GPs Dry Skin Lecl

8/2/2019 GPs Dry Skin Lecl

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Skin Barrier & Barrier Function:

The Role of DMS in Restoring Skin Barrier Function


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NORMAL SKIN

STRATUMCORNEUMSTRATUMLUCIDUM

STRATUMGRANULOSUM

STRATUMSPINOSUM

STRATUM BASALE


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Normal skin barrier is contributed by the stratum

Corneum which is composed of:

INTERCELLULAR LIPIDS

CERAMIDES

SEBACEOUS LIPIDS


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There are severalFACTORS which affectthe MOISTURECONTENT of the SKIN:

FACTORS

Secreted from the SEBACEOUSGLANDS Complex oily substance which formsan emulsion with sweat, providing afilm on the skin surface whichprevents TRANSEPIDERMAL WATERLOSS (TEWL) the evaporation ofmoisture from the skin

SEBUM

SEBUM

NMF

CEMENT SUBSTANCE
http://www.scf-online.com/english/24_e/images24_e/sebum_2_24_big.jpg


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There are severalFACTORS which affectthe MOISTURECONTENT of the SKIN:

FACTORS

Contained in the Stratum corneum This is a mixture of hydroscopic substances which arecapable of absorbing large quantities of water & retainingmoisture Main constituents are free amino acids (10%), sodiumpyrrolidone carboxylic acid (12%), urea (7%), lactate (12%)

Natural Moisturizing Factor (NMF)

SEBUM

NMF

CEMENT SUBSTANCE


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There are severalFACTORSwhich affect theMOISTURE CONTENT ofthe SKIN:

FACTORS

Consists of various lipids (e.g. ceramide) & proteins This may be found in between the corneocytes &

are important for preserving the moisture withinthe Stratum corneum

INTERCELLULAR CEMENT SUBSTANCE

SEBUM

NMF

CEMENT SUBSTANCE


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FEATURES

DRY SKIN or XEROSIS

presents in various degrees ofseverity & in different forms.

DRY SKIN

means dehydrated skin, or skinwhich has lost a certainamount of moisture within itscells.

The Stratum corneum of normal skin contains 15 -25% of moisture

in DRY SKIN, the levelfalls.


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The rate at which moisture is lost from the skin determines itsDRYNESS

Hydration of theskin is achieved bydiffusion from theBLOOD & LYMPH

VESSELS of theunderlying tissues &in a very minor way,from the sweatglands.


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DRY SKIN should be differentiated from the loss

of elasticity of the dermis which occurs withageing & excessive sun exposure

The WRINKLES which appear are due to thedeterioration of the collagen & elastic fibers of the

dermis & is to be differentiated from dryness

DRY SKIN VSWRINKLE
http://www.inmagine.com/dv702/dv702077-photo


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The condition can present in varying degrees of severity from a mildcosmetic dryness to severe scaling & cracking as in ICHTHYOSIS

Almost everybody will suffer from dry skin atsome time.

The condition is generally evident on theextremities & on the face.


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conditions leading toDRY SKIN

Relative HUMIDITY is important in determining the

moisture content of the stratum corneum.

People will tend to have more dry skin during

COLD months when HUMIDITY is LOW.

Dryness usually occurs when the relative humidity

falls below 30%.

The use of SOAPS & DETERGENTS has a degreasing

action on the skin allowing increased water loss &

leading to dryness.

HUMIDITY

HUMIDITY

CLEANSING AGENTS

AGE

CONDITIONS
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conditions leading toDRY SKIN

This condition is generallyknown as SENILEASTEATOSIS & can be veryitchy.

epidermal cells become smaller

rate of cell division in the epidermis is reduced

individual cells in the stratum corneumbecome larger

rate of sebum production decreases

rate of perspiration decreases

In the elderly, there is anincreased tendency to flaky

dry skin, particularly on the

lower legs.

SENILE ASTEATOSIS may be

due to certain changes of

the skin due to the ageing

process.

HUMIDITY

CLEANSING AGENTS

AGE

CONDITIONS
http://www.inmagine.com/dv702/dv702081-photohttp://www.inmagine.com/dv702/dv702081-photo


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GeneticAcquired A- PhysiologicalB- Dermatological

C- SystemicD- Drugs


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Atopic Dermatisis Ichthyoses

Disorders of Eccrine glands (EctodermatalDysplasias)

Keratosis Pilaris


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EATURES

The disorders of CORNIFICATION is adiverse group characterized bylocalizedor generalized scaling orhyperkeratosis.

These have beencalled ICHTHYOSIS, aterm from the Greekword ichthys forfish.


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Physiological Causes Seasonal Winters

Hot Bath & Excessive Shower

Prolonged exposure to warmth Excessive use of Soaps and Detergents

Senile

Dehydration

Post Menopausal


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Dermatological Vit. A Deficiency

Asteatotic Eczema

Pityriasis Alba Leprosy

Psoriasis


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Systemic Diabetes Mellitus (Autonomic Loss)

Chronic Renal Failure (Dehydration,Decreased Function of Eccrine Sweat Glandand Decreased Sebum)

Systemic Malignancies (Unknown Mechanism )

Hypothyroidism (Reduced Sweat and Oil)

Malnutrition


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Drugs Lipid Lowering Agents

Systemic Retinoids

Antihistamines Anticholinergics (Hyoscine, Pseudoephedrine)

Nictotine

Diuretics


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MANAGEMENT

Since DRY SKIN is the result of low

moisture content in the Stratum

corneum, the principle of therapy

is directed towards the INCREASE

HYDRATION of the skin.

MANAGEMENT

TREATMENT is achieved through replacement

of those factors responsible for maintainingthe moisture in normal skin, commonly

known as

MOISTURIZERS & EMOLLIENTS.
http://www.inmagine.com/crz327/crz327031-photo


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MANAGEMENT

MOISTURIZERS are products which aim to replace or add waterto the skin

HUMECTANTS are substances which penetrate the horny layer &attract water into the Stratum corneume.g. glycerin, urea, pyrrolidone carboxylic acid

For maximum efficacy, it is best to apply these products on slightlymoist skin, like immediately after bathing.

EMOLLIENTS are lipids which form barrier on the skinsurface to reduce moisture loss.The lipid may be animal or vegetable derived or it maybe obtained from mineral oils.Lipid may also be synthetic in origin.

MANAGEMENT


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Emollients remain the mainstay of treatment

for all dry scaling disorders


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Emollients have three basic properties: Occlusion

providing a layer of oil on the surface of the skin to slow

water loss and thus increase the moisture content of the

stratum corneum

Humectant

increasing the water-holding capacity of the stratum

corneum

Lubrication

adding a slip or glide across the skin.


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Emollients soothe, smooth and hydrate the skinTheir effects are short-lived and they should be applied

frequently even after improvements occurs

Emollients should be applied especially after bathing

to hydrate the stratum corneum while the skin is still

wet

They are useful in dry eczematous disorders


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Classical preparations;

Ointments (water-free)

Fatty creams (W/O)

Creams/Lotions (O/W)

Disadvantage:

Occlusive-Effect

Wash-Out-Effect


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DMS = Derma Membrane Structure

Skin oriented composition

Skin oriented lamellar structure


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Skin Lipids

Triglycerids

SqualeneCeramides

Cholesterol

Phospholipids

DMS Cream

Caprylic/Capric

Triglycerids (plant)

Squalane (plant )

Ceramide 3 (yeast)

Phytosterols (plant)

Phospholipids (plant)


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Cream/Lotion concentrate Physiologically oriented (ICL) epidermal lipids

surrogate Lamellar structures similar to SC bilayers

(High pressure) Barrier strengthening effect


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Emulsifiers Preservatives Mineral oil Fragrance


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Prolonged Moisturization Barrier enhancement

Protection against Hydro-& Lipophilic irritants Comparative barrier integrity study DMS vsConventional Emulsifier


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Technology platform for creams & lotions Lamellar organized, proposing a physiologicalfusion with SC lipids Does not contain emulsifiers having an impacton the barrier function Does not contain physiologically precarious

ingredients Shows superior claim substantiation in field ofbarrier recover and barrier support

DMS - ideal treatment for dehydrated & itchy skin


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GPs Dry Skin Lecl

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