Why everything you know about anti-aging is about to change
The skincare industry is fast approaching a watershed moment in the treatment of aging skin. Increasingly, scientific evidence suggests that many of today’s trademark treatments may actually exacerbate the conditions they’re designed to treat in the long term, thanks to a phenomenon known as inflammaging. This previously unseen consequence poses a challenge to product developers, who must adapt their formulations to meet shifting consumer demands or risk losing their shares of the market. As inflammaging goes mainstream, it foresees a widespread change in the industry–transforming everything from the ingredients that professionals use to the methods by which they use them.
First coined by University of Bologna Professor Claudio Franceschi more than a decade ago, inflammaging began as a theory linking the underlying inflammatory changes to the causes if most age-associated diseases. Since its inception, research continues to present insurmountable evidence taking this concept from theory to fact.
The term 'inflammaging' describes the aging phenomenon induced by chronic (persistent) inflammation. Most people are familiar with the visible inflammation that can be seen on the surface of the skin, with redness representing a sign of infection, irritation or discomfort. However, inflammation can also be invisible.
All skin (and certainly weakened or aged skin) is subject to inflammation, even at low intensities. It is this underlying inflammation that ultimately exhausts the body’s defense system, dismantling key youth-sustaining skin structures and resulting in collagen and elastin degredation and a breakdown of the skin’s barrier function.
The inflammaging process involves a highly complex chain of events, by which acute inflammation gradually gives way to chronic, or silent, inflammation. To understand how to combat inflammaging, one must first understand the inflammatory cascade of reactions that erode the skin’s structure–ultimately manifesting in the form of deep wrinkles, hyperpigmentation and flaccid, inelastic tissue.
Acute Versus Chronic Inflammation
Inflammation is the body’s response to cellular aggression or injury. It represents a defense mechanism designed to heal cells from injury and protect the body from the consequences of that injury. Cell injury may occur due to trauma, genetic defects, physical and chemical aggressions, tissue death, foreign bodies, immune reactions and infections. Inflammation also facilitates early tissue healing and repair and allows the body to restore itself to a normal form and function.
It all starts with acute inflammation, which is characterized by rapid onset and short duration. Generally associated with redness, swelling, pain, warmth and loss of function, acute inflammation manifests with the oozing of fluid and plasma proteins and the emigration of white blood cells (leukocytes). Of the five types of leukocytes that the body produces, it is primarily the neutrophils that make an appearance during acute inflammation, producing the whitish-yellow pus characteristic in wounds.
In contrast, chronic inflammation is of prolonged duration and manifests microscopically by the presence of two different categories of white blood cells, known as lymphocytes and macrophages. Lymphocytes function as ‘killer’ cells, disabling and destroying infected tissue such as tumors or infected cells, while macrophages literally consume cellular debris and pathogens. Together, these aggressive forms of white blood cells can result in the scarring of connective tissue and tissue death.
The Inflammatory Cascade
The healing of an injury is a complicated process. It starts as soon as the injury occurs and can take up to nine months or more to complete. There are three phases to the healing process: the inflammatory phase, the proliferation phase and the remodeling phase.
During the inflammatory phase, pro-inflammatory proteins enter damaged areas causing swelling as tissues push apart. Following this, white blood cells, including the macrophage, begin the proliferation stage by cleansing the wound and jumpstarting the repair process. During this stage, the wound contracts and receives the oxygen and nutrients vital for regeneration. Lastly, the remodeling stage is characterized by the production, organization and remodeling of collagen I and III to strengthen the wound.
However, even after the wound has healed, the resulting scar tissue is more vulnerable to injury and deformation than the original tissue. Science now shows that repeated injury leads to the chronic state of inflammation now known as inflammaging.
Inflammation and Skin Aging
Today, the direct link between extrinsic skin aging and inflammation is well established and documented. Elias and Feingold demonstrated the reciprocal effect of many chronic inflammatory diseases–such as psoriasis, atopic and seborrheic dermatitis–on the stratum corneum barrier, which maintains healthy hydration levels in the skin.
The integrity of this barrier is maintained by metabolic balance (i.e. synthesis of collagen fibers, replacement of old and worn out fibers) by enzymes called MMPs (Matrix Metalloproteinases) and is regulated by TIMPs (Tissue Inhibitors of Matrix Proteinases).
Inflammaging destroys this balance, decreasing cellular metabolic activity and collagen renewal. Externally, the skin loses its suppleness and elasticity and becomes flaccid. It is also known that inflammaging generates Reactive Oxygen Species (ROS), causing age-accelerating oxidative damage, which further perpetuates a chronic, pro-inflammatory state.
Inflammaging can be prevented, and even reversed, by using a wide spectrum of topical products formulated with anti-inflammatory and antioxidant ingredients. In addition to inhibiting the key mediators of inflammation and aging processes, these ingredients should help reinforce, protect and boost the Anti-Oxidant Response System.
Two different classes of anti-inflammatory agents seems to show promising results: COX inhibitors and 5-LOX inhibitors. Boswellic acid (found in the Boswellia serrata tree), resveratol (found in grapes) and tamanu oil (found in Tamanu tree nuts), are just some of the natural inhibitors that can be used in skincare.
While anti-inflammatory ingredients are essential in the fight against inflammaging, successful treatment must also address two major skin issues. The first is reinforcing and protecting the integrity of the barrier function, which can be achieved through targeted topical care. The second is the use of broad-spectrum UV protection.
As with any skin concern, inflammaging can worsen with prolonged sun exposure. Combined with treatments that target the source of inflammation, proper UV defense and barrier support can help minimize the visible effects of inflammaging.
Alternatives to Common Irritants
Equally as important as using anti-inflammatory ingredients is avoiding aggressive ingredients that can further wound the skin and prolong the inflammaging cycle.
Another common irritant to avoid is Benzoyl Peroxide. A mainstay of professional and everyday acne treatments, Benzoyl Peroxide can contribute to irritating oxidative damage. However, gentler alternatives exist in the form of Salicylic Acid and Sulfur, which have been shown to be just as effective.
Of course, no discussion of inflammaging would be complete without addressing skincare’s anti-aging hero: Retinol. The gold standard in renewal, Retinol achieves its goal often at the cost of irritating the skin. While retinoids themselves aren’t likely to change, science has found new ways to deliver these key ingredients through encapsulated systems that bypass their inflammatory side effects.
Inflammaging and the Future of Skincare As science continues to explore the dynamics of inflammaging, new products and treatments will emerge to address this nascent concern. In an industry that moves at breakneck speed, the advent of inflammaging serves as both a wakeup call and an ultimatum to product developers and cosmetic companies alike. The skincare game is changing. If companies don’t keep up, their customers will look elsewhere.
Tips to Combat Inflammaging in the Treatment Room:
1. Choose your acids wisely. Avoid acids of small molecular size, like Glycolic Acid, that can penetrate the dermis. Instead, choose acids of larger molecular size that work in the epidermal layer, like Lactic, Malic, Pyruvic and Tartaric Acids.2. Support the skin’s barrier function. After the exfoliation, reinforce the barrier function by protecting the NMF to guard against trans epidermal water loss (TEWL). This can be achieved with ingredients including ceramides, squalane, fatty acids, phospholipids, amino acids, lactates and PCA.
3. Don’t forget your anti-inflammatory and antioxidant ingredients. Soothe and replenish the skin with ingredients that counteract irritation and inflammation. And, since oxidation is an age-accelerating side effect of inflammaging, make sure you pack the skin with protective antioxidants. See sidebar for a list of recommended ingredients.
4. Protect your results. Inflammaging can worsen with prolonger sun exposure, so be sure to end every treatment with sunscreen application of SPF 30 or higher.