Normal Skin Care

Quynh-Giao Ly Nguyen

GENERAL PRINCIPLES OF NORMAL SKIN CARE

A variety of skin care products are available on the market, often touting skinrevolutionizing claims, to the point where a product exists for almost any kind of skin care concern. Despite the overwhelming number of products and advertising claims, the recommended skin care regimen is much less complex. Routine care of normal skin focuses on keeping it clean, balanced, protected, and free of irritation. These goals can be achieved with a simple regimen, often of three or fewer steps, performed once or twice daily, and adjusted accordingly to seasonal weather changes. The steps in this regimen include gentle cleansing, moisturizing, and protecting the skin from ultraviolet (UV) rays—the last of which can be skipped at night. In addition to discussing the principles underlying the recommended regimen, this section will analyze various popular skin care treatments available. A brief subsection on hair and scalp care is also included.

An important caveat to this section is that while “normal” skin refers to skin not affected by any disease process, it still encompasses a diversity of skin textures, colors, and complexions. The principles in this section are applicable to almost every “normal” skin type.

I. SKIN NUTRITION

A. Supplements. Dietary supplements may be beneficial in cases of difficulty obtaining nutrient(s) through normal dietary means. The risk of toxicity may outweigh the potential benefits to normal skin. Except in nutritional disorders such as avitaminoses (e.g., pellagra), there is no convincing proof that any dietary supplement can enhance skin, hair, or nail growth.

B. Topicals. Topical application delivers nutrients more quickly and effectively than dietary supplementation. However, since replicating cells in the skin, hair, and nails receive their nutrition from deep dermal vasculature, external application of nutrients—including antioxidants, amino acids, collagen, ribonucleic acid, and elastin—may not penetrate or stay long enough to have more than a transient effect. Even the best topicals only affect the cells near the surface, thus eventually losing the topicals’ imparted benefits once shed. Despite their limitations, the benefits of topicals loaded with antioxidants still make them worthwhile. For instance, vitamin E, which is stored in the stratum corneum, forms the first line of antioxidant defense and further has a protective effect on cellular membranes. In addition to vitamin C, vitamin E has been shown to improve the skin’s moisture retention and decrease freeradical damage.

C. Lifestyle. The majority of the skin’s nutrition is internally derived, and driven primarily by genetically determined physiologic factors and secondarily by
dietary intake. Though one cannot change their genetic makeup, they can optimize the health of their skin through prudent lifestyle choices such as getting enough rest and relief from stress.

D. Diet. A positive change in diet can manifest as skin changes within a few weeks. Antioxidants such as vitamin A are present in fish as well as yellow and green vegetables and have been shown to affect growth and differentiation of human keratinocytes in vivo, promoting cell turnover. Citrus fruits and sweet potatoes are foods rich in vitamins C and E, respectively, and are known to have a calming effect on skin. Melons are lauded for their high water content. In general, a diet high in vegetables, fruits, nuts, fish, and water can promote healthy skin.

II. CLEANSING THE SKIN

A. Formulation. As the first step in normal skin care, cleansing lifts away poreclogging buildup and stimulates circulation to the skin. The market offers a variety of cleansers for the face, from soaps to creams and lotions. Generally, one should consider skin type, environment, and makeup when choosing a cleanser, as no one formula will work best on everyone. Soap-and-water cleansing will remove most substances from the skin, including dirt, sweat, bacteria, and oils. Dry skin benefits more from superfatted soaps, which contain more fatty materials such as cold cream, cocoa butter, and lanolin. Transparent soaps, containing glycerin, are another option for those with dry and/or sensitive skin. Meanwhile, oily skin cleanses better with soaps high in surfactant. Those living in harsh environmental conditions, such as windy and/or low humidity cities, may wish to consider formulations for dry/sensitive skin. Those who use waterproof makeup may look to creamy formulations, which more easily remove oil-soluble ingredients. In many instances, an effective regimen consists of removing makeup with a cleansing cream followed by soap-and-water to clean the skin. “Synthetic soaps” are a more recent option. They are formulated with synthetic detergents that claim to be gentler and less drying on the skin.

B. pH. The pH of normal skin at its surface is approximately 5.5 (though some studies have reported a value below 5 for natural skin without any contact with product or water). Most natural soaps, which contain surfactants, are much more alkaline at pH 9 to 10 and transiently increase skin pH. This finding has been used in marketing for many synthetic soaps to promote their more neutral pH (usually below 7) and therefore superior efficacy. In general, maintaining skin at a lower pH has been linked to better skin health, preserving resident skin flora and reducing the risk of irritation. Recent studies have shown that Dove, a primarily synthetic soap of neutral pH, was the least irritating among 18 cleansers tested. At the same time, not enough evidence supports that other soaps, aside from potential side effects of irritation, are harmful to normal skin. It should be noted that even water will increase skin pH transiently. Nevertheless, a pH neutral cleanser may be a reasonable starting point when choosing a formulation.

C. Frequency. Excessive washing with soap or detergents can lead to dryness of the skin, an effect compounded in areas of high wind and low relative humidity. The use of a “mild” soap and a reduction in the number of washings to once or twice daily will minimize the drying effects. Those who must
wash their hands frequently are advised to use as little soap as possible and to apply an emollient such as petrolatum after washing.

D. Deep Cleansing. Methods of deep pore cleansing (e.g., “facials”) may decongest skin, temporarily improving appearance. No long-term benefits of this have been demonstrated.

III. MOISTURIZING THE SKIN

A. Formulation. Moisturizers or emollients function to increase the stratum corneum’s moisture level by (1) attracting water to the skin, (2) decreasing friction between the lamellae of the stratum corneum (lubrication), and/ or (3) forming a seal to lock in moisture. Though used synonymously with “moisturizers,” emollients are the actual lubricating agents in moisturizers that can be used alone on the skin. Petrolatum, for example, is a very effective and inexpensive emollient. Effective moisturizers usually contain a substantial amount of emollients as well as water-binding agents (humectants), anti-irritant substances, and antioxidants. It is best to apply a moisturizing agent after each cleansing, when skin is still damp. Selecting which moisturizing agent to use will largely depend on personal preference.

1. Emollients

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