Prevention of Cosmetic Problems
Cosmetic problems can be prevented through proper diagnosis and the use of carefully selected products. These products typically fall in the over-the-counter (OTC) realm and can be classified as true cosmetics or OTC drugs. Products that are considered co
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Zoe Diana Draelos
Cosmetic problems can be prevented through proper diagnosis and the use of carefully selected products. These products typically fall in the over-the-counter (OTC) realm and can be classified as true cosmetics or OTC drugs. Products that are considered cosmetics include moisturizers, lip balms, and shaving preparations while OTC drugs include sunscreens and antiperspirants. This chapter examines the use of these products in the prevention of cosmetic-related skin disease including facial eczema, eyelid dermatitis, cheilitis, postinflammatory hyperpigmentation, hyperhidrosis, and acne. These are common cosmetic problems that can be exacerbated or alleviated based on the dermatologist’s ability to correctly recommend prescription and complimentary nonprescription therapies.
16.1 Facial Eczema The face is the most complex area of the entire body because more products are designed for facial use than any other. The face contains sebaceous, eccrine, and apocrine glands, as well as keratinized and transitional skin. The face is also characterized by numerous follicular structures in the form of pigmented terminal hairs in the eyebrows, eyelashes, and male beard combined with white fine downy vellus hairs over the rest of the face. These follicular structures are the transition between the skin on the surface of the face and the follicular ostia associated with the follicle and sebaceous
Z. D. Draelos Department of Dermatology, Duke University School of Medicine, 2444 North Main Street, High Point, Durham, North Carolina NC 27262 e-mail: [email protected]
glands. This skin cannot be reached by traditional cosmetics and skin care products, but irritant or allergic reactions that occur at the skin surface can impact this follicular lining. Thus, moisturizer and cleanser formulations for the face must be hypoallergenic, noncomedogenic, and nonacnegenic, since the face is capable of all these reaction patterns.
16.1.1 Facial Moisturizers Facial moisturizers are the most important cosmetic in the prevention of facial eczema. These moisturizers attempt to mimic the effect of sebum and the intercellular lipids composed of sphingolipids, free sterols, and free fatty acids. They intend to provide an environment allowing healing of the stratum corneum barrier by replacement of the corneocytes and the intercellular lipids. Yet, the moisturizing substances must not occlude the sweat ducts, or miliaria will result; must not produce irritation at the follicular ostia, or an acneiform eruption will result; and must not initiate comedonal formation. Moisturizers are used to heal barrier-damaged skin by minimizing transepidermal water loss (TEWL) and creating an environment optimal for healing. There are three categories of substances that can be combined to enhance the water content of the skin, which include occlusives, humectants, and hydrocolloids (Table 16.1). Occlusives are oily substances that retard TEWL by placing an oil slick over the skin surface, while humectants are substances that attract
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