Cleansing, moisturising, and photoprotection (CMP) constitute the four major components of skin care routine for dermatological conditions.
About 40% of consumers are purchasing skincare products upon the recommendations of acquaintance rather than base on dermatologists' guidance. (1) Limited patient knowledge of skin condition, lack of educational materials, and inadequate time for patient education during dermatological consultations, are the main obstacles to establishing a CMP routine in holistic skin care routine.
With the plethora of products available on the market, it is not easy for physicians to verify the truthfulness of product claims, such as hypoallergenic, non-irritating, non-allergenic, non-comedogenic, and non-acnegenic. You should be aware that such common claims are marketing tools with minimal regulatory validation. (2)
With reference to cosmetics, you should be aware of the term “alcohol-free” products, because alcohol-free refers to the solvent ethyl alcohol, which can cause skin dryness. However, alcohol-free products can also contain “fatty alcohols” such as Cetyl, Stearyl, Cetearyl, or Lanolin alcohol, which can be confusing in an alcohol-free product claim. On the contrary, fatty alcohols are skin friendly as they help to retain moisture. In context with therapeutic moisturisers, as per the US FDA over-the-counter monographs, only products containing hydrocortisone or colloidal oatmeal can claim to provide eczema relief. (3) It is noteworthy that the regulation of ingredients and claims in cosmetics vary across countries. For instance, Benzoyl Peroxide is not allowed to be listed as a cosmetic ingredient in certain areas, while products containing colloidal oatmeal cannot claim to provide eczema relief in some others, thus requiring individualized consideration. This emphasizes the role of dermatologist guided CMP routine to reduce patient confusion over unsubstantiated product claims.
Cleansing (C) forms a vital component of holistic skin care. Studies have documented beneficial effects of cleansing in acne with removal of sebum leading to reduction in both inflammatory and non-inflammatory acne lesions. Cleansers for acne should be non-irritating, non-allergenic, non-comedogenic, non-acnegenic and alcohol-free while also removing excess sebum. Cleansing frequency recommendation varies across countries mainly depending on climatic conditions. In hot, tropical climates cleansing is recommended up to three times a day, while in dry, winter climates twice daily cleansing is sufficient.
Moisturisers should restore and strengthen skin barrier and provide immediate relief from itching, redness, and irritation. Additionally, moisturisers should be easy to apply to the skin, should not leave a greasy film, and should not stain clothing. The type of moisturiser recommended should be based on patient preference to ensure compliance. Moisturisers with known irritants, and sensitisers should be avoided. Moisturisers should be hypoallergenic, alcohol-free, water-based, and non-greasy, to avoid irritation of the sensitive skin. Water-based products have water as the main ingredient, feel light on the skin and offer a cooling effect due to water evaporation from the skin surface. Non-greasy products are beneficial as they do not leave greasy films after application and are less occlusive.
For sensitive skin, moisturisers with hydrophilic formulations and low lipid content are preferred because those with high lipid content such as mineral oils can lead to heat accumulation and worsen some skin conditions. Moisturisers for sensitive skin syndrome should restore barrier function and reduce water loss. Moisturisers with hydrating agents that retain water (Glycerine, Hyaluronic Acid, or Ceramides) are beneficial while the use of products containing irritants (e.g., Benzoic Acid, Sodium Lauryl Sulphate) should be minimised in sensitive skin syndrome.
Photoprotection constitutes the third important component of holistic skin care. Ultraviolet (UV) radiation is known to affect skin barrier function, trigger skin inflammation, and aggravate atopic dermatitis and rosacea. UV radiation can also increase the thickness of the stratum corneum and cause microbial dysbiosis and thus aggravate acne flares.
Furthermore, some topical and systemic acne therapies can increase the risks of phototoxicity. In these cases, one should therefore remember avoidance of midday sun and use of protective clothing as the first essential steps for photoprotection along with use of sunscreens.
For those with sensitive skin due to underlying acne, atopic dermatitis or rosacea, and idiopathic sensitive skin syndrome, sunscreen selection needs careful consideration to avoid potential irritants and allergens. One must bear in mind previous intolerance, irritant, or allergic experience. Inorganic UV filters (titanium dioxide and zinc oxide), also known as physical filters, have lower allergenic potential and are therefore preferred in sensitive skin conditions.
Sunscreen should not be applied over inflamed skin to prevent systemic absorption and photosensitization, an unmet need for sunscreens that can be applied over inflamed skin is identified. The panel recommends broad-spectrum (UVA/UVB) sunscreen with SPF 30 for atopic dermatitis and rosacea.
This is not my own work; it is taken from:
“Expert consensus on holistic skin care routine: Focus on acne, rosacea, atopic dermatitis, and sensitive skin syndrome” by Goh et al. (2022)1 Volume 22 Issue 6 Journal of Cosmetic Dermatology pages: 1933-1933 First Published online: March 28, 2023
References in the article:
(1) Higham R. Integration of moisturizers and cleansers into a busy dermatology practice. Cutis. 2005; 76(6 Suppl): 32-33.
(2) Xu S, Kwa M, Lohman ME, Evers-Meltzer R, Silverberg JI. Consumer preferences, product characteristics, and potentially allergenic ingredients in best-selling moisturizers. JAMA Dermatol. 2017; 153(11): 1099-1105.
(3) Hebert AA, Rippke F, Weber TM, Nicol NH. Efficacy of nonprescription moisturizers for atopic dermatitis: an updated review of clinical evidence. Am J Clin Dermatol. 2020; 21(5): 641-655. doi:10.1007/s40257-020-00529-9
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