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COSMETIC DERMATOLOGY: PRINCIPLES AND PRACTICE
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TABLE 8-6 Dietary Sources of Antioxidants84 CEREALS (WHOLEMEAL BERRIES Black currant Blackberry Blueberry Cloudberry Cowberry/ cranberry Crowberry Dog rose Rowanberry Sour cherry Strawberry LARGER FRUITS Clementine Date Grape Grapefruit Kiwi Lemon Pineapple Plum Pomegranate Orange VEGETABLES Artichoke Brussels sprouts Chili pepper Kale Parsley Pepper Red cabbage Spinach BEANS Broad beans Groundnut Pinto beans Soybeans ROOTS AND TUBERS Ginger Red beets
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NUTS, SEEDS, DRIED FRUITS Dried apricots Dried prunes Sun ower seeds Walnuts
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CHAPTER 8 NUTRITION AND THE SKIN
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Antioxidants are not panaceas for all health problems They offer significant benefits, but much additional research is required to grasp the full range of their capacities While several antioxidants impart wide-ranging ameliorative effects, it appears likely that greater benefits are bestowed by the synergistic activity of several antioxidants For example, the oral supplement DermaVite consists of a combination of, in descending order of concentration of a marine protein complex, alpha lipoic acid, vitamin C, red clover extract, tomato extract, pine bark extract, vitamins E and B3, soya extract, zinc, vitamin B5, and copper, that has demonstrated clinical efficacy in the treatment of cutaneous aging symptoms (eg, fine and coarse wrinkles, roughness, and telangiectasia) in a randomized, double-blind, placebo-controlled study86
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postprocedural observation days, with statistically significant reductions identified on 2 of the 4 days88 It is important to caution patients that high doses of oral arnica can be harmful, so this dose and potency should not be exceeded If a mild rash develops, the patient is likely sensitive to the compound helenalin, a key constituent found in arnica In this case, arnica use should be halted While not falling into the category of nutritional supplements, topical creams with arnica, like Donell Super Skin K-Derm Gel and Boiron Arnica Cream, are used in the author s practice to accelerate the pace of bruise healing
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Beta-Carotene
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Beta-carotene is a member of the carotenoid family, highly pigmented (red, orange, yellow), lipid-soluble substances naturally present in several fruits, grains, oils, and vegetables (such as apricots, carrots, green peppers, spinach, squash, and sweet potatoes) Notably, in a systematic study of antioxidants in dietary plants, carrots were found to have the lowest content of antioxidants of the array of roots and tubers screened84 Because it can be converted into active vitamin A (retinol), beta-carotene is a provitamin, as are alpha- and gamma-carotene Betacarotene has received substantially more attention than the other carotenoid compounds because it has been shown to contribute much more to human nutrition as compared to its related substances68 In 2006, Stahl and Krutmann reported that the systemic use of beta-carotene in dosages of 15 to 30 mg/d for 10 to 12 weeks had been shown to impart protection against UV-induced erythema, but was insufficient in terms of offering full
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Arnica
The use of the Arnica montana plant has been promoted by homeopathic practitioners for hundreds of years Arnica is used as a supplement for its antiinflammatory properties, which have been attributed to its constituent sequiterpene lactones87 Its primary skin care application is in the treatment and prevention of bruises (see 21) While taking arnica regularly offers little benefit to the skin, the author suggests it to patients before cosmetic procedures such as soft tissue augmentation Four homeopathic arnica pills labeled with 30x dilution taken 4 to 6 hours before a cosmetic procedure is recommended In a recent double-blind study of 29 patients given perioperative homeopathic A montana or placebo after undergoing rhytidectomy, smaller areas of ecchymosis were measured on the 4
protection against UVR89 More recently, investigators reviewed the literature up to June 2007 in PubMed, ISI Web of Science, and the epidermolysis bullosa acquisita Cochrane Library in conducting a metaanalysis of supplementation studies of dietary beta-carotene as protection against sunburn Meta-analysis of the seven studies identified revealed that beta-carotene supplementation did indeed confer protection against sunburn in a time-dependent fashion, with a minimum of 10 weeks of supplementation necessary90 Indeed, in September 2007, Stahl and Sies clarified that dietary carotenoids such as beta-carotene and lycopene, as well as flavonoids, contribute to the prevention of UV-induced erythema formation after ingestion and dispersal to light-exposed areas, including the skin and eyes Specifically, these micronutrients reduced sensitivity to UVinduced erythema in volunteers after 10 to 12 weeks of dietary intervention91 Clearly, there are limits to the protection afforded by beta-carotene In a large-scale randomized, double-blind, placebocontrolled 12-year primary-prevention trial of beta-carotene supplementation with follow-up, investigators found that supplementing with 50 mg of betacarotene on alternate days in apparently healthy male physicians from 40 to 84 years of age in 1982 (n 22,071) did not influence the development of a first basal cell or squamous cell carcinoma92 It is worth noting that beta-carotene supplementation has been demonstrated to contribute to elevating the risk of developing lung cancer in smokers and those exposed to asbestos93 There are minor risks inherent in taking too much beta-carotene and other provitamin A compounds Superficially, the tint of one s skin can be rendered more yellow by consuming
excess carotenoids Because of the inefficiency in the conversion of betacarotene into retinol, there is less risk posed by beta-carotene supplementation in comparison to vitamin A supplementation The author prefers to see patients derive the benefits of beta-carotene primarily from diet, but it can be a useful supplement for those living in warm climates where frequent sun exposure is more likely and whose diets do not include enough of this carotenoid
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