Dermatologists are always adding new tools, procedures and medications to their treatment arsenals, as well as tweaking their skincare advice to reflect up-to-date recommendations. How have skincare beliefs and practices changed in the past few years? What’s new and different in the business of fixing skin? Five dermatologists sound off.
Dermatologist, director of cosmetic and clinical research, Mount Sinai Hospital, New York City
The biggest shift in skincare that I have seen recently is a change of view on sunscreen. For many years, people questioned whether higher SPF levels were truly more effective than lower ones. A recent study performed on the ski slopes of Colorado showed that a sunscreen with SPF 100+ performed statistically better compared to a sunscreen with SPF 50. Now, I always recommend that my patients use sunscreen with the highest SPF level possible. I think of ultra-high SPF as an insurance policy to give the best level of protection possible.
We also know that people typically apply half as much sunscreen as they should, which means that they are not getting the level of protection listed on the bottle. SPF levels are determined by lab studies using a density of 2 mg/cm² worth of sunscreen. In order to achieve this in the real world, you need to use about a quarter-sized dollop for the face and 1 ounce — the amount in a shot glass — for the rest of the sun-exposed body. No matter what SPF level you are using, you still must reapply every two hours or immediately after heavy sweating or swimming.
Clinical instructor at the University of Southern California and dermatologist at Rapaport Dermatology of Beverly Hills
Accutane was once considered a last resort treatment for the most severe acne cases. Now Accutane has become a routine workhorse in our anti-acne armamentarium. While topical agents and oral antibiotics are staples and will always be the first line of treatment, the American Academy of Dermatology stated that, in cases where there is no significant improvement after two to three months of oral antibiotic treatment, dermatologists are advised to consider Accutane. This is because it can reduce inflammatory acne lesions and prevent scarring.
Our thinking has changed regarding a class of medications called “biologics” as well. Biologics are generally administered by injection to reduce the activity of pro-inflammatory molecules, thus reducing inflammation in patients with moderate to severe psoriasis and psoriatic arthritis. In the past, there were only two or three approved options, and they were reserved for the most severe cases. In recent years, many new biologic medications have been developed to have specific molecular targets, which helps minimize side effects and tailor treatment to each patient. Dermatologists are becoming more comfortable offering these medications, and an increasing number of patients are enjoying itch- rash- and pain-free lives.
Dermatologist, University of Rochester Medical Center
Let’s talk about aging. We used to think aging skin inevitably started to sag due to the effects of gravity. Sagging skin leads to wrinkles, jowls, turkey necks, droopy eyelids and the other colloquial terms we hear when patients express their concerns. Yet, recently, we have developed a much better understanding of the facial anatomy and structural changes in facial bone, fat, muscle and collagen that occur over time.
First and foremost, the rate at which we age can be attributed to external factors (sun exposure, pollution, stress) and internal factors (genetics, skin type, ethnicity). Physiologically, we lose volume in our face as we age, due to the loss of fat pads that previously helped maintain our rounded facial structure. Additionally, the bones supporting our eyes become wider and longer, and the length and height of our lower jawline decreases, making it less well-defined and therefore less able to support the surrounding skin that used to drape tightly against it. The space between the base of our nose and the upper lip also widens and the muscle atrophies, making the upper lip appear flatter and longer.
We also now know how collagen and elastin are lost. The external factors listed above, especially sun damage and pollution, can contribute to their destruction, resulting in loose, dull skin with little elasticity. This is why, when we make facial expressions such as frowning, our wrinkles stay in place (these are called static lines) instead of snapping back to the smooth skin that was once there. Furthermore, our skin loses more water as we age, in addition to the fatty layer of lipids and ceramides that are essential for adequate hydration and moisture.
Luckily, dermatologists are at the forefront of research; we’ve developed minimally invasive techniques and products to not only slow down the aging process, but also reverse signs of aging.
Director of Springhouse Dermatology and Aesthetics, Philadelphia and New York City
Next to skin cancer and aging, pigmentation is one of the most frequent concerns that I see, particularly in people of color. Patients with pigmentation often tan rather than burn and they have more melanin in their skin, or have melanin that responds quickly to light exposure. They also have fewer problems with sun damage. However, the same things that give them relative protection to cancer and aging also make them more prone to blotchy skin pigmentation and uneven coloration.
Uneven skin pigmentation is extremely troubling to some patients and a constant battle requiring all the tools that I have in my office — peels, lasers and topical creams that interrupt the pigment pathway. But the most important thing for pigmentation is sunscreen.
What I have learned about pigmentation has changed my approach to even indoor light. Light coming through windows, light generated by electronics and overhead lighting may “turn on” pigmentation in these susceptible people. I now make sure that I recommend using a non-chemical (or “physical”) sunscreen both inside and outside as part of a daily regimen. These physical sunscreens contain micronized zinc, titanium dioxide or, in some parts of Europe, tinasorb. They don’t cause breakouts and are often lightly tinted so as to disappear into the skin. I recommend they be used every day — rain or shine, indoors or out — for people who want to maintain their clear complexion and avoid pigmentation.
Dermatologist and dermatologic surgeon, Dr. Dennis Gross Dermatology, New York City
Previously, dermatologists have told patients to limit exfoliation to once or twice per week. Now, it is much more common to see derms recommending that their patients incorporate a daily gentle exfoliation into their skincare routine. The benefits of balanced, chemical exfoliation are endless. When we exfoliate and remove the very top layer of dead skin, we are increasing our cellular turnover. This gives you more than just bright, glowy skin; it also increases your body’s natural production of collagen, strengthens the skin barrier and diminishes fine lines and wrinkles.
It’s important to note, though, that you must use a gentle exfoliant if you are going to use it daily. I recommend a gentle acid peel. They’re formulated with a cocktail of acids at lower concentrations to avoid irritation. I have also seen a lot more dermatologists endorsing at-home devices, such as LED light therapy tools. In recent years, we’ve seen a jump in the efficacy of these devices, which target both wrinkles and acne.
Responses have been condensed and lightly edited.