Hyaluronic acid is a popular ingredient used in skincare regimens today that can be found in products ranging from serums to sheet masks. It is a non-sulfated glycosaminoglycan molecule that occurs naturally in the skin in the extracellular matrix molecules. Hyaluronic acid is an important component in skin moisture because of its ability to retain water molecules therefore acting as a humectant. Skin aging is affected by both intrinsic and extrinsic processes. Intrinsic processes are unpreventable and include hormonal changes as you age such as decreased estrogens and androgens leading to less collagen. Extrinsic processes include ultraviolet radiation exposure which causes skin damage. As you age, hyaluronic acid polymers shrink and the epidermis loses hyaluronic acid which leads to dehydration, atrophy, and loss of elasticity of the skin. There was a double blind, randomized study done to evaluate the effectiveness of a hyaluronic acid based product to decrease aging signs and improve face volume in wrinkles. The tested product was called Fillerina and the study was done with 40 female subjects with 20 divided into the 2 groups. The subjects’ loss of volume of their face contours, cheekbones and lips as well as wrinkles depth and volume were measured before the start of the study and after day 7, 14, and 30. Compared to the placebo group, the treatment group had an improvement in skin sagging and decreased wrinkle depth and volume. The placebo group had a slight worsening of their skin sagging but this can be due to normal differences in how much a person's skin sags. Overall, it was shown that the use of hyaluronic acid can improve skin moisturization and the appearance of aged skin.
References
Nobile V, Buonocore D, Michelotti A, Marzatico F. Anti-aging and filling efficacy of six types hyaluronic acid based dermo-cosmetic treatment: double blind, randomized clinical trial of efficacy and safety. J Cosmet Dermatol. 2014;13(4):277-287. doi:10.1111/jocd.12120
Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: A key molecule in skin aging. Dermatoendocrinol. 2012;4(3):253-258. doi:10.4161/derm.21923
Isotretinoin is a systemic retinoid derived from Vitamin A that is primarily used for severe, nodulocystic acne that is unresponsive to conventional therapies. Although extremely effective in inducing long term remission, isotretinoin is associated with numerous dermatologic and systemic adverse effects. Thus, this medication requires strict monitoring and patient education when prescribing/dispensing.
Common dermatologic side effects include cheilitis (dry, cracked lips), xerosis (dry skin), desquamation, photosensitivity, and epistaxis secondary to some mucosal dryness. The extent of these side effects are dose dependent and may emerge within the first few weeks of treatment. To help manage this dryness and discomfort, patients are advised to use moisturizers, lip balms, and artificial tears. In addition to these dermatologic side effects, there are numerous systemic risks, one of which being teratogenicity. As a result, patients using isotretinoin are required to adhere to the iPLEDGE REMS program. This requires patients of reproductive potential use at least two forms of contraception and to undergo monthly pregnancy testing prior to refills. Other systemic side effects include hyperlipidemia, hepatotoxicity, and mood disturbances like depression.
With this medication, routine laboratory monitoring would include baseline and periodic lipid panels, liver function tests, and pregnancy tests. Although lab monitoring is not required, it is important to continue to assess risk factors, evaluate medication regimens, and to ensure adequate follow up. As a pharmacist, it is our responsibility to ensure compliance with iPLEDGE, reinforce the necessity of contraception, counsel for adverse effects, and screen for drug interactions; particularly with tetracyclines and vitamin A supplements. Overall, isotretinoin remains as a cornerstone treatment for severe acne, but requires careful, multidisciplinary management.
Layton AM. The use of isotretinoin in acne. Dermatol Ther. 2009;22(5):393–403. doi:10.1111/j.1529-8019.2009.01253.x
Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.e33. doi:10.1016/j.jaad.2015.12.037
Bremner JD, Shearer KD, McCaffery PJ. Retinoic acid and affective disorders: the evidence for an association. J Clin Psychiatry. 2012;73(1):37–50. doi:10.4088/JCP.10r06426
Chia CY, Lane W, Chibnall J, Allen A, Siegfried E. Isotretinoin therapy and mood changes in adolescents with moderate to severe acne: a prospective study. Arch Dermatol. 2005;141(5):557–560. doi:10.1001/archderm.141.5.557