Over-The-Counter Anti-Aging Formulas —
Fountain of youth or fountain of wishful thinking?
by Eva A. Hurst, M.D.

    As director of the Washington University Center for Dermatologic and Cosmetic Surgery, I am asked by patients every day about recommendations for facial creams and topical therapies for anti-aging. America, as is true in most developed countries, is full of women (and frankly, nowadays, men) trying to recapture their youth via a wrinkle-free, more refreshed appearance. Baby-boomers abound, and many are eager for what I like to refer to as “the fountain of youth in a bottle.” As common as those middle-aged folks, wanting to turn back the hands of time, are young 20- to 30-somethings hoping to ward off the tell-tale skin signs of aging.
    One is constantly bombarded by television and print media with the latest and greatest over-the-counter cures for wrinkles and skin damage. These products range from ten dollars to literally hundreds of dollars per bottle. So, the question begs answering, what should the average person be applying to his or her skin on a daily basis?
    As a dermatologist, I keep it simple. The single most important thing that anyone, regardless of age or skin type, can apply to their skin on a daily basis is a broad-spectrum sunscreen. The data continues to mount that the number-one cause of skin cancer, wrinkles, sunspots, skin laxity and other signs of aging is ultraviolet (UV) exposure.
    The two types of dangerous UV light that penetrate our ozone and play a role in skin cancer and aging are UVA and UVB. Scientific research has now shown definitively that both are dangerous for our skin, even on a low-level daily chronic basis. Sunscreens that protect against UVA and UVB (which should be specified on the bottle) are widely available in sunscreen preparations, as well as many daily moisturizers, formulated for both men and women. 
    Physical sun blockers, such as zinc oxide and titanium dioxide, tend to be great for sensitive skin and in children, but are a little thicker than their counterparts, the chemical blocking sunscreens. 
    The chemical blockers deactivate harmful sun rays as they hit the skin. Common ingredients are avobenzone, oxybenzone, mexoryl and several others. Many of the chemical blockers are very effective sunscreens while being light-weight and easy to apply, although some people can be allergic to their components or preservatives. For a full disclosure of sunscreen ingredients and further information, I recommend visiting the American Academy of Dermatology website at aad.org. 
    In addition to sunscreen, the most commonly utilized and studied topical anti-aging preparations contain Vitamin A derivatives.  Vitamin A is a naturally occurring anti-oxidant in the skin.  It is available in several prescription-strength formulas, most commonly tretinoin (Retin-A). Only less potent forms are available for over-the-counter (OTC) use:  retinol, retinaldehyde and retinyl palmitate. 
    These ingredients are used in many OTC anti-aging formulations found at basic drugstores and up-scale department stores alike.  All are converted to their active form in the skin, which is known as retinoic acid. Very well designed scientific studies have shown that tretinoin (Rx strength) helps to increase collagen synthesis and decrease signs of aging, as well as to help prevent UV damage that can promote skin cancer. The OTC preparations have not been well studied, but likely help prevent cancer and aging to a lesser degree than prescription-strength retinoids. Unless contraindicated, I recommend a prescription-strength topical retinoid to all of my cosmetic consultation patients.
     Other anti-oxidants have been touted as potentially beneficial, but the actual science behind them is often lacking. Vitamin C is the best-studied OTC anti-oxidant, and is found in plentiful supply in normal skin.  Studies have shown that formulas that contain 10 percent Vitamin C applied for 12 weeks enhances the integrity of the skin’s support structures, which may translate into refreshed looking skin with fewer fine lines and textural changes. There is less evidence to support topical Vitamin E, as no scientific studies have actually proven an anti-aging benefit. Other agents, such as DMAE (dimethylaminoethanol), a Vitamin B derivative, and Co-enzyme Q-10 are anti-oxidants that theoretically may provide benefit from topical application, but there are no published scientific studies to show clinical benefit other than one study showing increased “skin firmness” from application of three percent DMAE.  Notably, some of these agents (reportedly Co-enzyme Q-10) can cause allergic dermatitis similar to poison ivy reaction in some individuals.   
    There are a myriad of botanical preparations on the market, typically classified as anti-oxidant or anti-inflammatory products.  Some of these include grape seed extract, milk thistle, green tea, ginkgo biloba and coffee bean extract, among many others.  There is little scientific evidence to support any of these as active anti-aging ingredients, although topical application of green tea has thus far been shown to reduce sun-induced skin damage in mice.
    Acid preparations include alpha hydroxy acids (with glycolic being most common) and salicylic acids. Both of these types of products have been shown to reduce facial hyperpigmentation associated with sun damage and to improve fine lines and wrinkles. They are common components of chemical peels, although OTC preparations are limited to very low-strength percentages of acid which are unlikely to yield significant benefit. Only physician’s offices are able to provide the stronger-strength chemical peels that are most likely to provide significant benefit as has been studied scientifically. However, these peels can increase the skin’s sensitivity to sun damage and can cause skin darkening if not utilized carefully in darker skin types. 
    Newer products on the market are copper peptides and pentapeptides. They are touted to be anti-oxidant and anti-wrinkle and may show promise in the future. However, currently in the medical literature, support for their use over other proven anti-aging remedies, such as retinoids, is definitely lacking. Currently, argireline, as well as some other proprietarily-held compounds, are being investigated as topical botulinum toxin-type preparations helpful in inhibiting muscle activity, leading to decreased wrinkle depth. I would anticipate we’ll certainly hear more about these compounds in the coming one to two years.
    Finally, one of my favorite topical anti-aging medications is hydroquinone, which inhibits pigment formation and can help fade sunspots and irregular brown discoloration of the face such as melasma. Most OTC products contain two percent or less, but prescription products contain four percent.  This medicine is scientifically proven to be beneficial for discoloration due to sun damage with short-term use. Two-percent OTC products are likely helpful, but often not to the degree of prescription strength. I prescribe it most often, secondary to retinoid products.
    To summarize, we are constantly bombarded by the next best (and often expensive) product to provide anti-aging benefit to our skin.  The bottom line is that topical treatments are helpful, if used wisely. I strongly recommend that patients read labels and not necessarily believe company claims when it comes to wrinkle-cure creams. I feel confident in saying that you can never go wrong with a broad-spectrum sunscreen and a topical retinoid product, preferably prescription strength. Many people with pigmentary problems will also benefit from topical products containing hydroquinone. As for the rest? Well, Vitamin C is the best studied OTC anti-oxidant, and newer botanicals or copper-containing peptides may end up showing benefit. The downside is potential allergic reactions or irritation from some of these topical medicines, so proceed with some skepticism before investing large amounts of money in products with these active ingredients.
    Finally, many patients with significant cosmetic motivations will choose to pursue additional cosmetic treatments with scientifically-proven benefit, such as microdermabrasion, botulinum toxin injection, filler injection and laser rejuvenation. These treatments, many with little or no down time, have been shown to provide significant and long-lasting benefit beyond that which is possible with topical preparations. Consultation with an experienced physician in the field of dermatologic or plastic surgery is recommended for those interested.