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How to Build a Skin Care Routine:

The Dermatologist's Guide to Designing a

Skin Care Regimen That Works For

Your Skin Type and Your Skin Concerns

As a dermatologist, I have spoken to (literally) thousands of my patients about their skin care regimen. That means I’ve spent many, many hours thinking about how to develop a skin care routine that works for you, your skin type, and your skin concerns.


I’ve also taken a stroll through Google, and it's amazing to me how much inconsistent advice, and even potentially harmful recommendations, are out there. That means that it’s really up to you to do your homework.  You might be tempted to purchase a product because your girlfriend said it works for her, or because the lady in the lab coat at the makeup counter really thinks you should buy it. 

 

Before you purchase that product, though, make sure you think about what your personal skin care goals are, what your current skin type is, and what ingredients and formulations you should be looking for. 

 

Developing A Skin Care Routine: Background

Everybody's Different: Why You Need to Create Your Own Personalized Skin Care Routine

The first rule of medicine, in absolutely any field, is that everybody’s different. In dermatology, my patients are dealing with different skin care concerns. They have different skin types, which will change over the years, and even may change by the seasons. We all have different preferences for the kind of formulations that we like to have on our skin. And our skin often reacts differently to the same exact product.

 

This is why I have thought long and hard about how to create a framework that’s flexible enough to cover these different skin care concerns, yet still able to provide some clear guidance.

 

If you’d like to work on developing your own skin care routine, here are my recommendations. These are informed by conversations with thousands of patients on what has worked for them, along with an extensive review of published medical research in this area.

When You Think About Your Skin Care, Think About the ACT Rules:

Adjustable, Consistent, Tailored

Before we get started, there are a few important rules for designing your skin care regimen. I call these the ACT rules.

You have to be ready to adjust your skin care routine, you need to be consistent when you’re trying a new product, and you need to make sure your products are tailored to your skin type and to your skin concerns.

  • Adjust: you WILL need to adjust your skin care products as you age, and many of us will need to adjust our skin care products based on the season

  • Consistent: the best skin care products won’t work unless you use them consistently

  • Tailored: make sure that the products you choose are tailored to your skin type and to your skin concerns

These are really important principles, and they’re not emphasized often enough. I myself have a winter set of products and a summer set of products. I’ve also had to change my product formulations dramatically over the last 10 years, as my skin has started to experience more dryness.

Consistency is also not talked about often enough. Some of the major beauty retailers send out skin care samples with every purchase. However, you shouldn’t be trying the latest and greatest skin care products one after the other. If you’re trying out a new product, remember that it takes about 28 days for your skin cells to turn over. That’s why dermatologists will tell you that most products need at least one month of use to see results.

Among my dermatology colleagues, one of our favorite anti-aging (and anti-acne) skin care products is a category called retinoids. When I prescribe tretinoin (brand name Retin-A), I tell my patients that they’ll need to use it for 8 weeks on average to see results.

A Skin Care Routine is More than Just Skin Care Products

I need to emphasize one big point before we get started on skin care products. A skin care routine is about far, far more than just skin care products. In fact, my favorite strategy for protecting the delicate skin around your eyes isn’t an eye cream: it’s big sunglasses.

 

It all comes back to one of my favorite sayings: When it comes to your best skin, make sure that you’re treating your skin right, inside and out. 

 

That means the right food, the right skincare, and the right lifestyle. 

 

For more on my favorite skin saving foods and the importance of “eating power”, you can check out my recommendations here. For more on the importance of lifestyle factors, especially stress management, beauty sleep, and exercise, please see this section of my website.

Along the same lines, one of the main foundations of a skin care routine is the right sun protection. But sun protection is about far more than just sunscreen. The best sun protection uses both SPB and SPF. 

 

·       SPB: Sun protective behaviors that include using sunglasses, hats, and clothing, and making the right choices on how to be out and about in the sun.

 

·       SPF: Skincare products with a Sun Protection Factor. Here are my tips for choosing sunblocks for those with sensitive skin. 

Prevention is Key: What You Do Now Helps Determine the Skin You'll Have 10 years from Now 

The skin care products you choose should help you treat your immediate concerns, but they should also incorporate preventive measures. For women in their 30s, I can promise you that what you do, starting today, will make a big difference in how your skin looks as you enter your 40s. And that holds true for every single decade. The choices you make today about sun protection, the right skin care products, nutrition and lifestyle factors, will make a big difference in the level of protection that you’re providing for your skin. I’m a huge skin defender, and you should be too.

 

Developing a Skin Care Routine: The Basics

When you’re choosing skin care products, it all comes down to your skin type and your main skin concern.

Skin Types:  Dry, Oily, “Normal”, Combination, and Sensitive

Skin Concerns: Examples include acne-prone, anti-aging, dark spots, prone to allergic skin reactions, seborrheic dermatitis, and others 

 

*The section that follows has a chart with guidelines on how to determine your skin type. 

The Foundation of a Skin Care Routine: The Main Skin Care Products to Focus On

The main players in your skin care routine are going to be 3 main ones, along with extra products based on your skin concerns. You’ll need to make choices about 

 

·       Your cleanser

·       Your moisturizer

·       Your sun protection

·       Additional Products: I also recommend additional products on top of these foundational products, based on your skin type and your main skin concern

Can Skin Care Products Really Make a Difference?

If you’ve read this far, I’m assuming that you’re already a believer in the power of skin care. As a dermatologist, I’m a huge believer in the power of topical products, because I’ve seen how well they work for many skin issues. “Topical products” means products that are applied to the surface of the skin. (Oral medications, on the other hand, are those that are taken by mouth.)

 

I’ve treated many patients with mild to moderate acne, and just 8 weeks of topical medications can transform their skin. With the right active ingredients, and the right formulations, the results can be amazing.

 

But (and this is a big one), it really depends on what you’re trying to treat. Fine lines and wrinkles can respond well to topical treatments. Deeper wrinkles or sagging skin are going to need more than just skin care. Those call for a consultation with your dermatologist and a discussion about potential treatment options such as non-invasive cosmetic procedures. 

 

Now, on to the details. 

 

How to Develop your Own Skin Care Regimen

1. Determine your Skin Type

There’s lots of overlap here, and there are lots of fine nuances, but I think it’s important to keep it basic. In general, I see five main skin types. 

 

·       Oily

·       Dry

·       “Normal”

·       Combination

·       Sensitive 

 

Here’s the general description of each:

Oily

  • Has a shiny appearance by the end of the day

Dry

  • Often feels “tight”
  • May feel rough
  • May have fine flaking on skin

Normal

  • No medical definition
  • Generally means that your skin is not too dry or too oily
  • Does not get irritated by usual skin care products

Combination

  • Different combinations of skin types in different facial zones
  • One common combination is normal skin over most of the face, with oily skin in the T-zone
  • The T-zone is the nose, the forehead and the chin
  • Another common combination is seborrheic dermatitis: Normal or oily skin over most of the face, with flaking and redness between the eyebrows and in the nasolabial folds (the lines that run from your nose to the corner of your lips)

Sensitive

  • Use of certain skin care products may trigger redness, burning, stinging or irritation
  • Has to be very careful with new products
  • May have history of more severe allergic skin reactions to products, with red rashes
  • Sensitive skin can also be a temporary state, and may result from too many skin products, over-exfoliation, irritating ingredients or improper technique.

2. Choose Your Products with the CESNA Approach: Five Steps To A Skin Care Regimen (*Not Every Step Needs To Be A Product)

C: Cleanser

E: Extra benefits

S: Sun protection

N: Night-time cleanser

A: Active treatment

 

Let me give you an example of how the CESNA approach works for someone like me. I have sensitive skin, and my main focus as I enter my 50s is slowing down the visible signs of skin aging. 

Skin Type: Sensitive

Skin Concern: Skin Renewal ( "Anti-Aging")

C

Cleanser

  • Rinse with lukewarm water

E

Extra Benefits

  • A serum with antioxidants or

  • Hyaluronic acid moisturizing cream

  • Antioxidants such as vitamins C or E to provide extra protection against free radicals

  • Vitamin C also blocks the production of melanin, reducing the development of black spots

  • Hyaluronic acid to help temporarily "plump" the skin

S

Sun Protection

  • SPB: Sun protective behaviors

  • SPF: Sun Block

  • Sun Protective behaviors: Sunglasses, hat, caution

  • Some days: Neutrogena Healthy Defense Daily Moisturizer SPF 50

  • If outdoors: Vanicream SPF 50 sunblock

N

Nighttime Cleansing

  • Oil-Based cleanser to dissolve make-up followed by

  • Gentle hydrating or foaming cleanser

  • Albolene Gentle cleanser (to remove eye makeup)

  • CeraVe foaming facial cleanser

A

Active Treatment

  • Retinoids

This may differ based on season and how dry my skin is. Some that I've used and liked are:

  • Neutrogena Rapid Wrinkle Repair Face Cream with Retinol

  • Differin Adapalene 0.1% gel

  • LaRoche-Posay Effaclar Adapalene 0.1% gel

  • Burt's Bees Renewal Firming Moisturizing cream with bakuchiol (contains added fragrance, so I no longer use it due to my sensitive skin, but could be an option for others)

The CESNA Approach to Developing a Skin Care Routine: Other Examples
When Choosing Products, Learn The Difference Between An Active Ingredient And A Vehicle

One of the things that I find frustrating when reading online guides to skin care regimens is that they sometimes recommend vehicles instead of ingredients. I don’t recommend using a “serum” or using a “toner”. These are just types of vehicles, and the category of “serums” alone may cover dozens of different active ingredients. Instead, I’ll recommend a vitamin C serum, or a hyaluronic acid serum. 

 

In fact, it’s really important to pay attention to both the active ingredient AND the vehicle.

You can think of active ingredients as the workhorses of your skin care regimen. These are the ingredients that actually do the work of modifying your skin or treating your skin concerns.  In fact, you can think of them as magicians: they help make the magic.

Vehicles, by themselves, don't create the magic. But you can think of them as a magician’s assistant. Sometimes they’re just there to look pretty, but sometimes they’re a critical part of pulling off the magic trick. 

 

  • Active ingredients: Examples include retinoids, niacinamide, vitamin C, hyaluronic acid

  • Vehicles: Examples include serums, toners, creams, lotions, and gels

Choosing Active Ingredients

This is a topic that really requires a textbook. But I’m going to give it a try here and give you the general outline on what I’m looking for when I’m evaluating active ingredients and looking over the research on new ingredients. 

 

When you’re learning about the abilities of an active ingredient, it’s important to focus on function. In other words, what does this ingredient actually accomplish when you apply it to your skin? 

 

Focus on function. Are you looking for an ingredient that inhibits the production of melanin, so that you’ll reduce your risk of dark spots? If so, there are several ingredients that can accomplish that same function. And you don’t need all five of them; you may just need one.

 

The following table is in NO way a complete list.  However, here are some examples of functions that are important for different skin types and concerns, along with examples of ingredients that can accomplish those functions.

Examples of Key Functions:
Important Actions Performed by Skin Care Ingredients  

Chemical Exfoliation

  • Helps loosen and remove dead cells from the skin surface

  • Also removes oil

  • Helps smooth out the surface texture of the skin

  • Reduces whiteheads and blackheads

  • May improve radiance

  • May be helpful for those with oily skin and acne

  • May help in skin renewal, although can cause redness and irritation

  • Alpha-Hydroxy Acids such as glycolic acid, lactic acid

  • Beta-Hydroxy acids such as salicylic acid

Increasing cell turnover

  • Helps skin cells slough off more effectively from the surface of the skin

  • Reduces whiteheads and blackheads

  • Helps smooth out the surface texture of the skin

  • Helpful in those with acne and seeking skin renewal

  • Formulation of vital importance 

  • Retinoids

Improving skin hydration (temporary effect)

  • Helps "plump" the skin

  • Temporarily reduces the prominence of fine lines and wrinkles

  • Hyaluronic acid

Reducing water loss from the skin

  • Moisturizing the skin

  • Strengthening and repairing the skin barrier

  • Petrolatum, Propylene glycol, Coconut oil, ceramides

Blocking the production of melanin (skin pigment) or blocking the transfer of melanin to skin cells

  • Helps block the development of dark spots on the face

  • Helps "brighten" the skin

  • Helps reduce PIH in those with acne  (post-inflammatory hyperpigmentation) 

  • Often used in those with melasma 

  • Vitamin C, Kojic Acid, Licorice extract, Niacinamide, Soy

  • Prescription hydroquinone, azelaic acid

Increasing collagen production

  • Reduction in fine lines and wrinkles

  • Retinoids

Antioxidants to prevent against free radical damage

  • Free radical damage contributes to fine lines and wrinkles, dark spots and even skin cancer risk

  • Vitamin C, Vitamin E, ferric acid, phloretin

 

Key Active Ingredients To Look For in Skin Renewal (Anti-Aging) Skin Care Products

  • Retinoids: The Skin Smoothers.

    • I call these the “smoothers” because they help smoothe out fine lines and wrinkles by increasing collagen production and helping smoothe out the skin’s surface texture. These are considered one of the most effective skin renewal ingredients available. 

  • Vitamin C: The Dark Spot Preventer.

    • This is the dark spot preventer because it helps block the production of melanin. It’s also a strong antioxidant, so helps provide an extra layer of free radical protection. 

  • Vitamin E: Extra Defense.

    • This antioxidant provides an extra dose of free radical defense.

  • Hyaluronic acid: The Temporary Plumper.

    • This is “the temporary plumper”, because as a humectant it attracts water to the skin’s layers. This produces a temporary plumping effect that helps diminish the look of fine lines and wrinkles. 

  • Caffeine: More Hype Than Science.

    • I consider this ingredient “more hype than science”. In one study, a cooling gel worked just as well in diminishing the appearance of dark circles with and without caffeine. 

The Main Ingredients That I Avoid When I'm Choosing Skin Care Products

I specialize in the treatment of sensitive skin, eczema, and allergic reactions of the skin. That means that I'm hyper-aware of ingredients that commonly trigger either irritation or allergic reactions. That's the main reason I avoid certain ingredients.

 

For my patients, I usually recommend products that do NOT contain: 

 

  • Fragrance. Of all the ingredients that I test for, the category of fragrance additives is one of the top triggers of skin issues. Among my patients, fragrance additives are the most common cause of allergic contact dermatitis (aka allergic skin reactions). 

Fragrances are challenging. To start with, when you see a product label that lists "fragrance", that's a little misleading. It sounds like it's just one ingredient. It's not. In fact, that single word may indicate the presence of 40 or more different fragrance additives. 

 

Because of labeling laws in the US, manufacturers do not need to tell you the ingredients that make up their secret "fragrance" mixture. To make it more challenging, products that are labeled as "fragrance-free" may in fact (quite legally) contain fragrance additives, due to loopholes in the labeling laws. For more information about fragrance allergy, please see my handout.

 

  • Formaldehyde preservatives. If you look at the top 10 causes of allergic skin reactions in North America, formaldehyde and formaldehyde-related preservatives are in the top 10 (not a great list to be on). For this reason, none of my recommended products contain formaldehyde or related preservatives

  • Methylisothiazolinone (MI). This ingredient is used as a preservative in skin care products. Unfortunately, over the last decade  we have started to see an epidemic of allergic skin reactions to this chemical. I never use products that contain MI anymore. 

Formulation Matters: Why Vehicles are So Important 

The right active ingredients are critical. However, it's just as critical to get the formulation correct.

 

For the best function, you need the right product. The “right” product has:

  • The right active ingredient…

  • Along with a formulation that can effectively deliver those ingredients to the skin layer where they can actually work.

  • That formulation also needs to work well for your skin type.

 

I'm really focused on formulations when it comes to certain active ingredients. For example, formulation is incredibly important when it comes to retinoids. Almost anybody can use a retinoid, but you’ll need to pay close attention to the formulation. That’s why retinoids come in vehicles ranging from creams, lotions, gels, and moisturizing creams to special microspheres.

 

Type of Vehicles

Type of

Vehicle

Physical Characteristics

Which makes it good for

But... think of this considerations

Lotion

  • Water-in-oil formulation with a higher proportion of water

  • Light moisturizing

  • Absorbs into skin well

  • Does not lock in moisture into the skin as well

Cream

  • Water-in-oil formulation

  • A thicker moisturizer

  • Best absorbed into skin when applied to damp skin

  • Helps lock moisture into skin

Ointment

  • Oil-in-water formulation

  • Thick, greasy feel

  • Seals moisture into skin

  • Greasy feel

  • Does not rub into skin

  • May rub off on clothing

Gel: Alcohol based

  • Alcohol base

  • Quick-drying

  • Dries out skin, may be irritating

Gel: Propylene glycol-based

  • Uses propylene glycol to create a "slippery" gel

  • Helps active ingredients penetrate into skin

  • May be irritating for some

Serum

  • Not clearly defined, but is typically a liquid that provides concentrated dose of active ingredients

Foaming cleanser

  • Liquid cleanser with foaming surfactants to remove dirt and another impurities from skin

  • Effective at removing oil from skin

  • May be too harsh for some

Hydrating cleanser

  • Uses different cleansing ingredients; non-foaming

  • Very gentle cleansers

  • Do not foam, and some patients feel as though they leave a residue on their skin

Peel

  • Many different types, but classic peels use different types of acids

  • Helps remove top layers of skin

  • Known for causing temporary redness and irritation of the skin

Toner

  • Not clearly defined

  • Typically refers to a liquid applied after cleansing and before moisturizing

Often (but not always) used to remove excess oil

Active ingredients may include

  • Alcohol or

  • Alpha-Hydroxy Acid or 

  • Ingredients such as Witch Hazel extract

  • May cause dryness, redness and irritation

 

Some Frequently Asked Questions When It Comes To Developing A Skin Care Routine

Why isn't my skin responding?

If you’re not seeing results, you need to consider a few factors.

 

  • Are you using the right product for your skin type and your skin care concern?

  • Are you using the product correctly?

  • Have you been using it long enough to see results?

  • Are you looking for results from a product that it just can’t accomplish? In other words, do you need a procedure instead of a product to get the results that you’re seeking?

As a dermatologist, what is your favorite brand of skin care products?

I don’t have one particular “favorite brand.” I have sampled so many products from so many companies. What I’ve discovered is this: there are many great products from many companies and across all price points.

I attend the American Academy of Dermatology meeting every year, where companies sample their latest offerings to dermatologists from across the world. What I’ve discovered is that there are so many great products out there.

Some of my patients prefer to stick with one particular brand, because they have clear directions on how to use the products and they like consistency. I think that’s a great approach for some.

I also think it’s just fine to mix and match brands, as long as you’re focused on how the different ingredients and products work together. That’s my personal approach.

And I’m actually not concerned about price point at all. There are certain ingredients that are likely to be more expensive. But beyond that, much of the price difference is related to the aesthetics of the product (such as the fragrance additives) or the aesthetics of the packaging. Which can add a lot to the price of the product. And, of course, as with any other luxury product, sometimes you’re simply paying for the brand name and the aura associated with that brand.

A few other reasons why I don't have a "favorite" brand.

My patients have such a range of skin types and different skin concerns. It’s so important to tailor your skin care regimen to you. Not all brands have products that cover all of these different skin concerns.

Also, personal preference makes such a huge difference, and is one of the main reasons why I hardly ever recommend one single particular product. I may tell you what I’ve personally used and liked. Or what a friend of mine or a patient has used and liked. But I simply can’t make an individualized recommendation.

 

I specialize in patients with sensitive skin, and I almost never recommend a single moisturizer to a patient. Instead, I give them samples of five different types so that they can try them and see what formulation they like. I’ve chosen these because I like the ingredient profile of all five, but my patients may like the feel of one particular product on their skin better than the others.

And your daily routine can also play a huge role in how you choose your skin care products. I have a particular hand cream that I love to use during the day, because I might be shaking hands throughout the day and I can’t use anything that’s too greasy. Factor that in as you’re choosing your skin care products.

How Do I Choose Which Active Ingredient To Use?

Sometimes I’ll pick up a beauty magazine and I’ll feel a sense of déjà vu. Why does it seem as though in every other issue they’re raving about a different new and amazing skin care ingredient? How can one person possibly use all of these fantastic (indispensable?) skin care ingredients?

 

This is where you need to stop and remind yourself of one important fact.

There are only so many ingredients that you can be putting on your face. There are only so many ingredients that you SHOULD be putting on your face. 

 

In fact, if you try to combine too many active ingredients into one product, you run the risks of:

 

  • One ingredient simply inactivating the other

  • Or worse, you run the risk of these ingredients worsening the side effects of each other

  • Or you could just be running the risk of wasting your money on three active ingredients, when you’d get just as great a result from one active ingredient

 

As just one example: if you’re looking for a chemical exfoliator, you might reach for either salicylic acid or glycolic acid. You shouldn’t reach for both, because you run the risk of irritation, stinging, redness, flaking, and a rash.

 

That’s one of the reasons that I personally use few active ingredients and few products. I’m looking for highly targeted, highly functional ingredients, so that I can use fewer products overall. 

How Dermatologists Keep Up With The Latest And Greatest Skin Care Ingredients

There are so many new ingredients, and it seems as though cosmetic chemists are creating new ones all the time. I’m a dermatologist, and it is still incredibly challenging for me to keep up with all of the latest ingredients. It's also a huge challenge to keep up with the many, many products on drugstore and department store shelves advertising those ingredients.

How do I investigate those claims? To start with, I rely on clinical studies. These are the studies that are performed in human volunteers. Of course, I'm not just looking for any "clinical studies": I’m looking for high-quality studies. 

I've seen more skin care ads than you can count, and I’m simply not impressed with those that advertise “4 out of 5 users noted improvement in fine lines and wrinkles within two weeks.”  I'm not impressed, because there’s a huge placebo effect in play every time you’re using an expensive product and looking at outcomes that are highly subjective. 

Have you ever looked in the mirror one day and thought that you looked older than usual? Really noticed a lot more fine lines that day, for whatever reason? And then one week later you looked in the mirror and felt much better about the way that your skin looked? That's what I mean by "subjective" measurements. Whether you're looking at your skin, or a dermatologist is looking at your skin, it can be hard to objectively measure the extent of your fine lines and wrinkles. 

That’s why I’m not as impressed with studies that only rely on user ratings. User ratings should definitely be one part of evaluating a product, but they’re one of the least important ratings when I’m trying to evaluate a new ingredient. 

I really most heavily on research studies. One of my favorite type of studies are what are known as “split-face” studies. You apply Product A to one side of the face, and then apply Product B to the other side. You continue for 12 weeks. And then you look at your face and see if you can spot a difference. Even better, you have an impartial researcher examine your skin and you see if THEY can spot a difference. (And, of course, this study is best if neither one of you knows which cream went on which side.) This type of study is known as a split-face, randomized,  double-blind (neither the volunteer nor the researcher knows which product is which) and controlled trial (meaning there's an active ingredient compared to a placebo). 

Another type of research study that I find very helpful are before-and-after randomized placebo-controlled trials. In this study, one group of patients uses Product A (containing the active ingredient) and the other group uses Product B (containing the same exact ingredients, without the active ingredient). At the end of that time, researchers see which group improved the most from baseline. 

Here are links to some before and after photos in published studies that have used this type of research methodology:

 

 

 

There actually aren’t that many of these types of studies available for many of the active ingredients that are out there. Which means it can be very challenging to draw conclusions about the latest and greatest ingredients. 

That’s why I tend to rely on ingredients that have a long track record behind them, with lots of clinical studies. For example, one category that's probably been studied more extensively than any other for the treatment of fine lines and wrinkles is retinoids. These have shown impressive results. On the other hand, other ingredients such as caffeine have yielded pretty disappointing results when studied with careful clinical trials. 

How Do Dermatologists Scientifically Evaluate A New Skin Care Ingredient?

Most dermatologists follow the 3-question approach developed by Dr. Albert Kligman, a prominent cosmetic dermatologist.


1. Can the active ingredient actually penetrate through the stratum corneum (the outermost layer of the skin) and then be delivered in a high enough concentration to target areas in the skin? 

2. Does the active ingredient have a biochemical basis for producing skin benefits? 

3. Are there published, peer-reviewed, double-blind, placebo-controlled clinical trials that help substantiate any of the claims made by this product?

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