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5/11/2023 Comments The right amount of skin care
Using the right amount of a skin care product is as important as picking the right product(s). If you don't apply enough of the product or for a too short duration, you will not get the optimal result. This is particularly crucial when using sunscreen to reach the sufficient SPF level and protection. According to a study published in the Journal of the American Academy of Dermatology by Andreas Storm MD et al. 95% of patients with a topical treatment under-dose, hence do not use enough cream.
If there is a specific user manual mentioning the dosage, or you got a prescription, follow their recommended instructions. If the product came without specific dosage instructions, there is a general rule of thumb. The recommended amount of product to apply varies, depending on the product type. THE 2 FINGERS RULE FOR SUNSCREEN For sunscreen you need 1/2 teaspoon for the face or enough to cover the bottom of a shot glass and a full shot glass for the body, which should add up to 2mg per cm2. Another method is using the "rule of nines, which is used for burns. The body areas are divided into 11 area's, each representing 9% of the total. Sunscreen can be applied to each of these areas at a dose of 2 mg/cm2 (regardless phototype) if two strips of sunscreen are squeezed out on to both the index and middle fingers from the palmar crease to the fingertips, thus 2 fingers. (1) The body areas are: 1 Head, neck, and face 2 Left arm 3 Right arm 4 Upper back 5 Lower back 6 Upper front torso 7 Lower front torso 8 Left upper leg and thigh 9 Right upper leg and thigh 10 Left lower leg and foot 11 Right lower leg and foot FINGERTIP UNITS For the use of other topical products there is a guidance created called Finger Tip Units or FTU's by CC Long and AY Finlay. It is a way of measuring the amount of product squeezed out of a tube with a 5mm diameter nozzle and applied from the distal skin-crease (the crease closed to the fingertip) to the tip of the index finger. The FTU concept has been used as a central part of an education programme for parents of children with atopic eczema, has been advocated to reduce the variation in usage of topical steroids and to encourage adherence to therapy. For a serum, you may need less as they are lightweight products which should be fully "absorbed" without residue. If the skin still feels sticky after 1 minute, you probably applied too much product. A guidance would be a pea size dot on forehead, right cheek, and left cheek, which is similar to the recommended amount of retinoids (Vitamin A). However, unlike Vitamin A, using too much serum usually isn't harmful for the skin, but increases the risk of "pilling". 
The precise number of FTU's required:
One FTU covers 286 cm2, more specifically in males and 312 cm2 in females 257 cm2. The quantity of cream in a fingertip unit varies: Adult male: 1 fingertip unit provides 0.5 g Adult female: 1 fingertip unit provides 0.4 g . Keep in mind this is a general guideline and the amount of product needed or results may vary also depending on skin type, concerns and the products particular attributes. Take care (in the right amount and duration) References: 1. BMJ. 2002 Jun 22; 324(7352): 1526.Simple dosage guide for suncreams will help users Steve Taylor et al. Illustration Tinea incognito with unjustified use of potent Topical Corticosteroids: a case series July 2017 International Journal of Basic & Clinical Pharmacology 6(8):2087 Haiya Sheth et al.
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Skin ageing is a biological degenerative process, marked by loss. The number of patients seeking nonsurgical rejuvenation of the face and the body is continuing to increase due to a growing ageing population concerned with physical appearance. Women wish to maintain a youthful appearance and attractiveness represent 92% of all cosmetic procedures.(1) Men are keen to maintain physical characteristics associated with virility.(2) Millennials are also increasingly concerned with preserving their beauty and youth.(3) Among the various treatment approaches, different minimally invasive techniques have been developed and dermal fillers currently come second after botulinum toxin type A (BTA).(3) Their use is increasing worldwide.
"The fear of looking done is the number 1 reason why patients don't seek treatment"* The range of fillers available for soft-tissue augmentation is constantly expanding. The latest advances in filler technology include bio-stimulators that exert their aesthetic effect by promoting predominantly collagenesis or biological stimulation of new collagen and sometimes also elastin production. Therewith they provide a biological answer to the skin ageing degeneration process, with gradual and often very natural results. Over the course of last years the knowledge on injectable bio-stimulators has grown, and therewith their safety and popularity as they provide subtle longer lasting results. Facial fillers can be broken into 3 main groups:
Bio-stimulating fillers promote the body’s natural production of some ECM components (mostly collagen) over a period of several months. Their differences are characterized by their property of inducing natural collagen production. SYNTHETIC BIOSTIMULATORS
Calcium Hydroxylapatite Calcium hydroxylapatite: Calcium hydroxylapatite is a type of mineral that is commonly found in human teeth and bones and in injectbales the calcium hydroxylapatite particles are suspended in a gel-like solution. The effects of this material last approximately 18 months with minimal inflammatory response. Radiesse is a biodegradable filler consisting of 30% synthetic CaHA microspheres (diameter of 25-45μm) suspended in a 70% aqueous carboxymethylcellulose gel carrier. The soluble carrier gel evenly distributes the Radiesse CaHA microspheres providing 1:1 correction and gradually dissipates leaving the microspheres at the injection site where they induce collagenesis (collagen type I and mostly collagen type III) by fibroblast activation. Animal studies have shown that this new collagen growth occurs as early as four weeks post-injection and continues for at least 12 months with an average duration of effect of 12 to 18 months, though some results have been noted 24 months post-injection. Radiesse provides both immediate (replacement volume) and long-lasting (collagen biostimulation) volume enhancement. (5) Poly-L-lactic acid PLLA is a biodegradable, bioresorbable biocompatible man-made polymer. This material has wide uses in absorbable stitches and bone screws. The effects of PLLA generally become increasingly apparent over time (over a period of several weeks) and its effects may last up to 2 years. There is an inflammatory response. PLLA is an alpha hydroxy acid polymer of the lactic acid L-enantiomeric structure that has been safely used in many applications and in medicine for more than 30 years. Its use has expanded worldwide, associated with good long-term aesthetic results thanks to its biostimulatory-collagen effect. PLLA-based fillers are supplied as a lyophilized powder to be reconstituted with sterile water. The collagen stimulatory properties were evidenced in human in subjects (n=14) who received PLLA injections (3 sessions, spaced 4 weeks apart) at the postauricular level by collagen histochemical determination on biopsies taken at different times. Increase of collagen type-I was shown at 3 and 6 months. This study opened the new class of collagen stimulators. The long duration of action was demonstrated in a first pivotal study comparing PLLA versus collagen (116/117 subjects, respectively); the long-term safety/efficacy was shown up to 25 months. The rationale for several sessions was first documented in a dedicated article; this modality allows the effect through collagen stimulation, a biological process to occur and avoids overcorrection. PLLA fillers are among the most clinically documented products. (6) Polymers, polycaprolactone The PCL-based collagen stimulator is composed of PCL microspheres suspended in a carboxymethyl-cellulose gel carrier providing immediate and sustained volumizing effects when injected; the morphology, the biocompatibility of the PCL microspheres embedded with the collagen fibers produced all contribute to the creation of a unique 3D scaffold for a sustained effect. Its safety has been investigated in clinical studies and vigilance surveys. It presents the advantage of a slower degradation than polylactic acid (PLLA) or polyglycolic acid (PGA), which both belong to the same chemical family. Both the S and M products induced collagen production. In animal, the M product induced collagen type-III and type-I at early stage (measure at 9 months), and later predominantly collagen type-I, that deposits around the PCL microspheres (measure at 21 months). Many fibroblasts were found near the PCL microspheres. Interestingly, new elastin fibers were also formed, and neovascularization with new capillaries observed as well. (7) NATURAL BIOSTIMULATORS 1. Platelet rich plasma 2. Platelet rich fibrin 3. Polynucleotides like Nucleofill or Nucleadyn 4. Exosomes Platelet-Rich Plasma (PRP): PRP treatments are produced by spinning a small volume of the patient’s own blood through a centrifuge. This separates and concentrates the blood’s components, including platelet-rich plasma and the “buffy coat,” a solution that contains immune cells. The provider combines these two components with a small amount of calcium chloride (which activates and keeps the PRP stable), then injects them into the treatment area. Over a period of months, PRP stimulates the body’s natural collagen production. Platelet-Rich Fibrin (PRF): PRF is produced using a process similar to PRP concentration. The active material is a fibrin matrix rich in platelets, stem cells, and immune cells. Like PRP, PRF treatment stimulates collagen production and is also implicated in tissue regeneration, though there’s less data on the durability of its effects. Because both treatments use material from the patient’s own body, so there’s no risk of rejection or similar complications. PRF and PRP effects are durable — typically lasting longer than 18 months. Polynucleotides: Polynucleotides are most often natural, highly purified DNA molecules extracted for example from trout gonads and activate specialised cells called myofibroblasts and adipocytes. PN containing devices act as short time temporary fillers thanks to the viscoelasticity of the long DNA fragments and improve skin well‐being (cell growth) and steady self‐repair (tissue regeneration). Read more Exosomes: The use of exosomes at the Aesthetic & Anti-Aging Medicine World Congress in Monaco was discussed during many session and some excellent results were presented. However their use is not yet approved and safety and long-term effect not yet established and largely depends on the source. Read more BOTULINUM TOXIN There is evidence that the neuromodulator or musclerelaxer Botinumtoxin after injection upregulated the expression of type I collagen, decreases the production of some MMPs in fibroblasts, preventing collagen degradation and improves collagen organisation. (8.9.) ENERGY BASED DEVICES Intense Pulsed Light/BroadBand Light, Radiofrequency Microneedling, lasers, High-Frequency Ultrasound, Electromagnetic Tec. stimulate collagen production via a controlled damage and repair mechanism. DERMO-COSMETICS WITH BIO-ACTIVES There are innovative dermo-cosmetic products containing bio-stimulating ingredients, working more superficial in comparison to in-office treatments and they therefor are potentially an excellent choice as adjunctive care for biological rejuvenation and revitalization for younger looking and acting skin. They are safe to use easy to apply over face, neck and décolletage. Unlike in-office treatments their effects are temporary (fully reversible as regulated), hence they require daily or twice daily application. Bio-stimulating active ingredients in skincare which have shown to particularly stimulate the fibroblast are for example:
VITAMIN C IS NEEDED FOR COLLAGEN SYNTHESES! Our skin needs Vitamin C to produce collagen and is not able to produce it, thus relies on external resources for supply. Therefore I highly recommend to either get enough Vitamin C from your diet or use a high quality topical product pre & post biostimulators. Read more As the biological degeneration takes place in different layers of the skin and it's underlying structures, combining in-office treatments specifically targeting those layers in a series of treatments may provide longer lasting results and give higher patient satisfaction.(13) Safety and outcome rely on the qualification and experience of your cosmetic doctor, dermatologist or plastic surgeon. Take care Special thanks MD FAAD Hassan Galadari Jair Mauricio Cerón Bohórquez M.D. References: 1. American Society Plastic Surgeons. 2020 national plastic surgery statistics; 2020. 2. Wat H, Wu DC, Goldman MP. Noninvasive body contouring: a male perspective. Dermatol Clin. 2018;36(1):49–55. 3. Wang JV, Akintilo L, Geronemus RG. Growth of cosmetic procedures in millennials: a 4.5-year clinical review. J Cosmet Dermatol. 2020;19(12):3210–3212. 4. Evaluation of the biostimulatory effects and the level of neocollagenesis of dermal fillers: a review. Haddad S, Galadari H, Patil A, Goldust M, Al Salam S, Guida S International Journal of Dermatology, 29 Apr 2022 5. J Clin Aesthet Dermatol. 2015 Jan; 8(1): 38–49. Calcium Hydroxylapatite Over a Decade of Clinical Experience Jani Van Loghem, MD, Yana Alexandrovna Yutskovskaya, MD,b and WM. Philip Werschler, MDc 6. Clin Cosmet Investig Dermatol. 2022; 15: 997–1019. Collagen Stimulators in Body Applications: A Review Focused on Poly-L-Lactic Acid (PLLA) Marie-Odile Christen Read more 7. Clin Cosmet Investig Dermatol. 2020; 13: 31–48. Polycaprolactone: How a Well-Known and Futuristic Polymer Has Become an Innovative Collagen-Stimulator in Esthetics Marie-Odile Christen and Franco Vercesi 8. Oh SH, Lee Y, Seo YJ, Lee JH, Yang JD, Chung HY, Cho BC. The potential effect of botulinum toxin type A on human dermal fibroblasts: an in vitro study. Dermatol Surg. 2012 Oct;38(10):1689-94. 9. El-Domyati M, Attia SK, El-Sawy AE, Moftah NH, Nasif GA, Medhat W, Marwan B. The use of Botulinum toxin-a injection for facial wrinkles: a histological and immunohistochemical evaluation. J Cosmet Dermatol. 2015 Jun;14(2):140-4 10 EADV 2022 Inhibition of extracellular matrix degrading enzymes and bio-stimulation of fibroblasts – A novel approach to mitigate the advanced degenerative process in skin aging Weise J, Vogelsang A, Sperling G, Welge V, Nölter A, Mielke H, Knott A, Harbig S, Stuhr A, Dunckel J, Warnke K, Geloven van A 11. EADV 2021 Multifaceted novel approach to increase skin’s own epidermal and dermal hyaluron content Bussmann T, Warnke K, Krüger A, Möller N, Harbig S, Stuhr A, Dunckel J, Geloven van A, Weise J | Beiersdorf AG, Hamburg, Germany 12. Photochemistry and Photobiology, 2005, 81: 581–587 Novel Aspects of Intrinsic and Extrinsic Aging of Human Skin: Beneficial Effects of Soy Extract Kirstin M. Su¨del et al 13. Combination Therapy in Midfacial Rejuvenation Humphrey et al. Dermatologic Surgery 42:p S83-S88, May 2016. *AMWC 2023 Tapan Patel 5/6/2023 Comments The impact of humidity on skin
Something I am asked quite regularly is if low humidity can dry out the skin. The answer is yes it can. However, it really depends on your skin. There are 4 skin types: normal, dry, combination and oily. According to the (AAD American Academy of Dermatology) sensitive skin is a skin type too, however some would say all skin is sensitive and I somewhat agree. Dehydrated skin is not a skin type, but a (temporary) condition. Your skin type is pretty much set for life and not changing with the seasons. There is an exception as normal, oily or combination skin may become dry(er) post-menopause. The environment, including temperatures and humidity impact our skin significantly.
Humidity Humidity is the amount of water vapor in the air. If there is a lot of water vapor in the air, the humidity will be high. A relative humidity of 70 percent means the air is at 70 percent of its water-holding capacity for the present temperature. Cold air cannot hold as much water vapor as warm air. Thus, as temperature falls, with no change in the amount of water in the air, the relative humidity rises. HIGH HUMIDITY A study showed that in a dry environment the skin hydration decreases but the amount of sebum increases to compensate for skin dryness. (1) High humidity can be beneficial if you have dry skin, however can cause problems if you have oily or combination skin. Low levels of humidity can negatively affect your skin, even when your skin is oily. In general high humidity levels has some benefits. Hydration The increased levels of moisture in the air in high humidity decrease trans-epidermal-water loss of water evaporation from the skin. Hence, your skin is able to maintain it's hydration levels. Increased cell regeneration A moisture-rich climate can also promote skin cell turnover and desquamation (the shedding of dead skin cells). Skin’s regeneration process is increased when your skin is well hydrated. The shedding of dead skin cells is the last step in this cell-turnover or regeneration process and good desquamation leads to smoother texture and more radiant skin. Well-ageing effects Fine lines and wrinkles are more noticeable if your skin lacks moisture and feels dry. Moreover, skin regeneration process declines as we age. Since high humidity positively contributes to hydration, lines and wrinkles are less pronounced and the regeneration process supported, therewith leading to more youthful looking skin. Increased sebum production If your skin is oily, high humidity (especially heat thus sweat) can increase sebum production. An overproduction of sebum, especially in combination or oily skin types can make your skin oily and greasy. Moreover, dirt and irritating particles may "stick" better to greasy skin. Acne prone skin Excess sebum and oil caused by high humidity (heat and sweat) increases the risk of clogged pores, break-outs and comedones (blackheads, and whiteheads). Heat or sweat rash Heat rash, or sometimes called prickly heat, sweat rash or miliaria, is a harmless but very itchy or prickling skin rash. It causes small red (raised) spots in places where sweat collects, such as the armpits, back, under the breasts, chest, groin, elbow creases and back of the knees, and the waist. Although uncomfortable, it is usually harmless and improves on its own after a few days. Tips to take care of your skin in humid conditions
LOW HUMIDITY Low levels of humidity most commonly negatively affect your skin. Decrease skin regeneration When your skin is not well hydrated, the skin's regeneration process including shedding of dead skin cells is impaired. This can lead to a more dull, rough or even flaky skin. Dehydrated skin Your skin can get dehydrated or deprived of moisture when exposed to low humidity levels and the skin looks less radiant or glowing. Sings of ageing When your skin lacks moisture, the skin is less plump and wrinkles, fine lines become more visible. Worsening of skin conditions If you have eczema or another problematic impaired barrier related skin condition, low humidity can cause flare-ups. It can also cause or worsen dry skin symptoms like redness, scaliness, rough texture, cracks, itchiness, stinging, burning and the skin might be more prone to irritation and infection. Tips to care care of your skin in low humidity
Take care References
Skin complaints related to visual display terminals (VDTs) such as smartphones, tablets, and computers are on the rise. Visually it's a rosacea-like dermatitis (erythema, oedema, papules or pustules), and can be accompanied by itch, pain and smarting (1). Some only have subjective symptoms and no visible skin problems.
It was thought that this skin condition might be caused by prolonged and repeated exposure to blue light emitted by electronic devices. The term "blue light" refers to the high-energy visible (HEV) light spectrum, which is present in the blue region of the visible light spectrum. As we are spending more and more time with or in front of screens from computers, tablets, or smartphones, there are increasing concerns about the harmful impact of blue light on skin. When referring to these light sources, we talk about artificial blue light. Dr Ludger Kolbe (Chief Scientist Photobiology) tested the radiation onto the skin emitted by different smartphones and tablets from various distances. Findings: the amount of blue light emitted during the conventional use of electronic devices is by far not enough to trigger harmful skin effects. If you sit in front of a monitor uninterrupted for a week at a distance from the screen of approximately 30 cm, this would be the same as the blue light intensity of spending one minute outside on a sunny day in Hamburg Germany at around midday at midsummer. If you hold a smartphone right next to the skin, the intensity does increase, but it would still take approximately 10 hours of uninterrupted use to match the effect on the skin of just one minute of sunlight as described. The emissions from electronic devices are barely noticeable in comparison to natural blue light directly from the sun and are, thus, negligible. The same does not apply for natural HEVIS, which does harm the skin. So is HEVIS from a screen is not causes screen dermatitis, what does? Overall, there is an overlap with skin complaints in buildings with ‘climate control’ problems (2), which may explain why screen dermatitis is relatively more common in atopic patients. The same authors found psychosocial conditions and high work-related stress to be indicators for developing VDT-related facial skin problems. Berg et al. (3) found that these patients frequently have sensitive skin: they are so-called ‘stingers’, reacting with stinging or itching when lactic acid (5%) (LAST-test or Lactic Acid Sting Test). In a large literature study, screen dermatitis was found to show many similarities with skin damaged by UV light or ionizing radiation (4). Ionizing radiation consisting of particles, rays with sufficient energy to cause ionization in the medium through which it passes. Examples are heat or light from the sun, microwaves from an oven, X rays from an X-ray tube and gamma rays from radioactive elements. In this large literature study, not only clinical but also immuno-histological manifestations were evaluated. Most striking was the increased number of mast cells in screen dermatitis, containing histamine. The latter is known to be released when mast cells are exposed to UV light and may be responsible for symptoms of itch, pain, oedema and erythema in screen dermatitis. Furthermore, Langerhans' cells in the epidermis were significantly decreased or virtually absent in screen dermatitis as well as in skin damaged by UV light or ionizing radiation. On the other hand, levels of some neuropeptides were determined, and although several differences were found with normal skin, no single marker was 100% able to distinguish between healthy skin and screen dermatitis (1). It is unclear whether VDTs leak electric or magnetic fields that affect our cells (4). In keeping with these findings are the conclusions of a case-referent study, stating that screen dermatitis most likely is the result of non-specific or irritant factors in subjects with sensitive skin (2). In conclusion: It is highly recommended to use SPF and protect the skin from natural HEVIS (with for example product containing Licochalcone A). However protection against artificial blue light won't likely prevent or improve screen dermatitis symptoms. Always consult your dermatologist for a proper diagnose and treatment. Take care. References:
It is widely known that skin´s own hyaluron is a precious molecule keeping our skin hydrated as it is a powerful humectant (attracting and binding water), hence giving the skin a natural plumpness and bounce. What many don´t know is that skin´s own hyaluronic acid content needs to be replenished continuously, as it´s half-life is only several hours up to one day 1. It´s degradation is fastened by 2 different pathways: an external influence via free radical activity or physical degradation and an internal pathway via enzymatic or biological degradation by a family of enzymes called hyaluronidase or abbreviated HYAL.
There are 6 different ones identified and HYAL 1 is the most active one. HYAL 1 “cuts” large size hyaluron molecules (the most capable of binding water) into smaller molecules, which are eliminated even faster. One of the strategies to maintain skin´s own hyaluron content is to inhibit the HYAL enzymes, especially HYAL1. Comparing photo-exposed skin to photoprotected skin showed significant increase in the expression of L-HA (low molecular weight HA) which are smaller or broken hyaluronic acid molecules. An increase of degradated hyaluron was associated with a significant expression of HYAL-1 (2)..UV, ROS or free radical activity leads to the activation of hyaluronidase (3,4). You may now wonder how it is possible that hyaluron filler injections can have a lasting effect of several months or even longer than a year. This is because in those injectable gels the hyaluron molecules are stabilized to protect them from the impact of free radicals and HYAL enzymes. Often this is done with chemical crosslinks (BDDE). Manufacturers of those hyaluron injectable gels use different stabilizing or crosslink technologies and different number of crosslinks, which impacts the gels consistency and longevity. They aren´t completely resistant to hyaluronidase, as it can be used to dissolve injected hyaluron. As hyaluron is anyway depleted and replenished every day, this dissolving procedure hardly affects skin´s own hyaluronic acid content. This is a common misconception. 
In skin care however, the use of crosslinked hyaluron (hence lasting for months or longer) does not make a lot of sense as we usually cleanse our skin twice daily and thus wash it away. It is too large to penetrate. There are some benefits for crosslinked hyaluron, but it does not impact the longevity of skin´s own hyaluronic acid content. One ingredient derived from the roots of Chinese Licorice plant called Enoxolone (also known as Glycyrrhetinic acid) however, has proven to decrease the HYAL1 activity by 54% (in vitro) (5.6). This is a novel and safe topical way to protect skin´s own hyaluronic acid content from fast degradation and elimination.
However, as mentioned before free radicals increase HYAL1 activity and as we age our skin becomes less resilient against accumulated oxidative stress. Therefore, the most optimal approach to inhibit increasing break down of hyaluronic acid is to combine HYAL1 inhibition with powerful anti-oxidants. In the illustration, which I created professionally, it is Saponin. Saponin is next to a powerful anti-oxidant, also a potent bio-stimulator of the fibroblast for hyaluron (+256%) and collagen (+49%) (6). Furthermore, Enoxolone stimulates melanin production, supports the skin's own repair mechanism against UV-induced DNA damage and inhibits enzymatic elastin degradation. What a power-couple to have in dermo-cosmetic products to manage the biological degenerative process of ageing skin. Take care 1. HA: a key molecule in skin aging E. Papakonstantinou 2. Dermatoendocrinol. 2012 Jul 1; 4(3): 253–258. doi: 10.4161/derm.21923 Hyaluronic acid: A key molecule in skin aging Eleni Papakonstantinou, 1 Michael Roth, 2 and George Karakiulakis 1 3. BMC Complementary and Alternative Medicine December 2013, 13:304| In vitro determination of the anti-aging potential of four southern African medicinal plants Authors Gugulethu NdlovuEmail, Gerda Fouche, Malefa Tselanyane, Werner Cordier, Vanessa Steenkamp 4. Bioorg Chem. 2018 Apr;77:159-167. doi: 10.1016/j.bioorg.2017.12.030. Epub 2018 Jan 4. In-vitro evaluation of antioxidant, anti-elastase, anti-collagenase, anti-hyaluronidase activities of safranal and determination of its sun protection factor in skin photoaging. Madan K1, Nanda S2. 5. EADV Poster 2021 A holistic hyaluron-centric anti-aging concept to improve static and dynamic wrinkles Geloven van A, Harbig S, Stuhr A, Dunckel J, Kuhn A, Dippe R, Warnke K, Beiersdorf AG, Hamburg, Germany 6. EADV Poster 2021 Multifaceted novel approach to increase skin’s own epidermal & dermal hyaluron content Bussmann T, Warnke K, Krüger A, Möller N, Harbig S, Stuhr A, Dunckel J, Geloven van A, Weise J, Beiersdorf AG, Hamburg, Germany 7. Hong et al. Glycyrrhetinic Acid: A Novel Modulator of Human Skin Pigmentation and DNA-Repair September 2009Journal of Investigative Dermatology Conference: 39th Annual European-Society-for-Dermatological-Research Volume: 129 
We all know the fairy tail sleeping beauty, however there is actual scientific evidence supporting that good sleep does make you more attractive. Chronic poor sleep quality is associated with increased signs of intrinsic ageing, diminished skin barrier function, lower satisfaction with appearance (1). A variety of studies in the literature have shown that sleep plays a role in restoring immune system function and that changes in the immune response may affect collagen production. (2) Before going into the science supporting that sleep makes you more beautiful, some tips for better sleep and less wrinkles:
A study was conducted with 60 healthy caucasian women, who were categorised as poor quality sleepers [Pittsburg Sleep Quality Index (PSQI) > 5, sleep duration ≤ 5 h] or good quality sleepers (PSQI ≤ 5, sleep duration 7-9 h. Good sleepers had significantly lower intrinsic skin ageing scores by SCINEXA(TM) . At baseline, poor sleepers had significantly higher levels of TEWL (trans-epidermal water loss). At 72 h after tape stripping, good sleepers had 30% greater barrier recovery compared with poor sleepers. At 24 h after exposure to ultraviolet light, good sleepers had significantly better recovery from erythema (redness). Good sleepers also reported a significantly better perception of their appearance and physical attractiveness compared with poor sleepers. (1) Sleep loss could also impact sexual behaviour and collaboration, because sleep is connected with attractiveness, which has an important impact in many social contexts (2). The notion of beauty sleep is actually very important, because sleep deprived people are perceived as more fatigued, less attractive, and even less healthy than when they are rested (3). Sleep deprivation is associated with increased signs of intrinsic skin ageing (fine lines, uneven pigmentation, reduced elasticity) (4), with much slower recovery rates after skin barrier disruption and lower satisfaction with appearance. If we compare people with a normal night sleep with the same persons but sleep deprived, the sleep deprived ones look more fatigued, with hanging eyelids, redder eyes, more swollen eyes, darker circles under the eyes, paler skin, more wrinkles and fine lines around the eyes, the corners of the mouth as being more droopy and more sad (5). In conclusion, the sleep is not connected only with good health (6,7), but is also a link between attractiveness and health. (2,8) Take care and sleep well
Reading the instructions on cleansing and care products can be misleading. When do I pat my skin dry first or when do I apply the product on damp skin? Even many recommendations from skin care guru's or skinfluencers are not completely correct.
In general it is recommended to apply a serum, eye care or moisturising / hydrating care product on damp skin, or immediately after bathing for the following reasons: Increased Absorption The primary benefit of applying skin care products to damp skin is that the skin is more receptive to the ingredients. Water helps to increase the hydration levels of the skin cells, which then improves the absorption of the skincare products. When the skin is damp, the skin's surface is more permeable, allowing the ingredients in the skin care products to penetrate deeper into the skin, and work their magic. Absorbing the ingredients more effectively, this leads to better results. The exception are products which require a very low pH level to penetrate, and be more effective, for example L-Ascorbic Acid (Vitamin C) and chemical exfoliating "acids" like hydroxy acids. The reason is that water has a pH level of 7-8, acidic formulations will be "neutralised" on damp skin. Better hydration Applying skin care products to damp skin helps to lock in moisture, leaving your skin feeling soft, supple, and hydrated. Hydration is critical for the skin because it helps to maintain and restore the skin's barrier function. The skin barrier protects the skin from losing hydration and prevents irritants and bacteria from entering. Applying serums and moisturisers on damp skin, increases the hydration benefits from the products. Improved spreadability Another advantage of applying skincare on damp skin is that it helps to improve the spreadability of the product. When we apply products such as serum or moisturiser to dry skin, they tend to settle in one area and can be challenging to spread evenly. On the other hand, when applied to damp skin, the skin care products can spread easily and evenly across the skin surface, ensuring maximum coverage and benefit. The exception are lipid rich products which are hydrophobe (water repelling), for example ointments, they might not spread evenly or easy on damp skin. Enhanced performance Applying skin care products to damp skin has been shown to improve their performance. This is because when products are applied to damp skin, they are less likely to evaporate, and the ingredients remain active for longer. This increased contact time with the skin leads to better, more effective results. The exception are products containing vitamin A, retinoids, tretinoin, retinal, retinol, retinaldehyde as damp skin increases the risk of irritation. Sensitive and hyper-sensitive skin Usually people with sensitive and hyper-sensitive skin have an impaired skin barrier function, hence ingredients will penetrate better in comparison to a resilient and well-functioning skin barrier. Applying products on (hyper)sensitive skin will therefore increase the risk of irritations. Be mindful which ingredients you use and use a pH rebalancing toner after cleansing and prior to any serum or care product you use. A toner is anyway an affordable product, which I highly recommend to use in every skin care routine. Read more. Study results on patients with dry skin and healthy volunteers In healthy subjects, compared to at control sites, the Stratum Corneum Water Content (SCW) was significantly higher at sites treated with the moisturizer immediately after bathing, with 1.0 and 2.0 mg/cm2 of the moisturizer, and with once- and twice-daily applications. In patients with dry skin, the SCW was significantly higher compared to control sites after 8 weeks when the moisturizer was applied twice daily. Read more. Take care. 4/30/2023 Comments Skip-care skin care routine
Skip-care is a skincare trend that has taken the beauty world by storm for a while now. It is a Korean beauty inspired technique that focuses on simplifying your skin care routine by skipping steps and using multi-purpose products. This skin minimalistic approach will save time, money and reduces the risk of skin irritation caused by the overuse of certain products or combinations.
Skip-care is rooted in the Korean beauty philosophy of ‘less is more’. The skincare industry in South Korea is one of the most innovative and advanced in the world, and they have been leading the way when it comes to skincare trends. The Korean beauty industry is famous for their 10-step skincare routine, which is aimed at improving overall skin health and beauty. However, this long and high-maintenance routine is not for everyone, and this is where skip-care comes in as an alternative approach. It aims to simplify the routine and accessible to people who do not have the time or resources to devote to a lengthy skincare routine. Skip-care steps:
If you want to go very minimal, you could combine cleanse and tone by using an all-in-one toning cleanser, skip the "treat" step and your skip-care routine is reduced to 2 steps only. Con's:
A benefit on top of saving time, money and reducing the risk of irritation is that by simplifying and streamlining your routine, you probably increase compliance. The best skin care routine is still the one you actually adhere to. Take care 4/30/2023 Comments All you need to know about baby skin
Baby skin is different from adult skin: more sensitive and less resilient. It is important to understand the differences, as it influences how to care for baby skin.
At birth, baby skin undergoes a dramatic change from an aqueous (in the womb) to a dry environment. Baby skin, hair, and fingernails all start to form during the first trimester of pregnancy and continue to develop.
RECOMMENDATIONS FOR BABY SKIN CARE 1. Avoid Fragrance and Other Irritants Fragrances and other irritants can exacerbate skin conditions in babies, such as eczema. Avoid products that contain fragrances, sulfates, and other ingredients that may cause irritation. 2. Use Gentle Cleansers When bathing your baby, use mild, soap-free cleansers that are specifically formulated for baby skin. Avoid using harsh soaps or chemicals that can strip the skin of natural oils. 3. Avoid Over-Bathing While it may be tempting to give your baby frequent baths, it is important to avoid over-bathing. Bathing too frequently can dry out the skin and cause irritation. Aim to bathe your baby no more than every other day, or as recommended by your pediatrician. 4. Moisturise Regularly To help maintain the skin’s natural moisture barrier, apply a gentle, fragrance-free moisturizer to your baby’s skin after bathing. Look for products that are specifically formulated for baby skin, and avoid those that contain ingredients that may cause irritation. 5. Be Sun-Safe Frequent sunburns and exposure to sunlight in childhood are strongly related to melanoma development; therefore, appropriate measures of photoprotection have been considered to decrease the risk of melanoma and nonmelanoma skin cancer. Since baby skin is more susceptible to damage from UV radiation, it is important to protect your baby from the sun. Use a broad-spectrum sunscreen, that is specifically formulated for babies, compliment this with a hat and special UV protective clothes if needed and avoid exposing your baby to direct sunlight during peak hours. 6. Prevent Diaper Rash Protect babies bum 24/7 from a nasty diaper rash. A safe and affordable product known to prevent, soothes and treats diaper rash is Aquaphor, There are special baby formulations available which can also include ingredients like zinc oxide and pathenol and off course are fragrance fee. In case of doubts or concerns don't hesitate to consult your pediatrician or pediatric dermatologist. Take care. 
It was always believed that the moment we are born, is the moment we are exposed to environmental influences. The truth is that there is ample evidence that already during pregnancy the mothers behaviour: smoking or food has a significant impact on how well we age. We know that all skin needs to be protected against UV and HEVIS by using sunscreen, especially in sun exposed areas from birth onwards.
Although you can not start too early taking care of your skin, the right age to start with a well-ageing skin care routine is actually just post-adolescence for 3 reasons. 1. During adolescence most start with their first cleansing and care routines to remove access of sebum, debris and reduce plus prevent break-outs or comedones. Boys may already shave facial hair. So teenagers or young adults are used to a morning- and evening skin care routine which benefits the overall sense of well-being. 2. Most commonly growth stops when puberty ends and this is the moment the degenerative biological process starts, even though there are no visible signs yet. 3. Prevention of pre-mature ageing skin is the most effective and efficient strategy. SKIN NEEDS CARE There is a movement stating that normal unproblematic skin doesn't need care. I strongly disagree. The choice of products at this age depends of course on the skin type, skin condition, skin health, and environment (like weather conditions, pollution), however the morning care should always focus on protecting every skin type, using suncreen (UV + HEVIS protection) and ideally complimented by anti-oxidants to reduce damaging free radical activity, while the evening routine should at least include proper cleansing (to remove dirt and pollutants), which may be followed by product catering to specific needs, like for example sebum regulating, barrier repairing or hydrating ingredients. I would not make a differentiation between darker or lighter skin in terms of photoprotection, as dark skin only has a natural SPF of 13.3 and light skin of 3.4, hence both not enough to prevent sun damage. However, dark skin has a lower amount of ceramides in the statum corneum and is therefore more prone to trans-epidermal water loss. LAZY SKIN? If you are afraid of spoiling your skin and making it "lazy" using skin care for a long time, know that all effects from a dermo-cosmetic product are 100% reversible, thus temporary. This is regulated by law and to enjoy the benefits from skin care, you need to keep using the products. When you stop, your skin will bounce back to it's original state at least after a full regeneration cycle of about 28 days. A few things to avoid are: sun-damage, especially burns, over-exfoliation (damaged skin barrier) and slugging of oily or acne-prone skin (breakouts). Take care. 
Polynucleotides (PNs) are a type of biomolecule that have recently gained traction in the field of skin care and aesthetic treatments. PNs are composed of multiple nucleotides, which are the building blocks of DNA and RNA. These biomolecules have shown promise in improving the appearance and health of the skin through their ability to stimulate cell growth (activate growth factors), tissue regeneration incl. collagen production, wound healing, fibroblast proliferation and have anti-inflammatory properties.
Polynucleotides (PN) are linear polymers composed of many nucleotide units and they play a key role in the storage and transmission of genetic information. There are two types of polynucleotides (aka nucleic acid) found in nature: ribonucleic acid (RNA) and deoxyribonucleic acid (DNA). As mentioned, PN are composed of nucleotides, which consist of 3 parts: a nitrogenous base, a phosphate group. and a five-carbon sugar (2'-deoxyribose in DNA or ribose in RNA). The five base nucleotides are adenine, guanine, cytosine, thymine, and uracil. A DNA molecule consists of two long polynucleotide chains composed of four types of nucleotide subunits: adenine, thymine, guanine, and cytosine, while RNA uses adenine, guanine, cytosine and uracil. REGENERATIVE AESTHETICS Regenerative aesthetics is an emerging branch of regenerative medicine with therapies or products aimed at recapturing youthful structure and function using the body's own systems. Examples of such treatments are platelet-rich plasma (PRP), the use of exosomes or polynucleotides. Dr. Kate Goldie explained soft tissue regeneration fundamentals as following: 1. Regeneration of tissue architecture (structure): tissue composition - component abundance, ratio's, position, density and biomechanics/integrity 2. Regeneration of tissue function: signaling, cell function, cellular components (incl. senescence), gene expression and molecular interaction. The 3 treatment pillars of regenerative aesthetics are: cells, biocues and bio-stimulatory scaffolds. Key superficial soft quiescent cells are the fibroblasts and adipose derived stem cells. One of the big advantages of regenerative aesthetics is by using the body's own system, the results are natural and focused on "skin health" (function) and "skin quality" (appearance). POLYNUCLEOTIDES IN REGENERATIVE AESTHETICS Polynucleotides are most often natural, highly purified DNA molecules extracted for example from trout gonads and activate specialised cells called myofibroblasts and adipocytes. PN containing devices act as short time temporary fillers thanks to the viscoelasticity of the long DNA fragments and improve skin well‐being (cell growth) and steady self‐repair (tissue regeneration). Studies support their dermal reactivating properties or their efficacy as “bioreactivating primers” of skin. The final outcome is more natural and in‐depth tissue regeneration and a healthier look of the skin: a more radiant complexion, even skin tone, reduced appearance of fine lines, wrinkles and sagging, faster wound healing, improved pore size and skin thickness, elasticity and hydration. Furthermore, PNs are generally well-tolerated by the skin and have a low risk of adverse effects. Their effectiveness may vary depending on the individual's skin type, age, and overall health. The long-term effects of PNs on the skin are not yet fully understood, and more research is needed to determine their safety and efficacy. There are various brands available which use polynucleotides in their (meso-) injection gels. For example Mastelli Srl, Italy NEWEST® (Polynucleotide and Hyaluronic Acid) for bio-revitalization, BR Pharm HP Cell Vitaran Skin Healers, NUCLEADYN® or Nucleofill®. One brand of (synthetic) polynucleotide-based skin care products is Yuva by Dr. Devgan Scientific Beauty. The Yuva line includes a range of products formulated with PNs, such as the Yuva Serum and the Yuva Enhancer. These products are marketed as being able to provide hydrating, anti-aging, and skin-rejuvenating benefits. THE FUTURE OF POLYNUCLEOTIDES While polynucleotides have many benefits, they also have some drawbacks. One of the primary limitations is their instability in certain environments. This instability can make it difficult to synthesize and manipulate polynucleotides in the lab. Moreover their are limitations, risks and ethical concerns harvesting or using (human identical) PN's, and long-term safety and efficacy data is not conclusive. However, PNs are a promising area of research in the field of skin care and aesthetic treatments and regeneration. We can expect to see further advancements in the development of PNs-based products and treatments. PNs are already used in combination with other biomolecules, such as hyaluronic acid, growth factors and anti-oxidants and used in combination with other treatments. For a personal recommendation on which aesthetic treatment is most suitable to aesthetically regenerate your skin, please consult an experienced board certified dermatologist, plastic surgeon or cosmetic doctor. Take care. 4/23/2023 Comments Mood boosting skin care
Mood-boosting skin care can be defined as a skin care routine that includes products and/or tools and techniques which (may be specifically designed) enhance our mood and mental well-being in addition to improving the overall health and appearance of the skin. Research has shown that skin care is becoming more than just a physical experience, but also a therapeutic and emotional one. The role of mood-boosting skin care in providing self-care and supporting mental well-being has become increasingly important and has profound benefits. ESSENTIAL OILS These mood boosting routines typically incorporate products that have essential oils that help to relax, uplift, and calm the mind, which in turn, affects an individual's mood positively. However, I am not a big fan of incorporating essential oils in a skin care routine as they can be irritating, cause skin sensitivity, redness and breakouts. Irritation and redness can be signs of sub-clinical inflammation and speed up the biological degenerative process called skin ageing or skin inflammageing. It is not a surprise that dermatologists warn against the use of most essential oils on the skin. When it comes to essential oils, it is best to use them in a diffuser and not skin care. Facial oils can be beneficial however in a skin care routine. Click here to read more about the use of facial oils. A SPA "ME" MOMENT The ancient Greeks were the first to suggest that spas and bathing could be used for therapeutic purposes and not just for hygiene and cleanliness (which are basic requirements for good skin health). A warm relaxing bath isn't always good for skin health however (1). On the other side a 20-30 second cold shower after a workout or sauna encourages the release of cold shock proteins. Cold shock proteins may help you maintain your muscle mass when you're too busy to make it to the gym or when you're taking some planned time off your training routine. Some cold shock proteins are known to decrease inflammation and support faster wound healing. Cold water immersion also activates brown fat, tissue that helps keep the body warm and helps it control blood sugar and insulin levels. It helps the body to burn calories, hence to lose weight. Click here to read more. A SPA BONDING MOMENT As time is precious, meaningful time together with friends, your partner or your kids, can boost your sense of satisfaction and strengthen bonds. Funny anecdote was that I was "masking" with my son, who was at the time 12 years old. While relaxing he asked me what his mask was actually doing and I told him that it makes you look younger. He immediately asked me to remove it, scared he would look afterwards like 7 years old. 
JADE ROLLERS & GUA SHA
I love using (refrigerated) jade rollers and gua sha, especially in the under eye area in the morning to reduce puffiness, increase the circulation and lymph drainage. It is important that the tools glide over the skin, don't tug and thus I apply a nourishing care product first. Moreover, applying skin care products using mindful techniques such as massaging in gentle circular motions can be therapeutic, providing a sense of calm and relaxation. SKIN CARE ROUTINES Mindful evening skin care routines have been shown to be particularly beneficial in unwinding after an overwhelming day, helping to reduce stress and induce better sleep. As it turns out, consistent routines provide more stability in your day, which is beneficial for your mental health and stress level regulation. Therewith every morning- and evening skin care routine is mood-boosting. DO GOOD, FEEL BETTER If you treat your self and your skin good, it will make your skin look better and even improve your quality of life. Self-care enhances feelings of self-worth, boost self-esteem and can even give a sense of accomplishment, is thus mood boosting, even without the use of aroma therapy or essential oils. Take care 
Glycation is one of the basic root causes of endogeneous (intrinsic) skin ageing and a very challenging one or almost impossible one to reverse. Glycation is an ageing reaction which begins in early life, developing clinical symptoms at around 30, and progressively accumulates in tissues and skin due to the glycated collagens that are difficult to be decomposed. Glycation occurs naturally in the body when sugars react with proteins and lipids to form advanced glycation end products (AGEs). AGEs can be exogenously ingested (through food consumption), inhaled via tobacco or endogenously produced and formed both intracellularly and extracellularly. AGE modifications lead to dermal stiffening, diminished contractile capacity of dermal fibroblasts, lack of elasticity in the connective tissues, contribute to hyperpigmentation and a yellowish skin appearance. The formation of AGEs is amplified through exogenous factors, e.g., ultraviolet radiation.
AGEs cause changes in the skin through 3 processes:
One study published in the Journal of Investigative Dermatology found that levels of AGEs were higher in the skin of older individuals compared to younger ones. The study also showed that there was a correlation between the level of AGEs and the severity of skin ageing. This suggests that inhibiting the production or accumulation of AGEs in the skin is a potential target for anti-ageing interventions or skin ageing management. AGEs are complex and heterogeneous, more than a dozen AGEs have been detected (however not all) in tissues and can be divided into three categories according to their biochemical properties. AGEs are formed through four pathways:
GLYCATION INHIBITION IS KEY AGEs can be crosslinked through side chains to form a substance of very high molecular weight, which is not easily degraded. The consequences from skin glycation are irreversible. This makes prevention or inhibition of the process the best potential strategy to maintain skin health and ageing skin management. One way to do this is by altering the diet to reduce the intake of sugars and carbohydrates, which are known to contribute to glycation. Several studies have found that reducing sugar intake can result in significant improvements in skin health, including reducing wrinkles and improving skin texture. 
AGE inhibitors
Another potential strategy is the use of topical agents that inhibit the formation or accumulation of AGEs in the skin. One study published in the Journal of Cosmetic Science found that a cream containing carnosine, a peptide that inhibits glycation, improved skin elasticity and reduced the appearance of wrinkles in individuals with ageing skin. Skincare containing NAHP or Acetyl Hydroxyproline inhibits the formation of AGEs significantly (in vitro), most likely through a mechanism where NAHP competes with the proteins for the sugar. Finally, NAHP sacrifices itself in place of the proteins and gets (at least partially) glycated. NAHP also prevents loss of cellular contractile forces in a glycated in vitro dermis model and counteracts the diminished cell-matrix interaction that is caused by glyoxal-induced AGE formation. Anti-Oxidants Moreover, I would suggest to combine those ingredients with an ingredient like Licochalcone A. Numerous high ranked publications support that Licochalcone A protects cells from oxidative stress mediated by e.g. UV and HEVIS (blue light) induced reactive oxidative species (ROS). Due to the activation and nuclear translocation of the transcription factor NrF2, the expression of anti-inflammatory, antioxidant and detoxifying enzymes are induced. These enzymes protect the skin cells (like keratinocytes and fibroblasts) from ROS-induced damage, like lipid peroxidation and DNA as well as protein damage. If Licochalcone A is combined with L-Ascorbic Acid, (the most active form of Vitamin C), it supporting skin's own collagen production, provides superior biological cell protection amongst other relevant benefits. My absolute favourite product is Eucerin Hyaluron-Filler Vitamin C Booster which I use daily as a serum in my morning routine. GLYCATION AND SKIN HEALTH Acne In addition to its role in ageing, glycation in the skin has also been linked to a range of skin health problems. One study published in the Journal of Cosmetic Dermatology found that the level of AGEs in the skin was significantly higher in individuals with acne than in those without acne. The study also showed that treating acne with a topical antibiotic significantly reduced the levels of AGEs in the skin. Atopic Dermatitis Another study published in the Journal of Investigative Dermatology found that individuals with atopic dermatitis had higher levels of AGEs in their skin than healthy individuals. This suggests that glycation may play a role in the development of inflammatory skin conditions. Diabetes + Woundhealing The correlation between high sugar levels and skin ageing can be seen in diabetic patients, where one-third of this population has skin complications. A prominent feature of ageing human skin is the fragmentation of collagen fibers, which severely damages the structural integrity and mechanical properties of the skin. Elevated levels of MMP-1 and MMP-2 and higher crosslinked collagen in the dermis of diabetic skin lead to the accumulation of fragmented and crosslinked collagen, thereby impairing the structural integrity and mechanical properties of dermal collagen in diabetes. Collagen crosslinking makes it impossible for them to easily repair, resulting in reduced skin elasticity and wrinkles. Keratinocytes and fibroblasts are the main cells involved in wound healing, but due to the high glucose (HG) microenvironment in diabetics, the functional state of these cells is impaired, thereby accelerating cellular senescence (programmed cell death). Conclusion We can't completely stop the glycation process, therefore it's important that we inhibit it from a young age onwards, hence monitor the sugar intake of our children, use daily SPF and invest in good dermo-cosmetic products containing ingredients like NAHP and powerful anti-oxidants like L-Ascorbid Acid (Vitamin C is needed for the production of collagen) and Licochalcone A (also anti-inflammatory). Preventing signs of ageing, specifically caused by glycation is most effective. If your skin shows (advanced) signs of ageing, you can get visible improvement using skin component (hyaluron, collagen and elastin) bio-stimulating ingredients like Retinol, Bakuchiol, Arctiin, Creatine or Glycine Saponin. Consult your dermatologist if you wish to improve your skin's appearance or skin health issues. Take care Special thanks: Ph.D. dr Julia M. Weise Manager Biological Testing & Dorothea Schweiger Lab Manager Facial Skin Biology Beiersdorf HQ Hamburg 3/21/2023 Comments Exosomes in skin care and treatments
Skin boosters using micro-injections with predominantly non-crosslinked hyaluron filler gels like Restylane® Vital, Juvéderm® VOLITE or Belotero® Revive are gaining popularity for very good reasons. Unlike traditional dermal fillers, they are not injected beneath the skin to volumise or shape the face. Instead, they are very fine dermal easily integrated "fillers" that are injected into the skin to hydrate, improve skin quality and give very natural results. They are also gently bio-stimulating, meaning they "stretch" the fibroblasts in the injected area and as a result this cell is producing more collagen. An effective bio-remodeling skin booster using 2 times 5 injection points (bio-aesthetic points - BAP) for a full-face treatment is Profhilo®. However, the recent K-beauty treatment via topical application or micro-injections with bio-remodeling exosomes is gaining popularity.
Exosomes are nano-sized cargos with a lipid bilayer structure carrying diverse biomolecules including lipids, proteins, and nucleic acids. These small extra cellular vesicles are secreted by most types of cells (skin relevant are the keratinocytes and fibroblasts) to communicate with each other. Exosomes circulate through bodily fluids and can transfer information. They can be either good or bad, however taken from a healthy young cell they will be sending the best messages. Studies have shown the efficacy of exosomes in skin ageing. They can facilitate skin remodeling (increasing collagen and decreasing senescent cells) leading to skin rejuvenation. Cells sleep because they don't get enough bio-stimulation: messages. Better messages is better skin architecture. This is why exosomes are so important. At the World Stem Cell Summit it used to be 90% about stem cells (they only life 28 days) and 10% about exosomes, now it is 50/50. The reason is called heterochronic parabiosis. 1. One of the most robust methods of improving the function of ageing tissues is that of heterochronic parabiosis,. The effect was shown in a study with a surgical procedure whereby a young and old mouse are joined together so the share one circulatory system. 2 This study according to dr Kate Goldie AMWC 2023 Monaco is proof that it is not the cells, but the messages they give that is transforming lots of different tissues, which has the ability to profoundly regenerate tissues. That is why people are so interested in exosomes. Exosomes taken from a very young cell give potentially the best messages as they "send the message" of youth. EV (Extra-cellular Vesicle) is the actual correct term as messages come as micro-vesicles and exosomes and form 2 different messages from the cell. 3 We start to understand active ingredients. In exosomes one of the most important ingredients is RNA and is part of the future of regenerative aesthetics. Messenger RNAs up-regulate and Micro-RNAs down-regulate. They physically go into the cell and change how the cells works. So we have to be cautious. In this study "The therapeutic and commercial landscape of stem cell vesicles in regenerative dermatology" dr Kate Goldie et al. assessed all available exosomes in the (UK) market. Most exosomes used in-office are extracted from human stem cells and frozen to keep them as stable. Unlike actual stem cells, exosomes don't have a nucleus and therefore they are safe to use. Exosome therapy is the application of topical exosomes after in-office treatments which disrupt the skin barrier, like laser resurfacing, chemical peelings or microneedling. Exosomes are also used in micro-injections as a stand-alone skin boosting treatment and in a few skin care products. Be aware that as usual, not all products are alike. The way exosomes are sourced (origin), size, their content (can be growth factors) and function determine largely their efficacy and the price of the product. One of the challenges is that we do not really know what is in the exosomes. They are like small packages with a lot of messengers. The use of exosomes looks promising for several indications: regenerative aesthetic medicine, healing, scar treatment, burns and atopic dermatitis, however their safety is not yet fully established and no official registration for their use granted. Take care 1. Cell Cycle. 2012 Jun 15; 11(12): 2260–2267. Heterochronic parabiosis for the study of the effects of aging on stem cells and their niches Irina M. Conboy 2. Heterochronic parabiosis reprograms the mouse brain transcriptome by shifting aging signatures in multiple cell types Methodios Ximerakis 3. J Cell Biol. 2013 Feb 18; 200(4): 373–383. Extracellular vesicles: Exosomes, microvesicles, and friends Graça Raposo et al 3/19/2023 Comments Skin Flooding
Skin flooding is the latest TikTok trend to counteract dry or dehydrated skin. It is basically layering hydrating mists, serums or creams to boost hydration in the skin. The idea is to start with a humectant-rich, lightweight products first and then add a thicker emollient to seal in the moisture on the skin. This is a trend which is suitable for all genders at all ages if products are chosen wisely.
DRY OR DEHYDRATED SKIN There is a difference between dry and dehydrated skin. Dehydrated skin is water-lacking skin, considered a skin condition and can be temporary, while dry skin is lipid-lacking skin and seen as a skin-type. All skin types (yes including oily skin) can be dehydrated. Picture yourself in an environment like airplane without any humidity. Our skin will react to this "dehydration condition" by either (over)production of oils and lipids to "protect" itself fro drying out or get very dehydrated. When the skin is producing a fierce amount of oils and lipids as compensation, you do not have lipid-lacking or dry skin, however your skin might be dehydrated. Lipid-lacking or dry skin has less ability to produce those oils or lipids and often has an impaired skin barrier. Lipids are the "mortar" between the bricks and when they are lacking, more water will evaporate from the skin and thus it loses hydration. FLOODING Therefore "flooding" without "suffocating" the skin, can be a good approach for dehydrated skin and all skin types at all ages. If you want to start your flooding regimen on damp skin, you start immediately after cleansing and toning or use a light mist containing hyaluronic acid and glycerin. Both ingredients are powerful humectants and attract and bind water to the skin surface. Afterwards you might want to first apply a hyaluronic acid containing serum and then a cream to "seal the deal". The difference between flooding and slugging is that flooding is focusing on maximising skin hydration or moisture, while slugging is focusing on prevention of trans-epidermal water loss by (semi)occlusion. Read more about slugging. HYALURONIC ACID Be aware not all hyaluronans are the same. There are different sizes. A macro-hyaluron (about 2000 kDa or larger) will lay on the surface of the skin and bind water there where the skin is losing the most water. A biologicaly active size hyaluron is the 52 kDa micro-hyaluron. This particular size molecule has proven to penetrate into the metabolic active layer of the epidermis, where is actually stimulates the keratinocytes (a certain skin cell) to produce +209% more hyaluron. This can be enough when you are young as the decline of hyaluron in the skin starts first in the epidermis. Be aware it is NOT recommended to use a hyalruon size below 30 kDa in skin care. Hyaluronic acid has the ability to bind and attract water up to 10.000 times is molecular weight, are great to plump up the skin, however the smaller sizes have a different function and can actually harm the skin by for example causing inflammation. LINES AND WRINKLES If you get a bit older, also the dermis will lose it's most important filling substance (hyaluron). There is another skin cell type which can be stimulated to produce more called the fibroblast. This cell is a key cell in the junction of the epidermis and dermis and the dermis, so deeper layer. The powerful anti-oxidant and bio-active Glycine Saponin or abbreviated Saponin can bio-stimulate this cell to produce +256% more skin's own hyaluron and +49% more collagen. Moreover, there are products on the market which contain all of the above PLUS Enoxolone. Enoxolone has the ability to inhibit the activity of an enzyme called HYAL1 >50%. HYAL1 is one of 6 different hyaluronidase enzymes which degrate skin's own hyaluron, hence eliminate it from our skin. These enzymes get more active in sun-exposed or mature skin and are partially responsible why our skin will lose hyaluron as we age. Together with the anti-oxidant Saponin, Enoxolone can slow down the elimination of skin's own hyaluron via 2 complimentary pathways: physical and enzymatic degradation. With other words, products containing 2 different sizes of hyaluron, Glycine Saponin and Enoxolone will fill, stimulate and defend skin's own hyaluron in both the epidermis (top layer) and the dermis (middle layer) of the skin. Great for dehydrated and early or visible signs of ageing, like fine lines and (even deepest) wrinkles. DAY AND NIGHT For daytime I would highly recommend a cream with protective SPF and for nighttime a product containing regenerative and barrier repairing Dexpanthenol or Pro-Vitamin B5. Anti-oxidants are good in every day and night time routine. If you want to use a refreshing hydrating mist, there is only one product with hyaluronic acid I recommend and it is Eucerin Hyaluron-Filler Mist Spray. The reason for this is that it has a skin friendly pH unlike (thermal) water. Water has a pH of 7-8 which is like a slight "insult" to the skin's healthy pH every time you spray. With the Hyaluron-Filler Mist Spray, you rebalance the skin's healthy pH level and use it as much as you like. pH to me is the foundation of good skin health. I have written a few pH related blog-posts and if you are interested simply click on the "read more" button below. Take care 3/16/2023 Comments Why slugging should not go viral
One of the current trends in skin care which I don't recommend for most skin types is "slugging". It means that a thick layer of an occlusive or semi-occlusive petrolatum-based product is applied most often shortly prior to bedtime.
One of the benefits of slugging is that this thick layer is acting like an extra barrier for the skin, hence reducing trans-epidermal water loss and penetration of particle matter or irritants. However, for a normal, combination or oily skin with an intact barrier slugging doesn't make any sense and will increase the risk of the development of milia (milk spots) are small, white cysts on your skin especially seen in the under-eye area, comedones (white - or blackheads) and worse papules (inflamed bumps) or pusteles ( a papule with a white or yellow tip). Moreover, a thick layer of product will rub off on your pillow case during the night. Slugging might make sense if your skin barrier is compromised (not intact), for example after a chemical peeling, more invasive laser treatment, over-exfoliation, or when you have extreme dry (lipid lacking) or dehydrated (water lacking) skin. It might also help to prevent irritants or allergens to enter the skin, hence decrease barrier related skin (hyper)sensitivity. However, I would "slug" very consciously and on recommendation of the dermatologist or plastic surgeon after a procedure as there are fantastic products available in the pharmacy or drugstore for (hyper)sensitive, (extreme) dry or dehydrated skin without risking slugging-related skin problems. Instead of a 100% petrolatum-based product, Aquaphor might be a better option at all times (also extreme cold weather), as it doesn't contain water (no risk of freezing), does contain humectants (they can bind and attract water), is semi-occlusive (protects but still "breaths"), is dermatologist recommended, affordable, available in a spray (no touch), tube, or tub and very well researched (evidence based) for a large variety of purposes. Take care 2/23/2023 Comments Cosmetic Intolerance Syndrome
Dermatologists and pharmacy-assistants or pharmacists are regularly confronted with consumers or patients who have tired about a 100 skin care products and "react" to almost all of them. This could be seen as sensitive or hyper-sensitive skin: self-reported facial presence of different sensory perceptions including tingling, stinging, burning, tingling, pain and pruritis (itch). Sensitive skin was first described by Maibach in 1987 under the name of Cosmetic Intolerance Syndrome. Irritant contact dermatitis (ICD) is caused by the non–immune-modulated irritation of the skin by a substance, leading to skin changes. Allergic contact dermatitis (ACD) is a delayed reaction in which a foreign substance comes into contact with the skin; skin changes occur after re-exposure to the substance. Sounds dramatic, and it is. Buying products to find out that you can not use them is a waste of money, disappointing and if you don't know the cause it is utterly frustrating or problematic. Symptoms can appear local systemic, occur immediately or sometimes with a delay of several hours or days and range from mild to very severe in case of a serious allergic reaction (even life threatening anaphylaxis) and may impact quality of life and/or sleep.
An easy way to avoid wasting your money on a new product is to ask for a sample. It is the most important reason why they exist. Usually with a few applications you can tell if you like the product and your skin likes it too. To find out specifically why your skin is (hyper-)reactive it is smart to go to your dermatologist and ask him/her/they for a test and advice after doing some home-work. You can prior to the appointment make a report as detailed as possible. Checklist for the appointment for a dermatologist / allergologist should contain: symptoms with timing, affected areas (face, scalp, body), co-medication, (family) history of skin diseases (for example atopic dermatitis, psoriasis, rosacea), occupational hazards (for example hair dressers exposed to chemicals), dietary changes, stress, menstrual cycle, use of washing detergents / fabric softeners, sun exposure (photosensitivity) or environmental triggers or changes (like mega-city pollution or skiing by low temperatures or wind), wear of (tight) clothes and anything you deem relevant like recently undergone (aesthetic) treatments. Of course cross-check the INCI's or ingredient lists of the products you use if there are common ingredient(s) listed. Most common triggers in cosmetics are easy to find: latex, dyes, metals and fragrance. Some ingredients are beneficial for skin, but your skin may need slowly adjust to them, like tretinoid or retinol. Some ingredients may be beneficial for some, however not good for your skin when used on a daily base like alpha-hydroxy-acids in high concentrations. I know that many mention preservatives as a potential trigger. Some certainly can be. However my experience (about 9 years of clinical tolerability and safety tests with modern dermatological skin care) is that almost all users tolerate products containing evidence based modern preservatives really well (rarely any side effects) and benefit from them as they reduce the risk of contaminations by unwanted growth of microflora in a product. Hence, they are there for your safety. Large companies have thousands of people working in R&D every day and know what they are doing and are there to provide you with the best they can offer, based on the latest regulations, insights and science. Moreover, they would not market products risking high complaint rates or more dermatological skin care without clinical proof of good / very good tolerability (even in sensitive skin). I therefor like to challenge the negative reputation preservatives in general have. We all remember that parabens were "killed" by reputation and because companies want to produce products consumers enjoy and love, they started formulating all their products without them. Truth is that most parabens were and are very safe based on ample evidence. In this case a family of beneficial preservatives suffered significantly because of 1 or 2 bad family-members. We don't formulate with parabens or known potential allergens. A very active and skilled safety department is taking care of that. Don't completely rely on the word hypo-allergenic. It only means that the risk of a reaction to one of the ingredients is reduced and does not provide a 100% guarantee. Don't think that "everything natural" is always good for you. For example latex (a well known potential allergen) comes from nature. Click the button below for a full list of potential allergens in skin care provided by the FDA. There are preservative, fragrance and dye free options available in skin care. Although "free off" claims are frowned upon by the industry or sometimes not even legal. Usually these "minimal" products come in specific safe packaging (mostly pumps) to avoid contamination, often also protecting them from air and light to avoid oxidation of certain ingredients in the formula. There are evidence based dermo-cosmetic products which actively sooth and calm the skin with ingredients like Symsitive®, reduce related redness or inflammation with licochalcone A or cool or reduce itch with methoxy-propanediol or polidocanol or a combination. Sometimes the solution is as simple as the problem. Sensitive (hyper) reactive skin can be caused by barrier impairment, which allows irritants to penetrate the skin, sensors in the skin to be exposed and water to evaporate from the skin.....hence often confused or overlapping with dry skin as the symptoms are identical. If your skin barrier is the problem, the solution is to avoid over-exfoliation or harsh cleansing, maintain the skin's healthy pH (around 5) and use products containing ingredients supporting barrier repair like urea and/or dexpanthenol. These are considered the gold standard as written in this position paper by Prof. M. Augustin et al 2019. In my opinion all skin is "sensitive", and it should be. It is our skin's function to protect us by sensing heat, cold, touch, pressure and pain for example. However when the skin does not tolerate "normal conditions", hence is overreacting to (common) ingredients in skin care, it is telling you "something is off" and it might be Cosmetic Intolerance Syndrome. Listen to your skin. Don't forget to ask for a sample and advice from the pharmacist when buying a new product or go to your dermatologist/allergologist to get a better understanding of the problem, so they can provide a tailored solution for you. Take care 
The fibroblast is one of the most important cells involved in ageing skin. You can find it in the lower layer of the epidermis and the dermis. It has many functions, one of which is the production of key components like hyaluron (filling + hydration), collagen (strength + structure) and elastin (flexibility + stretch). It particularly has to work hard to replenish hyaluronic acid or hyaluron as this filling component only has a half-life in the skin of several hours up to a day. Good quality collagen can last 15 years and elastin up to 70 years. It is also believed to be involved in the clean-up of dysfunctional components, like for example broken elastin, which is visible photodamage-damage and called solar elastosis. Fibroblast senescence (agedness) does also increase the risk of age spots. In proper ageing skin management, the fibroblast is a key target-cell.
Many aesthetic in-office treatments like ultrasound, radio-frequency, chemical peelings, laser etc. are based on causing controlled damage to the skin provoking wound-healing. This is the base of their rejuvenating or aesthetic impact. The number of new fibroblasts (myofibroblasts) is increased during the wound-healing process. Some injectables, like for example hyaluron-fillers cause the fibroblasts at the injection site to stretch and bio-stimulate collagen production. There are specific bio-stimulating injectable treatments. The most popular ones are Sculptra®, Radiesse®, Ellanse®, and a new one which combines hyaluron-filling and bio-stimulation is HArmonyCa®. As we age the fibroblast is undergoing some changes because of intrinsic and extrinsic factors. It loses it’s production power, it flattens, loses mechanical tension and therewith the ability to interact with other cells in the skin. It is becoming “tired and deaf”. My hypothesis was that injecting large droplets of hyaluron into the dermis might cause the fibroblast to become “lazy” via a negative feedback mechanism: when something is present in abundance, the fibroblast might not be stimulated enough to work hard to replenish it. This is not yet scientifically proven. It is important to keep the fibroblast in good shape and biologically active. We can stimulate it’s biological activity with skincare containing bio-stimulators, or ingredients which activate the production of important skin components by the fibroblast. On the other side we need to protect the cell from damage. Bio-stimulating active ingredients in skincare which have shown to particularly stimulate the fibroblast* are for example:
Protection from photo-damage we can achieve with a combination of sunscreen and anti-oxidants, more specifically Licochalcone A. Licochalcone A has a proven broad ability to protect the skin from damaging free-radicals or oxidative stress from UVA, UVB and HEVIS (High Energy Visible Light) affecting keratinocytes and fibroblasts. I am not yet aware of skincare ingredients which increase the number of (new) fibroblasts, like the semi or minimal invasive in-office treatments. It’s an interesting field to explore if this is possible without injury, inflammation or irritation. However, you probably get "more bang for your buck" by starting a a skincare routine with focus on bio-stimulation and protection of the fibroblast pre- and post minimal and semi invasive aesthetic treatments. This could be something we will proof with a clinical study. Take care *in vitro 
We all learned that sleeping in make-up is the ultimate skincare sin. What is bad about it is when you go 24 hours without washing your face and end up going to bed leaving your day-time make-up on. Over the course of the day, our skin accumulates pollutants, dirt and dead skin-cells.
If dirt and pollutants are left on the skin, they may cause micro-inflammation and contribute to premature ageing skin via a process called inflamm-aging and free-radical damage which is a major contributor to skin-ageing. The combination of both micro-inflammation and free-radical damage is called ox-inflammation. We should aim to reduce or preferably avoid it. Pollution, dirt and sebum (oils) can impact the skin's healthy pH balance and thus lead to a weakening of the skin barrier function, more sensitive skin, dehydration, slowed down skin-cell renewal process and thus ageing. Not removing dead skin cells together with dirt increases the risk of clogged pores. Make-up itself usually doesn’t contain harming ingredients. Coloured micro-pigments actually provide additional sun-protection. Make-up or foundation itself is thus not the problem, however the fact that we don’t cleanse our skin after a busy day and/or evening is what could make us age faster. Not doing your PM cleanse and care routine is anyway a missed opportunity to support your skin’s night-time recovery with beneficial active ingredients. If you go out in the evening, take the opportunity to cleanse before getting ready and get rid of debris which was accumulated during day-time. Don’t worry about falling asleep in your make-up once or twice. Just don’t make it a habit. I would always aim to remove eye make-up. Sleeping in full eye make-up (mascara, liner, eyeshadow) increases the risk of an eye-inflammation, redness and corneal abrasions. Waking up with “panda-eyes” filled with black rheum or goop isn’t pretty either. Take care 2/18/2023 Comments Skincare peri and post menopause
Our life expectance is increasing and the average age when menopause occurs didn't change much in the last decade. This is why more women will have to care for post menopause skin for a longer time. During and after menopause our skin will go through some changes and might even become problematic. In this blog post I will have a closer look into these changes.
Change During the start of menopause, also called peri-menopause, women will notice some changes to their skin. This is because estrogen levels start to decline (-35% between age 35-50) and as estrogen level decline, androgen level proportionately become more dominant. As a result, the majority of women experience drier skin. Or when the hormone levels are differently balanced they may get a more oily skin or develop acne tarda (adult acne), because the oil gland activity is increased. Another problem is that the skin's pH level will increase, which will impact skin health, barrier and microflora or microbiome. A higher pH value may result in problematic skin. Loss of biological activity Around this period the metabolic biological activity in the skin will decrease faster than in our 20s or 30s. The production of important components like hyaluronic acid (filling + hydration), collagen (strength + structure) and elastin (flexibility + stretch) by fibroblasts (a very important skin cell) isn't sufficient, while the speed of their degradation is inclining because the skin's natural resilience against damaging free radical activity is reduced and the activity of degradation enzymes, like hyaluronidase, collagenase and elastase is elevated. Therewith the presence of those important skin components is declining 30% in the first years. This leads to more advanced signs of ageing skin and an overall loss of skin quality: skin firmness, skin surface eveness, skin tone eveness and glow (Goldie, Clin Cosmet Invest Dermatol, 2021). Solution Skin ageing is a multifaceted continuous biological degenerative process, with an impact on overall skin quality, self perceived attractiveness, confidence and comfort (Quality of Life). The optimal solution should improve all 4 emergent perceptual categories or EPG's of skin quality (an important component of human attractiveness) as mentioned above. This can be achieved by supporting skin's own resilience against the inclined loss by degradation (reduce free radical and enzymatic activity) and increase skin's own biological activity, hence skin's own production of hyaluron, collagen and elastin with bio-active ingredients or bio-stimulators and inhibit human tyrosinase activity (reduce age spots). I will explain the 4 key actions below: 1. Bio-stimulators Some evidence based bio-actives we can find in skincare are:
2. Enzyme inhibitors Some ingredients in skincare which inhibit enzymatic degradation are:
3. Anti-oxidants Damaging free radical activity is increased in mature skin and ROS (Radical Oxidative Species) increase degradation of all components, enzymatic degradation and human tyrosinase activity, a powerful cocktail of anti-oxidants is a "must-have". The combination of fresh activated L-Ascorbic-Acid (primary defence with instant neutralisation of extra-cellular free radicals) and Licochalcone A (secondary defence with long-lasting intracellular stress protection is a valuable addition in any day or nighttime skincare regimen. Licochalcone A is moreover one of the most powerful anti-oxidants (if not the most powerful one) proven to reduce (deep) oxidative stress from High Energy Visible Light or HEVIS. As we know, free radicals from HEVIS damage the important skin-cell called the fibroblast and increase the risk of age spots. A product which development was initiated, supported and clinically tested by me is Eucerin's Hyaluron-Filler Vitamin C Booster. I highly recommend this product, especially after a collagen-stimulating in-office procedure. 4. Human tyrosinase inhibition A relatively new, effective and safe ingredient in skincare which was tested on inhibiting human tyrosinase is Thiamidol. Other ingredients in skincare were tested on mushrooms (Hornyak, Journal of Investigative Dermatology 2018 & Mann et al. 2018) and are not potent in reducing human tyrosinase activity. It took 10 years of pioneering research (dr Ludger Kolbe) and comparing 50.000 actives to patent and market it. In the mean time Thiamidol is loved and recommended globally by many dermatologists and evidence based with 35+ studies including >2000 participants with all Fitzpatrick phototypes. Every AM routine should at least have a skincare product with SPF of 15 or higher. An improvement of skin quality leads to an improvement of quality of life (van Geloven et al. EADV 2022). Hope this was helpful. Take care 2/15/2023 Comments GENDERED AGEISM
According to a survey with responses from 729 participants aged 18- 70+, with 65% of respondents coming from the United States and the majority of the remainder coming from Canada, the UK and Europe ‘lookism’ often trumps the performance of women when they are evaluated and often are pushed to the sidelines and/or pushed out to make room for younger workers. Once terminated, women find it much more challenging to get rehired at a time when may they lack funds for retirement. The pressure is especially high on single women and mothers 50+, which is a fast growing demographic. In many countries the retirement age is 67 years. It's not acceptable to be seen as less valuable or even irrelevant the last 17 years of your career, while having a lot of value to offer to jobs, companies and co-workers.
Ageing is a beautiful journey of collecting knowledge and experience. It is a privilege, however gendered ageism a growing and relevant problem. Physical ageing is a biological degenerative process, which can't be completely stopped, but can be positively influenced. For example, I work daily with a team on the creation of evidence based skincare products to significantly improve visible signs of ageing and quality of life. This requires that >80% of users agree that the product makes them feel more attractive, confident and comfortable in their skin. Unfortunately more needs to be done and age discrimination laws are less effective for mature women (McLaughin LABOUR 2020). Therefore gendered ageism should be addressed in diversity & inclusivity initiatives. When I turned 50, I joined an initiative in the company I work for called "New Generation 50+". It's a work-in-progress, however a start to reduce and hopefully together stop (gendered) ageism in the workplace and society. We should not accept the devaluation of mature women (or men). Many feel almost "invisible". If they don't "see you", make people listen to you and speak up if you feel you are not treated fairly. Many companies focus on recruiting "young talents". I would like to challenging them to hire, engage and retain 45+ talents. Being talented doesn't have an expiration date. Take care 
Vitamin C is a "must have" skin care ingredient our skin needs at any age.
One of the best researched skin care ingredients and proven to be very beneficial for skin is Vitamin C. Our skin uses Vitamin C as an anti-oxidant and the dermal fibroblasts need Vitamin C for the production of collagen. Two very good reasons to add this ingredients into your daily skincare routine whether you are twenty or eighty. Moreover, our skin depends on us for the needed supply, as our skin is not able to produce Vitamin C itself. We can either include enough Vitamin C in our diet or apply Vitamin C topically there where we need it the most. Usually this is the skin which is exposed to (sunlight) as this increases damaging free radical activity in our skin. An active form of vitamin C can reduce the free radical activity, which we call anti-oxidative effect. There are 4 things to consider when buying a skincare product containing Vitamin C:
Day or night? Some recommend to use Vitamin C during the night, as the active form of Vitamin C will oxidize in daylight. Hence, your skin can benefit from the Vitamin C longer during the night. I would recommend Vitamin C to be used during daytime (thus added to your morning routine), as we need protection from damaging free radicals the most during daytime and the oxidization of Vitamin C is actually a sign that the ingredient is doing it’s job! It’s even better to add Vitamin C both to your day & night time skincare routine. Is L-Ascorbid Acid enough? Vitamin C is counteracting free radicals from UV light. However, UV is not the only damaging light form as there is also High Energy Visible Light or abbreviated HEVIS. This penetrates even deeper into the skin where also the dermal fibroblasts reside. The dermal fibroblasts are our collagen and hyaluronic acid producing cells and a key target in an effective anti-ageing skincare strategy. Lichochalcone A (Licorice-root extract) has proven to be the most potent anti-oxidant to protect the dermal fibroblasts and neutralize free radicals from HEVIS. Moreover, Lichocalcone A increases Glutathione, which is a skin’s own anti-oxidant. Licorice-root extract is an anti-ageing hero. Summary The combination of Vitamin C and Lichocalcone A will protect our skin and dermal fibroblasts from free radical damage by UV and HEVIS and will provide superior biological cell protection in comparison to Vitamin C only. For me this is a good reason to use a product containing both ingredients as a first step after my cleansing routine in the morning. If you have sensitive eyes, I recommend to use an eye care prior, which will form a barrier to help to prevent the low pH Vitamin C product to migrate into the eye area. Afterwards you can use the other products of your skincare routine. I would like to put emphasis on using a SPF of 30 or higher during the day. This will not only help to protect your skin, but also support he anti-oxidative benefits and make them last longer. Hope this was helpful. Take care! 12/15/2018 Comments Aquatic wrinkles
After about spending some time in bathtub or in the pool, we can notice that our skin on particularly finger tops and toes start to wrinkle up. This wrinkling effect is believed to have a function.
When wet, things tend to be more slippery and our sophisticated skin is designed to counteract this by wrinkling up in a pattern optimised to provide a drainage network that improves grip, much like the tires on a car according to a study. Link to original publication. However, other studies would contradict that there would be a functional benefit for so called aquatic wrinkles. The osmosis theory Water molecules moving trough a semipermeable membrane from a low concentration area to a high concentration area is a process called osmosis. The shrinking and expanding effects of osmosis takes place simultaneously outer layer of the skin, causing wrinkles. The skin's outermost layer is also known as stratum corner could be responsible for this wrinkly reaction, The top layer of our skin consists of dead corneocytes. The longer these cells are attached to the skin, the bigger they are. The size of the corneocytes we actually use to objectively measure the skin's renewal and desquamation (shedding of cells) process. These dead (keratin containing) skin cells may absorb water and swell. The lower layer with living cells doesn't swell up. As top layer (which is increased in size) is still attached to the layer beneath, a wrinkly pattern is formed. The layer of dead skin cells is thicker at the palms of our hands and soles of our feet, the wrinkling effect is more evident. This response occurs more quickly in freshwater than seawater. Moreover, when we are exposed to water for a longer time, the water-repelling film on top of the outer layer of the skin may get impaired. The sympathetic nervous system / microcirculation theory It's known that there is a relationship between the wrinkling-effect and blood vessels constricting (narrowing) below the skin. When hands and feet are soaked in water, the nerve fibres in the skin shrink and the body temperature regulators loses volume. Therewith the top layer of the skin is pulled downward and the wrinkling pattern is formed. It is proven that wrinkling-effect response is impaired, if the nerves and/or blood vessels are damaged. Therewith the wrinkling effect can even be used to determine proper functioning of the sympathetic nervous system and/or skin's microcirculation. There is evidence that the wrinkling effect is impaired in patients suffering from diabetes: link to article. Regardless the cause, aquatic wrinkles disappear fast and the skin returns to normal once the water has evaporated. Take care. 
Psoriasis occurs in many different forms and levels of severity. The first signs may appear between the age of 15 and 35 and 75% of patients are diagnosed before the age of 46 according to the World Health Organisation. As there is no cure for the disease, the highest prevalence is seen in a more mature age group age 50-69. Many of the treatments which are part of the standard treatment guidelines for psoriasis cause as a side effect premature ageing skin. For example PUVA, next to being an effective treatment, does cause (severe) photo-damage. Many patients will undergo such treatments on and off or continuously throughout their life.
Although the primary goal of dermatology is to improve the functional attributes of the skin (health) and lessen the tremendous burden psoriasis may cause, ultimately one aims to improve the skin's physical attributes (appearance). Ageing skin is a biological degenerative process which influences the activity of collagen and hyaluronic acid producing cells (mainly fibroblasts) and leads to a decrease of skin components like collagen, hyaluron and functional elastin. Effective anti-aging skincare can support the protection of those cells and skin components (anti-oxidants and SPF) and thus slow down the fastened degenerative process. Some active ingredients (for example biologically active Glycine Saponin and Arctiin) have proven to effectively stimulate fibroblasts in the production of collagen and hyaluronic acid and thus replenish dermal components. Loss of those components and photo-damage eventually lead to visible signs of ageing. Although ageing skin is natural, premature ageing skin isn't necessary. Most patients will probably already use a moisturising facial skincare product. It makes sense to recommend anti-ageing skincare instead to be used in conjunction with treatments which as a side effect cause premature ageing skin, particularly for exposed areas like the face. As psoriasis oftentimes doesn't occur in the face (except in the hairline), anti-ageing skincare will pose a low to no risk to aggravate facial skin and there are anti-ageing skincare products available which have proven to be suitable for psoriasis patients. Take care. 
One of the frequently asked questions is, if it's necessary or if there is a benefit using a special eye care or cleansing products. Yes, there is!
As I mention in many of my previous posts, the right pH-level is very important for healthy skin. Skin usually prefers a pH of around 5. However there are some area's where the skin's natural pH balance is a little bit different. One of those area's is the area around the eyes. The preferred pH-level there is around 7, thus less acidic and more alkalic in comparison to your regular cleansing or care product for face or body. This is one of the most important reasons why I would recommend to use a special eye make-up remover and eye care product, as they are adjusted to the pH level most suitable for use in the eye area. Furthermore, special eye products are tested and proven to be safe when used around the eyes, while it isn't always recommended or proven for a regular face product. Some care products have a tendency to "travel" or migrate into the eye area. Even when not directly applied around the eyes, they might end up there. A special eye care product can form a "barrier" and thus help to prevent that unwanted products move to the eye area and cause irritation. I would particularly recommend the use of an eye cream when using other products containing gold standard anti-ageing active ingredients like Vitamin A, C (or derivatives of both), Hydroxy Acids (Alpha, Beta or Poly), when you have experienced some sensitivity of the eyes or eye area in the past or have a more problematic skin type. Eye care products preferably should not contain Vitamin C (L-Asorbic Acid or related) as it requires a low pH value of <4 to be active and do it's job properly. Eye care products with Vitamin C therewith are either too acidic to be used in the eye area or alternatively too alkalic for the Vitamin C to be effective. Safe to use in the eye area are products containing Hyaluronic Acid. Although "Acid" is in the name, Hyaluronic Acid isn't acidic. One of it's key functions is attract and bind water, which usually has a pH of ~7. Take care! |
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