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Intensive Treatments 

for the Rehabilitation 

of Sun Damaged Skin

by Dr Des Fernandes

Plastic Surgeon,

Capetown

South Africa

 

Once we have established a photoageing condition, simple home care may not be enough and we have to consider more intensive treatments that can be done by either a doctor or a skin care therapist.

Peeling is the first thing that comes to most people’s minds but I believe that this is a crude and probably misdirected way to restore healthy skin. Some doctors firmly believe that laser resurfacing is a good way to treat skin but I believe that we should never use anything that destroys skin cells. The skin is our largest organ and is remarkably fragile. The epidermis is a mere 0.2 mm thick and the horny layer only about 0.02 mm!

This beautifully intricate organ has to be treated with great respect and never tortured with the purpose of making smooth healthy skin. The most important cell is the keratinocyte that lies at the base of the epidermis.

I believe that we should use lighter peels and gently persuade the skin to become smoother and healthier. We should never forget that the normal destiny of the keratinocyte is to manufacture all the essential keratins and ceramides etc and then die in order to make a healthy, protective horny layer. The skin is the only organ that fulfils its prime function by dying. When you understand this point you can see the danger in treating the horny layer as simply a dead layer that we do not really need. We need the horny layer but we want it healthy.

Heavy peeling and laser resurfacing can smoothen this skin quite impressively but these treatments kill most of the epidermis and cause scarring in the dermis. This scarring smoothens the skin. The skin has been shocked into looking younger and the patient might have to wear heavy make-up for the rest of her life. Men therapists may say that’s OK, but if we listen to the patients then we’ll hear that they actually don’t want to wear make-up. I found that with time the skin is not normal - its too thin and so it actually shows up fine wrinkles eventually as the collagen melts away. I found that light peels are virtually just as effective as a heavily debilitating peel, provided they are repeated at reasonable intervals.

It is most important to stress that these types of results cannot be achieved by using peeling alone. One has to support the skin with Vitamin A. Vitamin A makes it possible. I used to rely on peeling to get the maximum effects but now, fortunately I have learned better and I believe that we are now working with the skin’s physiology to make the best skin that we can. We are doing this with a new machine that I designed which incorporates the best properties of electricity and sound in order to get the greatest penetration of vitamin A, C and other important molecules for a younger epidermis.

 

Iontophoresis and sonophoresis

The skin is designed to prevent chemicals from easily entering into the deeper layers and that has limited the changes that one can achieve in restoring health to skin. Iontophoresis is about a century old and works with a galvanic or direct current. This type of current has a charge that flows between negative and positive. If an ionised (charged) gel is used on the surface of the skin then it will be influenced by the current. Because similar charges repel, and opposite charges attract each other, one can drive a charged ion into the skin. Iontophoresis is undergoing a renaissance and has changed from a poorly understood magical treatment to a highly specialised mechanism that requires the utmost scientific accuracy to be effective.

Scientists have learned the chemical finesse that allows us to get specific active chemicals right into cells. We can substitute injections for diabetics, or relieve rheumatic pains with a simple iontophoretic system. When properly designed, chemicals may even be driven more than a centimetre deep into the skin.

Iontophoresis using specially designed current, can give about 400 % better penetration compared to simple topical application. This is opening up a major field for rejuvenation of the skin.

Iontophoresis has made it possible to achieve results, which we could never achieve before. An example is scarring from acne or chicken pox. Dermabrasions were never very effective but this was the best that we had. Now we can use iontophoresis to get even better results. However, the problem with iontophoresis is that it only works if the molecule can be ionised into positive and negative charged components. This is not an impediment for sonophoresis, which is the use of sound waves to drive chemicals into the skin by changing the barrier qualities of skin. Sonophoresis is also becoming refined and we will no doubt see more effective treatments resulting from sonophoresis.

By sonophoresis, I do not mean ultrasound. Ultrasound uses frequencies about 50 times higher than the upper limit of human hearing. It is not as effective as iontophoresis. Sonophoresis, on the other hand, is at the upper level of human hearing and is far more effective. Up to 4000% better penetration can be achieved within 5 minutes compared to simple topical application. At this stage there is only one machine that offers sonophoresis like this, the Environ® Ionzyme machine which incorporates both iontophoresis and sonophoresis.

This combination offers us opportunities to restore youth to photodamaged skin to a degree previously considered impossible. I predict that within a few years, peeling will become less important and the major changes in skin will be done by enhanced delivery systems

Unfortunately, the treatments do take time and these results can only achieved if the frequency of treatment is radically increased to at least twice a week for about 24 treatments. Of course, the result has to be maintained by periodic treatments. When one examines skin treated by these modalities with a microscope, the epidermis has been demonstrated to be between 30 to even 100% thicker after the treatment. The important keratinocytes become much more normal, pigmentation is reduced and a thicker layer of collagen is laid down in the upper dermis.

Summary:

For established photodamage and scarring, we have to rely on intensive treatments to make the skin smoother, lighter and more radiant. Newer treatments are being developed which have scientific validity and give both visual and clinical evidence of improvement to a degree that has never before been achieved by simple topical treatments.

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