The grey area between pharmaceutical and cosmetic preparations is increasing, in terms of promises of efficacy as well as the effects. This means more competencies on part of the cosmetician because she now can effectively treat various types of problem skins. Despite the enthusiasm though, it is quite important to respect the limitations in this case in order to avoid conflicts with the medical faculty but above all avoid conflicts with the law. Healing and curing activities are explicitly excluded in the Cosmetic Directive. Now, what exactly still falls under the category problem skin and where does the medical indication start? This is a rather complex question that often cannot be answered even by the experts who are in charge of the legislation.
Dry skin is a consequence of a barrier disorder. This type of skin, of course, is extremely sensitive based on the fact that if the skin hydration in the form of water vapor can pass through the skin barrier then the skin barrier, vice versa, is also open for the penetration of irritating working substances, allergens and microorganisms. The skin responds with erythema and itching. Now, the question arises whether we still deal with dry skin in this case or whether we already face the symptoms of atopic eczema? This is a rather difficult question, sometimes even for the physician.
What can be told for sure is that this skin also needs effective care. Dry, non-irritated skin can be treated with a lipid-rich cream which is equipped with a NMF (amino acids, urea) and hyaluronic acid. Atopic skin additionally requires substances that are anti-inflammatory, alleviate the itching and have a calming effect on erythemas. The ideal barrier cream is able to treat all the symptoms mentioned. However, in this context it is not allowed to promise a healing or curing effect. Counterproductive substances Ingredients as well as INCI terms of the preparations used are an important topic, hence. The following issues should be considered: Emulsifiers may facilitate barrier disorders. Sensitizing preservatives are counterproductive. The same applies for scents that already easily pass through the skin barrier of healthy skin. Mineral oils form a coating film on the surface and reduce the natural recovery potential of the skin.
Clinical studies show that a professional selection of cream bases and active agents can already achieve excellent results. In other words: we have now changed into the field of corneotherapy. Opposed to it is the conventional pharmaceutical treatment with its specific indications. The comparison The following table, which is not intended to be exhaustive, though, shows the indication in the first column, the second columns lists the typical pharmaceutical active agents and the last column names the alternative cosmetic agents for the adjuvant cosmetic skin care. As mentioned above, the appropriate cosmetic formulations can already achieve freedom of symptoms for the patient. This already seems like a gift to the individual concerned as he does not have to be afraid of the side effects which are characteristic for pharmaceutical preparations.
If the medical treatment with pharmaceutical active agents is combined with an adapted skin care, we refer to adjuvant corneotherapy. Quite often even identical active agents are used, however, with differing functional properties. But what is to be said against the use of azelaic acid (up to 1 per cent) as a consistency substance in a cosmetic skin care product for the rosacea skin? By way of comparison pharmaceutical preparations contain a multiple dosage and show antimicrobial activity. It can be assumed that specifically in liposomal preparations this component will synergistically contribute to the recovery process. There is an optimal interaction, if both pharmaceutical and cosmetic area apply the same base creams. In certain cases another alternative may be only the use of sera respectively tinctures instead of cream bases. Indication | Pharmaceutical active agents (partly also oral applications) | Cosmetic active agents | acne (oily skin)
oily skin with efflorescences and comedones | benzoyl peroxide, retinoids, erythromycin and other antibiotics, azelaic acid, linoleic acid, salicylic acid, hormones, fruit acids, zinc oxide | phosphatidylcholine (liposomes)1), linoleic acid, salicylic acid, azelaic acid, betulinic acid, vitamin A, yeast, ribwort, berberine | acne (dry skin)
low fat skin with efflorescences and comedones; from the 3rd decade of life | benzoyl peroxide, retinoids, erythromycin and other antibiotics, azelaic acid, linoleic acid, salicylic acid, hormones, fruit acids, zinc oxide. | vegetable triglycerides3), phosphatidylcholine (nanodispersions)1), linoleic acid, salicylic acid, azelaic acid, betulinic acid, amino acids (NMF), vitamin A, yeast, ribwort, berberine, phytohormones (red clover, soybean) | actinic keratosis
premalignant chronic solar damage | diclofenac, 5-fluorouacil, 5-aminolevulinic acid, photodynamic therapy (PDT) | boswellia | allergic contact eczema (contact dermatitis)
erythema, blisters, nodules, weeping blemishes after contact with allergens as e.g. nickel | corticoids, antihistamines, local anaesthetics | vegetable triglycerides3) and phytosterols to stabilize the skin barrier, avoiding dry skin | couperosis
weak connective tissue with vascular dilation | retinoids, antibiotics (minocycline, doxycycline, metronidazole), azelaic acid | vegetable triglycerides3), linseed oil, evening primrose oil, azelaic acid, betulinic acid, phosphatidylcholine (liposomes, nanodispersions)1), echinacea, butcher's broom | decubitus (bedsores) | D-panthenol, antibiotics, anti-inflammatory and re-fattening cream bases (prevention) | non-aqueous base of vegetable triglycerides3), phosphatidylcholine, hydrogenated phosphatidylcholine1), and phytosterols (prevention) | dry skin
skin barrier disorder: increased TEWL, low skin hydration | urea, linoleic acid, re-fattening cream bases | vegetable triglycerides3), linoleic acid, ceramides, CM-glucan, amino acids (NMF), phosphatidylcholine (nanodispersions)1), hydrogenated phosphatidylcholine (DMS base)2), aloe vera, hyaluronic acid, CM-glucan | gamma-radiation
erythema and dry skin due to radiotherapy | anti-inflammatory and re-fattening cream bases | phosphatidylcholine (nanodispersions)1), evening primrose oil, linseed oil, amino acids (NMF), CM-glucan, urea, aloe vera, boswellia, echinacea | hyper pigmentations
increased melanin formation | chemical peelings, hydrochinone | ascorbyl phosphate (vitamin C-phosphate); vitamin A, azelaic acid, phosphatidylcholine (liposomes, nanodispersions)1), extracts: mallow, peppermint, cowslip, lady's mantle, veronica, lemon balm, ribwort | ichthyosis (fish scale disease)
disorder of corneocyte desquamation | retinoids, urea (keratolytic) | vegetable triglycerides3), phytosterols, vitamin A, phosphatidylcholine (nanodispersions)1), hydrogenated phosphatidylcholine (DMS-base)2) | inflammation (dermatitis)
(cf. eczema, dermatoses, neurodermatitis etc.) | antibiotics, antimycotics, antihistamines, immunosuppressive agents, corticoids, chamomile, calendula, D-panthenol | evening primrose oil, linseed oil, boswellia, D-panthenol, phosphatidylcholine (nanodispersions)1), echinacea | laser treatments
pre- and follow-up care to impede melanin formation | --- | ascorbyl phosphate (vitamin C-phosphate), phosphatidylcholine (liposomes)1), extracts: mallow, peppermint, cowslip, lady's mantle, veronica, lemon balm, ribwort | neurodermatitis
inflammatory barrier disorder with pruritus, with varying degree of severity | antiseptics, corticoids, immunosuppressive agents, antihistamines, urea (skin hydration, pruritus), polidocanol (pruritus), evening primrose oil, D-panthenol | vegetable triglycerides3), linseed oil, evening primrose oil, linoleic acid, phytosterols, ceramides, urea, allantoin and other amides, phosphatidylcholine (nanodispersions)1), boswellia, hydrogenated phosphatidylcholine (DMS base)2) | perioral dermatitis
small red or inflamed nodules/blisters around the mouth | erythromycin, minocycline, metronidazole, azelaic acid, tannins | boswellia, phosphatidylcholine (nanodispersions)1), azelaic acid, green tea, hamamelis, echinacea, butcher's broom | perianal barrier disorder
sore areas on the buttocks, frequently caused by excessive body hygiene | antiseptics, hamamelis, D-panthenol, anti-inflammatory and re-fattening cream bases | non-aqueous base of vegetable triglycerides3), phosphatidylcholine1), hydrogenated phosphatidylcholine2), phytosterols | psoriasis
exfoliative dermatitis with inflammatory skin condition due to increased and accelerated cornification (hyperkeratosis) | dithranol (cignolin), salicylic acid, urea, tar preparations, corticoids, calcipotriol, retinoids, cyclosporin A, psoralen, fumaric acid, fumaric acid ester | evening primrose oil, linseed oil, phosphatidylcholine (liposomes, nanodispersions)1), fumaric acid, urea | rosacea
erythema and connective tissue disorder | retinoids, antibiotics (minocycline, doxycycline, metronidazole), azelaic acid | vegetable triglycerides3), linseed oil, azelaic acid, betulinic acid, phosphatidylcholine (nanodispersions)1), vitamin A | scars
indurations of the connective tissue with varying degree of severity | retinoids, heparin, chemical peeling | vitamins A, C, E, coenzyme Q10, D-panthenol, phosphatidylcholine (nanodispersions)1), hydrogenated phosphatidylcholine (DMS-base)2) | striae
scarred tissue caused by hyperextension | vitamin A acid, trichloroacetic acid (chemical peeling) | prevention: rose hip seed oil, linseed oil, vitamin E, coenzyme Q10, phosphatidylcholine (nanodispersions)1) | sun burns and burns
(erythema) | antiseptics, NSAID, D-panthenol | linseed oil, linoleic acid, D-panthenol, phosphatidylcholine (nanodispersions)1), echinacea, boswellia | toxic degenerative eczema
chronic cumulative toxic contact eczema | corticoids, allantoin, hamamelis, antiseptics, D-panthenol, anti-inflammatory and re-fattening cream bases | vegetable triglycerides3), evening primrose oil, linseed oil, phytosterols, hydrogenated phosphatidylcholine (DMS cream base)2), ceramides, urea, allantoin, D-panthenol, hamamelis |
Annotations to table: Phosphatidylcholine itself is a very effective active agent due to its linoleic acid content. On the other hand, it serves as an intensifying agent for the penetration of polar aqueous agents (in liposomes) and lipophilic agents (in biologically degradable nanodispersions). In particular fat oils as e.g. linseed oil, evening primrose oil as well as fat-soluble vitamins become better available for the metabolism and more acceptable for the customers in terms of sensorial properties. Besides triglycerides, phytosterols, squalan and ceramides, hydrogenated phosphatidylcholine is a texturing component of emulsifier and preservative free DMS base creams with skin-related membrane structure. Vegetable triglycerides can be neutral oils (medium-chain triglycerides), avocado oil, wheat germ oil, almond oil, or the like. Specific triglycerides like evening primrose oil (main active agent: gamma-linolenic acid), linseed oil (main active agent: alpha linolenic acid), rose hip seed oil (linoleic acid & alpha-linolenic acid) are listed separately. The active agents listed in the table above are used separately or in adequate combinations depending on the specific skin condition.
Dr. Hans Lautenschläger |
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