HOW TO TREAT WRINKLES

During the last few years there has been a huge increase in the use of preparations containing retinoic acid, derived from vitamin A, and of those containing glycolic acid, derived from sugar cane.  These preparations reduce both the depth and number of fine wrinkles by stimulating the production of collagen fibers, by delicate peeling of the upper layer of skin and by stabilizing the rate and quality of the production of the epidermis.  Skin which has suffered severe sun-induced damage can be treated by either superficial, medium or deep peeling, depending on the condition of the skin. Superficial and medium peeling can usually be performed in a dermatologist’s office and do not require hospitalization.  Deep peeling may produce side effects and requires constant medical supervision for several days.  Deep wrinkles can only be treated with laser resurfacing, dermabrasion, or by injecting fat or collagen directly into the wrinkles.  A facelift is the only way to fight loose wrinkeled skin caused by gravitational forces. Regardless of a person’s age, a sunscreen should be used to prevent additional damage to the skin and to preserve its moisture content.

RETINOIC ACID (Brand names: Retin A, Renova,
Locacid, Airol)

There are few women today who have not heard about a preparation whose scientific name is retinoic acid, and is marketed under the names “Retin A,” “Retavit,” “Locacid” and “Airol.”  The discovery of this substance, which in structure resembles vitamin A, caused a revolution in cosmetic dermatology.  Until its properties were discovered, the only treatment for wrinkles was the use of cosmetics to camouflage them or the use of face masks which would make wrinkles disappear for a few hours.  When retinoic acid was discovered it was demonstrated for the first time that there was a real possibility of decreasing the number of fine wrinkles and of improving the structure of the skin.  It is known today that retinoic acid can decrease the number of fine lines, lessen to a certain extent the size of enlarged pores and reduce the number of brown and white marks caused by overexposure to the sun.  It also increases the amount of blood which circulates to the skin, making it glow and look pinker.  Retinoic acid increases and regulates the cell division of the epidermis and thus the skin becomes thicker, smoother and more uniform in color.

These changes do not occur overnight.  A real improvement in the quality of the skin only appears after at least six months of strict, regular use.  It is also important to remember that the use of retinoic acid cannot replace plastic surgery or peeling, and has no influence on the deep wrinkles caused by continued damage to the collagen fibers as a result of the force of gravity or the action of the facial muscles.

HOW TO USE RETINOIC ACID

Retinoic acid is packaged in varying concentrations: 0.025%, 0.05% and 0.1%.  The concentration used depends upon the type of skin involved.  It is advisable to begin with the lowest concentration and to gradually increase.  People with fair, sensitive skins should use lower concentrations, and people whose skins are thickened and dark can use the higher concentration.  If the skin is oily, a gel preparation and not a cream should be used.  Retinoic acid causes hypersensitivity and it is therefore advisable to apply it in the evening, about 30 minutes before retiring for the night: the face should be washed with a mild soap and dried, and 15 minutes later a very thin layer of the cream or gel should be applied to the entire surface of the face, the upper chest and the forearms.  An amount the size of a pea is sufficient to cover the face and a similar amount is adequate for the forearms and upper chest.  A small amount may be applied under the eyes and on the lips, but under no circumstances should it enter the eyes or mouth, and it should not be applied to the eyelids.  Retinoic acid increases the sensitivity of the skin in general and to the sun in particular.  During the day the skin must be protected from exposure to the sun and a moisturizing cream containing a sunscreen must be used, or a sunscreen can be used instead of a moisturizer.  Men must apply a sunscreen every morning or a moisturizing cream containing a sunscreen instead of after-shave lotion.  During the first weeks, the skin may become red and peel slightly.  This is entirely normal and signifies that the retinoic acid has begun to influence the skin.  If the redness is especially severe the concentration may be reduced, or the cream may be applied every other day or once every three days.

WHAT ARE THE SIDE EFFECTS OF USING RETINOIC ACID?

There are two side effects which almost always occur when retinoic acid is used: the skin feels dry, and it burns slightly.  The dryness results from the action of the retinoic acid which reduces the thickness of the upper layer of the epidermis and the cornified layer, which are responsible for preserving the natural moisture of the skin.  The slight burning sensation that most people feel during the first few weeks is due to acidity.  Excessive irritation is usually caused by using too much of the cream or gel or by using too high a concentration.  If the redness or burning is especially annoying, treatment should be suspended for a number of days and then continued using a smaller amount (half the size of a pea for the whole face) applied once every two or three days.  At the beginning of the treatment, retinoic acid causes the skin to be thinner and therefore very sensitive to the sun, even to short periods of time during which it is unprotected.  It is therefore advisable to begin treatment in the Fall, and even then to apply a sunscreen regularly in the morning and at noon.  If the skin has been very severely damaged by the sun, when the treatment is initiated red marks may appear.  These marks are pre-cancerous lesions (solar keratosis) which have been made apparent by the retinoic acid.  After a number of months they are likely to become smaller or even disappear.

Retinoic acid is a safe medication, used by millions of men and women all over the world.  Its chemical composition is similar to that of a anti acne drug called isotretinoine (Accutane) which can cause congenital birth defects if taken by pregnant women.  There are no recorded cases of birth defects caused by the use of retinoic acid, nevertheless most dermatologists do not advise its use by pregnant women.

ACIDS DERIVED FROM SUGAR CANE, MILK OR FRUITS

In recent years dermatologists have become interested in  a group of chemical compounds derived from natural substances which may bring about a breakthrough in the treatment of acne and of marks and wrinkles caused by overexposure to the sun.  They are based on alpha hydroxy acids, naturally derived from sugar cane, fruits or milk.  The Journal of the Mayo Clinic Medical Center stated recently that preparations containing glycolic acids are the only cosmetic preparations apart from retinoic acid with a real chance of fighting wrinkles.  Like the action of another acid, called trichloroacetic acid (TCA), which has been used for many years by dermatologists for chemical skin peeling, high concentrations (50-70%) of glycolic and lactic acids cause burns.  However alpha hydroxy acids in general and glycolic acid in particular cause far less drastic changes than TCA.  After several weeks of daily use of these mild acids, a new epidermis is produced which has far fewer foci of sun-induced damage.  The new skin looks tighter and some of the wrinkles are smoothed over.

Some of the marks caused by the sun are linked to an accumulation of melanin in cells of the epidermis, and replacing the epidermis causes, among other things, a reduction in the number of these marks. 

Glycolic acid in 5% and 10% concentrations weakens the bonds between the dead skin cells in the upper layer of the skin (the cornified layer) and permits new cells underneath to replace them.  Replacing the dry, rough, impaired cornified layer with a new, smooth cornified layer makes the skin look smoother, uniform in color, and—most important—younger.  Higher concentrations of glycolic acid (50% to 70%) cause the upper layer of the skin (the epidermis) to separate from the layer beneath it (the dermis).  It also brings about a reduction in the number of cells which have undergone mutation or cancerous changes and thus reduces, to a certain extent, the risk of developing pre-cancerous and cancerous growths.  It has been stated, although as yet there is no concrete proof, that preparations based on alpha hydroxyl acids such as glycolic acid also influence the dermis.  Some researchers think that these substances penetrate the dermis and cause the creation of new collagen fibers, thus reducing the number of wrinkles in the skin.