I’m a Dermatologist, and These are the Three Skin-Care Actives I Tell All My Patients to Use

I’m a Dermatologist, and These are the Three Skin-Care Actives I Tell All My Patients to Use featured image
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Active ingredients may be the not-so-secret weapon to a healthy and radiant complexion, but Miami dermatologist Annie Gonzalez, MD says there are some rules for use—and knowing which ones play well together in a proper skin-care portfolio is step number-one.

“I like to tell patients, ‘Let’s get to know the ABCs of skin care.’” The reason why, she explains: Each letter is an acronym for the main three skin-care ingredients. “’A’ stands for vitamin A, which many of us may know—these are the retinoids and all of its derivatives including tretinoin and retinol. ‘B’ stands for vitamin B3, and that’s what we call niacinamide. Then ‘C’ stands for vitamin C, which is a powerhouse of an antioxidant, and something a lot of us already use.” Here’s what Dr. Gonzalez says to know about the trio of superstars.

Do you recommend mixing these ingredients together?

Absolutely. I always tell patients, “Let’s start with vitamin A, the retinoids, but let’s start them in the evening.” These ingredients tend to be very unstable molecules, so heat, UV, ultraviolet radiation, can break them down. Then, if you have more sensitive skin, you might want to start with a version of vitamin A that’s better tolerated. For example, retinaldehydes are better tolerated than tretinoin, which is a prescription retinoic acid that tends to cause more irritation on the surface. My big piece of advice is to start in the evening and start slowly—when you first start using them, try applying once or twice a week, and then pick up the frequency to every night, but gradually.

Do you hear any misconceptions surrounding any of these ingredients?

Patients tell me, “I think retinol thins out the skin, so maybe I shouldn’t use them for too long.” This is totally false! This is a myth that dermatologists should completely clarify. Vitamin A actually makes your dermis—which is that second layer of the skin—plumper. It helps to thicken skin, especially the longer you’ve been using them. Instead of thinning it out, if anything, it’s helping to keep skin firmer, because it is the only ingredient that actually goes down and affects gene expression directly. Vitamin A is basically telling our cells to behave more like younger cells. It also promotes collagen production directly, while inhibiting the breakdown of collagen. It’s an ingredient that is really helping our skin act younger and remain younger.

Can you share any products you recommend to patients that feature these ingredients?

Tretinoin is the gold standard for anti-aging, but let’s not forget that vitamin A started out as a drug prescribed for acne. And I still prescribe the generic version often for both patients with acne and for patients who just want to improve their skin appearance for photo-aging. As far as nonprescription favorites go, I really like the brand skinbetter science. They have a product called AlphaRet Overnight Cream that is great. The Alpha stands for the alpha-hydroxy acid, which they managed to combine safely with the retinoic acid. The great thing that the brand did is that they mixed those two ingredients into one stable formula and I, personally, never experience any irritation from it, and neither do most of my patients.

I look at vitamin C like the powerhouse antioxidant and I really like the SkinCeuticals C E Ferulic. The company has a lot of studies showing how effective the formula is at protecting us from free-radical damage, pollution, UV—all of thing things that generate reactive oxygen species, which is what our body interprets as oxidative stress, and what leads to aging skin. What these molecules do is they come in and they neutralize these free radicals—or at least the majority of them—which helps to diminish premature aging.

I also like the Skinbetter science’s vitamin C called the the Alto Defense Serum. It’s a different type of vitamin C form, what we call Tetrahexyldecyl Ascorbate (or THD ascorbate)

and what it tends to cause a little less irritation in some patients. I prefer the skinbetter science for more oily and sensitive skin patients. Then, with C E Ferulic, which is a very well-known and well-liked product, I prefer to recommend for more mature, dry patients.

Niacinamide, or vitamin B, may not be as well-known to some patients. What do you recommend looking for on the ingredient label?

You want to look for concentrations between 2 and 5 percent. Sometimes, you could find some between 5 and 10 percent. Going over a 10 percent niacinamide or B3 is not going to give you more protection and more benefits. Actually, irritation can occur if you go above a 10 percent. The sweet spot is really between a 2 percent and a 5 percent.

The other thing about niacinamide is that it’s a very good team player. It works well with other ingredients. I personally love telling my patients, “Go ahead and use it with your retinoid at night. Also, if you want to use it with your vitamin C in the morning, do that, too! You could use it twice a day with no issue.” An easy way to incorporate this water-soluble vitamin is to use a moisturizer that contains it. That way, you have all the other benefits of a moisturizer, which usually contain humectants and emollients, but then you also have your niacinamide in there, which is a great anti-inflammatory. It also helps to aid in hydration by increasing ceramides fatty acids. It has a great skin-barrier function and is great for oily patients. Plus, if I have a patient that’s acne-prone or is oily and I want to also help regulate some of their sebum production and address any hyperpigmentation issues, vitamin B also has these benefits. It can kind of cover any possible skin concern you may have, and it also works well with vitamin C and the retinoids.

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