Several readers have written to ask about skin care and anti-aging advice and, in an effort to answer their questions in the most professional manner possible, I sat down with Dr. Michael A. Tomeo, Chief of Dermatology at Holy Redeemer Hospital in Meadowbrook, PA to get his perspective on these issues.
Q: Many of my readers are interested in looking younger. What would you advise them to do?
A: When it comes to aging skin, the most important factor is sun exposure. Everyone, even those who avoid the sun, has had some level of sun exposure and damage has been done. Even still, it’s important to use sunscreens. Sunscreens are the foundation of skin care, particularly when you talk about aging skin. At least 80 percent of the aging you see is from sun exposure.
Q: Can the damage be reversed?
A: Retinoids are the first and best product. They are the gold standard for reversing sun related aging effects. The one we use most often as dermatologists is tretinoin. It’s found in the Retin-A line of products and is available by prescription. That molecule in particular has been tested and is highly effective. However there are a variety of other retinoids that are available over-the-counter in products such asNeutrogena. Some of the larger cosmetic/dermatological companies do offer similar molecules that are in the Vitamin A family. (Retinol is a form of Vitamin A and is found in many cosmetics.)
The alpha hydroxy acids are next. These products are derived from fruits and the most widely used is glycolic acid. Alpha hydroxy acids exfoliate the skin and cause a mild irritation which stimulates new collagen development. Retin-A does that in a similar fashion but also reverses abnormal cell growth to photo-damaged skin. Basically, it takes cells that are abnormal and it normalizes them.
Q: What’s the difference between a store-bought product and one I get from a dermatologist?
A: You’re not going to get the same therapeutic effect from a store-bought product. The concentrations of the active ingredients are lower. If you buy an alpha hydroxy acid product, look for one that has a concentration of at least five percent to be effective. If it’s below that, it’s probably not very active.
Q: What are other alpha hydroxy acids?
A: Glycolic acid is the most popular. Others include citric, malic, lactic and mandelic acids.
Q: If alpha hydroxys are derived from fruit, can I get the same benefit from swiping a slice of orange across my face?
A: It all comes down to whether the active ingredients will penetrate your skin. Your skin is an envelope that protects your organs. With that knowledge, you don’t want everything to penetrate it. In the case of anti-aging skin care products, the molecules are formulated to penetrate the skin.
Q: What about beta hydroxy acids? Are they effective?
A: Beta hydroxy acids include salicylic acid which dissolves cells. They are also found in products and cosmetics that have effects for acne and aging skin. Oil of Olay makes one.
Q: What else can I use to keep my skin looking young?
A: Physical exfoliation is also effective. The primary technique that we use as dermatologists is microdermabrasion.
Q: Is one better than the other at reversing sun damage that ages skin?
A: If you look at it as a pyramid, the retinoids are on the bottom. They are the base, the gold standard for reversing the aging effects of the sun. The alpha hydroxy acids are in the middle with the beta hydroxy acids on top of them. Then come the antioxidants. Do they do much? Truthfully, when they’re in a commercial product, not much. Probably because the concentration is too small, penetration is limited and actual effects don’t necessarily reverse cellular damage that may have occurred.
Q: There’s a lot of talk about antioxidants in the media. They seem ubiquitous in skin care products. What can you tell readers about them?
A: Vitamin C is the most powerful and tested of the antioxidants. It does have anti-aging properties such as reversing fine lines and wrinkles and it is an effective sunscreen. You’ll find it in a lot of cosmetics and skin care products. But you have to look at percentages. Vitamin C is most effective in concentrations of 10 to 20 percent. The consumer has to be careful before buying a product. You don’t know how much of the ingredient you’re getting and whether it’s effective. One way to be a little more assured is to buy the product through a dermatologist’s office. We sell an effective Vitamin C product. Why not go to a dermatologist’s office and spend the same amount of money on a product that you know will work?
Green tea is another antioxidant that’s effective because it has some anti-inflammatory properties. The key with antioxidants is decreasing the oxidative process which contributes to cellular aging and death. If you can provide that anti-oxidant effect to cells, you’ll make them live longer.
Q: What percentages should I look for when it comes to various products?
A: For salicylic acid, look for a product with a concentration of greater than two percent.
For glycolic acid, look for between five and 15 percent for daily use. As a peel, you need to use 15 to 30 percent.
Retinols, a form of Vitamin A, should be in concentrations of at least 0.2 percent to be effective.
Retinoids, which include retinol and tretinoin are the most effective at reversing sun damage. Tretinoin is a very active form and is the most therapeutic. It’s present in pharmaceuticals (e.g. Retin A) and in concentrations that range from 0.025 to 0.1 percent.
Any of these products can cause irritation.
Q: What kind of improvement should be evident?
A: Improvement of the appearance of fine lines, more brightness, lessening of yellowish, pale skin. With continued use of these products the skin should become less sallow and smoother and fine lines are diminished.
Q: Well, what exactly are the signs of aging and where are they first seen?
A: The signs of aging are most often seen on the face, neck, decollete, forearms and hands. The signs of aging include: age spots, wrinkles, sallow skin appearance, increased broken capillaries and sagging.
Q: Since most of the signs of aging are from the sun, is there any way to avoid the sun?
A: People often say, “I’m never in the sun,” and yet they show signs of aging. It’s a matter of tolerability. Certain individuals can have the same amount of sun exposure over a lifetime but one can show more damage due to their particular pigmentation. No, you can’t avoid the sun, even though you might not bask in it. The best thing you can do it to use sunscreen, every day.
Q: What else should I look for in an anti-aging skin care product?
A: It has to be formulated to penetrate. Not only is the percentage of active ingredients important but also the ph of the product for tolerability and penetration. In addition, there has to be some level of irritation in order for the product to be effective as an anti-aging product. Think about what you’re doing. You want to peel the skin at a subclinical or microscopic level.
Q: How has skin care changed?
A: In the old days you either put grease on your face or had a face lift. There was nothing in between. Nowadays we have chemical treatments and non-surgical ways to address aging. And at the other extreme we have face lifts. We’ve filled the gap between here and there. If you think of skin care as a continuum it would go like this: On one end are moisturizers and sunscreens. Then come chemical peels with alpha or beta hydroxy acids. Then come fillers and Botox and Botox-type injectables. After those are even stronger chemical peels such as trichloracetic acid (tca) or phenol peels that must be done under a doctor’s supervision. Next are the laser treatments and finally, surgery.
Q: Do you have any other advice on keeping skin young looking?
A: Use sunscreen and moisturizer every day. Winter dries out your skin. We’re inside much more and exposed to dry heat indoors. The result is dry, itchy skin. If you have a tendency towards certain skin diseases, such as eczema or psoriasis, those will flare up under these conditions. Use a therapeutic moisturizer that contains alpha hydroxy acids such as Eucerin Plus, Lachydrin (5 percent) or Amlactin (12 percent lactic acid). Additionally, you can look for products that contain urea, which is also a great moisturizer. Moisturizers plump up the skin. The better ones keep moisture in skin for a longer time. Humectants put moisture back in the skin. Emulsifiers coat the skin to protect it from moisture loss. Those can be used all over. Specifically, use sun screens containing moisturizers for the face, hands and arms. Brands such as Neutrogena and Cetaphil have moisturizers built into their sunscreens.
Michael A. Tomeo, MD is a Fellow of the American Academy of Dermatology (FAAD). He is the Chief of Dermatology at Holy Redeemer Hospital in Meadowbrook, PA and is a Clinical Instructor atHahnemann University Hospital in Philadelphia. His practice, Advanced Dermatology Center, is located in the Holy Redeemer Medical Office Building located in suburban Philadelphia.