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COSMECEUTICAL CRITIQUE: Master formulators: The ‘Julia Childs’ of skin care
In the multibillion-dollar skin care industry, there are many well-recognized brands. However, we sometimes forget that behind these products were formulators who took their scientific ideas and turned them into recipes for cosmetically elegant active formulations.
I have spent the last 15 years researching the activity of cosmeceutical ingredients for my new textbook, “Cosmeceuticals and Cosmetic Ingredients” (McGraw Hill, 2014). Each ingredient has its own quirks, and they all do not “play well in the sandbox” together. Formulation knowledge (cosmetic chemistry) is required to take these ingredients and combine them in a way that enhances rather than hinders their activity, just as a chef combines ingredients and cooking techniques to enhance the flavor and presentation of food. When I discuss cosmeceutical products, I always stress the importance of the ingredients and understanding ingredient interactions, because they determine the end product – how effective it is and how elegant it feels. If a product works well but smells bad and feels unpleasant, consumers will not use it.
Whom are we trusting when it comes to this science? The formulators, also known as cosmetic chemists, who put their blood, sweat, and tears into years of work to develop products that yield efficacious results. They are often behind the scenes, and their contributions are not always recognized. I refer to them as the “Julia Childs” of skin care, because they remind me of how Julia Child combined her knowledge of ingredients and aesthetic sensibilities to change the world of cooking.
I’d like to shine the spotlight on several top skin care formulators that I have met. Their relentless desire to perfect skin care recipes has helped the industry boom and has improved skin health.
Richard Parker
Location: Melbourne
Richard Parker is the CEO/founder of the Australia-based company Rationale. When he was unable to find skin care products that worked with his skin type, he decided to study cosmetic chemistry and create his own skin care line. Today, Rationale can be found in dermatologists’ and plastic surgeons’ offices across Australia. Parker’s passion for cosmetic science is evident. Australia has a high incidence of melanoma, and sunscreens undergo greater scrutiny there compared with other countries. One of the things that Parker is most proud of is his creation of SPF products that are “as elegant as they are effective.” This is a difficult combination to achieve, because sunscreens tend to be too white or too greasy; formulating them properly requires a “master chef.”
In addition to formulating effective and elegant sun protection, he has developed Essential Six: a combination of six products that work in synergy, delivering the perfect combination of active ingredients at the correct concentration to be recognized and utilized by skin cells.
In order to succeed in the formulations industry, you must possess a desire to make it better; and Parker does just that. It’s his wish for the industry to have an increased awareness of a holistic approach to skin care that includes immune protection, antioxidants, sunscreens, gentle cleansing, alpha-hydroxy acids, and vitamin A.
If being at the forefront of this evolution isn’t enough, Parker is devoted to continue his mission for years to come, all the while helping younger chemists/formulators embrace the culture.
“For the past 25 years, I have had the privilege to work with Australia’s leading dermatologists to create the best possible products and procedures,” he said. “At this stage of my career, it is so gratifying to see the younger generation of skin specialists embrace medical skin care as a part of best clinical practice.”
Chuck Friedman
Location: Wendell, N.C.
Chuck Friedman is a man who prides himself on the use of natural products – not a small achievement for a man who has been in the industry for almost half a century. His work as a formulation chemist has spanned globally recognized companies such as Lanvin-Charles of the Ritz, Almay, Estée Lauder, Burt’s Bees, and Polysciences.
Friedman prides himself on his natural products. His product list includes hypoallergenic and natural versions of cleansers; toners; exfoliators; moisturizers and masks; shampoos; conditioners; dandruff treatments and hair sprays; antiperspirants and deodorants; lip balms; salves and cuticle treatments; shaving creams and aftershaves; over-the-counter analgesics; acne treatments and sunscreens; toothpastes; and liquid soap.
Friedman has said that he is most proud of his Burt’s Bees Orange Essence Cleansing Cream, which won Health Magazine’s Healthiest Cleanser of the Year in 1999. The product is an anhydrous, 100% natural, self-preserving translucent gel-emulsion of vegetable oil and vegetable glycerin stabilized by a proprietary protein.
During his tenure in the industry, Friedman has faced many hurdles in creating his natural formulations – achieving esthetics, efficacy, and physical stability at temperature extremes while maintaining microbiological integrity and using more green, renewable ingredients while formulating with fewer petrochemicals. His breakthrough natural formulations developed at Burt’s Bees are emulated and marketed widely today.
Sergio Nacht
Location: Las Vegas
Sergio Nacht is a biochemist, researcher, and product developer with 48 years of formulation experience. Currently, he is chief scientific officer/cofounder at resolutionMD and Riley-Nacht.
“A better understanding of the structure and function of the skin has resulted in the development of better functional products that deliver clinically demonstrable benefits and not only ‘hope in a jar,’ ” he has said.
Nacht has coauthored more than 50 scientific papers, and he holds 17 international and U.S. patents.
Possibly his most significant accomplishment followed the discovery of what he believes is one of the biggest challenges in skin care formulation. Microsponge Technology is the first – and still the only – U.S. Food and Drug Administration–approved controlled-release technology for topical products that maximizes efficacy while minimizing side effects and optimizing cosmetic attributes by allowing slow release of ingredients. The microsponge is used to provide various therapeutic solutions for antiaging, acne treatment, skin firming, skin lightening, and mattifying – most notably as the lead technology behind Retin-A Micro.
Byeong-Deog Park
Location: Seoul, South Korea
Byeong-Deog Park holds a Ph.D. in industrial chemicals from Seoul National University, among his other achievements. Dr. Park’s company, Neopharm, is located in Seoul. He is a true scientist who has been awarded many patents in the areas of ceramides for the treatment of dry skin and atopic dermatitis; PPAR (peroxisome proliferator-activated receptor)-alpha in the treatment of inflammatory disorders; and an antimicrobial peptide, Defensamide, which has been shown to prevent colonization of Staphylococcus aureus. His research led to the development of a proprietary MLE (multilamellar emulsion) technology in which lipids and ceramides form the identical Maltese cross structure that is seen in the natural lipid barrier of the skin, allowing effective skin barrier repair.
With MLE technology, the ceramides, fatty acids, and cholesterol required for an intact skin barrier are replaced in the proper ratio and three-dimensional structure needed to emulate the skin’s natural structure. This reforms the skin’s barrier and prevents water evaporation from the skin’s surface. Dr. Park has said that he is most proud of his patented MLE technology, found in the brands Atopalm and Zerafite. He also combined MLE technology and Defensamide in an atopic dermatitis treatment known as Zeroid.
Dr. Park never ceases to impress me with his scientific knowledge and dedication to the scientific method. In a field where many products are considered “hope in a jar,” his cosmetically elegant products stand out as “verified science in a jar.”
Gordon Dow
Location: Petaluma, Calif.
Gordon Dow started Dow Pharmaceutical Sciences in his garage. Today, Dow Pharmaceutical Sciences (recently acquired by Valeant Pharmaceuticals International) is a leading company in the formulation and manufacturing of dermatological products.
Over the past 25 years, Dow has commanded the company’s evolution by carefully balancing science and business. He previously served as vice president of research and development for Ingram Pharmaceuticals, where he developed seven commercially successful products, including four dermatologicals. He also served as the executive secretary of the research advisory panel for the State of California. A few of Dow’s best-known products include MetroGel, Ziana, and Acanya.
The passion for science and skin care of these individuals has shaped the dermatologic landscape for the best. They would probably agree with Julia Child, who once said, “Find something you’re passionate about and keep tremendously interested in it.”
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in Miami Beach. She founded the cosmetic dermatology center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (McGraw-Hill, April 2002), and a book for consumers, “The Skin Type Solution” (Bantam, 2006). She has contributed to the Cosmeceutical Critique column in Skin & Allergy News since January 2001. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Galderma, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Stiefel, Topix Pharmaceuticals, and Unilever.
In the multibillion-dollar skin care industry, there are many well-recognized brands. However, we sometimes forget that behind these products were formulators who took their scientific ideas and turned them into recipes for cosmetically elegant active formulations.
I have spent the last 15 years researching the activity of cosmeceutical ingredients for my new textbook, “Cosmeceuticals and Cosmetic Ingredients” (McGraw Hill, 2014). Each ingredient has its own quirks, and they all do not “play well in the sandbox” together. Formulation knowledge (cosmetic chemistry) is required to take these ingredients and combine them in a way that enhances rather than hinders their activity, just as a chef combines ingredients and cooking techniques to enhance the flavor and presentation of food. When I discuss cosmeceutical products, I always stress the importance of the ingredients and understanding ingredient interactions, because they determine the end product – how effective it is and how elegant it feels. If a product works well but smells bad and feels unpleasant, consumers will not use it.
Whom are we trusting when it comes to this science? The formulators, also known as cosmetic chemists, who put their blood, sweat, and tears into years of work to develop products that yield efficacious results. They are often behind the scenes, and their contributions are not always recognized. I refer to them as the “Julia Childs” of skin care, because they remind me of how Julia Child combined her knowledge of ingredients and aesthetic sensibilities to change the world of cooking.
I’d like to shine the spotlight on several top skin care formulators that I have met. Their relentless desire to perfect skin care recipes has helped the industry boom and has improved skin health.
Richard Parker
Location: Melbourne
Richard Parker is the CEO/founder of the Australia-based company Rationale. When he was unable to find skin care products that worked with his skin type, he decided to study cosmetic chemistry and create his own skin care line. Today, Rationale can be found in dermatologists’ and plastic surgeons’ offices across Australia. Parker’s passion for cosmetic science is evident. Australia has a high incidence of melanoma, and sunscreens undergo greater scrutiny there compared with other countries. One of the things that Parker is most proud of is his creation of SPF products that are “as elegant as they are effective.” This is a difficult combination to achieve, because sunscreens tend to be too white or too greasy; formulating them properly requires a “master chef.”
In addition to formulating effective and elegant sun protection, he has developed Essential Six: a combination of six products that work in synergy, delivering the perfect combination of active ingredients at the correct concentration to be recognized and utilized by skin cells.
In order to succeed in the formulations industry, you must possess a desire to make it better; and Parker does just that. It’s his wish for the industry to have an increased awareness of a holistic approach to skin care that includes immune protection, antioxidants, sunscreens, gentle cleansing, alpha-hydroxy acids, and vitamin A.
If being at the forefront of this evolution isn’t enough, Parker is devoted to continue his mission for years to come, all the while helping younger chemists/formulators embrace the culture.
“For the past 25 years, I have had the privilege to work with Australia’s leading dermatologists to create the best possible products and procedures,” he said. “At this stage of my career, it is so gratifying to see the younger generation of skin specialists embrace medical skin care as a part of best clinical practice.”
Chuck Friedman
Location: Wendell, N.C.
Chuck Friedman is a man who prides himself on the use of natural products – not a small achievement for a man who has been in the industry for almost half a century. His work as a formulation chemist has spanned globally recognized companies such as Lanvin-Charles of the Ritz, Almay, Estée Lauder, Burt’s Bees, and Polysciences.
Friedman prides himself on his natural products. His product list includes hypoallergenic and natural versions of cleansers; toners; exfoliators; moisturizers and masks; shampoos; conditioners; dandruff treatments and hair sprays; antiperspirants and deodorants; lip balms; salves and cuticle treatments; shaving creams and aftershaves; over-the-counter analgesics; acne treatments and sunscreens; toothpastes; and liquid soap.
Friedman has said that he is most proud of his Burt’s Bees Orange Essence Cleansing Cream, which won Health Magazine’s Healthiest Cleanser of the Year in 1999. The product is an anhydrous, 100% natural, self-preserving translucent gel-emulsion of vegetable oil and vegetable glycerin stabilized by a proprietary protein.
During his tenure in the industry, Friedman has faced many hurdles in creating his natural formulations – achieving esthetics, efficacy, and physical stability at temperature extremes while maintaining microbiological integrity and using more green, renewable ingredients while formulating with fewer petrochemicals. His breakthrough natural formulations developed at Burt’s Bees are emulated and marketed widely today.
Sergio Nacht
Location: Las Vegas
Sergio Nacht is a biochemist, researcher, and product developer with 48 years of formulation experience. Currently, he is chief scientific officer/cofounder at resolutionMD and Riley-Nacht.
“A better understanding of the structure and function of the skin has resulted in the development of better functional products that deliver clinically demonstrable benefits and not only ‘hope in a jar,’ ” he has said.
Nacht has coauthored more than 50 scientific papers, and he holds 17 international and U.S. patents.
Possibly his most significant accomplishment followed the discovery of what he believes is one of the biggest challenges in skin care formulation. Microsponge Technology is the first – and still the only – U.S. Food and Drug Administration–approved controlled-release technology for topical products that maximizes efficacy while minimizing side effects and optimizing cosmetic attributes by allowing slow release of ingredients. The microsponge is used to provide various therapeutic solutions for antiaging, acne treatment, skin firming, skin lightening, and mattifying – most notably as the lead technology behind Retin-A Micro.
Byeong-Deog Park
Location: Seoul, South Korea
Byeong-Deog Park holds a Ph.D. in industrial chemicals from Seoul National University, among his other achievements. Dr. Park’s company, Neopharm, is located in Seoul. He is a true scientist who has been awarded many patents in the areas of ceramides for the treatment of dry skin and atopic dermatitis; PPAR (peroxisome proliferator-activated receptor)-alpha in the treatment of inflammatory disorders; and an antimicrobial peptide, Defensamide, which has been shown to prevent colonization of Staphylococcus aureus. His research led to the development of a proprietary MLE (multilamellar emulsion) technology in which lipids and ceramides form the identical Maltese cross structure that is seen in the natural lipid barrier of the skin, allowing effective skin barrier repair.
With MLE technology, the ceramides, fatty acids, and cholesterol required for an intact skin barrier are replaced in the proper ratio and three-dimensional structure needed to emulate the skin’s natural structure. This reforms the skin’s barrier and prevents water evaporation from the skin’s surface. Dr. Park has said that he is most proud of his patented MLE technology, found in the brands Atopalm and Zerafite. He also combined MLE technology and Defensamide in an atopic dermatitis treatment known as Zeroid.
Dr. Park never ceases to impress me with his scientific knowledge and dedication to the scientific method. In a field where many products are considered “hope in a jar,” his cosmetically elegant products stand out as “verified science in a jar.”
Gordon Dow
Location: Petaluma, Calif.
Gordon Dow started Dow Pharmaceutical Sciences in his garage. Today, Dow Pharmaceutical Sciences (recently acquired by Valeant Pharmaceuticals International) is a leading company in the formulation and manufacturing of dermatological products.
Over the past 25 years, Dow has commanded the company’s evolution by carefully balancing science and business. He previously served as vice president of research and development for Ingram Pharmaceuticals, where he developed seven commercially successful products, including four dermatologicals. He also served as the executive secretary of the research advisory panel for the State of California. A few of Dow’s best-known products include MetroGel, Ziana, and Acanya.
The passion for science and skin care of these individuals has shaped the dermatologic landscape for the best. They would probably agree with Julia Child, who once said, “Find something you’re passionate about and keep tremendously interested in it.”
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in Miami Beach. She founded the cosmetic dermatology center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (McGraw-Hill, April 2002), and a book for consumers, “The Skin Type Solution” (Bantam, 2006). She has contributed to the Cosmeceutical Critique column in Skin & Allergy News since January 2001. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Galderma, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Stiefel, Topix Pharmaceuticals, and Unilever.
In the multibillion-dollar skin care industry, there are many well-recognized brands. However, we sometimes forget that behind these products were formulators who took their scientific ideas and turned them into recipes for cosmetically elegant active formulations.
I have spent the last 15 years researching the activity of cosmeceutical ingredients for my new textbook, “Cosmeceuticals and Cosmetic Ingredients” (McGraw Hill, 2014). Each ingredient has its own quirks, and they all do not “play well in the sandbox” together. Formulation knowledge (cosmetic chemistry) is required to take these ingredients and combine them in a way that enhances rather than hinders their activity, just as a chef combines ingredients and cooking techniques to enhance the flavor and presentation of food. When I discuss cosmeceutical products, I always stress the importance of the ingredients and understanding ingredient interactions, because they determine the end product – how effective it is and how elegant it feels. If a product works well but smells bad and feels unpleasant, consumers will not use it.
Whom are we trusting when it comes to this science? The formulators, also known as cosmetic chemists, who put their blood, sweat, and tears into years of work to develop products that yield efficacious results. They are often behind the scenes, and their contributions are not always recognized. I refer to them as the “Julia Childs” of skin care, because they remind me of how Julia Child combined her knowledge of ingredients and aesthetic sensibilities to change the world of cooking.
I’d like to shine the spotlight on several top skin care formulators that I have met. Their relentless desire to perfect skin care recipes has helped the industry boom and has improved skin health.
Richard Parker
Location: Melbourne
Richard Parker is the CEO/founder of the Australia-based company Rationale. When he was unable to find skin care products that worked with his skin type, he decided to study cosmetic chemistry and create his own skin care line. Today, Rationale can be found in dermatologists’ and plastic surgeons’ offices across Australia. Parker’s passion for cosmetic science is evident. Australia has a high incidence of melanoma, and sunscreens undergo greater scrutiny there compared with other countries. One of the things that Parker is most proud of is his creation of SPF products that are “as elegant as they are effective.” This is a difficult combination to achieve, because sunscreens tend to be too white or too greasy; formulating them properly requires a “master chef.”
In addition to formulating effective and elegant sun protection, he has developed Essential Six: a combination of six products that work in synergy, delivering the perfect combination of active ingredients at the correct concentration to be recognized and utilized by skin cells.
In order to succeed in the formulations industry, you must possess a desire to make it better; and Parker does just that. It’s his wish for the industry to have an increased awareness of a holistic approach to skin care that includes immune protection, antioxidants, sunscreens, gentle cleansing, alpha-hydroxy acids, and vitamin A.
If being at the forefront of this evolution isn’t enough, Parker is devoted to continue his mission for years to come, all the while helping younger chemists/formulators embrace the culture.
“For the past 25 years, I have had the privilege to work with Australia’s leading dermatologists to create the best possible products and procedures,” he said. “At this stage of my career, it is so gratifying to see the younger generation of skin specialists embrace medical skin care as a part of best clinical practice.”
Chuck Friedman
Location: Wendell, N.C.
Chuck Friedman is a man who prides himself on the use of natural products – not a small achievement for a man who has been in the industry for almost half a century. His work as a formulation chemist has spanned globally recognized companies such as Lanvin-Charles of the Ritz, Almay, Estée Lauder, Burt’s Bees, and Polysciences.
Friedman prides himself on his natural products. His product list includes hypoallergenic and natural versions of cleansers; toners; exfoliators; moisturizers and masks; shampoos; conditioners; dandruff treatments and hair sprays; antiperspirants and deodorants; lip balms; salves and cuticle treatments; shaving creams and aftershaves; over-the-counter analgesics; acne treatments and sunscreens; toothpastes; and liquid soap.
Friedman has said that he is most proud of his Burt’s Bees Orange Essence Cleansing Cream, which won Health Magazine’s Healthiest Cleanser of the Year in 1999. The product is an anhydrous, 100% natural, self-preserving translucent gel-emulsion of vegetable oil and vegetable glycerin stabilized by a proprietary protein.
During his tenure in the industry, Friedman has faced many hurdles in creating his natural formulations – achieving esthetics, efficacy, and physical stability at temperature extremes while maintaining microbiological integrity and using more green, renewable ingredients while formulating with fewer petrochemicals. His breakthrough natural formulations developed at Burt’s Bees are emulated and marketed widely today.
Sergio Nacht
Location: Las Vegas
Sergio Nacht is a biochemist, researcher, and product developer with 48 years of formulation experience. Currently, he is chief scientific officer/cofounder at resolutionMD and Riley-Nacht.
“A better understanding of the structure and function of the skin has resulted in the development of better functional products that deliver clinically demonstrable benefits and not only ‘hope in a jar,’ ” he has said.
Nacht has coauthored more than 50 scientific papers, and he holds 17 international and U.S. patents.
Possibly his most significant accomplishment followed the discovery of what he believes is one of the biggest challenges in skin care formulation. Microsponge Technology is the first – and still the only – U.S. Food and Drug Administration–approved controlled-release technology for topical products that maximizes efficacy while minimizing side effects and optimizing cosmetic attributes by allowing slow release of ingredients. The microsponge is used to provide various therapeutic solutions for antiaging, acne treatment, skin firming, skin lightening, and mattifying – most notably as the lead technology behind Retin-A Micro.
Byeong-Deog Park
Location: Seoul, South Korea
Byeong-Deog Park holds a Ph.D. in industrial chemicals from Seoul National University, among his other achievements. Dr. Park’s company, Neopharm, is located in Seoul. He is a true scientist who has been awarded many patents in the areas of ceramides for the treatment of dry skin and atopic dermatitis; PPAR (peroxisome proliferator-activated receptor)-alpha in the treatment of inflammatory disorders; and an antimicrobial peptide, Defensamide, which has been shown to prevent colonization of Staphylococcus aureus. His research led to the development of a proprietary MLE (multilamellar emulsion) technology in which lipids and ceramides form the identical Maltese cross structure that is seen in the natural lipid barrier of the skin, allowing effective skin barrier repair.
With MLE technology, the ceramides, fatty acids, and cholesterol required for an intact skin barrier are replaced in the proper ratio and three-dimensional structure needed to emulate the skin’s natural structure. This reforms the skin’s barrier and prevents water evaporation from the skin’s surface. Dr. Park has said that he is most proud of his patented MLE technology, found in the brands Atopalm and Zerafite. He also combined MLE technology and Defensamide in an atopic dermatitis treatment known as Zeroid.
Dr. Park never ceases to impress me with his scientific knowledge and dedication to the scientific method. In a field where many products are considered “hope in a jar,” his cosmetically elegant products stand out as “verified science in a jar.”
Gordon Dow
Location: Petaluma, Calif.
Gordon Dow started Dow Pharmaceutical Sciences in his garage. Today, Dow Pharmaceutical Sciences (recently acquired by Valeant Pharmaceuticals International) is a leading company in the formulation and manufacturing of dermatological products.
Over the past 25 years, Dow has commanded the company’s evolution by carefully balancing science and business. He previously served as vice president of research and development for Ingram Pharmaceuticals, where he developed seven commercially successful products, including four dermatologicals. He also served as the executive secretary of the research advisory panel for the State of California. A few of Dow’s best-known products include MetroGel, Ziana, and Acanya.
The passion for science and skin care of these individuals has shaped the dermatologic landscape for the best. They would probably agree with Julia Child, who once said, “Find something you’re passionate about and keep tremendously interested in it.”
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in Miami Beach. She founded the cosmetic dermatology center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (McGraw-Hill, April 2002), and a book for consumers, “The Skin Type Solution” (Bantam, 2006). She has contributed to the Cosmeceutical Critique column in Skin & Allergy News since January 2001. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Galderma, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Stiefel, Topix Pharmaceuticals, and Unilever.
Update on Organics
As pressure grows on cosmetics companies to use more environmentally friendly ingredients and packaging, there has been a profound increase in organic/natural and eco claims on “green” beauty products. Terms such as botanical, natural, green, organic, and active naturals are used. Among these terms, only the term “organic” has legal requirements for its use.
There are different standards in the United States and in other countries about what “organic” means. This column will discuss the meaning of the term “organic” and the various organic certifications.
Origin of the Term
The term “organic” as currently used was coined in 1940 by J.I. Rodale, who founded the Rodale publishing empire with the magazine “Organic Farming and Gardening.” In 1992 the U.S. Department of Agriculture (USDA) approved the Organic Label and its accompanying standards; however, this “organic seal” applied mainly to agricultural foods and practices.
Organic Regulation
There was no recognized “organic” label for personal skin care products until 2002. In May of that year, the USDA made it clear, in a policy statement about the National Organic Program (NOP), that producers of nonfood products containing agricultural ingredients were eligible to seek certification. This policy allowed producers of nonfood items to display the iconic round, green “USDA Organic” seal to attest to “authentic” organic claims on certifiers' labels.
In April 2004, however, the USDA issued a surprising Guidance Statement reversing this position, indicating that producers of personal care products would not be eligible to seek certification and had to cease use of the green symbol. There was wavering on this decision until August 2005, when the Organic Consumers Association, representing more than 500,000 members, won a major victory in a lawsuit against the USDA. The outcome of the lawsuit was that nonfood products could now be certified with the organic seal.
This seal offers two kinds of organic certification. If a product contains 95% organic ingredients, it can be labeled as organic. If it contains between 75% and 94% organic ingredients, it can be labeled as “made with XX% organic ingredients.” The nonorganic ingredients must also be screened to ensure they conform to the organic food standards.
Regulatory Bodies
The USDA seal is the most common, but as it really applies to food products, many new standards have been created; however, no one standard has been universally agreed upon. There are various standards that differ from country to country. In addition, some of these standards were created by for-profit businesses that will certify products for a fee. Obviously, there is an inherent bias in this arrangement.
In Europe, one such organization that offers certification is the European Cosmetics Standards Working Group, which has developed the Cosmetics Organic Standard (COSMOS). For more information, visit www.cosmos-standard.org. Another popular certifying organization is NaTrue from Germany (www.natrue.org). This association signed an equivalency agreement with another certifying body in the United States known as the Natural Products Association. Now that these organizations have teamed up, they are a leading certification organization in China.
NaTrue and COSMOS appear to be the most popular certifying bodies in the United States but certification is a competitive field, and every certifying organization wants to claim to have the recognized standard. Other certifying bodies in the United States include NSF International, which was one of the first, and OASIS, which was created by a coalition of beauty product manufacturers.
Each certifying body has its own standards of what constitutes “organic,” and there are discrepancies among them. For example, some standards exclude products originating from livestock that have had any genetic engineering, whereas other standards do not.
Organic Topical Products
Although there are no long-term studies documenting the effects of using topical organic products or ingredients, consumers of organic products are typically as interested in what products do not contain as in what they do contain. The intent of the organic label is to assure consumers that the key cleansing and conditioning ingredients are derived from organically grown plants rather than conventionally grown plants, synthetic chemicals, or petroleum byproducts. In addition, topical organic products exclude or minimize any ingredients that could be considered potentially harmful to people, animals, waterways, or the environment. The rules about which ingredients can and cannot be included vary by regulatory body.
The Precautionary Principle
Sometimes certain ingredients are excluded from products on the basis of research. In other cases, exclusions are based on the “precautionary principle,” which holds that until the cumulative effects of exposures to a broad range of ingredients can be fully assessed, it is best to err on the side of caution and limit use. For example, although many chemical ingredients used in cosmetics are widely considered to be safe, some safety factors have not been fully studied.
It is virtually impossible to assess the cumulative effects of repeated exposures to ingredients found in personal care products that may come from multiple sources. This is important because consumers, especially women, use several skin, hair, and beauty products per day. Typical use of a variety of products could lead to a higher combined rate of exposure than is usually assessed in safety studies. In addition, because of the use of a variety of products, the ingredients could interact, the possibility of which may not be accounted for in single-ingredient safety studies. Furthermore, to accurately establish the baseline of the chemical exposures that people can safely tolerate, it would be necessary to account for all chemical exposures from food, urban smog, industrial waste, and other sources.
Ingredient Cautions
Parabens can be absorbed via the skin and travel into the bloodstream and tissues (NewScientist.com News Service, Jan. 12, 2004). One controversial study even found high concentrations of parabens in breast cancer tissue. Products containing parabens should be avoided by most people who know they are allergic to parabens. There are no convincing data that parabens are harmful in those not allergic to this group of compounds, but many are choosing to avoid products containing this preservative ingredient.
Toluene, which is found in many brands of nail polish, has been associated with detrimental effects on males in utero. Consequently, major companies such as L'Oréal and Revlon, as well as manufacturers of natural and organic products, have taken steps to eliminate toluene from their nail polishes. Toluene can also cause a skin rash, typically on the eyelids, in people who use toluene-containing nail polishes.
Several other ingredients also warrant cautionary notes, but even organic products can cause problems. For example, coconut oil, a popular organic ingredient, can cause acne. Allergies can develop in response to many essential oils and botanicals. In addition, because companies were not able to label their products as organic until recently, there have not been enough clinical research trials on the organic products on the market.
'Natural' Ingredients
It is important to note that products touted as “natural” are not necessarily organic. For example, “active naturals” is a term used by Aveeno to describe ingredients that are found in nature but have been improved upon in the laboratory. An example is the medicinal herb feverfew, which in the Aveeno Ultra-Calming products has had parthenolide removed. Parthenolide can lead to skin inflammation, so products containing feverfew function better as anti-inflammatories without it. Products also may contain natural ingredients such as aloe, chamomile, cucumber, or vitamin E, but if these have not been grown in the required manner, the organic seal cannot be used. In addition, “natural products” may also contain chemicals intended to act as preservatives or to improve texture.
That said, problems can, of course, be associated with ingredients that are natural or organic. For instance, many natural and organic brands contain certain fragrances and essential oils that can cause dermatitis. Organic products containing strong essential oils such as peppermint or rosemary can also irritate or inflame sensitive skin. Chamomile can induce allergies in some people (who may also tend to be allergic to wheat). Furthermore, conventional as well as some natural products contain a “perfume mix” to mask their odor. Components of the perfume mix are rarely listed on the product label because each company uses its own proprietary blend. Even a product listed as 95% organic could contain a perfume mix that might induce allergic reactions in some people.
The Future of Organics
Few product lines can meet the standards of the regulatory organizations, and it is expensive to meet and maintain these standards. There are a few well-made organic lines, such as Juice Beauty and Sophyto. However, organic does not equal efficacy. None of these products can come close to the results of a prescription retinoid.
At this point, organic products have not been subjected to the strict scrutiny of science to evaluate efficacy.
Toluene, found in many brands of nail polish, has been linked to detrimental effects of males in utero.
Source ©Ivan Mateev/iStockphoto.com
As pressure grows on cosmetics companies to use more environmentally friendly ingredients and packaging, there has been a profound increase in organic/natural and eco claims on “green” beauty products. Terms such as botanical, natural, green, organic, and active naturals are used. Among these terms, only the term “organic” has legal requirements for its use.
There are different standards in the United States and in other countries about what “organic” means. This column will discuss the meaning of the term “organic” and the various organic certifications.
Origin of the Term
The term “organic” as currently used was coined in 1940 by J.I. Rodale, who founded the Rodale publishing empire with the magazine “Organic Farming and Gardening.” In 1992 the U.S. Department of Agriculture (USDA) approved the Organic Label and its accompanying standards; however, this “organic seal” applied mainly to agricultural foods and practices.
Organic Regulation
There was no recognized “organic” label for personal skin care products until 2002. In May of that year, the USDA made it clear, in a policy statement about the National Organic Program (NOP), that producers of nonfood products containing agricultural ingredients were eligible to seek certification. This policy allowed producers of nonfood items to display the iconic round, green “USDA Organic” seal to attest to “authentic” organic claims on certifiers' labels.
In April 2004, however, the USDA issued a surprising Guidance Statement reversing this position, indicating that producers of personal care products would not be eligible to seek certification and had to cease use of the green symbol. There was wavering on this decision until August 2005, when the Organic Consumers Association, representing more than 500,000 members, won a major victory in a lawsuit against the USDA. The outcome of the lawsuit was that nonfood products could now be certified with the organic seal.
This seal offers two kinds of organic certification. If a product contains 95% organic ingredients, it can be labeled as organic. If it contains between 75% and 94% organic ingredients, it can be labeled as “made with XX% organic ingredients.” The nonorganic ingredients must also be screened to ensure they conform to the organic food standards.
Regulatory Bodies
The USDA seal is the most common, but as it really applies to food products, many new standards have been created; however, no one standard has been universally agreed upon. There are various standards that differ from country to country. In addition, some of these standards were created by for-profit businesses that will certify products for a fee. Obviously, there is an inherent bias in this arrangement.
In Europe, one such organization that offers certification is the European Cosmetics Standards Working Group, which has developed the Cosmetics Organic Standard (COSMOS). For more information, visit www.cosmos-standard.org. Another popular certifying organization is NaTrue from Germany (www.natrue.org). This association signed an equivalency agreement with another certifying body in the United States known as the Natural Products Association. Now that these organizations have teamed up, they are a leading certification organization in China.
NaTrue and COSMOS appear to be the most popular certifying bodies in the United States but certification is a competitive field, and every certifying organization wants to claim to have the recognized standard. Other certifying bodies in the United States include NSF International, which was one of the first, and OASIS, which was created by a coalition of beauty product manufacturers.
Each certifying body has its own standards of what constitutes “organic,” and there are discrepancies among them. For example, some standards exclude products originating from livestock that have had any genetic engineering, whereas other standards do not.
Organic Topical Products
Although there are no long-term studies documenting the effects of using topical organic products or ingredients, consumers of organic products are typically as interested in what products do not contain as in what they do contain. The intent of the organic label is to assure consumers that the key cleansing and conditioning ingredients are derived from organically grown plants rather than conventionally grown plants, synthetic chemicals, or petroleum byproducts. In addition, topical organic products exclude or minimize any ingredients that could be considered potentially harmful to people, animals, waterways, or the environment. The rules about which ingredients can and cannot be included vary by regulatory body.
The Precautionary Principle
Sometimes certain ingredients are excluded from products on the basis of research. In other cases, exclusions are based on the “precautionary principle,” which holds that until the cumulative effects of exposures to a broad range of ingredients can be fully assessed, it is best to err on the side of caution and limit use. For example, although many chemical ingredients used in cosmetics are widely considered to be safe, some safety factors have not been fully studied.
It is virtually impossible to assess the cumulative effects of repeated exposures to ingredients found in personal care products that may come from multiple sources. This is important because consumers, especially women, use several skin, hair, and beauty products per day. Typical use of a variety of products could lead to a higher combined rate of exposure than is usually assessed in safety studies. In addition, because of the use of a variety of products, the ingredients could interact, the possibility of which may not be accounted for in single-ingredient safety studies. Furthermore, to accurately establish the baseline of the chemical exposures that people can safely tolerate, it would be necessary to account for all chemical exposures from food, urban smog, industrial waste, and other sources.
Ingredient Cautions
Parabens can be absorbed via the skin and travel into the bloodstream and tissues (NewScientist.com News Service, Jan. 12, 2004). One controversial study even found high concentrations of parabens in breast cancer tissue. Products containing parabens should be avoided by most people who know they are allergic to parabens. There are no convincing data that parabens are harmful in those not allergic to this group of compounds, but many are choosing to avoid products containing this preservative ingredient.
Toluene, which is found in many brands of nail polish, has been associated with detrimental effects on males in utero. Consequently, major companies such as L'Oréal and Revlon, as well as manufacturers of natural and organic products, have taken steps to eliminate toluene from their nail polishes. Toluene can also cause a skin rash, typically on the eyelids, in people who use toluene-containing nail polishes.
Several other ingredients also warrant cautionary notes, but even organic products can cause problems. For example, coconut oil, a popular organic ingredient, can cause acne. Allergies can develop in response to many essential oils and botanicals. In addition, because companies were not able to label their products as organic until recently, there have not been enough clinical research trials on the organic products on the market.
'Natural' Ingredients
It is important to note that products touted as “natural” are not necessarily organic. For example, “active naturals” is a term used by Aveeno to describe ingredients that are found in nature but have been improved upon in the laboratory. An example is the medicinal herb feverfew, which in the Aveeno Ultra-Calming products has had parthenolide removed. Parthenolide can lead to skin inflammation, so products containing feverfew function better as anti-inflammatories without it. Products also may contain natural ingredients such as aloe, chamomile, cucumber, or vitamin E, but if these have not been grown in the required manner, the organic seal cannot be used. In addition, “natural products” may also contain chemicals intended to act as preservatives or to improve texture.
That said, problems can, of course, be associated with ingredients that are natural or organic. For instance, many natural and organic brands contain certain fragrances and essential oils that can cause dermatitis. Organic products containing strong essential oils such as peppermint or rosemary can also irritate or inflame sensitive skin. Chamomile can induce allergies in some people (who may also tend to be allergic to wheat). Furthermore, conventional as well as some natural products contain a “perfume mix” to mask their odor. Components of the perfume mix are rarely listed on the product label because each company uses its own proprietary blend. Even a product listed as 95% organic could contain a perfume mix that might induce allergic reactions in some people.
The Future of Organics
Few product lines can meet the standards of the regulatory organizations, and it is expensive to meet and maintain these standards. There are a few well-made organic lines, such as Juice Beauty and Sophyto. However, organic does not equal efficacy. None of these products can come close to the results of a prescription retinoid.
At this point, organic products have not been subjected to the strict scrutiny of science to evaluate efficacy.
Toluene, found in many brands of nail polish, has been linked to detrimental effects of males in utero.
Source ©Ivan Mateev/iStockphoto.com
As pressure grows on cosmetics companies to use more environmentally friendly ingredients and packaging, there has been a profound increase in organic/natural and eco claims on “green” beauty products. Terms such as botanical, natural, green, organic, and active naturals are used. Among these terms, only the term “organic” has legal requirements for its use.
There are different standards in the United States and in other countries about what “organic” means. This column will discuss the meaning of the term “organic” and the various organic certifications.
Origin of the Term
The term “organic” as currently used was coined in 1940 by J.I. Rodale, who founded the Rodale publishing empire with the magazine “Organic Farming and Gardening.” In 1992 the U.S. Department of Agriculture (USDA) approved the Organic Label and its accompanying standards; however, this “organic seal” applied mainly to agricultural foods and practices.
Organic Regulation
There was no recognized “organic” label for personal skin care products until 2002. In May of that year, the USDA made it clear, in a policy statement about the National Organic Program (NOP), that producers of nonfood products containing agricultural ingredients were eligible to seek certification. This policy allowed producers of nonfood items to display the iconic round, green “USDA Organic” seal to attest to “authentic” organic claims on certifiers' labels.
In April 2004, however, the USDA issued a surprising Guidance Statement reversing this position, indicating that producers of personal care products would not be eligible to seek certification and had to cease use of the green symbol. There was wavering on this decision until August 2005, when the Organic Consumers Association, representing more than 500,000 members, won a major victory in a lawsuit against the USDA. The outcome of the lawsuit was that nonfood products could now be certified with the organic seal.
This seal offers two kinds of organic certification. If a product contains 95% organic ingredients, it can be labeled as organic. If it contains between 75% and 94% organic ingredients, it can be labeled as “made with XX% organic ingredients.” The nonorganic ingredients must also be screened to ensure they conform to the organic food standards.
Regulatory Bodies
The USDA seal is the most common, but as it really applies to food products, many new standards have been created; however, no one standard has been universally agreed upon. There are various standards that differ from country to country. In addition, some of these standards were created by for-profit businesses that will certify products for a fee. Obviously, there is an inherent bias in this arrangement.
In Europe, one such organization that offers certification is the European Cosmetics Standards Working Group, which has developed the Cosmetics Organic Standard (COSMOS). For more information, visit www.cosmos-standard.org. Another popular certifying organization is NaTrue from Germany (www.natrue.org). This association signed an equivalency agreement with another certifying body in the United States known as the Natural Products Association. Now that these organizations have teamed up, they are a leading certification organization in China.
NaTrue and COSMOS appear to be the most popular certifying bodies in the United States but certification is a competitive field, and every certifying organization wants to claim to have the recognized standard. Other certifying bodies in the United States include NSF International, which was one of the first, and OASIS, which was created by a coalition of beauty product manufacturers.
Each certifying body has its own standards of what constitutes “organic,” and there are discrepancies among them. For example, some standards exclude products originating from livestock that have had any genetic engineering, whereas other standards do not.
Organic Topical Products
Although there are no long-term studies documenting the effects of using topical organic products or ingredients, consumers of organic products are typically as interested in what products do not contain as in what they do contain. The intent of the organic label is to assure consumers that the key cleansing and conditioning ingredients are derived from organically grown plants rather than conventionally grown plants, synthetic chemicals, or petroleum byproducts. In addition, topical organic products exclude or minimize any ingredients that could be considered potentially harmful to people, animals, waterways, or the environment. The rules about which ingredients can and cannot be included vary by regulatory body.
The Precautionary Principle
Sometimes certain ingredients are excluded from products on the basis of research. In other cases, exclusions are based on the “precautionary principle,” which holds that until the cumulative effects of exposures to a broad range of ingredients can be fully assessed, it is best to err on the side of caution and limit use. For example, although many chemical ingredients used in cosmetics are widely considered to be safe, some safety factors have not been fully studied.
It is virtually impossible to assess the cumulative effects of repeated exposures to ingredients found in personal care products that may come from multiple sources. This is important because consumers, especially women, use several skin, hair, and beauty products per day. Typical use of a variety of products could lead to a higher combined rate of exposure than is usually assessed in safety studies. In addition, because of the use of a variety of products, the ingredients could interact, the possibility of which may not be accounted for in single-ingredient safety studies. Furthermore, to accurately establish the baseline of the chemical exposures that people can safely tolerate, it would be necessary to account for all chemical exposures from food, urban smog, industrial waste, and other sources.
Ingredient Cautions
Parabens can be absorbed via the skin and travel into the bloodstream and tissues (NewScientist.com News Service, Jan. 12, 2004). One controversial study even found high concentrations of parabens in breast cancer tissue. Products containing parabens should be avoided by most people who know they are allergic to parabens. There are no convincing data that parabens are harmful in those not allergic to this group of compounds, but many are choosing to avoid products containing this preservative ingredient.
Toluene, which is found in many brands of nail polish, has been associated with detrimental effects on males in utero. Consequently, major companies such as L'Oréal and Revlon, as well as manufacturers of natural and organic products, have taken steps to eliminate toluene from their nail polishes. Toluene can also cause a skin rash, typically on the eyelids, in people who use toluene-containing nail polishes.
Several other ingredients also warrant cautionary notes, but even organic products can cause problems. For example, coconut oil, a popular organic ingredient, can cause acne. Allergies can develop in response to many essential oils and botanicals. In addition, because companies were not able to label their products as organic until recently, there have not been enough clinical research trials on the organic products on the market.
'Natural' Ingredients
It is important to note that products touted as “natural” are not necessarily organic. For example, “active naturals” is a term used by Aveeno to describe ingredients that are found in nature but have been improved upon in the laboratory. An example is the medicinal herb feverfew, which in the Aveeno Ultra-Calming products has had parthenolide removed. Parthenolide can lead to skin inflammation, so products containing feverfew function better as anti-inflammatories without it. Products also may contain natural ingredients such as aloe, chamomile, cucumber, or vitamin E, but if these have not been grown in the required manner, the organic seal cannot be used. In addition, “natural products” may also contain chemicals intended to act as preservatives or to improve texture.
That said, problems can, of course, be associated with ingredients that are natural or organic. For instance, many natural and organic brands contain certain fragrances and essential oils that can cause dermatitis. Organic products containing strong essential oils such as peppermint or rosemary can also irritate or inflame sensitive skin. Chamomile can induce allergies in some people (who may also tend to be allergic to wheat). Furthermore, conventional as well as some natural products contain a “perfume mix” to mask their odor. Components of the perfume mix are rarely listed on the product label because each company uses its own proprietary blend. Even a product listed as 95% organic could contain a perfume mix that might induce allergic reactions in some people.
The Future of Organics
Few product lines can meet the standards of the regulatory organizations, and it is expensive to meet and maintain these standards. There are a few well-made organic lines, such as Juice Beauty and Sophyto. However, organic does not equal efficacy. None of these products can come close to the results of a prescription retinoid.
At this point, organic products have not been subjected to the strict scrutiny of science to evaluate efficacy.
Toluene, found in many brands of nail polish, has been linked to detrimental effects of males in utero.
Source ©Ivan Mateev/iStockphoto.com
Luteolin
The flavone luteolin, 3′,4′,5,7-tetrahydroxyflavone, is a polyphenol commonly found in fruits, vegetables, and medicinal herbs (Curr. Cancer Drug Targets 2008;8:634–46). Luteolin is most often present in leaves, but is also found in rinds and other parts of plants.
The flavone and its glycosides have been identified in Bryophyta, Magnoliophyta, Pinophyta, Pteridophyta, and Salvia (Mini Rev. Med. Chem. 2009;9:31–59).
Luteolin is believed to have the potential to play a significant role in health, as it is considered to exhibit broad-ranging anti-inflammatory benefits (Proc. Natl. Acad. Sci. U.S.A. 2008;105:7534–9), as well as anticarcinogenic, antimicrobial, antioxidant, and immunomodulatory effects. Cancer, hypertension, inflammation, and other conditions have been treated with luteolin-rich plants in traditional Chinese medicine (Curr. Cancer Drug Targets 2008;8:634–46).
Notably, this antioxidant is present in the typical human diet in relatively low amounts (less than 1 mg/day) (Molecules 2008;13:2628–51). Dietary sources of luteolin include carrots, chamomile tea, celery, olive oil, oregano, peppermint, peppers, perilla, rosemary, and thyme (Mini Rev. Med. Chem. 2009;9:31–59; FEBS Lett. 1998;438:220–4).
This column will focus on recent research conducted on this antioxidant, particularly studies that imply potential dermatologic applications.
Antitumor Actions
In 2002, Ueda et al. studied the effects of orally administered perilla leaf extract on mice, and found that it inhibited production of tumor necrosis factor-alpha. The in vitro phase of the study led to their identifying luteolin, caffeic acid, and rosmarinic acid as active constituents of perilla. The investigators noted that only luteolin exhibited in vivo activity, however. Luteolin was responsible not only for suppressing the production of serum tumor necrosis factor-alpha, but also for suppressing arachidonic acid-induced ear edema, 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced ear edema, and oxazolone-induced allergic edema (Biol. Pharm. Bull. 2002;25:1197–202).
A year later, the same team reported on its examination of the effects of topically applied perilla leaf extract and luteolin on murine skin papillomas induced by TPA and 7,12-dimethyl- benz[a]anthracene. Significant decreases in tumor incidence and multiplicity were observed in mice topically treated with perilla leaf extract before TPA treatment, especially in mice treated with luteolin prior to TPA (Biol. Pharm. Bull. 2003;26:560–3).
Anticancer Actions
Recent reviews on the diverse benefits of luteolin suggest that the flavone exhibits anti-inflammatory and anticarcinogenic properties, not all of which can be attributed to its antioxidant activity. By protecting against carcinogenic stimuli, luteolin is believed to have the capacity, in vitro and in vivo, to delay or inhibit cancer cell development, suppress tumor proliferation, induce cell cycle arrest, and spur apoptosis through intrinsic and extrinsic signaling pathways. Interestingly, some epidemiologic evidence points to an inverse relationship between luteolin consumption and the risk of developing some types of cancer (Molecules 2008;13:2628–51).
In a recent review of the distribution and biologic activities of luteolin, López-Lázaro summarized preclinical studies of the flavone, which have demonstrated that it has wide-ranging pharmacologic activities, particularly anticancer, anti-inflammatory, antimicrobial, and antioxidant properties.
Significant cancer chemopreventive and chemotherapeutic potential is suggested by the capacity of luteolin to block angiogenesis, induce apoptosis, prevent carcinogenesis in animal models, decrease tumor growth in vivo, and sensitize tumor cells to the cytotoxic impact of some anticancer drugs. López-Lázaro also noted a wide range of potential mechanisms of action for the various biologic activities of luteolin (Mini Rev. Med. Chem. 2009;9:31–59). In fact, luteolin has been found to sensitize cancer cells to induced cytotoxicity by inhibiting cell survival pathways (e.g., phosphatidylinositol 3′-kinase, nuclear factor kappa B, and X-linked inhibitor of apoptosis protein), and by promoting apoptosis pathways, leading to, for example, the induction of tumor suppressor p53 (Curr. Cancer Drug Targets 2008;8:634–46).
Seelinger et al. compared the anticarcinogenic effects of luteolin to those of other flavonoids, and found that luteolin was typically the most effective, inhibiting tumor cell proliferation with half-maximal inhibitory concentrations (IC50) between 3 and 50 mmol in vitro and in vivo by intragastric application or as a food additive. They concluded that because luteolin has also been demonstrated to penetrate human skin, this polyphenolic compound is potentially a suitable agent for preventing and treating skin cancer and photoaging (Molecules 2008;13:2628–51).
Antioxidant Actions
In a 2004 study of the components of Zostera marina leaves, Kim et al. found that the constituents apigenin, chrysoeriol, and luteolin scavenged radicals and reactive oxygen species, specifically the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical and the superoxide radical in the xanthine/xanthine oxidase system.
Luteolin also inhibited matrix metalloproteinase-1 (MMP-1) expression by up to 44%, and suppressed the synthesis of interleukin-6, a cytokine known to spur MMP-1 expression.
The investigators concluded that the antioxidant capacity of luteolin and the other Zostera marina constituents tested, as well as their ability to suppress MMP-1 expression, suggests the potential use of these compounds as agents to prevent cutaneous photoaging (Arch. Pharm. Res. 2004;27:177–83).
In 2008, Seelinger et al. conducted a literature review to clarify luteolin's antioxidant, anti-inflammatory, and antiallergic activities. They found that luteolin is a natural antioxidant that exhibits less pro-oxidant potential than the most studied flavonoid, quercetin, and that it has a better safety profile than quercetin.
Luteolin also has been shown to possess superlative radical scavenging and cytoprotective qualities, particularly in complex biological systems, where it can interact with other antioxidants. Luteolin acts as an anti-inflammatory agent by activating antioxidative enzymes, inhibiting the nuclear factor kappa B pathway, and suppressing proinflammatory compounds.
The authors concluded that more quantitative research is necessary to determine the potential therapeutic benefits of this potent antioxidant (Planta Med. 2008;74:1667–77).
Ultraviolet Protection
In 2005, Morquio et al. mixed extracts of plants known to contain potent antioxidants, specifically Achyrocline satureioides and Epilobium parviflorum, with a cosmetic base, and applied the compounds to the back skin of rabbits. Subsequently, they exposed the skin to ultraviolet irradiation for 1 hour, and intracutaneously injected the irradiated areas with sodium salicylate.
The researchers then evaluated hydroxyl radical production by measuring 2,3-dihydroxybenzoic acid (2,3-DHBA) synthesis resulting from the hydroxylation of sodium salicylate. The production of 2,3-DHBA was found to be significantly increased by the UV irradiation, but was markedly diminished in association with the application of the Achyrocline satureioides cosmetic formulation. The authors attributed this antioxidant effect to the presence of high concentrations of flavonoid aglycones, including luteolin (Phytother. Res. 2005;19:486–90).
In 2007, Sim et al. studied the structure-activity relationship of several flavonoid compounds and their antioxidant and inhibitory effects against MMP activity in vitro and in human dermal fibroblasts induced by ultraviolet A light. The compounds examined included luteolin, myricetin, quercetin, kaempferol, apigenin, and chrysin. Luteolin, with the highest number of OH groups in the B ring, was shown to have the most potent antioxidant efficacy as ascertained using the DPPH method and the xanthine/xanthine oxidase system. The authors also noted that in association with the relative antioxidant strength of the flavonoids, the compounds dose-dependently suppressed collagenase activity and MMP expression. They concluded that flavonoids with a higher number of hydroxyl groups may be the most effective at preventing UV-induced cutaneous aging (Arch. Pharm. Res. 2007;30:290–8).
Prostaglandin Inhibitor
In a 2008 study, Papaliodis et al. investigated the effect of flavonoids on niacin-induced flush in a rat model, and sought to determine whether prostaglandin D2 (PGD2) and 5-hydroxytryptamine (5-HT) were involved.
The researchers recorded three skin temperature measurements from each ear for each time point immediately before intraperitoneal injection with either niacin or a flavonoid (quercetin or luteolin). They then measured temperature every 10 minutes for 1 hour. Ear temperature was increased by niacin to a maximum of 1.9 plus or minus 0.2 °C at 45 minutes.
Quercetin and luteolin administered intraperitoneally 45 minutes before niacin blocked the niacin effect by 96% and 88%, respectively, while aspirin inhibited the niacin effect by 30%. Plasma PGD2 and 5-HT were increased twofold by niacin, while luteolin suppressed plasma PGD2 and 5-HT by 100% and 67%, respectively, and aspirin lowered only PGD2 (by 86%).
The investigators concluded that the increased skin temperature in rats caused by niacin is linked to increases in PGD2 and 5-HT, and that luteolin may be the most suitable inhibitor of niacin-induced flush because it suppresses both mediators (Br. J. Pharmacol. 2008;153:1382–7).
Currently, luteolin is included as a minor ingredient in some nutritional and herbal supplements.
Conclusion
Much more research is necessary to ascertain whether the bioactive properties of luteolin can be readily harnessed for application in dermatologic and other medical conditions. Currently, the preponderance of evidence suggests that this flavonoid is at least as promising as its fellow flavonoid quercetin.
The flavone luteolin, 3′,4′,5,7-tetrahydroxyflavone, is a polyphenol commonly found in fruits, vegetables, and medicinal herbs (Curr. Cancer Drug Targets 2008;8:634–46). Luteolin is most often present in leaves, but is also found in rinds and other parts of plants.
The flavone and its glycosides have been identified in Bryophyta, Magnoliophyta, Pinophyta, Pteridophyta, and Salvia (Mini Rev. Med. Chem. 2009;9:31–59).
Luteolin is believed to have the potential to play a significant role in health, as it is considered to exhibit broad-ranging anti-inflammatory benefits (Proc. Natl. Acad. Sci. U.S.A. 2008;105:7534–9), as well as anticarcinogenic, antimicrobial, antioxidant, and immunomodulatory effects. Cancer, hypertension, inflammation, and other conditions have been treated with luteolin-rich plants in traditional Chinese medicine (Curr. Cancer Drug Targets 2008;8:634–46).
Notably, this antioxidant is present in the typical human diet in relatively low amounts (less than 1 mg/day) (Molecules 2008;13:2628–51). Dietary sources of luteolin include carrots, chamomile tea, celery, olive oil, oregano, peppermint, peppers, perilla, rosemary, and thyme (Mini Rev. Med. Chem. 2009;9:31–59; FEBS Lett. 1998;438:220–4).
This column will focus on recent research conducted on this antioxidant, particularly studies that imply potential dermatologic applications.
Antitumor Actions
In 2002, Ueda et al. studied the effects of orally administered perilla leaf extract on mice, and found that it inhibited production of tumor necrosis factor-alpha. The in vitro phase of the study led to their identifying luteolin, caffeic acid, and rosmarinic acid as active constituents of perilla. The investigators noted that only luteolin exhibited in vivo activity, however. Luteolin was responsible not only for suppressing the production of serum tumor necrosis factor-alpha, but also for suppressing arachidonic acid-induced ear edema, 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced ear edema, and oxazolone-induced allergic edema (Biol. Pharm. Bull. 2002;25:1197–202).
A year later, the same team reported on its examination of the effects of topically applied perilla leaf extract and luteolin on murine skin papillomas induced by TPA and 7,12-dimethyl- benz[a]anthracene. Significant decreases in tumor incidence and multiplicity were observed in mice topically treated with perilla leaf extract before TPA treatment, especially in mice treated with luteolin prior to TPA (Biol. Pharm. Bull. 2003;26:560–3).
Anticancer Actions
Recent reviews on the diverse benefits of luteolin suggest that the flavone exhibits anti-inflammatory and anticarcinogenic properties, not all of which can be attributed to its antioxidant activity. By protecting against carcinogenic stimuli, luteolin is believed to have the capacity, in vitro and in vivo, to delay or inhibit cancer cell development, suppress tumor proliferation, induce cell cycle arrest, and spur apoptosis through intrinsic and extrinsic signaling pathways. Interestingly, some epidemiologic evidence points to an inverse relationship between luteolin consumption and the risk of developing some types of cancer (Molecules 2008;13:2628–51).
In a recent review of the distribution and biologic activities of luteolin, López-Lázaro summarized preclinical studies of the flavone, which have demonstrated that it has wide-ranging pharmacologic activities, particularly anticancer, anti-inflammatory, antimicrobial, and antioxidant properties.
Significant cancer chemopreventive and chemotherapeutic potential is suggested by the capacity of luteolin to block angiogenesis, induce apoptosis, prevent carcinogenesis in animal models, decrease tumor growth in vivo, and sensitize tumor cells to the cytotoxic impact of some anticancer drugs. López-Lázaro also noted a wide range of potential mechanisms of action for the various biologic activities of luteolin (Mini Rev. Med. Chem. 2009;9:31–59). In fact, luteolin has been found to sensitize cancer cells to induced cytotoxicity by inhibiting cell survival pathways (e.g., phosphatidylinositol 3′-kinase, nuclear factor kappa B, and X-linked inhibitor of apoptosis protein), and by promoting apoptosis pathways, leading to, for example, the induction of tumor suppressor p53 (Curr. Cancer Drug Targets 2008;8:634–46).
Seelinger et al. compared the anticarcinogenic effects of luteolin to those of other flavonoids, and found that luteolin was typically the most effective, inhibiting tumor cell proliferation with half-maximal inhibitory concentrations (IC50) between 3 and 50 mmol in vitro and in vivo by intragastric application or as a food additive. They concluded that because luteolin has also been demonstrated to penetrate human skin, this polyphenolic compound is potentially a suitable agent for preventing and treating skin cancer and photoaging (Molecules 2008;13:2628–51).
Antioxidant Actions
In a 2004 study of the components of Zostera marina leaves, Kim et al. found that the constituents apigenin, chrysoeriol, and luteolin scavenged radicals and reactive oxygen species, specifically the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical and the superoxide radical in the xanthine/xanthine oxidase system.
Luteolin also inhibited matrix metalloproteinase-1 (MMP-1) expression by up to 44%, and suppressed the synthesis of interleukin-6, a cytokine known to spur MMP-1 expression.
The investigators concluded that the antioxidant capacity of luteolin and the other Zostera marina constituents tested, as well as their ability to suppress MMP-1 expression, suggests the potential use of these compounds as agents to prevent cutaneous photoaging (Arch. Pharm. Res. 2004;27:177–83).
In 2008, Seelinger et al. conducted a literature review to clarify luteolin's antioxidant, anti-inflammatory, and antiallergic activities. They found that luteolin is a natural antioxidant that exhibits less pro-oxidant potential than the most studied flavonoid, quercetin, and that it has a better safety profile than quercetin.
Luteolin also has been shown to possess superlative radical scavenging and cytoprotective qualities, particularly in complex biological systems, where it can interact with other antioxidants. Luteolin acts as an anti-inflammatory agent by activating antioxidative enzymes, inhibiting the nuclear factor kappa B pathway, and suppressing proinflammatory compounds.
The authors concluded that more quantitative research is necessary to determine the potential therapeutic benefits of this potent antioxidant (Planta Med. 2008;74:1667–77).
Ultraviolet Protection
In 2005, Morquio et al. mixed extracts of plants known to contain potent antioxidants, specifically Achyrocline satureioides and Epilobium parviflorum, with a cosmetic base, and applied the compounds to the back skin of rabbits. Subsequently, they exposed the skin to ultraviolet irradiation for 1 hour, and intracutaneously injected the irradiated areas with sodium salicylate.
The researchers then evaluated hydroxyl radical production by measuring 2,3-dihydroxybenzoic acid (2,3-DHBA) synthesis resulting from the hydroxylation of sodium salicylate. The production of 2,3-DHBA was found to be significantly increased by the UV irradiation, but was markedly diminished in association with the application of the Achyrocline satureioides cosmetic formulation. The authors attributed this antioxidant effect to the presence of high concentrations of flavonoid aglycones, including luteolin (Phytother. Res. 2005;19:486–90).
In 2007, Sim et al. studied the structure-activity relationship of several flavonoid compounds and their antioxidant and inhibitory effects against MMP activity in vitro and in human dermal fibroblasts induced by ultraviolet A light. The compounds examined included luteolin, myricetin, quercetin, kaempferol, apigenin, and chrysin. Luteolin, with the highest number of OH groups in the B ring, was shown to have the most potent antioxidant efficacy as ascertained using the DPPH method and the xanthine/xanthine oxidase system. The authors also noted that in association with the relative antioxidant strength of the flavonoids, the compounds dose-dependently suppressed collagenase activity and MMP expression. They concluded that flavonoids with a higher number of hydroxyl groups may be the most effective at preventing UV-induced cutaneous aging (Arch. Pharm. Res. 2007;30:290–8).
Prostaglandin Inhibitor
In a 2008 study, Papaliodis et al. investigated the effect of flavonoids on niacin-induced flush in a rat model, and sought to determine whether prostaglandin D2 (PGD2) and 5-hydroxytryptamine (5-HT) were involved.
The researchers recorded three skin temperature measurements from each ear for each time point immediately before intraperitoneal injection with either niacin or a flavonoid (quercetin or luteolin). They then measured temperature every 10 minutes for 1 hour. Ear temperature was increased by niacin to a maximum of 1.9 plus or minus 0.2 °C at 45 minutes.
Quercetin and luteolin administered intraperitoneally 45 minutes before niacin blocked the niacin effect by 96% and 88%, respectively, while aspirin inhibited the niacin effect by 30%. Plasma PGD2 and 5-HT were increased twofold by niacin, while luteolin suppressed plasma PGD2 and 5-HT by 100% and 67%, respectively, and aspirin lowered only PGD2 (by 86%).
The investigators concluded that the increased skin temperature in rats caused by niacin is linked to increases in PGD2 and 5-HT, and that luteolin may be the most suitable inhibitor of niacin-induced flush because it suppresses both mediators (Br. J. Pharmacol. 2008;153:1382–7).
Currently, luteolin is included as a minor ingredient in some nutritional and herbal supplements.
Conclusion
Much more research is necessary to ascertain whether the bioactive properties of luteolin can be readily harnessed for application in dermatologic and other medical conditions. Currently, the preponderance of evidence suggests that this flavonoid is at least as promising as its fellow flavonoid quercetin.
The flavone luteolin, 3′,4′,5,7-tetrahydroxyflavone, is a polyphenol commonly found in fruits, vegetables, and medicinal herbs (Curr. Cancer Drug Targets 2008;8:634–46). Luteolin is most often present in leaves, but is also found in rinds and other parts of plants.
The flavone and its glycosides have been identified in Bryophyta, Magnoliophyta, Pinophyta, Pteridophyta, and Salvia (Mini Rev. Med. Chem. 2009;9:31–59).
Luteolin is believed to have the potential to play a significant role in health, as it is considered to exhibit broad-ranging anti-inflammatory benefits (Proc. Natl. Acad. Sci. U.S.A. 2008;105:7534–9), as well as anticarcinogenic, antimicrobial, antioxidant, and immunomodulatory effects. Cancer, hypertension, inflammation, and other conditions have been treated with luteolin-rich plants in traditional Chinese medicine (Curr. Cancer Drug Targets 2008;8:634–46).
Notably, this antioxidant is present in the typical human diet in relatively low amounts (less than 1 mg/day) (Molecules 2008;13:2628–51). Dietary sources of luteolin include carrots, chamomile tea, celery, olive oil, oregano, peppermint, peppers, perilla, rosemary, and thyme (Mini Rev. Med. Chem. 2009;9:31–59; FEBS Lett. 1998;438:220–4).
This column will focus on recent research conducted on this antioxidant, particularly studies that imply potential dermatologic applications.
Antitumor Actions
In 2002, Ueda et al. studied the effects of orally administered perilla leaf extract on mice, and found that it inhibited production of tumor necrosis factor-alpha. The in vitro phase of the study led to their identifying luteolin, caffeic acid, and rosmarinic acid as active constituents of perilla. The investigators noted that only luteolin exhibited in vivo activity, however. Luteolin was responsible not only for suppressing the production of serum tumor necrosis factor-alpha, but also for suppressing arachidonic acid-induced ear edema, 12-O-tetradecanoylphorbol-13-acetate (TPA)-induced ear edema, and oxazolone-induced allergic edema (Biol. Pharm. Bull. 2002;25:1197–202).
A year later, the same team reported on its examination of the effects of topically applied perilla leaf extract and luteolin on murine skin papillomas induced by TPA and 7,12-dimethyl- benz[a]anthracene. Significant decreases in tumor incidence and multiplicity were observed in mice topically treated with perilla leaf extract before TPA treatment, especially in mice treated with luteolin prior to TPA (Biol. Pharm. Bull. 2003;26:560–3).
Anticancer Actions
Recent reviews on the diverse benefits of luteolin suggest that the flavone exhibits anti-inflammatory and anticarcinogenic properties, not all of which can be attributed to its antioxidant activity. By protecting against carcinogenic stimuli, luteolin is believed to have the capacity, in vitro and in vivo, to delay or inhibit cancer cell development, suppress tumor proliferation, induce cell cycle arrest, and spur apoptosis through intrinsic and extrinsic signaling pathways. Interestingly, some epidemiologic evidence points to an inverse relationship between luteolin consumption and the risk of developing some types of cancer (Molecules 2008;13:2628–51).
In a recent review of the distribution and biologic activities of luteolin, López-Lázaro summarized preclinical studies of the flavone, which have demonstrated that it has wide-ranging pharmacologic activities, particularly anticancer, anti-inflammatory, antimicrobial, and antioxidant properties.
Significant cancer chemopreventive and chemotherapeutic potential is suggested by the capacity of luteolin to block angiogenesis, induce apoptosis, prevent carcinogenesis in animal models, decrease tumor growth in vivo, and sensitize tumor cells to the cytotoxic impact of some anticancer drugs. López-Lázaro also noted a wide range of potential mechanisms of action for the various biologic activities of luteolin (Mini Rev. Med. Chem. 2009;9:31–59). In fact, luteolin has been found to sensitize cancer cells to induced cytotoxicity by inhibiting cell survival pathways (e.g., phosphatidylinositol 3′-kinase, nuclear factor kappa B, and X-linked inhibitor of apoptosis protein), and by promoting apoptosis pathways, leading to, for example, the induction of tumor suppressor p53 (Curr. Cancer Drug Targets 2008;8:634–46).
Seelinger et al. compared the anticarcinogenic effects of luteolin to those of other flavonoids, and found that luteolin was typically the most effective, inhibiting tumor cell proliferation with half-maximal inhibitory concentrations (IC50) between 3 and 50 mmol in vitro and in vivo by intragastric application or as a food additive. They concluded that because luteolin has also been demonstrated to penetrate human skin, this polyphenolic compound is potentially a suitable agent for preventing and treating skin cancer and photoaging (Molecules 2008;13:2628–51).
Antioxidant Actions
In a 2004 study of the components of Zostera marina leaves, Kim et al. found that the constituents apigenin, chrysoeriol, and luteolin scavenged radicals and reactive oxygen species, specifically the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical and the superoxide radical in the xanthine/xanthine oxidase system.
Luteolin also inhibited matrix metalloproteinase-1 (MMP-1) expression by up to 44%, and suppressed the synthesis of interleukin-6, a cytokine known to spur MMP-1 expression.
The investigators concluded that the antioxidant capacity of luteolin and the other Zostera marina constituents tested, as well as their ability to suppress MMP-1 expression, suggests the potential use of these compounds as agents to prevent cutaneous photoaging (Arch. Pharm. Res. 2004;27:177–83).
In 2008, Seelinger et al. conducted a literature review to clarify luteolin's antioxidant, anti-inflammatory, and antiallergic activities. They found that luteolin is a natural antioxidant that exhibits less pro-oxidant potential than the most studied flavonoid, quercetin, and that it has a better safety profile than quercetin.
Luteolin also has been shown to possess superlative radical scavenging and cytoprotective qualities, particularly in complex biological systems, where it can interact with other antioxidants. Luteolin acts as an anti-inflammatory agent by activating antioxidative enzymes, inhibiting the nuclear factor kappa B pathway, and suppressing proinflammatory compounds.
The authors concluded that more quantitative research is necessary to determine the potential therapeutic benefits of this potent antioxidant (Planta Med. 2008;74:1667–77).
Ultraviolet Protection
In 2005, Morquio et al. mixed extracts of plants known to contain potent antioxidants, specifically Achyrocline satureioides and Epilobium parviflorum, with a cosmetic base, and applied the compounds to the back skin of rabbits. Subsequently, they exposed the skin to ultraviolet irradiation for 1 hour, and intracutaneously injected the irradiated areas with sodium salicylate.
The researchers then evaluated hydroxyl radical production by measuring 2,3-dihydroxybenzoic acid (2,3-DHBA) synthesis resulting from the hydroxylation of sodium salicylate. The production of 2,3-DHBA was found to be significantly increased by the UV irradiation, but was markedly diminished in association with the application of the Achyrocline satureioides cosmetic formulation. The authors attributed this antioxidant effect to the presence of high concentrations of flavonoid aglycones, including luteolin (Phytother. Res. 2005;19:486–90).
In 2007, Sim et al. studied the structure-activity relationship of several flavonoid compounds and their antioxidant and inhibitory effects against MMP activity in vitro and in human dermal fibroblasts induced by ultraviolet A light. The compounds examined included luteolin, myricetin, quercetin, kaempferol, apigenin, and chrysin. Luteolin, with the highest number of OH groups in the B ring, was shown to have the most potent antioxidant efficacy as ascertained using the DPPH method and the xanthine/xanthine oxidase system. The authors also noted that in association with the relative antioxidant strength of the flavonoids, the compounds dose-dependently suppressed collagenase activity and MMP expression. They concluded that flavonoids with a higher number of hydroxyl groups may be the most effective at preventing UV-induced cutaneous aging (Arch. Pharm. Res. 2007;30:290–8).
Prostaglandin Inhibitor
In a 2008 study, Papaliodis et al. investigated the effect of flavonoids on niacin-induced flush in a rat model, and sought to determine whether prostaglandin D2 (PGD2) and 5-hydroxytryptamine (5-HT) were involved.
The researchers recorded three skin temperature measurements from each ear for each time point immediately before intraperitoneal injection with either niacin or a flavonoid (quercetin or luteolin). They then measured temperature every 10 minutes for 1 hour. Ear temperature was increased by niacin to a maximum of 1.9 plus or minus 0.2 °C at 45 minutes.
Quercetin and luteolin administered intraperitoneally 45 minutes before niacin blocked the niacin effect by 96% and 88%, respectively, while aspirin inhibited the niacin effect by 30%. Plasma PGD2 and 5-HT were increased twofold by niacin, while luteolin suppressed plasma PGD2 and 5-HT by 100% and 67%, respectively, and aspirin lowered only PGD2 (by 86%).
The investigators concluded that the increased skin temperature in rats caused by niacin is linked to increases in PGD2 and 5-HT, and that luteolin may be the most suitable inhibitor of niacin-induced flush because it suppresses both mediators (Br. J. Pharmacol. 2008;153:1382–7).
Currently, luteolin is included as a minor ingredient in some nutritional and herbal supplements.
Conclusion
Much more research is necessary to ascertain whether the bioactive properties of luteolin can be readily harnessed for application in dermatologic and other medical conditions. Currently, the preponderance of evidence suggests that this flavonoid is at least as promising as its fellow flavonoid quercetin.
Dead Sea Minerals
The palliative effects of immersing in baths or pools of thermomineral water, known as balneotherapy, have been known for centuries, with modern practices dating back to the 1800s and natural health spas dating back more than 3,000 years (Dermatol. Ther. 2003;16:132-40; Clin. Dermatol. 1996;14:659-64).
Places such as the Kangal hot spring in Turkey, the Blue Lagoon in Iceland, and the Dead Sea between Israel and Jordan are particularly popular “hot spots” for such therapy.
The Dead Sea is the lowest saline lake—and the lowest accessible point—on earth (400 meters, or about 1,300 feet, below sea level). Its therapeutic benefits have been well known for 1,500 years, with the modern era for such treatments beginning in 1959 (Clin. Dermatol. 1998;16:695-8). Over the past half century, the Dead Sea has become well recognized for its balneologic activity, allowing climatotherapy to be used for dermatologic and rheumatologic conditions.
In particular, Dead Sea climatotherapy is considered to be very effective in the treatment of psoriasis and, to a lesser extent, atopic dermatitis (J. Am. Acad. Dermatol. 2005;52:445-50; Arch. Dermatol. 1998;134:1416-20). Other conditions successfully treated with balneotherapy include acne, alopecia areata, chronic ulcers, contact dermatitis, dyshidrotic dermatitis, granuloma annulare, ichthyosis, lichen planus, lichen sclerosus and atrophicus, mycosis fungoides, palmoplantar keratosis, pityriasis rubra pilaris, pruritus, rosacea, scleroderma, seborrheic dermatitis, urticaria pigmentosa, vitiligo, and xerosis (Dermatol. Ther. 2003;16:132-40). Products that contain Dead Sea minerals are currently used to treat several of these cutaneous conditions.
Dissolved Minerals
The Dead Sea, which contains exceedingly high salt concentrations, acts as a reservoir of minerals with distinct evaporation properties. Dead Sea salts are the source of numerous chemical and health products. Specifically, various skin conditions and allergies, as well as arthritis and respiratory disorders, have been treated with Dead Sea-derived magnesium salts and sulfur-containing mud (Rev. Environ. Health 1999;14:257-67). Magnesium salts, which are known to have anti-inflammatory activity, are the prevailing minerals in Dead Sea water (Int. J. Dermatol. 2005;44:151-7). Compared with the world's oceans, the Dead Sea is more abundant in calcium, magnesium, potassium, and bromide, and lower in sodium, sulfate, and carbonate (Dermatol. Ther. 2003;16:132-40; Int. J. Dermatol. 1989;28:1-9).
Enzyme Stimulation
In 1985, Shani et al. found that glutathione peroxidase activity was significantly increased in 35 psoriatic Danes who received 4-week therapy at the Ein Bokek International Psoriasis Treatment Center along the Dead Sea in Israel. The drinking water at the center was found to be rich in selenium. The researchers assayed the activity of erythrocyte glutathione peroxidase, the most reliable marker for increases in selenium bioavailability, in the psoriasis patients, in 25 long-time local hotel workers, and in healthy volunteers who consumed low-selenium water. Enzymatic activity in the hotel workers was found to be 50% higher than in the low-selenium drinkers. The investigators concluded that selenium might play a beneficial role in psoriasis treatment (Pharmacol. Res. Commun. 1985;17:479-88).
That same year, several of the same researchers compared the penetration of electrolytes through the skin of healthy volunteers and psoriasis patients who bathed in the Dead Sea or comparable bath-salt solutions for a 4-week period. Only the psoriasis patients had significant increases in serum levels of bromine, calcium, and zinc (Pharmacol. Res. Commun. 1985;17:501-12).
Antiproliferative Action
Two years later, Shani et al. tested diluted Dead Sea brine and salt solutions, and found that they reversibly suppressed cell proliferation in vitro. They noted that bromides were more potent inhibitors than chlorides, and that potassium salts exhibited greater effectiveness than sodium or magnesium salts. The authors speculated that the penetration of minerals through the skin, along with antiproliferative effects, may help explain the effectiveness of Dead Sea spa treatments for psoriasis (Pharmacology 1987;35:339-47).
Interestingly, in 1996, investigators sought to identify the antiproliferative effects of certain Dead Sea minerals that play a role in ameliorating psoriasis, by comparing the in vitro proliferation of fibroblasts grown from biopsy specimens of healthy and psoriatic skin. They found that magnesium bromide and magnesium chloride exhibited significantly more potent inhibitory effects on cell growth than did their corresponding potassium salts and sodium chloride, and that these effects were manifested in healthy as well as psoriatic fibroblasts (Pharmacology 1996;52:321-8).
Moisturizing Action
In 1997, Ma'or et al. compared the cutaneous smoothing effects of three different liquid gels, one of which contained Dead Sea minerals. The formulations were applied to 20 mature women twice daily over 4 weeks, with computer-aided laser profilometry used to evaluate skin roughness before and after the treatment period. At the conclusion of treatment, the gel containing 1% Dead Sea mineral solution was associated with a 41% reduction in skin roughness. A 28% reduction was achieved with the use of the gel devoid of mineral additives, and a 10% reduction was seen with a control gel absent any antiwrinkle ingredients (Int. J. Cosmet. Sci. 1997;19:105-10).
Photodamage and Skin Cancer
In 2005, in a multicenter controlled cross-sectional study, investigators determined the prevalence of photodamage and skin cancer in a cohort of psoriasis patients undergoing climatotherapy by the Dead Sea. The cohort consisted of 1,198 patients (460 psoriasis patients and 738 controls) between 20 and 70 years of age who received treatment at the Dead Sea Solarium Clinic and participating outpatient clinics.
Results indicated that psoriasis patients were much more likely to manifest elastosis, poikiloderma, solar lentigines, and facial wrinkles than controls, with a dose response associated with increased exposure time to the Dead Sea. Control patients self-reported more previous skin cancers than psoriasis patients, but examinations revealed no differences in the prevalence of nonmelanoma skin cancer. Neither group included cases of malignant melanoma. The researchers concluded that Dead Sea climatotherapy poses no increased risk for developing skin cancer among psoriasis patients, but the prolonged solar exposure inherent in this therapeutic modality may increase the risk of inducing photodamage (J. Am. Acad. Dermatol. 2005;52:445-50).
Easing Chemotherapy's Side Effects
In another recent study, researchers assessed the effectiveness of Dead Sea products in mitigating the side effects of radiochemotherapy in 24 patients suffering from head and neck cancer. The control group consisted of 30 conventionally treated patients. The radiochemotherapy patients were directed to use two products containing Dead Sea minerals—a mouthwash (Lenom, made by Clinica Lenom Ltd.) and a moisturizing cream (Solaris)—three times daily for 1 week before, during, and up to 2 weeks following the conclusion of radiotherapy.
The investigators observed grade 1-2 mucositis in 13 patients treated with Dead Sea minerals (54%), with none exhibiting grade 3-4 mucositis. In the control group, 17 subjects (57%) had grade 1-2 mucositis, while grade 3-4 mucositis was noted in 4 (13%). In addition, grade 1-2 dermatitis was seen in 13 patients treated with Dead Sea minerals (54%), with none displaying grade 3-4 dermatitis, whereas grade 1-2 dermatitis was observed in 11 control patients (37%) and grade 3-4, in 5 (17%) (Isr. Med. Assoc. J. 2007;9:439-42).
On the Market
Several companies offer product lines that feature Dead Sea minerals, including Adovia Inc., Ahava, Health & Beauty Dead Sea Minerals, Kawar, La Cure, and Obey Your Body.
The array of such products includes hand and body lotions, bath salts, body butter, eye cream, cleansing mud masks, mineral mud soaps, mineral peeling soaps, body exfoliants, collagen firming creams with SPF, acne lotions, lightening cream with SPF, firming night creams, antidandruff and numerous other shampoos, scalp masks, and sunscreens.
Conclusions
The therapeutic effects of mineral waters at various spas, and at the Dead Sea in particular, have been well established. Such results help explain the popularity of makeup and other skin products that contain mineral ingredients. Vichy Thermal Spa Water (Vichy Laboratories Inc.) and La Roche-Posay Spa Water (La Roche-Posay) contain the anti-inflammatory minerals sulfur and selenium, respectively, and mineral-laden Dead Sea water is known to exert a lenitive influence on psoriasis, eczema, and other cutaneous conditions.
It remains unclear, however, how effective several products touted for harnessing the curative powers of the Dead Sea are in conferring similar benefits. Although these products likely do no harm and, given the host of other ingredients, probably at least contribute to moisturizing the skin, more research is necessary to establish these products as adjuvants for any of various skin disorders.
The therapeutic effects of immersion in the water of the Dead Sea have been well known for 1,500 years.
Source ©Edward Shtern/Fotolia.com
The palliative effects of immersing in baths or pools of thermomineral water, known as balneotherapy, have been known for centuries, with modern practices dating back to the 1800s and natural health spas dating back more than 3,000 years (Dermatol. Ther. 2003;16:132-40; Clin. Dermatol. 1996;14:659-64).
Places such as the Kangal hot spring in Turkey, the Blue Lagoon in Iceland, and the Dead Sea between Israel and Jordan are particularly popular “hot spots” for such therapy.
The Dead Sea is the lowest saline lake—and the lowest accessible point—on earth (400 meters, or about 1,300 feet, below sea level). Its therapeutic benefits have been well known for 1,500 years, with the modern era for such treatments beginning in 1959 (Clin. Dermatol. 1998;16:695-8). Over the past half century, the Dead Sea has become well recognized for its balneologic activity, allowing climatotherapy to be used for dermatologic and rheumatologic conditions.
In particular, Dead Sea climatotherapy is considered to be very effective in the treatment of psoriasis and, to a lesser extent, atopic dermatitis (J. Am. Acad. Dermatol. 2005;52:445-50; Arch. Dermatol. 1998;134:1416-20). Other conditions successfully treated with balneotherapy include acne, alopecia areata, chronic ulcers, contact dermatitis, dyshidrotic dermatitis, granuloma annulare, ichthyosis, lichen planus, lichen sclerosus and atrophicus, mycosis fungoides, palmoplantar keratosis, pityriasis rubra pilaris, pruritus, rosacea, scleroderma, seborrheic dermatitis, urticaria pigmentosa, vitiligo, and xerosis (Dermatol. Ther. 2003;16:132-40). Products that contain Dead Sea minerals are currently used to treat several of these cutaneous conditions.
Dissolved Minerals
The Dead Sea, which contains exceedingly high salt concentrations, acts as a reservoir of minerals with distinct evaporation properties. Dead Sea salts are the source of numerous chemical and health products. Specifically, various skin conditions and allergies, as well as arthritis and respiratory disorders, have been treated with Dead Sea-derived magnesium salts and sulfur-containing mud (Rev. Environ. Health 1999;14:257-67). Magnesium salts, which are known to have anti-inflammatory activity, are the prevailing minerals in Dead Sea water (Int. J. Dermatol. 2005;44:151-7). Compared with the world's oceans, the Dead Sea is more abundant in calcium, magnesium, potassium, and bromide, and lower in sodium, sulfate, and carbonate (Dermatol. Ther. 2003;16:132-40; Int. J. Dermatol. 1989;28:1-9).
Enzyme Stimulation
In 1985, Shani et al. found that glutathione peroxidase activity was significantly increased in 35 psoriatic Danes who received 4-week therapy at the Ein Bokek International Psoriasis Treatment Center along the Dead Sea in Israel. The drinking water at the center was found to be rich in selenium. The researchers assayed the activity of erythrocyte glutathione peroxidase, the most reliable marker for increases in selenium bioavailability, in the psoriasis patients, in 25 long-time local hotel workers, and in healthy volunteers who consumed low-selenium water. Enzymatic activity in the hotel workers was found to be 50% higher than in the low-selenium drinkers. The investigators concluded that selenium might play a beneficial role in psoriasis treatment (Pharmacol. Res. Commun. 1985;17:479-88).
That same year, several of the same researchers compared the penetration of electrolytes through the skin of healthy volunteers and psoriasis patients who bathed in the Dead Sea or comparable bath-salt solutions for a 4-week period. Only the psoriasis patients had significant increases in serum levels of bromine, calcium, and zinc (Pharmacol. Res. Commun. 1985;17:501-12).
Antiproliferative Action
Two years later, Shani et al. tested diluted Dead Sea brine and salt solutions, and found that they reversibly suppressed cell proliferation in vitro. They noted that bromides were more potent inhibitors than chlorides, and that potassium salts exhibited greater effectiveness than sodium or magnesium salts. The authors speculated that the penetration of minerals through the skin, along with antiproliferative effects, may help explain the effectiveness of Dead Sea spa treatments for psoriasis (Pharmacology 1987;35:339-47).
Interestingly, in 1996, investigators sought to identify the antiproliferative effects of certain Dead Sea minerals that play a role in ameliorating psoriasis, by comparing the in vitro proliferation of fibroblasts grown from biopsy specimens of healthy and psoriatic skin. They found that magnesium bromide and magnesium chloride exhibited significantly more potent inhibitory effects on cell growth than did their corresponding potassium salts and sodium chloride, and that these effects were manifested in healthy as well as psoriatic fibroblasts (Pharmacology 1996;52:321-8).
Moisturizing Action
In 1997, Ma'or et al. compared the cutaneous smoothing effects of three different liquid gels, one of which contained Dead Sea minerals. The formulations were applied to 20 mature women twice daily over 4 weeks, with computer-aided laser profilometry used to evaluate skin roughness before and after the treatment period. At the conclusion of treatment, the gel containing 1% Dead Sea mineral solution was associated with a 41% reduction in skin roughness. A 28% reduction was achieved with the use of the gel devoid of mineral additives, and a 10% reduction was seen with a control gel absent any antiwrinkle ingredients (Int. J. Cosmet. Sci. 1997;19:105-10).
Photodamage and Skin Cancer
In 2005, in a multicenter controlled cross-sectional study, investigators determined the prevalence of photodamage and skin cancer in a cohort of psoriasis patients undergoing climatotherapy by the Dead Sea. The cohort consisted of 1,198 patients (460 psoriasis patients and 738 controls) between 20 and 70 years of age who received treatment at the Dead Sea Solarium Clinic and participating outpatient clinics.
Results indicated that psoriasis patients were much more likely to manifest elastosis, poikiloderma, solar lentigines, and facial wrinkles than controls, with a dose response associated with increased exposure time to the Dead Sea. Control patients self-reported more previous skin cancers than psoriasis patients, but examinations revealed no differences in the prevalence of nonmelanoma skin cancer. Neither group included cases of malignant melanoma. The researchers concluded that Dead Sea climatotherapy poses no increased risk for developing skin cancer among psoriasis patients, but the prolonged solar exposure inherent in this therapeutic modality may increase the risk of inducing photodamage (J. Am. Acad. Dermatol. 2005;52:445-50).
Easing Chemotherapy's Side Effects
In another recent study, researchers assessed the effectiveness of Dead Sea products in mitigating the side effects of radiochemotherapy in 24 patients suffering from head and neck cancer. The control group consisted of 30 conventionally treated patients. The radiochemotherapy patients were directed to use two products containing Dead Sea minerals—a mouthwash (Lenom, made by Clinica Lenom Ltd.) and a moisturizing cream (Solaris)—three times daily for 1 week before, during, and up to 2 weeks following the conclusion of radiotherapy.
The investigators observed grade 1-2 mucositis in 13 patients treated with Dead Sea minerals (54%), with none exhibiting grade 3-4 mucositis. In the control group, 17 subjects (57%) had grade 1-2 mucositis, while grade 3-4 mucositis was noted in 4 (13%). In addition, grade 1-2 dermatitis was seen in 13 patients treated with Dead Sea minerals (54%), with none displaying grade 3-4 dermatitis, whereas grade 1-2 dermatitis was observed in 11 control patients (37%) and grade 3-4, in 5 (17%) (Isr. Med. Assoc. J. 2007;9:439-42).
On the Market
Several companies offer product lines that feature Dead Sea minerals, including Adovia Inc., Ahava, Health & Beauty Dead Sea Minerals, Kawar, La Cure, and Obey Your Body.
The array of such products includes hand and body lotions, bath salts, body butter, eye cream, cleansing mud masks, mineral mud soaps, mineral peeling soaps, body exfoliants, collagen firming creams with SPF, acne lotions, lightening cream with SPF, firming night creams, antidandruff and numerous other shampoos, scalp masks, and sunscreens.
Conclusions
The therapeutic effects of mineral waters at various spas, and at the Dead Sea in particular, have been well established. Such results help explain the popularity of makeup and other skin products that contain mineral ingredients. Vichy Thermal Spa Water (Vichy Laboratories Inc.) and La Roche-Posay Spa Water (La Roche-Posay) contain the anti-inflammatory minerals sulfur and selenium, respectively, and mineral-laden Dead Sea water is known to exert a lenitive influence on psoriasis, eczema, and other cutaneous conditions.
It remains unclear, however, how effective several products touted for harnessing the curative powers of the Dead Sea are in conferring similar benefits. Although these products likely do no harm and, given the host of other ingredients, probably at least contribute to moisturizing the skin, more research is necessary to establish these products as adjuvants for any of various skin disorders.
The therapeutic effects of immersion in the water of the Dead Sea have been well known for 1,500 years.
Source ©Edward Shtern/Fotolia.com
The palliative effects of immersing in baths or pools of thermomineral water, known as balneotherapy, have been known for centuries, with modern practices dating back to the 1800s and natural health spas dating back more than 3,000 years (Dermatol. Ther. 2003;16:132-40; Clin. Dermatol. 1996;14:659-64).
Places such as the Kangal hot spring in Turkey, the Blue Lagoon in Iceland, and the Dead Sea between Israel and Jordan are particularly popular “hot spots” for such therapy.
The Dead Sea is the lowest saline lake—and the lowest accessible point—on earth (400 meters, or about 1,300 feet, below sea level). Its therapeutic benefits have been well known for 1,500 years, with the modern era for such treatments beginning in 1959 (Clin. Dermatol. 1998;16:695-8). Over the past half century, the Dead Sea has become well recognized for its balneologic activity, allowing climatotherapy to be used for dermatologic and rheumatologic conditions.
In particular, Dead Sea climatotherapy is considered to be very effective in the treatment of psoriasis and, to a lesser extent, atopic dermatitis (J. Am. Acad. Dermatol. 2005;52:445-50; Arch. Dermatol. 1998;134:1416-20). Other conditions successfully treated with balneotherapy include acne, alopecia areata, chronic ulcers, contact dermatitis, dyshidrotic dermatitis, granuloma annulare, ichthyosis, lichen planus, lichen sclerosus and atrophicus, mycosis fungoides, palmoplantar keratosis, pityriasis rubra pilaris, pruritus, rosacea, scleroderma, seborrheic dermatitis, urticaria pigmentosa, vitiligo, and xerosis (Dermatol. Ther. 2003;16:132-40). Products that contain Dead Sea minerals are currently used to treat several of these cutaneous conditions.
Dissolved Minerals
The Dead Sea, which contains exceedingly high salt concentrations, acts as a reservoir of minerals with distinct evaporation properties. Dead Sea salts are the source of numerous chemical and health products. Specifically, various skin conditions and allergies, as well as arthritis and respiratory disorders, have been treated with Dead Sea-derived magnesium salts and sulfur-containing mud (Rev. Environ. Health 1999;14:257-67). Magnesium salts, which are known to have anti-inflammatory activity, are the prevailing minerals in Dead Sea water (Int. J. Dermatol. 2005;44:151-7). Compared with the world's oceans, the Dead Sea is more abundant in calcium, magnesium, potassium, and bromide, and lower in sodium, sulfate, and carbonate (Dermatol. Ther. 2003;16:132-40; Int. J. Dermatol. 1989;28:1-9).
Enzyme Stimulation
In 1985, Shani et al. found that glutathione peroxidase activity was significantly increased in 35 psoriatic Danes who received 4-week therapy at the Ein Bokek International Psoriasis Treatment Center along the Dead Sea in Israel. The drinking water at the center was found to be rich in selenium. The researchers assayed the activity of erythrocyte glutathione peroxidase, the most reliable marker for increases in selenium bioavailability, in the psoriasis patients, in 25 long-time local hotel workers, and in healthy volunteers who consumed low-selenium water. Enzymatic activity in the hotel workers was found to be 50% higher than in the low-selenium drinkers. The investigators concluded that selenium might play a beneficial role in psoriasis treatment (Pharmacol. Res. Commun. 1985;17:479-88).
That same year, several of the same researchers compared the penetration of electrolytes through the skin of healthy volunteers and psoriasis patients who bathed in the Dead Sea or comparable bath-salt solutions for a 4-week period. Only the psoriasis patients had significant increases in serum levels of bromine, calcium, and zinc (Pharmacol. Res. Commun. 1985;17:501-12).
Antiproliferative Action
Two years later, Shani et al. tested diluted Dead Sea brine and salt solutions, and found that they reversibly suppressed cell proliferation in vitro. They noted that bromides were more potent inhibitors than chlorides, and that potassium salts exhibited greater effectiveness than sodium or magnesium salts. The authors speculated that the penetration of minerals through the skin, along with antiproliferative effects, may help explain the effectiveness of Dead Sea spa treatments for psoriasis (Pharmacology 1987;35:339-47).
Interestingly, in 1996, investigators sought to identify the antiproliferative effects of certain Dead Sea minerals that play a role in ameliorating psoriasis, by comparing the in vitro proliferation of fibroblasts grown from biopsy specimens of healthy and psoriatic skin. They found that magnesium bromide and magnesium chloride exhibited significantly more potent inhibitory effects on cell growth than did their corresponding potassium salts and sodium chloride, and that these effects were manifested in healthy as well as psoriatic fibroblasts (Pharmacology 1996;52:321-8).
Moisturizing Action
In 1997, Ma'or et al. compared the cutaneous smoothing effects of three different liquid gels, one of which contained Dead Sea minerals. The formulations were applied to 20 mature women twice daily over 4 weeks, with computer-aided laser profilometry used to evaluate skin roughness before and after the treatment period. At the conclusion of treatment, the gel containing 1% Dead Sea mineral solution was associated with a 41% reduction in skin roughness. A 28% reduction was achieved with the use of the gel devoid of mineral additives, and a 10% reduction was seen with a control gel absent any antiwrinkle ingredients (Int. J. Cosmet. Sci. 1997;19:105-10).
Photodamage and Skin Cancer
In 2005, in a multicenter controlled cross-sectional study, investigators determined the prevalence of photodamage and skin cancer in a cohort of psoriasis patients undergoing climatotherapy by the Dead Sea. The cohort consisted of 1,198 patients (460 psoriasis patients and 738 controls) between 20 and 70 years of age who received treatment at the Dead Sea Solarium Clinic and participating outpatient clinics.
Results indicated that psoriasis patients were much more likely to manifest elastosis, poikiloderma, solar lentigines, and facial wrinkles than controls, with a dose response associated with increased exposure time to the Dead Sea. Control patients self-reported more previous skin cancers than psoriasis patients, but examinations revealed no differences in the prevalence of nonmelanoma skin cancer. Neither group included cases of malignant melanoma. The researchers concluded that Dead Sea climatotherapy poses no increased risk for developing skin cancer among psoriasis patients, but the prolonged solar exposure inherent in this therapeutic modality may increase the risk of inducing photodamage (J. Am. Acad. Dermatol. 2005;52:445-50).
Easing Chemotherapy's Side Effects
In another recent study, researchers assessed the effectiveness of Dead Sea products in mitigating the side effects of radiochemotherapy in 24 patients suffering from head and neck cancer. The control group consisted of 30 conventionally treated patients. The radiochemotherapy patients were directed to use two products containing Dead Sea minerals—a mouthwash (Lenom, made by Clinica Lenom Ltd.) and a moisturizing cream (Solaris)—three times daily for 1 week before, during, and up to 2 weeks following the conclusion of radiotherapy.
The investigators observed grade 1-2 mucositis in 13 patients treated with Dead Sea minerals (54%), with none exhibiting grade 3-4 mucositis. In the control group, 17 subjects (57%) had grade 1-2 mucositis, while grade 3-4 mucositis was noted in 4 (13%). In addition, grade 1-2 dermatitis was seen in 13 patients treated with Dead Sea minerals (54%), with none displaying grade 3-4 dermatitis, whereas grade 1-2 dermatitis was observed in 11 control patients (37%) and grade 3-4, in 5 (17%) (Isr. Med. Assoc. J. 2007;9:439-42).
On the Market
Several companies offer product lines that feature Dead Sea minerals, including Adovia Inc., Ahava, Health & Beauty Dead Sea Minerals, Kawar, La Cure, and Obey Your Body.
The array of such products includes hand and body lotions, bath salts, body butter, eye cream, cleansing mud masks, mineral mud soaps, mineral peeling soaps, body exfoliants, collagen firming creams with SPF, acne lotions, lightening cream with SPF, firming night creams, antidandruff and numerous other shampoos, scalp masks, and sunscreens.
Conclusions
The therapeutic effects of mineral waters at various spas, and at the Dead Sea in particular, have been well established. Such results help explain the popularity of makeup and other skin products that contain mineral ingredients. Vichy Thermal Spa Water (Vichy Laboratories Inc.) and La Roche-Posay Spa Water (La Roche-Posay) contain the anti-inflammatory minerals sulfur and selenium, respectively, and mineral-laden Dead Sea water is known to exert a lenitive influence on psoriasis, eczema, and other cutaneous conditions.
It remains unclear, however, how effective several products touted for harnessing the curative powers of the Dead Sea are in conferring similar benefits. Although these products likely do no harm and, given the host of other ingredients, probably at least contribute to moisturizing the skin, more research is necessary to establish these products as adjuvants for any of various skin disorders.
The therapeutic effects of immersion in the water of the Dead Sea have been well known for 1,500 years.
Source ©Edward Shtern/Fotolia.com
Saffron
Saffron (Crocus sativus), a member of the Iridaceae family, is native to Southwest Asia, particularly Iran, but was first cultivated in Greece. It has been used as a spice or food flavoring agent, as well as a fragrance, clothing dye, and medicine, for 3,000 years. Saffron also was used for various medical indications by the ancient Persians and Egyptians, and later by the medieval Europeans (Exp. Biol. Med. 2002;227:20-5).
The traditional uses of saffron are borne out in modern medicine, as this botanical product continues to be known for its antispasmodic, carminative, diaphoretic, emmenagogic, and sedative properties (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]). Significantly, pharmacologic studies have shown that saffron has other salubrious benefits, including antioxidant, antimutagenic, and immunomodulatory activities (Asian Pac. J. Cancer Prev. 2004;5:70-6). Much recent research has focused on these properties, as well as on evidence that the spice exhibits anticarcinogenic activity (Exp. Biol. Med. 2002;227:20-5). This column will briefly review the primary investigations of saffron that may potentially lay the groundwork for dermatologic applications.
Anticarcinogenic Actions
In 2004, Das et al. assessed the effects of an aqueous infusion of saffron on a two-stage skin papillogenesis/carcinogenesis mouse model, using 7,12-dimethyl benz[a]anthracin (DMBA) to initiate, and croton oil to promote, tumor formation. Saffron application was found to significantly decrease papilloma development during the pre- and postinitiation periods, especially when the saffron was administered during both periods. The authors attributed the inhibitory effects of saffron, at least in part, to the modulatory effects of C. sativus on phase II detoxifying enzymes, such as glutathione S-transferase, glutathione peroxidase, and superoxide dismutase (Asian Pac. J. Cancer Prev. 2004;5:70-6).
Early in 2009, Das et al. utilized a histopathologic approach to evaluate the chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis in mice. Animals were divided into five groups: three saffron-treated groups, a carcinogen control group, and a normal control group. Twice a week for 8 weeks, the carcinogen control and saffron groups were administered three topical applications of DMBA followed by croton oil on shaven dorsal skin. Only topical applications of the vehicle (acetone) were given to normal controls. The three saffron groups were orally fed with saffron infusions either before (group A), after (group C), or both before and after (group B) the application of DMBA.
Standard histologic examination revealed that the skin benefited from saffron treatments administered both before and after chemically induced skin carcinogenesis. Specifically, the saffron-fed groups exhibited inhibition of papilloma formation, as well as reductions in the size of papillomas that did form, compared with the control groups. The authors concluded that early treatment with saffron suppresses DMBA-induced skin carcinoma in mice, at least partly because of activation of cellular defense systems, namely cellular antioxidant enzymes (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]).
The anticarcinogenic properties of saffron were also demonstrated in much earlier studies. In 1991, Salomi et al. found that topical application of extracts of the common food spices Nigella sativa and C. sativus suppressed skin carcinogenesis initiation and promotion in a mouse model also using DMBA and croton oil. Specifically, they observed a delay in the formation of papillomas and a lower mean number of papillomas per mouse with application of a 100-mg/kg body weight dose of the extracts. They also evaluated the effects of the extracts on 20-methylcholanthrene (MCA)-induced soft tissue sarcomas in albino mice. Whereas tumor incidence was 100% in MCA-treated control mice, intraperitoneal administration of N. sativa and oral administration of C. sativus (both at 100 mg/kg body weight) 30 days after subcutaneous administration of MCA (745 nmol/day for 2 days) yielded tumor incidences of 33.3% and 10%, respectively (Nutr. Cancer 1991;16:67-72).
That same year, some of the same researchers, led by Nair, studied the antitumor activity of saffron extract against intraperitoneally transplanted sarcoma-180 (S-180), Ehrlich ascites carcinoma (EAC), and Dalton's lymphoma ascites (DLA) tumors in mice. The life spans of S-180, EAC, and DLA mice were increased respectively by 110.0%, 83.5%, and 112.5%, respectively, compared with baseline life spans, as a result of the oral administration of 200 mg/kg body weight of the saffron extract. In vitro, the extract was cytotoxic to S-180, EAC, DLA, and P38B tumor cells. The authors concluded that these results suggest the potential for saffron as an anticancer agent (Cancer Lett. 1991;57:109-14).
Speed Burn Healing
In a recent study of the potential role of saffron in wound healing, investigators compared the treatment of heat-induced burn wounds in rats using saffron pollen extract and silver sulfadiazine. Hot water was used to generate the wound. Rats were divided into four groups and treated with a topical cream control, base, saffron (20%), or silver sulfadiazine (1%) 24 hours after the induced injury.
Researchers measured wound size on day 25 and determined the average wound area to be 5.5, 4.1, 4, and 0.9 cm
Bioactive Components
In 2004, Giaccio evaluated the known constituents of saffron as well as its characteristics (e.g., antitoxic effects, hormonelike effects, and anticarcinogenic properties). Crocetin (8,8'-diapo-8,8'-carotenoic acid), a carotenoid and one of the main active ingredients in saffron, was of particular focus. This carotenoid is known to enhance oxygen's capacity to diffuse through liquids, including plasma, and has been shown to increase alveolar transport and cerebral and pulmonary oxygenation. Notably, crocetin also suppresses skin tumor promotion in mice and exhibits other anticarcinogenic properties, which are typically ascribed to its antioxidant activity. Although Giaccio highlighted the significant properties of a key constituent of saffron, the author acknowledged that the promising results associated with crocetin have been identified in vitro or in laboratory animals, but not in humans (Crit. Rev. Food Sci. Nutr. 2004;44:155-72).
In 2005, Assimopoulou et al. reported on a C. sativus extract (including crocin and safranal, two bioactive components). They found that a methanol extract of saffron demonstrated significant antioxidant activity against the 1,1-diphenyl-2-picrylhydrazyl radical. Crocin exhibited greater radical scavenging activity than safranal, but the scavenging capacity of the latter compound was still noted to be high. The investigators concluded that saffron has the potential for functional uses in foods, beverages touted for antioxidant activity, and medical purposes, namely in pharmaceutic and cosmetic formulations intended to confer antioxidant and antiaging activity (Phytother. Res. 2005;19:997-1000).
Conclusion
Although saffron has a long history of traditional uses, it is no turmeric in terms of the body of modern research and evidence. Nevertheless, current scientific investigations appear to be promising, suggesting a significant potential for the contemporary uses of this spice in medical practice. The data supporting saffron's antioxidant properties and successful topical use in animal models are encouraging. That said, while saffron is used as an oral supplement and in Ayurvedic medicine, much more research is necessary to determine its efficacy and effectiveness in topical skin care.
Saffron (Crocus sativus), a member of the Iridaceae family, is native to Southwest Asia, particularly Iran, but was first cultivated in Greece. It has been used as a spice or food flavoring agent, as well as a fragrance, clothing dye, and medicine, for 3,000 years. Saffron also was used for various medical indications by the ancient Persians and Egyptians, and later by the medieval Europeans (Exp. Biol. Med. 2002;227:20-5).
The traditional uses of saffron are borne out in modern medicine, as this botanical product continues to be known for its antispasmodic, carminative, diaphoretic, emmenagogic, and sedative properties (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]). Significantly, pharmacologic studies have shown that saffron has other salubrious benefits, including antioxidant, antimutagenic, and immunomodulatory activities (Asian Pac. J. Cancer Prev. 2004;5:70-6). Much recent research has focused on these properties, as well as on evidence that the spice exhibits anticarcinogenic activity (Exp. Biol. Med. 2002;227:20-5). This column will briefly review the primary investigations of saffron that may potentially lay the groundwork for dermatologic applications.
Anticarcinogenic Actions
In 2004, Das et al. assessed the effects of an aqueous infusion of saffron on a two-stage skin papillogenesis/carcinogenesis mouse model, using 7,12-dimethyl benz[a]anthracin (DMBA) to initiate, and croton oil to promote, tumor formation. Saffron application was found to significantly decrease papilloma development during the pre- and postinitiation periods, especially when the saffron was administered during both periods. The authors attributed the inhibitory effects of saffron, at least in part, to the modulatory effects of C. sativus on phase II detoxifying enzymes, such as glutathione S-transferase, glutathione peroxidase, and superoxide dismutase (Asian Pac. J. Cancer Prev. 2004;5:70-6).
Early in 2009, Das et al. utilized a histopathologic approach to evaluate the chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis in mice. Animals were divided into five groups: three saffron-treated groups, a carcinogen control group, and a normal control group. Twice a week for 8 weeks, the carcinogen control and saffron groups were administered three topical applications of DMBA followed by croton oil on shaven dorsal skin. Only topical applications of the vehicle (acetone) were given to normal controls. The three saffron groups were orally fed with saffron infusions either before (group A), after (group C), or both before and after (group B) the application of DMBA.
Standard histologic examination revealed that the skin benefited from saffron treatments administered both before and after chemically induced skin carcinogenesis. Specifically, the saffron-fed groups exhibited inhibition of papilloma formation, as well as reductions in the size of papillomas that did form, compared with the control groups. The authors concluded that early treatment with saffron suppresses DMBA-induced skin carcinoma in mice, at least partly because of activation of cellular defense systems, namely cellular antioxidant enzymes (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]).
The anticarcinogenic properties of saffron were also demonstrated in much earlier studies. In 1991, Salomi et al. found that topical application of extracts of the common food spices Nigella sativa and C. sativus suppressed skin carcinogenesis initiation and promotion in a mouse model also using DMBA and croton oil. Specifically, they observed a delay in the formation of papillomas and a lower mean number of papillomas per mouse with application of a 100-mg/kg body weight dose of the extracts. They also evaluated the effects of the extracts on 20-methylcholanthrene (MCA)-induced soft tissue sarcomas in albino mice. Whereas tumor incidence was 100% in MCA-treated control mice, intraperitoneal administration of N. sativa and oral administration of C. sativus (both at 100 mg/kg body weight) 30 days after subcutaneous administration of MCA (745 nmol/day for 2 days) yielded tumor incidences of 33.3% and 10%, respectively (Nutr. Cancer 1991;16:67-72).
That same year, some of the same researchers, led by Nair, studied the antitumor activity of saffron extract against intraperitoneally transplanted sarcoma-180 (S-180), Ehrlich ascites carcinoma (EAC), and Dalton's lymphoma ascites (DLA) tumors in mice. The life spans of S-180, EAC, and DLA mice were increased respectively by 110.0%, 83.5%, and 112.5%, respectively, compared with baseline life spans, as a result of the oral administration of 200 mg/kg body weight of the saffron extract. In vitro, the extract was cytotoxic to S-180, EAC, DLA, and P38B tumor cells. The authors concluded that these results suggest the potential for saffron as an anticancer agent (Cancer Lett. 1991;57:109-14).
Speed Burn Healing
In a recent study of the potential role of saffron in wound healing, investigators compared the treatment of heat-induced burn wounds in rats using saffron pollen extract and silver sulfadiazine. Hot water was used to generate the wound. Rats were divided into four groups and treated with a topical cream control, base, saffron (20%), or silver sulfadiazine (1%) 24 hours after the induced injury.
Researchers measured wound size on day 25 and determined the average wound area to be 5.5, 4.1, 4, and 0.9 cm
Bioactive Components
In 2004, Giaccio evaluated the known constituents of saffron as well as its characteristics (e.g., antitoxic effects, hormonelike effects, and anticarcinogenic properties). Crocetin (8,8'-diapo-8,8'-carotenoic acid), a carotenoid and one of the main active ingredients in saffron, was of particular focus. This carotenoid is known to enhance oxygen's capacity to diffuse through liquids, including plasma, and has been shown to increase alveolar transport and cerebral and pulmonary oxygenation. Notably, crocetin also suppresses skin tumor promotion in mice and exhibits other anticarcinogenic properties, which are typically ascribed to its antioxidant activity. Although Giaccio highlighted the significant properties of a key constituent of saffron, the author acknowledged that the promising results associated with crocetin have been identified in vitro or in laboratory animals, but not in humans (Crit. Rev. Food Sci. Nutr. 2004;44:155-72).
In 2005, Assimopoulou et al. reported on a C. sativus extract (including crocin and safranal, two bioactive components). They found that a methanol extract of saffron demonstrated significant antioxidant activity against the 1,1-diphenyl-2-picrylhydrazyl radical. Crocin exhibited greater radical scavenging activity than safranal, but the scavenging capacity of the latter compound was still noted to be high. The investigators concluded that saffron has the potential for functional uses in foods, beverages touted for antioxidant activity, and medical purposes, namely in pharmaceutic and cosmetic formulations intended to confer antioxidant and antiaging activity (Phytother. Res. 2005;19:997-1000).
Conclusion
Although saffron has a long history of traditional uses, it is no turmeric in terms of the body of modern research and evidence. Nevertheless, current scientific investigations appear to be promising, suggesting a significant potential for the contemporary uses of this spice in medical practice. The data supporting saffron's antioxidant properties and successful topical use in animal models are encouraging. That said, while saffron is used as an oral supplement and in Ayurvedic medicine, much more research is necessary to determine its efficacy and effectiveness in topical skin care.
Saffron (Crocus sativus), a member of the Iridaceae family, is native to Southwest Asia, particularly Iran, but was first cultivated in Greece. It has been used as a spice or food flavoring agent, as well as a fragrance, clothing dye, and medicine, for 3,000 years. Saffron also was used for various medical indications by the ancient Persians and Egyptians, and later by the medieval Europeans (Exp. Biol. Med. 2002;227:20-5).
The traditional uses of saffron are borne out in modern medicine, as this botanical product continues to be known for its antispasmodic, carminative, diaphoretic, emmenagogic, and sedative properties (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]). Significantly, pharmacologic studies have shown that saffron has other salubrious benefits, including antioxidant, antimutagenic, and immunomodulatory activities (Asian Pac. J. Cancer Prev. 2004;5:70-6). Much recent research has focused on these properties, as well as on evidence that the spice exhibits anticarcinogenic activity (Exp. Biol. Med. 2002;227:20-5). This column will briefly review the primary investigations of saffron that may potentially lay the groundwork for dermatologic applications.
Anticarcinogenic Actions
In 2004, Das et al. assessed the effects of an aqueous infusion of saffron on a two-stage skin papillogenesis/carcinogenesis mouse model, using 7,12-dimethyl benz[a]anthracin (DMBA) to initiate, and croton oil to promote, tumor formation. Saffron application was found to significantly decrease papilloma development during the pre- and postinitiation periods, especially when the saffron was administered during both periods. The authors attributed the inhibitory effects of saffron, at least in part, to the modulatory effects of C. sativus on phase II detoxifying enzymes, such as glutathione S-transferase, glutathione peroxidase, and superoxide dismutase (Asian Pac. J. Cancer Prev. 2004;5:70-6).
Early in 2009, Das et al. utilized a histopathologic approach to evaluate the chemopreventive effect of aqueous saffron on chemically induced skin carcinogenesis in mice. Animals were divided into five groups: three saffron-treated groups, a carcinogen control group, and a normal control group. Twice a week for 8 weeks, the carcinogen control and saffron groups were administered three topical applications of DMBA followed by croton oil on shaven dorsal skin. Only topical applications of the vehicle (acetone) were given to normal controls. The three saffron groups were orally fed with saffron infusions either before (group A), after (group C), or both before and after (group B) the application of DMBA.
Standard histologic examination revealed that the skin benefited from saffron treatments administered both before and after chemically induced skin carcinogenesis. Specifically, the saffron-fed groups exhibited inhibition of papilloma formation, as well as reductions in the size of papillomas that did form, compared with the control groups. The authors concluded that early treatment with saffron suppresses DMBA-induced skin carcinoma in mice, at least partly because of activation of cellular defense systems, namely cellular antioxidant enzymes (Acta Histochem. 2009 Mar 26 [doi:10.1016/j.acthis.2009.02.003]).
The anticarcinogenic properties of saffron were also demonstrated in much earlier studies. In 1991, Salomi et al. found that topical application of extracts of the common food spices Nigella sativa and C. sativus suppressed skin carcinogenesis initiation and promotion in a mouse model also using DMBA and croton oil. Specifically, they observed a delay in the formation of papillomas and a lower mean number of papillomas per mouse with application of a 100-mg/kg body weight dose of the extracts. They also evaluated the effects of the extracts on 20-methylcholanthrene (MCA)-induced soft tissue sarcomas in albino mice. Whereas tumor incidence was 100% in MCA-treated control mice, intraperitoneal administration of N. sativa and oral administration of C. sativus (both at 100 mg/kg body weight) 30 days after subcutaneous administration of MCA (745 nmol/day for 2 days) yielded tumor incidences of 33.3% and 10%, respectively (Nutr. Cancer 1991;16:67-72).
That same year, some of the same researchers, led by Nair, studied the antitumor activity of saffron extract against intraperitoneally transplanted sarcoma-180 (S-180), Ehrlich ascites carcinoma (EAC), and Dalton's lymphoma ascites (DLA) tumors in mice. The life spans of S-180, EAC, and DLA mice were increased respectively by 110.0%, 83.5%, and 112.5%, respectively, compared with baseline life spans, as a result of the oral administration of 200 mg/kg body weight of the saffron extract. In vitro, the extract was cytotoxic to S-180, EAC, DLA, and P38B tumor cells. The authors concluded that these results suggest the potential for saffron as an anticancer agent (Cancer Lett. 1991;57:109-14).
Speed Burn Healing
In a recent study of the potential role of saffron in wound healing, investigators compared the treatment of heat-induced burn wounds in rats using saffron pollen extract and silver sulfadiazine. Hot water was used to generate the wound. Rats were divided into four groups and treated with a topical cream control, base, saffron (20%), or silver sulfadiazine (1%) 24 hours after the induced injury.
Researchers measured wound size on day 25 and determined the average wound area to be 5.5, 4.1, 4, and 0.9 cm
Bioactive Components
In 2004, Giaccio evaluated the known constituents of saffron as well as its characteristics (e.g., antitoxic effects, hormonelike effects, and anticarcinogenic properties). Crocetin (8,8'-diapo-8,8'-carotenoic acid), a carotenoid and one of the main active ingredients in saffron, was of particular focus. This carotenoid is known to enhance oxygen's capacity to diffuse through liquids, including plasma, and has been shown to increase alveolar transport and cerebral and pulmonary oxygenation. Notably, crocetin also suppresses skin tumor promotion in mice and exhibits other anticarcinogenic properties, which are typically ascribed to its antioxidant activity. Although Giaccio highlighted the significant properties of a key constituent of saffron, the author acknowledged that the promising results associated with crocetin have been identified in vitro or in laboratory animals, but not in humans (Crit. Rev. Food Sci. Nutr. 2004;44:155-72).
In 2005, Assimopoulou et al. reported on a C. sativus extract (including crocin and safranal, two bioactive components). They found that a methanol extract of saffron demonstrated significant antioxidant activity against the 1,1-diphenyl-2-picrylhydrazyl radical. Crocin exhibited greater radical scavenging activity than safranal, but the scavenging capacity of the latter compound was still noted to be high. The investigators concluded that saffron has the potential for functional uses in foods, beverages touted for antioxidant activity, and medical purposes, namely in pharmaceutic and cosmetic formulations intended to confer antioxidant and antiaging activity (Phytother. Res. 2005;19:997-1000).
Conclusion
Although saffron has a long history of traditional uses, it is no turmeric in terms of the body of modern research and evidence. Nevertheless, current scientific investigations appear to be promising, suggesting a significant potential for the contemporary uses of this spice in medical practice. The data supporting saffron's antioxidant properties and successful topical use in animal models are encouraging. That said, while saffron is used as an oral supplement and in Ayurvedic medicine, much more research is necessary to determine its efficacy and effectiveness in topical skin care.
Cellulite
Edematous fibrosclerotic panniculopathy, or local lipodystrophy, better known as cellulite, may be best characterized as a skin surface alteration, nodularity, or dimpling that occurs in most women, typically in the buttocks and upper thighs, as well as the abdomen (Int. J. Cosmet. Sci. 2006;28:191-206). These lesions are typically depressed, compared with adjacent unaffected skin. Cellulite also is known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy.
Risk factors for cellulite include being female, overweight or obese, and elderly; having excess hormones or poor lymphatic drainage; and getting little exercise. Although cellulite often occurs in healthy, nonobese patients, obesity is known to exacerbate it (Dermatol. Surg. 1997;23:1177-81; J. Cosmet. Dermatol. 2005;4:221-2; Am. J. Dermatopathol. 2000;22:34-7).
Estimates of the frequency of cellulite in women range from 80% to 98% of postadolescent females across cultures (J. Dtsch. Dermatol. Ges. 2006;4:861-70; J. Cosmet. Laser Ther. 2004;6:181-5).
Etiology
The etiology of cellulite remains unclear, although several theories have been advanced (J. Cosmet. Laser Ther. 2005;7:7-10; Int. J. Cosmet. Sci. 2006;28:191-206; J. Cosmet. Laser Ther. 2004;6:181-5). Factors that have been cited as important in the pathophysiologic process include sex-specific morphologic differences, vascular changes, inflammation, and deterioration in connective tissue septa (J. Cosmet. Laser Ther. 2004;6:181-5; J. Dtsch. Dermatol. Ges. 2006;4:861-70).
One train of thought suggests that cellulite is derived from a disorder of endocrine-metabolic microcirculatory origin, in which changes in subcutaneous adipose tissue and the interstitial matrix manifest in unsightly bumps (Int. J. Cosmet. Sci. 2006;28:191-206).
The anatomy of this condition is an important factor. The morphologic differences in the fat lobes of men and women may account for the much greater frequency of this presentation in females. The degradation of collagen in the reticular dermis is thought to contribute to the development of cellulite by promoting weakness and compression of microcirculation in the dermis, as well as herniation of subcutaneous fat into the dermal layer. The characteristic signs of cellulite are then believed to result from the congestion of fluid and proteins in the dermis, forming fibrotic bands between the subcutaneous tissue and the dermis. Physiologic changes in the dermis, rather than in the subcutaneous fat layer, are thought to be primary.
Modes of Treatment
Although no treatment approaches have been deemed entirely successful, given their typically mild and temporary effects, cellulite therapies have included the use of noninvasive devices such as massage machines, radiofrequency systems, and laser and other light instruments; invasive surgery such as liposuction, mesotherapy, and subcision; carboxy therapy; topical therapy; and even oral modalities (J. Drugs Dermatol. 2008;7:341-5; J. Drugs Dermatol. 2007;6:83-4).
Massage appears to be the most effective modality for low-grade cellulite, as it is conducive to enhancing blood and lymphatic circulation and draining waste products. The effects are temporary, however, as they are with even the most effective topical products, which contain caffeine and theophylline and dehydrate the fat cells, temporarily shrinking them. For the highest-grade cellulite lesions, minimally invasive procedures such as subcision can render improvement (Int. J. Dermatol. 2000;39:539-44).
Topical Treatments
Despite the slew of products touted for treating cellulite, few have been tested in clinical trials.
In 1999, a 12-week, randomized, controlled trial evaluated the effectiveness of two different cellulite creams, aminophylline and a placebo, as well as the Endermologie ES1 massage machine (LPG Systems S.A.). Sixty-nine women began the study, and 52 women completed it.
The treatments studied were twice-daily application of aminophylline cream and twice-weekly use of the Endermologie. Patients served as their own controls. In group 1 (double blind), aminophylline was applied to one thigh/buttock and a placebo cream to the other. In group 2 (single blind), the Endermologie was applied to one thigh/buttock. In group 3, the Endermologie was applied to both sides, and the same cream regimen as in group 1 was used.
Clinical examination and photographic assessment before and after the trial revealed no statistically significant measurement differences between legs in any of the groups. The appearance of cellulite was judged in subjective assessments to have improved in only 3 of 35 legs treated with aminophylline and in 10 of 35 legs treated with the Endermologie machine. The investigators concluded that neither of the tested modalities is effective for cellulite treatment (Plast. Reconstr. Surg. 1999;104:1110-4).
In 2000, investigators reported the effects of topical retinol for treating cellulite in a left-right randomized, 6-month trial comparing the retinol with a placebo. The subjects included 15 women aged 26-44 years who had requested liposuction to ameliorate mild to moderate cellulite.
Following the treatment period, the researchers recorded an 11% increase in skin elasticity and a 16% decrease in viscosity in the retinol-treated area. It is important to remember that there is no accepted device that everyone agrees accurately measures skin elasticity, so these results must be interpreted with caution (Am. J. Clin. Dermatol. 2000; 1:369-74).
In 2005, investigators conducted a double-blind, randomized study in which 40 women with moderate cellulite were instructed to apply an anticellulite cream nightly for 4 weeks. This cream contained caffeine, green tea, black pepper, orange, and cinnamon bark extract. The active cream was applied on the right or left leg, and the placebo cream to the other leg. Participants were instructed to wear bioceramic-coated neoprene shorts to promote penetration of the active agent. Five blinded, independent physicians evaluated photos taken before treatment and after 4 weeks for improvement. Subject questionnaires were completed to assess tolerability and efficacy. A total of 34 subjects completed the study, of whom 21 reported overall improvement in their cellulite; 13 of the 21 reported greater improvement in the thigh receiving the active agent. The physician evaluators found that thighs treated with the active formulation showed greater improvement in 68% of subjects. No adverse effects were reported (J. Cosmet. Dermatol. 2005;4:93-102).
The investigators in this study had previously performed a double-blind, randomized study of 20 women who applied an anticellulite cream to affected sites nightly for 4 weeks. In that trial, the efficacy of the topical agent when used alone was compared with its efficacy when used in combination with an occlusive bioceramic-coated neoprene garment. Seventeen women completed the trial.
Responses to questionnaires showed that 76% of the participants identified overall improvement, with 54% indicating that the thigh treated with the topical agent and garment occlusion exhibited greater improvement. Measurements indicated a slightly greater reduction in thigh circumference in the occlusion group (1.3 cm vs. 1.1 cm).
Dermatologists evaluating the subjects reported improvement in 65% of thighs treated with occlusion and 59% of thighs treated only with the topical cream. They also observed greater improvement in occluded thighs than nonoccluded thighs in 65% of the participants. The investigators concluded that the occlusion achieved with the bioceramic-coated neoprene garment potentiates the activity of anticellulite cream (J. Drugs Dermatol. 2004;3:417-25).
Recently, investigators conducted a double-blind, randomized, controlled study of nine healthy women with grade II-III cellulite to assess a new anticellulite gel combined with a light-emitting diode (LED) array. The volunteers were randomly treated twice daily with an active phosphatidylcholine-based, cosmeceutical gel on one thigh and a placebo gel on the control thigh for 3 months. Each thigh also was exposed, twice weekly for 15 minutes, to LED light at red (660 nm) and near-infrared (950 nm) wavelengths. Height, weight, and body mass were measured and digital photographic images were taken at 0, 6, and 12 weeks, and then 18 months after the first treatment.
At 3 months, investigators found that eight of nine thighs treated with combination therapy improved, warranting a downgrading of the cellulite level. At 18 months, five of the eight responsive thighs regressed to the cellulite grade noted at the beginning of the study (J. Cosmet. Laser Ther. 2007;9:87-96).
At the Store
A group of investigators recently conducted a literature review of the botanical extracts used as active ingredients for treating cellulite and, given the dearth of published findings, also contacted the manufacturers of such products for information on their efficacy. The authors suggested that a product's capacity to reduce fat deposits through frequent topical use relies on the concentration of the active ingredient and its availability at the treatment site (Dermatol. Surg. 2005;31:866-72).
Conclusions
Although cellulite is physically harmless, the pervasiveness of this unaesthetic condition has provided the impetus for much research and the development of numerous treatment options, some of which can be rather expensive. Despite the relatively poor track record of most treatment options, therapy approaches continue to proliferate. In some instances, weight control may improve the appearance of cellulite.
Topical formulations containing a range of ingredients, including botanicals, have shown some promise, particularly those containing caffeine and theophylline, but with fleeting benefits most often observed in combination with another treatment modality. Lasers are being developed to treat cellulite. At this point there is no mechanical, surgical, laser, light, or topical therapy that has proven to be consistently efficacious. There is much research going on that may lead to advances in this area in the future.
Edematous fibrosclerotic panniculopathy, or local lipodystrophy, better known as cellulite, may be best characterized as a skin surface alteration, nodularity, or dimpling that occurs in most women, typically in the buttocks and upper thighs, as well as the abdomen (Int. J. Cosmet. Sci. 2006;28:191-206). These lesions are typically depressed, compared with adjacent unaffected skin. Cellulite also is known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy.
Risk factors for cellulite include being female, overweight or obese, and elderly; having excess hormones or poor lymphatic drainage; and getting little exercise. Although cellulite often occurs in healthy, nonobese patients, obesity is known to exacerbate it (Dermatol. Surg. 1997;23:1177-81; J. Cosmet. Dermatol. 2005;4:221-2; Am. J. Dermatopathol. 2000;22:34-7).
Estimates of the frequency of cellulite in women range from 80% to 98% of postadolescent females across cultures (J. Dtsch. Dermatol. Ges. 2006;4:861-70; J. Cosmet. Laser Ther. 2004;6:181-5).
Etiology
The etiology of cellulite remains unclear, although several theories have been advanced (J. Cosmet. Laser Ther. 2005;7:7-10; Int. J. Cosmet. Sci. 2006;28:191-206; J. Cosmet. Laser Ther. 2004;6:181-5). Factors that have been cited as important in the pathophysiologic process include sex-specific morphologic differences, vascular changes, inflammation, and deterioration in connective tissue septa (J. Cosmet. Laser Ther. 2004;6:181-5; J. Dtsch. Dermatol. Ges. 2006;4:861-70).
One train of thought suggests that cellulite is derived from a disorder of endocrine-metabolic microcirculatory origin, in which changes in subcutaneous adipose tissue and the interstitial matrix manifest in unsightly bumps (Int. J. Cosmet. Sci. 2006;28:191-206).
The anatomy of this condition is an important factor. The morphologic differences in the fat lobes of men and women may account for the much greater frequency of this presentation in females. The degradation of collagen in the reticular dermis is thought to contribute to the development of cellulite by promoting weakness and compression of microcirculation in the dermis, as well as herniation of subcutaneous fat into the dermal layer. The characteristic signs of cellulite are then believed to result from the congestion of fluid and proteins in the dermis, forming fibrotic bands between the subcutaneous tissue and the dermis. Physiologic changes in the dermis, rather than in the subcutaneous fat layer, are thought to be primary.
Modes of Treatment
Although no treatment approaches have been deemed entirely successful, given their typically mild and temporary effects, cellulite therapies have included the use of noninvasive devices such as massage machines, radiofrequency systems, and laser and other light instruments; invasive surgery such as liposuction, mesotherapy, and subcision; carboxy therapy; topical therapy; and even oral modalities (J. Drugs Dermatol. 2008;7:341-5; J. Drugs Dermatol. 2007;6:83-4).
Massage appears to be the most effective modality for low-grade cellulite, as it is conducive to enhancing blood and lymphatic circulation and draining waste products. The effects are temporary, however, as they are with even the most effective topical products, which contain caffeine and theophylline and dehydrate the fat cells, temporarily shrinking them. For the highest-grade cellulite lesions, minimally invasive procedures such as subcision can render improvement (Int. J. Dermatol. 2000;39:539-44).
Topical Treatments
Despite the slew of products touted for treating cellulite, few have been tested in clinical trials.
In 1999, a 12-week, randomized, controlled trial evaluated the effectiveness of two different cellulite creams, aminophylline and a placebo, as well as the Endermologie ES1 massage machine (LPG Systems S.A.). Sixty-nine women began the study, and 52 women completed it.
The treatments studied were twice-daily application of aminophylline cream and twice-weekly use of the Endermologie. Patients served as their own controls. In group 1 (double blind), aminophylline was applied to one thigh/buttock and a placebo cream to the other. In group 2 (single blind), the Endermologie was applied to one thigh/buttock. In group 3, the Endermologie was applied to both sides, and the same cream regimen as in group 1 was used.
Clinical examination and photographic assessment before and after the trial revealed no statistically significant measurement differences between legs in any of the groups. The appearance of cellulite was judged in subjective assessments to have improved in only 3 of 35 legs treated with aminophylline and in 10 of 35 legs treated with the Endermologie machine. The investigators concluded that neither of the tested modalities is effective for cellulite treatment (Plast. Reconstr. Surg. 1999;104:1110-4).
In 2000, investigators reported the effects of topical retinol for treating cellulite in a left-right randomized, 6-month trial comparing the retinol with a placebo. The subjects included 15 women aged 26-44 years who had requested liposuction to ameliorate mild to moderate cellulite.
Following the treatment period, the researchers recorded an 11% increase in skin elasticity and a 16% decrease in viscosity in the retinol-treated area. It is important to remember that there is no accepted device that everyone agrees accurately measures skin elasticity, so these results must be interpreted with caution (Am. J. Clin. Dermatol. 2000; 1:369-74).
In 2005, investigators conducted a double-blind, randomized study in which 40 women with moderate cellulite were instructed to apply an anticellulite cream nightly for 4 weeks. This cream contained caffeine, green tea, black pepper, orange, and cinnamon bark extract. The active cream was applied on the right or left leg, and the placebo cream to the other leg. Participants were instructed to wear bioceramic-coated neoprene shorts to promote penetration of the active agent. Five blinded, independent physicians evaluated photos taken before treatment and after 4 weeks for improvement. Subject questionnaires were completed to assess tolerability and efficacy. A total of 34 subjects completed the study, of whom 21 reported overall improvement in their cellulite; 13 of the 21 reported greater improvement in the thigh receiving the active agent. The physician evaluators found that thighs treated with the active formulation showed greater improvement in 68% of subjects. No adverse effects were reported (J. Cosmet. Dermatol. 2005;4:93-102).
The investigators in this study had previously performed a double-blind, randomized study of 20 women who applied an anticellulite cream to affected sites nightly for 4 weeks. In that trial, the efficacy of the topical agent when used alone was compared with its efficacy when used in combination with an occlusive bioceramic-coated neoprene garment. Seventeen women completed the trial.
Responses to questionnaires showed that 76% of the participants identified overall improvement, with 54% indicating that the thigh treated with the topical agent and garment occlusion exhibited greater improvement. Measurements indicated a slightly greater reduction in thigh circumference in the occlusion group (1.3 cm vs. 1.1 cm).
Dermatologists evaluating the subjects reported improvement in 65% of thighs treated with occlusion and 59% of thighs treated only with the topical cream. They also observed greater improvement in occluded thighs than nonoccluded thighs in 65% of the participants. The investigators concluded that the occlusion achieved with the bioceramic-coated neoprene garment potentiates the activity of anticellulite cream (J. Drugs Dermatol. 2004;3:417-25).
Recently, investigators conducted a double-blind, randomized, controlled study of nine healthy women with grade II-III cellulite to assess a new anticellulite gel combined with a light-emitting diode (LED) array. The volunteers were randomly treated twice daily with an active phosphatidylcholine-based, cosmeceutical gel on one thigh and a placebo gel on the control thigh for 3 months. Each thigh also was exposed, twice weekly for 15 minutes, to LED light at red (660 nm) and near-infrared (950 nm) wavelengths. Height, weight, and body mass were measured and digital photographic images were taken at 0, 6, and 12 weeks, and then 18 months after the first treatment.
At 3 months, investigators found that eight of nine thighs treated with combination therapy improved, warranting a downgrading of the cellulite level. At 18 months, five of the eight responsive thighs regressed to the cellulite grade noted at the beginning of the study (J. Cosmet. Laser Ther. 2007;9:87-96).
At the Store
A group of investigators recently conducted a literature review of the botanical extracts used as active ingredients for treating cellulite and, given the dearth of published findings, also contacted the manufacturers of such products for information on their efficacy. The authors suggested that a product's capacity to reduce fat deposits through frequent topical use relies on the concentration of the active ingredient and its availability at the treatment site (Dermatol. Surg. 2005;31:866-72).
Conclusions
Although cellulite is physically harmless, the pervasiveness of this unaesthetic condition has provided the impetus for much research and the development of numerous treatment options, some of which can be rather expensive. Despite the relatively poor track record of most treatment options, therapy approaches continue to proliferate. In some instances, weight control may improve the appearance of cellulite.
Topical formulations containing a range of ingredients, including botanicals, have shown some promise, particularly those containing caffeine and theophylline, but with fleeting benefits most often observed in combination with another treatment modality. Lasers are being developed to treat cellulite. At this point there is no mechanical, surgical, laser, light, or topical therapy that has proven to be consistently efficacious. There is much research going on that may lead to advances in this area in the future.
Edematous fibrosclerotic panniculopathy, or local lipodystrophy, better known as cellulite, may be best characterized as a skin surface alteration, nodularity, or dimpling that occurs in most women, typically in the buttocks and upper thighs, as well as the abdomen (Int. J. Cosmet. Sci. 2006;28:191-206). These lesions are typically depressed, compared with adjacent unaffected skin. Cellulite also is known as adiposis edematosa, dermopanniculosis deformans, status protrusus cutis, and gynoid lipodystrophy.
Risk factors for cellulite include being female, overweight or obese, and elderly; having excess hormones or poor lymphatic drainage; and getting little exercise. Although cellulite often occurs in healthy, nonobese patients, obesity is known to exacerbate it (Dermatol. Surg. 1997;23:1177-81; J. Cosmet. Dermatol. 2005;4:221-2; Am. J. Dermatopathol. 2000;22:34-7).
Estimates of the frequency of cellulite in women range from 80% to 98% of postadolescent females across cultures (J. Dtsch. Dermatol. Ges. 2006;4:861-70; J. Cosmet. Laser Ther. 2004;6:181-5).
Etiology
The etiology of cellulite remains unclear, although several theories have been advanced (J. Cosmet. Laser Ther. 2005;7:7-10; Int. J. Cosmet. Sci. 2006;28:191-206; J. Cosmet. Laser Ther. 2004;6:181-5). Factors that have been cited as important in the pathophysiologic process include sex-specific morphologic differences, vascular changes, inflammation, and deterioration in connective tissue septa (J. Cosmet. Laser Ther. 2004;6:181-5; J. Dtsch. Dermatol. Ges. 2006;4:861-70).
One train of thought suggests that cellulite is derived from a disorder of endocrine-metabolic microcirculatory origin, in which changes in subcutaneous adipose tissue and the interstitial matrix manifest in unsightly bumps (Int. J. Cosmet. Sci. 2006;28:191-206).
The anatomy of this condition is an important factor. The morphologic differences in the fat lobes of men and women may account for the much greater frequency of this presentation in females. The degradation of collagen in the reticular dermis is thought to contribute to the development of cellulite by promoting weakness and compression of microcirculation in the dermis, as well as herniation of subcutaneous fat into the dermal layer. The characteristic signs of cellulite are then believed to result from the congestion of fluid and proteins in the dermis, forming fibrotic bands between the subcutaneous tissue and the dermis. Physiologic changes in the dermis, rather than in the subcutaneous fat layer, are thought to be primary.
Modes of Treatment
Although no treatment approaches have been deemed entirely successful, given their typically mild and temporary effects, cellulite therapies have included the use of noninvasive devices such as massage machines, radiofrequency systems, and laser and other light instruments; invasive surgery such as liposuction, mesotherapy, and subcision; carboxy therapy; topical therapy; and even oral modalities (J. Drugs Dermatol. 2008;7:341-5; J. Drugs Dermatol. 2007;6:83-4).
Massage appears to be the most effective modality for low-grade cellulite, as it is conducive to enhancing blood and lymphatic circulation and draining waste products. The effects are temporary, however, as they are with even the most effective topical products, which contain caffeine and theophylline and dehydrate the fat cells, temporarily shrinking them. For the highest-grade cellulite lesions, minimally invasive procedures such as subcision can render improvement (Int. J. Dermatol. 2000;39:539-44).
Topical Treatments
Despite the slew of products touted for treating cellulite, few have been tested in clinical trials.
In 1999, a 12-week, randomized, controlled trial evaluated the effectiveness of two different cellulite creams, aminophylline and a placebo, as well as the Endermologie ES1 massage machine (LPG Systems S.A.). Sixty-nine women began the study, and 52 women completed it.
The treatments studied were twice-daily application of aminophylline cream and twice-weekly use of the Endermologie. Patients served as their own controls. In group 1 (double blind), aminophylline was applied to one thigh/buttock and a placebo cream to the other. In group 2 (single blind), the Endermologie was applied to one thigh/buttock. In group 3, the Endermologie was applied to both sides, and the same cream regimen as in group 1 was used.
Clinical examination and photographic assessment before and after the trial revealed no statistically significant measurement differences between legs in any of the groups. The appearance of cellulite was judged in subjective assessments to have improved in only 3 of 35 legs treated with aminophylline and in 10 of 35 legs treated with the Endermologie machine. The investigators concluded that neither of the tested modalities is effective for cellulite treatment (Plast. Reconstr. Surg. 1999;104:1110-4).
In 2000, investigators reported the effects of topical retinol for treating cellulite in a left-right randomized, 6-month trial comparing the retinol with a placebo. The subjects included 15 women aged 26-44 years who had requested liposuction to ameliorate mild to moderate cellulite.
Following the treatment period, the researchers recorded an 11% increase in skin elasticity and a 16% decrease in viscosity in the retinol-treated area. It is important to remember that there is no accepted device that everyone agrees accurately measures skin elasticity, so these results must be interpreted with caution (Am. J. Clin. Dermatol. 2000; 1:369-74).
In 2005, investigators conducted a double-blind, randomized study in which 40 women with moderate cellulite were instructed to apply an anticellulite cream nightly for 4 weeks. This cream contained caffeine, green tea, black pepper, orange, and cinnamon bark extract. The active cream was applied on the right or left leg, and the placebo cream to the other leg. Participants were instructed to wear bioceramic-coated neoprene shorts to promote penetration of the active agent. Five blinded, independent physicians evaluated photos taken before treatment and after 4 weeks for improvement. Subject questionnaires were completed to assess tolerability and efficacy. A total of 34 subjects completed the study, of whom 21 reported overall improvement in their cellulite; 13 of the 21 reported greater improvement in the thigh receiving the active agent. The physician evaluators found that thighs treated with the active formulation showed greater improvement in 68% of subjects. No adverse effects were reported (J. Cosmet. Dermatol. 2005;4:93-102).
The investigators in this study had previously performed a double-blind, randomized study of 20 women who applied an anticellulite cream to affected sites nightly for 4 weeks. In that trial, the efficacy of the topical agent when used alone was compared with its efficacy when used in combination with an occlusive bioceramic-coated neoprene garment. Seventeen women completed the trial.
Responses to questionnaires showed that 76% of the participants identified overall improvement, with 54% indicating that the thigh treated with the topical agent and garment occlusion exhibited greater improvement. Measurements indicated a slightly greater reduction in thigh circumference in the occlusion group (1.3 cm vs. 1.1 cm).
Dermatologists evaluating the subjects reported improvement in 65% of thighs treated with occlusion and 59% of thighs treated only with the topical cream. They also observed greater improvement in occluded thighs than nonoccluded thighs in 65% of the participants. The investigators concluded that the occlusion achieved with the bioceramic-coated neoprene garment potentiates the activity of anticellulite cream (J. Drugs Dermatol. 2004;3:417-25).
Recently, investigators conducted a double-blind, randomized, controlled study of nine healthy women with grade II-III cellulite to assess a new anticellulite gel combined with a light-emitting diode (LED) array. The volunteers were randomly treated twice daily with an active phosphatidylcholine-based, cosmeceutical gel on one thigh and a placebo gel on the control thigh for 3 months. Each thigh also was exposed, twice weekly for 15 minutes, to LED light at red (660 nm) and near-infrared (950 nm) wavelengths. Height, weight, and body mass were measured and digital photographic images were taken at 0, 6, and 12 weeks, and then 18 months after the first treatment.
At 3 months, investigators found that eight of nine thighs treated with combination therapy improved, warranting a downgrading of the cellulite level. At 18 months, five of the eight responsive thighs regressed to the cellulite grade noted at the beginning of the study (J. Cosmet. Laser Ther. 2007;9:87-96).
At the Store
A group of investigators recently conducted a literature review of the botanical extracts used as active ingredients for treating cellulite and, given the dearth of published findings, also contacted the manufacturers of such products for information on their efficacy. The authors suggested that a product's capacity to reduce fat deposits through frequent topical use relies on the concentration of the active ingredient and its availability at the treatment site (Dermatol. Surg. 2005;31:866-72).
Conclusions
Although cellulite is physically harmless, the pervasiveness of this unaesthetic condition has provided the impetus for much research and the development of numerous treatment options, some of which can be rather expensive. Despite the relatively poor track record of most treatment options, therapy approaches continue to proliferate. In some instances, weight control may improve the appearance of cellulite.
Topical formulations containing a range of ingredients, including botanicals, have shown some promise, particularly those containing caffeine and theophylline, but with fleeting benefits most often observed in combination with another treatment modality. Lasers are being developed to treat cellulite. At this point there is no mechanical, surgical, laser, light, or topical therapy that has proven to be consistently efficacious. There is much research going on that may lead to advances in this area in the future.
Cleansers
The use of soap-like substances for cleansing dates back as early as 2,500 BCE, and soap itself is believed to have been invented between 600 and 300 BCE (Soap Technology for the 1900's, Champaign, Ill., American Oil Chemists' Society, 1990, p. 1–47).
Interestingly, though, the soap production process remained a carefully protected secret until it was detailed in a publication in 1775, eventually setting the stage for the soap industry (Dermatol. Ther. 2004;17 Suppl 1:35–42).
The oldest brand, Yardley, made by a small perfumery and soap business, was founded in 1779, but the first industrial manufacturer of soap in an individually wrapped and branded bar did not occur until 1884 in England (American Soap Makers Guide, New York, Henry Carey Baird & Co., 1928, p. 914–9).
The soap industry grew substantially during the 20th century, fueled by increasing interest in cleanliness and other health benefits of soap, as well as in soap's sensory pleasures (J. Am. Acad. Dermatol. 1979;1:35–41). Concurrently, interest in health and hygiene led to the development of deodorant soaps, while the desire for beautiful skin and aromas led to the development of cleansing bars of different colors, shapes, and fragrances.
Modern Cleansing Agents
Increased awareness of soap-induced skin irritation drove consumer demand in the 1940s for mild cleansing bars. The introduction of synthetic detergents into the cleansing arena in 1948 led to the development of patently milder cleansing bars that were better for the skin than soaps (J. Am. Acad. Dermatol. 1979;1:35–41).
Mild cleansers have represented an increasing proportion of the cleanser market in recent years, and interest is growing in the functional benefits, especially moisturizing. Greater understanding of the effects of cleansing agents on skin and the use of milder surfactants and polymers have led to novel approaches to the delivery of skin care benefits from cleansers (Dry Skin and Moisturizers: Chemistry and Function, 2nd ed., Boca Raton, CRC Press, 2006, p. 405–28).
Hand washing is integral to personal hygiene and helps prevent infectious germ transmission, but frequent hand washing, of course, can itself lead to dry, damaged, and irritated skin (Contact Dermatitis 1995;32:225–32). Gentle cleansers and moisturizers are recommended to maintain a healthy skin barrier in these cases.
Facial cleansing is typically associated with freshening and improving appearance, including the removal of “oily” residues (including make-up) without damaging the skin. Foaming (surfactant-containing) and nonfoaming (low- to no-surfactant) systems and towelettes represent the currently available facial cleansing products (Dermatol. Ther. 2004;17 Suppl 1:35–42). Nonfoaming agents are usually mild but less efficient cleansers. Cleansing towelettes are convenient and easy to use.
Surfactants
Surfactants are the primary active ingredients in cleanser formulations, controlling the degree of mildness or irritancy of a product. The chief surfactants used in cleansers are anionic, because of their ideal foam and lather characteristics.
Soap (alkyl carboxylate) is the main surfactant used in most cleansing bars. Typically, soap is produced by saponification, which involves a reaction of a triglyceride oil/fat with an alkali. The oils most often used are vegetable oils, such as palm oil, palm oil derivatives (palm stearine, palm olein), rice bran oil, ground nut oil, and castor oil combined with coconut oil or palm kernel oil (Dermatol. Ther. 2004;17 Suppl 1:35–42).
Nonvegetable ingredients used in soap are generally derived from animal fat, such as tallow. Although soaps are effective cleansers, they are known to irritate the skin, eliciting reactions such as erythema, xerosis, and pruritus, particularly in cold weather (Dermatol. Ther. 2004;17 Suppl 1:35–42).
Newer classes of soaps—superfatted soaps, transparent soaps, and combination bars—have been developed to mitigate the irritancy of soaps, which is associated with poor rinsability and a high pH (Dermatol. Ther. 2004;17 Suppl 1:35–42; Cosmetics Toiletries 1995;110:89):
- Superfatted soaps. These are derived from incomplete saponification (neutralization), which is achieved by leaving unreacted fatty acids or oils in the product or by adding fatty alcohols, fatty acids, or esters during manufacturing. Superfatting usually enhances soap product characteristics, including mildness, moisturization, lather, mush value, and wear rate (Dermatol. Ther. 2004;17 Suppl 1:35–42; Indian J. Pediatr. 2002;69:767–9; The Manufacture of Soaps, Other Detergents and Glycerin, West Sussex, U.K., Ellis Horwood Limited, 1985).
- Transparent soaps. Made with a high level of humectants that tend to solubilize the soaps, leaving a transparent, clear appearance, transparent soaps also have high levels of active soap and an alkaline pH, which tend to promote irritancy. These products are usually mild, however, because of the presence of glycerin and low levels of fatty acids (Dermatol. Ther. 2004;17 Suppl 1:35–42).
- Combination bars. These cleansing agents combine natural soaps with milder synthetic surfactants and typically cause less irritation than normal soaps. Although the pH of these products is in the high range, the synthetic surfactants tend to suppress irritancy (Dermatol. Ther. 2004;17 Suppl 1:35–42).
- Synthetic detergent bars. Syndet bars, unlike soaps, are produced through esterification, ethoxylation, and sulfonation of oils, fats, or petroleum products, and are formulated in the neutral pH range. The synthetic surfactants frequently used in these bars include alkyl glyceryl ether sulfonate, alpha olefin sulfonates, betaines, sulfosuccinates, sodium cocoyl monoglyceride sulfate, and sodium cocoyl isethionate (Dermatol. Ther. 2004;17 Suppl 1:35–42). The unique molecular characteristics of sodium cocoyl isethionate have significantly contributed to the mildness of cleansing bars.
Cleansing Liquid Surfactants
Liquid cleansers often combine anionic and amphoteric surfactants. Anionic surfactants commonly used in liquid cleansers include soaps (salts of fatty acids) and synthetic surfactants such as alkyl ether sulfate, alkyl acyl isethionates, alkyl phosphates, alkyl sulfosuccinates, and alkyl sulfonates. Cocoamidopropyl betaine and cocoamphoacetate are the typical amphoteric or zwitterionic surfactants used.
Notably, nonionic surfactants such as alkyl polyglucoside and amino acid-based surfactants like acyl glycinates, alkyl glutamates, and sarcosinates are being increasingly incorporated as primary surfactants in cleanser systems for their mildness-enhancing activity (Surfactants in Cosmetics, New York, Marcel Dekker, 1997, pp. 427–71).
Although most liquid cleansers are formulated in the neutral to acidic pH range, products that contain soap (alkyl carboxylate) as the main active ingredient typically exhibit an alkaline pH.
Structurants and Other Ingredients
With cleansing bars, structurants such as long-chain fatty acids, waxes, and alkyl esters are necessary to maintain the solid format and facilitate the complex manufacturing process. In liquids, structurants impart the right rheology and consistency to the product for optimal dispensing and in-use experience. Structurants also ensure the physical stability of dispersed and suspended phases and confer moisturizing effects.
A moisturizing effect is provided in cleansing systems by water-soluble humectants such as glycerin. Emollients are included in cleansers to reduce the drying effects of surfactants. In moisturizing shower gels, typical emollients and occlusives include triglyceride oils, lipids, petrolatum, waxes, and mineral oil.
Other functional ingredients may be found in cleansers formulated for specific benefits. For example, bactericidal actives such as triclosan or triclocarban are contained in antimicrobial cleansers.
The Food and Drug Administration regulates synthetic cleansers and those designed to achieve antibacterial or other druglike effects. The Consumer Product Safety Commission regulates pure soap products.
Mild, Moisturizing, Cleansing Agents
Delivering lipids, emollient oils, and occlusives under cleansing conditions is one of the primary approaches to reducing visible signs of skin dryness and improving hydration. Incorporating high levels of emollients into a stable cleansing formulation and depositing the emollients on the skin during washing are achieved through specially structured surfactant formulations with cationic polymers to aid deposition and retention of oils and occlusives.
Emollient and occlusive ingredients used in cleansing liquid formulations include vegetable oils (soybean or sunflower seed) and petroleum jelly.
Hydrophobic emollients are more often included in cleansers because they are easier to deliver to skin than water-soluble moisturizers such as glycerin and other humectants.
Paradoxically, cleansing often leads to a weakening of the skin barrier. Consequently, for most skin disorders, cleansing with commonly used soap-based products may prove problematic and aggravate a patient's particular skin condition. In addition, prolonged daily use of cleansers that induce short-term damage can lead to xerosis, scaling, flaking, erythema, and pruritus. Therefore, mild cleansing is recommended for the management of compromised skin conditions such as acne, rosacea, atopic dermatitis, and photodamage.
Conclusion
Soap has an interesting and extensive history and has long been the primary cleansing agent. In recent decades, innovations have led to a marked increase in the variety and versatility of products used for cleansing and beautifying purposes.
Underlying many of these developments was the motivation to formulate products that would not cause irritation. Subsequently, agents have been developed that are more suitable for use on dry or sensitive skin or with compromised skin conditions.
Antibacterial soaps have also been formulated, but could conceivably contribute to the growing problem of antibacterial resistance. This information is available in more detail in the second edition of my book, “Cosmetic Dermatology: Principles and Practice” (McGraw-Hill Professional, 2009).
The use of soap-like substances for cleansing dates back as early as 2,500 BCE, and soap itself is believed to have been invented between 600 and 300 BCE (Soap Technology for the 1900's, Champaign, Ill., American Oil Chemists' Society, 1990, p. 1–47).
Interestingly, though, the soap production process remained a carefully protected secret until it was detailed in a publication in 1775, eventually setting the stage for the soap industry (Dermatol. Ther. 2004;17 Suppl 1:35–42).
The oldest brand, Yardley, made by a small perfumery and soap business, was founded in 1779, but the first industrial manufacturer of soap in an individually wrapped and branded bar did not occur until 1884 in England (American Soap Makers Guide, New York, Henry Carey Baird & Co., 1928, p. 914–9).
The soap industry grew substantially during the 20th century, fueled by increasing interest in cleanliness and other health benefits of soap, as well as in soap's sensory pleasures (J. Am. Acad. Dermatol. 1979;1:35–41). Concurrently, interest in health and hygiene led to the development of deodorant soaps, while the desire for beautiful skin and aromas led to the development of cleansing bars of different colors, shapes, and fragrances.
Modern Cleansing Agents
Increased awareness of soap-induced skin irritation drove consumer demand in the 1940s for mild cleansing bars. The introduction of synthetic detergents into the cleansing arena in 1948 led to the development of patently milder cleansing bars that were better for the skin than soaps (J. Am. Acad. Dermatol. 1979;1:35–41).
Mild cleansers have represented an increasing proportion of the cleanser market in recent years, and interest is growing in the functional benefits, especially moisturizing. Greater understanding of the effects of cleansing agents on skin and the use of milder surfactants and polymers have led to novel approaches to the delivery of skin care benefits from cleansers (Dry Skin and Moisturizers: Chemistry and Function, 2nd ed., Boca Raton, CRC Press, 2006, p. 405–28).
Hand washing is integral to personal hygiene and helps prevent infectious germ transmission, but frequent hand washing, of course, can itself lead to dry, damaged, and irritated skin (Contact Dermatitis 1995;32:225–32). Gentle cleansers and moisturizers are recommended to maintain a healthy skin barrier in these cases.
Facial cleansing is typically associated with freshening and improving appearance, including the removal of “oily” residues (including make-up) without damaging the skin. Foaming (surfactant-containing) and nonfoaming (low- to no-surfactant) systems and towelettes represent the currently available facial cleansing products (Dermatol. Ther. 2004;17 Suppl 1:35–42). Nonfoaming agents are usually mild but less efficient cleansers. Cleansing towelettes are convenient and easy to use.
Surfactants
Surfactants are the primary active ingredients in cleanser formulations, controlling the degree of mildness or irritancy of a product. The chief surfactants used in cleansers are anionic, because of their ideal foam and lather characteristics.
Soap (alkyl carboxylate) is the main surfactant used in most cleansing bars. Typically, soap is produced by saponification, which involves a reaction of a triglyceride oil/fat with an alkali. The oils most often used are vegetable oils, such as palm oil, palm oil derivatives (palm stearine, palm olein), rice bran oil, ground nut oil, and castor oil combined with coconut oil or palm kernel oil (Dermatol. Ther. 2004;17 Suppl 1:35–42).
Nonvegetable ingredients used in soap are generally derived from animal fat, such as tallow. Although soaps are effective cleansers, they are known to irritate the skin, eliciting reactions such as erythema, xerosis, and pruritus, particularly in cold weather (Dermatol. Ther. 2004;17 Suppl 1:35–42).
Newer classes of soaps—superfatted soaps, transparent soaps, and combination bars—have been developed to mitigate the irritancy of soaps, which is associated with poor rinsability and a high pH (Dermatol. Ther. 2004;17 Suppl 1:35–42; Cosmetics Toiletries 1995;110:89):
- Superfatted soaps. These are derived from incomplete saponification (neutralization), which is achieved by leaving unreacted fatty acids or oils in the product or by adding fatty alcohols, fatty acids, or esters during manufacturing. Superfatting usually enhances soap product characteristics, including mildness, moisturization, lather, mush value, and wear rate (Dermatol. Ther. 2004;17 Suppl 1:35–42; Indian J. Pediatr. 2002;69:767–9; The Manufacture of Soaps, Other Detergents and Glycerin, West Sussex, U.K., Ellis Horwood Limited, 1985).
- Transparent soaps. Made with a high level of humectants that tend to solubilize the soaps, leaving a transparent, clear appearance, transparent soaps also have high levels of active soap and an alkaline pH, which tend to promote irritancy. These products are usually mild, however, because of the presence of glycerin and low levels of fatty acids (Dermatol. Ther. 2004;17 Suppl 1:35–42).
- Combination bars. These cleansing agents combine natural soaps with milder synthetic surfactants and typically cause less irritation than normal soaps. Although the pH of these products is in the high range, the synthetic surfactants tend to suppress irritancy (Dermatol. Ther. 2004;17 Suppl 1:35–42).
- Synthetic detergent bars. Syndet bars, unlike soaps, are produced through esterification, ethoxylation, and sulfonation of oils, fats, or petroleum products, and are formulated in the neutral pH range. The synthetic surfactants frequently used in these bars include alkyl glyceryl ether sulfonate, alpha olefin sulfonates, betaines, sulfosuccinates, sodium cocoyl monoglyceride sulfate, and sodium cocoyl isethionate (Dermatol. Ther. 2004;17 Suppl 1:35–42). The unique molecular characteristics of sodium cocoyl isethionate have significantly contributed to the mildness of cleansing bars.
Cleansing Liquid Surfactants
Liquid cleansers often combine anionic and amphoteric surfactants. Anionic surfactants commonly used in liquid cleansers include soaps (salts of fatty acids) and synthetic surfactants such as alkyl ether sulfate, alkyl acyl isethionates, alkyl phosphates, alkyl sulfosuccinates, and alkyl sulfonates. Cocoamidopropyl betaine and cocoamphoacetate are the typical amphoteric or zwitterionic surfactants used.
Notably, nonionic surfactants such as alkyl polyglucoside and amino acid-based surfactants like acyl glycinates, alkyl glutamates, and sarcosinates are being increasingly incorporated as primary surfactants in cleanser systems for their mildness-enhancing activity (Surfactants in Cosmetics, New York, Marcel Dekker, 1997, pp. 427–71).
Although most liquid cleansers are formulated in the neutral to acidic pH range, products that contain soap (alkyl carboxylate) as the main active ingredient typically exhibit an alkaline pH.
Structurants and Other Ingredients
With cleansing bars, structurants such as long-chain fatty acids, waxes, and alkyl esters are necessary to maintain the solid format and facilitate the complex manufacturing process. In liquids, structurants impart the right rheology and consistency to the product for optimal dispensing and in-use experience. Structurants also ensure the physical stability of dispersed and suspended phases and confer moisturizing effects.
A moisturizing effect is provided in cleansing systems by water-soluble humectants such as glycerin. Emollients are included in cleansers to reduce the drying effects of surfactants. In moisturizing shower gels, typical emollients and occlusives include triglyceride oils, lipids, petrolatum, waxes, and mineral oil.
Other functional ingredients may be found in cleansers formulated for specific benefits. For example, bactericidal actives such as triclosan or triclocarban are contained in antimicrobial cleansers.
The Food and Drug Administration regulates synthetic cleansers and those designed to achieve antibacterial or other druglike effects. The Consumer Product Safety Commission regulates pure soap products.
Mild, Moisturizing, Cleansing Agents
Delivering lipids, emollient oils, and occlusives under cleansing conditions is one of the primary approaches to reducing visible signs of skin dryness and improving hydration. Incorporating high levels of emollients into a stable cleansing formulation and depositing the emollients on the skin during washing are achieved through specially structured surfactant formulations with cationic polymers to aid deposition and retention of oils and occlusives.
Emollient and occlusive ingredients used in cleansing liquid formulations include vegetable oils (soybean or sunflower seed) and petroleum jelly.
Hydrophobic emollients are more often included in cleansers because they are easier to deliver to skin than water-soluble moisturizers such as glycerin and other humectants.
Paradoxically, cleansing often leads to a weakening of the skin barrier. Consequently, for most skin disorders, cleansing with commonly used soap-based products may prove problematic and aggravate a patient's particular skin condition. In addition, prolonged daily use of cleansers that induce short-term damage can lead to xerosis, scaling, flaking, erythema, and pruritus. Therefore, mild cleansing is recommended for the management of compromised skin conditions such as acne, rosacea, atopic dermatitis, and photodamage.
Conclusion
Soap has an interesting and extensive history and has long been the primary cleansing agent. In recent decades, innovations have led to a marked increase in the variety and versatility of products used for cleansing and beautifying purposes.
Underlying many of these developments was the motivation to formulate products that would not cause irritation. Subsequently, agents have been developed that are more suitable for use on dry or sensitive skin or with compromised skin conditions.
Antibacterial soaps have also been formulated, but could conceivably contribute to the growing problem of antibacterial resistance. This information is available in more detail in the second edition of my book, “Cosmetic Dermatology: Principles and Practice” (McGraw-Hill Professional, 2009).
The use of soap-like substances for cleansing dates back as early as 2,500 BCE, and soap itself is believed to have been invented between 600 and 300 BCE (Soap Technology for the 1900's, Champaign, Ill., American Oil Chemists' Society, 1990, p. 1–47).
Interestingly, though, the soap production process remained a carefully protected secret until it was detailed in a publication in 1775, eventually setting the stage for the soap industry (Dermatol. Ther. 2004;17 Suppl 1:35–42).
The oldest brand, Yardley, made by a small perfumery and soap business, was founded in 1779, but the first industrial manufacturer of soap in an individually wrapped and branded bar did not occur until 1884 in England (American Soap Makers Guide, New York, Henry Carey Baird & Co., 1928, p. 914–9).
The soap industry grew substantially during the 20th century, fueled by increasing interest in cleanliness and other health benefits of soap, as well as in soap's sensory pleasures (J. Am. Acad. Dermatol. 1979;1:35–41). Concurrently, interest in health and hygiene led to the development of deodorant soaps, while the desire for beautiful skin and aromas led to the development of cleansing bars of different colors, shapes, and fragrances.
Modern Cleansing Agents
Increased awareness of soap-induced skin irritation drove consumer demand in the 1940s for mild cleansing bars. The introduction of synthetic detergents into the cleansing arena in 1948 led to the development of patently milder cleansing bars that were better for the skin than soaps (J. Am. Acad. Dermatol. 1979;1:35–41).
Mild cleansers have represented an increasing proportion of the cleanser market in recent years, and interest is growing in the functional benefits, especially moisturizing. Greater understanding of the effects of cleansing agents on skin and the use of milder surfactants and polymers have led to novel approaches to the delivery of skin care benefits from cleansers (Dry Skin and Moisturizers: Chemistry and Function, 2nd ed., Boca Raton, CRC Press, 2006, p. 405–28).
Hand washing is integral to personal hygiene and helps prevent infectious germ transmission, but frequent hand washing, of course, can itself lead to dry, damaged, and irritated skin (Contact Dermatitis 1995;32:225–32). Gentle cleansers and moisturizers are recommended to maintain a healthy skin barrier in these cases.
Facial cleansing is typically associated with freshening and improving appearance, including the removal of “oily” residues (including make-up) without damaging the skin. Foaming (surfactant-containing) and nonfoaming (low- to no-surfactant) systems and towelettes represent the currently available facial cleansing products (Dermatol. Ther. 2004;17 Suppl 1:35–42). Nonfoaming agents are usually mild but less efficient cleansers. Cleansing towelettes are convenient and easy to use.
Surfactants
Surfactants are the primary active ingredients in cleanser formulations, controlling the degree of mildness or irritancy of a product. The chief surfactants used in cleansers are anionic, because of their ideal foam and lather characteristics.
Soap (alkyl carboxylate) is the main surfactant used in most cleansing bars. Typically, soap is produced by saponification, which involves a reaction of a triglyceride oil/fat with an alkali. The oils most often used are vegetable oils, such as palm oil, palm oil derivatives (palm stearine, palm olein), rice bran oil, ground nut oil, and castor oil combined with coconut oil or palm kernel oil (Dermatol. Ther. 2004;17 Suppl 1:35–42).
Nonvegetable ingredients used in soap are generally derived from animal fat, such as tallow. Although soaps are effective cleansers, they are known to irritate the skin, eliciting reactions such as erythema, xerosis, and pruritus, particularly in cold weather (Dermatol. Ther. 2004;17 Suppl 1:35–42).
Newer classes of soaps—superfatted soaps, transparent soaps, and combination bars—have been developed to mitigate the irritancy of soaps, which is associated with poor rinsability and a high pH (Dermatol. Ther. 2004;17 Suppl 1:35–42; Cosmetics Toiletries 1995;110:89):
- Superfatted soaps. These are derived from incomplete saponification (neutralization), which is achieved by leaving unreacted fatty acids or oils in the product or by adding fatty alcohols, fatty acids, or esters during manufacturing. Superfatting usually enhances soap product characteristics, including mildness, moisturization, lather, mush value, and wear rate (Dermatol. Ther. 2004;17 Suppl 1:35–42; Indian J. Pediatr. 2002;69:767–9; The Manufacture of Soaps, Other Detergents and Glycerin, West Sussex, U.K., Ellis Horwood Limited, 1985).
- Transparent soaps. Made with a high level of humectants that tend to solubilize the soaps, leaving a transparent, clear appearance, transparent soaps also have high levels of active soap and an alkaline pH, which tend to promote irritancy. These products are usually mild, however, because of the presence of glycerin and low levels of fatty acids (Dermatol. Ther. 2004;17 Suppl 1:35–42).
- Combination bars. These cleansing agents combine natural soaps with milder synthetic surfactants and typically cause less irritation than normal soaps. Although the pH of these products is in the high range, the synthetic surfactants tend to suppress irritancy (Dermatol. Ther. 2004;17 Suppl 1:35–42).
- Synthetic detergent bars. Syndet bars, unlike soaps, are produced through esterification, ethoxylation, and sulfonation of oils, fats, or petroleum products, and are formulated in the neutral pH range. The synthetic surfactants frequently used in these bars include alkyl glyceryl ether sulfonate, alpha olefin sulfonates, betaines, sulfosuccinates, sodium cocoyl monoglyceride sulfate, and sodium cocoyl isethionate (Dermatol. Ther. 2004;17 Suppl 1:35–42). The unique molecular characteristics of sodium cocoyl isethionate have significantly contributed to the mildness of cleansing bars.
Cleansing Liquid Surfactants
Liquid cleansers often combine anionic and amphoteric surfactants. Anionic surfactants commonly used in liquid cleansers include soaps (salts of fatty acids) and synthetic surfactants such as alkyl ether sulfate, alkyl acyl isethionates, alkyl phosphates, alkyl sulfosuccinates, and alkyl sulfonates. Cocoamidopropyl betaine and cocoamphoacetate are the typical amphoteric or zwitterionic surfactants used.
Notably, nonionic surfactants such as alkyl polyglucoside and amino acid-based surfactants like acyl glycinates, alkyl glutamates, and sarcosinates are being increasingly incorporated as primary surfactants in cleanser systems for their mildness-enhancing activity (Surfactants in Cosmetics, New York, Marcel Dekker, 1997, pp. 427–71).
Although most liquid cleansers are formulated in the neutral to acidic pH range, products that contain soap (alkyl carboxylate) as the main active ingredient typically exhibit an alkaline pH.
Structurants and Other Ingredients
With cleansing bars, structurants such as long-chain fatty acids, waxes, and alkyl esters are necessary to maintain the solid format and facilitate the complex manufacturing process. In liquids, structurants impart the right rheology and consistency to the product for optimal dispensing and in-use experience. Structurants also ensure the physical stability of dispersed and suspended phases and confer moisturizing effects.
A moisturizing effect is provided in cleansing systems by water-soluble humectants such as glycerin. Emollients are included in cleansers to reduce the drying effects of surfactants. In moisturizing shower gels, typical emollients and occlusives include triglyceride oils, lipids, petrolatum, waxes, and mineral oil.
Other functional ingredients may be found in cleansers formulated for specific benefits. For example, bactericidal actives such as triclosan or triclocarban are contained in antimicrobial cleansers.
The Food and Drug Administration regulates synthetic cleansers and those designed to achieve antibacterial or other druglike effects. The Consumer Product Safety Commission regulates pure soap products.
Mild, Moisturizing, Cleansing Agents
Delivering lipids, emollient oils, and occlusives under cleansing conditions is one of the primary approaches to reducing visible signs of skin dryness and improving hydration. Incorporating high levels of emollients into a stable cleansing formulation and depositing the emollients on the skin during washing are achieved through specially structured surfactant formulations with cationic polymers to aid deposition and retention of oils and occlusives.
Emollient and occlusive ingredients used in cleansing liquid formulations include vegetable oils (soybean or sunflower seed) and petroleum jelly.
Hydrophobic emollients are more often included in cleansers because they are easier to deliver to skin than water-soluble moisturizers such as glycerin and other humectants.
Paradoxically, cleansing often leads to a weakening of the skin barrier. Consequently, for most skin disorders, cleansing with commonly used soap-based products may prove problematic and aggravate a patient's particular skin condition. In addition, prolonged daily use of cleansers that induce short-term damage can lead to xerosis, scaling, flaking, erythema, and pruritus. Therefore, mild cleansing is recommended for the management of compromised skin conditions such as acne, rosacea, atopic dermatitis, and photodamage.
Conclusion
Soap has an interesting and extensive history and has long been the primary cleansing agent. In recent decades, innovations have led to a marked increase in the variety and versatility of products used for cleansing and beautifying purposes.
Underlying many of these developments was the motivation to formulate products that would not cause irritation. Subsequently, agents have been developed that are more suitable for use on dry or sensitive skin or with compromised skin conditions.
Antibacterial soaps have also been formulated, but could conceivably contribute to the growing problem of antibacterial resistance. This information is available in more detail in the second edition of my book, “Cosmetic Dermatology: Principles and Practice” (McGraw-Hill Professional, 2009).
Barrier Repair Products
Cold atmospheric temperatures lead to lower humidity. In such conditions, water is more likely to evaporate from the skin, particularly in individuals with an impaired skin barrier. With the arrival of winter, a discussion of the importance of the skin barrier and how to repair it is appropriate. Notably, cosmeceutical barrier repair products have an important role to play.
The Skin Barrier
Several important functions are served by the skin barrier: preventing transepidermal water loss (TEWL), shielding the skin from allergens and irritants, and protecting against infections. This defensive role depends largely on corneocyte function and the surrounding extracellular matrix (J. Invest. Dermatol. 2005;125:183-200).
The cornified cell envelope that encases the corneocyte is a 10-nm-wide, insoluble layer composed of various highly crossed proteins, particularly loricrin, the principal component, and involucrin, desmoplakin, and periplakin (J. Cell Sci. 2001;114:3069-70). The envelope structure is formed via cross-linking by the calcium (Ca2+)-dependent transglutaminase-1 (TG-1) enzyme.
The water barrier function of the skin is largely attributed to the lipids in the extracellular matrix that surrounds the corneocytes (Adv. Lipid Res. 1991;24:1-26). (Of note, TEWL is considered insensible water loss through the skin, which differs from active perspiration.) This lipid mixture is composed of approximately 50% ceramides, 25% cholesterol, and 15% fatty acids (J. Lipid Res. 2007;48:2531-46). Changes in any of these three components of the extracellular matrix can lead to a disruption in skin barrier function.
Ceramides
Ceramides constitute 40% of the lipids in the human stratum corneum (SC) (J. Invest. Dermatol. 1987;88:2S-6S), but they are not present in significant amounts in the stratum granulosum or basal layer. Consequently, terminal differentiation is likely an important factor in ceramide synthesis. The basic structure of ceramides consists of a fatty acid covalently bound to a sphingoid base.
In a study conducted by Unilever, ceramide levels were shown to increase in keratinocytes after the exogenous application of sphingoid precursors (specifically tetra-acetyl phytosphingosine or TAPS) (J. Invest. Dermatol. 1996;106:871). In another study by Unilever, TAPS, combined with the fatty acids 1% linoleic acid and 1% juniperic acid, also increased ceramide levels (J. Invest. Dermatol. 1996;106:918). In the latter study, researchers found that barrier integrity was improved in patients treated with TAPS, and the improvement was even greater when TAPS was combined with linoleic and juniperic acids. These findings imply that topically applied lipid precursors integrate into ceramide biosynthetic pathways in the epidermis, augmenting SC ceramide levels and thus ameliorating barrier integrity.
Cholesterol
Most cholesterol is synthesized from acetate in cells such as the keratinocytes, although basal cells can also absorb cholesterol from the circulation. Cholesterol production increases when the epidermal barrier is impaired (“Skin Barrier.” New York: Taylor and Francis, 2006, pp. 33–42).
Both peroxisome proliferator-activated receptors and retinoid X receptors play a role in transporting cholesterol across keratinocyte cell membranes by augmenting expression of ABCA1, a membrane transporter that regulates cholesterol flow (“Fitzpatrick's Dermatology in General Medicine,” 7th ed., New York: McGraw-Hill, 2007, pp. 386-7).
Fatty Acids
Free fatty acids and fatty acids in the skin are bound in triglycerides, glycosylceramides, ceramides, and phospholipids. The free fatty acids in the SC are mainly straight chained (“Skin Barrier.” New York, Taylor and Francis, 2006, pp. 33–42). Essential fatty acids such as linoleic acid can be obtained only through the diet or topical application.
Currently, it is thought that no single lipid alone mediates barrier function, and that normal levels of ceramides, cholesterol, and fatty acids, in the correct ratio, are crucial for maintaining barrier integrity.
Interestingly, Man et al. evaluated barrier recovery by altering the barrier with acetone, then applying ceramides or fatty acids alone, or a combination of ceramides and fatty acids, and found that normal barrier recovery was achieved only with the application of all three extracellular matrix components—ceramides, fatty acids, and cholesterol (Arch. Dermatol. 1993;129:728-38).
Skin Barrier Repair
Occlusives. Occlusive ingredients, which are oily compounds often used in cosmetics because of their capacity to dissolve fats, coat the SC and inhibit TEWL. Occlusives also impart an emollient effect.
Petrolatum and mineral oil are two of the best occlusive ingredients available. Used as a skin care product since 1872 and considered one of the optimal moisturizing agents, petrolatum displays a water vapor loss resistance 170 times that of olive oil and is well known for being noncomedogenic (Dermatologica 1971;142:89-92; J. Am. Acad. Dermatol. 1989;20:272-7). By virtue of its long-standing status as the most effective occlusive moisturizing agent, petrolatum is typically thought of as the accepted standard to which other occlusive ingredients are measured (“Dry Skin and Moisturizers,” Boca Raton, Fla.:CRC Press, 2000, p. 251).
Other frequently used occlusive ingredients include beeswax, dimethicone, grapeseed oil, lanolin, paraffin, propylene glycol, soybean oil, and squalene (“Atlas of Cosmetic Dermatology,” New York: Churchill Livingstone, 2000, p. 83).
Significantly, occlusives are effective only when they coat the skin; upon removal, TEWL returns to its previous level. Occlusives are typically combined with humectant ingredients in moisturizers.
In 2004, investigators performing a randomized, double-blind, controlled trial observed that mineral oil and extra-virgin coconut oil were as efficacious and safe as moisturizers in treating mild to moderate xerosis in 34 patients, with both groups demonstrating enhanced surface lipid levels and skin hydration (Dermatitis 2004;15:109-16).
Natural oils. Given the increasing popularity of natural and organic ingredients, essential oils of botanic origin are now frequently used in moisturizing products or as moisturizing agents themselves. Some of the more effective include sunflower seed oil, evening primrose oil, olive oil, and jojoba oil.
Natural oils contain fatty acids that play key roles in maintaining the skin barrier. Linoleic acid, an omega-6 fatty acid, is present in sunflower, safflower, evening primrose, and jojoba oils. Besides its role as a component of structural lipids necessary for barrier integrity, linoleic acid is used by the body to produce γ-linolenic acid, a polyunsaturated essential cis-fatty acid important in prostaglandin synthesis and, thus, the inflammatory process.
Humectants. These water-soluble substances with high water absorption capacity can attract water from the atmosphere (if atmospheric humidity exceeds 80%) and from the underlying epidermis.
Application of a humectant results in a slight swelling of the stratum corneum, yielding the perception of smoother skin with fewer wrinkles. In low-humidity conditions, humectants may actually take water from the deeper epidermis and dermis, resulting in increased skin dryness (J. Biol. Chem. 2002;277:46,616-21), so these ingredients work better when combined with occlusive ingredients.
The most frequently used humectants include glycerin, sorbitol, sodium hyaluronate, urea, propylene glycol, α-hydroxy acids, and sugars, with glycerin especially important because it displays both humectant and occlusive qualities.
Glycerin. Glycerin (glycerol) exhibits hygroscopic characteristics closely resembling those of natural moisturizing factor (J. Soc. Cosmet. Chem. 1976;27:65). This allows the stratum corneum to retain high water content even in an arid environment.
Recently, glycerol was shown to play an important role in skin hydration, insofar as glycerol levels were shown to be associated with stratum corneum hydration levels (J. Invest. Dermatol. 2005;125:288-93).
Previously, two high-glycerin moisturizers were compared with 16 other popular moisturizers in 394 patients with severely dry skin (“Dry Skin and Moisturizers,” Baton Roca, Fla.:CRC Press, 2000, p. 217). The high-glycerin products were found to be superior to all the other products tested because they rapidly restored dry skin to normal hydration levels and helped prevent a return to dryness for a longer period than the other formulations, even those containing petrolatum. Of note, glycerin is included in the new Vaseline Intensive Rescue Moisture Locking Lotion and Dove lotion.
Climatic and Endogenous Changes
Cold, low humidity, aging-related changes in hormone levels, and even cholesterol-lowering statin drugs can contribute significantly to dry skin. Therefore, products used last year or even last month might not be ideal today.
When patients plan to travel from a warm-weather climate to colder areas during the winter, I remind them that the skin needs 3 days to acclimate and marshal its defensive capacity against cold temperatures. I also suggest that they moisturize on airplanes, where air is very dry, and plan to moisturize more frequently in cold-weather environments.
Specifically, I recommend what I consider to be the best barrier repair moisturizers: the Dove Proage product line, AtoPalm MLE Face Cream, MoistureWorx by DermWorx Inc., and Kinerase Ultra Rich Night Repair cream. For the body, I recommend TriCeram Ceramide Dominant Barrier Repair, Dove Proage Beauty Body Lotion, Vaseline Intensive Rescue Moisture Locking Lotion, Cetaphil Moisturizing Cream, and CeraVe Moisturizing Cream.
Regardless of the climatic conditions, for patients with dry skin, I always caution against using foaming cleansers, bubble baths, and bar soap, which denude the epidermis of lipids. Rather, I suggest a cleansing oil such as Shu Uemura or Laura Mercier cleansing oils. CeraVe, Dove, Aveeno, and Cetaphil are appropriate cleansers for moderately dry skin, and cold creams, such as Ponds and Noxema, are well suited for very dry skin. For nonfacial dry and sensitive skin not prone to body acne, a suitable product is Grandma Minnie's Oil's Well Nurturing Do-It-Oil (patients with a tendency to get acne should be advised to avoid this product or any other than contains coconut oil).
Finally, I remind patients that the skin and skin barrier can be repaired through diet and dietary supplementation. Specifically, omega-3 fatty acids, borage seed oil, and evening primrose oil may strengthen the skin barrier and ameliorate dryness and itching.
Cold atmospheric temperatures lead to lower humidity. In such conditions, water is more likely to evaporate from the skin, particularly in individuals with an impaired skin barrier. With the arrival of winter, a discussion of the importance of the skin barrier and how to repair it is appropriate. Notably, cosmeceutical barrier repair products have an important role to play.
The Skin Barrier
Several important functions are served by the skin barrier: preventing transepidermal water loss (TEWL), shielding the skin from allergens and irritants, and protecting against infections. This defensive role depends largely on corneocyte function and the surrounding extracellular matrix (J. Invest. Dermatol. 2005;125:183-200).
The cornified cell envelope that encases the corneocyte is a 10-nm-wide, insoluble layer composed of various highly crossed proteins, particularly loricrin, the principal component, and involucrin, desmoplakin, and periplakin (J. Cell Sci. 2001;114:3069-70). The envelope structure is formed via cross-linking by the calcium (Ca2+)-dependent transglutaminase-1 (TG-1) enzyme.
The water barrier function of the skin is largely attributed to the lipids in the extracellular matrix that surrounds the corneocytes (Adv. Lipid Res. 1991;24:1-26). (Of note, TEWL is considered insensible water loss through the skin, which differs from active perspiration.) This lipid mixture is composed of approximately 50% ceramides, 25% cholesterol, and 15% fatty acids (J. Lipid Res. 2007;48:2531-46). Changes in any of these three components of the extracellular matrix can lead to a disruption in skin barrier function.
Ceramides
Ceramides constitute 40% of the lipids in the human stratum corneum (SC) (J. Invest. Dermatol. 1987;88:2S-6S), but they are not present in significant amounts in the stratum granulosum or basal layer. Consequently, terminal differentiation is likely an important factor in ceramide synthesis. The basic structure of ceramides consists of a fatty acid covalently bound to a sphingoid base.
In a study conducted by Unilever, ceramide levels were shown to increase in keratinocytes after the exogenous application of sphingoid precursors (specifically tetra-acetyl phytosphingosine or TAPS) (J. Invest. Dermatol. 1996;106:871). In another study by Unilever, TAPS, combined with the fatty acids 1% linoleic acid and 1% juniperic acid, also increased ceramide levels (J. Invest. Dermatol. 1996;106:918). In the latter study, researchers found that barrier integrity was improved in patients treated with TAPS, and the improvement was even greater when TAPS was combined with linoleic and juniperic acids. These findings imply that topically applied lipid precursors integrate into ceramide biosynthetic pathways in the epidermis, augmenting SC ceramide levels and thus ameliorating barrier integrity.
Cholesterol
Most cholesterol is synthesized from acetate in cells such as the keratinocytes, although basal cells can also absorb cholesterol from the circulation. Cholesterol production increases when the epidermal barrier is impaired (“Skin Barrier.” New York: Taylor and Francis, 2006, pp. 33–42).
Both peroxisome proliferator-activated receptors and retinoid X receptors play a role in transporting cholesterol across keratinocyte cell membranes by augmenting expression of ABCA1, a membrane transporter that regulates cholesterol flow (“Fitzpatrick's Dermatology in General Medicine,” 7th ed., New York: McGraw-Hill, 2007, pp. 386-7).
Fatty Acids
Free fatty acids and fatty acids in the skin are bound in triglycerides, glycosylceramides, ceramides, and phospholipids. The free fatty acids in the SC are mainly straight chained (“Skin Barrier.” New York, Taylor and Francis, 2006, pp. 33–42). Essential fatty acids such as linoleic acid can be obtained only through the diet or topical application.
Currently, it is thought that no single lipid alone mediates barrier function, and that normal levels of ceramides, cholesterol, and fatty acids, in the correct ratio, are crucial for maintaining barrier integrity.
Interestingly, Man et al. evaluated barrier recovery by altering the barrier with acetone, then applying ceramides or fatty acids alone, or a combination of ceramides and fatty acids, and found that normal barrier recovery was achieved only with the application of all three extracellular matrix components—ceramides, fatty acids, and cholesterol (Arch. Dermatol. 1993;129:728-38).
Skin Barrier Repair
Occlusives. Occlusive ingredients, which are oily compounds often used in cosmetics because of their capacity to dissolve fats, coat the SC and inhibit TEWL. Occlusives also impart an emollient effect.
Petrolatum and mineral oil are two of the best occlusive ingredients available. Used as a skin care product since 1872 and considered one of the optimal moisturizing agents, petrolatum displays a water vapor loss resistance 170 times that of olive oil and is well known for being noncomedogenic (Dermatologica 1971;142:89-92; J. Am. Acad. Dermatol. 1989;20:272-7). By virtue of its long-standing status as the most effective occlusive moisturizing agent, petrolatum is typically thought of as the accepted standard to which other occlusive ingredients are measured (“Dry Skin and Moisturizers,” Boca Raton, Fla.:CRC Press, 2000, p. 251).
Other frequently used occlusive ingredients include beeswax, dimethicone, grapeseed oil, lanolin, paraffin, propylene glycol, soybean oil, and squalene (“Atlas of Cosmetic Dermatology,” New York: Churchill Livingstone, 2000, p. 83).
Significantly, occlusives are effective only when they coat the skin; upon removal, TEWL returns to its previous level. Occlusives are typically combined with humectant ingredients in moisturizers.
In 2004, investigators performing a randomized, double-blind, controlled trial observed that mineral oil and extra-virgin coconut oil were as efficacious and safe as moisturizers in treating mild to moderate xerosis in 34 patients, with both groups demonstrating enhanced surface lipid levels and skin hydration (Dermatitis 2004;15:109-16).
Natural oils. Given the increasing popularity of natural and organic ingredients, essential oils of botanic origin are now frequently used in moisturizing products or as moisturizing agents themselves. Some of the more effective include sunflower seed oil, evening primrose oil, olive oil, and jojoba oil.
Natural oils contain fatty acids that play key roles in maintaining the skin barrier. Linoleic acid, an omega-6 fatty acid, is present in sunflower, safflower, evening primrose, and jojoba oils. Besides its role as a component of structural lipids necessary for barrier integrity, linoleic acid is used by the body to produce γ-linolenic acid, a polyunsaturated essential cis-fatty acid important in prostaglandin synthesis and, thus, the inflammatory process.
Humectants. These water-soluble substances with high water absorption capacity can attract water from the atmosphere (if atmospheric humidity exceeds 80%) and from the underlying epidermis.
Application of a humectant results in a slight swelling of the stratum corneum, yielding the perception of smoother skin with fewer wrinkles. In low-humidity conditions, humectants may actually take water from the deeper epidermis and dermis, resulting in increased skin dryness (J. Biol. Chem. 2002;277:46,616-21), so these ingredients work better when combined with occlusive ingredients.
The most frequently used humectants include glycerin, sorbitol, sodium hyaluronate, urea, propylene glycol, α-hydroxy acids, and sugars, with glycerin especially important because it displays both humectant and occlusive qualities.
Glycerin. Glycerin (glycerol) exhibits hygroscopic characteristics closely resembling those of natural moisturizing factor (J. Soc. Cosmet. Chem. 1976;27:65). This allows the stratum corneum to retain high water content even in an arid environment.
Recently, glycerol was shown to play an important role in skin hydration, insofar as glycerol levels were shown to be associated with stratum corneum hydration levels (J. Invest. Dermatol. 2005;125:288-93).
Previously, two high-glycerin moisturizers were compared with 16 other popular moisturizers in 394 patients with severely dry skin (“Dry Skin and Moisturizers,” Baton Roca, Fla.:CRC Press, 2000, p. 217). The high-glycerin products were found to be superior to all the other products tested because they rapidly restored dry skin to normal hydration levels and helped prevent a return to dryness for a longer period than the other formulations, even those containing petrolatum. Of note, glycerin is included in the new Vaseline Intensive Rescue Moisture Locking Lotion and Dove lotion.
Climatic and Endogenous Changes
Cold, low humidity, aging-related changes in hormone levels, and even cholesterol-lowering statin drugs can contribute significantly to dry skin. Therefore, products used last year or even last month might not be ideal today.
When patients plan to travel from a warm-weather climate to colder areas during the winter, I remind them that the skin needs 3 days to acclimate and marshal its defensive capacity against cold temperatures. I also suggest that they moisturize on airplanes, where air is very dry, and plan to moisturize more frequently in cold-weather environments.
Specifically, I recommend what I consider to be the best barrier repair moisturizers: the Dove Proage product line, AtoPalm MLE Face Cream, MoistureWorx by DermWorx Inc., and Kinerase Ultra Rich Night Repair cream. For the body, I recommend TriCeram Ceramide Dominant Barrier Repair, Dove Proage Beauty Body Lotion, Vaseline Intensive Rescue Moisture Locking Lotion, Cetaphil Moisturizing Cream, and CeraVe Moisturizing Cream.
Regardless of the climatic conditions, for patients with dry skin, I always caution against using foaming cleansers, bubble baths, and bar soap, which denude the epidermis of lipids. Rather, I suggest a cleansing oil such as Shu Uemura or Laura Mercier cleansing oils. CeraVe, Dove, Aveeno, and Cetaphil are appropriate cleansers for moderately dry skin, and cold creams, such as Ponds and Noxema, are well suited for very dry skin. For nonfacial dry and sensitive skin not prone to body acne, a suitable product is Grandma Minnie's Oil's Well Nurturing Do-It-Oil (patients with a tendency to get acne should be advised to avoid this product or any other than contains coconut oil).
Finally, I remind patients that the skin and skin barrier can be repaired through diet and dietary supplementation. Specifically, omega-3 fatty acids, borage seed oil, and evening primrose oil may strengthen the skin barrier and ameliorate dryness and itching.
Cold atmospheric temperatures lead to lower humidity. In such conditions, water is more likely to evaporate from the skin, particularly in individuals with an impaired skin barrier. With the arrival of winter, a discussion of the importance of the skin barrier and how to repair it is appropriate. Notably, cosmeceutical barrier repair products have an important role to play.
The Skin Barrier
Several important functions are served by the skin barrier: preventing transepidermal water loss (TEWL), shielding the skin from allergens and irritants, and protecting against infections. This defensive role depends largely on corneocyte function and the surrounding extracellular matrix (J. Invest. Dermatol. 2005;125:183-200).
The cornified cell envelope that encases the corneocyte is a 10-nm-wide, insoluble layer composed of various highly crossed proteins, particularly loricrin, the principal component, and involucrin, desmoplakin, and periplakin (J. Cell Sci. 2001;114:3069-70). The envelope structure is formed via cross-linking by the calcium (Ca2+)-dependent transglutaminase-1 (TG-1) enzyme.
The water barrier function of the skin is largely attributed to the lipids in the extracellular matrix that surrounds the corneocytes (Adv. Lipid Res. 1991;24:1-26). (Of note, TEWL is considered insensible water loss through the skin, which differs from active perspiration.) This lipid mixture is composed of approximately 50% ceramides, 25% cholesterol, and 15% fatty acids (J. Lipid Res. 2007;48:2531-46). Changes in any of these three components of the extracellular matrix can lead to a disruption in skin barrier function.
Ceramides
Ceramides constitute 40% of the lipids in the human stratum corneum (SC) (J. Invest. Dermatol. 1987;88:2S-6S), but they are not present in significant amounts in the stratum granulosum or basal layer. Consequently, terminal differentiation is likely an important factor in ceramide synthesis. The basic structure of ceramides consists of a fatty acid covalently bound to a sphingoid base.
In a study conducted by Unilever, ceramide levels were shown to increase in keratinocytes after the exogenous application of sphingoid precursors (specifically tetra-acetyl phytosphingosine or TAPS) (J. Invest. Dermatol. 1996;106:871). In another study by Unilever, TAPS, combined with the fatty acids 1% linoleic acid and 1% juniperic acid, also increased ceramide levels (J. Invest. Dermatol. 1996;106:918). In the latter study, researchers found that barrier integrity was improved in patients treated with TAPS, and the improvement was even greater when TAPS was combined with linoleic and juniperic acids. These findings imply that topically applied lipid precursors integrate into ceramide biosynthetic pathways in the epidermis, augmenting SC ceramide levels and thus ameliorating barrier integrity.
Cholesterol
Most cholesterol is synthesized from acetate in cells such as the keratinocytes, although basal cells can also absorb cholesterol from the circulation. Cholesterol production increases when the epidermal barrier is impaired (“Skin Barrier.” New York: Taylor and Francis, 2006, pp. 33–42).
Both peroxisome proliferator-activated receptors and retinoid X receptors play a role in transporting cholesterol across keratinocyte cell membranes by augmenting expression of ABCA1, a membrane transporter that regulates cholesterol flow (“Fitzpatrick's Dermatology in General Medicine,” 7th ed., New York: McGraw-Hill, 2007, pp. 386-7).
Fatty Acids
Free fatty acids and fatty acids in the skin are bound in triglycerides, glycosylceramides, ceramides, and phospholipids. The free fatty acids in the SC are mainly straight chained (“Skin Barrier.” New York, Taylor and Francis, 2006, pp. 33–42). Essential fatty acids such as linoleic acid can be obtained only through the diet or topical application.
Currently, it is thought that no single lipid alone mediates barrier function, and that normal levels of ceramides, cholesterol, and fatty acids, in the correct ratio, are crucial for maintaining barrier integrity.
Interestingly, Man et al. evaluated barrier recovery by altering the barrier with acetone, then applying ceramides or fatty acids alone, or a combination of ceramides and fatty acids, and found that normal barrier recovery was achieved only with the application of all three extracellular matrix components—ceramides, fatty acids, and cholesterol (Arch. Dermatol. 1993;129:728-38).
Skin Barrier Repair
Occlusives. Occlusive ingredients, which are oily compounds often used in cosmetics because of their capacity to dissolve fats, coat the SC and inhibit TEWL. Occlusives also impart an emollient effect.
Petrolatum and mineral oil are two of the best occlusive ingredients available. Used as a skin care product since 1872 and considered one of the optimal moisturizing agents, petrolatum displays a water vapor loss resistance 170 times that of olive oil and is well known for being noncomedogenic (Dermatologica 1971;142:89-92; J. Am. Acad. Dermatol. 1989;20:272-7). By virtue of its long-standing status as the most effective occlusive moisturizing agent, petrolatum is typically thought of as the accepted standard to which other occlusive ingredients are measured (“Dry Skin and Moisturizers,” Boca Raton, Fla.:CRC Press, 2000, p. 251).
Other frequently used occlusive ingredients include beeswax, dimethicone, grapeseed oil, lanolin, paraffin, propylene glycol, soybean oil, and squalene (“Atlas of Cosmetic Dermatology,” New York: Churchill Livingstone, 2000, p. 83).
Significantly, occlusives are effective only when they coat the skin; upon removal, TEWL returns to its previous level. Occlusives are typically combined with humectant ingredients in moisturizers.
In 2004, investigators performing a randomized, double-blind, controlled trial observed that mineral oil and extra-virgin coconut oil were as efficacious and safe as moisturizers in treating mild to moderate xerosis in 34 patients, with both groups demonstrating enhanced surface lipid levels and skin hydration (Dermatitis 2004;15:109-16).
Natural oils. Given the increasing popularity of natural and organic ingredients, essential oils of botanic origin are now frequently used in moisturizing products or as moisturizing agents themselves. Some of the more effective include sunflower seed oil, evening primrose oil, olive oil, and jojoba oil.
Natural oils contain fatty acids that play key roles in maintaining the skin barrier. Linoleic acid, an omega-6 fatty acid, is present in sunflower, safflower, evening primrose, and jojoba oils. Besides its role as a component of structural lipids necessary for barrier integrity, linoleic acid is used by the body to produce γ-linolenic acid, a polyunsaturated essential cis-fatty acid important in prostaglandin synthesis and, thus, the inflammatory process.
Humectants. These water-soluble substances with high water absorption capacity can attract water from the atmosphere (if atmospheric humidity exceeds 80%) and from the underlying epidermis.
Application of a humectant results in a slight swelling of the stratum corneum, yielding the perception of smoother skin with fewer wrinkles. In low-humidity conditions, humectants may actually take water from the deeper epidermis and dermis, resulting in increased skin dryness (J. Biol. Chem. 2002;277:46,616-21), so these ingredients work better when combined with occlusive ingredients.
The most frequently used humectants include glycerin, sorbitol, sodium hyaluronate, urea, propylene glycol, α-hydroxy acids, and sugars, with glycerin especially important because it displays both humectant and occlusive qualities.
Glycerin. Glycerin (glycerol) exhibits hygroscopic characteristics closely resembling those of natural moisturizing factor (J. Soc. Cosmet. Chem. 1976;27:65). This allows the stratum corneum to retain high water content even in an arid environment.
Recently, glycerol was shown to play an important role in skin hydration, insofar as glycerol levels were shown to be associated with stratum corneum hydration levels (J. Invest. Dermatol. 2005;125:288-93).
Previously, two high-glycerin moisturizers were compared with 16 other popular moisturizers in 394 patients with severely dry skin (“Dry Skin and Moisturizers,” Baton Roca, Fla.:CRC Press, 2000, p. 217). The high-glycerin products were found to be superior to all the other products tested because they rapidly restored dry skin to normal hydration levels and helped prevent a return to dryness for a longer period than the other formulations, even those containing petrolatum. Of note, glycerin is included in the new Vaseline Intensive Rescue Moisture Locking Lotion and Dove lotion.
Climatic and Endogenous Changes
Cold, low humidity, aging-related changes in hormone levels, and even cholesterol-lowering statin drugs can contribute significantly to dry skin. Therefore, products used last year or even last month might not be ideal today.
When patients plan to travel from a warm-weather climate to colder areas during the winter, I remind them that the skin needs 3 days to acclimate and marshal its defensive capacity against cold temperatures. I also suggest that they moisturize on airplanes, where air is very dry, and plan to moisturize more frequently in cold-weather environments.
Specifically, I recommend what I consider to be the best barrier repair moisturizers: the Dove Proage product line, AtoPalm MLE Face Cream, MoistureWorx by DermWorx Inc., and Kinerase Ultra Rich Night Repair cream. For the body, I recommend TriCeram Ceramide Dominant Barrier Repair, Dove Proage Beauty Body Lotion, Vaseline Intensive Rescue Moisture Locking Lotion, Cetaphil Moisturizing Cream, and CeraVe Moisturizing Cream.
Regardless of the climatic conditions, for patients with dry skin, I always caution against using foaming cleansers, bubble baths, and bar soap, which denude the epidermis of lipids. Rather, I suggest a cleansing oil such as Shu Uemura or Laura Mercier cleansing oils. CeraVe, Dove, Aveeno, and Cetaphil are appropriate cleansers for moderately dry skin, and cold creams, such as Ponds and Noxema, are well suited for very dry skin. For nonfacial dry and sensitive skin not prone to body acne, a suitable product is Grandma Minnie's Oil's Well Nurturing Do-It-Oil (patients with a tendency to get acne should be advised to avoid this product or any other than contains coconut oil).
Finally, I remind patients that the skin and skin barrier can be repaired through diet and dietary supplementation. Specifically, omega-3 fatty acids, borage seed oil, and evening primrose oil may strengthen the skin barrier and ameliorate dryness and itching.
Stretch Marks
Stretch marks, or striae distensae, are scar tissue in the skin's dermal layer that result from rapid growth or weight gain. These lesions, which can be found crisscrossing the breasts, abdomen, hips, thighs, buttocks, and arms, occur in females and males, particularly as a result of adolescent growth spurts, pregnancy, obesity, rapid muscle growth (from weight lifting, for example), and prolonged use of topical steroids.
In these instances or periods of growth, collagen and elastin are not produced fast enough to accommodate the expansion of other cutaneous layers, rendering the normally elastic dermis less flexible and manifesting in visible epidermal marks.
Initially, these dermal alterations present as pink, red, or purple lesions, known as striae rubra. If the lesions are untreated, they become white (striae alba) and the texture of the lesion may change from swollen to flattened or moderately depressed. A high proportion of teenage girls and pregnant women are beset with striae distensae.
Dermatologists now have a number of options to tackle this cosmetically stressful condition, including novel laser treatments for striae alba, but the primary focus here is on topical and cosmeceutical options.
Prevention
There is no surefire method to prevent stretch marks per se, but avoidance of a rapid gain or loss of weight improves one's chances of not developing these lesions.
Several topical agents have demonstrated efficacy in high-risk patients. For individuals who are pregnant or experiencing adolescent hormonal changes, moisturizing three or four times daily is recommended. Skin becomes more pliant and elastic when it is well hydrated. Moisturizers that contain cocoa butter, shea butter, or Centella asiatica (also known as gotu kola) as a prime ingredient are the best. To increase their efficacy, massage such formulations deeply into the affected areas. I recommend Belli Elasticity Belly Oil, which contains healthy amounts of both cocoa butter and C. asiatica, to my patients.
Treatment
Identifying striae distensae early is crucial. Patients should be advised to seek treatment when stretch marks are still red or purple because the lesions are most likely to respond to at-home products and in-office peels at this stage. Once stretch marks are white, treatment becomes more difficult and less successful.
Striae rubra may respond to the glycolic acid in various over-the-counter (OTC) lotions, most likely through the alpha-hydroxy acid's capacity to stimulate collagen synthesis. I recommend brands with the highest concentration of glycolic acid, such as MD Forté Glycare I and NeoStrata Ultra Smoothing Lotion.
Topical vitamin C, if formulated properly, also has the capacity to promote collagen synthesis. It can be used individually or in combination with glycolic acid. I recommend SkinCeuticals C E Ferulic and La Roche-Posay Active C. Supplementation with oral vitamin C 500 mg twice daily may also confer some benefit.
Relastin, marketed as an eye cream and a face cream, is touted by its manufacturer for its ability to increase elastic tissue, which may ameliorate stretch marks. Its efficacy is unconfirmed at this point.
Retinoids
In an early study of retinoids for the treatment of striae distensae, 16 of 20 patients with stretch marks from various causes completed the study, 15 of whom exhibited significant clinical improvement (J. Dermatol. Surg. Oncol. 1990;16:267–70).
Retinoids promote the production of collagen and elastin. When retinoids are massaged nightly into striae rubra, the appearance and texture of the lesions can improve significantly. In fact, the use of 0.1% tretinoin for the treatment of striae rubra has been established as effective for more than a decade (Dermatol. Surg. 1998;24:849–56). Retinoids are not as effective for the treatment of striae alba, however, and are contraindicated in pregnant and breastfeeding women.
In a study evaluating commercial topical products for the treatment of striae alba, investigators tested two regimens on 10 patients who had abdominal striae alba with skin types ranging from I to V. Patients applied 20% glycolic acid (MD Forté) to the whole treatment area on a daily basis for 12 weeks. Patients also were directed to apply 0.05% tretinoin emollient cream (Renova) to half of the treatment area, and 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine cream to the other half.
Improvement in the appearance of stretch marks, assessed at 4 and 12 weeks, was documented for both regimens. In addition, a comparison of treated striae alba with untreated lesions revealed that both regimens were effective in decreasing papillary dermal thickness and increasing epidermal thickness (Dermatol. Surg. 1998;24:849–56).
In another study evaluating the effects of a retinoid, 20 women applied tretinoin cream 0.1% to abdominal striae induced by pregnancy. In this open-label, multicenter, prospective study, researchers observed marked improvement in all striae after 3 months, compared with baseline, with an average 20% reduction in the length of the target lesion. Despite the emergence in 11 patients of erythema and scaling, topically applied tretinoin significantly ameliorated pregnancy-induced striae distensae (Adv. Ther. 2001;18:181–6).
I recommend OTC retinol products such as Philosophy Help Me and Neutrogena Healthy Skin to my patients. Of course, prescription retinoids such as Retin-A, Tazorac, and Differin are stronger and, therefore, may be more effective than retinol. I also suggest retinoic acid peels, such as the Ultra Peel Exfoliating Treatment or the Esthetique Peel.
In-Office Treatment
Glycolic acid can be administered in the office at higher doses than those contained in OTC products. After three or four visits, patients usually notice a slight change in the length, width, and intensity of striae rubra. In-office glycolic peels are safe for all skin types, although lower concentrations should be used for people with darker skin tones. As suggested above, the combination of glycolic acid and a retinoid can be effective. In fact, various prescription-strength retinoids are often applied as a preparation for a glycolic acid peel.
Lasers
Since vascular lasers are designed to treat dilated blood vessels, which are characteristic of striae rubra, they present a potent treatment option. These instruments are associated with epidermal turnover as well as increased collagen production and elastic remodeling. I prefer the Dornier 940-nm laser for stretch marks, but some physicians use the 585-nm or 595-nm laser.
In a recent study, investigators treated 20 patients with striae rubra using the 1,064-nm long-pulsed Nd:YAG laser, which has been successfully used to foster dermal collagen synthesis. Subjective evaluations were made by patients (with 55% rating the results as excellent), and the investigators used before-and-after photos to assess treatment efficacy. Forty percent of the doctors considered the results to be excellent. Overall, the investigators found this laser to be an effective option for treating striae rubra, with minimal side effects (Dermatol. Surg. 2008;34:686–91).
In another study, researchers evaluated the efficacy of the Therma Cool TC (Thermage Inc.), in combination with a 585-nm pulsed dye laser, for the treatment of striae distensae in people with darker skin types. Overall improvement was termed “good and very good” by 89% of the participants in the subjective evaluation. Skin biopsies of nine patients also revealed that the level of collagen fibers in each sample increased (Dermatol. Surg. 2007;33:29–34).
In a previous study of patients with dark skin types (IV-VI), researchers studied the effects of a nonablative 1,450-nm diode laser on striae distensae. Eleven Asian patients were treated with the laser with cryogen cooling spray on half of the body; the untreated half served as the control. The investigators concluded that, for patients with skin types IV-VI, the nonablative 1,450-nm diode laser is not a viable option for treating stretch marks (Lasers Surg. Med. 2006;38:196–9).
Intense Pulsed Light
In research on the efficacy of intense pulsed light (IPL), investigators treated 15 women with abdominal striae distensae. Their study was based on the reported efficacy of IPL in fostering the synthesis of collagen and the ordering of elastic fibers. Before-and-after photos and skin biopsies of all 15 patients exhibited significant clinical and microscopic improvements, including differences in dermal thickness (Dermatol. Surg. 2002;28:1124–30).
A more recent examination of an IPL infrared device, the NovaPlus, which attains high fluences with high-frequency stacked pulses, was conducted on 10 patients who had striae distensae. Review of before-and-after photographs and three-dimensional skin surface analysis yielded an equal outcome, and few subjects observed improvement, but histologic assessment revealed improvement in epidermal and dermal condition. The researchers concluded that additional treatment sessions might afford better chances for desired cosmetic results, given the absence of side effects (Aesthetic Plast. Surg. 2008;32:523–30).
Fractional Photothermolysis
Despite the enhancements in overall treatment of striae distensae, few modalities have provided promise in significantly improving the appearance of striae alba.
Perhaps until now. In a recent study of the safety and efficacy of fractional photothermolysis for the treatment of stretch marks in Asian skin, researchers irradiated the striae distensae on the right buttocks of six female volunteers aged 20–35 years using a 1,550-nm fractional photothermolysis laser.
Patients were followed for 2 months. Fleeting mild pain and hyperpigmentation were the adverse events reported. Overall, significant amelioration in the appearance of the stretch marks was observed 2 months after treatment. Histologic examination revealed a substantial increase in epidermal thickness as well as collagen and elastic fiber deposition. Investigators also noted that skin elasticity had become somewhat normalized (Am. J. Clin. Dermatol. 2008;9:33–7).
Conclusions
Although preventive measures can be used to reduce the likelihood of developing stretch marks, prevention is a challenge.
Treatment options are continually expanding. Glycolic acid and retinoids have demonstrated efficacy in in-office procedures and OTC products. Vitamin C may also impart some benefit. In addition, lasers are emerging as viable treatment options. The vascular laser is recommended for striae rubra and the Fraxel laser for striae alba.
Patients are advised to begin at-home treatment for stretch marks upon first noticing them and to schedule a dermatologic visit.
Stretch marks, or striae distensae, are scar tissue in the skin's dermal layer that result from rapid growth or weight gain. These lesions, which can be found crisscrossing the breasts, abdomen, hips, thighs, buttocks, and arms, occur in females and males, particularly as a result of adolescent growth spurts, pregnancy, obesity, rapid muscle growth (from weight lifting, for example), and prolonged use of topical steroids.
In these instances or periods of growth, collagen and elastin are not produced fast enough to accommodate the expansion of other cutaneous layers, rendering the normally elastic dermis less flexible and manifesting in visible epidermal marks.
Initially, these dermal alterations present as pink, red, or purple lesions, known as striae rubra. If the lesions are untreated, they become white (striae alba) and the texture of the lesion may change from swollen to flattened or moderately depressed. A high proportion of teenage girls and pregnant women are beset with striae distensae.
Dermatologists now have a number of options to tackle this cosmetically stressful condition, including novel laser treatments for striae alba, but the primary focus here is on topical and cosmeceutical options.
Prevention
There is no surefire method to prevent stretch marks per se, but avoidance of a rapid gain or loss of weight improves one's chances of not developing these lesions.
Several topical agents have demonstrated efficacy in high-risk patients. For individuals who are pregnant or experiencing adolescent hormonal changes, moisturizing three or four times daily is recommended. Skin becomes more pliant and elastic when it is well hydrated. Moisturizers that contain cocoa butter, shea butter, or Centella asiatica (also known as gotu kola) as a prime ingredient are the best. To increase their efficacy, massage such formulations deeply into the affected areas. I recommend Belli Elasticity Belly Oil, which contains healthy amounts of both cocoa butter and C. asiatica, to my patients.
Treatment
Identifying striae distensae early is crucial. Patients should be advised to seek treatment when stretch marks are still red or purple because the lesions are most likely to respond to at-home products and in-office peels at this stage. Once stretch marks are white, treatment becomes more difficult and less successful.
Striae rubra may respond to the glycolic acid in various over-the-counter (OTC) lotions, most likely through the alpha-hydroxy acid's capacity to stimulate collagen synthesis. I recommend brands with the highest concentration of glycolic acid, such as MD Forté Glycare I and NeoStrata Ultra Smoothing Lotion.
Topical vitamin C, if formulated properly, also has the capacity to promote collagen synthesis. It can be used individually or in combination with glycolic acid. I recommend SkinCeuticals C E Ferulic and La Roche-Posay Active C. Supplementation with oral vitamin C 500 mg twice daily may also confer some benefit.
Relastin, marketed as an eye cream and a face cream, is touted by its manufacturer for its ability to increase elastic tissue, which may ameliorate stretch marks. Its efficacy is unconfirmed at this point.
Retinoids
In an early study of retinoids for the treatment of striae distensae, 16 of 20 patients with stretch marks from various causes completed the study, 15 of whom exhibited significant clinical improvement (J. Dermatol. Surg. Oncol. 1990;16:267–70).
Retinoids promote the production of collagen and elastin. When retinoids are massaged nightly into striae rubra, the appearance and texture of the lesions can improve significantly. In fact, the use of 0.1% tretinoin for the treatment of striae rubra has been established as effective for more than a decade (Dermatol. Surg. 1998;24:849–56). Retinoids are not as effective for the treatment of striae alba, however, and are contraindicated in pregnant and breastfeeding women.
In a study evaluating commercial topical products for the treatment of striae alba, investigators tested two regimens on 10 patients who had abdominal striae alba with skin types ranging from I to V. Patients applied 20% glycolic acid (MD Forté) to the whole treatment area on a daily basis for 12 weeks. Patients also were directed to apply 0.05% tretinoin emollient cream (Renova) to half of the treatment area, and 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine cream to the other half.
Improvement in the appearance of stretch marks, assessed at 4 and 12 weeks, was documented for both regimens. In addition, a comparison of treated striae alba with untreated lesions revealed that both regimens were effective in decreasing papillary dermal thickness and increasing epidermal thickness (Dermatol. Surg. 1998;24:849–56).
In another study evaluating the effects of a retinoid, 20 women applied tretinoin cream 0.1% to abdominal striae induced by pregnancy. In this open-label, multicenter, prospective study, researchers observed marked improvement in all striae after 3 months, compared with baseline, with an average 20% reduction in the length of the target lesion. Despite the emergence in 11 patients of erythema and scaling, topically applied tretinoin significantly ameliorated pregnancy-induced striae distensae (Adv. Ther. 2001;18:181–6).
I recommend OTC retinol products such as Philosophy Help Me and Neutrogena Healthy Skin to my patients. Of course, prescription retinoids such as Retin-A, Tazorac, and Differin are stronger and, therefore, may be more effective than retinol. I also suggest retinoic acid peels, such as the Ultra Peel Exfoliating Treatment or the Esthetique Peel.
In-Office Treatment
Glycolic acid can be administered in the office at higher doses than those contained in OTC products. After three or four visits, patients usually notice a slight change in the length, width, and intensity of striae rubra. In-office glycolic peels are safe for all skin types, although lower concentrations should be used for people with darker skin tones. As suggested above, the combination of glycolic acid and a retinoid can be effective. In fact, various prescription-strength retinoids are often applied as a preparation for a glycolic acid peel.
Lasers
Since vascular lasers are designed to treat dilated blood vessels, which are characteristic of striae rubra, they present a potent treatment option. These instruments are associated with epidermal turnover as well as increased collagen production and elastic remodeling. I prefer the Dornier 940-nm laser for stretch marks, but some physicians use the 585-nm or 595-nm laser.
In a recent study, investigators treated 20 patients with striae rubra using the 1,064-nm long-pulsed Nd:YAG laser, which has been successfully used to foster dermal collagen synthesis. Subjective evaluations were made by patients (with 55% rating the results as excellent), and the investigators used before-and-after photos to assess treatment efficacy. Forty percent of the doctors considered the results to be excellent. Overall, the investigators found this laser to be an effective option for treating striae rubra, with minimal side effects (Dermatol. Surg. 2008;34:686–91).
In another study, researchers evaluated the efficacy of the Therma Cool TC (Thermage Inc.), in combination with a 585-nm pulsed dye laser, for the treatment of striae distensae in people with darker skin types. Overall improvement was termed “good and very good” by 89% of the participants in the subjective evaluation. Skin biopsies of nine patients also revealed that the level of collagen fibers in each sample increased (Dermatol. Surg. 2007;33:29–34).
In a previous study of patients with dark skin types (IV-VI), researchers studied the effects of a nonablative 1,450-nm diode laser on striae distensae. Eleven Asian patients were treated with the laser with cryogen cooling spray on half of the body; the untreated half served as the control. The investigators concluded that, for patients with skin types IV-VI, the nonablative 1,450-nm diode laser is not a viable option for treating stretch marks (Lasers Surg. Med. 2006;38:196–9).
Intense Pulsed Light
In research on the efficacy of intense pulsed light (IPL), investigators treated 15 women with abdominal striae distensae. Their study was based on the reported efficacy of IPL in fostering the synthesis of collagen and the ordering of elastic fibers. Before-and-after photos and skin biopsies of all 15 patients exhibited significant clinical and microscopic improvements, including differences in dermal thickness (Dermatol. Surg. 2002;28:1124–30).
A more recent examination of an IPL infrared device, the NovaPlus, which attains high fluences with high-frequency stacked pulses, was conducted on 10 patients who had striae distensae. Review of before-and-after photographs and three-dimensional skin surface analysis yielded an equal outcome, and few subjects observed improvement, but histologic assessment revealed improvement in epidermal and dermal condition. The researchers concluded that additional treatment sessions might afford better chances for desired cosmetic results, given the absence of side effects (Aesthetic Plast. Surg. 2008;32:523–30).
Fractional Photothermolysis
Despite the enhancements in overall treatment of striae distensae, few modalities have provided promise in significantly improving the appearance of striae alba.
Perhaps until now. In a recent study of the safety and efficacy of fractional photothermolysis for the treatment of stretch marks in Asian skin, researchers irradiated the striae distensae on the right buttocks of six female volunteers aged 20–35 years using a 1,550-nm fractional photothermolysis laser.
Patients were followed for 2 months. Fleeting mild pain and hyperpigmentation were the adverse events reported. Overall, significant amelioration in the appearance of the stretch marks was observed 2 months after treatment. Histologic examination revealed a substantial increase in epidermal thickness as well as collagen and elastic fiber deposition. Investigators also noted that skin elasticity had become somewhat normalized (Am. J. Clin. Dermatol. 2008;9:33–7).
Conclusions
Although preventive measures can be used to reduce the likelihood of developing stretch marks, prevention is a challenge.
Treatment options are continually expanding. Glycolic acid and retinoids have demonstrated efficacy in in-office procedures and OTC products. Vitamin C may also impart some benefit. In addition, lasers are emerging as viable treatment options. The vascular laser is recommended for striae rubra and the Fraxel laser for striae alba.
Patients are advised to begin at-home treatment for stretch marks upon first noticing them and to schedule a dermatologic visit.
Stretch marks, or striae distensae, are scar tissue in the skin's dermal layer that result from rapid growth or weight gain. These lesions, which can be found crisscrossing the breasts, abdomen, hips, thighs, buttocks, and arms, occur in females and males, particularly as a result of adolescent growth spurts, pregnancy, obesity, rapid muscle growth (from weight lifting, for example), and prolonged use of topical steroids.
In these instances or periods of growth, collagen and elastin are not produced fast enough to accommodate the expansion of other cutaneous layers, rendering the normally elastic dermis less flexible and manifesting in visible epidermal marks.
Initially, these dermal alterations present as pink, red, or purple lesions, known as striae rubra. If the lesions are untreated, they become white (striae alba) and the texture of the lesion may change from swollen to flattened or moderately depressed. A high proportion of teenage girls and pregnant women are beset with striae distensae.
Dermatologists now have a number of options to tackle this cosmetically stressful condition, including novel laser treatments for striae alba, but the primary focus here is on topical and cosmeceutical options.
Prevention
There is no surefire method to prevent stretch marks per se, but avoidance of a rapid gain or loss of weight improves one's chances of not developing these lesions.
Several topical agents have demonstrated efficacy in high-risk patients. For individuals who are pregnant or experiencing adolescent hormonal changes, moisturizing three or four times daily is recommended. Skin becomes more pliant and elastic when it is well hydrated. Moisturizers that contain cocoa butter, shea butter, or Centella asiatica (also known as gotu kola) as a prime ingredient are the best. To increase their efficacy, massage such formulations deeply into the affected areas. I recommend Belli Elasticity Belly Oil, which contains healthy amounts of both cocoa butter and C. asiatica, to my patients.
Treatment
Identifying striae distensae early is crucial. Patients should be advised to seek treatment when stretch marks are still red or purple because the lesions are most likely to respond to at-home products and in-office peels at this stage. Once stretch marks are white, treatment becomes more difficult and less successful.
Striae rubra may respond to the glycolic acid in various over-the-counter (OTC) lotions, most likely through the alpha-hydroxy acid's capacity to stimulate collagen synthesis. I recommend brands with the highest concentration of glycolic acid, such as MD Forté Glycare I and NeoStrata Ultra Smoothing Lotion.
Topical vitamin C, if formulated properly, also has the capacity to promote collagen synthesis. It can be used individually or in combination with glycolic acid. I recommend SkinCeuticals C E Ferulic and La Roche-Posay Active C. Supplementation with oral vitamin C 500 mg twice daily may also confer some benefit.
Relastin, marketed as an eye cream and a face cream, is touted by its manufacturer for its ability to increase elastic tissue, which may ameliorate stretch marks. Its efficacy is unconfirmed at this point.
Retinoids
In an early study of retinoids for the treatment of striae distensae, 16 of 20 patients with stretch marks from various causes completed the study, 15 of whom exhibited significant clinical improvement (J. Dermatol. Surg. Oncol. 1990;16:267–70).
Retinoids promote the production of collagen and elastin. When retinoids are massaged nightly into striae rubra, the appearance and texture of the lesions can improve significantly. In fact, the use of 0.1% tretinoin for the treatment of striae rubra has been established as effective for more than a decade (Dermatol. Surg. 1998;24:849–56). Retinoids are not as effective for the treatment of striae alba, however, and are contraindicated in pregnant and breastfeeding women.
In a study evaluating commercial topical products for the treatment of striae alba, investigators tested two regimens on 10 patients who had abdominal striae alba with skin types ranging from I to V. Patients applied 20% glycolic acid (MD Forté) to the whole treatment area on a daily basis for 12 weeks. Patients also were directed to apply 0.05% tretinoin emollient cream (Renova) to half of the treatment area, and 10% L-ascorbic acid, 2% zinc sulfate, and 0.5% tyrosine cream to the other half.
Improvement in the appearance of stretch marks, assessed at 4 and 12 weeks, was documented for both regimens. In addition, a comparison of treated striae alba with untreated lesions revealed that both regimens were effective in decreasing papillary dermal thickness and increasing epidermal thickness (Dermatol. Surg. 1998;24:849–56).
In another study evaluating the effects of a retinoid, 20 women applied tretinoin cream 0.1% to abdominal striae induced by pregnancy. In this open-label, multicenter, prospective study, researchers observed marked improvement in all striae after 3 months, compared with baseline, with an average 20% reduction in the length of the target lesion. Despite the emergence in 11 patients of erythema and scaling, topically applied tretinoin significantly ameliorated pregnancy-induced striae distensae (Adv. Ther. 2001;18:181–6).
I recommend OTC retinol products such as Philosophy Help Me and Neutrogena Healthy Skin to my patients. Of course, prescription retinoids such as Retin-A, Tazorac, and Differin are stronger and, therefore, may be more effective than retinol. I also suggest retinoic acid peels, such as the Ultra Peel Exfoliating Treatment or the Esthetique Peel.
In-Office Treatment
Glycolic acid can be administered in the office at higher doses than those contained in OTC products. After three or four visits, patients usually notice a slight change in the length, width, and intensity of striae rubra. In-office glycolic peels are safe for all skin types, although lower concentrations should be used for people with darker skin tones. As suggested above, the combination of glycolic acid and a retinoid can be effective. In fact, various prescription-strength retinoids are often applied as a preparation for a glycolic acid peel.
Lasers
Since vascular lasers are designed to treat dilated blood vessels, which are characteristic of striae rubra, they present a potent treatment option. These instruments are associated with epidermal turnover as well as increased collagen production and elastic remodeling. I prefer the Dornier 940-nm laser for stretch marks, but some physicians use the 585-nm or 595-nm laser.
In a recent study, investigators treated 20 patients with striae rubra using the 1,064-nm long-pulsed Nd:YAG laser, which has been successfully used to foster dermal collagen synthesis. Subjective evaluations were made by patients (with 55% rating the results as excellent), and the investigators used before-and-after photos to assess treatment efficacy. Forty percent of the doctors considered the results to be excellent. Overall, the investigators found this laser to be an effective option for treating striae rubra, with minimal side effects (Dermatol. Surg. 2008;34:686–91).
In another study, researchers evaluated the efficacy of the Therma Cool TC (Thermage Inc.), in combination with a 585-nm pulsed dye laser, for the treatment of striae distensae in people with darker skin types. Overall improvement was termed “good and very good” by 89% of the participants in the subjective evaluation. Skin biopsies of nine patients also revealed that the level of collagen fibers in each sample increased (Dermatol. Surg. 2007;33:29–34).
In a previous study of patients with dark skin types (IV-VI), researchers studied the effects of a nonablative 1,450-nm diode laser on striae distensae. Eleven Asian patients were treated with the laser with cryogen cooling spray on half of the body; the untreated half served as the control. The investigators concluded that, for patients with skin types IV-VI, the nonablative 1,450-nm diode laser is not a viable option for treating stretch marks (Lasers Surg. Med. 2006;38:196–9).
Intense Pulsed Light
In research on the efficacy of intense pulsed light (IPL), investigators treated 15 women with abdominal striae distensae. Their study was based on the reported efficacy of IPL in fostering the synthesis of collagen and the ordering of elastic fibers. Before-and-after photos and skin biopsies of all 15 patients exhibited significant clinical and microscopic improvements, including differences in dermal thickness (Dermatol. Surg. 2002;28:1124–30).
A more recent examination of an IPL infrared device, the NovaPlus, which attains high fluences with high-frequency stacked pulses, was conducted on 10 patients who had striae distensae. Review of before-and-after photographs and three-dimensional skin surface analysis yielded an equal outcome, and few subjects observed improvement, but histologic assessment revealed improvement in epidermal and dermal condition. The researchers concluded that additional treatment sessions might afford better chances for desired cosmetic results, given the absence of side effects (Aesthetic Plast. Surg. 2008;32:523–30).
Fractional Photothermolysis
Despite the enhancements in overall treatment of striae distensae, few modalities have provided promise in significantly improving the appearance of striae alba.
Perhaps until now. In a recent study of the safety and efficacy of fractional photothermolysis for the treatment of stretch marks in Asian skin, researchers irradiated the striae distensae on the right buttocks of six female volunteers aged 20–35 years using a 1,550-nm fractional photothermolysis laser.
Patients were followed for 2 months. Fleeting mild pain and hyperpigmentation were the adverse events reported. Overall, significant amelioration in the appearance of the stretch marks was observed 2 months after treatment. Histologic examination revealed a substantial increase in epidermal thickness as well as collagen and elastic fiber deposition. Investigators also noted that skin elasticity had become somewhat normalized (Am. J. Clin. Dermatol. 2008;9:33–7).
Conclusions
Although preventive measures can be used to reduce the likelihood of developing stretch marks, prevention is a challenge.
Treatment options are continually expanding. Glycolic acid and retinoids have demonstrated efficacy in in-office procedures and OTC products. Vitamin C may also impart some benefit. In addition, lasers are emerging as viable treatment options. The vascular laser is recommended for striae rubra and the Fraxel laser for striae alba.
Patients are advised to begin at-home treatment for stretch marks upon first noticing them and to schedule a dermatologic visit.
Argan Oil
Argan oil is derived from the fruit of the Argania spinosa tree, which is native to the arid climate of southwestern Morocco, where the preponderance of research on the herb is conducted. Once prevalent in North Africa, the A. spinosa tree is presently grown only in Morocco, and although it is the second most common tree species there, it is considered endangered, so its oil, which is labor intensive to obtain, is becoming somewhat rare (J. Ethnopharmacol. 1999;67:7–14; SÖFW Journal 2005; 131:35–46).
Argan oil has been used for traditional purposes, including as a medicine, for several centuries (Pharmacol. Res. 2006;54:1–5). Dubbed “liquid gold,” the vitamin E-rich argan oil is highly sought after.
There is a paucity of research on this botanical compound, but the preponderance of recent investigations has focused on the cardiovascular benefits of virgin argan oil consumption. Specifically, antiatherogenic, cholesterol-lowering, antiproliferative, and antioxidant benefits have been observed (Ann. Nutr. Metab. 2005;49:196–201; Nutr. Metab. Cardiovasc. Dis. 2005;15:352–60; Evid. Based Complement. Alternat. Med. 2006;3:317–27; Cancer Invest. 2006;24:588–92; Cancer Detect. Prev. 2007;31:64–9).
Given argan oil's abundant supply of fatty acids, phenolic constituents, squalene, sterols, and tocopherols, it is also thought to be an important factor in enhancing the anticancer effects of the Moroccan diet (Eur. J. Cancer Prev. 2003;12:67–75).
Lipid-Lowering Action
The majority of published research on argan oil has been performed in Morocco by Anas Drissi and his colleagues. They recently studied the effects of regular consumption of the oil on the lipid profile and antioxidant status of 96 healthy Moroccan subjects (62 regular consumers and 34 nonconsumers), of whom 76 were women and 20 were men (Clin. Nutr. 2004;23:1159–66).
The researchers found that plasma LDL cholesterol levels were lower in the participants who regularly consumed virgin argan oil, compared with nonconsumers. The diets of the argan oil consumers contained higher levels of polyunsaturated fats.
The researchers also investigated the in vitro effects of the tocopherols, sterols, and polyphenols in the herbal extract on LDL peroxidation, and found that the argon oil consumers had lower plasma lipoperoxides, a higher molar ratio of α-tocopherol to total cholesterol, and a higher concentration of α-tocopherol, compared with nonconsumers. LDL oxidation was similar in the two groups, despite the fact that consumers had higher plasma antioxidant concentrations and lower lipoperoxide levels.
The investigators concluded that their findings clearly established that regular consumption of virgin argan oil confers antioxidant and cholesterol-lowering activity, suggesting the viability of this natural extract as a dietary adjunct for lowering the risk of cardiovascular events.
Sebum-Reducing Action
More recently, a topical application for argan oil has been deemed viable. Hristo Dobrev of Medical University Plovdiv (Bulgaria) assessed the efficacy of a cream for controlling sebum. The cream was composed of saw palmetto extract, sesame seeds, and argan oil, and was studied in 20 healthy volunteers—16 with oily facial skin and 4 with combination facial skin. During the winter months (January and February), participants applied the formulation to the face twice daily for a period of 4 weeks (J. Cosmet. Dermatol. 2007;6:113–8).
The volunteers were assessed clinically and by instrumental measurement before and after the study period. Questionnaires were completed by the participants to provide a subjective evaluation of efficacy, tolerance, and cosmetic qualities. Objective measurements were made using a photometric device (Sebumeter), sebum collector foils (Sebufix), a Visioscope camera, and surface evaluation of the living skin software.
Results indicated that all of the volunteers tolerated the product. In 95% of the participants, a visible sebum-regulating efficacy was observed. In addition, clinical evaluation scores and casual sebum levels declined significantly after 1 month of treatment. The researcher concluded that this argan oil-containing formulation was efficacious in mitigating greasiness and ameliorating the appearance of oily facial skin.
Liquid Gold in Morocco
Although argan oil might qualify as the latest flavor-of-the-month in terms of so-called miracle ingredients in the beauty industry, it is actually quite popular in France. For years, English and French tourists have been known to return with argan oil from vacations in Morocco. It is worth noting that the cultivation and harnessing of this resource endemic to Morocco are now being fostered by the Moroccan government, which helps to fund the argan cooperatives of Berber women who grind the A. spinosa fruits to extract the oil.
The government of Monaco is also offering support, and the United Nations Educational, Scientific and Cultural Organization has labeled the argan-growing region of Morocco, which comprises approximately 10,000 square miles, a biosphere reserve.
At the Store
Argan oil is the key ingredient in a line of products manufactured by Issahra Argan Cosmetics, and made available through Argan Body LLC. The product line includes Argan Oil (100% organic), Age Control Day Care (with argan oil), and Argan Creamy Milk Face Cleanser, among other products.
Argan oil is also included in the Superskin Concentrate product by Liz Earle, Naturally Active Skincare, as well as in several formulations by Kaeline Argatherapie, available through Xandra Renouvelle. In addition, Laboratoires Serobiologiques, based in Pulnoy, France, has developed proprietary ingredients such as Arganyl, for antiaging indications, and Argatensyl, specifically to combat wrinkles.
Conclusion
The body of research on argan oil is notably scant. However, its traditional uses and inclusion in novel products (as one of the latest ingredients of the moment in the beauty industry) suggest that further investigations are warranted and likely to be forthcoming. Indeed, randomized controlled trials are necessary for establishing the actual benefits and dermatologic applications to be derived, if there are any, from this rare botanical. The little evidence that is available, however, does appear promising.
Argan oil is derived from the fruit of the Argania spinosa tree, which is native to the arid climate of southwestern Morocco, where the preponderance of research on the herb is conducted. Once prevalent in North Africa, the A. spinosa tree is presently grown only in Morocco, and although it is the second most common tree species there, it is considered endangered, so its oil, which is labor intensive to obtain, is becoming somewhat rare (J. Ethnopharmacol. 1999;67:7–14; SÖFW Journal 2005; 131:35–46).
Argan oil has been used for traditional purposes, including as a medicine, for several centuries (Pharmacol. Res. 2006;54:1–5). Dubbed “liquid gold,” the vitamin E-rich argan oil is highly sought after.
There is a paucity of research on this botanical compound, but the preponderance of recent investigations has focused on the cardiovascular benefits of virgin argan oil consumption. Specifically, antiatherogenic, cholesterol-lowering, antiproliferative, and antioxidant benefits have been observed (Ann. Nutr. Metab. 2005;49:196–201; Nutr. Metab. Cardiovasc. Dis. 2005;15:352–60; Evid. Based Complement. Alternat. Med. 2006;3:317–27; Cancer Invest. 2006;24:588–92; Cancer Detect. Prev. 2007;31:64–9).
Given argan oil's abundant supply of fatty acids, phenolic constituents, squalene, sterols, and tocopherols, it is also thought to be an important factor in enhancing the anticancer effects of the Moroccan diet (Eur. J. Cancer Prev. 2003;12:67–75).
Lipid-Lowering Action
The majority of published research on argan oil has been performed in Morocco by Anas Drissi and his colleagues. They recently studied the effects of regular consumption of the oil on the lipid profile and antioxidant status of 96 healthy Moroccan subjects (62 regular consumers and 34 nonconsumers), of whom 76 were women and 20 were men (Clin. Nutr. 2004;23:1159–66).
The researchers found that plasma LDL cholesterol levels were lower in the participants who regularly consumed virgin argan oil, compared with nonconsumers. The diets of the argan oil consumers contained higher levels of polyunsaturated fats.
The researchers also investigated the in vitro effects of the tocopherols, sterols, and polyphenols in the herbal extract on LDL peroxidation, and found that the argon oil consumers had lower plasma lipoperoxides, a higher molar ratio of α-tocopherol to total cholesterol, and a higher concentration of α-tocopherol, compared with nonconsumers. LDL oxidation was similar in the two groups, despite the fact that consumers had higher plasma antioxidant concentrations and lower lipoperoxide levels.
The investigators concluded that their findings clearly established that regular consumption of virgin argan oil confers antioxidant and cholesterol-lowering activity, suggesting the viability of this natural extract as a dietary adjunct for lowering the risk of cardiovascular events.
Sebum-Reducing Action
More recently, a topical application for argan oil has been deemed viable. Hristo Dobrev of Medical University Plovdiv (Bulgaria) assessed the efficacy of a cream for controlling sebum. The cream was composed of saw palmetto extract, sesame seeds, and argan oil, and was studied in 20 healthy volunteers—16 with oily facial skin and 4 with combination facial skin. During the winter months (January and February), participants applied the formulation to the face twice daily for a period of 4 weeks (J. Cosmet. Dermatol. 2007;6:113–8).
The volunteers were assessed clinically and by instrumental measurement before and after the study period. Questionnaires were completed by the participants to provide a subjective evaluation of efficacy, tolerance, and cosmetic qualities. Objective measurements were made using a photometric device (Sebumeter), sebum collector foils (Sebufix), a Visioscope camera, and surface evaluation of the living skin software.
Results indicated that all of the volunteers tolerated the product. In 95% of the participants, a visible sebum-regulating efficacy was observed. In addition, clinical evaluation scores and casual sebum levels declined significantly after 1 month of treatment. The researcher concluded that this argan oil-containing formulation was efficacious in mitigating greasiness and ameliorating the appearance of oily facial skin.
Liquid Gold in Morocco
Although argan oil might qualify as the latest flavor-of-the-month in terms of so-called miracle ingredients in the beauty industry, it is actually quite popular in France. For years, English and French tourists have been known to return with argan oil from vacations in Morocco. It is worth noting that the cultivation and harnessing of this resource endemic to Morocco are now being fostered by the Moroccan government, which helps to fund the argan cooperatives of Berber women who grind the A. spinosa fruits to extract the oil.
The government of Monaco is also offering support, and the United Nations Educational, Scientific and Cultural Organization has labeled the argan-growing region of Morocco, which comprises approximately 10,000 square miles, a biosphere reserve.
At the Store
Argan oil is the key ingredient in a line of products manufactured by Issahra Argan Cosmetics, and made available through Argan Body LLC. The product line includes Argan Oil (100% organic), Age Control Day Care (with argan oil), and Argan Creamy Milk Face Cleanser, among other products.
Argan oil is also included in the Superskin Concentrate product by Liz Earle, Naturally Active Skincare, as well as in several formulations by Kaeline Argatherapie, available through Xandra Renouvelle. In addition, Laboratoires Serobiologiques, based in Pulnoy, France, has developed proprietary ingredients such as Arganyl, for antiaging indications, and Argatensyl, specifically to combat wrinkles.
Conclusion
The body of research on argan oil is notably scant. However, its traditional uses and inclusion in novel products (as one of the latest ingredients of the moment in the beauty industry) suggest that further investigations are warranted and likely to be forthcoming. Indeed, randomized controlled trials are necessary for establishing the actual benefits and dermatologic applications to be derived, if there are any, from this rare botanical. The little evidence that is available, however, does appear promising.
Argan oil is derived from the fruit of the Argania spinosa tree, which is native to the arid climate of southwestern Morocco, where the preponderance of research on the herb is conducted. Once prevalent in North Africa, the A. spinosa tree is presently grown only in Morocco, and although it is the second most common tree species there, it is considered endangered, so its oil, which is labor intensive to obtain, is becoming somewhat rare (J. Ethnopharmacol. 1999;67:7–14; SÖFW Journal 2005; 131:35–46).
Argan oil has been used for traditional purposes, including as a medicine, for several centuries (Pharmacol. Res. 2006;54:1–5). Dubbed “liquid gold,” the vitamin E-rich argan oil is highly sought after.
There is a paucity of research on this botanical compound, but the preponderance of recent investigations has focused on the cardiovascular benefits of virgin argan oil consumption. Specifically, antiatherogenic, cholesterol-lowering, antiproliferative, and antioxidant benefits have been observed (Ann. Nutr. Metab. 2005;49:196–201; Nutr. Metab. Cardiovasc. Dis. 2005;15:352–60; Evid. Based Complement. Alternat. Med. 2006;3:317–27; Cancer Invest. 2006;24:588–92; Cancer Detect. Prev. 2007;31:64–9).
Given argan oil's abundant supply of fatty acids, phenolic constituents, squalene, sterols, and tocopherols, it is also thought to be an important factor in enhancing the anticancer effects of the Moroccan diet (Eur. J. Cancer Prev. 2003;12:67–75).
Lipid-Lowering Action
The majority of published research on argan oil has been performed in Morocco by Anas Drissi and his colleagues. They recently studied the effects of regular consumption of the oil on the lipid profile and antioxidant status of 96 healthy Moroccan subjects (62 regular consumers and 34 nonconsumers), of whom 76 were women and 20 were men (Clin. Nutr. 2004;23:1159–66).
The researchers found that plasma LDL cholesterol levels were lower in the participants who regularly consumed virgin argan oil, compared with nonconsumers. The diets of the argan oil consumers contained higher levels of polyunsaturated fats.
The researchers also investigated the in vitro effects of the tocopherols, sterols, and polyphenols in the herbal extract on LDL peroxidation, and found that the argon oil consumers had lower plasma lipoperoxides, a higher molar ratio of α-tocopherol to total cholesterol, and a higher concentration of α-tocopherol, compared with nonconsumers. LDL oxidation was similar in the two groups, despite the fact that consumers had higher plasma antioxidant concentrations and lower lipoperoxide levels.
The investigators concluded that their findings clearly established that regular consumption of virgin argan oil confers antioxidant and cholesterol-lowering activity, suggesting the viability of this natural extract as a dietary adjunct for lowering the risk of cardiovascular events.
Sebum-Reducing Action
More recently, a topical application for argan oil has been deemed viable. Hristo Dobrev of Medical University Plovdiv (Bulgaria) assessed the efficacy of a cream for controlling sebum. The cream was composed of saw palmetto extract, sesame seeds, and argan oil, and was studied in 20 healthy volunteers—16 with oily facial skin and 4 with combination facial skin. During the winter months (January and February), participants applied the formulation to the face twice daily for a period of 4 weeks (J. Cosmet. Dermatol. 2007;6:113–8).
The volunteers were assessed clinically and by instrumental measurement before and after the study period. Questionnaires were completed by the participants to provide a subjective evaluation of efficacy, tolerance, and cosmetic qualities. Objective measurements were made using a photometric device (Sebumeter), sebum collector foils (Sebufix), a Visioscope camera, and surface evaluation of the living skin software.
Results indicated that all of the volunteers tolerated the product. In 95% of the participants, a visible sebum-regulating efficacy was observed. In addition, clinical evaluation scores and casual sebum levels declined significantly after 1 month of treatment. The researcher concluded that this argan oil-containing formulation was efficacious in mitigating greasiness and ameliorating the appearance of oily facial skin.
Liquid Gold in Morocco
Although argan oil might qualify as the latest flavor-of-the-month in terms of so-called miracle ingredients in the beauty industry, it is actually quite popular in France. For years, English and French tourists have been known to return with argan oil from vacations in Morocco. It is worth noting that the cultivation and harnessing of this resource endemic to Morocco are now being fostered by the Moroccan government, which helps to fund the argan cooperatives of Berber women who grind the A. spinosa fruits to extract the oil.
The government of Monaco is also offering support, and the United Nations Educational, Scientific and Cultural Organization has labeled the argan-growing region of Morocco, which comprises approximately 10,000 square miles, a biosphere reserve.
At the Store
Argan oil is the key ingredient in a line of products manufactured by Issahra Argan Cosmetics, and made available through Argan Body LLC. The product line includes Argan Oil (100% organic), Age Control Day Care (with argan oil), and Argan Creamy Milk Face Cleanser, among other products.
Argan oil is also included in the Superskin Concentrate product by Liz Earle, Naturally Active Skincare, as well as in several formulations by Kaeline Argatherapie, available through Xandra Renouvelle. In addition, Laboratoires Serobiologiques, based in Pulnoy, France, has developed proprietary ingredients such as Arganyl, for antiaging indications, and Argatensyl, specifically to combat wrinkles.
Conclusion
The body of research on argan oil is notably scant. However, its traditional uses and inclusion in novel products (as one of the latest ingredients of the moment in the beauty industry) suggest that further investigations are warranted and likely to be forthcoming. Indeed, randomized controlled trials are necessary for establishing the actual benefits and dermatologic applications to be derived, if there are any, from this rare botanical. The little evidence that is available, however, does appear promising.