When I first read the chapter on “Nutrition in Dermatology” during my course of residency, I came across this quote before the start of the section on Vitamins which grabbed my attention “If less is good, is more better?”

As we all know, vitamins are micronutrients (they are required in small amounts for the normal bodily functioning). With this knowledge, misconceptions of vitamin supplementations sprang up for various health benefits most of which are vague and commercialised for improvement of our general “well being”. The only indication medically for vitamin supplementation is for proven deficiencies of a certain vitamin.

In dermatology, only Vitamin A (retinoid) and Vitamin D are approved by the Food and Drug Administration (FDA) for specific diseases; Vitamin A for acne, psoriasis, cutaneous T cell lymphomas and Vitamin D for psoriasis. I will get into the details of these in later posts.

Let’s go back to the subject at hand: Vitamin C is a water soluble vitamin derived from our diet. Bell peppers, broccoli, spinach, tomatoes, citrus fruits such as oranges, lemons are its richest source. Vitamin C deficiency can cause a condition called “Scurvy” which presents with bleeding gums, fragile skin and hair abnormalities. This use to be a common disease for sailors around the fifteen century, since there were no refrigerators to keep fruits and vegetables fresh during long journey at sea at that time. The famous Portuguese explorer Vasco da Gama, the first European who opened the sea route to India reportedly lost hundreds of his sailors to scurvy.

The recommended daily allowance (RDA) of vitamin C is around 60mg per day and if you’re wondering how much that actually means think of the weight of a single grain of wheat. This can be obtained from both vegetable and fruit we consume daily. So unless you’re not eating your vegetables or fruits you’re unlikely to be deficient in vitamin C.

What research says about the role of Vitamin C in our skin?

From the observation that Vitamin C deficiency can cause fragile skin which would bruise easily with minor trauma and poor wound healing, it was obvious it has a definite role in the normal functioning of the skin.

Vitamin C plays an important part in formation of collagen which is the main structural component of the dermis responsible for the tensile strength of our skin (the ability of the skin to resists breakage under tension). Studies have shown that Vitamin C actively accumulates in the superficial layer of the skin (epidermis) however the level of Vitamin C in the skin does not increase beyond the maximum level reached in the blood; which means supplementing oral vitamin C is unlikely to have any additional effect on the skin.

Vitamin C is an anti oxidant. It helps removes the reactive oxidative species (ROS) from the epidermis (superficial most layer of the skin). These ROS are produced by various biological reactions that occurs in the skin from environmental exposure to Ultra Violet (UV) radiation, pollutants or smoking. ROS are thought to be responsible for accelerating the ageing process evident on the skin as dry, wrinkled skin with loss of elasticity. It has been shown in some studies that the concentration of Vitamin C is lower in ageing skin. The anti oxidant property of Vitamin C has been extensively researched, which led to the emergence of the use of this vitamin as an anti ageing ingredients in your skin care products.

As an antioxidant, it has been shown that Vitamin C can protect against both UVA and UVB induced sun damage. Therefore it has been incorporated in certain sunscreens either alone or with Vitamin E.

Another benefit of Vitamin C is its ability to decrease melanin (brown/black pigment) production by inhibiting the enzyme called tyrosinase required for melanin synthesis. Therefore it has been marketed in skin care products as an “anti blemish” , “glow enhancer”, “glow boosting” must have product for that clear, pigmentation free skin.

With such juicy beneficial effects of vitamin C on the skin, boomed the common practice of applying self made home remedies consisting of various concoctions of lemon or tomato juice in the name of science. This however is the biggest mistakes people make. And yes I was one of those people who would try all sorts of home remedies for my skin. It took me almost 9 years and two degrees to open my eyes to such nonsense. But I did learn from my mistakes. I’m hoping you guys would learn earlier from such posts.

Not only are these home made remedies ineffective, they also have potential side effects. Just because they are obtained naturally and are “chemical free” does not mean it is without any risks. These home made or do it yourself (diy) concoction contains various other components apart from vitamin C. And for some individuals, these may lead to allergic or irritant dermatitis. I’ve seen a patient during my residency walk in to the clinic with red inflamed cheeks after topical application of tomato paste to her face as a “diy face mask”.

Do commercially available Vitamin C products work?

For vitamin C to be able to perform all the above function in the skin, Vitamin C in skin care products has to be carefully and accurately formulated to deliver the active and stable form of Vitamin C at a pH of <3.5 which enables the molecule to be absorbed through the layers of the epidermis (superficial most layer of the skin). The efficacy of a vitamin C product also depends on the concentration, with higher concentration being more effective, the minimum concentration being 8% with a maximum of 20%. Concentration >20% are not more effective and are likely to cause more irritation instead. The entire process can be tricky. Vitamin C is highly unstable and gets easily oxidised on exposure to air which is indicated by the yellow brown discolouration of the product when its completely oxidised. The product will be ineffective at this point. Also as Vitamin C works synergistically with Vitamin E to perform the same function as an antioxidant, most research has been focussed on this combination.

Therefore with such strict parameters to put in mind, the development of Vitamin C for topical use is not an easy or cheap process and not all companies are able to deliver this in their skin care products.

Vitamin C is available commercially as creams, serums, scrubs. Creams contain various other components called vehicle in which the active ingredient and in this case vitamin C is suspended. Vehicles are usually preservatives, and other ingredients which helps in moisturising. The problem with this type of formulation is that the release of the active form of vitamin C that can be absorbed into the skin is uncertain. Also creams, scrubs so not contain adequate concentration of vitamin C. Research has shown that a concentration of at least 8% is required for topical vitamin C to work. Such a concentration are available as serums which are the newest form of skin care product that contain large and adequate amount of the active ingredients with very minimal additional components.

When and how to incorporate Vitamin C to your skin care regimen

Lets recap the benefits of Vitamin C for our skin. First, it protects against UV (UVA and UVB) induced sun damage. Secondly, it acts as an antioxidant and helps in collagen formation which will help reduce signs of ageing. And lastly, it can be use as a depigmenting agent hence beneficial for post acne pigmentation, sunspots, melasma and other pigmentary disorders.

So if you’re looking for something that can perform the above function for your skin, Vitamin C is worth a try. Years of research on topical Vitamin C serum shows that long term daily use of a topical vitamin C serum, does provide great results such as decrease in the number of fine lines, a more even skin tone with decrease in pigmentation.

So when buying a Vitamin C containing product remember that not every product available in the market actually does what it claims.

Do not jump at the sight of “Vitamin C” label, check for the concentration of Vitamin C, preferably go for the one with at least 10% concentration. Always opt for a serum instead of a cream. Research about the company, read the reviews before buying because a legit Vitamin C serum will burn a hole in your pocket.

Vitamin C serums are to be applied daily once in the morning after cleansing your face followed by a moisturiser 5 mins later. The amount will depend on the company’s instruction, usually 3-4 drops is the recommended. But I would advise to start slow, with a lower concentration or fewer drops and work up to the number of drops recommended as it can cause some mild irritation and dryness initially.

Conclusion

Vitamin C like other vitamins are vital for life and are required in very small concentration. Our body receives the perfect amount of vitamins from our diet. So when it comes to vitamins

“Less is definitely good, but more does not equate to better. In fact, more is unnecessary.”

Vitamin C can be beneficial for your skin when applied topically with a correctly formulated products that delivers the right type and amount of Vitamin C and for indications like anti-ageing, photoaged skin where levels of vitamin C in the skin has been shown to be lower than younger skin. Oral Vitamin C supplementation is not indicated except for the treatment of Scurvy (Vitamin C deficiency disorder). And homemade Vitamin C remedies does not deliver the same effect as one expects when reading about the benefits of vitamin C on the skin.

Featured image courtesy:Photo by Noah Buscher on Unsplash