• #5-3. Skin Care As an Adjunct Therapy



    I am surprised to see so many patients that still believe aggressive cleansing is good for the skin. Excessive cleaning and rubbing starts a vicious cycle as it strips the skin of intercellular lipids (ceramide, etc.), causing overproduction of sebum, which leads to cleansing again to remove it. Recently, many people are trying oil cleansing.


    Due to its affinity to sebum, cleansing oil removes lipids but it is very popular due to excellent cleansing action. Manufacturers also advertised cleansing oils to be gentler on skin than other cleansers. Due to such cleansing practices, a large majority of Japanese people now have much drier skin than 20 years ago. Air conditioning also dries the indoor air but I believe the obsession with cleanliness is a major cause of the widespread xeroderma in Japan.


    In my practice, I also see many patients with thin, weakened epidermis where even the capillaries can be visible. They practice thorough cleansing, careful moisturization with high-end cosmetic products but still complain of persistent dryness.


    Recently, some aesthetic clinicians are supporting what is called “skin fasting.” It refers to the practice of leaving the skin free of any make-up, soap cleansing or even lotion. The skin is cleansed with only water (not hot water). The skin becomes very dry for the first couple weeks but recovers the appropriate thickness of the stratum corneum as well as intercellular lipids, which leads to stronger, healthier skin. As the skin is not irritated through rubbing, inflammation subsides and even melasma lesions lighten in some cases.


    I use the example of the tribal people in Africa when I explain the benefits of skin fasting to my patients. People living in African deserts do not cleanse their skin or moisturize. The skin has natural ability to withstand even the strongest and hottest sun rays without any lotions or cleansing.


    People living in the cities need to wear make-up occasionally and it would be very hard not to apply any moisturizer after cleansing the skin of make-up. As the natural oils of the skin are removed through cleansing, moisturizer is needed to replenish them. Sometimes I suggest to my patients to only apply a thin layer of Vaseline and leave the skin unwashed and unmoisturized when they do not need to wear make-up.


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    Moisturizing the Dry Skin


    I use hydration therapy in patients complaining of dryness. Chemical peeling was once popular but is falling out of favor due to its damaging effects on the stratum corneum. Treatments that replenish the skin are becoming popular. Hydra-facials, where light peeling is followed by nutrition therapy, is often used but electroporation is the most popular choice of hydration therapy. The most widely used devices are Italy’s Acthyderm and Japan’s Mesoacthyis. Several Korean electroporation devices are also available in Japan.


    -To be continued

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