Today's best skin care and wrinkle-removing formula comes from prison inmates' athlete's foot treatment

As we age, wrinkles appear. Thousands of years ago, ancient people came up with various methods to protect their skin and remove wrinkles. Today, scientists have discovered many substances that can really improve the condition of the skin, especially vitamin A. There are also various physical therapies on the market, such as lasers and microneedles. Are these therapies reliable? What should we do to maintain a beautiful face? First, let's start by understanding why the skin wrinkles.

Written by Jon Anders Halvorson

Translation | Zhang Yao

When the facial muscles are relaxed, the forehead, eye area and even the entire face of a young person are smooth and wrinkle-free, but when the muscles start to work, lines and wrinkles appear. The elasticity of the skin allows it to be stretched again and again and then return to its original position.

Examples of how the skin moves with us can be found all over the body. For example, when you bend your knees, the skin stretches. The upper layers of the skin fold in at the same time as the deeper layers, and the skin follows the body's various movements in this way. When a woman is pregnant, the skin on her abdomen stretches dramatically. If she doesn't develop stretch marks during pregnancy, then a few months after the birth of the newborn, the skin on her abdomen will look normal. When we breathe, our chest expands a little and our abdomen tightens a little. The skin is elastic.

Skin is an extremely elastic organ. Imagine being able to be suspended by a giant fishhook that penetrates the skin on your back! It would be very difficult to find another material as tough as skin. Only when humans learned to make rubber did we have an object with elasticity comparable to that of skin.

Wrinkles appear when the elasticity of the skin decreases. Many people are annoyed by the aging of their skin, while some people keep their skin in good condition. With the growing demand for wrinkle reduction, manufacturers of face creams face a huge market, and the biggest question is whether wrinkle-reducing products are really effective. Skier Therese Jorg [1] used a lip cream to show us the ability of the skin to absorb drugs, and even low concentrations of active ingredients in drugs can quickly appear in the blood. So what we put on the skin can penetrate deep into the skin and also have an impact on the internal environment of the body.

[1] Therese Jorg is a famous Norwegian skier who has won many gold medals in major competitions. In August 2016, during a training camp in Italy, her lips reacted to ultraviolet rays and she received a lip cream containing chlortestosterone from the Norwegian national team doctor for treatment. After a drug test found that her blood contained the banned substance, she was banned for 18 months and missed the 2018 Pyeongchang Winter Olympics. -Translator's note

In addition to applying anti-wrinkle creams, there are many other treatments available, such as laser wrinkle removal, skin tightening, and injecting certain anti-wrinkle substances into the skin.

At this point, many questions come to mind:

Is this a scam? How is it done? Do these methods really work? Are there any dangers in doing this?

Strength and elasticity

The dermis provides strength and elasticity to the skin. It is located beneath the epidermis and contains a large amount of fibrous protein, the two most important of which are elastic fibers and collagen.

Figure 1 The dermis is the middle layer of the skin. Image source: Cleveland Clinic

Elastic fibers can be stretched or elongated 100 percent and then return to their original shape. In contrast, people with cutis laxa have almost no elasticity in their skin. This rare condition can make people look decades older than they actually are. Some teenagers with this condition undergo skin lifts because their skin is so loose.

Collagen is a long, filamentous protein that plays a supporting role in most organs. It is found in cartilage, bones, ligaments, tendons and skin. Collagen is very strong and can stretch like elastic fibers. People with Ehlers-Danlos syndrome are born with defective collagen in their bodies. These patients can pull their skin up 10 to 15 centimeters from the surface of their bodies. Some of them can even pull the skin on their neck up and completely cover their chin.

Aging and wrinkles

Wrinkles start to appear on the skin when the elasticity of the dermis decreases. The production of elastic fibers and collagen in the skin also gradually decreases, especially after the age of 40.

Wrinkles are caused by genetic factors and aging, but smoking and sun exposure can also reduce the elasticity of the skin. Long-wave ultraviolet rays from the sun, also known as UV-A rays, are the main cause of wrinkles. They are abundant in solariums, can easily penetrate glass, and are present in sunlight at any time of the year. The sun's short-wave rays, UV-B rays, cannot penetrate deep into the skin, so they do not have as much of an effect on wrinkle formation. Large amounts of UV-A rays alone are enough to give us wrinkles. We can see this in people who work as trailer drivers, who have one side of their face exposed to the sun all year round.

Figure 2 UV-A rays are the main cause of wrinkles. Image source: mondoscience.com

UV rays can react with several substances in the skin and damage it, especially the genetic material in the skin cells. The sun's rays can also disrupt the energy metabolism in the cells, so much so that we eventually lose the elastic fibers in the skin.

Although all people experience some degree of sun damage to their skin, the type of damage varies depending on the pigmentation of each person. People with very light skin, such as Celts or Scandinavians, have thinner skin and are at a higher risk of skin cancer. Their wrinkles are smaller and more superficial. On the other hand, people with slightly darker skin, such as those living in Mediterranean countries, have thicker, firmer skin, which results in deeper wrinkles. While wrinkles on European faces are mainly around the eyes, forehead and lips, darker skin, such as Asians and Africans, are more concentrated in the middle of the face, with typical wrinkles on the nasolabial folds that run down the sides of the nose to the corners of the mouth. In addition to wrinkles, sun-damaged skin also develops uneven pigmentation from small blood vessels in the superficial skin, which can cause the skin to become dry, dull and less translucent.

Ageing, especially wrinkle formation, occurs later in people with darker skin. Africans and Asians rarely have wrinkles before the age of 50. There is evidence that French women develop wrinkles 10 years earlier than Chinese women. The fact that darker skin has fewer wrinkles points to the importance of UV rays. However, it is not just the difference in pigmentation between different populations that can affect wrinkles. Africans have a thicker epidermis and a closer connection with the dermis. As for the skin itself, it is also related to the important substance collagen.

Does wrinkled skin mean that a person is old?

Since wrinkles are a sign of aging, when people see a person with many wrinkles, do they naturally assume that other parts of his body are also aging or suffering from diseases? When we see elderly people who are in good condition, we sometimes can't help but have this thought, and we feel that these elderly people look like they can live for a long time.

In Denmark, researchers investigated whether external signs of aging are linked to early death. After tracking 20,000 participants for 16 years, they found no correlation between having many wrinkles and early death. However, they also found that people who did not have gray hair lived longer than those whose hair turned gray.

Likewise, there was no correlation between the extent of wrinkles and heart disease. On the other hand, other signs of aging revealed some factors associated with heart disease risk, especially when they occurred together. These were fine dandruff, yellowish fat deposits around the eyes, also known as xanthelasmas, and diagonal folds on the earlobes. For this last phenomenon, we don't have a good explanation yet.

Treatment for new and old wrinkles

We have always been eager to improve and change our skin. Many of us do not reject aging, but just hope that the aging speed of our skin can be slower.

Ancient Egyptians used oils, salts, and soft white alabaster to treat their skin, and they used sour milk to make it shiny and firm. Cleopatra is known to have bathed and treated her skin with goat and donkey milk. Ancient Egyptians also used sandpaper to smooth the surface of their skin to make it softer. Ancient Greeks and Romans are said to have used mustard, incense, and resin packs to remove wrinkles and freckles. Turks used heat to gently burn the skin to improve its texture. Indian women used a mixture of urine and pumice stone to treat their skin. In many ways, these skin care methods are the same as the wrinkle treatments we use today.

Take urine, for example. Urine contains urea, a substance found in many moisturizers and cosmetics. It is also called carbamide. Urea binds to the skin and absorbs moisture from the air. Moisturizers containing urea are good for the skin because they make it smoother and less dry. Creams with high concentrations of urea have the primary function of exfoliating, or removing the outermost layer of the skin. It is also helpful when the skin is thickened due to psoriasis or eczema.

Ancient Egyptians used milk to care for their skin. The benefits of this method of skin care come from the lactic acid in milk, which is considered a type of alpha hydroxy acid. This acid stimulates the formation of new skin cells. Because alpha hydroxy acids are very small, they penetrate deeply into the skin and promote collagen production. Creams containing alpha hydroxy acids are also used to treat acne, rosacea, dryness, and sun-damaged skin.

Creams containing vitamin C can slightly slow the appearance of wrinkles and other skin changes that come with aging by somewhat slowing down the damage done to skin cells by ultraviolet rays. Vitamin C is necessary for the production of collagen in the skin and acts as a weak sunscreen.

Alpha-lipoic acid (ALA) is another ingredient commonly found in face creams that has proven benefits for improving skin. Lipoic acid is an antioxidant, so it can limit UV damage to the skin. Aging skin is prone to inflammation, and lipoic acid can slow or even reverse these symptoms. In a study involving 34 female subjects, the subjects applied a regular cream on one side of their face and a cream containing lipoic acid on the other side for 12 consecutive weeks. The researchers then combined before-and-after photos with the subjects' own evaluations to make judgments on the effectiveness of lipoic acid.

However, the most effective and proven anti-aging products are those containing vitamin A, such as tretinoin. These are the most important ingredients in today's anti-wrinkle creams. If you are only going to use one anti-wrinkle cream, you should choose one that contains a retinoid active ingredient.

Vitamin A: Anti-wrinkle weapon

Substances similar to vitamin A are called retinoids. Retinoids, or retinoic acid, are a word that comes from the word retina, which is the part of the eye that senses light. If the human body lacks vitamin A, our night vision will deteriorate.

As mentioned before, a lack of vitamin A can cause thickening of the skin. This led to the development of a vitamin A variant called retinoic acid. Retinoic acid is used to treat thickening of the skin in a variety of different conditions. Its side effects include irritation, mild redness, and peeling of the skin.

Albert M. Kligman, a Philadelphia researcher and dermatologist, showed great interest in retinoic acid. He realized that creams containing this substance could increase the division activity of skin cells, which would counteract the formation of blackheads. He believed that retinoic acid would have a relieving effect on acne, because acne usually develops from blackheads. However, creams made from retinoic acid are very irritating to the skin.

How to solve this problem?

Kligman was originally most interested in the study of fungal infections. In the 1950s, there was an epidemic of athlete's foot among prisoners in Holmesburg Prison, which was very close to Philadelphia. The prison contacted Kligman, a dermatologist, and he immediately saw the possibility of conducting skin research among prisoners. When he saw all the prisoners there, he claimed: "What I saw was acres of skin, just like a farmer seeing a fertile field for the first time!"

Figure 3 Retinoic acid can improve skin elasticity. Image source: Guido Mieth/Getty Images

From 1951 to 1973, he conducted many drug experiments in the prison, and these studies have been criticized as lacking ethics. During this period, Kligman admitted that the prisoners who participated in the experiments were compensated accordingly, but he used the prisoners as guinea pigs to test the efficacy of different concentrations of retinoic acid on them. Afterwards, one prisoner said that his skin had a lot of peeling and painful wounds during the experiment.

It wasn't until 1967 that Kligman finally found the optimal concentration for acne treatment, and he launched Retinoic A cream in 1971. Soon, some elderly patients who used the cream reported that their skin became smoother and had fewer wrinkles. The first patient study to demonstrate the cream's effectiveness in reducing facial wrinkles was published in 1986.

Using tretinoin for a few months can reduce wrinkles, smooth skin, and even reduce pigmentation. It can also brighten the skin, fight acne, rejuvenate the skin, and help reduce changes in skin cells. The substance tretinoin acts on the division of skin cells and the substances they produce, and also has an impact on the dermis, which is located deeper in the skin - more collagen and hyaluronic acid are produced, which can significantly improve the elasticity of the skin.

So far, several medical studies have been conducted to prove the efficacy of retinoic acid. Retinoic acid should be administered at a concentration greater than 0.02%. In a two-year study, three-quarters of patients who used a 0.05% retinoic acid cream daily reported improvements in fine lines, and half reported improvements in large wrinkles. Retinoic acid is effective for wrinkles, but it is not a miracle drug, and users may need to use it for a longer period of time to see results.

Retinoids may cause mild irritation to the skin and cause redness, so you need to be careful when you start using them. Another option is to start with a low-concentration cream and gradually increase the concentration. Each person needs to use this cream according to their actual situation, and you may need to wait a few months before you can reap the expected results of improving wrinkles.

There are several other types of retinoids, some available as prescription drugs, such as tretinoin and adapalene, and others that are considered skin care products, such as "retinol," "retinyl palmitate," "retinyl acetate," and "retinal." In theory, all of these substances have the same effect on the skin, reducing wrinkles and improving the appearance of UV damage.

To summarize, creams containing sunscreen and vitamin A are the most effective products for removing wrinkles so far. But is it possible that creams that have not been scientifically studied have the same or even stronger wrinkle-removing effect? ​​There are many ingredients and creams on the market for anti-wrinkle, and some cosmetic companies may have studied their products but choose not to publish relevant information. Perhaps they are afraid that such studies will yield bad results? Perhaps they want to keep their business secrets? Or perhaps their creams are so profitable that there is no need for scientific research?

Anti-wrinkle products have huge market potential, but expensive creams are not always better than cheaper ones.

Surface care of the skin

Thousands of years ago, the ancient Egyptians used sandpaper to smooth out wrinkles on their skin, and in fact, this method is still used today. Other similar methods used to remove wrinkles on the surface of the skin include peeling, laser and acupuncture.

Peeling involves chemically removing the outermost layer of skin. This method has been used for over 100 years to encourage the production of new skin cells and more connective tissue at a deeper level. Many different caustic chemicals are used to peel the outermost layer of skin, and the experience can be painful. Sometimes a topical numbing medication is applied to the patient's face first, but other times it is necessary to anesthetize the patient because the treatment is deeper into the skin. Gentle, less effective superficial peels can be done at home.

Laser wrinkle treatment using CO2 lasers began in the 1980s. Soon after, a confusing laser treatment called the yttrium aluminum garnet (YAG) laser appeared. This laser is used in surgery because it disperses itself through the skin layers. This ensures that the top layer of the skin is treated first, and then the layers are worked down. This sounds normal, but other types of lasers don't work this way. For example, a laser used to remove birthmarks will only target blood vessels in the deeper layers, leaving the surface of the skin mostly untouched.

With CO2 lasers, the principle is to burn away the outermost layer of skin by heating the water on the skin, a bit like a peel. This heating may cause the dermis to tighten, and this treatment may also increase the pigmentation in the skin.

Fractional laser therapy was introduced in the early 21st century. This laser ensures that only fixed points are treated, i.e. small areas of skin are treated, while the skin between the laser points is not affected. Therefore, these microscopic vertical beams of light can reach deeper into the skin than the original laser therapy. The typical specifications of such beams are 0.4 mm in diameter and about 1.3 mm in depth. New connective tissue forms in the areas of skin treated by these small beams, turning into tiny scars that pull the skin together. In short, fractional laser therapy will cause the dermis of the skin to thicken and tighten.

Fractional laser is considered one of the most effective treatments for superficial wrinkles, but it usually takes several sessions to see results. In a study of 30 people, almost all participants said their facial wrinkles improved by at least 50%, with the best results mainly in the removal of fine lines on the cheeks and around the eyes.

Figure 4 Fractional laser is considered one of the most effective treatments for superficial wrinkles, but this treatment usually requires several sessions to see results. Image source: int.eucerin.com

Acupuncture, also known as microneedling, causes tiny lesions to the skin. Think of it as a variation on fractional laser therapy. This form of treatment became more common in the mid-1990s. Needles a few millimeters long are inserted vertically into the skin, and these punctures promote collagen formation and increase skin elasticity. There are several different devices that can deliver this treatment, some of which are sharp-tipped bundles of needles that pass through the skin, each of which is tightly fixed together. After the treatment, the skin is left with a series of small, independent lesions, which activate the skin's own repair processes. Because the skin itself does not heat up, there is little risk of the treated skin developing more pigmentation. In general, acupuncture is considered less effective, but it is safer than peels and lasers, and numbing creams can be applied during the treatment to relieve pain. Generally, acupuncture for wrinkles also requires several treatments, with each treatment spaced a few weeks or months apart.

Figure 5 Laser, acupuncture, and peeling therapy all cause small injuries to the outermost layers of the epidermis and dermis.

Which treatment should I choose?

In addition to the above treatments, there are also "vampire therapy", anti-wrinkle heat therapy, facial fillers, Botox injections, etc. So, how should people deal with skin aging and wrinkle formation? In my opinion, we must do the following.

1. You need to get used to the fact that your skin will wrinkle and age.

2. You must quit smoking and take good sun protection measures.

3. You can spend some time, effort and money on anti-wrinkle creams and treatments that prevent and slow the growth of wrinkles on your skin.

4. Don't over-care for your skin, otherwise you are likely to get worse results.

As you can see, there are many different treatments available, and all you need to do is decide if you really want to treat your skin. Your motivation for seeking treatment may be to improve your appearance or to prevent skin diseases associated with aging.

Sunscreen can prevent both wrinkles and skin cancer. Both peels and minimally invasive lasers that act on the surface of the skin can eliminate skin cancer precursors. Studies have shown that patients who receive minimally invasive laser treatments that cause superficial wounds and bleeding have significantly fewer skin cancer precursors in their bodies in the years after receiving them.

If you're planning on getting a cosmetic treatment, you should think about what you want to achieve. For example, do you want to address wrinkles or uneven skin tone? Do you want to see a therapist or do it yourself? Can you maintain a skincare routine? How much do you want to spend on this type of treatment? There's a lot more to consider.

Perhaps the most important thing is to find a professional and experienced therapist who can handle all complications.

About the Author

Jon Anders Halvorsen (1968-), a Norwegian dermatologist and doctor of medicine from the University of Oslo. He specializes in skin diseases and has extensive medical experience. He has worked in many well-known hospitals such as St. Mary's Hospital in London and Oslo University Hospital in Norway. In addition, he has another identity - a folk singer. He won the Best Singer Award at the Local Music Festival in 2002, has collaborated with many musicians, and released a personal album, for which he was nominated for a music award.

This article is authorized to be excerpted from Chapter 6 "Adulthood - The First Appearance of Wrinkles" of "Skin Biography" (China Traditional Chinese Medicine Press, August 2022 edition), with some deletions and illustrations added by the editor (except Figure 5).

Special Tips

1. Go to the "Featured Column" at the bottom of the menu of the "Fanpu" WeChat public account to read a series of popular science articles on different topics.

2. Fanpu provides a function to search articles by month. Follow the official account and reply with the four-digit year + month, such as "1903", to get the article index for March 2019, and so on.

Copyright statement: Personal forwarding is welcome. Any form of media or organization is not allowed to reprint or excerpt without authorization. For reprint authorization, please contact the backstage of the "Fanpu" WeChat public account.