Healthy skin care is as important as the treatment of skin diseases; Thus, it will be possible to be protected from preventable skin changes. Recently, due to the sensitivity of the society on this issue, it is seen that all available means are used to maintain the healthy and youthful appearance of the skin, apart from the beautification efforts provided by cosmetic applications.
In addition to factors such as age, gender, body area, skin care; It is a complex and demanding process, related to personal skin structure, lifestyle and exogenous factors. In this article, healthy skin care principles are presented based on the different characteristics of the skin.
The basic principles of skin care applied to make the skin look healthy and prevent premature aging signs are cleaning, moisturizing and protecting the skin from the sun. There are also products such as the removal of unwanted hair, removal of dandruff, reduction of sweating, shaving products and masks. skin care; In addition to gender and age characteristics, it varies according to structural features (such as dry skin, oily skin, mixed skin, sensitive skin) and different parts of the body.
Age-related changes in the skin
Various external factors, especially ultraviolet (UV), are as effective as endogenous causes that play a role in aging. UV specifically affects the dermis. As age progresses, chemical factors such as changes in the quality and quantity of proteins, decrease in proteoglycan and hyaluronic acid also play a role in skin aging. In both sexes, dermal thickness decreases around the age of 50. Other changes can be summarized as follows:
- Skin softness is reduced
- While skin tension increases in young adults, there is a rapid decrease with age.
- After puberty, there is a decrease in skin elasticity
- While hormonal changes and sebum secretion increase during adolescence, sebum secretion decreases in adults and especially in postmenopausal women, and the skin becomes dry.
- The rate of corneocyte desquamation decreases with age.
Normal skin can be defined as skin without any visible lesions or discomfort. Biological processes such as keratinization, desquamation, water loss, sebum secretion and perspiration work in harmony.
oily skin; It occurs at puberty in the upper parts of the body where the sebaceous glands are dense. It is in two ways:
- Simple oily skin is common in adolescents and young adults. Thickening of the skin, increased sebaceous secretion, bright appearance on the facial skin, especially on the forehead and nose, are characteristic features. In severe cases, the follicle openings become prominent (kerosis). Mixed leather is a sub-variant of this type. While there is oily skin on one side, dry skin features showing epidermal atrophy and dandruff are observed right next to it.
- Clinically, acne vulgaris and seborrheic dermatitis appear on oily skin.
Dry Skin feels tight, scaly, rough, cracked, as well as coarsening, redness, and sometimes bleeding. Increased transepidermal water loss results in decreased barrier function of the stratum corneum.
Acquired dry skin: therapeutic agents such as a vitamin A derivative; ultraviolet rays; Temporary and regional dryness may occur due to external factors such as cold, hot, wind, dryness, exposure to chemicals such as detergents and solvents.
Structural dry skin: Physiological dry skin can take several forms.
- Fragile skin is located between dry and normal skin, and is seen in women or people with thin skin. Erythema and rosacea often accompany, there is sensitivity to external agents.
- Senile skin: An important feature of old age is dry skin.
- Minor dry skin (Xerosis vulgaris): May be of genetic origin, often seen in pale-skinned women. It occurs especially on the face, the back of the hands, and the arms.
Considering all these differences, three basic applications are accepted in principle in skin care.
MOISTURIZING THE SKIN
Removing dirt, sebum, sweat, dead cells, applied make-up and other external particles that cover the skin during the day to keep the skin healthy and good-looking are the purposes of skin cleansing. Skin cleaning is a social need in modern society. The word “cleansing” is preferred to the word “cleaning”. Because skin cleaning is a more sensitive and cosmetic procedure.
There are various cleaning routes to be recommended for different indications. Social skin cleaning will be explained here. While preparing cleansers, it is considered ideal to eliminate oil and all other sebaceous-derived lipidic secretions; Structural lipids such as cerebrosides and ceramides, which play a key role in preventing excessive water loss in the skin, should be preserved. Choosing the right surfactant is the most important factor to ensure a balanced effect on lipids. Poorly formulated cleansers not only dry out the skin, they also increase the risk of sensitization by subsequent moisturizers (for example, a reaction to moisturizers containing vit A). Strong anionic surfactants will increase the penetration of creams and the risk of sensitization.
Found in cleaners; There are 4 types of surfactants (surfactants), which have detergent, moisturizer, foaming, emulsifier and solubulizer functions. Surfactants have a wide pH range, so they affect the pH balance of the skin. Skin pH averages 5.3 (between 4 and 6.5). Acid pH can be achieved by adding citric acid, lactic acid, lemon juice to cleaners. Moreover; Water, moisturizers (glycerine, lanolin, vegetable oils), preservatives, fragrance and color agents (in some products), stabilizers, foam enhancers, thickeners, antibacterial agents, pH regulators are also included in the composition of the cleaners. Antibacterial additives are recommended for apocrine perspiration-related bad body odors and other medical indications. Transparent soaps contain high glycerin content. The medicinal value of exotic natural fruit and herbal cleansers is not fully known.
Most soaps and detergents are alkaline and increase the skin pH and disrupt the physiological protective “acid mantle” of the skin. These are the cleaners known as conventional soap or toilet soap with sodium salts and a fatty acid compound. In laboratory measurements, it has been shown that the pH of the skin washed with an alkaline soap increases by more than 2 units and this effect continues for 4 hours. In some studies, it has been shown that skin pH can return to normal between 30 minutes and 2 hours after washing with alkaline soap. However, in some people, even this short-term change can cause skin irritation. The increase in skin pH causes significant hardening on the skin surface, especially in the stratum corneum. In addition, frequent washing with soap may cause bacteria and fungi to settle, as it will disrupt the normal flora of the skin. Synthetic soaps (soap-free soaps) called “Sindet (synthetic detergent)” have a pH of 5.5 (mostly non-ionic), so they do not change the skin pH. They can be easily purified, therefore they are preferred. can be summarized as:
CREAMS: There are beeswax-borax type cleansing creams, fermenting cleansing creams, and emulsion cleansing creams. They can be removed from the skin by wiping without the need for washing. It should be preferred to wash with water, as cleaning only by wiping from the skin may cause irritation. They should not be perceived as humidifiers.
LOTIONS: They contain fatty alcohol, they can be wiped or rinsed. Creams and lotions are very suitable for removing make-up and removing solid particles in people with dry skin. Since they are oil-dissolving emulsions, the skin is covered with a moisturizing film while removing make-up. There are also forms developed for normal and oily skin. Creams and lotions also clean sebum, provided that they are washed.
LIQUID CLEANERS: It was developed in the 1950s for eczema in workers. It has been popular in hand and face cleaning since the 1970s-80s. They contain nonionic surfactant, which is claimed to be less irritating. Other advantages are that it is moisturizing and easy to rinse. It is also the best choice for whole body cleansing, but its expensiveness limits its use.
ABRASIVE CLEANERS: It easily removes the dead stratum corneum cells with the particles added into it, without the need for excessive rubbing, and provides a uniform and smooth surface on the skin. It has no superiority over other products in terms of cleaning. It should not be used more than once a week.
CLEANING FACE MASKS: It is not necessary for skin care. After it is applied to the skin as a thin layer, it is waited for 15-30 minutes and removed. It has no advantage over other cleaners.
The cleaners to be used vary according to the skin type. We can summarize them as follows:
CLEANING ON DRY SKIN
Cleansing creams are recommended for dry skin. These products are spread on the surface of the skin with fingers, wiped from the surface of the skin with the help of a napkin. However, as mentioned above, it is preferred to clean with water. Cleansing creams contain compounds that dissolve make-up and dirt on the skin. “Cold cream”, a well-known cleanser, is from this group. More modern products include non-ionic emulsifiers, such as “sorbiton YA esters” that end in a lightly structured compound. The advantage of these is that they do not affect ceramides and cerebrosides. Therefore, they are quite suitable for dry and very dry skin.
CLEANING FOR COMBINED SKIN
In people with combination skin, oily skin is adjacent to dry skin (forehead, nose oily, cheeks dry). In these cases, it is very important to choose a mild oil-in-water emulsion cleaner. Thus, while the excess fat in the T zone is removed, some lipid is added to the dry areas.
In some cases, increased sebum secretion with dry skin (dry seborrhea). In laboratory conditions, it can be shown that transepidermal water loss in the skin is increased in seborrheic individuals. In fact, this observation contradicts the fact that sebum is water-retaining in the skin and thus increases skin moisture. Dry skin does not look dry because it is covered with excess sebum; this is simply due to the sebum holding the cells in dry skin together, thus reducing the characteristic gray dandruff appearance of dry skin.
CLEANING ON OILY SKIN
The best method for this is to use a simple surfactant solution that does not contain oil, wax, or any other super-oily agent that further enhances lubrication.
Oily skin cleansers are expected to not only remove sebum and dirt, but also ensure that the skin is not re-oiled. Thus, it reduces the degree of shine and oiliness that occurs approximately 3 hours after cleaning. A good way to reduce shine is to add oil-absorbing materials, which remain on the leather surface when the cleaner is wiped off. For rinse-off cleaners, this technique is limited. Because when the skin is rinsed with water, the absorbed material will be completely washed. More modern cleaners have recently been developed by adding substances that affect the tension of the skin surface (the skin becomes lipophobic), such as polyquaternium compounds (ceraphyl 60). As a result, the sebum does not spread on the skin surface and stays in the grooves, so the shiny appearance is greatly reduced. According to these results, the oily appearance can be reduced by only affecting the distribution of sebum on the skin surface without reducing the amount of sebum.
Seborrhea, which is common in young people, is usually associated with acne. While clearing excess sebum and keeping the follicle openings open, the barrier integrity of the skin should be maintained without removing ceramides and cerebrosides.
The most important step in acne development is “P. acnes” colony. For this reason, acne development is prevented by adding antibacterial compounds such as “hexamidine diisothionate” to cleansers used on oily skin. Meanwhile, by cleaning the sebum in the follicle mouth, bacterial colonization in the infundibulum is also reduced. Still, a point to keep in mind; Even the most sophisticated cleanser (oily/acne prone skin) will not completely treat all skin surface lesions, but it will prevent new comedones from forming. Lotions or creams containing keratolytics such as “salicylic acid” or antibacterial agents such as “benzoyl peroxide” have been developed for treatment. These can quickly reduce the lesions on the skin, but; Since they are rinsed off, they do not remain on the skin surface long enough for the active substance to pass through the skin. This feature limits the effectiveness of the treatment. After all, we can say that a good cleaning will only prepare the skin for the next treatment.
Moisturizers alone do not prevent the skin aging process that occurs with advanced age or the effect of ultraviolet. However, there are some positive effects that can be seen on the skin. These include preventing damage caused by skin dryness; Protecting the skin against dirt, dust and other small particles in the air and providing temporary aesthetic improvement are the most important ones.
Even in the absence of a medical problem, dry skin bothers most people. The easiest way to moisturize the skin is to add water to the skin surface. There are several theoretical mechanisms for this:
- Applying occlusion (closed treatment)
- To assist or reinforce lipid synthesis in the intercellular space (Cholesterol, free fatty acids, ceramides, cerebrosides are used for this purpose)
- Using humectants
- Moisturizers and all other products used for skin care and maintaining skin health are called cosmeceuticals. Stratum corneum and epidermis structure can be improved with appropriate active ingredients to be added to cosmeceuticals.
- Occlusives (concealers, sealants); They reduce TESK by covering and closing the stratum corneum. Sebum and lipid that emerge from dead cells on the skin surface during skin regeneration are factors that have a natural occlusion effect. The most effective occlusive agent used for medical purposes is liquid and solid petrolatum. However, it is not accepted cosmetically as it causes an oily feeling on the skin. Other occlusive agents include paraffin, squalene, lanolin, soybean oil, grape seed oil, sesame oil, beeswax. Being a natural product and obtained from sheep’s wool, lanolin is important because it contains cholesterol, which is one of the stratum corneum lipids, and provides more occlusion, but it is not desired to be included in moisturizers because it is a contact sensitizer. Occlusives are more effective when applied immediately to damp skin after washing.
Occlusives are used as emulsifiers in moisturizers because they give a very oily feeling when applied alone on the skin. Water-in-oil emulsions mostly contain vaseline and leave an oily feel, so they are not preferred. They are still used as hand creams, on very dry skin or in winter conditions. Oil-in-water emulsions are the most commonly used forms of humectants. They are more aesthetic, they can be in the form of lotion or cream. Suitable for skins other than extremely dry or oily skin. Occlusive agents reduce water loss from the skin surface and provide a smooth skin appearance. However, they are effective only as long as they are on the skin surface. Also, it is not possible to reduce water loss from the skin surface by more than 40% with occlusives, so they should be used together with water traps.
Humectants are water-soluble substances that can penetrate the stratum corneum and bind water at a high rate there. When the humidity in the atmosphere is above 80%, they have the ability to absorb moisture from the environment and the epidermis. therefore they are used in combination with occlusives. As water traps absorb water into the stratum corneum, they provide slight swelling, making the skin look smooth and wrinkles temporarily reduced. It is possible to classify humectants in humidifiers into three groups:
- Small molecule compounds such as glycerin, propylene glycol and sorbitol,
- Macromolecules that cannot penetrate the skin such as glycosaminoglycans (such as hyaluronic acid, mucopolysaccharide), elastin, collagen,
- Natural moisturizing factors such as urea, lactic acid, glycolic acid, malic acid, pyruvic acid phospholipid. Liposomes found in various cosmetic products are in phospholipid structure.
A good moisturizing product should include occlusive and humectants together. Thus, they moisten the corneum and release water without making a definite occlusion. They have a water carrying capacity of 85% in terms of water release, thus providing effective skin elasticity by quickly giving them to the environment they are in. The softening is the most in the first few minutes, this depends on the water itself, it returns to its original state as the water is withdrawn. The real effects of moisturizers are measured by the long-term effects of the moisturizer on the skin surface related to the water holding capacity provided.
Depending on the patient’s age, gender, skin type, lifestyle and body area to be applied, it may be desirable to include some other substances in the humidifier.
Alpha hydroxy acids (AHA): In addition to showing keratolytic effect by reducing corneocyte adhesion in the lower parts of the stratum corneum, they also stimulate epidermal cell proliferation. Str thins the corneum, making it more flexible. It can increase the synthesis of AHA, GAG and collagen. It provides a taut and bright appearance as well as reducing fine lines and pigmentation on the skin. AHAs should be included in humidifiers in low concentration (4%) in sunny seasons and daytime sunscreens should be recommended. Body moisturizers should also contain AHA.
Antioxidants; free oxygen radicals (SOR) formed by the effect of UVR are theoretically responsible for skin aging. The five antioxidants known as “antioxidant network” are Vit C, Vit E, glutathione, lipoic acid, coenzyme Q10. Antioxidants such as Vit C and Vit E can prevent cell damage caused by SOR. Therefore, on intense sunbathing days, daily care products should include sunscreens as well as restoratives such as antioxidants. Apart from the antioxidant effect of Vit C, it is also recommended as a preventative for wrinkle formation due to its effect on collagen synthesis.
Tretinoin has an inhibitory effect on metalloproteinases: It reduces wrinkles, improves skin structure, and reduces lentigo and actinic keratosis.
Sunscreens should also be added to moisturizers and other cosmetics.
Today it is accepted that the main cause of skin aging is sun damage. Therefore, moisturizers must contain UVB and UVA protection. SPF 8 is sufficient for daily use.
Exotic ingredients: Ingredients such as allantoin, gelatin, vitamins, proteins, royal bee gel were not found superior to other ingredients in moisturizers. Recently, soy and its derivatives, which have an estrogen-type effect, and green tea are also included in the composition of expensive moisturizers. Since it is only an animal experiment, further studies are needed on this subject. Some moisturizers contain a substance called “spermaceti” obtained from whales, but it is clear that this substance, which is banned in the USA, will not be accepted by those who are against whale slaughter.
Surface water binding and release does not solve the problem of dry skin, but there is a significant improvement with an increase in internal water binding capacity. Modern moisturizers can increase water retention in the epidermis and dermis by stimulating the synthesis of GAG. This is achieved with vitamin A derivatives such as retinyl palmitate in the formula. GAGs, which are long chain amino sugars, increase internal water retention in the skin by binding many times their weight in water. The humidity of the external environment will also affect the water content of the leather. On the other hand, drinking 6-8 glasses of water a day is necessary for the amount of water in the skin, and more does not contribute, it is excreted in the urine.
Humidifier Usage Principles
- People with dry skin should avoid washing their faces frequently with soap.
- Moisturizers should be applied by gently rubbing after the skin is cleaned, while it is still moist.
- The frequency of application should be arranged according to the skin type, it is applied several times a day according to the need and the type of moisturizer applied in dry skinned people.
- If products with high water content are applied in cold weather and immediately go out to cold air, dryness of wet skin will increase in cold weather. In cold, dry and windy weather, moisturizers should be applied 20-30 minutes before going out, and oily creams should be preferred.
- Any product applied to the face should also be applied to the neck.
- Products with a moisturizing effect for the face are also effective for the body, but they are produced in the form of lotions that are easier to apply instead of creams and pomades because they have larger areas.
- It should be recommended to moisturize the body after the bath when the water content of the skin is the highest.
- Body oils applied after bathing in people with very dry skin will provide effective moisturizing.
- Studies have shown that only 50% of creams applied to the skin surface are found after 8 hours.
- Day creams should contain sunscreen.
- The application of creams applied to the face around the eyes should be avoided due to the risk of irritation.
- Classic care products contain 2 types of cream (day, night) according to lipid content and emulsion types. In order to obtain optimum care, the content and frequency of use of each product, the age of the person, skin type, season and climate characteristics should be considered.
Moisturizer selection according to skin types:
Moisturizers containing only humectants will not be sufficient for people with dry skin. Oily creams with a high occlusive effect should be applied. In normal skin, oil-in-water emulsions containing humectant will be appropriate. Except for the dryness that may occur in oily skin in cold weather, there is no need for a moisturizer. If combined skin is in question, moisturizer is not applied to the “T” area unless it is necessary, non-oily moisturizers containing humectant are applied to the remaining parts of the face. However, it may be required after a certain age in people who did not need moisturizer before due to drying of the skin.
Seasonal changes should also be considered.
Fragrances or preservatives in the moisturizer may be sensitizing to people with sensitive skin, hypoallergenic products should be preferred for these people.
PROTECTION AGAINST ULTRAVIOLET
Examples of misuse of sunscreens such as insufficient sun protection factor (SPF) value, application after sun exposure, application only once, or insufficient amount are frequently encountered. In controlled studies, it has been understood that sunscreens that should be applied 2mg/cm2 are applied only 0.5mg/cm2. For this reason, it can be accepted that the sunscreen used can be as protective as half of the SPF value written on it. Sun damage is now recognized as the main cause of skin aging, so moisturizers are expected to contain UVB and UVA protection.
Principles of use of sunscreen:
- The UV protection level in the product to be used must be suitable for the purpose. Sunscreen with at least SPF 15 for daily use; Those with skin types 1 and 2 should use factor 30. Protectors with SPF 2-10 provide minimal protection.
- Not only the skin type, but also individual characteristics (such as being at home, in the car, at work) should be considered.
- It should be applied more often on the nose.
- The effect of water-resistant protectors continues even after 40 minutes of activation in water. After swimming for a total of 40 minutes, the effect should not have decreased by more than 25%.
- The effect of waterproof protectors should continue even after 80 minutes of activation in water.
- Sunscreen should be applied at least 30 minutes before going out into the sun.
- Depending on the sun exposure during the day, the application frequency can be shortened to 2 hours. It should be kept in mind that applying products with high protection factor once or twice a day will not be enough.
- It should be known that the glass is not protective against UVA.
- It should be known that sunscreens do not prevent Vit D synthesis.
- Adequate amount should be applied all over the face, on the hands, on the lips and evenly.
- Because the term “sunblock” means full sun blocking, the FDA will not allow this term to be used.
LEATHER CARE IN DIFFERENT LOCALIZATIONS
- Purification (tonic)
- antiseborrheic, antiacne
- Anti-aging care
- Pigmentation remover
EYE CIRCLE CARE
- makeup remover
- Treatment of bags
- Syndets, liquid cleaners
- Substances that form a protective layer
- Paraffin, wax, cellulose, zinc oxide
- Allantoin, urea
- glycerin, propylene glycol, sorbitol, emulsifier, preservative, perfume, color)
- Moisturizers containing tea tree oil,
- Cleaning (soap, scrub, scrub, antibacterial, shower gel)
- Moisturizer (urea, glycerin, vaseline, after-sun moisturizers)
- Cellulite treatment (thinners)
- Breast care, abdomen, buttocks, thigh area