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  Crossing borders - on the boundaries of cosmetic skin care
 

There is only a smooth transition from problem skin to pathological skin conditions. Although it is not the job of professional cosmeticians to diagnose skin diseases, it is essential to know the borderlines. Otherwise there is a risk of getting into conflict with health legislation.

 

Problem skin or medical indication? That is the question arising in the case of barrier disorders. Dry skin belongs into the category of problem skin and can be identified by a high TEWL (transepidermal water loss) and low skin hydration, easily measurable with the Corneometer® probe. If the barrier disorder already is much more pronounced and shows signs of inflammation and pruritus, it may be atopic skin (neurodermatitis). Both cases demand for an appropriate and individually adapted skin care. In case of neurodermitic skin, it is recommended to seek medical advice as this condition definitely is a medical indication.
The appropriate cosmetic care of dry skin is a lipid-enriched cream enhanced with a NMF (Natural Moisturizing Factor, as e.g. amino acids, urea) and hyaluronic acid. Recommended for the atopic skin also are additional active agents with anti-inflammatory potential (essential fatty acids, boswellia) possibly also components to soothe the itching (as e.g. urea, allantoin and other amides). All these substances sound like medical drugs, however, they still belong to the cosmetic area as long as the cosmetic skin care abstains from explicitly promising the healing and soothing of diseases.
Adequate skin care concepts should go beyond this scope, though: emulsifiers may intensify barrier disorders, for instance. Hence, they should be avoided just as allergenic preservatives and perfumes which easily may penetrate through the disordered skin barrier. Mineral oils also are counterproductive as they form superficial films on the skin and thus impede its natural recovery.
So far, we are still discussing within the principles of corneotherapy. As experience teaches, a systematic selection of cream components and cosmetic active agents will lead to a significant recovery of the skin condition, sometimes even to a freedom from symptoms. The theory is scientifically supported by very successful clinical studies (cf. references hereto).
The following survey shows a summary of medical indications, pharmaceutical active agents and the adjuvant cosmetic skin care based on cosmetic active agents - the list is not intended to be exhaustive, though. It should be mentioned that the target-oriented approach may frequently switch the focus from the pharmaceutical treatment towards an adequate skin care.

 

Indication

Pharmaceutical active agents (partly also oral applications)

Cosmetic active agents

acne (oily skin)
oily skin with efflorescences and comedones

benzoyl peroxide, retinoids, erythromycin and other antibiotics, azelaic acid, linoleic acid, salicylic acid, hormones, fruit acids, zinc oxide

phosphatidylcholine (liposomes)1), linoleic acid, salicylic acid, azelaic acid, betulinic acid, vitamin A, yeast, ribwort, berberine

acne (dry skin)
low fat skin with efflorescences and comedones; from the 3rd decade of life

benzoyl peroxide, retinoids, erythromycin and other antibiotics, azelaic acid, linoleic acid, salicylic acid, hormones, fruit acids, zinc oxide.

vegetable triglycerides3), phosphatidylcholine (nanodispersions)1), linoleic acid, salicylic acid, azelaic acid, betulinic acid, amino acids (NMF), vitamin A, yeast, ribwort, berberine, phytohormones (red clover, soybean)

actinic keratosis
premalignant chronic solar damage

diclofenac, 5-fluorouacil, 5-aminolevulinic acid, photodynamic therapy (PDT)

boswellia

allergic contact eczema (contact dermatitis)
erythema, blisters, nodules, weeping blemishes after contact with allergens as e.g. nickel

corticoids, antihistamines, local anaesthetics

vegetable triglycerides3) and

phytosterols to stabilize the skin barrier, avoiding dry skin

couperosis
weak connective tissue with vascular dilation

retinoids, antibiotics (minocycline, doxycycline, metronidazole), azelaic acid

vegetable triglycerides3), linseed oil, evening primrose oil, azelaic acid, betulinic acid, phosphatidylcholine (liposomes, nanodispersions)1), echinacea, butcher's broom 

decubitus (bedsores)

D-panthenol, antibiotics, anti-inflammatory and re-fattening cream bases (prevention)

non-aqueous base of vegetable triglycerides3), phosphatidylcholine,  hydrogenated phosphatidylcholine1), and phytosterols (prevention)

dry skin
skin barrier disorder: increased TEWL, low skin hydration

urea, linoleic acid, re-fattening cream bases

vegetable triglycerides3), linoleic acid, ceramides, CM-glucan, amino acids (NMF), phosphatidylcholine (nanodispersions)1), hydrogenated phosphatidylcholine (DMS base)2), aloe vera, hyaluronic acid, CM-glucan

gamma-radiation
erythema and dry skin due to radiotherapy

anti-inflammatory and re-fattening cream bases

phosphatidylcholine (nanodispersions)1), evening primrose oil, linseed oil, amino acids (NMF), CM-glucan, urea, aloe vera, boswellia, echinacea

hyper pigmentations
increased melanin formation

chemical peelings, hydrochinone

ascorbyl phosphate (vitamin C-phosphate); vitamin A, azelaic acid, phosphatidylcholine (liposomes, nanodispersions)1), extracts: mallow, peppermint, cowslip, lady's mantle, veronica, lemon balm, ribwort

ichthyosis (fish scale disease)
disorder of corneocyte desquamation

retinoids, urea (keratolytic)

vegetable triglycerides3), phytosterols, vitamin A, phosphatidylcholine (nanodispersions)1), hydrogenated phosphatidylcholine (DMS-base)2)

inflammation (dermatitis)
(cf. eczema, dermatoses, neurodermatitis etc.)

antibiotics, antimycotics, antihistamines, immunosuppressive agents, corticoids, chamomile, calendula, D-panthenol

evening primrose oil, linseed oil, boswellia, D-panthenol, phosphatidylcholine (nanodispersions)1), echinacea

laser treatments
pre- and follow-up care to impede melanin formation

---

ascorbyl phosphate (vitamin C-phosphate), phosphatidylcholine (liposomes)1), extracts: mallow, peppermint, cowslip, lady's mantle, veronica, lemon balm, ribwort

neurodermatitis
inflammatory barrier disorder with pruritus, with varying degree of severity

antiseptics, corticoids, immunosuppressive agents, antihistamines, urea (skin hydration, pruritus), polidocanol (pruritus), evening primrose oil, D-panthenol

vegetable triglycerides3), linseed oil, evening primrose oil, linoleic acid, phytosterols, ceramides, urea, allantoin and other amides, phosphatidylcholine (nanodispersions)1),  boswellia, hydrogenated phosphatidylcholine  (DMS base)2)

perioral dermatitis
small red or inflamed nodules/blisters around the mouth

erythromycin, minocycline, metronidazole, azelaic acid, tannins

boswellia, phosphatidylcholine (nanodispersions)1), azelaic acid, green tea, hamamelis, echinacea, butcher's broom

perianal barrier disorder
sore areas on the buttocks,  frequently caused by excessive body hygiene

antiseptics, hamamelis, D-panthenol, anti-inflammatory and re-fattening cream bases

non-aqueous base of vegetable triglycerides3), phosphatidylcholine1), hydrogenated phosphatidylcholine2), phytosterols

psoriasis
exfoliative dermatitis with inflammatory skin condition due to increased and accelerated cornification (hyperkeratosis)

dithranol (cignolin), salicylic acid, urea, tar preparations, corticoids, calcipotriol, retinoids, cyclosporin A, psoralen, fumaric acid, fumaric acid ester

evening primrose oil, linseed oil, phosphatidylcholine (liposomes, nanodispersions)1), fumaric acid, urea

rosacea
erythema and connective tissue disorder

retinoids, antibiotics (minocycline, doxycycline, metronidazole), azelaic acid

vegetable triglycerides3), linseed oil, azelaic acid, betulinic acid, phosphatidylcholine (nanodispersions)1), vitamin A

scars
indurations of the connective tissue with varying degree of severity

retinoids, heparin, chemical peeling

vitamins A, C, E, coenzyme Q10, D-panthenol, phosphatidylcholine (nanodispersions)1), hydrogenated phosphatidylcholine (DMS-base)2)

striae
scarred tissue caused by hyperextension

vitamin A acid, trichloroacetic acid (chemical peeling)

prevention: rose hip seed oil, linseed oil, vitamin E, coenzyme Q10, phosphatidylcholine (nanodispersions)1)

sun burns and burns
(erythema)

antiseptics, NSAID, D-panthenol

linseed oil, linoleic acid, D-panthenol, phosphatidylcholine (nanodispersions)1), echinacea, boswellia

toxic degenerative eczema
chronic cumulative toxic contact eczema

corticoids, allantoin, hamamelis, antiseptics, D-panthenol, anti-inflammatory and re-fattening cream bases

vegetable triglycerides3), evening primrose oil, linseed oil, phytosterols, hydrogenated phosphatidylcholine (DMS cream base)2), ceramides, urea, allantoin, D-panthenol, hamamelis

Annotations to table:

  1. Phosphatidylcholine itself is a very effective active agent due to its linoleic acid content. On the other hand, it serves as an intensifying agent for the penetration of polar aqueous agents (in liposomes) and lipophilic agents (in biologically degradable nanodispersions). In particular fat oils as e.g. linseed oil, evening primrose oil as well as fat-soluble vitamins become better available for the metabolism and more acceptable for the customers in terms of sensorial properties.
  2. Besides triglycerides, phytosterols, squalan and ceramides, hydrogenated phosphatidylcholine is a texturing component of emulsifier and preservative free DMS base creams with skin-related membrane structure.
  3. Vegetable triglycerides can be neutral oils (medium-chain triglycerides), avocado oil, wheat germ oil, almond oil, or the like. Specific triglycerides like evening primrose oil (main active agent: gamma-linolenic acid), linseed oil (main active agent: alpha linolenic acid), rose hip seed oil (linoleic acid & alpha-linolenic acid) are listed separately. 
  4. The active agents listed in the table above are used separately or in adequate combinations depending on the specific skin condition.

If the medical treatment with pharmaceutical active agents is combined with an adapted skin care, we refer to adjuvant corneotherapy. Quite often even identical active agents are used, however, with differing functional properties. But what is to be said against the use of azelaic acid (up to 1 per cent) as a consistency substance in a cosmetic skin care product for the rosacea skin? It can be assumed that specifically in liposomal preparations this component will synergistically contribute to the recovery process. An overview on pharmaceutical active agents in cosmetic preparations has been recently published in Kosmetische Praxis 2010 (3), 10-13. There is an optimal interaction, if both pharmaceutical and cosmetic area apply the same base creams. Another alternative may be the use of sera respectively tinctures instead of cream bases, particularly in case of weeping or heavily fattening skin areas.

References and studies

  • Wolf G, Höger PH, Dermatologische Basistherapie mit hyperallergenen und noxenfreien Externa im Kindesalter, Journal der Deutschen Dermatologischen Gesellschaft 2008; 7 (1): 50-61
  • Lübbe J, Evidence-Based Corneotherapy, Dermatology 2000; 200: 285-286
  • Tabata N, O'Goshi K, Zhen YX, Kligman AM, Tagami H, Biophysical assessment of persistent effects of moisturizers after their daily Applications: Evaluation of Corneotherapy, Dermatology 2000;200:308-313
  • Suvorova K, Korneotherapie der Hautkrankheiten, die von der Störung der Epidermis begleitet werden (in Russisch), Les Nouvelles Esthétiques (Russische Version) 2004;4:28
  • Lautenschläger H, Geschichte und aktuelle Gesichtspunkte der Korneotherapie, Kosmetische Medizin 2005; 26 (2): 58-60
  • Schöffling U, "High Tech" und "Bio" im Cremetopf, Neuer Ansatz bei Dermokosmetika verbessert das Hautbild bei trockener, geschädigter und empfindlicher Haut, PTA heute 2002; 2: 8-18
  • Reinhardt HW, Gedanken zur sinnvollen Magistral-Rezeptur, Kosmetische Medizin 2006; 27 (1): 30-31
  • Valenta C, Stabilität: Cyproteronacetat in magistralen Zubereitungen, Österreichische Apotheker-Zeitung. 56 (2002) 676-678
  • Valenta C, Salbengrundlagen; ÖAZ 16 (2005), 770-773
  • Eberlein-König B, Eicke C, Reinhardt H-W, Ring J, Adjuvant Treatment of Atopic Eczema: Assessment of an Emollient Containing N-palmitoylethanolamide (ATOPA Study). JEADV 2008, 22: 73-82
  • Lautenschläger H, Liposomes, Handbook of Cosmetic Science and Technology (Barel AO, Paye M and Maibach HI), 155-163, CRC Press Taylor & Francis Group, Boca Raton 2006
  • Lautenschläger H, Dermopharmazie - Dekorative Kosmetik für die Problemhaut, Pharmazeutische Zeitung 153 (8), 28-30 (2008)
  • Lautenschläger H, Universelle Basiscremes mit Membran-Struktur für Hautpflege, Hautschutz und Dermatika, Österreichische Apothekerzeitung 56 (14), 679 (2002)

Dr. Hans Lautenschläger

 
Please note: The publication is based on the state of the art at the publishing date of the specialist journal.

Kindly inform us at koko@dermaviduals.de if you have found any misprint or any other relevant mistake on this page

© Copyright Kosmetik Konzept KOKO GmbH & Co.KG, Leichlingen, www.dermaviduals.de
Revision: 21.11.2010
 
 
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published in
Beauty Forum
2010 (8), 27-29

 
problem skin - further literature
Chain reaction - skin enzymes and enzyme defects
Contact dermatoses - causes, prevention and professional care of irritated skin
Perioral dermatitis - causes, treatment and differentiation
Acne - the potentials of cosmetic prevention
Overdoing skin care - too much of a good thing
Skin care before and after surgery
Careful with washing! - Gentle skin care for babies and small children
Skin care at strong sweat formation*
Repairing the barrier - on active agents and active agent systems to support the skin regeneration
Protecting the skin barrier - fungal infections and skin care
Shady sides - manifestations of light dermatoses
Landing approach - preparing for the final descent - skincare for pregnant women
Skin - from the outside in
Food intolerance - when food irritates the skin
Treatment of problem skins - an overview
Skin care during cancer therapy
Corneotherapy
Skin care for the vitiligo-affected skin - aspirations and reality
Cellulite from A to Z
Crossing borders - on the boundaries of cosmetic skin care
Corneotherapeutic skin care for the rosacea skin
Hormone cycles - menopause skin care
Skin care for the adolescent skin
Skin care for psoriasis skin - individually adapted
"I cannot tolerate this product" - the influence of medical drugs on skin and skin care
Delicate children skin - criteria for the adequate skin care
Stressed skin - itching & Co. - causes and remedies
Skin reactions - cosmetics and their effects
Scars - cosmetic prevention and skin care
Skin care during radiotherapy - soothing, vitalizing and protecting
Skin elasticity - what can cosmetics achieve?
Dermopharmacy - decorative cosmetics for problem skin
Couperosis - a field for active agent concentrates
Good looks, protection and skin care all inclusive: make-up for the problem skin
Photodamaged skin: sun-bathing and after sun care
"Acne caused by too many different moisturizing factors in creams?"
Irritated skin - skin in a state of turmoil
Actinic keratoses - an endemic disease?
Mixed skin - a skin with two different faces
Reddened Skin - what may cause the symptom?
History and current aspects of corneotherapy1)
Skin care for the neurodermitic skin - supporting the skin barrier
Cornification disorders - the adequate skin care
Skin barrier disorders - preventive measures
Acne - prevention and care
Essential fatty acids - cosmetic from inside and outside
Psoriasis - the appropriate care
Neurodermatitis - specific prevention