Corneotharapy

What does the future hold?

What is Corneotharapy? Simply put, corneotherapy is the treatment of the stratum corneum, or therapy with moisturizers. The term corneotherapy was coined by professor Albert Kligman in 1994. In summary, his studies proved the feasibility of corneotherapy, in which even the simple application of moisturizers targeted at the stratum corneum can produce unexpected and persistent clinical effects after their repeated treatments.

Kligman spoke of an outside-in therapy whereas “outside” is the stratum corneum and “in” are the therapeutic effects starting in the stratum corneum and working their way into the deeper skin layers. 
Kligman’s findings were made famous by an editorial published in Dermatology 2000, entitled Evidence-Based Corneotherapy by Jan Lubbe.

It should be mentioned that for the first time ever, the term “therapy” has been used in the context of skin care. In the majority of countries, the term therapy is used in a medical context, and is being applied here because Kligman and his colleagues have demonstrated medical significance with their findings.

At the same time, Kligman coined the term corneotherapy new base creams were developed modeled on cell membranes. They are bio mimicking or bio-identical and follow this outside-in concept. These membrane creams are able to restore disrupted skin barrier membranes. A disrupted skin barrier leads to increased TEWL and increased penetration of external materials; corneotherapy aims to repair the skin barrier, bi-layer to bi-layer. If the skin barrier does not get repaired we end up with skin conditions such as eczema, rosacea, acne, neuro dermatitis, to name but a few. 

Another notable distinction of Kligman’s work is that he selected cosmetic substances in accordance with dermatological criteria, carried out studies, and finally established clinically significant results, thus the basis of corneotherapy is rooted in dermatological cosmetics. Dermatological cosmetics are developed in accordance with dermatological criteria in compliance with rigorous medical science.

So what? You might ask.
It is time to establish a formal criterion in order to help inform consumers how they can distinguish between serious product policy and marketing gimmicks. The International Association for Applied Corneotherapy (IAC) has taken up this cause. The IAC promotes the further development of corneotherapy against a scientific background and conveys the findings to the non-scientific world.

There should be no recommendation of physical, chemical or medical skin treatments that affect the recoverability of the skin after reapplications or cause irreversible adverse effects. Meanwhile, the recommendation is to use a minimum of products for skin care.

As well, there should be no sales promotions focusing on compositions or treatments that objectively are not needed or overstrain the skin on the long term, such as daily bathing of babies using strong surfactant compounds.

Finally, there should be no product descriptions that do not conform to the actual physical, chemical and other properties of the products.

Preparations and treatments
Corneotherapeutic cream bases are characterized by the feature that they can be formulated with both pharmaceutical and cosmetic active agents. There are also formulations that correspond to the particular requirements of country-specific pharmacopoeias.

In practice, we see that every skin has its individual needs. That is the reason corneotherapeutic preparations usually consist of one or very few active agents that are focused on a certain indication.

After a skin analysis and anamnesis, the appropriate preparations for the diagnosed indication are individually combined. Corneotherapy’s aim is a long-term skin protection through dermatological cosmetics in the occupational field.

The Formal Criterion
True dermatological cosmetics, according to corneotherapeutic principles, are characterized as follows:

Compositions:

• Abstain from active agent cocktails with a multitude of components that ultimately only serve for sales promotion purposes.
• Minimum of auxiliary additives only.
• Abstain from additives requiring further additives: examples are polyethylene glycols (PEG) and their derivatives that are used as emulsifiers or consistency agents and need to be stabilized with antioxidants.
• Free from emulsifiers that cannot be degraded in the skin.
• Free from emulsifiers that are incompatible with the skin barrier or do not correspond to the physiology of the skin.
• Free from surface-active substances that feel pleasant on the skin despite a disordered skin barrier.
• Free from occlusive substances, unless occlusivity is explicitly required because of dermatological viewpoints. Occlusion leads to skin swellings and a reduced recoverability of the skin.
• Free from preservatives with allergenic potential.
• Free from ingredients with suspected endocrine adverse effects from the substance classes of sun protection filters, preservatives or denaturing agents.
• Free from ingredients that interfere with the experience of pain of the skin.
• Abstain from perfumes in skin care products.
• Free from strong chelating agents that inhibit physiological trace elements in the skin and are persistent.