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Daily Care for Acne, Hyperpigmentation, Aging, And Skin Care Department Daily Care for Acne, Hyperpigmentation, CE 2.0 Aging, and Sensitive Skin ANCC Contact Jennifer Linder , MD Hours hoosing the correct daily care ACNE to gently exfoliate acne include C regimen for your patients’ mild alpha hydroxy acids (AHAs), specific skin condition does not At least 90% of the population salicylic, azelaic and kojic acids, have to become an overwhelming has suffered from the devastat- and creamy scrubs formulated task. Determining which ingredients ing effects of acne at some point with smooth, round beads such to include can form the foundation in their life ( Szabo & Kemeny , as polyethylene or jojoba beads 2011). This chronic skin disorder ( Baldo et al., 2010). for the successful treatment of each presents in four grades: Grades Increased sebum production of the most common skin condi- I and II—acne simplex; Grades must be controlled to effectively tions. In turn, you and your patients III and IV—acne vulgaris. Each address this condition. A misguid- will achieve quick and long-term grade is marked by the erup- ed practice often used by those success. Although each patient’s tion of a combination of pustules, suffering with acne is the over- skin is a unique combination of papules, comedones, or cysts. drying of the skin. Harsh, abra- their environment, lifestyle choices, Understanding the etiology of sive, or overly drying products hereditary background, and current acne is imperative to determining can cause an increase in sebum product usage, there are specific an appropriate daily care routine. production and further inflam- ingredients that will help minimize The four main causes of this con- mation, exacerbating the very the appearance of the more com- dition are increased keratiniza- condition being treated. Science monly treated skin conditions: tion within the follicle, increased indicates that acne patients are sebum production, Propionibac- deficient in essential fatty acids acne, hyperpigmentation, aging, terium acnes ( P. acnes ) bacteria in their surface lipids, which can and sensitive skin. proliferation, and inflammation also result in increased sebum (Mancini, Baldwin, Eichenfield, production ( Treloar , 2003). Oils Friedlander, & Yan, 2011). To rich in essential fatty acids, such Jennifer Linder, MD, is in private practice, Dermatology and Mohs Surgery, Scotts- be effective, a daily care routine as borage seed oil, wheat germ dale, AZ; Chief Scientific Officer, PCA SKIN, for patients suffering with acne oil, and grape seed oil, can actu- Scottsdale, AZ; and Assistant Clinical Pro- should address these four main ally decrease sebum produc- fessor, WOS, Department of Dermatology, University of California, San Francisco. Dr. causes. tion, helping alleviate persistent Linder is a spokesperson for The Skin Can- Desquamation slows in acneic breakouts. Jojoba oil is also a cer Foundation; a member of the American skin due to increased sebum pro- satisfactory choice for those suf- Academy of Dermatology, the American Society for Dermatologic Surgery, and the duction and increased adherence fering with acne as its molecu- American College of Mohs Surgery; and of keratinocytes within the folli- lar structure closely resembles sits on the Editorial Board of the Cosmetics cle wall (Hsu, Litman, & Brodell, that of natural sebum, minimiz- Journal. 2011). Gentle exfoliation can help ing overproduction (Sandha & The authors report no conflicts of interest. minimize impactions by encour- Swami , 2009). Address correspondence to Jennifer Linder, MD, 6710 E. Camelback Road, Suite 220, aging the desquamation of com- A critical step in treating acne Scottsdale, AZ 85251. pacted surface cells. Ingredients is controlling the P. acnes bacte- DOI: 10.1097/PSN.0000000000000011 that have been found effective ria. Daily use of a cleanser or spot 172 Plastic Surgical Nursing ❙ October–December 2013 ❙ Volume 33 ❙ Number 4 Copyright © 2013 American Society of Plastic Surgical Nurses. Unauthorized reproduction of this article is prohibited. PPSN-D-13-00030.inddSN-D-13-00030.indd 117272 111/22/131/22/13 77:25:25 PPMM treatment containing benzoyl per- Cutaneous inflammation is a pigmented lesions but also allow oxide delivers oxygen into the fol- direct cause of hyperpigmenta- for improvement in skin function licle where the anaerobic P. acnes tion. The source of the inflamma- and cellular turnover ( Dewandre bacteria reside, effectively reduc- tion can vary from overexposure & Rubin , 2006). This combina- ing their proliferation ( Kircik , to UV rays, hormonal fluctuations, tion of daily care products, along 2013). Salicylic acid is also effec- or cutaneous injury, such as a with professional treatments, will tive because of its lipophilic char- burn, cut, or infection (Briganti, provide an optimal outcome for acteristics and ability to penetrate Camera, & Picardo, 2003). The the patient. oil-filled follicles to clear impac- beginning of pigment formation Inhibiting melanogenesis at tions (Baumann, Oresajo, Yats- takes place after the initial trigger multiple points is imperative for kayer, Dahl, & Figueras, 2013). causes the release of melanocyte- patients suffering with unwanted Controlling inflammation is stimulating hormone ( Briganti et pigment. To discourage pigment key when customizing a daily al. , 2003). Once this process is set formation, strategic integration care regimen for acne patients. in motion, a few strategies must of the following melanogenesis- Anti-inflammatory ingredients be executed: gentle exfoliation, inhibiting ingredients into a daily that work to soothe the skin encouraging cellular turnover, care regimen will halt the chain and minimize irritation include inhibiting the melanogenesis pro- reaction that results in melanin bisabolol (the active component cess, and consistent use of broad- deposition ( PCA SKIN , 2013): found in chamomile), aloe vera, spectrum UV protection. panthenol, salicylic and azelaic Because hyperpigmentation • Hydroquinone is synthetically acids, boldine extract, resvera- is a direct result of inflamma- produced or naturally found in trol, and epigallocatechin gallate tion, it is advisable to take a wheat, berries, coffee, and tea. from green tea ( Strowd , 2012). low-dose approach when exfo- It inhibits the binding of copper Ultraviolet (UV)-induced inflam- liating the skin. As keratinized to tyrosinase and induces mel- mation can antagonize the skin cells are exfoliated, pigment anocyte-specific cytotoxicity. of acne-prone patients, making deposition on the surface will • Retinoids are synthetically pro- sunscreen use essential. Broad- also dissipate. Using smooth, duced. They suppress the activ- spectrum sunscreen products round beads as the medium for ity of tyrosinase, decrease the containing higher percentages of exfoliation instead of crushed amount of melanosomes, and zinc oxide can make a profound kernels or nut hulls ensures inhibit melanosome transfer. difference in minimizing inflam- effective exfoliation without • Phenylethyl resorcinol is syn- mation. Additional ingredients causing unnecessary trauma. thetically produced. It inhibits to look for in a broad-spectrum Increasing and regulating cel- the conversion of tyrosinase to sunscreen product include milk lular turnover by implementing L-3,4-dihydroxyphenylalanine thistle-derived silybin and caf- strategic daily care products will (L-DOPA). feine for additional antioxidant amplify results and take treat- • Undecylenoyl phenylalanine protection. ment outcomes to the next level. is synthetically produced. It Stimulating cell renewal will aid prevents the synthesis of the in facilitating the removal of mel- melanocyte-stimulating hor- HYPERPIGMENTATION anin-filled keratinocytes ( Brigan- mone and, as a result, the for- ti et al. , 2003). The family of vita- mation of tyrosinase, melanin, One of the more challenging con- min A derivatives, also referred to and melanosome transfer. ditions skin health care profes- as retinoids, has been used with • Arbutin is naturally found sionals aim to treat is hyperpig- much success because of its high in wheat, pears, bearberries, mentation. This frustrating con- level of efficacy in the regula- blueberries, and cranberries. dition can affect a wide range tion of cellular proliferation and It suppresses the activity of of patients and can be caused turnover, bringing healthy cells tyrosinase and inhibits mela- by myriad internal and external to the surface at an increased nosome maturation. factors. Outstanding results are rate ( Halder & Richards , 2004). • Kojic acid is naturally found often achieved when 2 treatment Pure retinol (0.5%) is often toler- in soy, mushrooms, and rice considerations are addressed: ated well when slowly integrated bran. It chelates copper bound daily application of melanogen- into the patient’s nightly rou- to tyrosinase and decreases the esis inhibiting ingredients and tine to regulate cellular turnover number of melanosomes and proper patient education. and bring dyschromias closer to dendrites. The melanogenesis process is the surface ( PCA SKIN , 2013). • Glycyrrhiza glabra root extract a complex and often misunder- Superficial blended chemical (licorice root) suppresses the stood chain of events that must peels performed every 3 weeks tyrosinase activity of melano- be controlled at varying points. will not only help remove the cytes without cytotoxicity. Plastic Surgical Nursing ❙ October–December 2013 ❙ Volume 33 ❙ Number 4 173 Copyright © 2013 American Society of Plastic Surgical Nurses. Unauthorized
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