Kim Johnson

Study of the effectiveness of L ascorbic acid and vitamin a in the treatment of skin.

Kim Johnson Gray Clay Medical Aesthetics Education

Abstract

The effects of free radicals caused by frequent sun exposure and lifestyle choices is a topical issue. Antioxidants, L ascorbic acid and Vitamin A have been tested in this clinical trial as to their ability to combat damage to the skin. A clinical trial of 45 participants was conducted using a number of criteria to test the usefulness of each antioxidant, the results showed that L ascorbic acid was useful in the treatment of

pigmentation while vitamin A showed improved moisture content. Neither antioxidant repaired the skin completely and removed fine lines and wrinkles but showed to improve them slightly by improving hydration. The clinical trial also supported the views that the effects of sun damage on the skin are permanent and highlighted the need for a more intensive trial.

Introduction Our increasing love affair with the sun and daily lifestyle habits have caused a change in the number and severity of damaged skin cases seen by dermal therapists in Australia and throughout the world. In more recent years this issue has been further compounded by poor diet choices and incorrect care of the skin which has resulted in a growing need for clinical trials like this trial which focuses on the usefulness of antioxidants to assist with the effects of sun damage, like fine lines, dry and over aging skin, pigmentation and the neutralising of free radicals caused by excessive sun exposure and lifestyle choices. The underlying issue stems from free radicals which are oxygen atoms that attack the living cells within the body causing cell decay in the skin, this is supported by Bourgeois, c.f. (2003,p4) who states that “free radicals are very aggressive, able to react with all kinds of

biological molecules (lipids, proteins, DNA) in the vicinity and denature them”. Key to free radicals ability to cause damage is ‘denaturing’ which causes cell lysis from oxidative stress. Antioxidants play the vital role in neutralising and reversing the denaturing effect by donating electrons to the body and to bring balance and health to the skin. The two primary types of antioxidants used in many topical and oral treatments found on the market today are L ascorbic acid, commonly known as vitamin C and retinol known as Vitamin A. L ascorbic acid is an important nutrient and an essential component in the body’s production of collagen which thickens the skin and stimulates ground substance in the deeper layers of the dermis while, topical application of retinol has been found to enhance the skins photo protection against damaging UV rays. As stated by Espejo, R, (2010 p165) retinol can inhibit the enzyme responsible for the synthesis of melanin to prevent pigmentation.

Kim Johnson

Retinol also plays a significant role in the production of collagen and has simular effects to L ascorbic acid, however, retinol is also able to convert to retinoic acid and repair DNA from the receptors found in epidermal and dermal cells. This repair within the DNA facilitates increased activity within the dermis and helps to stimulate fibroblast activity in ground substance. This results in increased water retention, less lines and wrinkles. Finally, each of these antioxidants play a significant role in the production of collagen and GAG activity, improving hydration and bringing balance to the skin. As demonstrated above, L ascorbic acid and retinol are useful in combating the effects of free radicals that cause skin damage, however prior clinical trials have sort to establish which antioxidant is more useful for certain desired results. A study by Jenny, K. entitled, “Vitamins and photo aging do scientific data support their use" found there was significant data to establish that prescription topical retinoids were effective in reducing fine wrinkles (like those caused by sun damage), and that vitamin C may reduce the negative effects of UV radiation on the skin… but because of the bodies deficiencies to convert the ascorbic acid it was difficult to determine its true effect” Meanwhile, dissimilar to Jenny, K.’s findings, Fitzpatrick, R.E. (2002) was able to determine that that topical application of vitamin C increased collagen formation in the skin which facilitates the rebuilding process. This study seeks to further analyse the usefulness of using either L ascorbic acid or retinol to treat three of the effects of excessive sun damage, these being:

Reducing the pigmentation of the skin

Increase the skin’s moisture content; and

Reducing fine lines. Methods 45 female students aged 20-50 years old were selected. The students were asked to apply L ascorbic acid to the right side of face and retinol on the left every morning and evening over a 6 week period. The students were also asked to stop applying any other active ingredients. Throughout the trial students were learning about free radicals, antioxidants and discussions on their personal experience were also documented for the trial. Other criteria was also was also tested, which has not been used for the purpose of this study. Results For the purpose of the trial the students were asked to rate their observations as either no change, slight improvement or significant improvement. The outcomes in the areas of pigmentation, skin moisture content & fine lines have been discussed below: Effects on Pigmentation The results reflect that L ascorbic acid more effectively treated pigmentation of the skin with 7% showing significant improvement and a further 67% showing slight improvement. This is compared with Retinol which had results of 80% showing no change.

27%

67%

7%

80%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

L-Ascorbic Acid Vitamin A

Effects of L-Ascorbic Acid & Vitamin A on Pigmentation

No change Slight Improvement Signif icant Improvement

Kim Johnson

Effects on fine lines The results indicated that retinol was better in combating fine lines with 7% showing significant improvement, compared to 2% using L ascorbic acid, Over 50% of participants under both antioxidant reported no change in the effects on fine lines.

67%

31%

2%

58%

36%

7%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

L-Ascorbic Acid Vitamin A

Effects of L-Ascorbic Acid & Vitamin A on fine lines

No change Slight Improvement Signif icant Improvement

Effects on skin moisture content The results indicate that retinol is clearly more effective in increasing moisture content with 22% showing significant improvement compared to 4% using Lascorbic acid.

33%

62%

4%

18%

60%

22%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

L-Ascorbic Acid Vit amin A

Effects of L-Ascorbic Acid & Vitamin A on skin moisture content

No change Slight Improvement Signif icant Improvement

Discussion The results of the clinical trial support the findings in the study by Fitzpatrick, R.E., but were inconsistent with the findings of Jenny, K. as the trial indicated that neither antioxidant had significant effects on minimising fine lines, with note that non-prescription retanoids were used for the purpose of this trial, in contrast to the study conducted by Jenny, K who used prescription based retinoids The results of the trial support the importance of consumers gaining an understanding that once damage to the skin has occurred there are often regretful and permanent consequences. The above results show that over 50% of the participants had no improvement on the severity and number of fine lines to either side of their face and without ablative procedures or injections, these ‘fine lines’ are likely to remain indefinitely. However it is not all bad news as luckily we are able to maintain the skin and prevent further damage by using antioxidants like the topical creams used in this trial. This is evidenced in the skin moisture content increasing in 82% of participants after topical use of Retinol and 66% with L ascorbic acid which show how both antioxidants stimulate cell renewal resulting in fibroblast activity for the production of collagen & ground substance. An interesting area of the trial was found in the effects of pigmentation, with 73% of participants using L ascorbic acid showing improvement after topical use, compared to minor improvements using retinol, indicating L ascorbic acid is a more effective option to stop the enzyme that synthesises melanin and also acts as a skin lightening agent. This trial supports that either of these antioxidants will play a role in treating the skin concerns of consumers, however it is also up to the consumer to sufficiently educate themselves on the signs of skin damage and to seek the advice of a licensed therapist on the correct care of their skin and which of these two ingredients

Kim Johnson

they need to apply to help minimise the effects free radicals have on the body. Consumers knowledge of how and when to apply the antioxidants is also equally important, for example knowing to maintain an adequate routine of cleansing and stimulating of the basal cell turnover resulting will result in an increase in skin moisture and cells being at a more organised state. Therefore the results of this study gave a clear indication that each antioxidant was useful to treat and maintain the skin, but were ineffective in treating the permanent effects of sun damage. As this trial was susceptible to manipulation through the varying skin types of candidates, the differences in their personal area of concern and the lack of controls, it is recommended that a wide and more intensive clinical study be conducted on the effectiveness of antioxidants to treat skin damage. References 1. Fitzpatrick RE, et al. (2002) Double-blind,

half-face study comparing topical vitamin C

and vehicle for rejuvenation of photo damage. Dermatol Surg 2002

2. Jenny, K, MD, PhD, (2010) Vitamins and

photoaging: Do scientific data support their use?”, published online in the Journal of the American Academy of Dermatology,

3. Bourgeois, F. (2003), Antioxidant Vitamins &

Health, Cardiovascular Disease & Cancer, cataracts & aging, HNB Publishing, New York.

4. Espejo, R. (2010), The culture of Beauty,

opposing views, Green Haven Press, Detroit.

5. Antioxidants (2013) retrieved 7 October 2013, from http://www.nlm.nih.gov/ medlineplus/antioxidants.html

6. Goldfaden, G. MD. (2009), Revitalize Aging

Skin with Topical Vitamin C, retrieved from http://www.lef.org/magazine/mag2009/may2009_Revitalizing-Aging-Skin-with-Topical-Vitamin-C_01.htm