This blog discusses the spectrum between benign nevi, atypical nevi, and melanomas.
It depends can be such an unsatisfying answer. We all seek definitive responses to our questions. To that end, I will attempt to give you a more precise answer to the question, “What should I use on my skin?”
We have all heard that our skin is the largest organ in our body. As such, it really deserves a thoughtful plan. The skin on our faces and necks is different than the skin on our bodies in terms of quality of skin, thickness, and exposure to environmental aggressors. Our facial and neck skin has a better blood supply and greater density of follicles and oil glands. This skin is also naturally thinner than skin on the body and extremities. Finally, exposure to sun, infrared radiation, blue light from screens, and pollution is greater on the face and neck than on the body which is more often covered and protected.
To cleanse our skin, I always recommend non-soap cleansers. True soaps can strip our skin of the natural oils, leaving our skin dry and irritated. My favorite product for cleansing my face is Elta’s foaming facial cleanser. This product is an enzymatic cleanser. It gently foams when applied to damp skin, removing dirt, make-up, and products from the skin. I also like SkinMedica’s gentle cleanser, Cetaphil cleanser, or Cerave cleanser. Additionally, Clarisonic devices offer wonderful ultrasound technology cleansing of the skin. I use my Clarisonic daily with my gentle cleanser. For the skin of the body, one must first choose between bar or liquid gel cleansers. This is really a matter of personal preference. Again, though, I recommend using gentle non-soap cleansers. Products such as Lever 2000 or Dove are excellent for the body. If acne on the back and trunk (known informally as “bacne”), using a benzoyl peroxide cleanser such as our own Associated Skin Care benzoyl peroxide cleanser helps to decrease the bacteria count on the skin and open clogged follicles/pores.
Water temperature when cleansing is also a factor. While very hot water or showers may temporarily feel good, they are not ideal for our skin. It is better to use lukewarm water to avoid redness, flushing, or irritation of the skin. Minnesota weather can lead to dry skin, particularly in the winter. Soaking in the tub can help to hydrate the skin all over.
Once out of the water, this is the perfect time to moisturize the skin on the body. For winter dry skin, thicker creams such as Cetaphil or Cerave work well to seal the moisture into the skin. Creams are thicker than lotions and offer better hydration. They are typically sold in jars rather than pump dispensed bottles. In the summer or when the humidity is higher, lotion moisturizers such as Aveeno or Eucerin work well. If the skin is excessively dry, an ointment style moisturizer is best. The favorite among all dermatologists is Aquaphor ointment. This healing ointment can be used anywhere on the body, although I do not recommend it on the face for acne prone individuals. Aquaphor is a part of my daily care of my lips. This ointment is a lot of love for the lips or other chapped skin.
Now that our bodies are clean and hydrated, let’s move onto the money maker – our own individual beautiful faces. Before I go any further, I must confess that I am a maximalist – the opposite of a minimalist – when it comes to caring for my face. I am dedicating to protecting my skin with every advantage available. I will divulge exactly what I apply to my face every day. I will then give my abbreviated list of essential products for individuals who fall more into the minimalist camp or already have favorite products but would like a few new ideas to up the game.
First, some definitions are needed. Antioxidants neutralize free radicals in the skin. Free radicals are harmful agents that develop on our skin in response to ultraviolet radiation, infrared radiation, blue light and pollution. Left to their own devices, free radicals wreak havoc upon our skin, creating damage to our DNA which leads to skin cancer and aging of the skin.
Growth factors are proteins that support our new skin cells, encouraging them to develop into healthy, strong new skin cells. This is not the same as human growth hormone which is sometimes used by endocrinologist for hormonal dysregulation problems.
Peptides are also proteins. I think of these as nourishment for our collagen and elastin. Collagen and elastin form the network of support in our dermis. I think of the dermis as the insulation in the wall. Vessels and nerve fibers course through this layer of the skin. As environmental aggressors selectively thin our dermis, vessels become more obvious in the form of broken capillaries or spider veins on the face. Peptides nourish our fibroblasts, the cells responsible for making new collagen. By nurturing our fibroblasts, we can improve the quality and texture of our skin.
In addition to the damage to the dermis, environmental aggressors are also responsible for creating freckles (lentigines) and other dyspigmentation such as melasma. This uneven pigmentation makes the skin appear older and less vibrant. Topical lightening agents can help to fade these freckles over time when used with proper protection. There are prescription strength lightening agents such as hydroquinone. Although not common, hydroquinone can conversely cause dark pigmentation to develop. This is known as exogenous ochronosis. In addition, hydroquinones have been banned in Europe for fears of possible carcinogenesis (cancer causing). Given these problems, I prefer the plant based lightening agents.
Sunscreen is used to block the harmful effects of ultraviolet A (UVA) and ultraviolet B (UVB). Sunscreens are currently under investigation by the FDA. As dermatologists, we look forward to more straightforward packaging and labeling of sunscreens that will come from the long-awaited FDA monograph (due any time now). At this time, it is best to consider sunscreens as either physical blockers or chemical blockers. Physical blockers are primarily made of the minerals zinc oxide and titanium dioxide. They are the only products currently judged by the FDA as “generally regarded as safe and effective” (GRASE). When applied to the skin, physical blockers block the transmission of UVA/UVB into our skin. I think of physical blockers as reflecting the sun’s harmful rays off the skin. The other class of sun blocks is chemical blockers. chemical blockers are the long chemicals named as the active ingredients in sunscreen products such as oxybenzones. These agents work by absorbing the sun’s harmful rays and essentially neutralizing them. There is much debate as to how effective these products are. Some states, such as Hawaii, have banned chemical blockers for theoretical concerns that they may damage aquatic life in the ocean, specifically coral. Another downside to chemical blockers is that they sting the eyes and can irritate sensitive skin. While the FDA works to define whether chemical blockers are GRASE, I will say that I far prefer the use of chemical blockers to no sunscreen at all. My rule of thumb, also use physical blocker on the face. Consider physical blockers or combination physical/chemical blockers for the body in addition to sun protective clothing, hats and sunglasses.
Retinoids are the final ingredient to the best skin care. Retinoids are derivatives of vitamin A. Traditionally they have been used to treat and protect against acne break outs. They also cause a light exfoliation which gently lifts pigment from the skin while it also helps stimulate collagen, improving fine lines.
The first thing I apply to my clean face both day and night is SkinMedica’s TNS Essential Serum. This product is truly amazing. My fellow dermgirls and I always say that TNS is our “If I had to go to a desert island with only one product besides sunscreen” product. TNS is really 14 products in one. It contains the most sophisticated complex of anti-oxidants, growth factors and peptides to both protect and nourish our skin.
After I apply my TNS, I next use one pump of SkinMedica’s Lumivive – either am or pm depending on the time of day. Lumivive is another protective and corrective product. We think of it as a selfie filter for the skin. Added to any routine, this product helps take your skin to the next level. Lumivive AM is chock full of additional antioxidants. Used with sunscreen, Lumivive helps boost environmental protection by 8-10 times. In addition to making sunscreen work better, these antioxidants also increase protection against infrared radiation, blue light from all our screens, and environmental pollution. Lumivive PM helps to repair and correct the skin overnight. I think of it as rebooting the skin while sleeping.
The next step in my routine is PepUp by Colorescience. As the name infers, this product is full of the collagen nourishing peptides to rejuvenate the skin. Pepup also contains a proprietary agent called phytomoist which provides an extra boost of hydration – a fact that I love in the Minnesota climate.
Although I have fair skin, I have lived on planet Earth long enough to acquire some undesirable freckles and pigmentation. I have successfully treated this with SkinMedica’s Lytera a plant-based lightening and brightening agent. This product has been clinically shown to visibly reduce unwanted pigmentation. I use this both morning and night. In the evening, I add a pump of SkinMedica’s 0.025% retinol three times per week.
For the thin skin around my eyes, I am a huge fan of the Total Eye Restore Regimen by Colorescience. 3-in-1 Renewal System by Colorescience. This product comes with a kit including the Total Eye 3-in-1 Renewal cream, an evening eye concentrate solution, and hydrating masks. The am Total Eye Cream is really three products in one. First, making my little dermatologist’s heart sing, there is physical blocker SPF 35 in Total Eye. Second, it is lightly tinted with iron oxide. Iron oxide protects against infrared radiation. It also helps blend out dyspigmentation around the eyelids. Finally, Total Eye is corrective. Regular use diminishes visible crow’s feet. In the evening, the kit includes the pm Total eye solution. This is essentially the same as the am product but without the sunscreen and with more phytomoist to increase hydration to the eyelid skin. Once weekly, I apply a hydrating mask in the evening and let it sit on the skin for thirty minutes.
Facial moisturizer is next. My favorite product for daytime use is SkinMedica’s HA5. This product has five different types of hyaluronic acid (HA), a substance naturally found in our skin and joint spaces. HA is the common product used for cosmetic injections into the face to fill wrinkles/lines and re-volumize the skin envelope. HA5 is very lightweight but offers terrific hydration. Thedermgirls think of it as the connection to the injection. Because HA’s love water, they attract water molecules. This has the effect of inducing a superficial swelling to the skin which minimizes lines on the skin, creating a more radiant canvas.
Now for the most critical step, sun protection. I use Sunforgettable facial sunscreen over my whole face. I also apply a second layer of sunscreen called Even Up by Colorescience that further blends any uneven pigmentation. Finally, I set this with an application of the Sunforgettable Brush On SPF 50 powder. This product is an absolute game changer. I reapply my sunscreen powder several times throughout the day. This gives me great protection over the course of the day and is minimally disruptive. It literally takes less than 10 seconds to apply the brush on sunscreen to the face, neck and ears. All of these sunscreen products are physical blockers, so I never have any issues with eye irritation. These products are water resistant for up to 80 minutes, so reapplying sunscreen every 90 minutes or sooner if skin has been wet makes sense. In addition to my facial sunscreen, I always apply sunblock for the lips. Elta MD make a great lip sunblock. Colorescience also makes multiple SPF lip glosses in clear and pigmented varieties. After my sunscreen, I apply make-up, but this is just my own personal preference.
My evening routine is much the same as the am with a few tweaks. I start with removing makeup and cleansing. I use a cloth first to remove makeup. Colorescience makes a terrific cleansing cloth. Another good cleansing cloth is Simple. After removing my makeup, I use Elta foaming face wash with my Clarisonic. Immediately after cleansing, I apply TNS Essential Serum followed by my PM Lumivive and Pepup. Next I apply Lytera. Three to four times weekly, I apply my single pump of SkinMedica retinol. While a goal is to use this every night, I find that my skin becomes a little too peely and irritated. Three to four times weekly is the right balance for me, but everyone needs to experiment to determine your own best dosing. After the retinol, I apply SkinMedica HA5 to my whole face and Colorescience Total Eye Concentrate. As a Minnesota resident, weather can sometimes play havoc with my skin. On some occasions, I need an additional boost of moisture to my skin. For this, I turn to Cetaphil or Cerave cream. As discussed earlier, these are fantastic for the body. They are also very reliable non-comedogenic moisturizers for a dry face.
I know this blog is long, but I really wanted to share all of my own personal tricks of the dermatologic trade. I hope you all find this information useful. If you have any questions, feel free to reach out to me or to my wonderful aesthetician. Have fun but be safe!
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