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. 

Collagen Supplements - Do They Really Work? What Does?



Old or young? The difference is collagen

I've had many patients come to me and say they take excellent care of their skin,with a regimen that includes regular beautician visits, expensive skincare and that latest must-have - collagen supplements. Usually available in a drink, and costing up to USD100 per bottle, these supplements are not cheap, but come with a lot of promises for prolonged beauty and general health.

 

Collagen - is it really so important?

Collagen is a natural protein component of the skin that acts like a scaffold and the main building block for cells, tissues and organs. About a third of the protein content in your body is made up of collagen, which is found in the bones, muscles, and tissues of the organs. Collagen, keratin and elastin give the skin its strength, elasticity and structure.

The body naturally produces the collagen that it needs, but this production is gradually disrupted as part of the natural aging process. Women produce less collagen than men, and this collagen is lost at a rate of about 1% per year. This means that a woman has naturally lost almost half of the collagen from her skin by the age of 50.

Collagen is also greatly affected by environmental stresses such as sun exposure, nutrition, skin damage, and exposure to toxins such as pollutants, cigarette smoke and recreational drugs. With decreased collagen, the skin loses its natural elasticity and firmness, and fine lines, wrinkles and sagging appear.

 Poor collagen levels also affect the bones, and this picture (right) shows how collagen loss affects facial shape in extreme age degeneration.

Here's to your youth - anti-aging drinks claim to deliver beauty in a bottle, but do they really work?

 

Collagen supplements claim to offer a range of benefits, including

• reducing wrinkles
• reversing age of skin
• tighter skin
• plumps up skin
• improves skin elasticity

The truth is, however, that there is little to no evidence that beauty supplements, pills and drinks can do what they claim. Collagen is a type of protein which when ingested, is broken down by the digestive system into individual amino acids to be recombined by cells according to their needs.  

So many companies have jumped on the collagen bandwagon that it is very hard for consumers to realise that there is actually no scientific proof that collagen supplements have any effects on skin health and appearance at all. There is no guarantee that drinking collagen drinks would be any more effective than any source of protein such as meat, cheese, eggs or beans at restoring the collagen in your skin.

So if you can't get collagen through a drink, what about collagen in skin care products? Most collagen molecules applied to the skin in lotion, cream or gel forms are far too large to be absorbed into the dermis - they merely lie on the surface and get washed or rubbed off. There are some companies that are selling micronized collagen which are meant to be small enough to be absorbed into the skin, but it is unlikely these micro molecules would be in any form useable by skin cells. It is also highly likely that any collagen that actually manages to penetrate the skin would be challenged by the body's immune system as a foreign body. They would either cause an allergic reaction or simply be destroyed by the white blood cells before they manage to be of any benefit to the skin whatsoever.

What really works?

The abundance of collagen supplements on the market tells us that many people are genuinely concerned about their skin health. So, based on the best dermatological and anti-aging expert advice, what can be done to ensure we show up at our 20-year school reunions with our best faces forward?

Reduce collagen degradation
To ensure sufficient collagen in the skin, first prevent loss of the collagen that you already have. If you are not already on a proper sun care regimen, that should be your first priority. Studies have shown that sun protection is one of the most important ways in which you can combat aging. Cigarette smoke, like sun exposure, has also been shown to greatly degenerate collagen, and there is also evidence that improper and insufficient sleep has a negative effect on skin health. Read more about tips for choosing a good sunscreen in this previous post.

A nutritious diet
Eating the right foods and getting good sources of antioxidants from fruits and vegetables is very important for collagen production. Brightly coloured produce such as tomatoes, grapefruit and watermelon contain the powerful antioxidant lycopene, which helps prevent collagen degeneration. Fruits such as oranges, strawberries and red peppers also contain Vitamin C, something that is key for the optimum condition of the skin. Vegetables such as broccoli, leafy greens and cauliflower provide our skin with glucosinolates, which fight the free radicals that attack our collagen. Also key to skin health is the omega-3 fatty acid known as eicosapentanoic acid or EPA, which has anti-oxidative and anti-inflammatory effects to help protect and heal the skin. Omega-3 is readily available from food sources such as oily fish and spirulina. Avoid starchy foods and sugary substances; this helps
reduce inflammation which interferes with the body's natural collagen production processes.

Proper skin care
The right skin care helps regulate the optimum skin condition so that it is protected from extreme stresses. What works? Regular exfoliation with a gentle exfoliator scrub, or with alphahydroxy acids (AHAs) can help to 'exercise' the skin, and ensure healthy cell renewal. Skin care products that have been proven to help combat aging include products that have antioxidant properties, examples of which include green tea extracts, coffeeberry and DHEA. Try products with retinol, a Vitamin A derivative, sometimes known as Retin-A, which works to both stop collagen degradation from the effects of UV exposure while boosting collagen production.


Collagen Stimulating Dermal Fillers
Hyaluronic acid, a natural water-binding component of the skin, helps to stimulate collagen production by surrounding fibroblasts - the skin cells that produce collagen  - with plenty of water. As the skin ages, this important component of the skin also suffers a decline. 
 
Researchers at the University of Michigan medical school found that Restylane injections (Restylane's key component is hyaluronic acid) not only stimulated the fibroblasts around them to increase collagen output, but also seemed to be protective of the existing collagen in the area as well. The two top hyaluronic acid dermal filler brands are Restylane and Juvederm, and they work by immediately filling the area to plump out lines and wrinkles. The effects of the filler are enhanced by the collagen stimulation, so patients tend to need repeat sessions less frequently. 

Just like hyaluronic acid, poly-L-lactic acid or PLLA, has been shown to stimulate collagen growth. PLLA is a major component in Sculptra dermal fillers, which are injected deep into the dermal layer in a three-session treatment program which lasts up to two years. Sculptra has been proven to correct both collagen loss and fat atrophy, and is also FDA approved for AIDS patients who have severe cheek lipoatrophy (fat loss).

Radiesse, which has calcium hydroxylapatite as its collagen stimulating active ingredient, is another dermal filler that works very effectively in restoring volume in patients with deep lines or sagging skin. The effects of the collagen stimulation allows the volumising effect of Radiesse to last for about 12 months or more. 

Laser and RF collagen stimulation
Collagen production slows with the aging process, but where the skin is injured, collagen production is increased as part of the skin healing process. Aesthetic equipment such as carbon dioxide and Fraxel lasers, and radiofrequency modalities such as Thermage and Ultherapy all work by subjecting the skin to controlled damage, so that collagen renewal can be stimulated. All of these methods work very well to tighten the skin and improve its appearance, although lasers are designed to stimulate regrowth on the surface and epidermal (top layer) areas, and radiofrequency skin tightening works in the deeper dermal areas for greater wrinkle and line rejuvenation.



- 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 drop him an email at cosmedmd@gmail.com  

Sun Safety : Is Your Sunscreen Doing Its Job?

Proper sun protection should be of key concern for all people of all walks of life. With the correct sun care, skin whitening lotions, depigmentation treatments and anti-aging creams would probably be much less popular and certainly a lot less necessary.

A main factor in the health and appearance of the skin is its interaction with the sun. Ultraviolet (UV) rays in sunlight can cause skin darkening, accelerate the aging process, cause skin abnormalities and are the number one cause of skin cancer. So much damage is caused by lack of knowledge about the negative effects of the sun, and when the harm is done, it takes a lot of time, effort and often discomfort to reverse it. 

This recent blog post, detailing the damage done to a trucker's face from exposure to the sunlight through his driver's seat window, is compelling evidence of the damaging effects of sunlight.So it goes without saying that sun protection is a topic dear to the heart of any doctor who has any dealings with the skin. As with many skin care products, sun care products can be misleading and poorly understood, and thus are prone to being used improperly.

Proper medical-grade sun care is far more important than collagen drinks
and Vitamin A creams in the fight against premature aging. 

Daily sun care is of course, something that most of us know we must use, but it is easy to ignore the need for this when we are in a rush or when other issues seem more pressing. Despite their tender skin, sun protection for children is often something that is poorly utilised. For those who have undergone laser or other corrective skin care procedures, effective sun protection is of paramount importance. As the skin is healing, it is at its' most susceptible to damage.

Here are a few of my basic rules for proper, effective sun protection, whether you have recently undergone an aesthetic procedure, or even if you are only concerned with staying healthy in the sun.


1. Use a Sunblock With Zinc for Complete Protection. The SPF label on your sunscreen only refers to its UVB blocking components. UVB rays are responsible for burning the skin, but UVA rays are the ones that cause cancer, DNA mutation and cause deeper damage of the skin. UVA rays are only blocked by physical sunblock components that leave a white residue on your skin. This can be considered unsightly by some, and is why many cosmetic sunscreens do not contain it. UVA rays can be minimally blocked by some chemical components including titanium, but only a sunblock containing zinc will give you proper protection against UVA rays. There are formulations available that offer micronized zinc that does not leave an unsightly residue.

2. A Higher SPF May Not Be Necessary. An SPF of 30 blocks 96.5% of UVB rays, and an SPF of 45 blocks 98% of UVB. Therefore, any sunscreen with an SPF of at least 30 is more than sufficient for anyone who spends a moderate amount of time out in the sun. A higher SPF will not give you greater protection or prolong its effectiveness. I also have patients tell me their skin cream is SPF 15, their foundation is SPF15, and the powder is SPF 15, surely it all adds up to SPF 45! Unfortunately, no, different layers of sun protection may seem like more coverage, but in actual fact it does not provide increased protection.

3. Apply Sunblock To The Skin, 30 Minutes Before Exposure, and Reapply Frequently. For it to work effectively, sunblock needs to be applied to dry, cleansed skin, under your make-up or skin creams, where it can create a physical layer. Allow the sunblock to set and gain effectiveness for up to 30 minutes before exposure to the sun. It is also important to note that sunblock needs to be reapplied every 1.5 hours or so for full coverage. No sunblock lasts all day, despite their claims. Sunblock is also never completely waterproof, but some brands have water resistance that allow them to be used at the beach.

4. Look For Additives for Added Protection. If you can find a brand that offers added antioxidants such as Vitamins C & E, these additives have the ability to reduce inflammation and improve overall skin protection.

5. Oral Sunblock Can Be An Effective Tool For Photo-Protection. There are some antioxidant products in the market that act as oral sunblocks, to decrease the damaging effects of the sun. Used in conjunction with topical sun protection, they can be an added layer of protection against the long-term effects of sun damage.

6. Prevention is Better Than Cure. Avoiding exposure to sunlight isn't entirely practical, but minimising exposure when the sun is at its peak between the hours of 10am to 4pm helps. Use curtains and shades to minimise the amount of sunlight into your home, and sun protective clothing can give an added layer of protection when you are outdoors.

7. Darker Skin Is Not Immune To The Effects of UV Rays. Although darker skin types are naturally protected from the sun burning effects of UVB rays, damage can still be caused by UVA that result in melasma, sun spots and even cancer. Melasma, in particular,  is quite common in dark skin types and can be  very pronounced and widespread. It is especially hard to treat as the natural pigmentation of the skin makes it very sensitive to most melasma treatments currently available. The best advice is to use an SPF of at least 15 with zinc at all times, and avoid overt exposure to sunlight during peak sun hours.

Melasma in dark skin types can be very hard to treat 

The proper use of the right medical-grade sunblock can be very helpful in reducing the risks of sun related skin conditions such as cancer, melasma, pigmentation disorders and photoaging. Since sun damage isn't generally evident until years after the worst has been done, often patients come to me in their 40s and 50s lamenting their melasma, pigmentation and wrinkled complexions. In our tropical South East Asian countries, effective sun care must surely be one of the easiest ways to look good even in to maturity.

- Cosmetic Medicine , MD

Striking Evidence of Damaging Effects of Exposure to Sun

Veteran trucker's face with unilateral dermatoheliosis 

William Edward McElligott was a trucker for 28 years, and you don't have to be Sherlock Holmes to be able to tell. The damage from dermatoheliosis is very pronounced on the left side of his face, from exposure to the sun from his side window. On the right side of his face, he looks not much older than his actual age of 69, but the thickening, sagging and nodules on the other side looks like that of a much older person. 

His case was presented in the April 2012 issue of the New England Journal of Medicine, and is a very convincing piece of evidence of the negative effects of exposure to the sun. This patient's skin condition is consistent with the effects of Favre-Racouchot syndrome, a disorder caused by exposure of the skin to damaging sunlight. 

This kind of damage is typically caused by UVA rays, which are less intense than sunburn-causing UVB rays, but can be up to 50 times more prevalent. Such frequent and prolonged exposure to the sun can also cause DNA mutations that can lead to skin cancer.

This photo is a reminder of the importance of prevention and protection from excessive sun exposure, and the use of at least an SPF 30 sun block at all times is a must. Wearing protective clothing and hats are also important, as is the use of sunglasses to protect the eye and ocular area from photo-aging, especially during the peak sunlight hours of 10am to 4pm. 

CosMed, MD