Journal of Clinical and Aesthetic Dermatology

JUN 2017

An evidence-based, peer-reviewed journal for practicing clinicians in the field of dermatology

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46 JCAD journal of clinical and aesthetic dermatology June 2017 • Volume 10 • number 6 R E v I E W growth factor for the treatment of actinic purpura when applied twice daily for six weeks (n=6). 1 2 Ultrasound measurements indicated a mean (seM) skin thickening of 195.2 (35.7) µm while the mean number of purpuric lesions decreased from 15 (4.6) to 2.3 (0.7) over the same time period. NEW MOISTURIZING BRUISE FORMULA a new moisturizing bruise product (DerMend ® , Ferndale healthcare) has been formulated specifically for the treatment of actinic purpura. this product contains ingredients that effectively treat actinic purpura by improving local circulation, thickening the skin, and repairing the skin barrier. each of these ingredients and their known beneficial effects are described in detail below. Retinol. numerous studies have demonstrated the beneficial effects of topical retinol, a precursor of retinoic acid. In one study, retinol 0.1% was applied to the skin of healthy women 35 to 55 years old (n=41) every other day for two weeks, then daily for 10 additional weeks. this treatment increased epidermal thickness, and upregulated genes for collagen type 1, and collagen type 3 with corresponding increases in procollagen I and procollagen 3 protein expression and a significant reduction in facial wrinkles. 20 similarly, the topical application of 0.1% retinol in another study increased keratinocyte proliferation and epidermal thickness and improved major signs of skin aging. 2 1 a 52-week, double-blind, vehicle-controlled study demonstrated the ability of a retinol 0.1% formulation to significantly improve the appearance of photodamaged skin including a 44-percent improvement in lateral canthal fine lines and an 84-percent improvement in the appearance of mottled skin. 22 histology studies demonstrated increased expression of type 1 procollagen, hyaluronan, and Ki67, a marker for cell proliferation. When combined with a vitamin c- containing moisturizer, the application of topical retinol 0.1% for 12 weeks improved the appearance of women with mild- to-moderate hyperpigmented and photodamaged facial skin. 23 While no study has assessed the effects of retinol for the treatment of actinic purpura, the combination of topical 0.3% retinol and 1% vitamin K shortened the duration of laser- induced purpura when applied for two weeks prior and two weeks after undergoing treatment with a pulsed dye laser. 24 Alpha hydroxy acids. DerMend contains glycolic compound 4.4, a combination of glycolic acid and ammonium glycolate. Products containing the α-hydroxy acids glycolic acid and lactic acid and the b-hydroxy acid salicylic acid have been used for treating cosmetic skin conditions, such as seborrheic keratoses, melasma, actinic keratoses, and verrucae vulgares, and the rejuvenation of photoaged skin, for many years. 2 5,26 In vitro studies have shown that dermal fibroblasts grown in the presence of glycolic acid for 24 hours resulted in increased collagen production. 27 clinically, measured improvements in skin quality include decreased skin roughness, skin dryness, discoloration, solar keratoses, and overall pigmentation, increased collagen I and procollagen I, and improved quality of elastic skin nbers. 25,28,29 the long-term use of an α-hydroxy acid-containing product resulted in significant clinical improvements in facial skin tone and fine wrinkling, which were associated with psychosocial benefits. 30 Arnica oil. arnica oil is derived from the medicinal plant Arnica montana L. extracts of A. montana are rich in flavonoids and phenolic acids and demonstrate antioxidant activity in vitro and protection against oxidative damage in fibroblast- like cells. 31 the topical application of an A. montana- containing gel demonstrated beneficial effects on experimental wound healing in an animal model 32 and an A. montana- containing ointment improved pulsed-dye laser-induced bruising in human volunteers. 33 Ceramides. the barrier function of the stratum corneum is dependent on the presence of a lipid matrix that includes the epidermal sphingolipid ceramides. 34,35 as a result of skin barrier defects, up to 75 percent

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