Available via license: CC BY-NC
Content may be subject to copyright.
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 1
International Journal of Research in Medical Sciences
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
www.msjonline.org
pISSN 2320-6071 | eISSN 2320-6012
Systematic Review
Truths and myths about marketed anti-aging skin products:
a systematic review
Ghassan M. Barnawi1*, Azhar M. Barnawi2
INTRODUCTION
The skin acts as a barrier that segregates the body from
the outer environment. It has several roles such as
protection of the body from infections by
microorganisms, water loss and it has a cosmetic role.1
Skin aging involves fragility of the skin, loss of elasticity,
wrinkles and mottled dyspigmentation.2 Skin aging
occurs due to the accumulation of effects of several
factors including intrinsic (chronologic, genetic,
hormonal, metabolic) and extrinsic (ultraviolet A and B,
chemicals, toxins).3,4 These factors lead to accumulative
alteration in the structure and physiology of the skin at
each layer and in the skin appearance, especially on sun-
exposed skin areas.5
The intrinsically aged skin involves the thinned
epidermis, cell loss, fine lines, wrinkles and flattening of
the dermal-epidermal junction.6,7 The extrinsically aged
skin involves mottled dyspigmentation and coarse
wrinkling.4,5 There are several factors that can speed up
skin aging such as pollution, unhealthy nutritional
lifestyle, smoking, extreme temperatures and sleep
deprivation.4 Skin wrinkles are the most visible signs of
skin aging. They result from both a reduction in the
synthesis and an increase in the breakdown of collagen.8
ABSTRACT
Aging of the skin naturally occurs with increasing age due to several factors involving the reduction of collagen,
elastin and many other proteins which help maintain strength and integrity of the skin. Several strategies and
treatments were developed to fight and slow down this unstoppable ongoing natural process, however, many of the
widely available products may not be as efficient as advertised. The aim was to discuss and investigate the truths and
myths about skin anti-aging products and strategies by reviewing the previous studies conducted on this subject.
Google scholar database was explored to search for articles related to the current subjects starting from 2010 till 2021.
The included searching terms were a combination of anti-aging strategies and efficacy, anti-aging products and
myths, anti-aging products and usage of women and perception and attitude of women and anti-aging strategies. The
inclusion criteria included original articles conducted on anti-aging products and strategies and full text articles. A
total of 40 articles were obtained, only three articles were eligible for the inclusion criteria. The three studies included
a total number of 192 participants. Some anti-aging products were found to improve skin health and improve the level
of coarse and fine wrinkles and lines. However, their efficacy was limited and doesn't act as magic.
Keywords: Anti-aging, Products, Strategies, Efficacy, Women, Knowledge
1Department of Dermatology, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah,
Saudi Arabia
2Prince Mansour Military Hospital, Department of Family Medicine, Taif, Saudi Arabia
Received: 17 June 2021
Accepted: 02 July 2021
*Correspondence:
Dr. Ghassan M. Barnawi,
E-mail: gn-al@hotmail.com
Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.
DOI: https://dx.doi.org/10.18203/2320-6012.ijrms20212796
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 2
The overall collagen content is reduced by 1% per unit
area of the skin surface annually.9
A considerable reduction in the collagen content and
fibrillin-positive structures may contribute to wrinkles by
weakening the bond between the dermis and epidermis of
extrinsically aged skin.10,11 Collagen will also look
disorganized and irregular in older skin.12 In addition, the
total hyaluronic acid in the skin epidermis diminishes
markedly as we age, while it remains stable in dermis
skin.13 Glycosaminoglycans are the primary dermal skin
matrix constituents that assist in trapping and maintaining
the water content of skin, these compounds may be
associated with abnormal elastotic material, undergo
wear and tear with aging, become dehydrated and lose its
ability to function effectively.14
The skin folds indicate an aged personality, every
individual wants to look younger for the entire life, this
led to the discovery of many surgical and non-surgical
interventions to improve youthfulness.1 The skin anti-
aging strategies aim to reverse the signs of aging in the
dermis and epidermis and they are categorized as
cosmetological care, topical medical agents or topical
agents, invasive procedures, systemic agents, preventive
medicine, avoidance of external factors and adoption of
healthy lifestyle habits.1
There is no proven effective topical anti-aging treatment
or ingredient that completely impedes skin photoaging,
but there are products that can reduce and slow down
these changes. Many cosmetic products were advertised
to reduce the clinical signs of photoaged skin. However,
there are very few studies that support these claims.
These products may not be as effective as announced.1 As
there were no studies that confirm the efficacy of such
products, customers who predominantly are women may
be attracted to such products and perceive them as magic
or fountain of youthfulness. Therefore, this systematic
review was conducted on the available few studies
conducted on the efficacy of anti-aging products to
investigate the truths and myths about such products.
METHODS
The PRISMA checklist guidance for systematic review
and meta-analysis was followed to write this systematic
review.15 We revised electronic databases to select
eligible research articles between the year 2010 and the
year 2021 including the Google scholar database as it
provided a larger number of studies.
Figure 1: Planning of eligible criteria.
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 3
Search strategy
Several keywords were used for searching purposes,
including a combination of ‘anti-aging strategies and
efficacy’, ‘anti-aging products and myths’, ‘anti-aging
products and usage of women’, and ‘perception and
attitude of women and anti-aging strategies’. All the titles
and abstracts produced from this primary exploration
were revised thoroughly to prevent missing potential
studies. The obtained articles were then examined to
choose only original research articles evaluating the
efficacy of anti-aging products, the studies investigated
the knowledge, attitude and perception of women toward
anti-aging products. Only articles in English were defined
as articles of relevance, all original articles conducted on
human subjects were eligible, which were then included
in the second stage.
Eligibility criteria
The second step was deciding on the inclusion criteria to
select the eligible studies. The abstracts of the articles
were assessed manually to select the relevant studies for
revision. The inclusion criteria were studies conducted on
human subjects with cross-sectional, retrospective or
prospective study design. The final stage was gathering
the pre-defined information from the final record of
eligible articles and summarize them. Reviews and
studies which had incomplete or overlapped data were
excluded. Also unavailable full-text articles or
inappropriate study designs were excluded. The full
description of the search strategy is shown in Figure 1.
Data review and analysis
Stage one in the data review included a preliminary
review using a specifically designed excel sheet to extract
selected data. The chosen data from eligible studies were
then revised and summarized in one table under specific
titles.
RESULTS
This systematic review included three articles that met
the eligible criteria (Table 1).16-18 The three studies were
recently published between 2018 and 2017.16-18 The aim
of the three studies were checked, two studies
investigated the effect of anti-aging products on the skin,
one study investigated the effect of using melatosphere-
based cream for two months on skin texture and the other
study evaluated the efficacy of topical products including
night and day facial creams, night and day lip creams and
eye creams to reduce the appearance of wrinkles and
transepidermal water loss and to increase skin
moisturization.16,17 The last study investigated the
efficacy of different types of anti-aging products but
relied on data obtained from self-assessment of
customers.18 There were two trials included, each of the
three studies was of a different study design, one of the
trials was an open, prospective evaluator-blinded trial, the
other trial was controlled clinical and the third study was
a prospective cross-sectional study.16-18
Table 1: Summary of included studies.
Author
and
publication
year
Aim
Study design
Population
Tools used for
assessment
Results and findings
Milani et
al 201816
To evaluate the
effects on skin
texture of two
months of
treatment with a
Melatosphere™-
based cream
Open
prospective,
evaluator-
blinded trial
50 women aged
˃45 years with
mild to
moderate facial
skin aging
(Glogau score
2-4
Antera 3D computer-
assisted skin analysis
evaluation for the
assessment of coarse and
fine wrinkles of the
periorbital area and
melanin content-an
evaluator-blinded
investigator global
assessment (IGA) of skin
elastosis, roughness,
level of dyschromia, skin
dryness and the presence
of actinic damage using
a four-grade score from
0 (no sign) to 3 (severe
sign)-the assessment was
performed at baseline
and after two months of
treatment
t baseline, the mean
(SD) IGA score was
8.2 (1.0). After two
months the IGA
score significantly
decreased to 4.2 (1.4)
(49% reduction)
(p=0.0007);
ANTERA 3D
evaluations showed a
significant reduction
in the coarse and fine
wrinkle volume in
the target area of
31% and 18%,
respectively; melanin
content was reduced
significantly by
17%* topical
melatonin carried in
Melatosphere™
Continued.
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 4
Author
and
publication
year
Aim
Study design
Population
Tools used for
assessment
Results and findings
improves, in the short
term, signs of skin
aging evaluated
clinically and using
the antera 3D device
in women with mild
to moderate skin
aging.
Pinsky
201717
To evaluate the
efficacy of five
topical test
products
intended to
reduce the
appearance of
lines and
wrinkles,
increase skin
moisturization,
and reduce
transepidermal
water loss
A controlled
clinical trial
for each
individual test
product and an
experience
trial
5 women
participated in
56 day trial,
tested for the
effectiveness of
the facial (day
and night), eye
and lip (day and
night) creams
used as anti-
aging
-
The facial, eye, and
lip creams are
effective anti-aging
products that reduce
the appearance of
both fine and coarse
lines and wrinkles,
dramatically increase
the moisturization of
the skin, and, in the
case of the face and
eye products, reduces
transepidermal water
loss; these changes
last for at least 56
days without
significant adverse
effects.
Shah et al
201718
To determine the
efficacy of
different type of
anti-aging
products based
on consumer
self-assessment
and to insight
into their
perception and
knowledge about
these products
Prospective
cross-sectional
137 females
above 35 years
old using anti-
aging cosmetics
for at least 2
months
Survey containing 13
questions
15% of the
participants were
attracted by container
shape and
advertisements to
purchase; 4%
purchase a product
depending upon its
ingredients; 7% knew
the type of
ingredients used in
anti-aging cosmetics;
33% of the
population had a
problem of fine line
and wrinkles and
13% had rough and
dry skin, 18% had a
problem of open
pores and 11% had
age spots, 8%
individuals had
sagged skin; 23% of
the respondents
seems to be satisfied
with product and
16% does not find
the product useful at
all; improvement of
Continued.
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 5
Author
and
publication
year
Aim
Study design
Population
Tools used for
assessment
Results and findings
fine line/wrinkles
was felt by 35%;
reduction of pore
visibility was felt by
67%; 51% felt an
increase laxity;
improvement of skin
tone was felt by 31%
and 59% felt an
increase skin
hydration;
respondents with
higher age are not
satisfied with the
effectiveness of the
product no matter if
they have been using
it for long time; such
products do work to
improve skin
conditions but the
claim that wrinkles
could be cured
completely could not
be determined
The total number of included participants was 192
women, one trial included 50 women age older than 45
years with mild to moderate facial skin aging, the other
trial included only five women tested for the efficacy of
five products, the third study was conducted on 137
females with age older than 35 years and used anti-aging
products for at least two months.16-18 Only two articles
stated their assessment tools. One trial reported using
Antera 3D cameras and Investigator global assessment
(IGA), the former was to evaluate the coarse and fine
wrinkles of the periorbital area and the melanin content,
whereas the latter was to assess the level of elastosis,
roughness, dyschromia, skin dryness and actinic
damage.16 The other study used a survey containing 13
questions.18
After two months of using melatonin carried in the
melatosphere, there was a significant reduction in the
volume of coarse and fine wrinkles by 31% and 18%,
respectively. There was a significant reduction in the
level of skin roughness, skin dryness, actinic damage,
skin elastosis and dyschromia. The melanin content was
also reduced by 17%.16 The other trial lasted for 56 days,
reported that the five anti-aging products increased skin
moisturization, reduced water loss and reduced the
appearance of fine and coarse lines and wrinkles.17 Based
on the perspectives of women who used these anti-aging
products, 23% of females were satisfied with these
products and 16% reported that the products were not
useful at all. Only 35% reported improvements on the
fine lines and wrinkles, 67% reported a reduction in pore
visibility, 31% reported improvement in skin tone and
59% reported an increase in skin hydration. Only 7% of
women knew the type of ingredients used in anti-aging
cosmetics, 4% purchased the products depending upon
their ingredients and 15% were attracted by container
shape and advertisement to purchase the products.18
DISCUSSION
The signs of aging become obvious as life progresses,
and the primary proof of the aging process is the changes
of the skin.19 Some of the common and well known anti-
aging strategies like changing the diet, staying hydrated
and using over-the-counter skincare products aim to
reduce the appearance of fine lines and wrinkles and
prevent the new ones from appearing.20 Another skin
anti-aging therapy involves visiting professional
dermatology clinics for surgical procedures and fillers
that could lift the aged skin and give it back its tensile
strength for a more youthful appearance. Some of the
anti-aging treatments can be obtained by consulting a
dermatologist and get a prescription for a suitable anti-
wrinkle cream that would be useful and lead to
considerable results. However, the fastest results can be
obtained by undergoing a cosmetic procedure.21 This
clarifies that the optimal results obtained from the use of
anti-aging products, if they are effective are slow.
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 6
There are two main categories of agents that can be used
as anti-aging ingredients including antioxidants and cell
regulators. The antioxidants involve several components
such as vitamins, flavonoids, and polyphenols, which
reduce the degradation of collagen, whereas the cell
regulators involve peptides, retinol and growth factors
which have direct effects on the metabolism and affect
the production of collagen.5 The combination of vitamins
C and E results in higher protection against the oxidation
process compared to each of them alone.22,23
Vitamins C, B3 and E are the most important antioxidants
as they have the ability to penetrate the skin due to their
small molecular weight.24 It was reported that vitamin C
in a concentration ranging between 5% to 15% provides
major skin anti-aging effects.25,26 Vitamin B3 was found
to regulate cell metabolism and regeneration, a
concentration of 5% was found to have an anti-aging
effect.27 In addition, vitamin E has anti-inflammatory and
anti-proliferative effects in a concentration between 2%
to 20%, however, its effects are not as strong as that of
vitamin C and B3.28
It was demonstrated that although there are many various
compounds marketed as anti-aging products, there are
few studies that proved their efficacy such as the
compounds reported previously (vitamin C).5,29 However,
many individuals continue to use over the counter
products.29
In this systematic review, we could only find three
studies that were conducted to assess the efficacy of such
anti-aging products, two were trials and conducted on
anti-aging products whereas one study was conducted
based on the subjects’ self-reports.16-18 One trial found
that topical melatonin carried in the melatosphere
improved the signs of aging in the short term but only
improved the mild to moderate skin aging signs.16 The
other trial showed that the night and day cream of face
and lip as well as the eye cream were effective against
aging skin and reduced the appearance of coarse and fine
wrinkles and lines. They also reduced the water loss,
which lasted for 56 days with no considerable adverse
effects.17 However, based on opinions obtained from
women customers, a small percentage of women were
satisfied with their products, reported improvements in
lines and wrinkles, and noticed improvements in skin
tone, whereas a higher percentage that reached almost
50% and exceeded reported feeling an increase in laxity
and hydration and reduction in pore visibility. However,
the older age women were not satisfied with the
effectiveness of these products. The study could not
determine whether wrinkles were completely cured or
not.
So, we could conclude that the anti-aging products
studied are moderately effective, they are effective
against mild to moderate aging signs, and the products
could improve signs such as moderate and mild wrinkles
and lines. However, in advanced signs such as aging
signs of older individuals, these products are not effective
as they are slow-acting and improve the signs of low
degrees.
CONCLUSION
Anti-aging products were found to improve skin integrity
and improve the level of coarse and fine wrinkles and
lines. They can also keep the skin moisturized. However,
their efficacy is limited and does not act as magic such as
reported in the advertisement. The older females reported
less satisfaction with such products, reflecting that the
efficacy of these products is limited and can improve the
aging signs to a slight degree and does not improve the
aging appearance completely. Based on the females’
perspectives, a larger proportion of females purchases
such products depending on the shape and advertisement
of the products, and the fewest proportion purchase them
based on their ingredients. Further studies should be
performed on the efficacy of different anti-aging products
and strategies as there is an increase in the rate of using
these products, so their efficacy should be precisely
investigated and reported as there are very few studies
conducted on this subject.
Funding: No funding sources
Conflict of interest: None declared
Ethical approval: Not required
REFERENCES
1. Mohiuddin AK. Skin aging and modern age anti-
aging strategies. Pharma Tutor. 2019;7(8):22-70.
2. Bennett MF, Robinson MK, Baron ED, Cooper KD.
Skin immune systems and inflammation: Protector
of the skin or promoter of aging? J Investig
Dermatol Symp Proc. 2008;13(1):15-9.
3. Kohl E, Steinbauer J, Landthaler M, Szeimies RM.
Skin ageing. J Eur Acad Dermatol Venereol.
2011;25(8):873-84.
4. Krutmann J, Bouloc A, Sore G, Bernard BA,
Passeron T. The skin aging exposome. J Dermatol
Sci. 2017;85(3):152-61.
5. Ganceviciene R, Liakou AI, Theodoridis A,
Makrantonaki E, Zouboulis CC. Skin anti-aging
strategies. Dermatoendocrinol. 2012;4(3):308-19.
6. Zhuang Y, Lyga J. Inflammaging in skin and other
tissues-the roles of complement system and
macrophage. Inflamm Allergy Drug Targets.
2014;13(3):153-61.
7. Fisher GJ, Kang S, Varani J, Bata-Csorgo Z, Wan
Y, Datta S, et al. Mechanisms of photoaging and
chronological skin aging. Arch Dermatol.
2002;138(11):1462-70.
8. Masaki H. Role of antioxidants in the skin: Anti-
aging effects. J Dermatol Sci. 2010;58(2):85-90.
9. Shuster S, Black MM, McVitie E. The influence of
age and sex on skin thickness, skin collagen and
density. Br J Dermatol. 1975;93(6):639-43.
Barnawi GM et al. Int J Res Med Sci. 2021 Aug;9(8):xxx-xxx
International Journal of Research in Medical Sciences | August 2021 | Vol 9 | Issue 8 Page 7
10. Watson RE, Craven NM, Kang S, Jones CJ, Kielty
CM, Griffiths CE. A short-term screening protocol,
using fibrillin-1 as a reporter molecule, for
photoaging repair agents. J Invest Dermatol.
2001;116(5):672-8.
11. Contet-Audonneau JL, Jeanmaire C, Pauly G. A
histological study of human wrinkle structures:
comparison between sun-exposed areas of the face,
with or without wrinkles, and sun-protected areas.
Br J Dermatol. 1999;140(6):1038-47.
12. Oikarinen A. The aging of skin: chronoaging versus
photoaging. Photodermatol Photoimmunol
Photomed. 1990;7(1):3-4.
13. Elsner P, Maibach HI. Cosmeceuticals and Active
Cosmetics: Drugs versus Cosmetics. 2nd ed. New
York: Marcel Dekker; 2005.
14. Bernstein EF, Underhill CB, Hahn PJ, Brown DB,
Uitto J. Chronic sun exposure alters both the content
and distribution of dermal glycosaminoglycans. Br J
Dermatol. 1996;135(2):255-62.
15. Liberati A, Altman DG, Tetzlaff J, Mulrow C,
Gøtzsche PC, Ioannidis JP, et al. The PRISMA
statement for reporting systematic reviews and
meta-analyses of studies that evaluate health care
interventions: explanation and elaboration. PLoS
Med. 2009;6(7):1000100.
16. Milani M, Puviani M. Anti-aging efficacy of
melatonin-based cream: clinical and instrumental
skin evaluation. Cosmetics. 2018;5(4):60.
17. Pinsky MA. Efficacy and safety of an anti-aging
technology for the treatment of facial wrinkles and
skin moisturization. J Clin Aesthet Dermatol.
2017;10(12):27-35.
18. Shah F, Sarheed O, Ramesh KV. A prospective
study of knowledge and perception towards the
efficacy of anti-aging cosmetics among female
population of Ras Al Khaimah, UAE. J Cosmetic
Dermatol Sci Apps. 2017;7(3):275.
19. Tejasswini R. Treatment strategies in the
management of proactive skin health and anti-aging
improvement-a review. Clin Dermatol J.
2020;5(3):000215.
20. Yadav T, Mishra S, Das S, Aggarwal S, Rani V.
Anticedants and natural prevention of
environmental toxicants induced accelerated aging
of skin. Environment Toxicol Pharmacol.
2015:39(1):384-91.
21. Ferreira MS, Magalhães MC, Sousa-Lobo JM,
Almeida IF. Trending anti-aging peptides.
Cosmetics. 2020;7(4):91.
22. Kerscher M, Buntrock H. Anti-aging creams. What
really helps? Hautarzt. 2011;62:607-13.
23. Murray JC, Burch JA, Streilein RD, Iannacchione
MA, Hall RP, Pinnell SR. A topical antioxidant
solution containing vitamins C and E stabilized by
ferulic acid provides protection for human skin
against damage caused by ultraviolet irradiation. J
Am Acad Dermatol. 2008;59(3):418-25.
24. Bissett DL, Miyamoto K, Sun P, Li J, Berge CA.
Topical niacinamide reduces yellowing, wrinkling,
red blotchiness, and hyperpigmented spots in aging
facial skin. Int J Cosmet Sci. 2004; 26(5):231-8.
25. Nusgens BV, Humbert P, Rougier A, Colige AC,
Haftek M, Lambert CA, et al. Topically applied
vitamin C enhances the mRNA level of collagens I
and III, their processing enzymes and tissue
inhibitor of matrix metalloproteinase 1 in the human
dermis. J Invest Dermatol. 2001;116(6):853-9.
26. Haftek M, Mac-Mary S, LeBitoux MA, Creidi P,
Seite S, Rougier A, et al. Clinical, biometric and
structural evaluation of the long-term effects of a
topical treatment with ascorbic acid and
madecassoside in photoaged human skin. Exp
Dermatol. 2008;17(11):946-52.
27. Draelos ZD. The latest cosmeceutical approaches
for anti-aging. J Cosmet Dermatol. 2007;6(1):2-6.
28. Zhai H, Behnam S, Villarama CD, Arens-Corell M,
Choi MJ, Maibach HI. Evaluation of the antioxidant
capacity and preventive effects of a topical emulsion
and its vehicle control on the skin response to UV
exposure. Skin Pharmacol Physiol. 2005;18(6):288-
93.
29. Huang CK, Miller TA. The truth about over-the-
counter topical anti-aging products: a
comperhensive review. Aesthetic Surg J.
2007;27(4):402-12.
Cite this article as: Barnawi GM, Barnawi AM.
Truths and myths about marketed anti-aging skin
products: a systematic review. Int J Res Med Sci
2021;9:xxx-xx.
