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SKIN - More Than Just An Envelope

Posted by on 6/10/2014
SKIN - More Than Just An Envelope

Excerpt from Forever Young & Healthy 

by Roger Murray, M.D.


“Beauty is a childlike appearance engendering a feeling of love and protection.”  
–  Dr. Fournier

Facial beauty has been described in so many ways. The standards that apply in our occidental culture are balance, unity, symmetry, clarity, simplicity, youthfulness, smoothness and aesthetic color (1). If someone is perceived as being “beautiful,” he or she is also perceived as being more intelligent, more industrious, more capable, richer and innately more desirable to conceive with. The skin is also capable of emoting feelings. When a woman is pregnant, her skin takes on a special “glow,” or when someone is in love, you frequently hear “You can see it in his/her face.” Contrarily, when someone is depressed, you frequently hear “He looks so sad,” or if the skin’s surface is excessively sun damaged you hear “He/she looks so much older than he/she really is.” All of the above are emotional statements that may or may not have credibility, but nonetheless are emotional perceptions based on the appearance of the skin. The area of the face that portrays aging the most is mid-face and rejuvenation in this area produces the most dramatic results (3). Just as emotional feelings can be seen on the surface of the skin, emotional feelings cause real skin disorders. Itchy skin (pruritus) can be caused by nervousness; hives (urticaria) may represent suppressed anger; rosacea (a butterfly rash over the nose and cheeks) can be caused by feelings of inferiority and guilt; and the itchy little water bumps on the sides of your fingers (dyshidrosis) are usually seen in people who are under a lot of stress (4). Alopecia areata, which are usually dollar-sized and shaped bald spots in the hair, are almost always due to high levels of work or family stress. Acne is made worse with emotional stress. So, as much as the skin is a barrier to our environment, it is also a reflection of our emotional state.

To maintain and enhance the state of our skin, there is an entire industry devoted to maintaining a youthful and healthy look. Many of my patients ask me about this or that cream that they can buy at their local, usually high-end, department store. My answer is that, while there are some very good and legitimate companies that make very good creams, almost none of them are sufficiently strong enough to reverse significant skin aging. I point out to them that the skin products they produce have to be geared to the most sensitive of all skins; otherwise, they would have an army of unhappy customers with skin reactions. And since they don’t employ physicians in these department stores to handle these rashes, it is unlikely that they are going to get a significant improvement in their skin.

So, within medicine has arisen a new term: “cosmeceutical.” It is a product that is used for cosmetic purposes but has pharmaceutical-grade and strength ingredients to produce its effects. Most of these can only be purchased in physicians’ offices, because if not individualized for each patient, they can cause significant skin reactions.

The granddaddy of them all is Retin-A. The effect we want is smoother skin, but what  Retin-A does is realign the skin cells to a younger time in your life, causes new blood vessels to form, increases collagen and glycosaminoglycans (the bounce in your skin), decreases inflammation, improves the skin’s immune system, and causes the elastin fibers to thicken and realign, all of which result in younger skin.

Other products that are considered “cosmeceuticals” are:

1.            Retin-A

2.            Retinol

3.            Vitamin C and E

4.            Alpha Hydroxy acids (glycolic acid, lactic acid, malic acid, etc.)

5.            Beta hydroxyl acids (salicylic acid)

6.            Sun screens

7.            Antioxidants (alpha lipoic acid, DMAE, vitamins C and E)

8.            Topical Growth Factors

9.            Polyhydroxy acids (gluconic acid)

10.          Topical Hormones (estrogens, specifically Estriol)

11.          Compatible Solutes (ectoine)

Because young adults frequently have the beautiful skin attributes of youth, the one they think will give them more “beauty” is a sun tan. Unfortunately, this will take away their beauty 20 years from the time of their most intense exposure. As a practicing physician of more than 27 years, I can almost tell in a middle-aged adult where and in what part of the country they were raised. Those from the North have far fewer brown spots and photodamage (sun damage) than those raised in the South. As a caveat – I recently went to Moscow, Russia, where I have never seen such an accumulation of beautiful skin; their barely three months of summer keeps their skin flawless from sun damage.

When we talk about aging, we usually refer to normal or genetic aging and photo aging. In normal aging, the skin may eventually sag or droop, but the texture will stay smooth. In photo aging, brown sun-damaged spots appear, and the surface becomes lined with deep and superficial wrinkles. But in photo aging, you also get a premature expression of genetic aging along with loss of fat in the face. Just as we really start aging in our fifties, it seems we lose the fat in our faces and gain it in our “middles.”

It is the external skin that most of the beauty industry concerns itself with  – how to keep it smooth, wrinkle-free, soft and appealing. In this chapter, I will first cover what I think is the minimum of necessary facts you need to know about you skin and then go into detail about the incredible growth hormone cream.

The skin is composed of three layers: the epidermis, or outer layer; the dermis, the layer underneath the epidermis; and the hypodermis, below the dermis. About 95% of the epidermal cells are keratinocytes (skin cells that contain the protein keratin in them); the epidermis is composed of five different layers. These are the basal layer, the spinous layer, the granular layer, the transitional layer and the stratum corneum. We lose about one cup of water through our skin daily through insensible perspiration. Overall, our skin is about 65% water. That is why we keep hearing that we should drink more water, because the more we drink, the better our skin looks. As babies, we are about 90% water; by adulthood, we are down to 60%, and by the time we are in “old age” (Mark Twain’s definition of old age I think is the best. He said “old age” is always fifteen years older than you are), we are down to 40%. The basal cells are where all skin cells start their life. This layer continuously pumps out new skin cells throughout your life. It takes about 14 days from the time a skin cell starts its journey in this layer and makes its way to the stratum corneum, and it typically lasts for about another 14 to 16 days (2). In other words, you get a new layer of skin about every 30 days. It is, therefore, this layer that has all of the stem cells necessary for continued growth. It is also the layer that has the enzyme telomerase (the enzyme that stops a cell from aging), so this layer never dies. And also because it has the fragile stem cells, this is the layer that receives all of the damage from U.V. radiation (sunlight).

The stratum spinosum is named such because when you look at this layer under the microscope, the cells appear to have spines coming out of them.

The granular area is the layer that produces an abundance of different proteins. Most of these make the outer skin impermeable to many agents that might otherwise get absorbed and cause damage. That said, almost anything that you put on your skin will get absorbed to some degree. Just to give you an idea of the number of these different proteins that this layer produces, some of their names are:

1.    Profilaggrin

2.    Filaggrin

3 .   Loricrin

4.    Elafin

5.    Involucrin

6.    Kreatinin

7.    Envoplakin

Sometimes it’s hard for me even to imagine that a layer as thin as a piece of paper can produce this many proteins.

The transitional layer is a layer where the nuclei of the cells from the basal layer die and transition toward the stratum corneum.

The latter is the main barrier to water loss and protects us from mechanical injury. This layer is thickest in the palms and soles of the hands and feet and may be as thin as 15 cells thick in other parts of the body.

Perhaps the most important type of cell that lives in the epidermis is the melanocyte. This is the brown pigment in your skin and the one that is responsible for your tan. It is also the cell, which, when it goes awry, can cause malignant melanoma, a sometimes lethal skin cancer.

The Langerhans cell, also within the epidermis, can only be seen with an electron microscope and is the main immune cell of the skin. It is responsible for recognizing foreign antigens, engulfing them and then presenting the engulfed material to the T lymphocytes. As incredible as it seems, there are over 13 different genetic disorders that can affect the epidermis alone.

The Dermis

The dermis is primarily composed of collagen, about 75% of it. But, lest you think collagen is collagen, there are over 20 distinctly different types of it in the body. But about 80% to 90% of our collagen is what we call Type 1, and about 10% is type 3. The remainder is made of elastic and fibrous connective tissue and “ground substance.” The latter is made up of specialized proteins that give the bounce to younger skin: the glycoproteins, proteoglycans and glycosaminoglycans. When you go to your doctor and he gives you medical-grade and quality skin creams, most of them are in some way designed to regenerate or repair the above proteins. This layer provides the pliability, elasticity and strength to the skin. The dermis also has a network of elastic fibers. I like to compare this to a fish net. It supports and bends when necessary, but is able to bounce back. As time goes on (as we get older), the net becomes less resilient and begins to develop holes. There are also tonofilaments. These, too, give supportive structural integrity to the skin, much like rebar in concrete. It was Dr. A. Kligman’s groundbreaking paper and discovery of Retin-A that has allowed us to reverse almost all of the defects associated with the above-dermal aging.

With this brief introduction, I would like to focus on what I think is the next great breakthrough in skin technology: the skin growth factors. These can rebuild or induce new epidermal skin thickening, cause new collagen to grow, decrease inflammation, stimulate fibroblasts to grow, increase the glycosaminoglycans in the skin, help build new blood vessels and decrease skin aging, along with loss of wrinkles. While skin antioxidants will slow the aging process and, in some cases, repair the skin, growth factors will do all of the above and reverse some of the signs of skin aging – and when looked at under a microscope actually do make the skin resemble a younger time in that person’s life.

If you have read the book up to this point, you must realize that medically cold-processed bovine colostrum has huge amounts of growth factors and nutrition in it. Scientific Neutraceuticals has partnered with a German manufacturer to produce what we believe is a superb cosmeceutical to rejuvenate facial skin.

The ingredients are:

1.            Epidermal growth factor

2.            Fibroblast growth factor

3.            Transforming growth factor alpha and beta

4.            IGF-1and -2 (insulin-like growth factor, 1 and 2)

5.            Platelet-derived growth factor

6.            Glycolic acid

7.            Ascorbyl palmitate

8.            Ectoine

9.            Fat-soluble liposomes to enhance penetration into the skin

Epidermal Growth Factor   

Epidermal growth factor was first discovered in 1959. It causes thickening of the epidermis (the outermost layer of skin) and growth of the keratinocyte. If you recall, almost 80% of your skin cells are keratinocytes. In addition, it plays a major role in wound healing in the skin and causes new blood vessels to form.

Fibroblast Growth Factor

Fibroblast growth factor comes in two forms, acidic and basic. The one we are concerned with is the basic form. It is found in tissues throughout the body. It helps with nerve regeneration, vessel growth and in the movement of the keratinocyte to the surface of the skin, making it extremely useful in wound healing. It also greatly aids in the reparative process in acute and chronic sun damage.

Transforming Growth Factor Alpha and Beta

This very important growth factor enhances the growth of fibroblasts and helps with tissue repair after injuries, especially connective tissue. It helps regulate and upgrade the synthesis of collagen, and although it has been reported to decrease the progression of cancer, it is unlikely that it can do this in the skin (6).

It promotes wound healing, increases the thickness of the dermis and has been shown to decrease wrinkle depth, improve the texture of the skin, decrease sun damage pigmentation and rejuvenate the dermal layer of the skin. When the human skin is injured, these growth factors migrate to the site of injury and achieve maximum concentration within one hour (8).

IGF-1 and II

IGF’s role in skin is primarily as a wound healer. It does this by stimulating proliferation of fibroblasts and endothelial cells (the cells lining the innermost layer of the blood vessels).

Platelet-Derived Endothelial Growth Factor (PDGF)

The sources of this are the fibroblasts themselves and the platelets. It promotes wound healing by allowing the endothelial cells to repair and proliferate and acts as a chemo-attractant (it causes things to come to it chemically) and chemokinetic (causes the movement of cells towards something) for fibroblastic cells (7). It is thought that this chemical attraction causes the influx of connective tissue cells to come to the site of a skin injury to help repair itself. PDGF in the presence of TGF-beta causes a two to three times greater migration of PTGF toward a wound injury.

In a study conducted by Dr. R. Fitzpatrick (5) using growth factors for 60 days in photo-damaged skin, he reported that 11 of 14 patients (78% ) showed clinical improvement in wrinkle scores and that the collagen increased by 37%. The outer layer of the skin also increased in thickness by 27%. My own experience – by myself, office staff and patients having used this cream for a much longer period of time – has shown immense patient satisfaction and almost all the patients report that their skin looks more vibrant and smooth. We have also noted, but not published, that using the growth hormone cream after a microlaser peel (anywhere from 10 to 50 microns in thickness) accelerated healing far beyond our previous experience with gels and ointments. What we saw in our office was that patients returning after a few days typically were completely healed  – something that used to take at least seven to 10 days.

The Who, When and Why of This Cream

The when:

As a woman enters her forties, her estrogen levels begin to decrease. It is the estrogen in her skin that gives her the look of youthfulness. Smooth round contours, the absence of wrinkles, the paucity of hairs, and the softness of femininity. Starting around 40, the face begins to become angulated and the suborbital fat pads (the fat under the eyes) begin to age either by atrophy or hypertrophy. In the former case, the skin under the eyes begins to wrinkle and the area looks a little sunken. In the latter you begin to see the budges of the suborbital fat pads protruding. So, in my opinion, the “when” is in the late thirties, so we can delay the early signs of aging that begin to show up in the forties.

The who:

The thinner the skin, the more apt it is to show the signs of aging. A quick reference guide to that is simply to raise your forehead. If you see two or three forehead wrinkles you probably have “thick” skin. Four or five wrinkle lines indicates medium-thick skin and more than five or “washboard” forehead would indicate thin skin. The thinner skinned individuals should start a little earlier.

Depending on your Fitzpatrick skin type will also have a bearing on the “who.” Fitzpatrick Type I is the red-haired and freckled skin traits of the Irish, Type II is the blonde-haired, blue-eyed individuals and Type III are brown-eyed, brown-haired and medium- to light-complected people. Type IV are those with olive skin and who tan easily, and Type V are the American Indians and Asiatics. Types I through III are the most prone to sun damage, and if you are one of them and live anywhere in the middle to southern part of this country you would benefit more than the darker skin types.

The why:

There is both a simplistic and scientific answer to this one. The simplistic answer is because none of us likes to look in the mirror and see an aging face looking back at us. And while I personally don’t mind aging, I don’t like looking old. The scientific answer is because I believe that this cream is presently the most scientifically advanced cream in the world and will improve the health of your skin, bar none.

 

Bibliography:

1.    Terino and Flowers. The art of allosplatic facial Contouring, Mosby, 2000, Chapter 1, pp 3-6.

2.    Freinkel, R. The Biology of the Skin, Parthenon Publishing Group, 2001, pp19-29.

3.    Terino, E. and Flowers, R. The Art of Alloplastic Facial Contouring. Mosby, 2000, pp 3-11.

4.    Fitzpatrick, T. et al. Dermatology in General Medicine, Third Edition, McGraw Hill, 1987, pp11-14.

5.    Fitzpatrick, R. Endogenous Growth Factors as Cosmeceuticals. Dermatological Surgery, Vol. 31, No 7, Part 2, 2005, pp 827-831.

6.    Ramont, L. Transforming Growth Factor – beta 1 inhibits tumor growth in a mouse melanoma model by down regulating the plasminogen activations system. J of Exp Cell Res. 2003, (291), pp.1-10.

7.    Takehara S., Alteration of the chemotactic response of human skin fibroblasts to PDGF by growth factors. Exp Cell Res. 1994 Jun;212 (2):274-277.

8.    Grellner W., Transforming growth factors (TGF-alpha and TGF_beta1) in the determination of vitality and wound age: immunohistochemical study on human skin wounds. Forensic Sci Int. 2005 Oct 29;153(2-3):p.174-180. 


*These statements have not been evaluated by Food and Drug Administration. This product is not intended to diagnose, treat, cure or prevent any disease.*

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