Popular skin products

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

Salicylic acid is a widely used compound in various skincare products and medications, known for its ability to treat acne, psoriasis, and other skin conditions. Salicylic acid is a type of beta hydroxy acid (BHA) that is derived from willow bark and other plants. It is a colorless, crystalline organic acid that is soluble in alcohol and ether but only slightly soluble in water. Salicylic acid has anti-inflammatory, keratolytic, and antimicrobial properties, making it an effective treatment for a variety of skin conditions.

One of the primary uses of salicylic acid is in the treatment of acne. It works by penetrating the skin and dissolving the dead skin cells and oil that can clog pores, leading to acne breakouts. Salicylic acid is often found in acne cleansers, toners, and spot treatments. Salicylic acid is also used to treat other skin conditions, such as psoriasis, seborrheic dermatitis, and keratosis pilaris. It is effective in these conditions because it helps to soften and loosen dry, scaly skin, allowing it to be shed more easily. In addition to its skincare uses, salicylic acid is also used in medications to treat pain and reduce fever. It is a common ingredient in over-the-counter pain relievers, such as aspirin.

One of the key benefits of salicylic acid is its ability to exfoliate the skin. By dissolving the bonds between dead skin cells, salicylic acid helps to unclog pores and improve the texture and tone of the skin. This can lead to a smoother, clearer complexion. Salicylic acid also has anti-inflammatory properties, which can help reduce redness and swelling associated with acne and other skin conditions. Additionally, its antimicrobial properties make it effective at killing the bacteria that can contribute to acne breakouts.

While salicylic acid is generally considered safe for most people, there are some risks and considerations to be aware of. Some individuals may experience skin irritation or allergic reactions when using products containing salicylic acid. It is important to patch test any new skincare products and discontinue use if you experience any adverse reactions. Salicylic acid can also increase the skin's sensitivity to sunlight, so it is important to use sunscreen when using products containing salicylic acid to protect the skin from sun damage.

Retinoids are derivatives of Vitamin A that were FDA-approved in 1971. Retinoids have been used to treat hyperpigmentation, scarring, wrinkles, acne, and even cancer. They control several transcription factors such as RAR and RXR within the nucleus of cells, regulating epithelial cell growth and the rate of proliferation. Among the available retinoid products, topical tretinoin is the most potent. They actively work to prevent damage by UV rays, aiding in the anti-aging process. The RAR and RXR receptors increase the production of procollagen, blocking the release of inflammatory markers. 

Oftentimes, many physicians and dermatologists prescribe them with topical antibiotics to work synergistically. The products unclog blocked pores, enter the pores, and kill the bacteria causing the acne. Although the use of retinoids shows high rates of efficacy, it is not immediately added to the treatment regimen until step therapy is completed or further evaluation is completed. Patients with psoriasis are usually prescribed tazarotene which is available as a cream or gel to treat plaque psoriasis. Hyperproliferation of the skin cells is limited and inflammation is decreased. Other products used are adapalene, retinol, tretinoin, and bexarotene. Retinol and adapalene are available over-the-counter at reduced strengths in various products. OTC adapalene is available at a 0.1% concentration, whereas prescription adapalene is available at a 0.3% concentration. World-renowned beauty companies have released retinol products that comply with beauty standards even though they are not FDA-approved. FDA approval is not required for cosmetic products and ingredients as long as color additives are not included. Customers can still reap the anti-aging benefits as retinol converts to tretinoin over multiple steps. 

After prolonged or inappropriate usage, topical retinoids contribute to negative side effects such as skin dryness, redness, scaling, and pruritis. More rare side effects include swelling, blistering, and stinging of the skin. Photosensitivity to UV lights occurs, which is why it is essential to educate the patient on sunscreen to limit exposure to UV lights. For acne patients, a flare-up or purge period is expected upon initial usage. Topical retinoids can be used in pregnant patients, however, due to a few reported cases, the benefits must outweigh the risks of harm to the fetus. Oral isotretinoin, previously known as Accutane, treats severe cases of nodular acne. Isotretinoin is only available through the iPLEDGE Risk Evaluation and Mitigation Program (REMS). This program manages the prevention of fetal exposure to teratogenic drugs such as isotretinoin. With an array of available retinoid products, customers and patients can get the medical and cosmetic treatment they are looking for. 

References

1. https://pubmed.ncbi.nlm.nih.gov/35816071/

2. https://www.medicalnewstoday.com/articles/retinoids#:~:text=Retinoids%20are%20a%20class%20of,in%20immunity%20and%20skin%20health.

3. https://www.aocd.org/page/Retinoidstopical

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2699641/

Benzoyl Peroxide

Benzoyl peroxide is a widely used medication in dermatology renowned for its efficacy in the treatment of acne vulgaris, a common skin condition affecting millions worldwide. This compound, consisting of benzoyl group and peroxide, exerts potent antibacterial and keratolytic properties, making it a cornerstone in acne management.

Acne vulgaris arises from multifactorial causes, including excessive sebum production, follicular hyperkeratinization, bacterial proliferation (notably Propionibacterium acnes), and inflammation. Benzoyl peroxide addresses these underlying factors through various mechanisms of action.

Primarily, benzoyl peroxide functions as a potent antimicrobial agent, exerting bactericidal effects by generating free radicals upon contact with the skin. These free radicals penetrate the bacterial cell wall, inducing oxidative damage and ultimately leading to bacterial death. By targeting P. acnes, a key player in acne pathogenesis, benzoyl peroxide helps reduce bacterial colonization within the pilosebaceous unit, thereby mitigating inflammatory responses and preventing acne lesions.

Furthermore, benzoyl peroxide exhibits keratolytic properties, facilitating the removal of excess keratinocytes that contribute to follicular obstruction. By promoting desquamation and preventing the formation of comedones, benzoyl peroxide aids in unclogging pores and preventing the formation of new acne lesions. Additionally, its anti-inflammatory effects help alleviate redness, swelling, and discomfort associated with inflammatory acne lesions.

Benzoyl peroxide is available in various formulations, including gels, creams, lotions, and washes, with concentrations ranging from 2.5% to 10%. Lower concentrations are often recommended initially to minimize skin irritation and dryness, with higher concentrations reserved for more severe cases of acne or treatment-resistant lesions. The choice of formulation depends on individual preferences, skin type, and the severity of acne.

When incorporating benzoyl peroxide into a skincare regimen, it is essential to start with a small amount and gradually increase frequency and concentration to minimize potential side effects such as dryness, irritation, erythema, and peeling. Additionally, it is advisable to use sunscreen during the day and avoid concurrent use of other potentially irritating products to prevent exacerbating skin sensitivity.

Benzoyl peroxide is often used as monotherapy for mild to moderate acne or as part of combination therapy with topical retinoids, antibiotics, or oral medications for more severe cases. Combining benzoyl peroxide with other agents can enhance efficacy, reduce bacterial resistance, and address multiple aspects of acne pathogenesis simultaneously.

Despite its effectiveness, benzoyl peroxide may not be suitable for all individuals. Some may experience allergic reactions or excessive irritation, necessitating discontinuation of use. Additionally, benzoyl peroxide can bleach hair, clothing, and bedding, so caution should be exercised to prevent discoloration.

In conclusion, benzoyl peroxide is a versatile and effective medication widely used in the management of acne vulgaris. Its antibacterial, keratolytic, and anti-inflammatory properties make it a valuable tool in combating acne lesions and improving overall skin health. With proper use and monitoring, benzoyl peroxide can help individuals achieve clearer, healthier skin and regain confidence in their appearance.

Azelaic Acid

Azelaic acid is a versatile skincare ingredient that is becoming popular in everyday use. Azelaic acid is usually available as a cream in prescription form but now many skincare companies are making their formulations at a lower percentage to the prescription form. By making this product readily available, many can reap its benefits. The benefits of azelaic acid are evening tone, reducing irritation, and smoothing rough skin texture. (As I discuss this in-depth, I will be referring to azelaic acid as AZA for convenience) 

AZA stands out as a widely recognized topical treatment for acne. It has been proposed as a potential primary monotherapy for both non-inflammatory and inflammatory acne. Research indicates that AZA exhibits a triple-action impact on acne, encompassing a keratolytic effect, anti-microbial action, and anti-inflammatory properties. This suggests that AZA may effectively address various pathophysiological mechanisms associated with adult female acne. AZA is a great choice for those who do not want to try oral antibiotics or oral contraceptives. By working closely with their patients, dermatologists can create a unique skincare routine involving AZA that will benefit their patient. AZA products blend seamlessly with other skincare products, allowing you to incorporate them into your routine without concerns that the acid might dominate or neutralize the efficacy of other ingredients.

AZA is often compared to Vitamin C for its ability to reduce the appearance of dark spots and uneven skin tone. “Azelaic acid conquers this concern by helping to interrupt an enzyme (tyrosinase) in skin's uppermost layers that would otherwise lead to uneven skin tone and dark spots” (1).  Unlike vitamin C where its effectiveness is reduced by UV rays, AZA is not photosensitive. This allows AZA to be applied day and night, and in the day it should be followed by sunscreen. AZA is a dicarboxylic acid, which allows for mild exfoliating properties.  “Through the usage of its keratolytic abilities, that is, the way that azelaic acid can break down the dead, dull outer layers of skin, it refines skin texture (1)”. Regular application of AZA can lead to a reduction in clogged pores and bumps, promoting a radiant and healthy complexion.

AZA is a skincare ingredient known for its safety, demonstrating broad compatibility with all skin types and generally being well-tolerated, even by individuals with sensitive skin. AZA is beneficial for those with blemished skin, uneven tone, and bumpy texture as the ingredient can reduce the appearance of dark spots and rough texture. AZA is even suitable for those prone to redness and rosacea as it can be used to calm the skin.

While adverse reactions and side effects to AZA are uncommon, it is essential to be mindful of your skin's response. If you notice signs of irritation, consider reducing the frequency of use (such as applying every other day) or discontinuing use. AZA is generally gentle for all ages and ethnicities; however, if you have sensitive, reactive skin or a compromised skin barrier, the introduction of an active ingredient may lead to dryness, flaking, or irritation. Therefore, it is crucial to monitor your skin's reaction when incorporating any new ingredient into your skincare routine.

References:

1. https://www.paulaschoice.com/expert-advice/skincare-advice/ingredient-spotlight/azelaic-acid-for-skin.html

Popular Skin Products: Snail Mucin

Snail mucin, also known as snail secretion filtrate or snail slime, has gained significant popularity in the skincare industry for its numerous benefits on the skin. While it might sound unconventional, snail mucin has been used in traditional medicine for centuries, and in recent years, it has become a key ingredient in various skincare products. Snail mucin is made up of components like hyaluronic acid, allantoin, glycolic acid, and peptides, which have documented benefits for the skin. 

Snail mucin is rich in humectants, such as hyaluronic acid and glycolic acid, which are powerful water-binding agents. When applied to the skin, snail mucin helps attract and retain moisture, keeping the skin hydrated and plump. This hydration effect is beneficial for all skin types, particularly for those with dry or dehydrated skin, as it helps alleviate flakiness and tightness. It also is beneficial in skin repair and regeneration because it contains a potent combination of glycoproteins, peptides, and growth factors. These compounds stimulate the production of collagen and elastin, essential proteins responsible for maintaining skin elasticity and firmness. As a result, snail mucin helps reduce the appearance of fine lines, wrinkles, and scars, promoting a more youthful complexion. Snail mucin contains allantoin, a compound known for its skin-lightening properties. Regular use of products with snail mucin can help fade dark spots, sunspots, and other forms of hyperpigmentation, resulting in a more even skin tone and a brighter complexion. Another beneficial component of snail mucin is antioxidants including, vitamin E and superoxide dismutase, which help protect the skin from oxidative stress caused by free radicals. By neutralizing these harmful free radicals, snail mucin aids in preventing premature aging and maintaining overall skin health. One of the advantages of snail mucin in skincare is that it is generally non-comedogenic, meaning it is less likely to clog pores and cause acne breakouts.

In addition to the various cosmetic benefits, snail mucin has also been linked to disease benefits. Snail mucin possesses anti-inflammatory properties that help soothe irritated and sensitive skin. This can be particularly beneficial for individuals with conditions like acne, eczema, or rosacea, as it helps calm redness and reduce inflammation. A study done in 2018 showed that snail mucous decreased viability through cleavage of the Poly (ADP-ribose) polymerase (PARP),  and inhibited the metastasis of melanoma cells by blocking integrin function and expression. [2] Another study in 2020 showed that the anti-tumor activity in the melanoma cells was through snail mucin increasing expression of the cytokine TNFα and inhibiting NF-κB. [3] Though there still needs to be more studies done to validate the actual efficacy of it in real-world application in melanoma patients, the possibility of it being used for anti-tumor activity is of growing interest. 

1. Kim, Y., Sim, W., Lee, J., & Lim, T. (2022). Snail mucin is a functional food ingredient for skin. Journal Of Functional Foods, 92, 105053. doi: 10.1016/j.jff.2022.105053 

2. Ellijimi C., Ben Hammouda M., Othman H., Moslah W., Jebali J., Mabrouk H. B., et al. (2018). Helix Aspersa Maxima Mucus Exhibits Antimelanogenic and Antitumoral Effects against Melanoma Cells. Biomed. Pharmacother. 101, 871–880. 10.1016/j.biopha.2018.03.020

3. Premi S. (2020). Role of Melanin Chemiexcitation in Melanoma Progression and Drug Resistance. Front. Oncol. 10. 10.3389/fonc.2020.01305

Olaplex has revolutionized the haircare industry with its claim to repair and protect damaged hair. Olaplex is a hair treatment system that claims to repair and rebuild damaged hair by targeting and reconnecting broken disulfide bonds in the hair shaft. Disulfide bonds are responsible for hair's strength and structure, and they can be compromised by chemical treatments, heat styling, and environmental factors. Olaplex works by introducing a patented ingredient, bis-aminopropyl diglycol dimaleate (often referred to as the Olaplex Bond Building Chemistry), which is claimed to restore and strengthen these bonds.

Olaplex has gained popularity for its ability to repair and restore damaged hair. Studies have shown that Olaplex can significantly reduce hair breakage and improve the overall condition of chemically treated or heat-damaged hair. The treatment aims to rebuild the internal structure of the hair, resulting in improved elasticity, strength, and shine. Olaplex is often used in conjunction with hair color treatments to minimize damage caused by the coloring process. Studies have demonstrated that incorporating Olaplex into hair color treatments can help maintain the integrity of the hair while achieving desired color results. It works by protecting and reinforcing the hair's disulfide bonds during the chemical coloring process, reducing the risk of breakage and preserving the hair's health. Olaplex is believed to strengthen the hair from within, resulting in healthier, more resilient strands. By restoring the integrity of disulfide bonds, Olaplex can enhance the hair's structural integrity, reduce brittleness, and improve overall hair health. This strengthening effect can be particularly beneficial for individuals with damaged or compromised hair.

Several scientific studies have been conducted to evaluate the efficacy and performance of Olaplex. These studies have provided insights into the mechanism of action and benefits of Olaplex for hair health. Here are key findings from notable studies:

1. A Study by Davenport et al. (2017):

This study examined the impact of Olaplex on hair strength and integrity. The researchers found that Olaplex significantly reduced hair breakage and improved tensile strength. The study concluded that Olaplex can effectively repair and restore damaged hair, particularly in cases of chemically treated or heat-damaged hair.

2. A Study by Cho et al. (2018):

This study investigated the effects of Olaplex on hair damage caused by bleaching. The researchers compared the structural and mechanical properties of bleached hair with and without Olaplex treatment. The results showed that Olaplex-treated hair exhibited reduced damage, improved mechanical properties, and enhanced resistance to breakage. The study highlighted the protective and repairing capabilities of Olaplex in the context of hair bleaching.

Olaplex is often used in professional hair salons, and it is essential to have the treatment administered by a trained stylist. Professional application ensures proper product handling and appropriate treatment customization based on individual hair needs. Olaplex offers take-home products for maintenance and ongoing care. These products can help prolong the benefits of in-salon treatments. However, it is important to follow the recommended usage guidelines and consult with a professional for personalized recommendations. While Olaplex has shown promising results in repairing and strengthening damaged hair, individual experiences may vary. Factors such as hair type, extent of damage, and overall hair health can influence the effectiveness of the treatment. It is important to have realistic expectations and understand that results may differ based on individual circumstances.

Olaplex has emerged as a groundbreaking hair treatment system, backed by scientific studies that support its claims of repairing damaged hair and minimizing hair color damage. The patented technology of Olaplex targets and rebuilds broken disulfide bonds, resulting in stronger, healthier hair. While studies have demonstrated the effectiveness of Olaplex, individual variations and proper application should be considered. By understanding the science and studies behind Olaplex and seeking professional advice, individuals can make informed decisions about incorporating Olaplex into their haircare routine for improved hair health and resilience.

References

Testing Results - OLAPLEX Inc.” Olaplex, https://olaplex.com/pages/testing-results.

Popular Skin Products: Tretinoin

There are many topical products that are currently used for the treatment of skin. Skincare routines have become more popular whether it comes to treatment of acne, antiaging, or overall skin health. A major product that gained popularity is tretinoin. This product began to show efficacy in the 1960’s. It became the first retinoid approved for acne by the US Food and Drug Administration. Further, in 1995, tretinoin was approved for wrinkles, hyperpigmentation, and photodamage. The focus for tretinoin has been on reviving aging skin. UV radiation accelerates skin aging greatly by creating reactive oxygen species. Wearing sunscreen and using topical retinoids are useful as preventative measures against damage from the sun.

Tretinoin is a retinoid metabolite derived from Vitamin A. Its exact mechanisms are unknown, but it activates retinoic acid receptors to affect the genes, proteins, and cells of the skin. Tretinoin binds to and activates all three retinoic acid receptors, whereas adapalene and tazarotene only activate two of the receptors. Topical tretinoin helps to clear acne, increase cell turnover, stimulate the formation of collagen, inhibit collagen degradation, and inhibit enzymes that can break down the skin. Tretinoin is approved for acne, hyperpigmentation, and wrinkles.

It is believed that the mechanism of tretinoin in treating acne is the ability to reduce horny-cell adhesion, increase cell turnover, and increase mitosis. Common side effects of topical tretinoin for acne are dry skin, peeling skin, burning, and erythema. Tretinoin can be used in combination with clindamycin and benzoyl peroxide. It is advised for women to avoid the use of topical tretinoin during pregnancy.

There are other retinoids that are also used to treat skin conditions. Isotretinoin is approved for the treatment of acne in capsule form. Studies demonstrated that there was improvement in the appearance of the skin, but there was also lots of irritation associated with it. There have been nanoformulations developed to avoid the irritative side effects, but further studies are necessary. Retinol is another vitamin A derivative that can help produce hyaluronic acid, collagen, and elastin in the skin. Although, it is tenfold less potent than tretinoin. Studies show that a combination of retinol and retinyl esters may have an effect that is comparable to antiaging of tretinoin. Tazarotene is a selective third generation retinoid approved for topical treatment of psoriasis and acne. Its effects are comparable to that of tretinoin with a higher price point. Adapalene is another selective third generation retinoid used to treat acne and used off label for aging. Retinol and retinaldehyde can be found in cosmeceuticals which are not regulated the same as medicines. They are not tested for safety, quality, and efficacy the way that tretinoin, adapalene, and tazarotene are. This makes it difficult to make clinical decisions between other retinoids in comparison to tretinoin. There is a need for further studies to be done for comparison of tretinoin with conventional products and nanoformulations.

Aging is a natural process that is enhanced extrinsically by UV rays from the sun. tretinoin can slow this process down while also combatting other skin conditions. Further studies are required between tretinoin and other retinoid compounds to compare efficacy. Additionally, tretinoin is being further researched for its use in other conditions.

Resources:

Baldwin, H. E., Nighland, M., Kendall, C., Mays, D. A., Grossman, R., & Newburger, J. (2013). 40 years of topical tretinoin use in review. Journal of drugs in dermatology : JDD, 12(6), 638–642.

Milosheska D, Roškar R. Use of Retinoids in Topical Antiaging Treatments: A Focused Review of Clinical Evidence for Conventional and Nanoformulations. Adv Ther. 2022 Dec;39(12):5351-5375. doi: 10.1007/s12325-022-02319-7. Epub 2022 Oct 11. PMID: 36220974; PMCID: PMC9618501.

Written by Aleksandra Agranovich

New Skin Medications on the Market

Vtama (Tapinarof) Cream 1%: This medication is FDA approved for the treatment of plaque psoriasis in adults. Plaque Psoriasis is a chronic inflammatory skin condition that causes patches of red, inflamed, scaley skin. Vtama is a steroid-free medication and is safe to use for regular or long-term treatment. Some common side effects of Vtama may include folliculitis, allergic reaction, and rash or irritation.

Winlvi (clascoterone) Cream 1%: This medication is FDA approved for the treatment of acne vulgaris in patients 12 years or older. Acne Vulgaris is a common skin condition that occurs as a result of hormone production during puberty/adolescence. Winlevi binds to androgen receptors and reduces sebum production to prevent pimples from forming. The most common side effects of Winlevi may include reddening, rash, scaling, and dryness of the skin.

Opzelura (Ruxolitinib) Cream 1.5%: This medication is FDA approved for the treatment of mild to moderate eczema and nonsegmental vitiligo in patients 12 years or older. Opzelura is a JAK Kinase inhibitor that targets cytokines involved in inflammation. The most common side effects of this medication may include the common cold, bronchitis, ear infections, and hives. Some of the more serious side effects of Opzelura may include reduced ability to fight infection, tuberculosis, blood clots, and cancer.

Retinoid Therapy

Topical retinoids such as isotretinoin, adapalene, and tretinoin are commonly used in dermatology to treat various types of skin conditions. Retinoids are indicated for the treatment of acne vulgaris, psoriasis, photoaging, cutaneous T-cell lymphoma, and Kaposi’s sarcoma. These medications bind to and activate retinoic acid receptors to proliferate and differentiate cell growth (Cutan,2022). In addition, retinoids may also be used (off-label) for keratosis pilaris and hyperpigmentation. From a pharmacological standpoint, retinoid molecules are derived from Vitamin A and have a very similar structure. Retinoid molecules are fat soluble and can easily penetrate the skin barrier. The administration of retinoid therapy is contraindicated for woman who are pregnant or are planning to become pregnant. This is a major safety concern because retinoids act directly on the embryo and could cause birth defects. Some common side effects that may result from the use of retinoid therapy include burning and itching of the skin, redness, dryness, and hyperpigmentation.

Resources

Motamedi M, Chehade A, Sanghera R, Grewal P. A Clinician's Guide to Topical Retinoids. J Cutan Med Surg. 2022;26(1):71-78. doi:10.1177/12034754211035091

https://www.winlevi.com/?utm_source=Google&utm_medium=PaidSearch-CPC&utm_campaign=BND_OVP_Decision_Core_ALL_11.2.2022&utm_term=winlevi&utm_content=Core_EXM&gclid=Cj0KCQiA2-2eBhClARIsAGLQ2RkmONg4E4-vi_y5ghatewgowfXQcLOZtvX67ZW0rf8SgKdQJOvlrTUaAtSLEALw_wcB&gclsrc=aw.ds

https://in.rxengage.app/flow?pageId=e2827b97-68c5-419a-b9ba-c1bcef64f71b

https://www.opzelura.com/?utm_source=google&utm_medium=cpc&utm_campaign=OPZ-DTC_Branded_Opzelura_Phrase__%3BS%3BPH%3BBR%3BDRM%3BDTC%3BBR&utm_content=General_P&utm_term=opzelura&gclsrc=aw.ds&&gclid=Cj0KCQiA2-2eBhClARIsAGLQ2Rl2dP8UPvc5o4pOByjWCrXs3WK11o9IpcFlJyH_fIpnGdcsaqJHiEIaAvqUEALw_wcB

Written by Justin Ayob and Antonio Ortega Hyaluronic Acid in Wound Healing Hyaluronic acid is a polysaccharide that abundantly exists in the synovial fluid as a high molecular mass surrounding joints, cartilage, and tissues of the eye and skin. Hyaluronic acid’s physicochemical properties such as biodegradability, biocompatibility, nontoxicity, and non-immunogenicity makes it a versatile therapeutic agent in biomedical applications. A powerful antioxidant, hyaluronic acid is most used for its ability to bond water to tissue. Hyaluronic acid jellies at concentrations of 2% and 4% have been proven to have a protective dose-dependent effect on skin cells exposed to ethanol. Hyaluronic acid prevents apoptosis (mediated by decreased inflammation) and as a result protects against ethanol-induced cytotoxicity. Inability of highly viscous gel concentrations at 8% to penetrate skin cells did not provide ethanol-exposed cells protection against toxicity. Hyaluronic acid was studied in animal models for its wound healing potential in two full-thickness surgical wound models and was found to facilitate re-epithelialization, lead to the formation of soft tissue with good elasticity and increase microvascular density. Hyaluronic acid also showed promising results for connective tissue repair for tendon and cartilage repair in two rabbit models. Hyaluronic acid treatments have improved wound healing, satisfactory aesthetic results, and optimal recovery of affected areas without intervening with functionality of affected area in patients. Hyaluronic acid has been widely used as a therapeutic agent for a variety of applications including osteoarthritis, ophthalmic surgery, cosmetic applications and even tissue engineering. Whether through intradermal injections or topical applications, hyaluronic acid has been proven to be a safe and efficacious agent in facilitating skin repair for patients. References:

· Neuman, Manuela G et al. “Hyaluronic acid and wound healing.” Journal of pharmacy & pharmaceutical sciences : a publication of the Canadian Society for Pharmaceutical Sciences, Societe canadienne des sciences pharmaceutiques vol. 18,1 (2015): 53-60. doi:10.18433/j3k89d

· Sudha, Prasad N, and Maximas H Rose. “Beneficial effects of hyaluronic acid.” Advances in food and nutrition research vol. 72 (2014): 137-176. doi:10.1016/B978-0-12-800269-8.00009-9

Salicylic Acid - Chemical Peels Chemical peeling is controlled chemical injury to the skin using a chemical peeling agent that causes exfoliation of superficial layers of the skin which leads to the removal of superficial lesions. This leads to regeneration of new epidermal and dermal tissues which prompts the rejuvenation of smoother skin and an improved surface texture. Chemical peels can be divided into three categories based on their level of injury to the skin, i.e., superficial, medium-depth, and deep. Salicylic acid’s ability to exfoliate the stratum corneum has made it a useful peeling agent. Its ability to inhibit the formation of comedones make it particularly useful in patients with acne, but has indications as a peeling agent for melasma, photodamage, freckles and lentigines as well. Contraindications for salicylic acid include contact allergy to salicylates, active dermatitis at the peeling site, active infection, use of isotretinoin during the 3-6 month peeling procedure and pregnancy as salicylic acid is classified as a pregnancy category C drug by the US Food and Drug Administration. Standard practice for chemical peeling with salicylic acid involves a 20-30% salicylic acid formulation in an ethanol base. The peels are repeated every 2–4 weeks. Peak results are visible after 3–6 chemical peels varying on the severity of the condition being treated and the patient’s skin type. Salicylic acid is absorbed readily when applied topically to the skin and its absorption can be increased topically when combined with a hydrophilic base or kept under occlusion. In high concentrations, salicylates are toxic to the central nervous system and toxicity can present clinically as nausea, vomiting, dizziness, psychosis, stupor, and consequently coma and death. According to Fung et al who’s study concluded that the relative bioavailability of a salicylic acid skin peep preparation that uses a max formulation of 30% salicylic acid should not pose any significant risks to the systemic health in patients making salicylic acid a safe and useful treatment option as a chemical peel for patients. References

· Lee, Kachiu C et al. “Basic chemical peeling: Superficial and medium-depth peels.” Journal of the American Academy of Dermatology vol. 81,2 (2019): 313-324. doi:10.1016/j.jaad.2018.10.079

· Arif T. Salicylic acid as a peeling agent: a comprehensive review. Clin Cosmet Investig Dermatol. 2015 Aug 26;8:455-61. doi: 10.2147/CCID.S84765. PMID: 26347269; PMCID: PMC4554394.

· Fung W, Orak D, Re TA, Haughey DB. Relative bioavailability of salicylic acid following dermal application of a 30% salicylic acid skin peel preparation. J Pharm Sci. 2008;97:1325–1328

Acetylglucosamine

N-AcetylGlucosamine is a monosaccharide that usually polymerizes linearly through (1,4)-β-linkage. It’s the monomeric unit of the polymer chitin and a basic unit of hyaluronic acid and keratin sulfate on the skin's surface. N-acetylglucosamine functions as an anti-aging skincare product because of its ability to replenish hyaluronic acid. Hyaluronic acid is a key molecule for skin hydration, having an ability to hold 1,000 times its weight in water. The skin remains youthful because of the abundance in hyaluronic acid and high water content.

According to the Journal Dermatoendocrinology, the most dramatic histochemical change in aging skin is the disappearance of hyaluronic acid. Hyaluronic acid is a valuable ingredient in cosmetics, but the molecule weight is too big, making it unable to penetrate the skin effectively. That’s why acetylglucosamine comes in as a building block of hyaluronic acid to penetrate the skin and replenish hyaluronic acid in aging skin. This would increase the water content in the skin and result in a smooth, plump complexion. A study published by the Journal of Cosmetic Science evaluated the effects of acetylglucosamine and topical treatments showed the increase in skin moisturization and decreased in skin flakiness.

Hyaluronic acid has also been linked to having a protective effect on collagen synthesis. Elevated levels of degraded collagen and reduced collagen synthesis is known to cause signs of skin again. By replenishing the hyaluronic acid, acetylglucosamine could indirectly help to protect collagen synthesis. Acetylglucosamine has also shown to reduce the appearance of facial hyperpigmentation by reducing the production of melanin, in a recent research article.

References:

• Anti-aging: Why you should look out for acetyl glucosamine. The Dermatology Review. https://thedermreview.com/acetyl-glucosamine/. Published October 6, 2021. Accessed April 1, 2022.

• Chen J-K, Shen C-R, Liu C-L. N-acetylglucosamine: Production and applications. Marine drugs. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2953398/. Published September 15, 2010. Accessed April 1, 2022.

Carrot Seed Oil

Carrot oil is an essential oil that has started becoming a favorite in skincare. Carrots are rich in beta-carotene, the substance that gives them their orange color, but it has an entirely different effect on the skin. Carrot seed oil has become known for its antibacterial, antioxidant, and anti-inflammatory properties. If the oil has been extracted for skincare, it’s not meant for use internally and should only be used topically

Carrot extract is rich in the beta carotene, which are the antioxidants that are vital in fending off skin-damaging free radicals that are from the environment. Carrot extract also increases cell turnover, as a 2004 study showed that beta-carotene acts as a precursor to vitamin A, the vitamin responsible for cell regeneration, when it’s applied topically. The increased skin turnover would bring the younger, healthier skin cells to the surface. There are also anecdotal reports that indicate that carrot seed oil has anti-inflammatory properties and is soothing to the skin and scalp.

Research suggests that carotol, another compound in carrot seed oil, may reduce the activity of fungi that affect plant growth. There has also been another study that indicates carrot seed oil to have some degree of effectiveness against yeasts. A recent study has also shown that it is effective in combating several strains of bacteria, including listeria monocytogenes and staphylococcus aureus. This gives promising potential as an antibacterial and antifungal agent, but also beneficial for hard to treat infections and for wound care.

It is advised to dilute carrot seed oil with a carrier oil before applying to the skin or scalp. Putting too much carrot extract on the skin may cause that orange tinge on the skin. Most beauty formulations contain only a small percentage of carrot seed oil and typically used once a day, at night. Beta-carotene can easily oxidize and cause skin discoloration and irritation.

References:

• Whelan, C. (2019, October 25). The benefits of Carrot Seed Essential Oil. Healthline. Retrieved March 31, 2022, from https://www.healthline.com/health/carrot-seed-oil#risks

• Peter, S., & Hanson, C. (2022, March 26). Could carrots be the answer to all your glowy-skin dreams? Byrdie. Retrieved March 31, 2022, from https://www.byrdie.com/carrot-skincare

Honey

Honey has been increasing in popularity in the skincare and beauty industry. In its natural form, honey is produced by enzyme activity, plant matter, and live bacteria coming together. The process of creating honey makes it valuable for cosmetic uses, such as clearing acne, healing scars, and evening out skin tone.

Raw honey is backed with components beneficial for the skin, especially for acne or autoimmune skin conditions, like eczema or psoriasis. It helps acne by balancing the bacteria on the skin. Manuka honey has been studied in 2016 as an anti-acne product and is found to be significantly more effective than only using antibacterial soap to treat acne.. Honey speeds up the skin cells’ healing processes and reduces inflammation. It’s unclear how much honey is needed to apply to the skin to treat acne, but it’s possible that applying a small amount of honey to affected areas may help with clearing up acne breakouts.

Eczema is another condition that was studied. In 2017, a small study found that manuka honey helped to reduce the size of eczema lesions on the skin. The study, however, only had 14 participants and calls for large clinical trials to prove that honey can help with eczema. It’s unclear whether regular honey would be effective if used to relieve symptoms of eczema. Psoriasis can also be treated with honey, as a 2014 study showed the effect of medical-grade kanuka honey on psoriasis. The small study showed that kanuka honey was just as effective as aqueous cream in managing psoriasis lesions, but this also requires a larger study to confirm the effectiveness of honey.

If a person is allergic to pollen, celery, or other bee-related products, they should steer clear of using honey on the skin.

References:

• MediLexicon International. (n.d.). Honey for face: Benefits, recipes, risks, and more. Medical News Today. Retrieved March 30, 2022, from https://www.medicalnewstoday.com/articles/honey-for-face

• Watson, K. (2019, January 4). Honey for face: Uses and benefits. Healthline. Retrieved March 30, 2022, from https://www.healthline.com/health/honey-for-face#outlook

Squalene

Squalene is a polyunsaturated hydrocarbon found in certain fish oils, especially shark liver oil, in high amounts and some vegetable oils in smaller amounts. Human sebum contains 13% squalene as one of its major constituents. Squalane is a saturated derivative of squalene and also found in these sources. There has been an interest in squalene after its characterization in shark liver oil because of its use as a traditional medicine for decades. Several studies exhibited results that antioxidant, drug carrier, detoxifier, skin hydrating, and emollient activities of these substances has been reported both in animal models and in vitro environments.

Animal and plant squalene is too unstable to be used in skin care products because it becomes rancid and spoils quickly when exposed to oxygen. Before it can be used in skin care products, squalene must be hydrogenated into squalane, which is a stable form. Hydrogenation converts the squalene from an unsaturated oil to a saturated oil, squalane, and makes the oil more skin-friendly and helps increase shelf life.

Hydrated skin is healthy skin, so squalane has a lot of benefits. By boosting hydration, the skin can appear more vibrant and healthier. The antioxidants in the oils and creams also fight skin damage and free radicals, which can accelerate the aging process. Regular use can also boost collagen production, resulting in firmer skin. For acne-prone or oily skin, squalane is a good alternative for heavy or greasy oils. It’s lightweight and noncomedogenic, not clogging pores. It does penetrate pores and improve skin at the cellular level, but does not feel heavy. It also has anti-inflammatory properties that can reduce redness and swelling.

References:

• Higuera, V. (2020, October 12). What is Squalane and what are its benefits for skin and hair? Healthline. Retrieved March 28, 2022, from https://www.healthline.com/health/squalane#for-acne-or-oily-skin

• F;, K. S. K. K. (n.d.). Biological importance and applications of squalene and Squalane. Advances in food and nutrition research. Retrieved March 28, 2022, from https://pubmed.ncbi.nlm.nih.gov/22361190/

Centella asiatica is a medicinal herb that has been used as a panacea three thousand years ago in China, India, Africa, Philippines, Sri Lanka, and Madagascar. In traditional Asian medicine, the herb C. asiatica has been used for hundreds of years to improve small wounds, scratches, burns, hypertrophic wounds healing, and as an anti-inflammatory agent. It is also used as an antipyretic, diuretic, rheumatic, antibacterial, antiviral drug, treatment of vein insufficiency and for improving cognition, relieving anxiety, and as an anti-cancer agent.

C. asiatica contains triterpenoid saponins known as centelloids. The active compounds include pentacyclic triterpenes, mainly asiaticoside, madecassoside, asiatic and madecassic acids. Centella asiatica works by promoting fibroblast proliferation and increasing the synthesis of collagen as well as acidic mucopolysaccharides, increasing intracellular fibronectin content and mitotic activity in the germ layer, which improves the tensile strength of newly formed skin, which is also by inhibiting the inflammatory phase of hypertrophic scars and keloids.

In cosmetology, centella asiatica has been used as an effective anti-photoaging agent, mainly due to enhancement of type I collagen, which decreases in the skin with age. The action was confirmed in a randomized, double blind clinical trial conducted among 20 female participants with photoaged skin to examine the impact of 0.1% madecassoside with 5% vitamin C on the skin. Six month treatment resulted in a significant improvement in firmness, elasticity, and skin hydration. It is considered that centella asiatica’s beneficial effects come from madecassoside, a known inducer of collagen expression by activating the SMAD signaling pathway. Previous studies also confirmed beneficial effects of 5% vitamin C on photoaged skin, that resulted from stimulation of collagen synthesis in fibroblasts and control of matrix metalloproteinase enzymes responsible for degradation of collagen. Vitamin C and madecassoside creates a synergistic effect, causing the remodeling of the superficial dermis.

Centella asiatica is also confirmed to have an influence on increasing the metabolism of lysine and proline, the amino acids building the collagen molecules. In addition, the compounds increased the synthesis of tropocollagen, and mucopolysaccharides in the connective tissues. Results that were obtained showed the impact of centella asiatica on improving nutrition of tissues and connective vascular simulations. There was also a randomized, double-blind, placebo-controlled trial of the cream trofolastin, which is an extract with C. asiatica, 𝛂-tocopherol, hydrolyzed collagen, and elastin, carried out on 100 pregnant women. Half of them received a placebo and the other half had the trofolastin cream. The test lasted 30 months, which was carried through by 80 women (39 in the placebo group and 41 in the trofolastin group), and the results indicated that the striae occurred in 56% of the women in the placebo group and only 14 women had it in the trofolastin group.

In recommended doses, centella asiatica is not toxic and possible side effects are rare. Although it may cause local allergic reactions and burning, especially when used externally and subcutaneously. Skin problems such as eczema on the fingers and hands after external use for a period of 3 months and a vesicular reaction with pruritus after 20 days of applications were also observed.

References:

• ​​Bylka, W., Znajdek-Awiżeń, P., Studzińska-Sroka, E., & Brzezińska, M. (2013, February). Centella Asiatica in Cosmetology. Postepy dermatologii i alergologii. Retrieved March 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834700/

• Gohil, K. J., Patel, J. A., & Gajjar, A. K. (2010, September). Pharmacological review on Centella Asiatica: A potential herbal cure-all. Indian journal of pharmaceutical sciences. Retrieved March 25, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3116297/

Peptides are naturally occurring in the skin, but they are also in many skin care products. Peptides are amino acids that make up certain proteins needed by the skin. Collagen, for example, is made of three polypeptide chains, so adding peptides can stimulate your skin to make more collagen, leading to firmer, younger-looking skin. Collagen is naturally produced, but over time, collagen production decreases, which can cause the skin to look more wrinkled and less even and bright. Collagen is too large to be absorbed through the skin, which is why many people choose to eat collagen-rich foods or take collagen supplements, but peptides can be absorbed into the skin to be used by the body, hence incorporating peptides into skincare has many benefits for the skin.

With the growth of people’s knowledge on cosmeceuticals, the production of bioactive peptides with natural resources cannot meet the increasing demand of the people. Some researchers use biotechnology to synthesize bioactive peptides to increase the production efficiency and to remedy the disadvantages of poor stability and low skin permeability with peptide structure modification, adjusting the molecular weight of the peptide, or derivatization methods.

Overtime, skin goes through the process of aging which will become dry, lack elasticity, and lines and wrinkles will appear. The mechanism of skin aging can be divided into internal aging and external aging. Internal aging is due to the changes in cell metabolism, hormones, and metabolic processes, resulting in the decrease in elastin, collagen, fibroblasts, hyaluronic acid, and other substances in the skin. External aging is mainly caused by long-term illumination without protection. Other factors like heredity, malnutrition, pollution, diseases, and sub-health lifestyles also play a part in both external and internal aging. Bioactive peptides play important roles as an enzyme inhibitor, for example reducing collagenase and gelatinase activity, signal cascade tigger, which can stimulate the proliferation of collagen, elastin, proteoglycans, and glycosaminoglycans, inhibitor of transmission of neurotransmitters and enhance the muscle contraction and reduce common signs of again, such as wrinkles, and as a carrier to deliver or stabilize trace elements and contribute to wound healing.

Different sources of collagen peptides have different effects on anti-skin aging. It was found that type 1 collagen-derived collagen peptide can stimulate the synthesis of procollagen I, elastin, and fibrin in the skin, increase the synthesis of dermal matrix, and reduce the generation of eye wrinkles by ingesting collagen peptide derived from pig collagen I. Chicken-derived collagen peptide has significant effects on inflammatory changes, oxidative stress, collagen I synthesis, and cell proliferation. Overall, peptides are shown to improve the skin barrier, reduce wrinkles, provide more elastic skin, ease inflammation, and can help clear breakouts.

There are so many products on the market containing peptides, but it’s best to choose a serum or moisturizer that has prolonged contact with the skin. Peptides are often marketed as a miracle cure, but it’s often very expensive, not the most scientifically backed ingredient, and there are many different kinds of peptides, and some won’t have any effect on the skin.

References:

• Zhao, X., Zhang, X., & Liu, D. (2021, August 11). Collagen peptides and the related synthetic peptides: A review on improving skin health. Journal of Functional Foods. Retrieved March 18, 2022, from https://www.sciencedirect.com/science/article/pii/S1756464621003297

• Gallagher, G. (2020, June 12). Peptides for skin: Benefits, what to look for & side effects. Healthline. Retrieved March 18, 2022, from https://www.healthline.com/health/peptides-for-skin

Topical Vitamin C

Topical vitamin C is a dermatologist-favorite ingredient that helps slow early skin aging, prevent sun damage, and improve the appearance of wrinkles, dark spots, and acne. Vitamin C is an antioxidant that fights harmful free radicals (toxins) that come in contact with the skin from external sources like air pollution, smoking, solar radiation or from inside the body as a result of normal processes like metabolism. Free radicals can damage the skin and topical vitamin C can combate free radicals to improve the skin’s overall appearance. Although vitamin C can be obtained in a person’s diet, there’s no way to guarantee it goes to the skin. Using serums and other topical products is the most direct way to get those benefits.

Vitamin C has an excellent safety profile and most people can use topical vitamin C for extended periods of time without any adverse reaction. In rare cases, people with hypersensitive skin may experience minor irritation. It also brightens and impedes melanin production, which can help fade hyperpigmentation and smooth the skin's surface to reduce dullness, giving the skin a youthful glow. Vitamin C inhibits melanin synthesis by downregulating the activity of the enzyme tyrosinase. It interacts with the copper ions at tyrosinase-active sites and inhibits the action of tyrosinase, which is responsible for the conversion of tyrosine to melanin. A clinical study examining the effect of a topical formulation containing 25% vitamin C and a chemical penetration enhancer reported a significant decrease in pigmentation caused by melasma after 16 weeks, but vitamin C effects may not be as effective as other topical products containing hydroquinone.

Serums can help smooth out fine lines by plumping and hydrating the under-eye area. Some people say it can help alleviate discoloration associated with under-eye circles. According to a small study, vitamin C in the form of 10% sodium ascorbate was found to improve dark circles of the lower eyelid after 6 months of use by thickening the eyelid dermis and concealing dark coloration due to congested blood. Vitamin C has also been shown to act as an anti-inflammatory agent through its antioxidant capacity, reducing redness and puffiness.

Collagen is a natural protein that depletes over time and low levels of collagen can lead to fine lines and wrinkles. Vitamin C is known to boost collagen production through collagen synthesis because it is the essential cofactor for the two enzymes required for collagen synthesis, prolyl hydroxylase, which stabilizes the collagen molecule, and lysyl hydroxylase, which provides structural strength. Collagen production is tied to skin elasticity and firmness, and the boost of collagen production from a vitamin C serum can result in an overall tightening effect, which can help reduce the appearance of sagging skin, making the skin look firmer and more toned. Vitamin C is also known to be the primary replenisher of vitamin E, which has a role in protecting cell membranes against oxidative stress and maintaining the collagen network in the skin.

Vitamin C is one of the most powerful antioxidants in the skin. Its clinical application ranges from antiaging to anti-pigmentation and has an excellent safety profile, making it a popular cosmeceutical agent.

References:

• Doyle, A. (2021, November 15). 11 reasons to use a vitamin C serum. Healthline. Retrieved March 16, 2022, from https://www.healthline.com/health/beauty-skin-care/vitamin-c-serum-benefits#how-to-use

• Neera Nathan, M. D., & Payal Patel, M. D. (2021, November 10). Why is topical vitamin C important for skin health?Harvard Health. Retrieved March 16, 2022, from https://www.health.harvard.edu/blog/why-is-topical-vitamin-c-important-for-skin-health-202111102635

• Al-Niaimi, F., & Chiang, N. Y. Z. (2017, July). Topical vitamin C and the skin: Mechanisms of action and clinical applications. The Journal of clinical and aesthetic dermatology. Retrieved March 16, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5605218/

Galactomyces Ferment Filtrate

The luxurious Japanese skincare brand SK-II’s, famed Pitera essence’s primary ingredient is galactomyces ferment filtrate, a nutrient dense yeast extract derived from a controlled natural fermentation product typically from making sake. It’s simply the filtrate of the fermentation of a food substrate by the galactomyces microorganisms. During fermentation, the galactomyces yeast break down natural ingredients that they have been added to, making new compounds that are beneficial for the skin such as amino acids, organic acids, and antioxidants.

Fermented ingredients have become increasingly popular in Korean skincare products but they have not been thoroughly researched like some other skincare ingredients, however there is peer-reviewed research available. There are 4 main benefits that fermented ingredients have for the skin. Vitamins and antioxidants created by the fermentation process helps to strengthen the skin’s moisture barrier, keeping the skin hydrated and prevents water-loss as well as helping to prevent damage from environmental stresses from occurring. There are also amino acids, organic acids, and antioxidants that are created during fermentation to help nourish and hydrate the skin. The fermentation process also helps the skin absorb nutrients more easily and quickly as active ingredients are broken down into smaller parts by the microorganisms. There’s a study that compared the anti-aging efficacy of red ginseng and fermented red ginseng in the treatment of wrinkles, and it was found that fermented red ginseng had an increased efficacy in anti-wrinkle and skin brightening. Lastly, there’s a decreased likelihood of skin irritation because of the anti-inflammatory and antioxidant substances, such as flavonoids, that are created during fermentation.

Galactomyces is like an all-in-one ingredient that can do everything, such as improving the appearance of pores, strengthening the skin barrier, helping to control sebum production, and improving acne, pigmentation, and overall radiance. Galactomyces can help with hyperpigmentation caused by the melanocytes in the cells of the skin because of its ability to decrease the production of melanin. In an in vitro study, melanin in human melanocytes were reduced by 35% when treated with 5% of galactomyces ferment filtrate and reduced by 55% when treated with 10% of galactomyces ferment filtrate, both over a period of 25 days. It’s also shown to strengthen the skin’s barrier by upregulating the differentiation of keratinocytes and activating the aryl hydrocarbon receptor (ahR), which helps protect the skin from water loss and IV damage. There’s also the benefit of reduction of enlarged open pores and black heads by 15% and 21%, respectively, with 97% galactomyces ferment filtrate. Additionally, the 97% concentration also decreased sebum production by 65% and decreased the number of acne lesions by 9%. The antioxidant properties also assist in decreasing skin irritation and the signs of aging.

For benefits from galactomyces ferment filtration, it’s best to choose a first treatment essence because they contain the highest concentrations of galactomyces. First treatment essence is applied right after cleansing the skin, before everything else in a skincare routine. The directions are to pour some essence onto a cotton pad or onto clean hands and gently pat it onto the skin. Some people have also put the first essence into a small spray bottle and mist it onto their faces to ensure every part of the face benefits from the first essence while also making the product last longer.

References:

• Lee, M., Kim, H.-S., Cho, A., Jeon, S. H., Lee, N. K., Ahn, K. J., & An, I. S. (n.d.). The effects of essence-formed cosmetic ingredients containing the galactomyces ferment filtrate on skin improvements in keratinization, pores, sebum excretion, brightness and acne. Kor J Aesthet Cosmetol. Retrieved March 10, 2022, from http://www.e-ajbc.org/journal/view.php?number=697

• What is galactomyces ferment filtrate and how can it improve your skin? Korean Skincare Tips. (2020, January 24). Retrieved March 10, 2022, from https://koreanskincaretips.com/galactomyces-ferment-filtrate/

• Genesis Rivas Jul 15, 2021 @ 2:19 pm. (n.d.). The truth about how skincare ingredients get absorbed into the skin. HelloGiggles. Retrieved March 10, 2022, from https://hellogiggles.com/beauty/skin/does-skincare-get-into-bloodstream/

Hydrocolloid

Hydrocolloid has always been used for wound healing in the medical community. Now, patches with hydrocolloid, or “pimple patches”, have become one of the hottest products for acne. The main rule of acne is “don’t pick”, but it’s hard to resist the temptation every time and it only leads to an open wound with leaking pus, oil, and even blood. This is where pimple patches come in as a spot treatment for each pimple.

Pimple patches are small stickers that work by absorbing any drainage from the pimple and covering the wound to prevent trauma to the site, like picking. The hydrocolloid will gently absorb the excess fluids, like pus and oil, from the pimple and allow it to heal in a somewhat sterile, moist environment and keeps out bacteria, gunk, and dirty fingers that are prone to picking at the site. Just stick the patch on the clean, dry skin, and oozy pimple, then leave overnight. Peel it off in the morning, wash the skin, and slap on another patch if it’s oozy. By absorbing the toxins trapped under the skin, protecting the zit from external bacteria, sunlight, or picking, the patches can accelerate healing. Scars can be minimized with the protection from the finger picking at the pimples as well. There are also hydrocolloid bandages that cover more surface area for multiple pimples.

A lot of pimple patches now will have a layer of acne-treating ingredient or little needle-like darks that will push the ingredients into the skin before dissolving. Salicylic acid and benzoyl peroxide are always good ingredients to look for in the patches. Most patches are small and translucent, providing some coverage of the pimple and treating those problem spots discreetly. With the popularity of pimple patches, there are now ones that are like stickers with stars, happy faces, etc. It’s an attempt to reprogram the negative connotation around breakouts by giving a gold star and focus on acceptance rather than hiding. Confidence destigmatizes acne and wearing a patch can instill confidence in an unapologetic attitude.

Hydrocolloids, however, do not work on cystic zits. Patches don’t work on closed or seep lesions, or even blackheads and white heads. They only work on the traditional oozy, pus-filled bumps that are active and cannot prevent acne from coming. Cystic zits are under-the-skin inflammations that can only be quickly treated with cortisone shots from a dermatologist. A lot of patients with cystic acne can also get superficial acne, which can be treated with pimple patches, so there is a place for people with deeper acne to use patches. It’s still better to see the dermatologist to help with deeper acne.

There are no risks using those patches, unless it’s an allergic reaction to an active ingredient or the adhesive could cause irritation. They won't get rid of un-popped pimple overnight, but they can help treat zits, calm inflammation, speed up healing, and provide the much needed protection from constantly picking at the pimples. Patches are definitely worth a try to get rid of those pus-filled pimples that are popped or about to pop.

References:

1. Chloe Metzger Deputy Beauty Director Chloe Metzger is the deputy beauty director at Cosmopolitan. (2021, September 16). Okay, what's the deal with these pimple patches? Cosmopolitan. Retrieved March 9, 2022, from https://www.cosmopolitan.com/style-beauty/beauty/a28971674/do-hydrocolloid-patches-bandages-work/

2. Do pimple patches actually work? Cleveland Clinic. (2021, October 26). Retrieved March 9, 2022, from https://health.clevelandclinic.org/how-do-pimple-patches-work/ Akers, W. (2020, February 29).

3. Do those pimple stickers actually work? Healthline. Retrieved March 9, 2022, from https://www.healthline.com/health-news/do-those-pimple-stickers-actually-work

Collagen Supplementation for Aging Skin

Dietary supplementation has become more popular in recent years in the United States. Under the Dietary Supplement Health and Education Act (DSHEA) supplements are recognized as foods as opposed to drugs. This means that supplements are not regulated the same way that drugs are. Drugs undergo rigorous testing before they are approved by the FDA to be marketed for consumer use. The manufacturers of supplements are not required to show studies on the efficacy, safety or quality before marketing their supplement products. This may become dangerous because it leaves the task of evaluating each supplement to the consumer who may not have the time or knowledge to do so.

Collagen has become an increasingly popular ingredient in dietary supplements marketed to enhance beauty. Collagen is a protein that is used to make connective tissue and is a major component of bone, skin, muscles, tendons, and cartilage. Our bodies gradually make less collagen as we age, causing the skin to become thinner and drier. Collagen production also decreases due to excess sun exposure, smoking, excess alcohol, and lack of sleep and exercise (Bolke 2019). Collagen supplements are marketed as being able to improve hair, skin, and nails to give a more youthful look.

The efficacy of Elasten, a collagen-containing drink, was studied in a randomized, placebo-controlled trial. Elasten is a high coverage collagen complex which contains short chain oligopeptides composed of 5 to 8, 9 to 15, and 16 to 26 amino acids. These amino acid sequences are those found in human skin collagen proteins. The study population included 72 females ages 35 years or more who were randomized to receive either Elasten or placebo for 12 weeks. Efficacy was evaluated based on skin hydration, skin elasticity, depth of wrinkles, and skin density. At 12 weeks, mean skin hydration was significantly increased in the Elasten group by 28.0% (p<0.0001). Skin elasticity was increased in the Elasten group by 0.81 AU and in placebo by 0.75 AU (p<0.0004). The depth of wrinkles decreased to 118 µm in the Elasten group and to 151.4 µm in the placebo group. At 12 weeks the skin density of the Elasten group increased by 24.8% (p<0.0001) and 6.8% (p<0.0004) in the placebo group. None of the patients in the Elasten group reported any adverse effects (Bolke 2019). This study is promising for the use of collagen to lessen the effects of aging on skin but it is important to note that different collagen supplements contain different types and amounts of collagen so this study does not apply to all collagen products.

While taking collagen supplements can help to decrease signs of aging in the skin, it is worth it to also recognize prevention strategies. We can help to prevent the loss of collagen by limiting sun exposure (or wear sunscreen), getting 7-9 hours of sleep per night, avoid smoking cigarettes, managing stress, and exercising regularly (Collagen 2022).

References:

Bolke L, Schlippe G, Gerß J, Voss W. A Collagen Supplement Improves Skin Hydration, Elasticity, Roughness, and Density: Results of a Randomized, Placebo-Controlled, Blind Study. Nutrients. 2019;11(10):2494. Published 2019 Oct 17. doi:10.3390/nu11102494

Collagen. The Nutrition Source. https://www.hsph.harvard.edu/nutritionsource/collagen/. Published March 2, 2022. Accessed March 7, 2022.

Derma-rolling is a way of stimulating collagen production and can have many benefits on the skin. This technique has gained a ton of popularity in the past few years. Collagen is a protein that serves as one of the building blocks for bones, skin, hair, muscles, tendons, and ligaments. It provides the skin with a youthful and plump look. Many companies have been making devices that help making derma-rolling easy at home. It is a very safe and affordable alternative to visiting a professional for micro-needling. The results won’t be as good, but there are many benefits for derma-rolling at home. Derma-rolling has many benefits such as helping skin texture, making scars appear less noticeable, discoloration, wrinkles, and some people even have found benefits in hair growth. I started derma-rolling a few months ago and have found many improvements in my skin texture and dark spots. The progress has been slow, but there definitely has been a ton of progress and my skin feels much better now than it did months ago. Using the proper serums and skincare products with the derma-rollers is very important. It important to avoid the use of any harsh products when derma-rolling as it can increase the absorption. The increase in absorption can also benefit the skin with products such as hyaluronic acid or niacinamide which would help hydrate the skin more. Hyaluronic acid is the most commonly used product with derma-rolling because it helps keep the skin hydrated and soft. This seems like the most convenient way to treat acne scars as of right now. Although the progress takes time, it’s very inexpensive and easy to do at home.

References:

1. “Collagen Products: Healthy or Hype?” Cedars, https://www.cedars-sinai.org/blog/collagen-supplements.html.

2. Hoff, Victoria. “New to Dermarolling? Here's Everything You Need to Know.” Byrdie, Byrdie, 11 Apr. 2021, https://www.byrdie.com/how-to-use-a-derma-roller.

Bakuchiol

Bakuchiol is a new, natural alternative to retinol. Bakuchiol is derived from the seeds and leaves of the plant psoralea corylifolia. This plant is an herb used in Indian Ayurvedic and Chinese medicines and in Tamil Siddha practices. It contains anti-inflammatory and antibacterial properties, and is used to heal, calm and soothe the skin. Even though bakuchiol does not structurally resemble retinoids, it can function as a functional analogue of retinol. Like retinol, bakuchiol stimulates the growth of collagen. However, it does not decrease the size of oil glands, therefore there is no irritation. Bakuchiol helps to reduce wrinkles and the appearance of pores and increase skin firmness. It is also found that bakuchiol evens skin tone and has anti-acne properties. According to a study comparing retinol and bakuchiol, there was no difference in the efficacy of treating wrinkles and hyperpigmentation. However, those that used retinol had more skin dryness and stinging. Bakuchiol is more gentle and tolerable, but just as powerful as retinol.

Unlike retinol, bakuchiol is generally safe for all skin types. As it is a plant-based ingredient, it is less irritating and safer to use for sensitive skin. It is also safe to use bakuchiol twice a day, in the morning and at night. Unlike retinols, bakuchiol does not interact negatively with other skincare ingredients, so it is safe to use it with other products in a skincare routine. Bakuchiol also doesn’t make the skin more sensitive to the sun like retinol does. However, it is always recommended to wear SPF during the day regardless. References

1. Burcham, Chloe. “Bakuchiol: The New, Natural Alternative to Retinol.” Byrdie, Byrdie, 7 Feb. 2022, https://www.byrdie.com/what-is-bakuchiol.

2. Chaudhuri RK, Bojanowski K. Bakuchiol: a retinol-like functional compound revealed by gene expression profiling and clinically proven to have anti-aging effects. Int J Cosmet Sci. 2014;36(3):221-230. doi:10.1111/ics.12117

3. Dhaliwal S, Rybak I, Ellis SR, et al. Prospective, randomized, double-blind assessment of topical bakuchiol and retinol for facial photoageing. Br J Dermatol. 2019;180(2):289-296. doi:10.1111/bjd.16918

4. Spierings NMK. Cosmetic commentary: Is bakuchiol the new "skincare hero"?. J Cosmet Dermatol. 2020;19(12):3208-3209. doi:10.1111/jocd.13708

Glycolic acid is a water-soluble alpha hydroxy acid (AHA) derived from sugarcane. It is a widely used product for skincare. Alpha hydroxy acids are natural acids that are found in plants. They are made of very tiny molecules that can be absorbed by the skin easily. The small molecule size allows for better exfoliation compared to other AHAs. This property is ideal for smoothing fine lines, improving skin texture, and other anti-aging benefits. Glycolic acid works by speeding up skin cell turnover, which means it sheds dead skin cells quicker than it would on its own. This product also triggers the release of more collagen as well which makes the skin firm, plump, and elastic. Over time, the skin produce less and less collagen. It can also be destroyed by sunlight. Using glycolic acid on a daily basis can help in preserving collagen. There are many benefits of this popular treatment. Some of the benefits are anti-aging, hydration, helping damage from sunlight, complexion, exfoliation, and acne cleansing. One of the cons of glycolic acid is that it does not help with acne scarring which is a major issue in skin care. However, professionals can use a higher strength glycolic acid peel to help with scarring. One of the important things to keep in mind while using glycolic acid is to use sunscreen daily as the skin may be more sensitive to sunlight. Failure to use sunscreen regularly can do more harm than good. Glycolic acid is found in many drug stores and is a very popular product in the skin care world.

References:

1. Palmer, Angela. “How Glycolic Acid Is Used in Skincare.” Verywell Health, Verywell Health, 21 Jan. 2022, https://www.verywellhealth.com/glycolic-acid-15774.

2. Nall, Rachel. “Can Glycolic Acid Help Fight Acne?” Healthline, Healthline Media, 27 Jan. 2022, https://www.healthline.com/health/beauty-skin-care/glycolic-acid-for-acne#_noHeaderPrefixedContent.

Retinoids

Retinoids are vitamin A-based products for the skin. They are commonly used for antiaging to help reduce fine lines and wrinkles. Tretinoin, a type of retinoid, was first used as an acne treatment, but it was later discovered that it also fades actinic keratosis spots, evens pigmentation, and speeds superficial skin cell turnover. Retinoids increase the production of collagen, thus reducing fine lines and wrinkles. It also increases the production of new blood vessels in the skin, thus improving skin color. It may also fade age spots and soften rough patches.

There are three different topical, prescription retinoids: tretinoin (Retin-A), tazarotene (Avage, Tazorac), adapalene (Differin). With adapalene, there is also an over-the-counter version that is less concentrated at 0.1% vs 0.3%. There are also other over-the-counter products with retinoids, such as retinol. However, retinol is not as strong and effective in reducing wrinkles, but they do help in improving the appearance of photo-aged skin. Retinols are used routinely to improve uneven skin tone, pigmentation, and texture.

Many people can benefit from retinoids, but there are some people that may not be good candidates for these products, such as people who have skin allergies, dryness, a lot of redness or inflammation. People with moderate or severe acne scarring, or whose acne is associated with their menstrual periods or other hormonal changes should consult a dermatologist before trying a retinoid. Also, retinoids should not be used during pregnancy.

Side effects of retinoids include dryness and irritation; therefore it is recommended to start off slow and then build it up. For example, using retinoids every other night, and then gradually working it up to every night. It is also highly recommended to wear sunscreen during the day because the skin is more sensitive to the sun with retinoid use.

To see improvements in wrinkles, retinoids must be regularly used for 3 to 6 months, with the best results in 6 to 12 months. It is best to stick to the routine to maintain the benefits of retinoids.

References

1. “Do Retinoids Really Reduce Wrinkles?” Harvard Health, 22 Oct. 2019, https://www.health.harvard.edu/staying-healthy/do-retinoids-really-reduce-wrinkles.

2. “Retinoid or Retinol?” American Academy of Dermatology, https://www.aad.org/public/everyday-care/skin-care-secrets/anti-aging/retinoid-retinol.

Vitamin C

Like other body tissues, normal skin contains high concentrations of vitamin C. It is reported that in aged or photodamaged skin, there are lower levels of vitamin C. Also, there is an association between vitamin C deficiency and the loss of important skin functions such as poor wound healing, thickening of the stratum corneum and subcutaneous bleeding. Therefore, vitamin C is useful in improving the overall appearance of the skin. However, humans are not able to synthesize vitamin C because of the absence of the enzyme L-glucono-gamma lactone oxidase. Even with Vitamin C oral supplements, only a small amount will be biologically available and active in the skin. Therefore, using topical vitamin C is encouraged.

Topical vitamin C has been tested to help slow early aging, prevent sun damage, and improve the appearance of wrinkles, dark spots, and acne. Vitamin C helps stimulate collagen production, promotes synthesis and organization of barrier lipids and induces differentiation of keratinocytes to improve skin texture. Vitamin C is also a powerful antioxidant. Antioxidants fight harmful free radicals from external sources such as air pollution or internal sources such as metabolism because these free radicals can damage the skin. Also, when used with a broad-spectrum sunscreen, vitamin C helps protect the skin from harmful ultraviolet rays. Besides sunscreen, combining with ferulic acid and vitamin E can also help diminish redness and protect the skin from long term damage caused by ultraviolet rays. Vitamin C also decreases melanin synthesis which helps treat skin hyperpigmentation. Additionally, vitamin C has anti-inflammatory properties to control sebum production and acne.

It is suggested that vitamin C be used in the morning with a sunscreen. Vitamin C can be found in serums and creams, so it can be incorporated into a skin routine easily. There may be a mild tingling sensation with the use of vitamin C, therefore start applying it every other day and move on to every day if tolerated. Improvements in the skin may be seen with consistent use in as little as three months.

Vitamin C is available in many active forms: L-ascorbic acid, ascorbyl-6-palmitate and magnesium ascorbyl phosphate (MAP). L-ascorbic acid is the most biologically active. Yet, it has poor penetration into the skin because it is hydrophilic, unstable and charged. It has been found, however, that reducing the acidity to a pH below 3.5 can improve its stability and permeability. Ascorbyl-6-palmitate and magnesium ascorbyl phosphate are lipophilic and stable at neutral pH, but it was found that daily application did not increase the levels of L-ascorbic acid in the skin. Studies have also shown that the vitamin C concentration has to be between 8 and 20 percent for it to be effective. Therefore, when choosing a vitamin C product, it should be in the strength of 10 to 20% and a pH lower than 3.5.

It is still a challenge, however, to develop a stable vitamin C formula and to find the most efficient transepidermal delivery method in maximizing the concentration of active vitamin C in the skin. There are recent studies such as using nanoparticles, multi-layered microemulsions, ultrasound, iontophoresis, laser resurfacing and microdermabrasion to enhance vitamin C penetration into the skin. Though, these studies are small and incomplete.

References:

1. Al-Niaimi F, Chiang NYZ. Topical Vitamin C and the Skin: Mechanisms of Action and Clinical Applications. J Clin Aesthet Dermatol. 2017;10(7):14-17.

2. Neera Nathan, MD, and MD Payal Patel. “Why Is Topical Vitamin C Important for Skin Health?” Harvard Health, 10 Nov. 2021, https://www.health.harvard.edu/blog/why-is-topical-vitamin-c-important-for-skin-health-202111102635.

3. Pullar JM, Carr AC, Vissers MCM. The Roles of Vitamin C in Skin Health. Nutrients. 2017;9(8):866. Published 2017 Aug 12.doi:10.3390/nu9080866

Niacinamide

Niacinamide is a very popular ingredient in skincare due to its many benefits. Niacinamide is an active derivative of vitamin B3 or niacin. It is also called nicotinamide which is an essential water-soluble vitamin that is not synthesized in the body. Niacinamide is not the same thing as niacin, but the body can make niacinamide from vitamin B3 niacin supplements. Vitamin B3 is also found in foods like eggs, cereals, green vegetables, beans, fish and milk. However, to ensure that niacinamide is targeting skin concerns, it is best to use it topically.

It has been shown that niacinamide can act as an antioxidant, improve epidermal barrier function, decrease skin hyperpigmentation, reduce fine lines and wrinkles, decrease redness/blotchiness, decrease skin yellowness and improve skin elasticity. As an antioxidant, niacinamide inhibits oxidative processes such as protein oxidation, glycation and the Maillard reaction, hence the inhibition of skin yellowing and aging. It improves epidermal barrier function by upregulating the synthesis of ceramides and lipids and by stimulating keratinocyte differentiation. This may lead to less irritation and redness. Niacinamide can also increase dermal collagen and protein production and decrease excess dermal glycosaminoglycans. This helps reduce the appearance of fine lines and wrinkles. Niacinamide also reduces melanosome transfer from melanocytes to surrounding keratinocytes resulting in decreased epidermal hyperpigmentation and pigmented spots.

Niacinamide is one of the best ingredients for antiaging, hydration and brightening. It can help minimize the appearance of enlarged pores and textured skin, restore skin’s defenses against moisture loss and dehydration, and visible even out skin tone and discolorations from sun damage. It is present in serums, creams, body lotions, spot treatments and much more. These products come with varying concentrations, with most formulations being 5 percent or less. It is found that 5 percent formulas are effective for hyperpigmentation and sun damage. However, with sensitive skin, a 2 percent formulation should be started first. Niacinamide is generally safe to use, except for people who have preexisting allergies. To avoid widespread allergic reactions and product sensitivities, a patch test can be done by applying a dime sized amount of product onto the forearm and monitoring it for 24 hours for any side effects. If there are no side effects, it is safe to apply elsewhere. Using niacinamide is easy by incorporating it into a skincare routine in the order of cleanser, toner, exfoliant, serums/treatments, moisturizers, and sunscreen. Niacinamide can also be used with other active ingredients for better results, such as AHA, BHA, hyaluronic acid, zinc, hydroquinone, kojic acid and arbutin.

It may take up to 2-4 weeks of twice daily use to see results. This depends on the severity of the skin and the concentration of the niacinamide product. It is also important to note that continued use is necessary for improvement. The skin will not be completely poreless or flawless, but pores may look smaller, skin tone may look more even, fine lines and wrinkles may be reduced and there may be an overall healthier glow.

References

1. Cherney, Kristeen. “Niacinamide: 10 Benefits for Skin, Topical or Supplement, Side Effects.” Healthline, Healthline Media, 29 Aug. 2018, https://www.healthline.com/health/beauty-skin-care/niacinamide.

2. Davis EC, Callender VD. Postinflammatory hyperpigmentation: a review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20-31.

3. Levin J, Momin SB. How much do we really know about our favorite cosmeceutical ingredients?. J Clin Aesthet Dermatol. 2010;3(2):22-41.

4. Stordahl, Desiree. “NIACINAMIDE Benefits: What Does Niacinamide Do for Skin?: Paula's Choice.” Shop Paula's Choice, Paula's Choice, 13 Oct. 2021, https://www.paulaschoice.com/expert-advice/skincare-advice/ingredient-spotlight/how-niacinamide-helps-skin.html.

Benefits of Products Containing Salicylic Acid in Skincare

Salicylic acid has been around for a very long time and is still regarded as an effective acne treatment in skincare. It is a beta hydroxy acid that occurs naturally in plants and helps unblock clogged pores and exfoliate the skin. It works by breaking down the bonds between dead skin cells so they can release from the pores easier and breaking down oils which reduces acne breakouts and leaves skin feeling smoother. Salicylic acid products come in different concentrations over-the-counter ranging from 0.5% to 2%. Trained dermatologists sometimes use chemical peels with a salicylic acid concentration of up to 50%, but this isn’t for everyone.

One of my favorite salicylic acid products is Paula’s Choice Skin Perfecting 2% BHA Liquid Salicylic Acid Exfoliant. I stumbled upon this product about a year ago and have been using it ever since. The main ingredients in this product are 2% salicylic acid and green tea. These ingredients are perfect for my combination skin and helps sooth any irritation that I experience. When using this product, I always moisturize after and apply an SPF moisturizer. Using products that protect the skin from UV radiation is important because salicylic acid makes the skin more vulnerable to sunlight than it already is. My skin has been improving ever since I started using this product and I’ve noticed a significant decrease in acne breakouts.

Another amazing over-the-counter product that contains salicylic acid and works wonders is CeraVe’s SA Lotion for Rough & Bumpy Skin. This product has a combination of top tier skin care products and does a great job in leaving super smooth and moisturized skin. The main ingredients in this product are salicylic acid, ceramides, hyaluronic acid, and niacinamide. This combination is really effective in keeping the pores unclogged and improving texture. This is a product that I use regularly after showering and is an essential in my daily self-care routine.

However, some people aren’t able to use salicylic acid products due to their skin type and side effects to it. People who use salicylic acid products may experience mild burning, mild stinging, peeling skin, dryness, and mild irritation. The FDA also has a list of precautions to take when using products contain salicylic acid. This list includes patch testing prior to use, following labeled directions carefully, avoid use in children, and use sunscreen while using salicylic acid products. Other precautions that should be taken are avoiding ingestion of salicylic acid, stop use if experiencing side effects, and not using multiple salicylic acid products at the same time. The use of salicylic acid also has safety concerns in patients with kidney or liver conditions, allergies to salicylic acid, or pregnant or breastfeeding women.

I highly encourage giving salicylic acid products a try for those who can tolerate them. The have made the greatest impact in my skincare routine and know it can for others as well. My skin texture and acne has improves tremendously since I started using these products about a year ago.

References:

1. Shunatona, Brooke. “Breakouts Don't Stand a Chance against This Powerful Skincare Ingredient.” Byrdie, Byrdie, 21 Sept. 2021, https://www.byrdie.com/salicylic-acid.

2. “Salicylic Acid for Acne: Efficacy, How to Use, and More.” Medical News Today, MediLexicon International, https://www.medicalnewstoday.com/articles/salicylic-acid-for-acne#other-treatments.

Vitamin C For the Skin

One may argue that vitamin C is the world’s most popular vitamin. We hear all about it our entire lives. We are constantly reminded to always get our daily dose of it, especially when we are sick. It can be found as a supplement in several forms over the counter: gummies, chewable tablets, and regular tablets. It is advertised in food products such as orange juice and can even be made into a drink from water with some flavored powdered solutions. Vitamin C in the body is an antioxidant that fights against free radicals, compounds that are created when our body breaks down food or is exposed to radiation. These free radicals have links to heart disease, cancer, and other diseases. Because of the promise of capturing these free radicals and protecting ourselves of harm, we pump Vitamin C into our bodies, especially because our body does not produce this vitamin on its own. Since vitamin C is so great for our bodies on the inside, what about the outside?

Vitamin C serums and creams have taken the beauty market for a spin. Topical delivery of vitamin C, especially to the face has become increasingly popular. Our skin normally contains high levels of vitamin C, an amount that is similar to the vitamin C levels in different internal organ systems of our body. Many reports state that vitamin C levels in the skin may be lower in people of older age as well as skin that has been photo-damaged. Vitamin C, presented as ascorbic acid, is able to penetrate the skin when administered topically and when pH levels of the skin are below 4. The normal range for skin pH falls between 4 and 7. Because of the strict pH level that vitamin C can penetrate the skin when administered topically, it is important to be mindful of other topical applications that one is applying that may cause a shift in levels rendering the vitamin C ineffective. The delivery method of vitamin C has taken many forms such as creams, serums, drops, and even encapsulations into a lipospheric form for better transport into the lower layers of the epidermis.

Vitamin C has a number of positive effects on the skin. Because vitamin C is a co-factor hydroxylase that stabilizes the collagen molecule, it promotes collagen formation. Like its anti-radical function within the body, vitamin C also has an anti-radical effect on the surface of the skin. It can neutralize oxidants that are found in the environments that have easy access to the skin, as well as those found after exposure to UV rays. It is also noted that topically applied vitamin C can reduce the look of wrinkles and fine lines, and even reverse them. The efficacy of prevention of wrinkles or reversal of wrinkles heavily depends on the internal vitamin C status and not just the topical application of the product. Vitamin C’s role in our lives has steadily grown. It is no longer just the vitamin you take when you are feeling sick, but now has a role in preserving our skin as we age.

References:

1. Lambers H, Piessens S, Bloem A, Pronk H, Finkel P. Natural skin surface pH is on average below 5, which is beneficial for its resident flora. Int J Cosmet Sci. 2006;28(5):359-370. doi:10.1111/j.1467-2494.2006.00344.x

2. Mayo Foundation for Medical Education and Research. (2020, November 17). Vitamin C. Mayo Clinic. Retrieved February 3, 2022, from https://www.mayoclinic.org/drugs-supplements-vitamin-c/art-20363932#:~:text=Vitamin%20C%20is%20an%20antioxidant,disease%2C%20cancer%20and%20other%20diseases.

3. Pullar JM, Carr AC, Vissers MCM. The Roles of Vitamin C in Skin Health. Nutrients. 2017;9(8):866. Published 2017 Aug 12. doi:10.3390/nu9080866

Ceramides & Skin

The skin is our most exposed organ and subject to the most damage from outside influences, Compounds that protect the skin from this damage or allow the skin to show this damage less are gaining popularity. Ceramides make up a large portion of the barrier of the skin. They are a major lipid that forms part of the multi-lamellar barrier of the stratum corneum, contributing to 50% of it. Chemically, a ceramide is a sphingoid based conjugated to a fatty acid by an amide bond. They are being included more and more in skin products, especially daily moisturizers. Ceramides create a barrier to prevent the permeability and by doing so helps protect the epidermis from damage. Though the skin already has ceramides in its barrier, over time they are slowly lost. This loss leads to skin appearing duller and drier. Supplemental ceramides found in some brand moisturizers such as CeraVe and Cetaphil mitigate this appearance.

Ceramides can be included in creams, ointments, or lotions. The key to choosing the proper ceramide formulation is knowing what base balances well with your skin. For example, for someone who suffers from oily skin, using an ointment containing ceramides might cancel out the benefits of the ceramides when the oily skin becomes more of an issue. Many ceramide products and their details can be found over the counter, but if unsure of what product to use consulting a pharmacist or dermatologist may be in one’s best interest. Ceramides can also be included in skin cleansers and used twice a day.

There is a difference between synthetic and natural ceramides. Natural ceramides are ones that are already found in the skin and synthetic ceramides are those that are chemically reproduced to mimic what is in our skin and put into skincare products. The difference in the natural and synthetic ceramides is non-existent in terms of efficacy, as long as the skin is receiving some form of ceramide application the results will be the same. Many topical applications of skincare products require a level of understanding of which products can or cannot be combined. Ceramides do not interact with many popular topical applications such as hyaluronic acid, Vitamin C, or Alpha Albumin. In fact, it is recommended that a ceramide-containing product be mixed with these products to achieve maximum benefit for the desired appearance of the skin.

Ceramides are generally safe and there are rarely any reports of adverse effects. Everyone has different skin and so, though this product is generally safe, it is important to test out any product before you apply it to the entirety of an area of skin. A dime-sized amount of product should be applied to a small area, wait 24 hours, and then ensure that no itching, redness, irritation, or other side effects occur before applying the product to a larger area. Ceramide products are becoming increasingly popular in daily beauty products. These ceramides are supplementing the skin’s natural ceramide production and slow the effects of ceramide loss in the skin.

References:

1. Cherney K. Ceramides for Skin & Hair: 14 faqs about benefits, use, side effects. Healthline. https://www.healthline.com/health/beauty-skin-care/ceramide#takeaway. Published August 29, 2018. Accessed January 25, 2022.

2. Vollmer DL, West VA, Lephart ED. Enhancing Skin Health: By Oral Administration of Natural Compounds and Minerals with Implications to the Dermal Microbiome. Int J Mol Sci. 2018;19(10):3059. Published 2018 Oct 7. doi:10.3390/ijms19103059

3. Coderch L, López O, de la Maza A, Parra JL. Ceramides and skin function. Am J Clin Dermatol. 2003;4(2):107-129. doi:10.2165/00128071-200304020-00004

Retinol

Retinol has become a mainstay in several cosmetic lines over the past couple of years. Without a doubt, you will see a type of retinoic formulation on the counter of many people who are looking to maintain an ageless look. The skin is one of the organ systems in the body that undergo constant, harmful stress, especially due to UV rays from the sun. Skin is the most visible form of aging and being that our faces are most oftentimes exposed to the outside world, the face is where most anti-aging cosmetics and formulations are targeted. Skin goes through morphological changes with aging. The skin will start to have a thinner epidermis and dermis along with fewer keratinocytes and dermal stromal cells, but the real culprit to the look of aged skin is the thinning of the dermis. There is also a loss of collagen, the main structural portion of skin, that adds to the thinness as we age. Retinol, also known as Vitamin A, has been shown to produce anti-aging effects on the skin through the TGF-B/CTGF pathway.

Retinoids are the class of Vitamin A derivatives, while retinoic acid is the active form of Vitamin A. Retinol is the precursor to this retinoic acid and is the compound that can be found in the bottles that are purchased from beauty stores. When applied, the retinol penetrates the skin and undergoes a two-step conversion from retinol to retinaldehyde and then to retinoic acid. Though one may think directly applying retinoic acid would produce a better outcome on the skin, using pure retinoic acid can cause more significant side effects such as erythema, scaling, dryness, and pruritus. Retinol works by increasing the epidermal thickness and stimulating keratinocyte proliferation. In addition, it also increases extracellular matrix production by an enhanced TGF-B/CTGF pathway and increases dermal vascularity.

Retinol enhances the TGF-B/CTGF pathway by two mechanisms. The first is by directly increasing the expression of TGF-B1/CTGF and the second is by the inhibition of inhibitory Smad7, which blocks the pathway. The expression of major extracellular matrix proteins is regulated by the TGF-B1/CTGF pathway and the inhibition of Smad7 allows greater expression of the extracellular matrix protein. Overall, the topical application of retinol leads to positive skin changes in the epidermis and dermis through effects on skin cells, epidermal keratinocytes, dermal endothelial cells, and fibroblasts.

Many pharmacy students are familiar with another Vitamin A derivative, tretinoin. Tretinoin has been used for many years in dermatology and most commonly for acne. Tretinoin also has antiaging effects through treating photoaging. Photoaging can be described as the superimposition of photodamage on intrinsically aged skin brought about by premature aging that occurs through multiple chronic exposures of the skin to UV light. Isotretinoin also has antiaging properties that provide improvement in overall appearance, wrinkling, and sallowness of skin. Several Vitamin A derivatives at different concentrations and forms, such as liquids, serums, and creams, provide anti-aging effects and the use of topical retinol has gained popularity in the last few years.

References:

1. Shao Y, He T, Fisher GJ, Voorhees JJ, Quan T. Molecular basis of retinol anti-ageing properties in naturally aged human skin in vivo. Int J Cosmet Sci. 2017;39(1):56-65. doi:10.1111/ics.12348

2. Mukherjee S, Date A, Patravale V, Korting HC, Roeder A, Weindl G. Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety. Clin Interv Aging. 2006;1(4):327-348. doi:10.2147/ciia.2006.1.4.327

There are many products available on the market for skincare. It can often be overwhelming for patients due to the amount of products available on the market. These products can have several different ingredients, and the different combination products can be very overwhelming. Oftentimes, these products carry a hefty price tag. Depending on the ingredients, these products can be hundreds of dollars. As pharmacists, we can receive questions about what would be the most effective skincare routine for anti aging. This is one of the most common concerns, especially for women who are looking to prevent or reduce signs of aging on the face.

One of the most common causes of premature aging is exposure to harmful UV radiation. This can cause damage to the skin, causing an increase in fine lines and wrinkles. Despite the cosmetic issue that is related to harmful UV exposure, this can also increase the risk for skin cancer. Another cause of premature aging is smoking. Smoking damages the collagen and the elastic fibers in the skin. This makes the skin more saggy and less elastic. It also causes hypoxic skin and vasoconstriction, reducing blood flow to the skin. This is another mechanism contributing to premature aging. There is also a link between premature aging and unhealthy lifestyle. Unhealthy diet, lack of exercise, and increases in alcohol consumption can all have a negative effect on the skin.

There are several different strategies for preventing or treating premature signs of aging. One of the more pharmacologic treatments is hormone replacement therapies for females. Decreases in the amount of estrogen can increase the destruction of collagen. Hormone replacement for post menopausal women is linked to increases in collagen. Another method of preventing or treating aging is botulinum toxin. It is a cosmetic procedure using injections to decrease facial muscle contractions causing fine lines and wrinkles. It blocks the release of acetylcholine into the neuromuscular junction. It is very effective, but it is quite expensive. This would not be the right choice for all patients. There are also several antioxidants that can help fight the exposure of skin to the harmful UV radiation. It prevents the reaction of the UV rays with oxidative substances on the skins. Another important part of the skincare is the use of sunblock. Sunscreen is one of the most critical steps in a skincare routine. It prevents the damage that comes with the harmful UV radiation. Some people might ask what SPF they should select when choosing a face sunscreen. SPF 15 is the recommended sunscreen strength. Many patients think that the more SPF, the better the protection. In fact, SPF 30 only provides 4% more protection than SPF 15, and SPF 50 only has about 5% more protection than SPF 15. Therefore, patients should be advised to use at least SPF 15 on their skin.

Anti-aging skincare products can be very overwhelming to patients. The most important advice that we can give as pharmacists is to protect your skin with SPF. If patients do this, they are doing the best for their skin.

1. Shanbhag S, Nayak A, Narayan R, Nayak UY. Anti-aging and Sunscreens: Paradigm Shift in Cosmetics. Adv Pharm Bull. 2019;9(3):348-359.

Microneedling & Dermarollers

In recent years, there has been a rising interest in microneedling and dermarollers for various skin treatments. Microneedling, otherwise known as percutaneous collagen induction therapy, has been utilized for skin tightening, scar remodeling and hair growth. Because of the post-inflammatory hyperpigmentation that can occur in darker skin types after laser procedures, microneedling is often preferred. A standard medical dermaroller used in procedures has 192 fine microneedles that are 0.5-1.5 mm in length and made of silicon or stainless steel. It is pre-sterilized by gamma irradiation and intended for a single use only. Prior to the procedure, patients receive anesthesia. Topical lidocaine is applied in the area for 30 to 90 minutes, and it is then cleansed with alcohol.

The procedure consists of rolling done 15-20 times in horizontal, vertical, and oblique directions. This creates mini wounds in the dermis, inducing the wound healing cascade. Type I collagen expression increases, along with glycosaminoglycans, vascular endothelial growth factor (VEGF), fibroblast growth factor (FGF)-7, epidermal growth factor (EGF), and transforming growth factor (TGF)-β, which are all key signaling molecules for the production of collagen. This results in the tightening of skin and decreased appearance of scars. The entire procedure usually takes around 30 minutes and one session can cost from $100 to $700 per session, it is not covered by insurance. It will take more than one session for the treatment of moderate acne scars and is recommended to wait at least six weeks between session as this is the amount of time it takes for new collagen to form. Studies have shown boxcar and rolling acne scars improved greatly with microneedling while icepick scars were not as successful in treating. Adverse effects include pin-point bleeding during the procedure which occurs in every case, post-procedure pain/discomfort/burning, erythema and swelling. Aggressive treatment can result in “tramtrack” scarring resembling a crisscross hatch.

Microneedling may not be economically feasible for everyone, thus companies have capitalized at-home dermarollers. Because consumers do not have training to perform such a procedure, the needle lengths are far smaller to reduce the risk of self-injury. They are popularly used to enhance the transdermal delivery of skincare products such as serums. Nonetheless, if not careful, at-home dermarolling can cause substantial damage, so one should consult a professional first for serious concerns.

References:

Doddaballapur, Satish. “Microneedling with dermaroller.” Journal of cutaneous and aesthetic surgery vol. 2,2 (2009): 110-1. doi:10.4103/0974-2077.58529

Juhasz, Margit L W, and Joel L Cohen. “Microneedling for the Treatment of Scars: An Update for Clinicians.”Clinical, cosmetic and investigational dermatology vol.13 997-1003. 22 Dec. 2020.

The Benefits of Green Tea for Our Skin

The benefits of green tea have been no secret to those in the Eastern Hemisphere as it has been widely integrated into their skincare regimens for many centuries. However, in recent years green tea has taken the Western world by storm, emerging in households, cafes and in the skincare industry. Green tea is derived from the Camellia sinensis plant. Its components include polyphenols (catechins), amino acids (L-theanine), alkaloids (caffeine, theobromine, and theophylline) and many more. The effects of green tea differ depending on what layer of the skin it is acting upon. Strong antioxidant activity is evident in the stratum corneum of the epidermis, preventing oxidative damage caused by reactive oxygen species. Polyphenols in the deep layers of the skin have illustrated protection against UV radiation and disrupted the activity of various enzymes such as metalloproteinase, hyaluronidase and collagenase, known to cause skin aging due to their destructive influence on hyaluronic acid, elastin and collagen. Polyphenols also exhibit anti-inflammatory activity, improving skin microcirculation. This is because of their radical scavenging properties, which interrupt inflammatory processes. Improved microcirculation results in better oxygenation and increased nutrients reaching the skin. Polyphenols also indirectly boost vitamin C levels by preventing their oxidation which is key for the production of collagen.

Green tea has also shown advantages in the treatment of acne. Excess sebum production is one of the major constituents resulting in acne vulgaris. Research has suggested acne patients have increased phosphoinositide 3-kinase-Akt-mammalian target of rapamycin complex 1 (PI3K-Akt-mTORC1) signaling which induces sebum production. A major catechin found in green tea called EGCG lead to decreased mTOR phosphorylation and mTORC1 activity. EGCG has also shown to decrease the growth of P. acnes and reduce inflammation caused by P. acnes.

A split body comparative study was performed in 2013, where one group used green tea on one cheek and placebo control on the other and the second group used topical green tea and lotus on one cheek and placebo control on the other. A sebumeter was utilized to measure sebum secretion on both cheeks at baseline and days 15, 30, 45, and 60. After 60 days, both groups had significantly reduced sebum secretions compared to their respective placebo groups (green tea only: 27% reduction, p = 0.006 and green tea-lotus combination 25% reduction, p = 0.002). We can conclude from the studies results, that green tea is effective in the treatment of acne.

Reference:

Karamooz, Vida. “Green with Envy: How Green Tea Became Skin Care's Latest Super Ingredient.” DERMASCOPE, June 2016.

Koch, Wojciech. “Applications of Tea (Camellia Sinensis) and Its Active Constituents in Cosmetics.” US National Library of Medicine National Institutes of Health, Nov. 2019.

Saric, Suzana. “Green Tea and Other Tea Polyphenols: Effects on Sebum Production and Acne Vulgaris.” US National Library of Medicine National Institutes of Health, Mar. 2017.

Serum-

As we age, us humans are naturally prone to brown spots, wrinkles, and general dullness. Of course this isn’t ideal for anyone. Many females believe that serums can help reverse these future problems. Serums are either water or oil-based liquids that you spread on your face. Only a couple drops are needed to treat your whole face- the rule less is more comes into play here. It is important not to confuse it with a moisturizer or any other skincare product. A typical morning face skin care routine is a cleanser, toner, serum, moisturizer, and lastly sunscreen. These concentrated formulas are designed to penetrate deeply through the skin in order to effectively deliver the nutrients needed to prevent impending skin problems. “I definitely recommend serums for anyone who is concerned about aging. It’s a really good way to get extra anti-aging effects, more than your typical moisturizer and sunscreen,” Dr. Waldman states in the Harvard Health Publishing article.

There has been an ongoing debate as to how to both choose and use a skin serum. Aforementioned, serums are typically applied to the face after cleansing but before moisturizing. There are a wide variety of serums with some only having one main ingredient while others have multiple ingredients aimed to target multiple skin problems. These skin problems include dry skin, acne, dull skin, and wrinkles. Single ingredient serums typically have vitamin C as the key ingredient and multiple ingredient serums typically have vitamin C, vitamin E, and ferulic acid as the key ingredients. Vitamin C is key as a lot of literature has effectively demonstrated that it targets many different future skin problems including but not limited to helping to stimulate the growth of new collagen (skin elasticity), reverse skin damage from ultraviolet (UV) rays, and can even prevent brown spots from occurring. Vitamin C in particular functions as an antioxidant for sun protection, creating a more even skin tone, and preventing premature aging of the skin.

Different formulas are designated to target different skin problems. Glycolic acid and kojic acid can help target discoloration and fight blotchiness. In contrast, if the problematic areas include dryness and flakiness of the skin, a combination of glycolic acid, vitamin E, and niacinamide is a more optimal regimen. As evident, skin serums are not created equally and when searching for the perfect one, a person should look at what problematic areas she or he would like to target and fix. It is important to note that, however, skin serums can have powerful ingredients that can potentially irritate one’s skin. It’s essential to be cognizant of ingredients which can be possible irritants and to go to a dermatologist if need be for a consultation on what’s best for one’s skin. A common epitome of a problem when utilizing a skin serum that can be easily fixed is if one’s skin is sensitive to ingredients such as Vitamin C, one can substitute Vitamin C for retinol cream instead. These simple changes can easily enable one to pick the right serum for themselves and inevitably optimize their skincare routine.

References-

Skin serum: What it can and can’t do. Harvard Health Publishing- Harvard Medical School. https://www.health.harvard.edu/blog/skin-serum-what-it-can-and-cant-do-2018061214029

How to properly use different serums? Daily Sundial. https://sundial.csun.edu/163507/sundialbrandstudio/sundial-marketplace/how-to-properly-use-different-serums/

Top 3 benefits of Vitamin C Serum. Medical News Today. https://www.medicalnewstoday.com/articles/325801

Squalane Oil

Squalene is a lipid produced naturally by your own skin cells, as you age, the amount of squalene declines. Squalene isn’t only natural in humans, it is also found in olives, rice bran, and sugarcane. It can harvest from shark livers as well. For this oil to be incorporated into skin care produces it needs to be hydrogenated into squalene (squalene Is unstable when exposed to oxygen). Hydrogenated is a process which convers squalene from and unsaturated oil into a saturated oil, resulting in an increase in shelf life. Squalane improves moisture, but also fights skin damage and free radicals due to its antioxidant properties. Using squalane regularly increases collagen production to increase skin firmness. Since squalane is safe for all skin types, it’s lightweight and non-comedogenic, meaning it won’t clog your pores. Additionally, squalane has anti -inflammatory properties that reduce redness and swelling. This makes squalane good for eczema.

With any new product you introduce into your regimen, there is a risk of an allergic reaction, no matter how safe the product is. If you’re using squalane for the first time, don’t apply over a large area of your body, instead do a patch test (apply the product to a small section on your arm 1st ) to make sure you are not allergic to it. Signs on an allergic reaction include itching, redness, and swelling. Lastly when purchasing squalane, make sure the label says 100% plant derived. Some skin care brands source saualane from sharks which is not cruelty free or sustainable.

Kim SK, Karadeniz F. Biological importance and applications of squalene and squalane. Adv Food Nutr Res. 2012;65:223-233. doi:10.1016/B978-0-12-416003-3.00014-7

Collagen

Collagen Is the most abundant protein in the human body, found in bones, muscles, skin, and tendons. There are at least 16 types of collagens but 80 – 90 percent of the collagen in the body consists of types I, II, and III. The purpose of collagen is to help with tissues elasticity. As you age, the amount of collagen in your body decreases. High sugar diets increase the rate of glycation a process where blood sugars attach to proteins to form new molecules called advanced glycation end products (AGE). AGEs damage nearby proteins and can make collagen dry, brittle, and weak. The chemicals found in tobacco also causes damage to collagen. Nicotine narrows blood vessels in the outer layers of the skin, reducing the delivery of nutrients and oxygen to the skin. Even more, ultraviolet rays cause a rapid breakdown in collagen, damaging the fibers and causing elastin buildup, as the skin tries to rebuild itself, it forms wrinkles. Autoimmune disorders can cause antibodies to target destruction of collagen. Amongst the beauty community, collagen supplements are all the rage, and any anti-aging regimen will incorporate some type of collagen supplement. However, do collagen supplements even work? Some doubts include not knowing if the stomach acid will prevent supplements from being ingested into the tissues.

In one study, 60 healthy female subjects between 40-50 years were separated into 3 groups: topical formulation, oral supplementation, and oral placebo. The study evaluated the stratum corneum water content, skin viscoelasticity, dermis echogenicity, and skin pores parameters to see if collagen peptide supplementation works. The group with the topical formulation showed a significant increase in the stratum corneum water content and skin elasticity after 28-day period and also acted in the dermis echogenicity after 90 days with the formulation with peptides. The oral supplementation acted on skin elasticity and presented a more pronounced effect on dermis echogenicity, reducing skin pores after 90-day period.

Additionally, when it comes to topical formulations of retinol and tretinoin, they significantly promote collagen formation and are more reliable than creams containing just collagen.

Collagen injections are used to improve contours of the skin and fill out depressions., Fillers containing collagen are used to improve scares and remove lines and wrinkles from face. These fillers are sourced from humans and cows. Skin tests should be done before using collagen from cows, to avoid aggravating any allergies.

Wound dressing is another popular use of collagen by attracting new skin cells to wound area and promote healing by proving a platform for new tissue growth. Wound dressing is used in second degree burns (but not 3rd degree wounds), skin grafts, granulating wounds, and chronic wounds not responding to other treatment.

References:

Collagen Products: Healthy or Hype? Cedars. https://www.cedars-sinai.org/blog/collagen supplements.html. Accessed June 9, 2021.

Lodish H, Berk A, Zipursky SL, et al. Molecular Cell Biology. 4th edition. New York: W. H. Freeman; 2000. Section 22.3, Collagen: The Fibrous Proteins of the Matrix. Available from: https://www.ncbi.nlm.nih.gov/books/NBK21582/

Maia Campos PMBG, Melo MO, Siqueira César FC. Topical application and oral supplementation of peptides in the improvement of skin viscoelasticity and density. J Cosmet Dermatol. 2019;18(6):1693-1699. doi:10.1111/jocd.12893

Niacinamide is a water soluble vitamin that is used by the body as a source of niacin, or vitamin B3. It is a component of two coenzymes which is necessary for tissue respiration, lipid metabolism, and glycogenolysis, FDA indicated for use with the disease pellagra. While this product is commonly seen in tablet form in the pharmacy world, it is also a popular skincare product and active component of many moisturizers and serums. When used in skincare regimens, it is marketed to build up keratin and a lipid barrier which in turn keeps the skin healthy, firm and moisturized. It is also marketed to minimize redness, blotchiness, pore appearance, fine lines and wrinkles. It’s often an ingredient of choice in people suffering from acne, especially inflammatory acne with pustules and papules, because it regulates oil and reduces acne lesions on the skin. Most products for Niacinamide vary in strength, the 5% formulation being effective in treating hyperpigmentation, while the 2% formulation showing benefits in reducing redness in conditions like eczema or acne. Niacinamide alone comes as a serum, but can be found in lotions, moisturizers and creams. The product is very safe to use on the skin, the only risks being irritation or a hypersensitivity reaction. It’s best to do what’s known as a patch test: applying a small amount of product on the back of the hand or forearm and waiting. If no side effects occur, it’s safe to use on the face.

Niacinamide is often more effective and commonly seen in combination with Hyaluronic acid. Hyaluronic acid is a glycosaminoglycan that is naturally found in the body throughout the connective tissue. It’s the main component of what gives the skin its structure and moisture. It performs as a humectant and holds water molecules onto the surface of your skin, making it anti-aging, anti-wrinkle, wound-healing, moisturizing, and elasticity-increasing. The diameter and molecular weight of the hyaluronic acid formulation are actually important factors when using it. Smaller molecules will be able to get deeper into the skin, making it more effective for wrinkles and deep moisture. In terms of molecular weight, HA between 50 to 1,000 kDa is the most beneficial for skin, with about 130 kDa being the best. Anything higher won’t make too much of a difference, and anything lower might not benefit in wound healing. The main side effect is inflammation which usually only occurs if the wrong product is selected or if it’s over-used. Allergic reactions do not occur considering this an ingredient found naturally in our bodies. Hyaluronic acid has multiple FDA approved indications and has become an increasing popular skin care product. Common moisturizers in stores today have both Niacinamide and Hyaluronic acid as active ingredients.

1. https://www.healthline.com/hyaluronic-acid-for-skin

2. https://www.healthline.com/health/beauty-skin-care/niacinamide

3. Niacinamide (Lexi-drugs). Hudson, Ohio. Lexicomp, Inc. 2021

Azelaic acid is a topical product available both over the counter and through a prescription for the treatment of acne and rosacea. Its two FDA approved uses are acne vulgaris and rosacea, however the product over the counter is only for acne and gentle skin benefit. The most common brand name seen is Finacea, which comes in a foam or a gel and is used for the treatment of inflammatory papules and pustules of mild to moderate rosacea. Generic Azelaic acid is more commonly in cream form, indicated for the treatment of mild to moderate inflammatory acne vulgaris. It’s important to note that Azelaic acid is usually an adjunctive therapy for acne and is rarely the only medication a patient will use for their acne. While it’s used more often in prescription strength form and has been around for a while, it has recently been developed as a weaker strength form available to buy in stores.

There has been increasing popularity in Azelaic acid suspensions sold by skincare companies like the Ordinary and Paula’s Choice. It is marketed as a product that brightens the skin tone while visibly improving uneven skin texture and reducing signs of congestion, and as a multi-functional ingredient that offers antioxidant support. Prescription strength is usually 15 or 20% while the marketed option is 10%. Its actual mechanism of action and how it works for both acne and rosacea is mostly unknown. There is speculation that it decreases microcomedo formation for acne. It is also stated to clear pores of bacteria that may be causing irritation or breakouts, reducing inflammation so acne becomes less visible, less red, and less irritated, and gently encouraging cell turnover so your skin heals more quickly and scarring is minimized. Similar to other acne products, it takes weeks to see an improvement or change in skin, its onset of action being about four weeks. For acne, it should be used for about a month, but for rosacea it needs to be used at least 3 months.

Burning, stinging, tingling and irritation are the most common adverse effects seen with the use of Azelaic acid. The main warnings include hypersensitivity, photosensitivity and hypopigmentation. For acne, it should be applied twice daily (morning and night) in a thin layer on the face. For rosacea, it is applied the same way. Important counseling patients for a patient include washing their hands before and after, reduce frequency of use if irritation occurs, apply to a clean and dry face, and to shake the bottle well if using the foam.

1. Azelaic Acid (Lexi-drugs). Hudson, Ohio, Lexicomp, Inc. 2021.

2. Finacea (azelaic acid) foam [prescribing information]. Madison, NJ: LEO Pharma Inc; December 2020.

Adapalene is a common skin care product used for chronic acne that is available over the counter as Differin 0.1% gel. All other forms of Adapalene are prescription strength only. Adapalene is a derivative of retinoic acid, which modulates cellular differentiation, keratinization, and inflammatory processes, all of which represent important features in the pathology of acne vulgaris. Retinoids act through retinoid acid receptors (RARs) to regulate the proliferation and differentiation of epidermal cells that are critical to acne pathogenesis. This medication is only available topically in creams, gels or lotions (most commonly gel), and its only FDA approved use is for acne vulgaris. It is typically applied once a day in the evening or right before bed, but may need to be used only a few times weekly then gradually increased to daily dosing. It is fairly strong and can be harsh on the skin, often causing irritation.

An important thing to note when looking at Adapalene gel is its pharmacokinetic and pharmacodynamic profile. Its onset of action is about eight to twelve weeks, meaning that every day, long term use is necessary to achieve any type of result. Adapalene only delivers trace amounts of drug into actual circulation, so the only known side effects are topical or local to the area the medication is applied to. There is no evidence of systemic toxicity due to Adapalene use. The main warnings or precautions include hypersensitivity reactions, photosensitivity or skin irritation. Adverse effects can look like xeroderma, exfoliation, burning and stinging on the skin. There are important counseling points that we as pharmacists are responsible to tell our patients using Adapalene gel, to either prevent adverse effects or ensure successful treatment.

Patients using a product like Differin should avoid the sun or use proper protection from UV rays like sunscreen, sunglasses and clothing. They may burn more easily while using this medication. They also should avoid using any other irritating products or wax their skin. A very important thing to make known is that the skin may get worse before it gets better, but it’s essential to keep using it for the drug to be able to reach the onset of action where the skin will show improvement. A mild transitory sensation of warmth or slight stinging may occur shortly after application, and patients should be applying it at night onto a clean face. We can also remind our patient of the benefits while they patiently wait to see any: Adapalene regulates skin cell turnover to prevent pores from clogging, acts as an anti-inflammatory to reduce redness and swelling, and restores a healthy skin texture and tone by clearing acne.

1. Adapalene (Lexi-drugs). Hudson, Ohio, Lexicomp, Inc. 2021.

2. Adapalene Topical Solution (Adapalene) [prescribing information]. Canton, MS: Allegis Holdings, LLC; May 2019.

3. Differin Gel 0.1% (adapalene) [prescribing information]. Fort Worth, TX: Galderma; June 2018.

Building a proper skincare routine has become an increasingly popular trend that has patients looking all over the internet to read about products and regimens that work best for everyone. Truth is, great skin isn’t solely based on one's DNA and each regimen is personally tailored to each patient. I have done some research on what to include in a basic skincare regimen.

A skin-care routine should involve three basic steps- cleansing, toning, and moisturizing. These steps are the framework and other products can be added that can be changed along with a person’s skin needs. It is important to note that while a quick fix is what society strives for these days, results of a proper skincare routine come with weeks of consistent use. Experts say results could take as little as six weeks of daily use to notice a difference.

Finding the right cleanser is important based on one’s skin type. Essential healthy oils are needed on your skin so using a cleanser that strips all of the oils off the face is not ideal. Also, exfoliating should be limited to once a week, so a daily cleanser should not have abrasive ingredients. Washing the face morning and night will help avoid clogged pores, dullness, and acne.

Toners should be thought of as supplements when being added to a regimen. They are thin liquids used to give an extra shot of nutrients to the skin while balancing one’s complexion. Specific ingredients can be added to toners to add another layer of skin replenishment. Alpha and beta hydroxy acids can be added to remove dead skin cells that can contribute to clogged pores, and can improve sun damaged skin, all while minimizing dullness. Hyaluronic acid is an ingredient most talked about today. Hyaluronic acid helps to boost hydration and plump the skin to help treat fine lines and wrinkles. Hyaluronic acid works by preventing epidermal water loss by sealing water onto the skin. Rosewater and green tea can be used to calm irritation and reduce redness with its anti-inflammatory effect. Vitamins E and C can also be added to toners for their anti-aging effects. They fight daily exposure to free radicals that can age the skin. A toner should be applied to the skin immediately after cleansing and before applying anything else to the skin.

Moisturizers should be used to hydrate and soften the skin. They prevent water loss and should be used year-round. There are different moisturizers for different skin types. For example, those with oily skin should use a moisturizer gel. While those with dry skin should use a moisturizing cream. Moisturizers should be different for day and night. One’s daily moisturizer should have a built-in broad-spectrum SPF of at least 30. Sunscreen should be applied to the face daily, whether or not the sun is shining or if the temperature is warm or cold. Sunscreen plays a critical role in preventing the formation of certain skin cancers. A nightly moisturizer can be thicker to provide the skin with more moisture at night.

These three products are a part of the foundation of any skin regimen. Serums, creams, and masks can be added to tailor the regimen to meet each person's wants and needs. It is always important to remember skincare does not need to be expensive and consistency is key with product use.

References:

Jegasothy, S Manjula et al. “Efficacy of a New Topical Nano-hyaluronic Acid in Humans.” The Journal of clinical and aesthetic dermatology vol. 7,3 (2014): 27-9.

Molvar K. How to Build a Skin Care Routine. The New York Times. https://www.nytimes.com/guides/tmagazine/skincare-routine. Accessed January 26, 2021.

Hyaluronic acid is one of the best ingredients that can be used in skin care to prevent wrinkles. Hyaluronic acid is a glycosaminoglycan, which means that it is a substance that is part of the skin’s youth supporting matrix. Hyaluronic acid works to keep the skin stable, feeling renewed, and moisturized. It also works as a humectant which means that it draws moisture from its surroundings. Humectants hold water molecules onto the surface of the skin to keep it hydrated and are often found in water-based products such as moisturizers and serums. They have the ability to help boost hydration for all skin types, and can help heal dry, dehydrated, and aging skin. Hyaluronic acid prevents trans epidermal water loss by making sure water doesn't escape from the skin surface at a fast rate. Lastly, hyaluronic acid is also a post biotic, which means that it is a naturally occurring probiotic found in the skin's microbiome breakdown.

Researchers have found that one gram of hyaluronic acid can hold up to 6 liters of water. However, it also acts by not giving the skin too much water, which can break down substances that normally hold the skin surface together. When an individual’s skin is still young, it is capable of holding onto a significant amount of water and can retain a balance for moisture. As we age, our skin loses its ability to hold onto water, and this results in a loss of firmness, pliability, and plumpness in the skin. Hyaluronic acid works by adding moisture back into the skin which helps smooth the appearance of lines and wrinkles. In addition, hyaluronic acid is incredibly gentle and is able to be used on all different skin types. It could be used on the most sensitive, redness prone skin because it has natural calming benefits that is also suitable for breakout-prone skin. The diameter of hyaluronic acid is important because it determines how well it will penetrate into the skin. It is a substance that is under 500 Daltons which means that it's able to change the depth of wrinkles, increased moisture, increase elasticity around the eye, and is absorbed into the skin much better. Larger molecules greater than 500 Dalton’s have a more difficult time passing through the skin barrier and providing these anti-aging effects.

Since hyaluronic acid has a very low molecular weight, it has the potential of carrying other unwarranted chemicals and bacteria into the skin. if someone has compromised skin to begin with, they should cautious about using hyaluronic acid because it can cause bacteria to become easily trapped into the surface of the skin. Hyaluronic acid also plays a crucial role in wound healing. In a 2016 review article, hyaluronic acid was found to speed up wound healing by controlling inflammation and redirecting blood vessels to areas of damaged skin. Interestingly enough, another 2016 study observed that hyaluronic acid helped diabetic foot ulcers heal more quickly compared to standard wound dressing materials. It's fast healing properties are due to the fact that it's a major component of the extracellular matrix.

https://onlinelibrary.wiley.com/doi/abs/10.1111/wrr.12428

https://www.woundsresearch.com/article/hyaluronic-acid-inflammation-and-tissue-regeneration

Jegasothy, S Manjula et al. “Efficacy of a New Topical Nano-hyaluronic Acid in Humans.” The Journal of clinical and aesthetic dermatology vol. 7,3 (2014): 27-9.

Ultraviolet rays are absorbed through the skin leading to sunburns, skin cancer, wrinkles, and hyperpigmentation. A natural source of UV ray is the sun and artificial sources can be tanning beds, fluorescent lights and lasers. To prevent damage from UV rays, it is key to wear proper sun protection factor (SPF). SPF greater than 30 is required for proper coverage of both UVA and UVB protection. As you age and have longer sun exposure your skin starts to get damaged. Skin care companies advertise many products which may not be safe or effective long term. According to the American Academy of Dermatology, it is necessary to use the right products in order to maintain the overall look and health of your skin. A key component is avoiding the use of multiple products.

It is important to determine if your skin type is normal, oily, dry, sensitive, or a combination. Your skin type will help assist which products are best suited for you.

Managing skin care can become costly with the numerous products offered. It becomes difficult to decide which products are necessary and which are ineffective. Consumers must recognize it is important to understand the active ingredient in these products to determine if the product is required. Common products dermatologists recommend are moisturizers, retinol, niacinamide and vitamin C. Every individual’s skin type is different and may not tolerate some products. It is best to test the product before incorporating it into a skin care routine.

Moisturizers are used to hydrate the skin, prevent extreme dryness, or oiliness. Dehydrated skin may appear dull or flaky. Retinol is a derivative of vitamin A that penetrates the skin and helps with cellular processes to promote growth, division, and reproduction. Vitamin A is also known to have antioxidant properties. Antioxidants are substances that can help protect your skin cells against the effects of free radicals. Free radicals can be produced when your body undergoes processes to break down food or when exposed to irritants, such as tobacco smoke and radiation. Free radical exposure might play a role in diseases such as cancer, heart conditions, or other diseases. Niacinamide works by increasing the production of proteins known as keratin. It can help reduce the appearance of wrinkles and smoothen the texture of the skin. Often used for anti-aging or skin conditions like psoriasis. Vitamin C is another substance that allows for the biosynthesis of collagen. Collagen can help with hyperpigmentation of the skin. Vitamin C also has antioxidant properties that prevent damage of the skin from free radicals. Many of these products are naturally occurring and can be incorporated into our daily diet and skin care routine. Excessive use or intolerance may have damaging effects such dryness or discoloration. Being mindful of how much to use daily and the concentrations of these substances becomes crucial for proper skin care management. Some ingredients may penetrate the skin faster so smaller amounts of product are needed for it to be effective. Skin care management can start from adolescence to adulthood but UV ray protection is always necessary.

References:

Gehring W. Nicotinic acid/niacinamide and the skin. J Cosmet Dermatol. 2004;3(2):88-93. doi:10.1111/j.1473-2130.2004.00115.x

Levin J, Momin SB. How much do we really know about our favorite cosmeceutical ingredients?. J Clin Aesthet Dermatol. 2010;3(2):22-41

Mindreactor. (2019, February 06). The Importance of Moisturizing. Retrieved August 28, 2020, from https://www.utmedicalcenter.org/the-importance-of-moisturizing/

Vitamin A. (2017, October 27). Retrieved August 28, 2020, from https://www.mayoclinic.org/drugs-supplements-vitamin-a/art-20365945

Skin care tips dermatologists use. (n.d.). Retrieved August 28, 2020, from https://www.aad.org/public/everyday-care/skin-care-basics/care/skin-care-tips-dermatologists-use

Skin aging is a process that consists of intrinsic and extrinsic aging. Intrinsic aging, a natural process that occurs over time, is caused by hormonal changes that occur with increasing age such as the gradual decreased production of sex hormones from the mid-twenties and onward. The second is extrinsic aging, which is the result of exposure to external factors, mainly ultraviolet radiation. Approximately 80% of facial skin aging is attributed to UV-exposure. UV radiation damage initially causes a mild wound which, at first, has an increase of dermal hyaluronic acid. 5 minutes of UV exposure in mice caused enhanced deposition of HA, indicating that UV radiation induced skin damage at an extremely rapid rate. Youthful skin has resilience and pliability, among others, due to its high content of water. Injury, in addition to the normal process of aging, causes a loss of moisture. The key molecule involved in retaining this skin moisture is hyaluronic acid which has a unique ability to retain moisture in the skin. In addition, functions of hyaluronic acid also include the lubrication of joints, the filling of empty space, and the framework through which cells migrate to and from. In the study comparing hyaluronic acid to placebo, 76 females with periocular wrinkles applied hyaluronic acid twice daily around one eye and applied a vehicle control cream around the other eye. Measurements of skin hydration and skin elasticity were performed before treatment and 60 days after treatment. All hyaluronic acid based creams in this study show a significant improvement in skin hydration and overall elasticity values when compared to the control cream. Measurements of wrinkle depth using mean roughness and maximum roughness values revealed significant improvement in the hyaluronic acid group after 60 days of treatment when compared to the placebo-treated area.

References

Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: A key molecule in skin aging. Dermatoendocrinol. 2012;4(3):253-8.

Pavicic T, Gauglitz GG, Lersch P, et al. Efficacy of cream-based novel formulations of hyaluronic acid of different molecular weights in anti-wrinkle treatment. J Drugs Dermatol. 2011;10(9):990-1000.