Cosmetics are substances that are applied to the skin to improve its appearance, but have no apparent biologic function. Examples include: lipstick and rouge. Drugs or Pharmaceuticals are substances that alter the biologic function of tissue. The term "cosmeceutical" was coined by Dr. Kligman with the goal of describing a hybrid between a cosmetic and a pharmaceutical. Therefore, "Cosmeceuticals" are substances that not only improve the appearance of the skin but contain active ingredients that alter the function of the skin.
Our basic protocol for skin care is as follows:
- Rosiclense (as above)
The purpose of all moisturizers is to enhance hydration of the stratum corneum. Occlusives coat the stratum corneum and reduce TEWL. Humectants attract water from the underlying epidermis and atmosphere which hydrate the skin. Emollients soften and smooth the skin surface allowing for light reflection and a "radiant glow".
The use of antioxidants for the prevention and treatment of photoaging has been established by decades of scientific research. Some of these beneficial effects include exfoliation, improvement in dermal collagen synthesis and decreased collagen breakdown as well as angiogenesis. No other pharmaceutical or cosmeceutical available today has demonstrated these beneficial effects on cutaneous aging. We consider topical retinoids instrumental in maintaining skin health before and after cosmetic laser treatments.
Vitamin C and its derivatives are scientifically proven antiflammatory antioxidants that also promote collagen biosynthesis and are therefore widely used cosmeceuticals today. The primary role of Vitamin C is in the prevention of damage. It is commonly used to maintain results attained from cosmetic procedures.
- Cega 30 cream.
- Cega and ferrulic.
- Cega eye cream.
The first clinical trials describing the benefits of retinoids for the treatment of photodamage were published over twenty years ago (1986 and 1988). Many trials since these have confirmed the benefits by demonstrating that topical retinoids:
- Topical retinoids are useful prescription drugs that can prevent skin aging as well as treat photodamage.
- Retinoids increase Type I collagen formation in the dermal matrix.
- Common side effects include erythema (redness), desquamation (flakiness) and irritation due to decreased ceramides and compromised barrier function with increased TEWL (Trans Epidermal Water Loss).
- The beneficial effects of tretinoin can be achieved with low concentrations (0.25%) and three times weekly dosing.
- The benefits of a retinoid cease 24 weeks after discontinuing treatment and therefore require long term maintenance.
- When administered appropriately, most patients should be considered candidates for using retinoids as part of an ongoing skin care maintenance regimen to optimize skin aging.
Antiaging Benefits of Retinoids
Retinoids for prevention of photodamage:
Retinoids have recently been determined to prevent aging by inhibiting the action of damaging matrix metalloproteinase’s (MMPs) such as collagenase, stomelysin and gelatinase. These enzymes are upregulated with UVB exposure so retinoids can prevent these from degrading dermal collagen.
Exposure to UV irradiation (even a single dose) decreases collagen synthesis. It has been demonstrated by Fisher et al. that consistent pretreatment of skin with topical retinoids can prevent the loss of procollagen synthesis.
With appropriate and continued use over time this product can:
- Improve fine lines and wrinkles
- Improve skin texture by decreasing roughness
- Improve mild pigmentary changes (brown spots)
- Improve skin tone by increasing collagen
The use of retinoids for the prevention and treatment of photoaging has been established by decades of scientific research. Some of these beneficial effects include exfoliation, improvement in dermal collagen synthesis and decreased collagen breakdown as well as angiogenesis. No other pharmaceutical or cosmeceutical available today has demonstrated these beneficial effects on cutaneous aging. In fact, some patients have better clinical outcomes on retinoids than with a series of non-ablative laser treatments! Our clinicians consider topical retinoids instrumental in maintaining skin health before and after cosmetic laser treatments
Patient instructions for application of topical retinoids:
In order to gain maximum benefit from this prescription and minimize side effects, please follow these detailed instructions:
- In the evening, wash and dry skin with a mild cleanser (not soap).
- Once skin is dry, apply a pea-sized amount of medication and spread around face (this will NOT seem like enough, but do NOT be tempted to use more!)
- Follow this by applying a gentle hydrating moisturizer EVERY NIGHT and in the AM.
- Use the retinoid only 3 times per week for the first 2 weeks.
- After 2 weeks you may increase use to every other night.
- After 1 month you can increase to every night if you tolerate.
- Do not start using other irritating products such as hydroxyacids or Vitamin C at the same time as starting on your retinoid. These products may be added after one month of regular use if you have no side effects.
- Be sure to keep using retinoid at least three times per week, forever to maintain the Antiaging benefits on your skin.
- Always use a broad-spectrum sun block every day (even on cloudy days!)
- If you experience redness, flakiness or irritation try using a smaller amount not more than three times a week and call your prescriber for advice on cosmeceuticals that can enhance your skins ability to adapt to this important Antiaging treatment.
Note: Due to high concentrations of active medical ingredients,Topical retinoids are NOT available on line. Please call Afterglow to arrange a personalized skin care consultation with Dr Ebrahim and her highly experienced staff.
Application of Retinoids
Patients must be instructed on the topical application of retinoids to minimize adverse effects. Overuse will undoubtedly lead to redness, flakiness and irritation and is the likely cause of patients stating, “I’m allergic to Retin-A”. Take a careful history of the amount and frequency of application of this drug and be sure patient is on adequate barrier creams as it has been clearly described that ceramides and important lipid in maintaining the skin barrier can be reduced by 50% in patients using these products.
FACT: Most sun exposure is incidental and not from sunbathing.
FACT: 1 in 82 Americans will develop melanoma in their lifetime.
FACT: 1 in 5 Americans will develop skin cancer in their lifetime.
Sunscreens and Prevention
- Sunscreens can prevent wrinkles and saggy skin.
- Sunscreens can prevent skin discolorations.
- Sunscreens can reduce the risk of skin cancer.
SAFETY: Few adverse events are reported. The most Sunscreens acommon side effects include mild allergic contact dermatitis or comedone formation.
Concerns regarding Vitamin D Deficiency have been expressed in anecdotal reports but there is no scientific data to support this concern.
Ultraviolet irradiation accounts for 80-90% of photoaging changes observed in patients.
Tanning represents wounded skin from UV irradiation!
Despite this acknowledgement, many patients prefer to “get a little color”.
How to Use a Sunscreen
Sunscreens must be applied properly, regularly and in appropriate amounts to be optimally effective in preventing solar-induced UV damage.
When to Apply a Sunscreen:
30 minutes before going outside every day! Physicians recommend application 365 days a year – even on cloudy days! This author suggests that patients put it next to their deodorant or toothbrush. When patients ask why they should use sunscreen daily, I ask them do they only put deodorant when they’re planning to sweat?!
When to Reapply:
Every 24 hours or after swimming or sweating
How Much to Apply:
The current FDA standard for sunscreen application is 2mg/cm and yet studies suggest actual usage is only 25-50% of the amount used to rate the sunscreen SPF. Therefore, if 25% of this amount is used with an SPF#30, the actual protection is SPF of 7.5. If 50% of this amount is used with an SPF#30, the actual protection is SPF of 15.
To cover the average 1.73m adult, a total of 35 ml is required (2 tablespoons or 6 teaspoons, which equals one shot glass or a film canister)!
Schneider suggests the “teaspoon rule” whereby an adult should apply ½ a teaspoon (2.5ml) to each arm and to the face and neck.(2.5 ml x 3=7.5ml )
6 ml (just a bit more than a teaspoon) should be applied to each leg, the chest, and the back (6.0ml x 4=24ml.)
Total = 31.5cc-the amount in a shot glass! This means a 3 oz. tube of block should be used by 3 adults in one day at the beach!
Note: To apply 2.5 ml to face and neck, one must apply a portion, wait a few moments for absorption, and then reapply the remaining amount! You must tell your patients how to apply sunscreen to achieve proper dosage and photo protection.
DCL or Medique sunscreen or any others we have.