The main goal of a skin care regimen is to rebuild and protect the SC barrier, to allow repairs, and to improve recovery processes to maintain its structural and functional integrity. There is a cycle of steps to a healthy skin barrier, which will give you supple, radiant skin. The 5-step cycle is: cleanse, exfoliate, nourish, moisturize and protect.
First, cleansing seems simple, and it is, if you are using the right cleanser. Cleansing of the skin is a complex interaction between the SC barrier, environmental dirt, body secretions, and a surfactant. Washing of the skin is the single most common cause of dermatologic disease, yet it is necessary in terms of personal hygiene and health. Using the right cleanser will not strip our acid mantle and will keep the facial skin on the acidic side with a pH between 4 and 6. The natural acidity of the facial skin acts like a skin barrier that fights bacteria and other environmental aggressors. Harsh facial cleansers and soaps can alkalinize facial skin and weaken the skin barrier, as well as become irritating to the skin. The formulations of syndet cleansers include a mild synthetic surfactant, like glycerin, in addition to greater amounts of moisturizer and humectants than are found in soap-based products. The purpose in developing new synthetic detergents is to provide a product that is less irritating to the skin than traditional soaps.
Next step: exfoliate. What are the best exfoliation methods? The best exfoliation products for at-home use are alpha hydroxy acids (AHAs) like glycolic, retinol and tretinoin. These acids are able to improve the skin because their molecules are small enough to penetrate the outer (horny) layer of the skin and reach the lower (dermis) layer. Also, they work by dissolving the mortar that holds dead skin cells together, increasing cell turnover, and sloughing off dull, rough skin on the surface. Research has suggested that alpha hydroxy acids can also improve the skin's barrier functions (its ability to keep out unwanted substances, such as dirt and pollutants). In-office treatments include microresurfacing and chemical peels.
After exfoliation, we need to nourish and feed the skin with antioxidants. Our skin needs antioxidants and peptides to help improve fine lines, wrinkles and even pigmentation. Antioxidants work by neutralizing free radicals and protecting against the environmental damage that leads to visible signs of damage. Antioxidants, like vitamin C, can rebuild the skin's outer layers (barrier) and protect against the visible effects of oxidation. Antioxidants and peptides (like growth factors) are in many cosmeceuticals, and applied topically they influence the biological function of the skin. Antioxidants and peptides improve the appearance of the skin by delivering nutrients necessary for healthy skin and a healthy skin barrier. Antioxidants include vitamin C and E, panthenol, lipoic acid, green tea and beta carotene. Some of the most interesting antioxidants come from plants and are called botanicals. Roots, fruits, seeds, leaves and twigs are used to make botanicals, like black poppy, black rose, Japanese mandarin and black orchid, which all have antioxidant properties. Many botanical extracts used in cosmeceuticals contain antioxidants, which are substances that prevent energetic oxygen molecules created by ultraviolet (UV) radiation from damaging living things on earth.
In-office treatments, like chemical peels and microresurfacing, can also help to nourish the skin. Not only does microresurfacing help to exfoliate, but also creates circulation which nourishes the dermis by bringing blood to the surface. The circulation also helps with acneic skin by bringing O2 to the surface, killing the P. acne bacteria, as well as giving the skin a radiant glow. After an in-office treatment, our skin's barrier function is disrupted, but will return to normal within a few days.
Moisturizing the skin is the next step. The SC plays a crucial role as a water impermeable skin barrier, and so does moisturzing the SC. In order for the SC to remain intact, it must maintain flexibility and moisture for keeping the SC pliable. The epidermal layer not only protects us from environmental pathogens but also acts as a 'barrier' to water loss, which prevents transepidermal water loss (TEWL). Moisturizing and hydrating the skin helps with protecting the skin's barrier as well. With the realization that the SC is a dynamic and interactive tissue, new emphasis has been placed on agents that are used to moisturize the skin; these are suitably termed moisturizers like hyaluronic acid or glycerin, which are humectants. Their multiplicity and potential effects, including barrier functions, TEWL, and the exogenous or endogenous offenders that result in dry, scaly skin parallel the increased understanding of the SC.
Last, be sure to protect your skin by using an appropriate broad spectrum sunscreen of SPF 30 or higher. Sunscreens prevent photo-aging and photo-carcinogenesis (cancer from the sun), and should be the cornerstone of any skin care regimen. The use of sunscreen will also help to keep the skin's barrier intact and healthy, along with helping prevent UVA/UVB damage. There are both chemical and physical sunscreens; however chemical sunscreens can be irritating to the skin because the skin absorbs the chemical to then reflect the UV light. If the SC has been compromised or is sensitive, using a physical sunscreen is recommended. Physical sunscreens contain fine powders of zinc or titanium to reflect the UV light.
Achieving and maintaining healthy skin is more than just using skin care and sunscreen. Each step does not need to be followed on a daily basis, but using something like tretinoin or having in-office treatments like microresurfacing should be done on a regular basis for optimal skin health. Healthy skin and the SC are important in and of themselves, but will also add to better results if patients are also having any non-invasive or invasive facial procedures like non-ablative laser treatments or facial plastic surgery.