Showing posts with label Skin. Show all posts
Showing posts with label Skin. Show all posts

What's the Truth About Chocolate and Skin Care?

What's the Truth About Chocolate and Skin Care?

I'm a chocoholic for sure! I need to have a small fix every few days. I'm sure that this is at least partly due to my high school job in a candy store owned by my next door neighbors (it's here, Sweet Temptations, though it was named Candyland when I was in high school, they've moved and added in some ice cream from another shop they own). Anyways, yes, I made fudge every summer in high school. And caramel corn. And fresh squeezed lemonade.

So, yes, I require a lot of chocolate. Is it possible that this could actually work in my favor? Yes. Yes, it really could. Inspired by the amazing chocolate products from Too Faced, I thought I should look into this. I've done some reading, mostly in my favorite cosmetic dermatology text book.

It turns out that it is proven that polyphenols, which are found in cocoa, can do amazing things for your skin! Cocoa prevents oxidant damage, photoaging and keeps collagen around longer. Antiaging and chocolate? Yes, please!

Does Chocolate Really Cause Acne?
The short story is probably no. There have been many studies over the years looking at whether there is a real connection, and results have been somewhat mixed. It turns out that it's really hard to control so many variables in people's diet and predict how many blemishes they should have had. Most dermatologists agree that rather than the cocoa in chocolate, we should be concerned with the sugar in these foods. Sugar itself has been linked to changes in proteins in the skin, contributing to skin wrinkling and photoaging.


Polyphenols
There are more than 8000 natural occurring polyphenols, and they all have some degree of antioxidant activity. You'll find them in most vegetables, fruits, herbs, grains, coffee, tea and even red wine. You might recognize the name of some of these compounds, such as the much studied Resveratrol, found in red wine.

Polyphenols (specifically red clover extract which is rich in isoflavones) has been found to increase collagen production and maintain skin thickness in rats that had ovariectomies (in other words, were going through menopause).

What does this have to do with Chocolate? Cocoa is rich in polyphenols, specifically Flavanols and proanthocyanidins. So, there are lots of reasons to think that cocoa has some antioxidant effects (here's some evidence that it does, article 1 and article 2), helping to prevent oxidant damage, photoaging and keeping collagen around longer.

6

Skin 101: Acne, How it Starts, How to Treat It

Acne 101
In writing a post recently, I realized that I didn't have a good post that explained the basics of pimples, how they start and how the typical over the counter ingredients work to treat it. There's a reason you see the same active ingredients over and over in over the counter treatment products. There are many ways to target acne, but only a few key ingredients to do that.

Acne Pathophysiology
First, a brief look at how acne forms. There are obviously many more things involved in this process (and really, no one really understands the entire process. If we did we'd have a magic treatment to prevent all acne). But, to understand how treatments work on acne, you first need to understand the basics of how those blemishes are formed.

1. First, when you have a typical hair follicle, you'll find a small oil gland off of it. The normal cell cycle is for skin cells to slough off (aka- just basically fall off), and for new cells to be created underneath to replace them.

2. For some reason, within the hair follicle some of these cells will start to accumulate and clump together, rather than just going out as they usually do. As this happens, the oil production will increase some, the cells will clump together more, and the sides of the hair follicle will start to have inflammation. The inflammation contributes to more skin cells sloughing, clumping, more oil, etc. It basically becomes a downward spiral. The hair follicle starts to get clogged with oil and clumped skin cells.

3. As the hair follicle gets clogged with debris, you'll notice that rather than just having the walls of the hair follicle with inflammation, some of those cells will start to move into the debris as well. These are various types of white blood cells, and when they accumulate together you probably know them better as pus. Around this time you'll also have bacteria entering the mix. Typically this is p. acnes, which is usually just found around on your skin and such. It loves to eat oil, so this environment is perfect for it to thrive.

4. As the process spirals more and more out of control that hair shaft just fills up with everything. It will get big and swollen as it fills with sloughed skin cells, inflammation, bacteria and more sebum. You may even have the shaft rupture, allowing everything to infiltrate into the surrounding skin. That's not so bueno. If it is severe enough you might even see scarring later on down the road.


Retinoids
The first way to treat acne is to start up at the very beginning of that acne circle of death. The skin cells that are sloughed off have 2 reasons they are sticky and clog things up. The first is that they have slightly different charges on their cell surface, think of them as a bunch of little magnets. Little positive and negative areas line up and keep the cells close together. Once this has happened, an enzyme (transglutaminase) creates little cross bridge connections holding the cells together.

Retinoids will actually treat both of those issues. First, they help to normalize the rate at which the skin cells slough off. The cells that do slough off (at their newly improved rate) will have reduced charges and overall the levels of transglutaminase (and therefore cross bridges) are reduced as well. Blemishes under retinoid treatment are less cohesive and looser. You're less likely to have the whole follicle plug up and create the blemish, and then when it does the decrease in compactness means that other treatments will be able to penetrate into the blemish more easily. It's a win-win all around.


Antibiotics in Acne Treatment
So, remember back in Step 3 when I said that bacteria will infiltrate into the whole sebum-white cell-sloughed skin cell mess? It only makes sense that getting rid of the bacteria will help to stop the downward spiral of a pimple. Less bacteria=less inflammation=less pus, etc.

There are 2 main ways to treat the bacteria. The first is with Benzoyl Peroxide. Benzoyl Peroxide will create free radicals (read more about that in my antioxidants in skin care post), and those will directly attack and kill the bacteria. Keep in mind that due to the free radicals you'll see damage also to the area's skin cells, so there is a potential for speeding up aging.

The second way to treat the bacteria is obviously with antibiotics! Usually Clindamycin or Erythromycin are used. Both work equally well, though there's more risk of bacteria becoming resistant with Erythromycin. When used in combination with Benzoyl Peroxide the risk of resistance is lower. Both of these anti-biotics also work as anti-inflammatories. Both of these antibiotics need to be prescribed.

Finally, you'll sometimes see Sulfur (or Sodium sulfacetamide) used as the anti-biotic in over the counter meds. Sulfur can also work on the rate of skin cell sloughing, though it won't affect the charges and enzyme levels like a retinoid.

So, obviously cleaning the junk out of the pimple is a good thing. You should not do this by popping the pimple. That follicle won't only push everything out the pore, but it will likely also rupture back into the skin, spreading the inflammation and bacteria, resulting in an even bigger mess. Extractions can be performed by those trained to do it properly (such as an esthetician), or you could remove things from your pores using a mask like the Gelatin Mask to pull everything out. I'm also a big fan of a mud mask.

Alpha and Beta Hydroxy Acids are also great for helping to clear out the hair follicle. BHAs like Salicylic Acid are more effective because they are lipid soluble, so can penetrate into the sebum clogging the follicle much more easily. Note that Salicylic Acid is also anti-inflammatory.

I'm sure we've all seen in magazines the recommendations to head to your dermatologist for a steroid injection if you get a big blemish the day of an event. It really does work. Bringing down the inflammation makes the swelling go away, the redness is gone, and while that little plug of sebum and sloughed cells is still present, the blemish is much less apparent. If only it was always this easy!

There are a few ways to bring down inflammation to help acne. The first way is obviously steroids, but this should be avoided at all costs. You can have thinning of the skin from steroid use (steroid atrophy), but use of topical steroids can even cause "steroid acne". So, definitely no steroids! Instead, take advantage of the anti-inflammatory side effects of some of the other treatments, such as topical antibiotics and Salicylic Acid.

To help decrease sebum production you can use Retinoids (oral and topical both decrease oil production), or a hormonal treatment such as a birth control pill. There aren't any other ways to really decrease oil production, but you should also remember to not do things that increase oil production. Over washing of the skin will increase oil production quite a bit, so definitely stick to 2x a day at most.

You may have noticed something about all of the above Acne treatments. Very few of them work on blemishes that you already have. Instead, they work on changing the way your skin acts, so they prevent future blemishes. Which means that rather than seeing results quickly, you'll need to wait about 6-8 weeks to really see a result.

If you want to see immediate results, you should look for Salicylic Acid, Benzoyl Peroxide and steroids (with your physician). I've also had results using heat, with either a warm compress or my Tanda Zap.


 photo differential-diagnosis-acne.jpg
Keep in mind that not everything that looks like acne, is actually acne. If you've tried the typical over the counter treatments without any effect, then it is definitely time to head to your doctor. There's a huge list of alternative diagnoses, but they include things like Pityrosporum folliculitis, Rosacea, and Seborrheic dermatitis.


So, that's acne and acne treatment made super simple. Obviously there's a lot more to this than I've explained (I'm but a simple pediatric intensivist, not a dermatologist), and when in doubt I recommend seeing your doctor. Most primary care doctors do treat a lot of derm issues (we did a lot of rashes and acne back in my general peds days), and if needed they'll refer you on to a dermatologist.
12

Vitamin C in Skin Care: How Does it Work?

vitamin c in antiaging skin care
Vitamin C.... doesn't it kind of sound like someone just decided to take their grandmother's advice for the common cold and extrapolate that to anti-aging skin care? Or maybe it was just an ingredient laying around that was easy to incorporate into more items?

Actually, it really does work.

So, what does it do?

First, go back to my how anti-oxidants work in skin care post to review oxygen free radicals and how anti-oxidants scavenge up those extra electrons. Remember that while those free radicals may have been taken care of, the damage that they've already done is still there.

So, Vitamin C, aka ascorbic acid, is one of those anti-oxidants that go around mopping up free radicals. But it also does so much more!

Read on to learn about all the different things that Vitamin C does, a little more about how it does them (I promised I've translated as much as possible into "regular" language, though this post is definitely of a higher level than most), and what to look for in a Vitamin C preparation.
28

Sunscreen 101: Anti-Oxidants and Photoprotection

Sunscreen 101, how sunscreens work, uv range, antioxidants, anti-oxidants
If you read my giant post yesterday on anti-oxidants, you likely noticed that I kept bringing up photoprotection and how anti-oxidants helped repair sun damage. So, what is all that about? Can you use anti-oxidants instead of sunscreen? Are they an adjunct?

0

Anti-Aging 101: Anti-Oxidants

antioxidants in skin care
antioxidants in skin care and aging

As part of my Anti-Aging 101 Series, I have decided to revamp old posts that describe different ingredient categories. I'll go over how and if these ingredients work. Not a lot has changed regarding some of these ingredients (such as anti-oxidants), but I'm planning to take advantage of the 2 cosmetic dermatology books I have in revamping these posts, so there likely will be some new info.

The involvement of free radicals in the aging process was first proposed all the way back in 1956, and it is one of the few things in anti-aging that is widely accepted. Free radicals have not only been implicated in the overall aging process, but also in photoaging, skin cancer and inflammation (which in turn contributes to aging, photoaging and some postulate skin cancer).

So, what is a free radical? How can you mitigate all this damage, and what exactly is an anti-oxidant?

Well, what exactly is an antioxidant? It's something that fights free radicals. I think that it was explained best by Alton Brown from the Food Network.


creation of a free radical
Basically, the free radicals are created when they give up or lose an electron. That lose leaves a hole, and the newly created free radical doesn't know how to cope with this. It goes crazy trying to fix that hole, which means in your skin the free radical bounces around in skin cells, causing damage to things like your cell membrane or even your DNA, attempting to fix that hole.

What do the free radicals do to your skin? The reactive oxygen will go around seeking another electron, and it doesn't particularly care where it comes from. It can attack cellular proteins, cell membranes, parts of the cytoskeleton, the extra-cellular matrix, even the DNA of the cell itself. We don't know all of the exact mechanisms involved in free radical damage.

So, now that you know what a free radical is, how are they created? Pretty much anything that challenges the skin.
•UV Rays (Sunlight)
•Drugs
•Pollution
•Heat
•Cold

free radical neutralization
Antioxidants help to control the free radical damage by getting rid of the free radicals. They can donate an extra electron to the free radical, filling that hole and fixing the behavior. The free radical no longer goes around causing damage.

The skin does have it's own antioxidant system to help to counteract these free radicals, however over time the free radicals can continue to damage cells and their DNA. In addition, your body's antioxidants decrease with age, leaving the free radicals unchecked, and leaving your cells, cell membranes and DNA more vulnerable to damage. This results in loss of firmness, radiance, elasticity and can contribute over time to aging of the skin. Notice that I said over time. Because in theory you're experiencing this type of damage all the time, though more so after exposures to sun and such. But, the damage is cumulative and although you won't be able to see results right away, chances are you will see them in the long term. I think of this as similar to wearing sunscreen. You might not see a big difference now, but if you compare yourself to your friends that didn't do it in 10 years, you'll likely see a difference.

The skin does have it's own anti-oxidant system to help to counteract these free radicals. Our bodies are smart and produce anti-oxidants as part of its own normal processes as well as in response to those same stresses that create the free radicals! So, expose yourself to UV rays, there will be free radicals produced, but your body will respond with anti-oxidant production. Sounds great, right? Sure, except that it takes your body quite a bit longer to produce the extra anti-oxidants than it took the sun to create the free radicals. So, you will have a lag, which allows time for that damage to take place. As well, your body's ability to produce those anti-oxidants will decrease with age. That means more time for that damage to occur.

How does all of this translate over to your skin? You'll see loss of firmness, radiance, elasticity and can contribute over time to aging of the skin. Notice that I said over time. Because in theory you're experiencing this type of damage all the time, though more so after exposures to sun and such. But, the damage is cumulative and although you won't be able to see results right away, chances are you will see them in the long term. I think of this as similar to wearing sunscreen. You might not see a big difference now, but if you compare yourself to your friends that didn't do it in 10 years, you'll likely see a difference.

A huge number of antioxidants are on the market right now, here's a quick overview of a few of them. Note that some of these are applied topically, but some can also be taken orally. Is one better than the other? We're not sure. But, since most of these are simply vitamins, I think you probably couldn't go wrong with improving your diet and using a product with an anti-oxidant in it. Currently Vitamin C is the only anti-oxidant that really "treats" aging once it has occurred. This is likely due to the collagen production boosting affects of Vitamin C rather than the anti-oxidant effects. So, anti-oxidants are aging preventors, with the exception of Vitamin C. Just keep that in mind.

Now, this is the boring part of the post where I list a bunch of ingredients and quote a little bit of stuff from some reviews I've found on-line and then researched a bit on my own to make sure stuff was accurate. I'm by no means an expert on anti-oxidants (especially since there are so many of them), but here's some info on the ones you're most likely to run in to.


Allantoin
Long used to help protect the skin in creams and lotion, allantoin was thought to be a skin protectant. It has been called a "cell proliferant, epithelization stimulant, and a chemical debrider." Basically, it helps to exfoliate and stimulate new skin growth.

Alpha Lipoic Acid (ALA)
ALA is unique, as it is soluble in both water and lipids, so it easily penetrates into the skin. It seems to help protects Vitamins E and C, helping to boost their activity within the cell by "reenergizing" them. It is also converted in the skin into another chemical that has it's own antioxidant properties.

Copper Peptides
Copper has long been known to be important in the creation of collagen and elastin (again, important parts of the dermis), both of which are decreased with aging. Copper does have a bit more research than many other topical antioxidants, and some well design (aka- double-blind placebo controlled) research studies have shown improvement in fine wrinkles, hyperpigmentation and decreased photodamage. Copper increases the body's superoxide dismutase levels (see below). They even found a 17.8% improvement in skin thickness! Overall that does sound great, and copper is very appealing to add to products since it is non-irritating and pretty cheap to add to creams.

Dimethylaminoethanol (DMAE)
When used topically, DMAE has been found to increase firmness of the skin, likely because it helps to reduce some linking between proteins in the skin that happens with aging, as well as separate antioxidant properties.

Glutathione
Composed of glutamic acid, cysteine, and glycine, this little protein is found in all animal tissues, is one of your body's main antioxidants and is very decreased in the skin after skin exposure. Unfortunately it is water soluble, which means it does not absorb well when taken orally or applied topically. Not available in cosmetic products.

Grape and Grape Seed Extract
Proanthocyanidin, a very powerful antioxidant is found in grapes and grape seed extracts. While this antioxidant doesn't have strong evidence that it works topically (really, most of these things I'm listing don't have much evidence anyways), it was found to have strong effects on free radical damage of fat cells especially, as well as improved wound healing and prevention of tumors (both in mice).

Green and White Tea
Green Tea has some great things in it called polyphenols and they are one of the most widely studied anti-oxidants on earth. Polyphenols are a very large and diverse family. There are literally thousands of them, and they are all found in two. The 4 major ones found in tea have long complicated names, but they are shortened to ECG, GCG, EGCG and EGC. Confused yet? The EGCG is the main polyphenol that is responsible for anti-oxidant activity in both green and white tea and it is the most potent. It is important to know which polyphenols are included in a formulation, and to what concentration. The most effective products will contain 50 to 90% polyphenols and will be brown.

EGCG does offer photoprotection. This has been seen in mice with both oral and topical application, as well as in human skin. It is dose dependent (meaning, more ECGC will result in more effects), resulting in a decrease in redness, sunburned cells and less DNA damage after UV exposure.

Note that most of these studies were done specifically with ECGC as the ingredient. There are thousands of polyphenols in green tea, and most products on the market that contain green or white tea are not of a high enough concentration to demonstrate that they work. Look for ECGC ((-)EpiGalloCatechin-3-O-Gallate) and concentrations over 50%.

Idebenone
This is the synthetic analog of Ubiquinone (Coenzyme Q 10). It weighs less than CoQ10, and therefore has been shown to penetrate the skin more effectively. It has higher anti-oxidant activity than CoQ10, Vitamin E, Kinetic, and Vitamin C in a lot of studies. Currently it is available in Elizabeth Arden's Prevage Line only.

Lycopene
A natural pigment that is responsible for the red pigment we see in tomatoes, pink grapefruit, watermelon and apricots. Due to the chemical composition of Lycopene (something about double bonds) it is a stronger anti-oxidant than beta-carotene or Vitamin E. Increased intake of lycopene has been shown to prevent cancer and cardiovascular disease. Currently there is little information available regarding its use in anti-aging skin care products.

Melatonin
Yup, that stuff you take to help prevent jet lag is an antioxidant! It's released by the brain, and it's able to both act as an antioxidant, increase the activity of other antioxidants and to help decrease redness from sunburn. Oh, and help you reset your internal clock, but I'm not going to go into that!

Panthenol
An alcohol derivative of Vitamin B5, Panthenol is actually a humectant (see, it's here in my moisturizer post), and is very easily found in moisturizer, shampoo, conditioner, etc. Once it's in the skin, it get converted to an acid that is an important cofactor for Coenzyme A, allowing your skin to function normallly. It's pretty stable, but doesn't do well in acidic or basic environments or high heat.

Soy Isoflavones
Only available orally, Genistein and Daidzein help to enhance the antioxidants your body already makes. Mice were fed a solution with these 2 isoflavins, and for weeks afterwards their skin had decreased roughness and improved collagen levels after sun exposure. Does this mean that if you eat soy it will make your skin smoother? Not quickly, but it may help in the long run.

Spin traps
Spin traps are kinda cool, they react with the free radicals to create unreactive free radicals, so they can't cause any damage! I love the Your Best Face products, which feature Spin Traps.

Superoxide Dismutase (SOD)
An enzyme that destroy a very active reactive oxygen species (super oxide), this is a very big enzyme and it has a really hard time penetrating into your skin. This makes it very difficult to use as a topical agent. If it could get there, it would be very useful and would dramatically decrease redness from sunburn as well as the damage from the UV exposure.

Ubiquinone (Coenzyme Q 10)
This one likely sounds very familiar, as it can be found in a huge number of products on the market right now. It's also found in foods like fish and shellfish. CoQ10 is fat soluble and works within the cell's mitochondria (a little energy creating organ found within each cell) to help create energy and it helps to reduce damage of certain proteins even better than vitamin E. CoQ10 levels have been found to decrease with age, one reason that many feel it could be particularly useful for aging skin. It has been found to easily penetrate the skin when applied topically and then to significantly decrease an enzyme that chews up collagen after UVA exposure. Supplementation with CoQ10 has been found to reduce crow's feet, and supplementation will increase levels in the epidermis.

Vitamin A
Vitamin A was the first antioxidant to be used for anti-aging, and it's synthetic derivatives (the retinoids) are even more useful given their stability. Retinoids are the only agents that have been found to be effective against wrinkles in studies and are the gold standard.

Vitamin C
Also known as L-ascorbic acid, Vitamin C is that thing that gives you scurvy if you're deficient. It's water soluble and works in the early stages of production for collagen (it even helps to stimulate collagen production) and a few amino acids. Vitamin C has been found to be low in the skin after sun exposure and applying it topically after sun exposure will specifically combat the ROS brought on by UV exposure. Very few studies on Vitamin C in the setting of photodamage or in humans (rather than in petri dishes) have actually been completed.

Vitamin C is a great candidate for use. Unfortunately, no studies have found increased levels in the skin after oral supplementation, hence so many topical forms on the market. It can be formulated as water soluble or lipid soluble. Unfortunately, most of them can not penetrate the statum corneum (the very outer layer of the epidermis), which makes them expensive products that don't work. You will want a product that is lipid soluble, and that the company claims is "nonionic" or more lipophilic, both of which will help penetrate the skin. If they have some evidence of penetration that would be even better.

Vitamin C is easily degraded by both heat and light, as well as exposure to air. That means most products are inactivated within hours of opening them, therefore all of your money has just been wasted. Only buy Vitamin C preparations that are in air-tight packaging (such as a pump) that protect the product from any UV exposure.

Vitamin E
Alpha-tocopherol is found in membranes and tissues galore, and in fact the term "Vitamin E" actually refers to 8 different molecules that have the same activities (the one labelled "alpha-tocopherol" is the most active form). It is lipophilic, meaning it likes being around fats and cell membranes. It has been found to be the primary lipid-soluble anti-oxidant in the skin, and subsequently has become a very popular choice to help treat skin issues of all sorts. Higher vitamin E levels have been linked to lower risk of infection and cancer in elderly patients that have high blood levels of Vitamin E. Topical and oral Vitamin E has been shown to decrease sunburn damage (swelling, redness and inflammation) and even wrinkling when applied prior to UVB exposure.

So, should you take Vitamin E and apply it to your skin before going out in the sun? Hard to say. Studies have found that by taking a Vitamin E supplement every day you did not have any meaningful photoprotection. Currently many dermatologists feel that it likely needs to be used with other anti-oxidants such as Vitamin C to have an effect. As well, you can have reactions to certain types of Vitamin E (Tocopherol acetate seems to be the worst).



There are important things to remember about antioxidant use to fight aging.
1. It has not been proved clinically, even though it seems logical that antioxidants would help fight signs of aging.
2. Any effects you will see are likely to occur over a long period of time.
3. If you're going to use antioxidants on the skin, the formulation must be stable (meaning the antioxidant doesn't break down and become useless), must be a high enough concentration and must not only get to the target area but must stay there long enough to work.


antioxidants in skin care and aging


I've received samples in the past of some of the products mentioned in this post.
9

Bioelectricity and You: Can a Cream "Recharge" Your Skin?

aveeno, neutrogena, roc, anti-aging, explanation, brillance, e-pulse, electricity, currents, skin
I know by now you've likely seen the commercials, the ads in your magazine or even read famous dermatologists discussing this new breakthrough in skin care in a magazine (I think I've seen it in 3 at last count).

"Bioelectricity", just hearing that term makes me think... well, not that it's amazing. Honestly, that term makes me think of those copper bracelets they sell in the in-flight catalog or on late night television. You know the one, they show some guy wearing it while he's golfing and then they claim that the bracelet cured his diabetes? I thought of that immediately when I heard about these products. Then I did a pubmed search. Nothing. There was some nonsense about everyone knowing the electricity in your skin decreases as you age. I didn't learn that in med school. Obviously this was all nonsense.

Or, was it?

What exactly is electricity? It's a current. A current is movement of charged particles. Which means you just need some charged things moving around. Oh yeah, I did learn that in medical school. And I use it everyday in my ICU. We just don't call it electricity, we call it shifting.

A lot of things in our bodies are charged, and in order for our cells to function properly they need to be kept at certain levels in different compartments. Things like Sodium, Potassium and Calcium. They're all charged ions, kept at different levels in cells, out of cells, in different ares of the body. And they move around. That's current, and therefore electricity. If they can't move cells not only can't function properly, they actually die.

So, there is electricity in our bodies. Now what's this that Johnson & Johnson is doing? And, more importantly, does it actually work?

3

Anti-Aging 101: What Makes Us Age?

anti-aging, aging, 101, review, simplified, what makes us age
Wouldn't it be great if I could just tell you exactly what makes all of us age and give you a little pill you could take to fight it? Like a multi-vitamin that keeps you from getting wrinkles? Simply pop one a day?

Lucky for you, I made a very high tech and involved chart that shows you why humans age and turn into wrinkled little prunes.
causes of aging, anti-aging, aging, 101
I can tell that you are very impressed with my Photoshop skills! I drew that myself. (Ok, I drew the sun, the rest was just cut and paste!)

Really, there are some more definable things that make us look older. Here are the structural things that happen as we age, resulting in sagging and wrinkles.
1. Fat
2. Changes in the Skin
3. Bone Structure Changes


Notice that the changes in your skin are last aren't always the most prominent, though we all do tend to focus on our skin. Trust me, if the other two are out of whack, you're not going to be worrying about a couple of crow's feet!

Fat
When the fat isn't right, the problems are really easy to find. Basically, the current thinking is that in your face there are pockets of fat. Some of them are pretty much always there and will only start to go away with part of the aging process (this loss starts in your 30s for most people but is highly variable due to genetics). These pockets are deep and help provide structure, think deep in your cheeks or under your eyes. Some pockets are a bit more superficial and are more easily affected by weight fluctuations, but will also affect the overall appearance of your face/neck.

What are the results of changes in these fat pockets? If you've lost the fat, you might have sunken cheeks or increased hollows under your eyes (talk about dark circles!). Too much fat can be just as bad (and realize that when most of us gain weight, some of it does go to the bottom half of our face) resulting in a double chin, ill defined jaw line (or if there's enough on the neck, the dreaded turkey neck!) and can also make under eye bags bigger.

So, how to avoid these problems? Maintain a steady and healthy weight.

I do not mean being model thin (I've been backstage at Fashion Week, the girls are very scary in person. Please don't do that!)

I mean a healthy Body Mass Index. aka the BMI. Granted, the BMI is not for everyone (most notable are the large very musclar guys in the NFL, their muscle throws the whole thing off), but it works for all of us "normal" people. Back in the day when I was in primary care (oh, the days of vaccines and discussions about developmental milestones...) calculating BMI was something I did for every patient. It was plotted on a little growth chart, and if a kid was about 75% or higher it resulted in a discussion about portion control, increased veggies and decreased soda and Flaming Red Hot Cheeto intake. (The kids in So Cal are obsessed with that flavor of Cheetos and eating at least 1 large bag was universal amongst our patient population. Eat too many and they turn your poo red. Really.) Anyways, I hope your doctor calculates your BMI for you at your visits, and if not ask for it to be done.

To figure out what your BMI is on your own, there's a great BMI calculator from the National Heart, Lung and Blood Institute. Be honest and use the actual numbers of your weight and height, not the ones that you tell friends and family! Most likely you'll be surprised by where you fall in the curve. (I'm in the mid-range of healthy at 21.4, by the way.)

The way to make those fat pockets cause even more issues is to have massive weight fluctuations. Yes, if you are 800 pounds and can not leave bed, I agree you need to lose a lot of weight. But constantly yo yo dieting off the same 10-20 pounds is likely not going to help. I know Oprah has done it, but most of us aren't so lucky.

Obviously, a good plastic surgeon or cosmetic dermatologist can move fat around or use an injectable to fight these effects. That's not my specialty, so I'll just say find a good one if you're thinking about one of those options.


Skin Changes
As we grow older, the skin definitely changes. It's repair functions slow down really in your 30s, you have less collagen and elastin production also in your 30s (read my post on The Dermis to know why this is bad, you lose both structure and elasticity in the skin). These issues are exaggerated when skin is dry, well moisturized skin kind of "plumps up" and helps hide this a bit, at least temporarily. After menopause it all just gets worse, unfortunately. Decreased hormone levels lead to even more lose of elasticity, skin is thinner and drier.

Obviously, these are the things that I'll be addressing the most in my posts. Overall the goal is to increase collagen and elastin production, keep up cell turnover (which also helps with increased collagen and elastin production), moisturize the skin and keep the overall tone and texture of skin even. Some of the ingredient categories that help achieve these goals are Retinoids, Anti-Oxidants, and Peptides, just to name a few.

Bone Structure Changes
With age, everyone's bones will lose some mass. And while there does seem to be a little bit of debate about how much this affects aging. I've seen a lot of quotes from different plastic surgeons, some put a lot of stock in this, some say that if there are bony changes with age, especially after menopause, then you should only expect bones to change at the most a millimeter.

So, should you do anything about bony changes? Probably not much more than you would do to combat bone loss in the rest of your body. That means keeping up your calcium intake (either via diet or supplements), some level of physical activity and talking to your doctor about other options if needed.

5

12 Great Winter Skin Tips

bloomacious, winter skin tips, winter survival, dry skin
Have you checked out Bloomacious yet? They are a great site full of articles and tips! I particularly loved this post on surviving winter skin issues. The only thing that I would as is for tip #1, be sure to apply those rich creams to your skin within 3 minutes of leaving your shower, the longer you wait the more moisture leaves you skin. Apply liberally and quickly!

12 Tips for Winter Skin at Bloomacious
1

The Environmental Working Group's Sunscreen Report: Are They Right?



Today the news media is abuzz with the Environmental Working Group's Sunscreen Report. I'm not quite sure why this is suddenly news since I've seen it on their website for quite a while, but I definitely thought that I need to address the report and let you know my take.

First, a little bit of background on the Environmental Working Group. The Environmental Working Group is one of the founding partners of the Campaign for Safe Cosmetics. They run a website called Skin Deep, which is a nice website about ingredients in cosmetics. I like this website for a few things, primarily the fact that they often have a list of ingredients for many products (which saves me time from typing things in) and they sometimes will tell you what an ingredient does (which is something I can have problems finding on-line when I'm analyzing ingredient lists for my reviews).

The issue that I have with Skin Deep is the information that they supply for safety. (You can read more about how they compile this information here) I'm not really sure who they have reading studies to determine the validity and how well a study was performed, but I often find myself disagreeing with the EWG's conclusions. Studies that are not well done with major flaws, not performed in humans, and with levels of a substance much higher than can ever be achieved in a human may often grossly overstate their findings. I've found that the EWG then even more overstates the importance of these findings and concludes that by using a product with said ingredient you will be causing major health risks.

While I do agree that we need more information about many ingredients, I think that overstating the findings of poorly controlled studies is also dangerous. The preservative class known as parabens is a classic example of such gross overstatement of findings. I'm not going to get more into that here, but just know that many people disagree with their conclusions regarding ingredient safety.

Having said all that, the EWG's report came with some highlighted major points, so I'll discuss them one at a time.


Many products lack UVA protection.
Our analysis found that 7 percent of high SPF sunscreens (SPF of at least 30) protect only from sunburn (UVB radiation), and do not contain ingredient combinations known to protect from UVA, the sun rays linked to skin damage and aging, immune system problems, and potentially skin cancer. FDA does not require that sunscreens guard against UVA radiation.

This is incredibly true. SPF only refers to protection from UVB and a large number of US sunscreens do not protect against UVA rays at all. Many of those that do protect from UVA only protect from short-wave UVA and ignore the long-wave UVA waves. Really, this is rather inexcusable and I recommend looking for only sunscreens that provide broad spectrum UVA/UVB coverage.



I also think that you can't rely on the bottle to tell you if something is broad spectrum. Frequently the bottle just doesn't tell you the whole truth, and you need to analyze the ingredients yourself. Luckily, the US FDA currently has only approved 17 ingredients to act as sunscreens, and they are easily found under "Active Ingredients" on each product.

To help things along I developed this handy chart above. All 17 ingredients are on this, but they are currently randomly scattered around to allow space for all of them to show up. It isn't hard to line ingredients up though, notice that each UV range has it's own "width" (UVB is 3 boxes, Short UVA 2 boxes and Long UVA is 6 boxes) as well the colors become darker with increasing wavelength. Each ingredient is easy to "plug in" to the correct coverage so you can see if broad spectrum coverage is provided, like I do for each of my sunscreen reviews (check out this example, Kiehl's Vital Sun).


Sunscreens break down in the sun.
Paradoxically, many sunscreen ingredients break down in the sun, in a matter of minutes or hours, and then let UV radiation through to the skin. Our analyses show that 48% of products on the market contain ingredients that may be unstable alone or in combination, raising questions about whether these products last as long as the label says. FDA has not proposed requirements for sunscreen stability.

This is also true. There are some combinations of sunscreens that are much more stable while some combinations are well known to be very unstable once exposed to the sun. The best way to test stability has yet to be agreed upon, so there is often conflicting information about how stable an ingredient/combination is.

One well known example of this is Avobenzone with either Octocrylene or Octinoxate. There are quite a few studies looking at these combinations (just do a quick Medline search to find them), and they are mostly conflicting. There was one study in particular that found the Avobenzone/Octinoxate combination to be very unstable, lasting just a few minutes. However, the stability was tested differently than many other studies and subsequent studies have not confirmed these results. But, other studies about this same time did find that the Avobenzone/Octocrylene combination (much rarer in US sunscreen formulations but rather common in European formulations) to be more stable. The result? No one knows for sure what the best combination is. We know that Avobenzone/Octocrylene is stable, but we don't know for sure that Avobenzone/Octinoxate is unstable. I know the girls over on the Makeup Alley Skin Care board are likely shaking their heads at me (they are firm believers in the OctiNOxate mantra), but the studies are there.

Truly, we need a Gold Standard for testing stability. We need to have more published data about these combinations. We also likely need the FDA to regulate this.


Questionable product claims are widespread.
Many products on the market bear claims that are considered "unacceptable" or misleading under FDA's draft sunscreen safety standards. Claims like "all day protection," "mild as water," and "blocks all harmful rays" are not true, yet are found on bottles. Until FDA sets an effective date for these standards, industry is free to use hyped claims. Companies' decisions to inflate claims has spurred class action lawsuits in California.

Very true. All sunscreens should be reapplied every 2 hours, it doesn't matter what you've been up to. Reapply everything after swimming. Very few products on the market actually block all wavelengths in the UVA/UVB spectrum and even then even the highest SPF products only block about 95-99% of the rays. Really companies shouldn't state these things since it only makes the less educated consumer confused.


Many sunscreens contain nano-scale ingredients that raise potential concerns.
Micronized and nano-scale zinc oxide and titanium dioxide in sunscreen provide strong UVA protection, and are contained in many of our top-rated products. Repeated studies have found that these ingredients do not penetrate healthy skin, indicating that consumers' exposures would be minimal. Powder and spray sunscreens with nano-scale ingredients raise greater concerns, since particles might absorb more easily through the lungs than the skin. Studies of other nano-scale materials have raised concerns about their unique, toxic properties. FDA has failed to approve effective UVA filters available in Europe that, if approved here, could replace nano-scale ingredients.

Many physical sunscreens on the market today are smaller particles of Titanium Dioxide and Zinc Oxide, which allows them to create a finer film on your skin which is much more pleasant. (No more chalky white nose!) But, it does seem very reasonable that if you're spraying it on or applying powder all over that it might aerosolize into the air and you could breathe it in. We don't know how that affects your lungs.


The U.S. lags behind other countries when it comes to products that work and are safe.
FDA has approved just 17 sunscreen chemicals for use in the U.S. At least 29 are approved for use in the E.U. FDA has approved only 4 chemicals effective in the UVA range for use in the U.S., and has failed to approve new, more effective UVA filters available in the E.U. and Asia.

This is why it was such a big deal when Ecamsule was approved, it was the first in an incredibly long time. The Europeans are much more progressive than the US when it comes to sunscreen. Let me know if there is a cult sunscreen that people are importing now (I'm really not sure) and I'll pick it up to review when I'm in Paris in October!

Some sunscreens absorb into the blood and raise safety concerns.
Our review of the technical literature shows that some sunscreen ingredients absorb into the blood, and some are linked to toxic effects. Some release skin-damaging free radicals in sunlight, some could disrupt hormone systems, several are strongly linked to allergic reactions, and others may build up in the body or the environment. FDA has not established rigorous safety standards for sunscreen ingredients that fully examines these effects.

I think I've already addressed this concern above. I frequently don't agree with the EWG's conclusions about a product's safety, I think they have misinterpreted many studies.


Overall Results
Only 15% of 952 products analyzed met EWG's criteria for safety and effectiveness, blocking both UVA and UVB radiation, remaining stable in sunlight, and containing few if any ingredients with significant known or suspected health hazards. Our assessment is based on a detailed review of hundreds of scientific studies, industry models of sunscreen efficacy, and toxicity and regulatory information housed in nearly 60 government, academic, and industry databases.

I think that the EWG may be discounting many great sunscreens due to their ingredient safety analysis. Personally, I still think that there are a lot of great sunscreens available at many price points. I recommend analyzing the active ingredients for yourself for UVA/UVB coverage, applying 1 ounce of sunscreen per application and reapplying every 2 hours when you are out in the sun. Oh, and hope with me that the FDA finally completes their sunscreen regulation, which was mandated by Congress to be complete by 2006. This should give us standards for stability and hopefully some more approved ingredients as well as improved regulations for UVA coverage.

12

Aging Tips from Dr. Patricia Wexler!

patricia wexlerI can not even begin to tell you how exciting it is to have tips straight from Dr. Patricia Wexler appear in 15 Minute Beauty Fanatic.

Dr. Wexler has appeared in pretty much every beauty magazine available in the US, hardly a month goes by without a quote from her in my beauty bible, Allure. She’s even developed her own skin care line (available nationwide at Bath and Body Works and on QVC) with revolutionary ingredients like MMPi’s (they stop skin from being broken down basically). She's a huge proponent of sun screen, and I really think of her all covered up on the beach (as in this NY Times article) when I pick out my sunscreen for vacations (this prompts me to buy SPF 70 instead of SPF 30, not to mention my tunic cover-up).

wexler skin, skin careIn our 20’s, sun exposure may have already caused freckling, pigmentation and fine lines most obviously around the eyes.
• Tip: A good skincare regimen including daily exfoliation and moisturizing with an SPF of 30 will ensure youthful skin and thwart wrinkles from developing.
Try: Patricia Wexler, M.D. Dermatology Universal Anti-Aging Moisturizer SPF30
• Tip: Use at least one anti-aging product to prevent further damage to collagen and elastic tissue.
Try: Patricia Wexler, M.D. Dermatology Universal Anti-Aging Cleanser


In our 30’s, etched lines become more exaggerated especially around the eyes, and forehead. Stress and hormone manipulation may require adult acne relief. Men are particularly prone to follculitius of the beard, which can be treated with topical salicylic acid, exfoliation, and topical antibiotics.
• Tip: Avoid smoking, wear large sunglasses with UVA and UVB protection to protect the delicate eye area.
Try: Patricia Wexler M.D. Dermatology Intensive 3-in-1 Eye Cream
• Tip: Use antibacterial but not drying solutions. It is vital to incorporate your acne regimen into your anti-aging routine.
Try: Patricia Wexler M.D. Acnescription Exfoliating Acne Cleanser and Overnight Acne Repair Lotion


In our 40’s, lines previously only seen with movement become visible at rest.
• Tip: Use products that contain peptides for immediate relaxation of lines while promoting long term collagen and elastic stimulation. In addition, line fillers containing dermaxyl and polysilicone will give immediate improvement in the appearance of lines and wrinkles.
Try: Patrica Wexler M.D. Dermatology Fastscription No-Injection Line Filler for Lips and Eyes
• Tip: Pigmentation and dull sun damaged skin can be treated with glycolic peels, micro dermabrasion, and skin brightening moisturizers with peptides like Haloxyl and botanical brighteners.
Try: Patricia Wexler M.D Dermatology Resurfacing Microbrasion System and Skin Brightening Daily Moisturizer SPF30



Dr. Wexler will be appearing on the TLC program 10 Years Younger, where she'll be sharing her anti-aging recommendations with everyone! Check out the program guide and tv schedule for info on when to tune in!

images: QVC.com
1

Sunburn: A (Sometimes) Inevitable Problem That You Can Treat

How to treat a sunburn

How to treat a sunburn
In an effort to take advantage of living in California, my husband and I drove down to San Diego to check out the Padres' stadium (very nice). Did you hear about that absurdly long Padres Game on Sunday? Well, I took that picture from my seat, at that game. No, we did not stay for all 18 innings, luckily we left at the beginning of the 7th.

Unfortunately, I forgot my new Murad Sunscreen at home on the counter. Turns out that sunscreen doesn't work so well when it's still in the tube a hundred miles away rather than on your skin. So, I spent about 3 hours in direct sunlight with only my SPF 15 daily lotion to protect me! My husband (a real keeper) noticed I was "getting pink" and recommended heading for home. Unfortunately, the damage was already done and my nose and forehead turned a bit pink over the next few hours!

Fortunately, there are a few things that can be done to help ease the pain (and decrease the damage) of a sunburn!

Read on to learn how to treat a sunburn.


First, you'll need to understand the different phases of a sunburn:
• Immediate Redness: Occurs within minutes and fades
• Delayed Redness: Occurs after the immediate redness has faded and lasts for days
• Desquamation (peeling): Usually starts within the week

Note that all of these phases can be accompanied by different degrees of vascular permeability (basically, leaky blood vessels) that can result in swelling and blisters.

In addition, the UV damage induces actual DNA damage within the skin cells (the keratinocytes) which either then needs to be repaired by the skin or may result in cell death. The cell can never truly "fix" its DNA so this damage can build up over time and result in problems such as photo-aging of the skin or even cancer.


Things that help:
• Nonsteroidal Anti-Inflammatory Medications (Advil, Motrin): May decrease some of the early redness and decrease the degree of damage caused by the burn
• Ease the Pain & Itching: Itching can definitely make a bad sunburn much more uncomfortable! Try cool compresses or baths (avoid anything hot, either luke warm or slightly cool will be much more soothing), even cool lotions and creams will feel great, such as that aloe vera gel your mom used to keep in the fridge all summer long!
• Anti-histamines such as Benadryl will help with the itchiness but not the underlying issue.
• Moisturize! Applying lotion very liberally and frequently can help with itchiness and decrease peeling
• Vitamin E also helps to decrease redness and damage from a sunburn, but note that it needs to be applied pretty much as you are burning in order to see the effects. Perhaps make a ritual of applying a cream with Vitamin E after each sun exposure?
Oral Vitamins have been shown to make a difference! Studies have shown that the combination of 2g (2000 mg) of Vitamin C with 1000 IU of Vitamin E will decrease the sunburn reaction while Carotenoids (25 mg/day) and 500 IU Vitamin E will protect you against the development of redness with sun exposure. Vitamin C also will decrease both damage from the sun as well as redness after exposure. Bottom line? Vitamins that have anti-oxidant activity are good! Eat your veggies or take a vitamin daily.

Things that don't help:
• Steroids, both oral and topical: Studies have shown that if the burn is bad enough it might be worth a try under a doctor's supervision, but usually only have very small effects on the degree of redness
• Never unroof any of the blisters. They are protecting the fragile skin beneath from infection, so allow them to slough off on their own over time.


Most Important Tips!
Your skin is much more prone to another burn in the week after a sunburn. Please take extra precautions to decrease your sun exposure during this time period!

Remember, any change in your skin's color means that damage has been caused! This is regardless of whether that color change is a tan or a burn. There is no such thing as safe tanning. Remember your sunscreen!


Images
Baseball copyright 15 Minute Beauty Fanatic
Aloe Vera- Ricky Romero, Flicker
7

Photoimaging Analysis: A Scary but Informative Picture


As much as I talk about sunscreen on this blog, I haven't always been so sun aware. I distinctly remember my mom slathering me with sunscreen when I was trying to play in the backyard or at the beach as a kid. In high school I would occasionally lay out in our back yard to get some color, though I was afraid of turning red and usually still wore SPF 15. In college I decided that the reason I had never been tan not because of my pale Irish skin but because of the sunscreen. So, for one summer I worshipped the sun with my roommate and without sunscreen. I finally was "tan" with the aide of sunless tanner. I have regretted that summer for years, and while I have good skin now I'd like to stay that way!

So, I took advantage of the complimentary photo-imaging analysis available at Calidora. They have quite a few locations, so check them out, there might be one near you!

Anyways, it was quite and painless and was quite a bit like the image above (not me, that's from their website). You put your head inside of the white box pictured on the left and a high tech camera takes a picture of the left side of your face (the "drivers side" that gets more sun exposure and therefore usually is worse than the right).

From that single image they can do a huge amount of analysis! First I saw a greatly magnified image of my face, then a UV filter that showed the "hidden damage" and even an image that aged me by 10 years! The software even analyzed my face for wrinkles, pore size, brown spots and smoothness of skin. That info was given to me as a comparable number against other females my age and skin type.

I'm proud to say that I did not have a single wrinkle, therefore I was in the 99th percentile, but my freckles dropped me down to 76th percentile for spots, pores had me at 60 and my texture was a disappointing 51. When I aged by 10 years I stayed wrinkle free but I did become one giant freckle, which really was rather alarming. They did tell me which treatments would help my issues (microdermabrasion for the texture and pore issues, a series of 5 laser treatments for the freckles/spotting), but there was absolutely no pressure to sign up for anything. I'm not quite ready to start lasering and having microdermabrasion treatments, but in a few years I might be. In the meantime seeing that image of me in 10 years was definitely enough to keep me slathering on high SPF sunscreen!

Calidora Skin Clinic

As an aside, in the past few days I have seen commercials from Coppertone promoting their DermaPhoto Booth, which does similar UV analysis. If you're interested the booth is on tour across the US, but the dates are very limited so I would show up early or check out a local skin clinic for analysis instead.
4

The Skin, Retinoids

Update! This post was finally after updated after many years. Head over to this post, All About Retinoids, for a lot more information!

Retinoids are one of the most popular cosmeceuticals you can buy. They are all cousins of Vitamin A, and help in growth and development of many tissues, but for our purposes just know that it helps your skin to behave like healthy, young skin.

In nature Vitamin A has 3 forms (retinol, retinal/"retinaldehyde" and retinoic acid), and they can interchange via different chemical reactions. Tretinoin is often found as an ingredient, this is a slight different conformation of retinoic acid. The "strength" of retinoids depends on their ability to then interact with the appropriate receptors which then result in the retinoid effects. Different retinoids are attracted to the receptors in different strengths, and for the "natural" retinoids this strength increases from retinol to retinaldehyde to retinoic acid.

It can take >12 weeks to see any initial improvement in the skin with retinoid treatment, maximal effects won't be seen until 6-9 months. The best improvements are seen in skin roughness, hyperpigmentation and fine lines, but you will see some improvements in coarse wrinkles and freckles as well.

There are 2 ways which Vitamin A functions:
1. Antioxidants: Protection of tissues from damage from oxygen scavengers
2. Gene Activation: Retinoids can "turn on" a cell's DNA to produce certain things, such as increase cell production or increase production of a product like collagen or hyaluronic acid (which they do!)
3. Depigmentation: Retinoids help with hyperpigmentation via a few ways. The first way is that by increasing cell turnover, they increase shedding of skin cells that have accumulated too much melanin. They also interfere with melanocyte-keratinocyte pigment transfer (in otherwords, help prevent other skin cells from accumulating too much melanin) and help disperse melanosomes.

The net result of these mechanisms is that the epidermis thickens, cells increase in their turnover and the number of cells that produce sebum decrease. There are even changes in the anchoring tissues around the skin cells, making everything more stable. Atrophy of the epidermis is reduced, more collagen is made and hyperpigmentation is decreased.

It is important to note that the retinoid you use needs to be stable in the form you bought it, and active. There are a lot of different forms of retinoids, but they can be easily inactivated in certain creams/gels and with exposure to the sun. So, look for a retinoid that comes in a package that doesn't let in sunlight. As well, your packaging should be air tight to prevent oxidation and inactivation.

Another concern that many have regarding use of Retinoids is combination with other products. While it is true that Retinoids are less stable when in the same product as some ingredients (such as Alpha-Hydroxy Acids), there should be no issues with combining them on your face. In fact, many dermatologists suggest that using both will improve the efficacy of the the retinoid as it will be able to penetrate your skin more easily. If you're concerned about applying them on your face at the same time, try spacing out products by a few minutes.

In addition, many suggest applying retinoids at night. I was unable to find any evidence that they work better at night versus morning. However, they should be started slowly (a few times a week) and increased in frequency as your skin is able to handle them. Don't be surprised if you have some redness, peeling or even stinging with use. These problems will decrease with time, allowing you to increase your use of the product.

One final note: Retinoids will have side effects. The main issue will be skin irritation, with dryness, scaling of the skin and even redness. This is especially true with higher concentrations or more effective forms. You can combat this by decreasing your use of the retinoid, think using it once a day instead of twice or switching to an every other day or even every third day schedule. Let your skin tell you what it can handle. As well, something called "paradoxical hyperpigmentation" has been described. This basically means that even though most people see improvement in skin color with less hyperpigmentation and a more even tone, there are some that will see instead increased pigmentation. If you see this, you should probably discontinue use.

Most importantly: Retinoids will make your skin more sensitive to the sun! This makes your daily use of a broad spectrum sunscreen even more important!

Updated on 4/3/2010
Retinoid Picture
6

Sunscreen Active Ingredients

Sunscreen Active Ingredients
In preparation for a lot of sunscreen reviews, here's a bit of information about the acitve ingredients in sunscreen. While not the most exciting post (been stuck at work, this is the only post I have completed right now.... Sorry... expect me to spend all day Saturday writing!), I'll be referring to this post frequently in the near future!


There are two main types of Active Ingredients, which you should familiarize yourself with before you buy your next sunscreen.

Chemical
Chemical sunscreens absorb the UV rays, preventing them from reaching your skin.
examples: PABA (paraminobenzoic acid), oxybenzone, cinnamates, and butyl methoxydibenzoyl methane.

Physical
These ingredients actually reflect the UV rays off of the skin.
examples: zinc oxide and titanium dioxide.

In addition to considering the type of sunscreen, you need to consider what UV Spectrum you will be covering. You want broad-spectrum UVA and UVB coverage, which generally will take at least 2, usually 3 active ingredients. Look on the back of the sunscreen, legally they need to be listed there.

Short Wave UVA
• Benzophenones
- Oxybenzone
- Sulisobenzone
• Dioxybenzone
• Ecamsule (Mexoryl)

Long Wave UVA
• Avobenzone (Parsol 1789)
• Ecamsule (Mexoryl)

UVB
• p-Aminobenzoic acid (PABA)
- Padimate O: FDA approved as a photo-protectant, this ingredient has quite a bit of debate about it. There is some evidence that when it is activated by the sun it actually directly causes DNA damage to cells, making sun damage worse, it also protects somewhat into the short wave UVA spectrum.
• Salicylates
- Homosalate
- Octyl salicylate = Octisalate
- Trolamine salicylate
• Cinoxate
• Octylmethoxycinnamate = Octinoxate
• Octocrylene
• Ensulizole: This also protects into the short range UVA range

Broad Spectrum UVA and UVB
• Titanium dioxide
• Zinc oxide

Sunscreen Active Ingredients UV Coverage Range
Update, 4/10/08
See this cool new chart? It will show you more visually which parts of the UV spectrum each sunscreen covers! I spent a lot of time figuring this out, but really, those are all of the FDA approved sunscreen active ingredients, I'll be customizing this graphic for each sunscreen review!

The Skin Cancer Foundation's Seal of Recommendation
While I'll be reviewing quite a few sunscreens soon (and referring to this post often), I doubt that you'll bring a list of ingredients with you to Target. (I do hope you'll read the reviews and do a bit a research before you buy your next tube of sunscreen.) But, one of the easiest thing to do is to look for the Seal. The Seal has some requirements, companies seek it out and they can't buy it.

• A sun protection factor (SPF) of 15 or greater (note that they don't require broad spectrum UVA and UVB coverage, you'll need to check that out on your own)
• Validation of the SPF number by testing on 20 people
• Acceptable test results for phototoxic reactions and contact irritation
• Substantiation for any claims that a sunscreen is water- or sweat-resistant

You can view a list of all the products that have this Seal at The Skin Cancer Foundation's Site

5

The Skin, Antioxidants

antioxidants in skin care and aging
Much has been made in the lay press (meaning, ABC News and such), beauty mags, on-line, pretty much everywhere you look about anti-oxidants. They are reported to not only fix your skin, but will make it so that you never get cancer and live 20 years longer. Now, while I don't know for sure about any of those three (I'm pretty sure no one knows, actually), but dermatologists are pretty sure that anti-oxidants do help with aging, and there are plenty of studies on going right now. (Note that the only topical product shown to improve wrinkles is Retin-A.)

Well, what exactly is an antioxidant? It's something that fights free radicals. I think that it was explained best by Alton Brown of all people, who is a chef on the Food Network that my brother is obsessed with! (Really, he has severe food allergies so he does all of his own cooking. He has hundreds of Alton's episodes on tape and my little brother frequently cooks things like duck! Who knew a guy who can't match his clothes could do that? Amazing!)


creation of a free radical
Basically, the free radicals are created when they give up or lose an electron. That lose leaves a hole, and the newly created free radical doesn't know how to cope with this. It goes crazy trying to fix that hole, which means in your skin the free radical bounces around in skin cells, causing damage to things like your cell membrane or even your DNA, attempting to fix that hole.

So, now that you know what a free radical is, how are they created? Pretty much anything that challenges the skin.
•UV Rays (Sunlight)
•Drugs
•Pollution
•Heat
•Cold

free radical neutralization
Antioxidants help to control the free radical damage by getting rid of the free radicals. They can donate an extra electron to the free radical, filling that hole and fixing the behavior. The free radical no longer goes around causing damage.

The skin does have it's own antioxidant system to help to counteract these free radicals, however over time the free radicals can continue to damage cells and their DNA. In addition, your body's antioxidants decrease with age, leaving the free radicals unchecked, and leaving your cells, cell membranes and DNA more vulnerable to damage. This results in loss of firmness, radiance, elasticity and can contribute over time to aging of the skin. Notice that I said over time. Because in theory you're experiencing this type of damage all the time, though more so after exposures to sun and such. But, the damage is cumulative and although you won't be able to see results right away, chances are you will see them in the long term. I think of this as similar to wearing sunscreen. You might not see a big difference now, but if you compare yourself to your friends that didn't do it in 10 years, you'll likely see a difference.

A huge number of antioxidants are on the market right now, here's a quick overview of a few of them. Note that some of these are applied topically, but some can also be taken orally. Is one better than the other? We're not sure. But, since most of these are simply vitamins, I think you probably couldn't go wrong with improving your diet and using a product with an anti-oxidant in it.

Now, this is the boring part of the post where I list a bunch of ingredients and quote a little bit of stuff from some reviews I've found on-line and then researched a bit on my own to make sure stuff was accurate. I'm by no means an expert on anti-oxidants (especially since there are so many of them), but here's some info on the ones you're most likely to run in to.


Allantoin
Long used to help protect the skin in creams and lotion, allantoin was thought to be a skin protectant. It has been called a "cell proliferant, epithelization stimulant, and a chemical debrider." Basically, it helps to exfoliate and stimulate new skin growth.

Alpha Lipoic Acid (ALA)
ALA is unique, as it is soluble in both water and lipids, so it easily penetrates into the skin. It seems to help protects Vitamins E and C, helping to boost their activity within the cell by "reenergizing" them. It is also converted in the skin into another chemical that has it's own antioxidant properties.

Copper Peptides
Copper has long been known to be important in the creation of collagen and elastin (again, important parts of the dermis), both of which are decreased with aging. Copper does have a bit more research than many other topical antioxidants, and some well design (aka- double-blind placebo controlled) research studies have shown improvement in fine wrinkles, hyperpigmentation and decreased photodamage. Copper increases the body's superoxide dismutase levels (see below). They even found a 17.8% improvement in skin thickness! Overall that does sound great, and copper is very appealing to add to products since it is non-irritating and pretty cheap to add to creams.

Dimethylaminoethanol (DMAE)
When used topically, DMAE has been found to increase firmness of the skin, likely because it helps to reduce some linking between proteins in the skin that happens with aging, as well as separate antioxidant properties.

Glutathione
Composed of glutamic acid, cysteine, and glycine, this little protein is found in all animal tissues, is one of your body's main antioxidants and is very decreased in the skin after skin exposure.

Grape and Grape Seed Extract
Proanthocyanidin, a very powerful antioxidant is found in grapes and grape seed extracts. While this antioxidant doesn't have strong evidence that it works topically (really, most of these things I'm listing don't have much evidence anyways), it was found to have strong effects on free radical damage of fat cells especially, as well as improved wound healing and prevention of tumors (both in mice).

Green Tea
Green Tea has some great things in it call polyphenols and they have been widely reported to be the strongest anti-oxidant you can get. When mice drink them, there are marked changes in the enzymes in their skin, making serious changes in the way the skin reacts to the sun. Just knowing that makes me want to drink only green tea for the rest of my life, but there's a lot more! Even without UV radiation there are polyphenols that induce expression of enzymes to help fight free radical damage. In tissue culture fibroblasts in the dermis either decrease or delay changes they show with age. DNA damage from free radicals is dramatically reduced in the setting of Green Tea Polyphenols.

Melatonin
Yup, that stuff you take to help prevent jet lag is an antioxidant! It's released by the brain, and it's able to both act as an antioxidant, increase the activity of other antioxidants and to help decrease redness from sunburn. Oh, and help you reset your internal clock, but I'm not going to go into that!

Panthenol
An alcohol derivative of Vitamin B5, Panthenol is actually a humectant (see, it's here in my moisturizer post), and is very easily found in moisturizer, shampoo, conditioner, etc. Once it's in the skin, it get converted to an acid that is an important cofactor for Coenzyme A, allowing your skin to function normallly. It's pretty stable, but doesn't do well in acidic or basic environments or high heat.

Soy Isoflavones
Only available orally, Genistein and Daidzein help to enhance the antioxidants your body already makes. Mice were fed a solution with these 2 isoflavins, and for weeks afterwards their skin had decreased roughness and improved collagen levels after sun exposure. Does this mean that if you eat soy it will make your skin smoother? Not quickly, but it may help in the long run.

Spin traps
Spin traps are kinda cool, they react with the free radicals to create unreactive free radicals, so they can't cause any damage! They are very powerful though typically expensive. You can find them in products like Your Best Face skin care.

Superoxide dismutase (SOD)
An enzyme that destroy a very active reactive oxygen species (super oxide), this is a very big enzyme and it has a really hard time penetrating into your skin. This makes it very difficult to use as a topical agent. If it could get there, it would be very useful and would dramatically decrease redness from sunburn as well as the damage from the UV exposure.

Ubiquinone (Coenzyme Q)
This one likely sounds very familiar, as it can be found in a huge number of products on the market right now. This chemical works within the cell's mitochondria (a little energy creating organ found within each cell) to help create energy and it helps to reduce damage of certain proteins even better than vitamin E.

Vitamin A
Vitamin A was the first antioxidant to be used for anti-aging, and it's synthetic derivatives (the retinoids) are even more useful given their stability. Retinoids are the only agents that have been found to be effective against wrinkles in studies and are the gold standard.

Vitamin C
Also known as L-ascorbic acid, Vitamin C is that thing that gives you scurvy if you're deficient. It's water soluble and works in the early stages of production for collagen (it even helps to stimulate collagen production) and a few amino acids. Vitamin C has even been found to be low in the skin after sun exposure. Very few studies on Vitamin C in the setting of photodamage or in humans (rather than in petri dishes) have actually been completed. Vitamin C is easily degraded by both heat and light, which means that is is hard to include in topical formulations since it easily breaks down.

Vitamin E
Alpha-tocopherol is found in membranes and tissues galore, and in fact the term "Vitamin E" actually refers to 8 different molecules that have the same activities. It is lipophilic, meaning it likes being around fats, so it's really great at hanging around the membranes of cells and protecting them from destruction/damage. Studies have shown that when applied before sun exposure, you'll have less redness, swelling, DNA damage and sunburn. However, you probably should be avoiding the sunburn by use of sunscreen, rather than just putting on Vitamin E before you go out!


There are important things to remember about antioxidant use to fight aging.
1. It has not been proved clinically, even though it seems logical that antioxidants would help fight signs of aging.
2. Any effects you will see are likely to occur over a long period of time.
3. If you're going to use antioxidants on the skin, the formulation must be stable (meaning the antioxidant doesn't break down and become useless), must be a high enough concentration and must not only get to the target area but must stay there long enough to work.

7

The Skin, Hydroxy Acids

Some of the most frequently used skin care additives these days are Hydroxy Acids. Think of how many times you have purchased a product with an alpha hydroxy acid (AHA) such as glycolic acid, lactic acid and citric acid. Beta hydroxy acids (BHAs) include salicylic acid. What is the difference between the two? A few small differences in their chemical makeup means that AHAs are water soluble while BHAs are oil soluble. This difference means that they will have different uses- BHAs are able to get into clogged pores with oil and dirt and break up any problems; while AHAs are better for use on thick or sundamaged skin without acne.


Alpha Hydroxy Acids
Alpha hydroxy acids can be small to large, and many are derived from fruits. Perhaps the most popular is glycolic acid, which is the strongest and is thought to be the most effective. Glycolic acid (from sugar cane, shown here) is very frequently seen in those acid peels given in your derm's office. Lactic acid (derived from milk) is also very popular. Both glycolic and lactic acid have a lot of evidence regarding their effectiveness, as well they have a great ability to penetrate into the skin (and therefore to be effective).

Alpha hydroxy acids are very popular for one main reason, they've been shown to decrease the signs of aging, making the skin appear smoother and less mottled. How do they do this? They increase skin turnover! They do help to increase the rate at which the cornified layer is shed, helping to increase the rate of skin regeneration. There is even some (controversial) evidence that AHAs increase collagen and elastic fibers in the dermis. AHAs are most effective when their concentration is 5-8% and the pH is 3-4.

Alpha hydroxy peels are very popular in salons and in doctor's offices. In the salon the concentration is usually 20-30% and after several applications can have results that last about 6 months. In a doctor's office, 1 application of 50-70% can last 2-5 years! You'll see a dramatic decrease in fine lines and scars. However, due to the high acid content, these are the peels that cause major irritation for weeks! Remember that Sex and the City episode where Samantha got a peel and had to wear a veil? This is it. You can have weeks of redness, peeling and even oozing of the skin.

Alpha hydroxy acids can cause quite a bit of irritation. You can see redness, itching, flaking of the skin and even scarring with high concentrations. For those of us with a dark complexion, hydroxy acids can experience pigment changes. For those reasons, please exercise caution with hydroxy acids. Most over the counter preparations should be fine for pretty much anyone, but please don't go ordering a hydroxy peel that should be used in a doctor's office over the internet and using it on your own! Most of these peels have a concentration of 20-30% (if for use in a salon) or 50-70% (for use by a MD) and are very powerful. They are available on-line, but that doesn't make them a good deal or a great idea if you end up with scars. The FDA has helped us to some extent, they've put out guidelines that require all products to have a pH of over 3.5 and concentration less than 10%. However, please be careful!

Which AHA should you buy? Get one that is in it's own product that is a "leave on" product. A gel or a moisturizer is best, since there needs to be skin penetration for AHAs to work and a cleanser will simply wash off too quickly. You want 5-8% concentration (which may or may not be advertised) so look for the AHA to be 2nd or 3rd ingredient on the list. A pH 3.5-4 would be great as well, but you won't be able to find that out unless you bring pH test strips with you to the store!


Beta Hydroxy Acids

Beta hydroxy are also frequently used in cosmetic products, the most frequently used one is salicylic acid. The picture above shows the chemical reactions that create salicylic acid, the compound at the far right, a close cousin of aspirin. Salicyclic acid is the main BHA in use cosmetically, and it works much like AHAs. The salicyclic acid can penetrate into "oily" areas due to its lipophilic (oil loving) nature, and encourage cell turnover, helps to prevent pores from clogging (and helps to breakup up "plugs"). Similar effects on aged skin have been seen with beta hydroxy acids as those seen with alpha hydroxy acids- namely smoothing of the skin and wrinkles. Salicyclic acid is a frequent ingredient in acne meds and dandruff shampoos as well as wart medications and works best at pH 3-4 with 1-2% concentration. Since a lower concentration is needed, a product that lists the BHA in the middle (or even the bottom) of the ingredient list is still likely to be effective.

Note that Salicyclic acid is irritating to the skin just as the AHAs are, however not to the same extent. While it's true that BHAs do penetrate more deeply, since salicyclic acid is related to aspirin it has some anti-inflammatory properties.

Beta hydroxy acids are also being used in peels in your doctors office. Usually used at 25-40% concentration, these peels are generally milder than those done with alpha hydroxy acids. However, the peels do still penetrate fairly deeply (they do eliminate the epidermis down to the level of the granular layer), and they penetrate deeply into the pores, meaning they can help much more with acne (particularly inflammatory acne) than an AHA peel. Recovery time for a BHA peel is usually closer to a week for full cornified layer regeneration.


Warning
A word of warning about the use of Hydroxy Acids- studies have shown that using them makes your skin more sensitive to the sun, so please be sure to wear sunscreen! A good sunscreen should have a SPF of at least 15 (or higher) and shield against both UVA and UVB rays. Note that sunscreens are not stable at the same pH as alpha and beta hydroxy acids, so any products that combines the two are not likely to be effective as a sunscreen.



Alpha Hydroxy AcidsBeta Hydroxy Acids
glycolic acid
lactic acid
citric acid
mandelic acid
malic acid
tartaric acid
salicylic acid
2-hydroxy-5-octanoyl benzoic acid (aka-beta-lipohydroxyacid, B-LHA)
tropic acid



Beta Hydroxy Picture
Glycolic Acid Picture
5
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