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Submitted via the FutureDerm.com Facebook page via private message:
Hi I was wondering if you could recommend a good cream to help reverse/repair sun damaged skin? Thanks in advance! -Elizabeth H.
Sun-damaged skin is no illusion. After years of sun damage, the skin’s pigment-producing cells, called melanocytes, lose their ability to distribute pigment evenly. As the damage progresses, your face shows it in the form of freckles, sunspots, blotches, uneven pigmentation, blood vessels, a duller complexion, and wrinkles.
If you are curious about how much sun damage you have accumulated, you can use a Wood’s lamp, which projects a long wavelength of ultraviolet light deeper into the skin than visible light. If you have significant sun damage, it will show up as heavy freckling all over.
To fight these signs, we recommend the following:
Fight Fine Lines and Wrinkles and Sagging Skin with Retinol 6x per Week, AHAs 1x per Week
As Dr. Ranella Hirsch, former president-elect of the American Society of Dermatologic Surgeons, once said: “We have beautiful, profound data that shows if you use [retinoids] for 20 years, you’re going to look a lot better than someone who doesn’t.” Retinoids are considered by many dermatologists to be the gold standard of anti-aging, as it has been proven to do the following:
- Keep skin firm. Retinol prevents collagen loss by inhibiting matrix metalloproteinases, enzymes that degrade collagen (Archives of Dermatology, 2002);
- Treats fine lines, wrinkles, and mottled skin. Retinol accomplishes this by increasing cell turnover (Archives of Dermatology, 2002, amongst many others);
- Prevents future damage. In addition to the above, retinol also functions as an antioxidant, scavenging free radicals (Methods in Enzymology, 1992, amongst many others)
We, of course, recommend our FutureDerm Time-Release Retinol 0.5 ($54.95, FutureDerm.com; $39.95 until September 19, 2012). It has 0.5% retinol in a time-release, microencapsulated formula. It is also a lightweight gel, which makes it easy to apply immediately after cleansing, and to use in conjunction with hydroquinone, vitamin C, or niacinamide (all mentioned below).
Once per week, in place of retinol, we recommend using an alpha hydroxy acid treatment, such as a 10% glycolic acid. The reason we do not recommend using alpha hydroxy acids and retinoids together? Retinol requires the activity of enzymes called retinyl ester hydrolases, which operate best at a pH of 4.5-7 (a neutral pH). (Biochim Biophys Acta, 2002). Alpha hydroxy acids are obviously, well, acids, meaning that there is not optimal activity for retinoids at that pH. Once per week, I use Dr. Dennis Gross Alpha Beta Peel Pads ($72.00, Amazon.com) in place of retinol, so I can get the full benefits of both.
Fight Age Spots and Hyperpigmentation with Hydroquinone and Kojic Acid in 4-Month Cycles
Many dermatologists recommend using hydroquinone in four-month cycles, alternated in the off months with other milder tyrosinase inhibitors, such as azelaic acid, kojic acid, and arbutin.
For hydroquinone, I recommend PCA pHaze 13 Pigment Gel ($39.95, Amazon.com), followed by your favorite moisturizer. Despite controversy over hydroquinone, the vast majority of studies show that it is safe. As Dr. David J. Goldberg, M.D., a clinical professor of dermatology at the Mount Sinai School of Medicine states, “Over 100 scientific articles confirm hydroquinone is a safe topical for humans; no independent studies prove the opposite.”
Still, if you have darker skin, it may be advisable to avoid hydroquinone, as it has been associated in rare cases with reflux hyperpigmentation (ochronosis) in those with darker skin tones. While this occurs in less than 1% of cases, Exuviance Optilight Tone Corrector may be a better choice for those with darker skin tones, with vitamin C and retinol. While I estimate the vitamin C to be less than Skinceuticals CE Ferulic and the retinol to be less than 0.5%, it is a solid combination treatment that is great for those who can’t use hydroquinone.
For the four months you use kojic acid or other brighteners instead, I personally recommend Cape Fear Naturals Kojic Acid Cream Skin Brightener ($11.95, Amazon.com) with 4% kojic acid, the highest concentration available on the U.S. market without a prescription. Another great line is the Lumixyl line ($120.00, Amazon.com), a complex of oligopeptides developed through Stanford University. The peptides have been found to significantly inhibit tyrosinase, the rate-limiting enzyme in melanin production (The Journal of Drugs in Dermatology, 2009).
Fight Dullness and Sagging Skin with Vitamin C or Niacinamide
I recommend vitamin C as L-ascorbic acid in a treatment like Skinceuticals CE Ferulic ($109.00, Amazon.com). Though there are a number of vitamin C derivatives that are more stable than L-ascorbic acid in the presence of light and air, research has shown vitamin C needs an acidic base to be delivered into the skin (Journal of Biochemistry, 1993). For you ultra-scientific types, the ideal pH is less than 4.2.
Why Vitamin C?
According to the International Journal of Pharmaceutics, vitamin C has many favorable aspects for the skin, including:
- scavenging of free radicals (reacts with the superoxide anion or the hydroxyl radical);
- suppressing pigmentation of the skin (by inhibiting the enzyme tyrosinase);
- decomposing melanin;
- triggering collagen production and thereby increasing skin firmness;
- enhancing sunscreen protection
Likewise, niacinamide has been associated with all of the following, according to research published in a review in the journal Dermatologic Surgery:
- Reduces fine lines and wrinkles
- Reduces hyperpigmented spots
- Takes down red blotchiness
- Brightens skin sallowness (yellowing)
- Increases elasticity
I recommend niacinamide in the Olay ProX line ($37.59, Amazon.com). Alternatively, there is also nicotinic acid, another derivative of vitamin B3. I find nicotinic acid to be a little harder on the skin than niacinamide, so which to choose depends on your overall skin sensitivity and skin type. If your skin is dry, I recommend the Olay ProX line with niacinamide. If it is more oily, then you may love the NIA 24 products with nicotinic acid.
Bottom Line: Your Ideal Regimen for Fighting Sun Damage
- Cleanser of your choice.
- Concentrated vitamin C as L-ascorbic acid and E treatment, like Skinceuticals CE Ferulic.
- Treatment sunscreen, like NIA 24 UVA/UVB Sunscreen SPF 30 with nicotinic acid. Please keep in mind that there is always an adjustment period with nicotinic acid – your skin may become reddened or irritated before it gets better. This usually lasts 7 days or less. With that said, if your skin is particularly dry or sensitive, try Olay Regenerist Sunscreen SPF 50 with niacinamide instead.
- Cleanser of your choice.
- If fine lines, wrinkles, or sagging skin is your #1 concern: A concentrated retinol treatment 6x/week. We honestly recommend FutureDerm Time-Release Retinol 0.5, not just because it is ours, but because it is concentrated 0.5% retinol in a state-of-the-art time-release formula. Its lightweight consistency also makes it perfect to immediately try other treatments over top! And, of course, we have a 30-day money-back guarantee. One night per week, we also recommend glycolic acid in place of retinol, such as Dr. Dennis Gross Alpha Beta Peel Pads.
- If sunspots and hyperpigmentation are your #1 concern: Four months of nightly PCA pHaze 13 Pigment Gel (if you have fair to medium skin), or Exuviance Optilight Tone Corrector (if you have olive or dark skin). Following, four months of Cape Fear Naturals Kojic Acid Cream Skin Brightener or Lumixyl ought to do the trick. Especially when combined with a CE Ferulic by day. By God, your skin will be bright!
- If fine lines, wrinkles, sagging skin and hyperpigmentation are a concern: Use retinol or glycolic acid all over your face, and spot-treat with hydroquinone for 4 months. Then spot-treat with kojic acid or Lumixyl for the next 4 months.
- Follow with your favorite moisturizer.
As always, for a targeted regimen, speak to your dermatologist. Treatments like lasers and in-house LEDs are amazing for sun-damaged skin as well.
Hope this helps,