For those who perform in clinic dermaplaning, microdermabrasion and chemical peel treatments I need to ask the question; why?

Let’s get our skin nerdy thinking caps on and talk about the first three lines of skin barrier defense which are literally removed during an abrasive exfoliation treatment and why this treatment modality is not suitable for the skin; primarily the face considering this is where our main focus resides.

When performing any desquamating treatments to the skin, do you all think at a cellular level? Do you understand the lifecycle of the keratinocyte and what it requires to function and create the skin’s barrier defense systems? Do you consider the client’s level of biological cellular damage? What about the risk factors involved when it comes to the physiology of the skin and how the underlying cells and systems of the integumentary system will respond? From what I have seen all over social media, I think not.

In this post, I am only going to be focusing on the first three lines of skin barrier defense.

THE FIRST LINE OF SKIN BARRIER DEFENSE:
The Acid Mantle & Microbiome

I have often wondered why professional therapists choose this treatment modality when the Acid Mantle & Microbiome play a huge factor in the homeostasis of the skin, and why such a treatment is being performed without any consideration for this protective hydrolipidic barrier.

The Acid Mantle begins formation when the Periderm is replaced by the Stratum Corneum during the eleventh week of gestation and eventually will mix with the infants sweat, sebum and epidermic lipids to create the Vernix Caseosa and from here, the first line of skin barrier defense is formed. The Microbiome contains trillions of microorganisms such as bacteria, yeast, viruses and fungi to which takes up residence within the Acid Mantle once the infant moves from the uterus into the vagina; while also being obtained from direct skin-to-skin contact and exposure to the environment.

The Acid Mantle & Microbiome play a pivotal role in supporting the innate/adaptive immune system for the developing child, and excessive amounts of cleansing or unnecessary removal upsets the equilibrium of this colonisation causing them to move or die; and when this takes place nonresident bacteria may proliferate.

In today’s society it is relatively known that an extremely protected skin is not as resistant to many of the different external influences the skin will come into contact with such as allergens, dirt and other irritating substances. The skin just like all other bodily organs must undergo a learning process and adapt to its surroundings; and the increasing prevalence for barrier disordered skin conditions such as neurodermatitis or allergic reactions for example only substantiates this fact.

Majority of the skins microbiome consists of staphylococcus epidermidis and cutaneous bacteria (p.acnes) and there is a direct correlation between atopic dermatitis and staphylococcus in varying cases when it comes to this skin condition.

Let’s now take a look at the benefits of having an intact Acid Mantle & Microbiome:

The Microflora contains all of the properties to prevent non resident bacteria from developing while also helping to buffer the action between acidic and alkaline chemicals
The Microflora can only reside in a physiological pH of around 5.5 and works to maintain this pH balance
The Microflora inhibits the growth of pathogenic bacteria by consuming what little nutrients are available from the surface of the skin
The Acid Mantle prevents toxic matter from being absorbed into the skin
The Acid Mantle slows down the evaporation of the free water from the epidermis
The Acid Mantle acts as the skins primary lubricant

As you can clearly see the Acid Mantle & Microbiome are highly important for cutaneous health so would you knowingly destroy this ecosystem or compromise it with unnecessary desquamation?

THE SECOND LINE OF SKIN BARRIER DEFENSE:
The Stratum Corneum

The Stratum Corneum is not just a layer of static ‘dead’ tissue as it contains many intricate barrier functions to which all operate accordingly to enhance cellular communication between the Acid Mantle & Microbiome, corneocytes and corneodesmosomes for the underlying keratinocytes as these cells have the ability to communicate with all other cells and systems of the integumentary system to protect the body.

By continually removing the Stratum Corneum, you will release a cascade of inflammatory cytokines to which will alert the adaptive/innate immune system of a mechanical breech at the site of response and of course, wound healing will ultimately take effect; generating an increase in ROS (Reactive Oxygen Species) causing the degradation of our own natural built in antioxidant defense systems while releasing uncontrolled MMP activity to which will destroy our collagen, elastin and glycosaminoglycans.

The increase in blood circulation, collagen, elastin and hyaluronic acid resulting in a plumper, firmer and more glowing skin post an invasive treatment like dermaplaning and microdermabrasion, is the result of trauma generated by the wound healing process which in turn will have a negative knock on effect as I just previously mentioned to all of the cells and systems of the epidermis and dermis.

Our skin heavily relies on specific cellular nutrients to maintain perfect homeostasis, so if we continue to put the skin into a state of inflammation (whether we can ultimately see the inflammation or not), can we as professional therapists guarantee that these nutrient resources will be there when we need them the most? I personally do not believe so.

The Stratum Corneum is the physical barrier of the skin and is the first cell to have immediate contact with the outside environment; initiating cytokines and growth factors to the underlying tissues and cells of the skin on a daily basis. Preserving the integrity of the Stratum Corneum at all times is of fundamental importance to the viability of the entire epidermis and all of the related skin barrier defense systems. This will work to ensure that skin conditions like acne and pigmentation along with premature ageing are relatively controlled.

THIRD LINE OF SKIN BARRIER DEFENSE:
The Permeability Barrier (Multi-Lamellar Lipid Structure)

The Permeability Barrier, previously known as the Multi-Lamellar Lipid Structure, is formed by the keratinocyte during its journey through the epidermis and ultimately releases all of the oil/water content (bi-layers) into the intracellular space of the Stratum Corneum and govern the water movement of the epidermis while also fighting off external aggressive substances.

The Permeability Barrier is primarily composed of phospholipids; primarily Ceramides and is ester linked to the Essential Fatty Acids Omega 3 and 6 for strengthening epidermal cohesion between the Acid Mantle & Microbiome, Stratum Corneum and the Permeability Barrier (bi-layers) to which will selectively allow for the active and passive transfer of nutrients, hormones, oxygen, growth factors, cytokines and the removal of cellular waste. Always remember, if one cell is breached the rest will be affected.

Omega 3 & 6 are not metabolized by the body and are only available through excellent nutrition both topically and internally, so when a skin treatment therapist chooses a peeling modality where the first three lines of skin barrier defence are removed, has any thought been given for what the integumentary system requires and is heavily dependent on?

Ceramides of the bi-layers for example become part of the Acid Mantle when the corneocytes desquamate from the surface of the skin, and so when this takes place, the emulsifying action of these ceramides play a pivotal role in binding together the water/oil phase of the sebaceous/sudoriferous secretions and epidermic lipids of the skin to strengthen and make your Acid Mantle.

All cells and systems are composed of a thin microscopic membrane composed of phospholipids to which are reliant on Essential Fatty Acids for strength and integrity, so if we as professional therapists continue to tear down the bricks of our house (corneocytes) and the mortar (bi-layers), I sincerely doubt that you’re going to be a happy, healthy resident at the end of the day. You also need to keep in mind that all of this cellular damage can be accumulative and may not show its ugly face until years later.

Here comes the question I asked at the very beginning: Why?
Why are we removing important lines of cell barrier defense if they are there for a reason? If we have an unprotected skin we get an increase in oxidative stress and a decrease in cellular protection which contributes to the premature ageing process which after all is what we are trying to realistically slow down!

As International Skin Educator and IAC Leader Florence Barrett-Hill says:
‘Continual removal of the epidermis without consideration for keratinocyte health and cellular age is having a negative knock on effect to the viability of the entire epidermis and all of the related skin barrier defense systems.’

Always think three dimensionally and ask the following question:
What does a cell require to function or what is required to inhibit a function and then do your best within your in clinic treatments and home-care to supply it.

Written by Kai Atkinson

RESOURCES/REFERENCES:
https://www.pastiche-training.com/
https://www.corneotherapy.org/
http://www.dermaviduals.com/
https://onlinelibrary.wiley.com/…/…/j.1468-2494.2011.00644.x