|Murad Techinical Articles|
SUNSCREEN SENSE: HELPING EACH CLIENT SELECT WHAT'S BESTBy Howard Murad, M.D.
Just because "everybody knows" that the sun can cause skin damage and that you need to use a sunscreen daily, doesn't mean that "everybody" understands which sunscreen is best. As an aesthetician, you are in a key position to clarify fact vs rumor regarding sun exposure risks. In this way, you can help your clients make informed product decisions based on their own specific needs.
Is All Sunlight "Bad" for You?
To answer that question, we need to first examine the components of sunlight know as the solar spectrum These include three types of ultraviolet light - UVC, UVB and UVA. In addition, the solar spectrum also contains VISIBLE LIGHT AND INFRARED RADIATION.
UVC is almost completely absorbed by the ozone layer, so it has minimal effects on the skin. UVB is primarily responsible for sunburn or erythema. Peak hours for sunburn occur between 10 AM and 2 PM. The medical community now believe that UVB is a major cause of many skin cancers. However, UVB does NOT pass through window glass, unlike all other components of the solar spectrum. UVA is particularly tricky. Though it causes only 1/1000th of the redness of erythema caused by UVB, it penetrates past the epidermis, into the dermas layer. The solar spectrum emits UVA light all day long, and in much greater quantities than UVB. Furthermore. UVA can pass through glass. So if you regularly sit by a window, even though you don't feel heat or redness, you can still be exposed to the skin cancer - producing aspects of UVA. Another problem. With the advent of better UVB sun blockers. people feel they can stay in the sun longer, thereby running the risk of increased UVA penetration.
VISIBLE LIGHT can cause reactions with dyes. It is also responsible for Porphyria reactions in the form of blisters on the hands and face. Naturally, it passes through window glass.
INFRARED RADIATION, with its longer wavelengths, heats up the cells, and may cause damage over extended periods of time. It also passes through glass.
Does "Everybody" Really Need Sunscreens?
In a word, YES! But some need it more than others. The young are at greater risk. Recent theories state that 80% of damage caused by ultraviolet rays occurs before age 18 just because children spend more time in the sun. People who are very fair also burn easily.
In discussing sunscreens, the aesthetician should explain the risks of sun exposure mixed with certain types of common drugs, such as Accutane, Tetracycline, Retin-A, birth control pills or high-blood pressure medications to name but a few. Certain skin diseases like eczema, rosacea and melasma can also make an individual photosensitive. Equally important, those with a family history of skin cancer need appropriate protection. When Did Sunscreens Become Available? In 1928, a mixture of benzyl salicylate and benzyl cinnamate was believed to be the first sunscreen. In the discovery of Para-amino-benzoic acid or, as it's more commonly known, PABA. But is w as not unti1943 came 1978 ns that the FDA categorized sunscreens as drugs intended to protect the structure and function of the skin against sun damage.
What are the Main Types of Sunscreens?
PABA and PABA ESTERS, including Padimate 0 and Padimate A, were the first sunscreens patented. Today, then usefulness is limited compared to some of the newer sunscreens. Since they are only UVB blockers, and can produce a significant incidence of contact and photocontact dermatitis, up to 4% of the population may have a reaction to PABA and its derivatives. PABA may also cause yellow stains on clothing. CINNAMATES absorb UVB with minimal absorption of UVA, Since they are insoluble in water, they are used in waterproof products. SALICYLATES were actually the first UVB sunscreens used. They are non-water soluble, and very stable and nonsensitizing. BENZOPHENONES are UVA/UVB blockers. Since they are water-soluble, normal perspiration removes them. ANTHRANILATES are usually safe and stable compounds, used primarily for multiple UVA blockage. They are also oil-soluble. PHYSICAL AGENTS block UVA, UVB and infrared radiation. White zinc oxide, typically worn by lifeguards on Mei-noses, is an old-fashioned example. Today's new technology has reduced the particle size to micro-fine solution or lotion, a physical agent such as titanium oxide provides a broad protective barrier, yet is mor cosmetically elegant.
What is S.P.F.?
S.P.F. stands for Sun Protection Factor. It is based on the minimal erythema dose multiplied by the SPF nun The minimal erythema dose or MED is the amount of sun exposure required to produce mild redness. So. takes 10 minutes to produce MED and the SPF is 15, it takes 10 x 15 or 150 minutes of sun exposure to pro, redness with SPF 15 protection. This works well for UVB, but not for UVA since UVA rays do not produce measurable redness. However, a coupiE of methods have recently been developed for UVA measurement. One used phototoxic medication to induce more erythema after light exposure. The other used UVA as the single source of energy in photo testing.
How Important is Substantivity?
Substantivity is defined as the sunscreen's resistance to being washed off or removed by perspiration. It is virtually as important as the active ingredient itself. After all, what good is a sunscreen if it only works for five minutes? Newer products may now be classified as water-resistant, meaning the skin is protected for up to 40 minutes of continuous water exposure, and waterproof, with a continuous water exposure time of 80 minutes.
What's the Future of Sunscreen Protection?
Your role as skin care advisor looks even more important when it comes to the range of upcoming sunscreens. These include: (1) New ingredients with broader protection, (2) Natural agents, such as melanin, used in the sunscreen; (3) A combination of several active ingredients to act as free radical scavengers (free radicals are unstable molecules that are released in the cell and cause damage to it and these ingredients may also possibly reduce damage already inflicted by the sun); and (4) the addition of various vitamins such as Vitamins C, E and A, to enhance sunscreen effectiveness. Perhaps in no other area can your influence be so great because you need to get the word out that everyone requires sunscreen protection.
HOW TO IMPROVE YOUR RELATIONSHIP WITH THE DERMATOLOGIST: By Howard Murad, M.D.
We are entering an era where there is going to be an even closer partnership between the aesthetician and the dermatologist. The consumer. clients, patient is beginning to demand the benefits of the care that both professionals can give. As there is a critical role to be played by the aesthetician for the improvement of skin care. we may need to educate the physicians on how beneficial this joint relationship can be. In order to develop a referral relationship with the dermatologist, I would suggest that the aesthetician first do a little homework. Try to determine which dermatologist or cosmetic surgeons are open to the concept of working together with you. I feel certain that most physicians would like to work together as a team as long as they do not feel threatened (possible loss of patients). However they need to understand what services the aesthetician could perform.
Therefore. I would suggest that you do an inventory of all your services, especially listing those areas where the client would benefit from a combined effort of the two professionals. These could include paramedical make-up for post operative care. facials prior to and after chemical peeling, and acne care facials to help the acne clients. patients.
It is most helpful also to demonstrate to the physician your knowledge of skin care and skin disease. To this end I would suggest that you read all articles about skin cancer. skin disease. etc. not to treat them, but to recognize them so that your clients can be referred appropriately.
The aestheticians should be aware of the fact that they have as much to offer as the dermatologist. and should make this quite clear in any contacts they may have with a physician. It should also be clear that all patients referred to the salon would go back to the physician. and that the many clients in the salon will probably be referred to the physician for their medical care.
For example of one way in which this relationship can be established, we are including a letter that we sent to many of the dermatologists in our community. This was followed up with a phone call which was mostly directed to the office manager.
If time allows, maybe an opportunity could be set up to discuss the benefits that the patient/client could derive from the partnership of the doctor-aesthetician.
There are possibilities of having open house at your salon where the physician could speak on topics of interest to your clients, or the possibility of a similar structure at the physician's office where you could speak on a topic of interest to the patients.
Once you get a referral, it would be important to know exactly what the physician would expect or need in terms of care for the client. and of course to send a thank you note with a little bit of information as to what was accomplished. and what future plans there are for continued care.
WHAT EVERY SKIN NEEDS
When that question is asked of almost anyone with a skin care background, the answer is moisture - water. While that has been known fo centuries, it is only recently that we have been able to understan the many principles involved in adding water to the skin. We need to study the anatomy and physiology of the epidermins to begin to understand these principles. Briefly put, the entire function of the epidermis is to manufacture stratum corneum which will protect the skin from the enviroment assault. The stratum corneum not only act as a barrier to various assaults, it also acts to maintain the appropriate functions of the skin itself - to maintain the moisture of the skin, it helps balance body fluids.
Within the stratum corneum or odland bodies which are discharged from the keratincocytes into the intercellulear spaces. These granules establish a barrier to water loss since they are basically lipids which are hydrophobic, and therefore prevent transepidermal water loss while modulating cohesion of the stratum corneum. Besides thes odland bodies the lining epidermis also produces various other lipids which have a greater presence in the stratum corneum.
Ceramides are relatively impermeable to water and are resistant to oxidation and environmental assault. Natural moisture factors are hygroscopic water soluble substances which absorb water. Natural moisture factors result in epidermal cellular differentiation, a by-product of the protein synthesis profillagrin is the keratohyaline Granule at the stratum granuloseum - stratum corneum interface.
Now that we know a few of the of these facts as to how the epidermis functions, we can begin to understand how possibly we can improve on it. I feel this is a 5 step procedure.
1. We must add ceramides or substanced which are involved in ceramid production such as linoleac acid or borage oil to prevent transepidermal water loss.
2. We must exfoliate to remove stratum corneum which is not functioning appropriately.
3. We must add natural moisture factors such as sodium PCA & hyaluronic acid to absorb moisture from the environment.
4. We must add anti-inflammatory agents to reduce inflammation, such as Vitamin E, licorice extract, Aloe Vera gel, allantoins, etc. We know that inflammation leads to water loss as well as undesirable appearance of redness on the skin.
5. We must add agents that will normalize the function of the epidermis, such as Vitamin A derivatives.
I believe that only when all five of these steps are accomplished can we absolutely hydrate the skin.
Howard Murad, M.D.
UNDERSTANDING SPECIAL DENATURED ALCOHOL (SDA) By Howard Murad, M.D. and Paul Scott Premo
Alcohol, in the context of cosmetic formulations, is a frequently misunderstood ingredient. Despite the fact that alcohol can be extremely beneficial in a particular formula, its ambiguity has given rise to some controversy. That's why it is extremely important to understand not only what alcohol is, but, more important, the differences in the various types of alcohol.
Alcohol is a clear, colorless, volatile, flammable liquid synthesized or obtained by the fermentation of sugars and starches. Widely used as an external antiseptic, it is also used - either pure (absolute or ethyl) alcohol and denatured alcohol -- as a dispersing agent or solvent in everything from paint to perfume. For cosmetic purposes, we are most concerned with SD alcohol (SDA), which stands for Special Denatured Alcohol. Denatured means, simply, that denaturants have been added to ethyl or absolute alcohol to prevent oral consumption. A mild cosmetic alcohol, SDA is an excellent delivery vehicle commonly used in astringents, toners and gels. Alcohol's are also used as thickeners, solidifiers and solvents in perfumes, shampoos, skin and shaving preparations. Examples of Special Denatured Alcohol used in cosmetic formulations are SDA/3A, SDA/39C SDA/40 and SDA/40A. The number indicates the specific denaturing agent used.
There are also alcohols, such as cetyl or stearyl alcohol, that are forms of fatty acid waxes. Predominately unsaturated, waxy solid alcohols that are non-toxic to the skin, these alcohols function in an emollient manner and are used as thickeners and emulsifiers. They help build emulsions and in skin lotions and creams they build semi occlusive barriers preventing skin water loss (TEWL). The alcohols have no association with absolute, ethyl or SD alcohol.
Rubbing alcohol, or Isopropyl alcohol is another type of alcohol. It contains no less than 68 to 71 ethyl alcohol; the remainder consists of denaturants. It is most commonly used a a "rub-down" preparation or liniment, and as a local antiseptic.
While the trend is to "alcohol-free" skin toners and fresheners, especially for dry or sensitive skin, it is important to remember that SD alcohol is not necessarily dehydrating to the skin when it is mixed with other moisture-binding ingredients Its effects depends entirely on its concentration in the formulation and, of course, the chemistry of the total formulation. One ingredient cannot be taken out of context; its appropriateness relative to the formulation must be evaluated within the framework of the product and results you are trying to achieve, along with the other ingredients.
Oily-prone and acne-prone skin can benefit from formulations containing SDA. Generally, SDA is a mild, non-dehydrating, non-irritating, cosmetic alcohol used as a vehicle to improve the efficacy of a particular product. Combined with other ingredients, it is an ideal vehicle to allow better skin penetration.
MAKING THE BEST OF MENOPAUSAL SKIN By Howard Murad, M.D.
In the next 20 years, nearly 40 million American women will pass through menopause, a period commonly known as "change of life." By the year 2020, about 60 million women will be at or through this transition. What is menopause and why is it so unsettling? Menopause is the cessation of menstruation during which a woman's ovaries produce less of the female hormone estrogen and it signals unwanted aging for women in a society which highly prizes youth. In addition, menopause is unpredictable. The drop in hormone levels differs from woman to woman, as do overall menopausal symptoms. While the onset of menopause usually occurs between the ages of 45 and 55, some women in their early 30's experience menopausal sleeplessness, weight gain, irritability, temporary memory loss, hot flashes, brittle hair and dry skin.
Let's concentrate on the effects of menopause on maturing skin. Psychologists find that good, youthful skin qualh is one of the primary factors linked to a woman's physical self-esteem. Although the eventual dryness ar inelasticity of skin that come with age are inevitable facts of life, the aging process is a cumulative one that occu at varying rates from individual to individual far before menopause begins.
Three variables -- heredity, environment and lifestyle -- determine how a woman's skin will respond during menopause. How did her mother's skin age? Has she protected her skin from the drying, discoloring damage caused by environmental hazards such as sun, wind, pollution and indoor and outdoor heating? Does she live a healthy life that includes exercise, balanced nutrition and sufficient rest?
As menopause approaches, normal imbalances that upset a woman's skin equilibrium, combined with biological precedent and the lifestyle choices she has made, will determine the course of aging on her skin. To understand how to minimize, and in some cases even delay, the menopausal aging process of skin, we must first look at the structural changes that occur during the maturation cycle of this important organ. The subdermis, or layer of fat that cushions the skin, deflates while the production of collagen and elastin (structural protein tissue) lessens. The dermis (the skin's supporting and nourishing layer) thins out and the skin loses much of its "extensibility," or ability to bounce back. Sweat and oil secretions also slow down, causing the skin to lose much of its natural protective film, which in turn makes the skin susceptible to moisture loss and more vulnerable to damage. Wrinkles become facial highlights, while the skin assumes a dull, discolored, rough. dry appearance.
Mature skin also suffers from a decelerated cell renewal rate resulting in the accumulation of dead cells on its surface layer, the epidermis. This process of building and shedding cells in the right amounts is affected by hormone levels in the bloodstream.
Although there are no established rules for managing menopausal skin, proper skin care and long-term preventive techniques can help lessen its visible influence. Remember that skin reacts well to excellent treatment at all ages. The following whole-being therapeutic approach includes methods that encourage healthy, supple skin at any age.
First, since it is universally agreed that sun is the number one damaging influence on the skin, avoid the results of premature aging by wearing sunblock, protective clothing and sunglasses that protect against the sun's harmful rays while outdoors.
Living a balanced life shows on the face. Following the Greek maxim, "everything in moderation," exercise to keep the circulation moving. Good circulation sends nutrients, oxygen and moisture to the skin ridding it of excess impurities and toxins. Get plenty of sleep; eat a nutritious diet high in fibers, low in fats, salt and carbohydrates; avoid undue stress; don't smoke or over medicate and avoid excessive alcohol consumption. Hydrate the skin inside and out. Drink eight glasses of water a day. Always use a moisturizer and, as the skin 4 matures, moisturize more intensively.
Accelerate cell shedding or exfoliation with products that utilize the advanced alpha hydroxy acid (AHA) glycolic acid, a natural derivative of sugar cane. These formulations have proven beneficial in loosening the bonds that hold dead cells to the surface of the skin. The cells slough off more readily, softening the appearance of skin. The newer, fresher-looking skin below is exposed and is better able to absorb natural moisture from the air. Glycolic acid based skin treatments are available which contain special ingredient complexes that work to alleviate uneven skin tone, sallowness, and age and sun spots. The lightening agent hydroquinone helps to soften pigmentation flaws and restore skin clarity. Anti-oxidant vitamin complexes A and E help neutralize unstable oxygen molecules called free radicals that accelerate skin aging if left unchecked.
Even though we live in the 1990's, many myths still surround menopause. Combat these myths by learning about the subject beforehand to know what to expect. Then, to make the best of menopausal skin when the time comes. consult a dermatologist to initiate the most effective management program possible.
BASAL CELL CARCINOMA By Howard Murad, M.D.
Meredith Murad Hilane Murad Basal Cell Carcinoma is the most prevalent form of cancer and plagues close to 500,000 Americans every Traditionally, people in their later years have been most affected, especially men who have spent long periods c working outdoors. This classification is slowly changing, however, as both women and younger people are a:sr: , Basal Cell Carcinoma as commonly as men.
The major cause of Basal Cell Carcinoma is overexposure to ultraviolet rays from the sun. Chronic sun expe., accounts for approximately 95% of all Basal Cell Carcinomas which generally develop on exposed body parts sur:- the face, ears, neck, scalp, shoulders and back. Other causes of Basal Cell Carcinoma include: ingestion of arseic. complications with burns or scars and vaccinations. The depletion of the ozone layer, due to excessive amounts cf chloroflourocarbons in the atmosphere. also contributes to the development of skin cancer. This is because try: chlorofluorocarbons severely limit the ozone's ability to filter and protect against the sun's ultraviolet rays.
Because the affects of sun exposure are cumulative over the course of one's lifetime, the most likely candidates fcr the development of Basal Cell Carcinoma include people who have spent a lot of time in the sun. Those with fair skip and light hair are also more susceptible since they do not have the melanin protection that darker skinned people have. Individuals with outdoor occupations or hobbies and people living in high altitudes or close to the equator are also highly susceptible.
There are five major signs of Basal Cell Carcinoma and it is likely that two or more of these characteristics may occur simultaneously in the same tumor These five warning signs include: an open sore that remains open for three or more weeks and may bleed, ooze or crust; a reddish patch, usually appearing on the chest, shoulders, arms or legs. The patch may be irritated or may be free of any discomfort. Another warning sign of Basal Cell Carcinoma is the appearance of a smooth growth that is indented in the center and has elevated and rolled borders. Other characteristics of the cancer include: a shiny bump or nodule, often mistaken for a mole, usually pearly or transparent in nature and pink. red or white in color and scar-like area which is white, yellow or waxy and has undefined borders.
There is a wide variety of treatments available for Basal Cell Carcinoma although the exact method depends on the doctor's analysis of both the patient and the tumor. The most widely used method of treatment is called electrosurgery and curettage. in which the dermatologist scrapes off the cancerous tissue with a curette and then employs an electric needle to burn a safety margin around the scraped area. Doctors may also utilize some other common forms of treatment which include: excisional surgery, cutting out the entire growth; cryotherapy. using liquid nitrogen to freeze the cancerous tissue; radiation therapy, the use of X-rays to destroy the cells; laser surgery. the use of a laser beam to remove the tumor or destroy it by vaporization; or Moh's surgery. This is a very effective process whereby the doctor removes thin layers of the tumor and examines each one under a microscope to determine the pattern of the tumor. This process is repeated until the cancer is completely excised.
It is extremely important to recognize the signs of the Basal Cell Carcinoma because of its tendency to resemble other less harmful skin disorders such as psoriasis, eczema or moles. Repeated self-examination change or abnormalities of the skin should be reported to a physician immediately. Catching is crucial and any g surrounding tissue and require more extensive forms of treatment BcauseasalCmeoll more damage to Carcinoma in its early stages will aid in treatment as the tumor will grow over time and a larger tumor will cause more damage to surrounding tissue and require more extensive forms of treatment.
The Aesthetician's job is to council their clients to avoid repeated. prolonged sun exposure. especially between the hours of 10:00 AM and 3:00 PM. If they do spend time in the sun. they should be advised to wear sunscreen. It also helps for the aesthetician to be aware of the different skin types so that they can better aid their clients on skin care and cancer prevention. These skin types include: Type I; people with fair skin, blue (or sometimes brown) eyes. freckles and white unexposed skin. These people always burn easily and severely, tan lithe or none and peel. Type II: people with fair skin. red. blond or brown hair blue, hazel or brown eyes and white unexposed skin. People in Type II skin usually burn easily and severely. tan little and peel Type III includes the average caucasian who tansr fairly easily and burns only moderately. The fourth skin type describes people with white or light brown skin. dark hai and eyes and light brown or white unexposed skin. These individuals burn very little, tan easily and exhibit easily immediate pigment darkening when exposed to sun. People with skin type V have with an immediate pigment darkening reaction. The sixth and final skin t brown skin, rarely burn and tan very never burn and tan excessively exhibiting an immediate pigment darkening reaction.
Aestheticians should also be aware of suspicious areas on their client's skin and refer them to a physician if they suspect skin cancer. After a client has had surgery. the aesthetician can be helpful in introducing them to paramedical make-up which is very successful in masking the scars left by the surgical procedure.
CELL TURNOVER BY Howard Murad, M.D. and Paul Scott Premo
ONE OF THE UNIQUE FEATURES OF THE EPIDERMIS is its ability to regenerate or renew itself continuously. The constant process of shedding and renewing epidermal cells is called desquamation, from the Latin "desquamatous" meaning "to scale off".
This article presents a comprehensive analysis of this unique physiological process and its relevance to professional skin care. In addition, we will discuss both mechanical and chemical methods of accelerating the natural removal of dead skin cells.
The mechanics of desquamation are complex and frequently misunderstood. On first inspection this subject re-. ay appear complicated and technical, but stick with it. The time spent studying and the information gained will he worth the effort.
The epidermis is a self-renewing barrier to water loss and is resistant to chemical, physical and microbiology-, ins t. The epidermis is not uniform and can be subdivided into two basic layers: the outermost stratum corneum (the dead skin cells on the outer skin surface) and the viable stratum malpighi (the living part of the epidermis where cellular activity).activity). The stratum malpighi can be divided into three sub-sections (working inward from the corneum). the stratum granulosum (granule cell or granular layer), the stratum spinosum (prickle cell layer) stratum basale (basal cell layer).
THE MAJOR CELL OF THE EPIDERMIS is the keratinocyte, which produces the highly resistant insol keratin. Keratin provides the protective barrier function of the epidermis.
As the cells mature in the different levels of the epidermis and traverse from the basal cell layer outward stratum corneum, they change shape and structure. This entire physiological process of cellular proliferatic - represents the maturing of the keratinocytes and is referred to as keratinization. How long does it take for a keratinocyte to traverse the four layers? Estheticians are often taught that this is a 28-day process. This is a rough estimate for normal skin with no unusual conditions.
According to Walter Lever, MD, and Gundula Schaumberg-Lever, MD, in Histopathology of the Skin, medically it can take 26 to 75 days for this process to occur depending upon the age and condition of the skin. It can take up to 19 days for the epidermal cells to reproduce in the basal cell layer. The time required for the replicated cell to travel from the basal cell layer the granular layer is between 26 to 42 days with an additional 15 days until the cells are desquamated (sloughed) from the stratum corneum. Therefore, from basal cell replication to complete cell turnover would represent a total epidermal renewal time of 60 to 76 days. These findings were concluded both on the basis of fluorescent dye stains and autoradiographs.
WHAT FACTORS AFFECT THE SPEED OF DESQUAMATION? Probably the most important are the dermal influences such as epidermal growth factor (EGF), androgen and estrogen hormones, and various vitamins such as A and D. Epidermal chalones are hormones that inhibit the metabolic process thereby restraining epidermal mitosis. In addition, age, condition of the skin, genetic make up and the environment all influence normal cell proliferation. In general, the younger the skin, the faster the desquamation process.
Environmental factors also play a strong role. When the skin is exposed to excessive sunlight and environmental stress, a natural response of the stratum corneum is to become thicker to protect the sublayers of the epidermis. This results in a slower natural desquamation process and a dry, rough and sallow appearance to the skin Overexposure to sunlight that accounts for "skin peeling" may be evidence of disruption of normal epidermal proliferation.
Genetic disorders also can influence normal cell proliferation. In psoriasis, in particular, the total epidermal turnover time may be only seven to ten days: basal cell replication of one to two days, traversing the stratum malpighi from four to six days and final desquamation from the stratum corneum in two days. Abnormal epidermal proliferation is also observed in hyperkeratotic (scaly) disorders such as ichthyosis, a congenital skin disease characterized by dry, thickened, scaly skin.
Excessively dry, rough skin, medically termed epidermal xerosis, is a condition that affects many people. It appears to be the result of abnormal desquamation. There are cosmetic and medical methods available to counterbalance the effects of decreased desquamation and reestablish the equilibrium of the skin.
Exfoliation, from the Latin "exfoliatus" meaning "to strip off leaves," is the accelerated removal, through mechanical or cosmetic chemical intervention of corneocytes (dead epidermal cells ). Exfoliation substances and techniques provide substantial improvement in dry skin, acne and to modify photodamaged skin depending upon the technique and substance used.
Cosmetic exfoliation reduces corneocytes from the stratum corneum and is considered to be a non-invasive procedure. Cosmetic exfoliation can be administered mechanically or chemically. Both methods can provide positive benefits when properly recommended and administered. However, these methods can be misused by both practitioner and client and can result in irritant dermatitis.
Let's discuss each method and the pros and cons associated with its use.
MECHANICAL EXFOLIATION can be divided into two parts: the use of certain compounds and the use of certain tools. Mechanical exfoliating compounds include polyethylene particles or granules, silica, and crushed fruit pits and seeds. Tools include facial brushes, textured sponges and pads, and loofahs. Although the implements may be different, the theory and process of these products and tools are similar.
These substances require mechanical application by applying pressure on the epidermis. Friction and abrasion loosen and reduce corneocytes, providing a type of superficial planing. Improved smoothness and clarity are the objectives. However. excessive abrasion can result in skin irritation. It is difficult to administer consistent pressure during a treatment or home use. Too light a pressure may not be effective, but too heavy a pressure could be damaging. Abrasion may cause uneven skin stripping.
Use caution when recommending or administering abrasive materials on skin exhibiting any of the following conditions: pre-existing irritation (dermatitis), open wounds or lesions, sunburn, post-chemically peeled skin by a physician, couperous skin, severe acne or thin, crepe paper skin. As with any skin care treatment, the extent of mechanical exfoliation recommended will vary with the pre-existing condition of the skin, skin preparation and duration of use.
CHEMICAL EXFOLIATION involves the application of a variety of low concentrated chemicals. The following are the most common chemical substances used for exfoliation: salicylic acid (0.5 - 2% over-the-counter (OTC); resorcinol: enzymatic compounds such as papain, bromelain and pancreatin; and alpha hydroxy acids (AHAs).
Salicylic acid, resorcinol and enzyme compounds are keratolyic substances that decompose the keratin composition of the stratum corneum. AHAs function by interference with ionic bonding and intercellular cohesiveness between corneocytes, or the glue-like substance between dead skin cells. These substances are also considered non-invasive due to their low concentrations (5-10% home use), and are therefore limited to corneocyte reduction.
Salicylic acid and resorcinol are also effective external antiseptics, the former being approved by the Food and Drug Administration (FDA) and sold over-the-counter for the treatment and prevention of acne blemishes. When used in preparations as active ingredients, some associated contraindications are excessive skin dryness, peeling, erythema (redness), pruritus (itching) and epidermal hyperpigmentation - particularly with resorcinol.
Biological enzymes are proteolytic substances that decompose whole proteins into smaller fragmented proteins (amino acids, polypeptides, and di- and tri-peptides). Epidermal corneocytes are composed mainly of keratin protein of higher glycine (an amino acid) content than the harder keratin cystine content of hair and nails. The theoretical mechanism of action produced by enzymatic compounds is a "softening" or breaking down of the keratin protein, thus reducing corneocytes.
These substances are activated by constant contact with a moist environment (water) and are limited to the amount of corneocyte reduction. Minor irritation can result in some hypersensitive individuals.
AHAs are a group of non-toxic organic acids with origins in many food substances. Glycolic and lactic acids are the most widely used, primarily due to their small molecular orientation. The exact mechanism of action is unknown; however, the accepted theoretical application from these acids in low concentration is via interference with ionic bonding and cohesiveness between corneocytes as mentioned previously. In low concentrations (between 5-15%), these acids diminish corneocyte cohesion and are therefore indicated for conditions associated with hyperkeratinization. At these concentrations, a superficial non-invasive exfoliation is produced.
Cosmetic applications of AHAs are safe and beneficial when properly compounded and administered. Do not exceed recommended concentrations. Some potential complications arise when concentrations are too high and relative pH is too low (extreme acidity). Partial neutralization adjusts pH levels between pH 3.5 to 4.5, yielding solutions of ammonium/sodium glycolate or lactate. These preparations reduce the chance of skin irritations by modifying the pH.
The extent of chemical exfoliation, as with mechanical exfoliation, is determined by the pre-existing condition of the skin, skin preparation, exposure time and duration of use. As with mechanical exfoliation, exercise caution when administering chemical exfoliation on skin exhibiting skin irritations, sunburn, or open wounds and lesions.
Cosmetic chemical exfoliation using any of the aforementioned substances is often mistakenly promoted as "chemical peels". Chemobrasion, the scientific term for a chemical peel, is an INVASIVE procedure; it removes living tissue in addition to corneocytes. Chemical peels reach below the epidermis; therefore, they should be performed ONLY by a qualified dermatologist or cosmetic surgeon. There are risk factors, such as viral infection, persistent erythema. hypertrophic scarring and hyper-hypopigmentation, involved with chemical peels that a non-medical professional is not equipped to address.
COSMETIC AND MECHANICAL EXFOLIATION METHODS can provide substantial improvement in the appearance of the skin through encouraging normal epidermal desquamation. It is important that the practitioner understand how different substances can assist or impede this normal physiological process of the skin.
Whatever the methodology, the ultimate goal of the consumer is a clearer, smoother, healthier-looking complexion It is up to estheticians to let their clients know about the different ways to achieve this. Estheticians can offer the various non-invasive professional exfoliation treatments discussed in this article. They should refer consumers with more serious skin conditions to a qualified medical practitioner. Thoroughly educated estheticians can be a source of information for their clients, properly and cautiously evaluating the depth of the problem, and making clients aware of the alternative solutions.
HR Jakubovic and AB Ackerman, Epidermal Cornification, Dermatology Vol. 1, Moschella and Hurley MD (1985) p 18-20
W Lever, MD, and G Schaumberg-Lever, MD, Histology of the Skin, Histopathology of the Skin. Fifth Edition (1975) p 9-15
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