WHAT IS A POLY HYDROXYACID (PHA) (GLUCONOLACTONE OR G-4)?

Gluconolactone is a PHA derived from a sugar molecule that is found in the skin. Since it is a larger molecule containing multiple hydoxyl groups, it penetrates the skin slowly and with more hydrating properties compared to Alpha Hydroxyacid (AHA), making it optimal for sensitive skin patients. Gluconolactone is highly moisturizing, non-irritating and is also a natural anti-oxidant. Gluconolactone is a patented and exclusive technology of NeoStrata.
Gluconolactone provides the surface texture improvements of other AHAs such as glycolic acid, and offers the same full strength benefits including skin smoothening, reduction in the appearance of firmness and more even skin tone. Gluconolactone is perfect for sensitive and dry skin, cosmetically treated skin and first time AHA users.

WHAT ARE ALPHA HYDROXYACIDS (AHAs)?

Has are naturally occurring organic substances found in fruits, vegetables, sour milk and other foods. AHAs basically encourage the natural function of cell renewal within the skin's layers. This cell renewal process slows down as we age. AHAs work to loosen and remove the layers of dead cells that accumulate on the outermost layer of the skin, the stratum corneum. This build up of surface cells causes dryness, clogged pores, rough, dull and old looking skin. When the dry scales are shed off, the cells at the lower layers of the epidermis travel to the skin's surface to reveal a smoother, more radiant complexion.

WHAT ARE THE BENEFITS OF AHAs?

AHAs provide a consistent exfoliation that produces an initial thinning of the thickened skin, and an ongoing improvement in skin texture and quality.
If AHA usage is stopped, the skin will gradually revert back to its normal turnover rate. With continued use, AHAs can achieve youthful, healthy skin for a wide range of skin types and conditions including:

CAN YOU GET THE RESULTS FROM PHAS (GLUCONOLACTONE) AS QUICKLY AS FROM AHAs (GLYCOLIC ACID)?

Studies show significant anti-aging benefits with gluconolactone in twelve weeks. This is a similar time frame in which benefits from glycolic acid can be observed.

IF YOU GET THE FULL STRENGTH BENEFITS FROM NEOSTRATA® PHA (GLUCONOLACTONE) PRODUCTS, WHY CARRY THE AHA ONES?

Gluconolactone is an AHA and as such provides the same type of benefits as the more traditional AHAs including glycolic acid. Gluconolactone also offer some additional benefits including antioxidant effects, skin barrier conditioning and compatibility with sensitive and clinically sensitive skin. However, since more research is documented showing the benefits of glycolic acid some prefer to continue using glycolic acid. It is also beneficial to have the option of alternating between gluconolactone products and glycolic acid products if the skin has reached a plateau with either type. Additionally, different concentrations and product forms (gels, creams, lotions) to satisfy patient preferences are only available within the NeoStrata¨ AHA product line.

THERE ARE SO MANY PRODUCTS IN THE NEOSTRATA® LINE. HOW DO I KNOW WHICH PRODUCTS TO RECOMMEND TO MY PATIENTS?

Once you determine patient objectives along with their skin type, it is easy to recommend a system that consists of 2- 4 products.

The cleanser is a favorite regardless of skin type; it's oil and soap free, so it's the first step for both oily and dry skin patients. For moisturization, dry and sensitive skin types and first-time users, would fare best on the PHA (gluconolactone) products. More aggressive first-time users, oily skin and patients with less sensitive skin should look to the AHA home care products which range in concentration from 8% to 15%. Patients can always work their way up in concentration, so we recommend you start patients off on a lower concentration product to minimize the potential for irritation.

NeoStrata¨ has several formulations per category to appeal to different skin types and preferences. For example, gels and lotions are generally preferred by normal to oily/acne skin types, while creams are generally preferred by dry skin patients.
And of course, everyone needs good sun protection. The NeoStrata® line offers two daytime exfoliating products with a SPF 15.

For additional assistance, refer to our suggested skin care regimens.

ARE THERE NEOSTRATA® HOME CARE PRODUCTS ABOVE 15% AHA STRENGTH?

No. Products containing more than 15% free acid would be irritating to most people. In order to make products safe for home use, glycolic acid products are also partially neutralized often to a pH of between 3.5 and 4. NeoStrata¨ only offers higher free acid concentration levels in its Skin Rejuvenation System -- glycolic acid peel products for application within a physician's office.

DO ALL 15% AHA PRODUCTS WORK THE SAME?

No. All 15% AHA products are not the same. Percentages displayed on packaging do not always reflect true concentrations of available AHA. NeoStrata¨'s concentrations are true concentrations that range from 8-15% acid. Many other glycolic products available to patients list the percentage of glycolic acid added to the formulation, however, buffering agents can reduce this percentage significantly. For example, Alpha Hydrox claims 8% glycolic acid, but this is prepared in a 70% base solution resulting in an actual concentration of 5.6% glycolic acid - some of which is then neutralized. Whereas, NeoStrata® 15 with 15% glycolic acid is 21.5% glycolic acid prepared in a 70% base solution resulting in an actual concentration of 15% glycolic acid.

HOW LONG SHOULD PATIENTS EXPECT NEOSTRATA® HOME CARE PRODUCTS TO LAST?

With recommended usage, NeoStrata® home care products should last between 2 to 3 months. Based on usage, the cleanser may need to be replaced sooner.

WHAT IS NEOSTRATA® PROBLEM DRY SKIN TREATMENT USED FOR?

NeoStrata® Problem Dry Skin treatment is a complex blend of AHAs and antioxidants. It has been shown to be effective in treating ichthyosis, while other physicians have seen its benefits in treatment of psoriasis, lichen planus, statis dermatitis, hand dermatitis and dyshydrosis.

IF I DISPENSE PRODUCTS IN MY OFFICE, HOW DO I COMPETE WITH PRODUCT LINES THAT ARE SOLD IN DEPARTMENT STORES AND THE MASS MARKET?

Some product lines like NeoStrata® are sold only through physician's offices, and not through department stores or the mass market. These products are specifically designed to be a continuation of the office treatment and comprise your home care component. The free acid found in these products is higher and more effective than what is available over-the-counter. Explain to your patients that the products that you dispense are backed by scientific data. Also explain that when a physician puts you on an anti-aging protocol, it becomes a medical protocol.

IS THE MAIN DIFFERENCE BETWEEN THE NEOSTRATA® HOME CARE PRODUCTS AND THE IN-OFFICE PEEL SOLUTIONS (SKIN REJUVENATION SYSTEM) THE PERCENTAGE OF GLYCOLIC ACID PRESENT?

Yes, this is a main difference but not the only one. The glycolic acid in the Skin Rejuvenation System is also present as 100% free acid unlike the home care products. The peel solutions do not contain any neutralizing or buffering ingredients. As a result, they are much more strongly acidic (pH 0.6 Ð 1.6) than conventional AHA home care products (usually pH 3.5 and above). Since the objective of facial peeling involves rapid penetration of the acid in a short period of time, it is critical to use a formulation that maximizes the amount of free acid.

WHY ARE THE PH LEVEL AND PRODUCT VEHICLE IMPORTANT IN COMPARING GLYCOLIC ACID SOLUTIONS?

Glycolic acid penetrates the stratum corneum in the free acid form. The neutralized, salt form does not immediately penetrate the skin, and depending on the type of salt (i.e. sodium glycolate) may never penetrate. The pH of a product determines the proportion of the total concentration of glycolic acid that is present as the acid form and the portion that is in the neutralized salt form. As a quick rule of thumb, any product formulated at pH 3.8 will have approximately half of its total glycolic acid content in the free acid form (i.e. an 8% glycolic acid product at pH 3.8 would contain 4% free acid). A product formulated at a lower pH will contain a higher amount of free acid, and will penetrate faster than a similar product having a higher pH.

Product vehicle is important in maximizing product efficacy. Solutions tend to allow greater penetration than gel formulations, and gel formulations often require a higher pH to maintain stability thereby lowering available free acid. The NeoStrata® peel solutions are formulated at a low pH with propylene glycol and alcohol to minimize skin surface tension and enhance penetration.

ARE HIGH CONCENTRATION (>50%) GLYCOLIC ACID PEELS RECOMMENDED FOR AFRICAN-AMERICAN OR ASIAN SKIN?

There are many doctors that use the 70% peel on darker skin tones, however this decision should come after careful evaluation of the patient's skin and full knowledge of the possible risks. For more information on this topic review the article 'The Use of Glycolic Acid in Asian and Darker Skin Types' (J. Geriatr Dermatol 1996;4(SB):8B-11B). It is a useful reference for any doctors with this question as there are additional risks and precautions that should be considered when peeling darker skin tones.