Skin Deep - Clinical & Cosmetic Dermatology Blog

Skin Deep is a blog for dermatologists and skin care professionals with focus on theoretical, cosmetic and aesthetic dermatology. This blog is associated with ‘Dermatologists Sans Borders’ one of the largest curated groups of skin care professionals on facebook. If you are looking for non-technical information, please visit http://skinhelpdesk.com


A phosphatidylcholine hyaluronic acid chitin–nanofibrils complex


Wish you all a merry Christmas and a happy new year!

Ref: A phosphatidylcholine hyaluronic acid chitin–nanofibrils complex:

For the last few weeks I have been discussing about PRP. I came across this article and thought I will review this as it is closely related to PRP. It is from an open access Dovepress journal - Clinical, Cosmetic and Investigational Dermatology. So you should be able to download the full article from the linked page above. The study describes the use of block-polymer nanoparticles based on phosphatidylcholine, hyaluronan, and chitin nanofibrils entrapping amino acids, vitamins, and melatonin.

I have always reckoned that research in cosmetic dermatology may follow different rules from conventional clinical research. Do you still spot any incredulous arguments in this article?

The emphasis on ‘in vitro’ study is always dubious. In fact if you skim through the results section, you may get confused between what is ‘in vitro’ and what is ‘in vivo’.

How do you plan your study protocol when you test an expensive new intervention? You have to compare it to the less expensive gold standard in the form of a equivalence or superiority trial.  Here there is no comparison. So is it better than a simple moisturising cream?

We can see a hint of marketing tactics in the statement “This product was formulated to increase, accelerate, and ameliorate the activity of both antiaging cosmetics and injected temporary or permanent fillers” There is no mention of its effect on dermal fillers in the study design. If you can’t beat them, join them...

Sustainability is an important consideration in cosmetic dermatology. Figure 4 in the article shows that the general amelioration in all factors shows a declining trend during the regression period of 30 days. 90 days follow-up data may be more interesting. Will it show any apparent benefit at all?

There is no mention of the sample size any where! Or did I miss it?

The theory as a whole seems interesting and inspirational! If Only, it works as promised! I give only 2 peels.

GulfDoctor.net peel rating
My Rating: 2 peels
What is peel score?


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The paracrine effect (PRP Part 3)

DAXX pathway in TGF beta signaling
DAXX pathway in TGF beta signaling (Photo credit: Wikipedia)

This is a critical exploration of the potential utility (or otherwise) of Platelet Rich Plasma (PRP) in cosmetic treatments. Please read Part 1 & 2.

Transforming growth factor beta (TGF-β) is a s...
Transforming growth factor beta (TGF-β) is a secreted protein that controls proliferation, cellular differentiation, and other functions in most cells. http://en.wikipedia.org/wiki/TGFbeta (Photo credit: Wikipedia)
Coming to Transforming growth factor beta, TGF-β is a protein that has an inhibitory control over cellular proliferation and differentiation especially epithelial cells. TGF-β induces apoptosis in many cell types through the SMAD and DAXX pathways. It blocks advance through the G1 phase of the cell cycle. Higher concentrations of TGF-β are found in Alzheimer's Disease and Keratoconus. In short it has an effect opposite to that of PDGF.

Fibroblast growth factor (FGF) is a "promiscuous" growth factor with multiple actions on multiple cell types. In mature tissues/systems it is mostly involved in angiogenesis, keratinocyte organization, and wound healing processes. Its two variants FGF1 and FGF2 are more potent angiogenic factors than vascular endothelial growth factor (VEGF) or platelet-derived growth factor(PDGF) and can give rise to granulation tissue.  FGF can bind heparan sulfates in extracellular matrix and could have a paracrine effect that is very important in PRP.

Read all articles in this series on PRP.

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Platelet-derived growth factor (PRP Part 2)

English: Ribbon image of human PDGF receptor b...
English: Ribbon image of human PDGF receptor beta in complex with PDGF-B. This image was created using Pymol, based on 3MJG in the Protein Data Bank. (Photo credit: Wikipedia)
Did you read Part 1?

OK, Let us start our discussion on PRP with the Platelet Derived Growth Factor (PDGF) that served as a prototype growth factor for over 25 years. It plays an important role in blood vessel formation (angiogenesis) and it serves as an important mitogen for fibroblast through signalling pathways modulating cell cycle. Both these effects may be beneficial in skin rejuvenation. Though its overexpression has been linked to various fibrotic disorders and malignancies, it may not be important as far as PRP is concerned. However fibrotic skin disorders like scleroderma should be an important contraindication for PRP.  Here is a summary of PDGF from SLISE.


Read all articles in this series on PRP.

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The Twilight Saga


PRP or Platelet Rich Plasma is a recent cosmetic adaptation of an old technology with promising yet unsubstantiated clinical evidence. ie it is still in the twilight zone of clinical research and is often called  Vampire Facelift. (pun intended!). It is based on the theory that PRP is a rich source of many endogenous growth factors and cytokines that might play a role in enhancing wound healing. PRP is traditionally used in sports medicine and orthopedics but its cosmetic adaptation is based on the neoteric popularity of growth factors in this field. Growth factors could be a double edged sword in cosmetic dermatology. The following list includes the list of growth factors and cytokines present in higher concentration in PRP (courtesy wikipedia).




In the following posts I shall discuss the potential impacts (positive and negative) of these factors on skin from a cell biology perspective. I have no preconceived ideas at this stage neither have I explored them before. Together let us traverse this uncertain twilight zone. Perhaps we may be able to solve the mystery of PRP and who knows many other mysteries as well! BTW did you check out DermKnowledgeBASE?


Read all articles in this series on PRP.

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About Me

As a Dermatologist and Informatician my research mainly involves application of bioinformatics techniques and tools in dermatological conditions. However my research interests are varied and I have publications in areas ranging from artificial intelligence, sequence analysis, systems biology, ontology development, microarray analysis, immunology, computational biology and clinical dermatology. I am also interested in eHealth, Health Informatics and Health Policy.

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Bell Raj Eapen
Hamilton, ON
Canada