Topical retinoids in the treatment of aging of the skin

Cell-Free Blood Cell Secretome (BCS) Counteracts Skin Aging: Multi-Center Prospective Regenerative Aesthetic Medicine Study Using Exokine®

Background

The “Inflammation Theory of Ageing” identifies pro-inflammatory cytokines and oxidative damage as one cause of cellular and mitochondrial deterioration and aging. Cell-free blood cell secretome (BCS) also known as autologous conditioned serum (ACS) has shown anti-inflammatory and regenerative mode of action in musculoskeletal disorders and radicular compression.

Aim

To confirm that BCS can improve signs of skin aging from a previous study in a multi-center setting.

Methods

Prospective, one-armed, multi-center interventional therapeutic study. Ninety-five women with skin firmness loss were treated with four intra-dermal injection sessions in both cheeks at 0, 2, 4 and 6 weeks. BCS was processed with Exokine® medical device according to manufacturer’s instructions. Primary endpoints were cutometric R0 and R3 at 12 and 24 weeks. GAIS, FACE-Q^TM, Patient Attractivity Self-Assessment and safety were evaluated.

Results

Mean skin firmness (R0) improved significantly from baseline 0.40 mm to 0.38 mm at week 12 and to 0.36 mm at week 24. Mean skin tiring (R3) improved significantly from baseline 0.45 mm to 0.42 mm at week 12 and to 0.40 at week 24. FACE-Q^TM “Satisfaction with Skin” significantly improved from baseline to weeks 12, 24 and 48. So did “Satisfaction with Facial Appearance” and “Psychological and Social Function”. “Satisfaction with Decision” and “Satisfaction with Outcome” were stable at week 24 and 48. At week 48 patients assessed their age 1.68 years younger vs Baseline. FACE-Q^TM aging appraisal improves from Baseline 52.94 to 65.23 at week 48. GAIS, by both physicians and patients, confirm improvement of skin.

Conclusion

For up to 48 weeks four intra-dermal injections with cell-free BCS increase facial skin firmness and resilience to tiring and patients’ satisfaction with their facial appearance and skin. Patients perceive their face as younger. BCS has the ability to sustainably rejuvenate facial skin safely.

Study Registration

Registration on German clinical trials register: DRKS00013014.

1540-nm fractional erbium: Glass laser is a safe and effective modality for nonablative facial rejuvenation

BACKGROUND

Laser treatments for facial rejuvenation are common, with ablative modalities being of more common use for this indication. Efficient nonablative modalities are of rising demand.

AIM

Our aim was to determine the safety and efficacy of high-fluence, nonablative 1540-nm fractional Erbium:glass laser for facial rejuvenation.

PATIENTS AND METHODS

A retrospective study of patients treated with 3-4 treatments using the 1540-nm fractional Erbium:glass laser for facial rejuvenation, using 2500-3000 mJ/stacked pulses (51-61 mJ per pixel). Patients were followed-up for 3 months following their last treatment. Before and after photos were independently blindly evaluated by 2 dermatologists, who graded them using a scale from 0 (exacerbation) to 4 (76%-100% improvement) for 2 different facial regions (frontal face region and lateral canthal region). Pain perception and adverse effects as well as patient satisfaction were documented throughout the study.

RESULTS

Sixteen patients completed both treatment and follow-up period. At the 3-months posttreatment follow-up visit, moderate-to-significant improvement in rhytids appearance (mean grade of improvement: 2.93 for frontal face and 3 for lateral canthal region) was observed. Patients' satisfaction was high (4.25). Patients reported mild and transient erythema posttreatment with no other adverse effects.

CONCLUSION

The high-fluence 1540-nm fractional Erbium:glass laser is a safe and effective nonablative modality for facial rejuvenation.

Synthetic Retinoid Seletinoid G Improves Skin Barrier Function through Wound Healing and Collagen Realignment in Human Skin Equivalents

The outer epidermal skin is a primary barrier that protects the body from extrinsic factors, such as ultraviolet (UV) radiation, chemicals and pollutants. The complete epithelialization of a wound by keratinocytes is essential for restoring the barrier function of the skin. However, age-related alterations predispose the elderly to impaired wound healing. Therefore, wound-healing efficacy could be also considered as a potent function of an anti-aging reagent. Here, we examine the epidermal wound-healing efficacy of the fourth-generation retinoid, seletinoid G, using HaCaT keratinocytes and skin tissues. We found that seletinoid G promoted the proliferation and migration of keratinocytes in scratch assays and time-lapse imaging. It also increased the gene expression levels of several keratinocyte proliferation-regulating factors. In human skin equivalents, seletinoid G accelerated epidermal wound closure, as assessed using optical coherence tomography (OCT) imaging. Moreover, second harmonic generation (SHG) imaging revealed that seletinoid G recovered the reduced dermal collagen deposition seen in ultraviolet B (UVB)-irradiated human skin equivalents. Taken together, these results indicate that seletinoid G protects the skin barrier by accelerating wound healing in the epidermis and by repairing collagen deficiency in the dermis. Thus, seletinoid G could be a potent anti-aging agent for protecting the skin barrier.

A retinyl palmitate-loaded solid lipid nanoparticle system: effect of surface modification with dicetyl phosphate on skin permeation in vitro and anti-wrinkle effect in vivo

Surface-modified solid lipid nanoparticles (SLNs) containing retinyl palmitate (Rpal) were prepared by the hot-melt method using Gelucire 50/13(®) and Precirol ATO5(®). Dicetyl phosphate (DCP) was added to negatively charge the surfaces of the SLNs and thereby enhance the skin distribution properties of Rpal. In vitro skin permeation and in vivo anti-aging studies were performed using SLNs dispersed in a hydrogel. The SLNs were under 100 nm in size with an even polydispersity index (PDI), and the high absolute zeta-potential value was sufficient to maintain the colloidal stability of the SLNs. DCP-modified negative SLNs (DCPmod-SLNs) enhanced the skin distribution of Rpal 4.8-fold and delivered Rpal to a greater depth than did neutral SLNs. The in vivo anti-wrinkle effect of the DCPmod-SLN formulation was Rpal dose-dependent. However, the anti-wrinkle effects of the DCPmod-SLN formulations were significantly different from that of the negative control and effectively prevented the reduction of elastin and superoxide dismutase by UV irradiation. In conclusion, the DCPmod-SLN system presented is a good candidate for topical Rpal delivery.

Rejuvenating influence of a stabilized hyaluronic acid-based gel of nonanimal origin on facial skin aging

BACKGROUND

Skin changes associated with aging, such as loss of elasticity and turgor, can have a negative psychosocial impact. Current treatment options aimed at restoring elasticity are often ineffective or hampered by a poor risk/benefit ratio.

OBJECTIVE

Clinical observations and biophysical measurements were used to assess the effect of middermal placement of stabilized hyaluronic acid-based gel of nonanimal origin (NASHA, Restylane, Vital, Q-Med) on the appearance and elasticity of facial skin.

METHODS AND MATERIALS

In this pilot study, 19 female patients underwent a series of three treatment sessions, spaced 4 weeks apart, with NASHA injected into the lower cheeks. Elasticity, skin surface roughness, dermal thickness, and density were evaluated at each treatment session and at 4 and 12 weeks after the last treatment session. Patient satisfaction was assessed, and photographs were taken at each visit.

RESULTS

During the course of the study, skin elasticity and surface roughness improved significantly. Patient feedback was extremely positive.

CONCLUSION

Micropuncture placement of NASHA can exert a rejuvenating effect on facial skin.

The role of topical retinoids in the treatment of photoaging

Aging of the skin is a complex biological process which is influenced by the interaction of several intrinsic and extrinsic factors. Intrinsic or chronological aging is an inevitable, genetically programmed process, of unclear underlying mechanism, for which no prevention or effective treatment is currently available. Photoaging refers to the gross and microscopic cutaneous changes that are induced by cumulative exposure to UV radiation and are superimposed on the background of chronological aging. Although primarily an aesthetic problem with significant psychological effects, photoaging constitutes the background for the development of precancerous and cancerous skin lesions.Overwhelming clinical and histological evidence indicate that certain structural changes induced by excessive sun exposure can be reversed, to some extent, by the use of topical retinoids. A number of retinoid compounds, for example tretinoin, isotretinoin, retinaldehyde and tazarotene, have been employed for the treatment of photoaged skin, and demonstrate beneficial clinical and histological effects. Adverse effects have been limited to an irritant reaction of variable intensity presenting with dryness, scaling and erythema. Ongoing research will enhance our understanding of the molecular mechanisms that determine the effects of retinoids on photodamaged skin and contribute to the employment of new, more effective and less irritating retinoid compounds.

The effects of a novel synthetic retinoid, seletinoid G, on the expression of extracellular matrix proteins in aged human skin in vivo

BACKGROUND

Although retinoids have potential efficacy in aged skin, their side effect (skin irritation) remains a clinical problem. We designed a novel synthetic retinoid, seletinoid G, by using computer-aided molecular modeling, and investigated its effects on the expression of extracellular matrix proteins in human skin in vivo.

METHODS

Twenty-three subjects were tested on the buttocks using 4-day occlusive application of seletinoid G and all-trans retinoic acid (tRA). Skin irritation after topical application was quantified by the degree of erythema and cutaneous blood flow. The expression of extracellular matrix proteins and interstitial collagenase (MMP-1) in skin biopsies was investigated by immunohistochemical staining and Western blotting.

RESULTS

The topical application of seletinoid G under occlusion induced no skin irritation in contrast to tRA, which caused severe erythema. The topical treatment with seletinoid G increased the expressions of type I procollagen, tropoelastin, and fibrillin-1, and reduced MMP-1 in old skin in vivo. Seletinoid G was found to inhibit not only the UV-induced decrease of type I procollagen but the UV-induced increase of MMP-1 and c-Jun protein in young skin in vivo.

CONCLUSIONS

Seletinoid G is a novel synthetic retinoid, which has little the side effect of skin irritation after topical application. Seletinoid G can repair altered connective tissue in old skin and inhibit UV-induced collagen deficiency in young skin.

The role of dimethylaminoethanol in cosmetic dermatology

Skincare formulations for the improvement of aging skin are increasingly important consumer products. Here, we review available data on one such agent - 2-dimethylaminoethanol (DMAE) or deanol - that has recently been evaluated in a placebo-controlled trial. DMAE is an analog of the B vitamin choline and is a precursor of acetylcholine. Although the role of acetylcholine as a neurotransmitter is well known, growing evidence points to acetylcholine as a ubiquitous cytokine-like molecule that regulates basic cellular processes such as proliferation, differentiation, locomotion, and secretion in a paracrine and autocrine fashion. Indeed, this modulatory role may contribute to the cutaneous activity of DMAE. In a randomized clinical study, 3% DMAE facial gel applied daily for 16 weeks has been shown to be safe and efficacious (p < 0.05) in the mitigation of forehead lines and periorbital fine wrinkles, and in improving lip shape and fullness and the overall appearance of aging skin. These effects did not regress during a 2-week cessation of application. Beneficial trends (p > 0.05 but </= 0.1) were noted in the appearance of coarse wrinkles, under-eye dark circles, nasolabial folds, sagging neck skin, and neck firmness. Application was found to be well tolerated, with no differences in the incidence of erythema, peeling, dryness, itching, burning, or stinging between the DMAE and placebo groups. An open-label extension of the trial showed that the long-term application of DMAE gel for up to 1 year was associated with a good safety profile. The acute skin-firming effects of DMAE have been confirmed by quantitative measures of cutaneous tensile strength. In vitro studies in peripheral blood lymphocytes indicate that DMAE is a moderately active anti-inflammatory agent. Although its mechanisms of action in the skin remain to be elucidated, evidence suggests that the skin is an active site of acetylcholine synthesis, storage, secretion, metabolism, and receptivity. Muscarinic acetylcholine receptors have been localized to keratinocytes, melanocytes and dermal fibroblasts, whereas nicotinic acetylcholine receptors have been found in keratinocytes. The role of acetylcholine and the role of DMAE as a modulator of acetylcholine-mediated functions in the skin remain to be elucidated.Thus, the benefits of DMAE in dermatology include a potential anti-inflammatory effect and a documented increase in skin firmness with possible improvement in underlying facial muscle tone. Studies are needed to evaluate the relative efficacy of DMAE compared with other skin-care regimens (e.g., topical antioxidant creams, alpha-hydroxy acids).

Penetration and Metabolism of Topical Retinoids in ex vivo Organ-Cultured Full-Thickness Human Skin Explants

The human epidermis contains endogenous retinoids [retinol (vitamin A) and retinyl esters] and carotenoids (mostly beta-carotene). Previous studies in the mouse have shown that the enzymes involved in retinoid metabolism are present in the epidermis. In this study, we wanted to assess the skin penetration and metabolism of topical retinoids in the human. To do this, fresh surgically excised human abdominal skin was mounted on Franz perfusion cells. Topical retinoic acid, retinal, retinol and retinyl palmitate were applied at 2.5 mg/cm(2) in oil-in-water creams containing 0.05% retinoids on the donor compartment, while the receptor compartment was filled with culture medium. The skin was incubated for 24 h at 37 degrees C, then epidermal retinoid concentrations were determined by HPLC. The same experiment was performed with mouse back skin mounted on Franz cells. Finally, topical retinoids were applied on the back of hairless mice for 24 h; then the mice were sacrificed and retinoid concentrations were assayed in the epidermis. In all three models, retinol and its esters were found to be endogenous, as was the case in previous studies in the mouse in vivo. The four applied retinoids penetrated well into the epidermis. Topical retinoic acid did not increase endogenous retinoids, whereas the latter were greatly increased following topical retinal in the mouse. Retinal was also metabolized into retinoic acid, unlike topical retinol and retinyl palmitate, which only increased endogenous retinoids. Topical retinal and retinol did undergo a higher metabolism in both mouse models than in human skin. In summary, the penetration and metabolism patterns of topical retinoids were quite similar in the two mouse models used, indicating that the Franz cells appear to be a good model to predict in vivo metabolism of topical retinoids. When applying this concept to our results obtained in Franz cells with human skin, we conclude that topical retinol and retinal load human skin with both storage and functional vitamin A.

Rejuvenation of photoaged skin: 5 years results with intense pulsed light of the face, neck, and chest

BACKGROUND

Photorejuvenation involves the use of lasers or light sources to reverse signs of photoaging. Multiple devices have been shown to be effective over the short-term.

OBJECTIVE

To investigate the long-term clinical results on the face, neck and chest at 4 years using filtered flashlamp intense pulsed light (IPL) for treatment of photoaging changes of telangiectasias, dyspigmentation, and rough skin texture.

METHODS

A chart review of 80 randomly selected patients with skin types I-IV who were treated by IPL during 1996 and 1997 was performed. Photos and patient self-assessment were graded for features of textural smoothness, telangiectasia severity, and blotchy pigmentation into four categories of worse, no change, slightly better (less than 50% improvement) and much better (greater than 50% improvement).

RESULTS

At 4 years following initial treatment, skin textural improvement was noted in 83% of the subjects. Telangiectasias were improved in 82% of subjects, while pigmentation remained improved in 79%. The median number of treatments was 3. The face responded slightly better than the chest or neck. Most common side-effects included temporary mild crusting (19%), erythema (15%) and purpura (6%).

CONCLUSION

Signs of photoaging including telangiectasias and mottled pigmentation of the face, neck, and chest, can be improved by IPL with a long-lasting result. Minimal or no downtime with minimal adverse effects can be achieved with the settings reported. Skin textural smoothing, although not easily quantified, is an additional benefit observed long-term.