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

January 2019 | Volume 18 | Issue 1 | Original Article | 28 | Copyright © January 2019

Zoe Diana Draelos MD

Dermatology Consulting Services, PLLC, High Point, NC

BACKGROUND: Moisturizers create the illusion of smooth, soft skin by placing a temporary film over the skin surface or by imparting a transient hydration benefit that does not clinically improve the quality or appearance of skin. OBJECTIVE: The objective of this 8-week study was to assess the clinically relevant effects of a 3-step facial treatment program to improve the multiple qualities of photoaged skin. METHODS: Thirty-five female subjects were evaluated at baseline and after 2, 4, and 8 weeks. Measures included investigator and subject assessments and RESULTS: This novel approach resulted in significant objective, subjective, and bio-instrumental improvements in the appearance and quality of photoaged skin. At the end of the study, the investigator efficacy assessments demonstrated significant reduction in roughness, sebum, redness, and dirt with improvement in skin dryness, moisturization, clarity, smoothness, softness, radiance, and overall appearance without use of a moisturizer. The treatment products were well-tolerated. CONCLUSION: Use of this novel approach safely and effectively improved multiple clinical endpoints of photoaged skin through cleansing, aggressive exfoliation, and sebum reduction in the absence of a traditional moisturizer. J Drugs Dermatol. 2019;18(1):28-31.


Well-moisturized, hydrated, healthy skin is typically described as smooth and soft. Low transepidermal water loss (TEWL) is an instrumental indication the skin is well-hydrated with an intact barrier;1 however, unexfoliated skin can exhibit low TEWL while possessing poor tactile and visual properties. Retained rough skin scale can camouflage underlying smooth soft skin. Moisturizers are the basis for most anti-aging skin regimens, although many moisturiz- ers create temporary smooth, soft skin by placing a film over the skin surface, creating greater adhesion between the desquamating corneocytes.2,3 These qualities are beneficial from a cosmetic standpoint, but are temporary, lasting only until the film is disrupted or removed by washing.1 This explains why traditional anti-aging moisturizers must be used daily because the moisturizer does not address the cause of the rough skin. The following research evaluated a novel facial treatment system comprised of 3 steps: cleansing with lauryl oat amino acids and a blend of botanical extracts to remove surface debris; skin resurfacing with magnesium oxide crystals, Melaleuca alternifolia (tea tree) leaf oil, and glycerin to restore smoother skin texture; and oil control pads containing 2% salicylic acid and glycolic acid to provide exfoliation and remove surface sebum.


Study Subjects

Thirty-five female subjects with Fitzpatrick skin types I−III and approximately 50 years of age were enrolled. The subjects denied receiving regular facial treatments or visiting skincare professionals or dermatologists. Subjects had skin dullness, redness not related to rosacea, oiliness, rough or uneven skin texture, and dyspigmentation. Exclusion criteria included the presence of skin disease, use of systemic or topical medications that could influence the study outcome, hypersensitivity to any of the ingredients of the study products, pregnancy or planned pregnancy, breast- feeding, clinically significant unstable medical disorders, or any other illness or condition that could jeopardize the objectives of the study. Subjects of childbearing potential expressed their willingness to use an acceptable form of birth control during the study and to use only the assigned study products during the study, except for their normal non-medicated facial cosmetics. Each subject provided signed informed consent and a photography consent (Concordia Clinical Research's Institutional Review Board, Cedar Knolls, NJ) prior to participation.

Study Materials

Components of the Treatment Program (ZO® Getting Skin ReadyTM [GSRTM] Treatment Program; ZO Skin Health, Inc., Irvine, CA) included a mild foaming facial cleanser, an exfoliating scrub, and oil control pads.

Efficacy and Tolerability Measures

Digital images were obtained of the frontal face and 45° right and left angles, using six standardized lighting modes to ana-