Mineral Makeup and Its Role With Acne and Rosacea Jane Iredale, MA; Jennifer Linder, MD

Rosacea and acne have been the cause of physical and emotional distress forpatients worldwide. Part of the distress has originated from the inability to find products that provide coverage without exacerbating the conditions. This includes understanding the role of certain ingredients with their attendant negative and positive effects. Fifteen years of experience has shown that mineral makeup can play a large part in helping to repair patients' self-esteem as well as playing a meaningful role in skin improvement.

IDENTIFYING AUTHENTIC For physicians to assess mineral makeup and its ben­ MINERAL MAKEUP efits for their patients with rosacea and acne, it is neces­ Patients with acne and rosacea frequently seek options to sary to explore the chemical composition of authentic cover what they consider to be visually frustrating condi­ mineral powder. Many makeup brands are now mar­ tions. Regrettably, they often make choices that are not keting products they call mineral makeup, but they effective and potentially detrimental to their situation. do not utilize authentic minerals in their formulations. To serve these patients better, physicians should educate The incorrect use of the word mineral as a marketing themselves and their staffs about camouflaging options. term confuses patients and can lead to the use of prod­ Mineral makeup can be a satisfactory solution as it is a ucts that can potentially worsen their condition due to healthy, skin-friendly alternative to traditional makeup. problematic ingredients. Mineral makeup not only provides superior coverage and The original definition of mineral makeup is a makeup is easy to use, but it is also UV protective, noncomedo­ that eliminates talc, potential skin irritants, and comedo­ genic, and anti-inflammatory It is beneficial for physi­ genic ingredients, all of which are critical for patients to cians to increase their understanding of authentic mineral avoid if they have acne and rosacea. Authentic mineral makeup because, as with skin care, patients expect phy­ powders are primarily comprised of combinations of tita­ sicians to be the experts when it comes to anything that nium dioxide (TiO2), zinc oxide (ZnO), iron oxides, mica, affectsthe health and appearance of the skin. bismuth oxychloride (BiOCI), or boron nitride (BN). In authentic mineral powders, the minerals will appear at the top of the ingredients list because ingredients must Ms. Iredale is Founder and Chief Executive Office,; Iredale be listed in descending order by volume. In traditional Mineral Cosmetics, Ltd, Great BaJTington, Massachusetts. makeup, minerals are usually listed on the label under D1: Linder is a board certified dennatologist and fellowship­ the phrase may also contain, indicating that they may or trained Mohs surgeon in private practice, Scottsdale, may not exist in the formula and thattheir percentage is Arizona, and Clinical Instructo,; University of California, likely to be minimal. San Francisco. Unfortunately, the most common ingredient in tra­ Ms. Iredale is Founder and Chief Executive Officer ofIredale ditional makeup is talc, comprising 70% to 90% of the Mineral Cosmetics, Ltd. Di: Linder is a consultant, spealm; and formula. Although talc, also known as soapstone, is a l10norariwn recipient for sanofi-aventis US LLC, and a con­ mineral (magnesium silicate hydroxide), the definition of sultant, spealw; and honorarium recipient for Alle,gan Facial an authentic mineral makeup is one that contains no talc. Aesthetics. D,: Linder is also Chief Scientific Officer for PCA The dilution of actual mineral pigments in talc diminishes SKIN, in which she has an equity stahe. their benefits, deadens the look of skin, and increases the Co1Tespondence:Jane Iredale ([email protected]). requirement for reapplication. Coverage with a heavily

VOL. 22 NO. 8 • AUGUST 2009 • Cosmetic Dermatology® 407 MINERAL MAKEUP talc-based makeup is at best unsatisfactory and camou­ together Lo maximize the benefits and effectiveness of flage is almost impossible. mineral makeup. An authentic mineral formula containing a high per­ centage of minerals provides numerous benefits to patients Titanium Dioxide with acne and rosacea including sun protection, lack of Found in the minerals rutile (beach sand), anatase, and comeclogenic ingredients, anti-inflammatory action, and brookite (relatively rare), Ti02 is a naturally occurring versatile coverage. This concentrated pigment also gives oxide of titanium. lt is seldom used raw because of its the mineral powder adherence that rarely transfers or photocatalytic propensity. To make it effective and ben­ necessitates reapplication, which makes them useful for eficial, Ti02 is surface treated to eliminate oxidation and busy patients. to increase its ability to refract UV rays. Dimethicone is commonly used for this purpose, due to its ability to COMMON MISCONCEPTIONS increase the light-scattering properties of Ti 02. Approved

To comfortably answer patients' questions, it helps to have as an active physical sunscreen ingredient, Ti02 is anti­ a basic understanding of several of the common miscon­ inflammatory and provides coverage. ceptions about the minerals that are in mineral powders. Minerals used in mineral powders are inorganic, Zinc Oxide defined as without carbon molecules. Because carbon Manufactured from the mineral zincite, ZnO is a pure compounds are the basis for all living organisms, inor­ white mineral known for its anti-inflammatory and anti­ ganic compounds are considered to be of nonliving or microbial properties and is approved as an active physical mineral origin rather than biologic origin. Their inert sunscreen ingredient. nature eliminates the 1isk for bacterial contamination. This is in contrast to organic, defined as that which Mica contains carbon and therefore requires preservatives to Mica is naturally occurring; however, natural mica has prevent decay and contamination. not been used in cosmetics since 1960. Currently, all mica No minerals formulated in cosmetic powders are used used in cosmetics is manufactured. Mica can be used in directly from the earth and some are entirely manufac­ larger particle sizes to provide shimmer, or in small parti­ tured. Most minerals go through extensive refining pro­ cle sizes to render it matte and absorbent to the benefit of cesses and should be classified as inorganic compounds patients with oily skin. It is also ofte!1 used as a colorant. (eg, Ti02 and ZnO). A brittle metal that is used exten­ Although it is rare, some sensitivity to mica can occur. sively in mineral makeup, BiOCl is found as the mineral bismuth in the earth's crust and in certain types of ores. Bismuth Oxychloride This mineral requires considerable refinement and purifi­ Originating as the mineral bismuth, BiOCl is processed to cation before it can be used topically. produce an iridescent white or nearly white metal powder. Iron oxides used for cosmetics are wholly synthesized Its sheen has led it to being called synthetic pearl. It adds to avoid the heavy metal contamination found in nature. color, coverage, and adhesion to the finished product. Authentic minerals have no relationship to mineral oil, Of all the ingredients in mineral makeup, this is the one which is a liquid petrolatum, a by-product of petroleum. that is often blamed for irritation, usually clesc1ibed as As there is no scientific definition of the term natural as itching and burning. Although BiOCl is commonly used it relates to cosmetics and cosmeceuticals, the common in traditional makeup, it is present in mineral makeup in question asked by patients whether mineral makeup is larger quantities. natural cannot be truly answered. Boron Nitride WHICH MINERALS ARE USED AND WHY Manufacturedas a vvhite, silky powder, BN provides smooth­ The primary minerals used in mineral makeup are ben­ ness, coverage, slip, and sheen. lt is also known as the "soft eficial to patients with acne and rosacea because many focus" mineral because of its light-refractive qualities. are photoprotective, water resistant, noncomedogenic, 1 innately antibacterial, anti-inflammatory, and camouflag­ Iron Oxides ing. Mineral makeup is often favored over other makeup Iron oxides, commonly known as rust, are primarily foundations by patients with erythema following chemi­ used as colorants. All iron oxides used in cosmetics are cal peels and laser resurfacing, erythema caused by acne, required to be synthesized under stiict laboratory pro­ rosacea, melasma, and postinflammatory hyperpigmen­ cesses. Iron ore cannot be used directly from nature clue tation. 1 Several key mineral ingredients are combined to its heavy metal content.

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PROBLEMATIC INGREDIENTS Binders Mineral makeup was developed to benefit the conditions Binders, substances that hold powders together, can be that typically occur or worsen as a result of wearing tradi­ comedogenic, such as octyl palmitate, or can be ben­ tional makeup. Some types of acne, inflammation, contact eficial to the skin, such as dimethicone. This silicone is dermatitis, and allergies can be exacerbated or caused noncomedogenic, nonacnegenic, nonirritating, and non­ by ingredients commonly found in traditional makeup. 2 allergenic.3 Silicones also hold moisture in the epidermis Some ingredients that have been identified as problematic similar to the lipid bilayer, which is important to rosacea are emulsifiers, drug and cosmetic (D&C) dyes, fragrance, sufferers because dry skin and barrier dysfunction are synthetic prese1vatives, binders, and some mineral oils. common. Not addressing the banier dysfunction that leads to increased sensitivity, dryness and dehydration Emulsifiers will typically worsen the symptoms of rosacea.9 Emulsifiers potentially aggravate acne due to follicular irri­ tation. It is reasonable to assume they are acneic because Mineral Oil they emulsify the sebum and proteins residing within and Mineral oil is comedogenic. It is important to note that around the follicles3 Detergents are also known instiga­ some oils rich in omega-3 and omega-6 essential fatty tors of irritant contact dem1atitis reactions. 3 acids have demonstrated benefits for acne patients, to in contrast to mineral oil. D&C Dyes By eliminating the problematic ingredients identified, Colorants approved for drugs and cosmetics, known as the result is a makeup that produces fewer negative D&C dyes, were once derived from coal tar and are now effects in the skin. However, well-formulated mineral from petroleum. They are often comedogenic,4 particularly makeup can go further and claim actual measurable der­ the red dyes, which are commonly used in blush and result mal benefits. in breakouts in the cheek area. Every batch of syntheticdye is tested by the US Food and Drug Administration (FDA) BENEFITS for heavy metals and must be certified for use. The FDA Mineral makeup provides UVNUVB broad spectrum recognizes the ubiquitous nature of heavy metals and coverage, ease of use, and camouflage coverage. IL is also allows some parts per million, including lead at 20 ppm. noncomedogenic, nonacnegenic, nonirritating, hypoal­ This came to the publics attention in 2007 when the lergenic, anti-inflammatory, and useful for.all Fi1zpat1ick Environmental Working Group did a study on red lipsticks skin types. manufactured by different companies and found lead in 61 % of the lipsticks tested. 5 Always controversial, there UV Protection have been claims that some D&C dyes are carcinogenic. It is well established that sun protection is of critical impor­ tance to skins health. UV exposure and its resultant inflam­ Fragrance mation is credited with at least 80% of the signs of aging Fragrance can be an irritant, an allergen, and a pho­ and is a well-known trigger for rosacea. Lt is also true that tosensitizer. Ninety-five percent of chemicals used in many of the products that help treat acne make the skin fragrances are synthetic compounds derived from petro­ more sensitive to the sun, thereby increasing the risk for 1 leum. The European Union has led the way in safety damage and postinflammatory hyperpigmentation. t Min­ issues connected with fragrance, which appear on the eral makeup is a usefultool for demrntologists to dispense label as pa1Jw11 in the European Union or Jragrnnce in to their patients with acne and rosacea because it makes the United States. 6 A typical fragrance can contain up to sun protection easy and effective, while also minimizing 100 ingredients, which are exempt from product labeling the appearance of lesions and excessive redness. laws. A group of commonly used ingredients, phthalates ln addition, TiO2 and ZnO are inorganic sunscreens (plasticizers), has been linked to reproductive damage. 7 and the only 2 physical sunscreens listed in the FDA's sun protection monograph. The appropriate grade and Synthetic Preservatives percentage will give broad spectrum protection (UVB Synthetic preservatives are a controversial topic, with and UVA). They also perform well in water resistancy some companies choosing to avoid them altogether. Con­ tests and can reach the level of being very water resistant. tact dermatitis can be seen in reactive individuals exposed However, it would be a misconception to believe that all to synthetic preservatives. It is generally accepted that the mineral makeup provides UV protection. The level of pro­ formaldehyde group of preservatives is likely to cause the tection is dependent on the percentage and type of active most sensitivities. 8 ingredients used as well as the application and amount of

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coverage. For example, raw TiO2 is not an active ingredi­ or look heavy, it is probably an issue with application ent but is classed as a pigment. It is also photocatalytic, technique and not the minerals themselves. Patients can which is the phenomenon by which a relatively small apply minerals easily and quickly if the right tools are used. amount of light-absorbing material, the photocatalyst, Brushes with hand-tied natural hair are usually the tool of changes the rate of chemical reaction without itself being choice, giving the best application and blending properties.

consumed. As a result, raw TiO2 can cause damage to Sponges can be used for heavier camouflage work. the surrounding skin cells when exposed to UV rays. The Mineral powders come in 2 forms, loose and pressed. photocatalytic action is usually avoided by coating Slightly different application techniques apply to each. the particles with either fatty acids, alkyl silanes, alumina, They both require the skin to be cleari and prepared with or silica, such as dimethicone or cyclomethicone. This a layer of moisturizer. The moisturizer should be allowed additional ingredient must be listed on the product label. to absorb before applying the minerals. Mineral foundations can be rated as high as SPF 20 with loose mineral powders can be packaged in 2 ways. a UVA protection of medium. Of course, it is important One is in a jar with a sifter that requires a separate brush, to look for the sun protection level on the product label or a brush that dispenses powder. The other packag­ to ensure adequate UV coverage. ing option is a cylinder that dispenses mineral powder through a brush. To minimize scattering and to allow Ease of Use access to smaller areas such as the eyes and nose, the An authentic mineral powder functions as a founda­ correct tool for loose mineral powder in a jar is a chisel tion, concealer, powder, and sunscreen. Because it is powder brush. Patients should be taught proper applica­ concentrated pigment, it gives maximum coverage using tion techniques to ensure maximum coverage and the the minimum amount of product. It is the way minerals best cosmetic outcome. The brush is dipped lightly into interact with light that creates the illusion of perfection the minerals, any excess is tapped off, and the lid of the rather than traditional coverage, which is dependent on container or dish is used to work the powder into the the amount of product applied. brush so it is evenly distributed. The minerals should Minerals interact with light in multiple ways. They cling to the bristles all the way around the brush and not allow light to pass through the particles so it bounces off just on the ends. One brushload is then applied to each the skin, reflecting back some of its hue, literally taking quadrant of the face. The minerals should be applied in on the color of the skin. Minerals reflect, refract, and dif­ thin layers, finishing with downward strokes. If too much fuse light, creating a soft focus effect which minimizes is applied, a sponge with a nap (a flocked sponge) can be imperfections. They give a luminous .appearance to the employed to remove any excess. If additional coverage skin and impart a healthy, youthful glow. is needed in specific areas, a sponge can be used to spot This interaction with light makes matching color to treat as necessary. the skin easier in comparison to traditional makeup. In An alternative application technique for loose minerals fact, minerals blend so well with the skin that demarca­ is a brush that dispenses powder. It should be primed tion lines are rarely obvious. For coverage of the redness by running the brush over the knuckles or a tissue in caused by rosacea and acne, a yellow-based mineral pow­ order to visualize when the powder begins to disperse der eliminates the need for other types of camouflage. and to judge the proper amount of product needed. Mineral makeup comprises a variety of particle sizes. Circular motions are preferred when using this type of When applied to clean, moisturized skin, these par­ brush, beginning on the area of the face that needs the ticles cling together and create a surface tension that most coverage. overcomes gravity and holds the minerals tightly to the Pressed mineral powders have the advantage of being skin. The result is that they resist running, creasing, and easier to apply than loose minerals. Similar application smearing and can only be removed with a cleanser. As a techniques as those for loose powder are used; however, consequence, there is far less transference with mineral a flat-ended, natural hair brush works best with pressed makeup compared to traditional makeup. This resis­ powders. These pressed formulations often contain skin­ tance to transference adds a dimension of comfort for enhancing ingredients, such as antimddants, although the patients with acne or rosacea as they go about their daily pressing agent may or may not be beneficial. For example, lives without the continual concern of reapplication of as noted previously, octyl palmitate is comedogenic whereas their camouflage. dimethicone is not. For patients with acne and rosacea, it If minerals are applied properly, they should feel weight­ is critical they receive physician guidance on ingredients less. Some wearers report that for the first time in many to avoid. This education supports their treatment plan and years they can feel the air on their skin. If minerals feel reduces the likelihood of worsening their condition.

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Camouflaging Skin Imperfections sha_de can be applied before finishing with a layer of the The importance of camouflage cannot be underestimated pink-toned complexion shade. for patients suffering with acne and rosacea due to the If more coverage is needed, a flocked sponge can be immeasurable effect the diseases can have on patients' used to pick up additional powder. After working the quality of life and self-image. 2 These patients will find a powder into the sponge to ensure even distribution, way to cover the visible signs of their conditions whether the additional minerals can be applied with a roll-press it is recommended by a doctor or not. Without informed motion. A facial spritz can be utilized to set the miner­ choices, the camouflage they choose could be detrimental. als on the skin. Proper selection of mineral makeup It is important for dermatologists to recommend products and application technique are critical for patients of all to their patients that will allow them to minimize the Fitzpatrick skin types to achieve the healthy, visually appearance of their condition during treatment. These appealing results that they desire. informed recommendations will help patients avoid selecting a camouflaging product that may exacerbate the ADDITIONAL BENEFITS very condition they are working to hide. Mineral powders For the patient with rosacea and acne, a makeup that have been used to positive effect by dermatologists and claims it is noncomedogenic, nonacnegenic, nonirritat­ plastic surgeons for 15 years to camouflage imperfections ing, hypoallergenic, and anti-inflammatory must seem of all types. Some dermatologists have stated that min­ like the Holy Grail. However, these claims may or may eral makeup is a revolutionary addition to the cosmetic not be substantiated from brand to brand. There are camouflage market and that they offer an inexpensive legitimate laboratory tests that can be conducted forcom­ alternative forpatients. 13 edogencity and irritancy and they should be performed Mineral makeup is different from traditional camou­ by responsible manufacturers. Acnegenicity is harder to flagein other important ways, such as the time it takes to determine and is a separate issue from comedogenicity. achieve satisfactorycoverage and its subsequent removal. According to Draelos,3 it is of great importance when Traditional camouflage products are notoriously time selecting products for patients with acne and rosacea. consuming to apply. Depending on the severity of the Draelos3 contends that cosmetics that are acnegenic in lesions or flushing, a patient with acne or rosacea could one patient are hot necessarily acnegenic in another. The spend up to an hour attempting to achieve coverage formation of acne caused by cosmetics is rapid, usually that does not draw attention to itself. Many camouflage developing within 48 to 72 hours after product applica­ products require special cleansers that can be irritants in tion. Unfortunately, there are no accepted industrywide themselves, such as solvents containing propylene glycol, protocols to follow for acnegenicity testing. As a result, surfactants containing sodium lauryl sulfate, and alkaline many manufacturersrely on testimonials from consumers soaps. In contrast, mineral makeup is quickly applied and and responses from dermatologists. 3 needs no special cleanser for removal. An additional advantage of minerals is that they allow In addition to application, color matching is critical to the skin to breathe and functionnormally They lay on the optimizing coverage of acne and rosacea. Green has tra­ skin like overlapping fish scales, helping to lessen trans­ ditionally been used to cover redness on the theory that epidermal water loss and provide a filter against airborne green and red are complementary colors and, therefore, pollutants. This is particularly advantageous to sensitive, cancel each other out. This technique works well on an barrier-impaired, rosacea-prone skin. artist's canvas but not on human skin. Unfortunately, the result of green applied over red is a grey, ghostlike pallor, SUMMARY or green, both of which have. to be concealed. A better Once the marketing hype is eliminated, mineral makeup choice is a yellow-toned mineral base to cover redness stands up to its reputation as a genuinely innovative effectively and effortlessly niche product in the cosmetic world. Authentic mineral In natural light, a patient's complexion should be powders perform differently than traditional makeup matched to the powder on the jawline. If the matching from the way they look and act on the skin to the benefits color has a yellow undertone, that same powder is all they offer. Because of its many attributes, mineral makeup that is typically needed to neutralize the erythema. If, is the fastestgrowing segment of the cosmetic industry Its however, the matching complexion shade has a pink tone appeal goes far beyond the requirement for an everyday and if the erythema is not pronounced, then the matched makeup that benefits the skin. It is especially useful to color can be applied to a small section of the face to see those suffering from skin conditions such as acne and if it gives the required coverage. If it does not cover suffi­ rosacea. Minerals have now become an integral part of ciently, a yellow base of the same value as the complexion the tools offered by physicians and skin care specialists

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whose aim is to offer patients a product that not only /ph_risk/comm ittees/sccp/documen ts/out 98_en. pdr. Accessed hides visible imperfections but also enhances the look May 20, 2009. 7. Centers for Disease Control and Prevention. National report on and health of the skin. human exposure to environmental chemicals. http://www.cdc .gov/ExposureRepon. Accessed May 20, 2009. REFERENCES 8. Wilkinson JD, Shaw S, Andersen KE, et al. Monitoring levels or l. Steinman D, Steinman H. Skin camouflage. In: Kaminer MS, Arndt preservative sensitivity in Europe. a IO-year overview (1991- KA, Dover JS, et al, eds. Alias of Cos111clic Surgc1y. Philadelphia, PA: 2000). Contact Der111atilis. 2002;46:207-210. Elsevier Saunders; 2008:107-116. 9. Del Rosso JQ, Lehman PA, Raney SG. Impact or order or appli­ 2. Matsuoka Y, Yoneda I<, Sadahira C, et al. Effects or skin care and cation or moisturizers on percutaneous absorption kinetics: makeup under instmctions fromdermatologists on the quality or lire evaluation or sequential application or moisturizer lotions and or remale patients with acne vulgaris.J Dcnnatol. 2006;33:745-752. azelaic acid gel 15% using a human skin model. Culis. 2009;83: 3. Draelos ZD. Cosmetics in acne and rosacea. Sc111i11 Cutan Med 5111g. 119-124. 2001;20:209-214. 10. Letawe C, Boone M, Pierard GE. Digital image analysis or the effect 4. Fulton JE Jr, Pay SR, Fulton JE 3rd. Comedogenicity or cun-ent or topically applied linoleic acid on acne microcomedones. Clin therapeutic products, cosmetics, and ingredients in the rabbit ear. Exp Dennalol. 1998;23:56-58. J Am Acad Dcn11atol. 1984;10:96-105. 11. Russell JJ. Topical therapy for acne. Am Fam Physician. 2000;61: 5. Environmental Working Group. There's lead in your lipstick: 357-366. what cosmetic companies aren't telling you. http://www.ewg.org 12. I