Skincare 101 - Active Ingredients That Really Work

A key component of skincare products are the active ingredients, the components that help to restore the skin's optimal wellness and appearance. Active ingredients help to boost your skin's ability to combat and reverse the damages of environmental and internal ravages, and are an important part of your daily care routine.

Which skincare? Consumers are spoilt for choice.

There are literally thousands of skincare brands on the market, with many more being launched every day. Expensive skincare brands are often advertised heavily, with endorsements by beautiful celebrities and models, but do big advertising budgets guarantee great products? Other brands are less well advertised but they appeal to different niche markets, whether it be the close-to-nature, hypo-allergenic or chic-but-cheap sectors. they all have different ingredients and claims that make the right choice very hard to make.

Which products have proven efficacy?

Dermatologist-tested products, or those who have been proven through clinical trials and tests, are your best option for products that actually give you your money's worth.

Anti-wrinkle creams are among those that are the most popular in the market. Everyone dreams of creams that can erase lines and wrinkles overnight, but unfortunately there are few products that actually live up to their exorbitant claims. One active ingredient that is proven is tretinoin, a Vitamin-A derivative which has been shown in trials to improve skin exfoliation and stimulate collagen production. It has also been shown to reduce pigmentation, improve skin tone and texture, and give a 'rosy glow' due to increased blood circulation.

Tretinoin must be applied daily for a minimum of 6 months for noticeable results. It has been tested in many short and long term clinical studies, and has been proven to work even on severely aged and wrinkled skin. Tretinoin can be highly irritating to the skin and can cause acne and skin peeling in the initial stages, so it should be prescribed and administered carefully under a doctor's care. A high SPF sunscreen is a must to prevent the skin from continuing sun damage during the treatment process. Pregnant or lactating women should not use tretinoin, and it should also be avoided if you have rosacea (skin redness). Also commonly prescribed for the treatment of acne, tretinoin is also now available in micronized form to help with some of the side effects such as skin dryness and irritation.

Over-the-counter products with Vitamin A in the form of retinol do not have the same efficacy as prescription products as retinol is not as easily absorbed and used by the skin. Retinol can be more helpful as a preventative measure to help younger skin prevent the signs of aging. Other forms of Vitamin A such as tazarotene and adapalene are also available, but most patients find tazarotene highly irritating, and adapalene too gentle and non-effective.

Products containing hydroquinone are also effective for lightening of pigmentation problems such as freckles, melasma, liver spots and age spots. Hydroquinone works by inhibiting enzyme reactions within the skin, thus preventing pigmentation. Hydroquinone creams are available at 2% strength in OTC products, but your doctor can prescribe a cream up to 4% strength for better results. The use of a sunblock is essential during treatment with hydroquinone creams. Some doctors use a hydroquinone and tretinoin combination for stubborn melasma or hyperpigmentation cases.

Alpha-hydroxy acids such as glycolic acid or lactic acid work by exfoliating dead skin cells to allow for growth of new skin. They also help to unclog pores, improve skin texture and have an added benefit of skin lightening and depigmentation. The pore cleansing action of AHA also means it can be helpful in controlling mild to moderate acne. AHA creams are very commonly available, but the low acid content of most OTC products means they have limited effectiveness; for AHAs to really make any difference, they must have at least a 10% acid content or more, and have a low pH of around 2. 15% glycolic acid lotions are a useful additional treatment for melasma, when used in conjunction with treatment creams such as Tri-Luma.

A doctor-administered glycolic acid peel can be useful to restore the skin by exfoliation to reveal the younger, smoother, lighter skin beneath. Research has also shown that glycolic acid peels used in combination with topical active ingredients such as tretinoin, can increase the effectiveness of the anti-wrinkle or skin lightening process.

Beta-hydroxy acids or salicylic acid, is more suitable for younger, oily skin, as it is soluble in oil. It helps to soften keratin and promotes clearance of blocked pores. BHAs are also useful in promoting skin moisture levels and is an effective anti-inflammatory agent as well. Salicylic acid is also prized for it's ability to improve cell turnover and promote depigmentation, and is therefore a great alternative for those who are sensitive to AHA creams.

Antioxidants are active ingredients that help to fight the free radical activity that damages skin cells, and therefore should be an important ingredient in your daily fight against skin degeneration. The good news is that there are many antioxidants that have been shown to have great efficacy. Green tea  or olive extracts, for example, contain polyphenols, which have been featured in numerous clinical studies that show their ability to retain moisture, fight oxidative stress and prevent formation of skin damage. Alpha -lipoic acid is another potent antioxidant that can inhibit cellular aging, help soothe inflammation and promote detoxification of a variety of chemicals. Vitamin C, CoEnzyme Q-10 and caffeine are also antioxidative substances that show promise in the battle against premature aging.

Perhaps the single most effective skin care product that you can use to prevent premature aging and protect your skin against sun damage is proper sun protection and sunblock. I wrote about the importance of proper sun care in a previous article, Sun Safety: Is Your Sunscreen Doing Its Job?. If your skin is being attacked and damaged by the sun on a daily basis, then it cannot look its best and absorb any of the goodness from your active ingredients, and you are essentially wasting your efforts and your money.

Cosmetic Medicine, MD

Dr. Liow Tiong Sin is an aesthetic practitioner who practices in Kuala Lumpur and Melaka, Malaysia. He has more than 12 years of expertise with non-surgical cosmetic treatments, and  conducts training courses for other doctors from all around Asia. To connect with Dr. Liow, Like Cosmedmd's Facebook page. medical centre website or email. 

Understanding Melasma

Melasma

In Asia, melasma is a very prevalent and common problem. It most typically occurs with lightly pigmented skin types such as Asian and Hispanic skin, and also presents more commonly in women. Melasma can be caused by frequent exposure to the sun, but is also known to be caused by female hormonal changes due  to pregnancy or the use of oral contraceptive pills. Some patients are also found to have a genetic predisposition to the condition.

What is melasma?
Melasma typically occurs in three patterns: centro-facial - occurring on the forehead, cheeks, upper lip, nose and chin areas, malar - occurring on the upper cheek areas and mandibular - which is specific to the jaw line and sides of the cheek.

Melasma differs from freckles in that freckles are generally spread over wide areas of the face and occur as small, darkened spots of various sizes. Melasma that occurs in the epiderrmis (top layers of skin) responds better to treatment than dermal melasma. 

As melasma can build up very gradually over a number of years, proper diagnosis and treatment may not be sought until the melasma is at a very advanced or pronounced stage. Early stages of the condition may be only visible with the use of a Wood's lamp or computerised facial analysis system.

Treatment of melasma
Melasma treatment can be very difficult, as the pigmentation can be worsened with the wrong care. Physicians may choose to explore different options as different patients respond to different types of treatment. Epidermal melasma is the easiest to treat, with dermal melasma often recurring very rapidly after cessation of treatment. Hence, identification of melasma type can be a very important factor in  Here are some clinically-tested treatments for melasma that are the best available on the Asian market at the moment.

Tri-Luma
Tri-Luma is an FDA-approved treatment for melasma. It is a topical cream treatment for melasma that is well-tolerated and works well for most patients. It is a combination of hydroquinone - a lightening agent, Tretinoin - vitamin A derivative, and fluocinolone - an anti-inflammatory agent, and can be very effective if properly used.
The cream is applied to the affected areas once daily, and is effective within 6 - 8 weeks of use.



Cosmelan
Cosmelan is a facial mask treatment that works on facial pigmentation by inhibiting tyrosinase, an enzyme in the melanin formation process. The mask is applied by a doctor, and it is left on for a set number of hours depending on each patient's requirements. Peeling of the skin occurs on the second day of treatment, and usually resolves within the next few days to leave the skin clearer, smoother and more refined.
The treatment is combined with a topical skin treatment that the patient applies at home.

Fraxel
The Fraxel Re:store DUAL laser is the only laser that is FDA approved for the treatment of melasma. The treatment for melasma differs from that of other conditions, so it is important that the proper settings for melasma are used when Fraxel is given. In certain cases, the wrong Fraxel settings can result in a worsening of the melasma. Patients may be given a topical treatment such as Tri-Luma for pre- or post-treatment care. Treatments are typically given monthly for a three to four month period, and a few days' downtime as the skin darkens and peels is normal after every treatment.

IPL
IPL or Intense Pulsed Light is a very commonly found therapy that even beauty salons are offering today. While there are many horror stories of botched treatments and intensification of melasma pigmentation after such treatments, studies have shown that melasma can be very effectively treated with the right settings and protocol on an IPL machine. Li, et al. showed in a 2008 study conducted at the China Medical University in Shenyang, China, that 69 out of 89 Chinese women suffering from melasma, obtained a 51% to 100% improvement in their condition after a total of four IPL treatments in 3 week intervals.


Melasma can be successfully treated, but improvement usually takes time and repeated treatments,and may require a combination of different modalities for full effectiveness. Proper sun care, with sun avoidance, usage of hats or covers or high SPF sunscreen is a very important factor for successful resolution of the problem. In many cases, unless exposure to the sun or to hormonal factors can be minimised, melasma will recur after the prescribed treatment.

CosMed, MD