An integrative approach that is more than skin deep

Our skin is the body’s largest organ and how we treat it directly impacts how it feels, looks, functions and how well (or poorly) it ages. As a nutritionist, my main focus is on which foods to eat for skin health, but of course, there is so much more to it.

Q&A with Vanessa Lapiner, integrative dermatologist

I had the pleasure of chatting to Dr Vanessa Lapiner in a recent Instagram IGTV. Dr Lapiner is an internationally recognised full-spectrum dermatologist who has been published in a number of medical journals. She is also the founder of Tash.360, root4 skincare products and is the director and founder of AD&L, the first integrative dermatology practice in South Africa. We touched on so many different things, that I decided to pull out a few key themes from our discussion.  

Tell me about your passion and your philosophy when it comes to treating skin?

“The practice started in 2011. I was there operating in a complete vacuum but then I started embracing a more holistic approach to medicine and started reading a lot about it. One of the other dermatologists that works with me, Dr Tessa Hoffman, had a particular interest in Integrative Dermatology and I just absolutely found a passion in it. It made so much sense to me. I felt that I was doing my patients such a disservice, I’d been treating them so superficially by just treating symptoms. So then we added a Nutritionist into the practice, and an Integrative Functional Medicine doctor, and even got a Chiropractor who helps us just in terms of looking at patients more holistically. Just encourage them to start looking at inflammatory skin disorders as more than just being on the skin surface because it’s not. It’s just so much more than that – and we’ve seen amazing results.”

I understand that inflammation is often the root cause of problems and that a lot of people have systemic chronic inflammation. When it comes to topical applications and lasers and Dermapen and retinol and all of that – what is your view? How do you help someone choose the best products and the best protocols for treatment?

“Regardless of what they come in for, I always think within a pyramid. Start with your fundamentals at the bottom of the pyramid and then work your way up. Depending on how aggressively you want to treat your skin, you need to have realistic expectations. I think that when it comes to skincare, also because of the price point of so many products, patients expect fast results. Not taking into account that we’ve got a skin cell turnover cycle that slows down as we get older. So you are looking at a minimum of 6 to 8 weeks before you start to see major results from whatever you’re using and you need to be consistent, people do give up. So as a basis: 

  • Inflammation is a huge thing for me in terms of what you eat, lifestyle choices and what you can incorporate into your diet or supplements that are anti-inflammatory.
  • I like anti-inflammatory ingredients in skincare too, before you try to treat anything, you want to repair your skin.
  • You want to calm the skin down. You are loading one active on top of another and it’s just too much.  
  • The first thing I tell people to do is just stop everything and go right back to basics, the bottom of the pyramid.
  • You want to cleanse, you want to moisturise, repair your barrier and you want to apply SPF. That’s your core of what you want to do to your skin. 
  • Once you have established that, you know that you’re not and having an allergic reaction to any of the products, then you start adding in things that are specifically targeted at what your concern is. 
  • As a basic rule anti-inflammatory ingredients to look for are things like:
    • Niacinamide, the all-rounder in terms of benefits for the skin. 
    • Things like aloe vera are calming, just beautiful in skincare products.” 

I believe your view is that sleep is also fundamental for skin repair and rejuvenation?

Completely, I’m so upfront with my patients. If they smoke, skimp on sleep and don’t eat high nutrient-dense food and come in wanting to do really expensive resurfacing treatments, I just really gently try to explain that they are not spending money in the most efficient way because they are not addressing all the underlying factors. I think they just want a quick fix without the hard work that goes behind it.”

What is your view on vitamin D3? The idea that people with lower vitamin D3 are more susceptible to skin cancer?

“Vitamin D is a bit of a minefield when it comes to skin. Studies in Norway’s winter showed that people were getting enough vitamin D just by exposing their hands to UV light. If you are in the sun there’s a very limited period that you actually make vitamin D, you need very short contact with UV light to produce the vitamin. Vitamin D is very important, it’s important for immunity and does have a role in so many skin disorders such as acne, eczema and skin cancer. I’m all for supplementing, like a big fan of vitamin D supplementation, keeping in mind that it is a fat-soluble vitamin. You can’t just go and take 50,000 units a week. You need to first know what your baseline is and have someone monitoring you. I think that in winter when the UV index falls below 3 there’s a place for spending 20 minutes in the sun. At 10 o’clock in the morning, I’m getting some sun because it also increases endorphins and makes you feel good, but I think that in summer we get so much incidental UV light from walking, from our car to places if you’ve got kids… there’s no need to go chasing extra UV exposure.”

What else is important apart from diet?

“Apart from diet, protection is key. I think that I can go on about sunscreen all the time. My patients come in and they start rolling their eyes. In the same breath, antioxidants are important. Antioxidants both from a diet perspective as well as what you’re putting on your skin. You want to protect and preserve what you have so that when you’re sitting in your 40s, like me now, that you are not desperately trying to paddle backwards because you’ve abused your skin and you haven’t looked after it.”

In terms of protection and ageing, obviously, sunblock is key and then nutraceuticals and cosmeceuticals. What do you recommend?

Looking just at products rather than treatments, you are going to be looking for ingredients that are going to increase cell turnover, like your alpha hydroxy acids, beta hydroxy acids, colic acid, lactic acid and even salicylic acid. It’s going to shorten the time that the skin cells take to go from the bottom of the epidermis to the top of the epidermis. The skin automatically becomes more youthful. You get that kind of glow from using anything that’s going to increase cell turnover, and obviously, retinoids are key.”

What about retinoids?

The thing about retinoids is that there are so many different types and so many different concentrations and retinols, which you get in a lot of products, is not the same as a retinoid or retinoic acid because it goes through a conversion process. 

If you are starting out, you might want to start with retinol to let your skin get used to it and then you slowly work your way up to more prescription strength. When it comes to a specific brand, it’s a bit of a grey area. Something that I’ve struggled with because I’m a big proponent of a term – that I hesitate to say at the moment because it’s being knocked from all angles – is “clean beauty”.

What is clean beauty?

Personally, I have a list of ingredients that I like NOT to put on my skin. We have built a compounding pharmacy within our practice and for the past three and a half years, we have been developing products that are both clean and effective. It has been a bit of a nightmare to try to get it right. We failed preservative testing until we finally got it right. 

I think that choosing clean beauty comes down to your budget, it comes down to where you stand on the spectrum if you are happy to put whatever is going to work on your face, or you want to keep it cleaner.

What other skincare products do you recommend?

Retinoids, alpha hydroxy acids are kind of my next step up from ingredients that are going to support the skin barrier. Then look for ceramides, free fatty acids and cholesterol that are going to draw water into the skin. Then lastly right at the top, there is an exciting category called peptides which are so specific. They literally can messenger to switch on genes, relax muscles. Some call it liquid botox. There are others like matrixyl which is a peptide that stimulates more collagen formation. I think that skincare is getting more and more specific in the same way drugs are getting so specific to individual needs. I think personalising skincare is going to become a big thing in the future.

What is your take on collagen?

I think that we are very much on the fence at the moment. But I think that on the plus side if you are looking for a collagen, you’re going to look for hydrolyzed collagen so that it’s easily absorbed. The theory behind it is not that you ingest collagen and it miraculously travels to your skin and plumps up your cheeks, like you’ve had filler, that’s not the way it works. But it actually can stimulate your fibroblasts which are the cells that produce collagen to produce collagen more effectively. That’s the science behind it.”

The topic of integrative skin health is highly complex and really interesting. It also makes a lot of sense. To find out more, watch the full interview with Dr Lapiner on my IGTV and listen to her typical daily nutritional meal plan.

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