The debate needs to start with a physiologic assessment of what happens to make skin age. At the epidermal level, research shows us that very little long-term aging occurs. The reason for this is simple, any aging event like an acid peel or a sunburn will create damage to the various layers of the epidermis but it very rarely creates changes that are not corrected within six weeks. The skin is well aware of the need to maintain a functional epidermal barrier because without it, we would all eventually die. Think about it… without an adequate epidermal barrier the body will ooze, bleed, and eventually develop a life-ending infection. That is why the epidermis is continually replacing itself and why sunburn (and other) damage is almost always self-corrected. For these reasons, I do not consider the treatment of the epidermis an "anti-aging" event. While there is no question plumping the epidermis makes fine lines look better, they are still the result of a thinning dermis. While inhibiting melanocytes will help to even skin tone, our problem still exists at the dermal/epidermal junction (loss of antioxidant absorption to support melanocytes) and in the dermis itself.

The following skin conditions can occur:

• thinning to dermis
• dehydration
• poor elasticity
• dryness
• hyperpigmentation, uneven pigmentation
• depleted nourishment
• accumulated dead skin cells
• skin cancer
• inflammation
• lowers immune response
• weaken capillaries
• permeability to the cells

The most significant damage we see in the epidermis is dehydration; decreased immune response and disturbance to cell cohesion and melanin. Sunlight traumatizes the epidermis, activating enzymes that cause inflammation, which breaks down the protective layer around cells. The cell membrane becomes more permeable allowing cells to dehydrate.
Sunlight affects all aspects of dermal function. Sunlight generates free radicals that elevate enzymes called collagenase that degrade skin collagen. This results in the formation of "disorganized" collagen fibers as solar scars. When the skin repeats this imperfect rebuilding process over and over wrinkles develop.

The following are a list of pigmentation disorders.

• Sunspots
  Lentigos are a product of cumulative sun exposure, not directly related to sunburns from a single day.
• Freckles
  Ephildes develop in fair skin individuals as the skin's natural defense from sun exposure.
• Post-Inflammatory
  A common occurrence after injury to skin or severe irritation that may be a result of acne, bad chemical peels, rashes, or laser surgery.
• Melasma
  The darkening of the skin's pigmentation, caused by the female hormone estrogen. Normal in pregnancy, this brownish discoloration can also be caused by birth control pills that contain estrogen as well as foods that increase estrogen levels.

Sun-Sensitizing Medications
Sunlight in "conjunction" with medication and certain foods all affect the production of tyrasinase and melanin. So if your client is taking any of the following medications, be sure to advise them they should use a UVA protection, antioxidants, melanin inhibitors, and support the skin's immune system with daily home care.

• antidepressants
• birth control
• allergen medication
• cancer medications
• cold medications
• high blood pressure medications
• St. John's Wort
• antibiotics
• anti arthritis medications

Foods that Increase Pigmentation

• genistein found in soy
• foods with colorants
• coffee
• tea
• diet soda
• sugar-free foods
• aspartame – increases production of eumelanin (a type of melanin)

Cosmetic vs. Medical Preparations that Exfoliate and Peel
So what are the differences between an exfoliant and a peel? Exfoliants loosen the cohesion of dead cells by digesting, sloughing, or dissolving these cells from the upper layers of the epidermis. Exfoliants only work on dead skin cells and waste material. They do not affect living tissue and they do not initiate an inflammatory response.
A peel works by literally peeling cells and tissue. They affect mid–epidermis to mid-dermis, depending on the modality. Peels do not discriminate and therefore take living tissue with them in the process. They do initiate an inflammatory response. Knowing which layer of skin is affected by these solutions will help you to determine which one to use in repair and restoration of sun damage.

How exactly do these Exfoliants work?
Salicylic acid is derived from willow bark, winter green leaves, and sweet birch bark. It promotes exfoliation of the surface cells and in particular the cells lining the sebaceous ducts. It works on blackheads by loosening the plugs, and peels the rim of the pore thus creating a more exposed opening for removal. They prevent the cells lining the gland from sticking together, promoting more effective exfoliation and more even flow of sebum secretion. Salicylic acid is recommended for the treatment of bacteria, clogged pores, and thicker oilier skin types. It is an anti-inflammatory, however it does not increase the moisture barrier.
Fruity Acids such as glycolic, which is derived from sugar cane, cause the cells of the epidermis to become unglued, allowing the dead skin cells to slough off, making room for regrowth of the new skin. Concentrations of five to eight percent with pH 3 to 4 are used in a cosmetic practice. Fruity acids brighten pigmentation, soften fine lines, stimulate skin function, and are recommended for dry, thicker skin types.
Lactic Clay is derived from milk products and will increase the natural moisture barrier. It has an antioxidant and anti-inflammatory property, which calms irritated skin and is recommended for any skin type, but especially sensitive, thin skins.
Vitamin C is known as ascorbic acid and is a water-soluble vitamin. Vitamin C is required for the synthesis of collagen and neurotransmitters. Vitamin C is also a highly effective antioxidant. It can be found in oranges, grapefruit, strawberries, papaya, tomatoes, broccoli, and potatoes. It improves skin tone, skin pigmentation, skin texture, and softens skin. Caution should be used when applying vitamin C to sensitive, dehydrated skins.
Enzymes are natural, biological enzymes found in papaya, rice, mushrooms, barley, pineapple, and certain clays. They are used as keratolytic agents, which mean they dissolve dead skin cells and waste material. Enzymes are special organic substances that act as biological catalysts, which dissolves dead cuticle.
Enzymes improve circulation, skin tone, and texture; it softens skin and is non-irritating; it dissolves impurities and waste within the pore; and it is recommended for any skin type and condition.
Mechanical scrubs consist of finely ground seeds, nuts, skins, etc., mixed with a cream or oil and when applied, they mechanically slough off the dead skin cells. Mechanical scrubs soften skin, improve texture, circulation, and skin tone. They are recommended for thick, course skins with no visible signs of compromised capillaries.
Clays work also as biological catalyst by loosening, drawing, lifting, and dissolving dead skin cells. Since clays are a rich source of minerals, they provide so many other benefits to the skin's function. They improve skin pigmentation, skin tone, hydrate, offer antioxidant properties, and boost immune response.

Glycolic Acid – the percentage ranges from 30 to 70 percent - and pH will vary. It penetrates from mid-epidermis to dermis. This percentage of glycolic initiates an inflammatory response and can improve course skin texture, fine lines, and wrinkles and stimulates cell regeneration. Depending on the percentage and the pH, glycolic acids can be applied to face, hands, chest, arms, and legs.

Microdermabrasion –performed using a machine that sprays fine crystals across the skin, removing the top layer vacuuming the crystals and debris away. Another type of procedure is done with a machine using a diamond tip wand that rotates removing surface dead skin cells. Microdermabrasion works by causing a small amount of trauma to the skin, causing the skin to repair itself in a more organized fashion. Fibroblasts are initiated by inflammation. This inflammatory response should not be confused with heating of the skin. The presence of numerous chemicals that are involved in the inflammatory process show that a reparative process is going on post-treatment. Microdermabration smoothes the skin surface, decreases oiliness, thins skin, and fine wrinkles may appear smaller. It has been noted that there is also an increase in firmness with this treatment.

TCA – Trichloroacetic Acid –another commonly used peeling agent. Concentrations of 20 to 50 percent are commonly employed. TCA solution will produce a superficial shedding of the stratum corneum after a single application. A 20 percent TCA solution affects mid-epidermis, where a 50 percent solution affects upper-dermis. TCA improves acne scars, severe sun damage, skin wrinkling, skin cancers, severe sun damage and is only applied to the face.

Blue Peel – Unlike alphahydroxy peels or other superficial procedures, the Blue Peel allows your doctor to control the depth of the peel and the number of coats applied in order to tailor the process to the skin's specific needs. It is a low concentration of the chemical trichloroacetic acid (TCA) mixed with a special blue base to slow penetration. It is used to smooth scars, improve brown spots, skin cancers, age spots, fine wrinkles, and tattoos. It can be performed on the neck, chest, hands, arms, and legs.
Phenol Chemical Peel is a procedure in which a prepared phenol solution is applied to the face in order to burn the skin's outer layer, the epidermis, and part of the dermis. This is essentially no different from the process that takes place after a limited second-degree burn. The removal of a portion of the dermis stimulates the growth of new tissue and helps promote a partial rebuilding of the skin. It is used for severe cases of deep wrinkles, scarred skin, and severe sun damaged skin. It is only applied to the face.
Though aestheticians do not apply medical solutions, we play an intricate role in the support and recovery of medically treated tissue.

Anne C. Willis has been part of the aesthetic industry since 1976. As a contributor to several major trade magazines, co-author of industry books, and guest speaker to both international medical and aesthetic conventions, Willis has become a recognized expert in the field of aesthetics and spa therapies. Willis offers premiere educational programs and customized training to schools and spas. For more information, please call 828-230-5125, e-mail This email address is being protected from spambots. You need JavaScript enabled to view it., or visit www.annecwillis.com.