Does Everyone Need to Exfoliate?

Welcome to Culture Clinic, MedPage Today’s collaboration with Northwell Health to offer a healthcare professional’s take on the latest viral medical topics.

One need only to search the word “exfoliate” on TikTok to find an explosion of tips and tricks viewed by millions for the best way to exfoliate skin; the wrong way to exfoliate skin; the best exfoliants; and every glove, scrub, and acid in between.

It turns out, however, that most people don’t need to exfoliate, according to Raman Madan, MD, a dermatologist at Northwell Health in Glen Cove, New York.

“It’s like this huge trend — I don’t know where this obsession with exfoliation came from,” Madan told MedPage Today. “I can see why, because it probably feels good when you do it for a couple of minutes. But there’s really never a situation that I’d even recommend a patient should exfoliate.”

Madan noted that, at best, exfoliating strips natural oils from your skin. At worst, it can harm the skin barrier, leading to irritant contact dermatitis.

On the other hand, Raj Chovatiya, MD, PhD, of the Rosalind Franklin University Chicago Medical School, told MedPage Today that in some situations, certain exfoliation methods can help address legitimate concerns about scarring or pigmentation.

“There’s reasonable medical reasons to exfoliate,” he said.

Of note, both experts said there are products that can reduce oil and brighten skin more gently than harsh exfoliants.

What Is the Skin Barrier?

The “skin barrier” refers to the stratum corneum — the very first layer of skin where a combination of lipids and corneocytes, essentially dead keratinocyte cells, are continually shed as new keratinocytes develop below and move up through the other layers of skin.

Together, the layer acts as a hydrophobic shield that blocks out toxins, allergens, and microbes, and keeps water in. In atopic dermatitis, for example, defects in the skin barrier let these invaders in, which then activate an immune response and inflammation that leads to its characteristic irritation, itchiness, and redness.

How Does Exfoliating Affect the Skin Barrier?

According to Chovatiya, “exfoliation is kind of a blanket term that covers both microdermabrasion, chemical peels, etc. They’re all kind of the same throughout the same bucket.” Videos on TikTok focus largely on facial and body exfoliation with abrasive gloves, cloths, or scrubs.

Exfoliating generally refers to removing the outermost layer of the skin, Chovatiya explained. But “if you were to heavily exfoliate your skin, [it would] create new problems in terms of being raw and painful, potentially even scarring, depending on what you’re doing.”

Some social media-friendly “fixes” for “repairing” the skin barrier, like essential oils, he noted, could even add to this irritation — though skin reacts in highly individual ways to various products.

Madan said that for the most part, exfoliating offers few benefits and can do more harm than good. “You’re getting rid of natural oils on the skin,” he explained. “You’re basically irritating your skin, so a lot of people can develop what we call an irritant contact dermatitis. You can overdo it.”

What Is a Good Alternative to Harsh Exfoliants?

Chovatiya noted that in a few areas where dead skin cells can build up, like the heels of the feet, exfoliation can help smooth the surface of the skin. Madan recommended foot peels containing lactic acid and urea.

But for people who have scars, dark marks, or other pigmentation on the face, Chovatiya said he might suggest chemical exfoliation or microdermabrasion. In these cases, “the actual process of exfoliation can help to cause new collagen growth that helps to cause normalization of pigments.”

Madan, however, called treatments like these a “last resort.”

“All these things are kind of sexy, they’re available on TikTok,” he said. “People kind of market them off. But at the same time, there’s other safer benefits to get to the same route.” He added that he often has to counsel patients who got bad information on social media and are upset that it didn’t work.

“Patients kind of get thrown off, because they came in expecting one thing and getting another treatment,” he continued. “And then, from my end, it becomes a little more difficult because now I’m trying to convince them to use the treatment that works, because they had a preconceived notion instead of coming to me for my advice.”

Both experts noted that topical retinol and tretinoin can achieve brighter, healthier skin in the long term — usually while being more gentle on the skin barrier. These agents stimulate turnover of the skin as newer cells move into its upper layers, and reduce oil production.

Madan and Chovatiya emphasized that patients concerned about their skin barrier or using certain exfoliants should ultimately consult with a medical professional who can help clarify options for their particular skin.

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