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Corneotherapy By Kai Atkinson
CORNEOTHERAPY
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B y K a i A t k i n s o n , E d u c a t o r , d e r m a a e s t h e t i c s
WHAT IS CORNEOTHERAPY?
Simply put, Corneotherapy is a progressive and remedial skin treatment methodology with its core principle being the repair and maintenance of the stratum corneum, the outermost layer of the epidermis, and its neighbouring defence systems at ALL times. Corneotherapy is closely related to Corneobiology, which refers to a broad range of experimental studies focused on the anatomy, physiology and biology of the stratum corneum. that the stratum corneum was a coherent tissue of cornified cells (corneocytes) and was NOT, as previously depicted, a graveyard of “dead” keratinised cells. Dr. Kligman articulated that the stratum corneum has many highly diverse functions and that it is very much alive, and his findings were confirmed by Professor Peter M. Elias, the author of the book “Skin Barrier” as well as other prominent scientists in the dermatological field. within the stratum corneum and working their way into the deeper layers of the skin. This is achieved by using preventative interventions that are primarily directed to the correction and restoration of the stratum corneum and its defence systems. This corneotherapeutic approach leads to homeostasis (balance) as well as the improved functioning of the integumentary system (skin), where it serves as a defence mechanism to protect the host against many harmful external substances and microorganisms, while keeping the epidermis front of mind and in-tact at all times.
Unfortunately, the term “Corneotherapy” has reached the field of conventional cosmeceuticals that do not work with the principles of Corneotherapy and exploit its core principal by claiming to be corneotherapeutic for sales and marketing, in order to offer conventional approaches with more progressive and exciting labels.
SO, WHAT DOES TRUE CORNEOTHERAPEUTIC COSMETIC CHEMISTRY LOOK LIKE?
One of the key principles of Corneotherapy is the prescribing of therapeutic solutions that are customised to the specific skin condition being treated. True Corneotherapy must contain formulations that are as physiologically compatible with the skin’s structure and function as close as possible. So, what does that exactly mean? Simply put, a skincare formulation must mimic the cell membrane or the bi-layers that make up the permeability barrier of the stratum corneum, in order to repair, replenish and regenerate the lipid phases of the skin that are lost and/or compromised on a daily basis.
Many skincare products will aggravate skin conditions that have lost the first three lines of skin barrier defence and require topical formulations that do not contain conventional emulsifiers or other foreign ingredients. Instead, physiological lipids such as phosphatidylcholine (PC) which makes up a large proportion of all biological cell membranes, should be used, as well as ceramides, cholesterol, triglycerides and free fatty acids which make up the permeability barrier membrane of the stratum corneum.
Ceramides in corneotherapeutic formulations as an example, must be in the correct ratio as they provide an important contribution to the preservation and regeneration of the skin barrier. Ceramides are metabolised and released into the extracellular matrix of the stratum corneum by the keratinocytes of the epidermis. One of the most important ceramides is linoleic acid (Omega 6) containing ceramide 1. A decreasing availability of ceramide 1 will correlate with an increase in dermatological skin conditions and disorders such as acne, eczema, rosacea, psoriasis and atopic dermatitis.
For skincare to be considered corneotherapeutic, it must be manufactured by a true dermatological chemist that follows the principles of Corneotherapy, and at all times must remain free from conventional emulsifiers, fragrances/ perfumes, preservatives, parabens, silicones, amines or colours. Why? Because they have no physiological functioning and/or purpose within the integumentary system and can promote skin barrier disorders.
A long time has been spent researching and developing a skin physiological moisturising solution that is compatible with the lipid properties of the skin. Conventional oil in water (O/W) and/ or water in oil (W/O) emulsions must not be used as they disturb skin barrier defence by causing a detrimental “wash-out” effect of the skin’s own metabolic secretions.
The methodology of Corneotherapy requires greater understanding than most established beauty therapy training and/or dermal institutes provide, as it truly focuses on the repair and maintenance of the stratum corneum and its surrounding defence systems, rather than A Corneotherapist at ALL times will keep the first three lines of skin barrier defence front of mind when it comes to the therapeutic treatment of skin. They are as follows: • The acid mantle/microbiome • Stratum corneum • Permeability barrier (multi-lamellar lipid structure - ceramides, cholesterol, free fatty acids)
When the first three lines of skin barrier defence are compromised, the skin has the ability to reflect changes in other cells and systems of the body, and this is known as the site of response. Understanding and appreciating this synergy between the cells and systems of the epidermis, dermis and body, is a big part of Corneotherapy, and must be respected and practiced on a daily basis by professional therapists when working on and within the skin.
You will not be classified as a Corneotherapist if you ablate the skin with chemical peels or use other modalities such as the use of epi-blading/dermaplaning, plasma pen or microdermabrasion just to name a few. The stratum corneum is where terminally differentiated epidermal keratinocytes reside, and from here, become known as the corneocytes we know that play a role as the second in line of skin barrier defence. These diverse living cells of the innate immune system are densely packed within the permeability barrier that surrounds them, protecting against harmful external substances and microorganisms, as well as balancing the evaporation of trans-epidermal water loss (TEWL) from the skin.
So, why as professional therapists would you knowingly want to compromise the integrity of the skin with ablative peels or other accompanying modalities by continually removing important lines of skin barrier defence? As professional skin therapists, we should understand that when we have an unprotected skin due to the loss of these defence systems, we get an increase in oxidative stress, a decrease in cell protection, an increase in lipid-peroxidation and the resulting mitochondria DNA damage/ageing that will accelerate cellular senescence… (ah, doesn’t make a lot of sense!)
Working with the principles of Corneotherapy As previously discussed, working with the principles of Corneotherapy can be obtained by not using foreign ingredients that don’t work with the physiological processes of the stratum corneum. Conventional emulsifiers, fragrances/ perfumes, preservatives, parabens, silicones, amines or colours can never be used within a formulation. Corneotherapy is all about working with chemistry that is skin physiological, or at least similar to the skin, as well as being adapted to the needs for all individual skin types and conditions. So, if you want to work with the principles of Corneotherapy, you need to first and foremost remove what the skin doesn’t recognise or require and find a formulation that resembles the lipid phases of the skin.
Genuine corneotherapeutic skincare ranges will also be free from treatments that overexfoliate, peel and impair the stratum corneum, as that directly contradicts the aim of long-term sustainability of the skin barrier. The protection supports a gradual healing of inflammation
WHAT ARE THE BENEFITS OF CORNEOTHERAPY?
Corneotherapy is the number one preventative measure against premature ageing and potential skin problems. By repairing the skin’s barrier defence systems under the principles of Corneotherapy, we reduce TEWL and ensure external aggravating factors are held at bay. The best single strategy to preserve a healthy skin condition corresponding to age, is to preserve the natural skin barrier with the help of suitable and physiological products. Thus, both protection and prevention are optimally guaranteed.
One of the major advantages of Corneotherapy is that it is largely free of side effects in comparison with a treatment with topical pharmaceuticals. Preventively applied Corneotherapy practices may extend the intervals between flare-ups and reduce or even avoid the application of conventional dermatological products such as cortisone-based creams.
Quality dermatological cosmetics, however, do not come without a price, as products free of conventional emulsifiers require complicated production technology. By using physiological ingredients that replenish the bi-layers and stabilise TEWL, will support and maintain adequate skin hydration levels for a better functioning and sustainable skin overtime.
To summarise this article, Corneotherapy is not to be used for marketing ploys if the skincare product being advertised is NOT corneotherapeutic and/or, the skin treatment services being provided by professional clinics, does not maintain the first three lines of skin barrier defence. Corneotherapy is the care of the stratum corneum with chemistry that mimics skin structure and function, while incorporating therapeutic modalities and the use of pure actives that have a long-term and sustainable effect on the cells and systems of the epidermis and dermis, while keeping the integumentary system in-tact at ALL times!
