Why basic home care is important

Polina Laiter, medical cosmetologist PME, specialist in the field of natural restoration and rejuvenation of the face, member of the medical society of acupuncture of the Israeli Medical Association (Israel)

There are three clinical cases:

• Patient Ya. came to the clinic about deteriorating skin quality and signs of premature aging of the face. Diagnosis: rosacea, complicated by a violation of the barrier properties of the skin due to improper care (more precisely, lack of competent care) and changes in hormonal levels;
• Patient K. came to the clinic about deteriorating skin quality and signs of premature aging of the face. Diagnosis: acne, post-acne, pigmentation disorders, complicated by a violation of the barrier properties of the skin due to improper care;
• Patient X. came to the clinic due to unexpected complications after simultaneous plastic surgery “facelift” and blepharoplasty, as well as CO2 laser peeling.

What do you think these clinical cases have in common? Of course, all three women experienced functional changes in their skin barrier properties.

First technique: where to start?

How can you see and understand the extent of damage to the skin barrier layer at the first appointment? What should you pay attention to when functional disorders of the protective layer are disguised as a variety of conditions? What to recommend? Let's figure it out.

Home Care Assessment

First of all, at the first appointment I always ask to bring the products that the patient uses at home in order to analyze the balance of basic home care.

I adhere to clear and simple rules that I always voice to my patients. In facial skin care there are mandatory products that are used on an ongoing basis, and “working” or corrective products that need to be used depending on skin problems if they appear.

Corrective products are used when there are dermatological problems caused by chronic skin diseases, dermatoses or general diseases that affect the lipid metabolism of the skin, as well as aesthetic imperfections in the skin of the face and body, which visually begin to interfere. To such “problems” I include post-acne, a tendency to hyperpigmentation, a violation of the protective barrier (burning, redness, peeling), acne, seborrhea, rosacea, skin dehydration (flabbiness, yellow undertone, loss of tone).

To the basic, that is, mandatory, home care products I include a high-quality, always neutral “wash”, a high-quality moisturizer, or rather, two - always an acidic and neutral cream, a product with antioxidants, a product with peptides for the skin around the eyes and a high-quality acidic body cream.

History taking

I ask the patient about:

• individual characteristics (age, gender, stress, sleep patterns, sun exposure, flights, etc.);
• the presence of systemic diseases and concomitant pathologies (hypothyroidism, diabetes mellitus, hormonal changes, vitamin deficiencies, oncology, iron deficiency anemia, hematological diseases, etc.);
• lifestyle (smoking, alcohol, nutrition, deficiency or excess of vitamins, taking medications, drinking water, etc.);
• procedures that have been carried out recently (peelings, injections, operations, hardware).

Visual reface diagnostics

I pay attention to the color and tone of the skin, the presence or absence of pigmentation disorders, foci of inflammation, signs of irritation, and the condition of the stratum corneum of the skin.

Diagnostic procedure

I determine the degree of disruption of the skin barrier layer, how balanced it is and whether it is ready for more serious effects. I also pay attention to the reaction of the skin and blood vessels to the drugs used in the procedure.

conclusions

I analyze all the collected data and draw up a program for restoring the functions of the skin barrier layer. It may consist of corrections and recommendations for home care, or it may include a list of mandatory home care products and procedures in the clinic. That is, home care is always important, and in most cases its correction is enough to restore the functions of the protective layer of the skin.

General rules and recommendations for basic facial skin care when the barrier structures of the stratum corneum are damaged:

• reduce the rate of moisture evaporation so that the water content in the stratum corneum quickly increases;
• use substances that attract and retain water;
• use substances that restore the lipid barrier;
• use substances that protect the skin barrier from oxidation;
• use substances that protect the skin barrier from ultraviolet radiation;
• exclude from home care products that have a destructive effect on the barrier functions of the skin (natural soap, alcohol lotions);
• use mild cleansers (micellar solution, cleansing milk). In case of heavily soiled skin, you can use synthetic soap with a pH of 5.5–6. Soothing and softening additives (probiotic complex, plant extracts) are welcome;
• periodically tone the skin with a non-alcohol lotion with a soothing and anti-inflammatory effect - based on glycerin and polymers (synthetic or natural) containing water-soluble plant extracts rich in bioflavonoids (green tea extract, grape peel, etc.);
• to moisturize the stratum corneum and maintain its water balance, use preparations that contain substances that can attract and retain water (glycerin, sorbitol, hyaluronic acid, aloe gel, amino acids, lactic acid, etc.);
• use drugs that normalize the composition and structure of lipids in the stratum corneum (vitamin E, sweet almond seed oil extract).

Case studies

When they ask me what specific professional brands and preparations I use to treat functional disorders of the barrier layer of the skin and correct existing aesthetic defects, I always answer that they are different. And it is true. When working with cutaneous methods, there is not and cannot be a single rule and protocol.

The algorithm for the patient’s independent work at home, the sequence and number of procedures, the intervals between them and the result of correction are directly related and depend on the degree of functional impairment of the protective layer of the skin and its ability to recover. And these are extremely individual characteristics that depend on very, very many nuances.

Clinical case No. 1

Patient X., 32 years old. I went to the clinic about poor skin condition and difficulties in choosing suitable home care. Scars, congestive and age spots, and inflammatory elements are visually identified. Diagnosis: acne, post-acne.

The clinic carried out three procedures: the first – diagnostic – revealed a dysfunction (barrier properties) of the upper layer of the skin, the next two were carried out with a month’s break to allow the skin to adapt first to basic and then to corrective home care.

Sample procedure protocol:

• cleansing: apply a soft emulsion and carefully rinse with warm water after several minutes of exposure;
• peeling ABR 1.4 (the composition varied depending on the condition of the protective layer of the skin) was applied to the face in an even layer, exposure time was 10–15 minutes, then washed off with water;
• White peel peeling mask: spread over the skin in an opaque layer and leave for 10–15 minutes under a damp, warm cloth, then remove with wet wipes;
• At the end of the procedure, D-Red Balm was applied.

When choosing products, we took into account the color and type of skin, the condition of its barrier layer, the degree and duration of this situation, the combination of basic and corrective care, changes in skin condition during hormonal treatment, and the onset of possible pregnancy. An additional goal was to increase tone, improve skin color and texture, cleanse and reduce pores, and have a well-groomed and fresh appearance.

Home care:

• basic: Probiotic soap, Probiotic balancing cream, Probiotic day cream, Sunbrella SPF 30 (HL, Israel);
• corrective: Kure for problematic skin, Azelight 20% cream, Skin Tone whitening cream (Biofor, Israel).

The result of the treatment is shown in photo 1.

Clinical case No. 2

Patient Ya., 36 years old. I went to the clinic about poor skin condition and difficulties in choosing suitable home care. Irritation, peeling, redness, and inflammatory elements are visually determined. Diagnosis: rosacea.

As in the first case, the clinic carried out three procedures: the first – diagnostic – revealed a dysfunction (barrier properties) of the upper layer of the skin, the next two were carried out with a month’s break to allow the skin to adapt first to basic and then to corrective home care.

Sample procedure protocol:

• cleansing: apply a soft emulsion and gently rinse with warm water after several minutes of exposure;
• peeling ABR 1.4 (composition varied depending on the condition of the protective layer of the skin): applied to the face in an even layer, exposure for 10–15 minutes, then rinsed with water;
• cold hydrogenation;
• mechanical facial cleansing;
• A-Nox Mask - for problem areas; White Peel peeling was spread on the skin in an opaque layer and left for 10–15 minutes under a damp, warm cloth, after which it was removed with wet wipes.

When choosing products, we took into account the color and type of skin, the condition of the barrier layer, the degree and duration of this situation, preliminary treatment (there is a history of corticosteroid use), a combination of basic and corrective care, and nutrition. An additional goal was to increase tone, improve skin color and texture, cleanse and reduce pores, and have a well-groomed and fresh appearance.

Home care:

• basic: Probiotic soap (HL, Israel), Lacto10%, Igloo Moist (Noon, Israel), Sunbrella SPF 30 (HL, Israel);
• corrective: Double White vit.C+20% Azelaic Cream (Noon, Israel).

The treatment results are shown in photo 2.

Clinical case No. 3

Patient K., 27 years old. I went to the clinic about poor skin condition and difficulties in choosing suitable home care. Scars, multiple congestive and age spots, and inflamed elements are visually identified. Diagnosis: acne, post-acne.

The clinic carried out five procedures: the first - diagnostic - revealed a dysfunction (barrier properties) of the upper layer of the skin, the subsequent ones were carried out with a month's break to allow the skin to adapt first to basic and then to corrective home care.

Sample procedure protocol:

• cleansing: apply a soft emulsion and gently rinse with warm water after several minutes of exposure;
• peeling ABR 3.4 (the composition varied depending on the condition of the protective layer of the skin) was applied to the face in an even layer, exposure time was 10–15 minutes, then washed off with water;
• cold hydrogenation;
• mechanical facial cleansing;
• A-Nox Mask or White Peel peeling was spread over the skin in an opaque layer and left for 10–15 minutes under a damp, warm cloth, after which it was removed with wet wipes;
• At the end of the procedure, D-Red Balm was applied.

When choosing products, we took into account the color and type of skin, the condition of the barrier layer, the degree of acne and post-acne, the combination of basic and corrective care, and the onset of possible pregnancy. An additional goal was to increase tone, improve skin color and texture, cleanse and shrink pores, improve the characteristics of some scars, and give a well-groomed and fresh appearance.

Home care:

• basic: Probiotic soap, ABR lotion; Concentrated vit.C serum, ABR Restoring cream, ABR DAY DEFENSE cream, Sunbrella SPF 30 (HL, Israel);
• corrective: Total Repair Rx (Dermalosophy, Israel).

The results of the treatment are presented in photo 3.

***

Believe me, colleagues, functional disorders of the protective layer of the skin are always present to one degree or another in every patient and very often disguised as other problems.

Starting any program of aesthetic correction of the face and neck by checking the condition of the skin, I understand that without restoration its protective layer will not only not give me the opportunity to work further with the dermis, but will also not allow me to work with functional disorders of the deeper structures of the face - subcutaneous fat tissue , muscles, bones, joints, blood vessels. And this is extremely important both when correcting aesthetic deformations of premature or biological aging, and in case of unexpected months-long complications after invasion.

First published: Nouvel Aesthetic 2 (108)/2018