Every year, something new is being marketed – amazing results, proven to reduce wrinkles by 50%, and ads with beautiful models photoshopped. They know the buzz words. This year, it is stem cells and growth factors. The stem cells are from a plant which would be great if you were a radish. You will not grow new skin cells or collagen from plants. The growth factors are species specific and cannot be absorbed through the epidermis anyway. Actually, the scientists that work in this field tell me the only stem cells that will work seem to be from the foreskins of circumcised male infants. Effective stem cell therapy is a long way off and will be very expensive.
If you want to stimulate your skin stem cells or growth factors, you need to use your body’s own machinery or activate the DNA within the nucleus of your the cell using anti aging precursors. There are 4 main ways I know of to effectively reduce wrinkles; 1. Controlled wounding to stimulate your skin to grow new cells, collagen and elastic tissue by chemical peels, laser, etc– which is best done by your dermatologist or physician (I will not go into this in this post), 2. Some topical medications or serums (retinoids, high dose Vitamin C or glycolic acid, possibly potent antioxidants such as green tea or CoQ10) , 3. Orally with antioxidant supplements and a healthy diet, 4. Hormones (not that I am necessarily recommending this). But hormones such as estradiol, DHEA and growth hormones do work, especially estradiol. I will expand on each later in my post.
If you’ve wasted a lot of money on these “hope in a bottle” creams, don’t feel alone. I myself at the age of 55, still occasionally for these hype creams. I should know better by now! I was vacationing with my 20 year old daughter in NYC (she is beautiful and much younger version of me), when I got a look at myself in a mirror in the makeup department at Barneys, next to my youthful daughter. Next thing I know, I was talked into buying a $200 mushroom cream from France. Well, for some reason, it didn’t seem to work as well when I got home. I looked the same. It went in the closet, in a pile, with all my other previous , delusional investments.
The following is a list of what I think really works, based on research, 25 years experience with my patients and my own skin.
Topical serums (retinoids, high dose vitamin C or glycolic acid, and some antioxidants combined with zinc oxide block).
– Retinoids. The gold standard, proven to work with multiple studies and over 20 years. These substances are derived from Vitamin A and are naturally occurring in the skin. They work by binding to DNA at the nuclear level, activating the synthesis of growth factors and other proteins that then serve many functions to rebuild the skin. The effective retinoids include tretinoin (Retin A, Renova, Ziana gel), tazarotene (Avage, Tazorac) and high dose retinol.
Tretinoin (Retin A, Renova, Ziana): Concentrations of 0.02% to 0.025% are all that is needed for wrinkle reduction. Clinical studies have shown that stronger strengths do not work any better for wrinkle reduction. Higher doses are more effective if you are treating acne but not necessary for treating photodamage. Tretinoin must be used 5 times a week to see significant improvement and wrinkle reduction, 3 times a week for maintenance. Tretinoin is very lipid soluble through the skin and can penetrate too quickly in some skin types. You can slow it down by applying moisturizer first. Plenty of tretinoin will still get through, just at a slower rate.
Retinol: Retinol works but is 20 times less effective as tretinoin. It is a great alternative for the patient that just can’t get use to RetinA. The retinol product must contain at least 0.25% retinol to effectively reduce wrinkles. Many dermatology offices sell 0.25% to 1.0%. Store brands will be weaker but RoC Retinol Correxion should work. Note: Retinyl Palmitate and vitamin A are ineffective, so don’t be fooled.
Tazoratene (Tazorac, Avage): These creams have been proven to reduce wrinkles and do work. They are less irritating to some patients but my observation is that they are not quite as effective as the tretinoin (RetinA) creams. Many patients are, nonetheless, happy with tazarotene.
High Dose Vitamin C. Concentrations should be at least 10% and only the L-ascorbic acid works. Ascorbyl palmitate does not penetrate the stratum corneum so will not be absorbed, so don’t be fooled. The ascorbic acid should be in a container that is protected from the light and will decrease in potency quickly. Vitamin C works best and is the most stable when it is combined with vitamin E and ferulic acid. I think Skinaceuticals Vitamin C/E/Ferulic acid is hands down the best formula to use. The Skinaceuticals 20% Vitamin C is a close second. Vitamin C works especially well combined with a 9-17% zinc oxide sunblock, used together every morning. Elta MD and Elite 17%, sold in our office, are both excellent sunscreens.
Glycolic Acid, 5% or higher. We do not yet understand why glycolic acid works but it does work to improve the epidermal and dermal layers. I have seen it work for patients for 20 years. It is particularly effective on leathery skin, acne and in conjunction with Retin A cream to reduce scaly skin. Anywhere from a 5 to 20 % glycolic acid can be used daily, as tolerated. There are numerous glycolic acid creams available at doctor’s offices and beauty supply stores. They pretty much all work.
Antioxidants combined with zinc oxide sunblocks. Some antioxidants that have been microscopically and clinically proven to improve wrinkles include Coenzyme Q10, green tea, alpha lipoic acid, and Vitamin C/E/Ferulic. Curcumin also looks very promising. Your skin is exposed to the sun while you are driving, shopping, at sports events, etc. Most of the sun exposure we receive over our lifetime is incidental exposure received during these daily routines. Your skin will improve dramatically by just daily use of antioxidant and zinc oxide sunblock. Antioxidants protect your skin from UV radiation that causes aging, pigmenting and carcinogenic inflammation. Anti wrinkle regimes work only half as well if you are destroying your collagen as quickly as you are stimulating growth of new collagen.
Healthy diet, supplements.
Diet: Eat a healthy diet with lots of vitamins and antioxidants such as vegetables, berries, flax seed flakes, fish oils, olive oil, soy, green tea, red wine (especially pinot noir), pomegranate or Concord grape juice, kidney or pinto beans and lots of spices.
Vitamin D3 (especially when using sunscreen) – 4,000-6,000 units a day.
CoQ10 – 200 to 400 mg in the morning (Costco or Nature Made are good brands). High levels are detected in the skin within 2 weeks. CoQ10 has been shown to decrease crows feet, increases your energy level and is an excellent anti aging supplement. Every cell in your body needs this enzyme.
Fish oils – 1000 mg a day (Costco brand is potent and safe, i.e. not from the big fish at the top of the food chain).
Curcumin – 1000mg 1 – 2 times a day (Jarrows is good and without lead). Curcumin is one of the most promising new supplements along with resveratrol.
Green tea – Tea is best in a brew or try matcha powder which is the whole tea ground up. Starbucks has this but I recommend it without the syrup they normally use. The sugar free vanilla is what I get.
Alpha Lipoic Acid – Take 300-600mg a day. I prefer it at bedtime because this supplement can stimulate your appetite a few hours after taken, so a good time to be sleeping.
Resveratrol – 100-200 mg day. One glass of pomegranate or Concord grape juice or red wine will be adequate.
Vitamin C – 200 mg a day. Oral supplementation will not increase the skin concentration of vitamin C enough but helps prevent bruising.
Hormones: especially estradiol but also DHEA and growth hormone.
Again, I am not saying all women should be on estrogen. This is between you and your physician. I am just letting you know what really works. Estradiol does many things in the skin to increase collagen and elastic tissue. Most people already know this. It also probably does slightly increase the risk of breast cancer as testosterone increases the risk of prostate cancer in men. Very weak doses of estradiol cream can be effective and without observable elevation of blood levels of estrogen or systemic effects. Start with 0.1% or less. It is especially effective when combined with tretinoin cream. You will need a good compounding pharmacy. Your dermatologist will know of one.
DHEA and growth hormone is not recommended. It doesn’t work that well for the wrinkles compared to estradiol. You can naturally increase your own natural growth hormone level 10 times with weight bearing exercise. You can try for 10 minutes every day or 20 minutes 3 times a week. You will also have increase energy in a few days unless you strain something, so go slow – especially the men. Getting plenty of rest. This also increases growth hormone levels.
My ideal regimen for staying young, inside and on the outside, would be-
1. Eat healthy, weight bearing exercise with lots of sleep.
AM: Vitamin C/E/Ferulic or potent green tea serum with a zinc oxide sunblock-everyday.
PM: Retinoid with glycolic acid.
Vitamin D3 – 4,000 to 6,000
CoQ10 – 400mg
Curcumin – 1000 mg
Resveratrol – 200 mg
Fish oil – 1000 mg plus 1-2 tbsp of flax seed.
Alpha Lipoic Acid – 300 mg.
If this is too much to do, just try to eat right, exercise, sleep, wear your sunblock and don’t forget the vitamin D3 and CoQ10.
Dr. Mary Dobry is a San Diego dermatologist located at 4130 La Jolla Village Dr., CA 92037. 858-784-0590 or MaryDobry@DrDobryRx.com.