Esthetic physicians commonly prescribed high dose vitamin C as a bleaching agent What is the evidence of this practice?

1. High Dose
VITAMIN C
in Cosmetic Dermatology
Peter Nugraha Soekmadji
Department of Dermatovenereology
Faculty of Medicine
Maranatha Christian University
Bandung

2. Conflict of Interest Statement
• NO support or commercial funding for this
presentation or for any products mentioned
here

4. Water-
soluble
Potent
antioxidant
Various
biologic roles
VITAMIN C

5. ANTIOXIDANT

6. Shils et al. Modern nutrition in health and disease. 9th edition.

9. Farris PK. Topical vitamin C: a useful agent for treating photoaging and other dermatologic conditions. Dermatol Surg. 2005
Jul;31(7 Pt 2):814-7; discussion 818.
FUNCTION

10. METABOLISM
Duarte TL, Lunec J. Review: When is an antioxidant not an antioxidant? A review of novel actions and reactions of vitamin C. Free
Radic Res. 2005 Jul;39(7):671-86.

11. Steiling H, Longet K, Moodycliffe A, Mansourian R, Bertschy E, Smola H, Mauch C, Williamson G. Sodium-dependent vitamin C
transporter isoforms in skin: Distribution, kinetics, and effect of UVB-induced oxidative stress. Free Radic Biol Med. 2007 Sep
1;43(5):752-62.

12. Whitney EN. Understanding Nutrition. 11th edition.
INTAKE

13. Whitney EN. Understanding Nutrition. 11th edition.
SCURVY

14. Shils et al. Modern nutrition in health and disease. 9th edition.
BIOAVAILABILITY

15. Shils et al. Modern nutrition in health and disease. 9th edition.

16. Padayatty SJ, Sun H, Wang Y, Riordan HD, Hewitt SM, Katz A, Wesley RA, Levine M. Vitamin C pharmacokinetics: implications for
oral and intravenous use. Ann Intern Med. 2004 Apr 6;140(7):533-7.

17. Parrow NL, Leshin JA, Levine M. Parenteral ascorbate as a cancer therapeutic: a reassessment based on pharmacokinetics.
Antioxid Redox Signal. 2013 Dec 10;19(17):2141-56. doi: 10.1089/ars.2013.5372.

18. Parrow NL, Leshin JA, Levine M. Parenteral ascorbate as a cancer therapeutic: a reassessment based on pharmacokinetics.
Antioxid Redox Signal. 2013 Dec 10;19(17):2141-56. doi: 10.1089/ars.2013.5372.

20. Iwama M, Amano A, Shimokado K, Maruyama N, Ishigami A. Ascorbic acid levels in various tissues, plasma and urine of mice
during aging. J Nutr Sci Vitaminol (Tokyo). 2012;58(3):169-74.

21. Rhie G, Shin MH, Seo JY, Choi WW, Cho KH, Kim KH, Park KC, Eun HC, Chung JH. Aging- and photoaging-dependent changes of
enzymic and nonenzymic antioxidants in the epidermis and dermis of human skin in vivo. J Invest Dermatol. 2001
Nov;117(5):1212-7.

22. Rhie G, Shin MH, Seo JY, Choi WW, Cho KH, Kim KH, Park KC, Eun HC, Chung JH. Aging- and photoaging-dependent changes of
enzymic and nonenzymic antioxidants in the epidermis and dermis of human skin in vivo. J Invest Dermatol. 2001
Nov;117(5):1212-7.

23. What is the
roles of intravenous vitamin C
in medicine?

24. Parrow NL, Leshin JA, Levine M. Parenteral ascorbate as a cancer therapeutic: a reassessment based on pharmacokinetics.
Antioxid Redox Signal. 2013 Dec 10;19(17):2141-56. doi: 10.1089/ars.2013.5372.

25. What is the
available PREPARATION
of vitamin C?

26. Stamford NP. Stability, transdermal penetration, and cutaneous effects of ascorbic acid and its derivatives. J Cosmet Dermatol.
2012 Dec;11(4):310-7. doi: 10.1111/jocd.12006.

27. Campos PM, Gonçalves GM, Gaspar LR. In vitro antioxidant activity and in vivo efficacy of topical formulations containing vitamin
C and its derivatives studied by non-invasive methods. Skin Res Technol. 2008 Aug;14(3):376-80. doi: 10.1111/j.1600-
0846.2008.00288.x.

28. What is the
roles of VITAMIN C
in COSMETIC DERMATOLOGY?

29. Shin J, Kim YJ, Kwon O, Kim NI, Cho Y. Associations among plasma vitamin C, epidermal ceramide and clinical severity of atopic
dermatitis. Nutr Res Pract. 2016 Aug;10(4):398-403. doi: 10.4162/nrp.2016.10.4.398.

30. Lee WJ, Kim SL, Choe YS, Jang YH, Lee SJ, Kim do W. Magnesium Ascorbyl Phosphate Regulates the Expression of Inflammatory
Biomarkers in Cultured Sebocytes. Ann Dermatol. 2015 Aug;27(4):376-82. doi: 10.5021/ad.2015.27.4.376.

31. Burke KE. Interaction of vitamins C and E as better cosmeceuticals. Dermatol Ther. 2007 Sep-Oct;20(5):314-21.

32. Burke KE. Interaction of vitamins C and E as better cosmeceuticals. Dermatol Ther. 2007 Sep-Oct;20(5):314-21.

33. Stamford NP. Stability, transdermal penetration, and cutaneous effects of ascorbic acid and its derivatives. J Cosmet Dermatol.
2012 Dec;11(4):310-7. doi: 10.1111/jocd.12006.

34. Stamford NP. Stability, transdermal penetration, and cutaneous effects of ascorbic acid and its derivatives. J Cosmet Dermatol.
2012 Dec;11(4):310-7. doi: 10.1111/jocd.12006.

35. What is the
roles of INTRAVENOUS VITAMIN C
in cosmetic dermatology?

36. Lee GS. Intravenous vitamin C in the treatment of post-laser hyperpigmentation for melasma: a short report. J Cosmet Laser Ther.
2008 Dec;10(4):234-6. doi: 10.1080/14764170802187193.

37. Kliegman formula +
Vitamin C iontophoresis 7 sessions: xerosis
Lee GS. Intravenous vitamin C in the treatment of post-laser hyperpigmentation for melasma: a short report. J Cosmet Laser Ther.
2008 Dec;10(4):234-6. doi: 10.1080/14764170802187193.
PROTOCOLS

38. 11x monthly QS NdYAG
1064 nm, 7mm, 2,1 J/cm2
3x 7g IV vitamin C
+ 12th QS NdYAG
Lee GS. Intravenous vitamin C in the treatment of post-laser hyperpigmentation for melasma: a short report. J Cosmet Laser Ther.
2008 Dec;10(4):234-6. doi: 10.1080/14764170802187193.
PROTOCOLS

39. Clinical
effects???
Plasma
bioavailability
↑↑↑
Skin levels???
High dose
vitamin C
FUTURE DIRECTIONS