PracticeUpdate Dermatology May 2019

EXPERT OPINION 18

Oral Collagen Supplementation By InYoung Kim MD, PhD M y father, who had been consum- ing collagen supplements for joint pain, reported that his skin looked

Yes or no? The scientist in me says: “the jury is still out.” There is a need for a large-scale RCT with standardized and objective assess- ment of the results, including TEWL, skin collagen content, HA content, collagen fibril strength, MMP levels, etc. The optimal collagen formulation and dosing regimen for each dermatologic indication are also needed. But, as a believer in the gut–skin axis, I’d say, “Why not?” In fact, no adverse events have been reported. But let me emphasize that one cannot preclude the possibility of unlisted contaminants – an inherent concern with nutraceuticals that are not regulated. Now, more than ever, patients are asking about nontraditional therapies. As clini- cians, it’s essential to keep an open mind while critically assessing the evidence and providing proper counseling on potential safety concerns. Moreover, realistic expec- tations must be set. After all, there is no single regimen that will prove to be the panacea or fountain of youth! Overall, these preliminary data are exciting, and I look forward to seeing more high- er-level scientific evidence so that the scientist in me can be convinced – espe- cially for diseases with skin barrier and collagen disruption. But for now, I may still consider this a potential tool in my toolbox for those willing to try. Heck, it’s kept my father happy for years! References 1. Iwai K, Hasegawa T, Taguchi Y, et al. Identification of food-derived collagen peptides in human blood after oral ingestion of gelatin hydrolysates. J Agric Food Chem 2005;53(16):6531-6536. 2. Ichikawa S, Morifuji M, Ohara H, et al. Hydroxy- proline-containing dipeptides and tripeptides quantified at high concentration in human blood after oral administration of gelatin hydrolysate. Int J Food Sci Nutr 2010;61(1):52-60. 3. Shigemura Y, Kubomura D, Sato Y, Sato K. Dose-dependent changes in the levels of free and peptide forms of hydroxyproline in human plasma after collagen hydrolysate ingestion. Food Chem 2014;159:328-332. 4. Kawaguchi T, Nanbu PN, Kurokawa M. Distribution of prolylhydroxyproline and its metabolites after oral administration in rats. Biol Pharm Bull 2012;35(3):422-427. 5. Choi FD, Sung CT, Juhas MLW, et al. Oral collagen supplementation: A systematic review of dermatological applications. J Drugs Dermatol 2019;18(1):9-16. This commentary is based upon the article Oral Collagen Supplementation: A Systematic Review of Dermatological Applications by Choi FD et al. www.practiceupdate.com/c/78610

amazing 7 years ago. I laughed – how can oral collagen make it to the skin ? But then I looked for evidence. From the mouth to the skin: what’s the evidence? Collagen hydrolysate (CH), the most common form of collagen available for consumption, breaks down into peptides that are resistant to hydrolysis. After oral CH consumption, di- and tripeptides were detected in the blood in humans .1-3 In mice, radioactive labeling of dipeptides demon- strated their presence in the skin after CH ingestion, which persisted for 2 weeks, indicating absorption as well as cutane- ous delivery. 4 Clinical benefit? In this systematic review, 5 eight studies showed improvements in pressure ulcers, xerosis, skin aging, and cellulite with the use of CH. Three studies using collagen peptides also showed skin elasticity and hydration improvement, with one study suggesting a dose-dependent relationship. Outcomes were highly dependent on the tools used to determine efficacy. Although some objective measures were used, many of the studies relied on qualitative, subjec- tive measures such as visual scales and patient satisfaction.

Dr. Kim is currently a Resident at Case Western University/University Hospitals of Cleveland Medical Center in Cleveland, Ohio.

" …there is no single

regimen that will prove to be the panacea or fountain of youth! "

PRACTICEUPDATE DERMATOLOGY