that Accutane gave her. I don't care if you're using Accutane, if you're using tininoone, if you're using hydroquinone and clinamy, a prescription ingredient. you are not going to get those prescription results with topical skincare. But she never claimed that you are also going to need a complimentary set of ingredients to complement exactly what we just talked about. And that's more what this is tailored towards. This is based off of her life experience, the aesthetics she liked, some of the ingredients she found to be helpful and how she wants to maintain her post acne skin with this lineup. And I think that conversation is real. So, think of this as more of a line for acne prone skin to support potentially a prescription routine or if you don't have a dermatologist at all or won't see a dermatologist as something that can support an acne routine from maybe using a product like different in your skincare routine. — And then it comes into the second controversy which has gained a lot of traction and that's the idea of acne prone skin and kamtogenicity with things like shea butter. Look, we did a scams video just very recently and we've talked in depth. You can go back to that video, watch it. But comedogenicity, the testing for this is really not representative of real life. Not only for single ingredients, but formula trumps single ingredients. Like I think based off of when the criticism was coming out, look, if these products actually cause acne and the vast majority of users, that's different. But most of the critique was coming off of an ingredient list. And to be honest, from a social media perspective, I thought we were past that. Like we had single ingredient criticisms back when The Ordinary was coming to boom. And I think that the accepted theology, skincare theology, skinology was that really formula matters. And so this is no different to that. The whole formula trumps whether or not a single ingredient could be ktogenic. And again, from single ingredient tests is really not representative. So if you think about how a non-comtogenic claim is developed, you're generally putting maybe 50 patients with the products on their skin and you're looking to see if

any comedones developed during that time. Now, if these people are not acne prone or this particular product doesn't cause acne in them, then you can call the product non-comtogenic. But the reality is we don't know if ingredients are cometogenic or not. We really only know if the final formula is. And is going to cause any problem in you specifically. So if you use a product and it causes you to have acne, then it's ktogenic in you, but it might not be kamtogenic in me. And so this is very, very individualized. So, it got a lot of push back over certain ingredients being kamtogenetic, but without the final formula and you trying it on yourself, you have no idea whether it's going to clog your pores or not. But the truth is, if you have a certain ingredient that you know when you use it on your skin that it always breaks you out. I don't have anything like that, but I know when I eat peanut butter, I break out. So, I avoid peanut butter so I don't break out. But if you're somebody that has a certain ingredient that you always notice breaks you out, then it would be very reasonable to avoid this in this line and any other line that has that ingredient. Now, let's talk about each of the products individually and walk you through them. I think we've both had some experience with the products at this point and we can talk with some extent about how we feel about them. Now, I don't know Alex at all. I've never met her. I've seen some of her videos, but I do know the dermatologist who helped to formulate this line. So, Dr. Kieran Mian, who's an incredible dermatologist. She's brilliant. She actually when I was creating remedies, she tested our rich cream moisturizer formula, which a lot of you love. Gave a lot of positive feedback on that formula in general. She has done lasers on my own skin in the New York office. My wife goes to her for advice and so she's a very trusted dermatologist that tries lots of products and has strong opinions, especially when it comes to treating acne. So, she's somebody I trust with my own skin and she had a hand in developing these products as well. But regardless of that, we'll be completely unbiased when reviewing these formulas and give you our feedback on where these really fit in a routine and whether or not they're going to be right for you. So, it looks like this is organized by a pre-clanser, a cleanser, a treatment, and a moisturizer. So, let's start with the pre-clanser, the cleansing balm. So many of you know I love a cleansing bomb. Dr. Maxwell loves a cleansing balm. And this comes in a shredder which is very similar to the remedy one which is hygienic. Suspiciously similar I would say. So very similar formula. If you look at the ingredient list there are definitely some differences between them. Ours is a bit more of a stiffer cleansing balm. Like it's got more, how do I say it? Body — body to it. Um and this is a bit more on the oily side. Both are incredible at removing any makeup and any sunscreen. Both are fragrance-free. They're going to be gentle on the skin and they're going to remove everything pretty well. So, this is I think a great formula and I love cleansing balms whether you have acne or you don't have acne. — Yeah, I love the aesthetic. I used it melts into your skin and your hand like with cleansing balms just as long as it's not too greasy. That's definitely one side that people error on and uh just too stiff and chunky clunky. That's the other side where you can really miss. But yeah, it's effective, feels great. Nailed it. Next up is their exfoliating LHA and BHA cleanser. So, this is really meant to support like let's say that you are using tininoan or you're using azelleic acid. having something with LHA which is a capriil salicylic acid. It's basically a variation of salicylic acid. So it's also a beta hydroxy acid which means it's able to get into your pore, exfoliate, unclog pores. So this could help to support your tininoan and your aelic acid. It's not like you can't use your prescription ingredients if you're using this. So this is a good cleanser in terms of active ingredients for an acne routine. — Yeah. And I would say salicylic acid is one of the rare ingredients that shines in the cleanser. This is actually one of the rare functional cleansers. As far as aesthetics and product use, it's a lightweight gel cleanser. It has like a medium lather. It doesn't strip. So, I think it's very balanced. Nothing extraordinary. Certainly no misses on it. I like it. So, this is a gel texture and it actually is a really nice gel texture for the skin and I think people with and it foams nicely. So, acne will enjoy the texture of this product. It does have peppermint in it. So, if you're somebody with sensitive skin or some s sensitivity to menthols, then this could potentially irritate your skin. It's really low on the ingredient list and it's not something that you can even really smell or feel when you apply it to the skin. And then finally, I would say that 3. 4 oz. It's a bit on the smaller side, but what's good about this is that you could take it in a travel size. It does have one advantage to it. So, I would say price per ounce, a bit on the expensive side for products, but overall a good cleanser. All right, so next up, and I love this packaging here, is their 8% mandelic acid serum. What are your thoughts on this product? — So, I actually love this product. My main knock on it was actually, and this is probably just me, but I actually don't think it was. I found it hard to open. It's just unique packaging, and I'm not someone to read the labels, so I was like trying. It looks like you should be able to pull this off. It looks like a cap, but you don't. You just twist it. And now I still am confused. I don't remember what happens if I press it. Where's it coming out of? — So, it's like a So, that's the — Oh, you just keep pull twisting. Okay. Yeah. — So, see, hit me again. Basically, it is beautiful packaging. Comes in a nice serum dropper. Mandelic acid. Functionally, a very nice balanced alpha hydroxy acid that is underutilized. A larger molecule so that it doesn't cause as much irritation, but maybe has a lower sealing than its counterpart, glycolic acid. Right? So, nice gentle serum, not tacky, absorbs well into the skin, overall feels great. Mandelic acid, one of my favorites. It's super

gentle, larger molecule alpha hydroxy acid, so it's not as irritating as glycolic acid. Has become a favorite amongst estheticians. So, estheticians love this for their acne patients. Now, it's not classically an acne fighting ingredient, but a lot of times with sensitive skin, it can be really exfoliating. What I think is underrated about this formula is actually that it has hexorcinol. So, hexelinol is not only a good acne fighting ingredient, but it's also really good for dark spots that could potentially be left behind. And so this is an underrated ingredient in a product for somebody who has acne to treat both the acne and the post acne marks. Now, when we're looking at the video that we're reacting to here, this person's got tininoan. They also have tazaratine. They also have azelic acid. So where would this fit in a routine? Probably doesn't fit into an acne routine that already has so many prescription activives in one formula. But for somebody who has maybe mild acne, is looking for a supporting serum that's fragrance-free, this is a really good option for you. Now, one thing I'll add is uh when I posted about this product line, one of the most negative comments was about, "Oh, I just said the cleansing balm was buttery and I didn't like show any before and afters or talk about my results with the dark spot serum. " It actually brings up a bigger point in conversation. You shouldn't never trust before and after results online, ever. Even if the product is extraordinarily good, the idea that any individual is just using this one new product to create results that you should only see 12 weeks later is just extremely unrealistic. Especially from skin influencers or even dermatologists, the idea that someone would stop their entire skin care routine just to make sure this product worked for 12 weeks, show you those before and afters, it just doesn't happen. Doesn't exist. Never trust that. Yeah. And this is where you want to trust the clinical before and afters. somebody who does a controlled study where they're only allowed to use these products for a certain period of time. They take pictures throughout the time, but you even got to be more careful on Tik Tok shop. So, Tik Tok shop has got crazy people are trying to sell you products cuz they make commission on them, right? And so, they're going to show you the craziest before and afters that are generally filtered to try to make their skin look amazing from using this one product. The picture could be from like 20 years ago when their skin looked horrible and then now their skin is clear and they're like, "This product did it all. " Right? So, just be careful on Tik Tok shop. even from brands like my own brand. I see sometimes affiliates posting stuff and I'm a bit questioning like I don't know, you know, there's no way to stop them, right? Because people can post anything on Tik Tok shop unless you somehow figure out a way to deactivate their video, which is actually quite difficult to do. People can post really anything. So, just be careful, especially on Tik Tok shop, — right? So, the trust you garner for the results in a product, especially when it comes to anti-aging more than acne, is going to be in the formula list. Again, harping on this again, the formula is very important. trusted ingredients, thoughtful formula is much more important than before and afters that you'll see online. Okay, and this brings us to the moisturizer, their do more barrier boosting moisturizer. And I think this is the one that probably got the most negative. This is before anyone had even tried the product, right? Everyone who's trashing this video specifically around shea butter. Now, I love shea butter in a moisturizer if you know me. So, I'm looking at this as a pro. But there's a lot of people with acne prone skin who are thinking shea butter clogs their pores. Now, if you're somebody who's used a product with shea butter before and every time you use a product with shea butter, you break out, then don't use a product with shea butter. You know, that's that goes without saying. But in general, to say shea butter is pore clogging or acneic or ktogenic, the data just doesn't support that any single ingredient is kamtogenic without looking at the overall formula and without looking at you as an individual. And so, when it comes to a moisturizer, your experience and others experiences is really going to revolve around how hydrated does it feel? How are the aesthetics? Do you enjoy the experience? and then comparing that to other products you've used. I loved this moisturizer personally and I think the aesthetics of the whole line are great. It does have a slight scent to it. You know, there are ingredients that contribute to that and can be allergic or irritating for some people, but I think overall they really did a great job with the body. I think it's hydrating how it plays with your skin, especially if it's acne prone. You know, that's up to you. Unfortunately, I know that's difficult to not have a great source to predict how your skin will react to it. But one thing that's interesting with acne prone skin and I tell my patients this in the clinic all the time the better that your acne is treated the less acne prone or kamtogenic may be saying acne genenic kamtogenic ingredients will matter the better your acne is controlled the less your skin will develop acne when you try new things on your skin right and especially if you're somebody who's on Accutane you may even look for a very thick traditionally like people are using prolatum or aquaor on their skin and people consider those to be very pore clogging but they'll use those when you're on Accutane because a lot of the Accutane is going to be doing the heavy lifting. So, the more effective your treatments are, the less you have to worry about potentially your moisturizer clogging your pores. And I'd agree, this is a really nice from a tactile perspective, a nice moisturizer. It's somewhere between a gel and a cream. Maybe you can call it a gel cream, maybe a lotion, for example. Absorbs really nice. Isn't greasy at all. Again, that shea butter base is something that I personally like a lot. Now, this does have some essential oil type ingredients in it like lavender. Has some lemonine in it as well. And so, it does have like a mild scent to it. So, if you're somebody who's sensitive to fragrance, this is not something that you'd want to use in your routine. But if you're not sensitive to fragrance, it's just an enjoyable moisturizer to use, especially if you like something more in that gel, cream, lotion base. So, out of the gate, I think lots of

people bought the brand. But, I think the lesson from this video is one, you do need products outside of prescription products because prescriptions don't provide everything. So, you do need supporting products. Whether they're from Real Actives or another brand, you still need your cleanser, your moisturizer, and your sunscreen, and pick the ones that are going to be best for you. The second thing is you can't look at an ingredient list and say whether something is ktogenic or not. It's about the final formula and how it reacts with your skin. And then finally, I think the internet can be overly hyperritical on things in general, right? And so I think, you know, try things yourself. You don't always need to try every new influencer brand. We've been saying this in the very beginning. When a new influencer brand drops, you don't need to be the first one to dive on it and try the new products. But if it's somebody you like and somebody that you want to support and the ingredients work well for your skin, then I think it would be very reasonable to use this as a complimentary part of your routine. Now, this brand does not is not an acne treatment by any means. And I and I'll be paying close attention to see how they advertise this cuz I think they say that this is going to treat very severe acne or anything like that. I think that's just simply not true. And I don't think that they're I haven't seen them making that claim. For example, so if you somebody who needs Accutane, don't avoid Accutane and then use real activives, right? But if you're on Accutane, you could use their cleanser and their moisturizer, for example, to support your routine. — And if you have any questions about her intent, she has a lot of videos on her own page walking you through her Accutane journey, how many times she was on it, the fact that she stopped, the fact that this is not Accutane. So, you can certainly go down the rabbit trail if you're very passionate about this topic, which I know a lot of you are. There's a plethora of information for you to look at. We very rarely do celebrity skincare lines. Actually, this is just not something we do. But I think the most important takeaway here is just that marriage between over-the-counter prescription. It should be harmonious. Your skin care should look like that counter with less trenan, but with the complimenting over the counter married to prescriptions. That's where you're going to get the best results. — Favorite product from the line? Uh the cleansing balm. — Cleansing balm. Yeah, I'm with you. Good product. All right. Thank you all so much for tuning in. Let us know if you've actually tried the product, what you liked, what you didn't like. If you hated it, let us know. Please like, comment, and subscribe, and we'll see you in the next video. See you next time.