Aging, Acne, and the Armamentarium: Hot Topics From the Science of Skincare Summit

“I’m not a cosmetic dermatologist, but patients ask me all the time what they should be using. They come in with little pieces of paper, things that they’ve ripped out of magazines. ‘Is this good?’ ‘Is that good?’ and I don’t always know what to say. This conference allows me to learn more about these individual active ingredients,” said Hilary E. Baldwin, MD, about the Science of Skincare Summit 2023 held in Austin, Texas. The scientific rigor of the meeting in discussing over the counter treatment options was especially helpful, noted Baldwin, who added, “I think it’s very important for us all to be on the same page and be making sound scientific recommendations.”

In addition to Baldwin’s insights, Dermatology Times Expert Perspectives custom video series also features insights from Cheri N. Frey, MD; Adelaide A. Hebert, MD, FAAD; Kavita Mariwalla, MD, FAAD; Darrell S. Rigel, MD, MS; and Saranya P. Wyles, MD, PhD.

Acne Care and Innovations

“I think the future of skin care and care in general for our acne patients is very bright,” Baldwin said. “On the pharmaceutical side, we have new combination therapies. We have our first new triple combination therapy. We have even better formulations coming down the pipe, where we recognize that many of our acne medications can be quite irritating and that irritating medications don’t get used.”

Baldwin is optimistic about the future of acne care: probiotics, prebiotics, and postbiotics and their potential to manage acne using more natural means. Some companies, she said, are attempting to manufacture a subtype of Cutibacteriumacnes (formerly known as Propionibacterium acnes).

“It would be a very natural approach, which would not be using antibiotics,” Baldwin said. “We wouldn’t have to worry about antibiotic resistance, and I think it’s a possibility that we might be going there or in the future, or even [using] bacteriophages to kill the C acnes, as opposed to using an antibiotic to do that.”

Hebert echoed interest in recent acne research and innovations.

“We know in our skin of color patients, they tend to have postinflammatory hyperpigmentation as their acne lesions resolve, and we’ve learned that they have more inflammation within their acne lesions, and that results in the increased pigmentation, which persists considerably longer than their acne lesions,” Hebert said.

Herbert also commented on C acnes. She is excited to learn more about its role in the driving inflammatory components of acne.

Acne appears to be developing in patients at a younger age, added Hebert, who is also a pediatric dermatologist. This may be due to estrogens in the food chain, among other causations, she said.

“Fortunately, some of the new medications have been studied down to age 9,” Hebert said. “We are having an expanded understanding of acne in the younger age group, but we’re also developing therapies in that part of the age spectrum that can be beneficial to our patients.”

The Future of Skin Aging

Wyles was intrigued to see new hallmarks of aging emerge. DNA damage, oxidative stress, reactive oxygen species, and mitochondrial dysfunction contribute to skin aging.

“If we look at an active retinaldehyde, they can affect that skin turnover and break apart those factors that are contributing to senescence and modify those,” Wyles said. “We’re still early in trying to understand how those are affecting it, but it’s a new way of looking at skin care from a novel mechanism.”

Both Wyles and Frey mentioned retinoids as cornerstones of the antiaging therapeutic armamentarium.

“We’ve been looking at new molecules,” Frey said. “How do we deliver efficacy in the way that retinoic acid or tretinoin can?... I think the science behind the new molecules that are coming out is really, really impressive.”

Frey thinks everyone could benefit from retinoids, especially folks who live in sunny climates or have a history of skin cancers. “We do have some evidence that retinoids help to prevent skin cancers and specifically those cellular changes that lead to pre-cancers and skin cancers,” Frey said. “It is probably a crime if a dermatologist doesn’t recommend a retinoid for those patients because the benefits go beyond just anti-aging. They go beyond the surface. We’re really talking about making an impact and preventing skin cancer in those patients.”

Mariwalla described “pre-aging” as a new hot topic in dermatology. “You can’t prevent [aging] from occurring, but what you can do is modulate it,” Mariwalla said. “You can modulate your experience of it. You can modulate how your skin responds to it, and what we’re learning now is that aging isn’t just something that’s chronologic.”

Ultraviolet Exposure and Risk

Rigel discussed the direct relationship between ultraviolet exposure and aging, noting that a lack of sun protection contributes significantly to the risk of skin cancer and accelerates the skin aging process. Fortunately, he noted that advances have been made in the field, especially for skin of color.

Previously patients complained about the sheen and how sun protection, Rigel said. “The good news is that there are new products out there that really get rid of that problem... you can use it in a way to really make your skin protected and still look great,” he explained. “That’s basically what I say to them , and the fact is that they do adopt them. Most of my darker skinned patients really enjoyed having the tinted sunscreens to have the protection and still look great.”

Concluding Thoughts

All 6 experts were excited by the science and the advancement in the field, and appreciated the opportunity to come together to share and discuss research and practical implications. As Mariwalla said, “One of the things that’s great about the Science of Skin Care Summit is that you get to see what’s on the horizon.”