Nutrition and Skin

Johnson & Johnson Skin Research Center CPPW, a division of Johnson & Johnson Consumer Companies, Inc. All these products are closely related to the health, well-being and needs of the modern consumer.

Introduction and Overview

The focus on the deficiency of certain minerals is discussed along with their association with many skin diseases. Boyle's team focuses on the facts - using direct evidence of their beneficial effects on the skin.

Nutrients and Skin

Core Messages

Introduction

Vitamin A and the Skin

Naturally Occurring Retinoids
Synthetic Retinoids
Absorption, Distribution, and Metabolism
Mechanism of Action

Retinoid Receptors and Gene Regulation
Effect on Epidermal Growth and Differentiation
Effects on Sebaceous Gland Activity
Immunomodulatory and Antiinflammatory Properties

Therapeutic Uses

Psoriasis and Related Disorders
Disorders of Keratinization
Seborrhea, Acne, and Acneiform Disorders
Retinoids in Skin Cancer
Chronic Hand Eczema

Adverse Reactions and Tolerability .1 Mucocutaneous Complications

Ocular and Neurological Complications
Serum Lipids, Gastrointestinal Side Effects, Liver Function, and Endocrine Adverse Effects
Long-Term Toxicity: Bone Changes
Arthralgias and Myalgias
Teratogenicity

Re-introduction is recommended after normalization of enzyme levels with 25% of the original dose (Otley et al. 2006). Annual radiography of the ankle or thoracic spine is optional (Otley et al. 2006; Scheinfeld and Bangalore 2006).

Table 2.1Synthetic retinoids in current use Chemical structureGeneric nameInitial trade nameApproved medical use First generation All-trans retinoic acidTretinoinRetin-ATopical treatment of acne vulgaris, photodamage VesanoidSystemic treatment of acute pro

Introduction

Our understanding of the relevance of vitamin D metabolism in human skin has improved significantly in recent years. On the other hand, ultraviolet (UV) exposure is one of the major risk factors for epithelial skin cancer.

Relevance of the Cutaneous Vitamin D Endocrine System for Skin Physiology

Vitamin D Synthesis in Skin

The production of 1,25-(OH)2D3 in the kidney is regulated by a feedback mechanism of the hormone itself, but also by parathyroid hormone, calcium and cytokines such as interferon-g (IFNg) and tumor necrosis factor-a (TNFa). ) (Holick 2007). The metabolism of 1,25(OH)2D circulating in the blood to calcitroic acid is the result of another well-characterized biochemical reaction cascade.

Inhibition of Proliferation and Induction of Differentiation in Keratinocytes
Immunmodulatory Effects in the Skin
Regulation of Apoptosis
Cytoprotective Effects
Antioxidative Effects

Furthermore, 1,25-dihydroxyvitamin D3 (10−7 M) was demonstrated to have a photoprotective effect in WST-1 and crystal violet-based assays after irradiation of the keratinocytes with increasing doses of UVB light J/cm2). A significant cytoprotective effect was proven after 48 hours of pretreatment of the cells with 1,25-dihydroxyvitamin D3 at a concentration of 10−7 M (Trémezaygues 2009).

Clinical Studies of Vitamin D and Its Analogues in Psoriasis and Other Skin Diseases

Recently, a randomized, placebo-controlled, double-blind, multicenter study analyzing the efficacy and safety of topical becocalcidiol for the treatment of psoriasis vulgaris has been reported (Helfrich et al. 2007). Recently, the combination of acitretin and oral calcitriol has been reported for the successful treatment of plaque psoriasis (Ezquerra et al. 2007).

Treatment .1 Scalp Psoriasis

Nail Psoriasis
Face and Flexures
Skin Lesions in Children
Psoriatic Lesions in HIV Patients
Combination of Vitamin D Analogues with Other Therapies
Other Skin Disorders with Vitamin D Analogues

Vitamin D and Ichthyosis
Vitamin D and Scleroderma
Vitamin D and Vitiligo
Vitamin D and Skin Cancer
Vitamin D and Other Skin Diseases

Other case reports also demonstrated the efficacy and safety of vitamin D analogs in the treatment of psoriasis (Gray et al. 1992). Comparative effects of calcipotriol solution (MC 903) and placebo (MC 903 vehicle) in the treatment of scalp psoriasis.

Introduction

This cumulative damage leads to unattractive premature skin aging and precancerous and cancerous skin conditions. Unfortunately, less than 33% of the population regularly applies sunscreen despite the current increased advertising promoting the need for protection (The Skin Cancer Foundation - Guidelines 2010).

Vitamin C

Exciting studies in vitro compared newborn with aged (80- to 95-year-old) fibroblasts (Phillips et al. 1994). Topical vitamin C has also been shown to increase the synthesis of several specific skin surface sphingolipids (Uchida et al. 2001).

Fig. 4.1 Molecular structure of (a) l-ascorbic acid, (b) l-ascorbyl-6-palmitate, and (c) magnesium ascorbyl phosphate (Courtesy of Sheldon R

Vitamin E

The results in Table 4.1 (Burke et al. 2000) show that topical d-a-tocopherol inhibits sun blistering by 73% and tanning by 40%. The number of tumors ³2 mm on each mouse was counted and the mean number of tumors per mouse was calculated based on the total number of mice in each treatment group (Burke et al. 2000).

Fig. 4.4 Molecular structure of tocopherol isomers

Vitamin C with Vitamin E

Vitamin C with Vitamin E and Ferulic Acid

Unlike vitamins C and E, ferulic acid minimally blocks UVB and acts directly as a sunscreen, as shown in Fig. skin cancer.

Fig. 4.8 Photoprotection by topical vitamins C and E and ferulic acid. Skin was untreated (i) or pretreated with vehicle (ii), 0.5% ferulic acid (iii), 15% vitamin C + 1% vitamin E (iv), or 15%

Take-Home Messages

Introduction

Collectively and individually, all layers of the skin work toward the primary goal of protecting internal tissues and vital organs from daily environmental challenges.

Carotenoids and Skin

Dietary Carotenoids
Carotenoids Bioavailability and Biodistribution to Skin .1 Carotenoids Bioavailability

Factors Influencing Carotenoid Bioavailability
Carotenoids Biodistribution to Skin

Techniques to Analyze Carotenoids in Skin
Dietary Carotenoids Protect Skin Against Some of the Damaging Effects of UV Exposure

Damaging Effects of UV on Skin
Carotenoids are Scavengers of UV-Induced Reactive Oxygen Species that Damage DNA
Dietary Carotenoids Reduce Sunburn Development
Dietary Carotenoids and Skin Cancer

Future Perspectives on Systemic Photoprotection by Carotenoids

An exception may be the selective delivery of lutein and zeaxanthin to the macular region of the retina by HDL (Connor et al. 2007). Binding of carotenoids to dietary proteins has been shown to reduce their absorption in ferrets (Sundaresan et al. 2005). Parasitemia has generally been negatively correlated with plasma carotenoid concentrations (Metzger et al. 2001).

Synthetic lycopene showed a trend but did not reach statistical significance (Stahl et al. 2006). Human intervention studies with a mixture of carotenoids (ie, b-carotene, lycopene, lutein) confirmed the photoprotective effect of carotenoids (Heinrich et al. 2003).

Fig. 5.1 Structures of the most abundant dietary carotenoids

Antioxidants and Skin

Introduction
Positive and Negative Effects of Antioxidants
Polyphenols: Cocoa and Green Tea
Antioxidants Protect Human Skin from Premature Aging

Antioxidants form protective chains in the human skin and protect each other against the destructive action of free radicals. In this chapter, the results of various studies on the interaction of free radicals and antioxidants, specifically carotenoids, in the human skin are summarized and discussed. Fruits and vegetables contain various antioxidants, which are also found in the human body and, more specifically, in the skin (Darvin et al. 2005b, 2007).

This is because the various antioxidants form protective chains in the human organism and thus protect themselves against the destructive effects of free radicals. Long-term consumption of green tea polyphenol drink increased blood flow in the skin (article in preparation).

Fig. 6.1 Effect of high an low flavanol cocoa on cutaneous blood flow and plasma levels of total epicatechin

Take Home Messages

Introduction

Although only about 4% of the human body mass is made up of minerals, they play a significant role. Minerals are involved in the maintenance of electrical neutrality, osmotic pressure, solubility, buffer systems, nervous conditions and metabolism via constituents of enzymes; they are also components of bones and teeth (Anke et al. 1999). Minerals are classified as trace elements (each <0.1% of body weight) and major elements (each >0.1% of body weight).

Minerals and the Skin

Zinc

Functions
Deficiency
Impact on the Skin

Iron

Functions
Deficiency

Copper

Functions
Deficiency

Selenium

Functions
Deficiencies

Chromium

Functions

Silicon

Functions
Dietary Recommendation
Deficiency

Introduction

Ingrown nails (so-called Beau's lines) may be seen and attributed to zinc deficiency (Gaveau et al. 1987). Zinc itself may also have an effect beyond antifungal activity: the anti-inflammatory effect may reduce the hyperproliferation of dandruff-prone skin (Schwartz et al. 2005). The main cause appears to be depleted iron stores accompanied by suboptimal intake of the essential amino acid l-lysine (Rushton et al. 2002).

Total body selenium has been estimated to be 5-15 mg in adults (Patterson et al. 1989). Chromium ions are components of the glucose tolerance factor that is important for protein, glucose and lipid metabolism (Anke et al. 1999).

Table 7.1 Minerals for treatment of skin conditions or prevention and therapy of skin diseases Condition/

Probiotics and Skin

Probiotics
Eczema

Probiotics for Treating Eczema
Probiotics for Preventing Eczema

Probiotics for Other Skin Applications: Oral and Topical
Conclusion

Abnormalities of the skin microbiota are also well documented in psoriasis and eczema (Gao et al. 2008). Several studies on probiotics and IBS have been conducted with different probiotic candidates (Aragon et al. 2010). In the study by Wickens et al. 2008), which evaluated two probiotic treatments compared to placebo, L.

For example, CD14/-1721 polymorphisms may modulate the protective effects of raw milk intake on the development of eczema (Bieli et al. 2007). A recent Cochrane systematic review (Boyle et al. 2008) concluded that probiotics were not effective for the treatment of eczema.

Table 8.1Randomized controlled trials of probiotic ± prebiotic supplementation for the treatment of eczema StudyMethodsParticipantsInterventionsOutcomes Brouwer 2006 (Brouwer et al

Clinical Crossover Between Nutrition and Dermatology

Introduction

Johnson & Johnson Skin Research Center, CPPW, A Division of Johnson & Johnson Consumer Companies, Inc., Grandview Road 199, Skillman, NJ 08558, ZDA.

Diet and Acne

Could Certain Essential Nutrients Affect Acne?
Could Diet Affect Acne Status?
Status and Studies
Conclusion
Introduction

On the other hand, recent clinical studies have suggested a fairly close relationship between diet and acne (Smith et al. 2007a, 2008). The susceptibility of keratinocytes to the antiproliferative effects of vitamins A and D has been documented (Popadic et al. 2008). On the other hand, intake of high levels of omega-3 fatty acids is associated with decreases in inflammatory factors (James et al. 2000).

This conclusion is consistent with the latest studies (Smith et al. 2007a, 2008) on low-glycemic diets (discussed later). The work of Smith et al. 2007a, 2008) focused on the glycemic load, insulin sensitivity, hormonal mediators and acne.

Glycemic Load and Acne

Acne Pathophysiology: Could Acne Be a Metabolic Disease?

A review of data over the past few years suggests an increasing prevalence of acne in people over the age of 25, particularly women (Goulden et al. 1997). Insulin and IGF-I can also inhibit hepatic SHBG production (Singh et al. 1990), increasing the concentration of androgens that are bioavailable. Acne clinically appears during puberty, which is a transitional period of normal insulin resistance (Bloch et al. 1987; Moran et al. 1999).

Even before puberty, hyperinsulinemia has been found to predict the occurrence of acne in later years (Miller et al. The absence of acne in older, obese adults may be due to the fact that during puberty, insulin resistance and acne are inextricably linked to the growth hormone/IGF-I axis (Deplewski and Rosenfield 1999; Moran et al. 2002a).

Fig. 10.1 Mechanism of a high glycemic load diet promoting acne in insulin-resistant states

Secular Trends of Advancing Pubertal Age and Acne

Fluctuations in the incidence of acne during the normal life cycle appear to coincide with changes in insulin sensitivity, with insulin resistance also observed during pregnancy, menstruation, and menopause (Homko et al. Clinical observation suggests that insulin resistance is the underlying feature of PCOS . as it generally precedes and causes hyperandrogenism (Dunaif et al. 1989). Furthermore, decreasing insulin secretion and/or increasing insulin sensitivity by pharmacological interventions (eg, acarbose and metformin, respectively) decreases severity of acne symptoms in individuals with PCOS (Ciotta et al. 2001;

However, in obese hyperinsulinemic adults, there is a negative correlation between adiposity and GH levels (Pijl et al. 2001; Luque and Kineman 2006). Obese individuals not only have low basal GH output, they exhibit blunted responses to all recognized GH stimuli, including fasting, acute exercise, GH-releasing hormone, and insulin tolerance testing (Luque and Kineman 2006; Williams et al.

Evidence for a Role of Diet?

Clinical Evidence of a Therapeutic Effect of Low Glycemic Load Diets in Acne Vulgaris

A recent randomized controlled trial found that a low glycemic load (GL) diet that mimics the diet of acne-free populations can alleviate acne symptoms and hormonal markers of acne. Compared to controls, participants on the low-GL diet showed significant improvements in insulin sensitivity and hormonal markers of acne (increases in SHBG and IGFBP-1, indicating reduced bioavailability of testosterone and IGF-I) (Smith et al. 2007b ). This suggests that weight loss mediated the reduction of insulin resistance and associated hyperinsulinemia, which may be important in the clinical regression of acne.

These clinical observations may form a basis for future nutritional recommendations in the treatment of acne. It has yet to be objectively determined whether weight loss is the most important factor in the clinical relief of acne.

Fig. 10.2 Age-dependent association of acne severity and body mass index (BMI). Bivariate analysis was performed with a two-tailed Pearson’s correlation (n = 43)

Abnormalities in the Stratum Corneum in Atopic Dermatitis

Atopic Dermatitis and Impaired Barrier

Essential Fatty Acids and Atopic Dermatitis

Atopic Dermatitis and Aberrations in Stratum Corneum Structure and Function
Importance of Omega-6 EFA in Atopic Dermatitis
Effect of Omega-6 EFAs on Atopic Dermatitis
Introduction

Finally, the lipid component of the SC barrier is reduced with age and with the seasons (Rogers et al. 1996). In the absence of the LPP, a short periodicity phase (SPP) dominates (Bouwstra et al. 1998; Bouwstra and Ponec 2006). A significant thinner was SC was reported in the presence of these extra enzyme activities (Voegeli et al. 2009).

Mutations in the serine protease inhibitor Kazal type 5 (SPINK5) gene, which encodes the lymphoepithelial Kazal type 5 serine protease inhibitor (LEKTI), have been associated with NS (Kato et al. 2003). In the AD animal model reported by Man et al. 2008), serine protease activity occurred throughout the SC.

Hair Biology and Nutritional Influences

Healthy Hair
Hair Biology
Influence of Age, Sex, and Ethnicity
Influence of Adipose Tissue
Apoptosis and Hair Health
Stress
Circulation and Perfusion of Nutrients
Hair Fiber Stress
Influence of Pharmaceutical Drugs and Herbal Extracts
Disease and Inflammation
Historical Link Between Hair and Nutrition
Hair Color
Protein and Amino Acids
Androgens, Insulin Resistance, and Lipids
Trace Elements
Lipophilic Vitamins

During the anagen phase, the hair follicle is at its longest and extends deep into the dermal layer of the skin. Photochemical damage to the hair includes breakdown and loss of hair proteins as well as breakdown of melanin in the hair. One of the most troublesome in terms of emotional stress is hair loss due to chemotherapy.

Dysregulation of the hair follicle is also noted in a plethora of inflammatory conditions, particularly alopecia areata. In addition, there are changes in the production of the hair that make it less curly, depigmented and fragile to mechanical stress.