207: Cosmeceuticals and Skin Care in Dermatology Flashcards
What are the four main facial skin issues focused on in a phenotypic approach to skin care?
The four main facial skin issues are: 1. Skin hydration 2. Inflammation 3. Pigmentation 4. Skin aging risk factors
What is xerosis and what are its characteristics?
Xerosis, or ‘dry skin’, is characterized by: - Dull color (gray white) - Rough texture - Elevated number of ridges - Sensation of tightness or itching - Poor reflection of light due to rough surface - Multifactorial etiology, with the stratum corneum (SC) skin barrier being the most significant factor in its development.
What are the primary components of the stratum corneum (SC) bilayer lipid membrane?
The stratum corneum (SC) bilayer lipid membrane is composed of three primary groups of compounds in a (1:1:1) ratio: 1. Ceramides 2. Fatty acids 3. Cholesterol
How does transepidermal water loss (TEWL) affect the skin?
TEWL leads to: - Decreased water content in the SC - Abnormal desquamation of corneocytes - Visible clumps of keratinocytes, making skin appear rough and dry - Localized changes in pH affecting skin care product efficacy
What factors can impair the lipid bilayer of the stratum corneum?
Impairment of the lipid bilayer of the SC can be caused by: - Ultraviolet (UV) radiation - Detergents - Acetone - Chlorine - Prolonged water immersion - Incorrect choice of skin cleansers and moisturizers - Overzealous use of exfoliating methods
What is the role of sebum production in skin health?
Sebum production provides an occlusive layer on the skin surface that: - Retards transepidermal water loss (TEWL) - Contains wax esters, cholesterol, triglycerides, squalene, and vitamin E, which protect the skin from environmental insults and free radicals.
How does sebum production change throughout different life stages?
Sebum production changes as follows: 1. Low during childhood 2. Rising in the mid- to late teens 3. Generally stable for decades until it starts to decline in the 7th and 8th decades of life due to decreased androgen production.
What is the Natural Moisturizing Factor (NMF) and how is it produced?
NMF provides intracellular hydration and is derived from the breakdown of the protein filaggrin. It is broken down into free osmotically active amino acids, including histidine, glutamine, and arginine, which bind to water. The breakdown pace is regulated by aspartate protease (cathepsin), influenced by external humidity levels.
A patient with oily skin complains of dryness on their arms and legs. How should you address this?
Treat the oily facial skin with appropriate products but use barrier repair moisturizers on areas with fewer sebaceous glands, like the arms and legs.
What are Glycosaminoglycans (GAGs) and their role in skin hydration?
Glycosaminoglycans (GAGs), such as hyaluronic acid and heparan sulfate, bind and hold water, providing skin hydration and structural integrity. They play a crucial role in skin hydration and aging, although their exact mechanisms are still being researched.
What is the significance of Hyaluronic Acid (HA) in skin hydration?
Hyaluronic Acid (HA) can bind 1000 times its weight in water, contributing to skin volume and plumpness. It is produced mainly by fibroblasts and keratinocytes and has an estimated turnover rate of 2 to 4.5 days in mammals, playing a vital role in maintaining skin hydration.
How does Heparan Sulfate (HS) contribute to skin health?
Heparan Sulfate (HS) serves primarily as a humectant, bringing water to the skin surface. It is linked to skin rejuvenation by increasing the skin’s ability to hold onto water and restoring skin homeostasis, although it is too large to penetrate the skin when applied topically.
What is Aquaporin-3 (AQP3) and its role in skin hydration?
Aquaporin-3 (AQP3) is a water channel that facilitates fluid transport in the skin. It helps maintain transepidermal water permeability, protecting the skin against desiccation and potentially treating skin disorders related to hydration.
What are the ideal characteristics of skin according to the skin care parameter?
Ideal skin is characterized by balanced sebum secretion, an intact stratum corneum (SC) with an unbroken barrier, sufficient levels of Natural Moisturizing Factor (NMF) and GAGs, and normal expression of AQP3.
What types of ingredients are recommended for moisturizers for topical skin care?
Recommended ingredients for moisturizers include: 1. Barrier Repair: Ceramides, Cholesterol, Fatty acids, MLE technology 2. Occlusives: Oils (Argan, Safflower, etc.), Silicones, Petrolatum, etc. 3. Humectants: α-Hydroxy acids, Glycerin, Hyaluronic acid, Urea, etc.
What type of cleanser is preferable for oily skin types?
For oily skin types, a foaming cleanser containing surfactants is preferable to effectively remove excess lipids and provide a clean feeling to the skin.
What type of cleanser is recommended for dry skin types?
For dry skin types, a nonfoaming cleanser such as an oil, cream, or milk cleanser is recommended, as it helps deposit fatty acids on the skin, thereby repairing the skin barrier.
What role does the pH of a cleanser play in skin barrier function?
The pH of the cleanser plays a crucial role in skin barrier function. Soap cleansers that exhibit a high pH have been consistently shown to perturb the skin barrier. In contrast, dry skin types need a neutral or acidic cleanser, while oily skin types that do not exhibit inflammation can tolerate a higher-pH soap-type cleanser.
What are the effects of mechanical exfoliants on the skin?
Mechanical exfoliants, such as crushed shells, sugar, or aluminum particles, promote an immediate visual improvement of the skin. However, overuse can lead to barrier impairment, making it essential to combine them with barrier repair moisturizers for lasting benefits.
What is the recommended moisturizer for oily skin types?
Oily skin types should use a lighter lotion or serum-type moisturizer. They may also prefer humectant-containing moisturizers, such as those with hyaluronic acid and heparan sulfate analog, while avoiding heavy creams and oils.
What is the function of emollients in skin care?
Emollients are substances added to immediately soften and smooth the skin. They function by filling the spaces between desquamating corneocytes to create a smooth surface, which enhances light reflection and provides immediate visible improvement.
How do occlusives affect skin hydration?
Occlusives coat the surface of the skin and provide an emollient effect, helping to increase the penetration of previously applied ingredients and decrease transepidermal water loss (TEWL). Ingredients with high occlusive properties include petrolatum and oils.
What are humectants and how do they function in skin care?
Humectants are ingredients with high water absorption capabilities that attract water from the atmosphere. They are most effective in high humidity conditions and can help hydrate the skin, but their effects are temporary, usually lasting less than 24 hours.
What impact do medications have on skin type and sebum production?
Medications can affect skin type by changing sebum production rates or disrupting the skin barrier by affecting lipid production. For example, oral ketoconazole and spironolactone have been shown to decrease sebum secretion, while some cholesterol-lowering medications may increase the risk of dry skin.
A patient with oily skin complains of a greasy feeling after using sunscreen. What type of sunscreen should you recommend?
For very oily skin types, recommend a sunscreen in lieu of a moisturizer. Ensure it is noncomedogenic and lightweight.
A patient with dry skin reports tightness and itching. What cleanser should you recommend?
Recommend a nonfoaming cleanser such as an oil, cream, or milk cleanser to deposit fatty acids and repair the skin barrier.
A patient with oily skin complains about clogged pores. What type of cleanser should you recommend?
Recommend a foaming cleanser containing surfactants to remove excess lipids and provide a clean feeling.
A patient with dry skin is using a moisturizer but still feels dry. What additional ingredients should their moisturizer contain?
Ensure the moisturizer contains a 1:1:1 ratio of ceramides, fatty acids, and cholesterol for effective barrier repair.
A patient with oily skin is hesitant to use moisturizers. What type of moisturizer should you recommend?
Recommend a lighter lotion or serum-type moisturizer with humectants like hyaluronic acid or heparan sulfate.
A patient with dry skin is using a high-pH soap cleanser. What should you recommend instead?
Recommend a neutral or acidic cleanser to maintain the skin barrier and prevent further dryness.
A patient with oily skin complains of dryness after using a foaming cleanser. What should you recommend?
Recommend a foaming cleanser with milder surfactants or alternate with a nonfoaming cleanser to balance the skin.
A patient with dry skin is using a moisturizer but still experiences flakiness. What additional steps can they take?
Add a humectant-containing moisturizer with ingredients like hyaluronic acid or glycerin to improve hydration.
A patient with oily skin is using a heavy cream moisturizer and complains of breakouts. What should you recommend?
Switch to a lighter lotion or serum-type moisturizer with humectants and avoid heavy oils.
What are the basic care recommendations for dry and oily skin types?
- Oily skin types: Use a foaming cleanser and either a light moisturizer or no moisturizer at all. - Dry skin types: Use lipid-sparing cleansers such as nonfoaming cleansers and barrier repair moisturizers. - General: Humectants, occlusives, and exfoliants can be added to treat pigmentation and wrinkles, enhancing compliance by showing rapid visible results.
What are the four types of sensitive skin and their characteristics?
- Acne type: Prone to developing acne lesions such as papules, pustules, and cysts. 2. Rosacea type: Tendency toward recurrent flushing, facial redness, and hot sensations. 3. Stinging type: Predilection to stinging or burning sensations. 4. Allergic type: More likely to exhibit erythema, pruritus, and skin flaking on contact with allergens and irritants.
What are the primary factors in the pathogenesis of acne?
- Inflammation 2. Disordered keratinization 3. Presence of the bacteria P. acnes
What are the goals of acne treatment?
- Lowering P. acnes levels - Blocking inflammatory pathways - Normalizing keratinization
What should be included in a skin-care regimen for acne?
- Use acne medications such as benzoyl peroxide, clindamycin, salicylic acid, and retinoids combined with nonfoaming cleansers and noncomedogenic barrier repair ingredients. - Schedule acne treatment visits at weeks 4, 8, and 12 to improve compliance. - Monthly visits are suggested until the acne medications are tolerated and acne has significantly improved.
What are the characteristics and treatment considerations for rosacea?
- Characteristics: Facial redness and flushing, may include inflammatory papules and telangiectasias. - Treatment considerations: Use topical skin care geared toward vasoconstrictive, antimicrobial, and anti-inflammatory ingredients. Avoid vigorous exfoliation and triggers like extreme temperatures. Retinoids should be started slowly to avoid exacerbation.
A patient with dry skin and acne is struggling with their treatment regimen. What adjustments can you make to improve their compliance?
Combine acne medications like benzoyl peroxide or retinoids with nonfoaming cleansers and noncomedogenic barrier repair moisturizers to address dryness. Educate the patient about the 8-12 week delay in results.
A patient with rosacea reports worsening redness after using a retinoid. How should you modify their regimen?
Start the retinoid slowly by applying a low-strength retinoid on top of an anti-inflammatory moisturizer every third night. Gradually increase the dose and frequency as tolerated.
A patient with acne is not responding to topical treatments after 12 weeks. What additional steps can you take?
Consider using imaging systems like Canfield Visa CA to track bacterial counts and encourage compliance. Adjust the regimen or consider oral medications if necessary.
A patient with acne-prone skin is using benzoyl peroxide but reports irritation. How can you modify their regimen?
Combine benzoyl peroxide with noncomedogenic barrier repair moisturizers and nonfoaming cleansers to reduce irritation.
A patient with acne-prone skin is using salicylic acid but sees no improvement. What should you add to their regimen?
Add benzoyl peroxide or retinoids to target P. acnes and normalize keratinization.
A patient with acne-prone skin is using a retinoid but experiences dryness. What should you do?
Combine the retinoid with a noncomedogenic barrier repair moisturizer to address dryness.
What are some common anti-inflammatory ingredients used in skin care?
Common anti-inflammatory ingredients include: 1. Aloe vera: Soothing and hydrating 2. Argan oil: Moisturizing and nourishing 3. Arnica: Reduces inflammation 4. Bisabolol: Anti-inflammatory and soothing 5. Caffeine: Reduces redness and puffiness 6. Chamomile: Soothing and calming 7. Colloidal oatmeal: Protects and soothes skin 8. Cucumber: Hydrating and cooling 9. Feverfew: Anti-inflammatory properties 10. Green tea: Antioxidant and anti-inflammatory 11. Hamamelis (witch hazel): Soothing and anti-inflammatory 12. Licorice extract: Brightening and soothing 13. Niacinamide: Improves skin barrier function 14. Oxymetazoline: Reduces redness 15. Salicylic acid: Exfoliating and anti-inflammatory 16. Zinc: Soothing and healing
What is the recommended treatment for allergic contact dermatitis caused by cosmetics?
The recommended treatment includes: 1. Identify the allergen through patch testing or a detailed history/patient diary. 2. Aim for avoidance of the allergen. 3. Fortify the skin barrier with barrier repair ingredients. 4. Use cosmeceutical products that coat the skin to protect against nickel and other allergens.
What types of cleansers are recommended for sensitive skin types?
For sensitive skin types, the following cleansers are recommended: - Soothing cleansers that contain anti-inflammatory ingredients. - Hydroxy acid cleansers may irritate but can help decrease P. acnes counts.
What is the first step in managing a patient with a skin allergen?
Identify the allergen through patch testing or a detailed history/patient diary.
What is the aim for managing skin allergens?
Aim for avoidance of the allergen.
What should be used to fortify the skin barrier?
Use barrier repair ingredients.
What type of products can protect against nickel and other allergens?
Use cosmeceutical products that coat the skin.
What types of cleansers are recommended for sensitive skin types?
Soothing cleansers that contain anti-inflammatory ingredients are recommended.
What should patients with acne consider when using moisturizers?
Use noncomedogenic moisturizers without comedogenic ingredients.
What is the significance of oxymetazoline and brimonidine in treating rosacea?
They cause vasoconstriction, leading to rapid improvement in facial redness.
What steps should you take if a patient with sensitive skin reports stinging after applying a new product?
Identify and avoid products with stinging ingredients and introduce products one at a time.
How can you address a patient with acne-prone skin’s concerns about moisturizers?
Recommend noncomedogenic moisturizers and highlight studies showing improvement in acne.
What should a regimen for a patient with sensitive skin and rosacea include?
Include anti-inflammatory ingredients and avoid triggers like extreme temperatures.
What type of products should a patient allergic to fragrances use?
Recommend hypoallergenic products and avoid common allergens.
What type of cleanser should a patient with rosacea switch to if their current one worsens symptoms?
Switch to a soothing cleanser containing anti-inflammatory ingredients.
What should you do if a patient with sensitive skin reports redness and itching after using a new product?
Identify the allergen through patch testing and avoid it.
What should you recommend to a patient with sensitive skin using a product with α-hydroxy acids who reports stinging?
Discontinue the product and switch to one with anti-inflammatory ingredients.
What should you recommend to a patient with sensitive skin using a foaming cleanser who reports irritation?
Switch to a soothing, nonfoaming cleanser with anti-inflammatory ingredients.
What are the key considerations for skin care in patients with sensitive skin types?
Identify the predominant subtype and avoid inciting factors.
What are the primary mechanisms that impede the development of skin pigmentation?
Sunscreen use and inhibiting the tyrosinase enzyme.
What is the role of tyrosinase inhibitors in skin care?
They block the production of melanin.
What are the recommended practices for sunscreen use in skin care?
Sunscreen should be used daily, even indoors.
What are the forms of dyschromia associated with skin pigmentation?
Melasma, solar lentigines, and postinflammatory hyperpigmentation.
What precautions should be taken for a patient with stinging-type sensitive skin wanting to use a retinoid?
Avoid retinoids and low-pH products.
What should you do for a patient with sensitive skin and acne experiencing irritation from their treatment?
Introduce anti-inflammatory ingredients first.
What is the role of PAR-2 in the transfer of melanosomes?
PAR-2 allows melanosomes to transfer from melanocytes to keratinocytes.
How do soy and niacinamide affect melanosome movement?
They inhibit melanosome movement from melanocytes to keratinocytes.
What are the benefits of using exfoliants in skin care for pigmentation issues?
Exfoliants help remove the top layer of the stratum corneum.
What is lignin peroxidase and its significance in skin pigmentation?
It breaks down eumelanin and is effective in topical preparations.
What are the key components of a treatment regimen for pigmented skin types?
Daily broad-spectrum SPF and twice-daily tyrosinase inhibitor.
What lifestyle factors contribute to skin aging?
Sun exposure, smoking, and poor diet.
What is the difference between wrinkle-prone skin and non-wrinkle-prone skin?
Wrinkle-prone skin is found in patients over 20 who do not use anti-aging technologies.
What should you explain to a patient with melasma not seeing results after 4 weeks of treatment?
Changes in pigmentation are usually not visible until 12 weeks.
What maintenance regimen should you recommend to a patient with pigmented skin to prevent melasma recurrence?
Daily broad-spectrum SPF and an antioxidant like ascorbic acid.
What should you advise a patient using tyrosinase inhibitors concerned about tachyphylaxis?
Take a ‘holiday’ from tyrosinase inhibitors every 3-6 months.
What additional measures should a patient with melasma using sunscreen take?
Combine sunscreen with tyrosinase inhibitors and avoid triggers.
What should you add to a regimen for a patient with pigmented skin using exfoliants but seeing no improvement?
Combine exfoliants with tyrosinase inhibitors and sunscreen.
What should you recommend to a patient with acne-prone skin using a sunscreen that causes breakouts?
Recommend a noncomedogenic sunscreen.
What additional ingredient can help a patient with melasma using a tyrosinase inhibitor?
Add a PAR-2 blocking agent like soy or niacinamide.
What alternatives can you suggest to a patient concerned about the safety of hydroquinone?
Suggest kojic acid, arbutin, or licorice extract.
What type of sunscreen should a patient with melasma use?
Use a broad-spectrum SPF that blocks infrared light.
What are the main antiaging technologies proven to improve skin with long-term use?
Daily sunscreen, hydroxy acids, ascorbic acid, and retinoids.
What is the goal of antiaging skin care?
To halt the degradation of the main structural components of the skin.
What ingredients have convincing peer-reviewed data that improve wrinkles?
Hydroxy acids, ascorbic acid, and retinoids.
What are the mechanisms of how UV exposure results in skin damage?
Sunburn cell formation and collagenase production.
What is the role of cleansers in antiaging skin care?
Cleansers prepare the skin by removing sweat, dirt, and debris.
What is the main goal of moisturizers and serums in antiaging skin care?
To preserve and increase dermal levels of collagen and hyaluronic acid.
What are the benefits of retinoids in antiaging skin care?
They increase collagen synthesis and improve photoaged skin.
What are antioxidants used for in skin care products?
To neutralize free radicals that damage DNA and cell membranes.
What is the effect of hydroxy acids on the skin?
They improve fine lines and stimulate collagen production.
What should you recommend to a patient with wrinkle-prone skin about effective anti-aging ingredients?
Recommend daily sunscreen, retinoids, and antioxidants.
What lifestyle changes should you suggest to a patient with wrinkle-prone skin?
Minimize sun exposure and maintain a healthy diet.
How should a patient with wrinkle-prone skin start using retinoids?
Start with a low dose applied over a moisturizer every third night.
What should you explain about the role of antioxidants to a patient with wrinkle-prone skin?
Antioxidants neutralize free radicals and prevent glycation.
What are the four parameters used to assign a skin phenotype according to the Baumann Skin Types?
Dry or oily, sensitive or resistant, pigmented or nonpigmented, wrinkle prone or tight.
How does the Baumann Skin Type Indicator assist physicians in skin diagnosis?
It aids in identifying a patient’s skin type and assessing uneven pigmentation.
What is the significance of combining the four skin parameters in skin care?
It allows for tailored skin-care regimens based on individual characteristics.
What factors can lead to a change in skin type after determining the Baumann Skin Type?
Moving to a different climate or changes in stress levels.
What characteristics define the healthiest skin type?
Adequate sebum production and a robust skin barrier.
What factors should be considered when choosing skincare ingredients?
Characteristics of ingredients and their interaction with skin type.
What is the typical structure for a skincare regimen that suits the majority of skin types?
A regimen typically includes cleansing, moisturizing, and sun protection.
What factors should be considered in skincare formulations?
- Characteristics of ingredients: Understand how various ingredients interact with each other and the skin type.
- Prescription medications: Take into account how they will be affected by cosmeceuticals.
- Order of application: This affects stability, efficacy, and safety of the formulation.
- Ingredient properties: For example, hyaluronic acid can enhance penetration, while safflower oil can strengthen the skin barrier.
What is the typical structure for a skincare regimen that suits the majority of skin types?
A typical skincare regimen includes the following steps:
Time of Day | Step | Product Type |
|————-|——|————–|
| Morning | 1 | Cleanser |
| | 2 | Eye product |
| | 3 | Treatment product or medication |
| | 4 | Moisturizer |
| | 5 | Sunscreen |
| Evening | 1 | Cleanser |
| | 2 | Eye product |
| | 3 | Treatment product or medication |
| | 4 | Moisturizer |
| | 5 | Retinoid |
Why is patient education important in skincare regimens?
Patient education is crucial because:
- It instructs patients on how to properly apply products.
- The order of application can significantly affect the efficacy of the products.
- Providing a printed regimen with step-by-step instructions enhances understanding and compliance.
- Explaining the basis for product selection can improve patient outcomes and adherence to the regimen.
What are the recommendations for encouraging patient compliance in skincare regimens?
To encourage patient compliance:
1. Schedule a follow-up visit after 1 month to check on progress.
2. Routine follow-ups can help mitigate side effects and improve compliance.
3. Use an imaging system to track progress visually.
4. Schedule visits every month until the skin condition improves or the ideal ORNT skin type is achieved.
