A retinol, Vitamin C serum, sunscreens and more. / Photo by James B. Kelly.
SPENDING MANY months in the Middle East without benefit of sunscreen has led to my fair-skinned, blue-eyed husband’s many Moh’s surgeries. Moh’s is the gold standard for treating many basal and squamous cell carcinomas, often around the eyes, nose and lips. The procedure is done in stages (all in one visit) while the patient waits for results. After removing a layer of tissue, the surgeon examines it in an on-site lab. If any cancer cells remain, the surgeon removes another layer of tissue from that precise location, sparing as much healthy skin as possible. The process continues until no cancer cells remain.
So, who better to ask about must-have skin care products than Jim’s team of dermatologists in Pittsburgh: Dr. Melissa Pugliano, who specializes in Moh’s, and her partner, Dr. Stephanie Dietz. I was able to catch them on two recent afternoons for bits of conversation and emails in between appointments with patients.
They both agree on the importance of using at least a 30 SPF sunscreen every morning. Look for a broad-spectrum one that protects against UVA and UVB rays—even if you have no plans to go outside (UVA rays penetrate windows unless they’re tinted for protection). For discoloration like sun spots, freckles and melasma or rosacea, Pugliano recommends a product that contains titanium or zinc oxide. She also notes that sunscreens containing Mexoryl are useful for protecting the skin from UVA light for a longer time because of the compound’s good photo stability. Still, don’t forget to reapply after a couple of hours. (There is much debate about the potentially harmful effects of ingredients in sunscreens; look for The Environmental Working Group’s 2019 guide to sunscreens that comes out this spring.)
Incorporating a retinol in your routine is also one that both dermatologists recommend. Says Pugliano, “It can help with fine lines and discoloration of the face. Initially, it can cause some peeling or dry, red skin. If you’re not using it already, start slowly (e.g. Monday, Wednesday, Friday) and then increase to nightly as tolerated. Retinols can cause the skin to be more sensitive to the sun, so if you’re going somewhere you’re going to get a lot of sun, say, on a beach vacation, skip it. Also, stop it 10 to 14 days before any waxing procedure. You can find retinols at the drug store, at the beauty counter or in prescription formulations.”
Dietz says she uses nothing special for a cleanser (Cetaphil or Cerave). Pugliano uses one with glycolic acid (to lighten brown spots, although none were visible to this eye). As for a moisturizer, Dietz says, “I know people who use Crisco. Bottom line: someone has to like a product or be able to afford it. Cream is more emollient than a lotion so better for dryer skin.” She recommends Vanicream for Jim’s sensitive one. Serums of all kinds may be popular, but Dietz’s only endorsement: “Feels nice!”
According to Pugliano, “Eye creams that include caffeine can lighten dark circles as well as soften wrinkles. Once you are tolerating your retinoid or in place of one, you can use a product with Vitamin C to help with skin brightening, fine lines and overall skin tone.”
“Purchasing products can be overwhelming as the number of choices are vast and confusing, even for me,” admits Pugliano. “Beware of products that tout they are “natural.” Just because it is labeled natural doesn’t mean it doesn’t contain preservatives and other ingredients that can irritate your skin. Talk to your dermatologist when choosing or ask for samples before purchasing a product’s retail size.”
Personal preference plays a large role in choosing skin care products; what feels good on the skin and “works” for one individual may not suit another. When I asked Dietz for her key recommendation about skin care: “Don’t overdo it.”
I couldn’t resist bringing in my latest skincare purchase for a quick evaluation— Neova DNA Total Repair, $99 at Dermstore. The packaging says:
- Reduces visible damage from oxidative stress caused by free radicals
- Visibly improves the appearance of every apparent sign of sun-inflicted damage to skin DNA,
- Diminishes the visible signs of DNA damage, including fine lines, wrinkles and discolorations
Pugliano and her resident and fellow looked at the insert. Verdict: Even though it says “Validated in controlled clinical studies,” it doesn’t cite specific studies, so there’s no proof that it works. I must have looked disappointed because she told me to conduct my own experiment. “Try it on one-half of your face for a few weeks and then compare it with the other side where you didn’t use it. See if there’s any improvement.”
—Janet Kelly
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As soon as the thermostat gets switched from “cool” to “heat” my skin dries out. Using my retinol on alternating nights, always followed with a heavy moisturizer, and just moisturizer on the intervening nights, helps. I also change my cleansing routine, stopping the micellar water in favor of a balm, then a really mild cream cleanser. So sorry that Jim has to go through this so frequently, but clearly a cautionary tale for sunscreen.
Good idea to stop the micellar water. I’m sure that adds to the dry skin problem. What balm do you use?
Is there a paragraph missing from your skin care article? There’s a sudden jump to retinols between graphs 3 & 4.
Also, I read recently – god knows where – that retinols have not been tested on older – 65+ skin – and there’s some dr hesitancy about its use. Which makes some sense, as skin is thinner. ???
Thank you for reading, Steph! There is a sentence missing that I just put in.
It makes sense that retinols would cause irritation on older, thinner skin. My dermatologist (Dietz) told me to cut back when she saw how dry my skin was. She suggested using my Retin-A prescription formula every other night followed up by a moisturizer.
Nice!