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Sunscreens - shedding new light on an old topic


Are there any good reasons NOT to wear sunscreen? Surely not…

We know well enough of the dangers of skin cancer, which may not only be deadly as the dreaded melanoma, but also disfiguring and requiring numerous visits to the doctor’s office for multiple interventions. In addition, excessive sun exposure causes photo ageing and hyperpigmentation which is distressing to women and men alike.

Sunlight is certainly not all bad, and generally induces a sense of well-being, decreases the appetite, improves libido and assists with the synthesis of vitamin D.  South Africans are a sun loving society that embraces an outdoor lifestyle. While moderate and responsible exposure to the sun is good for your well-being, it is not possible to tan without damaging skin cells, leading to accelerated ageing, and increasing your risk of skin cancer.

As we head into 2021 hoping for a better year than the last, I thought we would relook at some of the controversies surrounding sunscreens and shed some light on new innovations and considerations concerning sunscreen use.

With conflicting information in the media many people are confused about whether they should be wearing sunscreen and uncertain of the product to choose. This can lead to them wearing no sunscreen at all. Let’s set the record straight.

The first point to make clear is that there is overwhelming scientific evidence that excessive sun exposure causes skin cancer and methods of sun protection including sunscreens can prevent this. Recent sunscreen studies conducted in Australia estimate that the current sunscreen recommendations have decreased the incidence of skin cancer by 10-15 %.

Sunscreen and Vitamin D

Possibly the current biggest controversy surrounding sunscreen use relates to Vitamin D deficiency. Reports have been conflicting. A review article published in the British journal of Dermatology last year sought to evaluate the available studies and concluded that there was not enough evidence to suggest that sunscreens decreased the production of Vitamin D. The original study that made this claim was done with an artificial light source different to what people are normally exposed to in the environment. Subsequent studies with real life circumstances could not prove a decrease in Vitamin D production with sunscreen use.

The only limitation of this review was that it didn’t take into account the newer very high protection sunscreens currently being used.

Remember that sunscreen does not fully prevent exposure to sunlight. To get maximum sun protection from a sunscreen one would need to apply 2mg/cm squared and reapply every 2-4 hours. Most people do not wear sunscreen in large enough quantities. Some of the analysis even suggested that there is still enough UV R exposure to produce adequate vitamin D even while using sunscreen.

Interestingly there are some people who do not produce enough Vitamin D even with large amounts of sun exposure, and some people with minimal sun exposure with normal Vitamin D levels. There seem to be as yet unidentified factors influencing Vitamin D synthesis.

More importantly you can get enough Vitamin D from oral supplements and diet without exposing yourself to an increased risk of skin cancer.

Sunscreen and its impact on the environment

UV filters oxybenzone,  camphor derivates, octocrylene, and octinoxate  have caused much recent controversy as they have been shown to accumulate in the water sources of the world and suspected of being responsible for the bleaching of coral reefs. They are not easily removed by conventional water treatment methods. As a result of this several states in the united states have banned these sunscreen ingredients. Of note is that the study that claimed the adverse effects on coral reefs used much larger concentration of oxybenzone than is actually found in even the busiest beaches in the world. However this is certainly a warning and has led sunscreen manufacturers to seeking alternative ingredients in their formulations.

It doesn’t however warrant a blanket boycott of all sunscreens. If anything, there is a shift towards using more physical or mineral blockers in sunscreens like zinc oxide and titanium dioxide which is recommended for sensitive skin and children.

Sunscreen and its relation to Frontal Fibrosing Alopecia

On that note physical blockers or mineral sunscreens have also been controversially linked to frontal fibrosing alopecia which is a condition that is caused by progressive fibrosis of the hair follicles of the frontal hairline resulting in hair loss and a receding hairline. Small quantities of titanium supposedly from titanium dioxide containing mineral sunscreens, have been found in the hair shafts of patients with frontal fibrosing alopecia. There is no conclusive proof yet that the sunscreens are the actual cause for frontal fibrosing alopecia.

Is sunscreen an endocrine disrupter?

Oxybenzone has been identified as an endocrine disrupter affecting the endocrine systems in rats and fish.  But for this to affect humans, one would need to apply an unrealistically large amount of oxybenzone to the skin for decades to absorb the quantities of avobenzone needed to cause any real danger. To date there have been no proven significant negative effects from oxybenzone in humans.

What about SPF ? The burning question is whether a higher SPF provides greater sun protection?

To recap, SPF or sun protection factor is actually only a measure of protection against UVB. An SPF of 30 means that you will be able to stay in the sun 30 times longer without burning, than you would be able to without wearing the sunscreen. This does not equate to 30 min and varies amongst individuals, as we all burn at different rates depending on our skin type.

SPF is measured in a test environment which is nothing like real life.It does not take into account sweating, environmental factors and the varying application by the sunscreen user.

In a test environment sunscreen is applied very thickly, at 2mg of sunscreen per square centimetre which is the minimum needed to get the protection labelled on the sunscreen.

Several investigations  have found that sunscreen users rarely apply sun screen adequately and evenly.The quantity that is actually applied by people is closer to 0.5mg per square centimetre. So we are never really getting the same protection as on the label.

Using a lower SPF sunscreen at quantities lower than 2mg per square centimetre actually reduces the overall sun protection factor.

However a recent study published in the Journal of the American Academy of Dermatologists (JAAD) confirmed that realistic usage of a higher SPF sunscreen of SPF 70 and above may provide enough sun protection to protect against photo ageing and skin cancer.

Another point worth emphasising is that while it is true that SPF15 filters out 93.3% of UVB, SPF30 96.7% and SPF50 98.3%, making it seem that there is very little benefit in using the higher SPF, one needs to consider that only the amount of UV light reaching your skin is important. If you look at it this way then SPF 15 allows 6.7% of UVB to reach your skin while SPF 50 allows only 1.7% of UVB. Its not about what you are filtering out, but rather about what you are allowing to reach your skin.

Why should you consider tinted sunscreen?

Tinted sunscreens containing ‘light reflectors’ protect against visible light which causes erythema in light-skinned individuals and hyperpigmentation in dark-skinned individuals. Visible light is the light that we see and makes up 44 % of the electromagnetic spectrum reaching the earth. Conventional broad spectrum sunscreens do not protect against visible light. For a sunscreen to do this it must be opaque and visible on the skin. The newer generation of physical sunscreens made with nanotechnology use small particle sizes of zinc oxide and titanium dioxide to decrease the “white” appearance of the sunscreen and make them more aesthetically suitable for use. Ironically these fine particles can no longer reflect visible light. Tinted sunscreens containing shades of iron oxide and titanium dioxide in various combination are not only able to blend with different skin tones, but are also able to reflect visible light. In this way they can protect against disorders of hyperpigmentation like melasma, post inflammatory hyperpigmentation and lichen planus pigmentosus.  Iron oxide pigment can also be found in tinted powder or brush on sunscreens which can be conveniently reapplied during the day.

Sunscreens treating early skin cancer

The latest research in sun screen technology has seen the development of a new generation of ‘active sunscreens’ containing DNA repair enzymes. These sunscreens have very high SPF and are in the unique position to be seen as potential treatment of early skin cancer (not melanoma) rather than just preventative treatment like regular sunscreens.  Skin cells have their own mechanisms to repair DNA damage caused by UVR, but with excessive sun exposure these mechanisms are overwhelmed which can lead to permanent DNA mutations causing skin cancer and photo ageing.  Scientific studies have shown that sunscreens containing photolyase and endonuclease can enhance the DNA repair mechanisms in damaged skin cells and reduce the lesions of early skin cancer in sun damaged skin. These novel sunscreens may also protect against photo ageing and prevent the breakdown of collagen in the dermis by decreasing the enzyme matrix metalloproteinase.


The science behind sunscreen technology and skin cancer prevention is by no means stagnant and while new challenges emerge regarding the potential dangers of ingredients, science will continue to forge ahead bringing new solutions and replacing old ones.

At the current time sunscreens remain our best solution to the prevention of skin cancer and photo-ageing.


  • The effect of sunscreen on vitamin D: a review*
    R.E. Neale iD ,
    1 S.R. Khan,1 R.M. Lucas iD ,
    2 M. Waterhouse,1 D.C. Whiteman iD 1 and C.M. Olsen iD 1
  • Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Rd, Herston, QLD, 4006, Australia
  • 2 National Centre for Epidemiology and Population Health, Australian National University, Australia
  • Linked Editorial: Wolf. Br J Dermatol 2019; 181:881–882.

  • High-SPF sunscreens (SPF $ 70) may provide
    ultraviolet protection above minimal recommended
    levels by adequately compensating for lower
    sunscreen user application amounts.
    Hao Ou-Yang, PhD,a Joseph Stanfield, MS,b Curtis Cole, PhD,c Yohini Appa, PhD,a and Darrell Rigel, MDd
    Los Angeles, California; Winston Salem, North Carolina; Skillman, New Jersey; and New York, New York

  • Photoprotection beyond ultraviolet radiation: A review of tinted sunscreens
    Alexis B. Lyons, MD,a Carles Trullas, MSc,b Indermeet Kohli, PhD,a Iltefat H. Hamzavi, MD,a and
    Henry W. Lim, MDa
    Detroit, Michigan; and Barcelona, Spain

  • DNA repair enzymes in sunscreens and their impact on
    photoageing—A systematic review.
    Hanna Luze1,2 | Sebastian Philipp Nischwitz1,2 | Iris Zalaudek3 | Robert Müllegger4 |
    Lars Peter Kamolz1,2

  • Review of environmental effects of oxybenzone and other sunscreen active ingredients.
    Samantha L. Schneider, MD, and Henry W. Lim, MD
    Detroit, Michigan
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Ageing Gracefully

We’re never ready for it but ageing is inevitable.
We’re ageing both inside and outside but the skin, which is the largest organ in the human body, suffers from the added onslaught of environmental factors more than any of our internal organs.

Certainly, we all care more about what is visible than what is not seen. As a result, ageing of the face, neck and chest area is considerably more bothersome to most even if we may suffer from a myriad of other systemic diseases. The truth is that a healthy and beautiful exterior appearance
represents overall well-being, and looking good makes people feel better psychologically and emotionally.

An even more interesting observation is that most patients want to look ‘better’ for their age and not necessarily ‘younger’.

So yes, we’re going to age, and yes how quickly we age is largely determined by our genetic make-up, but is it worth trying slow down the inevitable?

No matter how old you are there is always something that can make a difference if you should want to do so.

Where do I start with anti-ageing?

Let’s start with Skincare
Our skin changes as we age and while most of us did very little in our youth, we will need to do more to maintain a healthy skin as we grow older. Remember that most of your efforts with anti-ageing skincare also help to protect the skin from skin cancer.

As we age our skin is more susceptible to drying and easily becomes irritated and sensitive. A dry, dehydrated skin has a more wrinkled, dull appearance.

Maintenance of the skin barrier with a suitable moisturiser prevents dehydration and penetration of organisms, allergens and irritants that can cause inflammation of the skin.

Antioxidants and calming botanicals reduce inflammation which also prevent melanocyte stimulation and resultant hyperpigmentation.

The epidermal turnover rate decreases leaving dead surface skin cells and resultant poor texture and loss of skin radiance. Chemical exfoliation with glycolic acids helps to improve epidermal turnover. There is also resultant signalling to the dermis to improve collagen and elastin formation.

Advanced skincare formulations allow penetration of selective active ingredients into the dermis where we need them to work to prevent breakdown of collagen and elastin as well as stimulate the formation of new collagen to ultimately decrease the appearance of wrinkles.

Antioxidants combined with sunscreens neutralise free radicals for optimum sun protection. There is much evidence to prove the benefits of topically applied antioxidants to reduce skin cancer risk and decrease the breakdown of collagen and elastin in the dermis by scavenging free radicals.

Vitamin C, B3 (niacinamide), and E are the best-known antioxidants with good penetration into the skin. Antioxidants have significantly greater antioxidant properties when combined than alone.

Niacinamide is a powerful anti-ageing ingredient that regulates cell metabolism and cell regeneration. It has also been shown to reduce redness, improve hyperpigmentation and skin elasticity.
The optimal concentration in skin care in 5%.

Green tea polyphenols and numerous other botanicals have varying antioxidant properties that have proven a useful benefit in anti-ageing skincare.

Retinols (Vitamin A) have often been described as the ‘gold standard’ for anti-ageing. They stimulate the formation of collagen and elastic fibres to reduce wrinkles and fine lines and improve skin elasticity as well as increase and regulate cell turnover to improve skin texture. Retinols have antioxidant effects, reduce the signs of UV induced sun damage, improve hyperpigmentation and uneven skin tone.

Retinols, peptides and growth factors have numerous benefits which include stimulating collagen production ultimately leading to a plumper dermis and a healthier younger looking skin.

Sun protection includes responsible sun behaviour and sunscreen of at least SPF30. The sun is responsible for photo-ageing which is an accelerated form of ageing visible on sun exposed areas of our skin. New sunscreens with DNA repair enzymes have been shown to reduce the number of
precancerous lesions with regular use.

Anti-ageing ingredients are often found in combination to assist with incorporating more that one ingredient in a skincare regimen.

Most dermatologists and skincare therapists make use of a skincare pyramid which can be seen as a stepwise method of introducing anti-ageing skincare, starting from the basics at the bottom of the pyramid, which include sunscreen, antioxidants and DNA repair enzymes, and gradually adding more active ingredients based on tolerance and response.
We are also guided by your individual goals as in ‘what you are looking to improve the most’.

Anti-ageing Procedures
Chemical peels may be superficial, which include alpha and beta hydroxyacid peels and 10-30% TCA (trichloroacetic acid) peels; medium depth peels like 30-50 %TCA; or deep peels which include >50% TCA and phenol peels.
Superficial chemical peels are suitable for most skin types and have minimal downtime. It is important to go to a reputable therapist as not all peels are suitable for all skin types.

Dermal needling or collagen induction therapy makes use of fine needles to penetrate the skin, to break down old collagen in the dermis and stimulate fibroblasts to produce new collagen. Active ingredients for anti-ageing may be applied to the skin and ‘needled in’ for optimal benefit.

IPL (Intense pulsed light), lasers and radio-frequency devices are aimed at targeting various skin structures like blood vessels, collagen and pigment to improve the appearance of ageing skin.

Hyaluronic acid fillers injected superficially into the dermis can activate and stimulate fibroblasts to produce new collagen and inhibit the enzymes that break down collagen. More robust hyaluronic acid fillers injected deep onto bone or into deficient fat pads in the face can have a significant lifting effect and improve volume loss, simulating a face lift. This is often referred to as a non-surgical face lift.

Platelet rich plasma (PRP) is derived from whole blood which is spun down in a centrifuge. The plasma contains growth factors which is injected into the skin to stimulate collagen synthesis.

Botulinum toxin is injected into muscles to stop contraction. In this way they prevent repetitive creasing of the skin which in time would lead to a permanent wrinkle or furrow. The best benefit for this treatment is seen on the frown lines, forehead lines and crow’s feet. Injections need to be repeated every 3- 4 months and in time there is significant improvement in skin wrinkling. The treatment does not work on static lines.

There are various options to include anti-ageing procedures in your skin treatment plan. Chemical peels and dermal needling are usually added as a course of treatments after preparing the skin with a homecare regimen. Filler treatments are carried out according to a pre-discussed plan.

Is anti-ageing all about products and procedures?
In general, a healthy lifestyle with responsible sun protection is important to slow skin ageing.

A well-balanced diet is a great source of nutrients and oral antioxidants which also benefit the skin.

A good exercise routine, alleviates stress which through various mechanisms not fully understood, worsen disease and make us age faster. Perhaps less stress and anxiety makes us frown less with resultant less wrinkles.

Smoking increases the breakdown of collagen and elastin in the dermis leading to a more wrinkled skin.

There is a growing body of evidence that all forms of atmospheric pollution is detrimental to the skin and body, causing premature ageing, skin cancers and hyperpigmentation.

Though this seems like an exhaustive list, it is by no means complete!
Consult with your dermatologist or skincare therapist and come up with a treatment plan that you are comfortable with.

What you are able to achieve also depends on how much time, effort and budget you are willing to invest.

Start early, start simple, start somewhere…

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The Magic of Serums

Serums are often the ‘wonder product’ of most skincare brands, and the go-to product for most dermatology and specialist skincare clinics. With so many different options, it isn’t always easy to know which product to choose or even how these can fit into your skincare regimen.

So, let’s shed some light on the matter …

What are serums and why are they so special?
Serums are lightweight liquids or gels containing the highest quality, highest concentration of active ingredients specially formulated to enable the product to penetrate the epidermis to reach the deeper dermal layers of the skin. The sophisticated delivery systems ensure faster and efficient absorption of the product and consequently less wastage.

To be able to guarantee stability of these high quality ingredients while they are on the shelf, to ensure maximum benefit when the product is applied, is nothing short of scientific genius and the reason why serums are often more expensive.

In fact serums are generally the most expensive part of a skincare regimen and this is often the reason most patients are hesitant to use them.

It’s important to remember that very little product is required as the delivery systems are often superior to creams and lotions. With proper use and correct storage most serums actually end up lasting longer than creams or lotions and are ultimately more cost effective.

Where do serums fit in my skincare regimen?
Serums are best applied after cleansing and toning when the product can achieve maximum penetrance into the skin without being hindered by other products. There may be exceptions to this rule.

Serums may be used morning or night depending on the product.

Remember serums do not always give enough moisturise or hydration so you may still need to apply a moisturiser after the serum especially if your skin is dry.

Which serum should I choose?
Serums are often used to target specific skin types or skin concerns. A product range may have a variety of serums with different concentrations of active ingredients to suit different skin types . For example, an oily skin may benefit from a higher concentration of Vitamin C while a dry sensitive skin may only be able to tolerate a low concentration.

Serums may fall under the ‘prevent’ , ‘treat’ or ‘hydrate’ categories of a skincare brand.

Antioxidant serums containing combinations of Vitamin C, E and other ingredients will help prevent and reverse damage caused by sun exposure.

Various skin concerns like hyperpigmentation, acne, rosacea and dryness are targeted by appropriate ingredients found in different serums.

Since most serums contain superior active ingredients either alone or in power combinations, you may find a single serum effective for numerous skin concerns.

Can serums be combined?
Absolutely! Since most of us have more than one issue going on at once, it’s often necessary to treat more that one problem. So if you want an anti-ageing serum , and also a treatment for hyperpigmentation you may use more than one serum. In this case, you may apply one and wait a few minutes before applying the other or use them at different times of the day. Sometimes a single serum can fulfill all your needs.

Have a look at our Skinsmart product recommendations below where we try to help you find what you need, or complete our free online skin assessment here.

– Skinsmart Suggestions –

For hyper-pigmentation or uneven skintone:

*SkinCeuticals Discoloration Defense
*Neostrata Illuminating Serum

For skin redness and rosacea-prone skin:
*Neostrata Redness Neutralising Serum
*SkinCeuticals Phyto Corrective Serum

For hydration:
*SkinCeuticals Hydrating B5

For ageing and fine lines:
*Neostrata Tri-therapy Lifting Serum
*Neostrata Firming Collagen Booster
*SkinCeuticals HA Intensifier Serum

For prevention of free radical damage:

*Obagi C Clarifying Serum
*SkinCeuticals Phloretin CF
*SkinCeuticals C E Ferulic
*Neostrata Antioxidant Defense Serum

For skin barrier repair:
*SkinCeuticals Retexturing Activator
*Neostrata Bionic Face Serum

For mature skin prone to acne:
*SkinCeuticals Blemish + Age Defense Serum

If you are still unsure of what you need, email us at [email protected]. Our qualified medical therapist can give you the right advice for your skin concerns.

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Vitamin C – The Difference

There is an overwhelming amount of new vitamin C containing skincare products on the market, with marketing campaigns and social media urging one to use vitamin C in their skincare regimen. But what exactly does vitamin C do for the skin, and why is it important to invest in the right product?

Vitamin C is present in virtually all tissues in the human body and normal skin contains high levels of it.
Humans are unable to make Vitamin C so we need to get it from food. It is absorbed into the skin from blood vessels in the dermis with the help of sodium-dependent transport channels.

Vitamin C is a potent antioxidant which can be supplemented orally or applied topically as an anti-ageing ingredient in skincare.
Though oral Vitamin C has numerous benefits to the body, we are unsure of how much eventually filters through to the skin.
We do know however that supplementation whether oral or topical does increase the concentration in tissues with measurable benefits.

What are the benefits of vitamin C in the skin?

-Vitamin C as an antioxidant-
Vitamin C is a potent antioxidant that works by neutralising reactive oxygen species (ROS).
ROS formed by sun exposure and cellular processes causes damage to cellular DNA, cell membranes and collagen. The result is ageing skin and skin cancers.
Sunscreens are unable to fully protect against ultraviolet light (UVA, UVB) reaching the skin.
Comprehensive sun protection requires a topical antioxidant as well as a sunscreen.
In addition, recent evidence suggests that sunscreen is unable to protect against newly discovered environmental aggressors like infrared and pollution that contribute to declining skin health.

Vitamin C is able to bridge this gap in skin vulnerability.
Clinical studies have shown that sun exposure and smoking depletes vitamin C in the skin, while regular topical application can lead to a replenished skin reservoir.
Overall topical application of vitamin C will help treat and prevent the changes associated with skin ageing and skin cancer.

-Vitamin C in collagen synthesis –
Vitamin C is a co-factor in collagen synthesis, so it is vital for collagen formation. It also works by increasing the gene expression for collagen synthesis and reducing the breakdown with a resultant overall increase in the amount of collagen formed. In this way vitamin C plumps up the dermis to increase the thickness of ageing skin.
Studies have shown that topical application of Vitamin C increases collagen production in young skin as well as photo damaged skin meaning that the benefits can be seen from an early age.

-Vitamin C and hyperpigmentation-
Vitamin C inhibits the enzyme tyrosinase decreasing melanin production.
It stabilises melanocytes which react in particular to sunlight. The overall effect is reduced pigment production and improvement in uneven skin tone. Vitamin C can therefore be used in the prevention and treatment of disorders of hyperpigmentation including melasma and post inflammatory hyperpigmentation(PIH). It is used in combination with other skin lightening agents.

-Vitamin C as an anti inflammatory-
Vitamin C inhibits pro inflammatory cytokines interrupting the inflammatory cascade. It can be topically applied to reduce inflammation in skin conditions like acne and rosacea.
In rosacea it calms down inflamed skin and reduce redness.
In acne, the suppressive effect of Vitamin C on melanocytes and inflammation prevents the development of post inflammatory hyperpigmentation (PIH).

-Vitamin C in wound healing-
Vitamin C promotes the migration and proliferation of fibroblasts to areas of skin injury. In this way it promotes new collagen formation and aids in wound healing.

-Vitamin C for dry skin-
Topical application of Vitamin C is reported to improve the appearance and feel of rough, dry skin. Studies have shown that Vitamin C promotes the formation of the lipids in the upper layer of the skin. This helps to maintain the integrity of the skin barrier locking in moisture and alleviating dryness.

So we know the benefits of Vitamin C, but how do we get it to the skin?
A variety of Vitamin C preparations are available. Not all are equal and it is important to look for a reputable brand.
The challenge is getting topically applied vitamin C into the dermis where it can have optimal benefit.
L-Ascorbic acid is the biologically active and best studied form of Vitamin C and generally the form you should look for in skincare products.
There are other forms with varying clinical benefits.

L- Ascorbic acid is hydrophilic, which is why absorption through the skin surface which has lipophilic properties is not easy.
However studies have shown that L-Ascorbic acid in the right formulation with a pH lower than 4, can effectively penetrate into the skin. The optimum concentration is between 10-20%. Lower concentrations are suitable for sensitive skin types while higher than 20 % can be irritating to the skin.

L-Ascorbic acid is unstable, especially when exposed to light and heat, so it should be in an opaque or amber bottle and stored in a cool, dark place.
Lots of effort has gone into keeping Vitamin C in stable formulations so that it is still active when applied to the skin. When vitamin C has oxidized it becomes brown in colour.

Vitamin C is often combined with other antioxidants like Vitamin E and Ferulic. Combination formulations have a synergistic effect multiplying the antioxidant and photo-protective benefits and in some cases improving stability.

Vitamin C is safe to use with multiple clinical benefits to ensure a healthy and younger looking skin. At Skinsmart we stock a range of products that offer the benefits of Vitamin C – contact us to assist you in finding the Vitamin C formulation best suited to your skin type and skin concern.

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The Magic of Retinol


What is Retinol?

Retinol or Vitamin A belongs to the larger ‘class’ of retinoids. Retinoids have long been considered the gold standard of anti ageing skincare and as such should be a part of any anti ageing skincare regimen. Retinol applied to the skin is converted to retinoic acid (tretinoin) in skin cells which is the active form. There are various other forms of retinoids including retinaldehyde and retinyl esters. Retinol is vital to cellular processes but is depleted with age and sun exposure.

Retinoids can be divided into therapeutic retinoids which are prescription, and cosmeceutical retinoids.

The most well known prescription retinoids are:

-Tretinoin (Retin-A, Retacnyl, Ilotycin-A )
-Adapalene (Differin gel, Dapta gel)
-Isotretinoin (Roacutane, Oratane, Acnetane, Acnetret)

Skincare products contain cosmeceutical retinoids in the form of retinol, retinaldehyde and retinyl esters.
A few studies have shown that regular long term use of an adequate concentration of retinol in skincare offers the same benefits as topical prescription tretinoin but with less irritation.

What does Retinol do?

Retinol regulates the differentiation and proliferation of cells.
In skin cells retinol is converted to retinoic acid which binds to DNA receptors, correcting cell defects and promoting cell turnover. The quicker shedding of dead surface skin cells leads to overall brightening of a dull complexion, and aids in the treatment of acne as the follicles are unblocked.
Retinoids increase the expression of p53 in skin cells which prevents the formation of skin cancer.
Retinoids are anti-ageing as they increase the thickness of the epidermis and promote collagen production in the dermis thus reducing fine lines and wrinkles and repairing sun damage.
Retinoids also treat hyperpigmentation by increasing the turnover of the epidermis. They are usually combined with ingredients that inhibit the production of melanin.

At what age should I start using retinol?

Prescription tretinoin is used in teenage patients for the treatment of acne. Retinoids are used to treat psoriasis, scarring and hyperpigmentation. It is therefore safe to use retinol for anti-aging even in your 20’s especially if you have sun damage. Remember to stop using retinoids once you start planning to fall pregnant.

Does retinol make your skin sun-sensitive?

Yes they do, but retinoids mop up free radicals giving them antioxidant properties. They prevent and reverse sun damage and repair DNA to prevent skin cancer.

As mentioned retinol is depleted by sun exposure, so if you do have frequent sun exposure you should in fact use a retinoid on the skin.
However because of the irritant potential of retinoids, they are usually recommended for night time use and it is essential to use a sunscreen during the day.

Are there different strengths of retinoids?

Retinoic acid (tretinoin) is the most potent form, followed by retinaldehyde, retinol and the weakest, retinyl esters. The most commonly found form in cosmeceutical skin care is retinol. The concentration is important to ensure good results. Adapalene is a third generation retinoid with minimal potential to irritate the skin. You will have to wait 3-6 months to see the benefits of retinol on the skin, so be patient as the results may be worth the wait.

What’s the difference between retinols and retinoids?

Essentially, retinol is just a specific type of retinoid. With Retinoids being the ‘class’ or group of Vitamin A

Can you use retinol on acne-prone skin?

Yes. Retinoids in the form of tretinoin was actually first used to treat acne. It was then noticed that the older patients had improvement in skin texture, skin thickness and pigment marks. Topical tretinoin, and adapalene are first line treatment in the acne treatment guidelines. Retinoids help shed dead surface skin cells, unblocking the follicle. They are also antibacterial and decrease the amount of propionibacterium acnes on the skin.
Oral isotretinoin is the best treatment for severe acne as it is the only retinoid known to shrink sebaceous glands.

Can I use retinol while pregnant?
The oral retinoid ( Isotretinoin ) is teratogenic (an agent that can disturb the development of the embryo or fetus).
So pregnant women should avoid retinol and derivatives while pregnant, breastfeeding or planning a pregnancy.


As with any other skin care product, the key to seeing results is consistency. Improvements in textural changes take about two to four months to start to become visible. With continued use, you’ll see more and more positive changes that come with the magic of retinol.

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The light side of pigmentation

Hyperpigmentation is the darkening of areas of skin compared to the surrounding skin colour leading to uneven skin tone or large darker patches. It occurs when melanocytes are stimulated to produce increased pigment called melanin. Melanocytes can be stimulated by sunlight, hormones, trauma, inflammation, medication and a constantly growing list of other factors. It was recently discovered that vascularisation (increase in blood vessels) also has a role to play in melanocyte stimulation and hyperpigmentation.

Hyperpigmentation is a common and intensely distressing condition. The commonest forms seen are melasma, solar lentigenes (sun spots) and post inflammatory hyperpigmentation (PIH).

What causes hyperpigmentation? – new evidence!

Melasma and sunspots mostly occur on sun exposed areas, particularly the face, while PIH can occur in any area of skin trauma or skin conditions like acne, eczema or insect bites.

All forms of hyperpigmentation worsen with sun exposure. It is well established as the greatest contributor, with the condition worsening during summer and improving in winter when ultraviolet exposure is less intense.

Melasma is also strongly influenced by genetic and hormonal factors and is often precipitated by pregnancy or the use of the contraceptive pill.

The influence of other environmental factors is only recently being examined, and other causative factors have now come to our attention as contributing to skin ageing and hyperpigmentation.

The solar energy spectrum is composed of ultraviolet radiation (A, B and C), visible light and infrared. The visible light spectrum is the light that we see. It has longer wavelengths than ultraviolet A and B and therefore actually have a deeper penetration into the skin, though they have never been regarded as potentially harmful.

Recent studies have found that visible light stimulates melanocytes to produce pigment. This is especially significant in darker skinned individuals and it seems that repeated long term exposure to visible light may cause hyperpigmentation. In addition, visible light may also cause inflammation and induce reactive oxygen species causing DNA damage, though it has not yet been established as a cause of skin cancer.

Important to note that most traditional sunscreens do not adequately protect against visible light. Fe oxide in sunscreens and antioxidants offer protection from visible light.

Infrared or heat represents the longest wavelength of solar energy and hence penetrates even further than visible light. IR activates matrix metalloproteinase and causes the breakdown of collagen causing skin ageing. Infrared also causes hyperpigmentation by inducing inflammation and vascularization (production of blood vessels). There is currently no effective way of protecting against infrared and only topical antioxidants have shown to offer some protection.

Traffic related air pollutants including a harmful form of ozone called tropospheric ozone and polycyclic aromatic hydrocarbons cause the formation of free radicals which depletes our skins antioxidant reserve. This leaves the skin vulnerable to further insult including DNA mutations and melanocyte stimulation.

Treatment for hyperpigmentation

Hyperpigmentation is treated with a combination of topically applied creams, and skincare procedures like chemical peels and dermal needling.

A complete treatment regimen should:

  • Protect against factors that cause melanocyte stimulation
  • Inhibit the production of melanin by inhibiting the enzyme tyrosinase
  • Improve the turnover of cells that have accumulated pigment

Maintenance treatment is critical to ensure that results are lasting as hyperpigmentation should be seen as a chronic condition that requires constant management.

The gold standard skin lightening agent is hydroquinone which has come under scrutiny as it was used to lighten skin generally, not just for treating hyperpigmentation.

Hydroquinone works by inhibiting the enzyme tyrosinase. This medication can be prescribed where appropriate by a dermatologist in various combinations and works well when used responsibly.

Kojic acid is an effective and well studied skin lightening agent. It is an ingredient in numerous creams and generally well tolerated

Neoretin Booster Serum is a lightweight serum containing Kojic Acid and other active ingredients which inhibit melanin synthesis.

SkinCeuticals Metacell Renewal contains Kojic Acid and other active ingredients to target the early signs of ageing and hyperpigmentation.

NeoStrata Enlighten Pigment Gel contains Kojic Acid, Liquorice extract, citric acid and multiple other active ingredients to target hyperpigmentation.

Arbutin is a glycosylated hydroquinone extract and has been considered one of the safest and most effective skin lightening agents. Its effects may also be optimised when combined with other substances like vitamin c, liquorice, glycolic acid and kojic acid.

Arbutin inhibits the enzyme tyrosinase decreasing the production of melanin pigment.

The active ingredient is slowly released making it suitable for those with sensitive skin.

Obagi Nu-Derm System

The Nuderm system combines Arbutin and exfoliating ingredients to inhibit melanin production and remove cells containing pigment. Arbutin is a smaller molecule that penetrates deeper into the skin reaching the basal layer of the epidermis and inhibiting the enzyme tyrosinase.

Obagi C Clarifying Serum combines 10% Vitamin C and Arbutin to protect against sunlight and environmental aggressors and inhibit production of melanin. This product targets early ageing and hyperpigmentation.

Vitamin C is a potent antioxidant which indirectly inhibits the enzyme tyrosinase leading to decreased melanin production

The anti inflammatory effect reduces cell injury and pigment production.

SkinCeuticals CE Ferulic and SkinCeuticals Phloretin CF are patented combination antioxidant formulations. Vitamin C is combined with other antioxidants for a potent synergistic effect that protects against ultraviolet light and visible light and offers some protection against infrared (IR) and air pollutants.

Obagi Professional C serum 10%, 15% and 20%.

The Obagi Professional C range contains different concentrations of Vitamin C to suit different skin sensitivities.

Ellagic acid

Is a natural phenol antioxidant that inhibits the transfer of melanin to skin cells.

SkinCeuticals Advanced Pigment Corrector contains ellagic acid, niacinamide , vitamin and salacylic acid. It lightens dark spots by gentle exfoliation and prevents the formation of new pigment spots.

Tranexamic acid reduces pigmentation by its effect on the plasminogen activator pathway.

SkinCeuticals Discoloration Defense

Combines tranexamic acid (inhibits the UV induced production of melanin by melanocytes), Kojic acid , niacinamide and HEPES which work synergistically to inhibit melanin production and remove epidermal cells containing pigment.


Note from Dr. Kesiree

HYPERPIGMENTATION should be regarded as a chronic condition that needs to be constantly managed. Be consistent with your treatment regimen. Treatment protocols generally combine intense phases of prescription treatment and procedures with maintenance regimens.

No treatment regimen for hyperpigmentation would be complete without strict daily sunscreen use.

Book an appointment with your dermatologist or skincare professional for advice on how best to treat your hyperpigmentation

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Skincare in pregnancy – what is the evidence?

Pregnant women are wary of causing harm to their unborn babies during this vulnerable period in development. There is significant modification of lifestyle practices with huge emphasis on safer and healthier options. More than 50% of pregnant women also question their skincare regimen and seek guidance on the use of personal care products.

What are the common things that most women are most concerned about making them question use in pregnancy?
Women are concerned that certain ingredients in skincare products may be carcinogenic (causing cancer), teratogenic (harmful to the fetus) or unsuitable for their changing skin needs in pregnancy. In this article we explore the available evidence on a few commonly used ingredients to help you understand which products can be used safely when your pregnancy tests positive!

Vitamin A/ retinol
There is lots of evidence for the potential teratogenic effects of oral vitamin A and the drug commonly used for acne called isotretinoin. We do not actually know how much topically applied vitamin A is absorbed by the skin to eventually reach the circulation and the growing baby. There are however a few cases where birth defects were reported after using topical Vitamin A in pregnancy. The consensus opinion is that women should avoid products containing retinol during pregnancy, whether oral or topically applied.

Benzoyl peroxide
Benzoyl peroxide is a widely used over the counter treatment for acne. Minimal amounts are absorbed into the skin after topical application, but there have not been any reported ill effects in the babies whose mothers used topical treatment. Therefore this is one of the acne treatments considered safe for breakouts in pregnancy.

Topical antibiotics
Topical clindamycin and erythromycin are prescription antibiotics used mainly to treat acne. Studies have found both topical ingredients to be safe for use in pregnancy.

Salicylic acid
Topical salicylic acid is quite a common ingredient in acne treatments. The concentration in products as well as the amount of absorption into the blood stream varies. However it is still considered a small amount which is unlikely to cause any harm.

Glycolic acid
Glycolic acid is an alpha hydroxy acid found in many brands of resurfacing anti-ageing products. It is also used in face washes and creams to treat acne and hyperpigmentation.
There is minimal systemic absorption from topically applied glycolic acid so it does not pose a risk in pregnancy. However glycolic acid may be irritating to the skin especially in high concentrations, so first time users in pregnancy should be cautious.

Hydroquinone is a prescription skin lightening ingredient, banned as an over-the-counter product in South Africa. It may however be prescribed by doctors and dermatologists. There is a large amount of hydroquinone that is systemically absorbed after topical application. There is no conclusive evidence to suggest that hydroquinone will have an effect on your growing baby, but because of the large amount that is absorbed, it is not recommended for use in pregnancy.

Sunscreens generally have very little systemic absorption and are safe to use in pregnancy.
The general consensus is that the benefits of sunscreens outweigh any unsubstantiated risk.

In summary, apart from notably hydroquinone and retinol there is no evidence to suggest that most other common topically applied skincare ingredients will cause harm to a developing baby.

Bear in mind that does not exclude the possibility of a localized cutaneous reaction (skin reaction) to the ingredients as we must take into account that pregnancy may cause a change in your skins’ condition and its ability to tolerate products.

In addition to this, skin reactions to skincare products may occur irrespective of whether you are pregnant or not.
Remember that a product recommendation or prescription given before you fell pregnant may no longer be safe or appropriate once your status changes, and its best to confirm with your doctor.

At Skinsmart we have a tailored pregnancy skin assessment to assist you with your product choice. We recognise that pregnant women would also like to look and feel their best without compromising the health of their babies.

Please email us on [email protected] to book an appointment  if you would like more specific advice.

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What is a good topical antioxidant?

The best studied antioxidants are vitamin C and vitamin E. The potency of an antioxidant is determined by its ORAC (oxygen radical absorbance capacity) value.

Vitamin C is one of the most potent, and frequently used antioxidants. It has been extensively studied and proven to have powerful beneficial effects on the skin. Vitamin C is found in high concentrations in the skin, but this decreases with age and sun damage., hence the benefit of topically applied product. Other than being an antioxidant, Vitamin C is a cofactor in collagen production, improves wound healing and inhibits melanin synthesis, thus improving fine lines and wrinkles, targeting pigmentation and lightening dark spots.

Vitamin E otherwise known as tocopherol is another well studied skincare ingredient. Besides being a potent antioxidant, it is know for its natural moisturising and anti inflammatory properties. Unlike vitamin C which can be used alone, vitamin E is best used in combination formulations.

When in combination antioxidants work synergistically multiplying their antioxidant potential.

A few other potent topical antioxidants include green tea polyphenols, resveratrol, ferulic acid and phloretin.

The list is growing, but the limitation is adding these ingredients to skincare products so that they remain stable and effective when used.

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Antioxidants inside and out

Antioxidants are molecules that donate or remove electrons from oxygen free radicals or reactive oxygen species (ROS), neutralising and preventing them from causing damage to our cells and tissues.

Reactive oxygen species (ROS) cause extensive and sometimes irreversible damage to DNA, proteins and cell membranes, accelerating ageing and predisposing us to cancer and diseases. ROS are produced by environmental factors (exogenous factors) like ultraviolet light, smoking and pollution and internal factors (endogenous factors) like our basic metabolic processes.

While the body has its own internal systems producing antioxidants to ‘scavenge’ harmful free radicals, these become less effective as we grow older. In addition to this our internal DNA repair mechanisms become less efficient. There is growing evidence to support the benefits of oral and topically applied antioxidants to supplement our declining natural antioxidant systems and in this way slow down the ageing process and protect us from gene mutations and cancers.

The most well known micronutrient antioxidants are Vitamin E, vitamin C and beta carotene (precursor of vitamin A). Our bodies cannot make these antioxidants which is why they should be part of our diet.

The list of antioxidants superfoods is constantly growing from green tea, berries, beans, veggies and fish, to the more exotic like sumac, acai and Indian gooseberries. An entire industry is focused on finding foods with higher antioxidant potential.
While the theory seems sound that oral antioxidants protect us from ageing,heart disease, cancer and dementia, we still don’t know enough to prescribe what specific antioxidant supplements need to be taken orally, and most importantly in what quantities to be of benefit. The amount of oral antioxidants that eventually get to the skin surface is also uncertain.

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What is a skin peel?

Superficial skin peels involve the application of a chemical peeling agent to the skin in order to remove the damaged outer layers, resulting in the appearance of new, regenerated skin which is smooth-textured, even-toned and less wrinkled. These controlled peels range in strength from superficial peels, which can be performed by doctors and aesthetic therapists, to much deeper peels which are only conducted by medical professionals.


Superficial chemical peels are generally safe because they only affect the epidermis and can have beneficial effects on an array of skin concerns, including acne, pigmentation, melasma, sun damage and ageing. Even though penetration is superficial, positive changes can also be seen in the deeper layer of the skin, with the stimulation of collagen production in the dermis. Collagen is important for anti-ageing and skin repair.

There are a number of ingredients that can be used to peel the skin, but the most commonly used are alpha hydroxy acids (AHA), eg. glycolic, lactic, citric and malic acids, and Beta Hydroxy acids (BHA), eg. Salicylic acid.

AHAs occur naturally in sugar cane, milk, and a variety of fruits, and have been used on the skin for thousands of years, beginning with the Ancient Egyptian women who would bathe in sour milk to smooth their skin.

Patients usually tolerate the peel well, and will experience a tingling or itching sensation, or a feeling of warmth. The degree of tingling or itching is usually indicative of the overall condition of the skin, ie if the client is using good homecare products and the skin is well-hydrated, she may not feel the peel as intensely as a patient that has not looked after her skin well. Once the peel has been ‘neutralised’ the skin will once again feel comfortable, and only perhaps a little warm. This is due to increased blood circulation.

When the acids are applied to the skin, they break down the bonds between dead skin cells and the skin then sloughs off these cells over the next 2-3 days. As a result, the patient may experience a sand-papery texture, mild flaking or a tight feeling of the skin.  It is important at this time to keep the skin well-hydrated and to apply a good quality sunscreen.

Following this short period of dryness or flaking, a more youthful, healthier looking skin becomes visible. So the skin typically looks it’s best 3-4 days post treatment, with a beautiful radiant glow!

Post peel care is vitally important. The skin has been sensitized by the peel, so excessive sun exposure must be avoided for the next 48 hours. Heavy cardiovascular exercise should be avoided for 48 hours as perspiration will burn the skin, and will make the skin more vulnerable to bacterial infection. Do not use products containing active ingredients, like Vitamin A for 3 days pre- and post-peel.

It is always advisable to do a series of skin peels in order to achieve best results on specific skin concerns, and consult with your therapist regarding other aesthetic procedures like laser, microneedling and microdermabrasion, and how to structure good in-clinic routine treatments for optimal results.