Sample consultation — a real, full-length consultation prepared for “Alex”, a demonstration skin profile. Not a customer’s data. Yours is built from your own answers.
Your Personalised Skin Consultation
Prepared for Alex
Based on your 17 answers · 7 July 2026
Read this first
Your top priorities
- Your biggest lever isn't a new active — it's barrier repair. Fix leaky stratum corneum first, then layer targeted acne and pore work.
- The jawline cysts are hormonal, driven by your cycle despite Microgynon 30 — azelaic acid is your safest evidence-led route.
- Broken sleep at 3-4am is measurably worsening your redness and dehydration. This is not cosmetic — it's physiological.
- Your old La Roche-Posay SPF needs replacing before next week. UV filters degrade and yours is likely underperforming.
- London hard water is quietly antagonising every product you own. A post-cleanse rinse strategy will change your reactivity.
Skin Analysis
Based on what you've described, you don't have combination skin in the classical sense — you have a compromised barrier on your cheeks and reactive sebaceous glands in your T-zone, presenting simultaneously. The tightness after cleansing is diagnostic: healthy skin should feel neutral, not tight. That tightness is transepidermal water loss driven by an overly stripped stratum corneum (Del Rosso & Levin 2011).
The midday shine on your nose isn't proof you're oily — it's often reactive seborrhoea, where a dehydrated barrier signals for more sebum to compensate. Your CeraVe SA reaction confirms this: salicylic acid at 2% shouldn't sting for two days on intact skin. It stung because the acid mantle was already breached, likely by your Garnier micellar water residue combined with Zone 2 hard water.
The jawline and chin cysts a week pre-period are textbook androgen-mediated acne. Microgynon 30 (levonorgestrel + ethinylestradiol) contains a mildly androgenic progestin, so despite being on the pill, you're not getting the anti-androgenic protection a drospirenone-based pill would provide (Khunger & Mehrotra 2019).
“You don't have combination skin in the classical sense — you have a compromised barrier on your cheeks and reactive sebaceous glands in your T-zone, presenting simultaneously.”
Your enlarging nasal pores at 25-34 reflect a normal loss of dermal elasticity around the follicular ostia, accelerated by the daily pastry-and-chocolate pattern raising IGF-1 and sebum quality (Smith et al. 2007). This is remediable, but not with pore-stripping products — it requires sebum modulation and collagen support.
Key Findings
- Your 'sensitive combination' skin is actually a barrier-compromised phenotype with reactive sebum — not two separate skin types coexisting.
- Microgynon 30's levonorgestrel is androgenic and is contributing to, not preventing, your premenstrual jawline cysts.
- Zone 2 London water (>250 mg/L CaCO3) is depositing calcium and surfactant residue on your face with every rinse.
- Your 3-4am waking pattern coincides with peak cortisol; broken sleep is measurably impairing barrier recovery.
- Daily dairy (milk in coffee + yoghurt 3-4x weekly) is one of the more replicated dietary acne triggers in the literature.
- The CeraVe SA reaction was not a salicylic acid intolerance per se — it was an intolerance test on already-compromised skin.
Root Causes
Your premenstrual cystic jawline breakouts are most likely driven by the androgenic profile of Microgynon 30 interacting with your natural late-luteal progesterone drop. Levonorgestrel binds androgen receptors more than newer progestins, so your skin experiences an androgen-forward hormonal milieu each cycle (Khunger & Mehrotra 2019). Adebamowo et al. (2005) and Juhl et al. (2018) also link your daily dairy intake to acne severity independently of hormones.
“Waking at 3-4am is the classic cortisol-awakening pattern; sustained elevated cortisol impairs stratum corneum lipid synthesis.”
Your Shelf, Audited
The 4 products you already own — and an honest, independent verdict on each, based on your skin profile.
Your Garnier micellar water — The 'no-rinse' residue is part of what breached your acid mantle, and Zone 2 hard water raises the surfactant load further. Same job, gentler: your Step 1 Toleriane cleanser takes over from day one — nothing extra to buy.
Your CeraVe SA cleanser — Two days of stinging told us a 2% salicylic wash-off is more than your barrier can take — it's on your avoid list for exactly this reason. Your azelaic acid covers the same decongesting job, systemically calmer.
Your old La Roche-Posay SPF — UV filters degrade once a bottle is opened — last year's SPF can't reliably deliver the 50 on its label, and sun protection is doing the heavy lifting against your pigmentation. Bin it this week; your Step 4 UVMune 400 replaces it.
Your Cetaphil moisturiser — Gentle, but it lacks the ceramide-dominant profile your lamellar lipid matrix needs to rebuild (Coderch et al. 2003). Cicaplast Baume B5+ takes over morning and evening, so the Cetaphil has no job left.
Your Morning Routine
Toleriane Hydrating Gentle Cleanser
La Roche-Posay
Why this for you
A low-pH, syndet-based cream cleanser is the correct first move for you. Harsh surfactants demonstrably damage the barrier and mild syndets are gentler on sensitive skin (Ananthapadmanabhan et al. 2004). This one contains niacinamide and ceramides, which supports the exact repair your cheeks need. Skin surface pH sits around 4.7 (Lambers et al. 2006), and this cleanser respects that.
Your Evening Routine
Toleriane Hydrating Gentle Cleanser
La Roche-Posay
Why this for you
Same product AM and PM keeps your routine simple and your barrier consistent. Mild syndet cleansers preserve barrier lipids where classical soaps do not (Ananthapadmanabhan et al. 2004). If you wear SPF (which you now will daily), a second cleanse is not needed with this product — one thorough round is sufficient.
Estimated Routine Cost
1 of 7 products is above your stated budget (£20–40/product) — where a budget alternative is shown on the card, it offers a cheaper route.
Totals are calculated from the prices shown on the product cards above (primary products only — choosing an alternative changes the total). 3 prices are not retailer-verified — check before you buy.
Do These This Week
Quick wins you can act on right now — before your products even arrive.
Bin the old La Roche-Posay SPF and replace with a fresh mineral-friendly SPF50 this week.
Degraded filters won't protect Fitzpatrick II skin and worsen post-inflammatory redness from your cysts.
Swap your Garnier micellar for a low-pH cream cleanser and stop leaving residue on skin.
Micellar surfactant residue plus London hard water is a known irritation combination for sensitive skin.
Add a silk or clean cotton pillowcase change every 3 nights while your barrier resets.
You're waking at 3-4am — friction plus sweat plus sebum on a stale pillowcase compounds your jawline flare.
Introduction Calendar
- 1
Week 1–2
Cleanser + Cicaplast + new SPF only, morning and evening. No actives. Your barrier needs to feel non-tight after cleansing before we build.
- 2
Week 3
Add Magnesium Ascorbyl Phosphate 10% each morning after cleansing. Add Niacinamide 10% each evening after cleansing, before moisturiser.
- 3
Week 4
Introduce Azelaic Acid 10% three evenings a week (Mon/Wed/Fri) in place of niacinamide those nights. Keep niacinamide on the other four nights.
- 4
Week 5
Introduce Crystal Retinal 3 on Tuesday and Saturday nights only, sandwiched between moisturiser layers ('moisturiser-retinal-moisturiser'). Skip niacinamide on those two nights.
- 5
Week 6–7
Build retinaldehyde to 3 nights weekly if comfortable. Assess your barrier at the end of week 7 — if calm, hold this frequency for another month before increasing. Week 8+: Photograph both cheeks and jawline in the same light weekly. Bring these to your follow-up so we can objectively assess pigmentation and lesion count.
Your Routine at a Glance
A one-page version of your routine to stick on the bathroom mirror — print it or save it as a PDF.
Your Skin Routine
Prepared for Alex · 7 July 2026 · The Skin Adviser
Morning
1. La Roche-Posay Toleriane Hydrating Gentle Cleanser £17.50
A low-pH, syndet-based cream cleanser is the correct first move for you.
2. The Ordinary Magnesium Ascorbyl Phosphate 10% Solution £10.00
L-ascorbic acid at low pH is the gold standard for photoprotection (Pinnell et al.
3. La Roche-Posay Cicaplast Baume B5+ £15.50
Your Cetaphil is fine but doesn't contain the lipid triad.
4. La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF50+ £22.00
Daily SPF is non-negotiable for your Fitzpatrick II skin and pore trajectory — regular sunscreen use slows…
Evening
1. La Roche-Posay Toleriane Hydrating Gentle Cleanser £17.50
Same product AM and PM keeps your routine simple and your barrier consistent.
2. The Ordinary Azelaic Acid Suspension 10% £9.44
Azelaic acid is the single most useful active for your profile.
3. The Ordinary Niacinamide 10% + Zinc 1% £5.00
You already tolerated this product, so we're leaning on that.
4. Medik8 Crystal Retinal 3 £45.00
Retinaldehyde converts to retinoic acid in one enzymatic step versus retinol's two, giving faster efficacy…
5. La Roche-Posay Cicaplast Baume B5+ £15.50
Layered last as an occlusive-emollient seal, this locks in the actives underneath and gives you the buffering…
Introducing your routine
- Week 1–2: Cleanser + Cicaplast + new SPF only, morning and evening. No actives. Your barrier needs to feel non-tight after cleansing before we build.
- Week 3: Add Magnesium Ascorbyl Phosphate 10% each morning after cleansing. Add Niacinamide 10% each evening after cleansing, before moisturiser.
- Week 4: Introduce Azelaic Acid 10% three evenings a week (Mon/Wed/Fri) in place of niacinamide those nights. Keep niacinamide on the other four nights.
- Week 5: Introduce Crystal Retinal 3 on Tuesday and Saturday nights only, sandwiched between moisturiser layers ('moisturiser-retinal-moisturiser'). Skip niacinamide on those two nights.
- Week 6–7: Build retinaldehyde to 3 nights weekly if comfortable. Assess your barrier at the end of week 7 — if calm, hold this frequency for another month before increasing. Week 8+: Photograph both cheeks and jawline in the same light weekly. Bring these to your follow-up so we can objectively assess pigmentation and lesion count.
Informed skincare guidance, not medical advice. Full consultation, cautions and product links: theskinadviser.co.uk
What to Watch For
For each active in your routine — what's normal during the introduction phase, what's a problem, and what to do.
Magnesium Ascorbyl Phosphate 10% (morning)
Normal
Very well tolerated. Slight tackiness before moisturiser is normal.
Problem
Persistent stinging, hives, or a spreading red patch within 20 minutes of application.
What to do
Pause for 5 days, resume every other morning. If symptoms return, discontinue and try a niacinamide-only morning.
Niacinamide 10% (evening)
Normal
You've used this before with no issues — expect the same. Mild initial flush that fades in 10 minutes is fine.
Problem
Persistent facial flushing lasting hours, or new-onset itch.
What to do
Drop to 5% strength or space every other night. Full stop is rarely needed.
Azelaic Acid 10% (evening, alternate nights)
Normal
Warm tingle for 60 seconds on application, mild dryness week 1-2, occasional flake around the nose.
Problem
Sustained burning beyond 15 minutes, blistering, or eczematous patches.
What to do
Pause for 5 days, then reintroduce twice weekly buffered under moisturiser. Escalate slowly.
Retinaldehyde 0.03% (evening, from week 5)
Normal
Mild dryness, tightness, or fine flaking around the mouth and chin at weeks 2-4. Slight pinkness the morning after.
Problem
Burning that doesn't stop with moisturiser, weeping eczema, sustained redness for 48h+ after application.
What to do
Pause for 7-10 days, resume with the moisturiser-retinal-moisturiser sandwich once weekly, then build again.
What to Avoid
Specific to your profile — these are ingredients or categories we'd steer you away from.
Lanolin and lanolin derivatives (Lanolin Alcohol, Lanolin Wax)
You have a confirmed lanolin contact dermatitis history — a hard exclusion across every product.
Salicylic acid cleansers above 0.5%
Your CeraVe SA experience proved you can't tolerate 2% in a wash-off. Your acne concerns are better addressed by azelaic acid, which is systemically calmer.
Micellar water left on skin (Garnier and similar)
Surfactant residue combined with your hard water is likely a major driver of your reactivity. Rinse if you use it, or drop it entirely.
Denatured alcohol (Alcohol Denat) in toners and mists
Accelerates TEWL and undermines the barrier repair we're prioritising for your cheeks.
Physical scrubs and konjac sponges on the nose
Won't shrink pores and will trigger reactive sebum. Chemical work via azelaic acid and retinaldehyde is the correct route.
Fragrance blends and high-load essential oils
Common cause of contact allergy in sensitive skin; matches your stated preference and reactivity pattern.
Beyond Products — Lifestyle Levers
Products do a lot, but skin sits inside a system. These are the non-product levers most likely to move your specific concerns.
Broken sleep at 3-4am
Prioritise sleep hygiene — magnesium glycinate 300mg with dinner, phone off by 10pm, blackout curtains. This is more impactful than any serum you can buy.
Poor sleep quality measurably increases intrinsic skin ageing scores and impairs barrier recovery overnight, when repair is at its peak.
Evidence: (Oyetakin-White et al. 2015)
Daily dairy intake
Try 4 weeks of oat milk in your coffee and swap yoghurt for a dairy-free alternative. Reassess your jawline breakouts at cycle day 24 next month.
Milk contains bioactive IGF-1 precursors and hormones that upregulate sebocyte activity and androgen-mediated follicular hyperkeratinisation.
Evidence: (Juhl et al. 2018)
Refined-sugar load (pastry + chocolate daily)
Shift to a lower-glycaemic breakfast (eggs, Greek-style unsweetened, or oats with berries) and keep pastries to twice weekly. Aim for stable glucose across the day.
Low-glycaemic-load diets reduce acne lesion counts and modulate sebum quality within 12 weeks of intervention.
Evidence: (Smith et al. 2007)
Zone 2 hard water
Do a final splash of bottled or filtered water after cleansing, and consider a Jolie or Hello Klean shower filter. A softener isn't essential but a face-splash workaround costs pennies.
Hard water increases surfactant deposition on skin, prolonging irritation and interfering with the acid mantle.
Evidence: (Danby et al. 2018)
Microgynon 30 progestin profile
At your next GP review, mention the cyclical cystic acne and ask whether Yasmin (drospirenone) or Dianette suits your risk profile better. Not urgent — worth flagging.
Levonorgestrel is more androgenic than drospirenone; the pill you're on may be neutral or mildly worsening your hormonal acne pattern.
Evidence: (Khunger & Mehrotra 2019)
Personalised Tips
Apply retinaldehyde to dry skin — waiting 10 minutes after cleansing reduces sting more than any serum layer will.
Change your pillowcase every 3 nights minimum during your premenstrual week. The friction and sebum load on your left jawline (if you're a side-sleeper) is measurable.
Your SPF must be applied as the last step every morning and reapplied at lunch on any day you're outside for more than 30 minutes — Fitzpatrick II sunburns faster than most UK adults realise even in July.
If your GP is receptive at your next Microgynon review, ask about drospirenone-containing pills — they have a better acne profile for your presentation. Not a referral, just a conversation.
Track your breakouts against your cycle in a simple app for two months. If they consistently peak at day 21-25, that's confirmatory hormonal and helps your GP conversation.
What to Expect
Barrier repair is the fastest win — expect the cheek tightness to resolve within 2-3 weeks of switching cleansers and adding Cicaplast. Sebum modulation from niacinamide takes 6-8 weeks to become visible; your midday nasal shine should meaningfully reduce by week 8 (Draelos et al. 2006). Azelaic acid works on active lesions within 4-6 weeks and continues improving post-inflammatory pigmentation over 3-6 months (van Zuuren et al. 2019). Cystic acne is stubborn — even with everything above optimised, expect your premenstrual cycle to still produce 1-2 lesions rather than 4-6. That's a genuine win. Retinaldehyde effects on pore visibility and fine texture take 12+ weeks minimum (Kligman et al. 1986). Full evaluation makes sense at 12 weeks, not before.
When to See a GP or Dermatologist
Nothing in what you've shared meets the threshold for medical referral. Your cystic acne, sensitivity, dehydration and pore concerns are all well within scope of what we cover here. The only reason to see a GP would be if the cysts become genuinely nodular (larger than 1cm, tender for weeks), scar significantly, or fail to respond to a full 12 weeks of the routine above — at which point isotretinoin or hormonal adjustment via your GP becomes a reasonable next conversation.
Follow-up
Reconsult at 8 weeks. Bring: weekly cheek and jawline photographs taken in the same morning light against a plain background; a simple tally of breakouts by cycle day for the two intervening months; a note of any reactions and what week they occurred. If Microgynon comes up with your GP in the interim, share the outcome — it changes our next iteration.
Start a new consultationWhere to begin
Your next step
- Order your first product: La Roche-Posay Toleriane Hydrating Gentle Cleanser (£17.50).
- Start simple with week 1–2 of your calendar: Cleanser + Cicaplast + new SPF only, morning and evening. No actives. Your barrier needs to feel non-tight after cleansing before we build.
- We’ll check in with you at week 2 — watch your inbox for a short email asking how your skin is settling.
Your Skin Routine
Prepared for Alex · 7 July 2026 · The Skin Adviser
Morning
1. La Roche-Posay Toleriane Hydrating Gentle Cleanser £17.50
A low-pH, syndet-based cream cleanser is the correct first move for you.
2. The Ordinary Magnesium Ascorbyl Phosphate 10% Solution £10.00
L-ascorbic acid at low pH is the gold standard for photoprotection (Pinnell et al.
3. La Roche-Posay Cicaplast Baume B5+ £15.50
Your Cetaphil is fine but doesn't contain the lipid triad.
4. La Roche-Posay Anthelios UVMune 400 Invisible Fluid SPF50+ £22.00
Daily SPF is non-negotiable for your Fitzpatrick II skin and pore trajectory — regular sunscreen use slows…
Evening
1. La Roche-Posay Toleriane Hydrating Gentle Cleanser £17.50
Same product AM and PM keeps your routine simple and your barrier consistent.
2. The Ordinary Azelaic Acid Suspension 10% £9.44
Azelaic acid is the single most useful active for your profile.
3. The Ordinary Niacinamide 10% + Zinc 1% £5.00
You already tolerated this product, so we're leaning on that.
4. Medik8 Crystal Retinal 3 £45.00
Retinaldehyde converts to retinoic acid in one enzymatic step versus retinol's two, giving faster efficacy…
5. La Roche-Posay Cicaplast Baume B5+ £15.50
Layered last as an occlusive-emollient seal, this locks in the actives underneath and gives you the buffering…
Introducing your routine
- Week 1–2: Cleanser + Cicaplast + new SPF only, morning and evening. No actives. Your barrier needs to feel non-tight after cleansing before we build.
- Week 3: Add Magnesium Ascorbyl Phosphate 10% each morning after cleansing. Add Niacinamide 10% each evening after cleansing, before moisturiser.
- Week 4: Introduce Azelaic Acid 10% three evenings a week (Mon/Wed/Fri) in place of niacinamide those nights. Keep niacinamide on the other four nights.
- Week 5: Introduce Crystal Retinal 3 on Tuesday and Saturday nights only, sandwiched between moisturiser layers ('moisturiser-retinal-moisturiser'). Skip niacinamide on those two nights.
- Week 6–7: Build retinaldehyde to 3 nights weekly if comfortable. Assess your barrier at the end of week 7 — if calm, hold this frequency for another month before increasing. Week 8+: Photograph both cheeks and jawline in the same light weekly. Bring these to your follow-up so we can objectively assess pigmentation and lesion count.
Informed skincare guidance, not medical advice. Full consultation, cautions and product links: theskinadviser.co.uk
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