Do Anti-Aging Creams Work? Part 2

Today, we have the second in our two-part series on anti-aging creams. And, we start with a look at niacinamide, also know as nicotinamide, a form of vitamin B3.

I’ve talked about sunscreen and topical retinoids. What other skin cream components have been shown to help with skin aging?

While placebo-controlled trials are the standard in most medical research, they are still all too rare for cosmetic products. This raises efficacy questions—many are left with simply buying “hope in a jar”—as well as safety concerns. Cosmetics to this day contain an array of toxic chemicals. Of the more than 12,000 synthetic chemicals used in cosmetics, fewer than 20 percent have been recognized as safe. Of course, this doesn’t mean natural ingredients are necessarily harmless. Poison ivy is as natural as you can get, but you wouldn’t want to rub in on your face. However, there are some relatively safe natural options with varying degrees of efficacy.

In contrast to retinoic acid—a form of vitamin A that can be irritating—topical niacinamide (also known as nicotinamide) is a form of vitamin B3 that is non-irritating and found to be effective. It’s been described as one of the best studied cosmeceutical ingredients for anti-aging, but it looks like there are only two placebo-controlled human studies, which gives you an idea of the state of cosmeceutical science.

Skin photoaging is largely mediated by UV-induced free radical formation. One of the consequences of excess sun exposure is the oxidation of sugars and proteins in the skin into yellow-brown pigment that gives aging skin a yellowing, sallow appearance. Since niacinamide is a precursor to two potent antioxidants, the hope is that this process could be interrupted, and indeed, the first published study was entitled “Topical niacinamide reduces yellowing, wrinkling, red blotchiness, and hyperpigmented spots in aging facial skin.”

It was a 12-week, double-blind, placebo-controlled, randomized clinical split-face study of middle-aged women. In a split-face study, each woman is her own control, rubbing the active formulation (in this case, 5 percent niacinamide in moisturizer) on one side of her face, and the placebo (straight moisturizer) on the other half––though neither she nor the researchers know which side is which until the code is broken at the end. This controls for skin type and administration technique (different people apply facial products differently), but participants often use the same hand for applying the creams to both sides. So, unless specified that different gloves be worn, or hands washed in between, there can be cross-contamination.

Anyway, at the end of 12 weeks there was a small, 5 percent reduction in wrinkles and fine lines, and a slowing in the development in blotchiness, spots, and sallowness. A subsequent publication noted an improvement in skin elasticity as well. The magnitude of these effects may only be one-third to one-fifth as good as retinoic acid, but there were no reports of excess skin irritation. But use a four percent concentration, and application was limited to crow’s feet wrinkles around the eyes. Significant reductions in wrinkles by both subjective and objective measures were noted by the end of the eight-week study. Sixty-four percent of the niacinamide-side eye wrinkles underwent moderate or marked improvement, compared to zero percent on the placebo-side eyes.

Finally, today, we look at the pros and cons of alpha hydroxy acid lotions, chemical peels, and topical antioxidants in reversing the signs of aging.

There is a reason why there is a long historical use of fruit purees as facial masks, and perhaps why Cleopatra was said to bathe in sour milk. Alpha hydroxy acids, also known as fruit acids, are natural acids found in foods. They include citric acid (from citrus), glycolic acid (from sugar cane), lactic acid (from fermented fruits), malic acid (from a variety of fruits), and tartaric acid (from grapes).

High-strength concentrations are used for chemical peels. Concentrations over 40 percent can only be used by medical doctors. Professionals in salons can give more mild peels with 10 to 40 percent acid solutions, but concentrations under 10 percent are sold over the counter as exfoliants. Alpha hydroxy acids are thought to work by weakening cell-to-cell bonds to hasten the shedding of dead cells off the skin surface.

Three placebo-controlled studies of over-the-counter strengths have been published. The first compared an 8 percent glycolic acid lotion to an 8 percent lactic acid lotion to a placebo lotion applied daily on face and forearms for 22 weeks. Both the acids worked similarly, producing visible improvements in facial photodamage in more than 70 percent of the acid groups versus only 40 percent of the placebo group. All the participants were advised to wear protective clothing and regularly use sunscreen, which may help explain the benefits even in the placebo group.

Overall forearm photodamage and sallowness also improved significantly in the acid versus placebo groups. About 1 in 3 participants experienced transient redness, but only 1 (out of 74) left the study due to facial irritation.

The second trial found a 5 percent glycolic acid lotion for three months beat out placebo on lessening skin roughness and mottled discoloration on the face and neck, but failed to significantly reduce wrinkle scores.

The irony of alpha hydroxy acids is that while they can help with past photodamage, they can make future damage worse by increasing skin photosensitivity. So, taking precautions is recommended. The FDA recommends that all alpha hydroxy acid products be labeled with the prominent warning: Sunburn Alert: This product may increase your skin’s sensitivity to the sun and particularly the possibility of sunburn. Use a sunscreen, wear protective clothing, and limit sun exposure while using this product and for a week afterwards.

What about ascorbic acid, also known as vitamin C? If niacinamide works by turning into antioxidants, why not just apply antioxidants directly? Topical application can lead to vitamin E levels in the skin 10 times what is achieved with oral dosing and vitamin C up to 40 times higher (at least in mouse and pig skin, respectively). According to a review on topical anti-aging skin care by a prominent Beverly Hills plastic surgeon, “At a minimum, patients should be encouraged to use daily sunscreen, a topical retinoid every night, and a topical antioxidant daily.” But there’s only one antioxidant that’s been clearly shown to work.

Despite its ubiquity in skin care products, there is no evidence to support any role for topical vitamin E in skin aging, whether for wrinkles, discoloration, or texture.

The one study on topical CoQ10 also failed to work significantly better than placebo, but there is one type of vitamin C that has been shown to help.

Skin biopsy studies show that the topical application of a 5 percent solution of L-ascorbic acid (also known as just ascorbic acid, the type of vitamin C found in food) significantly increases the expression of collagen in human skin compared to placebo, suggesting “functional activity of the dermal [or skin] cells is not maximal in postmenopausal women and can be increased.” A split-face study involving the application of three drops of a 10 percent L-ascorbic solution for three months found significant improvements over the placebo side of the face in fine and coarse wrinkles, sallowness, and skin tone (firmness). Not knowing which side was which, 16 out of 19—84 percent of patients—correctly identified the vitamin C side as the one showing improvement.

Unfortunately, L-ascorbic acid is unstable in creams, turning an unsightly brown when it oxidizes, limiting its shelf life; so instead, the skin care industry uses more stable vitamin C esters or derivatives, such as ascorbyl palmitate, magnesium ascorbyl phosphate, ascorbic acid sulfate, ascorbyl stearate, etc. Unfortunately, there is no evidence that these compounds have comparable effects, likely because they are poorly absorbed and only minimally convert to the active form. The good news is that you can make your own.

Although vitamin C concentrations as low as 3 percent or 5 percent have been shown to have anti-wrinkle effects in split face or split neck and arm studies, 10 percent is recommended.

The 10 percent solution used in this study retails for a ridiculous $127 per ounce. You can make a DIY solution more than two thousand times cheaper simply by buying L-ascorbic acid in bulk and mixing 3 grams into 30 grams of water at a cost of about a nickel per ounce. You can mix it in an eyedropper and drip four to five drops on the palm of your hand and use your fingertips to apply over your face, neck, and upper chest daily. Just be careful to not get it into your eyes.