What are the guidelines for choosing and using a toner in a skincare routine?

Toners in Skincare: Evidence-Based Guidance

Toners are not recommended as an essential component of evidence-based skincare routines, as major dermatology guidelines do not include them in treatment algorithms for skin health. The American Academy of Dermatology's comprehensive acne and skincare guidelines make no mention of toners as therapeutic agents 1, 2, 3.

What the Evidence Actually Supports

Core Skincare Foundation

The evidence-based approach to facial skincare centers on three categories of products with proven efficacy:

Cleansers:

• Gentle liquid soap or soap-free gel cleansers are appropriate for daily facial cleansing 4
• These remove sebum and maintain skin health without the need for additional "toning" steps 5

Active Treatment Agents:

• Topical retinoids (adapalene 0.1-0.3%, tretinoin 0.025-0.1%) serve as the cornerstone for skin health, providing comedolytic and anti-inflammatory effects 1, 2
• Benzoyl peroxide (2.5-5%) functions as an antimicrobial agent with mild comedolytic properties 1, 2
• Azelaic acid (15-20%) offers comedolytic, antibacterial, anti-inflammatory, and skin-brightening effects, particularly valuable for post-inflammatory hyperpigmentation 6
• Salicylic acid (0.5-2%) provides over-the-counter exfoliation specifically for comedonal concerns 2

Moisturizers:

• Daily moisturizer use helps mitigate irritation from active ingredients 1
• Women with sensitive skin use approximately twice the amount of moisturizer per application (511 μg vs 290 μg) compared to those without sensitive skin 4

Why Toners Are Not Evidence-Based

The Marketing vs. Medicine Gap

Traditional toners claim to "balance pH," "remove residual impurities," or "prepare skin for other products." However:

• No clinical trial evidence supports these claims in dermatologic literature 1, 2, 3
• The American Academy of Dermatology's treatment algorithms proceed directly from cleansing to active treatments without intermediate steps 2, 3
• Properly formulated cleansers do not require pH "rebalancing" afterward 5

What People Actually Need Instead

If you're considering a toner for specific concerns, use these evidence-based alternatives:

For exfoliation/texture concerns:

• Salicylic acid 0.5-2% leave-on products provide proven comedolytic effects 2
• Chemical peels with salicylic acid 20-30% or alpha hydroxy acids offer more intensive treatment 2

For hydration:

• Apply moisturizer directly after cleansing to maintain skin barrier function 1
• Concurrent emollient use reduces irritation from active treatments 1

For brightening/pigmentation:

• Azelaic acid 15-20% has proven efficacy for post-inflammatory hyperpigmentation without the irritation risk of many "brightening toners" 6

Critical Pitfalls to Avoid

Don't layer unnecessary products:

• Adding steps between cleansing and treatment delays active ingredient penetration 2
• More products increase the risk of irritation, particularly in sensitive skin 4

Avoid products with unproven botanical claims:

• While tea tree oil, green tea, and witch hazel have been studied, evidence remains limited 2
• These ingredients are better incorporated into proven formulations (cleansers, moisturizers) rather than standalone toners 2

Don't use alcohol-based astringents:

• These can disrupt the skin barrier and cause irritation without therapeutic benefit 1
• If oil control is needed, benzoyl peroxide wash-off formulations are evidence-based alternatives 1

The Evidence-Based Skincare Algorithm

Step 1: Cleanse

• Use gentle liquid soap or soap-free gel cleanser 4, 5

Step 2: Apply Active Treatment

• For most concerns: topical retinoid (adapalene 0.1% is available over-the-counter) 2, 3
• For acne: combine retinoid with benzoyl peroxide 2.5-5% 2, 3
• For pigmentation: add azelaic acid 15-20% 6

Step 3: Moisturize

• Apply daily moisturizer to support skin barrier 1

Step 4: Sun Protection (morning only)

• Daily sunscreen is essential, particularly when using retinoids due to photosensitivity 1

No toner step appears in evidence-based algorithms 1, 2, 3.

When Patients Insist on Using Toners

If patients are committed to using a toner for personal preference:

• Choose alcohol-free formulations to minimize irritation risk 1
• Select products containing evidence-based active ingredients (salicylic acid, niacinamide) rather than purely cosmetic formulations 2
• Apply after cleansing but before prescription treatments to avoid interfering with active ingredient penetration 2
• Recognize this adds cost and steps without proven incremental benefit over the core three-step routine 2, 3