Proper use of skin care products can not only play a role in repairing the skin barrier and relieving inflammation, but also reduce symptoms such as dryness, burning and itching of the skin, reduce the dosage of drugs and prevent the recurrence of skin diseases, which can improve the quality of life of patients. In view of China’s national conditions and skincare management policies, in order to better standardize and guide dermatology clinicians’ knowledge of skincare products, the Dermatology Cosmetic Business Working Committee of the Dermatology Physicians Branch of the Chinese Medical Association has developed this skincare products dermatology application guideline after a long and thorough brewing and discussion, and under the guidance of evidence-based medical principles.
1.Introduction
1.1 Cosmetics
China’s definition of cosmetics: to apply spray or other similar methods, spread on any part of the human surface ( skin, hair, nails, lips, etc.) to clean, eliminate bad odor, skin care, beauty and grooming purposes of daily use chemical industrial products. China’s new regulations will be toothpaste, mouthwash and other oral cleaning and health care products are also included in the category of cosmetics.
1.2 Skin care products
According to the above definition, skin care products are cosmetic products used for the skin and its appendages, and are the main category of cosmetics. Therefore, in this paper, the following types of cosmetics are collectively referred to as skin care products
1.3 Medical skin care products
With the advancement of cosmetic science and related technology, the efficacy of cosmetics is both the driving force of the cosmetic industry and the biggest demand of consumers to use cosmetics. In the early 1970s, Albert Kligman, a renowned American dermatology professor, used the term cosmeceutcal to denote products with both cosmetic characteristics and certain efficacy, which is a superposition of the words cosmetic and pharmaceutical.
Chinese scholars translate “cosmeceuticals” as “medicinal cosmetics”, “functional cosmetics” or “active cosmetics”. “Most dermatologists in China refer to these products for clinical use as “medical skin care products” or “medical skin care products”. Although there are some differences in understanding and translation, in the past 20 years, a large number of skin care products with cosmetic effects have been widely used in clinical practice, and a wealth of evidence-based medical information has been accumulated. This guideline is based on numerous clinical applications and emphasizes that skin care products for clinical use should have the following characteristics.
① Higher safety: Although cosmetic products have passed strict safety tests and met relevant standards and requirements before being marketed, skin care products for clinical applications place more emphasis on streamlined formulations and rigorous screening of raw materials, and emphasize the absence or minimal inclusion of substances that can easily damage the skin or cause skin allergies, such as pigments, fragrances, preservatives, and irritating surfactants; in addition, product packaging also requires attention to Prevention of pollution, as far as possible, the raw materials and finished products of skin care products, such as clinical safety assessment.
② Clear efficacy: based on the physiological characteristics of different types of skin and the pathogenesis of skin diseases for research and development, its product components have a clear mechanism of action, has been confirmed by various types of tests, on some skin diseases can play a supplementary therapeutic role.
③ Clinical validation: The clinical efficacy and safety of the products have been verified through human trials before marketing to ensure less irritation and lower incidence of allergic reactions, etc.
2.Categories of clinically used skin care products
Based on the efficacy described in the product manual, we can broadly classify the skin care products used clinically in dermatology into the following categories.
2.1 Cleansing
Clinically used cleansing products generally use mild surfactants that are less irritating to the skin. Most attention is paid to the physicochemical properties of the products such as pH value. The components are added with ingredients such as chamomile, horsetail, natural spring water, moisturizing factors, etc., which have both cleansing and soothing effects and can relieve dryness and tightness of the skin.
2.2 Moisturizing and skin barrier repair
This type of skin care products often exert moisturizing and nourishing effects on the skin through the following ways.
①Moisture absorbent raw materials (including glycerin, butylene glycol, sodium lactate, urea and some other small molecules) absorb water from the environment to form a water concentration gradient in the skin stratum corneum from the inside out, so as to replenish the water lost by emanation from the stratum corneum.
②sealant raw materials (such as fatty acid, petroleum jelly, aloe vera, avocado oil, etc.) can form a thin hydrophobic oil film on the skin surface, which has the effect of reinforcing the skin barrier.
③Adding “bionic” raw materials with the same or similar composition as epidermis and dermis to supplement the shortage of natural skin components and enhance its own moisturizing, which has the effect of repairing skin barrier, such as natural moisturizing factor; lipid barrier agents, such as cymbidium fruit oil, ceramide; biological macromolecules, such as hyaluronic acid, collagen, etc.
2.3 Soothing category
This category of skin care products contains certain anti-inflammatory, anti-irritant and anti-oxidant ingredients, such as aloe vera, amaranth, chamomile, licorice extract, α-red myrrh alcohol, etc., which have better auxiliary anti-inflammatory and anti-allergic effects.
2.4 Oil control and anti-acne category
Zinc, vitamin B, evening primrose, tansy ketone, elm hydrangea, heavy floor extract and other components with the function of inhibiting sebaceous gland secretion are added, thus having the effect of reducing oil secretion. It contains low concentration of salicylic acid, fruit acids, retinoids and other components also has a certain dissolution of keratin and acne, so as to improve the discomfort of oily skin symptoms.
2.5 Whitening and spot removal
With the addition of active whitening ingredients such as arbutin, licorice flavonoids, tranexamic acid, vitamin C, green tea and Dianthus extract, it achieves whitening, spot removal and pigmentation reduction by inhibiting the action of tyrosinase, etc.
2.6 Sunscreen
With the addition of sunscreens such as titanium dioxide and benzophenone 3, it delays skin photoaging and prevents photodermatosis by physically covering, scattering light or chemically absorbing UV rays.
2.7 Promote wound healing class
With the addition of aloe vera, peptides, amino acids and hyaluronic acid, it can promote the healing of post-laser and minimally invasive wounds.
2.8 Skin rejuvenation and anti-wrinkle category
The addition of antioxidants such as vitamin E, green tea extract, vitamin A analogues, or ginseng, astragalus, and reishi extracts can improve the metabolic function of the skin and play a role in rejuvenating and slowing down skin aging.
2.9 Concealer type
The addition of opaque raw materials such as talcum powder, kaolin and other mineral powders can play a role in concealing imperfections and beautifying skin texture.
2.10 Others
Skin care products with the addition of ingredients that inhibit sweat secretion and antibacterial ingredients can be used to improve hyperhidrosis and armpit odor, and with the addition of ingredients that activate hair follicle metabolism, they can achieve the effect of promoting hair growth. Nowadays, with the rapid progress of cosmetic science and technology, more skin care products will be used in the future.
3.Dermatological diseases with damaged skin barrier
Mainly include the following diseases.
①Dry skin diseases: such as atopic dermatitis, eczema, pruritus, etc.;
②Erythematous scaling diseases: such as psoriasis, red furunculosis, erysipelas, etc;
③ facial dermatitis: seborrheic dermatitis, rosacea (rosacea), perioral dermatitis, chronic exfoliative lipitis, etc;
④Keratinization abnormal skin diseases: such as ichthyosis, peripapillary keratosis, exfoliative keratolysis, etc;
⑤ Drug-induced dry skin flaking: such as retinoic acid, benzoyl peroxide, etc;
⑥Physiological dry skin: mainly seen in the elderly or seasonal climate change caused by dry skin. The above diseases mostly choose skin care products of soothing class, cleansing class moisturizing and skin barrier repair class.
3.2 Sensitive skin
Mainly include the following diseases.
①Sensitive or intolerant subnormal skin ;
②Inferior cosmetics or improper use of cosmetics causing skin barrier damage;
③Medical origin, such as after laser and other minimally invasive surgery, various drug treatment caused by skin intolerance, such as hormone dependent dermatitis.
The above diseases also mostly choose skin care products of soothing, cleansing, moisturizing or skin barrier repair.
3.3 Seborrheic dermatoses
These include acne, seborrheic dermatitis, rosacea and other skin diseases. Most of the above diseases choose oil-control cleansing, oil-control and anti-acne skin care products, soothing or skin barrier repair skin care products also have good auxiliary therapeutic effects.
3.4 Pigmented skin diseases
Pigment-increasing skin diseases, such as melasma, post-inflammatory hyperpigmentation, melanosis, etc., this type of disease auxiliary application of whitening and spot-removing skin care products, and with moisturizing and soothing skin care products for basic care, external application of sunscreen, etc. have obvious therapeutic effect. Hypopigmented skin diseases, such as vitiligo, can be used to conceal the lesions with concealing skin care products while treating the disease with medication.
3.5 Photodermatoses
These include photosensitivity dermatitis, polymorphic sun rash, chronic actinic dermatitis, lupus erythematosus, dermatomyositis, skin photoaging, etc. The principle of skin care products selection is to emphasize the sun protection function, while applying moisturizers to improve the symptoms of dry and flaky skin. Clinically, skin rejuvenation products are used to slow down the photoaging of the skin.
3.6 Skin care after laser and other minimally invasive procedures
Skincare options for this category: soothing, cleansing, soothing wet mask, moisturizing or skin barrier protection products are used for basic care. Skin care products that promote trauma healing can accelerate the skin repair function, and sunscreen skin care products should also be used after the acute phase.
3.7 Others
Anti-odor and antiperspirant skin care products can be used for axillary odor and hyperhidrosis, and hair care products can be used for certain types of hair loss patients.
4. Precautions for applying skin care products
First of all, dermatologists must understand the types of skin care products and their respective mechanisms of action, master the basic characteristics of each of the main efficacy of raw materials and the correct use of various forms of skin care products; at the same time, they should be familiar with the approval number and the full composition of the product logo, refuse to exaggerate the efficacy of skin care products, and prohibit the use of counterfeit products that do not have all the necessary documents for the production of skin care products.
Second: choose skin care products reasonably according to the patient’s age, skin type, and the nature of skin diseases.
Third: Strengthen science education for patients. The establishment of a good doctor-patient relationship has a catalytic effect on popularizing the efficacy and use of skin care products, thus improving patient compliance. Finally, the receiving doctors and nurses should keep abreast of the patients’ situation after using skin care products, and if adverse reactions occur, discontinue the skin care products in time and actively treat them symptomatically.