The Most Important Skin Care Products

I meet and see a lot of different patients and each one is looking for that perfect product that will take care of everything. Well, the truth is, that perfect product does not exist, but rather a lot of great complementary products can be used to achieve good results. New skin care products keep coming on to the market but the most important ones that have been shown to make a difference in the literature over and over again, and these products have remained the same. Sure, you can try whatever is new and upcoming, but if you just want to know what the basics are, read on.

Skin care products work if they can change the skin surface or inside of the skin cell. The skin is in a constant state of renewal. A new skin cell forms deep in the dermis and slowly moves up to the skin surface over 6-8 weeks, to slough off. What happens as we age is that the percentage of skin that is renewing and sloughing off, diminishes. Young children (about 10 or so) have beautiful luminescent skin because everything is renewing and exfoliating at 100% like it should. As we age, the exfoliation process slows down, causing the skin to look duller, more uneven, and older. Skin that has problems with it, can also have a disruption in the renewing or exfoliation process exacerbating the skin condition. So at 30 years of age, the percentage of skin that is renewing and or exfoliating drops to about 70%, at 40 this is about 60% or lower; thus causing the skin to look older.

To help the skin look healthier and younger, the skin needs to be exfoliated. Many of my patients are using over the counter products to do this. The most popular items reported by my patients are the St. Ives Apricot Scrub, facials, and the hardest thing used was a scrubbing brush. Unfortunately these may not be the best products because exfoliation is dependent on depth of penetration. These are rather superficial and will not cause true skin changes. The young patient using a scrubbing brush can be injuring her skin even further and causing more damage. I believe in using skin care products that penetrate a little deeper and can cause the skin to rejuvenate as well. These two products have been on the market for some time and work well. They are alpha hydroxy acids and Retinols.

Alpha hydroxy acids are made from edible fruits and vegetables that when fermented become acidic, causing the skin to exfoliate. They are found in many over the counter products under the label AHA. AHA's help with exfoliation and skin rejuvenation thereby reducing fine lines, brown and red spots, even out skin tones, as well as help reduce acne. Some patients will not be able to tolerate them because they have very sensitive skin and it will irritate when applied. Typically, this resolves after a few weeks, but for those patients, it may be more useful to use the next generation of these products which is poly hydroxy acids. They are slightly bigger molecules and penetrate the skin slower, thus are more gentle for that sensitive skin.

What is the difference between over the counter AHA's, the salon grade, and the physician grade products? The difference is in the concentration of the AHA. The higher the grade of AHA, the more pure it is and thus more effective it is. The physician grade is about the same price as the salon grade so do yourself a favor, and buy something that works! You do have to use AHA's for awhile to see a difference and it is great for all ages and even pregnant women!

The next exfoliant is Retinols. This can be Retin-A, Renova, Tazorac, Tretinoin, etc. This is a much stronger product than the AHA because it is more penetrating. It is a great product to use because if you use it over time, greater than one year, it actually intrinisically repairs the skin cell that was damaged with the sun and age, thereby reducing wrinkles, fine lines, brown/red spots, acne, and scarring. Studies show that long term use of Retin-A at 0.1% will reduce the incidence of skin cancer!

The problem with Retin-A is the side effects of peeling and redness. This can be overcome by using a lower strength of retin-a, using an alternative breakdown product, or mixing it with a blender than will soften the delivery of Retin-A. For people who are very sensitive, I recommend starting with 0.025% cream and slowly building up to 0.05%. The goal is to be able to use 0.1% because this is what helps reduce skin cancer formation. The breakdown products such as retinaldehyde are more gentle on the skin and do not cause as much irritation and redness. The blender product is something that works synergistically with Retin-A to penetrate the skin without the same amount of redness. Retin-A should not be used by pregnant and lactating women.

The third product is Vitamin C. Vitamin C is the only product that prevents wrinkles (that's right, I said prevents wrinkles) and brightens the skin. Vitamin C stabilizes free radicals. Free radicals are cells that have become unstable due to a loss of an electron. (Do you remember in physics class how you learned that electrons and protons need to always be together in an atom, otherwise it becomes unstable? The free radical is an atom that has lost an electron). This unstable cell wants to become stable so it steals an electron from the next cell. The next cell now is unstable, and steals and electron from another cell and so on and so on. What Vitamin C does, is it comes by and donates the missing part to stabilize the cell. Vitamin C does not become unstable because it can intrinsically repair itself. Another question patients ask me is if their oral Vitamin C will be enough for them. No, because there is not enough skin penetration unless you did 25 Vitamin C pills daily.

The fourth type of product that helps the skin is lightening gels. These can be hydroquinone, Kojic acid, soy, licorice, etc. They all suppress the melanocytes (the cells that produce pigment) thus there are less darkened areas. Hydroquinone is the strongest of them all but the one that is the most controversial. THe FDA recently banned hydroquinone 2% that was commonly found in over the counter products like Porcelana, Esoterica, Black Opal.

This came after some controversial research showed an increase in cancer in laboratory rodents. This has not been shown in humans. Furthermore, across the world, it is difficult to find for these reasons but also because it was not regulated, patients were bathing in such high doses of 10-20% hydroquinone. (the strongest dose in the US is 4% found in prescription skin creams). At such high levels, patients experienced something called Ochronosis-graying of the skin and reflex darkening of the skin. Unfortunately this came from using such large concentrations for long periods of time. I typically provide a 4% hydroquinone for about 4-6 months and then use as needed. I still use hydroquinone with all the controversy because nothing else seems to work as well. I use hydroquinone in conjunction with other items such as the vitamin c to brighten the skin and retin-a to exfoliate the skin so you need less of hydroquinone then if you used it on your own.

The last item that is important is a total sun block. There are three types of sun rays: UVA, UVB, and UVC. UVC we are thus far protected because of the ozone layer. Once that is gone, we will need protection from that. UVB is a weaker sun ray and does not penetrate through glass. UVB causes sun damage and skin cancer. We are protected from it by using SPF. Using a SPF 15 is great because it will provide you great coverage without adding more chemicals to the skin. However, SPF does not protect you against UVA. UVA has both long and short rays and need to be blocked by using a physical barrier such as zinc, titanium and parasol. The new one on the market is by L'Oreal that has avobenzene.

I realize that this is a lot of information but be smart about what you are using and know what works and what doesn't. Most of these are very complementary to one another and many of my patients use a little of everything so they get less side effects from each product. So use the right products to help you maintain great skin!