Corneotherapy, a term coined by Dr. Albert Kligman, is a skin care concept based on repairing the stratum corneum and therefore improving the function of the skin barrier. Topically applied substances influence the biochemistry in the horny layer of the skin and subsequent processes in deeper skin layers, which consequently have effects on the constitution of the horny layer, creating a cyclical effect that starts at the surface of the skin. A healthy and functioning skin barrier provides overall protection against dehydration and the penetration of germs, allergens,
irritants, radicals, and radiation. This protection supports a gradual reduction in inflammation and other skin problems as the external causative agents are repelled by an intact skin barrier. The long term effects of corneotherapeutic treatment with the appropriate skin care products results in a healthy skin barrier without side effects.
The basis of corneotherapy has three core concepts:
- Prevention – for preventive corneotherapy, it is essential to avoid skin care products with harmful substances such as irritants and allergens, to select appropriate skin care ingredients, and to individually adapt skin care products to specific skin conditions.
- Protection - an important result of professor Kligman’s studies is the finding that appropriate moisturizers and lipids will not only support the integrity of the horny layer but also support the regeneration of deeper skin layers. In addition, recovery of the skin barrier will promote protection against premature aging and other skin conditions.
- Individualized Care – components of corneotherapy include a precise analysis of the skin and an individually adapted skin care system based on that analysis. The result is a modular system with a combination of base creams and skin care agents that allow the user to customize their skin care.
The Principles of Corneotherapy
- Moisturizers play a significant role in skin care by increasing skin elasticity and smoothing the skin. About 40 per cent of natural moisturizing factor (NMF) consists of amino acids that are not only responsible for the moisture content of the skin but also for correcting imbalances in the osmotic pressure of the skin. The amino acids and urea present in NMF also create a natural protection against reactive oxygen species, or free radicals. Natural NMF in the skin can be replenished with skin care products containing NMF encapsulated in liposomes as transport systems.
- Derma Membrane Structure - The barrier layers of the stratum corneum, which occur in the form of bilayers, mainly consist of ceramides, cholesterol, and palmitic acid. The natural structure of the skin suggests that skin care products with a similar composition of bilayers would be more compatible than other structures. One system that has a similar structure is known by the name derma membrane structure (DMS). DMS contains ceramides, phytosterols (similar to cholesterol), and hydrogenated phosphatidylcholine with chemically bound palmitic and stearic acid. These components are physiological and integrate easily into the natural skin balance. The advantage of these systems is that they are free of emulsifiers, which means that they avoid the "washout" effect of conventional O/W emulsions as well as potential barrier disorders which may be observed in this context.
- Sun Protection - Intense sun radiation creates two types of stress for the skin with both ultraviolet (UV) and infrared radiation (IR). While the skin can be protected with UV filters against UV radiation and melanomas, only adequate clothing and shade will help against infrared radiation. Infrared radiation is one of the main factors that causes premature aging of the skin and it should be addressed when creating an anti-aging skin care system. According to the principles of corneotherapy, if UV filters are used for sun protection, they should be integrated into a DMS matrix and applied only when significant sun exposure is expected. The constant use of day creams with UV filters should be avoided as they prevent the formation of the vitamins D2 (ergocalciferol) and D3 (cholecalciferol) with extended use. It is possible to reduce sensitivity to sun radiation by using CM-glucan as an active agent as it has cell protective effects. It also slightly smooths the skin and is an excellent additive for anti-aging base creams with a higher lipid content.
Supportive Skin Regeneration
- Components to avoid - A major prerequisite for corneotherapy is that components in skin care products should not affect skin regeneration or cause skin reactions. It is therefore recommended to avoid the following components:
- Perfumes - the number one allergen in skin care products
- Preservatives - the second most common allergen
- Mineral oil and non-volatile silicones - high concentrations can affect the skin regeneration
- Emulsifiers - may cause barrier disorders
- Essential Fatty Acids - Linoleic acid (omega-6) is an essential corneotherapeutic component and usually applied in bound form as native phosphatidylcholine. It also exists in the stratum corneum as barrier active ceramide I, deficits of which can lead to scaly skin with barrier disorders. Reduced concentrations of follicular lipids and ceramide I also play a significant role in the comedogenesis in acne. Due to its linoleic acid content and the additional sebum suppressive influence, phosphatidylcholine is highly effective in first and second grade acne cases. In addition to youth acne this also applies for acne tarda, which occurs at a later phase of life. Cornification disorders in general respond to this treatment. Other important essential fatty acids are triple unsaturated γ-linolenic acid (omega-6) contained in evening primrose oil and α-linolenic acid (omega-3) contained in linseed oil. Atopic persons who quite frequently suffer from the enzyme deficit delta-6-desaturase benefit from the topical treatment with γ- as well as α- linolenic acid. Rose hip oil has 25% α-linolenic acid. Oils with a significant percentage of linoleic acid are grape seed and wheat germ oil. The latter mentioned also has 15% barrier active palmitic acid similar to avocado oil with 20%. Just like the aforementioned oils, avocado oil is a powerful agent for the protection and natural regeneration of the skin due to its high content of phytosterols.
- Carriers for Active Agents - Different active agents require specific carriers to be effectively released into the skin. DMS and phosphatidylcholine-containing non-aqueous oleogels with DMS components gradually release active agents contained and provide a long term effect. In contrast, liposomes (with water soluble actives) and nanoparticles (with lipid soluble actives) disperse active agents relatively quickly into the horny layer and deeper skin layers. By adding DMS to liposomes and nanoparticles the release rates can be influenced according to the specific concentration.
- Vitamins - The most frequently applied regeneration supporting substances are vitamins and their esters, which are released in the skin by enzyme reaction. The most significant substances in this context are:
- Vitamin A - as acetate in nanoparticles
- Vitamin C - as phosphate in liposomes
- Vitamin E - as acetate in nanoparticles
- Yeast extract (B vitamins) - in liposomes
- Coenzyme Q10 - in nanoparticles
It should be noted that only low concentrations (0.5%) of Vitamin C are used in liposomes in order to activate collagen in the skin and inhibit tyrosinase activity, which can be very effective in laser treatments. Conventional and highly dosaged non-liposomal solutions (10% and higher) only have keratolytic effects.
- Physical Measures to Support Skin Regeneration - Stimulating microcirculation, preferably in the form of accompanying corneotherapeutic measures, is a major element in the natural regeneration process of the skin. Treatment techniques include massage, exercise, physiotherapy, and cold water showers. Cold water showers help improve skin elasticity, partially because of the increased release of adrenal hormones.
Individual Skin Treatment
Individualized treatment, one of the core concepts of corneotherapy, requires specific active agents to be used for different skin conditions. The objective is to provide supportive prevention by means of cosmetic skin care as well as to preserve a healthy skin barrier in the long term. The following is a list of recommended active active agents based on the principles of corneotherapy.
- Barrier disorders:
- Phytosterols from shea butter or avocado oil (skin protection)
- Fumaric acid in liposomes (psoriasis)
- Aloe vera extract (dry and cracked skin)
- Hamamelis extract (dry and cracked skin)
- Evening primrose nanoparticles (atopic skin, dry skin)
- Linseed oil nanoparticles (atopic skin, dry skin)
- Cornification disorders:
- Phosphatidylcholine in the form of liposomes, nanoparticles (acne, ichthyosis)
- Evening primrose nanoparticles (acne, anti-inflammatory)
- Linseed oil nanoparticles (acne tarda, anti-inflammatory)
- Vitamin A nanoparticles (acne, ichthyosis)
- Erythema, irritations
- Boswellia nanoparticles (anti-inflammatory by inhibiting the 5-lipoxygenase activity, actinic keratoses)
- Vitamin K nanoparticles (teleangiectases, couperosis, rosacea)
- Echinacea extract (teleangiectases, couperosis, rosacea, sun burns, perioral dermatitis)
- Evening primrose nanoparticles (anti-inflammatory effects)
- Linseed oil nanoparticles (anti-inflammatory effects)
- D-panthenol (stimulating cell proliferation)
- CM-glucan (cell protective effects)
Anti-aging Active Agents
Anti-aging active agents are those that may temporarily change the skin condition (smoothing, reduction of wrinkles, etc.). Some substances also have a positive influence on the moisture balance of the skin, such as hyaluronic acid and peptides. Examples include:
- Hyaluronic acid (skin-tightening)
- Para cress liposomes (reduction of wrinkles by relaxing muscle contractions)
- Palmitoyl-lysin-threonin-threonin-lysin-serin (influencing collagen synthesis)
- Acetyl-glutamic acid-glutamic acid-methionin-glutamic acid-arginin-arginin (reduction of wrinkles, similar to para cress)
- Green tea (improving the microcirculation)
- Grape seed extract liposomes (radical scavengers)
- Whitening liposomes (prevents hyper pigmentation by inhibiting tyrosinase activity)
- Phytohormones such as red clover liposomes (estrogen-like effects)
- Special pigments - optical reduction of wrinkles by changed light reflection)
Corneotherapy and Atopic Dermatitis
Using the concept of corneotherapy, Dr. Kligman has been able to show that persistent corneotherapeutic treatment of the disturbed homeostasis of skin with atopic dermatitis with appropriate skin care substances may achieve substantial clinical effects.
- Lautenschläger, Hans. "Medical Wellness - a powerful combination". Kosmetische Praxis 2007 (5), 30-32
- Wille, John J. (2006). Skin Delivery Systems: Transdermals, Dermatologicals, and Cosmetic Actives. Blackwell Publishing. ISBN 0813808480.
- Lautenschläger, Hans. "Corneotherapy and anti-aging". Profi Kosmetik 2005 (8), 36-37
- Lautenschläger, Hans. "History and current aspects of corneotherapy". Kosmetische Medizin 2005 26 (2), 58-60
- Lautenschläger, Hans. "Dermatological cosmetics - linking cosmetics and medicine,". Kosmetische Praxis 2005 (5), 12-14
- Kapes, B. "Treatment from the outside-in – corneotherapy unveiled as a possible new directive for stratum corneum". Dermatology Times, Jul 1, 2004
- Lautenschläger, Hans. "Specific active agents and bases in corneotherapy". Kosmetische Medizin 2004 (2), 72-74
- Lautenschläger, Hans. "Corneotherapy - more than just a surface application". Dermaforum 2004 (8); Forum Ästhetische Dermatologie 2004 (3), 1
- Kligman, A. "Corneotherapy, a new approach to the treatment of chronic dermatoses." Japanese Journal of Dermatology. 2000 110 (4), 768.
- Lautenschläger, Hans. A new concept for skin protection, Pharm. Ztg. 144 (13), 1038-1040 (1999)
- Grubauer, G, Elias, PM, Feingold, R. "Transepidermal water loss: the signal for recovery of barrier structure and function". Journal of Lipid Research 1989 (30), 323-333