Efficacy of an Aluminum Oxide Scrub Cream in the Treatment of Xerotic Skin of the Elderly

Abrasive agents used as exfoliants in acne and xerotic skin conditions have been criticized for being double-edged swords that might create more skin damage than benefit due to exaggerated use. Paradoxically, it has been demonstrated that scrub creams may induce beneficial changes in human skin similar to treatment with topical tretinoin. In the present study, the efficacy of an aluminum-oxide-based scrub cream in combination with an α-hydroxy acid formulation was compared to the α-hydroxy acid formulation alone in 12 elderly female volunteers with itchy, xerotic leg skin. Following a 2-week washout period, the midportions of the lower lateral legs were treated with the combined treatment on one leg and with the α-hydroxy acid formulation on the other for 3 weeks. Clinical scoring, self-assessment as well as objective measurements of transepidermal water loss (TEWL) and hydration were performed at baseline and 3 days after the last treatment. In 3 volunteers, punch biopsies were obtained at the same time points. Both treatment strategies improved xerosis and pruritus, the combined treatment was statistically more effective. Hydration was not affected by the treatments, whereas TEWL was significantly reduced by both treatments, more so with the α-hydroxy acid formulation, indicating an improvement in barrier function. The clinical and instrumental findings were supported by histological findings following the combined treatment showing thickening of the epidermis and partial correction of epidermal atypia indicating increased epidermal proliferation. It appears that the combination treatment used in a controlled fashion has the potential for reversing some of the changes induced by photoaging. The changes induced are most likely due to unspecific mechanical stimulation of epidermal proliferation in combination with increased exfoliation.