Have you ever found yourself standing in the skin care aisle staring at the sheer number of products and wondering what to choose? Many of us have. How do we decide which products are necessary? Does a daily skin care routine make a difference?

Skin care routines can be straightforward or complex, depending on your goals. For some, a consistent skin care routine including cleansing, moisturizer, and sunscreen may be all they need for overall skin health. Others may desire a more aggressive approach to slow the signs of aging and skin damage.

Are cheaper or more expensive products better for your skin?

It depends on what you are hoping to accomplish. To some extent, you may get what you pay for in terms of the quality of extra ingredients, but not always. More expensive doesn't always mean better. "My biggest advice to patients is to spend what you are comfortable spending," says Matthew Stephany, MD, Nebraska Medicine dermatologist. "I have had numerous patients tell me that they love their cheap moisturizer compared to the expensive product, and vice versa.  When it comes to these products, the biggest risk is to your pocketbook."

Is a daily skin care routine really necessary?

A true skin care routine may seem complicated, but the focus should be on skin protection, cleansing, moisturizing, prevention and support. While we can't prevent all signs of aging, there are strategies that can help protect and improve our skin.

The four categories to include in your skin care routine include:

1. Skin cancer prevention

UVA and UVB protection with a broad-spectrum sunscreen is essential to protect our skin. A recent study demonstrated that higher SPFs do provide further cancer protection. In addition to sunscreen, you'll also get protection from a brimmed hat and covering up with clothing, especially polyester, which by nature provides 50 SPF protection. There are also clothing brands on the market which provide various levels of sun protection.

 "The best way to treat your skin is to do your best to prevent excess UV radiation," says Dr. Stephany. "We don't have to cover up from head to toe, but we want to be smart about our UV exposure. How different levels of sunscreen SPF plays out for each individual may be different, so proper use of sunscreen is just as important as what SPF you are using." 

Sunscreen application recommendations:

• Adults – use 1 to 2 ounces per application 
• Children under 6 months should not use sunscreen
• Waterproof and sweatproof sunscreens provide about 80 minutes of protection 
• Reapply every two hours after swimming or excessive sweating and any time a towel is used 
• If you have thin hair, use spray or cream sunscreen on your scalp

Sunscreen types at a glance:

Mineral sunscreen:

• Scatters the light with zinc oxide or titanium dioxide
• Are all broad spectrum (blocking UVA and UVB rays)
• Is good for sensitive skin
• Can get chalky at an SPF 30+, a tinted physical blocker may be preferred

Chemical sunscreen:

• Converts UV radiation into small amounts of heat. Ingredients may include avobenzone, octocrylene and oxybenzone
• Are not all broad spectrum
• Is more likely to cause skin reactions for those with sensitive skin
• Doesn't cause chalky residue with higher SPFs

2. Cleanse

Clean skin is an important aspect of overall health. The most common active ingredients in cleansers are benzoyl peroxide and salicylic acid. Here are some tips:

• Exfoliating cleansers should be avoided with sensitive skin
• Moisturizing cleansers do not typically replace a moisturizer
• Certain cleansers may contain peptides, which may eliminate the need for additional serums. Serums can help brighten skin, reduce blemishes, boost hydration or fight signs of aging
• If you use bar soap, use sensitive soaps

3. Moisturize

Moisturizing fights off dry skin and provides multiple benefits, including improved texture and appearance and decreased inflammation (itch). Lotions (creams with water and alcohol), creams (ointment with water), and ointments (petroleum jelly) are different from one another, so watch for these words when shopping.

General recommendations:

• We recommend creams or ointments over lotions
• Basic is better: consider cost, texture on the skin and ingredients
• Applying once daily may not be adequate, especially in the winter months. Apply twice per day at a minimum (morning and night), more if your skin is very dry 
• If it feels good on your skin, use it
• Moisturizers that used to be effective may no longer provide enough moisture as we age

4. Anti-aging

Sun protection must be a priority every day. Even while driving, you're still getting UVA exposure through a window. As we age, we lose collagen and elastin, resulting in wrinkles and more easily bruised skin. We also lose subcutaneous fat and natural moisture, resulting in dry skin and more irritation. 

"For most individuals, a consistent skin care routine using sunscreen and moisturizer is all that's needed for overall skin health," says Dr. Stephany. "Skin aging will occur even with the most diligent use of sunscreen, but photoaging is what we can help prevent with sun protection."

What is photoaging? Basically, sun damage. UV radiation creates free radicals, which alter the DNA in your skin cells. This process leads to fine lines and wrinkles. 

"Changes in aging skin require changes to our daily routine," says Dr. Stephany. "The desired outcome will determine how aggressive your routine should be." 

Options for treating aging skin: 

• Retinoids and retinals: vitamin A treatments that are over-the-counter or prescription
• More in-depth prevention: botulinum toxin (such as Botox), a temporary treatment used as a preventive measure. Treatment approximately every three to four months
• Fillers: last for six to 12 months with certain formulas considered permanent
• Lasers: used to improve and potentially remove sunspots and redness, facial contouring and reduction of fine lines and wrinkles
• Chemical peels: several types of acids, each with a different depth of penetration

Additional anti-aging support products:
Newer research has revealed that the natural properties of collagen in the skin may be improved with various peptides and small molecules, including certain products containing hyaluronic acid, ascorbic acid (vitamin C) and tocopherols (vitamin E).

Should skin care products be applied in a certain order?

Begin with cleansing, followed by an anti-aging product, moisturizer and sunscreen. Additional tips include:

• If you'll be indoors, apply moisturizer and sunscreen (or a combo) for about 10 to 15 minutes before your foundation and makeup application
• If you'll be outside for most of the day, apply sunscreen on top of your makeup since you'll reapply later
• The best time to use moisturizer is right after a shower, bath or cleansing. You want to trap that moisture into the skin

Dermatology patients can purchase various skin care products that are hand-selected by Nebraska medicine dermatologists. Purchase skin care products from the dermatology team at Lauritzen Outpatient Center and Village Pointe Health Center.