|
||
| |
||
ADVANCES IN SKIN CARE, Part IV
THE ROLE OF FRUIT ACIDS
Timothy J. Mickel, M.D., F.A.C.S.
|
|
If you are not familiar with fruit acids and their rejuvenating effect on your skin, you are little behind the times ... several centuries behind. While the alpha hydroxy, or fruit acids, have taken the skin care and cosmetic industry by storm over the past decade, discriminating women around the world have enjoyed their beneficial effects since antiquity. Legend has it that Cleopatra bathed in sour milk so that its lactic acid would give her skin a smooth, youthful glow (perhaps the narrow, aquiline nose of Mark Anthony was chronically obstructed). Aristocratic women of the French court washed their faces with spoiled wine to benefit from the tartaric acid found in grapes. English, Spanish and Arabian women used lemon juice (citric acid) on their skin, while Polynesian women used sugar cane juice (glycolic acid) to enhance their natural beauty. The common denominator in each of these "all natural" treatments was the presence of an alpha hydroxy acid as the active ingredient.
Fruit acids were rediscovered in recent years by researchers looking for ways to treat a rough skin condition called icthyosis. Alpha hydroxy acids (AHAs) were found to produce significant smoothing of the skin by loosening the bonds between dead cells on the skin surface. Depending on the concentration of the acid, its pH and several other factors, this loosening results in either accelerated exfoliation or a superficial "peel". Clinicians quickly realized that this smoothing effect was not only useful in pathologic conditions like icthyosis, but also in patients with "normal" skin, who simply wanted to preserve a youthful appearance or reverse the early signs of aging or sun-damage. AHAs have since earned a role in the treatment of acne, superficial hyperpigmentation and many other skin conditions.While the primary effect of AHAs is to decrease the cohesion between cells in the top layer of the skin, there are many beneficial secondary effects. Decreased cohesion between skin cells not only results in accelerated exfoliation, but in a more uniform exfoliation than occurs naturally, which results in the smoothing effect mentioned above. Moreover, accelerated exfoliation stimulates new cell growth, and this increased "cell turnover" gives skin a fresher, younger look.
As we age, our skin becomes thinner, less elastic and contains less water. The dermis, or deep layer of the skin, contains less collagen than it did in our younger days. AHAs have been shown to increase the skin's water content, to increase the production of collagen and to increase the number and quality of the elastic fibers in the dermis. The numerous beneficial effects of the AHAs work in concert to help restore a youthful glow.
Nowadays, AHAs are generally synthesized in the lab to allow mass production rather than being used in their natural form, so you don't have to worry about smelling like salad dressing, sour milk or a wino in order to look good. The various AHAs differ in strength depending on their willingness to donate a proton, a science geek concept known as pKa. The potency of AHAs is also related to their pH. In general, the lower the pH, the more acidic the solution, and the greater the biologic effect. However, this comes with a price. The lower the pH, the more irritating the solution is to the skin.
AHA formulations used for office peels have a low pH (1.5 - 2.75) and are more irritating than products designed for home use, which are adjusted to a pH similar to skin (4.2 - 5.6) by neutralization or buffering. Of course, neutralized products are less effective. Allowing the AHA to react with an alcohol to form an ester is another way to decrease its irritability without compromising effect. This is the concept behind the glycolic acid esters used in the Glyderm program.
The effectiveness of AHAs also varies with molecular size. Smaller molecules are more active and penetrate the skin more deeply. Glycolic acid has the smallest molecular structure, followed by lactic acid, hence these are the most common AHAs found in commercially available preparations.
At Dermatique, we have used the Glyderm line of glycolic acid products as our preferred AHA program because it is simple, it is well tolerated by patients and it works. We offer pH adjusted home products with lower acid concentrations for sensitive skin and higher concentrations for more tolerant skin. The products come in either an emollient lotion for dry/intermediate skin, or an alcohol based solution for oily skin. The Glyderm program also includes six superficial office peels, with the strength increasing weekly in step wise fashion to insure safety and patient comfort. Over the past three years, we have performed hundreds of Glyderm peels with no significant complications and only occasional patchy redness that has resolved in 24 - 72 hrs.in every case. Patients report smoother skin, a subtle diminution of fine wrinkles and a pleasing "glow". They wear less make-up and what they do wear goes on more smoothly.
The Glyderm program is not a substitute for more aggressive forms of treatment, such as laser resurfacing, dermabrasion, chemical peel, facelift, browlift or blepharoplasty, where these procedures are indicated. It can and should be used, however, as an adjunct to these standard plastic surgical procedures to enhance and help maintain the overall result.
Because of their beneficial long term effects 'on skin health and maintenance, AHAs should probably be a standard part of every woman's skin care regimen. They have almost single handedly changed the direction of the skin care industry from merely preventive, to corrective. To learn more about the Glyderm program, skin antioxidants, sun protection, Retin-A or a specific plastic surgery procedure, stop by Dermatique for a free consultation.
Dr. Mickel is a board certified Plastic Surgeon and owner of Dermatique Skin and Body Salon. He has been in practice in Monroe since 1990.
