Clinical Associate Professor of Dermatology, New York University Langone Medical Center 

 

 

With a unique human touch and a sharp point of view, Doctor Doris Day tells us about the effects of Modern World on our skin.

Also for your reference, Dr Doris Day latest book, Beyond Beautiful: using the power of your mind and aesthetic breakthroughs to look naturally young and radiant

And this is Dr Doris Day website.

BEHIND THE WOMAN:

About your career and the people who inspired you:  I have had many broad inspirations from philosophers to writers and scientists along my journey to becoming a physician. I really believe that being a doctor it is a calling and a privilege, not just a job. You are a physician your entire life not just at work. It is service to others, and it requires a commitment to life-long learning. It is always about what we give our patients: education, science, art and some of it is as basic and powerful as simply acknowledging their concerns, helping our patient love him (her)self, see the best in themselves and helping them make choices to be a happier, healthier person.

In my journey in the humanities, I started as English major studying literature and philosophy and went through my own process of maturing, learning early (as a teenager) the value of life and love as well as the importance of living in the moment. My dad (who was a physician) has been a great source of inspiration in my life. He was driven by a deep passion for providing his patients with the best of care. He was a great teacher and made it clear that doctors have to know the science but, just as important is that we need to be healers who understand our patients and treat them as a whole rather than as a series of separate unrelated organ systems. He was also a poet and a singer.

Studying Medicine was initially a challenge for me because I did not start out in the sciences and didn’t think of myself as a scientist by nature. My early focus was more in the arts and humanities but learning the science was exciting and really helped me put everything together. Understanding how things work at the scientific, molecular and macro levels is critical because you cannot go to the abstract unless you get the concrete.

Very naturally, I became a Journalist because I wanted to educate. I felt people needed to understand their choices and understand that everybody has a role in their care and what follows. For me, it was about bringing it together in a larger context.  These are not different hats that I wear, there are all the same but they exhibit in certain ways. As a dermatologist, I understand that the world is internal and external and that things like pollution, stress, sleep and diet greatly impact your skin and that skin is a reflection of the health of the body. I look for the different ways that people are missing to look at how I can help them feel at their best.

 

ABOUT THE IMPACT OF MODERN WORLD ON SKIN

In this modern world, we are being more stressed than ever before. The skin is being insulted in many ways:  the ozone layer is diminishing, there is more pollution, many are less physically active, we are not sleeping enough and our diet is not as good as it should be… There is a lot of stress affecting our bodies and little by little, it shows in our skin.

What is the specific role of Pollution in all of this?

Our skin is under ever greater assault from pollution and toxic elements in the environment (especially if you live in a big city) that it has not yet evolved enough to neutralize on its own. This is mostly from oxidative stress which is defined as an over production of destructive reactive oxygen species (ROS) generated by three major components relating to pollution: Particle matter (PM), gases and aryl hydrocarbon receptors (AhR) ¹.  Among the primary pollutants, PM (Particulate Matter) have been documented to impact skin especially in urban population ². Particle matter carry on several hundreds of chemicals that are toxic to the skin. It is very important to use products that will help protect against the damage being done by the pollution particles and that will help repair damages. Some skincare companies have been looking at better understanding the impact of the pollution on the skin as well as what is going on in the skin. It is fascinating to know that some companies are very strong in their science and are looking into the genomics which will help possibly associate some certain genomic pattern with some higher susceptibility to pollution. Some researchers have also looked at the combined effect of pollution with other elements like sun rays³ and are some skincare companies are coming up with ways to protect and help repair combined damage. This is a fast-moving field and we are going to be able to address this any soon.

What do you see in the skin? What does pollution really do the skin? We know it can increase premature aging and skin cancer but more work needs to be done to continue to isolate the effects of pollution on the skin and separate out different elements of pollution and toxins on the skin. I would love to see more studies that show the specific effects of pollution on the skin: whether or not it amplifies the effects of sun damage on the skin, the role of genetics, the independent effects of pollution separate from other factors and ways it may compound other insults and stressors of the skin. I would like to understand what pollution does to the skin and at which level, alone and in combination with other factors.

What is the relationship between air quality and skin conditions? It is clear that air pollution is not just affecting skin on a cosmetic level, but also exerts detrimental effects and causes diseases of the skin. Several recent epidemiological studies have been suggesting that air pollution exposure is detrimental to atopic skin and should be controlled when managing these patients⁴. Pollution may also be a risk factor for patients presenting with melasma and other facial pigmentary dyschromias. It has been documented in the literature that the incidence of the disorders of facial hyperpigmentation and specifically, melasma, is increased in persons of skin type III-IV living in geographic regions with very heavy pollution ⁵. It is important to tell patients with darker skin complexion living in big cities to protect their skin everyday against pollutants.

What are your top anti-pollution ingredients?

High on my list are SOD (Superoxide Dismutase), Niacinamide and other antioxidants as well as some exfoliating ingredients such as salicylic acid that will help get pollution particles off the skin and/or out of the skin. The first step starts with proper cleansing to take pollution and dust off your skin, the second step is about repairing the skin using ingredients for wound healing and skin repair such as copper, niacinamide, vitamin A, vitamin C, glutathione and others.

If I could create my own dream skincare product against Pollution, I would combine some barriers elements such as a Hyaluronic Acid (a form of HA layering the skin in a breathable way but not allowing the pollution to reach it) with some additional ingredients such as niacinamide, caffeine, glutathione and vitamin A and C and other plant and sea extracts to help bind pollution and inactivate it, to ultimately protect and help repair damage done to the skin.

Are there any promising ingredients on the horizon? When looking for new promising ingredients, we should favor the selection and use of skincare ingredients derived from plants from the land and the sea.  A plant cannot move. To survive, it needs to adapt and to thrive often under difficult environmental conditions. Cocoa Extract and Artichoke extract are a few of the promising plant extracts that are triggering my interest.

What about the measurement of the anti-pollution effects of products? We are just starting to recognize that the exposure to pollution is local and that what you need here might to be different from what you need in a different country/location. Some advances have been made in the measurement of the anti-pollution effects of products but first we need to acknowledge that pollution is not the same everywhere which will require some personalized products. The challenge is that we still have a somewhat limited palette of ingredients available to us today which greatly limits going for personalized solutions.

 

YOUR VIEW ON SKINCARE INNOVATIONS

What does the future of skincare look like: My view of the future of skin care is one that is uniquely designed for each patient based on their genetics. It will be individualized skin care and will offer the right amount of protection and repair and help avoid premature aging of the skin. Unfortunately it may be a while before that is available in a way that has strong scientific backing and at a cost that is reasonable for the average person. For the products now available there are excellent options but, selecting the best products and knowing the order in which to apply them can be very confusing.  Everyone want to use the best product for their skin, patients often get information from many sources that are not at all scientific but do sound very serious and very often provide false information. I spend a lot of my time dispelling myths about the danger of sunscreens or about some of the products that my patients use that sound natural but do not have any evidence-based medicine…but meanwhile cost a lot of money. I guide them and help them navigate. It is however amazing to see that as a Doctor, I only have so much power. What my patients read or see on social media sites from some celebrities has very often more power and credibility in their eyes than my advice being always grounded and anchored in science.

What should be the role of dermatologist on Social Media? I am a member of the American Society of Dermatologic Surgery and Chair of the Social Media Committee.  My goal is to help doctors BE represented as the authority in skin care and aesthetics.  This is an area where we have to be careful as physicians to maintain a level of dignity and respect that gives us authority. We need to be relatable and accessible but not fall into the trap of thinking we are models or celebrities. It can be a fine line and one that is too easy to cross. I am hopeful that as starting the Social Media Committee, we will able to help better direct our members and other doctors and increase awareness to help educate the public on the best products and treatments available and that doctors are the go-to for these services.

The goal is for us to convey (in our own style) information about the services we provide, what a dermatologist is, what a dermatologist can do for you both from a medical and an aesthetic standpoint.  So that whenever you go and see any doctor you have a level of confidence that you are in the right place and you know what to expect.

We are here to educate, to talk about safety, efficacy, treatment outcome AND to be the GO TO source for accurate and honest information about things that are cutting edge.

What are your final words to protect your skin from the pollution threat?

The threat from pollution is real and it is not getting any better any time soon. Protect your skin and your health by eating a high antioxidant diet, by properly cleansing your skin and by using skincare products containing ingredients specifically tested against the most common toxins in pollution.

 

BIBLIOGRAPHY

1. Krutmann J et al. Pollution and skin: From epidemiological and mechanistic studies to clinical implications. Journal of Dermatological Science 2014
2. Lefebvre MA et al. consequences of urban pollution upon skin status; A controlled study in Shanghai area. Int J Cosmet Sci; 2006 June, 38 (3):217-23
3. J Soeur et al. Photo-pollution stress in skin: traces of pollutants from particulates matter impair redox homeostasis in keratinocytes to UVA 1. J. Dermatol Sci 2017 Ma; 86. (2):162-169
4. Kim J. Kim EH et al. Symptoms of atopic dermatitis are influenced by outdoor pollution. J. Allergy Clin Immunol 2013;132:495-7
5. Roberts WE; Pollution as a risk factor for the development of melasma and other skin disorders of facial hyperpigmentation- is there a case to be made. J. Drugs; Dermatol 2016 Apr; 14 (4):337-41.