In the “Four Hs” of skin care the most voluminous topics for skin health are in this category, and every possible healing compound or procedure may not be captured in this article. I have categorical thinking to help delve into our options. Skin has become my “jam” because I have been plagued with psoriasis that is always evading treatments, so it keeps me on my toes as far as fixing the host, which is an eastern approach. It also has me on the front line of innovative treatments and protocols (western approach) to see how far we have come to understand the complexity of the skin and our immune system. The categories include the treatment options involving the protoplasm, chemistry, and energy. Then we also must think about home programs as well as clinic-based programs. Since skin is our largest organ with multiple functions, it deserves our undivided attention.
Chemistry:
No matter what treatment you can receive at a clinic or with an aesthetician or a physician, there is no substitute for the home program. This is necessary for any substantial gains to fix a dermatologic condition. From quieting inflammation in the cases of acne, eczema, psoriasis to repairing the effects of aging and dryness, finding the home program for you needs to be specified. For instance, even the basic Fitzpatrick classification of skin will affect the types of home products you can use. If you have the extremely sensitive porcelain skin of a “Fitzpatrick Skin Type 1” you will never be able to tolerate the harshness of peroxides and mechanical exfoliants of scrubbing beads. As the same rules of a very dark “Fitzpatrick Skin Type 6” is concerned, you may not be able to tolerate certain products without getting uneven pigment. Inflamed skin needs help to quiet inflammation, and aging skin is sensitive, fragile, and parched, which requires a gentle, cooling, and hydrating approach.
Wash :
Nearly every skin type would do well with gentle non-soaps. Acne can be its own category, but sometimes I like to save the chemistry for the treatments and not in every phase of the skin care regimen. You can over process your skin, so let your facial wash help soften and moisturize while you wash. Washing is the gentlest form of exfoliation.
Moisturize:
It may be easiest to keep the moisturizer component of the regimen separate and simply such that the corrective ingredients can be added and removed throughout the week, while moisturizing would be daily. We have not talked about inactive ingredients that may pile up in a seemingly mild moisturizer. Try to look for the least amount of ingredients. Consider plants based, organic, and few preservatives which may backfire on your attempts to heal your skin. Even an acne or rosaceic skin needs moisture, but it does not need inflammation to add to the already angry skin.
Correct:
This arena is always racing to find the most efficacious ingredients to fix problem skin areas. Chemistry has its forte and has the trickiness of getting an ingredient to penetrate the skin for maximum benefit, yet some of these ingredients could be supplied in a great diet and with supplementation. Use this understanding interchangeably when talking about these ingredients.
· Vitamin C is imperative for cellular repair and difficult to esterify to help it become fat soluble to penetrate the skin. You will find this is in the “better” skin care lines, but do not forget to consider it internally daily
· Retinoids are vitamin A derivatives and do a fantastic job at anti-aging in the skin group who can tolerate this without getting red and “peely.” Vitamin A itself can be used to supplement orally, under supervision, if dosing is in question.
· Peptides are amino acid groups and may be attached to copper or be in the form of collagen precursors, portions of collagen, or other tripeptides, tetrapeptides, or pentapeptides. These are wonderfully hydrating and healing and even used in the wound healing field, and not just skin care regimens.
· Hyaluronic acid will allow skin to retain its moisture and elasticity.
· B5 and nicotinamide are in the B vitamin category to help as a humectant, produce keratin, and help with the ceramides (fatty acid molecules). These may also require chemical gymnastics to get them stable in a skin care product, so you may even want to add these healthy B vitamins to your daily intake by mouth.
· Bakuchiol is a natural botanical in Ayurvedic medicine used as a retinol replacement since it works as an anti-inflammatory and collagen stimulator to cut down wrinkles and hyperpigmentation
· Glycolic, lactic, and alpha-hydroxy acids are derived from fruits, milk, or sugar cane to behave as gentle chemical exfoliants, which is certainly necessary with parched epithelium or acne -laden skin which does not exfoliate well.
· Squalene a lipid product derived from marine or vegetable lipids to fill the niche to assist the hydration of the skin while it improves the barrier protection of the skin to fight off free radicals. Healthy amounts of EPA/DHA in fish oils also does wonders for all skin types.
· Green tea (EGCG) can reduce irritation and inflammation so much so that applying a green teabag to a cut aid in its healing! Certainly, drinking green tea will help overall skin healing and health
· Neuropeptides are essentially a rebranded version of the peptides mentioned above that promote many facets of improved skin health at multiple layers of the skin and are being promoted as having benefits to Botox, while research is underway to assess if they are biosimilar or not.
· Ivermectin reaches into the medicinal treatments for skin conditions, but it is a wonderful topical and oral agent used to squelch rosaceic skin.
· Ferulic acid assists in sun protection particularly well when piggy-backed with vitamin C. It is extracted from nuts , seeds and leaves.
In the chemistry department to treat underlying skin disorders, the compounds are almost too numerous to count, but also included several ingredients mentioned in the home treatment programs while the percentages may be higher and stronger, as in the case of the exfoliating acids. Accutane also exists in a prescriptive formulation and requires medical monitoring for this to work. We also have a whole arm of immunomodulators with a biologic sequence of proteins to affect a portion of the immune system. Steroids, higher dosed retinoids, and antibiotic regimens can go after clinic-based options. There is also a whole arena of medical grade nutraceuticals aimed at aggressive management to improves the body, which in turns, improves the skin.
Energy:
This may not be intuitive as an approach to skin until you realize that laser and ultrasound technology that is inundating the skin care market is all energetic work. The skin also requires vitamin D which requires light therapy! For the psoriatic and eczema patient there has been years of research utilizing UVB radiation and light treatments to target the lesions. Now that there is blue light therapy to target acne and aging, there are dermatology clinics using Blu-U with chemical photosensitization to achieve aggressive results in one treatment. Red light therapy has had so many applications and the skin in no exception. There are home units with less fluence or strength, while the clinics and operating rooms may employ larger fluence and stronger lasers to penetrate deep layers and target much more damaged skin for advanced healing to go with a home program.
Intense pulsed light (IPL) can be used on most skin types outside of the darker skin tones. This technology is using laser light in a pulsed fashion to stimulate collagen but also to go after hyperpigmentation and red broken blood vessels. Since it can target chromophores (unwanted colored pigments) it would have to potential to depigment Fitzpatrick 4-6 skin types and many times needs to be avoided.
Various ultrasound devices alone or with the laser treatments can go after skin tightening and may be a wonderful adjunct to the home program as well.
Protoplasm
This simply refers to the manipulation of the skin itself, and this is almost always implying a surgical, microblading, or microneedling approach. However, I will always quote my friends in the field that can nip and tuck skin, but if there is not a good skin care regimen, they are nipping and tucking distressed skin!!! Most times the efforts you do for yourself will pay off so that there is less sagging and drooping or loss of collagen. I also warn of using the fillers and additives to the skin. I worry that this could induce an inflammatory reaction since the immune system may view these substances as foreign objects. I also caution that this should be in the hands of someone very adept and skilled with natural products. If the contours of the face are altered to the point beyond recognition, even good skincare cannot rescue you from monstrous reconfiguration.
Skincare can be as simple or as complicated as you would like it to be. Doing something for the skin is better than doing nothing at all. Treat this organ well in your life and it will guard and protect you through life’s insults along the way.
