Skin facts

The skin is the largest organ in the body. It has many functions, including immunological,
sensory, and excretory functions. For instance, the skin excretes antimicrobial peptides that
prevent pathogenic bacteria from invading beyond the first layers of the skin.

The skin is composed of three basic layers:

https://medlineplus.gov/ency/imagepages/8912.htm

The epidermis of the skin is constantly regenerating and sloughing off, so that the external
barrier of the skin remains intact.

What we know as “pores” are actually hair follicles that have sebaceous glands at their base.
This is what produces the “oil,” or sebum, that can cause the appearance of blackheads and
whiteheads. This sebum also helps to maintain the integrity of the skin barrier.

A blackhead is a hair follicle with oxidized sebum inside of it, whereas a whitehead is a hair
follicle with largely unoxidized sebum. Acne results from the inflammation and/or infection with
the bacteria P. acnes that can occur when a hair follicle has been occluded by sebum.

Skin color is determined by a pigment called melanin that is produced by melanocytes, cells of
neuroendocrine origin that are interspersed throughout the bottom layer of the epidermis. In
response to UV radiation, melanocytes upregulate the production of melanin, which results in the
tan that individuals experience after sun exposure. However, different individuals produce
different amounts and types of melanin, and thus some are much more prone to UV damage to
the skin and skin DNA after sun exposure. Fair-skinned individuals tend to be more prone to this
damage than dark-skinned individuals, though anyone can get sunburn. Sun exposure can
accelerate loss of elasticity as well as hyperpigmentation, in addition to causing UV damage to
the skin.

Most skincare products that you can buy over-the-counter affect only the epidermis.
There are some treatments available at the dermatologist’s office that can reach the dermis, such
as Dermapen, microdermabrasion, and other treatments. These are effective, but expensive,
treatments that can be considered for a variety of skin conditions, such as hyperpigmentation and
uneven texture.

Skincare goals

Protect the barrier that protects you from environmental insult

Prevent and/or reverse signs of aging

Manage concerns specific to your skin (e.g., acne, rosacea, allergic reactions)

A basic skincare routine

In the morning:

Cleanse
Tone
Moisturize
Sun protection

In the evening:

Remove makeup thoroughly and cleanse

Tone
Treat specific concerns
Moisturize

Additional steps:

Exfoliation
2-3 times per week

Choosing skincare products

It’s all about what’s in a product, not how it’s marketed or how much it costs. There is a lot of
misleading messaging in the skincare industry, because their claims are not regulated by the
FDA. This is true of nutritional supplements, too.

Effective ingredients by skin concern:

For anti-aging

Retinol/retinoid/tretinoin: Derivatives of vitamin A that have been proven to treat acne and
photoaging of skin.1 Mild irritation (redness, dryness) may occur when it is first used. Can be
purchased in lower concentrations over-the-counter, or in higher concentrations prescribed by a
dermatologist.
In oral pill form, isotretinoin, trade name Accutane, is used in acne treatment. It is extremely
teratogenic in oral form, and so requires caution when used in women of childbearing age.

Copper tripeptide (GHK-Cu or glycine-histidine-lysine-Copper) complex: In several clinical

trials, Cu-tripeptide complex has been shown to speed skin healing after trauma2,3.

Vitamin C: An antioxidant that can be used topically to reduce damage caused by UV exposure
and other oxidative stressors in the environment4

For moisture

Hyaluronic acid: a sugar polymer present abundantly in skin extracellular matrix, retains
moisture well5

Ceramides: Waxy complexes present in skin that help in maintaining its moisture barrier6
Fun fact: The brand Cera-Ve is named after cera-mides!

For acne:

Retinol/retinoid: see above.

Salicylic acid: a beta-hydroxy acid (BHA) that acts as an exfoliant and mild anti-inflammatory7
Fun fact: Aspirin, a non-steroidal anti-inflammatory drug (NSAID), is chemically closely related
to salicylic acid.

Benzyl peroxide: an antimicrobial used to suppress P. acnes colonization of skin8

For sun protection:

There is controversy over whether organic (e.g. Oxybenzone) or physical (e.g. titanium dioxide,
zinc oxide) compounds are more effective and safe in sun protection. There is concern about the
degradation of these compounds, both organic and physical, on the skin into damaging radicals.
Current research suggests that the physical compounds provide more broad-spectrum UVA/UVB
protection and are generally safe for use on intact skin9, 10, 11

For exfoliation:
Avoid the popular St. Ives Apricot scrub! It’s harsh and can cause microtears in the skin.
Currently, a class-action lawsuit is underway against St. Ives for its misleading advertising
regarding this product:
https://www.theatlantic.com/health/archive/2017/01/i-dont-want-no-scrubs/512237/

Glycolic acid, lactic acid: alpha-hydroxy acids (AHAs) that help improve barrier function and
reduce pigmentation, as well as aid in skin exfoliation12

A note about product packaging:

Try to purchase products in tubes or with pumps. A jar that you can dip your fingers into is prone
to contamination with bacteria and debris from your fingers, as well as oxidation by sunlight.

Applying skincare products

How you put your products on is important, too! Always be very gentle with your skin; don’t
tug, scratch, or rub at it too harshly. The skin around your eyes is especially thin, so try to apply
eye cream or treatment with your ring finger only.

Sunscreen, no matter its SPF, wears off. Try to remember to reapply often during the day,
especially if you are going outside again.

Note about SPF, or Sun Protection Factor: it is measured on a logarithmic scale. This means
something with an SPF of 15 protects against about 93% of UV radiation, but SPF 30 protects
against about 97% of UV radiation. Thus, products with >SPF 15 are sufficient for sun
protection if used appropriately and reapplied as necessary.13

Product & brand recommendations (certainly not exhaustive!)

Cleansers
Vanicream – Gentle facial cleanser
SkinFix – Foaming oil cleanser
Bioderma – Sensibio micellar water

Treatments
Deciem – NIOD Copper amino complex
Deciem – The Ordinary Advanced retinoid
Deciem – Hylamide Sub-Q eyes
CosRx –Acne Pimple Master Patches
La Roche-Posay – Effaclar Duo Benzyl Peroxide treatment
CosRx – Triple C Lightning Liquid
Drunk Elephant – C-Firma Day Serum
Deciem – Hylamide – C25 Booster

Exfoliants
Nip+Fab – Glycolic fix pads
REN – Glycol Lactic Radiance Renewal Mask
Biologique Recherche – Lotion P50 (*not the 1970 version, which has phenol, a known irritant,
in it)
Drunk Elephant – TLC Framboos Glycolic Serum
Deciem – The Ordinary Glycolic Acid Toning Solution

Moisturizers, for face

Deciem – The Ordinary Squalene oil
Drunk Elephant – B Hydra Moisturizing Gel
SkinFix – Nourishing Cream

Moisturizers, for body

Aquaphor - Advanced therapy healing ointment
Vanicream - Moisturizing skin cream

Sunscreen
Neutrogena - Sensitive Skin Broad Spectrum Sunscreen
MD Solar Sciences – Mineral Crème Broad Spectrum SPF 50
La Roche-Posay – Antihelios 50 Mineral Ultra Light Sunscreen Fluid
Clinique – Mineral Sunscreen Fluid for Face

Resources to look up product reviews and ingredient safety evaluation

EWG SkinDeep Database: http://www.ewg.org/skindeep/

Tea with M.D. (written by a dermatology resident): http://www.teawithmd.com/
Caroline Hirons’ blog (a British esthetician known for her reviews: http://carolinehirons.com

Important note:
I am not a licensed dermatologist, only a person who knows a little about skin, reads a lot of
skincare blogs, and likes to try products. It is wise to get a thorough skin exam by a
dermatologist once a year, especially if you have risk factors for skin disease (e.g., history of
frequent sunburns, red hair, family history of skin disease). For specific skin conditions, like
eczema, moderate to severe acne, and psoriasis, medical attention is required for successful
treatment.
 References
1
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/23839179
2
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/22666519
3
https://en.wikipedia.org/wiki/Copper_peptide_GHK-Cu#Wound_healing_in_animals
4
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/11225195
5
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/23467280
6
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/12553851
7
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/18786494
8
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/19761357
9
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/27622230
10
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/19646780
11
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/19690452
12
https://www-ncbi-nlm-nih-gov.ezp-prod1.hul.harvard.edu/pubmed/19695482
13
http://www.skincancer.org/prevention/sun-protection/sunscreen/sunscreens-explained