Written by
Richard A. Strick, M.D.
Clinical Professor of Dermatology, UCLA School of Medicine
- Prior to
my Ethocyn research in vitro studies found that Ethocyn, which
is a non-steroidal DHT receptor blocker, increased the production
of elastin in tissue cultures of skin fibroblasts. I was asked
by Chantal Burnison, the chemist who had synthesized this novel
and patented compound and the CEO of the company which bears her
name, (Chantal Pharmaceutical) if I could test Ethocyn clinically
on skin and document its in vivo effects.
As you know, with intrinsic aging there is decreased production
of elastin, and with photo aging solar elastosis occurs which
leads to accumulation of elastin-staining material within the
dermis, but which does not contribute significantly to the elastic
tissue network in skin. Therefore, both types of aging changes
contribute to loss of skin elasticity and to formation of wrinkle
lines. It followed logically that if this compound could stimulate
the production of normal elastin in aging skin in vivo it would
help to restore the elasticity of youth. In view of the recent
reports that post menopausal women who receive hormonal replacement
therapy have less wrinkling than those who do not get replacement,
it makes sense that a DHT-receptor blocker in skin would be helpful
against such aging changes.
-
- My first
study involved 20 subjects 40 to 57 years old who applied Ethocyn
5% in an alcohol and water vehicle to their facial skin and to
the skin of their ventral forearms. Biopsies of the ventral forearm
skin were done at the beginning of the study and at 2 month intervals
during a 6 month period. This area was chosen because it is relatively
protected from the sun and I was concerned that solar elastotic
changes might make it difficult to impossible to quantify the
changes in elastic tissue using the computer image analysis techniques
utilized in the study.
The relatively high concentration in this pilot study was to be
sure that the DHT receptors would all be blocked. The alcohol
and water vehicle used in this pilot study was chosen in order
to be certain that any beneficial effects would be from Ethocyn
rather than from the vehicle. The tissue was stained with Verhoeff's
stain so that the elastin stained black. At the end of the study
the slides were randomized so that it was not known which slide
was from which patient at which time and then photographed through
the microscope with a camera which allowed the images to be stored
on a computer. Computer image analysis was then performed to determine
the percentage of surface area of each slide which took up the
elastic tissue stain. After breaking the code it was found that
the average increase in elastic tissue was about 100% as measured
by computer image analysis. The findings of this study were statistically
significant at a level of p<.001.
On microscopic examination the quality of the elastin which had
been produced was that of the normal collagen seen in youth. Subjects
reported that their skin was "smoother, tighter and less
wrinkled". I presented the findings of this study at the
American Academy of Dermatology meeting in August 1994, at the
1994 Dermatology Therapy Association meeting, and at UCLA Dermatology
Grand Rounds. The results are shown in Table
1.
The second study used Ethocyn Essence, a liquid form of 0.5% concentration
followed by the application of Ethocyn Moisturizing Cream 0.01%.
Because the results had been apparent faster than had been anticipated
in the first study, this was done as a three month study with
monthly biopsies. The subjects ranged in age from 40 to 77 years
old and biopsies were also done on 18 to 25 year olds and all
were analyzed blindly as with the first study.
The first month elastic tissue results showed a greater than 50%
increase and at 2 months the increase was over 100%, with all
subjects showing a response. Their skin had become visibly less
wrinkled, especially as they would smile, frown and talk, in many
cases the skin improved dramatically.
By 3 months there was an even further increase in the average
elastic tissue levels. By 2 months the elastic tissue levels were
comparable to the levels found in the control group of 18 to 25
year olds (average age 20). The p value for this study was also
<.001. The evaluation of ultra close-up photographs from the
beginning to the end of the study confirmed that the use of Ethocyn
improved the appearance at a high level of statistical significance.
Safety has been confirmed in both studies, and in other testing.
This product is not a photosensitizer, it is nonirritating and
it is hypoallergenic. It is completely metabolized within the
skin so that none of it is absorbed in an active form.
The results of this study were presented at the International
Society for Androgenic Disorders Symposium, the 1995 meeting of
the Dermatology Therapy Association, the UCLA Conferences on Aging,
and the St. Johns Hospital Dermatology Grand Rounds. The results
of this study are enclosed in the accompanying table.
Another study was then done by Stephen Tucker, M.D. and I in which
he did the biopsies and evaluated the patients and I did the computer
image analysis. This 20 patient study differed in that the biopsies
were taken from the dorsal forearms in order to determine whether
we could use the computer image analysis technique to evaluate
changes in sun damaged skin, or whether my initial concerns that
solar elastosis would mask the changes so they would not be perceived
by this system. As was feared, at least in this group of Texans,
the solar elastotic changes were so great that they did confound
the ability of the image analysis technique to quantify any changes.
This study did confirm the clinical benefit of the product in
that all but one of the 20 subjects was evaluated as improved
visibly with the use of Ethocyn on their facial skin.
Ethocyn has been available for use as a cosmetic since late 1994
and many thousands of people have noted improvement as was seen
in the studies and as was proven with the computer image analysis
techniques used in the studies. In a survey of 176 Ethocyn users
which I conducted 76% said that they had noticed significant improvement
in their skin. All but two of these people noted the improvement
within the first four months of use. Of those who did not say
that they had seen significant improvement at the time of the
survey more than half either had been using it less than two months
or reported that other people had noticed that their skin had
improved.
Ethocyn will not get rid of every wrinkle. However, it can be
expected to decrease wrinkles and to make the skin smoother and
to have a better texture. The results are especially noticeable
with the dynamics of facial expression and speech. For example,
frown or smile lines that stay after the expression changes and
slowly return to the neutral position, following use of Ethocyn
the increased elasticity will allow the skin to snap back into
the appropriate position, as it does in younger individuals. The
skin should be tighter and less sagging. This is also true for
other areas, such as the neck and the backs of the hands. Although
fine lines tend to do especially well some individuals see dramatic
improvement of deeper lines.
Results begin to be noticed within the first month or two of use
in many individuals and within three to four months in virtually
everyone. Since the improvement is gradual and may be subtle Ethocyn
may be used on one side first, keeping the other as a comparison
until the first sign of improvement is seen if the person wants
to test its efficacy. In fact the company making Ethocyn has used
people who have applied the product only to one side as a major
focus of their advertising campaign since that is such an obvious
way to show that it really works. In order to maintain the skin
elasticity it is necessary to continue to use the treatment.
Ethocyn
is hypoallergenic and it is compatible with other products used
to treat intrinsic and photo aging changes. It is used by some
plastic surgeons before and after face lifts and other such procedures
because it provides skin that is more elastic and healthier so
that the results are better. It has also been of benefit in conjunction
with skin resurfacing procedures for many patients.
Richard A. Strick, M.D.
- Clinical
Professor of Dermatology/Medicine
- UCLA School
of Medicine
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