Skin Care


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A protective, yet permeable barrier for the human body
Body’s largest organ
Most essential source of sensory stimulation

Published in: Health & Medicine, Lifestyle
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Skin Care

  1. 1. Cosmetic Dermatology in Primary Care
  2. 2. What is Skin? <ul><li>A protective, yet permeable barrier for the human body </li></ul><ul><li>Body’s largest organ </li></ul><ul><li>Most essential source of sensory stimulation </li></ul>
  3. 3. Three layers of skin <ul><li>Epidermis </li></ul><ul><li>Dermis </li></ul><ul><li>Subcutaneous fat (hypodermis) </li></ul>
  4. 4. Epidermis (outer layer) <ul><li>1. Stratum corneum - “dead outermost layer” consists of 15 - 40 layers </li></ul><ul><li>2. Granular layer </li></ul><ul><li>3. Spinous layer- is the matrix </li></ul><ul><ul><li>Melanocytes produce the pigment, melanin </li></ul></ul><ul><ul><li>Langerhans’ immune cells </li></ul></ul><ul><ul><li>Merkel’s sensory stimulation cells </li></ul></ul><ul><li>4. Basal layer- basal cells divide to make new skin about every 30 days </li></ul>
  5. 5. Dermis (middle layer) <ul><li>1. Papillary layer </li></ul><ul><ul><li>haphazardly arranged thin collagen </li></ul></ul><ul><li>2. Reticular layer </li></ul><ul><ul><li>thick collagen arranged parallel for structure </li></ul></ul><ul><ul><li>elastin fibers </li></ul></ul><ul><ul><li>sebaceous glands, hair follicle, blood vessels </li></ul></ul>
  6. 6. Free Radical Theory of Aging Dehnam Harman, 1956 <ul><li>First proposed theory of aging </li></ul><ul><li>Free radicals occur naturally with human metabolism and aging </li></ul><ul><li>Free radicals cause damage to DNA/RNA leading to decreased cell function and disease. </li></ul>
  7. 7. Intrinsic Aging <ul><li>Genetics set the internal clock of human metabolism </li></ul><ul><li>Decreased estrogens during menopause contribute to collagen loss in women </li></ul>
  8. 8. Extrinsic Aging <ul><li>Photodamage - 80% </li></ul><ul><li>Smoking </li></ul><ul><li>Stress </li></ul><ul><li>Poor nutrition </li></ul><ul><li>Pollution </li></ul><ul><li>Excess alcohol </li></ul>
  9. 9. Facts of Aging Skin <ul><li>Signs begin about age 30 </li></ul><ul><li>Texture changes </li></ul><ul><ul><li>Decreased cellular turnover in epidermis causing fine lines and wrinkles </li></ul></ul><ul><ul><li>Collagen decreases by 1% yearly after age 30 causing thinner skin </li></ul></ul><ul><ul><li>Decreased elastic fibers, fat, and blood vessels causing decreased elasticity </li></ul></ul><ul><ul><li>Decreased hair follicles, sweat ducts, and sebaceous glands </li></ul></ul><ul><ul><li>Decreased water binding capability causing dryer skin </li></ul></ul>
  10. 10. Clinical Signs of Aging Skin <ul><li>Mild dryness </li></ul><ul><li>Fine lines and wrinkles </li></ul><ul><li>Freckles </li></ul><ul><li>Moles </li></ul><ul><li>Spider veins </li></ul><ul><li>Skin tags </li></ul><ul><li>Red spots </li></ul>
  11. 11. Clinical Signs of Photoaging Skin <ul><li>Texture changes </li></ul><ul><ul><li>dryness, enlarged pores, wrinkles </li></ul></ul><ul><ul><li>pigment changes- sun spots, freckles, melasma </li></ul></ul><ul><li>Vascular changes </li></ul><ul><ul><li>spider veins, red spots, rosacea </li></ul></ul><ul><li>Degenerative changes </li></ul><ul><ul><li>Benign- seborrheic keratosis, skin tags, moles </li></ul></ul><ul><ul><li>Precancerous- actinic keratosis </li></ul></ul><ul><ul><li>Cancerous- melanoma, basal cell, squamous cell </li></ul></ul>
  12. 12. FACTS about PhotoAging <ul><li>20 minutes of sun exposure is enough to cause damage to the skin. </li></ul><ul><li>Sunburn and sun-tanning causes wrinkles and thinning skin. </li></ul><ul><li>Number one risk factor for all skin cancers is SUN EXPOSURE! (one blistering sunburn doubles the risk of skin cancer) </li></ul>
  13. 13. Photodamaged Skin
  14. 14. What is the treatment for Photoaging Skin? <ul><li>Diet high in fruits and vegetables </li></ul><ul><li>Adequate oral hydration ( 64 oz + daily) </li></ul><ul><li>Good daily skin care regimen </li></ul><ul><li>No Smoking </li></ul><ul><li>Rejuvenation procedures </li></ul><ul><li>Protection/Prevention </li></ul>
  15. 15. You Are What You Eat! <ul><li>64 oz water per day to hydrate </li></ul><ul><li>6 servings of fruits </li></ul><ul><li>6 servings of vegetables </li></ul><ul><li>Omega 3 fatty acid or fresh fish 3x week </li></ul><ul><li>Less than 2 servings of caffeine/day </li></ul>
  16. 16. What is Good Skin Care? <ul><li>Cleanse-PH balanced wash 2x/day </li></ul><ul><li>Exfoliate-chemical and physical </li></ul><ul><li>Hydrate-topically and orally </li></ul><ul><li>Protect </li></ul><ul><ul><li>UVA/UVB Sunscreen </li></ul></ul><ul><ul><li>Topical antioxidants </li></ul></ul><ul><li>Rejuvenate </li></ul><ul><ul><li>Retinoid 3 – 5x weekly </li></ul></ul><ul><ul><li>Optional Rejuvenation Procedures readily available </li></ul></ul>
  17. 17. Exfoliate <ul><li>1. Chemical exfoliation </li></ul><ul><ul><ul><li>Glycolic or Salicylic Acid daily skin care </li></ul></ul></ul><ul><ul><ul><li>Chemical peels </li></ul></ul></ul><ul><ul><ul><li>Retinoids </li></ul></ul></ul><ul><li>2. Physical exfoliation </li></ul><ul><ul><ul><li>Fine granular scrubs </li></ul></ul></ul><ul><ul><ul><li>Microdermabrasion </li></ul></ul></ul>
  18. 18. Microdermabrasion <ul><li>2 nd most common non-surgical cosmetic procedure in the United States </li></ul><ul><li>Mechanical removal of the outer 1-2 dead layers of skin with a “sand blasting” technique </li></ul><ul><li>No down time </li></ul><ul><li>Works well with chemical peels </li></ul>
  19. 19. Hydrate <ul><li>1. Drink 64 oz water daily </li></ul><ul><li>2. Topical moisturizers </li></ul><ul><ul><ul><li>Barriers- block water loss </li></ul></ul></ul><ul><ul><ul><ul><li>Petroleum, lanolin, paraffin, beeswax </li></ul></ul></ul></ul><ul><ul><ul><li>Emollients- smooth edges </li></ul></ul></ul><ul><ul><ul><ul><li>Petroleum </li></ul></ul></ul></ul><ul><ul><ul><li>Humectants- draw water into skin </li></ul></ul></ul><ul><ul><ul><ul><li>Glycerin, urea, hyaluronic acid, glycolic and lactic acid </li></ul></ul></ul></ul>
  20. 20. Protect
  21. 21. Skin Cancer Facts 2007 <ul><li>3% increase in all skin cancers </li></ul><ul><ul><li>1 million new cases of non-melanoma </li></ul></ul><ul><ul><li>60,000 new cases of melanoma </li></ul></ul><ul><ul><li>8,000 deaths last year from melanoma </li></ul></ul>
  22. 22. Topical C <ul><li>L-ascorbic Acid </li></ul><ul><li>Lasts 72 hours </li></ul><ul><li>Increases collagen synthesis </li></ul><ul><li>Decreases cell damage from sun 58% </li></ul><ul><li>10% minimum concentration to be effective </li></ul>
  23. 23. Prevage MD <ul><li>Topical antioxidant Idebenone </li></ul><ul><li>0.5% available over the counter </li></ul><ul><li>1% is prescription strength </li></ul><ul><li>Protects from sun, air pollution, smoke, and ozone 95% </li></ul><ul><li>Use twice daily; titrate up </li></ul>
  24. 24. UVB Protection <ul><li>SPF (Sun Protection factor) is a measurement of UVB protection only. </li></ul><ul><ul><li>Refers to the ability of a sunscreen to delay sun-induced redness in epidermis </li></ul></ul><ul><ul><li>SPF 30 blocks 97% for 2 hours; </li></ul></ul><ul><ul><ul><li>SPF 15 blocks 93%, </li></ul></ul></ul><ul><ul><ul><li>50 blocks 97%, </li></ul></ul></ul><ul><ul><ul><li>70 blocks 97% </li></ul></ul></ul>
  25. 25. UVA Protection <ul><li>Measured by PFA (protection factor) </li></ul><ul><li>Present sunrise to sunset </li></ul><ul><li>Present cloudy days, even in winter </li></ul><ul><li>Passes through windows </li></ul><ul><li>Penetrates deep into dermis </li></ul><ul><li>Cause up to 80% of skin damage </li></ul>
  26. 26. Sun Protection Tips <ul><li>Apply 30 minutes prior and every 2 hours </li></ul><ul><li>Apply generously </li></ul><ul><li>Choose Total UVB/UVA protection </li></ul><ul><ul><li>Titanium dioxide, zinc oxide – Sunblock </li></ul></ul><ul><ul><ul><li>Blue Lizard sensitive skin SPF 30+ </li></ul></ul></ul><ul><ul><li>Helioplex – avobenzone w/oxybenzone </li></ul></ul><ul><ul><ul><li>Neutragena Ultra Sheer Dry Touch SPF 55 </li></ul></ul></ul><ul><ul><li>Mexoryl SX – avobenzone w/Octocrylene </li></ul></ul><ul><ul><ul><li>Lancome UV Expert 20 </li></ul></ul></ul><ul><ul><ul><li>La Roche-Posay Anthelios SX </li></ul></ul></ul><ul><ul><ul><li>Ombrelle Sunscreen Lotion </li></ul></ul></ul>
  27. 27. UVA protection “What’s New” <ul><li>Zinc Oxide or Titanium Dioxide </li></ul><ul><ul><li>Physical barrier to block all sun rays </li></ul></ul><ul><li>Parsol 1789 (Avobenzone) </li></ul><ul><ul><li>Developed in 1992 to protect against UVA </li></ul></ul><ul><ul><li>Recently found unstable and loses effectiveness in 2 hours of exposure to sun. </li></ul></ul><ul><li>Helioplex </li></ul><ul><ul><li>Avobenzone stabilized with Oxybenzone to protect against UVA for 6 hours </li></ul></ul><ul><ul><li>Neutragena Ultra Sheer Dry touch </li></ul></ul><ul><li>Mexoryl </li></ul><ul><ul><li>Avobenzone stabilized with Mexoryl SX or Tinosorb to protect against UVA for 4 hours </li></ul></ul><ul><ul><li>Lancome UV Expert 20 and LaRoche-Posey Anthelios SX </li></ul></ul>
  28. 28. Summer Solstice <ul><li>June 21 st is the day of highest sun intensity. </li></ul><ul><li>On a clear day, intensity April 21 st equals that of August 21 st . </li></ul>
  29. 29. Sunscreen
  30. 30. Retinoids <ul><li>Stimulates collagen production </li></ul><ul><li>Decreases cell damage from sun exposure </li></ul><ul><li>Increases skin cell turnover </li></ul><ul><li>Helps prevent skin cancer </li></ul><ul><ul><li>Tretinoin (Retin-A, Renova) </li></ul></ul><ul><ul><li>Terazatane (Tazorac) </li></ul></ul><ul><ul><li>Differin (Adapalene ) </li></ul></ul>
  31. 31. Rejuvenation Procedures <ul><li>Chemical Peels </li></ul><ul><li>Botox </li></ul><ul><li>Facial Fillers </li></ul><ul><li>Laser treatments </li></ul>
  32. 32. Peels
  33. 33. What are Chemical Peels? <ul><li>Application of a chemical solution to produce a controlled peel. </li></ul><ul><li>Purpose: To allow peeling of the sun-damaged layers resulting in rejuvenation of the skin. Newer healthier cells and more even skin tones. </li></ul>
  34. 34. Benefits of Chemical Peels <ul><li>Benefits: </li></ul><ul><ul><li>Stimulates collagen and reduces the appearance of wrinkles. </li></ul></ul><ul><ul><li>Diminishes pigmentation associated with sun damage, acne, and melasma. </li></ul></ul><ul><ul><li>Treats pre cancerous changes of the skin. </li></ul></ul><ul><ul><li>Improves texture and pore size. </li></ul></ul>
  35. 35. Types of Peels
  36. 36. Glycolic Acid (AHA) <ul><li>Promotes exfoliation </li></ul><ul><li>Increase the density of collagen </li></ul><ul><li>Functions as moisturizer </li></ul><ul><li>Good for regular skin types </li></ul><ul><li>Causes superficial flaking and redness for 1 – 4 days </li></ul>
  37. 37. Salicylic Acid 17% <ul><li>Lipophilic : Penetrates the oil filled follicles in acne </li></ul><ul><li>Good for oily skin types </li></ul><ul><li>Anti-inflammatory properties are good for rosacea and acne </li></ul>
  38. 38. Jessnar’s Peel <ul><li>Medium depth peel </li></ul><ul><li>Lactic acid, Salicylic acid and Resorcinol </li></ul><ul><li>Causes minimal inflammation </li></ul><ul><li>Good for acne, rosacea and most sensitive skin </li></ul><ul><li>Good on all skin types </li></ul>
  39. 39. TCA Peel <ul><li>Medium depth “Wounding Peel” </li></ul><ul><li>Controlled peel of entire epidermal layer or down to papillary dermis </li></ul><ul><li>5 – 10 days “down time” </li></ul><ul><li>Builds collagen, decreases pore size, evens out skin tone, decreases pigment </li></ul><ul><li>Not for use on darker skin types </li></ul>
  40. 40. Botox <ul><li>Injection of botulinum toxin A </li></ul><ul><li>FDA approved for cosmetic use in Glabella </li></ul><ul><li>Works by causing temporary block in nerve signals preventing contraction of muscles </li></ul><ul><li>Glabella, crow’s feet, forehead and around mouth lasting approximately 3 months </li></ul><ul><li>Used for cosmetic purposes since 1981 </li></ul>
  41. 48. Facial Fillers <ul><li>Collagen </li></ul><ul><ul><li>Human – no skin testing required </li></ul></ul><ul><ul><ul><li>Cosmoderm, Cosmoplast </li></ul></ul></ul><ul><ul><li>Bovine – rarely used due to skin testing </li></ul></ul><ul><ul><ul><li>Is gold standard </li></ul></ul></ul><ul><li>Hyaluronic Acid </li></ul><ul><ul><li>Restylane, Hylaform, Juvaderm </li></ul></ul><ul><li>Radiesse – injectable facial contouring agent </li></ul><ul><li>Sculptra – injectable volumizing agent </li></ul>
  42. 50. Collagen <ul><li>Human vs Bovine </li></ul><ul><li>Cosmoplast is thicker than Cosmoderm </li></ul><ul><li>Last 3 – 4 months </li></ul><ul><li>Great for lip border, peri-oral lines, fine lines and wrinkles </li></ul><ul><li>No down time </li></ul>
  43. 51. Collagen Lip Augmentation
  44. 52. Hyaluronic Acids <ul><li>Hydrophilic in nature </li></ul><ul><li>Lasts 6 – 9 months </li></ul><ul><li>Great for nasolabial folds and deeper lines and wrinkles </li></ul><ul><li>No testing needed </li></ul><ul><li>Hylaform, Restylane & Juvederm </li></ul>
  45. 53. Juvederm
  46. 54. Juvederm before
  47. 55. Juvederm after
  48. 56. Radiesse <ul><li>Injectable implant </li></ul><ul><ul><li>Nasolabial folds, marionette lines, cheek implants </li></ul></ul><ul><li>Calcium Hydroxylapatie </li></ul><ul><li>Injected deeper into skin </li></ul><ul><li>Lasts 12 – 18 months </li></ul><ul><li>Shown to promote collagen after 3 months </li></ul>
  49. 57. Marionette before
  50. 58. After 3 months
  51. 59. Nasolabial before
  52. 60. After 3 months
  53. 61. Cheeks before
  54. 62. After 3 months
  55. 63. Sculptra <ul><li>Synthetic Poly-L-lactic acid </li></ul><ul><li>Injected into subcutaneous tissue </li></ul><ul><li>Increases skin thickness </li></ul>
  56. 64. Before Sculptra
  57. 65. Sculptra after 3 treatments
  58. 66. Lasers
  59. 67. IPL Photo-Facial <ul><li>Multiple wavelengths of light penetrate to different depths in the skin treating various conditions </li></ul><ul><li>Minimal down-time </li></ul><ul><li>Lightens age spots, decreases redness and red veins, and evens the skin tones </li></ul><ul><li>Stimulates collagen </li></ul><ul><li>Excellent for rosacea </li></ul>
  60. 76. IPL with Levulan Therapy <ul><li>Combination IPL with the chemical Levulan to provide a more aggressive rejuvenation of epidermis </li></ul><ul><li>Treats photoaging, precancerous skin lesions, hyperpigmentation, acne, and rosacea </li></ul><ul><li>Causes temporary photosensitivity </li></ul><ul><li>Light peeling for 5 – 7 days </li></ul>
  61. 77. Before
  62. 78. After 2 months
  63. 79. Laser Hair Removal <ul><li>Takes 6-8 treatments </li></ul><ul><li>Permanent hair reduction </li></ul><ul><li>Fast </li></ul><ul><li>Convenient </li></ul>
  64. 80. Before After 8 treatments
  65. 81. “ What’s New” <ul><li>Tissue tightening </li></ul><ul><li>Ablative fractional resurfacing </li></ul><ul><li>Non-ablative fractional resurfacing </li></ul><ul><li>Ablative erbium resurfacing </li></ul><ul><li>Profractional resurfacing </li></ul>
  66. 82. Ablative & Non-Ablative Skin Resurfacing CONFIDENTIAL Palomar Medical Technologies, Inc.
  67. 83. Mechanism of Light-induced Skin Rejuvenation Light absorption by tissue water Inflammatory response Release of inflammatory mediators into dermal interstitium Stimulation of fibroblast activity Increase of collagen production and proliferation of keratynocytes Limited thermal damage CONFIDENTIAL Palomar Medical Technologies, Inc.
  68. 84. Non-ablative skin resurfacing Lux 1540 and Fraxyl <ul><li>Produces microthermal treatment zones </li></ul><ul><li>Improves texture and pore size </li></ul><ul><li>Removes skin discolorations </li></ul><ul><li>Improves acne scarring </li></ul><ul><li>Treats hands, neck & de’collete’ </li></ul><ul><li>Reduces crows feet around eyes </li></ul><ul><li>Does not remove epidermis </li></ul>
  69. 85. Lux1540 Fractional ™ Laser for Texture, Wrinkles and Acne Scars CONFIDENTIAL Palomar Medical Technologies, Inc.
  70. 86. Lux 1540 Fractional Photos courtesy of Dr. Dwight Scarborough Pre Tx 1 Immediately After Tx 1 1 Week after Tx 1 8 Weeks after Tx 1
  71. 87. 6 weeks post tx #2 @50 MJ Pre-TX Aesthetica Cosmetic & Laser Center David B. Vasily, M.D. Lux1540 Fractional™ CONFIDENTIAL Palomar Medical Technologies, Inc.
  72. 88. Tiffani Hamilton, MD Lux 1540 Fractional ™ PreTx 1 PostTx 2
  73. 89. Lux 1540 Fractional™ PreTx 1 3 WeeksPost 2 tx CONFIDENTIAL Palomar Medical Technologies, Inc
  74. 90. Lux 1540 Fractional™ Stan Kovak MD-2 Weeks Post 4 TXs Post 4 Treatments w/o Botox
  75. 91. Lux 1540 Fractional™ 2 weeks Post 1 st Treatment Pre-Treatment CONFIDENTIAL Palomar Medical Technologies, Inc. Post-Treatment
  76. 92. Non-ablative tissue tightening <ul><li>Causes dermal and subcutaneous heating, without damaging the surface of the skin. </li></ul><ul><li>Thermage-radiofrequency heating </li></ul><ul><li>Polaris – combined technology </li></ul><ul><li>Titan- infrared broadband </li></ul><ul><li>Starlux IR - infrared </li></ul>
  77. 93. Thermage before After 3 months
  78. 94. Titan before & after
  79. 95. Titan before & after
  80. 96. Other New Treatments in 2007 <ul><li>Cellulite laser therapy </li></ul><ul><li>Portrait laser technology </li></ul><ul><li>Longer lasting fillers </li></ul><ul><li>Ablative lasers </li></ul><ul><li>We live a time of changing technology. There is something new every couple of months. </li></ul>
  81. 97. Provider Role in Skin Care <ul><li>Educate yourself </li></ul><ul><li>Evaluate patient risk </li></ul><ul><li>Do skin checks yearly </li></ul><ul><li>Discuss good skin care </li></ul><ul><li>Recommend sunscreen </li></ul><ul><li>Encourage smoking cessation </li></ul><ul><li>Provide education about services available </li></ul><ul><li> </li></ul>
  82. 98. Stop Smoking!
  83. 99. <ul><li>NOT ALL WRINKLES ARE CREATED EQUAL </li></ul>
  84. 100. Thank You <ul><li>Source </li></ul><ul><li> </li></ul>