AI Overload

I Asked a Dermatologist to Rate ChatGPT’s Skin Care Advice — Here’s What Happened

And there was one answer that it got wrong.

Written by Michelle Rostamian

There's no two ways about it: We're teetering to the point of no return as far as Artificial Intelligence is concerned — and the beauty industry is no exception. Beauty aficionados are using AI to concoct their own face washes, color match themselves, and even curate an entire skin care routine, complete with "tailor-made" products. This may seem well and all, but the real cause for concern comes into play when the technology is viewed as a virtual dermatologist of sorts, with some people foregoing a trip to their actual dermatologist in favor of AI's sheer convenience. "Because ChatGPT leverages the use of large language models that are trained on diverse data sources, its responses are only as good as the credibility of its sources," says Dr. David Li, a board-certified dermatologist based in Massachusetts whose research lies at the intersection of artificial intelligence and dermatology. According to Dr. Li, relying solely on ChatGPT for skin care advice could result in the incorrect choice and usage of products at best, and allergic reactions, aggravation of pre-existing conditions, and increased skin sensitivity at worst.

I decided to put ChatGPT's beauty knowledge to the test. Is it a reliable source? And most importantly, what would a real skin care expert say about the advice? I called on Dr. Li to get the lowdown.

Prompt: How do you apply retinol?

ChatGPT: Apply a pea-sized amount of retinol to clean, dry skin in the evening, avoiding sensitive areas, and follow with a moisturizer.

Dr. Li: This is pretty good advice and fairly similar to what I tell patients, but it lacks the level of detail that most patients would want to know. “Pea-sized” seems to be the term of choice for dermatologists and my guess is it’s dogma, carried forward from prior generations of dermatologists. We recommend using only a small amount especially when first starting because retinols and other vitamin A derivatives can cause skin sensitivity and dryness, and we don’t want patients to get discouraged by side effects off the bat. The advice to use on "dry skin in the evening" is true, as the sunlight can actually degrade the ingredient, and using retinol on wet skin or skin that has other products already on there can dilute the concentration of the retinol, meaning less of it is actually effective. Some people may not be aware of the "sensitive" areas ChatGPT is referring to. These are areas of the face where the skin is typically thinner and more prone to sensitivity, or areas where the retinol or other skin care products seem to collect and cause excessive dryness (the neck, under the eyes, and around the nasolabial fold/crease).

Prompt: How should I layer my skin care products?

ChatGPT: Layer skin care products starting with the thinnest consistency (like serums) to the thickest (like moisturizers), finishing with sunscreen in the morning or a heavier moisturizer/oil at night.

Dr. Li: This is generally correct but probably not for the correct reason that I would agree with. First off, I recommend the fewest necessary products or ingredients as possible. Too many leads to confusion, lost effectiveness of each individual component, and lost time. Serums and other medicated products are generally applied first because they are needed to penetrate the surface of the skin. If you apply an active ingredient on top of a thick layer of moisturizer, very little of it (if any) will actually make its way to the skin. Moisturizer is indeed usually next, and that’s to provide an added layer of barrier on the skin to trap in moisture. Sunscreen would be applied last, however, in this order, I usually specify that patients use mineral sunscreen, as it would then sit on top of the moisturizer/serum. Chemical sunscreens need to be absorbed into the skin in order to protect against UV light, so it may not be absorbed if applied on top of moisturizer.

Prompt: What areas of my body should I be applying skin care products?

ChatGPT: Apply skin care products to your face, neck, décolletage, and any other exposed areas like hands and arms to ensure comprehensive protection and care.

Dr. Li: This response is a bit lacking in my opinion — it’s one dimensional and poorly rationalized. I don’t think "exposed" versus "unexposed" should be the dictating factor for where to apply a skin care product. In general, you should apply skin care products to body parts if there is a good reason to do so. For example, we apply sunscreen on the face, hands, and arms as these areas are commonly exposed to the sun. We apply tretinoin to the face and neck to prevent and reduce fine lines. In addition, for any area of the body (exposed or not), you may want to apply moisturizer to protect the skin surface if you’re prone to dryness. An area like the abdomen isn’t generally exposed, but one may still choose to use a stretch mark cream after pregnancy. Same goes for the upper arms — they may not be exposed but one may still be using Amlactin for keratosis pilaris. Similarly, you may apply skin care products to your feet (e.g. urea cream) if you have thickened skin due to corns and repetitive friction. These are not necessarily exposed areas, but you still may have a good reason to be using skin care.

Prompt: How often should I exfoliate?

ChatGPT: Exfoliate your skin 1-3 times a week, depending on your skin type and sensitivity.

Dr. Li: This is a tough question to answer, so I would say that generally GPT’s ambiguous answer is more or less correct. Exfoliating the skin is not necessarily something that many people intentionally do and that’s okay. For instance, if someone is already using a salicylic acid cleanser a couple times a week as part of their regular cleansing routine, they don’t have to go out of their way to exfoliate in a separate step. However, some people who are more prone to rapid skin turnover may benefit from exfoliating a few times a week, and that number can vary from person to person depending on their personal tolerance. For instance, those with oily skin might not actually need to exfoliate more often, since it could lead to rebound oil production, so it really depends on the person. However, it is generally true that those with sensitive or eczema prone skin may not need to exfoliate as often to prevent side effects such as dryness and skin sensitivity.

Prompt: Can I mix my oils into my moisturizer?

ChatGPT: Yes, you can mix serums into your moisturizer, but it's generally more effective to layer them separately for optimal absorption.

Dr. Li: I would probably not recommend this due to the complexity of understanding solubility and efficacy. For instance, the most obvious factor is that the two may not mix well because a large proportion of moisturizers are water-based and contain humectants such as glycerin and hyaluronic acid. This means it wouldn't mix well with oils due to polarity differences. In addition, adding oils into a moisturizer would dilute the effect of any actives in either product. A larger theoretical question is also whether the ingredients may cancel out the effects of other ingredients. For example, we know that benzoyl peroxide is an ingredient that is difficult to compound with other ingredients because it hinders the effect of many other active ingredients. Therefore, figuring out whether it’s okay to mix oils into a moisturizer is a complicated matter and would require in-depth analysis with the manufacturer and chemist of the different products.

Prompt: How can I shrink enlarged pores?

ChatGPT: To shrink enlarged pores, regularly cleanse and exfoliate your skin with products containing salicylic acid or AHAs and use non-comedogenic skincare.

Dr. Li: This is a very good answer for things you can do at home to reduce the size of enlarged pores. AHAs and BHAs are great for gentle exfoliation to prevent clogged pores, and avoiding oily or comedogenic products can prevent buildup in the pores. What the answer doesn't cover are the in-office treatments for pores, such as prescription topical retinoids, which help to increase turnover and prevent blackheads and clogged pores. Also, there are procedures such as chemical peels, microneedling, and lasers that can be effective at reducing the appearance of pores.