Skin: So pristine when we are born… so variable as we age

Our skin is a reflection of us- it tells our age, our habits, our past experiences, our diseases, our current vitality… and it plays a big part in how we consider ourselves attractive.
Fundamentally, healthy skin is beautiful skin.
For something so basic and essential to life, skin is a remarkably complex organ. And it is as individualized to each of us as our own personalities-we all come with different genetic tendencies, ongoing disease states or sensitivities, and past or present health practices-that affect the way our skin behaves and appears.
Maintaining or maximizing the health and beauty of skin is possible for anyone, regardless of when the desire to do so is realized. Skin is is remarkably renewable and resilient and despite your age, genetics, skin disease, or amount of sun damage, with a well-designed skin care program, some degree of improvement is always possible.
When you make the decision to improve your skin, be aware of several facts:
1- There are countless numbers of skin products being marketed to promote skin rejuvenation, and the ability to differentiate among them is confusing even among professionals. While the effectiveness of prescription products are studied under strict conditions, over-the-counter and cosmeceutical-grade skin products are not subject to this rigid oversight, and manufacturers often flaunt claims of benefit that may not be justified. The field of skin care products is fiercely competitive, and consumers are often victims of exaggerated marketing promises.
2- Although there are many who promote themselves as being expert in skin care, dermatologists are the highest qualified experts in the field of skin disease and health. Those dermatologists who subspecialize in the study of skin care products remain the ultimate resource for determining the worth of a particular agent applied to skin, and how best to achieve or maintain optimal skin health and beauty.
3- While the biology of skin is complicated, and sophisticated formulating and scientific study is often needed to achieve a skin product that is both effective and able to penetrate the skin barrier without causing injury or irritation, skin products vary greatly with regards to their efficacy, and the cost of a product alone does not correlate with skin benefit.
4- Individuals who want to reverse or prevent the signs of premature skin aging, often have co-existing medical skin conditions such as acne, rosacea, melasma, seborrheic keratoses, eczema, psoriasis, or seborrheic dermatitis. Optimal skin care rejuvenation must entail treating ALL skin conditions, medical and cosmetic. The ideal skin care program is achievable with expert evaluation and a personalized skin regimen, which includes products and treatments specifically tailored to that individual’s medical and cosmetic conditions, and personal goals for outcomes and preferences. This philosophy differs greatly from the one-size-fits-all model used by most skin care lines or spas, and takes YOU into consideration- which makes all the difference.
5- Skin aging is multifactorial- so remember, treatment for reversing or preventing this is multifactorial too.
6- Good skin health depends on many factors, including genetics, protection from the environment, and nutritional support. Sunlight has the greatest impact on prematurely aging/degrading skin; this is compounded by cigarette smoke, pollution, toxins, and stress. As proof of this, compare the skin of your sun protected buttocks to the sun exposed skin of your face or chest.
While having a healthy diet and drinking plenty of water IS important for healthy skin, your body is not sophisticated enough to selectively deliver additional nutrients to skin that has been prematurely aged by the sun and less to the healthier skin that has been sun protected. Instead, nutrients from your diet are delivered equally to all skin surfaces, regardless of localized skin health, and excess nutrients are either excreted or accumulated internally (sometimes with toxic result).
To achieve optimal skin health, selective reparative agents need to be applied externally to the skin that has been most damaged- typically the sun exposed surfaces of face, neck, check, forearms and hands.

Dr. Julie Kenner, MD PhD is a board certified dermatologist with decades of experience using both prescription and non-prescription skin products to help her patients achieve their skin’s optimal health and beauty, regardless of preexisting conditions.
Over the years, Dr. Kenner listened to the frustrations of her patients trying to make sense of the dizzying number of skin care products available all claiming the same benefit. Separating fact from fiction in the competitive market of skin care products has become a daunting task for the serious consumer craving knowledge to guide their actions and purchases.
In response to this need, Dr. Kenner created a simple educational tool called the Topical Nutritional Pyramid™ . This framework, which categorizes and describes the eight basic groupings of skin rejuvenation products, is loosely fashioned after the familiar “food pyramid”, and has been designed to educate and empower patients to make healthy choices for their “skin diet”. Products in the different skin groupings complement each other and together make up a well balanced daily skin care “diet” which should be combined with a gentle washing program, and other selective treatments depending on baseline conditions. Similar to the original food pyramid concept of organizing food categories depending on health value, skin product categories near the base of the pyramid have the greatest impact on skin health or have the most data supporting their health benefits.
Maintaining skin health is best achieved by a combination of preventing further sun damage with sun protection, and repairing previous sun damage with rejuvenating skin products.

The greatest impact on the state of skin is the degree of accumulated sun damage, which tends to creep up on us until one day we notice.

What we show to the world with our sun-kissed face is, in fact, not a representation of our skin’s true age! To see the actual age of your skin – that skin that is the composite of your genetics, your chronological age, your diet, your stress level, your exposure to pollutants, etc- look at the skin of your bottom! Not bad~
The good news is: skin is very much alive and turning over and can be modified- no matter what our age. It is our living canvass, and if we want to change the picture, we can.

Just like your skin did not get where it is today, it will not get where you want to take it immediately- taking control of improving the look of your skin is a process.
Much like having a healthy and attractive body, skin must be attended to in some key ways. First and foremost, you must give your skin a healthy “diet”. While the basics of what your body needs for a healthy diet-protein, vegetables, fruit, grains, etc- have become elementary to our education, this concept of prioritizing and balancing nutrients for your skin is less well known, but equally important. This is because sun exposure, at any level, causes the destruction or disruption of key nutrients and components in our skin.
The human body is not yet evolved enough to selectively replenish different parts of our skin with differing amounts of ingested nutrients according to need- that is, more to sun damaged skin, and less to non-sun damaged skin. This means, if we try to orally supplement for skin nutrient losses incurred from excessive sun exposure by simply eating more vitamins or antioxidants, much of this effort will be wasted, or possibly harmful- water soluble nutrients in excess will simply be excreted, and fat soluble nutrients in excess can be toxic.
Therefore, in order for us to best address the health needs of our skin, we must replace the nutrient-deficient sun exposed skin of our bodies at a local –topical- level. In other words, in addition to a balanced and healthy internal diet, repairing damaged skin requires a healthy balance of reparative agents be applied externally.
Just as we learned the concept of following a healthy diet for our bodies when we were children using the “Food Pyramid”, a similar educational model can be devised for creating a healthy “skin diet” using a tool Dr. Kenner trademarked called “The Topical Nutritional Pyramid”.
Loosely based on the familiar food pyramid, Dr. Kenner’s “Topical Nutritional Pyramid” is an organizational structure to prioritize skin products. This pyramid has taken the 8 basic groupings of cosmeceuticals, and placed them in order of importance: products positioned at the base of the skin pyramid are either of more inherent value to skin, or are generally better defined scientifically (e.g., sunscreens, retinoids), whereas items less well studied, or with more narrow benefits, are closer to the top of the pyramid.

Simplifying this pyramid further, Dr. Kenner has lumped the 8 major skin care categories into 3 basic functions: Protection, Repair and Renewal.

A healthy “skin diet” should at a minimum be comprised of skin protection and basic reparative agents; a complete skin diet would be comprised of products providing protection, repair and renewal. With this framework, patients can be encouraged to, at a minimum, use sunscreens for skin health and progress logically on to a more “complete skin diet” if desired.
Much like maintaining our bodies, which may have concurrent disease requiring specialized medical intervention in addition to a healthy well-rounded diet, our skin may have concurrent specialized needs too. Dermatologists like Dr. Kenner are best equipped to diagnose and manage these special skin conditions such as acne, rosacea, seborrheic dermatitis, eczema, melasma, etc. Just like our bodies may need special medicines to treat our thyroid disease, high blood pressure, diabetes, etc. the dermatologist can prescribe additional skin treatments, such as acne or rosacea medication, to compliment a basic healthy “skin diet”.
Finally, just as it can take weight lifting, core strengthening, stretching or yoga to help get our bodies into great shape, it may take some additional encouragement, such as laser, medical grade facials and micro-needling.