Facial skin types

The concept of facial skin types

To have a targeted effect on the skin during various cosmetic procedures, it is necessary to correctly determine the skin type and its condition.

The division of facial skin into different types is based on the following parameters: keratinization rate, desquamation rate, water loss, intensity of sebum and sweating.

Classifications

There are many classifications of skin types. In particular, four main skin types are most often distinguished: normal, dry, oily, combination (mixed)

Normal skin is skin without visible changes or feelings of discomfort.

Absolutely normal skin is very rare. Patients with this type of skin, as a rule, do not seek cosmetology services. With age, as well as with improper care, normal skin, as a rule, dehydrates, becomes sensitive to external irritants.

Normal skin is characterized by freshness, purity, and absence of visible changes. Due to good blood supply, such skin has an even color with a matte sheen. The skin is elastic. The openings of the sebaceous glands ("pores") are very small, superficial, and barely noticeable. There is no peeling on the skin surface. The skin is resistant to external irritants. There is no discomfort regardless of the time of year, day, climate, or phase of the menstrual cycle.

Dry skin is thin, flaky, with small cracks, a feeling of tightness and tingling.

In their daily practical work, a dermatocosmetologist often has to deal with a symptom complex of dryness, or xerosis (from the Greek "Zeros" - dry), of the skin in patients with various conditions and diseases. The causes of skin xerosis have not yet been fully studied. However, it is known that this symptom complex is interconnected with four main factors: water deficiency in the stratum corneum, excessively frequent replacement of the epithelial layer, disruption of the skin's barrier properties, and decreased sebum production.

In case of dehydration of the stratum corneum, the skin looks flaky, the scales are tightly attached in the central part, and at the periphery they lag somewhat behind the skin surface and are separated from each other by crack-like grooves. The mouths of the sebaceous-hair apparatus can be expanded due to the loss of water in the superficial layers of the skin. Chronic damage to the skin by various obligate chemical and physical factors of weak strength, such as acids or ultraviolet rays, can cause accelerated proliferation of basal cells, which is a consequence of the inflammatory reaction. In this case, keratinocytes do not have time to quickly transform into horny scales, which histologically is expressed in the formation of a pathological process in the epidermis - parakeratosis, leading to peeling. Simultaneously with the slowdown in the differentiation of keratinocytes, there is a delay in the formation of lipids that perform a barrier function. The outcome of this condition is an increase in transepidermal water loss, which leads to dry skin. Impairment of the skin's barrier properties occurs due to a decrease in the amount of lipids between the horny scales in the stratum corneum. This is possible with the constant use of aggressive detergents and with a number of dermatoses (atopic dermatitis, ichthyosis, etc.). Skin xerosis in atopic dermatitis is caused by changes in the composition of the ceramides of the stratum corneum. Thus, with this dermatosis, a decrease in free ceramides associated with linoleic acid has been recorded. In psoriasis and lamellar ichthyosis, serious changes in the composition of the lipids of the stratum corneum have also been revealed. It has been shown that in these dermatoses there is an increase in the content of free ceramides of types 2, 3a, 4 and a decrease in the amount of ceramides 3b and 5. In psoriasis, a decrease in the content of bound ceramides of class B has also been recorded. It is believed that these disturbances in the ratio of ceramides, as well as changes in the levels of cholesterol and fatty acids in the stratum corneum of the epidermis, contribute to the inadequacy of keratinocyte adhesion and affect the rate of desquamation in these dermatoses, accelerating the renewal of the epithelial layer.

There are two main types of dry skin: acquired dry skin and constitutional dry skin.

Acquired dry skin is formed when various exogenous factors affect it. Such factors include acute and chronic UV radiation, various meteorological factors (wind, high temperature, low air humidity), constant skin care using anionic detergents, solvents and other aggressive substances. Thus, increased dryness of the skin is observed in people who constantly stay in air-conditioned rooms characterized by a certain microclimate unfavorable for the skin. Dry skin can also be a consequence of various therapeutic measures. In particular, dry skin is an expected side effect of systemic retinoid therapy. Similar changes are possible with external therapy with retinoids, benzoyl peroxide, azelaic acid, alpha-hydroxy acids, etc. Dryness, persistent erythema and thinning of the skin can occur in the practice of a dermatosmetologist as a consequence of repeated peeling procedures, laser resurfacing, dermabrasion. Under the influence of various exogenous and endogenous fakirs, theoretically any skin type can be transformed into dry skin. Such skin is usually classified as dehydrated.

Constitutionally dry skin may be associated with some genetic and physiological characteristics. In particular, it occurs in children aged 2 to 6 years, when there is a physiological decrease in sebum production by the sebaceous glands. Dry skin of the face, back, hands, shins is often recorded in women with white, thin skin, while similar characteristics are also observed in family members. In addition, dry skin can increase and dominate as a symptom complex with its aging (senile xerosis). Dry skin, its dehydration, thinning in menopause and premenopause are possible. This is explained by the fact that with age, partial and then complete atrophy of the sebaceous glands occurs. Constitutionally dry skin also occurs with various dermatoses: atopic dermatitis, ichthyosis, etc.

It should be remembered that dry skin can be a manifestation of serious diseases of internal organs and therefore requires a dermatocosmetologist to carefully collect anamnesis and conduct a complete examination of the patient's systems and organs.

Thus, the symptom complex of dry skin is a heterogeneous concept. Comprehensive care for such skin, including gentle cleansing and moisturizing, is fundamentally important along with the prescription of pathogenetic therapy.

Clinical types of dry skin (according to R. Baran, H. I. Maibach, 1998)

Variety		Mechanisms of formation
Acquired dry skin		The effect of exogenous irritants, iatrogeny, etc.
Constitutionally dry skin	non-pathological	Physiological and genetic characteristics, aging
	in case of pathology	Genetic defect of fatty acid metabolism, deficiency of a number of enzymes, etc.

The main causes of dry facial skin

Exogenous causes

• Incorrect, irrational skin care or lack of any care.
• Unfavorable working conditions (work in flammable workshops, prolonged exposure to the open air, etc.).
• Abuse of diets, fasting using various questionable methods.
• Abuse of alcoholic beverages, as well as smoking.
• Iatrogenic causes associated with the administration of medications or as a side effect of some cosmetic procedures.
• Other.

Endogenous causes

Hypo- and avitaminosis, kidney and liver disease, diabetes mellitus, thyroid disease, adrenal gland disease, infectious diseases accompanied by dehydration, some blood diseases, pituitary adenoma with hypopituitarism syndrome, paraneoplastic dermatoses.

Patients with dry skin visit a cosmetology office quite often. As a rule, with complaints about the appearance of redness and peeling of the skin, as well as a feeling of discomfort in the form of "tightening and tingling", paresthesia. The above complaints intensify especially after washing the skin of the face, as well as with changes in weather conditions, depending on the phase of the menstrual cycle, etc. The early appearance of signs of skin aging leads patients with dry skin to an appointment with a dermatologist-cosmetologist.

At a young age, dry skin looks attractive, it is “beautiful as a rose”, but, unfortunately, like a rose, it quickly fades. The skin is pale pink, matte, thin, delicate, with narrow, almost invisible pores, without an oily shine on the surface. Dry skin is characterized by freshness and purity. With improper care of this type of skin, erythema and peeling may appear, especially after washing, as well as dryness, peeling and small cracks on the red border of the lips and in the corners of the mouth. Subjective sensations of skin tightening, itching and paresthesia also occur. Dry skin is very sensitive to external irritants, especially to ultraviolet radiation.

Oily skin is thickened, with increased sebum production, shine, and enlarged openings of the sebaceous-hair apparatus.

In cosmetology, oily skin is usually divided into simply oily skin (a condition of seborrhea) and clinically oily skin (a condition of seborrhea complicated by the appearance of inflammatory acne).

Seborrhea is a special condition associated with hyperproduction of sebum and changes in its composition (i.e. qualitative and quantitative changes in sebum). Seborrhea is divided into liquid, thick and mixed. Each of these forms can serve as a background for the appearance of acne. In cases of clinically oily skin, various inflammatory acne is found - pustular, papular, indurative, phlegmonous, conglobate (see "Acne").

Combination (mixed) skin - skin with areas of thickening with dilated sebaceous gland openings and increased secretion of sebum in the central part of the face, which are combined with areas of atrophy and peeling on the lateral surfaces of the face and neck skin. It should be emphasized that a significant drawback of dividing the skin into normal, dry, oily and combination is that it reflects only the characteristics of sebum and sweating, without taking into account such important skin parameters as elasticity, turgor and the degree of expression of age-related changes. In addition to assessing the anamnesis data and the results of a visual examination of the skin using a magnifying lamp, dermatocosmetology traditionally uses a number of tests that allow more accurate determination of the skin type.

Fat test.

It is performed 2 hours after washing, using tissue paper, on skin without decorative cosmetics and other cosmetics. The tissue paper is applied with light pressure on the forehead, nose and chin. Then the edges of the tissue paper are pressed to the left and right cheeks.

Evaluation of test results:

• negative result - no greasy stains on tissue paper, typical for dry skin;
• positive result - greasy stains are observed only in the central part of the tissue paper applied to the forehead, nose, chin; depending on the intensity of the stains, it occurs in normal and combination skin types;
• a sharply positive result - the presence of 5 oily spots, which is typical for oily skin.

Skinfold test. Used to assess skin turgor. The skinfold is formed by squeezing the skin on the side of the face with two fingers.

Evaluation of test results:

• normal turgor - it is difficult to form a skin fold;
• turgor is slightly reduced - a fold can be formed, but it immediately smooths out;
• turgor is sharply reduced - a fold is easily formed and the share is preserved.

Rotational compression test. Allows to characterize skin turgor. The researcher places the thumb on the skin of the middle part of the face and, pressing lightly, performs a rotational movement.

Evaluation of test results:

• negative result - feeling of resistance to rotation and pressure;
• weakly positive result - the appearance of a disappearing fan of wrinkles;
• positive result - free rotation and formation of small, long-lasting wrinkles that appear even with light pressure.

The totality of the results of the above tests allows us to classify the skin into one of the following variants. It should be emphasized that the gradation of skin by its types indicated below also takes into account the degree of expression of age-related changes in the skin.

• The skin is normal, turgor is normal. The skin has a matte surface with a slight shine in the middle part of the face. Thin, barely noticeable in the middle part, the mouths of the sebaceous glands ("pores") are not filled with sebum. The test for fat content in this area is positive, on the lateral surfaces of the face - negative. The tone is normal, the rotational compression test is negative. The skin is resistant to local irritants and even without special cosmetic care retains its appearance for a long time. After 30 years, depending on the conditions and features of care, it acquires features characteristic of the next skin type.
• The skin is normal, turgor is slightly reduced. The surface is matte with a slight shine in the middle part of the face. The openings of the sebaceous-hair apparatus are small, superficial, not significantly expressed. The fat test in the middle part of the face is weakly positive, on the lateral parts it is negative or weakly positive, a skin fold is formed, but it is elastic, the rotational-compression test is weakly positive. There is a network of superficial wrinkles around the eyes. In the absence of proper care for such skin, signs of aging quickly become noticeable on it.
• The skin is normal, turgor is sharply reduced. The surface is matte with a slight shine in the middle part of the face. The openings of the sebaceous-hair apparatus are small, not significantly pronounced. The test for fat content in the middle part of the face is weakly positive, on the lateral parts it is negative. Mimic wrinkles are clearly expressed, the skin is thin, turgor is sharply reduced. Skin folds are easily formed. The rotational compression test is positive.
• The skin is dry, turgor is normal. The skin is matte, smooth, without wrinkles. The openings of the sebaceous-hair apparatus are almost invisible. The oiliness test is negative. The rotational compression test is negative. The skin is sensitive to any irritants. Regular care and protection from adverse environmental factors, primarily meteorological factors, are necessary.
• The skin is dry, the turgor is slightly reduced. The skin is matte, delicate. The openings of the sebaceous-hair apparatus are not noticeable, the test for fat content is negative, there are superficial wrinkles in the corners of the eyes. The skin fold is easily formed, elasticity is preserved. The rotational compression test is weakly positive. Systematic preventive cosmetic care is indicated, since signs of reduced skin turgor appear by the age of 30.
• The skin is dry, turgor is sharply reduced. The surface is matte, delicate, the mouths of the sebaceous-hair apparatus are invisible. Skin turgor is sharply reduced, the skin is thinned, especially in the eye area and around the mouth, static superficial and deep wrinkles are formed. Skin folds are easily formed and persist for a long time, the rotational compression test is positive
• The skin is oily, turgor is normal. The skin surface in the middle part of the face is shiny, with pronounced, sebum-filled openings of the sebaceous-hair apparatus, i.e. seborrhea is present. Comedones may be detected. The test for oiliness in the middle and lateral parts of the face is positive. The skin is smooth and wrinkle-free. It is difficult to form a skin fold. The rotational compression test is negative. Acne often appears during puberty. Regular care is recommended, using medicinal cosmetics, if necessary - pharmacological correction. Cosmetics on a fat basis are not recommended.
• The skin is oily, the turgor is slightly reduced. The skin surface is shiny, with a rough structure, the openings of the sebaceous-hair apparatus are widened, there are comedones. The test for oiliness in the middle part of the face is positive, in the lateral parts it may be negative. There are expression wrinkles, the skin of the eyelids is flabby. An elastic skin fold is formed. The rotational compression test is weakly positive. There is a tendency for inflammatory elements to appear, especially in the middle part of the face. Special care is required. The skin aging process is relatively slow.
• The skin is oily, turgor is sharply reduced. The oiliness characteristic corresponds to the previous skin type. Skin folds are formed arbitrarily, the rotational compression test is sharply positive.

The combination skin type is classified in the same way and is divided into: combination skin with normal, slightly reduced and sharply reduced turgor. It should also be noted that any skin type can be dehydrated and sensitive.

Sensitive" skin. In their daily practical work, a dermatocosmetologist often encounters the symptom complex of the so-called "sensitive" facial skin. Timely and correct interpretation of this symptom complex is extremely important for choosing further tactics for managing such patients. As a rule, increased skin sensitivity is caused by a number of dermatoses, in which the barrier properties of the skin are impaired and persistent or unstable erythema of the face is present, often along with other rashes. Such diseases include atopic dermatitis, rosacea, perioral dermatitis, seborrheic dermatitis, simple and allergic dermatitis, polymorphic photodermatosis and other dermatoses. Increased skin sensitivity occurs during menopausal aging, after a number of cosmetic procedures (peeling, laser resurfacing, microdermabrasion, dermabrasion, etc.), as well as with constitutional and genetically determined features of the skin and its vessels.