Photo: Tretinoin treatments, courtesy Drugs.com.
According to Dr. David E. Bank, director of the Center for Dermatology, Cosmetic & Laser Surgery, researchers discovered the anti-aging properties of Retin-A, a prescription topical treatment containing a derivative of vitamin A, in 1985, when it was first used as an acne treatment. Patients reported decrease in the appearance of wrinkles and smoother skin, in addition to a reduction in acne.
The active ingredient in Retin-A, tretinoin (brand name Renova), is the only chemical to date to receive FDA approval for anti-aging and anti-sun damage properties. According to research by Fisher et. al cited by Dr. Leslie Baumann in Cosmetic Dermatology, retinoids are effective in preventing and treating the collagen loss caused by photodamage. UV exposure decreases collagen types I and III with 24 hours, but treatment of the skin with all-trans retinoic acid prevents the loss of these types of collagen synthesis. In addition, Fisher et. al demonstrated that application of tretinoin inhibits the induction of matrix metalloproteinase genes (more here), which are in part responsiblefor collagen degradation.
Side effects of retinol include skin irritation, desquamation, and redness. In addition, use of vitamin A derivatives has been associated with birth defects, and so it is advisable for women who are pregnant, breast-feeding, or those who may become pregnant to avoid use of tretinoin, retinol, or retinyl palmitate. It is further notable that patients with sensitive skin should use lower concentrations of tretinoin (0.025% rather than 0.1%) or, alternatively, lower concentrations of different metabolites of vitamin A, namely retinol or retinyl palmitate. According to Dr. Baumann, retinol and retinyl palmitate should be present in concentrations of at least 0.04% to 0.07% and packaged properly (to avoid oxidation) in order to be effective, as they are in Neutrogena Healthy Skin with SPF 20 ($19.99, Drugstore.com) and Roc Retinol Actif-pur ($16.99, Drugstore.com).
So how are retinol and retinyl palmitate related to the proven-effective tretinoin? According to Dr. Baumann, retinol is classified as a cosmetic rather than a drug because it must first be converted to retinaldehyde, and then all-trans retinoic acid within the skin in order to be effective. In general, retinol is considered to be about 20 times less potent than retinoic acid, and thus higher concentrations of retinol need to be used to achieve similar efficacy to all-trans retinoic acid (i.e., 0.04% or 0.07% versus 0.025%). However, although retinol needs to be present in higher quantities than tretinoin in order to be effective, patients typically experience lower levels of irritation using retinol products. Similarly, retinyl palmitate is a combination of pure retinol and palmitic acid (a substance typically used in cosmetics as a cleansing agent), and so it too must be converted to retinaldehyde and then all-trans retinoic acid within the skin in order to be effective. However, when present in sufficiently high concentrations, retinyl palmitate displays results similar to that of retinol. One caveat: based on information from Dr. Baumann’s site, make-up products with retinol will expire approximately one month after opening, so use accordingly.
Tretinoin itself is available in five prescription formulas: Retin-A Micro (Johnson & Johnson), Renova (Johnson & Johnson), Avita, Differin (Galderma), and Tazorac (Allergan). According to Dr. Bank, Retin-A Micro uses microsphere technology to allow a more sustained release of tretinoin over time. Some patients may find Retin-A Micro drying, in which case Renova, a product with tretinoin delivered in a mineral-oil base, may be recommended. A third option, Avita, is considered to be less irritating than Retin-A Micro, but without the mineral-oil base that can stimulate acne in some patients. The fourth option, Differin, contains a different chemical, adapalene, and is considered to make skin less photo-sensitive than other tretinoin products. Lastly, the newest product, Tazorac, contains tazarotene, and may be drying, but was approved by the FDA in 1997 for the treatment of acne. According to Dr. Baumann, a 2000 study by Kakita et. al found that the efficacy of tazarotene 0.1% gel is clinically comparable to 0.1% tretinoin [in Retin-A Micro] and 0.025% gel tretinoin[Renova] and adapalene 0.1% gel [Differin].
Vitamin-A derivatives are thereby considered to be excellent prevention and treatment against the signs of aging caused by ultraviolet rays. However, the effects of vitamin A derivatives on sensitive skin can be harsh. As such, provided one is not breast-feeding, pregnant, or may become pregnant, s/he should talk to their dermatologist about making the right choice of tretinoin, retinol, or retinyl palmitate for a part of their anti-aging routine on a daily basis.
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September 30th, 2007
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Photo source: Murad.com
According to a recent Allure.com reader poll, 36% of respondees most dreamed of a cure for cellulite. And why not? Cellulite affects approximately 85-98% of women of all races. According to Dr. Leslie Baumann, it is caused by the irregular extrusion of adipose tissue (i.e., fat) into the reticular and papillary dermis (see below). This process may be exacerbated by weight loss. Baumann cites the research of Draelos et. al as having the most likely theory of the cause of cellulite: decreased circulation in the thighs and buttocks leads to increased amounts of enzymes that destroy elastin and collagen (elastase and collagenase, respectively), which in turn leads to the gaps in the dermal structure where fat cells peek through.
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There are currently four methods commonly used to treat cellulite: creams with methylxanthine; retinoids; herbal supplements; and Endermologie.
Methylxanthines include caffeine, theophylline (a component of green tea), and aminophylline. According to Draelos et. al, creams with methylxanthines are phosphodiesterase inhibitors. When phosphodiesterases are inhibited, this activates ß-adrenergic receptors, which in turn break down fat into its glycerol and fatty acid components. Methylxanthines may alternatively or additionally work by dehydrating the fat cells, decreasing their appearance through the skin. The exact mechanism by which methylxanthines work is not known; however, it has been demonstrated that methylxanthine creams should be used continuously for sustained results. Methylxanthines may be found in Neutrogena Anti-Cellulite Treatment, Retinol Formula ($18, Amazon.com) in the form of caffeine, and University Medical De-Cellulite Time-Released Anti-Cellulite System ($16.70, Amazon.com) in the form of aminophylline.
The retinoid tretinoin, available in the prescription formula Retin-A, has been demonstrated to increase the rate of cell turnover, to increase levels of collagen I in the skin, and to antagonize the induction of collagenase (Baumann). However, the effects of retinol on cellulite are not clear. (Retinol may be converted to tretinoin in the skin.) In a 2000 study by Pierard-Franchimont et. al, it was found that retinol affected skin tensions: elasticity was increased by 10.7%, while viscosity was decreased by 15.8% at retinol-treated sites, leading to a smoother skin appearance overall. However, the number of fat cells in retinol-treated areas did not appear to change, indicating that retinol may improve the skin overlying the fat cells, but not the fat itself. More research on the effects of retinoids/retinol oncellulite need to be conducted. For now, the ingredient is available with methylxanthines in Neutrogena Anti-Cellulite Treatment, Retinol Formula ($18, Amazon.com).
Herbal supplements have often gotten a bad name in the cellulite business, and for good reason: Rexall Sundown, Inc., the makers of Cellasene, an herbal supplement with ginkgo biloba, sweet clover, lecithins, and evening primose oil claiming to reduce cellulite, was sued in a class-action lawsuit in 2000 for $12 million. (more here). Today, other herbal supplements are on the market, which seem to be backed by more substantiative science. These include the Murad Anti-Cellulite Body Firm and Tone Supplement Pack ($135, Amazon.com), an A.M. and P.M. vitamin pack with numerous antioxidants and essential fatty acids. Dr. Murad, a pharmacist, dermatologist and associate clinical professor of dermatology at UCLA, treats cellulite nine ways; over the course of eight weeks, Murad’s program claims to reduce cellulite by up to 69% via vitamin supplements, creams and exfoliants (see above), increased water intake, exercise and exfoliation. Murad’s complete program is available here.
The final method commonly used to treat cellulite is Endermologie, an in-office, handheld machine that “kneads” the skin of cellulite-affected areas. The patient is covered in a nylon stocking, and his or her skin is sucked and kneaded between the rollers for 35 to 45 minutes (Baumann). The treatment is done approximately fourteen times, with 1-2 sessions per week. The cost per session is $80 to $130. However, there is strong ambiguity as to whether or not Endermologie is effective. A 1998 study in the journal Aesthetic and Plastic Surgery with 85 women between the ages of 21 to 61 found that 46 patients who completed seven sessions showed a mean index reduction in body circumference of 1.34 cm, while 39 patients who completed 14 sessions of treatments showed a mean index reduction in body circumference of 1.83 cm (Barrett). However, another study, involving 52 women, found no objective difference in thigh girth (at two points) or thigh fat depth. (Barrett) It thereby seems that Endermologie is not an effective solution to cellulite.
So what is a woman with cellulite to do? It seems that more research on cellulite needs to be conducted. At the present time, the best bet seems to be daily use of cream with methylxanthines, to improve the appearance of the fat cells, and retinol, to improve the appearance of the skin above the fat cells; both are available in Neutrogena Anti-Cellulite Treatment, Retinol Formula. In addition, although Murad’s complete eight-week anti-cellulite program is a bit pricey ($210), it promotes exercise, extra water intake, and antioxidant-rich vitamins, which are all beneficial to your health and overall well-being. The program also offers a 30-day money-back guarantee, so at the very least, you have been taking your vitamins and exercising for a month. My final bit of advice is to avoid crash-diets, which may exacerbate cellulite formation. Overall, however, more research clearly needs to be conducted in this area, and hopefully I will one day be writing with exciting, effective updates.
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September 29th, 2007
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Spider angiomas, also called spider nevi, are common and benign tumors, usually bright red and small (1 mm), made of blood vessels. According to Dr. Mark Crowe, M.D., a spider angioma consists of a central arteriole with radiating thin-walled vessels; the entire lesion is usually 0.5-1 cm in diameter. Commonly found on the face, neck, upper part of the trunk, and arms, spider angiomas may be present in as many as 10-15% of healthy adults and children. Usually, spider angiomas resolve themselves in young children, but are usually permanent without treatment in adults.
Spider angiomas may be caused by a number of factors. In women, spider angiomas normally develop during pregnancy, or while taking oral contraceptives, in both cases due to increased levels of estrogens. According to a 1999 study cited in the Journal of Postgraduate Medicine, Li et al. found that patients with elevated levels of estrogens and certain vasodilators demonstrated elevated levels of substance P; they postulated that this substance may play an important role in the pathogenesis of spider angiomas. However, spider angiomas usually resolve spontaneously within six months postpartum, or within six to nine months after discontinuing use of oral contraceptives. Other causes of spider angioma include hepatic (liver) cirrhosis, malignant liver disease, and other hepatic dysfunctions.
Cosmetic treatment of spider angiomas is conducted via electrodessication (the sealing off of blood vessels by monopolar high frequency electric current), intense pulsed light (IPL) laser, or liquid nitrogen treatment. According to Dr. Crowe, the risk of a scar is slightly higher with electrodessication than laser, but both generally yield desirable results. In electrodessication, the site is first briefly anesthesized by intradermal injection. Following, a 30-gauge needle is inserted directly into the central papule. The doctor moves the blood out of the spider by pressing firmly on the lesion and moving his finger to one side; following, the central arteriole is sealed off by electric current. In laser treatment, the intense pulsed dye laser heats the hemoglobin in the blood cells, which in turn cauterizes the vessels that make up the angioma. Angiomas can also be treated with liquid nitrogen therapy. Liquid nitrogen is a cold, liquefied gas that is sprayed on the skin with a spray gun; this works by freezing and destroying the blood vessels. According to the University of Illinois, removal of a spider angioma by any method may cause bruising, tenderness, focal changes in skin pigment, or tiny scars, and some angiomas may reappear after treatment.
Women with purely cosmetic concerns of spider angiomas should be advised to quit oral contraceptives (to lower the levels of estrogen in their blood). All patients with spider angiomas should reduce alcohol consumption. In a 1994 study by Ino et al., it was found that higher numbers of spider angiomas occurred in patients with alcoholic cirrhosis than those with cirrhosis due to hepatitis C viral infection. Patients are advised to speak to their dermatologist about whether electrodessication, laser, or liquid nitrogen are viable treatments for them. If professional treatment is not sought, a cover-up cream used for melasma or port-wine stains may be advisable, such as Neostrata Coverblend or Dermablend for Severe Skin Flaws.
I hope those with spider angiomas find this information helpful. If you have additional information, please comment below.
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September 27th, 2007
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Leave it to Patricia Wexler, the fashion-forward, world-famous Manhattan-based dermatologist, to put a phrase like “matrix metalloproteinase” on the map. Matrix metalloproteinases (MMPs) are collagen-degrading enzymes that play an important role in the aging picture. In a 1996 study by Fisher et al., it was found that UV exposure increase MMPs (and hence collagen production) in three steps, as mentioned in Cosmetic Dermatology. One, UV exposure increases the production of the transcription factor c-jun. Two, the “extra” c-jun combines with another transcription factor already present in high concentration, c-fos, to produce activator protein, AP-1. Three, AP-1 activates the MMP genes, which produce collagenase, gelatinase, and stromelysin-1. It may further be noted that there are twenty-three human MMPs, and MMP-1 has been found in studies to be the MMP responsible for collagen degradation.
In addition to UV radiation, MMPs are activated in other ways that are similar to free radicals: the natural aging process, environmental stresses, smoking, and pollution. And, similar to how natural antioxidants keep free radicals in check, the body naturally produces Tissue Inhibitors (TMPs) to keep levels of MMPs down. Unfortunately, however, as people age, MMP activity increases, while levels of Tissue Inhibitors (TMPs) decrease.
Matrix metalloproteinase activity can be stopped in two ways. The first is to prevent their production. This is best done with a sunscreen with high UVB protection (UVB has been directly liked to MMP production by Fisher et al.) Fortunately, the best UVB protection is easy to find: look for the sunscreen with the highest sun protection factor (SPF), a direct measure of UVB protection. The second method is to stop the degrading activities of the MMPs. According to Dr. Wexler, there are several substances that act as MMP inhibitors (MMPis): epigallocatechin-3-gallate (a derivative of green tea), retinoic acid, eicosapentaenoic acid (an omega-3 fatty acid), beta-carotene, DHEA (though this is controversial), polysaccharides, vitamin E, and vitamin C, and flavonoids. Research has shown all of these inhibit MMPs and increase TIMPs.
Patricia Wexler’s MMPi Skin Regeneration Serum uses MMPis to inhibit MMP activity in skin cells by more than 80%. According to Wexler’s website, MMP relative inhibition potency in competing products ranges from 1.6 – 15.4%; in Wexler’s serum, the same potency is 100%. Very exciting indeed.
So how does Wexler’s MMPi Skin Regeneration Serum fit into the anti-aging skin regimé? Based on current research, the ideal anti-aging regimé contains five elements: exfoliating ingredients at least once/week, antioxidants for free-radical protection, retinoids (not always for those with sensitive skin) for increased skin-cell turnover and collagen production, moisture-enhancing ingredients like sodium hyaluronate (not always for those with oily skin), and of course, a UVA/UVB sunscreen of at least SPF 30 for free-radical and MMP protection. Of these, Wexler’s MMPi Skin Regeneration Serum contains antioxidants, MMPis, and moisture-binding ingredients. If a moisturizer with SPF is applied over the serum, it seems to be an excellent, novel defense against aging. At $55.00 for 1 floz., I say, if you got it, go for it. 10/10. One of the best out there!
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September 26th, 2007
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Ah, yes, the antioxidant. While nearly everyone has heard of them, few know how they actually work. But it’s relatively simple.
Let’s get into some basic chemistry. Oxygen molecules are stable, or unreactive, when they have an even number of electrons. However, when oxygen molecules combine with other molecules, the oxygen can end up with an odd number of electrons. The oxygen molecule is now unstable and highly reactive, and the odd-numbered species is known as a free radical. This free radical really is a crazy, radical species: it starts a vicious chain reaction that attacks cells, proteins, and DNA, all of which contribute to aging.
The body defends against free radicals with antioxidants, which impede or slow the chain reaction. Antioxidants like beta carotene and vitamins C and E “break the chain,” stopping free radicals from ripping electrons off of other molecules. Other antioxidants, like superoxide dismutase, catalase and glutathione peroxidase, stabilize the unstable, reactive free radicals, and thereby slow the free radical chain reaction.
Unfortunately, the body does not produce or ingest enough antioxidants to neutralize all of the free radicals, which come from processes that are both endogenous (within the body, such as human metabolism) and exogenous (outside the body, from pollution, smoking, alcohol, and UV radiation, amongst other sources). Over time, this means free radicals accumulate a great deal of damage within the body (WebMD). As a means of defense against future UV-induced free-radical damage, most dermatologists recommend daily use of sunscreen with UVA/UVB protection and a SPF of at least 15. However, according to Skinceuticals, sunscreens only block 45-55% of free radical production. As such, many experts recommend a second line of defense, by using antioxidant supplements and antioxidant-rich topically applied treatments.
However, beware of overloading on antioxidant supplements. Although studies repeatedly conclude that levels of antioxidant vitamins found in most popular multivitamins are safe, it is easy to increase intake to toxic levels. Some of these levels are provided in this article from the Harvard School of Public Health, and additionally from How Stuff Works below:
| Antioxidant |
RDA (adults) |
Upper Level (adults) |
Comment |
| Vitamin E |
15 mg |
1,070 mg natural vitamin E785 mg synthetic vitamin E |
Higher amounts impair blood clotting, increasing likelihood of hemorrhage. |
| Vitamin C |
Women: 75 mg
Men: 90 mg |
2,000 mg |
Higher amounts could lead to diarrhea and other GI disturbances. Extremely high levels may lead to cancer, atherosclerosis, and kidney stones. |
| Beta-carotene |
None |
None |
Chronic high doses turn your skin yellow-orange, but it is not toxic. However, research indicates it is unwise to consume doses of beta-carotene beyond what is in a multivitamin and your regular diet. |
| Selenium |
55 micrograms |
400 micrograms |
Higher amounts could cause hair loss, skin rashes, fatigue, GI disturbances, and nervous system abnormalities. |
In addition to antioxidant supplements, take care selecting a quality antioxidant skincare product. According to Cosmetic Dermatology, vitamins C and E, glutathione, lipoic acid, and coenzyme Q10 are “network antioxidants,” which work together synergistically to regenerate or enhance their action. For instance, after vitamin E is used to neutralize a free radical, vitamin C or coenzyme Q10 can donate electrons to vitamin E, effectively “recycling” it in the system. For this reason, antioxidant products like Skinceuticals C E Ferulic are particularly valuable; when used with a sunscreen, this product has been shown to provide eight times the free radical protection of sunscreen alone.
Although antioxidants provide ample protection against future free radical damage, antioxidants have not as of yet been shown to reverse existing signs of aging. According to Paula Begoun, bestselling author of Don’t Go to the Skincare Counter Without Me, it is further unknown how many antioxidants are necessary to stop all or even most free-radical damage, or for how long antioxidants are effective before being used up. However, based on current research, antioxidants provide excellent prevention against aging, and should be used as a part of your regular skincare regular regimé.
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September 26th, 2007
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CoffeeBerry extract is the new antioxidant in town. Derived from the coffee cherry of the Coffea arabica when it is still green and “sub-ripe”, CoffeeBerry Extract contains an extremely high concentration of polyphenols, particularly chlorogenic acid, which serve as potent antioxidants (Baumann). In fact, according to Allure magazine, CoffeeBerry Extract currently has the highest antioxidant potential of any ingredient, based on its Oxygen Radical Absorbance Capacity Score (ORAC) — a method developed by the U.S. Department of Agriculture as the standard to measure the antioxidant capacity of natural substances. In plain terms, this means CoffeeBerry is a better antioxidant than green tea, white tea, vitamin C, vitamin E, grape seed extract or idebenone. In fact, CoffeeBerry Extract has ten times the antioxidant power of green tea (Baumann). However, no studies to date have compared the effect of CoffeeBerry alone to combinations of other antioxidants, which may act synergistically to sustain their levels in the skin.
Antioxidants are important components in the fight against aging. Without antioxidants, factors like sun exposure and pollution cause the skin to release free radicals, which (amongst other things) destroy collagen, one of the proteins that keeps skin looking plump, lifted, and unwrinkled. The body naturally produces antioxidants or acquires them from one’s diet or a supplement. However, antioxidant levels may be increased in the skin via topical application. As such, antioxidants are excellent prevention against future signs of aging.
Yet, the effects of CoffeeBerry are more than just preventative. According to results published in Allure magazine, the texture and tone of the skin treated with CoffeeBerry extract showed 46 per cent improvement in fine lines and wrinkles, 64 per cent in overall skin smoothness, and 79 per cent in skin hydration. CoffeeBerry may be so effective partially because of its mechanism of action in the cell. Unlike other antioxidants, CoffeeBerry combats free radicals throughout the entire skin cell, unlike many other antioxidants, which are limited to specific areas of the cell. Further, CoffeeBerry contains exfoliating polyhydroxy acids, which help the user see almost immediate improvement. Studies additionally confirm that the ingredient is safe and effective for dry skin and skin discoloration.
My personal advice? If you are not using a form of antioxidant protection, or if you are using a moisturizer with a single antioxidant, then switch to Revalé Skin’s CoffeeBerry, available here. However, if you are already using a form of antioxidant protection with three or more antioxidants fairly high in the ingredients list, then I would personally let RevaléSkin sit on the shelf, at least until research comes out comparing CoffeeBerry to a combination of antioxidants.
Overall, however, a great product. 9.5/10, only missing the 0.5 because it lacks other antioxidant ingredients. For more on antioxidants, please visit here.
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September 25th, 2007
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Accredited in The Skin Type Solution by one of my idols, Dr. Leslie Baumann (director, Division of Cosmetic Dermatology and Assistant Professor of Clinical Dermatology at the University of Miami), Relastin Eye Silk is the first skin care product that clinically demonstrates the ability to increase elastin in the skin. According to Baumann’s Cosmetic Dermatology, elastin fibers are found at the periphery of collagen bundles in the dermis, and they provide the skin with the ability to “recoil”.
Defects of elastin are associated with wrinkled and sagging skin. In a 1989 study in the Journal of Investigative Dermatology, a child with “wrinkled skin syndrome” was found to have a deficiency of elastin fibers. [Full article here.]
Normal damage to elastin fibers is incurred whenever the skin is exposed to the sun; elastin subsequently degrades into an amorphous substance that may be witnessed with light microscopy (Baumann).
So how do you make more elastin? Revance Therapeutics has developed Relastin, a moisturizer (or eye cream) with a patent-pending Zinc-Firming Complex that actually causes elastin levels in the skin to increase. This is largely unprecedented, as other formulations, of which there are two main types, only attempt to preserve current elastin levels in the skin. The first of these formulations feature matrix metalloproteinase inhibitors (MMPis), which inhibit matrix metalloproteinase 2 (and the other nineteen matrix metalloproteinases). Matrix metalloproteinase 2 is significant because it degrades elastin (Baumann). The second type of formulation features plant-or-animal-derived elastin as an ingredient. Unfortunately, application of elastin topically has never been demonstrated to increase its production in the skin. In skincare formulations, elastin is only an effective water-binding agent.
While elastin is only one part of the anti-aging picture in the skin, it is believed to be a major contributor to wrinkling and sagging. I personally — enthusiastically — picked up my own Relastin Eye Silk tonight. I’m pretty pumped!
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September 24th, 2007
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