Cosmetic Dermatology
Cosmetic Dermatology
Cosmetic Dermatology
Introduction Procedures
Cosmetics • Chemical Peels
Topical therapies • Microdermabrasion
• Moisturizers • Fillers
• Sunscreens • Botulinum toxin
• Antiaging cosmeceuticals • Platelet rich plasma
• Cosmetic camouflage • Lasers
• Adverse reactions MCQs
Photo Quiz
Introduction
Oil-in-water :
More cosmetically acceptable by patients
Not very effective for very dry skin conditions
Cream or lotion formulations
Water-in-oil :
Create an occlusive film on the skin surface; reduce water loss and
traps moisture in the skin
Stickier, less cosmetically acceptable
More effective for dry skin and ichthyotic conditions
Moisturizers – cosmeceutical agents
Contents of moisturizers :
Stearic, linoleic, linolenic, oleic, and lauric acid, fish oil, petrolatum,
shea butter, and sunflower seed oil Petroleum jelly, lanolin, mineral
oil, and silicones.
Glycerol, pyrrolidine carboxylic acid , Urea, lactic acid, glycolic acid.
Sesame oil, wheat germ oil and Vit E.
Bisabolol, squalane.
Sun and Ultraviolet index
Ultraviolet index :
Informs about amount of harmful effects of UVL on earth on a
particular day.
0-2 - minimal-sunburn occurs over an hour
3-4 - low-sunburn in 30-60 mins
5-6 - moderate-sunburn in 20-30 mins
7-9 - high-sunburn in 10-20 mins
10-15 - v high-sunburn in<10 mins
Sunscreens
Physical : Form an opaque layer which totally blocks out the sunrays
e.g zinc oxide, titanium dioxide and calamine.
Chemical : Absorb the rays and convert the energy to heat which is
diffused. These may selectively protect against UVA or UVB.
UVA blockers : Benzophenones, dibenzoylmethanes, Mexoryl.
UVB blockers : P-aminobenzoic acid (PABA) derivatives, salicylates,
cinnamates.
FDA Protocol
Vitamin A derivatives
Exfoliation, keratin regulation, epidermopoesis, collagen remodelling
and angiogenesis , anti-acne actions.
Improves photodamage, pigmentation, texture, fine lines and
wrinkles.
Retinoid dermatitis, sun sensitivity and irritation are common
problems.
Short contact, night use and low strength is recommended while
starting.
Oral carotenoids are used for photoprotection and anticancer
actions.
Topical Vitamin E and Vitamin C
Vitamin E
Photoprotection, reduces photoaging.
Improves skin roughness and reduces wrinkling.
Anti-inflammatory and immunostimulatory.
Wound healing, emollient properties.
Vitamin C
Water-or lipid-soluble forms.
Photoprotective and anti-inflammatory.
Reduces photoaging and wrinkles.
For effective topical application, vitamin C must be non-esterified,
acidic and optimally at 20% concentration.
Green tea-polyphenols
Soaps : Repeated use may strip the skin of its protective lipid layer.
Shampoos : Daily washing with harsh shampoos can dry the shaft
and make it brittle.
Fragrances : May cause photocontact dermatitis.
Hair colors : Frequent hair lightening or coloring can cause
irreversible damage to the hair shaft. Cosmetic alopecia may follow.
Adverse reactions to cosmetics and cosmeceuticals
Chemical Peels
Microdermabrasion
Microneedling
Injectables - botulinum, fillers, PRP
Lasers and other technologies
Chemical Peels
Mechanism
Epidermal and part of dermal tissue replacement by –
• Destruction
• Elimination
• Regeneration and remodelling
Controlled stage of inflammation
Classification of Peeling : Depth of Injury
Unrealistic expectations
Keloid tendency
Active severe acne
Active herpes simplex or bacterial infections.
Isotretinoin recipient in last 6 months.
Unstable vitilligo and psoriasis.
Associated photo aggravated skin diseases.
Salicylic peels during pregnancy, lactation and those sensitivity to
aspirin.
Phenol peels in cardiac patients.
Chemical peels for acne scars
Fillers
Botulinum toxin
Platelet rich plasma therapy
Intrinsic or Chronological
• Genetic makeup
Extrinsic factors
• Solar effects
• Smoking, Alcohol
• Malnutrition
• Gravitational effect
• Sleep lines
• Muscular action
Mechanisms of skin ageing
Epidermis
Thinner, Flattening of DE junction
Slow multiplication of cells and delayed healing time
Dermis
Loss of dermal thickness
Disorganized collagen bundles, abnormal elastin
Changes in glycosaminoglycans – less water holding power
Changes in appearance
Dryness, Skin peeling
Roughness, Pallor
Loss of protective power, delay in recovery from surface damage
Delaying skin ageing - Tips
Types of fillers :
Temporary : gets absorbed in 3 to 6 months
Semi-permanent : absorbed within 2 years
Permanent : lasts longer than 2 years
Sources :
Heterograft/Xenograft : Bovine collagen, porcine collagen,
hyaluronic acid
Allografts : Human-derived collagen
Autografts : Autologous fat, collagen,fibroblasts
Synthetic : Silicone, polytetrafluoroethylene
Classification of Dermal Fillers
Replacement Fillers :
Restore soft tissue volume lost in deep dermis or subcutaneous
space.
Collagen.
Hyaluronic acids (HAs).
Stimulatory Fillers :
Restore volume by stimulating fibroblast activity, collagen synthesis
and soft tissue growth.
Poly-L-lactic acid (PLLA).
Polymethylmethacrylate (PMMA) - Permanent.
Calcium hydroxylapatite (CaHA).
Target zones that are commonly treated
Storage
2C to 8C for up to 24 mo
Before reconstitution
Up to 6 wks at 4C
After reconstitution
The injections are performed using very small needles after numbing
the skin with a surface anesthetic cream over one hour.
A recovery period involving transient swelling; and in some cases,
bruising which is mild and transient.
PRP evokes an inflammatory response which is desired.
The results are normally seen within 2-3 months and may require 3
to 5 separate sessions.
In general, usually over a 3 to 4 week interval, patients should be
able to see improvements in: skin texture; complexion; and tone.
These improvements can continue for up to a year.
LASER
L - Light
A - Amplification by
S - Stimulated
E - Emission of
R - Radiation.
Principle : Chromophore
Time taken by the chromophore to loose 63% of its heat after being
heated up.
Different chromophores have different thermal relaxation times
depending upon their size.
TRT predicts the PULSE WIDTH to be used for a particular
chromophore.
Target Size TRT
Melanosome 1 1 us
Erythrocyte 7 20 us
Epidermis 50 1 ms
Blood vessel 50 1 ms
Alexandrite Holmium
CO2
KTP Nd:YAG
Ruby Er:YAG
Excimer Argon Dye
488 - 514
190 - 390
Microwaves
577-630
10600
2100
1064
2940
x-rays TV and
532
694
cosmic rays 755 radio
waves
UV VISIBLE
INFRARED
400 nm 700 nm
Lasers
Diode- 28J/cm2,
100ms. 3sessions
Lasers for Pigmented Lesions
Q- switched lasers
Persistent erythema
Vesiculation and crusting
Hyperpigmentation
Hypopigmentation
Scarring