USE OF
TOPICAL VITAMIN C
AND ITS EFFECTS ON PHOTODAMAGED SKIN TOPOGRAPHY
Excerpts From the Award Winning Abstract by Dr. Steven
S. Traikovich, 1988 Award for Best Scientific Paper by The American Academy of
Facial Plastic & Reconstructive Surgery
"Chronic insults to the skin such as ultraviolet light,
ozone, cigarette smoke, pollutants and other natural and synthetic environmental stimuli
lead to cumulative damage, and can result in photoaging and heliodermatitis".1
Chronic ultraviolet sun exposure leads to clinical changes in the skin such as laxity,
roughness, dryness, sallowness, pigmentation, telangectasia and wrinkles.2 Reactive oxygen
species such as free radicals unquestionably produce oxidative damage in skin. Ultraviolet
light contributes directly to photodamage, not only by generation of reactive oxygen
species but also by depression of antioxidant levels.3 Antioxidants are obviously
necessary for neutralizing oxygen molecular species such as oxygen free radicals, which
damage and destroy skin. Vitamin C (ascorbic acid) has been shown to have antioxidant
effects as well as a role in collagen stimulation...
"Ultraviolet light exposure depletes up to two-thirds of
cutaneous Vitamin C stores.4 Cutaneous levels not obtainable by ingestion of Vitamin C can
be reached with topical application. Topical Vitamin C provides more than twenty times the
amount of Vitamin C found in normal skin. Ascorbic acid stereoisomers D-ascorbic acid and
L-ascorbic acid exist, but only the L-ascorbic acid form can be used by the body. This
stable form of L-ascorbate has allowed pharmacological levels of Vitamin C penetration
targeted directly into the skin by topical application to effect antioxidant and collagen
stimulation. Because topical Vitamin C does not absorb light in UVB/UVA range, it is not a
sunscreen but exerts its effects by neutralizing oxygen free radicals.
"Skin inflammation, which is mediated by reactive oxygen
species, has been reported to be alleviated by topical use of Vitamin C on ultraviolet
radiation-induced erythema on porcine and human skin. This same study also showed a
protective effect on the inflammatory response when applied, even after sun exposure from
ultraviolet sunburn. Topical Vitamin C has also been used as a priming agent as well as a
postoperative agent in laser resurfacing erythema treatment. Furthermore, the introduction
of a stable preparation of L-ascorbic acid is now available that can penetrate the skin,
delivering L-ascorbate to the epidermis and dermis. It is anticipated that this enhanced
delivery technology utilizing a unique formulation of L-ascorbic acid, zinc sulfate and
L-tyrosine, will show an enhanced and longer-lasting effect on photodamage, prevention and
aging. The central hypothesis of this study is that a daily regimen of topical Vitamin C
will lead to subjective as well as objective improvement in human facial photoaging/
photodamage. Optical profilometry is an objective method for quantification of facial
wrinkles.
"Main Outcome Measures: Specific clinical parameters
evaluated: fine wrinkling, tactile roughness, visual dryness, coarse rhytids,
telangectasia, laxity/tone, pigmentation, keratoses and sallowness. Each of these
parameters were graded on a 0 to 9 point scale (0=None, 1-3=Mild, 4-6=Moderate and
7-9=Severe). Reference photographs were used to standardize grading criteria. Overall
investigator global scores were compared to baseline as: excellent (much improved), good
(improved), fair (slightly improved), no change or worse. Patient self-appraisal
questionnaires rated the degree of improvement (much improved, improved, slightly
improved, no change or worse) and reported side effects (burning, stinging, redness,
peeling, dryness, discoloration, itching, rash). Standard photography, including AP as
well as left and right oblique views, were obtained at baseline to facilitate subsequent
clinical evaluations and at the end of therapy for comparison. Optical profilometry
analysis of skin surface replicas of the crow’s feet region were obtained, comparing
baseline to end-of-study specimens.
"Optical profilometry analysis of skin surface replicas of
the crow’s feet region were obtained, comparing baseline to end-of-study specimens.
Silicone skin surface replicas were taken from the periorbital crow’s feet region at
identical sites bilaterally by the same technician. Alcohol skin cleansing of the
periorbital region was utilized before application of the adhesive rings and silicone
impression material (CuDerm Corporation, Dallas, TX). Precise application of the adhesive
replica locating rings was aided with caliper measurements to insure consistent distances
from reference points of the lateral orbital canthus and superior auricular tragus. This,
as well as use of reference close-up Polaroid photographs with adhesive rings properly in
place for each subject, facilitated relocating these sites for subsequent end-of-study
samples. Results:
"Three patients were eliminated from the study secondary to
the inability to follow-up at designated study protocol periods. Seven additional patients
were excluded from analysis because of breach in study protocol for active and control
designations. Of the 19 evaluable subjects, three were male (mean age=43) and sixteen were
female (mean age=48). Ages ranged from 36 to 72 years. Pre-study data revealed: 63% of
patients had a previous history of smoking, 52% utilized sunscreens on a regular basis,
52% admitted to excessive lifetime sun exposure. Side effects were mild and usually
resolved within the first two months of therapy. Side effects included, in decreasing
order of frequency: stinging (55%), erythema (24%), and dryness (.05%). All side effects
were easily treated with moisturization. In no case was topical required or topical study
regimen altered. The majority of initial improvement seen during this time period involved
tactile roughness/texture and skin hydration changes.
"Optical profilometry image analysis demonstrated a
statistically significant 73.7% improvement in Rz and Shadows North-South values with
active greater than control, as well as a trend for improvement in Rz North-South
parameter showing a 68.4% active greater than control improvement. Clinical investigator
assessment demonstrated statistically significant improvement with active greater than
control for fine wrinkling (p=.002), tactile roughness (p=.035), coarse rhytids (p=.010),
skin laxity/tone (p=.032), sallowness/yellowing (p=.031), and overall (p=.002). Patient
questionnaire results demonstrated statistically significant improvement overall with
84.2% active greater than control (p=.002). Photographic assessment demonstrated
statistically significant improvement with 57.9% active greater than control (p=.011).
"In this study, a 3 month daily regimen of topical Vitamin C
was shown to provide significant objective and subjective improvement of some of the
changes associated with photodamaged facial skin. These changes were gradual and became
progressively more evident as treatment continued. Clinical assessment and patient
questionnaire/self-appraisal have been the traditional areas of evaluation. These methods
demonstrated significant differences from vehicle in fine wrinkling, tactile roughness,
coarse rhytids, skin laxity/tone, allowness/yellowing, and overall skin improvement.
"Clinical and patient self-appraisal showed an 84%
correlation to predicting active versus control. Stinging did not have any significant
correlation with active or control agents. The vehicle control agent (Cellex-C
International, Toronto, Canada) was matched for color, consistency, and pH to the active
agent to ensure the blindness of the study. Stinging discrepancies were probably
associated with variations in skin type and surface flora among subjects, as well as
environmental exposure, cosmetic use, local tissue reactivity, variations in serum
application, and moisturizer use. |
"Photographic assessment did show significant improvement with active greater than
control but was found to have the least reliability (58%) in predicting active and control
sides. Inherent limitations in photography include fluctuations in lighting, head
position, facial expression and asymmetries. Consequently, the use of skin replica optical
profilometry to complement subjective evaluations with an objective method for the
quantification of skin surface texture changes with minimal variability or potential for
bias was utilized.
"Pre-and post-treatment comparison revealed significant
improvement with active greater than control for Rz North-South (.032) and Shadows
North-South (.032). In the case of Rz North- South, the values approached significance
(p=.084). Therefore, overall active topical Vitamin C treated skin topography is smoother
and less wrinkled than vehicle-control. The fact that Rz and Shadows represent fine to
intermediate depth lines and that Rz is largely a measure of deep wrinkles, suggests that
topical Vitamin C therapy had a more dramatic effect on superficial topography and less of
an effect with major furrows and creases.
"It should also be mentioned that there are an increased
number of Vitamin C based topical cosmetics available on the market. It appears that not
all preparations of topical Vitamin C are effective. Many of these products utilize
derivatives, esters and analogs of Vitamin C that are either unable to penetrate into the
skin, unable to be chemically converted to L-ascorbic acid (the only form that can be
utilized by the body), and/or unable to be delivered in adequate concentration to have an
effect. These ascorbic acid substitutes include ascorbyl palmitate, magnesium ascorbyl
phosphate, ascorbic acid magnesium phosphate, which are easily stabilized but must be
converted to L-ascorbate to be effectively useful. There is no direct evidence that
ascorbic acid derivatives enter the skin in appreciable amounts, and it appears that their
conversion to L-ascorbate is largely inefficient, therefore, precluding effective
concentration delivery. "This three-month study evaluated and did show topographic
improvement in facial photodamaged skin utilizing Cellex-C (Cellex-C International,
Toronto, Canada)."
WHAT THE WORLD IS SAYING ABOUT CELLEX-C:
"This product has a big celebrity fan club and
it’s not difficult to see why. The results were incredible: Within two weeks the skin
was soft, smooth and firm."
—Woman’s Health • UK
"Worth the Money - Splurge Benefits in a
Bottle Topical vitamin C, such as that found in Cellex-C High Potency Serum, can greatly
improve the tone and texture of your skin...as well as minimize wrinkles and fine
lines."
—Family Circle • US
"David Jones can hardly keep this little
serum on the shelves. Delivering up to 20 per cent more vitamin C than is available
through your diet, it can sting a little, but it’s worth it for this sort of radiance
and skin tone."
—Elle • Australia
Cellex-C has been around since 1990...The
target age group covers everyone from those in their mid twenties to those into their
seventies, and in every market Cellex-C has attracted a high percentage of male
customers...It is very important for people to understand that we’re not talking
everyday vitamin C here - we’re talking L - ascorbic acid...we will undoubtably see
an avalanche of me too products.. but consumers should not be fooled by cheap products
using vitamin C derivatives such as magnesium ascorbo-palmitate.
—The Australian Financial Review
Magazine • Australia
"...topical vitamin C cream called
"Cellex-C" is being hailed by doctors and beauty experts alike for its
remarkable ability to wipe away wrinkles, rejuvenate your facial appearances and help you
look years younger—all without harsh chemicals or cosmetic surgery. it’s so
effective it’s like a "face lift in a jar."
—Prevention Health Books:
"The Doctor’s Guide to Healing Yourself With Vitamins" • US
"Youth in a Bottle. Cellex-C may be the
first cosmaceutical to have a profound effect on the way the skin visibly ages."
—Today’s Dallas Woman •
US
Cellex-C Serum...may soon be hailed as the
skin care breakthrough of the century...
—Consumer’s Digest • US
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