What are the pros and cons of alpha hydroxy acid lotions and chemical peels, as well as the roles of topical antioxidants vitamin E and C, in reversing the signs of aging?
The Benefits of Topical Vitamin C for Reversing Skin Aging
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Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
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.
Please consider volunteering to help out on the site.
- Sunder S. Relevant topical skin care products for prevention and treatment of aging skin. Facial Plast Surg Clin North Am. 2019;27(3):413-418.
- Tran D, Townley JP, Barnes TM, Greive KA. An antiaging skin care system containing alpha hydroxy acids and vitamins improves the biomechanical parameters of facial skin. Clin Cosmet Investig Dermatol. 2015;8:9-17.
- Ahmed IA, Mikail MA, Zamakshshari N, Abdullah ASH. Natural anti-aging skincare: role and potential. Biogerontology. 2020;21(3):293-310.
- Huang CK, Miller TA. The truth about over-the-counter topical anti-aging products: a comprehensive review. Aesthet Surg J. 2007;27(4):402-412.
- Imhof L, Leuthard D. Topical over-the-counter antiaging agents: an update and systematic review. Dermatology. 2021;237(2):217-229.
- Stiller MJ, Bartolone J, Stern R, et al. Topical 8% glycolic acid and 8% L-lactic acid creams for the treatment of photodamaged skin. A double-blind vehicle-controlled clinical trial. Arch Dermatol. 1996;132(6):631-636.
- Thibault PK, Wlodarczyk J, Wenck A. A double-blind randomized clinical trial on the effectiveness of a daily glycolic acid 5% formulation in the treatment of photoaging. Dermatol Surg. 1998;24(5):573-577.
- Fiume MM. Alpha hydroxy acids. Int J Toxicol. 2017;36(5_suppl2):15S-21S.
- Humbert PG, Haftek M, Creidi P, et al. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol. 2003;12(3):237-244.
- Burke KE, Clive J, Combs GF, Commisso J, Keen CL, Nakamura RM. Effects of topical and oral vitamin E on pigmentation and skin cancer induced by ultraviolet irradiation in Skh:2 hairless mice. Nutr Cancer. 2000;38(1):87-97.
- Pinnell SR, Yang H, Omar M, et al. Topical L-ascorbic acid: percutaneous absorption studies. Dermatol Surg. 2001;27(2):137-142.
- Inui M, Ooe M, Fujii K, Matsunaka H, Yoshida M, Ichihashi M. Mechanisms of inhibitory effects of CoQ10 on UVB-induced wrinkle formation in vitro and in vivo. Biofactors. 2008;32(1-4):237-243.
- Elsner P, Fluhr JW, Gehring W, et al. Anti-aging data and support claims--consensus statement. J Dtsch Dermatol Ges. 2011;9 Suppl 3:S1-32.
- Nusgens BV, Humbert P, Rougier A, et al. Topically applied vitamin C enhances the mRNA level of collagens I and III, their processing enzymes and tissue inhibitor of matrix metalloproteinase 1 in the human dermis. J Invest Dermatol. 2001;116(6):853-859.
- Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg. 1999;125(10):1091-1098.
- Burke KE, Pinnell DM. Topical Vitamins E, C, and Ferulic Acid and Topical L-Selenomethionine. In: Sivamani R, Jagdeo JR, Elsner P, Maibach HI, eds. Cosmeceuticals and Active Cosmetics. CRC Press; 2015.
- Raschke T, Koop U, Düsing HJ, et al. Topical activity of ascorbic acid: from in vitro optimization to in vivo efficacy. Skin Pharmacol Physiol. 2004;17(4):200-206.
Motion graphics by Avo Media
Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.
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.
Please consider volunteering to help out on the site.
- Sunder S. Relevant topical skin care products for prevention and treatment of aging skin. Facial Plast Surg Clin North Am. 2019;27(3):413-418.
- Tran D, Townley JP, Barnes TM, Greive KA. An antiaging skin care system containing alpha hydroxy acids and vitamins improves the biomechanical parameters of facial skin. Clin Cosmet Investig Dermatol. 2015;8:9-17.
- Ahmed IA, Mikail MA, Zamakshshari N, Abdullah ASH. Natural anti-aging skincare: role and potential. Biogerontology. 2020;21(3):293-310.
- Huang CK, Miller TA. The truth about over-the-counter topical anti-aging products: a comprehensive review. Aesthet Surg J. 2007;27(4):402-412.
- Imhof L, Leuthard D. Topical over-the-counter antiaging agents: an update and systematic review. Dermatology. 2021;237(2):217-229.
- Stiller MJ, Bartolone J, Stern R, et al. Topical 8% glycolic acid and 8% L-lactic acid creams for the treatment of photodamaged skin. A double-blind vehicle-controlled clinical trial. Arch Dermatol. 1996;132(6):631-636.
- Thibault PK, Wlodarczyk J, Wenck A. A double-blind randomized clinical trial on the effectiveness of a daily glycolic acid 5% formulation in the treatment of photoaging. Dermatol Surg. 1998;24(5):573-577.
- Fiume MM. Alpha hydroxy acids. Int J Toxicol. 2017;36(5_suppl2):15S-21S.
- Humbert PG, Haftek M, Creidi P, et al. Topical ascorbic acid on photoaged skin. Clinical, topographical and ultrastructural evaluation: double-blind study vs. placebo. Exp Dermatol. 2003;12(3):237-244.
- Burke KE, Clive J, Combs GF, Commisso J, Keen CL, Nakamura RM. Effects of topical and oral vitamin E on pigmentation and skin cancer induced by ultraviolet irradiation in Skh:2 hairless mice. Nutr Cancer. 2000;38(1):87-97.
- Pinnell SR, Yang H, Omar M, et al. Topical L-ascorbic acid: percutaneous absorption studies. Dermatol Surg. 2001;27(2):137-142.
- Inui M, Ooe M, Fujii K, Matsunaka H, Yoshida M, Ichihashi M. Mechanisms of inhibitory effects of CoQ10 on UVB-induced wrinkle formation in vitro and in vivo. Biofactors. 2008;32(1-4):237-243.
- Elsner P, Fluhr JW, Gehring W, et al. Anti-aging data and support claims--consensus statement. J Dtsch Dermatol Ges. 2011;9 Suppl 3:S1-32.
- Nusgens BV, Humbert P, Rougier A, et al. Topically applied vitamin C enhances the mRNA level of collagens I and III, their processing enzymes and tissue inhibitor of matrix metalloproteinase 1 in the human dermis. J Invest Dermatol. 2001;116(6):853-859.
- Traikovich SS. Use of topical ascorbic acid and its effects on photodamaged skin topography. Arch Otolaryngol Head Neck Surg. 1999;125(10):1091-1098.
- Burke KE, Pinnell DM. Topical Vitamins E, C, and Ferulic Acid and Topical L-Selenomethionine. In: Sivamani R, Jagdeo JR, Elsner P, Maibach HI, eds. Cosmeceuticals and Active Cosmetics. CRC Press; 2015.
- Raschke T, Koop U, Düsing HJ, et al. Topical activity of ascorbic acid: from in vitro optimization to in vivo efficacy. Skin Pharmacol Physiol. 2004;17(4):200-206.
Motion graphics by Avo Media
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Title
The Benefits of Topical Vitamin C for Reversing Skin Aging
LicenseCreative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)
Content URLDoctor's Note
This is the last video in this four-part series on anti-aging skin products. If you missed any of the others, see:
- What Is the Most Important Anti-Aging Cream Ingredient?
- Topical Retinoids to Reverse Skin Aging
- The Benefits of Topical Niacinamide for Reversing Skin Aging
For more on how to live your longest, healthiest life, preorder my new book How Not to Age. (As always, all proceeds I receive from all of my books are donated to charity.)
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