Many products and methods are available to improve the appearance of skin. Some are for home use while others must be administered by a doctor.
Moisturizers help prevent dryness, bruising, and tearing, but used alone they have no effect on wrinkles. Moisturizers are most effective when applied to skin that is still damp after washing. These products retain skin moisture in various ways:
- Occlusives, such as petroleum jelly, prevent water from evaporating from the skin.
- Humectants, including glycerin, act by pulling water up to the surface of the skin from deep tissues. People with oily skin should use humectant moisturizers.
- Other products contain mixtures of fatty molecules (lipids), such as monolaurin. These help restore the skin's natural barrier against moisture loss and damage.
Most moisturizers contain combinations of these compounds. They usually have other ingredients, such as alpha hydroxy acids, sunscreen, collagen, hyaluronic acid, ceramides, and keratin. Collagen and keratin leave a protein film and temporarily stretch the skin, which may reduce wrinkles.
The skin under the eyes is very thin. It does not produce much of the protective oils that keep skin soft and supple. Under-eye products are advertised as being able to reduce puffiness and dark circles. They work in one of two ways:
- Temporarily constricting blood vessels to prevent the buildup of fluids
- Firming the skin with an invisible film
Follow the instructions on the package about how to use the product. Under-eye products are applied with light dabbing to stimulate absorption of the cream into the skin. The skin around the eyes is more sensitive than the rest of the face, so be sure to use products made for the eyelids.
Cosmetics can be effective in masking the signs of aging skin, including wrinkles and age spots. Cosmetic can also slow water loss from the skin. Many cosmetics contain sunscreen.
Apply moisturizers before foundation. If reddish discoloration is extensive or the skin is sallow, tinted moisturizers may be helpful and can be worn alone or under foundation.
Caking on make-up causes cracks at the wrinkle lines and increases the appearance of aging. Cover large areas of the face with a moderate-coverage foundation that has a matte or semi-matte finish. Facial powder reflects light and thus minimizes wrinkles. People with dry skin should not use facial powder, though.
When blemishes are visible, applying color correctors under foundation can be effective:
- Green neutralizers mask red lesions.
- Yellow will camouflage dark circles and bruises.
- Mauve (a purplish-pink color) helps neutralize sallow skin or yellowish blemishes.
- A white, pearled base helps minimize wrinkles.
Blushes and color washes can help conceal the spidery network of dilated capillaries on the nose and cheeks. Powder blushes blend easily on top of foundation.
Powder eye shadows applied on top of a moisturizer are better than cream-based shadows. Light-colored shadow, applied along the upper eyelid crease and above the iris (the colored part of the eye) is best for offsetting the appearance of deep-set eyes. A slightly deeper shade of the same color can be applied to the lower part of the eyelid and drawn out to the corner.
Lip-setting cream or facial foundation should be applied before lipstick to help prevent it from bleeding into surrounding wrinkles. A stiff bristle brush works better than a lip pencil. The brush helps keep the lipstick on and prevent it from bleeding. (Some women use the pencil itself for the full lip, which gives color but appears natural.)
Antioxidant Creams, Lotions, and Ointments
Antioxidants are substances that counter the effects of free radicals. Exposure to sunlight reduces antioxidants in the skin. But these antioxidants can be replaced.
Antioxidant ointments, creams, and lotions may help reduce the risk of wrinkles and protect against sun damage. Unlike sunscreens, they build up in the skin and are not washed away, so the protection may last longer. Selenium, coenzyme Q10 (CoQ10), and alpha-lipoic acid are antioxidants that can be applied to the skin. Evidence of their benefit is limited and more studies in humans are needed. More commonly used antioxidants are described below. Your dermatologist can tell you which product is right for you.
Vitamin A is important for skin health. UV radiation leads to vitamin A deficiency in the skin. Topical (applied to the skin) vitamin A products have been researched and approved for treating skin problems due to aging. Products include natural forms of vitamin A (retinol, retinaldehyde) and chemicals related to vitamin A called retinoids (adapalene, tretinoin, tazarotene, trifarotene). These products help repair skin damage due to sunburn and natural aging, such as fine wrinkles, liver spots, and rough skin. It may take months before the skin shows improvement. Side effects include redness, scaling, burning, and itching, which can be treated with moisturizer or a mild corticosteroid cream. Over time, these side effects tend to decrease. Sunscreen needs to be applied during the day because vitamin A products can cause the skin to be sensitive to sunlight.
Topical retinoids are the mainstay of treatment for people with mild to moderate photoaging. Retinoids are a class of naturally occurring or synthetic compounds related to vitamin A, also known as retinol. Clinically, they reduce the appearance of fine lines, improve skin texture, correct tone and elasticity, and slow the progression of photoaging. Tretinoin, or all-trans-retinoic acid, is the most widely investigated photoaging therapy. Tretinoin 0.05% emollient cream (Renova) and tazarotene 0.1% cream (Tazorac or Avage) are the only 2 retinoids approved by the US Food and Drug Administration (FDA) for this indication. Other topical retinoids used off-label for photoaging include adapalene, a synthetic derivative available by prescription, and retinol, which is found in many antiaging cosmeceutical products. These products are also approved to reduce acne lesions.
Topical retinoids may cause irritant reactions, such as scaling, redness, burning, and dermatitis, limiting patient compliance. Retinoids should be initiated at the lowest effective dose to minimize adverse effects. Also, use every other day while the skin adjusts until moving up to daily use. A minimum of 4 months use is necessary before benefits are appreciated. Moisturizer may be applied over some forms of these retinoids to avoid excessive irritation. They should be applied at bedtime as most retinoids are not stable in sunlight.
Although tazarotene is the only topical retinoid with a category X designation, other topical retinoids are not recommended during pregnancy (class C) or lactation.
Women who are pregnant should not use any product related to vitamin A. Oral isotretinoin is known to cause birth defects. Topical tretinoin may also cause birth defects.
Vitamin C, or ascorbic acid, is a strong antioxidant that may also help rebuild collagen. Though there are many vitamin C products, none has been approved as a treatment for age-related skin conditions. Most research on the effects of antioxidants on the skin has used this vitamin. In laboratory studies, vitamin C seems to reduce or even protect against damage to skin cells caused by UV radiation. Vitamin C also seems to help skin cells survive after exposure to UV rays. Vitamin C is best used in the morning along with sunscreen.
Antioxidants Under Investigation for Skin Care
Other antioxidants are being researched for their value in skin protection. Like vitamin C products, none of these antioxidants has been approved as a treatment for age-related skin conditions. Most of these products contain very low concentrations of antioxidants. In addition, the antioxidants are not well absorbed by the skin and have only a short-term effect. New ways of getting the ingredients into the skin may offset some of these problems.
- Vitamin E, particularly alpha tocopherol cream (a form of vitamin E), may decrease skin roughness, length of facial lines, and wrinkle depth.
- Niacinamide, a B complex vitamin, may have a positive effect on wrinkles and may be beneficial for wrinkles around the eyes.
- Pomegranate and soy extracts may help rejuvenate aging skin.
- Aloe, ginger, grape seed extract, and coral extracts contain antioxidants and are promoted as being healthy for the skin. However, evidence of their effects on wrinkles is weak.
- Honey is being studied for its antibacterial, wound healing, and cosmetic benefits. In cosmetic formulations, it may help to improve the skin's appearance and delay wrinkles and can act as a moisturizer.
Home Exfoliation: Abrasive Scrubs and Alpha Hydroxy Acids
Exfoliation (resurfacing) is one of the basic methods for improving skin and eliminating small wrinkles. It involves removing the top layer of skin to allow growth of new skin. As a result, they rejuvenate the skin. Home exfoliation methods include simple scrubs and special creams. Strong exfoliation methods may not be suitable for people with dark skin because scarring or discoloration may result. These products can lead to post inflammatory hyperpigmentation, which leaves the skin with more dark discoloration rather than eliminating the dark areas. If you are not sure of a product, talk to your dermatologist.
These involve using an abrasive material to remove the old top layer skin so that new skin can grow. Types of abrasives include sugar or salt grains, ground fruit pits, aluminum oxide particles, and tiny plastic beads (also called polyethylene beads or microbeads). Microbeads are the mildest scrub because the particles are smooth and round. Ground fruit pits and aluminum oxide are the strongest scrubs because their particles have rough edges that may injure the skin. The abrasive material is mixed with a base, often a cream or cleansing fluid. Scrubs can worsen certain skin conditions such as rosacea, where the skin is more sensitive with broken blood vessels.
Topical Alpha Hydroxy Acids and Similar Substances
Alpha hydroxy acids (AHAs) ease the shedding of dead skin cells and may even stimulate growth of collagen and elastin.
Natural alpha hydroxy acids include:
- Lactic acid (milk)
- Glycolic acid (sugar cane)
- Malic acid (apples and pears)
- Citric acid (oranges and lemons)
- Tartaric acid (grapes)
Most alpha hydroxy acid products contain glycolic acid. Skin care products are also made from polyhydroxy acids (PHAs) and beta hydroxy acids (BHAs) such as salicylic acid. Research suggests that PHA products may cause less skin irritation than AHA or BHA products.
Acid concentrations in over-the-counter AHA preparations are 2% to 10%. Prescription strength creams contain at least 12% glycolic acid. Glycolic acid peels of 30% to 70% concentration may be administered in a doctor's office. Treatment is done weekly or monthly.
Results of AHA treatment vary. Side effects can include skin burn, itching, pain, and scarring. AHA may increase the chance of sun damage to the skin, even at concentrations as low as 4%. Side effects can last up to a week after a person stops using the product. Experts advise that for home use, AHA concentrations of 10% or less are suitable. AHA peels of up to 60% are available without a prescription. These concentrations should be used only under a doctor's supervision. If side effects occur, stop using the product right away. When using these products, avoid sunlight and use sun protection as sun exposure may lead to postinflammatory hyperpigmentation.
Other Skin Treatments
Certain copper-containing compounds may protect skin. This is because copper is an antioxidant. Copper peptides may also help repair skin because it helps the skin grow collagen and elastin. Copper is harmful when there is too much in the body. Follow instructions on the package when using these products. Check with your dermatologist if you are not sure which product is right for you.
Many other peptides are found in over-the-counter skin preparation. Their suggested mechanism of help is in the production of proteins in the skin that reverse or repair damage.
This is a medication prescribed to treat precancerous and cancerous skin problems. It also seems to improve the appearance of skin damaged by the sun. Problems that may be corrected include wrinkles and spots but it is intended to destroy precancerous cells. The effects may be similar to those of laser therapy. When using fluorouracil, your skin will get very red and inflamed and will be more sensitive to the sun. These creams are usually used for 2 to 4 weeks and come in concentrations ranging from 0.5% to 5%.
Epidermal growth factor (EGF)
This is a type of protein (or polypeptide). It is being looked at for its role in improving the appearance of aging and wrinkled skin. EGF is found in several "cosmeceuticals," substances that are thought to provide both cosmetic and therapeutic benefits.
Herbs and Supplements
Many herbal products and supplements are advertised as being healthy for the skin. The FDA does not regulate herbal remedies and dietary supplements. Manufacturers and distributors do not need FDA approval to sell their products. Any substance that affects the body's chemistry can produce side effects that may be harmful. Check with your health care provider before using herbal products and supplements as they may cause unwanted side effects or interact with other medicines you are taking.
Some natural remedies can cause the skin to be extra sensitive to light (photosensitivity). They should not be used before talking with your provider:
- St. John's wort (Hypericum perforatum) is an herbal remedy for depression.
- Kava (Piper methysticum) is an herb promoted to calm nerves and reduce stress.
- Yohimbe (Pausinystalia yohimbe) is promoted to treat erectile dysfunction.
- Essential oils in many aromatherapy products can trigger photosensitivity. These include citrus oils (grapefruit, lemon, lime, orange, and bergamot), cumin, ginger, and angelica root oils.
A number of different botanical extracts are found in over-the-counter skin creams. However, the benefit of most of these for human skin changes has not been validated in scientific studies.