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      Neocollagenesis and Neoelastinogenesis: From the Laboratory to the Clinic

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          Abstract

          An internet search was made looking for articles about chemical and physical modalities that are known to induce collagen and elastin formation. Textbooks, independent articles, journals and books on pathology, biochemistry, aesthetic medicine and cosmetic and plastic surgery were used as references. Here, we take a look at various studies, in vitro and in vivo, that lend credence to the products and procedures used in clinical practice to induce neocollagenesis and neoelastinogenesis.

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          Most cited references 39

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          Retinoids in the treatment of skin aging: an overview of clinical efficacy and safety

          Aging of skin is an intricate biological process consisting of two types. While intrinsic or chronological aging is an inevitable process, photoaging involves the premature aging of skin occurring due to cumulative exposure to ultraviolet radiation. Chronological and photoaging both have clinically differentiable manifestations. Various natural and synthetic retinoids have been explored for the treatment of aging and many of them have shown histological and clinical improvement, but most of the studies have been carried out in patients presenting with photoaged skin. Amongst the retinoids, tretinoin possibly is the most potent and certainly the most widely investigated retinoid for photoaging therapy. Although retinoids show promise in the treatment of skin aging, irritant reactions such as burning, scaling or dermatitis associated with retinoid therapy limit their acceptance by patients. This problem is more prominent with tretinoin and tazarotene whereas other retinoids mainly represented by retinaldehyde and retinol are considerably less irritating. In order to minimize these side effects, various novel drug delivery systems have been developed. In particular, nanoparticles have shown a good potential in improving the stability, tolerability and efficacy of retinoids like tretinoin and retinol. However, more elaborate clinical studies are required to confirm their advantage in the delivery of topical retinoids.
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            In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin.

            To determine whether endogenous synthesis of new extracellular matrix may contribute to the degree and duration of clinical benefits derived from cross-linked hyaluronic acid dermal filler injections. In vivo biochemical analyses after filler injections. Academic referral center. Eleven healthy volunteers (mean age, 74 years) with photodamaged forearm skin. Interventions Filler and vehicle (isotonic sodium chloride) injected into forearm skin and skin biopsy specimens taken 4 and 13 weeks later. De novo synthesis of collagen, the major structural protein of dermal extracellular matrix, was assessed using immunohistochemical analysis, quantitative polymerase chain reaction, and electron microscopy. Compared with controls, immunostaining in skin receiving cross-linked hyaluronic acid injections revealed increased collagen deposition around the filler. Staining for prolyl-4-hydroxylase and the C-terminal and N-terminal epitopes of type I procollagen was enhanced at 4 and 13 weeks after treatment (P<.05). Gene expression for types I and III procollagen as well as several profibrotic growth factors was also up-regulated at 4 and 13 weeks compared with controls (P<.05). Fibroblasts in filler-injected skin demonstrated a mechanically stretched appearance and a biosynthetic phenotype. In vitro, fibroblasts did not bind the filler, suggesting that cross-linked hyaluronic acid is not directly stimulatory. Injection of cross-linked hyaluronic acid stimulates collagen synthesis, partially restoring dermal matrix components that are lost in photodamaged skin. We hypothesize that this stimulatory effect may be induced by mechanical stretching of the dermis, which in turn leads to stretching and activation of dermal fibroblasts. These findings imply that cross-linked hyaluronic acid may be useful for stimulating collagen production therapeutically, particularly in the setting of atrophic skin conditions.
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              Topical tretinoin for photoaged skin.

              Daily topical application of 0.05% tretinoin in a cream base was compared with its vehicle with regard to moderation of photoaging changes of the face and forearms. In comparison with the control tissue, tretinoin-treated tissue examined by light and electron microscopy showed the following effects: replacement of the atrophic epidermis by hyperplasia, elimination of dysplasia and atypia, eradication of microscopic actinic keratoses, uniform dispersion of melanin granules, new collagen formation in the papillary dermis, new vessel formation (angiogenesis), and exfoliation of retained horn in the follicles. Physiologic studies demonstrated: increased blood flow and dermal clearance, increased transepidermal water loss, and greater permeability and reactivity. It was concluded that topical tretinoin is capable of at least partly reversing the structural damages of excessive sunlight exposure and may be useful in decelerating the photoaging process.
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                Author and article information

                Journal
                J Cutan Aesthet Surg
                J Cutan Aesthet Surg
                JCAS
                Journal of Cutaneous and Aesthetic Surgery
                Medknow Publications & Media Pvt Ltd (India )
                0974-2077
                0974-5157
                Jul-Sep 2016
                : 9
                : 3
                : 145-151
                Affiliations
                [1 ]Skin Clinic @ Sumeru, Ahmedabad, India
                [2 ]Visiting Dermatologist, Department of Cosmetic Surgery, Shalby Hopsitals, Ahmedabad, Gujarat, India
                [3 ]Visting Dermatologist, Aarna Hospital, Ahmedabad, Gujarat, India
                [4 ]Medilink Hospital, Ahmedabad, Gujarat, India
                Author notes
                Address for correspondence: Dr. Sujata R Mehta-Ambalal, St. Xavier's College Corner, Navrangpura, Ahmedabad - 380 009, Gujarat, India. E-mail: sujata.ambalal@ 123456gmail.com
                Article
                JCAS-9-145
                10.4103/0974-2077.191645
                5064677
                Copyright: © Journal of Cutaneous and Aesthetic Surgery

                This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

                Categories
                Review Article

                Surgery

                cutaneous ageing, cutaneous scarring, neocollagenesis, neoelastinogenesis, wrinkles

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