Lifestyle Choices

Does the performance of alpha-hydroxy acids match the promise? Yes, when formulated correctly, AHAs do indeed exfoliate the outer layers of skin to treat clogged pores and blackheads, to smooth fine wrinkles, and to remove dry surface skin. You, the consumer, however, are confronted with advertising for a myriad of products containing AHAs, all promising youthful, wrinkle-free skin. Not all preparations are effective. When choosing, there are three key factors to consider:

• First is the form of alpha-hydroxy acid: glycolic acid and lactic acid are the most effective for decreasing wrinkles and treating dry skin.
• Second is the concentration of the AHA: the higher the concentration, the more effective the AHA. However, higher concentrations can sometimes result in dry, flaky skin and rashes. Concentrations from 1% to 8% glycolic acid and 1 % to 5% lactic acid are available without prescription in the United States. These are usually fine provided they are not applied to irritated or damaged skin. Concentrations of 8% to 12% glycolic and lactic acids are available only by prescription since they can cause irritation to your skin.
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• Third, is the acidity of the particular preparation: in order to be effective, the cream or gel containing the AHA must be acidic. Many formulations, however, are neutral in acidity (pH) and therefore completely ineffective. You can test the pH of any AHA product with litmus paper, which is available from a pharmacy. (This paper, when touched by a liquid or cream, turns a specific color for each degree of that liquid’s acidity.) By noting this color, you can determine the acidity of the AHA cream. AHA products are most effective at an acidic pH of 3 or below. (Neutral pH is 7; something is “acidic” if the pH is lower and “basic” if the pH is higher. The surface of the skin is slightly acidic, at a pH of 5.5.)

AHAs can be applied to your face once or twice each day when treating wrinkles. If you use a prescription formulation, follow your doctor’s advice. If treating very dry skin, 12% lactic acid is often prescribed by your dermatologist to be used three or four times each day.

Take care with AHAs

Without doubt, the effect of alpha-hydroxy acids increases your skin’s vulnerability to the sun. If you use AHAs, be careful, and commit yourself to decreasing your exposure to the sun by always applying a sunscreen of SPF greater than 20, always wearing a hat and other cover-ups when outdoors, and minimizing outdoor activities during peak sunlight hours whenever possible.

Another caution is that use of AHAs results in more intense skin penetration by other cosmetics and skin medications, thereby sometimes causing irritation that might not otherwise occur.

Changing cosmetics or decreasing your use of AHA will often solve the problem. Consult your dermatologist if you need advice.

Which is better, Retin A or AHAs?

As you have read, both retinoic acid and AHAs decrease wrinkles. Both require more than one or two months to show improvement. And both must be used regularly for continued benefit. Table 2 compares retinoic acid with AHAs. Retinoic acid is somewhat more effective, but it more frequently causes adverse reactions, such as increased sensitivity to the sun or to other skin- care products as well as dry, red, flaky skin, especially when it is first used. That is why Retin A requires a prescription while some AHA creams do not. Retin A works not only on the skin’s surface but also in the deeper dermis. The AHAs act mostly on the surface of the skin to smooth wrinkles and to treat dry skin. Retin A can only be used once each day, whereas your doctor might suggest that you apply the AHAs twice or three times each day.

Beta-hydroxy acids

Beta-hydroxy acids (BHAs) have a slightly different structure than the alpha-hydroxy acids: recently it has been shown that one such betahydroxy acid, salicylic acid, is even more effective than any alpha-hydroxy acid in dissolving the physiologic glue that attaches the old, dead surface skin cells to your skin: salicylic acid actually exfoliates measurably better than any alpha-hydroxy acid tested and is effective for longer periods of time.

While lactic and glycolic acids increase exfoliation markedly for the first one to two weeks of use, their effect slows down after four to eight weeks. Salicylic acid, on the other hand, increases exfoliation for the full eight weeks. (Longer time periods have yet to be studied.) Furthermore, salicylic acid stimulates even greater skin-cell renewal than lactic or glycolic acids, also for longer periods of time.

There are other important advantages to this beta-hydroxy acid. Salicylic acid is less irritating than any of the AHAs: there is less flaking, far less stinging, and less sensitivity to other cosmetics appled with salicylic acid than with lactic or glycolic acid.

Why are BHAs not given the hype of the alphahydroxy acids? Possibly because they have been used by dermatologists for years and because cosmetics companies did not find them as exciting to advertise as the “new, natural fruit acids” (which are not new, and usually not natural).

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