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The "Four Hs" of Skin Care

Updated: Jun 13

As a physician trained in anti-aging and regenerative medicine, now called functional and integrative medicine, I've come to categorize skin health into the "four Hs" of management and daily habits. In equal importance I consider: Hydration, Hormones, Help, and Hide. If you keep it this simple, you will have the skin you have always wanted.


Just when you think you are diligent about getting enough water your skin may tell you otherwise. Hydration to the skin comes from the inside as well as the outside. A very crude estimate of good water intake per day for women is 2.7 liters. Men require more. Plump, wrinkle-free skin only stays that way if it is well hydrated. Be careful of fluids that are considered "negative waters" such that the ounces you may drink behave as a diuretic, and you lose more than you intake. Alcoholic and caffeinated beverages are such negative waters. Take pictures of the before and after shots of just adding better water intake after 30 days. Hydration topically is crucial as well. Our oils (sebum) will also give the skin its hydration even though oil and water seemingly repel each other. The skin is so wonderfully constructed with layers such that there is a fattier layer in the dermis regulating the oils while close to the surface there is a corneal layer that is much more water receptive. Add some protein layers, immune cells, and proteins in the layers sandwiched between, there is an intricate system of fluid homeostasis to capitalize on with advanced skin care products.

"Pure water is the world's first and foremost medicine." Slovakian Proverb

Soaps may strip the fluid and oil layers, which can be desired in the acne prone skin, but for the average, dry, and aging skin, soaps can be disastrous to keeping the skin hydrated. Opt for the cleansers that are non-soap, which will clean without stripping the skin. I inherited sensitive, dry skin and now live in Colorado in the "mountain desert" climate. I look for products with humectants (substances that attract water) in advanced skin care lines that include such ingredients as: hyaluronic acid, B5, ferulic acid, squalene, glycerin, coconut oil, ceramides, or lactic acid. Remember that acne prone skin also needs hydration but such that will not clog and cause comedones (blackheads).


If you do not think hormones affect the skin, talk to a teenager riddled with acne despite all healthy efforts at controlling inflammation with diet and lifestyle. Certainly is the case at the other end of the hormonal spectrum in the post-menopausal patient with skin concerns. If Einstein were still alive, he may have told us that "E equals Elasticity." That "E" certainly stands for estrogen. With the appropriate symphony of hormones, the skin has a fighting chance to avoid the pitfalls from aging. It is so easy to look at menopausal skin and its sagging, crepe-like, wrinkled, and less nourished appearance. Estrogen helps defend against oxidative stresses to the skin as well as working with DHEA, testosterone, progesterone, and the thyroid to maintain the integrity and health of the skin.

I continue to be an advocate for bio-identical hormones in those patients who are candidates for hormone therapy. We are focusing on the skin health in this article, but the rest of the body enjoys the benefit of a solid hormone base, and the skin just becomes a reflection of overall health of the human body. The less synthesized and the more natural the hormones are, the better tolerated they are. The body knows how to process hormones exactly as they were manufactured in young adulthood. This is where the individualized, compounded, natural, plant-based hormones in the bio-identical category reign superior to keeping the body as youthful and optimal as possible without causing any detriment to the patient. Hormone balancing may help control acne just as it may in the advanced skin aging of the patient whose hormones are in the empty red zone. Do I personally use bio-identical hormone therapy? The answer is a resounding "yes."


The real power in skincare treatments is evolving so quickly and sometimes hard to keep up in the "who's who" of product lines and gadgets. When I approach a health concern I keep in mind of the protoplasm (the body parts), Chemistry (in, on, and around), and energy (in many forms). The care of skin is no different whether you are dealing with inflammatory skin disorders such as acne, eczema, psoriasis, or rosacea or the weather- beaten abuses suffered from too much sun, unhealthy food, diabetes, smoking, or rugged outdoor living. The approach needs to be individualized based upon your contributors, but thinking your way through the process has key principles shared by all. No one could pass any judgment on the mechanical issues you may want to address with a plastic surgeon such as getting rid of sagging skin, need procedures to remove skin cancers, or reversing advanced aging of the skin. That said, if a procedure would help you face the world easier, than it is your prerogative to help your skin with a procedural approach.

"It's important to always remember that beauty is an inside job. What we eat directly affects the appearance of our complexion and determines how we age." Nicholas Perricone, MD

Assisting your skin in the chemical arena almost seems limitless. Chemistry starts from food chemistry and daily intake. Is your diet high in inflammatory oils, sugars, chemicals, processing, gluten, dairy, artificial sugars, alcohol, soy? Is it ideal with plant foods, organic meats, good water, nutritious minerals, and vitamin support? It matters what you supply within, because as the skin is a large detoxing organ, and it reflects what is going on underneath those layers. There may not be enough room or time in the day to take all the excellent supplements for the skin, but you can consider the arsenal of healthy fats, vitamins E, C, D, A, B5, and minerals such as zinc and selenium to protect that skin from UV damage. Herbal extracts such as aloe vera, calendula, pine bark, chamomile, centella asiatica, lavender, sage, turmeric, dandelion, ginseng, and bakuchiol can be ingested, made as teas, or infused into great topical product lines. Chemistry can also lend a hand to the skin regimens at home or in the salon/office by using lactic and glycolic acids to exfoliate and peel distressed skin to give a rebirth to the dermal layers. There are also primers and photosensitizers for laser and light procedures, and as always, the science of chemistry for skin care is evolving faster than I type!

In no other facet of medicine have I seen physicists and inventors produce energy techniques for dermatological benefits. From heated ultrasound to innumerable laser gadgets, electrical, microcurrent, hyperbaric, microdermabrasion, Blue Light, red light, and UVA/UVB, there is a wide array of in-office and at-home devices. Clearly the at-home devices may not have as strong of a current or fluence as the office and operating room gadgets, but there is substantial evidence and research stating the benefits of tightening, reversing, correcting, and treating skin damage affects or quieting skin inflammation. I would caution to the energy techniques with gadgets and trying them on yourself without guidance. Keep in mind that one of the best energetic techniques we have is exercise, and the skin enjoys this as much as the rest of the body.


The consensus regarding skin aging is that it relates to amount of sun exposure. Environmental accelerants such as cigarette smoking, pesticides, drugs, air pollution, disinfectants, asbestosis, and industrial waste products will contribute and exacerbated the effects of UVA and UVB radiation. Clearly the idea is to have up to 15 minutes a day of natural sunlight but to avoid excessive amounts. The most ideal way to do this is with clothing. Landscapers and farmers have figure this out by keeping a wide brim hat, neck coverage and long-sleeved shirts with pants even if it is in the dead of summer.

Clothing is hard to use when dealing with the face. The competition is quite thick for medical and cosmetic companies to develop the best sun blocking products. There are chemical blockers and mechanical blockers. Mechanical blockers contain the pasty, white zinc block from yesteryear. Some products currently contain a certain amount of that. Chemical blockers are, indeed, certain compounds that block the UVA and UVB rays, but there is controversy as to whether sunblock creams will behave as accelerants to the photoaging process. Many of the foundations in make-up will carry a low level of SPF protection. Medical-grade cosmeceutical brands of SPF facial fluids can be tinted to behave as a makeup foundation. I always remind my patients that when a company gets an SPF rating it is with the process of applying the cream one-eighth inch thick every hour. We busy people do not reapply, then wonder why we are not getting the advertised SPF blockade that we need. I have tried so many, and my favorite SPF comes from standing in the shade! An umbrella in the sun is a close second.

Four simple concepts may look quite different from one person to the next. Find the integrated approach. Reverse your skin aging and sustain your youthful appearance and wow your friends!