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Dr. Tori Hudson, Portland, Oregon, Blog Healthline Blog

I think we all know what aging of the skin looks like: wrinkles, reduced tone, sagging areas, loss of fat pads in the face, dryness, skin pigmentation changes, telangiectasias and lentigines.  There are multiple influences on this normal age related process such that some individuals have more or less skin aging features.  Genetics, decline in estrogen with menopause, UV light exposure, cigarette smoking, alcohol, stress, select medications and weather exposure in general are the dominant influencers.  Darker skinned people have less severe intrinsic facial skin aging, with aging features onset typically being about 10 years later than Caucasians. As a result, darker skinned folks look younger than their lighter skinned same age peers.Shot of a woman applying lotion to her face

Ashwagandha (Withania somnifera, Solanaceae) has many health benefits, but chemopreventive effects on skin cancer and regulatory effects on melanin might be something unfamiliar to you.  In the current prospective, randomized, placebo-controlled, comparative study, the authors assessed the efficacy and safety of the topical application of a lotion (Punarved Bioceutical Private Ltd.; Mumbai, India) containing the 8% standardized ashwagandha root extract KSM-66® (Ixoreal Biomed; Hyderabad, India) on photoaged skin of healthy participants.

The study was conducted at a clinic in India and include males and females, aged 18-40.  These individuals had skin colors ranging from golden honey or olive to deeply pigmented dark brown to darkest brown.

Twenty-one males and 35 females were randomly assigned to use ashwagandha or placebo  lotion. The ashwagandha lotion was standardized to contain 5% withanolides.  The placebo group used an identical lotion without ashwagandha. The lotion was applied at a dose of 1 mL to their face immediately after using a standard cleanser twice daily for 60 days, and it had to be at least 8 hours between the two applications.

At baseline, the treatment group and the placebo group  were similar in demographic characteristics, physician global assessment scores, skin parameters, and quality-of-life scores.

The primary outcome was the change from beginning to the end of the study in the total and individual scores from a physician assessment that included five dermatological signs: skin wrinkles, pores, hydration/moisture, skin brightness/tone, and pigmentation.  Secondary outcomes were changes in transepidermal water loss (TEWL), melanin index, hydration, and sebum content in the facial skin.  Quality of life scores were also measured.

Three participants did not return for follow-up, one in the treatment group and two in the placebo group.

Greater improvements in scores from baseline to the end of the study were observed in the ashwagandha group in areas of TEWL, skin hydration, and skin elasticity.  TEWL decreased 15.12% in the ashwagandha group vs. 8.34% in the placebo group.  Improvements of 20.66% were seen in the ashwagandha group for skin hydration and 16.34% for skin elasticity.  Improvements of 9.5% for skin hydration and 3.73% for skin elasticity were reported in the placebo group.  Changes in melanin index were similar in the two groups with small percentages of increase with 2.82% in the ashwagandha group and 1.78% in the placebo group.  There were some mild skin irritations in both groups, 4 in the ashwagandha group and 5 in the placebo group.

Commentary: This study had a small sample size; short duration; and mighty young participants at younger than 40.  I would be curious to see if this product worked in women and men older than 50.  I will be asking my compounding pharmacist if they can make such a product.  Limitations include regulations on which botanicals compounding pharmacists can utilize and this seems to vary by jurisdiction.  A quick internet search resulted in several topical ashwagandha skin creams, although concentration and extract amount varied.  While I have been fortunate to have grown up in the fog, have good skin genes, and never used nicotine, I think I’ll give it a try and mention this to patients.

Reference: Narra K, Naik SK, Ghatge AS. A study of efficacy and safety of ashwagandha (Withania somnifera) lotion on facial skin in photoaged healthy adults. Cureus. March 15, 2023;15(3):e36168.

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