Document DJ6vzQ5rMzvJkdK4mVMeZrXn
WOUND HEALING WITH FIFLOW AA
In vivo confocal observations of acne scars reduction
process with Fiflow AA Oxygen: a wound-healing advance
Alain SAINTROND
Jaana PRINTZ
Marion NOUVET
The Innovation Company, Dreux, France (2018)
INTRODUCTION
Acne vulgaris is the most common type of acne skin disease. It generally appears with puberty when hair follicles are clogged with dead skin cells and sebum. Acne vulgaris can be characterized by open comedo (also called blackhead) or closed comedo (whitehead) and pimples appearing on oily skin that may present scarring.
Depending on the phototype and the melanin content of the skin, the scarring is more visible with darker phototypes. There are a wide range of treatments for acne scars such as surgical techniques, chemical peels, ablative lasers, fractional lasers and collagen induction therapy. However, dark-skinned individuals, due to their melanin content, cannot be treated by lasers because of the permanent depigmentation risk.
This problem is also enhanced by the sun. It is well-known that tanning tends to hide acne lesions. Although UV light may have anti-inflammatory effect, it is also comedogenic because sun exposure thickens the skin and promotes hyperkeratosis of both skin surface and follicle.
This study focuses on the treatment of acne scars using Fiflow AA and the follow-up observations with Reflectance Confocal Microscopy.
PRODUCTS
Oxygen therapeutics are derived from hemoglobin or perfluorochemical-based compounds. Fiflow AA is a mixture of fully fluorinated perfluorocarbons (hydrogen atoms have been replaced by fluorine) which are stable and inert due to the strong C-F bond. They have the key property for carrying gases, at 9 times superior to the function of respiratory gases in the human body. The solubility of the gases, notably oxygen and carbon dioxide, in Fiflow AA is a fully reversible phenomenon based on physical gas diffusion (Fick's law).
The following products, containing Fiflow AA (Perfluorohexane (and) Perfluoroperhydrophenanthrene (and) Perfluorodecalin (and) Perfluorodimethylcyclohexane), have been assessed in this study:
application
The testing has been performed according to a half-face method with to the following requirements:
Product
Serum PFI3696CS
Cream PFI3695CS
Oxygenated Serum PFI3480CS
Type of product
Serum
Cream
Serum
Batch number
PFI3696CS
PFI3695CS
PFI3480CS
Fiflow AA content
15%
10%
15%
Oxygen-saturated
No
No
Yes
Test location
Left side of the face and neck
Left side of the face and neck
Right side of the face and neck*
Amount
0.2g / 0.15 ml
0.2g / 0.15 ml
0.2g / 0.15 ml
Frequency of application
Twice a day
Twice a day
Twice a day
Times of application
Morning and evening
Morning and evening
Morning and evening
Frequency of measurements
Before application then once a week Before application then once a week Before application then once a week
Measurements duration
12 weeks
12 weeks
8 weeks
*The right side of the face and neck was the control skin area for 5 weeks then we started to apply the Oxygenated products.
Oxygenated Cream PFI3479CS Cream PFI3479CS 10% Yes Right side of the face and neck* 0.2g / 0.15 ml Twice a day Morning and evening Before application then once a week 8 weeks
Table 1: Studied products, characteristics and application parameters
For each side of the face and neck, the serum is applied first and then the cream was applied after. The products were evenly spread on the whole part of the face.
subject
Our subject was a 30-years+ (non-smoker) woman with a phototype IV. Our subject showed a lot of acne scars on her face which have developed over 15 years and had tried to treat with benzoyl peroxide creams.
Age
Gender
30
Female
Table 2: Subject description
Phototype IV
Test location Face
Sun exposure Occasional
Tabacco consumption No
Alcohol consumption Rare
REFLECTANCE CONFOCAL MICROSCOPY
The Reflectance Confocal Microscope (RCM) is a non-invasive device making possible to have in vivo measurements by optical biopsies and to observe internal skin layers up to the deep dermis. It has a laser probe for observing deep skin layers and blood microcirculation, a macro digital camera VivaCam to capture macroscopic skin images and has a digital high-resolution screen.
MULTIPARAMETER SKIN ANALYZER
The multiparameter skin analyzer is a non-invasive method to perform in vivo measurements of skin properties by means of different probes (macro-camera, skin colour, ultrasounds, hydration, skin elasticity and sebum collecting devices).
Macroscopic aspect (left side) Time of measurement
Before having started the study
Camera
Macro-camera from the multiparam- Macrocamera from the Reflectance
eter skin analyzer
Confocal Microscope
12 weeks after applying the Serum and Cream twice a day
Macroscopic aspect (right side) Before having started the study
12 weeks after applying the oxygenated Serum and Cream twice a day
Table 3: Comparison of macroscopic aspect of the skin before and 12 weeks after using Serum and Cream (left side) and skin before and 8 weeks after using Oxygenated Serum and Cream (right side)
Air Quality Index
Impact of Air Quality Index on skin hydration properties In Vivo testing - DermaLab Skinlab Combo - Hydration pin probe
1 subject - Dark phototype - 30-years old woman
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30-Jan-2018
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11-Mar-2018 21-Mar-2018 31-Mar-2018 10-Apr-2018
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Date of study
Air Quality Index (Paris)
Control than with BTX Serum and Cream loaded with oxygen
With BTX Serum and Cream
Graph 1: Skin hydration depending on air quality index and applied products
Skin conductance defininf skin hydration (S) Air Quality Index; Skin Luminosity (L*)
Impact of Air Quality Index on skin color properties In Vivo testing - DermaLab Skinlab Combo - Skin colour probe 1 subject - Dark phototype - 30 years old woman - Control Skin Area then with Oxygenated Serum & Cream
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1-Mar-2018 11-Mar-2018 Date of study
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Air Quality Index (Paris) Skin Luminosity (L*) Melanin Erythema b*
Graph 2: Evolution of skin color by using serum & cream containing Fiflow AA and impact of Air Quality Index
Skin hydration shows a lot of variation. The Air Quality Index has an impact on skin hydration. Skin hydration has been increased by 120% after 8 weeks of oxygenated products application vs. 211% after 12 weeks of serum and cream use.
Melanin index has been reduced by 8% after 12 weeks of application. Skin Luminosity shows fewer variations.
Air Quality Index
Impact of Air Quality Index on sebum content In Vivo testing - DermaLab Skinlab Combo - Sebum tape
1 subject - Dark phototype - 30-years old woman
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0 20-Jan-2018
30-Jan-2018
9-Feb-2018
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1-Mar-2018 11-Mar-2018 Date of study
21-Mar-2018 31-Mar-2018 10-Apr-2018
0 20-Apr-2018
Transparency of the film (sebum content - %)
Air Quality Index (Paris)
Control than with BTX Serum and Cream loaded with oxygen
With BTX Serum and Cream
Graph 3: Evolution of sebum amount depending on the products and Air Quality Index
Sebum content has decreased up to 66% with the use of cream and serum containing Fiflow AA. However, serum and cream with Fiflow AA Oxygen tend to increase the sebum content. This phenomenon is enhanced with the Air Quality Index and so when the air is more polluted.
The restructuring of skin layers is shown only with the use of cream and serum (non-oxygenated). This impact is also observed with the use of oxygenated cream and serum..
Table 4.
Collagen density and Skin thickness
Increase of collagen density with the use of serum and cream containing Fiflow AA Reflectance Confocal Microscope analysis
Before
After 6 weeks
After 12 weeks
The above picture show the restructuring of the dermis. Collagen network is visibly more week after week. After 12 weeks, the collagen network is dense, strong and composed of long and thin collagen fibers and bright bundles.
Table 5.
Stratum Corneum structure
Restructuring of Stratum Corneum with the use of serum and cream containing Fiflow AA
Before
. ArdA
After 6 weeks
After 12 weeks
At the beginning of the study, the skin displays wide furrows and bright corneocytes. Week after week, the skin furrows became thinner and corneocytes are less bright and smaller. It highlights the increase of skin moisturization and rejuvenation.
Table 6.
Stratum Granulosum structure
Restructuring of Stratum Granulosum with the use of serum and cream containing Fiflow AA
Before
After 6 weeks
After 12 weeks
Before starting the study, Stratum Granulosum was not well structured with bright, molted and amorphous keratynocytes. There was no visible honeycomb pattern of keratinocytes. With the use of serum and cream containing Fiflow AA, the skin layer became well-defined with a visible honeycomb pattern of regular keratinocytes. This is typical in healthy young skin.
Table 7.
Dermal Epidermal Junction structure
Restructuring of Dermal-Epidermal Junction with the use of serum and cream containing Fiflow AA
Before
After 6 weeks
After 12 weeks
In Reflectance Confocal Microscopy, Dermal Epidermal Junction shows the blood flow and dermal papillae. Before starting study, this layer was not clearly defined with elongated and few dermal papillae. Capillary loops and blood flow were not clearly visible. The daily application of serum and cream with Fiflow AA has boosted blood flow. Vessels are more visible and there is more dermal papillae, which are also round-shaped and more regular.
CONCLUSION The long-term study shows a reduced pigmentation of acne scars as soon as 2 weeks after the start of the study. On the right side of the face (control area), acne scars and bumps are still present then this side of the face have been chosen to test oxygenated serum and cream with Fiflow AA Oxygen.
After one month of treatment, skin hydration, skin luminosity, skin thickness and collagen network density have significantly increased due to the oxygenating power of Fiflow AA Oxygen on the skin cells. It consequently improves cell breathing and moreover, it stimulates fibroblasts and collagen network density. These results improved week after week for the both sides of the face.
The use of oxygenated serum and cream with Fiflow AA Oxygen are isotonic oxygen-saturated products that enhanced the effects of Fiflow AA due to the more oxygen content that is delivered into the skin. Although these saturated products enhance the skin layers restructuring, they also seem to increase sebum content of the skin contrary to the other side of the face, which does not show pimples anymore.
The Air Quality Index has a strong impact on skin properties mainly on skin surface properties such as hydration, skin colour and sebum. This is due to the pollutant gases contained in air that can be removed with the use of Fiflow AA products.
To observe the long-term effects on acne, it is essential to regularly apply these products and use a medium Fiflow AA mixture version which would be loaded but not saturated with oxygen. It would also be relevant to combine these products with an application of an exfoliating treatment with AHA to enhance the effects.
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