Women’s Health Update

By Tori Hudson, ND

Conjugated Linolenic Acid from Pomegranate May Improve Healing After Facial Laser Resurfacing

It is not uncommon for women (and some men likely as well) to seek dermatology procedures to stave off the effects of aging and/or skin damage from sun or conditions such as severe acne. One such procedure is ablative fractional skin resurfacing. Some of the problems that occur after the procedure include erythema, edema, and crusting, which can last from 5 to 14 days. The market place offers attempts at remedying these post-procedure issues. One such item is conjugated linolenic acid (CLA). Pomegranate seed oil is a rich source of conjugated linolenic acid (CLA) and has been shown to promote keratinocyte proliferation and epidermal regeneration. A topical proprietary product, PomegaMD, was used in a prospective, randomized, controlled, evaluator-blind clinical trial to assess the safety and efficacy of Pomega topical CLA treatment to promote healing and improve skin quality following ablative laser resurfacing of the face.

The study included 34 healthy subjects aged 18 to 74 years who had undergone any ablative or non-ablative energy treatment in the last three months or had a history of hypertrophic or keloidal scarring. All participants underwent a standard fractionated carbon dioxide laser resurfacing treatment to the face. The resurfaced areas were treated with either the test regimen (n=24) or 1% dimethicone ointment the standard-of-care control (n=10) for 28 days. During the first 14 days after the procedure, a thick occlusive ointment was applied to the face. During the next 14 days, a concentrated repair serum and healing cream of PomegaMD were applied. In the control group, dimethicone ointment was applied throughout the 28-day trial.

In the abstract, it is stated that the Pomega group had “significantly reduced edema on post-procedure day 3 and itching on days 1 and 3.” However, in the results section it is stated that there was no significant difference between groups for any of the investigator ratings including edema. And, it appears the report in the results section noted that aside from significant reductions in itching on day 1 post-procedure in the Pomega group, there were no statistical differences between the treatment and control groups.

At day 14, improvements in wrinkling were greater in the Pomega group compared with the control group; however, at day 30, no between-group differences were observed.

Commentary: The authors reported that they demonstrated the safety and efficacy of this anti-oxidant topical regimen of conjugated linolenic acid derived from pomegranate oil extract, but the results are not exactly clear that was the case. Despite the confusion, I think it is a safe option for this circumstance of post-laser ablative therapy to the face.

Wu DC, Goldman MP. A topical anti-inflammatory healing regimen utilizing conjugated linolenic acid for use post-ablative laser resurfacing of the face: a randomized, controlled trial. J Clin Aesthet Dermatol. October 2017;10(10):12-17.

Topical Polyphenols May Improve Acne Rosacea Symptoms

Acne rosacea is a chronic inflammatory skin condition of the face that presents with persistent redness and is often also associated with telangiectasia, edema, pustules, papules, burning, and stinging. The cause of acne rosacea is not well understood but is thought to be associated with immune dysregulation, impaired function of the skin barrier, and a vascular hyper-reactivity. Acne rosacea can sometimes be triggered by sun exposure, stress, diet, cosmetics, microbes and hormonal changes. Topical metronidazole or oral antibiotic tetracycline are the most common conventional prescriptions, although it is not always a satisfactory solution. Botanical treatments should be considered, although they can be more unsatisfactory all too often. This systematic review of human clinical trials evaluated the effectiveness of polyphenol-based therapies in treating rosacea.

The research methodology included a search of PubMed, EMBASE, AGRICOLA, BIOSIS, Web of Knowledge, and Scopus databases for English-language articles published up to September 2016. Of the 814 articles that resulted from the search, six met all of the inclusion criteria for review. All these studies reported on topical rosacea treatments and included the following polyphenols: silymarin from milk thistle; licochalcone from Chinese licorice; an extract from quassia; and flavonoids from Chrysanthellum indicum.

Select studies stand out. The first was an eight-week, parallel group study between patients with facial erythema caused by erythematotelangiectatic rosacea and patients with non-rosacea erythema. Both groups used a combination of licochalcone A-containing products including a cleanser, cream, moisturizer, and concealer at least once daily. The non-rosacea patients had a statistically significant improvement in erythema at four and eight weeks. The rosacea group had statistically significant but modest improvement only at week eight.

Another study was on the use of licochalcone A-containing products as an adjunct to metronidazole 0.75%; 33 patients with either erythematotelangiectatic (ET) rosacea or papulopustular (PP) rosacea were treated. Patients used metronidazole and their own products for the first two weeks of the study, and then used metronidazole and licochalcone A-containing products for the last two weeks. The ET patients showed significant improvement in erythema at two and four weeks. There was a small decrease in papule count after weeks two and four but no significant decrease in pustules after two weeks, but there was at week four.

A 30-day randomized, double-blind, placebo-controlled trial of silymarin-methylsulfonylmethane (SMSM) was conducted on patients with ET or inflammatory rosacea. The SMSM group experienced a significant improvement in both the erythema score and the erythema index when compared to baseline and placebo. Patients had a significant reduction in papules and pustules for both the treatment group and the placebo group. Another trial was done using a silymarin cream twice daily for 12 weeks. Patients experienced a 58% decrease in erythema over the 12-week period, but half of the patients were also using various prescription rosacea treatments during the trial, and all the patients were using a sunscreen.

Other studies showed some improvement in erythema, telangiectasias, papules and pustules with a 4% quassia extract gel twice daily. Ferrari and Diehl conducted a 45-day, open-label, single-group trial of a 4% quassia extract gel applied twice daily.

Commentary: One of the challenges of topical agents for acne rosacea, whether pharmaceutical or botanical or nutrient bases, is that they can be drying or irritating. In this systematic review, polyphenols had some potential in treating acne rosacea, but there certainly weren’t any home runs. Since acne rosacea occurs mostly in women, it is suspect that we look for more underlying mechanisms in the realm of hormonal influences and microbiota influences.

Saric S, et al. The role of polyphenols in rosacea treatment: A systematic review. J Altern Complement Med. December 2017;23(12):920-929. 

Compounded Medications

Here are a few selections from my clinical recipe book of compounded medications for select skin conditions, that I’ve collected—thanks to trial and error and the skills of your reliable and smart compounding pharmacist.

Acne vulgaris

• Azelaic acid 10%, green tea 2%, niacinamide 4%, saw palmetto 5%, tea tree oil 5%, ascorbic acid 10%. Apply to involved area once daily.

• Ascorbic acid 1%, azelaic acid 10%, salicylic acid 2%. Apply once daily to face.

Acne rosacea

• Niacinamide 4%, biotin 0.1%, ALA 0.5% gel. Apply once daily to face.

• Metronidazole 1%, azeleic acid 1%. Apply once to twice daily.

Atopic dermatitis

• Vitamin B12 0.7% in Xematop. Apply twice daily.

• Beta glucan 0.5%, green tea 0.5%, milk thistle 10%, MSM 5% in Xematop. Apply twice daily.

Vulvar non-specific dermatitis

• Glutamine 10 mg/gm, tranilast 20 mg/gm, aloe 20 mg/gm. Apply ½-1 gm daily to vulva.

Antifungal nail cream

• Ketoconazole 2%, terbinafine 2%, ibuprofen 2% in DMSO benzyol alcohol solutions. Apply to affected nails twice daily.