DESIGNING A SKIN

CARE ROUTINE
BY RAJANI KATTA MD

How To Create A Regimen Customized for

Your Skin Type and Your Skin Concerns

 ABOUT THE AUTHOR
Dr. Rajani Katta

Welcome!

Over my 20+ years as a practicing

dermatologist, I’ve talked to thousands of
patients about their skin care products.

What I’ve learned is that the most

important part of designing a skin care
routine is that it has to be customized.
Customized for your skin type and your
skin concerns.

In this e-book, I've outlined some of the

basics on how to design your own skin
care routine. If you have more questions,
please let me know. I’m launching a new
podcast soon called The Dermatology
Podcast, and would love to hear from you.
While I can’t address individual medical
questions, I would love to discuss general
skin care questions.
About me
I’ve been a board-certified dermatologist for
To send topic suggestions, please email us
over 20 years.
My advice on skin care and diet has been
at podcast@[Link].
featured in many magazines and TV
appearances. Wishing you all the best,
I’m an educator, a speaker, and the author
Rajani Katta MD
of 7 books.
I was a professor at the Baylor College of
Medicine for over 17 years, and now serve on Eat good mostly plants, not too much
the voluntary clinical faculty of Baylor as - Michael Pollen
well as the University Of Texas at Houston.

Rajani Katta MD | Skin Defense | [Link]

 DESIGNING A SKINCARE
ROUTINE
CHAPTERS
01 Background

02 The Basics

03 Developing Your Own Skin Care Routine

04 Some FAQs About Skin Care Routines

05 Developing an Anti-Aging Skin Care

Regimen

06 Retinoids

07 Vitamin C

08 Developing a Skin Care Regimen for Dark

Spots

09 Developing a Skin Care Regimen for

Acne-Prone Skin

10 Developing a Skin Care Regimen for

Allergic/Sensitive Skin

Rajani Katta MD | Skin Defense | [Link]

 Chapter 1
Developing A Skin Care
Routine: Background
 EVERYBODY'S DIFFERENT:
WHY YOU NEED TO CREATE YOUR OWN
PERSONALIZED SKIN CARE ROUTINE

The first rule of medicine, in absolutely any field, is that

everybody’s different. In dermatology, my patients are dealing
with different skin care concerns. They have different skin
types, which will change over the years, and even may change
by the seasons. We all have different preferences for the kind
of formulations that we like to have on our skin. And our skin
often reacts differently to the same exact product.

This is why I have thought long and hard about how to create
a framework that’s flexible enough to cover these different
skin care concerns, yet still able to provide some clear
guidance.

If you’d like to work on developing your own skin care routine,

here are my recommendations. These are informed by
conversations with thousands of patients on what has
worked for them, along with an extensive review of published
medical research in this area.

dr. rajani katta | Skin Defense | KattaMD

 WHEN YOU THINK ABOUT YOUR SKIN
CARE, THINK ACT:
ADJUSTABLE, CONSISTENT, TAILORED
Before we get started, there are a few important rules for designing your skin care regimen. I
call these the ACT rules.

You have to be ready to adjust your skin care routine, you need to be consistent when you’re
trying a new product, and you need to make sure your products are tailored to your skin type
and to your skin concerns.

Adjust: you WILL need to adjust your skin care products as you age, and many of us
will need to adjust our skin care products based on the season

Consistent: the best skin care products won’t work unless you use them consistently

Tailored: make sure that the products you choose are tailored to your skin type and to
your skin concerns

These are really important principles, and they’re not emphasized often enough. I myself
have a winter set of products and a summer set of products. I’ve also had to change my
product formulations dramatically over the last 10 years, as my skin has started to
experience more dryness.

Consistency is also not talked about often enough. Some of the major beauty retailers send
out skin care samples with every purchase. However, you shouldn’t be trying the latest and
greatest skin care products one after the other. If you’re trying out a new product,
remember that it takes about 28 days for your skin cells to turn over. That’s why
dermatologists will tell you that most products need at least one month of use to see
results.

Among my dermatology colleagues, one of our favorite anti-aging (and anti-acne) skin care
products is a category called retinoids. When I prescribe tretinoin (brand name Retin-A), I
tell my patients that they’ll need to use it for 8 weeks on average to see results.

dr. rajani katta | Skin Defense | KattaMD

 A SKIN CARE ROUTINE IS
MORE THAN JUST SKIN CARE PRODUCTS

I need to emphasize one big point before we get started on skin care products. A
skin care routine is about far, far more than just skin care products. In fact, my
favorite strategy for protecting the delicate skin around your eyes isn’t an eye
cream: it’s big sunglasses.

It all comes back to one of my favorite sayings: When it comes to your best skin,
make sure that you’re treating your skin right, inside and out.

That means the right food, the right skincare, and the right lifestyle.

For more on my favorite skin saving foods and the importance of “eating power”,
you can check out my recommendations here. For more on the importance of
lifestyle factors, especially stress management, beauty sleep, and exercise,
please see this section of my website.

Along the same lines, one of the main foundations of a skin care routine is the
right sun protection. But sun protection is about far more than just sunscreen.

The best sun protection uses both SPB and SPF.

SPB: Sun protective behaviors that include using sunglasses, hats, and
clothing, and making the right choices on how to be out and about in the sun.

SPF: Skincare products with a Sun Protection Factor. Here are my tips for
choosing sunblocks for those with sensitive skin.

dr. rajani katta | Skin Defense | KattaMD

 Prevention is Key
What You Do Now Helps Determine the
Skin You'll Have 10 years from Now

The skin care products you choose should help you treat your
immediate concerns, but they should also incorporate
preventive measures. For women in their 30s, I can promise
you that what you do, starting today, will make a big
difference in how your skin looks as you enter your 40s. And
that holds true for every single decade.

The choices you make today about sun protection, the right
skin care products, nutrition and lifestyle factors, will make
a big difference in the level of protection that you’re
providing for your skin.

I’m a huge skin defender, and you should be

too.

dr. rajani katta | Skin Defense | KattaMD

 Chapter 2
Developing A Skin Care
Routine: The Basics
 WHEN YOU’RE CHOOSING SKIN CARE
PRODUCTS, IT ALL COMES DOWN TO YOUR
SKIN TYPE AND YOUR MAIN SKIN
CONCERN.
Skin Types: Dry, Oily, “Normal”, Combination, and Sensitive

Skin Concerns: Examples include acne-prone, anti-aging, dark spots, prone to

allergic skin reactions, seborrheic dermatitis, and others

*The section that follows has a chart with guidelines on how to determine your
skin type.

THE FOUNDATION OF A SKIN CARE

ROUTINE: THE MAIN SKIN CARE
PRODUCTS TO FOCUS ON

The main players in your skin care routine are going to be 3 main ones, along with
extra products based on your skin concerns. You’ll need to make choices about

Your cleanser·
Your moisturizer·
Your sun protection·
Additional Products: I also recommend additional products on top of these
foundational products, based on your skin type and your main skin concern

dr. rajani katta | Skin Defense | KattaMD

 CAN SKIN CARE PRODUCTS REALLY MAKE
A DIFFERENCE?
If you’ve read this far, I’m assuming that you’re already a believer
in the power of skin care. As a dermatologist, I’m a huge believer
in the power of topical products, because I’ve seen how well they
work for many skin issues. “Topical products” means products
that are applied to the surface of the skin. (Oral medications, on
the other hand, are those that are taken by mouth.)

I’ve treated many patients with mild to moderate acne, and just 8
weeks of topical medications can transform their skin. With the
right active ingredients, and the right formulations, the results
can be amazing.

But (and this is a big one), it really depends on what you’re trying
to treat. Fine lines and wrinkles can respond well to topical
treatments. Deeper wrinkles or sagging skin are going to need
more than just skin care. Those call for a consultation with your
dermatologist and a discussion about potential treatment
options such as non-invasive cosmetic procedures.
Eat good mostly plants, not too much
- Michael Pollen
Now, on to the details.

dr. rajani katta | Skin Defense | KattaMD

 Chapter 3
Developing Your Own Skin Care
Routine
 1. DETERMINE YOUR SKIN TYPE
There’s lots of overlap here, and there are lots of fine nuances, but I think it’s
important to keep it basic. In general, I see five main skin types.

Oily·
Has a shiny appearance by the end of the day
Dry·
Often feels “tight”
May feel rough
May have fine flaking on skin
“Normal”·
No medical definition
Generally means that your skin is not too dry or too oily
Does not get irritated by usual skin care products
Combination·
Different combinations of skin types in different facial zones
One common combination is normal skin over most of the face, with oily skin
in the T-zone
The T-zone is the nose, the forehead and the chin
Another common combination is seborrheic dermatitis: Normal or oily skin
over most of the face, with flaking and redness between the eyebrows and in
the nasolabial folds (the lines that run from your nose to the corner of your
lips)
Sensitive
Use of certain skin care products may trigger redness, burning, stinging or
irritation
Has to be very careful with new products
May have history of more severe allergic skin reactions to products, with red
rashes
Sensitive skin can also be a temporary state, and may result from too many
skin products, over-exfoliation, irritating ingredients or improper technique.

dr. rajani katta | Skin Defense | KattaMD

 2. CHOOSE YOUR PRODUCTS WITH THE
CESNA APPROACH: FIVE STEPS TO A SKIN
CARE REGIMEN (*NOT EVERY STEP NEEDS
TO BE A PRODUCT)

dr. rajani katta | Skin Defense | KattaMD

 Let me give you an example of how the CESNA approach works
for someone like me. I have sensitive skin, and my main focus
as I enter my 50s is slowing down the visible signs of skin aging.

dr. rajani katta | Skin Defense | KattaMD

 This is my guideline chart:

dr. rajani katta | Skin Defense | KattaMD

 WHEN CHOOSING PRODUCTS, LEARN THE
DIFFERENCE BETWEEN
AN ACTIVE INGREDIENT AND A VEHICLE
One of the things that I find frustrating when reading online guides to skin care
regimens is that they sometimes recommend vehicles instead of ingredients. I
don’t recommend using a “serum” or using a “toner”. These are just types of
vehicles, and the category of “serums” alone may cover dozens of different active
ingredients. Instead, I’ll recommend a vitamin C serum, or a hyaluronic acid
serum.

In fact, it’s really important to pay attention to both the active

ingredient AND the vehicle.

You can think of active ingredients as the workhorses of your skin care regimen.
These are the ingredients that actually do the work of modifying your skin or
treating your skin concerns. In fact, you can think of them as magicians: they
help make the magic.

Vehicles, by themselves, don't create the magic. But you can think of them as a
magician’s assistant. Sometimes they’re just there to look pretty, but sometimes
they’re a critical part of pulling off the magic trick.

Active ingredients: Examples include retinoids, niacinamide, vitamin C,

hyaluronic acid
Vehicles: Examples include serums, toners, creams, lotions, and gels

dr. rajani katta | Skin Defense | KattaMD

 CHOOSING ACTIVE INGREDIENTS
This is a topic that really requires a textbook. But I’m going to
give it a try here and give you the general outline on what I’m
looking for when I’m evaluating active ingredients and looking
over the research on new ingredients.

When you’re learning about the abilities of an active ingredient,

it’s important to focus on function. In other words, what does
this ingredient actually accomplish when you apply it to your
skin?

Focus on function. Are you looking for an ingredient that

inhibits the production of melanin, so that you’ll reduce your
risk of dark spots? If so, there are several ingredients that can
accomplish that same function. And you don’t need all five of
them; you may just need one.

The table on the following page is in NO way a complete list.

However, here are some examples of functions that are
important for different skin types and concerns, along with
examples of ingredients that can accomplish those functions.

dr. rajani katta | Skin Defense | KattaMD

 KEY FUNCTIONS:
IMPORTANT ACTIONS PERFORMED BY SKIN
CARE INGREDIENTS
Chemical Exfoliation
Helps loosen and remove dead cells from the Alpha-Hydroxy Acids such as glycolic acid,
skin surface lactic acid
Also removes oil Beta-Hydroxy acids such as salicylic acid
Helps smooth out the surface texture of the
skin
Reduces whiteheads and blackheads
May improve radiance
May be helpful for those with oily skin and acne
May help in skin renewal, although can cause
redness and irritation

Increasing cell turnover

Helps skin cells slough off more effectively Retinoids
from the surface of the skin
Reduces whiteheads and blackheads
Helps smooth out the surface texture of the
skin
Helpful in those with acne and seeking skin
renewal
Formulation of vital importance

Improving skin hydration (temporary effect)

Helps "plump" the skin Hyaluronic acid
Temporarily reduces the prominence of fine
lines and wrinkles

Reducing water loss from the skin

Moisturizing the skin Ceramides, coconut oil, dimethicone,
Strengthening and repairing the skin barrier others

dr. rajani katta | Skin Defense | KattaMD

 KEY FUNCTIONS:
IMPORTANT ACTIONS PERFORMED BY SKIN
CARE INGREDIENTS

Blocking the production of melanin (skin pigment)

or blocking the transfer of melanin to skin cells
Helps block the development of dark spots Vitamin C, Kojic Acid, Licorice extract,
on the faceHelps "brighten" the skin Niacinamide, Soy
Helps reduce PIH in those with acne (post- Prescription hydroquinone, azelaic acid
inflammatory hyperpigmentation)
Often used in those with melasma

Increasing collagen production

Reduction in fine lines and wrinkles Retinoids

Antioxidants to prevent against free radical

damage
Free radical damage contributes to fine lines Vitamin C, Vitamin E, ferulic acid, phloretin
and wrinkles, dark spots and even skin cancer
risk

dr. rajani katta | Skin Defense | KattaMD

 THE MAIN INGREDIENTS THAT I AVOID WHEN
I'M CHOOSING SKIN CARE PRODUCTS
I specialize in the treatment of sensitive skin and allergic reactions of the skin.
That means that I'm hyper-aware of ingredients that commonly trigger irritation
or allergy. That's the main reason I avoid certain ingredients. For my patients, I
usually recommend products that do NOT contain:

Fragrance. Of all the ingredients that I test for, the category of fragrance
additives is one of the top triggers of skin issues. Among my patients,
fragrance additives are the most common cause of allergic contact
dermatitis (aka allergic skin reactions).

Fragrances are challenging. To start with, when you see a product label that lists
"fragrance", that's a little misleading. It sounds like it's just one ingredient. It's
not. In fact, that single word may indicate the presence of 40 or more different
fragrance additives.

Because of labeling laws in the US, manufacturers do not need to tell you the
ingredients that make up their secret "fragrance" mixture. To make it more
challenging, products that are labeled as "fragrance-free" may in fact (quite
legally) contain fragrance additives, due to loopholes in the labeling laws. For
more information about fragrance allergy, please see my handout.

Formaldehyde preservatives. If you look at the top 10 causes of allergic skin

reactions in North America, formaldehyde and formaldehyde-related
preservatives are in the top 10 (not a great list to be on). For this reason, none
of my recommended products contain formaldehyde or related preservatives

Methylisothiazolinone (MI). This ingredient is used as a preservative in skin

care products. Unfortunately, over the last decade we have started to see an
epidemic of allergic skin reactions to this chemical. I never use products that
contain MI anymore.

dr. rajani katta | Skin Defense | KattaMD

 FORMULATION MATTERS: WHY VEHICLES
ARE SO IMPORTANT
For the best function, you need the right product.
The “right” product has:

The right active ingredient…

Along with a formulation that can effectively
deliver those ingredients to the skin layer where
they can actually work.
That formulation also needs to work well for your
skin type.

I'm really focused on formulations when it comes to

certain active ingredients. For example, formulation
is incredibly important when it comes to retinoids.
Most people can successfully use a retinoid, but you’ll
need to pay close attention to the formulation. That’s
why retinoids come in vehicles ranging from creams,
lotions, gels, and moisturizing creams to special
microspheres.

dr. rajani katta | Skin Defense | KattaMD

 TYPE OF VEHICLES

dr. rajani katta | Skin Defense | KattaMD

 TYPE OF VEHICLES (CONTINUED)

dr. rajani katta | Skin Defense | KattaMD

 Chapter 4
Some FAQs about Skin Care
Routines
 WHY ISN'T MY SKIN RESPONDING?
If you’re not seeing results, you need to consider a few factors.
Are you using the right product for your skin type and your skin care concern?
Are you using the product correctly?
Have you been using it long enough to see results?
Are you looking for results from a product that it just can’t accomplish? In other words, do you
need a procedure instead of a product to get the results that you’re seeking?

AS A DERMATOLOGIST, WHAT IS YOUR

FAVORITE BRAND OF SKIN CARE PRODUCTS?
I don’t have one particular “favorite brand.” I have sampled so many products from so many
companies. What I’ve discovered is this: there are many great products from many companies
and across all price points.

I attend the American Academy of Dermatology meeting every year, where companies sample
their latest offerings to dermatologists from across the world. What I’ve discovered is that
there are so many great products out there.

Some of my patients prefer to stick with one particular brand, because they have clear
directions on how to use the products and they like consistency. I think that’s a great approach
for some.

I also think it’s just fine to mix and match brands, as long as you’re focused on how the different
ingredients and products work together. That’s my personal approach.

And I’m actually not concerned about price point at all. There are certain ingredients that are
likely to be more expensive. But beyond that, much of the price difference is related to the
aesthetics of the product (such as the fragrance additives) or the aesthetics of the packaging.
Which can add a lot to the price of the product. And, of course, as with any other luxury product,
sometimes you’re simply paying for the brand name and the aura associated with that brand.

dr. rajani katta | Skin Defense | KattaMD

 A FEW OTHER REASONS WHY I DON'T HAVE A
"FAVORITE" BRAND.
My patients have such a range of skin types and different skin concerns. It’s so important to
tailor your skin care regimen to you. Not all brands have products that cover all of these
different skin concerns.

Also, personal preference makes such a huge difference, and is one of the main reasons why I
hardly ever recommend one single particular product. I may tell you what I’ve personally used
and liked. Or what a friend of mine or a patient has used and liked. But I simply can’t make an
individualized recommendation.

I specialize in patients with sensitive skin, and I almost never recommend a single moisturizer
to a patient. Instead, I give them samples of five different types so that they can try them and
see what formulation they like. I’ve chosen these because I like the ingredient profile of all five,
but my patients may like the feel of one particular product on their skin better than the others.

And your daily routine can also play a huge role in how you choose your skin care products. I
have a particular hand cream that I love to use during the day, because I might be shaking hands
throughout the day and I can’t use anything that’s too greasy. Factor that in as you’re choosing
your skin care products.

HOW DO I CHOOSE WHICH ACTIVE INGREDIENT

TO USE?
Sometimes I’ll pick up a beauty magazine and I’ll feel a sense of déjà vu. Why does it seem as
though in every other issue they’re raving about a different new and amazing skin care
ingredient? How can one person possibly use all of these fantastic (indispensable?) skin care
ingredients?

This is where you need to stop and remind yourself of one important fact.

There are only so many ingredients that you can be putting on your face. There are only so many
ingredients that you SHOULD be putting on your face.

dr. rajani katta | Skin Defense | KattaMD

 In fact, if you try to combine too many active ingredients into one product, you run the risks of:

One ingredient simply inactivating the other

Or worse, you run the risk of these ingredients worsening the side effects of each other
Or you could just be running the risk of wasting your money on three active ingredients,
when you’d get just as great a result from one active ingredient

As just one example: if you’re looking for a chemical exfoliator, you might reach for either
salicylic acid or glycolic acid. You shouldn’t reach for both, because you run the risk of irritation,
stinging, redness, flaking, and a rash.

That’s one of the reasons that I personally use few active ingredients and few products. I’m
looking for highly targeted, highly functional ingredients, so that I can use fewer products
overall.

HOW DERMATOLOGISTS KEEP UP WITH THE

LATEST AND GREATEST SKIN CARE
INGREDIENTS
There are so many new ingredients, and it seems as though cosmetic chemists are creating
new ones all the time. I’m a dermatologist, and it is still incredibly challenging for me to keep up
with all of the latest ingredients. It's also a huge challenge to keep up with the many, many
products on drugstore and department store shelves advertising those ingredients.

How do I investigate those claims? To start with, I rely on clinical studies. These are the studies
that are performed in human volunteers. Of course, I'm not looking for just any "clinical studies":
I’m looking for high-quality studies.

I've seen more skin care ads than you can count, and I’m simply not impressed with those that
advertise “4 out of 5 users noted improvement in fine lines and wrinkles within two weeks.” I'm
not impressed, because there’s a huge placebo effect in play every time you’re using an
expensive product and looking at outcomes that are highly subjective.

dr. rajani katta | Skin Defense | KattaMD

Have you ever looked in the mirror one day and thought that you looked older than usual? Really
noticed a lot more fine lines that day, for whatever reason? And then one week later you looked
in the mirror and felt much better about the way that your skin looked?

That's what I mean by "subjective" measurements. Whether you're looking at your skin, or a
dermatologist is looking at your skin, it can be hard to objectively measure the extent of your
fine lines and wrinkles. That’s why I’m not as impressed with studies that only rely on user
ratings. User ratings should definitely be one part of evaluating a product, but they’re one of the
least important ratings when I’m trying to evaluate a new ingredient.

I rely most heavily on research studies. One of my favorite type of studies are what are known
as “split-face” studies. You apply Product A to one side of the face, and then apply Product B to
the other side. You continue for 12 weeks. And then you look at your face and see if you can spot
a difference. Even better, you have an impartial researcher examine your skin and you see if
THEY can spot a difference. (And, of course, this study is best if neither one of you knows which
cream went on which side.) This type of study is known as a split-face, randomized, double-
blind (neither the volunteer nor the researcher knows which product is which) and controlled
trial (meaning there's an active ingredient compared to a placebo).

Another type of research study that I find very helpful are before-and-after randomized
placebo-controlled trials. In this study, one group of patients uses Product A (containing the
active ingredient) and the other group uses Product B (containing the same exact ingredients,
without the active ingredient). At the end of that time, researchers see which group improved
the most from baseline.

Here are links to some before and after photos in published studies that have used this type of
research methodology:

Treatment of post-inflammatory hyperpigmentation due to acne in African-American

women, before and after 40 weeks of treatment with tretinoin
Treatment of fine wrinkling before and after 24 weeks of treatment with retinol
Treatment of fine lines and wrinkles, before and after 12 weeks of treatment with retinol

There actually aren’t that many of these types of studies available for many of the active
ingredients that are out there. Which means it can be very challenging to draw conclusions
about the latest and greatest ingredients.

dr. rajani katta | Skin Defense | KattaMD

That’s why I tend to rely on ingredients that have a long track record behind them, with lots of
clinical studies. For example, one category that's probably been studied more extensively than
any other for the treatment of fine lines and wrinkles is retinoids. These have shown impressive
results. On the other hand, other ingredients such as caffeine have yielded pretty disappointing
results when studied with careful clinical trials.

HOW DO DERMATOLOGISTS SCIENTIFICALLY

EVALUATE A NEW SKIN CARE INGREDIENT?
Most dermatologists follow the 3-question approach developed by Dr. Albert Kligman, a
prominent cosmetic dermatologist.

1. Can the active ingredient actually penetrate through the stratum corneum (the outermost
layer of the skin) and then be delivered in a high enough concentration to target areas in the
skin?

2. Does the active ingredient have a biochemical basis for producing skin benefits?

3. Are there published, peer-reviewed, double-blind, placebo-controlled clinical trials that help
substantiate any of the claims made by this product?

dr. rajani katta | Skin Defense | KattaMD

 Chapter 5
Developing an Anti-Aging
Skincare Regimen
 THE DERMATOLOGIST'S GUIDE TO SKIN
RENEWAL SKIN CARE PRODUCTS
("ANTI-AGING SKIN CARE")

As a dermatologist, one of the most common questions I’m asked is this:

"What products should I use to help slow down the visible signs of skin aging?"

When we’re talking about skin renewal approaches (also known as “anti-aging“
skin care), it’s important to realize that there are many different approaches.

ACHIEVING A YOUTHFUL GLOW

How do you achieve a youthful, healthy glow? While plastic surgery may help
reverse some of the visible signs of skin aging, achieving a youthful glow
requires more than just a procedure. I like to talk about the impact of food,
skin care, and lifestyle. When it comes to youthful, glowing skin, all of these
can make a big difference.

Lifestyle factors such as sleep, stress management, and exercise can

help improve blood flow to the skin and limit the impact of damaging
hormones such as cortisol
Nutrient-rich foods can help support skin circulation, combat free
radicals, and also contribute to a healthy glow
Skin care has an important role to play as well

dr. rajani katta | Skin Defense | KattaMD

 THE ROLE OF SKIN CARE PRODUCTS IN
SKIN RENEWAL
There are multiple skin care ingredients and procedures that can help renew your
skin's appearance.

At a basic level, removing the top layer of dead skin cells from the skin's surface can
help "brighten" and "freshen" the skin's appearance. This is called exfoliation, and it
can either be done with ingredients in skin care products ("chemical exfoliants" such
as glycolic acid or salicylic acid) or it can be done with physical methods (such as
scrubs or devices).

Ingredients such as retinoids are another important category of skin renewal

ingredients. Retinoids help increase cell turnover, important for skin renewal.
Studies have also shown that retinoids actually help contribute to the production of
new collagen in the skin.

Certain procedures can lead to collagen remodeling, with new collagen produced in
the skin after controlled damage to the skin. These procedures include
microneedling and certain laser procedures.

While all of these, though, there's a delicate balance. You need an intact skin barrier:
it provides protection against UV radiation, microbes, and more, and it's a key part
of maintaining healthy skin. So while "remodeling" the skin may help with skin
renewal, it has to be done extremely carefully.

I've actually treated many patients who have over-exfoliated. Afterwards, they
developed very sensitive skin, because their skin barrier no longer worked as well.
Some have even developed allergic reactions to skin care products.

As we discuss skin renewal ingredients, it’s really important to keep that idea of
balance in mind. You have to balance your goal of skin renewal with the need to
protect your skin barrier.

dr. rajani katta | Skin Defense | KattaMD

 THE VISIBLE SIGNS OF SKIN AGING
Although there's some variation in how we describe the features of aging skin,
there's a general agreement in the medical community that these features include:

1. Fine lines and wrinkles. While some of this is due to aging itself, a significant
factor is the amount of UV radiation that reaches our skin and damages the collagen
and elastic fibers in the skin.

2. Sagging. Think about an elderly person with jowls, and how that contrasts with
the firm jawline of a 20-year-old.

3. Atrophy. If you've spent time around elderly persons, especially those who've
sustained a lot of sun damage, you'll know that their skin becomes more fragile as
they age. This is because our skin thins (or in medical terms, atrophies) as we age.

4. Loss of elasticity. Someone in their 20s has tight, taut skin that bounces back
when you pinch it. As you age, your skin loses that ability to bounce back.

5. Pigment changes. As we age, we accumulate a lot more freckles and dark spots.
The medical term for one type of these dark spots is solar lentigos. I call these sun
spots, because they're due to cumulative UV exposure catching up to us.

6. Changes in skin texture. Older skin starts to show more changes of roughness
and dryness. The skin just doesn't hold onto moisture as well. And it doesn't matter
how many glasses of water you drink--the loss of natural oils in the skin predisposes
us to dry, rougher skin as we age.

7. Changes in microvasculature. Microvasculature is the medical term for the small

blood vessels in our skin. Some people report that their skin looks more "sallow" as
they age, meaning that they no longer have that healthy glow or freshness of
youthful skin.

dr. rajani katta | Skin Defense | KattaMD

 SKIN CARE PRODUCTS CAN TARGET SOME OF
THESE VISIBLE SIGNS OF SKIN AGING
There are a number of over-the-counter (and prescription) skin care ingredients that can
help reduce or minimize some of these features of aging skin. The right skin care routine
and the right skin care products can help treat and even reverse:

Fine lines and wrinkles

Pigment changes
Changes in skin texture

It's important to recognize the limitations of skin care, though: we just don't have
evidence that skin care products can help reverse loose, sagging skin or deep wrinkles.

ACTIVE INGREDIENTS IN SKIN RENEWAL

(ANTI-AGING) SKIN CARE PRODUCTS
Retinoids: The Skin Smoothers.
I call these the “smoothers” because they help smoothe out fine lines and wrinkles
by increasing collagen production and helping smoothe out the skin’s surface
texture. These are considered one of the most effective skin renewal ingredients
available.

Vitamin C: The Dark Spot Preventer.

This is the dark spot preventer because it helps block the production of melanin. It’s
also a strong antioxidant, so helps provide an extra layer of free radical protection.

Vitamin E: Extra Defense.

This antioxidant provides an extra dose of free radical defense.

Hyaluronic acid: The Temporary Plumper.

This is “the temporary plumper”, because as a humectant it attracts water to the
skin’s layers. This produces a temporary plumping effect that helps diminish the
look of fine lines and wrinkles.

dr. rajani katta | Skin Defense | KattaMD

 ACTIVE INGREDIENTS IN SKIN RENEWAL
(ANTI-AGING) SKIN CARE PRODUCTS
Niacinamide (vitamin B3): The Gentle Skin Renewer.
While its effects are not as strong as retinoids, clinical trials have
demonstrated improvements in dark spots, improvement in fine lines and wrinkles,
and improvement in epidermal barrier function resulting in less skin irritation.

Caffeine: More Hype Than Science.

I consider this ingredient “more hype than science”. In one study, a cooling gel
worked just as well in diminishing the appearance of dark circles with and without
caffeine.

THE MAIN INGREDIENTS THAT I AVOID

WHEN I'M CHOOSING SKIN CARE PRODUCTS
I specialize in the treatment of sensitive skin, eczema, and allergic reactions of the skin.
That means that I'm hyper-aware of ingredients that commonly trigger either irritation or
allergic reactions. That's the main reason I avoid certain ingredients.

For my patients, I usually recommend products that do NOT contain:

Fragrance. Of all the ingredients that I test for, the category of fragrance additives is
one of the top triggers of skin issues. Among my patients, fragrance additives are the
most common cause of allergic contact dermatitis (aka allergic skin reactions).

Fragrances are challenging. To start with, when you see a product label that lists
"fragrance", that's a little misleading. It sounds like it's just one ingredient. It's not. In fact,
that single word may indicate the presence of 40 or more different fragrance additives.

Because of labeling laws in the US, manufacturers do not need to tell you the ingredients
that make up their secret "fragrance" mixture. To make it more challenging, products
that are labeled as "fragrance-free" may in fact (quite legally) contain fragrance additives,
due to loopholes in the labeling laws. For more information about fragrance allergy,
please see my handout.

dr. rajani katta | Skin Defense | KattaMD

 THE MAIN INGREDIENTS THAT I AVOID
WHEN I'M CHOOSING SKIN CARE PRODUCTS
Formaldehyde preservatives. If you look at the top 10 causes of allergic skin
reactions in North America, formaldehyde and formaldehyde-related preservatives
are in the top 10 (not a great list to be on). For this reason, none of my recommended
products contain formaldehyde or related preservatives

Methylisothiazolinone (MI). This ingredient is used as a preservative in skin care

products. Unfortunately, over the last decade we have started to see an epidemic of
allergic skin reactions to this chemical. I never use products that contain MI
anymore.

FORMULATION MATTERS:
WHY VEHICLES ARE SO IMPORTANT
The right active ingredients are critical. However, it's just as critical to get the
formulation correct.

For the best function, you need the right product. The “right” product has:

The right active ingredient…

Along with a formulation that can effectively deliver those ingredients to the skin
layer where they can actually work.
That formulation also needs to work well for your skin type.

I'm really focused on formulations when it comes to certain active ingredients. For
example, formulation is incredibly important when it comes to retinoids. Most people can
use a retinoid, but you’ll need to pay close attention to the formulation. That’s why
retinoids come in vehicles ranging from creams, lotions, gels, and moisturizing creams to
special microspheres.

LINK TO LESS ALLERGENIC SKIN

RENEWAL SKIN CARE PRODUCTS

dr. rajani katta | Skin Defense | KattaMD

Chapter 6
Retinoids
 WHAT ARE RETINOIDS?
Retinoids are a category of medications that have powerful effects against
acne and skin aging. They come in different topical formulations (topical
means "applied to the skin"). Topical retinoids include both prescription
medicated creams and gels, as well as over-the-counter (OTC) products.
Some examples of retinoids include

tretinoin (example: prescription brand name Retin-A)

adapalene (example: OTC brand name Differin)
tazarotene (prescription only)

Retinoids are very effective in the treatment of certain types of mild to

moderate acne. They are especially helpful in preventing the formation of
comedones (otherwise known as blackheads and whiteheads). Retinoids
also work to improve the visible signs of skin aging, including fine lines and
wrinkles, rough skin, and dark spots.

While they can be very effective, retinoids can also cause a whole lot of
skin irritation. That’s why it’s so important to avoid these common
mistakes. Follow your doctor’s instructions closely, and always read the
package insert prior to using these products.

While your skin adapts to the treatment, it's common to experience

irritation in the form of redness and dryness. While some mild irritation is
considered normal, you should contact your physician if you experience
persistent problems. Your dermatologist may then prescribe a lower
strength of the medication. She may also prescribe a different formulation,
since that can also make a big difference in how your skin reacts to the
medication. Retinoids come in moisturizing creams, lotions, microspheres,
and gels.

dr. rajani katta | Skin Defense | KattaMD

 RETINOIDS: KEY FACTS
Retinoids are a category of skin care ingredients that are derivatives of vitamin A.
Retinoids have been in use for decades, and are widely used in the treatment of
mild to moderate acne.
They are also used to reduce the visible signs of skin aging.
For my patients seeking effective skin renewal skin care products, I recommend
products with retinoids most often.
There are both natural and synthetic retinoids.
They may be found in either prescription medications or over-the-counter
products.
Ingredients used in prescription medications include retinoic acid (also known as
tretinoin), adapalene, and tazarotene.
Retinoid ingredients used in over-the-counter products include retinol,
retinaldehyde, and retinyl esters.
Although they can be irritating, most people can still use products with retinoids.
It's really important to make sure that you're using them the correct way, and it's
equally important to find a formulation that works for your skin.
For patients with less sensitive skin who can handle the potential irritation, the
prescription retinoids are considered the most effective.
For those with more sensitive skin, I usually recommend products with either
retinol or retinaldehyde.

We have a large body of literature on retinoids, mainly focused on studies of the

prescription ingredient retinoic acid. This compound has shown effectiveness, over
decades, in the treatment of acne. It has also been studied and shown effective in
reducing multiple signs of skin aging. As just one example, strong clinical trials have
shown that it helps improve the appearance of fine lines and wrinkles. Research has
shown that it also helps to even out skin tone, enhance cell turnover, and improve
collagen production.

If you'd like to read about the biochemical mechanism of action of retinoids, as well as
a review of the many clinical research trials performed on retinoids, this medical
journal article provides a great review.

dr. rajani katta | Skin Defense | KattaMD

 RETINOIDS IN THE TREATMENT OF
SKIN AGING
Retinoic acid is one of the most studied, and most effective, compounds for treating
the visible signs of skin aging, including fine lines and wrinkles, skin roughness, and
dark spots.

While there are fewer studies for the retinoid ingredients found in OTC products,
these have also shown promising results. The most promising ingredient is
adapalene, an ingredient that used to be available only by prescription, but that is now
available in both a prescription (higher concentration) and an OTC (lower
concentration) formulation. Other promising OTC retinoid ingredients include retinol
and retinaldehyde. These other ingredients aren't as effective as the prescription
ingredients, but they're a lot less irritating for most people.

Retinoic acid improves many of the visible signs of skin aging. It does this by
improving fine lines and wrinkles, reducing surface roughness, increasing skin
collagen production, and helping to even out skin tone by reducing the appearance of
dark spots.

Improves the Appearance of Fine Lines and Wrinkles

Promotes epidermal cell turnover by binding to retinoic acid receptors. This

activates certain genes that are involved in cellular proliferation and
differentiation, which helps dead skin cells slough off from the surface of the skin
more effectively.
Increases the capacity of the epidermis to hold water through stimulation of
glycosaminoglycan synthesis
Also stimulates collagen synthesis through increases in procollagen
Also prevents further breakdown of the dermal matrix by inhibiting the enzymes
that break down collagen

dr. rajani katta | Skin Defense | KattaMD

 Evens out Skin Tone

Enhances epidermal cell turnover.

This helps reduce the amount of contact between keratinocytes (skin cells) and
melanocytes (pigment-producing cells).

Reduces Skin Roughness

Promotes epidermal cell turnover

Helps dead skin cells slough off from the surface of the skin more effectively

dr. rajani katta | Skin Defense | KattaMD

 DIFFERENT TYPES OF RETINOIDS:
RETINOIC ACID, RETINOL, RETINALDEHYDE
Retinoic acid is the biologically active form of vitamin A.
If you use retinol and retinaldehyde in a skin care product, they are absorbed into
the skin. They are then converted into retinoic acid.
Retinol is oxidized into retinaldehyde in the skin. Retinaldehyde is oxidized into
retinoic acid.

Retinol and retinaldehyde can produce significant improvement

in the appearance of fine and deep wrinkles

In one clinical study, researchers reported that retinaldehyde was effective and well
tolerated in patients with photodamage (skin damage due to years of UV exposure).
"At week 18, a significant reduction of the wrinkle and roughness features was
observed with both retinaldehyde and retinoic acid."

In studies, the use of topical retinol has also resulted in significant improvement in
reducing the visible signs of skin aging.

For example, this study used a split-face treatment and compared the use of retinol
cream (on one side of the face) to tretinoin cream (on the other side of the face).
After 12 weeks, they showed significant improvement in multiple signs of aging skin,
including overall sun damage, fine lines and wrinkles, coarse lines and wrinkles,
"skin tone brightness", skin pigmentation, and rough skin. In this study, they actually
found equivalent results between the use the retinol cream and a comparable dose
of tretinoin cream.

dr. rajani katta | Skin Defense | KattaMD

 RETINYL ESTERS SUCH AS
RETINYL PROPIONATE AND RETINYL PALMITATE
ARE NOT AS EFFECTIVE FOR REDUCING THE VISIBLE
SIGNS OF SKIN AGING

Retinyl esters include derivatives of retinol such as retinyl acetate, retinyl propionate, and
retinyl palmitate. These have been widely used in cosmetic products, but I don't typically
recommend them, since we have limited evidence that they're effective. They were first
studied because of animal studies: retinyl propionate was able to promote collagen
formation in mice exposed to UV radiation. However, results from a double-blind, placebo-
controlled trial were not promising. In this study, volunteers used either a topical retinyl
propionate cream or placebo for almost a year (48 weeks). At the end, researchers could not
demonstrate any statistically significant difference between the active cream or the
placebo cream, either in clinical visible features or in skin biopsy changes.

Here are some links to before and after photos of

patients who have used topical retinoids in clinical
studies:

Treatment of post-inflammatory hyperpigmentation due to acne in African-American

women, before and after 40 weeks of treatment with tretinoin

Treatment of fine wrinkling before and after 24 weeks of treatment with retinol

Treatment of fine lines and wrinkles, before and after 12 weeks of treatment with retinol

If you'd like to see how to incorporate retinoids into your skincare

routine, we created a sample list of hypoallergenic anti-aging
products.

dr. rajani katta | Skin Defense | KattaMD

 BAKUCHIOL: FURTHER RESEARCH NEEDED
ON THIS "NATURAL RETINOL ALTERNATIVE",
BUT PROMISING PRELIMINARY RESULTS

One natural compound that I'm interested in is a substance called bakuchiol. This
compound is NOT a retinoid, but it seems to have several of the same impacts in the
skin. That's why it is sometimes referred to as a "natural retinol alternative."

Bakuchiol is a phytochemical, found mainly in the seeds of a plant from India called
babchi. Bakuchiol and retinol have different chemical structures, but they seem to
work in the skin in similar ways. Laboratory studies suggest that both compounds
affect genes in our skin cells that impact retinoic acid receptors. Studies also suggest
that both act to increase certain enzymes that promote collagen synthesis. Bakuchiol
has also demonstrated some impressive antioxidant effects.

In one randomized, placebo-controlled, double-blind study, 44 patients were asked to

apply either bakuchiol 0.5% cream twice a day or retinol 0.5% cream twice a day to
their face. High resolution photographs were taken before, during, and after
treatment, and dermatologists assessed the patients for redness and pigmentation.
Neither the patients nor the researchers knew which group was using which product.

After using the products for 12 weeks, both groups were found to have a significant
decrease in wrinkle surface area and hyperpigmentation (dark marks). In terms of side
effects, the bakuchiol group did well with the treatment, while the retinol users
reported that they had more flaking and stinging on their face.

Since this is a small study, we definitely need more research to understand more
about the potential side effects, the potential benefits, and if certain people might
react to this ingredient differently. It is intriguing preliminary research, though, and
I'm watching out for more studies on this interesting substance.

dr. rajani katta | Skin Defense | KattaMD

 DIFFERENT TYPES OF RETINOIDS

dr. rajani katta | Skin Defense | KattaMD

 TOP 10 MISTAKES MADE WHEN USING
TOPICAL RETINOIDS
Mistake #1: Using retinoids in the morning

Why? Retinoids make your skin more sensitive to sunlight, which is

why they're prescribed for use at bedtime.

Mistake #2: Not using sunblock

Why? Even though you're only using retinoids at bedtime, you'll still
need sunblock in the morning. If you are prone to acne, make sure
it's labeled "non-comedogenic" so that it doesn’t make acne worse.
If you have sensitive skin, make sure you look for sunblocks that
only contain physical sunblock ingredients, that are truly fragrance-
free, and that are low in allergens. And if you're prone to dark marks,
make sure that you're using a broad-spectrum sunblock that
contains physical sunblock ingredients such as zinc oxide and
titanium dioxide. These are important to block visible light, which
can make hyperpigmentation worse.

Mistake #3: Using a harsh cleanser

Why? Since retinoids can cause redness and dryness, it’s important
to use a gentle cleanser. This might be a gentle foaming cleanser or
a hydrating cleanser, depending on your skin type. Most people will
have to avoid medicated cleansers at bedtime. That's because the
ingredients in certain medicated cleansers, such as salicylic acid or
benzoyl peroxide, can increase your risk of skin irritation.
dr. rajani katta | Skin Defense | KattaMD
 Mistake #4: Using the products on top of damp skin

Why? Retinoids are meant to be applied to dry skin, unlike your

moisturizer. After washing your face, gently pat dry. Most people
should wait an extra 5-10 minutes before applying their retinoid.

Mistake #5: Using them every night right from the start

Why? Most dermatologists will recommend that during the first two
weeks of using a retinoid, you should only apply it every other night.
This gives your skin time to adjust. Assuming your skin adjusts well,
then most people can start using it every night. For some people,
though, this is still too irritating. They might only be able to handle
the medication every other night. Even though this is a lighter
schedule, it will still produce results for most.

Mistake #6: Using too much medication on your face

Why? This is a common mistake, and can really cause problems. A

little bit goes a long way when it comes to retinoids. In fact, only a
pea-sized amount is used for the entire face. I like the "Five Dot"
method. Dot the medication on your forehead, both cheeks, chin,
and then a tiny amount on the nose. Then rub in to provide a very
thin and even layer over the whole face.

dr. rajani katta | Skin Defense | KattaMD

 Mistake #7: Applying the medication close to the eyes to treat fine lines
and wrinkles

Why? This is very tricky. For most people, the skin around the eyes is
extra-sensitive, and they won’t be able to use retinoids too close to the
eyes or the mouth. Your dermatologist may recommend a different
product to use next to the eye area. This product may contain a lower
strength of retinoids, or may not contain any retinoids at all. It may also
have a more moisturizing base.

Mistake #8: Applying an extra dose of retinoid cream to a pimple

Why? These medications work best to prevent the formation of new

pimples. If used on one individual pimple, they'll only inflame your skin.

Mistake #9: Using during pregnancy

Why? These medications are not recommended for use in pregnancy,

since oral retinoids (medications taken by mouth) have been shown to
increase the risk of birth defects.

Mistake #10: Expecting overnight results

Why? It may take as long as 6-8 weeks for the medication to begin
working, so you would need to continue using it for at least that long to
see results.

dr. rajani katta | Skin Defense | KattaMD

Chapter 7
Vitamin C
 THE DERMATOLOGIST'S GUIDE TO
VITAMIN C IN SKIN CARE:THE BENEFITS
VS. THE HYPE

When it comes to glowing, radiant skin, a lot of my

patients reach for the bottle. As in, that bottle of the
latest skin serum, expensive moisturizer, or high-tech
night cream.

Vitamin C skin care products are popular, but

it's important to know the difference behind
the science-supported benefits and the over-
hyped marketing claims.

Before you reach for that bottle, it helps to know the

science of skin care ingredients.

Vitamin C is an especially popular skincare ingredient

right now. Research studies have found that it can
help your skin in some ways, but also that it's probably
over-hyped in other ways.

dr. rajani katta | Skin Defense | KattaMD

 Where does Vitamin C excel?
It provides an extra layer of protection against free radical damage.
It boosts the protective effects of sunscreen.
It helps prevent freckles and dark spots by running interference with
melanin-producing cells and the enzymes that produce melanin.

Where is the hype stronger than the science?

We just don't have strong evidence that topical vitamin C actually
firms up collagen in those who consume a healthy diet.
Topical vitamin C is not the best choice for erasing fine lines and
wrinkles.
Topical vitamin C isn't the best choice for erasing dark spots.

Vitamin C Has Long Been Known To Be Critical For

Healthy Skin
We've actually known for centuries about the importance of
vitamin C for skin health. Centuries ago, sailors were at high risk
for scurvy, a disease caused by a deficiency of vitamin C in their
diet. Without enough vitamin C, sailors would develop a whole
slew of problems, including bleeding gums and wounds that just
wouldn't heal. That's because vitamin C is a critical component in
the production and maintenance of collagen.
That's one of the reasons that researchers have looked so closely
at vitamin C as an anti-aging ingredient in skin care formulations.

dr. rajani katta | Skin Defense | KattaMD

 VITAMIN C: BEFORE YOU REACH FOR A SKIN
CREAM, MAKE SURE YOU'RE GETTING ENOUGH
VITAMIN C IN YOUR DIET
Your skin is an amazing organ, and most of the time it functions beautifully. It
protects you from the elements, from the cold and the heat, and from all of the
different chemicals and objects that we brush up against all day long.

It is also the major line of defense against UV radiation.

In fact, your skin is under siege every minute of every day, from UV radiation, smoke,
pollution, and other forces. These forces all act to increase the production of free
radicals. Free radicals are molecules that contain an unpaired electron, and they're
very dangerous to the lipids, proteins, and DNA in your skin. In fact, one of the major
causes of skin cancer is the accumulation of DNA damage that results from the free
radicals produced by UV radiation.

Your body, thankfully, has wonderful systems in place to fight these free radicals.
These systems include certain enzymes in the skin, such as superoxide dismutase
and glutathione peroxidase. These protective systems also include plenty of
antioxidants, including vitamins C and E.

Although these antioxidants are constantly being used up, they're also constantly
being replenished: the foods that you eat provide a consistent supply of these
important chemicals. (That's why the antioxidants in your food are so critical to
healthy skin.)

The antioxidants found naturally in certain foods make their way from your digestive
system, to your blood supply, and from there to the tiny blood vessels that supply
your skin. They then diffuse into the epidermis and dermis, where they protect your
skin from free radicals. That's the "inside-out" approach to skin protection.

Research has also documented that an extra dose of antioxidants from your skin
care products can also help replenish your skin's supply.

dr. rajani katta | Skin Defense | KattaMD

 THE HYPE ALERT: ANY STUDY OF TOPICAL
VITAMIN C AND ITS EFFECTS ON COLLAGEN
NEEDS TO LOOK AT DIETARY INTAKE
Which brings us to one of the major unanswered questions with
vitamin C in skin care. If you're getting enough vitamin C in your
diet, does using it topically actually increase the vitamin C content
any higher in your skin? Good question, and we still don't know for
sure.

We do know that if you don't have enough vitamin C in your diet,

then that extra dose from a topical application may help your
skin. And this may be where all the hype about vitamin C
originated.

In one study, topical vitamin C was used on the forearm, and then
levels of a marker of collagen production were measured via skin
biopsies. While the topical vitamin C did seem to increase the
production of skin collagen, there was a major caveat.

This increase in collagen production was much more

apparent in women with the lowest levels of vitamin C
in their diet.
That's why the first step in skin care starts from the inside: you
need to ensure a diet that's naturally rich in antioxidants. That's the
foundation of glowing, radiant skin.

Vitamin C products in your skin care products may add a little extra
insurance.

dr. rajani katta | Skin Defense | KattaMD

 THE SCIENCE OF SKIN CARE: WHAT DO THE
STUDIES SHOW?

Vitamin C and other antioxidants provide an extra layer of

protection against free radical damage.

Free radicals are molecules that contain an unpaired electron, and they're
dangerous. I think of them as ping ponging around your epidermis and dermis,
and leaving a lot of damage in their wake. They directly harm your skin's
proteins, lipids, and DNA. They also activate harmful enzymes called MMPs:
matrix metalloproteinases. These MMPs include collagenase and elastase, and I
call these "scissor enzymes". These scissor enzymes snip away at the collagen
and elastic fibers that support your skin. Without strong intact collagen and
elastic fibers, your skin starts to lose its strength and elasticity, ultimately
leading to wrinkling and sagging of skin.

Topical vitamin C can block this harmful sequence of events. In one study of
healthy adults, a mixture of vitamin C and other antioxidants were applied to the
skin after exposure to ozone. This topical mixture helped to prevent the
activation of these scissor enzymes, thus protecting the skin.

In another study, volunteers used a skin cream containing vitamin C that was
encapsulated in liposomes. They were then exposed to UV radiation. The
researchers found that the use of this skin cream resulted in increased vitamin
C levels in the skin's epidermis and dermis, AND resulted in increased protection
against UV radiation.

dr. rajani katta | Skin Defense | KattaMD

 THE SCIENCE OF SKIN CARE: WHAT DO THE
STUDIES SHOW?
Vitamin C boosts the protective effects of sunscreen.

Studies have found that using sunscreen with antioxidants provides greater
protection against UV-induced skin damage than just using sunscreen alone.
In one study, using a sunscreen that contained vitamins C and E provided
greater protection against photodamage than just sunscreen alone. These
results held true for both UVA and UVB damage. (UVA and UVB are the major
types of UV radiation that damage the skin.) Remember, even the best
sunscreens allow some penetration of UV radiation, and antioxidants do a
great job of battling UV-induced skin damage.

Vitamin C helps prevent dark spots by interfering with the

production of melanin.

In one animal study, a topical formulation containing both vitamin C and

vitamin E was used on the skin, and then followed by UV radiation exposure.
Usually, UV radiation leads to increased activity of melanocytes, which are the
melanin-producing cells in the skin. This leads to tanning, and eventually to
permanent freckles and "sun damage spots" called solar lentigos. In this study,
however, this particular topical formulation was able to reduce the activity of
the melanocytes.

Laboratory studies have also looked at this process. Studies have looked
specifically at human melanocytes, and whether treating these cells with
vitamin C derivatives could help reduce their production of melanin. These
studies have confirmed that this works: in one experiment, melanocytes
reduced their production of melanin by 50% following treatment with a vitamin
C derivative.

dr. rajani katta | Skin Defense | KattaMD

 A FEW CAVEATS: WHERE THE HYPE IS
STRONGER THAN THE SCIENCE
Topical vitamin C is not the best choice for erasing fine lines
and wrinkles

We just don't have strong evidence that topical vitamin C actually firms up
collagen.

The studies right now indicate that using vitamin C topically can certainly help
protect collagen, especially if you're not getting enough in your diet. That extra
dose from your skin cream can increase levels of vitamin C in your epidermis and
dermis, and that can protect your collagen. Beyond that, though, we just don't
have good evidence that topical vitamin C will REPAIR collagen damage.

To actually repair collagen damage, dermatologists are far more likely to

recommend ingredients that have much more research supporting them.
Derivatives of vitamin A, including retinol and prescription-strength tretinoin,
have much more supportive evidence when it comes to effective collagen
remodeling.

Topical vitamin C isn't the best choice for erasing dark spots

The research has found that they can certainly prevent the
development of dark spots following UV exposure, but the research
showing that they can lighten dark spots is much less robust. While
they may help somewhat, most dermatologists will advise stronger
treatments if you're trying to lighten dark spots. These include
prescription strength vitamin A derivatives such as tretinoin, or
bleaching creams that contain safe concentrations of hydroquinone.
dr. rajani katta | Skin Defense | KattaMD
 Choosing a Product

If you'd like that extra layer of protection against free radical skin damage, or
would like a protect that helps reduce the activity of skin melanocytes, then
you may be reaching for a skin care product that contains vitamin C. Before
you do, though, make sure you choose the right product.

Judge a Product By Its Package

Vitamin C is very prone to oxidation. It's a strong antioxidant because it

donates an extra electron to neutralize free radicals. However, that also
means that it's prone to oxidation itself. In the presence of light, heat, and
even oxygen, the vitamin C molecule can start to destabilize. That means it
loses its effectiveness. Some researchers are even concerned that an
unstable vitamin C molecule can actually create MORE skin damage.

That's why the proper packaging is so important. You want to make sure the
vitamin C product is protected from light, heat, and oxygen. Some of the
products come in an opaque glass bottle with a stopper, which helps address
some of these issues.

dr. rajani katta | Skin Defense | KattaMD

 The Proper Formulation Is Critical

Just because it contains vitamin C, doesn't mean that it will be effective. For
vitamin C especially, the proper formulation is critical. Vitamin C is a water-
soluble molecule, and your skin barrier is meant to repel water. In some cases,
though, vitamin C is able to penetrate the skin barrier effectively. Studies have
demonstrated some penetration at the right pH (less than 4). The
concentration matters also: the optimal concentration for
absorption, efficacy, and tolerability is thought to be between 10% and 20%.
What that means is that at this level you'll have absorption (penetration
through the skin barrier), efficacy (effective results), and tolerability (not too
much irritation).

There are also different forms of vitamin C. While ascorbic acid can penetrate
the skin barrier, it's not the most stable molecule, so researchers have studied
other forms of it. [More on that in a moment.]

Finally, although vitamin C is a potent antioxidant, it's only one of the major
players. Research has found that vitamin C functions much better in the
presence of vitamin E. The combination functions even better when combined
with ferulic acid. Researchers are looking at other combinations of
antioxidants, so keep an eye out for advances in this area.

dr. rajani katta | Skin Defense | KattaMD

 CHOOSING AN EFFECTIVE FORMULATION:
RESEARCH INTO DERIVATIVE MOLECULES
When formulating an effective topical vitamin C product, cosmetic
chemists have to deal with several major issues relating to the product's
effectiveness. With a vitamin C product, you need to make sure it's able to
handle these issues:

It needs to penetrate the skin barrier

The molecule has to be stable, meaning it's able to resist oxidation
The molecule must either be in the form of ascorbic acid, or in a form that
the body can convert to ascorbic acid

While chemists have created other formulations, there are potential issues
with each one: You can add a phosphate group to ascorbic acid to help
stabilize the molecule, but that seems to interfere with its absorption through
the skin.

You can use a glucoside form of the molecule because it's stable and it
penetrates the skin, but it's unclear as to how effectively the body is able to
convert that molecule.

You can use a palmitate version, because that's lipid soluble, which translates
to increased uptake through the skin and animals, but there are still a
few questions about this formulation. Is it truly stable, and is the body able to
convert it?

Liposomes are another formulation, and due to the addition of lipids, they may
be better able to penetrate through the lipid skin barrier. This is one
formulation to keep an eye on.

dr. rajani katta | Skin Defense | KattaMD

 DESIGNING A SKIN CARE REGIMEN
Should you add vitamin C to your skin care regimen? If you'd like an extra layer of
protection against UV-induced skin damage, or you'd like to limit the formation of dark
spots, then a vitamin C product may be a good addition.

However, you do need to be aware that some of the hype about vitamin C is just that:
hype.

What does that mean for you? It means that a topical vitamin C product isn't likely to be
your dermatologist's first choice to erase fine lines and wrinkles, firm up collagen, or erase
dark spots. For these issues, you'd need to use your vitamin C product in conjunction with
other products.

The foundation of a skin care regimen is:

Sun protection
Cleansers and moisturizers suited to your skin type
A diet naturally rich in antioxidants and other powerful substances

For anti-aging skin care regimens:

Your dermatologist will often recommend a vitamin A derivative used at bedtime
If you're using a vitamin C product, the most effective ones are formulated in
combination with other antioxidants

THE BOTTOM LINE

As a dermatologist, one of my major guiding principles is this: Your skin care
regimen should always be customized to YOUR skin type and YOUR skin care
concerns.

If you'd like that extra layer of protection against free radical skin damage, or would
like a product that helps reduce the activity of skin melanocytes, then you may be
reaching for a skin care product that contains vitamin C.

Before you do, though, make sure you choose the right formulation in the right
package. Speak to your dermatologist about their recommendations.

dr. rajani katta | Skin Defense | KattaMD

 Chapter 8
Developing a Skincare Regimen
for Dark Spots
 The Treatment of Hyperpigmentation and
Facial Dark Spots
Why Ingredients Such as Hydroquinone, Azelaic Acid, Vitamin C,
Kojic Acid, Licorice Extract, Niacinamide, Soy, and Tretinoin May
Be Helpful
If you’ve ever developed a dark spot on your skin after an acne
breakout, then you know all about post-inflammatory
hyperpigmentation (PIH). That’s the medical term for the dark
discoloration on your skin that appears after that annoying pimple
finally goes away. PIH can also appear after a mosquito bite, a rash, or
really any type of skin inflammation.

Why does it occur? Because of melanocytes.

The Science of Hyperpigmentation: The Biochemistry of

Melanocytes and the Skin Pigment Melanin

Why do some of us develop dark spots after inflammation or injury to

the skin?

These dark spots result from the activity of a particular cell that lives
in our skin called a melanocyte.

Melanocytes produce Melanin: Too much Melanin can result

in Dark Spots, Solar Letigos, Post-inflammatory
Hyperpigmentation, or Melasma

dr. rajani katta | Skin Defense | KattaMD

 THE SCIENCE OF MELANOCYTES,
MELANOSOMES, AND MELANIN
Melanocytes are the cells that produce melanin. Keratinocytes are the cells that
make up the layers of our skin. It's the connection between these two that help
determine skin color and skin tone.

Melanocytes make melanin, your skin pigment. (One of the key enzymes in that
process is called tyrosinase; you'll hear more about that enzyme in a minute,
because it's a key player in the development of effective treatments.)

All of us, no matter our skin tone, have melanocytes scattered throughout our skin.
A single melanocyte has long “arms“ called dendrites, and a single melanocyte is
able to connect with approximately 36 different keratinocytes via these arms.

That connection matters, because that's how melanocytes transfer melanin to your
skin cells.

That melanin is found in small bundles inside the cell called melanosomes. I like to
picture melanosomes as tiny little footballs inside the cell. Your melanocyte
transfers those tiny little footballs to many different keratinocytes, and that's why
you see skin coloration. It might be nice and even (your skin tone) or it might be
irregular, resulting in dark spots or patches.

In some situations, your melanocytes start to "activate" and produce more

melanin than usual. For example, after exposure to UV radiation, melanocytes
start to amp up their melanin production. We call that tanning.
Other signals can trigger more melanin production, such as a rash or a pimple.
That can result in PIH: post-inflammatory hyperpigmentation, which are the dark
spots or patches that are left on your skin after the inflammation subsides.
Another signal, for some women and fewer men, is a condition called melasma.
In this condition, a rise in hormone levels, such as during pregnancy or with oral
contraceptives, can trigger dark patches on certain areas of the face such as the
forehead, cheeks, and above the lips.

dr. rajani katta | Skin Defense | KattaMD

 HOW THE SCIENCE OF MELANIN PRODUCTION HAS
LED TO THE TREATMENT OF
HYPERPIGMENTATION:
THE ROLE OF HYDROQUINONE, AZELAIC ACID,
VITAMIN C, KOJIC ACID, LICORICE EXTRACT,
NIACINAMIDE, AND SOY
Learning about the biochemistry behind the process of hyperpigmentation has
led us to different treatments that can be effective for some types of
pigmentation, in some people.

Hydroquinone: A Tyrosinase Inhibitor

Hydroquinone is a tyrosinase inhibitor. Tyrosinase is the enzyme that converts tyrosine

to melanin. One way to block the production of melanin is to block the activity of this
enzyme. That's why hydroquinone (HQ) is so effective at treating hyperpigmentation.

Hydroquinone is a small molecule that's able to penetrate the skin effectively.

It is often found in prescription products used to treat hyperpigmentation.
In some places, it's also available OTC.
It's banned in the European Union as a cosmetic additive, so cannot be sold there
OTC.
It is available in the United States at an OTC concentration of 2%.
In both countries, it's available as a prescription product, usually at a 4%
concentration.

While HQ can be very effective at treating hyperpigmentation, dermatologists are very

careful when prescribing it. That's because if it's used at high concentrations, or even if
used at low concentrations for long periods of time, it can actually cause darkening of
the skin. When I'm prescribing hydroquinone, I always put a time limit on its use.

dr. rajani katta | Skin Defense | KattaMD

 Other Ingredients That Help Block the Production of
Melanin:
Azelaic Acid, Vitamin C, Kojic Acid, and Licorice Extract

Azelaic acid is a prescription product that has also been shown to inhibit the
production of melanin. It's often used as a prescription treatment for acne,
because it reduces the production of acne lesions while also helping reduce
the hyperpigmentation that can result from acne.

Vitamin C is an antioxidant, which helps protect the skin from the damage
induced by free radicals. Vitamin C also helps reduce the activity of tyrosinase,
thus helping reduce the production of melanin. In clinical studies, it's shown
benefit in reducing the development of facial dark spots. For more on the
science behind vitamin C in skin care, please see this post.

Kojic acid is available in some OTC products. It's derived from natural sources,
and also helps block the production of melanin. While not as effective as the
prescription ingredients, it is helpful for some.

Licorice extract is derived from the root of the plant Glycyrria Glabra Linnem. It
has several benefits, including the ability to reduce the production of free
radicals and anti-inflammatory abilities. It also improves hyperpigmentation
by reducing the production of melanin. Again, it has milder effects than
prescription products.

dr. rajani katta | Skin Defense | KattaMD

 Ingredients That Help Improve Hyperpigmentation By
Blocking The Transfer of Melanosomes:
Niacinamide and Soy

Niacinamide, also known as nicotinamide, is vitamin B3. Topical OTC products

containing niacinamide have been helpful in treating the visible signs of skin
aging as well as some types of hyperpigmentation. It does this by several
methods, one of which is that it interferes with the transfer of melanosomes
(the little "football" bundles of melanin) from melanocytes to keratinocytes.

Niacinamide has been studied in multiple clinical trials, which is why it's often
used in anti-aging skin care products, typically in conjunction with other
ingredients. In one clinical trial, for example, use of a 2% niacinamide gel
reduced hyperpigmentation after 4 weeks of use.

Soy extracts also seem to inhibit melanosome transfer. These are, again, often
used with other ingredients, but may be helpful in evening out skin tone. In one
study, volunteers used a moisturizer with soy extracts for 12 weeks and
compared it to just the moisturizer base alone. After 12 weeks, the moisturizer
with soy extracts was better at evening out skin tone and blotchiness, along
with improving dullness and skin texture.

Ingredients That Help Improve Cell Turnover:

The Role of Retinoids

Retinoids, such as prescription tretinoin (brand name Retin-A) have also shown
to be helpful in the treatment of hyperpigmentation. That’s one of the reasons
why, when I treat a patient with acne who's prone to developing dark spots
afterwards, I make sure that tretinoin is one of my treatments. Tretinoin helps
reduce hyperpigmentation because it increases cell turnover, and also helps
reduce transfer of melanosomes to keratinocytes.

dr. rajani katta | Skin Defense | KattaMD

dr. rajani katta | Skin Defense | KattaMD CHAPTER 2 12
 Chapter 9
Developing a Skincare Regimen
for Acne-prone Skin
 CHOOSING THE RIGHT SKIN CARE PRODUCTS
FOR ACNE-PRONE SKIN
If your skin is prone to acne, you do need to make several adjustments to your
skin care regimen. You’ll need to think about the types of active ingredients to
include in your regimen. The choice of vehicle, which is another word for the
skin care product formulation, is also very important. Finally, you also need to
think about what types of ingredients to avoid.

CAUSES OF ACNE: MULTI-FACTORIAL

Acne is what we call a multi-factorial condition. This
means that there several different factors that play a
role in your tendency to develop acne.
The two major causes are genetics and hormonal factors. Environmental
factors, stress levels, the foods that you eat, and the skin care products that
you use can also play a role.

Some of these other factors probably impact acne because of their effects on
hormones. For example, certain foods, such as added sugars and refined
carbohydrates, can change the level of hormones in your bloodstream. Some
of these hormones, including one called IGF-1 (insulin-like growth factor 1) have
been shown in research studies to increase oil production and skin
inflammation, both of which contribute to acne.

dr. rajani katta | Skin Defense | KattaMD

 THE SKIN FACTORS THAT LEAD TO ACNE
Genetics, hormonal changes, and other environmental and lifestyle factors can
lead to certain changes in the skin. The skin changes seen in people with acne
can include:

An increase in oil production (sebum)

An increase in skin inflammation
Hyperkeratosis. Many people with acne have “stickier” skin cells that don't
slough off the surface of the skin normally. These can start to clog pores.
The presence of bacteria on the surface of the skin (Propionibacterium
acnes) which can worsen skin inflammation

These skin findings can produce the clinical skin findings

seen in acne.

For example, if you’re an adolescent, the hormone changes of puberty will usually
lead to an increase in oil production on the skin. At the same time, these skin cells
can become "stickier". What that means is that your pores are more likely to be
clogged with oil and dead skin cells. On your skin, that can produce whiteheads
and blackheads (in medical terms these are known as open and closed
comedones). Sometimes these clogged pores (and the substances within) can be
irritating to the skin, which produces inflammation, which can produce red
pimples on the skin surface. Bacteria may also contribute, further worsening the
redness and inflammation of the skin.

dr. rajani katta | Skin Defense | KattaMD

 TREATMENT OF ACNE DEPENDS ON THE TYPE
OF ACNE
In general, the type of skin lesions that we see in acne break down into:

Whiteheads and blackheads, also known as open and closed comedones

Papules, which are the inflamed red bumps of acne
Pustules, which are pus-filled skin lesions
Cysts, which are inflamed lesions underneath the surface of the skin
Nodules, which are larger and deeper acne lesions

Treatment with topical medications will often help reduce the number and severity of
blackheads and whiteheads. Certain topical medications can also be effective against
papules and pustules, or at least partially effective.

For patients with cysts and nodules, it’s very important to talk to your dermatologist about
treatments, since over-the-counter products or medications typically won't be strong
enough. It's also really important to see your dermatologist if you’re using topical products
but are not seeing any improvement in your acne, especially if you're starting to develop
scarring.

CHOOSING SKIN CARE PRODUCTS:

THE IMPORTANCE OF VEHICLES
Active ingredients are the ingredients that help a product achieve its goals. Vehicles, just like
their name suggests, are the formulation that carries the active ingredient.

If you’re prone to acne, it’s really important to pay attention to the vehicle. In general, you
want to look for products that are labeled as "non-comedogenic" (although that label isn’t
perfect).
If you have oily skin and are prone to acne, it’s important to avoid thicker, heavier
formulations. In general, you’ll look more for lotions, gels, and possibly alcohol-based gels
and toners.
If you have sensitive skin, you should avoid gels and toners that contain alcohol.
If you have dry skin, you should avoid alcohol.

dr. rajani katta | Skin Defense | KattaMD

 CHOOSING SKIN CARE PRODUCTS:
PAY ATTENTION TO ALL SKIN CARE
AND HAIR CARE PRODUCTS
Since oil-containing moisturizers and cosmetics may worsen acne, you should
examine labels and use only those that are “non-comedogenic” (although this label
isn't perfect). This applies to moisturizers, foundation, powder, and blush.

Makeup is fine as long as you're careful and choose the right products. You can
also use moisturizers if your skin feels dry, as long as you're careful with
product choices. Also be careful with oily hair products, such as mousses or gels,
and avoid getting them on your forehead or on your pillow.

ACTIVE INGREDIENTS THAT ARE HELPFUL

IN THE TREATMENT OF ACNE
There are several active ingredients that are available over-the-counter and that
have been shown to be effective for the treatment of milder forms of acne. Each
of these ingredients, though, can cause redness, irritation, and stinging, so
they're not recommended for everyone. Combining products that contain these
ingredients can also be challenging, since that can just worsen overall irritation of
the skin.

Although products that contain these ingredients may help in milder cases of
acne, it can take up to 8 weeks of use to see improvement.

Salicylic acid
Benzoyl peroxide
Retinoids

dr. rajani katta | Skin Defense | KattaMD

 SALICYLIC ACID IN CLEANSERS,
SPOT TREATMENTS, AND PEELS
Salicylic acid is what's known as a chemical exfoliator. It helps to loosen dead skin
cells from the surface of the skin, and keep them from clogging pores. While this
ingredient may be found in cleansers, spot treatments, or chemical peels, many
patients start with a medicated cleanser that contains salicylic acid. Although
this is a milder treatment, it may still cause irritation.

BENZOYL PEROXIDE: AN ANTI-

INFLAMMATORY AND ANTIBACTERIAL
INGREDIENT
Benzoyl peroxide (BP) has been used as a treatment for acne for decades. It has
anti-inflammatory and antibacterial properties, but it can also cause several side
effects. These include drying of the skin, redness, irritation, and even bleaching
of pillowcases. When it comes to BP, the formulation is extremely important. You
need to find a formulation that doesn't irritate your skin, but that's still effective.
And although rare, some people become allergic to BP.

BP MAY BE FOUND IN CLEANSERS, CLEANSING

PADS, LOTIONS, CREAMS, OR GELS
These are sold under different brand names, and come in different strengths
Options include 2.5%, 5%, or 10%
The higher the strength, the more effective the medication. However, note
that the higher strengths are also more likely to cause dry skin and irritation.
Those with oily skin may prefer a gel formulation
Those with dry or normal skin may prefer a lotion or cream formulation
Benzoyl peroxide is sold under different brand names

dr. rajani katta | Skin Defense | KattaMD

 IF YOU'RE USING BENZOYL PEROXIDE,
IT'S IMPORTANT TO USE IT CORRECTLY
In general, we recommend applying a thin layer [to the entire area that tends to
break out] at bedtime. If you do this consistently over 4-8 weeks, it can prevent
new acne bumps. Be careful, though, because BP can cause irritation in some
people and can bleach out dark pillowcases.

Some people with oily skin choose to use BP creams in conjunction with a
medicated cleanser. (Cleanse first, pat skin and wait for it to dry completely, then
use the BP cream.) However, this combination has a higher risk of irritation,
meaning it can cause more redness and peeling.

USE OF BENZOYL PEROXIDE

FOR ACNE ON THE BACK
In general, for acne on the back, dermatologists recommend starting with a
medicated acne wash that contains benzoyl peroxide. Lather up, leave on the
back for 5-10 minutes in the shower, then wash off. Most products come in a 5%
or 10% concentration.

If the wash is not too irritating, but isn't helping after 4 weeks, then we usually
recommend adding a BP cream that you leave overnight on the back. As always,
these can cause irritation and bleach out clothing and bedsheets.

RETINOIDS, SUCH AS RETINOL AND

ADAPALENE
Retinoids are very effective for comedonal acne and mild papulopustular acne,
but the strength of the active ingredient and the formulation is very important.
While retinoids can be very effective, they can also cause redness, stinging, and
skin irritation. That's why it's so important to use them properly. Since these
medications cause sensitivity to sunlight, they are used at bedtime, and sun
protection is recommended the next morning. It's also important to remember
that it can take up to 8 weeks of use to see results.
dr. rajani katta | Skin Defense | KattaMD
 Chapter 10
Developing a Skincare Regimen
for Allergic/Sensitive Skin
 MANY DIFFERENT CAUSES OF SENSITIVE SKIN
There are different causes for sensitive skin. For some people, genetics play a role.
Some people have a skin barrier that doesn't function as well, whether that's due to
genetics or skin conditions such as eczema (atopic dermatitis). If you have sensitive
skin, you may be more likely to develop symptoms of itching, irritation, or stinging
after applying certain skin care products.

Sensitive skin can also be a temporary state. If you're handwashing frequently, you
can start to strip away the natural oils from the skin barrier. That can contribute to
an impaired skin barrier, which can lead to sensitive skin. Along the same lines,
over-exfoliating, or using harsh products on the skin, can also lead to impairment of
the skin barrier.

Sometimes other skin conditions can contribute to sensitive skin as well. For
example, many rosacea patients find that their skin is sensitive to different skin
care products.

THE APPROACH TO SENSITIVE SKIN

Regardless of the cause, approaching a skin care
routine when you have sensitive skin boils down to two
main things.

Avoiding products that cause irritation

Choosing products that help build up and strengthen the skin barrier

dr. rajani katta | Skin Defense | KattaMD

 INGREDIENTS THAT CAUSE IRRITATION
Certain ingredients may work well in treating certain concerns, but at the same
time may cause irritation. If you have sensitive skin, you need to be careful when
using ingredients such as (note that this is not a complete list):

Salicylic acid
Glycolic acid
Retinoids
Vitamin C

While you may be able to use some version of these ingredients, you'll need to be
really careful.

Some people with sensitive skin can still use these active ingredients if they

Choose a lower concentration

Choose a vehicle that is more moisturizing/less irritating
Use the ingredient less frequentlyAdjust the other components of their skin
care routine

For example, retinoids are known to have powerful effects when it comes to skin
renewal/anti-aging benefits. For somebody with sensitive skin, a dermatologist
would recommend a retinoid that comes in a lower concentration, and that is
formulated in a moisturizing base. And instead of using it every night, you might
need to use it every third night instead.

Also, you would want to make sure that the other products in your skin care
regimen were not irritating. That means choosing cleansers that are hydrating
instead of foaming, and possibly choosing thicker moisturizers.

dr. rajani katta | Skin Defense | KattaMD

 AVOIDING VEHICLES THAT CAUSE IRRITATION
While certain active ingredients can cause irritation, the vehicles in which they
travel are just as important.

There are a number of different vehicles, ranging from lotions to creams to gels
to toners and more.

Vehicles that are alcohol-based can definitely cause stinging and drying of the
skin. For some people with sensitive skin, other ingredients in their products can
also cause symptoms, although this varies a lot from person to person. For
example, some of my patients have noted stinging and irritation when using
products with propylene glycol, while others handle it just fine.

CHOOSING PRODUCTS TO PROTECT AND

STRENGTHEN THE SKIN BARRIER
In general, moisturizing properly will help strengthen the skin barrier.

Choose skin care products that are thicker

Apply moisturizers on top of damp skin to help lock in moisture: In other
words, step out of the shower, towel off partially, and while your skin is still
damp, apply moisturizer on top of damp skin
Creams and ointments are the most effective at locking moisture into the
skin when applied on top of damp skin
Creams and ointments typically come in tubs or tubes, and have a higher
oil/lipid content. This higher lipid content means that they can lock moisture
into the skin more effectively
Lotions usually come in pump bottles, and they have a higher water content,
so they don’t hold moisture into the skin as well
As with so much else in medicine, though, everybody’s different. Some people
find that a heavier moisturizer actually irritates their skin more. For these
individuals, a lighter lotion formulation may actually be less irritating.

dr. rajani katta | Skin Defense | KattaMD

 ALSO BE CAREFUL OF ALLERGIC REACTIONS
OF THE SKIN
Sometimes “sensitive“ skin is actually inflamed skin, and if that inflammation is
due to allergic reactions to your skin care products, then you may need to do
some detective work or undergo testing.

I specialize in allergic contact dermatitis. In this type of allergic reaction, a

substance or product applied to the skin can trigger an allergic reaction. Unlike
other types of allergy, though, this one can be very delayed. It can take, on
average, 2 to 3 days for the reaction to appear. In some cases, it can take as long
as one week.

In other words, if you’re allergic to your moisturizer, you won’t experience burning
when you first apply it. Instead, 2 to 3 days later, you’ll notice a rash at the area
where you applied the moisturizer. And this rash, once it shows up, can take up to
eight weeks to go away, even if you never reapply that moisturizer again.

AVOID THESE INGREDIENTS IN YOUR SKIN

CARE PRODUCTS
The most common triggers for allergic skin reactions to skin care products are
fragrance additives and preservatives. Avoiding products that contain natural
fragrances, synthetic fragrances, formaldehyde preservatives, and
methylisothiazolinone is helpful for those with either sensitive skin or with
suspected allergic reactions of the skin. This handout is updated yearly, and links
to products that do not contain these common triggers of allergic reactions.

dr. rajani katta | Skin Defense | KattaMD

 LINK TO LESS ALLERGENIC SKIN CARE
PRODUCTS

LINK TO LESS ALLERGENIC MAKEUP

PRODUCTS

dr. rajani katta | Skin Defense | KattaMD

 If you enjoyed this book...
You can find more information on our website
[Link]

You'll find handouts and medical journal articles on

preventive dermatology, diet and dermatology, and allergic
skin reactions.

For links to the handouts mentioned in the book, please see

[Link]

Author: Rajani Katta MD

Book Designer: Dina Zamil
Design Contributors: Ariadna Perez-Sanchez, Shelly Fu

dr. rajani katta | Skin Defense | KattaMD