Summary of Mandelic Acid for the Improvement of Skin ...

1 Summary of Mandelic acid for theImprovement of skin ConditionsMandelic acid has been used in medicine for manyyears as a urinary antiseptic. Methenamine mandelate(Mandelamine , Parke-Davis, Morris Plains, NJ) has theurinary antiseptic action of both methenamine andmandelic acid . In concentrations of 35g to 50g/100L ofurine, it inhibits Staphylococcus aureus, bacillus proteus,escherichia coli, and aerobacter , Mandelic acid has a structure similar to thatof other well-known It is a nontoxic substancethat, after being ingested orally, is excreted in the urine. The author s interest in Mandelic acid stems from itsdual nature as an AHA with both potential cosmeceuticalactivity and well-established antibacterial trials with Mandelic acid had two aims: todetermine whether it can produce antiaging effects onthe skin similar to those produced by glycolic acid , andto assess the antibacterial action of Mandelic acid intreating acne and preventing gram-negative bacterialinfections after laser the past 3 years, Mandelic acid , analpha-hydroxy acid (AHA) named after theGerman mandel ( almond ) and derivedfrom the hydrolysis of an extract of bitteralmonds,1 has been studied extensively forits possible uses in treating common skin problems suchas photoaging, irregular pigmentation, and acne.

2 Anopen-trial investigation conducted at the GatewayAesthetic Institute and Laser Center in Salt Lake City,Utah, has shown that Mandelic acid is useful insuppressing pigmentation, treating inflammatorynoncystic acne, and rejuvenating photoaged , it has proven useful in preparing the skin forlaser peeling and in helping the skin heal after lasersurgery. This article discusses the characteristics ofmandelic acid , its efficacy in the treatment of wrinkles,pigmentation, and acne, and its role in recoveryfollowing laser acid (alpha-hydroxybenzeneacetic acid ) is an8-carbon alpha-hydroxy acid with the chemical formulaHOCH(C6H5)COOH and structure2: The Mandelic acid molecule is larger than the glycolicacid molecule, a widely used AHA. In addition, mandelicacid, which has a pK of , is stronger than glycolicacid, which has a pK of at 25oC.

3 The acidity ofAHAs may vary considerably with changes intemperature. Mandelic acid has a high melting point, ispartially soluble in water, and is freely soluble in isopropyiand ethyl Mandelic acid occurs in twoenantiomeric forms that may affect Taylor is a clinical instructor in the Department of Derma-tology at the University of Utah, and Director of the GatewayAesthetic Institute and Laser Center in Salt Lake City Cosmetic Dermatology JUNE 1999 MEDICAL USESRESEARCH METHODSP reliminary trials were open and uncontrolled, and in-cluded more than 1,100 patients over the past 3 patients were followed with photographic docu-mentation and global evaluations, and were monitoredfor Improvement and adverse effects methods typicalof the evaluation of a new cosmetic product.

4 PatientsFig. 1: Melasma in 45-year-old female (left) with hyperpigmen-tation caused by glycolic acid plus hydroquinone, and samepatient (right) 9 months after use of Mandelic acid evaluated for Improvement in acne, skin texture,wrinkles, lentigenes, and melasma. Mandelic acid is prepared in an algae extract (MandelicMarine Complex , NuCelle, a division of North AmericanMedical, Idaho Falls, ID) gel or lotion base in 2% to 10%concentration for topical use. Additional preparations werecombined with topical vitamins (including vitamins A, C,E, D3) and sunscreen with SPF 15. Patients were instructedto use the products twice daily. Chemical peels were performed with 30% and 50% Mandelic acid . A 2% Mandelic acid wash was used tocleanse the skin , followed by the application of mandelicacid using gauze applicators.

5 As the product was applied,the skin was gently rubbed. Exposure times were usuallylimited to 5 minutes; however, longer applications alsoappeared to be safe. Peels were performed at weekly orbiweekly intervals. After the peel, the skin was cleansedwith water, and a mild topical steroid (desonide ) was applied in a single application. For 2 to 4 weeks before and after laser resurfacing,patients were treated with Mandelic acid products and asemi-permeable ointment designed to aid healing afterlaser surgery. Patients were evaluated for the following: timeto reepithelialization, incidence of gram-negativeinfections, duration of postresurfacing erythema,postinflammatory pigmentation, milia, and other post-operative results from the open clinical trials using theseproducts are encouraging in several diverse areas relatedto skin care:1.

6 Fine wrinkles and lines appear to improve, much likephotoaged skin does with the use of 10% glycolic acidpreparations. skin texture improves quickly within days orweeks in characteristic AHA therapeutic fashion. A notabledifference between glycolic acid and Mandelic acidproducts is the lack of skin irritation and erythema that oftenaccompanies skin treatments with glycolic acid in 30% to70% preparations used for peeling. As with glycolic acid ,the effect is sustained over months and years of treatment,with gradual and continued Improvement in fine lines andwrinkles being the characteristic benefit. It is noteworthy that a remarkable difference was seen inthe treatment of darkly pigmented skin types. Improvementcan be seen in fine wrinkles and lines in patients withFitzpatrick skin types I through VI without anypostinflammatory hyperpigmentation.

7 This includes Asianskin types, which have universally been able to usemandelic acid products without any postinflammatoryhyperpigmentation. In contrast, the author has observed in his dermatologypractice a large number of darkly pigmented patients whohave developed irritation, erythema, and subsequentpostinflammatory hyperpigmentation while treating the skinwith 5% to 10% glycolic acid , tretinoin, or Chemical peeling with Mandelic acid , when comparedwith glycolic acid peels, produced less erythema, and wasless likely to result in crusting or blistering or other adverseeffects on the epidermis. The onset of erythema is morepredictable and gradual, and there is less likelihood that hot spots will develop in dry areas of the face ( , onthe cheek lateral to the commissure).

8 Repeated, weeklypeeling with 5-minute exposure times, followed by washingwith water, was well tolerated by most patients. Repeatedpeeling is useful for treating acne, melasma, lentigenes,and fine photoaging damage ( , wrinkles, dullness, skintexture changes).3. Abnormal pigmentation, including melasma,postinflammatory hyperpigmentation, and lentigenes,improved quickly when treated with Mandelic acidproducts. In many patients, melasma improved upto 50%after 1 month of treatment using 10% Mandelic acid pigmented lentigenes respond much more slowly -Cosmetic Dermatology JUNE 1999 27 RESULTSFig. 2: Melasma and lentigenes in 48-year-old female (left),and same patient one month after use of Mandelic acid (darklesion under left eye removed with liquid nitrogen).Fig. 3: 29-year-old female with 11-year case of melasma (left),and same patient after one month of Mandelic acid BID (right).

9 M. B. Taylorsemipermeable ointment allowed easy cleansing of theskin without occluding bacteria and dead- skin Mandelic acid products were used preoperativelyand postoperatively, postinflammatory hyperpigmentationrarely this study was not a double-blind, controlled study,it included many patients over a 3-year period. Impressionshave been sustained over the course of the study thatmandelic acid products, used alone or in tandem withantioxidant vitamins, have multiple beneficial effects as askin treatment including antibacterial effects andimprovement in photoaged skin , acne, abnormalpigmentation, and skin texture. Safe use in darkly pigmentedskin types was also a major difference seen when themandelic acid products were compared with glycolic acidand of Interest: The author is a member of the Boardof Directors of North American Medical, manufacturer andproducer of NuCelle Mandelic Marine Complex AM.

10 The chemistry of alpha-hydroxy acids. Cosmet Der-matol. 1994;7 (suppl 10) Acids, Aromatic. Ullman s Encyclopedia ofIndustrial Chemistry. volA-13. New York, NY: VCH Publishers;1989 Merck Index, 7th ed. Rahway, NJ: Merck 1978 and antiseptics. Encyclopedia of Chemicala result characteristic of treatment with other AHA products with gradual fading over a period of weeks or acid products used with prescription-strengthbleaching agentscontaining hydroquinone or kojic acid also showed excellentfading with no adverse effects, and may hasten the benefitsof treatment. Dermal melasma has often been resistant to topicaltreatments, but marked Improvement was seen in patientswho had failed other topical treatments with tretinoin,hydroquinone, and steroids. Many of these patients wereof darker skin types, and had experienced postinflammatoryhyperpigmentation from other topical products.