I AMMONIO LATTATO "ATTIVATO" LA RISPOSTA DERMATOLOGICA ALLE IPERCHERATOSI

Ipercheratosi intrinseca Ipercheratosi estrinseca

"ACTIVATED" AMMONIUM LACTATE THE RIGHT REPLY TO HYPERKERATOSIS

Emulsione - Ammonio Lattato 14%

Emulsione - Ammonio Lattato 8%

Ammonio Lattato 7%

i Oli i lineari e ramificati - Ammonio Lattato 5%

\Wcw n u localmente 2 volte al dì.

A NEW MAVICEUT/CAl®

Dermatologically tested

• Effective for initial .and maintenance therapy (1•2

•3l

• Compatible with all the drugs and cosmetics • Formulated to treat mild-to-moderate inflammatory acne, indispensable for patients with sensitive skin

REDUCTION OF SURFACE LIPIDS DURING THE TREATMENT WITH KERATOTAL ACNE

go..-- -n ·_ lO ___ P_<0_005_Wl_il*lg~uMeoted------

z 60+---------0

t so+-------=> fil 40+-----0::

';!! 30+--->---

20

10

10 15 20 25 giorni

I lii Untreated lii Treated l 30

=> Decreases the Squalene content of acne affected skin

EFAITG

0,5

=> Significantly reduces EFAITG ratio

CLINICAL RESUL TS<1•2

•3

,

ACTIVITY CARRIED OUT BY KERATOTAL ACNE ON THE LINOLEIC ACID ANO SQUALANE CONTENTS OF SURFACE

LIPIDS IN SUBJECTS AFFECTED BY ACNE JUVENILIS

4,0

3,5

~ 3,0

~ 2,5

!Z 2,0

~ 1,5 z 8 1,0

..,. 0,5

n=30

6 settimane

lliil Squalene • Llnoleic Acid l => Reduces excess lipids

10 12

z 90+------------------~ o ~ 85

~ 80+-------------~ J: z 75+-------+-------~

:;:: ~ 70+--------#-------~

WEEK1 WEEK2

::> lncreases skin hydration by 97%

Please see a brief summary of prescribing information on next page ~

KfRATOJ'ALACNE. THE GENTLE ANTIACNE TREATMENT WITH NO-DRUG CONTENT

For more information cali to: Mavi Sud Sri V.le dell'Industria 1 04011 Aprilia (LI) ltaly Tel.+39.6.92.86.261 Fax +39.6.92.81.523 E-Mail:mavi@colosseum.it URL=http://www.colosseum.it/st81/mavi

REFERENCES: 1,2 - Data on file Mavi Sud

BRIEF SUMMARY

DESCRIPTION Keratotal Acne is a special fat-free lamellar phosphatidylcholine emulsion developed for the treatment of acne. lt is delivered in a special phospholipidic-vehicle linoleic acid rich which contains glicolic acid and salicilic acid partially neutralized by a special patented blend of aminoacids

INDICATIONS Keratotal Acne is indicated for the treatment of acne. Absolutely necessary as a cosmetic substitute or support in pre­summer and summer periods, when treatment with conventional keratolitic agents (benzoil peroxide, retinoic acid, ecc.) is not recommended. Penetrates pores to eliminate excess sebum, most acne blemishes, acne pimples, blackheads and whiteheads in a short period treatment. lts continously use helps to prevent the development of new acne efflorescences

ADVERSE REACTIONS In the first days of application transient effect such as stinging or itching may be observed

HOWTOUSE Twice a day. Before applications cleanse the skin thoroughly; if stinging occurs, reduce application to once a day for the first ten days of treatment

3 - M. Ghiczy, H.P. Nissen, H. Biltz (1996) The treatment of Acne Vulgaris by phosphatidilcholine from Soybeans, with a high conteni of linoleic acid. J. Appl. Cosmetol. 14, 137-145

A NEW MAVICEUTICAL®

Lip protective with Glycoaminoacids<*> INDICATIONS

Cosmetic adjuvant in all the forms of cheilitis and lips dryness caused by:

•Retinoids • • • • UV rays • • • • Wind • • • • Weather • • • • Environmental pollutants • • •

HOW TO USE

Such as Cheilitis or chapped lips Actinic cheilitis (acute and chronic) Allergie cheilitis ,Exfoliative cheilitis Angular cheilitis

Use day and night as a regular lipstick

(*) partially neutralized by a special patented blend of aminoacids

Please see a brief summary of prescribing information on next page

~

KERATOTAlLABBRAM Lip protective with Glycoaminoacids<·> IN ALL THE DISORDERS OF THE MUCOCUTANEOUS INTEGUMENT OF THE LIPS

For more information cali to: Mavì Sud Sri V.le dell'Industria 104011 Aprilia (Lt) ltaly Tel. +39.6.92.86.261 Fax +39.6.92.81.523 E-Mail:mavi@colosseum.it URL=http://www.colosseum.it/st81/mavi

(•)partially neutralized by a special patented blend of aminoacids

BRIEF SUMMARY

DESCRIPTION Keratotal Labbra is a fast­a c ti n g, uncoloured treatment to protect the lips from premature ageing and skin cancer due to UV rays. lt helps to keeps the lips very moist and well protected from the dryness caused by UV, wind, weather and environment.

INDICATIONS In ali forms of dryness caused by the use of retinoids or other drugs, or by environmental pollutants. To avoid the premature lips ageing caused by UV activity.

ADVERSE REACTIONS No adverse reactions to the use of this product are known.

HOWTOUSE Apply as a regular lipstick. Keratotal Labbra is intended for round-the-clock use.

PUfOLIC® Integratore dietetico

di acido folico, magnesio e di acidi grassi polinsaturi 0)-6 ed ro-a

20capsu/e

BRIEF SUMMARY

what?

when?

where?

why?

How to use

tn7. mav1

THE EVOLUTION IN COSMETIC SCIENCE

PUFOLIC® Dietary supplement with Folic Acicl, Magnesium ancl Polyunsaturatecl Fatty Acicls omega-6 ancl omega-3

Dietary supplement with Folic Acid, Magnesium and Polyunsaturated Fatty Acids omega-6 and omega-3, which have a high content of DHA (docohexaenoic acid).

Fundamental for an optium development of the brain and retinai

structures in the fetus.

• Activates synapsis and promotes neuron growth;

• controls erythropoiesis;

• optimizes membrane formation by protecting the internal

structures of cells; • acts within the synthesis of proteins, particularly keratins,

thanks to its optimum, balanced content of folic acid, magne­

sium, omega-6 and omega-3 (DHA) in 1 :4 ratio.

Before, during and after pregnancy, to prevent deficiencies due

to poor intake, absorption and use of FOLIC ACID, OMEGA-6,

OMEGA-3 and MAGNESIUM

and to reduce the risk of • functional neurologie disorders in the fetus;

• spina bifida;

• gestational hypertension;

• uterine hypercontractility;

• skin diseases (psoriasis, atopic eczema, alopecia, etc.);

• imbalances among HDL, LDL, VLDL and cholesterol that may

be caused by a deficiency in the above essential nutrients.

1 to 2 capsules daily, according to a physician's directions.

For more information cali to: Mavi Sud Sri - Viale dell'Industria, 1 Aprilia (LT} ltaly Te/. +39.6. 92.86.261 - Fax +39.6. 92.81.523 E-Mail:mavi@colosseum.it URL:http://www.cofosseum.it/stB 1 / mavi

Trimestrale di Dermatologia Cosmetologica Quarterly Review of Cosmetic Dermatology

EDITOR

ASSOCIATE EDITOR

ASSISTANT EDITOR

SECRETARY EDITOR

EDITORI AL AOVISORY BOARO

P.MORGANTI PhD. SECRETARY GENERAL INTERNATIONAL SOCIETY of COSMETIC DERMATOLOGY Via Innocenzo Xl, 41 - 00165 Roma (haly) • Fax +39-6-63.80.839

S.D. RANDAZZO M.D. Profcs.<;or of DERMATOLOGY UNIVERSITY OF CATANIA Via lacona, 7 • 95124 Ca1ania (haly) ·Fax +39-95-7159894

M.B.JAMES M.D. PROGRAM DIRECTOR INTERNATIONAL SOCIETY of COSMETIC DERMATOLOGY JAMES CLINIC Sui1c 1076 Tanncry Lane Camdcn. Maine 04843 USA· Fax 001-407-9972137

M. PASCOLI Via Innocenzo Xl, 41 · 00165 Roma (haly) ·Fax +39-6-92.81.523

P. AGACHE G. BELLOMONTE W.F. BERGFELD B. BERRA R.CAPUTO O. CARLESIMO D. CERIMELE E. CHIACCHIERINI I .COTTE M.A. DINA G. FABRIZ I J.A. GRAHAM L. GAGLIARDI B. GUARNERI AJ. JOUHAR F.H. KEMPER A.M. KLIGMAN N. LOPRIENO S. MADDIN G. PUGLISI C.L. MENEGHI NI N. ORENTREICH E. PANCONESI R. PAOLETTI W.E. PARISH L. PUGLISI W. RAAB G. RABBIOSI A. REBORA V. RIZZA G. SALVATORE A.SANNA P. SANTOIANNI H. SCHAEFER A. SERTOLI A.STAMMATI H. TRONNIER V. VALKOVIC

MD. Prof. of Dcm1a1. Ccni rc Hosp. Rcgional dc Bcsançon (F) CChcm, Prof. ofChcm., Food Dcpan ISI. Sup. Sani1à • Romc ( I) MD. FACP Cleveland Cl inie Ohio (USA) DSc. Prof. of Biol. Chcm. Un iv. of Mi lano (I) MD. Prof. and Chainnan. Dcpan of Dcnn:ll. Univ. of Milano ( I) MD, Prof .. Dcpan. of Dcnn:ll. Univ. of Romc (I) MD, Pror. and Chainmm. Depart . of Dcm1at. Catholic Un iv. of Romc (I) CChcm. Prof. and Chainnan. Dcpan. Tcchn. of Commcrcc Univ. of Romc (I) DSc, Prof. of Cosmc1. IPIL Lyon (F) MD. Prof. and Chainnan. Dcpart. of Phruol. Anal. Catholic Univ. of Romc (I) MD. Ass. Prof. of Paedria1ic Dcm1a1ologiS1, Ca1hol ic Univ. of Rome (I) B.Sc, PhD. Dcp1. Dcrma1ology Un iv. of Pennsylvania (USA) D.Ch. Dcpan. of Pharm. Chcm. ls1. Sup. Sani1à of Rome ( I) MD, Prof. and Chairman. Dcpan. of Derma!. Univ. of Messina (I) M.B.MRSC Beacoosfield (GB) MD. Emeri1us Prof .. Pharmacology & Toxicology. Univ. MunSlcr (D) MD, PhD, Prof. of Dcrmalol. Univ. of Pennsylvania Philadclphia (USA) DSc, Prof. of Gene1ica Univ. of Pisa (I) MD. ERCP Clin. Prof. Dcrma1ol. Div. Dcrmai. Univ. BR. Columbia, Vancouver (C) CChem. Dcpan. of Phannacol. and Tox. Univ. of Catania ( I) MD. Prof. and Chairman, Dcp>n. of Derma!. Univ. of Bari ( I) MD. Clin. Prof. of Dem1a1. New York (USA) MD. Prof. and Chainnan, Dcpan. of Derma!. Univ. of Firenze (I) MD. Prof. and Chainnan. Dcpart. of Phannacol. and Tox. Univ. of Milano (I) MA, PhD. BVSc. Hcad of Environmcn1al Safe1y Division. Unilcvcr Research Schan brook (GB) DSc. Prof. of Pharmacognosy Univ. of Milano (I) MD, Prof. and Chaim1an, Dcpan. of Derma!. Univ. of Wien (A) MD. Prof. and Chairman. Dcpart. of Dcm1a1. Univ. of Pavia (I) MD, Prof. and Chairman. Depan. of Derma!. Un iv. of Genova (I) PhD. Prof. of Biol. Chcm. Univ. of Ca1ania (I) CChcm. Dcpan. ofToxicol. lsl. Sup. Sani1à of Rome (I) MD, Prof. and Chainnan. Dcpan. of Microbio!. Catholic Univ. of Rome (I) MD, Prof. and Chainnan. Depan. of Dcnna1. Univ. of Napoli (I) Ph.D., Prof. and Scicn1ific Oircclor L'Oreal, Paris (F') MD. Assoc. Prof. of Allergie and Occupa1ional Dcm1a1. Univ. of Firenze (I) DSC, Dcpan. ofToxicol. lns1. Sup. Sani1à of Rome (I) MD. Emcri1us Prof .. Derma1ology .. Univ. Wiuen-Herdccke (D) Ph.D. Prof. of Physic Rudcr Boskovic lnsl. of Zagrcb (CRO)

GENERAL INFORMATION The JOURNAL OF APPLIED COSMETOLOGY is an international journal devoted to publisching originai papers, reviews and other materiai which represent a useful contribution to research on the sk in and on cosme­tics. It is aimed at cosmetic chemists, dermatologists, microbiologists, pharmacists, experimental biologists, toxico­logists, plastic surgeons, and ali other scientists· working on products which will come into con.taci with the skin and its appendages. The Journal is publisched quarterly in English. It is -distributed to cosmetic chemists, dermatologists, plastic surgeons, medicai and pharmaceutical schools, medicai libraries, selected hospitals and research institutions throught the world, and by subscription to any other interested individuals or organizations. Statements and opinions expressed are persona! to the respective contributors and are nor necessarily endorsed by the Editor(s), Advisers, Publishers of Distributors of this Journal.

COPYRIGHT Submitted materiai must be the originai work of the autor(s) and must not have been submitted for publication elsewhere. By submitting a manuscript, the authors agree that the copyright for their articles is transferred to the publisher if and when the article is accepted for publication. None of the conteni of this publication may be reproduced in whole or in part, translated, stored in a retrieval system, or transmitted or distributed in any form or by any means (electronic, mechanical, photocopy, recording or otherwise) without the prior written permission of the Publishers.

Sections of J ournal

The following sections will be features of the Journal:

Originai Laboratory Studies: descriptions of originai investigative laboratory research in cosmetics and rela­ted areas.

Special Reports: Items of special interest to the readers, including reports on meetings, societies, legislation, etc.

Generai Artic/es: scientific articles of generai interest to our readers will be considered for publication. These articles should be concerned with newer developments in such related fields as dermatology, biology, toxico­logy, etc.

Slzort Communications: the lenght should not exceed S typewritten pages with not more than 3 figures included. Headings ("Materials", "Discussion", etc.) as well as Summaries are to be omitted. If accepted, these submission will appear in print in a very short time.

Letter to the Editor: comments on Journal a1ticles are invited as well as brief contributions on any aspects of cosmetic science. Letters may include figures, and/or references, but brevity is necessary.

Guest Editorials: concise, authoritative, substantiated commentary on specific topics of contemporary interest.

Book Reviews: book and monographs (domestic and foreign) will be reviewed depending on their interest and value to subscribers. Send materiai for review to the Editor, Dr. P. Morganti. No such materiai will be returned.

Address: ali papers should be submitted to: Dr. P. Morganti INTERNA TJONAL EDIEMME Via Innocenzo Xl, 41 00165 Rome - Italy Te!. 0039/6/393.78.788 Fnx. 0039/6/63.80.839

INFORMATION FOR AUTHORS

Papers must be submitted in Eng lish. Authors whose mother tongue is not English should arrange for the ir manuscripts to be written in proper English prior to submission.

Procedure of Submissio11 of Manuscripts: submit three copies of both the manuscript and all illustrati ve materiai to the above address.

Orga11izatio11 of the Ma11uscript: investigati ve studies should be organi zed as follow: title, abstract page, introduction, materi ai and methods, results, d iscussion. acknowledgments, references, legend for figures, tables. All pages should be numered consecuti vely starting with the abstract. The entire manuscript is to be typewritten, double-spaced, and with 3 cm margins. Tracie names must be capitalized: the common name for compounds may be used if the formai chemical name as established by international convention is g iven after the first use. Any abbrev iations other than those which are generall y accepted must be defined. In the text, references to dual authors will use both surnames throu­ghout. For mul tiple authors, use the surnames of al! authors at the fi rst refcrence and onl y the first author fol ­lowed by "et al." thereafter. Please mark in the marg in of the manuscri pt the desired position of the figures and tables. To allow faster publication only set of proofs will be furnisched to the author including the figures and tables in their final position.

Title page: list the title, name(s) and degree(s) of author(s). department(s) and institution(s) at which the work was done, city, state, and postai code. Any preliminary report or abstract of the work should be re ferred to as a footnote to the title.

Summary: each paper must be headed by an English language title of not aver 70 c haracters (including spa­ces) suitable far use as a running head and must also be proceded by an Eng lish summary not exceeding 300 words typed double-spaced. The summary wi ll include statements of the problem, method of study, results, and conc lusions. S ince this summary will be used by astracting journals, it must be self- explanatory aild should not inlcude abbreviations, footnotes, and references.

Foot11otes: should be li sted consecutively at the bottom of the page on which they fall , designateci by the fo l­lowing symbols in a rder *,+,+,§. II,**, etc.

Key Words: key words far computerised s torage and retrieval of in fo rmation should be incorporated in the summary.

Refere11ces: the references have to be abbreviateci as listed in the lndex Medicus. The style of the references must conform to thc examples given below: I) Robbins CR, Ke llych ( 1970) Ami noacid composition of human hair. Text Res J 40:89 1-896 2) Strehler BL ( 1977) Time, cells and agi ng 2nd edn. Academic Press, New York 3) Ebling FJ. Rook ( 1972) Ciclic acti vity of the fo llicle. In : Textbook of dermatology 11 , Blackwell , Oxford, p. 1567-1 573.

Illustratio11s: figures should be numbered consecutively using Arabic numerals Tables should be numbered consecut ively, using Roman numerals. Ali photographs should be black and white, g lossy and unmounted. The number and s ize of illustration should be restricted to the minimum needed to clari fy the text. Authors requi ­ring extra space far illustrations will be charge accordingly. This is also the case for color illustrations. All figures, photographs, graphs, or diagrams should be submitted on separate sheets .

Animai Experiments: descriptions o f animai experi ments should include full details of the types of animai used (inbred, etc.) and the conditions under which they were kept (standard diet , etc .)

Trade Names: all common cosmetic ing red ients should be re ferred to by the ir generic names, as indicatcd in the latesr editi on of CTFA Cosmetic Ing redienr Dicti onary, and the European Pharrnacopeia. Ifa material s i ~ not li sted , then the trademarked name can be used, with the chemical composition given in footnotes.

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Quarterly Review of Cosmetic Dermatology

INFORMAZIONI PER L'ABBONAMENTO L'abbonamento annuale comprende quattro numeri. ~possibi le ottenere abbonamenli •t prezzo ridotto da parte dci riccrca1ori che lavorano presso Istitut i che abbiano sotto.serino almeno un abOOnamcnto a prezzo nonnale. L'Edi tore po1ra fornire a richiesta notizie più dettagliate. Le sottoscrizioni di abbonamento possono essere cffclluatc mediante assegni postali. bancari. di conto corrente o per contanti indirizzandoli a: INTERNATIONAL EDIEMME - Via Innocenzo Xl. 41- 00165 Roma c/c bancario n. 3184/51 Banca di Roma Ag. I - Aprilia (LT) - Italia

Abbonamento JOURNAL OF APPLIED COSMETOLOGY

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Trimestrale di Dermatologia Cosmetologica Quarterly Review of Cosmetic Dermatology

Contents

Generai Articles

115 Biologica! functions and therapeutic properties of urea. W. Raab

125 Practical treatment of dry skin. W. Raab

Originai Laboratory Studies

133 A comparative double - blind within subject study of the efficacy and tolerability of two different derivatives of Vitamin A on skin thickness and elasticity: retinoic acid and conjugated retinyl palmitate.

139

147

Notes

E. Thom

A new cosmeceutical tor the "orange peel" skin. P. Morganti. S.D. Randazzo. G.Fabrizi, C. Bruno

Enhancing the glycolic acid efficacy by piezoelectric vibrations. P. Morganti, S.D. Randazzo, G.Fabrizi

160 1997 Awards.

Book Review

161 Mechanism of transdermal drug delivery.

Index

Drug and Pharmaceutical Sciences. Series/8 Russel O. Pohs a nd Richard H.Guy Editors

162 lndex to Volume 15, 1997

XIX Announcements Clinica! Design Group lnc. - Seminar Series for Medicai Devices San Diego, CA . January 13/ 22, 1998

6th Congress of European Society for Pediatrie Dermatology Rome, ltaly. September 14-18, 1999

• CARTA ECOLOGICA· ENVIRONMENTALLY PAPER • PAPIER ECOLOGIQUE • PAPEL ECOLOGICO ~ ,.,,_lh,. ....... ~

J Appl Cosmetol 15, 115-123 (October-December 1997)

BIOLOGICAL FUNCTIONS ANO THERAPEUTIC PROPERTIES OF UREA W, Raab*

·Allergy Clinic 'lnnere Stadt' in Vienna, Austria

Received: October 25, 7995

Key words: Urea, Dry skin, Atopy, Glucocorticoid, Moisturizer,

Synopsis

Although urea is know for about 50 years, its use as a topica! drug or as an adjunct is obtaining more and more attention in topica! dermatotherapy, Urea is absolutely non-toxic, undesirable ac­tions occur only, if skin state and concentration of urea are on a disbalance. Urea proved to be a most valuable substance for restoring hydration in dry skin and in eczemas due to skin dryness. The­refore, urea ranks among the standards in atopy, for the treatment of eczema as well as for the inter­val care.

Riassunto Sebbene si conosca l'urea già da circa 50 anni, il suo uso come farmaco o cosmetico topico sta otte­nendo sempre più attenzione nella dermoterapia topica. L'urea è assolutamente atossica e si possono verificare effetti indesiderati solo nel caso in cui le condizioni della pelle e la concentrazione di urea siano sbilanciate. L'urea ha provato di essere una sostanza di grande valore per il ripristino dell'idratazione nella cute secca e negli eczemi causati dalla cute secca. L'urea si colloca quindi tra le scelte standard nei casi di atopia, per il trattamento degli eczema e per le terapie di intervallo.

115

810/og1cal funct1ons and therapeutic propert1es of urea

INTRODUCTION

Urea (carbamide), the diamide of carbonic acid. is a naturally occuring degradation product of various prote ins in man. Up to 30 g were produ­ced dail y. Urca is found in ali organs and body liquids. On thc skin surface, urea is an impor­tant component of the natural moisturizing fac­tor containcd in the hydrolipid emulsion. About 50 years back, urea was reccommended for the topica! treatment of hand eczema but only 30 years back. the first experimental data were collected on its biochemical and pharma­cological activi ties. The moisturiz ing capacity of urea in the s tratum corneum, especia lly in xe­rotic states, was discovered. In 1988, a sympo­sium was he ld in Salzburg, Austria, the procee­dings of which contain all the information avai­lable on the various actions of urea in dermato­logy and cosmetology ( 1 ). The more recent pub­blications are compi led in a review article publi­shed 1993 (2). Today, urea belongs to the standard substances used in dermatologica! therapy and skin care.

TOXICITY

Urea lacks any systemic tox ic ity. Urea formerly was used as a diurctic drug; doses up to I .O g/kg bodyweight were given intravenously, without any undesirable action. Therefore, following absorption from exte rnal preparations, no tox ic effects o f urea can be found. The tolerance of urea de pends on the state of the skin and on the concentration of urea. The vehi­cle applied may influence the tolerance, too. On healthy skin , urea may be used in concentra­tions up to 20%. Most products, however, con­tain 5- 10% of urea, only, as iffitating effects on slightly damaged skin should be avoided. Such e ffects might develop as a consequence of osmotic act ivity.

116

BIOCHEMICAL FUNCTIONS OF UREA ON THE SKIN

Urea is an important component of the natural mo is turi z ing factor of the stratum corne um. Water is bound by an inc lusion in the c rysta l s tru cture o f urea and only s lowly liberated. Urea s tems from the sweat and from the pro­cess o f keratinization. The natural moi s turi ­z ing fac to r cons is ts of vari ous ions (24%), py rrolidone carbo xylic acid ( 12%). variou s o the r ca rboxy l ic ac id s (50%), am ines and am ides ( 17%) and urea (7%). One shou ld not undcrsti mate the amount of natural mois turi ­z in g fac to rs in the s tratum corneu m w ic h make up about 25% of the dry weight of the total horny layer. S tratum co rne um of health y sk in contain s about 40 M urea per lo M amino acids which co rresponds to about 28 µ g/2.5 cm2 (2). In dry sk in , urea content is s igni ficant ly lowe r (50% in some ins tances, only). C lin ically nor­mai skin of a topic individuals conta ins o nly 30% urea compared to normai va lues. In c li ­nicall y d iseased s kin (a topic eczema), urca conteni is lowered to 20% of normai values (Fig. 1, 2). From these data the conc lu sion may be rea­ched tha t urea is one of the m ost important components of the natural moisturizing factor of human skin.

MOISTURIZING ACTIVITY OF UREA

Urea exerts a wide ranges of pharmacological activities when applied on the skin: - moisturiz ing activity, - desquamating action (lysis of cementing sub-

s tance), - an timicrobial action (uptake of wate r in terfe­

res with the growth requirements of microor­ganisms),

30

20

10

Fig. I

µg/2.5 cm.!

25A

12.3

Fcmalc'

U RF. \ IN HUMA 'I SKI:\

29.8

16.1

Normai SkinO

27.9

13.7

Tot:.tl

UREA IN llU\l AN SKIN, REI.ATEO TO AGF. A'>D DRYNESS

25 µg/2.5 cm'

20

15

IO

16 - 20 a 21 - 30" .11 - 40 a

lleallhJ Sk in 0 Skin of Alopic l'cr~ons 0 Atopic Ectcma O

Fig. 2

60 %"/n \\:llcr uptnkc

50

40

30

20

IO

I l 20 34 o 23 38 o nd 58 Normai P,orimic lchthyo1ic

nd: noi done

Pl:i in \\'::Her O 4Mll glJcerol O 5.1\111 urca 13

Fig. 3: Water uptoke of normai, psoriotic, ond ichfhyotic strotum corneum following immersion in vorious solutions (Swonbeck, from 3).

10-'

101

WRaab

lo~dpm cm2

IOOOmin

··-----·· 1 orr urca in \\ ater-in-oil emulsion

A•-----.t.a "•1ter-in-oil emulsion <ilone

••t------i•• trilialcd "ater alone

Fig. 4: The influence of ureo on the water binding copo­city of humon strotum corneum (Wohlrob from 3).

- "antiinfl ammatory" action (antipro li fe rat ive, antiedcmatous, antipruritic).

- enzyme inh ibiting action (mostly against pro­teases) and

- keratolyt ic act ion (true ke ratinolys is occurs under the influence of urea in a concentration o f 40%).

T he most important (and therapeutically most w ide ly used) ac t ion of urea is its moisturi ­z ing capac it y. By imm ers ing s t ra tu m co r­neum fro m dry skin (psoriati c, ichthyotic) in S M urea/ I, the uptake of water could be si­gnificantly inc reased. In these experimen ts, urea sho wed definite ly highe r ac tivity than g lycero l, a humectant which is w ide ly used in cosmetic produc ts. In another se ries of ex­pe riments, tritia ted wate r was applied o n the s kin s ur face in th e fo rm of a wa te r-in -oi l

117

81olog1col tunct1ons and theropeut1c propert1es of ureo

emulsion with 10% urea . The water reten­tion , judged by ho w long tritiated wa ter could be detected and in which amount, was s ignificantly higher than in the controls with the vehicle alone. (Fig.4). The application of urea containing emuls ions decreases skin roughness due to the moisturi ­zing action of urea; maybe, the desquamating action of urea contributes to this effect. In atopic skin, this decrease in roughness, jud­ged by the replica method , was expec ia lly pronunced. (Fig. 5, 6). A vast number of experiments has been con­ducted to ascertain the moisturizing property of urea (figures 3, 4, 5, 6). Various methods have been used to probe this effect: corneome­try, measurement of conductivity, evaporime­try and profilometry. By electron microscopy, a loosening of the Jayers within the stratum corneum could be demonstrated, indicating a moisturizing effect (2) . Cf. Fig. 7 , 8, 9. In diseased skin , too, experimental investiga­tions have been performed to demonstrate the moisturizing (and antieczematous) action of urea. In the European Study (Barcelona, Ham­burg, Vienna) a statistically significant increa­se in moisture and a statistically significant decrease in TEWL occurred following a four week treatment of atopic eczema with a prepa­ration containing I 0% urea ( 4 ). Cf. Fig. I O.

KERATOLYTIC ANO DESQUAMATING PROPERTIES OF UREA

In concentrations up to 20%, urea exerts a con­centration-depending desquamating action on the stratum comeum. By this effect, skin pene­tration is facilitated. Cf. Fig. IO, 11. In a 40% concentration, urea has been shown to exert true keratinolytic properties. Nail plates in fungal diseases may thus be dissolved.

118

% decrease of roughness parameters

30

20

IO

Stan Placebo Urca cream

Fig. 5: Decreose of skin roughness porometers RZ ond RA 60 min. otter the oppticotion of o silicone-contoining wo­ter-in-oil emutsion with 5% ureo os compored to the vehi­cle without ureo. Meon volues of ten normai individuo/s were given (Puschmonn from 3).

% dccrease or roughness parameters

30

20

10

Stan I day 5 day 8 day

Fig. 6: Decreose of skin roughness porometers RZ ond RA following the use of o silicone-contoining woter-in-oil emulsion with 5% ureo. Meon volues of 9 o topic indivi­duols were given (Puschmonn, from 3).

140

130

120

110

W Roob

,.--~~~--t•t-~~~-·~~~---i·----------.

' '

' ' ' ' '

' ' '

' ' ' '

' " ':,,' ..... :&

'' -·------ -- ------·--- ------ -- - --- -- --- -- ---·--- ------ ---·· .. :': .......... .. .. ...... ..

60 75

••1----~•• Oil-in-water emulsion with 5% urea

•a-----..,•• Oil-in·water emulsion without 5% urea

••1----~•• Untreated control site

90 105 120 time/min

Fig. 7: Skin moisture ofter opp/icotion of o silicone-contoining oil-in-woter emulsion with ond without 5% ureo. meosure­ment by determinotion of the dielectric constont. Meon volues of 35 heolthy individuols were given. (Puschmonn, from 3).

140

130

120

110

100

90

Pre-treatment phase

.Àr.ol~----•• Placebo

IO 15 Treatment phase

••1-----•• 5 % Urea

25 Post-treatment phase

days

Fig. 8: Skin moisture following the opp/icotion of o silicone-contoining oil-in-woter emulsion with ond without 5% ureo tor two weeks. Meon volues of 6 heolthy individuo/s were given (Puschmonn, from 3).

119

Biologica! functions and therapeutic properties of urea

Fig. 9: Hyperkerototic skin in chronic eczema before ond offer the opplicotion of ureo 10% + solicylic acid 5% tor 10 days. REM materio/ from biopsies, mognificotion 2.5(),J x. From 2, with the permission of the outors Plugshoupt ond FrCih.

European Study

10% Urea in Chronic Eczema

Hydration TEWL +80%

69U(!)

+30%(!)

D Start 4 wceks Start 4 wceks

C oncomitant cli11ical ammelioration

Fig. 10

120

ANTllNFLAMMATORY ACTIONS OF UREA

An antiproliferative effect of urea has been de­monstrated in states of accelerated cellular tur­nover (e.g. psoriasis vulgaris) but no atrophoge­nic effect in normai skin could be observed. The antiedematous ac tion of urea is connected with its diuretic acti vity. In states of lymphosta­sis, a dramatic response can be evoked by topi­ca! applications of I 0% urea. The antipruritic activity of urea mainly is due to its moisturizing capacity. On the other hand , a directed influence of urea on those enzymatic activ ities which provoke itch could be demon­strated.

ANTIMICROBIAL ACTIVITY OF UREA

By its strong wate r binding capacity, urea inhi­bits the growth of microorganisms. Therefore, urea may be regarded as a preservative-saving substance.

UREA COMBINED WITH OTHER DRUGS

Via three mechanisms, urea increases the phar­macological activities of other simul taneously applied drugs: - v ia its moi sturizing capacity (increased ab­

sorption), - via its desquamating properties (increased ab­

sorption) and - via the formation of hydrophilic adducts (in­

creased re lease from the preparation and in ­creased uptake by the skin).

Lastly, synergistic effects much be mentioned between urea and some topically applied drugs with antiinflammatory or keratolytic action. An example is shown in Fig.9.

WRaab

USES OF UREA IN DERMATOLOGY

Urea alone

Dry skin , old skin , photodamaged skin. Atopic skin , (therapy and interval skin care). Psoriasis vulgaris and other scaly dermatoses. Ichthyosis and ichthyos iform skin conditions, hyperkeratoses, keratoses. Onycholysis (40%!)

Urea in combinations

With glucocorticoids (hydrocortisone, halc ino­nid): atopic eczema, chronic dry eczema, Pso­riasis vulgaris, ali old, hyperkeratotic, scaly, re­sistant inflammatory skin lesions. (5-1 0% urea, O, 1- 1 % steroid).

With anthralin ( 17% urea + 0,5-2% anthral in): Psoriasis v ulgaris, prolonged applications or short contact therapy.

80

60

~o

20

Trnnsmission (1apc mcthod)

O C \' J'kU IO L

C: Control V: Vehicle

M"ale score

2.5

1.5

0.5

Fig. 11 - Desquamating action o f urea

121

81olog1col funct1ons ond theropeut1c propert1es of ureo

With polydocanol (5% urea + 3% polydoca­nol): atopic eczema, treatment and interval skin care.

With tretinoin (10% urea + 0,03% tretinoin): non-inflammatory, non-erythrodermic ichthyo­sis.

With salicylic acid (10% urea + 5% salicylic acid): stubborn hyperkeratosis, corns, eventual­ly warts.

With bifonazole (40% urea+ 1 % bifonazole): onychomycosis.

Among the combinations of urea with other drugs, the preparations containing urea and a glucocorticoid have found widest application. Urea increases the biovailability of the steroid ("hydrocortisone develops into triamcinolone") but does not alter the incidence and severeness of undesirable effects.

122

W Raab

REFERENCES

1. Raab, W. (Editor) (1989), Harnstoff in der Dermatologie, Hautarzt 40, Suppi. IX. 2. Raab, W. (1993), Harnstoff in der Dermatologie, TW Dermatologie 23: 257-269. 3. Raab, W. (1990) , Use of urea in cosmetology, Cosmet. Toiletr. 1054: 97-102. 4. Vilaplana, J. et al. (1994) , Jnternationale, multizentrische Prilfung der Wirksamkeit und Vertrag­

lichkeit der externen Therapie chronischer Ekzeme mit einem 10% igen Harnstoffpraparat, Akt. Dermat. 20: 227-231.

Author Address: Univ. Prof Dr. W. Raab Walfischgasse 3 A - 1010 Vienna, Austria

123

J. Appl Cosmeto/. 15, 125-131 (October-December 1997)

PRACTICAL TREATMENT OF DRY SKIN

W. Roab• ·Medicai Director, Allergy Clinic ' lnnere Stadt' Vienna, Austria

Received: October 25, 7995.

Key words: Dryness, Moisture, Ultraviolet, Age, Photodamage, Atopy.

Synopsis

Dry skin rnay result of exogenous or of endogenous factors. Exogenous factors may be excluded by informing the patient of his fa lse behaviour. If endogeno us factors are the cause of the dry skin state, reasonable measures of skin cleansing, skin care and skin protection sho uld be considered.

Riassunto

La pelle secca può essere il risultato di fattori esogeni o endogeni. I fattori esogeni si possono elimi­nare facendo presente al paziente il suo comportamento errato. Nel caso invece in cui siano fattori endogeni la causa della secchezza della pelle, dovranno essere prese in considerazione misure adatte per la sua de tersione, cura e protezione.

125

Proct1cal treatment of dry sk1n

INTRODUCTION

Water is the softener of the horny layer and se­cures smoothness, elasticity and suppleness. Under normai conditions, water enters the horny Iayer via transdermal diffusion (TEWL). The evaporation of water from the skin surface is prevented by the action of the natural moi­stourizing factors (NMF). The water balance of the horny layer is depicted in figure 1, the com­position of the NMF is shown in figure 2. Dry skin is either caused by external factors or by endogenous changes.

Fig. 1

Fig.2

126

Water balance of the horny layer

Evaporalion ~ D Drv, air movement fewNMF, large surrace

NMF of Human Skin

EXTERNAL CAUSES OF DRY SKIN Among the external causes of dry skin, abuse of soaps and detergents must be mentioned on the first hand. But often a prolonged contact with water is the reason for skin dryness, as the NMF is dissolved and rinsed off. For facial skin, prolonged exposure to a dry en­vironment causes skin dryness, unless the water loss is prevented by the application of moisturi­zing skin care products.

ENDOGENOUS REASONS FOR DRY SKIN

There are three endogenous reasons for dry skin: - constitution, especially atopy, - genetic ageing and - photodamage. In atopy, the disturbed barrier function must be regarded as the main reason for skin dryness. Furthermore, there is almost always some in­flammation present which causes skin dryness. In senile skin, water Ioss is increased due to the numerous wrinkles and folds which increase the surface. Furthermore, water supply is decreased as generai circulation is reduced and an atrophy of rete plugs occurs (reduced size of the contact area with the supplying derma! tissues). In photodamage, the surface is even more in­creased than in senile skin as there are nume­rous wrinkles and deep folds (elastosis); solar keratoses provoke a further increase in water loss. - The mechanisms for endogenous dry skin are depicted in figure 3.

SIGNIFICANCE OF DRY SKIN

For the patient, dry skin causes an unpleasant "old and neglected" appearance. Steady applica­tion of skin care products is needed to counteract

itch and tension. From the dermatologica! point of view, dry skin often is the cause of eczemas and infections, especially in older persons.

REGIMEN IN DRY SKIN

Three important measures have to be taken to counteract dry skin and to prevent the distur­bing consequences of this skin state: - mild, non-alkaline skin cleansers, - regular application of O/W or W/0-emulsions

with moisturizing compounds, and - skin protection against ali kinds of environ­

mental influences (ultraviolet, heat, cold).

Fig. 3

W Raab

CLEANSING MEASURES IN DRY SKIN Skin cleansing may be effectuated by the appli­cation of - natural (soaps) and synthetic detergents (syndets), - adsorptive cleansing agents (e. g. oatmeal), - desquamating agents ("exfoliation") and pee-

ling agents, - dermabrasive agents, e. g. polyethilene granu-

les (cf. 2,5). The best way of cleansing dry skin is the use of slightly acid, mild detergents. In cases of very sensitive skin, in atopy or in atrophic skin, the use of adsorptive complexes should be prefer­red. Oatmeal extracts, prepared for cleansing purposes, contain complexes consisting of poly­saccharides, oligosaccharides, oils and proteins. That means that the complex exhibits lipophilic and hydrophilic groups on its surface thus per­mitting the removal of lipophilic and hydrophi­lic "dirt" (substances from the environment, de­composition products of sweat, sebum and topi­cally applied preparations) by adsorption. Figure 4 demonstrates the roughness of the skin sur­face following the use of soaps, detergents or ad­so1ptive cleansing agents with smoothing additives.

SKIN ROUGHNESS AFTER CLEANSING

20-

15

10- - - - ~ - - - - - - -

5-

Soap

Stari value

------------------------- ----------------· /

O il bath Sinder and additives Adsorptive cleanser and addith·es

Fig. 4: Skin roughness affer different forms of cleansing, determined by the colour retention method

127

Proct1col treotment of dry sk1n

SKIN HYDRATION

Skin hydration may be effectuated by the appl i­cation of emollients (pseudo-occlusive effect c losing small clefts on the surface of the stratum corne um), by the appli cation of mois turing compounds, or by the increase of oxygen ten­sion in the stratum corneum. The various possi­bilities of increasing hydration in the stratum corneum are depicted in figure 5.

Fig.5

Among the moisturizers, humectants (e. g. gly­cerol) and moisturizers have to be mentioned. Mo isturi zers s uch as mucopol ysaccharid es (hyaluronic acid) are preferable as they retain water even in a dry environment and offer it to the horny layer. Under such unfavorable cond i­tions, humectants may even wi thdraw water from the skin (cf. figure 6). T he obse rva ti o n that oxygen tens ion in th e horny layer decreases steadily wi th increas ing age (figure 7) has provoked investigations of the changes in dry skin following the application of oxygen delivering preparations ( 1). In fact, applications of a cream containing oxy­gen (4,5%) in 10% perfluordecaline signi fican­tly increases oxygen tension in the horny layer as compared to the vehicle (6,7). Cf. figure 8. Para lle l to the increase in oxygen tension an in­crease in moisture was noted (figure 9). Further­more, wrinkle number and depth decreased un­der the influence of an oxygen de!ivering cream (figure I 0).

WATER UPTAKE (g/ lOOg)

100%

Relali"e humidity: 33% I Relati"e humidity: 75% I 80%

60%

P) rolidone carbo~y l ic acid O Glycerol O

Fig. 6: Water uptoke by different moisturizing compounds. hmuectonts ond true moisturizers depending upon the hu­midity in the environment

128

W Raab

OXYGEN IN AGEING SKIN 40

"" ~ = 30 = o ............

-----.:::':"::".:":~:::::::o=:'lll'9~ ............. . ~~~~~~~~~~~~ ----------Rise factors for microangiopathia

Q.

20

I O

age o

20 30 40 50 60

Fig. 7: Oxygen pressure in the skin, depending upon age. Note the reduced oxygen pressure in persons with risk factors for micorangiopathis such as cigarette abuse

OXYGEN IN HUMAN SKIN

40 4.5% 02 in PerOuordecaline (hvice daily)

30

20

days IO

8 12 16 20 24 28

Fig. 8

:: SKIN MOISTURE 90 =

~ ~ ~

80 ~ ~ 3 E o STOP

70 u 4.5 % 02 in 10% Perfluordecaline (twice daily)

60

50

40

days JO

4 12 16 20 24 28

Fig. 9

129

Proct1col treotment of dry sk1n

SKIN PROTECTION

Most forms of environmental stress increase skin dryness. Therefore, protection against phy­sical influences or, even better, avoivance of those plays an important role in treatment and prophylaxis of dry skin states. Ultraviolet irra­diation , UVB as well as UVA, provokes skin dryness due to alterations of the epidermis and the dermis over the years (3, 4). As it is non rea­listic to try to keep people out of the sun, doc­tors should advise their patients to apply sun protecting creams in a reasonable manner.

130

30

20

10

Fig. 10

DEPTH ANO NUMBER OF WRINKLES AFTER OXYGEN SUPPLY (14d)

Deplh Number

15

10

5

W Raab

REFERENCES

1. Artmann, C. et al.(1993), Sauerstoff in der Haut. Ein neuer Parameter der Hautalterung, SOFW Journal 1993 15, l -5.

2. Raab, W. (1990), Skin cleansing in health and disease, Wien. Med. Wschr. 140, Suppi. 108. 3. Raab, W., Zeitalterung und Umweltalterung der Haut, hautnah 611994 Dermatologie, 589-594. 4. Raab, W. (1994), Reinigung, Pflege und Schutz der Altershaut, Handbuch der Gerontologie. Bd.

7, 365-388, Fische1; Stuttgart, l ena, New York. 5. Raab, W. und U. Kindl (1997), Pflegekosmetik. Fischer und Covi, Stuttgart und Eschhorn (211d

ed.). 6. Stanzi, K. et al.(1993), A new cosmetic product containing molecular oxygen, Eurocosmetics

1993 l , 1-6 7. Zastrow, L. et al., The effectiveness of molecular oxygen in cosmetic formulations, In press.

Author Address: W. P. Raab, M. D., FAAD Professor in Dermatology 3, Walfischgasse A-1010 Vienna, Austria

131

' J. Appl Cosmetol. 15, 133-138 (October-Oecember 1997)

A COMPARATIVE OOUBLE-BLINO WITHIN SUBJECT STUOY OF THE EFFICACY ANO TOLERABILITY OF TWO OIFFERENT OERIVATIVES OF VITAMIN A ON SKIN THICKNESS ANO ELASTICITY: RETINOIC ACIO ANO CONJUGATEO RETINYL PALMITATE Erling Thom, Ph,D, •

"Medstat Research Ltd, Lillestn2im, Norway

Received: June 78, 7997.

Key words: Retinyl palmitate. Retinoic acid. Comparative study, Skin elasticity, Skin thickness.

Synopsis

A randomized comparative double-blind within subject study of topica! administration of two diffe­rent Vitamin A preparations - conjugated retinyl palmitate, RP (0,2%) and retinoic acid, RA (0.025%) for 3 months in 20 females caused significant changes in skin thickness and elasticity as well as in the participants own judgment of skin improvement using visual analogue scales. The results indicate that both galenica! formulations exert a comparable effect, while the tolerability of the RP formu lation was significantly better. It might be of great importance for the efficacy of the RP cream that the compound is conjugated and thus having a better skin biovalability than unconju­gated RP has. Whether the clinial effect is due to metabolism of RP to RA or re tino! in the skin can not be answered by this study, but should be subject to further percutaneous absorption studies. Other studies indicate that the mechanism of action for RP creams might be due to biotransforma­tion to retino! rather than to RA.

Riassunto Uno studio randomizzato a doppio-cieco è stato condotto per tre mesi su 20 donne utilizzando due divers i preparati a base di vitamina A: retini! palmitato coniugato (RP 0,2%) ed acido retinoico (RA 0.025%). Le due formulazioni hanno provocato cambiamenti significativi sia nello spessore che nel­la elasticità della pelle . I risultati indicano che entrambe le formulazioni galeniche svolgono un'attività paragonabile, ma la tollerabilità della formul azione RP è stata significativamente maggiore. Potrebbe essere di grande importanza per l'efficacia della formulazione RP il fatto che la miscela sia coniugata ed abbia perciò una biodisponibilità cutanea migliore rispetto ad un RP non coniugato. Questo studio non ha potuto rispondere al quesito se l'effetto clinico sia dovuto al metabolismo dell 'RP che si trasforma in RA o in retinolo nella pelle. Questo argomento dovrebbe essere oggetto di ulteriori studi sull'assorbimento percutaneo. Altri studi indicano che il meccanismo d'azione delle creme RP può essere dovuto alla biotrasformazione in retinolo, piuttosto che in RA.

133

A comporot1ve double - blmd wlfh1n sub;ect study of the eff1cocv ond tolerob111tv.

INTRODUCTION

Data has previously been reported on the effi­cacy and tolerability of a skin cream containing conjugated Retinyl palmitate (RP) (1,2). The aims of these two studies were to investigate the effect of the cream on skin thickness and elasti­city and in addition to study the duration of the effect after treatment was stopped. From these studies we have clearly documented that use of conjugated RP results in an increase in skin thickness and an improvement in skin elasticity. These observations have been confirmed by others (3,4) using other measuring techniques. RP is a widely used ingredient in cosmetic for­mulations. Because it is the most stable of the available vitamin A esters it can be directly in­corporateci into an anhydrous base or the oi l base of a cosmetic cream or lotion. RP is li ­pophilic and photostable. Ofter products contai­ning RP are advertised as having benefica) ef­fects on the appearance of the skin. A great number of products containing RP are marke­ted. Previous studies suggest that enzymes pre­sent in the skin metabolize RP during skin ab­sorption. Esterase activity hydrolyzes RP to reti­no) (Vitamin A), wich is oxidized in many tis­sues to Retinoic acid (RA) primarJy by alcohol dehydrogenase. RP can therefore be class ified as a prodrug where the inactive RP is transfor­med to active substances by metabolic biotran­sformation reactions in the skin. Recently a number of studies have been carried out with RA creams showing that this com­pound has a positive effect on photo-aged skin (5-8). Preparations containing RA have been re­gistered in some countries as e thicaJ drugs for treatment of aging skin. However, one main drawback with this type of treatment is that a number of patients ( 4-10%) develop soreness in and miscolouring (redness) of the skin (6). As mentioned above RA has been convincingly documented as having an effect on the treatment of the aging skin and retino) is also a compound with know pharmacological activity (9). Pre-

134

vious studies have shown the formation of all ­trans-retinoic acids after topica) application of ali-trans-retino! in vivo in hairless mouse skin (10). Recently, however, a study showed that re­tino! was the only detectabJe metabolite fol­lowing administration of RP both in guinea pig and human skin, while no retinoic acid was de­tectable ( 11 ). About 30 and 18% of topically ap­plied RA were absorbed from an acetone vehi­cle by hairless guinea pig and human skin, re­spectively. Less than I% of the applied dose of RP diffused from the skin into the receptor fluid. In human skin, 44% of the absorbed RP was hudrolyzed to retino!. An essential prerequisite for an optimaJ penetra­tion of the lipohilic RP into the skin is to mo­dify che solublity of the compound by the use of tweens ( 12, 13). The producer of the RP prepara­tion used in this srudy has developed a process where RP in conjugated with a complex poly­saccharide thereby making the compound water soluble. In thi s way the penetration of RP throu­gh the skin and into the diffusion celi receptor fluid is enhanced. The same technique has been used succesfully to enhance the bioavailability of drug substances both administered perorally as well as topically (14). Based on the abovementioned infonnation and our previous experiences with conjugated RP, we decided to carry out a clinica) comparison on skin thickness and skin elasticity following treatment with an cream containing either RA or conjugated RP in order to gain an indirected impression of the bioequivaJency of these two substances.

MATERIAL ANO METHODS

The study was carried out as a randomized dou­ble-blind study in 20 femaJes with each partici­pant using both formulations one on the right and the other the left volar (protected) part of the forearm, respectiveJy. The administration of the formu lations was randomized, such that haJf of the partici pants used formu lation A on the

right arm and formulation B on the left ann and vice a versa for the other women. The tota! treatment period was 3 months and administra­tion was b.i.d. (in the morning and evening) du­ring the study period. The study was carried out in accordance with the Declaration of Helsinki.

The investigational formulations

The two formulations used in this study were: A conjugated RP cream made by Pedersens Labo­ratorium, Vejle, Denmark, containing 0.2% RP and a cream containing 0.025% RA made with the same cosmetic properties and apperance as the conjugated RP cream. Formulation A is identica! to the marketed preparations Sincera®, Demelle®, Luscinia® and Rebilt®. The investiga­tional products were packed in identica! packa­ges in order to keep the study blinded.

Measurements of skin thickness and skin elasticity

The measurements of skin thickness and skin elasticity were performed by ultrasound using Dermascan A and Dermaflex instruments, re­specti vel y (Cortex Inc. Aarhu s, Denmark). Measurements were carried out at baseline, after 1 month and after 3 months, by the same person (ET) on ali three occasions and measurements were performed at the mid-region of the volar part of the forearm. Ali measurements were in triplicate and average values used for statistica! evaluations.

Se/f-eva/uation by the partecipant

At the same time as each ultrasound measures was made, participants made a self evaluation of skin quality using visual analogue scales of 10 cm with endpoints of "no change" and "very pronunced change". Subjects were asked to sco-

E. Thom

re the global change in skin quality by placing a mark on the line between the endpoints. The di­stance from the zero point ("no change") to the mark was used as the score for the subject.

Statistica/ methods

A significance level of 5% was used in the tests and two-tailed tests were applied. Mean was used for estimation of continous and near conti­nous variables, and Student procedure was used for construction of confidence interval of the mean. The one-sample t-test was used analysing change over time within groups. Analysis of ca­variance and two-sample t-test were used to compare arms with regard to continous varia­bles.

RESULTS

20 females aged between 40 and 60 years (mean 51.4 yrs) were included in the study and ali par­ticipants were compliant with the protocol. Ali participants gave their infonned consent to take part in the study after having received written and verbal infonnation about the study.

Efficacy parameters, skin thickness and e/asticity

The results from the skin thickness measure­ments are shown in Table I. Formulation A re­sulted in a average increase in skin thickness of 3 1 % compared with 33% for formu lation B. This increase in skin thisckness was significant (p<O.O 1) for both formulations, while the diffe­rence between the two formulations was not si­gnificantly different. In Table II the viscoelastic properties of the skin following administration of fonnulations A and B, respectively, are presented. The results show that formulation A improved the elasticity by 19% on average, compared with 20% for B.

135

A comparative double - blind within subject study of the eff1cacy and tolerability .. .

Both formulations improved the elasticity of the skin significantly (p<0.01), but again the diffe­rence in elasticity improvement between the two formulations was not significant.

Efficacy parameters, self-evaluation by use of VAS

The VAS results are shown in Table III.

A

B

A

B

A significant improvement (p<O.O 1) in skin quality was reported for both forearms. The dif­ference in skin improvement between the two formulations is, however, not significant.

Table I Changes in skin thickness (mm) after administration of conjugated RP

(A) and RA (B) creams for 3 months, respectively (N=20)

Formulation Initially After I month After 3 months Mean (SD) 0.90 (0.12) 1.01 (0.17) 1.18 (0.1 5) Range 0.71-1.24 0.74- 1.27 0.90-1.34 Mean (SD) 0.88 (0.15) 1.02 (0.15) 1.17(0.17) Range 0.70-1.25 0.76-1.30 0.90-1.37

Table Il Changes in skin elasticity (%) after administration of conjugated RP (A)

and RA (B) creams for 3 months (N=20)

Formulation Initiallv After 1 month After 3 months Mean (SD) 59.3 (7.9) 65.2 (8.2) 70.6 (8.4) Range 44.3-81.0 50.2-81.2 51.3-85.0 Mean (SD) 60.0 (7.5) 67.2 (8.0) 7 1.2 (8.6) Range 45.4-80.8 46.4-81.6 52.4-86.0

Table lii Changes in VAS scores (cm) after administration of conjugated RP (A)

and RA (B) creams for 3 months (N=20)

Formulati on After I month After 3 months A Mean (SD) 1.8 ( 1.2) 6.3 (1.6)

Range 0.0-3.5 1.0-8.3 B Mean (SD) 1.9 ( 1.5) 6.5 (1.8)

Range 0.3-3.4 1.2-8.6

136

Tolerability At each visit subjects were asked if they had had any problems and/or side-effects with the treatments they had used. Seven of the subjects reported skin soreness af­ter using the RA formulations and 2 of these aJso reported a considerable redness in the skin I /2- 1 hour after application. The reported side­effects are, however, transient and none of the subjects stopped the treatment due to the side­effects. One subject reported redness of the skin following administration of the conjugated RP formulation. The tolerability was significantly in favour of formulation A, the conjugated RP formulation. This is also revealed in the preference choice from the users (see below).

Preference choise from the subjects On completion, subjects were asked to give a preference for one of the two creams they had used taking into account the effect, the tolerabi­lity and the cosmetic properties of the creams. Thirteen subjects prefered the conjugated RP cream, formu lation A, whi le 4 prefered the RA cream, and 3 subjects had no preference. The difference in preference is significantly in fa­vour of the conjugated RP formu lation.

DISCUSSION

In recent years knowledge of the effect and me­tabolism of vitamin A derivatives in the human skin ( 15, 16) has been accumulating. The results from the present study indicate that both, the 0.025% RA cream and a 0 .2% conju­gated RP cream bring about a comparable effect in skin composition and morphometry. No si­gnificant differences could be detected either in sk in thickness or elasticity improvement between the two creams. As the tolerability of

E Thom

the conjugated RP is significantly better than the RA, the conjugated RP may represent a va­luable alternative to RA. As have been stressed by other investigators (3,4) it is of utmost importance that the RP is in a form allowing skin penetration. In a previous comparative study we reported a significant dif­ference between conjugated and non-conjugated RP in the effect on the skin parameters (1). The change in solubility of the RP is probably essen­tial for making the ester available in sufficient concentration. To our knowledge no percutaneous absorption and metabolism studies have been carried out with conjugated RP. Such studies are needed in order to explain the mechanism of action behind the effect seen in skin parameters measured. The minimal conversion of retino! to RA may not be relevant to the application of formu la­tions containing RP to the human skin. Both retino! and RA can have pharmacological effects on human skin. Retino! is about 50% as potent as RA in inducing epidermal hyperplasia in the hairless mouse ( 11 ). It has, however, been shown that retino! is for­med in hairless guinea pig and human skin after topica! application of RP, but if further metabo­lism to R occurs, it is to small to detect. Any biologica! response of skin treated with retinyl palmitate formulations may be due to ester hy­drolysis of the parent compound to retinol. The use of RP in cosmetic formu lations may result in a significantly improved delivery of retino! into the skin.

137

A comporot1ve double - bilnd wlfhin sub;ect study of the eff1cocy ond tolerobillfy .

REFERENCES

1. Thom E (1993), Skin treatment with two different galenica! fonnulations of retinyl palmitate in humans,J.Appl. Cosmetol. 11, 71-76.

2. Thom E (1994), Long-tenn effects after topica! application of active retinyl palmitate, J.Appl. Cosmetol. 12, 45-50.

3. Counts DF, Skreko, Mcbee J, Wich G (1988), The effect of retinyl palmitate on skin composi­tion and morphometry, J.Soc.Cosmet.Chem. 39, 235-240.

4. Fthenakis CG, Maes DH, Smith WP (1991), In vitro assessment of skin elasticity using balli­stometry, J.Soc.Cosmet.Chem. 42, 211-222.

5. Kligman AM, Grove GL, Hirose R, Leyden JJ (1986), Topica! tretinoin for photoaged skin, J.Am.Acad.Dermatol. 15, 836-859.

6. Weiss KS, Ellis CN, Headington JT, Hamilton TA, Vorhess KK (1988), Topica! tretinoin im­proves photoaged skin: a double-blind vehicle controlled study, JAMA 259,527-532.

7. Bhawan J, Gonzales-Serva A, Nehal K, Labadie R, Lufrano, Thorne G et al. (1991), Effect of tretinoin on photodamaged skin, Arch.Dermatol. 127, 666-672.

8. Rafal FS, Griffiths CEM, Cherie MRCP, Ditre M, Finkel LJ, Hamilton TA et al. (1992), To­pica! tretinoin (retinoic acid) treatment for liver spots associated with photodamage, New Engl J Med. 6, 368-374.

9. Gilchrest BA (1992), Retinoid phannacology and the skin. In H. Mukhtar (ed.) Phannacology of the skin, CRC Press, Boca Raton, 167-181.

10. Connor MJ, Smit MH (1987), The formation of all-trans-retinoic acid from ali-trans-retino! in hairless mouse skin, Biochem Pharmacol 36, 919-924.

11. Boehnlein J, Sakr A, Lichtin Leon J, Bronaugh RL (1994), Characterization of esterase and alcohol dehydrogenase activity in skin. Metabolism of retinyl palmitate to retino! (Vitamin A) during percutaneous absorption, Pharm Res 8, 1155-1159.

12. Jarrett A, Jackson RJ (1980), The effect of vitamin A on the skin and istrole as a cosmetic agent. Abstract 11 th lnternational I FSCC Congress Research and Technology. Venice 23-26 Sept.

13. Spearman RIC, Jarret A (1974), Biologica! comparison of isomers and chemical fonns of vi­tamin A (retino!), Br J Dermatol. 90, 553-560.

14. Paginton JS (1987), Beta-cyclodextrin: the success of molecular inclusion, Chemistry in Bri­tain 23, 455-458.

15. Wolf G (1996), A history of vitamin A and retinoids, FASEB J 10, 1102-1104. 16. Fisher GJ, Voorhees JJ (1996), Molecular mechanisms of retinoid actions in skin, FASEB J 10,

1002-1013

Author Address: Erling Thom, Ph.D. P.O. Box 210 N-2001, lillestrç!Jm, Norway Fax: (+47)63.81.92.50

138

J Appl Cosmetol 15. 139-145 (October-December 1997)

A NEW COSMECEUTICAL FOR THE "ORANGE PEEL" SKIN

P, Morganti", S.D. Randazzo .. , G.Fabrizi ... end C. Bruno••••

• President/Director, R & D Mavi Sud S.r.l,, Viale dell'Industria l, 04011 Aprilia (LT), ltaly, Department of Dermatology, Dermatologists Training School, Il University of Naples, ltaly,

•• Department of Dermatology, University of Catania, ltaly. ••• Department of Dermatology, Catholic University of Rome, ltaly. •••• Physiology lnstitute, University of Urbino, ltaly.

Received: May 7, 1997 Presented at 2sd Symposium on Cosmetic Efficacy - New York, 28-30 Aprii, 7997.

Key words: TCDS, Cellulitis, Orange-peel skin, Skin hydration, TEWL, 3C System®, Dermoscan e

Synopsis

"Cellulitis" represents an unaestheticism capable of modifying the harmony of the figure referring to modem rules. The skin opaque, arid, scabrous and painful to the touch is characterized by a rugged appearence known as "orange peel skin". The present study was designed to evaluate the activity of a new Transdermal Cosmetic Delivery System (TCDS) on the anterior lateraJ surface of the thighs of 30 female volunteers (aged 18-30) presenting cutaneous signs of "cellulitis" of different degrees of intensity, treated each night for 21 days with this special patch in a double blind study. Before and after the study the thickness of the cutaneous tissue was controlled by the Dermoscan C® (Denmark, vers ion 3 at 20-MHz) and skin hydration and TEWL by 3C System® (Rome, Italy). The TCDS caused a both a decrease of skin thickness, and of the cellulitic layer thickness and a contem­porary high increase of skin hydration and TEWL (p<0.005). No adverse reactions were observed. The obtained results seem to prove the validity of this new co­smeceutical device for the treatment of the so called "cellulitis".

Riassunto La "cellulite" rappresenta un inestetismo capace di modificare l 'armonia della figura secondo i para­metri moderni. La pelle opaca, arida, scabra e dolorante al tatto è caratterizzata da un aspetto ruvido noto come "pelle a buccia d'arancia". Con il presente studio si è voluta valutare l'attività di un nuovo cerotto transdermico denominato Transdermal Cosmetic Delivery System (TCDS). La valutazione é stata effettuata sulla superficie antero-laterale delle coscie di 30 donne volontarie (di età compresa tra i 18 e i 30 anni), che presen­tavano segni cutanei di una cellulite con diversi gradi di intensità, trattate ogni notte per 21 giorni

139

A new cosmeceut1cal tor the "orange peef" sk1n

con questo speciale cerotto in uno studio a doppio cieco. Lo spessore della pelle è stato controllato prima e dopo lo studio tramite il Dermoscan C3 (Den­mark, versione 3 a 20 MHz), l ' idratazione della pelle e la TEWL per mezzo del 3C System*. Il TCDS ha provocato una diminuzione dello spessore della pelle, una diminuzione dello spessore del­lo strato di cellulite ed un contemporaneo aumento sia dell 'idratazione cutanea globale (p<0.005) da addebitarsi essenzialmente all 'attività occlusiva esercitata dal cerotto, che del TEWL. Non sono state rilevate reazioni collaterali. I risultati ottenuti sembrano provare la validità di questo nuovo mezzo cosmetico per il trattamento della cosiddetta "cellulite".

140

INTRODUCTION

"Cellulitis" represents an unaestheticism capa­ble of modifying the harmony of the figure re­ferring to modem rules. The skin opaque, arid, scabrous and painful to the touch is characteri­zed by a rugged appearence known as "orange peel" skin (1 -3).

STUDY DESIGN

The present study was designed to evaluate the activity of a new Transdermal Cosmetic Deli­very System (TCDS) on the anterior lateral sur­face of the thighs of 30 fornaie volunteers (aged 18-30) presenting cutaneous signs of cellulitis at d ifferent degrees of intensi ty, localized on the anterio r-lateral surface of thighs, treated each night for 21 days with this special patch (4x4 cm ) in a double blind study. In order to eliminate possible extemal influen­ces 15 women were randomly treated on the ri ­ght or on the left thigh with both the active-pat­ches or with the vehicle-patches (contro!), the other side serving as untreated contro!. In this way both the active and the contro! patches were indifferently applied both on the right and the left tigh. The selected subjects were not taking drugs for systemic administration or ant i-cellulitis topic products and, moreover, had not undergone spe­cific diets before and during the cl inica! trial 's peri od.

MATERIALS ANO CHEMICALS

I. 4x4 cm patch with acrylic base (vehicle-con­tro l B);

2. 4x4 cm patch enriched with centella asiatica and fucus vesicolosus extracts so that each plaster contains a tota! of I O mg active com­pounds, 0.2 mg/cm2 of which are centella tri-

P Morgonlt, SO Rondozzo. G Fobrtzt, C Bruno

INSTRUMENTAL MEASUREMENTS

Ulfrasound-8-mode imaging

This two-dimensional B-scan procedure gives ultrasounds single lines (A-Scan lines) corre­sponding to a cross-sectional image of the skin. In fact when a beam of ultrasounds passes th­rough the different layers of the skin, different echoes are produced depending on the acoustic characterist ics of the exam ined areas ; those echoes are recorded by the instrument and vi ­sualized on the screen as peaks (A-Scan). By measuring the distance among the peaks, it is possible to determine the th ickness of the diffe­rent structural components of the skin (I 0). Before and after the study the thickness of the subcutaneous tissue was controlled on 3 points of skin surface for both the thighs by the Der­moscan C®, (Denmark) version 3, at 20-MHz. Skin hydration and TEWL were controlled by 3C System®, (Rome, Italy) which was previou­sly used by our team (I I).

3C System®

This computerized system through the capacita­tive resistance permits a simple and quick con­tro! of surface lipids, skin hydration and TEWL The 3C System® collects up to 10/15 measure-

terpens (4-9). 3C System®

141

A new cosmeceutrcal far the "orange pee/" skrn

ments over 25 seconds sampling period and re­cords the mean value automatically standardi­zing the environmental conditions (RH=50%, T=22°C). Measurements were performed on lst day (baseline) and after 7, 14, 21, 28, 35 days. TEWL is expressed as the amount of water eva­porated per unit of surface in 1 hour gr/m2/h and the system collects up 10/15 measurements over 25 second sampling period and record the mean value automatically (11).

Statistica/ analysis

Differences in TEWL, skin hydration and sub­cutaneous tissue thickness were examined for statistica! significance using the non-parametric Friedman test. When the Friedman test revealed significant values between the treatments, mul­tiple comparisons of all groups were conducted by the Wilcoxon-Wilcox tests.

RESULTS

Tue obtained results are reported in Fig. 1, 2 and 3.

COMMENTS

As already proven by our group and by other authors the scan-ultrasound tecnique seems to be the best methodology feasible for measuring the variations of the cellulitic layers during an anti-cellulitis treatment (12-18). As it can be seen on Fig. 1 patch application on day 21 highlights a remarkable change in the thickness of the cutaneous layer (p<0.005) befo­re and after the treatment. This change is surely due to the activity carried out by the used active ingredients, since the sole vehicle has proved to be ineffective. It is also interesting to point out that the patch-

SUBCUTANEOUS TISSUE THICKNESS BEFORE ANO AFTERTREATMENT BY AN "ANTl-CELLULITIS" PATCH

Time = 21 days (One patch daily) - n = 15 - RH = 50% - t = 22 •e 5,70

5,65

5,60 5.545 :!: 0.521

5,55

5,50

~ 5,45

5,40

5,35

5,30 5.2A5 :!: 0.641

5,25

5,20

5,15 Baseline Mean Value

Untreated Final Mean Valuo

Vehicle Patch Final Mean Value

Active Patch

Active-Patch values are highly significant as Baseline and Vehicle (p <0.005)

Fig. 1

142

P Morgont1, SO Rondozzo G Fobnz1 C Bruno

TEWL OF THIGH-SKIN TREATED BY "ANTl-CELLULITIS" PATCHES

UNTREAi ED 2

0 +-~~~~~+-~~~~~+-~~~~~+-~~~~~+-~~~~--l

o 7 14 21 28 35 DAYS

I c:=Juntreated Skin Area --- Vehicle Patch-Treated ........... Aclive Patch-Treated I Untreated Versus Patch-Treated (Vehicle and Active) = p < 0.005 - Active-Patch Versus Vehicle-Patch = ns

Fig , 2

HYDRATION OF THE THIGH-SKIN TREATED BY "ANTl-CELLULITIS" PATCHES

n = 15 - RH = 50% - t = 22 •e 70

60

56,7 :t 1

50

w 40 (/)

~ "' u ;!!; 30 z o

~ 20 o >-:z: ....

10

o o 7 14 21 28 35 DAYS

I-+- VEHICLE PAT CH ..... ACTIVE PATCH I Patch-Treated versus Baseline = p < 0.005 - Vehicle-Patch versus Active-Patch = ns

Fig , J

143

A new cosmeceutical for the "orange pee/" skin

treatment causes the TEWL to increase conside­rably (p<0,005), indipendently from the presen­ce of the active ingredient. This means that it acts by changing the stratum corneum barrier. That should be the reason why the active ingre­dients seem to be able to easily reach the hypo­derm. By interrupting the treatment TEWL gets back to normai values (p<0.005) (Fig. 2). Also concerning the cutaneous hydration the in­creasing problem is due also to the occlusive ef­fect caused by the patch (p<0,005) (Fig. 3). No adverse reactions were observed. Obtained data seem to confirm what we pre­viously proved (4-8), i.e. that the TCDS (Tran­sdermal Cosmetic Delivery System) is an help­fui cosmeceutical device, easy and quick to use, and capable of giving good results in the treat­ment of the cutaneous unaesthetism called "cel­lulitis".

Aufhor Address: P. Morganti, PhD - Research and Development MAVI Sud srl - Via del!' Industria I, 04011 Aprilia (LT) , ITALY Phone: + 39 06 9286261 Fax:+ 39 06 9281523 E-mail=mavi@colosseum.it U RL=http://www.colosseum .itlst81 /mavì

144

P Morgant1. SO Randazzo. G Fabnzi. C Bruno

REFERENCE

1. Braun Falco O., Scherwitz C. (1972), Histopathologie der Sog. Zellulitis. Hautartz, 23, 71 -75 2. Binazzi M., Papini M. (1983), Aspetti chimico-istomorfologici. In: (Ribuffo-Bartoletti eds) La

cellulite, Ed. Salus Internazionale, Roma, Italy 3. Scherwitz C., Braun Falco O. (1978), So-called cellulitis, J.Dermatol.Surg.Oncol. 4, 230-234 4. Morganti P., Celleno L. and Vasselli A. (1995), A new Transdermal Delivery Cosmetic System

to contro! the skin localized lipodystrophy, J.Appl.Cosmetol. 13, 15-20 5. Morganti P. (1995), Nuove applicazioni di principi attivi vegetali: il cerotto cosmetico, Cosm.

News, 107-109 6. Morganti P., Tiberi L., Vasselli A., Tolaini M. V., Serafini G., Celleno L. (1995), Transdermal

Cosmetic Delivery System: a new device for cosmetic use. Evaluation of its effects in the treat­ment of so called "cellulitis", Presented at IFSCC Congress, Montreux, Switzerland, 18-21 Sep­tember 1995

7. Morganti P. (1996), The cosmetic patch: a new frontier in Cosmetic Dermatology, Soap, Cosm. Chem. Special. (February) , 48-50

8. Morganti P, Fionda A., Tiberi L. (1996), The TransdèrmaJ Cosmetic Delivery System: A new cosmeceutical device, Presented at Active lngredients Conference, Paris 13-14 November 1996, in print on Cosmetics & Toiletries.

9. Morganti P., F ionda A., Tiberi L., Icare M., Rusch F., Elia U. (1996), Extraction, analysis by HPLC of cosmetic active ingredients from an anti -cellulitis transdermal delivery system, Submit­ted for pubblication.

10. Seidenari S. (1995), Ultrasound B-mode imagine and in-vivo structure analysis. In: Non invasi­ve methods and the skin (Serup and Jemec Edrs.), CRC Press !ne., Bocaraton, Florida, p. 257

11. Cardillo A., Morganti P. (1994), A fast non-invasive method for skin hydration contro!, J. Appl.Cosmetol. 5, 105-120

12. Webb S. (1990), "The Physics of medicai imaging", Ed. Adam Hilger, Bristol. 13. Edwards C. (1988), Non invasive in vivo measurement of dimensions and properties of stratum

corneum and epidermis by A-Scan ultrasound, 15th IFCC /11tematio11al Congress 4, 263-4 14. Pugliese P.T. (1989), Use of ultrasound in evaluation of skin care products, Cosm. Toil. 104, 61-76 15. Armengol R., Girones E., Belles A. et al. (1992), Quantitative evaluation of the anti-cellulitis

efficacy by scan-ultrasound and its relation with clinic studies, 17th IFCC lnt. Congr. Voi. 3, 1218- 1240

16. Fornage B.D. and Anderson M.D. (1995), Ultrasound examination of the skin and subcuta­neous tissues at 7 .5 to I O MHz. In: Non-invasive methods and the skin (Serup and Jemec Eds.), CRC Press lnc., Bocaraton, Florida, p. 279

17. Agner T. (1995), Ultrasound A-mode measurement of skin thickness. In: Non-invasive methods and the skin (Serup and Jemec Eds.), CRC Press Inc. , Bocaraton, Florida, p. 289

18. Morganti P. (1997), A new peloid mask of Etruscan origin. Presented at IN-COSMETICS Con­ference, Di.isseldorf, May 6. Published on the Conference Proceedings "Modem challenges to the Cosmetic Formulations", p.451-456, J. Appl.Cosmetol. 15, I 09

145

. ~" ....

J. Appl. Cosmetol. 15. 147-159 (October-December 1997)

ENHANCING THE GLYCOLIC ACID EFFICACY BY PIEZOELECTRIC VIBRATIONS P. Morgonti", S.D. Rondozzo•• ond G.Fobrizi***

• President/Director, R & D - Mavi Sud S.r.l., Viale dell'Industria l, 04011 Aprilia (LT), ltaly.

Department of Dermatology, Dermatologists Training School, Il University of Naples, ltaly. •· Department of Dermatology - University of Catania, ltaly.

••• Department of Dermatology, Catholic University of Rome, ltaly.

Received: May 7, 7997 Presented at 2sd Symposium on Cosmetic Efficacy, New York, 28-30 Aprii, 7997.

Key words: Glycolic acid, Piezoelectric vibration, Skin Maste~. Skin ageing, 3C System®, Skin ela­sticity, Skin hydration, Surface lipids, TEWL.

Synopsis

As it is well known, AHAs improve skin hydration by binding water to the stratum corneum. In addition, when applied topically in concentration between 8% and 70% they decrease corneocyte cohesion and stratum corneum thickening, including various levels of epidermal separation. Among the various AHAs available, glycolic acid has enjoyed the greatest popularity. Its higher concentrations (from 50% to 70%) are being used for superficial skin peeling,meanwhile, iow concentrations (from 8% to 30%) have been reported to act as moisturizing agent capable of causing a decrease in corneocyte attachment. The glycolic acid activity is always correlated to some degree of irritation, and stinging or burning is its common side effect-especially at the begining of treatment. This study investigates and compares the effect of a 20% glycolic acid product, partialiy neutralized at 4,5 pH with a special blend of aminoacids, used as "lunch time peel" on skin degrea­sed by a cleansing lotion combined with or without a new "piezoeiectric technology" called "Skin Master®". Skin Master® activity is based on mechanical energy trasmitted to the skin by a series of ultrasound vibrations. Through the Skin Master® device, a significant exfoliation of the horny layer is obtainable together with a contemporary micromassage of the skin with an evident hyperemia. In this way, it is possible to enhance the glycolic acid absorption and its activity at medium/low con­centrations. In order to explore the activity of this 20% glycoiic acid-containing product and to ve­rify the real use of the Skin Master®, Skin Elasticity (RER by Dermafiex®), Clinica! Scoring (CS) (according to Effendy et al.), Stratum Corneum Turnover Time (SCTT) by the Dansylchioride Methodology (Jansen at al.), TEWL, Superficial Skin Lipids and Skin Hydration were controlled by 3C System® Technology (Rome, ltaly) on 30 women aged 35-56 who were observed weekly for 3 months. No significant adverse reactions were noted during the 90-day study. The obtained results indicate a significant reduction (p<0.005) of SCTT (+ 20%), substantial modi­fication of TEWL, and an increase of superficial skin lipids ( + 27% ), skin hydration ( + 70%) and skin eiasticity ( + 12% ). These benefits were significantly (p<0.05) improved (+ 25%) when the Skin Master® was used.

147

Enhancing the glycoilc acid efficacy by piezoelectnc vibrat1ons

Riassunto

Come è noto gli alfaidrossiacidi aumentano l'idratazione cutanea legando l'acqua allo strato corneo. Inoltre, quando sono applicati topicamente in concentrazioni tra 1'8% ed il 70% fanno diminuire la coesione dei corneociti e l'inspessimento dello strato corneo, accelerando a vari livelli la divisione cutanea. Tra i vari AHA disponibili, l'acido glicolico è quello che gode della più grande popolarità. Le sue alte concentrazioni (dal 50% al 70%) sono utilizzate per il peeling cutaneo superficiale, men­tre le basse concentrazioni (dall '8% al 30%) sono risultate agenti idratanti in grado di causare anche una diminuzione nella coesione dei corneociti . L'attività dell'acido glicolico è sempre correlata a qualche tipo di irritazione, ed il prurito e l'arros­samento ne sono comuni effetti collaterali, soprattutto all'inizio del trattamento. Con questo lavoro si sono voluti valutare gli effetti di un prodotto contenente una percentuale del 20% di acido glicolico, parzialmente neutralizzato ad un pH 4,5 tramite una speciale miscela di ami­noacidi. Il prodotto viene utilizzato come "lunch time peel" sulla pelle precedentemente detersa con una lozione detergente, in combinazione o no con la nuova tecnologia piezoelettrica denominata "Skin Master®". L'attività dello Skin Master® è basata sulla energia meccanica trasmessa alla pelle da una serie di vi­brazioni ad ultrasuoni. Con l'uso dello Skin Master® si ottiene una significativa esfoliazione dello strato corneo, insieme ad un contemporaneo micromassaggio della pelle con evidente iperemia. In questo modo è possibile aumentare l 'assorbimento dell'acido glicolico e la sua attività a concentrazioni medio I basse. Per analizzare l 'attività di questo prodotto e per verificare il reale uso dello Skin Master0

, sono state controllate settimanalmente e per tre mesi 30 donne di età compresa tra i 35 e i 56 anni con la tecno­logia del 3C System® (Rome, Italy). I valori controllati riguardavano l'elasticità della pelle (RER Derrnaflex®), il grado di eritema della cute (Clinica! Scoring - CS secondo Effendy et al. ), il rinnovo delle cellule cutanee, Stratum Corneum Turnover Time (SCTT) con la Dansylchloride Methodology (Jansen et al.), la TEWL, i lipidi cutanei di superficie e l' idratazione della pelle. Durante la durata dello studio (90 giorni) non sono stati riscontrati significativi effetti collaterali. I risultati ottenuti indicano una riduzione significativa (p<0.005) dello SCTT (+ 20%), una modifica sostanziale della TEWL, ed un aumento dei lipidi cutanei di superficie (+27%), dell'idratazione cu­tanea (+70%) e dell'elasticità della pelle (+12%). La positività dei dati è risultata significativamente più elevata ( + 25% p<0.05) nelle aree trattate con lo Skin Master®.

148

As it is well known AHAs improve skin hy­dration and photo-induced skin ageing by bin­ding of water to the stratum corneum ( 1-17). In addition, when applied topically in concen­tration between 8 and 70% they decrease cor­neo c y te cohesion and s tratum corneum thickenig, including various levels of epider­mal separation, Among the various AHAs available, glycolic acid has enjoyed the grea­tes t popularity, Its high er concentrations (from 50 to 70%) are beeing used for superfi­cial skin peeling meanwhile low concentra­tions (from 8 to 30%) have been reported to act as moisturizer agent capable also to cause a decrease in corneocyte attachment (18-21). The glycolic acid activity is always correlated to some degree of irritation and stinging or burning is its common side effect, especially at the beginning of treatment (22), These side effects are linked to its own irri­tant properties as acid, but are also based on the following factors: concentration, pH, per­centage and type of neutralizers used to adjust acidity, vehicle formulation, cleaning and/or degreasing treatment used, period of time the acid remains on the skin, skin area and skin type (23). Because of glycolic acid known ability to be effective on some photodamage, pigmenta­tion, scarring condition and fine wrinkles im­provement, physicians and aestheticians are using it primarily in high/medium concentra­tions, For these reasons the use as "refresher peel" of a glycolic acid solution at medium degree concentration of simpler use should be interesting fot both the medicai community and aestheticians, particularly if without side effects. This study investigates and compares the ef­fect of a 20% glycolic acid-peel, partially neutralized at 4.5 pH with a special blend of aminoacids (*), used as "lunch time peel", on skin degreased by a cleansing lotion or by a new "piezoelectric technology" called Skin Master"'.

(*) Trade nome: Keratotal"' Peel

P Morgant1, S.O Randazzo, G.Fabriz1

STUDY PROJECT

In order to verify the real use of the Skin Master® and to explore the activity of this 20% glycolic acid-peel, Stratum Corneum Tumover Time (SCTT). Skin elasticity, Clinica! scoring and TEWL were controlled on upper forearm; Skin lipids and Hydration were controlled on the fa ce.

Skin Master8

3C Systerrf'

CHEMICALS

Gel A: water gel of glycolic acid 20% (lml = g 0,224 of GA) partially neutralized by Na OH (pH 4.5) GA.

GelB: water gel of glycolic acid 20% (lml = g 0,224 of GA) partially neutralized by aminoacids (pH 4.5) GA-Arg/Gly (*).

149

Enhancmg the glyco/1c ac1d eff1cacv by p1ezoelectnc v1brat1ons

Cleansing Lotion: (pH 4.5) Aqua, Ceteareth-6, Isopropyl myrista­te, Octyl steara te , Lactic acid , Sorbito!, Propylene glycol, Glycerin, Gelatin-Glycine(IJ, Hydrolyzed collagen, Tocophery I ace tate, Retinyl palmitate, Linoleic acid, Linolenic acid, Disodium EDTA, Imidazolidinyl urea, Methylparaben, Parfum (*).

Gel-Vehicle: water, propylene glycol, xantan gum (pH 4.5).

Moisturizing Lotion: Soybean liposome con­taining l 0% lecithin frac ti on with 80% pho­sphatidylcholine linoleic acid-rich.

Skin Master®

Technical specifications Actuator frequency: 25.000 Hz+/- 10% Vibration at time actuator: 30 micron pp Frequency: O.I - IOOOHz Work cycle: 5 sec. Maximum of current: 10-600 microA

Skin Master®'s activity is based on mechanical energy transmitted to the skin by a series of ultrasound vibrations of its special actuator. The extreme part of the actuator, induced to vibrate by piezoeletric device, produces com­pression and decompression on the skin surface. The outcome of this treatment is a smooth relaxed and cleaned skin and toned musculature.

3C System®

This computerized system through the capacita­tive resistance permits a simple and quick con­tro! of surface lipids, skin hydration and TEWL. The 3C System"' collects up to 10/15 measure­ments over 25 seconds sampling period and records the mean value automatically standardi­zing the environmental conditions (RH=50%, T=22°C) (11).

(*) Trade nome: TS Gentle C/eansing

150

TEST PROCEDURE ON THE FACE

Patients Fourthy healthy women volunteers, age range 35 to 56, skin type III/IV, part!cipated in the study. Each woman had at least a moderate degree of photodamage as defined by an overall score of 5 with separate scores for each side of the face on a visual analogue scale of O (none) to 10 (severe). The number of actinic keratoses and wrinkling improvement were also counted. No topica! retinoid use or other topica! medica­tions or cosmetic antiaging products were allowed for 1 month prior to study initiation. The subjects were observed daily or weekly for three months (January-March) always by the same investigator. Patients were randomly divided into four treat­ment groups of 1 O individuals. After baseline eva­luation, one group was treated twice a week by a 20% glycolic acid "refresher peel" (partially neu­tralized by aminoacids at pH 4.5) (Gel B) for 2 months, after cleansing the face with a Cleansing Lotion (TS Gentle Cleansing) (Group 1). The second group was treated with the same peel, after cleansing the skin, previously wetted with distilled water, by using the Skin Master® (Group 2). The thirth and the fourth group were respecti­vely treated as the first and the second but used also a phospholipid-based moisturizing lotion twice daily.

Procedure

To perform the peel the following procedure was utilized: the Gel B (glycolic acid peel) was applied uniformly over the entire face after the skin was cleansed with Gentle Cleansing or Skin Master®. Application times were started at 15 minutes for each peel treatment.

(1) USA patented n°4806525/ Feb.2, 7989

P Morgont1. S D. Rondozzo. G.Fobnz1

w cn < w a: o ~ ~

w cn < w a: o w e ~

SKIN FACE HYDRATION OF PATIENTS TREATED BY A 20% GLYCOLIC ACID·PEEL PARTIALLY NEUTRALIZED BY AMINOACIDS·ARG/GLY AT pH 4.5

n = 40 • RH = 50% • t = 22 ·e 100

-/ 80

~ ~ -

/ 60

~ ~ f- -

~ ~ ~

: I ~ldl -

~ ~

40

20

I--~ Sili ~

-·20

-60

·80 --100

15 30 45 60 75 90 DAYS

~ CL+GA+M ~ SM+GA+M ~ CL+GA ~ SM+GA I Treatment period: 2 Months (Twice a Week) with and without using a molsturizlng lotlon (Twice a Day)

All p values are highly s ignificant (p < 0.005) as to Baseline

Fig. I Abbreviations: CL=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Master

SKIN FACE LIPIDS OF PATIENTS TREATED BY A 20% GLYCOLIC ACID·PEEL (PARTIALLY NEUTRALIZED BY AMINOACIDS·ARG/GLY AT pH 4,5) ANO BY MOISTURIZING CREAM (TWICE A DAY)

n =40 • RH = 50% -t= 22 •e

w ~ 15 +-------11--:.,,c----+--- -+-- - = w a: o ~ 10 +-------lf------+''-"';""'""'--~ ~

11.1:t1

O +------l-----+----+------11-------+----~

o 15 30 45 60 75 90 DAYS

I • SM+GA • CL+GA A CL+GA+M • SM+GA+M

Peel-Treatment period: 2 Month (Twice a Week) with and without a moisturizing lotion (Twice a Day)

All p value are highly significant (p < 0.005) as to Baseline and Groups

Fig. 2 Abbreviations: CL=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Master

151

Enhancmg the glycollc ac1d eff1cacy by p1ezoelectnc v1brat1ons

SKIN FACE CLINICAL SCORE ASSESSMENTS AT WEEK 12 OF PATIENTS TREATED (TWICE A WEEK) BY A 20% GL YCOLIC ACID·PEEL PARTIALL Y NEUTRALIZED BY AMINOACID-ARG/GL Y

n = 40 • RH = 50% • I = 22 ' C

6

5

4

3

2

o SM + GA

FINE WRINKLING AROUND EYES

CL+ GA SM+GA+M CL+GA+M

~ Baseline Before ~ After al Week 12

CREASE LINES AROUNO MOUTH AND CHEEKS

SM+ CL+ GA·GLY/ARG GA·GLY/ARG

SM+GA ·GLY/ARG

+M

GA·GLY/ ARG +M

~ Baseline Before [ill After al Week 12

All p values are highly significant (p < 0.005) as to Baseline and to Groups

Peel-Treatment period: 3 months (Twice a Week) wlth and w lthout using a moisturlzing lotlon (Twlce a Day)

Fig. 3 Abbreviations: CL=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion , SM=Skin Master

Every two weeks at I 0.00 a.m. surface lipids, sk.in hydration, the number of crease lines and the de­gree of wrinkling improvement were controlled. Tue obtained results are reported in Fig l ,2,3.

TEST PROCEDURE ON THE FOREARM

Strafum corneum turnover time (SCm Tue right or left foream1 was marked with 7 areas of 2cm2 each, treated in this way:

AREA I Cleansed with Cleansing Lotion + Gel A

AREA 2 + vehicle Gel

AREA 3 Skin Master +Gel A

AREA 4 + vehicle Gel

AREA 5 Cleansing Loti on +Gel B

AREA 6 Skin Master +Gel B

AREA 7 UNTREATED

152

Areas treated by Skin Master* were previously wetted with distilled water. Prior to treatment the stratum corneum was la­belled with dansyl chloride according to Jansen et al. (24) methodology. According to Effendy et al. (25) dansyl chloride was finely triturated into white petrolatum at 5% (w/w) and applied to right volar forearm of the volunteers under semi-occlusive dressing for 24 h. Subsequently, after remove of any excess materiai with soft t issue paper, and after c leansing the area by cleansing lotion or by Sk.in Master*, test sub­stances were applied. The clearance of the fluo­rescence was examined under UV illumination. SCTT was the time in days between staining (day 0) and fluorescence disappearance. O, l ml. of g lycolic acid-Gel-B (pH 4.5), g ly­coli c acid-Gel-A (pH 4 .5) and vehic le (pH 4.5) were applied respectively to the dansyl chloride-labelled areas pre-treated by Clean­s ing Lo tion or S kin Master4'> volar fo rearm areas using polypropylene chambers ( 19 mm

P Morganti. S D. Randazzo, G.Fabnzi

STRATUM CORNEUM TURNOVER TIME (SCTT) ANO SCTT 50 OF FOREARM SKIN TREATED BY A 20% GLYCOLIC ACID-PEEL PARTIALLY NEUTRALIZED BY NaOH OR AMINOACID-ARG/GLY (pH 4,5)

n = 40 - RH = 50% - t = 22 •e

SM + GA SM+GA CL + GA CL+GA SM+ +NaOH -GL Y/ARG -NaOH -GL Y/ARG VEHICLE

I D SCTT 50 • SCTT I CL+ VEHICLE

CONTROL UNTRATED

Ali p values are highly significant (p < 0.005) as to Control values and Groups

Fig. 4 Abbreviations: CL=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Master

ERYTEMA/SCALING SCORE OF FOREARM-SKIN TREATED BY A 20% GLYCOLIC

ACID.PEEL PARTIALLY NEUTRALIZED BY NaOH OR AMINOACID-ARG/GLY

n = -RH = 50% - T = 22 ·e -pH = 4,5 3,0 ~----~------r-----~-----.,.--------,

5

• SM+GA-NaHO (Gel A) .6 CL+GA-NaHO (Gel A)

10 15

e SM+GA-ARG/GL Y (Gel B) + CL+GA-ARG/GL Y (Gel B)

20 * SM+VEHICLE X CL+VEHICLE

Ali p values are highly significant (p < 0.005) as to Baseline and Groups

25 TIME (Days)

Fig. 5 Abbreviations: CL=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Master

153

Enhonc1ng the glycot1c ac1d ett1cocy by p1ezoelectnc v1brot1ons

diameter) on paper adhesive tape for 15 min. Once daily (5 consecutive days for 2 weeks) according to the metho~ described by Effendy et al. Chambers with an erythema score of 3.0 or grea­ter were not reapplied. Vehicle Gel served as contro!. Untreated skin served as a contro! site. The obtained results are reported in Fig. 4 and 5.

ERYTHEMA SCALING SCORES

Each test site was always examined and graded for erythema and scaling according to:

ERYTHEMA: O = no erythema 0.5 = equivocai reaction I = slight erythema 2 = moderate, uniform erythema 3 = intense 4 = fiery redness with edema

SCALING: O = no scale I minimal, fine 2 moderate 3 Jarge flakes, intense peeling

Skin elasticity

Skin elasticity has been controlled weekly I O a.m. to ali patients on a marked forearm area by Der­maflex" A( (Cortex Technology, Hadsund, Den­mark) (26). Tue evaluation of the skin was deter­mined electronically by measuring electric capa­citance between the marked skin surface and the electrode placed in the top of the suction chan1ber. The parameters used were: suction 450m bar, suc­tion period 20s, number of cycles 5. The obtained results are reported in Fig. 6 and 7.

DISTENSIBILITY OF FOREARM-SKIN TREATED BY A 20% GLYCOLIC ACID.PEEL PARTIALLY NEUTRALIZED BY NaOH OR AMINOACID-ARG/GLY (pH 4.5)

n = 40 - RH = 50% - t = 22 •e

6 / .

4.4 ±0.3 4.5± 0.2 4 .6 ± 0.3 4 .6± 0.4 4 .3 :t0.4 ::::=- ~ 4.2± 0.3

:::::::::;: e=-.::::::::;; -

5

4 ,,. - ~ --; 1 .,

v- '---- '"----3

' ' . v- ' - - -: 2

·•

' ~ v- .' - - - - -

' ; li - - - - - - L- : -..... o CL + CL+ SM + SM+ SM+ CONTROL

UNTRATED GA-NaOH GA-Gl Y/ARG GA·NaOH GA-OLY/ARG VEHICLE

All p value are NOT significant as to Untreated Contro! and Groups

Fig. 6 Abbreviations: C L=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Master

154

P Morgant1. S D. Randazzo. G Fabrw

RELATIVE ELASTIC RETRACTION (RER) OF FOREARM-SKIN TREATED BY A 20% GLYCOLIC ACID-PEEL PARTIALLY NEUTRALIZED BY NaOH OR AMINOACID ARG/GLY (pH 4,5)

n = 40 • RH = 50% • t = 22 ·e 9 O/ 88 j 0.93

84± 0.91 ~~ A AA

0 V 75 ± 0.90 72±0.87

8

~

7 o v 65 ± 0.95

"' 60 v- f---

50 /-- ~

40 ,..'-- ~

,..'-- -30

20 ,..- -(/~ -10

o = ....,..,_ I

..__,:-;:-:I I ~.,., ~

CONTROL SM + CL + SM + CL + SM + UNTRATED VEHICLE GA·NaOH GA·NaOH GA·GLY/ARG GA·GLY/ARG

All p values are highly significant (p < 0.005) as to Untreated and Groups

Fig. 7 Abbreviations: CL=Cleansing Lo1ion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Mas1er

TEWL, SUPERFICIAL SKIN LIPIOS ANO SKIN HYORATION

TEWL, skin Jipids and hydration were control­Jed weekly on the skin face by the 3C System"' methodology (Dermotec, Rome, Italy) (27). Thi s computerized system permi ts a simple and quick determination of TEWL, superficial skin lipids, hydration and pH, whi le the envi­ronmental conditions are automatically stan­dard ized (50% RH and 22°C) by the use of proper correction factors. TEWL is expressed as the amount of water eva­porated per unit of surface in 1 hour gr/m2/h and the system collects up 10/ 15 measurements over 25 second sampling period and record the mean value automatically. The obtained results are reported in F ig. 1, 2 and 8.

RESULTS ANO OISCUSSION

Eryfhema and Scaling

As expected the Gel A application (20% glyco­lic acid partially neutralized by NaOH at pH 4.5), compared to its vehicle (p<0.005), caused a strong erythema (2nd degree) from the second day of treatment on the cutaneous area already cleansed with cleansing lotion. This erythema turned out even stronger when the cleansing was carried out by us ing Skin Master"' (3 de­gree), that, as expected, allowed the glycolic acid to pass through the cutaneous Iayers even quicker. The Gel B application (20% glycolic acid par­tially neutralized at pH 4.5 by aminoacids) has recorded, on the contrary, only a slight erythema from day 8 to day I O as compared to its vehicle

155

Enhoncing the glycolic oc1d eff1cocv by piezoelectr1c v1brot1ons

TRANSEPIDERMAL WATER LOSS OF FOREARM·SKIN TREATED BY A 20% GLYCOLIC

ACID·PEEL PARTIALLY NEUTRALIZED BY NaOH OR AMINOACID-ARG/GLY (pH 4,5)

n =40 • RH = 50% • t = 22 •e

~:-,~~~~e::==:==~ ===~F==: 2+-~~~-+-~~~-+-~~~-+-~~~-+-~~~--+-~~~-<

o 2 5 10 15 20 25 DAYS

• SM+GA-NaOH

.6. CL+GA-NaOH

e SM+GA·ARG/GLY * SM+VEHICLE

+ CL+GA-ARG/GLY X CL+VEHICLE

All p values are highly significant (p < 0.005) as to Vehicle and to Groups

Fig. 8 Abbreviatio11s: CL=Cleansing Lotion, GA=Glycolic Acid, M=Moisturizing Lotion, SM=Skin Master

(p< 0.005), and produced evident scaling from day 1 O to day 18. This did not occur with the vehicle (Fig. 5).

TEWL

In accordance with Effendy et al. TEWL at the GA-treated area increased on day 10 and main­tained significantly hi gher levels than the un­treated or vehicle-treated skin (p<0.005). Only the areas treated with g lycolic acid partiall y neutralized with ARG/GLY aminoacids showed TEWL levels similar to the vehicle. These levels were higher only when the skin was pre-treated by Skin Master®, and when gly­colic acid (GA) partially neutralized with NaOH was used, implying that the water barrier of Stra­tum Comeum is altered by the glycolic acid treat­ment more or less clearly not only in relation to the quantity of free glycolic acid, but also to the kind of used neutralizer and to the intensity of the cleansing treatment used. What seems even more

156

interesting is the fact that the alterati on of the barrier seems not to be dependent from the pH, as often asserted by different authors (15,19, 21-22), but from the kind of neutralizer used (Fig. 8). The glycolic acid used, neutralized by a mix.­ture of aminoacids, acted in a way fairly similar to the vehicle (Fig. 8), unlike the same glycolic acid neutralized by NaOH.

SCTT

Glycolic ac id has significantly reduced SCTT and SCTT-50 with respect to the vehicle and the contro! (Fig. 4), both when partially neu­tralized with NaOH (14.0±7, p<0.005) and by aminoac ids ( 14.0±1, p<0.005)), after clean­si ng previously the skin with Cleansing Lo­tion. The use of the Skin Master® has furtherly reduced the SCTT (GA-Arg-Gly 13. 1±0.9 and GA-Na OH 12.9±0.9) (p<0.005), proving that this type of cleansing helps the absorption and therefore the activity of glycol ic ac id and of

active ingredients in generai. These results prove, as already verified by ourselves and other authors, that glycolic acid acts as Stra­tum Corneum cel I renewal accelerator, and that the intens ity of activ ity a nd the the erythema degree is strictly related also to the means of cleansing used and to the used che­mical neutralizers (Fig. 4 and 5). It seems not to depend, therefore, only on the free glycolic ac id.

Superficial skin lipids, hydration and e/asticity

As it is known and as can be seen the every­two-week treatment with glycolic acid, conside­rably improves the skin elasticity (RER) (Fig. 7) (pH<0.005 with regard to contrai), but not the skin distensibility (Fig. 6). Concerning hydration and surface lipids (Fig. I and 2) it is evident that the peeling reduces the skin hydration and seems to have an influence a lso on superficial skin lipids thanks to the exfoliating activity caused by g lycolic acid if used in 20% concentrations without the use of emoll ients. When the treatment is integrated by the use twice a day of an emollient cream re­sults invert.

Clinica/ score assessmenf

Before (Day O) and after 12 weeks of treatment cl inica( score assessment was checked by the same dermatologist for all patients GA-treated (p<0.005). The individuai signs of fine wrink­ling around eyes and crease lines around mouth and cheeks were scored on 0-10 visual analogue scales with separate scores for each side of the face. The patients treated also w ith the post-peel moisturizing cream (twice a day)and pre-treated by Skin Master~ demonstrated the highest im­provement on wrinkling and crease lines also at week 4 and 8 (p<0.05) in respect to other grou­ps (Fig. 3).

P. Morganti, S.D Randazzo, G.Fabriz1

CONCLUSION

As already supported by several authors g lyco­lic acid carries out an interesting biologica! acti­vity, w hich is not completely explained yet. From these first data, however, it seems possi­ble to say that it obtainable an interesting in­crease of celi turnover by using lighter and sim­pler peeling, that can be performed also by ex­pert aestheticians. It is of extreme importance to perform before the treatments a careful clean­sing. and it is fundamental not only the pro­duct's pH and the neutralizing degree, but the kind of neutralizer used, that affects a lso the erythemigenic components and the stinging ac­tivity carried out by this AHA. It is also fundamental the use of moisturizing creams after the peeling treatments, in ordcr to improve the appearance of photoaged sk in by reducing fine wrinkling and crease lines and to enhance the radiance of the skin giving com­plexion a fresh, youthful glow. Finally, we found highly interesting the use of the Skin Maste~ as new cleansing means, to be used to deeper cleanse the skin when there is a need to accelerate and improve the absorption and the activity of AHAs or other cosmetic acti­ve ingredients.

Aufhor Address: P. Mmga11ti, PhD - Research and Development MAVI Sud srl - Via del!' Industria 1, 04011 Aprilia (LT), JTALY Phone: + 39 06 9286261 Fax:+ 39 06 9281523 E-mai I =mavi@colosseum .i I URL=h1tp ://www.colosseum .itlst81 Ima vi

157

Enhoncing file glycolic oc1d eff1cocv by p1ezoelectnc vibrot1ons

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159

Notes

1997 AWARDS

1997 can be considered particularly successful by Pierfrancesco Morganti, Ph.D., Editor in Chief of our Joumal. Dr. Morganti , Jeading an outstanding team of cosmetic and pharmaceutical scientists, accepted two coveted awards during this year.

Their work, "The transdermal cosmetic delivery system: a new cosmeceutical device" was awarded "The Elegance Engineering Innovation Award" by Cosmetics & Toiletries magazine. This award was announced and publicly presented to Dr. Morganti during the I 997 Advanced Technology Con­ference in Dusseldorf, Gennany on May 3, I 997.

The European Academy of Dermatology and Yenereology (E.A.D.Y.) Poster Prize was awarded and presented to Dr. Morganti by Prof. W.J.Cunliffe during the 6° E.A.D.Y. Congress in Dublin, lreland on September 15, 1997. The title of the poster was "A new cosmeceutical far all year round acne therapy".

Congratulation from the entire editoria! staff of the Joumal to the Secretary General of Intemational Society of Cosmetic Dermatoly far such outstanding success. This reflects well on both the Society and the Joumal. Many of our membership rnay have equally significant honors, and we would be pleased to announce them here, also.

D1: P.Morgami receiving his Award from TJ.Malafronte President of Amerchol

160

Editoria! Staff of the Journal of Applied Cosmetology

The Elegance Engineering lnnovation Award from Cosmetics & Toi/etries® magazine

and >ponsorcd by Amcrchol Corp.

BookRev1ew

MECHANISM OF TRANSDERMAL DRUG DELIVERY Drug and Pharmaceutical Sciences. Series/8

Russel O. Pohs and Richard H. Guy Editors

Published by Marce/ Dekker, New York - 376 hard bound, il/ustrated ISBN: 0-8247-9863-5 • US$ 750.00 Price subject to change without notice Marce! Dekker Inc., 270 Madison Avenue - New York, NY 10016-0602

This new book about transdermal delivery has surely hit the target, providing the readers with a fu ll survey of the mechanisms that are at the basis of Transdermal Delivery. This relatively new metho­dology was developed, as it is known, through three steps or generations, that gradually led to the realization of a better regulation, a better dosage and a better end-user comfort. The objective of the development was the improvement of the transfer and absorption mechanisms through the use of particular ingredients (or enhancers), the redaction of the patch 's dimensions, the improvement of the outward appearance to the advantage of portability. This new book edited by Pohs and Guy in the "Drugs and Pharmaceutical Sciences" series of Mar­ce! Dekker highlights "what is known", giving a "summary of what is happening now", together with "a perceptive look at what is to come in the area of mechanism and enhancement of molecular transport accross the stratum comeum" It begins by highlighting al i the most sophisticated technolo­gies used to enhance the path ways of transdermal Stratum Comeum penetration including the usage of Penetration Enhancers, as new chemical molecules, of Orthophoresys and Sonophoresys, based on the use of ultrasonic energy. It is necessary to remind the reader that the need to stay in depth, improve and widen the knowledges and practical uses of drugs with controlled release arises from different requirements, and among those from the request of chemists of improving client 's com­pliance towards the drugs (e.g. by decreasing the number of daily administrations) and making more steady the hematic and topica! leve! of active ingredients. For these purposes patches are used to ob­tain a steady release of the drug in the space of a day or more, and an extreme user-friendly product. Naturally, it is necessary to evalute the safety of this new device and to determine the degree of risk connected to its use. Ali the methodologies this interesting book deals with, those concerning the contro] of Stratum Cor­neum 's bilayers lipids, as well as those about th newest systems for the contro! of the drug release at cutaneous leve!, are described with plenty of detai ls and bibliographic notes. This book makes a useful reading for researchers who know the technological development which patches have under­gone in these last years, for graduates in medicine, biologists, pharmacists and students willing to learn the basis and the mechanisms of activity that regulate cutaneous absorption and the release of drugs and cosmetics through the organ skin.

P. Morganfi, Ph.D

Editor in Chief

161

lndex to Volume 15, 1997

lndex to Volume 15, 1997

Contents

Note

1997 Awards 160

Book Review

Mechanism of transdermal drug delivery, Drug and Pharmaceutical Sciences. Series/8 Russe! O. Pohs and Richard H. Guy Editors

161

Generai Articles

Skin care products and evaluation of few skin parameters: is the future already here? M,G, Tucci, C. Zucchini, G, Ricotti, A Fionda, L. Morresi.

S. Scrrcsi, A. De Benediuis, G. Biagini

43

Contact allergy to preservatives and perfumed compounds used in skin care products. G. Angelini, G.A. Vena, C. Foti, M. Grandolfo

49

The use of a capacitance device to evaluate the hydration of human skin. V. Zuang, C. Rona, F. Distante, E. Berardesca

95

A new peloid mask of etruscan origin. G. Fabrizi , P. Morganti

109

162

Biologica! functions and therapeutic properties of urea. W. Raab

115

Practical treatment of dry skin. W. Raab

125

Originai Laboratory Studies

An in vitro selection of new cosmetic active compounds: from screening tests on monolaye­red fibroblast culture to efficiency study on 3-D Derma! Equivalent. C. Augustin, V. Frei. E. Perrier, A. Huc, O. Damour

1

Demonstration of the anti-wrinkle efficacy of a cosmetic product. Correlation between clinica! observations and instrument methods. J.G. Camarasa, P. Anthoine, M.J. Tribo Boixareu, E. Serra

Baldrich. L. Aubert

13

Effect of phosphatidylcholine linoleic acid-rich and glycolic acid in acne vulgaris. P. Morganti, S.D. Randazzo, A. Giardina, C. Bruno, M. Vin­

centi, L. Tiberi

21

Role of topica! g lycolic acid and phosphatidyl­choline linoleic acid-rich in the pathogenesis of acne. Linoleic acid versus squalene. P. Morganti, A. Agostini , C. Bruno, G . Fabrizi

33

Hirsutism. Profile 011 Egyptian Females H. M. El-Kahky, A. Imam, M. El-Okbi

59

Clinica] and instrumental evaluation of the ac­tivity of an anti-wrinkle cosmetic product on cutaneous relief and photoaged skin. E. Berardesca, F. Distante, P. Anthoine, G . Rabbiosi,

L. Aubert

69

Topica! tretinoin for photoaging. The China ex­perience. Xinghua Gao, Hong-Duo Chen, Albert M. Kligman

77

Human skin fibroblast culture to test glycolic and lactic acid solutions. M. Mattioli Belmonte, MG. Tucci , E. Vellucci, R. Solmi,

G .Ricotti, O. Talassi, G. Biagini , P. Morganti

85

Clinica! evaluation of two baby wipes in a cross-over study. C. Feliciani , M. Di Carlantonio, R. Bellucci, M. Guarracino,

P. Amerio

103

A comparative double - blind within subject study of the efficacy and tolerability of two dif­ferent derivatives of Vitamin A on skin thick­ness and elasticity: retinoic acid and conjugated retinyl palmitate. E. Thom

133

A new cosmeceutical for the "orange peel" skin. P. Morganti, S .D. Randazzo, G.Fabrizi, C. Bruno

139

Enhancing the glycolic acid efficacy by piezoe­lectric vibrations. P. Morganti , S.D. Randazzo, G.Fabrizi

147

lndex to Volume 15, 1997

163

Author index

Author lndex

Agostini A., see Morganti P., 33 Amerio P., see Feliciani C., 103 Angelini G., Contact allergy to preservatives and perfumed compounds used in skin care pro­ducts, 49 Anthoine P., see Camarasa J.G., 13; see Berar­desca E., 69 Aubert L., see Camarasa J.G. , 13; see Berarde­sca E., 69 Augustin C., An in vitro selection of new co­smetic active compounds: from screening tests on monolayered fibroblast culture to efficiency study on 3-D Derma! Equivalent., 1 Bellucci R., see Feliciani C., 103 Berardesca E., Clinica! and instrumental eva­luation of the activity of an anti-wrinkle cosme­tic product on cutaneous relief and photoaged skin, 69; see Zuang V., 95 Biagini G., see Tucci M.G., 43; see Mattioli Belmonte M., 85 Bruno C., see Morganti P., 21; see Morganti P., 33 Camarasa J.G., Demonstration of the anti­wrinkle efficacy of a cosmetic product. Correla­tion between clinica! observations and instru­ment methods, 13 Damour O., see Augustin C., 1 De Benedittis A., see Tucci M.G., 43 Di Carlantonio M., see Feliciani C., 103 Distante F., see Berardesca E., 69; see Zuang V., 95 El-Kahky H.M., Hirsutism. Profile on Egyptian Females, 59 EI-Okbi M., see El-Kahky H.M. 59 Fabrizi G., A new peloid mask of etruscan origin, 109; see Morganti P., 33; see Morganti P., 147; see Morganti P., 139 Feliciani C., Clinica! eval uation of two baby wipes in a cross-aver study, 103 Fionda A., see Tucci M.G., 43 Foti C., see Angelini G., 49 Frei V., see Augustin C., 1

164

Giardina A., see Morganti P., 21 Grandolfo M., see Angelini G., 49 Guarracino M., see Feliciani C., 103 Hong-Duo Chen, see Xinghua Gao, 77 Huc A., see Augustin C., 1 Imam A., see El-Kahky H.M. 59 Kligman A.M., see Xinghua Gao, 77 Mattioli Belmonte M., Human skin fibroblast culture to test glycolic and lactic acid solutions, 85 Morganti P., Effect of phosphatidylcholine li­noleic acid-rich and glycolic acid in acne vulga­ris, 21; Role of topica! glycolic acid and pho­sphatidylcholine linoleic acid-rich in the patho­genesis of acne. Linoleic acid versus squalene. 33; see Fabrizi G., 109; A new cosmeceutical far the "orange peel" skin, 139; Enhancing the glycolic acid efficacy by piezoelectric vibra­tions, 147; see Mattioli Belmonte M., 85 Morresi L., see Tucci M.G., 43 Perrier E., see Augustin C., 1 Raab W., Biologica! functions and therapeutic properties of urea, 115; Practical treatment of dry skin, 125 Rabbiosi G., see Berardesca E., 69 Randazzo S.D., see Morganti P., 21; see Mor­ganti P., 139; see Morganti P., 147 Ricotti G., see Tucci M.G., 43; see Mattioli Belmonte M., 85 Rona C., see Zuang V., 95 Serra Baldrich E., see Camarasa J.G., 13 Serresi S., see Tucci M.G., 43 Solmi R., see Mattioli Belmonte M., 85 Talassi O., see Mattioli Belmonte M., 85 Thom E., A comparative double - blind within subject study of the efficacy and tolerability of two different derivatives of Vitamin A on skin thickness and elasticity: retinoic acid and conju­gated retinyl palmitate, 133 Tiberi L., see Morganti P., 21 Tribo Boixareu M.J., see Camarasa J.G., 13 Tucci M.G., Skin care products and evaluation of few skin parameters: is the future already here?, 43; see Mattioli Belmonte M., 85 Vellucci E., see Mattioli Belmonte M., 85 Vena G.A., see Angelini G., 49

Vincenti M., see Morganti P., 21 Xinghua Gao, Topica! tretinoin for photoaging. The China experience, 77 Zuang V., The use of a capacitance device to evaluate the hydration of human skin, 95 Zucchini C., see Tucci M.G., 43

Author index

165

Sub1ect tndex

Subject lndex 3C System®, 21, 24, 139; computerized system for measurements of skin parameters, 141 Acne, 21; and squalene, 36; papules, 26; pusto­les, 26; and phosphatidylcholine, 27; and skin hydration, 29; and sebum secretion, 35; and hy­perkeratosis, 35; and oleic acid, 35; and TEWL, 36; and linoleic acid, 36 Acne-affected skin, and squalene concentra­tion, 38 Acne juvenilis, therapy by phosphatidylcholine cream, 35 Acylceramide, of comedones, 23 Age-spot, treatment of, 149 AHAs, 85 Alfa-amyl cinnamaldehyde, 51 Alphahydroxy acid, 85 Anthralin, and urea, 121 Anti-cellulitis, treatment by a natural mud, 111 Anti-wrinkle, efficacy, 13 Ascorbic acid, 4 Baby wipes, evaluation, 103 Benzalkonium chloride, 45 Benzylparaben, 54 Bifonazole, and urea, 122 Bioengineering instrument, 95 Biopeptides, 3 Biotechnology, 3; innovative, 1 Bronopol, 51 Butylhydroxyanisole, 51 Butylhydroxytoluene, 51 Butylparaben, 54 Cadmium chloride, 45 Capacitance, 95 Carbamide, 116; toxicity of, 116; moisturizing activity of, 116; biochemical functions of, 116; Keratolytic and desquamating activity of, 118; antimicrobial activity of, 121; in Dermatology, 121 Celi, proliferation, 3, 86; morphology, 89; con­tro! by SEM, 91 Cellulitis-patch, 140 Cellulitis, 109, 139; treated by a natural peat mud, 112

166

Ceramide-1, and linoleic acid, 23 China, photoaging in, 77 Chinese, 77 Chloracetamide, 51 Chlorexidine digluconate, 23, 35 Cholesterol, 110 Chondroltin-4-Sulphate, ~ Cinnamaldehyde, 51 Cinnamic alcohol, 51 Comedone, open and closed, 26 Contact allergy, 49 Contact dermatitis, and fragrances, 50; eye­lids, 50; hands, legs and face, 50 Contrast microscopy, semiquantitative celi contro!, 89 Corinebacterium acnes, 35; count and pho­sphatidylcholine, 39 Corneometer®CM 820, 95 Corneosurfametry, and skin care products eva­luation, 44 Cosmeceutical, a new, 21, 33; glycolic acid peel as, 147 Cosmetic, efficiency of, 1; moisturizing agent, 9 Cream, pH, 85 Cutaneous relief, 15 Dansylchloride, 147 Depilation, 60 Derma! equivalent, 3 Derma! matrix, 3 Dermoscan®C, 139 Diapers, 104 Dimethylthiazol diphenyltetrazolium bromi­de, 45 Dry skin, and urea, 121; significance of, 126; extemal causes of, 126; endogenous reason for, 126; regimen in, 127; cleansing measures in, 127; and environmental stress, 130 Dry-roughness, 77 Dyspigmentation, 77 EFA, deficiency, 35 Elastin, soluble fraction of, 4; synthesis, 7 Electrolysis, 66 Emulsion science, 3 Epidermal lipids, linoleic acid, 21 Epidermolysis, 86

Epilation,60 Ergosterol, 110 Erythema, 154 Essential fatty acids, deficiency, 35 Ethylparaben, 54 Eugenol, 51 European Community, cosmetics directive of, 3; directive 93/35, 95 Extracellular Matrix, neosynthesis of, 6 Face, 77 Fibroblast, human, 4, 85; proliferation rate of, S, 14, 90; culture, 8, 86; morphology, 89; Formaldehyde, 51 Freeze fracture, 45 Geraniol, 51 Glucocorticoids, and urea, 121 Glycolic acid, 21, 85, 147; and phosphatidyl­choline, 27, 33; and skin ageing, 147; 20% treatment, 147; and photodamage, 149; low concentration of, 149; increases skin elasticity, 155; reduction of SCIT by, 156 Glycosaminoglycans, 4; synthesis of, 5; reali­sed, 6; electrophoresis of, 7 High-moor Peat, 109 Hirsutism, on egyptian females, 59; grading, 63; and electrolysis, 66 Hydroxycitronellal, 51 Hyperkeratosis, 35 Hyperkeratinization, provoved by FFA, 35 Image analysis, 18 Imidazolidinyl urea, 51 Interleukin-6, 45 Isoeugenol, 51 Isothiazolinones, 55 Kathon CG, 51 Keratinocytes, 3 Keratosis, 86 L-Glutamin, 3 Lactate dehydrogenase, 45 Lactic acid, 85 Laser, confocal scanning microscopy, 45 Lauryl sulphate, 45 Linoleic acid, cosmetic activity of, 21, 33; con­tent in a natural mud, 111 Liposome,21,33,45;soybean,23;

Subject Jndex

Magnetic resonance, 46 Mavigen, ldroschiuma, 24, 35 Melanocytes, 3 Methylparaben, 54 Milk, 3 Monolayered culture, 3 Mud, a natural ancient, 109; cosmetic use of a, 111 Natural Mud, 109 Oak moss, 51 Oleic acid, increase, 23 Orange-peel, skin, 139 Orthophoresys, 161 Parabens, 51 Patch, anti-cellulitis, 140 Peat Mud, 111; characteristics, 110; Ashes' analy­sis, 110; fatty acids content, 110, 111; sterol con­tent, 111 Peloid, 109; peat etruscan mud, 109; Ashes' analy­sis, 110; fatty acid content, 110; sterol content, 111 Penetration Enhancers, 161 Phosphatidylcholine, 21; in acne therapy, 21, 33; and surface lipids, 27; and glycolic acid, 27; topica! activity, 28; and p.acnes counts, 39; co­smetic activity of, 21, 33 Photoaging, in Orientals, 79 Photodamage, 77; treatment of, 149 Pigmentation, treatment of, 149 Polydocanol, and urea, 122 Premature aging, 77 Preservatives, contact allergy to, 49 Proline, incorporation, 6 Propionibacterium acnes, 30 Propylparaben, 54 Quaternium 15, 51 Retin-A"', 77 Retinoic acid, 133 Retinyl palmitate, 133 Rheology, 3 Salicylic acid, 23, 35; and urea, 122 Sallowness, 77 Scintillation counter, 4 SCTT, 149 Sebum, linoleic acid concentration in, 21 Sitosterol, 111 Skin, reconstructed, 3; aged, 8; evaluation, 15;

167

Sub1ect lndex

tolerabili ty, 15; replica, 17; surface lipids, 24; free fa tty acids/triglycerides ratio, 24; hydration, 25; surface, 26; topography, 44; equivalent, 44; fi broblasts, 45; photoaged, 69; roughness, 81; pH measurements, 106; microbiology evalua­tion, 107; hydratation, 128; thickness and elasti­c i ty, 135; thi ckn ess, 142; hydratation and TEWL, 143; ageing treatment, 147; elasticity, 154 Skin ageing, 147 Skin care, products evaluation, 43 Skin lipids, reduction of, 27 Skin Master~, 147 Sodium metabisulfite, 51 Sonophoresys, 161 Soya, 3 Stratum Corneum Turnover Time, 147 Squalene, increase, 23; concentration in acne, 38 TCDS, 139 TEWL, 35, 139, 149; measurements of acne af­fected patients, 36; skin, 143 Thymidine, tritiated, 88 Transdermal Cosmetic Delivery System, 141 Transdermal delivery, mechanism of, 161 Tretinoin, topica!, 77; and urea, 122 Triclosan, 51 Urea (carbamide), toxicity of, 116; moisturizing activity of, 116; biochemical functions of, 116; Keratolytic and desquamating activity of, 118; antimicrobial activity of, 121; in Dermatology, 121 Vitreoscilla filiformis, 70 Wa rts, 86 Wheat, 3 Wrinkle, depth, 17; treatment, 77 Wrinkles, 77

168

Announcement

6fh Congress of European Society

tor Pediatrie Dermatology

Rome, September 14-18,1999 Catholic University of Rome

Auditorium of Congress Center

This Scientific Congress has been organized by: "Centro Internazionale Studi e Ricerche in Dermatologia"

"lslilufo di Oinica Dermatologica dell'Università Cattolica del Sacro Cuore" "Gruppo Italiano di Dermatologia Pediatrica"(GIDEP)

under the patronage of: "Società Italiana di Dermatologia e Venereologia" (SIDEV)

lf you wish to receive further information, please contact: G.Fabrizi, MD - lst. Clinica Dermatologica Univ. Cattolica del Sacro Cuore

Tel./Fax: +39-6-30.13.250

Announcement

Announcement

Clinica/ Design Group /ne Seminar Series tor Medicai Devices

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• Regislration Fee: European venues sm up to 30 days before the event. S 10901hereafter. VAT not applicable.

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Nof,'S

' Notes

Notes

Chiuso in tipografia: December 16, 1997 Journal of Applied Cosmecology published quarrerly by INTERNATIONAL EDIEMME, Via Innocenzo XI, 4 1 00165 Roma Icaly. Direccore responsabile: P. Morganci. Direzione, Redazione ed Amminiscrazione: Via Innocenzo Xl, 4 1 00165 Roma Iraly. Scampa: Grafica Flaminia, Roma. Impaginazione: GRAFO' Comunicazione visiva, Roma. Copercina: Dr.ssa M.G. Tucci - Dip. Ricerche INRCA -Ancona Iraly. ISSN 0392-8543 Spediz. Abb. Poscale 70% Filiale di Roma Auc. del Trib. di Roma n. 3 173/83 del 8-7-83.

THE ANTIAGING LINE

GLYCOLIC ACID ACTIVATED BY GELATIN - GLYCINE® TO NORMALIZE THE SKIN TURNOVER

-~ ~~ -; _:ì

· ··~

LA LINEA ANTIAGING CON ACIDO GLICOLICO H ATTIVATO" PER NORMALIZZARE

IL TURNOVER CUTANEO

~ La Ricerca Scientifica L/Y.../Y_/. nella Dermocosmesi

maVI MAVI SUD s.r.l. Aprilia (LT) · ltoly

THE EVOLUTION IN COSMETIC SCIENCE

DE PIGMENTANTE

CUTANEO

CON IDROCHINONE,

ACIDO GLICOLICO

E SCHERMO FISICO

SKIN LIGHTNER WITH HYDROQUINONE, GLYCOLIC ACID AND NON·CHEMICAL UVA SCREEN

ACROMOS®

Primo del tra/lomento con Acromos Before the lrealmenl with Acromos

Dopo l mese di troffo~enlo con Acromos Affer one mounth of lrealmenl with Acromos

Una risposta ottimale alle ipermelanosi cutanee Indicazioni: lpermelanosi acquisite di origine

metabolica, endocrina, nutriziona le,

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Modo d'uso: l-2 volte al dì per non meno di 8 settimane

~ La Ricerca Scientifica . L/Y...JY..J. nella Dermocosmesi

mavt MAVI SUD s.r.l. Aprilia ILT)-ltaly

THE EVOLUTION IN COSMETIC SC/ENCE