Skincare Q&A: Katie Keel, ARNP

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One of the foundations of Lady in Grey is to provide perspective on a variety of topics. Not just my perspective, but also that of experts that can really give valuable information or insights. With that in mind, I am excited to introduce the blog’s first Q&A!

Katie Keel is an old friend from highschool and a nurse practitioner at a dermatologist office in my hometown of Ocala, FL. For years she has unknowingly been giving me skincare recommendations through our mutual best friend who always passes along whatever wisdom she learned from Katie (Thanks, Tiff!). She’s brilliant, funny and beautiful and I’m so excited to share her insights and advice. So, without further ado…

Q: Katie, tell us about yourself and your profession.

A: My name is Katie Keel and I am an Advanced Registered Nurse Practitioner (ARNP) at MidState Skin Institute in Ocala, FL. I have been in my current position for 3 years and prior to that worked on the Burn Intensive Care Unit at Shands. ARNPs are Master’s degree trained healthcare providers that are able to do many of the things a physician can. My current day to day involves skin cancer screenings, diagnosis and management of skin conditions (like acne, eczema, psoriasis, rashes, etc), surgical excisions, and cosmetics including Botox and filler.

Q: Before we dive in to skincare, I want to ask you about skin types. Everyone has their own unique skin type, but how do you figure out what yours is? I’ve been guessing what mine is for years.

A: The main skin types are dry, oily, combination, and sensitive. Dry means you have skin that is prone to flaking and peeling. Oily people commonly have issues with shine and “greasy” face complaints. Combination as the name entails means you have areas of oil, usually the T-zone, and areas of dryness. Sensitive people find that products can make their face red or irritated and typically need to use fragrance and dye free products.

Q: And everyone’s skin type requires a different skincare routine?

A: There are several products that are important regardless of skin type. Cleanser, vitamin C serum, and sunscreen are all non-negotiables. Most companies have specific lines or products that target each specific skin type such as dry, acne or redness prone, oily, sensitive or combination.

Q: I think it’s so important to take good care of our skin for many reasons, mainly vanity if I’m being honest, but what do you think are the most important parts of a skincare routine?

A: Removing all makeup every night, a vitamin C serum, and sun protection are absolute MUSTS! Not only does makeup clog your pores but it can also accelerate the aging process. A good vitamin C antioxidant serum should be included due to its ability to absorb free radicals and stimulate collagen. Sun protection will be harped on later 🙂

Q: Do you make [your husband] Tyler take care of his skin too? I’ve been trying to push this on my husband but it hasn’t really caught on…yet!

A: Since I am the one that does the shopping, if I buy it and put it in the shower he will use it ;). However he isn’t great at applying sunscreen but he is great about wearing SPF sun shirts and hats with a brim so I guess I can live with that (for now). He is pretty low maintenance so getting him to use serums or moisturizers is not  going to happen any time soon.

Q: Growing up in Florida, as you know very well, being in the sun is part of the lifestyle and, at least for me, no one was really pushing the daily sunscreen PSA like I hear now. Do you think sunscreen daily is necessary no matter where you live?

A: Yes! Technically tanned skin is sun damaged skin. Even if you think skin cancer won’t happen to you think again – we see patients younger and younger every day with nonmelanoma and melanoma skin cancers. A tan might look pretty now but a skin cancer scar could look ugly forever.

Q:  I hear so many tips and tricks for preventing wrinkles and signs of aging, and try most of them with no idea if they’re actually working. What are some tips and tricks you use or think really work?

A: Retinols and prescription Retin-A have been shown to stimulate collagen synthesis; meaning they stimulate your skin to make its own natural collagen. This will help with fine lines, wrinkles, and uneven skin tone and texture. I am also an advocate of learning to sleep on your back. I love the YourFace pillow from Amazon. Pricey for a pillow but worth it! I am also a believer in preventative and well placed Botox and filler.

Q: What about exfoliating. How important is it and how often should we be exfoliating?

A: I am a big fan of chemical exfoliation and by that I mean mild acids like glycolic and lactic and retinoids like OTC retinol and prescription Retin-A. These will all cause slight peeling as your skin is getting used to them. Usually we recommend 2 to 3 times a week to start to minimize that sloughing. Some people are able to work up to nightly use so long as excess irritation does not occur. Physical exfoliation should be done carefully with a product that is not too abrasive. Certain scrubs have tiny round plastic beads which have been proven to be bad for the environment – so much so that the government is banning them in certain states. Other products have particles that are so irregular they can cause micro tears to the skin. Safer products that I love are Honey Cleanse by Circadia and Dermalogica Daily Microfoliant. These are gentle enough to do every day. If you want to splurge and get a professional microdermabrasion once every few months that is a good idea too. Your skin cell turnover occurs naturally every 30 days so make sure you are not overdoing it.

Q: Now let’s talk about products. What are products (or ingredients) that women should stay away from?

A: Two big ones are mineral oil and chemical sunscreens (ex: oxybenzone). Oxybenzone can act like estrogen in the body, alters sperm production in animals and is associated with endometriosis in women. It has fairly high rates of skin irritation, allergy, and can flare acne and rosacea. Mineral oil is a no-no because it is a by-product of the distillation of petroleum to produce gasoline. It’s long been used as a common ingredient in lotions, creams, and cosmetics. The issue is that it is comedogenic meaning it clogs your pores and has no beneficial value for your skin. Companies add it as a filler because it is so cheap and helps the product spread easier.

Q: What are products that you love?

A: I wear makeup everyday so it is important to me that I get it all off every night. I love Dermalogica PreCleanse for this. You use it while your skin is dry and it dissolves all the makeup. Then you wash with your favorite cleanser. My current favorite sunscreen is UV Elements by EltaMD. It is a purely physical sunscreen so you don’t have to worry about the chemicals discussed earlier. Added bonus – it also has vitamin C and hyaluronic acid. I have acne prone skin so my other holy grail product is Clinique Acne Solutions foundation. It has 0.5% of salicylic acid so it helps treat your acne and acne scarring while you wear it. The coverage is awesome as well.

Q: What’s a myth about skincare you hear most often wish could be debunked once and for all?

A: That skin health is not linked to diet. Food is medicine and what you put in your body will make a difference in the clarity and health of your skin. Drinking plenty of water can help with hydration and clarity of the skin as well as decrease eye puffiness and dark circles. Dairy has been linked to acne in numerous randomized controlled studies and a recent article proved that people who consumed low glycemic content foods had less acne. Those who consumed the vitamin B3 supplement nicotinamide—cut their rate of new squamous-cell and basal-cell skin cancers by 23% compared with placebo after 1 year among patients at high risk for skin cancer. Nicotinamide also reduced the risk for developing actinic keratosis, a common precancer of the skin.

Q: My last question is something Sophia Amoruso always asked her guests at the end of her podcast “GirlBoss Radio”that I found inspiring and motivating. What was something you did recently that made you feel like a #GirlBoss whether it was personal or professional? (Lady in Grey is ALL ABOUT that empowerment!)

A: Just this past week I received a two page letter from a patient thanking me for taking her skin condition seriously. She had been struggling with it for over a year and had already seen two physicians for the same rash and was left without any answers or improvement in her condition. I did some bloodwork and a couple biopsies and found that she has a serious autoimmune disease and now we are going in the right direction with her treatment. I was just doing my job but it is definitely nice to be thanked for it and really fulfilling I found something other healthcare providers missed.


Now everyone go check the ingredients of your products and pick up some self tanner, sans mineral oil and oxybenzone, K?! I know I am. 

If you’re in the Ocala area check out MidState Skin Institute and their range of services from clinical to cosmetic. Skin is your body’s largest organ- take care of it and preserve it! I always tell my husband the investments I make in my skin now we’ll BOTH appreciate in 10-20 years :).

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