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[upbeat music playing]

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[narrator] There's a reason skin care
commercials don't zoom in that close.

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And if they do,
it's this pristine, animated landscape.

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A real close-up of skin
can be a little unsettling.

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Ew!

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Ew. What is that?

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[gasps]

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[narrator] Even the most perfect skin
is a rough and broken terrain,

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crisscrossed with oily gullies
and studded with hairs.

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And in this strange land,

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there be dragons.

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Scientists believe these Demodex mites
are on the face of every adult human.

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There are almost certainly some burrowed
into your face follicles right now.

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And they are far from alone.

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Our skin hosts vast herds
of bacteria, fungi,

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and even miniscule viruses.

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This isn't a harmful infestation.

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In fact, we need many
of these microscopic passengers

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to keep our skin healthy.

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But skin care companies
tell a very different story.

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Mainly, that what you need

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is an overwhelming array of products.

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[announcers] The first
acne-proofing gel cleanser.

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- Hyaluronic acid serum.
- Micro-sculpting cream.

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It's a cleanser and a mask.

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Hydration is the foundation
of healthy skin.

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Wake up to younger-looking skin
in just five...

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-[voices overlapping]
-[silence]

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[narrator] Can we trust all these products
to do what they promise?

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And is there some secret
to healthy, beautiful skin?

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[man 1] Let's begin with the skin,

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by taking a look at it
from the doctor's point of view.

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She has lovely skin.
That's what I was most impressed by.

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[man 2] If you keep your skin clean,
there's less chance

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that a disease will be able
to get started.

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If my skin's fresh and healthy-looking,

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I guess it's 'cause
I've gotten down to basics.

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From your chin to your ears.

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From your nostrils to the temples.

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[man 3] The healthy skin
is a beautiful skin.

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[Okonedo] If there's one thing the experts
want you to know about skin, it's that...

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It is our largest organ.

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Our largest organ.

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Our largest organ.

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[Okonedo] Skin is your immune system's
first and best line of defense.

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I like to use the analogy of a brick wall.

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So, the bricks are the cells,

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and the mortar is our natural oils.

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[Okonedo] This wall, the epidermis,

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is completely rebuilt about once a month.

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New cells are born down here

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and make their way to the surface,
where they flake off.

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The pores you can see are actually
the openings of hair follicles.

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They're nearly everywhere on your body,
not just the places that look hairy.

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Glands attached to the follicles put out
an oily, waxy substance called sebum.

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[Skotnicki] That helps lubricate our skin
and acidify our skin.

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[Okonedo] Your skin's pH isn't neutral.
It's closer to five.

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And that makes it harder
for harmful bacteria to grow.

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If your protective brick wall breaks down,

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it's easier for foreign particles
or germs to get in.

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Your immune system will leap into action,

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your skin will get red and itchy.

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And this whole army of immune cells
will detect and attack the intruders.

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And then, of course, there's the most
remarkable feature of your skin.

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The host of creatures who call it home.

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Billions of years before we evolved,

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microbes colonized
every corner of the globe.

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From Arctic glaciers,

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to sulfurous pools,

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to volcanic vents in the ocean floor.

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When skin finally showed up,

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that was just
one more habitat to colonize.

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You actually have trillions
of different bacteria, fungi,

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viruses, protozoa,

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even small insects.

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The skin has a very striking diversity
of different environments.

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[Okonedo] Your face is an oily marshland.

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Your armpits are dark, wet jungles.

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Your forearms are dry savannas.

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Your microbiome is first formed
when you are born into the world.

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You're suddenly populated
by your mother's biome,

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and that forms
the sort of concrete foundation

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that's going to stick with you
for the rest of your life.

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[Okonedo] And as you grow,
it continues to develop,

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shaped by your experiences.

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[Oh] So, that can be

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where you live,

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if you have pets,

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who you live with,

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and who you encounter on a regular basis.

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Each of us
have kind of a unique signature.

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[Okonedo] Scientists spent
the last couple of decades

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learning which species live where.

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Now they're trying to figure out
what all those critters are up to.

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There's a bacillus bacteria
living in between our toes

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that eats a compound
in our sweat called leucine,

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and it contributes
to that rank and sweaty foot smell.

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Why on earth would we want
to coevolve with this microbe

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that produces bad odors?

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It turns out that this bacillus

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is a very potent inhibitor
of fungal infections.

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[Okonedo] Our feet produce
a weird amount of leucine.

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It's almost as if our bodies
are laying out a feast for these bacteria

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so they'll keep us
from getting athlete's foot.

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Then there's Staphylococcus epidermidis,

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which is found at different sites
all over the body.

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Yeah, we love staph epidermidis.

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It can recruit immune cell types

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that allow us to heal wounds
and combat infection.

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- They can kill pathogenic bacteria.
-[bacteria shouts]

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[Okonedo] Antibiotics can do that too.

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[bacteria scream]

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Though helpful bacteria
are often collateral damage,

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and some pathogens are evolving
resistance to these drugs.

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It's a terrifying trend around the world,

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especially in hospitals.

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Julia Oh's lab is genetically engineering
a strain of epidermidis

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to attack one of the most common
antibiotic-resistant bacteria.

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Basically like a search and destroy bot.

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[Okonedo] This souped-up epidermidis
only attacks

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when it senses
this one particular pathogen.

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[Oh] And then produces
a kind of napalm in response.

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[Okonedo] And finally,
scientists think that microbes

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train our immune systems
to tell friend from foe,

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so we only react to things
that are actually harmful.

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We don't know exactly what would
happen without our microbiomes.

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We've never made germ-free people.

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But we have made germ-free

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mice.

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They grow up not having been exposed
to any live microbes.

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They live their lives in a bubble.

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And these mice
have all sorts of different defects.

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[Okonedo] Without that microbial boot camp
in early life, their immune systems are

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confused.

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They might ignore real threats,

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while overreacting to harmless substances,

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even attacking their own cells.

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Children are growing up
in more sterile environments,

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and more and more of them
are coming down with the disorders

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of an overactive immune system.

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Eczema, allergy,

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asthma, hay fever.

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I mean, it's skyrocketed.

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[Okonedo] But not in Amish country.

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Scientists report that Amish kids

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have surprisingly low rates
of asthma and allergies.

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[Hamblin] Amish children grow up
with lots of siblings,

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spend lots of time outdoors,

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and tend to have stables

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of lots of different animals,
right up against the house.

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[Okonedo] They're exposed
to lots of different microbes,

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and that seems to help them develop
a well-trained immune system.

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The secret to healthy skin

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is partly just not messing up
your microbiome.

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And for hundreds of thousands of years,
humans pretty much left theirs alone.

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Until they created civilization.

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All over the world, humans started
to wash their skin with water,

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often as part of religious rituals.

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Then more and more of them
packed into cities,

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and communicable diseases flourished
as they never had before.

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In the mid-19th century,

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scientists discovered the culprit.

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Germs.

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Some of the first microbes we discovered
were the ones that do us harm.

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Cholera pandemics
had killed millions around the globe.

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The plague had wiped out
nearly a third of Europe.

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And in the US,

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tuberculosis was responsible
for a quarter of all deaths.

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The idea came to be that maybe
we should wash these things off.

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[Okonedo] We'd been using
different forms of soap for centuries,

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mostly to clean laundry.

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But now, public health officials started
pushing for its regular use on skin.

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[man 1] The aim of this technique

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is to reduce the number
of pathogenic organisms.

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[man 2] And that's the special reason
why people wash with soap.

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In the early 20th century,
you had the soap boom.

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There were beauty soaps

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bath soaps,

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health soaps,

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all of them
fundamentally the same product.

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[Okonedo] Luxury soaps for the wealthy

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were more expensive,
but functionally identical.

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It became a branded product,
and with that came advertising.

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[Okonedo] Soap makers pioneered
the marketing tricks

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that are still used today.

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Like celebrity endorsements.

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This one features women's rights luminary
Elizabeth Cady Stanton.

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This ad,

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with its sensual embrace

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and risqué slogan,

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was one of the first ever to prove

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that sex sells.

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What these products were selling
was actually a sense of superiority,

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whether that be to another race,

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to another class.

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[Okonedo] Soap ads often deployed
racist caricatures,

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depicting people with darker skin
as dirty.

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Or as savages, who needed
the civilizing influence of soap.

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Soap was about beauty,

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and beautiful skin was white skin.

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[Hamblin] Basically, if there was
an insecurity that was really deeply held,

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the soap industry found a way
to prey upon it and promise a solution.

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[Skotnicki]
Soap would transform your life.

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You would be more socially acceptable.

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Saying it's going to make you glow
and make you find a husband.

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[Okonedo] And soap companies
used science-y language

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to bolster their claims.

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They made their pitch to housewives

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by funding and producing
daytime radio dramas.

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And these "soap operas" soon moved to TV.

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The makers of Ivory soap
owned The Guiding Light,

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until it ended in 2009.

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[man on TV] Presented by Ivory soap,
the most famous soap in the world.

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By the mid-20th century,

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at least in wealthy countries,
every person was using soap regularly.

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[Okonedo] And they were using it
all over their bodies every day.

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Soap is a simple enough chemical,

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one that can clear away
the accumulated grime of civilization,

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the chemicals that irritate your skin,
like pollution and makeup,

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and disease-causing germs.

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Washing with soap has saved so many lives,

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but soap also erodes the mortar
in that brick wall,

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disrupting your defenses.

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And, because it's pretty basic,

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soap can change the pH of your skin.

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When we overclean and over-wash,
you're preventing it from doing its job.

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You've messed with the chemistry
of your skin. You've changed the oils.

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If the oil are sort of the soil
in which your microbial ecosystem grows,

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you've messed with it enough
that what comes back

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is a little imbalanced.

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[Okonedo] Decades ago,

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people didn't know about these
potential problems with overusing soap.

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They just noticed
it could make you feel dry and itchy.

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The industry
found a solution for that too.

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[woman on TV] Soap dries your skin,

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but Dove creams your skin while you wash.

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[Okonedo] Dove contained a moisturizer.

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That introduced this whole new idea
that you might need other products,

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products to actually counteract
the soaps you've been using.

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You need a second thing,

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which opened the door
for a whole flood of other products,

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besides just soap.

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[Okonedo] In 1968,

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Clinique debuted
with a three-step routine,

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which they suggested
was as essential as brushing your teeth.

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00:12:10,400 --> 00:12:13,070
Some of those old soap makers diversified

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and grew into international giants.

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And new players entered the scene.

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You had a huge explosion

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00:12:20,700 --> 00:12:23,830
of K-beauty brands
coming into the Western world,

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and everyone went completely mad for it.

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["Gidalyuh" by A-Dream, Sara Lynn Choi
and HYON D playing]

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The Korean ten-step skin-care routine
was something I coined many years ago.

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Around 2015

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is when I started to see

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00:12:42,510 --> 00:12:45,680
more and more people
talking about the trend.

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[Okonedo] For a few decades now,

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South Korea has been trying
to increase exports of its cultural goods.

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K-dramas,

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K-pop,

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and K-beauty.

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[Cho] In Korea, skin is always first.

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00:13:00,780 --> 00:13:04,620
They really value skin
as being more important

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than makeup or fashion.

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00:13:07,240 --> 00:13:10,250
They are quite brilliant.
They're using ingredients

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00:13:10,330 --> 00:13:13,630
that a lot of brands hadn't really
considered using in the past.

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00:13:22,510 --> 00:13:24,300
[Okonedo] Scientists
are still figuring out

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00:13:24,390 --> 00:13:26,760
if and how all these ingredients work,

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00:13:26,850 --> 00:13:30,350
but K-beauty products in general
have gotten enthusiastic reviews.

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They were really well-made,

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and also they were inexpensive.

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If you're completely new to skin care,
and you wanna get started,

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I would just recommend
going with a few basics.

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If you're putting on sunscreen,
makeup, aftershave,

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you wanna wash that stuff off
at the end of the day.

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[Okonedo] There are now
a bunch of alternatives to soap,

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like synthetic detergents
and oil-based cleansers,

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00:13:54,120 --> 00:13:57,550
that can be gentler
on the mortar of our walls. Still...

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You'd be amazed at the number
of cleansers that strip your skin.

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00:14:01,260 --> 00:14:04,840
After you cleanse,
usually your pH is all out of whack.

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[Okonedo] And that's where toners come in.

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Generally, they move your skin
towards a healthy acidity,

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just like your sebum does naturally.

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00:14:14,520 --> 00:14:17,650
Moisturizers can also help
repair the damage of cleansing.

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00:14:17,730 --> 00:14:20,530
We have moisturizers because
you have to put back what you've removed.

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00:14:20,610 --> 00:14:24,150
[Okonedo] Some moisturizers
actually mimic our natural mortar.

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00:14:25,070 --> 00:14:27,780
You probably don't need
to exfoliate when you're young.

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00:14:27,870 --> 00:14:30,790
Your skin does a good job
replacing itself naturally.

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00:14:30,870 --> 00:14:32,160
[Fetto] As you get older,

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00:14:32,250 --> 00:14:35,670
your skin cell turnover slows down.

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00:14:35,750 --> 00:14:38,000
Your skin starts to look really dull.

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00:14:38,090 --> 00:14:40,590
So you may want to exfoliate once a week

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00:14:40,670 --> 00:14:42,630
as you get older, 40 plus.

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[Okonedo] Then there are
all the acne products.

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00:14:46,390 --> 00:14:49,680
Remember,
your skin is covered in hair follicles,

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00:14:49,760 --> 00:14:52,560
and they can get blocked
by sebum and dead cells.

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00:14:53,310 --> 00:14:56,400
If this blockage stays buried,
it's a whitehead.

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00:14:56,480 --> 00:14:59,400
Expose it to air,
and it oxidizes, darkening.

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00:15:00,440 --> 00:15:02,740
Bacteria can grow in these blockages.

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00:15:02,820 --> 00:15:05,360
Immune cells can rush in
to fight infection,

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00:15:05,450 --> 00:15:07,450
and dead cells start to pile up.

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00:15:07,530 --> 00:15:09,870
That's the white stuff inside of a zit.

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00:15:10,530 --> 00:15:13,540
We still don't fully understand
all the factors leading to acne,

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00:15:13,620 --> 00:15:15,870
genetics, hormones, bacteria,

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00:15:15,960 --> 00:15:19,380
all the stuff we put on our skin,
or how they interact.

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00:15:19,460 --> 00:15:22,090
Dermatologists argue
about the role of diet.

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00:15:22,170 --> 00:15:24,760
It seems like greasy foods
aren't a problem,

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00:15:24,840 --> 00:15:26,930
but sugary foods might be.

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00:15:27,010 --> 00:15:30,890
But we do know one thing.
Acne isn't caused by dirty skin.

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00:15:30,970 --> 00:15:34,350
I had pretty bad acne as a teenager.

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00:15:34,430 --> 00:15:36,230
I was under the idea

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00:15:36,310 --> 00:15:39,360
that if I used soap
and washed three times a day,

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00:15:39,440 --> 00:15:41,360
I could get off
whatever these microbes were

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00:15:41,440 --> 00:15:43,900
that was causing me to break out.

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00:15:43,980 --> 00:15:48,030
And it seems pretty clear
that I was probably making things worse.

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00:15:48,700 --> 00:15:51,330
[Okonedo] Some scientists think
the best way to treat acne

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00:15:51,410 --> 00:15:53,830
might be to add bacteria to our skin

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00:15:53,910 --> 00:15:57,210
to establish a balanced,
healthy microbiome.

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00:15:59,920 --> 00:16:02,630
[Fetto] So, the word anti-aging...

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00:16:05,090 --> 00:16:06,220
It's a problem.

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00:16:06,300 --> 00:16:09,220
It makes it automatically feel like

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00:16:09,300 --> 00:16:10,970
there is something wrong

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00:16:11,050 --> 00:16:13,510
with you having wrinkles.

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00:16:13,600 --> 00:16:17,100
You want to age.
That is a natural process of life.

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00:16:17,770 --> 00:16:20,560
[Okonedo] Below your epidermis
is a thicker dermis layer

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00:16:20,650 --> 00:16:24,320
that's woven through with proteins
called elastin and collagen.

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00:16:24,400 --> 00:16:27,570
When your skin is stretched,
this matrix helps it bounce back.

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00:16:28,200 --> 00:16:30,910
And as we age, we produce less and less,

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00:16:30,990 --> 00:16:33,370
which allows the skin to fold and wrinkle.

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00:16:33,950 --> 00:16:36,580
Certain things speed up this process.

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00:16:36,660 --> 00:16:38,710
Toxins, pollution,

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00:16:38,790 --> 00:16:41,920
and the sun's UV rays,
which can also cause cancer.

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00:16:42,000 --> 00:16:45,170
A pigment called melanin
produced in these cells

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00:16:45,250 --> 00:16:47,170
can block some of these rays.

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00:16:47,260 --> 00:16:49,630
The more melanin you have,
the darker your skin is.

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00:16:49,720 --> 00:16:53,430
And that extra protection
means darker skin seems to age slower.

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00:16:53,510 --> 00:16:55,060
But we still need SPF,

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00:16:55,140 --> 00:16:59,100
because we are still susceptible
to the UV rays of the sun.

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00:16:59,180 --> 00:17:01,270
[Okonedo] Most other
anti-aging ingredients

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00:17:01,350 --> 00:17:03,770
aren't backed up by a lot of evidence.

341
00:17:03,860 --> 00:17:07,190
The only thing
that's really been proven scientifically

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00:17:07,280 --> 00:17:08,990
with good studies

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00:17:09,070 --> 00:17:11,160
is retinoic acid and retinol.

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00:17:11,910 --> 00:17:14,240
[Okonedo] These spur
the production of collagen,

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00:17:14,320 --> 00:17:18,290
but can irritate your skin and shouldn't
be used by pregnant women.

346
00:17:20,250 --> 00:17:23,830
To recap,
your skin is doing a lot naturally,

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00:17:23,920 --> 00:17:27,460
so try to avoid using, or overusing,
products that mess that up.

348
00:17:28,050 --> 00:17:31,470
A lot of exfoliating scrubs
and harsher, foamy soaps

349
00:17:31,550 --> 00:17:33,470
can damage your brick wall.

350
00:17:33,550 --> 00:17:35,930
Look for cleansers with a low pH.

351
00:17:36,010 --> 00:17:38,390
And if you're concerned
about a skin condition,

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00:17:38,470 --> 00:17:41,520
talk to a dermatologist.
There might be treatments that can help.

353
00:17:42,020 --> 00:17:44,690
But don't worry too much about a few zits.

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00:17:44,770 --> 00:17:48,280
The idea that we all need to be completely
rid of these things all the time

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00:17:48,360 --> 00:17:49,820
is artificial.

356
00:17:49,900 --> 00:17:53,740
The industry has a way
of pathologizing irregularities

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00:17:53,820 --> 00:17:55,910
that are not actual medical issues.

358
00:17:55,990 --> 00:17:57,990
Having pimples

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00:17:58,080 --> 00:18:00,620
is not necessarily a problem.

360
00:18:01,540 --> 00:18:03,540
[Okonedo] Just like a century ago,

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00:18:03,620 --> 00:18:07,130
skin care ads today play up
science-y images and language.

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00:18:07,210 --> 00:18:10,550
The latest buzzwords
are pre and probiotic.

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00:18:10,630 --> 00:18:14,010
These products are supposed
to enhance your skin microbiome.

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00:18:14,090 --> 00:18:17,180
We don't have evidence
that any of these products

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00:18:17,260 --> 00:18:19,100
are helpful in themselves.

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00:18:19,680 --> 00:18:22,140
[Okonedo] But in one respect,
the industry appears

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00:18:22,230 --> 00:18:23,810
to have radically changed.

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00:18:23,890 --> 00:18:26,270
[Fetto] We may look at
advertising right now

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00:18:26,360 --> 00:18:28,190
and believe that

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00:18:28,270 --> 00:18:32,190
the skin care industry
is incredibly inclusive.

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00:18:32,820 --> 00:18:34,820
But that's just forward facing.

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00:18:35,450 --> 00:18:38,370
So many brands that I speak to,

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00:18:38,450 --> 00:18:40,830
the journey their product has taken

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00:18:40,910 --> 00:18:42,750
from conception

375
00:18:42,830 --> 00:18:45,120
to when it actually hits the shelves,

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00:18:45,210 --> 00:18:47,420
in no part of that journey

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00:18:47,500 --> 00:18:51,380
has there been anyone
that is not Caucasian.

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00:18:52,880 --> 00:18:55,720
[Okonedo] When Dove released
this ad in 2017,

379
00:18:56,390 --> 00:18:59,300
some saw ugly echoes of an earlier time.

380
00:18:59,390 --> 00:19:02,220
Dove apologized, and took down the ad,

381
00:19:02,310 --> 00:19:05,140
but Dove's parent company Unilever
sells products

382
00:19:05,230 --> 00:19:08,190
that are designed to whiten your skin.

383
00:19:08,270 --> 00:19:10,270
[Fetto] Quite a few brands, huge brands,

384
00:19:10,360 --> 00:19:13,150
have developed skin-lightening creams,

385
00:19:13,240 --> 00:19:15,240
and they've been selling those for years.

386
00:19:15,990 --> 00:19:18,410
Following the death of George Floyd

387
00:19:18,490 --> 00:19:22,540
and all the protests
that happened all over the world,

388
00:19:22,620 --> 00:19:25,330
rather than taking
these products off the market,

389
00:19:25,410 --> 00:19:27,540
they just changed their names.

390
00:19:27,620 --> 00:19:29,460
It's solved nothing.

391
00:19:29,540 --> 00:19:31,000
What is the messaging?

392
00:19:31,090 --> 00:19:33,170
Whiter is better.

393
00:19:33,260 --> 00:19:35,090
[echoing] Whiter is better.

394
00:19:35,170 --> 00:19:38,760
[Okonedo] We're told we need to have
lighter skin, cleaner skin, dewy,

395
00:19:38,840 --> 00:19:40,550
glowing, poreless skin.

396
00:19:40,640 --> 00:19:43,520
And we need more products to get us there.

397
00:19:44,270 --> 00:19:48,350
We are using
way too many products on our skin.

398
00:19:48,440 --> 00:19:50,520
If we're healthy doing less,

399
00:19:50,610 --> 00:19:52,570
why don't we do less?

400
00:19:52,650 --> 00:19:54,740
I use water only.

401
00:19:55,400 --> 00:19:56,740
I always wash my hands.

402
00:19:56,820 --> 00:19:59,280
I'm very good about
washing my hands with soap,

403
00:19:59,360 --> 00:20:02,620
but the rest of my body is just water.

404
00:20:02,700 --> 00:20:07,500
You both get used to the feeling,
and your body seems to adapt a little bit.

405
00:20:08,210 --> 00:20:09,960
Oh my God. I mean,

406
00:20:10,040 --> 00:20:12,960
that would not work for me.
It just wouldn't.

407
00:20:13,050 --> 00:20:15,170
I think my skin would freak out.

408
00:20:15,260 --> 00:20:19,220
So I don't think
any skin needs 15 products,

409
00:20:19,300 --> 00:20:22,800
but I don't think every skin
only needs three products.

410
00:20:23,600 --> 00:20:27,520
[Okonedo] And remember, products aren't
the only way we influence our skin.

411
00:20:27,600 --> 00:20:30,900
Skin is actually a beacon
for our overall health.

412
00:20:30,980 --> 00:20:33,020
[Hamblin] How we're sleeping,
how we're eating,

413
00:20:33,110 --> 00:20:34,650
how much stress we're under.

414
00:20:34,730 --> 00:20:38,570
[Okonedo] Staying hydrated, exercising,
spending time outdoors.

415
00:20:38,650 --> 00:20:42,370
All of those factors really have an impact
on what your skin looks like.

416
00:20:42,450 --> 00:20:46,290
There are so many different ways
to take care of your skin correctly.

417
00:20:46,370 --> 00:20:48,960
There are so many different ways
to do it right.

418
00:20:49,040 --> 00:20:52,630
You are a unique individual.
You have co-evolved with your microbes.

419
00:20:52,710 --> 00:20:54,340
Skin care can be a fun place

420
00:20:54,420 --> 00:20:57,630
to discover
that unique part about yourself.

421
00:20:57,710 --> 00:20:59,170
And...

422
00:21:01,840 --> 00:21:04,260
there are lots of ways to be normal.

423
00:21:05,180 --> 00:21:08,980
[closing theme music playing]