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My Evidence-Based Skincare Routine

2022-06-28 · Long video (solo, talking head or whiteboard) · Ali, Usama · recording, 14:05 · watch on YouTube

Topic: Health, sleep and habits · mode: Explanation and tutorial · tags: Evidence-based framing, His medical past

With clips from his friend, the dermatologist Usama Syed, Ali sets out a simple evidence-based skincare routine: moisturise twice a day, wear sunscreen every day, use a retinoid in the evening, and optionally a gentle hydrating cleanser, with the CeraVe, Altruist and Dermatica products he uses.

What is said

The parts of the video and what is said in each (★ — how much it matters to the video).

00:00:00 — The simple routine in brief, why have one, and the help of dermatologist Usama Syed

  • ★★★ Ali says the perfect skincare routine is simple: use a moisturiser, use a sunscreen every day and a retinoid every evening, and wash your face with a cleanser if you really want to. — 00:00:00
  • ★★ Ali gives two reasons for a skincare routine, healthy skin and pretty skin, and asks which actions he can take today that his future self would be very glad for. — 00:00:29

00:00:58 — Rule 1: moisturise; the skin barrier and which moisturiser to buy

  • ★★ Ali, who trained as a doctor but is not a skincare specialist, enlisted his friend Dr. Usama Syed, a New York-trained dermatologist, to find out what to do for good skin. — 00:00:58
  • ★★ Ali says that, apparently, about 90% of the results of skincare come from following three or four simple rules. (hedged) — 00:00:58
  • ★★ Usama Syed says the skin's most important job is to be a barrier that keeps irritants and allergens out and locks moisture in; dry, cracked skin weakens it, causing inflamed, red, itchy skin and even infections. — 00:00:58
  • ★★ Usama Syed says evidence-based moisturisers replenish the paste of fats and proteins between the skin's cells, keeping the barrier intact so the skin keeps its moisture and does not become inflamed and itchy. — 00:01:46
  • ★ Ali says dry skin is especially likely after a hot shower, which dries the skin and strips away its natural protective oils. — 00:01:46
  • ★★ Usama Syed's main recommendation for moisturiser, as Ali relays it, is any standard product from Eucerin, CeraVe or La Roche-Posay, huge companies with budgets for research and quality control. — 00:01:46
  • ★★★ Usama Syed firmly believes no skincare product should ever cost more than $30: beyond that you pay for fluff, and an effective active ingredient can always be had for less. — 00:02:15
  • ★★ Ali's main moisturiser is CeraVe PM, which he uses in the evening: it is very chill, available everywhere, reasonably priced and feels really nice on his skin. — 00:02:15

00:02:44 — Rule 2: sunscreen every day; photoageing, broad spectrum, SPF and comfort

  • ★★ Ali cites a New England Journal of Medicine case report of a truck driver whose left side of the face was exposed to sunlight through the window for 28 years: at 69, that side looked like an 86-year-old's skin. — 00:02:44
  • ★★ Ali says regular unprotected sun exposure damages the skin even if you never get sunburned and only tan. — 00:02:44
  • ★★ Ali explains photoageing: the sun's UV radiation mutates the DNA in skin cells, and over time more unprotected UV exposure brings more wrinkles and dark spots and can lead to skin cancer. — 00:03:31
  • ★★ Usama Syed says sunscreen adds a physical barrier beyond the skin's own melanin, which stops the sun creating genetic mutations, helping prevent skin cancer and photoageing. — 00:03:31
  • ★★ Ali advises a broad-spectrum sunscreen, because both UVA and UVB rays damage the skin, where people once thought only UVB did. — 00:04:00
  • ★★ Ali says it does not really matter whether a sunscreen is physical or chemical; what matters is that its SPF is high enough. — 00:04:30
  • ★ Ali explains that a sunscreen's SPF number is how much longer the sun takes to redden your skin with the sunscreen on than without it. — 00:04:30
  • ★★ Usama Syed advises typically not going below SPF 30. — 00:04:59
  • ★★ Usama Syed says people never get a sunscreen's labelled protection, which assumes a thick caked-on layer: most get around 60% of the true SPF. — 00:04:59
  • ★★ Ideally sunscreen is topped up every few hours, Ali says; he does not bother, but uses SPF 50, since even then he likely gets only SPF 30, 20 or 15 levels of protection. — 00:05:28

  • ★★★ Some SPF is way better than none, Ali says: a comfortable SPF 30 sunscreen you like and will actually wear beats a gold-standard SPF 100 you buy once and never use. — 00:05:57

    “some SPF is way better than no SPF.”

  • ★★ In the mornings Ali uses Altruist Dermatologist Face Fluid, a moisturiser with SPF 50, on his face; it costs about $11 in the UK. — 00:05:57

  • ★★ On his body Ali uses Altruist Dermatologist Sun Cream SPF 50, especially on very sunny days in a T-shirt and shorts; it costs about $4 or £5 in the UK. — 00:06:26
  • ★ Ali says you can find whatever sunscreen product works for you in your own country; the brand does not really matter. — 00:06:26

00:06:48 — Rule 3: a retinoid; its effects, strengths, side effects and how to start

  • ★★ Although he went to medical school, Ali had not heard of retinoids as good for normal people's skin, only as a treatment for acne, which is how they started out. — 00:06:48
  • ★ Ali says retinoids began as a vitamin A-based acne treatment in the 1970s, before researchers found that the active ingredient, retinol, also had anti-ageing effects. — 00:06:48

  • ★★★ Usama Syed calls retinoids as close to a miracle ingredient as skincare has: they credibly reduce uneven pigment, wrinkles and acne breakouts, seen in clinical trials and skin biopsies, with minimal downside, so they are worth your time. — 00:07:17

    “I think it is as close as possible to a miracle ingredient”

  • ★★ Ali says a strong enough retinoid used long enough reduces wrinkles by promoting collagen and elastic fibres in the dermis, reduces uneven pigmentation such as dark spots from sun damage, and makes skin cells regenerate faster. — 00:07:47

  • ★★ Starting a retinoid means playing a long game, Ali says, since results take a long time; when you are young with few wrinkles, he thinks it is mostly preventative rather than curative. — 00:08:16
  • ★★ Ali says retinoids can make skin more sensitive, peeling and sometimes painful, which is why many people do not stick with them long enough to see the benefits. — 00:08:16
  • ★★ Ali explains that retinols are the weaker kind of retinoid, found in most over-the-counter anti-ageing products, while stronger retinoids such as tretinoin, which he uses, are generally prescribed by a doctor. — 00:08:45
  • ★★ Prescription retinoids bring a bigger change than retinols but potentially stronger side effects, so Ali advises being more careful with them and even consulting a doctor before starting one. — 00:09:14
  • ★★ Usama Syed tells people that a retinoid should make them feel at least a little dry at the start; if it does not, it is probably not strong enough. — 00:09:14
  • ★★ The over-the-counter retinoid product Usama Syed recommends for beginners, Ali says, is Differin Gel, about $20, with adapalene, a newer retinoid that irritates less than many others. — 00:09:44
  • ★★ Ali gets tretinoin from Dermatica, an online consultation where a doctor reviews photos of your skin and prescribes; it arrives monthly, for about seven months now, and he has moved up from 0.025% to 0.1%. — 00:10:13

00:10:42 — Rule 4: an optional gentle hydrating cleanser

  • ★★ The general recommendation for retinoids, Ali says, is to start with a tiny pea-sized amount every other night and work up to once a night, with lots of moisturiser to keep the skin from drying out. — 00:10:42
  • ★★ Some dermatologists say a cleanser is for heavy cosmetics, visible dirt or a lot of sweat, Ali relays; for most people, washing the face with water is enough. — 00:10:42
  • ★★ Ali tends to get troubled areas around his nose and finds he is more prone to breakouts when he forgets to cleanse, which he calls an n of one. — 00:11:22
  • ★★ Ali calls a cleanser a slightly optional fourth rule with some incremental benefit, and advises a gentle hydrating cleanser that does not strip the skin's oils, after which the skin should feel more moisturised. — 00:11:22
  • ★★ Ali likes that CeraVe products, such as the CeraVe Hydrating Cleanser he uses, do not try to wow you with a hero ingredient: they look like medication, which he says is what skincare needs to look like. — 00:12:02

00:12:31 — Ali's morning and evening routine and how the conversation simplified it

  • ★★★ Ali's morning skincare: he cleanses his face in the shower with CeraVe Hydrating Cleanser, dries it with a face towel and puts on Altruist SPF 50 Face Fluid, a sunscreen and moisturiser in one: just two products. — 00:12:31
  • ★★★ Ali's evening skincare: after brushing his teeth he washes his face with warm water and CeraVe Hydrating Cleanser, dries it, puts on his Dermatica retinoid cream and after a few minutes moisturises with CeraVe PM lotion. — 00:12:31
  • ★★ Ali thought skincare would be complicated and did not want to bother, until Usama Syed and other dermatologists said only three or four products matter; he has used this routine for about eight months. (hedged) — 00:13:09

Threads in this video

Where the stories that moved here went next

Mentioned

Central: Altruist · CeraVe · retinoid · Usama

Also: Dermatica · Differin Gel · Eucerin · La Roche-Posay · New England Journal of Medicine · New York

Also centred on Usama: I'm Moving to America 🇺🇸 - Life Update

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