The Skin Health & Beauty Pyramid was created using extensive scientific literature, clinical data, and in-depth reviews on ingredients, formulations and technologies affecting skin biology, safety and efficacy. To attain optimal skin health, this guide helps to simplify and prioritize topical product choices by providing a ‘roadmap’ for physicians and skin therapists when making recommendations to their patients or clients in order to meet their expectations and budget.
In many cases, a multi-pronged approach is advisable to help repair and reverse damage to the cellular structure of their skins and to prevent further damage. Prescription creams generally only have one ingredient i.e. tretinoin in a tube whereas modern cosmeceutical formulations have the edge of incorporating multiple active ingredients that work synergistically together.
Fundamental (Base layer)
The base layer of the pyramid addresses the protection and repair of the skin and the products and ingredients used at this fundamental level are non-negotiable. This is the ‘must have daily’ level and everyone who is serious about attaining optimal skin health should protect their skin from the sun and other environmental aggressors on a daily basis.
If you do not protect your skin at this stage, then any other active ingredients in the Transform and Optimize phase will be minimized or negated as accumulative environmental damage will continue without the necessary protection.
Environmental aggressors include the sun but also visible light, infrared radiation, air pollution and ground-level ozone. Sunscreens protect against UV radiation but there are other environmental threats such as air pollution, ground-level ozone, and cigarette smoke where antioxidants are needed to provide additional protection.
At this level, there are two vital steps required to protect the skin: a high factor, broad-spectrum sunscreen and an antioxidant which inhibits environmental oxidative stress by scavenging free radicals that are destructive to the skin. This is the stage to prevent accelerated skin ageing and DNA damage that can cause skin cancer.
If the budget limits one from accessing ingredients contained in the following two higher levels of the pyramid, then as a baseline minimum, the fundamental level is the place to stay. As and when your budget allows for it, you can comfortably introduce the next level of transformative active ingredients.
If preventative measures were not taken early on in life to protect the skin, then products containing DNA-repairing enzymes would be an added benefit for damage that has already occurred at a cellular level – this is especially important for those at risk or who have had skin cancer. These days we are fortunate to have photo-protective sunscreens that contain not only antioxidants but also DNA Repair enzymes.
Transform (Middle layer)
The middle layer of the pyramid introduces transformative ingredients that target both early and advanced signs of photo-damage (sun damage) and this is the ‘need to have’ level. When underlying structural changes occur in the skin, due to accumulative UV damage, this is the time to introduce ingredients that transform and make a visible difference on both a superficial and a deeper level in the skin. These structural changes include fine lines, wrinkles, sagging, pigmentation, rough uneven skin texture, dull complexion with a lack of radiance, together with dryness due to a lack of moisture in the skin and this is usually related to a compromised skin barrier.
The ingredients at this level not only address skin ageing and moisture but are also able to target certain skin conditions such as acne and pigmentation. Often transformative ingredients can cause some transient irritation when first introduced to the skin but at this point, it is worthwhile to challenge the skin a little in order to boost it. This is a step-up level where the medical professional or skin therapist takes the client’s skin care regimen to the next level in order to keep them motivated and compliant when they see the visible results. If you stay at the fundamental level with skin ageing concerns you might feel frustrated. It is, however, still important to use the fundamentals and to start low and slow with active ingredients – low concentrations introduced to the skin over a slow period of time.
The ingredients at this level, include Alpha Hydroxy Acids (AHAs) which exfoliate dead cells on the surface of the skin that leads to dullness and dryness. They do this by increasing cellular turnover giving the skin a youthful glow. In clinical trials, they have been shown to increase both dermal and epidermal hyaluronic acid levels, both increasing moisture in the skin and preventing transepidermal water loss. In acne, by increasing cellular turnover, AHAs help to break up or dissolve the sticky top layer of the skin that blocks the pores which causes blackheads and whiteheads. The increased cellular turnover also helps lighten superficial pigmentation.
Natural skin lipids deplete as we get older and this coupled with environmental damage causes our skin to become dry, dull and wrinkled. Supplementing with skin-identical moisturizing ingredients like ceramides and essential fatty acids will help to keep the skin barrier functioning optimally by keeping moisture in and protecting the skin from transepidermal water loss.
Retinoids (Vitamin A) stimulate structural proteins such as collagen and elastin and encourage cell regeneration. They help to thicken the epidermis and improve the rough texture of the skin, they even out skin tone and lighten pigmentation. Both are effective in addressing signs of ageing, acne and pigmentation and although their mechanisms are different, there is an overlap in how retinols improve the quality of the skin. These ingredients will give the skin a boost and it is important to try and incorporate either one or both ingredients depending on your level of photo-damage. Once you are at this level and if your skin is in need of the ‘big guns’, then you can introduce the ingredients at the Optimize level.
Optimize (Top layer)
The top layer of the pyramid looks at cell stimulation and maintenance of the skin and incorporates special cell-communicating ingredients that target more advanced aged skin. This is the ‘nice to have’ level and makes use of growth factors and peptides which have been proven to optimize cell stimulation and cell regeneration. Our skin relies on structural proteins but as we age so cell regeneration slows down and if the cells are not stimulated they eventually die.
Peptides and growth factors both signal the skin, in a call to action. Peptides communicate instructions to stimulate the skin cells for different purposes or outcomes i.e. collagen synthesis and Growth factors stimulate biochemical pathways to promote tissue repair and cellular regeneration.
These ingredients are often found in the newer technologies and therefore tend to be more expensive. Adding this final layer to the fundamental and transformative levels of the pyramid, especially for very sun-damaged skin, makes for a comprehensive skincare routine.
Why the Pyramid is relevant today
People are increasingly seeking help to improve skin health and reverse damage to their skin due to poor lifestyle choices. Their greatest desire is to seek the right advice and to obtain information from a consistent and trusted source.
With so many products professing to reverse signs of ageing, the overwhelmed consumer is often left at the mercy of products that come with a big marketing budget and little else. Promises of the eternal fountain of youth are the main attraction but they often result in dashed hopes and expectations and a much lighter wallet.
With so many cosmeceutical products flooding the market, the different combinations of ingredients and formulations must be fully understood. It can be extremely confusing to not only the patient but also to a busy skin health professional who has to find the time to keep up with the ever-changing product market.
The goals of the Skin Health and Beauty Pyramid for patients as published in the Journal of Drugs in Dermatology April 2014 Volume 13 Issue 4:
- Educate on the deleterious effects of photo-ageing on skin health.
- Provide a hierarchical ordering of key cosmeceutical categories concerning a beneficial impact on the skin, so that appropriate usage choices can be made.
- Serve as a reference to help patients supplement or scale back on their skincare regimen as needed, without compromising essential skincare.
Reference: Published in the Journal of Drugs in Dermatology April 2014 Volume 13 Issue 4: The Skin Health and Beauty Pyramid: A Clinically Based Guide to Selecting Topical Skincare Products.
