Extracellular Matrix Modulation: Optimizing Skin Care and Rejuvenation Procedures

April 2016 | Volume 15 | Issue 4 | Supplement Individual Articles | 63 | Copyright © April 2016


Alan D. Widgerow MBBCh MMed FCS FACS,a Sabrina G. Fabi MD FAAD FAACS,b
Roberta F. Palestine MD,c Alexander Rivkin MD,d Arisa Ortiz MD FAAD,b Vivian W. Bucay MD FAAD,e
Annie Chiu, MD,f Lina Naga MD,g Jason Emer MD,h and Paul E. Chasan MD FACSi

aChief Medical Officer ALASTINTM Skincare Inc., Carlsbad, CA
bDepartment of Dermatology, University of California San Diego, San Diego, CA
cThe Dermatology Center, Bethesda, MD
dDavid Geffen, UCLA School of Medicine, Los Angeles, CA
eBucay Center for Dermatology and Aesthetics, San Antonio, TX
fThe Derm Institute, Redondo Beach, CA
gWashington Institute of Dermatologic Laser Surgery, Washington, DC
hThe Roxbury Institute, Beverly Hills, CA
iRanch & Coast Plastic Surgery, Del Mar, CA

table 2
oleuropein (a lypo-oxygenase activity inhibitor) and phosphatidylserine (PS) (a signal enzyme activator) are included in the ALASTINâ„¢ Skin Nectar with TriHexâ„¢ technology formulation to decrease inflammation.

‘Skin Bed Preparation’ (Prior to Skin Rejuvenation Procedures)

The basic pre-requisite for regenerative wound healing, particularly in the case of chronic non-healing wounds, is that of adequate wound bed preparation. The logical approach to changing the degradative ECM wound environment in wound bed preparation is wound debridement and absorption of corrosive wound fluid to stimulate vascularization and decrease bacterial burden.13,14 Removal of the senescent cells and their products may contribute greatly to this change.15 Only then can exogenously applied growth factors and biologics be expected to stimulate the surrounding healthy tissue and promote wound healing.13
In much the same way, it is logical to adopt this paradigm in dealing with the changes seen in photo-damaged and aged skin. This sequence too, is a chronic one, with disturbances in ECM matrix constitution, senescent cells, and an imbalance of proteolytic mechanisms. Invasive resurfacing procedures are designed to denature collagen and proteins, producing more protein fragments that normally stimulate collagen regeneration. However, in a background of excessive existing photoinduced protein fragmentation, clearance of these fragments may facilitate the regenerative phase and hasten healing. Thus, in order to stimulate matrix regeneration, improve skin health maintenance, and to optimize rejuvenative procedures, a sequence of ‘skin bed preparation’ and matrix modulation would seem appropriate. This would take the form of ECM modulation by aiding in the removal of protein degradation products, balancing inflammatory mediators and proteases, and stimulating basal keratinocytic stem cells and fibroblasts setting the stage for regeneration of procollagen, collagen, elastin, and ECM ground substance. In effect, this constitutes a 'recycling of the ECM' for optimizing regenerative functions.
From the aspect of matrix degradation described above, a sequence of targeted approaches to repair and regenerate would appear logical as follows:
  • “Mopping-up” of excess collagen and elastin fragments in the ECM with balanced MMP production
  • Combatting oxidative stress, ROS end products generated in ECM
  • Stimulation of procollagen and collagen to regenerate the ECM, increasing lysyl oxidase beneficial cross linkages and improved fiber alignment (decorin, dermatopontin)
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