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48 APRIL 2014 | Med Esthetics and glycosaminoglycans, such as hyaluronic acid, that plump and hydrate skin, says Kulesza. A 2006 study from Japan that compared a range of alpha-hydroxy acids in reducing fi ne lines and wrinkles (Journal of Dermatology, January 2006) showed increased levels of collagen 1 and procollagen 1 in the skin of pa- tients treated with either glycolic or lactic acid. A 2013 review of glycolic acid peel therapy (Clinical, Cosmetic and Investigational Dermatology, December 2013) identifi ed multiple studies supporting the use of glycolic acid for antiaging and pigmentation concerns. Four studies included in the review reported a reduction in fi ne lines and wrinkles as well as improved skin texture follow- ing treatment with glycolic acid-based peels. The authors did note, however, that glycolic acid was not effective in improving deep lines and wrinkles. More than 10 studies reviewed showed a reduction in melasma and/or post- infl ammatory hyperpigmentation following treatment with glycolic acid peels. ANTIOXIDANTS Similar to sunscreen, some of the most effective antiaging ingredients play a big role in preventing photodamage and the signs of aging, rather than reversing them. This is cer- tainly true of antioxidants. Their effi cacy in protecting skin against photo and environmental damage is supported by years of clinical study. Two of the most recent studies highlighting the role of antioxidants in photoprotection and antiaging skin care appeared in Photodermatology, Pho- toimmunology & Photomedicine ("Photoprotection of Skin Beyond Ultraviolet Radiation," January 2014) and Facial Plastic Surgery ("Nonprescription Topical Treatments for Skin Rejuvenation," February 2014). There are numerous antioxidants used in skin care, in- cluding vitamins C & E, green tea, coenzyme Q10, alpha lipoic acid and idebenone. "What do antioxidants do? They may have a photo- protective effect, and they may prevent certain types of damage to the living cell that are caused by reactive oxygen species cumulatively over time," says Kulesza. "If we're talking about ascorbic acid, fi broblasts use vitamin C to make collagen and elastin. I recommend to physicians, if they are prescribing retinoids, use vitamin C along with the retinoid. The retinoid is turning on the cells, telling it to make those proteins. That will give the cells the nutri- ents they need to make the collagen and elastin." PEPTIDES Peptides have been creating a lot of buzz in the skincare industry for the past several years. These short strings of amino acids act as signaling molecules, telling cells to take action. "For example, if you get a cut, a peptide signal tells the cells to cause infl ammation in the area to tell the body, We need to fi x this," says Neal Kitchen, PhD, a molecular and cell biologist and member of the Hydropeptide Board of Scientifi c Advisors (hydropeptide.com). Just some of the peptides currently used in topical formulations include: Matrixyl 3000 (palmitoyl oligopep- tide and palmitoyl tetrapeptide-7) and Argirelene (acetyl hexapeptide-3) for wrinkle reduction and Lumixyl (deca- peptide-12) and B-White (oligopeptide-68) for pigmenta- tion concerns. In a lab setting, peptides that signal cells to relax muscles, reduce pigment and stimulate collagen and elastin have been identifi ed. The challenge has been to formulate those peptides in a stable and high enough concentration to affect visible changes in the skin. "When you look on a molecular level at a cell, you see protein receptors on the surface of that cell. A peptide can bind to one of these receptors and generate a response," says Kitchen. "What you need is enough peptide to generate a big enough response that it triggers an action within that cell. There are a couple of ways of doing this. One is having a lot of peptide in your formula- tion, and the other way is to generate the response by multiple pathways." He explains: "Let's say we have peptide A, and peptide A generates a response on one receptor. Then you have peptide B that generates a similar response, but it does it through a different receptor. By having both of them attach to the cell through the same formulation, that actu- ally amplifi es the response in a much more signifi cant way than if we were only to use one peptide. That amplifi ed response is critical to reach the threshold needed to gen- erate the response for an action like skin regeneration." Kulesza stresses that peptides, while lacking the com- pelling data of retinoids, hydroquinone and antioxidants, nonetheless have a role. "They usually have very good safety, and they have a modest effect in the treatment of photoaging." Inga Hansen is the executive editor of MedEsthetics. BEYOND THE HYPE Extreme Lifting Complex Cream (Dermatude.com) incorporates a blend of antioxidant vitamins A, C and E. Vitamin A helps to rejuvenate mature skin; Vitamin C protects the skin and neutralizes free radicals while Vitamin E delays the external effects of aging. B e y o n d H y p e M E D 4 1 4 . i n d d 4 8 Beyond Hype MED414.indd 48 3 / 1 3 / 1 4 9 : 2 1 A M 3/13/14 9:21 AM