Types of facial skin

The concept of skin types

For the purposeful impact on the skin during various cosmetic procedures, it is necessary to correctly determine the skin type and its condition.

At the heart of the division of the facial skin into different types lie the following parameters: the rates of keratinization, the rate of desquamation, the loss of water, the intensity of fat and sweating.

Classifications

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

Normal skin is the skin without visible changes and sensations of discomfort.

Absolutely normal skin is very rare. Patients with this type of skin, as a rule, do not go to institutions of cosmetology. With age, as well as with improper care, normal skin, as a rule, is dehydrated, becomes sensitive to external irritating factors.

Normal skin is characterized by freshness, purity, no visible changes. Due to good blood supply, this skin has an even color with a matt tint. Skin is elastic. The mouth of the sebaceous glands ("pores") is very small, superficial, hardly noticeable. Peeling on the skin surface is absent. The skin is resistant to external irritant factors. Feelings of discomfort are absent regardless of the time of year, day, climatic conditions, the phase of the menstrual cycle.

Dry skin - thinned, with peeling, small cracks, sensations of constriction and tingling.

In everyday practical work, the dermatocosmetologist often has to face a symptomatic complex of dryness, or a xerosis (from the Greek "Zeros" - dry), skin in patients with various conditions and diseases. The causes of the onset of xerosis of the skin are currently not fully understood. However, it is known that this symptom complex is interlinked with four main factors: water deficiency in the stratum corneum, excessively frequent changes in the epithelial layer, a violation of the barrier properties of the skin and a decrease in sebum production.

In the case of dehydration of the stratum corneum, the skin looks flaky, the scales are tightly attached in the central part, and along the periphery they somewhat lag behind the surface of the skin and are separated from each other by fractured grooves. The mouth of the sebaceous-hairy apparatus can be widened by loss of water in the surface layers of the skin. Chronic skin damage 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 is histologically expressed in the formation of a pathological process in the epidermis - parakeratosis, leading to peeling. Simultaneously with the delay in the differentiation of keratinocytes, a delay in the formation of lipids fulfilling the barrier function occurs. The outcome of this condition is an increase in transepidermal water loss, which leads to dry skin. Infringement of barrier properties of a skin arises because of reduction of quantity of lipids between horny scales in a stratum corneum. This is possible with the constant use of aggressive detergents and with a number of dermatoses (atopic dermatitis, ichthyosis, etc.). Skin conjunctivitis in atopic dermatitis is caused by changes in the composition of ceramides of the stratum corneum. So, with this dermatosis, a decrease in free ceramides associated with linoleic acid is registered. In psoriasis and lamellar ichthyosis, serious changes in the lipid composition of the stratum corneum have also been identified. It was shown that with these dermatoses there is an increase in the content of free ceramides of types 2, 3, 4, and a decrease in the number of ceramides 3b and 5. In psoriasis, a decrease in the content of bound Class B ceramides is also recorded. It is believed that these violations in the ratio of ceramides, as well as changes in levels cholesterol and fatty acids in the stratum corneum of the epidermis contribute to the inferiority 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 is constitutionally dry skin.

Acquired dry skin is formed when exposed to various exogenous factors. These factors include acute and chronic UFO, various meteorological factors (wind, high temperature, low humidity), permanent skin care using anionic detergents, solvents and other aggressive substances. So, the raised dryness of a skin is observed at the persons constantly staying in the air-conditioned premises, characterized by certain adverse for a skin microclimate. Dryness of the skin can also be a consequence of various therapeutic measures. In particular, the expected side effect of systemic retinoid therapy is dry skin. Similar changes are possible with external therapy with retinoids, benzoyl peroxide, azelaic acid, alpha hydroxy acids, etc. Dryness resistant erythema and thinning of the skin can occur in the practice of dermatosmetologist as a result of repeated procedures of peeling, laser resurfacing, dermabrasion. Under the influence of various exo- and endogenous fakirs, theoretically any type of skin can be transformed into dry skin. Such skin is usually classified as dehydrated.

Constitutionally, dry skin can be associated with certain genetic and physiological characteristics. In particular, it occurs in children from 2 to 6 years of age, when there is a physiological decrease in sebum production by sebaceous glands. Dryness of the skin of the face, back, hands, and shins is often recorded in women with white, thin skin, while similar traits are also observed among family members. In addition, the dryness of the skin can grow and dominate as a symptomatic complex in its aging (senile xerosis). Perhaps the appearance of dry skin, its dehydration, thinning in menopause and premenopause. This is due to the fact that with age, there is a partial, and then a complete atrophy of the sebaceous glands. 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 the internal organs and therefore requires the dermatocosmetologist to carefully collect the history and complete examination of the patient by systems and organs.

Thus, the symptomatic complex of dry skin is a heterogeneous term. Complex care for such skin, including gentle cleansing and moisturizing, is fundamentally important along with the appointment of pathogenetic therapy.

Clinical varieties of dry skin (according to R. Varan, N. I. Maibach, 1998)

Variety		Mechanisms of formation
Acquired dry skin		The effect of exogenous stimuli, iatrogenia, etc.
Constitutionally dry skin	non-pathological	Physiological and genetic features, aging
	in pathology	Genetic defect in the metabolism of fatty acids, deficiency of a number of enzymes, etc.

The main causes of dry skin of the face

Exogenous causes

• Wrong unsound skin care or lack of any care.
• Unfavorable working conditions (work in combustible shops, long stay in the open air, etc.).
• Abuse of diets, fasting on various questionable methods.
• Abuse of alcoholic beverages, as well as smoking.
• Iatrogenic causes associated with prescribing medications or as a side effect of some cosmetic procedures.
• Others.

Endogenous causes

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

Patients with dry skin turn to a cosmetology cabinet very often. As a rule, with complaints of the appearance of redness and flaking of the skin, as well as a feeling of discomfort, in the form of "tightening and tingling," paresthesia. The above complaints are aggravated especially after washing face skin, as well as changing weather conditions, depending on the phase of the menstrual cycle, etc. Early appearance of signs of skin fading leads patients with dry skin type to admission to a dermatologist-cosmetologist.

At a young age, dry skin looks attractive, it is "beautiful as a rose," but unfortunately it fades like a rose. Skin pale pink, matte hue, thin, delicate, with narrow, almost imperceptible pores, without fatty gloss on the surface. Dry skin is characterized by freshness, purity. With improper skin care of this type, there may be erythema and scaling, 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. There are also subjective sensations of constriction of the skin, itching and parasthesia. Dry skin is very sensitive to external irritant factors, especially to ultraviolet radiation.

Oily skin is thickened, with increased greasiness, luster, dilated mouths of the greasy-hairy apparatus.

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

Seborrhea is a special condition associated with overproduction 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 - pustular, papular, indurative, phlegmonous, conglobata (see "Acne") are found.

Combined (mixed) skin - skin that has thickened areas with enlarged estuaries of the sebaceous glands and increased secretion of sebum in the central part of the face that is combined with areas of atrophy and flaking on the side faces of the face and neck skin. It should be emphasized that a significant drawback of dividing the skin into a normal , dry, greasy and combined is that it reflects only the characteristics of fat and sweating, without taking into account such important skin parameters as elasticity, turgor and the degree of expression of age changes Nij. In addition to assessing the history and results of visual examination of the skin using a lamp-magnifier, dermatocosmetology traditionally uses a series of tests to more accurately determine the type of skin.

Test for fat content.

It is carried out after 2 hours after washing, with the help of tissue paper, on the skin without decorative cosmetics and other cosmetic products. Cigarette paper is carried out with a light pressure on the forehead, nose and chin. Then the edges of the papyrus paper are pressed to the left and right cheeks.

Evaluation of test results:

• a negative result - the absence of greasy spots on tissue paper, is characteristic of dry skin;
• a positive result - grease spots are observed only in the central part of the tissue paper applied to the forehead, nose, chin; depending on the intensity of the spots occurs in normal and mixed skin types;
• a dramatically positive result - the presence of 5 fatty spots, which is typical for oily skin.

Skin fold test. It is used to assess skin turgor. The skin fold is formed by squeezing two fingers of the skin of the side of the face.

Evaluation of test results:

• normal turgor - skin fold is difficult to form;
• the turgor is somewhat lowered - a fold can be formed, but it is immediately aligned;
• The turgor is sharply reduced - the fold is easily formed and the share is preserved.

Rotational-compression test. It gives an opportunity to characterize the skin turgor. The researcher applies a thumb to the skin of the middle part of the face and, with a slight tap, performs a rotational movement.

Evaluation of test results:

• negative result - a feeling of resistance to rotation and pressure;
• a weakly positive result - the emergence of a vanishing wrinkle fan;
• positive result - free rotation and the formation of small, long-lasting wrinkles, arising even with a slight pressure.

The combination of the results of the above tests allows you to refer the skin to one of the following options. It should be emphasized that the gradation of the skin indicated below by its types also takes into account the degree of expression of age-related skin changes.

• The skin is normal, the turgor is normal. The skin has a matte surface with a slight shine in the middle part of the face. Thin, hardly visible in the middle part of the mouth of the sebaceous glands ("pores") are not filled with leather fat. The test for fat content in this area is positive, on the side faces of the face - negative. The tonus is normal, the rotation-compression test is negative. The skin is resistant to the action of local irritants and even without special cosmetic care it retains its appearance for a long time. After 30 years, depending on the conditions and characteristics of care, it acquires features characteristic of the following skin type.
• The skin is normal, the turgor is somewhat reduced. The surface is matte with a slight shine in the middle part of the face. The mouth of the sebaceous-hairy apparatus is small, superficial, not significantly pronounced. The fatness test in the middle part of the face is weakly positive, on the side parts negative or weakly positive, the skin fold is formed, however it is elastic, the rotational compression test is weakly positive. Around the eyes there is a network of superficial wrinkles. In the absence of full-fledged care for such skin, it quickly becomes noticeable signs of aging.
• The skin is normal, the turgor is sharply reduced. The surface is matte with a slight shine in the middle part of the face. The mouth of the sebaceous-hairy apparatus is small, not significantly pronounced. The fatness test in the middle part of the face is weakly positive, on the side parts it is negative. Mimic wrinkles are clearly expressed, the skin is thin, the turgor is sharply reduced. A skin fold is easily formed. The rotational-compression test is positive.
• The skin is dry, the turgor is normal. Skin is matte, smooth, without wrinkles. The mouth of the sebaceous-hairy apparatus is almost invisible. The fat test is negative. The rotation-compression test is negative. Skin is sensitive to any irritants. Regular care and protection from unfavorable factors of the external environment, first of all - meteorological factors, are necessary.
• The skin is dry, the turgor is somewhat reduced. Skin is matte, delicate. The mouth of the sebaceous-hairy apparatus is imperceptible, the fatness test negative there are superficial wrinkles in the corners of the eyes. The skin fold forms easily, elasticity is preserved. Rotational-compression test is weakly positive. A systematic preventive cosmetic treatment is shown, since signs of a decrease in skin turgor appear by the age of 30.
• The skin is dry, the turgor is sharply reduced. The surface is matte, tender, the mouth of the sebaceous-hairy apparatus is invisible. The skin turgor is sharply reduced, the skin is thinned, especially in the eye and around the mouth, static superficial and deep wrinkles are formed. The skin fold is formed easily for a long time, the rotational-compression test is positive
• The skin is oily, the turgor is normal. The surface of the skin in the middle part of the face is shiny, with pronounced sebum-filled mouths of the sebaceous-hairy apparatus, i.e., the condition of seborrhea takes place. Comedones can be found. The test for fat content in the middle and lateral parts of the face is positive. Skin without wrinkles, smooth. It is difficult to form a skin fold. The rotation-compression test is negative. In puberty, acne often occurs. Regular care is recommended, with the use of medical cosmetics, if necessary - pharmacological correction. Do not use fat-based cosmetics.
• The skin is oily, the turgor is somewhat reduced. The surface of the skin is shiny, with a rough structure, the mouth of the sebaceous-hairy apparatus is expanded, there are comedones. The fatness test in the middle part of the face is positive, in the lateral parts may be negative. There are mimic wrinkles, the skin of the eyelids is flabby. A flexible skin fold is formed. Rotational-compression test is weakly positive. There is a tendency to the appearance of inflammatory elements, especially in the middle part of the face. Special care is required. The aging process of the skin is relatively slow.
• Oily skin, turgor is sharply reduced. The fat characteristic corresponds to the previous type of skin. Skin folds are formed arbitrarily, the rotation-compression test is sharply positive.

In the same way, they classify the combined skin type and distinguish: combined skin with a normal, slightly reduced and sharply reduced turgor. It should also be noted that any type of skin can be dehydrated and sensitive.

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