Most Frequently Asked Questions
1.
What
is the difference between NeoStrata products and Exuviance Products?
Both the NeoStrata
and Exuviance brands offer high quality, advanced anti-aging and therapeutic skin
care using NeoStrata Company’s patented AHA, PHA and bionic acid technology.
The NeoStrata brand
products are formulated for use by physicians and their patients to maximize skin
care in conjunction with other treatment modalities. The products generally do not
contain ancillary ingredients that may interact with skin during treatment, including
fragrances and colors. NeoStrata brand products are only available through a physician.
The Exuviance brand
products are designed to provide ‘physician-quality’ while also including additional
skin benefit ingredients such as vitamins, marine and botanical extracts, and colors
and fragrances to appeal to the prestige product user. The Exuviance products are
available through various retail outlets. Exuviance Professional products are available
for use by skin care professionals in spas and salons, and some are available for
resale to their patients.
2.
What
percentage of AHA is in the Exuviance products?
Exuviance products
contain up to 11% of hydroxyacids; product selection depends on the intended use
of the products. Exuviance Professional products contain up to 12% hydroxyacids
and the Exuviance Professional Revitalizing Peel contains 30% glycolic acid.
3.
What
are the effects of AHAs on skin?
Alpha-hydroxyacids
have been shown to decrease the bonding properties between surface skin cells stimulating
transient exfoliation and cell turnover. Epidermal structure has been shown to normalize,
or become more youthful, with AHA use leading to normal melanin distribution (evening
of pigmentation/clarity), thickened cell layers and skin plumping. Histology studies
with higher concentrations of AHAs have shown dermal effects including: collagen
deposition, reversal from globular elastotic fibers to elongated, functional elastic
fibers, and glycosaminoglycan (GAG) deposition that leads to significant skin plumping
and the reduction in appearance of wrinkles and fine lines. Aside from prescription
retinoids, there are NO other ingredients on the market that can demonstrate these
significant skin benefits.
4.
What
is the difference between AHAs and PHAs?
Polyhydroxy acids
are alpha hydroxyacids with additional (i.e., poly) hydroxy groups on the molecule.
The added hydroxys make the PHA compounds more moisturizing due to their strong
humectant properties. In addition, the PHA compounds have been found to be more
gentle without the stinging and burning that often accompanies AHA use. Since PHAs
share the same fundamental structure as AHAs, they provide similar anti-aging benefits
and exfoliation. Some PHAs such as gluconolactone and the complex PHA lactobionic
acid are antioxidants. Studies with the PHA gluconolactone indicate that it can
increase the skin’s resistance to chemical challenge thereby making it very useful
for sensitive skin.
5.
How
do the PHAs function as anti-oxidants?
Gluconolactone and
lactobionic acid are chelating agents that trap oxidation-promoting metals in skin.
Interestingly, lactobionic acid is currently used in organ transplant preservation
(as a component of Viaspan by DuPont) due to its potent anti-oxidant properties.
The PHAs have also
been shown to function as an antioxidants by inhibiting the oxidation of other readily
oxidizable substances including the drugs anthralin and hydroquinone, as
well as banana peels. Since oxidation and skin degradation due to UV
induced free radical damage are a cause of skin aging, the potent antioxidant benefits
of PHAs may play an important role in its anti-aging effects.
Additionally, research
with organ preservation has revealed that lactobionate is a cryptic inhibitor of
matrix metalloproteinase (MMPs) enzymes obtained from human liver effluents
during transplantation. Implications for benefits in skin are great considering
that MMPs are responsible for the degradation of the skin’s extracellular matrix
and structural integrity thereby contributing to wrinkle formation, skin laxity
and telangiectasia. Naturally occurring tissue inhibitors of MMP protect the skin
from degradation caused by the MMPs, however UV exposure and aging lead to an increase
in MMP activity and the resultant visual and morphological signs of photodamage.
The use of lactobionic acid to inhibit MMPs may provide a significant benefit to
photoaged skin.
6.
What
is the compatibility of NeoStrata and Exuviance products with other cosmetics
and drugs; what is the order of application?
NeoStrata and Exuviance products can be used in conjunction with other cosmetic
and therapeutic skin care regimens. In general, the recommended procedure is: (1)
wash and dry face; (2) apply topical medications if appropriate and allow to absorb
(a few minutes); (3) apply leave-on skin care products and sunscreen (not wipe off
toners or solutions); (4) apply make-up. Consult your physician for any specific
questions regarding drug compatibility with skin care products.
7.
What
products do you recommend for acne prone patients?
- Use a gentle, non-drying cleanser to remove sebum without over drying:
- Apply anti-acne medication:
- Use adjunctive products to enhance anti-acne effects and condition the skin:
- The NeoStrata and Exuviance glycolic acid peels can be used adjunctively with other
topical and systemic anti-acne regimens.
8.
What
products can be used for sensitive skin?
The NeoStrata and
Exuviance brand PHA products are recommended for use on sensitive skin since they
provide anti-aging and adjunctive therapeutic benefits while being gentle, non-stinging
and skin conditioning.
9.
What
products do you recommend for rosacea?
The NeoStrata and
Exuviance brand PHA products are recommended for use on sensitive skin including
rosacea since they provide anti-aging and adjunctive therapeutic benefits while
being gentle, non-stinging and skin conditioning. A clinical study with the Exuviance
Gentle Cleansing Creme, Soothing Toning Lotion, Multi-Protective Day Fluid SPF 15
and Evening Restorative Complex showed excellent compatibility of the PHA products
with rosacea and atopic dermatitis, and some users were able to lower or discontinue
their topical medicines to treat these conditions. Additionally, the Exuviance/NeoStrata
Anti-Bacterial Facial Cleanser is recommended for skin cleansing twice daily since
there may be an infective organism promoting the condition of rosacea.
10.
Which
NeoStrata and Exuviance products can be used in conjunction with microdermabrasion?
To smooth the skin
before microdermabrasion and promote a more uniform, even microdermabrasion to the
skin, NeoStrata recommends use of hydroxyacid products at least two weeks prior
to receiving the procedure. Following the procedure, the following products should
be used as long as the skin is intact and not open or wet. Daytime use of one of
the SPF 15 containing Exuviance or NeoStrata PHA products is strongly recommended
including, Exuviance Multi-Protective Day Fluid/Creme, NeoStrata Daytime Protection
Cream or NeoStrata Oil Free Facial Lotion. Additionally, the following products
are suggested:
11.
When
can peels be performed after microdermabrasion?
A sufficient period
of time should pass following the use of any of treatments and products that affect
the skin’s barrier to allow the skin to heal before a peel is performed. If the
peel is performed too soon after a microdermabrasion procedure there may be an increase
in the reactivity of the skin to the glycolic acid leading to a deeper peel and
the potential for unintended results and longer healing. If a superficial microdermabrasion
is performed, at least two weeks should pass before peeling. If a deeper microdermabasion
is performed, allow at least one month before peeling.
12.
Which
products should be used prior to a glycolic acid peel?
If the person has
never used glycolic acid, a glycolic acid containing product should be used for
two weeks prior to the peel to test the skin’s reactivity before applying the peel.
The Exuviance Multi-Defense Day Fluid or Creme SPF 15, and the NeoStrata Skin Smoothing
Cream are good choices. If skin tolerance to glycolic acid is known, then either
a PHA or AHA product should be used for two weeks prior to the peel to initiate
preliminary exfoliation and smooth the skin.
13.
What
is the expected response of a peel? How often should peels be performed?
Following a superficial peel, stinging, itching, burning, tightness, minor swelling
and peeling of the surface layers of the skin may occur depending on individual
skin responsiveness to the glycolic acid. These sensations will gradually diminish
over the course of the week as the skin returns to its normal appearance. If hyperpigmentation
occurs, apply skin lightening products as soon as tolerated. For example, Exuviance
Professional Intense Lightening Complex or NeoStrata Gel for Age Spots and Skin
Lightening.
Timing between peels
is determined by the response to the previous peel. Peels can be performed as soon
as two weeks later if there is minimal discomfort and desquamation after the previous
peel and the skin has healed completely. However, if a subsequent peel is conducted
within a week or two, skin reactivity to glycolic acid may be increased resulting
in a stronger effect than desired with a longer healing phase. If a greater effect
occurred with the previous peel, the next peel should be scheduled at least four
weeks apart, after the skin has fully healed.
14.
What
is the maintenance after the peel?
- Wash
the area very gently as directed by the physician. Following superficial peels,
NeoStrata Facial Cleanser or Antibacterial Cleanser, or Exuviance Gentle Cleansing
Creme, Purifying Cleansing Gel or Moisturizing Anti-Bacterial Facial Cleanser can
be used.
- Apply
NeoStrata NutriCream or Bionic Face Cream, or Exuviance Professional Ultra Rich
Restorative Creme twice daily for at least one week until the skin returns to its
normal appearance. Then resume regular use of the NeoStrata or Exuviance AHA or
PHA products.
- Do not
use abrasive or exfoliating sponges on the area.
- Avoid
sun exposure until the skin returns to a near-normal appearance. Use a broadspectrum
(UVA/UVB) sunscreen with at least SPF 15 as soon as tolerated by the skin.
- To avoid
the possibility of scarring:
- Do not
peel, pick, scrape or scratch the skin
- Do not
use a mask or any exfoliating facials on the skin
- Do not
wear tight head bands, hats, etc. (if the face has been peeled)
- Do not
expose the skin to sun
- Call
your physician or skin care specialist for any questions or concerns.
15.
Can a person with a history of Herpes infections receive a glycolic acid
peel?
Recurrent Herpes infections
have been attributed to minor traumas, exposure to other infections, UV radiation,
neural or dental surgery, dermabrasion, and emotional stress. Experience with the
Skin Rejuvenation System has shown that superficial peeling can stimulate Herpes
outbreaks in prone individuals. In order to prevent a Herpes breakout, prone patients
should be instructed by the physician to take an oral antiviral drug (acyclovir,
valacyclovir, etc.) as directed by the manufacturer (usually a couple of days before
the procedure continuing for a few days after the procedure). Any patient that experiences
moderate to severe Herpes infections should not undergo peeling with the Skin Rejuvenation
System. Any patient with an ACTIVE herpes breakout should not be peeled until fully
healed.
16.
Which
products do you recommend before laser surgery? (also see number 15)
Prior to non-ablative
laser surgery in which the surface of the skin is not removed, an AHA or PHA product
is recommended for use to smooth the skin and prevent light scattering of the laser
beam. Skin lightening products are also useful prior to performing laser or peels
on individuals with the potential to hyperpigment following the procedure.
Suggested products:
NeoStrata Gel for Age Spots and Skin Lightening
17.
Which
products do you recommend following laser surgery?
Non-ablative laser surgery targets the deeper skin layers where collagen and elastic
fibers are found. To target the top layers of skin and promote skin smoothness with
an even skin tone, use of the AHAs and PHAs is recommended.
18.
NeoStrata recommends the use of NeoStrata
and Exuviance products with non-ablative laser procedures to provide the
following benefits: (as per Dr. BERNSTEIN)
-
pre-procedure to reduce and make compact the stratum corneum. This allows the laser
light source to penetrate the skin without significant light scattering thus providing
an optimal effect.
-
pre-procedure to reduce pigmentation in the skin; skin melanin absorbs the light
energy and causes the skin to heat up which causes negative side effects.
-
pre-procedure and post-procedure to enhance epidermal cell turnover to provide an
epidermal benefit to complement the dermal effect of non-ablative laser.
-
pre-procedure and post-procedure to provide an enhanced skin benefit to all levels
of skin. Dr. Eric Bernstein has just published an article showing collagen gene
induction in the dermis.
-
Intermittent use of glycolic acid peels after skin has fully healed from laser to
optimize the effects of laser.
ü
Suggested product regimen:
-
pre-procedure am: SPF 30 sunscreen
-
pre-procedure pm: Exuviance Intense Lightening Complex* then NeoStrata
Skin Smoothing Lotion with PHA over it (NeoStrata/Exuviance Bionic Face Cream or
Bionic Serum)
-
post-procedure am: SPF 30 sunscreen
-
post-procedure pm (first week): PHA (Bionic Face Cream or Bionic Serum) only for
one week while the skin is somewhat sensitive
-
post-procedure pm (one week later): Skin Smoothing Lotion with PHA (Bionic Face
Cream or Bionic Serum)
* The goal
is to provide a more even skin tone before the laser procedure to minimize side
effects from excessive heat build up in the skin. The length of pre-treatment depends
on the skin tone and may be up to 2 months.
19.
What
is the difference between Bio-Hydrating Cream and Bionic Face Cream
The Bio-Hydrating
Cream contains 15% gluconolactone and is promoted for use with adult acne and as
the “NeoStrata-15” PHA product. The Bionic Face Cream contains 8% gluconolactone
with 4% lactobionic acid and is intended for intense moisturization of dry, photoaged
skin, or for use following non-ablative laser, microdermabrasion and peels.
20.
What
is the purpose of the Renewal Cream?
The Renewal Creme
and Exuviance Professional Rejuvenating Complex contain 12% PHA with 1% retinyl
acetate (pro-vitamin A). It is recommended for use once daily on more severe photoaged
skin and can also be used adjunctively for acne as long as other retinoids products
are not being used.
21.
What
products can be used on dry skin?
The PHA products are
recommended for use on dry skin since the PHAs are potent moisturizing compounds.
22.
What
are the results of using Vespera Bionic Serum?
Results
of a twelve week clinical study on 26 women with twice daily Vespera Bionic Serum
application indicate significant improvements in photoaging at the evaluated 6 and
12 week time points for all of parameters including: fine lines, wrinkling, pore
size, laxity, roughness, sallowness, pigmentation, and clarity. Analysis of silicone
replicas revealed significant improvements in texture parameters representing the
depth, number and spacing of fine lines and coarse lines thus providing strong support
for the clinical grading scores. The product was well tolerated by the users.
To assess skin plumping,
Vespera was applied to the forearms three times daily and skin thickness was measured
using calipers. Results showed a statistically significant increase (p<0.05)
in skin thickness measurements at 12 weeks when compared to the untreated arm, and
in comparison to baseline with a total increase of 9.7%. Untreated forearm skin
thickness measurements were not statistically changed between baseline and endpoint.
There were no significant increases in irritation on the treated arm demonstrating
tolerability with exaggerated use of three times daily.
Refer to publication: Green BA, Edison BL, Wildnauer RH, Sigler ML. Lactobionic
acid and Gluconolactone: PHAs for Photoaged Skin.
Cosmet Dermatol 2001; 9:24-28.
23.
How
does Lactobionic acid affect pore size, and improve uneven pigmentation?
It is believed that
the AHAs/PHAs affect pore size by helping to cleanse out cellular debris and also
enhance skin elasticity. The epidermal cell turnover effects and normalization process
help to correct hyperpigmentation and promote a more even appearance.
24.
Can
AHAs and PHAs be used to improve skin under eye circles?
A visit to a dermatologist can determine whether the circles are due to hyperpigmentation
(increased melanin production), and if so whether it is epidermal (surface) or dermal
(deep) in its location, or due to blood deposits (hemosiderin) in the skin. The
latter is common and does not respond well to topical treatments. Epidermal hyperpigmentation
can be treated successfully with skin lightening products such as the NeoStrata
Bionic Skin Lightening Cream, SPF 15, or the Exuviance Skin Lightening Gel or Exuviance
Professional Intense Lightening Complex (available through skin care professionals).
Dermal hyperpigmentation does not respond as well to topical treatments. It is also
advisable to use the CoverBlend Multi-Function Concealer with PHA to cover the dark
circles and the Exuviance Hydrating Lift Eye Complex for moisturization and diminishment
of the appearance of fine lines and wrinkles.
25.
What
is the difference between CoverBlend and the Exuviance Foundations?
The Exuviance Foundations
with SPF 15 sunscreens and 4% PHA provide medium coverage for daily cosmetic use.
CoverBlend Concealing Treatment Make-Up SPF 20 with 4% PHA provides a natural appearance
and heavy coverage/opacity for use by individuals desiring to conceal a mark or
coloration on the skin. This product is ideally suited for those with vitiligo,
port-wine stains, birth marks, burn scars, and for use in theatre. CoverBlend is
smudge-proof and water-resistant.
26.
Explain
CoverBlend application techniques and various uses.
CoverBlend is an opaque
concealing makeup designed to cover areas on skin with deep pigmentation or coloration,
for example, Port-Wine stains, vitiligo, birth marks, post-laser redness, etc. The
products are applied to clean skin using a layering technique to provide the desired
degree of opacity. There is an optional finishing powder to reduce skin reflectance.
27.
Does
NeoStrata Company test on animals?
NeoStrata Company, Inc. does not conduct animal testing on its marketed skin care
products including the NeoStrataÒ and ExuvianceÒ brands. All routine product
safety testing is carried out on human volunteers or using in vitro models.
28.
Does NeoStrata Company use animal derived ingredients?
NeoStrata Company
endeavors to use non-animal derived ingredients whenever possible, by substituting
plant-derived and synthetic materials in their place.
29.
Can
AHAs/PHAs be safely used for long periods of time? Is there an increase in
sun sensitivity?
NeoStrata Company is not aware of any data indicating that there are safety issues with
long-term use of alpha-hydroxyacids (AHAs). On the contrary, there are people with
ichthyosis (severe dry skin) that have been using high concentrations of AHAs over
large portions of their bodies for many years (since the early 1970s) and there
are no reported long-term adverse events.
One negative effect that has been reported with the use of AHAs pertains to a small,
but statistically significant increase in the skin's susceptibility to UV light
as measured by the sunburn cell model. Notably, this effect can be prevented with
use of a low level sunscreen (SPF 3). As a general rule, we recommend use of at
least SPF 15 sunscreen in combination with daytime AHA use. All of NeoStrata’s daytime
products are formulated with SPF 15 sunscreens. Use of the PHAs (gluconolactone)
has not demonstrated this increase in sun sensitivity, and therefore may be another
option.
Clinical studies have demonstrated that there is a regression in skin benefits after
AHA use is discontinued. Therefore, skin will no longer improve after AHA use is
discontinued.
30.
How
will the labeling of NeoStrata’s AHA-containing products change to reflect
FDA’s concern of increased sun sensitivity?
We will strengthen
our existing recommendation: “Daily use of a sunscreen recommended with this product”,
on all NeoStrata and Exuviance formulations that contain glycolic acid or lactic
acid, that do not contain a sunscreen. (Note, the statement will appear on the outer
carton only, not the inner package, and not samples. The peels are not going to
contain this warning because there are extensive warnings listed in the printed
physician guidelines booklet. The new wording will appear on the next productions
of new cartons and will be phased-in over the next year.)
Daily use of sunscreen or sun avoidance is recommended with use of this AHA product
and for one week after to minimize the risk of sun sensitivity/sunburn.
31.
What
is the meaning of the term ‘oil-free’ in cosmetic products?
NeoStrata and Exuviance
products are considered oil free if they do not contain mineral oil, petrolatum
(petroleum jelly), or other natural oils such as peanut oil or macadamia nut oil.
32.
What
is the meaning of the term ‘non-comedogenic/non-acnegenic’ in cosmetic products?
- Non-comedogenic: product use does not cause black heads and white heads (comedones).
- Non-acnegenic: product use does not cause acne.
33.
Can
someone with celiac sprue use NeoStrata and Exuviance products?
The alcohol in some
NeoStrata and Exuviance products is derived from a grain source. Some of the long
chain fatty acids, lecithin, etc. are also obtained from a plant source. As a result,
NeoStrata and Exuviance products may not be safe for use by people having celiac
sprue. We welcome any experiences with NeoStrata and Exuviance products from celiac
sprue customers to help build our understanding of the success of product use with
this condition; please send correspondence to
Bgreen@neostrata.com.
34.
Can
NeoStrata and Exuviance products be used during pregnancy?
Unfortunately, it is nearly impossible to conduct product safety studies on pregnant
women. As a result, there are no controlled clinical studies describing the safety
of AHA products on pregnant or lactating women. While glycolic acid and gluconolactone are naturally
occurring compounds, which are considered to be very safe, NeoStrata recommends
that all pregnant and lactating women seek the advice of their physician before
using AHA containing products. In addition, NeoStrata recommends that all drug products
including, skin lightening topicals with hydroquinone or kojic acid, and acne treatments
with salicylic acid be discontinued during pregnancy and lactation. Furthermore,
NeoStrata does not recommend the use of skin renewal peels during pregnancy and
lactation since many women experience significant skin changes during this time
and therefore the response to a peel is less predictable.
For additional information, the Cosmetic Ingredient Review (CIR) board reviewed
the safety of glycolic acid and lactic acid as formulated in cosmetic formulations.
Their final report addressed the issue of safety in pregnancy, and in their conclusions
they did not recommend any restrictions of use in this population. However, it is
important to note that the CIR conclusions pertained to AHA products containing
a maximum of 10% glycolic acid or lactic acid and a minimum pH of 3.5. For further
information, the publication can be obtained from the Cosmetics, Toiletries and
Fragrances Association (CTFA) at 202-331-1770.
The polyhydroxy acid (PHA) gluconolactone, is converted to gluconic acid in the
presence of water in the body. Both gluconolactone and gluconic acid are found naturally
occurring in the human body. There are several drugs on the market including vitamin
supplements that are prepared as the gluconate salt. Often times a substance that
is irritating to the gastrointestinal tract can be made less irritating by formulating
it as the gluconate salt. Common vitamin supplements include ferrous gluconate and
calcium gluconate, which are safely given both orally and intravenously.
35.
What
are anti-oxidants, Vitamin E and Vitamin C ingredients.
Many NeoStrata and Exuviance formulations feature combinations of AHAs and/or
PHAs with anti-oxidant vitamins including vitamin C and vitamin E to help neutralize
free radicals generated by exposure to sunlight and prevent them from damaging skin
and causing skin aging.
36.
Explain
Retinol and Retinyl Acetate as an ingredient in comparison to Renova, Retin-A
or Vitamin A.
Vitamin A is the generic
term for a variety of fat-soluble substances including retinol, retinyl palmitate,
retinyl acetate, retinaldehyde and the provitamin A carotenoids such as beta-carotene.
Vitamin A or retinol is found in foods and biological tissues as retinyl esters
such as retinyl acetate and retinyl palmitate. Retinyl palmitate is the major storage
form of Vitamin A in the body, primarily in the liver. The best known function of
vitamin A is in vision where it participates as the metabolite retinal (retinyl
aldehyde) in the visual cycle.
Retinoic acid is formed
from retinol in the body and is the active ingredient in Renova and Retin-A. It
plays an important role in the development of skin by regulating growth, and has
demonstrated benefits in treating acne and photoaging and naturally enhances the
repair of photodamaged skin.
Retinol and retinaldehyde (retinol in the aldehyde form) are commonly used in cosmetic
formulations, but are very unstable and quickly degrade in the presence of oxygen.
Retinol in the ester form, including retinyl palmitate and retinyl acetate, is called
‘pro-retinol’ because these compounds require conversion to retinol in the body
before being active. Retinyl palmitate is highly stable and therefore most often
used in formulations. However, there is an excess of retinyl palmitate in the skin
naturally because it is the storage form for retinol in the body. Retinyl acetate
is more stable than retinol and retinaldehyde and can be easily formulated in skin
care products. In addition, the acetate form is not stored in the body and therefore
would not already be present in excess, which may make this form preferable over
retinyl palmitate.
37.
Explain
sunscreen protection ingredients including Avonbenzone/Parsol 1789.
Sunscreens protect skin from sun by absorbing ultraviolet (UV) light, instead of
your skin cells and DNA absorbing the UV light. Common UVB absorbing sunscreens
include octyl methoxycinnamate, octyl salicylate, and homosalate, and the newest
sunscreen which protects in both the UVA and UVB range is avobenzone (Parsol 1789).
Physical sunscreens, such as zinc oxide and titanium dioxide, protect the skin by
reflecting the sun’s rays away from skin.
38.
What
is the reason for including a PHA in the NeoStrata Daily Protection Sunscreen SPF
29?
The gluconolactone in the Daily Protection Sunscreen is intended to provide anti-oxidant
protection. Since this sunscreen is a companion product to the other NeoStrata and
Exuviance formulations, it is not intended to be used alone as a ‘treatment’ product.
AHA and/or PHA benefits should come from additional product usage.
39.
Are
NeoStrata and Exuviance product Kosher for Passover?
Some NeoStrata and Exuviance products contain ethyl alcohol derived from corn. Some
of the conditioning/emollient ingredients are derived from other plant sources.
Beta glucan, derived from a grain source, is contained in our Exuviance prestige line of skin care products. Unfortunately,
NeoStrata cannot guarantee that all products meet the strict dietary guidelines
of Kosher law, or the restrictions required during the Passover holiday.
