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Revisiting the Skin Health Pyramid

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Dermatologist Zoe Draelos, MD, has published an update to her Skin Health Pyramid, a clinically based guide to selecting topical skin care products, to reflect new ingredients and new knowledge of the most effective topical regimens.

Published in the Journal of Drugs in Dermatology (June 2021), “Revisiting the Skin Health and Beauty Pyramid” follows the same three-level approach to effective anti-aging topicals as the original paper, published in the same journal in April 2014.

The Three Layers of the Pyramid Include

Pyramid Base: Protection and Repair. Dr. Draelos notes that the basis for any skin care regimen must be sun protection in the form of sunscreen. But, new research highlighting the risks of outdoor visible light, particularly for higher Fitzpatrick skin types, necessitates the use of inorganic optically opaque filters, such as zinc oxide and titanium dioxide, for anti-aging purposes. Other blocking agents include charcoal, pigments and red algae.

She recommends patients be advised to wear a sunscreen as well as a moisturizer and/or facial foundation to help protect skin against visible light and aerolized pollutants.

In addition, topical and oral antioxidants that can protect against infrared A-induced reactive oxygen species and MMP-1 expressions should be included as the base of any anti-aging skin care regimen. These may include retinol, ascorbic acid, alpha-tocopherol and green tea polyphenols.

Pyramid Middle: Renewal. Products that promote moisturization, exfoliation and cell turnover are the second pillar of anti-aging skin care, as they serve to enhance skin water content, thereby reducing fine lines and wrinkles.

These include occlusive agents (petrolatum, shea butter, lanolin, waxes, and mineral and vegetable oils) as well as humectants (hyaluronic acid, sodium PCA, glycerin, sorbitol, etc.). Rough, scaly skin will benefit from desquamation with alpha-hydroxy acids.

Retinoids, such as tretinoin, retinols, retinyl esters, retinoic acid, retinyl palmitate and retinsphere technology, also form the middle layer of skin care, as they regulate growth of the epidermal cells and promote differentiation of cell lines.

Pyramid Top: Activation and Regeneration. Peptides that can help activate and regenerate the dermis are at the top of the pyramid. They are joined in the updated paper by stem cells, growth factors and circadian rhythm modifiers.

Dr. Draelos emphasizes that developing a home care regimen that includes ingredients from all three layers of the pyramid offers optimal skin rejuvenation, as it addresses age- and environmental-related changes from the outermost to inner layers of the skin.

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