Uncapping the Science of Cosmeceuticals: What's New in Topical Skin Regeneration?

What's going on in the world of cosmeceuticals? According to Suneel Chilukuri, MD, there are a lot of promising developments for skin recovery and rejuvenation. He gives an update on technologies like exosomes, PDRN, and more. Plus, Steve Hawkes, MMS, PA-C gives an update on isotretinoin and Matt Bruno, MPAS, PA-C shares career advice.

Like what you're hearing? Want to learn more about the Dermatology Education Foundation? Explore assets and resources on our website.

Transcript

Transcript provided as a courtesy; it has not been edited for accuracy.

Welcome to the Dermalorian Podcast from the Dermatology Education Foundation.

Four decades ago, dermatologist, Dr. Albert Kligman, coined the term cosmeceutical to describe the unique category of topical skin care products that were more functional than makeup but lacked the potency of pharmaceutical agents. Over that time, the field has evolved dramatically with a wide variety of established and many emerging technologies coming into use.

Cosmeceuticals are marketed for a range of uses from enhancing skin recovery to correcting short-term damage from environmental exposures to reversing the signs of skin aging and rejuvenating the skin. Increasingly, cosmeceuticals are considered an essential element of regenerative approaches to cosmetic dermatology. Cosmetic dermatologist, Dr. Suneel Chilukuri from Refresh Dermatology in Houston, Texas, answers the question on everyone's mind.

Suneel Chilukuri:

What's going on in the cosmeceutical world? We're seeing that we have more and more items that are very similar to what we have from a pharmaceutical company. The problem is they're not always doing all the studies. And what's our unmet need? When we have a patient that comes in, she's sun-damaged, she's had lots of life that she's lived, can we regenerate and bring her back? And so we look at this whole concept of regenerative medicine. And I don't say it's something new, I think we just have better tools for it right now. And when you look at what patients are searching for, this increase in the search terms has gone up by 10 times over the last 10 years.

So I'm going to share with you a couple of cases. This is one of my very close friends. He was 64 at the time. He comes in, he says, "They took a large chunk of my shoulder off." So I did send him for a Mohs micrographic surgery. He got this taken off, and luckily, they didn't close it.

And what treatment options do we have? Well, we could have done a linear closure or he could have had a linear closure done. He's a very active gentleman, and what his biggest complaint is on day one and day two, he couldn't swim. And every time that he moved to go to the gym, it was leaking is what he said. Same thing, we wouldn't do a skin graft in a very active person like this.

Regranex, I don't don't know if anybody still uses, I don't know if it's even still on the market. This was a miracle cure for us when we're doing diabetic ulcers and things like that back in the day. We had Bactroban, bacitracin, and Silvadene.

So what other options do we have, and what can we look at that's coming up? Exosomes, right? And what are exosomes? All they are are communication factors. And the way that I describe it, back in the day, if we had the Whitepages, most of you guys don't even know what the Whitepages are, but if you had the Whitepages, you used to put in Sally Smith. And in Sally Smith, there's two or three pages of Sally Smith, if not more. When you have Google, what ended up happening, you put Sally Smith, Houston, Texas, between the age of 40 and 45. And that's what an exosome does. It's more efficient in bringing the right inflammatory response into there.

And anytime that now there's 12 different companies in the world that are talking about exosomes, anytime that they say they have an exosome, ask what the markers are. And that three hallmark markers are going to be CD9, CD81, and CD63. They have to have that by definition to be an exosome.

What can we do with this? We have scars that we can improve, skin rejuvenation, of course, pigmentary regulation, as well as hair growth. And does it actually work well in vitro testing? Depending on which company you're talking to, in vitro testing was done by one of the largest companies out of Korea. This is ExeCoBio is the name of the company that produces this. And what they showed is increased fibroblastic activity that also translated not just in vivo but in vitro into... I'm sorry, not just in vitro but in vivo into what we see with the skin and re-epithelialization at a much faster rate.

So what do we need to look for as a practitioner? What do we need to know and what do we need to examine? What's the safety? And anytime we add anything to our practice, I ask myself four questions: is it safe, is it efficacious, is it easy to use, meaning it's off the shelf, and what's the return on investment? Does the patient see enough of a change that you're willing to charge them for it and they see a value in it? So I think there's a role. We just don't know exactly what that role is.

What do I use it for in aesthetic medicine? A lot of times I'm doing combination therapy. We can do multiple levels of lasers, different types of devices that we can combine. And at the end, I can consistently say, you're going to have one day of downtime despite doing 3, 4, 5 energy-based devices all in the same day.

Here's another example. The 27-year-old girl that was referred to me, I take care of her mother, and she was finishing her FBI training. She was going rifle shooting to... I don't know what the hell they were shooting. This is Texas, right? So you just expect this. We don't even ask questions anymore. And what ended up happening, she didn't shoot herself, but the recoil of the rifle came and smacked her in the middle of the glabella. She couldn't leave this remote area. So again, she's an FBI agent. She's this tiny little pipsqueak of a person. She's about 5'2 and 90 pounds of muscle. So not a big person.

So what can we do with something like this? If I'd seen her at the acute phase, I would've used some of the exosomes, and then we could then add, after three days or four days of the initial portion, we can use something called PN or PDRN. So polydeoxyribonucleotides or PN, polynucleotides.

So if anybody has a social media account, you see this all over the place with this new sperm facial that Kim Kardashian is talking about. So it's not a sperm facial, but it is from semen.

What is the PN or PDRN doing and what inflammatory process is being brought into place? So again, the research is out there. The question becomes how do we effectively harness this, and why would it theoretically work? Because there's a tremendous amount of DNA overlap between humans and a particular type of salmon. There's two different types of wild salmon. And this one part that's harvested by a company out of Korea, it's called pharmaceutical something. I think it's PR. Pharmaceutical Research is what the actual name of the company is. Here in the US is called Rejuran, it's their North American branch, but there's a tremendous amount. So there's a lot of genetic similarity, which I would've never known.

I want to share with you, now we're doing a split-scar study. We finished the split-scar study, and we're about to do a dual scar study.

Host:

Dr. Chilukuri shifts the conversation to preventive skin care. But first, just in time for Acne Awareness Month, dermatology physician assistant, Steve Hawkes, provides an update on the effective use of isotretinoin. Here is this month's Dermalorian Clinical Clip.

Steve Hawkes:

Isotretinoin has been a great medication, and it's kind of evolved to where they have this lidose technology that's been very good for those people who don't really eat a fatty diet. And that's what's really important for the regular isotretinoin that doesn't have that lidose technology. They don't eat that fatty diet, then that means they're not absorbing it. If they're not absorbing it, they're not going to get better.

So that's a great technology that's out there. If that's available, that's a great medication. If it's not available, then yes, I've had one patient specifically that talked about she just takes three or four scoops of peanut butter with her medication, with the isotretinoin, and that's great. Avocados are great, but that fatty meal is really crucial to the absorption of that medicine and having it be worthwhile for them.

A lot of those side effects, the dryness, the dry eyes, sometimes the nose bleeds, those are pretty common, and so we need to really know how to help those patients get through that. And there's the nasal sprays, the ocean spray, or the saline spray is great. Dr. Dan's lip balm is great. The CeraVe healing ointment, the Cetaphil healing ointment. Aquaphor is great, but making sure those patients really get on those early. And also, I do start my patients at a lower dose for at least a week and a half, sometimes longer until they get used to those symptoms, and then we put them back to their normal dosing.

Host:

Let's get back to Dr. Chilukuri's update on the world of cosmeceuticals.

Suneel Chilukuri:

So here's a girl where this was after an implant of something for snoring. And you can see that we marked it out. I used an Nd:YAG laser. You can use whatever you want just as a drug delivery system. So basically causing a non-ablative type laser there to introduce something into that area. And then this is what I'm putting in, I'm doing a split-scar study.

On the first side, all I did, this is very, very complicated, I just dripped a little bit of product on there, and then I applied it. Super complicated, right?

On the other side though what we do is we actually inject it, it's between 30 and 45 degrees, and you want to go into the mid to deep dermis here, and you apply... we're putting 0.05 cc's into these injection points.

And I was curious, what's it going to do? And there's a pretty significant improvement. You can see it even better and feel it better on the patient. So now it's nice and flat. And not only that, but the erythema has improved pretty dramatically.

So in prevention, what else can we do? We really have to understand what aging does, and we have to understand the concept of cellular senescence, and the way... and all from the environment that we're seeing. Cellular senescence is not a dead cell.

Think about it like living in Florida. You have six or seven centurions that are walking in front of you as you're trying to go to your plane. What ends up happening, even though you're young, you're active, you can't bypass them. And as a result, you adapt their pace. And eventually you're like, "Huh, this pace is pretty good for me too." And that's exactly what happens with cellular senescence, and we call it inflammaging.

And so what can we do for that? So the central driving of aging is senescence cells. That's what we're just talking about here. So not that exciting. So not only are we seeing things externally, what we deal with on a regular basis, but because there's this break in the skin just from environmental factors and whatnot, we see that there's chronic low dose inflammation that's going on.

And the question becomes, can we do something about it? And we can. And so we know that there's a certain accumulation of cells that go on as you have cellular senescence and get aging. So we know there's extrinsic aging, intrinsic aging, and what we understand is reactive oxygenation of species is a big part of this. So can we do something topically to actually improve that and decrease the amount of DNA methylation that's going on? And we can do that. And that's the crazy part.

So this study that was done by a company called OneSkin, it's three Brazilian PhDs who created this company. Now there's five of them. They're all women. They're frigging brilliant. And what they did is they just measured what are some of those markers of inflammation that are going on there, and what can we do to improve? Typically, we talk about external things that we're doing. We're using devices, we're using retinols, we're using neuromodulators.

But what if we can do a topical? And this is out on the market now. It's a company called Pavise, P-A-V-I-S-E. The inventor of this particular molecule is a girl named Sophie Bai. She's also the CEO. It's called DiamondCore Technology. And what she experimented with, and this is Mitch Goldman was one of the researchers. The other one is Matt Avram who's out of the Harvard group.

And you can see that there's not just improvement of sun protection, but it actually increases fibroblastic activity to come over to that area. So it's something that can be put on safely. It's the only sunscreen that I know of so far immediately post-procedure, whether it's microneedling, radiofrequency microneedling resurfacing or whatnot. And what's inside there, it's also important because the DiamondCore, however it's created, allows better absorption of these other ingredients as well.

And so when we're talking about for melasma, the unique portion about this is something called Pycnogenol. Pycnogenol not only stops cellular senescence, but it also stops the heat shock protein from turning on the pigmentary cells. So that's the melanocyte.

That OneSkin that I was talking about, they created a 10-sided peptide, which is, it's not made in nature, so they created one, and they showed that there's an improvement of the biological skin age of 2.5 years just by applying it topical. So there's studies that are being done, several that have already been finished here, and we can see that there's a reversal of human skin aging.

And one of the things, if you don't put creams or sunscreen on your eyes, what I want to share with you I thought that was so interesting. Typically, our upper eyelid is 20 to 30 years older than the rest of our skin. And the lower eyelid is about 20 years, 15 to 20 years. So all of a sudden, that's all I put on. I don't care about the rest of my face. Now I'm just putting this product on my eyes, and I'm hoping to stay looking younger.

So again, clinical studies are being performed. There's a lot that's going on inside this space, and it's not that you need to apply to all these things, it's just to know what's out there and realize that there's actual clinical trials that are going on.

So a couple companies that you want to pay attention to, OneSkin because they're just geeks, they're like us. They want to really see what's out there and how the study's being created. The other one is Pavise, and they're going to have a couple other things coming down the pipeline, and I hope she doesn't get her VC or PE funding because they're just going to commercialize it rather than let her do what she does at her MIT lab.

So what else can we do with this? Cellular senescence is found in greater concentration in patches of melasma. I want you to start thinking about cellular senescence and what we as dermatologists can do to enhance our patients', not just appearance, but their overall life and even change the epigenetics of the skin. So we're in the middle of a research project now, we're three years in, and I can guarantee that we are changing epigenetics of the skin, we're reversing the pyrimidine dimers to improve the overall health of the skin, but decrease skin cancer and actinic keratosis.

Host:

The future of cosmeceutical development certainly seems promising. What about the future of your career? In this month's Dermalorian Derm Decoder dermatology physician assistant, Matt Bruno, explains why he thinks continuing education is a crucial element of long-term career advancement.

Matt Bruno:

I think that when it comes to the inflammatory disease spectrum and particularly these autoimmune conditions, the one really wonderful thing is the innovation that's come into the market. And I started in 2006, I got to see Humira and Enbrel come into the space, which was very unique. And you really watch the evolution of the science to the point where we just got a lot more narrow-focused. We're able to actually treat pathways instead of broad spectrum. And I think, of course, when you do that, as you know, you can increase the level of safety, and with that confidence.

So we have this unique ability now to really reach out and make very, very impactful differences on these diseases. The education is there, the understanding of the comorbidities, as been discussed before, for the necessity of actually reaching out and increasing that level of care to systemic therapies is well-known.

And so I think that industry, the pharmaceutical industry does a fantastic job of giving us the resources and the education both through the medical science teams and as well as the commercial teams so that everybody has access to these drugs, not just providers as far as the knowledge, but also patients when you start talking about the patient assistance programs and whatnot on formulary.

So it's really been a wonderful evolution. I think that you start to see a rising tide raises all ships, you start to really see the elevation of standard of care. We've improved the mindset and the approach and maybe the appetite, if you will. We've gone from PASI 50, now we really don't look at anything that doesn't hit a PASI 90 or a PASI 100 even, we're raising the bar. So we're in a great, great place. And atopic dermatitis is falling right into that now. In the golden age, we have all these new therapies coming out with that. So I think the people that are just coming into it probably don't realize how lucky they are.

Host:

Speaking of rising tides, DEF is keeping an eye on the shore as it gears up to catch the big wave of dermatology education and innovation in July at the DEF Essential Resource Meeting or DERM2025. The four-day educational event kicks off on Wednesday, July 23rd and ends Saturday, July 26th. You can check out the faculty and the agenda online at dermnppa.org, and keep an eye on your inbox while the meeting is underway so that you can get updates on all the education and other fun events. Thanks for joining us for the Dermalorian Podcast from the Dermatology Education Foundation. The Dermalorian Podcast is produced for the DEF by Physician Resources.