Two-Step Skincare Regimen Addressing Aging in Three Unique Geographic Locations: A Prospective, Multi-Center, Open-Label Study

January 2023 | Volume 22 | Issue 1 | 16 | Copyright © January 2023


Published online January 1, 2023

Joel L. Cohen MD FAAD FACMSa, Melanie Palm MD MBAb, Brian Biesman MD FACSc, Morgann Young MSd, Tatiana Kononov BS MBAd, Alisar S. Zahr PhDd

aAboutSkin Dermatology & AboutSkin Research, Greenwood Village, CO
bArt of Skin MD, Solana Beach, CA
cBrian S Biesman MD FACS, Nashville, TN
dRevision Skincare®, Irving, TX

Abstract
Background: Extrinsic factors including solar radiation and air pollution significantly impact facial skin aging. The efficacy and tolerability of a 2-step skincare regimen consisting of a vitamin C antioxidant serum (VCAS) and a 100% mineral tinted sunscreen moisturizer (TSM) were evaluated in women with hyperpigmented and photodamaged facial skin exposed to beach, mountain, and river-traversed basin city stressors.
Methods:
This was an institutional review board (IRB)-approved, multi-center, prospective, open-label study involving healthy subjects. Thirty-six females aged 35 to 60 years with Fitzpatrick Skin Types I to V and exhibiting moderate to severe hyperpigmentation and moderate photodamage were recruited. The VCAS was applied to the global face twice-daily (morning and evening), and the TSM was applied in the morning with at least 2 reapplications during daily activity for 12 weeks. Clinical grading with a validated scale, standardized photography, and a self-assessment questionnaire were performed at baseline and weeks 4, 8, and 12.
Results: Statistically significant improvements were shown in clinically graded efficacy parameters at weeks 4, 8, and 12. Subjects showed an average improvement of 11.7%, 14.9%, and 19.1% in overall photodamage and an average improvement of 19.5%, 23.4%, and 24.5% in clarity/brightness at weeks 4, 8, and 12, respectively. Forehead lines and cheek lines demonstrated clinically significant improvement from baseline to week 12. Both products were well-tolerated and well-perceived by subjects.
Conclusion: The 2-step skincare regimen was well-tolerated and effective in improving extrinsic signs of facial aging induced by solar radiation and air pollution stressors after 12 weeks of use.

J Drugs Dermatol. 2023;22(1):16-22. doi:10.36849/JDD.7154

Citation: Cohen J, Palm M, Biesman B, et al. Two-step skincare regimen addressing aging in three unique geographic locations: A prospective, multi-center, open-label study. J Drugs Dermatol. 2023 Jan 1;22(1):16-22. doi: 10.36849/JDD.7154. 

INTRODUCTION

Ultraviolet radiation (UVR), visible light (VL) radiation, and infrared radiation (IR) make up 6.8%, 38.9%, and 54.3% of the total solar radiation, respectively, and each plays a significant role in extrinsic skin aging.1 Long-term daily UVR exposure leads to sub-optimal functioning of the skin due to epidermal and dermal damage caused by UVB (290-320 nm) and UVA (320-400 nm) radiation, respectively. These effects include UV-induced immunosuppression, changes in matrix metalloproteinase (MMP) homeostasis, and inflammation. Furthermore, UVR triggers the production of free radicals such as reactive oxygen species (ROS) that disrupt skin structure and function.1 VL (400-760 nm) can also produce photobiological effects.2 High Energy Visible (HEV), specifically blue-violet light (400-450 nm), significantly increases and prolongs hyperpigmentation compared with UVB irradiation.2 Lastly, IR radiation (760-3000 nm) penetrates into the subcutaneous tissue and upregulates dermal MMPs, resulting in further damage to collagen and elastin structure.3,4

Another key extrinsic contributor to skin aging is air pollution. High levels of air pollution are found in many cities in the United States (US) and across the globe. According to the 2021 World Air Quality Report, only 3% of cities met World Health Organization's (WHO) air quality guidelines.5 The "State of the Air" 2022 report by the American Lung Association states that over 40% of Americans (over 137 million people) live in places with unhealthy levels of pollution, and these numbers are climbing.6 Exposure to air pollutants upregulates specific pathways in the skin that lead to hyperpigmentation and free radicals, where exposure to these harmful compounds increases ROS production, lipid peroxidation, and oxidative DNA damage in the skin, as well as decreases epidermal antioxidants and cell proliferation. All these processes promote skin aging.7,8

It is critical to protect the skin from major extrinsic stressors, or factors of aging, to ensure skin health and minimize skin aging. Skincare products that can prevent or mitigate the effects of