Aesthetic Dermatology

WAIKOLOA, HAWAII – Just because a dermatologist has photodynamic therapy equipment in the office doesn’t mean it should be applied to every skin condition that comes through the door, Dr. Jerome M. Garden cautioned at the Hawaii Dermatology Seminar sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.

"Used selectively, I think PDT can be truly worthwhile in some of our patients. But we run into problems when we decide it’s a cure-all for everything. Just because it’s available does not always make it the best choice around," said Dr. Garden, who is director of the Physicians Laser and Dermatology Institute as well as a professor of clinical dermatology and biomedical engineering at Northwestern University in Chicago.

Looking through the literature, it’s quickly apparent that PDT has been used to treat a bewildering array of dermatologic disorders, in most cases with less than stellar results.

"In my practice, I’m using PDT to treat just two things: actinic keratoses and actinic cheilitis, which is a close cousin. Why am I not using it to treat more disease processes? Because it has to be worth it. PDT is not simple to do. It takes a lot of your time and it costs you money. Insurance doesn’t necessarily help you with this. Either the patient’s insurance will reimburse you at an incredibly low rate, where it’s basically costing you money to do it, or you go outside of the insurance – and PDT is an expensive procedure," he noted.

The substantial time expenditure involved in PDT stems from the need to use microdermabrasion or another method of skin preparation to help the topical photosensitizing agent penetrate better. This is followed by an incubation time of 1-3 hours as the photosensitizer finds its target, and then light therapy to create the reactive oxygen species, which kills the targeted cells. The duration of light therapy is source dependent; blue light, for example, must be applied for 15-20 minutes.

PDT has other shortcomings in addition to the cost and time involved. It can be painful and entails several days of down time because of scaling and crusting. Plus, multiple treatment sessions are usually required, the dermatologist continued.

The 2012 American Society for Dermatologic Surgery member survey found that dermatologic surgeons performed roughly 205,000 PDT procedures during the year. The bulk was for actinic keratoses, acne, and rosacea.

"I didn’t even know until I saw this list that anybody treats rosacea with PDT," noted Dr. Garden. "A lot of people out there who are doing PDT use it for many more things than I do. But I’m just telling you what I do."

"I’ve tried it for acne. It helps, but depending on the light source, it can be a painful procedure. There’s a lot of desquamation afterward, and you have to go through it a few times. So you have to have a highly motivated patient – and even then, it doesn’t work all the time," he said.

Dr. Garden cited a Danish split-face study of pulsed-dye laser-assisted PDT vs. pulsed-dye laser therapy alone. Twelve weeks after completing three treatment sessions, the PDT side showed an 80% reduction in inflammatory acne lesions, compared with a 67% drop with pulsed-dye laser, and a 53% decrease in noninflammatory lesions compared to a 42% reduction with laser alone (J. Am. Acad. Dermatol. 2008; 58:387-94).

"Even without the topical photosensitizer, patients did pretty well," he commented.

As for PDT in cutaneous malignancies, Dr. Garden highlighted a recent literature review by dermatologists at the University of South Florida, Tampa, which concluded that the therapy is equivalent or superior to cryosurgery for actinic keratoses. The investigators also deemed PDT suitable for Bowen’s disease lesions provided they are large, widespread, or on difficult to treat areas, as well as for squamous cell carcinomas, but only when surgery is contraindicated. PDT may also provide better cosmetic outcomes than surgery or cryosurgery for superficial basal cell carcinomas (Dermatol. Surg. 2013;39:1733-44).

Dr. Garden called PDT his current first-line treatment for actinic cheilitis.

"I used to use the CO₂ laser exclusively. It works very well, much better than PDT. But when I’d strip off the top layer of skin with the CO₂ laser, patients would end up with an open wound that took a long time to heal. That’s hard for the patient to tolerate. And occasionally we’d see fibrosis of the lip. You don’t see that with PDT, although with PDT you usually need to do two or three treatments, and the area is red and swollen for 2-4 days. I like PDT. It’s my go-to therapy. When it fails, I turn on the CO₂ laser," he said.

In treating actinic keratoses, he reserves PDT for patients with numerous lesions over a large field.

"It does work, but it’s a lot of effort. So if you’re just going after a handful of [actinic keratoses] do you need PDT? Probably not," Dr. Garden said.

Ending on an encouraging note, the dermatologist pointed to the ongoing substantial research commitment to PDT as very promising. Finding more specific photosensitizers is a priority. And ablative fractional laser-assisted delivery of the standard photosensitizer methyl aminolevulinic acid appears to be "an exciting development," in Dr. Garden’s view, although to date the work is limited to animal studies.

Dr. Garden reported having financial relationships with Alma, Candela & Syneron, and Palomar/Cynosure.

The SDEF and this news organization are owned by the same parent company.

bjancin@frontlinemedcom.com

WAIKOLOA, HAWAII – Just because a dermatologist has photodynamic therapy equipment in the office doesn’t mean it should be applied to every skin condition that comes through the door, Dr. Jerome M. Garden cautioned at the Hawaii Dermatology Seminar sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.

"Used selectively, I think PDT can be truly worthwhile in some of our patients. But we run into problems when we decide it’s a cure-all for everything. Just because it’s available does not always make it the best choice around," said Dr. Garden, who is director of the Physicians Laser and Dermatology Institute as well as a professor of clinical dermatology and biomedical engineering at Northwestern University in Chicago.

Looking through the literature, it’s quickly apparent that PDT has been used to treat a bewildering array of dermatologic disorders, in most cases with less than stellar results.

"In my practice, I’m using PDT to treat just two things: actinic keratoses and actinic cheilitis, which is a close cousin. Why am I not using it to treat more disease processes? Because it has to be worth it. PDT is not simple to do. It takes a lot of your time and it costs you money. Insurance doesn’t necessarily help you with this. Either the patient’s insurance will reimburse you at an incredibly low rate, where it’s basically costing you money to do it, or you go outside of the insurance – and PDT is an expensive procedure," he noted.

The substantial time expenditure involved in PDT stems from the need to use microdermabrasion or another method of skin preparation to help the topical photosensitizing agent penetrate better. This is followed by an incubation time of 1-3 hours as the photosensitizer finds its target, and then light therapy to create the reactive oxygen species, which kills the targeted cells. The duration of light therapy is source dependent; blue light, for example, must be applied for 15-20 minutes.

PDT has other shortcomings in addition to the cost and time involved. It can be painful and entails several days of down time because of scaling and crusting. Plus, multiple treatment sessions are usually required, the dermatologist continued.

The 2012 American Society for Dermatologic Surgery member survey found that dermatologic surgeons performed roughly 205,000 PDT procedures during the year. The bulk was for actinic keratoses, acne, and rosacea.

"I didn’t even know until I saw this list that anybody treats rosacea with PDT," noted Dr. Garden. "A lot of people out there who are doing PDT use it for many more things than I do. But I’m just telling you what I do."

"I’ve tried it for acne. It helps, but depending on the light source, it can be a painful procedure. There’s a lot of desquamation afterward, and you have to go through it a few times. So you have to have a highly motivated patient – and even then, it doesn’t work all the time," he said.

Dr. Garden cited a Danish split-face study of pulsed-dye laser-assisted PDT vs. pulsed-dye laser therapy alone. Twelve weeks after completing three treatment sessions, the PDT side showed an 80% reduction in inflammatory acne lesions, compared with a 67% drop with pulsed-dye laser, and a 53% decrease in noninflammatory lesions compared to a 42% reduction with laser alone (J. Am. Acad. Dermatol. 2008; 58:387-94).

"Even without the topical photosensitizer, patients did pretty well," he commented.

As for PDT in cutaneous malignancies, Dr. Garden highlighted a recent literature review by dermatologists at the University of South Florida, Tampa, which concluded that the therapy is equivalent or superior to cryosurgery for actinic keratoses. The investigators also deemed PDT suitable for Bowen’s disease lesions provided they are large, widespread, or on difficult to treat areas, as well as for squamous cell carcinomas, but only when surgery is contraindicated. PDT may also provide better cosmetic outcomes than surgery or cryosurgery for superficial basal cell carcinomas (Dermatol. Surg. 2013;39:1733-44).

Dr. Garden called PDT his current first-line treatment for actinic cheilitis.

"I used to use the CO₂ laser exclusively. It works very well, much better than PDT. But when I’d strip off the top layer of skin with the CO₂ laser, patients would end up with an open wound that took a long time to heal. That’s hard for the patient to tolerate. And occasionally we’d see fibrosis of the lip. You don’t see that with PDT, although with PDT you usually need to do two or three treatments, and the area is red and swollen for 2-4 days. I like PDT. It’s my go-to therapy. When it fails, I turn on the CO₂ laser," he said.

In treating actinic keratoses, he reserves PDT for patients with numerous lesions over a large field.

"It does work, but it’s a lot of effort. So if you’re just going after a handful of [actinic keratoses] do you need PDT? Probably not," Dr. Garden said.

Ending on an encouraging note, the dermatologist pointed to the ongoing substantial research commitment to PDT as very promising. Finding more specific photosensitizers is a priority. And ablative fractional laser-assisted delivery of the standard photosensitizer methyl aminolevulinic acid appears to be "an exciting development," in Dr. Garden’s view, although to date the work is limited to animal studies.

Dr. Garden reported having financial relationships with Alma, Candela & Syneron, and Palomar/Cynosure.

The SDEF and this news organization are owned by the same parent company.

bjancin@frontlinemedcom.com

WAIKOLOA, HAWAII – Just because a dermatologist has photodynamic therapy equipment in the office doesn’t mean it should be applied to every skin condition that comes through the door, Dr. Jerome M. Garden cautioned at the Hawaii Dermatology Seminar sponsored by the Global Academy for Medical Education/Skin Disease Education Foundation.

"Used selectively, I think PDT can be truly worthwhile in some of our patients. But we run into problems when we decide it’s a cure-all for everything. Just because it’s available does not always make it the best choice around," said Dr. Garden, who is director of the Physicians Laser and Dermatology Institute as well as a professor of clinical dermatology and biomedical engineering at Northwestern University in Chicago.

Looking through the literature, it’s quickly apparent that PDT has been used to treat a bewildering array of dermatologic disorders, in most cases with less than stellar results.

"In my practice, I’m using PDT to treat just two things: actinic keratoses and actinic cheilitis, which is a close cousin. Why am I not using it to treat more disease processes? Because it has to be worth it. PDT is not simple to do. It takes a lot of your time and it costs you money. Insurance doesn’t necessarily help you with this. Either the patient’s insurance will reimburse you at an incredibly low rate, where it’s basically costing you money to do it, or you go outside of the insurance – and PDT is an expensive procedure," he noted.

The substantial time expenditure involved in PDT stems from the need to use microdermabrasion or another method of skin preparation to help the topical photosensitizing agent penetrate better. This is followed by an incubation time of 1-3 hours as the photosensitizer finds its target, and then light therapy to create the reactive oxygen species, which kills the targeted cells. The duration of light therapy is source dependent; blue light, for example, must be applied for 15-20 minutes.

PDT has other shortcomings in addition to the cost and time involved. It can be painful and entails several days of down time because of scaling and crusting. Plus, multiple treatment sessions are usually required, the dermatologist continued.

The 2012 American Society for Dermatologic Surgery member survey found that dermatologic surgeons performed roughly 205,000 PDT procedures during the year. The bulk was for actinic keratoses, acne, and rosacea.

"I didn’t even know until I saw this list that anybody treats rosacea with PDT," noted Dr. Garden. "A lot of people out there who are doing PDT use it for many more things than I do. But I’m just telling you what I do."

"I’ve tried it for acne. It helps, but depending on the light source, it can be a painful procedure. There’s a lot of desquamation afterward, and you have to go through it a few times. So you have to have a highly motivated patient – and even then, it doesn’t work all the time," he said.

Dr. Garden cited a Danish split-face study of pulsed-dye laser-assisted PDT vs. pulsed-dye laser therapy alone. Twelve weeks after completing three treatment sessions, the PDT side showed an 80% reduction in inflammatory acne lesions, compared with a 67% drop with pulsed-dye laser, and a 53% decrease in noninflammatory lesions compared to a 42% reduction with laser alone (J. Am. Acad. Dermatol. 2008; 58:387-94).

"Even without the topical photosensitizer, patients did pretty well," he commented.

As for PDT in cutaneous malignancies, Dr. Garden highlighted a recent literature review by dermatologists at the University of South Florida, Tampa, which concluded that the therapy is equivalent or superior to cryosurgery for actinic keratoses. The investigators also deemed PDT suitable for Bowen’s disease lesions provided they are large, widespread, or on difficult to treat areas, as well as for squamous cell carcinomas, but only when surgery is contraindicated. PDT may also provide better cosmetic outcomes than surgery or cryosurgery for superficial basal cell carcinomas (Dermatol. Surg. 2013;39:1733-44).

Dr. Garden called PDT his current first-line treatment for actinic cheilitis.

"I used to use the CO₂ laser exclusively. It works very well, much better than PDT. But when I’d strip off the top layer of skin with the CO₂ laser, patients would end up with an open wound that took a long time to heal. That’s hard for the patient to tolerate. And occasionally we’d see fibrosis of the lip. You don’t see that with PDT, although with PDT you usually need to do two or three treatments, and the area is red and swollen for 2-4 days. I like PDT. It’s my go-to therapy. When it fails, I turn on the CO₂ laser," he said.

In treating actinic keratoses, he reserves PDT for patients with numerous lesions over a large field.

"It does work, but it’s a lot of effort. So if you’re just going after a handful of [actinic keratoses] do you need PDT? Probably not," Dr. Garden said.

Ending on an encouraging note, the dermatologist pointed to the ongoing substantial research commitment to PDT as very promising. Finding more specific photosensitizers is a priority. And ablative fractional laser-assisted delivery of the standard photosensitizer methyl aminolevulinic acid appears to be "an exciting development," in Dr. Garden’s view, although to date the work is limited to animal studies.

Dr. Garden reported having financial relationships with Alma, Candela & Syneron, and Palomar/Cynosure.

The SDEF and this news organization are owned by the same parent company.

bjancin@frontlinemedcom.com

WAIKOLOA, HAWAII – Our editor, Heidi Splete, catches up with attendees at the Hawaii Dermatology Seminar to find out what they learned at the meeting that they will take back to their practices.

During a coffee break video interview, doctors said they enjoyed presentations on tips to treat fine lines around the eyes and mouth, the link between psoriasis and increased cardiovascular risks, and the "two Cs" of potential leather allergies.

hsplete@frontlinemedcom.com

WAIKOLOA, HAWAII – Our editor, Heidi Splete, catches up with attendees at the Hawaii Dermatology Seminar to find out what they learned at the meeting that they will take back to their practices.

During a coffee break video interview, doctors said they enjoyed presentations on tips to treat fine lines around the eyes and mouth, the link between psoriasis and increased cardiovascular risks, and the "two Cs" of potential leather allergies.

hsplete@frontlinemedcom.com

WAIKOLOA, HAWAII – Our editor, Heidi Splete, catches up with attendees at the Hawaii Dermatology Seminar to find out what they learned at the meeting that they will take back to their practices.

During a coffee break video interview, doctors said they enjoyed presentations on tips to treat fine lines around the eyes and mouth, the link between psoriasis and increased cardiovascular risks, and the "two Cs" of potential leather allergies.

hsplete@frontlinemedcom.com

1. Which of the following suture properties is most responsible for accommodation of edema postoperatively?

a. memory
b. plasticity
c. pliability
d. size
e. stretching

2. Which of the following has the highest memory?

a. coated polyester (Ethibond Excel)
b. poliglecaprone 25 (Monocryl)
c. polyglactin 910 (Vicryl)
d. silk
e. stainless steel

3. The most worrisome consequence of capillarity is:

a. increased potential of translocation of bacterium in a wound
b. increased reactivity
c. increased spitting of suture
d. increased wound edema
e. decreased tensile strength

4. Which of the following would be an excellent choice for closing the mucosal surface on an Abbe flap repair?

a. 2-octyl cyanoacrylate (Dermabond Advanced)
b. 5-0 chromic gut
c. 5-0 coated polyester (Ethibond Excel)
d. 5-0 polybutester (Novafil)
e. polypropylene (Prolene)

5. Knot security is thought to be most directly related to which property of suture:

a. coefficient of friction
b. configuration
c. memory
d. size
e. tensile strength

1. Which of the following suture properties is most responsible for accommodation of edema postoperatively?

a. memory
b. plasticity
c. pliability
d. size
e. stretching

2. Which of the following has the highest memory?

a. coated polyester (Ethibond Excel)
b. poliglecaprone 25 (Monocryl)
c. polyglactin 910 (Vicryl)
d. silk
e. stainless steel

3. The most worrisome consequence of capillarity is:

a. increased potential of translocation of bacterium in a wound
b. increased reactivity
c. increased spitting of suture
d. increased wound edema
e. decreased tensile strength

4. Which of the following would be an excellent choice for closing the mucosal surface on an Abbe flap repair?

a. 2-octyl cyanoacrylate (Dermabond Advanced)
b. 5-0 chromic gut
c. 5-0 coated polyester (Ethibond Excel)
d. 5-0 polybutester (Novafil)
e. polypropylene (Prolene)

5. Knot security is thought to be most directly related to which property of suture:

a. coefficient of friction
b. configuration
c. memory
d. size
e. tensile strength

1. Which of the following suture properties is most responsible for accommodation of edema postoperatively?

a. memory
b. plasticity
c. pliability
d. size
e. stretching

2. Which of the following has the highest memory?

a. coated polyester (Ethibond Excel)
b. poliglecaprone 25 (Monocryl)
c. polyglactin 910 (Vicryl)
d. silk
e. stainless steel

3. The most worrisome consequence of capillarity is:

a. increased potential of translocation of bacterium in a wound
b. increased reactivity
c. increased spitting of suture
d. increased wound edema
e. decreased tensile strength

4. Which of the following would be an excellent choice for closing the mucosal surface on an Abbe flap repair?

a. 2-octyl cyanoacrylate (Dermabond Advanced)
b. 5-0 chromic gut
c. 5-0 coated polyester (Ethibond Excel)
d. 5-0 polybutester (Novafil)
e. polypropylene (Prolene)

5. Knot security is thought to be most directly related to which property of suture:

a. coefficient of friction
b. configuration
c. memory
d. size
e. tensile strength

Peptides have recently generated interest as biologically active compounds incorporated into cosmeceutical products intended to treat aging skin. Peptides are composed of chains of amino acids, which are derived from DNA transcription. In typical cellular settings, peptides communicate or signal between DNA and the cellular network. Consequently, they are thought to be capable of being used or exploited to direct cells to maintain youthful behavior, yielding a stable, nonaging manifestation. In addition, peptides can be rendered by protein degradation, thus forming an essential feedback inhibition and upregulation loop (Facial Plast. Surg. 2009;25:285-9). Downregulation of metalloproteinases (MMPs), notably collagenase, by peptides is a good example, as well as a window into why peptides have sparked interest within antiaging research (Dermatol. Surg. 2005;31[7 Pt 2]:832-6, discussion 836).

Researchers at the University of Tennessee, Memphis, performed some of the seminal work that has paved the way for understanding how to harness the activity of natural peptides by showing that the production of the extracellular matrix in fibroblasts is fostered by a pentapeptide subfragment of propeptide of type I collagen (J. Biol. Chem. 1993;268:9941-4).

But the foundational work setting the stage for development of cosmeceutical peptides has been in the research for ameliorating wounds, which dates back several decades and can be traced to the use of yeast extracts for wound care in the 1930s, later leading to the extraction of a usable protein fraction (Dermatol. Ther. 2007;20:343-9; Clin. Ther. 1991;13:430-4). Signal peptides, enzyme-inhibitor peptides, neurotransmitter-inhibitor peptides (or neuropeptides), and carrier peptides are the four primary classes of topical or cosmeceutical peptides. This column will offer a brief summary of each and acknowledge additional recent research. Future columns may address each of these peptide categories pertinent to antiaging cosmeceuticals.

Signal peptides

Specific bioactive amino acid chains have been discovered in recent years that promote human skin dermal fibroblast growth in vitro and in vivo, and reduce the length and depth of wrinkles (Dermatol. Ther. 2007;20:343-9). The most popular signal peptide is the lysine-threonine-threonine-lysine-serine (KTTKS) located on type 1 procollagen. To enhance epidermal delivery, it has been linked to palmitic acid, thus the marketed version (Matrixyl) is a palmitoyl pentapeptide, which has been shown to augment the synthesis of collagen by fibroblasts and yield reductions in fine lines and wrinkles, according to quantitative analysis and self-reports (J. Biol. Chem. 1993;268:9941-4; Int. J. Cosmet. Sci. 2005;27:155-60).

New signal peptides are expected to be stronger and better targeted than those presently marketed (Facial Plast. Surg. 2009;25:285-9). Signal peptides promote the synthesis of matrix proteins, collagen in particular, which leads to firmer, younger looking skin, and also augments levels of elastin, proteoglycans, glycosaminoglycans, and fibronectin (Int. J. Cosmet. Sci. 2009;31:327-45).

Enzyme-inhibitor peptides

These peptides suppress enzymatic activity either directly or indirectly. Enzyme-inhibiting peptides extracted from soybeans have been incorporated into antiaging, moisturizing, and cleansing products as well as hair care formulations (Int. J. Cosmet. Sci. 2009;31:327-45). In a small study in 10 white females, a 2% soya biopeptide performed better than did placebo in collagen and glycosaminoglycan promotion (Int. J. Cosmet. Sci. 1999;21:299-311).

More recently, a rice peptide derived from germinated black rice, which has been used in traditional Asian medicines, was found to block MMP activity and dose-dependently stimulate hyaluronan synthase 2 gene expression (a twofold increase) in human keratinocytes (J. Microbiol. Biotechnol. 2007;17:271-9). Such peptides are found in antiaging and hair products.

In addition, antioxidant activity, a high affinity to chelate with copper, and the capacity to suppress tyrosinase activity and keratinocyte apoptosis have been displayed by the enzyme-inhibiting peptide sericin, derived from the silkworm Bombyx mori (Int. J. Cosmet. Sci. 2009;31:327-45). Sericin also has been shown to facilitate the intrinsic moisturization of skin by restoring amino acids and imparting an occlusive effect (J. Cosmet. Dermatol. 2005;4:250-7).

Neuropeptides

Neuropeptides are known to mediate skin inflammation and, thus, contribute as an underlying aspect of reactive skin conditions (Eur. J. Dermatol. 2010;20:731-7). Also known as neurotransmitter-affecting peptides, these compounds are included in cosmeceuticals to mimic the action of botulinum toxin A. Essentially, they inhibit acetylcholine release at the neuromuscular junction.

The best known of these is acetyl hexapeptide-3, marketed as Argireline. Attached to acetic acid residue, this synthetic peptide, based on the N-terminal end of the synaptosomal-associated protein (SNAP)–25 that blocks soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex development and catecholamine release (Int. J. Cosmet. Sci. 2009;31:327-45), is thought to suppress the release of neurotransmitters, easing facial tension, and thus reducing wrinkles. Evidence of its effectiveness has appeared largely in proprietary studies. Much more research is necessary to establish the suitability of this form of peptide for topical antiaging applications.

Carrier peptides

Carrier peptides stabilize and transport trace elements essential for healing wounds and enzymatic processes (Dermatol. Ther. 2007;20:343-9). Although it also confers signal peptide effects, glycyl-L-histidyl-L-lysine (GHK), a naturally occurring tripeptide initially isolated from human plasma (Nat. New Biol. 1973;243:85-7), is known mainly as a carrier peptide. It is typically linked with copper, given its high affinity for it, and several studies have shown that copper peptide molecules using GHK (glycyl-L-histidyl-L-lysine-Cu²⁺ or GHK-Cu) deliver varied restorative effects, including the improvement in the appearance of fine lines and wrinkles (Dermatol. Ther. 2007;20:343-9). This tripeptide complex has been used for many years to accelerate wound healing and is found in several moisturizers. Significantly, the GHK-Cu complex also has been shown to stimulate collagen synthesis (FEBS Lett. 1988;238:343-6) and to augment sulfated proteoglycans levels in fibroblast cultures as well as experimental animal wound models (J. Clin. Invest. 1993;92:2368-76). GHK-Cu also influences tissue remodeling by raising the levels of MMP-2 and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) (Life Sci. 2000;67:2257-65). More research is necessary to ascertain the efficacy of copper peptide as an antiaging agent.

Recent general research findings

A double-blind clinical study in 2004 of 20 healthy women volunteers between 40 and 62 years of age revealed that a gel formula containing 3% of a collagen-like hexapeptide significantly reduced the total surface of wrinkles as well as the number and average depth of wrinkles (Int. J. Tissue React. 2004;26:105-11).

In 2005, a literature review of studies published on the effects and practical applications of peptides as topical agents for skin improvement showed that peptide cosmeceuticals seem to exhibit the potential to blunt the visual effects of aging on the skin, and that formulations must be stable, absorbed into the skin, and biologically active (Dermatol. Surg. 2005;31[7 Pt 2]:832-6, discussion 836).

In 2007, investigators reported on the development of a new hand care formulation derived from wool peptides. The keratin fraction from wool was shown through long-term in vivo studies to enhance cutaneous hydration, water-holding capacity, and elasticity in volunteers with dry skin. In addition, the researchers found that the keratin peptide preparation blunted some of the adverse effects due to surfactant exposure (J. Cosmet. Sci. 2007;58:99-107).

That same year, researchers reported that they prepared two stable cosmetic formulations, an emulsion with an external aqueous phase for normal-to-dry skin and a gel for oily skin, with acetyl hexapeptide-8 (Argireline) as the active ingredient (J. Cosmet. Sci. 2007;58:157-71).

Previously, Argireline was shown in healthy women volunteers, in a skin topography analysis of an oil/water (O/W) emulsion containing 10% of the hexapeptide, to have decreased wrinkle depth up to 30% after 30 days of treatment. Researchers determined that the synthetic hexapeptide significantly suppresses neurotransmitter release comparably to botulinum toxin A, with fewer side effects but lower efficacy. They also noted that Argireline displayed no in vivo oral toxicity and evoked no irritation at high doses, suggesting that the peptide is a topical nontoxic antiwrinkle alternative to botulinum toxins (Int. J. Cosmet. Sci. 2002;24:303-10).

In 2008, investigators tested a hydrolyzed keratin peptide derived from wool on skin in two different formulations. Long-term in vivo studies yielded significant differences between the control and treated sites, with the treated areas exhibiting an increase in hydration and elasticity because of keratin peptide application. The investigators also noted measurements showing that the keratin formulations supported skin barrier integrity, enhancing its water-holding capacity. In particular, the formulation combining keratin peptide with internal wool lipids in a liposome suspension showed promising effects that they deemed appropriate for new cosmetic products (Skin Res. Technol. 2008;14:243-8).

Conclusion

Peptide cosmeceuticals represent a new and popular choice for consumers shopping for antiaging products. Are they worthy options? As always, the capacity of topical products to penetrate the skin and exert a biologic impact is of great significance. Some products appear to exert antiaging effects, but most evidence of effectiveness has emerged from in vitro studies or small in vivo investigations. More research, in the form of large randomized controlled trials, is necessary to establish the effectiveness of these intriguing products. As it is, though, numerous products are on the market and this area of research and product development shows promise.

Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in Miami Beach. She founded the cosmetic dermatology center at the University of Miami in 1997. Dr. Baumann wrote the textbook "Cosmetic Dermatology: Principles and Practice" (McGraw-Hill, April 2002), and a book for consumers, "The Skin Type Solution" (Bantam, 2006). She has contributed to the Cosmeceutical Critique column in Skin & Allergy News since January 2001 and joined the editorial advisory board in 2004. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Galderma, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Stiefel, Topix Pharmaceuticals, and Unilever.

Peptides have recently generated interest as biologically active compounds incorporated into cosmeceutical products intended to treat aging skin. Peptides are composed of chains of amino acids, which are derived from DNA transcription. In typical cellular settings, peptides communicate or signal between DNA and the cellular network. Consequently, they are thought to be capable of being used or exploited to direct cells to maintain youthful behavior, yielding a stable, nonaging manifestation. In addition, peptides can be rendered by protein degradation, thus forming an essential feedback inhibition and upregulation loop (Facial Plast. Surg. 2009;25:285-9). Downregulation of metalloproteinases (MMPs), notably collagenase, by peptides is a good example, as well as a window into why peptides have sparked interest within antiaging research (Dermatol. Surg. 2005;31[7 Pt 2]:832-6, discussion 836).

Researchers at the University of Tennessee, Memphis, performed some of the seminal work that has paved the way for understanding how to harness the activity of natural peptides by showing that the production of the extracellular matrix in fibroblasts is fostered by a pentapeptide subfragment of propeptide of type I collagen (J. Biol. Chem. 1993;268:9941-4).

But the foundational work setting the stage for development of cosmeceutical peptides has been in the research for ameliorating wounds, which dates back several decades and can be traced to the use of yeast extracts for wound care in the 1930s, later leading to the extraction of a usable protein fraction (Dermatol. Ther. 2007;20:343-9; Clin. Ther. 1991;13:430-4). Signal peptides, enzyme-inhibitor peptides, neurotransmitter-inhibitor peptides (or neuropeptides), and carrier peptides are the four primary classes of topical or cosmeceutical peptides. This column will offer a brief summary of each and acknowledge additional recent research. Future columns may address each of these peptide categories pertinent to antiaging cosmeceuticals.

Signal peptides

Specific bioactive amino acid chains have been discovered in recent years that promote human skin dermal fibroblast growth in vitro and in vivo, and reduce the length and depth of wrinkles (Dermatol. Ther. 2007;20:343-9). The most popular signal peptide is the lysine-threonine-threonine-lysine-serine (KTTKS) located on type 1 procollagen. To enhance epidermal delivery, it has been linked to palmitic acid, thus the marketed version (Matrixyl) is a palmitoyl pentapeptide, which has been shown to augment the synthesis of collagen by fibroblasts and yield reductions in fine lines and wrinkles, according to quantitative analysis and self-reports (J. Biol. Chem. 1993;268:9941-4; Int. J. Cosmet. Sci. 2005;27:155-60).

New signal peptides are expected to be stronger and better targeted than those presently marketed (Facial Plast. Surg. 2009;25:285-9). Signal peptides promote the synthesis of matrix proteins, collagen in particular, which leads to firmer, younger looking skin, and also augments levels of elastin, proteoglycans, glycosaminoglycans, and fibronectin (Int. J. Cosmet. Sci. 2009;31:327-45).

Enzyme-inhibitor peptides

These peptides suppress enzymatic activity either directly or indirectly. Enzyme-inhibiting peptides extracted from soybeans have been incorporated into antiaging, moisturizing, and cleansing products as well as hair care formulations (Int. J. Cosmet. Sci. 2009;31:327-45). In a small study in 10 white females, a 2% soya biopeptide performed better than did placebo in collagen and glycosaminoglycan promotion (Int. J. Cosmet. Sci. 1999;21:299-311).

More recently, a rice peptide derived from germinated black rice, which has been used in traditional Asian medicines, was found to block MMP activity and dose-dependently stimulate hyaluronan synthase 2 gene expression (a twofold increase) in human keratinocytes (J. Microbiol. Biotechnol. 2007;17:271-9). Such peptides are found in antiaging and hair products.

In addition, antioxidant activity, a high affinity to chelate with copper, and the capacity to suppress tyrosinase activity and keratinocyte apoptosis have been displayed by the enzyme-inhibiting peptide sericin, derived from the silkworm Bombyx mori (Int. J. Cosmet. Sci. 2009;31:327-45). Sericin also has been shown to facilitate the intrinsic moisturization of skin by restoring amino acids and imparting an occlusive effect (J. Cosmet. Dermatol. 2005;4:250-7).

Neuropeptides

Neuropeptides are known to mediate skin inflammation and, thus, contribute as an underlying aspect of reactive skin conditions (Eur. J. Dermatol. 2010;20:731-7). Also known as neurotransmitter-affecting peptides, these compounds are included in cosmeceuticals to mimic the action of botulinum toxin A. Essentially, they inhibit acetylcholine release at the neuromuscular junction.

The best known of these is acetyl hexapeptide-3, marketed as Argireline. Attached to acetic acid residue, this synthetic peptide, based on the N-terminal end of the synaptosomal-associated protein (SNAP)–25 that blocks soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex development and catecholamine release (Int. J. Cosmet. Sci. 2009;31:327-45), is thought to suppress the release of neurotransmitters, easing facial tension, and thus reducing wrinkles. Evidence of its effectiveness has appeared largely in proprietary studies. Much more research is necessary to establish the suitability of this form of peptide for topical antiaging applications.

Carrier peptides

Carrier peptides stabilize and transport trace elements essential for healing wounds and enzymatic processes (Dermatol. Ther. 2007;20:343-9). Although it also confers signal peptide effects, glycyl-L-histidyl-L-lysine (GHK), a naturally occurring tripeptide initially isolated from human plasma (Nat. New Biol. 1973;243:85-7), is known mainly as a carrier peptide. It is typically linked with copper, given its high affinity for it, and several studies have shown that copper peptide molecules using GHK (glycyl-L-histidyl-L-lysine-Cu²⁺ or GHK-Cu) deliver varied restorative effects, including the improvement in the appearance of fine lines and wrinkles (Dermatol. Ther. 2007;20:343-9). This tripeptide complex has been used for many years to accelerate wound healing and is found in several moisturizers. Significantly, the GHK-Cu complex also has been shown to stimulate collagen synthesis (FEBS Lett. 1988;238:343-6) and to augment sulfated proteoglycans levels in fibroblast cultures as well as experimental animal wound models (J. Clin. Invest. 1993;92:2368-76). GHK-Cu also influences tissue remodeling by raising the levels of MMP-2 and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) (Life Sci. 2000;67:2257-65). More research is necessary to ascertain the efficacy of copper peptide as an antiaging agent.

Recent general research findings

A double-blind clinical study in 2004 of 20 healthy women volunteers between 40 and 62 years of age revealed that a gel formula containing 3% of a collagen-like hexapeptide significantly reduced the total surface of wrinkles as well as the number and average depth of wrinkles (Int. J. Tissue React. 2004;26:105-11).

In 2005, a literature review of studies published on the effects and practical applications of peptides as topical agents for skin improvement showed that peptide cosmeceuticals seem to exhibit the potential to blunt the visual effects of aging on the skin, and that formulations must be stable, absorbed into the skin, and biologically active (Dermatol. Surg. 2005;31[7 Pt 2]:832-6, discussion 836).

In 2007, investigators reported on the development of a new hand care formulation derived from wool peptides. The keratin fraction from wool was shown through long-term in vivo studies to enhance cutaneous hydration, water-holding capacity, and elasticity in volunteers with dry skin. In addition, the researchers found that the keratin peptide preparation blunted some of the adverse effects due to surfactant exposure (J. Cosmet. Sci. 2007;58:99-107).

That same year, researchers reported that they prepared two stable cosmetic formulations, an emulsion with an external aqueous phase for normal-to-dry skin and a gel for oily skin, with acetyl hexapeptide-8 (Argireline) as the active ingredient (J. Cosmet. Sci. 2007;58:157-71).

Previously, Argireline was shown in healthy women volunteers, in a skin topography analysis of an oil/water (O/W) emulsion containing 10% of the hexapeptide, to have decreased wrinkle depth up to 30% after 30 days of treatment. Researchers determined that the synthetic hexapeptide significantly suppresses neurotransmitter release comparably to botulinum toxin A, with fewer side effects but lower efficacy. They also noted that Argireline displayed no in vivo oral toxicity and evoked no irritation at high doses, suggesting that the peptide is a topical nontoxic antiwrinkle alternative to botulinum toxins (Int. J. Cosmet. Sci. 2002;24:303-10).

In 2008, investigators tested a hydrolyzed keratin peptide derived from wool on skin in two different formulations. Long-term in vivo studies yielded significant differences between the control and treated sites, with the treated areas exhibiting an increase in hydration and elasticity because of keratin peptide application. The investigators also noted measurements showing that the keratin formulations supported skin barrier integrity, enhancing its water-holding capacity. In particular, the formulation combining keratin peptide with internal wool lipids in a liposome suspension showed promising effects that they deemed appropriate for new cosmetic products (Skin Res. Technol. 2008;14:243-8).

Conclusion

Peptide cosmeceuticals represent a new and popular choice for consumers shopping for antiaging products. Are they worthy options? As always, the capacity of topical products to penetrate the skin and exert a biologic impact is of great significance. Some products appear to exert antiaging effects, but most evidence of effectiveness has emerged from in vitro studies or small in vivo investigations. More research, in the form of large randomized controlled trials, is necessary to establish the effectiveness of these intriguing products. As it is, though, numerous products are on the market and this area of research and product development shows promise.

Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in Miami Beach. She founded the cosmetic dermatology center at the University of Miami in 1997. Dr. Baumann wrote the textbook "Cosmetic Dermatology: Principles and Practice" (McGraw-Hill, April 2002), and a book for consumers, "The Skin Type Solution" (Bantam, 2006). She has contributed to the Cosmeceutical Critique column in Skin & Allergy News since January 2001 and joined the editorial advisory board in 2004. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Galderma, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Stiefel, Topix Pharmaceuticals, and Unilever.

Peptides have recently generated interest as biologically active compounds incorporated into cosmeceutical products intended to treat aging skin. Peptides are composed of chains of amino acids, which are derived from DNA transcription. In typical cellular settings, peptides communicate or signal between DNA and the cellular network. Consequently, they are thought to be capable of being used or exploited to direct cells to maintain youthful behavior, yielding a stable, nonaging manifestation. In addition, peptides can be rendered by protein degradation, thus forming an essential feedback inhibition and upregulation loop (Facial Plast. Surg. 2009;25:285-9). Downregulation of metalloproteinases (MMPs), notably collagenase, by peptides is a good example, as well as a window into why peptides have sparked interest within antiaging research (Dermatol. Surg. 2005;31[7 Pt 2]:832-6, discussion 836).

Researchers at the University of Tennessee, Memphis, performed some of the seminal work that has paved the way for understanding how to harness the activity of natural peptides by showing that the production of the extracellular matrix in fibroblasts is fostered by a pentapeptide subfragment of propeptide of type I collagen (J. Biol. Chem. 1993;268:9941-4).

But the foundational work setting the stage for development of cosmeceutical peptides has been in the research for ameliorating wounds, which dates back several decades and can be traced to the use of yeast extracts for wound care in the 1930s, later leading to the extraction of a usable protein fraction (Dermatol. Ther. 2007;20:343-9; Clin. Ther. 1991;13:430-4). Signal peptides, enzyme-inhibitor peptides, neurotransmitter-inhibitor peptides (or neuropeptides), and carrier peptides are the four primary classes of topical or cosmeceutical peptides. This column will offer a brief summary of each and acknowledge additional recent research. Future columns may address each of these peptide categories pertinent to antiaging cosmeceuticals.

Signal peptides

Specific bioactive amino acid chains have been discovered in recent years that promote human skin dermal fibroblast growth in vitro and in vivo, and reduce the length and depth of wrinkles (Dermatol. Ther. 2007;20:343-9). The most popular signal peptide is the lysine-threonine-threonine-lysine-serine (KTTKS) located on type 1 procollagen. To enhance epidermal delivery, it has been linked to palmitic acid, thus the marketed version (Matrixyl) is a palmitoyl pentapeptide, which has been shown to augment the synthesis of collagen by fibroblasts and yield reductions in fine lines and wrinkles, according to quantitative analysis and self-reports (J. Biol. Chem. 1993;268:9941-4; Int. J. Cosmet. Sci. 2005;27:155-60).

New signal peptides are expected to be stronger and better targeted than those presently marketed (Facial Plast. Surg. 2009;25:285-9). Signal peptides promote the synthesis of matrix proteins, collagen in particular, which leads to firmer, younger looking skin, and also augments levels of elastin, proteoglycans, glycosaminoglycans, and fibronectin (Int. J. Cosmet. Sci. 2009;31:327-45).

Enzyme-inhibitor peptides

These peptides suppress enzymatic activity either directly or indirectly. Enzyme-inhibiting peptides extracted from soybeans have been incorporated into antiaging, moisturizing, and cleansing products as well as hair care formulations (Int. J. Cosmet. Sci. 2009;31:327-45). In a small study in 10 white females, a 2% soya biopeptide performed better than did placebo in collagen and glycosaminoglycan promotion (Int. J. Cosmet. Sci. 1999;21:299-311).

More recently, a rice peptide derived from germinated black rice, which has been used in traditional Asian medicines, was found to block MMP activity and dose-dependently stimulate hyaluronan synthase 2 gene expression (a twofold increase) in human keratinocytes (J. Microbiol. Biotechnol. 2007;17:271-9). Such peptides are found in antiaging and hair products.

In addition, antioxidant activity, a high affinity to chelate with copper, and the capacity to suppress tyrosinase activity and keratinocyte apoptosis have been displayed by the enzyme-inhibiting peptide sericin, derived from the silkworm Bombyx mori (Int. J. Cosmet. Sci. 2009;31:327-45). Sericin also has been shown to facilitate the intrinsic moisturization of skin by restoring amino acids and imparting an occlusive effect (J. Cosmet. Dermatol. 2005;4:250-7).

Neuropeptides

Neuropeptides are known to mediate skin inflammation and, thus, contribute as an underlying aspect of reactive skin conditions (Eur. J. Dermatol. 2010;20:731-7). Also known as neurotransmitter-affecting peptides, these compounds are included in cosmeceuticals to mimic the action of botulinum toxin A. Essentially, they inhibit acetylcholine release at the neuromuscular junction.

The best known of these is acetyl hexapeptide-3, marketed as Argireline. Attached to acetic acid residue, this synthetic peptide, based on the N-terminal end of the synaptosomal-associated protein (SNAP)–25 that blocks soluble N-ethylmaleimide-sensitive factor attachment protein receptor (SNARE) complex development and catecholamine release (Int. J. Cosmet. Sci. 2009;31:327-45), is thought to suppress the release of neurotransmitters, easing facial tension, and thus reducing wrinkles. Evidence of its effectiveness has appeared largely in proprietary studies. Much more research is necessary to establish the suitability of this form of peptide for topical antiaging applications.

Carrier peptides

Carrier peptides stabilize and transport trace elements essential for healing wounds and enzymatic processes (Dermatol. Ther. 2007;20:343-9). Although it also confers signal peptide effects, glycyl-L-histidyl-L-lysine (GHK), a naturally occurring tripeptide initially isolated from human plasma (Nat. New Biol. 1973;243:85-7), is known mainly as a carrier peptide. It is typically linked with copper, given its high affinity for it, and several studies have shown that copper peptide molecules using GHK (glycyl-L-histidyl-L-lysine-Cu²⁺ or GHK-Cu) deliver varied restorative effects, including the improvement in the appearance of fine lines and wrinkles (Dermatol. Ther. 2007;20:343-9). This tripeptide complex has been used for many years to accelerate wound healing and is found in several moisturizers. Significantly, the GHK-Cu complex also has been shown to stimulate collagen synthesis (FEBS Lett. 1988;238:343-6) and to augment sulfated proteoglycans levels in fibroblast cultures as well as experimental animal wound models (J. Clin. Invest. 1993;92:2368-76). GHK-Cu also influences tissue remodeling by raising the levels of MMP-2 and tissue inhibitors of metalloproteinases (TIMP-1 and TIMP-2) (Life Sci. 2000;67:2257-65). More research is necessary to ascertain the efficacy of copper peptide as an antiaging agent.

Recent general research findings

A double-blind clinical study in 2004 of 20 healthy women volunteers between 40 and 62 years of age revealed that a gel formula containing 3% of a collagen-like hexapeptide significantly reduced the total surface of wrinkles as well as the number and average depth of wrinkles (Int. J. Tissue React. 2004;26:105-11).

In 2005, a literature review of studies published on the effects and practical applications of peptides as topical agents for skin improvement showed that peptide cosmeceuticals seem to exhibit the potential to blunt the visual effects of aging on the skin, and that formulations must be stable, absorbed into the skin, and biologically active (Dermatol. Surg. 2005;31[7 Pt 2]:832-6, discussion 836).

In 2007, investigators reported on the development of a new hand care formulation derived from wool peptides. The keratin fraction from wool was shown through long-term in vivo studies to enhance cutaneous hydration, water-holding capacity, and elasticity in volunteers with dry skin. In addition, the researchers found that the keratin peptide preparation blunted some of the adverse effects due to surfactant exposure (J. Cosmet. Sci. 2007;58:99-107).

That same year, researchers reported that they prepared two stable cosmetic formulations, an emulsion with an external aqueous phase for normal-to-dry skin and a gel for oily skin, with acetyl hexapeptide-8 (Argireline) as the active ingredient (J. Cosmet. Sci. 2007;58:157-71).

Previously, Argireline was shown in healthy women volunteers, in a skin topography analysis of an oil/water (O/W) emulsion containing 10% of the hexapeptide, to have decreased wrinkle depth up to 30% after 30 days of treatment. Researchers determined that the synthetic hexapeptide significantly suppresses neurotransmitter release comparably to botulinum toxin A, with fewer side effects but lower efficacy. They also noted that Argireline displayed no in vivo oral toxicity and evoked no irritation at high doses, suggesting that the peptide is a topical nontoxic antiwrinkle alternative to botulinum toxins (Int. J. Cosmet. Sci. 2002;24:303-10).

In 2008, investigators tested a hydrolyzed keratin peptide derived from wool on skin in two different formulations. Long-term in vivo studies yielded significant differences between the control and treated sites, with the treated areas exhibiting an increase in hydration and elasticity because of keratin peptide application. The investigators also noted measurements showing that the keratin formulations supported skin barrier integrity, enhancing its water-holding capacity. In particular, the formulation combining keratin peptide with internal wool lipids in a liposome suspension showed promising effects that they deemed appropriate for new cosmetic products (Skin Res. Technol. 2008;14:243-8).

Conclusion

Peptide cosmeceuticals represent a new and popular choice for consumers shopping for antiaging products. Are they worthy options? As always, the capacity of topical products to penetrate the skin and exert a biologic impact is of great significance. Some products appear to exert antiaging effects, but most evidence of effectiveness has emerged from in vitro studies or small in vivo investigations. More research, in the form of large randomized controlled trials, is necessary to establish the effectiveness of these intriguing products. As it is, though, numerous products are on the market and this area of research and product development shows promise.

Dr. Baumann is chief executive officer of the Baumann Cosmetic & Research Institute in Miami Beach. She founded the cosmetic dermatology center at the University of Miami in 1997. Dr. Baumann wrote the textbook "Cosmetic Dermatology: Principles and Practice" (McGraw-Hill, April 2002), and a book for consumers, "The Skin Type Solution" (Bantam, 2006). She has contributed to the Cosmeceutical Critique column in Skin & Allergy News since January 2001 and joined the editorial advisory board in 2004. Dr. Baumann has received funding for clinical grants from Allergan, Aveeno, Avon Products, Galderma, Mary Kay, Medicis Pharmaceuticals, Neutrogena, Philosophy, Stiefel, Topix Pharmaceuticals, and Unilever.

Dry skin occurs throughout the year, but for many people it’s most prevalent and problematic in winter. Cold temperatures, low humidity, and strong, harsh winds deplete the skin of its natural lipid layer, which would normally help keep the skin from drying out. Skin of color in particular, can become very flaky, dry, and "ashy" in the winter. Differences in the stratum corneum barrier in skin of color may contribute to the propensity toward ashiness.

The barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss. Compared with skin in white people, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness. The epidermal barrier in darker skin has been shown to be stronger when exposed to mechanical or chemical challenge. Although the size of the individual corneocytes is the same in black and white skin, the desquamation rate in certain locations is higher in black skin. This is likely due to increased desquamatory enzyme levels such as cathepsin L2 in the lamellar granules of darker pigmented individuals leading to an ashy manifestation of the skin.

Black skin also has the highest sebum content of all ethnicities, but has the lowest ceramide level, and is thus the most susceptible to transepidermal water loss and xerosis of any ethnic group. Of note, one study has shown that the use of a certain type of fatty acid body wash or a synthetic "syndet" bar reduced ashiness.

Although no large, multiethnic group studies have been performed to examine the skin barrier physiologic properties and their relation to clinical signs of disease, these small studies do shed light on some of the ethnic variation in skin barrier function.

In clinical practice, these small variations should play a role in personalized treatment regimens for common conditions such as acne and atopic dermatitis. In my practice, black patients with acne often have high sebum content, but they cannot tolerate drying medications such as benzoyl peroxide because of their skin sensitivity and intolerance to skin drying. These patients often also present with ashy, dry skin in certain areas, and oily, acne-prone skin in other areas, leading to more complex skin care regimens. Understanding these basic concepts can help better tailor our basic skin treatments and education for skin of color patients in the winter and throughout the year.

Sources:

Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin. Cutan. Med. Surg. 2009;28:115-29.

Feng L, Hawkins S. Reduction of "ashiness" in skin of color with a lipid-rich moisturizing body wash. J. Clin. Aesthet. Dermatol. 2011;4:41-4.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to sknews@frontlinemedcom.com.

Dry skin occurs throughout the year, but for many people it’s most prevalent and problematic in winter. Cold temperatures, low humidity, and strong, harsh winds deplete the skin of its natural lipid layer, which would normally help keep the skin from drying out. Skin of color in particular, can become very flaky, dry, and "ashy" in the winter. Differences in the stratum corneum barrier in skin of color may contribute to the propensity toward ashiness.

The barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss. Compared with skin in white people, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness. The epidermal barrier in darker skin has been shown to be stronger when exposed to mechanical or chemical challenge. Although the size of the individual corneocytes is the same in black and white skin, the desquamation rate in certain locations is higher in black skin. This is likely due to increased desquamatory enzyme levels such as cathepsin L2 in the lamellar granules of darker pigmented individuals leading to an ashy manifestation of the skin.

Black skin also has the highest sebum content of all ethnicities, but has the lowest ceramide level, and is thus the most susceptible to transepidermal water loss and xerosis of any ethnic group. Of note, one study has shown that the use of a certain type of fatty acid body wash or a synthetic "syndet" bar reduced ashiness.

Although no large, multiethnic group studies have been performed to examine the skin barrier physiologic properties and their relation to clinical signs of disease, these small studies do shed light on some of the ethnic variation in skin barrier function.

In clinical practice, these small variations should play a role in personalized treatment regimens for common conditions such as acne and atopic dermatitis. In my practice, black patients with acne often have high sebum content, but they cannot tolerate drying medications such as benzoyl peroxide because of their skin sensitivity and intolerance to skin drying. These patients often also present with ashy, dry skin in certain areas, and oily, acne-prone skin in other areas, leading to more complex skin care regimens. Understanding these basic concepts can help better tailor our basic skin treatments and education for skin of color patients in the winter and throughout the year.

Sources:

Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin. Cutan. Med. Surg. 2009;28:115-29.

Feng L, Hawkins S. Reduction of "ashiness" in skin of color with a lipid-rich moisturizing body wash. J. Clin. Aesthet. Dermatol. 2011;4:41-4.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to sknews@frontlinemedcom.com.

Dry skin occurs throughout the year, but for many people it’s most prevalent and problematic in winter. Cold temperatures, low humidity, and strong, harsh winds deplete the skin of its natural lipid layer, which would normally help keep the skin from drying out. Skin of color in particular, can become very flaky, dry, and "ashy" in the winter. Differences in the stratum corneum barrier in skin of color may contribute to the propensity toward ashiness.

The barrier function of the skin depends on the structure of the corneocytes, lipid content, and transepidermal water loss. Compared with skin in white people, black skin has more corneocyte layers and a more compact stratum corneum with greater intercellular cohesiveness. The epidermal barrier in darker skin has been shown to be stronger when exposed to mechanical or chemical challenge. Although the size of the individual corneocytes is the same in black and white skin, the desquamation rate in certain locations is higher in black skin. This is likely due to increased desquamatory enzyme levels such as cathepsin L2 in the lamellar granules of darker pigmented individuals leading to an ashy manifestation of the skin.

Black skin also has the highest sebum content of all ethnicities, but has the lowest ceramide level, and is thus the most susceptible to transepidermal water loss and xerosis of any ethnic group. Of note, one study has shown that the use of a certain type of fatty acid body wash or a synthetic "syndet" bar reduced ashiness.

Although no large, multiethnic group studies have been performed to examine the skin barrier physiologic properties and their relation to clinical signs of disease, these small studies do shed light on some of the ethnic variation in skin barrier function.

In clinical practice, these small variations should play a role in personalized treatment regimens for common conditions such as acne and atopic dermatitis. In my practice, black patients with acne often have high sebum content, but they cannot tolerate drying medications such as benzoyl peroxide because of their skin sensitivity and intolerance to skin drying. These patients often also present with ashy, dry skin in certain areas, and oily, acne-prone skin in other areas, leading to more complex skin care regimens. Understanding these basic concepts can help better tailor our basic skin treatments and education for skin of color patients in the winter and throughout the year.

Sources:

Talakoub L, Wesley NO. Differences in perceptions of beauty and cosmetic procedures performed in ethnic patients. Semin. Cutan. Med. Surg. 2009;28:115-29.

Feng L, Hawkins S. Reduction of "ashiness" in skin of color with a lipid-rich moisturizing body wash. J. Clin. Aesthet. Dermatol. 2011;4:41-4.

Dr. Wesley practices dermatology in Beverly Hills, Calif. Do you have questions about treating patients with dark skin? If so, send them to sknews@frontlinemedcom.com.