Skin Care

Cosmetic Dermatology in Primary Care

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

Three layers of skin Epidermis Dermis Subcutaneous fat (hypodermis)

Epidermis (outer layer) 1. Stratum corneum - “dead outermost layer” consists of 15 - 40 layers 2. Granular layer 3. Spinous layer- is the matrix Melanocytes produce the pigment, melanin Langerhans’ immune cells Merkel’s sensory stimulation cells 4. Basal layer- basal cells divide to make new skin about every 30 days

Dermis (middle layer) 1. Papillary layer haphazardly arranged thin collagen 2. Reticular layer thick collagen arranged parallel for structure elastin fibers sebaceous glands, hair follicle, blood vessels

Free Radical Theory of Aging Dehnam Harman, 1956 First proposed theory of aging Free radicals occur naturally with human metabolism and aging Free radicals cause damage to DNA/RNA leading to decreased cell function and disease.

Intrinsic Aging Genetics set the internal clock of human metabolism Decreased estrogens during menopause contribute to collagen loss in women

Extrinsic Aging Photodamage - 80% Smoking Stress Poor nutrition Pollution Excess alcohol

Facts of Aging Skin Signs begin about age 30 Texture changes Decreased cellular turnover in epidermis causing fine lines and wrinkles Collagen decreases by 1% yearly after age 30 causing thinner skin Decreased elastic fibers, fat, and blood vessels causing decreased elasticity Decreased hair follicles, sweat ducts, and sebaceous glands Decreased water binding capability causing dryer skin

Clinical Signs of Aging Skin Mild dryness Fine lines and wrinkles Freckles Moles Spider veins Skin tags Red spots

Clinical Signs of Photoaging Skin Texture changes dryness, enlarged pores, wrinkles pigment changes- sun spots, freckles, melasma Vascular changes spider veins, red spots, rosacea Degenerative changes Benign- seborrheic keratosis, skin tags, moles Precancerous- actinic keratosis Cancerous- melanoma, basal cell, squamous cell

FACTS about PhotoAging 20 minutes of sun exposure is enough to cause damage to the skin. Sunburn and sun-tanning causes wrinkles and thinning skin. Number one risk factor for all skin cancers is SUN EXPOSURE! (one blistering sunburn doubles the risk of skin cancer)

What is the treatment for Photoaging Skin? Diet high in fruits and vegetables Adequate oral hydration ( 64 oz + daily) Good daily skin care regimen No Smoking Rejuvenation procedures Protection/Prevention

You Are What You Eat! 64 oz water per day to hydrate 6 servings of fruits 6 servings of vegetables Omega 3 fatty acid or fresh fish 3x week Less than 2 servings of caffeine/day

What is Good Skin Care? Cleanse-PH balanced wash 2x/day Exfoliate-chemical and physical Hydrate-topically and orally Protect UVA/UVB Sunscreen Topical antioxidants Rejuvenate Retinoid 3 – 5x weekly Optional Rejuvenation Procedures readily available

Exfoliate 1. Chemical exfoliation Glycolic or Salicylic Acid daily skin care Chemical peels Retinoids 2. Physical exfoliation Fine granular scrubs Microdermabrasion

Microdermabrasion 2 nd most common non-surgical cosmetic procedure in the United States Mechanical removal of the outer 1-2 dead layers of skin with a “sand blasting” technique No down time Works well with chemical peels

Hydrate 1. Drink 64 oz water daily 2. Topical moisturizers Barriers- block water loss Petroleum, lanolin, paraffin, beeswax Emollients- smooth edges Petroleum Humectants- draw water into skin Glycerin, urea, hyaluronic acid, glycolic and lactic acid

Skin Cancer Facts 2007 3% increase in all skin cancers 1 million new cases of non-melanoma 60,000 new cases of melanoma 8,000 deaths last year from melanoma

Topical C L-ascorbic Acid Lasts 72 hours Increases collagen synthesis Decreases cell damage from sun 58% 10% minimum concentration to be effective

Prevage MD Topical antioxidant Idebenone 0.5% available over the counter 1% is prescription strength Protects from sun, air pollution, smoke, and ozone 95% Use twice daily; titrate up

UVB Protection SPF (Sun Protection factor) is a measurement of UVB protection only. Refers to the ability of a sunscreen to delay sun-induced redness in epidermis SPF 30 blocks 97% for 2 hours; SPF 15 blocks 93%, 50 blocks 97%, 70 blocks 97%

UVA Protection Measured by PFA (protection factor) Present sunrise to sunset Present cloudy days, even in winter Passes through windows Penetrates deep into dermis Cause up to 80% of skin damage

Sun Protection Tips Apply 30 minutes prior and every 2 hours Apply generously Choose Total UVB/UVA protection Titanium dioxide, zinc oxide – Sunblock Blue Lizard sensitive skin SPF 30+ Helioplex – avobenzone w/oxybenzone Neutragena Ultra Sheer Dry Touch SPF 55 Mexoryl SX – avobenzone w/Octocrylene Lancome UV Expert 20 La Roche-Posay Anthelios SX Ombrelle Sunscreen Lotion

UVA protection “What’s New” Zinc Oxide or Titanium Dioxide Physical barrier to block all sun rays Parsol 1789 (Avobenzone) Developed in 1992 to protect against UVA Recently found unstable and loses effectiveness in 2 hours of exposure to sun. Helioplex Avobenzone stabilized with Oxybenzone to protect against UVA for 6 hours Neutragena Ultra Sheer Dry touch Mexoryl Avobenzone stabilized with Mexoryl SX or Tinosorb to protect against UVA for 4 hours Lancome UV Expert 20 and LaRoche-Posey Anthelios SX

Summer Solstice June 21 st is the day of highest sun intensity. On a clear day, intensity April 21 st equals that of August 21 st .

Retinoids Stimulates collagen production Decreases cell damage from sun exposure Increases skin cell turnover Helps prevent skin cancer Tretinoin (Retin-A, Renova) Terazatane (Tazorac) Differin (Adapalene )

Rejuvenation Procedures Chemical Peels Botox Facial Fillers Laser treatments

What are Chemical Peels? Application of a chemical solution to produce a controlled peel. Purpose: To allow peeling of the sun-damaged layers resulting in rejuvenation of the skin. Newer healthier cells and more even skin tones.

Benefits of Chemical Peels Benefits: Stimulates collagen and reduces the appearance of wrinkles. Diminishes pigmentation associated with sun damage, acne, and melasma. Treats pre cancerous changes of the skin. Improves texture and pore size.

Glycolic Acid (AHA) Promotes exfoliation Increase the density of collagen Functions as moisturizer Good for regular skin types Causes superficial flaking and redness for 1 – 4 days

Salicylic Acid 17% Lipophilic : Penetrates the oil filled follicles in acne Good for oily skin types Anti-inflammatory properties are good for rosacea and acne

Jessnar’s Peel Medium depth peel Lactic acid, Salicylic acid and Resorcinol Causes minimal inflammation Good for acne, rosacea and most sensitive skin Good on all skin types

TCA Peel Medium depth “Wounding Peel” Controlled peel of entire epidermal layer or down to papillary dermis 5 – 10 days “down time” Builds collagen, decreases pore size, evens out skin tone, decreases pigment Not for use on darker skin types

Botox Injection of botulinum toxin A FDA approved for cosmetic use in Glabella Works by causing temporary block in nerve signals preventing contraction of muscles Glabella, crow’s feet, forehead and around mouth lasting approximately 3 months Used for cosmetic purposes since 1981

Facial Fillers Collagen Human – no skin testing required Cosmoderm, Cosmoplast Bovine – rarely used due to skin testing Is gold standard Hyaluronic Acid Restylane, Hylaform, Juvaderm Radiesse – injectable facial contouring agent Sculptra – injectable volumizing agent

Collagen Human vs Bovine Cosmoplast is thicker than Cosmoderm Last 3 – 4 months Great for lip border, peri-oral lines, fine lines and wrinkles No down time

Hyaluronic Acids Hydrophilic in nature Lasts 6 – 9 months Great for nasolabial folds and deeper lines and wrinkles No testing needed Hylaform, Restylane & Juvederm

Radiesse Injectable implant Nasolabial folds, marionette lines, cheek implants Calcium Hydroxylapatie Injected deeper into skin Lasts 12 – 18 months Shown to promote collagen after 3 months

Sculptra Synthetic Poly-L-lactic acid Injected into subcutaneous tissue Increases skin thickness

IPL Photo-Facial Multiple wavelengths of light penetrate to different depths in the skin treating various conditions Minimal down-time Lightens age spots, decreases redness and red veins, and evens the skin tones Stimulates collagen Excellent for rosacea

IPL with Levulan Therapy Combination IPL with the chemical Levulan to provide a more aggressive rejuvenation of epidermis Treats photoaging, precancerous skin lesions, hyperpigmentation, acne, and rosacea Causes temporary photosensitivity Light peeling for 5 – 7 days

Laser Hair Removal Takes 6-8 treatments Permanent hair reduction Fast Convenient

“ What’s New” Tissue tightening Ablative fractional resurfacing Non-ablative fractional resurfacing Ablative erbium resurfacing Profractional resurfacing

Ablative & Non-Ablative Skin Resurfacing CONFIDENTIAL Palomar Medical Technologies, Inc.

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.

Non-ablative skin resurfacing Lux 1540 and Fraxyl Produces microthermal treatment zones Improves texture and pore size Removes skin discolorations Improves acne scarring Treats hands, neck & de’collete’ Reduces crows feet around eyes Does not remove epidermis

Lux1540 Fractional ™ Laser for Texture, Wrinkles and Acne Scars CONFIDENTIAL Palomar Medical Technologies, Inc.

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

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.

Tiffani Hamilton, MD Lux 1540 Fractional ™ PreTx 1 PostTx 2

Lux 1540 Fractional™ PreTx 1 3 WeeksPost 2 tx CONFIDENTIAL Palomar Medical Technologies, Inc

Lux 1540 Fractional™ Stan Kovak MD-2 Weeks Post 4 TXs Post 4 Treatments w/o Botox

Lux 1540 Fractional™ 2 weeks Post 1 st Treatment Pre-Treatment CONFIDENTIAL Palomar Medical Technologies, Inc. Post-Treatment

Non-ablative tissue tightening Causes dermal and subcutaneous heating, without damaging the surface of the skin. Thermage-radiofrequency heating Polaris – combined technology Titan- infrared broadband Starlux IR - infrared

Thermage before After 3 months

Other New Treatments in 2007 Cellulite laser therapy Portrait laser technology Longer lasting fillers Ablative lasers We live a time of changing technology. There is something new every couple of months.

Provider Role in Skin Care Educate yourself Evaluate patient risk Do skin checks yearly Discuss good skin care Recommend sunscreen Encourage smoking cessation Provide education about services available http://generalhealthinformation.co.cc

NOT ALL WRINKLES ARE CREATED EQUAL

Thank You Source http://generalhealthinformation.co.cc

Skin Care

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