Skin Care

Department

The Science Behind Vitamins

Jennifer Linder, MD

he use of topically applied vitamins

has become a ubiquitous part of
clinical skin care. While a part of the
skins antioxidant system that assists
in protecting it from oxidative damage,
vitamins A, C, and E have also proven
their ability to treat photoaging, acne,
cutaneous inflammation, and hyperpigmentation (Burgess, 2008). Understanding these vitamins unique mechanisms
of action and how they work in concert
helps the clinician select the appropriate
topicals for their patients.

VITAMIN A
Retinoids encompass all members
of the vitamin A family, including retinoic acid, its analogues,
and derivatives (e.g., retinol, tazarotene, and adapalene). Retinoic
acid is the retinoid that interacts directly with the retinoic acid
receptors. Topically applied retinaldehyde and retinol effectively
bind with cellular retinol binding
Jennifer Linder, MD, is a dermatologist and
Mohs micrographic skin surgeon, serving
as Chief Scientific Officer for PCA SKIN.
She holds a clinical faculty position in the
Department of Dermatology at University of
California, San Francisco, is a spokesperson
for The Skin Cancer Foundation, and is a
member of the AAD, the ASDS, and the
ACMMSCO.
The authors report no conflicts of interest.
Address correspondence to Jennifer
Linder, MD, 6710 E Camelback Rd, Ste
220, Scottsdale, AZ 85251 (e-mail:
jlindermd@pcaskin.com).
DOI: 10.1097/PSN.0b013e31827720e2

180

protein and are then converted

to retinoic acid within the skin
(Kang, 2005). Retinoids are effective for the treatment of aging
skin, as they are responsible for
multiple matrix-protecting actions
within the skin, including decreasing collagenase and elastase levels
(Kang, 2005). In addition, retinol,
retinaldehyde, and retinoic acid
have demonstrated the ability to
stimulate dermal fibroblast production, increase messenger ribonucleic acids (mRNAs) for types I
and III collagen, and trigger glycosaminoglycan production when
applied topically (Draelos, 2005;
Kang, 2005).
In addition to treating skin aging
and extracellular matrix (ECM)
breakdown, retinoids assist in the
reduction of existing skin discoloration and hinder future hyperpigmentation by inhibiting tyrosinase, enhancing cell turnover, and
limiting melanosomal phagocytosis (Draelos, 2005; Lotti & Theirs,
2007; Rendon & Gaviria, 2005)
For more sensitive skin, similar yet
more gradual results to retinoic
acid may be achieved with retinol,
without the heightened irritant risk
commonly associated with retinoic
acid (Kang et al., 2005).

VITAMIN C
L-Ascorbic acid is the only topical form of vitamin C that is fully
bioavailable to the skin, and it

Plastic Surgical Nursing

is the only one to provide all of

the cutaneous benefits attributed
to vitamin C. Topically applied
L-ascorbic acid can serve as a primary, secondary, or coantioxidant
that effectively quenches reactive
oxygen species in the aqueous environment of the skin (Farris, 2005).
This antioxidant powerhouse is
an important ingredient in the
fight against skin aging; it protects
the ECM from breakdown, but
rather than directly inhibiting the
expression of a particular matrix
metalloproteinase (MMP) enzyme,
vitamin C upregulates levels of
the endogenous tissue inhibitor of
MMP-1 (Nusgens et al., 2001).
L-Ascorbic acid is also a cofactor for collagen-stabilizing enzymes
prolyl and lysyl hydroxylase and
activates transcription of and stabilizes procollagen mRNA (Farris,
2005; Nusgens et al., 2001). Although
esters such as ascorbyl palmitate
and magnesium ascorbyl phosphate
are beneficial when administered
orally, the acids in the skin are not
strong enough to cleave the esters
covalent bonds to free the L-ascorbic
acid. Therefore, L-ascorbic acid is
preferred for topical use to maximize collagen production.
Vitamin C is a useful addition
to hyperpigmentation treatment
plans. This important vitamin is
able to convert dopaquinone back
to Levo-Dihydroxyphenylalanine
during the process of melanogenesis, preventing melanin formation
(Badreshia-Bansal & Draelos, 2007;

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Rendon & Gaviria, 2005). L-Ascorbic acids proven antioxidant,

anti-inflammatory, and photoprotective capabilities may also help
prevent melanogenesis.

VITAMIN E
Constituents of the vitamin E family include tocopherol, tocotrienols,
and tocopheryl acetate, and are
effective anti-aging ingredients.
Research demonstrates tocopherols ability to inhibit the activity
of fibroblastic protein kinase C
and the production of collagenase
(Ricciarelli, Maroni, Ozer, Zingg,
& Azzi, 1999). Studies have also
found that tocotrienols are capable
of decreasing nuclear factor-B
activation, which is responsible for
the production of several MMP
enzymes (Ahn, Sethi, Krishnan, &
Aggarwal, 2007). This reduction of
MMP production is important in
avoiding the unnecessary breakdown of healthy ECM components. Dl--tocopherol was proven
to prevent the immunosuppression caused by UV radiation, effectively reducing cancer formation
(Gensler & Magdaleno, 1991).

INHERENT INSTABILITY
For proven ingredients, even
decades of positive study outcomes and visible results do not
guarantee that every product containing the proven ingredient will
deliver the expected outcomes.
Having these important vitamins
formulated properly is of the
utmost importance to ensure that
they provide benefit to the skin.
Improved stabilization technologies are newly available for the
production of effective and stable
vitamin topicals (Burgess, 2008).
Vitamin A is highly susceptible to oxidation and instability in
formulation (Guaratini, Gianeti,
& Campos, 2006). Because of its
sensitivity, it is critical to limit the
raw materials exposure to water,
air, and light during formulation,
Plastic Surgical Nursing

as well as for the duration of the

finished products expected shelf
life. Nitrogen blanket technology
is often required during vitamin
A product manufacturing to minimize the retinoid raw materials
contact with oxygen. This highly specialized technology is not
frequently used in the cosmetic
industry. Without its use, the raw
material can potentially be partially oxidizedeven before packaging. Polymer stabilization systems
that protect retinoid raw materials
are now more widely available,
making it possible to manufacture
effective topicals without the use
of nitrogen blanket technology.
L-Ascorbic acid (vitamin C) is
a water-soluble antioxidant that is
also highly susceptible to oxidation
(Austria, Semenzato, & Bettero,
1997). Although water-based vitamin C topical products can be effective, their shelf life typically does not
extend past 1 year. This beneficial
actives efficacy can be preserved
through the use of anhydrous product bases, by packaging the finished
product in opaque materials and
by limiting oxygen contact with the
finished product through an airless
container or nasal-tipped orifice.
While there are always advances
to be made in this area of skincare,
topical vitamins will continue to
be utilized by the clinician as one
of the best methods of protection
against oxidative damage, external
aging factors, acne, inflammation,
and hyperpigmentation (Burgess,
2008). The more research that is
done will provide only more vehicles to obtain the best results from
vitamins A, C, and E for all patients.

REFERENCES
Ahn, K. S., Sethi, G., Krishnan, K., &
Aggarwal, B. B. (2007). -Tocotrienol
inhibits nuclear factor-B signaling
pathway through inhibition of receptor-interacting protein and TAK1
leading to suppression of antiapoptotic gene products and potentiation
of apoptosis. The Journal of Biological Chemistry, 282, 809820.
Austria, R., Semenzato, A., & Bettero,
A. (1997). Stability of vitamin C

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derivatives in solution and topical

formulations. Journal of Pharmaceutical and Biomedical Analysis, 15(6),
795801.
Badreshia-Bansal, S., & Draelos, Z. D.
(2007). Insight into skin lightening
cosmeceuticals for women of color.
Journal of Drugs in Dermatology,
6(1), 3239.
Burgess, C. (2008, July). Topical vitamins. Journal of Drugs Dermatology,
7(7, Suppl.), s2s6.
Draelos, Z. D. (2005). Retinoids in cosmetics. Cosmetic Dermatology, 18, 35.
Farris, P. K. (2005). Topical vitamin C: A
useful agent for treating photoaging
and other dermatologic conditions.
Dermatology Surgery, 31, 814818.
Gensler, H. L., & Magdaleno, M. (1991).
Topical vitamin E inhibition of
immunosuppression and tumorigenesis induced by ultraviolet irradiation.
Nutrition and Cancer, 15(2), 97106.
Guaratini, T., Gianeti, M. D., & Campos,
P. M. B. G. M. (2006). Stability of cosmetic formulations containing esters
of vitamins E and A: Chemical and
physical aspects. International Journal of Pharmaceutics, 327(1/2), 1216.
Kang, S. (2005). Mechanism of action of
retinol. Cosmetic Dermatology, 18, 68.
Kang, S., Duell, E. A., Datta, S. C.,
Wang, Z. Q., Reddy, A. P., Tavakkol,
A., et al. (2005). Application of retinol to human skin in vivo induces
epidermal hyperplasia and cellular
retinoid binding proteins characteristic of retinoic acid but without
measurable retinoic acid levels or
irritation. Journal of Investigative
Dermatology, 105, 549556.
Lotti, T., & Theirs, B. H. (Eds.). (2007).
Dermatologic clinics: Pigmentary disorders. Philadelphia: Elsevier Saunders.
Nusgens, B. V., Humbert, P., Rougier,
A., Colige, A. C., Haftek, M., Lambert,
C. A., et al. (2001). Topically applied
Vitamin C enhances the mRNA level
of collagens I and III, their processing enzymes and tissue inhibitor of
matrix metalloproteinase 1 in the
human dermis. Journal of Investigative Dermatology, 116, 853859.
Rendon, M. I., & Gaviria, J. I. (2005).
Review of skin lightening agents.
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Ricciarelli, R., Maroni, P., Ozer, N.,
Zingg, J. M., & Azzi, A. (1999).
Age-dependent increase of collagenase expression can be reduced
by -tocopherol via protein kinase C
inhibition. Free Radical Biology and
Medicine, 27, 729737.

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Copyright 2012 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited.
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