JUL-AUG 2018

MedEsthetics—business education for medical practitioners—provides the latest noninvasive cosmetic procedures, treatment trends, product and equipment reviews, legal issues and medical aesthetics industry news.

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With age, various components of the skin's natural mois- turizing factor (NMF), such as amino acids, urea and lactic acid, decline. "This not only leads to a reduction in water content, but slows down the rate that corneocytes (dead cells) exfoliate from the skin surface," says John Kulesza, president of skincare formulator Young Pharmaceuticals. "That creates a buildup of dead cells causing a rough tex- ture and dull appearance." Topical moisturizers can help return skin to a healthier, more youthful state. To reap the greatest benefi ts, the right combination of hydrators must be used, depending on the patient's individual needs and concomitant skin concerns. A New Trifecta Moisturizing ingredients have typically been separated into three categories: occlusives that prevent water loss, humectants that attract and bind water to the skin, and emollients that fi ll in the space between dead skin cells to smooth the surface of the skin. But Kulesza prefers a slightly different terminology. "Some occlusive agents are also emollients. Barrier re- pair agents are emollients, yet not all emollients repair the lipid barrier," he explains. "That's why I prefer the terms hygroscopic, hydrophobic and barrier repair." Hygroscopic ingredients, which include glycerin, urea, and hyaluronic acid, act as water magnets to attract and then bind water to the skin. Hydrophobic ingredients include petrolatum, min- eral oil, squalene and other lipids that form a fi lm on the skin's surface to prevent water from evaporating. Barrier repair ingredients typically include a mixture of naturally occurring skin lipids—cholesterol, fatty acids and ceramides—to supplement the natural oils in the skin and maintain a healthy skin barrier. Here's how these ingredient groups work. Hygroscopic molecules rich in hydroxyl (OH) functional groups can form hydrogen bonds with other water molecules. For in- stance, hyaluronic acid is a chain of sugar molecules. Each molecule consists of a ring of six carbon atoms, and each is connected to a water-loving hydroxyl group, says Kulesza. The hydrophopic ingredients, also referred to as oc- clusives, create a barrier to prevent water loss. "The granddaddy of which is petrolatum," says Kulesza. "Con- trary to popular belief, petrolatum doesn't cause acne. It is very greasy, which is why it's usually not appropriate for patients with acne or oily skin, but it's not active in various bioassays of comedogenicity." Barrier repair agents contain cholesterol, fatty acids and ceramides. But just containing these ingredients is not enough. For best results, they must be formulated in a way that mimics their natural organization in the skin, notes Kulesza. He considers "multi-lamellar emulsion," whereby the lipids and water are layered in way that resembles an onion where one layer of lipids surrounds a layer of water that surrounds another layer of lipids,etc., to be most effective. Surfactants, usually lecithin, are used to create such emulsions. San Diego and Beverly Hills, California-based derma- tologist Tess Mauricio, MD, adds that any moisturizer that increases skin hydration will help to repair and protect the skin barrier. "Occlusive moisturizers, like Aquaphor, as well as humectant ingredients, such as urea and sodium lactate, can help," she says. A product that includes ingredients from all three catego- ries is ideal for aging skin. But which category is most impor- tant? Dermatologist and founder/CEO of Episciences, maker of the Epionce skincare line, Carl Thornfeldt, MD, focuses fi rst on barrier repair ingredients, noting that a healthy skin barrier is more important than just adding hydration. "I also consider the amount of humectant in the product and look for it in the upper half of the ingredient list," he says. Ingredients that help to maintain a healthy skincare barrier are key to keeping skin well hydrated. THE BEST DEFENSE © GETTY IMAGES 46 JULY/AUGUST 2018 | Med Esthetics

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