Skincare

1. SUNSCREEN, SUNSCREEN, SUNSCREEN

I know you've heard this a million times but sunscreen is absolutely THE MOST important thing you can do for your skin. Even if you don't apply to your whole body, using an SPF 30+ sunscreen (for some people with pigmentary disorders like melasma, we will recommend 50+) on your face should be a minimum. Besides causing skin cancers, sunlight is the #1 factor causing aging of the skin (wrinkling, pigmentary changes, "sun spots"). For a really clear example of this, here is a photo of one-sided photoaging published in the New England Journal of Medicine in a truck driver (who gets sun on the left side of his face while working). Ideally, you would use a "physical" sunscreen that has zinc oxide or titanium dioxide but these can leave white streaks on the skin, especially for darker skin types. If you have this problem you can get "chemical" sunscreens that have compounds like avobenzone, octinoxate and oxybenzone. There are also a number of products that are 1/2 and 1/2 which leverage the advantages of both. Physical sunscreens work immediately while you want to apply chemical sunscreens ~30 minutes before you go out into the sun.

3. Moisturizer

A lightweight non-comedogenic (look for that term on the bottle/box) moisturizer in the evening and morning is an important part of taking care of your skin. They help to lock in moisture and restore your skin's barrier, which can also decrease rashes if you're breaking out because of scratching dry skin causing a cycle of inflammation.

4. Topical vitamin C

The last topical product I'll talk about with patients interested in a cosmetic skincare regimen is vitamin C. It has been shown to brighten skin and even skin tone as well as stimulate collagen synthesis but its number one effect is as an antioxidant. As an antioxidant it can help to neutralize free radicals generated by environmental exposures. It does break down when exposed to UV so you need to layer a sunscreen on top to make sure it has an effect.

Update

First, thank you gentlemen for a Sunday reminder about the power of community. It's been beautiful to see the engagement and advice in the comments. I want to do an update for some of the common questions that came up:

OK what do I absolutely have to do?

• If you're going to pick just one thing to use, put on a moisturizer with SPF 30+ before you go out in the morning. Trust me, I get it. In my younger years, I wasn't always consistent with this but it doesn't take much. Make it a part of your morning routine. It adds an extra few seconds but it's like brushing your teeth, and your younger, less wrinkled, and less prone to skin cancer future face will thank you. An ounce of prevention is worth a pound of cure.

Sunscreen? Do I have to? It's cloudy out.

• I recommend that everyone incorporate sunscreen to their morning routine. Like I wrote above. just like you brush your teeth, look at it as a thing you do every day and it becomes much less of a hassle. Yes its ideal to reapply every two hours and that is the American Academy of Dermatology's recommendation but don't make the perfect the enemy of the good. Use it every morning and if you can find a way to do it more frequently that's even better. Don't use the fact that you don't want to reapply as a reason to not do it at all.

• I'll avoid getting too far into the weeds of the science but sunlight has UVA AND UVB. UVB does peak at mid-day but UVA is constant ALL day. UV also penetrates clouds. So cloudy days aren't a free pass to skip your sunscreen. UVB is more responsible for sunburns and DNA damage leading to cancer while UVA is more responsible for photoaging and tanning but there is overlap there and UVA can cause skin cancer as well. SPF is actually just a measure of how protective sunscreen is against UVB but look for a BROAD-SPECTRUM sunscreen which means that it will protect against both. To protect against visible light which can worsen hyperpigmentation and some conditions like melasma, use a tinted sunscreen. The TLDR here is just use sunscreen every day before you go out.

What order should I use the products?

• I'm not aware of any studies that look into this but what I generally advise patients is to apply any prescription medications to clean, dried skin first, then layer other products and finish with moisturizer and sunscreen.

What specific products do you recommend?

I wanted to not list specific products because I'm personally a bit suspect of posts that push brands or products but since it's been requested, I'll list as many as I can think of that I've used myself, my patients have reported good results from, or other dermatologists I know use. I'll focus on more affordable brands available in most stores that sell skincare products. A few that are pricier I'm mentioning mainly because of how many dermatologists I know use or recommend them. This is by no means an exhaustive list and I'm sure I will be leaving out some great products.

• Moisturizer

  • La Roche-Posay face moisturizer - I personally like this one because it is hydrating but not too thick

  • CeraVe PM facial moisturizing lotion

  • Vanicream daily facial moisturizer

  • Cetaphil daily oil-free moisturizing lotion

  • Neutrogena Hydro Boost - This one's a love it or hate it. It has HA and is a gel rather than a lotion or cream so the texture is off-putting for some people while others love it.

• Sunscreen

  • EltaMD Daily Tinted Broad-Spectrum SPF 40 - EltaMD is one of those brands that most dermatologist are familiar with for sunscreen and makes good products. They have a few different lines but this is a best seller. This one has physical and chemical sunscreen compounds. They also make a non-tinted version and other lines if it isn't for you.

  • La Roche Posay Anthelios UV Correct - Friends of mine use this and they swear by it. It is a chemical sunscreen.

  • La Roche-Posay Anthelios Mineral Tinted Sunscreen - Also a bit of a love it or hate it quality but for me rubs in very nicely and I like that it is a purely mineral sunscreen.

  • Supergoop Unseen Sunscreen - Some of my patients absolutely love this. It is a chemical sunscreen but they love the finish and feel of it.

  • Others to look into: Cetaphil, CeraVe, TiZO (Titanium dioxide and zinc oxide sunscreens), Neutrogena

• Vitamin C Serums

  • SkinCeuticals C E Ferulic - This is very expensive for a daily skincare product and I don't know how necessary it is to go to a product that is this pricy but it is a favorite among dermatologists for themselves and their patients so I felt that I had to include it in the list. Has vitamin E and ferulic acid which are antioxidants too. Be warned that it has an iron-like smell to it.

  • Paula's Choice C15 Super Booster - Same ingredients as SkinCeuticals at a cheaper price. Haven't used it personally but have heard good experiences from others.

  • Vichy LiftActiv Vitamin C serum - You'll see a trend here. This also has vitamin E and ferulic acid like the Paula's Choice and SkinCeuticals serums. Also more affordable than both of the above.

  • La Roche-Posay Vitamin C Serum - Has a more gel-like quality than others but it is more affordable and still has 10% vitamin C.

  • The Ordinary Ethylated Ascorbic Acid - I recommend this brand for many patients for a variety of OTC agents like azelaic acid too. In my experience, their products are effective and very cost-effective.

  • A note about vitamin C products: minimize how long you leave the cap open and how much light exposure it gets because the ingredient is prone to oxidation and breakdown when exposed to air and light. They come in oilier serums instead of water-based vehicles because it also breaks down when mixed with water.

• Gentle Cleansers

  • Cetaphil Gentle Skin Cleanser - Great and affordable cleanser.

  • CeraVe Hydrating Facial Cleanser - Another affordable and effective cleanser.

  • Vanicream Gentle Facial Cleanser - Also a great cleanser, good for those with sensitive skin.