Podcast: What is the Best Skin Care Routine?

Dr. Shari Lipner: I can’t tell you how many patients come in and we look at their med list, biotin is one of them. And it may seem harmless, but the problem with biotin is that it interferes with certain laboratory tests. And if someone’s taking biotin, when those bloods are drawn, it can actually miss a heart attack.

Courtney: Welcome to Health Matters – your weekly dose of the latest in health and wellness from NewYork-Presbyterian. I’m Courtney Allison.

These days it seems like everyone has a take on the ideal skincare routine. So rather than listen to an influencer or celebrity, we decided to ask one of our experts: what is the right way to care for our skin over time? And what vitamins and products are actually important?

This week, we talk to Dr. Shari Lipner, a dermatologist at NewYork-Presbyterian and Weill Cornell Medicine, who gives us her recommendations for how to take the best possible care of your skin so that it stays healthy. She also addresses some myths about skin and aging.

Courtney: Dr. Lipner, thank you so much for joining us today.

Dr. Shari Lipner: It’s great to be here, Courtney.

Courtney: So what does it mean to take care of your skin? I think to some extent we’re all aware of our skin and things like wrinkles. What are some of these proactive measures that could help?

Dr. Shari Lipner: Yeah, it’s super confusing these days for people to understand what to do with their skin. There’s just so much information out there that it’s overwhelming, you know, what to do. And so even though, perhaps, rubbing a banana peel on someone’s skin makes them look good, we want to have a study that actually shows banana peel versus something else makes you look good. And so if there’s no study like that, then that’s anecdotal evidence. And that’s not something we go by. We go by evidence-based medicine.

Courtney: Right.

Dr. Shari Lipner: So one of the most important things that we can do, that’s actually quite simple, and doesn’t take a lot of time, is to make a routine out of applying a moisturizer with sunscreen every single morning.

And that’s not just if you are out swimming or out in the sun by the beach. This is a daily activity, because UV rays can damage the skin, cause skin aging, and make you more prone to skin cancer, even in a cloudy day or even in the winter months. So that’s one simple thing that each and every one of us can do in the morning as part of our daily routines.

Courtney: I’m actually very proud of that. Even if I’m staying inside all day, I put sunscreen on.

Dr. Shari Lipner: I mean, that’s a great idea because there is some ambient UV rays that can penetrate windows. We know that even if someone is driving in a car, there are UV rays that actually penetrate the windows. And you may not realize that you’ll go outside later in the day, and this way you won’t even have to think about it.

Courtney: So what do you recommend as a proper skin regimen for the average person? What are the basics we should all be doing or avoiding?

Dr. Shari Lipner: Yeah. So, you know, people think it’s, it’s this complex thing and, you know, they’re busy, they have to go to work in the morning. Maybe they have to get some kids ready in the morning and they don’t have time for a routine. The good news is to have young and healthy skin, it’s actually quite simple.

Just like we’re used to brushing our teeth every day, we can do a simple skincare routine that fits into the morning, and doesn’t cause you to be late for work. And so what I recommend is washing your face with a gentle cleanser that’s fragrance-free, and then applying a vitamin C serum in the morning. Let that dry. Then applying a moisturizer with a sunscreen, SPF 30. That’s really all you have to do.

Courtney: What is it about the vitamin C serum that’s so good for your skin? Because I feel like there’s so many serums out there you don’t always know. And then I, yeah, dermatologist told me a couple years ago, yeah, the vitamin C serum is the one. What is it about vitamin C?

Dr. Shari Lipner: So there’s two features of vitamin C that’s helpful for people’s skin. One is that it’s an antioxidant. So theoretically, it can prevent skin aging. And the second thing is, it is a blocker of the UV rays. So both of those things will help you look and feel younger.

Courtney: I did not know that but I have noticed a little bit of a difference with that, so that is good to know! So we’ve covered how listeners can take care of their skin in the morning. Do you have any best-practices for how to care for skin at night?

Dr. Shari Lipner: Now the nighttime routine is a little bit different than the morning time routine. It starts off with washing the face with a gentle cleanser to get off those oils, bacteria, dirt, makeup, anything that people may apply during the day.

But then, for those patients that are not pregnant or intending to become pregnant, it’s a good idea to apply a retinoid at night. Again, there’s not a ton of data on prevention of skin aging, but probably applying retinoids is the best thing that you can do for your skin. There’s actually evidence that it can help fade some of those subtle wrinkles, those fine lines.

And so it’s a really, really useful thing to do in the nighttime. Now, retinol is an over the counter retinoid. And topical retinoids are prescription medicines that are derived from vitamin A. So they’re actually derived from vitamins and they can help exfoliate the skin. They can help eliminate some of those skin lines. They also have acne fighting capabilities. So if you’re prone to acne, that’s kind of a double whammy for you.

The only negative about retinoids is that they can be drying, especially people with skin that is already dry or people that have eczema or rosacea. And so for application of retinoids, I recommend consulting with a board certified dermatologist to really get your regimen that’s individualized for you.

But in general, what I recommend to my patients is to apply a pea-sized amount of a retinoid and start off with just three nights a week with days in between. So a sample regimen would be Monday, Wednesday, and Friday nights. Now, if you’re getting dry just from doing that, what you can do is you can dilute it with a little moisturizer, and that’s a simple trick that may help you get acclimated to the retinoid.

Courtney: And so once you put retinoid, should you wait a little bit before putting moisturizer on or does it not really matter?

Dr. Shari Lipner: Yes, I would recommend letting the retinoid dry before putting on the moisturizer. So usually give it about five to 10 minutes.

Courtney: I know you should always be careful about sunscreen, but I thought I heard if you’re using retinoids, you should be extra careful about sunscreen.

Dr. Shari Lipner: So I think there’s a lot of misinformation about retinoids.

Courtney: Mm-hmm.

Dr. Shari Lipner: You know, people think that they shouldn’t apply retinoids in the morning because of sunlight. But the reason that as board certified dermatologists, we recommend applying retinoids at night is because the sunlight inactivates the retinoids. So it’s not that it’s dangerous, it’s just that it won’t be effective. And so the best time to apply retinoids is at night to get the best efficacy.

Courtney: What age would you recommend someone consider using retinoids for skin aging?

Dr. Shari Lipner: Yeah, I think for adults. So I think probably, you know, people who are in their twenties could start using that as part of their routine. But keep in mind that retinoids generally, we don’t recommend them in pregnancy. So, you know the twenties, the thirties, even the forties is a time where a lot of women start family planning. And so, even if it’s been part of your routine for many, many years, it’s important always to keep in the back of your mind.

Courtney: I wanted to go back when you mentioned the banana peel, I was just laughing ’cause to your point, there’s a lot of myths out there. So I actually genuinely wasn’t sure if that is a myth or if you were just making a joke. Is banana peel a myth out there?

Dr. Shari Lipner: So banana peel does have some nutrients in it. It has vitamin C and though, so from that standpoint, you know, it could be beneficial to rub it on your face.

The problem is that vitamin C in the banana peel, it’s not really formulated to penetrate the skin. So if you wanna get vitamin C onto your skin, it’s probably not the best way to do it. The other thing is, you know, banana peel has other things in it, and it could be irritating to your skin, especially for people who have skin conditions such as eczema or psoriasis.

So my recommendation is if you wanna get vitamin C onto your skin, don’t do it by way of a banana peel. A vitamin C serum that’s really formulated to penetrate the skin is a better move. And vitamin C use is actually evidence-based. It’s not a myth. And so vitamin C has antioxidant properties, and in a serum form it can help with skin aging and also provide some sun protection. Now, it shouldn’t substitute for a sunscreen but if you use vitamin C in the morning plus a sunscreen, you’ll get extra sun protection.

Courtney: So are there any other common myths that you consistently hear about skin health?

Dr. Shari Lipner: Yeah, there’s a lot of myths surrounding skin health because I think that many patients want kind of a quick fix for their skin condition. They want a holistic approach, which, you know, I think is great. But certainly I think if someone has a skin condition, be it like eczema, psoriasis, et cetera, we, we don’t know of a way to just use diet or supplements to cure those skin conditions. And perhaps one day we’ll have a better understanding of that. But right now there’s not really enough evidence to support diet or supplements for treating skin conditions.

Some things that are popular, very popular, is use of a supplement called biotin. And it’s even marketed by many of these vitamin companies as a supplement for skin, hair, and nails. And patients just kind of eat that up, that they’re taking the supplement for their skin, hair, and nails.

I can’t tell you how many patients come in and we look at their med list, biotin is one of them. And, you know, it may seem harmless and, you know, I think for a while I thought it was harmless. But the FDA put out two warnings about biotin. And the problem with biotin is that it interferes with certain laboratory tests.

And some examples are pregnancy tests, thyroid tests, and troponin tests. And so if someone is having chest pain and we measure cardiac enzymes, those are called troponins. And if someone’s taking biotin when those bloods are drawn, it can actually miss a heart attack. And if you’re whisked off to the emergency room with chest pain, you know, you won’t have time to stop your biotin and your doctor won’t know what’s going on. So that’s one reason not to take biotin.

There’s actually very little evidence that biotin is beneficial for hair, skin, and nails. So there’ve been some small studies perhaps showing some benefit, but in general, the patients who did have benefit to their hair were biotin deficient. Most of us get more than enough biotin from our diets. And as for the nail data, the studies that were done showing improvement in brittle nails and nail growth, these studies were tiny. They didn’t have any controls, and so we don’t know if it really works.

So, you know, for all these reasons, I think, biotin is likely not helpful for skin, hair, and nails and there are some dangers to using it and we have good options for all of these conditions. So it’s really best to have a board certified dermatologist diagnose your condition and have an individualized plan for you.

Courtney: So, going back to the bigger picture, what’s the number one thing you might tell a patient who is looking to protect their skin over time?

Dr. Shari Lipner: Yeah, so I think the number one thing to be mindful of is to get into the routine of applying a moisturizer with SPF 30 every morning, that’s gonna help your skin look and feel good, keep you looking young, and keep you away from getting skin surgery.

Courtney: Thank you so much for your time, Dr. Lipner. It was so great having you.

Dr. Shari Lipner: It was great to be here, Courtney.

Courtney: Our many thanks to Dr. Shari Lipner. I’m Courtney Allison

Health Matters is a production of NewYork-Presbyterian.

The views shared on this podcast solely reflect the expertise and experience of our guests. To learn more about Dr. Lipner’s work with patients, check out the show notes.

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