PracticalDermatology

Integrated Skincare refers to the use of clinically proven topical skincare in combination with procedures. Skincare products can be used to ready or prime the skin for procedures, moisturize and protect the redeveloping barrier, reduce microbial growth, enhance wound healing, mitigate symptoms like burning and stinging, reduce complications such as hyperpigmentation and scarring, and optimize results.¹ In the past decade, studies have elucidated the synergy between topical skincare and procedures.

Studies of Note

Early studies demonstrate that non-ablative fractional lasers can be used to enhance delivery of skincare products through the stratum corneum, a practice now referred to as laser-assisted delivery. Using a non-ablative low energy 1927nm laser (Clear and Brilliant, Solta Medical) at 5%, 7.5% and 10%, treatment coverage, ex vivo skin was treated once followed by an antioxidant mixture containing vitamin C, E, and ferulic (CE Ferulic, Skinceuticals). Measurement of uptake using high performance liquid chromatography demonstrated a 17-fold increase of the antioxidant serum following the non-ablative laser treatment.²

In vivo studies were conducted on forearm skin and facial skin using the same laser and antioxidant serum. Forearm studies demonstrated the safety of utilizing the laser and antioxidant serum combination.³ The laser plus antioxidant serum-treated arm demonstrated a significant reduction in erythema following a single laser treatment compared to the arm treated with laser alone. Forty subjects then received a series of six facial non-ablative laser treatments over 12 weeks either alone or followed by CE ferulic.³

Histologic evaluation showed the combination treatment resulted in enhanced wound healing and expedited pigment removal. According to patients’ self-assessment, the use of CE ferulic after laser resulted in a reduction in the number of days the skin remained red (5 days versus 7 days) and a slightly greater improvement in skin radiance, texture, firmness, fine lines and wrinkles, dyschromia, and overall improvement compared to the laser alone. These results mirrored those of the investigator graded improvement.

The use of the same antioxidant serum following CO₂ ablative resurfacing revealed similar results, including a reduction in erythema, crusting, and healing time with use of the antioxidant serum.⁴ Additionally, the antioxidant serum mitigated the reduction in beta fibroblastic growth factor (bFGF) that occurred following laser treatment alone. The authors suggest that this may explain the enhanced wound healing seen in the antioxidant group.

Other cosmeceutical formulations have been tested in combination with lasers and other resurfacing procedures. In a 15-patient, single-blinded, randomized study, subjects received an IPL or PDL followed by fractionated CO₂ resurfacing.⁵ Skincare included the test system of a nectar, balm, and moisturizer containing a proprietary peptide blend (Trihex Technology, Alastin), while control subjects used a bland dimethicone ointment, petrolatum cream, and ceramide moisturizer. The products were started 3 weeks before the laser treatments and continued 12 weeks after. Subjects reported less stinging, burning, and redness and greater satisfaction with the test system. Investigators noted more significant healing at day 7 and less erythema and exudate on day 8.

The use of topicals in combination with microneedling also confirms synergistic benefits. In a split face study, melasma patients received weekly microneedling treatments for 12 weeks.⁶ The entire face was bathed with a 0.5% topical tranexamic acid (TXA) solution and half the face received microneedling while other half received a sham device. The melanin index was significantly reduced on both sides of the face compared to baseline, but there was a statistically significantly greater improvement at 12 weeks on the side receiving microneedling plus TXA.⁷ The use of a multi-ingredient antiaging moisturizer containing Astragalus membranaceus root extract, tetrahexyldecyl ascorbate, urosolic acid, peptide blend including palmitoyl tripeptide-38, ceramide blend, natural cholesterol, fatty acid, jojoba esters, sodium hyaluronate, and ubiquinone (DEJ Face, Revision Skincare) was tested in an open label study in combination with radiofrequency (RF) microneedling.⁷ The product was used twice daily for 2 weeks before, immediately after, and twice daily for four weeks after the RF microneedling procedure with 2 passes. Glogau scores were not significantly improved with the combination treatment, but 100% of the patients demonstrated improvement in lines and wrinkles with an average improvement of 25.1%.

Several studies have looked at topical skincare products in combination with body tightening and body contouring procedures. Patients received two monthly RF skin tightening treatments on the buttocks and thighs and used a topical containing a tripeptide, yeast extract, and rice protein on one side (Body Tight Concentrate, Skinceuticals). There was statistically significant improvement in firmness, tightness and skin texture on the side using the topical treatment compared to the side receiving RF alone.⁸

In a randomized, double-blind pilot study, a topical product containing a proprietary blend of peptides believed to stimulate autophagic breakdown of lipid droplets and expedite the apoptotic process (TransForm Body Treatment, Alastin Skincare), was used twice daily on one arm following two 35-minute sessions of cryolipolysis while a comparator moisturizer applied to the other side served as a control.⁹ Using standardized photography, Canfield 3D image analysis, and blinded investigator assessment, skin laxity and arm contour on the side using the test product showed enhanced improvement as early as 8 weeks and continued improvement for 24 weeks compared to control.⁹

More recently, the same peptide-containing lotion was used in a double-blind, comparator-controlled, split body study; patients received either 6 weekly RF body tightening treatments or one session with up to four cycles of cryolipolysis to the abdomen.¹⁰ The topical peptide treatment resulted in increased volume loss as measured by 3D image analysis and was statistically significant over the comparator at 8 and 12 weeks.

Supporting Better Outcomes

The studies reviewed here demonstrate the benefits of integrated skincare for improving outcomes, enhancing healing, and improving the patient experience.

Drs. Farris and Lain are co-founders of the Science of Skincare Summit, to be held October 28-30 in Austin, TX. For information: scienceofskincaresummit.com

1. Angra K, Lipp MB, Sekhon S, Wu DC, Goldman MP. Review of Post-laser-resurfacing Topical Agents for Improved Healing and Cosmesis. J Clin Aesthet Dermatol. 2021 Aug;14(8):24-32.

2. Unpublished data on file: Solta Medical and Skinceuticals

3. Elford E, et al ASLMS 2012 Poster Presentation

4. Waibel J, et al. Laser Surg Med 2015;48(3): 1-5.

5.Vanaman Wilson MJ, Bolton J, Fabi SG. A randomized, single-blinded trial of a tripeptide/hexapeptide healing regimen following laser resurfacing of the face. J Cosmet Dermatol. 2017 Jun;16(2):217-222.

6. Xu Y, Ma R, Juliandri J, Wang X, Xu B, Wang D, Lu Y, Zhou B, Luo D. Efficacy of functional microarray of microneedles combined with topical tranexamic acid for melasma: A randomized, self-controlled, split-face study. Medicine (Baltimore). 2017 May;96(19):e6897.

7. Gold MH, et al. JCD 2019;00:1-10.

8. Goldberg DJ, Yatskayer M, Raab S, Chen N, Krol Y, Oresajo C. Complementary clinical effects of topical tightening treatment in conjunction with a radiofrequency procedure. J Cosmet Laser Ther. 2014 Oct;16(5):236-40.

9. Widgerow AD, Moradi A, Poehler J. A Double-Blind Randomized Controlled Trial Evaluating the Efficacy and Tolerability of a Topical Body Treatment in Combination With Cryolipolysis Procedures. J Drugs Dermatol. 2019 Apr 1;18(4):342-348

10. Moradi A, Poehler J, Bell M. A randomized double-blind trial evaluating the efficacy and tolerability of topical body treatment with TriHex Technology® combined with abdomen cryolipolysis or radiofrequency procedures. J Cosmet Dermatol. 2020 Mar;19(3):677-681.