A Basic Guide to Exfoliation

(A version of this article originally appeared on Dermascope.com)

Exfoliation has been touted as a “must do” skin-care step for long enough now that nearly every skin-care customer realizes it is a recommended part of their regimen. But knowing a product or step is beneficial doesn’t always mean we're will adopt it. In fact, in my practice and in my work with Lexli, I often encounter individuals who simply reject the idea of exfoliation:

“My grandmother didn’t exfoliate and she had gorgeous skin.”

“I’ve heard that exfoliation causes your skin to thin.”

“I have sensitive skin that can’t tolerate exfoliation.”

“I tried it and it made me break out.”

“I’m in the public eye and cannot have my face constantly peeling.”

Any of these sound familiar?

Such rebuttals to exfoliation just reiterate the misconceptions and misinformation that abound on the topic. My goal is to set the record straight.

Exfoliation in History

While many believe exfoliation to be a relatively new trend in skin care, the reality couldn’t be further from the truth. History abounds with anecdotes of exfoliation practices. For example, Cleopatra took frequent milk baths to maintain her complexion. Little did she know that her positive results were due to the milk’s lactic acid content, which gently exfoliated her skin. In ancient Egypt, wine was applied to the skin, the tartaric acid content of which helped to minimize the signs of aging. Ancient Greeks and Romans applied a mix of pumice and oils to their skin, which allowed them to mechanically exfoliate. 

In more modern days, dermatologists began using chemicals to minimize the signs of aging in the late 1800s and by the 1970s, dermabrasion was introduced as a professional treatment. The selection of properly formulated at-home exfoliation products was limited, however, to harsh facial scrubs until the early 1990s when alpha-hydroxy acids (AHAs) entered the market by way of moisturizers. It is that singular development that dramatically changed the skin-care industry. Today, AHAs are found in nearly all skin care product categories, with a vast selection of exfoliation products available for at-home use. Many of these exfoliators provide excellent results that complement professional treatments and, in some cases, even rival them.

Making Sense of the Exfoliation Process

On a simplistic level, exfoliation is the process of removing the outermost layer of dead skin cells to reveal the softer, fresher looking skin below. The mechanism by which exfoliation works is far more involved, however.

Our skin is constantly undergoing a natural exfoliation process whereby cells are produced deep within the skin and rise through the layers until they are eventually sloughed off the surface. In healthy skin, this process takes approximately 30 days to complete. However, as we age and/or as skin becomes damaged due to excess sun exposure, pollution, smoking and more, this cellular turnover slows, causing the buildup of dead skin cells (hyperkeratosis). Because the skin must maintain a consistent thickness, as the keratin layer builds up, the dermis layer thins.

As the factory of our skin where beneficial skin proteins like collagen and elastin are formed, a healthy dermis is vital to beautiful skin. When it is compromised due to aging and damage, dermal function slows. The result? Skin begins to show characteristics associated with aging, including fine lines and wrinkles, enlarged pores, dryness, redness, uneven tone and texture, broken capillaries, breakouts and more.

When a regular exfoliation practice that uses properly formulated products is introduced, the keratin layer is forced to thin. This process prompts the dermis to again thicken, thereby ramping up its production of the proteins that give skin its strength and elasticity. From an aesthetic standpoint, the removal of the outermost layer of dead skin softens fine lines, improves skin tone and texture, minimizes pore size and more. 

Exfoliation and Sensitive Skin

According to a 2011  survey by the International Society of Dermatology, 50.9% of women and 38.2% of men claim to have sensitive skin. Most of these cases are self-diagnosed, which makes it impossible to know the specific cause of their sensitivity. However, sensitive skin can generally be attributed to genetics (in a small percentage of cases), skin disorders like rosacea or eczema, allergies, improper skin function or a weakened skin barrier. While many dermatologists and estheticians will tell you that sensitive skin should rarely be exfoliated, there are exceptions to that rule. In fact, in some cases, exfoliation may be just the thing sensitive skin needs.

The skin barrier (stratum corneum) is an outer layer comprised of dead skin cells, each surrounded by skin oils. By forming an impenetrable barrier, it keeps the good stuff inside our skin (moisture) and the bad stuff out of it (environmental toxins). The skin’s barrier function is easily weakened due to the over-use of aggressive skin care products or clogged pores. When barrier weakness is due to improper skin care, such as over-washing with harsh cleansers or exfoliating too frequently with products that contain ingredients known to cause inflammation, the best medicine is to go back to a simplistic skin care regimen that focuses on moisturization. Otherwise, as counterintuitive as it may sound, exfoliation should be considered.

Exfoliation’s ability to thicken the dermis, thus repairing skin function, is a factor that alone can lead to an improvement in sensitive skin symptoms. However, exfoliation also helps to eliminate much of the debris that clogs pores, and in doing so, it improves barrier function while allowing moisturizers and skin care treatments to work more effectively, thus helping to heal damage. A regimen that includes regular exfoliation along with the frequent use of emollient-rich moisturizers and serums will allow many with sensitive skin to see a marked improvement in their conditions. They key is to monitor the situation so over-exfoliation doesn’t become a factor, as it could lead to a worsening of symptoms.

Side Effects

At-home exfoliation, just as in professional exfoliation treatments, is not without side effects, such as redness, dryness and, in some cases, peeling. Those with clogged pores may find that as the exfoliation process removes blockages from the skin, the debris that was suppressed in the hair follicle is purged, leading to breakouts. As skin function normalizes, these symptoms become less prevalent and, within approximately a month, they should disappear completely. (Those who continue to experience side effects from an exfoliator beyond that period of time, product use should be stopped, as an allergic reaction could be to blame.)

Selecting an Exfoliation Product

As mentioned earlier, there is no shortage of exfoliators on the market and, for that reason, trying to select the best one can be confusing. For the most effective at-home exfoliation, I recommend selecting a product formulated with alpha- or beta-hydroxy acids (AHAs and BHAs) over the use of a scrubbing polish or facial brush. While many individuals claim to see positive results from the latter methods, these products have the potential to create microscopic tears in the skin. This can lead to inflammation, which in turn leads to other skin issues. What’s more, these products don’t have the ability to exfoliate as effectively as chemical exfoliants.

AHAs and BHAs are well tolerated by most individuals. The key is to find a product that offers a pH that is acidic enough to generate an acceptable level of exfoliation. Many exfoliation formulations for at-home use include a minimal amount of acid to avoid the risk of burning or peeling. However, these products don’t provide much of a benefit to the skin. This is why I suggest generally looking for a product that offers a pH in the range of 2.0 – 4.0 – a level that is significantly more acidic than the skin (pH=5.0).  Lexli AloeGlyC® meets this requirement, while featuring a high concentration of pharmaceutical-grade aloe vera to counteract the potential for burning or inflammation. 

There really is a sound rebuttal to nearly every excuse that one could make for avoiding an exfoliation practice. With an abundance of safe and effective exfoliators on the market today, you have the opportunity to achieve healthier, more beautiful skin at home, as long as you exfoliate properly and regularly.

Simple Skincare, Beautiful Skin: A Back-to-Basics Approach

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