When you design a regimen for your patients, every step matters. I have heard doctors say, “Use any moisturizer that you have at home,” and I cringe. This is because the moisturizer that your patients use dramatically affects the efficacy and side effects of the other products in their skin care regimens. For enhanced results, select a moisturizer for each patient based on his or her skin type, condition, and the treatment product(s) in the regimen.
Moisturizers and Ingredient Efficacy
Moisturizers do play an important role in skin hydration and appearance, but their role in the effectiveness of the overall skin regimen is much more involved. Every ingredient in moisturizers affects the efficacy of the other products in the regimen by affecting pH, the skin barrier and the chemical structure of various ingredients. Moisturizers regulate the penetration of other topical ingredients which changes the efficacy and the incidence of side effects.
Ingredients like oleic acid and hyaluronic acid increase the absorption rate of ingredients that are applied before and after by creating tiny holes within the skin. This can be both beneficial and detrimental to the overall regimen, depending on the skin type and ingredients. For example, anti-aging ingredients such as peptides have trouble penetrating the skin. Therefore, a moisturizer that contains oleic acid or hyaluronic acid can increase the absorption of peptides into the skin and enhance their benefits. Retinoids, on the other hand, can cause dryness and flaking in sensitive skin types, so you do not want to increase the penetration of these ingredients in patients with rosacea.
Moisturizers that contain occlusives form a protective seal on top of treatment products. This not only helps to increase penetration by forcing the product into the skin, but it also keeps the treatment product from being wiped off the skin or rubbed off onto a pillowcase or sheets overnight. Moisturizers that include humectants may pull water onto the skin and dilute or enhance the effectiveness of the ingredient.
Effect of Fatty Acids in Moisturizers
I am certain that you have heard that the best moisturizers contain an equal 1:1:1 ratio of fatty acids, cholesterol and ceramides. However, less discussion is made about the type of fatty acid that is best in a moisturizer. Choose a moisturizer with stearic acid as the predominant fatty acid because it works better with ceramides and cholesterol to strengthen the skin barrier. Avoid oleic acid (this is in oleic oil) unless you want to weaken the skin barrier and increase penetration.
The Skin Barrier
The skin barrier is made up of fatty acids (green), cholesterol (purple) and ceramides (orange) to form a watertight coating around skin cells.
The above image shows the ideal skin barrier (with stearic acid) with minimal space between the lipids. However, the structure of the skin barrier is affected by which fatty acids are present.
Oleic acid increases penetration as compared to the fatty acid stearic acid. This is because the “legs” on the fatty acids chains of stearic acid are closer together than those of oleic acid and can pack more closely together, making the skin barrier stronger.
This is an image of the skin barrier when oleic acid is the fatty acid, showing spaces between the lipids that allows water and other ingredients to easily pass through.
For this reason, the choice of fatty acid is critical in a moisturizer. Look for moisturizers with stearic acid – the labels will say glyceryl stearate, stearic acid, myristoyl/palmitoyl oxostearamide/arachamide MEA, or shea butter.
Humectants vs. Occlusives
Moisturizers can contain varying types of ingredients, each with their own set of functions and benefits. Humectants like hyaluronic acid, glycerin, and hydroxy acids pull in moisture from their environment. Humectants pull water onto the surface of the skin and will dilute other ingredients placed on the skin’s surface. The additive effect of water will change the efficacy and side effects of other products in the regimen.
Occlusive agents like argan oil, safflower oil, beeswax, and mineral oil are waxy or oily substances that form a protective seal over the skin. They push other ingredients into the skin and provide the added benefit of keeping other ingredients from being wiped off of the skin to enhance their penetration and efficacy.
Heparan Sulfate in Moisturizers
Other moisturizing ingredients such as heparan sulfate perform more specialized functions. New research has shown that heparan sulfate can play a significant role in improving signs of skin aging, including wrinkles, dehydration, and photodamage. This novel ingredient is a naturally-occuring glycosaminoglycan (GAG) that can be formulated using a lower molecular weight in order to effectively increase skin penetration. Heparan sulfate draws in moisture like other GAGs, but also affects how well skin cells “hear” signals that the treatment products send.
Hyaluronic Acid in Moisturizers
Hyaluronic acid (HA) is a very popular additive in moisturizers. It can be low, medium or high molecular weight and crosslinked or uncrosslinked. In some cases, all of these forms are included in the product as in SkinMedia HA5 Hydrator. HA is used in topical medications to increase drug delivery because it increases penetration. Using a HA products on a patient who is beginning a retinoid can increase the incidence of retinoid dermatitis. It is always important to consider the actions of every product placed on the skin and how they affect the other products placed before and after.
The right moisturizer makes a huge difference when it comes to increasing the effectiveness and reducing the side effects of the treatment product(s) in a regimen. Therefore, it is crucial that your patients are provided with detailed instructions that outline how, when, and in what order to apply each product in their regimen.
As described in this article, the order in which each product is applied can make a world of difference for the outcome. The science is complicated and impossible to think through thoroughly during the patient consult. In order to easily design scientifically correct and efficacious skin care regimens, I developed the Skin Type Solutions Software (STS) to automatically generate an efficacious regimen based on the patient’s Baumann Skin Type®. The system allows you to recommend the correct cleanser, and moisturizer to enhance the efficacy of the treatment product. You choose the brands you want to sell and the software generates the regimens automatically. Don’t worry – you can easily customize them and add in prescription medication is you prefer.
If you’d like to learn more about how the STS system works, please contact us online, email firstname.lastname@example.org or call 305-714-5322. You can also connect with me (Leslie Baumann) on LinkedIn, where I post more articles, skin care news, and research updates.
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