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Create your free business website! www.ascpskincare.com 25 Restoring the acid mantle (in other words, getting the skin back to an acidic pH) is the first step in restoring barrier function. Raising the pH of the skin for sustained periods of time can bring on or heighten the symptoms of acne, atopic dermatitis, rosacea, photodamage, and other conditions—not only affecting the epidermis, but also the dermis. Keep the skin acidic! Corneotherapy: Restoring the Skin Barrier When the skin barrier has been compromised, simply using anti- inflammatory ingredients is not enough to restore it. We must pursue treatments that return the barrier to its natural state of balance. This area of skin care is known as corneotherapy or skin barrier therapy. An important goal of corneotherapy is to generate the three lipids that form the permeability barrier. When we provide these to the skin in the correct ratio using topical corneotherapeutic products, the synthesized lipids make their way through the stratum corneum to be processed along with those that were generated within the skin, forming the lamellar membranes that make up the permeability barrier. The lipids in corneotherapeutic products must always be chemically identical to those within the stratum corneum. Restoring the acid mantle (in other words, getting the skin back to an acidic pH) is the first step in restoring barrier function. This will: • Turn off inflammatory processes within the epidermis. • Allow the permeability barrier to start reforming. • Improve the skin's antimicrobial defenses, decreasing the penetration of allergens and pathogens. Do Barrier Repair Creams Work? As the terms barrier repair and corneotherapy become more widely known, they have started to show up more often in product marketing. Many manufacturers who use these terms do not provide any supporting data that their products do what they claim. On closer inspection, many so-called barrier repair products do not contain the ingredients needed to get results. They may even cause more harm to the skin barrier. Here are the most common reasons why a barrier repair product does not work: • It does not contain all three of the necessary lipids: ceramides, cholesterol, and long-chain free fatty acids. • It does not contain the correct ratio of those lipids. • It has an incorrect pH. Poor formulations often use silicones or other occlusive ingredients in an attempt to "block up the gaps" and prevent further TEWL. These substances impede the natural functionality of the skin barrier instead of restoring it. This means some products touted as barrier repair products actually have the opposite effect—a situation that should be of great concern to any skin care professional. Getting it Right With all this in mind, what are the basics you need to know in order to practice effective corneotherapy? Here are the key points: • Respect the integrity of the epidermis, starting with the first lines of barrier defense. • Keep the skin's surface pH acidic. • Restore the antimicrobial barrier and natural UV-B filters. • When looking for a barrier repair product, use only those that provide ceramides, cholesterol, and long-chain free fatty acids in the 1:1:1 or 3:1:1 ratio. At the same time, these are the things to avoid: • Any procedure or product that decreases hydration. • Mineral oils and other petroleum-based products. • Products that contain emulsifiers. These have the side effect of destroying the lipid structures within the permeability barrier. • Products that contain fragrance. • Products that contain preservatives. With a better understanding of the structure and function of the skin barrier, estheticians will recognize the importance of treating it with the respect it deserves. Overexfoliating, harsh or incorrect modalities, and incorrect product formulations all work together to create an inflammatory situation for your client. The key to success in treating skin starts with a full assessment of the health of the skin barrier and the correct strategies to begin the repair process. Once the barrier is restored, wonderful and lasting results can be achieved for your client. Kathryn Mazierski is a practicing esthetician, writer, researcher, and a nationally recognized expert in cosmetic chemistry and skin physiology. She develops training programs in the emerging field of corneotherapy and is a distributor for the Dermaviduals corneotherapy skin care range. Contact her at info@dermavidualsusa.com.