Alpha Hydroxy acids (AHAs) are a collection of compounds made from familiar food products. Among the most widely known are glycolic acid (from sugar cane), lactic acid (sour milk), malic acid (apples), citric acid (citrus fruits), and tartaric acid (wine grapes).

“Alpha hydroxy acids are great exfoliators and increase blood flow to the skin, so they can help to minimize fine lines and wrinkles” says Kenneth Beer, MD, a clinical instructor in dermatology at Duke University in Durham, N.C. Other potential skin care benefits include lightening of dark spots and a reduction in the appearance of blackheads and acne.

AHA’s increase exfoliation by loosening the “glue” that holds skin cells together. In doing so dead skin cells are removed, oil is controlled, the look of fine lines is reduced, skin coloring is improved and the tone is evened out.

AHAs, are a class of chemical compounds that consist of a carboxylic acid substituted with a hydroxyl group on the adjacent carbon. They may be either naturally occurring or synthetic. AHAs are well known for their use in the cosmetics industry. They are often found in products claiming to reduce wrinkles or the signs of aging, and improve the overall look and feel of the skin. They are also used as chemical peels available in a dermatologist’s office, beauty and health spas and home kits, which usually contain a lower concentration. Although their effectiveness is documented Many well-known α-hydroxy acids are useful building blocks in organic synthesis: the most common and simple are glycolic acid lactic acid, citric acid, mandelic acid.

Cosmetic applications
Understanding skin structure and cutaneous aging is helpful to a discussion of the topical action of AHAs. Human skin has two principal components, the avascular epidermis and the underlying vascular dermis. Cutaneous aging, while having epidermal concomitants, seems to involve primarily the dermis and is caused by intrinsic and extrinsic aging factors.

AHAs are a group of organic carboxylic compounds. AHAs most commonly used in cosmetic applications are typically derived from food products including glycolic acid (from sugar cane), lactic acid from sour milk), malic acid (from apples), citric acid (from citrus fruits) and tartaric acid (from grape wine). For any topical compound to be effective, including AHA, it must penetrate into the skin where it can act on living cells. Bioavailability (influenced primarily by small molecular size) is an important factor in a compound’s ability to penetrate the top layer of the skin. Glycolic acid, having the smallest molecular size, is the AHA with greatest bioavailability and penetrates the skin most easily; this largely accounts for the popularity of this product in cosmetic applications.

Epidermal effect
AHAs have a profound effect on keratinization, which is clinically detectable by the formation of a new stratum corneum. It appears that AHAs modulate this formation through diminished cellular cohesion between comeocytes at the lowest levels of the stratum corneum.

Dermal effects
AHAs with greater bioavailability appear to have deeper dermal effects. Glycolic acid, lactic acid and citric acid, on topical application to photo damaged skin, have been shown to produce increased amounts of mucopolysaccharides and collagen and increased skin thickness without detectable inflammation, as monitored by skin biopsies

by Diane Gibby • M.D., P.A., F.A.C.S

And the majority of women believe that beautiful skin is important—but not because it makes them feel young or sexy, but because it makes them feel good about themselves. A national survey trying to determine women’s feeling and beliefs about their skin concluded that 96 percent of women are striving for radiant skin.

However, as we get older, maintaining healthy skin and a clear, youthful complexion becomes harder and harder. Especially when it comes to the face. As the most exposed part of your body, your face is vulnerable to the destructive rays of the sun, acne, rashes, allergic reactions, and a whole range of injuries that can leave visible scars. Smoking, yo-yo dieting, nutrition and proper hydration also play pivotal roles in how your skin looks and feels.

As a woman ages, the collagen network that supports her skin can weaken and cause facial lines to form. Collagen gives skin strength and suppleness as well as an inherent ability to retain moisture, so as skin matures it may also become dryer.

The good news is the science of skin care has made dramatic inroads into skin care formulations. Breakthrough advances are bringing rapid changes to the skin care industry. Women now have many options when it comes to choosing an individual skin care regime.

Using moisturizing skin care products that contain exfoliating glycolic acids can help keep the skin looking fresh and decrease the appearance of fine lines. Retin-A is also useful in working to eliminate fine wrinkles, sun damage and age spots by continually sloughing off the outermost, dead layer of skin and increasing collagen production. Retin-A can be even more effective when used in combination with other treatments, such as glycolic acid or bleaching cream.

One of the safest and best choices are products that contain alpha-hydroxy acids (AHAs). Functioning as chemical exfoliators, AHAs help shed older, top-layer skin cells, unclog pores and step up circulation leaving skin with a fresh, glowing appearance.

AHA’s can also improve acne. Lotions or cremes that contain AHA’s, in addition to salicylic acid, have been known to effectively unclog blackheads and whiteheads.

Another skin care product available today is Renova, released on the market in March 1996. Similar to Retin-A and manufactured by the same company, Renova contains the active ingredient tretinoin. Tretinoin, a Vitamin A derivative, increases dermal thickness by increasing collagen production.

Since Retin-A was generally used for the treatment of acne, Renova has been formulated in an emollient base, with less drying effect. This product, much like Retin-A, can be used to improve fine wrinkles and to reverse some skin changes related to photoaging (sun damage).

In the past, vitamins were not widely used in cosmetics because it was believed they could not penetrate the skin. New formulations have made this possible and as a result, vitamins are now being used extensively in skin care products. Vitamins of particular interest in a skin care program are Vitamin A, E, C, D and Panthenol (Pro Vitamin B5). Although topical vitamins may have some anti-oxidant properties, they can not replace or substitute for a healthy diet!

Whatever skin care treatment you choose, protecting yourself from harmful UVA and UVB rays emitted by the sun (or tanning booths) is the most important way to take care of your skin. There is no substitute for this type of protection, and of all the options, this is the most important. Be sure to protect your skin by using a sunscreen with an SPF of 15 or more.

Much like exercise, a personalized skin care program you will use on a consistent basis is important. I recommend Aesthessence, a line of skin care products that combines effective levels of alpha-hydroxy acids to stimulate cell rejuvenation with luxurious botanical ingredients to moisturize, replenish and clarify the complexion. Different formulations can be used to benefit your unique skin type.

by Diane Gibby • M.D., P.A., F.A.C.S

Skin
Many women experience a “glow” during pregnancy but some may develop changes in skin pigmentation, known as melasma (or the “mask of pregnancy”), which is common in the facial area. Studies suggest that up to three in four women may develop these changes which are characterized by a blotchy brown increase in pigment. Since sun exposure can make these areas darker, it is important to a wear sunscreen with a SPF of at least 15. Surface-layer melasma sometimes fade on its own after delivery; when it doesn’t, treatment starts with hydroquinone, a topical bleach, often used in conjunction with skin care products containing Alpha Hydroxy Acids.

Stretch Marks
Up to 90 percent of women develop stretch marks during pregnancy, and there’s not a cream on earth that will keep them from forming (though keeping these areas well-moisturized keeps skin in good condition and just feels good!). That’s because stretching occurs not on the skin’s surface but deep down, causing structural changes to collagen and elastin. Most of these red marks will gradually fade to a silvery white over time. While there are no topical treatments that can successfully remove stretch marks they can be surgically excised in procedures such as a tummy tuck or breast lift.

Spider Veins
These small, dilated blood vessels located close to the surface of the skin are a common imprint of pregnancy that often show up on the face and legs. Some go away following delivery, while others remain. Spider veins on the face can be improved with laser treatments, while small veins on the legs are usually treated with sclerotherapy, which involves the injection of a salt-like solution into the vessel.

Your skin care needs will likely change during pregnancy and during the postpartum period. Hormonal changes can cause previously dry skin to produce oil and otherwise oily skin to feel tight and dry.

by Diane Gibby • M.D., P.A., F.A.C.S

The skin, which helps to produce vitamins, regulate the body’s temperature, and prevents harmful environmental hazards such as ultraviolet light from damaging our internal organs, can be greatly affected.

The dermis is the supportive layer of the skin made up of collagen, elastic fibers (elastin) and hair follicles. Without collagen and elastin, the skin becomes wrinkled, poorly adherent to the body and loses much of its resiliency. Research has shown that estrogen has a direct effect on the thickness and plenitude of both collagen and elastin and with the onset of menopause the amount of collagen decreases by as much as 2 percent per year. Most of us recognize these changes as sagging, wrinkled skin. And because collagen and elastic fibers are a part of the supporting structure of the skin, the alterations weaken the skin making it more prone to injury.

Although the aging process cannot be stopped or reversed, there are many ways of slowing down the changes, which occur to the skin through aging and menopause. Avoiding the harmful rays of the sun and using sun protection can protect the skin. As we age our skin cells grow slower and it takes longer to repair the damage.

A good diet is also an important contributor to resilient skin. Foods rich in Vitamin E and C and selenium can reduce damage done to the skin by serving as antioxidants, which aid in fighting free radicals. Free radicals are dangerous chemicals that can sometimes cause genetic damage when they interfere with cell metabolism. But even if you stay out of the sun and eat right, chances are your skin will still need some fine-tuning during menopause.

Dry Skin
As you age, your skin’s sebaceous glands produce less of the lubricating oil called sebum, which can lead to dry skin. Low humidity, wind and cold may make the problems worse. Fight back by using a daily moisturizer rich in alpha hydroxy acids to stimulate cell rejuvenation. Certain topical preparations such as Aesthessence, combine many natural elements together in a single formulation to replenish hormone-deprived skin. Gently exfoliating several times a week will help rid the skin of dead, dry cells and allow moisturizers to penetrate deeply.

Wrinkles
Over the years, the connective tissues collagen and elastin gradually lose their strength and elasticity, leading to wrinkles. If your skin is showing some of the ravages of time, consider the following:
Prescription creams: Tretinoin (brand name Retin A and Renova) helps slough off dead cells and steps up collagen production, firming the skin and reducing fine wrinkles.

Chemical peels
This procedure can be done in a physician’s office using light sedation. It will improve the deeper wrinkles by removing outer layers of skin. Dermal fillers. Creases from facial expressions—squinting, smiling, frowning—can be plumped up with soft tissue fillers that are either injected or surgically implanted under the skin.

Botox
Injections of Botox can be used to temporarily weaken the underlying muscles that contribute to the development of frown lines between the eyes, crow’s feet, forehead
wrinkles and neck folds. The treatment lasts three to four months.

Laser Surgery
To smooth moderate wrinkles a surgeon uses short, powerful pulses of energy to selectively destroy sun damaged outer and middle layers of skin. Lasers can also be used to remove age spots and to smooth scars.

Cosmetic Surgery
Whether an eye lift or a face lift, cosmetic surgery is the most effective way to improve deep wrinkles and sagging skin. Remember, cosmetic surgery is not intended to make you look 20 again. But rather an excellent way to improve your
appearance by giving a rested, youthful look.

by Diane Gibby • M.D., P.A., F.A.C.S

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