2003 ANNUAL SCIENTIFIC MEETING THE IMPACT OF COSMETIC DERMATOLOGY ON SKIN CARE AND COSMETICS Zoe Diana Draelos, M.D. Dermatology Consulting Services, 2444 North Main Street, High Point, NC 27262 Introduction 209 There are several cosmetic dermatologic procedures that may impact the approach the cosmetic chemist takes to product formulation, as well as creating new product opportunities. Skin changes associated with aging can be dermatologically categorized as alterations of texture, color, and contour. Texture Alterations The texture of the skin is the appearance of the surface as it relates to the amount of light reflected back to the human eye. This light reflection can be altered by desquamating corneocytes and/or the sebum-based film present on the skin surface. Removal of desquamating corneocytes is accomplished medically through the use of glycolic or salicylic acid based peels that chemically induce corneocyte disadhesion or microdermabrasion that mechanically induces corneocyte disadhesion. This removal of corneocytes reduces the natural SPF of the skin and creates enhanced percutaneous penetration creating iatrogenically induced sensitive skin. After the initial medical exfoliation procedure, maintanence of the skin surface can be achieved through the use carefully designed cosmetic applicators and cleansing cloths, which induce mechanical exfoliation, or the continued use of topical polyhydroxy acids, which induce chemical exfoliation. Skin smoothness is also impacted by the increasing size of the sebaceous glands with age, which ultimately translates into increased pore size. The increased sebaceous gland size creates an uneven skin surface increasing the need for cosmetics that enhance light reflection from the skin surface. Color Alterations The primary undesirable facial color alterations present with advancing age are the appearance of red and brown skin tones. Red tones become more apparent with chronic UV-induced inflammation, ultimately resulting in rosacea in Caucasian individuals. The redness is enhanced by the wetting effect of sebum which increases the optical translucency of the stratum corneum, allowing improved visualization of telangiectatic dermal vessels. While these vessels can be destroyed with laser, the resulting skin color is usually uneven creating the need for pigmented cosmetics. Brown tones, due to enhanced epidermal melanin, can be removed with medium depth face peels, unless the pigment is in the dermis. Following treatment, the pigment may rapidly return without the use of skin lightening preparations, UV A photoprotection, and skin care products formulated to reduce inflammation. Inflammation from irritation induced by cleansers, moisturizers, and/or pigmented cosmetics can result in rapid skin darkening.

210 JOURNAL OF COSMETIC SCIENCE Contour Alterations Contour alterations, more commonly known as wrinkles, can be due to cutaneous dehydration, facial expression, or redundant skin. Cutaneous dehydration wrinkles are the most common and can be rapidly corrected with moisturizing formulations containing occlusives (petrolatum, silicone) and humectants (glycerin). Wrinkles of facial expression are present when the face is in motion. Botox Cosmetic, which denervates the facial muscles, can relax wrinkles that are present with facial motion. Wrinkles of the face that disappear with pulling on the skin can be minimized through the use of filler substances, such as autologous fat, collagen, and hyaluronic acid. These substances expand the skin filling the void left by lost endogenous collagen. Commonly, facial wrinkles are skin creases that cannot be removed with filler substances. These are facial folds commonly around the mouth and lower face present both at rest and with facial movement where cosmetics migrate only increasing the appearance of the folds. Enhanced film forming abilities and skin substantivity accompanied by enhanced light reflection to minimize the depth of the fold are required to improve the facial appearance. Future Directions There are needs that have not been met in the cosmetics, skin care, and treatment market. Colored cosmetics should provide better film-forming characteristics with increased adherence to adnexal structures, such as the pores and follicular ostia, to prevent migration into redundant skin folds of the face. Skin care products that absorb sebum and reflect light while providing increased coverage and sun protection would create the appearance of improved skin texture. Treatment products with anti-inflammatory effects would not only reduce facial redness, but inhibit the cumulative inflammatory effects physically observed as extrinsic UV-induced aging. Summary To keep abreast of changes in the appearance-related market, new cosmetics and skin care products must compliment the wide array of consumer driven antiaging procedures. This presentation has discussed cosmetic dermatology research and presented issues regarding opportunities for new products as they relate to medical procedure induced alterations in the physiology of skin performance and appearance.