Topical Skin Care

Topical skin care is an industry. We need to get practical when choosing topicals.  Many cosmeticeuticals seem to have a true pharmacologic effects (drug effects) although it is not legal to make such claims in the U.S. unless the product is already classified as a drug.  The process to  approve a topical as a drug is an expensive one. Therefore cosmeceuticals have not been scrutinized as have the retinoid family of topical drugs.
For topical skin care to have an impact, application has to be consistent.  Topicals cannot resurface the skin nor remove deep lines, unlike medical procedures. Yes, you make observe some immediate improvement  but this is usually a temporary effect of hydration or temporary tightening due to peptides contained in  some cosmetics.  We can't argue with an immediate favorable effect.  However,  we should seek to preserve our appearance, minimize signs of photoaging such as brown spots, fine lines and skin laxity and slow the aging process.  The younger we start with daily topical care, the better the end game will be. Over a period of years to decades, proper skin care can prevent the development of a significant amount of skin aging, not to mention reduce skin cancer risk. 

When a skin disease is present,  such as acne or rosacea, there are many excellent prescription topicals that can help more than most cosmeceuticals.
If you suffer with mel

asma,  breakouts, rosacea or acne then your dermatologist will likely prescribe a combination of topical(s) and/or oral medications.  If you are here for antiaging advice, the recommendations are simpler:

1.  Sunscreen  

I prefer you choose only sunscreens that have a non-chemical active ingredient.  The active will be zinc oxide, titaneum dioxide and sometimes added iron oxide.  The downside to non-chemical sunscreens  is that they can be less cosmetically elegant than their chemical containing counterparts .  I recommend you shop where you can test the product such as at Sephora or Ulta. Try the many available brands such as Bare Minerals or Color 

Science.  If you need a quick fix, consider EltaMD chemical free tinted sunscreen. If possible,  choose a tinted mineral sunscreen in order to filter more visible and infrared light.  The higher end products have a palate of colors to better match your skin tone. Tinted minerals filter more of the various electromagnetic radiation that we now know as harmful. h  The product SPF should be at least a SPF30.  Minerals, unlike chemicals, do not degrade when exposed to sunlight, they are like 

"shiny flakes" that reflect the sunlight.  If you don't sweat or rub them off, one application may suffice for the day, but it's generally a good idea to reapply once during 

during the day.  I recommend a layered approach to sunscreen application, apply  a cream based mineral first with an spf rating and then cover with a Mineral Powder which should also have an spf rating.  It is true that zinc or titanium mineral makeups will help filter UV light, but without an SPF rating, you cannot know how effective, or ineffective, the product might be in screening harmful UV.  Lines such as Bare Minerals and Jane Iredale are unfortunately, constantly changing their product lines and removing spf ratings due probably to more stringent rating requirements.  


The IT line available at Sephora has a great line of CC creams, with all mineral sunscreen content in an SPF 40-50 range.   Make sure your base coat (primer) AND a covering foundation that are mineral containing only (no chemical sunscreens) AND have an SPF rating in the 15-30+ range.

 Bare Minerals makes BB Primer with a 30 SPF and comes in four colors.

Bare Minerals BB Primer SPF 30 

For minimalists, Covergirl presently markets and SPF 20 "aqua smooth" solid makeup with all mineral sunscreen (titaneum dioxide) and is available in various colors at the local pharmacy.  Note these companys' lines are constantly changing.  

Jane Iredale has various products that are rated with an SPF.  Pharmaca carries a partial Jane Iredale product line.

Layering mineral sunscreens improves UV protection. Some mineral powders are available in tubes with an integrated brush making them easier to reapply throughout the day. (see mineral powder
link above)  

If you are a minimalist, or covering large areas with sunscreen, Sun Bum all mineral sunscreen (pictured)
(non chemical) 
is a great product and available widely such as at Target or Amazon ($14.95).  If you shop around, please check the label's active ingredients to make sure their mineral sunscreen is not also using chemical sunscreen agents.  Mineral "only" sunscreens use only zinc oxide, titaneum dioxide or iron oxides. 

If you suffer from MELASMA (the mask of pregnancy) and  cannot regularly use multilayered sunscreen as above, you can supplement with a sunscreen stick, one of at least SPF 50.  The stick should preferably 100% mineral content.  To improve your results choose a mineral sunscreen that also contains iron oxide which filters more of the visible light;  wavelengths that cause tanning and pigmentation.  Iron oxide addition will make the sunscreen tinted to an extent but adds a significant amount of visible light protection.  Iron oxide is not considered a true sunscreen so it is found on the list of inactive ingredients below the "active" zinc and titanium oxide sunscreen agents.  Skinceuticals has an iron oxide sunscreen below:

Physical Fusion Sun Defense SPF 50

A high SPF, all mineral sunscreen stick isn't always easy to find.  Here is one suggestion:  

Retinoids differ from retinols!  Retinols are less effective cousins to retinoids. Retinoids can be drying and make you a tad bit sun sensitive.  Retinoids are decades old and have yet to be deposed by ANY other substance for topical skin rejuvenation.  All retinoids are prescription items, except one;  Adalapene 0.1% gel.  Adalapene 0.1%  is  inexpensive and FDA approved as an over the counter anti-acne drug in ge form.  Purchase Adalapene gel as La Roche Posay Effaclar Adalapene Gel 0.1%  or Differin gel at  Target, Rite Aid, CVS, or Amazon  (Store Locator) .Like all retinoids, apply a pea sized amount over your face at night.  Avoid your lips and eye area.  If you are a bit dry, use it only 2-3 times a week until you can tolerate it more often.  Look for subtle but real results in 6 months (acne improvement in 6-12 weeks.  Never stop!
Patients in their 70s + who have used retinoids faithfully for a decade or more look amazing despite never having any laser or other cosmetic treatments.  Most all also used sunscreen faithfully and stayed out of the sun! If you want or can tolerate stronger retinoids you will need a prescription.  Ortho has a new Tretinoin (Altreno) 0.05% lotion in a moisturizing base (it is stronger than Adalapene 0.1%).  This is the prescription retinoid I most commonly prescribe.  It is available for a flat fee of $115 online with a prescription or about $135 at the pharmacy.  

Altreno is a non-generic form of "retin A"  (tretinoin 0.05%) and utilizes an elegant formulation.  
Remember,  Altreno, like all tretinoin retinoids requires a doctor's prescription.  One tube will last about 3 months. Other prescription only retinoids include  Adalapene 0.3% and Tazarotene (Tazorac).

3.  Antioxidants   This is the optional part of the equation.  If used in the morning,  antioxidants probably do buffer the sun's ability to damage skin DNA. You can change you antioxidant at will, feel free as it is not certain which, if any, are effective.   Go ahead and buy that $500 cream you've been wanting.  Or purchase one of the inexpensive Deciem (The Ordinary) antioxidants.  Skin Ceuticals is also a higher end and trusted name for topicals.  Which do I like?  I change my mind too so no guilt.  If you have excess pigmentation I like Skin Ceuticals Discoloration Defense or AzaClear Brightening pads (azelaic acid + niacinamide) typically sold by a physician.  Our office sell the AzaClear products. For no particular reason,  I like The Ordinary's  Resveratrol 3%/Ferulic Acid 3% (less than $10).  If you have  sensitive skin it might sting a bit.  Topical Vitamin C is a popular topical antioxidant (e.g. Skin Ceuticals 10% vitamin C), or use The Ordinary's version  30% Vitamin C suspension in silicone.  For rosacea,  AzaClear cream (azelaic acid + niacinamide) is one of my favorites.

Consistency is most important.  Keep it simple.  If you use the products (sunscreen and retinoid) and don't see a change, you are wrong!  There is slow but sure microscopic change, proven through decades of validated scientific reseach studies.  The changes in your skin include reversal of microscopic sun damage, improvement in pigmentation and even fine lines after 6-12 months of regular use. Have faith and be patient.

4.  Moisturizers

Use as needed.  I recommend a quality hyaluronic acid containing moisturizers (HA).  HA is also anti-inflammatory.  You can spend a bit more money for products such as Skin Ceuticals Hydrating B5 Gel.  but even less expensive products from a quality company such as La Roche Hyalu B5 gel are effective.  

5.  Oral Supplements? 
The only oral supplement that I regularly recommend is Niacinamide.  Niacinamide has been shown to reduce skin pre-cancers in high risk individuals.  Whether it's antioxidant properties will help those of us who are not immune-suppressed or who are yet to develop skin cancer has not been investigated.   Niacinamide orally may also help control acne and rosacea pustules.  The double blind, placebo controled study of niacinamide and skin cancer prevention in high risk individuals was published in the New England Journal of Medicine, a revered medical journal.  The dose found effective was 500mg  twice a day.  I recommend patients take 1000 mg as a single dose for simplicity once in the am,  although 500mg twice a day may give more even blood levels. Niacinamide 1000mg is easily found on Amazon and in most pharmacies.  

Oral collagen remains controversial and without any peer reviewed studies to show significant efficacy. 

Heliocare contains polypodium extract (an amazonian fern) and has been definitively shown to increase the threshold for sunburn,  which is desirable.  However in some studies 3 pills daily (two in the am, one at noon) were necessary for it to significantly impact facial pigmentation (melasma).  Unlike polypodium, niacinamide (mentioned above) has a well controlled study to show it might reduce skin cancer incidence in those with a history of non-melanoma skin cancer,  unlike polypodium extract.

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