My Evidence-Based Skincare Routine

Transcription

All right, so having the perfect skincare routine is actually pretty simple. All you need is a few things. Number one, use a moisturizer. Number two, use some kind of sunscreen every day. Number three, use some kind of retinoid every evening. Feel free to wash your face with a cleanser if you really want to. And in fact, you can do two in one, and you can get this sunscreen moisturizer combination. And that is all you need to know to get a really solid skincare routine going. But okay, let's go a little bit deeper into the details. Like, why should we have a skincare routine in the first place? And then what is the scientific evidence that these are the sorts of products that we should actually care about? Well, there's two main reasons. Number one, for healthy skin, and number two, for pretty skin. And a question that I like to think about is, what are the actions that I can take right now, today, that my future self would be very glad for? So, in theory, if I can find the perfect evidence-based productive skincare routine that helps me maximize my skincare results with minimum effort, then I'm winning in terms of health and also in terms of looks. The problem is that there are millions of skincare products out there, like avocado face masks and charcoal cleansers and LED therapy and snail slime face creams. Slather on the slime. Now, I trained as a doctor, but I'm not a skin care specialist. So, I've enlisted the help of my friend and New York-trained dermatologist, Dr. Usama Syed, to find out exactly what we should actually be doing to get good skin. And apparently, to get like 90% of the results, all we have to do is follow three or four simple rules and we'll do absolutely fine. So, why should we actually use a moisturizer? Well, the most important thing that the skin does is that it acts as a barrier to the outside world, and it keeps irritants and allergens outside of our body and locks in moisture. If our skin loses moisture and gets dry and cracked, that barrier gets weakened, which means inflamed, red, itchy skin, and you might even get infections. And the way the skin is built is they call it a brick and mortar system, where you know, you have the little cells which are the bricks called the keratinocytes, and you have the mortar, which is like the little paste in between it, made up of different types of fats and proteins. Now, what these moisturizers do, especially the ones that are evidence-based, is they will replenish that layer of paste to help keep that barrier intact. So you don't lose moisture, therefore, you don't have inflammation, itchy skin. Now, anyone can get dry skin, but you're especially likely to get it after having a hot shower because that dries out your skin and strips away your natural protective layer of oils. So we want to find a good moisturizer that rehydrates that skin, replaces our natural fats and proteins, and helps keep the skin barrier intact. So, what sort of moisturizer do we actually want to get? Well, Osama's main recommendations for moisturizer are any standard product from Eucerin, CeraVe, or La Roche-Posay, mainly because those are huge companies that have the budgets to do lots and lots of research and quality control on their products. I firmly believe no skincare product should ever cost more than $30. Because anything beyond that point is you're paying for the fluff. The active ingredient and getting something effective can always be done for less than $30. So, what products do I use? Well, my main dedicated moisturizer is from CeraVe, and I use CeraVe PM for moisturizing in the evening. It's very nice, it's very chill, it's available absolutely everywhere, it's reasonably priced, and it feels really nice on my skin. And then in the mornings, I use the Altruist Dermatologist Face Fluid SPF 50 moisturizer, which is a moisturizer combined with sun cream. And this brings us to rule number two of my productive skincare routine, which is to use a sunscreen every single day. Well, have a look at this case report from the New England Journal of Medicine, which is one of the most prestigious medical journals in the world. They looked at this truck driver who had spent 28 years working with just the left side of his face being exposed to sunlight through the driver's side window. He's 69 years old in this photo, but the researchers said that the left side of his face, which has a bunch of wrinkles and damage from sun exposure, is apparently more like what you'd expect from an 86-year-old's skin. That's what the sun does to your skin if you're regularly exposed to it without any protection. And that happens even if you never actually get sunburnt, but you just tan. Technically, this is called photoaging or dermatoheliosis, and it happens because the sun is constantly bombarding us with UV radiation that mutates the DNA in our skin cells. And then in the long term, the more of this UV light that we're exposed to without protection, the more we get wrinkles and dark spots from that DNA mutation. And that DNA mutation can also lead to skin cancer, which is ultimately just unrepaired DNA mutations that snowball into cancer. So, what sunscreen does is it gives you an extra layer of that protection, so that not relying upon your own pigment, your own melanin, instead, we're giving a physical barrier which will stop genetic mutations being created by the sun. And not only is that great for preventing skin cancer, also it prevents things like photoaging. All right, so what sort of sun cream should you get? Well, there's loads of different options on the market, but there's mainly three things that you want to consider here. Well, the first thing you want to look for is that you want to find a sunscreen that's broad spectrum. Now, back in the day, people used to think that it was only UVB rays that actually damaged our skin, but now we know that it's UVA rays and also UVB rays, and broad spectrum sunscreen has protection for both sorts of rays, and therefore gives you the maximum protection. Now, some sunscreen is physical and some is chemical. It doesn't really matter which type of variety you go for. What matters is that the SPF is high enough, and that is the second thing that we need to look out for. Now, the actual SPF number of the sunscreen refers to how much longer it would take for the sun to make your skin go red with the sunscreen on compared to without the sunscreen on. So, if it would normally take 1 hour of direct sunlight on your cheeks to make them a little bit red, then in theory, with SPF 15, it would take 15 hours if you got exposed to the exact same amount of sunlight. But it's not quite that simple. And there's extra issues that we do want to consider with SPF. Firstly, we don't need to actually burn for the sun to damage our skin and cause aging. We want to be protected well before our skin actually gets physically red. Secondly, the SPF is calculated based on a pretty thick amount of sun cream actually going on the skin. I do say don't go below 30 typically. The number that you get on there, you never truly get that level of protection based on how normal people wear it, because it would rely upon like a pretty thick layer of sunscreen like caked on there. Most of us will be getting around like say 60% of that true SPF protection factor. So, if you use a 50, you'll actually get a 30. If you use a 30, you'll get a 15, kind of thing. And finally, in reality, we sweat and smudge our faces all the time, which takes away a lot of our sun cream protection during the day. So, in an ideal world, we actually want to top up our sunscreen every few hours. I don't personally bother with this, but what I do try and do is I use a high SPF like SPF 50 because chances are even with SPF 50, I'm only really likely to get SPF 30 or 20 or 15 levels of protection. Now, the final thing to think about with sun cream is comfort. And the issue with the max SPF sunscreens is that they can be uncomfortable or make you look like you're wearing this sort of white pasty makeup. And the thing we want to bear in mind is that some SPF is way better than no SPF. So, actually, an SPF 30 sun cream that you actually like and feels comfortable on your skin and that you're actually going to wear is way better than the state-of-the-art gold standard SPF 100 sun cream that you buy once and then never really use because it makes you look like a clown. All right, so what products do I actually use? Well, in the mornings, I use Altruist Dermatologist Face Fluid, which has SPF 50 built into a moisturizer. So that's what I use on my face. This one costs about $11 here in the UK. And then usually on my body, I will also use the Altruist Dermatologist Sun Cream with SPF 50, and this is what I use on my arms, on my legs, on my neck, on my shoulders, whatever, especially if it's a very sunny day and I'm going out in t-shirt and shorts. And this one's actually really cheap. It's about $4 or 5 pounds here in the UK. But to be honest, you can find whatever product works for you in your country. It doesn't really matter. All right, so this one is a little bit more rogue. So, we've all probably heard of moisturizers and sunscreens, but most people have not heard of retinoids. And in fact, I hadn't really heard of retinoids as being good for normal people's skin, even though I went to med school. I'd only really heard of retinoids being a treatment for acne, and that's exactly what they started out as. It was like this vitamin A-based treatment for acne in the 1970s. But then, researchers found that the active ingredient, retinol, actually had a bunch of anti-aging effects as well. I think it is as close as possible to a miracle ingredient that you'll get anywhere in the world of skincare. When it comes to retinoids, they genuinely lay a credible scientific case for helping reduce pigment unevenness, helping to minimize wrinkles, help to minimize acne breakouts. And they do all of these things to a level where it's noticed in clinical trial data and on biopsy samples from the skin. Something that does all of those things with minimal to no downside, I consider that to be something which it really is worth your time. Now, there's been a ton of research and studies into retinoids, and like Osama says, they've pretty consistently found that when you apply a strong enough retinoid for a long enough time, then there's three main positive effects that you get. Firstly, retinoids reduce wrinkles by promoting the growth of collagen and elastic fibers in the dermis or the thick middle layer of our skin. And if we have enough collagen and elastic fibers deeper down in our skin, then it gives our skin a healthy, young-looking structure. Aging and UV damage makes us lose these collagen fibers, and that's what makes our skin sag and look old. The second positive thing that you get from retinoids is that they reduce uneven pigmentation, i.e., like dark or discolored spots that you get on your skin, particularly, again, from sun damage. And thirdly, retinoids also make our skin cells regenerate faster, which means our skin consistently looks fresh and new. So, overall, basically, retinoids make most people's skin look younger and smoother and healthier. So, if like me, you do want to start using retinoids, then remember that you are playing a really long game because it does take a long time to see results. And to be honest, when you're young and you don't really have that many wrinkles, I think it's mostly preventative rather than kind of curative, as it were. And the thing with retinoids is that they can also make some people's skin feel a little bit more sensitive. It can make your skin peel, and it can sometimes make your skin feel a little bit painful. And that's why a lot of people don't actually stick with it long enough to see the benefits. So, what sort of retinoid should you get? Now, this is where it kind of gets complicated because retinoids actually come in different types of strength. Now, the first big one is retinols. Now, retinols are part of the retinoid family, but they are the weaker version. Now, if you see any kind of skincare product labeled anti-aging and you can get it over the counter, it usually has some kind of retinol in it, i.e., the weaker version of a retinoid. Then we have retinoids, which are stronger and they're generally prescribed by a doctor. And tretinoin is one of the most common ones and the one that I use. You'll see a bigger change with retinoids than retinols because they're stronger, but the side effects can potentially be stronger as well, like peeling and dry skin and like a little bit more sensitivity. So, if you are going for a retinoid, then it is worth it to be a little bit more careful with these and maybe even consult a doctor before actually starting to use one. What I always tell people is when you're using a retinoid at the beginning, it should make you feel a little bit dry at least. If it doesn't even teeter on the edge of making you feel a bit dry, you wonder whether you need a higher strength because maybe your skin is just more tolerant and maybe you need to apply more. Because it should be, especially at the beginning, it should be like, 'Oh, I feel a little bit dry today. Like, I need to put on more moisturizer since I started my retinoid this first week.' And if you don't feel that, it's probably not strong enough for you. The over-the-counter retinoid-based product that Osama recommends for beginners is Differin gel, which costs about $20 and has a slightly newer type of retinoid in it called adapalene, which causes less irritation than a lot of other retinoids. But because that one's kind of hard to get in the UK, the one that I get is actually from a place called Dermatica, which is like this online consultation type thing. They do an online consultation with you, you send them some pictures of your skin. It's a bit of a faff initially because technically a doctor has to review those images and prescribe it for you, at least here in the UK. But then once you've been prescribed it, they just send you it every month. I've been getting the deliveries for about seven months now. So, I initially started on a 0.025% tretinoin, and then over the last seven or eight months, it's been upped to 0.1% tretinoin, which is like a decent level of strength for a retinoid. And remember, the general recommendation for retinoids is to start with a tiny pea-sized amount every other night and then work your way up to once a night using lots of moisturizer at the same time, and this helps keep your skin from drying out. So, when it comes to cleansers, it's basically, water is good at, you know, removing debris, but a cleanser is supposed to kind of help to remove some of the oils that might stay on your skin that are hard to remove with just water. Some dermatologists say that if you're using lots of heavy cosmetics or if you have visible dirt or like loads of sweat on your face, then yeah, you can use a cleanser. But actually, for most people, you could just clean your face using water without needing to worry about these kind of products. Anecdotally, for me, I find that on days where I'm consistently using my cleanser morning and evening, those weeks I tend to get a lot a lot less breakouts of like random shit on my face. Like I tend to get kind of troubled areas around the nose and stuff. And generally I find that if I've forgotten to cleanse, then I'm more prone to those kind of things. So, n equals one, but, yeah, this is rule number four and it's a little bit optional. It will have some benefit incrementally and you should focus on a hydrating cleanser that doesn't end up stripping your skin of all the oils and leaving you feeling tight. It should end up being very gentle and in the end your skin should actually feel more moisturized even after having cleansed it. So, a hydrating cleanser like this one is going to remove the oily stuff without theoretically stripping away all of your skin's natural oils. And it will also usually contain special ingredients like hyaluronic acid, which apparently keeps your skin hydrated, and ceramides, which is what all the CeraVe products include, which are basically fats that replace some of your skin's natural oils so you can lock in moisture and keep that skin barrier intact while also having a cleanser. So, the one that I use is the CeraVe Hydrating Cleanser. It's pretty reasonably priced and you can get it from most places. And what I like about the CeraVe products is that they're very like chill. They're not like trying to overly wow you with the avocado extract or the hero ingredient. It's just literally, it looks like medication and that's what skincare really needs to look like. It doesn't need to be as fancy as a lot of these other really expensive products that we get sold by random influencers. So, here is my overall productive skincare routine, adding up all of this evidence-based stuff. In the morning, I wake up and I shower and I cleanse my face in the shower with the CeraVe Hydrating Cleanser. And then when I'm out of the shower, I dry my face with a face towel, and I put on the Altruist SPF 50 face fluid, which is the sunscreen and moisturizer rolled into one. So it's just two products in the morning and it's super nice and easy. And then in the evening, after brushing my teeth, I generally wash my face with warm water, and again, I use the CeraVe Hydrating Cleanser in the sink. And then again, I dry my face with a face towel, and then I put on my Dermatica retinoid cream. And then after giving it a few minutes to settle in, I moisturize with the CeraVe PM moisturizing lotion, and that feels pretty good. And that's it. Like, honestly, before having this extensive conversation with Osama and a few other dermatologists to be like, what should I actually be using for my skincare routine? I thought skincare was going to be this complicated thing and I didn't want to bother with it. But now, like once I saw the before and after photos, and once I spoke to dermatologists and they were like, yeah, these are the only three or four products that actually matter, it simplified the whole thing. And now I've been using this kind of productive skincare routine for the past eight months, I think now. You can also find my full interview with Osama about skincare on my vlog channel. He goes in depth on more products and treatments that he'd recommend. So check it out if you like. And if you're interested in more legit skincare advice from an actual board certified dermatologist, then definitely check out Osama's channel linked down in the video description. Hope you enjoyed the video. Hope you got something out of it. And hopefully, see you in the next one. Bye-bye.