What medical treatments are available for wrinkles?
Vitamin A Topical Products (Tretinoin and Retinol)
Topical products containing natural forms of vitamin A (retinol, retinaldehyde) or vitamin A derivatives called retinoic acids (tretinoin,) have proven to be beneficial for skin damaged by the sun and also by natural aging.
Tretinoin (known commercially as Retin-A) is available only in prescription form (Avita, Renova, Differin). It produces a rosy glow, and reduces large wrinkles, brown spots, and surface roughness. It may also be applied to face, neck, chest, hands, and forearm. The cream should be applied at least twice a week. Noticeable improvement takes from two to six months. Because Retin-A may increase a patient's sensitivity to the sun, a thin coat is best administered at bedtime.
A sunblock should be worn during the day, and overexposure to the sun should be avoided. Almost all patients experience redness, scaling, burning, and itching after two or three days that can last up to three months. Very low concentrations (.025%) may offer the same improvement as higher concentration and produce less irritation. A daytime moisturizer or low-dose corticosteroid cream, such as 1% hydrocortisone, may help reduce irritation. Oral tretinoin can cause birth defects, and women should avoid even topical Retin-A when pregnant or trying to conceive.
Retinol, a natural form of vitamin A, could not, until recently, be used in skin products because it was unstable and easily broken down by UV radiation. Stable preparations are now sold over the counter. In the right concentrations, retinol may be as effective as tretinoin and studies indicate that it has fewer side effects. An animal study suggests that adding antioxidant creams (such as those containing vitamins C or E) may offer added protection against degradation of retinol, but not tretinoin. The FDA warns that over-the-counter retinol skin products are unregulated; the amount of active ingredients is unknown, and some preparations, in fact, may contain almost no retinol.
Antioxidants are substances that act as scavengers of oxygen-free radicals, unstable particles that can damage the body's cells and even their genetic material. The most well-known antioxidants are vitamins A, C, E, coenzyme Q10 (CoQ10), and beta carotene. There is some evidence that lotions and creams containing antioxidants may help protect the skin when applied before sun exposure. (They do not seem to provide benefit after exposure.) Topical vitamin E particularly alpha tocopherol (a form of vitamin E) cream decreased skin roughness, length of facial lines, and wrinkle depth. Both green tea and ginger appear to have properties that may provide some protection against cancer. Green tea skin care products are now available. Scientific studies will be needed to learn if they are actually beneficial. The substance silymarin, found in the milk thistle family (which includes artichokes), may inhibit UVB-promoted cancers in animals. Aloe, lemon oil, and coral extracts contain antioxidants and are promoted as being healthy for the skin, although evidence of their effects on wrinkles is weak.
Alpha Hydroxy Acid and Home Exfoliation
One of the basic methods for improving skin and eliminating small wrinkles is exfoliation (also called resurfacing), which is the removal of the top layer of skin to allow regrowth for new skin. Methods for doing this run from simple scrubs to special creams to intensive peeling treatments, including laser resurfacing. People with darker skin are at particularly higher risk for scarring or discoloration with the more powerful exfoliation methods.
Scrub gently with a mildly abrasive material and a soap that contains salicylic acid to remove old skin so that new skin can grow. The motion should be perpendicular to the wrinkles. Use textured material or cleansing grains with microbeads. Organic materials, such as loofahs or sea sponges may harbor bacteria. Avoid cleansing grains that contain pulverized walnut shells and apricot seeds, which can lacerate skin on a microscopic level. Cleansing grains with microbeads don't have sharp edges and remove skin without cutting it. Exfoliation using scrubs, however, can worsen certain conditions, such as acne, sensitive skin, or broken blood vessels.
Alpha hydroxy acids facilitate the shedding of dead skin cells and may even stimulate the production of collagen and elastin. Lactic and glycolic acids are used most often in commercial products. The preparations containing lactic acid may be slightly more effective than those made with glycolic acid. Products have also been developed that are made from larger molecules called poly-alpha-hydroxy acids and others from beta-hydroxy acids or BHAs (usually containing salicylate acid, the primary ingredient in aspirin). Manufacturers claim that such products are less likely to irritate the skin.
Moisturizers help prevent dryness, bruising, and tearing but have no effect on wrinkles by themselves. They should be applied while the skin is still damp. These products retain skin moisture in various ways: Occlusives, such as petroleum jelly, prevent water from evaporating. Humectants, including glycerin, act by pulling water up to the surface of the skin from deep tissues. People with oily skin generally should use the humectant type.
More powerful compounds, such as one called monolaurin (Glylorin), contain mixtures of fatty molecules called lipids, which may help restore the skin's natural barriers against moisture loss and damage. Most moisturizers contain combinations of these and usually have other ingredients, such as AHA, sunscreens, collagen, and keratin. (Collagen and keratin leave a protein film and temporarily stretch the skin.) They range widely in price, and a major consumer organization found little difference in general between the more and less expensive products.