Clinical Practice CPD Clinical Article
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the first 12 hours which produces 50-60% recovery, with full recovery taking up to three days. In older people this may take up to a week or longer. Reaccumulating skin lipids becomes the most critical factor in restoring barrier function. As stated before, normal skin contains an equimolar ratio of cholesterol, ceramide and free fatty acids of which 50% is the essential acid, linoleic acid. Work by Dr Carl Thornfeldt and other researchers(11, 12) has shown that barrier recovery is markedly accelerated by changing the proportion of the key lipids to a 3:1:1 ratio with ceramide or cholesterol dominance. In one study this ratio produced a 75% barrier recovery within four hours compared to only 35% with the equimolar ratio 1:1:1. Work has shown that formulas containing just ceramide or cholesterol or fatty acids have either no significant barrier repair properties or adversely affect barrier function. Certain non-physiological lipids such as petrolatum, glycerin, lanolin, bees wax, and squalene provide some barrier repair. 100% petrolatum is known to markedly improve barrier function by 43% in 45 minutes. The other non-physiological lipids work by different mechanisms and also improve barrier function, but at different time points and to various degrees. Thornfeldt and others developed skincare technology that combined the best ratio of the three key barrier repair lipids with low therapeutic concentrations of these non-physiological lipids. The EpiB complex, which forms a key component of the platform technology within Epionce skincare, has been shown to produce an 89.6% repair of the skin barrier with complete normalisation after two hours.(6) For extrinsic ageing the ideal repair ratio of the physiological lipids is a 3:1:1 ratio with cholesterol as dominant combined with petrolatum and glycerin between 3-15% concentrations of each. When used regularly, barrier-repairing moisturisers not only help to produce and maintain remission of many inflammatory skin diseases but they also help reverse and prevent the activation of extrinsic ageing. An independent, split face, double blind, prospective controlled clinical study using this barrier repair formulation showed a highly statistically significant
Figure 5: Healthy lipid ratio is key to a healthy barrier
improvement in tactile roughness, clarity and reduction in fine lines and wrinkles after 12 weeks of use.(13) Many of the very light moisturising products are actually very destructive to the external skin barrier because they are deficient in the total amount of lipid needed and often negatively affect the normal skin lipid ratio, thus damaging barrier integrity.
SUMMARY • An intact skin barrier is the first line of defence against harmful environmental insults • The integrity of the stratum corneum regulates DNA synthesis of the epidermis • Many skin diseases and ageing are characterised by external skin barrier abnormalities • A disrupted external skin barrier is a primary driver for unwanted chronic inflammation • After exfoliating procedures, the barrier must be rapidly regenerated, otherwise the benefits of the procedure are reduced • Rapid closure of the external skin barrier postprocedure is achieved with appropriately formulated combinations of physiological and nonphysiological lipids • Practitioners now have available barrier-repair moisturisers proven in clinical studies to treat the signs of ageing skin
Figure 6: Lipid layer made of three lipids, ceramide, cholesterol and free fatty acids
fatty acid (Stearic Acid)
Lipids that make up the external skin
Ageing, skin disease and poor skin repairbarrier are in a ratio of 1:1:1 lead to a deterioration of the skin barrier and Lipids that make up the the normal ratio of healthy lipids changes. external skin barrier are in a ratio of 1:1:1 Epionce is formulated to restore a healthy lipid ratio and external skin barrier.
REFERENCES
cholesterol
Lipids that make up the external skin barrier are in a ratio of 1:1:1
Lipids that make up the external ski As a co-owner of Woodford Medical, Mervyn Patterson is a highly barrier are inDr a ratio ofdoctor 1:1:1 experienced aesthetic providing
1) A.W. Johnson, ‘Cosmeceuticals: function and the skin barrier’, in Cosmeceuticals 2nd ed, ed. by Z.D. Draelos (Philadelphia: Saunders-Elsevier, 2009), pp. 7-14. 2) G. Dell’Acqua, ‘Sensitive Skin and Skin Barrier’, Cosmetics & Toiletries, 123:12 (2008), 71-75. 3) J.A. Bouwstra, G. Pilgram and M. Ponec, ‘Structure of the Skin Barrier’, in Skin Barrier, ed. by Peter M. Elias and Kenneth R. Feingold (New York: Taylor Francis, 2006), 65-96. 4) J.Q. DelRosso, ‘Moisturizers: Function and Clinical Applications’, in Cosmeceuticals 2nd ed, ed. by Z.D. Draelos, (Philadelphia: Saunders/Elsevier, 2009), pp. 97-103. 5) Kenneth R Feingold, ‘The role of epidermal lipids in cutaneous permeability barrier homeostasis’, Journal of Lipid Research (2007), 48: 2531–2546. 6) Medical Barrier Cream Superior in Cutaneous Healing (2014) <http:// www.epionce.com/wp-content/uploads/2011/09/10_ClinicalStudy_ EpionceSuperiorinCutaneousHealing.pdf 7) Z.D. Draelos, ‘Noxious sensory perceptions in patients with mild to moderate rosacea treated with azelaic acid 15% gel’, Cutis, 74(4) (2004), 257-60. 8) Peter M. Elias, ‘Defensive functions of the Stratum Corneum: Integrative Aspects’, in Skin Barrier, ed. by Peter M. Elias and Kenneth R. Feingold (New York: Taylor Francis, 2006), pp. 5-14. 9) CIR publication (1983), “Final Report on the Safety Assessment of Sodium Lauryl Sulfate and Ammonium Lauryl Sulfate”, International Journal of Toxicology 2 (7): 127–181.
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ceramides
a wide range of non-surgical treatments. Financial disclosures: Medical director at Eden Aesthetics. Distributors of Epionce / Agera skincare, and Colorescience mineral makeup. Dermagenesis microdermabrasion and Dermafrac microneedling @drmervpatterson
10) Marrakchi S, Maibach HI (2006). “Sodium lauryl sulfate-induced irritation in the human face: regional and age-related differences”. Skin Pharmacol Physiol 19 (3): 177–80. 11) Peter M. Elias and Kenneth R. Feingold, ‘Does the tail wag the dog?’, Archives of Dermatology, 137 (2001), 1079-81. 12) C.R. Thornfeldt, M. MaoQing, Peter M. Elias et al, ‘Optimisation of physiological lipid mixtures for barrier repair’, J Invest Dermatol, (1996), 1090-1101. 13) Renewal Facial Cream Reduces Signs of Photoaging (2014) <http://www.epionce. com/wp-content/uploads/2011/09/2_ClinicalStudy_RenewalPhotoaging.pdf >
Aesthetics | March 2014