- Email: [email protected]
Facial hyperpigmentations
Course
S55
C8. Dermatocosmetology
brushing and combing and a variety of cosmetic treatments. External weathering factors including humidity, wind, sea-salt, dust and pollution also contribute to the cuticular hair damage, specially in previously (cosmetically) damaged hair or in particular hair alterations as those seen in dysplasic hair. Material: (SEM) Images were obtained from 75 cases including: Hair dysplasia, ectodermic dysplasia, metabolic disorders and external agents. Results: The alterations observed on retrospective microscopic photographs lead us to propose a classifications for cuticular hair damage Grade I (saw-margins of the cuticular cells with detachment and initial fissuration); Grade II (fissuration, depressions and decreased number of cuticular layers); Grade IU (orificies of cuticula and partial decuticulation); and Grade IV (total loss of cuticular layer). Conclusions: The cuticular hair damage provoked by weathering and hair cosmetic procedures in “sensitive” hair such as hair dysplasia can be easily included in our classification in order to clarify the degree of such alteration.
C8 6 El
Cosmetics
for men
R. Baran. 42, Rue des Serbes,
Cannes,
France
The general and the histological aspect of a man’s skin is different from that of a woman’s. The skin care market for men is expanding. Six main types of products provide cosmetic needs. (1) alcoholic perfumery (2) shaving products (3) hair products (4) hair colouring products (5) hair thickeners (6) scalp camouflage (7) washing products (8) antiperspirants and deodorants (9) beauty products and sun protection
IC8-7
Overview
of peeling
Christopher M.E. Rowland Payne. The Royal I C8-4
How to choose
R.P.R. Dawber. Department Hospital,
Oxford,
the right shampoo of Dermatology,
Churchill
USA
The term shampoo comes from the Hindi word CLpn$ meaning to press or knead. It has developed to mean the action of washing the hair and scalp; shampoo sales are approximately 50% of the hair care products market. The science underpinning modem shampoo technology has become diverse, exact and serves the need of such products in their present day multiple functions - not only cleansing, but also conditioning, aesthetic considerations; and the ability to be sophisticated ‘vehicles’ for medical ingredients for treating diseases such as pityriasis capitis, psoriasis and hair shaft infestations. Does it work? I C8-5 Laser epilation: Agneta Troilius. Dep of Dermatol, University Malmoe,
Hospital
Sweden
The longterm removal of unwanted hair has been a challenge for health care for a long time. Since the theory of selective phototbermolysis was proposed in 1983 by Anderson and Parrish many lasers and noncoherent light sources have been produced. Red/near infrared light is transmitted through epidermis to dermis, where the light is absorbed by the melanin in the epidermis, hair shaft and hair bulb with a minimal fraction absorbed by the surrounding tissue. When the proper parameter values are used, the follicle temperature rises above its damage threshold while the temperature of the surrounding tissue remains enough to avoid skin damage. There are individual variations of lengths of the anagen phases and there are anatomical variations of the growth cycle. Results: after several treatments of the early anagen phase: Slower regrowth. Induces telogen in partially damage anagen hair. Reduced diameter of regrowing hair. Lighter hair and decreased hair density. Conclusion: Yes - it works, but the question of permanancy still remains. More research is needed as well as long term results.
Hospital,
London
& Surrey,
Marsden
UK
Peeling is a treatment used by every dermatologist. Indications are legion and include eruptions e.g. psoriasis, lesions e.g. solar keratoses, and field change e.g. solar elastosis. Peeling methods include physical friction e.g. finger friction or loofah friction; desquamating agents e.g. salicylic acid or urea; cryosurgery; fruit acids e.g. glycolic or acetic acid; composite preparations e.g. Jessner’s solution; more powerful chemical agents e.g. trichloracetic acid (TCA) and phenol; and mom powerful physical agents e.g. dermabrasion or laser resurfacing. The therapeutic ratio of desired effect/adverse effect is narrow with the more powerful agents. Using several coats/layers/passes at the same or consecutive treatment sessions improves the therapeutic ratio and helps achieve a more even result e.g. acetone-Jessner-TCA peel. Caution is needed especially in pigmented or vasoreactive (tosaceous) or fine skin types. An accidentally deeper peel results if the skin is consecutively or concomitantly inflamed for other reasons such as a brisk dermatographic response or intercurrent fever. Ill effects principally depend on depth of inflammation and include burning sensation, erythema; exudation, transient dyspigmentation and scarring. Dyspigmentation may occur in all except the fairest of skin types. Mild injuries cause hyperpigmentation and severe ones cause hypopigmentation. Hyperpigmentation depends not only on erythema but also on UV exposure. After treatment sun avoidance is especially important whilst erythema persists. This may be an action of topical retinoids. Phenol has an additional specific melanotoxic effect which is employed therapeutically when its derivative, hydroquinone, is used as a depigmenting preparation. Peeling treatments are effective, adaptable, simple and inexpensive. 1C8-8 1 Facial hyperpigmentations G.E. PXrard. L.i&e,
Belgium
Facial hyperpigmentations are heterogeneous in nature. Epidermal melanoses are due to the hyperactivity of melanocytes with abundant release of melanin to keratinocytes. Freckles,
Course
SSti
CB. Der~norocostt~etology
hormone-induced epidermal melasma and UV-induced pigmentation are typical examples. Dermal melanoses (melanoderma and ceruloderma) are due to the release of melanin into the dermis with storage in dendrocytes. Such aspect is typical for post-inflammatory hypermelanoses and dermal melasma. Pigmented storage diseases belong either to inborn metabolic disorders or to drug-induced hyperpigmentations. Neoplasms of melanocytic and non-melanocytic origin increase in number and diversity with age. Dermoscopy, clinical observation under ultraviolet light, cyanoacrylate skin surface stripping and skin biopsy are of the utmost importance for classification and therapeutic management. Non-invasive measurements of the skin colour are useful to monitor the changes. I C8-9
Therapeutic failures in acne: Cosmetic consequences and management
D. Lehucher Ceyrac’. L. Sulimovic’. Paris,
‘HGpital
Saint Louis,
France
The therapeutic failures in acne may be defined as either primary resistances of juvenile acne to conventional treatments or flare ups with aggravations under oral isotretinoin treatment or occurrence of acne relapses in adults. The common consequence of these relapses is represented by extremely inesthetic scars, especially in predisposed individuals. ‘lXvo types of scars may be encountered: the hypertrophic or keloid scars and the atrophic or depressed scars. Pigmental alterations of the skin are frequently associated. Treatment of these scars should take a number of factors into consideration in order to avoid aggravation of the existing lesions. Some therapeutic measures such as prevention of sun exposure, peeling and depigmentation agents, dermal abrasion with CO* laser are common to both types of scars. Other techniques are more specific for either hypertrophic scars (local injection of long acting corticosteroids alone or combined with cryotherapy, silicone foils, compression) or for atrophic or depressed scars (bovine collagen, hyaluronic acid, punch elevation or excision with graft). C&i 0
Side effects
E. Haneke. Dept Dermatol,
of nail cosmetics Univ
Witten/Heniecke,
Wupperml,
Germany
Side effects of nail cosmetics may be favourable or harmful, occur on or around the nail apparatus as well as far away on the skin or even as life-threatening intoxications, be due to allergy or chemical or mechanical irritation. Frequent use of emollients inadvertently softens the nail plate making it more flexible and shiny, less brittle and improving the periungual skin. Allergy to nail cosmetics varies considerably between different countries with toluenesulfoneamide/formaldehyde resin in nail hardeners and lacquers being the most important allergen causing onycholysis. paronychia, nail dystrophy, nail shedding, irritant and allergic dermatitis. New substances to avoid formaldehyde have brought new allergies. Characteristically, allergic dermatitis is observed from nail lacquer on the face, particularly around the eyes, and on the sides of the neck. Sculptured nails may lead to onycholysis and secondary bacterial and fungal infection due to unfavourable lever conditions of the long nail; permanent
paraesthesia has also been observed. Applying nail cosmetics often is associated with inadvertent trauma. Acetonitrile nail removers when accidentally ingested cause severe cyanide poisoning and have therefore to be kept away from children. C8-11 n
Recent site
allergens
A. Pons-Guiraud. HOpital sur In Pew,
Paris,
according
Saint-Louis,
lnstitut
to the anatomic de Recherche
France
Intolerance to cosmetics should be considered very rare in relation to the importance of the cosmetic market. Nevertheless, in the consultation of dermato-allergology, at the hospital St Louis (Paris), 6% of patients have side effects of cosmetic applications Ubiquitous allergens: Frugrances actually remain the first source of cosmetic allergy. all cosmetics and toiletries contain fragrance materials, even “unscented” or “fragrance free” products may contain a “masking” perfume. The fragrance allergy affects about 1% or 2% of the general population and relevance is only established in about 70% of the cases. The essential oils, more and more used in aromatherapy and parfumery, are responsible for many adverse effects, complicated and prolongated by spices and Ravours in foods and beverages. Preservatives: If the allergy to the chloro-methylisothiaolinone (Kathon CG’) is less frquent because of its decreasing use in cosmetics the Eluryl K 400 and especially the dibromoglutaronitrile, is still a frequent allergen. Wool-wax alcohols and Amerchol L 101: Amerchol L 101 increases the detection of lanolin contact allergy. Emulsifiers: the dimethylaminopropylumine (DMAPA) used in the systhesis of CAPB and contaminant of CAPB preparations is likely to be the actual sensitizer, rather than to CAPB itself. Sunscreens: The contact and the photocontact sensitivity to sunscreens are decreasing because of physical UV blockers incorporated in UV filters and cosmetics. According to the anatomic site: Eye-lids: Colophany, formaldehyde and paratertiarybutylphenol resin, mercury and perfumes are always the main allergens. Lips: Many molecules are allergenic in lipsticks, nail vanishes, dental preparations or foods. Scalp: Except the classical allergens (dyes) new allergens are hydrolysed animal proteins (Crotein Q) added in shampoos or conditioners, hair dye Basic Blue 99.2-7 dihydroxy-naphtalene in hair dyes and even the henna. Nails: The commonest allergen in nail polishes remain the toluene sulfonamide formaldehyde, ongly recently replaced in some products by ester resins. Collaboration between the pharmaceutical and cosmetic industries. It allows tile detection of new allergens and give the best guide for research and progress in the field of cosmetology. References [I] Dooms-Goossens A., Contact allergy to cosmetics. Cosmetics and Toiletries, 1993, 108,43-46. [2] De Groat AS!., Frosch P.J.. Adverse reactions to fragrances. A clinical review. Contact Dermatitis, 1997, 36.57. [3] Sainio E.L., Engstrom K., Henriks-Eckermann M.I., Kanerva L., Allergenic ingredients in nail polishes. Contact Dermatitis, 1 1997.37, 155-162
S55
C8. Dermatocosmetology
brushing and combing and a variety of cosmetic treatments. External weathering factors including humidity, wind, sea-salt, dust and pollution also contribute to the cuticular hair damage, specially in previously (cosmetically) damaged hair or in particular hair alterations as those seen in dysplasic hair. Material: (SEM) Images were obtained from 75 cases including: Hair dysplasia, ectodermic dysplasia, metabolic disorders and external agents. Results: The alterations observed on retrospective microscopic photographs lead us to propose a classifications for cuticular hair damage Grade I (saw-margins of the cuticular cells with detachment and initial fissuration); Grade II (fissuration, depressions and decreased number of cuticular layers); Grade IU (orificies of cuticula and partial decuticulation); and Grade IV (total loss of cuticular layer). Conclusions: The cuticular hair damage provoked by weathering and hair cosmetic procedures in “sensitive” hair such as hair dysplasia can be easily included in our classification in order to clarify the degree of such alteration.
C8 6 El
Cosmetics
for men
R. Baran. 42, Rue des Serbes,
Cannes,
France
The general and the histological aspect of a man’s skin is different from that of a woman’s. The skin care market for men is expanding. Six main types of products provide cosmetic needs. (1) alcoholic perfumery (2) shaving products (3) hair products (4) hair colouring products (5) hair thickeners (6) scalp camouflage (7) washing products (8) antiperspirants and deodorants (9) beauty products and sun protection
IC8-7
Overview
of peeling
Christopher M.E. Rowland Payne. The Royal I C8-4
How to choose
R.P.R. Dawber. Department Hospital,
Oxford,
the right shampoo of Dermatology,
Churchill
USA
The term shampoo comes from the Hindi word CLpn$ meaning to press or knead. It has developed to mean the action of washing the hair and scalp; shampoo sales are approximately 50% of the hair care products market. The science underpinning modem shampoo technology has become diverse, exact and serves the need of such products in their present day multiple functions - not only cleansing, but also conditioning, aesthetic considerations; and the ability to be sophisticated ‘vehicles’ for medical ingredients for treating diseases such as pityriasis capitis, psoriasis and hair shaft infestations. Does it work? I C8-5 Laser epilation: Agneta Troilius. Dep of Dermatol, University Malmoe,
Hospital
Sweden
The longterm removal of unwanted hair has been a challenge for health care for a long time. Since the theory of selective phototbermolysis was proposed in 1983 by Anderson and Parrish many lasers and noncoherent light sources have been produced. Red/near infrared light is transmitted through epidermis to dermis, where the light is absorbed by the melanin in the epidermis, hair shaft and hair bulb with a minimal fraction absorbed by the surrounding tissue. When the proper parameter values are used, the follicle temperature rises above its damage threshold while the temperature of the surrounding tissue remains enough to avoid skin damage. There are individual variations of lengths of the anagen phases and there are anatomical variations of the growth cycle. Results: after several treatments of the early anagen phase: Slower regrowth. Induces telogen in partially damage anagen hair. Reduced diameter of regrowing hair. Lighter hair and decreased hair density. Conclusion: Yes - it works, but the question of permanancy still remains. More research is needed as well as long term results.
Hospital,
London
& Surrey,
Marsden
UK
Peeling is a treatment used by every dermatologist. Indications are legion and include eruptions e.g. psoriasis, lesions e.g. solar keratoses, and field change e.g. solar elastosis. Peeling methods include physical friction e.g. finger friction or loofah friction; desquamating agents e.g. salicylic acid or urea; cryosurgery; fruit acids e.g. glycolic or acetic acid; composite preparations e.g. Jessner’s solution; more powerful chemical agents e.g. trichloracetic acid (TCA) and phenol; and mom powerful physical agents e.g. dermabrasion or laser resurfacing. The therapeutic ratio of desired effect/adverse effect is narrow with the more powerful agents. Using several coats/layers/passes at the same or consecutive treatment sessions improves the therapeutic ratio and helps achieve a more even result e.g. acetone-Jessner-TCA peel. Caution is needed especially in pigmented or vasoreactive (tosaceous) or fine skin types. An accidentally deeper peel results if the skin is consecutively or concomitantly inflamed for other reasons such as a brisk dermatographic response or intercurrent fever. Ill effects principally depend on depth of inflammation and include burning sensation, erythema; exudation, transient dyspigmentation and scarring. Dyspigmentation may occur in all except the fairest of skin types. Mild injuries cause hyperpigmentation and severe ones cause hypopigmentation. Hyperpigmentation depends not only on erythema but also on UV exposure. After treatment sun avoidance is especially important whilst erythema persists. This may be an action of topical retinoids. Phenol has an additional specific melanotoxic effect which is employed therapeutically when its derivative, hydroquinone, is used as a depigmenting preparation. Peeling treatments are effective, adaptable, simple and inexpensive. 1C8-8 1 Facial hyperpigmentations G.E. PXrard. L.i&e,
Belgium
Facial hyperpigmentations are heterogeneous in nature. Epidermal melanoses are due to the hyperactivity of melanocytes with abundant release of melanin to keratinocytes. Freckles,
Course
SSti
CB. Der~norocostt~etology
hormone-induced epidermal melasma and UV-induced pigmentation are typical examples. Dermal melanoses (melanoderma and ceruloderma) are due to the release of melanin into the dermis with storage in dendrocytes. Such aspect is typical for post-inflammatory hypermelanoses and dermal melasma. Pigmented storage diseases belong either to inborn metabolic disorders or to drug-induced hyperpigmentations. Neoplasms of melanocytic and non-melanocytic origin increase in number and diversity with age. Dermoscopy, clinical observation under ultraviolet light, cyanoacrylate skin surface stripping and skin biopsy are of the utmost importance for classification and therapeutic management. Non-invasive measurements of the skin colour are useful to monitor the changes. I C8-9
Therapeutic failures in acne: Cosmetic consequences and management
D. Lehucher Ceyrac’. L. Sulimovic’. Paris,
‘HGpital
Saint Louis,
France
The therapeutic failures in acne may be defined as either primary resistances of juvenile acne to conventional treatments or flare ups with aggravations under oral isotretinoin treatment or occurrence of acne relapses in adults. The common consequence of these relapses is represented by extremely inesthetic scars, especially in predisposed individuals. ‘lXvo types of scars may be encountered: the hypertrophic or keloid scars and the atrophic or depressed scars. Pigmental alterations of the skin are frequently associated. Treatment of these scars should take a number of factors into consideration in order to avoid aggravation of the existing lesions. Some therapeutic measures such as prevention of sun exposure, peeling and depigmentation agents, dermal abrasion with CO* laser are common to both types of scars. Other techniques are more specific for either hypertrophic scars (local injection of long acting corticosteroids alone or combined with cryotherapy, silicone foils, compression) or for atrophic or depressed scars (bovine collagen, hyaluronic acid, punch elevation or excision with graft). C&i 0
Side effects
E. Haneke. Dept Dermatol,
of nail cosmetics Univ
Witten/Heniecke,
Wupperml,
Germany
Side effects of nail cosmetics may be favourable or harmful, occur on or around the nail apparatus as well as far away on the skin or even as life-threatening intoxications, be due to allergy or chemical or mechanical irritation. Frequent use of emollients inadvertently softens the nail plate making it more flexible and shiny, less brittle and improving the periungual skin. Allergy to nail cosmetics varies considerably between different countries with toluenesulfoneamide/formaldehyde resin in nail hardeners and lacquers being the most important allergen causing onycholysis. paronychia, nail dystrophy, nail shedding, irritant and allergic dermatitis. New substances to avoid formaldehyde have brought new allergies. Characteristically, allergic dermatitis is observed from nail lacquer on the face, particularly around the eyes, and on the sides of the neck. Sculptured nails may lead to onycholysis and secondary bacterial and fungal infection due to unfavourable lever conditions of the long nail; permanent
paraesthesia has also been observed. Applying nail cosmetics often is associated with inadvertent trauma. Acetonitrile nail removers when accidentally ingested cause severe cyanide poisoning and have therefore to be kept away from children. C8-11 n
Recent site
allergens
A. Pons-Guiraud. HOpital sur In Pew,
Paris,
according
Saint-Louis,
lnstitut
to the anatomic de Recherche
France
Intolerance to cosmetics should be considered very rare in relation to the importance of the cosmetic market. Nevertheless, in the consultation of dermato-allergology, at the hospital St Louis (Paris), 6% of patients have side effects of cosmetic applications Ubiquitous allergens: Frugrances actually remain the first source of cosmetic allergy. all cosmetics and toiletries contain fragrance materials, even “unscented” or “fragrance free” products may contain a “masking” perfume. The fragrance allergy affects about 1% or 2% of the general population and relevance is only established in about 70% of the cases. The essential oils, more and more used in aromatherapy and parfumery, are responsible for many adverse effects, complicated and prolongated by spices and Ravours in foods and beverages. Preservatives: If the allergy to the chloro-methylisothiaolinone (Kathon CG’) is less frquent because of its decreasing use in cosmetics the Eluryl K 400 and especially the dibromoglutaronitrile, is still a frequent allergen. Wool-wax alcohols and Amerchol L 101: Amerchol L 101 increases the detection of lanolin contact allergy. Emulsifiers: the dimethylaminopropylumine (DMAPA) used in the systhesis of CAPB and contaminant of CAPB preparations is likely to be the actual sensitizer, rather than to CAPB itself. Sunscreens: The contact and the photocontact sensitivity to sunscreens are decreasing because of physical UV blockers incorporated in UV filters and cosmetics. According to the anatomic site: Eye-lids: Colophany, formaldehyde and paratertiarybutylphenol resin, mercury and perfumes are always the main allergens. Lips: Many molecules are allergenic in lipsticks, nail vanishes, dental preparations or foods. Scalp: Except the classical allergens (dyes) new allergens are hydrolysed animal proteins (Crotein Q) added in shampoos or conditioners, hair dye Basic Blue 99.2-7 dihydroxy-naphtalene in hair dyes and even the henna. Nails: The commonest allergen in nail polishes remain the toluene sulfonamide formaldehyde, ongly recently replaced in some products by ester resins. Collaboration between the pharmaceutical and cosmetic industries. It allows tile detection of new allergens and give the best guide for research and progress in the field of cosmetology. References [I] Dooms-Goossens A., Contact allergy to cosmetics. Cosmetics and Toiletries, 1993, 108,43-46. [2] De Groat AS!., Frosch P.J.. Adverse reactions to fragrances. A clinical review. Contact Dermatitis, 1997, 36.57. [3] Sainio E.L., Engstrom K., Henriks-Eckermann M.I., Kanerva L., Allergenic ingredients in nail polishes. Contact Dermatitis, 1 1997.37, 155-162