INTRODUCTION
Photoaging is a leading concern for patients seeking dermatologic
care. The long-term effects of ultraviolet (UV)
radiation include rhytides, dyschromia, lentigines, actinic
damage, and malignant neoplasms. As public knowledge has
increased regarding the link between sun exposure and photoaging,
patients have become interested in both preventing and
treating the adverse effects of UV radiation.
Today's dermatology patient has often sought online medical
advice prior to their consultation, and may have a strong desire
to utilize only organic and natural ingredients. What is meant by
the terms "organic" and "natural"? Organic is a term designated
by the United States Department of Agriculture (USDA), but it is
not regulated by the US Food and Drug Administration (FDA). To
complicate matters, the FDA has no definition for the term natural.
Despite a lack of standardized guidelines across organizations to
set parameters for organic labeling, organic products have multiplied
and some organic products may be equally, if not more,
modified than conventional products. In addition, natural products
are not necessarily organic. For the purposes of this article, natural
products will refer to ingredients derived from nature, mainly
plants, which are later improved upon in the laboratory. This improvement
is what allows the natural ingredient to perform its
intended effect on the skin: by increasing its ability to penetrate
into the epidermis, by allowing it to remain on the skin without
denaturing, and by ensuring that it plays an active role in vivo.
Natural products have gained popularity in recent years due
to the presence of antioxidants, and increased use of this term
in the popular media. Free radicals are highly reactive oxygen
species that can cause significant damage to lipids, proteins,
carbohydrates and DNA. They accumulate during daily activities
such as respiration and exercise, but can be exacerbated by
inflammation, drugs, and the environment, enhancing the degree
of oxidative damage.1 The environmental factors that can
drastically increase free radical production include UV radiation,
smoking, and stress. Free radical production can overwhelm
endogenous antioxidant activity, leading to oxidative stress
and contributing to the aging process. Replenishment of endogenous
antioxidant stores with natural products containing a
wealth of antioxidants is protective against oxidative damage.
Natural products that may play a role in preventing and treating
photoaging include mushrooms, feverfew, green tea, licorice,
olive oil, soy, and coffee berry. In this review, we will discuss
clinical studies to support this claim, with basic science studies
included when there is a paucity of clinical data. It is important
to remember that while basic science data may hint at the
efficacy of a product or its mechanism of action, this will not
necessarily translate to in vivo effect or mechanism. Although it
is encouraging that the clinical studies discussed show a benefit
when used in human subjects, the studies are limited and
the data is not powered to allow for definitive recommendations.
As an additional caveat, some mentioned studies discuss
the use of extracts, or ingredients obtained from a particular
substance. Extracts do not always contain all of the active ingredients
of the original product and can vary from one another
based on the method of removal. This variation makes it difficult
to generalize data from individual studies, especially when
the method of extraction, ingredients within the extract, and
additive substances are not defined.
Mushrooms
Mushrooms have been utilized for medicinal purposes for many
years. They contain potent antioxidants, including phenolic acids,
flavonoids, tocopherols, ascorbic acid, and carotenoids.1
Mushroom polysaccharides prevent oncogenesis, exhibit antitumor
activity, and prevent tumor metastasis via activation of
the host immune response.2 Mushroom species vary in composition,
and some mushrooms may exhibit minimal antioxidant
properties. In addition, the efficacy of mushrooms can be affected
by variations in preparation.
