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Oxidation, glycation main culprits of skin damage

Q. How does protein glycation damage the skin?

Zoe Diana Draelos, M.D.
A. The skin sustains many insults that are cumulative over a lifetime and lead to the appearance of aged skin. Two of the most important insults that the skin sustains are oxidation and glycation. Oxidative damage is the effect most familiar to the dermatologist, and it is caused by dermal protein damage from reactive oxygen species. These reactive oxygen species can be created by UV radiation and combustion byproducts interacting with the oxygen present within the skin. Glycation is a second insult to the skin protein, and it is caused by the linking of sugars with dermal proteins.

The linking of sugars to proteins is a common reaction, resulting in the brown color of toasted bread, the dark grill marks on meat and the simulated tanning of the skin from dihydroxyacetone-containing self-tanning creams. Over time, this same glycation reaction occurs in normal skin (but at an accelerated rate in diabetics). Glycation of body proteins results in many of the conditions associated with aging, including cataracts, macular degeneration, diabetic neuropathy, coronary artery disease and lower-extremity skin ulcers. Glycated proteins are less elastic and more rigid than normal proteins, thus producing findings from decreased contractility in the heart to decreased skin rebound.

The new frontier of preventing signs of aging skin — beyond antioxidants — is antiglycation agents. Ingredients designed to help prevent skin glycation will become the new cosmeceutical category of the year.

Q. Are the blue light devices sold over the counter effective in the treatment of acne?

A. The efficacy of blue light for acne has been well vetted and commercialized in professional devices. The mechanism of acne is understood to be the activation of porphyrins by blue light, resulting in the production of reactive oxygen species that kill Propionibacterium acnes. Most clinical studies demonstrate that blue light is almost as effective as oral antibiotics, but continued treatment is necessary to maintain acne control. The question is whether consumer devices are as effective as professional devices. In general, the answer is "no."

Zoe Diana Draelos, M.D., is a Dermatology Times editorial adviser and consulting professor of dermatology, Duke University School of Medicine, Durham, N.C. Questions may be submitted via e-mail to

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