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Monthly Archives: November 2016

The Skin Care Benefits of Alpha Hydroxy Acids

Skin care fads come and go, but alpha hydroxy acids (AHAs) have been popular for some time.

AHAs are a collection of compounds made from familiar food products. Among the most widely known are glycolic acid (from sugar cane), lactic acid (sour milk), malic acid (apples), citric acid (citrus fruits), and tartaric acid (wine grapes).

The original seekers of younger-looking skin used these natural compounds many centuries ago, going back as far as the ancient Egyptians. In the United States, their popularity has skyrocketed in recent years. First, dermatologists used them for in-office facial peels, then they found their way into many skin care products after their FDA approval for over-the-counter use in 1992. Today you can find AHAs in hundreds of items, ranging from face and body creams to sunscreen, acne products, shampoos, cuticle softeners, and lightening agents.

“Alpha hydroxy acids are great exfoliators and increase blood flow to the skin, so they can help to minimize fine lines and wrinkles,” says Kenneth Beer, MD, a clinical instructor in dermatology at Duke University in Durham, N.C., who is in private practice in Palm Beach, Fla.

Other potential skin care benefits include lightening of dark spots and a reduction in the appearance of blackheads and acne.

AHA Skin Care Products: Making the Right Choices

“There is no ‘best’ concentration, nor ‘best’ preparation,” says Robin Ashinoff, MD, director of cosmetic dermatology at Hackensack University Medical Center in Hackensack, N.J. It all depends on your skin type and the amount of improvement desired.

The main difference among alpha hydroxy acid skin care products is their concentration and pH. At over-the-counter levels, alpha hydroxy acids are generally safe for many people, though those with sensitive skin, rosacea, or seborrheic dermatitis may be more likely to get a rash and need to halt treatment or try a different brand. Typically, over-the-counter skin care products, such as moisturizers or lotions, contain less than 5-percent glycolic acid; medical-grade “cosmeceuticals” (products that are a cross between cosmetics and pharmaceuticals, or drug-strength meds) have 8 to 14 percent. These products are designed for daily use, but it can take months to show improvement.

“Quicker, better results can be obtained with 20- to 30-percent glycolic acid peels, but results are temporary and need to be repeated frequently,” says Dale Isaacson, MD, an associate clinical professor at George Washington University Medical Center who is in private practice in Washington, D.C. These peels must be done by trained cosmetologists.

The best and longest-lasting results come from peels done at 50- to 70-percent concentrations, but they have the most risk of side effects and a doctor must apply them.

AHA Skin Care Products in a Nutshell

The pros:

  • Subtle improvement gives skin a fresher look.
  • With lighter peels, there’s fine-line reduction without any down time.
  • AHAs often lighten age spots and remove blackheads as part of the results.
  • Drugstore brands are inexpensive to try on your own.

The cons:

  • At-home products at low concentrations may take months to show results.
  • The most effective peels must be done in a doctor’s office and can be expensive.
  • Deep peels have a longer healing time; skin will look sunburned for a couple of days and then peel.
  • New skin is more sensitive to sun damage; you’ll need to be vigilant about sunscreen.

The next time you’re browsing for skin care products, look for those containing one of the alpha hydroxy acids. And be sure to buy extra sunscreen — not just because AHAs expose new skin to sun damage, but because a good sunscreen is also one of the best ways to prevent any further aging of your skin.

What’s Your Skin Type?

Skin is generally classified into one of four categories: normal, oily, dry, and combination, says Susan Van Dyke, MD, a dermatologist with Van Dyke Laser and Skin Care in Paradise Valley, Ariz. However, your skin type can change as you age, and other factors like genetics and even illness can play a part. “It’s multi-factorial,” Dr. Van Dyke says.

Normal skin, which has a good balance of moisture, small pores and an even tone, is the goal of most skin care regimens. Most people have normal skin, Van Dyke says, but to maintain its good condition, it’s important to minimize its exposure to the sun. A facial sunscreen with an SPF of at least 30 is ideal for preventing wrinkles and other sun damage.

“Put it by your toothpaste and use it,” Van Dyke says. “It doesn’t matter if it is snowing or raining — get in that habit so you always have it on. Incidental sun exposure is what gets you.”

Skin Care: Quieting Oily Skin

Oily skin is identified by an excess of oil (the technical term is sebum) on the face. Some people with oily skin begin to feel greasy only a few hours after washing. “A very oily person would feel the need to wash their face between noon and 5 p.m., because oil has built up during the day,” Van Dyke says. Oily skin can be an inherited trait, but it can also be caused by puberty, which causes oil glands to go into overdrive. You may also notice more oil on your “T-zone” because of all the oil glands in the forehead, nose, and chin.

People with oily skin generally don’t need a regular moisturizer, but sunscreen is still necessary to reduce exposure to UV rays. Choose an oil-free sunscreen, suggests Van Dyke says, one that’s specifically formulated for the face and are less likely to create blackheads and clog pores. “There are plenty of oil-free sunscreens available,” Van Dyke says. “Go to the drugstore, read labels, and try samples of different ones. There’s no excuse not to use sunscreen anymore.”

Skin Care: Soothing Dry Skin

Dry skin, on the other hand, suffers from a lack of natural moisture — there’s little oil to act as a surface barrier and lock in moisture. People with dry skin feel a tightness about their face, and their skin is often irritated. Flaking is another symptom, but it’s not always a sure sign of dry skin. “You can have flaky skin and not be dry,” Van Dyke says. Sometimes, severely dry skin can become itchy and painful, leading to a condition called eczema.

Treatment of certain medical conditions can sometimes lead to dry skin. For example,breast cancer treatment may stop hormone production which could in turn affect the quality of your skin. “This will throw people into a menopausal situation at an early age,” Van Dyke says. “Suddenly, there’s no oil production.” Naturally-occurring menopause can have the same effect; most women begin to experience drier skin as they hit their late forties. To care for dry skin, use a gentle, soap-free cleanser, and moisturize adequately. A second application of moisturizer may be needed during the day, Van Dyke adds.

Skin Care: Balancing Combination Skin

Combination skin is a blend of both oily and dry skin. People with combination skin usually find that their oily skin is concentrated in the T-zone, while their cheeks remain dry. Combination skin can be influenced by genetics and, again, by puberty, when oil glands increase their production of sebum. Sometimes a variety of products are needed to treat combination skin. “You may have to treat different parts of the face slightly differently,” Van Dyke says. For example, a mild cleanser and moisturizer may be needed on the cheeks, while an anti-acne product with benzoyl peroxide might be necessary on the T-zone.

If you’re still not sure about your skin type or the best way to nourish it, consult adermatologist who can recommend an over-the-counter skin care regimen or offer you a physician’s line of products. Look for a doctor who is board-certified by the American Academy of Dermatology. “Your dermatologist is absolutely your best skin-care expert,” Van Dyke says.

The Diet for Dry Skin

If you have dry skin, you know that lotions and moisturizers help. But can certain dietary choices combat dry, itchy, scaly skin?

“The most important part of the skin barrier is lipids, including phospholipids, free fatty acids, cholesterol, and ceramides,” says Amy Newburger, MD, an attending physician in the Dermatology Department at St. Luke’s Roosevelt Medical Center. “Skin without enough fat in it has a protein predominance and is kind of like a mess made just of twigs with no glue between them.” Water easily escapes through a barrier without lipids, allowing skin to become dehydrated.

Polyunsaturated fatty acids are necessary for the production of intercellular lipids — the “glue” between the “twigs” in the stratum corneum, or surface of the skin. They also have an anti-inflammatory effect on irritated skin. Two types of fatty acids that are “essential” — that is, they must be obtained through the diet — are omega-3s, and omega-6s.

Foods that are high in omega-3 fatty acids include fatty fish like salmon, herring, mackerel, anchovies, and sardines, as well as flaxseed oil, some types of eggs, and grass-fed beef. Evening primrose oil and borage seed oil, which are high in omega-6s, help hydrate the skin and prevent water from evaporating, says Leslie Baumann, director of the University of Miami Cosmetic Medicine and Research Institute. “If you don’t like fish or are pregnant and can’t eat it, omega-3 supplements are a good option.” Most Americans get enough omega-6s through their diet because they’re contained in corn and safflower oils.

While anecdotal success of fatty acids for alleviating dry skin has not been conclusively bolstered by research, several studies have shown significant positive effects: In a 2006 study of 50 patients with atopic dermatitis, 96 percent of those given capsules of evening primrose oil for five months showed notable reduction in intensity, itching, and dryness of the skin. In another study, of 29 elderly patients, borage seed oil supplements taken in pill form helped reduce water loss from the skin by 10.8 percent. And in a study of 118 infants with high risk of developing atopic dermatitis, those who were given borage seed oil and went on to develop the condition experienced a lower severity of the disorder than those in a placebo group. On the other hand, a 2006 meta-analysis of 22 studies that tested the effects of essential fatty acid supplementation found that no significant benefit was conferred on people with atopic dematitis by plant and fish oil supplements. More studies must be conducted before conclusions can be reached.

Vitamins and Minerals for Dry Skin

“Vitamin C is necessary for the function of the enzyme that causes collagen to form,” says Dr. Newburger, “and collagen acts as a sponge for moisture.”

Newburger adds that copper and zinc are also necessary. Together, vitamin C, zinc, and copper keep collagen denser, which in turn allows for plump, hydrated skin. “Any good multivitamin with trace minerals in it contains zinc and copper,” says Newburger. Zinc has also been found to have anti-inflammatory effects, which is vital for maintaining smooth skin.

Caffeine, Alcohol, and Dry Skin

While consuming caffeine is unlikely to dehydrate you, it does make the blood vessels constrict, which is why it’s used in eye creams (to reduce puffiness). “Long term, this means a reduced amount of blood flow and nutrients though the tissues,” warns Newburger. “And if you don’t have healthy circulation, you won’t have age-appropriate cell turnover.”

In the case of alcohol, Michele Murphy, a registered dietitian at NewYork Presbyterian–Weill Cornell Medical Center, explains that although it’s a diuretic, you’d need to be severely dehydrated to experience any noticeable changes. “The average person having a glass of wine with dinner every night and maintaining adequate fluid intake is unlikely to see any real difference,” she says. Contrary to popular belief, drinking large amounts of water does not affect skin. “The water we drink that’s processed internally isn’t going to impact the external look or feel of the skin,” Murphy says. Instead, it’s the skin’s outer layer that is essential for keeping moisture in.

Don’t Overdo It

If you’re already eating a balanced diet with sufficient fats, adding more fats or taking supplements is not necessarily a quick fix for dry skin. “If you’re deficient in fat or certain vitamins, it does have the potential to affect the look or feel of your skin,” says Murphy. “But supplementing beyond what the body needs has not been shown to improve skin.”

Tips to Choosing the Right Skin Care for You

Selecting skin-care products can be a daunting task, what with all the choices filling pharmacy aisles. You’ll find dozens of over-the-counter products with such labels as “maximum strength,” “clinical strength,” and “original prescription strength” — plus seemingly identical products that are available only by prescription. What do all these labels mean, and how do you know which product is the best one for you? Here are some answers.

How Much Active Ingredient?

The active ingredient in an over-the-counter product is often the same as the one found in its prescription counterpart, but at a lower dosage. Over-the-counter dandruff shampoo contains a lower dosage of the active ingredient ketoconazole (1 percent), while the prescription-strength versions contain 2 percent. Inhydrocortisone anti-itch cream, the maximum over-the-counter dosage is 1 percent, while prescription-strength creams contain 2.5 percent. According to U.S. Food and Drug Administration (FDA) regulations, once a product’s active ingredient reaches a certain percentage — such as 1.5 percent for hydrocortisone, or 2 percent for salicylic acid in acne treatments — it requires a prescription from a doctor.

Sometimes It’s Just a Marketing Strategy

Because the FDA does not closely regulate over-the-counter skin-care products, a company can label a product “maximum strength” or “clinical strength” for any reason it sees fit — and the label is no guarantee that the product will actually be any stronger than others on the market. The best way to find out whether you are really getting the “maximum” strength of an ingredient is to check the ingredients label, says Robyn Gmyrek, MD, assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons. “Compare the label with other products on the shelf,” says Dr. Gmyrek, and check the percentage of the active ingredient in each product.

Although an increase in the active ingredient in a product of 1 percent may not seem as though it would significantly affect the strength, it can, says dermatologist Doris Day, MD, director of Day Cosmetic, Laser and Comprehensive Dermatology in New York City and a professor at NYU Medical School. For this reason, it’s best to test a new skin-care product by applying a dime-sized amount on your forearm, to see if it causes a reaction.

Prescription Products Must Be Approved by the FDA

For the FDA to approve a product’s switch from over-the-counter to prescription-strength status, regulations require a company to show that even a slight increase in the amount of active ingredient (for example, 1 percent) “changes the structure or function of the skin.” All prescription products are reviewed by the FDA and have gone through numerous clinical trials, says Debra Jaliman, MD, a New York City dermatologist. The FDA also decides what dosage level constitutes a prescription. Some OTC products may be labeled “original prescription strength,” which means a prescription from a doctor was once required, but the product is now available without one.

Finding the Right Product for You

How do you know which product to try? Stronger dosages can have harsher effects on your skin, so it’s generally safer to start with a lower dosage. Try the basic OTC product for a minimum of two weeks to gauge the results, then move on to a maximum- or clinical-strength product, if necessary, or request a prescription, says Dr. Day. For acne, you should expect to wait a little longer — from four to six weeks — to see results. And if any product irritates your skin or makes symptoms worse, see your doctor immediately.