Purpose of this Document
Dermatology in the 21st century is an academic complex ruined by beauty companies that do not have their consumers’ best interests in mind. This document does not seek to teach people how to achieve “Glass Skin” or “Invisible Pores’. I instead want to touch on the benefits of healthy skin, and how it is ultimately better at self regulation than the results of your sephora spending habits.
This is a pared down look at skincare from the perspective of someone who saw dramatic benefit after reducing the number of steps and products in their routine and wishes to take a more evidence-based look at how the skin functions.
Components and Functions of Skin
Unless you have a skin condition like acne, psoriasis, rosacea etc. your skin accomplishes all the functions you seek to aid with products. It self-exfoliates in a 27 day cycle, it moisturizes using sebum and other oils, and it most importantly protects the body from pathogens and other exogenous threats. For our purposes it consists of two main layers; the Epidermis (outer skin) and the Dermis.
The Epidermis
This layer of skin is most concerned with protection and the prevention of water loss, it is also the layer of skin that everyone sees! Its main function is keratinization in which cells rise from the dermis, expel their cytoplasm and nutrients, and fill themselves with the protein keratin. Keratin filled cells (keratinocytes) are what ultimately gives the epidermis its protective effects. Over time these cells die off and go through the process of desquamation; controlled invisible shedding. Abnormal desquamation occurs in certain skin conditions or in over-use of exfoliants, this is when visible patches of skin shed all at once, like so.
The Dermis
This layer contains everything we consider important to the skin, sweat glands, sebaceous glands (the oil makers), and hair follicles. What allows the dermis to have so many functions is the blood vessels that transport nutrients and waste in a highly efficient manner. The Dermis is also home to the targets of anti-aging products; collagen, elastin, and reticular fibers.
Aging
As the skin ages the Epidermis becomes thinner and thus loses its protective capabilities, alongside this the elastic fibers that hold the skin taught are slowly weakened. This results in a functional loss, an increase in the propensity for skin damage; and an aesthetic loss, facial structure is covered by wrinkles and hidden under flaps of skin. I'm not going to go into the philosophical implications for considering older people less attractive, you can't bait me into that discussion, it's really boring.
Skin Flora
On the skin there exists colonies of bacteria that help the skin to produce certain chemicals that it would otherwise be unable to. Enzymes and proteins that aren’t coded in human DNA are produced by bacteria in symbiotic relationships with us. The populations of different bacteria varies by the climate of the skin, for instance the bacteria in your nose creases are far different than bacteria on your cheeks. An excess in the population of one of these bacteria may result in skin conditions such as acne, dermatitis, psoriasis, and rosacea. Normally the skin would keep this in check via antibacterial proteins and an acidic PH balance, however when these systems fail, infection begins.
Why Skincare?
There are two reasons for skincare; aiding the functionality of the skin via treatment of skin conditions, and making it look pretty. As stated prior, I'm not going into the philosophical implications of regarding skin conditions as ugly, however I will show how to treat them!
There are many steps one can use to prevent their skin from becoming damaged, the most primary of which is to strengthen the skin barrier (the epidermis) either by thickening it or supplementing it’s functions to treat conditions.
Sunscreen
The best way to maintain a healthy skin barrier is by using sunscreen, without it, melanin is the one thing that can protect the skin from UV radiation. There is no difference in efficacy between chemical and mineral sun protectants. However, material protectants tend to leave a white cast, especially when using an adequate amount.
Moisturizer
Moisturizers are products that seek to prevent water loss (occlusives), or provide moisture to the skin (humectants). Humectants claim to moisturize the skin, however the means by which this is accomplished are somewhat ironic. They tend to steal water from the Dermis layer (where it actually has a function) and deposit it on the epidermis for aesthetic value. Occlusives are actually very useful, they act like a second skin barrier, preventing water from escaping via transepidermal water loss. These are the products used in treating skin conditions like eczema and psoriasis, however anyone can use them for aesthetic value as well!
Cleansers
Your face isn't dirty. Full stop. Literally washing off your face with water is all you need, the rest is overkill. Imagine taking a hammer and then smashing a toddler’s head in, that's what you’re doing to your skin with surfactants, just don't do them. If you’re concerned with oily skin, use an oil cleanser, this causes your skin to produce less oil as it interprets external oils as excess production. Oil cleansing also dissolves excess, as opposed to traditional surfactants which just reduce both water and oil.
Other Treatments
Retinol, Exfoliation, Azelaic Acid, Peptides, these treatments are superficial for those who don't have skin conditions. However!! They can provide aesthetic value if used carefully.
Aesthetics
The first priority for anyone seeking to make their skin look nice is to first make sure their skin is healthy, this means treating existing conditions like acne or rosacea, but also not overusing things like exfoliants or retinoids.
Retinoids
Retinoids are forms of Vitamin A, a vital part of the skin during development and onwards. They’re actions include increasing the frequency of cell turnover, thickening the skin barrier, and increasing the production of collagen and elastin. These three actions pose both functional and aesthetic benefits; retinoids strengthen the skin barrier (when used correctly) and reduce the appearance of fine lines (when used correctly.) Do not use them if you have sensitive/reactive skin or rosacea as they can exacerbate these conditions. Also weirdly enough it can help prevent and treat skin cancer?
Exfoliants
These chemicals fall under the more aesthetic category, having little function in the treatment of skin conditions (except acne). Their aesthetic use tends to thin out the epidermis which reduces the skin's ability to protect itself. HOWEVER, they do smooth out the skin and give the appearance of a #youthful sheen of moisture. If you decide to use them I would suggest using products with Gluconolactone, Lactic Acid, and Lactobionic acid. These newer age exfoliants have similar (if not greater) effect sizes without damaging the skin with overuse.
Azelaic Acid
This ingredient would have been the perfect treatment for acne if Tretinoin (high strength retinol) didn’t exist. It targets literally every pathogenic origin from the bacteria itself to the overproduction of sebum in the skin. However it does have an excellent use case, in people whose skin cannot tolerate retinol (it's more common than you think,) Azelaic Acid is able to both treat acne and the possible irritation that may result from it. While I truly do love it, its use is too specific. To account for this some dermatologists have been touting it as the perfect cure for redness, it's not, just use vaseline like a normal person.
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