Presented by: Hayes Gladstone, MD
Director Dermatologic Surgery
Stanford University Medical Center
May 12, 2010
- Overcleansing can dry the skin, so use moisturizing soap.
- Don’t let the skin dry out: Moisturize two or more times a day.
- Stay out of the sun and use sunblock with an SPF of 30 or more that contains titanium dioxide or zinc oxide.
- Prescription and over-the-counter cosmeceuticals may help repair skin damage, although the science is inconclusive in many current products.
- Don’t believe all the advertising hype, and be sure to stay away from harsh chemicals.
Open the pages of a magazine or enter the doors of any department store and consumers are barraged with products to keep skin fresh and wrinkle-free. But what products actually do work? And, with so much conflicting information, what is the best way to take care of the body’s largest and most resilient organ?
Hayes Gladstone, MD, an associate professor of dermatology, took time to separate the hype from scientific fact at a presentation sponsored by the Stanford Health Library. “The skin is the organ most exposed to the environment and its evolution has been designed to preserve it from cold, heat, moisture, and other external elements,” he said.
Effective skin care involves three basic steps: cleansing; moisturizing, and avoiding sun damage. From there, a range of products known as cosmeceuticals may improve skin function and prevent signs of aging. Cosmeceuticals are a huge and lucrative business, said Gladstone, and because most products are not regulated by the Food and Drug Administration, many claims are not backed up by scientific research.
Many people have dry skin because of their cleansing routines, not because their skin is normally dry. Most people tend to overdo skin hygiene by using soap that actually dries out the skin, causing flaking, itching, and irritation. Dry skin remains one of the top reasons people turn to a dermatologist, said Gladstone.
Dryness causes a cascade of events that can lead to cracks and fine wrinkles, which decrease the skin’s effectiveness as a barrier and can cause itchiness, an immune system response. Scratching simply exacerbates the reaction, creating a vicious cycle and sometimes introducing infection.
“The most important aspect of skin care is prevention,” said Gladstone. “By the time you see flakiness and cracks, it’s already too late.”
Use soap with a high moisture content (like Dove) rather than a harsh product like Irish Spring. Since water can also dry the skin by wicking moisture from the lipid base layer, use gloves when doing dishes or housework, and keep showers short.
Moisturizers prevent water loss by creating a barrier over the skin. The most effective agent remains petrolatum (petroleum jelly), which has been shown to aid in wound healing and alleviate the symptoms of itching. Many people find petrolatum too greasy, so some products add dimethicone, an emollient that fills in minute gaps in the skin surface to make it appear smoother. Other products include glycerin, which creates a stronger barrier and lasts longer.
While these products do hydrate the skin, the protective coating does not last, so it’s important to reapply moisturizer two or three times a day. For over-the-counter products, Gladstone recommends Eucerin, Cetaphil, and Aquaphor. He suggested moisturizing creams as a first step, followed by topical creams containing retinol or vitamin A.
Dermatologists recognize that the most potent product on the market today to prevent and reverse the signs of aging is sun protection, said Gladstone. The sun’s ultraviolet spectrum includes UVB radiation, which causes sunburn, and UVA radiation, which causes premature aging and skin cancer.
Skin damage is caused by both UVA and UVB rays, so select a sunscreen or sunblock that protects against both. If using a sunscreen, pick one with SPF of 30 to 60; under 30 is insufficient coverage and over 60 appears to be more of a marketing concept, he said. Gladstone recommends using a sunblock with titanium or zinc oxide, which is made of microparticles to deflect the sun’s rays. He recommends Blue Lizard, T-Silc Sheer, Tizo3, and sunscreens using mexoryl, including Shaka Shake. Higher concentrations are still not available in the United States.
Since sunscreens only go so far, Gladstone also recommends wearing long sleeves and using specially treated clothing like CoolBar apparel, which are made with titanium dioxide fibers, and wearing hats with wide brims to protect the neck and ears. And no direct sun from 11 am to 3 pm, he advised.
Gladstone acknowledged the current debate over Vitamin D deficiency, but explained that most people get enough sun exposure for sufficient Vitamin D production even when using sunblock.
Alpha Hydroxy acids remove the outer layer of skin cells through a process known as exfoliation. Commonly used hydroxy acids include glycolic acid and salicylic acid. Hydroxy acids can be added to daily-use moisturizers or can be incorporated into solutions used in dermatologists’ offices, such as chemical peels.
Vitamin A products, or retinoids, are founded on the strongest science, said Gladstone. Vitamin A, found in foods like carrots, citrus, and tomatoes, is important to both skin and eye health. Topical formulations of Vitamin A can cause increase cell turnover and diminish fine lines.
The best-acting retinoid is tretinoin (Renova or RetinA), which is available only by prescription. Retinol is a less potent cosmeceutical form of Vitamin A available over the counter, including products made by Neutrogena. Because prescription Vitamin A can cause skin irritation and sun sensitivity, many people respond well to the less potent over-the-counter versions, said Gladstone.
Antioxidants, which prevent oxygen molecules from damaging cells, are found in many botanicals. Ingredients such as Vitamin E and Vitamin C, copper peptides, and niacinamide (Vitamin B3) may work by scavenging for free radicals or assist in wound healing but seem to work at the same level as regular moisturizers, he said. As far as antioxidant moisturizers with vitamin C or E, he said some studies, particularly in Europe, appear to support the benefit of topical antioxidants, but Vitamin E can cause an allergic reaction that can cause redness. Flavinoids, found in soy and green tea, may enhance collagen production but also have not been researched sufficiently, he added.
“You don’t need to use all the vitamins. Choose one that works for you,” he said. “You may want to stick with a cleanser, a moisturizer, a sunscreen, and RetinA. That should be sufficient for most people.”
Bleaching agents appear to stop pigment creation but can take several months and can even induce dark granules in some skin types. For dark spots, first make sure they’re not cancerous, and then try a bleaching cream, such as Lustra Cream (with 2 percent glycolic acid and 4 percent hydroquinone). Tri-Luma, another good selection, contains steroids so should be used only for a short term.
“There are limitations to any products, so it’s important to look into what works and what is only hype,” said Gladstone. “Cosmeceuticals can only go so far. Often it takes more than just a cream to make skin look great.”
Gladstone suggested a routine that includes a sunblock with titanium dioxide, a bleaching agent (Lustra Cream) and an antioxidant in the morning, a retinoid (Renova) at night, and moisturizer two times a day.
About the Speaker
Hayes Gladstone, MD, director of the division of dermatologic surgery at Stanford, is an associate professor of dermatology and, by courtesy, of otolaryngology – head and neck surgery. He specializes in minimally invasive procedures for the cosmetic and therapeutic surgery, wound healing, and using new technologies including Mohs micrographic surgery to diagnose and treat skin cancer.
For More Information:
Stanford Dermatology Clinic
Stanford Advanced Skin Care Center
Stanford Department of Dermatology