12- Topical vitamins

Dr .Safwan Al Adwan
Consultant Dermatologist & aesthetics
Associate Professor
Topical vitamin C
• Topical vitamin C or ascorbic acid is a popular vitamin
being added to skin care products.
• Currently, there are many advertising claims of a topical
formulation containing antioxidants that will protect
against and reverse ageing.
Topical vitamin C
• However, the truth is that many of the available
formulations contain very low concentrations of
antioxidants that are not well absorbed by the skin.
• Vitamin C is an antioxidant, which when manufactured
into a stable topical formulation, is proven to be effective
in protecting against photoageing of the skin.
How does topical vitamin C work?
• To understand how topical vitamin C works an understanding of
the relationship between free radicals and antioxidants in the
body is necessary.
How does topical vitamin C work?
• Free radicals are molecules created as a by-product of
oxygen metabolism as our bodies create energy at the cellular
level.
• The oxygen molecule loses one electron, turning it into a free
radical.
How does topical vitamin C work?
• The free radical formation can also be augmented by external
factors such as pollutants, sunlight, radiation, emotional stress,
smoking, excessive alcohol, infection, and some drugs.
How does topical vitamin C work?
• Free radicals float around the body looking for electrons to
rebalance themselves.
• If necessary, free radicals steal electrons from normal healthy
cells, this being the cause of various conditions ranging from
accelerated ageing to deadly cancers.
How does topical vitamin C work?
• Antioxidants protect healthy cells by donating an electron to the
free radicals.
• The body produces antioxidants naturally, and we can also get
them from the foods we eat and from supplements.
• Topical vitamin C has shown to protect the skin from UV
damage caused by prolonged sun exposure by
reducing the amount of free radical formation and
sunburn cells.
• Exposure to UV light has also shown to decrease the
naturally occurring vitamin C levels in the skin.
• Thus the topical application of vitamin C restores these
photoprotectant levels.
• Other studies also suggest that vitamin C may play a
part in the collagen biosynthetic pathway by activating
collagen metabolism and dermal synthesis of elastic
fibres.
What is topical vitamin C used for?
• Improve skin appearance by reducing fine lines and
wrinkles.
• Wound healing as it aids in stabilizing collagen.
• Protects against or lessens the severity of sunburns.
Who should use topical vitamin C?
• Everyone will benefit from maintaining adequate vitamin C
levels.
• For most people, this can be achieved by eating more than five
servings of fruit, vegetables and juices daily.
• There are many topical vitamin C preparations available that
claim to benefit photoaged skin.
• However, almost all of these claims have no rigorous scientific
testing to back them.
Most of the available products are
useless !
• A correctly formulated topical vitamin C preparation is a costly
process.
• Many available formulations are ineffective.
• The problems lie in the fact that vitamin C is most commonly
found in the form, L-ascorbic acid, which is highly unstable
when exposed to oxygen, making it useless.
Most of the available products are
useless !
•.
• Also, many of the currently available topical vitamin C
preparations do not penetrate the skin sufficiently to make any
difference.
• Research is underway to optimise a stable and effective topical
vitamin C formulation.
Scurvy !
• The treatment and
prevention of scurvy, which
is due to dietary vitamin C
deficiency, requires oral
replacement of ascorbic
acid.
Topical retinoids ( Vitamin A)
• Topical retinoids are medications derived from vitamin A
formulated as a cream, lotion, foam, emulsion, or gel.
What are topical retinoids used for?
• Acne vulgaris and its complications

• Applied to the face once daily at bedtime, topical retinoids such

as adapalene, isotretinoin, tretinoin (retinoic acid), and
trifarotene can help mild to moderately severe acne.
What are topical retinoids used for?
• Acne vulgaris and its complications

• They are effective first-line treatment for comedonal and

inflammatory acne, but are not recommended as monotherapy for
severe acne, especially if there are pustules with deep nodules
and cysts.
• It may take 12 weeks or longer before improvement is seen.

• Topical retinoids may reduce the severity of existing scarring and

subsequent acne scarring.
What are topical retinoids used for?

• Photodamage and photoageing

• If used long term (>6 months) topical

tretinoin can reduce freckling, solar
lentigines, fine wrinkling, solar comedones,
sun-induced skin fragility, and actinic
keratoses .
What are topical retinoids used for?
• Melasma

• Topical tretinoin may be combined

with other active ingredients in skin
bleaching cream to treat melasma.
What are topical retinoids used for?
• Darier disease and others

• Topical isotretinoin, tretinoin, and

adapelene have been used for localised
Darier disease, reporting significant
clinical improvement in symptoms.
• Topical retinoids may be used to treat
many dermatoses .
Calcipotriol ( Vitamin D Derivative)
• Calcipotriol is a prescription medication used mainly for
psoriasis.
• It is moderately or very effective for about 80% of patients.
• This means the patches become less scaly and thick, but red
patches often persist despite continued treatment.
Psoriasis pre-calcipotriol Psoriasis post-calcipotriol
How does calcipotriol work?
• Calcipotriol acts like vitamin D.
• It is antiproliferative, reducing the abnormal proliferation of
keratinocytes that occurs in psoriasis, and it induces cell
differentiation, normalising epidermal growth.
What are the side effects of topical
calcipotriol?
• It may sting or cause an irritant dermatitis (dry itchy rash) on
facial skin: use very cautiously in psoriasis affecting this area.

• When used on other sites, wash hands carefully to reduce the

chance of inadvertent application to the face.

• Treated psoriasis may develop peeling around the edge of

the plaques.
What are the side effects of topical
calcipotriol?
• Surrounding skin may be irritated i.e. become red, dry and itchy.

• About 1% is absorbed through the skin.

• An overdose (more than 100g/week) could have an effect on
calcium metabolism.
• If large doses are necessary, calcium levels in blood and urine
should be monitored.