Epidermolytic hyperkeratosis

Our skin is a nine-pound organ that serves as a portal for everything we come in contact with. Our skin is also perpetually changing -- shedding its outer layer in favor of the new collagen matrix below. In fact (here's an interesting statistic), by the time we reach senior citizen status, we will have shed nearly 40 pounds of dead skin. As we age, this process of sloughing off dead and damaged cells begins to slow down, and the accumulated layers of old skin can grow thick and coarse.

Collagen, the skin's fibrous network of protein that surrounds blood vessels and is responsible for suppleness and a youthful appearance, begins to break down as we get older, as well. By the time we reach our mid-30s, fine lines (I prefer to call them laugh lines) may become noticeable around the eyes and, eventually, defined lines, sagging skin, and deep wrinkles may form. In fact, as time marches on, it seems to be doing so across our face.

That was then ... (thankfully) this is now!

The 1980s saw the dawn of a skin product, available by prescription only, that promised to not only get rid of acne, but to reverse the signs of aging skin: retin-A. Unfortunately, retin-A also promised some unpleasant side effects, including extreme sensitivity to the sun. The alternative was a chemical face peel. Although this method did strip away superficial layers of skin to reveal new skin, the procedure could be expensive, and often left the person looking as though they had indeed suffered a chemical burn. It seemed we were doomed to live with aging skin, or suffer through rather risky means of slowing this process.

Then, in 1992, a new generation of age-defying products was born that offered anti-aging results without the harsh effects of chemical peels or retin-A -- alpha-hydroxy acids, or AHAs.

AHAs are acids derived from fruits, sugar cane, and, in some products, milk. In effect, they are a milder version of the chemical peel, but they work to reduce the signs of aging by gently removing dead skin and encouraging the proliferation of new cell growth. While fruit peels are not new (Cleopatra reputedly used them), they are considered a modern breakthrough in skin care.

The market quickly became flooded with AHA products. But now, seven years after their "rediscovery," AHAs have had to make room on the shelf for several cousins to complete the hydroxy family. In an article published earlier this year in Cosmetic Dermatology, Zoe Draelos, M.D., informed colleagues about the latest hydroxy acids to appear on the scene; a sampling includes: triple hydroxy acids, combination hydroxy acids, and polyhydroxy acids. Other literature mentions gamma, delta, and epsilon hydroxy acids.

AHAs & BHAs: layers of difference

At present, we are most familiar with AHAs (in the form of glycolic acid) and beta-hydroxy acids (BHAs). We already know that alpha hydroxys promote a mild peeling effect, but what's the difference between alpha hydroxy and beta hydroxy?

AHAs are best for equalizing skin tone and repairing sun-damaged skin. Bryan Barron, a make-up artist and skin-care consultant to the cosmetic industry, located in Seattle, Wash., believes that what counts in a natural peel is concentration and pH, and that it's important to understand how these two products differ.

"Alpha hydroxys," he says, "are most effective at a 4-8 percent concentration. Any lower than that and they will not exfoliate but will [only] moisturize." Barron also believes that AHAs are most effective at a pH of 3-4. A lower pH will not exfoliate; and higher levels can irritate the skin. Barron further recommends that an AHA product be used on a one-month-on and then a one-month-off basis, since they tend to have a "drop-off" rate.

Beta hydroxys, on the other hand, are quite different. BHAs are actually salicylic acid (obtained from the barks of willow and other sources), and are fat soluble. "In contrast to AHAs, which are water soluble, BHAs," Barron explains, "have an affinity with oily skin and can break through and help clear up excess oil." Ideally, a BHA should have a 1-2 percent concentration and a pH of 3. Otherwise, they could produce redness and flaking skin. Barron also says that "it is important to note that BHAs do not have a drop-off rate, they just keep exfoliating; therefore, use them sparingly and try to alternate them with an effective AHA product."

Deciphering the alphabet soup of ingredients

So, how do you know what acids are listed in your favorite fruit peel? AHA and BHA can sometimes be vague terms for the consumer, since they are really intended to inform the chemist as to the molecular structure of the carbon chain and which direction the active hydroxy lies. If AHA or BHA isn't specified on the label, the ingredients may refer to the specific acid involved, such as tartaric (grapes), lactic (milk), sorbic (lemon and other citrus fruits), or malic (from apples).

According to Shelley Marleen Hess, a holistic practitioner and author of Putting Your Best Face Forward, there is a simple mathematical "test" for consumers to determine the actual formulation of a product: first, divide the number of commas used in listing the ingredients of a product by the number 4. "If the [resulting] number is 4 or less, then the first ingredient is 90 percent of the entire formulation. If the number is greater than 4, then the first two ingredients comprise 60 percent of the entire formulation."

Tick, tock ... tick, tock -- can we slow that `aging' clock?

But what everyone wants to know is if AHA or BHA fruit peels can turn back the clock and make us look younger. They can, to some degree. Over-the-counter (OTC) AHA or BHA peels used on a nightly basis for a period of several weeks can minimize the appearance of fine lines around the eyes,, mouth, and throat. Recent studies show that glycolic acid promotes collagen production in human tissue culture, and on real people, and AHAs prove to be effective at improving the appearance of several cosmetic problems. However, deep lines (a.k.a. wrinkles), especially those induced by sun damage, are not strongly affected by OTC concentrations of 10 percent or less. These type of imperfections are treated in a specialist's office or skin-care center with concentrations ranging from 50 to 70 percent. All skin-care experts agree that using a sun block with an SPF of 15 or more in conjunction with fruit peels is crucial for maximizing benefits and avoiding further damage to the skin. Also, don't forget that cigarette smoking, excessive alcohol and caffeine consumption, an insufficient amount of sleep, and dehydration all wreak havoc on skin, no matter how much sunscreen or AHAs or BHAs you use.

User recommendations -- to each her (or his) own

Barron makes some recommendations for using fruit peels for exfoliating; these peels are grouped according to skin type, which he considers a "relative term." As Barron suggests, "It is important to keep in mind that skin is [mutable], always changing in response to what is occurring both internally and externally. Get to know your skin and how it functions at varying points of the day, season, whatever, and choose [a method] accordingly."

For dry skin with little or no sensitivity:

1. A cream-based, water-rinsable scrub.

2. A cream or lotion-based AHA product that features glycolic and/or lactic acid (both are good water-binding agents, as well as exfoliants.)

For normal or combination skin:

1. A water-based rinsable scrub.

2. An AHA or BHA lotion used once per day.

3. A fruit acid or glycolic peel used no more than once per week.

For oily and blemish-prone skin:

1. A slightly abrasive, gel-based scrub.

2. A BHA gel with or without azaleic acid (not to be used in conjunction with any prescription acne drugs or OTC acne medications).

For "thin," sensitive skin:

1. Use a soft washcloth with a milky cleanser only when necessary.

2. Use a paste of baking soda or oatmeal -- both are gentle and have anti-inflammatory properties.

3. Those with extremely sensitive skin should avoid fruit peels and any acids, be they synthetic or natural. They are too irritating for this type of skin and tend to create more problems than they solve.

REFERENCES

Personal interviews with Bryan Barron and Shelley Marlene Hess.

Draelos, Zoe, M.D. "Hydroxy Acid Update" Cosmetic Dermatology, 1998.

Kempers, S., et al. "An evaluation of the effect of an alpha hydroxy acid-blend skin cream in the cosmetic improvement of symptoms of moderate to severe xerosis, epidermolytic hyperkeratosis and ichthyosis," Cutis 61 (5):347-50, January 1998.

Moy, L.S., et al. "Glycolic acid modulation of collagen production in human skin fibtroblast cultures in vitro," Dermatological Surgery 22(5): 439-41, May 1996.

Piscopo, Nicole. "Hydroxy acids: If alphas are good, are betas better?" Cox News Service, The Standard Times, 1997.

Slavin, J.W. "Considerations in alpha hydroxy acid peels," Clinics in Plastic Surgery 25(1):45-52, January 1998.

Thibault, P.K., et al. "A double-blind randomized clinical trial on the effectiveness of a daily glycolic acid 5% formulation in the treatment of photoaging," Dermatological Surgery 24(5):573-7, May 1998.

Karyn SiegeI-Maier is a freelance writer who specializes in herbs, alternative medicine, and new age issues. Karyn is a frequent contributor to national and regional magazines, newsletters, newspapers, and other publications. She is currently working on a series of herbal books.

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