Patients often inquire about what natural products they might introduce into their routine to promote healthy skin and prevent sun damage. While photoprotection through the use of broad-spectrum sunscreen remains a mainstay of anti-aging and preventive regimens, there are numerous botanical agents and dietary supplements that claim to be effective against aging skin and UV-induced damage. Many of these claims are not substantiated by well-designed studies. However, a few agents have been studied in small trials which show some efficacy and are worth considering.

Common complaints from patients inquiring about anti-aging skincare include lentigines (“sun spots”), uneven pigmentation, fine lines and wrinkles (rhytides), textural changes, and increased laxity. Chronic, unprotected sun exposure leads to these changes, which are collectively known as dermatoheliosis, or “photoaging,” This process occurs when ultraviolet radiation triggers a cascade of signal transduction that ultimately results in increased expression of matrix metalloproteinases, enzymes that degrade types I and III collagen in the dermis. Dermal vasculature is directly injured by UV radiation and indirect DNA damage occurs via the generation of reactive oxygen species (ROS). While UVA rays are thought be the primary culprit in photoaging due to their deeper penetration into the dermis, UVB rays are also thought to play a role in skin damage (Han et al. 2014; Fisher et al. 2002; Sternlicht and Werb 2001).

See Table 2.1.

Green tea is rich in plant polyphenols, compounds that exhibit strong antioxidant, anti-inflammatory and immunomodulatory properties (Elmets et al. 2001; Katiyar et al. 2000). The primary antioxidants in green tea are epigallocatechin gallate (EGCG) and epicatechin gallate (ECG). The amount of oral green tea consumption for maximal health benefit is typically 3–6 cups per day, although cutaneous concentrations of green tea polyphenols after oral consumption have not been well quantified. While consumption of green tea in moderation is considered to be very safe, concerns over the safety of concentrated green tea extracts have arisen due to case reports of hepatotoxicity (Sarma et al. 2008). Patients should be counseled about these reports, and should be advised to limit their consumption to reasonable amounts; they should also be advised to exercise caution about taking supplements containing green tea extracts, as these may be impure and/or contain other potentially toxic ingredients. Topical formulations of green tea have been studied for their effects on photoprotection and photoaging (Li et al. 2009).

Flavonoids are secondary plant metabolites, found in many fruits and vegetables as well as in red wine, tea and cocoa (Heinrich et al. 2006). These compounds have been shown to demonstrate anti-oxidant and anti-inflammatory effects in vitro and as such have been investigated for their potential benefits in cutaneous aging and repair of ultraviolet damage. There are no large randomized controlled trials focusing on the cutaneous effects of oral flavonoid consumption, and there are no definitive recommendations on the doses of flavonoids needed to achieve clinically significant improvement in the skin. In the two studies listed below, the amount of flavanols (a particular class of flavonoids) consumed by the subjects was 100 g (3.5 oz) daily; this is approximately the weight of a standard chocolate bar. Since dark chocolate contains more cocoa than milk chocolate, dark chocolate is richer in flavanols than milk chocolate; however, the final flavanol concentration in any chocolate preparation is highly dependent on the type and amount of processing (Ried et al. 2012; Latham et al. 2014). Flavanol concentrations vary greatly among different chocolate products, and the cocoa percentage often listed on the packaging is not a reliable indicator of the concentration; two bars that contain 70% cocoa, for example, may contain different flavanol concentrations (Ried et al. 2012).