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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Page 49 of 68 | JULY/AUGUST 2018 47 © GETTY IMAGES Variations That Affect Skin Hydration The moisturization needs of aging skin can vary due to seasonal and geographic changes. Joel L. Cohen, MD, director of AboutSkin Dermatology and DermSurgery in Greenwood Village and Lone Tree, Colorado, notes that Colorado's higher altitude and lack of humidity often necessitates skincare products that include more occlusive ingredients, especially for new residents to the state. "What they used elsewhere may dry them out here," he says. "Skin also dries out in winter, and is made worse with forced indoor heating, so patients may need to use a heavier moisturizer in the winter months." Cleansing habits can also contribute to dry skin by disrupting the skin's NMF. "Certain common detergents in cleansers, such as sodium lauryl sulfate, may deplete the NMF," says Kulesza. "Some skincare product ingredients, including solvents like propylene glycol and preservatives like Kathon (shown on labels as methylchloroisothiazoli- none or methyhisothiazolinone), also deplete the NMF." Acne, Atopic Dermatitis and Rosacea Patients with skin diseases, such as acne, rosacea or atopic dermatitis, may have lower ceramide levels in their skin, which decreases its water-binding capacity. This can occur as a result of the skin concern itself or the treatments used to control it. "For our acne patients, using a retinoid and often the accompanying cleansers like salicylic acid or benzoyl per- oxide, can make the skin dry and irritated," says Dr. Cohen. "To combat this, patients sometimes seek out old-fashioned moisturizers that are more often meant for off-face emol- lient use, like shea and cocoa butter. They don't realize many of these oily ingredients can actually cause acne to fl are." Providing these patients with oil-free and non-comedo- genic moisturizers can help relieve their discomfort, Dr. Cohen says. Patients with acne and oily skin usually prefer skin hydra- tors that contain hygroscopic ingredients, says Kulesza, because these ingredients are water-soluble and have a light, non-greasy texture. Rosacea shares many characteristics of acne, including the erythema and irritation, so hygroscopic ingredients help these patients as well. Because rosacea sufferers also expe- rience lipid abnormalities, they often benefi t from products rich in barrier repair agents. Occlusive ingredients are important for patients with atopic dermatitis (AD) whose skin is not intact, while humectants help support a healthy skin barrier, says Dr. Mauricio. "Urea and lactate are wonderful for maintenance to improve elasticity and improve the skin barrier function, but can sting when applied on cracked and irritated skin," she adds. "All ingredients that can improve the NMF can improve atopic dermatitis." Kulesza encourages practitioners to acquaint themselves with corneotherapy—a treatment methodology for skin disease developed by Albert Kligman, MD, that focuses on repair and maintenance of the skin barrier—if they are not already familiar with it. (Learn more at "Practitioners who focus on corneotherapy are often more successful in treating and preventing acne, rosacea, atopic dermatitis, and various cosmetic indications, such as photo- aging and hyperpigmentation," he says. Heather Larson is a freelance writer based in Washington State. , ."

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