by Charles E. Crutchfield III, M.D.
Walk into the skin care/cosmetic area of any major department store, and it is dizzying to see the hundreds, if not thousands, of choices for skin care. To complicate matters, there are sales people wearing white coats looking like either mad scientists or doctors, who are all too eager to recommend their company’s multi-step skin care program. Even in our homes, we are flooded with late-night infomercials touting the latest products that promise to solve your skin care woes. The good news is, smart skin care can be a simple four-step process: cleansing, hydration, protection and correction.
Cleansers with either no detergent or a very low detergent value help preserve the natural oils in your skin. You don’t need harsh cleansers or exfoliants; just use a cotton washcloth. Your skin will naturally exfoliate itself. Several good over-the-counter cleansers include Vanicream Cleansing Bar, Cetaphil and Dove Unscented Cleansing bar. Everyone’s skin chemistry is different, so experiment until you find a product that works best for your skin type.
Dry skin causes more skin problems than just about any other single issue. The skin itself contains natural humectants (moisturizers) such as hyaluronic acid and other moisture-attracting molecules. The key to keeping your skin moist is to apply an emolient moisturizing lotion after bathing. Gently pat your skin dry with a cotton towel and immediately apply a lotion. This does two things: it creates a protective barrier and seals in moisture. It also adds additional moisturizer to the skin. Some moisturizing lotions generate an increased production of the body’s natural hyaluronic acid. Moisturizers should be applied over the entire body twice daily–at least once after bathing. This contributes more to overall skin care and skin fitness than just about anything else, if done on a regular basis.
One of the newest lotion on the market is CeraVe. It is a microlaminated, multivescular emulsion containing small droplets, which break down for several hours after you apply it, providing continued moisture. Other good moisturizing products include Aveeno Moisturizing Lotion with Colloidal Oatmeal and Amlactin XL Moisturizing Lotion.
Sun protection is a major concern for the prevention of skin cancer, as well as lines and wrinkles. One of life’s cruel ironies is that most people will receive 75 percent of their total lifetime sun exposure by the age 21. In other words, by the time most of us are wise enough to protect ourselves from the sun; it’s too late. The most effective sunscreens contain both an SPF (sun protection factor) of 15 or higher and UVA (ultraviolet A) protection. The SPF protects against burn, which is caused by UVB (ultraviolet B) rays. UVA rays actually penetrate much deeper and cause more long-term damage, such as skin cancer. To properly protect your skin, apply sunscreen 30 minutes before sun exposure (it takes 20 minutes for the lotion to set in the skin) and reapply every hour. Of course, it should be applied even more frequently if you are perspiring or swimming. MelaShade is a great, new sunscreen that is designed specifically for the face.
The second component is sun-protective clothing. The key here is to make sure the fabric has an extremely tight weave that blocks out the sun’s harmful rays, yet is lightweight and vented for comfort. Coolibar produces an extensive line of sun-protective clothing and accessories for adults and children.
The third protective measure is use topical creams containing antioxidants. The skin undergoes many biochemical processes, and some of the byproducts–called free radicals–can be very damaging to the skin. Also, we are assaulted with other damaging pollutants from the environment, such as cigarette smoke and other environmental pollutants. Creams containing antioxidants essentially “mop up” these free radicals, preventing additional skin damage. I suggest using an antioxidant-rich cream as part of your daily skin protection regimen. Don’t forget to wear UVB-protective eye wear; it is as important to good eye health as sunscreens are to the skin.
The correction of skin problems that are associated with aging and ultraviolet damage is one of the fastest growing areas of skin care. I was recently asked why I think so many people are engaging in cosmetic dermatology services. My answer was simple: We have medications now that really work to correct aging and damaged skin, such as antioxidant-containing lotions, mild chemical peels using alpha-hydroxy acid, Javani hydrating microdermabrasion facials, and additional prescription-strength products.
The operative phrase in cosmetic dermatology is “less is more.” Generally speaking, lines can be classified as one of two types: Static lines are those you see when you look in the mirror without any facial expression. Smiling or frowning, on the other hand, created dynamic lines. In my practice, I use primarily Botox Cosmetic to treat dynamic lines, such as crow’s feet, frown lines between the eyebrows and lines on the forehead. I prefer hyaluronic acid filling agents to correct static lines. Hyaluronic acid is found in the body as a supporting molecule through the skin; it is also a major component of the lubricating fluids in our joints and inside our eyes. Because it is a naturally occuring substance, allergies to hyaluronic acid are essentially nonexistent. Hyaluronic acid also does not contain additional particles that can form complicated granulomas, or inflamed nodules, later in life. Another plus: Recent studies have shown that when one injects certain hyaluronic acid products in the skin, they stimulate fibroblasts, or cells, to produce more collagen. Human collagen can last five years or longer, which gives an added benefit. The hyaluronic acid products I utilize most frequently in my practice are Restylane and Juvederm. Some of the newer developments for skin correction include various laser treatments. I use intense pulsed light therapy to remove sun freckles, and the new Pixel laser to treat superficial lines, wrinkles, and acne scars. The Aramis laser is pain free and does a good job of minimizing lines and wrinkles. The Fraxel laser is very good at treating mild acne scars and dark, blotchy skin–especially the condition melasma (dark patches associated with pregnancy and the initiation of birth control pills) normally seen on the cheeks and forehead. There are newer infrared and heating treatments that also will produce skin tightening to diminish fine lines and wrinkles. Some of these techniques work very well for some patients, but not all. When I put one of my patients on a skin correction or rejuvenation program, I use a series of superficial chemical peels (usually over a six-month period). Javani hydrating microdermabrasion facial, Botox Cosmetic and Restylane Injections to correct and fill in unwanted facial lines and wrinkles, and finally, a combination of both Aramis and Pixel lasers for additional contouring and smoothing effects.
Charles E. Crutchfield III, M.D., is a graduate of the Mayo Medical Clinic Medical School, Clinical Associate Professor of Dermatology at the University of Minnesota Medical School, and Medical Director of Crutchfield Dermatology in the Minneapolis/St. Paul area. He has been selected as one of the “Best Doctors in America” by his peers, an honor bestowed on only four percent of all practicing physicians. www.CrutchfieldDermatology.com