Does anti-ageing skincare actually work?

Tegan Taylor: Norman, are you a skincare girly?

Norman Swan: Well, I do look at my skin from time to time, but I don't slather myself every morning or night.

Tegan Taylor: Really?

Norman Swan: Yeah, I don't look like a ghost with a mask on when I go to bed.

Tegan Taylor: Well, then to what do we owe the juiciness of your complexion at your advanced age of…51?

Norman Swan: Yeah, something like that. Well, my standard response to that, I say that I get some Viagra, I liquidise it, turn it into cream and rub it on my face because it keeps my skin erect.

Tegan Taylor: I regret asking this question.

Norman Swan: But that's not true, that's not what I do. Well, you did ask, I am just giving you my standard response.

Tegan Taylor: I just can't get erect skin out of my head.

Norman Swan: But the bottom line is, in terms of anti-ageing, my skincare is slathering on sunscreen.

Tegan Taylor: You know what? Me too. Like, I definitely spend more than you do on skincare products. But the one that I have noticed made the biggest difference was when I found a 50-plus sunscreen that I liked and I started wearing it every damn day. That's the biggest change I've noticed in my skin.

Norman Swan: Yeah, but you know, I did wonder about all these ageing compounds. So Shelby, you know, the What's That Rash? producer, and I went down to some very famous cosmetic shops and had a look around. And it's just amazing.

[shop audio] I just want something that's going to make me look younger, plumper skin. No. So this is fill and repair. The whole of the back is their ingredients, and most of it's water. How much is that? Oh, that's 120 bucks. Right.

Tegan Taylor: And I think you got kicked out of the shop.

Norman Swan: Yeah, we did.

Tegan Taylor: So that video is going to be on our Instagram @ABChealth, which is also where you can ask us your question.

Norman Swan: It will be. But there's a lot of products on the shelf that are anti-ageing. And in fact, that's what this What's That Rash? is about.

Tegan Taylor: Indeed. You are physician and journalist Dr Norman Swan, on Gadigal land.

Norman Swan: And you are Tegan Taylor, health reporter extraordinaire, and you're on Jagera and Turrbal land.

Tegan Taylor: And today's question is from Yazz.

Yazz: Hi, Tegan. Hi, Norman. Okay, can we talk skincare, because I have so much of it, vitamin C creams and eye creams and retinols and BHAs and AHAs, and I don't really know what most of it is or what it does, or even if it works. Is it worth me having all this skincare? Or should I just stick with sunscreen and save my money? Thanks.

Tegan Taylor: Yeah, I mean, I didn't submit this question, Yazz did, but it's one that I've asked myself as well before, Norman. But I guess probably the place to start here is, why does our skin age at all? Why do we look different as we age?

Norman Swan: Two reasons. One is the inherent ageing of our body. And that actually varies according to our genes and our ethnicity, and I'll come back to that in a minute. And the other is that we go out in the sun and our skin gets really damaged. And depending on the nature of your skin, and again your ethnicity and genetics, people respond more or less to the ageing effect of the sun. So let's start off with the ageing effect of the sun because that really dominates in Australia. The UVB tends to burn you but the UVA goes really deep. And you get things like actinic keratosis, where the skin gets damaged and dry and itchy, and it's a precancerous condition. You get thinning of the skin. So even more than natural ageing, you get blotchiness, you get pigmentation of the skin, and you get wrinkles, and you get quite deep wrinkles as a result of photo ageing. So the sun is really quite toxic to your skin. And how can you tell whether or not what you've got is maybe natural ageing versus the sun? You look at a part of your body which doesn't get the sun. So one part of your body that doesn't get the sun is your inner arm, unless you put your hands behind your head when you're sunbaking, your inner arm, and the other is your buttocks.

Tegan Taylor: Quite literally where the sun don't shine.

Norman Swan: Well, it didn't shine until recently, but if you've been to the beach these holidays, you'll notice that there are young women out there with these new bikinis on…

Tegan Taylor: I think they've been very popular in Brazil for a very long time.

Norman Swan: They have. But I don't think the dermatologists can go to the buttocks anymore to assess your ageing skin versus the place where the sun don't shine.

Tegan Taylor: But you're right, one of the research papers that I did look at for this, I did notice that they were using the butt. And is that because you can measure the effects on a particular individual's body by kind of using their butt as a control, because it's not getting the photo ageing, and then their face presumably is the other place that they would look.

Norman Swan: That's right. But it's hard to find wrinkles in the bum, there's more dimples than wrinkles.

Tegan Taylor: Aren't they sort of comparing cheek and cheek?

Norman Swan: Oh very good, very good, yes, I wish I'd thought of that one. So then there's natural ageing, which is partly genetic, and they work together, obviously, the sun and natural ageing. But for example, there is some research suggesting that, for example, if you're Chinese ethnicity, you tend to have wrinkles around the eyes, and you wrinkle less, and you probably wrinkle about ten years later than somebody who is Anglo. So a Chinese person's face is more preserved. But also, there's a tradition in China of hiding the face from the sun. So people are quite protective of the sun in many Asian countries. So that gets a bit confused there as to what is genetics and what is not. But essentially, with ageing, the collagen doesn't get produced as well. You get thinning of the skin, you get blood vessels showing, and your wrinkles are a bit finer than the wrinkles from sun ageing, but it can be very hard to tell the two apart.

Tegan Taylor: So, obviously…well, I'm guessing, obviously to avoid as much sun ageing as possible, what you're looking for is a broad-spectrum sunscreen, something that protects you against those UVA and UVB lights. But you did mention there collagen, and that's making me think of all the different ingredients that I have seen on the sides of various skincare products over the years. Which of the ingredients are we looking for, if we're looking to make any difference to reverse the signs of ageing? Because I'm guessing that the sunscreen kind of only protects you against future ageing.

Norman Swan: Yes. You'd have to say, before we start, when testing is done on skin creams, on cosmetic creams and anti-ageing creams, it's not done…at least when they're not prescription, when they're just over the counter, it's not done it for effectiveness, it's just on are they safe. So you cannot rely on a lot of the evidence here. But in essence, the substances that seem to work are vitamin A, and vitamin A has various forms, but it's retinol. And there are stronger forms of retinol called retinoic acid and isotretinoin acid. But essentially the common ones over the counter are retinol, and there is evidence that retinol can, to some extent, reverse the signs of ageing skin, and indeed sun damaged skin.

There's vitamin C, and there's interesting evidence on vitamin C as a strong antioxidant, at least certain concentrations. There's also a substance called hyaluronic acid. And this is really a plumper, or a lubricant in skin and joints. And hyaluronic acid sometimes can be used as an injection, but we're talking about over the counter, and you can find hyaluronic acid in creams and ointments and so on. And there is a little bit of evidence that it helps to plump up the subsurface of the skin. None of these things are permanent. None of these things change your aged skin forever. But they do make a little bit of difference according to the best evidence we could find.

Tegan Taylor: I have a question about hyaluronic acid, because I had always seen it in skincare commercials and on sides of skincare bottles. But you mentioned to me an application for it that I had never heard of before.

Norman Swan: Yeah, for sore knees when you've got osteoarthritis of the knee, your surfaces are worn away, and you've probably got less lubrication from cartilage in your knee. And there are some products on the market which have hyaluronic acid in it, and they can help. There's one in particular can cause quite bad allergies in the knee. So you've got to be careful of these and take advice, and they're not that cheap. But yeah, you can get some temporary relief on your knee, and whether or not your knee's been in the sun has nothing to do with it.

Tegan Taylor: You don't have a younger looking knee on one side.

Norman Swan: No, it feels younger though.

Tegan Taylor: So what about more intense treatments? I hear about acid peels, I hear about AHAs and BHAs, which I think stands for alpha and beta hydroxy acid. Do they help?

Norman Swan: Look, the acids can help, peels can help just in terms of your appearance, but as anybody will tell you, after a peel eventually it goes back to where it was before. And again, you've just got to watch these products because there's all sorts of other stuff in them which might cause an allergy. You might get a response to them. One of the products I was looking at the other day in the shop, the ingredients filled one side of the carton and they were in German. So I have no idea what was happening there. But that just gives you an idea, so you'll see somewhere in there is hyaluronic acid, somewhere in there is retinol, somewhere in there there might be these acids, but in amongst everything else. And they're trying to compete on…really, I suspect they're competing on how fancy and convincing they can make the product.

Tegan Taylor: So you're saying that there's evidence for vitamin A, there's evidence for vitamin C, but what kind of…?

Norman Swan: So vitamin C as a topical…in an ointment or a cream.

Tegan Taylor: But those sorts of studies that show that evidence, are they over-the-counter skincare products? Or are they that thing applied directly to the skin? Like, if I'm buying a cream that has it as an ingredient, is it going to give the same result as the people saw in that study?

Norman Swan: Well, there's no standardisation on like drugs. So it's different for some of the prescription medications in this area. And some of the injectables, they are much more regulated because they are prescription. But these, there's all sorts of other stuff in it which could be interacting, and you've no guarantee that the hyaluronic acid in one product is going to have the same effect as hyaluronic acid in another, even if the concentration looks the same, because there's all this other stuff around, and all the other stuff around could affect the absorption of it.

Tegan Taylor: Okay, so to Yazz's question, what's worth the money? Or if you're going to spend the money, what should you be looking for if you actually want to get these anti-ageing effects?

Norman Swan: Well, you've got to think about your age, because what I didn't tell you was that when I went into one of the shops, which is a very famous cosmetic shop, there were young girls in there, and when I say 'young girls', I'm talking about 13, they looked as if they were 13 or 14 years old.

Tegan Taylor: Oh my gosh, yes. So my young girls, I have a couple who live in my house, and they're not into skincare, but some of their peers really are and are using products that are from brands that I would consider massive splurges for myself as a professional person, certainly not something you'd be buying with 11- or 12-year-old pocket money.

Norman Swan: And they're buying products that are supposedly anti-ageing. And you've got no idea what some of these products are going to be doing for a child's normal skin, and that's a worry.

Tegan Taylor: So it's not like they can freeze their gorgeous 12-year-old skin in time and just stay looking like that forever.

Norman Swan: No. And to the credit of the shop, you had assistants saying to these girls, 'You don't need these.' You know, they would just go on online. So there's obviously something going on amongst kids. So look, the bottom line here is, if you really want to have an effect here, prevention through sunscreen, you don't want it to be any worse than it is, so slathering that on, hats, covering your body. And then look for products that are as simple as they can be, with retinol, vitamin C, hyaluronic acid. There is a little bit of evidence, but it's prescription drugs, that oestradiol, an oestrogen cream, can make a difference for postmenopausal skin ageing, but that's a prescription product, not over-the-counter. So just be sensible, go for simplicity. And if it's not working, chuck it out.

Tegan Taylor: And Norman, on the thing about sun protection and staying out of the direct sun, if people are interested in knowing more about that, we did do a previous episode of What's That Rash? about is there such a thing as too much sun protection. So if you want to listen to that, just scroll back up to the feed, it came out on the 3rd of January. So that's very much about the external forms of ageing that we mentioned before, sun protection, and then these sorts of products, chosen wisely, could make a difference to maybe reverse some of those signs a little bit. Is there anything we can do for the internal ageing that you talked about before?

Norman Swan: Well, you stay young by doing the stuff that we know about which is exercise, keeping your immune system's level of inflammation as low as possible, and that's through diet, getting your microbiome in good shape through probiotic means, which is about the Mediterranean diet and so on, not smoking. Smoking does stuff up your skin and increases the oxidation of the skin underneath the layers of the skin, so smoking will speed that up. And if smoking does it, it's quite likely that small particulate air pollution does it as well. So there's things like that which affect direct environmental damage, and speeds up ageing.

Tegan Taylor: So what I'm hearing is if you're in the age bracket where maybe some of those signs of ageing are starting, there is some evidence for some of the ingredients in these things, but proceed with caution because the evidence base is a little thin.

Norman Swan: And if you want a comparator, keep your buttocks covered.

Tegan Taylor: That's right, that's what your skin should have looked like all along. Thank you so much Yazz for the question and thank you for everyone else who has been sending their questions in. Scott actually wrote in also asking about skincare, about moisturiser, and said, 'I think the closest I've come to moisturiser is when I spilled oil on my chin during a meal.'

Norman Swan: Yeah, I'm sure lots of blokes would say the same thing. Although, you know, they do say that skincare for men is a huge industry, although it's just a quiet one.

Tegan Taylor: Most of the men I know just grow beards to cover it up,

Norman Swan: We'll no doubt cover questions on moisturisers in a future What's That Rash?.

Tegan Taylor: But I want to know what your skincare routine is, folks. So DM us @ABChealth on Instagram or email us, thatrash@abc.net.au.

Norman Swan: And if you haven't already, why don't you subscribe to What's That Rash?? And you can do that wherever you get your podcasts.

Tegan Taylor: Yep, smash that follow button so you never miss an episode, because why would you want to? We're so charming and engaging, Norman.

Norman Swan: And we'll have another question for you answered next week.

Tegan Taylor: See you then.