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Wednesday, April 23, 2014
Several interventions are available to restore the skin to a more optimum state.
[NOTE: These procedures should be administered only by trained, certified skin care professionals, individuals who can evaluate your skin condition and recommend the appropriate treatment strategy. They can also discuss the amount of improvement that can be expected from a given product or procedure, since the effectiveness varies from one person to another.]
The retinoids are topical medications derived from Vitamin A and include Renova, Retin-A, Retin-A Micro, and Differin. The retinoids control and promote the process of removal of the cells from the very top layer of the stratum corneum, a process referred to as exfoliation. They produce a more compact stratum and a smoother skin surface. The retinoids increase the thickness of the epidermis, decrease the pigment (melanin) content and even the coloration. The quality of the dermal-epidermal junction is improved. They increase the collagen in the dermis, reduce the inflammation and reduce the elastic damage. The increase in collagen reduces the fine wrinkles and increases skin firmness. The physiological changes result in skin that has the characteristics of younger skin.
Bleaching agents, such as kojic acid and hydroquinone, lighten the skin by decreasing the process of skin pigment production. Less pigment results in lighter skin coloration. These materials must be used with a sun screen or a sun block, however. They can be used in combination with topical retinoids.
Trained professionals, i.e., dermatologists and plastic surgeons, use three techniques for restoring the skin surface: chemical peels, dermabrasion, and laser resurfacing. The technique is selected on a highly individual basis and the choice depends on the skin condition, extent of photodamage, location on the body, skin type, etc.
The chemical peel uses chemicals to remove the top layers of skin. The hydroxy acids, including glycolic acid, salicylic acid and trichloroacetic acids, are commonly used. The nature and extent of the skin effects depend upon the concentration of the acid, the acidity (pH), the type of hydroxy acid, and the frequency of use. The products include over the counter moisturizers, which are generally 4-8% in concentration of hydroxy acid, and chemical peels, which range from 10-70% in concentration. The treatments weaken the attachments between the cells in the top layers of the epidermis to allow their removal and smooth the skin surface. They increase the rate of cell turnover in the epidermis and decrease pigmentation in the dermis. The higher concentration peels increase collagen production in the dermis.
In dermabrasion, the epidermis and part of the dermis are mechanically removed, purposely creating a "wound". As the wound heals, the skin remodels itself. The pigmentation is normalized, reducing the darkened spots. The dermal collagen increases and the damage to elastin fibers is repaired. These changes have the effect of reducing the level of wrinkling and increasing color uniformity.
Laser resurfacing removes the epidermis and part of the dermis by vaporizing the tissue and creating a wound. During the healing process the epidermis thickens. The pigmentation becomes more uniform, since some of the darkened areas are removed. The dermal-epidermal junction has the normal undulating appearance and is stronger. The dermis thickens and collagen density increases. The remodeling process reduces the wrinkles. The laser can be targeted to areas of greater damage in order to optimize results. Some of the newer lasters are designed to minimize the amount of epidermis that needs to be removed. Laser methods are continually being refined. These methods are often advertised to consumers, but should be discussed with a trained physician who can discuss the advantages and disadvantages of various approaches.
All three restoration techniques rely on the skin's restorative properties to create new tissue with improved properties. The results are dependent upon a number of individual factors, including extent of damage, skin condition and reactivity, existing medical conditions, etc. The chemical peel, dermabrasion, and laser resurfacing procedures must be discussed a physician trained, certified and experienced in their use with successful outcomes.
Last Reviewed: Apr 04, 2006
Marty O Visscher, PhD
Professor of Pediatrics
College of Medicine
University of Cincinnati