Prospective Evaluation of the Efficacy of a Food Supplement in Increasing Photoprotection and Improving Selective Markers Related to Skin Photo-Ageing

Intradermal Treatment with a Hyaluronic Acid Complex Supplemented with Amino Acids and Antioxidant Vitamins Improves Cutaneous Hydration and Viscoelasticity in Healthy Subjects

Intradermal injection of bioactive compounds is used to reduce the effects of aging skin. The aim of this work is to study the response of facial injection of a hyaluronic acid complex supplemented with amino acids and antioxidant vitamins on skin rejuvenation. A total of 40 healthy adult subjects were recruited to whom this complex was injected into the facial skin, three consecutive times every two weeks. Together with assessing the degree of skin hydration, the level of skin microcirculation, wrinkles, skin color, and skin biomechanical parameters were evaluated. Using the GAIS scale, the degree of satisfaction of the participants was assessed. At 42 days (D42), there was an 11-12% increase in skin hydration and viscoelasticity, a 23% increase in skin density, a 27% increase in skin microcirculation, and a significant lightening and whitening of skin color, but without causing changes in skin wrinkles. A value between 1 and 3 on the GAIS scale was observed between 70 and 92% of the participants, and 87% of subjects found their skin more beautiful, 85% would recommend this treatment, and more than 50% found their face rejuvenated. In summary, the intradermal treatment tested suggests skin rejuvenation, with a good degree of safety.

Beneficial Effects of Multi-Micronutrient Supplementation with Collagen Peptides on Global Wrinkles, Skin Elasticity and Appearance in Healthy Female Subjects

INTRODUCTION

With ageing, collagen production slows down, leading to wrinkle appearance and loss of elasticity. Replenishing key structural molecules through oral supplementation is a promising strategy that complements the topical delivery of cosmetic products and creates a holistic skincare regimen. The present study assessed the effectiveness of a food supplement with collagen peptides, vitamins and minerals in improving the quality of the skin and general wellbeing of healthy women.

METHODS

This was an open-label study of 135 women aged between 45 and 65 years. A 3-month treatment phase followed a 4-week washout phase, with visits scheduled at baseline and after each month of treatment. Subjects received three tablets of Richelet Skin Renewal daily. The primary outcome was change from baseline to month 3 in global wrinkles score by expert grader analysis. Secondary outcomes included changes in skin elasticity and other skin attributes, product assessment via self-perception questionnaires and total antioxidant status.

RESULTS

A total of 116 subjects completed the study. The mean global wrinkles score indicated a statistically significant decrease from 5.9 at baseline to 5.0 at month 3 (p < 0.0001), with 83.6% of subjects showing an improvement; significant changes were reported at all intermediate visits. The increase in skin elasticity was also statistically significant (R2 score 0.74 at month 3; p < 0.0001). All subjects (100%) demonstrated significant improvements in skin texture, skin tone evenness, skin radiance and overall skin quality at the month 3 visit.

CONCLUSIONS

The study product achieved statistically significant, noticeable effects on global wrinkles, skin elasticity and a range of skin attributes after 3 months of use in healthy women. These results strengthen the evidence for supplementation of collagen peptides and other micronutrients as an effective component of anti-ageing skincare.

The effect of tomato and lycopene on clinical characteristics and molecular markers of UV-induced skin deterioration: A systematic review and meta-analysis of intervention trials

Lycopene as a natural antioxidant that have been studied for ultraviolet radiation (UVR) photo protection and is one of the most effective carotenoids to scavenge reactive oxygen species (ROS). This review aims to summarize the protective effect of tomato and lycopene on skin photo damage and skin photoaging in healthy subjects by reviewing the existing population intervention experiments. A total of five electronic databases including PubMed, Scopus, EBSCO, Web of Science and Cochrane Library were searched from inceptions to January 2021 without any restriction. Out of 19336 publications identified, 21 fulfilled the inclusion criteria and were meta-analysis. Overall, interventions supplementing tomato and lycopene were associated with significant reductions in Δa*, MMP-1, ICAM-1 and skin pigmentation; while tomato and lycopene supplementation were associated with significant increase in MED, skin thickness and skin density. Based on the results of this systematic review and meta-analysis, supplementation with tomato and lycopene could reduce skin erythema formation and improve the appearance and pigmentation of the skin, thereby preventing light-induced skin photodamage and skin photoaging. Lycopene-rich products could be used as endogenous sun protection and may be a potential nutraceutical for sun protection.

Antioxidants in Photoaging: From Molecular Insights to Clinical Applications

Photoaging (PA) is considered a silent disease affecting millions of people globally and is defined as skin damage due to prolonged exposure to ultraviolet radiation (UVR) from the sun. Physiologically, the skin is in a state of renewal and synthesis of components of the extracellular matrix (ECM). However, exposure to UVR affects the production of the ECM, and the functioning and response of skin cells to UVR begins to change, thus expressing clinical and phenotypic characteristics of PA. The primary mechanisms involved in PA are direct damage to the DNA of skin cells, increases in oxidative stress, the activation of cell signaling pathways responsible for the loss of skin integrity, and cytotoxicity. The medical and scientific community has been researching new therapeutic tools that counteract PA, considering that the damage caused by UVR exceeds the antioxidant defense mechanisms of the skin. Thus, in recent years, certain nutraceuticals and phytochemicals have been found to exhibit potential antioxidant and photoprotective effects. Therefore, the main objective of this review is to elucidate the molecular bases of PA and the latest pharmaceutical industry findings on antioxidant treatment against the progression of PA.

The Promising Role of Polyphenols in Skin Disorders

The biochemical characteristics of polyphenols contribute to their numerous advantageous impacts on human health. The existing research suggests that plant phenolics, whether consumed orally or applied directly to the skin, can be beneficial in alleviating symptoms and avoiding the development of many skin disorders. Phenolic compounds, which are both harmless and naturally present, exhibit significant potential in terms of counteracting the effects of skin damage, aging, diseases, wounds, and burns. Moreover, polyphenols play a preventive role and possess the ability to delay the progression of several skin disorders, ranging from small and discomforting to severe and potentially life-threatening ones. This article provides a concise overview of recent research on the potential therapeutic application of polyphenols for skin conditions. It specifically highlights studies that have investigated clinical trials and the use of polyphenol-based nanoformulations for the treatment of different skin ailments.

Clinical Applications of Polypodium leucotomos (Fernblock®): An Update

Exposure to sun radiation leads to higher risk of sunburn, pigmentation, immunosuppression, photoaging and skin cancer. In addition to ultraviolet radiation (UVR), recent research indicates that infrared radiation (IR) and visible light (VIS) can play an important role in the pathogenesis of some of these processes. Detrimental effects associated with sun exposure are well known, but new studies have shown that DNA damage continues to occur long after exposure to solar radiation has ended. Regarding photoprotection strategies, natural substances are emerging for topical and oral photoprotection. In this sense, Fernblock^®, a standardized aqueous extract of the fern Polypodium Leucotomos (PLE), has been widely administered both topically and orally with a strong safety profile. Thus, this extract has been used extensively in clinical practice, including as a complement to photodynamic therapy (PDT) for treating actinic keratoses (AKs) and field cancerization. It has also been used to treat skin diseases such as photodermatoses, photoaggravated inflammatory conditions and pigmentary disorders. This review examines the most recent developments in the clinical application of Fernblock^® and assesses how newly investigated action mechanisms may influence its clinical use.

Photoprotection for people with skin of colour: needs and strategies

Skin of colour or pigmented skin has unique characteristics: it has a higher eumelanin-to-pheomelanin ratio, more mature melanosomes, an increased amount of melanin distributed in the upper layers of the epidermis, and more efficient DNA repair compared with lighter skin. However, individuals with skin of colour are at a significant risk of skin damage caused by ultraviolet radiation, including the development of photodermatoses and photoageing changes such as uneven skin tone, and are predisposed to pigmentary disorders. In fact, one of the most common conditions leading to dermatology consultations by patients with skin of colour is photoexacerbated pigmentary disorders. Unfortunately, individuals with skin of colour may be less prone to engage in photoprotective measures, including the use of sunscreens. Physicians are also less likely to prescribe sunscreens for them. There is thus a clear need for better education on photodamage and for more efficient and suitable photoprotection in populations with skin of colour. However, this need has thus far only partially been met, and the development of sunscreen products designed to provide optimal photoprotection for people with skin of colour remains a challenge. Targeted sunscreens for individuals with skin of colour require optimal cosmetic appeal (leaving no white residue and not disrupting skin tone). They should include broad-spectrum [ultraviolet (UV)B/UVA] protection with high sun protection factor, as well as protection against long-wave UVA (UVA1) and visible light, as these wavelengths are capable of inducing or augmenting pigmentary disorders. They may also contain depigmenting agents for patients with pigmentary disorders.

Oral Supplementation and Systemic Drugs for Skin Aging: A Narrative Review

Skin aging is influenced by intrinsic and extrinsic factors and involves multiple pathogenic mechanisms. The most widely used treatments are topical products and minimally invasive procedures. Evidence on the benefits of systemic therapy is limited for several reasons: Reliance on mostly small and predominantly female samples, short study durations, methodologic heterogeneity, and a lack of consensus on which outcome measures are clinically relevant. Furthermore, systemic drugs and oral supplements are not without adverse effects. Oral hydrolyzed collagen and oral hyaluronic acid are well tolerated, and numerous clinical trials show they can mitigate some signs of skin aging. Low-dose oral isotretinoin is another option, but it has a higher risk of adverse effects. Evidence is lacking on the effects of the many dietary supplements on offer, such as vitamins, flavonoids, plant extracts, and trace elements. The future of skin aging management would appear to lie in the use of senolytic and senomorphic agents targeting senescent cells in the skin.

[Translated article] Oral Supplementation and Systemic Drugs for Skin Aging: A Narrative Review

Skin aging is influenced by intrinsic and extrinsic factors and involves multiple pathogenic mechanisms. The most widely used treatments are topical products and minimally invasive procedures. Evidence on the benefits of systemic therapy is limited for several reasons: reliance on mostly small and predominantly female samples, short study durations, methodologic heterogeneity, and a lack of consensus on which outcome measures are clinically relevant. Furthermore, systemic drugs and oral supplements are not without adverse effects. Oral hydrolyzed collagen and oral hyaluronic acid are well tolerated, and numerous clinical trials show they can mitigate some signs of skin aging. Low-dose oral isotretinoin is another option, but it has a higher risk of adverse effects. Evidence is lacking on the effects of the many dietary supplements on offer, such as vitamins, flavonoids, plant extracts, and trace elements. The future of skin aging management would appear to lie in the use of senolytic and senomorphic agents targeting senescent cells in the skin.

Commentary: Facial Aesthetic Dermatological Procedures and Photoprotection in Chinese Populations

The medical literature on aesthetic dermatology has primarily focused on a light-skinned patient population, yet patients of darker skin types have different needs and priorities. In Chinese individuals, key concerns include altered pigmentation, which is perceived to age the individual, and also relates to the Chinese cultural standard of beauty of fair skin; many seek aesthetic treatment for this. Non-invasive cosmetic procedures such as lasers and injections are also gaining in popularity in the Chinese market, but this population is prone to hyperpigmentation as an adverse effect of such procedures. Considered and tailored approaches, both to primary concerns of photoaging and the side effects of cosmetic treatments, are warranted.

On the Potential Role of the Antioxidant Couple Vitamin E/Selenium Taken by the Oral Route in Skin and Hair Health

The relationship between oxidative stress and skin aging/disorders is well established. Many topical and oral antioxidants (vitamins C and E, carotenoids, polyphenols) have been proposed to protect the skin against the deleterious effect induced by increased reactive oxygen species production, particularly in the context of sun exposure. In this review, we focused on the combination of vitamin E and selenium taken in supplements since both molecules act in synergy either by non-enzymatic and enzymatic pathways to eliminate skin lipids peroxides, which are strongly implicated in skin and hair disorders.

Efficacy and Safety of Oral Green Tea Preparations in Skin Ailments: A Systematic Review of Clinical Studies

Green-tea-based products and their polyphenols, especially epigallocatechin-3-gallate, have attracted great attention over the years as possible nutraceuticals, due to their promising bioactivities, especially antioxidant and anti-inflammatory, which could be exploited in several diseases, including skin ailments. In this context, the present study aimed at reviewing clinical evidence about the benefits of the oral administration of green tea preparations and its polyphenols to relieve skin disorders, to point out the current knowledge, and to suggest possible novel strategies to effectively exploit the properties of green tea, also managing safety risks. To this end, a systematic review of the existing literature was carried out, using the PRISMA method. Few studies, including five focused on UV-induced erythema and skin alterations, three on photoaging, two on antioxidant skin defenses, and one on acne and genodermatosis, were retrieved. Despite several benefits, clinical evidence only supports the use of oral green tea preparations to protect skin from damage induced by ultraviolet radiation; in other cases, conflicting results and methodological limits of clinical trials do not allow one to clarify their efficacy. Therefore, their application as adjuvant or alternative sunscreen-protective interventions could be encouraged, in compliance with the safety recommendations.

Anti-Inflammatory and Anticancer Effects of Microalgal Carotenoids

Acute inflammation is a key component of the immune system's response to pathogens, toxic agents, or tissue injury, involving the stimulation of defense mechanisms aimed to removing pathogenic factors and restoring tissue homeostasis. However, uncontrolled acute inflammatory response may lead to chronic inflammation, which is involved in the development of many diseases, including cancer. Nowadays, the need to find new potential therapeutic compounds has raised the worldwide scientific interest to study the marine environment. Specifically, microalgae are considered rich sources of bioactive molecules, such as carotenoids, which are natural isoprenoid pigments with important beneficial effects for health due to their biological activities. Carotenoids are essential nutrients for mammals, but they are unable to synthesize them; instead, a dietary intake of these compounds is required. Carotenoids are classified as carotenes (hydrocarbon carotenoids), such as α- and β-carotene, and xanthophylls (oxygenate derivatives) including zeaxanthin, astaxanthin, fucoxanthin, lutein, α- and β-cryptoxanthin, and canthaxanthin. This review summarizes the present up-to-date knowledge of the anti-inflammatory and anticancer activities of microalgal carotenoids both in vitro and in vivo, as well as the latest status of human studies for their potential use in prevention and treatment of inflammatory diseases and cancer.

The potential effect of Polypodium leucotomos extract on ultraviolet- and visible light-induced photoaging

Photoaging induced by both ultraviolet and visible light has been shown to lead to increased inflammation and dysregulation of the extracellular matrix. Standardized extract of the Polypodium leucotomos fern, PLE, possesses anti-inflammatory and antioxidant properties, and has been shown to potentially mitigate photoaging through various mechanisms. This comprehensive review presents the data available on the effects of P. leucotomos extract on UV and VL-induced photoaging in vitro as well as in vivo in murine and human models.

Systemic photoprotection in 2021

Systemic photoprotection aims to negate the negative effects of ultraviolet radiation-induced DNA damage. Systemic supplements may be used as a monotherapy or in combination with topical sunscreens. Using the keywords 'carotenoids', 'flavonoids', 'systemic photoprotection', 'polyphenols' and 'polypodium leucotomos extract', we searched the databases MEDLINE and EMBASE to find relevant English-language articles. Few trials have supported the use of any of these supplements as monotherapy, impeding the recommendation of these systemic supplements as an alternative to sunscreen for photoprotection. Nicotinamide has exhibited clinically relevant benefits in reducing nonmelanoma skin cancers in trials and could be recommended as an adjunctive therapy for the most vulnerable indviduals. Further research is required, which needs to be of higher statistical power, using more clinically meaningful outcome measures with comparison to the current gold standard of care (topical photoprotection) to support the use of alternative therapies in clinical practice.

Impact of ultraviolet radiation and exposome on rosacea: Key role of photoprotection in optimizing treatment

Background

Pathophysiology of rosacea is not completely understood and involves a complex interaction among genetics, ultraviolet (UV) light, microorganisms, impaired skin barrier, neuronal and vascular dysfunction, and immune system disruption.

Aims

To describe the etiology of rosacea with an emphasis on the role of UV radiation and exposome, and to review the importance of non‐pharmacologic strategies focusing on photoprotection.

Methods

We conducted a narrative review of the literature. We performed literature searches with PubMed from January 1990 to November 2020 using the keywords “rosacea”, “pathogenesis”, “ultraviolet radiation”, “exposome”, “photoprotection”, “sunscreens” and “non‐pharmacologic agents”. The search was limited to English, Spanish, and French language articles.

Results

Several environmental factors such as UV light, diverse microorganisms, air pollution, tobacco smoking, nutrition, and psychological stress showed to trigger or worsen rosacea. UV radiation was reported to induce pro‐inflammatory, pro‐angiogenic, and pro‐fibrotic responses. We found 6 original articles about the impact of sunscreens on rosacea. The use of sunscreens containing ingredients with emollient, anti‐inflammatory, and/or vasoregulatory properties was shown to significantly improve symptomatology.

Conclusion

UV radiation and the exposome play a key role in the development of rosacea. UV light is implicated in all significant aspects of rosacea: skin inflammation, neoangiogenesis, telangiectasia, and fibrosis, and may even initiate rosacea. While the use of sunscreens is widely recommended, the literature on the impact of photoprotection in rosacea is scarce. Adequately formulated sunscreens could not only provide the required level of photoprotection, but may also help to mitigate the barrier dysfunction, neutralize facial redness (tinted sunscreens), and decrease inflammation and vascular dysfunction.

Management Pearls on the Treatment of Actinic Keratoses and Field Cancerization

Field cancerization (FC) is a chronic disease involving multiple clinical and subclinical actinic keratoses (AK) on large photo-exposed surfaces with multifocal areas of dysplasia and precancerous changes. Patients and treatment must be properly monitored and managed to avoid aggravation and progression of the disease. Management of actinic keratoses includes lesion-directed treatments, such as cryotherapy and field-directed therapies. Field-directed therapies may have the potential to address subclinical damage, reduce AK recurrence rates and potentially reduce the risk of squamous cell carcinoma development. Multiple studies have demonstrated the efficacy of field-directed treatments, including 5-fluorouracil, photodynamic therapy, imiquimod, chemical exfoliation with trichloroacetic acid and diclofenac gel, for multiple AK and FC. The choice of therapy should be based on multiple factors, such as efficacy, tolerability, patient risk profile, costs and cosmetic results. Management of AK includes not only treatment but also prevention. Medical devices, such as sunscreens containing liposome-encapsulated DNA repair enzymes, can repair DNA damage associated with chronic UV radiation and reduce the number of new AK lesions. Here we provide therapeutic pearls and expert opinions on the treatment of AK and FC (as monotherapy or in combination) with the overall aim to achieve better, faster, and well-tolerated clinical responses.

Use of a Topical Film-Forming Medical Device Containing Repairsomes® in a Patient with Xeroderma Pigmentosum to Avoid Progression to Skin Cancerization

This paper reports a case of xeroderma pigmentosum in a 78-year-old woman with a 17-year history of multiple basal cell carcinomas, keratoacanthoma, and lentigo maligna melanoma, in different photoexposed facial regions. To prevent aggravation of these medical conditions, for five years, the patient had been applying a film-forming topical medical device (MD) containing the DNA-repair enzyme photolyase in liposomes and high-protection UV filters (Repairsomes) twice a day. During this time, the patient had no clinical or dermatoscopic evidence of new skin cancer lesions. However, at her last visit, the patient had a new basal cell carcinoma on the face, in the right supramaxillary area. After questioning, the patient recognized that she had not been applying the product on a regular basis during the last year. This may have been a coincidence; however, there is clinical evidence of the preventive effect of this MD in reducing the cancerization field and consequently the development of skin cancer. This product contains a light-activated flavoenzyme called photolyase which creates the condition to revert cyclobutane pyrimidine dimer. In the discussion of this case, we review recent publications and stress some important aspects on the role of photoprotection and photorepair as a strategy to more effectively reduce the risk of UV-induced premalignant and malignant skin lesions compared to traditional photoprotection strategies.