The use of stem cells in skin care and esthetic medicine has generated a lot of excitement. However, there remains a great deal of confusion about the differences between growth factors, stem cells, plant stem cells and other related technologies. Let’s discuss the pros and cons of one of the most exciting technological advancements in skin care and hopefully get a little better understanding of what they are and how they can help us.
 
Plant stem cells:

Several companies offer plant stem cells, but they are not like human stem cells and do not provide any of the benefits of human stem cells. Plant stem cells appear to provide some modest improvements in the skin, but they are primarily formulated in conjunction with other actives or peptides because they are not very active themselves. Often, they are a plant extract and offer a similarly modest impact on the skin. They are not making growth factors or activating wound-healing the way human stem cell technology does.

Human stem cells:

Human stem cells are primarily being harvested from adults and have, therefore, become less controversial than in the past. Although they have potential in fat injections and face-lifts to offer more stable tissue replacement, they are otherwise not part of skin care as you know it. Instead, stem cells are being induced to make fibroblasts by implanting fibroblast DNA into a ghost cell. This is known as induced pluripotent stem cells (IPS). Stem cells can also be encouraged to grow skin-targeted growth factors by leaving them in the same growth media as a fibroblast. Let’s be clear: If you are simply using stem cells, the growth factors that might be made—and there’s no guarantee a cell will make growth factors—are less likely to be skin-specific. Some labs are harvesting stem cells from certain locations on the body to help with that issue, but that is a relatively new approach and does not apply to products on the market today. The gold standard is still to use fibroblasts harvested from circumcised infant skin. All cells are grown in an environment that is typically called “growth media.” It is the concentration of growth factors in the growth media, their stability, their delivery system and the amount of growth media used, which ultimately determine how effective a product can be. Those are the key areas to examine if you are trying to decide which product is best for you.

Growth factors:

What aging skin really needs are growth factors. Even the use of stem cells in plastic surgery is primarily with the hope that they will become growth factor production cells, such as fibroblasts or macrophages. The research shows that growth factors have the potential to increase collagen production and improve wound-healing, among other improvements. However, most growth factor research is done in vitro (test-tubes/petri dishes) and does not reflect the challenges that penetration has on those molecules. Typically, only a fraction of 1% of topically applied growth factors will actually penetrate the skin enough to activate anti-aging pathways. That being said, these molecules can be very powerful and remain an important part of a comprehensive approach to reverse aged skin. It is preferable that growth factors have a delivery system, such as liposomes, but there is promising new research on a process that creates growth factors that are enveloped in an exoskeleton that the cells naturally form. This exoskeleton has many receptors that increase penetration and activity along with improving stability.

One of the most challenging problems with growth factors and cytokines, or wound-healing peptides, is their stability. Without a stability system, growth factors will fall apart in the bottle or on the skin. Exoskeletons are a breakthrough, but there are other stabilized growth factors on the market. Most growth factors made individually are created by programming Escherichia coli (E. coli) bacteria. This process can match the amino acids, creating a bioidentical version, but it cannot mimic the three-dimensionality of human cell-derived growth factors. It is this special shape that makes growth factors from stem cells and fibroblasts much more stable and active in the skin.

Without a doubt, stem cells are definitely going to be part of the future of esthetic medicine. And although plant stem cells often act more like plant extracts, using human stem cells to make IPS cells that become fibroblasts; using stem cells that are encouraged to act like fibroblasts in the growth media; and using fibroblasts directly are all ways of growing the more than 150 different growth factors and cytokines naturally found in the skin. This is preferable to using one or two growth factors because they are more stable—it creates a more balanced anti-aging approach, and it replenishes everything that is lost instead of over-emphasizing one aspect of wound-healing.
 
No matter which product you select, growth factors are only a part of what is needed to achieve actual dermal thickening. The number of fibroblasts, the skin’s overall nutritional supply, immune cells and collagen-activators all decline as clients’ age. To make growth factors work optimally, they need to be combined with ingredients that can overcome these other bottlenecks in the age-reversing process. A home care regime that works synergistically will give your skin the best chance at slowing down the aging process and speeding up a healthier, fuller overall look.

 

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre

Our very own Dr. Benjamin Barankin was quoted in the March 2015 issue of The Chronicle of Skin & Aging discussing a variety of new developments in our understanding and treatment of rosacea. Click here to view the full article.

Did you know that May is both skin cancer and melanoma awareness month in the United States? In the U.S., more than 2 million people develop skin cancers each year, and skin cancer is the most common form of cancer in North America.

Myth: Botox is painful

Fact: Botox discomfort is very mild, most people rating it a 1 out of 10 in pain (like a mosquito bite)

Myth: Botox freezes everything and you look like a Hollywood weirdo or you look fake.

Fact: Botox performed properly by an expert dermatologist can make you look relaxed and more youthful, without anyone knowing you had anything done.

Myth: Botox is easy to do, anyone can treat you

Fact: Yes, injecting any needle is easy to do. However, to know which muscles to inject, at what depth, what quantity, and be able to avoid nerves and blood vessels, requires a significant knowledge of anatomy and overall beauty. Stick with a dermatologist for optimal results and safety.

Myth: I can’t do Botox since I can’t spare any downtime

Fact: There is no down time with Botox. You can have a swelling for 15 minutes where the Botox was injected, but that’s about it. A small percentage of people get a tiny purple dot (bruise) that is easy to cover and disappears within a few days. Occasionally you can get a headache for which over the counter headache medicines can be taken. Seldom, the eyebrows or eyelids can feel heavy or droopy, although this goes away usually within 2-3 weeks and can be avoided in experienced hands.

Myth: Botox kicks in right away, I’ll see the results as soon as I leave the clinic

Fact: Botox takes a few days to kick in, with most of the effect evident by 7-10 days.

Myth: Botox lasts 3 months.

Fact: The duration of Botox is variable. For most people, 4 months is a typical duration. However, some people have 3 months, while others have 5-6 months duration. The more consistently you receive Botox, the more likely it is to last longer with future treatments.

As a leading expert in rosacea, our very own Dr. Benjamin Barankin was quoted in “Emerging therapies offer clinical alternatives for rosacea” in The Chronicle of Skin & Allergy. He discusses a new topical treatment for rosacea (ivermectin) which is a great treatment for rosacea that has papules and pustules. He also discusses topical brimonidine (Onreltea gel) which is a great new option for rosacea patients with persistent redness of their face. He also discusses the importance of enquiring about eye involvement with rosacea since up to 50% of people are affected.

Left to right: ivermectin cream, Onreltea gel.

Last week, the U.S. Food and Drug Administration (FDA) approved Kybella (deoxycholic acid), a treatment for adults with moderate-to-severe fat below the chin, known as submental fat. We should hopefully have this treatment in Canada within 1-2 years.

The April 21st issue of The Medical Post featured a terrific article on Medical Misconceptions, and some interesting facts. For instance:

 Truth:

1. The average doctor retires at age 71 (probably because we have no pension, sick days, vacation days, or drug plan)

2. The average number of hours of training to become a doctor is over 40,000

3. The average age a doctor actually starts working after residency is 31.

4. A leading cause of physician burnout is uncompensated paperwork of 5-10 hours per week on average.

 

Myths/False:

1. Doctors are paid for writing prescriptions. This is blatantly false and always has been.

2. Doctors get all sorts of free goodies from drug companies ; in fact, doctors no longer are allowed to even get a pen with a drug name on it.

I am still often surprised when patients come into our clinic and admit that they don’t wear sunscreen. Certainly I can understand that patients who are a little older may not be in practice of applying sunscreen daily or properly due in fact to being raised to believe that the sun is good for us. For those people, I say we may have been under that impression when we were young, but the world has changed and with the sun stronger now and the depletion of the ozone layer, you would have to be in complete darkness not to have heard that excessive sun exposure can be fatal.

For younger patients, there is no excuse. To think a little colour is worth risking your life for, I say that is what bronzer is for. Be safe, be smart. But there is another group that has me worried the most. Those with darker skin feel that since they don’t burn, they are not at risk. If you fall into this category, be sure to read on. This may save your life.

Dark color skin young boy smiling in the pool

Although people of colour have a lower risk of developing skin cancer than Caucasians, skin cancer is often diagnosed at a more advanced stage in people of colour, thus making it more difficult to treat and the prognosis much worse.

A study “Skin cancer and photo protection in people of colour: A review and recommendations for physicians and the public,” published in the Journal of the American Academy of Dermatology, provides recommendations for the prevention and early detection of skin cancer in people of colour based on a comprehensive review of available data.

The 5-year survival rate for Blacks and Latinos diagnosed with melanoma is lower than Caucasians, likely due to the fact that it is often more advanced when diagnosed. For example, the 5-year survival rate for Black Americans is 73% compared to 91% in Caucasians. This study was done in the USA, and therefore we don’t have the statistics for Canada. However, we can assume the numbers would be similar.

Tips for Patients

Many people of colour mistakenly believe that they are not at risk, but skin cancer is colour blind. Skin cancer can look and develop differently in individuals with skin of colour than it does in individuals with lighter skin. In fact, when skin cancer is diagnosed in people of colour, it is often found in areas of the skin that are not typically exposed to the sun. Specifically, the bottom of the foot is where 30% to 40% of melanomas are diagnosed in people of colour (e.g. music superstar Bob Marley, who died of his melanoma, had it on his foot). Nearly 8% of melanomas in Asian Americans occur in the mouth. Squamous cell carcinoma (SCC) — the most commonly diagnosed skin cancer in Blacks — often develops on the buttocks, hip, legs and feet.

Woman on the beach applying sun cream on her shoulder

It is recommended that patients with skin of colour should be advised to check their skin monthly and make an appointment with their dermatologist if anything suspicious is noted.  It is also recommended that patients:

  • Pay special attention to the palms of the hands, soles of the feet, the fingernails, toenails, mouth, groin and buttocks.
  • Look for any spots or lesions that are changing, itching, or bleeding or any ulcers or wounds that will not heal.

Unprotected exposure to ultraviolet rays has been identified as a risk factor for skin cancer in people of colour. Basal cell carcinoma (BCC), the most commonly diagnosed skin in cancer in Asian Americans and Latinos, is most frequently found on sun-exposed areas of the skin, such as the head and neck. Skin of colour patients also should be reminded to:

  • Seek shade whenever possible.
  • Wear sun-protective clothing, including a wide-brimmed hat (baseball cap doesn’t protect your ears and nose) and sunglasses.
  • Avoid tanning beds.
  • Apply sunscreen with a sun protection factor of at least 30 to all exposed areas of the skin before going outdoors. When outdoors, reapply sunscreen every 2-3 hours, and after swimming or sweating or towelling.
  • Take a vitamin D supplement because they are at a higher risk of vitamin D deficiency, especially individuals with darker skin.

While I may have the palest of pale skin, and moles quite visible, the fact that I have such contrast makes it easier to detect if something looks off. Because I burn easily, I wear sun protection every day of the year, even in winter. I have taken most of my risks away. Education and observation are key and action based on those may save your life.

~ Sheri Roselle, Medical Esthetician at Toronto Dermatology Centre

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