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Daily care of the skin of seniors
- 30min
- May. 2022
- Supported by
The cosmetics intended for seniors are essentially hygiene and hydration products intended to combat skin dryness connected with intrinsic aging and are intended to maintain the integrity of the skin and the cutaneous surface film. A protective function with regard to ultraviolet rays (UV) is often associated with these and sometimes a corrective function for imperfections connected with skin aging.
Hygiene
Washing the skin with water does not eliminate all of the impurities present on the surface of the skin. Certain of these are only soluble in a greasy substance, which requires using products that are able to emulsify these lipids into fine drops that may then be rinsed away. Detergents reduce the surface tension between water and air, and create a foaming effect which is not directly correlated with the properties of washing with detergent. The more significant the foaming effect, the more the significant the aggressive effect is on the skin covering. The foaming action is often accompanied by a stripping action on the corneal layer, particularly if the pH is alkaline.
The use of toiletries by seniors must respect the epidermis and not irritate the skin. It is recommended to use fatty soaps enriched with moisturizing agents which have surface tension agents that are less aggressive. These have shown their effectiveness in treating skin dryness (xerosis).1 Syndets or dermatological bars are the most used by patients and their care givers, but when applied in too great a quantity, they participate in drying the skin. It is important to use them when washing with warm water (35-37 °C) because water that is too hot aggravates xerosis.
Evolutions in cosmetics now offer us cleaning oils which have the advantage of foaming, not drying the skin and rinsing easily. They are developed in such a way as not to cause slipping in contact with the surfaces of the bathtub or shower. Their composition in fact is made of very little oil, a lot of water (whether from thermal sources or not) and numerous surfactants (a mixture of anionics, amphoterics, and non-ionics). They have an agreeable character and are easy to use. They are lipid-replenishing and leave a protective film after rinsing.2
The face
Toiletries provide mild washing for the face and high-quality make-up removal. The application of these products must be followed by careful rinsing, by preference by misting using thermal source water. Aggressive drying should be avoided; the skin should be patted dry without rubbing. Micellar water, which is lighter and often better tolerated, offers an alternative to cleansing milks for daily washing.
Baths
These have a temporary relief effect on pruritis. However, they must be limited to two each week among seniors who suffer from skin dryness. Warm and of a short duration, they must be taken preferably in the morning in order to allow the accumulation of sebum for the following night. Pruritis has an effect of escalating in the evening. The use of bath oils among elderly persons is not recommended because of the risk of slipping or falling, but emollient powders based on wheat or oat starch are authorized. After the bath or the shower, an emulsion of water in oil should be applied to the entire body in order to compensate for the dissolution of the hydrolipidic film. It is useful to maintain a sufficient ambient hygrometric level in the residence or the bedroom by using a humidifier if necessary. The temperature must be set to the lowest level that is compatible with the comfort of the patient.
Bibliography
- Hoffman L et al. Benefits of an emollient body wash for patients with chronic winter dry skin. Dermatol Ther 2008;21:416-21.
Link to abstract - Verdier-Sévrain S et al. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol 2007;6:75-82.
Link to abstract - Kafi R et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol 2007;143 :606-612.
Link to full publication - Cohen-Letessier A. Cosmetics in skin aging. Ann Dermatol Venereol 2009;136:S367-71.
Link to abstract
Cosmetic products among seniors
Cosmetics for aging skin must have the objective of maintaining hydration, compensating for the inadequacy of the lipidic film and providing significant cutaneous relief.
Moisturizing cosmetics
Numerous cosmetics are available that contain molecules whose active role in maintaining the hydration of the corneal layer is demonstrated. The cosmetic approaches to cutaneous hydration are either to slow the evaporation of the intrinsic water, or to provide exogenous water and to fix it in the corneal layer, or, finally, to combine these two methods.
The retention of water may be effected by the use of hydrophilic filmogenic polymers and/or by the use of hydrophobic filmogens. The action mechanism of these two types of components is different.
The first regulate the transepidermal water loss and the second have a more or less occlusive effect that reduces the transepidermal water loss. The fixation of water is ensured by agents known as “humectants” represented principally by hygroscopic substances similar to the components of natural moisturizing factors (NMF). By fixing water until the saturation level is reached, these substances are able to partially reduce the hydric loss. Thanks to its three hydroxyl groups, glycerol is one of the most active humectant agents and the most used in the moisturizing products available on the market.
Figure 1. Pigmentation problems: actinic lentagines.
The additives are also in the composition of emollients with the objective of being protective, anti-inflammatory or improving the moisturizing qualities of the topical product. This is the case with urea, a physiological component of the corneal layer which, in low concentration, allows for more significant hydration. It acts indirectly by modifying the structure of the proteins that can fix the water. Lactic acid and sodium lactate are also normal majority components of the natural moisturizing factors, with a very strong ability to capture water, demonstrated by persistent effectiveness, even after washing the surface of the skin. Dexpanthenol is a derivative of vitamin B5 which favors the regeneration of the skin. Glycine possesses anti-itching properties. Aquaporins favor the transport of water and the solutes such as glycerol and urea.2
The sales price of a product is very important to take into consideration for certain elderly subjects. In effect, the cost of the products is often an obstacle for observing the prescription. The emollients exist in various pharmaceutical forms, from creams to body milks, with balms or pomades for localized zones. Creams are often used for the face, whereas fluids are preferred for the body, because they allow large surfaces to be covered and possess a power to penetrate rapidly. To the extent possible, they should be applied twice each day or at least after washing. Mists are having increasing success. These new products for the body contain active moisturizing agents to be sprayed without massaging and they appear to be less appropriate for the elderly as they are less emollient.
Depigmenting cosmetics
The request to remove pigmented spots among elderly subjects (figure 1) is very strong, in order to obtain a radiant complexion and a homogeneous skin color. Age spots are in the first place.
They appear on the uncovered parts (face and hands) and are due to repeated and accumulated weak doses of sunlight. The hydroquinone in pharmaceutical preparations or in depigmenting peelings is not effective on these lesions. Vitamin C is an anti-oxidant which reduces the melanin already oxidized into lighter colored melanin. Azelaic acid is not very effective on age spots. Retinoic acid appears to have a depigmenting effect via its action on the keratinocyte turn-over. Numerous other active ingredients such as kojic acid, phytic acid and glycolic acid are used alone or in association, either in pharmaceutical preparations, or in various specialized products in order to optimize the depigmenting effect.
Figure 2. Dermal aging: wrinkles, lines and ptosis.
Anti-aging cosmetics
Skin aging is accompanied by growing requests by patients to repair the signs of age (figure 2). There are numerous agents with anti-aging properties that are used alone or in association, in creams or in complements to injections and peelings.
Among the anti-aging active ingredients, retinol is the first to have proven its anti-aging effectiveness by increasing the production of glycosaminoglycans (GAG) and procollagen. However, its packaging must protect it from light and it may be an irritant on delicate skin, thus leading to the applications being spaced over time. Alpha-hydroxy acids allow increased turn-over at the epidermal layer and dermal stimulation (production of collagen, GAG and elastic fibres). Fractionated hyaluronic acid penetrates better into the epidermis, it reduces the depth of the wrinkles, improves the complexion and is well tolerated. In addition to its photoprotective action, vitamin C has an anti-inflammatory and antioxidant action that is very interesting, but its fragility requires appropriate packaging. Soya extracts (isoflavones) and vine extracts (resveratrol) have an action on photo-induced cancerogenesis. Niacinamide has anti-oxidant properties and reduces pigmentation. Dimethylaminoethanol is a precursor of acetylcholine which reduces sagging and improves firmness by acting on the fibroblasts and the myofibroblasts.
Botox-like active ingredients are peptides (microfragments of proteins) derived from plants or synthesised, which set off a dermal chain reaction to limit muscular contraction by acting on the nerve-muscle connection. Folic acid has a protective effect on keratinocyte after irritation by UV rays. Anti-glycants (silicon and its derivatives, carnosine, etc.) reduce the physiological glycation of collagen and elastin, which rigidifies the dermis. Sirtuins repair the degradations of RNA and DNA. Lipoaminoacids have an anti-inflammatory action. One must be vigilant with regard to the concentration of all of these active ingredients and the products containing them, which differ depending on the brand and the price of the anti-aging cosmetics.3,4
Bibliography
- Hoffman L et al. Benefits of an emollient body wash for patients with chronic winter dry skin. Dermatol Ther 2008;21:416-21.
Link to abstract - Verdier-Sévrain S et al. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol 2007;6:75-82.
Link to abstract - Kafi R et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol 2007;143 :606-612.
Link to full publication - Cohen-Letessier A. Cosmetics in skin aging. Ann Dermatol Venereol 2009;136:S367-71.
Link to abstract
Photoprotection & Corrective make-up
Photoprotection
The addition of external photo-protectors to emollients for sun protection of the photo-exposed zones allows photoaging and the aggravation of xerosis by UV rays to be limited without a deleterious effect on the synthesis of vitamin D. It is recommended to limit the sun exposure of senior subjects by means of chemical and mechanical protection (clothing, hats) and by avoiding the hot hours of the day, as there is a general risk of dehydration, aggravation of xerosis and a risk of photo-induced cancer. In fact, with age, the cutaneous anti-radical defenses collapse, with a risk of the appearance of the first pre-cancerous lesions, actinic keratosis, among fair photo-types. Along with treatment of these lesions (cryotherapy, dynamic phototherapy, topical 5-FU, etc.), persistent chemical sun protection that is applied to the uncovered zones from April to October (one to two applications per day) is to be preferred.
Corrective make-up
With age, in order to mask the wrinkles and fine lines, a more covering, fluid or compact base should be used, depending on the desires and the type of skin. This also allows pigmented spots on the face to be masked. For the lips (a lipstick with the help of a fine brush in order to spread it up to the base of the lips in order to avoid the material attaching to the downy hairs, then fixing it with the finger). The colour green may mask erythrosis or an established rosacea (figure 3). In order to mask the wrinkles around the eyes, neutral make-up is preferred. A natural makeup on the cheeks and a volumising lipstick also allow the lower part of the face to be rejuvenated.
In all cases, cosmetics can provide pleasure and comfort for seniors and help them to tolerate the signs of age, by associating it with or by replacing medical-surgical rejuvenating techniques (laser, injections, lifts).
Figure 3. Corrective make-up.
Bibliography
- Hoffman L et al. Benefits of an emollient body wash for patients with chronic winter dry skin. Dermatol Ther 2008;21:416-21.
Link to abstract - Verdier-Sévrain S et al. Skin hydration: a review on its molecular mechanisms. J Cosmet Dermatol 2007;6:75-82.
Link to abstract - Kafi R et al. Improvement of naturally aged skin with vitamin A (retinol). Arch Dermatol 2007;143 :606-612.
Link to full publication - Cohen-Letessier A. Cosmetics in skin aging. Ann Dermatol Venereol 2009;136:S367-71.
Link to abstract