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COSMETICMANAGING CONSULTATION MELASMA

Camouflaging Melasma Dyspigmentation Zoe Diana Draelos, MD

amouflage are an important part of for camouflaging purposes. A good camouflage artist treating the melasma patient. Not only do they will usually purchase color palettes from at least 2 differ- provide additional photoprotection, they also ent companies to facilitate mixing of cosmetic shades to C 2 restore the patient’s self-confidence while dermatologic match a patient’s skin tone. treatment is under way. Makeup bases and foundations are the primary Dyspigmentation of the face caused by melasma is a cosmetics designed to camouflage underlying dyspig- cosmetic challenge. The difficulty lies in blending the mentation. Facial foundations are available as hard various brown tones associated with the condition. grease paints, soft grease paints, pancake makeup, and Topical prescription intended to lighten the liquid makeup. darkened skin usually take a minimum of 3 months to Hard grease paints come in stick form and consist produce clinically acceptable results, necessitating the of in an anhydrous, waxy base. Application need for camouflage techniques in the interim. These requires great skill and is more time consuming than camouflage techniques can simply be incorporated by with other makeup bases. Hard grease paints are the patient into a daily grooming routine once the basic extremely long wearing but are mainly reserved for principles COS have been mastered. Persons who can trainDERM theatrical uses. patients in the use of these techniques include paramedi- Soft grease paints come in a jar, tin, or squeeze tube. cal camouflage artists, aestheticians, dermatologists, plas- They have a creamy texture owing to the incorporation of tic surgeons, and cosmetic consultants. Their successful low-viscosity oils in addition to in the anhydrous use of camouflage cosmetics requires a well-formulated preparation. They usually contain a high proportion quality product applied with the skill of a stage makeup of to provide superior coverage.3 Soft technicianDo and the artistic abilities Not of a painter. grease paintsCopy are designed to completely cover all under- lying skin and form an opaque cover. They tend to have Camouflaging Principles a high shine and do not survive body heat; thus, some Camouflaging principles are adapted from stage makeup type of setting is required to prolong wear. The techniques. Pigmentation defects can be camouflaged setting powder is applied directly over the grease paint to either by applying an opaque cosmetic that allows none prevent the cosmetic from being rubbed off. of the abnormal underlying skin tones to be seen or by Pancake makeup is packaged in flat, round contain- applying a of a complementary color. For ers and is removed from the compact by stroking with example, skin areas that are lighter than the natural skin a wet sponge. The product is composed of talc, kaolin, color can be camouflaged with a darker brown cosmetic, zinc oxide, precipitated chalk, titanium dioxide, and iron while darker areas can be minimized by applying facial oxide.4 Pancake makeup dries quickly and has a matte, foundations of a lighter hue.1 or dull, finish. Unfortunately, body warmth and perspira- tion cause it to come off easily, but it is easily retouched, Camouflage Cosmetics if necessary. There are many companies in the and Liquid camouflage makeups are similar to those mar- Europe that manufacture cosmetics specifically designed keted for general use; however, increased amounts of titanium dioxide provide superior coverage while still Dr. Draelos is Clinical Associate Professor, Department of allowing visualization of some of the underlying skin. Dermatology, Wake Forest University School of Medicine, Liquid camouflage makeup usually contains a higher Winston-Salem, North Carolina. concentration of oils to allow full color development and The author reports no conflict of interest in relation to improved wearability. It is probably the most popular cos- this article. metic for camouflaging melasma dyspigmentation.

VOL. 20 NO. 5 • MAY 2007 • Cosmetic Dermatology® 281

Copyright Cosmetic Dermatology 2010. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher. MANAGING MELASMA

Application Techniques which can result from covering facial landmarks. Other col- The camouflage facial foundations that best cover melasma ored facial cosmetics (ie, shadow, eyeliner, mascara) are dyspigmentation are the creamy soft grease paints that are usually necessary to give an attractive final appearance.5 squeezed from a tube or scooped from a jar or tin with a Camouflage cosmetics should be worn only when needed spatula and applied to the back of the hand for warming and should be thoroughly removed at bedtime.6 Because of and blending. Soft grease paints are the easiest to use of the waterproof nature of these products, removal requires the camouflaging products since they exhibit a long play more than washing with and water. Most cosmetic time (ie, time before the cosmetic dries), good blending companies provide an oily for removal and recom- characteristics, minimal application skill, excellent cover- mend subsequent cleansing of the skin with soap and water. age, and adequate wearability for most people. However, If the patient has mild melasma and does not require an they do require a special application technique. opaque cosmetic, a traditional facial foundation can be used Initially, a makeup base that is closest to the patient’s and applied in 3 consecutive layers, allowing 5 minutes of natural skin color must be selected. Blending usually is drying time after each application. necessary, but no more than 3 colors should be combined to avoid producing a final color quality that is muddy. In Adverse Reactions to Camouflage Cosmetics patients with an underlying pigmentation problem, skin Camouflage cosmetics are typically used by patients with- dyspigmentation counts as 1 color. Thus, the melasma out difficulty. A specially trained paramedical camouflage patient should never mix more than 2 foundation artist or aesthetician instructs the patient on blending colors to achieve an attractive final color match. and applying the makeup. Two to 3 hour-long sessions Once the closest foundation color has been selected, it are enough to resolve most of the problems encountered may be necessary to blend in yellow if the individual has with the cosmetic, but sometimes difficulties arise. a sallow complexion, or if the patient has a ruddy Most camouflage foundations contain a high con- complexion. All facial tones should be represented in the centration of oils, which may (rarely) cause comedone final foundationCOS blend if an acceptable color match isDERM to formation in predisposed individuals. Evaluating ingre- be obtained. Blending is usually done by applying a small dient lists for the absence or presence of comedogenic amount of the makeup to the back of the hand, which oils is not of much practical value; rather, the foundation provides a good surface for blending and can be easily should be use-tested by the patient. This is accomplished held up to the face to evaluate the color match. Blending by applying a small amount of the cosmetic to the upper makeup on the back of the hand also warms the product, lateral cheek daily for a 2- to 4-week period, followed by allowingDo for easier mixing and application.Notdermatologic Copy evaluation. The final foundation color mix is then dabbed from Allergic contact to camouflage makeup is the central face outward to approximately 0.25 in into rare since formulations are generally fragrance free and the hairline and is blended over the ears and beneath have a low preservative concentration. It is possible, the chin. It is necessary to feather the cosmetic where however, for both allergic and irritant application ends to achieve a more natural appearance. to occur in people using camouflage cosmetics. These The importance of dabbing cannot be overemphasized, products can be open or closed patch-tested “as is.” since rubbing will remove the makeup as it is applied. The cosmetic should actually be pressed into the skin and References allowed to dry for 5 minutes. 1. Draelos ZD. Use of cover cosmetics for pigmentation abnormali- Once the makeup has dried, the cosmetic must be set ties. Cosmet Dermatol. 1989;2(5):14-16. 2. Rayner V. Clinical : A Medical Approach to Esthetics with an unpigmented, finely ground, talc-based powder Procedures. Albany, NY: Milady Publishing Co; 1993. to prevent smudging, improve wearability, provide water- 3. Schlossman ML, Feldman AJ. Fluid foundation and blush proof characteristics, and impart a matte finish. Camouflage makeup. In: De Navarre MG, ed. The Chemistry and Manufacture makeup is designed to be worn with this powder and does of Cosmetics. Wheaton, Ill: Allured Publishing Corp; 1988: 748-751. not function properly without it. The powder should be 4. Harry RG. Harry’s Cosmeticology. 7th ed. New York, NY: Chemical pressed, not dusted, on top of the foundation. Publishing; 1982:304-307. Finally, a reddish powdered is dusted over the 5. Draelos ZD. Cosmetics have a positive effect on the postsurgical central face (ie, central forehead, nose, and chin) and patient. Cosmet Dermatol. 1991;4(6):11-14. 6. Thomas RJ, Bluestein JL. Cosmetics and hairstyling as adjuvants to the upper cheeks to mimic the natural color variations scar camouflage. In: Thomas RJ, Richard G, eds. Facial Scars. St. of the face and to prevent a flat, masklike appearance, Louis, Mo: CV Mosby; 1989:349-351. ■

282 Cosmetic Dermatology® • MAY 2007 • VOL. 20 NO. 5 Copyright Cosmetic Dermatology 2010. No part of this publication may be reproduced, stored, or transmitted without the prior written permission of the Publisher.