Dermatocosmetology of adolescence

In everyday practical work, the dermatologist and dermatocosmetologist have to increasingly take adolescents. This fact can be explained by the increasing demand for qualified cosmetology services among the population, good knowledge of adolescents and their parents, and also, often, the desire of adolescents to change their appearance. Currently, specialists are far from prohibiting all known salon procedures for adolescents. However, when choosing procedures, a professional should focus on a number of anatomical and physiological features of the skin in 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 rows of cells in the epidermis. So, the number of rows of cells of 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 parts of the skin. It is known that the pH of the skin surface of adolescents is more alkaline than in adults. Data on the greater permeability of the stratum corneum for medicinal and toxic substances in children from 10 to 16 years are accumulated. 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. Consequently, adolescents are extremely undesirable in all procedures that dramatically violate the barrier properties of the skin, in particular, brashing, deep peeling, dermabrasion, etc. With caution all physiotherapeutic procedures related to improving the delivery of an agent deep into the skin, ultrasound and iontophoresis, should be performed. In this case, you should exercise special care when introducing topical steroids with ultrasound (for example, for the treatment of hypertrophic and keloid scars). When carrying out procedures that change the pH of the skin surface (disincrustation, peelings), it is recommended to focus on individual tolerability.

A distinctive feature of the skin composition of children and adolescents is its increased hydration. If the skin of an adult contains 6-8% of water, then in the skin of older children and adolescents is up to 10-15% of the water of the whole organism. There is an abnormal tendency to water retention in various pathological processes, such as herpes simplex, streptococcal impetigo, etc. This feature is usually taken into account by professionals when diagnosing these dermatoses. However, the tendency to fluid retention in the skin is important to bear in mind when performing any invasive procedure, for example, facial cleansing. To reduce local fluid retention after the procedures, microcurrent therapy in the lymph drainage regime can be recommended.

To the most common dermatoses in adolescents, referring to a cosmetologist, you can include acne and atopic dermatitis. In any case, the salon should be given 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 acne, adolescents can be prescribed skin cleansing, drying and anti-inflammatory masks, darsonvalization (cauterizing action - large doses), therapeutic laser, superficial peeling, disinfestation, cosmechanics procedure, oxygen therapy, photochromotherapy, photodynamic therapy. Important is the fact that the absence or inferiority of proper pathogenetic therapy at the time of the commencement of procedures can cause an aggravation of the course of acne. With regard to ultraviolet irradiation, this procedure can be recommended only after the end of the course of therapy and in those adolescents who note an improvement in the course of acne in the summer. Otherwise, under the influence of UV radiation, only a temporary "masking" of defects occurs, and later (2-3 weeks after insolation), the following exacerbation occurs. With indurative acne with stagnant phenomena, Jacquet massage, oxygen therapy can be recommended. Any massage in adolescence should be done 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 for managing patients with acne. Given the current understanding of the violation of the barrier properties of the skin in a patient with acne, cleaning should be as gentle as possible. In particular, voreisation can further destroy the barrier properties of the skin, enhance the traineepidermal loss of water, leading to dehydration of the skin. The most appropriate cleaning options for teenagers include cleaning with the so-called "cool hydrogenation", which avoids vaporization. The previous external therapy with retinoids (adapalene-Differin) or azelaic acid (Skinoren) significantly improves the cleaning procedure for at least 2-3 weeks. In recent years, more and more attractive is ultrasonic cleaning, providing a good cosmetic effect after the course of procedures.

I would also like to emphasize that cleaning should not substitute pathogenetic therapy for acne, but only supplement it. Cleaning is not indicated with the predominance of inflammatory elements, especially pustular. If the cosmetologist sees the need to prescribe this procedure in the presence of pustular acne, then the skin should be prepared with benzoyl peroxide (Basiron AC) for 10-14 days, and then perform the procedure.

With regard to the correction of scarring and post-inflammatory pigmentation, it is desirable to achieve clinical improvement of acne before carrying out various bleaching (LHE-therapy, peeling) and leveling procedures (peelings). If the cosmetologist sees the need to prescribe these procedures, then choose the most gentle methods of exposure (for example, superficial, less often the average depth of peeling and microdermabrasion, LHE-therapy). Usually such procedures are carried out after the end of the period of puberty and the stabilization of the flow of acne.

One of the complications of acne can be the milium. With a tendency to form miloons, it is important from the very first stages of therapy to focus on modern drugs that have keratolytic and comedolytic action (adapalene-Differin, azelaic acid-Skinoren). The appearance of miloons can be partly facilitated by dehydration of the stratum corneum in patients with acne. Such patients are shown moisturizers and procedures (for example, moisturizing masks). It is recommended to remove the milium mechanically with a needle, less often they are removed with a laser. For 1-2 weeks before the removal can be done skin preparation (using azelainic, salicylic acid, hydroxy acids), facilitating the procedure for the extraction of milium. A similar tactic of managing patients can be suggested in the presence of primary miliums, which are considered a developmental defect. When managing adolescents with atopic dermatitis in a cosmetic salon, a specialist needs to take into account an individual and family atonic anamnesis. Microcurrent therapy can be used (especially when the process is localized on the face skin, steroid dependence, etc.), moisturizing masks, ultrasonic cleaning, oxygen therapy. 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 shown Carrying out of irritating procedures that violate the barrier properties of the skin (vaporization, brushing, disinfestation, vacuum massage, peeling, laser "grinding", microdermabrasion, dermabrasion, etc.), use of cosmetics with a pungent odor containing allergens, in a season, typical for exacerbation of atopic dermatitis. Exacerbation of atopic dermatitis against the background of cosmetic procedures can also contribute to the lack of proper pathogenetic therapy. In addition, in recent years, systemic preparations intended to restore the barrier properties of the skin, containing omega-fatty acids (for example, omeganol, Omega-3, Elteans) have become increasingly popular. At the appearance of the first signs of the onset of exacerbation of atopic dermatitis (worsening of atopicheskogo cheilitis, erythema, edema of the face) is recommended refusal to perform any procedures and the appointment of therapy in accordance with the severity of exacerbation (topical glucocorticoids, H2-histaminoblockers of the 2nd or 3rd generation, psychotropic preparations, plant stimulators of cortisol production, oral detoxifying agents, etc.).

In addition to acne and atopic dermatitis in adolescents who seek cosmetician, can be identified, as a concomitant disease of 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 character of peeling, in which the marginal zone of the papule remains free of scales: scaling, being the final stage of the process, does not "manage" as the psoriatic element grows. In the progressing stage of psoriasis, there is an isomorphic irritation reaction (Kebner's symptom), which is expressed in the appearance of psoriatic eruptions at the sites of skin trauma, sometimes even the most insignificant. An isomorphic reaction usually occurs about 2 weeks later, and sometimes later in the areas of skin damage. Given the risk of the phenomenon of Kebner, in a cosmetic salon should refrain from any invasive procedures, as well as manipulations associated with mechanical or chemical skin irritation. Only moisturizing and disinfecting masks, micro-current therapy can be prescribed. In the stationary and regressing stages, the spectrum of procedures is significantly expanded. 

In the case of diagnosis of neoplasms in adolescents, a consultation of the oncologist-dermatologist is necessary in order to adequately diagnose and decide on the tactics of further management and the timing of the removal of one or another neoplasm. In benign disease, the disease usually tries to remove tumors and malformations of the skin after the end of puberty.

To remove such formations as spider nevus (spider nevus), red nasal granularity 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 amount of intervention during the procedure and reduces the risk of scar formation.

Laser destruction on 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 the case of diagnosing a molluscum contagiosum, mechanical removal of the formations with tweezers was shown, followed by treatment with 2% alcohol solution of potassium iodide. Electrocoagulation, cryo- and laser destruction. Are not recommended because of the high risk of subsequent scarring.

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

Thus, a number of anatomical and physiological features of the skin of adolescents determine the choice of a cosmetic manipulator by a specialist. 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 the expected effects. It is worth emphasizing once again the importance of the most gentle approach in choosing procedures, as well as the need for an integrated and analytical approach in assessing the skin condition in adolescents.

[1], [2], [3], [4]