1. It starts with the cleanser. Over-the-counter (OTC) cleansers are either petrolatum-based or are based on soap products-both of which are suboptimal for damaged skin. Also OTC cleansers are not tailored to the moisture level of the patient’s skin.

    Dr. Katsaros prescribes cleansers on the basis of the moisture content of the skin:

    • For normal skin: Botanical based cleansers (that avoid petrolatum) are best.
    • Oily Skin: Foaming cleansers from either Skin Medica or Obagi for oily/acne. These products are not petrolatum based, but have low concentration salicylic acid which dissolve plugs in the pores. Salicylic acid is also effective in killing the bacteria that cause acne.
    • Dry or sensitive skin responds to Skin Medica sensitive cleansers.
  2. Toners are used to restore the pH to normal. They are used after cleansers, which tend to reduce the skin pH that occurs after the cleansing process. Toners are not required for OTC products, they are used after cosmeceutical cleansers-especially the foaming cleansers.

    Dr. Katsaros recommends:

    • Skin Medica restorative toner for dry or damaged skin.
    • Skin Medica Rejuevenative toner for normal/oily skin.
    • Obagi toner for normal/oily skin.
  3. If the skin is wrinkled or saggy, growth factors are needed. This is analogous to fertilizer for a sub-optimal lawn. Growrh factors are needed by the basal skin cells to create a healthy, strong matrix. Tissue Nutrients System (TNS) provide growth factors for aged and wrinkled skin. These growth factors are actually taken from human fibroblast cultures. After 3 months of treatment with growth factors, fine wrinkles are reduced because the thickness of the collagen matrix (that supports the skin) becomes thicker and tighter.
    Dr. Katsaros recommends the following growth factors:

    • TNS Essential Serum is for normal skin.
    • TNS Recovery Complex is for dry or very sensitive skin.

    Not all growth factor systemsare created equal. OTC products sometimes are labeled as having nutrients or growth factors-but the growth factor concentration used in OTC products is less than 10%, which is useless. Prescription grade TNS systems have growth factors in concentrations of 40-50%.

  4. Moisturizers protect the face from wind damage, dirt, pollen, debris, makeup and pollutants. Over-the counter moisturizers are petrolatum based and are intended for skin with normal moisture content. Cosmeceutical moisturizers are designed for the specific moisture content of the patient.

    Dr. Katsaros recommendations:

    • Oily skin: Ultrasheer moisurizers are best for oily or acne proned skin.
    • Normal skin moisture, not damaged: Microsplit Vitamin C/E anti-oxidant preperations are acceptable.
    • Wrinkled and/or thin skin: High level anti-oxidants.
    • Thin Skin: Add estradiol if skin is thin.
    • Very Dry Skin: Requires tissue growth factors, ceramide. May add estradiol or anti-oxidants later.
  5. Sun screens are an essential part of skin care. Good quality makeup (like the color cosmetics line) has sun screen protection built in.

    Not all sunscreens are created equal. The SP rating is the least important factor in sun protection. A sun screen with high SP rating that easily dissolves in water (or sweat) will not protect the skin very long-regardless of SP rating. A sun screen that is part of a heavy cream, will stay on, but may plug the pores and cause acne.

    A mineral based SP30 sun screen that is highly water resistant strikes good balance between sun protection-without smothering the pores. Cancer patients may need shade or some SP50 screen.

    Dr. Katsaros likes:

    • Skin Medica and Obagi sun screens. Usually SP30 is adequate for most patients.
    • Cancer guard or Shade for skin cancer patients.

    Acne, hyperpigmentation, thin skin, scarring, wrinkling and other skin conditions wil modify this base protocol. Laser treatments, wrinkle fillers, laser facials, photofacials and surgery may be added to any protocol for optimal results.

    For many of our patients, the retail store is not the optimal place to receive skin care. As a result physicians are bringing medical science into skin care.