Evaluate Before You Exfoliate

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Although exfoliation can improve your skin’s appearance, there are different kinds of exfoliation, and what works for one patient may not work for another, according to the American Academy of Dermatology.

Here, from board-certified dermatologist Mary P. Lupo, MD, FAAD, clinical professor of dermatology, Tulane University School of Medicine, New Orleans, are some things to consider before exfoliating.

Exfoliation, the process of removing the topmost layer of dead skin cells, can be done chemically, by applying an acid to dissolve the cells, or by using a brush or scrub.

The results are immediate, Lupo says, because the removal of dead cells leaves the skin looking brighter. Additionally, it can improve the performance of topical skin treatments, since they can penetrate further thanks to the removal of cells. The long-term benefits, Lupo says, can even include increased collagen production, which leads to younger-looking skin.

Lupo says that the people likeliest to benefit from exfoliation treatment include those who have premature aging because of sun exposure, as well as people with noninflammatory acne (acne with only blackheads and whiteheads).

However, Lupo cautions, there are some people for whom exfoliation treatment is not an option. On the other hand, Lupo says, individuals with inflammatory acne, which includes cysts and pustules, should consult a board-certified dermatologist before selecting an exfoliation method. More aggressive chemical or mechanical treatments (brushes, for example) could actually make their condition worse.

Lupo says that the same is true for people with rosacea, since many types of exfoliation can increase facial redness.

And aggressive exfoliation could even result in postinflammatory hyperpigmentation (PIH), or the appearance of dark spots on the skin. People of color or those who notice such dark spots after burns or bug bites may be at risk of PIH.  These patients should avoid aggressive exfoliation treatments.

Other cautions: exfoliation may aggravate other skin conditions like herpes simplex, molluscum contagiosum and warts, because these conditions include raised, fluid-filled bumps that could open and become infected.

To prevent any missteps, Lupo suggests consulting with a board-certified dermatologist. These factors should be taken into consideration:

Your Skin Type. If you have dry or sensitive skin, Lupo recommends sticking with milder chemical exfoliation options, such as a salicylic acid peels administered in a dermatologist’s office. People who have oily, thicker skin may be able to use stronger chemical treatments, such as an over-the-counter 2percent salicylic acid wash, or mechanical exfoliation methods, such as a motorized brush or a scrub that contains exfoliating particles.

The Timing of Your Treatment. How often should you exfoliate? Lupo says that depends on both your skin type and the strength of your treatment method. Those with oily, thicker skin may need to exfoliate as often as once a day, Lupo says, while those with dry or sensitive skin may need to limit at-home treatments to once or twice a week.

The more aggressive the procedure, Lupo says, the less often it needs to be done: Chemical peels and microdermabrasion procedures performed by a dermatologist are generally administered just a few times over a couple of weeks.

What You’re Buying. There are a wide variety of exfoliation products available in stores and online, but not all of them are safe and effective. Lupo suggests doing some research to confirm that the product you’re considering comes from a reputable company. If you are buying over-the-counter chemical products, she suggests buying ones with a low acide concentration (no higher than 10 percent glycolic acid or 2 percent salicylic acid.

A board-certified dermatologist can help you choose an at-home exfoliation option and perform a variety of exfoliation procedures in the office. Plus, Lupo says, your dermatologist may decide to have other treatments, like laser therapy, in addition to exfoliation.

For more information on healthy skin, visit the American Academy of Dermatology website (www.aad.org).