PEER-REVIEW | DERMATOLOGY | Table 1 Conditions characterized


by compromised SCPB and chronic


inflammation3 Extrinsic skin ageing (Photoaging) Winter itch


Sensitive skin


Certain ichthyoses Melasma


Dermatitis (all types)


Psoriasis - especially erythrodermic,


pustular, and inverse


Premalignant actinic keratosis


Polymorphous light


Acne, rosacea, keratosis pilaris


Intra follicular barrier anomaly:


phase, cannot be assumed to adequately repair a


compromised SCPB. A truly repairing topical product needs to specifically incorporate SCPB repairing ingredients at the therapeutic concentrations. Ingredients documented to have barrier repair function are listed in Table 2. In an open clinical evaluation of over 100 commercially available products, only 11% of the moisturizing product improved SCPB function when assessing TEWL by evaporimeter7


. The importance of barrier function contributing to


photoprotection was documented by applying a topical product containing a mix of only the three physiologic barrier lipids of the stratum corneum (cholesterol, ceramide and linoleic acid) without any sunscreen- specific ingredients. This formulation provided an SPF function of 5.28


. Additionally, this


semiocclusive product produced an 89.6% reduction of TEWL with one application 45 minutes following complete destruction of the stratum corneum, indicating nearly complete permeability barrier repair. In comparison, TEWL reduction is more than double the 43.1% reduction at the same time point by application of occlusive 100% pure white petrolatum3


. The physiological lipid product


was also statistically superior to prescription


strength Table 2 Most effective


topically applied non-physiologic


barrier repair3-4 White petrolatum Lanolin Mineral oil Safflower Olive


Sunflower, wheat germ, apricot


Glycerin Beeswax Avocado Mallow


38 ❚


hydrocortisone in reducing cutaneous erythema and edema induced by three common insults: topical tretinoin, topical tazarotene, and UVB. A pilot study using the physiologic lipid formulation after resurfacing


laser accelerated


cutaneous healing by 80% compared to occlusive greasy antibiotic ointment or topical ointment. This improvement was defined by re-epithelialization and reduction of erythema as observed by a dermatologist that resides in another region of the US9


. Disrupting the stratum


repairing enzymes along with other groups of biologic response modifiers to upregulate lipid and protein synthesis4,5


. Controlling the seven inflammatory pathways that


occur in damaged or diseased skin is also very important for long-term disease prevention. No synthetic ingredients block all of these but several herbal extracts modulate multiple pathways. These herbs are listed in Table 3. There are over 200 herbs known to have anti-inflammatory effects in skin3


.


Antioxidant Certain sunscreen products on the market add anti- oxidant ingredients in an effort to boost photoprotective


The importance of barrier function contributing to


corneum permeability barrier from any insult initiates six inflammatory cascades including release of growth factors, histamine-1 activation, release of cytokines, activation of certain nuclear receptors, and bacterial activation of toll like receptors. Depending on the insult, the arachidonic acid cascade may be activated. The seventh is glycation induced inflammation, which is not released to SCPB. Repair of the SCPB is also complex with release of key ions, gene activation to upregulate


March 2015 | prime-journal.com


photoprotection was documented by applying a topical product containing a mix of only the three physiologic barrier lipids of the stratum corneum without any sunscreen-specific ingredients.


effectiveness based on an in vivo study that showed applying vitamin C and E plus ferulic acid enhances photoprotection10,11


. However, in a more recent


comparative open label human clinical trial, one to three antioxidants added to FDA approved sunscreen ingredients for commercial sunscreens did not enhance photoprotection beyond what the sunscreen ingredients themselves provided. In this same study,


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