Most adults are familiar with diabetes, a disease afflicting over 30 million Americans. Individuals with diabetes have elevated glucose (blood sugar) levels because insulin (the hormone which regulates glucose levels) is not functioning correctly. Insulin acts as a chemical messenger allowing cells to absorb blood sugars, providing the energy needed for cellular function and survival.
The blood sugar (glucose) molecules are unable to enter the cell, so they bind with proteins or lipids forming destructive compounds called advanced glycation end products or glycotoxins through the glycation process. These toxic sugar compounds called AGEs cause tissue damage and chronic inflammation, leading to many serious health concerns.
Many adults are unaware that AGES are also responsible for glycated skin.
The following 10 points illustrate why each aesthetician needs to become familiar with skin glycation and the best ways to address it for successful client outcomes.
- Skin glycation typically begins around age 30 to 35.1 Most experts agree that the onset of glycated skin or its outward presentation appears consistent with the aging process, in the 30- to 35-year range. The glycation process occurs at the cellular level of the skin; therefore, results are not visibly evident until the damage is well underway. Eventually, the client can experience accelerated aging, causing wrinkles, the loss of elasticity, and even impaired barrier function.
- Glycation causes cross-linking. The skin’s dermal layer houses many essential components, including proteins that deliver elasticity, structure, and support. Collagen and elastin fibers form a robust and mesh-like structure, similar to a net, that supports and gives the skin its flexibility. Cross-linking is a destructive process causing collagen fibers to become stiff, brittle, and easy to break, reducing structural support. Loss of structural integrity to elastin fibers contributes to sagginess. The damage attributed to cross-linking prevents the cells and tissues of the dermis from functioning correctly.
- Ultraviolet exposure accelerates AGE production.2 Incorporate the use of a broad-spectrum, anti-inflammatory sunscreen into the client’s skin care products. Incorporate client education on all benefits of ultraviolet protection, not just skin glycation. Remember that to add that protection on all exposed areas of skin is essential, as skin cancer and glycation can occur anywhere.
- AGEs promote vascular endothelial growth factor (VEGF) production, a contributing factor for rosacea and couperose.3 Endothelial cells produce a signal protein (VEGF) that stimulates the formation of tiny blood vessels called capillaries. Couperose, caused by the loss of elasticity, presents when small facial capillaries expand. Rosacea is a sensitive skin condition that develops in the mid-to-late thirties, causing dilated capillaries, redness, irritation, flushing, damaged tissue, papules, pustules, and even ocular damage.
- AGEs repel moisture, leading to dry, cracked, and wrinkled skin; include glycerin, hyaluronic acid, and other humectants to protect against dehydration. AGEs also attach to lipids, meaning that the skin’s protective lipid layer within the stratum corneum and the cellular membrane bilayers at all skin levels are at risk. In addition to humectants, incorporate ceramides AP, EOP, NG, NP, and NS, phytosphingosine, sphingosine, and lecithin for lipid protection into the client’s homecare regimen.
- Diets high in carbohydrates and fats increase the amount of AGEs in the bloodstream, promoting oxidative stress and inflammation, which accelerate skin aging. Individuals can combat this destruction by consuming a healthier, low glycemic diet, rich in fruits and vegetables, and by avoiding foods like white bread, white rice, and white potatoes.
- AGE production increases by eating processed foods and specific cooking methods, such as grilling, roasting, frying, broiling, searing, and toasting. Today’s busy lifestyles make it very tempting to eat frozen foods for lunch and dinner, or even worse, the drive-through! Avoid processed foods, cook by boiling or steaming, or use a crockpot when possible. Plan ahead. Prepare healthy meals that last through the busy work week.
- Low pH inhibits AGE development.4 The skin’s pH is acidic, ranging from 4.5 to 6.2 pH varies by ethnicity, gender, area, externally, and internally. A recent study found that meats cooked with acidic ingredients can cut AGE production in half. Ingredients used in the study were:
- distilled white vinegar with a pH of 2.4 (1,000 times more acidic)
- lemon juice with a pH of 2 to 3 (1,000 times more acidic)
- tomato juice with a pH of 4.1 to 4.6 (10 times more acidic)
- Antioxidants, peptides, enzymes, and coenzymes reduce AGEs.5 Look for products with ingredients, including acetyl tetrapeptide 5, vitamins B1-thiamine, B6-pyridoxine, or pyridoxal-5-phosphate, vitamin C, vitamin E-tocopherol, superoxide dismutase, resveratrol, glucosamine, carnosine, benfotiamine, soy proteins like genistein, arginine, and lysine polypeptide, turmeric, and blueberry stems, amongst many others.
- Reduce AGEs through exercise.6 During exercise, muscles pull glucose from the blood for fuel, which lowers blood sugar levels, with effects lasting for 24 to 72 hours. Note, always check with a doctor before beginning an exercise regimen, as the physician knows the amount of exercise activity that is best for their patient.
Fighting glycated skin requires a multifaceted approach. The aesthetic professional must:
- Develop an effective professional treatment plan that consists of anti-glycation components (primarily collagen induction therapies) that may include individual or combination modalities: chemical peels, microneedling, LED, light therapy (laser), radiofrequency, ultrasound, or any additional treatment that stimulates new collagen and elastin production. Additionally, neurotoxins, including Botox, Dysport, Xeomin, and fillers may be utilized to minimize the appearance of glycated skin. Please note, any modality penetrating the dermis requires treatment by a physician, physician’s assistant, or registered nurse. Aestheticians should develop relationships with these medical professionals that are willing to accept patient referrals.
- Recommend the appropriate daily care products, as topical protection against glycation and its inhibition is a crucial factor in a successful outcome.
- Educate the client as to how a healthy diet, cooking methods, and exercise affect the skin.
The client benefits by receiving a holistic treatment program targeting skin glycation with wellness to achieve an improved state of health displayed by beautiful, radiant skin. Additionally, the improvement in the client’s overall appearance provides unsolicited advertising for your clinical expertise.
1 Pugliese, Peter T. “Physiology of the Skin: The Impact of Glycation on the Skin, Part 2.” SKIN INC. Apr 2008. https://www.skininc.com/skinscience/physiology/17660024.html.
2 Crisan, Maria, Marian Taulescu, Diana Crisan, Rodica Cosgarea, Alina Parvu, Cornel Catoi, and Tudor Drugan. “Expression of Advanced Glycation End-Products on Sun-Exposed and Non-Exposed Cutaneous Sites during the Ageing Process in Humans.” PloS One 8, no. 10 (2013): e75003. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3792075.
3 Wikipedia. 2019. S.v. “Vascular endothelial growth factor.” Last modified 16 August 2019. https://en.wikipedia.org/wiki/Vascular_endothelial_growth_factor
4 Uribarri, Jaime, Sandra Woodruff, Susan Goodman, Weijing Cai, Xue Chen, Renata Pyzik, Angie Yong, Gary E. Striker, and Helen Vlassara. “Advanced Glycation End Products in Foods and a Practical Guide to Their Reduction in the Diet.” J Am Diet Assoc 110, no. 6 (2010): 911-116.e12. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3704564.
5 Goldfaden, Gary and Robert Goldfaden. “Prevent Glycation-Induced Skin Aging with Topical Nutrients.” LifeExtension Magazine. Nov 2009. https://www.lifeextension.com/Magazine/2009/11/Prevent-Glycation-Induced-Skin-Aging-with-Topical-Nutrients.
6 Yoshikawa, T., A. Miyazaki, and S. Fujimoto. “Decrease in serum levels of advanced glycation end-products by short-term lifestyle modificiation in non-diabetic middle-aged females.” Med Sci Monit 15, no. 6 (2009): PH65-73. https://www.ncbi.nlm.nih.gov/pubmed/19478714/.