Acne (acne vulgaris) disease is mostly observed in teenagers both male and female which comes under the category of inflammatory disease and it is mostly characterized by following symptoms: pimples, greasy skin, blackheads, whiteheads and even scarring. The 21st Century way to treat this disease is by the utilization of ‘Cosmeceuticals’. Cosmeceuticals can be stated as the hybrids of cosmetics and pharmaceuticals arena which carries out enhancing attributes along with health benefit properties. Cosmeceuticals market is budding on a huge scale as the present population is constantly facing the problems of acne.
Even though acne is not physically disabling and its psychological impact can be striking and contributing to low self-esteem, depression and anxiety. As a result, there is very important demand for effective acne therapies for management of acne.
Present article primarily focuses on acne, its causes, symptoms, trends, statistics along with its management/treatment with the use of healthcare market capturer cosmeceuticals.
Human skin is the largest organ of the body accompanied with two important layers dermis and epidermis. This skin can be affected by various skin disease of which acne can be very harmful. This varies from low level acne to extreme level acne. Acne (acne vulgaris) acts by forming the lesions which is governed by following four factors: Increased sebum production, colonization by propionibacterium acnes, hyperkeratinization, and inflammatory reaction. A study were conducted in which 4576 patients were interviewed who were facing dermatological problems and it was observed that 55 per cent of this patients with acne seemed to have a relation with sequential episodes of emotional stress followed by worsening of this condition, another study was performed in the year 1950 in which a quantitative increase as well as intensifying of acne was observed when the candidates faced stressful interviews and the anger was intentionally induced during this procedure. This were some non technical reasons of intensifying of acne where one of the technical aspect of worsening of acne is excess secretion of glucocorticoids and androgens hormones which imbalances the overall contents.
Acne is mostly subjected to the areas where there is abundant sebaceous gland as it is a disorder of sebaceous follicles and such type of pilosebaceous units are sited at face, chest and back. In today's competitive world acne is having a huge negative psychosocial effect as it can lead to a development of feeling such as low self esteem, embarrassment, unemployment and depression. The bacteriology of acne is not very complicated Corynebacterium acnes and Staphylococcus alone or in combination contributes to pathogenisis by secondary infection.
Different types of acne
Blackheads: In dermatology it is classified under comedones. Oxidation of debris inside the follicles takes place because of which they remains open and hence the black colour appears.
Whiteheads: They are small blemishes with whitish “heads”. They are originated when the sebaceous follicles gets bind with sebum and dead skin cells.
Papules and pustules: They are often pink, small, solid, rounded bumps which peaks out through the skin whereas the other is a pimple with full of having base red and top covered with pus.
Cystic acne or nodules: They are hard, large and painful and generating deep inside the skin whereas the only difference between cyst and nodules is that cysts are filled with pus.
Acne scarring
Acne can lead to the scarring of skin and there are different types of acne scarring.
Rolling scars: They consists of large depressions in the skin which generally have rounded sloping edges hence it is called as rolling scars.
Boxcar scars: Broad, shallow or deep depressions mostly angular in shape with sharp vertical edges which mainly resembles the scars left by chicken pox.
Ice pick scars: They develop deep pits usually 2 mm across. They penetrate in to the skin and thus provide an appearance of having been punctured by an ice pick.
Hypertrophic and keloids scars: Hypertrophic scars are mainly caused due to wound infection, wound closure with surplus tension generally within 4 to 8 weeks of such injury whereas keloids can form in midchest. They appear as firm, mildly tender, bosselated tumours with a shiny surface even sometimes telangiectasia.
Risk factors and prevalence of facial acne vulgaris
A study was conducted in china to quantitate risk factors and prevalence of facial acne vulgaris in which 10 to 18 years old, 3163 students were selected from 7 schools. Self administered questionnaires and physician examinations were the source of information. All the potential risk factors such as age, gender, diet, skin type, sleeping habits and cosmetic facial make-up were considered during this study. Higher prevalence and severity of acne vulgaris were observed with increasing age. The overall data were collated the numbers were found are as follows: Acne vulgaris was prevalent in 53.5 per cent of adolescents with 51.3 per cent in males and 58.6 per cent in females. Out of which a total combined of 25.8 per cent of inflammatory acne was observed in males and females followed by 7.1 per cent of acne scarring. Also prevalence and severity of acne vulgaris were calculated according to the ages such as 15.6 per cent, 44.9 per cent and 70.4 per cent for 10, 13 and 16 years of youths respectively whereas it was more in girls under and boys over 14 years of age.
(This data may change country wise and location wise due to risk factors such as age, gender, diet, skin-type, sleeping habits, cosmetic facial make-up, stress, climate, drugs, environmental exposures, repetitive skin trauma)
Acne vulgaris (clinical research statistics)
Sr. No. Region name No of Studies
1 Central America 14
2 East Asia 35
3 Japan 09
4 Europe 58
5 Middle East 21
6 North America 257
7 Canada 35
8 Mexico 5
9 United States 238
10 North Asia 1
11 Pacifica 10
12 South America 13
13 South Asia 08
14 Southeast Asia 12
As per the data derived from Clinical trials.gov there are overall 448 studies on Acne Vulgaris has been conducted all over the world.
Cosmeceuticals care
There are various types of treatments for acne such as Azelaic acid cream, Alpha-hydroxy acids, Antibiotics, Birth control pills, Isotretinoin, Laser and other light therapies, Chemical peels, Acne removal. The type of treatment varies from level to level such as cosmeceuticals can play a vital role in preventing the acne from reaching to a painful exacerbate level.
Cosmeceutical ingredients and its mechanisms
Cosmeceuticals have enhancing as well as pharmaceutical benefit. Bioactive ingredients such as vitamins, growth factors, enzymes, antioxidants, ceramides, minerals, herbs and essential oils are present in cosmeceutical products. These products along with coloring and enhancing the skin also carry out the function of collagen growth and rejuvenating the skin. A cosmeceutical is made up of different type of cosmeceutical ingredients.
Alpha Hydroxy Acids (AHAs): Alpha Hydroxy Acids restore the hydration and influences cell shedding in the outer layers of the epidermis thus reduces the sign of aging, hence enhancing the texture of the skin.
Antioxidants – The mechanism of antioxidants is to limit the production of free radicals which detiorates the skin. It helps in carrying out the process of tightening, toning and calms the inflamed skin. Vitamin C, vitamin E, Panthenol and Alpha Lipolic Acid are some of the vital antioxidants for the skin. Vitamin C nurtures or slow down the damage of collagen material and also plays a major role in DNA damage repair.
Botanicals – There is a need for the implementation of regulation activities of the botanicals as well as their therapeutic properties should be largely explored. They mostly are the part of herbal cosmeceuticals. Green tea extract protects against the ultraviolet (UV) radiation response as they are the effective suppressor of carcinogenic activity from ultraviolet radiation. Ferulic acids which are derived from plants accompanied with vitamin C and vitamin E provides a good amount of ultraviolet protection. Because of its entirely different mechanism from suncreens it can act as a good supplement to sunscreens as per the report by Murray et al. Grape seed extract good wound healing agent as well as a sun protection factor in humans.
Depigmenting agents: These are added to the formulation and are also called as skin enlightening agents. Common depigmenting agents are Hydroquinone, Ascorbic acid, Kojic acid and licorice extract.
Moisturizers: They are accompanied with three main properties which provide occlusive, humectants and emollient effects. Occlusive agents such as petrolatum, lanolin, mineral oil, paraffin, squalene, silicone derivatives are greasy in nature which blocks TEWL by forming a hydrophobic film on the skin surface. Humectants play the role of attracting the water from dermis to epidemis whereas emollients ensures the smoothness of the skin by filling skin flakes with droplet of oil.
Topical peptides: These peptides stimulates angiogenesis, production of granulation tissue, and synthesis of new collagen. These peptides are made up of small sequence amino acids chain. They are classified in to three classes of peptides signal peptides, carrier peptides, neurotransmitter inhibiting peptides.
Cosmeceuticals regulatory aspects
There is no proper regulation governing the cosmeceutical term. According to the US Food and Drug Administration a product can be drug, cosmetic or both but as such the US Food and Drug Administration does not state any category of cosmeceuticals.
Market value
Currently value of pharmaceutical and cosmetic market is around Rs 35,000 crores and visualizing a growth rate of 10 per cent per year. Marketing strategies such as brand building and direct selling are most widely used of which brand building is costly as compared to direct selling but the gestation period is large in direct selling. As a result various top cosmeceutical brands such as Rationale, Ultraceuticals, Dermaquest, Synergie skin, Alpha H are blooming in markets.
According to data monitor analysis source cosmeceutical sales by country has been acquired in (US$ million). United States has shown a CAGR of 5.4 per cent from 06–11 followed by Spain and France whereas Sweden has shown the lowest CAGR of 2.6 per cent among the 10 largest cosmeceutical selling markets.
Conclusion
It is always stated that prevention is better than cure in the same manner skin disorder such as acne and others can be corrected at initial stages by managing them with the help of cosmecuticals. As it cures them at the initial stage and prevents them from getting piled up so it can be of great choice for skin disorders. Cosmeceuticals can become more effective if its regulatory background is strengthened so that it can always prevent the various surgical operations for the treatment of skin disease if proper awareness about the medical benefits of cosmeceuticals is created and broaden.
(Author is a Mumbai based pharmaceutical and healthcare consultant)