Skin 103: Basic Care

This installment of our series on skin discusses general strategies one may use to slow, prevent, or ameliorate the visible signs of aging. (Later topics will deal with specific ingredients.)

The anti-aging cosmeceuticals market is already a multi-billion dollar industry. As aging baby boomers and younger people focus on looking as good as possible at every age, the growing demographics ensure a growing marketplace with more and more competing products constantly being introduced.

Who do you trust?

As BFT has amply demonstrated, marketers are not bound by ethical considerations in their sales pitches…anything and everything that can separate an unwary consumer from their money will be tried and should be expected.

Subterfuge abounds in this market sector. Buzz words “sell” and airbrushed photos of beautiful young people are seductive sales tools. Scientific claims and jargon are used without scientific proof. Personal recommendations (allegedly from personal use and experience) are often shamelessly and openly commingled with the profit motives of the “reviewer” who just so happens to also be a seller of the product. Of course, they would never recommend something that they did not genuinely believe in. That would never happen, would it?

Don’t be fooled. BFT is here to help. The final installments of this series will review skin care ingredients that have shown efficacy in the laboratory and on real people. For now, let’s look at the basic ways to best care for one’s skin and combat the effects of aging.

“The Warmth of the Sun”

The Beach Boys hit song can be forgiven for giving poor advice to America’s youth. After all, it was more than half a century ago that the California surf culture and sun worshipping were all the rage. We now know better than to languish for hours in the mid-day sun.

An obvious exception: any southern beach during college spring break. The good news is that liberal use of sun blocking protection by sun worshipers is common during these times – primarily in order to maximize “sun time” by preventing dreaded and disabling acute severe sunburn. Long term protective effects are a secondary concern at best. The bad news is that for many, vacation days at the beach are the only days of the year when sun protection is used.

For different reasons and for many centuries, the cult of the sun was decidedly different.

 

 

“Alabaster Good / Bronze Bad”

Had Marie Antoinette not met her destiny at the executioner’s blade, she might have gone to her dotage unsullied by wrinkles and age spots. Her skin had seen little if any sun exposure; alabaster colored skin was the norm for people of the aristocracy.

In fact, until the beginning of the last century, it was quite possible to distinguish members of the upper and lower classes solely by the color of their skin. Bronzed and wrinkled skin identified laborers, sailors, and toilers of the field – those who earned their living (and lived their lives) under the sun.

The aristocracy did not need to venture into the sunshine to earn a living. When they chose to do so – for sports, picnics, walks, or travel – they were able to afford the finest in clothing and accessories to keep the UVA and UVB at bay. Women wore full length clothes including gloves and parasols. Some even went as far as to put lead-based cosmetics on their skin to artificially whiten their skin tone.

 

An Historical Downside to Fashion Fads

As one might expect, the change in attitude about sun exposure came about via the fashion world.

In the 1920’s, Coco Chanel, the influential Parisian designer, returned from her vacation in the South of France with a golden glow (actually the left-over results of inadvertent sunburn.) That single suntan turned bronze skin into a fashion craze on par with her quilted purses.

One would hope that if Mademoiselle C were alive today, she’d turn her nose up at the thought of exposing her precious epidermis, and more importantly, her dermis, to the wrinkle-causing, cancer-spawning sun (or its not-any-better-no-matter-how-much-you-kid-yourself cousin, the tanning bed). Hopefully, she would get her browner skin in a newfangled way — by bottle, booth or airbrush…and make sure to slather herself with effective sun protection every time she ventured out of doors.

For there is a price to pay.

Scientific Evidence of Sun Damage Effects  

Because the destructive power of the sun on skin is cumulative over decades, studies on the effectiveness of sun protection take many years to complete. Long term placebo controlled studies do not exist but there is more than enough data to show the benefit of limiting sun exposure is real. Historical data linking cumulative sun exposure to delayed deleterious effects abounds. (Similar historical data first incriminated the now non-disputed damaging and lethal effects of tobacco smoke.) Evidence for the real and theoretical benefits of reducing sun exposure is accumulating rapidly.

Young et al provide evidence in their 2007 Journal of Investigative Dermatology article entitled: The Detrimental Effects of Daily Sub-Erythemal Exposure on Human Skin In Vivo Can Be Prevented by a Daily-Care Broad-Spectrum Sunscreen.

Using sophisticated markers of cell injury, cell recovery, and genetic up and down regulation, their conclusion was: “daily sub-erythemal sun exposure in skin … results in clinical, cellular, and molecular damage. Much of this damage, and in some cases all of it, can be inhibited by a low sun protection factor sunscreen that may be effective in the prevention of long-term photodamage, including skin cancer.”

The moral of this story is simple and absolute     …   “whenever exposed to the sun, wear protection.”

There is simply no other preventative measure that can compare in protecting skin from aging.

Moisturizing

It’s amazing. Google search for images of “skin moisturizing” and you’ll see hundreds of thousands of hits, nearly every one of them a photo of a product for sale or the the unwrinkled flawless skin of some teenaged or twenty-something young woman. Not a furrowed brow or wrinkled cheek to be seen. (See, it’s true, beauty sells.) So what about moisturizing? Is it helpful? Is it advisable? The answer to both is “yes”.

With aging, old skin cells from the stratum corneum exfoliate at a slower pace, and replacement from deeper epidermal layers is delayed. At the same time, the cell to cell adhesion of youth is reduced which allows increased loss of moisture from deeper skin layers.

Moisturizer is helpful with benefits from both the aqueous and lipid components. The aqueous phase directly contributes to improved hydration of deeper layers while the lipid phase contributes to the intercellular lipid matrix of the stratum corneum and provides an additional “top layer” hydrophobic barrier, helping to keep moisture in the skin. Improved moisturization improves skin turgor, tone, and suppleness. The lipid surface also reduces skin friction, flakiness, and scaling.

 Cleansers

Skin cleansers may be an important adjunct to the regimen of those who use cosmetics, have sensitive or compromised skin, or utilize topical therapies. Cleansers emulsify dirt, oil and microorganisms on the skin surface so that they can be easily removed. During cleansing, there is a complex interaction between the cleanser, the moisture skin barrier, and skin pH.

Cleansing, with water, soap or a liquid cleanser, will affect the moisture skin barrier. Soap will bring about the greatest changes to the barrier and increase skin pH. Liquid facial cleansers are gentler, effecting less disruption of the barrier, with minimal change to skin pH, and can provide people with a cleanser that is a combination of surfactant classes, moisturizers and acidic pH in order to minimize disruption to the skin barrier.

The choice of facial cleanser is important for people with normal skin, as well as for those people with sensitive skin and skin diseases such as atopic dermatitis and acne vulgaris. Within the liquid cleanser category, the least irritating cleanser will contain non-ionic/silicone-based surfactants combined with moisturizers, as they will cause the least disruption to the moisture skin barrier and the normal skin flora.

For many people, particularly men who seldom use cosmetic products, plain water can provide adequate cleaning for simple day to day skin care. The more exposure to particulate, organic, and toxic substances one has, the more important skin cleansing becomes and the less likely water will be sufficient.

Skin Care from the Inside Out 

During the course of aging, both skin function and appearance are affected. Changes in appearance are the most visible signs of aging and include wrinkles, irregular pigmentation, sagging, atrophy, elastosis, and telangiectasia. It has been shown that appearance is an indicator of overall health status, and “looking old for one’s age” is associated with increased risk of mortality.

All organs are impacted by nutritional status and the skin is no different. In 2007, Cosgrove et al published an article entitled: Dietary nutrient intakes and skin-aging appearance among middle-aged American women in the American Journal of Clinical Nutrition. Their finding were informative.

The study focused on wrinkled appearance, senile dryness, and skin atrophy (independent of factors known to affect skin aging) in 4025 women between the ages of 40 and 74.

Higher vitamin C intakes were associated with a lower likelihood of a wrinkled appearance and senile dryness. Higher linoleic acid intakes were associated with a lower likelihood of senile dryness and skin atrophy. Increase in fat and carbohydrate intakes increased the likelihood of a wrinkled appearance and skin atrophy. These associations were independent of age, race, education, sunlight exposure, income, menopausal status, body mass index, supplement use, physical activity, and energy intake.

Coming Soon

BFT will continue its series on the skin and skin care by examining classes of ingredients used in skin care products and reviewing the scientific literature, or lack thereof, that supports that use.

As always, stay tuned and invite your friends and loved ones to join the BFT family.

21 Comments

  1. Kelsey says:

    What brands of moisturizers do you recommend?

    • drjohn says:

      That depends on your skin type, climate where you live, and any issues you may have with your skin. If you have dry skin you may want to look at moisturizers with shea butter, which has excellent penetrating oils. For oily skin you may want to shy away from oils and think about hyaluronic acid as your principal moisturizing ingredient (it has very marked water retention capabilities). For medium skin, something in the middle – you need to experiment. The key is to avoid anything that will break down the skin’s barrier function, which dryness alone will do, but dryness plus harsh chemicals and other nasties will do more quickly. We are fond of ceramides for repair and maintenance (not plant phytocermaides which cause problems, but “pseudoceramides” which are bioidentical to the human version). Look for ceramide 2 or 3 on the label.

      • Kay says:

        Hi, Dr. John, just came across your site today looking up Renovage and very informative.

        I had read that HA, since it is a humectant, is best used when humidity is above 65 or 70% so it pulls moisture from the air, otherwise it will pull moisture from the skin layers and dehydrate.

        What are your thoughts on this?

        • drjohn says:

          That theory assumes a diffusion constant gradient of water between air and skin. And it assumes that water drawn from the atmosphere is somehow going to be transported into skin. But the function of most moisturizers is to trap moisture against loss to the outside, not to drag it in from the atmosphere. Unless you get 100% HA, it will be diluted with (attached) water.

          Skin is a complex membrane system, with number of different mechanisms contributing to the barrier effect. We now know that the epidermis itself (not just deeper dermal layers) contains HA. When the barrier is beached skin quickly tries to replace the HA by making more. It is the most physiologic of topical barrier enhancers. We like it for that reason.

          • Kay says:

            Thanks for reply. There’s been times I’ve put on a HA serum and my skin looks worse the next day, I assume it was low humidity.

            I’ve read that sodium hyaluronate is the salt part of HA and is a superior ingredient to HA as it can penetrate deeper and I’ve also read SH is the one and the same as HA, just a different name. Can you tell me is there a diffference?

            On that same note, salt does attract water, through osmosis. We salt cucumber and beef to pull water to the surface.

          • drjohn says:

            As a weak acid, hyaluronate needs to be combined with a weak base to form a salt in order to be stable. True of lots of things you put on your skin. But that is not like NaCl (table salt). Because HA itself is such a huge molecule, it takes very little sodium to make it a salt. So, don’t worry about the salt designation. Now, because it is so big a molecule, intact HA molecules will not penetrate the skin’s outer barrier. Think of it a forming a film on top of your skin to trap moisture.

    • drjohn says:

      We are fond of hyaluronic acid as a natural moisturizer. Usually with a variety of physiologic oils.

  2. Antoinette Crowne says:

    Dear dr. John,

    I just happened on some of your articles, and I love the candid honest approach to skin care that you seem to advocate. I have a very small and very young on line skincare business that was initiated after years of personal use of the two product lines I sell out of France. I particularly love the ingredients in my anti aging serum which addresses many preventative issues but mostly inflammation. I would love for you to take a look and let me know if I can forward you a couple of products to experiment and review in your to the point honest style.

    Thank you

  3. alesia garafola says:

    can you advise what you recommend for discoloration? I am 47 and after i had my child at 40 i have a horrible mask that i have used everything to minimize, i would like to zero in on ONE product that actually really works!!!! please help!!!!!

  4. Melissa says:

    Can you recommend a good cream for dark circles under the eyes? I have tried so many and none work. I understand dark circles are also hereditary. I am of South Pacific Islander ethnicity. Thanks so much!!

    • drjohn says:

      Hi Melissa. You would need to tell us what didn’t work. We tend to get folks to try simple and inexpensive solutions first, then if they fail with that go on to more advanced (and more expensive) solutions. Total Effects Dark Circle Minimizing Cream from Olay costs under $20. The next level up might be a retinoid containing cream. The top of the list is an anti-melangenetic growth factor product. You should also make sure you deal with related issues like puffiness/bags, hollows (loss of volume), and allergies (hay fever is the most common culprit in this category).

  5. Pam says:

    Dr, John,
    I’m 62, fair skinned and my under eye area is troubling me. After reading your last reply to Melissa, I think I realized my dark circles are due to loss of volume more than anything else. (I’d always thought it was something else, but my skin is fairly thin underneath, and crepey.) I do have puffiness in the am which creates another issue for disguising.

    My questions:
    Are your Anteage products formulated to be used around the eyes – specifically under the entire eye area and on the upper lids?
    Do your products improve sagging?
    I’m a former smoker with lines around my mouth. Do your products help smooth these types of lines?

    Thank you.

    • drjohn says:

      Pam, we are scheduled to do an update of stem cells and growth factors in anti-aging skin care products (our field of research – upon which all our products are based). Watch our front page for news.

      Dark circles reflect many aspects of aging skin, including fluid retention cycles (from repeated packing and unpacking of bags until they wear out), hydration issues, breakdown of skin protective barrier from natural tearing, trauma from rubbing, allergies, and the vulnerability of that region to hollowing with age related volume loss. A really effective anti-aging system does several things. First – it must aid in skin regeneration by promoting breakdown of old, gnarly, rigidly cross linked collagen bundles while simultaneously promoting the building of new, fresh, nice stretchy cross linked new collagen bundles. Just doing one of these is of not help. And these have to be tightly coordinated. Second – it must provide nutrients as building blocks for the fresh, new tissues. Third – this only happens if there is the right environment – that is to say NO INFLAMMATION. because inflammation is how we got those lines, wrinkles, bags, discolorations, bumps, flakes etc. in the first place. Why repeat that – might just make it worse. Fourth it needs to prevent further damage. Keep a good skin barrier for moisture. protect against sun, maybe some DNA repair at night for the rays that get through. Any product that accomplishes all this will help with all visible signs of aging including those you mentioned.

  6. Ucci says:

    Dear Dr John,
    I am 26 with very fair skin and I’m already starting to get wrinkles on my forehead and around my eyes. Apart from sunscreen, which apply everyday, is there any product that I should be using, maybe at night, to contrast the signs of aging? Thank you in advance!

  7. Kim Dobie says:

    A few months ago I had IPL therapy done (in BC, Canada) and unfortunately it didn’t go well. Long story short, I ended up with a skin infection and uncontrollable inflammation. Now that my skin has finally started to recover I am noticing a leathery/orange peel texture and worsening rosecea. I’m 31 years old and currently taking oral low dose doxycycline, topical Rosiver cream (ivermectin) and pro derm regenerating cream. Is there anything else I could be doing for the unusual skin texture changes? It has been a tough couple of months and any information would be helpful as I’m worried for the future of my skin.

    Many Thanks,
    Kim

    • drgeorge says:

      So sorry to hear of your plight following IPL. During a lecture a couple years ago about the pitfalls of energy based skin treatments, an attorney said that IPL is the greatest cause of lawsuits. Certainly, it has proven benefits but the person administering the treatment must be cautious to control the energy appropriately for the skin type being treated and err on the side of caution always.

      Horn tooting time again: you may want to consider trying products with recognized efficacy in tamping down inflammation, such as the ones we produce which contain the hero ingredient bone marrow mesenchymal stem cell conditioned media. Why these cells? They are in control of healing and regeneration in all humans (they migrate from the bone marrow into the blood where they access all tissues.) We have seen countless examples of inflammation being reduced, including many users who have had particularly good results managing rosacea. Drgeorge was the first person to try the product almost six years ago and has not had a recurrence of his rosacea since, despite discontinuing Metrogel, oral doxycycline, and topical steroids. The key is reducing inflammation naturally, something other cell-derived products based on fibroblasts, fat stem cells, and umbilical stem cells cannot do – that’s just not the physiologic role those cells play.

      If interested in trying our products, contact us. We offer all BFT readers a discount and everything is fully guaranteed.

  8. Diya says:

    Hi Drs. I am regular reader of your blog. I feel compelled to write to you guys, mainly because there is so much unregulated fad skincare on the market and there are so few products that actually deliver results. I am in my mid 30s and have been using the Ante Age serum for about 7 months now with really exceptional results. My skincare has always been very basic, I use a strong acid exfoliator (Biologique Recherche) and a Vitamin C serum. About 7 months ago I added the Ante Age serum to my regimen. While the acid and vitamin c kept my skin well exfoliated and light on the pigments, I still had visible lines on my forehead and sides of the mouth, for which I used to get botox. In the 7 months that I have used Ante Age, I have to say that THE singular most promising result has been a dramatic reduction in my fine lines, to the point that I have not had botox in over a year. I am thrilled that I read the blog and finally committed to adding this product to my daily skincare. Thank you for developing a product that really works and still keeps my skincare regimen simple.

    • drgeorge says:

      Hello, Diya.

      Now, that’s the kind of comment we love reading. Thank you for taking the time to write to us.

      Drjohn & Drgeorge

  9. Patty says:

    Hi Dr John-more great “facts and truth” instead of hype. When I read Pam’s comment about dark circles being a “loss of volume”, that hit the nail on the head!!
    I have idiopathic chronic urticaria that I take cyclosporine for (inhibits immune response)-/could this be the culprit?
    Thx

    Are there products that would help- like peptides

    • drjohn says:

      Yes, but the urticaria also causes blood vessel and lymphatic instability. I would go for a GF-based product that is also anti-inflammatory. It can contain VEGF (vascular GF) but should also contain IL-10 and/or TGF-beta 3.

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