and/or concentration based on how your skin responds. If you experience irritation, and it continues, cut back on the frequency, reduce the concentration, or stop altogether.
Step 4: Apply a serum filled with antioxidants, barrier-repair substances, and other beneficial ingredients. These kinds of ingredients are compatible with almost any topical prescription product.
Note: Many people ask us about using an over-the-counter retinol product, such as a serum, plus a prescription retinoid like Renova. It’s fine to use both; generally, you should apply the over-the-counter retinol product first, followed by your prescription retinoid. Do you need both? No, but some people see greater benefit from the combination, or they simply like to alternate a stronger and weaker retinol product. As with any active ingredient, pay attention to how your skin responds and adjust your routine accordingly. Doubling up on retinol products is too much for some people’s skin—more isn’t necessarily better, and you never want to tip the scale in favor of irritation.
Step 5: Apply your prescription product. This is the best place in your routine to apply your prescription product, especially if it has a cream or lotion texture. If it’s a liquid, apply it after Step 3.
Step 6—DAYTIME: Never forget to apply a moisturizing, broad-spectrum sunscreen rated SPF 30 or greater every day. Protecting your skin from the sun not only prevents signs of aging, but also helps repair skin and helps heal many skin disorders by reducing the underlying inflammation. So, unless your physician says otherwise (which may be the case for those with severe psoriasis), always apply sunscreen.
Step 6—NIGHTTIME: Apply a skin-repairing moisturizer and/or serum every night. Moisturizers and serums work effectively with almost any topical prescription; choose one or both based on your skin type and personal preferences, and apply it around the eyes, too. You can add a separate eye cream if needed.
If you’re also using targeted treatment products, apply these either before your daytime or nighttime moisturizer or, if spot-treating, dab the product on top of your moisturizer, after having already applied your prescription product.
A lot of experts suggest you mix your topical prescription medication with your moisturizer to minimize the risk of dryness or irritation. That’s an option, but it’s unlikely to make a big difference; applying your prescription product first and then applying your moisturizer or serum afterward essentially does the same thing. (However, with regard to mixing products, you shouldn’t mix any skincare product with a sunscreen, because diluting a sunscreen with a serum, moisturizer, or prescription product decreases the sunscreen’s effectiveness.) Sunscreen should always be the last step in your skincare routine, regardless of the prescription product.
If you’re experiencing bothersome side effects, talk to your physician about cutting back on how frequently you apply the topical medication, but keep in mind that if you cut back too much you won’t get any benefit. If you’re using your prescription product less than three times per week, and it still causes irritation, you should talk with your physician about using a different medication or trying a lower dose, which your skin may tolerate better.
In our research and personal experience, we’ve noted that there are doctors who recommend prescription and over-the-counter products and usage steps that don’t seem to make sense, at least to us, and likely not to you, either—we hear from a lot of people who are dissatisfied with their doctor’s advice. Despite these issues, you must follow your doctor’s recommendations—or get a second opinion from another medical doctor or pharmacist.
Chapter 6
Sun Damage and Sunscreen Questions Answered
Sun Damage Is Never Pretty
Sun protection is so important it has its own chapter and merits us repeating as often as we can: Daily exposure to UV light without protection, even for a minute, is the single worst thing you can do to your skin. Research has made it clear that repeated, unprotected sun exposure, getting sunburned, or repeatedly getting tan causes DNA damage that triggers skin cells to mutate. [8,9,37] Over the years and in the absence of sun protection and sun-smart behavior, these mutations often turn into skin cancers.
Even if you’re lucky enough to avoid skin cancer, years of unprotected sun exposure or, worse, deliberate tanning either from the sun or a tanning bed, puts your skin on the fast track to aging. You’ll see wrinkles, sagging, brown spots, texture changes, large or misshapen pores, and reduced skin healing (including from acne breakouts) far sooner than those who are diligent about protecting their skin from UV light. [7,41,42]
We emphasize “UV light” because, although the sun emits other wavelengths of light as well, UV light is what really causes sun damage to skin, even on cloudy or overcast days. In other words, sun damage isn’t only a threat when the sun is shining; it’s a threat whenever and wherever you see daylight. And the damage starts happening the first minute your skin sees daylight! [43,44] That research shocked even us. Protecting skin every day of the year, rain, snow, or shine is critically important if your goal is to have healthy, young-looking skin for as long as possible.
The problem is that the topic of sunscreens and all the details surrounding their use has become a confusing mess of incomplete or misleading information—which is what this chapter aims to sort out!
How and When You Apply Sunscreen Is Important!
Using a daytime moisturizer with sunscreen and knowing how to apply it is a complicated, confusing, and controversial issue, and we certainly can understand if you’re wondering what to do. This is especially true about the recommendation to reapply sunscreen every two hours—no matter what! This seems ridiculously inconvenient, to say the least. If you’re wearing makeup, are you supposed to wash it all off, reapply sunscreen, and then redo your makeup every two hours throughout the day? Who has time for all that?! We straighten that out below.
There’s no question that wearing sunscreen daily, 365 days a year, minimizes signs of premature aging. Whether you decide to be sun smart is up to you; we know lots of you still feel that a summer or vacation tan is a must or that getting “just a little tan” is fine, but please at least consider the information below because, and we’re not exaggerating, your skin’s life depends on it.
The following research-supported facts will help you make sense of sunscreen, so you can get the best protection from the sun’s harmful rays:
“SPF,” which stands for Sun Protection Factor, is an indicator of the length of time that your skin can be exposed to sunlight without turning pink (meaning your skin will start burning) when wearing an SPF-rated product.
Although using a product rated SPF 15 is acceptable, the latest research suggests that higher SPF ratings are far more desirable because they provide better protection. [45,46] Look for sunscreens rated SPF 30 or greater, and/or consider layering SPF products for enhanced anti-aging protection.
The two types of UV rays that damage skin are UVA and UVB. UVA rays are far more damaging because they’re present all day long, year-round, and penetrate deeper into the skin than the shorter wavelength UVB rays. UVB rays are present with visible sunlight and can cause sunburn, while UVA rays promote tanning. UVB rays are strongest in sunny climates and between the hours of 10:00 a.m. and 2:00 p.m. UVA rays maintain a consistent intensity during daylight hours, throughout the entire year. [9,47]
Sunscreens labeled as providing “broad-spectrum” protection should protect your skin from both UVA and UVB rays. [9,47]
All sunscreens with an SPF rating provide reliable UVB protection, as there are numerous UVB filters approved for use in sun-protection
