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Received: 24 September 2019    Revised: 20 November 2019    Accepted: 21 November 2019

DOI: 10.1111/jocd.13252

ORIGINAL CONTRIBUTION

Clinical evidences of benefits from an advanced skin care

routine in comparison with a simple routine

Cyril Messaraa MS1  | Nicola Robertson MS1 | Melissa Walsh BA1 |

Sarah Hurley MS1 | Leah Doyle1 | Anna Mansfield1 | Lorna Daly BSc1 |
Claire Tansey BSc1 | Alain Mavon PhD2

1
Oriflame R&D, Bray, Ireland
2 Abstract
Oriflame Skin Research Institute, Oriflame
Cosmetics AB, Stockholm, Sweden
Correspondence
Cyril Messaraa, Oriflame Research and
Development Ltd, R&D, Bray Business Park,
Kilruddery Co. Wicklow, Bray, Ireland.
Email: Cyril.messaraa@oriflame.com
Background: The use of a skin care routine is commonly promoted by the cosmetic
industry, yet there is a lack of clinical evidence to support this practice over the use
of a single skin care product.
Aims: In the present study, we aimed at showing the clinical benefits of using a com-
prehensive skin care routine vs a simple one.
Methods: Skin micro-/macro-topographic, skin color, and superficial/deep hydration
were collected at baseline and after 4 weeks of use, on forty-nine women randomly
allocated to two groups. The first one followed the use of an advanced routine (AR:
Cleanser/Toner/Eye cream/Serum/Day & Night cream), while the other group was
instructed to use a simple routine (SR: Cleanser & Day cream).
Results: Hemoglobin heterogeneity was found to be significantly reduced only in
the SR group. However, the AR outperformed the SR when it comes to improving
superficial hydration, deep hydration, skin roughness, mean pore area, melanin het-
erogeneity, and crow's feet wrinkle depth. A significant increase in skin brightness
from baseline was only recorded when using the AR while both routines significantly
improved the nasolabial wrinkles.
Conclusion: These findings advocate for using a relevant daily routine as it demon-
strates the visible skin benefits over a short period, while driving the creation of
habits for the prevention of aging signs.

KEYWORDS

anti-aging, skin care routine, skin color, skin hydration, wrinkle reduction

1 |  I NTRO D U C TI O N
Skin care products use history is well documented and can be
traced back to the origin of the civilization,1 yet their complexity
has exponentially increased over the last century. Novel technolo-
gies led to cutting edge ingredient developments, launches of new
product formats with the likes of softening lotions by Shiseido
in 1897, water in oil emulsions by Nivea in 1911 or even new
functions, such as the first protective oil by Garnier in 1935, and
so forth. Beyond new emerging formats, the use of skin care prod-
ucts as part of a routine rapidly gained popularity in modernized
countries, like the iconic 3-step skin care systems from Clinique
(cleanse/exfoliate/moisturize) popularized in 1967 following the
interview of a dermatologist in Vogue. 2 Since then, routines be-
came increasingly sophisticated with the influence of eastern
countries, particularly South Korea with 10 steps or beyond,

J Cosmet Dermatol. 2019;00:1–7. wileyonlinelibrary.com/journal/jocd© 2019 Wiley Periodicals, Inc.     1 |

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enticing women to extend their routine3 and the promotion of
3,4
multi-step regimens by celebrities and influencers.
While countless vehicle-controlled studies have demonstrated
about the benefit of actives over a vehicle alone and/or vs gold stan-
dard ingredients,5-7 clinical evidence about the benefits of a skin
care routine remains scarce, despite the claimed benefits of using
products as part of a regimen. Reported efficacy of regimens is avail-
able in the dermatological field, to address skin conditions such as
acne,8,9 atopic dermatitis, or rosacea.10,11 The efficacy of a skin care
regimen comprising of a serum with a retinol ester, a lotion with SPF
30 and a night cream, was evaluated vs another regimen consisting
of a SPF 30 sunscreen combined with a prescription tretinoin for-
mulation, a very potent active.12 The tested regimen did perform
similarly to the prescribed tretinoin regimen while presenting a bet-
ter tolerability.13 Another recent study investigated the efficacy and
tolerability of a natural-based routine at managing skin sensitivity
symptoms, using a synthetic dermatologist-recommended regimen
(cleanser & lotion) as a control.14 Benefits of routine comprising of
3 to 6 steps for a substantial period (from 3 to 24 weeks) have been
reported,15-18 although the incremental effect of using multiple prod-
ucts vs a basic routine was not demonstrated. A recent presentation
outlined the synergistic effect of a topical regimen in combination
with oral supplementation on quality of life, albeit the combo set
was outperforming the topical regimen only on three dimensions of
TA B L E 1   Products and frequency of use of the two routines
Routine Products Frequency
AR (advanced Cleanser and toner, eye cream, Morning
routine) serum, day or night cream and
evening
SR (simple routine) Cleanser, day cream Morning
the questionnaire (Social life, self-confidence, and energy); however,
no differences were observed with clinical grading or desquamation
index.19 In a previous investigation, we did show the benefits of using
an advanced skin care routine over a simple routine, although on very
few skin features. 20
In the present study, we aimed at assessing the benefit of the
daily use of an advanced skin care routine (AR), comprising of five
steps, in comparison with a simple—or time conscious—routine (SR)
of two steps on a much wider array of skin parameters: superficial
hydration, deep hydration, color-related parameters, micro- and
macro-topography. To put it another way: Is it worth it to spend
more budget and time in the bathroom to improve the overall skin
appearance?
2 | M E TH O DS
2.1 | Study panels
Volunteers aged 25-55 years were recruited and randomly allo-
cated to two different groups: one using the AR (n  =  29, mean
age  =  45, SD  =  7) and another one using a SR (n  =  20, mean
age = 42, SD = 7). All procedures involved in the study were ex-
plained in detail, and written informed consent was obtained from
all volunteers. Prior to baseline measurements, all volunteers went
through a wash-out phase of two weeks and were requested to
exclusively use a moisturizer provided to them. Following a period
of 20 minutes of acclimatization under controlled temperature
and humidity (21°C ± 2°C, relative humidity 50% ± 5%), volunteers
went through a set of imaging and probe measurements at base-
line and 4 weeks later. The study was conducted in conformance

TA B L E 2   Key ingredients for efficacy

Main Function Ingredient Present in
in each of the tested products
Moisturization Glycerin Day cream, night cream, eye
cream, serum, toner
Butylene glycol Night cream, serum, eye cream
Betaine Day cream, night cream, serum
Sodium hyaluronate Eye cream, serum
Anti-aging Jania rubens extract and sodium Day cream, night cream, eye
carrageenan cream, serum
Antioxidant Euterpe oleracea fruit extract and Day cream, night cream, eye
lactobacillus ferment cream, serum
Emollient Esters and silicones Day cream, night cream, eye
cream, serum
Pore reduction Saccharide isomerate Serum
Skin renewal Glycolic acid Night cream
Skin barrier Niacinamide Night cream
Sun protection Organic and Inorganic UV filters Day cream
Pollution particles Biosaccharide Gum-4 Day cream
repelling
Soothing Bisabolol Toner
MESSARAA et al.
with the most recent recommendations of the World Medical
Association (Declaration of Helsinki 1964, amended in Fortaleza,
Brazil, 2013).
2.2 | Study products
By AR, we refer to the use of a cleansing and toning step, an eye
cream, a serum, and a day cream containing SPF 30. At night time,
the use of the day cream was substituted with a night cream of
a different composition and free of SPF. The day cream, the eye
cream, the serum, and the night cream were all oil in water emul-
sions. By SR, we refer to the use of a cleansing step followed by the
day cream only, thus at daytime only. The products and associated
frequencies of use are listed on Table 1. The routines were de-
signed to target early signs of aging (eg, fine lines, dullness, pores),
and relevant ingredients to achieve the desired efficacy are listed
on Table 2
2.3 | Topographic, color and chromophores
measurements
Topographic, color-related, and chromophoric data of the face (cheek
and temple) were collected on a measuring area of 5.6 × 5.6 cm with
the Antera 3D (Miravex), a hand-held camera with multipurpose
capabilities. 21-23
2.4 | Biophysical measurements
Superficial levels of hydration were collected using the Corneometer
CM825 (CK Electronic GmbH), while deeper levels of hydration were
collected using the MoisturemeterEPID (Delfin Technologies Ltd)
triplicate measurements per volunteer and per probe were collected
and subsequently averaged
Location of the measurements and generated parameters from
each instrument are shown in Figure 1.
2.5 | Statistical analysis
Descriptive statistics such as mean, standard deviation, and 95% con-
fidence interval were computed. Normality of the data was checked
using Shapiro-Wilkinson, with a threshold set at α = 0.01. For each
routine, paired-test or Wilcoxon matched pairs test if normality of
the data was not assumed, were computed for baseline comparisons,
with a threshold set at α = 0.05. As for between routine comparison,
the delta values of the two groups (AR and SR) were compared using
unpaired t test or Mann-Whitney U test if normality of the data was
not assumed, with a threshold set at α = 0.05. Bar plots are shown as
mean ± 95% confidence interval.
All calculations were performed using STATISTICA™ V13 (Tibco).
|
      3
F I G U R E 1   Location of the skin features collected on face
3 | R E S U LT S
3.1 | Skin topography changes
Figure 2 depicts crow's feet wrinkles and nasolabial wrinkles depth
variations following 4  weeks of treatment, for AR and SR groups.
Crow's feet wrinkles depth decreased significantly by 7.3% for the
AR group vs baseline (P < .05). This decrease was significantly higher
than the SR group (P < .05), where no reduction in crow's feet depth
was observed. With regard to nasolabial wrinkles, both SR and AR
significantly decreased the wrinkle depth vs baseline (P < .05), by 8.3
and 10.7%, respectively.
Figure 3 outlines variations of microtopographic skin features
such as skin roughness and mean pore area, following 4 weeks of
treatment with the two routines. Both skin roughness and mean
pore area were significantly reduced with the usage of the AR vs
baseline (P < .05), by 9.1% and 14.4%, respectively. Additionally, the
magnitude of the changes provided by the AR is significantly higher
than those measured for the SR.
3.2 | Skin hydration changes
Variations in skin hydration at a superficial (Capacitance) and deeper
(Tissue dielectric constant) levels following 4 weeks of treatment
with both routines are shown on Figure 4. Skin capacitance was
significantly increased with both routines compared to baseline
(P < .05), by 16% for the SR and 92% for the AR. With regard to the
tissue dielectric constant, a significant increase of 25% from baseline
was only observed for the AR (P < .05). The AR significantly outper-
formed the SR (P < .001) regardless of the depth of the skin hydra-
tion measurement.
3.3 | Skin pigmentation changes
Overall skin brightness did increase from baseline in both groups;
however, a significant improvement (P < .05) was observed in the
AR group only. Melanin heterogeneity was significantly reduced by
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4       MESSARAA et al.
11.7% in the AR group vs baseline (P < .05) and by −2.7% in the SR
group (P < .01). As for the hemoglobin heterogeneity, there was an
observed reduction of 6.6% and 2.8% for the SR and AR groups, re-
spectively (Figure 5). Figure 6 illustrates how the AR improved the
facial skin of one volunteer, in a comprehensive manner. (Table 3).
4 |  D I S CU S S I O N & CO N C LU S I O N
By means of hydration, color-related and topographic measure-
ments, this study aimed to demonstrate the benefits of using a
5-step skin care routine twice daily, in comparison with a two steps
routine used once daily, over a duration of 4 weeks.
The AR not only outperformed the SR when it comes to su-
perficial hydration, it was also the only routine capable of im-
proving hydration at a deeper level. This was the most expected
result since both the number of products applied and frequency
of use were greater with the AR. The latter would logically lead
F I G U R E 2   Crow's feet wrinkles (A)
and nasolabial wrinkles (B) depth absolute
changes vs baseline, following the usage
of a SR and an AR during 4 weeks. Bar
Plots describe mean ±95% CI. *signals a
significant difference vs baseline (paired
t test or Wilcoxon matched pairs test,
P < .05). Significant difference between
the performance of the two routines is
shown by the P value between the bar
plots (unpaired t test or Mann-Whitney U
test, P < .05)
F I G U R E 3   Skin roughness (A) and
mean pore area (B) absolute changes vs
baseline, following the usage of a SR and
an AR during 4 weeks. Bar Plots describe
mean ±95% CI. *signals a significant
difference vs baseline (paired t test or
Wilcoxon matched pairs test, P < .05).
Significant difference between the
performance of the two routines is shown
by the P value between the bar plots
(Unpaired t test or Mann-Whitney U test,
P < .05)
to a greater intake of hygroscopic substances for the skin and an
increased layering from both occlusive lipids and polymeric film
formers, as opposed to the SR. Greater moisture content would
in turn, irrespective of the actives contribution in the formulas,
provide additional benefits such as an optimal maturation and
desquamation process of the stratum corneum, 24 diminishing the
flaky appearance of the skin and reducing fine lines. 25 These con-
comitant benefits of hydration were notably seen with the supe-
rior efficacy of the AR over the SR at improving fine topographic
parameters of the skin, here skin roughness and mean pore area.
Both routines reduced the nasolabial wrinkles to a similar extent,
yet the AR significantly surpassed the SR on the crow's feet wrin-
kles, and we may assume that the use of the eye cream played
a key role in the distinct performances. The latter featured so-
dium hyaluronate and brought an additional load of glycols and
anti-aging actives. The benefits of skin hydration upon desquama-
tion would likely explain the discrepancies in performance when
it comes to skin brightness and melanin heterogeneity, since both
MESSARAA et al. |
      5

F I G U R E 4   Skin capacitance (A) and

tissue dielectric constant (B) absolute
changes vs baseline, following the usage
of a SR and an AR during 4 weeks. Bar
Plots describe mean ±95% CI. *signals a
significant difference vs baseline (paired
t test or Wilcoxon matched pairs test,
P < .05). Significant difference between
the performance of the two routines is
shown by the P value between the bar
plots [unpaired t test or Mann-Whitney U
test, P < .05])

F I G U R E 5   Skin brightness (A), melanin heterogeneity (B), and hemoglobin heterogeneity (C) absolute changes vs baseline, following
the usage of a SR and an AR during 4 weeks. Bar Plots describe mean ±95% CI. * signals a significant difference vs baseline (paired t test or
Wilcoxon matched pairs test, P < .05). Significant difference between the performance of the two routines is shown by the P value between
the bar plots (unpaired t test or Mann-Whitney U test, P < .05)

routines had the same day cream featuring SPF 30. The effect of
an AR upon hemoglobin heterogeneity remains unclear as a sig-
nificant improvement from baseline was only observed in the SR.
Nonetheless, the percentage of positive respondents was slightly
in favor of the AR group. Yet, it is worth mentioning that the AR
was not formulated specifically for this type of skin concern but
some data indicate that a routine purely intended to address this
11
type of issue can perform with the right actives.
Beyond the multiple fold quantitative benefits measured with
the use of the AR over the SR, there is also a qualitative dimension of
using an AR. The cleansing step would remove the excess of sebum
in the morning, while cleansing at night would help to remove the
pollution particles and oxidized lipids by the pollution accumulated
over the day. 26,27 Toning would infuse the skin with a first load of hy-
dration. 28 The eye cream would be dedicated to target skin concerns
specific to this area, especially when considering recent evidences
that moisturizers containing SPF are insufficiently applied on this
part of the face. 29 The main purpose of serum would be the delivery
of relevant actives to the skin, for pore reduction, antioxidant, and
anti-aging benefits in the current study. The day cream formulated
with UV filters would bring protection against the sun, and the in-
corporation of specific film formers, here the biosaccharide gum,
would prevent the adhesion of pollution particles throughout the
day. Meanwhile, the night cream would be designed to treat the skin
overnight, in line with circadian rhythm patterns,30 with niacinamide
for the skin barrier and glycolic acid for skin turnover in the present
study.
Putting more effort and time into addressing visible aging signs
is still relevant, regardless of the emerging pro-aging trend, 31 as a
couple of investigations did demonstrate that these signs are used
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6       MESSARAA et al.

F I G U R E 6   A 49-year-old volunteer
before (left) and after 4 weeks (Right) of
using an AR twice daily

TA B L E 3   Percentage of positive respondents for all measured a massaging device with an anti-aging cream when it comes to fa-
parameters with both routines cial wrinkles, texture, and neck sagging. 36 The contribution of a
simple—yet potent—step like the exfoliation, still popular despite
% positive respondents
concerns over irritation or lack of convenience, 37 remains to be
AR (Advanced addressed. Synergistic effects between topical products and well-
  SR (Simple Routine) Routine) ness products to bring “beauty from within” are scarce in the liter-
Superficial Hydration 74 97 ature19 and would benefit from additional data. Lastly, the hedonic
Deep hydration 53 82 aspects of using a routine deserve to be explored as there is a
Skin roughness 50 76 growing number of available techniques of psychometric, physi-
Mean pore area 60 83 ological, or behavioral nature. 38 A gesture as simple as the touch

Crow's feet wrinkles 53 72 convey pleasure, 39 and we believe that the application of a com-
prehensive routine holds strong potential to deliver an improved
Nasolabial wrinkles 65 83
well-being.
Skin brightness 75 86
The above findings promote the use of an advanced routine for
Melanin heterogeneity 70 97
a healthy-looking skin with multiple benefits compared to a simpler
Hemoglobin 65 69
one, by means of objective evaluation. We also advocate for the par-
heterogeneity
allel development of multi-tasking products/boosters to offer flexi-
bility while ensuring performance, within a reasonable time spent in
as cues for age perception by other people. 32-35 Encouraging peo- the bathroom.40
ple to embrace a longer skin care routine should, nonetheless, not
come at the price of safety. Increased exposure to preservatives AC K N OW L E D G M E N T
systems should be managed carefully with appropriate levels to A special thanks to the Oriflame clinical testing team for their help
avoid potential adverse events, while using sound methodology during the data collection and to Céline Marque and Susanne Fabre
to assess the safety of a routine on top of the safety of individual for their support in the writing of this manuscript. This work was
products. It seems equally pertinent to study the impact of apply- funded entirely by Oriflame Cosmetics.
ing multiple products upon skin microbiome and ensure that no
dysbiosis occurs, particularly in the context of very heavy routines C O N FL I C T O F I N T E R E S T
made in K-Beauty. Oriflame is manufacturing and selling skin care products individually
To build on these results, other potential areas warrant addi- and as part of routines.
tional investigations. One of them being the boosting effect of skin
care devices (eg, massaging and microcurrent) upon routine use. A ORCID
previous study demonstrated the increased benefits of combining Cyril Messaraa  https://orcid.org/0000-0002-4948-9949
MESSARAA et al. |
      7

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