Modern Day Exfoliation Treatments
BY KLARA DOERT
DERMASCOPE, DEC 04, (107-109)

An unhealthy epidermis causes a diminished barrier function, dehydration, scaling, flaking and roughness. To improve the texture of the skin, different exfoliation ( desquamation) methods were developed. After exfoliation there is an improvement in the health of the skin as the products with active ingredients are deeply penetrated through the epidermal layers. There is a whole range of exfoliation techniques on the market from microdermabrasion, to deep chemical peels and non-ablative laser resurfacing.

This article will cover some of the more traditional exfoliation methods based on the newest technology! The potential of shifting of the epidermal surface to generate a skin- smoothing effect has been heightened with the development of many keratolytic products in recent years.

When studying the subject of exfoliation we can divide the process into two methods:

1. Chemical ingredients which digest (‘eat up’) the dead skin cells and dissolve the intercellular ‘cement’
2. Mechanical exfoliation systems, which “scrub” off dead skin cells from the Stratum Corneum.

Ancient methods of exfoliation included sea sand, granulated apricot seeds and similar natural abrasive material used to remove the dead skin cells of the surface of the Stratum Corneum. Later mechanical or electrical brushes were introduced in conjunction with exfoliation creams/gels containing exfoliation agents. The modern day scrubs are still used today in professional treatments and home care regimens. Modem day Jojoba wax pearls are used as a mechanical exfoliation agent for even sensitive skirt.

Mechanical exfoliants work by digesting the intercellular cement surrounding the skins cells, increasing desquamation. The 'eaters' are based on keratolytic compounds containing hydroxyl acids: Alpha Hydroxyl (AHNs) include Glycolic, Lactic, Citric, Malic and Tartaric Acid. Beta Hydroxyl Acids (BHRs) include Salicylic and Citric; Benzoyl Peroxide, Sulfur, Resorinol and various enzymes.

Fruit acids have transformed skin care and have enjoyed huge commercial success since their introduction in the early 1970's. An understanding of the total formula and the action on the skin including concentration of acids, pH-value and choice of fruit acids, offers the skin care technician a myriad of professional options. The success of therapy depends on the skin diagnosis for the particular individual.

Glycolic acid from sugar cane has strong keratolytic properties, citric acid as slight keratolytic properties, malic acid from apples is stimulating, tartaric acid from grapes is regenerating and lactic acid from milk is hydrating. Therefore a cocktail of various fruit acids is the way to go!

Skin sensitivity, skin type, skin condition and skin color needs to be taken into account. It's a fact that most fruit acid products need to contain free acids -not neutralized -to penetrate and have significant benefits on the skin. However, newer technologies are offering buffered formulas with an elevated pH that offer a wider variety of usage for all skin types. Aside from their demonstrable benefits on skin turnover and exfoliation, fruit acids have been shown to reverse some of the histological signs of photo-aging in the dermis, where wrinkles and sagging actually occur.

The client may be using Tretinoin, Tazarotene, or another prescription drug that already has a keratolytic effect on the skin. The skin will be thinner and more sensitized. When the barrier function is minimized, exfoliation is a contraindication to the treatment.
The aesthetician or client want 'more, better, faster' results and may not understand the nature of exfoliants or the importance of barrier function.

Get the clients history.
A client consultation is mandatory.
Do not Use products with a pH less than 3.5

Analyze the skin properly, and make sure the product is in the right base vehicle for the client's skin.

Do not use more than one exfoliant system on one client at the same time!
Make sure that there is a plan of treatment, and that it proceeds at a steady, but slow pace. Apply a soothing and hydrating mask after every fruit acid exfoliation.

Fruit acids have been shown to increase the skin's sensitivity to sunlight, necessitating the use of sunscreens during the day (SPF 15 or higher).

Poly hydroxyl acids (PHA) are considered the next generation of AHA's. They provide some unique benefits that other traditional AHXs do not offer. One of the most important benefits is that they are gentle and non-irritating. Therefore, even the most sensitive skin (e.g. dermatitis, rosacea, eczema) will tolerate PHXs because they do not contribute to sensitivity!

Vitamin A derivates work inside the cell and normalize I cell production of keratinocytes. Retinoids prove to be use in cosmetic applications but are limited by the skin's inflammatory response in its application. Newer vitamin A products with micro sponge-delivery system are minimizing the occurrence completely.

Vitamin C offers a milder peeling action and helps build up collagen fibers at the same time. If a stable source used, e.g. Magnesium-Ascorbyl Phosphate or Sodium-Ascorbyl Phosphate, the concentration of vitamin C does not have to so high. Higher levels of vitamin C causes sensitivity in a delicate skin. Vitamin C has also a lightening effect, as the oxidation from Pre-Melanin to Melanin will be decreased.

Enzymes are biocatalysts, involved in every aspect of every living thing. This group of protein molecules initiate a cellular action or cause a reaction to speed up. Lipids attach dead skin cells or keratinocytes, to each other. Enzymes used in skin C2 are categorized as proteases. Proteases are proteolytic, meaning they break down proteins (in our case keratin). Enzymes are catalysts, which can either enhance the rate of keratinocyte proliferation or promote desquamation, therefore increasing rate of epidermal turnover and 'smoothing' of skin. enzymes play a central role in the formation and maturation of the Stratum Corneum. They are known to be intimately involved in the process of keratinisation. Enzymes act by breaking down the extra cellular domains leading to desquamation.

Proteolytic enzymes can be harvested from a range of sources: fruits, vegetables, marine life and animals. However, two major obstacles exist when it comes to using enzymes in cosmetics, namely their instability and their potential to be allergens. This protein species is highly unstable in an aqueous environment and can cause an allergic reaction. The most commonly used enzymes in skin care are papain from papaya, bromelain from pineapple, and pumpkin protease. Papain and bromelain have been shown to be more stable than others. Both have high detoxifying properties. Biotechnology has also overcome these obstacles and developed a stabilized protease in the form of insoluble crystals, which cannot be absorbed by skin tissue and is therefore hypoallergenic. These 'safe' enzymatic exfoliants can be used even on sensitive skin.

Age related changes in skin differ between the epidermal and dermal layers. Changes in the epidermis appear as a dry, rough and scaled surface. Dermal layer changes show the development of lines and wrinkles. A mechanical exfoliation often is not enough to cater to these aging factors, therefore deeper exfoliation techniques based on fruit acids (AHA, BHA) and enzymes can be chosen to treat an aging skin.

For all exfoliation agents additional ingredients should be added on to create calming and soothing effect while built in humectants combat the drying effect from the application.

This is a very exciting time to be a practitioner in the professional skin care industry. Never before have there been so many exfoliating options to choose from. With all the technological advancements in the future we will be sure to see more exciting products on the market that enhance to surface of the epidermis and contribute to a better looking skin for the clients we treat.