Copper and wrinkles

I assume that you, like me, do not wake up looking your best.  So here's interesting news from Korea via Prevention Magazine in cooperation with Bergdorf Goodman. 


That which keeps our skin firm and fresh are two proteins--collagen and elastin--and a substance called hyaluronic acid.  Collagen gives structure to the skin and promotes the foundation in which elastin provides elasticity (e.g. the ability to spring back to smoothness after being smushed all night against the pillow) while hyaluronic acid cushions and moisturizes.  Sun exposure, smoking, dry air, pollution, facial expressions, and sleep positions along with aging hasten the loss of these three substances and the progression of lines to wrinkles to furrows and folds.


Apparently copper oxide can be absorbed by intact skin wherein it facilitates the process of making these structural proteins and stabilizes them within the sub-surface structure.  Korean dermatologists took these copper characteristics and ran with them, theorizing that sleeping on pillowcases made of copper-saturated fibers could reduce wrinkles(1).  61 volunteers were recruited to snooze perchance to lose their bags and sags. They were graded and measured by 'expert graders' as well as with an objective skin wrinkle measuring device called the 3D Image Analysis GFM PRIMOS.


A significant decrease in crow's feet as well as in 3 'roughness parameters' was both observed and measured at 4 and 8 weeks into the study in the copper-pillowcase group but not in the usual bed linen controls.  That translates into shallower wrinkles and better overall appearance! An earlier study (2) noted these same improvements after a mere 2 weeks of nighttime copper exposure.


So here's where BergdorfGoodman.com comes in.  You can order a coppery pillowcase for $60.  I was so-so on the prospect after reading the news in Prevention and somewhat more interested now that I've read the study.  It does seem like the perfect 'milestone' birthday gift, but I'm unsure if I'm ready to buy one myself.  Let me know if you give it a try!
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1) Baek, JH et al.  Reduction of facial wrinkles depth by sleeping on copper oxide containing pillowcases. http://www.ncbi.nlm.nih.gov/pubmed/22938003
2) Borkow, G et al. Improvement of facial skin characteristics using copper oxide containing pillowcases. http://www.ncbi.nlm.nih.gov/pubmed/19467028

Idiopathic erythema

My friends used to worry that my father, a psychiatrist, was secretly diagnosing their psychopathology when they'd stop by the house. On average, one word--adolescence--was all that was needed to label our deviance from normal behavior during those formative years.

Sometimes, I like to play 'guess the diagnosis' when I'm out and about in public. During PTA meetings at my daughter's high school, I'd sit and wonder why another parent's face was so red (the meeting content, as you may guess, was simply riveting!). I never did figure it out, nor do I have the slightest idea what happened to the man in the years since last we met. I was disturbed, however, to come across an item in a medical journal that suggested that his diagnosis may not have been benign.

Idiopathic erythema is a fancy way of saying the skin is red and we don't know why. One of my fellow residents during training had allergic dermatitis (eczema) as a cause of his not-so-idiopathic erythema. Those patients who are red for unknown reasons tend to be male (73%) and older (average age 69 years in one study).

Out of 218 Singaporeans studied by dermatologists there, 18% were ultimately found to have cancer. Dr. Steven Thng and his colleagues concluded, "We recommend close follow-up with reevaluation for malignancy even if the intitial investigation had been negative."

I hope this fellow is doing well, ruddy but cancer-free. But I now have something new to think about when a patient complains "Boy is my face red!"

L-carnitine for your hair

Those of you who follow my Menopause Moments blog might already be taking this stuff to boost your brain. So here's good news from TheDermBlog.com that this supplement may stimulate hair growth.

Hair follicles go through cycles wherein hair grows (anagen) and then falls out (telogen). Hair aging badly becomes thinner, finer, and more colorless with each cycle. Progesterone promotes glorious hair (think hair during pregnancy) and precipitous drops in this hormone cause hair loss (think hair after pregnancy or during menopause). Testosterone causes hair loss in a characteristic pattern (those thinning temples and shiny pink crowns of aging men and some women). Minoxidil or Rogaine improves circulation to hair follicles and sort of helps men and women hold onto their hair. So what does l-carnitine do?

When hair follicles were cultured in the lab (if they can grow 'em in a dish, why can't they grow 'em on our heads?) in the presence of l-carnitine, researchers at the University of Hamburg observed several positive things: the growth phase lasted longer, fewer hair matrix cells keeled over dead, and more matrix cells proliferated. At a molecular level, less TGFbeta2 factor, less TGF-beta II receptor protein, and falling levels of caspase 3 and 7 confirmed a more-growth-less-death environment for the hairy little cell community(1).

The German dermatologists summed it up thus: "l-carnitine, a frequently employed dietary supplement, may stimulate hair growth by increasing energy supply to the massively proliferating and energy-consuming anagen hair matrix." Whoa, I would like to use "massively proliferating" and "my hair" in the same sentence. How do you say "Please don't hate me because I have beautiful hair" in German?
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1. Foitzik, K et al. L-carnitine-L-tartrate promotes human hair growth in vitro. Exp Dermatol. 2007 Nov;16(11):936-45.

Skinceuticals C E Ferulic

So what's Arlen Specter doing on my blog? Well, he's got those pouchy things going on on either side of his mouth. And that's my newest obsession--my little pouchy things where acne scars are coalescing with wrinkles. I googled Arlen Specterish pouchoid look and found TheDermBlog.com Well, actually not, I don't exactly remember what I googled but it was some combination of Vitamin C serum and aging skin. Topical vitamin C is known to stimulate collagen production, and collagen is the fibrous tissue that keeps your cheeks off your chin and your chin off your collar. And Dr. Benabio's excellent blog noted that this fern-derived antioxidant called ferulic, when combined with topical C, stablizes the latter and allows it to penetrate better into damaged skin. And he said someday soon, topical C plus ferulic would be available.

I am computer woman, see me google. Off to vitamin C AND ferulic arriving at Skinceuticals C E Ferulic Sample Size . What the heck, thinks I, it was on sale in December, so for $25, why not?

Fast forward to three weeks later, a patient told me today my skin looked great. "Good color," she said, "You look healthy!" Need I say more?

September, 2009 update: Still using CE Ferulic. A little goes a long way--one tiny sample body supplies nightly face application for over a month. Skin looking so good that my 20-something year old daughter noticed it and took one of my bottles for herself! Get your own CE Ferulic my dear!

Conditioner for limp, pathetic hair

No news to regular readers that my hair is a source of some angst to me. Progesterone cream helps to keep it on my head, but nothing was giving it that shine and manageability I sought. Conditioners, mousse, volumizer, sprays, gels...all gave me the dog-caught-in-a-rainstorm look. My neighbor/friend/hair consultant just sadly shakes her glowing bouncy locks as she trims my hair in about five minutes, says no product exists to improve this mane.

So, far be it for me to be a beauty consultant, but this tip is too good not to share. I was flipping through Health Magazine, checking "The best anti-aging secrets: Looking younger isn't all about serums, needles, and lasers. Here's 17 all natural moves." This is the same article that gave us the all natural move of chugging our coffee ASAP so as not to stain our aging yellowing teeth.

This was the #1 tip from Lisa Hedley, the founder and creative director of the Mayflower Inn & Spa:

Open Sesame (Oil): First thing every morning I massage organic sesame oil from the health food store all over my body. Working it in wakes me up and really gets my blood circulating. Plus the oil hydrates my skin, giving it a healthy glow. Then I jump in the shower--the oil naturally cleans away dead skin cells.

I thought that would be the sort of thing my daughter would enjoy--all that blood circulating and glowing in the morning. She said let's get real here, I'm not going to do that before I go to work. So I'm left with this bottle of sesame oil, and I'm sure as heck not going to smear it all over me pre-shower and risk falling in the tub and cracking my skull open. But...wait, I think, what if I massage it into my scalp, toss some coffee quickly past my pearly whites, then wash my hair? Couldn't hurt, maybe could leave a healthy hair glow?

Who'd'a thunk it? My hair is fabulous (in a relative sense)--soft, shiny, no frizz, no flyaway, no static. I'm sure it will be hard to keep my husband from running his fingers through it when and if he finally notices. Six bucks for 13 oz. of the organic stuff from King Soopers. I highly recommend it.

Estriol and wrinkles

Estriol is the darling of the natural hormone set. A weak little estrogen, it is, in fact, a metabolic byproduct of the normal breakdown of the body's two stronger circulating estrogens, estrone and estradiol. Enormous quantities are necessary to preserve bone mass, but itty bitty bits dabbed on your aging visage may improve the quality of your skin.

A .3% topical cream, available by prescription from compounding pharmacies, was applied daily to the wrinkled surfaces of a group of perimenopausal ladies. Not only did skin elasticity and firmness improve after six months of use, but also wrinkle depth and pore size decreased. Skin biopsy specimens (now how much did they pay these ladies for that?) showed increased numbers of collagen fibers. Serum hormone levels did not change and there was no evidence of any systemic hormone effects, suggesting that topical estriol is safe for use in women unable to use full-dose estrogen replacement therapy.

What's a liver spot?

I recently spoke at a training session for the DermAnalysis scanner. This gizmo uses black light (UVA) to highlight areas of sun damage and dryness. The scanee sticks her head under a drape, screams with horror to discover her entire face lit up with blotchy purple and orange sun-ravaged areas, then jerks herself free of the machine seeking soothing explanations from the screener. While this UV scan cannot diagnose skin cancer, it certainly facilitates discussion of skin care.

Here's a brief lexicon of skin destruction:

Solar Lentigines: A fancy name for liver spots (aka horrid age spots) which have absolutely nothing to do with the liver whatsoever. They are, instead, the result of sun-deranged melanocytes overproducing the skin pigment called melanin. Some of these skin melanocytes just give up after years of tanning and quit producing melanin at all, resulting in white patches (see below).

There are a couple of remedies for an ugly lentigo, none of which include bleaching. A prescription product called Solage applied twice daily will fade these hummers. Melanocytes hate to be frozen, so liquid nitrogen will also work.

Idiopathic guttate hypomelanosis: A big name for tiny white spots on sun-damaged skin. Age plus sun equals death to certain touchy little groups of melanocytes. Nothing to be done about them.

Solar elastosis: This is basically at the root of this skin aging thing. Sunshine--right, the very sun you sought in college as you slathered on the baby oil and placed a reflector beneath your neck--causes breakage and clumping of the elastic fibers in the skin. As a result, skin sags and the superficial layers of the epidermis bunch up.

Cutis rhomboidalis: Talk about feeling bad about your neck! Think the deeply plowed neck skin of Midwestern farmers and ranchers. Crisscrossing furrows through thick yellowish skin. No cure for this, grow your hair long.

Poikiloderma of Civatte: I don't know who this Civatte fellow is, but this condition equals a combination of all of the above sun mess plus dilated capillaries on the anterior chest of women who faced up to the sun many times too often. No more decolletage for Suzanne Somers on those infomercials!

Seborrheic keratoses: These are big scary variegated growths that typically appear on the torsos of aging susceptibles (if you can picture these on your parents skin, you're on your way to growing your own). They have a 'stuck-on' warty appearance, and can grow to alarming proportions. Not to worry. Not dangerous from a skin cancer point of view, but distressing nonetheless. They can be surgically removed.

And here's the rest of the tour:

Crow's feet result from overuse of the orbicularis ocli muscles that activate when you crinkle your eyes during really big smiles. Furrowed brows result from chronic worry creasing your forehead. Marionette lines crease the skin from the angles of the lips to the jawline. Angular cheilitis results from really big marionette lines, perhaps coupled with loss of teeth collapsing cheeks further, resulting in folds at the lip angles that fill with saliva and residual toothpaste. This irritating ooze from mouth leads to red and painful inflammation.

Who needs a shingles shot?

Leftover chickenpox can cause a world of trouble.

My 59 year old patient was miserable. I saw her two days after the onset of painful blisters on her ear and in her ear canal. Besides the discomfort, she had terrible bouts of vertigo, and her mouth drooped on the same side as the blisters. "What is it?" I asked neurologist Adam Wolff, MD by phone. "Ramsay Hunt Syndrome," he answered, kindly not adding the word 'obviously.'

Nearly all of us of a certain age have done battle as children with the herpes zoster virus. Way back when, we broke out in the characteristic bite-like rash of chickenpox. Since then, we have carried the residual zoster virus-particles in our nerve cell bodies along the spine and the base of our brain. Our immune system has kept a lid on the little buggers who now wait for an immune lapse so they can break free of surveillance and multiply along the axons of the nerves. When they do, we will develop a painful blistering rash in the area of skin supplied by the affected nerves, and, occasionally, paralysis in the facial muscles or other neurological syndromes such as Bell's Palsy or this Ramsay Hunt business.

While immune problems from cancer, chemotherapy, AIDS, or steroid therapy increase our risk of shingles, just ourselves growing older are at elevated risk. And the older we get, the more likely we are to develop complications with shingles, in particular a prolonged pain syndrome known as post-herpetic neuralgia (PHN) that can last for months to years past the breakout.

Researchers from the Mayo Clinic sorted through scores of medical records from adult Minnesotans to determine the incidence of recurrent herpes zoster (HZ) illness in both the healthy and immunocompromised residents of the area prior to the availability of the shingles shot (Zostavax). Most Minnesotans with HZ troubles were free of immune troubles, succumbing to shingles at a rate of 4 per 1,000 each year. The older the subjects, the more likely they were to let loose their resident HZ and suffer from painful complications. Specifically, 68% of the affected group were 50 and over, and 1 in 4 of them developed HZ-related complications.

So who needs a shingles shot? It is specifically indicated for persons over 60 who wish not to suffer from PHN in their golden years. Trust me, my patients with PHN find those years of pain not so very golden. While it is not yet tagged for persons between 50-59, this younger group of oldsters could benefit as well. The problem for them, for now, is that insurance may not pay for this pricey shot until the FDA approves the vaccine for that age group.

Keeping aging skin intact

Age seizes my skin and turns my hair from black to white: My knees no longer bear me and I am unable to dance again like a fawn.
--Sappho

Fawn, schmawn, I'm just working here at getting the snow shoveled and hoofing it up and down 19th Avenue on a regular basis. But this post is not about the dancing abilities of an aging hippie, but rather this business of age-seized skin.

The passing years have definitely grabbed Ms. McM in a dermal sort of way. In her mid-60's, her 'photo-aged' or sun-damaged skin had thinned to the point that it ripped like old cloth when subjected to trauma such as banging against the bedframe and other household objects. Her forearms and shins are crisscrossed with fine white line where tears have turned to scars.

Skin that tears easily is common in older women, though generally in those more aged yet than Ms. McM. Thinned out skin is also responsible for the unsightly purplish blotches that appear on the forearms of older women. Loss of collagen between layers of skin allows the epidermis or top layer to shear over the dermis below when the arm is rubbed or bumped. As a result, tiny blood vessels rupture and bleed between the layers, at times in a rather dramatic and extensive manner.

Blotches are ugly, rips are devastating. Ms. McM was pleased, however, to show me her well-healed, blotch-free arms and legs during yesterday's visit. Her dermatologist had recommended the regular application of Retin-A cream (generic tretinoin cream) to the areas. Studies have shown that photo-aged skin produces significantly less collagen than protected skin (and scientists have the buttocks biopsies to prove it!). Further biopsies from philanthropic old gals prove that Retin-A restores collagen formation in their wrinkled, sunstruck forearms.* Newer studies suggest that tazarotene cream is even better--but more expensive!

Retin-A is pricey as well, even though it is available generically. Ms. McM noted one month's supply set her back over $100, but she bought additional tubes in Mexico for 6 bucks each.
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*Griffiths, C, et al. NEJM. Volume 329:530-535.

Vertical ridges in nails

Ridgy and brittle, that's nails after menopause. While these vertical ridges may be a 'normal' part of aging, either the ridgy nature of the nail or the underlying cause of the ridges makes for nails that break under ordinary circumstances such as brushing your fingertips on the wall as you switch on a light.

After noting how my aging not-so-goldilocks responded to local progesterone cream, I decided to try the same on my not-so-goodlooking nails. Now, 18 months into the experiment, only two of my nails remain beridged and bedraggled. All the other groovy spots have grown out, leaving the attractive oval nails of old that I had when I was young.

I used over-the-counter progesterone cream (Puritan is a good place to buy) for the nail purpose. I wonder if I might've seen quicker results with the prescription strength cream I use on my scalp.

Kinetin may slow skin aging

Rough, wrinkled, and brown. It's not the worst thing that can happen whilst aging, but not particularly what you want for your cheeks, your neck, or the backs of your hands. N6-furfuryladenine, aka kinetin, promotes cell growth in plants and perhaps in your skin.

Here's one enthusiastic endorsement for kinetin kream from drugstore.com:

I absolutely love this product! As a woman of 50, I've found that Kinerase has given my skin a clarification or glow that I have not seen in years. I use it twice daily with my other moisturizer. When one of my friends asked me if I had some type of treatment (i.e. Botox), I knew this was the right product. Results do take time.

Dr. Suresh I. S. Rattan, PhD, DSc, Associate Professor of Biogerontology at the University of Aarhus, Denmark, who happens to be the patent holder for N6-furfuryladenine for use on aging skin says:

...when you grow normal cells in the lab they have a limited number of times they multiply and divide—termed a cell's replicative life span. But when I added N6-furfuryladenine to these cultures the cells did not age as fast, the process slowed down dramatically.

In a year-long study of 96 subjects with sun-damaged old skin, the majority of the studied leathernecks noted a decrease in fine wrinkles and roughness. A lucky third of them noticed less 'mottled hyperpigmentation.'

A final note of caution from Dr. Rattan, who basically warns that if a little is good, a lot is not better:

In cell cultures when a concentration of say 250 micromolars of N6-furfuryladenine was used, we got good results, but when we used 500 micromolars of N6-furfuryladenine the cells started dying.

Am I going to buy this stuff? I think not; a one month supply costs $65!

HairMax LaserComb

Aim this low-level cold-beam laser at your scalp if you're seeing too much of it through your thinning mane. Now FDA-approved, this gadget proved successful in 93% of the balding participants enrolled in the clinical trial.

How much new hair do you get for your $545? Here's the summary:

The study concluded that 93% of the participants (ages 30-60) using the HairMax LaserComb had an increase in the number of terminal (thick) hairs. The average number of terminal hairs per square centimeter increased by 19 hairs/cm2 over a six-month period.

Your average scalp has 250 hairs per square centimeter. People shelling out big bucks for this LaserComb are obviously not your average-scalped sort of customers. If the average skull has 600 cm2 of scalp, this device could add 11,400 hairs to their heads.

Worth it? Hard to say, but here's what one medical commentator had to say:

The LaserComb makers have failed to advertise that their product can double as a handy pointer during CME [continuing medical education] presentations...Even though the FDA has concluded the device is safe, what if one sustains retinal damage from using it incorrectly? Sure, I've been literally blinded by my own vanity, in both eyes--but my hair is positively lustrous.

Reduce the reductase...

and save your hair. If you're wondering just what is sending your former glorious locks into the bathroom drain, it's 5-alpha reductase. This enzyme turns testosterone into the more potent dihydrotestosterone form in your hair follicles, causing them to jump off your scalp and onto the floor.

Progesterone is an excellent inhibitor of this enzyme which is why prescription strength progesterone cream to scalp can save the mane.

Like fertilizer on a sparse lawn...

...a chemical enticement encourages the skin to fill in hair-growing structures.*

---RJ Davenport

Dr. Davenport goes on to explain why hair gets increasingly pathetic with age. People are born with all the hair follicles they'll ever have. Over time, hair follicle performance 'falters,' and these hair-replenishing structures spend more time resting than growing. Follicles, along with every thing else that's fresh and young in humans, shrink with age.

Is there good news? A molecule called beta-catenin can induce new hair follicles, at least in mice. Dr. Davenport feels that this research may hold hope that hair can be saved as we age.
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*R. J. Davenport, Hair Trigger. Sci. Aging Knowl. Environ. 2005 (27), nf54 (2005)