Cosmeceuticals

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Cosmeceuticals

• The topical treatment of photoaging at home
• Dr Catherine Boorer
• BMed FRACS Plas

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The Aging Face

• Intrinsic chronological aging
• Vs
• Extrinsic photoaging

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Intrinsic Chronological Aging

• Largely genetic
• Includes the effects of
• Gravity
• Facial expression
• Hormonal changes

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Intrinsic Chronological Aging

• Skin appearance
• Unblemished surface
• Thin
• Wrinkles
• Loss of elasticity
• Sagging
• Histology
• Atrophy of epidermis, dermis and subcutaneous
  tissues

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Intrinsic Chronological Aging

• Treated predominantly with surgery

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Photoaging

• Skin appearance
• Thick and leathery
• Wrinkled
• Rough
• Sallow
• Telangiectasia
• Mottled hyperpigmentation
• Premalignant or malignant skin lesions

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Photoaging

• Histology
• Thickened stratum corneum
• Thin atrophic epidermis with cellular atypia
• Irregular dispersion of melanin
• Loss of dermal glosaminoglycans and collagen
• Loss of normal dermal vasculature
• Elastosis (abnormal elastic fibres in dermis)

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Photoaging

• Mechanism
• UVA and UVB light
• free radicals are generated by and may mediate
  the harmful effects of UV light on the skin
• free radicals are thought to be responsible for
  the majority of cell damage that causes aging
• free radicals cause DNA mutations, structural and
  enzymatic protein alterations and lipid
  peroxidation
• Activation of metalloproteinases which break down
  collagen in the dermis

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Photoaging

• Predominantly treated non surgically
• Skin products
• Non ablative office treatments
• Ablative resufacing

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Home skin care

• Aims
• Minimise further sun damage (photoaging)
• Keep skin exfoliated
• Reverse some pre-existing changes
• Even out pigmentation

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Sunscreens

• The most successful means of preventing
  photoaging
• Broad spectrum (UVA UVB)
• Correct SPF

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Cosmeceuticals

• Multitude of skin products on the market
• A cosmeceutical is a cosmetic product whose
  active ingredient is meant to have to have a
  beneficial physiological effect
• They are not drugs and are therefore not
  subjected to rigorous trials and testing

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Cosmeceuticals

• Efficacy depends on the form of the active
  ingredient, its concentration and the vehicle in
  which it is delivered
• Lack of labelling laws makes it difficult for the
  consumer to know if the product can deliver its
  claims

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What Works?

• Randomised, double blind, controlled trials exist
  for a number of substances which prove their
  efficacy

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Tretinoin

• Tretinoin is a hormone
• it induces its effects by binding to retinoic
  acid receptors on skin cells which brings about
  numerous changes through protein synthesis

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Tretinoin

• Histologic effects
• Epidermis
• thinner stratum corneum
• reversal of atypia
• thickened epidermis
• uniform dispersion of melanin
• Dermis
• increased collagen synthesis
• angiogenesis

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Tretinoin

• Clinical effects
• changes in skin texture and pigmentation
• evident after daily use for 4-8 weeks
• improvement in fine wrinkling
• occurs after approx 4 months of use
• some patients experience irritation and redness
• require less frequent application or lower
  concentrations

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Tretinoin

• Available on prescription only
• Commercial preparations (Retin-A 0.05 or 0.01)
• Compounding pharmacist
• potentially teratogenic

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Alpha Hydroxy Acids

• The most common synthetic AHAs in use are
  lactic and glycolic acids
• Actions
• at low concentrations cause desquamation of the
  stratum corneum by disrupting cellular adhesion
• at higher concentrations epidermolysis occurs
• with long term use there is an increase in
  collagen and elastin synthesis, and an increase
  in glycosaminoglycan concentration in the dermis

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Alpha Hydroxy Acids

• Clinical effects
• Concentrations lt 10 improve skin texture and
  pigmentation
• At higher concentrations there is also
  improvement in fine wrinkles
• skin irritation less common than with tretinoin

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Alpha Hydroxy Acids

• AHA products are available over the counter in
  concentrations of 2-20
• concentrations of 20-70 are used as chemical
  peels
• can be used daily and in combination with
  tretinoin in advanced photoaging
• Safe in pregnancy

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Depigmenting Agents

• Block melanin production
• Decrease intensity of lentigos, freckles and
  melasma
• Pigmentation may return within 6 months of
  stopping use or excessive sun exposure
• Resistent or darker pigmentation may need IPL or
  laser

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Depigmenting Agents

• Hydroquinone
• Available in up to 2 concentrations over the
  counter
• Higher concentrations on prescription (4-10)
• Limit use to 6 months

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Depigmenting Agents

• Kojic acid
• By product rice wine industry
• Difficult to stabilise in commercial preparations
  
• Compounding pharmacist 4-10

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Exfoliation

• Removes the dull superficial layer of skin,
  stratum corneum
• Chemical
• Tretinoin
• AHA
• Mechanical
• Scrubs
• Microdermabraision

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Other cosmeceuticals

• Retinoids (tazarotene, adapalene), retinols,
  copper, growth factors, vitamins C and E, amino
  acids, Coenzyme Q10, hyaluronic acid, carotenes,
  alpha lipoic acid and other antioxidants.

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Summary

• Cornerstones of at home skin care
• Sunscreens
• Tretinoin
• Alpha hydroxy acids
• Depigmenting agents

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Suggested Skin Care Regime

• Morning
• Clean skin
• Cheap and gentle eg. cetaphil
• Apply sun protection
• Standalone sunscreen or sunscreen combined with
  moisturiser, antioxidants etc

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Suggested Skin Care Regime

• Evening
• Clean skin, remove makeup
• Treatment products
• AHA (8-15)
• Tretinoin for more severe photo damage (0.01 -
  0.1)
• Depigmenting agent if required

• Use separate commercial preparations or use an
  experienced compounding pharmacist to combine
  products at concentration required