How To Get – and Keep – Healthy Skin

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Your skin is your body’s largest organ, and it’s fairly simple to take care of. But there are many different types of skin, and each need different kinds of care. Your skin might be oily or dry, tan or burn easily, be dotted with moles or creased with fine lines. It can be tough to know exactly what habits or products will keep your skin at its healthiest – and the signs of trouble to watch for. UH certified nurse practitioner Susan Mayne, CNP, who specializes in dermatology, leads us through the maze of skin health and gives practical tips on how to get your skin to look and feel its best.

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Transcript

Pete Kenworthy

We all look in the mirror, and most of the time it has something to do with vanity, right? We're fixing our hair. We're taking care of a pimple. Maybe shaving. But what about that moment that you look in the mirror and your first reaction is concerned? Like, what does that bump? Was it there before? Is that color okay? Should I maybe get that checked out?

Macie Jepson

I know exactly what you're talking about, and I have other concerns as well. You know, as we get older, things, start showing up. Things, we don't even like to talk about: age spots, moles, wrinkles, lack of elasticity. I mean, I could go on and on. When should we be concerned, though?

Pete Kenworthy

Yeah. You mentioned wrinkles. You know, those come with getting older, but can we do anything to make those go away, right? Keep our skin looking healthy. We all want to look younger, right?

Macie Jepson

Yeah. Yeah, absolutely. I definitely want to know the secret if there is one. I'm sure you do, too, Pete. You know, a lot of people would. Skin health is so important to our emotional health, really, how we feel about ourselves. It's also a window into sometimes more serious health issues. Today on the podcast, we're going skin-deep. Hi everybody. I'm Macie Jepson.

Pete Kenworthy

And I'm Pete Kenworthy. And this is Healthy@UH. Today, we're talking about healthy skin, both from how it looks and feels to what to watch out for. Joining us for expert insight as Susan Mayne, Certified Nurse Practitioner in Dermatology at University Hospitals in Cleveland, Ohio, Susan, thanks for joining us.

Susan Mayne, CNP

Thank you so much. Thanks for having me, Macie and Pete.

Pete Kenworthy

Let’s start with how to look our best, right? Are there actual things we can do to look better, to look younger? Do those exist?

Susan Mayne, CNP

Well, let's talk about beauty and aging. So, what happens as we age? We have these kind of fatty deposits in our skin. And when we're young, that youthful look is this kind of round face, right? So, as we age, we lose the collagen fibers. There's a buzzword there. We lose some of those fatty deposits. They start kind of sagging. So, we end up with a more oval face or like an upside down triangle. So, that's what we want to keep from happening. Now there are, to your question, Pete, there's a therapeutic spectrum. At one end are your over-the- counter topicals that, you know, we can all easily access, your hyaluronic acids, your Retinols, things like that. So, at the other end of the spectrum, there are there's plastic surgery, liposuction. There's Botox. There's fillers, all very expensive stuff. Okay?

So, what I want to talk today, I want to talk in depth about skin function, skincare and skin products. Because I truly believe that if you understand how the skin functions, if you understand the products that we use and how to use them, you'll make better decisions. So, you won't be stuck in those six aisles of skincare products, spending thousands of dollars unnecessarily. So, as we age, you know, things change. Our environment changes. Our geography can change. Our skin changes. Gravity takes over. So, your skin is always changing. So, rather than just tell you what you use right now, or, you know, point you in a direction where your skin is now, if you understand these things, you know, as your skin changes, as you age, you're going to use different products. I mean, even humidity can affect skin. So, let's talk about the skin.

So, what is its function? Its function is 1) to keep moisture in. So, it's a barrier. It keeps water in. Without it, we would turn into beef jerky. So, not so pretty, but very tasty, right? So, another thing it does is it protects us from the environment. And basically, skin is our armor. So, when I talk about the skin barrier in this podcast, I'm talking about the upper most layer, the epidermis, even higher than that. So, the very upper layer of the upper dermis is the stratum corneum. Okay? And that's what is really affected by beauty products and all that good stuff. And this layer of skin is made up of these lipids, which are natural fats. And they are essential components, and they play a role in maintaining skin strength. So, those components are cholesterol, free fatty acids, and ceramides at a one to one to one ratio.

Now, once that's thrown off balance, all heck breaks loose. Okay? So, we want to, and it's a balance that is very hard to keep, but you could do it. You know, we'll talk about that. So one-to-one ratio, cholesterol, free fatty acids and ceramides. And ceramides, that's another buzzword, hyaluronic acid, stuff like that. So, how do these three things work together to give us that youthful appearance? Okay? They accelerate recovery from damage, and they stave off dryness. That's how they work. So, we have external and internal conditions that affect the skin barrier. Okay? Sun exposure, number one. So, nothing's going to age you more than UV exposure. We're going to talk more about that later on when it comes to melanoma and skin cancers. Humid, humidity affects skin. Allergens, irritants, harsh chemicals, over-washing, over-exfoliating, yada, yada, yada.

So, a lot of things affect skin. Okay? Even genetics. So, navigating your way through all of these cosmetic and skincare products can be very difficult. But there are three basic categories of skincare products we're going to talk about: cleansers, moisturizers and astringents. Okay? They balance hygiene while preserving the barrier function, your skin function. So, hygiene, keeping moisture in, making sure we have that one to one to one ratio. All right. So, cleansers, moisturizers, astringents. Let's talk about cleansers. Okay? PH makes a difference. So, your skin has a pH. Cleansers have a pH. All of these things. Your skin is normally naturally at a pH around 5.7, which is slightly acidic, but that's a good thing because that's what kills off these bacteria, fungus, even viruses that can really harm us. So, cleansers, three types of cleansers. Okay? True soaps, combars and syndet cleansers.

Now these are bars or liquids. So, true soaps have a pH between nine or 10, much, much higher than our skin. An example is Ivory. Okay? Very drying. It's a high pH, and this is going to disrupt the epidermis, but it does leave you feeling clean or tight. My analogy for that would be like windshield wipers on a dry windshield. So, it just kind of catches, catches, catches. So, when you feel your skin after using a true soap, like Ivory, it's very dry. It's not very oily. It's just kind of soft. A lot of people like that feeling. That's not good for the skin. Okay? Only, only if you have extremely oily skin would I suggest you use something like that. So, that covers true soaps.

So, next are combars. Dial and Irish Spring are an example. These are milder cleansers than true soaps. And they're good for normal skin with a moderate amount of environmental dirt. So, we want to keep the moisture. We want to get rid of the oil, if we have oily skin. We also want to get rid of the dirt. Okay? So, syndet cleansers, these are the Doves, Cetaphil bar, Oil of Olay Foaming. These are your beauty cleansers. They contain about less than 10 percent true soap and carry pH between 5.5 and 7. Now remember your skin is normally at 5.7. Okay? These are the least damaging to skin in persons with very dry skin or any form of inflammation like eczema, something like that. So, we, those are the three types. Okay? These tend to be the foaming cleansers. Okay? So, foaming cleansers are pretty darn harsh. If you've got, you know, normal skin, dry skin, you want to go with a non-foaming cleanser. Okay? We'll talk about that in a second.

Now we also have body washes. So, we have, these body washes came along years ago. They were developed in an attempt to both clean dirt and moisturize at the same time. So, those are, those are great, too. Again, foaming, but they serve two different purposes. Now, if you're using a body cleanser like that, make sure you're using a little puff ball and that introduces both water and air and allows for the cleansing and the moisturizing to happen. Okay? So, let's talk about the non-foaming cleansers. These include lipid free cleansers and cold creams. Okay? So, these are your creams like CeraVe Gentle, you know, cream wash, Cetaphil, these gentle cleansers. They're excellent at removing cosmetics with low levels of environmental dirt. So, most of us who work in the office, we're, you know, we're not exposed to a lot of dirt. We wear our makeup. So, these are really good cleansers for normal to drier skin. So, lipid, free cleansers, they are soap free liquid products. They're applied either to dry or kind of moistened skin. And they're rubbed to produce minimal lather, rinsed away, wiped away. Okay?

So, foaming and non-foaming. Foaming tend to dry out the skin. Non-foaming tend to kind of preserve that moisture. So, if you have dry skin, go with the non- foaming cleanser. Okay? If you have very, very oily skin, a foaming cleanser is just fine.

Macie Jepson

Wait. Let me jump in here for a second, because I would never have thought of using just an everyday bar soap on my face. And you're mentioning really common products that have been around for a really long time. Do you mean we don't need to be spending money on special products to cleanse our faces?

Susan Mayne, CNP

That is what I mean. We don't. Not on cleansers. So, you can use a bar soap. You have oily skin, it's foaming, use a bar soap. Use a gentle cleanser, like a cream cleanser like CeraVe, Cetaphil if you have normal to dry skin.

Pete Kenworthy

So, does that wrap up cleansers? And then moisturizers are next, right?

Susan Mayne, CNP

Yeah. Let's talk about moisturizers. So, when it comes to moisturizers, there is a hierarchy. There are ointments. There are creams. There are lotions. At the top of that are ointments. They are the most moisturizing product that you could use for your skin. Then creams, a little less moisturizing than ointment, then lotion. So, really anything that comes in a pump, unless it's a big jar of CeraVe that has the pump, which is really good for people like me, who are really lazy about putting their moisturizer on. But most products that come with a pump are lotions. Now these are thin. They, you know, don't keep you feeling sticky. They smell good. They're all that good stuff, but they're not really made for moisturizing. If you want to moisturize, stick with a cream, if you can't stand the greasiness of an ointment. Ideally an ointment, especially during our dry winter months here where we have no humidity, nobody has a humidifier on their HVAC system anymore, so ointments are best for moisturizing.

Macie Jepson

Can you over-moisturize your skin? Or is that a blanket statement that's good for any age group?

Susan Mayne, CNP

I don't think there's a product out there unless you dipped yourself in paraffin where you would have 100 percent occlusion. So, if you occlude the skin at 100 percent, yeah, that's a problem. But even Vaseline or Aquaphor, these ointments, they, give you about 99 percent occlusion. That 1 percent makes a very big difference for the skin. So, so not really. You cannot. Keep yourself greasy.

Pete Kenworthy

And finally, the third category, third and final category: astringents.

Susan Mayne, CNP

Astringents are used to remove the oily residue left behind after cleansing. So, we cleanse, we use an astringent, then we moisturize.

Macie Jepson

There are a lot of them out there. And I would think that some of them could be really harsh, especially for particular kinds of skin. So, could you kind of break down what is out there and who needs to use what?

Susan Mayne, CNP

So, astringents, they can be very harsh. They can be very drying. Just be cautious. In dermatology, we tend to use salicylic acid for those who have acne. Another astringent is witch hazel. You could use that. But again, these can be very drying depending on all the other products that you're using on your skin also. Another one is glycolic acid. That’s an astringent.

Pete Kenworthy

So, there's a puzzle to this, right? Figuring out which cleanser, which moisturizer and which astringent you can use together?

Susan Mayne, CNP

So, know your skin type. That's what's important, you know. You kind of change your products as your skin type changes. If you have normal skin, then go with a gentle cleanser. If you have very, very oily skin, no harm in using a foamy or bar soap, that kind of cleanser. If you have very irritated, red, inflamed skin, make sure you're using the gentle stuff. And then change it up as your skin changes.

Macie Jepson

All right. Can we just finally talk about products? I mean, that's what I've been wanting to talk about here. Are they a waste of money? Can they make a difference? Can they really go under the skin and change the way we look? Because that's what the ads say, right?

Susan Mayne, CNP

Absolutely. Let's talk about retinoids. Okay? So, our retinols are the over-the- counter. Retinoids are prescription. If you get a Retin-A as a prescription and it’s much stronger than the over-the-counter stuff, so be very careful. We'll talk a little bit more about that a little later. So, retinol penetrates deep into the skin. It has an exfoliating effect, and it improves the texture and the tone of your skin. Okay? It increases the production of elastin in collagen, too. So, this stuff is good. Everyone should be using it. And let me tell you, you are never too old to use a retinol, because even the, like, I have a lot of elderly that come in and say, it's just too late. It's not. It will make a difference. So, retinols can also tighten non-sun exposed skin. So, if you use it on, you know, the back of your arm, it could make a difference, too. So, you could use it at any time in your life on any part of your body. These are just great stuff.

Macie Jepson

Before you go onto the next product. Retinol: over-the-counter or physician?

Susan Mayne, CNP

So, the prescription retinoids are much stronger. Okay? So, we use, we often use that not only for fine lines and wrinkles, but we use it for acne, too, because another thing retinols do is they keep pores unclogged, and they improve blemishes. So, it slows down…so, blackheads come from the inside out…it slows that process down. So, we use them often for acne treatment, too. Another bonus is it improves texture, tone, and it balances hydration level and controls excess oil.

Macie Jepson

So, this isn't something that we would want to get from the drug store.

Susan Mayne, CNP

No. It is. Absolutely. If you want a really strong retinoid or if you are seeking treatment for, say, acne, because we use these products for these inflammatory processes. The over-the-counter retinols are gentler. They're great. But remember all of these take about three to six months to really see a difference.

So, have patience. Use them, and I think you'll be very happy with what you see.

So, be patient, because it generally takes about three to six months of daily application of retinols to see a noticeable difference. Also, you don't, because they can be very drying. I mean, basically, they're kind of slow chemical peels. So, either if you start becoming irritated, dry, flaky, either pull back on them or, you know, bump up your moisturizing with that. Also, we don't recommend retinols for pregnant women. So, retinoids and alpha hydroxy acids, which you've heard, I'm sure, they differ in their mechanism of action for treatment of photo damage or UV exposure causing us to look a little older. But concurrent use of both of these produces a synergistic effect by combining the retinoid with the alpha hydroxy acid, which induces exfoliation without all the trauma of using a, you know, scrubby brush or a pumice on your face. Don't ever do that. And it enhances that epidermal hydration. So, these products you'll see more and more of where they're combining both the retinoid and the alpha hydroxy acid.

Pete Kenworthy

Okay. So, retinols are covered here. And I'm guessing there are other things that we could have in our toolbox. And I admittedly don't know a lot about any of these, any of these beauty products, but what else is there? What else can be used like a retinol that can help us with our skincare, with our desire to look younger, get rid of wrinkles, et cetera?

Susan Mayne, CNP

So, another big thing out there is vitamin C serum. So, long-term sun exposure, again, what does it do to your skin? It reduces the tone. It increases roughness, dryness, wrinkles, and even vascular changes. So, you turn red. You get these little red splotches. You get these pigment changes. And all of that is oxidative damage. Okay? Vitamin C is an antioxidant. So, vitamin C also plays a role in collagen stimulation. The stuff is great. What I do want to tell you is be very cautious because it's an, it can oxidize. So, don't buy vitamin C serum in anything but an opaque container because the sun does damage it. It's like an avocado. So, if you have this vitamin C, and it's all brown and yucky it, then it's been oxidized. Do not buy vitamin C serum in a glass container because you want to keep that. And there are some retinoids also that you've got to be very careful with. Don't let the sun hit them.

Macie Jepson

So, just like retinol products, vitamin C, you can spend $5 at the drug store or $150, you know, just walking into a dermatologist’s office. And it's really confusing about where to spend your money and what's worth it.

Susan Mayne, CNP

Start with the inexpensive stuff. Go cheap. See how it works for you. If it's not really working, then maybe, you know, a little more expensive. And sometimes the additives make a difference: the fillers, the vehicles. It all really depends on how your skin responds to these products. And just change it up a little bit. But you don't have to spend $300 on a little bottle of skincare product. And also, you know, your diet does make a difference with skin. But as far as I know, as far as the studies that I know that are out there, none of it is going to make a difference firming up or collagen building.

Pete Kenworthy

None of, you’re talking about none of ingesting things specifically for that, not talking about eating fried chicken. You're talking about none of these products, ingestible products.

Susan Mayne, CNP

Right. Exactly.

Macie Jepson

So, you're saying I can get rid of my 1995 container of bovine powdered collagen that I put in my coffee every morning.

Susan Mayne, CNP

Macie, get rid of it.

Macie Jepson

I can spend that money on something else. So, before we move on to skin damage and serious issues to look for, sunscreen, et cetera, can we put a bow on this, I mean, with maybe three or four points that you would like to make about products and skincare?

Susan Mayne, CNP

Sure. So, again, know your skin type. You know, know that a lot, many of your foaming cleansers are going to be a little more drying. Even the bar soaps foam. Anything, you know, anything that foams. The non-foaming cleansers, those gentle creams, a little less drying. Make sure that when you're treating your skin, layering is a big issue, too. So, make sure, so, when I say layering, what I mean is cleanse the skin first, then apply any, say, you have a prescription from your dermatologist or your primary, that goes on next, then moisturizer. So, that moisturizer is going to help that product get even deeper into the skin and be more effective. And you don't have to spend a lot on these beauty products. Know your skin type, but, you know, try the inexpensive stuff and then move your way up if you want, if it's just not doing well.

Pete Kenworthy

So, the beauty information is awesome, but we would be remiss not to talk to you about other skin related issues, right? And the one that's kind of top of mind is sun damage, right? Sun damage, sunscreen. What do we need to be aware of? I think most people know that sun can really damage your skin, but can you give us a brief why and really kind of the precautions we should take?

Susan Mayne, CNP

So, the sun emits ultraviolet radiation in the form of UVA, UVB, much more UVB. So, the UVB rays tend to stay a little more shallow in the skin, where the UVA rays tend to go a little deeper. Okay? So, this is what makes tanning beds so dangerous. Tanning beds are basically mostly UVA, where if we're just out and about in the sun, it's UVB, and it tends to be a little more shallow. UVA will go deeper. It will mutate DNA. It will make a lot of, and it can cause cancers, melanoma being the worst, of course. So, with tanning beds, if you use it even just once before the age of 35, you have significantly increased your risk of melanoma later on in life. They should be outlawed.

So, another thing with UVA UVB, both emitted from the sun, windows and glass. So, we think we're protected from all that bad stuff when we're in our cars, when we're in our offices. We are not. And the most dangerous aspect of that is that UVB is being filtered more than UVA, which is more dangerous. So, you'll see a lot of pictures, if you just even Google it, of, say, truck drivers, that's a good example. They drive, that window is on their left hand side. If you see those photos between, you know, here's your one, here's your 15, you will see significant change in the left side of their face. So, it's more wrinkled. It's more damaged, and that's UVA. And it can happen in the office setting, too. So, be very cautious, which is why every morning you put your moisturizer on, make sure it has some at least SPF 30 in it.

Pete Kenworthy

So, obviously the sun damages your skin. When you're in places with a lot of sun exposure, wear at least an SPF 30, protect yourself from future cancer risk, right? So, there are obviously times that hasn't happened. We've been exposed to a lot of sun throughout our lives, and then things start to pop up, right? And they cause concern because they weren't there the last time we looked at ourselves or the last time we felt our skin, right? Generally, we're talking about moles here, right? So, I've certainly been concerned about them before. And usually it's nothing to worry about, but sometimes it is. So, the question to a long-winded question is, are there any rules to get checked out and when to tell yourself it's okay? Isn't there an acronym about moles, I think?

Susan Mayne, CNP

There is. Yeah, definitely. The ABCDEs of melanoma. So, let's talk about melanoma. What are the factors? What are the risk factors for developing melanoma? There are many of them, and that includes genetic factors, environmental factors, your skin type. So, lighter skin types tend to develop more melanoma. If you have a lot of moles, you know, that puts you at a little higher risk of developing melanoma. If you have a family history of melanoma, that's a tick in risk factors. So, important is any family history, especially your primary, like your mother, your father. And another thing is 80 percent of melanoma can develop on intermittently sun exposed skin, 80 percent. So, even if he had one little burn in the past, you could develop a melanoma there. Some develop within most themselves that you have. Some just come out of nowhere. So, look everywhere when you're looking. Okay? Even one little sunburn and it could develop on that part of your body.

Macie Jepson

What are we looking for?

Susan Mayne, CNP

So, to Pete's point, the ABCDEs of melanoma. Okay? This is pretty easy. So, A: asymmetric. Okay? If you have a mole, and we have a lot of somewhat asymmetric moles. You don't have to perfectly fold it up and the edges should meet. But if you have something that looks like the State of Florida, you know, something like that, then we would consider that asymmetric. B: borders. So, A: asymmetric, B: borders. So, look at the edges of those moles. Are they really wonky? Are they rigid? You know, do they look like a rocky coastline kind of thing? C is color. We have moles that have maybe a few different colors in them, but those are the ones you need to keep an eye on. Typically, normal moles have one color. They're not asymmetric. The borders look good. And they're one color. If you have a few colors in any mode, then get that checked out. Okay?

D: diameter. So, if you have a mole that say, you know, six millimeters tends to be our go-to as far as diameter goes. That's about the size of your pinky print. Okay? Or an eraser head. So, if you've got something that is much bigger than that, that's another thing to kind of, that's another thing that will throw up a red flag. Okay? Most importantly, is it evolving? So E is evolving.

A: asymmetry, B: borders, C: color, D: diameter, E: evolving. Is it changing quickly? Most of our moles don't change that fast. They just don't. So, do you have something that you looked at it and then a week later you noticed it changing? That's something that raises a red flag for melanoma, too. Okay? Sometimes it's very hard to get into dermatology, and you're kind of sweating these moles out. So, what I do and what I tell my patients is to just get yourself something with a millimeter on it, a millimeter measuring device. Take a picture with your phone, go back to it about a couple months later while you're waiting for that derm appointment. If it's changing, then let your provider know.

Pete Kenworthy

And the good news here is…I think I'm right on this...this is a lot like breast cancer in that, or any cancer for that matter, if they're caught early, there's a lot of good news there, right?

Susan Mayne, CNP

Absolutely. With a lot of the recent therapies, if we can catch these melanomas early, you've got, you know, around a 90 percent or greater survival rate.

Macie Jepson

So, I'm just trying to think about what all we've discussed. And I would think wrapping it up that the more we take care of our skin from the beginning, the less of those products we need in the end, for one thing. We could save a lot of money and be healthier. But what I'm hearing from you is whether it's skincare or medical issues, knowing your body and your skin is really important.

Susan Mayne, CNP

Absolutely. Keep an eye out. And I don't want to hear the excuse: I can't see my back. I can't do... There are mirrors. So, look at yourself. Have your spouse or a friend take a look at you. Stay out of the sun as often as you can. And if you are going to be in it, wear your sunscreen. Again, both aging and cancers. And play around with different skin products. Don't spend a lot of money. Know your skin type and try different things out.

Macie Jepson

This is so helpful because products can be confusing. Ads are coming at us from everywhere. A lot of them are asking us to spend a lot of money. Thank you for breaking this down. Teaching’s the basics of taking care of our skin. This was really interesting.

Susan Mayne, CNP

Thank you, Macie. And thank you, Pete, for having me. We appreciate it.

Pete Kenworthy

Yeah. Susan Mayne, Certified Nurse Practitioner in Dermatology at University Hospitals in Cleveland, Ohio. Thank you again. And remember, you can find and subscribe to this podcast on iTunes, Google Podcasts, Stitcher or wherever you get your podcasts. Search University Hospitals, or Healthy@UH depending on where you subscribe.

Macie Jepson

And as always, for more health news, advice from our medical experts and Healthy@UH podcasts, go to UHHospitals.org/blog.