Actives – where the Action’s At. The “A” in P.E.A.C.H.
The central letter in P.E.A.C.H., it is for the “A” of Actives that you come to Peach as opposed to a department store.
After protection and exfoliation, here are the ones that really count.
Please note, this is about ingredients, not brands.
No secret potions. No silly stories about lost Amazonian tribes that never seem to age. Nothing about crazy old Japanese brewery workers with the lily-smooth hands. Not a word about anything from the Dead Sea, and rien in faux French.
Just the facts, ma’am, just the facts.
1) Vitamin A
If you know about protecting your skin, if you know about exfoliating, the next thing to get into is Vitamin A. It was the first described cosmeceutical (Kligman 1986 http://www.ncbi.nlm.nih.gov/pubmed/3771853 ), it is still the best researched, most potent, best understood. It is natural and organic. It directly stimulates DNA to make new collagen and glycosaminoglycans.
Vitamin A, in the form of retinol esters, is in dairy products, eggs, meat, liver, kidney, and oily saltwater fish. Provitamin A, in the form of beta-carotene, is in brightly-coloured fruits and vegetables.
BUT, if you eat loads of Vitamin A or take excessive Vitamin A supplements orally you will damage your liver.
Furthermore, excess vitamin A intake in pregnancy has been related to birth defects
SO, you CAN“T eat enough Vitamin A to get the effects we want on your skin. You have to apply it directly to your skin.
Your skin fibroblasts and keratinocytes have specific Vitamin A receptors just waiting to be stimulated by Vitmain A. They then in turn stimulate your skin cell DNA directly to bring about these changes:
Stronger, thicker dermis. More collagen. More hyaluronic acid. Deeper rete ridges. More blood supply (angiogenesis). Thicker living epidermis (like younger skin). Compaction of dead cell layer of epidermis (like younger skin). Faster epidermal cell turnover (like younger skin). Wash through of epidermal pigment, for less pigmentation and pigment irregularity.
That all means: smoother, stronger skin with fewer fine lines and more even colour and better glow.
It’s all been proven many times, at different centres, clinically and by biopsy. No doubt.
Let me tell you something: All swords are two-edged.
Every potent treatment can sometimes cause side effects. The only creams that never cause side effects are those that never do anything at all.
If you suddenly start using high-potency Vitamin A on your skin your skin will become red flakey and irritated inside a week. This is called a RETINOID REACTION. It is dose-related, predictable, and reversible on ceasing or diminishing the dose. IT IS NOT AN ALLERGY. So if this happens, just reduce the FREQUENCY of application.
Vitamin A is fat soluble, so it builds up in tissues. Therefore, you should start applying it just twice a week for the first fortnight, thence 3x per week, thence 4x per week, etc, until you build up to applying it every night. If you get irritation, slow up the dosing for a week or two, then try building up the dose again. Don’t worry, you’ll get there.
And don’t use much. Our staff will show you, depending on the form you use. But it is strong. It’s medical. Just use a bit.
Secondly, sunlight can react with potent Vitamin A on your face to cause a photosensitive reaction. Redness again. But this reaction is NOT SUNBURN. Vitamin A on your skin is PROTECTIVE against UVA damage, it doesn’t cause it.
The answer is easy. Just apply it at night. Not in the morning. No problem.
Thirdly, as mentioned above, there is a relationship between high-dose oral vitamin A use in pregnancy and birth defects. So, even though the application of Vitmain A in any form on to facial skin causes no detectable change in blood levels of vitamin A, and even though the total dose of vitamin A in a daily cream isn’t anything close to that which might cause birth defects, we still recommend that pregnant women avoid application of any form of vitamin A to their skin. Just to be safe, and to cause no hint of concern.
Which Vitamin A do I recommend?
Whichever does the job in a tolerable manner.
For starters, as far as we know, all Vitamin A effects are mediated through the direct action of Retinoic acid onto DNA (via specific receptors and binding proteins, etc). Therefore, Retinoic acid is the most potent of the Vitamin A forms. However, it is also most likely to cause side effects, and is available only on a doctor’s prescription. Other Vitamin A forms can be more pleasant to use. So, Dr Mahony prescribes it for patients in consultation when that is the best option, but not otherwise. Retinoic acid comes in 0.025%, 0.05% and 0.1% depending on the brand.
Retinaldehyde (aka “retinal”) is the next most potent. Your body rapidly oxidises Retinaldehyde to Retinoic acid via ‘retinaldehyde oxidase’ (there being just one oxygen atom difference between the two in terms of chemical structure). Retinaldehyde is available over the counter. Because it is almost as strong as Retinoic acid, it comes as a 0.1% serum.
Retinol is next strongest. Chemically, Retinol has two hydrogen atoms that Retinaldehyde does not have. For Retinol to work, it has to be converted to Retinaldehyde by having these two hydrogen atoms removed by the rather slow enzyme ‘retinol dehydrogenase’, then the resulting Retinaldehyde has to be oxidised to Retinoic acid as mentioned above. Because this process is a bit slow, and because other things can happen to Retinol (it can get stored instead as Retinyl palmitate) Retinol serums come as a higher % than Retinaldehyde. We stock Retinol creams and serums in concentrations from 0.3% up to fully 8%.
We use and recommend at Peach any and all of these three forms of Vitamin A. We see them all work. We see them all cause side effects when used excessively. We understand that the higher activity of Retinoic acid necessitates a lower % strength in those formulas, and that the lower activity of Retinol allows a higher % strength in Retinol formulas.
Some forms of Vitamin A we do not recommend…
One of the commonest forms of Vitamin A you see around in cosmetic skin care is Retinyl palmitate. Retinyl palmitate is made by sticking together a Retinol molecule with a palmitic acid molecule. This particular combination is called an “ester”, and makes Retinol easy to store in the body. This is, in fact, how your body stores it. It is also the actual form of Vitamin A found in meats, etc (see above). HOWEVER, Retinyl palmitate has no activity in itself, and the process by which it can be activated back to Retinol is very very slow and inefficient.
Retinyl palmitate doesn’t cause irritation. It doesn’t cause a retinoid reaction. But it doesn’t cause any significant improvement in your skin, either! It doesn’t do much of anything at all!
Manufacturers can put Retinyl palmitate in their skin care products and tell everyone (without actually lying) that their products contain Vitamin A, safe in the knowledge that none of their customers will complain of side effects, and that the shelf life will be long because Retinyl palmitate breaks down so very slowly. The customers just won’t see any significant improvement in their skin over and above that brought about by the simple act of moisturisation inherent in applying the carrier.
Synthetic prescription retinoids we do not recommend because we have seen no convincing evidence that they offer any proven significant advantage over the natural and potent Vitamin A versions discussed above.
What to do
Talk to any of the staff about getting Vitamin A into your skin care strategy.
2) Vitamin C
Vitamin C is the next active you should consider.
Every Australian schoolkid learns about Vitamin C.
We all learnt about how sailors used to suffer from scurvy; about how their teeth fell out and how they would easily bruise and often die from a lack of Vitamin C, and how Captain Cook pioneered the use of lime juice as essentially a Vitamin C supplement for his sailors and how this saved so many of their lives.
The features of scurvy are mostly to do with a failure of collagen synthesis, since Vitamin C is vital to the formation of collagen.
And in cosmetic dermatology it has been further demonstrated that if potent formulations of Vitamin C are applied to skin then collagen formation in the dermis is enhanced, resulting in thicker and stronger collagen.
Stronger collagen means better skin tone and fewer wrinkles.
Aside from this action, Vitamin C is an important anti-oxidant. By quenching some of the free radicals formed when you skin is exposed to UV light, Vitamin C helps reduce sunburn effects and thus acts synergistically with your sunscreens to further protect skin.
Vitamin C is water-soluble and an anti-oxidant. Oxygen is inevitably dissolved in any water. Which means that if Vitamin C is in contact with water for any period of time it will oxidise in the water, rendering it a “pro-oxidant”. In other words, it goes “off”.
For this reason, all Vitamin C skin preparations have to be serums or at least fairly oily. If you put Vitamin C in an oil it won’t go “off” as it sits on the shelf waiting for you to buy it.
Since all potent Vitamin C skin preparations are oily, they are NOT recommended for those with acne.
As it so happens, those with acne tend to have pretty strong skin already, since the very same testosterone causing the acne also promotes the formation of thick strong skin.
By and large, patients with oily or acneic skin do not benefit from Vitamin C-based skin care. (In the unusual event that a patient with oily or acneic skin wanted to use Vitamin C in their skin care routine to help prevent wrinkles and build skin strength, our best advice is for them to buy a Vitamin C powder that they can mix freshly with their other skin care every day for immediate application. This neatly side-steps the whole issue.)
But for those past their acne days, Vitamin C is their next best weapon against premature skin ageing.
3) Vitamin E
Vitamin E is the next active to know about, but I can cover the thrust of it pretty quickly.
Like Vitamin A, Vitamin E is a fat-soluble anti-oxidant. Like Vit A and Vit C, we know that applying Vitamin E prior to sun exposure will reduce the deleterious effects of UVB. Oral Vitamin E supplementation can help with atopic dermatitis, and topical applicatoin, in conjunction with hydroquinone, helps to reduce the unwanted pigmentation of melasma.
The antioxidant effect of Vitamin E works like this: One molecule of Vitamin E can neutralise two free-radical molecules. But then it is spent…until it meets a Vitamin C molecule. The Vitamin E molecule dumps these two extra electrons onto the Vitamin C molecule, and is then the Vitamin E molecule is ready to neutralise another two free radicals.
Thus, Vitamin C has an effect to recycle the anti-oxidant activity of Vitamin E molecules. The Vitamin E molecules, in turn, extend the capacity of a certain amount of Vitamin C to soak up free radicals, by acting in fat molecules.
And so, Vitamin E and Vitamin C are often found together in the one skin-care product, so that they can work together.
But, on its own, Vitamin E does bugger all.
People think Vitamin E is great for burns, great for healing, great for scars, but, really, it does very little. Skin care manufacturers like it because it is a “vitamin”, so it sounds all healthy and natural and organic, it’s cheap, and it doesn’t cause any side effects. Vitamin E causes little if any side effects because it causes little if any of any effects.
4) Vitamin B3
Niacin, niacinamide, nicotinamide: those words essentially all refer to the same stuff.
Niacinamide has many of the same effects as Vitamin A, but without the redness. It actually reduces the redness of Vitamin A and so is a perfect adjunct to topical Vitamin A
It improves the water-retaining property of skin, reducing trans-epidermal water loss (“TEWL”).
It reduces the redness and irritation caused by irritants. Reduces facial red blotchiness.
It can help reduce hyper pigmentation.
It helps to reduce texture and wrinkles.
And it is well tolerated and natural. What’s not to like about Vitamin B3?
5) Vitamin B5
Panthenol, pro-vitamin B5, pantothenol, again all refer to essentially the same stuff.
Improved barrier function leading to improved healing. Also promotes fibroblast proliferation ( a “good thing”).
So it improves moisturisation, diminishes dryness, roughness, scaling, itch and redness. Great stuff.
Softer smoother skin that is less irritated.
All well proven in the scientific literature.