Protocol development in integrative medicine is not typically a simple process. Individuals require individualized care, and what works for one patient may not work for another.

To establish these protocols, we first developed a Rating Scale that could be used to discern the rigor of evidence supporting a specific nutrient’s therapeutic effect.

The following protocols were developed using only A through C-quality evidence.

Class
Qualifying studies
Minimum requirements
A
Systematic review or meta-analysis of human trials
 
B
RDBPC human trials
2+ studies and/or 1 study with 50 + subjects
C
RDBPC human trials
1 study

As life expectancy increases, concerns surrounding skin and its integrity while aging increase. Dermal changes are to be expected with age, as a variety of factors contribute to cutaneous health. Environmental factors such as sun exposure, air pollution, and lifestyle choices all play a role in eliciting premature aging and damaging skin cells. (13) Genetic factors such as ethnicity and gender also play a role. (5)

Hydration levels in skin are found to inversely correlate with age. Elasticity determined by collagen production also decreases. Texture may also change with age as the dermis thins and roughness increases. Increased depth and number of sulci (wrinkles) occur as well. (5) Addressing these common hallmarks of aging skin may help preserve youthfulness and prevent further damage to the skin barrier. 

The ingredients presented below help address a variety of common factors in skin aging such as transepidermal water loss and elasticity.

Collagen

Total of 2.5-10 g per day, minimum 8 weeks (2)(4)

  • Type I collagen hydrolysate derived from fish has been shown to improve wrinkles and roughness, as well as increase collagen density, skin firmness, skin moisture, and skin elasticity (3)(10)
  • A systematic review of 11 studies found both short and long term collagen supplementation improved wound healing and skin aging factors like elasticity, hydration, and dermal collagen density (4)
  • BioCell Collagen, collagen from chicken sternal cartilage, improved skin appearance  and dryness shown by decreases in facial lines, wrinkles, and crows feet and a 12% increase in skin elasticity and cutaneous collagen content (17)
  • Skin hydration, collagen density in dermis, and dermal collagen network integrity all improved when given Peptan®F and Peptan®P; additionally ex vivo experiments found supplementation to induce collagen and glycosaminoglycan production (2)
  • Low-molecular weight collagen improved skin hydration, elasticity and visual assessment of skin wrinkling when compared to placebo (10)
Collagen in the Fullscript catalog

Hyaluronic Acid

Oral: 120 mg, once per day, minimum 6 weeks (9)(15)
Topical: Apply 0.1% hyaluronan formulations, twice per day, minimum 2 months (16) 

  • Oral hyaluronic acid has been shown to increase skin moisture content and skin elasticity (7)(9)
  • Compared to placebo, greater improvements in wrinkle volume ratio, wrinkle area ratio, and whole sulcus volume ratio were observed when oral hyaluronic acid was administered (15)
  • High (800k) and low (300k) molecular weight oral hyaluronan supplementation both improved skin moisture content and subjective facial aging symptoms compared to placebo; low molecular weight hyaluronan improved moisture content as early as 2 weeks compared to placebo (9)
  • When using hyaluronic acid in topical form, twice daily application found all tested molecular weights (50, 130, 300, 800, and 2000 kDa) to improve skin hydration and overall elasticity; additionally, 130 and 50 kDa improved mean and max roughness as well as wrinkle depth (16)
Hyaluronic acid in the Fullscript catalog

Pycnogenol

75-100 mg, total per day, minimum 30 days (6)(14)

  • Postmenopausal women experienced improved skin hydration, skin elasticity, and increased mRNA expression of hyaluronic acid synthase-1 (HAS-1); a more pronounced effect was found for those suffering from dry skin conditions (11)
  • Clinical grading of skin photoaging scores and age spot pigmentation decreased in women with mild to moderate photoaging (6)
  • Women with melasma experienced a decrease in average area affected and pigmentary intensity when supplemented with pycnogenol; additionally, a general effectiveness rate of 80% was found (14)
Pycnogenol in the Fullscript catalog

Turmeric

Variable based on form (follow manufacturer’s dose instructions)

  • A systematic review of 18 studies found that skin disease severity improved compared to control in a variety of skin conditions including facial photoaging when using topical and/or ingested turmeric (19)
  • Herbal combination containing turmeric (but not turmeric extract on its own) decreased transepidermal water loss in skin compared to placebo after four weeks (20)
  • Hot water extract of curcuma longa improved skin hydration as shown by increased hyaluronan production; additionally, UVB-induced tumor necrosis factor-α and interleukin-1β were inhibited at the mRNA and protein levels (1)
  • A systematic review of 11 studies found turmeric to improve a variety of skin conditions including facial redness (12)
Turmeric in the Fullscript catalog

Astaxanthin

2-6 mg, total per day, minimum 8 weeks (8)(18)(21)

  • Male and female subjects experienced improved skin wrinkle and elasticity on crows feet, as well as skin texture, moisture content of corneocyte layer, and corneocyte condition on cheeks; male subjects had improved skin wrinkles, elasticity, and transepidermal water loss on crows feet, as well as moisture content and sebum levels on cheeks (18)
  • When given in conjunction with 3 g of collagen, 2 mg of astaxanthin per day improved skin elasticity, skin barrier integrity, and transepidermal water loss in photoaged facial skin; gene expression improved as shown by an increase in procollagen type I mRNA expression and a decrease in MMP-1 and -12 mRNA expression (21) 
  • Moisture loss in skin decreased in irradiated skin, while roughness and texture of skin improved in non-irradiated areas when healthy subjects were supplemented with 4 mg of astaxanthin and exposed to UV induced skin deterioration (8)
Astaxanthin in the Fullscript catalog

Disclaimer

The Fullscript Integrative Medical Advisory team has developed or collected these protocols from practitioners and supplier partners to help health care practitioners make decisions when building treatment plans. By adding this protocol to your Fullscript template library, you understand and accept that the recommendations in the protocol are for initial guidance and may not be appropriate for every patient.

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References
  1. Asada, K., Ohara, T., Muroyama, K., Yamamoto, Y., & Murosaki, S. (2019). Effects of hot water extract of Curcuma longa on human epidermal keratinocytes in vitro and skin conditions in healthy participants: A randomized, double-blind, placebo-controlled trial. Journal of Cosmetic Dermatology, 18(6), 1866–1874. https://pubmed.ncbi.nlm.nih.gov/30809971/ (C)
  2. Asserin, J., Lati, E., Shioya, T., & Prawitt, J. (2015). The effect of oral collagen peptide supplementation on skin moisture and the dermal collagen network: evidence from an ex vivo model and randomized, placebo-controlled clinical trials. Journal of Cosmetic Dermatology, 14(4), 291–301. https://pubmed.ncbi.nlm.nih.gov/26362110/ (C)
  3. Borumand, M., & Sibilla, S. (2014). Daily consumption of the collagen supplement Pure Gold Collagen® reduces visible signs of aging. Clinical Interventions in Aging, 9, 1747–1758. https://pubmed.ncbi.nlm.nih.gov/25342893/ (C)
  4. Choi, F. D., Sung, C. T., Juhasz, M. L. W., & Mesinkovsk, N. A. (2019). Oral Collagen Supplementation: A Systematic Review of Dermatological Applications. Journal of Drugs in Dermatology: JDD, 18(1), 9–16. https://pubmed.ncbi.nlm.nih.gov/30681787/ (A)
  5. Dąbrowska, A. K., Spano, F., Derler, S., Adlhart, C., Spencer, N. D., & Rossi, R. M. (2018). The relationship between skin function, barrier properties, and body-dependent factors. Skin Research and Technology: Official Journal of International Society for Bioengineering and the Skin , 24(2), 165–174. https://pubmed.ncbi.nlm.nih.gov/29057509/ (F)
  6. Furumura, M., Sato, N., Kusaba, N., Takagaki, K., & Nakayama, J. (2012). Oral administration of French maritime pine bark extract (Flavangenol(®)) improves clinical symptoms in photoaged facial skin. Clinical Interventions in Aging, 7, 275–286. https://pubmed.ncbi.nlm.nih.gov/22956863/ (C)
  7. Göllner, I., Voss, W., von Hehn, U., & Kammerer, S. (2017). Ingestion of an Oral Hyaluronan Solution Improves Skin Hydration, Wrinkle Reduction, Elasticity, and Skin Roughness: Results of a Clinical Study. Journal of Evidence-Based Complementary & Alternative Medicine, 22(4), 816–823. https://pubmed.ncbi.nlm.nih.gov/29228816/ (C)
  8. Ito, N., Seki, S., & Ueda, F. (2018). The Protective Role of Astaxanthin for UV-Induced Skin Deterioration in Healthy People-A Randomized, Double-Blind, Placebo-Controlled Trial. Nutrients, 10(7). https://pubmed.ncbi.nlm.nih.gov/29941810/ (C)
  9. Kawada, C., Yoshida, T., Yoshida, H., Sakamoto, W., Odanaka, W., Sato, T., Yamasaki, T., Kanemitsu, T., Masuda, Y., & Urushibata, O. (2015). Ingestion of hyaluronans (molecular weights 800 k and 300 k) improves dry skin conditions: a randomized, double blind, controlled study. Journal of Clinical Biochemistry and Nutrition, 56(1), 66–73. https://pubmed.ncbi.nlm.nih.gov/25834304/ (B)
  10. Kim, D.-U., Chung, H.-C., Choi, J., Sakai, Y., & Lee, B.-Y. (2018). Oral Intake of Low-Molecular-Weight Collagen Peptide Improves Hydration, Elasticity, and Wrinkling in Human Skin: A Randomized, Double-Blind, Placebo-Controlled Study. Nutrients, 10(7).   https://pubmed.ncbi.nlm.nih.gov/29949889/ (B)
  11. Marini, A., Grether-Beck, S., Jaenicke, T., Weber, M., Burki, C., Formann, P., Brenden, H., Schönlau, F., & Krutmann, J. (2012). Pycnogenol® effects on skin elasticity and hydration coincide with increased gene expressions of collagen type I and hyaluronic acid synthase in women. Skin Pharmacology and Physiology, 25(2), 86–92. https://pubmed.ncbi.nlm.nih.gov/22270036/ (C)
  12. Mata, I. R. da, Mata, S. R. da, Menezes, R. C. R., Faccioli, L. S., Bandeira, K. K., & Bosco, S. M. D. (2020). Benefits of turmeric supplementation for skin health in chronic diseases: a systematic review. Critical Reviews in Food Science and Nutrition, 1–15. https://pubmed.ncbi.nlm.nih.gov/32713186/ (A)
  13. McDaniel, D., Farris, P., & Valacchi, G. (2018). Atmospheric skin aging-Contributors and inhibitors. Journal of Cosmetic Dermatology, 17(2), 124–137. https://pubmed.ncbi.nlm.nih.gov/29575554/ (F)
  14. Ni, Z., Mu, Y., & Gulati, O. (2002). Treatment of melasma with Pycnogenol. Phytotherapy Research: PTR, 16(6), 567–571. https://pubmed.ncbi.nlm.nih.gov/12237816/ (C)
  15. Oe, M., Sakai, S., Yoshida, H., Okado, N., Kaneda, H., Masuda, Y., & Urushibata, O. (2017). Oral hyaluronan relieves wrinkles: a double-blinded, placebo-controlled study over a 12-week period. Clinical, Cosmetic and Investigational Dermatology, 10, 267–273. https://pubmed.ncbi.nlm.nih.gov/28761365/ (B)
  16. Pavicic, T., Gauglitz, G. G., Lersch, P., Schwach-Abdellaoui, K., Malle, B., Korting, H. C., & Farwick, M. (2011). Efficacy of cream-based novel formulations of hyaluronic acid of different molecular weights in anti-wrinkle treatment. Journal of Drugs in Dermatology: JDD, 10(9), 990–1000. https://pubmed.ncbi.nlm.nih.gov/22052267/ (C)
  17. Schwartz, S. R., Hammon, K. A., Gafner, A., Dahl, A., Guttman, N., Fong, M., & Schauss, A. G. (2019). Novel Hydrolyzed Chicken Sternal Cartilage Extract Improves Facial Epidermis and Connective Tissue in Healthy Adult Females: A Randomized, Double-Blind, Placebo-Controlled Trial. Alternative Therapies in Health and Medicine, 25(5), 12–29. https://pubmed.ncbi.nlm.nih.gov/31221944/ (B)
  18. Tominaga, K., Hongo, N., Karato, M., & Yamashita, E. (2012). Cosmetic benefits of astaxanthin on humans subjects. Acta Biochimica Polonica, 59(1), 43–47. https://pubmed.ncbi.nlm.nih.gov/22428137/ (C)
  19. Vaughn, A. R., Branum, A., & Sivamani, R. K. (2016). Effects of Turmeric (Curcuma longa) on Skin Health: A Systematic Review of the Clinical Evidence. Phytotherapy Research: PTR, 30(8), 1243–1264. https://pubmed.ncbi.nlm.nih.gov/27213821/ (A)
  20. Vaughn, A. R., Clark, A. K., Notay, M., & Sivamani, R. K. (2018). Randomized Controlled Pilot Study of Dietary Supplementation with Turmeric or Herbal Combination Tablets on Skin Barrier Function in Healthy Subjects. Journal of Medicinal Food, 21(12), 1260–1265. https://pubmed.ncbi.nlm.nih.gov/30457892/ (C)
  21. Yoon, H.-S., Cho, H. H., Cho, S., Lee, S.-R., Shin, M.-H., & Chung, J. H. (2014). Supplementating with dietary astaxanthin combined with collagen hydrolysate improves facial elasticity and decreases matrix metalloproteinase-1 and -12 expression: a comparative study with placebo. Journal of Medicinal Food, 17(7), 810–816. https://pubmed.ncbi.nlm.nih.gov/24955642/ (C)