Trends in Aesthetics: Beyond Ultraviolet Light
As dermatology expands its understanding of aesthetics and aging, an increasing body of scientific and clinical evidence highlights the key role that atmosphere and pollution play in skin health, wellness, and aging. Oxidative stress injury to skin cells and tissues play a central role in skin health and wellness.
Our research team has published on the important role that UV light has in terms of damaging skin tissue at the cellular, molecular, and structural level that translates to visible and tangible evidence of skin aging. Using a panel of immunohistochemical assays, our team demonstrated that oxidative injury results in damage to lipids that serve a key role in skin barrier protection in the stratum corneum; and damages DNA and proteins in the dermis.1 Oxidative DNA damage is associated with both aging and skin cancers. Therefore, prevention of oxidative stress is essential and may decrease signs of skin aging and lower the risk for skin cancer.
Previously, the understanding of environmental assaults to skin was limited to UV radiation damage. It is crucial that dermatologists embrace the fact that skin aging extends beyond UV-induced skin damage alone. Significant attention has recently centered around how atmospheric conditions, including pollution and ozone, contribute to skin health, wellness, appearance, and disease.
Atmospheric Skin Aging
Atmospheric skin aging is a collective term for visible aging caused by regular exposure to a combination of sun and pollution. Particulate matter and ozone contribute to aging skin and increases in hyperpigmentation, wrinkling, rough texture, dullness, and laxity. One of the key aspects to appreciate is that various environmental factors that extend beyond UV damage also increase cellular reactive oxygen-free radicals in skin tissues, resulting in oxidation and changes consistent with molecular and clinical features associated with extrinsic aging.
Ozone has an important role in the extrinsic aging process. Ozone, once widely discussed in the 1980s and 1990s in environmental discussions, is now making new waves in the skin health arena because of the impact on aesthetics. Ozone is a highly reactive gas that occurs due to natural and man-made processes. Globally and nationally, ozone is often highest in densely populated urban areas. Suburban and rural areas may also feature high amounts of ozone. Ozone occurs in the Earth’s upper (stratosphere) and lower (troposphere) atmospheres. At ground level, in the Earth’s lower atmosphere, ozone is created by pollutants emitted by cars, power plants, industrial processes, and other sources. In addition to ozone serving as a source of skin aging, there is evidence that ozone may serve as a carcinogen.
A significant portion of our laboratory’s research efforts have centered around the study of antioxidants, alone and in combination, to counter skin oxidative stress. This field of scientific study is important to our specialty and our patients. Nearly all of the treatments that include antioxidants fall within the burgeoning category of cosmeceuticals. When recommending cosmeceutical products to friends, patients, and colleagues, I highlight products that have a cohesive and meaningful scientific story complete with documented clinical results that support use and will yield clinical patient benefit.
Recent research demonstrates that ozone damages skin cells, depleting the natural antioxidants, in particular, vitamins C and E, leaving the skin vulnerable to harmful environmental agents. Published in vitro and in vivo translational and clinical research emphasizes that ozone and other environmental factors that harm the skin can be mitigated. When paired with SkinCeuticals broad-spectrum sunscreens, both antioxidants provide comprehensive protection against appreciable signs of aging caused by exposure to ozone and pollution. Research2-4 conducted in partnership with academician Giuseppe Valacchi, PhD, a leading expert and researcher in the study of ozone, and cosmeceutical company SkinCeuticals, has for the first time demonstrated in live skin 3-D cultures and in vivo that ozone pollution may cause extrinsic skin aging. Dr Valacchi’s findings indicate that the application of antioxidants CE Ferulic and Phloretin CF helped prevent and reduce cellular damage caused by ozone exposure. Both CE Ferulic and Phloretin CF protected against ozone-induced type III collagen degradation.
Based upon years of clinical research, we know that a daily regimen of well-studied and clinically-proven antioxidant serum combined with a broad-spectrum sunscreen daily will provide comprehensive skin protection from UV and atmospheric aging. As dermatologists, educating and empowering patients to prevent skin aging and skin cancer is the critical first step toward healthy skin.
Extending beyond antioxidants, devices have an important role in aesthetic and medical dermatology. As a laser surgeon, I can share that patients can benefit tremendously from treatment with ablative and nonablative lasers and other impactful energy-based devices. One of the most exciting developments in medical and aesthetic skin therapy is the increasing use of light emitting diodes for the treatment of dermatologic conditions, including skin rejuvenation and wound healing.5