The Case for Exfoliation: Breaking through consumer myths about this vital skin care step

Written by Ahmed Abdullah, M.D., F.A.C.S., F.I.C.S.

Exfoliation has been touted as a vital skin care step for long enough now that nearly every skin care consumer realizes it is a recommended part of their regimen. But knowing that a product or step is beneficial does not always mean consumers will adopt it. In fact, many skin care professionals have encountered clients who claim that exfoliation just is not their thing.

Their excuses? “My grandmother didn’t exfoliate and she had gorgeous skin.” “I’ve heard that exfoliation causes your skin to thin.” “I have sensitive skin that can’t tolerate exfoliation.” “I tried it and it made me break out.” “I’m in the public eye and cannot have my face constantly peeling.” Do any of these sound familiar? These and other excuses for dodging exfoliation reiterate the prevalence of misconceptions and misinformation that abound on the topic. But considering that this one skin care step has the proven ability to generate dramatic improvements in skin health and beauty, it makes sense that skin care professionals and physicians should work to set the record straight. By educating about how exfoliation works at a cellular level, while helping them select a properly formulated product, professionals can prove that exfoliation is, indeed, a worthwhile step for nearly everyone.

EXFOLIATION IN HISTORY
While many believe exfoliation to be a relatively new trend in skin care, the reality could not be further from the truth. History overflows with anecdotes of exfoliation practices. For example, Cleopatra took frequent milk baths to maintain her complexion. Little did she know, her positive results were due to the milk’s lactic acid content, which gently exfoliated her skin. In ancient Egypt, they applied wine to the skin, of which the tartaric acid content helped to minimize the signs of aging. The Ancient Greeks and Romans applied a mix of pumice and oils to their skin, which allowed them to mechanically exfoliate.
In more modern days, dermatologists began using chemicals to minimize the signs of aging in the late 1800s; by the 1970s, dermabrasion was introduced as a professional treatment. The selection of properly formulated homecare exfoliation products was limited, however, to harsh facial scrubs until the early 1990s when alpha hydroxy acids entered the market by way of moisturizers. It is that singular development that dramatically changed the skin care industry. Today, alpha hydroxy acids are found in nearly all skin care product categories, with a vast selection of exfoliation products available for homecare use. Many of these exfoliants provide excellent results that complement professional treatments and, in some cases, even rival them.

MAKING SENSE OF THE EXFOLIATION PROCESS/
On a simplistic level, exfoliation is the process of removing the outermost layer of dead skin cells to reveal the softer-, fresher-looking skin below. The mechanism by which exfoliation works is far more involved, however.
The skin is constantly undergoing a natural exfoliation process whereby cells are produced deep within the skin and rise through the layers until they are eventually sloughed off the surface. In healthy skin, this process takes approximately 30 days to complete. However, during the aging process and/or as the skin becomes damaged due to excess sun exposure, pollution, smoking and more, this cellular turnover slows, causing hyperkeratosis. Because the skin must maintain a consistent thickness, as the keratin layer builds up, the dermis layer thins. As the factory of the skin where beneficial skin proteins like collagen and elastin are formed, a healthy dermis is vital to beautiful skin. When it is compromised, due to aging and damage, dermal function slows. As a result, the skin begins to show characteristics associated with aging, including fine lines and wrinkles, enlarged pores, dryness, redness, uneven tone and texture, broken capillaries, breakouts, and more.
When a regular exfoliation practice that uses properly-formulated products is introduced, the keratin layer is forced to thin. This process prompts the dermis to thicken again, thereby ramping up its production of the proteins that give skin its strength and elasticity. From an aesthetic standpoint, the removal of the outermost layer of dead skin softens fine lines, improves skin tone and texture, minimizes pore size, and more. With the use of properly-formulated products, exfoliation does not thin the overall skin but, rather, thins the buildup of unnecessary keratin layers to thicken the dermis.

EXFOLIATION AND SENSITIVE SKIN
According to a 2011 survey by the International Society of Dermatology, 50.9 percent of women and 38.2 percent of men claim to have sensitive skin. Most of these cases are self-diagnosed, which makes it impossible to know the specific cause of their sensitivity. However, sensitive skin can generally be attributed to genetics (in a small percentage of cases), skin disorders like rosacea or eczema, allergies, improper skin function, or a weakened skin barrier. While most will say that sensitive skin should rarely be exfoliated, there are exceptions to that rule. In fact, in some cases, exfoliation may be just the thing sensitive skin needs.
The stratum corneum is an outer layer comprised of dead skin cells, each surrounded by skin oils. By forming an impenetrable barrier, it keeps the moisture inside the skin and the environmental toxins out of it. The skin’s barrier function is easily weakened due to the overuse of aggressive skin care products or clogged pores. When barrier weakness is due to improper skin care, such as overwashing with harsh cleansers or exfoliating too frequently with products that contain ingredients known to cause inflammation, the best medicine is to go back to a simplistic skin care regimen that focuses on moisturization. Otherwise, as counterintuitive as it may sound, exfoliation should be considered.

SIDE EFFECTS
Exfoliating at home, like professional exfoliation treatments, is not without side effects, such as redness, dryness, and, in some cases, peeling. Those with clogged pores may find that as the exfoliation process removes blockages from the skin, the debris that was suppressed in the hair follicle is purged, leading to breakouts. As skin function normalizes, these symptoms should become less prevalent and, within approximately a month, they should disappear completely. If a client continues to experience side effects from an exfoliatnt beyond that period of time, product use should be stopped. In that case, the client may be having an allergic reaction to an ingredient in the formulation.
Exfoliation does not make most individuals break out or peel. However, if a client is in the small percentage of individuals who experience these side effects, the symptoms should be temporary. If symptoms remain after a month of product use, discontinue the product, as these side effects are likely due to an allergy.

SELECTING AN EXFOLIATION PRODUCT
As mentioned earlier, there is no shortage of exfoliants on the market and, for that reason, selecting the best one for clients can be a challenge. For the most effective homecare exfoliant, select a product formulated with alpha or beta hydroxy acids over the use of a scrubbing polish or facial brush. While many individuals claim to see positive results from the latter methods, these products have the potential to create microscopic tears in the skin. These tears can lead to inflammation, which in turn leads to other skin issues. Furthermore, these products do not have the ability to exfoliate as effectively as chemical exfoliants.
Alpha hydroxy acids and beta hydroxy acids are well tolerated by most individuals. The key is to find a product that offers a pH that is acidic enough to generate an acceptable level of exfoliation. Many exfoliation formulations for use at home include a minimal amount of acid to avoid the risk of burning or peeling. However, these products do not provide much of a benefit to the skin. It is suggested to look for a product that offers a pH in the range of 2.0 to 4.0, a level that is significantly more acidic than the skin. Products that include a concentration of aloe vera in the formulation are beneficial, as well, as aloe successfully counteracts the potential for burning and inflammation.

There really is a rebuttal to nearly every excuse clients can make for not implementing a regular exfoliation practice. With an abundance of safe and effective exfoliants on the market today, individuals have the potential to achieve healthier, more beautiful skin within their own home. But that does not make the services of an aesthetician, dermatologist, or plastic surgeon unnecessary. Consumer exfoliants provide results more slowly than professional treatments. Furthermore, consumers are easily overwhelmed by the range of exfoliation products and ingredients available to them and can benefit from professional guidance in that regard.
By recommending homecare exfoliation regimen that supplements professional skin care treatments, clients will not only take comfort in knowing that they are using a product that will work for them, but also in experiencing quicker results.

 

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