A Novel Approach to Enhancing the Quality and Appearance of Photoaged Skin

gration effects that create the illusion of immediately improved skin roughness.The tactile smoothness created by the moistur- izer is the result of friction reduction between the finger and the skin created by ingredients that induce skin slip, such as dimethicone, cyclomethicone, and cyclopentasiloxane. Anti- aging moisturizers also function as emollients by temporarily smoothing down desquamating skin scale to make the skin feel soft. Dimethicone, cyclomethicone, and cyclopentasiloxane also function as emollients, in addition to ingredients such as cetyl alcohol, propylene glycol, octyl palmitate, isopropyl stearate, and isopropyl palmitate. Placing a film over the skin surface and smoothing down desquamating corneocytes are temporary cosmetic improvements that are only realized while the film is continuous over the skin surface. Rubbing and water contact will immediately destroy the film or remove transient emollients and the cosmetic effect will also immediately disappear. Thus, the skin is not actually smooth and soft; it only appears smooth and soft. The goal of this research was to comprehensively address the overall quality and appearance of photoaged skin without moisturization in a more meaningful and functional manner. Wetting the skin with water/cleanser, followed by mechanical exfoliation and an oil control pad achieved smoother, softer skin without a moisturizer. Instead of smoothing the skin scale repeatedly with daily applications of a moisturizer, the skin scale was permanently removed to initiate cellular renewal.The improvement was observed as early as week 2, with contin- ued cumulative improvement noted until the study terminated at week 8. Continued use of the 3-step regimen would be re- quired, however, as the skin scale is continually produced and accumulating. Excess sebum output can accentuate the appearance of pores and retained skin scale. Sebum also acts as a wetting agent, similar to the exogenous emollients previously discussed, extending the retention time of skin scale. Removal of sebum from the skin surface is therefore essential to optimize exfoliation. These were the roles of the oil control pad containing astringent ingredients. The efficacy of the 3-step regimen created an opportunity to evaluate the difference between the appearance of moisturized photoaged skin, when a product film or transient emollient moisturizers is covering the skin surface, and unadorned, smooth, soft, photoaged skin. Well-moisturized skin, through the use of a moisturizer, does not yield permanence of effect, and is not functionally relevant. The 3-step regimen created functionally smooth, soft skin that was a reality rather than a cosmetic illusion.

The 3-step treatment resulted in multiple statistically significant improvements in photoaged skin that a common moisturizer alone cannot deliver. At week 4, subjects demonstrated reduc- tions in skin roughness, sebum, redness, with improvement in skin dryness, the appearance of moisturization, clarity, smoothness, softness, radiance, and overall appearance.These improvements progressively continued throughout the study, maintaining significance at week 8 with minimal tolerability issues. This research demonstrated that multiple improvements in skin quality and appearance can be achieved through a cleansing, exfoliating, and oil control regimen rather than temporary wetting of skin scale through the use of traditional moisturizers.

Zoe Diana Draelos MD received funding from ZO Skin Health to conduct the research.

The author gratefully acknowledges the editorial assistance of Dr. Carl S. Hornfeldt, Apothekon, Inc., during the preparation of this manuscript.This study was sponsored by ZO® Skin Health, Inc., Irvine, CA.

1. Draelos ZD. The science behind skin care: moisturizers. J Cosmet Dermatol. 2018;17:138-144. 2. Del Rosso JQ. Factors influencing optimal skin care and product selection. In: Draelos ZD, Thaman LA, eds. Cosmetic Formulation of Skin Care Prod- ucts. New York, NY: Taylor & Francis Group; 2006:115-121. 3. Draelos ZD. Modern moisturizer myths, misconceptions, and truths. Cutis. 2013;91:308-314.