User login
Review of plant phenolics, part 3: Nonflavonoid compounds
Polyphenols are widely distributed in the plant kingdom, and are found in copious supply in multiple vegetables, fruits, herbs, grains, tea, coffee beans, honey, and red wine, for example. They are an especially important source of antioxidants and are increasingly the focus of research due to their potent and diverse biologic activities. In the conclusion to my three-part review of polyphenols, this column identifies representative compounds from the classes of nonflavonoid polyphenols and provides a brief update on research.
Phenolic acids: ferulic acid
Derived from curcumin, ferulic acid is noted for exhibiting multiple biologic activities, including antiapoptotic, anticarcinogenic, antidiabetic, hepatoprotective, and cardioprotective, among others. Its beneficial effects are thought to be mediated through its antioxidant and anti-inflammatory characteristics.1 In a small 2008 study, a stable formulation of 15% l-ascorbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid was applied topically to normal-appearing human skin for 4 days and was found to impart significant photoprotection against solar-simulated UV radiation and was especially effective at diminishing thymine dimer mutations, which are linked to skin cancer. The authors also noted that the mechanism of action of this antioxidant formulation differs from that of sunscreens and, therefore, may serve as a supplement to such products.2 (It is worth noting that ferulic acid has been approved as a sunscreen agent in Japan.3)
In 2015, Ambothi et al. used Swiss albino mice to assess the photochemopreventive effects of ferulic acid against chronic (30-week) UVB, finding the intraperitoneal and topical administration of the phenolic acid effective in significantly lowering the incidence of UVB-induced tumor volume and weight in the mice skin.4 The next year, Hahn et al. reported that pretreatment with ferulic acid protects human dermal fibroblasts from UVA-induced photodamage.5 Also in 2016, Chaiprasongsuk et al. found that several dietary phenolics, including ferulic acid, deliver protection against UVA-induced melanogenesis through indirect regulation of the Nrf2-ARE pathway.6
Lignans: flaxseed
Flaxseed lignans, which exhibit a wide range of biologic activities, are best known for their antioxidant properties.7 In a 2017 study using atopic dermatitis–induced NC/Nga mice, Yang et al. found that fermented flaxseed oil administered orally was successful in relieving symptoms such as erythema, edema, pruritus, and epithelial damage.8 Two years earlier, Draganescu et al. developed a topical flaxseed extract formulation that displayed wound healing capabilities on Wistar rats.7 Emulsions produced from the oils and seeds of transgenic flax have also been found to protect against oxidative stress in hamster fibroblasts, with investigators suggesting that the emulsions have potential to protect the skin against such damage.8
Stilbenes: resveratrol
The antioxidant potency of resveratrol has been cited for conferring a wide range of salutary effects, including antitumorigenic as well as antiaging activity. In 2008, a resveratrol-based skin care formulation intended to combat photoaging was reported to exhibit 17-fold greater antioxidant activity than idebenone.9 In a different study that year, resveratrol, the primary active polyphenolic constituent in red wine, was assessed in terms of topical/transdermal delivery viability, given previously established benefits shown via systemic administration. Several hydrogel systems used as resveratrol vehicles were shown to be safe and effective methods for cutaneously delivering the therapeutic effects of this antioxidant.10 Since then, resveratrol has been demonstrated to penetrate the skin via topical administration, reinforcing the antioxidant system of the stratum corneum and delivering increases of antioxidants to human epidermal tissue.11
In 2014, Farris et al. showed that a proprietary topical antioxidant blend of resveratrol, baicalin, and vitamin E applied topically at night yielded statistically significant amelioration of fine lines and wrinkles, as well as skin firmness, elasticity, laxity, hyperpigmentation, radiance, and roughness over a 12-week period.12 Resveratrol has also been shown in mice to suppress the inflammatory response and improve survival from severe burns with bacterial infections.13
Hydrolyzable tannins: ellagic acid
Ellagic acid, a dimer of gallic acid, has been reported to impart anti-inflammatory, antitumor, immunomodulatory, and antifungal activities.14-16 Ortiz-Ruiz et al. have noted that while ellagic acid is used as a whitening agent, it can act as a substrate to rather than an inhibitor of tyrosinase, as it is oxidized by the enzyme to an unstable o-quinone. However, as a potent antioxidant, ellagic acid can block melanogenesis by reducing o-quinones and semiquinones.17
In a double-blind, placebo-controlled, 4-week trial to assess the effects of orally administered ellagic acid–rich pomegranate extract on the pigmentation of 13 women after UV exposure, with healthy volunteers randomly assigned to high-dose, low-dose, and control groups, luminance values decreased by 1.73% in the high-dose group and 1.35% in the low-dose group, as compared with the control group, and stains and freckles were reported to be diminished.18 A 2016 study in human dermal fibroblasts by Baek et al. suggested that ellagic acid displays antiphotoaging activity, as the polyphenol protected against UVB-induced oxidative stress potentially through an Nrf2-dependent pathway.15
Condensed tannins (Proanthocyanidins): pycnogenol
Pycnogenol has been used in an antioxidant mixture also including vitamins C and E, as well as evening primrose that when orally administered for 10 weeks to female SKH-1 hairless mice exposed three times weekly to UVB irradiation demonstrated the capacity to significantly inhibit wrinkle formation by markedly suppressing UVB-induced MMP activity while promoting collagen production.19 In a 2012 study of 112 women with mild to moderate photoaging, orally administered pycnogenol was shown to yield significant reductions in clinical grading of skin photoaging scores.20 Four years later, a review by Grether-Beck et al. suggested that oral administration of pycnogenol imparts photoprotection, diminishes hyperpigmentation, and improves skin barrier function and the stability of the extracellular matrix.21
Lignins: various woody plants
Recognized as efficient natural scavengers of reactive oxygen species, lignins are complex phenolic polymers that are abundant in nature, particularly in various tree species and agricultural products. In 2004, Dizhbite et al. isolated lignin samples from deciduous and coniferous trees to assess their capacity as natural antioxidants. Samples were assessed against the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical in homogeneous conditions, with the commercially available kraft lignin noted for displaying antibacterial activity associated with its radical-scavenging properties.22 Four years later, Ugartondo et al. studied several lignins and reported a strong antioxidant capacity at various concentrations that were innocuous to normal human cells and stable when exposed to UVA. The investigators concluded that lignins may be viable for inclusion in cosmetic and topical medical formulations.23
Conclusion
A brief survey of the polyphenolic landscape obviously cannot do the subject justice. From the dermatologic perspective, this diverse family of compounds factor into the skin care formulations becoming more prevalent in the established armamentarium, as well as the direct-to-consumer market. Given the increasing attention paid here and elsewhere to the impact of diet on the skin, the status of this dynamic class of polyphenolic compounds, which includes several antioxidants and is found in numerous plants, appears to be well deserved and warrants much more research.
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Food Chem Toxicol. 2017 May;103:41-55.
2. J Am Acad Dermatol. 2008 Sep;59(3):418-25.
3. J Pharm Biomed Anal. 2008 Mar 13;46(4):645-52.
4. Food Chem Toxicol. 2015 Aug;82:72-8.
5. Ann Dermatol. 2016 Dec;28(6):740-8.
6. Redox Biol. 2016 Aug;8:79-90.
7. Int J Biol Macromol. 2015 Jan;72:614-23.
8. Evid Based Complement Alternat Med. 2017;2017:5469125.
9. J Cosmet Dermatol. 2008 Mar;7(1):2-7.
10. Biol Pharm Bull. 2008 May;31(5):955-62.
11. Arch Dermatol Res. 2017 Aug;309(6):423-31.
12. J Drugs Dermatol. 2014 Dec;13(12):1467-72.
13. Inflammation. 2015;38(3):1273-80.
14. Dermatol Ther. 2012 May-Jun;25(3):252-9.
15. Korean J Physiol Pharmacol. 2016 May;20(3):269-77.
16. Phytother Res. 2015 Jul;29(7):1019-25.
17. J Dermatol Sci. 2016 May;82(2):115-22.
18. J Nutr Sci Vitaminol (Tokyo). 2006 Oct;52(5):383-8.
19. Photodermatol Photoimmunol Photomed. 2007 Oct;23(5):155-62.
20. Clin Interv Aging. 2012;7:275-86.
21. Skin Pharmacol Physiol. 2016;29(1):13-7.
22. Bioresour Technol. 2004 Dec;95(3):309-17.
23. Bioresour Technol. 2008 Sep;99(14):6683-7.
Polyphenols are widely distributed in the plant kingdom, and are found in copious supply in multiple vegetables, fruits, herbs, grains, tea, coffee beans, honey, and red wine, for example. They are an especially important source of antioxidants and are increasingly the focus of research due to their potent and diverse biologic activities. In the conclusion to my three-part review of polyphenols, this column identifies representative compounds from the classes of nonflavonoid polyphenols and provides a brief update on research.
Phenolic acids: ferulic acid
Derived from curcumin, ferulic acid is noted for exhibiting multiple biologic activities, including antiapoptotic, anticarcinogenic, antidiabetic, hepatoprotective, and cardioprotective, among others. Its beneficial effects are thought to be mediated through its antioxidant and anti-inflammatory characteristics.1 In a small 2008 study, a stable formulation of 15% l-ascorbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid was applied topically to normal-appearing human skin for 4 days and was found to impart significant photoprotection against solar-simulated UV radiation and was especially effective at diminishing thymine dimer mutations, which are linked to skin cancer. The authors also noted that the mechanism of action of this antioxidant formulation differs from that of sunscreens and, therefore, may serve as a supplement to such products.2 (It is worth noting that ferulic acid has been approved as a sunscreen agent in Japan.3)
In 2015, Ambothi et al. used Swiss albino mice to assess the photochemopreventive effects of ferulic acid against chronic (30-week) UVB, finding the intraperitoneal and topical administration of the phenolic acid effective in significantly lowering the incidence of UVB-induced tumor volume and weight in the mice skin.4 The next year, Hahn et al. reported that pretreatment with ferulic acid protects human dermal fibroblasts from UVA-induced photodamage.5 Also in 2016, Chaiprasongsuk et al. found that several dietary phenolics, including ferulic acid, deliver protection against UVA-induced melanogenesis through indirect regulation of the Nrf2-ARE pathway.6
Lignans: flaxseed
Flaxseed lignans, which exhibit a wide range of biologic activities, are best known for their antioxidant properties.7 In a 2017 study using atopic dermatitis–induced NC/Nga mice, Yang et al. found that fermented flaxseed oil administered orally was successful in relieving symptoms such as erythema, edema, pruritus, and epithelial damage.8 Two years earlier, Draganescu et al. developed a topical flaxseed extract formulation that displayed wound healing capabilities on Wistar rats.7 Emulsions produced from the oils and seeds of transgenic flax have also been found to protect against oxidative stress in hamster fibroblasts, with investigators suggesting that the emulsions have potential to protect the skin against such damage.8
Stilbenes: resveratrol
The antioxidant potency of resveratrol has been cited for conferring a wide range of salutary effects, including antitumorigenic as well as antiaging activity. In 2008, a resveratrol-based skin care formulation intended to combat photoaging was reported to exhibit 17-fold greater antioxidant activity than idebenone.9 In a different study that year, resveratrol, the primary active polyphenolic constituent in red wine, was assessed in terms of topical/transdermal delivery viability, given previously established benefits shown via systemic administration. Several hydrogel systems used as resveratrol vehicles were shown to be safe and effective methods for cutaneously delivering the therapeutic effects of this antioxidant.10 Since then, resveratrol has been demonstrated to penetrate the skin via topical administration, reinforcing the antioxidant system of the stratum corneum and delivering increases of antioxidants to human epidermal tissue.11
In 2014, Farris et al. showed that a proprietary topical antioxidant blend of resveratrol, baicalin, and vitamin E applied topically at night yielded statistically significant amelioration of fine lines and wrinkles, as well as skin firmness, elasticity, laxity, hyperpigmentation, radiance, and roughness over a 12-week period.12 Resveratrol has also been shown in mice to suppress the inflammatory response and improve survival from severe burns with bacterial infections.13
Hydrolyzable tannins: ellagic acid
Ellagic acid, a dimer of gallic acid, has been reported to impart anti-inflammatory, antitumor, immunomodulatory, and antifungal activities.14-16 Ortiz-Ruiz et al. have noted that while ellagic acid is used as a whitening agent, it can act as a substrate to rather than an inhibitor of tyrosinase, as it is oxidized by the enzyme to an unstable o-quinone. However, as a potent antioxidant, ellagic acid can block melanogenesis by reducing o-quinones and semiquinones.17
In a double-blind, placebo-controlled, 4-week trial to assess the effects of orally administered ellagic acid–rich pomegranate extract on the pigmentation of 13 women after UV exposure, with healthy volunteers randomly assigned to high-dose, low-dose, and control groups, luminance values decreased by 1.73% in the high-dose group and 1.35% in the low-dose group, as compared with the control group, and stains and freckles were reported to be diminished.18 A 2016 study in human dermal fibroblasts by Baek et al. suggested that ellagic acid displays antiphotoaging activity, as the polyphenol protected against UVB-induced oxidative stress potentially through an Nrf2-dependent pathway.15
Condensed tannins (Proanthocyanidins): pycnogenol
Pycnogenol has been used in an antioxidant mixture also including vitamins C and E, as well as evening primrose that when orally administered for 10 weeks to female SKH-1 hairless mice exposed three times weekly to UVB irradiation demonstrated the capacity to significantly inhibit wrinkle formation by markedly suppressing UVB-induced MMP activity while promoting collagen production.19 In a 2012 study of 112 women with mild to moderate photoaging, orally administered pycnogenol was shown to yield significant reductions in clinical grading of skin photoaging scores.20 Four years later, a review by Grether-Beck et al. suggested that oral administration of pycnogenol imparts photoprotection, diminishes hyperpigmentation, and improves skin barrier function and the stability of the extracellular matrix.21
Lignins: various woody plants
Recognized as efficient natural scavengers of reactive oxygen species, lignins are complex phenolic polymers that are abundant in nature, particularly in various tree species and agricultural products. In 2004, Dizhbite et al. isolated lignin samples from deciduous and coniferous trees to assess their capacity as natural antioxidants. Samples were assessed against the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical in homogeneous conditions, with the commercially available kraft lignin noted for displaying antibacterial activity associated with its radical-scavenging properties.22 Four years later, Ugartondo et al. studied several lignins and reported a strong antioxidant capacity at various concentrations that were innocuous to normal human cells and stable when exposed to UVA. The investigators concluded that lignins may be viable for inclusion in cosmetic and topical medical formulations.23
Conclusion
A brief survey of the polyphenolic landscape obviously cannot do the subject justice. From the dermatologic perspective, this diverse family of compounds factor into the skin care formulations becoming more prevalent in the established armamentarium, as well as the direct-to-consumer market. Given the increasing attention paid here and elsewhere to the impact of diet on the skin, the status of this dynamic class of polyphenolic compounds, which includes several antioxidants and is found in numerous plants, appears to be well deserved and warrants much more research.
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Food Chem Toxicol. 2017 May;103:41-55.
2. J Am Acad Dermatol. 2008 Sep;59(3):418-25.
3. J Pharm Biomed Anal. 2008 Mar 13;46(4):645-52.
4. Food Chem Toxicol. 2015 Aug;82:72-8.
5. Ann Dermatol. 2016 Dec;28(6):740-8.
6. Redox Biol. 2016 Aug;8:79-90.
7. Int J Biol Macromol. 2015 Jan;72:614-23.
8. Evid Based Complement Alternat Med. 2017;2017:5469125.
9. J Cosmet Dermatol. 2008 Mar;7(1):2-7.
10. Biol Pharm Bull. 2008 May;31(5):955-62.
11. Arch Dermatol Res. 2017 Aug;309(6):423-31.
12. J Drugs Dermatol. 2014 Dec;13(12):1467-72.
13. Inflammation. 2015;38(3):1273-80.
14. Dermatol Ther. 2012 May-Jun;25(3):252-9.
15. Korean J Physiol Pharmacol. 2016 May;20(3):269-77.
16. Phytother Res. 2015 Jul;29(7):1019-25.
17. J Dermatol Sci. 2016 May;82(2):115-22.
18. J Nutr Sci Vitaminol (Tokyo). 2006 Oct;52(5):383-8.
19. Photodermatol Photoimmunol Photomed. 2007 Oct;23(5):155-62.
20. Clin Interv Aging. 2012;7:275-86.
21. Skin Pharmacol Physiol. 2016;29(1):13-7.
22. Bioresour Technol. 2004 Dec;95(3):309-17.
23. Bioresour Technol. 2008 Sep;99(14):6683-7.
Polyphenols are widely distributed in the plant kingdom, and are found in copious supply in multiple vegetables, fruits, herbs, grains, tea, coffee beans, honey, and red wine, for example. They are an especially important source of antioxidants and are increasingly the focus of research due to their potent and diverse biologic activities. In the conclusion to my three-part review of polyphenols, this column identifies representative compounds from the classes of nonflavonoid polyphenols and provides a brief update on research.
Phenolic acids: ferulic acid
Derived from curcumin, ferulic acid is noted for exhibiting multiple biologic activities, including antiapoptotic, anticarcinogenic, antidiabetic, hepatoprotective, and cardioprotective, among others. Its beneficial effects are thought to be mediated through its antioxidant and anti-inflammatory characteristics.1 In a small 2008 study, a stable formulation of 15% l-ascorbic acid, 1% alpha-tocopherol, and 0.5% ferulic acid was applied topically to normal-appearing human skin for 4 days and was found to impart significant photoprotection against solar-simulated UV radiation and was especially effective at diminishing thymine dimer mutations, which are linked to skin cancer. The authors also noted that the mechanism of action of this antioxidant formulation differs from that of sunscreens and, therefore, may serve as a supplement to such products.2 (It is worth noting that ferulic acid has been approved as a sunscreen agent in Japan.3)
In 2015, Ambothi et al. used Swiss albino mice to assess the photochemopreventive effects of ferulic acid against chronic (30-week) UVB, finding the intraperitoneal and topical administration of the phenolic acid effective in significantly lowering the incidence of UVB-induced tumor volume and weight in the mice skin.4 The next year, Hahn et al. reported that pretreatment with ferulic acid protects human dermal fibroblasts from UVA-induced photodamage.5 Also in 2016, Chaiprasongsuk et al. found that several dietary phenolics, including ferulic acid, deliver protection against UVA-induced melanogenesis through indirect regulation of the Nrf2-ARE pathway.6
Lignans: flaxseed
Flaxseed lignans, which exhibit a wide range of biologic activities, are best known for their antioxidant properties.7 In a 2017 study using atopic dermatitis–induced NC/Nga mice, Yang et al. found that fermented flaxseed oil administered orally was successful in relieving symptoms such as erythema, edema, pruritus, and epithelial damage.8 Two years earlier, Draganescu et al. developed a topical flaxseed extract formulation that displayed wound healing capabilities on Wistar rats.7 Emulsions produced from the oils and seeds of transgenic flax have also been found to protect against oxidative stress in hamster fibroblasts, with investigators suggesting that the emulsions have potential to protect the skin against such damage.8
Stilbenes: resveratrol
The antioxidant potency of resveratrol has been cited for conferring a wide range of salutary effects, including antitumorigenic as well as antiaging activity. In 2008, a resveratrol-based skin care formulation intended to combat photoaging was reported to exhibit 17-fold greater antioxidant activity than idebenone.9 In a different study that year, resveratrol, the primary active polyphenolic constituent in red wine, was assessed in terms of topical/transdermal delivery viability, given previously established benefits shown via systemic administration. Several hydrogel systems used as resveratrol vehicles were shown to be safe and effective methods for cutaneously delivering the therapeutic effects of this antioxidant.10 Since then, resveratrol has been demonstrated to penetrate the skin via topical administration, reinforcing the antioxidant system of the stratum corneum and delivering increases of antioxidants to human epidermal tissue.11
In 2014, Farris et al. showed that a proprietary topical antioxidant blend of resveratrol, baicalin, and vitamin E applied topically at night yielded statistically significant amelioration of fine lines and wrinkles, as well as skin firmness, elasticity, laxity, hyperpigmentation, radiance, and roughness over a 12-week period.12 Resveratrol has also been shown in mice to suppress the inflammatory response and improve survival from severe burns with bacterial infections.13
Hydrolyzable tannins: ellagic acid
Ellagic acid, a dimer of gallic acid, has been reported to impart anti-inflammatory, antitumor, immunomodulatory, and antifungal activities.14-16 Ortiz-Ruiz et al. have noted that while ellagic acid is used as a whitening agent, it can act as a substrate to rather than an inhibitor of tyrosinase, as it is oxidized by the enzyme to an unstable o-quinone. However, as a potent antioxidant, ellagic acid can block melanogenesis by reducing o-quinones and semiquinones.17
In a double-blind, placebo-controlled, 4-week trial to assess the effects of orally administered ellagic acid–rich pomegranate extract on the pigmentation of 13 women after UV exposure, with healthy volunteers randomly assigned to high-dose, low-dose, and control groups, luminance values decreased by 1.73% in the high-dose group and 1.35% in the low-dose group, as compared with the control group, and stains and freckles were reported to be diminished.18 A 2016 study in human dermal fibroblasts by Baek et al. suggested that ellagic acid displays antiphotoaging activity, as the polyphenol protected against UVB-induced oxidative stress potentially through an Nrf2-dependent pathway.15
Condensed tannins (Proanthocyanidins): pycnogenol
Pycnogenol has been used in an antioxidant mixture also including vitamins C and E, as well as evening primrose that when orally administered for 10 weeks to female SKH-1 hairless mice exposed three times weekly to UVB irradiation demonstrated the capacity to significantly inhibit wrinkle formation by markedly suppressing UVB-induced MMP activity while promoting collagen production.19 In a 2012 study of 112 women with mild to moderate photoaging, orally administered pycnogenol was shown to yield significant reductions in clinical grading of skin photoaging scores.20 Four years later, a review by Grether-Beck et al. suggested that oral administration of pycnogenol imparts photoprotection, diminishes hyperpigmentation, and improves skin barrier function and the stability of the extracellular matrix.21
Lignins: various woody plants
Recognized as efficient natural scavengers of reactive oxygen species, lignins are complex phenolic polymers that are abundant in nature, particularly in various tree species and agricultural products. In 2004, Dizhbite et al. isolated lignin samples from deciduous and coniferous trees to assess their capacity as natural antioxidants. Samples were assessed against the 1,1-diphenyl-2-picrylhydrazyl (DPPH) radical in homogeneous conditions, with the commercially available kraft lignin noted for displaying antibacterial activity associated with its radical-scavenging properties.22 Four years later, Ugartondo et al. studied several lignins and reported a strong antioxidant capacity at various concentrations that were innocuous to normal human cells and stable when exposed to UVA. The investigators concluded that lignins may be viable for inclusion in cosmetic and topical medical formulations.23
Conclusion
A brief survey of the polyphenolic landscape obviously cannot do the subject justice. From the dermatologic perspective, this diverse family of compounds factor into the skin care formulations becoming more prevalent in the established armamentarium, as well as the direct-to-consumer market. Given the increasing attention paid here and elsewhere to the impact of diet on the skin, the status of this dynamic class of polyphenolic compounds, which includes several antioxidants and is found in numerous plants, appears to be well deserved and warrants much more research.
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Food Chem Toxicol. 2017 May;103:41-55.
2. J Am Acad Dermatol. 2008 Sep;59(3):418-25.
3. J Pharm Biomed Anal. 2008 Mar 13;46(4):645-52.
4. Food Chem Toxicol. 2015 Aug;82:72-8.
5. Ann Dermatol. 2016 Dec;28(6):740-8.
6. Redox Biol. 2016 Aug;8:79-90.
7. Int J Biol Macromol. 2015 Jan;72:614-23.
8. Evid Based Complement Alternat Med. 2017;2017:5469125.
9. J Cosmet Dermatol. 2008 Mar;7(1):2-7.
10. Biol Pharm Bull. 2008 May;31(5):955-62.
11. Arch Dermatol Res. 2017 Aug;309(6):423-31.
12. J Drugs Dermatol. 2014 Dec;13(12):1467-72.
13. Inflammation. 2015;38(3):1273-80.
14. Dermatol Ther. 2012 May-Jun;25(3):252-9.
15. Korean J Physiol Pharmacol. 2016 May;20(3):269-77.
16. Phytother Res. 2015 Jul;29(7):1019-25.
17. J Dermatol Sci. 2016 May;82(2):115-22.
18. J Nutr Sci Vitaminol (Tokyo). 2006 Oct;52(5):383-8.
19. Photodermatol Photoimmunol Photomed. 2007 Oct;23(5):155-62.
20. Clin Interv Aging. 2012;7:275-86.
21. Skin Pharmacol Physiol. 2016;29(1):13-7.
22. Bioresour Technol. 2004 Dec;95(3):309-17.
23. Bioresour Technol. 2008 Sep;99(14):6683-7.
Review of plant phenolics, Part 2: flavonoid compounds
This column picks up with a recent literature review suggesting potential benefits of topically applied or orally administered flavonoid polyphenolic substances. The discussion is based on at least one sample compound from each flavonoid category.
Flavonols: quercetin
Known to exert substantial antioxidant and anti-inflammatory activities, quercetin has been shown in various cellular and animal-based models to deliver photoprotection from UV and contribute to wound healing.1 In a single center, single-blind trial with 30 healthy volunteers, a 1% topical quercetin cream was found to be effective in reducing erythema, itching, and wheal diameter in experimentally-induced skin stress.2 Quercetin also has been reported to have the capacity to inhibit melanin production.3
Flavones: apigenin
Flavanones: naringenin
The citrus flavanone naringenin shows promise as a preventive agent against cutaneous aging as well as carcinogenesis. In a 2008 study, naringenin exerted an anti-apoptotic effect in UVB-damaged cells, significantly extending long-term cellular survival, and facilitating the removal of cyclobutane pyrimidine dimers from the genome.7 More recently, topical naringenin has been shown in mice to mitigate the cutaneous inflammation and oxidative stress caused by UVB irradiation,8 and, present in Lippia graveolens, to protect against chronic UVB-induced damage including phototumorigenesis.9
Isoflavones: red clover, genistein, and daidzein
Red clover, the isoflavones of which have been demonstrated – in high dietary concentrations – to contribute to low incidence of osteoporosis and menopausal symptoms, was shown in a 2006 study to exert anti-aging effects in mice, indicating potential for alleviating the cutaneous aging brought on by declines in estrogen.10 In 2011, Lipovac et al. showed that oral supplementation with red clover extract improved scalp hair and skin status as well as libido, mood, sleep, and fatigue in a study with 109 postmenopausal women.11
The topical application of the soy isoflavones genistein, daidzein, and glycitein has shown promise as a treatment for photoaging and photodamage.12 Genistein has been noted for its antioxidant and antibrowning activity, and has exhibited anti-aging properties in mouse studies and photoprotective activity in humans.13 A 2015 study by Zhao et al. in cultured skin fibroblasts and nude mouse skin indicated that daidzein treatment appears to increase skin collagen production and suppress collagen degradation.14
Flavan-3-ols (catechins): epigallocatechin 3-gallate
Already considered a potent antioxidant, epigallocatechin 3-gallate (EGCG) continues to receive attention for conferring an expanding range of health benefits. This catechin, which is the most abundant and potent of such compounds in green tea, has exhibited the capacity to hinder UVB-induced collagen-degrading matrix metalloproteinases (MMPs).15 EGCG also has been proposed as a preventive and therapeutic agent for keloids, given findings indicating that it hampered the proliferation and migration of keloid fibroblasts in vitro, as well as in vivo by interrupting the signal transducer and activator of transcription 3 (STAT3) signaling pathway.16 Further, EGCG has been suggested as a potential therapeutic approach to atopic dermatitis (AD) given success against AD-like skin lesions in a murine model.17 An investigation of the anti-aging cutaneous effects of EGCG on d-galactose-induced aging in mice revealed that subcutaneously injected EGCG yielded overall improvement in the structure and function of the skin.18 EGCG also is known to yield improvements in skin condition by providing DNA protection, reactivating damaged cells, and increasing cellular energy production.3
Perhaps most importantly, formulations containing green tea extracts have been shown in a small study of 20 volunteers to exert protection against photoaging and photoimmunosuppression, with the extract hindering the expression of MMP-9 and MMP-2.19 Wrinkle reduction also was observed in another clinical study involving topical green tea.20 The tea plant Camellia sinensis is one of the best sources of antioxidant catechins, particularly green tea (unfermented), but also white (unfermented), black (fermented), and oolong (semifermented) tea.21
Anthocyanins: cyanidin
A 2017 in vivo study in mice found that cyanidin hindered the binding of the cytokine interleukin-17A to the IL-17RA subunit to reduce inflammation.22 In a 2007 study, methanol extracts of black raspberries, strawberries, and blueberries were tested for the capacity to inhibit UV-induced activation of nuclear factor–kappa B (NF-kappaB) and activator protein–1 (AP-1) in mouse epidermal cells. The methanol fractions of black raspberries, which contain the anthocyanin cyanidin-3-rutinoside, were found to time- and dose-dependently inhibit the UV effects on NF-kappaB and AP-1, unlike the other berries, which do not contain cyanidin-3-rutinoside.23 The pretreatment of human keratinocytes with the anthocyanin cyanidin-3-O-glucoside also has been demonstrated to protect against a wide array of UVB-induced damage,24 and acai fruit–derived cyanidin and malvidin have been shown recently to thwart UVA-induced stress in immortalized fibroblasts.25 Further, cyanidin derived from elderberries has exhibited antiproliferative and apoptotic potential on melanoma cells in a 2017 mouse model, indicating a potential role in skin cancer treatment.26
Conclusion
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Eur J Pharm Biopharm. 2016 Nov;108:41-53.
2. Clin Cosmet Investig Dermatol. 2016 Feb 26;9:55-62.
3. Int J Mol Sci. 2016 Feb 18;17(2):160-201.
4. Cancer Res. 2008 Apr 15:68(8):3057-65.
5. J Acupunct Meridian Stud. 2013 Oct;6(5):252-62.
6. Evid Based Complement Alternat Med. 2012;2012:912028.
7. Photochem Photobiol. 2008 Mar-Apr;84(2):307-16.
8. PLoS One. 2016 Jan 7;11(1):e0146296.
9. J Photochem Photobiol B. 2017 Feb;167:72-81.
10. Phytother Res. 2006 Dec;20(12):1096-9.
11. Obstet Gynecol Int. 2011;2011:949302.
12. Int J Pharm. 2008 Nov 19;364(1):36-44.
13. Biomed Pharmacother. 2016 Aug;82:379-92.
14. Australas J Dermatol. 2015 Feb;56(1):e7-14.
15. Food Chem Toxicol. 2008 Apr;46(4):1298-307.
16. J Invest Dermatol. 2008 Oct;128(10):2429-41.
17. Int Immunopharmacol. 2008 Sep;8(9):1172-82.
18. Mech Ageing Dev. 2017 Mar 24;164:1-7.
19. Skin Res Technol. 2009 Aug;15(3):338-45.
20. Int J Cosmet Sci. 2010 Apr;32(2):99-106.
21. Int J Cosmet Sci. 2015 Oct;37(5):455-64.
22. Sci Signal. 2017 Feb 21;10(467). eaaf8823.
23. Nutr Cancer. 2007;58(2):205-12.
24. J Agric Food Chem. 2006 May 31;54(11):4041-7.
25. J Photochem Photobiol B. 2017 Jul;172:42-51.
26. Int J Mol Sci. 2017 Apr 30;18(5):949.
This column picks up with a recent literature review suggesting potential benefits of topically applied or orally administered flavonoid polyphenolic substances. The discussion is based on at least one sample compound from each flavonoid category.
Flavonols: quercetin
Known to exert substantial antioxidant and anti-inflammatory activities, quercetin has been shown in various cellular and animal-based models to deliver photoprotection from UV and contribute to wound healing.1 In a single center, single-blind trial with 30 healthy volunteers, a 1% topical quercetin cream was found to be effective in reducing erythema, itching, and wheal diameter in experimentally-induced skin stress.2 Quercetin also has been reported to have the capacity to inhibit melanin production.3
Flavones: apigenin
Flavanones: naringenin
The citrus flavanone naringenin shows promise as a preventive agent against cutaneous aging as well as carcinogenesis. In a 2008 study, naringenin exerted an anti-apoptotic effect in UVB-damaged cells, significantly extending long-term cellular survival, and facilitating the removal of cyclobutane pyrimidine dimers from the genome.7 More recently, topical naringenin has been shown in mice to mitigate the cutaneous inflammation and oxidative stress caused by UVB irradiation,8 and, present in Lippia graveolens, to protect against chronic UVB-induced damage including phototumorigenesis.9
Isoflavones: red clover, genistein, and daidzein
Red clover, the isoflavones of which have been demonstrated – in high dietary concentrations – to contribute to low incidence of osteoporosis and menopausal symptoms, was shown in a 2006 study to exert anti-aging effects in mice, indicating potential for alleviating the cutaneous aging brought on by declines in estrogen.10 In 2011, Lipovac et al. showed that oral supplementation with red clover extract improved scalp hair and skin status as well as libido, mood, sleep, and fatigue in a study with 109 postmenopausal women.11
The topical application of the soy isoflavones genistein, daidzein, and glycitein has shown promise as a treatment for photoaging and photodamage.12 Genistein has been noted for its antioxidant and antibrowning activity, and has exhibited anti-aging properties in mouse studies and photoprotective activity in humans.13 A 2015 study by Zhao et al. in cultured skin fibroblasts and nude mouse skin indicated that daidzein treatment appears to increase skin collagen production and suppress collagen degradation.14
Flavan-3-ols (catechins): epigallocatechin 3-gallate
Already considered a potent antioxidant, epigallocatechin 3-gallate (EGCG) continues to receive attention for conferring an expanding range of health benefits. This catechin, which is the most abundant and potent of such compounds in green tea, has exhibited the capacity to hinder UVB-induced collagen-degrading matrix metalloproteinases (MMPs).15 EGCG also has been proposed as a preventive and therapeutic agent for keloids, given findings indicating that it hampered the proliferation and migration of keloid fibroblasts in vitro, as well as in vivo by interrupting the signal transducer and activator of transcription 3 (STAT3) signaling pathway.16 Further, EGCG has been suggested as a potential therapeutic approach to atopic dermatitis (AD) given success against AD-like skin lesions in a murine model.17 An investigation of the anti-aging cutaneous effects of EGCG on d-galactose-induced aging in mice revealed that subcutaneously injected EGCG yielded overall improvement in the structure and function of the skin.18 EGCG also is known to yield improvements in skin condition by providing DNA protection, reactivating damaged cells, and increasing cellular energy production.3
Perhaps most importantly, formulations containing green tea extracts have been shown in a small study of 20 volunteers to exert protection against photoaging and photoimmunosuppression, with the extract hindering the expression of MMP-9 and MMP-2.19 Wrinkle reduction also was observed in another clinical study involving topical green tea.20 The tea plant Camellia sinensis is one of the best sources of antioxidant catechins, particularly green tea (unfermented), but also white (unfermented), black (fermented), and oolong (semifermented) tea.21
Anthocyanins: cyanidin
A 2017 in vivo study in mice found that cyanidin hindered the binding of the cytokine interleukin-17A to the IL-17RA subunit to reduce inflammation.22 In a 2007 study, methanol extracts of black raspberries, strawberries, and blueberries were tested for the capacity to inhibit UV-induced activation of nuclear factor–kappa B (NF-kappaB) and activator protein–1 (AP-1) in mouse epidermal cells. The methanol fractions of black raspberries, which contain the anthocyanin cyanidin-3-rutinoside, were found to time- and dose-dependently inhibit the UV effects on NF-kappaB and AP-1, unlike the other berries, which do not contain cyanidin-3-rutinoside.23 The pretreatment of human keratinocytes with the anthocyanin cyanidin-3-O-glucoside also has been demonstrated to protect against a wide array of UVB-induced damage,24 and acai fruit–derived cyanidin and malvidin have been shown recently to thwart UVA-induced stress in immortalized fibroblasts.25 Further, cyanidin derived from elderberries has exhibited antiproliferative and apoptotic potential on melanoma cells in a 2017 mouse model, indicating a potential role in skin cancer treatment.26
Conclusion
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Eur J Pharm Biopharm. 2016 Nov;108:41-53.
2. Clin Cosmet Investig Dermatol. 2016 Feb 26;9:55-62.
3. Int J Mol Sci. 2016 Feb 18;17(2):160-201.
4. Cancer Res. 2008 Apr 15:68(8):3057-65.
5. J Acupunct Meridian Stud. 2013 Oct;6(5):252-62.
6. Evid Based Complement Alternat Med. 2012;2012:912028.
7. Photochem Photobiol. 2008 Mar-Apr;84(2):307-16.
8. PLoS One. 2016 Jan 7;11(1):e0146296.
9. J Photochem Photobiol B. 2017 Feb;167:72-81.
10. Phytother Res. 2006 Dec;20(12):1096-9.
11. Obstet Gynecol Int. 2011;2011:949302.
12. Int J Pharm. 2008 Nov 19;364(1):36-44.
13. Biomed Pharmacother. 2016 Aug;82:379-92.
14. Australas J Dermatol. 2015 Feb;56(1):e7-14.
15. Food Chem Toxicol. 2008 Apr;46(4):1298-307.
16. J Invest Dermatol. 2008 Oct;128(10):2429-41.
17. Int Immunopharmacol. 2008 Sep;8(9):1172-82.
18. Mech Ageing Dev. 2017 Mar 24;164:1-7.
19. Skin Res Technol. 2009 Aug;15(3):338-45.
20. Int J Cosmet Sci. 2010 Apr;32(2):99-106.
21. Int J Cosmet Sci. 2015 Oct;37(5):455-64.
22. Sci Signal. 2017 Feb 21;10(467). eaaf8823.
23. Nutr Cancer. 2007;58(2):205-12.
24. J Agric Food Chem. 2006 May 31;54(11):4041-7.
25. J Photochem Photobiol B. 2017 Jul;172:42-51.
26. Int J Mol Sci. 2017 Apr 30;18(5):949.
This column picks up with a recent literature review suggesting potential benefits of topically applied or orally administered flavonoid polyphenolic substances. The discussion is based on at least one sample compound from each flavonoid category.
Flavonols: quercetin
Known to exert substantial antioxidant and anti-inflammatory activities, quercetin has been shown in various cellular and animal-based models to deliver photoprotection from UV and contribute to wound healing.1 In a single center, single-blind trial with 30 healthy volunteers, a 1% topical quercetin cream was found to be effective in reducing erythema, itching, and wheal diameter in experimentally-induced skin stress.2 Quercetin also has been reported to have the capacity to inhibit melanin production.3
Flavones: apigenin
Flavanones: naringenin
The citrus flavanone naringenin shows promise as a preventive agent against cutaneous aging as well as carcinogenesis. In a 2008 study, naringenin exerted an anti-apoptotic effect in UVB-damaged cells, significantly extending long-term cellular survival, and facilitating the removal of cyclobutane pyrimidine dimers from the genome.7 More recently, topical naringenin has been shown in mice to mitigate the cutaneous inflammation and oxidative stress caused by UVB irradiation,8 and, present in Lippia graveolens, to protect against chronic UVB-induced damage including phototumorigenesis.9
Isoflavones: red clover, genistein, and daidzein
Red clover, the isoflavones of which have been demonstrated – in high dietary concentrations – to contribute to low incidence of osteoporosis and menopausal symptoms, was shown in a 2006 study to exert anti-aging effects in mice, indicating potential for alleviating the cutaneous aging brought on by declines in estrogen.10 In 2011, Lipovac et al. showed that oral supplementation with red clover extract improved scalp hair and skin status as well as libido, mood, sleep, and fatigue in a study with 109 postmenopausal women.11
The topical application of the soy isoflavones genistein, daidzein, and glycitein has shown promise as a treatment for photoaging and photodamage.12 Genistein has been noted for its antioxidant and antibrowning activity, and has exhibited anti-aging properties in mouse studies and photoprotective activity in humans.13 A 2015 study by Zhao et al. in cultured skin fibroblasts and nude mouse skin indicated that daidzein treatment appears to increase skin collagen production and suppress collagen degradation.14
Flavan-3-ols (catechins): epigallocatechin 3-gallate
Already considered a potent antioxidant, epigallocatechin 3-gallate (EGCG) continues to receive attention for conferring an expanding range of health benefits. This catechin, which is the most abundant and potent of such compounds in green tea, has exhibited the capacity to hinder UVB-induced collagen-degrading matrix metalloproteinases (MMPs).15 EGCG also has been proposed as a preventive and therapeutic agent for keloids, given findings indicating that it hampered the proliferation and migration of keloid fibroblasts in vitro, as well as in vivo by interrupting the signal transducer and activator of transcription 3 (STAT3) signaling pathway.16 Further, EGCG has been suggested as a potential therapeutic approach to atopic dermatitis (AD) given success against AD-like skin lesions in a murine model.17 An investigation of the anti-aging cutaneous effects of EGCG on d-galactose-induced aging in mice revealed that subcutaneously injected EGCG yielded overall improvement in the structure and function of the skin.18 EGCG also is known to yield improvements in skin condition by providing DNA protection, reactivating damaged cells, and increasing cellular energy production.3
Perhaps most importantly, formulations containing green tea extracts have been shown in a small study of 20 volunteers to exert protection against photoaging and photoimmunosuppression, with the extract hindering the expression of MMP-9 and MMP-2.19 Wrinkle reduction also was observed in another clinical study involving topical green tea.20 The tea plant Camellia sinensis is one of the best sources of antioxidant catechins, particularly green tea (unfermented), but also white (unfermented), black (fermented), and oolong (semifermented) tea.21
Anthocyanins: cyanidin
A 2017 in vivo study in mice found that cyanidin hindered the binding of the cytokine interleukin-17A to the IL-17RA subunit to reduce inflammation.22 In a 2007 study, methanol extracts of black raspberries, strawberries, and blueberries were tested for the capacity to inhibit UV-induced activation of nuclear factor–kappa B (NF-kappaB) and activator protein–1 (AP-1) in mouse epidermal cells. The methanol fractions of black raspberries, which contain the anthocyanin cyanidin-3-rutinoside, were found to time- and dose-dependently inhibit the UV effects on NF-kappaB and AP-1, unlike the other berries, which do not contain cyanidin-3-rutinoside.23 The pretreatment of human keratinocytes with the anthocyanin cyanidin-3-O-glucoside also has been demonstrated to protect against a wide array of UVB-induced damage,24 and acai fruit–derived cyanidin and malvidin have been shown recently to thwart UVA-induced stress in immortalized fibroblasts.25 Further, cyanidin derived from elderberries has exhibited antiproliferative and apoptotic potential on melanoma cells in a 2017 mouse model, indicating a potential role in skin cancer treatment.26
Conclusion
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Eur J Pharm Biopharm. 2016 Nov;108:41-53.
2. Clin Cosmet Investig Dermatol. 2016 Feb 26;9:55-62.
3. Int J Mol Sci. 2016 Feb 18;17(2):160-201.
4. Cancer Res. 2008 Apr 15:68(8):3057-65.
5. J Acupunct Meridian Stud. 2013 Oct;6(5):252-62.
6. Evid Based Complement Alternat Med. 2012;2012:912028.
7. Photochem Photobiol. 2008 Mar-Apr;84(2):307-16.
8. PLoS One. 2016 Jan 7;11(1):e0146296.
9. J Photochem Photobiol B. 2017 Feb;167:72-81.
10. Phytother Res. 2006 Dec;20(12):1096-9.
11. Obstet Gynecol Int. 2011;2011:949302.
12. Int J Pharm. 2008 Nov 19;364(1):36-44.
13. Biomed Pharmacother. 2016 Aug;82:379-92.
14. Australas J Dermatol. 2015 Feb;56(1):e7-14.
15. Food Chem Toxicol. 2008 Apr;46(4):1298-307.
16. J Invest Dermatol. 2008 Oct;128(10):2429-41.
17. Int Immunopharmacol. 2008 Sep;8(9):1172-82.
18. Mech Ageing Dev. 2017 Mar 24;164:1-7.
19. Skin Res Technol. 2009 Aug;15(3):338-45.
20. Int J Cosmet Sci. 2010 Apr;32(2):99-106.
21. Int J Cosmet Sci. 2015 Oct;37(5):455-64.
22. Sci Signal. 2017 Feb 21;10(467). eaaf8823.
23. Nutr Cancer. 2007;58(2):205-12.
24. J Agric Food Chem. 2006 May 31;54(11):4041-7.
25. J Photochem Photobiol B. 2017 Jul;172:42-51.
26. Int J Mol Sci. 2017 Apr 30;18(5):949.
Review of plant phenolics, part 1
Polyphenols are well known as the largest group of and most widely distributed phytochemicals among plants.1 These secondary plant metabolites, which are produced in response to environmental hazards that contribute to free-radical synthesis,2 are represented by more than 8,000 naturally occurring compounds. This family of widely divergent substances has gained increasing attention in recent years as polyphenols have been found – in vegetables, fruits, herbs, grains, tea, coffee beans, honey, and red wine – to be the most abundant sources of antioxidants in the human diet and are known to exert antioxidant, anti-inflammatory, and antimicrobial benefits to human health.3-7 The most prevalent and studied polyphenols are known as flavonoids, but nonflavonoid polyphenols are increasingly well investigated. This column will address the basic chemistry of these compounds. Subsequent columns will discuss the latest research on the cutaneous benefits of selected flavonoid and nonflavonoid polyphenols.
Chemistry and sources
Polyphenols share a common structural component: a phenol or an aromatic ring, usually two, with at least one hydroxyl, methyl, or acetyl group linked via a three-carbon bond to form a six-unit heterocyclic ring.8,9 When the “parent polyphenol” known as cinnamic acid is further catalytically transformed, scores of polyphenolic compounds result. These substances are divided into classes: glycosylated phenylpropanoids, flavonoids, isoflavonoids, stilbenoids, coumarins, curcuminoids, as well as phenolic polymers such as tannins, proanthocyanidins, suberin, lignins, and lignans. The flavonoids, which are the largest and most varied phenolic substances in plants, can be further divided into several categories: flavones (based on the 2-phenylchromen-4-one skeleton, such as apigenin and luteolin); flavonols (based on the 3-hydroxy-2-phenylchromen-4-one skeleton and functional group, such as quercetin, kaempferol, myricetin, and fisetin); flavanones (based on the 2,3-dihydro-2-phenylchromen-4-one skeleton and functional group, such as naringenin, hesperidin, and eriodictyol); isoflavones (based on the 3-phenylchromen-4-one skeleton, such as genistein and daidzein); flavanols – also known as flavan-3-ols or catechins – (based on the 2-phenyl-3,4-dihydro-2H-chromen-3-ol skeleton and functional groups, such as epicatechin, epicatechin 3-gallate, epigallocatechin, epigallocatechin 3-gallate (EGCG), catechin, and gallocatechin); and anthocyanins (based on the 2-phenylchromenylium ion skeleton, e.g., cyanidin and pelargonidin).5,10
The broader category of nonflavonoid polyphenols is rich and diverse, but is particularly noted for comprising the tannins, phenolic polymers of high molecular weight, which are divided into three classes, hydrolyzable tannins (such as ellagic acid, found in pomegranate, raspberries, strawberries, cranberries, and walnuts), derived tannins (created during food handling and processing and present in, for example, black and oolong teas), and condensed tannins (or proanthocyanidins, which are polymer chains of flavanols, such as catechins, and include pycnogenol, leukocyanidin, and leucoanthocyanin).1,4,5,8,10 There are a plethora of other nonflavonoid polyphenols, many of which confer health benefits, including stilbenes (such as resveratrol, found in red wine), lignans (such as enterodiol, found in flaxseed and flaxseed oil), lignins (found in green beans, carrots, peas, and Brazil nuts), and phenolic acids, such as hydroxybenzoic and hydroxycinnamic acids, among which caffeic and ferulic acids are often present in foods. In fact, hydroxycinnamic acids, which are the most common phenolic acids present in plant tissues, are present in numerous foods, such as apples, pears, plums, cherries, apricots, peaches, black currant, blueberries, potatoes, spinach, lettuce, cabbage, broccoli, asparagus, wine, and coffee.9
Broad health benefits have been associated with hundreds of polyphenolic substances. Notably, some of the best-known research results on polyphenols have reported on the success of various topical applications of green tea catechins, ferulic acid, and resveratrol, and other related compounds. Antioxidant, anti-inflammatory, and antimicrobial activities are the most common biologic properties associated with polyphenols, and antiaging activity has been widely reported.10
Conclusion
While the classification system for the 8,000 polyphenolic compounds may seem intimidating, the same essential activity is conferred by these abundant substances. Further, it is important to note the significant health benefits potentially derived from the oral consumption as well as topical application of polyphenols. The next two columns will delve into the research findings of flavonoid and nonflavonoid polyphenols.
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. J Am Diet Assoc. 1999 Feb;99(2):213-8.
2. Ann N Y Acad Sci. 2012 Jul;1259:77-86.
3. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2003 Dec;147(2):137-45.
4. J Nutr. 2000 Aug;130(8S Suppl):2073S-85S.
5. Annu Rev Nutr. 2002;22:19-34.
6. Pharmacol Ther. 2001 May-Jun;90(2-3):157-77.
7. Free Radic Biol Med. 2001 Jun 1;30(11):1213-22.
8. J Nutr. 2003 Oct;133(10):3248S-3254S.
9. Int J Mol Sci. 2016 Feb 18;17(2):160.
10. Asia Pac J Clin Nutr. 2004;13(Suppl):S72, 2004.
Polyphenols are well known as the largest group of and most widely distributed phytochemicals among plants.1 These secondary plant metabolites, which are produced in response to environmental hazards that contribute to free-radical synthesis,2 are represented by more than 8,000 naturally occurring compounds. This family of widely divergent substances has gained increasing attention in recent years as polyphenols have been found – in vegetables, fruits, herbs, grains, tea, coffee beans, honey, and red wine – to be the most abundant sources of antioxidants in the human diet and are known to exert antioxidant, anti-inflammatory, and antimicrobial benefits to human health.3-7 The most prevalent and studied polyphenols are known as flavonoids, but nonflavonoid polyphenols are increasingly well investigated. This column will address the basic chemistry of these compounds. Subsequent columns will discuss the latest research on the cutaneous benefits of selected flavonoid and nonflavonoid polyphenols.
Chemistry and sources
Polyphenols share a common structural component: a phenol or an aromatic ring, usually two, with at least one hydroxyl, methyl, or acetyl group linked via a three-carbon bond to form a six-unit heterocyclic ring.8,9 When the “parent polyphenol” known as cinnamic acid is further catalytically transformed, scores of polyphenolic compounds result. These substances are divided into classes: glycosylated phenylpropanoids, flavonoids, isoflavonoids, stilbenoids, coumarins, curcuminoids, as well as phenolic polymers such as tannins, proanthocyanidins, suberin, lignins, and lignans. The flavonoids, which are the largest and most varied phenolic substances in plants, can be further divided into several categories: flavones (based on the 2-phenylchromen-4-one skeleton, such as apigenin and luteolin); flavonols (based on the 3-hydroxy-2-phenylchromen-4-one skeleton and functional group, such as quercetin, kaempferol, myricetin, and fisetin); flavanones (based on the 2,3-dihydro-2-phenylchromen-4-one skeleton and functional group, such as naringenin, hesperidin, and eriodictyol); isoflavones (based on the 3-phenylchromen-4-one skeleton, such as genistein and daidzein); flavanols – also known as flavan-3-ols or catechins – (based on the 2-phenyl-3,4-dihydro-2H-chromen-3-ol skeleton and functional groups, such as epicatechin, epicatechin 3-gallate, epigallocatechin, epigallocatechin 3-gallate (EGCG), catechin, and gallocatechin); and anthocyanins (based on the 2-phenylchromenylium ion skeleton, e.g., cyanidin and pelargonidin).5,10
The broader category of nonflavonoid polyphenols is rich and diverse, but is particularly noted for comprising the tannins, phenolic polymers of high molecular weight, which are divided into three classes, hydrolyzable tannins (such as ellagic acid, found in pomegranate, raspberries, strawberries, cranberries, and walnuts), derived tannins (created during food handling and processing and present in, for example, black and oolong teas), and condensed tannins (or proanthocyanidins, which are polymer chains of flavanols, such as catechins, and include pycnogenol, leukocyanidin, and leucoanthocyanin).1,4,5,8,10 There are a plethora of other nonflavonoid polyphenols, many of which confer health benefits, including stilbenes (such as resveratrol, found in red wine), lignans (such as enterodiol, found in flaxseed and flaxseed oil), lignins (found in green beans, carrots, peas, and Brazil nuts), and phenolic acids, such as hydroxybenzoic and hydroxycinnamic acids, among which caffeic and ferulic acids are often present in foods. In fact, hydroxycinnamic acids, which are the most common phenolic acids present in plant tissues, are present in numerous foods, such as apples, pears, plums, cherries, apricots, peaches, black currant, blueberries, potatoes, spinach, lettuce, cabbage, broccoli, asparagus, wine, and coffee.9
Broad health benefits have been associated with hundreds of polyphenolic substances. Notably, some of the best-known research results on polyphenols have reported on the success of various topical applications of green tea catechins, ferulic acid, and resveratrol, and other related compounds. Antioxidant, anti-inflammatory, and antimicrobial activities are the most common biologic properties associated with polyphenols, and antiaging activity has been widely reported.10
Conclusion
While the classification system for the 8,000 polyphenolic compounds may seem intimidating, the same essential activity is conferred by these abundant substances. Further, it is important to note the significant health benefits potentially derived from the oral consumption as well as topical application of polyphenols. The next two columns will delve into the research findings of flavonoid and nonflavonoid polyphenols.
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. J Am Diet Assoc. 1999 Feb;99(2):213-8.
2. Ann N Y Acad Sci. 2012 Jul;1259:77-86.
3. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2003 Dec;147(2):137-45.
4. J Nutr. 2000 Aug;130(8S Suppl):2073S-85S.
5. Annu Rev Nutr. 2002;22:19-34.
6. Pharmacol Ther. 2001 May-Jun;90(2-3):157-77.
7. Free Radic Biol Med. 2001 Jun 1;30(11):1213-22.
8. J Nutr. 2003 Oct;133(10):3248S-3254S.
9. Int J Mol Sci. 2016 Feb 18;17(2):160.
10. Asia Pac J Clin Nutr. 2004;13(Suppl):S72, 2004.
Polyphenols are well known as the largest group of and most widely distributed phytochemicals among plants.1 These secondary plant metabolites, which are produced in response to environmental hazards that contribute to free-radical synthesis,2 are represented by more than 8,000 naturally occurring compounds. This family of widely divergent substances has gained increasing attention in recent years as polyphenols have been found – in vegetables, fruits, herbs, grains, tea, coffee beans, honey, and red wine – to be the most abundant sources of antioxidants in the human diet and are known to exert antioxidant, anti-inflammatory, and antimicrobial benefits to human health.3-7 The most prevalent and studied polyphenols are known as flavonoids, but nonflavonoid polyphenols are increasingly well investigated. This column will address the basic chemistry of these compounds. Subsequent columns will discuss the latest research on the cutaneous benefits of selected flavonoid and nonflavonoid polyphenols.
Chemistry and sources
Polyphenols share a common structural component: a phenol or an aromatic ring, usually two, with at least one hydroxyl, methyl, or acetyl group linked via a three-carbon bond to form a six-unit heterocyclic ring.8,9 When the “parent polyphenol” known as cinnamic acid is further catalytically transformed, scores of polyphenolic compounds result. These substances are divided into classes: glycosylated phenylpropanoids, flavonoids, isoflavonoids, stilbenoids, coumarins, curcuminoids, as well as phenolic polymers such as tannins, proanthocyanidins, suberin, lignins, and lignans. The flavonoids, which are the largest and most varied phenolic substances in plants, can be further divided into several categories: flavones (based on the 2-phenylchromen-4-one skeleton, such as apigenin and luteolin); flavonols (based on the 3-hydroxy-2-phenylchromen-4-one skeleton and functional group, such as quercetin, kaempferol, myricetin, and fisetin); flavanones (based on the 2,3-dihydro-2-phenylchromen-4-one skeleton and functional group, such as naringenin, hesperidin, and eriodictyol); isoflavones (based on the 3-phenylchromen-4-one skeleton, such as genistein and daidzein); flavanols – also known as flavan-3-ols or catechins – (based on the 2-phenyl-3,4-dihydro-2H-chromen-3-ol skeleton and functional groups, such as epicatechin, epicatechin 3-gallate, epigallocatechin, epigallocatechin 3-gallate (EGCG), catechin, and gallocatechin); and anthocyanins (based on the 2-phenylchromenylium ion skeleton, e.g., cyanidin and pelargonidin).5,10
The broader category of nonflavonoid polyphenols is rich and diverse, but is particularly noted for comprising the tannins, phenolic polymers of high molecular weight, which are divided into three classes, hydrolyzable tannins (such as ellagic acid, found in pomegranate, raspberries, strawberries, cranberries, and walnuts), derived tannins (created during food handling and processing and present in, for example, black and oolong teas), and condensed tannins (or proanthocyanidins, which are polymer chains of flavanols, such as catechins, and include pycnogenol, leukocyanidin, and leucoanthocyanin).1,4,5,8,10 There are a plethora of other nonflavonoid polyphenols, many of which confer health benefits, including stilbenes (such as resveratrol, found in red wine), lignans (such as enterodiol, found in flaxseed and flaxseed oil), lignins (found in green beans, carrots, peas, and Brazil nuts), and phenolic acids, such as hydroxybenzoic and hydroxycinnamic acids, among which caffeic and ferulic acids are often present in foods. In fact, hydroxycinnamic acids, which are the most common phenolic acids present in plant tissues, are present in numerous foods, such as apples, pears, plums, cherries, apricots, peaches, black currant, blueberries, potatoes, spinach, lettuce, cabbage, broccoli, asparagus, wine, and coffee.9
Broad health benefits have been associated with hundreds of polyphenolic substances. Notably, some of the best-known research results on polyphenols have reported on the success of various topical applications of green tea catechins, ferulic acid, and resveratrol, and other related compounds. Antioxidant, anti-inflammatory, and antimicrobial activities are the most common biologic properties associated with polyphenols, and antiaging activity has been widely reported.10
Conclusion
While the classification system for the 8,000 polyphenolic compounds may seem intimidating, the same essential activity is conferred by these abundant substances. Further, it is important to note the significant health benefits potentially derived from the oral consumption as well as topical application of polyphenols. The next two columns will delve into the research findings of flavonoid and nonflavonoid polyphenols.
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. J Am Diet Assoc. 1999 Feb;99(2):213-8.
2. Ann N Y Acad Sci. 2012 Jul;1259:77-86.
3. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2003 Dec;147(2):137-45.
4. J Nutr. 2000 Aug;130(8S Suppl):2073S-85S.
5. Annu Rev Nutr. 2002;22:19-34.
6. Pharmacol Ther. 2001 May-Jun;90(2-3):157-77.
7. Free Radic Biol Med. 2001 Jun 1;30(11):1213-22.
8. J Nutr. 2003 Oct;133(10):3248S-3254S.
9. Int J Mol Sci. 2016 Feb 18;17(2):160.
10. Asia Pac J Clin Nutr. 2004;13(Suppl):S72, 2004.
Skin care Q and A for your staff
in helping us be more efficient with our time. I asked my staff to put together a list of the most common patient skin care questions. This column can be used as a guide for your staff when answering questions about skin care.
Q: Should my sunscreen be applied first or last?
A: The best way to remember is that medications should be applied closest to the skin and sunscreen should be applied closest to the sun. I recommend that morning skin care be applied in the following order:
Step 1. Facial cleanser
Step 2. Eye products (protect the delicate eye area from the medication)
Step 3. Treatment product (medications, or the most important active ingredients)
Step 4. Moisturizer (if needed)
Step 5. Sunscreen
Q: When can I restart my normal skin care regimen after receiving dermal fillers?
A: The morning after receiving dermal fillers, you can resume your normal facial skin care regimen.
Q: How do I treat my skin after receiving cosmetic injections such as Botox?
A: After you are injected with dermal fillers, keep the Arnica gel, Arnica pads, or post procedure product on your face until bedtime. Prior to bed, wash your face with a gentle cleanser and lukewarm water. Do not use any scrubs, facial brushes, or hydroxy acids. Apply a soothing gel or soothing moisturizer. Do not use hot water on the face for 48 hours. Avoid hot showers, saunas, facial steaming, facial massage, and exercise for 48 hours. If you must exercise, try to keep the face cool with an ice filled bottle of water. Heat makes you more likely to bruise.
Q: Will retinol make my skin sun sensitive?
A: Retinol breaks down upon sun exposure so it should only be used at night. It is a myth that retinol makes your skin sun sensitive. Retinol is a form of vitamin A that helps protect your skin from sun damage by reducing levels of an enzyme called collagenase that is produced after sun exposure. For this and other reasons, retinol can help protect your skin from sun damage. However, if your skin gets irritated from the retinol and you go into the sun, you can develop postinflammatory hyperpigmentation – or dark patches on the skin. It is a good idea to always wear sunscreen in the morning every day whether you are using retinol or not.
Q: What do I do to treat the dark circles under my eyes?
A: Dark circles can be caused by sluggish blood flow around the eyes leading to deposition of a pigment found in blood called hemosiderin. Dark circles around the eyes also can be caused by an increased amount of the pigment melanin that occurs from sun exposure, heat, estrogen, and stress. Treatments include lifestyle habits that increase blood circulation, such as smoking cessation and exercise. Supplements such as horse chestnut may help improve circulation. Ingredients such as the tyrosinase inhibitors ascorbic acid, kojic acid, arbutin, and hydroquinone will help decrease melanin production, and may improve dark circles caused by increased melanin. Wearing a daily sunscreen around the eyes is a very important part of improving the appearance of dark circles under the eyes.
Q: Do I need an eye cream?
A: Most people need an eye product whether it is a serum, gel, or cream. Eye treatment products are usually one of the first skin care products that male patients purchase. The most common indications for eye treatment products are dark circles under the eyes, puffy eyes, dryness, fine lines, or redness. Each one of these indications requires very different ingredients; therefore, most people need more than one eye product depending on what eye issues they are experiencing. Eye treatment products can protect the delicate eye area from medications such as tretinoin that gets on the pillowcase and is transferred to the eye area at night. Eye products that have humectants, such as heparan sulfate or hyaluronic acid, should be used to treat fines lines and dryness, but these may make eyes puffy. For those with dry and puffy eyes, a second eye product with vasoconstrictive ingredients should be used in the daytime while the hydrating one is used at night. Antiaging eye products with retinol and hydroxy acids may irritate sensitive skin types so they can be paired with a soothing eye product. Consider using different eye products for the morning and evening depending on what eye issues need to be treated.
Q: Will moisturizer make my acne worse?
A: Noncomedogenic moisturizers can help improve acne and speed recovery. Using the proper cleanser and moisturizer will make acne medications more tolerable. Many patients cannot tolerate their acne medications every day. The bacteria that cause acne reproduce every 12 hours. For this reason, acne medications must be used consistently twice a day. Using the proper cleanser and moisturizer makes this possible in most patients. Avoid moisturizers with coconut oil, isopropyl myristate, and other ingredients known to cause acne.
Q: Why does my face get so red after washing it?
A: Rosacea-prone skin types get red from the friction of washing the face – even if just using water. If this occurs, use skin care products with anti-inflammatory ingredients such as argan oil, green tea, fever few, chamomile, caffeine, resveratrol, and niacinamide to sooth the skin. These can be paired with prescription rosacea medications such as Rhofade (oxymetazoline hydrochloride) to reduce facial redness. People with rosacea-prone skin types should avoid facial brushes, scrubs, and vigorous exfoliation.
Q: Why is my melasma not getting better on skin lighteners?
Educating our staff on the basics of skin care can make our office much more efficient. If you liked the format of this column or have questions that you hear often from patients, please email me at [email protected].
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, Aclaris, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
in helping us be more efficient with our time. I asked my staff to put together a list of the most common patient skin care questions. This column can be used as a guide for your staff when answering questions about skin care.
Q: Should my sunscreen be applied first or last?
A: The best way to remember is that medications should be applied closest to the skin and sunscreen should be applied closest to the sun. I recommend that morning skin care be applied in the following order:
Step 1. Facial cleanser
Step 2. Eye products (protect the delicate eye area from the medication)
Step 3. Treatment product (medications, or the most important active ingredients)
Step 4. Moisturizer (if needed)
Step 5. Sunscreen
Q: When can I restart my normal skin care regimen after receiving dermal fillers?
A: The morning after receiving dermal fillers, you can resume your normal facial skin care regimen.
Q: How do I treat my skin after receiving cosmetic injections such as Botox?
A: After you are injected with dermal fillers, keep the Arnica gel, Arnica pads, or post procedure product on your face until bedtime. Prior to bed, wash your face with a gentle cleanser and lukewarm water. Do not use any scrubs, facial brushes, or hydroxy acids. Apply a soothing gel or soothing moisturizer. Do not use hot water on the face for 48 hours. Avoid hot showers, saunas, facial steaming, facial massage, and exercise for 48 hours. If you must exercise, try to keep the face cool with an ice filled bottle of water. Heat makes you more likely to bruise.
Q: Will retinol make my skin sun sensitive?
A: Retinol breaks down upon sun exposure so it should only be used at night. It is a myth that retinol makes your skin sun sensitive. Retinol is a form of vitamin A that helps protect your skin from sun damage by reducing levels of an enzyme called collagenase that is produced after sun exposure. For this and other reasons, retinol can help protect your skin from sun damage. However, if your skin gets irritated from the retinol and you go into the sun, you can develop postinflammatory hyperpigmentation – or dark patches on the skin. It is a good idea to always wear sunscreen in the morning every day whether you are using retinol or not.
Q: What do I do to treat the dark circles under my eyes?
A: Dark circles can be caused by sluggish blood flow around the eyes leading to deposition of a pigment found in blood called hemosiderin. Dark circles around the eyes also can be caused by an increased amount of the pigment melanin that occurs from sun exposure, heat, estrogen, and stress. Treatments include lifestyle habits that increase blood circulation, such as smoking cessation and exercise. Supplements such as horse chestnut may help improve circulation. Ingredients such as the tyrosinase inhibitors ascorbic acid, kojic acid, arbutin, and hydroquinone will help decrease melanin production, and may improve dark circles caused by increased melanin. Wearing a daily sunscreen around the eyes is a very important part of improving the appearance of dark circles under the eyes.
Q: Do I need an eye cream?
A: Most people need an eye product whether it is a serum, gel, or cream. Eye treatment products are usually one of the first skin care products that male patients purchase. The most common indications for eye treatment products are dark circles under the eyes, puffy eyes, dryness, fine lines, or redness. Each one of these indications requires very different ingredients; therefore, most people need more than one eye product depending on what eye issues they are experiencing. Eye treatment products can protect the delicate eye area from medications such as tretinoin that gets on the pillowcase and is transferred to the eye area at night. Eye products that have humectants, such as heparan sulfate or hyaluronic acid, should be used to treat fines lines and dryness, but these may make eyes puffy. For those with dry and puffy eyes, a second eye product with vasoconstrictive ingredients should be used in the daytime while the hydrating one is used at night. Antiaging eye products with retinol and hydroxy acids may irritate sensitive skin types so they can be paired with a soothing eye product. Consider using different eye products for the morning and evening depending on what eye issues need to be treated.
Q: Will moisturizer make my acne worse?
A: Noncomedogenic moisturizers can help improve acne and speed recovery. Using the proper cleanser and moisturizer will make acne medications more tolerable. Many patients cannot tolerate their acne medications every day. The bacteria that cause acne reproduce every 12 hours. For this reason, acne medications must be used consistently twice a day. Using the proper cleanser and moisturizer makes this possible in most patients. Avoid moisturizers with coconut oil, isopropyl myristate, and other ingredients known to cause acne.
Q: Why does my face get so red after washing it?
A: Rosacea-prone skin types get red from the friction of washing the face – even if just using water. If this occurs, use skin care products with anti-inflammatory ingredients such as argan oil, green tea, fever few, chamomile, caffeine, resveratrol, and niacinamide to sooth the skin. These can be paired with prescription rosacea medications such as Rhofade (oxymetazoline hydrochloride) to reduce facial redness. People with rosacea-prone skin types should avoid facial brushes, scrubs, and vigorous exfoliation.
Q: Why is my melasma not getting better on skin lighteners?
Educating our staff on the basics of skin care can make our office much more efficient. If you liked the format of this column or have questions that you hear often from patients, please email me at [email protected].
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, Aclaris, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
in helping us be more efficient with our time. I asked my staff to put together a list of the most common patient skin care questions. This column can be used as a guide for your staff when answering questions about skin care.
Q: Should my sunscreen be applied first or last?
A: The best way to remember is that medications should be applied closest to the skin and sunscreen should be applied closest to the sun. I recommend that morning skin care be applied in the following order:
Step 1. Facial cleanser
Step 2. Eye products (protect the delicate eye area from the medication)
Step 3. Treatment product (medications, or the most important active ingredients)
Step 4. Moisturizer (if needed)
Step 5. Sunscreen
Q: When can I restart my normal skin care regimen after receiving dermal fillers?
A: The morning after receiving dermal fillers, you can resume your normal facial skin care regimen.
Q: How do I treat my skin after receiving cosmetic injections such as Botox?
A: After you are injected with dermal fillers, keep the Arnica gel, Arnica pads, or post procedure product on your face until bedtime. Prior to bed, wash your face with a gentle cleanser and lukewarm water. Do not use any scrubs, facial brushes, or hydroxy acids. Apply a soothing gel or soothing moisturizer. Do not use hot water on the face for 48 hours. Avoid hot showers, saunas, facial steaming, facial massage, and exercise for 48 hours. If you must exercise, try to keep the face cool with an ice filled bottle of water. Heat makes you more likely to bruise.
Q: Will retinol make my skin sun sensitive?
A: Retinol breaks down upon sun exposure so it should only be used at night. It is a myth that retinol makes your skin sun sensitive. Retinol is a form of vitamin A that helps protect your skin from sun damage by reducing levels of an enzyme called collagenase that is produced after sun exposure. For this and other reasons, retinol can help protect your skin from sun damage. However, if your skin gets irritated from the retinol and you go into the sun, you can develop postinflammatory hyperpigmentation – or dark patches on the skin. It is a good idea to always wear sunscreen in the morning every day whether you are using retinol or not.
Q: What do I do to treat the dark circles under my eyes?
A: Dark circles can be caused by sluggish blood flow around the eyes leading to deposition of a pigment found in blood called hemosiderin. Dark circles around the eyes also can be caused by an increased amount of the pigment melanin that occurs from sun exposure, heat, estrogen, and stress. Treatments include lifestyle habits that increase blood circulation, such as smoking cessation and exercise. Supplements such as horse chestnut may help improve circulation. Ingredients such as the tyrosinase inhibitors ascorbic acid, kojic acid, arbutin, and hydroquinone will help decrease melanin production, and may improve dark circles caused by increased melanin. Wearing a daily sunscreen around the eyes is a very important part of improving the appearance of dark circles under the eyes.
Q: Do I need an eye cream?
A: Most people need an eye product whether it is a serum, gel, or cream. Eye treatment products are usually one of the first skin care products that male patients purchase. The most common indications for eye treatment products are dark circles under the eyes, puffy eyes, dryness, fine lines, or redness. Each one of these indications requires very different ingredients; therefore, most people need more than one eye product depending on what eye issues they are experiencing. Eye treatment products can protect the delicate eye area from medications such as tretinoin that gets on the pillowcase and is transferred to the eye area at night. Eye products that have humectants, such as heparan sulfate or hyaluronic acid, should be used to treat fines lines and dryness, but these may make eyes puffy. For those with dry and puffy eyes, a second eye product with vasoconstrictive ingredients should be used in the daytime while the hydrating one is used at night. Antiaging eye products with retinol and hydroxy acids may irritate sensitive skin types so they can be paired with a soothing eye product. Consider using different eye products for the morning and evening depending on what eye issues need to be treated.
Q: Will moisturizer make my acne worse?
A: Noncomedogenic moisturizers can help improve acne and speed recovery. Using the proper cleanser and moisturizer will make acne medications more tolerable. Many patients cannot tolerate their acne medications every day. The bacteria that cause acne reproduce every 12 hours. For this reason, acne medications must be used consistently twice a day. Using the proper cleanser and moisturizer makes this possible in most patients. Avoid moisturizers with coconut oil, isopropyl myristate, and other ingredients known to cause acne.
Q: Why does my face get so red after washing it?
A: Rosacea-prone skin types get red from the friction of washing the face – even if just using water. If this occurs, use skin care products with anti-inflammatory ingredients such as argan oil, green tea, fever few, chamomile, caffeine, resveratrol, and niacinamide to sooth the skin. These can be paired with prescription rosacea medications such as Rhofade (oxymetazoline hydrochloride) to reduce facial redness. People with rosacea-prone skin types should avoid facial brushes, scrubs, and vigorous exfoliation.
Q: Why is my melasma not getting better on skin lighteners?
Educating our staff on the basics of skin care can make our office much more efficient. If you liked the format of this column or have questions that you hear often from patients, please email me at [email protected].
Dr. Baumann is a private practice dermatologist, researcher, author and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, Aclaris, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
Pre- and postprocedure skin care guide for your surgical patients
Whether patients are having a biopsy, surgical excision, or Mohs surgery, the outcome will be improved when the proper skin care is used before and after the procedure. This is a guide that you can use to educate your patients about pre- and postprocedure skin care needs.
Presurgery skin care and supplements
The goal is to speed healing and minimize infection, scarring, and hyperpigmentation. For 2 weeks prior to surgery, recommend products that have been shown to speed wound healing by increasing keratinization and/or collagen production. Ingredients that should be used prior to wounding include retinoids such as tretinoin and retinol. Several studies have convincingly shown that pretreatment with tretinoin speeds wound healing.1,2,3 Kligman and associates evaluated healing after punch biopsy and found the wounds on arms pretreated with tretinoin cream 0.05% to 0.1% were significantly smaller – by 35% to 37% – on days 1 and 4, and were 47% to 50% smaller on days 6, 8, and 11, compared with the untreated arms.4 Most studies suggest a 2- to 4-week tretinoin pretreatment regimen5 because peak epidermal hypertrophy occurs after 7 days of tretinoin application and normalizes after 14 days of continued treatment.6 This approach allows the skin to recover from any retinoid dermatitis prior to surgery. Adapalene should be started 5-6 weeks prior to procedures because it has a longer half-life and requires an earlier initiation period.7
Although wound healing studies have not been conducted in this area, pretreating skin with topical ascorbic acid8 and hydroxyacids9 might help speed wound healing by increasing collagen synthesis.
Ingredients and activities to avoid presurgery
Patients should avoid using ingredients that could promote skin tumor growth. Although there are no studies evaluating the effects of growth factors on promoting the growth of skin cancer, caution is prudent. To reduce bruising, patients should avoid aspirin, ibuprofen, naproxen, St. John’s Wort, vitamin E, omega-3 fatty acids supplements, flax seed oil, ginseng, salmon, and alcohol. Most physicians agree that these should be avoided for 10 days prior to the procedure. Smoking should be avoided 4 weeks prior to the procedure.
Postsurgery skin care and supplements
Oral vitamin C and zinc supplements have been shown to speed wound healing in rats when taken immediately after a procedure.10 Oral Arnica tablets and tinctures are often used prior to and after surgery to reduce bruising and inflammation. There is much anecdotal support for the use of Arnica, but clinical trial evidence substantiating its efficacy to prevent bruising and reduce swelling is scant.
A protein important in wound repair, defensin, is available in a topical formulation. Defensin14 has been shown to activate the leucine-rich repeat-containing G-protein–coupled receptors 5 and 6 (also known as LGR5 and LGR6) stem cells. It speeds wound healing by increasing LGR stem cell migration into wound beds. Wounds should be covered to provide protection from sun exposure until reepithelialization occurs. Which occlusive ointments and wound repair products to use are beyond the scope of this article. Once epithelized, zinc oxide sunscreens can be used. These have been shown to be safe with minimal penetration into the skin.15
Ingredients to avoid post surgery
Topical retinoids should not be used post skin cancer surgery until epithelialization is complete. A study by Hung et al.16 in a porcine model used 0.05% tretinoin cream daily for 10 days prior to partial-thickness skin wounding demonstrated that use of tretinoin 10 days prior to wounding sped reepithelialization while use after the procedure slowed wound healing.
Acidic products will sting wounded skin. For this reason, benzoic acid, hydroxy acids, and ascorbic acid should be avoided until the skin has completely reepithelialized. Products with preservatives and fragrance should be avoided if possible.
Vitamin E derived from oral supplement capsules slowed healing after skin cancer surgery and had a high rate of contact dermatitis.17 Chemical sunscreens are more likely to cause an allergic contact dermatitis and should be avoided for 4 weeks after skin surgery. Organic products with essential oils and botanical ingredients may present a higher risk of contact dermatitis due to allergen exposure.
Conclusion
To ensure the best outcome from surgical treatments, patient education is a must! The more that patients know and understand about the ways in which they can prepare for their procedure and treat their skin after the procedure, the better the outcomes will be. Providers should give this type of information in an easy-to-follow printed instruction sheet because studies show that patients cannot remember most of the oral instructions offered by practitioners.
Encourage your patients to ask questions during their consultation and procedure and to get in touch with your office should they have any concerns when they leave. These steps help improve patient compliance and satisfaction, which will help you maintain a trusting relationship with established patients and attract new ones through word-of-mouth referrals.
Please email me at [email protected] if you have any other pre- and postprocedure skin care advice.
Dr. Leslie S. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Aesthetic Plast Surg. 1995 May-Jun;19(3):243-6.
2. Plast Reconstr Surg. 2011 Mar;127(3):1343-5.
3. J Am Acad Dermatol. 1998 Aug;39(2 Pt 3):S79-81.
4. Br J Dermatol. 1995 Jan;132(1):46-53.
5. J Am Acad Dermatol. 2004 Dec;51(6):940-6.
6. J Korean Med Sci. 1996 Aug;11(4):335-41.
7. Eur J Dermatol. 2002 Mar-Apr;12(2):145-8.
8. Proc Natl Acad Sci U S A. 1981 May;78(5):2879-82.
9. Exp Dermatol. 2003;12 Suppl 2:57-63.
10. Surg Today. 2004;34(9):747-51.
11. Ophthal Plast Reconstr Surg. 2017 Jan/Feb;33(1):47-52.
12. Wound Repair Regen. 1998 Mar-Apr;6(2):167-77.
13. Dermatol Surg. 1998 Jun;24(6):661-4.
14. Plast Reconstr Surg. 2013 Nov;132(5):1159-71.
15. ACS Nano. 2016 Feb 23;10(2):1810-9.
16. Arch Dermatol. 1989 Jan;125(1):65-9.
17. Dermatol Surg. 1999 Apr;25(4):311-5.
Retinoids should be used 2-3 times prior to procedures to speed healing.
Retinoids should not be used after the procedure until reepithelization has occurred.
Vitamin C and zinc supplements taken post procedure might speed wound healing.
Retinoids should be used 2-3 times prior to procedures to speed healing.
Retinoids should not be used after the procedure until reepithelization has occurred.
Vitamin C and zinc supplements taken post procedure might speed wound healing.
Retinoids should be used 2-3 times prior to procedures to speed healing.
Retinoids should not be used after the procedure until reepithelization has occurred.
Vitamin C and zinc supplements taken post procedure might speed wound healing.
Whether patients are having a biopsy, surgical excision, or Mohs surgery, the outcome will be improved when the proper skin care is used before and after the procedure. This is a guide that you can use to educate your patients about pre- and postprocedure skin care needs.
Presurgery skin care and supplements
The goal is to speed healing and minimize infection, scarring, and hyperpigmentation. For 2 weeks prior to surgery, recommend products that have been shown to speed wound healing by increasing keratinization and/or collagen production. Ingredients that should be used prior to wounding include retinoids such as tretinoin and retinol. Several studies have convincingly shown that pretreatment with tretinoin speeds wound healing.1,2,3 Kligman and associates evaluated healing after punch biopsy and found the wounds on arms pretreated with tretinoin cream 0.05% to 0.1% were significantly smaller – by 35% to 37% – on days 1 and 4, and were 47% to 50% smaller on days 6, 8, and 11, compared with the untreated arms.4 Most studies suggest a 2- to 4-week tretinoin pretreatment regimen5 because peak epidermal hypertrophy occurs after 7 days of tretinoin application and normalizes after 14 days of continued treatment.6 This approach allows the skin to recover from any retinoid dermatitis prior to surgery. Adapalene should be started 5-6 weeks prior to procedures because it has a longer half-life and requires an earlier initiation period.7
Although wound healing studies have not been conducted in this area, pretreating skin with topical ascorbic acid8 and hydroxyacids9 might help speed wound healing by increasing collagen synthesis.
Ingredients and activities to avoid presurgery
Patients should avoid using ingredients that could promote skin tumor growth. Although there are no studies evaluating the effects of growth factors on promoting the growth of skin cancer, caution is prudent. To reduce bruising, patients should avoid aspirin, ibuprofen, naproxen, St. John’s Wort, vitamin E, omega-3 fatty acids supplements, flax seed oil, ginseng, salmon, and alcohol. Most physicians agree that these should be avoided for 10 days prior to the procedure. Smoking should be avoided 4 weeks prior to the procedure.
Postsurgery skin care and supplements
Oral vitamin C and zinc supplements have been shown to speed wound healing in rats when taken immediately after a procedure.10 Oral Arnica tablets and tinctures are often used prior to and after surgery to reduce bruising and inflammation. There is much anecdotal support for the use of Arnica, but clinical trial evidence substantiating its efficacy to prevent bruising and reduce swelling is scant.
A protein important in wound repair, defensin, is available in a topical formulation. Defensin14 has been shown to activate the leucine-rich repeat-containing G-protein–coupled receptors 5 and 6 (also known as LGR5 and LGR6) stem cells. It speeds wound healing by increasing LGR stem cell migration into wound beds. Wounds should be covered to provide protection from sun exposure until reepithelialization occurs. Which occlusive ointments and wound repair products to use are beyond the scope of this article. Once epithelized, zinc oxide sunscreens can be used. These have been shown to be safe with minimal penetration into the skin.15
Ingredients to avoid post surgery
Topical retinoids should not be used post skin cancer surgery until epithelialization is complete. A study by Hung et al.16 in a porcine model used 0.05% tretinoin cream daily for 10 days prior to partial-thickness skin wounding demonstrated that use of tretinoin 10 days prior to wounding sped reepithelialization while use after the procedure slowed wound healing.
Acidic products will sting wounded skin. For this reason, benzoic acid, hydroxy acids, and ascorbic acid should be avoided until the skin has completely reepithelialized. Products with preservatives and fragrance should be avoided if possible.
Vitamin E derived from oral supplement capsules slowed healing after skin cancer surgery and had a high rate of contact dermatitis.17 Chemical sunscreens are more likely to cause an allergic contact dermatitis and should be avoided for 4 weeks after skin surgery. Organic products with essential oils and botanical ingredients may present a higher risk of contact dermatitis due to allergen exposure.
Conclusion
To ensure the best outcome from surgical treatments, patient education is a must! The more that patients know and understand about the ways in which they can prepare for their procedure and treat their skin after the procedure, the better the outcomes will be. Providers should give this type of information in an easy-to-follow printed instruction sheet because studies show that patients cannot remember most of the oral instructions offered by practitioners.
Encourage your patients to ask questions during their consultation and procedure and to get in touch with your office should they have any concerns when they leave. These steps help improve patient compliance and satisfaction, which will help you maintain a trusting relationship with established patients and attract new ones through word-of-mouth referrals.
Please email me at [email protected] if you have any other pre- and postprocedure skin care advice.
Dr. Leslie S. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Aesthetic Plast Surg. 1995 May-Jun;19(3):243-6.
2. Plast Reconstr Surg. 2011 Mar;127(3):1343-5.
3. J Am Acad Dermatol. 1998 Aug;39(2 Pt 3):S79-81.
4. Br J Dermatol. 1995 Jan;132(1):46-53.
5. J Am Acad Dermatol. 2004 Dec;51(6):940-6.
6. J Korean Med Sci. 1996 Aug;11(4):335-41.
7. Eur J Dermatol. 2002 Mar-Apr;12(2):145-8.
8. Proc Natl Acad Sci U S A. 1981 May;78(5):2879-82.
9. Exp Dermatol. 2003;12 Suppl 2:57-63.
10. Surg Today. 2004;34(9):747-51.
11. Ophthal Plast Reconstr Surg. 2017 Jan/Feb;33(1):47-52.
12. Wound Repair Regen. 1998 Mar-Apr;6(2):167-77.
13. Dermatol Surg. 1998 Jun;24(6):661-4.
14. Plast Reconstr Surg. 2013 Nov;132(5):1159-71.
15. ACS Nano. 2016 Feb 23;10(2):1810-9.
16. Arch Dermatol. 1989 Jan;125(1):65-9.
17. Dermatol Surg. 1999 Apr;25(4):311-5.
Whether patients are having a biopsy, surgical excision, or Mohs surgery, the outcome will be improved when the proper skin care is used before and after the procedure. This is a guide that you can use to educate your patients about pre- and postprocedure skin care needs.
Presurgery skin care and supplements
The goal is to speed healing and minimize infection, scarring, and hyperpigmentation. For 2 weeks prior to surgery, recommend products that have been shown to speed wound healing by increasing keratinization and/or collagen production. Ingredients that should be used prior to wounding include retinoids such as tretinoin and retinol. Several studies have convincingly shown that pretreatment with tretinoin speeds wound healing.1,2,3 Kligman and associates evaluated healing after punch biopsy and found the wounds on arms pretreated with tretinoin cream 0.05% to 0.1% were significantly smaller – by 35% to 37% – on days 1 and 4, and were 47% to 50% smaller on days 6, 8, and 11, compared with the untreated arms.4 Most studies suggest a 2- to 4-week tretinoin pretreatment regimen5 because peak epidermal hypertrophy occurs after 7 days of tretinoin application and normalizes after 14 days of continued treatment.6 This approach allows the skin to recover from any retinoid dermatitis prior to surgery. Adapalene should be started 5-6 weeks prior to procedures because it has a longer half-life and requires an earlier initiation period.7
Although wound healing studies have not been conducted in this area, pretreating skin with topical ascorbic acid8 and hydroxyacids9 might help speed wound healing by increasing collagen synthesis.
Ingredients and activities to avoid presurgery
Patients should avoid using ingredients that could promote skin tumor growth. Although there are no studies evaluating the effects of growth factors on promoting the growth of skin cancer, caution is prudent. To reduce bruising, patients should avoid aspirin, ibuprofen, naproxen, St. John’s Wort, vitamin E, omega-3 fatty acids supplements, flax seed oil, ginseng, salmon, and alcohol. Most physicians agree that these should be avoided for 10 days prior to the procedure. Smoking should be avoided 4 weeks prior to the procedure.
Postsurgery skin care and supplements
Oral vitamin C and zinc supplements have been shown to speed wound healing in rats when taken immediately after a procedure.10 Oral Arnica tablets and tinctures are often used prior to and after surgery to reduce bruising and inflammation. There is much anecdotal support for the use of Arnica, but clinical trial evidence substantiating its efficacy to prevent bruising and reduce swelling is scant.
A protein important in wound repair, defensin, is available in a topical formulation. Defensin14 has been shown to activate the leucine-rich repeat-containing G-protein–coupled receptors 5 and 6 (also known as LGR5 and LGR6) stem cells. It speeds wound healing by increasing LGR stem cell migration into wound beds. Wounds should be covered to provide protection from sun exposure until reepithelialization occurs. Which occlusive ointments and wound repair products to use are beyond the scope of this article. Once epithelized, zinc oxide sunscreens can be used. These have been shown to be safe with minimal penetration into the skin.15
Ingredients to avoid post surgery
Topical retinoids should not be used post skin cancer surgery until epithelialization is complete. A study by Hung et al.16 in a porcine model used 0.05% tretinoin cream daily for 10 days prior to partial-thickness skin wounding demonstrated that use of tretinoin 10 days prior to wounding sped reepithelialization while use after the procedure slowed wound healing.
Acidic products will sting wounded skin. For this reason, benzoic acid, hydroxy acids, and ascorbic acid should be avoided until the skin has completely reepithelialized. Products with preservatives and fragrance should be avoided if possible.
Vitamin E derived from oral supplement capsules slowed healing after skin cancer surgery and had a high rate of contact dermatitis.17 Chemical sunscreens are more likely to cause an allergic contact dermatitis and should be avoided for 4 weeks after skin surgery. Organic products with essential oils and botanical ingredients may present a higher risk of contact dermatitis due to allergen exposure.
Conclusion
To ensure the best outcome from surgical treatments, patient education is a must! The more that patients know and understand about the ways in which they can prepare for their procedure and treat their skin after the procedure, the better the outcomes will be. Providers should give this type of information in an easy-to-follow printed instruction sheet because studies show that patients cannot remember most of the oral instructions offered by practitioners.
Encourage your patients to ask questions during their consultation and procedure and to get in touch with your office should they have any concerns when they leave. These steps help improve patient compliance and satisfaction, which will help you maintain a trusting relationship with established patients and attract new ones through word-of-mouth referrals.
Please email me at [email protected] if you have any other pre- and postprocedure skin care advice.
Dr. Leslie S. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. Aesthetic Plast Surg. 1995 May-Jun;19(3):243-6.
2. Plast Reconstr Surg. 2011 Mar;127(3):1343-5.
3. J Am Acad Dermatol. 1998 Aug;39(2 Pt 3):S79-81.
4. Br J Dermatol. 1995 Jan;132(1):46-53.
5. J Am Acad Dermatol. 2004 Dec;51(6):940-6.
6. J Korean Med Sci. 1996 Aug;11(4):335-41.
7. Eur J Dermatol. 2002 Mar-Apr;12(2):145-8.
8. Proc Natl Acad Sci U S A. 1981 May;78(5):2879-82.
9. Exp Dermatol. 2003;12 Suppl 2:57-63.
10. Surg Today. 2004;34(9):747-51.
11. Ophthal Plast Reconstr Surg. 2017 Jan/Feb;33(1):47-52.
12. Wound Repair Regen. 1998 Mar-Apr;6(2):167-77.
13. Dermatol Surg. 1998 Jun;24(6):661-4.
14. Plast Reconstr Surg. 2013 Nov;132(5):1159-71.
15. ACS Nano. 2016 Feb 23;10(2):1810-9.
16. Arch Dermatol. 1989 Jan;125(1):65-9.
17. Dermatol Surg. 1999 Apr;25(4):311-5.
Improving compliance with cosmeceutical-prescription combinations
As clinicians who have been in practice for even a relatively short period of time know, patient compliance is an integral aspect of achieving optimal patient outcomes. However, studies show that patient compliance with treatment of many dermatologic disorders, including acne and psoriasis, is often poor.1,2
In 2007, Feldman showed that patients are more likely to use their products in the days before and the days after their dermatologist visit.3 He suggested that more frequent office visits would boost compliance. I have found that this is true and I recommend seeing patients every 4 weeks when implementing a new treatment regimen. I have also found that combining prescription medications with the proper corresponding skin care products helps decrease side effects and speed results when patients apply the products correctly.
To increase the chance of patients using the products correctly, they should be educated about how and when to use the products. I cannot overemphasize the importance of this, as illustrated by the following story of a patient who came in with facial redness and irritation. Upon questioning, I learned that she was using her facial cleanser but was not washing it off and left it on all day. She said, “No one told me to wash it off!” While washing a cleanser off may seem obvious, cultural, gender, ethnic, and geographical differences can lead to misunderstandings.
The problem with patient education is that it takes time. It is best if education is provided by staff, but keeping them trained and up to date is also difficult. Most dermatologists only have 3-5 minutes per patient so streamlining the process of designing a treatment plan and educating the patient and recruiting your staff to help is crucial. Before I discuss how to streamline the process, let’s first look at our goals for patients.
To achieve good patient outcomes, the patient needs to:
- Understand what medications and products to use.
- Understand when and how to use the products.
- Understand the order in which to use the products (step 1, step 2, etc.).
- Purchase the products (from you or elsewhere).
- Tell you if they do not purchase the products, for whatever reason (insurance will not cover, too expensive, could not find them, etc.).
- Use the products consistently.
- Inform you if they do not use the products (too busy, did not have them on a trip, etc.).
- Report any side effects so you can adjust the therapy accordingly.
You can see why it is so difficult to get patients to be compliant. Many factors – such as time, memory, education level, understanding, motivation, cost, convenience, and insurance coverage – can get in the way of these important components. Giving patients a printed regimen with instructions, selling the products in your practice, and providing some sort of interaction to keep patients engaged is key. In my June 2015 Dermatology News column, I discussed why you should consider selling products in your practice. In the future, I will discuss ways to engage your patients, but for now, let’s focus on how to quickly and effectively provide your patients with printed regimens and patient instructions without increasing office visit times.
Streamlining the Process of Generating a Skin Care Regimen That Includes Prescription Medications
Identify patients’ phenotypes
Divide patients into phenotypes based on skin care needs to save yourself time with the recommendation process.
Many doctors do this with a disease-based approach, such as acne, rosacea, eczema, psoriasis, etc. I prefer to classify my patients according to 16 Baumann Skin Types based on four parameters: hydration status, propensity for inflammation; presence or absence of uneven pigmentation; and presence of lifestyle habits, such as sun exposure, that increase an individual’s risk of skin aging.4,5,6 To quickly diagnose the patient as a particular Baumann Skin Type, I use a tablet-based validated questionnaire called the Baumann Skin Type Indicator (BSTI).7 This questionnaire is self-administered by the patient in the waiting room and serves several purposes that facilitate my practice:
- To collect historical and current data.
- To diagnose skin type.
- To ask specifically about skin allergies.
- To learn preferences such as tinted vs. nontinted, or chemical vs. physical sunscreen.
- To inquire about what issues the patient wants to discuss, such as thinning eyelashes, hair loss, dry body skin, toenail fungus, warts, eczema, and other topics that might not come up during the appointment.
- To learn and document habits that affect the skin, such as tanning bed exposure, sun exposure, and smoking.
- To stimulate the patient to think about how daily actions such as sunscreen use and sun exposure affect their skin health.
Whether you choose to use my questionnaire or one of your own, using a validated method that can be initiated by staff in the waiting room saves time in the exam room.
Include prescription medications in the skin care regimen
Often, we think of skin care regimens and prescription medications as two different entities. In actuality, these should be combined.
For example, when treating acne, every item the patient uses plays a role. For example, if they are washing the face with Ivory soap and then applying benzoyl peroxide and a retinoid they will experience dryness and irritation. Then they will buy a moisturizer that might cause acne. (It is very hard for them to know which moisturizers and sunscreens will not worsen acne). By providing them with the exact names of cleansers, moisturizers, and sunscreens to use, they will be better able to tolerate their prescription acne medications.
The same is true with psoriasis, eczema, seborrheic dermatitis, contact dermatitis, and most of the other ailments that dermatologists treat. You must also tell them the order to use them in. For example, I always have patients apply the retinoid over the noncomedogenic moisturizer for the first few weeks to help them adjust to the retinoid. Later, once they have passed the high-risk period of retinoid dermatitis, I move the retinoid to under the moisturizer.
Psoriasis treatment (topical) is another good example. If they are going to use a surfactant-laden soap on their skin, they will impair their barrier and absorb more of the topically applied drug. Conversely, if they use a barrier repair moisturizer, they will absorb less. Telling the patients exactly which body cleansers and moisturizers to use with topical psoriasis medications will help standardize the response. For this reason, giving patients printed regimens is not limited to treatment of acne, rosacea, and photoaging, but rather should be done for patients with all skin issues and phenotypes.
Have informational material for each phenotype at your fingertips
You can have a plan for each patient phenotype that is designed ahead of time. You will save yourself hours of time if you have preprinted instructions sheets made for each of these phenotypes. You can use Touch MD, The Canfield Visia Camera Patient Portal, your EMR, or other systems to organize this material and deliver it to patients.
I personally use the Skin Type Solutions Software System (STSFranchise.com) that I developed and patented to house and export my patient instructions. Using a standardized methodology to provide educational information through video, preprinted sheets, emails, and other methods allows you to educate your patients at their pace and in the media with which they are most comfortable. To have this flexibility, the educational information must be developed prior to the patient visit. Categorizing the education information by phenotype makes this possible.
What the informational material should contain
Educational information should include important information about the phenotype, the do’s and don’ts for the phenotype, an exact skin care regimen containing clear steps that include product names including brand names, prescription medications, the order in which the products should be applied, and clear instructions on how to use the products.
The patient should be informed about what to do if anticipated adverse events occur, such as redness and peeling from retinoids or dryness from benzoyl peroxide. The same is true about injectable biologic medications for psoriasis. The patients need information on where to inject the product, how often, how to clean the skin beforehand, and what to put on the skin after the injections. It is always important with any skin issue for the patient to know when to contact the office. The American Academy of Dermatology and other organizations offer educational brochures for patients, but they cannot be customized. Patients prefer a customized approach to educational material. They don’t want to read information that does not apply to them. I have found that dividing patients into 16 distinct Baumann Skin Types helps target the right information to the corresponding skin phenotypes.
Summary
Patients need education and guidance to be compliant and improve their outcomes. Your staff needs to be a part of the education process, but taking the time to train your staff and educate your patients is always an issue. Developing a standardized methodology will help overcome these hurdles and solve this problem. The methodology should provide directed education and clear communication with written instructions delivered in the media of the patient’s choice. Doing this will yield better compliance and outcomes.
If you have any questions, suggestions or ideas of how to solve these issues, please share them with me at [email protected].
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. JAMA Dermatol. 2015 Jun;151(6):623-6.
2. J Am Acad Dermatol. 2004 Aug;51(2):212-6.
3. J Am Acad Dermatol. 2007 Jul;57(1):81-3.
4. Dermatol Clin. 2008 Jul;26(3):359-73.
5. Baumann L. Cosmetics and skin care in dermatology. In: Wolff K, ed. Fitzpatrick’s Dermatology in General Medicine, 7th ed. New York, NY: McGraw-Hill; 2008:2357-2364.
6. Baumann L. The Baumann skin typing system. In: Farage MA, Miller KW, Maibach HI, eds. Textbook of Aging Skin. Berling, Germany: Springer-Verlag; 2010:929-944.
7. Journal of Cosmetics, Dermatological Sciences and Applications. 2016;6(1):34-40.
As clinicians who have been in practice for even a relatively short period of time know, patient compliance is an integral aspect of achieving optimal patient outcomes. However, studies show that patient compliance with treatment of many dermatologic disorders, including acne and psoriasis, is often poor.1,2
In 2007, Feldman showed that patients are more likely to use their products in the days before and the days after their dermatologist visit.3 He suggested that more frequent office visits would boost compliance. I have found that this is true and I recommend seeing patients every 4 weeks when implementing a new treatment regimen. I have also found that combining prescription medications with the proper corresponding skin care products helps decrease side effects and speed results when patients apply the products correctly.
To increase the chance of patients using the products correctly, they should be educated about how and when to use the products. I cannot overemphasize the importance of this, as illustrated by the following story of a patient who came in with facial redness and irritation. Upon questioning, I learned that she was using her facial cleanser but was not washing it off and left it on all day. She said, “No one told me to wash it off!” While washing a cleanser off may seem obvious, cultural, gender, ethnic, and geographical differences can lead to misunderstandings.
The problem with patient education is that it takes time. It is best if education is provided by staff, but keeping them trained and up to date is also difficult. Most dermatologists only have 3-5 minutes per patient so streamlining the process of designing a treatment plan and educating the patient and recruiting your staff to help is crucial. Before I discuss how to streamline the process, let’s first look at our goals for patients.
To achieve good patient outcomes, the patient needs to:
- Understand what medications and products to use.
- Understand when and how to use the products.
- Understand the order in which to use the products (step 1, step 2, etc.).
- Purchase the products (from you or elsewhere).
- Tell you if they do not purchase the products, for whatever reason (insurance will not cover, too expensive, could not find them, etc.).
- Use the products consistently.
- Inform you if they do not use the products (too busy, did not have them on a trip, etc.).
- Report any side effects so you can adjust the therapy accordingly.
You can see why it is so difficult to get patients to be compliant. Many factors – such as time, memory, education level, understanding, motivation, cost, convenience, and insurance coverage – can get in the way of these important components. Giving patients a printed regimen with instructions, selling the products in your practice, and providing some sort of interaction to keep patients engaged is key. In my June 2015 Dermatology News column, I discussed why you should consider selling products in your practice. In the future, I will discuss ways to engage your patients, but for now, let’s focus on how to quickly and effectively provide your patients with printed regimens and patient instructions without increasing office visit times.
Streamlining the Process of Generating a Skin Care Regimen That Includes Prescription Medications
Identify patients’ phenotypes
Divide patients into phenotypes based on skin care needs to save yourself time with the recommendation process.
Many doctors do this with a disease-based approach, such as acne, rosacea, eczema, psoriasis, etc. I prefer to classify my patients according to 16 Baumann Skin Types based on four parameters: hydration status, propensity for inflammation; presence or absence of uneven pigmentation; and presence of lifestyle habits, such as sun exposure, that increase an individual’s risk of skin aging.4,5,6 To quickly diagnose the patient as a particular Baumann Skin Type, I use a tablet-based validated questionnaire called the Baumann Skin Type Indicator (BSTI).7 This questionnaire is self-administered by the patient in the waiting room and serves several purposes that facilitate my practice:
- To collect historical and current data.
- To diagnose skin type.
- To ask specifically about skin allergies.
- To learn preferences such as tinted vs. nontinted, or chemical vs. physical sunscreen.
- To inquire about what issues the patient wants to discuss, such as thinning eyelashes, hair loss, dry body skin, toenail fungus, warts, eczema, and other topics that might not come up during the appointment.
- To learn and document habits that affect the skin, such as tanning bed exposure, sun exposure, and smoking.
- To stimulate the patient to think about how daily actions such as sunscreen use and sun exposure affect their skin health.
Whether you choose to use my questionnaire or one of your own, using a validated method that can be initiated by staff in the waiting room saves time in the exam room.
Include prescription medications in the skin care regimen
Often, we think of skin care regimens and prescription medications as two different entities. In actuality, these should be combined.
For example, when treating acne, every item the patient uses plays a role. For example, if they are washing the face with Ivory soap and then applying benzoyl peroxide and a retinoid they will experience dryness and irritation. Then they will buy a moisturizer that might cause acne. (It is very hard for them to know which moisturizers and sunscreens will not worsen acne). By providing them with the exact names of cleansers, moisturizers, and sunscreens to use, they will be better able to tolerate their prescription acne medications.
The same is true with psoriasis, eczema, seborrheic dermatitis, contact dermatitis, and most of the other ailments that dermatologists treat. You must also tell them the order to use them in. For example, I always have patients apply the retinoid over the noncomedogenic moisturizer for the first few weeks to help them adjust to the retinoid. Later, once they have passed the high-risk period of retinoid dermatitis, I move the retinoid to under the moisturizer.
Psoriasis treatment (topical) is another good example. If they are going to use a surfactant-laden soap on their skin, they will impair their barrier and absorb more of the topically applied drug. Conversely, if they use a barrier repair moisturizer, they will absorb less. Telling the patients exactly which body cleansers and moisturizers to use with topical psoriasis medications will help standardize the response. For this reason, giving patients printed regimens is not limited to treatment of acne, rosacea, and photoaging, but rather should be done for patients with all skin issues and phenotypes.
Have informational material for each phenotype at your fingertips
You can have a plan for each patient phenotype that is designed ahead of time. You will save yourself hours of time if you have preprinted instructions sheets made for each of these phenotypes. You can use Touch MD, The Canfield Visia Camera Patient Portal, your EMR, or other systems to organize this material and deliver it to patients.
I personally use the Skin Type Solutions Software System (STSFranchise.com) that I developed and patented to house and export my patient instructions. Using a standardized methodology to provide educational information through video, preprinted sheets, emails, and other methods allows you to educate your patients at their pace and in the media with which they are most comfortable. To have this flexibility, the educational information must be developed prior to the patient visit. Categorizing the education information by phenotype makes this possible.
What the informational material should contain
Educational information should include important information about the phenotype, the do’s and don’ts for the phenotype, an exact skin care regimen containing clear steps that include product names including brand names, prescription medications, the order in which the products should be applied, and clear instructions on how to use the products.
The patient should be informed about what to do if anticipated adverse events occur, such as redness and peeling from retinoids or dryness from benzoyl peroxide. The same is true about injectable biologic medications for psoriasis. The patients need information on where to inject the product, how often, how to clean the skin beforehand, and what to put on the skin after the injections. It is always important with any skin issue for the patient to know when to contact the office. The American Academy of Dermatology and other organizations offer educational brochures for patients, but they cannot be customized. Patients prefer a customized approach to educational material. They don’t want to read information that does not apply to them. I have found that dividing patients into 16 distinct Baumann Skin Types helps target the right information to the corresponding skin phenotypes.
Summary
Patients need education and guidance to be compliant and improve their outcomes. Your staff needs to be a part of the education process, but taking the time to train your staff and educate your patients is always an issue. Developing a standardized methodology will help overcome these hurdles and solve this problem. The methodology should provide directed education and clear communication with written instructions delivered in the media of the patient’s choice. Doing this will yield better compliance and outcomes.
If you have any questions, suggestions or ideas of how to solve these issues, please share them with me at [email protected].
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. JAMA Dermatol. 2015 Jun;151(6):623-6.
2. J Am Acad Dermatol. 2004 Aug;51(2):212-6.
3. J Am Acad Dermatol. 2007 Jul;57(1):81-3.
4. Dermatol Clin. 2008 Jul;26(3):359-73.
5. Baumann L. Cosmetics and skin care in dermatology. In: Wolff K, ed. Fitzpatrick’s Dermatology in General Medicine, 7th ed. New York, NY: McGraw-Hill; 2008:2357-2364.
6. Baumann L. The Baumann skin typing system. In: Farage MA, Miller KW, Maibach HI, eds. Textbook of Aging Skin. Berling, Germany: Springer-Verlag; 2010:929-944.
7. Journal of Cosmetics, Dermatological Sciences and Applications. 2016;6(1):34-40.
As clinicians who have been in practice for even a relatively short period of time know, patient compliance is an integral aspect of achieving optimal patient outcomes. However, studies show that patient compliance with treatment of many dermatologic disorders, including acne and psoriasis, is often poor.1,2
In 2007, Feldman showed that patients are more likely to use their products in the days before and the days after their dermatologist visit.3 He suggested that more frequent office visits would boost compliance. I have found that this is true and I recommend seeing patients every 4 weeks when implementing a new treatment regimen. I have also found that combining prescription medications with the proper corresponding skin care products helps decrease side effects and speed results when patients apply the products correctly.
To increase the chance of patients using the products correctly, they should be educated about how and when to use the products. I cannot overemphasize the importance of this, as illustrated by the following story of a patient who came in with facial redness and irritation. Upon questioning, I learned that she was using her facial cleanser but was not washing it off and left it on all day. She said, “No one told me to wash it off!” While washing a cleanser off may seem obvious, cultural, gender, ethnic, and geographical differences can lead to misunderstandings.
The problem with patient education is that it takes time. It is best if education is provided by staff, but keeping them trained and up to date is also difficult. Most dermatologists only have 3-5 minutes per patient so streamlining the process of designing a treatment plan and educating the patient and recruiting your staff to help is crucial. Before I discuss how to streamline the process, let’s first look at our goals for patients.
To achieve good patient outcomes, the patient needs to:
- Understand what medications and products to use.
- Understand when and how to use the products.
- Understand the order in which to use the products (step 1, step 2, etc.).
- Purchase the products (from you or elsewhere).
- Tell you if they do not purchase the products, for whatever reason (insurance will not cover, too expensive, could not find them, etc.).
- Use the products consistently.
- Inform you if they do not use the products (too busy, did not have them on a trip, etc.).
- Report any side effects so you can adjust the therapy accordingly.
You can see why it is so difficult to get patients to be compliant. Many factors – such as time, memory, education level, understanding, motivation, cost, convenience, and insurance coverage – can get in the way of these important components. Giving patients a printed regimen with instructions, selling the products in your practice, and providing some sort of interaction to keep patients engaged is key. In my June 2015 Dermatology News column, I discussed why you should consider selling products in your practice. In the future, I will discuss ways to engage your patients, but for now, let’s focus on how to quickly and effectively provide your patients with printed regimens and patient instructions without increasing office visit times.
Streamlining the Process of Generating a Skin Care Regimen That Includes Prescription Medications
Identify patients’ phenotypes
Divide patients into phenotypes based on skin care needs to save yourself time with the recommendation process.
Many doctors do this with a disease-based approach, such as acne, rosacea, eczema, psoriasis, etc. I prefer to classify my patients according to 16 Baumann Skin Types based on four parameters: hydration status, propensity for inflammation; presence or absence of uneven pigmentation; and presence of lifestyle habits, such as sun exposure, that increase an individual’s risk of skin aging.4,5,6 To quickly diagnose the patient as a particular Baumann Skin Type, I use a tablet-based validated questionnaire called the Baumann Skin Type Indicator (BSTI).7 This questionnaire is self-administered by the patient in the waiting room and serves several purposes that facilitate my practice:
- To collect historical and current data.
- To diagnose skin type.
- To ask specifically about skin allergies.
- To learn preferences such as tinted vs. nontinted, or chemical vs. physical sunscreen.
- To inquire about what issues the patient wants to discuss, such as thinning eyelashes, hair loss, dry body skin, toenail fungus, warts, eczema, and other topics that might not come up during the appointment.
- To learn and document habits that affect the skin, such as tanning bed exposure, sun exposure, and smoking.
- To stimulate the patient to think about how daily actions such as sunscreen use and sun exposure affect their skin health.
Whether you choose to use my questionnaire or one of your own, using a validated method that can be initiated by staff in the waiting room saves time in the exam room.
Include prescription medications in the skin care regimen
Often, we think of skin care regimens and prescription medications as two different entities. In actuality, these should be combined.
For example, when treating acne, every item the patient uses plays a role. For example, if they are washing the face with Ivory soap and then applying benzoyl peroxide and a retinoid they will experience dryness and irritation. Then they will buy a moisturizer that might cause acne. (It is very hard for them to know which moisturizers and sunscreens will not worsen acne). By providing them with the exact names of cleansers, moisturizers, and sunscreens to use, they will be better able to tolerate their prescription acne medications.
The same is true with psoriasis, eczema, seborrheic dermatitis, contact dermatitis, and most of the other ailments that dermatologists treat. You must also tell them the order to use them in. For example, I always have patients apply the retinoid over the noncomedogenic moisturizer for the first few weeks to help them adjust to the retinoid. Later, once they have passed the high-risk period of retinoid dermatitis, I move the retinoid to under the moisturizer.
Psoriasis treatment (topical) is another good example. If they are going to use a surfactant-laden soap on their skin, they will impair their barrier and absorb more of the topically applied drug. Conversely, if they use a barrier repair moisturizer, they will absorb less. Telling the patients exactly which body cleansers and moisturizers to use with topical psoriasis medications will help standardize the response. For this reason, giving patients printed regimens is not limited to treatment of acne, rosacea, and photoaging, but rather should be done for patients with all skin issues and phenotypes.
Have informational material for each phenotype at your fingertips
You can have a plan for each patient phenotype that is designed ahead of time. You will save yourself hours of time if you have preprinted instructions sheets made for each of these phenotypes. You can use Touch MD, The Canfield Visia Camera Patient Portal, your EMR, or other systems to organize this material and deliver it to patients.
I personally use the Skin Type Solutions Software System (STSFranchise.com) that I developed and patented to house and export my patient instructions. Using a standardized methodology to provide educational information through video, preprinted sheets, emails, and other methods allows you to educate your patients at their pace and in the media with which they are most comfortable. To have this flexibility, the educational information must be developed prior to the patient visit. Categorizing the education information by phenotype makes this possible.
What the informational material should contain
Educational information should include important information about the phenotype, the do’s and don’ts for the phenotype, an exact skin care regimen containing clear steps that include product names including brand names, prescription medications, the order in which the products should be applied, and clear instructions on how to use the products.
The patient should be informed about what to do if anticipated adverse events occur, such as redness and peeling from retinoids or dryness from benzoyl peroxide. The same is true about injectable biologic medications for psoriasis. The patients need information on where to inject the product, how often, how to clean the skin beforehand, and what to put on the skin after the injections. It is always important with any skin issue for the patient to know when to contact the office. The American Academy of Dermatology and other organizations offer educational brochures for patients, but they cannot be customized. Patients prefer a customized approach to educational material. They don’t want to read information that does not apply to them. I have found that dividing patients into 16 distinct Baumann Skin Types helps target the right information to the corresponding skin phenotypes.
Summary
Patients need education and guidance to be compliant and improve their outcomes. Your staff needs to be a part of the education process, but taking the time to train your staff and educate your patients is always an issue. Developing a standardized methodology will help overcome these hurdles and solve this problem. The methodology should provide directed education and clear communication with written instructions delivered in the media of the patient’s choice. Doing this will yield better compliance and outcomes.
If you have any questions, suggestions or ideas of how to solve these issues, please share them with me at [email protected].
Dr. Baumann is a private practice dermatologist, researcher, author, and entrepreneur who practices in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote two textbooks: “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and “Cosmeceuticals and Cosmetic Ingredients,” (New York: McGraw-Hill, 2014), and a New York Times Best Sellers book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Dr. Baumann has received funding for advisory boards and/or clinical research trials from Allergan, Evolus, Galderma, and Revance. She is the founder and CEO of Skin Type Solutions Franchise Systems LLC.
References
1. JAMA Dermatol. 2015 Jun;151(6):623-6.
2. J Am Acad Dermatol. 2004 Aug;51(2):212-6.
3. J Am Acad Dermatol. 2007 Jul;57(1):81-3.
4. Dermatol Clin. 2008 Jul;26(3):359-73.
5. Baumann L. Cosmetics and skin care in dermatology. In: Wolff K, ed. Fitzpatrick’s Dermatology in General Medicine, 7th ed. New York, NY: McGraw-Hill; 2008:2357-2364.
6. Baumann L. The Baumann skin typing system. In: Farage MA, Miller KW, Maibach HI, eds. Textbook of Aging Skin. Berling, Germany: Springer-Verlag; 2010:929-944.
7. Journal of Cosmetics, Dermatological Sciences and Applications. 2016;6(1):34-40.
Ursolic acid
Ursolic acid (3beta-hydroxy-urs-12-en-28-oic acid) is a pentacyclic triterpenoid found naturally in apples, waxy berries, rosemary, oregano, and several other plants and herbs used in medicine and the diet.1,2 It is known to have significant antioxidant, anti-inflammatory, and antiproliferative properties, and has also been associated with a wider range of biologic activities, including anticancer, antimicrobial, antitumor, antiwrinkle, anti-HIV, cytotoxic, and hepatoprotective.3,4 In addition, ursolic acid is the focus of human clinical trials for potential uses in cancer and skin wrinkles.4 While this triterpenoid is known to suppress tumor formation and viability in various kinds of cancer, including skin cancer, several forms of cancer are resistant to ursolic acid.
Anti-inflammatory activity
In a 2013 study of the antibacterial and anti-inflammatory effects of Syzygium jambos on acne, Sharma et al. found that ursolic acid was one of the constituents of the leaf extracts that contributed to a significant suppression of the release of inflammatory cytokines interleukin (IL)-8 and tumor necrosis factor-alpha.5
In 2010, Yang et al. identified ursolic acid as a key constituent of Acanthopanax koreanum fruit, a popular fruit in Jeju Island, South Korea, extracts of which they found to exhibit significant anti-inflammatory activity and suitability as a topical agent.6
Yasukawa et al. conducted an in vivo two-stage carcinogenesis test in mice in 2009 in which extracts of the branches of Hippophae rhamnoides displayed significant antitumor activity after initiation with 7,12-dimethylbenz[a]anthracene (DMBA) and promotion with 12-O-tetradecanoylphorbol-13-acetate (TPA). Ursolic acid and (-)-epigallocatechin were the constituents found to have the greatest inhibitory effects on TPA-induced inflammation.7
A 2002 study by Chattopadhyay et al. revealed that the ursolic acid present in Mallotus peltatus extract (long used in traditional folk medicine to treat skin infections and intestinal disorders) may partially account for the broad anti-inflammatory and antimicrobial activity of the plant.9
In 1997, Máñez et al. noted that ursolic acid was among two of the four selected natural triterpenoids tested and found to be significantly effective against inflammation in a TPA multiple-dose model of chronic skin inflammation.10
Anticancer activity
In 2015, Cho et al. reported on the inhibitory effects on skin tumor promotion from the topical application of ursolic acid, resveratrol, or the combination of the two prior to TPA treatment on mouse skin. The combination of the two botanical agents yielded the strongest suppression of TPA-induced epidermal hyperproliferation, skin inflammation, inflammatory gene expression, and skin tumor promotion.11
In another study that year buttressing the combination of the two botanical agents, Junco et al. demonstrated that chloroquine could be used to sensitize B16F10 metastatic mouse melanoma to the anticancer activities of ursolic acid and resveratrol. The investigators concluded that the combination of ursolic acid or resveratrol with chloroquine has potential for inclusion in melanoma treatment in humans.12 Previously, Junco et al. observed that the anti–skin cancer effects of ursolic acid are augmented by P-glycoprotein inhibitors, and that ursolic acid and the stilbene resveratrol, a potent antioxidant, work synergistically, although not by blocking P-glycoprotein. The investigators suggested that ursolic acid along with resveratrol and/or P-glycoprotein inhibitors have potential as effective anti–skin cancer regimens.
In 2014, Lee et al. showed that ursolic acid can differentially modulate apoptosis in cutaneous melanoma and retinal pigment epithelial cells exposed to ultraviolet to visible broadband radiation, exhibiting the potential to protect normal cells while sensitizing melanoma cells to the effects of UV radiation.13 These findings supported earlier work by the team showing that pretreatment of human cells derived from a malignant skin melanoma markedly enhanced the sensitivity of melanoma cells to UV radiation, while providing some photoprotection to retinal pigment epithelium.
Also that year, Soica et al. demonstrated, using in vitro tests and in vivo skin cancer models, that the mixture of oleanolic and ursolic acids and in complex with cyclodextrin rendered a synergistic antitumor activity.14
A year earlier, Kowalczyk et al. showed that the combined action of phytochemicals – dietary calcium D-glucarate and topical ursolic acid and resveratrol – was effective in suppressing the initiation (with 7,12-dimethylbenz[a]anthracene [DMBA]) and promotion (with TPA) of skin tumorigenesis in SENCAR mice. Ursolic acid alone or in combination with calcium D-glucarate significantly diminished epidermal hyperplasia when applied during promotion. All of the antipromotion protocols led to significant decreases in cyclooxygenase-2 and interleukin (IL)-6 expression. The researchers concluded that ursolic acid strongly inhibits skin tumor promotion and inflammatory signaling, and warrants attention as a potential preventive agent against skin and other epithelial cancers.15 Kowalczyk et al. had previously found that ursolic acid and other phytochemicals displayed significant in vitro and in vivo antioxidant and antitumorigenic activity, inhibiting murine skin carcinogenesis by blunting tumor initiation and tumor promotion/progression.16
In 2006, beta-ursolic acid isolated from Salvia officinalis was found by Jedinák et al. to be effective in suppressing lung colonization of beta16 mouse melanoma cells in vivo.17
Huang et al. showed in 1994 that extracts of the leaves of Rosmarinus officinalis (rosemary) were effective in suppressing tumor initiation and promotion in a two-stage skin tumorigenesis mouse model. Topically applied ursolic acid isolated from the leaves was found to hinder TPA-induced ear inflammation, ornithine decarboxylase activity, and tumor promotion. The number of tumors per mouse also declined significantly due to the topical application of ursolic acid concurrent with twice weekly application of the tumor-promoter TPA in DMBA-initiated mice.18
Antiaging and other activities
In 2015, Herndon et al. conducted an open-label clinical trial in 37 females (aged 35-60 years) to ascertain the effectiveness of an anti-aging moisturizer containing Astragalus membranaceus root extract, a peptide blend including palmitoyl tripeptide-38, standardized rosemary leaf extract (ursolic acid), tetrahexyldecyl ascorbate (THD ascorbate), and ubiquinone (coenzyme Q10). Subjects were instructed to apply the moisturizer once in the morning and once in the evening, and were assessed at baseline, and after 4, 8, and 12 weeks of twice daily application. Clinical evaluations after 8 weeks revealed a statistically significant improvement in all grading parameters (fine lines and wrinkles, clarity/brightness, visual roughness, tactile roughness, redness, hyperpigmentation, and overall appearance), with even more pronounced improvement at 12 weeks. The product was found to be mild and well tolerated, and digital photography reinforced clinical assessments and self-evaluations.19
Lee et al. reported in 2012 on in vitro results suggesting that ursolic acid was effective as an inhibitor of matrix metalloproteinase (MMP)-1 after UVB exposure and was more effective than retinoic acid.20
Based on studies with hairless mice, Lim et al. found in 2007 that ursolic and oleanolic acids can enhance the recovery of skin barrier function and, via peroxisome proliferator-activated receptor-alpha, spur epidermal keratinocyte differentiation. They concluded that both acids have potential for use as agents to promote epidermal permeability barrier function.21
In 2003, Soo et al. observed that pretreatment with ursolic acid inhibited UVA-induced oxidative stress and activation and expression of MMP-2 in HaCaT human keratinocytes. They concluded that ursolic acid may merit attention for the prevention of UVA-induced photoaging.22
Three years earlier, Yarosh et al. showed that liposomes containing ursolic acid augmented ceramide content in cultured normal human epidermal keratinocytes and collagen content in cultured normal human dermal fibroblasts. Over an 11-day period, clinical tests with the ursolic acid–containing liposome (Merotaine) revealed increases in the ceramide content in human skin.23 Two years later, many of the same researchers duplicated their results. This new study also demonstrated that ursolic acid liposomes raise ceramide levels in normal human epidermal keratinocytes, in contrast to the effects of retinoic acid, earlier shown to reduce such levels. They concluded that ursolic acid liposomes show promise for use alone or in combination to replenish or maintain cutaneous ceramide and collagen levels.24 Notably, ursolic acid is incorporated into topical oils and creams intended to confer rejuvenating effects to the skin.
Conclusion
Ursolic acid is a compelling ingredient. I especially will be interested in the results of ongoing human clinical trials of this triterpenoid for treating cancer and skin wrinkles. As it is, ursolic acid is known to exert significant inhibitory activity against tumor formation and tumor cell viability in the laboratory. Given its wide range of biologic activity, and some promising cutaneous results, there is reason to believe that ursolic acid has the potential to play an increasingly useful role in topical skin care agents and dermatologic practice.
References
1. J Dermatol. 2007 Sep;34(9):625-34.
2. Folia Histochem Cytobiol. 2011;49(4):664-9.
3. J Cosmet Dermatol. 2004 Jan;3(1):26-34.
4. J Enzyme Inhib Med Chem. 2011 Oct;26(5):616-42.
5. BMC Complement Altern Med. 2013 Oct 29;13:292.
6. J Biomed Biotechnol. 2010;2010:715739.
7. Fitoterapia. 2009 Apr;80(3):164-7.
8. Biosci Biotechnol Biochem. 2004 Jan;68(1):85-90.
9. J Ethnopharmacol. 2002 Oct;82(2-3):229-37.
10. Eur J Pharmacol. 1997 Sep 3;334(1):103-5.
11. Cancer Prev Res (Phila). 2015 Sep;8(9):817-25.
12. Melanoma Res. 2015 Apr;25(2):103-12.
13. Apoptosis. 2014 May;19(5):816-28.
14. Molecules. 2014 Apr 17;19(4):4924-40.
15. Int J Oncol. 2013 Sep;43(3):911-8.
16. Carcinogenesis. 2009 Jun;30(6):1008-15.
17. Z Naturforsch C. 2006 Nov-Dec;61(11-12):777-82.
18. Cancer Res. 1994 Feb 1;54(3):701-8.
19. J Drugs Dermatol. 2015 Jul;14(7):699-704.
20. Bioorg Khim. 2012 May-Jun;38(3):374-81.
21. J Dermatol. 2007;34(9):625-34.
22. Eur J Pharmacol. 2003 Aug 29;476(3):173-8.
23. Horm Res. 2000;54(5-6):318-21.
24. Arch Dermatol Res. 2002 Jan;293(11):569-75.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Ursolic acid (3beta-hydroxy-urs-12-en-28-oic acid) is a pentacyclic triterpenoid found naturally in apples, waxy berries, rosemary, oregano, and several other plants and herbs used in medicine and the diet.1,2 It is known to have significant antioxidant, anti-inflammatory, and antiproliferative properties, and has also been associated with a wider range of biologic activities, including anticancer, antimicrobial, antitumor, antiwrinkle, anti-HIV, cytotoxic, and hepatoprotective.3,4 In addition, ursolic acid is the focus of human clinical trials for potential uses in cancer and skin wrinkles.4 While this triterpenoid is known to suppress tumor formation and viability in various kinds of cancer, including skin cancer, several forms of cancer are resistant to ursolic acid.
Anti-inflammatory activity
In a 2013 study of the antibacterial and anti-inflammatory effects of Syzygium jambos on acne, Sharma et al. found that ursolic acid was one of the constituents of the leaf extracts that contributed to a significant suppression of the release of inflammatory cytokines interleukin (IL)-8 and tumor necrosis factor-alpha.5
In 2010, Yang et al. identified ursolic acid as a key constituent of Acanthopanax koreanum fruit, a popular fruit in Jeju Island, South Korea, extracts of which they found to exhibit significant anti-inflammatory activity and suitability as a topical agent.6
Yasukawa et al. conducted an in vivo two-stage carcinogenesis test in mice in 2009 in which extracts of the branches of Hippophae rhamnoides displayed significant antitumor activity after initiation with 7,12-dimethylbenz[a]anthracene (DMBA) and promotion with 12-O-tetradecanoylphorbol-13-acetate (TPA). Ursolic acid and (-)-epigallocatechin were the constituents found to have the greatest inhibitory effects on TPA-induced inflammation.7
A 2002 study by Chattopadhyay et al. revealed that the ursolic acid present in Mallotus peltatus extract (long used in traditional folk medicine to treat skin infections and intestinal disorders) may partially account for the broad anti-inflammatory and antimicrobial activity of the plant.9
In 1997, Máñez et al. noted that ursolic acid was among two of the four selected natural triterpenoids tested and found to be significantly effective against inflammation in a TPA multiple-dose model of chronic skin inflammation.10
Anticancer activity
In 2015, Cho et al. reported on the inhibitory effects on skin tumor promotion from the topical application of ursolic acid, resveratrol, or the combination of the two prior to TPA treatment on mouse skin. The combination of the two botanical agents yielded the strongest suppression of TPA-induced epidermal hyperproliferation, skin inflammation, inflammatory gene expression, and skin tumor promotion.11
In another study that year buttressing the combination of the two botanical agents, Junco et al. demonstrated that chloroquine could be used to sensitize B16F10 metastatic mouse melanoma to the anticancer activities of ursolic acid and resveratrol. The investigators concluded that the combination of ursolic acid or resveratrol with chloroquine has potential for inclusion in melanoma treatment in humans.12 Previously, Junco et al. observed that the anti–skin cancer effects of ursolic acid are augmented by P-glycoprotein inhibitors, and that ursolic acid and the stilbene resveratrol, a potent antioxidant, work synergistically, although not by blocking P-glycoprotein. The investigators suggested that ursolic acid along with resveratrol and/or P-glycoprotein inhibitors have potential as effective anti–skin cancer regimens.
In 2014, Lee et al. showed that ursolic acid can differentially modulate apoptosis in cutaneous melanoma and retinal pigment epithelial cells exposed to ultraviolet to visible broadband radiation, exhibiting the potential to protect normal cells while sensitizing melanoma cells to the effects of UV radiation.13 These findings supported earlier work by the team showing that pretreatment of human cells derived from a malignant skin melanoma markedly enhanced the sensitivity of melanoma cells to UV radiation, while providing some photoprotection to retinal pigment epithelium.
Also that year, Soica et al. demonstrated, using in vitro tests and in vivo skin cancer models, that the mixture of oleanolic and ursolic acids and in complex with cyclodextrin rendered a synergistic antitumor activity.14
A year earlier, Kowalczyk et al. showed that the combined action of phytochemicals – dietary calcium D-glucarate and topical ursolic acid and resveratrol – was effective in suppressing the initiation (with 7,12-dimethylbenz[a]anthracene [DMBA]) and promotion (with TPA) of skin tumorigenesis in SENCAR mice. Ursolic acid alone or in combination with calcium D-glucarate significantly diminished epidermal hyperplasia when applied during promotion. All of the antipromotion protocols led to significant decreases in cyclooxygenase-2 and interleukin (IL)-6 expression. The researchers concluded that ursolic acid strongly inhibits skin tumor promotion and inflammatory signaling, and warrants attention as a potential preventive agent against skin and other epithelial cancers.15 Kowalczyk et al. had previously found that ursolic acid and other phytochemicals displayed significant in vitro and in vivo antioxidant and antitumorigenic activity, inhibiting murine skin carcinogenesis by blunting tumor initiation and tumor promotion/progression.16
In 2006, beta-ursolic acid isolated from Salvia officinalis was found by Jedinák et al. to be effective in suppressing lung colonization of beta16 mouse melanoma cells in vivo.17
Huang et al. showed in 1994 that extracts of the leaves of Rosmarinus officinalis (rosemary) were effective in suppressing tumor initiation and promotion in a two-stage skin tumorigenesis mouse model. Topically applied ursolic acid isolated from the leaves was found to hinder TPA-induced ear inflammation, ornithine decarboxylase activity, and tumor promotion. The number of tumors per mouse also declined significantly due to the topical application of ursolic acid concurrent with twice weekly application of the tumor-promoter TPA in DMBA-initiated mice.18
Antiaging and other activities
In 2015, Herndon et al. conducted an open-label clinical trial in 37 females (aged 35-60 years) to ascertain the effectiveness of an anti-aging moisturizer containing Astragalus membranaceus root extract, a peptide blend including palmitoyl tripeptide-38, standardized rosemary leaf extract (ursolic acid), tetrahexyldecyl ascorbate (THD ascorbate), and ubiquinone (coenzyme Q10). Subjects were instructed to apply the moisturizer once in the morning and once in the evening, and were assessed at baseline, and after 4, 8, and 12 weeks of twice daily application. Clinical evaluations after 8 weeks revealed a statistically significant improvement in all grading parameters (fine lines and wrinkles, clarity/brightness, visual roughness, tactile roughness, redness, hyperpigmentation, and overall appearance), with even more pronounced improvement at 12 weeks. The product was found to be mild and well tolerated, and digital photography reinforced clinical assessments and self-evaluations.19
Lee et al. reported in 2012 on in vitro results suggesting that ursolic acid was effective as an inhibitor of matrix metalloproteinase (MMP)-1 after UVB exposure and was more effective than retinoic acid.20
Based on studies with hairless mice, Lim et al. found in 2007 that ursolic and oleanolic acids can enhance the recovery of skin barrier function and, via peroxisome proliferator-activated receptor-alpha, spur epidermal keratinocyte differentiation. They concluded that both acids have potential for use as agents to promote epidermal permeability barrier function.21
In 2003, Soo et al. observed that pretreatment with ursolic acid inhibited UVA-induced oxidative stress and activation and expression of MMP-2 in HaCaT human keratinocytes. They concluded that ursolic acid may merit attention for the prevention of UVA-induced photoaging.22
Three years earlier, Yarosh et al. showed that liposomes containing ursolic acid augmented ceramide content in cultured normal human epidermal keratinocytes and collagen content in cultured normal human dermal fibroblasts. Over an 11-day period, clinical tests with the ursolic acid–containing liposome (Merotaine) revealed increases in the ceramide content in human skin.23 Two years later, many of the same researchers duplicated their results. This new study also demonstrated that ursolic acid liposomes raise ceramide levels in normal human epidermal keratinocytes, in contrast to the effects of retinoic acid, earlier shown to reduce such levels. They concluded that ursolic acid liposomes show promise for use alone or in combination to replenish or maintain cutaneous ceramide and collagen levels.24 Notably, ursolic acid is incorporated into topical oils and creams intended to confer rejuvenating effects to the skin.
Conclusion
Ursolic acid is a compelling ingredient. I especially will be interested in the results of ongoing human clinical trials of this triterpenoid for treating cancer and skin wrinkles. As it is, ursolic acid is known to exert significant inhibitory activity against tumor formation and tumor cell viability in the laboratory. Given its wide range of biologic activity, and some promising cutaneous results, there is reason to believe that ursolic acid has the potential to play an increasingly useful role in topical skin care agents and dermatologic practice.
References
1. J Dermatol. 2007 Sep;34(9):625-34.
2. Folia Histochem Cytobiol. 2011;49(4):664-9.
3. J Cosmet Dermatol. 2004 Jan;3(1):26-34.
4. J Enzyme Inhib Med Chem. 2011 Oct;26(5):616-42.
5. BMC Complement Altern Med. 2013 Oct 29;13:292.
6. J Biomed Biotechnol. 2010;2010:715739.
7. Fitoterapia. 2009 Apr;80(3):164-7.
8. Biosci Biotechnol Biochem. 2004 Jan;68(1):85-90.
9. J Ethnopharmacol. 2002 Oct;82(2-3):229-37.
10. Eur J Pharmacol. 1997 Sep 3;334(1):103-5.
11. Cancer Prev Res (Phila). 2015 Sep;8(9):817-25.
12. Melanoma Res. 2015 Apr;25(2):103-12.
13. Apoptosis. 2014 May;19(5):816-28.
14. Molecules. 2014 Apr 17;19(4):4924-40.
15. Int J Oncol. 2013 Sep;43(3):911-8.
16. Carcinogenesis. 2009 Jun;30(6):1008-15.
17. Z Naturforsch C. 2006 Nov-Dec;61(11-12):777-82.
18. Cancer Res. 1994 Feb 1;54(3):701-8.
19. J Drugs Dermatol. 2015 Jul;14(7):699-704.
20. Bioorg Khim. 2012 May-Jun;38(3):374-81.
21. J Dermatol. 2007;34(9):625-34.
22. Eur J Pharmacol. 2003 Aug 29;476(3):173-8.
23. Horm Res. 2000;54(5-6):318-21.
24. Arch Dermatol Res. 2002 Jan;293(11):569-75.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Ursolic acid (3beta-hydroxy-urs-12-en-28-oic acid) is a pentacyclic triterpenoid found naturally in apples, waxy berries, rosemary, oregano, and several other plants and herbs used in medicine and the diet.1,2 It is known to have significant antioxidant, anti-inflammatory, and antiproliferative properties, and has also been associated with a wider range of biologic activities, including anticancer, antimicrobial, antitumor, antiwrinkle, anti-HIV, cytotoxic, and hepatoprotective.3,4 In addition, ursolic acid is the focus of human clinical trials for potential uses in cancer and skin wrinkles.4 While this triterpenoid is known to suppress tumor formation and viability in various kinds of cancer, including skin cancer, several forms of cancer are resistant to ursolic acid.
Anti-inflammatory activity
In a 2013 study of the antibacterial and anti-inflammatory effects of Syzygium jambos on acne, Sharma et al. found that ursolic acid was one of the constituents of the leaf extracts that contributed to a significant suppression of the release of inflammatory cytokines interleukin (IL)-8 and tumor necrosis factor-alpha.5
In 2010, Yang et al. identified ursolic acid as a key constituent of Acanthopanax koreanum fruit, a popular fruit in Jeju Island, South Korea, extracts of which they found to exhibit significant anti-inflammatory activity and suitability as a topical agent.6
Yasukawa et al. conducted an in vivo two-stage carcinogenesis test in mice in 2009 in which extracts of the branches of Hippophae rhamnoides displayed significant antitumor activity after initiation with 7,12-dimethylbenz[a]anthracene (DMBA) and promotion with 12-O-tetradecanoylphorbol-13-acetate (TPA). Ursolic acid and (-)-epigallocatechin were the constituents found to have the greatest inhibitory effects on TPA-induced inflammation.7
A 2002 study by Chattopadhyay et al. revealed that the ursolic acid present in Mallotus peltatus extract (long used in traditional folk medicine to treat skin infections and intestinal disorders) may partially account for the broad anti-inflammatory and antimicrobial activity of the plant.9
In 1997, Máñez et al. noted that ursolic acid was among two of the four selected natural triterpenoids tested and found to be significantly effective against inflammation in a TPA multiple-dose model of chronic skin inflammation.10
Anticancer activity
In 2015, Cho et al. reported on the inhibitory effects on skin tumor promotion from the topical application of ursolic acid, resveratrol, or the combination of the two prior to TPA treatment on mouse skin. The combination of the two botanical agents yielded the strongest suppression of TPA-induced epidermal hyperproliferation, skin inflammation, inflammatory gene expression, and skin tumor promotion.11
In another study that year buttressing the combination of the two botanical agents, Junco et al. demonstrated that chloroquine could be used to sensitize B16F10 metastatic mouse melanoma to the anticancer activities of ursolic acid and resveratrol. The investigators concluded that the combination of ursolic acid or resveratrol with chloroquine has potential for inclusion in melanoma treatment in humans.12 Previously, Junco et al. observed that the anti–skin cancer effects of ursolic acid are augmented by P-glycoprotein inhibitors, and that ursolic acid and the stilbene resveratrol, a potent antioxidant, work synergistically, although not by blocking P-glycoprotein. The investigators suggested that ursolic acid along with resveratrol and/or P-glycoprotein inhibitors have potential as effective anti–skin cancer regimens.
In 2014, Lee et al. showed that ursolic acid can differentially modulate apoptosis in cutaneous melanoma and retinal pigment epithelial cells exposed to ultraviolet to visible broadband radiation, exhibiting the potential to protect normal cells while sensitizing melanoma cells to the effects of UV radiation.13 These findings supported earlier work by the team showing that pretreatment of human cells derived from a malignant skin melanoma markedly enhanced the sensitivity of melanoma cells to UV radiation, while providing some photoprotection to retinal pigment epithelium.
Also that year, Soica et al. demonstrated, using in vitro tests and in vivo skin cancer models, that the mixture of oleanolic and ursolic acids and in complex with cyclodextrin rendered a synergistic antitumor activity.14
A year earlier, Kowalczyk et al. showed that the combined action of phytochemicals – dietary calcium D-glucarate and topical ursolic acid and resveratrol – was effective in suppressing the initiation (with 7,12-dimethylbenz[a]anthracene [DMBA]) and promotion (with TPA) of skin tumorigenesis in SENCAR mice. Ursolic acid alone or in combination with calcium D-glucarate significantly diminished epidermal hyperplasia when applied during promotion. All of the antipromotion protocols led to significant decreases in cyclooxygenase-2 and interleukin (IL)-6 expression. The researchers concluded that ursolic acid strongly inhibits skin tumor promotion and inflammatory signaling, and warrants attention as a potential preventive agent against skin and other epithelial cancers.15 Kowalczyk et al. had previously found that ursolic acid and other phytochemicals displayed significant in vitro and in vivo antioxidant and antitumorigenic activity, inhibiting murine skin carcinogenesis by blunting tumor initiation and tumor promotion/progression.16
In 2006, beta-ursolic acid isolated from Salvia officinalis was found by Jedinák et al. to be effective in suppressing lung colonization of beta16 mouse melanoma cells in vivo.17
Huang et al. showed in 1994 that extracts of the leaves of Rosmarinus officinalis (rosemary) were effective in suppressing tumor initiation and promotion in a two-stage skin tumorigenesis mouse model. Topically applied ursolic acid isolated from the leaves was found to hinder TPA-induced ear inflammation, ornithine decarboxylase activity, and tumor promotion. The number of tumors per mouse also declined significantly due to the topical application of ursolic acid concurrent with twice weekly application of the tumor-promoter TPA in DMBA-initiated mice.18
Antiaging and other activities
In 2015, Herndon et al. conducted an open-label clinical trial in 37 females (aged 35-60 years) to ascertain the effectiveness of an anti-aging moisturizer containing Astragalus membranaceus root extract, a peptide blend including palmitoyl tripeptide-38, standardized rosemary leaf extract (ursolic acid), tetrahexyldecyl ascorbate (THD ascorbate), and ubiquinone (coenzyme Q10). Subjects were instructed to apply the moisturizer once in the morning and once in the evening, and were assessed at baseline, and after 4, 8, and 12 weeks of twice daily application. Clinical evaluations after 8 weeks revealed a statistically significant improvement in all grading parameters (fine lines and wrinkles, clarity/brightness, visual roughness, tactile roughness, redness, hyperpigmentation, and overall appearance), with even more pronounced improvement at 12 weeks. The product was found to be mild and well tolerated, and digital photography reinforced clinical assessments and self-evaluations.19
Lee et al. reported in 2012 on in vitro results suggesting that ursolic acid was effective as an inhibitor of matrix metalloproteinase (MMP)-1 after UVB exposure and was more effective than retinoic acid.20
Based on studies with hairless mice, Lim et al. found in 2007 that ursolic and oleanolic acids can enhance the recovery of skin barrier function and, via peroxisome proliferator-activated receptor-alpha, spur epidermal keratinocyte differentiation. They concluded that both acids have potential for use as agents to promote epidermal permeability barrier function.21
In 2003, Soo et al. observed that pretreatment with ursolic acid inhibited UVA-induced oxidative stress and activation and expression of MMP-2 in HaCaT human keratinocytes. They concluded that ursolic acid may merit attention for the prevention of UVA-induced photoaging.22
Three years earlier, Yarosh et al. showed that liposomes containing ursolic acid augmented ceramide content in cultured normal human epidermal keratinocytes and collagen content in cultured normal human dermal fibroblasts. Over an 11-day period, clinical tests with the ursolic acid–containing liposome (Merotaine) revealed increases in the ceramide content in human skin.23 Two years later, many of the same researchers duplicated their results. This new study also demonstrated that ursolic acid liposomes raise ceramide levels in normal human epidermal keratinocytes, in contrast to the effects of retinoic acid, earlier shown to reduce such levels. They concluded that ursolic acid liposomes show promise for use alone or in combination to replenish or maintain cutaneous ceramide and collagen levels.24 Notably, ursolic acid is incorporated into topical oils and creams intended to confer rejuvenating effects to the skin.
Conclusion
Ursolic acid is a compelling ingredient. I especially will be interested in the results of ongoing human clinical trials of this triterpenoid for treating cancer and skin wrinkles. As it is, ursolic acid is known to exert significant inhibitory activity against tumor formation and tumor cell viability in the laboratory. Given its wide range of biologic activity, and some promising cutaneous results, there is reason to believe that ursolic acid has the potential to play an increasingly useful role in topical skin care agents and dermatologic practice.
References
1. J Dermatol. 2007 Sep;34(9):625-34.
2. Folia Histochem Cytobiol. 2011;49(4):664-9.
3. J Cosmet Dermatol. 2004 Jan;3(1):26-34.
4. J Enzyme Inhib Med Chem. 2011 Oct;26(5):616-42.
5. BMC Complement Altern Med. 2013 Oct 29;13:292.
6. J Biomed Biotechnol. 2010;2010:715739.
7. Fitoterapia. 2009 Apr;80(3):164-7.
8. Biosci Biotechnol Biochem. 2004 Jan;68(1):85-90.
9. J Ethnopharmacol. 2002 Oct;82(2-3):229-37.
10. Eur J Pharmacol. 1997 Sep 3;334(1):103-5.
11. Cancer Prev Res (Phila). 2015 Sep;8(9):817-25.
12. Melanoma Res. 2015 Apr;25(2):103-12.
13. Apoptosis. 2014 May;19(5):816-28.
14. Molecules. 2014 Apr 17;19(4):4924-40.
15. Int J Oncol. 2013 Sep;43(3):911-8.
16. Carcinogenesis. 2009 Jun;30(6):1008-15.
17. Z Naturforsch C. 2006 Nov-Dec;61(11-12):777-82.
18. Cancer Res. 1994 Feb 1;54(3):701-8.
19. J Drugs Dermatol. 2015 Jul;14(7):699-704.
20. Bioorg Khim. 2012 May-Jun;38(3):374-81.
21. J Dermatol. 2007;34(9):625-34.
22. Eur J Pharmacol. 2003 Aug 29;476(3):173-8.
23. Horm Res. 2000;54(5-6):318-21.
24. Arch Dermatol Res. 2002 Jan;293(11):569-75.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Heparan sulfate
The discussion this month focuses on an exciting new ingredient that is showing great promise as a topical antiaging agent. For years we have known that aging skin needs more collagen, elastin, and hyaluronic acid. It is time to add a new player to the antiaging team – heparan sulfate (HS). New studies have shown that lower levels of HS are associated with aged skin. This is what you need to know.
Significance of HS
Endogenous HS, an essential glycosaminoglycan (GAG), contributes to skin development and homeostasis, and thus actively promotes skin health.1 GAGs such as HS and hyaluronic acid are well known as endogenous superhydrators that bind and retain water, thus contributing to skin hydration as well as preserving the structural integrity of collagen and elastin fibers. Specifically, HS and its protein-bound forms (HS proteoglycans such as syndecan, glypican, and perlecan) – the most common constituents on the cell surface and in the extracellular matrix (ECM) – play an important role in cutaneous cell proliferation, migration, communication, and activation as well as collagen fiber development, basement membrane regeneration, granulation tissue formation, and cell adhesion related to wound healing.1 This results from their capacity to bind, store, present, degrade, and amplify growth factors and cytokines.
Accordingly, mature skin would be potently activated by its endogenous growth factors (at lower concentration) as cell signal is amplified (lower threshold of activation) by HS analogs. When used topically, HS analogs appear to promote the formation of healthy and functional ECM, resulting in firmer, more elastic, and stronger skin. Augmenting the amount of HS in the skin may yield a rejuvenating effect by expanding the skin’s ability to hold water and restore cutaneous homeostasis. Studies with an HS analog have demonstrated that the formulation penetrates into skin, enhancing hydration, reducing transepidermal water loss, and improving the appearance of wrinkles and skin tone.1 The use of HS analogs or mimics, known as matrix therapy, has been shown to be effective clinically in cutaneous and corneal healing formulations, exhibiting proof of concept in humans, according to Barritault et al.3
Matrix therapy also has been employed successfully in plastic and aesthetic procedures. Zakine et al. assessed the impact of using ReGeneraTing Agents (RGTA) – biodegradable polymers designed to mimic HS in the ECM of damaged tissue – in 17 patients with breast hypertrophy who underwent mammoplasty. Patients received topical treatment on one breast 1, 4, 8, and 11 days after surgery. The investigators also evaluated a different group of 50 patients after centrofacial lifting. These patients received RGTA drops bilaterally in the treatment area after surgery. Inflammation, hypertrophic scars, and pruritus were noted less frequently for the breasts treated with RGTA. Similarly, in patients receiving a centrofacial lift, scar inflammation, edema, and bruising were significantly less frequent in the treated group (10%), compared with the untreated group (90%).4
In 2015, Gallo et al. reported that 15 patients using a new HS analog formulation in an 8-week study displayed improvement in various skin metrics, including hydration, firmness, elasticity, barrier function, and the appearance of fine lines and wrinkles. The investigators concluded that photodamaged skin may benefit from the use of novel topically applied products containing low-molecular-weight HS.1
The synthetic heparan sulfate Cacipliq20 was reported in 2015 to have been used successfully to treat a chronic lower-extremity ulcer in a 22-year-old male patient with Stewart-Bluefarb syndrome,5 and in 2016 to treat a refractory sickle cell ulcer, with the encouraging outcome demonstrated by complete wound coverage and significant improvement in pain score.6 In 2012, Polieri et al. showed that HS 1% cream was comparable or more effective than glycosaminoglycan-polysulphate gel in alleviating the signs and symptoms of hematomas or subcutaneous hematic extravasations in a study with 96 white men and women.7
Conclusion
Heparan sulfate does appear to be a novel viable antiaging option. Endogenous heparan sulfate is involved in skin defense against pathogens, dehydrated/dried skin, redness, and wound healing. Theoretically, then, HS analogs should be able to modulate these processes. More research is necessary to determine if this is the case, however. In the meantime, HS analogs are extremely well tolerated by all patients and especially those with sensitive skin, which is often the case with aging skin. Further, HS analogs promote skin hydration, providing resistance to compressive forces as well as keeping skin looking healthy. Anecdotally, I can report that I have been using the Senté Dermal Repair Cream in my rosacea patients without any problems. I think HS analogs represent a good option for patients who cannot tolerate retinoids.
Resources
1. J Drugs Dermatol. 2015 Jul;14(7):669-74.
2. Proteoglycans in Skin Aging, in “Textbook of Aging Skin” (Heidelberg, Berlin: Springer-Verlag, pp. 109-120).
3. Joint Bone Spine. 2016 Sep 20. doi: 10.1016/j.jbspin.2016.06.012.
4. Ann Chir Plast Esthet. 2010 Oct;55(5):421-8.
5. Int Wound J. 2015 Apr;12(2):169-72.
6. Int Wound J. 2016 Feb;13(1):35-8.
7. ISRN Orthop. 2012 Jan 17. doi: 10.5402/2012/504151.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
The discussion this month focuses on an exciting new ingredient that is showing great promise as a topical antiaging agent. For years we have known that aging skin needs more collagen, elastin, and hyaluronic acid. It is time to add a new player to the antiaging team – heparan sulfate (HS). New studies have shown that lower levels of HS are associated with aged skin. This is what you need to know.
Significance of HS
Endogenous HS, an essential glycosaminoglycan (GAG), contributes to skin development and homeostasis, and thus actively promotes skin health.1 GAGs such as HS and hyaluronic acid are well known as endogenous superhydrators that bind and retain water, thus contributing to skin hydration as well as preserving the structural integrity of collagen and elastin fibers. Specifically, HS and its protein-bound forms (HS proteoglycans such as syndecan, glypican, and perlecan) – the most common constituents on the cell surface and in the extracellular matrix (ECM) – play an important role in cutaneous cell proliferation, migration, communication, and activation as well as collagen fiber development, basement membrane regeneration, granulation tissue formation, and cell adhesion related to wound healing.1 This results from their capacity to bind, store, present, degrade, and amplify growth factors and cytokines.
Accordingly, mature skin would be potently activated by its endogenous growth factors (at lower concentration) as cell signal is amplified (lower threshold of activation) by HS analogs. When used topically, HS analogs appear to promote the formation of healthy and functional ECM, resulting in firmer, more elastic, and stronger skin. Augmenting the amount of HS in the skin may yield a rejuvenating effect by expanding the skin’s ability to hold water and restore cutaneous homeostasis. Studies with an HS analog have demonstrated that the formulation penetrates into skin, enhancing hydration, reducing transepidermal water loss, and improving the appearance of wrinkles and skin tone.1 The use of HS analogs or mimics, known as matrix therapy, has been shown to be effective clinically in cutaneous and corneal healing formulations, exhibiting proof of concept in humans, according to Barritault et al.3
Matrix therapy also has been employed successfully in plastic and aesthetic procedures. Zakine et al. assessed the impact of using ReGeneraTing Agents (RGTA) – biodegradable polymers designed to mimic HS in the ECM of damaged tissue – in 17 patients with breast hypertrophy who underwent mammoplasty. Patients received topical treatment on one breast 1, 4, 8, and 11 days after surgery. The investigators also evaluated a different group of 50 patients after centrofacial lifting. These patients received RGTA drops bilaterally in the treatment area after surgery. Inflammation, hypertrophic scars, and pruritus were noted less frequently for the breasts treated with RGTA. Similarly, in patients receiving a centrofacial lift, scar inflammation, edema, and bruising were significantly less frequent in the treated group (10%), compared with the untreated group (90%).4
In 2015, Gallo et al. reported that 15 patients using a new HS analog formulation in an 8-week study displayed improvement in various skin metrics, including hydration, firmness, elasticity, barrier function, and the appearance of fine lines and wrinkles. The investigators concluded that photodamaged skin may benefit from the use of novel topically applied products containing low-molecular-weight HS.1
The synthetic heparan sulfate Cacipliq20 was reported in 2015 to have been used successfully to treat a chronic lower-extremity ulcer in a 22-year-old male patient with Stewart-Bluefarb syndrome,5 and in 2016 to treat a refractory sickle cell ulcer, with the encouraging outcome demonstrated by complete wound coverage and significant improvement in pain score.6 In 2012, Polieri et al. showed that HS 1% cream was comparable or more effective than glycosaminoglycan-polysulphate gel in alleviating the signs and symptoms of hematomas or subcutaneous hematic extravasations in a study with 96 white men and women.7
Conclusion
Heparan sulfate does appear to be a novel viable antiaging option. Endogenous heparan sulfate is involved in skin defense against pathogens, dehydrated/dried skin, redness, and wound healing. Theoretically, then, HS analogs should be able to modulate these processes. More research is necessary to determine if this is the case, however. In the meantime, HS analogs are extremely well tolerated by all patients and especially those with sensitive skin, which is often the case with aging skin. Further, HS analogs promote skin hydration, providing resistance to compressive forces as well as keeping skin looking healthy. Anecdotally, I can report that I have been using the Senté Dermal Repair Cream in my rosacea patients without any problems. I think HS analogs represent a good option for patients who cannot tolerate retinoids.
Resources
1. J Drugs Dermatol. 2015 Jul;14(7):669-74.
2. Proteoglycans in Skin Aging, in “Textbook of Aging Skin” (Heidelberg, Berlin: Springer-Verlag, pp. 109-120).
3. Joint Bone Spine. 2016 Sep 20. doi: 10.1016/j.jbspin.2016.06.012.
4. Ann Chir Plast Esthet. 2010 Oct;55(5):421-8.
5. Int Wound J. 2015 Apr;12(2):169-72.
6. Int Wound J. 2016 Feb;13(1):35-8.
7. ISRN Orthop. 2012 Jan 17. doi: 10.5402/2012/504151.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
The discussion this month focuses on an exciting new ingredient that is showing great promise as a topical antiaging agent. For years we have known that aging skin needs more collagen, elastin, and hyaluronic acid. It is time to add a new player to the antiaging team – heparan sulfate (HS). New studies have shown that lower levels of HS are associated with aged skin. This is what you need to know.
Significance of HS
Endogenous HS, an essential glycosaminoglycan (GAG), contributes to skin development and homeostasis, and thus actively promotes skin health.1 GAGs such as HS and hyaluronic acid are well known as endogenous superhydrators that bind and retain water, thus contributing to skin hydration as well as preserving the structural integrity of collagen and elastin fibers. Specifically, HS and its protein-bound forms (HS proteoglycans such as syndecan, glypican, and perlecan) – the most common constituents on the cell surface and in the extracellular matrix (ECM) – play an important role in cutaneous cell proliferation, migration, communication, and activation as well as collagen fiber development, basement membrane regeneration, granulation tissue formation, and cell adhesion related to wound healing.1 This results from their capacity to bind, store, present, degrade, and amplify growth factors and cytokines.
Accordingly, mature skin would be potently activated by its endogenous growth factors (at lower concentration) as cell signal is amplified (lower threshold of activation) by HS analogs. When used topically, HS analogs appear to promote the formation of healthy and functional ECM, resulting in firmer, more elastic, and stronger skin. Augmenting the amount of HS in the skin may yield a rejuvenating effect by expanding the skin’s ability to hold water and restore cutaneous homeostasis. Studies with an HS analog have demonstrated that the formulation penetrates into skin, enhancing hydration, reducing transepidermal water loss, and improving the appearance of wrinkles and skin tone.1 The use of HS analogs or mimics, known as matrix therapy, has been shown to be effective clinically in cutaneous and corneal healing formulations, exhibiting proof of concept in humans, according to Barritault et al.3
Matrix therapy also has been employed successfully in plastic and aesthetic procedures. Zakine et al. assessed the impact of using ReGeneraTing Agents (RGTA) – biodegradable polymers designed to mimic HS in the ECM of damaged tissue – in 17 patients with breast hypertrophy who underwent mammoplasty. Patients received topical treatment on one breast 1, 4, 8, and 11 days after surgery. The investigators also evaluated a different group of 50 patients after centrofacial lifting. These patients received RGTA drops bilaterally in the treatment area after surgery. Inflammation, hypertrophic scars, and pruritus were noted less frequently for the breasts treated with RGTA. Similarly, in patients receiving a centrofacial lift, scar inflammation, edema, and bruising were significantly less frequent in the treated group (10%), compared with the untreated group (90%).4
In 2015, Gallo et al. reported that 15 patients using a new HS analog formulation in an 8-week study displayed improvement in various skin metrics, including hydration, firmness, elasticity, barrier function, and the appearance of fine lines and wrinkles. The investigators concluded that photodamaged skin may benefit from the use of novel topically applied products containing low-molecular-weight HS.1
The synthetic heparan sulfate Cacipliq20 was reported in 2015 to have been used successfully to treat a chronic lower-extremity ulcer in a 22-year-old male patient with Stewart-Bluefarb syndrome,5 and in 2016 to treat a refractory sickle cell ulcer, with the encouraging outcome demonstrated by complete wound coverage and significant improvement in pain score.6 In 2012, Polieri et al. showed that HS 1% cream was comparable or more effective than glycosaminoglycan-polysulphate gel in alleviating the signs and symptoms of hematomas or subcutaneous hematic extravasations in a study with 96 white men and women.7
Conclusion
Heparan sulfate does appear to be a novel viable antiaging option. Endogenous heparan sulfate is involved in skin defense against pathogens, dehydrated/dried skin, redness, and wound healing. Theoretically, then, HS analogs should be able to modulate these processes. More research is necessary to determine if this is the case, however. In the meantime, HS analogs are extremely well tolerated by all patients and especially those with sensitive skin, which is often the case with aging skin. Further, HS analogs promote skin hydration, providing resistance to compressive forces as well as keeping skin looking healthy. Anecdotally, I can report that I have been using the Senté Dermal Repair Cream in my rosacea patients without any problems. I think HS analogs represent a good option for patients who cannot tolerate retinoids.
Resources
1. J Drugs Dermatol. 2015 Jul;14(7):669-74.
2. Proteoglycans in Skin Aging, in “Textbook of Aging Skin” (Heidelberg, Berlin: Springer-Verlag, pp. 109-120).
3. Joint Bone Spine. 2016 Sep 20. doi: 10.1016/j.jbspin.2016.06.012.
4. Ann Chir Plast Esthet. 2010 Oct;55(5):421-8.
5. Int Wound J. 2015 Apr;12(2):169-72.
6. Int Wound J. 2016 Feb;13(1):35-8.
7. ISRN Orthop. 2012 Jan 17. doi: 10.5402/2012/504151.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Wheat in skin care
Gluten-free food products have inundated the marketplace in recent years as the food industry has responded to greater awareness of celiac sprue disease and wheat sensitivity. Gluten is the primary form of wheat protein.
Wheat is a versatile and globally popular member of the Poaceae or Gramineae family known as grasses; it is of the Triticum species with Triticum aestivum and Triticum vulgare being particularly pervasive.1 In traditional Iranian medicine, the topical application of wheat germ oil has been used to treat psoriasis.2
Moisturization
In 2008, N. Akhtar and Y. Yazan investigated the effects of a stable emulsion containing two ingredients included to exert anti-aging effects: vitamin C and wheat protein. The antioxidant vitamin C was entrapped in the inner aqueous phase of the water-in-oil-in-water emulsion while wheat protein was incorporated in the oily phase. The investigators prepared and applied stable emulsions to the cheeks of 11 volunteers over 4 weeks, finding that the formulation increased skin moisture.7
Melanoma and wheat supplementation
Demidov et al. reported in 2008 on a randomized, pilot, phase II clinical trial to assess the impact of the adjuvant use of a fermented wheat germ extract nutraceutical (Avemar) in high-risk cutaneous melanoma patients. Investigators compared the efficacy of dacarbazine-based adjuvant chemotherapy on survival parameters of melanoma patients to that of the identical treatment supplemented with a 1-year administration of fermented wheat germ extract nutraceutical (FWGE), which is generally recognized as safe. They reported that after a 7-year follow-up, significant differences favoring the nutraceutical group were observed in progression-free and overall survival. Including nutraceutical as an adjuvant treatment for such patients was recommended by the authors.8
Telekes et al. noted that nutraceutical is registered as a special nutriment for cancer patients in Hungary that has exhibited potent anticancer activity on cell lines and immunomodulatory activity in vivo.9 In 2005, Boros et al. reported that orally administered FWGE suppressed metastatic tumor dissemination and proliferation during and after chemotherapy, surgery, or radiation, with benefits seen in some human cancers and cultured cells as well as some autoimmune disorders and in chemical carcinogenesis prevention.10
Hypersensitivity and allergic reactions
The risks of sensitization to topical wheat proteins are thought to be higher in patients with atopic dermatitis, who have an impaired skin barrier.1 Indeed, Codreanu et al. have suggested that topical products containing food proteins of known allergenicity (including wheat) are contraindicated for neonates and infants with atopic dermatitis.11
In 2015, Bonciolini et al. studied 17 patients (13 females and 4 males, median age 36 years) with nonceliac gluten sensitivity presenting with nonspecific skin lesions. The eczema-, psoriasis-, or dermatitis herpetiformis-like lesions on the extensor surfaces of the upper and lower limbs, especially, were confirmed histologically, but immunopathological evaluations revealed pervasive C3 deposits along the dermoepidermal junction in a microgranular/granular pattern (82%). Notably, all of the patients improved markedly after initiating a gluten-free diet.12
In 2014, Fukutomi et al. conducted a case-control study of Japanese women aged 20-54 years (157 cases) who self-reported wheat allergy to ascertain the epidemiologic relationship between food allergy to wheat after exposure to facial soaps containing hydrolyzed wheat protein. There were 449 age-matched controls without wheat allergy. Participants answered a Web-based questionnaire about their use of skin and hair care products. The investigators found that current use of the facial soap Cha no Shizuku (Drop of Tea), which contains hydrolyzed wheat protein, was significantly linked to a greater risk of wheat allergy, with use of the soap more frequent in consumers whose wheat allergy had newly emerged (11% vs. 6% in controls).13
Cha no Shizuku had earlier been implicated in provoking hundreds of cases of allergic reactions between 2009 and June 2013. R. Teshima noted that the soap contains acid-hydrolyzed wheat protein produced from gluten after partial hydrolysis with hydrogen chloride at 95 ° C for 40 minutes.14
It is worth noting that case reports of allergic reactions to facial soap containing hydrolyzed wheat protein continue to appear. Iseki et al. described in 2014 a 38-year-old woman who experienced irregular headaches, sleepiness, and an episode of facial rash eruption after daily use for about 1 year of a facial soap with hydrolyzed wheat proteins (Glupearl 19s, which is also used in Cha no Shizuku). The investigators added that the patient’s serum contained wheat-specific IgE antibodies. Symptoms disappeared after the patient abstained from wheat.15
In 2012, Tammaro studied cutaneous hypersensitivity to gluten in 14 female patients (aged 12-60 years) with celiac disease who presented with eczema on the face, neck, and arms, after topical application of gluten-containing emollient cream, bath or face powder, or contact with foods containing wheat and durum. Five of the patients tested positive for wheat and durum wheat, while none of the 14 control patients tested positive. Improvement in cutaneous lesions, with no relapses during a 6-month follow-up, resulted when these patients used gluten-free cream and bath powder, and wore gloves before handling wheat-containing food.16
In 2011, Celakovská et al. studied the impact of wheat allergy in 179 adults with atopic eczema (128 females, 51 males; average age 26 years), using open exposure and double-blind, placebo-controlled food challenge tests, as well as specific serum IgE, skin prick, and atopy patch tests. The double-blind, placebo-controlled food challenge test showed that the course of atopic eczema was exacerbated by wheat allergy in eight patients (4.5%). A positive trend revealing that the course of atopic eczema was impacted by wheat allergy emerged during follow-up (at 3, 6, 9, and 12 months).17
Contact urticaria also has been reported to have been induced by hydrolyzed wheat proteins in cosmetics and is notable for the potential to precede food allergies.2,3 A wide variety of protein hydrolysates found in hair products have been associated with inducing contact urticaria, particularly in patients with atopic dermatitis.4
In 2006, Laurière et al. studied nine female patients without common wheat allergy who presented with contact urticaria to cosmetics containing hydrolyzed wheat proteins; six also had experienced generalized urticaria or anaphylaxis in response to foods containing such wheat proteins. Analyses revealed the importance of hydrolysis in augmenting the allergenicity of wheat proteins through contact or consumption.18 Immediate contact urticaria in reaction to hydrolyzed wheat protein in topical products also has been reported in a child.19
Conclusion
Can the presence of wheat hydrolysates in personal care products adversely affect a patient with celiac sprue or wheat sensitivity? The short answer appears to be “yes.” Given the use of hydrolyzed wheat protein in various skin care products, it is important that consumers who have celiac disease or sensitivity to wheat be advised to avoid skin care formulations with such active ingredients. On the positive side of the wheat ledger, there are some indications (albeit in very limited research) that the plant protein may impart beneficial health effects. Much more research is necessary to delineate the full impact of wheat on skin health.
I thank my dermatologist colleague Sharon E. Jacob, MD, at the University of Miami, for suggesting this topic.
References
1. Dermatitis. 2013 Nov-Dec;24(6):291-5.
2. Iran J Med Sci. 2016 May;41(3 Suppl):S54.
3. Contact Dermatitis. 2007 Feb;56(2):119-20.
4. Ann Dermatol Venereol. 2010 Apr;137(4):281-4.
5. Allergy. 1998 Nov;53(11):1078-82.
6. J Drugs Dermatol. 2013 Sep;12(9 Suppl):s133-6.
7. Pak J Pharm Sci. 2008 Jan;21(1):45-50.
8. Cancer Biother Radiopharm. 2008 Aug;23(4):477-82.
9. Nutr Cancer. 2009;61(6):891-9.
10. Ann N Y Acad Sci. 2005 Jun;1051:529-42.
11. Eur Ann Allergy Clin Immunol. 2006 Apr;38(4):126-30.
12. Nutrients. 2015 Sep 15;7(9):7798-805.
13. Allergy. 2014 Oct;69(10):1405-11.
14. Yakugaku Zasshi. 2014;134(1):33-8.
15. Intern Med. 2014;53(2):151-4.
16. Dermatitis. 2012 Sep-Oct;23(5):220-1.
17. Acta Medica (Hradec Kralove). 2011;54(4):157-62.
18. Contact Dermatitis. 2006 May;54(5):283-9.
19. Contact Dermatitis. 2013 Jun;68(6):379-80.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Gluten-free food products have inundated the marketplace in recent years as the food industry has responded to greater awareness of celiac sprue disease and wheat sensitivity. Gluten is the primary form of wheat protein.
Wheat is a versatile and globally popular member of the Poaceae or Gramineae family known as grasses; it is of the Triticum species with Triticum aestivum and Triticum vulgare being particularly pervasive.1 In traditional Iranian medicine, the topical application of wheat germ oil has been used to treat psoriasis.2
Moisturization
In 2008, N. Akhtar and Y. Yazan investigated the effects of a stable emulsion containing two ingredients included to exert anti-aging effects: vitamin C and wheat protein. The antioxidant vitamin C was entrapped in the inner aqueous phase of the water-in-oil-in-water emulsion while wheat protein was incorporated in the oily phase. The investigators prepared and applied stable emulsions to the cheeks of 11 volunteers over 4 weeks, finding that the formulation increased skin moisture.7
Melanoma and wheat supplementation
Demidov et al. reported in 2008 on a randomized, pilot, phase II clinical trial to assess the impact of the adjuvant use of a fermented wheat germ extract nutraceutical (Avemar) in high-risk cutaneous melanoma patients. Investigators compared the efficacy of dacarbazine-based adjuvant chemotherapy on survival parameters of melanoma patients to that of the identical treatment supplemented with a 1-year administration of fermented wheat germ extract nutraceutical (FWGE), which is generally recognized as safe. They reported that after a 7-year follow-up, significant differences favoring the nutraceutical group were observed in progression-free and overall survival. Including nutraceutical as an adjuvant treatment for such patients was recommended by the authors.8
Telekes et al. noted that nutraceutical is registered as a special nutriment for cancer patients in Hungary that has exhibited potent anticancer activity on cell lines and immunomodulatory activity in vivo.9 In 2005, Boros et al. reported that orally administered FWGE suppressed metastatic tumor dissemination and proliferation during and after chemotherapy, surgery, or radiation, with benefits seen in some human cancers and cultured cells as well as some autoimmune disorders and in chemical carcinogenesis prevention.10
Hypersensitivity and allergic reactions
The risks of sensitization to topical wheat proteins are thought to be higher in patients with atopic dermatitis, who have an impaired skin barrier.1 Indeed, Codreanu et al. have suggested that topical products containing food proteins of known allergenicity (including wheat) are contraindicated for neonates and infants with atopic dermatitis.11
In 2015, Bonciolini et al. studied 17 patients (13 females and 4 males, median age 36 years) with nonceliac gluten sensitivity presenting with nonspecific skin lesions. The eczema-, psoriasis-, or dermatitis herpetiformis-like lesions on the extensor surfaces of the upper and lower limbs, especially, were confirmed histologically, but immunopathological evaluations revealed pervasive C3 deposits along the dermoepidermal junction in a microgranular/granular pattern (82%). Notably, all of the patients improved markedly after initiating a gluten-free diet.12
In 2014, Fukutomi et al. conducted a case-control study of Japanese women aged 20-54 years (157 cases) who self-reported wheat allergy to ascertain the epidemiologic relationship between food allergy to wheat after exposure to facial soaps containing hydrolyzed wheat protein. There were 449 age-matched controls without wheat allergy. Participants answered a Web-based questionnaire about their use of skin and hair care products. The investigators found that current use of the facial soap Cha no Shizuku (Drop of Tea), which contains hydrolyzed wheat protein, was significantly linked to a greater risk of wheat allergy, with use of the soap more frequent in consumers whose wheat allergy had newly emerged (11% vs. 6% in controls).13
Cha no Shizuku had earlier been implicated in provoking hundreds of cases of allergic reactions between 2009 and June 2013. R. Teshima noted that the soap contains acid-hydrolyzed wheat protein produced from gluten after partial hydrolysis with hydrogen chloride at 95 ° C for 40 minutes.14
It is worth noting that case reports of allergic reactions to facial soap containing hydrolyzed wheat protein continue to appear. Iseki et al. described in 2014 a 38-year-old woman who experienced irregular headaches, sleepiness, and an episode of facial rash eruption after daily use for about 1 year of a facial soap with hydrolyzed wheat proteins (Glupearl 19s, which is also used in Cha no Shizuku). The investigators added that the patient’s serum contained wheat-specific IgE antibodies. Symptoms disappeared after the patient abstained from wheat.15
In 2012, Tammaro studied cutaneous hypersensitivity to gluten in 14 female patients (aged 12-60 years) with celiac disease who presented with eczema on the face, neck, and arms, after topical application of gluten-containing emollient cream, bath or face powder, or contact with foods containing wheat and durum. Five of the patients tested positive for wheat and durum wheat, while none of the 14 control patients tested positive. Improvement in cutaneous lesions, with no relapses during a 6-month follow-up, resulted when these patients used gluten-free cream and bath powder, and wore gloves before handling wheat-containing food.16
In 2011, Celakovská et al. studied the impact of wheat allergy in 179 adults with atopic eczema (128 females, 51 males; average age 26 years), using open exposure and double-blind, placebo-controlled food challenge tests, as well as specific serum IgE, skin prick, and atopy patch tests. The double-blind, placebo-controlled food challenge test showed that the course of atopic eczema was exacerbated by wheat allergy in eight patients (4.5%). A positive trend revealing that the course of atopic eczema was impacted by wheat allergy emerged during follow-up (at 3, 6, 9, and 12 months).17
Contact urticaria also has been reported to have been induced by hydrolyzed wheat proteins in cosmetics and is notable for the potential to precede food allergies.2,3 A wide variety of protein hydrolysates found in hair products have been associated with inducing contact urticaria, particularly in patients with atopic dermatitis.4
In 2006, Laurière et al. studied nine female patients without common wheat allergy who presented with contact urticaria to cosmetics containing hydrolyzed wheat proteins; six also had experienced generalized urticaria or anaphylaxis in response to foods containing such wheat proteins. Analyses revealed the importance of hydrolysis in augmenting the allergenicity of wheat proteins through contact or consumption.18 Immediate contact urticaria in reaction to hydrolyzed wheat protein in topical products also has been reported in a child.19
Conclusion
Can the presence of wheat hydrolysates in personal care products adversely affect a patient with celiac sprue or wheat sensitivity? The short answer appears to be “yes.” Given the use of hydrolyzed wheat protein in various skin care products, it is important that consumers who have celiac disease or sensitivity to wheat be advised to avoid skin care formulations with such active ingredients. On the positive side of the wheat ledger, there are some indications (albeit in very limited research) that the plant protein may impart beneficial health effects. Much more research is necessary to delineate the full impact of wheat on skin health.
I thank my dermatologist colleague Sharon E. Jacob, MD, at the University of Miami, for suggesting this topic.
References
1. Dermatitis. 2013 Nov-Dec;24(6):291-5.
2. Iran J Med Sci. 2016 May;41(3 Suppl):S54.
3. Contact Dermatitis. 2007 Feb;56(2):119-20.
4. Ann Dermatol Venereol. 2010 Apr;137(4):281-4.
5. Allergy. 1998 Nov;53(11):1078-82.
6. J Drugs Dermatol. 2013 Sep;12(9 Suppl):s133-6.
7. Pak J Pharm Sci. 2008 Jan;21(1):45-50.
8. Cancer Biother Radiopharm. 2008 Aug;23(4):477-82.
9. Nutr Cancer. 2009;61(6):891-9.
10. Ann N Y Acad Sci. 2005 Jun;1051:529-42.
11. Eur Ann Allergy Clin Immunol. 2006 Apr;38(4):126-30.
12. Nutrients. 2015 Sep 15;7(9):7798-805.
13. Allergy. 2014 Oct;69(10):1405-11.
14. Yakugaku Zasshi. 2014;134(1):33-8.
15. Intern Med. 2014;53(2):151-4.
16. Dermatitis. 2012 Sep-Oct;23(5):220-1.
17. Acta Medica (Hradec Kralove). 2011;54(4):157-62.
18. Contact Dermatitis. 2006 May;54(5):283-9.
19. Contact Dermatitis. 2013 Jun;68(6):379-80.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Gluten-free food products have inundated the marketplace in recent years as the food industry has responded to greater awareness of celiac sprue disease and wheat sensitivity. Gluten is the primary form of wheat protein.
Wheat is a versatile and globally popular member of the Poaceae or Gramineae family known as grasses; it is of the Triticum species with Triticum aestivum and Triticum vulgare being particularly pervasive.1 In traditional Iranian medicine, the topical application of wheat germ oil has been used to treat psoriasis.2
Moisturization
In 2008, N. Akhtar and Y. Yazan investigated the effects of a stable emulsion containing two ingredients included to exert anti-aging effects: vitamin C and wheat protein. The antioxidant vitamin C was entrapped in the inner aqueous phase of the water-in-oil-in-water emulsion while wheat protein was incorporated in the oily phase. The investigators prepared and applied stable emulsions to the cheeks of 11 volunteers over 4 weeks, finding that the formulation increased skin moisture.7
Melanoma and wheat supplementation
Demidov et al. reported in 2008 on a randomized, pilot, phase II clinical trial to assess the impact of the adjuvant use of a fermented wheat germ extract nutraceutical (Avemar) in high-risk cutaneous melanoma patients. Investigators compared the efficacy of dacarbazine-based adjuvant chemotherapy on survival parameters of melanoma patients to that of the identical treatment supplemented with a 1-year administration of fermented wheat germ extract nutraceutical (FWGE), which is generally recognized as safe. They reported that after a 7-year follow-up, significant differences favoring the nutraceutical group were observed in progression-free and overall survival. Including nutraceutical as an adjuvant treatment for such patients was recommended by the authors.8
Telekes et al. noted that nutraceutical is registered as a special nutriment for cancer patients in Hungary that has exhibited potent anticancer activity on cell lines and immunomodulatory activity in vivo.9 In 2005, Boros et al. reported that orally administered FWGE suppressed metastatic tumor dissemination and proliferation during and after chemotherapy, surgery, or radiation, with benefits seen in some human cancers and cultured cells as well as some autoimmune disorders and in chemical carcinogenesis prevention.10
Hypersensitivity and allergic reactions
The risks of sensitization to topical wheat proteins are thought to be higher in patients with atopic dermatitis, who have an impaired skin barrier.1 Indeed, Codreanu et al. have suggested that topical products containing food proteins of known allergenicity (including wheat) are contraindicated for neonates and infants with atopic dermatitis.11
In 2015, Bonciolini et al. studied 17 patients (13 females and 4 males, median age 36 years) with nonceliac gluten sensitivity presenting with nonspecific skin lesions. The eczema-, psoriasis-, or dermatitis herpetiformis-like lesions on the extensor surfaces of the upper and lower limbs, especially, were confirmed histologically, but immunopathological evaluations revealed pervasive C3 deposits along the dermoepidermal junction in a microgranular/granular pattern (82%). Notably, all of the patients improved markedly after initiating a gluten-free diet.12
In 2014, Fukutomi et al. conducted a case-control study of Japanese women aged 20-54 years (157 cases) who self-reported wheat allergy to ascertain the epidemiologic relationship between food allergy to wheat after exposure to facial soaps containing hydrolyzed wheat protein. There were 449 age-matched controls without wheat allergy. Participants answered a Web-based questionnaire about their use of skin and hair care products. The investigators found that current use of the facial soap Cha no Shizuku (Drop of Tea), which contains hydrolyzed wheat protein, was significantly linked to a greater risk of wheat allergy, with use of the soap more frequent in consumers whose wheat allergy had newly emerged (11% vs. 6% in controls).13
Cha no Shizuku had earlier been implicated in provoking hundreds of cases of allergic reactions between 2009 and June 2013. R. Teshima noted that the soap contains acid-hydrolyzed wheat protein produced from gluten after partial hydrolysis with hydrogen chloride at 95 ° C for 40 minutes.14
It is worth noting that case reports of allergic reactions to facial soap containing hydrolyzed wheat protein continue to appear. Iseki et al. described in 2014 a 38-year-old woman who experienced irregular headaches, sleepiness, and an episode of facial rash eruption after daily use for about 1 year of a facial soap with hydrolyzed wheat proteins (Glupearl 19s, which is also used in Cha no Shizuku). The investigators added that the patient’s serum contained wheat-specific IgE antibodies. Symptoms disappeared after the patient abstained from wheat.15
In 2012, Tammaro studied cutaneous hypersensitivity to gluten in 14 female patients (aged 12-60 years) with celiac disease who presented with eczema on the face, neck, and arms, after topical application of gluten-containing emollient cream, bath or face powder, or contact with foods containing wheat and durum. Five of the patients tested positive for wheat and durum wheat, while none of the 14 control patients tested positive. Improvement in cutaneous lesions, with no relapses during a 6-month follow-up, resulted when these patients used gluten-free cream and bath powder, and wore gloves before handling wheat-containing food.16
In 2011, Celakovská et al. studied the impact of wheat allergy in 179 adults with atopic eczema (128 females, 51 males; average age 26 years), using open exposure and double-blind, placebo-controlled food challenge tests, as well as specific serum IgE, skin prick, and atopy patch tests. The double-blind, placebo-controlled food challenge test showed that the course of atopic eczema was exacerbated by wheat allergy in eight patients (4.5%). A positive trend revealing that the course of atopic eczema was impacted by wheat allergy emerged during follow-up (at 3, 6, 9, and 12 months).17
Contact urticaria also has been reported to have been induced by hydrolyzed wheat proteins in cosmetics and is notable for the potential to precede food allergies.2,3 A wide variety of protein hydrolysates found in hair products have been associated with inducing contact urticaria, particularly in patients with atopic dermatitis.4
In 2006, Laurière et al. studied nine female patients without common wheat allergy who presented with contact urticaria to cosmetics containing hydrolyzed wheat proteins; six also had experienced generalized urticaria or anaphylaxis in response to foods containing such wheat proteins. Analyses revealed the importance of hydrolysis in augmenting the allergenicity of wheat proteins through contact or consumption.18 Immediate contact urticaria in reaction to hydrolyzed wheat protein in topical products also has been reported in a child.19
Conclusion
Can the presence of wheat hydrolysates in personal care products adversely affect a patient with celiac sprue or wheat sensitivity? The short answer appears to be “yes.” Given the use of hydrolyzed wheat protein in various skin care products, it is important that consumers who have celiac disease or sensitivity to wheat be advised to avoid skin care formulations with such active ingredients. On the positive side of the wheat ledger, there are some indications (albeit in very limited research) that the plant protein may impart beneficial health effects. Much more research is necessary to delineate the full impact of wheat on skin health.
I thank my dermatologist colleague Sharon E. Jacob, MD, at the University of Miami, for suggesting this topic.
References
1. Dermatitis. 2013 Nov-Dec;24(6):291-5.
2. Iran J Med Sci. 2016 May;41(3 Suppl):S54.
3. Contact Dermatitis. 2007 Feb;56(2):119-20.
4. Ann Dermatol Venereol. 2010 Apr;137(4):281-4.
5. Allergy. 1998 Nov;53(11):1078-82.
6. J Drugs Dermatol. 2013 Sep;12(9 Suppl):s133-6.
7. Pak J Pharm Sci. 2008 Jan;21(1):45-50.
8. Cancer Biother Radiopharm. 2008 Aug;23(4):477-82.
9. Nutr Cancer. 2009;61(6):891-9.
10. Ann N Y Acad Sci. 2005 Jun;1051:529-42.
11. Eur Ann Allergy Clin Immunol. 2006 Apr;38(4):126-30.
12. Nutrients. 2015 Sep 15;7(9):7798-805.
13. Allergy. 2014 Oct;69(10):1405-11.
14. Yakugaku Zasshi. 2014;134(1):33-8.
15. Intern Med. 2014;53(2):151-4.
16. Dermatitis. 2012 Sep-Oct;23(5):220-1.
17. Acta Medica (Hradec Kralove). 2011;54(4):157-62.
18. Contact Dermatitis. 2006 May;54(5):283-9.
19. Contact Dermatitis. 2013 Jun;68(6):379-80.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Topix Pharmaceuticals, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Silver
Silver is a naturally occurring chemical element (number 47 on the periodic table) with the chemical symbol Ag, which is derived from the Latin word argentum (árgyros in Greek), from the Indo-European root “arg-,” meaning “shining,” “white,” or “gray.” It has been used for medical purposes since ancient times, with Hippocrates (circa 460-370 BCE) noting the beneficial healing and disease-altering activity of the element.1
In modern times, silver compounds – in metallic, nanocrystalline, and ionic formulations – have exhibited broad antibacterial activity and attracted interest for topical antiseptic use in wound dressings.2 Nanocrystalline silver dressings were introduced commercially as antimicrobial dressings in 1998.3 Silver is now used in dressings, catheters, cleansers, ophthalmic ointments, and myriad other medical products. In 2010 alone, an estimated 15 metric tons of silver were incorporated into medical products worldwide.4 It also is included in personal care products, textiles, and water purification devices. In topical skin preparations, the noble metal is included as colloidal silver (suspension of silver particles in an aqueous base) or nanosilver (as nanoparticles ranging from 1 nm to 100 nm in at least one dimension).5 Silver has been used to treat burns and wounds, but this discussion will be limited to acne, atopic dermatitis, and the anti-inflammatory response.
Anti-inflammatory uses
For several decades, noble metals including silver have been known to exert anti-inflammatory activity.7-11 In the case of silver, its anti-inflammatory properties appear to be mediated by its influence on the cytokine system. Silver nanoparticles inhibit the activity of interleukin-6 (IL-6), IL-12, IL-1beta, and tumor necrosis factor–alpha (TNF-alpha). This impact on the cytokine system is responsible for the impact of silver in demonstrably alleviating symptoms of rheumatoid arthritis.3
In 2004, Bhol et al. used dinitrochlorobenzene (DNCB) to induce allergic contact dermatitis in a guinea pig model, finding that topical nanocrystalline silver cream dose-dependently decreased erythema and as effectively as topical steroids and immunosuppressants.12 The next year, Bhol and Schechter showed that nanocrystalline silver suppressed allergic contact dermatitis in mice, inhibited TNF-alpha and IL-12 expression, and induced inflammatory cell apoptosis.13
In 2008, Nadworny et al. used a porcine contact dermatitis model to investigate the anti-inflammatory activity of nanocrystalline silver. They found that nanocrystalline silver treatments reduced DNCB-induced erythema and edema, promoted apoptosis in dermal cells, and diminished matrix metalloproteinase (MMP) and proinflammatory cytokine expression.3 The investigators speculated that the lower TNF-alpha observed in the silver-treated animals occurred due to apoptosis of the inflammatory cells.
Acne
Silver acts as a bactericidal and anti-inflammatory agent, without generating free radicals, as seen with benzoyl peroxide. Therefore, it is a compelling option for responding to the presence of Propionibacterium acnes. However, silver has not been approved by the Food and Drug Administration for this use. Even though formal acne studies have not been performed with silver sulfadiazine, it has long been used “off-label” for this purpose. As suggested above, the use of silver sulfadiazine for acne is limited by the risk of sulfa allergy. Cosmetic appearance and ease of use also are limiting factors, as silver sulfadiazine preparations are characterized by a thick, white pasty consistency. Other options for use of silver to treat acne include silver-containing cleansers and textiles.
Atopic dermatitis
A 2006 study in patients with atopic dermatitis demonstrated that silver-coated textiles could significantly diminish Staphylococcus aureus density after 2 days of wearing, with the effect enduring through the end of 7 days of treatment and then 1 week after removal of the textiles.14 Within 2 weeks, objective and subjective symptoms of atopic dermatitis were significantly enhanced in association with the silver-coated textiles, compared with cotton, without measurable adverse effects. A technology called Padycare incorporates silver into micromesh material (82% polyamide, 18% Lycra) used in clothing and bedding.15 As compared with topical formulations applied directly to the skin, textiles confer certain advantages such as preventing scratching and protecting against irritating substances and allergens. Washing of silver-infused textiles is a possible disadvantage, though, as the amount of silver lost from textiles can range from a 100% loss after four washings to less than a 1% loss.16 It also is important to note that there are concerns regarding the potential of silver to leak from textiles into the water supply, and eradicating the beneficial bacteria used to treat the water.
Conclusion
Despite centuries of medical use, silver has not been approved by the FDA for any medical applications. Further study, particularly in terms of safety and efficacy, is necessary. Nevertheless, it is used off-label before and after minimally invasive dermatologic procedures (for example, dermal filling, botulinum toxin injections, chemical peeling) because of its antimicrobial and anti-inflammatory activities as well as soothing qualities for facial skin and the skin barrier. Silver appears to be particularly suitable for use as an acne therapy option due to the low risk of bacterial resistance, lack of irritation, and its preservation of the skin barrier unlike harsher options such as retinoids, antibiotics, and benzoyl peroxide.
References
1. Adv Skin Wound Care. 2006 Nov-Dec;19(9):472-4.
2. Clin Infect Dis. 2009 Nov 15;49(10):1541-9.
3. Nanomedicine. 2008 Sep;4(3):241-51.
4. J Antimicrob Chemother. 2013 Jan;68(1):131-8.
5. Nanocrystalline Silver: Use in wound care, in Current Advances in the Medical Application of Nanotechnology (Manchester, England: Bentham Books, 2012, pp. 25-31).
6. Nanomedicine. 2013 Jan;9(1):39-54.
7. Jpn J Pharmacol. 1965 Jun;15(2):131-4.
8. J Allergy Clin Immunol. 1995 Aug;96(2):251-6.
9. Inflamm Res. 2003 Dec;52(12):487-501.
10. J Nutr Environ Med. 1997;7(4):295-305.
11. Clin Exp Pharmacol Physiol. 2000 Mar;27(3):139-44.
12. Clin Exp Dermatol. 2004 May;29(3):282-7.
13. Br J Dermatol. 2005 Jun;152(6):1235-42.
14. Curr Probl Dermatol. 2006;33:152-64.
15. J Eur Acad Dermatol Venereol. 2006 May;20(5):534-41.
16. Environ Sci Technol. 2008 Jun 1;42(11):4133-9.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis, Neutrogena, Philosophy, Topix, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Silver is a naturally occurring chemical element (number 47 on the periodic table) with the chemical symbol Ag, which is derived from the Latin word argentum (árgyros in Greek), from the Indo-European root “arg-,” meaning “shining,” “white,” or “gray.” It has been used for medical purposes since ancient times, with Hippocrates (circa 460-370 BCE) noting the beneficial healing and disease-altering activity of the element.1
In modern times, silver compounds – in metallic, nanocrystalline, and ionic formulations – have exhibited broad antibacterial activity and attracted interest for topical antiseptic use in wound dressings.2 Nanocrystalline silver dressings were introduced commercially as antimicrobial dressings in 1998.3 Silver is now used in dressings, catheters, cleansers, ophthalmic ointments, and myriad other medical products. In 2010 alone, an estimated 15 metric tons of silver were incorporated into medical products worldwide.4 It also is included in personal care products, textiles, and water purification devices. In topical skin preparations, the noble metal is included as colloidal silver (suspension of silver particles in an aqueous base) or nanosilver (as nanoparticles ranging from 1 nm to 100 nm in at least one dimension).5 Silver has been used to treat burns and wounds, but this discussion will be limited to acne, atopic dermatitis, and the anti-inflammatory response.
Anti-inflammatory uses
For several decades, noble metals including silver have been known to exert anti-inflammatory activity.7-11 In the case of silver, its anti-inflammatory properties appear to be mediated by its influence on the cytokine system. Silver nanoparticles inhibit the activity of interleukin-6 (IL-6), IL-12, IL-1beta, and tumor necrosis factor–alpha (TNF-alpha). This impact on the cytokine system is responsible for the impact of silver in demonstrably alleviating symptoms of rheumatoid arthritis.3
In 2004, Bhol et al. used dinitrochlorobenzene (DNCB) to induce allergic contact dermatitis in a guinea pig model, finding that topical nanocrystalline silver cream dose-dependently decreased erythema and as effectively as topical steroids and immunosuppressants.12 The next year, Bhol and Schechter showed that nanocrystalline silver suppressed allergic contact dermatitis in mice, inhibited TNF-alpha and IL-12 expression, and induced inflammatory cell apoptosis.13
In 2008, Nadworny et al. used a porcine contact dermatitis model to investigate the anti-inflammatory activity of nanocrystalline silver. They found that nanocrystalline silver treatments reduced DNCB-induced erythema and edema, promoted apoptosis in dermal cells, and diminished matrix metalloproteinase (MMP) and proinflammatory cytokine expression.3 The investigators speculated that the lower TNF-alpha observed in the silver-treated animals occurred due to apoptosis of the inflammatory cells.
Acne
Silver acts as a bactericidal and anti-inflammatory agent, without generating free radicals, as seen with benzoyl peroxide. Therefore, it is a compelling option for responding to the presence of Propionibacterium acnes. However, silver has not been approved by the Food and Drug Administration for this use. Even though formal acne studies have not been performed with silver sulfadiazine, it has long been used “off-label” for this purpose. As suggested above, the use of silver sulfadiazine for acne is limited by the risk of sulfa allergy. Cosmetic appearance and ease of use also are limiting factors, as silver sulfadiazine preparations are characterized by a thick, white pasty consistency. Other options for use of silver to treat acne include silver-containing cleansers and textiles.
Atopic dermatitis
A 2006 study in patients with atopic dermatitis demonstrated that silver-coated textiles could significantly diminish Staphylococcus aureus density after 2 days of wearing, with the effect enduring through the end of 7 days of treatment and then 1 week after removal of the textiles.14 Within 2 weeks, objective and subjective symptoms of atopic dermatitis were significantly enhanced in association with the silver-coated textiles, compared with cotton, without measurable adverse effects. A technology called Padycare incorporates silver into micromesh material (82% polyamide, 18% Lycra) used in clothing and bedding.15 As compared with topical formulations applied directly to the skin, textiles confer certain advantages such as preventing scratching and protecting against irritating substances and allergens. Washing of silver-infused textiles is a possible disadvantage, though, as the amount of silver lost from textiles can range from a 100% loss after four washings to less than a 1% loss.16 It also is important to note that there are concerns regarding the potential of silver to leak from textiles into the water supply, and eradicating the beneficial bacteria used to treat the water.
Conclusion
Despite centuries of medical use, silver has not been approved by the FDA for any medical applications. Further study, particularly in terms of safety and efficacy, is necessary. Nevertheless, it is used off-label before and after minimally invasive dermatologic procedures (for example, dermal filling, botulinum toxin injections, chemical peeling) because of its antimicrobial and anti-inflammatory activities as well as soothing qualities for facial skin and the skin barrier. Silver appears to be particularly suitable for use as an acne therapy option due to the low risk of bacterial resistance, lack of irritation, and its preservation of the skin barrier unlike harsher options such as retinoids, antibiotics, and benzoyl peroxide.
References
1. Adv Skin Wound Care. 2006 Nov-Dec;19(9):472-4.
2. Clin Infect Dis. 2009 Nov 15;49(10):1541-9.
3. Nanomedicine. 2008 Sep;4(3):241-51.
4. J Antimicrob Chemother. 2013 Jan;68(1):131-8.
5. Nanocrystalline Silver: Use in wound care, in Current Advances in the Medical Application of Nanotechnology (Manchester, England: Bentham Books, 2012, pp. 25-31).
6. Nanomedicine. 2013 Jan;9(1):39-54.
7. Jpn J Pharmacol. 1965 Jun;15(2):131-4.
8. J Allergy Clin Immunol. 1995 Aug;96(2):251-6.
9. Inflamm Res. 2003 Dec;52(12):487-501.
10. J Nutr Environ Med. 1997;7(4):295-305.
11. Clin Exp Pharmacol Physiol. 2000 Mar;27(3):139-44.
12. Clin Exp Dermatol. 2004 May;29(3):282-7.
13. Br J Dermatol. 2005 Jun;152(6):1235-42.
14. Curr Probl Dermatol. 2006;33:152-64.
15. J Eur Acad Dermatol Venereol. 2006 May;20(5):534-41.
16. Environ Sci Technol. 2008 Jun 1;42(11):4133-9.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis, Neutrogena, Philosophy, Topix, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.
Silver is a naturally occurring chemical element (number 47 on the periodic table) with the chemical symbol Ag, which is derived from the Latin word argentum (árgyros in Greek), from the Indo-European root “arg-,” meaning “shining,” “white,” or “gray.” It has been used for medical purposes since ancient times, with Hippocrates (circa 460-370 BCE) noting the beneficial healing and disease-altering activity of the element.1
In modern times, silver compounds – in metallic, nanocrystalline, and ionic formulations – have exhibited broad antibacterial activity and attracted interest for topical antiseptic use in wound dressings.2 Nanocrystalline silver dressings were introduced commercially as antimicrobial dressings in 1998.3 Silver is now used in dressings, catheters, cleansers, ophthalmic ointments, and myriad other medical products. In 2010 alone, an estimated 15 metric tons of silver were incorporated into medical products worldwide.4 It also is included in personal care products, textiles, and water purification devices. In topical skin preparations, the noble metal is included as colloidal silver (suspension of silver particles in an aqueous base) or nanosilver (as nanoparticles ranging from 1 nm to 100 nm in at least one dimension).5 Silver has been used to treat burns and wounds, but this discussion will be limited to acne, atopic dermatitis, and the anti-inflammatory response.
Anti-inflammatory uses
For several decades, noble metals including silver have been known to exert anti-inflammatory activity.7-11 In the case of silver, its anti-inflammatory properties appear to be mediated by its influence on the cytokine system. Silver nanoparticles inhibit the activity of interleukin-6 (IL-6), IL-12, IL-1beta, and tumor necrosis factor–alpha (TNF-alpha). This impact on the cytokine system is responsible for the impact of silver in demonstrably alleviating symptoms of rheumatoid arthritis.3
In 2004, Bhol et al. used dinitrochlorobenzene (DNCB) to induce allergic contact dermatitis in a guinea pig model, finding that topical nanocrystalline silver cream dose-dependently decreased erythema and as effectively as topical steroids and immunosuppressants.12 The next year, Bhol and Schechter showed that nanocrystalline silver suppressed allergic contact dermatitis in mice, inhibited TNF-alpha and IL-12 expression, and induced inflammatory cell apoptosis.13
In 2008, Nadworny et al. used a porcine contact dermatitis model to investigate the anti-inflammatory activity of nanocrystalline silver. They found that nanocrystalline silver treatments reduced DNCB-induced erythema and edema, promoted apoptosis in dermal cells, and diminished matrix metalloproteinase (MMP) and proinflammatory cytokine expression.3 The investigators speculated that the lower TNF-alpha observed in the silver-treated animals occurred due to apoptosis of the inflammatory cells.
Acne
Silver acts as a bactericidal and anti-inflammatory agent, without generating free radicals, as seen with benzoyl peroxide. Therefore, it is a compelling option for responding to the presence of Propionibacterium acnes. However, silver has not been approved by the Food and Drug Administration for this use. Even though formal acne studies have not been performed with silver sulfadiazine, it has long been used “off-label” for this purpose. As suggested above, the use of silver sulfadiazine for acne is limited by the risk of sulfa allergy. Cosmetic appearance and ease of use also are limiting factors, as silver sulfadiazine preparations are characterized by a thick, white pasty consistency. Other options for use of silver to treat acne include silver-containing cleansers and textiles.
Atopic dermatitis
A 2006 study in patients with atopic dermatitis demonstrated that silver-coated textiles could significantly diminish Staphylococcus aureus density after 2 days of wearing, with the effect enduring through the end of 7 days of treatment and then 1 week after removal of the textiles.14 Within 2 weeks, objective and subjective symptoms of atopic dermatitis were significantly enhanced in association with the silver-coated textiles, compared with cotton, without measurable adverse effects. A technology called Padycare incorporates silver into micromesh material (82% polyamide, 18% Lycra) used in clothing and bedding.15 As compared with topical formulations applied directly to the skin, textiles confer certain advantages such as preventing scratching and protecting against irritating substances and allergens. Washing of silver-infused textiles is a possible disadvantage, though, as the amount of silver lost from textiles can range from a 100% loss after four washings to less than a 1% loss.16 It also is important to note that there are concerns regarding the potential of silver to leak from textiles into the water supply, and eradicating the beneficial bacteria used to treat the water.
Conclusion
Despite centuries of medical use, silver has not been approved by the FDA for any medical applications. Further study, particularly in terms of safety and efficacy, is necessary. Nevertheless, it is used off-label before and after minimally invasive dermatologic procedures (for example, dermal filling, botulinum toxin injections, chemical peeling) because of its antimicrobial and anti-inflammatory activities as well as soothing qualities for facial skin and the skin barrier. Silver appears to be particularly suitable for use as an acne therapy option due to the low risk of bacterial resistance, lack of irritation, and its preservation of the skin barrier unlike harsher options such as retinoids, antibiotics, and benzoyl peroxide.
References
1. Adv Skin Wound Care. 2006 Nov-Dec;19(9):472-4.
2. Clin Infect Dis. 2009 Nov 15;49(10):1541-9.
3. Nanomedicine. 2008 Sep;4(3):241-51.
4. J Antimicrob Chemother. 2013 Jan;68(1):131-8.
5. Nanocrystalline Silver: Use in wound care, in Current Advances in the Medical Application of Nanotechnology (Manchester, England: Bentham Books, 2012, pp. 25-31).
6. Nanomedicine. 2013 Jan;9(1):39-54.
7. Jpn J Pharmacol. 1965 Jun;15(2):131-4.
8. J Allergy Clin Immunol. 1995 Aug;96(2):251-6.
9. Inflamm Res. 2003 Dec;52(12):487-501.
10. J Nutr Environ Med. 1997;7(4):295-305.
11. Clin Exp Pharmacol Physiol. 2000 Mar;27(3):139-44.
12. Clin Exp Dermatol. 2004 May;29(3):282-7.
13. Br J Dermatol. 2005 Jun;152(6):1235-42.
14. Curr Probl Dermatol. 2006;33:152-64.
15. J Eur Acad Dermatol Venereol. 2006 May;20(5):534-41.
16. Environ Sci Technol. 2008 Jun 1;42(11):4133-9.
Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in the Design District in Miami. She founded the Cosmetic Dermatology Center at the University of Miami in 1997. Dr. Baumann wrote the textbook “Cosmetic Dermatology: Principles and Practice” (New York: McGraw-Hill, 2002), and a book for consumers, “The Skin Type Solution” (New York: Bantam Dell, 2006). Her latest book, “Cosmeceuticals and Cosmetic Ingredients,” was published in November 2014. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon, Evolus, Galderma, GlaxoSmithKline, Kythera Biopharmaceuticals, Mary Kay, Medicis, Neutrogena, Philosophy, Topix, and Unilever. Dr. Baumann also developed and owns the Baumann Skin Type Solution skin typing systems and related products.