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Dr. Tarbox: Hello and welcome to "Skincast," the podcast for people who have skin and want to know how to take the very best care of it. My name is Michelle Tarbox, and I am an associate professor of dermatology and dermatopathology at Texas Tech Ï㽶ÊÓƵ Health Sciences Center in beautiful, sunny Lubbock, Texas. And I'm being joined today by . . .

Dr. Johnson: Hey, my name is Luke Johnson. I am a pediatric dermatologist and general dermatologist with the Ï㽶ÊÓƵ of Utah.

And we had this idea to create a special Halloween episode of "Skincast." And so, joining us today, we've got a couple of guests, including the person who originally thought of this idea. She's sitting next to me right now. Her name is Lindsay. Lindsay, thanks so much for joining us. Do you want to introduce yourself?

Lindsay: Sure. My name is Lindsay Johnson. I am a physician assistant in family medicine as well as a theater nerd and Halloween person. I enjoy Halloween. Let's just put it that way.

Dr. Johnson: And you happen to be married to me.

Lindsay: And I happen to be married to you, yes.

Dr. Johnson: And, Michelle, you also brought a guest.

Dr. Tarbox: I did. Rebecca, do you want to introduce yourself?

Rebecca: Sure. Why not? So I'm Rebecca Nelson. I am neither a medical professional nor a dermatologist, but I am a professional opera singer and I spend a lot of time in stage makeup. So I will be sharing my experiences of what I know in that area.

Dr. Tarbox: And Rebecca is related to me in the most possible related way possible because she is my identical twin sister.

Rebecca: Yes. I could frame her for murder.

Dr. Johnson: So in terms of Halloween, the most dermatologically relevant thing that might happen is that people put on costumes and makeup. So this might be an episode mostly about Halloween makeup and stage makeup and how to do it right and how not to do it wrong.

For me, my makeup is mostly, I just do a little bit of foundation and guyliner and that's it. So I'm going to kind of step back and let you guys do most of the talking today.

Lindsay: I guess I have a story I could start with of something not to do. So when I was in high school, many moons ago, I played the wicked witch of the west in a production of "The Wizard of Oz." Yes. So that meant I had to start the show as Almira Gulch with normal stage makeup on, and then I had very little time to transform myself into a green witch, which did take some doing. And that meant green cream, probably . . . is it Ben Nye? Am I right? Am I remembering correct?

Dr. Tarbox: Yes. That's the one you talked about.

Lindsay: Cream makeup all over my face and also on my hands, but I did not know at the time how to set the makeup. So it would get all over my costume. You know, I had to not touch anything backstage. I think it got on the dog that was playing Toto. So I have learned since, but I'd like to hear from your two perspectives . . . and I know, Michelle, you also do a lot of community theater . . . what I did wrong and what I should have done instead.

Dr. Tarbox: Becca, why don't you take us through your normal makeup application that you go through and what the most important things you think are? And then I'll contribute some thoughts from the dermatology side.

Rebecca: Sure. So I'm actually going to talk about stage makeup prevalently, because we're talking about Halloween and theater, which is always more exaggerated than, you know, going from day to night with your Maybelline.

So when you're talking about grease-based paint, which is what most Halloween makeup is, there are certain things that you really need to keep in mind.

Number one, for any kind of makeup, is that whatever you are using to apply the makeup to your face must be clean. If it's your hands, they need to be clean. If it's a brush, it needs to be clean. If it's a sponge, it needs to be clean.

If these are implements that are being used by multiple people, that goes double. So it's very important. You can transmit all kinds of bacteria to eyes and things like that if brushes and sponges are not properly cleaned. So that's the first thing.

Also, you want to start with a clean canvas, so your face should be clean before you apply the makeup.

Once you've applied the makeup, it's important to set it, as you mentioned. There's a setting powder that we use in the theater. It's just a very . . . actually when you see those comedies and they're like, "Powder," and there's a giant powder puff that smacks someone in the face, it's a small version of that. And that actually sets the makeup so that it doesn't bleed and get all over everything.

But it's interesting because in some ways the circumstances that you're in when you're in a stage production, you're under heat, you're under lights, you're sweating, are going to be similar to what you might experience with your face in a crazy night out in Halloween. You're running around very excited and you're sweating. So it's important also to think about the aftercare. So once you've had the makeup on and you've done the trick or treating, or whatever, you've had your party, removing the makeup properly is also very important.

So you're going to want to use either micellar water with just a regular cotton pad, or we actually even use baby wipes at the theater, but it is important to start with a clean face and end with a clean face. Those are two of the most important things.

Dr. Tarbox: The theater part of me says the baby wipes actually are pretty helpful because they're also bigger territory. It's a bigger towelette. Whenever you're really putting a lot of makeup on, a normal face wipe for a normal day of makeup being cleansed off is not going to cut it. You're either going to have to use five of those things . . .

Rebecca: You have to use seven of them, yeah.

Dr. Tarbox: Or you just get the one big hearty baby wipe. Now, you want to worry a little bit about gentleness of ingredients in those. The water wipes, Luke, that we've talked about I think on one of the podcast episodes are pretty hypoallergenic, not fragranced, and don't tend to because a lot of irritation because of preservatives and things like that.

There's three big problems with a lot of what most people are going to think about as Halloween makeup, and that's going to be those little kind of pallets with little individual pots of colored paint and usually a character suggestion on the front of a blister pack with a cardboard backing.

So those products, first of all, and most importantly, are not FDA regulated. That means anything can be in them. So they can have stuff that's never intended to be put on faces. It's this weird loophole where those are not subject to FDA regulations. So I've seen some that have known severely irritating chemicals in them and on sale at a local Halloween store and the Halloween aisle at a convenience store. So FDA non-approval is a huge problem.

Second problem is they're usually really cheap, so you get the whole palette for $5 or something like that. So they're using the cheapest ingredients possible. And to get the most bang for the least buck in terms of pigment cost, usually, these are going to be oil-based because that makes the pigments really intense, it makes them stay on well, and it causes the pigment to kind of retain its intensity even with more spread out use. Oil-based stuff, a little bit more likely to irritate the skin, and then cheap FDA non-approved ingredients, problematic.

The third problem is because the FDA doesn't regulate these things, no one is enforcing expiration dates. So if you're not paying attention, there have been products sold on the shelves that have been four years out from their expiration date with inferior ingredients. So name of the game is you get what you pay for.

I advise people, especially those who have sensitive skin, to buy makeup that's intended actually for stage use and never to buy those little palettes that you can get cheaply in the convenient store. It's convenient, but it could create a nightmare you don't want to deal with afterwards. And then just trying to use the theatrical makeup.

There are a lot of different companies that make good, gentle theatrical makeup, and some that even make water-based ones for very sensitive skin. It's not going to be as intensive of a pigment, but you can get the suggestion of a tiger or whatever you want going.

Yeah, I think those are good things to start with. But the cheaper the cosmetic, the more likelihood that you're going to have irritating ingredients that are bad for your skin.

You didn't ever sleep in it, did you, Lindsay?

Lindsay: Oh, no, but I did have a hard time . . . Of course, I didn't know about setting with powder. I also didn't know about either the baby wipes, the water wipes, micellar water, or what I did ended up doing in college theater makeup classes, which was Pond's cold cream.

Rebecca: Oh, yeah. That also works.

Lindsay: Putting that on to get the oil-based stuff off, wiping it off, and then washing with water and soap and stuff.

So I would go home . . . this is high school, so you'd do the show and then you stay out late with a cast party. And I would go home and I would have green stuff all up into my hairline, and it was pretty comical afterwards.

Rebecca: Michelle, if somebody wanted to risk it with the cheap pins and they did a patch test, do you think that would be advisable?

Dr. Tarbox: So that's actually something I wanted to bring forward also. So if you are the risk-taking variety or if cost is an issue and you really want to try to use one of these less expensive topicals, knowing that that might cost you a doctor visit later or potentially be makeup you can't use, you could try what's called an open use test.

So an open use test is sort of the at-home equivalent of patch testing we would do in the dermatologist's office. The way you do a use test is you apply whatever product it is you're trying to test. I usually have people look at their forearms and find a mole or something so that they can do it in the same place multiple days in a row, and you apply it the way you're going to use it. So if you were using a stage makeup, you'd apply it like you'd apply the stage makeup.

You obviously wouldn't apply a cleanser and then leave it on because that would irritate anybody's skin, but if it's something that's intended to be left on . . .

So I have a handy freckle I'm showing you guys on the Zencastr podcast platform with video that I use for my use tests, and I'll just apply something around that little mole for three or four days in a row, and usually at least a week before I actually have to use it, to check to see if I've got a contact allergy to that product or if it's made out of irritating chemicals.

And if you don't get a reaction to that, you could potentially use the topical product, whatever it is, safely.

Now, one thing that I've also talked to people about is trying to set the stage for success with this. So before you would ever start putting the makeup on, face has to be clean, and then it needs to be gently moisturized in a way that's not going to plug up pores. So I like patients to use a gentle lotion that doesn't have any fragrances or anything heavily irritating in it. Something like CeraVe lotion can be used. You could also potentially use some of the really gentle primers. And then kind of putting a little . . .

Rebecca: Yeah, we use primers.

Dr. Tarbox: Yeah. And then putting a little bit of a protective base in place before you put all this makeup on.

So you have some interesting thoughts, Becca, about powder application and long you can leave that stuff on.

Rebecca: Yeah. So it depends on how much you're sweating actually, and what the purpose of the makeup is. But I would say that even if it's for fun and for Halloween, I wouldn't leave thick grease paint on a face longer than three or four hours because your skin needs to breathe.

I have colleagues that are in some really makeup-intense roles right now. We're doing "The Magic Flute," and the guy playing Papageno, who's the bird guy, has really extreme makeup. And he just had too many shows in a row and had a breakout around his eyes, even though he was basically doing the right things. So duration of the makeup on the skin is also a factor. So I definitely wouldn't say, "Let's spend 12 hours in stage makeup."

Dr. Tarbox: As a primary care specialist, Lindsay, I bet you've seen somebody come in with a rash after using one of these things. Have you ever encountered that?

Lindsay: I've heard stories. I don't know if I've seen it directly right after Halloween, but it makes sense that if you leave it on for a long period of time, you know, you're going to plug it up. You absolutely can get acne breakouts and rashes and whatnot.

Dr. Tarbox: And what I've seen personally is some of the para makeup things like . . . I just made up a term, para makeup.

Lindsay: Para makeup.

Dr. Tarbox: So one of the things I've seen is patients who come in after using false eyelashes with cheap adhesive and they have this horrible eyelid dermatitis. So another I think important thing is if you're going to use false eyelashes and want to incorporate those into your costume, even if you want the crazy ones with feathers and sparkers coming off of them that you would never use in everyday life, buy those, fine, but don't use the glue that comes with them. Buy the glue from a cosmetic company like Sephora or something where they're intended to be used regularly. Those are actually regulated by the FDA, unlike the costume products, so that you're not putting something irritant near your eye.

And then also, of course, some people will incorporate the theater contacts, and some of those are not made well. And so, trying to get a theatrical contact from a company that actually makes other reputable lens products is a good idea as opposed to just buying whatever you can kind of find. And you can find all sorts of crazy things on the interwebs these days.

Rebecca: Just generally speaking from a community theater perspective or even just doing the makeup with your friends, there are two types of products that I would say should not be used by more than one person. And that would be any kind of product that goes in the eye or around the eye, so mascara, and what goes on the lips.

So we try and have our own lipstick and our own mascara at the theater because it's just very, very easy to transmit bacteria with those products. So those are two things where it's really not great to share with your friends.

Lindsay: Yeah. I've had a family of kids that came in with impetigo from having face paint put on. All four kids had had face paint applied and all of them had impetigo because there was reuse of the sponge and the makeup for each subsequent kid, and so that's a recipe for disaster.

Rebecca: Yeah. That's why the sponges have to be washed. That's crazy.

Dr. Johnson: So maybe this is a dumb question, but if you use brushes and things, how do you clean those?

Rebecca: So they can be washed with an alcohol mixture. I know that they actually sell specific makeup brush cleansing formulas at makeup stores and stuff like that. But they can be soaked in this . . . I'm not entirely sure what it's made of. I know there's alcohol in it, but I know that beauty supply stores have these.

Dr. Tarbox: And a lot of the time we recommend you just, if you are in a pinch, you cleanse the brush with whatever you use to cleanse your face.

Rebecca: Soap and water also works.

Dr. Tarbox: And then it does have to dry for certain applications. Sometimes in theater, they will use the theater trick of a water bottle with vodka in it, usually cheap vodka, and then you spray that for the clothing, you spray that for the costumes that can't be laundered in between to try to kill some of the bacteria and odor.

Other weird things. Sometimes people have like the little mats to cleanse the brushes, and those are, I think, very helpful. They have a little texture to them.

I do totally agree that the cleansing needs to happen. But anything that's made for your face is usually sufficient to cleanse the brush.

If you have a wooden handle and natural bristles, you want to be careful not to let them stay wet too long because the wood can rot and that can cause problem with the bristles falling out.

And then other weird stuff too. Some of the things that I've seen the most reaction from is fake blood. So the theatrical fake blood that comes especially in the little blister packs is not made well at all.

Rebecca: That's also not FDA-approved, I'm guessing.

Dr. Tarbox: And it can directly interact with the oil-based makeups. So I've seen people come in with like. . .

Dr. Johnson: So use real blood.

Dr. Tarbox: I mean . . .

Rebecca: But stage blood, like actual stage blood, is fine. I have lots of experience with that because I'm a soprano and we get killed all the time. So if it's actual theatrical stage blood, not something sold by Spirit of Halloween or whatever, but actual theatrical stage blood, that is actually tested.

Dr. Tarbox: Yeah, red dyes can be dangerous. If you're in a pinch and you need to make it yourself, you can use food coloring, most people don't have a reaction to that, and mix it with corn syrup and cornstarch. Or you can add a little chocolate syrup to give it some opacity, because real blood . . . you know, Luke and Lindsay, real blood is not see-through. So whenever you see this gelatinous red stuff, you're like, "Sure, that's blood."

Rebecca: That's what you'd like to think it looks like.

Lindsay: I do have one more. I hope this could be a public service announcement for our young men or just men who are in the high school or community theater productions, and moms or whatever, helping out with the makeup and they're playing a straight/cis character but they've got the longest lashes you've ever seen because they've got the mascara and they've got the guyliner. When they're playing a character who doesn't really call for mascara, what should they do for their eye makeup?

Rebecca: Right. So I mean, eyeliner, it depends on the size of the stage. So eyeliner is pretty standard. Obviously not with a little wing or something, but just to make the eyes stand out a little bit. I mean, the opera house that I work at has over 1,500 seats in it, so we want the people who are up in the nosebleed section still to be able to see that we have eyes. But it's not standard practice that the guys use mascara.

So just a little bit of eyeliner to make the eyes stand out a little bit more. And usually, they'll use a base just to even out the skin tone and maybe a little bit of contour just to show jawline and stuff like that.

But if it's just a regular cis male character, you don't see a lot of mascara and stuff like that. Just really very standard, boring, non-shiny eyeliner.

Dr. Tarbox: And I think like a tinted brow gel . . .

Rebecca: Like a pencil.

Dr. Tarbox:. . . is helpful too because re-darkening the brow is sometimes necessary after applying the base face makeup. And men tend to have heavier brows than women, so you can kind of combat some of the feminizing effect of makeup on a man.

Rebecca: If you do that, if you do have makeup in the eyebrows, it's important to remember to remove that makeup in the eyebrows because sometimes people miss that part somehow, and then you can actually get folliculitis in your eyebrows. Look at me using medical terminology. Was that right?

Dr. Tarbox: Good job.

Lindsay: Yes. It was perfect. Great.

Dr. Tarbox: Said the opera singer. Great job.

Rebecca: "Said the opera singer."

Dr. Johnson: Well, that's probably what we've got time for today. So big thanks to Becca and Lindsay for joining us.

Rebecca: It was great.

Dr. Johnson: And I hope you guys all have a fun and safe Halloween. "Skincast" comes to you every two weeks, and you can find our entire archive on Apple Podcasts or wherever you get your podcasts. Michelle, you and I also have another podcast.

Dr. Tarbox: Yes. So we co-host the "Dermasphere" podcast. It is an hour long typically, and it covers upcoming and current topics in our literature. It is directed at dermatologists and the dermatologically-curious.

Dr. Johnson: So if you're a super dermatology nerd like we are, you might check that out. Otherwise, have a great time. See you next time.

Dr. Tarbox: Happy Halloween!