Physical exfoliation involves the act of mechanically removing dead skin cells, this can be as simple as using a mitt, loofah, or sponge or as ‘technical’ as using electric brushes such as Clarisonic. Chemical exfoliation is a slower process that requires a product to help break down dead skin cells, examples include glycolic, lactic, salicylic & retinoic acids.

It really comes down to what your goals are, your skin type (sensitive vs resistant), & how much insight you have regarding your skin’s irritant threshold. I prefer gentle physical exfoliation as a starting point, as you can control the amount of force & time. This means you have control over the exfoliation process. Once you have underwood this process, you can move to advanced modalities including deeper physical exfoliation & skin priming using chemical exfoliants. Crawl before you walk, walk before you run, run before you fly.

Physical exfoliators include brushes, scrubs, sponges, cloths & mitts. These objects work by mechanically removing dead skin cells. The extent of exfoliation is dependent on the pressure applied, time of exfoliation & grit of the exfoliator. Examples include-

Scrubs: Most famously are apricot seeds. These seeds or kernels can be found in many brands. Unless you have resistant skin, the grit rating of this type of exfoliant is high. Best used as a body scrub. More gentle solutions include jojoba beads, coffee grounds, salt and sugar grains, ground oatmeal, & plastic microbeads. 

Brushes (electric): The best known is the Clarisonic. This device provides circular motions of various brush stiffness. User controls the pressure & time of exfoliation. 

Mitts, towels & cloths: not as fancy as eclectic brushes, but you will not run out of charge. Again pressure, time, and roughness will control the level of mechanical exfoliation. 

Sponges: Most famously the Konjac Sponge. These are gentle on the skin and can be combined with bland cleansers of chemical exfoliators. 

Chemical exfoliators are products that break down dead skin cells. They can also increase the speed of cell turnover & have secondary effects such as pigment reduction & collagen stimulation. Examples of chemical exfoliators include-

Alpha Hydroxy Acids: namely glycolic, lactic, mandelic, & citric acid. For home use these compounds are buffered at pH of around 3.5 (acidic), with concentrations ranging from 8% to 15%. In comparison clinical peels are unbuffered acidic solutions with concentrations of 20% to 70%.

Beta Hydroxy Acid: The only member is salicylic acid. This acid penetrates the oil gland better cf. AHAs, additionally BHA has anti-inflammatory effects & hence can be useful for patients who suffer from acne, blackheads, & oily skin. BHAs are best used as wash, in concentrations ranging from 1-2%. Dermatologists can compound a bespoke recipe of 2 to 16% salicylic acid, depending on the area used & skin condition treated. 

Retinoic acid or retinol can also function as a chemical exfoliator. These range in concentrations of 0.5% retinol to 5% retinoic acid. The later is reserved for clinic use with exfoliation lasting up to 3 weeks. 

Enzymatic exfoliation: include fruit enzymes including papain from papayas, & bromelain from pineapple. These are usually found in masks & are less popular compared to AHAs & retinoids. 

Here are some really simple examples of how to start a chemical exfoliation program. 

• AHAs, start off with glycolic acid 8% once a week, in the pm. You then apply your chosen skin care ‘active’ 30 minutes after. 
• BHA, if you have acne prone skin, wash with a BHA in the morning. Salicylic acid 2% is a simple formulation. Start alternate days, increase as tolerated. 

Don’t combine acids if you are just starting out. For more information on how to exfoliate based upon your skin type (oil, dry, sensitive) see below. 

The rate limiting factor is not your dedication towards exfoliation but your skin sensitivity & threshold. Dermatologists suggest twice a week to begin with (or as little as once a week if you have sensitive skin). The ideal time intervals between exfoliation is dependent on-

• Your skin’s sensitivity
• Your goals
• Your skin care products
• The type of exfoliation (physical vs chemical) 
• Any medications you are taking (Accutane) 

As a rough guide, start twice a week with either (don’t pick both)-

1. Chemical exfoliators such as salicylic acid washes in the morning, or AHA / Glycolic Acid washes in the evening.
2. Physical exfoliator such as Clarisonic clean in the am or pm. 

If your skin does not protest, increase by one day a week. Back off if you have skin irritation. 

By removing the top layer of dead skin cells, other active ingredients can penetrate better. This means at the same concentration your chosen ingredient, whether it be retinol, ascorbic acid, niacinamide, or antioxidants can work harder. This is also referred to as skin priming. 

An example of how to prime your skin with a physical exfoliator- 

1. Use gentle pressure with Clarisonic Brush for 60-90 seconds 
2. Pat dry
3. Apply chosen skin care active

An example of how to prime your skin with a chemical exfoliator- 

1. Apply or wash your face with glycolic acid
2. Pat dry
3. Apply your skin care active of choice

*Patients with sensitive skin should not attempt to ‘prime’.

**As always gradually add skin priming to your routine

***At some point, your skin WILL get irritated. This depends on how sensitive your skin is, the amount of priming & the concentration as well as the formulation of your active.

For just oily skin (with no sensitivity), my preference is double cleansing. Second cleanser is a salicylic acid wash.

Guide: Salicylic acid oil free 2% wash by Neutrogena in am.

Caution: Sensitive skin

Next Step: Add gentle physical exfoliator in PM (Clarisonic or equal)

* For rosacea & sensitive skin patients, exfoliation to reduce oil production can be extremely tricky. My advice is that you consult a medical dermatologist (not me, I am a procedural dermatologist). Oil production can be decreased with hormonal meds, spironolactone or vitamin A analogues. 

Dry skin exfoliation should always be followed by an intense moisturiser. Once again, being gentle & slow is the key. 

Guide: Oatmeal exfoliating, twice a week followed by moisturiser.

Caution: Skin can be irritated with exfoliation. Retinoids can add to dry skin. 

Next Step: Add chemical exfoliator such as AHA 8% or better still Lactic Acid. 

Exfoliation in people with sensitive skin is extraordinarily complex & should be started under the guidance of a skin care professional. Sensitive skin patients include rosacea, reactive skin, eczema, allergic skin types & patients on sensitizing medications like Accutane.

Guide: Physical exfoliation once a week; oatmeal or Clarisonic Brush, extremely gentle pressure 20-40 seconds per side with bland cleanser. I do not recommend chemical exfoliation in this subgroup, acknowledging that some patients can tolerate low dose (0.5%) retinol in a good (not cheap) formulation. 

Caution: Easy to over step & cause skin irritation. 

Next Step: See a skin care professional for options such as short contact chemcal peel exfoliation, gentle physical exfoliation with Hydrafacial, modified microdermabrasion, dermal toning & others. 

I prefer physical exfoliation first, namely the use of konjac sponges, mitts, or devices like Clarisonic. This way you control the exfoliation process based upon pressure & passes. Start off once a week, increasing to two to three sessions as tolerated. 

Guide: Gentle pressure, spend 60 to 90 seconds overall.

Caution: Sensitive skin

Next Step: Firmer pressure, increase frequency (2 -3 times per week), addition of chemical exfoliants (once to twice a week), advanced exfoliation involves the combination of physical & chemical exfoliants. 

Chemical exfoliation is best. I would suggest BHAs, namely salicylic acid over AHAs as the former has anti-inflammatory actions & penetrates the oil gland better. Neutrogena 2% Salicylic acid wash is excellent (orange packaging). 

Guide: Exfoliate once a day, preferably in the morning.

Caution: Sensitive skin? Use every second morning, titrate according to irritation.Next Step: Add retinol 0.5% at night as tolerated, 0.1% retinol if resistant, option to increase to a prescription retinoid.

With age, oil or sebum production decreases & skin can be particularly dry. My products of choice include retinol & AHAs as chemical exfoliants. Moisturiser with Hyaluronic acid to improve skin hydration. 

Guide: Exfoliation should be at night with retinol / glycolic acid. Start with 0.5 to 1.0% retinol for at least 8 weeks. Option to add glycolic acid 8 to 10% every second night, 30 minutes before retinol application. 

Caution: Excessively dry skin, photosensitivity with retinol – glycolic acid.

Next Step: Prescription retinoids & or lactic acid 3-6% compounded if excessively dry. 

Not a good idea as your skin is super sensitive. The dryness & flaky skin is actually due to chemical exfoliation from being on the drug. The best way to reduce this retinoid induced chemical exfoliation is to moisturise frequently- up to 4 to 5 times a day. Especially important just before bedtime. 

To remove excess dry skin – flakes, you can use a Clarisonic (or equivalent) in a super gentle setting. Moisturise the brush with a plain cleanser like Ego Wash, Cetaphil wash or Aveeno (gentle line of washes). Add gentle pressure for 30 seconds. Pat not rub dry, then use your plain moisturizer of choice. Do not over do it. Check with your dermatologist if he or she has any other suggestions. Most dermatologists will say NO to exfoliators, I am just teaching you a safe way if you INSIST on exfoliation whilst on Accutane. 

Chemical exfoliator ingredients include glycolic, lactic, salicylic acids, as well as lesser-known acids like malic, lactobionic, citric and mandelic. Other ingredients include retinol & retinoic acid. Plant enzymes like papaya, pineapple, and pomegranate are also great natural exfoliators for sensitive skin types.

I have nothing against apricot seeds, in fact I did an exfoliation video with beach sand once. It’s all about finesse, namely unless you have really thick, resistant skin, large particle exfoliators including seeds, sand, coffee grounds & beads will more than likely cause skin irritation. This can be compounded by the use of super strength skin care lines, as they are so freely available in today’s market. Reason enough? These larger particles can, however be useful as a body or foot exfoliator. 

A sensible skin care routine that involving exfoliators goes something like this;

AM: Cleanser, SPF, Make up, with the option of antioxidants (Ferulic acid, Ascorbic Acid, Tocopherol)

PM: Physical exfoliation with cleanser, Retinol or Niacinamide – Ascorbic Acid, AHAs or pigment correctors

*There are many ways to exfoliate, with endless combinations. The use of an electric exfoliator such as Clarisonic enables you to control the pressure & time of exfoliation. The use of ingredients such as retinoic, lactic, glycolic acids enhance the exfoliation process as these ingredients are actually chemical exfoliators. 

** Disclaimer: My work is focused on procedural dermatology, namely to cut, laser, & inject. Skin care guides can be given by your skin care practitioner or expert. My clinical team @cliniccutis can guide you through your skin care routine.