When dealing with the dizzying array of creams, serums and sprays designed to save your skin, what you don't know can cost you money — and protection.
Back in the late 1970s, I had the opportunity to profile the brilliant, colorful Penn dermatologist and researcher, Dr. Albert Kligman, the man who developed Retin A — still the most significant drug for skin care in the last 50 years.
I had barely opened my reporter’s notebook when he let loose a diatribe on his favorite subject: wrinkles. “The wrinkle,” Kligman, who died at age 93 in 2010, declared, “is a goddamn real disease. The anguish caused by wrinkles is far worse than what’s caused by heart disease. Do you know anybody who gets up every day and worries about cancer? No, huh. But everybody worries regularly about their dry skin and their fucking wrinkles.”
Nobody dies from wrinkles. They don’t affect our health or interfere with our vital functions. In the pantheon of medical maladies, wrinkles don’t rate more than a passing mention. And virtually no medical professional took them seriously before Kligman, who opened one of the nation’s first clinics for aging skin right here in Philadelphia. His academic colleagues, deep into the scholarly pursuit of serious problems like skin cancer, scoffed at him for wasting time in the mundane realm of aging skin. He ignored their scorn because he sincerely believed that good health requires the maintenance of physical attractiveness. “If you’re old and have dry, wrinkly skin, people look at you with pity,” he told me. “But if you’re old and have smooth skin, you get treated with respect and admiration.”
Well, haven’t times changed? Today, Kligman would probably grace the cover of every beauty magazine, applauded as the father of the multibillion-dollar skin care industry. What he understood, even before the baby boomers set off on their passionate quest for endless youth, is that skin is the difference between looking like your biological age 50 or passing for 35.
Hardening arteries, declining sex drive, your heart muscle growing flaccid — those are hidden signs of aging shared between you and your doctor. The only public display of aging is the one thing you can’t hide — your face. And there is now an army of professionals armed with lotions and potions and procedures to slow down — and even reverse — the clock on facial aging.
Getting Deep Into Skin
To understand how skin ages, you need some very basic middle-school science. Skin is our most durable organ and an expert multitasker. It serves as an infection barrier between the body and the environment; it regulates temperature; it houses millions of nerve endings that give us our sense of touch and response to pressure and pain; it synthesizes the essential vitamin D. You already know that skin has three layers. The epidermis, which guards the body from invaders, is made of clumps of cells called keratinocytes that are regularly shed about every 21 days. Next is the dermis, the scaffolding containing all the goodies — oil glands, blood vessels, nerve endings, sweat glands, hair follicles. Its tissue is made up of elastin, fibrillin and collagen, the support structure that gives skin a firm, young appearance. The bottom layer is fat, a kind of mattress that helps keep us warm and stores energy.
Skin ages from the outside in as well as the inside out. The most damaging outside factors are sun, smoke and, to some degree, environmental pollutants. Most of these can be easily controlled. Use sunscreen every time you walk outside and don’t smoke. Inside deterioration is harder to manage. As we age, new cells don’t replace old ones as rapidly as they once did, so skin looks duller. Skin thins over time as the fat layer decreases. Oil glands secrete less lubricant, so instead of glowing we look dry, and elastin and collagen production really sloooows down. Oh, and let’s not forget gravity and the joys of sagging!
The raison d’être of the skin care industry is to mediate both these internal and external changes with products designed to defend against Mother Nature’s increasing laxity.
Don’t deceive yourself that anything in a jar or bottle can restore youth. And don’t trust claims like “laboratory-tested” or “clinically proven” that may mean nothing more than that a product works on lab rats but is unlikely to have undergone the kind of rigorous testing required for drugs. In fact, cosmetics and cosmeceuticals (skin products sold by doctors and spas instead of drugstores) are not regulated by the FDA, so any scientific promises made about one of these products should be taken with a grain of salt. The one and only drug approved for skin care is tretinoin, the generic version of the Retin A originally developed by Dr. Kligman.
Retin A, or retinol acid, which was recommended as part of a daily skin regimen by everyone interviewed for this article, isn’t the Fountain of Youth, but it remains the gold standard of skin care. Because it’s a drug, it has been scientifically proven to ameliorate sun damage (along with a slavish adherence to sunscreens), reduce blotchiness, stimulate skin tissues, palliate fine lines and wrinkles and improve skin texture by increasing cell turnover. Yes, all that dermatological assistance, contained in one little tube. Some people with sensitive skin have trouble tolerating tretinoin because it can initially produce dryness, flakiness and redness.
Center City dermatologist Dr. Jason Neustadter suggests experimenting until you find a formulation that works best for your skin. “You only need a pea-size amount to cover your whole face,” he says, “and you can start out using it every other night.” One alternative to the three available prescription strengths is a weaker OTC product with retinol on the label. The problem is, you don’t know how much retinol is in the drugstore cream so the results can be wildly different. You should see a change in about eight weeks.
Neustadter is a believer in the KISS approach to skin care: keep it simple, stupid. “A handful of good products is better than a shelf full of stuff,” he says. His skin regimen is based on what he calls The Big Three: sunscreen, antioxidant and retinol with the addition of a moisturizer and eye cream.
Sunscreen is the be-all-and-end-all of skin care. Without a daily sunscreen, don’t waste your time and money on anything else. For your face, you want a sunscreen with 30 SPF that contains zinc and titanium to block both UVA and UVB rays. The good news is that an inexpensive over-the-counter product called CeraVe AM, a combination sunscreen and daytime moisturizer, was on everyone’s recommended list and its zinc is absorbed so you won’t look like a lifeguard with a white nose. Ellen Ehrlich, a registered nurse clinician in dermatology, advises that if you spend a lot of time driving, consider tinting your car windows to keep the sun out. And don’t fool yourself that a hat is enough to eschew sunscreen, because sun reflects off the sidewalk.
Antioxidants are also on everyone’s essential daily care list because they scavenge about attacking free radicals, those byproducts of oxidation that cause degenerative changes to skin cells associated with premature aging. You can eat your antioxidants in foods like blueberries, strawberries, oranges and dark leafy greens — and you can feed them directly to your skin from an expensive little jar. “Here is a good example of ‘you get what you pay for,’ ” says Neustadter. “Antioxidants like vitamin C are unstable and need to be properly compounded to deliver the right concentration into the dermis. This is one place I’d spend the money for a good cosmeceutical.” Several experts interviewed liked CE Ferulic, a product from Skin Ceuticals, a company that makes its research available to the public. Other frequently mentioned cosmeceuticals are those made by Skin Medica and Neocutis. (All are available online.) Neustadter prefers antioxidants in serum rather than cream form because serums are lighter and have smaller molecules than creams, so they are better able to penetrate deeper into the dermis. Creams are fine for moisturizers, which basically lay on the top of the skin to hydrate it. “As far as moisturizers go,” Neustadter points out, “a $9 product from the drugstore can be as good as something 10 times as expensive.”
You could drive yourself crazy trying to choose good drugstore skin products. Dermatologists like the La Roche Posay line available at CVS, or you can check out the lists periodically published by beauty magazines like Allure. Two other perennial favorite lines seem to be the Olay Regenerist and L’Oréal. Keep in mind, however, that cosmeceuticals have more biologic action than these mass-market compounds, along with fewer preservatives and a higher concentration of active ingredients. Sometimes, you want to buy caviar and sometimes, salmon roe will suffice.
You can also go totally natural by filling your skin care needs in your grocery cart at Whole Foods. Rachael Pontillo, author of Love Your Skin, Love Yourself, is a local natural products proponent and adviser. She likes the mineral-based sunscreen Osmosis Shade, argan oil with a few drops of lavender, sandalwood and frankincense for her daily under-eye treatment, a dab of shea butter for a moisturizer, aloe vera gel for a weekly firming and tightening mask, and Osmosis Purify for an exfoliating cleanser. Product lines she approves of include Dr. Hauschka and Acure. “Only Western culture relies on chemical products for skin care,” says Pontillo. “The holistic approach includes what you put in your body as well as on the surface.”
To Pontillo’s suggestions, I’d add my own personal fave, a night cream called African Secret that I buy at Whole Foods for about $15 and apply after my Retin A right before bed. The four-ounce jar seems to last forever and is packed with goodies that include shea butter, coconut oil, beeswax, baobab oil and royal jelly. It even got the stamp of approval from my go-to aesthetician, Jane-Marie D’Amato at Deme in Center City.
D’Amato is the skin care guru I visit every few months for a clinical facial, which is as important to anti-aging as a good daily skin care routine — and as different from a spa facial as a Swedish massage is from a chiropractic adjustment.
While spa facials are relaxing and will hydrate the skin, they are, at best, superficial in terms of serious skin care. If you are a devotee of regular spa facials, you might want to ponder instead putting your money into the more science-based maintenance of a clinical facial every three months, such as the kind Ellen Ehrlich offers at Main Line Dermatology or from a clinical aesthetician like D’Amato. A clinical facial will include an analysis of your skin’s current needs (which change seasonally) along with procedures like derma-planing, which uses a scalpel to skim off dead cells and peach fuzz, some kind of light acid peel to further exfoliate dead cells and give your skin a youthful glow, micro-dermabrasion to polish the skin surface and maybe a laser zap to get rid of unwanted pigmentation. “You can’t make a 50-year-old look 20,” D’Amato says. “But you can make her look refreshed and well-rested.”
Solutions for Ablutions
Finally, here are some useful tips I picked up from all the specialists I interviewed. Spend a little time reading labels and becoming ingredient-savvy. Look for things like peptides — amino acids with skin-repair properties — that have been kicking up a fuss since 2008, when it was observed that using them on burn victims hastened healing. They seem to trick the skin into thinking it needs to produce collagen. Caffeine is gaining popularity as a skin care ingredient for its effect on dehydrating fat cells and tightening skin. Ceramides, which are naturally found in the epidermis, are garnering attention as an additive in moisturizers for combating dry skin and maintaining the skin barrier.
Among the antioxidants known to repair skin damage, look for açai oil, green tea extract and acids with names like alpha-lipoic, alpha-hydroxy, hyaluronic and salicylic. Mild bar soaps are fine for the shower, but for your face use a cleanser like Cetaphil, CeraVe, or Acqua Glycolic. Moisturizers are best applied on damp skin. If you want to keep your whole body as smooth as a baby’s, leave a container of Eucerin or Nivea in the shower and rub it all over before you towel off, especially in the drying months of winter, when your arms and legs can look like a lizard.
Skin care is like exercise. To maintain a youthful appearance, it needs to be a daily, lifelong commitment. And give any skin routine at least three months to show a result. Those overnight sensations are as believable as the tooth fairy. It’s a no-brainer that the healthier your diet, the better your skin will be, and to look younger as you get older, it’s wise to start a skin care regimen when you are under 40. For some women, skin care will be the last stop on the anti-aging express; for others, it is the beginning of the journey.
Carol Saline is the chief medical affairs correspondent for Inside. This article originally appeared in Inside Magazine, a Jewish Exponent publication.