Are cosmetics based on alpha hydroxy acids safe to use when purchased over the internet?

Alpha hydroxy acids (AHAs) are used in dermatology for topical treatment of skin disorders. Some regulatory bodies, including Food and Drug Administration (FDA), recommended labeling cosmetic products with sunburn alerts and proposed limitations regarding concentrations of AHAs in cosmetic products. In addition, The Cosmetic Ingredient Review (CIR) Expert Panel recommended 10% of AHAs in products as the maximal safe concentration. With a rapidly increasing trend of online purchasing of cosmetic products, it is important that their labels convey the necessary warnings and that they be harmonized with regulatory bodies regarding the recommended concentrations of AHAs. The aim of this report was to investigate whether or not the sunburn alert, as well as AHA recommendations mostly used for exfoliating cosmetic products, was visible to consumers during the online purchasing. The compliance with FDA and CIR Expert Panel standards was analyzed in the first 50 cosmetic products obtained after the conducted investigation on the Amazon.com e-commerce company website using the search term "AHA anti-aging." It was found that exfoliating cosmetic products contained AHAs in a broad range of concentrations, from 2.5 up to 70%. Nineteen out of 50 products contained a concentration of AHAs greater than recommended. Twelve products did not contain any data at all regarding the concentration of AHAs. Sunburn alerts were present in 16 out of 50 analyzed product pages. In conclusion, more efforts should be made in providing users with information and the necessity of protection from potential complications after topical AHAs product treatments.

Probiotic supplement combined with topical therapy in the treatment of mild to moderate acne: results from an Italian single centre interventional study.

BACKGROUND: Acne is a chronic inflammatory disease of the pilosebaceous unit resulting from different cofactors. The alteration of the skin microbiome has recently been revealed to play a role in acne pathogenesis. Concerns with side effects of available systemic treatment for acne resulted in a greater focus on topical therapies, such as topical azelaic acid which showed to be an effective and safe treatment option for acne. The aim of our study was to evaluate the efficacy of a new treatment protocol for acne based on an oral supplement composed of biotin and 3 strains of lactic ferments combined with a topical gel composed of azelaic acid, hydroxypinacolone retinoate, and α-hydroxy acids. METHODS: An Italian single-center interventional study was performed enrolling patients suffering from mild-to-moderate-acne. Patients were treated with a supplement based on biotin and 3 strains of lactic ferments, combined with a topical gel product (azelaic-acid, hydroxypinacolone retinoate, and α-hydroxy acids). All enrolled patients were scheduled for a total of 2 visits, a baseline visit (V0) and a follow-up visit after 60 days of treatment (V1). RESULTS: A total of 30 patients were enrolled in the study. Between V0 (baseline) and V1 (60 days), there was a reduction of 37.4% in the GAGS Score, 40.7% in the SEBUTAPEtm Score, and 18% in the TEWL Score, and an increment of 44% in the T-Blue Test Score. No cases of serious AEs were reported in our experience. CONCLUSIONS: Our results confirmed the promising therapeutic role of a probiotic supplement associated with topical therapy in the treatment of mild to moderate acne.

Efficacy of alpha hydroxy acid combined with intense pulsed light in the treatment of acne vulgaris: A meta-analysis.

BACKGROUND: Acne patients frequently receive combination therapy. However, there has been no rigorous review of the efficacy of combining alpha hydroxy acid with IPL for acne vulgaris treatment. OBJECTIVE: Assessing the effectiveness and safeness of alpha hydroxy acids in combination with IPL in the treatment of people with acne vulgaris. METHODS: A computer search of common biomedical databases, including PubMed, Web of Science, Cochrane Library, Embase, Wanfang, CNKI, SinoMed, and VIP, was extensively conducted to identify previous studies on randomized controlled trials of alpha hydroxy acid combined with IPL in the management of acne vulgaris. RESULTS: A total of 18 publications were included (1435 patients with common acne met the inclusion criteria). The meta-analysis showed that alpha hydroxy acid (AHA) combined with IPL had higher overall efficacy than the control group (OR = 4.24; 95% CI 2.66 ~ 6.74; p < 0.01). In the case of acne vulgaris, AHA combined with IPL and the AHA alone showed a remarkable difference in total efficiency (OR = 4.10; 95% CI 2.12 ~ 7.91; p < 0.01), and AHA combined with IPL were more effective than IPL alone (OR = 4.02; 95% CI 2.25 ~ 7.16; p < 0.01). In addition, the occurrence of adverse reactions that occurred in AHA combined with IPL and control groups did not differ (OR = 0.86; 95% CI 0.46 ~ 1.60; p = 0.64). CONCLUSION: AHA combined with IPL therapy was superior to other therapies. Although it was slightly more expensive, it was effective and had a wide range of applications.

Topical treatment for postinflammatory hyperpigmentation: a systematic review.

BACKGROUND: Topical measures are the mainstay treatment for postinflammatory hyperpigmentation (PIH). Numerous studies have assessed the efficacy of topical medications for the treatment of PIH, but few have evaluated the quality of evidence supporting these topical therapies. We performed a systematic review to evaluate the evidence of topical treatments for PIH. METHODS: We included English-language studies that evaluated topical medications for PIH. We searched PubMed, MEDLINE, and EMBASE from conception to March 29 2021. We used the modified Grading of Recommendations, Assessment, Development and Evaluation scale (GRADE) scale to assess quality of evidence. RESULTS: Forty-seven of 1,224 studies with 1,853 subjects were included. Topical agents with high-quality studies included retinoids, hydroxy acids, corticosteroids, thiamidol, niacinamide and plant-derived products. Sunscreens with SPF30 or greater was recommended in almost every study. Common side effects included desquamation, burning, stinging, dryness, and pruritus. CONCLUSIONS: Retinoids, hydroxy acids and broad-spectrum sunscreen were supported by the greatest number of high-quality studies. Ongoing inflammation may be subtle, especially in darker skin phenotypes. Herein, we proposed an evidence-based algorithm for PIH based on the high-quality studies. There is a need to adopt a validated outcome measure for PIH to better compare efficacy between various treatments in future studies.

Is maintenance treatment in adult acne important? Benefits from maintenance therapy with adapalene, and low doses of alpha and beta hydroxy acids.

Background: Adult acne is a chronic disease with uncontrolled exacerbations, associated with a psychological burden of the patient and medical expenses. Aims: The aim of the study was to check the efficacy of maintenance therapy of adult acne. It is essential part of treatment as adult acne usually has a long-lasting and recurring course. Methods: In the study, the efficacy of maintenance therapy in patients with adult acne is evaluated. In this study, 100 patients (aged 25-39 years of age) with mild and moderate adult acne were enrolled. Results: The maintenance therapy (adapalene 0.1% three times a week and low doses of alpha and beta hydroxy acids) led to a significant decrease in the number of acne lesions (from 31.3 to 12.25; p < .001) and severity of seborrhea (p < .001). Conclusions: Maintenance therapy brings significant improvements in the reduction of non-inflammatory and inflammatory lesions in patients with mild and moderate adult acne.

Dual Effects of Alpha-Hydroxy Acids on the Skin.

AHAs are organic acids with one hydroxyl group attached to the alpha position of the acid. AHAs including glycolic acid, lactic acid, malic acid, tartaric acid, and citric acid are often used extensively in cosmetic formulations. AHAs have been used as superficial peeling agents as well as to ameliorate the appearance of keratoses and acne in dermatology. However, caution should be exercised in relation to certain adverse reactions among patients using products with AHAs, including swelling, burning, and pruritus. Whether AHAs enhance or decrease photo damage of the skin remains unclear, compelling us to ask the question, is AHA a friend or a foe of the skin? The aim of this manuscript is to review the various biological effects and mechanisms of AHAs on human keratinocytes and in an animal model. We conclude that whether AHA is a friend or foe of human skin depends on its concentration. These mechanisms of AHAs are currently well understood, aiding the development of novel approaches for the prevention of UV-induced skin damage.

Role of ATP-Sensitive K+ Channels in Myocardial Infarct Size-Limiting Effect of Chronic Continuous Normobaric Hypoxia.

The role of KATP channels in myocardial infarct size-limiting effect of chronic continuous normobaric hypoxia was examined in a rat model based on a 20-min coronary occlusion and subsequent 3-h reperfusion. Rats were adapted to normobaric hypoxia (12% O2) for 21 days. This hypoxia produced a pronounced infarct size-limiting effect, which had been prevented by 0.3 mg/kg glibenclamide, a non-selective inhibitor of entire pool of KATP channels, or 5 mg/kg 5-hydroxydecanoate, an inhibitor of mitochondrial KATP channels. The study highlighted the important role of mitochondrial KATP channels in myocardial infarct size-limiting effect of chronic normobaric hypoxia.

Peeling químico, una herramienta útil en la consulta / Chemical Peeling: A Useful Tool in the Office

Las exfoliaciones químicas (más conocidas como peelings químicos) son tratamientos utilizados frecuentemente en dermatología estética. En concreto el peeling con ácido tricloroacético se ha utilizado desde hace años y una de sus principales limitaciones clásicamente era sus efectos secundarios. Presentamos una revisión práctica de las características, mecanismos de acción, indicaciones y complicaciones de los peelings en general, tanto los superficiales como el peeling con ácido tricloroacético (AU)

Chemical peeling is a common treatment in cosmetic dermatology. A peel that has been used for many years is trichloroacetic acid. Its adverse effects have for a long time been a major limitation. We present a practical review of the characteristics, mechanisms of action, indications, and complications of superficial chemical peels and of peeling with trichloroacetic acid (AU)

Fifty years of research and development of cosmeceuticals: a contemporary review.

Facial rejuvenation can be categorized into skincare and facial contouring. Research and development of cosmeceuticals is aimed at addressing the major signs of photoaging: wrinkles, dyschromia, and sallowness. Assessment of photoaging comes in clinical and photographic forms; a photonumeric scale developed by Griffiths et al. has been assured of its validity and reliability for the assessment of severity of photoaging in qualitative studies. Treatment of photoaging comes in two categories: preventive and reversal of signs; whilst sunfactors are the most efficient and essential in preventing photodamage, research and development of cosmeceuticals for facial rejuvenation has been robust, thanks to several landmark studies in the last fifty years, funded by some of the forerunners in contemporary cosmetic industry. Stem cell research remains the current forerunner in research concerning cosmeceuticals. Nevertheless, high-quality, randomized control trials remain scarce within the contemporary literature, and more research and trials without funding by the industry are required to give rise to impartial comparisons between various cosmeceutical products. The "perfect cream" for facial rejuvenation remains elusive.

The unfolded protein response in the therapeutic effect of hydroxy-DHA against Alzheimer's disease.

The unfolded protein response (UPR) and autophagy are two cellular processes involved in the clearing of intracellular misfolded proteins. Both pathways are targets for molecules that may serve as treatments for several diseases, including neurodegenerative disorders like Alzheimer's disease (AD). In the present work, we show that 2-hydroxy-DHA (HDHA), a docosahexaenoic acid (DHA) derivate that restores cognitive function in a transgenic mouse model of AD, modulates UPR and autophagy in differentiated neuron-like SH-SY5Y cells. Mild therapeutic HDHA exposure induced UPR activation, characterized by the up-regulation of the molecular chaperone Bip as well as PERK-mediated stimulation of eIF2α phosphorylation. Key proteins involved in initiating autophagy, such as beclin-1, and several Atg proteins involved in autophagosome maturation (Atg3, Atg5, Atg12 and Atg7), were also up-regulated on exposure to HDHA. Moreover, when HDHA-mediated autophagy was studied after amyloid-ß peptide (Aß) stimulation to mimic the neurotoxic environment of AD, it was associated with increased cell survival, suggesting that HDHA driven modulation of this process at least in part mediates the neuroprotective effects of this new anti-neurodegenerative drug. The present results in part explain the pharmacological effects of HDHA inducing full recovery of the cognitive scores in murine models of AD.

Blocking of the ATP sensitive potassium channel ameliorates the ischaemia-reperfusion injury in the rat testis.

There is increasing evidence that the effects of administered ATP sensitive potassium (KATP ) channel openers or blockers during ischaemia are still controversial in many organs/tissues. Testicular torsion detorsion which causes ischaemia-reperfusion (IR) injury, cannot be predicted, thus an effective drug should be administered during or after the ischaemia. The aim of this study was to examine whether the administration of KATP channel openers or blockers during ischaemia ameliorates IR injury in the testis. Eight-week-old male Sprague-Dawley rats were subjected to 2 h right testicular ischaemia followed by 24 h reperfusion. The selective mitochondrial (mito) KATP channel blocker, 5-hydroxydecanoate (5-HD) (40 mg/kg), the non-selective KATP channel blocker glibenclamide (5 mg/kg), the selective mito KATP channel opener diazoxide (10 mg/kg) and the non-selective KATP channel opener cromakalim (300 µg/kg) were administered intraperitoneally 15 min prior to the ischaemia or 75 min after the induction of ischaemia. Tissue damage was evaluated by malondialdehyde concentration, myeloperoxidase activity, histological evaluation and TdT-mediated dUTP nick end labelling assay in the testis. There was a significant increase in oxidative stress, neutrophil infiltration, histological damage and apoptosis in the testicular IR model. A significant reduction in the testicular IR injury was observed with the administration of glibenclamide, but not 5-HD, diazoxide or cromakalim during ischaemia. The administration of non-selective KATP channel blocker glibenclamide ameliorated the testicular IR injury. On the other hand, the selective mito KATP channel blocker, 5-HD and KATP channel openers did not reduce the testicular IR injury. These data suggest that blocking of the membrane KATP channel may have a protective effect during the testicular ischaemia. Glibenclamide could be an effective drug to manage the post-ischaemic injury caused by the testicular torsion-detorsion.

Potential therapeutic targets for hypoxia-induced pulmonary artery hypertension.

BACKGROUND: Hypoxic pulmonary artery hypertension (PAH) as a severe pulmonary disease is characterized by changes of pulmonary vascular reconstruction. Mitochondrial ATP-sensitive potassium channel (mitoKATP) was considered as one of factors responsible for the proliferation of hypoxic pulmonary arterial smooth muscle cells (PASMCs), although the exact mechanisms remain unclear. METHODS: Pulmonary artery hypertension was induced in rats with or without 5-hydroxydecanoate (5-HD). The mean pulmonary artery pressure, morphologic changes, mRNA and protein expressions of voltage-gated potassium channels (Kv1.5 channel), were measured. The concentrations of monocyte chemo-attractant protein-1 (MCP-1) and transforming growth factor-beta1 (TGF-ß1) were detected. Furthermore, pulmonary arterial smooth muscle cells (PASMCs) were isolated and cultured with or without hypoxia pretreated with or without 5-HD or/and Kv1.5 inhibitor 4-aminopyridine (4-AP). Mitochondrial membrane potential (Δψm) and the proliferation of PASMCs were detected. RESULTS: 5-HD significantly prevented the development of PAH by blocking the mitochondrial membrane depolarization, increased the expression of voltage-gated potassium channels, and reduced pulmonary hypertension mediated by TGF-ß1 or MCP-1 signaling pathway. CONCLUSION: The MitoKATP plays an important role in the development of PAH and may be therapeutic target for the treatment of disease.

An evaluation of the benefits of a topical treatment in the improvement of photodamaged hands with age spots, freckles, and/or discolorations.

BACKGROUND: Photoaging of the hands is common due to frequent exposure to environmental factors. OBJECTIVE: To evaluate the efficacy of a topically applied cream formulated with an alpha-hydroxy acid, depigmenting agents, and antioxidants to improve the appearance of characteristics associated with photodamaged hands. METHODS: This was a single-site, open-label study of a proprietary topical treatment (Vivité Vibrance Décolleté, Allergan, Inc.) in adult female subjects with moderate-to-severe photoaging of the hands. The treatment was administered to the hands twice daily over an 8-week period. Treatment efficacy was assessed at baseline and weeks 4 and 8 using the Investigator Global Assessment (IGA) score based on the percentage coverage and color depth of photodamaged areas. The severity of age spots, freckles, and hand skin discoloration were also assessed; digital and ultraviolet photography of the hands was performed. Subject-reported assessments of treatment efficacy were evaluated using a questionnaire administered at week 8. Statistical significance was defined with an α set at P≤.05. RESULTS: Thirty-five subjects were enrolled with a mean age of 55.6 years; 33 subjects completed the study. The IGA of the appearance of hand photodamage improved from a mean (standard deviation) score of 5.0 (0.8) at baseline to 3.1 (1.5) and 2.6 (1.3) at weeks 4 and 8, respectively (1=mild; 9=severe). Based on expert-grader evaluation, subjects demonstrated statistically significant improvements from baseline in IGA at weeks 4 and 8 in age spots and freckling at weeks 4 and 8, (P<.0003) and in skin discolorations at week 8 (P<.05). The majority of subjects reported that they perceived improvements in each of the 9 parameters associated with skin appearance. No adverse events were reported. CONCLUSIONS: The appearance of age-related hand pigmentation characteristics were significantly improved at 4 and 8 weeks of treatment. Subjects reported post-treatment improvements in other characteristics associated with healthy skin.

A double-blind, randomized clinical trial of 20% alpha/poly hydroxy acid cream to reduce scaling of lesions associated with moderate, chronic plaque psoriasis.

BACKGROUND: Salicylic acid is a topical keratolytic agent used to reduce scaling and hyperkeratosis associated with psoriasis vulgaris. However, its use is limited due to potential systemic toxicity. Hydroxyacids also modulate keratinization and desquamation. Therefore, they may serve a beneficial role in the treatment of hyperkeratotic conditions. To date, there are no clinical studies in the literature regarding the efficacy of hydroxyacids for psoriasis treatment. PURPOSE: To evaluate the therapeutic efficacy of topical 20% alpha-hydroxy/polyhydroxy acid versus standard salicylic acid to reduce scaling in patients with moderate, chronic psoriasis. METHODS: Twenty-five subjects with moderate, chronic psoriasis were enrolled in a 2-week, double-blind, left-right, randomized, bilateral comparison clinical trial to compare the efficacy of 20% alpha-hydroxy/polyhydroxy acid emollient versus 6% salicylic acid cream and 24 were randomized/completed. Clinical evaluations to assess the severity of psoriasis and scaling were performed using a 6-point scale prior to treatment, as well as following 1 and 2 weeks of therapy. RESULTS: Twenty-four participants completed the study. Both 20% alpha-hydroxy/polyhydroxy acid emollient and 6% salicylic acid cream were efficacious in reducing scale of psoriatic lesions. The topical 20% alpha-hydroxy/polyhydroxyacid reduced scaling at a faster rate; however, following 2 weeks of treatment the efficacy of both products were relatively the same. CONCLUSION: 20% alpha-hydroxy/polyhydroxyacid is as efficacious as salicylic acid in regards to the de-scaling of psoriatic plaques. Additionally, 20% alpha-hydroxy/polyhydroxyacid cream may yield quicker results and less toxicity than salicylic acid.

[Efficacy of AboundTM for hand-foot syndrome caused by capecitabine].

Hand-foot syndrome( HFS) has been reported to be the most common adverse effect of capecitabine, with an incidence of more than 50%. AboundTM, containing ß-hydroxy-ß-methyl butyric acid( HMB), L-glutamine, and L-arginine is effective in the treatment of decubitus ulcers and in wound healing; however, whether AboundTM is efficacious for HFS caused by capecitabine is not clear. This study aimed at evaluating the effectiveness of AboundTM in the recovery from HFS caused by capecitabine. Capecitabine administration was discontinued in 6 patients with more than grade 2 HFS, and AboundTM was administered. The time to recovery was examined. The median time to recovery to less than grade 1 HFS was 10 days( range, 4-14 days). The grade of HFS decreased following the administration of AboundTM. The findings of this study suggest that AboundTM is effective against HFS caused by capecitabine.

The neuroprotective effect of diazoxide is mediated by mitochondrial ATP-dependent potassium channels in a rat model of acute subdural hematoma.

Acute subdural hematoma (ASDH) results in neuronal death due to mitochondrial dysfunction and a subsequent cascade of apoptotic and necrotic events. We previously demonstrated that mitochondrial ATP-dependent potassium (mitoK(ATP)) channels have a major role in cerebral ischemic preconditioning in vivo and in vitro. However, the role of the mitoK(ATP) channel has not been investigated in the context of ASDH. Thus, the purpose of this study was to determine whether the mitoK(ATP) channel mediates neuroprotection in a rat model of ASDH. Male Wistar rats were subjected to subdural infusion of 400 µL autologous venous blood. The rats were assigned to four experimental groups pretreated intraventricularly 15 minutes before ASDH with (1) vehicle (n=10); (2) the mitoK(ATP) channel agonist diazoxide (n=9); (3) diazoxide plus the selective mitoK(ATP) channel antagonist 5-hydroxydecanoate (5-HD) (n=6); or (4) 5-HD alone (n=6). Infarct volume was assessed at 4 days after ASDH. Brain edema formation was also measured. Pretreatment with diazoxide significantly reduced infarct volume and brain edema formation after ASDH. However, the effects of diazoxide were abolished by co-treatment with 5-HD. 5-HD alone increased infarct volume. These data suggest that the mitoK(ATP) channel is an important mediator of the neuroprotective effects of cerebral preconditioning in a rat model of ASDH.

Cosmetic and dermatologic use of alpha hydroxy acids.

Alpha hydroxy acids (AHAs), in particular glycolic acid, are a class of chemical compounds frequently used in cosmetics and dermatology. This review summarizes the current knowledge regarding chemistry, mechanism of action as well as the different indications ranging from cosmetic skin hydration to acne proven by clinical trials. Overall AHAs depending on the concentration used present an ingredient for cosmetic products or medical devices with proven efficacy.

Efficacy of an alpha-hydroxy acid (AHA)-based cream, even in monotherapy, in patients with mild-moderate acne.

AIM AND METHODS: The treatment of mild-moderate acne with topical drugs in association with appropriate cosmetics is currently the golden standard. The tolerability and efficacy of a cream formulated with a new mix of alpha-hydroxy acids (Hyseac AHA cream) in 248 patients with mild-moderate acne (comedonic, inflammatory, or mixed) have been investigated in a multicenter, non-randomized, open study by 10 dermatologists from different Italian areas during their routine practice. The medication with Hyseac AHA cream was prescribed at first consultation for 60 days, twice a day, either as a monotherapy (49.2% patients) or in association with a pharmacological treatment (50.2%). RESULTS: The tolerability was good to excellent in 92.3% patients, without significant differences between patients using AHA cream in monotherapy (90.0%) or associated with concomitant pharmacological treatment (97.6%). The efficacy was overall high in 64.2% patients, again without significant differences related to concomitant pharmacological treatment or not (64.8% vs. 63.3%) and/or the acne clinical type (comedonic vs. inflammatory vs. mixed: 69.2% vs. 66.7% vs. 58%). CONCLUSION: The results of this study, while confirming the high tolerability and efficacy of this AHA cream in the treatment of mild/moderate acne, reasonably suggest its possible use also in monotherapy. Furthermore, its use can be reasonably hypothesized as a maintenance treatment after specific pharmacological treatment even in more severe acne types.

Photoaging: prevention and topical treatments.

A rapidly increasing number of people visit dermatologists for the prevention and treatment of aging skin. Sun avoidance and sunscreen use are widely accepted strategies of primary prevention against photoaging. Convincing evidence shows that topical application of retinoids has an effect on reversing, at least partially, mild to moderate photodamage. Antioxidants and alpha-hydroxy acids can alter the skin structure and function. Enzymes that repair DNA damage or oligonucleotides that enhance the endogenous capacity for DNA damage repair may prove to be future preventive/therapeutic interventions for aging skin.