Dr. Teo Soleymani is a double-board-certified dermatologist and specialist in skin cancer and reconstructive surgery. He discusses science and clinically supported protocols to improve skin health and give your skin a more youthful appearance and structure, reducing premature ageing and skin cancer risk. He discusses the impact of sun exposure on skin. He discusses skincare routines to significantly improve skin appearance. He outlines how caffeine, nicotine, alcohol, and stress impact the skin and describes how nutrition and anti-inflammatory diets can improve skin health. He also discusses the causes and treatments for skin cancer and common skin conditions, including dandruff, acne, rosacea, eczema, psoriasis, and vitiligo.
The Impact of Stress on Skin Health and Appearance
Skin is the body's largest and most dynamic organ, with its surface cells turning over completely approximately every 28 days. This regenerative capacity allows skin to heal itself and serves as a model for studying various diseases.
Stress, both acute and chronic, significantly impacts skin appearance and health. The dermis, rich in blood vessels, nerves, hair follicles, and glands, is where most biological activity related to stress response occurs.
Acute Stress: Leads to immediate changes, such as hair loss (e.g., during exam periods, after major illness, or pregnancy), and temporary paleness or a gaunt appearance due to vasoconstriction that shunts blood away from the skin to muscles in a "fight or flight" response.
Chronic Stress: Primarily mediated by cortisol, which breaks down collagen and elastin and thins vessel walls, leading to accelerated skin aging. The visible signs of chronic stress on the skin are noticeable and can be mitigated by reducing stress.
Effects of Caffeine, Nicotine, and Alcohol on Skin
Caffeine: While caffeine is a known vasoconstrictor, its effect on skin capillaries at typical consumption levels (coffee, tea) is minute and transient. Chronic high caffeine intake may be linked to increased sebum production, leading to oilier skin, but data is equivocal. The temperature of hot beverages, rather than caffeine itself, is more likely to cause flushing and redness, especially in sensitive skin conditions like rosacea.
Nicotine: A known vasoconstrictor, nicotine, especially when smoked, causes measurable and chronic vasoconstriction in the skin. This contributes to faster skin aging and increases the risk of poor wound healing post-surgery. Vaping nicotine has similar negative effects on skin, while patches and gums have less impact due to lower concentrations reaching the skin. Refraining from nicotine use is recommended for healthier, younger-looking skin.
Alcohol: Generally has negative effects on skin, both short-term and long-term.
- Acute Effects: Acts as a mild diuretic, causing dehydration, which can lead to temporary hollowness, under-eye bags, and increased sebum production to compensate for dryness. In some populations (e.g., certain Asian populations), an inability to break down acetaldehyde causes a bright red flush or "Asian glow" due to vasodilation.
- Long-Term Effects: Chronic diuretic effects can lead to persistent skin dryness and increased sebum, potentially causing breakouts. Alcohol consumption is often associated with lifestyle choices (e.g., neglecting skincare routines, poor hydration/diet) that negatively impact skin health and accelerate aging. High-percentage alcohols can disrupt the gut microbiome and cause gut immobility, which may manifest in skin issues. There are generally no positive effects of alcohol on skin health.
Skin Hydration, Cleansing, and Moisturizing
Hydration: Drinking excessive amounts of water or fluids has not been strongly linked to improved skin hydration in individuals leading a balanced or sedentary life; skin hydration is largely genetically determined.
Moisturizers: Moisturizers are generally recommended to maintain the skin's barrier. When selecting a moisturizer, look for products that are non-comedogenic (won't clog pores). There are three main types: ointments (greasiest, best barrier protection), creams (water-oil emulsions), and lotions (lighter, often powder in water). The best choice depends on skin type: greasy ointments are ideal for eczema-prone skin, while lighter, non-comedogenic options are better for acne-prone skin. Pump bottles tend to contain lighter, less moisturizing products due to alcohol content, whereas jars offer more occlusive (and potentially acne-causing) moisturization.
Cleansing: Simple, mild, fragrance-free cleansers like unscented Dove bar soap or Cetaphil are highly recommended by dermatologists for sensitive skin, even for newborns and children, and are cost-effective. Over-cleansing, especially with harsh or alcohol-based products, is a significant problem in hyper-hygienic societies like the United States. It strips natural oils and eradicates the normal skin microbiome, opening the skin to pathogens. The frequency of cleansing should be determined by individual skin characteristics (e.g., oiliness, dryness, age). Showering after sweating is recommended to prevent irritation and yeast overgrowth.
Bags Under Eyes: These are typically caused by fluid retention (lymphatic changes, high salt intake, allergies) and age-related fat herniation, often exacerbated by positional changes during sleep.
Scalp Health: Dry or flaky scalp is often due to seborrheic dermatitis (medical dandruff) or psoriasis. Dandruff is treated by lowering yeast overgrowth (e.g., zinc or ketoconazole shampoos) and dampening the immune response. The hair on the head is dead; scalp treatments primarily target the living skin of the scalp, not the hair itself. Shampoos can strip natural oils from hair, making it appear dull or lifeless, but do not cause hair loss or damage.
Skincare Costs, Active Ingredients, and Sun Protection
Cost vs. Efficacy: More expensive skincare products are not necessarily better; in fact, they often contain more ingredients, including fragrances, that can be problematic for sensitive skin. The beauty industry inflates prices based on aesthetic desire rather than medical efficacy. Dermatologists typically recommend cheap, cost-effective products with minimal ingredients.
Active Ingredients: Most active ingredients in over-the-counter products are not at therapeutic concentrations because higher concentrations would classify them as drugs regulated by the FDA. For significant skin changes, a dermatologist visit is often required for prescription-strength treatments.
Sun Exposure: While excessive UV exposure causes premature aging (e.g., wrinkles, sun damage), Dr. Soleymani advocates for some sun exposure as beneficial for overall wellness, mood, and vitamin D synthesis. He suggests 15-20 minutes of sun on forearms for vitamin D and not to stay out long enough to turn red. Paradoxically, sun exposure is not clearly linked to the most common skin cancers (basal cell carcinoma), and the deadliest skin cancers (melanoma, squamous cell carcinoma) often arise in sun-protected areas. Genetics and the immune system play a huge role in skin cancer development that sunscreen cannot address.
Sun Protection Strategies: Physical barriers like shade, clothing, and hats are often more effective than topical sunscreens.
- Mineral Sunscreens (Zinc Oxide, Titanium Dioxide): These are preferred. They are considered inorganic or physical sunscreens, traditionally thought to reflect UV rays, but also work by absorbing them without chemical change. They have a long safety record and are recommended for infants (6 months and under) due to children's thinner skin barrier. Look for "broad-spectrum" coverage (UVA and UVB) and an SPF of 30 or greater.
- Chemical Sunscreens: These are organic sunscreens that absorb UV radiation and dissipate energy as heat through a chemical reaction. Concerns exist regarding their absorption into the bloodstream (at levels 100-500 times higher than FDA thresholds in some studies) and potential endocrine disruption or nervous system effects due to their phenolic structure, which mimics hormones. Many common chemical sunscreen ingredients have been reclassified by the FDA as "not generally recognized as safe and effective" (not GRAS).
- Oral Supplements (Polypodium leucotomos): A fern extract that acts as an internal sun shield, increasing the skin's minimal erythema dose (resistance to burning) and protecting against visible light, which is beneficial for conditions like melasma. It can be taken daily or as needed, often in conjunction with topical sunscreens.
Nutrition and Skin Health
There is a strong connection between the gut microbiome and skin health; modulating gut dysregulation with an anti-inflammatory diet can reduce the intensity and severity of inflammatory skin conditions like psoriasis, eczema, and acne.
A high-protein, anti-inflammatory diet (animal-based proteins, fruits, vegetables) is recommended for optimal skin health, as pro-inflammatory foods can exacerbate skin issues through glucose-insulin pathways and gut microbiome byproducts.
Collagen Supplementation: While popular, collagen is made of non-essential amino acids, meaning the body can synthesize it. Studies showing benefits may be confounded by participants' restrictive diets or placebo effects. Some apparent benefits, like plumper skin, may be due to increased blood osmolality from protein intake, drawing water into vessels, rather than direct collagen density increase. There's no clear evidence that ingested collagen directly targets skin collagen density.
Omega-3 Fatty Acids: These are anti-inflammatory and can improve skin health. However, they can thin the blood, increasing bruising risk, and should be stopped before surgery.
Advanced Treatments and Skin Conditions
Prescription Retinoids: These are highly effective medications (e.g., tretinoin, adapalene) that increase skin turnover (from 28 days to 7-9 days), reduce skin cancer and pre-cancer risk, and stimulate new collagen and elastin production. They are distinct from over-the-counter retinols, which are inactive prodrugs and often less stable. Retinoids require a prescription due to potential devastating birth defects if used during pregnancy.
Laser Resurfacing: Procedures like non-ablative (less downtime) and ablative (more aggressive, longer downtime) laser resurfacing improve skin appearance and can reduce skin cancer risk by eliminating mutations and activating genes for more youthful skin cells. This differs from superficial exfoliation methods like microdermabrasion, which only scrape off dead skin cells.
Photobiomodulation (Red Light & Near Infrared): Red light therapy can improve vascular flow, aid hair restoration, support post-procedure recovery, and mitigate UV damage. While effective, the efficacy of home devices varies greatly depending on energy density and wavelength; large wall panels are generally more effective than battery-powered face masks. The use of light therapy in medicine has historical roots, with a Nobel Prize awarded for photobiomodulation in the early 1900s.
Psoriasis: An immune-mediated inflammatory skin condition, characterised by red patches with silvery scales. Treatment involves targeting the immune system (with modern biologics, specific to interleukins), topicals (steroids, moisturizers), diet, weight loss, and UV phototherapy. Sunlight can clear psoriasis, which is why it flares in winter.
Vitiligo: An autoimmune depigmentary skin disorder where the immune system attacks melanocytes (pigment-producing cells), resulting in patchy loss of skin color. Patients with Vitiligo have a lower incidence of skin cancer, possibly due to heightened immune surveillance. Treatments focus on suppressing the immune response, including topical medications, UV light (e.g., excimer laser), and new JAK inhibitors.
Acne: A common condition caused by an overproduction of sebum, bacterial proliferation (P. acnes), and an immune response. High glycemic index foods, sugary processed foods, and non-fat dairy products (due to emulsifiers) can exacerbate acne. Treatment targets all three causes (reducing sebum, killing bacteria, calming immune system). Pimple popping is discouraged due to the risk of scarring from activated enzymes (Matrix Metalloproteinases). Mild topical corticosteroids can temporarily reduce redness but long-term use can thin skin and worsen scarring.
Rosacea: Often called "adult acne," it presents in four forms: redness (erythematotelangiectatic), pimples (papulopustular), enlarged nose (phymatous), and ocular. Triggers for redness include alcohol, UV light, spicy foods, hot beverages, and emotional stress. Treatments for redness include lasers (e.g., pulsed dye laser), while breakouts are treated with creams and oral medications.
Eczema (Atopic Dermatitis): Characterised by a genetic skin barrier defect, environmental allergens, and an aberrant immune response. Treatment focuses on sealing the barrier with moisturizers, avoiding triggers (fragrances, preservatives, allergens), and calming the immune system (topical steroids, biologics).
Tattoos: Generally not inherently bad for skin, but ensure sterile equipment and non-allergenic inks (reds can be problematic). The primary challenge is the difficulty in surveying for skin cancers within heavily tattooed areas.
Skin Cancer Surveillance and Prevention
The three most common skin cancers are basal cell carcinoma, squamous cell carcinoma, and melanoma. Squamous cell carcinoma now causes more deaths in the US annually than melanoma.
Risk Factors and Screening: Family history and genetics play the largest role in skin cancer predisposition. Annual full-body skin exams by a board-certified dermatologist are recommended, covering every inch of skin. Tools like whole-body photography and AI-based software can assist in tracking moles.
HPV and Skin Cancer: HPV (Human Papillomavirus) is a significant cause of squamous cell carcinomas in non-sun-exposed areas, including the mouth and genital regions, affecting increasingly younger patients. The Gardasil vaccine, which provides immunity to cancer-causing HPV strains, is recommended for sexually active individuals, with guidelines extending up to the late 40s for both men and women. HPV also causes non-sexually transmitted warts (e.g., plantar warts).
Future of Skin Cancer Vaccines: The field is on the forefront of developing cancer vaccines, including mRNA vaccines, to prime the immune system to target cancer cells, which could revolutionise cancer treatment.
Skin as a Biosensor and Holistic Health
The skin, hair, and nails serve as a "biosensor," reflecting acute and chronic internal health conditions, stress levels, and nutritional status. The body sheds non-essential parts like hair and nails when under stress to conserve energy for fighting illness.