One Dermatologist’s perspective on the most frequently asked questions regarding skin care…

What products should I be using to keep my skin looking young?

Contrary to what the cosmetic industry would have you believe there is not a magic fountain of youth cleverly disguised as a bottle of moisturizer at the cosmetic counter in the mall.  More often the Strivectins and La Mers do not contain secret ingredients just high price tags and great marketing.

By far the most effective way to maintain youthful skin is to avoid the accumulation of damage to the skin caused by solar radiation. The UVA and UVB rays of sunlight breakdown collagen and elastic fibers in the skin and lead to premature aging.  These rays also contribute to the development of brown sun spots and pigment irregularities that greatly increase the age of the skin.  The daily use of a good sunscreen product with SPF 15 to SPF 30 covering both UVA and UVB rays (ideally zinc oxide based) is a priority for any effective skin care regimen.

However, damage does accumulate despite even the most diligent attempts at proper sunscreen use.  Products such as Retin-A and OTC Retinol have credible scientific and clinical data establishing these products’ abilities to make valuable and measurable effects on the skin’s production of new collagen and elastic fibers. Additionally, the active ingredients of these two products are able to slough abnormal skin and even the pigment irregularities that accumulate with time.  Ultimately, I believe that these types of products are the most effective proactive means of addressing solar damage and the accumulation of free radicals in the skin.  Given the ability of ones skin to tolerate and accommodate to the use of these products I utilize them as the workhorse in a skin care regimen.

Finally, a proactive skin care regimen should incorporate a mild wash and a moisturizer with active antioxidants.  Although these products cannot solely salvage years of accumulated sun damage; they do help to decrease the accumulation of oxidative stress that results from pollution, solar radiation, ionizing radiation, inflammation, and metabolic stress with the natural aging process.

What is Retin-A?  How does it work? Should I be using Retin-A?

Retin-A is a general term used to refer to prescription products that contain the active ingredient tretinoin.  Tretinoin can be combined with different delivery vehicles and at varying concentrations. These combinations are then labeled with trade names such as Retin-A Micro, Renova, and Atralin.

The benefits of any product containing tretinoin comes directly from the properties of tretinoin.  This molecule is capable of penetrating the skin barrier and binding to specific skin cell receptors.  The ultimate effect is the increased production of elastic and collagen fibers, stabilization of normal skin activity, faster turnover of skin and thus the prevention of accumulation of abnormal cells. These beneficial effects are not linked to the concentration of tretinoin; in fact several studies have shown that increasing concentrations only increase side effects such as redness and peeling but do not add to the beneficial effects.

Although, I consider tretinoin to be the workhorse of a good regimen it is not tolerated by all skin types.  For most, tretinoin can be successfully added and tolerated if incorporated slowly into a regiment.  Often using this product once weekly and only increasing the frequency of application to two to three times weekly as the skin allows will provide a smooth transition to its use.  However, some skin types will be continually plagued by redness, skin irritation, skin sensitivity, and intolerable peeling.  For these skin types it may be more beneficial to start with a more mild and non-prescriptive form of a retinoid called Retinol.

Retinol does not provide the same degree of effect on the skin as tretinoin due to a difference in its molecular properties.  It is however still valuable in evening pigment irregularities and most likely offers positive effects of collagen and elastic fiber production.  The benefit to this product is that it can be found over the counter and is usually very easily tolerated.  I would still recommend a slow incorporation into one’s weekly regimen.

What are antioxidants and should I be using these products?

The cosmeceutical industry has begun to bombard the market with products that contain higher levels of antioxidant ingredients.  These ingredients are aimed at scavenging free radicals in the skin that result from daily exposure to radiation, pollution, sun, and general aging.  It is believed that the accumulation of these free radicals leads to skin cell DNA mutation, loss of elasticity, and pigment irregularities.

We do know that the skin has the intrinsic ability to scavenge these free radicals in an effort to minimize the accumulation of cellular damage.  However, we believe that many of these intrinsic mechanisms are overwhelmed by the numerous assaults on the skin by modern lifestyles as well as the numerous sources of pollutants in today’s world.  The cosmeceutical industry is making an attempt to mimic the body’s natural occurring mechanisms.

Many of these synthesized or purified antioxidants have been proven to be effective in the lab; however, not all products are created equally and consumers should be aware of expensive products will little data to substantiate their claims.  More reputable companies have developed delivery systems which enable these antioxidants to penetrate the skin barrier at a concentration that is effective within the skin.

As noted before, I do not believe that one antioxidant can cure all of the damage accumulated over years; however, I do find a great deal of value in incorporating these products into general skin care maintenance.  As there are a number of these products available and each has its own area of proficiency I would encourage consumers to discuss these products with a trusted dermatologist or medical esthetician to ensure that the most effective and appropriate product is chosen for one’s skin type and areas of concern.

Thank you for allowing us to serve your dermatologic concerns.  We are truly honored to be trusted members of your health care team.

Sincerely,
Staci Ward-Hestdalen, MD
Board Certified Dermatologist