COSMETIC CONSULTATION New Technology Provides Cosmetically Elegant Photoprotection Zoe Diana Draelos, MD; Christian Oresajo; Margarita Yatskayer; Angelike Galdi; Isabelle Hansenne he primary preventable cause of photoaging is United States, as there is no official rating system for exposure to UVA radiation. This wavelength UVA photoprotection yet. T emitted by the sun is present year round in all Ecamsule absorbs UVA radiation in the range of 320 to latitudes. Currently, the majority of sun-protective prod- 360 nm, but its peak absorbance occurs at 345 nm. It is ucts provide excellent UVB protection with minimal UVA typically combined with other organic sunscreen ingredi- protection. Although UVB protection is important in ents, such as avobenzone and octocrylene. Avobenzone, order to prevent sun damage to the skin from occurring, which is a photounstable photoprotectant, becomes UVA protection is equally important. New developments photostable when combined with octocrylene. These in raw material science have led to the manufacture of ingredients yield a photostable broad-spectrum sunscreen novel ingredients able to provide unprecedented photo- combination. However, the active sunscreen agents are protection COSin the UVA spectrum. DERMonly part of the formulation. Also important in sunscreen One of the most significant developments in cutaneous is the construction of the vehicle to deliver the photo- UVA protection was the discovery of ecamsule (Figure 1), protectants in an aesthetically pleasing manner, enticing also known as Mexoryl SX. Mexoryl SX, which has patients to wear the product. Sunscreens fail to be effec- the International Nomenclature of Cosmetic Ingredients tive if they remain in the bottle. name of terephthalylidene dicamphor sulfonic acid, is In order to evaluate the efficacy and tolerability of a water soluble. It is a benzylidene camphor derivative from moisturizing sunscreen containing ecamsule in combina- the familyDo of photoprotectants thatNot is known for excellent tion withCopy avobenzone and octocrylene, a research study photostability. Mexoryl SX was approved by the US Food was executed with a new FDA-approved daily moisturizer and Drug Administration for use as a sunscreen; however, with a sun protection factor (SPF) of 15. it has not been added to the sunscreen monograph. Ecamsule is a unique photostable UVA sunscreen Method ingredient. When a photon of UVA radiation strikes The 12-week, single-center study enrolled 25 healthy, ecamsule, it undergoes reversible photoisomerization nonpregnant female subjects ranging in age from followed by photoexcitation. The absorbed energy is 35 to 65 years who displayed mild to moderate fine lines, radiated from the skin as heat. This transformation of wrinkles, and hyperpigmentation. All subjects signed an UVA radiation into heat prevents photoaging. However, institutional review board–approved informed consent the ability of ecamsule to protect the skin against UVA form and were asked to use a provided cleanser twice radiation cannot be listed on the packaging in the Dr. Draelos is Consultant and Researcher for the Skin Care Industry and Primary Investigator, Dermatology Consulting O Services, High Point, North Carolina. Mr. Oresajo, Ms. Yatskayer, HO S SO H Ms. Galdi, and Ms. Hansenne are scientists, Research and 3 3 Development, all at L’Oréal Recherche, Clark, New Jersey. O Dr. Draelos is a researcher for L’Oréal USA. Mr. Oresajo, Ms. Yatskayer, Ms. Galdi, and Ms. Hansenne are all employees of L’Oréal USA. Research for this study was provided by an unre- stricted educational grant from L’Oréal USA. Figure 1. The chemical structure of ecamsule. 16 Cosmetic Dermatology® • JANUARY 2008 • VOL. 21 NO. 1 Copyright Cosmetic Dermatology 2010. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. daily and the SPF 15 daily moisturizer in the morning. roughness (P5.001). Continued improvement was noted Assessments were performed at baseline and weeks 2, 4, at week 4, with statistically significant improvement in 8, and 12. Measurements included investigator ordinal radiance (P,.001), roughness (P,.001), and overall grading of fine lines, wrinkles, radiance, skin roughness, global assessment (P,.001). Week 8 revealed continued skin tone, hyperpigmentation, and global assessment improvement in skin appearance with statistical signifi- at each visit. The ordinal scale was defined as follows: cance in skin radiance (P,.001), roughness (P,.001), 05none, 0.55very minimal, 15minimal, 1.55very mild, scaling (P5.027), and tone (P5.004) and overall global 25mild, 2.55moderate, 35moderately severe, 3.55severe, and 45extremely Baseline Week 2 Week 4 Week 8 Week 12 severe. The investigator also performed an 2.5 objective assessment of erythema, scaling, and acne in addition to asking subjects for 2.0 † their perception of product-induced itch- † ing and stinging. The previously described * † † ordinal rating scale was used. Subject self- 1.5 assessments were also obtained at each visit † † using the ordinal scale in terms of lines, Mean Data 1.0 † † wrinkles, dryness, redness, color, acne, † † peeling, itching, and stinging. Compliance † was determined from diaries completed by 0.5 † the subjects. The study also incorporated noninva- 0 sive assessmentCOS techniques at baseline and DERMRadiance Roughness Global Assessment weeks 2, 4, 8, and 12. Corneometry, the Figure 2. Grading results showing the improvement of skin radiance and rough- measurement of the water contained in ness and global assessment in patients using a moisturizing sunscreen contain- the skin through electrical impedance, was ing ecamsule in combination with avobenzone and octocrylene from baseline to evaluated along with chromameter mea- week 12. Asterisk indicates clinical significance (P≤.05); dagger, changes based on a scale of 0 to 4, where 05none, 0.55very minimal, 15minimal, 1.55very mild, 25mild, surements in order to evaluate skin redness 2.55moderate, 35moderately severe, 3.55severe, and 45extremely severe. and melanin content. Both readings were taken from the medial cheeks in an area Do NotBaseline WeekCopy 2 Week 4 Week 8 Week 12 representative of the entire face. Digital photographs were obtained for documen- 3.0 tation and showed the face at full-frontal view, 45° to the right, and 45° to the left. 2.5 † Results * 2.0 All 25 female subjects who enrolled suc- † cessfully completed the study. No adverse 1.5 † experiences were encountered during the Mean Data study, providing an excellent tolerability 1.0 profile. All of the ordinal data were ana- lyzed utilizing a 2-tailed, unpaired Mann- 0.5 Whitney T test with significance defined at the level of P≤.05. 0 The investigator noted improvement Skin Tone Hyperpigmentation in a variety of different areas both early Figure 3. Grading results showing the improvement of skin tone and hyper- and late in the study (Figures 2 and 3). pigmentation in patients using a moisturizing sunscreen containing ecamsule At the end of week 2, the investigator in combination with avobenzone and octocrylene from baseline to week 12. noted statistically significant improvement Asterisk indicates clinical significance (P≤.05); dagger, changes based on a scale 5 5 5 5 5 in radiance (P5.029), a visual assess- of 0 to 4, where 0 none, 0.5 very minimal, 1 minimal, 1.5 very mild, 2 mild, 2.55moderate, 35moderately severe, 3.55severe, and 45extremely severe. ment of the reflectivity of the skin, and VOL. 21 NO. 1 • JANUARY 2008 • Cosmetic Dermatology® 17 Copyright Cosmetic Dermatology 2010. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. COSMETIC CONSULTATION assessment (P,.001). Finally, by week 12, the investiga- the use of the SPF 15 daily moisturizer. Similarly, there tor noted improvement in radiance (P,.001), roughness was also a gradual trend toward decreased facial ery- (P,.001), scaling (P5.027), tone (P,.001), pigment thema from 16.23 at baseline to 13.99 at week 12. This is (P5.026), and overall global assessment (P,.001). The noteworthy because it indicated the absence of product- investigator data demonstrated that the SPF 15 daily induced inflammation. moisturizer produced immediate improvement in the appearance of the skin that gradually continued. Comment The investigator data were collaborated by the subject One of the biggest challenges dermatologists face is data. The subjects noted a statistically significant light- convincing patients to wear sunscreen on a daily basis. ening of skin color at weeks 4 (P5.015) and 8 (P5.020) There is no doubt that the best treatment for facial pho- as a result of applying the SPF 15 daily moisturizer. toaging is the prevention of further photodamage and the They also reported a statistically significant (P5.015) creation of a UV-free environment for photorepair. The improvement in skin dryness at week 4. No increase only ingredients that can provide this type of protection in acne, peeling, itching, or stinging, was reported by for the face are sunscreens. Older sunscreen formula- the subjects during the use of the product, yielding an tions contained greasy organic photoprotectants that left excellent safety profile. a sticky, heavy film on the face. Their UVA-protective Noninvasive assessments also confirmed the investiga- abilities were limited along with their photostability. New tor and subject impressions of excellent skin moisturiza- sunscreen ingredients, such as