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The Skin your customers are in

By Yousry Naguib, Ph.D.

Vitamin Retailer magazine, Nov. 2005

As we age, gravity takes its not-so-gentle toll on our appearance, causing muscles to loosen, collagen to degrade, and skin to start sagging and sliding. Skin is the largest and most noticeable organ in the body; it’s a gatekeeper for everything inside the body. The skin, capable of self-regeneration, is the only organ in the human body that is constantly exposed to the external environment. In addition to providing the body with a protective barrier, it also combats bacterial and viral pathogens, protects against physical and chemical assaults, contains sensory organs which assist with regulatory functions, and helps to regulate body temperature through sweat glands.

Human skin consists of two major layers – the outermost thin layer “epidermis” and the inner thick layer “dermis.” The vascular epidermis serves as protection against the environment and assists in maintaining homeostasis. The epidermis itself is made up of epithelial tissue and is rich in keratinocytes that provide keratin, which is a typical protein that provides some rigidity to the skin. The epidermis is in a constant state of repair.

The dermis is made up of connective tissue which contains the extra cellular matrix (ECM). ECM is composed primarily of type I collagen (natural protein that forms the connective tissues), which is responsible for the strength and structural integrity of the skin. The space between the cells in the ECM is filled with hyaluronic acid (HA), which plays an essential role in cellular hydration, allows for the proper transfer of nutrients, facilitates intracellular communication, and improves elasticity of the skin [1]. The dermis also contains blood vessels, sensory cells, hair follicles and sweat glands.

The belief that skin is the outer reflection of a person’s inner being may explain why Americans spend millions of dollars on skin care products. The major skin problems include wrinkles, eczema, acne, Psoriasis, and athlete’s foot.

Wrinkles- as we age fine lines start to bracket our mouth and radiate out from the corners of our eyes. These early aging signs get more noticeable as our skin gets dryer and less elastic over time.

To address skin aging, skin creams containing antioxidants such as Coenzyme Q10, vitamin E and vitamin C, DMAE (dimethyl amino ethanol), astaxanthin, and alpha-lipoic acid have been developed. In addition, supplements containing hyaluronic acid (HA) are becoming increasingly popular in recent years. Hyaluronic acid, also referred to as hyaluronan, is a ubiquitous polysaccharide present at high concentrations in cornea, skin, and joints.

Hyaluronic acid (HA) was first isolated by Meyer and Palmer in 1934 from the vitreous of bovine eyes [2], which was later identified as a high molecular weight (600,000-10,000,000 daltons) glycosaminoglycan- polysaccharide formed by repeating disaccharide units consisting of N-acetylglucosamine and glucuronic acid. A Dalton is an arbitrary unit of measurement used in science.

HA possesses two major molecular characteristics that contribute to its physiological functions: its unique ability to retain water, and its instructive effects on cell signaling and behavior (adhesion, migration and proliferation). HA has been widely used for osteoarthritis, ophthalmology, and cosmetics for skin care.

The largest amount (approximately 50%) of HA in our body resides in skin tissue, where it is synthesized primarily by dermal fibroblasts and by epidermal keratinocytes. When the amounts of HA in the skin tissues decrease due to aging, the water retention and resilience of skin will be lost, thereby causing rough skin, and fine wrinkles. To help compensate for the decline in HA with aging, HA containing dietary supplement products from natural sources such as rooster combs and certain bacterial cultures have been developed.

Natural HA molecules have comparatively large molecular weight and are not easily absorbed in the body. A low molecular weight (50,000 daltons to 200,000 datlons) HA, extracted from rooster combs, called “Injuv®” containing 9% HA, has been developed for oral consumption. Injuv® has been demonstrated to make the skin feel soft due to its ability to retain moisture in the ECM in the skin. In a clinical study conducted at Ostuma University in Japan, 96 women, aged 22 to 65 years, were given 6 capsules; each containing 70 mg Injuv® standardized to 9% HA, for 45 days. Each subject was instructed to complete a subjective questionnaire at the end of the study. Eighty subjects reported improvement in skin moisture and smoothness.

Another natural source of HA is collagen II, which is found predominantly in articular cartilage. Products based on collagen II, such as Biocell Collagen-II (hydrolyzed sternum chicken collagen type II protein) containing 10% HA and UC-II (undenatured sternum chicken collagen type II) are also sold as dietary supplements.

For years, Japanese women have been drinking skin care elixirs comprised of a porcine collagen, seaweed extract, HA, and dermatantic acid among other nutrients to make their skin youthful and vibrant. This drink is known as Toki, the Japanese _expression which means, "You have a smooth, radiant, porcelain-like skin."

In a clinical study, 40 women (aged 35 to 65 years) who consumed Toki for 60 days showed significant improvements in dermatological assessment parameter, including radiance, and appearance of fine lines and wrinkles.

Hormones play a central role in skin appearance and are implicated in skin aging. The anti-aging properties of a date palm kernel extract rich in phyto-hormones was examined in ten healthy women volunteers, ages 46 to 58, who applied either a cream containing 5 percent date palm kernel or placebo on the eye area twice a day for five weeks. Clinical evaluation showed that topical application of date palm kernel reduced the total surface of wrinkles by 27.6 percent, and reduced the depth of wrinkles by 3.52 percent [3].

The antioxidant carotenoid “astaxanthin” in combination with tocotrienols has been shown in a recent study in Japan to provide significant improvement in fine wrinkles and pimples and in moisture levels in subjects with dry skin in two to four weeks. Astaxanthin in combination with glycosaminoglycans and omega-3 fatty acids is also reported to improve skin hydration, elasticity, skin tone and fine lines.

Eczema- a particular type of inflammatory reaction of the skin in which there are typically vesicles (a small fluid-filled blister) in the first stage, followed by swelling, bumps, crusting, and scaling of the skin. Eczema characteristically causes itching and burning of the skin. There are numerous types of eczema; the most common ones are: atopic dermatitis – a chronic skin disease characterized by itchy, inflamed skin; and contact eczema – a localized reaction that includes redness, itching, and burning where the skin has come into contact with an allergen (an allergy-causing substance) or with an irritant such as an acid, a cleaning agent, or a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions.

For many people, eczema has become a life-long struggle to control its symptoms. Although a number of treatments have been successful in managing the discomfort of eczema, no one treatment has safely or effectively worked for everyone. It is important to keep the skin from drying out by the application of moisturizers and emollients. Dietary supplements can also help relief symptoms of eczema.

Research has shown that people with eczema tend to have a deficiency in the fatty acid gamma-linolenic acid (GLA). GLA is found in evening primrose (EPO), borage oil, and black currant seed oil. In the body, GLA is converted to a hormone-like substance called prostaglandin E1, which has anti-inflammatory properties. Some, but not all, clinical trials have shown that EPO and borage oil are useful in the treatment of eczema. A Japanese topical ointment called Shiunko has been reported to help improve symptoms of eczema. The ointment contains sesame seed oil and four herbs: Lithospermum radix, Angelica radix, Cera alba, and Adeps suillus. The ointment when applied to the skin of atopic dermatitis patients twice daily for three weeks reduced bacteria counts in four of the seven people using Shiunko. The results suggest that Shiunko may be an effective treatment for atopic dermatitis and skin infections caused mainly by the bacteria Staphylococcus [4].

Researchers in Japan examined Kampo formulas, along with dietary advice, in 95 patients with recalcitrant (resistant to microbial attack) atopic dermatitis. The overall result was “markedly effective” in 19 patients, “moderately effective” in 33, “slightly effective” in 36 and “ineffective” in four patients. The most commonly used formula was Hochuekki-to which contains Astragalus root, liquorice, jujube, ginseng, white Atractylodes rhizome, fresh ginger and Chinese Angelica root [5].

A recent randomized, placebo controlled, double blind study at the Freiburg University in Germany examined the therapeutic efficacy of St. John’s wort in treating atopic dermatitis. In this study 18 patients suffering from mild to moderate atopic dermatitis were treated with a cream containing Hypericum extract standardized to 1.5% hyperforin (verum) or placebo twice daily over a period of four weeks. The eczematous lesions improved significantly with St. John’s wort cream compared to the placebo [6].

Leaves and bark of witch-hazel are commonly used in herbal medicine. Topical cream of witch-hazel is used in Europe to treat inflammatory skin conditions such as eczema. One double-blind trial found that a topical witch-hazel ointment (applied four times daily) was as effective as bufexamac anti-inflammatory cream for people with eczema [7]. However, another trial found that witch-hazel was no better than placebo when compared with hydrocortisone for people with eczema [8].

Acne- a common skin change that occurs during the teen years and may persist into adulthood. Acne may vary in severity from a few blackheads to severe cystic lesions; it may be present on the face and neck as well as the chest and back. Acne results from a combination of hormone stimulation and overproduction of oils in the sebaceous glands of the skin. It affects nearly 17 million people in the United States; boys often have more severe outbreaks of acne than girls.

Acne is normally treated by combination of three ingredients: alpha hydroxy acid (such as glycolic acid), retionoids or vitamin A derivatives, and benzoyl peroxide.

Other non-prescription products include salicylic acid, Melaleuca alternifolia (tea tree oil), Urtica dioica (as an infusion consumed two or three times a day), and Calendula officinalis (applied topically as a wash, infusion mixed with witch hazel). A double-blind study compared the topical use of 5% tea tree oil to 5% benzoyl peroxide and found that, although the tree oil was less potent, it had fewer side effects [9].

Psoriasis- a chronic skin condition characterized by patches of silvery scales that cover areas of reddish skin. They often appear on the scalp, knees, elbows, buttocks, genitals, and nails. Psoriasis may be, at least in part, an autoimmune disorder (where the immune system falsely recognizes portions of the body as "foreign").

Purified eicosapentaenoic acid (EPA, one of the fatty acids found in fish oil) at an oral dosage of 3.6 grams per day was found to reduce the severity of psoriasis after two to three months [10].

In a clinical study on 49 patients with psoriasis, treatment of the psoriatic skin with Oregon grape (Mahonia aquifolium) ointment for four weeks showed a marked reduction in the _expression of activation molecules in the skin of patients with moderate psoriasis but not more severe cases [11].

A double-blind trial found that topical application of an aloe extract (0.5%) in a cream was more effective than placebo in the treatment of adults with psoriasis. The aloe cream was applied three times per day for four weeks [12].

Athlete's Foot- a fungal infection of the feet. Its symptoms include a red itchy rash with flaking or peeling that starts between the toes. The feet often emit a strong smell. Generally, athlete's foot does not cause serious problems and can be treated with non-prescription medications.

Tea tree oil has been traditionally used to treat athlete's foot. One trial reported that application of a 10% tea tree oil cream reduced symptoms of athlete's foot just as effectively as drugs and better than placebo, although it did not eliminate the fungus.
The compound ajoene, found in garlic, is an anti-fungal agent.

In a group of 34 people using a 0.4% ajoene cream applied once per day, 79% experienced complete clearing of athlete's foot after one week; the remainder had complete clearing within two weeks [13]. All participants remained cured three months later. One trial found a 1% ajoene cream to be more effective than the standard topical drug terbinafine treating athlete's foot [14].

Natural remedies seem promising in treating a wide variety of skin disorders, including wrinkles, acne, eczema, psoriasis, and athlete’s foot. In order to keep skin healthy and radiant, it needs both external and internal care.

References

[1] Sakai S. et al. Hyaluronan exists in the normal stratum corneum.
J Invest Dermatol. 2000; 114:1184

[2] Meyer K, Palmer JW. The polysaccharide of the vitreous humor.J Biol Chem 1934; 107:629

[3] Bauza E et al. Date palm kernel extract exhibits anti-aging properties and significantly reduces skin wrinkles. Int J Tissue React 2002; 24:131

[4] Higaki S et al. Efficacy of Shiunko for the treatment of atopic dermatitis. J Int Med Res 1999; 27:143

[5] Kobayashi H, Mizuno N, et al. Diet and Japanese herbal medicine for recalcitrant atopic dermatitis: efficacy and safety. Drugs Exp Clin Res 2004; 30:197

[6] Schempp CM et al. Topical treatment of atopic dermatitis with St. John’ wort cream—a randomized, placebo controlled, double blind half-side comparison. Phytomedicine 2003; 10 Suppl 4:31

[7] Swoboda M, Meurer J. Treatment of atopic dermatitis with Hamamelis ointment. British Journal of Phytotherapy 1991; 2:128

[8] Korting HC, Schafer-Korting M, Klovekorn W, et al. Comparative efficacy of Hamamelis distillate and Hydrocortisone cream in atopic eczema. European Journal of Clinical Pharmacology 1995; 48:461).

[9] Bassett IB, et al. A comparative study of tea tree oil versus benzoylperoxide in the treatment of acne. Med J Aust. 1990; 153:455.

[10] Kojima T et al. Long-term administration of highly purified eicosapentaenoic acid provides improvement of psoriasis. Dermatologica 1991; 182:225

[11] Gulliver WP, Donskt HJ. A report on three recent clinical trials using Mahonia aquifolium 10% topical cream and a review of the worldwide clinical experience with mahonia aquifolium for the treatment of plaque psoriasis. Am J Ther 2005; 12:398

[12] Syed TA et al. Management of psoriasis with Aloe vera extract in a hydrophilic cream: a placebo-controlled, double-blind study. Trop Med Int Health 1996; 1:505

[13] Ledezma E et al. Efficacy of ajoene, an organosulphur derived from garlic, in the short-term therapy of tinea pedis. Mycoses 1996; 39:393

[14] Ledezma E et al. Efficacy of ajoene in the treatment of tinea pedis: a double-blind and comparative study with terbinafine. J Am Acad Dermatol 2000; 43 (5 Pt 1):829

 

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