In the skin-care aisle at the CVS pharmacy closest to my office, there are 106 different products for acne. I lurked in the store for an hour last week tallying anything with the words “acne,” “blemish,” or “blackhead” on the packaging. I did not include products labeled “pore refining,” because that seems fake.
There are 101 antiaging products on the shelves. This includes anything that claims to fight wrinkles, or that is labeled “antiaging” or “age defying.” I did not count the following terms: “age perfect,” “lifting,” “for sagging skin,” or “for mature skin,” even though those were clearly meant to evoke antiaging effects without explicitly saying so.
There were 155 types of body lotion and 177 types of face lotion, although in certain cases it was hard to tell which category a particular product would fall under. I included anything called a “lotion,” “moisturizer,” “cream,” “gel,” “gel-cream,” “cream-gel,” “moisturizing oil,” “salve,” “hydrating mist,” “intense-hydration concentrate,” and in one case—may God have mercy on my soul— “daily liquid care.” I did not tally “cream cleansers,” “serums,” “treatments,” “fillers,” or “elixirs.”
These are just some of the over-the-counter skin-care products available at one drugstore. We haven’t even gotten into cleansers, let alone masks or scrubs or toners. Suffice it to say, figuring out what skin-care products to use can be daunting.
The skin-care industry uniquely straddles the line between health and aesthetics, between drugs and cosmetics. Acne and other skin conditions often require medical treatment and prescription drugs, yet it’s possible to treat some breakouts, or dryness, or redness, at home. Sometimes there may be nothing wrong, per se, but one’s skin could always be a little more even, a little softer, a little glowier, couldn’t it? There’s also a certain amount of care needed to maintain the status quo—to stay clean, moisturized, and protected from the sun.
All of these pursuits fall under the umbrella of “skin care.” The industry does little to help anyone make sense of it. In fact, it is often deliberately confusing.
A few common skin-care ingredients are regulated as drugs. These include those in sunscreen; salicylic acid and benzoyl peroxide, which are used to treat acne; and adapalene, the main ingredient in the newly over-the-counter product Differin. Many more are not. The Food and Drug Administration defines “drugs” as:
Articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease. ... [And] articles (other than food) intended to affect the structure or any function of the body of man or other animals.
It defines “cosmetics” as:
Articles intended to be rubbed, poured, sprinkled, or sprayed on, introduced into, or otherwise applied to the human body ... for cleansing, beautifying, promoting attractiveness, or altering the appearance.
When does “altering the appearance” cross over into “affecting the structure or function of the body?” Skin-care companies are very careful in their phrasing to stay on the less burdensome cosmetic side of that line. Many of the antiaging products on the CVS shelves claim to “diminish the look of fine lines and wrinkles” (emphasis mine). Commercials throw out statistics like 90 percent of women saw improvements in the skin after just one use of product X, Y, or Z. But “wrinkles do look better when you hydrate the skin,” says Tiffany Cukrowski, a dermatologist at the Midwest Center for Dermatology and Cosmetic Surgery. “So it has a moisturizing effect, not a true antiaging effect.”
Cosmetics are innocent until proven guilty. Their ingredients don’t have to be proven safe, or effective. Even if a particular ingredient has some evidence behind it, cosmetic manufacturers aren’t required to prove that the ingredient works in that product’s specific formulation, or at that particular concentration. Often, the only way to figure out if something works is to try it.
The skin-care landscape is vast, overwhelming, and shimmering with mirages. But more and more people are trying to navigate it. The skin-care market is projected only to keep growing in the next couple years, according to data from Euromonitor, a market-research provider. “Everybody’s obsessed with skin care right now,” Ashley Weatherford writes in the The Cut.
In The Outline, Krithika Varagur writes that “perfect skin has become the thinking woman’s quest.” She goes on to say that skin care is a consumerist scam, but she’s touched on something with her emphasis on “thinking.” Confronted with the multitudinous choices and absent good information about the efficacy of different products, many skin-care fans have become citizen scientists—educating themselves and each other about what works and experimenting on their own faces.
“For most of my life I wasn’t too serious about skin care. I’d use random drugstore products that I was drawn to on a purely superficial level,” the beauty writer Rio Viera-Newton told me in an email. “Only after college, when, for various medical reasons, I went off birth control and started having really aggressive, painful breakouts, did I decide I wanted to create a routine for myself. I was initially really overwhelmed by all the information and advice out there on the internet. I read just about every article on hormonal acne and would binge-watch ‘How I Cured My Hormonal Acne’ YouTube videos for hours.”
Viera-Newton eventually got it figured out—partly by consulting a dermatologist, and partly by narrowing down her online searches to recommendations from people who shared her dry, sensitive skin type. She built up a routine, and is now dispensing skin-care advice for The Strategist. A post she wrote in the summer of 2017, “The Google Doc I Send to People Who Ask About My Skin,” details her elaborate skin regimen. It was so widely shared that one of the autofill options when I google her name is “Rio Viera-Newton google doc.”
Framing the article as Viera-Newton’s advice to her friends was savvy. Because there are so many products out there, and because there are so many good reasons to be skeptical of brands’ claims about them, word of mouth often feels like the most trustworthy resource for information on over-the-counter skin care. People often turn to their friends—or their favorite beauty bloggers—to find out what really works. (Dermatologists, of course, are the best resource, but if you don’t have a medical reason to see one, you’re not likely to pop in and ask if you should be using Noxzema or Neutrogena face wash.)
My own skin-care routine is cobbled together with prescriptions from my dermatologist alongside recommendations from coworkers at bars, from the beauty writer Arabelle Sicardi, from the private makeup and skin-care Slack channel I share with my friends (called “People With Faces”), and from the subreddit r/SkincareAddiction.
This forum is the most visible repository of the apparently growing interest in the science of skin care. It has more than 450,000 readers, and the growth curve of its subscriber base has notably steepened since mid-2017. Its posts are a mix of memes, users seeking advice, product reviews, before-and-after skin selfies, and “shelfies”—pictures of users’ bathroom shelves crowded with products. But it also has an exceptionally well-organized reference section, summarizing the conclusions of the hive mind on ingredients, the identification and treatment of certain skin conditions, the best products, and how to build an effective routine with them. Many posts refer to scientific papers in their explanations.
The core of the subreddit’s advice boils down to a routine of two to five steps: Cleansing and moisturizing, with the “optional” additions of exfoliating (chemical exfoliators are preferable to scrubs), spot-treating blemishes, and sunscreen (“optional but highly recommended”). It has product recommendations for each of those categories (the community crowdsources its “Holy Grail” recommendations), and there are further rabbit holes to burrow into if you want to get into antiaging or specialty serums or whatnot.
“The advice was definitely decent,” Cukrowski, the dermatologist, says of the subreddit. “Especially the part where they talked about whether you need a toner or not. I always tell my patients you don’t need a toner unless you’re really oily.”
Michelle Wong is a moderator at r/SkincareAddiction, and a high-school science teacher in Sydney, Australia, with a chemistry Ph.D. She says that “on the whole, [r/SkincareAddiction] is probably one of the most scientifically accurate sources. Where they get it wrong is mostly in the details and the really nitty-gritty. But if you follow the advice on there, it will be maybe 90 percent the same as a completely accurate regime.”
Wong also runs the popular blog Lab Muffin, where she writes about the science of skin care—explaining how the molecules in micellar water remove makeup, or why hyaluronic acid is such a good moisturizer. Her Instagram, where she often debunks beauty myths, has more than 32,000 followers.
“When I started my blog I didn’t think I would get any sort of audience, but it’s gotten quite big,” she says. “A lot of people tell me, ‘I hated science, but this is really interesting. If it’d been taught like this in school, I would’ve been really interested in chemistry.’ So people are getting more educated about how things work.”
Dana Sachs, a dermatologist at the University of Michigan, says she’s seen her patients “come in and ask more pointed questions about different products than they used to.”
Some skin-care brands are catching on to this savvy consumer base. In late 2016, the beauty company DECEIM launched its brand The Ordinary, a line of simply packaged serums labeled with just their active ingredients and concentrations. You can buy “Retinol 0.2 percent in Squalane,” or “Magnesium Ascorbyl Phosphate 10 percent,” or “Niacinimide 10 percent + Zinc 1 percent”—not exactly the catchiest-sounding products. But according to DECEIM’s former co-CEO, Nicola Kilner (who has left the company under bizarre circumstances since our interview), The Ordinary is the company’s biggest brand, and sold 8 million units in its first year. She attributes this to the brand being “led by consumers.”
The Ordinary started listing the pH of its products as a result of customers clamoring for that information, Kilner says. And in the closed Facebook group “The Ordinary and DECEIM Chat Room,” which has nearly 32,000 members, she says the discussions can get pretty scientific, with users sharing spreadsheets of their routines and talking about ingredient interactions.
“We’re led by the fact that they do have this appetite,” Kilner says. “They do want to learn. They no longer want to just believe in hocus-pocus potions. They want to actually understand what ingredients they’re using at what percentage.”
Unfortunately, this desire for understanding can quickly run up against a wall. Academic studies are often inaccessible to the public. And even though there is some good research on skin care out there, it’s understandably skewed toward prescription drugs and the treatment of medical skin conditions like acne and eczema.
“My background is in medicinal chemistry, so I’m used to saying if [a study] is under 100 subjects, then it’s not worth looking at,” Wong says. “But in skin care, if it has more than 10 subjects, it’s amazing, because there’s just not funding. Because it’s not regulated as drugs.”
For ingredients that do have evidence behind them, there are often caveats and unknowns that remain.
Take the chemical compounds known as retinoids. “There is really good evidence behind topical retinoids exerting a positive antiaging benefit in skin,” Sachs says. They increase skin’s collagen production, and can combat hyperpigmentation. Prescription retinoids like tretinoin are a mainstay of dermatological antiaging treatment. But the form found in over-the-counter products—retinol—is what is known as a prodrug, meaning it doesn’t convert into the active form of retinoic acid until it’s in the body. Some studies have found retinol to be an effective antiaging treatment, though far less potent than tretinoin (and less irritating). But retinol is “extremely unstable and easily gets degraded to biologically inactive forms on exposure to light and air,” as one meta-analysis put it.
With an over-the-counter product, “you don’t necessarily know how much of it you’re getting, or how active the ingredient is,” Sachs says. “Not that we know what the right concentration is.” Even the most dogged amateur skin-care scientist won’t be able to figure out what research doesn’t yet know, or what information is hidden by manufacturers.
Another issue with many topical skin products, Sachs says, is that “they have to penetrate the very strong stratum corneum, which is the top layer of the skin.” The skin is a barrier, after all, designed to keep things out. With cosmetics that aren’t tested, there’s no way to know if the molecules penetrate deep enough into the skin to have any effect.
One popular group of ingredients that Sachs and Cukrowski are both skeptical of is peptides. Peptides are chains of amino acids, often included in antiaging serums and creams, with the thought that they might stimulate collagen production. “But one of the issues with peptides—that I don’t know the answer to—is they tend to be huge molecules that don’t necessarily penetrate into the skin,” Sachs says.
“The peptides are a big scam,” Cukrowski says.
Indeed, skin care, like any trend, has seen its share of backlash. In her Outline article, “The Skincare Con,” Varagur questioned the purpose of the entire industry: “All of this is a scam. It has to be. ... Most skin care is really just a waste of money.” There certainly are ample opportunities to waste one’s money on insanely pricey serums and lotions.
But just because there are some dubious claims floating around doesn’t mean we should throw our baby-smooth skin out with the bathwater. There are also things like sunscreen, and acne medication, and moisturizer, that are uncontroversially effective.
“As we get older, skin gets thinner, it gets drier,” Sachs says. “The barrier is not as good as it used to be. Whenever there are breaks in the barrier, that’s when you are more prone to infection, that can lead to inflammation in the skin. Moisturizing the skin is really key to keeping it in good shape. Now does the type of moisturizer matter? I don’t know the answer to that.”
What that leaves you with, in many cases, is anecdotal evidence, and trial and error-ing products on your own face.
“Obviously the problem with that is you have one face, so it’s like an n=1 trial,” Wong says. “You don’t know if the product works or if it was sunny that week, so you got more sun, or you started exercising that week as well.”
There’s an element of trial and error in medical dermatology, too. People have different skin types, and some are more irritated by certain ingredients than others. “It’s not like shooting in the dark,” Sachs says. But “that’s the art of medicine. It’s not going to be a one-size-fits-all for every person who comes in, otherwise, we wouldn’t spend as long training as we do. There are not cookbook recommendations for all the things out there.”
Of course, any would-be citizen skin-care scientists should practice lab safety. It’s possible to overdo it and injure yourself with harsh scrubs or exfoliating acids, or to have a bad reaction to an ingredient that you didn’t patch test before rubbing it all over your face. And despite the popularity of 10-step Korean skin-care regimens, there’s also a threshold past which adding more products to your routine isn’t likely to yield additional results.
“You really just need a sunscreen, a cleanser, and a moisturizer,” Wong says. “On top of that, if your skin isn’t already quite good, then you might need an antiaging or anti-acne product. But once you have the right products, a lot of it is just fiddling, [getting] decreasing marginal returns.”
The skin-care craze is sometimes derided as just another unattainable beauty standard—now women are supposed to look flawless without makeup?—to which others respond that it’s a form of self-care. A ritual, a devotional. It can be all of those things. But it’s also an at-home science project, one with results you can see in the mirror.
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