Reassessing the Skin Care Regimen

The cosmetic and beauty industry is one of the world’s oldest professions, dating as far back as 1000 B.C. to the Picts, a tribe in Scotland. The use of ointments and oils was recorded on papyrus by the Ancient Egyptians, and cold cream is said to have been invented by the ancient Greek physician Galen. The quest for beautiful skin will bring many patients seeking expert advice to the dermatologist’s office. The aim of this section is to try and simplify a topic that is constantly changing. Technologic advances of the past several decades have provided a great deal of information about skin structure and function as well as cellular and molecular mechanisms of aging.

The skin’s appearance is dependent on many factors, including brightness and the way it reflects light.Healthy looking skin and how it reflects light is as important to younger-looking skin as is diminishing wrinkles. Lack of proper skin care can accelerate the aging process. It is therefore worthwhile to include a review of basic skin care, which comes down to cleansing and moisturizing.

The stratum corneum (SC) is a highly specialized structure whose brick and mortar composition is made up of terminally differentiated corneocytes (brick) intertwined within a specialized lipid matrix (mortar), which forms the skin’s protective moisture barrier [1]. The SC is made up of dead corneocytes that are formed following apoptosis or planned death of migrating keratinocytes. The ability of the SC to retain moisture is through a variety of smallmolecular- weight compounds collectively called the natural moisturizing factor (NMF) [2, 3]. The NMF functions as a humectant and consists of many compounds, including lactic acid, urea, and amino acids, which are breakdown products of filaggrin and cis-urocanic acid whose role is not clear but is believed to have a free-radical-scavenging role [4, 5]. The highest levels of NMF are found in the lowest regions of the SC where the greatest amount of moisture is retained.

The lipid matrix of the SC is made up of bipolar lipids in alternating hydrophilic and hydrophobic rows. The lipids consist of fatty acids, ceramides, and cholesterol, which form the SC mortar by surrounding the NMF thereby preventing moisture loss known as TEWL (transepidermal moisture loss.) Without this lipid bilayer, the hydrophilic NMF would evaporate and the resultant TEWL would clinically result in dry and aged-looking skin.


Cleansing is necessary in order to remove environmental dirt, microorganisms, makeup, and metabolic byproducts that can otherwise be damaging to the skin. Finding a cleanser appropriate for skin type that will not harm the moisture barrier while ensuring that a moisturizer is used to replenish and protect the moisture barrier is as important as any anti-aging ingredient.