Glutathione (GSH) either as oral supplements or IV drips as skin lightening agents are the go-to treatments for glowing and bright skin especially in Asian countries and India, where the quest for fair skin is a never ending journey.
In this post we will see what glutathione is? Does it work as a skin lightening agent ? Are there any studies to back up its use in beauty spas or clinics? Is it safe? And is it worth it?
The evidence for oral or topical glutathione for skin lightening is still not convincing yet to warrant a unanimous recommendation for skin lightening or as a treatment for pigmentation
Is there a way to naturally increase GSH stores in our body?
YES you can.
The most economical & sustainable way to prevent glutathione depletion in our body is by preventing the need for GSH in the body in the first place by reducing oxidative stress.
Lifestyle habits that one can make to reduce oxidative stress :
Limit alcohol consumption
Quit smoking
Diet rich in fruits, vegetables and nuts which delivers amino acids required for GSH production or rich in other antioxidants : Tomatoes, oranges, spinach, asparagus, avocado, berries, walnuts, almonds ( best consumed raw or lightly steamed)
Whey protein is a good source of cysteine (an amino acid essential for GSH synthesis)
Pregnancy, one of the most beautiful journey for a women, but it can be associated with many skin changes that can be bothersome and add unnecessary stress during this time.
These changes in the skin, hair or nails are normal and expected, but the good news is, they are temporary and resolve spontaneously post delivery to a great extent even if not completely to a pre pregnant state. Let’s look at what these changes can be and how you can address them.
Hyperpigmentation
This one of the most common change that can see seen in upto 90% of pregnant women. It is more pronounced in women with brown to darker skin type. Body folds, or areas of the body which are normally pigmented such as the under arms, inner thighs, become more pigmented. For some women, diffuse hyperpigmentation can occur.
Such pigmentation does not require any treatment but if one is concern and wants to address it then one can use some product such as lotions, toners etc. Be careful not to overuse AHA’s (gycolic acid) the the underarm areas.
Melasma
Another common pigmentation issue that develops during pregnancy.
Which skincare are safe to use during pregnancy?
Most skincare, be it moisturisers or serums or sunscreens (chemical or physical) can be used safely during pregnancy.
Experts often recommended limiting the amount of exposure to or avoiding certain ingredients as a precautionary measure and not because the ingredient is harmful to the mother or the developing baby.
Hydroquinone (HQ) can be substantially absorbed into the blood stream when applied topically to the skin. Even though there have never been reports of it causing any adverse effects to the baby when used during pregnancy. It is still recommended to limit one’s exposure to HQ or avoid it during pregnancy.
Retinoids are recommended to be avoided during pregnancy based on the evidence that Oral vitamin A analogues when taken orally during pregnancy can cause birth defects in the developing baby. And as topical retinoids are also vitamin A derivatives, it’s recommended to avoid using them during pregnancy if possible just as a precautionary measure. There is no evidence to suggest that one needs to discontinue topical retinoids if one is trying to conceive.
If you are conflicted with making a decision on whether to avoid such ingredients or continue using them in you routine during pregnancy, it’s best to discuss this with your treating dermatologist and gynaecologist who can help guide you make the decision that is best suited for you individually.
Stretch marks
When it comes to preventing pregnancy stretch marks or reducing their appearance, there are not much options out there and most products available in the market that promises otherwise do not work.
The use of products containing cantella asiatica or silicones or hyaluronic acid have some weak evidence that they may help with the appearance of the stretch marks when applied regularly. However these are not miracle creams, you may still develop stretch marks despite using such products regularly.
If you want to try such products, go ahead, just make sure to spend some time massaging the products into your skin as the increase blood circulation to the skin as a result of the massage may be able to help to some extent and set realistic expectations so that you do not get disappointed.
Oils such as rosemary oil, olive oil, cocoa butter, shea butter have never been proven to help.
We’ve all heard of acids such as glycolic acids, and if you’re acne prone- salicylic acid and the rest. These acids are used in skincare products as chemical exfoliants i.e they help to chemically detach cells in the upper most layer of the skin from one another, yielding a more youthful, smoother, brighter skin.
What are the various types of acids used in skincare ?
How do they work?
Lower strength acids as found in OTC cosmetics (usually <10%) works at the level of the epidermis specifically at the stratum corneum (upper most layer of skin) and causes exfoliation.
Higher strength acids (>20%) are used as in-office procedures by professionals as chemical peels. Higher strength and lower molecular size acids such as glycolic acid can penetrate deep into the skin (upto the dermis) to boost collagen, GAG’s production thereby increasing the thickness of skin, and reversing signs of photoageing such as wrinkles, deep lines, sun spots etc.
Concept behind exfoliation
As we age our skin cell turn over (cells from the lower layer, divide and mature and are eventually shed off) slows down. As a results more cells from the startum corneum accumulate on the surface which gives aged skin a more dull, and rough appearance. Chemical exfoliation using acids helps speed up the process of shedding the upper layers of the skin. Hence, incorporating acids in our skin care are of benefit a we age and and for addressing certain skin concerns. They are un-necessary for younger age groups as their skin can naturally exfoliate at a good rate.
Rough estimate on the average skin cell turnover with various age groups
Acids beyond exfoliation
Uses of acids in skin care products can be more than just for exfoliation. Different acids have a slightly unique properties that help address specific concerns.
How to choose a chemical exfoliant?
Firstly, not everyone needs a chemical exfoliant in their routine. If you do not have any skin concerns, or if you are happy if your existing routine, continue what works for you regardless of whether you have such acids or not in your routine.
Amongst AHAs :
Glycolic acid is most commonly used and widely available in skincare products. However being of smaller molecular size, it can penetrate the deeper layers of the skin and cause irritation for some.
Lactic acid: another common AHA, but has additional properties of being able to retain water thus hydrating the skin. It’s also less irritating as compared to GA
Mandelic acid : a larger molecular weight AHA that is great for people not tolerating other acids or for people with sensitive skin as it is least irritating.
PHA and PBHAs, the newer generation acids. Not only do they provide gentle chemical exfoliation, some PBHAs such as lactonionic acid help hydrate and soothe the skin.
Note: The tolerability of such acids are also dependent on the overall formulations. Some products have a combination of these acids for maximum benefit and least irritation. Most often you only require a single product, and try not to use too many chemical exfoliants in your skin care routine without a professional consultation.
Irritation is the most common side effect of using such products. It can present as redness, burning or itching. It can also be seen as bumps resembling acne. Start by using such products just once-twice a week instead of every night and do not forget your sunscreen.
Some people may be allergic to certain acids, always perform a patch test prior to using such products especially if you have sensitive skin.
Over exfoliation can disrupt your skin barrier, making it sensitive, dry and irritated. In this case, stop using such chemical exfoliants and jut stick to the basics: cleanser, moisturiser and sunscreen.
If you already have a routine for your acne or pigmentation, please consult your dermatologist prior to incorporating such products in your routine.
Dark circles though very common, can be difficult to address. Many factors are involved in causing dark circles, such as ethnicity, bone structure, anatomy of the skin etc, and most times a cream or serum cannot address all the factors involved, thus resulting in failure of treatment.
Let’s try to understand more about dark circles here.
What causes dark circles ?
There can be intrinsic factors (internal, genetically predetermined factors, inevitable) or extrinsic factors (external, environmental impact, modifiable).
These factors are non modifiable and most topical products such creams/serums cannot completely address these factors
Extrinsic factors can be modified to reduce the risk of developing or worsening of dark circles
Types of dark circles
Understanding the type of dark circles helps guide the treatment options.
So you have been using eye creams religiously for a long time and you still have not seen results. Why isn’t t it working for you?
Lack of sun protection: The under eye area is a commonly missed site during sunscreen application.
Not making the necessary lifestyle changes: Ongoing stress, lack of sleep, not cutting down on smoking and alcohol.
Underlying cause not addressed: Continuous scratching from eczema irritation.
Lack of patience: Depigmenting creams take time to work
Incorrect choice of product or treatment: Some form of dark circles benefit more from prescription medications or from a combination of products + in office procedures such as fillers, chemical peels etc
Unrealistic expectation: No creams/serum can 100% reduce dark circles. Shadowing effect due to bone structure cannot be corrected by creams. Constitutional pigmentation respond only minimally to OTC products.
Medically termed as “Post Inflammatory Hyperpigmentation” or PIH, these are dark brown to blue to black pigmentation that are left behind as a sequelae of the acne.
PIH can cause more concerns for individuals with acne than the acne itself but the good news is that, PIH are lesser evils of all pigmentation issues that occurs in our skin, they are preventable and completely treatable for many.
So why do PIH occurs ?
Skin type (i.e darker skin type), along with UV radiation and ongoing inflammation from the acne all work together to cause PIH
How can one minimise the risk of development of dark spots or PIH?
Though PIH/dark spots from acne can fade with time, we do see many individuals whose PIH last longer than expected.
Why is my PIH not fading?
Do over the counter products work for PIH post acne?
To some extent, YES, they do!
OTC products that addresses pigmentation along with treatment for acne and sun protection can definitely help fade acne scars as long as they are superficial epidermal PIH. Deep/Dermal PIH or mixed type of PIH would respond better to prescription medications +/- in office procedures such as chemical peels, LASERS etc
I got a few questions on how to store skincare products when one is living in a hot tropical country with summers of >35°C and when instructions on product labels read “store below 25°C or store sunscreen below 30°C?
This is actually a great question and concern for consumers, I was so impressed at this level of consciousness and curiosity when it comes to skincare and cosmetics.
Since I am not a skincare or cosmetic developer, I am not fully aware of the best answer for this question and so I took the liberty to ask for help from a pharmacist and a post graduate in advanced cosmetology: Catarina Cabeçadas to answer this question. She is also the writer of “The skin balance blog“
I’ve written post on this a while ago, and not much data was available then regarding truncal acne.
So here’s an update on another common issue : Truncal acne.
Truncal acne refers to the acne involving the back and or chest. Around 50% of patients with facial acne also suffer from truncal acne while ~ 3% suffer from just truncal acne without any acne on their face.
How is it different from facial acne?
Truncal acne has been neglected in comparison to facial acne. Not much studies are available on this entity and treatment options are limited as well. Creams or gel that are available for face may not be enough or prove to be too costly for application over large surface areas such as the back or the chest.
Triggers for truncal acne
Triggers are external factors that could cause development of acne in genetically predisposed individuals.
Whey protein supplements have been reported to cause acne eruption in body builders
How is body acne treated?
In general, treatment of truncal acne follows the same principles as for facial acne.
The only difference is that one needs to be mindful for the choice of products for truncal acne. A small 15g cream or gel may prove to be too costly as it may not be enough to treat large surface areas such as the back and chest.
Lotion or foam formulation may be a better and more convenient choice for the back/chest.
Few are available as over the counter (OTC), while medications such as antibiotics, retinoids or steroids require prescription and supervision by a dermatologist
When in doubt of the diagnosis and how to use these products
If you have a personal history of developing hypertrophic or keloidal scars (thick, large scars), early treatment will help prevent such scar formation
Severe extensive involvement may require a course on antibiotics or isotretinoin
Managing post truncal acne scars either atrophic, hypertrophic or pigmented scars may require in office procedures such as chemical peels or LASERS, etc
Be it cracked feet, corns or calluses, everyone of us has suffered from either of these conditions at least once in our lifetime.
Corns and calluses
Corns and calluses are common issues arising on the feet. They are keratotic skin lesions that occur as a results of repeated pressure and friction leading to thickening of the skin as a protective mechanism to prevent ulcerations.
How corns and calluses form?
Corns and calluses
Cracked feet/ Heel fissure
How to take care of your feet?
All factors that contribute to cracked feet, corns and calluses such as friction, pressure and hyperkeratosis (thickened skin) needs to be addressed accordingly.
Atopic dermatitis or eczema is a chronic inflammatory skin condition characterised by recurrent acute flares of erythematous (red) itchy skin rash with all without some oozing.
Atopic eczema (AE) usually starts in infancy (< 1 year) or during childhood. Some children outgrow the disease while for maturity it may persist into adulthood. AE can also present for the first time in adulthood
It is estimated that approximately 2.3 million people worldwide suffers from AE. The number of cases is increasing globally including in Asia. Though AE has a lower prevalence in India compared to other Asian countries, the prevalence has consistently increase over the years.
How does one develop AE?
AE is cause by numerous factors interplaying with each other.
Itching is a hallmark feature of atopic eczema. Itching can worsen the rash or even trigger the onset of eczematous rash.
For this reason atopic eczema is rightfully termed as an “itch that rashes“
Itching in atopic eczema patient can become chronic, lasting for >6 weeks. Scratching to relief the itching can set in motion a viscous itch scratch cycle.
Atopic dermatitis is more than just skin deep?
The damaged skin barrier in patients with atopic dermatitis/eczema allows various allergens (proteins able to mount an immune response in the skin, body) to penetrate the skin, thereby sensitising an individual and causing allergic immune response seen clinically as red itchy rash.
Similar process can occur in the lining of the nose, pharynx predisposing patients to be sensitised to inhaled allergens such as pollen, pollution, dust etc resulting in Allergic rhinitis and or Bronchial Asthma.
A follow up article on the treatment and skin care measures for atopic eczema will be posted in the next blog post.
Atopic eczema in skin of colour
Prevalence of atopic eczema has been reported to be higher in individuals with skin of colour. However the clinical presentation of AE in darker skin tone is different from AE in Caucasians.
Erythema (redness) is usually masked in darker skin tone individuals. Other presentation or associated features are hyperlinear palms, prurigo nodularis, peri orbital melanosis (dark circles), lichenified lesions (thickened hyperpigmented skin) etc.
Parabens have been been used since the 1920s safely as preservatives in skin care products, cosmetics and various other toiletries items used in our every day life. Parabens are also present in certain food such as blueberries, strawberries, grapes, barley etc though in small quantities. Parabens are also used in pharmaceutical companies in various medications. Even though they’ve been around for 70 years, parabens still remains a controversial ingredients in the skin care industry. They were first victimised as sensitisers that are able to cause contact allergic dermatitis. In the recent years, parabens are again under scrutiny as potential endocrine disruptors acting as the hormone estrogen. They have also been falsely linked to breast cancer and infertility.
Now let’s see if all these claims are true! Before we dive into the research available on parabens, let’s understand a little background on these molecules and how the processed inside our body.
Background on paraben
Parabens are esters of parahydroxybenzoic acid (PHBA). There are different classes of parabens: methyl, ethyl, butyl, and propyl – paraben are the four most commonly used ones with a good track record.
Metabolism of parabens
Why are parabens present in skin care products and cosmetics?
Effective antimicrobials at even low concentrations hence acts as preservatives.
Minimal toxicity
Chemically inert
Odourless
Low cost
pH neutral
They have been used safely since the 1920s as have been extensively studied for the safety profile in humans
With such advantages properties, a number of skin care products, cosmetics contain paraben as the choice of preservative.
Parabens as sensitisers
Parabens were labelled as contact sensitiser i.e Able to cause contact allergic dermatitis when applied to the skin. However, cases of paraben allergies have been consistently low with parabens being the culprit in only ~0.6 to 1% of the individuals with contact allergic dermatitis.
Most of these paraben allergies occurs in individuals with compromised skin barrier such as when products containing parabens were applied on eczematous or wounded skin.
An interesting observation called “PARABEN PARADOX” in which the same above individuals who reacted to paraben when applied to compromise skin, didn’t have any problems with the same paraben containing cream was applied to normal skin.
Parabens were even named the contact non-allergen of the year in 2019 by the American contact dermatitis society. Parabens are also the least allergenic preservative present in the market
Parabens as endocrine disruptors
It has been shown in vitro studies (lab studies) that parabens are able to bind to estrogen receptors. Amongst the various parabens, butyl paraben has the highest oestrogenic activity but overall has a weak oestrogenic potential and is 10,000 times less potent than the naturally present hormone estradiol. When lab animals was subcutaneously injected with high dose of paraben it was shown to cause increase in the size of the uterus. Though these findings may seem alarming, they do not represent the effects of parabens in humans.
Though parabens may act as endocrine destructors in vitro, there is no evidence that they are endocrine disruptors in humans.
Paraben linked to breast cancer
As paraben and can mimic estrogen and bind to estrogen receptors, there is a theoretical risk that they could increase the risk of breast cancer. However as stated earlier, parabens have only a weak oestrogenic activity. Even if they can bind to these estrogen receptors, there is no evidence that it can produce any effects in humans. Another reason why parabens are linked to breast cancer is because some studies were able to isolate parabens from cancerous breast tissues. But most of the studies came that came to this conclusion did not assess the presence of parabens in normal breast tissue.
One study found that parabens were present in the adjacent normal breast tissue as well.
One epidemiological study reported no increased risk of breast cancer incidence in patients using antiperspirant or deodorants. However details on the composition of these products were lacking from this study.
So far, there is still no convincing evidence that parabens increases the risk of breast cancer.
Parabens and infertility
Consequences of demonising parabens
With companies being forced to cater to a market that embraces “Paraben free“, alternative preservative with lesser known properties and effects on humans are being used instead.
Avoiding the use of preservatives in cosmetics and skincare products is dangerous as this provides a favourable environment for micro organisms to grow which can result in various skin infections.
Skin care marked as “paraben free” are more expensive due to the use of other more expensive preservatives and because “paraben free” is a great marketing strategy. This would prove to be too expensive for patients who depend on moisturisers or other products to help maintain a healthy skin especially in countries like India.
For these reasons use of parabens have not been banned from cosmetics or skincare products as the benefits of these molecules far out weighs their theoretical in vitro or animal studies risks
I am not saying that parabens are 100% safe, and completely risk free, because nothing on earth is risk free. The best approach in such situation is to try to understand the available data and to weigh the benefits against the risk.
So who should use “paraben free” products?
Individuals with a known allergy to parabens should opt for paraben free products. or if paraben free is your personal choice.
Michelle from Lab Muffin, who talks about the science of beauty, wrote such a great blog posts on this topic as well. Do check that out for an even detailed read.
Dr Naphisabet Wanniang 