An Evaluation of Efficacy and Tolerability of Novel Enzyme Exfoliation Versus Glycolic Acid in Photodamage Treatment
November 2015 | Volume 14 | Issue 11 | Original Article | 1306 | Copyright © November 2015
Maria Mekas BSN,a,b Jennifer Chwalek MD,a,c Jennifer MacGregor MD,a,d and Anne Chapas MDa,c
aUnion Square Laser Dermatology, New York, NY
bMemorial Sloan Kettering Cancer Center, New York, NY
cMount Sinai Medical Center, New York, NY
dColumbia University Medical Center, New York, NY
BACKGROUND: Glycolic acid acts by chemical destruction of adhesions between skin cells to exfoliate superficial skin layers and excess pigmentation. It is well known to improve the appearance of photoaged skin, but is associated with varying degrees of skin irritation. Hydrolyzed salmon roe proteins destroy cell adhesions enzymatically with potentially less irritation than acid treatments. This double-blind prospective study assesses the efficacy and tolerability of hydrolyzed roe versus glycolic acid, and glycolic acid with citric acid.
METHODS: 75 female subjects with mild to moderate photodamage, all skin types, and ages 31-70 years, were enrolled. In this 12 week study of twice daily self-treatments, patients were assigned to one of 3 groups; Group 1 (n-19) was assigned hydrolyzed roe cream, Group 2 (n=17), 4% glycolic acid, or Group 3 (n-16), 8% glycolic acid plus 2% citric acid. All patients used the same mild face wash and SPF 30 sunscreen throughout the study. Patients were evaluated at weeks 0, 8 and 12 for objective and subjective tolerability, improvement in photodamage by VISIA Complexion Analysis, modified Packman and Gans method, Visual Analog Scale (VAS), and answered an opinion questionnaire.
RESULTS: Group 1 improved in skin clarity from a VAS 44.1 to 55.7 (P
=0.0317) at week 12. VISIA mean scores correlated with office evaluation showing improvement in brown spots from 453 to 417 (P
= 0.0115) at 12 weeks. Group 2 improved in superficial fine lines at week 8 (-5.9, P
=0.0428) and week 12 (-9.1, P
=0.0019). Group 3 improved at week 12 in skin clarity (11.5, P
= 0.0469) and skin roughness (-13.3, P
= 0.0426), and in hyperpigmentation at week 8 (-9.4, P
=0.0462) and week 12 (-14.6, P
CONCLUSION: Topical hydrolyzed roe protein used twice daily improves skin clarity. It has good tolerability with fewer instances of stinging
and burning than the other glycolic acid containing creams. Patient’s opinions of the 3 products were similar.
J Drugs Dermatol
Aging skin is characterized by the appearance of wrinkles, fine lines, hyperpigmentation, and loss of radiance, smoothness, firmness, skin tone clarity and evenness, as well as alterations in pore size. The natural aging process and exposure to the sun (photodamage) are the main causes of these changes. To acquire a more youthful appearance and rehabilitate photoaged skin patients frequently turn to skin resurfacing procedures, such as chemical peeling, dermabrasion, and exposure to laser radiation.
Alpha hydroxyl acids; glycolic acid, lactic acid, malic acid, and pyruvic acid, are among the most widely used superficial peeling agents.1-4 Glycolic acid, the smallest alpha hydroxyl acid (AHA), can stimulate the growth of new skin. The exfoliating activity of these agents is postulated to work by dissolving adhesions between cells in the upper layers of the skin to induce shedding of dry scales from the skin’s surface.5 Numerous formulations containing hydroxy-acids have been used in clinical practice for decades to treat a variety of skin conditions and incorporated into a variety of cosmetic preparations.2 Despite the popularity of glycolic acid as an exfoliant, there have been reports of skin irritation , especially at higher concentrations, ≥ 10%.6,7 Consequently, there has been an ongoing effort to find less irritating substances that provide similar benefits.
In a serendipitous finding, scientists observed that women working in a salmon farm in Norway had remarkably smooth skin on their hands, despite working with their hands in cold water all day long. The skin appeared to repair itself, and many of the women also reported a notable improvement of skin ailments. The scientists identified an enzyme in the salmon eggs that breaks down the eggshell during the hatching process, without damaging the embryo. From the hatching water scientists identified the enzymes from hydrolyzed salmon roe proteins that, when applied to human skin, selectively break down dead skin cells.8,9