1

Cosmeceuticals are defined as agents claiming to have medicinal properties, example anti-aging etc.

smeceuticals are the most recent expansion to the health business and are portrayed as a cosmetic item with

ug-like properties. Skin Type II individuals are responsive to the usual aesthetic treatments and most treatments

n safely be done without the danger of adverse side effects such as hyper- or hypopigmentation occurring. 1

Classification of cosmeceutical

The different types of cosmaceuticals present in the market are:

Sunscreen

A good sunscreen regimen is the foundation of healthy skin. A daily sunscreen regimen would

reduce pigmentation and sun damage. Evidence shows a heightened risk of sunburn, skin malignancy and

premature skin aging with UV radiation exposure. Pharmacologically, sunscreens have been divided into

chemical or physical depending on their mode of action. Chemical sunscreens prevent sunburn by absorbing

UV radiation and re-emitting this as heat. An example is Para Benzoic Acid (PABA). Physical sunscreens

form a barrier to reflect this UV radiation. Examples include zinc and titanium oxide. Used daily and in the

right amount, these agents have led to a statistical reduction in the occurrence of skin cancer, photoaging, and

sunburns.1

os,Z.,Cosmaceuticals:unidentified,unclassified and unregulated,Clinics in Dermatology,Volume 27,2009page

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kin Lightening:

Acquired hyperpigmentation is a common concern and can be secondary to inflammation and trauma,

ormonal imbalances, photodamage, systemic medical conditions. The cosmeceutical agent which target

yspigmentation is wide-ranging. When used in combination with exfoliants to aid in cosmeceutical penetration,

hese agents achieve peak efficacy. To target the dyspigmentation in our client, cosmeceuticals would be useful.

Glycolic acid accelerates keratinocyte renewal by shortening the cell cycle and increases desquamation of

melanin carrying cells. Vitamin C blocks the production of pigment through its reduction of L-dopaquinone,

which is a precursor of melanin. Botanicals, like soy, kojic acid have a lightening effect too, though the evidence

s weak. Hydroquinone works by inhibiting the activity of tyrosinase, the enzyme needed to make melanin, hence

educing the production. It enhances melanosome breakdown (melanin pigment granules) in the skin's pigment

ells (melanocytes).2.

Exfoliants

Exfoliants remove the upper layers of the epidermis. AHA (Alpha Hydroxyl Acid) works by thinning the

pidermal stratum corneum through the reduction of corneocyte cohesion at the lowest levels of the stratum

orneum, adjacent to the stratum granulosum. Clinically, exfoliants enhance the quality of the skin and reduce

igns of aging such as thinning of the skin, fine rhytides, and dyspigmentation.2

Treatment Protocol

os,Z.,Cosmaceuticals:unidentified,unclassified and unregulated,Clinics in Dermatology,Volume 27,2009page

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g,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
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For this patient, pigmentation is a common problem. Here are key skin-lightening agents relevant to

my client’s skin condition and desired outcome.

Hydroquinone It is the gold standard skin lightening agent, but can cause significant side-eff‫ٴ‬ects such

s skin irritation and exogenous ochronosis. It is now a prescription-only medication in most countries and is

widely used in combination with vitamin C, glycolic acid and retinol.1

Glycolic acid (AHA) Glycolic acid increases the renewal of pigmented cells and through this action also

mproves the penetration of other agents e.g. hydroquinone. As it carries a risk of irritation, desquamation, and

ostinflammatory hyperpigmentation, it is important to start patients at lower concentrations and gradually build

p.2

Ascorbic acid (Vitamin C) It has a low irritating effect and serves as a mild lightening agent. Retinoids Нese

work best in combination therapies, being mildly effective when used alone. As lightening agents can cause

arrier damage, their administration can be delivered through moisturizing agents which help to minimize their

rying and therefore barrier damaging effects.

All patients should be aware that treatment with these agents can result in skin injury leading to post

nflammator\ hyperpigmentation, causing further darkening of the pigmentation condition.2

os,Z.,Cosmaceuticals:unidentified,unclassified and unregulated,Clinics in Dermatology,Volume 27,2009page

4

g,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
y,Volume 3,Issue 2,2-4
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Humectants These agents help to enhance movement of water from the dermis to the epidermis aiming to

ncrease the hydration of the stratum corneum. Examples include glycerin, hyaluronic acid, and panthenol.3

Stratum corneum modifiers Нese agents modify the structure and function of the stratum corneum e.g. through

reduction of corneocyte adhesion or increasing the keratinocyte binding sites for water. Examples include

eramides, urea, and lactic acid.2

Emollients Нese agents act as ‘glue’ between corneocytes which are desquamating, therefore allowing the skin

o appear smooth and supple. Examples include cetyl stearate and dicaprylyl maleate. In summary, moisturizers

will oіen contain a combination of the above ingredients so as to target the pathophysiology of dry skin on many

evels. 2

Нera aim of treatment is to increase the water content of skin, enhance the smoothness and suppleness of skin and

lleviate any symptoms resulting from the dryness.2

Pigmentation

n Fitzpatrick skin type II patients, pigmentation is a common problem. Here are key skin-lightening agents

elevant to our client’s skin condition and desired outcome. 2

g,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
y,Volume 3,Issue 2,2-4

H.,Zhang,Li.,Wei,H.,Chen,H.,Efficacy and safety of innovative cosmaceutics,Ckinics in Dermatology,26,367-

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Hydroquinone

t is the gold standard skin-lightening agent but can cause significant side-effects such as skin irritation and

xogenous ochronosis. It is now a prescription-only medication in most countries and is widely used in

ombination with vitamin C, glycolic acid and retinoids.2

Peptides

Peptides have in vitro evidence of their use in cell regulation, copper delivery (which is an essential mineral

or wound healing) and stimulation of cellular mechanisms vital for skin health. Examples include carrier

eptides and signal peptides (e.g. pentapeptide Pal- KTTKS); neurotransmitter peptides (e.g. hexapeptide

Argireline) which have been shown to inhibit the release of neurotransmitter resulting in muscle weakness

Retinoids

These work best in combination therapies, being mildly effective when used alone. As lightening agents can

ause barrier damage, their administration can be delivered through moisturizing agents which help to minimize

heir drying and therefore barrier damaging effects. All patients should be aware that treatment with these agents

an result in skin injury leading to post inflammatory hyperpigmentation, causing further darkening of the

igmentation condition.2

g,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
y,Volume 3,Issue 2,2-4

H.,Zhang,Li.,Wei,H.,Chen,H.,Efficacy and safety of innovative cosmaceutics,Ckinics in Dermatology,26,367-

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Facial wrinkles

or our client, upper face wrinkles, glabellar lines, forehead lines, and crow’s feet would be common concerns.

Cosmeceutical agents which improve the appearance of facial wrinkles are constituents of

moisturizing creams and are broadly divided into categories which reflect their mechanism of action.2

Botanical antioxidants

These can be divided into flavonoid, polyphenol, and carotenoid antioxidants. Flavonoids include soy and

ilymarin, polyphenols include curcumin and green tea whereas carotenoids include lutein and lycopene.2

Vitamin antioxidants

Vitamins such as Vitamins A, C, and E can act as antioxidants.. Vitamin E

s a good antioxidant and photo-protective. In the skin, Vitamin E is the primary anti-oxidant of the skin

arrier. It arrests chain propagation by scavenging lipid peroxyl radicals. Studies have shown reduced

cute skin responses (erythema, oedema, lipid peroxidation) and chronic skin reactions (skin wrinkling,

kin tumor formation) to UVR if topical Vitamin E is applied. Vitamin C occurs naturally. It has anti-

geing properties through the following modes of action.

Reduces oxidative stress.

Collagen and elastin synthesis.

Photo protection and anti-inflammatory

Topical vitamin C application shows clinical signs of improvement on photo damaged skin Collagen

roduction is also increased, and this has a skin tightening and firming effect

Chang,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
rgery,Volume 3,Issue 2,2-4

owes,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

sing,Volume 1,Issue 5,231-235
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Combination Therapy

The combination therapy is universally used.This includes the combination gel containing clindamycin

hosphate 1.2% tretinoin 0.025%.This combination is best choice in this patients because of the skin type .

Aesthetic treatments for Fitzpatrick Skin

Botox and fillers work well on this skin type4

Microdermabrasion and all types of chemical peels including Chemibrasion by Nimue and mid-dermal peels such

s Mela M and TCA can be done safely Laser & Light such as Pearl, Titan, Laser Genesis, and LimeLight skin

reatments can be safely used on skin type II with minimal pain and no downtime or side effects4

Chang,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
rgery,Volume 3,Issue 2,2-4

owes,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

sing,Volume 1,Issue 5,231-235
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Radiofrequency such as Accent, TriPollar, and Velashape radiofrequency procedures can be safely used on skin

ype II with minimal pain and no downtime or side effects4

Chang,D., Evidence Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial
rgery,Volume 3,Issue 2,2-4

owes,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

sing,Volume 1,Issue 5,231-235
Mesotherapy and transdermal mesotherapy can be safely used in skin type II as well as

Carboxytherapy and

Dermapen skin needling

Aggressive Ablative resurfacing treatments ( not done at Skin Renewal) such CO 2 laser, Erbium Yag laser, and

henol peels can result in permanent hypopigmentation (whitish skin that has lost its pigmentation) and should be

voided or used with caution in Skin Type II.4

Skin Care Regimen for Skin

Exfoliate the skin:

Clean skin twice a day. If you have dry or sensitive skin, use a gentle creamy cleanser that does not contain

ulfate. Oily or acne prone skin should cleanse with a salicylic acid cleanser Exfoliate twice a week if you have

ormal or oily skin. Exfoliate once a week if you have sensitive skin or active acne.

The correctness of skin problem:

Wrinkles: Once the signs of aging such as wrinkles appear on the facial skin, it is time to initiate

he most powerful corrective treatments such as growth factors and peptides to improve collagen

ontent and wrinkling. 4

owes,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

sing,Volume 1,Issue 5,231-235
Growth Factors and Peptides found in Dermaheal offer the ultimate in anti-aging and laser-free skin

emodeling products. Set out to be the most powerful, corrective product on the market and is available at all

kin Renewal clinics.4

Retinoic Acid /Retinaldehyde binds to receptors in the skin cells. Regular treatment over several months can

ead to a partial reversal of extrinsic photo-aging. Retinoic Acid such as Retin A should not be used during

regnancy because it is potentially teratogenic. It is only available on prescription. Renewal cream by Neostrata

ontains a less irritating form called Retinol and is available at all Skin Renewal clinics.4

Alpha hydroxyl acids (AHAs) and Polyhydroxy acids (PHA) such as glycolic acid, lactic acid, and

luconolactone are primarily used as chemical exfoliants. Long-term use of these leads to increased collagen and

lastin synthesis, and increased glycosaminoglycan concentration in the dermis. Clinically, concentrations less

han 10% improve skin texture and pigmentation, while higher concentrations lead to improvement in fine

wrinkling. AHAs and PHAs are considered safe in pregnancy and cause less skin irritation than retinoic acid and

re available in Neostrata products at all Skin Renewal clinics.4

Additional Skin Care ingredients to improve wrinkles in Skin Type II: a Copper peptide, Epidermal growth

actor, Insulin growth factor, Fibroblast growth factor, Vit C, Oligopeptide - 34, Oligopeptide - 51, Oligopeptide-

3 and Pentapeptide – 15.4

will suggest a morning and evening protocol for my patient based on my knowledge:

n the morning

es,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

g,Volume 1,Issue 5,231-235
 Sunscreen to protect the skin and reduce photo-aging and further pigmentation.

• AHA based exfoliants to renew skin and enhance penetration of additional cosmeceuticals.

• Vitamins C, E with ferulic acid to increase absorption.

• Moisturizer to keep skin hydrated and supple.

At night

Topical retinoid in combination with AHA based exfoliants for synergistic skin rejuvenation to reduce photo-

amaged skin. • Hydroquinone to lighten existing pigmentation

• Moisturizer rich in Peptide and ceramide to hydrate and plump up the skin, reducing the appearance of

wrinkles.

Hydrating face mask once a week-rich in humectants (panthenol), polyphenols (green tea) and mucilage (Aloe

era) to lock in moisture, reduce inflammation and enhance the skin barrier respectively

f the sign and symptoms persist and skin damaged further than Surgical Interventions can be prescribed.

People with Fitzpatrick skin type II usually get a light tan with frequent exposure to sun. They have a very

igh risk for skin cancer including melanoma which is considered as the deadliest kind of skin

es,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

g,Volume 1,Issue 5,231-235
 ancer. Therefore these patients are advised to take extreme care, use sunscreen and protect themselves from the

angerous UV rays as extreme sun exposure can result in serious damage, premature aging

nd skin cancers such as squamous cell carcinoma SCC. The incredible advancement in the field of cosmetic

cience has produced a great variety of fresh skincare products with advanced and highly refined dynamic

ngredients. Here we will discuss specific clinical skin conditions relevant to our Fitzpatrick Type 2 skin type

lient and will prescribe skincare treatment for these patients. So Nonabrasive laser rejuvenation is suitable in this

ase.2

Based on the type of skin I think I can also go for the

Nonablative laser rejuvenation can improve the texture and appearance of the skin and reduce uneven skin tone,

without damaging the outer layer of the skin (epidermis). Nonablative lasers (e.g., visible light lasers, mid-

nfrared lasers bypass the and deliver energy to the underlying layers of skin (dermis), stimulating collagen

rowth and skin tightening.4

Also, laser is an increasing trend these days.

es,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

g,Volume 1,Issue 5,231-235
Laser techniques versus other surgical techniques

i) CO2 laser versus unoccluded Baker’s phenol chemical peel

have found an article which suggests that The results of this small within-patient study (Chew 1999) suggest

hat there was a greater improvement (wrinkle score decreased) in upper-lip wrinkles with Baker’s phenol

hemical peel than with CO2 laser treatment. No permanent

dverse events such as hyperpigmentation, hypopigmentation, scarring, infections or contact dermatitis were

bserved4

Another studies suggested that

CO2 laser versus dermabrasion

There was significant improvement in this case.4

es,L.,Exploring the science of cosmaceuticalsused to achieve optimal skin health,Journal of Aesthetic

g,Volume 1,Issue 5,231-235
 References

Bowes, L., Exploring the science of cosmaceuticals used to achieve optimal skin health, Journal of Aesthetic

Nursing, Volume 1, Issue 5,231-235

Chang, D., Evidence-Based Cosmeceuticals for a Fitzpatrick Skin Type II Patient, Cosmetology & Oro Facial

urgery, Volume 3, Issue 2,2-4

Draelos,Z.,Cosmaceuticals:unidentified,unclassified and unregulated,Clinics in Dermatology,Volume

7,2009page 431-434

Gao, H., Zhang, Li., Wei, H., Chen, H., Efficacy, and safety of innovative cosmetics, Clinics in Dermatol