Adolescent dermatocosmetology

In their daily practical work, dermatologists and dermatocosmetologists increasingly have to see adolescents. This fact can be explained by the increasing demand for qualified cosmetology services among the population, the good awareness of adolescents and their parents, and, often, the desire of the adolescents themselves to change their appearance. At present, specialists are far from prohibiting all known salon procedures for adolescents. At the same time, when choosing procedures, a professional should focus on a number of anatomical and physiological features of the skin of individuals in this age range, as well as the most common dermatoses in children and adolescents.

The skin of children and adolescents is characterized by a smaller number of cell rows in the epidermis. Thus, the number of rows of cells in the spinous layer is 2-7, while in adults - from 3 to 8-15 rows. The granular layer is represented by 1-2 rows of cells (in adults - 1-3). Researchers also note a smaller thickness of the oral layer in different areas of the skin. It is known that the pH of the skin surface of adolescents is more alkaline than that of adults. Information has been accumulated on the greater permeability of the stratum corneum for medicinal and toxic substances in children from 10 to 16 years old. The listed features of the structure of the epidermis and its stratum corneum indicate the imperfection of the barrier properties of the skin, on the one hand, and its high permeability, on the other. Therefore, all procedures that sharply disrupt the barrier properties of the skin, in particular brushing, deep peeling, dermabrasion, etc., are highly undesirable for teenagers. All physiotherapeutic procedures associated with improving the delivery of one or another agent deep into the skin - ultrasound and iontophoresis - should be carried out with caution. In this case, special care should be taken when administering topical steroids using ultrasound (for example, for the treatment of hypertrophic and keloid scars). When carrying out procedures that change the pH of the skin surface (desincrustation, peelings), it is recommended to focus on individual tolerance.

A distinctive feature of the skin composition of children and adolescents is its increased hydration. If the skin of an adult contains 6-8% water, then the skin of older children and adolescents contains up to 10-15% of the water of the entire body. An abnormal tendency to water retention is noted in various pathological processes, such as simple herpes, streptococcal impetigo, etc. Professionals usually take this feature into account when diagnosing these dermatoses. At the same time, it is important to keep in mind the tendency to fluid retention in the skin when performing any invasive procedure, such as facial cleansing. To reduce local fluid retention after procedures, microcurrent therapy in lymphatic drainage mode may be recommended.

The most common dermatoses in adolescents who visit a cosmetologist include acne and atopic dermatitis. In any case, the salon should prescribe adequate basic skin care in accordance with its type (gentle cleansing, adequate moisturizing, effective photoprotection) and pathogenetic therapy taking into account the clinical form and severity of the process.

In case of acne in teenagers, skin cleansing, drying and anti-inflammatory masks, darsonvalization (cauterizing effect - large doses), therapeutic laser, superficial peeling, desincrustation, cosmechanics procedure, oxygen therapy, photochromotherapy, photodynamic therapy can be prescribed. It is important that the absence or inadequacy of proper pathogenetic therapy by the time the procedures begin can cause an exacerbation of acne. As for ultraviolet irradiation, this procedure can be recommended only after the end of the course of therapy and for those teenagers who note an improvement in the course of acne in the summer. Otherwise, when exposed to ultraviolet irradiation, only temporary "masking" of defects occurs, and later (2-3 weeks after insolation) the next exacerbation occurs. In case of indurative acne with congestion, Jacquet massage and oxygen therapy can be recommended. Any massage during adolescence should be performed without the use of oils in order to avoid the comedogenic effect of the latter.

Skin cleansing, or so-called "comedoextraction", is an important additional procedure in the management of patients with acne. Given modern concepts of disruption of the barrier properties of the skin in patients with acne, cleansing should be as gentle as possible. In particular, vaporization can contribute to further destruction of the barrier properties of the skin, increase transepidermal water loss, leading to skin dehydration. The most appropriate cleansing options for adolescents include cleansing with so-called "cool hydrogenation", which allows avoiding vaporization. The cleansing procedure is significantly facilitated by previous external therapy with retinoids (adapalene - Differin) or azelaic acid (Skinoren) for at least 2-3 weeks. In recent years, ultrasonic cleansing has become increasingly attractive, providing a good cosmetic effect after a course of procedures.

I would also like to emphasize that cleansing should not replace pathogenetic therapy for acne, but only complement it. Cleansing is not indicated if inflammatory elements, especially pustular ones, predominate. If a cosmetologist sees the need to prescribe this procedure in the presence of pustular acne, then the skin should be prepared with benzoyl peroxide (Baziron AC) for 10-14 days, and then the procedure should be performed.

As for the correction of scars and post-inflammatory pigmentation, it is desirable to achieve clinical improvement of acne before various whitening (LHE therapy, peelings) and leveling procedures (peelings). If the cosmetologist sees the need to prescribe these procedures, then the most gentle methods of action should be chosen (for example, superficial, less often medium-depth peeling and microdermabrasion, LHE therapy). Usually, such procedures are carried out after the end of puberty and stabilization of the acne course.

Milia may be one of the complications of acne. If there is a tendency to form milia, it is important to focus on modern drugs with keratolytic and comedolytic action (adapalene - Differin, azelaic acid - Skinoren) from the very initial stages of therapy. The appearance of milia may be partly due to dehydration of the stratum corneum in patients with acne. Moisturizing agents and procedures (for example, moisturizing masks) are indicated for such patients. Mechanical removal of milia with a needle is recommended; less often, they are removed with a laser. 1-2 weeks before removal, skin preparation can be performed (using products containing azelaic, salicylic acid, hydroxy acids), facilitating the procedure of enucleating milia. Similar patient management tactics can be proposed in the presence of primary milia, which are considered a developmental defect. When managing adolescents with atopic dermatitis in a beauty salon, a specialist must take into account the individual and family atonic anamnesis. Microcurrent therapy (especially when the process is localized on the skin of the face, steroid addiction, etc.), moisturizing masks, ultrasonic cleaning, oxygen therapy can be used. When choosing cosmetic lines, specialists usually focus on those intended for the care of sensitive skin and restoring the barrier properties of the skin (for example, the "Coco" line). Not indicated Carrying out irritating procedures that disrupt the barrier properties of the skin (vaporization, brushing, desincrustation, vacuum massage, peeling, laser "grinding", microdermabrasion, dermabrasion, etc.), using cosmetics with a strong odor, containing allergens, as well as actively performing cosmetic procedures in the season typical for exacerbation of atopic dermatitis. Exacerbation of atopic dermatitis against the background of cosmetic procedures can also be facilitated by the lack of proper pathogenetic therapy. In addition, in recent years, systemic drugs intended to restore the barrier properties of the skin, containing omega fatty acids (for example, omeganol, Omega-3, Elteans) have become increasingly popular. When the first signs of an incipient exacerbation of atopic dermatitis appear (worsening of the course of atopic cheilitis, erythema, facial edema), it is recommended to refuse any procedures and prescribe therapy in accordance with the severity of the exacerbation (topical glucocorticoids, 2nd or 3rd generation H2-histamine blockers, psychotropic drugs, herbal stimulants of cortisol production, oral detoxifying agents, etc.).

In addition to acne and atopic dermatitis, adolescents seeking medical advicea cosmetologist, may be identified as a concomitant disease psoriasis. When choosing cosmetic procedures in such cases, it is important to focus on the stage of the process. The progressive stage of the disease requires the greatest caution. It is characterized by peripheral growth of previously formed elements, the appearance of new miliary papules and the central nature of peeling, in which the marginal zone of the papule remains free of scales: peeling, being the final stage of the process, seems to "not keep up" with the growth of the psoriatic element. In the progressive stage of psoriasis, an isomorphic irritation reaction is observed (Koebner's symptom), which is expressed in the occurrence of psoriatic rashes at the sites of skin injury, sometimes even the most insignificant. An isomorphic reaction usually appears after about 2 weeks, and sometimes later at the sites of skin damage. Given the risk of the Koebner phenomenon, in a beauty salon, one should refrain from any invasive procedures, as well as manipulations associated with mechanical or chemical irritation of the skin. Only moisturizing and disinfecting masks, microcurrent therapy can be prescribed. In the stationary and regressive stages, the range of procedures is significantly expanded.

In case of neoplasm diagnosis in adolescents, it is necessary to consult an oncologist-dermatologist in order to adequately establish a diagnosis and decide on the tactics of further management and timing of removal of a particular neoplasm. In case of benign course of the disease, they usually try to remove neoplasms and skin malformations after the end of puberty.

To remove such formations as spider nevus, red granularity of the nose and some others, it is advisable to use a surgical laser, rather than electrocoagulation or cryodestruction. It is laser destruction that allows you to control the volume of intervention during the procedure and reduces the risk of scar formation.

Laser destruction against the background of systemic and external immunomodulatory therapy, adequate skin care can also be recommended for vulgar, plantar and flat (juvenile) warts. At the same time, in case of diagnosis of molluscum contagiosum, mechanical removal of formations with tweezers is indicated, followed by treatment with a 2% alcohol solution of potassium iodide. Electrocoagulation, cryo- and laser destruction are not recommended due to the high risk of subsequent scarring.

It should be emphasized that other cosmetic procedures are contraindicated for all viral dermatoses, including herpes manifestations, due to the risk of their dissemination.

Thus, a number of anatomical and physiological features of adolescent skin determine the specialist's choice of certain cosmetic procedures. It should also be noted that in the process of working with adolescents, it is extremely important to inform parents about the range of prescribed procedures, their mechanisms of action and expected effects. It is worth emphasizing once again the importance of the most gentle approach when choosing procedures, as well as the need for a comprehensive and analytical approach when assessing the skin condition of adolescents.

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