Estimulación facial con factores de crecimiento plaquetario en consulta de Dermatología / Facial stimulation with platelet growth factors in Dermatology consultation

RESUMEN El envejecimiento es un proceso complejo que trae consigo cambios celulares, histológicos y cutáneos. Estos últimos son una de sus manifestaciones más evidentes. El plasma rico en plaquetas es una fuente fiable de obtención de células para regenerar tejidos; por su fácil disponibilidad es un material inocuo. La bioestimulación con el mismo, por su parte, es un conjunto de procedimientos para activar las funciones anabólicas de los fibroblastos, producción de colágeno, elastina y ácido hialurónico. La tendencia al empleo de este en tratamientos antiedad es cada vez mayor. El objetivo de este trabajo fue realizar una actualización del tema, para exponer aspectos importantes sobre formas de aplicación, indicaciones, complicaciones y contraindicaciones. Existen varios métodos para la bioestimulación facial, tales como la realización de pápulas, napagge y retroinyección. Se han empleado en alopecia androgénica, areata, envejecimiento cutáneo, etc. Las complicaciones más observadas son dolor, eritema, ardor y sangrado local. Entre las contraindicaciones más comunes se observan el herpes simple recidivante, coagulopatías, tratamiento con anticoagulantes, colagenopatías y neoplasias (AU).

ABSTRACT Aging is a complex process that brings with it cellular, histological and cutaneous changes, the latter being one of its most obvious manifestations. Platelet-rich plasma is a reliable source of cells to regenerate tissues; due to its easy availability, it is a harmless material. Bio-stimulation with it is a set of procedures to activate the fibroblasts anabolic functions and the production of collagen, elastin and hyaluronic acid. The tendency to use it in anti-aging treatments increases faster and faster. The objective of this work was updating the topic to expose important aspects about application methods, indications, complications and contraindications. There are several methods of applying facial bio-stimulation such as performing papules, napagge, and retroinjection. It has been used in androgenic alopecia, alopecia areata, cutaneous ageing, etc. The most commonly found complications are pain, erythema, burning and local bleeding. The most common contraindications include recidivist herpes simplex, coagulopaties, anticoagulant treatment, collagen-related diseases and neoplasms (AU).

Stability and Sensory Evaluation of an Innovative Antiaging Formulation Based on Marine Ingredients

Abstract The high consumption of antiaging cosmetics represents an outstanding opportunity for the development of new processes and attractive products in the cosmetic industry. Stability studies and sensory analyses are critical steps in the development process and production chain. Here we present a potential antiaging cosmetic product with innovative sensory characteristics. Caviar extract antioxidant properties were firstly evaluated by the DPPH method since it is an important mechanism against skin aging. Ca-alginate beads containing 2% of caviar extract and 0.2% of black pigment were prepared to obtain spheres similar to caviar. The beads were incorporated in a gel phase (hydroxyethylcellulose 2.5%) containing 3% of dimethylaminoethanol. Stability was evaluated in different storage conditions (sunlight exposure, 5 ± 2 °C, 37 ± 2 °C and r.t.) through the parameters: appearance, color and odor, pH (6-7), density (0.98-1.14 g.mL-1), centrifugation and average size. After approval by the Committee for Ethics in Research (n° 3.503.061), 30 volunteers tested the new formulation and answered a questionnaire. At 2%, caviar extract was able to scavenge 10.9% ± 0.58 of DPPH radical. Formulations showed good stability after 90 days, even considering the average size (7.47 ± 0.41 - 8.4 ± 0.65 mm2). 90% of the sensory test participants reported that they would buy the new product. Therefore, the new product developed demonstrates a promising potential as an attractive cosmetic product.

An overview about oxidation in clinical practice of skin aging

Abstract Free radicals are unstable chemical species, highly reactive, being formed by cellular entities of different tissues. Increased production of these species without proper effective action of endogenous and exogenous antioxidant systems, generates a condition of oxidative stress, potentially provider of skin disorders that extend from functional impairments (skin cancer, dermatitis, chronic and acute inflammatory processes) even aesthetic character, with the destruction of structural proteins and cellular changes with the appearance of stains, marks and lines of expressions and other signs inherent to the intrinsic and extrinsic skin aging process. The antioxidants are chemical substances commonly used in clinical practice for topical application and may contribute in the fight against the radical species responsible for many skin damage. This paper summarized the main evidence of the benefits brought by the topical application of antioxidants in the skin, considering the amplitude of the indicative performance of antioxidant activity by in vitro and ex-vivo tests as well as in vivo tests. It is recognized that a breadth of product performance tests should be explored to truly identify the effectiveness of antioxidant products for an anti-aging effect.

Tretinoin peel: a critical view

Abstract The tretinoin peel, also known as retinoic acid peel, is a superficial peeling often performed in dermatological clinics in Brazil. The first study on this was published in 2001, by Cuce et al., as a treatment option for melasma. Since then, other studies have reported its applicability with reasonable methodology, although without a consistent scientific background and consensus. Topical tretinoin is used for the treatment of various dermatoses such as acne, melasma, scars, skin aging and non-melanoma skin cancer. The identification of retinoids cellular receptors was reported in 1987, but a direct cause-effect relation has not been established. This article reviews studies evaluating the use of topical tretinoin as agent for superficial chemical peel. Most of them have shown benefits in the treatment of melasma and skin aging. A better quality methodology in the study design, considering indication and intervention is indispensable regarding concentration, vehicle and treatment regimen (interval and number of applications). Additionally, more controlled and randomized studies comparing the treatment with tretinoin cream versus its use as a peeling agent, mainly for melasma and photoaging, are necessary.

Antioxidants in dermatology

Abstract The skin cells continuously produce, through cellular respiration, metabolic processes or under external aggressions, highly reactive molecules oxidation products, generally called free radicals. These molecules are immediately neutralized by enzymatic and non-enzymatic systems in a physiological and dynamic balance. In situations where this balance is broken, various cellular structures, such as the cell membrane, nuclear or mitochondrial DNA may suffer structural modifications, triggering or worsening skin diseases. several substances with alleged antioxidant effects has been offered for topical or oral use, but little is known about their safety, possible associations and especially their mechanism of action. The management of topical and oral antioxidants can help dermatologist to intervene in the oxidative processes safely and effectively, since they know the mechanisms, limitations and potential risks of using these molecules as well as the potential benefits of available associations.

In vitro and cellular activities of the selected fruits residues for skin aging treatment

ABSTRACT Peel extracts of litchi and rambutan, and that of tamarind seed coat were investigated in relation to their utility in skin-aging treatments. Standardized extracts of tamarind were significantly (p < 0.05) more efficient at O2 •- scavenging (IC50 = 27.44 ± 0.09) than those of litchi and rambutan (IC50 = 29.57 ± 0.30 and 39.49 ± 0.52 μg/ml, respectively) and the quercetin standard (IC50 = 31.88 ± 0.15 μg/ml). Litchi extract proved significantly (p < 0.05) more effective for elastase and collagenase inhibition (88.29 ± 0.25% and 79.46 ± 0.92%, respectively) than tamarind (35.43 ± 0.68% and 57.69 ± 5.97%) or rambutan (31.08 ± 0.38% and 53.99 ± 6.18%). All extracts were safe to human skin fibroblasts and inhibit MMP-2, with litchi extract showing significantly (p < 0.01) enhanced inhibition over the standard, vitamin C (23.75 ± 2.74% and 10.42 ± 5.91% at 0.05 mg/ml, respectively). Extracts suppress melanin production in B16F10 melanoma cells through inhibition of tyrosinase and TRP-2, with litchi extract being the most potent, even more so than kojic acid (standard). These results highlight the potential for adding value to agro-industrial waste, as the basis for the sustainable production of innovative, safe, anti-aging cosmetic products.

Use of silicon for skin and hair care: an approach of chemical forms available and efficacy

Abstract Silicon is the second most abundant element on Earth, and the third most abundant trace element in human body. It is present in water, plant and animal sources. On the skin, it is suggested that silicon is important for optimal collagen synthesis and activation of hydroxylating enzymes, improving skin strength and elasticity. Regarding hair benefits, it was suggested that a higher silicon content in the hair results in a lower rate of hair loss and increased brightness. For these beneficial effects, there is growing interest in scientific studies evaluating the efficacy and safety of using dietary supplements containing silicon. Its use aims at increasing blood levels of this element and improving the skin and its annexes appearance. There are different forms of silicon supplements available and the most important consideration to be made in order to select the best option is related to safety and bioavailability. Silicon supplements are widely used, though there is wide variation in silicon bioavailability, ranging from values below 1% up to values close to 50%, depending on the chemical form. Therefore, the aim of this study was to evaluate the scientific literature related to the different chemical forms of silicon supplements available and the limitations and recent progress in this field. According to reported studies, among the different chemical forms available, the orthosilicic acid (OSA) presents the higher bioavailability, whereas the others forms have absorption inversely proportional to the degree of polymerization. However, clinical studies evaluating safety and efficacy are still lacking.

Oral isotretinoin in photoaging: objective histological evidence of efficacy and durability

AbstractBACKGROUND:The off-label use of oral isotretinoin in photoaging is a therapeutic tool that has been used by dermatologists. There are few studies to corroborate its effectiveness and durability.OBJECTIVES:To assess, both clinically and histologically, the changes caused by the use of oral isotretinoin in skin photoaging as well as the duration of the effects.METHODS:20 female patients, aged 45-50 years, with phototypes II-VI, none of whom had experienced menopause, were treated with 20mg oral isotretinoin, 3 days a week, for 12 weeks. They underwent clinical analysis and skin biopsies in the pre-auricular region, while histologic cuts enabled assessment of the solar elastosis level and morphologic analysis.RESULTS:Clinically, patients, as well as the researching and the assessor physicians, noticed improvement in skin quality. One patient presented severe solar elastosis, 11 manifested the moderate form, while 8 presented the discreet type. According to histological analysis, 65% of the patients revealed alteration in the distribution and thickness of the elastic fibers, which can be interpreted as a histological improvement, while 60% showed an increase in collagen density. We observed an increase in collagen density, from 51.2% to 57.4%, (p=0.004). At the end of the 12-week follow-up period, this density decreased to 54.7% (p=0.050). There was an increase in the density of elastic fibers, from 26.5% to 31.3%, (p=0.02), which had dropped to 27.5% at the end of the 12-week follow-up period.CONCLUSIONS:The study confirmed the role of oral isotretinoin in remodeling the extracellular matrix against photoaging, as well as its durability after 12 weeks, especially when we consider collagen fibers.

Randomized clinical efficacy of superficial peeling with 85% lactic acid versus 70% glycolic acid / Estudo randomizado da eficacia clinica dos peelings superficiais de acido lactico 85% versus acido glicolico 70%

BACKGROUND: Peeling is a procedure which aims to accelerate the process of skin exfoliation. OBJECTIVES: Development of formulations containing lactic acid at 85% or glycolic acid at 70% and the evaluation of these formulations on clinical efficacy in reduction of fine wrinkles. METHODS: Preliminary stability tests were carried out and an in vivo study was performed with three groups with 9 representatives each. One was the control group, which used only sunscreen; another one used lactic acid+sunscreen, and the last group used acid glycolic+sunscreen. Clinical efficacy was assessed with a CCD color microscope, through the digitization of images before and after treatment. The applications were carried out by a dermatologist, once a mont h every 30 days, during 3 months. The area with wrinkles was calculated by planimetry point counting, in accordance with Mandarin-de-Lacerda. RESULTS: The formulations were stable in the visual and Ph evaluation. There was no improvement in the control group; for lactic acid, there was significant improvement after the second peeling application on the outer lateral area of the right eye and after the third application on the outer lateral area of the left eye. For the glycolic acid group, there was significant improvement in the outer lateral area of the left eye after the first application, and of the right eye region, after three applications. The formulations used must be kept under refrigeration and should be manipulated every 30 days. CONCLUSIONS: Both peelings were effective in reducing fine wrinkles of the outer lateral eye area after three applications (p≤0.05%). It was observed that peeling efficacy in the external-lateral region of one eye might be different compared with that in skin of the external-lateral region of the other eye, relative to the speed of skin improvement. .

FUNDAMENTOS: Peeling visa a acelerar o processo de esfoliação da pele. OBJETIVOS: Desenvolver formulações contendo ácido láctico a 85% ou ácido glicólico a 70% e avaliar sua eficácia clínica na redução de rugas finas. MÉTODOS: Testes preliminares foram efetuados e estudo in vivo foi realizado em três grupos com nove representantes cada, separados de forma randomizada. Um grupo foi controle, utilizando apenas fotoprotetor; outro utilizou ácido láctico e fotoprotetor; o último usou ácido glicólico e fotoprotetor. Para eficácia clínica, empregou-se microscópio CCD color, digitalizando-se as imagens do pré e do pós-tratamento. As aplicações foram realizadas por médica dermatologista uma vez por mês, a cada 30 dias, durante três meses. A área com traços de ruga foi calculada pela planimetria por contagem de pontos. RESULTADOS: As formulações foram estáveis na avaliação visual e de pH. Não houve melhora no grupo controle; para o grupo do ácido láctico, houve melhora significativa após a segunda aplicação do peeling na região lateral externa do olho direito e após a terceira aplicação na região lateral externa olho esquerdo. Para o grupo do ácido glicólico, houve melhora significativa na região lateral externa olho esquerdo após a primeira aplicação e, depois de três aplicações, na região lateral externa do olho direito. As formulações magistrais empregadas no estudo devem ser mantidas sob refrigeração e manipuladas a cada 30 dias. CONCLUSÕES: Tanto o peeling de ácido láctico quanto o de ácido glicólico foram eficazes na diminuição de rugas finas da região lateral externa dos olhos após ...

Triple nanoemulsion potentiates the effects of topical treatments with microencapsulated retinol and modulates biological processes related to skin aging / Tripla nanoemulsao potencializa os efeitos do tratamento topico com retinol microencapsulado e modula processos biologicos relacionados ao envelhecimento da pele

BACKGROUND: The sum of environmental and genetic factors affects the appearance and function of the skin as it ages. The identification of molecular changes that take place during skin aging provides biomarkers and possible targets for therapeutic intervention. Retinoic acid in different formulations has emerged as an alternative to prevent and repair age-related skin damage. OBJECTIVES: To understand the effects of different retinoid formulations on the expression of genes associated with biological processes that undergo changes during skin aging. METHODS: Ex-vivo skin samples were treated topically with different retinoid formulations. The modulation of biological processes associated with skin aging was measured by Reverse Transcription quantitative PCR (RT-qPCR). RESULTS: A formulation containing microencapsulated retinol and a blend of active ingredients prepared as a triple nanoemulsion provided the best results for the modulation of biological, process-related genes that are usually affected during skin aging. CONCLUSION: This association proved to be therapeutically more effective than tretinoin or microencapsulated retinol used singly. .

FUNDAMENTOS: A soma de fatores genéticos e ambientais afeta a aparência e a funcionalidade da pele ao longo do envelhecimento. O conhecimento a respeito das mudanças moleculares durante o envelhecimento fornece biomarcadores e possíveis alvos para intervenções terapêuticas. O ácido retinoico em diferentes formulações surgiu como uma alternativa para prevenir e reparar os danos da pele associados ao envelhecimento. OBJETIVOS: Avaliar comparativamente os efeitos de diferentes formulações contendo retinoides na expressão de genes associados a processos biológicos que são alterados com o envelhecimento da pele. MÉTODOS: Peles ex vivo foram topicamente tratadas com diferentes retinoides, micro e nanoencapsulados. A modulação dos processos biológicos associados ao envelhecimento da pele foi medida por PCR quantitativa, precedida de transcrição reversa (RT-qPCR). RESULTADOS: A formulação contendo uma mistura de princípios ativos incorporados em uma tripla nanoemulsão e retinol microencapsulado apresentou os melhores resultados de modulação de genes relacionados a processos biológicos que são normalmente alterados durante o envelhecimento da pele. CONCLUSÃO: Essa associação demonstrou uma maior eficácia terapêutica quando comparada ao uso isolado de tretinoína ou retinol microencapsulado. .

Combined treatment with botulinum toxin and hyaluronic acid to correct unsightly lateral-chin depression* / Tratamento combinado com toxina botulínica e ácido hialurônico para correção da depressão inestética lateral mentoniana

With aging, anatomical changes are observed in the face. In the lower third, these changes are expressed as ptosis of the angle of the mouth, lip enhancement groove mentalis; decrease in concavity between the jaw and neck and very noticeable platysmal banding. The repeated contraction of muscles of the lateral-chin together with the band platysmal side form what are called a marionette groove. Treating the whole lateral-chin area can result in a more harmonious aspect of the face when compared with treatment of a marionette groove in isolation. In this paper we describe combined treatment of the lateral chin area using botulinum toxin and fillers.

Com o envelhecimento observamos mudanças anatômicas na face. No terço inferior essas mudanças se expressam como ptose do ângulo da boca; acentuação do sulco lábio mentoniano; diminuição da concavidade entre a mandíbula e o pescoço e formação de bandas platismais bem evidentes. A contração repetida dos músculos da região latero-mentoniana juntamente com a banda platismal lateral, forma o que chamamos de sulco de marionette. Ao tratarmos toda região latero-mentoniana conseguimos um resultado mais harmônico, quando comparado com o tratamento isolado do sulco de marionette. Nesse artigo apresentamos o tratamento combinado da região latero mentoniana com o uso de toxina botulínica e preenchedores.

Clinical, biometric and ultrasound assessment of the effects of daily use of a nutraceutical composed of lycopene, acerola extract, grape seed extract and Biomarine Complex in photoaged human skin / Avaliações clínica, biométrica e ultrassonográfica dos efeitos do uso diário de um nutracêutico a base de licopeno, extrato de acerola, extrato de semente de uva e Complexo Biomarinho na pele fotoenvelhecida humana

BACKGROUND: The use of nutraceuticals has become frequent in the cutaneous approach to photoaging. OBJECTIVES: To assess the clinical efficacy of a nutraceutical product composed of lycopene, acerola extract, grape seed extract and Biomarine ComplexT in photoaged human skin. METHODS: 50 women, from 35 to 60 years of age, phototypes I to III, were assessed. For 120 days, they associated the nutraceutical product with the use of a sunscreen FPS15. On days 0 (D0), 30 (D30), 60 (D60), 90 (D90) and 120 (D120) they were evaluated and underwent Medical Assessments and Self-Assessment and cutaneous biometric analyses (corneometry, sebumetry and pH-metry) in the skin of the left zygomatic region and the upper medial side region of the left arm; on days 0 (D0), 30 (D30) and 120 (D120) the skin of the same regions was analyzed by ultrasound. On days 0 (D0) and 120 (D120) skin biopsies were performed in the areas where instrumental evaluation was performed (to evaluate collagen and elastic fibers). RESULTS: There was an improvement of the general status of the skin of all volunteers by the Medical and Volunteer Self- Assessments; increased parameters of cutaneous hydration, reduction of pH, increasing of ultrasound density and a histological increment of collagen and elastic fibers (both on the face and arm); there was a reduction of seborrhea (only on the face) CONCLUSIONS: The daily use of a nutraceutical product containing lycopene, acerola extract, grape seed extract and Biomarine ComplexT showed an important adjuvant effect to counteract skin photoaging.

FUNDAMENTOS: O uso de nutracêuticos se tornou uma condição frequente na abordagem cutânea do fotoenvelhecimento. OBJETIVOS: Avaliar a eficácia clínica do uso de um produto nutracêutico a base de licopeno, extrato de acerola, extrato de semente de uva e Complexo BiomarinhoT na pele fotoenvelhecida humana. MÉTODOS: Foram avaliadas 50 mulheres, de 35 a 60 anos de idade, fototipo I a III. Por 120 dias, elas associaram ao uso de fotoprotetor FPS15 a tomada diária do produto nutracêutico em questão. Nos dias 0 (D0), 30 (D30), 60 (D60), 90 (D90) e 120 (D120) elas foram avaliadas, quando sofreram Avaliações Médica e Auto-Avaliação e análises biométricas cutâneas (corneometria, sebumetria e pHmetria) nas peles da região zigomática esquerda e face súpero-medial do braço esquerdos; nos dias 0 (D0), 30 (D30) e 120 (D120) a pele das mesmas regiões foram analisadas do ponto de vista ultrassonográfico. Nos dias 0 (D0) e 120 (D120) biópsias cutâneas foram realizadas nas respectivas áreas das análises instrumentais (para avaliar colágeno e das fibras elásticas). RESULTADOS: Houve melhora do estado geral da pele de todas as voluntárias pelas Avaliações Médica e Voluntária; aumento alterações dos parâmetros cutâneos na hidratação, redução do pH cutâneo, aumento da densidade ultrassonográfica e aumento histológico na densidade colágena e elástica (tanto na face quanto no braço); redução da seborreia somente na face. CONCLUSÕES: O uso diário de um produto nutracêutico a base de licopeno, extrato de acerola, extrato de semente de uva e Complexo BiomarinhoT mostra-se um adjuvante importante na abordagem do fotoenvelhecimento cutâneo.

Topical estradiol does not interfere with the expression of the metalloproteinase-1 enzyme in photo exposed skin cells / Estradiol tópico não interfere na expressão da enzima metaloproteinase-1 em células da pele fotoexposta

BACKGROUND: In postmenopausal women there is a rapid destruction of dermal collagen, resulting in accelerated skin ageing, which is manifested by cutaneous atrophy, increased number and depth of wrinkles and sagging. This accelerated catabolism of the collagen is due to estrogen deficiency and increased synthesis of the metalloproteinase-1 enzyme, which degrades the dermal collagen. OBJECTIVES: To assess whether the use of topical estradiol 0.05% cream on photo exposed skin can inhibit the expression of the metalloproteinase-1 enzyme on the dermis and subsequently the rapid loss of collagen in women after menopause. METHODS: We included 40 postmenopausal women without hormone replacement therapy. Information about lifestyle, lipid profile, blood glucose level, thyroid hormones, mammography, Pap smear and transvaginal ultrasound were obtained to rule out associated diseases. Skin biopsy of the right preauricular region was performed before and after treatment with topical estradiol 0.05% for 30 days. The biopsy specimens were subjected to immunohistochemistry to identify the expression of the metalloproteinase-1 enzyme. RESULTS: There was no statistically significant difference on the expression of the metalloproteinase-1 enzyme in keratinocytes, fibroblasts and endothelial cells before and after treatment with topical estradiol for 30 days. CONCLUSION: Treatment with estradiol 0.05% cream, in photo exposed skin for 30 days, does not inhibit the production of metalloproteinase-1.

FUNDAMENTOS: Na pós-menopausa, ocorre rápida destruição do colágeno dérmico, com consequente envelhecimento acelerado da pele, que se expressa com atrofia cutânea, aumento do número e da profundidade das rugas e flacidez. Esse catabolismo acelerado do colágeno ocorre por deficiência estrogênica e aumento na síntese da enzima metaloproteinase-1, que degrada o colágeno dérmico. OBJETIVOS: Avaliar se o uso de estradiol tópico a 0,05% em creme na pele fotoexposta pode inibir a expressão da enzima metaloproteinase-1 na derme e, consequentemente, a perda acelerada do colágeno em mulheres na pósmenopausa. MÉTODOS: Foram incluídas 40 mulheres na pós-menopausa sem terapia de reposição hormonal. Informações sobre hábitos de vida, perfil lipídico, níveis glicêmicos, hormônios tireoidianos, mamografia, colpocitologia oncótica e ultrassom transvaginal foram obtidas para excluir doenças associadas. Biópsia de pele da região pré-auricular direita foi realizada antes e após tratamento com estradiol tópico a 0,05% por 30 dias. Os espécimes de biópsia foram submetidos à reação imunoistoquímica para identificar a expressão da enzima metaloproteinase-1. RESULTADOS: Não foi observada diferença estatisticamente significativa na expressão da enzima metaloproteinase-1 em queratinócitos, células endoteliais e fibroblastos da pele antes e após tratamento com estradiol tópico por 30 dias. CONCLUSÃO: O tratamento com creme contendo estradiol a 0,05% em pele fotoexposta por 30 dias não inibe a produção da enzima metaloproteinase-1.

Cyclooxygenase-2 inhibitors modulate skin aging in a catalytic activity-independent manner

It has been proposed that the pro-inflammatory catalytic activity of cyclooxygenase-2 (COX-2) plays a key role in the aging process. However, it remains unclear whether the COX-2 activity is a causal factor for aging and whether COX-2 inhibitors could prevent aging. We here examined the effect of COX-2 inhibitors on aging in the intrinsic skin aging model of hairless mice. We observed that among two selective COX-2 inhibitors and one non-selective COX inhibitor studied, only NS-398 inhibited skin aging, while celecoxib and aspirin accelerated skin aging. In addition, NS-398 reduced the expression of p53 and p16, whereas celecoxib and aspirin enhanced their expression. We also found that the aging-modulating effect of the inhibitors is closely associated with the expression of type I procollagen and caveolin-1. These results suggest that pro-inflammatory catalytic activity of COX-2 is not a causal factor for aging at least in skin and that COX-2 inhibitors might modulate skin aging by regulating the expression of type I procollagen and caveolin-1.

Effects of isoflavones on the skin of postmenopausal women: a pilot study

OBJECTIVE: The aim of this study was to evaluate the effects of isoflavones on the skin of postmenopausal women. DESIGN: A prospective study was performed with 30 postmenopausal women before and immediately after the end of treatment with 100 mg/day of an isoflavones-rich, concentrated soy extract for six months. A skin punch was performed in the gluteal region for sample collection before and immediately after the treatment program. Morphometric determination of epidermal thickness, the papillary index (wrinkling), and the amount of dermal elastic and collagen fibers was assessed. In addition, the number of blood vessels in the sample was also evaluated. The paired Student¡¯s t-test was used for statistical analysis (P ¡Ü 0.05). RESULTS: Isoflavone treatment resulted in a 9.46% increase in the thickness of the epidermis in 23 patients. In addition, the papillary index was reduced in 21 women. The papillary index was inversely proportional to skin wrinkling, i.e., there were a large number of papillae after treatment. The amount of collagen in the dermis was increased in 25 women (86.2%). In 22 women (75.8%) we observed that the number of elastic fibers increased. The number of dermal blood vessels was significantly increased in 21 women.CONCLUSION: Our data show that the use of a concentrated, isoflavone-rich soy extract during six consecutive months caused significant increases in epithelial thickness, the number of elastic and collagen fibers, as well as the blood vessels.

Standard guidelines of care for chemical peels.

Chemical peeling is the application of a chemical agent to the skin, which causes controlled destruction of a part of or the entire epidermis, with or without the dermis, leading to exfoliation and removal of superficial lesions, followed by regeneration of new epidermal and dermal tissues. Indications for chemical peeling include pigmentary disorders, superficial acne scars, ageing skin changes, and benign epidermal growths. Contraindications include patients with active bacterial, viral or fungal infection, tendency to keloid formation, facial dermatitis, taking photosensitizing medications and unrealistic expectations. PHYSICIANS' QUALIFICATIONS: The physician performing chemical peeling should have completed postgraduate training in dermatology. The training for chemical peeling may be acquired during post graduation or later at a center that provides education and training in cutaneous surgery or in focused workshops providing such training. The physician should have adequate knowledge of the different peeling agents used, the process of wound healing, the technique as well as the identification and management of complications. FACILITY: Chemical peeling can be performed safely in any clinic/outpatient day care dermatosurgical facility. PREOPERATIVE COUNSELING AND INFORMED CONSENT: A detailed consent form listing details about the procedure and possible complications should be signed by the patient. The consent form should specifically state the limitations of the procedure and should clearly mention if more procedures are needed for proper results. The patient should be provided with adequate opportunity to seek information through brochures, presentations, and personal discussions. The need for postoperative medical therapy should be emphasized. Superficial peels are considered safe in Indian patients. Medium depth peels should be performed with great caution, especially in dark skinned patients. Deep peels are not recommended for Indian skin. It is essential to do prepeel priming of the patient's skin with sunscreens, hydroquinone and tretinoin for 2-4 weeks. ENDPOINTS IN PEELS: For glycolic acid peels: The peel is neutralized after a predetermined duration of time (usually three minutes). However, if erythema or epidermolysis occurs, seen as grayish white appearance of the epidermis or as small blisters, the peel must be immediately neutralized with 10-15% sodium bicarbonate solution, regardless of the duration of application of the peel. The end-point is frosting for TCA peels, which are neutralized either with a neutralizing agent or cold water, starting from the eyelids and then the entire face. For salicylic acid peels, the end point is the pseudofrost formed when the salicylic acid crystallizes. Generally, 1-3 coats are applied to get an even frost; it is then washed with water after 3-5 minutes, after the burning has subsided. Jessner's solution is applied in 1-3 coats until even frosting is achieved or erythema is seen. Postoperative care includes sunscreens and moisturizers Peels may be repeated weekly, fortnightly or monthly, depending on the type and depth of the peel.