A version of this article was originally published in Vice earlier this year, but following the airing of Radio National’s program on skin care (in which this article and myself are featured), I thought I would also put it up on the blog.
Being interviewed by Richard Aedy was an absolute dream come true: RN is my favourite station and being on the radio is something I have always wanted to try (albeit perhaps not at 6:30 am on a Monday morning!) While I’m still too nervous to listen to the program, I hope some day I can re-enter the ABC studio’s TARDIS and try it all out again.
Happy reading and listening 🙂
My mum bought a moisturiser the other day, and this is what is said on the packaging:
‘A light non-greasy formula based on actives extracted from Beech Tree Buds and stabilised using Ultra High Frequencies. Tests have shown that these actives smooth the cutaneous microrelief leading to a 10% wrinkle reduction being observed after only 4 weeks. Additional tests have shown that skin moisturisation improved by 30%.’
After I finished laughing at this ridiculous spiel, I tried to find the studies proving the ‘10% wrinkle reduction’ and ‘30% moisturisation improvement’… and couldn’t. In fact, there was nothing I could find online to support these claims. Even the website written on the jar didn’t exist! Although this disappointed me, I was far from surprised: there are very few academic papers about over-the-counter moisturisers, and many of those that do exist are small and/or funded by the manufacturer (not to mention often guarded by patents and laws that protect trade secrets). One of the reasons for the lack of good studies is that independent research institutes often have little interest in performing them. Another is that for cosmetics manufacturers rigorous peer-reviewed research can be both costly and disadvantageous; according to ‘bad science’-debunker Dr. Ben Goldacre, ‘if [studies] show no effect, then your business is trash; but if they do show an effect, then busybodies wade in to regulate your pharmaceutically-active product.’
This lack of evidence and transparency wouldn’t fly for medicines or medical products; the Therapeutic Goods Administration (TGA) just wouldn’t allow it. But as long as cosmetic companies stick to soft vague language like ‘revitalise’ and ‘refresh’ and avoid any therapeutic claims (i.e. saying they can prevent, diagnose, cure or alleviate a disease, ailment or defect) they escape TGA assessment and don’t have to prove anything.
The other issue I have with my mum’s new moisturiser, and other moisturisers like it, is the misleading and pseudoscientific language on the label. The fact this exists is hardly revelatory; people like Ben Goldacre have been exposing these questionable behaviours for years, and occasionally a company gets into trouble for it. Technically cosmetic companies aren’t allowed to use this language; according to the Trade Practises Act 1974, ‘scientific and technical terms and symbols should not be used unless they are accompanied by a clear and accurate statement of their meaning’. But it’s not hard to find a moisturiser that flagrantly ignores these instructions.
A paucity of studies and misleading language is unethical, unscientific and confusing to consumers. How can consumers know what to believe? And, in this case, how can they find out what their moisturisers actually do?
So what can moisturisers do? Can they make us look younger (as many of them claim), or is how youthful we look mostly up to our genes, age and environment? I decided put the question to Dr. Alexandra Stedman, a GP and cosmetic medicine specialist working in Perth.
The first things Alex mentions is that there is no single way to define what ‘younger’ skin looks like. When cosmetic companies use this vague term on their moisturisers, it’s impossible to know whether they are referring to lines and wrinkles, dryness, pigmentation, turgor, resilience, pliability, glow or all of the above.
‘If we assume that looking younger means having healthier looking skin, then moisturisers do definitely work’, Alex explains. ‘I see clients who use products versus those that don’t, and the users certainly look healthier. But do they look younger? I don’t know. Their skin has a better texture and feels healthy to touch and treat. But unless I had a comparison with them without moisturiser, how could I say they looked younger, and how could I measure that?’
‘Just look at the skin of the eczematous and aged patients we see. So much healthier when moisturised! But again, I ask is it younger?’
When we use moisturisers, our skin looks healthier because it’s less dry: by reducing evaporation from the skin, moisturisers increase the skin’s hydration. According to Alex, people don’t have to use fancy or expensive moisturisers to achieve this. ‘A simple sorbolene will work’, she comments.
But what about moisturisers that contain ‘active ingredients’? Do any of those may skin look ‘younger’?
‘Sunscreen definitely works’ says Alex, and do so by reflecting or scattering damaging UV radiation. Indeed, there is enough agreement about sunscreen’s ability to slow the effects of ageing that the TGA treats moisturisers with sunscreen as medicines. What’s pleasing is that this claim, unlike many others on cosmetics, is backed up by good science. For example, in a large randomised control trial published in the Annals of Internal Medicine in 2013, there was no detectable increase in skin ageing over 4.5 years in the daily sunscreen group.
There’s also evidence to show that vitamin A derivatives (or retinoids) can improve skin appearance by increasing cell turnover, thickening deep skin layers and slowing collagen breakdown. However, because active retinoids like retinoic acid (also called tretinoin) can cause redness and burning it is only available on prescription. While some moisturisers contain weaker retinoids such as retinol, their slow metabolism to retinoic acid and the small quantities used mean these creams are far less effective. Many don’t even indicate the concentration of retinol present, relying on the hype around vitamin A to sell the product.
Then there is hyaluronic acid (HA), the skin’s key moisture retention molecule (1g of HA can hold almost 6L of water). When injected into the skin, HA also has a remarkable affect on collagen, the molecule that keeps skin firm and supple. ‘Hyaluronic acid injected into the skin definitely works to stimulate collagen and improve elasticity,’ explains Alex, who regularly uses the hyaluronic acid fillers Juvederm and Restylane in her patients. ‘But does it work if used topically? I don’t know.’ The traditional thinking about topical HA is that the molecule is too large to penetrate the skin. This means that while it can sit on the skin surface and bind water, it cannot stimulate collagen production like the injectable form. Recently, two studies have reported the benefits of smaller, more penetrating HA-like molecules (low molecular weight HA and nano-HA) on skin hydration and elasticity, although neither paper directly comments on the impact on collagen synthesis.
So aside from moisturisers, is there anything else that can make us look ‘younger’? Botox and fillers like Juvederm and Restylane can certainly go some way to reducing wrinkles. Eliminating dry skin and dead cells with a chemical or physical exfoliant can also improve the appearance of fine lines and wrinkles. But if you are seriously worried about having old-looking skin, then like anything in medicine prevention is better than cure. ‘The main preventable causes of skin ageing are sun exposure and smoking’, stated British Association of Dermatologists spokeswoman Nina Goad in a 2009 piece for The Guardian. ‘So if you’re worried about wrinkles, limiting these factors is sensible.’