The Skincare Basics

The perception of youthful, healthy skin stems from a number of features of the epidermis and dermis, including the density and quality of the extracellular matrix, the distribution of cells within connective tissue, the appearance of cornified cells at the skin surface, and variations in skin’s natural fluorescence. Alterations in skin physiology result in a number of visible skin conditions, including xerosis, acne, and abnormal pigmentation, that impact one’s appearance. A combination of over the counter (OTC) and cosmetic skincare products delivered in a regimen can play a significant role in assisting us to restore our skin’s health and beauty.

Protection, prevention, cleansing, and moisturising are the key components of an effective skincare routine. As most sun damage results from everyday, incidental ultraviolet exposure, rather than occasional bursts while on vacation, dermatologists recommend daily use of sunscreens.

The most effective active ingredients for blocking out both ultraviolet A and ultraviolet B are either zinc oxide or avobenzone. Categorized as OTC drugs, sunscreens must undergo safety and efficacy testing and meet stringent labeling requirements. No new sunscreen actives have been approved by the FDA since the 1990s, but advancements in formulation chemistry and technology have improved sunscreen aesthetics, ease of application, and performance in an effort to encourage consumer compliance. Sunscreen should always be a mandatory final step of every at-home skincare program.

There is a dizzying array of cleansers for removal of makeup, pollution, and excess sebum and moisturizers for hydration and delivery of beneficial ingredients. Some contain FDA-approved active ingredients for restoration of the skin’s barrier function, but most do not. The formula’s vehicle should ideally support a specific skin type (oily, dry, or combination) and enhance the activity of an active ingredient if present. Formulas with similar or identical ingredients do not necessarily perform to the same degree. A formula is unique, like a recipe. The combination of eggs, sugar, flour, and butter, depending on the amount of each ingredient, as well as the mixing and cooking process, can create either a pancake or a soufflé. The same is true when it comes to product formulations, and a misinformed consumer can be fooled by the marketing tactics of competitive products. Clinical testing and before and after photos are your best guide for making specific product recommendations to your patients.

In general, gel-based and bar cleansers are best for oily complexions, whereas cream or lotion-based ones are better for normal to dry skin. Moisturisers supply humectant agents, which draw water into the stratum corneum from the environment and dermis below. Moisturizers also include occlusive agents that act as a barrier to trans-epidermal water loss. In almost all cases, products contain both humectants, like hyaluronic acid, urea, and allantoin, and occlusives, including petrolatum, mineral oil, and lanolin. Humectants are present in the water phase of a formula; occlusives are in the oil phase. Oil in water formulations tend to be lightweight gels, lotions, and serums and are best suited for normal to dry skin. Water in oil formulations may be ointments or creams and offer superior hydration for dry skin.

Recommending the appropriate cleanser, moisturiser, and sunscreen for you will depend on your skin type, that is, normal, dry, or oily. The specific FDA-approved active and/or functional cosmetic ingredients that you should look for in their products will depend on their primary skin condition, concern, or goals.

The key attribute of a youthful, healthy-looking complexion is radiance. Radiance is determined by light reflectance from the surface of smooth skin. With age, radiance diminishes as the epidermal cell turnover rate slows down. This results in the buildup of dead keratinocytes in the stratum corneum and follicular ostia, creating the appearance of rough, dry skin, enlarged pores, and poor light reflection.

Exfoliation, through chemical or physical means, is the process of removing excess corneocyte buildup, which in turn stimulates cell turnover, resulting in a more polished, smoother, translucent surface. Over the past 2 decades, exfoliation has gained in popularity because of its almost immediate demonstrable benefits and the ease and variety of available products.

Commonly used chemical exfoliants include glycolic, lactic, and malic acids, known as α-hydroxy acids (AHAs), and salicylic acid, which is a β-hydroxy acid. Concentrations in excess of 10% to 15% in the case of AHA and 2% in β-hydroxy acid require professional administration; however, concentrations below this threshold may be safely used at home on a regular basis. Exfoliating products continue to evolve as manufacturers seek the right balance of ingredients, generally in concentrations ranging from 7% to 10% and buffered to a pH above 3.5, to reduce the risk of burning and irritation. Recent market introductions include polyhydroxy acids, such as Lactobionic Acid and Gluconolactone; because of their larger molecular size, these acids are better tolerated. They also help to strengthen the skin’s barrier function and serve as antioxidant chelating agents, absorbing free radicals generated by ultraviolet exposure. Mandelic Acid is a good choice for gentle exfoliation of sensitive skin. Finally, as our understanding of the relationship between desquamation and hydration advances, new strategies for exfoliation have emerged, including using glycerin to aid desmosomal digestion, thereby promoting keratinocyte desquamation through improved epidermal moisture levels.

Physical exfoliation is available for consumers in a wide range of products as an alternative to or in combination with chemical exfoliation; these products include topical cleansing scrubs containing a variety of abrasive solid particulates, mechanical facial brushes, sonicating devices, and mildly abrasive cosmetic tools such as micro-exfoliating rollers. Physical exfoliation induces an immediate desquamation, which in some cases can produce a temporary disruption of the skin barrier, resulting in increased trans-epidermal water loss. Such products may not replace the need for professional peels, deep needle rolling, or laser treatments but can be helpful in maintaining visible radiance.

As we grow older, our skin’s inherent antiaging mechanisms diminish: defenses weaken, critical processes slow, and the rate of breakdown of key constituents increases. Although cosmetic procedures have a significant positive impact on specific aspects of aging, such as deep wrinkling, sagging, and volume loss, they do not necessarily address the overall quality of the skin. Recommending an at-home skincare regimen based on our individual needs is synergistic with the services cosmetic dermatologists and surgeons provide. Clinically proven products, formulated with the right ingredients for a specific skin concern and delivered in an aesthetically appealing system, will both maximise the outcome and increase the longevity of benefits from the treatments provided while empowering us all to personalise and control the skincare journey

The above is taken from the following and please do read the full article for more information:

Rodan K, Fields K, Majewski G, Falla T. Skincare Bootcamp: The Evolving Role of Skincare. Plast Reconstr Surg Glob Open. 2016 Dec 14;4(12 Suppl Anatomy and Safety in Cosmetic Medicine: Cosmetic Bootcamp):e1152. doi: 10.1097/GOX.0000000000001152. PMID: 28018771; PMCID: PMC5172479.