WHAT ABOUT SKIN TYPE?

Just the other day, I was meeting with a group of ladies in their late twenties. One of the women, who is struggling with adult acne, asked me a question that I kind of dread: “What is the one single thing we all can do that can get rid of our pimples?” If I could give her a simple one-size-fits-all answer, I wouldn’t have to work another day in my life and would be living on my own private island!

As with most skincare-related questions, the answer is complicated. I need to know important information before I can give a correct answer that is specific to the person asking a question. You are unique, and so is your skin! Is your skin oily or dry? How old are you? Is your skin sensitive and/or red, or do you have family members with severe acne or other chronic skin conditions? It’s helpful to know your occupation, your hobbies, your interests. In other words, a variety of skin types, genetic factors, and environmental conditions play a role in the kinds of skin issues that plague us. That’s why there are so many treatment options for acne and other conditions. A successful acne treatment plan—or any skincare treatment plan—must be tailored to you personally. And it must be based on your specific skin type.

The Fitzpatrick test is a well-known and dependable skin classification system that was developed in 1975 by Harvard Medical School professor Thomas Fitzpatrick, MD. It’s pretty straightforward, and an excellent and fun way to figure out what kind of skin you have. Remember, our skin changes as we age: your skin at nineteen is not the same as it will be at thirty, forty, or beyond. So even if you think you know your skin type, if you haven’t taken this or another similar skin quiz in a while, you might be due for a redo. Skin type quizzes like the Fitzpatrick Skin Type measure two factors: genetic disposition and your skin’s reaction to sun exposure. Skin type quizzes are available online—and they even do the calculations for you!

MAKE THE RIGHT CHOICES

Different kinds of skin types are determined by genetics. We are born with a certain kind of skin, and we have to make the best of whatever gifts we’ve been given. Such skin types vary and depend on several factors that can include:

• water content, related to your skin’s firmness and comfort;
• lipid or oil content, related to your skin’s texture and nutrition; and
• sensitivity, or the degree to which your skin tolerates topical and ingested substances.

Once you know the kind of skin you have, you can make the appropriate choices to take care of it. What follows are some general guidelines for taking care of your skin according to type.

NORMAL

The majority of people have normal skin—a balance of water and lipids in your skin. You don’t have many imperfections or harsh sensitivities to external stimuli. Your pores are small, and your complexion is clear. Normal skin usually has good circulation, little trace of oil, and a soft, smooth, even tone.

Basic Care for Normal Skin

• Wash your face two times a day using a mild cleanser and lukewarm water.
• Use sunscreen during the day.
• At night, apply a light moisturizer.

Did You Know

Soaps, in general, have gotten a bad rap, and now most people prefer to wash their faces with cleansers or washes. Soaps definitely clean our skin, but they contain harsher ingredients such as sodium lauryl sulfate, which is a surfactant, using foam and bubbles to help remove the oil, dirt, sweat, and debris. However, this can strip the protective layer of natural oils and proteins on the surface of our skin that helps to maintain the moisture barrier. Antibacterial soaps contain triclosan, which helps to destroy bacteria on the skin; however, this ingredient irritates some people’s skin. I’ll admit it’s nice to use a soap that leaves your skin smelling fragrant, but soaps with a strong scent actually work against you, drying you out more.

All this being said, not all soaps are bad! Those bar soaps that you can see through contain glycerin, which helps keep the moisture in your skin. Also, there are superfatted soaps impregnated with extra lipids such as stearic acid, lanolin, or triglycerides to form a protective barrier on the skin’s surface, minimizing the loss of moisture. Cleansers and washes were created to be less harsh on the skin, and more moisturizing and hydrating, which is why many dermatologists recommend them over soaps.

DRY SKIN

Dry skin often has visible pores and sometimes a visibly dull, rough complexion. Red patches are sometimes evident. As you age, your skin loses its elasticity, and lines are visible. When dry skin is exposed to conditions such as wind, sun, dry air, cold air, dry indoor heat, long, hot showers and baths, and certain ingredients in soaps and cosmetics, it can become flaky, or it can crack and peel, itch, and even become inflamed. Very dry skin can develop a scaly appearance, especially on the hands, arms, and legs. Severely dry skin can become itchy and painful and lead to eczema (inflamed and irritated skin). Menopause can also contribute to dry skin, and more women begin to experience drier skin as they age.

I have very dry skin. In fact, I have a skin condition called atopic dermatitis, meaning my skin’s moisture barrier is not that great. I keep a tub of moisturizer in my shower and by my bedside. If I don’t have moisturizer close at hand, I’m usually in trouble after twenty-four hours. If I start to itch a little, I know I’ve got to get up from my (probably comfortable) position and put on some moisturizer stat, because the more I scratch, the more I’ll itch. Sometimes, when I’m particularly dry, I’ll put petroleum jelly such as Aquaphor or Vaseline on my skin. Some of you with oily skin probably recoil in horror imagining zit central after doing the same, but those of us with dry skin sometimes need to slather on a heavy ointment in order to keep our skin hydrated.

Did You Know

Drinking water does nothing to hydrate dry skin! I mean, if you’re dehydrated, yes, your skin can look more sallow. But the more you drink, the more you’ll . . . pee, and your skin won’t look amazingly improved.

Basic Care for Dry Skin

• Switch out long, hot showers and baths in favor of warm, short showers. Go for the coolest temperature that you can. Avoid long Jacuzzi soaks. Personally, I hate cool showers, so I compromise and take very quick hot showers, with minimal soap or cleanser.
• Instead of soap, use a gentle, unscented, soap-free cleanser. You don’t need an expensive brand, either. Cetaphil, CeraVe, and Dove have great, inexpensive mild cleansers.
• After washing, pat skin dry gently with a soft towel.
• Moisturize while your skin is still damp. I keep a tub of moisturizing cream in the shower so that when I’m just towel dry and still damp, I slather on the moisturizer. This keeps water from evaporating from your skin and drying you out more.
• When outdoors, use sunscreen and wear sunglasses rated for blocking 99 to 100 percent of UVB and UVA to protect both your eyes and the skin around your eyes.
• Avoid putting direct heat on your face from blow-dryers, portable heaters, and other similar implements.

SENSITIVE

Sensitive skin reacts to environmental elements more severely than other skin types. You may be more prone to allergies or to contact dermatitis, which is when your skin reacts after having come in contact with an irritant such as makeup, certain plants, or even something that blows in from a breeze, like pollen. If you have sensitive skin, understand what external factors cause it to react, leading to rashes, dryness, or bumps. Common irritants include perfumes, bath soaps, laundry detergents, cosmetics, household cleaners, dryer sheets, certain fabrics, latex, plants, certain foods, nickel (which can be found in watches, zippers, and jewelry), and even some moisturizers. People with sensitive skin can often develop allergic contact dermatitis. Interestingly, although this is often seen as a rash around the eyes, the condition is not usually caused by eye shadow or moisturizer or anything else applied on the eye area.

Did You Know

You can use the same exact cosmetic product daily for decades and then suddenly, out of the blue, develop a sensitivity to one of its ingredients. So don’t immediately eliminate a product that you have been using for years as the possible culprit for your red, irritated, bumpy, itchy skin. If you don’t know the cause of your rash but suspect it’s something you are coming into contact with, try to eliminate everything that you apply to your skin. Then stick with only a mild cleanser such as Cetaphil, and slowly add products back into your regimen, one at a time, to see if you can isolate the source of the irritation.

Basic Care for Sensitive Skin

• Use scent-free products.
• Avoid products with dyes, such as laundry detergents.
• Don’t use topical products that are acidic or that contain alcohols.
• Stick to fibers or fabrics that are nonirritating. (For example, some people are sensitive to wool, which is a natural fiber. “Natural” doesn’t guarantee a product or fiber won’t be irritating to your skin.)
• Use fragrance-free sunscreen.

I have dry and sensitive skin. And the older I get, the more sensitive and drier it seems. The key is knowing what type of skin you have, because then you can head off problems at the pass before you are deeply involved in a relationship with redness, irritation, flaking, and bumpiness.

COMBINATION

Combination skin has an imbalance of lipids and water. It can be dry or normal in some areas and oily in others, especially around the so-called T-zone, commonly defined as the forehead, nose, and chin. Combination skin is common, and requires that different areas of the face and body must be treated accordingly. Combination skin can sometimes show itself through enlarged pores on some areas of the face, blackheads on the nose or the T-zone in general, and shiny skin on the forehead or chin.

What about if you’re unsure which type of skin you have? You’re not alone; some people just aren’t sure. Sometimes I’ll ask a patient if they are dry or oily, and they’ll reply, “I just don’t know.” So I’ll ask them about two situations: (1) When they wash their face, does the skin feel a little tighter a few minutes later? This is a sign of dry skin. (2) When their photo is taken, do they notice a conspicuous shine on the forehead, cheeks, or chin? Well, they likely have an oily complexion.

Basic Care for Combination Skin

• Use a soap-free cleanser.
• Treat oily sections with a light moisturizer and dry sections with an oil-based moisturizer.
• Use a gentle exfoliation product.
• Use sunscreen during the day.

Did You Know

Pore size is largely genetic. There are many products and devices out there devoted to the promise of shrinking the size of these “holes” we hate in our face, but this is largely temporary. We’re all really born this way, and we pore this way. So, in general, don’t expect these products or treatments to make pores disappear for good.

OILY

The technical term for oily skin is excess sebum on the face. Oily skin peaks in younger people, who are going through hormonal changes that happen during puberty, adolescence, and even into the twenties and sometimes into the thirties. As with other skin types, a tendency toward oily skin is genetic. So no, the pizza you ate last night does not cause oily skin! It happens when glands in the skin secrete too much oil. If you have oily skin, you might notice that your pores are large, your skin often has a sheen that is not caused by perspiration, and you have a propensity for blackheads and other blemishes. But remember the positive side of having oily skin: you have your own built-in moisturizer! One of my dear friends, also a dermatologist, has oily skin. One day during our dermatology residency training in Illinois, I mentioned to her that my skin was so terribly dry. She looked at me with subtle contempt, rubbed her nose and cheek with her finger, and said, “Here,” as she presented me with her own human-made moisturizer. We still laugh about this. People like my oily friend will stay younger looking for longer, unlike us dry skin types!

Did You Know

You may detest your oily skin, but you are actually lucky! Your built-in moisturizer will keep your skin more youthful, and the fact is that you will likely get a little drier as you age. So don’t detest it. Embrace it while it lasts.

Basic Care for Oily Skin

• Wash twice a day with a mild cleanser.
• Use a light moisturizer at night that is labeled “noncomedogenic” and “oil free.” The same holds true for sunscreens.
• Avoid cosmetics and lotions that contain ingredients such as lanolin, mineral oil, and cocoa and shea butters.
• Use spot acne treatments as needed.
• Blot oily skin with a skin blotting paper.