Latest / The Science of Skin / The Role of Topicals for managing Advanced Glycation End Products (AGEs) in Skin

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The Role of Topicals for managing Advanced Glycation End Products (AGEs) in Skin · The Science of Skin

• 0:00
  SPEAKER_00: This episode is brought to you by Skin Suticles, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
• 0:08
  SPEAKER_00: To learn more, visit www.skinseuticals.com.
• 0:22
  SPEAKER_01: Hi, I'm Dr.
• 0:23
  SPEAKER_01: Patty Ferris.
• 0:24
  SPEAKER_01: I'm a board certified dermatologist, and I'm your host for this episode of Skin Care Confidential.
• 0:29
  SPEAKER_01: We're very excited to be involved with a, I'm going to say it's a skincare confidential takeover by Skin Suiticals.
• 0:37
  SPEAKER_01: We're going to be highlighting some of the material and the abstracts that they're presenting at this year's American Academy of Dermatology.
• 0:43
  SPEAKER_01: And that brings me to our guest today, Dr.
• 0:46
  SPEAKER_01: Zoe Dre Los, who's going to be presenting an abstract with some very interesting information about aging.
• 0:53
  SPEAKER_01: So, Zoe, welcome back to Skincare Confidential.
• 0:56
  SPEAKER_01: Thank you, Patty.
• 0:57
  SPEAKER_01: So I'm going to start by reading Zoe's bio, and it's so ridiculous because everybody knows Zoe Dre Los, but I'm going to give you the highlights.
• 1:04
  SPEAKER_01: She's a research and clinical board certified dermatologist, of course, a fellow of the American Academy of Dermatology.
• 1:10
  SPEAKER_01: She juggles a private practice in High Point, North Carolina.
• 1:13
  SPEAKER_01: She's a consulting professor at Duke.
• 1:16
  SPEAKER_01: And in 1988, she founded Dermatology Consulting Services to initiate and perform research.
• 1:22
  SPEAKER_01: And she works in every field in dermatology: aging skin, acne, rosacea, psoriasis, devices.
• 1:29
  SPEAKER_01: What don't you work on, Zoe?
• 1:31
  SPEAKER_01: She has one of the most prolific research centers, no doubt, in the country, and does such a great job.
• 1:36
  SPEAKER_01: So we're so grateful for your contribution to the literature in that regard.
• 1:40
  SPEAKER_01: Some things people may not know, which I find super interesting about Zoe's background.
• 1:45
  SPEAKER_01: She has a degree in mechanical engineering.
• 1:47
  SPEAKER_01: And if you ever sit on a consulting board with her, that comes out loud and clear when they start talking about packaging.
• 1:52
  SPEAKER_01: Everybody else falls asleep and Zoe's like, well, we could do it this way.
• 1:55
  SPEAKER_01: We could do it that way.
• 1:56
  SPEAKER_01: I've seen you create packaging, which is phenomenal.
• 2:00
  SPEAKER_01: She's also a Rhodes Scholar.
• 2:01
  SPEAKER_01: She's a member of AOA.
• 2:03
  SPEAKER_01: She's authored numerous textbooks, 14 textbooks, including Cosmetics and Dermatology and Hair Cosmetics.
• 2:10
  SPEAKER_01: She was the editor of cosmetic dermatology, but I think you passed the baton on that one a while ago.
• 2:15
  SPEAKER_01: She's authored numerous chapters and textbooks posters, conducted over, I would say, 900 clinical studies at this point, and written over 650 published papers.
• 2:26
  SPEAKER_01: So any paper you see on topical skincare, likely somewhere in that author list, has Dr.
• 2:31
  SPEAKER_01: Zoe Dreilos.
• 2:32
  SPEAKER_01: Zoe was also on the board of directors of the American Academy of Dermatology and served as vice president of our academy.
• 2:38
  SPEAKER_01: She's also received numerous awards from the Society of Cosmetic Chemists and all kinds of awards for her contribution in that regard.
• 2:46
  SPEAKER_01: So, Zoe, welcome.
• 2:47
  SPEAKER_01: Thank you, Patty.
• 2:48
  SPEAKER_01: Super excited to have you here.
• 2:50
  SPEAKER_01: So today we're going to be talking about something that I think is really fascinating.
• 2:54
  SPEAKER_01: It's really gaining, I think, a lot of traction in the field of skin aging, and that is advanced glycation end products.
• 3:00
  SPEAKER_01: And you've published so extensively on this.
• 3:03
  SPEAKER_01: So let's sort of start basic and tell our listeners about ages, AGEs, how do we get them?
• 3:09
  SPEAKER_01: How do they form?
• 3:10
  SPEAKER_01: What do they do?
• 3:11
  SPEAKER_01: And why are we so worried about those?
• 3:14
  SPEAKER_02: Sure.
• 3:15
  SPEAKER_02: Well, advanced glycation end products or AGEs are where proteins are crosslinked by sugars, those sugars being glucose.
• 3:23
  SPEAKER_02: So that can occur in the food we eat.
• 3:25
  SPEAKER_02: For example, when you take a piece of bread and you toast it in the toaster, you get that brown material on the top.
• 3:32
  SPEAKER_02: That browning is actually the crosslinking of the sugars that are in the bread with the proteins that are in the bread as well.
• 3:40
  SPEAKER_02: You see that in meat.
• 3:42
  SPEAKER_02: When you grill meat, for example, grill marks, those are AGEs, advanced glycation end products, where maybe that thick sugary barbecue sauce you put on that piece of meat now is binding to the proteins in the meat itself.
• 3:55
  SPEAKER_02: We can get advanced glycation end products by eating all of those products and pretty much anything that comes out of the oven, anything that's browned on top, anything that's got that nice crunchy top, that's an AGE.
• 4:08
  SPEAKER_02: So now let's take that and put that inside the body.
• 4:11
  SPEAKER_02: Our skin and our organs don't necessarily become crunchy when advanced glycation end products occur, but they do become more rigid and less flexible.
• 4:20
  SPEAKER_02: So for example, if you have very high circulating glucose levels, like you might see in type 1 and type 2 diabetes, that extra sugar binds to proteins in the body, making those proteins less functional.
• 4:33
  SPEAKER_02: So if you think about diabetes, which is an advanced example of aging, you think about diabetic nephropathy.
• 4:40
  SPEAKER_02: Well, those are AGEs forming in the kidney, so that the kidney doesn't function as well and doesn't filter as well.
• 4:46
  SPEAKER_02: You think about AGEs forming in the heart, coronary artery disease that's premature in diabetics.
• 4:53
  SPEAKER_02: You think about poor healing and diabetics of the skin.
• 4:56
  SPEAKER_02: Well, that again is because the sugars from this blood are crosslinking with the proteins in the skin, making it less able to heal.
• 5:04
  SPEAKER_02: So AGEs are formed in our bodies, but we also consume them as well.
• 5:09
  SPEAKER_01: So talking just a little bit more specifically about the advanced glycation and products in the dermis and what do they do to the sort of viscoelastic properties of the dermis?
• 5:21
  SPEAKER_02: Well, when you get the sugar cross-linking the proteins that are supposed to move and flex as our bodies move and we experience life, they don't do that anymore.
• 5:30
  SPEAKER_02: And so what you basically see on a macro level is diabetic ulcers.
• 5:36
  SPEAKER_02: But what you see on a more micro level, that might happen in someone that has a normal circulating glucose level, is you're still going to see that inflexibility.
• 5:44
  SPEAKER_02: And that leads to decreased elastic properties of the skin, which leads to fine lines and wrinkles.
• 5:49
  SPEAKER_02: And as we age, we accumulate more AGEs in our body.
• 5:54
  SPEAKER_02: And a lot of those glucose molecules are what we consume.
• 5:57
  SPEAKER_02: So individuals that eat a high sugar diet are said to have sugar sag, which is sort of the new kind of TikTok word for aging.
• 6:06
  SPEAKER_02: And sugar sag is basically a consumery term that means the production of advanced glycation end products within the skin itself.
• 6:14
  SPEAKER_01: So interesting, isn't it?
• 6:16
  SPEAKER_01: So when do ages start?
• 6:18
  SPEAKER_01: I remember studies showing that they started very early, like in the 20s, you began accumulating them in the skin.
• 6:25
  SPEAKER_02: Oh, absolutely.
• 6:26
  SPEAKER_02: I mean, they probably start at birth.
• 6:28
  SPEAKER_02: There's just not enough of them to see, but they do accumulate throughout life.
• 6:33
  SPEAKER_02: And the higher your serum glucose is, the more rapidly they accumulate because there are more sugars to glycate the proteins.
• 6:40
  SPEAKER_02: And so that's the reason why diet is very important.
• 6:43
  SPEAKER_02: Um, I don't know that boiled food tastes as good as crunchy baked food.
• 6:47
  SPEAKER_01: For sure not.
• 6:49
  SPEAKER_01: For sure not as good as grilled food.
• 6:52
  SPEAKER_02: No, but boiled food, you know, has no AGEs and baked and roasted food does.
• 6:57
  SPEAKER_02: Right.
• 6:58
  SPEAKER_02: Um and then, of course, you know, learning to eat sugars, you know, staying away from like high fructose corn syrup that produces tremendous high serum glucose spikes and those types of things can be very, very helpful.
• 7:11
  SPEAKER_02: And then, of course, the whole arena of cosmoceuticals where we now have skincare products that attempt to inhibit the production or possibly even reverse existing AGEs in the skin.
• 7:23
  SPEAKER_01: And AGEs are also responsible for some of the clinical stigmata like sallowness and as you mentioned, the SAG.
• 7:31
  SPEAKER_01: So it it behooves us to either block the formation of them or hopefully influence that process in some way, whether it's with topicals or improving your diet, probably easier to use a cream, right?
• 7:44
  SPEAKER_02: So let's let's talk about chicken.
• 7:48
  SPEAKER_02: It's much better than boiled chicken.
• 7:49
  SPEAKER_01: Boiled and poaching, not on my list, that's for sure.
• 7:53
  SPEAKER_01: So let's talk about you did the first study on the original version of AGE interrupter, which is a skin physical product.
• 7:59
  SPEAKER_01: And I remember you studied it in diabetic.
• 8:02
  SPEAKER_01: So let's sort of set the stage by talking about the first study on what we're going to call it the OG version of AGE interruptor.
• 8:09
  SPEAKER_02: Okay.
• 8:09
  SPEAKER_02: Well, we enrolled 20 women, and these women had diabetes, and we basically gave them the cream to use twice a day, and they used it on the face and on the hands.
• 8:20
  SPEAKER_02: So we were trying to look at the effects of an AGE inhibitor cream on both those areas.
• 8:24
  SPEAKER_02: And we saw improvement, you know, in clarity, fine lines, wrinkles, and overall skin performance after application of the cream itself.
• 8:32
  SPEAKER_02: So that sort of gave us an indication that a cream might improve skin appearance in individuals that had diabetes.
• 8:40
  SPEAKER_01: So interesting.
• 8:42
  SPEAKER_01: I remember when that study came out.
• 8:43
  SPEAKER_01: It's a long time ago now.
• 8:45
  SPEAKER_01: So, how does the new AGE interruptor advance differ from that original formulation?
• 8:53
  SPEAKER_02: Well, there have been new molecules that have been introduced in the cosmosceutical space to address AGE formation.
• 8:59
  SPEAKER_02: So the first one is wild fruit flavonoids, and those have been added.
• 9:03
  SPEAKER_02: Those are potent antioxidants.
• 9:05
  SPEAKER_02: They also inhibit the formation of AGEs.
• 9:09
  SPEAKER_02: And then that has been coupled with glycerotinic acid.
• 9:12
  SPEAKER_02: Glycerotinic acid is a licorice extract.
• 9:14
  SPEAKER_02: It is a very potent anti-inflammatory.
• 9:17
  SPEAKER_02: So that anti-inflammatory effect with the wild fruit flavonoids actually affect your AGEs.
• 9:24
  SPEAKER_02: And then in addition to that, proxalane, which was included in the original formulation, has been increased in its concentration.
• 9:31
  SPEAKER_02: And that is supposed to address the breakdown in collagen and improve collagen.
• 9:36
  SPEAKER_02: So the idea is that you improve the collagen while you're inhibiting the formation of AGEs.
• 9:42
  SPEAKER_01: Got it.
• 9:43
  SPEAKER_01: So in the more recent study which you're going to present, you looked at the advanced formulation, the brand new formulation in combination with radio frequency microneedling.
• 9:53
  SPEAKER_01: And, you know, we're talking so much about this integrated, as we call it, skincare, where we're using skincare products to enhance the procedures that we're doing.
• 10:03
  SPEAKER_01: And I'm going to have you outline the study, but one of the things that I love about it, when I lecture on integrated skincare, I always say, you know, there's pre-procedure, then there's intra procedure, and then you have the post-procedure.
• 10:16
  SPEAKER_01: And so you influenced all of those phases of healing from radio or microneedling radio frequency.
• 10:24
  SPEAKER_01: So let's talk about that study a little bit.
• 10:26
  SPEAKER_02: Well, it's a very interesting study.
• 10:28
  SPEAKER_02: We enrolled, excuse me, Fitzpatrick's skin type one and two women.
• 10:33
  SPEAKER_02: One half of the face they treated with a bland moisturizer, the other half of the face they treated with the cream with the AGE ingredients in it.
• 10:41
  SPEAKER_02: The idea was to allow each person to act as their own control.
• 10:45
  SPEAKER_02: And I did not know which side of the face used the AGE product versus the bland product, and the subjects did not either.
• 10:51
  SPEAKER_02: So it was a vehicle control, double-blinded study.
• 10:54
  SPEAKER_02: So what we did is we had them use the bland moisturizer on the half of the face for two weeks prior to procedure, and then use the AGE cream on the opposite side of the face.
• 11:05
  SPEAKER_02: Then they underwent full face microneedling with insulated needles.
• 11:10
  SPEAKER_02: Then what we did is we had them use just a bland ointment post-healing for a week.
• 11:15
  SPEAKER_02: And then they went back to using either the bland moisturizer on one half of the face or the AGE product on the opposite side of the face.
• 11:24
  SPEAKER_02: Then we saw them back, they came back at one week, four weeks, eight weeks, and we compared the two sides of the face using each individual as their own control.
• 11:33
  SPEAKER_02: And indeed, in the side of the face that was treated with the AGE ingredients over the bland moisturizer, we saw superior improvement in fine lines, wrinkles, laxity, overall skin appearance.
• 11:44
  SPEAKER_02: And it was statistically significant.
• 11:47
  SPEAKER_02: And I like the design of the study because we allowed people to act as their own control, to balance differences between right and left face.
• 11:54
  SPEAKER_02: We actually randomized them.
• 11:56
  SPEAKER_02: So half the group used the product on the right, half the group used the product on the left to try and get rid of any differences that might have been there at the beginning from more solar exposure on the driver's side, et cetera.
• 12:07
  SPEAKER_02: And then we tried to look at the combination of an AGE with a procedure to see if we could stimulate better healing, reduction in retinas, improved appearance.
• 12:17
  SPEAKER_02: And so I think what the study really showed is that a cosmosceutical for AGEs is a better pre and post-procedure product.
• 12:27
  SPEAKER_02: But I think what we also found is that it works better than the vehicle.
• 12:32
  SPEAKER_02: Because many times you ask yourself, is the moisturizer doing the heavy lifting or are the specialty ingredients doing the heavy lifting?
• 12:40
  SPEAKER_02: So the fact that it was a bland moisturizer compared to the AGE product kind of answers that question.
• 12:46
  SPEAKER_02: So we tried just to kind of narrow down and hone in on those AGE ingredients specifically.
• 12:52
  SPEAKER_01: And for that one week, they used an ointment?
• 12:55
  SPEAKER_02: Yes, uh-huh.
• 12:56
  SPEAKER_02: They used a posed healing ointment, a petrolatum based product.
• 12:59
  SPEAKER_01: Right.
• 13:00
  SPEAKER_02: Because we wanted to be sure that there wasn't anything that was going to impede healing.
• 13:04
  SPEAKER_01: Right.
• 13:05
  SPEAKER_02: So and we let people use that on both sides of the face to be sure that when we restarted the AGE product versus the vehicle, that we were starting from a level playing field.
• 13:16
  SPEAKER_00: This episode is brought to you by Skin Suiticals, the number one medical aesthetic skincare brand worldwide and the leader in antioxidant science.
• 13:25
  SPEAKER_00: To learn more, visit www.skinseuticals.com.
• 13:32
  SPEAKER_01: Talk a little bit about the exposome and things like I know that ultraviolet light even can exacerbate or contribute advanced glycation and products.
• 13:42
  SPEAKER_02: Right.
• 13:42
  SPEAKER_02: Well, the exposome is really the new concept that combines extrinsic aging and intrinsic gauging.
• 13:48
  SPEAKER_02: So the exposome is the cumulative oxidative insults that the body sustains over a lifetime.
• 13:57
  SPEAKER_02: And we've always been talking about UV radiation and sunscreens, and we know that that's very important.
• 14:04
  SPEAKER_02: But now the exposome really deals with everything, for example, pollution and reactive oxygen species created by nanoparticle pollution that hits your skin, cigarette smoke and smoky environments where you have these combustion particles that are also nanoparticles that land on your skin.
• 14:22
  SPEAKER_02: We're also talking about internal, like metabolomics, proteomics, how the metabolism of the body does contribute to intrinsic aging, but how that intrinsic aging might be affected by eating a low glycemic diet.
• 14:37
  SPEAKER_01: I was going to say, so we so this would be part of the intrinsic, fit into the intrinsic factors that are contributing to skin aging.
• 14:46
  SPEAKER_02: Right.
• 14:47
  SPEAKER_02: But you know, AGs are interesting, Patty, because not only are they intrinsic too, but they're also extrinsic as well in terms of what occurs in the skin.
• 14:58
  SPEAKER_02: So AGEs kind of fit into both categories.
• 15:02
  SPEAKER_02: Yes.
• 15:03
  SPEAKER_01: Yeah.
• 15:03
  SPEAKER_01: Well, I know when they wrote that original paper, nutrition was in was part of the exposome.
• 15:09
  SPEAKER_01: So that's so interesting.
• 15:11
  SPEAKER_01: Um, also, advanced glycation end products can upregulate inflammation, I know, I think, through their interaction with rage or the receptor for AGE.
• 15:20
  SPEAKER_01: So that may also be an important pathway when we talk about skin aging because we're talking so much about inflammation.
• 15:26
  SPEAKER_02: Right.
• 15:27
  SPEAKER_01: And you mentioned the glycerotinic acid, which we know is a great cosmoceutical ingredient to downregulate inflammation.
• 15:34
  SPEAKER_02: Definitely.
• 15:35
  SPEAKER_02: Inflammation is sort of the final common pathway for intrinsic and extrinsic aging.
• 15:40
  SPEAKER_02: And so that's why there's so many ingredients that come from botanicals, like the wild fruit flavonoids I mentioned, because antioxidants and anti-inflammatories are kind of one and the same.
• 15:51
  SPEAKER_02: They are.
• 15:52
  SPEAKER_02: And so anything that really has an antioxidant effect also has an anti-inflammatory effect and possibly might be beneficial in aging.
• 16:00
  SPEAKER_01: Yes, and all of the flavonoids are such the polyphenols in general, such good anti-inflammatory and anti uh oxidant molecules.
• 16:08
  SPEAKER_01: It's so interesting.
• 16:09
  SPEAKER_01: So, as we kind of would counsel patients now looking at prevention, you know, how do we how do we approach them?
• 16:18
  SPEAKER_01: Because really, if you did something when you were younger, you could certainly influence skin aging in terms of AGE accumulation very significantly.
• 16:28
  SPEAKER_02: It's true.
• 16:29
  SPEAKER_02: Really, prevention is the name of the game.
• 16:31
  SPEAKER_02: And so starting an AGE product earlier in life may be beneficial.
• 16:35
  SPEAKER_02: You know, we don't have any long-term data to look at that, but we do know in twin studies that individuals that are exposed to more oxidative insults, i.e., a lot of outdoor UV exposures, cigarette smoking, alcohol consumption, high glycemic diet, we do know that they do age faster.
• 16:54
  SPEAKER_02: So I think starting young, teaching your children to eat healthily, uh, and then starting in on good skincare, I think both of those things taken together, probably the most that we can do at this point to prevent AGE formation.
• 17:10
  SPEAKER_01: Yeah, and it's it's such an important point.
• 17:12
  SPEAKER_01: I find the younger consumers are so interested in prevention.
• 17:16
  SPEAKER_01: You know, they talk so much about it on social media.
• 17:19
  SPEAKER_01: It's such a big focus for them, which is great.
• 17:23
  SPEAKER_01: Um, but I would love to see them getting out of the sun.
• 17:26
  SPEAKER_01: They seem to be doing everything, putting everything on their face, but they're still laying in the sun.
• 17:31
  SPEAKER_01: They're still compromising themselves with UV radiation.
• 17:35
  SPEAKER_01: And of course, we're talking now more about longer wavelengths of light, too.
• 17:38
  SPEAKER_01: You know, the visible light range and infrared.
• 17:41
  SPEAKER_01: So, I mean, do those play into AGE formation?
• 17:45
  SPEAKER_01: I don't know that they do.
• 17:48
  SPEAKER_02: Well, I think visible light is more of an issue for pigmentation.
• 17:52
  SPEAKER_02: Right.
• 17:52
  SPEAKER_02: Um, and then heat induced by infrared radiation um can induce the inflammatory response.
• 17:59
  SPEAKER_02: But I think ultraviolet radiation, UVA, UVB are most important because they're so highly energetic.
• 18:05
  SPEAKER_02: And because they're so highly energetic, they're the most damaging.
• 18:08
  SPEAKER_02: So they produce more reactive oxygen species than other less energetic wavelengths of solar radiation.
• 18:15
  SPEAKER_01: It would be very interesting to me to know if pollutants contribute to AGE formation because they upregulate oxidative stress in the skin, without a doubt.
• 18:24
  SPEAKER_02: Yeah, they definitely do, and they do induce inflammation.
• 18:28
  SPEAKER_02: So, you know, all of this is sort of linked together.
• 18:31
  SPEAKER_02: Um, each of these factors that we've discussed is cumulative over a lifetime.
• 18:36
  SPEAKER_02: So AGE is just one part of the overall insults that the body sustains, both internally and externally, throughout life.
• 18:45
  SPEAKER_01: Yeah, it's it's so interesting.
• 18:47
  SPEAKER_01: So, what other types you mentioned something that I was happy to hear you say, I want to go back to it, and that is that when you designed the study, and I like the design of the study as well, because I think it really got you exactly what the data that you were looking for, but I like that you said that the split-face study was such a good design because it does allow the patient to serve as their own control.
• 19:07
  SPEAKER_01: Many times when we're reading studies or when I'm looking at comments on studies, people make comments about split-face studies, you know, implying that a split-face study isn't as good as just, you know, sort of a regular vehicle controlled study.
• 19:20
  SPEAKER_01: And we've, you know, you and I have both seen and published many split-face studies, a common way to do it in the cosmetic industry.
• 19:28
  SPEAKER_02: Right.
• 19:29
  SPEAKER_02: Split-face studies are a little bit controversial because if they don't work, you don't know if it's because the patient got them mixed up or they didn't apply it, or compliance was poor, or they liked the one that had the active ingredient in it best, and they used that over their whole face, and they forgot about the vehicle.
• 19:46
  SPEAKER_02: So we basically have a database of subjects that we use, and so we selected these subjects because they understood the concept of research, how important it was to put right on right, left on left, and then they also were reliable.
• 20:01
  SPEAKER_02: And so I think part of running a good split face study is carefully selecting your subjects and honing in your population so that you achieve the best compliance possible.
• 20:11
  SPEAKER_02: And sometimes that's very, very difficult.
• 20:13
  SPEAKER_02: But in this case, since there's so much difference in appearance between the right and left face, especially people who drive a lot and get a lot more sun damage on their left side, you really you really can't do a full-face study because you you don't know uh what the differences are right to left sides.
• 20:32
  SPEAKER_02: So I think the study design was good, but I do agree that having a good study population is key to getting good results.
• 20:39
  SPEAKER_01: Yeah, that's interesting.
• 20:40
  SPEAKER_01: I didn't realize you had you could sort of cherry pick your subjects that that are going to be compliant because it is that is crucial.
• 20:47
  SPEAKER_01: And you're right, if they're getting benefits from the active, they're gonna say, oh, well, I'm just gonna put this all over.
• 20:52
  SPEAKER_01: Because why wouldn't you?
• 20:53
  SPEAKER_01: Who doesn't want to look better?
• 20:54
  SPEAKER_01: So interesting.
• 20:56
  SPEAKER_01: What other things are you did you find in this study that you thought would be where did you find anything that was surprising?
• 21:03
  SPEAKER_01: I mean, because you did get statistically significant improvement in so many of the parameters.
• 21:09
  SPEAKER_02: Well, I think it was surprising that we saw results so early on in the study.
• 21:14
  SPEAKER_02: Um, I also think it was interesting that minimizing the AGEs improved healing, post-radiofrequency microneedling, that was that was very interesting to me as well.
• 21:24
  SPEAKER_01: And I thought about that real hard.
• 21:26
  SPEAKER_01: I mean, we know that AGEs can impair wound healing, but also the flip side we really didn't know, which is that they could enhance wound healing if we block them or remove them.
• 21:38
  SPEAKER_01: So that's I think really interesting.
• 21:40
  SPEAKER_02: Or even just from the plain anti inflammatory effect of the wild fruit flavonoids and the glycerotinic acid and the glycerotenic acid.
• 21:47
  SPEAKER_02: It may be that there is a role for botanical anti inflammatories post procedure.
• 21:53
  SPEAKER_01: Yeah.
• 21:54
  SPEAKER_02: Um, you know, a certain amount of inflammation is necessary for the body to clean up the area.
• 21:58
  SPEAKER_02: For example, healing is so much prolonged.
• 22:00
  SPEAKER_02: After laser resurfacing, because the wound is so clean, all the all the char has been burned, so people don't tend to heal as quickly.
• 22:08
  SPEAKER_02: But with radiofrequency microneedling, you don't get a clean char.
• 22:12
  SPEAKER_02: Um, there is more debris, the skin does want to induce inflammation to heal, but you don't want so much that there's discomfort and inflammation and erythema post-procedure.
• 22:22
  SPEAKER_02: Post-inflammatory hyperpigmentation.
• 22:24
  SPEAKER_02: Yeah, creams like this might indeed reduce redness, uh, reduce post-procedure healing time, etc.
• 22:32
  SPEAKER_02: And that's you know a whole nother area to examine.
• 22:35
  SPEAKER_01: Yeah, that makes total sense too.
• 22:37
  SPEAKER_01: Um, I'm really curious why you selected radio frequency microneedling.
• 22:45
  SPEAKER_02: Uh we selected radio frequency microneedling for a couple of reasons.
• 22:50
  SPEAKER_02: Um one is it's become very, very popular.
• 22:53
  SPEAKER_02: Absolutely.
• 22:54
  SPEAKER_02: Two, it didn't have any downtime because we didn't want to wait too long between the time where we stopped the two creams pre-treatment and restarted them.
• 23:03
  SPEAKER_02: So we didn't want it to be like three, four weeks delay before we could restart.
• 23:07
  SPEAKER_01: Like a blade of resurfacing would have been.
• 23:09
  SPEAKER_01: Okay.
• 23:10
  SPEAKER_02: And uh then the other reason we chose radio frequency microneedling is that um this was a device that I was very familiar with, and it actually had ultrasound guided needle placement.
• 23:22
  SPEAKER_02: And so I like that a lot because we tried to enroll a very diverse population of women, and so with this particular machine, we were able to place the needle exactly where we wanted it by doing an ultrasound first, looking at skin thickness, and then programming the machine.
• 23:38
  SPEAKER_02: And so, what that allowed us to do is deliver the same treatment to each subject so we had a lot more consistency.
• 23:45
  SPEAKER_02: Because as you might imagine, if you do if you're more aggressive and do more passes on one subject, fewer on the other, then when you're comparing your post-treatment AGE cream, you might not have parity there because there's a different degree of a different injury.
• 24:00
  SPEAKER_02: Exactly.
• 24:00
  SPEAKER_02: So that's so interesting.
• 24:10
  SPEAKER_01: Oh, that's so interesting.
• 24:12
  SPEAKER_01: So I remember the study that Joe Weibel did with CE ferulic, where she looked at post-uh CO2 non-ablative resurfacing, and she found significant improvement in healing as well.
• 24:25
  SPEAKER_01: Using she was using CE ferulic, but that antioxidant and ferulic, of course, is a botanical as well.
• 24:32
  SPEAKER_01: But it was a very interesting study.
• 24:34
  SPEAKER_01: But yeah, uh, so you you eliminated some of the variables by using that particular device.
• 24:39
  SPEAKER_02: Yes.
• 24:40
  SPEAKER_01: So interesting.
• 24:41
  SPEAKER_01: Well, look, uh that's all of my questions, and I want to thank you for your time, and I want to thank Skinceuticals for allowing us to present this super interesting study.
• 24:50
  SPEAKER_01: Sometimes I think people don't get to read the abstracts.
• 24:53
  SPEAKER_01: There's so much going on at the academy.
• 24:55
  SPEAKER_01: So we like to bring them to life with Skincare Confidential, and Zoe Dre Los brings it all of it to life.
• 25:01
  SPEAKER_01: Thank you so much, Zoe.
• 25:02
  SPEAKER_01: I appreciate your expertise, and thanks for joining us.
• 25:05
  SPEAKER_00: Thanks for having me.
• 25:07
  SPEAKER_00: This episode is brought to you by Skin Piticals, the number one medical aesthetic skincare brand worldwide, and the leader in antioxidant science.
• 25:15
  SPEAKER_00: To learn more, visit www.skinseuticals.com.