The Aestheticians Journal | December 2021-January 2022 issue | E- Journal by The Aestheticians Journal

Total Pages : 36 December 2021 Vol 14* Issue 10 100

Minoxidil Induced Hypertrichosis Over Face In A 15 Year Old Girl–A Case Report Adult Onset Acne-A Multipronged Disease

Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT–DID THIS REALLY HELP? Skin Microbiome Effect of Intense Pulsed Light (IPL) Therapy for Acne

If Undelivered, return to Paradigm Infocom Pvt. Ltd. 22, 2nd floor, Shreeji Bhavan, 275-279 Samuel Street, Masjid Bunder (W), Mumbai-4000 03

EXECUTIVE EDITOR & PUBLISHER Dom Daniel

CORPORATE OFFICE 22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W), Mumbai-4000 03, INDIA.

EMAIL: theaestheticiansjournalindia@gmail.com Website: theaestheticiansjournal.com

TEL: +91 22 2345 1404 +91 22 2345 5844

Printed, Published, Edited and Owned by Dom Daniel Printed at Swastik Printer, Gala No.9 & 10, Vishal Industrial Estate, Bhandup (West), Mumbai- 400078. Published at 22 Shreeji Bhavan, 275/279, Samuel Street, Masjid Bunder (West), Mumbai - 400003. India.

Medical dermatology and recent era of cosmetic Dermatology The evolution of Cosmetic Dermatology from a grey area with questionable products and procedures has evolved to predictable safe treatments. As a result many of the young Dermatologists are opting for it. Clinical Dermatology is considered tougher as correct diagnosing and proper treatment are key to a successful practise. The current pandemic has reinforced the importance of clinical Dermatology as the main stay of a Dermatologists practise. There are a large number of Covid induced Dermatological conditions which a Dermatologists needs to be a knowledgeable of. A balanced approach is prudent with a judicious mix of investment in devices for Aesthetic Dermatology with a strong knowledge of Clinical Dermatology. This issue has articles on Minoxidil induced hypertrichosis over face, Adult onset acne-a multipronged disease, Effect of Intense Pulsed Light (IPL) therapy for acne along with a Case study on treatment for post-covid hair fall in women with Microneedling and LLLT.

“The Aestheticians Journal” takes no responsibility for unsolicited photographs or material

- Dom Daniel ALL PHOTOGRAPHS, UNLESS OTHERWISE INDICATED, ARE USED FOR ILLUSTRATIVE PURPOSE ONLY.

Executive Editor & Publisher

Views expressed in this Journal are those of the contributors and not of the publisher. Reproduction in whole or in parts of texts or photography is prohibited. Manuscripts, Photographs and art are selected at the discretion of the publisher free of charge (advertising excluded). Whether published or not, no material will be returned and remains the property of the publishing house, which may make use of it as seen fit. This may include the withdrawal of publication rights to other publishing houses.

Published for the period of December-2021

December 2021

07 Minoxidil Induced Hypertrichosis Over Face In A 15 Year Old Girl –A Case Report Dr. Pragya Nair, MD (Dermatology) Dr. Jinal Tandel, 2nd year Resident Dr. Dhruv Patel, 3rd year Resident

Minoxid il Over FaInduced Hype rtrich ce In Girl–A A 15 Year Ol osis Case Re d port Minoxid

il Induced

Hypertri

chosis

Dr. Shrut akirth

MD, DVD i D. Sheno Professo i r and Head, Departm ent of Dermato Kanachu logy, r Institute Mangalu of ru, Karnata Medical Sciences ka ,

Over Face

In A 15

Year Old

Girl –A

Case Report

Dr. Pragya

Nair MD (Derm atology) Professor and Head Departmen t of Derm Pramukhsw atology, Venereolo ami Medi gy and cal Colle Lepro ge, Kara msad, Guja sy, rat Dr.

Dr. D. Indira

Jinal Tan

del

2 year Resid Departmen ent t of Derm Pramukhsw atology, Venereolo ami Medi gy and cal Colle Lepro ge, Kara msad, Guja sy, rat nd

MD (DVL) Associa te Departm Professor ent of DVL Osmania Osmania Medical College/ Hyderab General Hospital ad

Dr. Dhruv

Patel 3 rd year Resid Departmen ent t of Derm Pramukhsw atology, Venereolo ami Medi gy and cal Colle Lepro ge, Kara msad, Guja sy, rat Abstra

Minoxidil is a periph to indiscr used iminate eral vasodi in patient lator minoxidil prescr use of 5% s of Topica topical hypert l minoxi ibed by practitioner dil solutio ension. a genera is widely for genera n (TMS) l lized hair used Key words alopec in androg loss. ia and : Minoxi enetic hair as an off dil, Hypert alopec loss label agent ia areata richosis, . Around in patient Introd s using (0-5) % uction minoxidil of by hypert are affecte richosis, d Minoxidil face caused especially is used on the hypert by local in patient ension produc transfe s of t. TMS for its r of the vasodilatory induce is more periph d hypert action. eral richosis patients, common Many concentratio both of these with higher developed hypert male and n and also the amoun female, richosis t of minoxi dependent on the basis of trying topica and this was we report dil applied patient a s l minoxi . with facial case of 15 year Here (AGA). [1] with androg dil in enetic female hypertrichosi Its topica alopec by the l use was ia s second FDA for approv ary in ed men and androgenetic alopec women ia in 1988 and Decem ber

2021

Adult Onset

Acne-A

Adult On Multipro

nged Disease

set Acne -A M Disease ultipronged Dr. Ranjan

Raval MD, DVD Professor and HOD GCS Medi cal Colle ge, Ahm edabad

10 Adult Onset Acne-A Multipronged Disease

Dr. Kalgi

MD, DNB Baxi Majmu (Dermatolo ndar Assistant gy) Professor Departmen t of Derm SVP Hosp atology ital, Ahm edabad

Dr. Ranjan C. Raval, MD, DVD Dr. Kalgi Baxi Majmundar, MD, DNB (Dermatology) 10

Acne vulgaris inflamm is a atory chronic disease piloseb Acne aceous of vulgaris, the is unit. charac conven considered terised Clinically tionally by the a diseas such teenag ers, the as comed cardinal lesions e of the adolescent pustule ones, especially s nodule popula papules, by the tion, s and genera common Howev l popula cysts, condition this acne er, based on tion. is associ multiple the age is classifi ated stigmata group, ed as. inflamm like scars, with atory hyperp post • Neona erythem tal acne igment ation and a. The (from birth weeks of this upto 4-6 etiopat of age) hogenesis seemin gly straigh condition • Infantil tforwar e acne is d multifactorial, (3-12 elucida months, manifest ted below as late may as in brief: as 16 month Endoc • Mid s) rinological childho od acne Androg (1-7 years) ens, Cortico factors: • Prepub steroid ertal acne s Enviro (7-12 years) nment • Adoles al..factors:.. cent acne .. • UV Radiat (12-19 years) Adult onset ion acne • Diet and Lifesty Adult onset le acne by • Drugs onset of definition acne after means, the age There is of 25 years. • Cosme an increas tics acne in ed adult female prevalence of • Syndro as “Adult s, also mic known onset acne of (AFA), as Female compa s” red to males. it was believe Initially, d that acne has adult a very onset with endoc high associ rinological ation abnorm alities.

10 Decemb

er 2021

Case Study

On Treatme

nt For

Case St Post-Co udy On Treatm vid Hair ent For Fall With LLLT–D Microneedl In Women ing And ID THIS REALLY HELP? Dr. Keertha Post-Cov

id Hair

Fall In

Women

With Micronee

dling And

14 Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT–DID THIS REALLY HELP?

LLLT–DID

THIS REALLY

HELP?

na Bhaska

r P. Red

Assistant dy Professor Departmen t Sciences, of Dermatolog y, Akas Bangalore. h Institute Consultant of Medi Dermatolog cal ist- Deva nahalli, Banaglore

Abstra

Dr. Keerthana Bhaskar P. Reddy, MD

Hair fall is the major afforda women issue among ble option and st covid-1 for TE are sufferin Covid-19 virus caused 9 virus survivo g from stresso 1 by rs term r. effects–sequehair fall as long Key words people : covid-1 are sufferin lae. 35% LLLT, 9, hair of Micron g from sympto loss, eedling ms long term telogen , Trichog effluviu sore throat, like fatique, ram, m, dermap malaise headac en , Introd breath, he, shortne uction mood ss of swings and major , depres hair loss. sion Hair loss and system The immun is overac can sabota thinning of hair e tive. Hair in women are deprive ge the self-co d or deplete follicle cells quality of nfidenc life. The Teloge d of nutrien n effluviu precipitating e and causes ts. m (TE) premat sequela is the possib ure termina event the anagen of covid-1 le tion 9. The study phase was to aim of and subseq of this transition to the assess of active uent the respon catage phases post-covid n and telogen se , resultin micron hair g in hair eedling In dermat using Derma fall to shedding. ology Low-le vel laser clinics pen and apparent light therapy manifestation increasingly in women . In this (LLLT) new onset has been diffuse were study a hair loss subjected 5 patient infected in covid-1 s patient to micron and LLLT eedling with tenoge s, clinically compa 9 weekly once followe topical n effluviu tible applica m. 2 d by patients, 3 tion of applica were hospita Out of 5 procap tion once il topical were treated lized and respon daily. with antibio se was Treatm tics, system ent corticosteroid assess standa s for ed based rdized infectio their COVID ic seven trichog point scale on patient n. The presen -19 ram tations and assess s sugges of these everybody ment. t that Almost infection may had an COVID Therefo be a signific -19 improv re, micron ement. of TE. TE ant trigger eedling caused with LLLT by azithro combin other medica is an excelle ed mycin tions nt and or out, and cannot be the is a source global pandem ruled ic itself of psycho social stress.

Decemb

er 2021

Skin Microbio

Skin M

icrobiom e

Dr. Treacy

18 Skin Microbiome

Pharm

aceuti

Pharmaceutic

Dr. Patrick J. Treacy MICGP, MBCAM, H. Dip Dermatology, DRCOG, DCH, LRCSI, DTM MBBCh Rebecca McMahon Medical Aesthetician, Ailesbury Clinic Dublin, and Dr Treacy Skincare Advisor

& Rebecc

MICGP, MBCAM, a McM H. Dip DRCOG, Dermatolo ahon DCH, LRCS gy, Medical Aestheticia I, DTM MBB Ch n, Ailes and Dr Treacy bury Clini Skincare c Dublin, Advisor cal Grade

d Produ

cts clinical al graded ly proven highly produc regulat scientifically ts are tested at ed and differen within the the ingredi and t concen achieve produc trations ts are require ents the optima 99% pure. to l effect. d to be important That does It is also to mainta high percen not only in proper mean a function tage of by using barrier active ingredi but also a higher macronutrien ents such as ingredients carboh quality ts ydrates of other and lipids within , protein and micron Ingredients the formula s, utrients within tion. as vitamins such a cosme and essent produc Topica ial minera l applica t are require ceutical 70% pure. tions of ls. d to be may be micron used to utrients provide protective These a healthi produc barrier, er ts are in conjun dietary delivery designed require ction with system ments. with s to allow to reach ingredients Cosm the deeper eceuti skin to cals are layers provide of the have both produc nutrien ts that cosme growth ts for tic and . These skin (medical or therapeutic also protec drug-like) ingredients effects t and can intended to and are improv provide have a e skin cells to on skin benefic functio ial health various n, hence and beauty effect skin conditi treating cosmetics, ons such . Like Pigmentation they are as acne. as creams applied , dehydr topically ageing. or lotions ation, Effectiv and active ingredi but contain ely, these cosme ents that high-quality cell ceutica influence functio l and ingredients n. The skin pharmaceutic a produc word make the describ t that a differen skin functio al es is a cross a cosme t way. n in To fully betwee tic and their impact n unders tand A cosmeceutica a pharmaceutic medica be cogniz lly, we al. l is essent ant of must skin care ially a surrounding produc the chemis t that AHAs, try biologically contain Vitamin A and active s a E, antioxi C, Vitamin is though compo dants, und that t to have and a growth range factors effects pharmaceutic of peptid on all used es, which al the to promo skin. are pharmaceutic te younge and healthi Both al and r, fresher grade er looking cosme skin care , ceutica a cockta skin. Somet l produc il of imes effect skin ts actively at a cellular and minera amino acids, vitamin cosme level, wherea ls are tic produc s, also used adjunct s ts have to protec as an term effect. a shorter t and skin. One They are revitaliz can achiev e the by doctor s to restore usually used health e proper by using skin pigmentation, pH, remove produc or restore ts that are barrier, and the skin leave skin intende the way d. nature grade

18 Decemb

er 2021

Effect

of Intense

Pulsed

Light (IPL)

Therapy

Effect of In (IPL) Thtense Pulsed Li erapy fo gh r Acne t Dr. Bhanot

h Bal

M.D. (DVL aji Naik ), FHM Assistant Professor Departmen t of DVL Governme , Governme nt nt Gene ral Hosp Consultan Medical Colle ge, Ongo ital, t Dermotolo le, Andh Ongole, gist in Sri ra Andhra Balaji Nursi Pradesh Pradesh ng Hom e,

26 Effect of Intense Pulsed Light (IPL) Therapy for Acne

Dr. B.R. Kira

MBBS ayee Fellow in Cosm etology Consultan t Cosmetolo and Aesthetics at Pune Managing gist and Laser Speci Director, Ongole, Sri Balaj alist, Andhra i Nursing Pradesh Home,

Dr. Bhanoth Balaji Naik, M.D. (DVL), FHM Dr. B.R. Kiranmayee, MBBS, Fellow in Cosmetology and Aesthetics

Abstra

26 Decemb

er 2021

December 2021

for Acne

Acne is one of effect the most is evoked disorde prevale by visible r and nt skin light that single and UV is absorb cause most comm for visit ed by on (protoporphyr porphy to a Derma Acne vulgari rins in IX, tologist. III) that coprop s is a orphyrins are produc common in adoles ed by cents and disease It is P. acnes. followe young a chronic d adults. inflamm It is reactive oxygen by generation atory diseas piloseb of species aceous e of the bacter which units. icidal effects have . These have absorp In recent porphy decade tion peaks rins s IPL 542, 578, photod at 400, ynamic acts by 630, 510, therapy photothermo and 665 nm. of acne in treatm Selecti vulgaris. lysis of ent ve P acnes vessels porphy smaller rins (protop produc blood es which supplying sebace orphyrin coprop ous glands reduce orphyrin IX and sebum III) during and prolifer produc their growth has an absorp tion. Hb ation in tion peak The use These follicula at 580 porphy of IPL offers r units. nm. rins have cover the spectru the possib an absorp m near absorp ility to tion ultravio tion peaks Hb and spectru let and m of light. of both porphy visible rins; hence, suitable tool for In acne, acne treatm it is a IPL shows ent. Keyw photod ords ynamic photo therm : P h o t o d y olysis ,pilose n a m i c , baceo us,

Editorial Board Dr. Pragya Nair

MD (Dermatology) Professor and Head Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Karamsad, Gujarat

Dr. Jinal Tandel

2nd year Resident Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Karamsad, Gujarat

Dr. Keerthana Bhaskar P. Reddy

MD Assistant Professor Department of Dermatology, Akash Institute of Medical Sciences, Bangalore. Consultant Dermatologist- Devanahalli, Banaglore

Dr. Patrick J. Treacy

MICGP, MBCAM, H. Dip Dermatology, DRCOG, DCH, LRCSI, DTM MBBCh

Dr. Dhruv Patel

3rd year Resident Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Karamsad, Gujarat

Rebecca McMahon Medical Aesthetician Ailesbury Clinic, Dublin

Dr. Bhanoth Balaji Naik Dr. Ranjan C. Raval MD, DVD Professor and HOD GCS Medical College, Ahmedabad

M.D. (DVL), FHM Assistant Professor Department of DVL, Government General Hospital, Government Medical College, Ongole, Andhra Pradesh Consultant Dermotologist in Sri Balaji Nursing Home, Ongole, Andhra Pradesh

Dr. B.R. Kiranmayee Dr. Kalgi Baxi Majmundar MD, DNB (Dermatology) Assistant Professor Department of Dermatology SVP Hospital, Ahmedabad

MBBS Fellow in Cosmetology and Aesthetics at Pune Consultant Cosmetologist and Laser Specialist, Managing Director, Sri Balaji Nursing Home, Ongole, Andhra Pradesh

December 2021

Minoxidil Induced Hypertrichosis Over Face In A 15 Year Old Girl –A Case Report

Minoxidil Induced Hypertrichosis Over Face In A 15 Year Old Girl– A Case Report Dr. Pragya Nair

MD (Dermatology) Professor and Head Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Karamsad, Gujarat

Dr. Jinal Tandel

2nd year Resident Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Karamsad, Gujarat

Dr. Dhruv Patel

3rd year Resident Department of Dermatology, Venereology and Leprosy, Pramukhswami Medical College, Karamsad, Gujarat

Abstract Minoxidil is a peripheral vasodilator used in patients of hypertension. Topical minoxidil solution (TMS) is widely used in androgenetic alopecia and as an off label agent in alopecia areata. Around (0-5) % of patients using minoxidil are affected by hypertrichosis, especially on the face caused by local transfer of the product. TMS induced hypertrichosis is more common with higher concentration and also dependent on the amount of minoxidil applied. Here we report a case of 15 year female with facial hypertrichosis secondary 6

December 2021

to indiscriminate use of 5% topical minoxidil prescribed by a general practitioner for generalized hair loss. Key words: Minoxidil, Hypertrichosis, hair loss Introduction Minoxidil is used in patients of hypertension for its peripheral vasodilatory action. Many of these patients, both male and female, developed hypertrichosis and this was the basis of trying topical minoxidil in patients with androgenetic alopecia (AGA).[1] Its topical use was approved by the FDA for androgenetic alopecia in men and women in 1988 and

Minoxidil Induced Hypertrichosis Over Face In A 15 Year Old Girl –A Case Report

1992 respectively.[2] Topical minoxidil induced hypertrichosis is not an uncommon occurrence and has been reported essentially near the areas of application mainly over the face and especially the temple and the preauricular region.[3] But, generalized hypertrichosis, is rare and has been described mainly in children and adolescents.[4] Here we report an young girl who developed facial hypertrichosis after use of topical minoxidil for generalized hair loss. Case Report A 15 year girl presented to dermatology department with complaints of excess facial hair since 20 days. Patient was applying topical minoxidil 5% over the scalp for generalized hair loss and topical clindamycin-adapalene combination for acne over the face prescribed by a general practitioner, since almost 2 months. She was weighing 37 Kg and her height was 150cm. She has used 5 bottles of 60 ml 5% minoxidil. She was applying random and variable amount of minoxidil twice a day over the scalp. There was history of dribbling of solution over areas of face while applying it over scalp. There was no history of any major illness in the past. No similar complaints in the family members were present. She attained menarche at the age of 12 years and her cycles were regular (3-4 days/28 days) without pain and clots. After 1 month of treatment she gives history of developing facial hairs which gradually darkened and thickened. She also had complaint of increase in density of eyebrows and gradual lengthening. On examination, terminal hairs were seen covering forehead, chin, upper lip. [Figure-1] and bilateral cheeks. [Figure-2a,&2b] Synophrys was seen. She was adviced for undertaking hormonal assays to rule out hirsutism but she did not consent. She was advised to stop minoxidil application and was kept on regular follow-up. After withdrawal of minoxidil 5% solution there was remarkable decrease in facial hair.

not fully understood, possible mechanisms by which minoxidil causes hair growth include agonistic affects on adenosine-triphosphate (ATP)-sensitive potassium channels, increased duration of the anagen growth phase, prostaglandin stimulation in the dermal papillae, its action on vasculature or on the follicle cell DNA synthesis.[5,6]

Figure..1:..Hypertrichosis..over forehead, upper lip, chin and cheeks with Synophrys

There are reports of hypertrichosis in children and newborn due to oral administration of minoxidil in child or in the mother during pregnancy respectively.[6] Topical minoxidil can also cause hypertrichosis usually localized to the face, but may occasionally involve limbs and other body areas.[7] Around (0-5) % of patients receiving TMS (topical minoxidil solution) are affected by hypertrichosis especially on the face and is caused by local transfer of the product. TMS induced hypertrichosis is more common with higher concentration and also dependent on the amount applied.[3,8] Systemic absorption of topically applied minoxidil is minimal and is about 1.4%.[9] In cases of generalized hypertrichosis, it is proposed that, there is increased sensitivity of the follicular apparatus which might be responsible for the widespread growth of hair.[6] However, absorption varies among individuals, which explains the reports of tachycardia and palpitations with topical use of minoxidil, suggesting that it can reach high concentrations in plasma, especially in children.[5]

Figure 2: Terminal hairs seen over forehead, cheek a) On left side of the face b) On right side of the face Discussion Topical minoxidil is widely used for androgenetic alopecia, however offlabel uses include alopecia areata in both adults and children. Though

Dawber and Rundegren in their study on facial hair growth and hypertrichosis as separate entities using 5% and 2% TMS compared with placebo observed more cases of hypertrichosis in the group treated with 5% TMS, more common in women, especially >50 years of age and those who had facial hair before starting the treatment.[8] Individuals of Mediterranean, Hispanic, and Middle December 2021

Minoxidil Induced Hypertrichosis Over Face In A 15 Year Old Girl –A Case Report

Eastern ethnicity more often have facial hair.[10] In their study, minoxidil was not detected in blood in any of the reported cases. Therefore, hypertrichosis at distant sites in sensitive individuals could have been an idiosynchratic reaction resulting from hypersensitivity of the follicles to minoxidil.[8] In the cases reported in the literature, hypertrichosis usually appears 2 to 3 months after starting treatment and disappears 1 to 5 months after discontinuation.[10] In contrast, in our case hypertrichosis appeared earlier, with in 1 month of starting the treatment. There are reported cases of generalized hypertrichosis following topical application of minoxidil and corticosteroid.[4,10] But in our case, patient was using topical minoxidil alone, the clinical picture resulted mainly from indiscriminate use of minoxidil. Increased susceptibility of the hair follicle to minoxidil might also have played a role. Minoxidil induced hypertrichosis usually responds after stopping minoxidil. Minoxidil should be used only for the approved indications like androgenetic alopecia and alopecia areata. Physician also should explain the patient about the proper method of usage of minoxidil, amount to be used, avoid dribbling of solution and importance of regular follow up to decrease the incidence of hypertrichosis. Before prescribing topical minoxidil, treating physicians should take full clinical history and thorough clinical examination should be done to assess the risk of hypertrichosis and in such cases, lower concentrations of minoxidil or other alternative therapies should be used. Avoidance of use of other drugs which aggravate hypertrichosis like topical corticosteroids should be avoided in patients who are prone for hypertrichosis. Patients of generalized hair loss should be properly 8

December 2021

evaluated and treated accordingly. Indiscriminate use of minoxidil for generalised hair loss should be avoided by physicians. References 1. Yesudian P. Serendipity in Trichology. Int J Trichol 2011;3:1-2. 2. Rogers NE, Avram MR. Medical treatments for male and female pattern hair loss. J Am AcadDermatol. 2008;59:547-66. 3. Lucky AW, Piacquadio DJ, Ditre CM, Dunlap F, Kantor I, Pandya AG, et al. A randomized, placebo-controlled trial of 5% and 2% topical minoxidil solutions in the treatment of female pattern hair loss. J Am AcadDermatol. 2004;50:541-53. 4. Chellini PR, Pirmez R, Raso P, Sodré CT. Generalized hypertrichosis induced by topical Minoxidil in an adult woman. Int J Trichol 2015;7:182-3. 5. Rampon G, Henkin C, Souza PRM, de Almeida Jr HL. Infantile generalized hypertrichosis with topical minoxidil. An Bras Dermatol 2016;91:87-8. 6. Herskovitz I, Freedman J, Tosti A. Minoxidil induced hypertrichosis in a 2 year-old child. F1000Res 2013;2:226. 7. Peluso AM, Misciali C, Vincenzi C, et

al.:

Diffuse

hypertrichosis

during

treatment with 5% topical minoxidil. Br J Dermatol1997;136:118–20. 8. Dawber RP, Rundegren J. Hypertrichosis in

females

solution

applying

and

minoxidil

normal

topical

controls.

EurAcadDermatolVenereol 2003;17:271-5. 9.

Verma

SB.

Minoxidil-induced

hypertrichosis in a 4-year-old child. Indian J DermatolVenereolLeprol 2016;82:304-5. 10. Gargallo V, Gutierrez C, Vanaclocha F, Guerra-Tapia A. Hipertricosis generalizada secundaria

minoxidil

tópico.

Dermosifiliogr 2015;106:599-600.

Actas

Adult Onset Acne-A Multipronged Disease

Adult Onset AcneA Multipronged Disease Dr. Ranjan C. Raval

MD, DVD Professor and HOD GCS Medical College, Ahmedabad

Dr. Kalgi Baxi Majmundar MD, DNB (Dermatology) Assistant Professor Department of Dermatology SVP Hospital, Ahmedabad

Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit. Clinically characterised by the cardinal lesions such as comedones, papules, pustules nodules and cysts, this common condition is associated with multiple stigmata like scars, post inflammatory hyperpigmentation and erythema. The etiopathogenesis of this seemingly straightforward condition is multifactorial, as elucidated below in brief: Endocrinological factors: Androgens, Corticosteroids

Acne vulgaris, conventionally is considered a disease of the teenagers, the adolescent population, especially by the general population. However, based on the age group, acne is classified as. • Neonatal acne (from birth upto 4-6 weeks of age) • Infantile acne (3-12 months, may manifest as late as 16 months) • Mid childhood acne (1-7 years) • Prepubertal acne (7-12 years) • Adolescent acne (12-19 years)

Environmental..factors:....

Adult onset acne

• UV Radiation

Adult onset acne by definition means, onset of acne after the age of 25 years. There is an increased prevalence of acne in adult females, also known as “Adult onset acne of Females” (AFA), as compared to males. Initially, it was believed that adult onset acne has a very high association with endocrinological abnormalities.

• Diet and Lifestyle • Drugs • Cosmetics • Syndromic

December 2021

Adult Onset Acne-A Multipronged Disease

Contrary to this earlier belief, recent studies indicate that majority of females presenting with adult onset acne, are in fact normoandrogenic without any major endocrinological abnormality. Such patients tend to have a history of acne in adolescence as well. However, that said, for any adult female presenting with acne, it is considered prudent to rule out associated endocrinological abnormality in adult onset acne. Clinically adult onset acne, with a predominant mandibular distribution with papulopustular and nodular lesions is considered as a sign of underlying endocrinological abnormality. Associated dermatological conditions which further indicate an underlying hormonal abnormality include presence of hirsutism, patterned hair loss, and acanthosis nigricans. Premenstrual flares are commonly noted, but only ~20% of women with acne have irregular menses. Up to 30% of those in the latter group have other signs of hyperandrogenism. A small distinct subset of adult onset comedonal acne has been observed in smokers. Psychological distress and clinical depression are often found to be associated with adult onset acne, even when the lesions are mild. Endocrinological abnormalities associated with Adult onset acne Polycystic ovarian syndrome PCOS is diagnosed according to the Rotterdam criteria - Two of the following must be present: • Overt symptoms of androgen excess (hirsutism, acne and/or alopecia). • Ovulatory dysfunction (irregular or prolonged menstrual cycles). 10

December 2021

• Polycystic ovaries. Using the Rotterdam criteria, between 5 and 10% of adult women are classified as having the syndrome. PCOS almost certainly encompasses a spectrum of related ovarian endocrinopathies. Women with PCOS are frequently but not always overweight, have one or more raised serum androgen levels or a raised free androgen index and are insulin resistant, all of which predispose to acne. Adult women with PCOS often have other signs of peripheral hyperandrogenism including androgenic alopecia and hirsutism. SAHA syndrome: Seborrhoea, Androgenetic alopecia, Hirsutism, Acne-Can be ovarian, adrenal, hyperprolactinemic, idiopathic. HAIR-AN syndrome: Subset of SAHA syndrome with insulin resistance. Late onset Non classical congenital adrenal hyperplasia.

suggestive of PCOD, these values are very much higher, elevated above 200 ng/ml in case of hormone secreting tumours and are associated with sudden onset and severe hirsutism. An elevation in the range of 150-200 ng/ml is seen in Congenital Adrenal hyperplasia. Serum prolactin: may or may not be elevated. Antimullerian Hormone: Higher levels associated with PCOD and persistent acne. For adrenal cause Raised DHEA-S levels (4000-8000 ng/ ml)-Non classical Congenital Adrenal hyperplasia;>8000 for androgen secreting tumours. 17-OH Progesterone levels-Normal or raised in case of CAH; significantly raised in cases of late onset. Serum testosterone: 150-200 ng/ ml in cases of CAH. ACTH stimulation test-gold standard for NCAH.

Most of these syndromes have onset in adolescence.

Dexamethasone suppression test, serum and urinary cortisol levels -fod Cushing syndrome

Other systemic associations include

B) Metabolic profile

Androgen secreting tumours

For ruling out insulin resistance

Acromegaly

Fasting and post prandial blood sugar

Prolactin secreting tumours

Fasting insulin

Approach to adult onset acne

Insulin/glucose ratio

Investigations are usually aimed at assessing the hormonal and metabolic profile in cases of adult onset acne.

Lipid profile

A) Hormonal profile: should ideally be performed non day 1-3 of menstrual cycle For ovarian causes Serum LH/FSH ratio: A ratio higher than 2:1 is suggestive of PCOD Serum testosterone >150 ng/ml-

Others: serum electrolytes for CAH and androgen secreting tumours Radiological investigations USG abdomen pelvis for ovaries: presence of more than 12 follicles of size 2-9 mm and volume >10 mm3 arranged peripherally is considered diagnostic for PCOD, as per the Rotterdam criteria.

Adult Onset Acne-A Multipronged Disease

The NIH criteria, however does not include polycystic ovaries as a diagnostic criterion. Other imaging findings include ambiguous genitalia in CAH, CT scan thorax and abdomen for androgen secreting tumours. Management The approach to management of adult onset acne should be based on the etiology. For mild cases not associated with underlying hormonal abnormality, the management remains the same as adolescent acne including topical retinoids, topical benzyl peroxide, topical and systemic antibiotics. However it has been generally observed that adult onset acne are usually treatment resistant, and exhibit a subnormal response to tetracycline antibiotics as compared to the adolescent counterpart. Low dose systemic isotretinoin (0.5-1 mg/kg) has shown promising results. Hormonal therapy Summarized in the table below: Table 1: Hormonal therapy

Table adapted from Fourth Edition “Dermatology” by Jean Bolognia.

Other approaches that can be tried

associated with this condition, thus

include chemical peeling agents, low

leading to significant improvement in

dose blue light therapy.

the quality of life.

In summary, adult onset acne is a

References

multifaceted disease requiring a case

1. Kaur S, Verma P, Sangwan A, Dayal S, Jain V. Etiopathogenesis and therapeutic approach to adult onset acne. Indian journal of dermatology. 2016 Jul 1;61(4).

to case based therapeutic approach. Timely

and

appropriate

therapy

can prevent the local complications associated with acne, as well as

3. “Dermatology”by edition

Jean

Bolognia,4th

2. Rooks textbook of Dermatology,9th edition

reduce the psychosocial morbidity December 2021

NEWS

Mechanism behind ineffective psoriasis drugs identified Psoriasis is a chronic inflammatory autoimmune disease that manifests as red, scaly skin patches. It is caused by an overactive immune system. Beyond the physical dimensions of disease, psoriasis has an extensive emotional and psychosocial effect on patients, affecting social functioning and interpersonal relationships.There is no causal treatment for the disease, but the symptoms can be significantly alleviated with modern therapies. Complex changes in the networks of immune cells and the messengers they use to communicate with each other are responsible for the development of the skin disease. Interleukin-12, a messenger molecule of immune cells, was long considered to trigger the development of psoriasis. Now, researchers have shown that interleukin-12 does not actually cause the skin disease but protects against it. This also explains why common psoriasis drugs that block the messenger show insufficient treatment efficacy.Clinical trials revealed that newly developed drugs blocking only the messenger interleukin-23 are more effective than previous treatments targeting both interleukin-23 and interleukin-12 in psoriasis patients. The responsible mechanism has so far remained unknown. Now, researchers have uncovered the underlying molecular mechanisms.The research teams of immunology have systematically investigated the function of interleukin-12 in psoriasis. They show that the messenger does not contribute to the disease on the contrary, it protects against it. These results surprised us, because so far drugs for the treatment of psoriasis also aim at blocking interleukin-12. Detailed studies in mice and with human tissue now show that various cell types in the skin are also equipped with receptors for interleukin-12. Not only the T cells of the immune system, but also keratinocytes, horn-forming skin cells that build up the epidermis, can thus recognize the messenger. In fact, the recognition of interleukin-12 by these skin cells was responsible for the protective effect of the messenger, as the researchers found out. Interleukin-12 is essential for the normal, physiological function of keratinocytes. For example, it prevents the increased cell division observed in psoriasis. Their findings indicate that blocking interleukin-12 is not advisable, and such drugs should therefore no longer be used to treat psoriasis patients. Accordingly, psoriasis drugs should only block the messenger substance interleukin-23, but no longer interleukin-23 and -12 together.

Critical role of mechanosensor in skin wound healing The skin, the largest organ of the body, protects against external insults while also enabling touch sensation. Wounding of the skin interferes with these functions and exposes the body to an increased risk of infection, disease and scar formation. During wound healing, keratinocytes, the most abundant cell type in the topmost layer of the skin, move inward from the edges of the wound to close the wound gap. This helps to restore the skin barrier, re-establishing the skin's protective function. According to recently published study shows PIEZO1, an ion channel mechanosensor found within cells, has been revealed to play a key role in regulating the speed of skin wound healing. Researchers found that in mice lacking the ion channel protein PIEZO1 in keratinocytes, skin wounds heal faster than in mice with increased PIEZO1 function in keratinocytes. Their collaborators observed that in mice with reduced PIEZO1, wound healing is faster. They wanted to determine the 'how', 'when' and 'where' of PIEZO1's involvement, in order to find potential treatments that might speed healing.For this, their lab developed new approaches to visualize PIEZO1 while wound healing is taking place in vitro.PIEZO1 is among a number of other proteins that are able to sense mechanical cues and provide instructions on the actions the cell should take. Previous research suggested that mechanosensors are instrumental in wound closure, however the specific mechanosensor involved, was unknown. This was the first study in which the role of PIEZO1 in wound healing was investigated. Earlier studies in the field showed that mechanical cues regulate keratinocyte migration during wound healing. Here, they show that in keratinocytes, PIEZO1 is, in fact, acting as the mechanosensor that processes such cues to regulate the speed of wound healing.Surprisingly; they found that PIEZO1 accumulates at the wound edge and inhibits healing. The findings from this study provide an understanding of how skin wound healing occurs and have the potential to guide research into new wound healing treatments. However, more research needs to be performed to

December 2021

Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT–DID THIS REALLY HELP?

Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT– DID THIS REALLY HELP? Dr. Keerthana Bhaskar P. Reddy

MD Assistant Professor Department of Dermatology, Akash Institute of Medical Sciences, Bangalore. Consultant Dermatologist- Devanahalli, Banaglore Abstract Hair fall is the major issue amongst women and Covid-19 virus survivors are suffering from hair fall as long term effects–sequelae. 35% of people are suffering from long term symptoms like fatique, malaise, sore throat, headache, shortness of breath, mood swings, depression and major hair loss. The immune system is overactive. Hair follicle cells are deprived or depleted of nutrients. Telogen effluvium (TE) is the possible sequela of covid-19. The aim of this study was to assess the response of active post-covid hair fall to microneedling using Dermapen and Low-level laser light therapy (LLLT) in women. In this study 5 patients were subjected to microneedling and LLLT weekly once followed by topical application of procapil topical application once daily. Treatment response was assessed based on standardized seven point scale and trichogram assessment. Almost everybody had an improvement. Therefore, microneedling combined with LLLT is an excellent and

affordable option for TE caused by covid-19 virus stressor.1 Key words : covid-19, hair loss, LLLT, Microneedling, Trichogram, telogen effluvium, dermapen Introduction Hair loss and thinning of hair in women can sabotage the self-confidence and quality of life. The precipitating event causes premature termination of the anagen phase and subsequent transition to the catagen and telogen phases, resulting in hair shedding. In dermatology clinics increasingly apparent manifestation has been a new onset diffuse hair loss in covid-19 infected patients, clinically compatible with tenogen effluvium.2 Out of 5 patients, 3 were hospitalized and were treated with antibiotics, systemic corticosteroids for their COVID-19 infection. The presentations of these patients suggest that COVID-19 infection may be a significant trigger of TE. TE caused by azithromycin or other medications cannot be ruled out, and the global pandemic itself is a source of psychosocial stress. December 2021

Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT–DID THIS REALLY HELP?

Further studies will be needed to understand the long-term prevalence and prognosis of TE associated with COVID-19 infection. Proinflammatory cytokines are released and anticoagulation mechanisms are impaired, which may provoke TE via the systemic inflammatory response and/or microthrombi in the hair follicles. In dermatology clinics increasingly apparent manifestation has been a new onset diffuse hair loss in covid-19 infected patients, clinically compatible with tenogen effluvium. The patients are all female with no history of hair loss. Material and methods The study included patients willing for minimally invasive procedures as hair fall treatment and following criteria was included: • Patients healed from corona virus and suffering from hair loss from april 2021 to july 2021 were considered. • History of abrupt, excessive, alarming, diffuse, generalized shedding from a normal looking head. • The patients were all female with history of hair loss, from age of 20 to 45. • They all experienced excessive hair loss within weeks to months after being tested negative for corona virus. • Blood tests like TSH, CBC were made. • Hair pull test at all sites of scalp. Exclusion criteria • Uncooperative for the procedure. • Unwilling for regular follow up. • Pregnant women. • Patients with history of frequent headache. 14

December 2021

• Patients with expectations.

unrealistic

• Absence of widening of central parting. •

Absence of any other underlying cause for chronic diffuse hair loss except for post covid recovery.

Selection of patient was done who could come for regular follow-up and thus included in the study after taking the written and informed consent to start the procedure. Selected patients for this study showed • Strongly positive hair pull test. • Miniaturization of hairs • Trichogram with reduction anagen:telogen ratio.

• Video dermoscopy shows short tip-pointed regrowing hair. Discussion Hair is a protein filament that grows from follicles found in the dermis, or skin. It is one of the defining characteristics of the mammals, composed primarily of hard fibrous proteins (88%) known as Keratin. Telogen effluvium (TE) is characterized by diffuse hair shedding 2-3 months after a stressor, and COVID-19 infection is potentially one such stressor. Excessive shedding of normal club hair (telogen hairs). The most common cause of diffuse hair loss in females. It can be Acute telogen effluvium-Telogen effluvium (TE) of less than 6 months and Chronic telogen effluvium characterized by Chronic diffuse loss persisting beyond 6 months. Various causes of telogem effluvium are Physiological conditions like Post partum effluvium, Physiological effluvium of newborn, Early stage of androgenic alopecia; Physical or Emotional stress like Infections (malaria, typhoid) Malnutrition, Hypo

and hyperthyroidism, Iron deficiency, Surgical procedures, Chronic illness (syphilis, SLE, hepatic and renal failure) and Drugs like Oral retinoids (etretinate, acitretinate), OCP’s, HRT, Anti-thyroids, anti-coagulants, Beta blockers. Patients who were infected with the virus were under immense psychosocial and physiologic stress. In a person with high fever brain reroutes resources to vital functions and hair follicle gets fewer nutrients. Abrupt onset, rapid diffuse generalized shedding of hairs seen 2-3 months after a triggering event. 100-1000 hairs/day may be lost. Usually anagen phase can last several years. 80-90% hairs are in this phase. Telogen phase is a resting phase where 10-20% of hair follicles are in this phase at a time. Trichoscopy Trichoscopy is the term coined for dermoscopic imaging of the scalp and hair. This novel diagnostic technique, both simple and non-invasive, can be used as a handy bed side tool for diagnosing common hair and scalp disorders.3 Dermoscopy of normal healthy scalp shows follicular units containing 2-4 terminal hairs and 1 or 2 vellus hairs. In our study we made use of trichoscopy to assess thinning and density of hair follicle in patiwnts with post-covid hair fall. Microneedling Microneedling is a simple officebased procedure lasting 10 to 20 minutes depending on the area to be treated. The patients must be counselled prior to the procedure explaining the expected outcomes, delayed response, and need for multiple sittings.2 This can be done through dermaroller or by using dermapen.4,5

In Premature Greying of Hair New

Revgrey

Solution

Helps to stimulate natural hair pigmentation and REVERSE THE GREY HAIR

HAIR PIGMENTATION a-MSH biomimetic tetrapeptide

Euk 134

Super Anti-oxidant

Amisol Trio

Cuticle Repair & Conditioning Agent

30% Reduction in Grey Hair density

after 3 months of treatment*

December 2021 *Ref.: IFF Lucasmeyer cosmetics, Greyverse technical file; in vivo study; 15 caucasian men (18-35 years old, grey hair >20%)

APEXSKIN Revgrey Aestheticians Journal Advt / Dec 2021

Greyverse

(Image analysis)

Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT–DID THIS REALLY HELP?

Dermaroller

•

Dermaroller is a hand held device with many small surgical needles which are attached to a wheel, when rolled over the skin, cause microscopic wounds. Dermapen Dermapen [Figure 5] is an automated microneedling device which looks like a pen. This device makes use of disposable needles and guides to adjust needle length for fractional mechanical resurfacing. The tip has about 12 needles arranged in rows. It makes use of a rechargeable battery to operate in two modes, namely, the high speed mode (700 cycles/ min) and the low speed mode (412 cycles/min) in a vibrating stamp-like manner. 2 It has the advantage of being reusable in different patients as the needles are disposable, safe as the needle tips are hidden inside the guide, and more convenient to treat. It can also be used in narrow areas such as the nose, around the eyes and lips without damaging the adjoining skin. It makes the procedure less painful and more economical as there is no need to buy a new instrument every time.6 This device helps trigger the body’s wound healing response. Wound healing can stimulate the production of proteins that are responsible for the development of the new hair follicle.This then stimulates the blood circulation for the follicles to encourage hair growth. This technology has been designed to overcome the issues of varying pressure application and the subsequent depth of penetration achieved.7 Advantages of dermapen

Can be perfomed without using topical anesthesia.

Hair thinning and reduced central hair density.

LLLT Low powered (cold) lasers generate laser light which provides light energy to all the hair roots which accelerates or triggers the hair growth. It was found in mice mold in 1960 as paradoxical hypertrichosis to differeng wavelength (red light). Mechanism of action 1) Increasing growth factor production in the hair follicles by stimulating the cytochrome oxidase production. 2) Improves cellular level respiration. 3) Increases ATP production.

Figure 1: Picture showing widening of the central partition and scalp visibility due to loss of hair in young female

4) LLLT works by increasing blood flow to the scalp and hair follicles, encouraging hair volume and healthier looking hair. Advantages of LLLT • Safe and effective • Low cost • Affordable • No huge time commitment • Triggers hair growth • It can be used as an additive or alternative to standard treatment

Figure 2 : Trichoscopy showed reduction in hair density without any other pathological findings.

• It also helps to increase density and hair growth Results Interesting outcomes represented by a hair density increase of 27-45 ± 5 hairs/cm2 were observed using computerized trichograms.

• There is no downtime and the patient can resume daily work the very next day. • Minimally invasive and painless. • Stamp pressure can be adjusted. 16

December 2021

Figure 3 : Trichoscopy showed increase in hair density after multiple sessions of microneedling and LLLT

Case Study On Treatment For Post-Covid Hair Fall In Women With Microneedling And LLLT–DID THIS REALLY HELP?

Conclusion There is a hint of direct viral damage to hair follicle in Covid-19 TE. In this small group of study almost every body had an improvement. Therefore, microneedling combined with LLLT is an excellent and affordable option for TE caused by covid-19 virus stressor. These procedures should be considered along with existing therapeutic modalities for better patient compliance and faster hair fall control. Figure 4: LASER CAP

7. Camirand A, Doucet J. Needle dermabrasion. AesthetPlastSurg 1997;21:48-51.

Financial support and sponsorship Nil

Conflicts of interest There are no conflicts of interest. References 1. Olds H, Liu J, Luk K, Lim HW, Ozog D, Rambhatla PV. Telogen effluvium associated with COVID-19 infection. DermatolTher. 2021;34(2):e14761. doi:10.1111/dth.14761.

Figure 5A: Dermapen

2. Arora S, Gupta BP. Automated microneedling device–A new tool in dermatologist's kit–A review. J Pak Med Assoc 2012;22:354-7. 3. Jain N, Doshi B, Khopkar U. Trichoscopy in alopecias: Diagnosis simplified. Int J Trichol 2013;5:170-8. 4. McCrudden MT, McAlister E, Courtenay AJ, GonzálezVázquez P, Singh TR, Donnelly RF. Microneedle applications in improving skin appearance. ExpDermatol 2015;24:561-6.

Figure 5B : Image showing performing microneedling using derma pen

5. Singh A, Yadav S. Microneedling: Advances and widening horizons. Indian Dermatol Online J 2016;7:24454. 6. Lewis W. Is microneedling really the next big thing? Wendy Lewis explores the buzz surrounding skin needling. PlastSurgPract 2014;7:24-8.

December 2021

Skin Microbiome

Skin Microbiome Dr. Patrick J. Treacy

MICGP, MBCAM, H. Dip Dermatology, DRCOG, DCH, LRCSI, DTM MBBCh

Rebecca McMahon Medical Aesthetician Ailesbury Clinic, Dublin

Pharmaceutical Graded Products Pharmaceutical graded products are highly regulated and the ingredients within the products are required to be 99% pure. That does not only mean a high percentage of active ingredients but also a higher quality of other ingredients within the formulation. Ingredients within a cosmeceutical grade product are required to be 70% pure. These products are designed with delivery systems to allow ingredients to reach the deeper layers of the skin to provide nutrients for skin growth. These ingredients can also protect and provide cells to improve skin function, hence treating various skin conditions such as acne. Pigmentation, dehydration, and ageing. Effectively, these high-quality cosmeceutical and pharmaceutical ingredients make the skin function in a different way. To fully understand their impact medically, we must be cognizant of the chemistry surrounding AHAs, Vitamin C, Vitamin A and E, antioxidants, growth factors and a range of peptides, which are all used to promote younger, fresher, and healthier looking skin. Sometimes a cocktail of amino acids, vitamins, and minerals are also used as an adjunct to protect and revitalize the skin. One can achieve proper skin health by using products that are 18

December 2021

clinically proven scientifically and tested at different concentrations to achieve the optimal effect. It is also important to maintain proper barrier function by using macronutrients such as carbohydrates, proteins, and lipids and micronutrients such as vitamins and essential minerals. Topical applications of micronutrients may be used to provide a healthier protective barrier, in conjunction with dietary requirements. Cosmeceuticals are products that have both cosmetic and therapeutic (medical or drug-like) effects and are intended to have a beneficial effect on skin health and beauty. Like cosmetics, they are applied topically as creams or lotions but contain active ingredients that influence skin cell function. The word describes a product that is a cross between a cosmetic and a pharmaceutical. A cosmeceutical is essentially a skin care product that contains a biologically active compound that is thought to have pharmaceutical effects on the skin. Both pharmaceutical and cosmeceutical grade skin care products actively effect skin at a cellular level, whereas cosmetic products have a shorter term effect. They are usually used by doctors to restore pH, remove pigmentation, or restore the skin barrier, and leave skin the way nature intended.

Skin Microbiome

Figure :1- Structure of the skin and cosmeceutical active function Types of Cosmeceutical

powerhouse of active ingredients

sensitized skin, pigmented and sun

Ingredients

within

regimen.

damaged skin, acne/oily skin, loss of

require. This is mainly seen in

tone and elasticity, loss of volume as

• Anti-Oxidant

cosmeceutical

reduced keratinocyte and fibroblast

well as superficial lines and wrinkles to

• Anti-Inflammatory

production, leading to decreased

encourage rapid cellular turnover that

• Ascorbic Acid

barrier function and stem cell activity,

will renew and re-texturize the skin.

• Defensin

wound healing.

as well as slow keratinisation and

When

targeting

concerns,

the

above

cosmeceuticals

skin

should

• DNA Repair Enzymes

Peptides composed of chains of

improve skin rejuvenation, increase

• Growth Factors

amino

their

the firmness and the elasticity of skin,

structure, and transport nutrients

as well as improve skin complexion,

and signal messengers to other cells.

and

When amino acids link together, they

wrinkles. They also revive dull, tired

form chains called peptides – when

looking skin, improve skin tone and

peptides form longer chains of amino

elasticity, especially in the face, neck,

acids, they become the building

and décolletage area. It is important

blocks of proteins. Proteins make up

to note that the producers of modern

much of the body’s tissues, organs,

top-level skin care are now looking

and skin, one of the most important

at the use of plant technology, fruit-

skin proteins in collagen. 75% of our

based products and extracts as

skin is made up of collagen protein.

well as marine based formulations,

• Heparin Sulphate • Hyaluronic Acid • Niacinamide • Peptides • Retinoids • Stem Cells Facial of

aging

many

consequence

interacting intrinsic and

acids

give

proteins

extrinsic factors. The most important

Cosmeceuticals

must

also

of these include sun exposure, or

scientifically verify the claims stated

photoaging and the intrinsic changes

on their packaging; hence it is

associated with chronological aging.

accepted that these formulations are

Many skin functions deteriorate with

backed by science, clinical studies,

time and as time goes by the cellular

and rigorous testing. The main areas

activity of the skin begins to slow

of concerns that these formulations

down, which is why we need the

address are ageing skin, sensitive/

prevention

and

improve

these innovative formulations will give products an organic, green, healthy feel while still being performance driven.

The

aesthetic

industry

thrives on innovation and thanks to increased curiosity among men and women of all ages about what exactly goes into our skincare products as we December 2021

Skin Microbiome

look for cleaner scientifically proven plant-based technology that is result driven. To train your skin and achieve skin health your cellular function requires a good workout, and your skin will feel it through desquamation, a gentle tingle and occasionally some patients may experience some redness, but this does not last for long. Change is simply happening to your skin. It is normal and part of the restorative powers of the skincare products that contain highly active ingredients to

create

performance

driven

formulations. Always follow the advice of your skin care professional and start your cosmeceutical skin care regimen slowly. Key Cosmeceutical Ingredients Below key

brief

outline

ingredients

included in

acids

have

become

increasingly

popular in recent years. Skin care products

with

acids

with

help

alpha-hydroxy fine

lines

and

wrinkles, irregular pigmentation, sun damage, oil control, desquamation while also helping to shrink enlarged pores. Side effects of alpha-hydroxy acids include mild irritation and sun sensitivity. To avoid susceptibility to the sun, sunscreen should be applied in the morning. To help avoid skin irritation, start with a product with a maximum concentration of 10% to 15% AHA. To allow your skin to get used to alpha-hydroxy acids, you should initially apply the skin care product every other day, gradually December 2021

used

hyperpigmentation,

age

spots

and

dark

to such

spots

related to pregnancy or hormone therapy (melasma

likely to cause any irritation resulting

Your doctor can also prescribe a

in them being better option for those

cream with a higher concentration

with rosacea, sensitive and reactive

skin types. PHA’s are chemical

does

exfoliants – The most common being

counter treatments. Hydroquinone

Gluconolactone,

treatment goes hand in hand and

Galactose

and

hydroquinone not

chloasma).

respond

your to

skin

over-the-

Lactobionic Acid. Again, like AHA’s,

is combined with

poly-hydroxy acids help skin care

because sun exposure causes skin

penetrate deeper into the lower layers

hyperpigmentation – the concern

of the skin, exfoliating dead skin cells

that hydroquinone is working on and

on the surface of the skin resulting in

creating solutions within the skin. It is

a more even skin tone and improved

best to test hydroquinone-containing

skin texture. PHA’s also fight glycation

products in a small area first to ensure

which is a process that takes place

there are no adverse

when digested sugar permanently

some people are allergic to it. If you

attaches to the collagen in your skin

are allergic to hydroquinone you

and can weaken it, along with elastin

may benefit from use of products

levels.

containing kojic acid.

Acid)

Products containing alpha-hydroxy

lighten

are

to alpha-hydroxy acids but are less

level advanced skincare that bring

Alpha - Hydroxy acids (AHAs)

products

Polyhydroxy acids have a similar effect

Beta - Hydroxy

used correctly.

care

Poly - Hydroxy acids

cosmeceutical, medical grade, top positive change to your skin when

working up to daily application.

acid

(Salicylic

sunscreen

reactions as

Kojic Acid Kojic acid is also a remedy and

Salicylic acid removes dead skin

solution for the treatment of pigment

and improves the texture and colour

problems and age spots. Discovered

of sun-damaged skin. It penetrates

in 1989, kojic acid works similarly to

oil-laden hair follicle openings and,

hydroquinone and is derived from

as a result, greatly helps with oily

a fungus, studies have shown that

and acne prone skin types. Once

it is effective as a lightening agent,

salicylic acid is put to work on

slowing production of melanin. With

the skin, it penetrates the pores

continued use, Kojic acid may make

and dissolves the bonds between

your skin more susceptible to sun

surface skin cells. It is this process

also so the importance of SPF on the

that unclogs pores and makes it a

skin is a must when using this acid.

great fighter against blemishes due to its antibacterial properties. Salicylic

Retinoids

Acid is a deep cleaning ingredient

Examples of retinoids include retinol,

that mops up excess oil and dirt of

retinal aldehyde, and retinyl esters.

the skin and it is due to the exfoliating

They are used to improve acne and

properties that makes it stand out on

acne scarring, mottled pigmentation,

the skin care spectrum.

skin aging, skin texture, tone and colour, the skin's hydration levels

Hydroquinone Skin

care

hydroquinone lightening

are also increased with the use of

products are

agents.

containing

often These

called skin

retinoids. Retinol

derived

from

vitamin

Skin Microbiome

A, tretinoin, which is the active

fountain of youth." This is because

soluble in both water and oil, which

ingredient in prescription Retin-A

the substance occurs naturally and

permits its entrance to all parts of the

and Renova creams, are a stronger

quite abundantly in both humans

cell. Due to this quality, it is believed

version of retinol.

and animals. Hyaluronic acid is a

that alpha-lipoic acid can provide the

component of the body's connective

greatest protection against damaging

tissues and is known to cushion and

free radicals when compared with

lubricate. As you age, however, the

other antioxidants. Alpha-lipoic acid

forces of nature diminish hyaluronic

diminishes fine lines, it gives the skin

acid. Diet and smoking can also affect

a healthy glow, and boosts levels of

your body's level of hyaluronic acid

other antioxidants, such as vitamin C.

Here are why skin responds to skin care products with retinol: vitamin A has a molecular structure that is small enough to get into the lower layers of skin. Retinyl palmitate is another ingredient related to retinol but is less potent to the skin’s cells. L-ascorbic acid

hyaluronic acid are most frequently used to treat dry, dehydrated, and

This is the only form of vitamin C that you should look for in your skin care products. There are many skin care products on the market today that boast vitamin C derivatives as an ingredient (magnesium ascorbic phosphate or ascorbyl palmitate, for example), but L-ascorbic acid is the only useful form of vitamin C in skin care products. With age and sun exposure, as collagen synthesis in the skin decreases, leading to wrinkles. Vitamin C is the only antioxidant proven to stimulate the synthesis of collagen, minimizing fine lines, scars, and wrinkles. Proven clinical studies suggests that L-ascorbic acid

over time. Skin care products with

significantly

improves

the

appearance of photodamaged skin. Initial use of vitamin C containing creams can cause slight stinging and/ or redness, but these side effects generally subside with continued use.

As the largest organ of the human

hydration and firmness.

body, skin is colonised by many beneficial microorganisms that also

Copper peptide

serve as a physical barrier to prevent

Copper peptide is often referred to as

the invasion of pathogens. Thus, our

the most effective skin regeneration

skin is home to millions of bacteria,

product, even though it has only

fungi and viruses that compose

been on the market since 1997. Here

what is called the skin ‘microbiota’.

is why: Studies have shown that

In fact, there is a community of a

copper peptide promotes collagen

total

and elastin production, acts as an

mostly bacteria, living in and on the

antioxidant, and promotes production

body. Many of them reside in our

of glycosaminoglycans. Studies have

gastrointestinal tract, but many others

also shown that copper-dependent

live in diverse places like our mouth

enzymes increase the benefits of

and on our skin. This community of

the body's natural tissue-building

micro-organisms represent 50% of

processes. The substance helps to

us by cell count and collectively the

firm, smooth, and soften skin, doing it

genes harboured in these trillions

in less time than most other anti-aging

of microbial cells constitute our

skin care products. Clinical studies

microbiome. To put it simply the

have found that copper peptides also

microbiome is the ecosystem of

remove damaged collagen and elastin

the skin. It compromises all the

from the skin and scar tissue because

microorganisms that are living in or on

they

our skin. We are all working towards

activate

the

skin's

system

responsible for those functions.

Skin care products containing this

Alpha - lipoic acid

are

often

used

with

vitamin C products to assist in effective penetration. Hyaluronic acid (also known as a glycosaminoglycan) is best known for its ability to hydrate the skin resulting in fine lines and wrinkles being less pronounced. In news reports, you might have heard of hyaluronic acid as the "key to the

skin microbiome:

ageing skin as it will improve the skins

Hyaluronic acid

substance

A general understanding of the

You may have heard of alpha-lipoic acid as "the miracle in a jar" for its anti-aging effects. It is a newer, ultrapotent antioxidant that helps fight future skin damage and helps repair past damage which is apparent when looking at top level skin care. Alphalipoic acid has been referred to as a "universal antioxidant" because it is

maintaining

trillion

microorganisms,

naturally

balanced

ecosystem and healthy skin. Skin

microorganisms

have

long

adapted to utilise the sparse nutrients that are available on the skin. This article will show us how to help provide this nutritional support. The skin microbiome has an essential role in the protection against invading pathogens, the education of our immune system and the breakdown December 2021

Skin Microbiome

natural

skin

on our skin but also by factors

of the topic increased by 130%

conditions and diseases occur when

such as food and environmental

across global skin care

the skin barrier is broken or when the

pollution.

balance between commensals and

host factors and the skin microbiome

the skin microbiome’s importance,

pathogens is disturbed., resulting

were

it still remains relatively unknown

in an altered microbial state. An

operational taxonomic. A subset of

within the skin industry, which is

enhanced understanding of the skin

the correlations between microbial

expected to focus on it within the

microbiome is necessary to gain

features and host attributes were

next 5-10 years and then probably

insight into microbial involvement in

site specific. To further explore the

include the exposome, and external

human skin disorders and to enable

relationship

environmental factors like pathogens,

novel pro microbial and antimicrobial

skin microbiome of the skin.

therapeutic

products.

Many

approaches

for

their

treatment. Up to one billion bacteria inhabit every square centimetre of our skin. There is a huge diversity in distinct species of bacteria, both harmful and beneficial. Traditionally it was recommended to destroy all the so called ’bad’ bacteria on the skin. However, the abundance of our thriving beneficial microbes keeps the pathogenic microbes in check and maintains a harmonious balance. However, when pathogenic microbes dominate, this balance is disturbed, and we enter a state of dysbiosis.

generally

between

dominated

between age and the

People who suffer from rosacea understand

just

how

harmful

compromised skin barrier can be. Research published in the Journal of Clinical Gastroenterology shows that

unbalanced

microbiome

may be linked to intestinal bacterial overgrowth,

which

cause

these

inflammatory responses that lead to the development of rosacea and other common skin disorders. The trick is to maintain diversity and to strike the balance with beneficial bacteria dominating the bad.

several diseases including cancer,

over, the protective barrier of the

inflammatory bowel disease, obesity,

skin is compromised. Every time we

and asthma and the

skin. If you

take an antibiotic it takes two years

have an unhealthy gut it can have

for good gut bacteria to replenish

overall

to correct levels again, while really

the

anything that goes wrong in our gut,

appearance of your skin, including

from antibiotics, to stress, diet, and

spots,

eczema,

lifestyle will show up on your face as

and rosacea. The gut microbiome is

premature ageing including fine lines,

the bacteria found in your intestines

wrinkles, rosacea, blemishes, and

that influences your overall health,

inflammation. When your microbiome

especially your skin. Our lifestyle

is balanced, your skin looks and feels

choices,

healthy.

big

associated

impact

our

health and especially inflammation,

our

diet,

our

use

antibiotics and medications and the environment we live in can influence the composition of the microbiome

the health of our skin. The exposome encompasses the factors a person is exposed to from the moment they are born until they die. This will inspire a bespoke and holistic approach to the future of skincare, the skins microbiome and health, such as exposome – measuring wearable devices,

bespoke

personalised

DNA

ingestible, Nutrition,

and

products that boost skin health are all focused on the upcoming trend of

Scientific

research

regarding

the

microbiome. 2. Microbiomes and Immunology. Scientists now realise that our skin needs a certain amount of these bad bacteria to help our immune system work efficiently. Clinical data supports the positive impact of cosmeceutical prebiotic and probiotic products in controlling and defending the skins health and balance of both good and bad. Naturally, cosmetic chemists skincare.

Skin Industry

skin care products respond to rising

from your microbiome can play a

microbiome

significant role in skin flare-ups.

more mainstream than academic

December 2021

These factors significantly influence

1. Microbiome trends within the

Since 2019, research on the skin’s

by the skin care products we put

with our DNA and affect our health.

can see this translation to topical

infection. Banishing good bacteria

This balance is affected not only

period. However, despite

skin microbiome.

When this bad bacterium takes

that

fungi, pollution, and plants that interact

with

Dysbiosis

Associations

launches

and

fast

has

become

gaining

much

traction

become one of the industry’s hottest trends. It is estimated that mention

concerns

Microbiome-balancing about

environmental

pollution, causing skin sensitivity and premature ageing. These products will empower the skin to repair and protect itself, by boosting the skin’s immune system and boosting its

Skin Microbiome

natural defence barrier. 3. Affecting microbiomes into your skin We

have

been

aware

the

prebiotic is the fertiliser providing the

simpler

food to enable the garden to grow

products, and more natural formulas.

whilst inhibiting the weeds.

Patients are more educated on skincare

1. What products are best?

products

and

cleaner

routines,

and seek more information and

Finding

and health for some time, and the

can preserve the already healthy

consumption of oral probiotics has

bacteria

This

environments. In the past, personal

become increasingly popular. This

ingredient

selectively feeds good

service and a quality product was

popularity is expected to continue

bacteria, starving any unwelcome

enough to satisfy people but now

to skin as patients become more

microorganisms.

suggest

proper skincare includes technology,

informed of the topic. Prebiotics are

you should look for certain types of

health services, and nutrition as part of

ingredients that promote the growth

saccharides which are sugars that

a beauty routine. Hence, I feel we need

of good bacteria, much like fertilizer for

feed good bacteria. Probiotics can

to inquire about our patient’s lifestyle

plants and flowers. Probiotics are

come in the form of fermented skin

and external influences that may

ingredients in the form of healthy

care. Fermentation is the process

have an altering effect on their skin’s

bacteria. You can take a prebiotic and

of introducing healthy bacteria to

health. From this type of an in-depth

probiotic tablet for your gut, but what

break

acids.

analysis, we will understand why the

options are out there for skin? If you

Fermented food products can be

skin is functioning as it is by looking

want younger, hydrated, healthier,

great

microbiome.

at diet, nutrition and environmental

clearer, and smoother looking skin

Incorporating some of those foods

factors having an influence on the

it is vital to include probiotic foods

into cleansers, toners, serums,

skin’s microbiome. Bacterial flora of

in your diet or in supplement form

and creams can be great for the

the gut play an important role in the

to give your skins microbiome a

skin microbiome, too! They can

development of the human immune

significant boost to achieve healthy

help preserve

the balance of good

system in early life. The EAT study

skin. Research is delivering promising

bacteria

on your skin and help

investigated how the infant gut flora

results for treating all skin with topical

restore it.

the skin microbiome is balanced. The ideal skin care formulations should

contain a combination of probiotics with prebiotics.

down for

with

routines,

connection between gut bacteria

prebiotics and probiotics to ensure

products

beauty

your

skin.

Experts

sugars

your

prebiotics

and

gut

against

environmental

stress,

generally

protecting

viability

improved

during

cell

osmostress

metabolism induction.

Probiotics have been shown to

helps sensitive skin, affected by

stimulate the immunity of the skin and

sweat, swimming pool water, and

protect it from irritation and stress. An

sea water. The

in vivo study of 20 volunteers showed

general

that skin treated with probiotic lysates

against

showed a reduction in stinging, water

stresses improves skin microbiota,

loss and barrier dysfunction.

and

Prebiotics provide the ‘food’ for

the good bacteria living on your skin. It provides a nutritional source for the good bacteria, whilst inhibiting overgrowth of the harmful bacteria. I like to use the garden metaphor: Probiotic bacteria are the seeds that grow and flourish on the skin and the

promotion of

homeostatic external

conditions

and

extreme

healthier skin. Another in-vitro

study evaluated the ability of active ingredients to promote the synthesis of

potentially harmful and polluted

evolves during infancy, in relation

AECTIVE is a Probiotic that works

and

advice regarding skin exposure to

antimicrobial

peptides,

which

contribute to the skin’s antimicrobial defences.

to hygiene factors, eczema, food allergy and the introduction of solid foods. The study was performed by a group of researchers from King’s and Guy’s and St Thomas’ NHS Foundation Trust and included 1,303 exclusively breastfed infants from England and Wales. Stool samples were collected at enrolment, six and twelve months to study the evolution of their gut microflora. All participants were examined for eczema and food allergies until three years of age. Six foods (cow’s milk, egg, wheat, sesame, peanut, and cod fish) were introduced into infant diets along side breast feeding and compared to exclusive breast feeding

2. New thinking and questions we

until six months of age. The study

need to be asking.

found the early introduction of these

Consumers

are

moving

towards

allergenic solids from three accelerated

the

December 2021

months

development 23

Skin Microbiome

of greater gut bacteria diversity,

gut microbiota, which can lead to

ecology, genomics and therapeutic

compared

antibiotic-associated

diarrhoea,

opportunities of the skin microbiome.

feeding. They concluded that there

especially in children. Fortunately,

Drug Discov. Today Dis. Mech. 10,

seemed to be a relationship between

several studies have shown that

e83–e89 (2013).

the type of bacteria in the gut and

taking probiotics during the antibiotic

the development of eczema, the

course can however reduce the risk

manipulation of the gut bacteria in

early life might reduce the likelihood

One review of 23 studies including

of eczema in babies predisposed to

nearly

develop it.

taking probiotics at the same time

3. Grice, E. A. The intersection

of microbiome and host at the

exclusive

breast

3. Diet and the microbiome

400

children

antibiotics

could

diarrhoea. found

that

reduce

the

between

skin

microbiota

and

immunity. Science 346, 954–959 (2014).

risk. A larger review of 82 studies

skin

As diet is important in relation to the

including over 11,000 people found

metagenomic-based

skin’s microbiome, it is something

similar

Genome Res. 25, 1514–1520 (2015).

we need to enquire about. A recent

studies

pilot study led by British Gut showed

Saccharomyces

that diets can change gut microbial

particularly

diversity, even within a few days.

should also be taken after a course

Dietary

of antibiotics to restore some of the

cheese and yogurt-heavy diet, dietary

healthy bacteria in the intestines that

cleanses using only plant foods, and

may have been killed.

interventions

included

fasting. The dietary interventions, especially cleanses

the

and

fasts,

dramatic

showed

adults.

These

Lactobacilli and probiotics were

effective.

Probiotics

genomic-

and

insights.

4. Kong, H. H. et al. Temporal shifts in the skin microbiome associated with disease flares and treatment in children with atopic dermatitis. Genome Res. 22, 850–859 (2012). This is the first study in which the skin of individuals with atopic dermatitis was

Conclusion

longitudinally

sampled

and

sequenced.

I feel it is important to consider the

changes, but not in the same way in

microbiome when discussion proper

5. Paulino, L. C., Tseng, C. H., Strober,

different individuals. Professor Rob

skincare as it performs several critical

B. E. & Blaser, M. J. Molecular analysis

Knight, co-founder of American Gut,

functions,

pathogens

of fungal microbiota in samples from

said: ‘Unlike our human genomes,

from colonising the skin, protects

healthy human skin and psoriatic

which are all more than 99 per cent

us from environmental damage, and

lesions. J. Clin. Microbiol. 44, 2933–

the same, our microbiomes

are

communicates

2941 (2006).

mostly

one

system. The skin has its own unique

another. These microbial differences

ecosystem consisting of millions of

may explain why our bodies respond

bacteria, fungi, and viruses which

differently to different diets but may

make up the skin microbiota. We

ultimately help us predict which diets

have long known about the health

will work for which people.’ It was

benefits of maintaining balance in the

also found at Kings College London

gut microbiome but when it comes

that

to skin care, bacteria have generally

quite

did

results

interface:

induce

different

microbiome

patients

were

from

Parkinson’s

deficient

preventing

with

our

immune

good

been perceived as something we

bacteria. Research in diabetes and

need to remove. Today, the skin

cancer is continuous also.

microbiome is increasingly thought

4. When is the best time to take probiotics?

probiotics

to be the key to enhancing skin appearance – addressing the causes of skin conditions rather than just the

While most doctors advise taking after

antibiotics,

new

research has found that it is better

antibiotic-associated

2. Belkaid, Y. & Segre, J. A. Dialogue

symptoms. References

to take them just two hours apart.

1. Scharschmidt, T. C. & Fischbach,

Taking antibiotics

M. A. What lives on our skin:

can alter the

December 2021

NEWS

Study finds plume generated during laser tattoo removal generally viewed as safe A tattoo is one of the permanent body art. A design is made by puncturing the skin with needles and injecting ink, dyes and pigments into the deep layer of the skin.Results of a new analysis based on benchmarks from the National Institute for Occupational Safety and Health (NIOSH) suggest that the levels of metals and volatile organic compounds generated during laser tattoo removal procedures are generally safe.While tattoo removal plume has not been previously studied, an analysis from 2016 found that laser hair removal plume contains toxic compounds, including carcinogens and environmental toxins, underscoring the importance of using smoke evacuators, good ventilation, and respiratory protection. Ultrafine particles can become lodged in human alveoli in the lungs. For the study of laser tattoo removal plume, conducted air sampling to determine the gaseous, particulate, and microbiological content of laser tattoo removal plume. They performed the study in ex vivo pig skin and in humans undergoing routine laser tattoo removal, and measured ultrafine particulate concentrations, metals, volatile organic compounds, and airborne bacteria. For the swine portion of the study, they found that levels of metals including aluminum, copper, manganese, phosphorus, potassium, titanium, and zirconium were all below occupational exposure limits. All organic compounds including acetone and benzene were also below occupational exposure limits. This is different than what we found in the study of laser plume generated during hair removal. In laser hair removal, these were all elevated to a concerning extent. For the human part of the study, particle concentrations for ultrafine particulates were higher in the dermatologist’s breathing zone and near the tattoo removal site than in the rest of the treatment room or outside of the room. Concentrations were 30 times lower for human skin than for pig skin. We’re not sure why, but there were higher levels of ultrafine particulates right around the area we treated.Still, they were all below exposure limits that would be concerning in terms of NIOSH. So, although they were elevated, they were still considered safe. That was the case for organic compounds as well.

Glycerin is safe, effective in psoriasis model Psoriasis is a skin disease that causes red, itchy scaly patches, most commonly on the knees, elbows, trunk and scalp. Psoriasis is a chronic, multisystem inflammatory disease with predominantly skin and joint involvement. Patients with psoriasis have reported that glycerin, an inexpensive, harmless, slightly sweet liquid high on the list of ingredients in many skin lotions, is effective at combating their psoriasis and now scientists have objective evidence to support their reports. Scientists found that whether applied topically or ingested in drinking water, glycerin, or glycerol, helps calm the classic scaly, red, raised and itchy patches in their psoriasis model.The studies also provide more evidence of the different ways glycerin enables the healthy maturation of skin cells through four stages that result in a smooth, protective skin layer. Psoriasis is an immune-mediated problem that typically surfaces in young adults in which skin cells instead multiply rapidly, piling up into inflamed patches. They have experimental data now to show what these patients with psoriasis are reporting that glycerin, a natural alcohol and water attractor known to help the skin look better, also safely helped it function better by helping skin cells mature properly. Topically, glycerin is known to have a soothing, emollient effect. But another key part of its magic, which skin researcherhas helped delineate, is its conversion to the lipid, or fat, phosphatidylglycerol, which ultimately regulates the function of keratinocytes, our major skin cell type, and suppresses inflammation in the skin. Glycerin gets into the skin through avenues like aquaporin-3, a channel expressed in skin cells, and the MCG scientists have shown that once inside, aquaporin 3 funnels glycerin to phospholipase-D-2, an enzyme that converts fats in the external cell membrane into cell signals, ultimately converting glycerin to phosphatidylglycerol. The scientists found that topical glycerin reduced the levels of hydrogen peroxide entering skin cells. When they added glycerin and hydrogen peroxide at the same time directly to skin cells, they found that glycerin protected against the oxidative stress from hydrogen peroxide. Glycerol is basically outcompeting the hydrogen peroxide in getting in there and preventing it from being able to enter and increase oxidative stress. Oil and water don't mix, so yet another way glycerin may be helpful is by supporting the skin's major role as a water permeability barrier so that, as an extreme, when we sit in a bathtub the bath water doesn't pass through our skin so we blow up like a balloon.

December 2021

Effect of Intense Pulsed Light (IPL) Therapy for Acne

Effect of Intense Pulsed Light (IPL) Therapy for Acne Dr. Bhanoth Balaji Naik

Dr. B.R. Kiranmayee

MBBS, Fellow in Cosmetology and Aesthetics at Pune Consultant Cosmetologist and Laser Specialist, Managing Director, Sri Balaji Nursing Home, Ongole, Andhra Pradesh

Abstract Acne is one of the most prevalent skin disorder and single most common cause for visit to a Dermatologist. Acne vulgaris is a common disease in adolescents and young adults. It is a chronic inflammatory disease of the pilosebaceous units.

(protoporphyrin IX, coproporphyrins III) that are produced by P. acnes. It is followed by generation of reactive oxygen species which have bactericidal effects. These porphyrins have absorption peaks at 400, 510, 542, 578, 630, and 665 nm. Selective photothermolysis of smaller blood

photodynamic therapy in treatment

vessels supplying sebaceous glands

of acne vulgaris. P acnes produces

which reduce sebum production. Hb

porphyrins (protoporphyrin IX and

has an absorption peak at 580 nm.

coproporphyrin III) during their growth

The use of IPL offers the possibility to

and proliferation in follicular units.

cover the absorption peaks of both

These porphyrins have an absorption

Hb and porphyrins; hence, it is a

spectrum near ultraviolet and visible

suitable tool for acne treatment.

In acne, IPL shows photodynamic December 2021

light that is absorbed by porphyrins

In recent decades IPL acts by

spectrum of light.

effect is evoked by visible and UV

Keywords:Photodynamic, photothermolysis,pilosebaceous,

Effect of Intense Pulsed Light (IPL) Therapy for Acne

patterns,

hypercornification

cytokines,

inflammasomes,

Introduction

chemokines,

neuroendocrine

regulatory mechanisms, diet and

Acne is one of the most prevalent skin

other

disease worldwide with complex and

implicated in the activation of immune

multifactorial

detection and response.9

pathogenesis

affects

up to 90% of the population.1,2 Acne vulgaris is a chronic inflammatory skin condition of the pilosebaceous unit

pro-inflammatory

targets

Results We observed results in 96 patients (36 male+60 female) for results of IPL treatment on inflammatory acne. With IPL Monotherapy+Isotretinoin with 3-4 sittings 70-80% results.

Management of acne with IPL Therapy

IPL+ Minocycline ER+ Isotretinoin with 2-3 sittings 90-95% results

significantly associated with psycho-

Intense pulsed light (IPL) is an

with

social

shows

incoherent high-intensity pulsed light

Minocycline

various clinical presentations include

with a wide range of wavelength

supplementation

noninflammatory lesions (i.e.open and

targeting various chromophores in

results with no (or) minimal recurrence

closed

inflammatory

the skin.8 IPL therapy is one of the

with 2-3 sittings. Advantages are

lesions (i.e.papules, pustules, and

emerging options shows increasingly

no pain, less time, accurate results

nodules), seborrhea, deep pustules

useful and effective in the treatment

and good patient compliance. With

or pseudocysts and ultimate scarring

of acne.10 It has been proven to

the help of RF minimizing scar, skin

in few of them.4

be useful in reducing inflammatory

tightening, skin rejuvenation, color

lesions of acne.2

improvementwith

comorbidities.3

comedones),

It mainly affects adolescent and young

adults, leads to significant

It is a most effective and safe

morbidity that is associated with

monotherapy

for

residual scarring and higher incidence

inflammatory acne vulgaris, it helps

of psychological, social, emotional

to improve the skin elasticity and

distress such as poor self-image,

decreasing the amount and depth of

depression, anxiety, which leads to a

wrinkles with a low complication risk.11

negative impact on the quality of life.2,

IPL acts by multiple mechanisms of

4, 5, 6,7

actions in the treatment of acne. The

giving

(or)

95-98%

minimal

recurrence.

Propionibacterium acnes (P. acnes) levels and decrease in the sebaceous

pathogenesis

gland function. 8

acne

including

microbiological,

and

immunological mechanisms. Excess 2

sebum production, hypercornification of pilosebaceous duct, abnormality of the microbial flora, especially ductal colonization with Propionibacterium and

IPL+

Isotretinoin+zinc

managing

Multiple factors are involved in the

acnes

recurrence.

ER+

main mechanism is to reduce the

Pathogenesis

hormonal,

minimal

inflammation

the

follicle and surrounding dermis are considered the major factors in the pathogenesis of acne.1,8

Also, it reduces the inflammation and sebaceous gland size and downregulates

tumor

necrosis

alpha,

thereby reducing the initial lesion count and preventing the formation of new lesions. IPL works on selective thermal damage of P. acnes, which produce and store porphyrin. IPL penetrates hair follicles and to target P. acnes by triggering porphyrin

Other several factors such as genetic

activation. This mechanism helps to

predisposition,

pro-inflammatory

reduce the erythema in inflammatory

lipids acting as ligands of peroxisome

acne. The bactericidal activity of

proliferator-activated

IPL against P. acnes and it shows

the sebocytes, toll-like receptor-2

triggering porphyrin synthesis, which

acting on keratinocytes, recognition

helps to reduce active lesions and

eruption of new lesions of acne. 12

receptors

pathogen-associated

molecular

December 2021

Effect of Intense Pulsed Light (IPL) Therapy for Acne Effect Patient1 of Intense Pulsed Light (IPL) Therapy for Acne

Before treatment

After treatment Patient- 2

Before treatment

After treatment 28

December 2021

Effect of Intense Pulsed Light (IPL) Therapy for Acne

Patient- 3

Before treatment

After treatment

Patient- 4

Before treatment

After treatment

Patient- 5

Before treatment

After treatment December 2021

Effect of Intense Pulsed Light (IPL) Therapy for Acne

Patient- 6

The Treatment of this light‑based therapy shows great improvements in

inflammatory

acne

and

acne

scarring, with more limited benefit for noninflammatory (comedonal) acne.13 Conclusion The management of acne lasers and

light‑based

alternative

devices

conventional

an acne

modalities in patients such as who Before treatment

is non‑responder, noncompliant, or

After treatment

in antibiotic resistance patients. It is

Patient- 7

the best medical treatment options for non-responders associated with minimal adverse effects.3 In

recent

decades

many

types

of light sources including Intense Pulsed Light for the treatment and improvement of acne. IPL is the most effective treatment modality for facial acne.14 It has three important therapeutic roles in acne vulgaris i.e., photochemical,

Before treatment

photothermal

and

photo immunological.6 It exerts an anti‑inflammatory effect through

the

downregulation

tumor necrosis factor-alpha (TNF‑α) and upregulation of transforming growth factor‑beta 1 (TGF‑ß)/Smad3 signaling.15 Recent

few

studies

show

the

result of IPL in nodulocystic acne patients, treated successfully without encountering any significant side

After treatment

effects. IPL technology involves the Discussion Acne vulgaris is the most common skin disorder of humans. It is defined as a multifactorial chronic inflammatory disease of pilosebaceous unit. The four main pathogenic mechanisms of

IPL

viz.

production,

increased

sebum

hyperkeratinization,

different treatments are available such

application of non-coherent, non-

as keratolytics, antibiotics, retinoids

laser broadband, filtered flash lamp

and

source directed to the skin.1

antiandrogens.

Conventional

therapy with antibiotics and retinoids yield mixed results and can be complicated by antibiotic resistance

1. Puttaiah M, Jartarkar SR. Intense pulsed

and adverse treatment profiles.

light: A promising therapy in treatment

Therefore,

the

new

forms

such

propionibacterium acnes colonization,

therapeutic

modalities

and the inflammatory reaction. For

light‑based

therapy

the management of acne vulgaris,

developed for the treatment of acne.

December 2021

Reference

have

been

of acne vulgaris. Our Dermatol Online. 2017;8(1):6-9. 2. Karan S, Vikrant J, Anil G. A comparative studybetween

topical

adapalene

Effect of Intense Pulsed Light (IPL) Therapy for Acne

(0.1%) versus a combination of topical

therapy on tear proteins and lipids in

adapalene(0.1%) and intense pulsed light

meibomian gland dysfunction. J Ophthalmic

therapy in the treatment of inflammatory

Vis Res 2019;14:3-10.

andnoninflammatory facial acne vulgaris: A split-face randomized controlledtrial. Indian J Drugs Dermatol 2019;5:19-25.

12. AJAY J. DESHPANDE.Efficacy and Safety Evaluation of High-density Intense Pulsed Light in the Treatment of Grades

3. Rai R, Natarajan K. Laser and light

II and IV Acne Vulgaris as Monotherapy in

based

Dark-skinned Women of Child Bearing Age.J

treatments

acne.

Indian

DermatolVenereolLeprol 2013;79:300-9.

ClinAesthetDermatol.2018;11(4):43–48.

vulgaris

13. Moustafa A. El Taieb, Mohammed Abu

management: what’s new and what’s still

El Hamd and Sanaa S. Aly.A COMPARATIVE

true? Int J Adv Med 2015;2:1-5.

STUDY

Seth

Mishra

Acne

5. Mathew ML, KarthikR,Mallikarjun M, Bhute S, Varghese A. Intense pulsed light therapy for acne-induced post-inflammatory erythema.

Indian

Dermatol

Online

2018;9:159-64.

INTENSE

PULSE

LIGHT AND MEDICAL THERAPY FOR TREATMENT OF FACIAL ACNE VULGARIS: CLINICAL

EFFICACY

MALONDAILDEHYDE

AND

SERUM

LEVELS.AAMJ,

VOL10, NO4, OCT 2013 – SUPLL 1;352364.

6. Patidar MV, Deshmukh AR, Khedkar MY. Efficacymof intense pulsed light therapy in the treatment of facial acne vulgaris:Comparison of two different fluences. Indian J Dermatol 2016;61:545-9.

14. M Kumaresan, C R Srinivas. EFFICACY OF

IPL

TREATMENT

ACNE

VULGARIS: COMPARISON OF SINGLEAND BURST-PULSE MODE IN IPL.Indian J Dermatol 2010:55(4):370-2.

7. A.U. Tan, B.J. Schlosser, A.S. Paller.A review of diagnosis and treatment of acne in adultfemale patients. International Journal ofWomen's Dermatology 4 (2018) 56–71. 8.

BETWEEN

AmanyMatar,

May

15. Pei S, Inamadar AC, Adya KA, Tsoukas MM. Light-based therapies in acne treatment. Indian Dermatol Online J 2015;6:145-57.

Samahy,

SamahHassen and Nashwa EL-Khazragy. Effect of Intense Pulsed Light on Oxidative Stress in Acne Vulgaris.Journal of Recent Advances in Medicine Vol 1 issue 1 January 2020;14-19. 9. Bhat YJ, Latief I, Hassan I. Update on

etiopathogenesis

Acne.

Indian

and

treatment

DermatolVenereolLeprol

2017;83:298-306. 10. Barikbin B, Ayatollahi A, Younespour SH, Hejazi S. Evaluation of efficacy of intense pulsed light (IPL) system in the treatment of facial acne vulgaris: comparision of different pulse durations; a pilot study. J Lasers Med Sci.2011;2(2):67-72. 11. Ahmed SA, Taher IME, Ghoneim DF, Safwat AE. Effect of intense pulsed light December 2021

NEWS

Skin stem cells get moving for enhanced skin regeneration Skin stem cells, also called keratinocyte stem cells, are responsible for skin regeneration and wound closure through a process called re-epithelialization. Live-imaging and computer simulation experiments showed that human skin stem cells motility is coupled with their proliferative and regenerative capacity and old stem skin cells have a significantly reduced motility. Although sometimes hard to accept, with aging, many things in our bodies change. One of these is the ability of the skin to regenerate. Old skin is just not as good as young skin at healing wounds. However, the molecular and cellular mechanisms underlying this are largely unknown. Now, researchers have identified a mechanism to explain why this happens and potentially how it can be fixed. Researchers have found that the ability of skin stem cells to heal wounds is linked with their ability to move towards the injury. Their study identified the signalling pathway of EGFR (Epidermal Growth Factor Receptor), and COL17A1 (collagen type XVII alpha 1 chain) as a key player in the regulation of motility. Understanding mechanisms that underlie the age-associated reduction in regenerative capacity is the first step to develop targeted treatments for age-associated chronic nonhealing disorders, such as diabetic ulcers. In a published study have revealed that the ability of skin stem cells to repair skin after an injury may be linked with their ability to move towards the injury.To understand the mechanisms behind this reduced motility in old stem cells, the researchers compared the wound healing and proliferative ability of skin stem cells derived from young mice (12 weeks old) and aged mice (19-25 months old). The experiments showed that a specific molecule, called EGFR, drives skin stem cell motility and that EGFR signalling is reduced in old stem cells. EGFR acts by preventing the degradation of a specific type of collagen, COL17A1, which is necessary to hold the layers of the skin together. Interestingly, COL17A1 coordinates the movement of skin stem cells towards the injury by regulating actin and keratin filament networks in the cells. The researchers found that with age, a decrease in EGFR signalling occurs, leading to lower levels of COL17A1 and skin stem cells with reduced mobility that are less able to re-epithelialize the skin.

New, promising opportunities for treating skin fibrosis Collagen, the main component of the skin's extracellular matrix, can cause a pathological condition if it is in excess. Applying an electric field to the skin affects collagen pathways, temporarily reducing collagen production and increasing its degradation. These results open new therapeutic perspectives for the topical treatment of skin fibrosis characterized by excessive collagen deposition. When an electric field is applied around a tumour, it "permeabilizes" the cells locally and temporarily. This permeabilization ensures, for example, the massive entry of anticancer molecules into cells and tissues, which reduces the amount of doses injected into patients and limits side effects: this is the hospital-based approach of electrochemotherapy that has been used to treat skin tumours since the 1980s.Interestingly, physicians using this method, and for that matter the patients themselves, have observed an aesthetic and functional healing of the sites treated in this way. However, the mechanisms behind this observation had never been elucidated. A research team used a highly sophisticated synthetic skin model, especially used to treat large burns. This artificial skin model has the advantage of being rich in extracellular matrix, comparable to human skin in terms of composition and organization. This matrix is mainly composed of collagen, well known in cosmetics for its role in the skin's mechanical properties. Collagen, like the whole extracellular matrix, is finely regulated, in particular by its degradation by specialized enzymes which prevent it from being in excess. If this balance is disturbed, the matrix reaches a pathological or disease state, as is the case with fibrotic or hypertrophic scars, characterized by excessive collagen deposition. Using this artificial skin model, scientists have shown that applying an electric field to the skin affects many genes that influence collagen production and maturation. As soon as four hours after applying the electric field, less collagen is produced. This lasts for several days. In addition, enzymes that degrade collagen have increased activity for at least 48 hours.The application of an electric field to the skin therefore presents a great potential for future therapeutic use in the treatment of skin fibrosis. 32

December 2021

NEWS

Gel fights drug-resistant bacteria and induces body’s natural immune defense Skin diseases can be caused by viruses, bacteria, fungi, or parasites. The most common bacterial skin pathogens are Staphylococcus aureus and group A ß hemolytic streptococci. New research shows the fight against multidrug-resistant bacteria, scientists have developed a new kind of antibiotic-free protection for wounds that kills drug-resistant bacteria and induces the body's own immune responses to fight infections. Researchers say that the new treatment is based on specially-developed hydrogels consisting of polymers known as dendritic macromolecules. They say the hydrogels are formed spontaneously when sprayed on wounds and 100 percent degradable and non-toxic. Dendritic hydrogels are excellent for wound dressing materials because of their soft, adhesive and pliable tactile properties, which provide ideal contact on the skin and maintain the moist environment beneficial for optimal wound healing. The antibacterial effects of the hydrogels have yet to be fully understood, but the key lies in these macromolecules' structure. It's distinguished by well-ordered branches that terminate with a profusion of cationic, charged contact points. Bacterial cells are interactive, and so are dendritic macromolecules. When they meet, it doesn't turn out well for the bacteria. Researcher says that despite containing no antibiotics, the hydrogels show excellent antibacterial qualities and were effective against a broad spectrum of clinical bacteria, killing both Gram-positive and Gram-negative bacteria, including drug-resistant strains isolated from wounds. The material also reduces inflammation. The hydrogels were tested against several clinically relevant infectious bacteria, including Staphylococcus aureus (S. aureus), and Pseudomonas aeruginosa (P. aeruginosa). The hydrogels were shown to be 100 percent effective in killing P. aeruginosa; and almost equally effective in killing S. aureus. Cell infection tests demonstrated that the gel not only efficiently killed clinical drug-resistant bacteria from wounds, but also induced the expression of naturally-existing antimicrobial peptides or endogenous antibiotics in human skin cells. These endogenous antibiotics help fight bacteria and clear the infection. Contrary to traditional antibiotics, where bacteria may develop resistance quickly, resistance towards antimicrobial peptides, is very rarely seen. The hydrogel is even more successful in killing methicillin-resistant S. aureus (MRSA) when compared to a commercially available hydrogel wound dressing in use today.

FDA issues warning about use of dermal fillers with needle-free devices Dermal fillers, also known as injectable implants, soft tissue fillers, lip and facial fillers, or wrinkle fillers are medical device implants approved by the FDA for use in helping to create a smoother and fuller appearance in the face, including nasolabial folds (the lines extending from the sides of the nose to the edges of the mouth), cheeks, chin, lips, and back of the hands. According to recent news, the Food and Drug Administration issued a warning about the use of needle-free devices for injecting dermal fillers, which are promoted to the public on social media and have resulted in serious and permanent injuries. Specifically, the warning advises consumers and health care professionals “not to use needle-free devices such as hyaluron pens for injection of hyaluronic acid (HA) or other lip and facial fillers, collectively and commonly referred to as dermal fillers or fillers.” According to the statement, is aware of serious injuries and in some cases, permanent harm to the skin, lips, or eyes with the use of needle-free devices for injection of fillers.Needle-free devices and lip and facial fillers for use with these devices are being sold directly to consumers online, and are promoted on social media to increase lip volume, improve the appearance of wrinkles, change the shape of the nose, and other similar procedures, according to the FDA warning. The FDA points out that FDA-approved dermal fillers are for prescription use only, and should be administered only by licensed health care professionals using a syringe with a needle or cannula, and advises consumers not to buy or use lip or facial fillers sold directly to the public. These products may be contaminated with infectious agents or chemicals. Moreover, “needle-free injection devices for aesthetic purposes do not provide enough control over where the injected product is placed,” the statement adds. In addition to infections, other risks include bleeding and bruising, formation of lumps, allergic reactions, blockage of a blood vessel (which can result in necrosis, blindness, or stroke), and transmission of diseases from sharing devices. The FDA’s recommendations for health care providers include not using any aesthetic fillers with a needle-free device, and not using approved dermal fillers in such devices. December 2021

SUBSCRIBE TO

INDIA’S ONLY JOURNAL ON AESTHETIC DERMATOLOGY

Pay Rs. 600/- ONLY

“The Aestheticians Journal”

Get Your Annual Subscription of

is available for subscriptions strictly to MD, DNB, DDV, MS, Mch only on submission of Credentials along with the payment.

Demand Draft to be Drawn in favour of The AESTHETICIANS Journal

The Publisher retains the right to accept OR reject any application for subscription should it be presented without supporting credentials.

The AESTHETICIANS Journal

All Payments to be sent to: The AESTHETICIANS Journal

22, Shreeji Bhavan, 275-279, Samuel Street, Masjid Bunder (W.), Mumbai- 400 003, INDIA Tel: +91 22 23451404 Email: theaestheticiansjournalindia@gmail.com

The Publisher decision to accept or reject any application for subscription is ﬁnal.

Since we are governed by Indian Postal Service, we need your complaints in written on theaestheticiansjournalindia@gmail.com Please send your complaints by 15th of every month failing which no complaint will be entertained.

Annual Subscription Form Rs. 600/-

Clinic Name: _____________________________________________________________ Doctor’s Name: ___________________________________________________________ Address: ____________________________________ City: _______________________ ____________________________________________ Pincoce: ____________________ Pincode : State: _________________ Tel: _________________ Mobile: _____________________ E-mail: ______________________________________ DD Details: __________________

December 2021

Introducing

The Next generation Itraconazole

SUBA Itraconazole 50 mg Capsules

Equivalent to 100 mg of Conventional Itraconazole

A B C +

Absorption

Bioavailability

Clinical Efficacy

Greater...

A B c

Absorption Bioavailability Clinical Efficacy

R.N.I. No.MAHENG/2010/44622 Postal Registration No.MCE/295/2021-23 Posted at Mumbai Patrika Channel Sorting Office Mumbai-1 on 5th & 6th Every Month Published on 1st of Every Month