The Skin Consult E-Book

Sahil Singh

• Herausgeber: WS
• Kategorie: Lebensstil
• Sprache: Englisch

Seitenzahl: 582

Veröffentlichungsjahr: 2024

Beschreibung

“Whether you are a medical practitioner or just interested in the skin and its function…prepare to be inspired, informed and empowered.”
Prof. E.A.Christofides – Plastic & Reconstructive Surgeon
"A comprehensive reference handbook for anyone who wishes to understand the aging process"
Dr.Y.Lalloo - Specialist Dermatologist
“Sahil distills the mysteries of skincare in an accessible and articulate style. The Skin Consult reads like an actionable & demystifying Dermatology crash-course.”
Dr. A. Pramchand
"Sahil’s approach is unconventional, insightful and holistic in a manner that is simply not considered by the skincare industry. This book is the PERFECT guide to not only your skin longevity, but your overall health”
Tamara Moen - Advanced Medical Esthetician
Discover the secrets to saving thousands on skin care products and treatments in this must-read book. The key to effective skincare is understanding how the skin functions, together with what products, ingredients and lifestyle choices create the most positive changes. Contrary to popular belief, you don’t need tons of products or treatments.
As a skin care entrepreneur that has created and produced high performance skin care products for dermatologists, plastic surgeons and other skin care professionals for over 15 years, Sahil unpacks his industry knowledge in this concise and indispensable skin guide.
Popular myths and trends are debunked; ingredients are demystified, lifestyle & dietary choices are dissected to explain the direct links to many common chronic skin conditions. Gut health, modern diets and more are put under the spotlight to reveal the skin in ways that will blow your mind.
The Skin Consult will help you understand your skin intimately; how to manage common concerns effectively, affordably and without being seduced by marketing fluff designed to get you to part with your hard earned money! Get your copy today.
Benefits:
- Save money on skin care products and treatments
- Become an expert on skin physiology and the aging process
- Understand the causes of common skin concerns like pigmentation, fine lines, and breakouts
- Learn how lifestyle choices and hormonal imbalances can affect your skin
- Improve your skin health with small habitual changes
- Debunk myths and trends and make informed purchasing decisions
What's Inside:
- Skin physiology and aging process explained
- Common skin concerns and their causes
- The link between diet, gut health, and skin health
- Debunked myths and trends in the skin care industry
- The 5 skincare ingredients you need
- Tips for addressing skin concerns intelligently
- Suitable for all ages (18-80)

Leseprobe

Copyright © 2024 Sahil Singh

All rights reserved. No part of this publication may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Cover design by Brendan Chidrawi

First printing edition 2024.

Published by The Skin Consultancy

www.theskinconsultancy.com

[email protected]

This book is dedicated to my son Aran, and the memory of my late son Kiyan.

Love you both forever

“The skin and the aging process can be both complex and intricate. The skincare market is one of the most booming industries with an overwhelming choice of skincare products and treatments. This book is a comprehensive reference handbook for anyone who wishes to understand the aging process in a more simplified manner, and apply these knowledge tools to their skincare choices.”

Dr.Yashmita Lalloo - Specialist Dermatologist

“I have known Sahil for 40 years, and true to his personality, he has left no stone unturned in bringing you this wonderfully written, personal, scientific, honest, yet accessible approach to everything one might want to know about our most misunderstood, and yet surprisingly, one of our most robust, and easy to look after organs in our body. As a plastic surgeon, I found this book thoroughly useful, and it will no doubt be my go-to book for all my patients wanting to learn more about one of the most beautiful, fascinating, and misunderstood structures of our being, and one that makes us so unique.”

Dr.O’Sharran Roy Singh - Plastic & Reconstructive Surgeon

“What sets ‘The Skin Consult’ apart is the valuable emphasis on the skin's ability to heal itself in many ways. In straightforward, clear language, Sahil has created a framework for deeply understanding the complexities of the skin systems, while challenging misconceptions. This book provides great insights into the body’s biggest organ - THE SKIN”

Brigit Filmer - Brigit Filmer Spa, Skin & Esthetics

“Having worked in the personal care industry for over thirty years, I found this book extremely refreshing, as it has a well-documented approach to skincare in general. Sahil’s research is sound and has a unique approach to the fundamentals of taking care of your skin. A phenomenal read.”

Bradford Rolfe - Managing Director, Rolfe Laboratories

“Sahil distills the mysteries of skincare in an accessible and articulate style. The Skin Consult reads like an actionable & demystifying Dermatology crash course for the layman.”

Dr.Ashiq Pramchand

“If you are passionate about skincare and your skin’s health, whether you’re a professional or not, this is the book for you. It is comprehensive and informative on key skincare ingredients. Loaded with practical advice on how to achieve healthy, glowing skin at any age. Let this be your Skincare Bible!”

Michelle Rayner - Esthetician

“This book is a MUST-HAVE for any skincare practitioner. It offers insight into all the elements of the skin from structure, function, anatomy & physiology to treatments, ingredients & the modern aggressors we face. This book will definitely form part of my induction training to any therapist we employ and as a great reference manual for my clinic.”

Shaista Gafoor - Senses Wellness Institute

“If I could describe this book in one word, it would be “transformative.” From the very first page, this book made me feel like I was sitting down with a wise friend, who's just as passionate about skincare as I am. Sahil has masterfully tackled the myths we’ve all heard a million times - yes, even the one about toothpaste as a spot treatment! Each debunking is a giggle at how easily we fell for old wives’ tales.

But it’s not all just myth-busting; the book dives into the nitty-gritty of the skin’s structure and functions in a way that’s surprisingly fascinating. I found myself marveling at how much our skin does for us - protecting, healing, and aging so gracefully. The science is delivered with such care, that even complex concepts feel accessible and relatable. Understanding my skin’s needs, and the science behind those fancy-sounding ingredients, gave me a newfound confidence in my skincare routine. Each ingredient is described in detail, with its benefits laid out like a well-crafted love letter to our skin, which had me mentally noting down products to try and those to avoid!

That being said, ‘The Skin Consult’ isn’t just about skincare; it’s about self-care and finding joy in the little rituals that make us feel beautiful in our own skin. It’s a radiant read that leaves you feeling informed and uplifted, and is a must-read for anyone looking to elevate their skincare game. It’s absolutely brimming with wisdom!”

Hariska Naidu - Pharmacist

“A talented author, Sahil carefully peels away at the complex layers of Dermatology in a fascinating, yet accessible style. A must-read with a clear focus on holistic health and skin clarity”

Dr. Ishq Pramchand

“As an advanced medical esthetician who has worked around the world for over 20 years, I found ‘The Skin Consult’ to encompass an anti-aging approach in the most profound way! Sahil’s approach is unconventional, insightful and holistic in a manner that is simply not considered by the conventional methodology used in the industry. This book is the PERFECT guide to not only your skin longevity, but your overall health”

Tamara Moen - Advanced Medical Esthetician

Contents

Foreword

Introduction

Function & Structure of The Skin

A Broader View on Skin

Structural and Functional overview

Basic Functions of the skin

The Aging Process

Predictable Change

Structural Changes

Characteristics of Aging skin

Contributing factors

Maintenance & Preventative Care

Maintenance through the Ages

Teenage skin

Skin in your 20’s

Skin in your 30’s

Skin in your 40’s

Skin in your 50’s and over

Summary

Common Concerns

Pigmentation

Fine Lines & Wrinkles

Dehydration & Dryness

Breakouts

Dull Skin

Corrective Care

Corrective Measures

Treating Pigmentation

Treating Lines & Wrinkles

Managing problematic skin

Controversial Ingredients

Controversy & Balance

Preservatives

Endocrine Disruptors

Skin Bleaching Agents

Miscellaneous

Dietary Skin Health

Dietary Skin Health

Food Triggers

Eczema & diet

Psoriasis & diet

Insulin Resistance & skin manifestations

The Gut-Skin Connection

The Gut-Skin Connection

Lectins

Fibre

Artificial sweeteners & emulsifiers

Summary

Myths, Trends & Misrepresentations

Myths & Trends

Myth: Expensive products are better

Myth: All Sun exposure is dangerous

Trendy Ingredients & Categories

Common Misleading Strategies

Common Home Remedies

Essential Ingredients

Retinoids (Vitamin A)

Vitamin C

Skin Identical Lipids

Hyaluronic Acid

Alpha-Hydroxy Acids

Deepen your Knowledge

Additional Content

Acknowledgments

My interest in skincare started when I was about 11 years old. Like most youngsters, I was completely indifferent to my skin health until the first pimple erupted on my face and I became desperate to get rid of it. The first strategy that was recommended was to use a face wash – I was led to believe that if my skin was ‘cleaner’, there would be less likelihood of breakouts. As my skin progressively got worse through my teen years, I eventually consulted with a dermatologist who prescribed a course of antibiotics (minocycline) that cleared my skin up over a period of three months. This newfound skin clarity lasted for a year or so until I was about 17 years old, whereafter my skin started erupting aggressively again. I then went back to the dermatologist who put me on a course of Roaccutane, which cleared up my skin over a few months. While I was on this course of medication, I was prescribed a face wash and a moisturizer that I believed were essential in maintaining clear skin, and I used these brands for years after I had finished the Roaccutane course. If I had known then what I know now, I would have been horrified at the lack of any active ingredients in those products, would have thrown them into the trash, and opted instead to source a range of high-performance products with proven actives.

I always found it fascinating that you could apply products to the skin and create a change in its appearance (and health, which I would learn later). My father, who was a General Practitioner loved treating skin conditions, and it was a dream of his to specialize in dermatology. When discussing dermatology, he remarked: “There’s no cure for anything and your patients keep coming back”. As I learned more about skin through my own research and discussions with professionals, I learned that this was true for many skin conditions such as eczema, psoriasis, and even acne. Not only is there no established cure for eczema and psoriasis; there isn’t consensus on what causes these afflictions either. With acne, it’s a little more nuanced in that we do clearly understand the cascade of events that lead to breakouts; however, there isn’t much discussion about the catalysts that trigger the established cascade of events. My general interest in health drew me down a rabbit hole of information over many years, exposing little pieces of a big puzzle that had to be put together into a digestible format in order to understand what the actual picture looked like.

Over more than twenty years, my career path involved distributing leading dermatological devices from the United States, skin analysis systems from Europe, micro-needling devices from Denmark, formulating and manufacturing high-performance skincare products for skin specialists, and finally owning a vertically integrated esthetics treatment room. I have had the pleasure and privilege of working closely with some of the finest minds in dermatology, plastic surgery, and esthetics from around the globe.

Throughout my career, I drew knowledge and inspiration from some individuals around me. Buddy Reardon, a pharmacist and business partner who had experience in running the first successful esthetic practice in our neighborhood, was a constant sounding board and fountain of knowledge. Her experience helped me to understand the common challenges that clients in her clinic experienced.

When I was working on the initial concepts for products that I was developing, I had a friend in the office next door, Lauren Shaw who I still affectionately call ‘Neighbor’ to this day. Lauren was the first ‘test subject’ to use the initial samples, give me feedback on the first packaging designs, and who watch the entire process from initial concept to mass production, while lending moral support.

Tess Singh and Stephanie Bolstad were the first long-term users of my prototype products, who also participated in regular skin analysis imaging to determine the results. The results of these analyses validated that what I was working on could have a real, meaningful impact.

My friend and business partner Hitesh Patel always believed in, and supported me, even when I was doubtful of myself. Hitesh and I exhibited our first skincare products in New York in 2010, before many other adventures that led to winning awards at the Symrise Pharmaceutical & Cosmetic Review new product competitions in 2016 & 2017. This resulted in cult-like status for several products, and features in every major magazine including Cosmopolitan, Marie-Claire, Glamour, Elle, Good Housekeeping & Fair Lady.

My friend & dermatologist Dr. Raj Singh who always supported me as a loyal customer is an entrepreneur who is never afraid to try something new, and at one stage we worked together on developing an online consultation system for patients around the world – this was a long before telemedicine became popular with the advent of the smartphone and broadband internet. Without Raj, the production of some early batches wouldn’t have been possible as I could not manage the initial batch sizes alone economically, and he was always willing to share in the yield.

This book began as a joint project between Thejal Singh and I. Thejal is an incredibly gifted clinical esthetician who partnered with me in an esthetic treatment room for several years. When speaking about Thejal to others, I used to affectionately refer to her as ‘The Skin Whisperer’. We thought that it would be a fantastic project to pool our knowledge and create a body of work that could impact people positively. In 2021 we worked together to create what would become the backbone of this book – the structure and format. While we didn’t complete the book together as we had originally planned, I don’t believe that I would have attempted this project without Thejal and for her inspiration & support, I will always be grateful.

I’ve poured knowledge and passion into this book in the hope that it will make a difference to you, the reader. The skincare industry is laced with misrepresentations and half-truths and is prone to preying on consumer's vulnerabilities. Large multinational skincare brands often make ludicrous claims and create multi-million dollar marketing campaigns, designed to get you to part with your money based on exaggerated statements and selective data. Much of the industry relies on consumer naivety & ignorance. Of course, there are some brands that do have the best interests of their customers at heart, but these are few and far between in my experience. This is not always based on malicious intent, but mostly due to the lack of broader knowledge within the organizations themselves. Most skincare businesses focus only on a topical application approach and ignore the connection between the skin and the rest of the body. These are certainly controversial statements, but after being in this industry for over 20 years I’m afraid that it is my conviction that this is accurate. It is my firm belief that you don’t need too many products or treatments to create healthy skin. It is also my belief that you need far more than just skincare; you also need to live in optimal health. Your lifestyle has so much more to do with your skin than you could possibly imagine. It is my deepest wish that after reading this book, it will affect you deeply and prepare you for what lies ahead, whatever your age is. If you are suffering from one of the common concerns, I hope that the book gives you an honest account of what may be happening, and answers some questions that you may not have even thought to ask. There is no perverse incentive to sell you any products or treatments via this book. Everything in this book is what I believe to be true in light of the publicly available information on hand today, combined with my personal experience in the industry. I am not a medical doctor and this book does not contain medical advice. These are my opinions and hypotheses based on years of personal research and anecdotal evidence – much of which is based on self-experimentation. I believe firmly in the message of this book and I would like to believe that I am an example of the integrity of the contents. I follow most of the principles and guidelines fastidiously, using only what products and treatments I believe are necessary for optimal skin and body health (they are linked). As a 46-year-old man (at the time of writing this book) who is often mistaken for someone much younger, I view that as a strong validation. I hope that you find value in this book and that it genuinely helps you on your skin journey.

Part of the inspiration for writing this book came from realizing that it is very difficult for most people to have a simple conversation about their skin with a skincare professional, without the expectation or pressure to purchase a product or treatment thereafter. It also became apparent that there was no clear & definitive guide on how to understand the skin changes over time and what actions could be taken prophylactically. It became clear that it would be vital to not only explain how and why the skin changes over time, but to also include the best practices and products necessary to maintain optimal skin health throughout the entire aging process. To be able to obtain this information from a skincare professional would take hundreds of hours and thousands of dollars in consultation fees, and consequently, I believe that there is massive value in this book that you can refer to throughout your life for insight and guidance, whatever your common skin concern may be. May this book be your indispensable guide to aging well, and maintaining your skin (and body) in optimal health.

Please enjoy this book that was written with passion, love, and integrity. Wishing you a lifetime of great skin!

Sahil

Disclaimer

This book does not contain medical advice and is not intended to treat, diagnose or cure any condition or disease. The contents are the opinions of the author and do not constitute medical advice. If you have a suspected medical condition you should seek the advice of a medical practitioner. The author accepts no liability for misuse of the contents, or information given and no guarantees or warranties are implied or expressed within the contents of this book. The author shall be held harmless for any potential complications or damages caused by misuse or misinterpretation of the contents in this book. Any actions taken by the reader based on information provided in this book are solely at the risk of the reader and the author is expressly held harmless and will not accept any liability whatsoever.

About the Author

Sahil is a serial entrepreneur who has been active in the skincare industry for over 20 years. After suffering from cystic acne as a teenager, he became fascinated with skincare products, medications, and their mechanisms of action. He developed close friendships with dermatologists, plastic surgeons, and other doctors while distributing dermatological devices. After acquiring a leading medical wholesaler in 2006, he built a manufacturing facility producing multivitamin syrups and other complementary medicines, primarily supplying the South African government. His interest in skincare led him to create his first skincare range in 2009. Over the next few years, he worked closely with leading cosmetic chemists around the world, refining and developing new products. Sahil’s passion and desire to create a unique performance brand culminated in the launch of the dr.dermal® cosmeceutical brand – an award-winning range that has been coveted by customers around the world.

Sahil also formulates and produces high-performance skincare ranges for dermatologists, plastic surgeons, esthetic doctors, and esthetic practices around the world. He has also worked with leading retail chains in South Africa developing performance skincare products for their franchises. In 2016 he opened an esthetic clinic where he developed and formulated every product used in the clinic, making it completely vertically integrated. He was also the sole importer and distributor of the equipment used for treatments in the clinic.

Foreword

In today’s world, health and self-care is not just a trend but a necessity. As such, our skin stands as a frontline ambassador of our wellbeing.

Sahil Singh has dedicated a large part of his career to the understanding and care of the skin. His knowledge about skincare and skin disorders is second to none. His journey into the realm of skincare began with a curiosity about the skin’s role in health and disease. Sahil’s passion for understanding the intricacies of skin physiology and pathology is matched only by his dedication to sharing this knowledge with others. This book brings together a wealth of knowledge incorporating the latest information and historical anecdotes to offer a comprehensive understanding of the skin’s structure and function and its importance to our overall well-being.

It is not just about vanity; it’s about self-respect, confidence, and health. This book is a roadmap to understanding, nurturing, and enjoying your skin. As you read, you will appreciate the skin’s resilience, it’s ability to adapt, and its importance in shaping our sense of identity. The book is broken up into chapters which makes it easy to understand, whether you are a skincare novice, medical practitioner, or just an enthusiast.

The aging process is well explained which has become a “hot topic” over the years. More specifically, the physiology of the aging process is broken down according to the different decades of life. This makes it easier to understand and apply goal-directed prevention and treatment.

As you read the book, it appears that the words were written specifically with you in mind. Specific problems are addressed and most of us can relate to many of the issues that are discussed and explained.

The summaries at the end of each chapter are also helpful in collating all the information that was explained. We all know that the skin is the largest organ in the body, but it is also a complex fascinating organ that serves as our interface with the world.

As you delve into this book, whether you are a medical practitioner or just interested in the skin and its function, you will embark on a journey through the remarkable world of skin. Prepare to be inspired, informed, and empowered as you read the pages ahead.

Prof EA Christofides

Plastic and Reconstructive Surgeon

FC(Plast Surg) (SA), MMED Plast (Wits)

Introduction

The skin is an incredibly complex structure that contains around 1.6 trillion cells and makes up about 15% of total body weight. The skin is the largest organ and it performs several functions, some of which are obvious, and some that are more subtle and nuanced. The most obvious role of the skin is to function as a protective barrier that shields us from our environment; resisting pollution, liquids, dust, and more. Our skin’s other components like hair, nails, sweat, and oil glands make up what is known as the integumentary system. Hair provides a degree of insulation and warmth to the body, while also acting as a filter in the nose and around the eyes. Our nails provide a protective layer to the sensitive nerve endings in our fingers and toes. They also provide an enhancement to delicate movements, by providing counter pressure exerted on the soft tissue of our fingers and toes. Our sweat glands help to regulate our body temperature and excrete minerals and heavy metals, while our sebaceous glands secrete a complex of lipids that form part of the skin barrier and make the skin more water-resistant.

In addition to the physiological functions of the skin, there are social aspects to our largest organ that make it instrumental in our varying degrees of vanity. The skin is arguably our first characteristic that is visually recognized by others. Wars have been fought, and entire populations have been decimated due to skin color. A brutal slave industry thrived for hundreds of years where skin color was the main qualifying criterion to enslave another human being.

Whether it is the color of our skin that either blends in, or stands out amongst others, or radiates health with a glowing complexion (or not), our skin either overtly, or covertly imbues a sense of wellbeing. In some cultures, societal status is defined by skin tone, and great efforts are made to achieve blemish free and brighter (or darker) skin. Conventionally, what is often attempted to be achieved in these cultures is to obtain a skin tone that is unconventional and diametrically opposed to the common demographic. This can bring up unhealthy obsessions with one's own skin tone and an unusual dissatisfaction with one’s natural appearance. It is common for those with white skin to make great attempts to tan their skin to darken their appearance, while darker-skinned cultures can spend small fortunes on whitening creams to lighten their skin. These are individual decisions and the observation is not made with any judgment, however, one can’t help but notice the irony.

In addition to our outer skin with which we are familiar, you will notice that the skin around the mouth changes texture at the lips, and again changes texture within the mouth. This inner skin starts within the mouth and continues through the digestive system for about 30 feet until it concludes at the anus, where it again resumes the appearance of outer skin with which we are familiar. The skin is a total barrier inside and out, that regulates precisely what can enter the body externally or internally. When we take this structure into context, the foods that we eat and which enter the digestive system pass through various processes in the lumen of the digestive tract but are not really ‘inside’ the body as they are separated from flesh and blood by our ‘inner skin’ or mucosa - the ultra-thin lining within the alimentary canal. This food within the digestive tract is still ‘outside’ of the body and has not been absorbed into the cells.

The body is also an electromagnetic conductor. With around 70% of the body being water, and the skin being composed of 64% water, the skin can be thought of as the conductive material around our bodies that functions as an antenna. If you’ve experienced a static electricity shock, this is an elegant example of how the body can discharge excess electrons stored within. Our bodies constantly absorb electrons from the environment, whether in the form of sunlight, electromagnetic waves like WiFi, cellular signals, or more. Experts on Grounding have shown that by wearing rubber-soled shoes daily, we prevent the discharge of excess electrons in our bodies that can cause inflammation and other internal health problems. By removing our shoes and walking outside with bare feet, our miraculous skin allows instant conductivity, and the excess charge is transmitted into the earth within a matter of seconds.

It’s important to think of the skin as a multi-functional organ in this way to understand how everything is connected. What we put on our skin externally can only protect it effectively, if we feed it from within with foods that nourish not only our skin but all of our other organs. There is an interconnectedness between the skin and our other organs, our hormones, and our environment. What we hope to achieve with this book is that you may gain a new understanding of your skin and can make appropriate decisions to enhance your skin’s health primarily; also improving your overall health by eliminating certain universally deleterious products and habits that are ubiquitous in modern society.

Function & Structure of The Skin

Chapter 1

A Broader View on Skin

A common human approach is for us to separate broad topics into easily identifiable sections. When we examine our bodies, we have many categories that form the basis of medical specialties such as skin (dermatology), eyes (ophthalmology), lungs (pulmonology), bones and joints (orthopedics), and more. To consider the body as a whole and to try to understand how all its functions and processes operate and interact at once is a daunting and overwhelming prospect.

It is natural for us to identify problems that we are experiencing in a specific area, decipher what category that problem falls into (perhaps via our GP), and then consult with a specialist in that field to treat the concern. One of the drawbacks of this method is that it can sometimes miss the connections between different systems within our bodies. Skin conditions for example may present due to dietary sensitivities and their subsequent reactions; and while we may receive temporary relief from symptoms with various creams that are prescribed, the root cause of the problem can be overlooked with this incomplete approach.

What we have to realize is that our body functions as a unit - like a very specialized machine, with thousands, if not millions of functions and processes occurring simultaneously all day, every day. Our bodies are constantly receiving stimuli from the environment. Whether we are eating food, standing in the sunlight or swimming in cold water, our body as a whole (as well as each of its individual components) is striving to achieve balance. Using the above examples, when we’re eating, our body assimilates and absorbs nutrients from food and converts those nutrients into energy and building blocks for the maintenance of the body, sending what is needed to every cell in the body and discarding what isn’t needed as waste. When we are standing in the sunlight receiving energy in the form of solar radiation, our skin absorbs this energy and uses it for various biological processes. Solar energy, specifically UV-B rays create vitamin D from the cholesterol in the skin providing a degree of protection against skin cancer.1 Solar UV-A rays stimulate nitric oxide synthesis in the skin, dilating blood vessels, improving circulation, reducing inflammation, and improving wound healing2. Too much sun however, and the radiation can become damaging as we absorb too much energy and the UV rays go so far as to cause large-scale cellular oxidization, burns, DNA damage, and mutations3. When we swim in cold water, the body adjusts our blood circulation, pulling more blood to the vital organs and away from the skin to keep the organs functioning optimally while the body is exposed to the cold environment. Since cold exposure can shock the body, it releases adrenaline and other hormones that help us cope by increasing vasodilation and circulation. Our heart rate will also rise to circulate blood more rapidly to deliver more oxygen and nutrients to a stressed body.

Each of the above scenarios, while entirely different involve your skin in different ways. New skin cells are created daily, and this process requires building blocks obtained from nutrition, or occasionally borrowed from other parts of the body when nutrition is inadequate. In addition to the responses to solar radiation described above, the skin will adapt to the warmth of direct sunlight, increasing blood flow to the skin for thermoregulation. In a cold environment, the skin will also change appearance, contracting tiny muscles at each hair follicle causing goosebumps. If it is very cold, the skin sends a signal to the brain that in turn instructs the pancreas to release glucagon, to start burning glycogen in the muscles for the energy required for shivering that raises the body’s core temperature.

Our focus in this book is your skin and so we will spend more time describing its functions and structure, but hopefully, it will be in a broader context that helps you to see your skin as more than just an outer layer that we protect for our vanity and appearance. Your skin is a living, breathing adaptable organ that constantly strives to achieve homeostasis in any environment. Understanding its functions and how they change in each environment can help you to hack your skincare habits in an intelligent way, to maximize your own benefits in total skin health. It is our belief that skin health is the ultimate goal and that the glowing, vibrant appearance of skin is the byproduct of total skin health. This objective will require more than just skincare products and skin treatments since those only take action on the skin itself, but do not account for other processes deeper within your body, and the interconnectedness of all organs, body, and mind that also affect your skin. We therefore have to accept that total skin health requires us to also consider the health of our body (and mind).

Chapter 2

Structural and Functional overview

Basic Structure of the skin

Epidermis

The skin functions as the outermost layer that provides a barrier between yourself and the elements. At a very basic level, there are two important layers called the epidermis (outer) and dermis (inner). The epidermis is the thin, visible layer that we are familiar with as the surface of our skin. Two perpetual processes that occur within the epidermis are cellular renewal and shedding. The life cycle of a skin cell is approximately 30 days, with the skin cell originating in the deepest layer of the epidermis as a stem cell, and moving towards the surface taking on more keratin and becoming tougher as it transforms and migrates towards outer layers. Due to this process and the keratin rich structure that it evolves into, the skin cell is also commonly called a keratinocyte. The shape of the keratinocyte also changes during its lifecycle; starting as a column-like structure and flattening out as it reaches the surface and dies out. The epidermis can vary in thickness from 0.05mm on the upper eyelid to around 1.5mm on the palms and soles of the feet - which both have an extra layer. The epidermis can also be thickened further by pressure and friction as evidenced by callouses and corns. The deepest layer of the epidermis also contains melanocytes, responsible for producing melanin that protects against UV damage and gives skin its characteristic skin tone. The outermost layer of your skin is completely dead, and it is completely replaced every two weeks through the continuous process of renewal and shedding. We shed so much skin continuously, that it’s estimated that we will shed 3.5kg in dead skin cells over a year. Shed skin cells consequently form a major constituent of house dust.

Dermis

Beneath the epidermis, lies the thicker dermis composed predominantly of collagen and elastin. The dermis has two layers, the thin papillary layer directly beneath the epidermis that has a rich network of blood vessels and nervous tissue that provides support to the epidermis. The thicker and stronger reticular layer lies beneath the papillary layer and is composed almost entirely of collagen (up to 80%). This connective tissue layer of collagen and elastin embodies the skin with great strength and elasticity. The strength and durability of this layer is why the dermis (in other animals of course) is used for the production of leather. The dermis is also home to specialized structures like hair follicles and their attached muscles, oil & sweat glands, and extremely sensitive nerve cells that allow us to feel the sensations of touch and pressure. The thickness of the dermis can vary from 1mm to 4mm in most areas and is thinner in sensitive areas like the eyelids.

There is also a fatty layer beneath the dermis called the hypodermis. This subcutaneous layer of fat provides a degree of insulation and loosely connects the skin to the body, allowing for flexibility and motion.

Summary

The skin is a protective barrier composed of two main layers (epidermis & dermis) that are attached loosely to the body by a layer of subcutaneous fat. The outer layer of the epidermis consists of dead skin cells that are tougher than the cells in the layers beneath since they contain larger amounts of keratin. The cells in the epidermis constantly renew from the deepest layers towards the surface, with the outer layer being completely replaced every 2 weeks or so. The deepest levels of the epidermis receive nutrition from a network of blood vessels that travel through the dermis below, through the subcutaneous fatty layer, and originate from the larger blood vessels within the body. The strong and durable dermis contains nerves, hair follicles, muscles that control the hair position, touch and pressure sensors, and glands, and is composed predominantly of collagen. The fatty layer beneath the dermis is a store of energy surrounding your body that also insulates against temperature and provides a degree of shock absorption.

How do we unify the above to understand the skin as a whole so that we can at a quick glance assess an overview of what the basic structures are that require care, maintenance, and targeted nutrition? One perspective is to break the complex structures down to their most simple unifying factors. Whether we are discussing the epidermis, dermis, or hypodermis, all of these skin layers are composed of cells. There are many different types of cells of course, from fat cells, muscle cells, skin cells, nerve cells, and blood cells to name a few. However, all of these cells have common features such as a cell membrane, a nucleus, mitochondria, DNA, lysosomes, etc. All the cells in our bodies are ancestors of stem cells - these are the magic ‘starter’ cells that can become any other cell in your body. They exist throughout our bodies even as adults, where their function is to repair and maintain their surrounding specialized tissues. Every process that occurs in our skin (and in our entire body as well) starts with action at a cellular level. All physical and metabolic processes in our body require energy, which is generated at a cellular level through the mitochondria that generate ATP. In order for us to understand how to care for and maintain our skin in the most effective manner, we have to constantly take a macro and micro view. This perspective allows us to adapt our approach to skincare to suit our individual needs, demands, and deficiencies. A one-size-fits-all approach is bound to have limitations due to individual differences and nuances.

Chapter 3

Basic Functions of the skin

Barrier Function

The outermost layer of the epidermis is the stratum corneum which serves as the primary barrier between our bodies and the environment. It provides us with a waterproof barrier to the elements, and also retains moisture within our skin and prevents excessive loss of moisture in harsh environments conducive to desiccation. You may have heard of the term ‘TEWL’. Many nourishing skin creams are promoted as products that reduce ‘TEWL’ (trans epidermal water loss). As the name suggests, ‘TEWL’ is the loss of moisture through the epidermal barrier. The barrier function exists due to the hydrophobic (water resistant) properties of the substances that lie in-between the cells in the stratum corneum. This intra-cellular matrix consists of ceramides, cholesterol and fatty acids - all of which are fats that are naturally water resistant.

UV Protection

Ultraviolet radiation is one of the most persistent assaults on our skin that we face. Our skin’s natural defense against UV assault is to produce melanin, which is why skin tans during sun exposure. Some skin types obviously contain more melanin than others due to evolutionary requirements to mitigate more frequent sun exposure. Melanin is an excellent UV absorber (this is the same function that chemical absorbers perform in sunblock creams) as well as demonstrating antioxidant and free radical scavenging properties. With UV radiation being widely regarded as the main causative factor in the development of skin cancer, the importance of the protective nature of melanin is displayed in the numerous studies that show a far lower incidence of skin cancer in darker skin types than in fairer skin types. 4 White skins are 70 times more likely to develop skin cancer than black skins5 . In fact, White skins allow more than twice as much UVB and three times as much UVA to penetrate the skin when compared to Black skin. 6

Temperature Regulation

As our sensory organ that is directly in touch with our environment, our skin responds to hot and cold stimuli to regulate our body heat. While we need to retain a relatively constant core temperature for optimal functioning, our extremities and skin can vary dramatically with our environment. When exposed to heat, our body responds by dilating blood vessels to increase blood flow closer to the skin's surface, allowing heat to escape through our skin by radiation and conduction. Our sweat glands also start to function when we are hot, coating our skin with sweat that carries heat out of our body and provides a cooling sensation as the sweat evaporates. When we feel cold, our body responds to stop heat from escaping and to retain heat internally to maintain our core temperature. Our blood vessels constrict, slowing blood flow down and reducing blood flow to the skin surface, where heat would be lost through conduction. Muscles at the hair follicles contract to make the hairs stand erect, capturing a small layer of air around our bodies that conserves warmth.

Light Modulation

It may surprise you to learn that your skin contains proteins called opsins that are sensitive and reactive to light. Opsins have been detected in several animals (chameleons, frogs, octopus for eg) and are instrumental in enabling rapid responses to danger and increasing survival odds. 7While the opsins in human skin have been found to mediate processes such as melanogenesis, wound healing, and photoaging, little is known about the physiological functions in human skin. The most obvious role would likely be between these dermal opsins and our circadian rhythm. We also know that light (UVA spectrum) plays a role in nitric oxide synthesis and blood vessel dilation in our skin. This occurs independently of our ability to visually detect light. The growing field of photo-biomodulation, a form of light therapy based on non-ionizing8 light sources, is being applied to treat various skin conditions including acne, psoriasis, atopic dermatitis, hair loss, and more. Red light therapy for example is a well-established treatment to reduce inflammation, joint pain, and oxidative stress.

Conductivity

Almost all of us have experienced a static electricity shock. To understand this phenomenon, we must first understand that all matter is made up of atoms. Atoms contain protons, neutrons, and electrons. Protons are positively charged, electrons are negatively charged and neutrons are neutral. Opposite charges are attracted to each other (positive attracted to negative) and like charges repel each other. You would no doubt have encountered this phenomenon with magnets. Rubbing certain items together can transfer electrons, such as when you rub your shoes on the carpet. During this process, your body collects extra electrons that cling to your body until they can be released. When you touch someone or something with a positive charge, the excess electrons are released from your body to the other person or object instantly as a static discharge (or shock). This is an equalization of the electrical potential between objects.

Now, let’s think of this equalization of electrical potential on a larger scale. Our planet is like a battery, being wirelessly charged by the Sun. The Sun emits photons that are split by the atmosphere into positive and negative charges. The excess negative charge (electrons) has to be discharged in order to reach an equalization of electrical potential, and this is predominantly achieved through lightning strikes; an instant transfer of electrons into the earth that holds a negative charge. The positive charge remains in the ionosphere about 100km above the earth.

This is interesting, but what does it have to do with your skin? Well, we all know that free radicals play a significant role in aging and inflammation. The phenomenon of ‘free radical aging’ was first described in 1956 by Denham Harman.9 This is why we are constantly encouraged to apply antioxidants to our skin - to scavenge free radicals and neutralize the oxidization chain reaction. But what exactly is a free radical? It is an atom or molecule with an unpaired electron that must steal an electron from another source. The most common free radicals in our bodies are called Reactive Oxygen Species (ROS) - Oxygen has a strong ability to form free radicals by oxidizing substances. Antioxidants donate an electron to free radicals so that they don’t ‘steal’ them from another stable source, thereafter triggering a chain reaction, since the once stable source would become a free radical itself. Oxidization as a chain reaction is easily understood when we think of a browning apple, or rusting metal - it is a continuous and persistent process due to the chain reaction of oxidation. Free radicals are positively charged and are neutralized by the donation of a negatively charged electron10. This is where the electrical potential of the earth becomes significant. Due to the global atmospheric electron circuit, the earth is a limitless, infinitely renewable source of electrons that we can absorb instantly by direct contact with the earth (bare feet on grass for example). Since we instantly equalize with the electrical potential of the earth by contact, we become part of the energy circuitry of our planet as a whole. It is thought that the instant flow of free electrons into the body from the earth neutralizes ROS and reduces inflammation11by donating electrons to the free radicals.

The Aging Process

Predictable Change

Time marches forward and despite our valiant resistance, the best we can do is slow down the effects of time. To stop the aging process in its tracks is beyond our current capabilities. We know that we will age with time and the signs of aging appear obvious to us - wrinkles, sagging skin, blotchy patches et cetera. Those of us who take pride in our appearance and want to appear younger than our chronological age invest time and effort into skin treatments and products that are marketed to us in a way that usually targets our insecurities and appeals to our sense of vanity. It’s difficult to deny because we all have some degree of vanity. If you are reading this book, there is a high probability that you are deeply interested in your skin health and appearance, and why shouldn’t you be? As mentioned in the previous chapter, skin health is the ultimate goal in our opinion and a byproduct of healthy skin will be the glowing, vibrant appearance that many of us covet.

While the esthetic appearance of our aging skin is of course very important, there are many other changes that occur within the skin that are important from a structural and functional perspective. It is equally important (if not more important) to prioritize the health of the entire skin system to ensure that a holistic approach is adopted. In a nutshell, one wouldn’t apply a new coat of paint to a rusting car - it would be crucial to address the underlying rust before addressing the exterior appearance. While this metaphor provides a simplified example of the preferable approach of remedying any underlying conditions before esthetic enhancement, your skin - thankfully - is far more complex and can accommodate and even thrive while you address its needs both internally and externally.

There are a number of predictable structural changes that occur in our skin as we age. The combination of these factors lead to the symptoms of natural aging such as wrinkles, sagging skin, loss of moisture, poor texture and uneven appearance.

Chapter 4

Structural Changes

All three layers of the skin (epidermis, dermis, and hypodermis) are thin with age. The structure and function of the cells within each layer also change over time.

Epidermal changes with normal aging

The number of epidermal cell layers remains constant, but the structure of the cells (the keratinocytes) becomes shorter and fatter. The cellular renewal cycle in the epidermis slows down and the quantity of cells in the epidermis decreases over time. It’s interesting to note that epidermal thinning is more pronounced in women after menopause and this is due to the reduction in estrogen. 12 The corneocytes (the cells in the outermost layer of the epidermis) also become larger as a result of decreased cellular turnover. The number of active melanocytes also decreases with age contributing to uneven pigmentation in elderly skin. Sebum production also decreases significantly in aged skin even though the number of sebaceous glands remains constant. The water and lipid balance in the stratum corneum decreases with age affecting the skin’s TEWL.

Dermo-epidermal junction

While the abovementioned junction isn’t a distinctive layer, it is a very important site where the epidermis and the dermis meet. The most consistent structural change observed in aged skin is a flattening of this junction due to shear stress sustained by friction between the dermis and epidermis. 13This flattening results in a loss of a sustained surface between the layers resulting in a decreased supply of nutrients and oxygen.

Dermal changes with normal aging

There are a number of changes that occur in the dermis with aging. The most notable of which is the reduction in collagen and elastin in the dermis. After the age of 20 we lose around 1 to 1.5% of our collagen per year. Women also lose a further 30% of their skin collagen in the first 5 years after menopause due to the lack of estrogen. The amount of hyaluronic acid in our dermis also steadily declines with aging. The common thread between collagen, elastin and hyaluronic acid is that they are all produced directly or indirectly by the fibroblasts in the dermis. The fibroblasts in the dermis are responsible for developing connective tissue, extracellular matrix of proteins & other nutrients and play a vital role in enabling skin to recover from injury. As we age, the number of fibroblasts decrease steadily. The ability of the fibroblasts to function normally also reduces with age. The presence of healthy, functioning fibroblasts in the dermis is the cornerstone to reducing the signs of prematurely aging skin.

Hypodermal thinning

As we age the thin subcutaneous layer of fat called the hypodermis also thins out in most parts of our body and fat deposition tends to store around the thighs, waist, and abdomen. There are however several reasons to believe that this fat deposition pattern in later life is predominantly caused by lifestyle rather than just chronological aging and genetics.

Chapter 5

Characteristics of Aging skin

The common signs of aging such as wrinkles, fine lines, sagging skin, loss of elasticity are all symptoms of underlying structural degradation. We are exposed to many contributing factors that accelerate our skin's structural decay on a daily basis. Whatever the trigger may be, such as constant exposure to free radicals, ROS (reactive oxygen species), AGE’s (advanced glycation end products) or UV overexposure, the symptoms are similar in that glycation, oxidation and DNA damage (caused by UV overexposure) all alter the state and behavior of our otherwise normally functioning cells. The combination of these factors also contributes synergistically to the decline in skin integrity.

Fine lines, wrinkles, loss of elasticity

As we lose collagen and elastin, the elasticity of the skin reduces. As a result of this process, the skin’s ability to return to its regular state after stimulation is reduced. As an example, despite the appearance of wrinkles during expression in a child, the wrinkles disappear when expression returns to normal immediately without any sign of the wrinkle. As we age and the elasticity and structural integrity reduce, the lines stay for longer and can eventually become permanent expression lines. In some dermatological tests, the skin is depressed and thereafter timed to evaluate the duration required for the skin to return to normal - this process can occur in minutes in young skin and take over 24 hours in aged skin. 14Since collagen is also a crucial component in the wound healing process, the healing process slows down and it’s common to see persistent wounds in elderly skin that are reluctant to fully heal.

In our image-conscious society, we have a tendency to focus on vanity areas. We are more likely to take extra care and attention of our face than we are to our necks (and décolletage in women), and this commonly presents with neck and décolleté that appear more aged than the face. Consequently, it is of considerable benefit to devote as much attention to the neck, décolleté, and arms as is it to the face to prevent the appearance of one area from aging at a different rate to another.

Dark under eye

It is also common for the eyes to be the first area to express symptoms of premature aging. The skin around the eye is thinner than the rest of the facial skin and as the hypodermis beneath the eye thins, the thinner skin allows the appearance of underlying blood vessels to become visible, darkening the appearance of the under eye.

Dryness & dehydration (they’re not the same!)

The loss of hyaluronic acid combined with the skin's barrier integrity diminishing with age contributes to an imbalance in the skin's ability to retain sufficient moisture leading to drier and more dehydrated skin. Dehydrated due to the skin’s increasingly limited ability to hold water due to the reduction in hyaluronic acid, and dry due to the compromised lipid balance in the skin barrier.

Chapter 6

Contributing factors

UV damage

The most common culprit cited in premature aging is UV damage due to sun exposure. The damaging effects of UV overexposure is well documented, but little is spoken about the beneficial effects of measured UV exposure. This is something that we will discuss in much greater detail in a later chapter but it’s important to note that like almost everything else, the poison is in the dose. Our intention is not to trivialize the dangers of overexposure to UV which can burn the skin, cause DNA mutations, trigger an oxidative reaction and cause skin cancer. It is vital to take a balanced approach and understand how the skin responds to UV exposure and how in measured amounts it can be beneficial.

Glycation

While UV damage takes most of the credit for long-term skin damage, another hidden culprit is glycation and advanced glycation end products (AGEs). When our systemic glucose levels are too high, free glucose can irreversibly bond with proteins and lipids in our tissues, forming AGEs. AGEs not only permanently damage our tissues (such as collagen & elastin), but they trigger an inflammatory response and lead to a chronic state of low-grade inflammation.

Smoking

The appearance of your skin dramatically declines with smoking. There are several reasons for this and some are immediately recognizable due to the unique behavior associated with smoking. For example, smokers pucker their lips in order to inhale; this unique contraction of muscles leads to the development of deep vertical wrinkles on the lips over time. Smokers tend to squint to minimize the discomfort of smoke in their eyes and this stimulates the early development of eye wrinkles and crow’s feet. Skin can also be stained yellow by tobacco and this can be noticed on many smoker’s fingers and a yellow complexion in some smokers. Nicotine also triggers the melanocytes to produce melanin and leads to darker patches, spots, and uneven skin tone. Lips are also commonly stained darker in smokers due to increased melanin and poor circulation. One of the most well-known consequences of smoking is that it constricts blood vessels and reduces circulation. While this does of course affect every part of your body, we will limit our discussion to the effects on the skin. Your skin receives oxygen and nutrients through a network of blood vessels and a reduction in circulation depletes essential nutrients causing a decline in your skin's regular functions. This impact extends further and also reduces the healing ability of your skin. It’s well documented that smokers respond more poorly to skin treatments than do non-smokers. 15 The toxins in cigarette smoke are toxic to collagen and elastin which are the primary structural proteins that give skin its elasticity. Smokers consequently experience deeper wrinkles, greater loss of elasticity, and develop under eye bags rapidly. The toxic effects of cigarette smoke are also not unique to the smoker; the negative effects extend to those in close proximity who are exposed to their toxic secondhand smoke.

Air pollution

The quality of the air in our environment directly affects our skin. In congested urban areas, there is a higher degree of exposure to particulates from vehicle emissions such as diesel exhaust particles. The size of these particles can vary greatly and ultra-fine particles can penetrate the skin barrier and directly pollute the dermis inducing oxidative stress and inflammation. Other particles can also be inhaled and passed into the bloodstream to reach the skin via circulation. In addition to particulates, there are also gases such as nitrogen dioxide and ground-level ozone that are directly linked to prematurely aging skin. Exposure to nitrogen dioxide and particulate matter specifically increases the formation of facial pigmentation spots. Ground-level ozone causes alterations to the stratum corneum and triggers oxidative stress. The resulting depletion of antioxidants affects the deeper levels of the epidermis and dermis and disrupting regular collagen metabolism resulting in wrinkle formation.16 These pollutants are however all primarily linked to vehicle emissions and consequently is a factor to be considered if one’s environment is urban.

Fitzpatrick skin photo-types

The color of your skin plays a role in your skin's aging process. The American dermatologist Thomas Fitzpatrick developed the Fitzpatrick scale as a method of categorizing skin in order to receive the correct dosage of UVA light in PUVA therapy17. The scale is based on the amount of melanin in the skin with Type 1 being the lightest skin type and Type 6 being the darkest skin type. The characteristics of the various skin types are summarised below:

Skin Type

Tanning ability

I

Always burns, never tans (typically pale white skin, blonde/red hair)

II

Burns easily, tans poorly (typically fair skin, blue eyes)

III

Tans after initial burn (typically darker white skin)

IV

Burns minimally, tans easily (typically light brown skin)

V

Rarely burns, tans darkly easily (typically brown skin)

VI

Never burns, always tans darkly (typically dark brown or black skin)

The degree to which each skin type burns easily shows the protective quality of melanin in the skin. Not only does the photo-protective quality of melanin protect against the UV assault - it also provides antioxidant properties that scavenge free radicals and reduce oxidative stress. These factors are significant contributors to premature aging and lighter Fitzpatrick skin types consequently require additional maintenance and protection to guard against environmental aggressors.18

Maintenance & Preventative Care

Maintenance through the Ages

The changes in the skin over time are predictable and being able to anticipate the expected shifts allows us opportunities to adopt appropriate skincare protocols to remain ahead of the curve. In order to age well, certain actions are required in order for us to prevent premature aging to ensure that we age gracefully and maintain our skin in optimal health. In this chapter, we will discuss the skin and its characteristics through each decade, together with our recommendations to maintain optimal health. We will also discuss essential products and their functions so that you can understand the desired outcomes at a deeper level. We recommend that you read every section even if you are not in that age group - the information will provide insight into how your skin may have changed in earlier years and what action can be taken to address any negative consequences in later years. Reading into the years ahead of you will also prepare you for anticipated changes that can be pre-empted.

Chapter 7

Teenage skin

Skin in our teenage years is at its most vital with abundant collagen giving the skin fullness, elasticity, and radiance. The teenage years also mark major hormonal shifts in the body and in some cases, it is unfortunately the period when many begin to experience breakouts. We will discuss breakouts in more detail in the next chapter so if this is of particular interest, please skip ahead to the next chapter to read the section on ‘Breakouts’. The teenage years mark a period of rapid growth and our body experiences a state of transient insulin resistance. This is a period during which the body elevates our blood insulin levels - insulin is an anabolic hormone; it plays an important role in shuttling nutrients such as glucose & amino acids to where they are required for growth. This insulin-resistant state occurs in order to efficiently feed our body with nutrients to support the growth phase. The physiological changes that occur in the skin during the teen years include increased sebum production, increased cellular turnover, and a shift in the type of bacteria and fungi that colonize the facial skin19.