Akiko Tozawa^(1)
(1)Tozawa Clinic - Tokyo. Japan

		[Dermatology]
	[Allergy & Clinical Immunology]

PRESENTATION

The treatment of skin atopy with vitamin A and antioxidant vitamins. By Dr. Akiko Tozawa

My name is Akiko Tozawa and I have been in practice as a doctor in Tokyo for 35 years. I was educated at Nihon Medical College and today I am on the board of governors of that college. About ten years ago I was offered some skin care creams made by a friend of mine, Dr. Des Fernandes. Contrary to his advice I tried them on patients with atopy and to my delight, as well as surprise, the patients came back with better skin. I have subsequently taken a special interest in this problem that plagues Japan and today I am totally involved in allergic problems and skin care for atopy patients. Treatment regime Following my request, Dr Fernandes has created special creams and gels for topical application of vitamin A, C, E, beta-carotene and d-panthenol combined with Australian tea tree oil specifically for treating atopy patients. I requested all patients to stop using cortisone products before starting this regime. They were warned that their symptoms would get worse as a result but that after a few weeks their skin would feel more comfortable. Patients applied the cream or the gel at least twice a day in the following manner: First the skin was cleaned with a simple cleansing gel, then the cream was applied directly onto the problem areas. In people with thickened rough skin, I suggested that they use an alpha hydroxy acid toner to help reduce the thickened horny layer and facilitate penetration of the vitamins. (In cases with a great deal of flaking, I also used a dilute ammonium lactate solution as a toner) Patient selection All patients attending my clinic for atopy were advised to use this regime. Over the past 5 years I have treated 1830 patients and have been able to assess the results in 1464 patients. 366 patients have stopped the treatment or have been lost to follow-up. The main reason for stopping treatment can be attributed to the aggravation of the symptoms when the patients stop using topical steroids. I insist that the patients have to stop using steroids at the time of starting to use the Environ® cream. Since September 1998 we have used the Environ® Ionzyme DF1998 machine to treat severe atopy cases and to date we have treated over 600 patients with iontophoresis. With iontophoresis we can get better penetration of the ionisable vitamins into the skin.  The vitamin A probably penetrates mainly by electro-poration, whereas the ascorbic acid is easily ionised.

Results: Simple topical application of vitamin A and the antioxidant vitamins has resulted in major changes in life style for many people with atopy.

In my study, the success rate was 80% by merely using this home-care regime. This compares favourably with the success rate for cortico-steroids. The success rate when using iontophoresis is even greater and is close to 90% The most outstanding feature of iontophoresis is that the patients experience a significant improvement of the skin within a very short time. Within one or two treatments, itchiness of the skin is improved. Discussion Vitamin A and the antioxidant vitamins C, E, beta-carotene and panthenol are normally found in skin. However, because these vitamins are also photo-labile, they are easily degraded when skin is exposed to sunlight. Vitamin A and C and D are especially vulnerable to ultra-violet A (UV-A) irradiation. Because UV-A rays penetrate clouds, window glass and most clothing materials, we are constantly at risk to lose the normal levels of vitamin A in the skin. This may be the main reason for so-called “UV-A allergic” skin conditions. One thing is sure, the repetitive exposure of skin to sunlight results in lowered skin levels of vitamin A and C etc each day and that, unfortunately, is not corrected each day by the body. As result a chronic deficiency develops in sun-exposed skin which eventually becomes manifest as photo-damage. The impairment of vitamin A activity in the skin results in inadequate function of the Langerhans cells and as a result allergic problems of skin are more likely in sun-damaged skin than in protected skin. That is the reasoning behind using vitamin A as a therapeutic agent in skin atopy. Beta-carotene is normally found in higher levels in Japanese skin than in Caucasian skin, but in my experience, I found that the addition of beta-carotene also results in healthier skin amongst the Japanese. Beta-carotene can be broken down in cells to two molecules of retinaldehyde, which in turn can be transformed into retinoic acid or retinol. Retinoic acid is the form of vitamin A that does all the work in the nucleus. There are various retinoic acid receptors that act as ligands and promote numerous genes responsible for normal skin. Without a doubt, in skin atopy there is also a massive onslaught of free radical activity that has to be addressed in order to allow the natural forces of the body to begin their repair work. Vitamin C is probably the most powerful antioxidant to stabilise cellular membranes. This is a paradox because vitamin C is water-soluble and cellular membranes are lipophilic. Of course, l-ascorbic acid has a major role in re-activating d-alpha-tocopherol from its oxidised form back into its active state as a free radical quencher. Vitamin E is also essential for the stabilisation of lipids. Beta-carotene is an extremely powerful antioxidant in contrast to vitamin A, which is a very weak antioxidant. My work with iontophoresis has shown that we can get better penetration of the vitamins and healthier skin within a shorter time.

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		[Dermatology]
	[Allergy & Clinical Immunology]

Akiko Tozawa
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Last update: 16/02/00