Cleansers
Cleansers are the first step toward healthy skin. Unfortunately, most individuals are accustomed to harsh, drying soaps that are counterproductive to
good skin care, especially for the
post-resurfaced skin. Traditional soaps are alkaline by nature and strip essential oils and protective lipids from the skin, leaving it dry and raw. The “antibacterial” soaps may be safely used on the body but are too astringent and alkaline on the more sensitive
facial skin and furthermore unnecessary for proper cleaning. Abrasive components, like pumice, only serve to irritate the skin and may exacerbate conditions such as acne or otherwise sensitive skin. Unlike conventional soaps (pH 8-9), cleansers are pH balanced to the skin (pH 5.5) and maintain the acid mantle, which is particularly critical for oilier skin types. Alkaline soaps will excessively remove oil and stimulate increased oil production, leaving the skin even oilier.
Cleansers may be divided into two principal types: creamy and foaming. The former type is particularly suited for dry skin, as it maintains greater moisture than the foaming type. Creamy
cleansers work well with the
post-resurfaced skin or in older patients who tend to have more desiccated skin. In addition, creamy
cleansers are better at removal of
cosmetics than foaming
cleansers. However, foaming
cleansers offer the patient the visual appeal of lather like traditional soap products and may more effectively clean oilier skin than cream-based cleansers are capable.
Cleansers should really only be used once to twice daily. After the face is rinsed, a washcloth may be used to pat dry the skin. If the skin should require additional cleansing during the day, water alone will suffice unless an unusual amount of dirt or debris is accumulated.
Toners
Toners are designed to balance the pH (if an alkaline cleanser is used) and remove any residual debris (e.g., lingering
make-up) after use of a
cleanser.
Toners that contain salicylic acid may benefit the
acne-prone skin but may at times promote
acne flare-up. However, quality, pH-balanced
cleansers have effectively made
toners in most cases superfluous. If a toner is used, one should avoid a product that contains alcohol or acetone, both of which are detrimental to the skin due to the caustic nature of these agents.
Moisturizers After any kind of
cleansing (and/or
toning) of the
skin, no matter how gentle, the skin is left somewhat dehydrated and requires effective
moisturization. Even
oily skin that appears to need no
moisturization benefits from a good
moisturizer. In fact, a
moisturizer will assist in keeping the oil production in check, especially after a
cleanser has stripped some of the native oils away.
In general,
moisturizers may be either water- or oil-based. The former is better for
acne-prone or oily skin, whereas the latter is better designed for
drier skin types. Combination skin (oily skin distributed along the central T zone of the face) should be treated with a water-based product. However, during the winter months when the air may be quite dry, then a water-based product may be used in combination with an oil-based product for areas that remain dry despite water-based
moisturization.
A
moisturizer should be used once in the morning and once at night. The morning
moisturizer may contain an
SPF (
Sun Protection Factor), which is a critical element to healthy skin. The lip should also be protected with a moisturizing balm that contains an effective
SPF. Prolonged, direct sun exposure, particularly between 10 am and 4 pm during the height of direct rays, should be avoided as much as possible. Sun protection may consist of a physical blocking agent, e.g.,
titanium dioxide or
zinc oxide, or a chemical block, e.g.,
octyl methoxycinnamate. A combination of a physical and a chemical block will work together synergistically to achieve the best protection, while minimizing the chemical load that would be imparted by a pure chemical blocking agent. Generally speaking, an
SPF 30 is optimal for indirect, daily sun exposure with only a nominal gain with higher
SPF strengths. Beyond an
SPF 30, the
face may have a reaction to the product if used on a daily basis. Conversely, the body can tolerate much higher chemical and physical blocks than can the face. All patients that have undergone
interventional skin resurfacing should avoid any product with a chemical block for the first 30 days to reduce the likelihood of irritation and
dermatitis.
A different
moisturizer should be used at night that contains no
SPF but instead has a higher lipid content, which acts to nourish and replenish the skin. The skin undergoes its maximal replenishment during the nighttime hours of rest, and therefore nightly
moisturization with proper lipid-based ingredients is critical to ensuring
healthy skin. As part of any
moisturizing program, the patient should drink plenty of water during the day. Water spray mists to the face add little benefit but may instead dry the skin further when evaporated.
In addition to a strict
daily regimen of skin care, certain topical agents may serve a medicinal purpose to
rejuvenate aging skin. The two types that will be discussed are
alpha hydroxy acids and
vitamin A derivatives.
Alpha hydroxy acids
Alpha hydroxy acids (AHA) are
antioxidants that also act to reduce the signs of
aging by gently peeling the outer part of the
epidermis.
Glycolic acid is a type of
AHA derived from sugarcane, whereas lactic acid represents another
AHA, which is a constituent of milk.
AHAs may come packaged in high-end
moisturizers or
anti-aging creams, or alternatively as a separate product. Usually 8-12%
AHA may act as an effective exfoliant and may be used up to twice daily after
cleansing and before application of a
moisturizer. Higher strengths of
AHAs exist (70%) that act as a
physician-strength chemical peel, which violates the full expanse of the
epidermis. However,
TCA peels may offer the physician more control and efficacy than these higher potency
AHA solutions.
AHAs are particularly useful for the
younger face, which exhibits early
signs of aging, or may be used as an alternative to the more irritating
vitamin-A derivatives, e.g.,
tretinoin (
Retin-A,
Renova). Alternatively,
AHAs may be used for a couple of months, as a transition before engaging in a full program of
tretinoin in order to prime the skin and minimize unwanted irritation.
Vitamin-A Derivatives
Tretinoin, which is a
vitamin-A derivative, comes in different forms, e.g.,
Retin-A,
Retin-A Micro, and
Renova. The effect that these agents have on ridding the face of the stigmata of
aging is much more pronounced than that of
AHAs. However,
tretinoin products are quite harsh and drying on most types of skin. Actually, some red irritation is desired as an endpoint, which signals that the skin is responding appropriately to the product.
Retin-A comes in different strengths (0.025%, 0.05%, 0.1%) with the latter two concentrations more suited to facial rejuvenation as well as different formulations (cream and gel) with the former better for
facial rejuvenation and the latter appropriate for oily,
acne-prone skin.
Retin-A Micro reportedly offers a more sustained release of the active ingredient over the 24-hour period and may be used instead.
Renova has had great success as an alternative to
Retin-A and has been considered less irritating to the skin, as the creamier base relieves the drying effect engendered by the medicine.
The method of application is as critical to success as compliance and may considerably influence the level of compliance if done properly. We recommend that patients start slowly on
tretinoin-based products, perhaps every third day and advancing to every other day and finally to every day as the skin tolerates it.
Retin-A or
Renova is applied only at night after the face is gently cleansed. At least 10 minutes (preferably 30 minutes) are allowed to transpire before application of the medicine because a moist skin may accelerate the absorption leading to undesired sensitivity. Only a pea size of the cream is placed on the index finger and equally distributed at four points on the face: the central forehead, each cheek, and the chin. Then this modest aliquot is spread evenly over those four quadrants. A night
moisturizer may then be immediately applied. It is very important that you remain out of direct sunlight during use of the product, as it causes photosensitivity. Therefore, a good
sunblock should always be used in conjunction with
Retin-A or
Renova. Also, you will only observe the benefit of the medicine after several weeks to months of consistent usage. Unfortunately, the beneficial effects may be erased if the product is discontinued. Rather than using the harsher medicinal products like
Retin-A, gentler
retinol-containing products can be used that impart less
skin irritation and dryness.
For more information about the
medical-grade skin care products that Dr. Lam offers, please stop by the office at your convenience.
are discussed in the separate 
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