Introduction: The ABCs of Skincare

Skincare - the eternal balance between skin type, individual sensitivity and breakout potential with relation to the activity of skincare ingredients. Also the most cost-effective way of improving skin quality long-term.

So, what are active ingredients and how do you decide what to use?

Active ingredients are biologically active compounds in skincare addressing specific concerns, for example skin texture, enlarged pores, scarring, fine lines, wrinkles, breakouts, pigmentation - the list goes on. The simple answer is to seek professional advice for a customised routine suitable for you, but there are many great skincare resources on the internet, and there is no reason not to do some research before taking the next step.

First of all, there are some excellent retail (non-clinic) brands which contain relatively high levels of active ingredients not requiring approval from the Therapeutic Goods Authority [TGA] as they are considered cosmetics. However, as some ingredients can cause irritation, most retail brands opt to have lower concentrations and a more elegant formulation (texture), so that it is better tolerated. For the majority of the population with no specific skin concerns this works fairly well, except over the longer term with the high level of UV exposure in Australia it may not be sufficient to mitigate most sun-damage or worse, prevent skin cancer. Sunscreen, for example, falls under TGA jurisdiction as it is a therapeutic product essential to skin cancer prevention and not a cosmetic, but that is a topic in itself that will be discussed in detail in a separate blog entry.

A commonly prescribed morning routine would be to cleanse, use a vitamin B3 (niacinamide) and/or vitamin C serum, an appropriate moisturiser (preferably one with hyaluronic acid), then a broadspectrum sunscreen. Makeup goes on last. Vitamins B5 (panthenol) and E (tocopherol) can be used both morning and night, while vitamin A products are usually recommended for night use, again with an appropriate moisturiser for skin type as it can cause dryness. Without further ado, let's go through the vitamins used in skincare - alphabetically.

The Vitamins of Skincare:

Retinoids, more widely known as vitamin A, are available in different chemical forms, namely retinol, retinaldehyde and tretinoin (prescription-only). Vitamin A is one of the best studied ingredients in skincare, and the only true anti-aging ingredient that has stood the test of time - provided one can tolerate its use. From repairing DNA to reversing sun damage, increasing cell turnover as well as reducing sebum (oil) production and inflammation, retinoids take some getting used to as there may be an initial phase of breakouts, dryness and redness which often causes some distress. It can increase sun sensitivity and should be used at night (although some formulations claim minimal photosensitisation) with adequate sun protection during the day. Persistent use is worth it in most instances, as the end result is smoother, brighter skin with a more even skintone, and for acneic skin a great treatment for scarring once the initial breakouts are controlled.

Vitamin B3, or niacinamide, is another well studied ingredient that is a potent antioxidant and anti-inflammatory; it repairs the skin barrier and reduces pigmentation, rosacea, acne, fine lines and wrinkles, and can be used as an adjunct or standalone active in acne-prone skin that cannot tolerate high doses of topical vitamin C. However, there have been cases where it has paradoxically caused breakouts or flushing of the skin, but it is unclear whether that was due to the activity of the niacinamide or the base in which it was delivered. Skincare is very individual, and not everyone will respond favourably to what are usually considered relatively benign ingredients.

Lesser known is panthenol or vitamin B5, which is usually added to moisturisers as it is a powerful humectant that improves hydration, an anti-inflammatory and aids healing.

To better understand the benefits of vitamin C, we have to first understand what free oxygen radicals are. UV damage (especially to UVA exposure), environmental pollution/toxins and personal habits such as smoking or even diet (fried foods, saturated fats, alcohol) give rise to biochemical reactions that result in the formation of unstable molecules with an unpaired electron. These are known as free oxygen radicals that cause a chain reaction damaging to cellular membranes and DNA, which contributes to premature skin aging.

Vitamin C, in particular the chirally correct L-ascorbic acid, is an essential cofactor to collagen synthesis in the human body, meaning the body makes collagen much more efficiently in its presence by stimulating fibroblasts directly. Collagen and elastin are proteins in the skin that make it appear smooth and supple. Broad spectrum sunscreens can reach up to 98% blockout of the UV rays, however washout from sweating and the lack of reapplication may mean that coverage is seldom ideal and only slightly more than half of the free oxygen radical related damage can be prevented by sunscreen alone. When applied topically prior to sun exposure, vitamin C is extremely effective in neutralising free oxygen radicals by donating a free electron without becoming an unstable molecule itself. It also reduces pigment production. While vitamin C does not increase sebum production or cause acne directly, its irritant potential being an acidic compound can cause reactivity with sensitive or acneic skin types, and its use may need to be built up from a lower concentration. Water-soluble or oil-soluble forms of vitamin C may be chosen (to increase penetration) depending on individual skin type, but vitamin C mostly resides within our cells to scavenge free oxygen radicals.

Included for completeness is vitamin D3 (calcitriol), which is made in the skin in response to sun exposure (UVB) and essential for oral calcium absorption, in addition to other effects on mood. Calcitriol has become increasingly popular in skincare. Topically, vitamin D3 has been used in the treatment of psoriasis (technically it is a steroid hormone as is vitamin A) and appears to be absorbed through the skin quite effectively. It exhibits photoprotective effects against UV radiation (antioxidant), repairs the skin barrier and also decreases inflammation, and usually comes in an oil soluble form which may not be suitable for acneic skin. More studies are required to determine whether it is worthwhile adding to the daily routine.

Vitamin E, or tocopherol, is another useful adjunct in the antioxidant arsenal, and is often paired with vitamin C. It is an oil soluble vitamin which is usually attached to cell membranes and is regenerated by vitamin C, augmenting its antioxidant effect.

This concludes a very brief introduction to the vitamin actives used in anti-aging skincare. While these ingredients have seemingly overlapping treatment profiles, it's important to note that different individuals will respond differently, and it is fortunate that we are able to use a bespoke combination to achieve the desired results while avoiding undesirable side effects.

There are still a wealth of topics to be covered, from moisturisers to sunscreens, chemical peels and other non-surgical rejuvenation treatments. Let us know what you would like to read about next!