Key Ingredients in Your Skin Care Routine

Patients often ask me about the components of a good preventative skin care routine.

There are so many products on the market that skin care can be overwhelming. Some people are great at following an extensive multistep regimen, and some people consider it a win if they wash their face once a day. Most of us fall somewhere in between. In that case, I recommend hitting the high points. A routine including sunscreen, moisturizer, cleanser, vitamin C and retinoid accomplishes that goal. This routine will help prevent skin cancer and photoaging as well as reverse some of the damage that has already been done.

Vitamin C, or ascorbic acid, plays many important roles in our bodies. It acts as an antioxidant for our cells, scavenging free radicals that cause tissue damage. It aids in wound healing and collagen production and boosts our immune system. Just as it is so important for the health of our bodies, it is also highly beneficial for the health of our skin.

Over our lifetimes, our skin suffers many insults that contribute to wrinkles, loss of elasticity, and discoloration. vitamin C can help protect against these insults and regenerate healthy skin. Vitamin C is a crucial nutrient for cells called fibroblasts to synthesize collagen in our skin. Our skin encounters many harmful oxidants from environmental pollutants and damaging UV rays. Vitamin C works with other antioxidants in the skin, such as vitamin E and glutathione, to capture and neutralize these oxidants before they can damage our skin cells.

Vitamin C is also beneficial in lightening and preventing skin pigmentation. It inhibits an enzyme called tyrosinase, which is responsible for producing pigment in our skin. I recommend topical vitamin C as part of a skin care routine in patients with conditions like melasma, postinflammatory hyperpigmentation and lentigines (sunspots).

Not all forms of topical vitamin C are created equally. Absorption into the skin is based on how lipophilic, or fat-soluble, the compound is. I recommend pharmaceutical-grade vitamin C formulations sold in physicians’ offices or medical spas for the best results and most effective ingredients.

Topical retinoids are also very beneficial in maintaining our skin health. They effectively prevent and smooth fine lines and wrinkles, treat acne and clogged pores, lighten pigmentation and speed up skin cell turnover. Retinoids can help thicken the skin and stimulate collagen and elastin production in the dermal layer.

Retinoids are even important in skin cancer prevention. In essence, they tell our skin cells how to behave. If they divide too quickly, as precancerous and cancerous cells do, they help to turn off this process and promote the death of atypical cells.

I am often questioned about the difference between Retin-A (Tretinoin) and retinol. They are both from the family of retinoids or vitamin A derivatives, but their strengths vary significantly. Retinol is often sold in over-the-counter creams and some in-office skin care lines; however, it does not require a prescription. It differs from Tretinoin in that it requires more steps to be broken down into retinoic acid, the ingredient that is absorbed into the skin. Side effects such as dryness and peeling are milder with retinol. On the other hand, Tretinoin is a pure form of retinoic acid that is absorbed much more quickly into the skin and can cause redness and irritation in some individuals.

Despite their best efforts, some individuals cannot tolerate topical retinoids in any form. In these cases, I often recommend topical azelaic acid, which is not as potent but has similar benefits and is easier to tolerate.

Since retinoids can be irritating, I often recommend that patients start with a lower concentration, two to three nights per week, under moisturizer. If they are still experiencing dryness and irritation with the slow approach, I advise mixing the retinoid with a moisturizer or even applying it on top of a thin layer of moisturizer. Once patients have worked their way up to five to seven nights per week without significant irritation, I like to increase the strength of their retinoid. Retinoids can also be photosensitizing, meaning they may cause one to sunburn more easily. Daily sun protection is critical when using retinoids.

With any skin care routine, it is important to be patient and not give up too quickly when you are not seeing the desired results. These ingredients take three to six months to see significant improvement, but you will be so glad you stuck with them years later when your skin is still glowing and flawless!

Sarah Baker, MD, FAAD, Ark-La-Tex Dermatology

“I recommend hitting the high points. A routine including sunscreen, moisturizer, cleanser, vitamin C and retinoid accomplishes that goal. This routine will help prevent skin cancer and photoaging as well as reverse some of the damage that has already been done.”

-DR. SARAH BAKER, MD, FAAD