Pandemics raise a lot of questions, specifically in the field of public health. If one occurs, or threatens to occur, scientists rush to figure out what is and needs to be available to combat the illness - whether that be via treatment or through the prevention of transmission. The COVID pandemic of the last few years is no exception. In a few short years, researchers and medical providers have come together to provide vaccinations, treatments, and literaturesupported recommendations to prevent transmission of infection. But, as the SARS-CoV-2 virus continues to mutate and change, these public health initiatives must adapt. So, what else is out there?

An already well-respected antimicrobial class of chemicals, known as benzalkonium chlorides, hold significant potential. Their use began in the early 1900s, gaining market recognition as a potent disinfectant and antiseptic. These days, benzalkonium chlorides are used in a wide range of products within industry, agriculture, clinical medicine, and personal products. One major reason these chemicals are used in such a widespread manner is that they are known to be effective with minimal safety concerns. Other than reports of some skin irritation in sensitive individuals, one is probably unaware theyʼre using and benefiting from these products. (1)

With the current pandemic, antiviral agents have gained a lot of attention. The good news is, benzalkonium chloride, though considered a broad spectrum antimicrobial, seemingly has some significant potential in adding to the host of antiviral products used to combat the spread of SARS-CoV-2. It has the ability to disrupt the lipid membranes of enveloped viruses, thereby deactivating them – this includes enteroviruses, rotaviruses, norovirus, influenza virus, rhino viruses, herpes simplex virus, hepatitis A virus, and thankfully, coronaviruses. (2)

So, what about SARS-CoV-2, the specific virus responsible for the COVID-19 pandemic still raging worldwide? At first, the research available was scarce, but as time has gone on more and more has been found supporting the use of benzalkonium chlorides in the prevention of SARS-CoV-2 spread and infection.

One study published in early 2021 tested the effectiveness of 0.2% benzalkonium chloride and 0.13% benzalkonium Qimei Hand Sanitizing Wipes. This was important, especially since there has been a shortage of alcoholbased sanitizers throughout the pandemic, due to alcohol-based sanitizers being the only option recommended by the CDC. Hospitals and outpatient healthcare professionals needed another option. The scientists in this study found that both concentrations were effective in deactivating the SARS-CoV-2 1300 1st St Suite 368, Napa, CA 94559 (916) 260-7483 | transformsalonluxe@gmail.com virus. In their discussion, they cited that in some situations, the benzalkonium chloride based products might be even more effective than the alcoholbased products because they were non-toxic and less irritating to the skin than alcohol-containing sanitizers, thus resulting in improved compliance and better hand hygiene compliance from healthcare workers. These researchers felt so strongly about the data, they concluded benzalkonium chloride containing sanitizers should be given the same expedited approval to manufacturers, making these products more available worldwide. (3)

Hand-sanitizers and topical disinfectants arenʼt the only places benzalkonium chlorides can provide assistance. A study by Tunon-Molina, et al in late 2021 decided to look into whether these chemicals could be used in personal protective equipment used by healthcare providers, specifically facial protection. Their goal was to develop a transparent face shield with intrinsic antimicrobial activity, thereby reducing surface transmission of disease and the production of infectious waste, another source of potential transmission to healthy individuals. They found that their single-use face shields, made by coating a transparent polyethylene terephthalate product with benzalkonium chloride, was successful at inactivating enveloped viruses, including coronaviruses. Their hope is that this novel idea can be translated for use in goggles, helmets, and other forms of personal protective equipment in the healthcare setting. (4)

At Telorevers Anti-Aging, Inc, benzalkonium chloride is added to manicure and pedicure formulas for its antimicrobial actions, but it is obvious thereʼs more to the story when it comes to these compounds. Though more research needs to be done in the personal-care product realm, it is likely that its presence is preventing the spread of not only bacterial or fungal infections, but also of viral infections, specifically against our biggest current adversary, the SARS-CoV-2 virus.

Dr. Mary Hall, ND, LAc

Medical Writer and Medical Advisory Board

References:

Beatriz Merchel Piovesan Pereira and Ilias Tagkopoulos. 2019. Benzalkonium chloride: uses, regulatory status, and microbial resistance. Appl Environ Microbiol: 85(13): e00377-19.

“Exploring whether Benzalkonium Chloride could be effective against SARS-CoV-2”. 2021. Pharmaceutical Technology. https://www.pharmaceutical-technology.com/ sponsored/benzalkonium-chloride-quats-sars-cov-2/
Ogilvie, B.H., Solis-Leal, A., Lopez, J.B., Poole, B.D., Robison, R.A., Berges, B.K. 2021.

Alcohol-free hand sanitizer and other quaternary ammonium disinfectants quickly and effectively inactivate SARS-CoV-2. J Hosp Infect: 108: 142-145.

Tunon-Molina, A., Marti, M., Muramoto, Y., Noda, T., Takayama, K., Serrano-Aroca, A.2021. Antimicrobial face shield: next generation of facial protective equipment against SARS-CoV-2 and multidrug-resistant bacteria. Int J Mol Sci: 22(17): 9518

According to the Centers for Disease Control, an estimated 37.3 million Americans have diabetes, thatʼs about 11.3% of the entire population. On top of that, another 96 million adults have prediabetes, making this one of the single most damaging and prevalent diseases in the United States (1). Unfortunately, the health issues related to diabetes are physiologically widespread, affecting multiple organ systems. This results in an array of uncomfortable and hard to treat symptoms that researchers at TeloRevers Anti-Aging, Inc are working diligently to relieve. The Essential-Dm PediPod manicure/pedicure formula, with ingredients supported by research, is one treatment they have provided, specifically to support skin ailments caused by diabetes.

Epidemiologic research has shown that a whopping 79.2% of individuals with diabetes, skin conditions will be present. This includes an array of microbial skin infections and inflammatory skin diseases, as well as chronically dry skin, all of which can result in uncomfortable and hard to treat symptoms (2). Because diabetes is so hard to treat with success, finding alternative ways to prevent and support these presentations can be essential to maintaining quality of life.

The Essential-Dm PediPod contains ingredients to nourish and protect the skin with the goal of both soothing current issues, while preventing future problems. By combining medical philosophies from both eastern and western traditions, it has been designed to include green tea extracts, grape seed extract, rosemary, arnica, Vitamin E, and benzalkonium chloride, all of which contain anti-inflammatory and/or antimicrobial properties.

A concern with diabetic patients is that when blood sugars are uncontrolled long term, peripheral circulation is reduced, and therefore so is the ability of the skin to heal - in some cases this can be so severe, patients can lose their limbs. Green tea, containing a high relative content of an active polyphenol known as epigallocatechin gallate, or EGCG, is one medicinal herb that can combat some of these skin concerns, specifically by supporting wound healing. Though the specific mechanisms are quite complex, ECGC has been found to have antioxidant, anti-inflammatory, antimicrobial, angiogenic, and antifibrotic properties, which benefit all stages of wound healing (homeostasis, inflammation, proliferation, and remodeling).(3)

A 2019 animal study looked a little closer. They referenced the knowledge that in mice with diabetes, the persistent inflammation in the later stages of wound repair is specifically what delays healing. They found that ECGC, the active constituent in green tea, was able to inhibit the accumulation of white blood cells, the inflammatory cascade, and a specific signaling pathway known as Notch-1. Therefore, they concluded that EGCG was a novel potential medicine to treat chronic wounds, especially in diabetic patients. (4)

Grape seed extract, another ingredient of the Essential-Dm PediPod formula, is also supported in the literature as a treatment for wound healing and other diabetic complications. Though it is usually thought of as an oral supplement, a 2014 study by Hemmati et al, showed its potential benefit when applied topically. These researchers performed surgery on small skin lesions, with the study group receiving 2% grape seed extract cream and the controls receiving placebo. After monitoring the healing process for 21 days, they found that the treatment group had complete repair of wounds by day 8, compared to day 14 in the control group, which was statistically significant. They attributed this success on the ability of the grape seed extract to release endothelial growth factors, therefore closing the wound and improving circulation, as well as its ability as an antioxidant and antibacterial, reducing inflammation and the risk of infection. (5) In diabetics, where wounds go unnoticed and healing times are extended, this could be a novel way to prevent complications.

Though Rosemary is also known to improve wound healing, it has a bit more of a broader spectrum when it comes to its actions on skin health. The ability of its active constituents to act topically as an antioxidant and antiinflammatory have made it a commonly used herbal medicine both in the pharmaceutical and cosmetic industries. For example, carnosic acid, one of the active molecules in rosemary, was found to act as an anti-inflammatory, specifically by mediating microcirculation – pharmaceutically, this would improve healing and skin health; cosmetically, it would reduce redness, swelling, and signs of aging. A comprehensive review of potential topical applications also cited studies touting rosemary as an anti-fungal, a protectant against UV damage, an adjunctive treatment for skin cancers, a possible treatment to improve the appearance of cellulite, and a possible promoter of hair growth in individuals with alopecia.(6) All these potential benefits is what led it to be added to the Essential-Dm PediPod formula.

The last herb included in the formula is colloquially known as Arnica. Though most commonly thought of as a strictly musculoskeletal herb, the actual mechanisms behind why it works for strains, sprains, and bruising may indicate significant implications on skin health. Much of arnicaʼs success in studies is attributed to its strong antioxidant activity, one study finding that at concentrations up to 100 mg/L, it possessed a significant protective effect against hydrogen peroxide induced oxidative stress (inflammation), especially in skin cells.(7) In the skin of diabetics, an imbalance of free radicals and antioxidants within the skin cells causes tissue damage and delayed wound healing.(8) Therefore, supplying the strong antioxidants from arnica to the skin causes an overall improvement in tissue health, hydrating, protecting, and repairing the skin.

Herbs arenʼt the only remedies that are in the Essential-Dm PediPod however. Vitamin E, a fat-soluble vitamin known for its significant health effects, has also been included. Like many of the herbs, much of Vitamin Eʼs popularity in dermatology and cosmetics is attributed to its antioxidant properties. However, it also has the ability to moderate the biosynthesis of collagen and glycosaminoglycans in the skin. Therefore, on top of supporting wound healing, reducing inflammation, and hydrating the skin, it also supports theintegrity and strength of the skin itself.(9) This could prevent known diabetic complications such as infection or ulcer formation.

In addition to these topical effects, Vitamin E has shown to have neuroprotective andcardioprotective effects when taken orally. Both circulatory and nerve conduction issues occur in diabetics, especially when blood sugars are poorly controlled. Theoretically, topical application of Vitamin E could benefit superficial nerves and microvasculature, improving outcomes with diabetics experiencing complications.(10)

These natural compounds are combined with benzalkonium chloride, a potent FDA-approved antimicrobial that is known to be minimally irritating to the skin. Researchers have worked diligently to combine traditional medicinal philosophies with modern medicine, providing a new, novel way to support patients suffering from various skin conditions. The Essential-Dm PediPod formula, containing green tea extracts, grape seed extract, rosemary, arnica, and Vitamin E, truly combines beauty with health, specifically formulated with diabetic patients in mind, preventing and aiming to heal painful, often debilitating symptoms.

Dr. Mary Hall, ND, LAc

Medical Writer and Medical Advisory Board

References:

“Diabetes: National Diabetes Statistics Report.” Centers for Disease Control and Prevention. https://www.cdc.gov/diabetes/data/statistics-report/index.html Duff, M., Demidova, O. Blackburn, S., Shubrook, J. 2015. Cutaneous manifestations of diabetes mellitus. Clin Diabetes: 33(1): 40-48.

Xu, F., Lv, Y.L, Zhong, Y.F., Xue, Y.N., Wang, Y., Zhang, L.Y., Hu, X., Tan, W.Q. 2021. Beneficial effects of green tea ECGC on skin wound healing: a comprehensive review. Molecules: 26(20): 6123.

Huang, Y.W., Zhu, Q.Q., Yang, X.Y., Xu, H.H., Sun, B., Wang, X.J., Sheng, J. 2019. Wound healing can be improved by (-)-epigallocatechin gallate through targeting Notch in streptozotocin-induced diabetic mice. FASEB J: 33(1): 953-964.

Hemmati, A.A., Foroozan, M., Houshmand, G., Moosavi, Z.B., Bahadoram, M., Maram, N.S. 2014. The topical effect of grape seed extract 2% cream on surgery wound healing. Glob J Health Sci: 7(3): 52-58.

De Macedo, L.M., dos Santos, E.M., Militao, L., Tundisi, LL, Ataide. J.A., Souto, E.B., Mazzola, P.G. 2020. Rosemary (Rosmarinus officinalis L., syn Salvia rosmarinus Spenn.) and its topical applications: a review. Plants (Basel): 9(50: 651.

Craciunescu, O., Constantin, D., Gaspar, A., Torna, L, Utoiu, E., Moldovan, L. 2012. Evaluation of antioxidant and cytoprotective activities of Arnica montana L. and Artemisia absinthium L. ethanolic extracts.

Deng, L., Du, C., Song, P., Chen, T., Rui, S., Armstrong, D. Deng, W. 2021. The role of oxidative stress and antioxidants in diabetic wound healing. Oxid Med Cell Longev: ecollection.

Mohammad Abid Keen and Iffat Hassan. 2016. Vitamin E in dermatology. Indian Dermatol Online J: 7(4): 311-315.

Zaffarin, A.S.M., Ng, S.F., Ng, M.H., Hassan, H., Ekram, A. 2020 .Pharmacology and pharmacokinetics of vitamin E: nanoformulations to enhance bioavailability. Int J Nanomedicine: 15: 9961-9974. it