A Discussion of Skin-Related Inflammation
EDS Skin Care Forums Forum Index » Skin Care and Makeup Forum

free skin care · Fri Jul 24, 2009 8:09 am

I would like to start and keep this thread open for the posting of discussions and articles related to skin inflammation. As many of us use products and devices which promote skin rejuvenation - there is also the potential for inflammation, which can damage the skin.

Thank you, Barefoot

Below, for reference, is a study.

: J Cosmet Dermatol. 2008 Mar;7(1):78-82. Links
Chronic inflammation is etiology of extrinsic aging.
Thornfeldt CR.Founder & CEO, Episciences, Inc., Fruitland, ID, USA. drcarl@epionce.com

Skin care regimens using active ingredients that are recommended by physicians who treat mucocutaneous conditions including aging should become more focused on reversing and preventing chronic inflammation. This adjustment of therapeutic and preventive strategies is necessary because chronic inflammation appears strongly linked to many preventable and treatable skin diseases and conditions such as visible skin aging. Mucocutaneous inflammation as the final common pathway of many systemic and mucocutaneous diseases including extrinsic aging has been established at the molecular and cellular levels. The corollary to this strategy includes inhibition of primary activators of mucocutaneous inflammation such as stratum corneum permeability barrier disruption, blocking any pro-inflammatory environmental insult such as ultraviolet radiation, and quenching tissue responses to these insults. This review will present the scientific rationale substantiating the conclusion that chronic inflammation is the common denominator in many mucocutaneous pathophysiologic processes including extrinsic skin aging.

PMID: 18254816 [PubMed - indexed for MEDLINE]

free skin care · Sun Jul 26, 2009 6:27 am

I'll be following this with interest. Very Happy

"blocking any pro-inflammatory environmental insult such as ultraviolet radiation"

Is this referring to the use of sunscreen?

free skin care · Mon Jul 27, 2009 11:44 am

Very interesting!
Thank you Barefoot!

I am constantly wondering the same darned thing... Laughing

In one sense I use peels, retin-a,c-serums, dermarollers,etc which all purposefully cause inflammation, and then use LED's,emu, ultrasound, take a lot of Fish oils,etc...and the rest to bring it all down. I feel like a constant paradox! LOL Laughing

It is very confusing!

One thing I will say, however, is that I tend to use my 63 year old gorgeous mother as a guide! She has never had a facelift,botox, etc..
She was a religious sunbather/ beach bunny in her youth and we all spent a lot of time in the sun growing up. She still goes to the beach and uses a 30 on her face anda baseball hat( we are fair and blonde, btw) And has been using retin-a for 30 years, as well as various vitmain-c serums since the 1980's,when I remember her getting vitamin C ( Cellex-C creams) from Canada...
She has never been extremely gentle on her skin!
And she has gorgeous and flawless skin! Taught, clear,radiant! People think she is 50! She also may get a little sunburn here and there by accident..
Also, get this (she is hillarious): She will actually burn off handspots with a match ..Her hands are clear!
...
Also, my dad has been using retin-a for 15 yrs (mom got him into it b/c he was a lifeguard when he was young!) And he looks amazing! AndI know it has gotten rid of pre-cancers on him, for sure!

Weird!??? Confused

I am thinking that maybe some inflammation is good,then? Rolling Eyes

I ,as you can see ,come from a family of DIY'ers...

The saga continues!

free skin care · Mon Jul 27, 2009 5:41 pm

mandapanda wrote:

Very interesting!
Thank you Barefoot!

I am constantly wondering the same darned thing... Laughing

In one sense I use peels, retin-a,c-serums, dermarollers,etc which all purposefully cause inflammation, and then use LED's,emu, ultrasound, take a lot of Fish oils,etc...and the rest to bring it all down. I feel like a constant paradox! LOL Laughing

It is very confusing!

One thing I will say, however, is that I tend to use my 63 year old gorgeous mother as a guide! She has never had a facelift,botox, etc..
She was a religious sunbather/ beach bunny in her youth and we all spent a lot of time in the sun growing up. She still goes to the beach and uses a 30 on her face anda baseball hat( we are fair and blonde, btw) And has been using retin-a for 30 years, as well as various vitmain-c serums since the 1980's,when I remember her getting vitamin C ( Cellex-C creams) from Canada...
She has never been extremely gentle on her skin!
And she has gorgeous and flawless skin! Taught, clear,radiant! People think she is 50! She also may get a little sunburn here and there by accident..
Also, get this (she is hillarious): She will actually burn off handspots with a match ..Her hands are clear!
...
Also, my dad has been using retin-a for 15 yrs (mom got him into it b/c he was a lifeguard when he was young!) And he looks amazing! AndI know it has gotten rid of pre-cancers on him, for sure!

Weird!??? Confused

I am thinking that maybe some inflammation is good,then? Rolling Eyes

I ,as you can see ,come from a family of DIY'ers...

The saga continues!

Wow, your mom is pretty hardcore! I'm still quite baffled that she uses matches to burn off age spots. Though, I think she is a perfect example of how different things work for different people. It seems that the people who are going the 302/"less is more" route are the ones who have exhausted their skin with other harsher methods with terrible or little to no results.

free skin care · Mon Jul 27, 2009 8:42 pm

mandapanda wrote:

And has been using retin-a for 30 years, as well as various vitmain-c serums since the 1980's,when I remember her getting vitamin C ( Cellex-C creams) from Canada...

mandapanda, how often does your mother use Retin A - every night, etc? Same question for the C products?

free skin care · Mon Jul 27, 2009 8:45 pm

Coconut wrote:

It seems that the people who are going the 302/"less is more" route are the ones who have exhausted their skin with other harsher methods with terrible or little to no results.

Not all of us, coconut. I had great results with the harsher methods, but I was tired of my spots coming back and continually having to use the hydroquinone. I also have concerns about long term use of Retin A, hydroquinone, etc. on internal organs.

free skin care · Mon Jul 27, 2009 9:40 pm

Hi Mandapanda,
I'm also curious as to how your mother uses REtin a and what percent? Does she blend it with anything or layer it with other products? Just like to know since it sounds like she's doing something right! THanks!

free skin care · Tue Jul 28, 2009 6:30 am

Yep! My mom is definitely hardcore.. Laughing

But I guess it works for her!
As far as the burning off of age spots... She said the Dr basically zaps them with the electric needle or liquid nitrogen anyhow, so she just does the same thing. It forms a tiny scab and then flakes off. I think she uses retin-a on it to prevent scarring.

She uses retin-a every night. Sometimes every other night in the summer, if she is in the sun.
She uses vitamin C products every morning.
That is it.
At night, after retin soaks in, a little while later, she puts on a very basic OTC moisturizer like Oil of Olay stuff or Clinique Dramatically different Moisturizing lotion.

Also, another tip:
For years she used Clinique's moisture stick under her eyes a few times a day when she did her lipstick. She kept it in her purse..All it was was pure waxy petroleum and other stuff I think. I believe they discontinued it?
But now she found another generic moisture stick..Burt's Bee's or something
( Shea Butter/Jojoba?)
I really think this has been key at keeping under-eye wrinkles at bay.

She actually has quite sensitive skin,like me..but this has worked for her for years.

Oh,BTW: I think she uses the Retin-A.1%, and maybe drops it to .05% in summer.

Like some of you,I have also had rebound pigmentation from Hydroquinone. I feel like you have to stay on it for pigment not to come back..And the fact that it is a chemical scares me.
I am doing more natural treatments for this now, like DIY from SkinActives and Phyto plus from Skin Ceuticals, Prolight, etc...
Cool

free skin care · Thu Sep 03, 2009 9:48 am

I have finally received something concrete and useful regarding inflammation:

Acute inflammation caused by esthetic procedures is beneficial for rejuvenation. On average, acute inflammation will last about two weeks in an adult, although in elderly skin it may last up to four weeks. At that point, if the inflammation is not turned off, a transformation of cells and chemistry into chronic inflammation occurs. Chronic inflammation is destructive. This is why peels shouldn’t be done too frequently - no less than 14 days apart. The problem with recurrent/frequent exfoliation or chronic use of retinoids is damage to the skin barrier. This damage greatly upregulates destructive MMPs to a much higher degree than occurs with an immediate acute injury that activates acute inflammation. It has also been discovered that damage to the skin barrier by any cause will activate chronic inflammation if the insult is recurrent and frequent (as in daily use of a retinoid).

This comes from Dr. Thornfeldt's office - he is a leading researcher on skin/barrier repair and inflammation.

BF

free skin care · Thu Sep 03, 2009 12:44 pm

Barefootgirl wrote:

This comes from Dr. Thornfeldt's office - he is a leading researcher on skin/barrier repair and inflammation.

BF

Is this the Dr. Thornfeldt that is the creator of Epionce skin care?

free skin care · Thu Sep 03, 2009 4:14 pm

Does Dr. Thornfeldt have a recommended protocol for using products that cause acute inflammation so as not to turn into chronic inflammation? Ex. Retinoids

Thanks!

free skin care · Thu Sep 03, 2009 5:15 pm

Barefootgirl wrote:

It has also been discovered that damage to the skin barrier by any cause will activate chronic inflammation if the insult is recurrent and frequent (as in daily use of a retinoid).

Very interesting information Barefootgirl. However, I'm not sure what to make of his comments about using a retinoid every day. This seems to go against much of what I've read about Retin-A. I do use it everyday and have never actually had any kind of irritation - not any that I'm aware of anyway. The theory with Retin-A is that your skin becomes accustomed to it after continued use and, therefore, there should not be any continued peeling or irritation.

free skin care · Thu Sep 03, 2009 5:59 pm

Barefootgirl wrote:

I have finally received something concrete and useful regarding inflammation:

Acute inflammation caused by esthetic procedures is beneficial for rejuvenation. On average, acute inflammation will last about two weeks in an adult, although in elderly skin it may last up to four weeks. At that point, if the inflammation is not turned off, a transformation of cells and chemistry into chronic inflammation occurs. Chronic inflammation is destructive. This is why peels shouldn’t be done too frequently - no less than 14 days apart. The problem with recurrent/frequent exfoliation or chronic use of retinoids is damage to the skin barrier. This damage greatly upregulates destructive MMPs to a much higher degree than occurs with an immediate acute injury that activates acute inflammation. It has also been discovered that damage to the skin barrier by any cause will activate chronic inflammation if the insult is recurrent and frequent (as in daily use of a retinoid).

This comes from Dr. Thornfeldt's office - he is a leading researcher on skin/barrier repair and inflammation.

BF

Great thread BF!

Reading the above info reminded me of what Dr Yarosh says in his book.. He advises that Retin-A and AHA's be used 6 weeks on then 6 weeks off..

I wholeheartedly agree with not overdoing anything, especially if it causes 'chronic' inflammation. I think the aim for anti aging benefits is to aim for a little 'acute' inflammation followed by rest + repair..

What's left out of the article you shared above, that I think is extremely important, is the need to replace the antioxidants that have been stripped from the stratum corneum, with regular use of exfoliants, Retin-A, AHA's etc.. Sometimes I feel that too many people forget this important step in their skincare regime, and then wonder why they have irritation and so much worse..

free skin care · Thu Sep 03, 2009 6:46 pm

Keliu wrote:

Barefootgirl wrote:

It has also been discovered that damage to the skin barrier by any cause will activate chronic inflammation if the insult is recurrent and frequent (as in daily use of a retinoid).

Very interesting information Barefootgirl. However, I'm not sure what to make of his comments about using a retinoid every day. This seems to go against much of what I've read about Retin-A. I do use it everyday and have never actually had any kind of irritation - not any that I'm aware of anyway. The theory with Retin-A is that your skin becomes accustomed to it after continued use and, therefore, there should not be any continued peeling or irritation.

This does raise some questions. A lot of the information I have seen is that for most people (and a lot of dermatologists seem to recommend it) the daily use of Retin-a provides the best results.

I found this information from another doctor..." Dr. Ciraldo thinks the overuse of exfoliating agents like Retin-A and retinol, derivatives of vitamin A, are major causes of impaired barrier function. "I treat women who come in with very dry, wrinkled skin, especially around the eyes where the skin is thin," explains Dr. Ciraldo. "Applying a potent retinol like Retin-A nightly only exaggerates crow's feet.""

Some of the studies for retin-a use on crows feet show some of the best results. I was in one of my local drug stores the other day and overheard a conversation on the same aisle between to women talking about their skin care and one was talking about using Obagi and how it was extremely intense but the results were great. I do have to admit her skin looked very good and wrinkle free.

So what are we to believe about retin-a use....does it get rid of the wrinkles or eventually cause more damage and cause more wrinkles?

free skin care · Thu Sep 03, 2009 7:02 pm

lisacollins00 wrote:

So what are we to believe about retin-a use....does it get rid of the wrinkles or eventually cause more damage and cause more wrinkles?

By far, the bulk of clinical information supports the use of Retin-A as a treatment for anti-aging. However, like everything, it should be used with common sense. So, if you do happen to constantly have irritated skin from its use, it would be prudent to discontinue or rest for a while.

free skin care · Thu Sep 03, 2009 7:23 pm

Don't forget with the Retin A studies that the best results were had with nightly use for 1 year and then they were supposed to back off to just a few times a week to maintain.

free skin care · Thu Sep 03, 2009 7:27 pm

I am trying to get more information as far as protocols, but in the meantime, I think we can at least gain from this that we should not use any products on a continuous basis that evoke irritation - even retinoids.

If we want to use retinoids on a continuous basis, we should be be sure to use forms that do not trigger irritation - which might mean switching to retinol or retinyldehyde or a retinyl ester, if necessary.

As far as I am concerned, I am going to continue using Retin A, but not continuously. I am going to cycle it and throttle back at first signs of discomfort or peeling.

I no longer do chemical peels because I believe they do more harm than good, in most cases.

I will also likely purchase one of the Epionce barrier repair creams to have on hand in case my skin becomes red or irritated. I also read in one of the inflammation articles that any time the barrier is damaged - it should immediately be repaired with a repair cream.

When it comes to dermarolling, that is a separate issue and I defer to Dr. Fernandes's research on that one.

As I get more info, will report back, BF

free skin care · Thu Sep 03, 2009 10:15 pm

Aaargh this is killing me. What are we to believe!
People that have been using retin a for 20 or 30 years are saying their skin is wrinkle free. You'd think that it should look horrendous if it were chronically inflammed. Confused

free skin care · Fri Sep 04, 2009 12:52 am

Here's a great paper on Retin-A written by the doctor who "discovered" it.

Topical treatments for photoaged skin
Separating the reality from the hype

Albert M. Kligman, MD, PhD

VOL 102 / NO 2 / AUGUST 1997 / POSTGRADUATE MEDICINE

--------------------------------------------------------------------------------

This is the second of four articles on skin disorders

Preview: Baby boomers have grown up, and when they look in the mirror, they don't like what they see happening. Those early years under the sun have left their mark--photoaging. Within two decades, more than half of the US population will be over 50, so calls for products that halt the process and repair the damage will not stop anytime soon. In this article, Dr Kligman provides an overview of what manufacturers of drugs, cosmetics, and "cosmeceuticals" offer, along with commentary on the accuracy of their claims.

--------------------------------------------------------------------------------

Mention of the changes wrought by aging immediately conjures up the image of a face marked by creases, wrinkles, sagging folds, an uneven texture with blotchy hyperpigmentations interspersed with bleached spots, keratoses, and other unsightly manifestations. In the public's mind, this portrait constitutes the ruin brought on by aging, but the fact is that virtually none of these changes are due to the passage of time. They are not inevitable; indeed, they are largely preventable. The dreaded emergence of prematurely aged facial skin is a direct consequence of cumulative insult from ultraviolet radiation, a process now termed photoaging (1).

People are living longer than ever before. For sun-worshipping cultures, this means that the multiple manifestations of photoaging will become progressively accentuated. In addition, photoaging effects are appearing at a younger age, owing to such factors as more leisure time among children, higher attendance at summer camps, and admiration of a tanned appearance.

Cosmetic surgeons have a cornucopia of interventions that can restore a remarkably youthful appearance. However, most people seek topical products to help improve their skin, ideally by reversing some of the structural degradation caused by the sun. The marketplace is bustling with advertisers purporting that their products have marvelous "anti-aging" effects. It can be very difficult to separate puffery from fakery. In many cases, product claims are grossly exaggerated and engender false hope, but in other cases, some products do yield benefits.

Retinoids
Retinoids are the "gold standard" against which all other pharmaceutical remedies for photoaging can be compared. No other known chemicals or drugs can duplicate the diversity of anatomic and physiologic effects brought about by retinoids. Structurally, these substances resemble the parent compound vitamin A (retinol), and they have similar pharmacologic effects.

The best-known topical retinoid is trans-retinoic acid, or tretinoin (Retin-A), which was introduced more than 30 years ago. Other topical retinoids for photoaging are already on the market, and more may be coming that probably will have effects similar to those of tretinoin. For example, a 0.05% emollient cream formulation (Renova) was introduced recently that is less irritating than 0.05% Retin-A cream but equally effective. Another new form is Retin-A Micro, which entraps tretinoin in "microsponges," allowing slow metered release to reduce irritation.

Numerous publications worldwide have documented topical tretinoin's ability to improve the appearance of photoaged skin (figure 1) by reducing wrinkles, decreasing laxity, bleaching hyperpigmented spots, and bringing about a smoother surface, a more uniform texture, and a rosy glow (2-4). Structural changes underlying these cosmetic benefits include correction of epidermal atrophy, deposition of new collagen, generation of new vessels (angiogenesis), and enhancement of mitogenesis (increasing cell turnover). Enhanced mitogenesis promotes shedding of melanin-laden keratinocytes, resulting in bleaching (depigmentation) (5).

Another capability of retinoids is evacuation of materials retained in dilated follicles, which the laity recognizes as large pores. Retained materials include bundles of vellus hairs and microcomedones consisting of horny impactions of corneocytes. Bacteria and yeasts heavily colonize these impactions, distending the orifices and giving the appearance of blackheads.

Additionally, pretreatment with tretinoin for 2 to 3 weeks enhances healing and cosmesis after a chemical or laser peel.

In view of the diverse beneficial effects of topical tretinoin, it is a pity that the drug is so vastly underused. Sales of "antiaging" cosmetics far exceed those of tretinoin. One reason may be the widespread misconceptions regarding the frequency and nature of adverse events, which have kept many physicians from ever prescribing the drug. Many primary care physicians and an embarrassing number of dermatologists do not know how to use tretinoin effectively.

Misconceptions about safety and sensitization
Safety is not a big issue with tretinoin. After decades of use, not a single instance of irreversible side effects, such as scarring, congenital malformations, or systemic abnormalities, has been recorded.

A common misconception is that tretinoin is a photosensitizer. Although initially the face does become somewhat more susceptible to sunburn, this effect normalizes after the drug has been applied for a couple of months. In the meantime, all that is required are simple protective measures, such as avoiding the midday sun, applying a broad-spectrum titanium dioxide-based sunscreen (sun protection factor >15), and wearing a wide-brimmed hat.

A recent review summarizes problems encountered in using tretinoin and offers sensible guidelines for primary care physicians (6).

Patient instructions on application and expectations
With proper instructions, which should take at least 15 minutes to convey and review, topical tretinoin can be prescribed any time of year in any geographic region. Providing written directions to assure proper use and compliance is also helpful. Physicians who cannot allot adequate instruction time to a new patient should not prescribe tretinoin.

Patients should be warned about early, subjective discomfort, such as stinging or burning and sometimes mild erythema and scaling. In fact, patients can use these symptoms as an indication that the drug is working and can monitor the amount of drug to apply by deliberately inducing them. After some weeks, accommodation generally takes place and discomfort ceases.

Tretinoin should be applied at night. A pea-sized amount of cream is placed on each temple and then spread with the fingers over the entire face, including directly around the eyelids where fine wrinkles are common. (Except for transient stinging, no harm comes from getting tretinoin in the eyes, despite excessive cautions included in the package insert.) After application, no other substance or cosmetic should be used that may dilute or chemically inactivate the drug.

Owing to the exfoliating effect of tretinoin, fine scaling and dryness may occur, especially in winter. Applying a moisturizer generously in the morning is helpful. The best moisturizing agent is petroleum jelly, but it is too greasy for most people. It now comes in a creamy version that is almost as moisturizing as the original. Other effective warhorses are Nivea Ultra Moisturizing Creme and Eucerin creams (not the lotions).

A conservative regimen consists of starting with 0.025% tretinoin cream and increasing to 0.05% cream as tolerance develops. Beneficial effects can be obtained more quickly with the highest concentration (0.1%); however, side effects occur more frequently and are intolerable for some patients. In hot weather, some patients prefer gel (0.01% and 0.025%) over oily formulations. The most potent formulation is 0.05% solution, which requires closer monitoring.

Daily applications should continue for about 1 year, after which Monday, Wednesday, and Friday applications are sufficient for most patients; for others, weekend use is adequate. Since the clock never stops turning, treatment continues indefinitely.

Treatment initiation according to sun-exposure history
When to begin treatment depends on the extent of photoaging. Most sun damage to the skin occurs in childhood. Histologic studies in Celts with apparently normal skin type I (ie, skin burns easily and tans poorly) have found that a surprising amount of damage has already been done to the dermal matrix by age 10. Thus, in blond, blue-eyed, light-skinned, freckled, Scotch-Irish persons, tretinoin therapy may be started before puberty if there is a history of sunburns in childhood, even if signs of photo-aging are not clinically evident. Examination of the skin under Wood's light is a simple way to estimate the degree of photodamage, since subclinical freckles and lentigines appear as conspicuous dark patches.

For persons living in sunny areas, treatment begun in the 20s and 30s is advantageous, even in those with skin type IV (ie, dark skin that burns minimally and tans very easily), unless they have a history of minimal sun exposure in childhood.

Chemopreventive effects
Early retinoid therapy is particularly worthwhile for cancer-prone persons, since these agents are known to prevent tumor progression, a process known as chemoprevention. In older patients with photodamage that includes many actinic keratoses and perhaps past basal cell cancers, the combination of nightly tretinoin and twice-daily use of the chemotherapeutic agent 5-fluorouracil (Efudex, Fluoroplex) is an effective anticancer regimen (7).

Antioxidants and other "active" agents
Abundant laboratory evidence shows vitamins C and E to be free-radical quenchers. They have been shown in a multitude of in vitro systems to function as antioxidants, which protect cells against ultraviolet radiation. (For a complete review, see Fuchs and Packer ( Cool

.) Formulations containing vitamin C, E, or both are available on the market, but for the most part, claims of antiaging effects have not been supported by scientific proof.

Manufacturers profess that recent vitamin C formulations have been modified to increase fat solubility, resulting in enhanced transcutaneous penetration. Vitamin C concentrations of 10% or more result in far higher levels within the skin than can be achieved by any conceivable oral dosage. In addition, vitamins C and E are natural collaborators and participate in reciprocal self-regulating cycles of regeneration. Thus, the scientific rationale for prevention and reversal of photodamage with vitamins C and E is logical. But so far, there is little compelling evidence that such combinations are effective in vivo.

Marketplace momentum is well ahead of scientific fact. Manufacturers claim that vitamin C and E formulations have antiaging effects comparable to those of retinoids. Although this claim has not been validated by double-blind controlled studies, these intensively advertised products are extremely successful, judging by their high sales numbers, even though they probably do nothing more toward improving photodamaged skin than their vehicle alone would accomplish. The marketplace push is toward use of more and more free-radical scavengers, such as superoxide dismutase, which is often combined with a melange of herbs, minerals, enzymes, hormones, and unpronounceable substances of marine origin.

Cost-conscious buyers should be encouraged to resist these seductive fantasias, which resemble the snake-oil exotica of a bygone era. A working rule is that a formulation will probably not live up to its claims if it contains more than three "active" ingredients. Another dictum is that efficacy does not necessarily correlate with cost; cheaper preparations are often just as effective as expensive ones.

Alpha hydroxy acids
These natural fruit acids, used since antiquity, have recently been "rediscovered" as a topical application to improve the appearance of photoaged skin. They include a bevy of acids that have in common a hydroxy radical in the alpha position next to the terminal acid group. Common examples are glycolic, lactic, and citric acids. (See Van Scott and Yu (9) for a scholarly review of the actions of alpha hydroxy acid.)

Only a few years ago, a simple product from Avon (Anew) containing 4% glycolic acid hit the market with a big bang. Its commercial success was so great that there are now hundreds of manufacturers of alpha hydroxy formulations. Products come in a dazzling and bewildering array of compositions--often two to five fruit acids along with ever more numerous ancillary ingredients, such as vitamins and antioxidants. Claims for cosmetic formulations have increasingly expanded to include myriad benefits under the rubric of antiaging. Scientific evidence to support such claims is incomplete and controversial. Suffice it to say that unrestrained hype has overtaken the entire field of fruit acids. Formulations vary greatly in efficacy, so it is probably wise to stick with well-known manufacturers.

What sober and sensible comment can be made about the alpha hydroxy phenomenon? Clearly, these substances must provide some perceivable benefit to have reached $1 billion in sales worldwide. A proper perspective of the biologic effects of hydroxy acids may be better attained by realizing that they are distributed in three tiers:

Low-concentration (usually not exceeding 10%) mass-marketed cosmetic formulations. Activity is pH-dependent. Products with lower pH (<3.5) show greater efficacy; many formulations have a pH higher than this. Complete neutralization destroys efficacy.
Moderate-concentration (usually 20% to 30%) solutions for light peeling. These are used in salons by aestheticians.
High-concentration (eg, usually unbuffered 70% for glycolic acid) peeling solutions for resurfacing of photoaged facial skin. These are intended for office use by physicians.
One incontestable biologic property of all alpha hydroxy acids is that they enhance shedding of surface corneocytes (10). When corneocytes are retained as loose aggregates in photoaged skin, the surface becomes rough and scaly and feels dry. Exfoliation of old, hard, dried-out corneocytes results immediately in a smoother, more uniform surface, which is readily perceived by touch. Although rapid smoothing of rough skin is the main reason for the phenomenal success of alpha hydroxy acids, prolonged use also leads to moderate bleaching of the mottled pigmentary appearance of photoaged skin, further enhancing surface texture.

Although the improvements fruit acids produce are unmistakable, the mechanism by which they cause corneocytes to detach from each other is not understood. Other vexing questions also remain. For example, is the alpha position of the hydroxy group a prerequisite for efficacy? This structural position has not been proved to be mandatory and, in fact, it is probably irrelevant. There is evidence that any weak acid can induce exfoliation. A case in point is acetic acid, the parent compound of glycolic acid. It contains no hydroxy radical but is as effective as glycolic acid in achieving textural benefits. Of course, its odor is objectionable, but we have it from no less an authority than Cleopatra that vinegar increased her attractiveness.

All alpha hydroxy acids are effective in reducing the excessive scaling of ichthyotic disorders and are capable of removing retained scales. Strictly speaking, they are not moisturizers, but since they are helpful in relieving the signs and symptoms of dry, xerotic skin, they fulfill the requirement for product labeling as a moisturizer. A little-known but worthwhile benefit is that foundation lotions and camouflage cosmetics can be applied more easily and uniformly on facial skin that has been treated for 2 to 3 weeks with cosmetic formulations of alpha hydroxy acids.

Alpha hydroxy acids are moderately beneficial in improving the signs of photoaging (11). Some dermatologists are persuaded that concomitant use of topical tretinoin has synergistic effects. Apart from somewhat increased stinging and burning, the two agents are not basically incompatible. Nonetheless, it would be difficult to show convincingly that alpha hydroxy acids substantially increase the antiaging benefits of tretinoin.

As regards glycolic acid peels administered by cosmetic surgeons, moderate benefits in appearance are obtainable. However, peels are required every 2 to 4 weeks to maintain enhanced textural improvements. The safety of repeated procedures over long periods has recently come under question and is presently unresolved. Although the Food and Drug Administration has expressed concern about possible adverse effects of long-term use of cosmetic formulations, accumulated evidence does not suggest that there is an appreciable hazard. Resurfacing facial skin with an ultra-pulsed CO2 laser is undoubtedly more effective than peel procedures.

Other exfoliant formulations
It should surprise no one that in the highly competitive marketplace of "cosmeceuticals," other exfoliants are being explored and sold. The most venerable one, salicylic acid, a beta hydroxy phenolic acid, has been used for treating such dermatologic disorders as dandruff and psoriasis for more than a century. Salicylic acid, unlike fruit acids, is insoluble in water and has different biologic effects, which may bring added benefits. A newly introduced product line (Oil of Olay Daily Renewal Cream) contains 1.5% salicylic acid in a moisturizing base. It is less irritating than alpha hydroxy acid formulations and is at least as effective. Already, formulations combining salicylic acid and various alpha hydroxy acids are becoming available.

Summary
Most patients have committed the usual folly of recreational sunbathing in childhood, and in adulthood they notice the manifestations in the mirror. Increasingly, they are seeking professional advice regarding the growing stream of products that promise to improve their photoaged skin. Physicians need to be informed about the great range and complexity of products available, if for no other reason than to steer patients clear of traveling-medicine-show products. A better reason is to be able to provide guidance on proper use of formulations that have proven benefit.

The author has served as a consultant to Ortho Pharmaceutical Corporation.

References
Gilchrest BA. A review of skin aging and its medical therapy. Br J Dermatol 1996;135(6):867-75
Weiss JS, Ellis CN, Goldfarb MT, et al. Tretinoin therapy: practical aspects of evaluation and treatment. J Int Med Res 1990;18(Suppl 3):41-8C
Olsen EA, Katz HI, Levine N, et al. Tretinoin emollient cream: a new therapy for photodamaged skin. J Am Acad Dermatol 1992;26(2 Pt 1):215-24
Kligman LH, Kligman AM. The nature of photoaging: its prevention and repair. Photodermatol 1986;3(4):215-27
Gilchrest BA. Retinoids and photodamage. Br J Dermatol 1992;127(Suppl 41):14-20
Kligman AM. Topical retinoic acid (tretinoin) for photoaging: conceptions and misperceptions. Cutis 1996;57(3):142-4
Robinson TA, Kligman AM. Treatment of solar keratoses of the extremities with retinoic acid and 5-fluorouracil. Br J Dermatol 1975;92(6):703-6
Fuchs J, Packer L. Oxidative stress in dermatology. New York: Dekker, 1993
Van Scott EJ, Yu RJ. Actions of -hydroxy acids on skin components. J Geriatric Dermatol 1995;3(A):19A
Van Scott EJ. Dry skin et cetera, corneocyte detachment, desquamation, and neo-strata. Int J Dermatol 1987;26(2):90
Stiller MJ, Bartolone J, Stern R, et al. Topical 8% glycolic acid and 8% l-lactic acid creams for the treatment of photodamaged skin: a double-blind vehicle-controlled clinical trial. Arch Dermatol 1996;132(6):631-6

--------------------------------------------------------------------------------

Dr Kligman is professor emeritus, department of dermatology, University of Pennsylvania School of Medicine, Philadelphia. Correspondence: Albert M. Kligman, MD, PhD, Department of Dermatology, University of Pennsylvania School of Medicine, 226 Clinical Research Bldg, 415 Curie Blvd, Philadelphia, PA 19104-6142.

free skin care · Fri Sep 04, 2009 2:52 am

Mishey wrote:

People that have been using retin a for 20 or 30 years are saying their skin is wrinkle free. You'd think that it should look horrendous if it were chronically inflammed.

I do not think it is an "either/or" situation. I think it is a "how" situation.

BF

free skin care · Fri Sep 04, 2009 5:03 am

Barefootgirl wrote:

Mishey wrote:

People that have been using retin a for 20 or 30 years are saying their skin is wrinkle free. You'd think that it should look horrendous if it were chronically inflammed.

I do not think it is an "either/or" situation. I think it is a "how" situation.

BF

Agree. On an old forum that was full of really knowledgeable people, most of the long time Retin A users were not using nightly still. They had went down to just a few days a week only, and some of them would stop in the summer months completely and resume in the fall.

free skin care · Fri Sep 04, 2009 9:02 am

I have a theory about why some people get good results with tretinoin and other people get irritation and their skin worsens... It is the same principle that Dr. Paul Clayton has used to explain the results of the famous Finnish study that found that vitamin A increases the risk of cancer in smokers.

The anti-oxidants A, C, and E work in a combined anti-oxidant cycle. According to Dr. Clayton,

Dr. Clayton wrote:

Anti-oxidants work together. When Vitamin E neutralises a lipid free rapid, it becomes a free radical itself--and a pro-oxidant, unless neutralised ('refreshed') by a cartenoid [e.g., vitamin A]. The caretenoid is oxidised in this reaction, and becomes a dangerous pro-oxidant in turn; one which can cause considerable tissue damage unless it is neutralised by vitamin C. Now the C becomes a radical--but a stable, and therefore a safe one, which is water soluble and can be excreted in the urine. Vitamin C can be regarded as the foundation of the anti-oxidant systems...Many tests show that Vitamin C tends to be used up first. When the C is gone, the carotenoids go next, then Vitamin E; and when the E has all been used up lipid oxidation begins. Adding either C or E will prevent the lipid oxidation but does not protect proteins from oxidative damage. To protect proteins you must add other anti-oxidants such as flavonoids or glutathione (of which more later). So when it comes to anti-oxidants, monotherapy (ie: attempting to prevent free radical damage with a single anti-oxidant) is both theoretically and demonstrably wrong."

In other words, if you flood your body with vitamin E, but don't have enough carotenoids to buffer the E, or if you flood your body with carotenoids and/or vitamin A in particular but don't have enough vitamin C to buffer the carotenoids, then you can actually cause more tissue damage by having a greatly imbalanced anti-oxidant intake than if you hadn't increased anti-oxidant supplementation in the first place. I wondered for a long time whether this could explain why some people get good results with the extra vitamin A derivatives and other people get bad results. This would explain why excess vitamin A and E that is unbalanced by excesses of other anti-oxidants can cause tissue damage in some people [the un-neutralized vitamin A and E tend to be more reactive than the pro-oxidants they neutralize], but why excess vitamin C tends to be neutral in the body. Anyway, even this does not explain the varying results with tretinoin, it at least underscores the importance of whole foods and some of the risks of taking individual supplements.

And some further interesting quotations from Dr. Clayton:

Dr. Clayton wrote:

Anti-oxidants work best to prevent disease when given together rather than as monotherapies. Our foods contain complex mixtures of anti-oxidants, and before the arrival of the supplement industry, we obtained all our anti-oxidants from food. For example, many supplements contain beta carotene, but there are over 600 caretenoids in fruits and vegetables, so why supplement with just one?...The many studies which have looked at the effects of single anti-oxiants are, in part, an unfortunate hangover from the pharmaceutical mind-set. Despite the headlines, it is not very helpful to single out any one micro-nutrient (such as lycopene or selenium) as being 'anti-cancer'; it is the general nutritional status that is important. For example, low selenium has been linked to arthritis and myocardial disease in China, coronary artery disease in Finland, breast cancer in New Zealand, and goitre in Zaire. Each country has a typical nutritional profile through which the low selenium filters, causing a characteristic pattern of ilnness in each territory...One exception to the general rule that anti-oxidants work best in combination may be co-enzyme Q10, which combines anti-oxidant and mitochondrial supporting actions, and is relatively unlikely to have any significant pro-oxidative potential...Even Q10, however, can turn pro-oxidant during intensive exercise, and so it's best combined with beta carotene and vitamin C.

I found all this fascinating, so though others might too Smile

free skin care · Fri Sep 04, 2009 9:11 am

Very interesting, cm5597. I will have to look into this Dr. Paul Clayton and see what else he has to say. Thanks for posting the info.

free skin care · Fri Sep 04, 2009 10:18 am

yes, thank you. I have heard this before - and believe it may explain why some med. professionals combine vitamins in serums or rotate them (as you probably know, they remain in the skin for sometime after application).

My background in Science is limited, but I've read the explanation for this several times (but did not understand it well enough to repeat it!)

BF

free skin care · Fri Sep 04, 2009 12:06 pm

Barefootgirl wrote:

It has also been discovered that damage to the skin barrier by any cause will activate chronic inflammation if the insult is recurrent and frequent (as in daily use of a retinoid).

Thank you BFgirl for the interesting piece of info! I wonder if things such as manual exfoliation, Clarisonic, AHA/BHA serums or even microfiber cloths constitute as "recurrent insult" to the skin barrier? A lot of us rely on these methods to battle acne! Which is the lesser of 2 evils? Thanks!

Automatic Message

If this is your first visit to the EDS Forums please take the time to register. Registration is required for you to post on the forums. Registration will also give you the ability to track messages of interest, send private messages to other users, participate in Gift Certificates draws and enjoy automatic discounts for shopping at our online store. Registration is free and takes just a few seconds to complete.

Click Here to join our community.

If you are already a registered member on the forums, please login to gain full access to the site.