boards’ fodder Cosmeceuticals Contributed by Elisabeth Hurliman, MD, PhD; Jennifer Hayes, MD; Hilary Reich MD; and Sarah Schram, MD.

INGREDIENT FUNCTION MECHANISM ASSOCIATIONS/SIDE EFFECTS Vitamin A/ Antioxidant (reduces free Affects gene transcription  Comedolysis epidermal thickening, dermal Derivatives (retinal, radicals, lowers concentration differentiation and growth of regeneration, pigment lightening retinol, retinoic of matrix metalloproteinases  cells in the skin acid, provitamin reduces collagen degradation) Side effects: Irritation, erythema, desquamation A, asthaxanthin, Normalizes follicular Elisabeth Hurliman, lutein) epithelial differentiation and keratinization MD, PhD, is a PGY-4 dermatology resident Vitamin C (L Secondary endogenous Ascorbic acid: necessary L-ascorbic acid + alpha-tocopherol (vitamin E)= ascorbic acid, antioxidant in skin cofactor for prolylhydroxylase UVA and UVB protection at University of tetrahexyldecyl and lysyl hydroxylase Minnesota department ascorbate) Lightens pigment Zinc, resveratrol, L-ergothioneine and tyrosine add of dermatology. (affects melanogenesis) L-ascorbic acid: scavenges to vitamin C bioavailability free oxygen radicals, Protects Vitamin E from oxidation stimulates collagen synthesis

Improves skin texture and hydration

May interrupt melanogenesis by interacting with copper ions

Vitamin E/ Primary endogenous antioxidant Prevents lipid peroxidation; Alpha tocopherol is the most physiologically Tocopherols, in skin scavenges free oxygen active isomer Jennifer Hayes, MD, Tocotrienols radicals is a medical and Inhibits clotting, so do not use on Alpha tocopherol inhibits cycloprimidine dimer fresh healing wound formation via p53 tumor suppressor gene cosmetic dermatologist in private practice in Main lipid-soluble antioxidant in May reduce skin cancer Sebastopol, Calif. humans

Flavonoids: soy, Antioxidant Prevents lipid peroxidation; Soy: contains genestein and diadzein curcumin, silymarin scavenges free radicals (phytoestrogens increase skin thickness); (milk thistle UVA/B protection, anticarcinogenic extract), pycnogenol (French maritime Silymarin: contains silybin, silydianin and bark extract) silychristin; UVB protection, anticarcinogenic

Curcumin inhibits NF-kB

Pycnogenol (pine bark extract) contains taxifolin, Hilary Reich, MD, catechin & procyanidins is a dermatologic Co-Q10 Ubiquinone Tertiary endogenous antioxidant surgeon and cosmetic in skin dermatologist, and Ellagic Acid Antioxidant Inhibits UVA-mediated Oral ellagic acid 5% increases sunscreen SPF assistant professor activation of cellular by 25% at the University of pathways in keratinocytes Minnesota department Polyphenols (green All antioxidants Reduces lipid peroxidation; Green tea: contains epicatechin, epicatechin-3- of dermatology. tea, pomegranate, scavenges free radicals gallate, epigallocatechin, and epigallocatechin- resveratrol) Resveratrol is also an anti- 3-gallate; UVA/B protection, antiangiogenic, inflammatory anti-carcinogenic

Pomegranate: contains pantothenic acid, alkaloids, polyphenols and ellagic acid

Resveratrol: phytoestrogen-like effect, found in grapes, cranberries, blueberries, bilberries & peanuts

Aloe Vera Anti-inflammatory May decrease the following: Mucilage (active plant ingredient) contains choline Sarah Schram, MD, cyclooxygenase and choline salicylate is a dermatologic and lipoxygenase, proinflammatory cytokines Active ingredients: salicylic acid, surgeon and cosmetic and UVB-induced PGE2 carboxypeptidase, polysaccharides and aloesin dermatologist in private release by keratinocytes practice in Tuscon, May cause allergic contact dermatitis Ariz., and affiliated faculty member at Gingko Anti-inflammatory Not known Contains bilobalides, gingkolides, gingkolic acid University of Minnesota.

irectionsin D­Residency p. 1 • Fall 2015 boards’ fodder Cosmeceuticals Contributed by Elisabeth Hurliman, MD, PhD; Jennifer Hayes, MD; Hilary Reich MD; and Sarah Schram, MD.

INGREDIENT FUNCTION MECHANISM ASSOCIATIONS/SIDE EFFECTS

Licorice Extract Lightens pigment Disperses melanin and Contains liquiritin and isoliquertin, which disperse (glabridin) inhibits tyrosinase melanin and glabridin which inhibits tyrosinase

Kojic Acid Lightens pigment Inhibits tyrosinase Hydrophilic fungal derivative

Aloesin Lightens pigment Inhibits tyrosinase Hydroxymethylchromone inhibits tyrosinase competitively

Arbutin Lightens pigment Inhibits tyrosinase; may Gluconopyranoside inhibit melanosome maturation

Selenium Antioxidant Cofactor for glutathione Protects against UV-induced erythema and skin peroxidase and thioredoxin cancer in mice reductase

Zinc Antioxidant May replace harmful redox Reduces UV-induced sunburn in mice active elements.

May induce synthesis of free radical scavengers

Ferulic Acid Antioxidant Reduces lipid peroxidation, UV absorber, synergistic with vitamins C, E and (4-hydroxy-3- scavenges free radicals beta-carotene methoxy-cinnamic acid)

Arnica Anti-inflammatory Not known Reduces bruising, may help wound healing; may cause allergic contact dermatitis (Compositae family)

Matrikines Regulatory peptide factors

Niacinamide Anti-inflammatory; collagen Inhibits mast cell histamine Increased collagen synthesis in-vitro and regulator (affects fibroblast release normalization of glycosaminoglycan synthesis metabolism) Increases collagen and Lightens pigment ceramide synthesis

Copper Cofactor Regulates collagen Transport protein cofactor; Functions with zinc  changes dermal fibers activates collagen synthesis (more discrete, less clumped)

References: 1. Baumann, L. (2007). Less-known botanical cosmeceuticals. Dermatologic Therapy, 20(5), 330-342. 2. Bowe, W.P. & Pugliese S. (2014). Cosmetic benefits of natural ingredients, Journal of Drugs in Dermatology 13 (9), p. 1021-1025. 3. Bruce, S. (2008). Cosmeceuticals for the attenuation of external and intrinsic dermal aging. Journal of Drugs in Dermatology, 7 (2 suppl), s17-22. 4. Draelos ZD (2012). Cosmetics & cosmeceuticals. In: Bolognia JL, Jorizzo JL & Schaffer JV (2012, Ed). Dermatology, Ch. 153, Elsevier, Saunders. 5. Geng A & Dufresne Jr. R.G. (2012). Complementary & alternative medicine. In: Bolognia JL, Jorizzo JL & Schaffer JV (2012, Ed). Dermatology, Chapter 133, Elsevier, Saunders. 6. Kerscher, M. & Buntrock, H. (2011). Update on cosmeceuticals. Journal der Deutschen Dermatologen Gesellschaft, 9(4), 314-326. 7. Roy K. & Forman S.B. (2013). Miscellaneous topical agents. In: Wolverton, SE (Ed). Comprehensive Dermatologic Drug Therapy, Chapter 55, Elsevier, Saunders. 8. Sami N. (2013). Topical retinoids. In: Wolverton, SE (Ed). Comprehensive Dermatologic Drug Therapy, Chapter 41, Elsevier, Saunders.

irectionsin www.aad.org/DIR Fall 2015 • p. 2 D­Residency