Vol. 5, n. 1, January-March 2009 1th International ... - Salute per tutti

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Zoe Diana Draelos Clinical Dermatology Center High Point, North Carolina, USA. Evaluating acne cosmetica SU M M A R Y I ntroduction What exactly does a patient mean when she states that a certain cosmetic causes her face to “breakout”? Does this mean that she experiences formation of a comedone, papule, pustule, nodule, cyst, or red rash? Sometimes it is difficult to understand exactly what is meant. Also, it is hard for the patient to establish a cause and effect relationship. From a dermatologic standpoint, the term that is still used to refer to cosmetic-related acne is “acne cosmetica”. Acne cosmetica is a concept that was developed many years ago when there was concern that cosmetics could indeed cause comedone formation. The issue of comedogenicity in relation to cosmetics arose in 1972 when Kligman and Mills described a low-grade acne characterized by closed comedones on the cheeks of women ages 20 to 25. 1 Many of these women had not experienced adolescent acne. The authors proposed that substances present in cosmetic products induced the formation of closed comedones and, in some cases, a papulopustular eruption. Presently, personal conversations with Dr. Kligman indicate that he no longer believes currently marketed cosmetics cause comedone formation, yet acne related to cosmetics remains a problem. There remain lists in the literature of ingredients that supposedly cause acne, yet it is practically impossible to find formulations that possess none of these substances. The list contains some of the most effective emollients (octyl Evaluating acne cosmetica For all purposes, acne cosmetica is a concept of the past, which the industry has done its best to re m e d y. Skin care manufacturers are keenly aware of the need to test and formulate products without skin side effects. Acne cosmetica, perh a p s , is a term that is no longer applicable. KE Y W O R D S: Acne cosmetica, comedogenic, resonance delocalization stearate, isocetyl stearate), detergents (sodium lauryl sulfate), occlusive moisturizers (mineral oil, petrolatum, sesame oil, cocoa butter) and emulsifiers found in the cosmetic industry. 2 A product line that avoided all of these substances would not perform well on the skin and would possess low cosmetic acceptability. There are many myths regarding cosmetics and cosmeceuticals and the acne that they may or may not cause. It is worthwhile examining these myths to determine where the medical truth lies. osmeceuticals do not produce acne C if labeled noncomedongenic and nonacnegenic Similar to hypoallergenic, noncomedogenic and nonacnegenic are marketing claims carrying no implied regulation. They were developed to create a new consumer image for cosmetic lines designed to minimize acne. In order to make the claim noncomedogenic, rabbit ear or human comedogenicity testing should be undertaken. Both the animal and the human model are based on the presence of new comedone formation after the exposure of skin to the finished cosmetic. Human testing is considered to be more accurate, but the results are highly dependent on the skill of the contract testing laboratory. Acnegenic claims are based Journal of Plastic Dermatology 2009; 5, 1 95
96 Z. D. Draelos on human use testing and the evaluation of volunteer subjects following product use for an increase in the presence of acne. Many manufacturers, however, make noncomedogenic and nonacnegenic claims based on the safety profiles of the individual ingredients in the formulation. This is inaccurate. Noncomedogenic and nonacnegenic claims should be made based on clinical testing of the finished formulation. The dermatologist should still consider all products labeled noncomedogenic or nonacnegenic as problematic. ineral oil is comedogenic M Mineral oil is one of the most common ingredients in skin care products and colored cosmetics. It is a light weight inexpensive oil that is odorless and tasteless. One of the common concerns regarding the use of mineral oil is its presence on several lists of comedogenic substances. These comedogenic lists were developed many years ago, yet remain frequently quoted in the dermatologic literature. There are several important points to consider. First, there are different grades of mineral oil. There is industrial grade mineral oil, which is used as a machine lubricant that is not of the purity required for skin application. Cosmetic grade mineral oil is the purist form without contaminants. Industrial grade mineral oil may be comedogenic, but cosmetic grade mineral oil is not. Quality manufacturers only purchase quality products from quality suppliers who guarantee the quality of the materials they provide. I personally believe that cosmetic grade mineral oil is noncomedogenic and I have never found it to be comedogenic in any of the testing I have performed for the skin care industry. unscreens produce acne S Many patients note the occurrence of "break outs" following the use of sunscreens. These patients typically present with perifollicular papules and pustules in a random distribution over the face. This eruption appears within 24 to 48 hours after wearing a facial suns c reen. I have not performed biopsies on patients who develop this problem, but I would like to put forth a hypothesis based on my knowledge of how sunscreens function. Journal of Plastic Dermatology 2009; 5, 1 Most of the sunscreens on the market today are based primarily on UVB absorbing ingredients, such as octylmethoxycinnamate, oxybenzone, homosalate, etc. Many also have UVA absorbing ingredients, such as avobenzone, titanium dioxide, or zinc oxide, as secondary sunscreens. All of the UVB sunscreens and avobenzone function by transforming ultraviolet radiation to heat energy through a process known as resonance delocalization. This heat energy is appreciated by many patients who will state that they do not like wearing sunscreens, since the gels or lotions make them feel hot. In some patients, I believe that the increased sweating induced by the sunscreens accompanied by the warm sunny weather cause increased activity by the eccrine glands. This may cause miliaria rubra that may be magnified by the occlusive nature of the water resistant, rub proof product. Thus, I believe that much of the problem with sunscreen induced break out is the formation of papules or pustules around the eccrine duct ostia without the sebaceous gland involvement that characterizes true acne. ore size can be reduced P with glycolic acid peels Glycolic acid is a water-soluble chemical exfoliant. It cannot enter the oily mileu of the pore and thus does not exfoliate within the pore. Glycolic acid may improve the smoothness of the skin surface creating the illusion of reduced pore size, but it cannot measurably reduce pore size. As a matter of fact, there is no cosmeceutical ingredient that can measurably reduce pore size. Salicylic acid is an oil-soluble chemical exfoliant that can remove debris from the pore creating the appearance of skin smoothness, but it too cannot measurably reduce pore size. It is important to distinguish between real pore size reduction and an improved cosmetic appearance. complex skin care regimen of A multiple cleansers, moisturizers, and ancillary skin care products is necessary for clear skin There are many different approaches to skin care. There is the no nonsense bar of soap and water twice daily approach and the
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Daniele Innocenzi: un mio grande am
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Enzo Berardesca Manuela Carrera Der
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