Exfoliants are meant to help remove the accumulation of superficial skin cells, keratin and sebum from the skin to treat and prevent acne and give the skin a ‘glow’ by revealing the skin hiding behind this layer. Read more...
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What is exfoliation?
When I discuss exfoliants I find it best to first to take a step back and understand what an exfoliant actually is to better understand the different types and the role they can play in your skin care routine.
Our skin is dynamic- it is constantly renewing itself. During this renewal process, ‘dead skin cells’, sebum or oil, and keratin, a protein from our skin, are accumulating at the surface. These naturally will shed or exfoliate on their own. However, it has been shown that sometimes they will linger and sometimes accumulate in our pores or on the surface of our skin. This can result in the potential for acne or just a ‘dull’ overall appearance of the skin.
Exfoliants are meant to help remove the accumulation of superficial skin cells, keratin and sebum from the skin to treat and prevent acne and give the skin a ‘glow’ by revealing the skin hiding behind this layer.
How do chemical exfoliants work?
Chemical exfoliants are products that use ingredients such as alpha hydroxy acids, beta hydroxy acids, or enzymes to dissolve the fats or lipids in the superficial layers of skin to help shed these cells and the by-products of these cells such as keratin and sebum or oil.
Alpha hydroxy acids such as glycolic acid, citric acid, and lactic acid break apart superficial skin cells by breaking apart the adhesions that hold them together. They are found in higher concentrations in chemical peels meant to treat acne, discoloration, and aging. In lower concentrations, they will often be seen in cleansers and topicals. These can be a bit aggressive depending on the concentration of a product.
Beta hydroxy acids such as salicylic acid are milder than alpha hydroxy acids but work in a similar way. Salicylic acid is a common ingredient in acne washes and spot treatments. It can also be found in moisturizers or creams for psoriasis to help shed or peel excess flaking or dryness of the skin.
Enzymes are even milder and are essentially fruit extracts such as papaya that are known to help exfoliate but not too aggressively. I often apply these after microdermabrasion to further assist in exfoliation afterward but are not too effective alone. If you have very sensitive skin, however, this is a wonderful option to play with.
Chemical exfoliants come in a number of varying strengths. I find it best to start with an enzyme exfoliant or beta hydroxy acid such as salicylic acid and then increase the strength gradually as your skin can tolerate the alpha hydroxy acids. The plant-based enzyme exfoliants work well and are relatively mild.
If your underlying concern is acne, then consider beta hydroxy acid-based exfoliants since these tend to be well tolerated. Be careful to avoid using too many different versions of exfoliants at the same time. I often find my acne patients are using a salicylic acid cleanser, a retinoid, and a scrub all at the same time. They are wondering why their skin is so red, raw, and sensitive all the time. I even find at some point people are more bothered by the redness than the acne itself! Looking at a regimen like this, there are 2 chemical exfoliants and a physical exfoliant being used simultaneously. Some people need this and some people can tolerate it. Not everyone can get away with a combo like this!
Look at your products, the ingredients, and the claims. If there are too many products focused on exfoliation as their primary mechanism of action, it is worth substituting one for an acne product that treats acne with a different approach to get the best results. Examples of these include anti-inflammatory topicals that have anti-acne properties such as rosewater-based products, azelaic acid (this is not an alpha hydroxy or beta hydroxy acid, it’s a dicarboxylic acid. It has antibacterial and anti-inflammatory properties. Its made by a natural yeast on our skin), topical antibiotics or oral medications with the help of your dermatologist.
What about exfoliating gloves and towels?
Physical exfoliants are products that work by manually removing the excess by the abrasive or gritty quality. This can be through the addition of granules, sugar, seeds, or nutshells to a cleanser or devices such as loofahs or brushes. The goal is to help shed or remove the buildup on our skin directly.
I realize there are a lot of devices, exfoliating gloves, loofahs, and skin brushes on the market I’m not a fan of tools. The amount of bacteria that have been shown to build up in loofah sponges alone in studies is enough proof that these may not be a great idea- unless you are meticulous about constantly cleaning these in a bleach solution. I have had cases where patients have been so aggressive with facial scrubbing brushes and mechanical devices that they actually developed impetigo (an infection with staph bacteria) as a result. To get a simple wash, just use your hands. After all, once you have soap and water on them- they are clean! If you would like to use a gentle exfoliative then stick with ones that wash down the drain and are not reused. Sugar scrubs, apricot scrubs, etc. all work well for this purpose.
Loofahs have been shown to grow Pseudomonas, Klebsiella, Enterococcus, Staphylococcus, and more!! If you couple the fact that the bacteria are trapped in the fibers of the loofah and that these sponges are used to exfoliate the skin, the risk of infection is much higher.
Towels are considered to be a ‘fomite’ that can transmit disease as well. Not only can they hold bacteria, but viruses are also known to be transmitted by contact as well. Molluscum is a type of virus that can cause small papules on the skin and last for over a year in some cases. It is spread amongst families and has been linked to shared towel use in some cases.
Our hands can be easily cleaned! I recommend avoiding devices for our skin as the ability to effectively clean these after each use is limited. If you are seeking some exfoliation that these can provide, try using scrubs that rinse down the drain. Sugar scrubs, apricot scrubs, or any kind of gritty cleanser can achieve the same results. The benefit is that these are not reused as they rinse down the drain!
Is shaving a good solution for getting smoother body skin?
Shaving for the purpose of smoother body skin is the basis of Dermaplaning. Dermaplaning involves using a blade to remove peach fuzz and superficially exfoliate the skin. The result is smoother-appearing skin especially when light reflects off the skin given the fact that there is less build-up of hair and dead skin on the surface. It is as safe as routine shaving.
Which ingredients should be in your moisturizer?
Hyaluronic acid tops the list of ingredients because it is very effective at drawing moisture to it. It’s a little confusing to some people because they worry that it might be irritating because of the word ‘acid’. It is also a bit misleading because many people think that Hyaluronic acid ON the skin will provide the same effect as injected INto the skin as we do with fillers. This is not the case. Hyaluronic acid applied on the skin does not fill the skin. It actually draws moisture to it and hydrates the skin at the surface so effectively it can give the appearance of minimizing fine lines and wrinkles. In spite of these common misconceptions, it’s a wonderful dry skin product. It is ideally used in conjunction with a moisturizer on top of it. The main reason for this is that if the skin is excessively dry, the Hyaluronic acid will still ‘seek’ moisture to pull into it. It may paradoxically dry your skin further if it doesn’t find it!! Remember to apply a moisturizer on top so it can pull this extra hydration in from the product. Glycerin is in tons of products for dry skin! It’s a wonderful product that, similar to Hyaluronic acid, absorbs moisture like a sponge. These types of products are called humectants- they literally attract moisture into the skin. Glycerin is lightweight, mild, and very effective at keeping the skin hydrated. Before the ‘product explosion’ of countless options to try these days, I used to recommend just buying glycerin and mixing it with a regular moisturizer to help the product spread easier, hydrate, and not leave the skin feeling too greasy. You can still do that and save a lot of money:)
Panthenol is another humectant that makes it ideal as a serum for dry skin as it attracts moisture as well. This one is also found commonly in hair products designed to trap moisture and protect the hair follicles.
Niacinamide is also known as vitamin B3. Although this can hydrate the skin as well, most of its reputation is built on its anti-inflammatory effects. It’s been used as an add-on for acne treatments for years to reduce the redness and inflammation associated with breakouts. For dry skin, most people will start with what appears to be ashy and dry skin. If this lingers too long without being addressed, those dry cracked areas of the skin can become inflamed and exquisitely sensitive (think of those times when you apply hand sanitizer and your skin just feels like it’s on fire!) With this concept, I always go back to the analogy of giving my patients- think of your skin as not smooth like a wall, it’s more like a cobblestone street. When your skin dries out it’s as though the mortar that holds the bricks (your skin cells) together is breaking down. This leaves it open to any insult from the environment which will inflame and irritate your skin. Think of niacinamide as a key anti-inflammatory that will help bring down this inflammation while also hydrating your skin! Botanical water/oil are very common ingredients to find in serums. It is always nice to look for ingredients such as Argan oil that can hydrate the skin without clogging your pores. These alone are wonderful. However, when I look through products in large cosmetic stores I’ll often find these ingredients with anti-aging serums. If you are treating dry skin, please look at the labels! Avoid buzzwords like ageless, age-defying, anti-aging- these will often have added alpha hydroxy acids that may irritate dry skin.
Vitamin E is lightweight, effective, and very very affordable! It is a cost-efficient way to deliver safe and easy moisture to your skin without leaving you feeling too greasy!
What about dry feet—should you use certain creams/lotions to keep them smooth?
Dry feet that result in thickened heels and calluses are challenging conditions. When the skin thickens and dries it can start to “crack” like pavement on a sidewalk and becomes sensitive or sore. Scrubbing this is not effective as it recurs rapidly. Moisturizers containing keratolytic, ingredients meant to chemically exfoliate the skin, are most helpful. Look for ingredients such as salicylic acid or urea in your products.
Research shows that skin hydration levels start to decline in the mid-afternoon and continue into the evening—can you share why this might be?
This is likely due to a combination of internal and external factors. Internal hormonal fluctuations throughout the day such as steroids released by our adrenal glands, vasopressin, and sex hormones such as estrogen and testosterone can impact skin hydration levels. Environmental stresses, sweating as well as climate can also impact skin hydration.