Dr. Bernstein on Daily Skin Care
1. Most of the characteristics that we associate with an aged appearance actually result from long-term sun exposure. These unwanted changes include extra blood vessels on our face (commonly referred to as broken blood vessels), brown spots, enlarged pores, and most distressingly wrinkles and sagging skin in sun exposed areas. Proof that these changes result from long-term sun exposure can be easily acquired when looking at sun-damaged and sun protected skin in the same individual. It is very difficult to differentiate sun protected skin from a seventy year old from sun protected skin taken from a twenty year old, when looking at it under the microscope, but skin taken from sun damaged sites tells the true story.
2. The changes that we associate with aging truly do result from long-term sun exposure, or in some instances smoking. Evidence of this is the fact that most people are aged more severely on the side of their face that faces the window in the car. Thus, drivers will be more aged on the left side while passengers will be more aged on the right side. This also illustrates the fact that skin aging is a daily process that sadly does not occur on the beach, but more often in the car. This is because we spent the majority of our time outside in the car. Patients with significant sun damage around the mouth are often smokers, and I can identify these people before they tell me their smoking history. This is not, as commonly believed, due to pursing ones lips to draw upon a cigarette. Instead, this aging is from the formation of free radicals, which occur when smoke is absorbed directly into the skin. In addition to free radicals causing skin damage as a result of smoking, approximately 50% of sun damage is due to the formation of free radicals. This damaged skin then becomes furrowed where our facial expression lines move our skin. If we didn’t smoke or never went into the sun, we could move our mouths, foreheads, and brows as much of we like without getting permanent creases in our skin. These creases only occur because our skin becomes permanently changed by long-term sun-exposure and smoking.
3. Because of the role of free radicals in skin aging, and the high prevalence of acquiring sun exposure in the car, sunscreens with special ingredients that block the UVA rays coming through the car window are necessary for protection on a daily basis. Burning UVB rays are blocked by the car window, while the UVA rays are allowed to pass through. Thus, driving makes us experiencing the aging effects of the sun without enjoying the benefits of being at the beach, going skiing, or just plain having fun outside. Blocking UVA rays is somewhat more difficult than blocking the UVB burning rays. To block these UVA rays we use special sunscreens such as Parsol 1789 (avobenzone), or the chemical-free physical blocking sunscreens that block all wavelengths including the aging UVA rays coming through the windows of our cars (zinc oxide and titanium dioxide).
4. When we get sunburned, it is easy to see that the damaging effects of the sun last long after the sun has set. However the same is true when we don’t get sunburned and just get simple sun exposure. Although we do not see the redness of a sunburn after incidental exposure to the sun such as driving to work in our car or going to the mailbox to check the mail, there is a low level inflammation in our skin after minimal sun exposures. In addition, severely sun-damaged skin can be inflamed all of the time even without sun exposure. Thus our circulating cells can continually damage our skin long after the sun has set. For this reason, adding an antioxidant to our skin care regimen can fight the free-radical damage our inflammatory cells do to our skin, during and after the sun goes down. This is the reason I recommend incorporating antioxidants into one’s skin care regimen in the morning and evening as well. In addition to preventing damage, antioxidants can also help repair the skin. Variations in sun damage are apparent due to different levels of sun-protection.
5. I recommend a sunscreen containing product with significant UVA protection each and every morning. Then in the evening I have patients apply an AHA lotion, followed by a mild nurturing antioxidant product. We use special AHA products that have antioxidant properties as well as the typical exfoliating effects seen with typical AHAs. To supplement this treatment, we add a gentle antioxidant that further protects the skin.
For dry skin on the body, it’s best to apply a moisturizer WHILE WET in the shower or bath, and towel off after. This traps some of the water on the skin and pushes it in the skin. Applying a moisturizer after toweling off will prevent some evaporative loss, but not drive as much water into the skin. I recommend applying AHAs at night, but not immediately after a shower since they can sting if applied then. These products strip away dead skin and cause GAGs to form in skin promoting hydration from the inside out.
6. In addition to topical lotions, we offer special AHA peels which are not actually peels but treatments to the skin which make the skin somewhat pink for the period of an hour or so. These are commonly referred to as “lunch time peels”. In addition we offer non-ablative laser skin rejunivation to augment the topical products and sometimes combine that treatment with citric acid peels for maximal effects.
7. Every person regardless of the status of their skin is a candidate to use sunscreens every morning, as well as products to help rejunivate their skin and help protect it in the evening. The incidental exposure we get in the car, going from the car to work etc. is enough to cause skin aging and damage our skin. Patients with mild to moderate photodamage are the best candidates for laser skin rejunivation or citric acid peels. Patients with very severe wrinkling are best treated with the traditional laser resurfacing.
8. People often feel a mild tingling after applying an AHA lotion. This often decreases over time. Some people upon staring a mild AHA product will not experience any tingling or irritation and can move up to a stronger formulation. I recommend patients start using AHA products every other night to determine if they are going to be too sensitive to it. If not, after about a week increase to nightly use. After using the face lotion for a month, you can consider moving up to the higher strength face lotion. This should be alternated for a week or two every other night with the original face lotion to determine if the stronger product is right for you. In addition, some people often need to decrease the strength of their face lotion during dry, winter months. Some products such as the strongest AHAs or Retin-A may need to be discontinued or used less frequently during the winter. Dry skin is more sensitive, and the dry winter air holds a lot less water than in other times of the year.
9. Following initial use of our skin products, your skin will feel softer and smoother almost immediately or within a few days. This effect is due to the ability of AHAs to remove the dead skin layer (called the stratum corneum). Removing this layer makes our skin more healthy looking, vibrant and supple. It also helps hide shadows on our skin better, and shadows are what cause fine lines, wrinkles and acne scars to show. These skin problems (unlike brown spots and spider veins) are the same color as our surrounding skin, so the reason we see them is that they cast shadows on our skin. Getting rid of the surface dead skin makes our skin more reflective, hiding fine lines, wrinkles and acne scars.
Continued use of AHAs can actually cause an increase in skin thickness, generating new skin formation. Work done in our laboratory has demonstrated an increase in GAGs and collagen gene expression in skin treated twice daily with AHAs. GAGs are the sugars in our skin that babies are loaded with. They are also the one of the first components of new skin formation in a healing wound. Products like AHAs and Retin-A and its relatives produce a healing response in the absence of an actual wound. Thus, continued use of these products will improve the appearance of fine lines and wrinkles initially through surface changes, and eventually through changes throughout the skin.
To answer your specific questions or schedule a consultation, call Dr. Bernstein today at 610-645-5551.
During the summer months you tend to sweat more frequently. Should you wash your face more often than in the winter months? If so, how many times a day?
During the spring and summer we certainly can perspire more necessitating more face washing. The good news is that the air is more humid (holds more moisture) than in the winter, so our skin can tolerate more washing. Still, it’s key to choose the right wash, i like our LaseResults Exfoliating and Hydrating Cleanser because it does those 2 things-and I tell my patients to use it with the Clarisonic Brush for more complete make-up removal. Also, people with oily skin may feel the need to use a toner for further de-grease their skin, but for medium to dry skin-avoid the toner.
How do you protect your skin while engaging in outdoor water activities? Are there any unique tips or tricks for before or after swimming? How can you protect skin from harmful rays, chlorine and salt water?
When outside in the water-one MUST use a water-resistant sunscreen. I like Coppertone Sport in the blue bottle (this no-slip grip makes it great for golf/baseball as well), but i personally use the Kids Coppertone Sport because I prefer the scent. I also like Banana Boat Sport-the coconut smell reminds me of the beach. After swimming it’s key to pick hair-care products that clean and yet are gentle to the skin. Also, Aquaphore (the dermatologist’s duct tape) is also great for lips and dry cracked heel skin when after swimming.
Are there specific areas of the face to focus on that will make your look younger?
Topical products that work are the first line of defense (protect) and offense (repair) in the fight against skin aging. Less is more-then one should investigate non-ablative laser treatments from an experienced laser surgeon recommended by one’s peers and other docs, along with considering toxins like Botox and injectable fillers.
How does taking care of your skin differentiate between skin tones?
I’m very, very light skinned, so the sun can really wreak havoc on my skin and chase me inside if I’m not careful. For skin of color, there are a whole set of different problems. Acne prone skin can show the pigmented spots where acne has healed much more prominently in the summer sun. In addition, melasma can get way worse in the summer due to sun exposure. The keys are to use sunscreen EVERY day and get UV-blocking clear window film for your car. I think that should be standard on every new car rolling off the lot.
Are there any specific skincare tips and tricks for skin of color?
AHAs are great for skin of color to even out pigmentation and remove ashy skin that can result from chlorine in pools drying our arms and legs. Also, the prescription retinoids (like Retin-A) can help improve acne in patients with skin of color, while also lightening the pigmentation caused by these spots. Many of my lighter-skinned patients get more skin irritation with retinoids, but they can tolerate the mild ones like adapalene (Differin).
What are the most common skincare problems for skin of color and how do you treat them?
Areas of increased and decreased pigmentation due to inflammation from a number of causes like acne, eczema, scratching or rubbing, or melasma are very common in skin of color. Lasers do not do a great job with this type of pigment. Topical products to address the underlying cause of the pigmentation as well as clear up the pigmentation are the key-and many are prescription creams and lotions such as topical steroids, retinoids etc. A visit to the dermatologist is my prescription for treating these problems.