Mineral waters: instead of cosmetics or better than cosmetics?

Abstract

Cosmetics are regarded as products, other than soaps, intended to be rubbed, poured, sprinkled or sprayed on, or otherwise applied to, the human body for cleansing, beautifying, promoting attractiveness, or altering the appearance of the skin.1 This definition includes such products as skin creams, lotions, perfumes, cleansers, lipsticks, deodorants, and face makeup. Cosmetics are able to improve the structure, morphology, and appearance of the skin through the activity of very specific ingredients; however, these changes are not permanent and interrupting the cosmetic process, will cause the reappearance of the skin problems. Cosmetics are mostly used for the care of nonaffected skin or as an adjuvant therapy for moderate skin disorders. Advances in biochemistry and physiology of the skin have enabled the development of specific products for different skin types, divided according to cosmetologic characteristics, particularly for moderate skin disorders. When we observe our patients’ skin, it is possible to identify different types of skin, each one with specific characteristics. Normal skin has no visible lesions or sensations of discomfort. It results from the equilibrium of various continuous biological processes, which create a harmoniously balanced state of suppleness, elasticity, and color. Greasy skin2 is characterized by skin thickening and an increase in sebaceous secretion, giving the face a shiny appearance, especially on the nose and forehead. Complications frequently associated with greasy skin include acne and seborrhoeic dermatitis. It is also possible to include in this group scalp seborrhoea, which in mild cases can be considered to be simple greasy skin. Dry skin appears rough, scaly, and cracked, and patients refer to a sensation of tightness. Dry skin is usually caused by increased transepidermal water loss, consequent to a decrease in the stratum corneum barrier function. Dry skin can be caused by the action of external factors on normal or, rarely, greasy skin; it can also be a constitutional condition, such as fragile skin, senile skin, and the dry skin of atopic dermatitis.3,4 Combined skin, or mixed skin, constitutes a frequent variant of greasy skin. This type of skin is characterized by the association, on the face, of areas of thickened skin with a shiny aspect and slightly marked keratosis (seborrheic plaques) and areas of epidermal atrophy and slight desquamation (plaques of dry skin). Usually these subjects have an oily forehead and nose and very dry cheeks and chin. In addition, in some cases high levels of sebum and skin dryness may occur on the same areas. This condition has been observed in patients who have excessive sebum secretion and who define themselves as having greasy skin. This also increased transepidermal water loss, which is indicative for dry skin. Commonly, sebum is considered able to retain water inside the skin and therefore increase skin moisturization. Dry skin covered by big quantities of sebum does not look dry because the sebum keeps the dry skin cells glued onto the skin surface, reducing the greyish, scaly, rough appearance of dry skin. Combined skin is frequently observed in women who choose the wrong cosmetics in trying to remove the large amount of sebum that covers the skin; this also induces more skin dryness by removing lipids necessary for the correct equilibrium of the skin. Sensitive skin has been defined by Maibach and colleagues5 as many clinical (and frequent) conditions characterized by erythema, xerosis, pytiriasic desquamation, and often associated with subjective sensations such as burning or itching. The etiopathogenesis of this condition is not completely known, but it has been hypothesized that an altered degranulation of cutaneFrom the Department of Dermatology, University of Florence, Florence, Italy and the Department of Dermatology, University of Prague, Prague, Czech Republic Address correspondence to Torello M. Lotti, MD, Department of Dermatology, University of Florence, Via Alfoni 37, 50121 Florence, Italy. E-mail address: tlotti@unifi.it.