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Treatment of Problem Skins – An Overview

Posted: 13 September 2013 by dermaviduals

Dr. Hans Lautenschläger

If you start out to renovate a building you should begin with the roof. In terms of the problem skin, first priority should be given to the skin barrier. Next step then is the renovation or in other words the recovery of the skin. Which active agents are appropriate in this case? The following article will provide assistance.

 
Except for normal skin any other skin condition poses a challenge when it comes to finding the appropriate skin care. The preparations should protect the skin but the active agents should perfectly arrive at the spot where they are needed. According to the corneotherapeutic theory established by Professor Dr. Albert Kligman, the Gordian knot is untied by transporting the active agents via so-called transport vehicles into the skin and then reclosing the skin barrier with lamellar cream bases without sealing the skin surface. This procedure minimizes the wash out of active agents and skin care components during skin cleansings.

The individual steps

As a matter of fact, the treatment of acne, neurodermatitis & co. pertains to the responsibilities of a physician. However, in addition to the medical treatment, each problem skin also needs appropriate cosmetic care which is every bit as important as the medication. In order to achieve adequate results though, a correct skin analysis and detailed background knowledge on cosmetic active agents are required. The trial and error method here only is time-consuming and annoys the persons affected. The following chart provides some clues on the potential active agents.

Skin type

Cleansing

Peeling

Toning (lotion)

Masks

Massage

Dry and low-fat skin Alkyl polyglycosides (gel) or triglycerides (milk) Jojoba beads; no peelings in case of cracked skin Phosphatidylcholine, D-panthenol Skin recovery: Vitamins A, B3, C, E, linoleic acid

Radical scavengers: Oligomeric proanthocyanidins (OPC)

Moisturizers: Amino acids, hyaluronic acid, glycerin, aloe, alginic acids

Astringents (for cracked skin): Gallic acid, tannins, polyphenols

Barrier protection: Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides, squalane

Wheat germ oil, avocado oil, jojoba oil
Barrier-disordered skin prone to inflammations Alkyl polyglycosides (gel) or triglycerides (milk) no Phosphatidylcholine, D-panthenol; CM-glucan before wet shaving Anti-inflammatory: α- and γ-linolenic acid, boswellia acids

Anti-itching: Urea, allantoin, fatty amides

Antimicrobial: Betulinic acid

Skin recovery: Vitamins A, B3, C, E, linoleic acid

Moisturizers: Amino acids, hyaluronic acid, glycerin; after laser treatments and shavings also CM-glucan, alginic acid, aloe

Barrier protection: Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides, squalane

Evening primrose oil, wheat germ oil, avocado oil
Senile skin: horny dry, wrinkled Alkyl polyglycosides (gel) or triglycerides (milk) Jojoba beads or enzymes Phosphatidylcholine, D-panthenol Skin recovery: Vitamins A, B3, C, E, phytohormones, phosphatidylcholine

Moisturizers: Amino acids, hyaluronic acid, glycerin, alginic acids

Metabolic stimulators: Caffeine, green tea, coenzyme Q10

Radical scavengers: Oligomeric proanthocyanidins (OPC)

Wrinkle reduction: Spilanthol, peptides

Barrier protection: Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides

Avocado oil, wheat germ oil, jojoba oil
Normal and combination skin
Alkyl polyglycosides (gel) or triglycerides (milk) Jojoba beads or enzymes D-Panthenol Moisturizers: Amino acids, glycerin

Barrier protection: Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides, squalane

Jojoba oil
Rosacea skin, couperosis skin
 
Alkyl polyglycosides (gel) or phosphatidylcholine, azelaic acid (lotion) no D-Panthenol Anti-inflammatory: α- and γ-linolenic acid, boswellia acids

Skin recovery: Vitamins A, B3, C, E

Moisturizers: Amino acids, glycerin

Radical scavengers: Oligomeric proanthocyanidins (OPC)

Antimicrobial: Azelaic acid, betulinic acid

Vaso-stabilizing: Echinacea, Butcher’s broom

Barrier protection: Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides, squalane

With mask components
Oily skin Alkyl polyglycosides (gel) Jojoba beads or enzymes Phosphatidylcholine, D-panthenol Skin recovery: Vitamins A, B3, C, E, phosphatidylcholine

In case of dry skin also moisturizers: Amino acids, glycerin

Rose hip seed oil
Blemished skin prone to acne Alkyl polyglycosides (gel) or phosphatidylcholine, azelaic acid (lotion); in case of dry skin possibly triglycerides (milk) Enzymes; in case of dry skin also jojoba beads Phosphatidylcholine, D-panthenol, azelaic acid Anti-inflammatory: α- and γ-linolenic acid

Skin recovery: Vitamins A, B3, C, E, phosphatidylcholine, linoleic acid, phytohormones

Antimicrobial: Azelaic acid

Moisturizers (in case of dry skin): Amino acids, glycerin

Barrier protection (in case of dry skin): Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides, squalane

Rose hip seed oil, wheat germ oil
After Sun
Alkyl polyglycosides (gel) or triglycerides (milk) no Phosphatidylcholine, D-panthenol, CM-glucan Anti-inflammatory: α- and γ-linolenic acid, boswellia acids

Skin recovery: Vitamins A, B3, C, E; D-panthenol

Moisturizers: Amino acids, hyaluronic acid, glycerin, alginic acids, aloe

Possibly with mask components
Psoriasis prone skin Alkyl polyglycosides (gel) or phosphatidylcholine, fumaric acid (lotion) no Phosphatidylcholine, D-panthenol, fumaric acid Anti-inflammatory: α-, γ-linolenic acid and boswellia acids

Antimicrobial: Betulinic acid

Skin recovery: Vitamins A, B3, C, E, fumaric acid

Barrier protection: Phytosterines, ceramides, long-chained fatty acids, hydrogenated phosphatidylcholine, triglycerides, squalane

With mask components

 

Annotations to the different treatment steps

  • Cleansing: Alkyl polyglycosides are an example for very gentle cleansing components in gels. Triglycerides are typical fat solvents in emulsions (milk); the residues are removed with a little sponge or with water. Liposomal lotions with phosphatidylcholine (PC) are multifunctional, i.e. they cleanse and simultaneously transport PC-bound linoleic acid (anti-inflammatory) and optionally azelaic acid (antimicrobial) into the skin; and in case of psoriasis also fumaric acid.
  • Peeling: Jojoba beads are gentle wax bodies for the mechanical exfoliation. There is a large variety of enzyme peelings as for instance in form of powders to be mixed with water and to be left on the skin for some time before they are rinsed off with water.
  • Toning means to prepare the skin for the passage of active agents. This requires components such as PC and D-panthenol since they prepare the skin barrier for the permeation of the active agents of the following mask. Exception: CM-glucan.
  • Mask: The active agents that should pass the skin barrier are applied first. Subsequently, the barrier protective substances are lightly massaged into the skin (Exceptions: oily skin and after sun products). The massage can possibly be intensified by using massage oils.
  • Massage: The pure oils can be applied directly or in combination with the barrier protective substances as indicated for the mask. Convenient in this context are analogously combined massage creams.

The products for the skin care at home may contain active agents of the mask and the oils cited in the column “massage”.
As the paper shows, the customized application of a relatively small repertoire of active agents already is sufficient in order to provide effective skin care for a multitude of different skin problems. Several agents cited in the chart are representative for other substances with similar efficacy (e.g. radical scavengers). On the other hand, several active agents, such as amino acids, are multifunctional (in this case moisturizers and radical scavengers), even if they are only cited for a specific application.