Re: Cosmetic/Skincare Breakouts

[Guest guest]

Matija (or anyone), do you understand this recommendation?

" ...There is tremendous variability in patients who present with

frequent acneiform eruptions following cosmetic use, but a general

rule of thumb is to recommend the use of powder over liquid

cosmetics, thus avoiding the emulsifier. For example, a powder blush

can be used over a liquid blush, a facial powder over a liquid

foundation, or a powder eye shadow over a cream eye shadow. "

At first, I thought the recommendation was going to be to chose a

powder base over (= instead of) a liquid base. The emulsifier is in

the liquid, right? And I see that powder bases are recommended by

Jane Ireland and other companies that specialize in makeup for

sensitive skins.

So how would using a powder over a liquid product help prevent

eruptions? That makes it sound like the emulsifier is in the powder,

and the liquid prevents the emulsifier from direct skin contact.

Marjorie

Marjorie Lazoff, MD

> Hi,

>

> Here's a Q&A from Dermatology Times that discusses why some

cosmetics

> and skincare products may cause breakouts.

> Take care,

> Matija

>

>

> May 15, 2002

> By: Zoe Draelos, M.D.

> Dermatology Times

>

> Q. Why do some cosmetics and skincare products cause breakouts?

>

> A. It is important to determine exactly what the patient means when

> they present with the complaint of " breakouts. " Most reputable

> cosmetic companies test their cosmetics and skincare products and

can

> substantiate the claims of noncomedogenic and nonacnegenic. These

> claims simply mean that the product does not cause comedones or

acne,

> however, other acneiform eruptions of the face are possible

following

> cosmetic or skincare product use. In my experience, the most common

> cause of a " breakout " following 48 hours of product use is a

> perifollicular irritant contact dermatitis. This time frame is too

> short for the development of true acne, but certainly within the

time

> frame for irritant contact dermatitis. This finding may be covered

> under the claim of hypoallergenic, meaning reduced allergy, but it

is

> still possible for patients with sensitive skin to develop problems.

>

> Women who develop breakouts with many topical products may be

> developing irritation from the emulsifier, which emulsifies the oil

> and water components of the formulation into a single phase.

However,

> the emulsifier can also emulsify sebum, which is in highest

> concentration at the follicular ostia. The follicular ostium is

> generally the anatomic site of the acneiform lesion. There is

> tremendous variability in patients who present with frequent

> acneiform eruptions following cosmetic use, but a general rule of

> thumb is to recommend the use of powder over liquid cosmetics, thus

> avoiding the emulsifier. For example, a powder blush can be used

over

> a liquid blush, a facial powder over a liquid foundation, or a

powder

> eye shadow over a cream eye shadow.

>

> Remember that the skincare products and cosmetics most likely to

> cause problems are those that are applied directly to the skin and

> remain on the skin for the longest period of time. This means that

> sunscreens, moisturizers, cosmeceuticals, and facial foundations

are

> the most likely culprits. A process of elimination can be used to

> determine which product is causing difficulty. This is accomplished

> by using each skin care product or cosmetic alone on the face for

> five days to determine if the symptoms can be recreated. It is

> generally not worthwhile to patch test these cosmetics or skin care

> products on the back, since facial skin is a unique milieu that is

> not accurately reproduced on the back.

[Guest guest]

It's not very well written, unfortunately. I was taken aback by the

wording too. I would guess she means use the powder instead of the

liquid formulations. The other way to comprehend her phrasing

(putting a powder on top of a liquid) does not get rid of the

emulsifier and would continue to cause the problems.

I want to know what emulsifier she's talking about so I can avoid

them in the future....

Take care,

Matija

> > Hi,

> >

> > Here's a Q&A from Dermatology Times that discusses why some

> cosmetics

> > and skincare products may cause breakouts.

> > Take care,

> > Matija

> >

> >

> > May 15, 2002

> > By: Zoe Draelos, M.D.

> > Dermatology Times

> >

> > Q. Why do some cosmetics and skincare products cause breakouts?

> >

> > A. It is important to determine exactly what the patient means

when

> > they present with the complaint of " breakouts. " Most reputable

> > cosmetic companies test their cosmetics and skincare products and

> can

> > substantiate the claims of noncomedogenic and nonacnegenic. These

> > claims simply mean that the product does not cause comedones or

> acne,

> > however, other acneiform eruptions of the face are possible

> following

> > cosmetic or skincare product use. In my experience, the most

common

> > cause of a " breakout " following 48 hours of product use is a

> > perifollicular irritant contact dermatitis. This time frame is

too

> > short for the development of true acne, but certainly within the

> time

> > frame for irritant contact dermatitis. This finding may be

covered

> > under the claim of hypoallergenic, meaning reduced allergy, but

it

> is

> > still possible for patients with sensitive skin to develop

problems.

> >

> > Women who develop breakouts with many topical products may be

> > developing irritation from the emulsifier, which emulsifies the

oil

> > and water components of the formulation into a single phase.

> However,

> > the emulsifier can also emulsify sebum, which is in highest

> > concentration at the follicular ostia. The follicular ostium is

> > generally the anatomic site of the acneiform lesion. There is

> > tremendous variability in patients who present with frequent

> > acneiform eruptions following cosmetic use, but a general rule of

> > thumb is to recommend the use of powder over liquid cosmetics,

thus

> > avoiding the emulsifier. For example, a powder blush can be used

> over

> > a liquid blush, a facial powder over a liquid foundation, or a

> powder

> > eye shadow over a cream eye shadow.

> >

> > Remember that the skincare products and cosmetics most likely to

> > cause problems are those that are applied directly to the skin

and

> > remain on the skin for the longest period of time. This means

that

> > sunscreens, moisturizers, cosmeceuticals, and facial foundations

> are

> > the most likely culprits. A process of elimination can be used to

> > determine which product is causing difficulty. This is

accomplished

> > by using each skin care product or cosmetic alone on the face for

> > five days to determine if the symptoms can be recreated. It is

> > generally not worthwhile to patch test these cosmetics or skin

care

> > products on the back, since facial skin is a unique milieu that

is

> > not accurately reproduced on the back.

[Guest guest]

> I want to know what emulsifier she's talking about so I can avoid

> them in the future....

Unfortunately for us, I think the article is talking about all

emulsifiers, Matija. It sounds like any emulsifier (any ingredient

that enables the oil and water components to remain in a single

solution) also emulsifies sebum, which is associated with the site of

acne formation; " the emulsifier can also emulsify sebum, which is in

highest concentration at the follicular ostia. The follicular ostium

is generally the anatomic site of the acneiform lesion. "

I've never heard that before, and I would think daily use of a good

cleanser would get rid of even emulsified sebum. (Ah, the search for

an effective but gentle cleanser continues... )

My product sensitivity follows a pretty consistent pattern: a near-

immediate itch and/or burning, then a breakout about 12-36 hours

later. The breakout is literally the other shoe falling, and if I

didn't know I might attribute the breakout to something more recent.

This article gives that phenomenon has a name: perifollicular

irritant contact dermatitis. It does last a shorter time than acne --

2-4 days, as compared to pimples that hang around for a week or so.

I posted something about a month ago about irritant contact

dermatitis, in response to a flurry of posts about dry skin. I'd not

heard before that it was associated with breakouts. Also called non-

allergic contact dermatitis, it is very common but usually discussed

in relation to the hand, not the face. An allergy clinic site from

New Zealand (http://www.allergyclinic.co.nz/guides/24.html) writes

what I think is a succinct description, " ...Contactants are

detergents and surfactants, acid and alkali solutions, organic

solvents, sometimes even water. The deleterious effect of these

agents is the removal of the fat emulsion on the skin surface, a

damage to the function of the epidermal skin barrier, and removal of

the water-binding substances of the outer layer. The single exposure

is usually harmless but by accumulation destructive. The clinical

consequences are dryness, scaling and fissuring, progressing to

eczematous dermatitis. It occurs where the skin is thinnest...The

most common predisposing factor for this type of contact dermatitis

is the presence of an atopic predisposition. [a predisposition to

allegies in general] "

And we know that irritant contact dermatitis is more common when the

protective epidermal barrier is already compromised (such as from

rosacea's chronic inflammation).

I also thought it was verrrrry interesting that another article you

posted described skin sensitivity (which they refer to as

a " neurosensory problem " ) as occuring much more commonly among fair-

skinned types -- just as in rosacea; " Results from studies completed

so far show that most persons in the United States with sensitive

skin are phototype I "

So we can begin to develop a list of features about rosacea:

-more common in fair-skinned individuals (who are also more

suspectible to skin sensitivity, blushing/flushing, and increased

burning/cancer in response to sunlight)

-association with some auto-immune disorders (such as thyroid, lupus)

-association with conditions that, while not immune-mediated

themselves, are themselves strongly associated with immune-mediated

disorders (such as Raynaud's)

And other features that I've not seen described or proven, but which

I suspect is true:

-?increased incidence of other skin disorders, esp acne vulgaris,

seborrheic dermatitis, eczema and irritant contact dermatitis

-?increased incidence of food-related dermatitis such as food

intolerances

Finally, some interesting questions that arise from the above, and

other things I've been wondering about:

- is there an anatomic or physiologic feature of phototype I skin

(most common skin type in both skin sensitivity and rosacea, both of

which involve burning) that makes it especially suspectible to

neurosensory symptoms?

-why it is that overuse of topical steroids leads to a condition

pathologically indistinguishable from rosacea? Is it due to the side

effects of topical steroids, and/or the side effects of chronic

suppression of inflammation?

Marjorie

Marjorie Lazoff, MD

[Guest guest]

I assume this person wanted this expressed to the group, but I'll

leave it anonymous just in case:

I find this very interesting. I am nearly convinced that my

condition resulted from the overuse of benzoyl peroxide 10% solution--

although I know this isn't a steroid. I never had a history of

flushing and I never had acne, but I began using this on my nose

(compulsively in an attempt to prevent breakouts)and I overused it

for a year before I first noticed my nose was pinkish in color and

would occasionally flare. This is only true where I applied the BP.