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Page 10 of 24 Reilly et al. Plast Aesthet Res 2021;8:2 I http://dx.doi.org/10.20517/2347-9264.2020.153

Several studies have suggested that following a healthy and balanced diet can help treat acne, especially
food rich in vitamin A, vitamin D, vitamin B3 and vitamin B5 which help reduce inflammation, lesions,
[51]
and scars . Niacinamide, or vitamin B3, is commonly used to reduce swelling and redness due to its anti-
inflammatory properties and also helps regulate the amount of oil produced by sebaceous glands in skin.
Furthermore, niacinamide regulates skin tone, helps minimise marks on the skin and reduce appearance
[52]
of hyperpigmentation . Clinical studies using daily oral supplementation containing pantothenic acid
in healthy human adults with mild and moderate acne has shown the reduction of total facial acne and
blemishes after 8- and 12-weeks respectively versus placebo control [53,54] . A deficiency in Vitamin D (25
hydroxyvitamin D3) was shown to correlate with increased severity of acne lesions, which could be
[55]
mitigated by supplementation with oral cholecalciferol at 1000 IU/day for 2 months .
Changes in collagen synthesis and degradation during pregnancy and postpartum have been instrumental
in understanding collagen turnover in ECM remodelling. Collagen and elastin undergo a marked increase
[56]
in pregnancy followed by a rapid decrease during involution . Pregnant women can experience many
integumentary distortions, including skin stretch and hair loss (which can be pre- or post-partum) whereas
post-partum skin elasticity needs to be restored by helping to tighten the skin on the abdominal area. As
pregnancy progresses, the skin around the stomach area, hips, thighs, and breast expands and many women
develop stretch marks. Pregnancy stretch marks (striae gravidarum) are common at later stages affecting up
to 90% of women and depend on the viscoelastic tension forces of the skin. During pregnancy, hormones
soften collagen fibres by decreasing the bonding between them and increasing the appearance of stretch
[57]
marks . Loose skin on the stomach area is very common, and skin may never revert back to its original
elasticity.

Other forms of stretch marks (striae distensae; striae rubrae) are lines or streaks across the skin, usually
[58]
quite narrow and can be pink, red, or purple . They usually start off darker and fade over time leaving pale
marks and lines in the skin. The most affected areas are the abdomen, breasts, and thighs. Stretch marks are
also caused by sudden growth, weight gain (e.g., obesity) or puberty.

Collagen supplementation during and after pregnancy (in particular during breastfeeding) can be a key
beneficial support to the immense amount of changes that the body goes through during that period,
supporting a hydrated and more elastic skin architecture, making it healthier and stronger, especially post-
partum. It has also multiple benefits for joints, ligaments, muscle which will help carrying the baby during
the pregnancy period and help alleviate muscle soreness and injuries.

[59]
Since the pioneering work of Albright et al. in 1941 the association between atrophied skin, menopausal
status of women and prevalence of osteoporosis have been studied extensively. It has been shown that
[60]
a decrease in skin thickness and collagen content occurs with decreasing oestrogen concentration .
Symptoms associated with the menopause include hot flushes, insomnia, decreased skin elasticity,
decreased skin hydration, varicose veins, cellulite and impaired cognitive function. These symptoms can
lead to frustration and impact negatively on Quality of Life outcomes. Men, on the other hand, have a
gradual decline in testosterone levels (which has less impact on collagen content) and therefore experience
less symptoms if compared with women of similar characteristics and age. Several studies support the
anti-ageing properties of oestrogens in postmenopausal women showing a positive effect increasing skin
collagen content, thickness, elasticity, and hydration as well as improving would healing and reducing
wound complications [61,62] .

Studying the collagen content of the skin during menopause, an average decline of 2.1% on skin collagen
content and 1.13% on skin thickness per each postmenopausal year during the first 15-18 years of post-
menopause was observed [63,64] . In a study carried out on 65 women of varying age and menstrual cycle