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Viewpoint: Exfoliation: Right or Wrong?

By: Ben Johnson, MD
Posted: July 23, 2008, from the August 2008 issue of Skin Inc. magazine.
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The dermis has a different set of priorities. It also tries to maintain its thickness, but fails under the weight of the huge demands for nutrients and the inability of the dermal blood supply to keep pace. When fewer demands of inflammation are placed on the skin, the dermis handles the load much better, and its thinning is substantially reduced. When inflammatory demands are abnormally high, as in the case of rosacea, the dermis thins even more rapidly, resulting in the increasing number of visible capillaries for rosacea sufferers throughout time. When the dermis thins, the worst case scenario includes sagging skin, broken capillaries and wrinkles. These events are not life-threatening, so the process is allowed to continue. It is reasonable to believe that the starving dermis becomes even more starved every time the epidermis has a new repair demand that takes its needed resources—which begs the question: Is exfoliation helpful?

Exfoliation has been a primary solution for anti-aging for many years. There is no question that compromising the integrity of the epidermal barrier increases the rate of turnover. After all, the skin is rushing to replace its thickness, and it can only do so by starting at the base and working its way up. Does that mean exfoliation is anti-aging?

Unfortunately it is not. Restoring the thickness and integrity of the barrier and improving the turnover rate have no impact on the dermis, where aging actually occurs. Additionally, the daily demand for new layers of the epidermis puts even more of a strain on the limited nutrient supply, which means something has to give.

Forcing the repair of those epidermal layers at twice the rate the skin has intentionally chosen will utilize scarce nutrients twice as quickly. The loser in all of this is the dermis, because it can—and will—thin faster the more it is starved. Also, remember that exfoliating the epidermis increases photodamage, which will further increase aging.

Peels and penetration

Dermal thinning is a difficult problem because of several factors: 1. The average skin care product has a very small dermal penetration rate, which means most of the anti-aging ingredients never impact the appropriate target; and 2. Aggressive treatments, such as trichloroacetic acid (TCA) peels and many lasers that get to the dermis are typically traumatic enough to age the skin before any positive result. For example, according to my personal research, one study showed TCA thinned the dermis by 30% in one application—that is 30 years of aging in five minutes. The body usually recovers most of that loss as it heals, but how often does full recovery occur, and should these peels really be called anti-aging, based on this evidence?