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Skin Care Routines | Understanding the Basics

Updated: Mar 31

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Photo credit: Techei



What exactly is a skincare routine?



The answer is not as simple as you think.



This is a question I have spent the past 20 years as a Dermatologist trying to find a uniform answer for and here is what I have decided the answer is:




A skincare routine can be defined as skin care steps and/or skin care products used with some level of consistency that serves the purpose of maintaining and protecting your skin and potentially addressing particular skin challenges, concerns, or needs.


Most people think the answer is simple because we have had so much marketing thrown at us giving us a general sense that a skin care routine is something we are just supposed to be doing with our skin. After 20 years and having evaluated the skin of over 100,000 patients of every age from premature infants through >100 years of age, I had to reflect on the reality of the wide range of “routines”, outcomes of these routines, and the challenges my patients face in answering this question. There are skin care products made by so many different skincare brands - some focused on actually addressing particular skin concerns and others just focused on marketing buzz trying to capture the attention of Google and Social Media platforms. But do we actually need any of these products? The answer is likely no.










 


Let’s start with skincare basics: Is there anything I have to do with my skin routinely to care for it?



To really look closer at this question, defining skincare basics is one part and defining the word “routinely” is also important to address.


Skin care basics start right after birth. The basics include :

  1. Cleanse

  2. Protect

  3. Restore/Repair/Treat if needed

“Routinely” when it comes to skincare can be defined as consistently for maintenance. To further define routinely, frequency of skin care product use could be considered. However, the frequency of skin care product use can vary widely from person to person based on their particular skin needs and skin experience. It is important to avoid assumptions that frequencies such as daily, twice daily, or multiple times daily are “mandatory”. This just is not the case.







Cleansing skin care routines: Can you define the steps for cleansing and frequency needed routinely?



The word cleanses simply means to clean or remove impurities, dirt, and debris. In skin care, cleansing is assumed to mean with soap or other cleaning agents or skin care cleansing products. The reality is that this is not always necessary.



Water is effective at removing or cleaning superficial dirt and water soluble debris from the skin. Soap or cleansers are added in to remove oil soluble dirt and accumulations on the skin from sebum and natural oils as well as products we may use such as moisturizers, makeup, etc.



In terms of a routine, using water to clean the face can be achieved by splashing water on the face from the sink or simply allowing shower water to flush the facial skin with water. That qualifies. Setting aside time before and/or after the shower to wash the face again can overdo it.



Increasingly we have learned in the past couple of decades that even for babies washing too frequently and/or using cleansers too frequently will clean dirt and debris but, if used too often, will start to break down our skin’s natural barrier and predispose us to the risk of excessively dry skin called xerosis, and potentially eczema and risk of skin sensitivities.




 















 





 



If using skin care products and/or makeup, adding soap or cleanser to your routine can help reduce product buildup on the skin. Natural oils on our skin in addition to oil and sebum can start to accumulate as well. This requires soaps or cleansers as these tend to be oil soluble and water alone may not effectively remove them. That being said, every time you use water on your skin do not require soap or cleansers to be present. From a routine perspective, soaps or cleansers can be used daily if your skin can tolerate them, however, use every other day or every third day to the overall skin while still using water on a daily basis can reduce the chances of excess dryness. Targeted routine use of soaps or cleansers for areas of the skin that may need added attention include:


  • Areas of the skin with potential for product accumulation such as the face, underarms, and hands

  • Areas of skin based on product accumulation or a higher tendency to accumulate bacteria or yeast such as skin folds

  • Areas of the skin exposed to environmental dirt, debris, and/or pollution



To summarize, cleansing the skin involves:


  • Using water on a daily basis on the skin removes superficial dirt, and debris, and reduces the accumulation of microorganisms on the skin.

  • Using soaps or cleansers on a routine basis routine defined by your particular skin needs based on skin challenges or experiences with daily use of soaps or cleansers to targeted areas of concern based on product use, skin folds at higher risk for microbe accumulation, and environmental exposures.






Protecting skin care routines: Can you define the steps for protecting the skin and the frequency needed routinely?




Protecting the skin appears to be the step that is given the least attention but is likely the most important. When people talk about cleansing they are often thinking about skin needs but more often considering cultural norms and practices that define cleaning rituals. The goal often, obviously, is to avoid the impression of lacking cleanliness.


Understanding the function of the skin can help place the importance of protecting the skin into perspective. The skin is a complex organ that plays a number of roles. Although many think of it through just a cosmetic lens, the reality is that our skin is playing a number of vital functions in our overall well-being. When I counsel my patients on taking care of their skin, it’s not just about how it looks. Understanding the skin and its roles will help you understand why we need to care for it.


Only in the past couple of centuries has the skin really been understood to be a complex organ. Prior to that it was viewed as a tarp or container and often looked at as an affliction when something went wrong. Think of the plagues and how visual the descriptions of the skin were!

Advances in Dermatology have shown this to be far from the truth. We now know the skin serves an essential role to communicate between your body and the environment around you.




 




 



The skin serves many functions.
  1. Protection. The first role our skin plays is protecting our body from the environment. Think allergens, infectious agents such as bacteria, yeast, fungi, viruses, pollutants…

  2. Sensory organ. There are sensory receptors located in varying concentrations throughout our skin. These allow you to feel a pinprick, vibration, pressure… Your skin is in communication with your nervous system to convey these sensory messages.

  3. Climate control. By controlling the local flow of blood to your skin by constricting or dilating your blood vessels, your skin can help your body regulate its heat balance. If it is a little too hot, it even has the ability to produce sweat so this can evaporate and cool the skin further.

  4. Manufacturing. Your skin is busy producing Vitamin D for your body through its interaction with UV.

  5. Immune system. I often explain our skin as almost like having its own immune system that interacts with our internal immune system but in many ways has a role of its own. Interacting with pathogens and allergens it can play a role as your first line of defense.

  6. Excretion. Our skin can help get rid of wastes and toxins in the body.

  7. Fluid Balance. Through sweating, our skin can play a role in reducing our water load.


Think of your skin as not smooth like a wall but more like a brick wall of a cobblestone street. Caring for your skin the right way and recognizing the need to protect it will keep the mortar that holds your skin cells together intact and able to perform at its best.







To protect your skin consider the role of:
  • Moisturizers: If the environment you live in is dry or lacks moisture in the air, applying it on the surface through ingredients intended to moisturize or hydrate the skin can be effective.

  • Clothing: Most of our skin comes into contact with textiles at some point during the day or night. Choosing textiles that can supplement and protect your skin without aggravating or irritating it is important.

  • Humidifiers: If your environment does not offer moisture in the air, adding it to the air with humidifiers can also be helpful.

  • Water Temperature: Avoiding excessively hot water in contact with the skin can also benefit your skin by avoiding vasodilation, skin breakdown, and potential itching.

  • UV protection: Through sunscreen products and UV protective clothing, providing your skin with a protective barrier from environmental stresses will keep the DNA of your cells protected from damage and its consequences.


Restore/Repair/Treatment skincare routines: Can you define the steps for addressing particular skin challenges and the frequency needed routinely?



This is the step where marketing usually takes over and leaves people confused about which products to choose and how to integrate them into their routine.


To address this step, the most important thing to do first is to ask yourself this question:

“What bothers me about my skin?”
The answers could be :
  • Breakouts

  • Fine Lines

  • Pigmentation

  • Redness

  • Blotchiness

  • Broken blood vessels

  • Rough spots

  • Raised bumps

  • Deeper lines or wrinkles

  • Enlarged pores

  • Dry skin

  • Oily skin

  • Combination skin

  • Rough skin

Once you make a list of specifically targeted concerns, the next step is to choose ingredients that target these concerns. There may be overlap in some ingredients addressing several targeted concerns and avoiding redundancy in your products is helpful to avoid a routine that gets out of hand. In this category is the wide range of skincare products and skin care ingredients we see at beauty stores. I am often asked, “shouldn’t I be using a serum?” This is where we sit down to discuss your skin care goals so that this step in your skincare routine can be addressed appropriately.



There are so many products by so many brands. I find the process of choosing a product to be overwhelming. Should I just see a doctor to find out which skincare brand is right for me?

The answer to this is no and yes. And, in that order.

When you first approach the daunting challenge of finding a skincare brand and products to suit your needs, it is not a bad idea to start somewhere to get a better sense of:
  • How products work

  • Your skin's response

  • Your personal preferences

...and build from there.




Let's start with how products work. What should I start with and where should I find it?

Where to start with products is likely the drugstore or grocery store. The products that you will find here are simple, straightforward, affordable, and work well.

Brands to consider include:
  • Neutrogena

  • CeraVe

  • Oil of Olay

  • La Roche Posay

  • Cetaphil

  • Aveeno

Check out my list of products by these brands to try out!






If I just focus on expensive products, wouldn’t my skin look great?



Does this sound familiar?


“I bought [fill in blank with really expensive cream] and it didn’t even work!”


Magic does not come in a product with higher price tags. More often than not when it comes to skincare the higher price tags are based on packaging and marketing and not effectiveness.


Of course, there are always going to be exceptions but the reality is that the majority of people out there (myself included) do just fine with drugstore brands for the majority of their skincare routine. I would much rather that patients have a ‘go-to skincare routine’ that is affordable, consistent, and effective.


To bounce around from product to product or splurge on pricey basics will not be sustainable in the long run with disposables like skin care.


Start with the drugstore- look at your basic products for cleanser, moisturizer and sunscreen, and even anti-aging products. Start here. If that works and achieves your skincare goals- don’t change a thing. Sit back and re-evaluate what actually bothers you and if a product can realistically live up to your expectations.






Talk to your dermatologist about what products actually do so that you don’t waste your money. My favorite example of this is when people tell me they are using a vitamin C cream. In their minds, they are thinking they are using a ‘healthy’ cream because it’s vitamin C, and what’s healthier than that- right? The reality is that vitamin C creams have a particular niche in the skincare world and are not necessarily for everyone. This is really important to understand in light of an article I read once about a dermatologist that said she spent a ridiculous amount of money on her skincare routine monthly.




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