Welcome to my newsletter about skin rejuvenation products that I've written for Beauty Buzz. I am a board certified dermatologist in Kansas City, Missouri and have taken a real interest in cosmetic dermatology in the past few years. This area of expertise is quickly growing and at times confusing when trying to fairly evaluate treatments and products.

There are so many claims about skin rejuvenation products that it takes some understanding of the basic components to make an educated choice. Even now, I still have to make a real effort to question the company, the sales person or research the ingredients to fully evaluate a product. Unfortunately, this wasn't really covered in medical school, so I spend a lot of time searching peer-reviewed journal articles to make a valid judgment. Irealize that there may be other products that are beneficial, but if I can look at medical data and objective pathologic evidence, it will make a definite impression on me.

The first "true" anti-aging product was Retin A. It became so popular overnight that it sold out of the pharmacies nationwide. This was back in the mid-80's. What happened, though had consequences. First, most insurance companies began to deny coverage of this prescription acne medication because they assumed it was being ordered for wrinkle therapy. Second, it was grossly misused by patients in an attempt to eradicate their wrinkles quickly, and became known as a very irritating product. I still spend A LOT of time trying to educate patients that when used CORRECTLY, very few patients are unable to use the product. Recently, Renova became available. This IS Retin A (tretinoin .05% active ingredient), but in a moisturizing cream base. As the skin ages, it typically becomes drier. Thus, Renova is better tolerated for use as a skin rejuvenating cream. In addition to helping improve the appearance of fine lines and blotchy color, it can help reduce some of the photoaging changes that can lead to actinic keratoses, a form of a precancerous growth. I always stress to patients that Renova should be started every other night, to decrease their risk of irritation.

There's been a lot of hype about Retinol, in many over the counter cosmetics. Retinol IS NOT Retin A or Renova, despite what I've been told by many a cosmetics sales person. Retinol is approximately 5 times weaker than Renova, but I do believe that it has a place in skin rejuvenation. Check out the percentage of Retinol in the product you're looking at. Lancome's product is 0.5%, and Afirm, a line directly sold only to dermatologists ranges from 0.3% to 0.6%. The 0.6% is the highest percentage I've found so far. Should you know of any others, please let me know. For patients who either haven't been able to tolerate Renova or can't get to a dermatologist for a prescription, I think that using a high percentage of Retinol over a prolonged period of time will have some benefit. I do think that Renova is still considered the gold standard by medical professionals. Two things to keep in mind. I've heard lots of claims that Renova is SO expensive compared to the retinol products. It just isn't so. Renova comes in a 20 gram tube that should last 3-6 months, depending upon your use, and runs $25 to $35. Most retinols are at least this price. Yes, Renova in a much larger tube will cost up to $75, but usually there's no point in getting such a large tube. Also, retinol can be equally as irritating as Renova, so I would definitely start out using it on an every other night basis just to make sure you can tolerate it. Retinol should be equally as photosensitizing (increases your sunburn potential) as Renova, so do exercise caution when getting sun, and wear your sunscreen!

Vitamin C based creams have also gained popularity in the fight against aging. I was initially introduced to Cellex C when asked to do a TV news story about it and other "wrinkle creams". I was pretty surprised to find an article in the Journal of the American Academy of Dermatology about it and that there was definite evidence that the vitamin C was able to produce pathologically documented improvement of the collagen in the dermis, which is where "wrinkle formation " occurs. Even more surprising, the department of dermatology at Duke had done the research, so it meant something! Since then, many other vitamin C based creams have been developed, each claiming to be superior. I am sure that some of them likely offer the same benefits of Cellex C, it is just unclear which ones, when there are no studies to prove which are effective. I do recommend incorporating some form of vitamin C based product into your skin rejuvenating regimen. It would typically be applied every morning before applying makeup and sunscreen.

Alpha hydroxy acids are yet another group of "cosmeceuticals" used for skin rejuvenation. Glycolic acid has proven to be the most effective. Kristin, of Beauty Buzz, and I have had several discussions about how to determine what to use. First, let me say that I would highly recommend incorporating glycolic acid into your routine. Next, you must be very careful when selecting a product so that you don't burn your skin. Glycolic acid IS acid, which means it has a very low pH. If you can find one with a slightly higher pH, it will probably be less irritating. Also, the typical OTC product that claims to contain glycolic acid in it (perhaps a moisturizer or cosmetic), usually is in the 3-5% range. Medical literature suggests that a minimum of 15% is needed to produce true improvement in skin texture, reducing discoloration, acne, and fine lines. I start patients at 15% and try to get them up to 20%, if possible. Of course, I'm in a situation where I can monitor patients closely for problems. I am also in a position where sales reps routinely approach me about their product lines, and I can test them myself, before considering recommending them to others. For those of you who are familiar with my website , you already know that I have patients use the M.D. Forte brand of glycolic acid. This is mainly because the product is buffered to a higher pH, and unlikely to cause irritation, besides the fact that it goes on nicely and has been very effective. There are currently about 5-6 main brands of glycolic acid directly marketed to physicians, and I have experienced my share of rashes to some of them. Certainly, M.D. Forte is not the only nice brand out there, but do be careful and try to select a brand name, not one mixed up with a private label. And do start out on the low side of the range. You can always work up to a stronger product.

The last group of skin rejuvenation items are the Beta Hydroxy Acids. I hate to tell you this, but BHAs are nothing more that salicylic acid, which has been used FOREVER by dermatologists for everything from acne to warts and callouses. Yes, it is an exfoliator, but the only thing glamorous about it is that someone in PR has renamed it and given it lots of hype. I think if it's incorporated into another item, it can only help, but I'm not impressed with it alone.

So what do I do for my skin rejuvenation regimen? In a word, EVERYTHING! I use a glycolic acid wash twice a day, Vitamin C every morning, and alternate Renova with 20% glycolic acid at night. I'm also very diligent about my sun protection and NEVER go out in the sun without sunscreen. I attended a meeting a few weeks ago where several new categories of ingredients are under investigation, so I suspect our list of options will continue to grow. Thank you for taking the time to read this article. I hope you have found it useful.

Audrey Kunin, M.D.

Dr. Audrey Kunin owns and maintains her website www.aaaskindoctor.com , where she offers free skin related medical information and skin care products that have been highly successful for her patients. She welcomes visits from any interested Beauty Buzz readers. She has been featured on several local television new shows and radio talk shows for her expertise in the field of dermatology. In addition to her practice, Dr.. Kunin also holds a position as Clinical Instructor in the Department of Dermatology at the University of Kansas Medical School.