Skincare and Sun Protection<br />Heather Woolery-Lloyd, M.D.<br />Director of Ethnic Skin Care<br />Voluntary Assistant P...
Disclosures<br />Johnson and Johnson-Investigator, Speaker<br />Allergan-Investigator, Consulting<br />Stiefel/Glaxo-Speak...
Overview<br />Skin Types<br />Effects of ultraviolet light in the skin<br />Photoaging<br />Sun Protection<br />Antioxidan...
Baumann Skin Typing System<br /><ul><li>Oily or Dry
Sensitive or Resistant
Pigmented or Non-Pigmented
Wrinkled or Tight</li></li></ul><li>
Skin type and Sun protection<br />Every skin type needs sun protection<br />To prevent photoaging and wrinkles<br />To pre...
Understanding Solar Radiation<br />
Understanding Solar Radiation<br />UVC<br />UVB<br />UVA<br />Visible<br />Infrared<br />
Summary of Solar Wavelengths<br />
Short term Effects of UV<br /><ul><li>Direct DNA damage
Immunosuppression
Sunburn</li></ul>Mitchell D . Et al Radiation Research. 1990;123:299-303<br />D’Ambrosio S  et al Journal of Investigative...
Sunburn<br />Protective mechanism to remove the irreversibly damaged skin cells after excessive UV radiation<br />Mechanis...
Long Term Effects of UV<br />Epidermal thickening<br />Skin cancers<br />Pigmentary disorders-melasma, brown spots, age sp...
Photoaging: Causes<br />
Photoaging UVA and UVB<br />UVB absorbed in epidermis<br />Induces matrix metalloproteinases (enzymes that breakdown colla...
Photaging <br />Dry and Rough<br />Wrinkled<br />Thin  and fragile<br />Poor elasticity<br />Sallow color<br />Dark spots<...
Causes of skin aging<br />Intrinsic 20%<br />Genetic<br />Extrinsic 80%<br />Chronic sun exposure<br />Smoking<br />Pollut...
Photoaging: Treatment and Prevention<br />
Melanin: A Natural Photoprotectant<br />Acts as a natural filter<br />Five times as much UVR reaches the upper dermis of w...
Melanin: A Natural Photoprotectant<br /><ul><li>The photoprotection observed in dark skin is due to
increased melanin content
unique distribution of melanosomes in dark skin</li></ul>Kaidbey KH. J Am AcadDermatol. 1:249, 1979.<br />
Melanosomes in Black and White Skin<br />Black<br />White<br />Szabo Ggerlad AB, Patnak MA, Fitzpatrick TB Nature 1969<br ...
Prevention of Photoaging:Sunscreen<br />
What does SPF mean?<br />Sunburn protection factor<br />Amount of protection from UVB<br />Does not measure protection fro...
What does SPF mean?<br />SPF measures induced redness on unsensitized skin following UVB exposure<br />SPF compares the ti...
What does PFA mean?<br />PFA measures induced pigmentation on unsensitized skin following UVA exposure<br />PFA compares t...
What does PFA mean?<br /><ul><li>The PFA grading system of UVA protection will soon be required by the FDA to claim UVA co...
Will be quantified on a four point scale of (1* to 4*)
Will allow consumers to compare UVA coverage between various formulations</li></li></ul><li>Sunscreen Application<br />Cor...
Sun Protection<br />Correct application: 2mg/cm2<br />Most users achieve an SPF of 20% to 50% of the expected SPF because ...
Facial Sunscreen <br />
Sunscreen Application<br />Realistically, individuals may not change the quantity of facial sunscreen <br />Increasing the...
Treatment of Photoaging:Retinoids<br />
Matrix Metalloproteinase (MMP)<br />Induced by UVB<br />Breakdown collagen in the skin<br />Retinoic acid inhibits MMP’s<b...
Tretinoin 0.02% cream<br />Baseline<br />24 weeks<br />
Treatment and Prevention of Photoaging:Antioxidants<br />
What is an antioxidant?<br />When our cells use oxygen, they naturally produce byproducts called free radicals<br />Free r...
Antioxidants<br />Treatment of human skin with the antioxidants inhibits the induction of collagenase by ultraviolet light...
Topical Antioxidants<br />Physiologic Antioxidants <br />Vitamin C – From diet<br />Vitamin E – From diet<br />Ubiquinone ...
Antioxidants in Sunscreen<br />Antioxidants improve photoprotection <br />act as free radical scavengers to prevent UV ind...
Green Tea Extract: Inhibition of UV-Induced Redness<br /><ul><li>Antioxidants significantly protect the skin from UV light...
Natural Therapies in Skin Care<br />
Licorice Extract<br />Active components:<br />Glabridin<br />Liquiritin<br />Licochalcone A<br />Anti-inflammatory<br />Us...
Licorice Extract for RednessLichocalcone A<br />62 subjects with mild to moderate facial redness<br />Four product skin ca...
Licorice for Facial Redness<br />Weber TM. Journal of Cosmetic Dermatology. 5(3):227-32, 2006 Sep<br />
Licorice Extract for PigmentLiquiritin<br />Blinded vehicle controlled<br />20 women aged 18 to 40 years with melasma<br /...
Licorice Extract<br />One month<br />Baseline<br />
Green Tea<br /><ul><li>Green tea is made from the steaming and drying of the fresh leaves of the tea plant Cammeliasinensi...
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Skin Care & Sun Protection - Dr. Woolery-Lloyd

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Dr. Heather Woolery-Lloyd of University of Miami Health System discussed ethnicity and skincare at the 2011 WellBeingWell Conference in Miami.

Skin Care & Sun Protection - Dr. Woolery-Lloyd

  1. 1. Skincare and Sun Protection<br />Heather Woolery-Lloyd, M.D.<br />Director of Ethnic Skin Care<br />Voluntary Assistant Professor<br />Department of Dermatology and Cutaneous Surgery<br />Miller/University of Miami School of Medicine <br />
  2. 2. Disclosures<br />Johnson and Johnson-Investigator, Speaker<br />Allergan-Investigator, Consulting<br />Stiefel/Glaxo-Speaker<br />Somabella Laboratories, LLC-Major Shareholder<br />
  3. 3. Overview<br />Skin Types<br />Effects of ultraviolet light in the skin<br />Photoaging<br />Sun Protection<br />Antioxidants in skin care<br />Natural therapies<br />
  4. 4. Baumann Skin Typing System<br /><ul><li>Oily or Dry
  5. 5. Sensitive or Resistant
  6. 6. Pigmented or Non-Pigmented
  7. 7. Wrinkled or Tight</li></li></ul><li>
  8. 8. Skin type and Sun protection<br />Every skin type needs sun protection<br />To prevent photoaging and wrinkles<br />To prevent skin cancer<br />To prevent hyperpigmentation and brown spots<br />
  9. 9. Understanding Solar Radiation<br />
  10. 10. Understanding Solar Radiation<br />UVC<br />UVB<br />UVA<br />Visible<br />Infrared<br />
  11. 11. Summary of Solar Wavelengths<br />
  12. 12. Short term Effects of UV<br /><ul><li>Direct DNA damage
  13. 13. Immunosuppression
  14. 14. Sunburn</li></ul>Mitchell D . Et al Radiation Research. 1990;123:299-303<br />D’Ambrosio S et al Journal of Investigative Dermatology (1981) 77, 311–313<br />Benjamin CL et al ToxicolApplPharmacol 2007; 224: 241–248<br />Beissert S et al J InvestigDermatolSymp Proc 1999; 4: 61–64.<br />
  15. 15. Sunburn<br />Protective mechanism to remove the irreversibly damaged skin cells after excessive UV radiation<br />Mechanism of programmed cell death-apoptosis<br />
  16. 16. Long Term Effects of UV<br />Epidermal thickening<br />Skin cancers<br />Pigmentary disorders-melasma, brown spots, age spots<br />Visible signs of photoaging<br />
  17. 17. Photoaging: Causes<br />
  18. 18. Photoaging UVA and UVB<br />UVB absorbed in epidermis<br />Induces matrix metalloproteinases (enzymes that breakdown collagen)<br />UVA absorbed in the dermis<br />Induces reactive oxygen species (ROS)<br />Induces mitochondrial DNA mutations<br />
  19. 19. Photaging <br />Dry and Rough<br />Wrinkled<br />Thin and fragile<br />Poor elasticity<br />Sallow color<br />Dark spots<br />Redness<br />
  20. 20. Causes of skin aging<br />Intrinsic 20%<br />Genetic<br />Extrinsic 80%<br />Chronic sun exposure<br />Smoking<br />Pollution<br />
  21. 21. Photoaging: Treatment and Prevention<br />
  22. 22. Melanin: A Natural Photoprotectant<br />Acts as a natural filter<br />Five times as much UVR reaches the upper dermis of white skin when compared to black skin<br />The average protection offered by melanin <br />black skin SPF13.4<br />white skin SPF 3.4. <br />Kaidbey KH, Agin PP, Sayre RM et al. J Am Acad Dermatol. 1:249, 1979.<br />
  23. 23. Melanin: A Natural Photoprotectant<br /><ul><li>The photoprotection observed in dark skin is due to
  24. 24. increased melanin content
  25. 25. unique distribution of melanosomes in dark skin</li></ul>Kaidbey KH. J Am AcadDermatol. 1:249, 1979.<br />
  26. 26. Melanosomes in Black and White Skin<br />Black<br />White<br />Szabo Ggerlad AB, Patnak MA, Fitzpatrick TB Nature 1969<br />Grosdahl IK, Szabo G J Invest Dermatol 1978<br />Jimbow K, Quevedo WC, Prota G, Fitzpatrick TB (1999) Biology of melanocytes. In I. M. Freedberg, <br />
  27. 27. Prevention of Photoaging:Sunscreen<br />
  28. 28.
  29. 29. What does SPF mean?<br />Sunburn protection factor<br />Amount of protection from UVB<br />Does not measure protection from UVA<br />SPF 15 blocks 93% of UVB<br />SPF 30 blocks 97% of UVB<br />SPF 45 blocks 98% of UVB<br />
  30. 30. What does SPF mean?<br />SPF measures induced redness on unsensitized skin following UVB exposure<br />SPF compares the time of UVB exposure necessary to induce redness in the presence of product with the time needed to induce the same redness in the absence of product<br />This ratio (protected/unprotected) is the SPF <br />Example:<br />Sunburn in 30min(protected) /sunburn in 1 min(unprotected)=SPF30<br />
  31. 31. What does PFA mean?<br />PFA measures induced pigmentation on unsensitized skin following UVA exposure<br />PFA compares the time of UVA exposure necessary to induce pigmentation in the presence of product with the time needed to induce the same pigmentation in the absence of product<br />This ratio (protected/unprotected) is the PFA <br />
  32. 32. What does PFA mean?<br /><ul><li>The PFA grading system of UVA protection will soon be required by the FDA to claim UVA coverage
  33. 33. Will be quantified on a four point scale of (1* to 4*)
  34. 34. Will allow consumers to compare UVA coverage between various formulations</li></li></ul><li>Sunscreen Application<br />Correct application of sunscreen is essential to achieve the desired SPF and PFA<br />One European study showed that students applied one fifth the recommended sunscreen quantity<br />Correct quantity of sunscreen for the body is 2mg/cm2<br />Body-30 ml (1 oz)-small shot glass<br />Face- 1.2gm –1/2 bottle cap<br />Reapply every 2 hours<br />Autier P, Boniol M, Severi G, Dore JF, Br J Dermatol 2001;144:288-291.<br />Stokes RP, Diffey BL Photodermatol Photoimmunol Photomed 1997;13:186-188.<br />
  35. 35. Sun Protection<br />Correct application: 2mg/cm2<br />Most users achieve an SPF of 20% to 50% of the expected SPF because inadequate sunscreen quantities are applied<br />Examples:<br />SPF 30 becomes SPF 10-15<br />SPF 15 becomes SPF 3-7<br />Stokes RP, Diffey BL. How well are sunscreen users protected? Photodermatol Photoimmunol Photomed 1997;13:186-188.<br />
  36. 36. Facial Sunscreen <br />
  37. 37. Sunscreen Application<br />Realistically, individuals may not change the quantity of facial sunscreen <br />Increasing the SPF from 15 to 30 for a product used daily is one possible solution to address this problem <br />For extensive sun exposure such as at the beach and other outdoor events, generous sunscreen application is encouraged!<br />
  38. 38. Treatment of Photoaging:Retinoids<br />
  39. 39. Matrix Metalloproteinase (MMP)<br />Induced by UVB<br />Breakdown collagen in the skin<br />Retinoic acid inhibits MMP’s<br />Retinoids prevent and treat wrinkles<br />Examples: tretinoin, tazorotene, adapalene<br />
  40. 40. Tretinoin 0.02% cream<br />Baseline<br />24 weeks<br />
  41. 41. Treatment and Prevention of Photoaging:Antioxidants<br />
  42. 42. What is an antioxidant?<br />When our cells use oxygen, they naturally produce byproducts called free radicals<br />Free radicals cause damage and inflammation in the skin<br /> Antioxidants act as "free radical scavengers”<br />Antioxidants prevent and repair damage done by free radicals<br />
  43. 43. Antioxidants<br />Treatment of human skin with the antioxidants inhibits the induction of collagenase by ultraviolet light1<br />Skin uses antioxidants to protect itself from stress due to UV and pollution2<br />Topical antioxidants increase the skin’s antioxidant reservoir2<br />1. Kang S, et al. J Invest Dermatol. 2003;120:835-841.<br />2. Pinnell SR. J Am AcadDermatol. 2003;48:1-19.<br />
  44. 44. Topical Antioxidants<br />Physiologic Antioxidants <br />Vitamin C – From diet<br />Vitamin E – From diet<br />Ubiquinone (coenzyme Q10) – Synthesized<br />Glutathione – Synthesized<br />Botanical Antioxidants<br />Soy isoflavones<br />Tea polyphenols<br />Ellagic extract (Pomegranate)<br />Coffeeberry Extract<br />Pinnell SR. J Am Acad Dermatol. 2003;48:1-19.<br />
  45. 45. Antioxidants in Sunscreen<br />Antioxidants improve photoprotection <br />act as free radical scavengers to prevent UV induced inflammation<br />Adding antioxidants to sunscreen is a new concept in sun protection. <br />Kang S, et al. J Invest Dermatol. 2003;120:835-841.<br />
  46. 46. Green Tea Extract: Inhibition of UV-Induced Redness<br /><ul><li>Antioxidants significantly protect the skin from UV light damage</li></ul>Elmets CA, et al. J Am Acad Dermatol. 2001;44:425-432.<br />
  47. 47. Natural Therapies in Skin Care<br />
  48. 48. Licorice Extract<br />Active components:<br />Glabridin<br />Liquiritin<br />Licochalcone A<br />Anti-inflammatory<br />Used for redness<br />Inhibits melanogenesis<br />Used for brown spots<br />Yokoda T, et al. Pigment Cell Res. 1998;11:355-361.<br />Dieck K, et al. Poster abstract AAD; Feb 18-22, 2005; New Orleans, La.<br />Kolbe L et al. Arch Dermatol Res. 2006;298:23-30.<br />
  49. 49. Licorice Extract for RednessLichocalcone A<br />62 subjects with mild to moderate facial redness<br />Four product skin care regimen for 8 weeks<br />Improvement in redness at 4 and 8 weeks<br />Compatible with the sensitive skin of patients with rosacea <br />Weber TM. Journal of Cosmetic Dermatology. 5(3):227-32, 2006 Sep<br />
  50. 50. Licorice for Facial Redness<br />Weber TM. Journal of Cosmetic Dermatology. 5(3):227-32, 2006 Sep<br />
  51. 51. Licorice Extract for PigmentLiquiritin<br />Blinded vehicle controlled<br />20 women aged 18 to 40 years with melasma<br />Split face (liquirtin vs vehicle)<br />Twice daily for 4 weeks<br />Significant improvement in melasma<br />Amer M, Metwalli M. Int J Dermatol. 2000;39:299-301.<br />
  52. 52. Licorice Extract<br />One month<br />Baseline<br />
  53. 53. Green Tea<br /><ul><li>Green tea is made from the steaming and drying of the fresh leaves of the tea plant Cammeliasinensis, a process that preserves its polyphenolic components.
  54. 54. Photoprotectants
  55. 55. Antioxidants </li></li></ul><li>Green Tea<br />Antioxidant and anti-inflammatory<br />Provides natural protection from ultraviolet light<br />Useful in rosacea<br />
  56. 56. Soy<br /><ul><li>Soy interferes with melanin transfer
  57. 57. Treats hyperpigmentation</li></li></ul><li>Soy-Clinical Data<br /><ul><li>12 week randomized double-blinded </li></ul> vehicle controlled study comparing moisturizer with soy to vehicle<br /><ul><li>Significant improvement in:
  58. 58. Mottled pigmentation
  59. 59. Blotchiness
  60. 60. Dullness
  61. 61. Fine lines</li></ul>Overall texture<br />Overall skin tone<br />Overall appearance<br />Wallo W J Drugs Dermato 2007;6(9):917-22<br />
  62. 62. Total Soy and SPF 30 Moisturizer<br />12 Weeks<br />Baseline<br />Nebus J, et al. Poster presented at: 64th Annual Meeting of the AAD. March 3-7, 2006; San Francisco, CA.<br />
  63. 63. Oral Agents for Sun Protection<br />Proanthocyanidins-Melasma<br />Pine tree bark extract<br />Grape seed extract<br />Polypodium Leucotomos-Melasma<br />Ellagic Acid<br />Handog EB. International Journal of Dermatology. 48(8):896-901, 2009 Aug. <br />
  64. 64. Summary<br />Sunscreens can prevent UV damage<br />Antioxidants and natural therapies offer good adjuncts to sun protection<br />Basic skin care regimen<br /> AM: sunscreen + antioxidant PM: retinoid<br />Oral photoprotective agents offer a novel mode of sun protection<br />Photoaging is preventable<br />
  65. 65. Thank You!<br />

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