How to Build a Skincare Routine: A Dermatologist’s Guide to What Your Skin Actually Needs

Reviewed by Dr Matete Mathobela – Specialist Dermatologist practising in Century City, Cape Town, Cape Gate Mediclinic and Life West Coast Private Hospital. Founder of MD Cosmeceuticals by Matete Derma and MD Dermoutlet.

Medical Disclaimer: This article is intended for educational purposes only and does not replace individual medical advice, diagnosis or treatment. If you have a persistent skin condition or are considering prescription skincare or professional procedures, consult an appropriately qualified healthcare professional.

Introduction

If you are trying to work out how to build a skincare routine, it is easy to feel as though you need a cleanser, toner, exfoliant, Vitamin C serum, hyaluronic acid, retinol, eye cream, peptides and several other products before your routine is complete.

You don’t.

Healthy skin does not require a complicated routine. A better approach is to establish the essentials first and then add products or treatments only when there is a reason for them.

This principle is supported by the Skin Health and Beauty Pyramid, first proposed by Mayoral, Kenner and Draelos and later updated by dermatologist Dr Zoe Draelos. The framework places protection and repair at the foundation, followed by renewal and, finally, more advanced approaches to activation and regeneration.

Using this concept together with established principles of basic dermatological skincare, we can simplify how to build a skincare routine into four practical levels:

FOUNDATION → PREVENT → TREAT → OPTIMISE

These are not four stages that everyone needs to complete. They are a way of deciding what your skin actually needs and what can remain optional.

2-Minute Read

Every skincare routine should begin with the foundation: appropriate cleansing, moisturisation according to the needs of your skin, and photoprotection.

Once that foundation is established, additional skincare can be considered according to your age, skin concerns and goals.

The important point is that more skincare does not automatically mean better skincare.

A teenager with healthy skin may need only Level 1. Someone in their 20s interested in prevention may add selected Level 2 products. A young adult with acne may require Level 3 treatment without needing an elaborate anti-ageing routine. Someone with healthy skin who wants further rejuvenation may choose to explore Level 4.

In a Nutshell

If you remember only five things from this guide:

• Start with the foundation.
• Photoprotection is one of the most important preventative measures for long-term skin health.
• Add healthy-ageing ingredients when they become relevant to your skin and goals, rather than simply because you reach a particular birthday.
• Targeted treatment should have a specific target and, particularly for skin disease or persistent concerns, should be guided by a dermatologist.
• Advanced skincare and aesthetic procedures are optional optimisation, not requirements for healthy skin.

What You’ll Learn

By the end of this guide, you should understand:

• How to build a skincare routine from the basics upwards
• What belongs in a basic skincare routine
• How to adapt the foundation to different skin types
• When to start thinking about prevention and healthy ageing
• Where antioxidants, Vitamin C and retinoids fit
• When skincare becomes targeted treatment
• Where professional treatments such as chemical peels, lasers and microneedling fit
• Where PRX, BioRePeel, WonderM and botulinum toxin may fit
• Why you may never need every level of the skincare pyramid

Why Skincare Should Be Built From the Bottom Up

The Skin Health and Beauty Pyramid provides a useful way of thinking about skincare because it recognises that not every product has the same priority.

In the updated model, Draelos divides skincare into three broad levels:

Protection and repair → renewal → activation and regeneration.

Protection forms the base. Renewal comes next. More sophisticated regenerative approaches sit towards the top.

Modern skincare routines can easily reverse this order. Someone may be using peptides, multiple serums, exfoliating acids and advanced treatments while inconsistently applying sunscreen or struggling with an irritated skin barrier.

When deciding how to build a skincare routine, it therefore helps to ask one question first:

What does my skin actually need?

Only after establishing that foundation do we need to consider what else could be beneficial.

LEVEL 1: FOUNDATION — The Basic Skincare Routine

For most people, the foundation is remarkably simple:

Cleanse. Moisturise. Protect.

These principles remain the same, but how we achieve them differs from person to person.

The Basic Routine Changes With Your Skin

A good foundation should respond to the skin in front of you. In particular, the type of cleanser and moisturiser you choose should reflect your skin type and circumstances.

And What About Sunscreen?

Photoprotection remains part of the foundation across all of these groups.

For adults, a broad-spectrum sunscreen of at least SPF 30 should be used on exposed skin, with SPF 50+ often preferred when UV exposure is high or when managing conditions in which UV or visible light can contribute, such as melasma and other pigmentation disorders.

The sunscreen itself can still be individualised.

Oily or acne-prone skin may do better with a lightweight, non-comedogenic formulation. Dry skin may prefer a more moisturising sunscreen, while sensitive skin may require a formulation chosen for better tolerability.

For people with melasma or post-inflammatory hyperpigmentation, particularly in darker skin phototypes, a tinted sunscreen containing iron oxides can provide additional protection against visible light.

For babies and young children, photoprotection also includes shade, protective clothing and hats, with sunscreen use adapted appropriately to age.

The principle is therefore simple:

The foundation stays the same. How we achieve it changes according to the skin.

Does Everyone Need a Moisturiser?

Not everyone needs the same amount or type of moisturiser.

Someone with very dry or eczema-prone skin may need a rich moisturiser more than once daily and over large areas of the body. Someone with oily skin may need only a lightweight moisturiser, while some people may find that a moisturising sunscreen provides sufficient hydration during the day.

The goal is not to apply moisturiser simply because it appears on a skincare checklist.

The goal is to maintain comfortable, adequately hydrated skin and support normal barrier function.

Why Sunscreen Deserves Special Attention

In the Skin Health and Beauty Pyramid, photoprotection sits at the foundation of skincare for a reason.

Ultraviolet radiation contributes to:

• Photoageing
• Fine lines and wrinkles
• Uneven pigmentation
• Changes in skin texture
• DNA damage
• Skin cancer

For conditions such as melasma and post-inflammatory hyperpigmentation, visible light may also contribute to pigmentation, particularly in darker skin phototypes.

Sunscreen therefore should not be viewed only as an anti-ageing product.

It is part of basic preventative skin health.

Who May Benefit From Keeping Skincare at the Foundation Level?

Potentially, many people.

Learning how to build a skincare routine also means recognising when you don’t need to add anything else.

There is one important exception to the idea of “staying” at Level 1.

Someone receiving treatment for acne, eczema, pigmentation or another dermatological condition may require Level 3 treatment, but the foundation still remains underneath that treatment. Gentle cleansing, appropriate moisturisation and photoprotection can become even more important when prescription or potentially irritating treatments are being used.

What Professional Treatments Are Needed at Level 1?

None are required.

Professional treatments are not necessary simply to maintain healthy skin.

Someone may choose an occasional gentle facial or hydrating treatment because they enjoy it or like the cosmetic effect, but these should be considered optional rather than an essential component of basic skin health.

This is an important distinction when deciding how to build a skincare routine: professional treatments should complement good everyday skincare, not replace it.

LEVEL 2: PREVENT — When Should You Start Thinking About Healthy Ageing?

There is no single birthday when everyone suddenly needs an “anti-ageing” routine.

Skin ageing reflects a combination of intrinsic ageing and external exposure, particularly cumulative ultraviolet radiation. Genetics, skin phototype, smoking, pollution, lifestyle and previous sun exposure can all influence when and how visible ageing develops.

Photoprotection therefore starts long before wrinkles appear.

For adults interested in prevention, additional healthy-ageing skincare often becomes relevant during the 20s and early 30s, but age should be a guide rather than a rule.

What Can You Add for Prevention?

Keep the Level 1 foundation and add only what has a useful purpose.

You do not automatically need everything in this table.

For some people, prevention may simply mean excellent daily sunscreen use plus one well-chosen antioxidant or retinoid.

A simple preventative routine might look like:

Morning: Cleanse → Vitamin C → moisturiser if needed → sunscreen

Evening: Cleanse → retinoid → moisturiser

This should always be modified according to skin sensitivity, tolerability, pregnancy and other individual factors.

Age Is Only One Part of the Decision

A 24-year-old with significant acne and post-inflammatory hyperpigmentation may require dermatologist-directed treatment and therefore move directly from the foundation into Level 3: TREAT.

A 34-year-old with healthy but sensitive skin and very little photoageing may choose to remain predominantly within Levels 1 and 2.

A 50-year-old who is happy with their skin and wants a minimal routine may also choose to keep things simple.

This is why how to build a skincare routine cannot be determined by age alone.

Professional Treatments at the Prevention Level

Professional treatments remain optional.

For someone with healthy skin who wants to maintain skin quality or address very early signs of photoageing, selected options may include:

• Superficial chemical peels
• Gentle rejuvenating treatments
• Microneedling
• Selected laser treatments

The treatment should still be appropriate for the person’s skin type, skin phototype, goals and risk of complications such as post-inflammatory hyperpigmentation.

At this level, procedures are not being used because healthy skin requires them. They are elective additions for someone who wants to do more.

You Don’t Have to Climb the Entire Skincare Pyramid

This is one of the most important principles when learning how to build a skincare routine.

The four levels are not a ladder that everyone is expected to climb.

Someone with a skin condition does not need to complete the prevention level before receiving treatment, and someone interested in healthy ageing does not automatically need advanced procedures.

The framework is there to help prioritise what matters.

Start with the foundation. Add what your skin needs. Leave out what it doesn’t.

LEVEL 3: TREAT — When Skincare Becomes Treatment

The first two levels focus primarily on maintaining healthy skin and supporting healthy ageing. Level 3 is different.

You enter the treatment level because there is a specific skin concern or diagnosed condition that needs to be addressed.

This can happen at any age. A teenager with acne may need Level 3 treatment, while an older adult with healthy skin may not.

The key principle is:

Targeted skincare should have a target.

Rather than adding active ingredients because they are popular, treatment should be selected according to the condition being treated, skin type and phototype, previous treatments and individual tolerance.

For persistent skin concerns or skin disease, treatment should ideally be guided by a dermatologist, particularly when prescription medication, stronger active ingredients or professional procedures are being considered.

What Conditions May Need Targeted Treatment?

Different conditions require different approaches. Even when two conditions look similar, the underlying diagnosis may change the treatment completely.

Skin protection remains part of treatment across all of these conditions. The most appropriate sunscreen may differ according to skin type, diagnosis and treatment. Acne-prone skin may prefer a lightweight, non-comedogenic formulation, while sensitive or eczema-prone skin may require a particularly well-tolerated sunscreen. Pigmentation-prone skin may benefit from tinted sunscreen containing iron oxides when visible-light protection is relevant.

The table is deliberately broad. Treatment for a skin condition should not be reduced to selecting an ingredient from a list.

For example, melasma, post-inflammatory hyperpigmentation and lichen planus pigmentosus can all cause increased pigmentation, but they are different conditions and may require different treatment strategies.

Diagnosis comes before treatment.

Your Foundation Doesn’t Disappear When Treatment Starts

Starting treatment does not mean abandoning the basic skincare routine.

Level 3 sits on top of Level 1, not instead of it.

Your routine may therefore become:

FOUNDATION + TARGETED TREATMENT

Gentle cleansing, appropriate moisturisation and consistent photoprotection continue while treatment is added for the specific condition.

This can become even more important when using retinoids, benzoyl peroxide, prescription pigmentation treatments or other potentially irritating therapies. Supporting the skin barrier may improve comfort and treatment tolerability.

More is not necessarily better. In some cases, simplifying the rest of the routine while introducing treatment is preferable to combining several active ingredients at once.

Where Do Professional Treatments Fit?

At Level 3, professional procedures can become part of a therapeutic strategy rather than simply something performed for general rejuvenation.

A procedure does not automatically belong to Level 3 simply because it is performed in a clinic.

Its purpose determines where it belongs.

Microneedling performed to improve established acne scars belongs under TREAT. The same procedure performed on otherwise healthy skin for general rejuvenation may belong under OPTIMISE.

Similarly, a chemical peel incorporated into a dermatologist-directed pigmentation programme is a treatment, while a superficial peel performed mainly for smoother, brighter-looking skin may fall under PREVENT or OPTIMISE.

This distinction is important because professional procedures should not be viewed as interchangeable treatments. The correct procedure depends on what we are trying to achieve.

Special Considerations in Skin of Colour

Professional treatments require particular care in darker skin phototypes.

Inflammation can stimulate melanogenesis and contribute to post-inflammatory hyperpigmentation. An unnecessarily aggressive procedure may therefore worsen pigmentation rather than improve it.

Treatment planning should consider:

• The diagnosis
• Skin phototype
• Tendency to develop post-inflammatory hyperpigmentation
• Whether active inflammation is present
• Previous treatment response
• The type and intensity of the proposed procedure
• Pre- and post-procedure skincare
• UV and visible-light exposure where relevant

This does not mean darker skin cannot undergo procedures such as chemical peels, microneedling or appropriate laser treatments. It means patient selection, treatment choice and treatment parameters matter.

The goal is not to choose the strongest treatment available.

It is to choose the most appropriate treatment with a favourable balance between potential benefit and risk.

Treatment Is Individual

Two people with the same diagnosis may still require different treatment plans.

One person with acne may respond well to topical treatment alone, while another may require oral medication. One patient with melasma may be managed predominantly with topical therapy and strict photoprotection, while another may eventually benefit from carefully selected procedures as part of a broader treatment plan.

This is why learning how to build a skincare routine at the treatment level becomes less about following a standard product sequence and more about understanding the condition being treated.

The foundation remains simple:

Cleanse appropriately. Support the barrier. Protect the skin.

Then add the treatment that the skin actually needs.

LEVEL 4: OPTIMISE — When You Want to Do More

Level 4 is about going beyond what is necessary for healthy skin or the treatment of a specific skin condition.

At TREAT, there is a defined concern we are trying to manage.

At OPTIMISE, the skin may already be healthy or appropriately treated, but the person would like to further improve its appearance, skin quality or signs of ageing.

This level is optional. There is no particular age at which advanced skincare or aesthetic treatments become necessary, and you do not need to reach Level 4 to have healthy skin.

Who Might Consider Optimisation?

Optimisation may be considered by someone concerned about:

• Fine lines and wrinkles
• Dynamic expression lines
• Reduced firmness or elasticity
• Uneven texture
• Enlarged pores
• Crepey skin
• Loss of radiance
• Established photoageing
• General skin-quality improvement

These concerns often become more noticeable from the 30s, 40s and beyond, but chronological age alone should not determine when someone considers advanced skincare or procedures.

The decision should be based on what you would like to improve, the condition of your skin and whether the expected benefit justifies adding another product or treatment.

What Does Advanced Home Skincare Look Like?

The foundation and appropriate preventative skincare remain in place. More advanced products can then be considered according to individual goals.

This part of the framework relates closely to the upper level of the Skin Health and Beauty Pyramid, where activation and regeneration are considered.

However, the evidence supporting advanced skincare technologies is not equal. Some ingredients and technologies have considerably more clinical evidence than others, and newer or more expensive does not automatically mean more effective.

Most importantly, advanced skincare does not replace the foundation.

A sophisticated serum cannot compensate for inconsistent photoprotection or an unhealthy skin barrier.

Where Do Professional Treatments Fit?

Professional treatments do not necessarily belong to one fixed level. The reason for doing the treatment determines where it fits.

A procedure used to manage acne, pigmentation, scarring or another specific concern may belong under TREAT. The same procedure performed on otherwise healthy skin to improve texture, radiance or signs of ageing may belong under OPTIMISE.

This distinction is important because professional treatments are not interchangeable.

For example, microneedling performed for acne scars has a different purpose from microneedling performed for general rejuvenation. Similarly, BioRePeel incorporated into an acne or pigmentation programme serves a different purpose from BioRePeel used primarily to improve brightness and texture.

The treatment itself does not define the level. The reason for doing it does.

Skin Protection Still Matters at the Optimisation Level

No matter how advanced your skincare or treatment programme becomes, photoprotection remains part of the foundation.

Daily broad-spectrum sunscreen should continue, with the formulation chosen according to your skin type and individual needs. For pigmentation-prone skin, a tinted sunscreen containing iron oxides may provide additional visible-light protection where appropriate.

Photoprotection is also particularly important around professional procedures, when appropriate pre- and post-treatment skincare should be followed.

Advanced skincare and professional treatments may improve specific aspects of skin quality and ageing, but they cannot compensate for ongoing UV exposure.

Putting All Four Levels Together

If you are wondering how to build a skincare routine, the entire approach can be simplified into one framework:

Photoprotection continues through every level. Moving into prevention, treatment or optimisation does not mean leaving the foundation behind.

The goal when deciding how to build a skincare routine is not to reach the highest level or accumulate as many products and treatments as possible. It is to establish a strong foundation and then add only what is appropriate for your skin, concerns and goals.

Keep the foundation. Protect the skin. Add what has a purpose. Leave out what doesn’t.

Ready to Build Your Skincare Routine?

Start with the essentials and add products according to your skin type, concerns and goals. Explore dermatologist-selected cleansers, moisturisers, sunscreens, antioxidants, retinoids and targeted skincare at MD Dermoutlet.

Dermatologist’s Perspective

When patients ask me how to build a skincare routine, I usually encourage them to think about what their skin actually needs before thinking about how many products they should use.

A good routine does not need to be complicated. For many people, appropriate cleansing, moisturisation and consistent photoprotection provide a strong foundation. If you want to support healthy ageing, selected evidence-based ingredients such as antioxidants or retinoids can then be added where appropriate.

If there is a specific concern such as acne, melasma, post-inflammatory hyperpigmentation, rosacea or eczema, the approach changes. At that point, the priority is identifying and treating the condition rather than simply adding more cosmetic products. This is particularly important with pigmentation, where different conditions can look similar but require different treatment strategies.

Professional treatments can also have a place, but they should have a clear purpose. A chemical peel, laser or microneedling treatment used for acne scarring or pigmentation is serving a different role from the same procedure used for general rejuvenation.

The same applies to advanced skincare and aesthetic treatments. Peptides, biostimulatory treatments, PRX, BioRePeel, WonderM or botulinum toxin may be useful for selected people, but they are not requirements for healthy skin.

Ultimately, how to build a skincare routine should be guided by your skin type, concerns, goals and tolerance—not by the number of products on your bathroom shelf.

Frequently Asked Questions

What is the most basic skincare routine?

For most people, a basic routine consists of appropriate cleansing, moisturisation according to the needs of the skin, and daily photoprotection. The individual products should be adapted to your skin type.

Do I really need a 10-step skincare routine?

No. There is no evidence that healthy skin requires a 10-step routine. Additional products should have a clear purpose rather than being added simply to make a routine more comprehensive.

At what age should I start an anti-ageing skincare routine?

There is no single correct age. Photoprotection should begin early, while additional preventative skincare often becomes relevant in the 20s and early 30s for people interested in healthy ageing. Skin type, sun exposure, concerns and individual goals are more useful than age alone.

Should I start Vitamin C or retinol first?

It depends on your skin and goals. Vitamin C is commonly used in the morning for antioxidant support, while retinoids have stronger evidence for improving several features of photoageing. You do not necessarily need both at the same time, particularly when starting a new routine.

Do oily skin types still need moisturiser?

Often, yes, but they may not need a rich cream. A lightweight, non-comedogenic moisturiser may provide sufficient hydration without feeling heavy. Some people may also find that a moisturising sunscreen provides adequate daytime hydration.

Does darker skin need sunscreen?

Yes. Darker skin contains more melanin and has some natural protection against UV radiation, but this does not eliminate the need for photoprotection. Sunscreen is particularly important when managing pigmentation disorders, and tinted formulations containing iron oxides may provide additional visible-light protection where appropriate.

When should I see a dermatologist instead of treating my skin myself?

Consider dermatological assessment when a skin problem is persistent, worsening, difficult to diagnose, causing scarring or significant pigmentation, or not responding to appropriate over-the-counter skincare. Conditions such as persistent acne, melasma, rosacea, eczema and unexplained pigmentation may benefit from an accurate diagnosis before additional active products are introduced.

Do I need professional skin treatments?

Not necessarily. Professional treatments are not required for healthy skin. They may be useful when treating a specific condition or when someone wants additional improvement in texture, pigmentation, scarring or signs of ageing.

Are advanced treatments better than basic skincare?

Not necessarily. Advanced treatments address particular concerns, but they do not replace the fundamentals. Consistent photoprotection and appropriate basic skincare remain important even when someone is having lasers, peels, microneedling, injectables or biostimulatory treatments.

How do I know which level of the skincare pyramid I need?

Start with FOUNDATION. Add PREVENT if healthy ageing is a goal, move into dermatologist-directed TREAT when there is a specific skin condition or persistent concern, and consider OPTIMISE if your skin is healthy or appropriately treated and you want additional cosmetic improvement.

You do not need to progress through every level.

Related Articles

For more guidance on building a routine and choosing products according to your skin’s needs:

• SBR Repair vs Renew vs Protect vs Lotion: Which SBR Moisturiser Is Right for Your Skin?
• 7 Best SkinCeuticals Products for Dry Sensitive Skin
• Protecting Your Barrier Through the Seasonal Shift
• 4 SkinCeuticals Vitamin C Serums Compared: Which One Is Right for Your Skin?
• How to Choose a Gentle Cleanser Without Damaging Your Skin Barrier
• La Roche-Posay Lipikar: The Complete Dermatologist’s Guide
• Hyperpigmentation: The Complete Dermatologist’s Guide
• La Roche-Posay Cicaplast: The Complete Dermatologist’s Guide to Skin Barrier Repair (South Africa)
• La Roche-Posay Toleriane: The Complete Dermatologist’s Guide for Sensitive Skin (South Africa)

If reading is too much for you, listen to our video on the basics of skincare.

Looking for skincare?
Explore dermatologist-selected skincare for different skin types and concerns at MD Dermoutlet

References

1. Mayoral FA, Kenner JR, Draelos ZD. The Skin Health and Beauty Pyramid: A Clinically Based Guide to Selecting Topical Skincare Products. Journal of Drugs in Dermatology. 2014;13(4):414–421.
   Read the original Skin Health and Beauty Pyramid article
2. Draelos ZD. Revisiting the Skin Health and Beauty Pyramid: A Clinically Based Guide to Selecting Topical Skincare Products. Journal of Drugs in Dermatology. 2021;20(6):695–699. doi:10.36849/JDD.5883. This is the updated framework on which much of our FOUNDATION → PREVENT → TREAT → OPTIMISE concept is based.
   Read the updated Skin Health and Beauty Pyramid article
3. Zip C. The Role of Skin Care in Optimizing Treatment of Acne and Rosacea. Skin Therapy Letter. 2017;22(3):5–7. This is particularly useful for supporting the role of cleansing, moisturisation and photoprotection as basic supportive skincare.
   Read the article on PubMed
4. American Academy of Dermatology. Skin Care on a Budget. Practical dermatologist guidance covering gentle cleansing, moisturisation, skin-type appropriate products and broad-spectrum SPF 30+ photoprotection.
   Read the American Academy of Dermatology guidance
5. Hughes MCB, Williams GM, Baker P, Green AC. Sunscreen and Prevention of Skin Aging: A Randomized Trial. Annals of Internal Medicine. 2013;158(11):781–790. This provides particularly strong evidence for placing photoprotection at the foundation of healthy-ageing skincare.
   Read the sunscreen and skin ageing study on PubMed
6. Sitohang IBS, Makes WIM, Sandora N, Suryanegara J. Topical Tretinoin for Treating Photoaging: A Systematic Review of Randomized Controlled Trials. International Journal of Women’s Dermatology. 2022;8(1):e003.
   Read the tretinoin and photoageing systematic review
7. Castanedo-Cazares JP, Hernandez-Blanco D, Carlos-Ortega B, et al. Near-visible Light and UV Photoprotection in the Treatment of Melasma: A Double-blind Randomized Trial. Photodermatology, Photoimmunology & Photomedicine. 2014;30(1):35–42. This supports the discussion of visible light and iron-oxide-containing photoprotection in pigmentation.
   Read the visible-light and melasma study on PubMe