Seems like the term "alpha hydroxy acid" comes up whenever skin care is mentioned. AHAs have truly gone mainstream. Almost every skin care product boasts that it contains AHAs. Have you ever wondered what they are, what they actually do, if they are safe, how to use them safely or if they are right for you?

WHAT ARE AHAs?

Alpha hydroxy acid (AHA) is a blanket term for a variety of fruit acids such as Glycolic, Citric, Lactic, Malic and Tartaric. These acids, when used correctly, help to smooth the skin, enhance the effects of other skin rejuvenation treatments, keep problem skin under control, attract moisture to the skin, even texture and complexion of skin and reverse some of the effects of UV damage. They can be used to achieve these goals over a period of time or in quick sessions.

When included in a product at an effective concentration AHAs help disintegrate the "glue" that hold dead, dry skin cells to the surface of the skin. By doing so, the epidermis is exfoliated leaving a silky texture. Removal of this external barrier enables easier, deeper penetration of other skin treatments as well.

WHERE DO AHAs COME FROM?

Each acid is derived from a different source. While all AHAs share a similar molecular structure, their differences become relevant as to how each is used. Glycolic acid, for instance, is typically used for skin rejuvenation. Citric acid helps work as an antioxidant and promotes the production of collagen. These are a few of the most common AHAs used today:

• GLYCOLIC ACID

  Most people hear the term AHA and immediately think of glycolic acid. This is certainly the most commonly used member of the AHA family for skin rejuvenation. Glycolic acid comes from sugar cane and can also be made synthetically. Its small molecular size allows it to penetrate the skin more easily, which contributes to its effectiveness. Glycolic acid works in a number of ways, primarily through its exfoliation properties. Glycolic acid helps dissolve the "glue" that holds the skin cells together. This leads to exfoliation. In addition, glycolic acid helps reduce the surface skin oils and can help remove blackheads and other skin impurities as well as smooth out fine wrinkle lines. Other benefits of glycolic acid include it's moisturizing ability; the potential for it to help bleach unwanted skin discoloration; and its ability to help draw other skin treatments more deeply into the skin. Glycolic acid is also thought to help stimulate collagen production within the dermis to some degree. Glycolic acid is the base of the MD Formulations product line for skin care, acne therapy and skin rejuvenation.

• CITRIC ACID

  Citrus fruit serve as the source of this skin rejuvenating AHA. While Vitamin C tends to be considered a class of its own, it does technically belong in the AHA category. Citric Acid, or Vitamin C, acts as an antioxidant as well as helps stimulate collagen fiber production within the dermis. It also tends to have a weak activity helping bleach unwanted skin discoloration that often accompanies the aging skin process. Exfoliation is not its main function and realistically should not be considered an exfoliator. Vitamin C is used in Cellex-C and SkinCeuticals for its skin rejuvenation and antioxidant properties.

• LACTIC ACID

  Lactic acid comes from sour milk. An ideal skin softener, lactic acid is frequently used by dermatologists to cut through thick, rough skin. Lactic acid works both as an exfoliator as well as helps hold water within the skin. Dermatologists originally used it as a skin rejuvenation AHA until studies showed that glycolic acid gave superior results for this use. Lactic acid may be combined with other AHAs to help boost product effectiveness. Higher potency lactic acid products include AmLactin, Impruv Deep Moisturizing Lotion, as well as the prescription version (same strength), LacHydrin.

• MALIC ACID

  This is a fruit derived AHA usually made from unripe apples and green grapes. While it has no obvious benefits for skin treatments, it has been suggested it may help increase oxygen supply to the muscles for certain diseases such as fibromyalgia. Products that contain Malic Acid include DERMAdoctor Handy Manum Medicated Skin Repair Serum with 1% Hydrocortisone & Neova Balancing Toner.

• TARTARIC ACID

  This is actually a by-product of the fermentation process that takes place while making wine. Tartaric acid holds a unique position within the food industry, but has been showing up in several skin care products like Neova Radiant Skin Cleanser and Neova Skin Revealing Treatment.

AHA Combinations

While Malic and Tartaric Acids may not be widely as a main ingredient, there are many brands that use a combination of AHAs in their ingredients. MD Skincare incorporates multiple alpha hydroxy acids (glycolic, lactic, malic, tartaric) with beta hydroxy acid in their 2-step peel systems, MD Skincare Alpha Beta Daily Face Peel - 30 applications and MD Skincare Alpha Beta Daily Body Peel. The BetaPlex line from Cellex-C uses alpha and beta hydroxy acids such as lactic acid, citric acids, glycolic acid, malic acid and tartic acid. Cellex-C BetaPlex Complexion Collection is an amazing way to acquaint yourself with this line. DERMAdoctor KP Duty Dermatologist Body Scrub with Chemical + Physical Medi-Exfoliation incorporates both glycolic, lactic and azelaic acids to slough off the rough outer layer of the skin, revealing newer, youthful skin under the surface.

SAFETY FIRST?

AHAs are safe when used with caution and according to directions. The amount of AHA in the product and the pH are the determining factors of a product's strength and irritation you may experience. Don't forget this is an acid we are discussing-too much can cause a burn.

Medical strength AHAs start at a concentration of 8%. This is the baseline of where truly effective results will begin to be obvious. When using AHA-containing products purchased at the drug, grocery, or department store, the percentages are generally going to be negligible. The average AHA you may come across will be in the 3% range. If you are entering into a regimen that is more goal and rejuvenation based, there will be an option of strengths to choose from. It is important to start at the lowest strength and work up to the highest, slowly. Trust me, it is not a race to move up to the highest percentage of acid. Skin rejuvenation is a long-term commitment and if the skin is not acclimated to the product slowly, irritation will follow.

Many women take it for granted that the use of glycolic acid as a daily product or a chemical peel must result in noticeable redness, dryness and flaking. Some wear these signs like a badge of honor and are skeptical of any product that doesn't cause some suffering. This is not necessary now that buffered glycolic acid products are on the market. Buffering takes the acid and increases the pH without changing the percent concentration. This can result in a 14% buffered glycolic acid such as MD Formulations Continuous Renewal Complex being less irritating than the grocery store 3%. The buffering does not make it any less effective. Exfoliation takes place in a less visible manner. In fact, dermatologists may combine the use of these buffered glycolic acids to help boost a rejuvenation regimen that uses products notorious for causing flaking, such as Renova or Retinols and by alternating their use every other night, cuts down on the flaking, hydrates the skin and provides an additional active ingredient at the same time. MD Formulations lists the pH of each of their glycolic acid products, as well as the percentage of glycolic acid present in the products.

There has been a trend for some companies or physicians to offer extremely high concentrations of glycolic acid, 40% and up. Often this is being done on the internet. Some are promoting home peel kits. We have even received some calls from frantic consumers who have used such products and want to know what do do now that they are having serious side effects. These are products that can have significant side effects such as burning, temporary or permanent skin discoloration and even scarring. You cannot be too careful of what you are buying.

Exfoliation due to any product, including AHAs, causes the skin to be more susceptible to the elements and must be protected. Sun protection is always important. When you are using an exfoliating agent it becomes mandatory! DERMAdoctor Body Guard Exquisitely Light SPF 30 For Face & Body is an oil free sunscreen that provides complete, sheer broad-spectrum protection. You may also notice that your skin requires additional moisture. If this is the case, try using a cream based AHA (in case you're not) or you may apply a plain moisturizer over your AHA product such as MD Formulations Moisture Defense Antioxidant Comfort Creme for normal/dry skin types or MD Formulations Moisture Defense Antioxidant Hydrating Gel for combination/oily skin.

Not too long ago, an article appeared that scared a lot of people regarding AHAs. It was suggested that these products might cause cancer. However, within the article, the concerns were really about increased sun burn potential and side effects due to the caustic nature of the acid. There is no evidence of AHAs causing any type of cancer.

We receive a lot of inquiries about the use of AHAs during pregnancy. In general, AHAs are typically considered safe to use while pregnant or nursing. As always, it is a good idea to discuss your use of all products with your doctor during this special time.

ARE AHAs RIGHT FOR YOU?

If you feel that your skin is looking dull, lifeless or uneven, using an AHA product may benefit you. As the skin ages, it can lose that lustrous youthful glow. Using an AHA can quickly restore a fresh, healthy appearance. Look for something that is low to moderate in strength, such as MD Formulations starter level products and use a sunscreen daily. If you have a sensitive skin condition such as rosacea, you may find that AHAs are not appropriate for your skin as they may increase your redness and/or cause stinging. However, many rosacea patients actually have oily, tougher skin and can tolerate the use of these products. In that case, they can be beneficial for both oil reduction, pore cleansing as well as provide their rejuvenation benefits. If you are using any prescriptions that affect your skin or suffer a specific skin condition such as Rosacea, be sure to check with your prescribing physician.

AHA products are also great for softening rough elbows, knees, hands and feet. Apply products such as DERMAdoctor KP Duty Dermatologist Moisturizing Therapy For Dry Skin or AmLactin Moisturizing Body Cream to these areas once or twice a day.

AHAs can help to enhance other treatments such as lightening therapies as well. By ridding the skin of dead cells, the treatment product (such as an acne medication or bleaching agent)is able to reach the site where it is needed without unnecessary interference.

The next time you see a product that features alpha hydroxy acids, take a minute to ask yourself why you are using it and if it is of any benefit to you. I hope this gives you more confidence in choosing your next rejuvenation product.

Thank you for taking the time to read my newsletter. I hope you have found it informative.

Audrey Kunin, M.D.

(Any topic discussed in this article is not intended as medical advice. If you have a medical concern, please check with your doctor.)

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