340 JOURNAL OF THE SOCIETY OF COSMETIC CHEMISTS on their faces as well as in their general health. Many of the skin problems we as dermatologists have to treat are so-called "neurogenic" in origin. In my own practice this constitutes 66 per cent of the conditions we treat. This broad term actually is a kind word for unsolved emotional stresses, and, if we analyze these emotional stresses, they are in reality a personal conflict with one's own morals a battle between "what I want" and "what I should." COSMETIC NEEDS Now I would like to say something about some cosmetic needs we have. Proper cosmetic care actually means more than emphasis on vanity. It means good hygiene. But in general, I feel that, while it is certainly essential, most cosmetic efforts have been centered on the idea of adequate lubrication. Protection against undue water loss and protection against excessive heat loss are also important objectives. Good cosmetic care means an attempt at reversal or slowing of the changes which naturally develop with age and at prevention of the progression of these changes to their extremes. We cannot compare the care of living skin with the care of leather. We have to keep in mind that the cells of the skin are func- tioning protoplasm and are always in a state of change. Whatever is put on the skin must not plug up the sweat and oil ducts, and it must allow for gaseous, water and lipid interchange, while enhancing properties of flexibility and toughness (13). One of the common problems which confronts the dermatologist is this plugging. Older women who use all the face cosmetic preparations available frequently develop multiple firm intracutaneous white papules called milia. These are simply due to plugged pores and they are not easy to clear up. Too frequent application of waxes is almost certain to produce this effect in many women. Perhaps the commonest occasion where dermatologists become aware of the cosmetics field is in connection with allergic responses. In my own opinion, persons who have a problem with the sweat and oil mechanisms are more likely to have trouble with cosmetics. However, of the truly allergic responses we see, most of them would be attributable to coloring materials and metallic compounds. It is perhaps because of these occasional dermatitis cases that some physicians angrily tell patients to "throw away all cosmetics," without discrimination. One of the most important needs in the field is the need to recognize differences in quality of the sweat. Underarm perspiration differs chem- ically from general body sweat. Sweat from the face is different from that of the feet. Sweat changes its chemistry in excessive heat. People with different personalities have different qualities to the sweat, and so do sick people. Many of our patients exhibit eruptions on the face which are,

THE DERMATOLOGIST, THE OLDER WOMAN AND COSMETICS 341 in truth, allergic responses to their own sweat as applied with pressure from their own hands. The chemistry of the sweat of the hands in a highly nervous woman is different from that encountered in the emotionally stable person. Profuse sweating in the scalp even increases the rapidity of hair loss in oncoming baldness. I would like to see a series of antiperspirant cosmetics developed with these differences in mind, some to do one thing, some another. We need to neutralize palmar sweat or change the character of the sweat on some persons so that it is rendered noninjurious to the skin. We need to prepare lotions for the old, dry, cold skin, lotions which diffuse readily, are easily applied, and which lubricate. We also need preparations for the older person that will hold body heat in. We are not concerned so much with the sweating here because it is much reduced anyway. We need an anti- perspirant for certain scalps. We need mildly keratolytic preparations for regular attention to the skin of the feet. We need good cosmetics for regular use which will protect against actinic radiation. We need new agents to protect against the excessive degreasing action of modern household chemicals. We need new thought given to nonirritating bleaching preparations for use on the skin, based on a knowledge of different types of hyperpigmentation, whether it be iron, melanin or hemoglobin derivatives. As a dermatologist, I feel that cosmetic science has already contributed heavily. I know that cosmetic chemists are faced with special prob- lems in the field of pseudo-medicinal agents. They have to avoid practicing medicine, yet we want many things from them. Another group of items we need, and this despite all the recent efforts, is a series of shampoos. We need one that, when it removes oil from the hair, does not stimulate the skin to even greater oil production. All doctors are familiar with the patient for whom we prescribe an oil-removing shampoo because her hair gets oily by the fifth day--and after we have prescribed such a preparation, her hair is oily in two days. I would like to see a line of preparations developed for the older skin for application to natural skin folds and to surfaces of skin Which are in apposition. We need nonskid bath preparations for the older person who no longer is agile enough to feel safe in a bathtub. We need special softeners and antipruritics for this group. And in the selection of cos- metics, we need to remember that due to differences in vascularity, in- nervation and function, all the skin, even in the same individual, cannot be treated alike. We desperately need a substance which will protect the face and neck during the hair-drying process. This blast of hot air over the cheeks and sides of the neck, in my opinion, causes definite premature aging changes along the sides of the neck.