According to a 2007 study in Archives of Dermatology, 0.05 percent oxymetazoline (a blood vessel constrictor) applied to the skin of patients with rosacea improved their symptoms. Oxymetazoline is currently found in topical decongestants as Oxymetazoline hydrochloride in Afrin, Nasivion, Vicks Sinex, Visine L.R., and Zicam, and as a nasal spray. In the March 2008 issue of Allure, University of Miami dermatologist Dr. Leslie Baumann calls the finding of treating rosacea with oxymetazoline a “breakthrough.” Dr. Stuart D. Shanler, an NYC dermatologist who coauthored the study, further tells Allure, “We hope to have a product formulated specifically for the skin within the next few years.” The researchers also plan to test oxymetazoline on acne and sunburn. Exciting indeed! 
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March 9th, 2008
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Cosmetic Dermatology News, Rosacea Treatments |
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BENEV Azalex Gel contains 10% azelaic acid over-the-counter. Photo courtesy Amazon.com.
Azelaic acid (like kojic acid) is a bleaching agent that is commonly used in alternating four-month cycles with hydroquinone (Cosmetic Dermatology). Azelaic acid has also been found to be effective as an acne treatment, and, to a lesser extent, a rosacea treatment. However, how effective is azelaic acid? Could you use it instead of hydroquinone? And is it safe? For these answers and more, read on.
How effective is azelaic acid as a bleaching agent?
According to a double-blind study in the International Journal of Dermatology, over the treatment period (24 weeks), a 20% azelaic acid cream yielded 65% good or excellent results. In fact, 20% azelaic acid had “no significant treatment differences” observed when compared to 4% hydroquinone (the prescription level) with regard to overall rating, reduction in lesion size, and pigmentary intensity. Side effects, such as allergic sensitization or exogenous ochronosis (associated with hydroquinone) were not observed with 20% azelaic acid.
Should I consider azelaic acid over hydroquinone if I have dark skin?
Yes (i.e., typically Hispanic or Black skin tones). Ochronosis, a darkening of the skin that is caused by a build-up of phenylalanine or tyrosine, has been linked to hydroquinone use, but primarily in those with darker skin. In fact, according to the American Journal of Clinical Dermatology, the majority of patients with ochronosis are Black, but it has been reported to occur in Hispanics and Caucasians as well. Exogenous ochronosis is prevalent among South African Blacks, but is relatively uncommon amongst this population within the U.S. As such, those of African-American descent may wish to take extra precautions in avoiding products with resorcinol and excessive sun exposure when using hydroquinone products.
Can azelaic acid be used to treat acne?
Yes. According to a 1996 study in the journal Cutis (Cutaneous Medicine for the Medical Practitioner), 20 percent azelaic acid alone is effective in mild to moderate forms of acne, with an overall efficacy comparable to that of tretinoin (0.05 percent), benzoyl peroxide (5 percent), and topical erythromycin (2 percent). For moderate to severe acne, 20 percent azelaic acid may be favorably combined with minocycline with 90 percent good/excellent results, and may contribute towards reducing recurrences following discontinuation of systemic therapy (maintenance therapy with azelaic acid). Further, according to this 1989 study, 20% azelaic acid cream was not only equally as effective as 0.05% tretinoin cream, but was also better tolerated, causing fewer local side effects than the topical retinoid.
Can azelaic acid be used to treat rosacea?
Yes, and significantly so. According to a 1999 double-blind, randomized, multicenter study in Acta Dermato-Venereologica, treatment with 20% azelaic acid twice daily for 3 months resulted in significantly more favorable overall improvements than vehicle in both physician and patient ratings. In addition, more than 90% of patients rated the overall local tolerability of their treatment as good or acceptable. In addition, a separate study in the Archives of Dermatology found that 15% azelaic acid was significantly more effective than 0.75% metronidazole in improving the inflammatory lesions and erythema of rosacea.
A side note: Does hydroquinone (an azelaic acid bleaching alternative) really cause cancer?
Hydroquinone is currently the most commonly used bleaching agent in the United States. Although it is a metabolite of benzene and therefore exhibits potential carcinogenic properties, most studies that suggest a link between hydroquinone and cancer are those in which hydroquinone is applied in impractically high concentrations. In fact, according to Dr. Susan C. Taylor, M.D., a Philadelphia-based dermatologist in the October 2007 issue of Elle magazine,”The maximum levels of hydroquinone currently allowed (2 percent for over the counter, 4 percent for prescription) aren’t dangerous. At worst, it might cause redness or irritation, but only if your skin is sensitive or allergic to the medication.” Dr. Leslie Baumann further adds in Cosmetic Dermatology, “The most serious human health effect seen in workers exposed to hydroquinone is pigmentation of the eye and, in a small number of cases, permanent corneal damage.”
In what products is azelaic acid found?
20% azelaic acid is available by prescription only in Azelex. 15% azelaic acid is also available by prescription only in Finacea. Over-the-counter, the best product I could find, with 10% azelaic acid, is BENEV Azalex Gel ($80.00, Amazon.com). Although SD alcohol 40 is the main ingredient (never a good thing), it also contains more hydrating glycosaminoglycans, glycerin, and butylene glycol. I do wish the product didn’t contain the alcohol, though! A second excellent product is Mychelle Clear Skin Serum ($23.25, Amazon.com), which contains a seemingly high unspecified concentration of azelaic acid, and also niacinamide and retinol. Unfortunately, Mychelle Clear Skin Serum also contains low-molecular weight alcohols, which can be drying, and ylang-ylang/patchouli essential oils, which may make some individuals break out. At any rate, these are two sources of azelaic acid available over-the-counter.
Overall…
I love azelaic acid! Research shows 20% azelaic acid to have the bleaching efficacy of prescription-strength hydroquinone, without the negative side effects for darker skins. Research has also shown acne-fighting effects similar to prescription-strength tretinoin (and we all know how I love tretinoin!) Finally, the ingredient helps some signs of rosacea. I give this ingredient an enthusiastic thumbs-up, and will post as more companies release over-the-counter products with more azelaic acid.
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February 9th, 2008
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Acne Treatments, Best Products, Best Products, General Cosmetic Dermatology, Hyperpigmentation Treatments, Pore Size Treatments, Product Reviews, Rosacea Treatments, Spotlight On... |
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Green tea extract is quickly becoming one of the most common ingredients in skin care formulations, like in Replenix Topix Cream or Esteé Lauder Daywear (shown above). But how effective is green tea in topical moisturizers?
Where does green tea come from?
Green tea comes from the steaming and drying of the tea plant Camellia sinesis.
Polyphenol EGCG as a Potent Antioxidant in Skin Care
Green tea contains the polyphenol epigallocatechin-3-gallate (EGCG), which has been shown to have remarkable preventive effects against photocarcinogenesis and phototoxicity in mouse models. While EGCG comprises only 50% of “green tea extract” found in skin care and cosmeceuticals (Mukhtar), there is still enough EGCG to demonstrate anti-inflammatory and anti-carcinogenic properties in most skin care and cosmeceuticals.
In a 2001 study in the journal Carcinogenesis, topical application of EGCG to human skin resulted in decreased oxidative stress and an increase in antioxidant enzymes after UV irradiation. Specifically, catalase and glutathione activity were increased due to the application of EGCG. A further 2003 study in Molecular Epidemiology and Cancer Prevention found that the polyphenols in green tea prevent UVB-induced oxidation of lipids and proteins and prevents against the depletion in antioxidant enzymes experienced after UVB exposure in mouse skin.
Fights against skin cancer
In a 1994 study in the mouse, Wang et. al. discovered that administration of 1.25% green tea extract (12.5 g green tea in 100 mL water) as the sole source of drinking water reduced the number and incidence of skin tumors that were induced with the agent 12-O-tetradecanoylphorbol-13-acetate.
In the journal Preventive Medicine, it was reported in a 10-year study of 419 patients in Japan that the first incidence of patients who had consumed more than 10 cups of green tea per day was 7.3 years later for females and 3.2 years later for males when compared to their gender-specific counterparts adjusted for lifestyle differences who had consumed under 3 cups per day. Unfortunately, considering that one 8 oz. cup of green tea contains about 20-40 mg of caffeine, ten-cup consumption may not be entirely good for your skin, as prolonged exposure to caffeine has been suggested by Whitmore and Levine to thin the skin. In addition, over 250 mg of caffeine (the amount in about twelve 8-oz. cups) is associated with restlessness, nervousness, insomnia, flushing of the face, increased urination, muscle twitching, irritability, and irregular heart beat and psychomotor agitation. Unfortunately, drinking decaffeinated green tea may also not have a preventive effect against skin cancer: “In our studies, if we remove the caffeine from tea and feed the decaffeinated tea to mice at a moderate dose, it loses most of its effectiveness at inhibiting … skin cancer,” says Allan Conney, Ph.D., director of the Laboratory for Cancer Research at Rutgers University College of Pharmacy in New Jersey.
Despite the probability of thinning the skin and experiencing caffeine overdose symptoms, according to a 1999 study by Fujiki et. al., there were no severe adverse effects among patients who volunteered to consume 15 green tea tablets per day for 6 months (2.25 mg green tea extracts, 337.5 mg EGCG, 135 mg caffeine).
Prevents AGE Formation
It has been reported that the advanced glycation endproduct glucosepane is responsible for the hardening of collagen as one ages. Unfortunately, green tea was found by a study in the Archives of Biochemistry and Biophysics to be more effectual against advanced glycation endproduct formation in the aorta than in the skin of the mouse. Despite this finding, what is good for your circulation is good for your skin, so consuming green tea daily to prevent advanced glycation endproducts in your aorta is a good idea, even if it doesn’t help your skin’s collagen!
Is green tea safe in skin care formulations?
According to Dr. Leslie Baumann’s Cosmetic Dermatology, no contact allergies have been reported from green tea.
In summary…
Green tea is an excellent ingredient for the skin that exhibits many beneficial effects for the skin when consumed orally, including antioxidant, anti-inflammatory, anti-carcinogenic and photoprotective properties.
Update on Green Tea and Rosacea (January 18, 2008)
According to Dr. Gary Goldfaden, M.D., “In a recent dermatological comparison study, the use of a lotion containing a tea extract produced a 70% improvement in rosacea compared to use of a lotion containing the base ingredients alone. This tea extract is rich in antioxidant polyphenols and contains a variety of potent flavonoids.” Verifying this is a 2003 study in the Journal of Nutritional Biochemistry, which reports that green tea reduces UVB-induced inflammation as measured by double-fold skin swelling. As such, products with a high concentration of green tea polyphenols, such as TOPIX Replenix Serum ($46.25, 4Derm.com), with reported green tea content that is 90% active polyphenols.
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December 4th, 2007
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Antioxidant Treatments, Rosacea Treatments, Spotlight On... |
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