Skin care or skincare is a range of practices that support skin integrity, enhance its appearance, and relieve skin conditions. They can include nutrition, avoidance of excessive sun exposure, and appropriate use of emollients. Practices that enhance appearance include the use of cosmetics, botulinum, exfoliation, fillers, laser resurfacing, microdermabrasion, peels, retinol therapy,[1] and ultrasonic skin treatment.[2] Skin care is a routine daily procedure in many settings, such as skin that is either too dry or too moist, and prevention of dermatitis and prevention of skin injuries.[3]

Skin care is a part of the treatment of wound healing, radiation therapy and some medications.

Background

Skin care is at the interface of cosmetics[4] and dermatology.[5]

The US Federal Food, Drug, and Cosmetic Act defines cosmetics as products intended to cleanse or beautify (for instance, shampoos and lipstick). A separate category exists for medications, which are intended to diagnose, cure, mitigate, treat, or prevent disease, or to affect the structure or function of the body (for instance, sunscreens and acne creams), although some products, such as moisturizing sunscreens and anti-dandruff shampoos, are regulated within both categories.[4][6]

Skin care differs from dermatology by its inclusion of non-physician professionals, such as estheticians and wound care nursing staff.[1][7] Skin care includes modifications of individual behavior and of environmental and working conditions.[7]

Neonate

Guidelines for neonatal skin care have been developed. Nevertheless, the pediatric and dermatological communities have not reached a consensus on best cleansing practices, as good quality scientific evidence is scarce.[8] Immersion in water seems superior to washing alone, and use of synthetic detergents or mild liquid baby cleansers seems comparable or superior to water alone.[8] Add from [9][10]

Sunscreen

A woman applying sunscreen

Sun protection is an important aspect of skin care. Though the sun is beneficial in order for the human body to get its daily dose of vitamin D, unprotected excessive sunlight can cause extreme damage to the skin. Ultraviolet (UVA and UVB) radiation in the sun's rays can cause sunburn in varying degrees, early ageing and an increased risk of skin cancer.[11] UV exposure can cause patches of uneven skin tone and dry out the skin. It can even reduce skin's elasticity and encourage sagging and wrinkle formation.

Sunscreen can protect the skin from sun damage; sunscreen should be applied at least 20 minutes before exposure and should be re-applied every four hours. Sunscreen should be applied to all areas of the skin that will be exposed to sunlight, and at least a tablespoon (25 ml) should be applied to each limb, the face, chest, and back, to ensure thorough coverage. Many tinted moisturizers, foundations and primers now contain some form of SPF.

Sunscreens may come in the form of creams, gels or lotions; their SPF number indicates their effectiveness in protecting the skin from the sun's radiation. There are sunscreens available to suit every skin type; in particular, those with oily skin should choose non-comedogenic sunscreens; those with dry skins should choose sunscreens with moisturizers to help keep skin hydrated, and those with sensitive skin should choose unscented, hypoallergenic sunscreen and spot-test in an inconspicuous place (such as the inside of the elbow or behind the ear) to ensure that it does not irritate the skin.

Elderly

Skin ageing is associated with increased vulnerability.[12] As one ages, so does their skin. Fine lines, bruising, spots, dry skin, and more can slowly, overtime become more apparent. Although wrinkles occur naturally as we age, smoking can worsen the appearance of wrinkles. As humans spend time in the sun, we are not aware of the long-term effects. As time progresses, sunspots, dryness, wrinkles, or even cancer can occur from sun exposure. This can also occur by tanning either with the sun or with the usage of UV lights. The exposure to UV makes skin less ecstatic. Skin problems including pruritus are common in the elderly but are often inadequately addressed.[13] A literature review of studies that assessed maintenance of skin integrity in the elderly found most to be low levels of evidence, but the review concluded that skin-cleansing with synthetic detergents or amphoteric surfactants induced less skin dryness than using soap and water.[12] Moisturizers with humectants helped with skin dryness, and skin barrier occlusive reduced skin injuries.[12] When taking baths or showers, using warm water rather than hot can aid with dryness.

Young vs old skin

There is limited evidence that moisturizing soap bar; combinations of water soak, oil soak, and lotion are effective in maintaining the skin integrity of elderly people when compared to standard care.[14]

Acne

Acne ridden face
Representation of acne

According to the American Academy of Dermatology, between 40 and 50 million Americans develop acne each year.[15] Although many associate acne with adolescence, acne can occur at any age, with its causes including heredity, hormones, menstruation, food, and emotional stress.[15]

Those with inflammatory acne should exfoliate with caution as the procedure may make conditions worse and consult a dermatologist before treatment.[15] Some anti-acne creams contain drying agents such as benzoyl peroxide (in concentrations of 2.5 - 10% ).[16]

Pressure sore

Pressure sores are injuries to the skin and underlying tissue as a result of prolonged pressure on the skin. A known example of a pressure sore is a bedsore called a pressure ulcer.

Stoma

Add from [17][18]

When cleaning the stoma area, plain warm water should be use and dry wipe to gently clean around the stoma. Pat gently and make sure not to rub the area. Put all used wipes in a disposable bag and wash your hands after.

Wound healing

Wound healing is a complex and fragile process in which the skin repairs itself after injury. It is susceptible to interruption or failure that creates non-healing chronic wounds.[19]

Radiation

Radiation induces skin reactions in the treated area, particularly in the axilla, head and neck, perineum and skin fold regions.[20] Formulations with moisturising, anti-inflammatory, anti-microbial and wound healing properties are often used, but no preferred approach or individual product has been identified as best practice.[20][21] Soft silicone dressings that act as barriers to friction may be helpful.[20] In breast cancer, calendula cream may reduce the severity of radiation effects on the dark spot corrector.[21][22] Deodorant use after completing radiation treatment has been controversial but is now recommended for practice.[22] Add from[23][24][25][26]

EGFR

Epidermal growth factor receptor (EGFR) inhibitors are medications used in cancer treatment. These medications commonly cause skin and nail problems, including rashes, dry skin and paronychia.[27] Preventive intensive moisturizing with emollient ointments several times, avoidance of water-based creams and water soaks (although in certain circumstances white vinegar or potassium permanganate soaks may help), protection the skin from excessive exposure to sunshine, and soap substitutes which are less dehydrating for the skin than normal soaps, as well as shampoos that reduce the risk of scalp folliculitis, are recommended. Treatment measures with topical antibiotic medication can be helpful.[27][28][29]

Cosmeceuticals are topically applied, combination products that bring together cosmetics and "biologically active ingredients". Products which are similar in perceived benefits but ingested orally are known as nutricosmetics. According to the United States Food and Drug Administration (FDA), the Food, Drug, and Cosmetic Act "does not recognize any such category as "cosmeceuticals." A product can be a drug, a cosmetic, or a combination of both, but the term "cosmeceutical" has no meaning under the law". Drugs are subject to an intensive review and approval process by FDA. Cosmetics, and these related products, although regulated, are not approved by FDA prior to sale.

Procedures

Skin care procedures include use of botulinum;[30] exfoliation; fillers; laser medicine in cosmetic resurfacing, hair removal, vitiligo, port-wine stain and tattoo removal; photodynamic therapy; microdermabrasion; peels; retinol therapy.[1]

References

  1. 1 2 3 Penzer R, Ersser S. Principles of Skin Care: A Guide for Nurses and Health Care Practitioners. John Wiley & Sons, 2010. ISBN 9781405170871
  2. ↑ Rodulfo, Kristina (2018-04-06). "Ultrasonic Face De-Gunking Spatulas Are a Thing and You're Going to Want One". ELLE. Archived from the original on 2019-02-03. Retrieved 2020-03-08.
  3. ↑ Lichterfeld A, Hauss A, Surber C, Peters T, Blume-Peytavi U, Kottner J (2015). "Evidence-Based Skin Care: A Systematic Literature Review and the Development of a Basic Skin Care Algorithm" (PDF). J Wound Ostomy Continence Nurs. 42 (5): 501–24. doi:10.1097/WON.0000000000000162. PMID 26165590. S2CID 3841975. Archived (PDF) from the original on 2023-04-30. Retrieved 2019-12-13.
  4. 1 2 Kessler R. More than Cosmetic Changes: Taking Stock of Personal Care Product Safety. Environ Health Perspect; DOI:10.1289/ehp.123-A120 Archived 2015-09-08 at the Wayback Machine
  5. ↑ Random House Webster's Unabridged Dictionary. Random House, Inc. 2001. Page 537. ISBN 0-375-72026-X
  6. ↑ FDA. Cosmetics: Guidance & Regulation; Laws & Regulations. Prohibited & Restricted Ingredients. [website]. U.S. Food and Drug Administration, Silver Spring, MD. Updated 26 January 2015. Archived 2019-04-23 at the Wayback Machine
  7. 1 2 Schwanitz HJ, Riehl U, Schlesinger T, et al. (2003). "Skin care management: educational aspects". Int Arch Occup Environ Health. 76 (5): 374–81. doi:10.1007/s00420-002-0428-z. PMID 12719982. S2CID 41740856.
  8. 1 2 Blume-Peytavi U, Hauser M, Stamatas GN, Pathirana D, Garcia Bartels N (2012). "Skin care practices for newborns and infants: review of the clinical evidence for best practices". Pediatr Dermatol. 29 (1): 1–14. doi:10.1111/j.1525-1470.2011.01594.x. PMID 22011065. S2CID 27763545.
  9. ↑ Lund C, Kuller J, Lane A, Lott JW, Raines DA (1999). "Neonatal skin care: the scientific basis for practice". Neonatal Netw. 18 (4): 15–27. doi:10.1891/0730-0832.18.4.15. PMID 10633681. S2CID 20122791.
  10. ↑ Telofski LS, Morello AP 3rd, Mack Correa MC, Stamatas GN (2012). "The infant skin barrier: can we preserve, protect, and enhance the barrier?". Dermatol Res Pract. 2012: 1–18. doi:10.1155/2012/198789. PMC 3439947. PMID 22988452.{{cite journal}}: CS1 maint: multiple names: authors list (link) CS1 maint: numeric names: authors list (link)
  11. ↑ Clark A, Hessler JL (Aug 2015). "Skin Care". Facial Plast Surg Clin North Am. 23 (3): 285–95. doi:10.1016/j.fsc.2015.04.002. PMID 26208767. S2CID 32542642.
  12. 1 2 3 Kottner J, Lichterfeld A, Blume-Peytavi U (2013). "Maintaining skin integrity in the aged: a systematic review". Br. J. Dermatol. 169 (3): 528–42. doi:10.1111/bjd.12469. hdl:1854/LU-8691723. PMID 23773110. S2CID 42191236.
  13. ↑ Beauregard S, Gilchrest BA (1987). "A survey of skin problems and skin care regimens in the elderly". Arch Dermatol. 123 (12): 1638–43. doi:10.1001/archderm.1987.01660360066014. PMID 3688904.
  14. ↑ Cowdell, Fiona; Jadotte, Yuri T; Ersser, Steven J; Danby, Simon; Lawton, Sandra; Roberts, Amanda; Dyson, Judith (2020-01-23). Cochrane Skin Group (ed.). "Hygiene and emollient interventions for maintaining skin integrity in older people in hospital and residential care settings". Cochrane Database of Systematic Reviews. 1 (1): CD011377. doi:10.1002/14651858.CD011377.pub2. PMC 6996088. PMID 32006460.
  15. 1 2 3 "Acne clinical guideline". American Academy of Dermatology. 2018. Archived from the original on 2019-05-18. Retrieved 2019-09-26.
  16. ↑ "Topical Acne Drug Products". CFR - Code of Federal Regulations, Title 21, U.S. Food and Drug Administration. 1 April 2018. Archived from the original on 23 December 2016. Retrieved 23 December 2016.
  17. ↑ Skin care management of gastrointestinal fistulas JL Dearlove - Surgical Clinics of North America, 1996 - Elsevier* Peristomal skin care: an overview of available products P Black - Br J Nurs, 2007 - silesse.com
  18. ↑ Nix D, Ermer-Seltun J (2004). "A review of perineal skin care protocols and skin barrier product use". Ostomy Wound Manage. 50 (12): 59–67. PMID 15632457.
  19. ↑ Flanagan M. Wound Healing and Skin Integrity: Principles and Practice. John Wiley & Sons, 2013. ISBN 9780470659779
  20. 1 2 3 Herst PM (2014). "Protecting the radiation-damaged skin from friction: a mini review". J Med Radiat Sci. 61 (2): 119–25. doi:10.1002/jmrs.46. PMC 4175840. PMID 26229646.
  21. 1 2 McQuestion M (2006). "Evidence-based skin care management in radiation therapy". Semin Oncol Nurs. 22 (3): 163–73. doi:10.1016/j.soncn.2006.04.004. PMID 16893745.
  22. 1 2 McQuestion M (2011). "Evidence-based skin care management in radiation therapy: clinical update". Semin Oncol Nurs. 27 (2): e1–17. doi:10.1016/j.soncn.2011.02.009. PMID 21514477.
  23. ↑ Aistars J (Aug 2006). "The validity of skin care protocols followed by women with breast cancer receiving external radiation". Clin J Oncol Nurs. 10 (4): 487–92. doi:10.1188/06.CJON.487-492. PMID 16927902.
  24. ↑ Bolderston A, Lloyd NS, Wong RK, Holden L, Robb-Blenderman L (2006). "The prevention and management of acute skin reactions related to radiation therapy: a systematic review and practice guideline". Support Care Cancer. 14 (8): 802–17. doi:10.1007/s00520-006-0063-4. PMID 16758176. S2CID 23910103.
  25. ↑ Kumar S, Juresic E, Barton M, Shafiq J (Jun 2010). "Management of skin toxicity during radiation therapy: a review of the evidence". J Med Imaging Radiat Oncol. 54 (3): 264–79. doi:10.1111/j.1754-9485.2010.02170.x. PMID 20598015. S2CID 19719583.
  26. ↑ Trueman E (2015). "Management of radiotherapy-induced skin reactions". Int J Palliat Nurs. 21 (4): 187–92. doi:10.12968/ijpn.2015.21.4.187. PMID 25901591.
  27. 1 2 Califano R, Tariq N, Compton S, et al. (2015). "Expert Consensus on the Management of Adverse Events from EGFR Tyrosine Kinase Inhibitors in the UK". Drugs. 75 (12): 1335–48. doi:10.1007/s40265-015-0434-6. PMC 4532717. PMID 26187773.
  28. ↑ Thatcher N, Nicolson M, Groves RW, et al. (2009). "Expert consensus on the management of erlotinib-associated cutaneous toxicity in the U.K." Oncologist. 14 (8): 840–7. doi:10.1634/theoncologist.2009-0055. PMID 19679688. S2CID 2455128.
  29. ↑ Kiyohara Y, Yamazaki N, Kishi A (2013). "Erlotinib-related skin toxicities: treatment strategies in patients with metastatic non-small cell lung cancer". J. Am. Acad. Dermatol. 69 (3): 463–72. doi:10.1016/j.jaad.2013.02.025. PMID 23602600.
  30. ↑ http://www.allergan.com/assets/pdf/botox_cosmetic_pi.pdf Archived 2015-09-10 at the Wayback Machine
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