Facial Foundations, Powders, and Blushes
The formulation and use of colored cosmetics is an area of dermatology where medicine, science, art, and appearance intermingle. This makes the study of colored cosmetics both challenging and fascinating. Colored cosmetics are of medical significance for their ability to function as camouflaging aids. Recognizing dermatoses that rarely may be related to the use of foundations also is important. The formulation and efficacy of colored cosmetics is grounded firmly in the science of cosmetic chemistry and skin physiology. Yet, colored cosmetics are valued for their appearance-enhancing capability and the intangible aspects of well-being that their use imparts.
A discussion of the art and science of colored cosmetics can provide a fund of knowledge useful to the physician in tackling problems related to appearance and dermatologic disease.
Facial foundations1,2
Facial foundations are designed to add color, to cover blemishes, and to blend uneven facial color in women of all skin colors. Facial foundations available for white or light skin must be formulated in at least 7-8 shades; however, facial foundations for black or dark skin must be formulated in at least 10-12 or more shades to cover the tremendous variation in skin pigmentation. In basic terms, a facial foundation is a pigmented moisturizer that can be customized to meet the needs of a variety of skin types.
Facial foundation is applied to the entire face, used on a daily basis, and worn for an extended period of time. For this reason, facial foundation plays an important role in skin treatment, but it is also the facial cosmetic most likely to be problematic. Facial foundation is a relatively modern product, invented and patented by Max Factor in 1936 in the form of a cake makeup used primarily in the film industry. Popular demand for this cosmetic developed shortly thereafter as women found the excellent coverage, velvety look, and added facial color desirable. Since that time, the variety and popularity of facial foundations has expanded tremendously.
Formulation
Four basic facial foundation formulations are available, oil-based, water-based, oil-free, and water-free or anhydrous forms. Oil-based products are designed for dry skin, while water-based products can be adapted for all skin types. Oil-free formulations are used for oily skin, while anhydrous forms are extremely long wearing and are used for camouflage or theatrical purposes.
Oil-based foundations are water-in-oil emulsions containing pigments suspended in oil, such as mineral oil or lanolin alcohol. Vegetable oils (eg, coconut, sesame, safflower) and synthetic esters (eg, isopropyl myristate, octyl palmitate, isopropyl palmitate) also may be incorporated. The water evaporates from the foundation following application, leaving the pigment in oil on the face. This creates a moist skin feeling, which is especially desirable in patients with a dry complexion. Oil-based foundations do not shift color as they mix with sebum because the color is fully developed in the oily phase of the formulation. These foundations are easy to apply because the pigment can be spread over the face for up to 5 minutes prior to setting.
Water-based facial foundations are oil-in-water emulsions containing a small amount of oil in which the pigment is emulsified with a relatively large quantity of water. The primary emulsifier is usually soap (eg, triethanolamine, nonionic surfactant). The secondary emulsifier, present in smaller quantity, is usually glyceryl stearate or propylene glycol stearate. These popular foundations are appropriate for minimally dry to normal skin. Because the pigment is already developed in oil, this foundation type also is not subject to color drift. The application time is shorter than with oil-based foundations because of the lower oil content. These products usually are packaged in a bottle.
Oil-free facial foundations contain no animal, vegetable, or mineral oils. They contain other oily substances, such as the silicones dimethicone or cyclomethicone. These foundations usually are designed for individuals with oily complexions because they leave the skin with a dry feeling. Silicone is noncomedogenic, nonacnegenic, and hypoallergenic, accounting for the tremendous popularity of this type of facial foundation formulation. These products usually are liquids packaged in a bottle.
Oil control facial foundations should not be confused with oil-free facial foundations. All facial foundations contain a blotter designed to absorb sebum. Oil control facial foundations simply contain additional blotters, such as talc, kaolin, starch, or other polymers, designed to absorb sebum in higher concentration. Usually, these products are formulated with dimethicone; however, mineral oil may be added to some formulations. Thus, oil-control foundations are not necessarily oil-free.
Water-free or anhydrous foundations are waterproof. Vegetable oil, mineral oil, lanolin alcohol, and synthetic esters form the oil phase, which may be mixed with waxes to form a cream. High concentrations of pigment can be incorporated into the formulation, yielding an opaque facial foundation. The coloring agents are based on titanium dioxide with iron oxides, occasionally in combination with ultramarine blue. Titanium dioxide acts as a facial-concealing or covering agent. These products can be dipped from a jar, squeezed from a tube, wiped from a compact, or stroked from a stick. These foundations are well suited for use in patients with facial scarring who desire camouflaging.
Surface characteristics
Facial foundations are manufactured in a variety of finishes, including the following: matte, semimatte, moist semimatte, and shiny. The finish is the surface characteristic of a cosmetic. Matte finish foundations yield a flat look with no shine and generally are oil-free. They are good for patients with oily skin who tend to develop some shine after a foundation has been applied. A semimatte finish has minimal shine and is generally an oil-free foundation or water-based foundation with minimal oil content. This finish works well on slightly oily to normal skin.
A foundation with more shine is known as a moist semimatte foundation and generally is water-based with moderate oil content. This finish works well on normal-to-dry skin. Shiny finishes are found in oil-based foundations and are only appropriate for persons with dry skin. The shinier foundations with increased oil content also have increased moisturizing ability.
Application
The foundation selected should match the natural facial color as closely as possible. This can be difficult because the nose and cheeks have redder tones than the forehead and chin. The foundation is matched to the skin along the jaw line because this is where the color must be blended carefully beneath the chin. Mismatched facial foundations generally leave a demarcation at the jaw line. A foundation color should be selected in natural sunlight; the bright artificial fluorescent lights used in most stores distort color perception.
In general, facial foundation should be applied with the fingertips. A dab of foundation should be placed on the forehead, nose, cheeks, and chin and then blended with a light circular motion until it is spread evenly over all the facial skin, including the lips. Finally, a puff or sponge should be used, stroking in a downward direction, to remove any streaks and to flatten vellus facial hair. Special care should be taken to rub the foundation into the hairline, over the tragus, and beneath the chin. Foundation also should be blended around the eyes and, if desired, may be applied to the entire upper eyelid. The foundation should be allowed to set or dry until it can no longer be removed with light touch. If additional coverage is desired, a second layer of foundation can be applied
Adverse effects
Facial foundations are a rare cause of allergic and irritant contact dermatitis. Usually, the fragrance or preservative ingredients account for most cases of allergic contact dermatitis reported. Irritant contact dermatitis is much more common because this product is worn by patients with dermatitic skin for 8 hours or more on a daily basis. Facial foundation can be open or closed patch tested as is.
Some facial foundations are labeled for sensitive skin. The exact meaning that this marketing claim delineates is unclear. Evaluation of these products fails to reveal avoidance of any particular chemicals or group of allergens. These products sometimes contain a substance known to soothe skin, such as allantoin. These formulations may be designed to minimize any dermatitis resulting from use of the products, allowing the patient to continue wearing facial foundation.
Facial powders3
Facial powders provide coverage of complexion imperfections, oil control, a matte finish, and tactile smoothness to the skin. Originally, facial powder was applied over a moisturizer to function as a type of powdered foundation. Liquid foundations have largely replaced the powdered foundation; however, for patients who wish sheer coverage with excellent oil control, a powdered foundation performs excellently. An appropriate moisturizer for the patient's skin type is first applied and allowed to set or dry, followed by application of a full coverage translucent powder.
Formulation
Full coverage powders contain predominantly talc (hydrated magnesium silicate) and increased amounts of covering pigments. The covering pigments used in face powder can be listed in order of increasing opaqueness, as follows: titanium dioxide, kaolin, magnesium carbonate, magnesium stearate, zinc stearate, prepared chalk, zinc oxide, rice starch, precipitated chalk, and talc. It generally is accepted that the optimum opacity is achieved with a particle size of 0.25 microns. Magnesium carbonate also can be used to improve oil blotting, to keep the powder fluffy, and to absorb any added perfume. Kaolin (hydrated aluminium silicate) also may function to absorb oil and perspiration. Full coverage face powders usually are packaged in a compact and applied to the face with a puff.
Transparent facial powders are more popular today to add coverage and to improve oil-blotting abilities of a previously applied liquid foundation. Transparent powders have the same formulation as full-coverage powders except they contain less talc, titanium dioxide, or zinc oxide because coverage is not a priority. Transparent facial powders commonly have a light shine, produced by nacreous pigments, such as bismuth oxychloride, mica, titanium dioxide–coated mica, or crystalline calcium carbonate.
Facial powder usually includes iron oxides as the main pigment, but other inorganic pigments, such as ultramarine, chrome oxide, and chrome hydrate, also may be used. These powders are designed to augment the underlying skin and foundation tones; therefore, transparent powders can be used by patients who have difficulty finding an appropriately tinted facial foundation.
Application
Facial powders are removed from a compact with a puff or dusted loosely from a container with a brush. They impart a matte finish to the face. Patients who desire a shiny or moist semimatte facial appearance should avoid powder because it absorbs the oil in the foundation, thus destroying the dewy appearance. Patients with dry complexions also may wish to avoid facial powder because it can further dry the skin. The oil-absorbing abilities of facial powder are extremely valuable in the patient with an oily complexion prone to develop a facial shine.
Adverse effectsThe incidence of allergic contact dermatitis to facial powder itself is low; however, added fragrances may pose a problem. A more common problem with facial powders is irritant contact dermatitis due to coarse particulate matter, such as nacreous pigments, in the formulation. Inhalation of the powders may cause problems in patients with asthma or vasomotor rhinitis. Facial powder may be open or closed patch tested as is.
Facial blushes2
Facial blushes, also known as rouges, are designed to enhance rosy cheek color. In many cases, rosy cheeks simply indicate vasomotor instability or fine telangiectatic mats from actinic damage; however, cheek color remains fashionable.
Formulation
Blush and rouge are actually synonyms for a cosmetic designed to add color to the cheeks; however, to many consumers, blush denotes a powdered product, while rouge denotes a cream product. Powdered blushes are more popular and are formulated identically to compact face powder, except more vivid pigments are added. Because color rather than coverage is desired, powdered blushes do not contain much zinc oxide. Cream rouges are formulated like anhydrous foundations that contain light esters, waxes, mineral oil, titanium dioxide, and pigments.
Application
For a natural appearance, cheek color should be applied beginning at a point directly beneath the pupil on the fleshy part of the cheek, sweeping upward beyond the lateral eye. This placement is designed to create or accentuate high cheekbones, which are a desired quality among women.
Adverse effects
The adverse reaction concerns with blushes and rouges are identical to that for facial powders (see adverse effects of facial powders above). The products can be open or closed patch tested as is.
Facial Cosmeceuticals
The new trend in cosmetics is the development of pigmented products that enhance the face and also contain ingredients that may reverse or prevent aging. These products might be termed treatment cosmetics, but the label used in the cosmetics industry is cosmeceutical. These cosmeceuticals are designed to address the major cause of cutaneous aging, which is oxidation of skin structures from highly reactive oxygen molecules present in the oxygen-rich environment. Oxygen, while necessary for life, also destroys tissue with continued exposure.
Other organisms, especially plants, have evolved mechanisms for protection against oxidative stresses. These protective mechanisms provide interesting chemicals that can be extracted and added to topical antioxidant preparations for human use in the treatment of benign photodamage. The cosmetics and skin care industry is spending tremendous resources searching for botanical antioxidants that can provide human cutaneous protection from oxidative damage.
Antioxidant botanicals quench singlet oxygen and reactive oxygen species, such as superoxide anions, hydroxyl radicals, fatty peroxy radicals, and hydroperoxides. Many botanical antioxidants have been commercialized and are available from raw material suppliers. These botanical antioxidants are briefly discussed, as are the currently popular botanical antioxidants, such as soy, kinetin, curcumin, silymarin, and pycnogenol, which are commonly incorporated in cosmeceutical facial colored cosmetics.
Categorizing botanical antioxidants
The botanical antioxidants are too numerous to mention in one article. However, most botanical antioxidants can be classified into one of three categories as flavonoids, carotenoids, and polyphenols. Flavonoids possess a polyphenolic structure that accounts for their antioxidant, UV protectant, and metal chelation abilities. Carotenoids are chemically related to vitamin A, which encompasses all of the naturally occurring retinol derivatives. Lastly, polyphenols compose the largest category of botanical antioxidants. The following is a list of commercialized botanical antioxidants and their chemical class based on the previously discussed categories:
- Flavones
- Rutin (apples, blueberries)
- Quercetin (apples, blueberries)
- Hesperidin (lemons, oranges)
- Diosmin (lemons, oranges)
- Xanthones
- Mangiferin (mango plant)
- Mangostin (bilberry plant)
- Carotenoids
- Astaxanthin (tomatoes)
- Lutein (tomatoes)
- Lycopene (tomatoes)
- Polyphenols
- Rosmarinic acid (rosemary)
- Hypericin (St. John's wort)
- Ellagic acid (pomegranate fruit)
- Chlorogenic acid (blueberry leaf)
- Oleuropein (olive leaf)
Soy
Soybeans are a rich source of flavonoids called isoflavones, such as genistein and daidzein. These isoflavones function as phytoestrogens when orally consumed and have been credited with the decreased rates of cardiovascular disease and breast cancer observed in Asian women.4 Some of the cutaneous effects of soy have been linked to its estrogenic effect in postmenopausal women. Topical estrogens have been shown to increase skin thickness and promote collagen synthesis.5 It is interesting to note that genistein increases collagen gene expression in cell culture; however, no reports of this collagen-stimulating effect in topical human trials have been published. Genestein has also been reported to function as a potent antioxidant, scavenging peroxyl radicals and protecting against lipid peroxidation in vivo.6,7
Curcumin
Curcumin is a polyphenol antioxidant derived from the turmeric root. Tumeric is a popular natural yellow food coloring used in many products, from prepackaged snack foods to meats. It is sometimes used in skin care products as a natural yellow coloring in products that claim to be free of artificial ingredients. Curcumin is consumed orally as an Asian spice, frequently found in rice dishes to color the otherwise white rice yellow. However, this yellow color is undesirable in cosmetic preparations because yellowing of products is typically associated with oxidative spoilage.
Tetrahydrocurcumin, a hydrogenated form of curcumin, is off-white in color and can be added to skin care products not only to function as a skin antioxidant, but also to prevent the lipids in the moisturizer from becoming rancid. The antioxidant effect of tetrahydrocurcumin is reported by cosmetic chemists to be greater than vitamin E. Resveratrol, a chemical related to curcumin, is found in red wine, accounting for the antioxidant effect of this beverage.
Silymarin
Silymarin is an extract of the milk thistle plant (Silybum marianum), which belongs to the aster family of plants, including daisies, thistles, and artichokes. The extract consists of 3 flavonoids derived from the fruit, seeds, and leaves of the plant. These flavonoids are silybin, silydianin, and silychristin. Homeopathically, silymarin is used to treat liver disease, but it is a strong antioxidant, preventing lipid peroxidation by scavenging free radical species. Its antioxidant effects have been demonstrated topically in hairline mice by the 92% reduction of skin tumors following UVB exposure.8 The mechanism for this decrease in tumor production is unknown, but topical silymarin has been shown to decrease the formation of pyrimidine dimers in a mouse model. Silymarin is found in a number of high-end moisturizers for benign photoaging to prevent cutaneous oxidative damage.9
Pycnogenol
Pycnogenol is an extract of French marine pine bark (Pinus pinaster), which is reported to function as a plant-derived antioxidant. It is a water-soluble liquid that contains several phenolic constituents, including taxifolin, catechin, and procyanidins. It also contains several phenolic acids, including p -hydroxybenzoic, protocatechuic, gallic, vanillic, p -coumaric, caffeic, and ferulic. It is a trademarked ingredient that is sold for oral consumption as a preventative for cardiovascular disease and as a topical skin antioxidant. It is a potent free radical scavenger that can reduce the vitamin C radical, returning the vitamin C to its active form. The active vitamin C in turn regenerates vitamin E to its active form, maintaining the natural oxygen-scavenging mechanisms of the skin.10
Pycnogenol is the ideal antiaging additive because it demonstrates no long-term toxicity, no mutagenicity, no teratogenicity, and no allergenicity. It is consumed orally to enhance the production of nitric oxide, which inhibits platelet aggregation in coronary artery disease, thus it is also deemed safe for topical use. In short, pycnogenol is one of the new types of oral supplements sold for improving the appearance of benign photoaged skin from the inside, while topical application is said to augment this effect. As with many trademarked dietary supplements, validating the purported benefits is difficult.
Kinetin
Unlike the previously discussed compounds, kinetin is a not a naturally occurring plant substance. It is a member of the N6-substituted adenine derivatives, known as cytokinins. In plants, this hormone has been shown to stimulate transcription and influence the cell cycle by stimulating growth. It is also a plant antioxidant. The specific cytokinin that is used in the commercial moisturizers currently marketed is N6-furfuryladenine. Kinetin is said to improve benign photoaging by decreasing fine wrinkles, improving pigmentation, and increasing skin smoothness. It is typically compared to the retinoids; however, human cells do not contain kinetin receptors while they do contain retinoid receptors. Whether moisturizers containing this active agent provide benefits above and beyond those attributed to moisturization alone is currently unknown.
Astaxanthin is a pink carotenoid found in high concentration in salmon, accounting for the characteristic pink color of the fish. This is the rationale for antiaging diets recommending the ingestion of a serving of salmon 5 times weekly.11 For topical application purposes, astaxanthin is obtained from the marine microalgae Haematococcus pluvialis. The efficacy of astaxanthin is attributed to antioxidant abilities.12
Few topical studies exist to confirm the topical effect of astaxanthin,13 but it has been studied extensively as an oral supplement.14 Astaxanthin in concentrations of 0.03-0.07% produces a pink colored cream. This limits the concentration that can be used, but no topical adverse reactions have been associated with this carotenoid. The topical antioxidant benefits of astaxanthin have not been established.
Lutein
Another carotenoid found in topical cosmeceuticals is lutein. It is naturally found in green leafy vegetables, such as spinach and kale. Lutein is an antioxidant in the plant kingdom, also being used for blue light absorption. In the animal kingdom, lutein is found in egg yolks, animal fats, and the corpus luteum. It is a lipophilic molecule, not soluble in water, characterized by a long polyene side chain composed of conjugated double bonds. These double bonds are degraded by light and heat, a universal characteristic of carotenoids to a greater or lesser degree.15 The topical value of lutein in wound healing has never been evaluated.
Lycopene
Lycopene is a potent carotenoid found in most fruits and vegetables with a red color, including tomatoes, watermelon, pink grapefruit, papaya, gac, red bell pepper, and pink guava. Lycopene is a highly unsaturated hydrocarbon containing 11 conjugated and 2 unconjugated double bonds, which makes it a longer molecule than any other carotenoid.16 This makes its absorption into the skin is doubtful. It undergoes cis -isomerization possibly when exposed to sunlight. Even though lycopene was the new oral supplement added to many commercial multivitamins this year, its topical value has never been documented. It is safe for skin application, but it may stain the skin in high concentrations.
Pomegranate
Pomegranate, botanically known as Punica granatum, is a deciduous tree bearing a red fruit native to Afghanistan, Pakistan, Iran, and northern India.17 It was brought to California by the Spanish settlers in 1769 and is commercially cultivated for its juice. Pomegranate juice, commonly consumed in the Middle East, provides about 16% of the adult requirement of vitamin C per 100-mg serving. It also contains pantothenic acid (also known as vitamin B-5), potassium, and antioxidant polyphenols. These substances have been demonstrated to protect against UVA- and UVB-induced cell damage in SKU-1064 human skin fibroblasts.18
Pomegranate juice has also been purported to reduce oxidative stress, affect low-density lipoprotein levels, and platelet aggregation in humans and apolipoprotein e – deficient mice.19,20 It has also been studied for improving hyperlipidemia in diabetic patients.21 It is found in some wound healing preparations to promote healing, but its value has never been demonstrated.
Summary
Plant antioxidants are an important reservoir of active ingredients in the search for relevant human antioxidants. Currently, there is not enough scientific data to determine which botanical antioxidant shows the most promise; however, it is worthwhile for the dermatologist to become familiar with these substances in terms of their purported function and activity.
Facial Cosmetics and Acne
What exactly does a patient mean when reporting that a certain cosmetic causes her face to "break out?" This phrase may refer to formation of a comedone, papule, pustule, nodule, cyst, or red rash. In addition, patients often have difficulty establishing a cause-and-effect relationship. From a dermatologic standpoint, the term that is still used to refer to cosmetic-related acne is acne cosmetica.
Acne cosmetica is a concept that was developed many years ago when cosmetics could indeed cause comedone formation. The issue of comedogenicity in relation to cosmetics arose in 1972 when Kligman and Mills described a low-grade acne characterized by closed comedones on the cheeks of women aged 20-25. Many of these women had not experienced adolescent acne. The authors proposed that substances present in cosmetic products induced the formation of closed comedones and, in some cases, a papulopustular eruption. Presently, personal communication with Dr. Kligman indicates that he no longer believes currently marketed cosmetics cause comedone formation, yet acne related to cosmetics remains a problem.
The literature reports lists of ingredients that supposedly cause acne, but finding a formulation that possesses none of these substances is practically impossible. The list contains some of the most effective emollients (eg, octyl stearate, isocetyl stearate), detergents (eg, sodium lauryl sulfate), occlusive moisturizers (eg, mineral oil, petrolatum, sesame oil, cocoa butter), and emulsifiers found in the cosmetic industry. A product line that avoids all of these substances would not perform well on the skin and would possess low cosmetic acceptability.
There are many myths regarding cosmetics and cosmeceuticals and the acne that they may or may not cause. Examining these myths to determine the medical truth is worthwhile.
The first myth is that cosmeceuticals do not produce acne if labeled noncomedogenic and nonacnegenic. Similar to the term hypoallergenic, labels that describe products as noncomedogenic and nonacnegenic are marketing claims carrying no implied regulation. They were developed to create a new consumer image for cosmetic lines designed to minimize acne.
In order to market a product as noncomedogenic, rabbit ear or human comedogenicity testing should be undertaken. Both the animal and the human model are based on the presence of new comedone formation after the exposure of skin to the finished cosmetic. Human testing is considered to be more accurate, but the results are highly dependent on the skill of the contract testing laboratory. Acnegenic claims are based on human use testing and the evaluation of volunteer subjects who report any increased acne following product use. Many manufacturers, however, make noncomedogenic and nonacnegenic claims based on the safety profiles of the individual ingredients in the formulation. This is inaccurate. Noncomedogenic and nonacnegenic claims should be made based on clinical testing of the finished formulation. Therefore, dermatologists should still consider all products labeled noncomedogenic or nonacnegenic as potentially problematic.
The second myth is that mineral oil is comedogenic. Mineral oil is one of the most common ingredients in skin care products and colored cosmetics. It is a lightweight inexpensive oil that is odorless and tasteless. One of the common concerns regarding the use of mineral oil is its presence on several lists of comedogenic substances. These comedogenic lists were developed many years ago yet remain frequently quoted in the dermatologic literature.
Several points are important to consider. First, different grades of mineral oil are available. Industrial grade mineral oil is used as a machine lubricant and is not of the purity required for skin application. Cosmetic grade mineral oil is the purist form without contaminants. Industrial grade mineral oil may be comedogenic, but cosmetic grade mineral oil is not. Quality manufacturers only purchase quality products from quality suppliers who guarantee the standards of the materials they provide. This author considers cosmetic grade mineral oil noncomedogenic based on findings from testing performed for the skin care industry.
The third myth is that sunscreens produce acne. Many patients note the occurrence of breakouts following the use of sunscreens. These patients typically present with perifollicular papules and pustules in a random distribution over the face. Eruptions appear within 24-48 hours after wearing a facial sunscreen. This author has not performed biopsies on patients who develop sunscreen-related acne, but presented below is a hypothesis based on how sunscreens function.
Most sunscreens available today are based primarily on UVB-absorbing ingredients, such as octylmethoxycinnamate, oxybenzone, and homosalate. Many also have UVA-absorbing ingredients, such as avobenzone, titanium dioxide, or zinc oxide, as secondary sunscreens. All of the UVB sunscreens and avobenzone function by transforming ultraviolet radiation to heat energy through a process known as resonance delocalization. This heat energy is appreciated by many patients who state that they do not like wearing sunscreens because the gels or lotions make them feel hot.
In some patients, the increased sweating induced by the sunscreens and the sunny weather may cause increased activity of the eccrine glands. This may cause miliaria rubra that may be magnified by the occlusive nature of the water-resistant, rub-proof sunscreen product. Thus, much of the problem with sunscreen-induced acne is the formation of papules or pustules around the eccrine duct ostia without the sebaceous gland involvement that characterizes true acne.
The fourth myth is that pore size can be reduced with glycolic acid peels. Glycolic acid is a water-soluble chemical exfoliant. It cannot enter the oily milieu of the pore and thus does not exfoliate within the pore. Glycolic acid may improve the smoothness of the skin surface, creating the illusion of reduced pore size, but it cannot measurably reduce pore size. In fact, no cosmeceutical ingredient can measurably reduce pore size. Salicylic acid is an oil-soluble chemical exfoliant that can remove debris from the pore, creating the appearance of skin smoothness, but it too cannot measurably reduce pore size. It is important to distinguish between real reduction in pore size and an improved cosmetic appearance.
Myth 5 is that a complex skin care regimen of multiple cleansers, moisturizers, and ancillary skin care products is necessary for clear skin. There are many different approaches to skin care, from the no-nonsense soap-and-water approach to the 20-step skin care routine. No routine is established as better. In Japan, skin care is a complex ritual of multiple cleansers, toners, and moisturizers. The Japanese are also considered to have the most sensitive skin of all races, and the incidence of atopic dermatitis is dramatically rising in Japan. Perhaps this due to the use of extensive skin care products. However, without doubt, the more the skin is manipulated, the more opportunity there is for problems to arise. The best advice may be to recommend moderation in skin care.22
Myth 6 is that acne breakouts after age 30 years in women are rare and benefit from special skin care. Acne after age 30 years is actually becoming more and more common in women. The cause of this trend is not known, but it appears to be related to fluctuating hormones and the onset of premenopause and perimenopause. This supposition is based on the observation that the acne is not characterized by open and closed comedones, but rather inflammatory papules and pustules. Because these lesions are in the lower epidermis and dermis, special skin care routines cannot have a dramatic effect. Thus, the use of oral antibiotics and hormonal therapies, such as birth control pills or estrogen replacement therapy, are the best options for acne control in this population. Cosmetics and skin care products have little effect on this type of acne. Many mature patients mistake this cyclic hormonal acne for acne related to cosmetic product use.
Summary
For all purposes, acne cosmetica is a concept of the past, which the industry has done its best to remedy. Skin care manufacturers are keenly aware of the need to test and formulate products without skin side effects. Yet, many acne myths persist. This article has posed possible answers to some of the most common acne myths submitted by several dermatologists.
Facial Cosmetics for Camouflaging
Camouflaging facial cosmetics are designed to minimize contour and color irregularities or abnormalities of the face based on the same principles used by an artist in painting a picture.
Contour irregularity camouflaging
The correction of irregular facial surface contours is based on the principle that dark colors make protuberances appear to recede, while light colors make surface depressions appear shallower. Creating an even-appearing surface on a scarred face is achieved through artist shading. Powdered blush-type products are best suited for this purpose. Areas of the face that need to be lightened should be brushed with a light pink or peach pearled blush or buffer. Areas of the face that need to be darkened should be brushed with a deep plum or bronze matte finish blush or highlighter.
These same principles can be used to optimize the shape of the face, the size of the forehead and chin, or the contour of the nose, based on established ideal facial proportions. The perfect facial shape is considered to be oval and symmetrical about the midline. An oval face is one and one-half times as long as it is wide and should taper gradually from its widest dimension at the forehead to its smallest dimension at the chin. The face should be divided into equal thirds from superior to inferior, as follows: forehead to the glabella, glabella to the subnasale, and subnasale to the base of the chin. The face should divide equally into fifths from ear to ear, with each fifth being the width of one eye.
A round face can be camouflaged to appear more oval by shading the lateral margins with a darker colored blush to deemphasize the increased width. An oblong face is shaded with a darkly colored blush along the forehead and chin to deemphasize the increased length. A square face is darkened bilaterally at the jaws.
This same shading technique also can be used to correct forehead and chin dimensions. To achieve the effect, low-set foreheads should have a light blush applied beneath the hairline, while high foreheads should have a dark blush applied at this location. A receding chin should have a light blush applied at the tip and sides. A double chin should be shaded with a dark blush under the entire jawbone.
The artistic application of facial cosmetics is no substitute for surgical revision, which may be recommended in certain cases.
Color irregularity camouflaging
Pigmentation abnormalities can be camouflaged by either applying an opaque cosmetic that covers underlying skin tones or by applying foundations of complementary colors. For example, red pigmentation can be camouflaged by applying a green foundation, the complementary color to red. The blending of the red skin with the green foundation yields a brown tone, which can be covered readily by a more conventional facial foundation. Furthermore, yellow skin tones can be blended with a complementary colored purple foundation to yield brown tones.
Skin areas that are lighter or darker than desired can be camouflaged by applying facial foundations with the appropriate amount of brown pigment.
Application technique for camouflaging facial foundations
The most popular camouflage facial foundations are creamy products that are scooped from a jar or tin with a spatula and applied to the hand for warming. These products are the easiest to use because they exhibit a long playtime, good blending characteristics, minimal application skill, excellent coverage, and adequate wearability for most individuals.
Initially, a makeup base must be selected that is closest to the patient's natural skin color. Blending usually is necessary, but no more than 3 colors should be combined because this produces a muddy final color quality. If the patient has an underlying pigmentation irregularity, this counts as 1 color.
Once the closest foundation color has been selected, blending in yellow if the individual has a sallow complexion or reds if the patient has a ruddy complexion may be necessary. All facial tones should be represented in the final foundation blend if a good color match is to be obtained. Blending usually is performed by applying a small amount of the makeup to the back of the hand. This provides a good surface for blending that can be held up to the face easily to evaluate the color match and also warms the product, which allows easier mixing and application.
The final foundation color mix is dabbed, not rubbed, over the area to be camouflaged and then applied from the central face outward into the hairline for approximately one fourth of an inch and blended over the ears and beneath the chin. Feather the cosmetic where application ends to achieve a more natural appearance. The importance of dabbing cannot be overemphasized because scars do not contain appendiceal structures, such as follicular ostia, that are necessary for good cosmetic adherence. Rubbing removes the makeup as it is applied. The cosmetic should be pressed into the skin and allowed to dry for 5 minutes.
Following this drying period, the cosmetic must be set with an unpigmented, finely ground, talc-based powder to prevent smudging, to improve wearability, to provide waterproof characteristics, and to impart a matte finish. Camouflaging makeup is designed to be worn with this powder and does not function properly without it. The powder should be pressed, not dusted, on top of the foundation.
Lastly, shading and highlighting principles, as previously discussed, are employed to minimize contour abnormalities. Unfortunately, the camouflage foundation may actually accentuate surface irregularities, for example, of a scar, and normal skin structures, such as pores and wrinkles. Depressed scars usually appear darker than the surrounding skin, even though the same color foundation has been applied, because of the presence of shadows. Thus, a lighter powdered rouge is applied over the scar. If the scar is elevated, a darker powdered rouge is applied. Other colored facial cosmetics (eg, eye shadow, eyeliner, mascara) are usually applied to achieve the final appearance.
In general, removal of camouflaging cosmetics requires more than soap and water washing because of the waterproof nature of the product. Most companies provide an oily cleanser for cosmetic removal and then recommend soap and water cleansing of the skin. The cosmetic should only be worn when needed and thoroughly removed at bedtime.
Self-Tanning Creams
Self-tanning creams produce a golden skin color overnight without sun exposure. The golden color appears natural on persons with blonde or light brown hair who tend to have golden hues to their skin, but it may appear less natural on Mediterranean individuals with an olive complexion or extremely fair persons with pink skin tones.
Formulation
The active ingredient in self-tanning creams is 3-5% dihydroxyacetone incorporated into a glycerin and mineral oil base to form a white cream that turns the stratum corneum golden. Chemically, the dihydroxyacetone acts as a sugar to interact with amino acids in the stratum corneum to produce melanoidins. Formulations are available for the face and body, but most do not incorporate a sunscreen, and the golden skin color is minimally protective against actinic damage. Higher concentrations of dihydroxyacetone are used to produce darker coloring of the stratum corneum.
The color is not permanent and is lost as the stratum corneum desquamates; thus, continued use is necessary. The major disadvantage of these products is that they stain all contacted skin surfaces, including the palms of the hands, if the cream is not removed. These products also produce deeper staining of the follicular ostia and may accentuate seborrheic keratosis, actinic keratosis, porokeratosis, and ichthyotic skin. Many patients are not aware that they have these skin conditions until the self-tanning cream highlights the irregularity.
Adverse effects
Allergic contact dermatitis from use of the product is infrequent, but several cases of dihydroxyacetone allergy have been reported. Self-tanning creams can be open or closed patch tested as is.
Lipstick
Lip color has been used since the time of the Sumerians, dating to 7000 BCE. Use of lip color has been practiced by many civilizations, from the Egyptians, Syrians, Babylonians, Persians, and ancient Greeks and Romans to present civilizations. Modern lipstick was introduced around 1920 when the push-up holder, still used today, was invented.
Formulation
Lipsticks are mixtures of waxes, oils, and pigments in varying concentration to yield the characteristics of the final product. For example, a lipstick designed to remain on the lips for a prolonged period of time is composed of high wax, low oil, and high pigment concentrations. On the other hand, a product designed for a smooth creamy feel on the lips is composed of low wax and high oil concentrations.
The waxes commonly incorporated into lipstick formulations are white beeswax, candelilla wax, carnauba wax, ozokerite wax, lanolin wax, ceresin wax, and other synthetic waxes. Usually, lipsticks contain a combination of these waxes selected and blended carefully to achieve the desired melting point. Oils then are selected, such as castor oil, white mineral oil, lanolin oil, hydrogenated vegetable oils, or oleyl alcohol, to form a film suitable for application to the lips. The oils are also necessary for dispersion of the pigments.
Several types of coloring agents are used in lipsticks. Indelible coloring, or lip staining, is achieved through the use of bromo acids, consisting of fluoresceins, halogenated fluoresceins, and related water-insoluble dyes. Other pigments consist of insoluble dyestuffs and lake colors. Metallic lakes are insoluble dyes precipitated or "laked" on a metallic substrate, such as aluminium. For example, Food, Drug, and Cosmetic (FD&C) Blue No. 1 is an azo dye precipitated on aluminium, which transforms the insoluble dye to a pigment. Other lake colors are based on calcium or barium salts.
Adverse effects
Several ingredients unique to lipstick formulation can cause difficulty in the sensitized patient. Castor oil, found in almost all lipsticks because of its excellent ability to dissolve bromo acid dyes, rarely can cause allergic contact dermatitis. More common lipstick sensitizers used in the mid-1920s were the bromo acid dyes, one of which is eosin (Drug and Cosmetic [D&C] Red No. 21). Eosin was used commonly in the indelible red lipsticks popular at that time. These indelible lipsticks are now making a comeback because of the demand for a long-wearing lip product.
The safety of the coloring agents used in lipsticks has received a great deal of attention because of the inevitable entry of lipsticks into the mouth. The Food and Drug Administration (FDA) divides certified colors into the following 3 groups: FD&C colors, D&C colors, and External Drug and Cosmetic colors. Only the first 2 groups can be used in lipsticks. The External Drug and Cosmetic colors can only be used in locations where they are not likely to enter the mouth.23
Lip cosmetics can be open or closed patch tested because their irritating potential is low.
Eye Shadow
Eye shadow is a cosmetic designed to impart color primarily to the upper eyelid. Eyelid cosmetic use dates to antiquity, recorded as early as 4000 BC. Green powder made from malachite was applied heavily to both the upper and the lower eyelids. Eyelid glitter composed of ground beetle shells was also popular. Modern eye shadow cosmetics became popular between 1959 and 1962.
Formulation
Eye shadows are available as pressed powders, anhydrous creams, emulsions, sticks, and pencils. Color variety is extensive, but no coal tar derivatives can be used in the eye area.
Pressed powder eye shadows are the most popular formulation and are applied to the eyelid by lightly stroking a soft sponge-tipped applicator across the skin. These eye shadows are predominantly talc with pigments and zinc or magnesium stearate used as a binder. Kaolin or chalk may be added to improve oil absorption and to increase wearability.
Variation in eye shadow surface texture can range from matte to a pearled shine to a metallic shine. Titanium dioxide is used in pastel matte-finish eye shadows to improve coverage. However, it is not found in pearled shine–finish eye shadows because it tends to mask the desired pearled effect. Bismuth oxychloride, mica, and fish scale essence are the standard materials used to produce a pearly shine. A metallic shine is obtained by adding copper, brass, aluminum, or silver powders.
Adverse effects
The eyelid skin is the thinnest on the body and is frequently affected by both irritant and allergic contact dermatitis. The North American Contact Dermatitis Group has determined that 12% of cosmetic reactions occur on the eyelid, but only 4% of them could be linked to eye makeup use. Furthermore, determining the etiology of the eyelid dermatitis with routine patch testing may be difficult. Many substances, such as nail polish, can be transferred to the eye area by the hands, complicating dermatologic evaluation.
If eye cosmetics are the source of the dermatitis, the distinction between irritant and allergic contact dermatitis must be made. Irritant contact dermatitis is more common than allergic contact dermatitis. Open or closed patch testing can be performed as with eye shadows; however, use testing is recommended. Use testing is performed by placing the eye shadow at the corner of the eye for 5 consecutive nights followed by evaluation of the skin for allergic or irritant contact dermatitis.
Mascara
Mascara has been applied since Biblical times and today is the most commonly used eye cosmetic. The original mascara worn by women of many ancient civilizations was kohl, based on antimony trisulfide. The purpose of modern mascara formulations is to darken, lengthen, and thicken the eyelashes.
Formulation
Mascara must be formulated carefully to allow easy and even application without smudging, irritancy, or toxicity. The US FD&C Act prohibits the use of coal tar colors on the eyelashes. Therefore, mascara colorants must be selected from vegetable colors or inorganic pigments and lakes. Colors employed include iron oxide to produce black, ultramarine blue to create navy, and umber or burnt sienna or synthetic brown oxide to create brown.
Liquid mascara is the most popular modern formulation. Liquids can be divided into water-based, solvent-based, and water/solvent hybrid varieties. These products are unique in that they are applied from an automatic mascara tube consisting of a round brush that is inserted through a small aperture to remove a metered amount of product.
Water-based mascaras are so named because they are formulated from waxes (eg, beeswax, carnauba wax, synthetic waxes) and pigments (eg, iron oxides, chrome oxides, ultramarine blue, carmine, titanium dioxide) and resins dissolved in water. They are classified as oil-in-water emulsions. The water evaporates readily, creating a fast-drying product that thickens and darkens the lashes. The product is water-soluble, allowing for easy removal, but unfortunately smudges with perspiration and tearing. Some water-based mascaras are labeled water-resistant if they contain an increased amount of wax or a polymer to improve adherence of pigment to the lashes.
Water-based mascaras are contaminated easily with bacteria, which readily grow in water, and must include preservatives, usually parabens. Thus, these products may cause an allergic reaction in individuals who are sensitive to parabens; however, water-based mascaras are generally the least sensitizing of the mascara types. Some patients may experience contact irritancy from the emulsifiers required to maintain the pigment in solution.
Solvent-based mascaras are formulated with petroleum distillates to which pigments (eg, iron oxides, chrome oxides, ultramarine blue, carmine, titanium dioxide) and waxes (eg, candelilla wax, carnauba wax, ozokerite, hydrogenated castor oil) are added, making them waterproof. As a result, the product performs well with perspiration and tearing, but removal is difficult and requires an oil-based lotion or cream. Deposits may form on the lashes if the product is incompletely removed. Care must be taken to avoid smudging the product immediately after application because solvent-based mascaras have a prolonged drying time.
Preservatives are still added to solvent-based mascaras, but microbial contamination is not a great problem because the petroleum-based solvent is antibacterial. Some products also contain talc or kaolin to improve lash thickening and nylon or rayon fibers to lengthen lashes. Solvent-based mascaras can irritate the eye.
Some mascaras combine both solvent- and water-based systems to form either a water-in-oil or oil-in-water emulsion. The idea is to create an optimal product that thickens with a short drying time, such as water-based mascaras, but provides waterproof lash separation, such as solvent-based mascaras. The water in the formulation requires incorporation of a good preservative system.
Adverse effects
Modern liquid mascaras provide an applicator that is inserted into the tube between uses, providing numerous opportunities to inoculate bacteria into the mascara. The most feared adverse effect of mascaras is that of infection, particularly Pseudomonas aeruginosa corneal infections, which can permanently destroy visual acuity. Staphylococcus epidermidis and Staphylococcus aureus organisms also may proliferate in contaminated mascaras. Infections are more common if the eyeball is traumatized with the infected mascara.
Even though mascaras contain preservatives, discard all mascara tubes after 3 months and do not allow multiple persons to use the same mascara tube. Individuals with recurrent bacterial infections due to colonization should select solvent-based mascaras.
Fungal organisms also can contaminate mascaras and result in eye infection. This is rare and usually only found in patients who are immunocompromised or wear contact lenses.
The pigment contained within mascaras can result in conjunctival pigmentation, if the mascara is washed into the conjunctival sac by lacrimal fluid. This colored particulate matter can be observed on the upper margin of the tarsal conjunctiva. Histologically, the pigment is seen within macrophages and extracellularly with varying degrees of lymphocytic infiltrate. Electron microscopy suggests that ferritin, carbon, and iron oxides are present within the tissues. Unfortunately, no treatment is available for the condition, which fortunately is usually asymptomatic.
Allergic contact dermatitis has been reported to rosin (colophony) and dihydroabietyl alcohol (abitol) contained in some mascaras. Mascaras can be open or closed patch tested as is, but they should be allowed to thoroughly dry prior to closed patch testing to avoid an irritant reaction from the volatile vehicle.
Summary
Colored cosmetics are an important part of the dermatologic armamentarium. They can camouflage contour and pigment abnormalities, provide moisturization, and create a sense of personal well-being, but they can also induce disease. Familiarity with these products results in better patient care.
Keywords
cosmetics, colored cosmetics, facial foundations, facial powders, pressed powder, base, blush, rouge, acne cosmetica, cosmetic-associated acne, sunscreen and acne, self-tanning products, sunless tanning, lipstick, lip stick, camouflage makeup, scar, scarring, mascara, eye shadow
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Further Reading
Keywords
cosmetics, colored cosmetics, facial foundations, facial powders, pressed powder, base, blush, rouge, acne cosmetica, cosmetic-associated acne, sunscreen and acne, self-tanning products, sunless tanning, lipstick, lip stick, camouflage makeup, scar, scarring, mascara, eye shadow
