Cleopatra put spoiled milk on her face to stay young, which probably marks one of the first recorded lactic acid skin peels in history. 2000 years later, one might ask about the progress we’ve made.
To this day, we use chemical or laser peels and other treatments that either remove the outer layer of skin or inflame the deeper skin in hopes that the process of “healing” will lead to renewed, refreshed skin. In the 90s, Cleopatra’s lactic acid was replaced with hi-tech and high-powered CO2 lasers. It was, for a time at least, the holy grail of plastic surgeons and dermatologists despite the months of difficult recovery for patients. Over time, however, we began to see the effects of these touted procedures in the form of thinned, wax paper white skin and a rapid return of the very wrinkles we sought to reverse. Enthusiasm waned.
At the other end of the spectrum, glycolic acid peels became the “hot” skin care product for home use – only this time with English instructions instead of ancient Egyptian. The treatment was gentle, easy to use, and the microscopic photos of fresh, young looking cells were tantalizing. Only problem was that after a few years, we saw little rejuvenation of the skin and too much facial redness and sun sensitivity. Enthusiasm waned.
Excitement almost as exuberant as the initial reaction to CO2 lasers met the next panacea – devices that could heat and tighten the deep layers of skin without creating a weeping wound on the outer layer of skin. There must have been – and still are today – dozens of companies that set out to free us of the ills of aging by heating the deep dermis of our skin, whether through laser, radio frequency, or highly focused ultrasound. No matter how cool the technology, they all did the same thing – heat and injure the deep skin so that “healing” would work its magic. Yet again, we see limited benefits, lots of pain associated with the treatments, and occasionally severe complications.
Then there are the treatments for hyperpigmentation – a remarkably stubborn and frustrating problem. Here, hydroquinone has been the flagship molecule for preventing cells from making melanin (skin pigment), and thereby lightening the skin. In some patients, if you mix the hydroquinone with several other ingredients, you occasionally see nice results. But overall, treatment failures are too common as are extreme sun sensitivity, skin irritation, and even rare complications as severe as permanent skin discoloration.
“For the past 2000 years, we have been trying to tackle skin aging by irritating or removing the outer layers of the skin”
Finally, there are the retinoids, of which isotrentoin (Retin-A) was the founding father. The science was fantastic with evidence of retinoid receptors firing up tired repair pathways, and restoration of normal collagen and elastin on microscopic studies. It looked like we were finally getting somewhere. Only problem was that despite all the science, it didn’t look so good to real people, and patients struggled – yet again – with redness, unbearable sun sensitivity, and even new spider veins (actually small, superficial vessels that show through the skin) that looked worse rather than better.
So we are now trying isotrention’s more gentle cousin, retinol. It’s today’s rage. And as Dolly Parton said, “Here we go again.”
So let’s recap. For the past 2000 years, we have been trying to tackle skin aging by irritating or removing the outer layers of the skin, or at least preventing the production of the important protective molecule, melanin – all in hopes of turning back the clock. We’ve all heard the famous Einstein quote, “Insanity is doing the same thing over and over again and expecting different results.” Well, could it be time for a new approach that neither injures the skin nor prevents production of protective pigments?
New science is emerging in skin care emphasizing the role of the sun and pollutants in creating oxidative stress on skin cells, which in turn produce free radicals and inflammation, which in turn create more oxidative stress, and on and on. The inflammation that gets worse and worse is exactly the pathway leading to redness, hyperpigmentation, and yes – aging!
With this in mind, researchers are now looking at products that focus on healing and restoring the healthy oxidative balance of young skin through antioxidants, anti-inflammatory molecules, and pro-repair signaling molecules. Products are becoming available that sooth the skin and protect against the sun rather than the opposite. Plants that spend 100s of years basking in incessant desert light are models for how we might protect our own skin. Even caffeine, a product of the coffee plant, is turning out to be a powerful skin protectant. It’s getting interesting.
Halleluiah? Well, you tell me. 2000 years since Cleopatra, a new paradigm is finally emerging that addresses the source of skin aging, blotchiness, and redness, rather than making several of the source problems worse. I’d say that’s a spiritual moment!