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Evaluating Your Routine

A General Guide to Cleansing and Caring for Your Body Post-Shower

Over the past few weeks, I have been testing some new ideas when it comes to body skincare. For most of us who love skincare, we invest oodles of money into our faces. From fancy washes to serums to exfoliators to creams, we carefully read every ingredient, study the texture of each serum, and examine our faces way too closely in the mirror each morning, looking for overnight improvements.

But most of us are not nearly as discerning about our body care. Sure, we might purchase the slightly more expensive body wash in cleanser aisle at Target or splurge on a fancy body butter from time to time, but for the most part, when it comes to our bodies, we don’t really care as much. We frequently abuse our body’s skin with hot showers we refuse to give up, soap it down with a fluffy loofah, towel off, and go on about our day.

In short, we don’t invest much time nor effort in the skin of our bodies until it itches, flakes, peels, scars, or bruises. Then we slather on some expensive miracle cream and hope it gets better overnight before we forget about it all over again.

Fortunately, caring for the body to achieve the best skin of your life is pretty easy, but it does require some sacrifices and changes be made, most of which begin right in the shower.


Stop Taking Hot Showers

I can hear the screaming now. I know, hot showers objectively feel great. They’re soothing and for many of us, a time to unwind and relax. Over the past month, I have transitioned the shower handle from as high as it will go, practically cooking me, to a bit more middling. I do not take cool showers or even lukewarm showers by any means, but I don’t take ones that leave me red anymore, either.

The reason for this is that hot showers strip the skin’s natural lipids much easier and quicker than cooler water and they make any cleansers that are used much more stripping by shrinking the size of the micelles produced by your cleanser, which allows for deeper penetration into the skin. This produces inflammation and dryness.

This is probably the toughest transition of them all, and I know, I know – you can pry my hot showers from my cold, dead hands. I get it. Thankfully, when you start to take cooler showers and begin taking care of your skin, hot showers feel hotter and a bit more unpleasant – almost like a burn. I don’t know why this is necessarily (perhaps a thinner layer of protective dead skin cells), but it has made the transition much easier for me.

Bonus: My hair is softer and my rosacea is less angry, too.


Put Down the Soap

The earliest recorded use of soap dates back to 2800 BC, in ancient Babylon. By the late 18th century, European and American companies began to promote the connection between cleanliness and health. As the use of soap became common and hygeine improved, the population of pathogenic microorganisms shrunk.

By 2018, most of us wash our clothes frequently, sleep in (relatively) clean sheets, wash our hands after using the bathroom (I hope), and have access to showering or bathing in clean water. Most people also do not interact with harsh chemicals or use products like bug spray often.

Because of the general cleanliness of most people’s lives and homes, it is unnecessary to use soap on your body with such high frequency. Our bodies have much fewer sebaceous glands (oil glands) than our faces or scalp and sweat is largely water-soluable (washes with water). As such, most of us do not need to use soap on our bodies (sans genital regions) every day.

I first began to explore this when I was watching one of Dr Dray’s vlogs where she admits to not using soap on her body and rants that the use of soap these days is largely beneficial to padding the pockets of companies that manufacture the products, such as Unilever or Bath and Body Works. Intrigued, I decided to nix soap (except for soaping my bottom, of course) and see what would happen.

In fact, I’ve used soap twice over my entire body in one month and both times were to remove sunscreen or other chemicals, like when I sprayed fungicide all over my tomato plants and the wind blew it back onto my body (ew). I do not smell any different (according to myself as well as people who are around me every day) nor do I feel any less clean than I did when I was using soap at each shower.

So the rule of thumb here: Soap is only needed for removing chemicals – such as bug sprays, sunscreens, or chemicals you may interact with at work (if you get them on your body) – or if you have a condition that requires cleansing, such as folliculitis or athlete’s foot.


When You Do Soap…

… use gentler soaps. Sodium lauryl sulfate is the enemy of healthy skin, particularly if you take hot showers, as it is one of the smaller molecular weight surfactants that can produce micelles that can penetrate the stratum corneum of the skin. Bar soaps (except for Dove body bars, which are synthetic soaps and not what is called “true soaps”) should also be ditched due to their high pH values that strip the skin and make it more difficult for the skin to readjust to it’s natural pH after showering.

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Some of the products in my shower

I picked up a bottle of CeraVe Hydrating Body Cleanser to experiment with, and it does indeed feel much less stripping than my usual liquid Dove and Olay. It is also not scented, which… while scented body products are nice, the scents don’t usually linger long after they’ve been washed away and the fragrance only serves to further irritate dried out skin.

If you can find a sulfate-free and fragrance-free body wash, this is ideal for use during the few times you need to use soap. Most health food stores contain such products.


Moisturize Immediately After Showering

You know those clickbait titles like, “The one simple trick that changed my skin forever,” usually followed by, “Doctor’s hate her”? This is my one simple trick that changed my skin forever.

Ever since I was a child, I’ve heard from every dermatologist (and allergist, surprisingly) that I’ve visited that I should be applying moisturizer directly out of the shower, onto wet skin. The reasoning for this is that water removes water, so when you towel off after a shower, that water ontop of your skin takes water in your skin with it. By applying a moisturizer directly onto wet skin, you’re not only sealing in this water that would otherwise be stripped, but you are also providing water for the humectants in the product (such as glycerin) to work best.

If you take nothing else away from this post, take this. It has completely changed my skin for the better. It’s soft, supple, and hydrated. It no longer looks dry or scaly, my KP is nowhere to be found, and even shaving feels less irritating.

Admittedly, moisturizing after a shower feels a bit odd. The first time I stepped out of the shower, armed with CeraVe Moisturizing Cream, I steeled for a strange and chilly experience. And it was, but then I got used to it, and my skin began to improve practically overnight. I started noticing other changes, too – my hyperpigmentation from old scars started to fade and when I shaved my legs for the first time since switching my routine around, not only were they perfectly smooth without that kind of patchy skin roughness that seems to follow even the best leg shaves, but they didn’t even burn.

See, I have very sensitive skin, and for me, shaving is a bit of a ritual since my skin can get very irritated. I would soak in a bath, slather on shaving cream (I use Cremo), wait a few minutes, and then shave with a fresh blade on a razor. Then I’d quickly dump my legs back into the water, where they’d tingle and burn slightly. When exiting the shower, I’d towel off and then race to put on a soothing cream, like Aveeno. Unsure if this was brought on by the addition of moisturizing post shower or the removal of soaping during the shower, I nixed my ritual of lotioning myself down for a week and shaved again. Immediately, my skin felt irritated and I had that weird roughness that is a combination of missed hairs and dry, dead skin. I added moisturizing back in, and sure enough, all was well again.

I have been asked if you can do this with lotions like AmLactin, which contain AHAs, without reducing the efficaciousness of the product, and so I tried it. Turns out that it does not reduce how effective the product is, an in fact, helps it to absorb quite a bit quicker in some instances. So never fear – moisturize away!

I also began to do this for my face and just started to apply actives (BP, AHAs, BHAs, Differin, etc) on top. As usual, I’d leave occlusives for last, but simply applying my HadaLabo Premium with some of my facial lotion (Cheryl Lee MD) really improved my skin’s texture, softness, and ability to heal quicker. I’m also happy to report that not only did it not reduce the effectiveness of my actives, it seemed to reduce how much my skin would get irritated by said actives if I had otherwise dried my face and waited to apply them before applying my moisturizers. This is not entirely surprising, as healthy skin is not only more efficient, but reducing water loss reduces the amount of irritation that can be caused in the skin by otherwise irritating products.

This tip also makes it easier to layer essences or hydrating toners, as in many Asian beauty routines, since the first layer sinks in relatively well due to the amount of water on the skin, allowing for more (and less sticky layers) to be applied on top.

Moisturizing after the shower can feel a bit slimey, so I recommend either dripping dry for a minute while applying your facial products or toweling off specific areas, like your back, the back of the knees, and stomach. From there, apply your cream of choice liberally all over. You may find you want to use less or more, depending on your tolerance for the sensation.

After moisturizing, I wrap myself up in a robe and walk around or read while “soaking in.”


Making it Into a Routine

I’ll admit: none of this feels super easy. Ditching hot showers was hard, nixing soap was strange at first, and moisturizing immediately after felt slimey. However, I am advocating all of these things because they work. There is a reason you hear all of these things again and again, and it isn’t to rob you of the joy of a hot shower or the scent of your body wash. It is because it is absolutely the best way to solve persistent dry skin, irritation, and vastly improve conditions like keratosis pilaris and eczema.

Here’s my routine:

  • Shower
    • Apply Clinique Take the Day Off Balm before jumping into shower. Get in, rinse off.
    • Wash hair, put in conditioner and do the rest of my routine
    • Shave
    • Cleanse my ahem bottom with soap on a sponge
    • Rinse out conditioner
  • Moisturize
    • Wrap hair in towel
    • Towel off eyes, lips, back of knees, and back.
    • Apply HadaLabo Premium Lotion all over face and neck
    • Wait a few seconds and apply a second layer of HadaLabo Premium, mixed with jojoba oil and moisturizer, if feeling extra dry. Apply any extra along neck and chest.
    • Apply AmLactin generously all over. If I’ve shaved my legs that shower, I apply CeraVe Moisturizing Cream to them as AmLactin immediately after shaving can burn my legs. Apply a second layer of AmLactin to my KP-prone arms and legs once I am done with the rest of my body.
    • Wrap up in a robe. Read a book or surf Reddit while moisturizers soak in.

And that is pretty much it. That routine alone has not only cut 5 minutes out of my showering time, but has also softened my skin all over, improved previously unpleasant experiences like shaving, and made my dry skin disappear.

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A Guide to Visiting a Dermatologist

Up until my twenties, I saw the same dermatologist that burned off warts from the back of my hand when I was a child. He was the same dermatologist that saw my mom and even my dad, on the rare occasions that he would visit a doctor at all, but when I was 20, I was in need of a skin-punch biopsy for a diagnosis of a rare disease. My dermatologist was incredibly busy and couldn’t see me for weeks, which wasn’t ideal when I needed to be able to go the same day that I was having flare-ups, which were unpredictable. So I got a referral from my rheumatologist for a dermatologist he know that would be able to see me the same day, and I was taken immediately on a day I was having a flare-up.

Being as I had seen the same dermatologist my whole life and had generally pretty good skin most of my life, I stared at the documents I had been given to fill out while in the waiting room. I filled out everything, stating I was there for a punch biopsy, and lingered on the last page. At the bottom was the question, “What else would you like to discuss with the doctor today?” I lingered for awhile before finally writing, “the acne on my forehead.”

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Closed comedones

Like a large number of people, I had had closed comedones on my forehead since I had hit puberty. While they didn’t particularly trouble me enough to drive me into a dermatologist office before, I figured I might as well get the most out of my co-pay and my infrequent dermatologist visits (prior to this visit, I had seen my family dermatologist about a skin tag in my eyelashes at some point when I was 15-17, and eczema/atopic dermatitis when I was 13).

During the visit, I told the doctor about my forehead acne without much detail, and hoped she would know exactly what to do. She looked at me and said, “Yep! A retinoid will clear that right up! I’m gonna write you a prescription for Ziana. Just use this once a day, at night, after you wash your face! Sound good?”

And it did. Fast-forward and I was 6 months deep into a break-out that never ended, with spots that had heads the size of pencil erasers. I had become a hermit, ashamed of my skin, and barely able to sleep on my sides from the pain.

Everywhere I looked online told me it was “just purging,” and it would get better with time, but it never did. I even cried in public at an Ulta while on the phone with my boyfriend, lamenting that my face was ruined forever and there was no end in sight. Of course, like everyone going through an acne breakout, I assumed it was every skin product except the prescription I had been given by a doctor to make my acne better. After all, a doctor helps you, and I trusted the knowledge and nature of a doctor to have my best interest in mind. I believe I called the office once to ask what I should do, and they assured me it would get better in time.

Unfortunately, it turns out that by the time I started to figure out what was actually happening, it was all way too late. To this day, I have light pitted scarring in places from the 8 month moderate-to-severe zit explosion on my face that never ceased. It has taught me a lot and pressed me to learn a lot about how skin actually functions, and that I probably should not have used that tretinoin once a day, that I have very sensitive skin that still struggles to tolerate tretinoin, and that I should not have remained with a doctor who I began to trust less and less.

From this experience, I went on to many others with doctors who made me cry (one looked at my face and said when I woke up “looking like that,” I shouldn’t be using anything on my face because everything was breaking me out) and who I just couldn’t talk to before arriving on a doctor who was wonderful, specializing in people with auto-immune conditions and skin conditions.

Sadly, my experience doesn’t seem to be entirely an uncommon phenomenon, and most people don’t know how to talk to their doctor (dermatologist or otherwise). Being as I’ve seen every type of doctor – from cardiologist to rheumatologist to dermatologist – and on a semi-regular basis (I see a rheumatologist every three months for tests/check-ups), I figured I would help anyone else who is in the same shoes I was in my early 20s navigate the waters a bit.


When to See a Dermatologist the First Time

Many times on Reddit, I see people posting things like:

  • “What is this?”
  • “What does this look like to you?”
  • “What is on my mouth? HELP!”
  • “I don’t know what to do anymore”
  • “I’ve tried everything and nothing works”
  • “What should I try next?”

If you’ve hit the point where you feel like you are at the end of your rope, tried everything, or just can’t identify that weird rash, it is time to see a doctor. I know it is not always in people’s financial reach (particularly those of us in the US…), but there are many resources now for prescription strength topicals and a doctor’s care that don’t even require leaving the house or having insurance (particularly Curology).

If any of the following statements seem to identify with you, it is time to see a doctor:

  • Is your acne leaving indented scars?
  • Does it interfere with your day to day life on a regular basis (such as not wanting to leave the house or avoiding friends)?
  • Does it seem to be linked to your periods or hormonal shifts?
  • Did it onset very suddenly, without routine changes?
  • Is it spreading? Any skin condition that seems to spread, especially if it spreads rapidly, requires professional medical treatment.
  • Have you tried every fancy skincare product, every spot treatment, and dumped hundreds or thousands into skincare with no results?

Picking a Doctor

The worst doctor I ever saw was one my insurance picked out for me while the best was one I picked out for myself.

The first thing I suggest is asking your friends for recommendations. If you’re a redditor, you may be able to ask your local city subreddit for recommendations as well (though this can be tough if you are in a less populated city). Typically, your friends will be honest with you about why they went and their experience, which is what you want.

From there, search for the doctor online. Yelp can be a toss-up for quality of reviews – some people will give restaurants fewer stars for having to ask for extra napkins, for example. You also aren’t receiving the whole picture on why that person went to the doctor in the first place, what their history is, what their skin is like, or what their concerns are. Because of this, I trust Yelp a little less, but it can still be a good place to get a general idea of what people tend to go to this doctor for the most.

You can also search through their Vitals and HealthGrades pages. This is how I found the dermatologist I fell in love with. These pages tend to have better (albeit fewer) reviews and more information. Make sure you look for the doctor’s specialties, if they have any. Many doctors will specialize in one or two things, such as acne, rosacea, or melanoma. Try to find one that specializes what you’re interested in talking about.

Finally, don’t forget their own page. Some doctors will have their own Instagrams. This can be a good way to get an idea of what most people see them for, and what they prefer to talk about or specialize in. Keep in mind that doctors are just like anyone else, and will post the things they feel the most positively about.

Once you’ve combed through the exhaustive list of resources online, narrow it down to the doctor you feel the most sure about, and set up an appointment.


Your First Visit

Before your first visit, as things occur to you throughout the day, write down everything you’d like to discuss onto two sheets. Frequently, we forget everything we want to talk about or feel anxious about asking a “stupid question.” When the doctor asks, “Is there anything else?” I’ll admit that I’ve said, “Oh, no, that’s it!” when in reality, I have a burning question that I am just too ashamed to ask. When your doctor comes into the room, after introductions, hand them one of the sheets of questions, and let them know that you’d like to discuss what is on the list. This way, you have your list of questions in front of you in case you get anxious or forgetful, and they have your questions in front of them so you cannot dodge out of a question from shame last minute.

Make sure you include any relevant details you can think of. Habits, previous records (such as allergy records, GI records, etc. – bring your other doctor’s information in case your dermatologist’s office needs to request documents be faxed over), family history (cancer, autoimmune, skin conditions), and a thorough history of your medications and supplements. This means prescription drugs (topical and oral) as well as supplements like fish oil, turmeric, cranberry pills, lysine, etc. Include dosage, frequency, and what you’re taking them for. Write your current routine down and what hasn’t worked and why (couldn’t use this product because it was too drying or made my skin burn, for example).

Take pictures of your skin in a well-lit condition on its worst days. This can be a huge help to your doctor when determining what the correct diagnosis is. Also, this helps to establish a pattern, which is crucial. Note what you were using or what changes may have taken place around the time of the photos.

Before they leave, make sure you ask how to apply the prescription topicals they recommend or if you should take any oral medications that are prescribed with or without food (and if you can take it with fruit juices like grapefruit juice, which causes issues for some oral medications). If you forget, ask your pharmacist! They are specialists in drug usage and interaction, potentially even more so than your doctor, and are required by law to ask if you have any questions about the medication.

Remember that you are paying to be there and the doctor wants to help answer your questions. After all, they went through years of medical school to help people.

Bullet pointed list for ease:

  • Write down all concerns onto two sheets. One for your doctor and one for you.
  • Write down habits.
  • Gather any relevant previous medical records (especially for any endocrine disorders, allergies, PCOS, or other hormonal conditions). If you no longer have the records (ex. diagnosis at a young age), then just make sure you note it and about at what age you were diagnosed.
  • Gather any other doctor’s information (name and phone number) in case your dermatologist needs documents faxed to their office.
  • Gather your family history on both sides (usually most doctors are just looking for direct relatives, like parents and siblings). Autoimmune, cancer, skin conditions, etc.
  • Write down all oral medications, dosage, frequency, and why you’re taking them.
  • Write down all supplements, dosage, and frequency.
  • Write down current routine.
  • Write down what you have tried and what hasn’t worked as well as why (skin sensitizing, burning, dryness, etc.)
  • Ask them how to use the topicals they prescribe.
  • Ask them if you should take any oral prescriptions with food and if it is safe to take with fruit juices, if you consume fruit or fruit juices, particularly grapefruit.

One last tip is to not wear makeup! They need to see your bare skin. Wearing sunscreen and moisturizer is fine, but make sure they can see your skin clearly.


Following Up

Follow up with your doctor frequently and if you have any concerns. Make the follow-up appointments in the office, while you’re there, and put the appointment in your phone calendar so you don’t forget. Take a card so you have their current phone number in case you have any questions.

Don’t be afraid or ashamed to follow-up, either. Perhaps the worst part of any skin condition is the shame aspect that is frequently attached. Many people with skin conditions report avoiding interactions with people, and feeling an extremely low sense of self-esteem. This can impact not only how we see ourselves in the mirror, but our inclination to be an advocate for ourselves.

If you’re feeling at all like your skin (or maybe not even your skin – something else that has happened to you) has severely impacted your life and your self-esteem, consider talking to a therapist.

While not specifically acne-related, I went through abuse in my childhood and trauma in my teen years. This left me with CPTSD (complex post-traumatic stress disorder), panic disorders, generalized anxiety, and a propensity to tunnel down into the deepest, darkest holes of depression. I had always known that seeing a therapist (and psychiatrist) would be good for me, but I didn’t even go to my first visit until I was 26. I was petrified of opening up to a stranger, having them “analyze” me, feeling like a specimen or a spectacle, and isolated.

My first visit to my therapist was maybe a little awkward because of that. I talked openly about my life, but I didn’t really dig deep into the things I felt were troubling me the most. I continued like this for maybe six months, seeing my doctor every other Friday, talking about life and getting his perspective on things I was dealing with in my day-to-day.

But then one session, I brought up some of the feelings that had been bothering me all week, and it just started to flow out of me like a broken dam. It was life-changing. I walked out exhausted from the tears, but feeling brave, safe, and honestly, not at all as “crazy” as I once perceived myself to be. Finally having a diagnosis for the mental pain I was suffering was possibly one of the most re-assuring and comforting experiences of my entire life, and allowed me to step away from the pain and see it more objectively.

Therapy isn’t cheap, and I understand that better than anyone, but it shouldn’t be something you are afraid of. If you want to try talking to a therapist, but you aren’t able to afford office visits (check with your insurance – some insurance providers will reimburse you the cost with a receipt + a reimbursement claims form) or feel too nervous to sit down with a doctor outside of your own comfort zone, there is online therapy. One of the ones I see recommended the most is betterhelp (though I have never used it myself).

Please, do not be afraid. It can change your life and liberate you in ways you may not have even thought possible.

 

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Evaluating Your Routine: Hydroxy Acids

When I was younger, I spent almost every waking moment browsing skincare communities. Most posts in those communities boils down to routine help, selfies, or general questions, but sometimes, skincare routines in popular media come up. One such routine was displayed in the film American Psycho with Christian Bale. You can do a quick Google search and find numerous articles, blog posts, and videos about Patrick Bateman’s infamous daily routine and people who’ve tried to follow it.

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In the film, Patrick Bateman — a man with deep, anti-social behaviors — details his morning routine:

“I live in the American Gardens Building on W. 81st Street on the 11th floor. My name is Patrick Bateman. I’m 27 years old. I believe in taking care of myself and a balanced diet and rigorous exercise routine.

“In the morning if my face is a little puffy I’ll put on an ice pack while doing stomach crunches. I can do 1000 now.

“After I remove the ice pack I use a deep pore cleanser lotion. In the shower I use a water activated gel cleanser, then a honey almond body scrub, and on the face an exfoliating gel scrub. Then I apply an herb-mint facial mask which I leave on for 10 minutes while I prepare the rest of my routine. I always use an after shave lotion with little or no alcohol, because alcohol dries your face out and makes you look older. Then moisturizer, then an anti-aging eye balm followed by a final moisturizing protective lotion.”

Showing the audience this routine reveals to us how much emphasis Bateman puts on his outwards appearance — a central theme to the film.

Most people care deeply about their appearance, whether they’re following a Bateman-esc routine or trimming their brows. After all, glowing skin is typically a sign of health.

Bateman’s routine puts particular emphasis on a youthful appearance, with multiple scrubs, peels, and moisturizers; and indeed it is exfoliation and skin-cell turnover that keeps your skin looking younger and healthier, but how do we get there from here? What should a good exfoliation routine look like? Where do you even start?

In this post, I’ll be breaking down some of the things that can keep us looking younger: AHAs, BHAs, and LHAs.


Introduction to Hydroxy Acids

You may remember from my post on moisturizers that skin cells (keratinocytes) begin deep in the stratum basale — the deepest layer of the epidermis — and work their way upwards, flattening out, hardening, dying, and eventually flaking away.

Stratum+corneum,+top+layer+of+skin,+graph

However, some skin cells are not quite as good at this as others. They will build up, stick together, or get “stuck” in the pores (hair and oil gland openings) of skin. Hydroxy acids are what is called an “active” skincare ingredient — basically something that performs an action on the skin. In this case, rejuvenation and exfoliation. They are largely found in botanical sources, which is why they are frequently referred to as fruit acids, and are divided up based upon the hydroxyl groups on their molecular structures. Hydroxy acids posses the ability to separate skin cells from the stratum corneum, which can be hugely beneficial to skin diseases that are characterized by a build up of dead skin (or hyperkeratosis), such as acne. Many also have the ability to stimulate the growth of collagen in the deeper layers of the skin, resulting in the reduction of fine lines over time.[1][2][3][4][7]

If you want to think of it in a more simple way, hydroxy acids are solutions that break down the “glue” that holds skin cells together (not the skin cells themselves), but like with anything that performs an action on the skin, this can be very irritating. Whether or not it is irritating to you depends on your needs and the formulations as well as the concentrations of the exfoliants you pick.


AHAs

The term AHA is short for “Alpha Hydroxy Acid.” It is the most common of the chemical exfoliants you can find. They’re usually associated with creating glowing, youthful skin due to their ability to exfoliate away the upper layers of the stratum corneum so effectively.

They work best around a pH of 3.5, which allows for better absorption. The higher the pH, the lower the amount of acid that is absorbed by the skin. To demonstrate this, one study compared the effects of glycolic and lactic acid on the skin when applied at different pH values. At a pH of 3, the total absorption of a 5% glycolic acid cream in 24 hours was 27%. When increasing the pH value to 7, that absorption tanked to a mere 3.5%. Similarly, 5% lactic acid had a total absorption of 30% over 24 hours at a pH of 3, which dropped to 10% when the pH was boosted to a value of 7. [5]

They are water-soluble, meaning that they work best directly on clean, dry skin. Some even have humectant properties, allowing them to draw moisture into the upper layers of the skin.

All AHAs create photo-sensitization — or sensitivity to the sun — due to their ability to exfoliate the stratum corneum.

AHAs are also generally not recommended for rosacean or eczema-prone skin, as they can worsen the inflammation that is common in these conditions. Additionally, avoid using AHAs in combination with other forms of exfoliation (such as physical scrubbing) or prescription topicals given to you by your dermatologist, especially tretinoin/Retin-A.

There are multiple types of AHAs, and they come in various forms, differentiated by molecular size and source. The most common types of AHAs are glycolic, mandelic, and lactic.

Glycolic

The most common form of AHA is glycolic, and it’s found in nearly every AHA product you can find these days. It has a small molecular structure, meaning it can penetrate the upper layers of the skin more easily and quickly, but it is also the most irritating due to these properties. It’s usually found in products in concentrations of 8-10%. Some examples of popular products with glycolic acid:

Paula’s Choice 8% AHA Gel – Recommended

Water (Aqua), Glycolic Acid (alpha hydroxy acid/exfoliant), Sodium Hydroxide (pH adjuster), Chamomilla Recutita Matricaria Flower Extract (chamomile/skin-soothing), Aloe Barbadensis Leaf Juice (hydration), Camellia Oleifera Leaf Extract (green tea/antioxidant/skin-soothing), Sodium Hyaluronate (skin replenishing), Panthenol (hydration), Sodium PCA (skin replenishing), Propylene Glycol (hydration), Butylene Glycol (hydration), Hydroxyethylcellulose (texture-enhancing), Polyquaternium-10 (texture-enhancing), Phenoxyethanol (preservative), Sodium Benzoate (preservative).

Pixi Glow Tonic

Aqua, Aloe Barbadensis Leaf Juice, Hamamelis Virginiana (Witch Hazel) Leaf Extract, Aesculus Hippocastanum (Horse Chestnut) Seed Extract, Glycolic Acid, Ammonium Glycolate, Glycerin, Butylene Glycol, Hexylene Glycol (and) Fructose (and) Glucose (and) Sucrose (and) Urea (and) Dextrin (and) Alanine (and) Glutamic Acid (and) Aspartic Acid (and) Hexyl Nicotinate, Panax Ginseng Root Extract, Phenoxyethanol, Sodium Benzoate, Biotin, Polysorbate 20.

Nip + Fab Glycolic Fix Daily Cleansing Pads

Aqua (Water), Glycerin, Glycolic Acid, Polysorbate 20, Sodium Hydroxide, PEG-12 Dimethicone, Hamamelis Virginiana (Witch Hazel) Water, Phenoxyethanol, Benzyl Alcohol, Alcohol Denat. (SD Alcohol 40-B), Disodium EDTA, Globularia Alypum (Blue Daisy) Extract, Panthenol, Lactic Acid, Parfum, Limonene, Ethylhexylglycerin, Dehydroacetic Acid, Sodium Hyaluronate, Linalool, Geraniol, Citral.

CosRX AHA 7 Whitehead Power Liquid

Pyrus Malus (Apple) Fruit Water, Butylene Glycol, Glycolic Acid, Niacinamide, Sodium Hydroxide, 1,2-Hexanediol, Panthenol, Sodium Hyaluronate, Xanthan Gum, Ethyl Hexanediol.

Lactic Acid

Lactic acid is the second most common of all AHAs, and can be frequently found hanging out in the ingredients with other AHAs or BHAs , though it is a fine exfoliator on its own. It has a larger molecule than glycolic, making it slower to act and less irritating — ideal for more sensitive skin. It is usually derived from milk, and has the best humectant properties out of all of the acids. Some examples of popular products with lactic acid:

Sunday Riley Good Genes All-In-One Lactic Acid Treatment

Opuntia Tuna Fruit (Prickly Pear) Extract, Agave Tequilana Leaf (Blue Agave) Extract, Cypripedium Pubescens (Lady’s Slipper Orchid) Extract, Opuntia Vulgaris (Cactus) Extract, Aloe Barbadensis Leaf Extract & Saccharomyses Cerevisiae (Yeast) Extract, Lactic Acid, Caprylic/Capric Triglyceride, Butylene Glycol, Squalane, Cyclomethicone, Dimethicone, Ppg-12/Smdi Copolymer, Stearic Acid, Cetearyl Alcohol And Ceteareth20, Glyceryl Stearate And Peg-100 Stearate, Arnica Montana (Flower) Extract, Peg-75 Meadowfoam Oil, Glycyrrhiza Glabra (Licorice) Root Extract, Cymbopogon Schoenanthus (Lemongrass) Oil, Triethanolamine, Xantham Gum, Phenoxyethanol, Steareth-20, Dmdm Hydantoin.

The Ordinary Lactic Acid 10% + HA

Aqua (Water), Lactic Acid, Glycerin, Pentylene Glycol, Arginine, Potassium Citrate, Triethanolamine, Sodium Hyaluronate Crosspolymer, Tasmannia Lanceolata Fruit/Leaf Extract, Acacia Senegal Gum, Xanthan Gum, Trisodium Ethylenediamine Disuccinate, PPG-26-Buteth-26, Ethyl 2,2-Dimethylhydrocinnamal, PEG-40 Hydrogenated Castor Oil, Ethylhexylglycerin, 1,2-Hexanediol, Caprylyl Glycol.

AmLactin 12% Alpha-Hydroxy Therapy Daily Moisturizing Body Lotion – Recommended (for body)

Water, Lactic Acid, Light Mineral Oil, Glyceryl Stearate, PEG 100 Stearate, Propylene Glycol, Glycerin, Magnesium Aluminum Silicate, Laureth 4, Polyoxyl 40 Stearate, Cetyl Alcohol, Methylparaben, Propylparaben, Methylcellulose.

Mandelic Acid

Mandelic acid has only just begun to appear on the scene, though it has been around for awhile. It is one of the best choices for very sensitive skin, and great for acne-prone skin due to its anti-bacterial and anti-microbial nature. It is derived from almonds and has moderate humectant properties, floating somewhere between glycolic and lactic. An example of a popular product with mandelic acid:

Stratia Skin Soft Touch AHA with 10% Mandelic Acid – Recommended

Water (Aqua), Mandelic Acid, Propylene Glycol, Polyacrylate Crosspolymer-6, Panthenol, Aloe Barbadensis Leaf Juice, Matricaria Recutita (Chamomile) Flower Extract, Glycerin, Sodium Hyaluronate, Allantoin, Sodium Hydroxide, Diazolidinyl Urea, Iodopropynyl Butylcarbamate.

There are also plenty of products that combine several alpha hydroxy acids together, such as:

Drunk Elephant TLC Framboos Glycolic Night Serum

Water, Glycolic Acid, Butylene Glycol, Glycerin, Sodium Hydroxide, Salicylic Acid, Lactic Acid, Citric Acid, Vitis Vinifera (Grape) Juice Extract, Aloe Barbadensis Leaf Juice, Opuntia Ficus-Indica Extract, Aesculus Hippocastanum (Horse Chestnut) Seed Extract, Camellia Sinensis Leaf Extract, Rubus Idaeus (Raspberry) Fruit Extract, Saccharomyces Cerevisiae Extract, Buddleja Davidii Meristem Cell Culture, Sclerocarya Birrea Seed Oil, Sodium Hyaluronate Crosspolymer, Allantoin, Hydroxyethylcellulose, Galactoarabinan, Propanediol, Disodium EDTA, Xanthan Gum, Hexylene Glycol, Phenoxyethanol, Caprylyl Glycol, Ethylhexylglycerin, Sodium Nitrate, Potassium Sorbate, Pentylene Glycol, Sodium Benzoate.

Dr. Dennis Gross Skincare Alpha Beta Extra Strength Daily Peel

Water (Aqua), Alcohol Denat., Glycolic Acid, Potassium Hydroxide, Hamamelis Virginiana (Witch Hazel) Leaf Extract, Salicylic Acid, Polysorbate 20, Lactic Acid, Mandelic Acid, Malic Acid, Citric Acid, Salix Alba (Willow) Bark Extract, Menthyl Lactate, Camellia Sinensis Leaf Extract, Achillea Millefolium Extract, Chamomilla Recutita (Matricaria) Flower Extract, Soy Isoflavones, Copper PCA, Zinc PCA, Disodium EDTA, Fragrance (Parfum), Sodium Benzoate.


BHAs

BHA is short for “Beta Hydroxy Acid.” These acids are slightly more complex than AHAs due to their oil-solubility. They are able to penetrate not just the skin, like AHAs, but also the pores of the skin. This is what makes them an ideal choice for acne-prones, who tend to have lipid-rich sebaceous glands.

BHAs work best around pH values of 3, and in concentrations of 1-2%. They’re frequently found with AHAs, but can be found in formulations without the addition of other hydroxy acids.

BHAs are not as photo-sensitizing as AHAs [6], but it is still frequently recommended that you wear a sunscreen when using any hydroxy acid.

There are two major types of BHAs: salicylic acid and lipohydroxy acid.

Salicylic Acid

When discussing BHAs, the ingredient that is usually being discussed is salicylic acid, which is derived from salicin — the same stuff in asprin. Due to this origin, salicylic acid should be avoided if you have an asprin allergy.

Salicylic acid has no humectant properties, and can cause drying of the skin. Though if formulated correctly, this can largely be avoided which can make BHA a much more effective acne treatment for some than harsher, more drying topicals such as benzoyl peroxide.

It can also be soothing to some skin types, such as rosacean skin or acne skin, and is pretty well-tolerated overall.

Some examples of popular products with salicylic acid:

Paula’s Choice 2% BHA Liquid  – Recommended

Water (Aqua), Methylpropanediol (hydration), Butylene Glycol (hydration), Salicylic Acid (beta hydroxy acid/exfoliant), Polysorbate 20 (stabilizer), Camellia Oleifera Leaf Extract (green tea/skin calming/antioxidant), Sodium Hydroxide (pH balancer), Tetrasodium EDTA (stabilizer).

Stridex Triple Action Pads, Alcohol Free (Red Box)

Salicylic acid 2.0%, Ammonium lauryl sulfate, ammonium xylenesulfonate, citric acid, DMDM hydantoin, fragrance, menthol, PPG-5-Ceteth-20, purified water, simethicone, sodium borate, tetrasodium EDTA.

Lipohydroxy Acid

Lipohydroxy acid is a derivative of salicylic acid, with unique properties. It has a higher molecular weight and an added fatty chain, making it more lipophilic (oil loving) than its parent SA.

First developed by L’Oreal in the 1980s, it penetrates the skin less easily due to it’s lipophilic properties. This slower penetration means that it breaks down the glue of the skin cells slower, but it is still unclear whether or not this results in less irritation.

Like other hydroxy acids, LHA thins the stratum corneum, but has dermal thickening properties. In one study, it was shown to be as effective as tretinoin, due to it’s stimulation of structural skin proteins and lipids. [7]

It is excellent for acne skin due to it’s lipophilic nature, and in one study, showed a decrease of 85% in follicular plugs over 14 days. [8]

It is only available in products made by L’Oreal, so it is difficult to get your hands on a wide variety. Some examples:

SkinCeuticals LHA Cleansing Gel

aqua / water / eau, coco-betaine, propylene glycol, peg-120 methyl glucose dioleate, sorbitol, glycerin, glycolic acid, triethanolamine, sodium laureth sulfate, sodium chloride, disteareth-100 ipdi, phenoxyethanol, salicylic acid, capryloyl salicylic acid, menthol, methylparaben, disodium edta, steareth-100.

La Roche-Posay Effaclar Duo

Water, Isostearyl Alcohol, Glycerin, Pentylene Glycol, Silica, Carbomer, Capryloyl Salicylic Acid, Potassium Hydroxide, Tocopheryl Acetate, Acrylates/c10-30 Alkyl Acrylate Crosspolymer, Disodium EDTA, Epilobium Angustioflium Flower/leaf/stem Extract.

SkinCeuticals LHA Toner

Water / Eau, Alcohol Denat., Glycolic Acid, Sodium Hydroxide, Capryloyl Salicylic Acid, Salicylic Acid.


All Together Now

  • If you’re sensitive, avoid AHA and BHA used together. Multiple hydroxy acids in one product increase your likelihood of a reaction. It’s better to start low and slow when introducing skin to a hydroxy acid.
  • Lower concentrations for beginners. If you’ve never used a hydroxy acid, go for lower concentrations, such as 1% BHA (Paula’s Choice makes a 1% variety of BHA) and 4-5% glycolic acid. If your skin is sensitive and generally reactive, look for larger molecules, like lactic or mandelic acid.
  • If you’re oily-skinned, rosacean, or acne-prone, try BHA. I cannot understate enough how great BHA is. It is generally soothing and can break through oils on the skin, making it ideal for acne.
  • Do not use physical exfoliation like scrubs, towels, or a Clarisonic when using a chemical exfoliant. Your stratum corneum thins when using a chemical exfoliant, so you shouldn’t need to be physically scrubbing your skin, which can just create irritation.
  • Use hydroxy acids infrequently. Unlike Patrick Bateman, most people do not need daily exfoliation. Use a hydroxy acid two to three times a week. Tweak this based on how your skin reacts.
  • Back off if you’re breaking out. Skin irritation can occur with hydroxy acids, usually in the form of breakouts. If this occurs, discontinue use until your skin clears. Re-introduce the product slowly and use fewer days per week. If the reaction re-occurs, discontinue use entirely.
  • Use a sunscreen during the day. Except for salicylic acid, hydroxy acids thin the stratum corneum and photo-sensitize the skin. You must use a sunscreen during the day to prevent damage and sunburn.
  • Be careful when using BP/retinol/retinoids with AHAs/BHAs if you are very sensitive. If you’re very sensitive with conditions such as rosacea or eczema, be cautious when using other actives in addition to AHAs/BHAs. This can be too much for some skin.
  • Use at night. As I said above, hydroxy acids photo-sensitize you. Use them at night for this reason.
  • Use hydroxy acids as close to the skin as possible. Applying any skin “active” right after you cleanse is ideal. This ensures it is as close to the skin as possible, and does not need to penetrate any additional products to work.

Sources

  1. Effects of alpha-hydroxy acids on photoaged skin: a pilot clinical, histologic, and ultrastructural study.
  2. A review of skin ageing and its medical therapy
  3. Epidermal and dermal effects of topical lactic acid
  4. Glycolic Acid Treatment Increases Type I Collagen mRNA and Hyaluronic Acid Content of Human Skin
  5. Labmuffin – Why does pH matter for AHAs and BHAs
  6. The effects of topically applied glycolic acid and salicylic acid on ultraviolet radiation-induced erythema, DNA damage and sunburn cell formation in human skin
  7. The Use of Lipohydroxy Acid in Skin Care and Acne Treatment
  8. Comedolysis by a lipohydroxyacid formulation in acne-prone subjects.
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Evaluating Your Routine: Sunscreen

Big sigh.

Sunscreen. The product that is touted as liquid gold among skincare enthusiasts, but neglected among… well, virtually everyone else.

There’s a lot I could explain on the topic of sunscreen, but being as much of it is pretty deep in the weeds, I will attempt to cut through a lot of the extra in this post and give you the simplified “how it works” version, as well as attempt to convince you why you should give sunscreen a try if you aren’t using it already.

First though, I’d like to alleviate some feelings I have on the topic.

Frequently, on skincare blogs and in skincare communities, sunscreen is touted as such a necessity that it is considered a pearl-clutching offense to even leave the house without it. Most sun damage is cumulative, and absolutely no one should be mocked for avoiding actual cancer, but there is a point where the insistence of some encroaches on the comfort of others. That is to say that while sunscreen is incredible, I am by no means pushing the usage of sunscreen on everyone. I understand that the filters bother some people, can aggravate existing conditions, and that sometimes… life happens. We don’t always have a bottle of sunscreen around when we need to dash out of the house. We don’t always want to slather it on before sitting outside to read a book. I certainly don’t.

And that’s okay. 

Do what makes you comfortable, and live your life. Just be reasonable and safe about it.

Whew.

With that out of the way, let’s dive right in, shall we?


Introduction to UV Radiation

You may remember the electromagnetic spectrum from science class and learning about radiation, such as light, heat, and radio waves. In short, it’s energy that’s moving. Leaving out a large portion of the electromagnetic spectrum for relevancy’s sake, there is light that we can see (known as the visible spectrum) as well as ultraviolet radiation.

uv-color-spectrum

The sun emits three types of invisible ultraviolet radiation known as UV-A, UV-B, and UV-C. UVC is filtered out completely by the ozone layer of the Earth’s atmosphere, but both UVB and UVA can reach the surface. While that may not seem so bad, climate change and depletion of the ozone layer has lead to an increase in UV radiation at the surface.

As you may remember from the previous post, the epidermis is comprised of several layers, including the stratum basal. This layer is enriched with epidermal stem cells (cells that can give rise to other cells of the same type), and give life to all epidermal structures, including sweat and oil glands as well as hair follicles. The layer beneath the stratum basal — the dermis — is also composed of stem cells that give rise to collagen and immune cells. These stem cells are essential to the skin as one of the systems of the body with a high rate of cell turnover.

When UVB radiation reaches our skin, our skin cells absorb the photons from the radiation, warping the DNA, rearranging nucleotides, and ultimately leading to defects. This damage causes a depletion of the epidermal stem cells, and ultimately, skin aging. [4] UVA can reach deeper into the skin, causing the most damage to our stem cells responsible for elasticity. This is why UVA damage is sometimes referred to as UV-Aging (with UVB as UV-Burning).

The skin attempts to counteract this damage by creating melanin (the pigment responsible for the color of our hair, skin, and eyes). Think of melanin as little umbrellas, attempting to shade the skin cells from the sun.

As sun exposure continues, the skin eventually begins to burn — the cells so damaged that they flake away and are discarded by the skin. The inflammation that follows is the presence of blood flow to the effected regions.

This is why even tanning — whether sun or tanning bed — is skin damage.

Surprisingly (or perhaps unsurprisingly), this damage begins to add up.


Visualizing Sun Damage

You may have seen the photo of the truck driver or even the video of what skin looks like in ultraviolet.

 

The epidermis thickens as a result of long-term exposure. The dermis loses elasticity. Inflammation occurs, parching the skin of essential moisture. This cascade of effects not only shows up later as wrinkles, but also can worsen eczema, acne, rosacea, or any other condition aggravated by dryness or inflammation.

trucker

And if we burn more than five times in our lives, our risk of skin cancer is doubled. According to the American Academy of Dermatology, 95% of melanoma cases are attributable to UV exposure. It is the most common type of cancer in the United States, with current estimates at 1 in 5 Americans developing skin cancer in their lifetime (or 9500 people every day). [1] You’re at an even higher risk of skin cancer on the driver’s side of your body, due to exposure while driving. [3]

If this isn’t enough, we can see changes in the structure of skin and it’s cells. According to a blog post by KindOfStephen, a group of researchers (with the funding of La Roche Posay) looked at the effects of UVB exposure on skin protected with high SPF (sun protection factor) and UVAPF (UVA protection factor) sunscreen as well as skin that was not protected.

sunscreen2

To quote directly from KindOfStephen’s post: “What they found was that doses of UVB that caused long-lasting erythema (redness) caused morphological changes in the skin. Changes observed were spongiosis (abnormal accumulation of fluid), microvesicles, sunburn cells, and blood vessel dilation. None of these were observed in skin that was protected by the sunscreen.” [2]

sunscreen2-1.jpg


Sunscreen Filters

So now that you know how ultraviolet radiation affects skin cells and you want to dip your toe into the sunscreen world, where do you even start? There are so many filters, so many ingredients, and you’ve even heard about sunscreen causing coral bleaching. Don’t worry, I’m going to get into these things, but first let’s break down the filters.

There are a large number of sunscreen filters available across the world. In the US there are only 16 approved filters, but only 8 are used, and out of that, only 2 of those protect from UVA.

Now you might be asking, “Wait, only two protect from UVA? I thought all sunscreen just protected me from the sun’s UV rays?” You wouldn’t be alone in this assumption. Even I thought this up until about 10 years ago.

Unfortunately, the United States doesn’t really have guidelines around UVA protection, unlike many other countries. In Asian sunscreens, the level of UVA protection is usually denoted by a PPD (persistent pigment darkening) rating, represented with plus symbols, such as ++++. In the EU and Canada, this is is simply a number. The higher the number (or the higher the number of plus symbols), the better the protection from UVA rays. Some sunscreen brands in the EU list their SPF along with the PPD value, ex. SPF 100/PPD 40. In the United States, we largely have to guess based on the percentage of listed filters or simply import them from other countries. I generally recommend sunscreens with high percentages of zinc oxide and titanium dioxide for this reason.

Below I’ve created a chart with the most common sunscreen filters you can get your hands on, along with their range, and some additional notes. For a more complete list of sunscreen filters, please refer to Skinacea’s UV Filters Chart [5]. I’ve also included two of the sunscreens implicated in the killing or bleaching of coral. For a more complete list of that, please check out this BadgerBalm article [6].

Sunscreen_list

Now I know what you’re thinking: why inorganic and organic? And furthermore, I thought zinc oxide and titanium dioxide were organic sunscreens and not the chemical variety.

The difference between these types of filters can be defined by chemistry. Titanium dioxide and zinc oxide do not contain carbon — they’re made of metal and oxygen, thus classified as inorganic. [7] However, both inorganic and organic filters work roughly the same — by absorbing the energy, bending, and eventually relaxing. Some filters do this better than others. For instance, avobenzone, as I noted above, must be stabilized by other filters. Instead of relaxing, avobenzone changes structure and breaks down, becoming more irritating to the skin. This is generally referred to as photostability, and while it is not typically harmful to wear a sunscreen that is unstable, it is just a bit of a pain, requiring re-application often and correctly to keep getting the amount of protection on the bottle.

Speaking of that protection, how do you know you’re even applying sunscreen right, or how much you should be using? Thankfully, science has an answer for just about everything.


Sunscreen Application and Care

Most sunscreens need to create a film over the skin in order to work effectively. This is particularly important for inorganic sunscreens, which are particle suspensions. This means you should be applying them evenly to get the best coverage and protection. Wait before applying any makeup to allow the sunscreen to dry down a bit and form a coating.

You also need to be applying the right amount to get the protection listed on the bottle. Yes, this even means your foundation or BB cream (which you should not be relying on makeup for sunscreen in the first place). Here’s a general guideline on how much you should be using on each portion of your body:

quarter-teaspoon-sunscreen-comparison

1/4″ teaspoon of sunscreen

  • Face: 1/4 teaspoon of sunscreen
  • Neck (front and back)1/4 teaspoon of sunscreen
  • Arms: 1/2 teaspoon of sunscreen per arm
  • Legs: 1 teaspoon of sunscreen per leg
  • Chest: 1 teaspoon of sunscreen
  • Back: 1 teaspoon of sunscreen

Applying less gives you less protection than listed on the bottle. For spray sunscreens, you need to apply several thin layers. Make sure to rub in each layer to avoid the streaky sunburn.

Sunscreens also have a shelf life of only about 3 years. Anything older than that should be tossed. Also be sure to keep your sunscreen in a cool place — even when at the beach. High temperatures of cars or direct sun will break down your sunscreen and render it less effective.

Lastly, re-apply your sunscreen when you are sweating or swimming. I know this is a pain, but if the two times I’ve burnt extremely bad in my life have taught me anything, it’s that the inability to sleep due to pain from sunburns can make the healing period one of the longest sets of weeks in your life.


Sunscreen Myths

  1. Darker skinned people don’t need sunscreen because they don’t burn. While it is true that caucasians have a higher risk of developing melanoma than the general population, skin cancer can affect anyone, regardless of skin color. In fact, skin cancer in patients with skin of color is often diagnosed in its later stages, when it’s more difficult to treat. They’re also less likely than Caucasian patients to survive melanoma, and are more prone to skin cancer in areas that aren’t commonly exposed to the sun, including under the nails. [1]
  2. Inorganic reflect sun rays, while organic filters absorb them. Both classes of filters work much the same, stretching, absorbing, and eventually releasing the energy. There is very little that is “reflected,” though inorganic sunscreens do have flashback (white cast under flash photography) due to their ability to reflect energy above the UV spectrum. [7]
  3. Inorganic sunscreen sits on the skin while organic sunscreens absorb. KindOfStephen put this best: “… if we want to protect ourselves from the rain we need to hold the umbrella above our heads. Sunscreens work the same way, you want them to absorb the energy before they can reach our skin cells, particularly the living cells. The most effective way for this to be done is to have them on the surface of the skin in a continuous and even layer.” [7]
  4. Sunscreens need time to activate on the skin. Sunscreens absorb UV due to their chemical makeup, not due to a chemical reaction that takes place on the skin.
  5. If I wear sunscreen, I won’t get adequate vitamin D. Vitamin D is very important to our bodies, and many people are deficient in it. However, thanks to the many well-formulated vitamin D supplements on the market today, we can get D3 just as efficiently as if we were sitting in the sun for an hour. Check with your doctor before taking any supplements. 
  6. Glass blocks all UV. Glass only filters UVB rays, so you still must wear sunscreen to be protected from the most harmful rays — UVA.

General Sunscreen Guidelines

  1. Apply your sunscreen after moisturizer and before makeup. Think of it as the barrier that protects your skin from the outside. I typically apply my sunscreen as the last step in my AM routine and do my eye makeup while I wait for it to sink in.
  2. Apply your sunscreen under your eyes. Avoid the top of the lid, which can get oily and cause the sunscreen to “run” into your eyes later in the day. Protection of the delicate undereye area prevents darkening that can look similar to undereye circles, as well as premature aging and wrinkles.
  3. Wear sunscreen, not moisturizer with SPF or makeup with SPF. As I mentioned above, sunscreen in moisturizer or makeup is not adequate.
  4. Don’t neglect your driver’s side. It’s easy to forget about our bodies, but as I mentioned, skin cancer is especially common on the driver’s side of the body. Avoid this with sunscreen, UV protective clothing, or special UV tinting.
  5. Wear at least SPF 30, but don’t worry about trying to wear SPF 100. There is very little difference between the amount of protection that SPF 30 provides versus SPF 100, when applied correctly. For example, SPF 30 blocks nearly 97% of UVB rays, while SPF 50 blocks an estimated 98% of UVB rays. [10] On top of this, higher SPF values mean more filters, which can irritate some skin. Good guidelines are at least SPF 30 but no more than SPF 50.
  6. Wear the highest amount of SPF you can tolerate. For some, this is SPF 15, and that’s okay. Whatever your skin can tolerate is better than nothing at all.
  7. When in doubt, wear a hat. There are plenty of UV-protective clothing options (and UV-blocking umbrellas!) on the market today. When I know I am going to be out in the sun for a long period of time, I will frequently bring a hat with me in addition to my sunscreen.
  8. Wear sunscreen and avoid the sun if you’re especially sun sensitive. This means skin with acne, rosacea, eczema, psoriasis, or under the treatment of photo-sensitizing (sun sensitivity) ingredients like retinol, retinoids, isotretinoin (Accutane), benzoyl peroxide, AHAs like glycolic acid or lactic acid, and topical steroids (such as triamcinolone).

Sources

  1. American Academy of Dermatology – Skin Cancer
  2. Kind of Stephen – Visualizing how a daily sunscreen can protect the skin from UV damage
  3. Study: Driving May Contribute to Left-Side Skin Cancers
  4. Ultraviolet Radiation-Induced Skin Aging: The Role of DNA Damage and Oxidative Stress in Epidermal Stem Cell Damage Mediated Skin Aging
  5. Skinacea – UV Filters Chart: Sunscreen Active Ingredients
  6. BadgerBalm – Coral Reef Friendly / Reef Safe Sunscreen
  7. Kind of Stephen – “Physical” vs. “chemical” sunscreens and other sunscreen myths
  8. Skinacea – How much sunscreen should I apply?
  9. The Derm Blog – Is that sunscreen in your car still good?
  10. Skin Cancer Foundation – Does a higher SPF sunscreen always protect your skin better? 
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Evaluating Your Routine: Moisturizers

Welcome back! It’s been a couple days since my last post in this ongoing series. I’ve had family visiting and have been busy giving the tour of Los Angeles.

This post will be a bit long, and with good reason — moisture is extremely important to skin health.


An Introduction to Moisturizers

“Moisturizer” is a bit of a vague marketing term. Moisturizers do not necessarily add moisture to the skin as much as they reduce or slow the amount of water that skin loses. They’re important to everyone who cleanses their skin, whether with water or a cleanser, but even more critical for those with conditions that cause the skin to lose moisture more easily, such as eczema. In short, moisturizers provide a barrier against moisture loss by creating a soothing, protective film.

But let’s slow down a little. Why does the skin lose moisture in the first place, and where does it even get moisture? To answer this, I present to you a helpful diagram of the skin’s epidermis.

Stratum+corneum,+top+layer+of+skin,+graph.png

Epidermal_layers.pngYou may remember from Health or Biology class that skin is generally broken into three major layers: Epidermis (or the upper most layer — what we can see with our eyes), the dermis (the middle layer — where most of the nerve endings, oil glands, hair follicles, blood vessels, and collagen hang out), and the hypodermis or the subcutaneous layer (where our fat lives).

There are multiple layers of each of these three basic layers, but we will be focusing on the layers of the epidermis, particularly the stratum corneum.

The epidermis is composed of thousands of cells known as keratinocytes. They begin life deep in the stratum basale, where they slowly make their way upwards, propelled by the growth of new cells below. As these cells get closer to the surface, they flatten down, harden, die, and eventually flake away. Some skin does this well, some not so well (dry skin, acne skin, etc.).

This process is generally referred to as skin cell turnover, and as we get older, this process gets slower and slower. In children, this only takes about two weeks, and in teens it is three to four weeks. Once you’re into your adult years, this slows down to a month, and by the time you’re over 50, it’s closer to 45 to 90 days.

Nowadays, we have ingredients that can speed this process up when applied topically, but that’s another post for another time.

The water that keeps these skin cells happy and healthy comes from deep within the epidermal layers and works its way upwards, until it is eventually lost to evaporation, but just like any organ of the body, it functions best with moisture. When skin is broken or it’s natural processes disrupted by wounds, burns, exposure to surfactants (cleansers), or extreme dryness (winter), it loses water quicker. That’s why doctors tell you to keep wounds moist and covered and you feel the desire to use richer moisturizers in the winter. When you keep even the upper most layers of the skin hydrated, the cells aid in elasticity and the enzymes within the skin are able to function more efficiently.

In short, moisturizing helps to repair the skin, increases water content, reduces trans-epidermal water loss (water evaporating out of the skin), and maintains the appearance of the skin. They do this by acting as humectants, occlusives, emollients, and rejuvenators.

Occlusives

Occlusive is a fancy word for a sealant — a compound that is generally hydrophobic and prevents water from evaporating.

They’re not typically very appealing because they can feel heavy or greasy, but they are the most effective ingredient at reducing trans-epidermal water loss. This property makes them particularly effective when used immediately after a shower or cleansing, while the skin is damp.

The most effective occlusive agent is petrolatum — a bland little ingredient with a bad reputation. It is the most commonly used ingredient in skin care and reduces water loss by 99%. It’s able to initiate production of lipids by penetrating into the upper layers of the stratum corneum (“sealing the cracks” in the skin, so to speak), and can reduce the appearance of fine lines and dryness caused by dehydration.

The second most common ingredient is dimethicone, though it is permeable to water vapor, which makes it less ideal for compromised or damaged skin.

Occlusives, when used alone in a skin care routine, are the last step. I personally apply a touch of Vaseline on the driest parts of my face after applying moisturizers and prescription medications.

Other common types of occlusives include squalene, paraffin, lanolin, cetyl alcohol, beeswax, and cholesterol.

Humectants

Humectants are kind of like the hydrators of skin care ingredients. They’re hydroscopic, meaning they are able to attract and hold onto water molecules. However, due to their water-loving way, they can pull water away from the dermis and cause excessive water loss. This is why humectants are almost always combined with occlusives, like petrolatum.

The most common humectants are glycerin or glycerol and hyaluronic acid, but there are also hydroxy acids (another post, another time), propylene glycol, and urea.

Emollients

Emollients are the ingredients that serve the primary function of filling in the cracks between skin cells. Many times, occlusives can be used and function as emollients. These ingredients are what make your skin feel soft after applying a moisturizer, and are commonly natural oils like rosehip seed oil.

While simple, these ingredients can assist in the inflammatory response of the skin, and are very individual. For example, you may notice that your skin seems to act better when you use rosehip seed oil, thanks to the linoleic acid (an omega 6) within the oil.

Rejuvenators

Rejuvenators replenish the proteins in skin, and include ingredients such as collagen, keratin, and elastin. These ingredients have limited permeability due to their large molecular size, but they can fill a similar role as emollients, filling in fine lines and smoothing the skin.

A Note on Ceramides

Ceramides are a fairly new breakthrough in cosmeceuticals. They’re naturally found in the lipids of the skin, and help to maintain the skin barrier (the function of the skin that holds onto moisture and keeps out unwanted chemicals). In a 1990 study, “it was found that the level of ceramides was greatly reduced in the stratum corneum in patients with atopic dermatis. It was subsequently concluded that an insufficiency of ceramides in the stratum corneum is an important factor in atopic dry skin. Subsequently, ceramides have been added to many moisturizes used in the treatment of both atopic and normal skin.” [1]

You can find ceramides starring in many creams and lotions now, and even at your local drugstore in brands like CeraVe.


All Tied Together

When I first began resolving my own skin issues, the greatest barrier (and what finally solved my acne) was finding a moisturizer that worked for me. I have several sensitivities and am unable to use a handful of common ingredients as well as a large number of uncommon ingredients. Skin needs are unique and individual in this way. You may find that you need to try many products to find what works best for you, but here are some guidelines to get you started.

  • Look for simple ingredient lists. Ingredient lists proven by the science are the best kind. Try to find something without fragrance, essential oils, and if you have particularly sensitive skin, without natural nut or plant oils, such as jojoba, rosehip, marula, or almond oil. This also makes it easier to rule out what causes your skin problems, so you aren’t fluttering from one product with an exhaustively long ingredient list to another, just hoping.
  • Use an occlusive on your driest parts. Vaseline (brand name for petrolatum) is one of the most bland products on the market, and is comprised of one of the most boring molecules around. It is incredibly non-reactive and well-tolerated. Pat it on after a shower, after your moisturizer, on damp skin.
  • Moist skin heals best. Keep cuts, scrapes, and scratches under a bandage with a glob of Vaseline. Same for acne spots with an open wound. Moist skin also scars less.
  • Seek out ceramides. These crown jewels are amazing for all skin types, but especially skin that is dry or acne-prone.
  • Don’t be afraid of moisture if you have acne. Many times, we fear moisture and oil as the cause of acne, but as I’ll start to explain, skin that is prone to acne tends to lack a lot of the moisture and good fats that keep it healthy.
  • Hydrated skin absorbs ingredients better. Remember when I said that skin that is hydrated functions more efficiently? Skin that is hydrated also uses other ingredients more effeciently. This means that you may experience more irritation from topical prescriptions like tretinoin/retinoids, AHAs, BHAs, LHAs, etc. Simply back down on how much you use of these products and celebrate — your skin is healthy!
  • Use a humidifier if it’s dry in your home. I have a simple digital humidity gauge in my bedroom so I can track the humidity of the room at any given time. Ideal humidity levels are between 40-60%. When humidity levels dip below this, such as in the winter when the heat is running frequently, I use a humidifier to boost the humidity levels. This is fantastic for your skin and prevents humectants from “pulling” too much moisture out of the deeper layers of your skin.

 

Sources:

  1. Nolan, K. and Marmur, E. (2012), Moisturizers: Reality and the skin benefits. Dermatologic Therapy, 25: 229–233
  2. Chemistry of skin: Trans-epidermal water loss (TEWL)
  3. SkinTherapyLetter

 

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Evaluating Your Routine: Cleansers

So in my previous post, “Evaluating Your Routine: The Very Basics,” I posed the following question:

What does your skin feel like after you cleanse? Does it feel dry – parched and tender? Does it feel dry but quickly become oily? In my experience, this is usually a cleanser issue. It’s generally recommended that everyone should use “creamy” cleansers (these are usually cleansers that do not suds due to lacking the sudsing ingredients of sodium lauryl sulfate or sodium laureth sulfate), and are advertised as “gentle,” “hydrating,” and “creamy”), and there are more options than ever within this category, from CeraVe to Skin Laundry.

However, if you find that creamier cleansers give you problems, you may need something that is a bit more translucent in appearance (meaning less moisturizing agents). These can be a bit tougher to find that fit within the usually-strict guidelines of no SLS/SLES (sodium lauryl sulfate or it’s gentler cousin, sodium laureth sulfate), so I usually advise people to experiment with what works. For me, this is Paula’s Choice Hydralight Cleanser, but there are also options like La Roche Posay Effaclar or Glossier’s Milky Jelly Cleanser.

In this post, I’ll be breaking down general cleansers as well as oil cleansers (or the oil-cleansing method aka OCM) and micellar cleansers. Let’s dive right in!


Cleansers work by dissolving or binding to things on the skin that aren’t normally rinsed away by water, such as the waxes or oils produced by our skin.

Without getting too into the weeds, they are able to do this with surfactants  (or “the thing that makes cleansers sudsy”). The most common surfactants, and the ones you may have heard of are SLS and SLES (sodium lauryl sulfate and sodium laureth sulfate). These ingredients work by binding to the lipids (oils such as jojoba oil or silicones like dimethicone) and then being whisked away by their water-loving properties. Once mixed with water, surfactant molecules cluster together into little spheres known as micelles. Some surfactants molecular size allows them to penetrate deeper into the skin (namely SLS), where they can bind to skin cells. As you can imagine, this is very irritating to skin, and is what causes the eventual drying that you may experience after using some products.

501_Structure_of_the_skin

So by increasing the size of these molecules or adding additional ingredients, we get a gentler cleanser.

If you’ve hung out in any beauty circle, you’ve probably also heard chatter of pH – “What is the pH of that cleanser? Have you tried the CosRx Low pH Cleanser?”. The pH value of a cleanser can have an impact on how harsh your cleanser is on your skin as well, and simply put, it’s because the surface of your skin is naturally pretty acidic.

Going back to Chemistry class really quickly, you’ll probably remember something called the “pH Scale.”

ph-scale

Things on the left side of the scale (1-6) are considered acidic. Things on the right side (8-14) are considered basic or alkaline. And of course, there is what is considered neutral, or pH 7. Skin has a pH of around 5.5, but becomes more basic the further down into the dermis you go, reaching a pH of about 7. Why is this important, you may be asking? Well, if you think back to your high school Chemistry course, you may have remembered the good ol’ baking soda and vinegar reaction. When this reaction — called an acid-base reaction — occurs, the baking soda and vinegar exchange atoms and form different compounds, namely water and carbon dioxide. This is because bases are compounds that generally want to donate atoms and acids are compounds that generally want to accept atoms.

As skin comes in contact with other ingredients, even water, the pH temporarily raises and other compounds are created. Fatty acids (read: acidic components) of the skin are removed.

Healthy skin can usually re-balance itself within an hour or so. Some skin takes longer to do this, especially skin that is prone to irritation, such as skin with acne, rosacea, eczema, or psoriasis. This is why your boyfriend can cleanse his face with a Dial soap bar and have glowing skin an hour later, while you’re busily slathering on layer after layer of moisturizer.

Using a cleanser that is closer to our skin’s natural pH is the obvious solution to this problem, and most modern cleansers are formulated much better than those of the past.

So now you’re probably asking yourself: Well, how can I test the pH of the cleanser I would like to buy? And how do I know the surfactant isn’t going to irritate my skin?

A general rule of thumb is to look for mild surfactants, such as decyl glucoside, or multiple surfactants, like decyl glucoside, coco-glucoside, disodium cocoyl glutamate, disodium laureth sulfosuccinate, cocoyl methyl glucamide, sodium cocoyl isethionate, and lauryl lactyl lactate.

You should also look for moisturizers, like oils, ceramides, cholesterol, and humectants (water-binding ingredients such as glycerin, hyaluronic acid, or squalane). Avoid saponified oils (please don’t use Dr. Bronner’s on your skin) and bar soap.

Now I know you’re asking: What about oil cleansers then?


What if I told you that your grandmother was ahead of the game?

Nearly all of us have seen a tub of Pond’s Cold Cream hanging out in our grandmother’s bathroom or on her vanity. You might’ve seen her dab some all over her skin and wipe away all of her makeup with a tissue. She may have sworn by it as the thing that kept her looking young, and she’s not entirely wrong.

I like to think of oil cleansers as being broken down into two types of cleansers — wipe-off cleansers like your grandmother’s Pond’s, and emulsifying cleansers like the translucent oil cleansers that come in a pump or tub.

The former — wipe-off cleansers — are the most common mixtures in the cosmetics industry. They are usually simple mixtures of oil and water, and are high in water content, which makes them inexpensive.

cold_cream

They spread easily and often leave an oily or richly moisturized feeling behind. They’re typically purchased by people with mature skin, but are a great alternative for people with dry skin.

The latter — emulsifying cleansers — are also mixtures of oil and water, but are higher in oil content, which makes them more expensive. They contain emulsifiers that bind well to water, which allows them to rinse away in water.

oil_cleansers

The benefit of these cleansers is there is no real “sudsing” action on the skin. Indeed many of them can actually feel “moisturizing” due to their ingredient makeup. They are also excellent for breaking down make-up and other waterproof things, such as mascara, due to the high oil content.

When picking out an oil-cleanser, look for shortened ingredient lists. Don’t be swayed by extracts or other frills that will wash away. The oil itself will be the biggest point of irritation (or not) for your skin, so don’t be afraid of “boring” oils like mineral oil or petrolatum, which is one of the blandest, most non-reactive molecules around.

Just one more to go…


Micellar water is quite literally made up of micelles, or the molecular bunches of surfactants that group up, their water-loving butts faced outwards. These larger bunches of molecules, diluted in combinations of water and hydrating ingredients (such as glycerin), are the most mild of cleansers.

The percentage of surfactant to other ingredients is generally so low that micellar water does not need to be washed away. This allows the hydrating ingredients, such as glycerin, to stay on the skin after the debris has been removed.

bioderma

This makes micellar water ideal for sensitive skin or prepping the skin for product application, when cleansing with a standard cleanser and water will be too drying.


So what does this all mean? Here are some general skin cleanser guidelines to follow:

  • Cleanse your skin at least once a day. At the end of the day, your skin not only has a build-up of oils, but also debris and particulates in the air.
  • Don’t pile it on. Your non-sudsing cleanser does not need to suds to work.
  • Two-step cleanse for removing make-up. Most make-up is waterproof and does not easily cleanse away. Use an oil cleanser to break down the make-up and remove it.
  • Use cottons to remove cream cleansers like Pond’s. The friction will help to remove grime and dirt. Splash with water after to remove any leftover emulsifiers.
  • Use cool water when cleansing. Hot water can make surfactants penetrate deeper by reducing the size of the micelles, which is why your hot shower is more irritating and drying to your skin than the less-fun cooler shower.
  • Moisturize. Even water strips away the valuable fatty acids in your skin. Using a moisturizer on your skin after will help your skin to re-balance itself quicker.


Sources and Further Reading:

 

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Evaluating Your Routine: The Very Basics

Welcome to my first post in my series, “Evaluating Your Routine.”

If you’ve ever eagerly picked up a new skincare product and slathered it on, only to be greeted with a skin reaction (allergic or acne), this series is for you. In each post, I’ll be breaking down a step within the classic skincare routine and helping you evaluate your current routine so you can make changes where it may be best rather than scrapping everything all at once.

Most people already have a routine, even if it begins and ends with cleansing their skin in the shower. Just because your routine is not expensive or ten steps does not mean it is bad. However, since you are here, I can assume that you would like to change something about your skin (and thus your routine). Much of these changes will come with time and individual experimentation, but having a solid foundation will make this process easier.

A Note on Patch Testing

I know, I know. I’m no fun at parties. However, if you have allergies or sensitive skin, this will be critical. I’ve used serums from a well-trusted brand only to wake up to hives all over my face. I’ve used Korean beauty favorites only to end up with breakouts so swollen and extreme that my right eye was nearly swelled shut by my puffy eyebrow. Ever since, I’ve used new products on only one temple for the first week.

But I’m getting ahead of myself. If you’ve never patch tested a product before, or you’re asking the screen, “But what is patch testing?”, let me explain. Patch testing means taking a small amount of the product and applying it to a portion of your skin that is typically reactive but otherwise hidden from view. For instance, when testing people for allergies, the allergens are usually applied all over the subject’s back. When patch testing a new makeup product or facial skincare product, consider testing on your forearm for allergic reactions first, and then a portion of your face that is not usually affected by hormonal or stress breakouts. For me, this is my temples. Apply a small amount of product to this location once a day (or twice, if this is how you’d normally use the product) and see how your skin reacts over the next couple days. I’ve used photos on my phone to track this so I know if it is causing something less visible than simply enormous breakouts.


Where To Begin

It’s tempting to throw everything you have into the trash and buy a bunch of new things at the latest Sephora sale, but this is completely unnecessary to get started. It’s possible to identify the holes in your routine by asking yourself some questions.

  • What does your skin feel like after you cleanse? Does it feel dry – parched and tender? Does it feel dry but quickly become oily? In my experience, this is usually a cleanser issue. It’s generally recommended that everyone should use “creamy” cleansers (these are usually cleansers that do not suds due to lacking the sudsing ingredients of sodium lauryl sulfate or sodium laureth sulfate), and are advertised as “gentle,” “hydrating,” and “creamy”), and there are more options than ever within this category, from CeraVe to Skin Laundry. However, if you find that creamier cleansers give you problems, you may need something that is a bit more translucent in appearance (meaning less moisturizing agents). These can be a bit tougher to find that fit within the usually-strict guidelines of no SLS/SLES (sodium lauryl sulfate or it’s gentler cousin, sodium laureth sulfate), so I usually advise people to experiment with what works. For me, this is Paula’s Choice Hydralight Cleanser, but there are also options like La Roche Posay Effaclar or Glossier’s Milky Jelly Cleanser.
  • What does your skin feel like after you moisturize? Does it still feel parched? Does it burn? Does it feel tingly? Does it get very red and not return to a more normalized flush after a few minutes? This is usually due to an incompatible moisturizer.There are several reasons this may happen. Most often than not, it is due to too many irritants or too few of the ingredients your skin needs.Common irritants include fragrance (or perfum), alcohol (or alcohol SD-40 – not to be confused with ingredients like cetyl alcohol, which are technically “fatty alcohols” — something I’ll get into in another post), menthol or camphor (cold and “tingly” feeling ingredients), clove extract, essential oils,  or citrus oils. Of course nothing is ever truly hypoallergenic or non-irritating, and you may have problems with otherwise “good” ingredients, but starting by ruling out common irritants is a good place to start.

    If your skin feels dry after moisturizing, your moisturizer may contain too few of the ingredients your skin needs, such as good fats and oils. Try using a heavier moisturizer (such as a cream instead of a lotion). If you’ve already done this but your skin is still thirsting for moisture, try sleeping with a humidifier near your bed and using an occlusive (water-trapping ingredient), such as Vaseline, on your driest areas at night.

  • What does your skin texture look like? Do you get acne, small red bumps, or red patches? Skin conditions and texture can be genetic, but sometimes it can be due to exfoliating habits. When you cleanse, are you scrubbing your face with a washcloth, facial scrub brush, sponge, scrub, or Clarisonic? Scrubbing and rubbing can be very irritating to some skin types. Try dropping these cleansing tools and/or products for a couple weeks, using only your hands to cleanse. Watch how your skin reacts. If it begins to improve, you can try slowly re-introducing these cleansing and exfoliating tools. You could also try a chemical exfoliant (something that, again, I’ll get into in another post) and ditch physical exfoliation all together.
  • Does your skin look dull? If you have skin that is dull in appearance, it is usually due to not enough exfoliation or lack of antioxidants. This is generally a more “advanced” solve that I’ll help you tackle later.
  • Do you have unwanted freckling, dark spots, or irritation only on the driving side of your face? This is usually due to the lack of sunscreen, or using an inadequate sunscreen. There are a lot of things to consider when buying a sunscreen, but a general rule of thumb is to make sure you’re applying a full 1/4 teaspoon of the product to your face to receive the coverage listed on the bottle and to wear a sunscreen that is SPF 30 or above.

 

A Basic Routine

Now I know you’re probably wondering, “What is a basic routine then? What should I be doing?” This is highly individual, but generally, you should be using a cleanser that can remove whatever you wear during the day (two cleansers for makeup, one for day-to-day products like moisturizer and sunscreen), a moisturizer that seals in the moisture of your skin, and a sunscreen during the day (yes, seriously – skin cancer is one of the most common forms of cancer, outnumbering all other forms of cancer combined, and sun damage can seriously wreak havoc on how skin looks and functions). Your AM/PM skin routine should look something like this:

AM

Cleanse
Moisturize
Sunscreen
Makeup

PM

Cleanse
Moisturize


Once you have a small number of products that work for you, you can begin experimenting and building upon your routine.

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