Balmy San Diego was the site of the American Academy of Dermatology’s Annual Meeting, where more than 9000 dermatologists from around the world visited with vendors showcasing everything from lasers to skin care formulas. When they weren’t on the trade show floor, derms descended on the San Diego Convention Center Conference rooms to get insights from their peers on the issues impacting their practices.
 

Susan Taylor, MD, opened the hot topics skin care session with an apropos subject—sun protection. She noted that sunscreens do more than provide UV protection. In her research, Taylor reviewed a typical sunscreen formula that contained veinstone and octocrylene. Thirty-two female subjects, ranging from I-III on the Fitzpatrick scale, applied product for 52 weeks.

 
Compared to the placebo group, the sunscreen-wearing group showed improved skin textures, skin clarity, even skin tone, mottled and pigmented skin and crow’s feet, according to professional evaluators.
 

“And the subjects thought so, too!” recalled Taylor.
 

In another 52-week study, subjects apply a broad-spectrum SPF 30 formula. When the year was up, test subjects reported improved tone and pigmentation.

 
“Sunscreen improves the parameters of photoaging,” she concluded. “What else can regular use of sunscreen improve?”
Taylor’s presentation turned to other ingredients found in sunscreen formulas. She noted that licorice glycyrrhiza glabra has anti-inflammation and antioxidant properties.
 

“When fibroblasts treated with licorice were irradiated, there was a 0% increase in ROS,” Taylor noted.

 
What about adding enzymes, specifically DNA-photolyase, to a sunscreen formula? In one study, 35 subjects with actinic keratosis, applied sunscreen containing DNA-photolyase and had a 70% improvement in lesions. Other ingredients also show promise. Test subjects who applied a sunscreen that contained soy showed improvement in skin roughness, blotchiness and luminosity. When vitamins A, C and E were added the soy sunscreen, after 8 weeks of use, there was a significant decrease in melanin production, according to Taylor, who noted that visible light, especially 415nm light, can cause considerable damage
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She also reminded AAD attendees that, despite the controversy surrounding it in consumer circles, 4% hydroquinone remains dermatology’s gold standard for treating pigment disorders.

 
Taylor closed her presentation by sharing the advice she gives all of her patients regarding sun care.

 
“I recommend applying sunscreen, waiting 20 minutes and applying it again,” she told the audience.

 
If consumers take her advice, they surely will get better coverage and sun care marketers will get a big boost in sales, too!
 
 
 
The Power of Three

 
The link between growth factors and cosmetics began in 2002, recalled Amy Taub, MD. During the past 16 years, these materials have become extremely controversial, being blamed for causing cancer. Ironically, growth factors have also been viewed as ineffective because these high molecular weight proteins cannot get past the stratum corneum.
 
 
With those limitations in mind, Taub suggest three alternatives to growth factors:
 
1.   Heparan Sulfate
2.   Tripeptide Palmytoyl
3.   Defensin (a small molecule).

 
Heparan sulfate is a component of the extracellular matrix. This glycosaminoglycan is covalently attached to core proteins to form proteoglycans. Haparan sulfate is much smaller than growth factors and plays a role in skin healing.

 
According to Taub, when a heparin sulfate cream was applied to skin for eight weeks, there was improvement in hydration, firmness and elasticity.
 

Tripeptide Palmytol (Tri-Hex) improves collagen and elastin production and promotes healing.

 
Finally, Defensins are microbiocidal peptides that activate new stem cells. When applied to skin, Defensins (alpha-defensin 5) improves pores, deep wrinkles and superficial wrinkles. It reduces melanin formation, too, according to Taub.

 
Procedurally Speaking…
 
When consumers are looking for more dramatic results than they can get from a cream or serum, they usually turn to the knife. According to estimates, there were 1.8 million surgical cosmetic procedures in 2016 and 15.5 million minimally-invasive procedures. Obviously, there’s a growing market for pre- and post-procedure skin care products, noted Dr. Diane Berson of Weill Medical College of Cornell University.

 
Pre-treatment skin care improves healing and reduces complications. For example, prior to skin peels, skin is cleansed with alcohol.

 
“Now we use hypochlorous acid,” Berson explained. “It is safe and well-tolerated.”

 
She also uses hypochlorous acid after filler injections. She gives her patients post-procedure kits that contain a wash, hypochlorous acid and a silicone balm. The goal is to help hydrate skin.

 
“Growth factors are very popular post-procedure because they boost collagen and elastin production,” according to Berson.

 
By the time a person reaches 50 years of age, skin loses 50% of hyaluronic acid, according to Berson, who noted epidermal lipids contain 2% ceramide, 4% cholesterol and 2% fatty acid. A new material to is conjugated linoleic acid which has been shown to boost moisture levels in skin.
 

Finally, Berson said more patients are interested in sustainability.

 
“All of our patients are looking for sustainable products and ingredients like allantoin, aloe, beeswax and, of course, coconut oil,” she explained.

 
With that in mind, she suggested dermatologists consider hydrolyzed roe enzymes which can exfoliate skin. Berson also promoted heparan sulfate, which supports the extra cellular matrix and decreases transepidermal water loss.
 
 
Break on Through…
 

No matter how powerful the ingredient, if it can’t reach the target, it is of little use to the dermatologist. To that end, Zoe Diana Draelos, MD, reviewed cutaneous delivery systems.

 
“How do we get stuff through the skin?” she asked the audience. “Whether you’re talking about drugs or cosmetics, it’s the same and we have a lot of options.”
 

Physical options include masks, rolling and electric current. According to Draelos, paper masks temporarily hydrate skin, but once removed, TEWL begins immediately. A better option are hydrogel patches that can be loaded with ingredients such as salicylic acid, hydroquinone, aloe vera and even snail mucus.

 
“Polymer is better than paper to reduce TEWL,” she explained. “When worn overnight they hydrate skin to produce a temporary but dramatic reduction in wrinkles.”

 
For those dorms who perform derma-rolls, she recommended applying hyaluronic acid, peptides, growth factors and antioxidants on skin *before rolling.
 

“One word of caution, derma-rolling can deliver anything to skin, it is similar to a laser,” Draelos warned. “You don’t want to deliver preservatives, pigments or emulsifiers into the skin.”
 

Galvanic current, iontophoresis, involves applying a positively-charged (acid pH) serum or gel to skin. The process assists the penetration of any water-based product into the skin.

 
Chemically-speaking, Draelos noted that solvents such as propylene glycol and ethylene glycol destroy the stratum corneum and enable ingredients to penetrate skin.

 
Emulsions, she said, are very effective delivery systems. Most are oil-in-water creams, but newer products include oil-in-water-in-oil (OWO) and water-in-oil-in-water (WOW) formulas. Draelos also highlighted microemulsions and nanoemulsions, noting that the later is better suited for essential oils, ceramides and triglycerides.

 
Microencapsulated delivery systems protect actives such as vitamin D and retinols, which are very light- and oxygen-sensitive ingredients.

 
“Encapsulation is the future of delivery systems,” Draelos concluded.
 
 
A Big Number….
 

Global nutraceutical sales topped $198 billion in 2016 and are expected to reach $285 billion in 2025, according to Patricia Farris, MD, the final speaker of the session.

 
She ticked off a grocery list of products on the market including supplements for skin, hair and nails; vitamins A, D, B and niacin; and minerals like iron, selenium and collagen.