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5/11/2023 Comments

The right amount of skin care

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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".

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The precise number of FTU's required:
  • face 1
  • front neck and décolletage 1
  • back neck 0.5
  • face and neck (front and back) 2.5 
  • front of trunk 6.7
  • back of trunk 6.8 
  • arm and forearm 3.3 
  • hand 1.2 
  • leg and thigh 5.8 
  • foot 1.8 
  • entire body 40 units

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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5/7/2023 Comments

Biostimulators: regenerative fillers with natural results

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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:
  1. classic dermal fillers (mainly hyaluronic acid-based) 
  2. biostimulating fillers
  3. bioremodelers (Profhilo) or skin boosters (mainly hyaluronic acid based) improving overall skin quality and hydration
There is evidence that classic dermal fillers stimulate collagen production by stretching of the dermal fibroblasts near the injection side (4). Although classic hyaluron based fillers are still the most popular treatment for soft tissue augmentation, I will focus on bio-stimulators.

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
  1. Ceramics, Calcium Hydroxylapatite (CaHA) Radiesse 30% microspheres Merz  or Crystalys Luminera 55.7% microspheres Allergan
  2. NEW Mix of Hyaluron filler = CaHa HArmonyCa: Calcium hydroxyapatite microspheres 25-45 microns in diameter (55.7%) cross-linked sodium hyaluronate gel (20 mg/ml), phosphate buffer. Lidocaine hydrochloride (3 mg/ml) Allergan or NEAUVIA stimulate 26 mg/ml Ha crosslinked with PEG = 1% CaHa
  3. Poly-L-lactic acid (PLLA) Sculptra 150 mg/vial Galderma or Lanluma V [210 mg /vial] and Lanluma X [630 mg/vial] Sinclair Pharmaceuticals
  4. Polymers, polycaprolactone (PCL) Ellansé, 30% microspheres Sinclair ​or GOURI
  5. Polydioxanone (PDO) a resorbable, synthetic biocompatible polymer, a material we know from PDO threads - brand Ultra-COL
  6. Polymethyl methacrylate (PMMA), Bellafill 20% microspheres in bovine collagen, Suneva Medical - permanent polymer (not recommended)
Besides their different compositions, formulations, product preparations and injection modalities, their main differences consist of their degradation kinetics, level of efficacy and duration of action. The aliphatic polyesters, PCL and PLLA, degrade slowly by hydrolysis of the ester bonds and have a long duration with PCL having the longest. CaHA degrades more rapidly by a different mechanism. 

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:
  • Creatine (bio-stimulation of collagen I and IV by + 35%  and elastin with +36%) (10)
  • Glycine Saponin (bio-stimulation of hyaluron production +256% and collagen +49%) which is also a powerful anti-oxidant (11.12)
  • Arctiin (bio-stimulating collagen production + inhibiting of HN-Elastase responsible for collagen & elastin degradation) (10)
A 52 kDa Micro-Hyaluron molecule has proven to be the most potent to bio-stimulate the production of hyaluron by keratinocytes with 209%. (11) Read more about inhibiting hyaluron degradation

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

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5/6/2023 Comments

The impact of humidity on skin

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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
  • Wash your face regularly with a gentle cleanser to remove sweat, dirt, and impurities
  • Use a toner to re-balance skin's pH level after cleansing
  • Use a (light) moisturiser at all times, preferably with SPF
  • Apply anti-oxidants. For example a product combining fresh L-Ascorbic Acid and Licochalcone A (excellent for every skin type)
  • If you have oily skin, use a care product with oil-control or sebum regulating properties (for example: L-Carnitine) 
  • Avoid touching your face
  • Exfoliate to encourage the removal of dead skin cells 
  • Drink plenty of water
  • Wear loose cotton clothes
  • Take (short) cool baths or showers
  • Use antiperspirant (designed to reducing sweat)
  • Don't neglect the skin of your body or lips

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
  • Wash your face with a very gentle (not stripping) cleanser 
  • Use a toner to re-balance skins pH level, this supports skin's barrier function
  • Apply a lipid rich (or if needed a semi-occlusive - this prevent trans-epidermal water loss) moisturizer
  • You can use care products containing hyaluronic acid. If well formulated, they will not decrease (this is a myth) however improve skin's own hydration
  • Apply SPF during daytime (always)
  • Exfoliate not more than 2 times per week - avoid over-exfoliation  
  • Drink plenty of water (always)
  • Take (short - never hot) baths or showers
  • A humidifier can add moisture to the air and prevent skin dryness. A study showed that to avoid dryness of the eyes and skin, it is necessary to maintain a relative humidity level of > 30% . (2)
  • Don't neglect the skin of your body or lips

​Take care

References
  1. A study of skin characteristics according to humidity during sleep. Sue Im Jang et al. Skin Res Technol. 2019 Jul;25(4):456-460.
  2. Physiological and subjective responses to low relative humidity Yujin Sunwoo et al. J Physiol Anthropol. 2006 Jan.

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5/5/2023 Comments

Screen dermatitis, allergic to your computer?

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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:
  1. Johansson O, Hilliges M, Han S W. A screening of skin changes, with special emphasis on neurochemical marker antibody evaluation, in patients claiming to suffer from “screen dermatitis” as compared to normal healthy controls. Exp Dermatol 1996: 5: 279– 285.
  2. Stenberg B, Eriksson N, Mild K H, Hoog J, Sandstrom M, Sundell J, Wall S. Facial skin symptoms in visual display terminal (VDT) workers. A case-referent study of personal, psychosocial, building- and VDT-related risk indicators. Int J Epidemiol 1995: 24: 796– 803
  3. Berg M, Lonne-Rahm S B, Fischer T. Patients with visual display unit-related facial symptoms are stingers. Acta Derm Venereol 1998: 78: 44– 45.
  4. Gangi S, Johansson O. Skin changes in “screen dermatitis” versus classical UV- and ionizing irradiation-related damage – similarities and differences. Exp Dermatol 1997: 6: 283– 291.12

READ MORE ABOUT COMPUTER RELATED SKIN DISEASES
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5/4/2023 Comments

Hyaluronidase, the enzyme killing skin´s own hyaluron

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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.

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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

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5/4/2023 Comments

Good sleep is great for skin and well-ageing

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​​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:
  • Have a routine. Go to bed at a similar time each night and get up at the same time each morning, including on the weekends. It helps to have a skin care routine! Read more
  • Make sure your bedroom is quiet, dark, relaxing, and at a comfortable temperature
  • Remove electronic devices, such as TVs, computers, and smart phones, from the bedroom
  • Avoid large meals, caffeine, and alcohol before bedtime
  • Get some exercise. Being physically active during the day can help you fall asleep more easily at night.
  • Sleep on your back. Side sleeping causes "compression wrinkles" in face and décolletage. When you are young, they disappear, but when you are more mature, they become more permanent.
  • If you sleep in the side, sleep on a silk pillow cover. Silk’s slippery surface reduces friction on the skin (and hair), and thus reduces the risk of facial wrinkles and morning creases that other fabrics might cause when you sleep on your side or face. 

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

  1. Does poor sleep quality affect skin ageing? P Ovetakin-White, A Suggs, B Koo, M S Matsul, D Yarosh, K D Cooper, E D Baron, 2015.
  2. Medical Hypotheses Volume 75, Issue 6, December 2010, Pages 535-537 Can poor sleep affect skin integrity? V. Kahan et al.
  3. Rhodes G. - The evolutionary psychology of facial beauty. Annu Rev Psychol. 2006;57:199–226. 
  4. Axelsson J, Sundelin T, Ingre M, Van Someren EJ, Olsson A, Lekander M. - Beauty sleep: experimental study on the perceived health and att ractiveness of sleep deprived people. BMJ. 2010;341:c6614. 
  5. Oyetakin-White P, Koo B, Matsui M, Yarosh D, Fthenakis C, Cooper K, Baron E. - Effects of Sleep Quality on Skin Aging and Function. J Invest Dermatol. 2013; :S126–S126. 
  6. Sundelin T, Lekander M, Kecklund G, Van Someren EJW, Olsson A, Axelsson J. - Cues of fatigue: eff ects of sleep deprivation on facial appearance. SLEEP. 2013;9:1355–1360. 
  7. Bryant PA, Trinder J, Curtis N. - Sick and tired: does sleep have a vital role in the immune system. Nat Rev Immunol. 2004;4:457–467. 
  8. Horne J. - Why we sleep—the functions of sleep in humans and other mammals. Oxford University Press. 1988;23:15–17. 
  9. Maedica (Bucur). 2017 Sep; 12(3): 191–201. Perceived Age and Life Style. The Specific Contributions of Seven Factors Involved in Health and Beauty, Victor Gabriel CLATICI et al.

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5/1/2023 Comments

Pat dry first or apply on damp skin?

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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.

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    ABOUT THIS SITE AND ME

    There is an overwhelming variety of contradicting information and opinions, leaving us all a bit confused. As a hybrid between an expert, scientist and skinfluencer, I will attempt to detangle and debunk skin or related topics one after the other. It might be a long journey, as our knowledge gets deeper, our innovations faster, our demands higher and our dreams bigger. I hope you will find this blog informative, useful and wish you enjoy many visits and don't hesitate to leave your comments in the comment box.

    "Live your best life & take care"

    I hold a full-time job a senior global medical & innovation manager in a top tier German skin care company. My specialty is frequently referred to as "anti-ageing". As anti-ageist I rather call it well-ageing regenerative skin care and procedures. My passion is my profession: everything related to skin care, dermatology and aesthetics. 

    This is my private blog, all opinions expressed are my own & 100% honest.

    ​All rights reserved. The information provided is not intended as substitute for professional medical advice, diagnosis, or treatment. Always seek professional medical advice from your physician or other qualified healthcare provider with any questions you may have regarding a medical condition or problem. ​

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