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When Free Radicals Attack:
An Anti-Aging Arsenal
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Sept 22, 2009
Dear Friends,
Happy first day of fall! I haven't written anything in awhile, as I've been busy building my website! I will use the site to publish and archive my newsletters, as well as to post information about skin care and cosmetic dermatology. I hope you will find it interesting. And if anyone has any suggestions, please speak up!
I started a series on skin care back in February. The first letter was about moisturizers, and the second was about sun protection. Next, I want to discuss anti-aging treatments. This is what my patients are usually interested in when they ask, "What should I use on my skin?"
Have you ever looked in the mirror and seen some lines that weren't there before? If you're over 40, especially if you're pale like me, you probably have. Not a good feeling. I'll digress a minute here to recount a visit I had with a very sweet lady a few years ago. She came to see me in the office and was quite upset about all the wrinkles that had suddenly appeared on her face two months previously. She was 82 and had deep lines on her forehead and cheeks; the result of years in the Texas sun, time spent on the lake, etc. In other words, a full life. But she insisted that the wrinkles hadn't been there until two months earlier! She wanted something done! I stalled for time, puzzled. We discussed what was going on in her life, what her grandkids were doing, etc. Later in the conversation, she mentioned that her daughter had taken care of her when she had her cataracts removed.....two months before. Ah, mystery solved. One of the downsides to better vision, I guess. I ended up reassuring her that she was beautiful and gave her a prescription for RenovaŽ (and a referral to a plastic surgeon; there is only so much I can do!).
Was RenovaŽ going to erase 60 years of sun damage and make the wrinkles disappear? No, but it couldn't hurt. In fact, retinoids such as RenovaŽ and RetinAŽ are the "gold standard" when it comes to topical anti-aging cosmeceuticals. (A bit of explanation is in order: the term "cosmeceutical" refers to a class of products that lie in the gray zone between drugs and cosmetics. Some cosmeceuticals are available by prescription, but most are over-the-counter products. A cosmeceutical is a product that does more than adorn or beautify; it actually has a biologic effect on the skin, due to the inclusion of any number of active ingredients).
The term retinoid refers to a chemical in the vitamin A family. This includes the prescription products Retin-AŽ, RenovaŽ, AvageŽ, and TazoracŽ, and nonprescription retinol, retinoic acid, and retinaldehyde. This is the best studied class of antiaging products and has the most supporting scientific evidence for efficacy. When it comes to treatment of sun damage (dullness, rough texture, fine lines and brown spots), I routinely recommend a prescription retinoid, such as RenovaŽ or Retin-AŽ. Retinoids work at the cellular level to regulate proper growth and turnover of cells, decrease inflammation, enhance immunity, inhibit tumor formation, and inhibit collagen breakdown. Retinoid therapy results in smoother skin, enhanced light reflection (skin that "glows"), diminishment of fine lines, and decreased pigmentation. Prescription retinoids can cause irritation and redness in some people. This can sometimes be dealt with by decreasing application frequency, or mixing with a moisturizer. If these measures fail, then nonprescription retinol, which is weaker, is a good second choice. There are many good over the counter retinol products, such as Neutrogena Healthy Skin Anti-Wrinkle Cream, RoC Multicorrexion Intensive Night Cream or Replenix Retinol Smoothing Serum (carried in our office). These products are usually used at night. Because they decrease the thickness of the stratum corneum (the dead skin cell layer), retinoids do make the skin more sensitive to the sun; thus, daily sunscreen use is a must!
The second most studied class of anti-aging products is antioxidants. The term antioxidant is a bit of a buzzword in the skin care industry right now, as well as in the general health/wellness arena. Antioxidants are molecules that neutralize free radicals. OK, what are free radicals? (Hold onto your hats; I'm now going to review some biochemistry. You may want to skip to the next paragraph!). Free radicals are ions or molecules that have an unpaired electron. This unpaired electron makes them highly unstable, and they tend to initiate chain reactions that ultimately damage cells, DNA, and proteins. What causes free radicals to form? The main source of free radicals is normal cellular metabolism (the process by which cells burn fuel for energy). Luckily, the body has natural defense mechanisms in place to deal with this. However, environmental stress, such as pollution or radiation, can result in a rapid increase in free radicals which can overwhelm our bodies' natural defenses. This is a situation referred to as oxidative stress and may play a role in some neurodegenerative diseases, cardiovascular diseases, and general aging. But we're talking about the skin here. In the skin, ultraviolet radiation from the sun creates free radicals that go on to destroy collagen and result in wrinkles and aged skin.
So, how do antioxidants work? They donate electrons to the free radicals, thus neutralizing them. There are many different kinds of antioxidants. Some are enzymes made by our bodies, including superoxide dismutase, catalase and glutathione perioxidase. Many come from the plant world. This isn't too surprising, as plants are constantly exposed to ultraviolet radiation from the sun and have evolved these mechanisms to protect themselves. A brief (and incomplete) list of plant antioxidants includes flavonoids, such as soy, silymarin, curcumin, quercetin, rutin and ginkgo biloba; polyphenols, such as green tea, coffeeberry, ferulic acid, grapeseed, pomegranate and resveratrol; and carotenoids, such as lutein and lycopene.
Another group of antioxidants are the vitamin antioxidants. This group includes Vitamin C, Vitamin E, Vitamin B3 (Niacinamide) and Vitamin B5 (Panthenol). Finally, there are some nutritional antioxidants, which include idebenone, ubiquinol, and alpha lipoic acid.
Antioxidants can play an important role in the treatment of sun damage. Some of these compounds are better studied than others. Vitamin C has been extensively studied and has been shown to improve fine wrinkling, skin roughness, pigmentation and texture. It stimulates collagen production and helps to maintain optimal levels of vitamin E in the skin. There are many vitamin C products on the market, though various formulations differ in their ability to deliver the active ingredient and retain stability of the molecule. Cellex C Serum for Sensitive Skin, Philosophy Save Me, and DDF C3 Plus Serum are all examples of good vitamin C formulations. When combined with vitamin E, vitamin C also confers sun protection. Young Pharmaceuticals makes a product called Cega Ferulic serum that contains a form of vitamin C called tetrahexyldecylascorbate for enhanced skin penetration. This is combined with vitamin E and the polyphenol ferulic acid. I recommend this product frequently as part of an anti-aging regimen. (We carry it in our office). I use it under my sunscreen.
So, to summarize, my favorite regimen for treating sun damage (besides a good sunscreen) is a retinoid at night and an antioxidant in the morning. The retinoid helps to undo sun damage and the antioxidant helps to prevent it. As I've indicated, there are hundreds of topical antioxidants out there. They probably all provide some benefit to the skin, but the effect is dependent on concentration, stability, and deliverability of the active molecule. Scientific studies concerning topical antioxidants are surprisingly few, and many products contain only trace amounts. Vitamins C has the most science behind it, and that's why I recommend it, but I don't have anything against green tea, resveratrol, idebenone, etc.
There are other classes of cosmeceuticals, such as peptides, alpha-hydroxy acids, and lightening agents, which I will cover in future letters, but I'll stop here for now.
Have a great week and thanks for reading,
Kathy Farady
Balcones Dermatology
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Katherine Farady, M.D.
phone:459-4869
David: ext 19
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