por el Q ∴ H ∴ Jorge Morales Arce México Se denomina moral al conjunto de creencias, normas y circunstancias que acreditan que una persona a lo largo de su vida logre ser una buena persona, su grupo social determinará si el comportamiento es correcto es decir, si se orienta al bien o al mal lo correcto o lo incorrecto de sus acciones. Son las reglas o normas por las que s
Epionce.oneagencylondon.coComparing Epionce® & Prescription Renova®
In a controlled clinical study, an Epionce regimen produced similar results in improving the appearance of photoaging parameters com- Parameter
Epionce (% Change) Renova (% Change)
pared to the gold standard Renova (prescription 0.05% tretinoin).
Using a split-face methodology, an Epionce regimen was compared with prescription Renova (0.05% cream) in a six-month double-blind, prospective, controlled clinical trial during the winter and spring months. The study consisted of 25 panelists who used no sunscreen during the study period. The regimen consisted of Epionce Renewal DISCUSSION
Facial Cream applied twice daily and Epionce Lytic Tx applied nightly, Epionce appears to be the first nonprescription (cosmeceutical) 7-15 minutes prior to Renewal Facial Cream application. The Renova product line to directly compare itself to Renova, the prescription gold regimen consisted of Renova (0.05%) nightly and Johnson & Johnson standard to treat visible signs of skin aging. This data clearly thrusts Softlotion™ 24 Hour Moisture, applied twice daily. The latter has a Epionce to the forefront of non-prescription amelioration of extrinsic consistency similar to that of Epionce Renewal Facial Cream. Most of aging. Most importantly, it validates this new concept for reversing/ the middle-aged population living in the region where the study was preventing visible photoaging by optimizing stratum corneum bar- conducted, who use Renova, also use a moisturizer twice daily (during rier function while safely reversing/preventing activation of chronic inflammatory factors. This breakthrough concept is intuitively based upon increasingly published cutaneous pathobiology discussed in the following paragraphs. A compromised stratum corneum permeability Board-certified dermatologists performed the clinical assessment for barrier results in the activation of chronic cutaneous inflammation both regimens. The clinical results showed no statistical difference by releasing and stimulating synthesis of proinflammatory biologic between the two regimens, although the Epionce regimen was numeri- response modifiers. With as many as fifty percent of women having cally superior in 5 of 7 parameters, as in Table 1. sensitive skin, including individuals exhibiting signs of extrinsic skin aging, a large segment of the population has a documented incompe- tent permeability barrier with accompanying chronic inflammation.2,3 Parameter
Epionce (% Change) Renova (% Change)
Barrier disruption releases pre-formed interleukins (IL-1 alpha and beta, IL-8, IL-12), tumor necrosis factor alpha, growth factors (epider- mal platelet derived, fibroblast and transforming growth factors and granulocyte colony stimulating factor), substance P, and calcium, among others.3 These biologic response modifiers activate nuclear receptors (activating protein-1 and nuclear factor kappa beta) which encode for gene transcription of other biologically active compounds including adhesion molecules, chemokines, selectins, defensins and proteinases. One group of these end products, matrix metallopro- *Skin was cleansed prior to application of leave-on products teinases, destroys collagen, elastin and ground substances thereby producing microscars, which progress to the visible fine lines and wrinkles of extrinsic aging. It follows that chronic exfoliation, unlike In Table 2, the histologic parameters were mixed with comparable the reports in lay literature, is actually destructive, producing visible results with reduction of epidermal and papillary dermal thickness. The Epionce regimen was statistically significantly superior (p<0.05) in increasing epidermal glycosaminoglycans 13.3% vs. 7.4% with Renova The gold standard for photoaging therapy is prescription retinoids. regimen. Dermal density measured by ultrasound also was statistically Renova was the first retinoid therapy approved by the FDA. Retinoids superior (p<0.05) of Epionce, with an increase in dermal density by are known to induce exfoliation, contact irritant and photoirritant 20.8% vs 10.3% with Renova. Renova induced a statistically significant reactions.1,4 The frequency of local skin irritation, desquamation, burn- increase (p<0.05) of stratum corneum compaction of 44.4% vs. 20% for ing sensation, erythema, pruritis and dry skin reaches up to 59% in pa- Epionce. The Epionce regimen induced a highly statistically significant tients using the product. Most reactions were mild, but the incidence (p<0.001) lower incidence of eyelid mild erythema and scaling than of severe reactions was 5% with 0.05% tretinoin cream.5 In a study of Renova. Nonprescription Epionce, with unique mechanisms of action, people with acne and sensitive skin, 23% withdrew by day 29 of treat- is the first cosmeceutical with clinical and histologic results compara- ment.6 The documented incidence of photoirritation to UVB in humans Comparing Epionce & Prescription Renova, cont.
and prevention of visible extrinsic aging. They provide a safe and The FDA has made cautionary recommendations regarding exfoliat- effective over-the-counter therapy that results in healthy, optimally ing compounds due to concerns of increasing chronic inflammation, inducing tumorigenesis.7 Furthermore, the disruption of the perme-ability barrier allows a significantly increased ingress of environ- REFERENCES
1. Nyirady J, Grossman R. Evaluation of Tretinoin Cream 0.05% as a potential cause of phototoxicity
mental insults, including proinflammatory molecules, inducing even and photoallergy. Cosmet Dermatol. 2003;16 (4 Suppl) 14-17.
more destructive chronic cutaneous inflammation. The difference 2. Johnson AW. Population perspectives of sensitive skin. Making sense of sensitive skin. Maibach in the mechanisms of action for Epionce from traditional anti-aging HI (chair). Supplement to Skin and Allergy News. Elsevier. 2003;2:6.
3. Elias PM, Feingold KR. Does the tail wag the dog? Role of the barrier in the pathogenesis of therapies does not preclude combining them. In fact, using Epionce inflammatory dermatoses and therapeutic implications. Arch Dermatol. 2001;137: 1079-1081.
Renewal Facial Cream with Renova and Tazorac® eliminated irritant 4. Kligman AM. Topical retinoic acid (Tretinoin) for photoaging: Conceptions and misconceptions. reactions (pending publication). Anecdotal observations suggest clini- Cosmet Dermatol. 2003;16: (4 Suppl) 3-6.
5. Kang S, Leyden JJ, Lowe NJ, Ortonne JP, Phillips TJ, Weinstein GD, Bhawan J, Lewkaya DA, cal efficacy is improved by combining Epionce and retinoids. Retinoid Matsumoto RM, Sefton J, Walker PS, Gibson JR. Tazarotene Cream for the treatment of facial delivery appears enhanced after Epionce use because retinoids were photodamage. Arch Dermatol. 2001;137:1597-1603.
originally developed for teenagers afflicted with acne who have much 6. Leyden JJ, Grove GL. Randomized facial tolerability studies comparing gel formulations of retinoids used to treat acne vulgaris. Cutis. 2001;67 (6 Suppl) 17-27.
higher lipid content in their skin than more mature patients. It follows 7. Kraeling ME, Bronaugh RL. In vitro percutaneous absorption of alpha hydroxy acids in human that the infusion of Epionce lipids into photoaged skin would be ex- skin. J Soc Cos Chem. 1997; 48;187-197.
pected to maximize retinoid efficacy and minimize adverse reactions. Epionce products are a significant advance in the pursuit for reversal
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