Improvement In Skin Appearance Research Articles

Cosmeceuticals: undefined, unclassified, and unregulated

The cosmeceutical category is an undefined, unclassified, and unregulated area of dermatology that is yet in its infancy. Traditional cosmeceuticals involve the topical application of biologically active ingredients that affect the skin barrier and overall skin health. The ability of these ingredients to enhance skin functioning depends on how they are formulated into products that can maintain the integrity of the active ingredient, deliver it in a biologically active form to the skin, reach the target site in sufficient quantity to exert an effect, and properly release from the carrier vehicle. In the United States, cosmeceuticals are sold as cosmetics, making marketing, packaging, and aesthetic appeal important considerations. Ideally, the cosmeceutical should be clinically tested for efficacy to ensure a proven skin benefit and also to substantiate marketing claims. Governmental limitations of efficacy claims restrict cosmeceutical development because products can only be assessed in terms of their ability to improve skin appearance but not function. Improving function would remove the cosmeceutical from the cosmetic category and place it in the drug category. Herein lies the challenge of defining the cosmeceutical category.

A multicenter study of cellulite treatment with a variable emission radio frequency system

Radio frequency (RF) systems have been reported as producing electrothermally mediated and subcutaneous effects. The present study evaluates a new approach to treat cellulite with a bipolar RF device. The buttocks of 50 patients were treated, 10 from each of five multinational centers with a novel bipolar RF technology set at 6 J/cm(3), which changes its frequency between 0.6 and 2.4 MHz according to impedance of tissue. Twelve weekly sessions were given for 12 minutes on each buttock, with a treatment end point of 42 degrees C external skin temperature. Cellulite changes and tissue condition were assessed before and immediately after the first session, before the final 12th session, and 2 months thereafter. The patient Satisfaction Index was recorded. Objective evaluation involved clinical photography, three-dimensional optical skin surface measurement, and histological findings. Almost all patients noted improvement of cellulite and body silhouette at the final session, which slightly decreased at the 2-month assessment. Improved skin appearance was objectively detected. Histological findings following the first session showed reactive edema and lysis of adipocyte membranes, possibly implicated in the final effects achieved. The RF technology used in the present multicenter study improved the general aspect of skin and cellulite, with high patient Satisfaction Index. Maintenance sessions might lead to even better and longer-lasting results.

Percutaneous Collagen Induction: Minimally Invasive Skin Rejuvenation without Risk of Hyperpigmentation—Fact or Fiction?

Photoaging is generally treated by ablative procedures that injure the epidermis and basal membrane and lead to fibrosis of the papillary dermis. Damaging the epidermis significantly can cause potential adverse effects such as dyspigmentation. It was recently shown in clinical trials that percutaneous collagen induction therapy is an alternative for safely treating wrinkles and scars and for smoothening the skin without the risk of dyspigmentation. The purpose of this study was to increase current knowledge regarding whether percutaneous collagen induction therapy presents an effective means for skin rejuvenation without risk of dyspigmentation, as the authors' clinical data suggested. Fifty-six rats were assigned to three groups: group A (n = 24), percutaneous collagen induction therapy plus skin care; group B (n = 24), skin care; and group C (n = 8) controls. The authors evaluated the effect of percutaneous collagen induction therapy on the epidermis, melanocytes, and the pigmentation markers interleukin-10 and melanocyte-stimulating hormone. Percutaneous collagen induction therapy left the epidermis intact without any damage to the stratum corneum, any other layers of the epidermis, or the basal membrane. No signs of dermabrasive reduction of epidermal thickness were evident 24 hours after the procedure. The number of melanocytes neither increased nor decreased in any of the groups. DNA microarray experiments demonstrated that interleukin-10 was increased in percutaneous collagen induction therapy-treated skin after 2 weeks. Concerning the MC1R (melanocyte-stimulating hormone) gene, gene expression microarray analysis indicated a faint down-regulation both 24 hours and 2 weeks after percutaneous collagen induction therapy. Percutaneous collagen induction therapy offers a modality with which to rejuvenate and improve skin appearance and quality without risk of dyspigmentation.

Non‐invasive evaluation techniques to quantify the efficacy of cosmetic anti‐cellulite products1

The majority of women suffer from the unattractive sight of dimpling skin on the thighs and buttocks, globally known as cellulite. Cellulite can be regarded as the most investigated non-disease, because, from the cosmetic viewpoint, most women desire a reduction in cellulite severity. Despite investigations made, cellulite is still not well understood at the cellular level, which leads to controversy regarding the investigative methods for cellulite reduction as well as the development of products to treat cellulite skin. The aim of our work was to improve the set up of macrophotography for making images of dimpled skin and to automatize image analysis of 20 MHz ultrasound imaging - these two methods being just two of a variety of available methods for investigating cellulite skin. Macrophotography was standardized on the aspects of volunteer's positioning, skin illumination, background used, and camera position. It was performed before, during and after a 3-month-treatment of a cosmetic product. Scoring assessments of the generated images were made by the volunteers themselves as well as by six trained experts. Ultrasound imaging was performed at the baseline visit in order to correlate the newly developed analysis with the visually rated cellulite score. A second study is also presented showing a variety of parameters that can be used for cosmetic testing of cellulite products: skin firmness, blood circulation and circumferential thigh measurements. Standardization of macrophotography minimized differences in image features between assessment times, therefore, enabling follow-up rating assessments of the images. A custom-made rating program simplified the scoring procedure by presenting images as blind and randomized, and by implementing computer-based analysis using an online rating scale. Volunteers and experts scored significant improvement of skin appearance over the course of a 3-month cosmetic treatment. Image analysis of ultrasound imaging was automatized, and a modification of the commonly known roughness parameter Ra was implemented to characterize cellulite severity. Comparison with the visually rated cellulite score showed an existing correlation between the score and the modified parameter Ra(m). Further parameters investigated in an exemplary study, as mentioned above, demonstrated a significant improvement of skin appearance after treatment with a cosmetic product. Macrophotography and ultrasound imaging can be regarded as important tools for determining and quantifying the aspects of cellulite. With a gold standard missing for investigating cellulite severity, these two methods may not determine cellulite at the cellular level, but they do characterize the skin appearance so typical for cellulite. Combined with a variety of other methods, macrophotography and ultrasound imaging can very well define cellulite-reducing efficacy from the cosmetic point of view.

Effects of cellulite treatment with RF, IR light, mechanical massage and suction treating one buttock with the contralateral as a control

Background and objectives: A system that combines bipolar radio frequency (RF) and intense infrared light (IR) together with mechanical massage and suction has recently been reported as being efficient for cellulite treatment. The present split study was designed to evaluate the efficacy of such a system through various treatments of cellulite located on the buttocks. Methods: Ten patients were enrolled for 12 sessions of 30 minutes each performed over one buttock, the other buttock serving as an untreated control. Sessions were conducted twice a week for a period of 12 weeks. Clinical photography and profilometry were carried out to assess textural changes before (baseline) and 2 months after the final treatment. Histopathology was performed at baseline, 2 hours after the first session, and just before the 12th session and 2 months thereafter. Results: All patients noted improvement in the treated buttock before the final session, which was maintained at the 2‐month assessment. Improved skin appearance was noticed after the first session and was maintained throughout the study. All patients were satisfied with the results and requested further treatment in order to balance the results in both buttocks. Random histological analyses suggested dermal firmness, fibre compaction and tightening of skin layers, including the subcutis, as possible reasons for the effects achieved. The authors recognize that the small number of participants limits the statistical power of the study. Conclusions: Treatment sessions with the combined RF, IR light and mechanical massage and suction system were complication free, produced improvements in the overall cellulite appearance and skin condition, suggesting that further treatment sessions for maintenance could sustain patient satisfaction index (SI) and lead to lasting results. Based on the good results in the limited trial population, further studies with larger patient populations are warranted.

The latest cosmeceutical approaches for anti‐aging

SummaryBackground Cosmeceuticals provide a new therapeutic frontier for anti‐aging in dermatology. The most dramatic signs of cutaneous aging include the lack of skin surface regularity, the formation of rhagades, and the increased presence of dyspigmentation.Background The objective of this review is to illustrate how these three needs of maturing skin can be met by novel ingredients incorporated into carefully constructed formulations designed to deliver scientifically measurable and visibly noticeable improvement.Conclusion Skin surface irregularity can be improved through increased skin turnover facilitated by topical niacinamide, while the appearance of fine lines can be diminished through the application of moisturizers containing engineered peptides and over‐the‐counter retinoids, such as retinyl propionate. Finally, skin pigmentation can become more regular with the topical application of N‐acetyl glucosamine and ultraviolet A photoprotective ingredients. Furthermore, combining cosmeceutical ingredients in a moisturizing vehicle can magnify benefits and profoundly improve skin appearance.

Effects of Topical Copper Tripeptide Complex on CO2 Laser–Resurfaced Skin

To evaluate the role of skin care products that contain a copper tripeptide complex, glycyl-l-histidyl-l-lysine-Cu(2+) (GHK-Cu), in treating carbon dioxide (CO(2)) laser-resurfaced skin. Patients meeting the inclusion criteria underwent circumoral skin resurfacing using a CO(2) laser at standard settings. Patients were then randomized to receive posttreatment skin regimens with or without GHK-Cu. Evaluations for erythema throughout the posttreatment period were performed using computer software and blinded evaluators. In addition, overall improvement in wrinkles and overall improvement in skin appearance 12 weeks after treatment were assessed. Patients completed a validated questionnaire before and 12 weeks after treatment. Thirteen patients completed the study. Computer analysis and blinded evaluators found no statistically significant differences between groups for earlier resolution of erythema. All the patients experienced significant improvement in wrinkles and overall skin quality, but no differences were found between groups. The results of the questionnaire indicated a significant difference in the posttreatment improvement of overall skin quality for patients using GHK-Cu (P = .04). Copper tripeptide complex (GHK-Cu) skin care products placed on CO(2) laser-resurfaced skin offered no significant reduction or resolution of posttreatment erythema. Objective evaluation found no significant improvement in wrinkles or overall skin quality. However, patient satisfaction was significantly higher for those who used GHK-Cu skin care products after CO(2) laser skin resurfacing.

Cutaneous effects compared between higher fluence with fewer treatments and lower fluence with more treatments in a combined IR laser/radio frequency system

Background and aims: A combined infrared (IR) laser/radio frequency (RF) system has recently been reported to create rejuvenation‐related cutaneous effects, but was associated with high levels of pain and some complications. The present study was designed to evaluate the cutaneous effects of the same system with a lower fluence and more treatments. Methods: Twenty patients were randomly assigned into two groups of 10 individuals each: Group A was treated at 50 J/cm2 / 100 J/cm3 (laser/RF), respectively, two passes, three treatment sessions 30 days apart; Group B at 30 J/cm2 / 50 J/cm3, three passes, five treatment sessions 15 days apart. Objective comparisons were made at the same time points with a computer program based on the clinical photography. Results: Group A noted more improvement in wrinkles than Group B at the first assessment, but both groups showed slight and progressive deterioration at the 2‐ and 6‐month assessments. Improved skin appearance was maintained throughout in both groups. The authors recognize that the comparatively small number of subjects possibly limits the statistical power of the study. Conclusions: Lower fluences and more treatment sessions with the combined 900 nm laser/RF system were complication‐free, produced improvements in the overall skin condition and less pain during sessions, suggesting that this combination may produce better patient compliance. Further treatment sessions may improve the results with implications in skin rejuvenation.

Comparison of Patients' Assessments on Overall Facial Rejuvenation and Procedural Pain Seen with a Fluorescent Pulsed-Light Source and Those Seen with a Traditional Intense Pulsed-Light Source

Introduction: Intense pulsed-light (IPL) treatments are effective alternatives to ablative procedures for improving the appearance of photodamaged skin. Currently, there are multiple IPL sources to modulate photoaged skin, but there are no studies comparing the efficacy of or pain associated with 2 different PL sources. Therefore, we chose to compare patients' assessments of overall cutaneous rejuvenation and pain associated with a fluorescent PL source and a traditional IPL source. Materials and Methods: We performed a retrospective analysis of 24 patients who were treated with both a fluorescent PL source and a traditional IPL source. These patients completed questionnaire surveys that assessed (by a graded scale) pain during the procedure and overall satisfaction with each IPL source. The Wilcoxon signed-rank test for paired data as well as McNemar's test were used to compare overall facial rejuvenation and procedural pain between the 2 light sources. Results: For both light sources, most patients reported “fair” or better improvement in skin appearance. The patients did not report a significant difference in overall skin improvement between the treatments with each light source. In addition, most patients did not report having pain during recovery after procedures by either light source. However, patients did report significantly less pain during treatments with the fluorescent device compared with the traditional IPL source. Discussion: IPL sources provide safe and effective nonablative treatment for facial photorejuvenation. Patients are equally satisfied with the effects seen with both traditional and fluorescent PL source, but reported less pain with the fluorescent PL procedure during treatments.

ULTRASTRUCTURAL OBSERVATIONS OF HUMAN SKIN FOLLOWING IRRADIATION WITH VISIBLE RED LIGHT-EMITTING DIODES (LEDs): A PRELIMINARY IN VIVO REPORT

Ablative and nonablative skin rejuvenation procedures with lasers and intense pulsed light (IPL) systems have become very popular for photorejuvenating sun- and chronologically aged skin. Both procedures demand deposition of heat damage in the upper dermis. A new generation of light-emitting diodes (LEDs) with laser-like wavebands and phototherapeutically useful output powers are now reported to be successful for noninvasive athermal photorejuvenation of age-damaged skin. This study was designed to examine the ultrastructural changes induced by irradiation of human skin with visible red LED energy. Six adult male volunteers who satisfied all study criteria had the skin over their fibula irradiated once per week for 8 weeks with a visible red LED-based system at an irradiance of 105 mW/cm 2 , 15 min/session and a radiant flux of 94 J/cm 2 . Skin punch biopsies taken from each subject after the second and eighth treatment sessions were routinely prepared for transmission electron microscopy (TEM) and were examined under an electron microscope. After the 2nd session, the skin showed normal undamaged tissue with slight interstitial edema and vimentin filaments notable in fibroblasts. After the 8th session, the number of fibroblasts in the dermis had increased with numerous vimentin filaments in their cytoplasm, and a mild inflammatory infiltration could be seen. The ultrastructure of human skin after 8 LED phototherapy sessions showed no damage-related abnormalities. Mild athermallymediated inflammation was seen together with an increased fibroblast count and enhanced metabolism, which could be related to the enhanced synthesis of collagen and which in facial skin would probably result in an improved skin appearance.

Prescribing oral contraceptives on cosmetic purpose in adolescents

A new oral contraceptive (OC) containing dienogest (DNG) as progestagen with both antiandrogenic and antimineralocorticoid activity has been developed. Our objective was to compare the effects of 35 μg ethinil-estradiol (EE)/2 mg cyproterone acetate (CPA), 30 μg EE/150 μg desogestrel (DSG) and 30 μg EE/2 mg dienogest (DNG) on mild to moderate cases of acne. This prospective, comparative study was completed over 9 treatment cycles. A total of 114 young women with facial acne and seborrhea were recruited. Treatment was assigned in three groups: OC containing CPA or DSG for 6–9 cycles in 96 cases and DNG for 6 cycles in 18 cases. Acne lesions and sebum production were evaluated. After 3 cycles, all cases showed improvement of skin appearance. Depending on cases' evolution, we prolonged treatment for 6 cycles in 91 cases and for 9 cycles in other 23. At the end of the therapy, in first two groups, we obtained complete remission of acne in 92%, of seborrhea in 78%, of inflammatory lesions in 73%. In those 18 cases receiving OC containing DNG, we remarked superior results: improvement of lesions after 1-month treatment and complete healing after 6 cycles. This new preparation EE/DNG may provide useful hormone therapy for adolescents with androgen-related conditions such as greasy skin and acne.

Microdermabrasion: A Clinical and Histopathologic Study

Microdermabrasion is a widely performed skin rejuvenation procedure. Few studies have examined its efficacy. To evaluate the clinical and histopathologic effects of microdermabrasion. Fourteen patients underwent microdermabrasion treatments over 12-14 weeks. Self-rated questionnaires were given before and after the treatment series and were evaluated by a paired t-test. Three of the 14 patients were treated for moderate to severe acne scarring. Acute histologic effects were assessed ex vivo on human abdominal skin. Chronic histopathologic effects were examined in three volunteers who underwent skin biopsies before and after a treatment series on the dorsal forearms. By patient assessment, there was statistically significant improvement in roughness, mottled pigmentation, and overall improvement of skin appearance, but not in rhytides. Acne scarring sometimes improved, but required deeper ablation. Acutely the stratum corneum was homogenized and focally compacted. Chronically there was epidermal hyperplasia, decreased melanization, and some increase in elastin. Microdermabrasion improves some aspects of photoaging and select cases of acne scarring.

A double-blind, comparative, placebo-controlled study of the efficacy and tolerability of 4% hydroquinone as a depigmenting agent in melasma

AIM: The objective of this study was to evaluate the efficacy and tolerability of hydroquinone 4% cream with sunscreens, controlled by placebo, in the treatment of melasma. METHODS: A total of 48 patients were randomly chosen, 24 in the hydroquinone 4% group and 24 in the placebo group. Patients were instructed to use and apply additional sunscreen. The treatment lasted 12 weeks, with an evaluation of efficacy, tolerability and photographs taken every 3 weeks. Efficacy was classified as 'total improvement', 'partial improvement' or 'failure'. Tolerability was classified as 'excellent', 'good', 'fair' or 'poor'. RESULTS: The difference between the efficacy of the hydroquinone 4% and placebo groups was statistically significant. In the hydroquinone group, 40% of the patients showed complete disappearance of spots at the end of the treatment and there was no therapeutic failure reported. In the placebo group, 10% of the patients showed 'total improvement' and therapeutic failures occurred in 20% of the patients. Both treatments were well tolerated, with no serious adverse events reported. CONCLUSIONS: The results indicate that hydroquinone 4% is a safe and effective drug for the treatment of melasma and that sunscreens are important as concomitant treatment by way of preventing repigmentation and improving skin appearance. ( J Dermatol Treat (2000) 11: 173-179)

Alpha hydroxyacids modulate stratum corneum barrier function

Alpha hydroxyacids (AHAs) are used to enhance stratum corneum desquamation and improve skin appearance. The purpose of this study was to evaluate whether some AHAs improve skin barrier function and prevent skin irritation. Eleven healthy subjects (aged 28 +/- 6 years, mean +/- SD) entered the study. Six test sites of 8 x 5 cm (four different AHAs, vehicle only (VE) and untreated control (UNT) were selected and randomly rotated on the volar arm and forearm. The four different AHAs at 8% concentration in base cream were glycolic acid (GA), lactic acid, tartaric acid (TA) and gluconolactone (GLU). The products were applied twice a day for 4 weeks (2 mg/cm2). At week 4, a 5% sodium lauryl sulphate (SLS) challenge patch test was performed under occlusion for 6 h (HillTop chamber, 18 mm wide) on each site. Barrier function and skin irritation were evaluated by means of evaporimetry (Servomed EP-1) and chromametry (a* value, Minolta CR200) weekly, and at 0, 24 and 48 h after SLS patch removal. No significant differences in transepidermal water loss (TEWL) and erythema were observed between the four AHAs at week 4. After SLS challenge, GLU- and TA-treated sites resulted in significantly lower TEWL compared with VE, UNT (P < 0.01) and GA (P < 0.05) both at 24 and 48 h. Similarly, a* values were significantly reduced after irritation in GLU- and TA-treated sites. This study shows that AHAs can modulate stratum corneum barrier function and prevent skin irritation; the effect is not equal for all AHAs, being more marked for the molecules characterized by antioxidant properties.

6E 1. Antiandrogens and antiestrogns—I 236. Antiandrogenic activities of 17β-hydroxy-16,16-di-methylestr-4-en-3-one (SC-14207) on sebum and hamster flank organs

A new oral contraceptive (OC) containing dienogest (DNG) as progestagen with both antiandrogenic and antimineralocorticoid activity has been developed. Our objective was to compare the effects of 35 μg ethinil-estradiol (EE)/2 mg cyproterone acetate (CPA), 30 μg EE/150 μg desogestrel (DSG) and 30 μg EE/2 mg dienogest (DNG) on mild to moderate cases of acne. This prospective, comparative study was completed over 9 treatment cycles. A total of 114 young women with facial acne and seborrhea were recruited. Treatment was assigned in three groups: OC containing CPA or DSG for 6–9 cycles in 96 cases and DNG for 6 cycles in 18 cases. Acne lesions and sebum production were evaluated. After 3 cycles, all cases showed improvement of skin appearance. Depending on cases' evolution, we prolonged treatment for 6 cycles in 91 cases and for 9 cycles in other 23. At the end of the therapy, in first two groups, we obtained complete remission of acne in 92%, of seborrhea in 78%, of inflammatory lesions in 73%. In those 18 cases receiving OC containing DNG, we remarked superior results: improvement of lesions after 1-month treatment and complete healing after 6 cycles. This new preparation EE/DNG may provide useful hormone therapy for adolescents with androgen-related conditions such as greasy skin and acne.