INTENSE MOISTURISING FORMULA

Dr Bhagwat Gunale, MD
Training Slides

Introduction
Epidermis 5 layers
Stratum corneum Stratum lucidum Stratum granulosum Stratum spinosum Stratum basale

Stratum Corneum serves as barrier function of the skin

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What is Epidermal Barrier?

Epidermal Barrier
Stratum corneum protects the epidermal barrier
water loss & penetration of irritants & allergens analogous to a reinforced brick wall
corneocytes - bricks corneodesmosomes locking the bricks together and lamellar lipids - waterproofing cement

Dermatology Update 2003. Montreal, Quebec November 6-8, 2003. As presented by Michael Cork at Dermatology Update 2003.

What is natural moisturizing factor and what is its role in skin

Natural Moisturing Factor (NMF)

Water soluble humectants

15-20% wt of SC
Water holding capacity of SC & elasticity of SC Water content of normal SC 10 - 30%

Am J Clin Dermatol 2003; 4 (11): 771-788

Natural Moisturizing Factor (NMF)

Am J Clin Dermatol 2003; 4 (11): 771-788

Natural Desquamation of Skin

Proteases continuous shedding of corneocytes by loosening the desmosome corneocyte connections Desquamation - degradation of corneodesmosomes by enzymes dependent upon water and pH for their activity Water content & pH of skin are imp in SC renewal

Less water dry skin

When we call skin as Dry Skin?

Dry Skin
DRY SKIN means dehydrated skin, or skin which has lost a certain amount of moisture The Stratum corneum of normal skin contains 10 30 % of water In DRY SKIN, the level falls Decreased water content of the stratum corneum to less than 10% --- abnormal desquamation of corneocytes
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Pathophysiology of Dry Skin

SC architecture - most imp factor in
water flux and retention in the skin and overall level of moisturization

4 key processes for the formation and functioning of the SC are

corneocyte process hydration l/t flexibility SC lipid process defective barrier Natural moisturizing factor (NMF) & Desquamation process less water in SC l/t efficiency of desmosomes - desqaumation

Skin Therapy Letter. 2005; 10(5):1-8.

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ed TEWL

Excessively dry, flaky skin Corneocyte cohesion desquamation

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What is TEWL ?
TEWL - Trans-epidermal water loss It is the measurement of the quantity of water that passes from inside a body through the epidermal layer (skin) to the surrounding atmosphere via diffusion and evaporation processes.
Normal Skin: Balanced TEWL

Dry Skin: Excess TEWL13

Hyperkeratinization
Hyperkeratinization is either a primary or a principal associated event in a majority of dermatological disorders including: Psoriasis Chronic localized plaque psoriasis Palmoplantar psoriasis

Severe xerotic eczema

J Am Acad Dermatol. 1984; 11:867-879

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Effect of Hyperkeratinization
The clinical manifestation of hyperkeratotic dry skin disorders:
Increased corneocyte cohesion & decreased desquamation Increased TEWL Less flexibility of stratum corneum causing excessively dry and

flaky skin
Cracking and fissuring Erythema and Pruritus

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Dry skin: Signs and symptoms

Dry skin refers to roughened, flaky or scaly skin that is less flexible than normal skin and dry to the touch The signs (what is seen) and symptoms (what is felt) of dry skin are:
Rough, scaly, or flaking skin Itching Cracks (fissures) in the skin, which may bleed if severe
http://www.aad.org/skin-conditions/dermatology-a-to-z/dry-skin/signs-symptoms/dry-skin-signs-and-symptoms-

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J Eur Acad Dermatol Venereol. 2005 Nov; 19(6):672-88; quiz 686-7.

Conditions associated with Dryness

Xerotic eczema Palmoplantar / Plaque type Psoriasis

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Psoriasis
Most commonly appears as inflamed, edematous skin lesions covered with a silvery white scales

Skin is the main organ affected

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Psoriasis

Chronic localized plaque psoriasis

Palmoplantar psoriasis

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Xerotic Eczema

Severe xerotic eczema Dry, itchy skin, especially on the arms, legs, and sides of body Skin lines accentuated & fine cracking

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Moisturization & Gentle Cleansing are indispensible in Dry skin management AAD

http://www.skincarephysicians.com/eczemanet/moisturizing_cleansing.html
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Moisturizing formulation
Moisturizers are defined as chemicals that increase the water content of the SC and are hydrating agents. Different moisturizing formulations
Cream For localized dryness Lotion For all over body dryness with advantage of spreadability Soap Offers cleansing & moisturizing benefits

Skin Therapy Letter. 2005; 10(5):1-8.

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How Moisturizers Work

The moisturizing treatment involves
Repairing the skin barrier Retaining/increasing water content Reducing TEWL

Restoring the lipid barriers' ability to attract, hold and

redistribute water, and Maintaining skin integrity and appearance.

Skin Therapy Letter. 2005; 10(5):1-8.

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How Moisturizers Work

As occlusives, humectants, and emollients

Reduce skin friction and increase skin hydration

providing water directly to the skin from their water phase and by increasing occlusion, as measured by a decrease in TEWL

Skin care products not only form an inert, epicutaneous layer, but they also penetrate and influence the structure and function of the skin

Skin Therapy Letter. 2005; 10(5):1-8.

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Moisturization principles
Occlusive action
These hydrophobic agents form an occlusive film on the skin Reduces TEWL by preventing evaporation of water from the stratum corneum. May also help to restore the lipid barrier of the skin.
Skin Therapy Letter. 2005; 10(5):1-8.
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Common substances with occlusive properties Fatty acids: Lanolin acid, Stearic acid Fatty alcohol: Cetyl alcohol, stearyl alcohol Hydrocarbon oil / waxes: Caprylic/capric triglyceride, mineral oil, paraffin, petrolatum, silicone derivatives (dimethicone / simethicone), squalene Polyhydric alcohol: Polyethylene glycol Sterols: Cholesterol

Moisturization principles
Humectant agents Attracts water to the skin from the deeper dermis or from the environment The hydration of the SC normalizes the intercellular lipids & the natural Common substances with humectant properties
Gelatin Glycerin Honey Hyaluronic acid Panthenol Propylene glycol Sodium lactate Sodium pyrrolidine carboxylic acid Sorbital Urea

desquamation process

Skin Therapy Letter. 2005; 10(5):1-8.

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Moisturization principles
Emollients
Skin softness, enhanced flexibility, and smoothness Fill the cracks between clusters of desquamating corneocytes e.g. stearic, linoleic, cyclomethicone, dimethicone

Skin Therapy Letter. 2005; 10(5):1-8.

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What is the Ideal Moisturizer?

What is the Ideal Moisturizer?

1. Effective - hydrating the SC, reduces and prevents TEWL 2. An emollient - makes skin smooth and supple 3. An aid in restoring the lipid barrier, i.e. duplicating and enhancing the skin's natural moisture retention mechanisms

4. Cosmetically elegant and acceptable

5. Absorbed rapidly - providing immediate hydration 6. Moisturizing to sensitive skin - i.e. hypo-allergenic, nonsensitizing, noncomedogenic 7. Long-lasting
Skin Therapy Letter. 2005; 10(5):1-8.
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Elovera-IMF

Composition
Key Ingredients Aloe Extract 10% Sodium Lactate & Sodium Gluconate 1% Vitamin E Acetate 0.5% Allantoin 0.35% Hyaluronic Acid (as Sodium Hyaluronate) 0.1% Other Ingerdients
Purified Water Caprylic/Capric Triglyceride Cetearyl Olivate (and) Sorbitan Olivate Hydrogenated Olive Oil (and) Olive Oil (and) Olive Unsaponifiable Light Liquid Paraffin Glycerin Stearic Acid Cetostearyl Alcohol Polyoxyethylene 20 Cetyl Ether Octyldodecanol Glyceryl Monostearate Phenoxyethanol (and) Methylisothiazolinone Dimethicone Triethanolamine Homopolymer Type C (Carbomer 980) Diethylhexyl Syringylidene Malonate (and) Metabisulphite Fragrance Disodium Edetate Quaternium 15

Hyaluronic Acid
Skin - about 50% of total HA in the body 1,000 - 10,000 disaccharide units as long, unbranched chains

Composed of 1 molecule each of glucuronic acid and Nacetylglucosamine

Makes skin moist & elastic

Hyaluronic Acid
HA content decreases with aging - elasticity & wrinkle on skin Thin, invisible, transparent, viscoelastic surface film fixes moisture on the surface of the skin (1000 times more than own weight of the film) Helps to preserve suppleness, elasticity and tone

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Topical HA & HA Fillers

What is the difference between topical HA skin care products and HA gel-based wrinkle fillers? Medium & large HA molecules cannot penetrate the skin in significant amounts

HA gel-based wrinkle fillers are injected under a wrinkle

May improve localized imperfections (e.g. wrinkles, furrows, depressed scars) but cannot revitalize the skin overall Topical HA forms a film on skin and decreases TEWL
http://EzineArticles.com/1335106

AHAs
The therapeutic effect of AHAs
Improve skin surface cosmetically Improve the flexibility of the SC Thin SC bends more readily without fissuring or cracking

Hydration of SC provides its suppleness Hydration - does not function to reduce sufficiently the thick SC found in severe hyperkertatotic disorders

Am Acad Dermatol. 1984 Nov; 11(5 Pt 1):867-79

AHAs on Moisturization
The effect of hydroxy acids on the duration of skin moisturization

Lactic acid maintains skin moisturization for longer time than other hydroxy acids

Int J Cosmet Sci. 1996 Apr; 18(2):75-83.

AHAs on Moisturization
Increases in skin moisturization after long-term use of hydroxy acids

L( +) form much less irritating than both D( -) form & glycolic acid
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Int J Cosmet Sci. 1996 Apr; 18(2):75-83.

Sodium Lactate
Very hygroscopic - strong humectant properties

Sodium salt of natural L(+)-Lactic Acid

Component of NMF of skin Water holding capacity is second to that of HA Excellent moisturizer, immediate & prolonged skin hydration
Int J Cosmet Sci. 1996 Apr; 18(2):75-83 Br J of Dermatol. 1997, 137; 934:938

Sodium Lactate
SC Flexibility, even at low humidity

Prevents reappearance of dry skin

Increases skin cell renewal

Br J of Dermatol. 1997, 137; 934:938

Ichthyoses Effect AHAs

Time Sequence of Improvement* of Lamellar Ichthyosis Topically Treated Three Times Daily

Arch Dermatol. 1974 Oct; 110(4):586-90.

Sodium Gluconate
PHAs provide additional humectant and moisturization properties compared with AHAs Enhance SC barrier function Most PHAs also possess antioxidant properties Exfoliation, skin smoothing, and antiaging effects

Scavenges free radicals, thereby protecting skin from some of the damaging effects of UV radiation

Cutis.2004 Feb; 73(2 Suppl):3-13.

Aloe Vera
Many natural sugar-like molecules that together form very long and large molecules - gelatinous aspect These molecules hold water molecules together - good moisturizer The polysaccharides in aloe vera create a barrier that prevents moisture loss from the skin (reduces TEWL)

Indications & Dosage

Dry, scaly skin associated with
Palmoplanter & plaque psoriasis Xerotic eczema Ichthyosis vulgaris

Dosage Elovera IMF cream/lotion to be applied gently on the affected area of the skin Use regularly, specially recommended for use after washing or bathing

Summary
Elovera-IMF is a complete moisturizer with
Humectants Hyaluronate, Na Lactate, Na Gluconate, Glycerin Occlusives Caprylic triglyceride, dimethicone

Occlusives & humectants ensure TEWL & adequate hydartion of SC

Conclusion
Moisturizers serve as an important first-line therapeutic option for patients with dry skin / hyperkeratotic skin and can be highly beneficial in improving the clinical signs and symptoms of challenging dermatologic conditions

Cutis. 2005 Dec; 76(6 Suppl):7-12.

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Thank You

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