Why do you think preteens have become so interested in skin care?
I think there are a couple of reasons. Certainly, the prevalence of social media. This unfortunate pursuit of perfection makes children and teenagers look at their peers doing all these skin care routines, and promising something that will keep them "perfect." That is a driving force: seeing peers that they identify with that are promising perfection.
Also keep in mind that a lot of these people on social media have filters on and that what we see in social media is not reality.
What else have you seen in your practice related to this trend?
I have patients come to my office with a bag full of products, and they say, "Oh, I've tried everything for acne, and nothing works."
But the reality is they've tried all products that are over the counter, and they have cystic acne or scarring acne where no matter how much skin care you have or how long your routine is, that's probably not going to be enough to help. So, I do have a lot of patients that, from the get-go, are already frustrated from trying many products and not seeing a result. What they need to do is see a board-certified dermatologist to have their concerns addressed.
What is the best skin care routine for preteens?
Around this time, preteens are going through hormonal changes, and some will start seeing more oil production and more pimples coming here and there.
There are three basic steps. Wash their face, both morning and night, or after doing sports. The second step is moisturizing their face, morning and night. We live in Colorado, and I want to debunk a myth that if your face is oily, you don't need to moisturize. You need to moisturize all over – whether you have dry, normal or oily skin, because if you don't moisturize your skin, oily skin will dry out and produce more oil. So even teens or preteens who are starting to have some pimples, still need to moisturize. The third step is to apply sunscreen in the morning every day because, even in summer or winter, we get exposed to sunlight.
Sunscreen should be reapplied before going outside, every two hours if they're playing outside, and every hour if at the pool, beach or doing active sports outside or going in the water.
Is there danger in using retinol and other anti-aging products at too young an age?
There’s no danger in using retinol, but there's really no need for a preteen to use it. The benefits of retinol are it helps with the appearance of fine wrinkles, skin discoloration and sunspots, stimulating collagen formation and skin texture, which are essentially not active skin problems of preteens or teens. The most common skin problem preteens and teens have, affecting 80% of them, is acne. Rather than buying expensive retinol, preteens could consider getting OTC adapalene gel, which is much more effective than retinol in treating acne.
And if they are wondering “How do we prevent our dark spots, our wrinkles, our decreasing collagen formation, and all of the photo-aging changes that happen with time?" The best way is with sunscreen and sun protection.
We do know that during the first 20 years of life, kids and adolescents get the most exposure to the sun than at any other time in their lifetime. So, they should be very diligent about protecting themselves from the sun. That's going to have a more positive effect on their skin than going to a beauty supply store or another department store to get antioxidants, retinol, vitamin C and any other actives in skin care. The most effective way to protect yourself from photoaging is sun protection.
What else should preteens, or their parents, know about pimples?
If you have a teen or a preteen who is starting to get pimples, blackheads and whiteheads, it’s valuable to add a salicylic acid product or benzoyl peroxide wash to their skin care routine.
There is also a gel that a preteen can use at night that is over the counter called adapalene gel. If I have a patient who says, “Oh, I'm starting to get some pimples,” I usually will have them start with adapalene gel at night.
How to use it? Wash their face before bedtime and let their skin dry for about five minutes. Then apply adapalene using the “sandwich method”: Apply a layer of moisturizer first to the entire face, spread a pea-sized amount of adapalene all over the face, and then add another layer of moisturizer. So that's the sandwich – moisturizer, adapalene and moisturizer. That can help to keep the pores unplugged, help with minor blackheads and whiteheads, and prevent acne from forming once it has cleared.
You want to start using adapalene slowly as may cause dry skin, redness and irritation. We usually recommend starting with two nights a week and then, after one or two weeks, we go to three nights a week and increase the frequency as tolerated to ideally get to using nightly or every other night.
At what age do you recommend starting a skin care routine?
When we think about skin care, automatically our brain goes to 10 steps in the morning, 10 steps at night. We've been sold on this idea that we must have this complex routine – morning and night. But skin care means taking care of your skin. And we should start taking care of our skin as young as when our moms are putting our moisturizer on us as babies.
When they are independent enough to be able to wash their face and put cream on their face, that's when we should start having kids start their skin care – using a gentle wash, a moisturizer and sunscreen.
Here is a video of my daughter doing her skin care routine at age three.
I think we need to change how we understand skin care and how we define it, to see what younger kids need.
What other skin care concerns do you see in preteens?
Skin irritation is a common complaint. Unfortunately, one of the biggest problems in having that multistep approach to skin care is that a lot of ingredients that are on the store shelves are ingredients that cannot be combined and don't go together, either because using them together irritates your skin or because they block each other by deactivating one of the ingredients.
So that's the risk of just going with the flow and trying a lot of products. You don't get any guidance of what you're using, what the side effects of each of them are. There are certain things that you can only use at night. There are certain things you can only use in the morning. There are certain things that you cannot combine. Adapalene, for example, should only be used before bedtime. It is not recommended to use it during the day because it gets inactivated by UV light, and it also makes you more sun sensitive.
There are certain things that you can only use at night. There are certain things you can only use in the morning. There are certain things that you cannot combine.
Is there anything that you would like to add?
A common question I get is about the proper order to apply skin care products. A general rule of thumb is to start with the product with the lightest or thinnest consistency and then go to the thickest. So, start with your cleanser and then go to a serum (if you have or need one), then moisturizer and then sunscreen. Follow me on Instagram @dermaskinmd for more tips on skin care and skin health.
Note: This interview was edited for length and clarity.
