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HIGH on skin

Health Ingredients Generation Homeostasis Health The skin is the most seen and public organ but yet, the least understood organ. The skin never lies; as sensory, nerves, temperature measurement, blood flow, perspiration and pore dilation activities are assessed during lie detection tests. Additionally, infrared cameras are used by security at airports to detect a fever amongst a crowd. We have to understand who we are and what our cells are made of as we recognise ourselves by our skin. A magnificent array of chemical reactions takes place on a molecular and cellular level within the skin. Human skin is a complex living material but in biomechanical tests it reveals its homogeneous nature. Our environment can directly influence who we are. The skin reacts immediately and directly to the outside environment. Human skin can be stretched to several times its original size and still maintain its original phenotypic properties. Such impressive expansion is possible because the skin is a highly specialised mechanical structure, responding through a network of interconnected cascades of chemical reactions, with the participation of extracellular, cytoplasmic and nuclear membranes. Healthy skin is the level of functional and metabolic efficiency of a living organism. In human skin it is the ability to adapt and self-manage when facing physical, mental, psychological and social changes. Our skin’s health is a complex biological process influenced by a combination of intrinsic (genetics, cellular metabolism, hormone and metabolic processes) and extrinsic (chronic light exposure, pollution, ionising radiation, chemicals, toxins) factors. Ingredients Particular compounds and molecules need to be applied to the demanding skin in order to assist and supplement a homeostatic balance at all times even when the skin is exposed to social and environmental stressors. A product with measurable quality, safety and efficacy standards should be considered. Stereo chemical properties of the active and inactive ingredients applied to the skin is explicitly important, i.e. the chemical characteristics of a compound should be understood in order to ensure that a therapeutic and biological benefit is obtained on a cellular level. There are two main groups of agents that can be used as skin health topical components, the antioxidants and the cell regulators. The antioxidants, such as vitamins, polyphenols and flavonoids, reduce collagen degradation by reducing the concentration of free radicals in the tissues. The cell regulators, such as retinols, peptides and growth factors (GF), have direct effects on collagen metabolism and influence collagen production. Vitamins C, B3, and E are the most important antioxidants because of their ability to penetrate the skin through their small molecular weight. The water-soluble, heat-labile local L-ascorbic acid (vitamin C) in concentrations between 5 and 15% was proven to have a skin anti-aging effect by inducing the production of Collagen-I, and Collagen-III, as well as enzymes important for the production of collagen, and inhibitors of matrixmetalloproteinase (MMP) I (collagenase I). Vitamin E (α-tocopherol) used as a component of skin products has antiinflammatory and antiproliferative effects in concentrations between 2 and 20%. It acts by smoothing the skin and increasing the ability of the stratum corneum to maintain its humidity, to accelerate the epithelialisation, and contribute to photoprotection of the skin. Vitamin A (retinol) are also a group of agents with antioxidant effects. Retinol is, at the moment, the substance that is most often used as an anti-aging compound. It has been shown that retinol has positive effects not only on extrinsic but also on intrinsic skin health and has a strong positive effect on collagen metabolism. It has been shown to be able to reduce the signs of UV-induced early skin health, such as wrinkles, loss of skin elasticity and pigmentation. Polypeptides or oligopeptides are composed of amino acids and can imitate a peptide sequence of molecules such as collagen or elastin. Through topical application, polypeptides have the ability to stimulate collagen synthesis and activate dermal metabolism. Chemical peels are methods to cause a chemical exfoliation of defined skin layers to induce an even and tight skin as a result of the regeneration and repair mechanisms after the inflammation of the epidermis and dermis. Chemical peels are classified into three categories. Superficial peels [α-β-, lipo-hydroxy acids (HA), trichloroacetic acid (TCA) 10–30%] exfoliate epidermal layers without going beyond the basal layer; medium-depth peels (TCA above 30 to 50%) reach the upper reticular dermis; deep peels (TCA > 50%, phenol) penetrate the lower reticular dermis. The depth of peeling depends not on the substance used only, but on its concentration, pH of the solution and time of application. A number of skin modifications have been reported after several weeks: epidermal architecture returns to normal, melanocytes are present and distributed uniformly, basal cells contain small melanin grains distributed homogeneously, the thickness of the basal membrane is homogeneous, in the dermis, a new sub epidermal band of collagen appears, elastic fibers form a new network, often parallel to those of collagen. If superficial peelings target the corneosomes, cause desquamation, increase epidermal activity of enzymes, lead to epidermolysis and exfoliation, medium-depth peels cause coagulation of membrane proteins, destroy living cells of the epidermis and, depending on the concentration, the dermis. Deep peels coagulate proteins and produce complete epidermolysis, restructure of the basal layer and restoration of the dermal architecture. Generation Healthy and functioning skin barrier is important protector against dehydration, penetration of various microorganisms, allergens, irritants, reactive oxygen species and radiation. The skin barrier may be specifically adjusted to allow penetration. For this reason, daily skin care may increase skin regeneration, elasticity, smoothness, and thus temporarily change the skin condition. Mechanical activation of the skin initiates the signalling pathways, which in turn activate the transcription of factors stimulating gene expression, that causes a cascade of events which results in an increased mitotic activity and collagen synthesis. Changes in the skin tissue occurring during dermatological treatments initiate these paths that also increase the mitotic activity and the synthesis of collagen. However, if external stimuli such as mechanical stress reach sufficiently large values, they may cause irreversible deformation and damage to the skin, resulting in

Balanced Skin Biochemistry

The skin is the most visible organ, yet the least understood, with a magnificent array of chemical reactions taking place within it on a molecular and cellular level. Addressing skin biochemistry is key in combatting the effects of ageing. The skin never lies – literally – as sensory, nerve, temperature, blood flow, perspiration and pore dilation activities are assessed during lie detection tests. With this in mind, it’s apparent that we have to understand who we are and what our cells are made of, as we recognise ourselves by our skin. Human skin is a complex living material but reveals its homogeneous nature in biomechanical tests. Our environment can directly influence who we are and the skin reacts immediately and directly to the outside environment. The skin and subcutaneous tissue provide a protective covering of the body, capable of stretching and contracting. Skin thickness measurements are used to evaluate skin characteristics, and biomechanical skin parameters change with time. The process of ageing is the reason why the skin becomes thinner, stiffer, less tense and less flexible. Flexibility and reactivity Human skin can be stretched to several times its original size and still maintain its original phenotypic properties. Such impressive expansion is possible because the skin is a highly specialised mechanical structure, responding through a network of interconnected cascades of chemical reactions, with the participation of extracellular, cytoplasmic and nuclear membranes. When the skin is stretched above its physiological limit, a series of reactions activating ion channels, integrins, growth factor receptors and G-receptors conjugated with protein reactions takes place. These reactions aim to restore the homeostatic balance. The skin also comprises a network of immune cells and antimicrobial peptides that increase in response to microbial invasion. In order to achieve cellular longevity and amplified cellular energy, cell metabolic activity should function at an optimal state. The main source of cellular energy is the mitochondrion. A skin cell, such as a fibroblast or a keratinocyte, can typically contain anything between 100 to 2 000 mitochondria that produce the molecule adenosine triphosphate, which provides energy for a cell during mitotic activity and enhances cell turnover time. Mechanical activation of the skin initiates the signalling pathways, which in turn activate the transcription of factors stimulating gene expression, causing a cascade of events that result in increased mitotic activity and collagen synthesis. Changes in the skin tissue that occur during dermatological and surgical treatments initiate these paths, also increasing mitotic activity and the synthesis of collagen. However, if external stimuli such as mechanical stress reach sufficiently large values, they may cause irreversible deformation and damage to the skin. Incorrect pH imbalances ionic activity to the skin, which may inherently degrade or destabilise proteins. The right biochemical and dermatological interventions Biomechanical tests of the human skin help to quantify the effectiveness of dermatological products, detect skin diseases, and help to schedule and plan surgical and dermatological interventions and treatments. One person’s skin metabolic profile differs from another according to social and environmental pressures, and the biomechanical parameters of the skin alter over the course of one’s life. During the ageing process, the skin becomes thinner, stiffer, less tense and less flexible, and protective functions against mechanical injuries decrease. Due to the complex importance of cell kinetics, the active ingredients of topical products should therefore comprise specific pharmacokinetic properties that assist against mechanical injury. Particular compounds and molecules need to be applied to the demanding skin in order to assist and supplement a homeostatic balance at all times, even when the skin is exposed to social and environmental stressors. A product with measurable quality, safety and efficacy standards should be considered. The overall architectural building blocks of the skin – such as macromolecule kinetic pathways, cell permeability and cell polarity – should be assessed carefully when products are applied topically. Applying products with stereo chemical properties of the active and inactive ingredients to the skin is explicitly important. This means that the chemical characteristics of a compound, for instance vitamin C (ascorbic acid), should be thoroughly understood in order to ensure that a therapeutic and biological benefit is obtained on a cellular level. Molecular weight is important, as the compound applied topically should be dramatically smaller than the target skin cell macromolecule it needs to bind with, in order to stimulate a biological response. There are various derivatives and compound by-products available on the market that ultimately only apply more metabolic strain on a skin cell. Products should stimulate ample membrane ion channelling in order to activate and increase transient ATP production and not arouse an inflammatory response. It has been found that mitochondria from skin cells cannot be isolated thoroughly with solutions at neutral or alkaline pH levels, which highlights the importance of an acidic milieu in the skin. Incorrect pH provides an imbalanced ionic activity to the skin, which may inherently degrade or destabilise proteins. A product with the correct pH should thus contribute or absorb hydrogen atoms to or from the skin, rather than reacting with extracellular proteins. Ionic activity enables optimal transdermal absorption and therapeutic protein binding both inside and outside the cell, indicating the important role pH plays in skin chemistry. The “conductivity” and “polarity” of product ingredients promotes product absorption by means of ion channelling, hydrophobic and hydrophilic properties, isotonic, hypertonic and hypotonic activity. The aforementioned are all considerations for an ageing or injured skin that requires specific topical exposure or dermatological intervention to accommodate the biochemical changes of skin over time.

Doctor applying honey-based wound care to a patient's upper arm

Use of Honey-Based Dressings to Increase Patient Compliance: Case Reports

Introduction A considerable amount of research has been performed to identify and continuously develop novel therapeutic approaches and technologies for the management of acute and chronic wounds.1 The development of new approaches however, requires the understanding of the physiological trajectory of normal wound healing, described as the phases of haemostasis, inflammation, proliferation and remodelling. These four highly programmed, integrated and overlapping phases, occur in a specific time frame and sequence, in order for successful wound healing to occur.2-3 Numerous factors can cause a disruption or affect one or more of these stages,1 resulting in a non-healing chronic wound or delayed wound healing.3 The latter has, through history, been a global concern due to the distress and discomfort it causes to the patient.4 Subsequent to the rate of wound healing and especially in aesthetically sensitive locations, the degree of scarring post wound healing becomes an important factor to consider due to the life-long psychological and/or functional implications it may have on the patient.5 Although novel wound care techniques, such as negative pressure wound therapy (NPWT), have been developed and implemented with great success in the past two decades, patient-related factors play an important role in considering other therapies. A study performed in 2014 highlighted patients’ experience with the use of NPWT, particularly the effect this therapy had on the patients’ personal environment (physical, mental, social and spiritual aspects).4 One important factor to consider is the possibility of infection, as a wound causes a break in the integrity of the skin and therefore increases the susceptibility to microorganism infiltrations and subsequent infection. By preventing or treating the infection effectively, it can significantly improve wound healing.6 Accomplishing this task has become a difficult endeavour in the modern age, due to the increased resistance of microorganisms towards antibiotics as a result of the inappropriate use of these products. Hence, exploring alternative therapies becomes increasingly crucial, and although many exist, implementation thereof may be challenging.7 By considering the aforementioned factors, the author’s approach in the case was utilising a product (Wound Occlusive®) containing an age-old remedy, honey. The utilisation of honey-based topical products has re-emerged in the past few decades, with more evidence and data supporting beneficial claims associated with the use of honey-based products on wounds, such as the pH lowering effect on the wound; the ability to penetrate through biofilms; the debriding capacity; and the antibacterial and anti-inflammatory activity.8 Clinical Cases 1. Patient A: A 66 years old male presented with a post-skin flap surgical wound. Injury to the patient’s knee resulted from a car accident earlier in the year, where a skin flap was eventually performed. The wound has been treated using a NPWT dressing. The main complaint of the patient was that his quality of life had been affected by the current treatment as he was no longer able to function in his current job, and implied that the use of the dressing necessitated him to visit a professional nurse for every dressing change, while he was not noticing real improvements. The patient had diabetes Type 1 (well-controlled), was a non-smoker and appeared generally healthy. The wound (42 mm [length] x 21 mm [width]) was located on the lateral side of the left knee, and during the first observation it could be stated that there were clear signs of inflammation and oedema in the tissue surrounding the knee and wound. The patient was admitted to hospital just prior to the appointment due to severe pain in the wound. During admission the NPWT dressing was replaced and the decision was made during the initial appointment after admittance to hospital that removal of the vacuum dressing would be postponed for another five days, which served as an observation period. The treatment protocol adopted consisted of cleaning the wound with saline followed by an application of a thick paste of Wound Occlusive®. An absorbent dressing was applied as a secondary dressing due to the amount of exudate on the wound. Initially the wound dressing was changed every 48 hours, and after two sessions of 48 hours, the dressing change was moved to a 72 hours regimen. Figure 1 shows that the size of the wound decreased significantly over the period of one month. In addition, it is observed that inflammation and oedema surrounding the wound had also decreased after one week of treatment; this observation was also supported by patient’s feedback. 2. Patient B: A 13-year-old male presented with significant soft tissue injuries in the face post suture. The injury was the result of a hyena bite. The injury extended from the frontal region through the right orbital, right infraorbital, right upper cheek, right nasolabial and the contralateral perioral area. 3. Patient C: A 31-year-old healthy male presented with a brown recluse spider bite, otherwise known as the violin spider. The bite took place approximately eight days before surgical debridement of the wound was performed. The wound measured 75 mm (length) x 20 mm (width) x 5 mm (depth) located on the left antebrachium (forearm). After surgical debridement the wound was left open, whereafter the treatment protocol adopted consisted of cleaning the wound with saline followed by an application of a thick paste of Wound Occlusive®; an absorbent dressing was applied initially to accommodate the amount of exudate on the wound, although this was changed after 48 hours to a paraffin gauze dressing followed by the application of a crepe bandage. From Figure 3a to Figure 3c it can be noted that both the length, width and depth of the wound decreased within the period of one week. Additionally, it should be mentioned that the amount of exudate present on the wound bed was markedly lower and no signs of infection could be noted. Discussion Wounds can significantly affect a patient’s quality of life in numerous ways due to pain, odour, decreased mobility, social isolation, psychological problems such as depression and anxiety, and the inability of the patient to perform daily duties and activities.9 These factors place emphasis on the importance of treating

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