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Skin Care-Seattle Healing Arts PowerPoint Presentation

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Skin Care-Seattle Healing Arts Presentation Transcript

Slide 1 - 1 SKIN AND SKIN CARE Angela Heithaus, MD Internal Medicine Seattle Healing Arts December 8, 2006
Slide 2 - 2
Slide 3 - 3 True or False? The way to find the right skin care product is by buying lots of different products until you find the one that works for you (if you’re lucky) The more expensive a product, the better it will work Fragrance-free products contain no perfume or fragrance Ivory soap is for sensitive skin The food I eat won’t affect my skin Paying attention to my skin is a waste of time!
Slide 4 - 4 The Skin Anatomy, Histology, Physiology Intrinsic aging/Photoaging SKIN CARE OBAGI pharmaceutical grade products Ablative vs non ablative procedures
Slide 5 - 5 The skin says it’s so! How do we judge a person’s age? By surveying numerous changes on the surface of the skin! Wrinkling Pigmented blotches Sagging Sallowness Dry, leathery look and texture Various growths
Slide 6 - 6 Skin: The Largest Body Organ! Architecturally the skin is probably the most complex body organ Skin layers Epidermis (including stratum corneum) Dermis Subcutaneous tissue
Slide 7 - 7 Functions Epidermis Stratum corneum: barrier + natural moisturizing factor 50,000 nucleated cells/mm Keratinocytes (supports S. corneum) Melanocytes (pigmentation) Langerhans cells (immune function) Dermis Collagen, elastin (provides structural support to the Epidermis) Subcutaneous Tissue support from shock, heat modulation, circulation, calorie storage
Slide 8 - 8 Epidermis Keratinocyte: Produces Keratin 90% of cells Half the cells remain in place Distributed along the rete ridges Anchor the epidermis onto the dermis Other half undergo differentiation Changes from a nucleated (living) cell To a non-nucleated (dead) cell The keratinocytes travel towards the skin surface Remains in the stratum corneum for two weeks Exfoliates off thereafter
Slide 9 - 9 Epidermis Melanocyte: Produces pigment Responsible for color and variation in color Number of melanocytes to keratinocytes Size of the melanocytes, Distribution of melanosomes Quantity of melanin produced
Slide 10 - 10 Epidermis Langerhans Cells: Immune Function spread out amongst the keratinocytes mop up invading foreign substances that have found their way into the body Transport IFS to special white cells (lymphocytes) in the lymph glands where they are neutralized Compliments: Dr. John Gray
Slide 11 - 11 Dermis Fibroblasts: Produce ground substance and fibers in connective tissue Collagens Possesses high strength and prevents the skin from being torn from overstretching Elastic fibers Provides elasticity, ‘give’ Ground Substance: Hyaluronic Acid, GAG Most important constituent in the ground substance; lubricant that allows collagen fiber to slide past each other Has extraordinary water holding capacity at least 1000 times its dry weight
Slide 12 - 12 Collagen/Elastic Fiber
Slide 13 - 13 Subcutaneous Tissue Contains Fat and Connective Tissue Supports blood vessels and nerves Supplies energy reserve Regulates body temperature Contains deeper hair follicles and sebaceous and sweat glands (apocrine, eccrine)
Slide 14 - 14 Aging vs. Photoaging Intrinsic Aging: Inevitably occurs as an organism progresses in chronological age Extrinsic Aging: Results from environmental effects such as UV exposure, pollution
Slide 15 - 15 Aged Epidermis In the very young, cell turnover averages 20 days By the 30’s, cell cycle begins to gradually slow down Decrease in number and function of cells-keratinocytes,melanocytes, Langerhans cells Renewal of skin becomes slower
Slide 16 - 16 Aged Dermis Decrease in activity and number of fibrocytes Loss of collagen, elastin and hyaluronic acid Rete ridges (pegs) reabsorb and the dermal-epidermal junction flattens
Slide 17 - 17 Photoaging from the Sun Up to 90% of the visible skin changes attributed to aging are caused by sun exposure Everybody regardless of race or ethnicity is vulnerable
Slide 18 - 18 UV light On a typical summer’s day, the UV energy received 3.5% UVB and 96.5% UVA Of the UVB reaching the skin: 70% is absorbed by the stratum corneum; 20% reaches the viable epidermis and 10% reaches the upper dermis UVA (I,II) radiation is absorbed partly by the epidermis, but 20-30% of this radiation reaches the deep dermis
Slide 19 - 19 DNA Damage Damage to DNA causes most of the adverse effects of photo-damage skin Cellular DNA directly absorbs UVB which causes lesions The lesions block transcription and replication If not repaired, it can lead to misreading of the genetic code – cause cell mutations and cell death UVA also damages the DNA but not directly UVA damage is induced indirectly through absorption by chromophores that release reactive forms of oxygen These free radicals cause breaks in the DNA strand Lisa Graft
Slide 20 - 20 Other culprits in increasing free radicals Diet Stress Pollution Cigarette smoke
Slide 21 - 21 Sun Exposure Accelerates Aging Damage to DNA, causing cells to go awry, leading to cancer Disintegration of enzymes necessary for production of important cell components Breakdown of collagen, the supporting structure Breakdown of elastin, which gives resilience and bounce Loss of hyaluronic acid, which holds water and gives volume
Slide 22 - 22 Skin Cancers Basal Cell – Forms in the basal layer of epidermis Sqaumous Cell – Forms in the middle portion of epidermis Typically neither Basal nor Sqaumous metastasize and are rarely fatal Melanoma – Begins in the melanocyte Much more fatal; killing 1 in 4 that develop it
Slide 23 - 23 Basal Cell Carcinoma Basal cell carcinoma is the most common type of skin cancer Fortunately, it is also the least aggressive form of skin cancer People with fair skin, blond or red hair and blue or green eyes are at the highest risk of developing basal cell carcinoma. They appear as small, fleshy, shiny or pearly bumps or nodules, generally on sun-exposed areas of the body (face, ears, neck, arms, and hands) Bolognia
Slide 24 - 24 Malignant Melanoma Incidence has increased dramatically over the last few decades Predominant in Caucasian skin with a lower tendency in deeply pigmented skin Not usually associated with chronic actinic damage, but is associated with short term extreme exposures
Slide 25 - 25 Squamous Cell Carcinoma Actinic Keratosis are the precursors in about 5-20% of cases Found predominantly on sun-exposed regions of the body, in people with light skin, light hair, and light eyes These tumors may appear as red, scaly patches or as raised, crusty growths The cure rate is over 95 percent with early diagnosis and treatment Without proper treatment they can metastasize and even be deadly
Slide 26 - 26
Slide 27 - 27 Summary Skin care begins with a fundamental understanding of: Skin Cell Functions Individual Skin type: dry vs oily; sensitive vs resistant; pigmented vs non-pigmented; wrinkled vs tight Effects of intrinsic and extrinsic aging factors
Slide 28 - 28 Dermatologic arsenal Good, effective sun block Topical Antioxidants to neutralize free radicals Retinoids to increase cell renewal by stimulating cells to reproduce Dipigmenting agent for hyperpigmentation
Slide 29 - 29 Before you begin, Prep the Skin! Cleaners- Glycolic and lactic acids: remove dead skin and help hydrate dry skin Salicylic acid (BHA), benzoyl peroxide for oily, acne prone skin Toners recommended only for more resistant and oily skin
Slide 30 - 30 Topical Antioxidants Vitamin C (L-ascorbic acid) Prevents breakdown of collagen, increases production Reduces pigmentation Vitamin E (alpha tocopherol) Healing of skin
Slide 31 - 31 Physical sunblock Zinc Oxide (Z-Cote HP1) Blocks UVB, UVA I,II (290-380 nm) 2 mg/cm2 Daily SPF of at least 15 Avoid exposure from 10 AM to 4 PM For increased exposure use SPF 45-60 reapply every hour
Slide 32 - 32 RETINOIDS Stimulate fibroblast growth formation Increase cell regeneration and turn-over Stimulate dermal collagen synthesis Increase exfoliation
Slide 33 - 33 RETINOIDS First generation Trans-retinoic acid or tretinoin (retin-A) 13-cis-retinoic acid or isotretinoin (accutane) Second generation Etretinate and acitretin (tegison, soriatane) Third generation Arotenoids (?cancer tx)
Slide 34 - 34 Hydroquinone Bleaching agent Reduction of pigmentation Melasma, solar lentigos, freckles 2% OTC, 4% Rx
Slide 35 - 35 Pharmaceutical Grade Skin Care ProductsObagi Most effective delivery of vitamin C and hydroquinone on the market Rx strength retinoids and hydroquinone Particularly effective for photoaged and pigmented skins Used pre and post ablative procedures to prep and heal the skin
Slide 36 - 36 Obagi Systems Obagi-C Rx Obagi Nu-Derm Obagi Professional-C Serums
Slide 37 - 37 Non ablative /Ablative Procedures Non Ablative IPL (intense pulse light); non-ablative peels; microdermabrasion; fillers (restylane,sculptra,radiesse); thermage (radiofrequency affecting collagen); botox Ablative Dermabrasion/dermasanding; ablative laser and chemical peels; surgeries
Slide 38 - 38 BOTOX Purified neurotoxin produced by Clostridium Botulinum Applied intramuscularly Deep furrows of forehead, crow’s feet, marionette lines Only treatment of its kind approved by FDA Effects last from 4-6 months Myoblock= 6 weeks New guy on the block: Reloxin
Slide 39 - 39
Slide 40 - 40 Thank You for Your Attention
 

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