[upbeat music playing]
[narrator] There's a reason skin care commercials don't zoom in that close.
And if they do, it's this pristine, animated landscape.
A real close-up of skin can be a little unsettling.
Ew!
Ew. What is that?
[gasps]
[narrator] Even the most perfect skin is a rough and broken terrain,
crisscrossed with oily gullies and studded with hairs.
And in this strange land,
there be dragons.
Scientists believe these Demodex mites are on the face of every adult human.
There are almost certainly some burrowed into your face follicles right now.
And they are far from alone.
Our skin hosts vast herds of bacteria, fungi,
and even miniscule viruses.
This isn't a harmful infestation.
In fact, we need many of these microscopic passengers
to keep our skin healthy.
But skin care companies tell a very different story.
Mainly, that what you need
is an overwhelming array of products.
[announcers] The first acne-proofing gel cleanser.
-Hyaluronic acid serum. -Micro-sculpting cream.
It's a cleanser and a mask.
Hydration is the foundation of healthy skin.
Wake up to younger-looking skin in just five…
-[voices overlapping] -[silence]
[narrator] Can we trust all these products to do what they promise?
And is there some secret to healthy, beautiful skin?
[man 1] Let's begin with the skin,
by taking a look at it from the doctor's point of view.
She has lovely skin. That's what I was most impressed by.
[man 2] If you keep your skin clean, there's less chance
that a disease will be able to get started.
If my skin's fresh and healthy-looking,
I guess it's 'cause I've gotten down to basics.
From your chin to your ears.
From your nostrils to the temples.
[man 3] The healthy skin is a beautiful skin.
[Okonedo] If there's one thing the experts want you to know about skin, it's that…
It is our largest organ.
Our largest organ.
[Okonedo] Skin is your immune system's first and best line of defense.
I like to use the analogy of a brick wall.
So, the bricks are the cells,
and the mortar is our natural oils.
[Okonedo] This wall, the epidermis,
is completely rebuilt about once a month.
New cells are born down here
and make their way to the surface, where they flake off.
The pores you can see are actually the openings of hair follicles.
They're nearly everywhere on your body, not just the places that look hairy.
Glands attached to the follicles put out an oily, waxy substance called sebum.
[Skotnicki] That helps lubricate our skin and acidify our skin.
[Okonedo] Your skin's pH isn't neutral. It's closer to five.
And that makes it harder for harmful bacteria to grow.
If your protective brick wall breaks down,
it's easier for foreign particles or germs to get in.
Your immune system will leap into action,
your skin will get red and itchy.
And this whole army of immune cells will detect and attack the intruders.
And then, of course, there's the most remarkable feature of your skin.
The host of creatures who call it home.
Billions of years before we evolved,
microbes colonized every corner of the globe.
From Arctic glaciers,
to sulfurous pools,
to volcanic vents in the ocean floor.
When skin finally showed up,
that was just one more habitat to colonize.
You actually have trillions of different bacteria, fungi,
viruses, protozoa,
even small insects.
The skin has a very striking diversity of different environments.
[Okonedo] Your face is an oily marshland.
Your armpits are dark, wet jungles.
Your forearms are dry savannas.
Your microbiome is first formed when you are born into the world.
You're suddenly populated by your mother's biome,
and that forms the sort of concrete foundation
that's going to stick with you for the rest of your life.
[Okonedo] And as you grow, it continues to develop,
shaped by your experiences.
[Oh] So, that can be
where you live,
if you have pets,
who you live with,
and who you encounter on a regular basis.
Each of us have kind of a unique signature.
[Okonedo] Scientists spent the last couple of decades
learning which species live where.
Now they're trying to figure out what all those critters are up to.
There's a bacillus bacteria living in between our toes
that eats a compound in our sweat called leucine,
and it contributes to that rank and sweaty foot smell.
Why on earth would we want to coevolve with this microbe
that produces bad odors?
It turns out that this bacillus
is a very potent inhibitor of fungal infections.
[Okonedo] Our feet produce a weird amount of leucine.
It's almost as if our bodies are laying out a feast for these bacteria
so they'll keep us from getting athlete's foot.
Then there's Staphylococcus epidermidis,
which is found at different sites all over the body.
Yeah, we love staph epidermidis.
It can recruit immune cell types
that allow us to heal wounds and combat infection.
-They can kill pathogenic bacteria. -[bacteria shouts]
[Okonedo] Antibiotics can do that too.
[bacteria scream]
Though helpful bacteria are often collateral damage,
and some pathogens are evolving resistance to these drugs.
It's a terrifying trend around the world,
especially in hospitals.
Julia Oh's lab is genetically engineering a strain of epidermidis
to attack one of the most common antibiotic-resistant bacteria.
Basically like a search and destroy bot.
[Okonedo] This souped-up epidermidis only attacks
when it senses this one particular pathogen.
[Oh] And then produces a kind of napalm in response.
[Okonedo] And finally, scientists think that microbes
train our immune systems to tell friend from foe,
so we only react to things that are actually harmful.
We don't know exactly what would happen without our microbiomes.
We've never made germ-free people.
But we have made germ-free
mice.
They grow up not having been exposed to any live microbes.
They live their lives in a bubble.
And these mice have all sorts of different defects.
[Okonedo] Without that microbial boot camp in early life, their immune systems are
confused.
They might ignore real threats,
while overreacting to harmless substances,
even attacking their own cells.
Children are growing up in more sterile environments,
and more and more of them are coming down with the disorders
of an overactive immune system.
Eczema, allergy,
asthma, hay fever.
I mean, it's skyrocketed.
[Okonedo] But not in Amish country.
Scientists report that Amish kids
have surprisingly low rates of asthma and allergies.
[Hamblin] Amish children grow up with lots of siblings,
spend lots of time outdoors,
and tend to have stables
of lots of different animals, right up against the house.
[Okonedo] They're exposed to lots of different microbes,
and that seems to help them develop a well-trained immune system.
The secret to healthy skin
is partly just not messing up your microbiome.
And for hundreds of thousands of years, humans pretty much left theirs alone.
Until they created civilization.
All over the world, humans started to wash their skin with water,
often as part of religious rituals.
Then more and more of them packed into cities,
and communicable diseases flourished as they never had before.
In the mid-19th century,
scientists discovered the culprit.
Germs.
Some of the first microbes we discovered were the ones that do us harm.
Cholera pandemics had killed millions around the globe.
The plague had wiped out nearly a third of Europe.
And in the US,
tuberculosis was responsible for a quarter of all deaths.
The idea came to be that maybe we should wash these things off.
[Okonedo] We'd been using different forms of soap for centuries,
mostly to clean laundry.
But now, public health officials started pushing for its regular use on skin.
[man 1] The aim of this technique
is to reduce the number of pathogenic organisms.
[man 2] And that's the special reason why people wash with soap.
In the early 20th century, you had the soap boom.
There were beauty soaps
bath soaps,
health soaps,
all of them fundamentally the same product.
[Okonedo] Luxury soaps for the wealthy
were more expensive, but functionally identical.
It became a branded product, and with that came advertising.
[Okonedo] Soap makers pioneered the marketing tricks
that are still used today.
Like celebrity endorsements.
This one features women's rights luminary Elizabeth Cady Stanton.
This ad,
with its sensual embrace
and risqué slogan,
was one of the first ever to prove
that sex sells.
What these products were selling was actually a sense of superiority,
whether that be to another race,
to another class.
[Okonedo] Soap ads often deployed racist caricatures,
depicting people with darker skin as dirty.
Or as savages, who needed the civilizing influence of soap.
Soap was about beauty,
and beautiful skin was white skin.
[Hamblin] Basically, if there was an insecurity that was really deeply held,
the soap industry found a way to prey upon it and promise a solution.
[Skotnicki] Soap would transform your life.
You would be more socially acceptable.
Saying it's going to make you glow and make you find a husband.
[Okonedo] And soap companies used science-y language
to bolster their claims.
They made their pitch to housewives
by funding and producing daytime radio dramas.
And these "soap operas" soon moved to TV.
The makers of Ivory soap owned The Guiding Light,
until it ended in 2009.
[man on TV] Presented by Ivory soap, the most famous soap in the world.
By the mid-20th century,
at least in wealthy countries, every person was using soap regularly.
[Okonedo] And they were using it all over their bodies every day.
Soap is a simple enough chemical,
one that can clear away the accumulated grime of civilization,
the chemicals that irritate your skin, like pollution and makeup,
and disease-causing germs.
Washing with soap has saved so many lives,
but soap also erodes the mortar in that brick wall,
disrupting your defenses.
And, because it's pretty basic,
soap can change the pH of your skin.
When we overclean and over-wash, you're preventing it from doing its job.
You've messed with the chemistry of your skin. You've changed the oils.
If the oil are sort of the soil in which your microbial ecosystem grows,
you've messed with it enough that what comes back
is a little imbalanced.
[Okonedo] Decades ago,
people didn't know about these potential problems with overusing soap.
They just noticed it could make you feel dry and itchy.
The industry found a solution for that too.
[woman on TV] Soap dries your skin,
but Dove creams your skin while you wash.
[Okonedo] Dove contained a moisturizer.
That introduced this whole new idea that you might need other products,
products to actually counteract the soaps you've been using.
You need a second thing,
which opened the door for a whole flood of other products,
besides just soap.
[Okonedo] In 1968,
Clinique debuted with a three-step routine,
which they suggested was as essential as brushing your teeth.
Some of those old soap makers diversified
and grew into international giants.
And new players entered the scene.
You had a huge explosion
of K-beauty brands coming into the Western world,
and everyone went completely mad for it.
["Gidalyuh" by A-Dream, Sara Lynn Choi & HYON D playing]
The Korean ten-step skin-care routine was something I coined many years ago.
Around 2015
is when I started to see
more and more people talking about the trend.
[Okonedo] For a few decades now,
South Korea has been trying to increase exports of its cultural goods.
K-dramas,
K-pop,
and K-beauty.
[Cho] In Korea, skin is always first.
They really value skin as being more important
than makeup or fashion.
They are quite brilliant. They're using ingredients
that a lot of brands hadn't really considered using in the past.
[Okonedo] Scientists are still figuring out
if and how all these ingredients work,
but K-beauty products in general have gotten enthusiastic reviews.
They were really well-made,
and also they were inexpensive.
If you're completely new to skin care, and you wanna get started,
I would just recommend going with a few basics.
If you're putting on sunscreen, makeup, aftershave,
you wanna wash that stuff off at the end of the day.
[Okonedo] There are now a bunch of alternatives to soap,
like synthetic detergents and oil-based cleansers,
that can be gentler on the mortar of our walls. Still…
You'd be amazed at the number of cleansers that strip your skin.
After you cleanse, usually your pH is all out of whack.
[Okonedo] And that's where toners come in.
Generally, they move your skin towards a healthy acidity,
just like your sebum does naturally.
Moisturizers can also help repair the damage of cleansing.
We have moisturizers because you have to put back what you've removed.
[Okonedo] Some moisturizers actually mimic our natural mortar.
You probably don't need to exfoliate when you're young.
Your skin does a good job replacing itself naturally.
[Fetto] As you get older,
your skin cell turnover slows down.
Your skin starts to look really dull.
So you may want to exfoliate once a week
as you get older, 40 plus.
[Okonedo] Then there are all the acne products.
Remember, your skin is covered in hair follicles,
and they can get blocked by sebum and dead cells.
If this blockage stays buried, it's a whitehead.
Expose it to air, and it oxidizes, darkening.
Bacteria can grow in these blockages.
Immune cells can rush in to fight infection,
and dead cells start to pile up.
That's the white stuff inside of a zit.
We still don't fully understand all the factors leading to acne,
genetics, hormones, bacteria,
all the stuff we put on our skin, or how they interact.
Dermatologists argue about the role of diet.
It seems like greasy foods aren't a problem,
but sugary foods might be.
But we do know one thing. Acne isn't caused by dirty skin.
I had pretty bad acne as a teenager.
I was under the idea
that if I used soap and washed three times a day,
I could get off whatever these microbes were
that was causing me to break out.
And it seems pretty clear that I was probably making things worse.
[Okonedo] Some scientists think the best way to treat acne
might be to add bacteria to our skin
to establish a balanced, healthy microbiome.
[Fetto] So, the word anti-aging…
It's a problem.
It makes it automatically feel like
there is something wrong
with you having wrinkles.
You want to age. That is a natural process of life.
[Okonedo] Below your epidermis is a thicker dermis layer
that's woven through with proteins called elastin and collagen.
When your skin is stretched, this matrix helps it bounce back.
And as we age, we produce less and less,
which allows the skin to fold and wrinkle.
Certain things speed up this process.
Toxins, pollution,
and the sun's UV rays, which can also cause cancer.
A pigment called melanin produced in these cells
can block some of these rays.
The more melanin you have, the darker your skin is.
And that extra protection means darker skin seems to age slower.
But we still need SPF,
because we are still susceptible to the UV rays of the sun.
[Okonedo] Most other anti-aging ingredients
aren't backed up by a lot of evidence.
The only thing that's really been proven scientifically
with good studies
is retinoic acid and retinol.
[Okonedo] These spur the production of collagen,
but can irritate your skin and shouldn't be used by pregnant women.
To recap, your skin is doing a lot naturally,
so try to avoid using, or overusing, products that mess that up.
A lot of exfoliating scrubs and harsher, foamy soaps
can damage your brick wall.
Look for cleansers with a low pH.
And if you're concerned about a skin condition,
talk to a dermatologist. There might be treatments that can help.
But don't worry too much about a few zits.
The idea that we all need to be completely rid of these things all the time
is artificial.
The industry has a way of pathologizing irregularities
that are not actual medical issues.
Having pimples
is not necessarily a problem.
[Okonedo] Just like a century ago,
skin care ads today play up science-y images and language.
The latest buzzwords are pre and probiotic.
These products are supposed to enhance your skin microbiome.
We don't have evidence that any of these products
are helpful in themselves.
[Okonedo] But in one respect, the industry appears
to have radically changed.
[Fetto] We may look at advertising right now
and believe that
the skin care industry is incredibly inclusive.
But that's just forward facing.
So many brands that I speak to,
the journey their product has taken
from conception
to when it actually hits the shelves,
in no part of that journey
has there been anyone that is not Caucasian.
[Okonedo] When Dove released this ad in 2017,
some saw ugly echoes of an earlier time.
Dove apologized, and took down the ad,
but Dove's parent company Unilever sells products
that are designed to whiten your skin.
[Fetto] Quite a few brands, huge brands,
have developed skin-lightening creams,
and they've been selling those for years.
Following the death of George Floyd
and all the protests that happened all over the world,
rather than taking these products off the market,
they just changed their names.
It's solved nothing.
What is the messaging?
Whiter is better.
[echoing] Whiter is better.
[Okonedo] We're told we need to have lighter skin, cleaner skin, dewy,
glowing, poreless skin.
And we need more products to get us there.
We are using way too many products on our skin.
If we're healthy doing less,
why don't we do less?
I use water only.
I always wash my hands.
I'm very good about washing my hands with soap,
but the rest of my body is just water.
You both get used to the feeling, and your body seems to adapt a little bit.
Oh my God. I mean,
that would not work for me. It just wouldn't.
I think my skin would freak out.
So I don't think any skin needs 15 products,
but I don't think every skin only needs three products.
[Okonedo] And remember, products aren't the only way we influence our skin.
Skin is actually a beacon for our overall health.
[Hamblin] How we're sleeping, how we're eating,
how much stress we're under.
[Okonedo] Staying hydrated, exercising, spending time outdoors.
All of those factors really have an impact on what your skin looks like.
There are so many different ways to take care of your skin correctly.
There are so many different ways to do it right.
You are a unique individual. You have co-evolved with your microbes.
Skin care can be a fun place
to discover that unique part about yourself.
And…
there are lots of ways to be normal.
[closing theme music playing]