Download a reference chart of anti-aging ingredients.

Skin care lotions and potions promise the pearls of youth, vowing to erase everything from wrinkles to sunspots.

However, some products are better than others, as many over-the-counter ingredients are more firmly based in science. A patient's regimen should start with a daily dose of moisturizer, and we also recommend a variety of other ingredients, including retinoids, alpha hydroxy acids and beta hydroxy acids.

First, Moisturize

Moisturizers provide the building blocks for healthy skin, protecting and keeping it hydrated. Moisturizers should be soothing, healing and protective without being allergenic or comedogenic. The product should also be silky and smooth, promoting and implying healthy skin just by its application. Finally, it doesn't have to cost a great amount of money-as most basic moisturizers can do the trick.

Patients should look for moisturizers with humectants and emollients-since studies show these two ingredients work synergistically together and more effectively than when one ingredient is used alone.1 Humectants (e.g. glycerin, propylene glycol, sorbitol) increase the water-holding capacity of skin by attracting and holding on to water.2,3 Emollients (e.g. dimethicone) are oils and lipids that occlude the skin's surface, making it soft, supple and flexible.2

Moisturizers are often co-marketed as anti-aging products, being packaged with other ingredients, especially antioxidants that are already found in the skin. (See Table for a full overview of these ingredients.)4 While antioxidants can work wonders, we commonly recommend three classes of ingredients to further bolster an at-home program.

Retinoids

Retinoids are the most touted topical anti-aging ingredients and with good reason. Studies show that retinoids can increase collagen production; stop, block and reverse photodamage; and thicken the epidermis and dermis.5-9 Tretinoin (brand name: Retin-A; all-trans retinoic acid) is considered the gold standard; it has been extensively studied and has the largest body of evidence in the treatment of aging skin.10

Because of the success of the pharmaceutical version, retinol has become the main ingredient of cosmetic OTC anti-aging products.11 While the results have been limited compared to the prescription strength product, over the counter ingredients have been shown to decrease photodamage by reducing fine wrinkles and enhancing skin smoothness.12 Another benefit is that the skin may tolerate retinol, the parent compound of prescription tretinoin, better because it's milder.13 Thus, patients could always start off with an OTC product containing retinol if they are reluctant or are not interested in using prescription-strength tretinoin.  

When prescribing these prescription-strength and OTC products, health care providers should recommend a moisturizer to offset retinoic acid's initial irritation and related stratum corneum barrier compromise. In fact, studies have shown that improving stratum corneum barrier function before beginning topical tretinoin therapy and continuing to use barrier-enhancing moisturization during treatment eases the patient through the early phase of facial retinization.14

Alpha-hydroxy Acids

Alpha-hydroxy acids are another popular anti-aging ingredient. These fruit acids, including glycolic acid, malic acid, citric acid, polyhydroxy acids and lactic acid, restore skin health by exfoliating the skin.15

AHAs have been used to treat a variety of dermatologic conditions, including photodamage, acne, acne scarring, melasma, post-inflammatory hyperpigmenation and dry skin.12 In fact, studies show AHAs can smooth the skin and decrease corneocyte cohesion, causing exfoliation.16 In addition, AHAs increase epidermal and dermal thickness resulting in firmer and thicker skin with a decrease in fine lines and wrinkles.17,18

Glycolic acid is one of the most commonly used AHAs to treat photoaged skin. It acts as a "skin refreshing" peeling agent, and is commonly used in topical products as well as moisturizers. The effects of AHAs on skin vary depending on its concentration and pH.19 The FDA has mandated that the concentration of glycolic acid in OTC products cannot exceed 10 percent.20 Mild peels of 10 percent to 40 percent can be used by trained cosmetologists in salons, but peels of 40 percent or more can only be used by medical practitioners.20 Patients with at least some degree of photodamage should see some improvement in fine lines, skin texture and pigmentaiton if they use a glycolic acid-based moisturizer containing less than or equal to 10 percent glycolic acid for three to six months.21-22 Keep in mind that increasing concentrations and decreasing pH are associated with increased irritation, so it is a good idea to recommend topical glycolic acid formulations with dosages of 4 percent to 8 percent for home use.19

Beta-hydroxy Acids

An alternative to AHAs is beta-hydroxy acid (BHA).23 Salicylic acid is one of the most common and popular beta-hydroxy acids and can be used for normal, acnegenic or photodamaged facial skin. Like AHAs, BHAs decrease corneocyte cohesion, which causes exfoliation. However, BHAs have the ability to penetrate the pilosebaceous unit, which allows a more pronounced comeodolytic effect.16,24,25 Additionally, the efficacy of AHAs are highly dependable on their pH and concentration and this does not seem to be the case with BHAs.26

Salicylic acid is available OTC in concentrations from 0.5 percent and 2 percent and in prescription preparations greater than 2 percent.27 Because it is a keartolytic, salicyclic acid has been used to treat many skin disorders (e.g. psoriasis, seborrheic dermatitis, warts) in addition to acne.24,28-30 It is widely used in OTC anti-aging preparations because of its exfoliating properties. Salicylic acid peels of 30 percent are often used as an office-based treatment for photaging, which improves solar lentigines, keratoses and actinic damage.31-33

Despite the availability of numerous ingredients, the most cost-effective intervention is prevention by the use of sunscreen and by healthy lifestyle choices (e.g. not smoking). However these anti-aging ingredients as well as a moisturizing product can provide a safe and effective topical treatment that can help ameliorate the signs of aging skin and give your patients the impression of eternal youth. (Click Page 2 for References.)

Jodi Ann LoGerfo, MSN, APRN, BC, FNP-C, is a family nurse practitioner, board certified in family medicine and specializing in dermatology. She is in group practice at the Orentreich Medical Group in New York. Jodi has an extensive background in pharmaceuticals, conducting research and developing dermatological products for the Orentreich Medical Group. She is also an associate of the Orentreich Foundation for the Advancement of Science and the Orentreich Research Corp.

Moisturizers and the Anti-Aging Arsenal

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Hi Rebecca. Thank you for your interest in the article.
Since you live in sunny Hawaii, a major part of your anti-aging regimen should be sun protection. Daily application of a sun protection product with an SPF of at least 30 or higher, as well as sun avoidance and clothing are essential. If you participate in sports or water activities, you should use a sun protection product that is water resistant or waterproof. The product should be broad spectrum, providing both UVA and UVB protection and it should be worn EVERY DAY and reapplied often (every 2 hours if you are outside).
There are many OTC products that contain the ingredients mentioned in the article, but for prescription-based treatment topical tretinoin (Retin-A) is the gold standard, improving aging skin and reversing age-related changes.
A healthy lifestyle can only help your skin-not smoking, drinking plenty of water and of course wearing sun protection.
Although estrogens have been shown to have positive effects on skin, particularly alleviating those changes that occur with aging, we cannot recommend its use as a treatment for aging skin.
I hope this helps!
Best regards,
Jodi

Jodi  LoGerfo,  FNP-C,  Orentreich Medical Group, LLPNovember 19, 2009
New York, NY



Hi...

Just read the article ANTI AGING ARSENAL by Jodi ANN LoGerfo, MSN, APRN, BC, FNP-C...Can I ask her these questions??

Are there products out there specifically she can recommend with all those properties sold over the counter or prescription? I am over 50 yo and live in Hawaii where it's sunny for the most part of the year.
Any other recommendations for good skin such as plenty of H20 and exercise?
Is hormonal replacement (e.g. Premarin) good to maintain healthy, younger, looking skin?

Thanks for the reply.
Rebecca



Rebecca ,  RNCNovember 11, 2009




     

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