MAY-JUN 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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© GETTY IMAGES TRUE GROWTH FACTORS Our skin contains many different types of growth factors, but two of the most-discussed in antiaging medicine are epidermal growth factor and keratinocyte growth factor. Each growth factor binds to a corresponding receptor, such as the epidermal growth factor receptor, and acts as a key opening a lock, explains Leslie Baumann, MD, dermatol- ogist, researcher and CEO of Skin Type Solutions. "Most of these locks make something grow," she says. "For example, vascular endothelial growth factor makes blood vessels." In an effort to stimulate the skin, product formulators began adding actual growth factors to their topical formula- tions in hopes of unlocking these receptors and initiating ag- ing skin to make more of the things it needs to stay healthy and youthful. "Allergan's SkinMedica TNS line and Merz' NEOCUTIS line contain human-derived growth factors," says Manzo. "But most of the growth factors formulated in topical skin- care are plant-derived, such as apple stem cell extracts." There has been some controversy over the use of human-derived growth factors in skin care. The fi rst con- cern is safety. We depend on MMPs to destroy damaged cells, and there are concerns that artifi cially stimulating cells that otherwise would be destroyed may allow them to proliferate and could cause cancer. At this point, though, scientists have not seen such a case. The second issue is whether human-derived growth factors can penetrate the stratum corneum. In a study by Caroline Aldag, et al, published in Clinical, Cosmetic and Investigational Dermatology (September 2016), researchers explain that growth fac- tors are typically larger than 15,000 Da, and molecules greater than 500 Da cannot easily penetrate an uncom- promised stratum corneum. "It is similar to the old days when people would say, 'Hey there's col- lagen in this cream,'" says Manzo. "We knew that applying collagen topically didn't really work, but we didn't know why. It turns out that collagen is a very large molecule that can't penetrate. It is the same thing with growth factors." Dr. Baumann is also skeptical about the utility of topical growth factors. "I am not sure of the role that growth factors play in skin rejuvenation," she says. "We need to learn a lot more before I can be very enthusiastic about them." Plant-derived growth factors have been used as a less costly and potentially safer alternative to human-derived growth factors, but they also have shortcomings, says Manzo. "The reason plant-derived growth factors don't work very well is because they are the wrong enantiomer—they look the same as human growth factors but it's actu- ally a mirror image," he says. "With synthetic peptides, we can orient the molecules perfectly and use them like a message in a bottle to initiate particular actions." 46 MAY/JUNE 2018 | Med Esthetics Epidermal growth factor has the most research to support its use in wound healing and skin care. RESTORING GROWTH

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