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Antioxidants, Anti-aging and Skin Rejuvenation
Vitamin A - Part 3
By Peter T. Pacik, M.D., F.A.C.S.

The last e-mail dealt with the two main categories of aging: natural and environmental. We know that the body is capable of healing itself; however, environmental factors such as ultraviolet radiation and smoking can overwhelm the body's natural defenses. Oxidative damage caused by a wide variety of "free radicals" is countered by the body's defense mechanisms in the form of antioxidants, such as naturally occurring Vitamins A, C and E. These "antioxidants" enhance the body's natural healing capabilities, hence the development of topical treatments containing these vitamins. Today's e-mail will discuss some of the fundamental knowledge concerning Vitamin A and a list of products that contain Vitamin A.

Almost everyone has heard of Retin-A, which is a Vitamin A prescription drug (generic name tretinoin) developed as an acne cream in the 1970's. Kligman et al ¹ are credited with the early understanding of topical application of Vitamin A. It was noted that it also helped sun damaged skin, fine wrinkling, mottled hyper-pigmentation and skin roughness. Vitamin A is actually a skin irritant and causes drying of the skin and sun sensitivity. Renova was then developed as a cream base (water in oil emulsion, including light mineral oil) to counteract the drying. Tazorac (tazarotene) is another prescription Vitamin A cream for the treatment of acne and psoriasis and has been shown in medical studies to be as or more effective than Renova.

In addition to the clinical improvement of skin, numerous microscopic changes are noted, such as improvement or reversal of ultraviolet radiation induced changes, normalization of cell architecture, formation of new collagen, and formation of new blood vessels. Several studies have shown increased collagen synthesis. Although early studies were performed with higher concentrations of tretinol (.1%), later studies proved that lower concentrations (.025%) had similar beneficial effects without the irritation. Most of the studies done use a pure form of Vitamin A and studies are showing that the addition of a Vitamin A product can enhance a glycolic skin care program.

Retinol and Retinyl Palmitate are the over-the-counter derivatives of Vitamin A (tretinoin). Retinol is stronger than retinyl palmitate, and often they are combined in certain formulations. Retinyl Palmitate (also known as Vitamin A Palmitate) is the ester of retinol combined with palmitic acid and is thought to be less irritating than retinol.

It is important to note that any prescription drug or product containing Vitamin A or its derivatives can cause redness, burning or stinging, peeling and increased sunburn potential. The safety of Vitamin A creams has not been established for pregnancy or nursing; therefore, should be avoided at these times. If you discover that you are pregnant, simply discontinue further use of Vitamin A products. Because of increased sun sensitivity, sunscreens are a must when using products containing Vitamin A or its derivatives.

For those who would like to use a pure Vitamin A (prescription drug such as Retin-A, Renova or Tazorac), it can be used in the evening after cleansing on an alternating basis with a glycolic cream or lotion. The Vitamin A derivative, Retinyl Palmitate, is available in the Nutri-A Daily Repair Cream. This weaker, less irritating form of Vitamin A is usually used after the glycolic cleanser in the evening. Nutri-A may be used alone (instead of a glycolic cream or lotion) or on alternating evenings with glycolic products. The MD Forte Daily Regimen also includes products that contain Retinol and Retinyl Palmitate in addition to Vitamin C, E and glycolic compounds. If you are new to the MD Forte line, please follow the guidelines in the 4-Step Daily Regimen and "graduate" slowly to the higher levels.

For more information, please visit our Web site skincare-md.com and our plastic surgery website plasticsurgerypa.com. All of our previous educational e-mails , as well as The MD Forte 4-Step Daily Regimen, Obagi Nu-Derm System Daily Regimen, and Obagi-C Rx Recommended Daily System Application are found on our website www.skincare-md.com. If you have any additional questions or would like to speak to or would like to speak to Lisa Roberge, our esthetician, please feel free to call us during office hours Monday thru Thursday 9-4, Friday 9-3 EST at 1-800-640-0290 or (603) 669-0290. If there are any topics that you would like covered in these educational e-mails, suggestions or concerns you may have, please let us know. We encourage you to share your experiences both positive and negative with us. Your comments are important to us.

Peter T. Pacik, M.D., FACS
Medical Director

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