When they hear the word collagen most people think of skin but there’s actually a lot more to collagen than just skin.
By Dr Lynn Chiam
What is collagen?
Collagen is the most abundant protein found in mammals, including us. It makes up around 25 to 35 percent of the protein in our bodies, and it is not just found in the skin. Collagen is found in tendons, ligaments, cartilage, muscles, bones, blood vessels, the gut, the intervertebral discs, the cornea and the skin.
Medical uses for collagen
Collagen has a very strong molecule with a triple helical structure which prevents it from being broken down by enzymes and allows other cells to adhere to it. For this reason and for its pore structure, permeability, and hydrophilicity (water-loving quality) it makes an ideal extracellular matrix or scaffold, and is widely used in skin, bone, and other tissue regeneration.
It is used as a natural wound dressing because it is resistant against bacteria, helps to keep the wound sterile because of its natural ability to fight infection, and it forms a matrix to guide and attract the body’s own cells to heal the wound.
Both human and bovine collagen have been used as dermal fillers for treatment of wrinkles and skin ageing, although hyaluronic acid (HA) fillers like Restylane are more often used now.
Oral collagen supplements and topical collagen creams
In recent years numerous collagen supplements have appeared on the market claiming to relieve the symptoms of rheumatoid arthritis and osteoarthritis; usually with hydrolysed type II collagen and often mixed with chondroitin sulphate, and sometimes hyaluronic acid. Type II collagen is the kind found in the articular cartilage and hyaline cartilage that coats the surfaces of our joints to protect the bones from wear. So the theory goes that taking it as an oral supplement may help protect joint surfaces.
However there have yet to be any large scale, independent studies to support this and many doctors and scientists remain sceptical. Like all proteins, collagen is broken down into amino acids before absorption by the body, so there is no reason why orally ingested collagen should affect connective tissue in the body.
The same question of efficacy applies to oral collagen supplements that claim to stimulate collagen production in the skin. There is also a lack of scientific evidence for the claimed anti-ageing effects of the many creams, lotions or other beauty products containing collagen.
Collagen and the skin
The skin is made up of three basic layers: the epidermis, dermis, and subcutaneous tissue, each layer has its own internal subdivisions. Collagen and keratin within those layers give the skin its strength, waterproof quality and elasticity.
The epidermis is the outermost layer composed mainly of keratinocyte and it has five layers; the top one, the stratum corneum, is made of dead skin cells that shed about every two weeks. The epidermis regulates water loss, determines our skin colour and contains immune cells and touch receptors.
The deepest layer of the skin is the subcutaneous tissue, a layer of fat and connective tissue that houses larger blood vessels and nerves. This layer is important in the regulation of the body’s temperature.
In the middle is the dermis, by far the thickest skin layer, which is composed of the papillary and reticular layers. The papillary is composed of fine and loosely arranged collagen fibres while the reticular layer is thicker and made of thick collagen fibres that are arranged parallel to the surface of the skin. It is this layer that gives our skin its elasticity. As we age the production of collagen slows and eventually halts. We lose collagen and our skin loses its elasticity and starts to develop wrinkles. As we grow older still we also start to lose some of the subcutaneous tissue in the face and even more collagen; this makes our wrinkles become deeper and eventually our skin begins to sag from lack of structural support from collagen and subcutaneous tissue.
Luckily there are some things we can do to encourage our skin to produce more collagen and delay unwanted signs of ageing.
The dos and don’ts for battling wrinkles
Before we start doing thing to protect and improve our skins we should stop doing things which are harmful to our skins.
- Don’t smoke! For your general health and your skin’s sake. Smoking both contributes to collagen degradation and reduces the skin’s ability to make new collagen.
- Don’t go out without sunscreen. The sun’s ultraviolet (UV) radiation penetrates the skin’s surface to the dermis layer and causes collagen to weaken and break down at a higher and faster rate than natural ageing. It can also cause abnormalities and malfunctions in skin cells so collagen cells become unable to regenerate themselves, and the skin becomes even more vulnerable to sun damage. Use at least a SPF 30 UVA and B sunscreen daily.
- Get plenty of sleep. Lack of sleep causes the body to produce more cortisol, a stress hormone that can break down skin cells. However, when you get enough sleep, the body produces more human growth hormone, which keeps skin from thinning, and therefore makes it less likely to wrinkle.
- Eat colourful foods. Eat plenty of dark green, leafy vegetables, and red, orange and blue fruits and vegetables. Cabbage and kale etc are loaded with lutein, an antioxidant that helps improve skin elasticity. Red, orange and blue fruit and vegetables contain antioxidants that increase collagen as does the vitamin C in citrus fruits. Prunes and blueberries also contain high levels of antioxidants.
- Apply a topical antioxidant. There is strong evidence that good topical antioxidants, such as those containing vitamins C and E, reduce the harmful effects of the ultraviolet rays that manage to get through your sunscreen.
- Try retinoids. They’re a class of chemical compounds that are related to vitamin A. Our skins seem to love retinoids; they help to diminish fine lines and age spots while promoting collagen production. There is probably more evidence that they are effective at reducing signs of ageing than any other type of anti-ageing cream.
- Try dimethylaminoethanol (DMAE). Some people have side effects of dryness and redness with retinoid-based products and find that DMAE offers them the same reduction of fine lines and improved overall appearance of ageing skin without side effects of retinoids
Aesthetic skin rejuvenation and tightening devices
There are several different kinds of devices that can help to stimulate collagen production and thus reduce fine lines and wrinkles and tighten the skin. They do this by inducing controlled thermal injury to the deep dermis which stimulates collagenases, the production of new collagen. This can be done with lasers or with radio frequency (RF) technology.
Lasers like the Mixto, a fractional CO2 laser system, use a high-speed scanner to deliver a precise matrix of Microspots that penetrate to the dermis, causing an immediate reaction that leads to collagen remodeling and new collagen formation.
This technique makes the healing process much quicker than ablative lasers and enables patients to get back to their normal lives sooner but there is still redness of the skin for a couple of days and maybe some peeling after that.
Patients experience a sensation of heat on the surface of the skin but a topical anaesthetic cream is applied to the face before treatment to manage this. On the plus side the Mixto also treats surface blemishes and minor pigmentation problems all in the same treatment. Two or three treatments a month apart may be required to achieve the maximum effect.
Radio frequency (RF) treatments.
While RF treatments like the Exilis use a different technology and deliver a different kind of energy to stimulate the collagen cells, the process is basically the same. The RF energy heats up the cells enough to cause remodelling of existing cells and the formation of new collagen cells. Depending on the setting, the Exilis can also remodel and reduce unwanted fat so it works well for areas like eye bags and jowls because it can reduce the fatty deposits and stimulate collagen to tighten the skin with the same treatment.
Exilis stimulates the fat cell to emulsify (liquefy) the fat within the cell. Then the liquefied fat moves from inside the cell through a temporary pore formed in the cell membrane to outside where it is absorbed by the lymphatic system which excretes it as normal bodily waste.
Usually two to four treatments are required to achieve the desired result. Unlike laser treatments, there is no downtime and no anaesthesia is required so patients can assume normal activities immediately following treatments.
Dr. Lynn Chiam is a dermatologist at the Children Adult Skin Hair and Laser Clinic. She is currently a Visiting Consultant at Kandang Kerbau Women’s and Children’s Hospital, Head of the Education Committee at the National Skin Centre, as well as the Medical Advisor to the Eczema Support Group (Singapore).