Ferulic acid 12% peel: An innovative peel for constitutional type of periorbital melanosis-Comparing clinical efficacy and safety with 20% glycolic peel and 15% lactic peel

Natural autophagy activators: A promising strategy for combating photoaging

BACKGROUND

Photodamage to the skin stands out as one of the most widespread epidermal challenges globally. Prolonged exposure to sunlight containing ultraviolet radiation (UVR) instigates stress, thereby compromising the skin's functionality and culminating in photoaging. Recent investigations have shed light on the importance of autophagy in shielding the skin from photodamage. Despite the acknowledgment of numerous phytochemicals possessing photoprotective attributes, their potential to induce autophagy remains relatively unexplored.

PURPOSE

Diminished autophagy activity in photoaged skin underscores the potential benefits of restoring autophagy through natural compounds to enhance photoprotection. Consequently, this study aims to highlight the role of natural compounds in safeguarding against photodamage and to assess their potential to induce autophagy via an in-silico approach.

METHODS

A thorough search of the literature was done using several databases, including PUBMED, Science Direct, and Google Scholar, to gather relevant studies. Several keywords such as Phytochemical, Photoprotection, mTOR, Ultraviolet Radiation, Reactive oxygen species, Photoaging, and Autophagy were utilized to ensure thorough exploration. To assess the autophagy potential of phytochemicals through virtual screening, computational methodologies such as molecular docking were employed, utilizing tools like AutoDock Vina. Receptor preparation for docking was facilitated using MGLTools.

RESULTS

The initiation of structural and functional deterioration in the skin due to ultraviolet radiation (UVR) or sunlight-induced reactive oxygen species/reactive nitrogen species (ROS/RNS) involves the modulation of various pathways. Natural compounds like phenolics, flavonoids, flavones, and anthocyanins, among others, possess chromophores capable of absorbing light, thereby offering photoprotection by modulating these pathways. In our molecular docking study, these phytochemicals have shown binding affinity with mTOR, a negative regulator of autophagy, indicating their potential as autophagy modulators.

CONCLUSION

This integrated review underscores the photoprotective characteristics of natural compounds, while the in-silico analysis reveals their potential to modulate autophagy, which could significantly contribute to their anti-photoaging properties. The findings of this study hold promise for the advancement of cosmeceuticals and therapeutics containing natural compounds aimed at addressing photoaging and various skin-related diseases. By leveraging their dual benefits of photoprotection and autophagy modulation, these natural compounds offer a multifaceted approach to combatting skin aging and related conditions.

Comparative Analysis of Efficacy of Lactic Acid 30% with Ferulic Peel 12% (Combination Peel) Versus TCA 10% with Ferulic Peel 12% (Combination Peel) for Photoageing Skin

OBJECTIVES

Chemical peels are used to treat photoageing, pigmentation, improve complexion and dull skin, fine lines and scars. The objective of this study is to do comparative analysis of Lactic Acid 30% with Ferulic peel 12% (combination peel) versus TCA 10% with Ferulic peel 12% (combination peel) for Photoageing Skin.

MATERIALS AND METHODS

This is a retrospective study from September 2021 to 2022 with total 50 female patients aged between 25 and 40 years were treated. Randomisation of patients was done (simple randomisation using lottery method) for both groups with 25 patients enrolled in each group. The first group (Group A-25 patients) were treated with lactic acid 30% with Ferulic peel 12% (combination peel). The second group (Group B-25 patients) were treated with TCA 10% with Ferulic peel 12% (combination peel). Inclusion and exclusion criteria have been defined for the study. Two scales have been used for assessing the results: Allergan Skin Roughness Scale (ASRS) and Allergan Fine Line Scale (AFLS). ASRS and AFLS scores were assessed at pre-treatment (pre) and post treatment (post-1 month after last peel session). Data were summarised in Mean ± SD (standard deviation). Pre and post groups were compared by paired t test. The pre to post change in outcome measures between two independent groups were compared by independent Student's t test. Discrete (categorical) groups were compared by Chi-square (χ2) test. A two-tailed (α=2) P < 0.05 was considered statistically significant. Analyses were performed on SPSS software (Windows version 22.0). Patients were followed up for 6 months post treatment.

RESULTS

In Group A, comparing the pre and post ASRS score, paired t test showed significant (P < 0.001) decrease or improvement of 56.1%. In Group B, comparing the pre and post ASRS score, paired t test showed significant (P < 0.001) decrease or improvement of 52.8%. Comparing the pre to post mean decrease or improvement in ASRS score of two groups, Student's t test showed similar (P > 0.05) improvement between the two groups though it was 2.5% higher in Group B as compared to Group A. In Group A, comparing the pre and post AFLS score, paired t test showed significant (P < 0.001) decrease or improvement of 63.2% at post as compared to pre. In Group B, comparing the pre and post AFLS score, paired t test showed significant (P < 0.001) decrease or improvement of 58.8% at post as compared to pre. Further, comparing the pre to post mean decrease or improvement in AFLS score of two groups, Student's t test showed similar (P > 0.05) improvement between the two groups though it was 16.7% higher in Group A as compared to Group B.

CONCLUSION

Study found both the treatments equally effective in the management of ageing skin after 6 months of treatment. However, study needs further validation on larger sample size, varied age groups and male gender.

LEVEL OF EVIDENCE V

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Ferulic acid - a novel topical agent in reducing signs of photoaging

INTRODUCTION

Continuous production of reactive oxygen species, induced by UV radiation, is one of the main mechanisms contributing to skin photoaging. Therefore, the use of novel superior antioxidants, which ferulic acid belongs to, is an innovative treatment option. The aim of this study was to evaluate the effect of 14% ferulic acid peel on skin hydration, topography, the level of melanin, and the severity of erythema, in people with skin photoaging symptoms.

METHODS

20 women aged 45 to 60, received 8 treatments of chemical peeling in 1-week intervals. Efficacy was measured using The Multi Probe Adapter (MPA) Systems (Courage + Khazaka electronic GmbH, Köln, Germany). The measurements were taken before, 8, and 12 weeks after the first treatment. Additionally, the photo documentation was made with Fotomedicus (Elfo) and VISIA® Complexion Analysis System (Canfield Scientific, Inc.). Results The objective evaluation showed statistically significant improvement in all measured skin parameters (P<0,05). The best results of skin hydration and melanin level were observed right after the end of the series (P<0,001). The best improvement in erythema reduction was noted a month after the last treatment (P<0,0001). At the control, untreated point none of the probes showed statistically significant changes.

CONCLUSION

In conclusion, a series of treatments with 14% ferulic acid peel has a significant bleaching, erythema-reducing, and moisturizing activity. The results achieved by apparatus, are reflected by photo documentation. The effects achieved during a series persist over time.

Two superior antioxidants: Ferulic acid and ascorbic acid in reducing signs of photoaging-A split-face comparative study

The assessment of the signs of photoaging in mexametric (melanin and erythema index), corneometric (hydration level), and cutometric (elasticity) examination after the treatment with ascorbic acid and ferulic acid. This study was conducted in a group of 20 women aged 39-61 (mean age 54), with Fitzpatrick skin types II and III. The study included a series of eight treatments performed once a week. Two layers of peeling, based on 14% ferulic acid (left half of the face) and 12% l-ascorbic acid serum (right half of the face) were applied. To determine skin parameters: moisture, elasticity, melanin level, and erythema intensity, the Multi Probe Adapter Systems (Courage + Khazaka electronic GmbH, Köln, Germany) were used. Additionally, before and after the series of treatments, photographs were taken with the standardized photographic system Fotomedicus (Elfo®). The results of mexametric measurement for melanin level and erythema intensity were statistically significant (p < 0.0001) for both acids. Slightly greater lightening of the skin was demonstrated for ascorbic acid. The results of corneometric measurement of hydration level for ferulic acid and ascorbic acid were both statistically significant (p < 0.0001). First beneficial changes in improved elasticity could be observed as early as after 8 weeks but the increase in flexibility grew with time (after 12 weeks). These changes affected both acids and all measurement points. The changes in parameters were highly statistically significant (p < 0.0001). Based on the conducted research, it is not possible to state which of the tested acids is more effective in reducing the symptoms of photoaging. Both acids (ascorbic and ferulic), which have a high antioxidant potential, affect the measurable parameters of the skin: pigmentation (melanin index), erythema (erythema index), skin hydration, and elasticity.

Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures

Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18−57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.

Comparative Analysis of Efficacy of Lactic Acid with Ferulic Peel (Combination Peel) Vs Ferulic Peel Alone as a Monotherapy for Photoaging

OBJECTIVES

Chemical peels are used to treat fine lines, photoaging, skin discoloration and scars. The objective of this study is to do a comparative analysis of lactic acid 30 % with ferulic peel 12 % (combination peel) versus ferulic peel 12% alone as a monotherapy for photoaging.

MATERIALS AND METHODS

This is a prospective study from Feb 2016 to 2020 in which a total of 60 female patients with ages between 25 and 36 years were treated. Randomization of patients was done for both groups with 30 patients enrolled in each group. The first group of 30 patients was treated with ferulic peel 12 % (hydroalcohol base) with L-ascorbic acid 15% as a sealer alone (i.e., Group A). In the second group, 30 patients were treated with lactic acid 30 % with ferulic peel 12% (hydroalcohol base) with L-ascorbic acid 15% as a sealer (combination peel) (i.e., Group B). Inclusion and exclusion criteria have been defined for the study. Two scales have been used for assessing the results, Allergan Skin Roughness Scale (ASRS) and Allergan Fine Line Scale (AFLS). ASRS and AFLS scores were assessed at pre-treatment (pre) and post-treatment (post 1 month after last peel session) and compared using Student's paired t test and independent t test.

RESULTS

The results showed significant and higher improvement of 27% and 42%, respectively, in ASRS (1.37 ± 0.49 vs. 1.87 ± 0.51, diff = 0.50, 95% CI = 0.24 to 0.76, p < 0.001) and AFLS (1.20 ± 0.41 vs. 2.07 ± 0.58, diff = 0.87, 95% CI = 0.61-1.13, p < 0.001) scores in patients treated with lactic acid and ferulic peel as compared to patients treated with ferulic peel alone. No complications were observed in our study.

CONCLUSION

The study found the combination of lactic acid and ferulic peel significantly more effective than ferulic peel alone in the management of fine lines, photoaging and skin discoloration. The findings of this study may need to be further validated on a larger sample size and multicentric analysis. Initial results of our 4-year study have yielded promising results.

LEVEL OF EVIDENCE III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .