BASIS Medical Technologies 2012 1

BASIS Skin Care Training

Skin Care Training 2011A.J. Lloyd

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Normal Skin

• Body’s largest organ with 4 important functions– Protection

• UV, chemicals, microbials

– Sensation• receptors for touch, pain, pressure and temperature

– Thermoregulation• Hairs and adipose tissue prevents heat loss/hypothermia• Sweat glands and vascular blood supply prevent hyperthermia

– Metabolic function• Adipose tissue in subcutaneous layers provides energy supply• Vitamin D synthesized in epidermis for calcium regulation

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Skin Structure EP

IDER

MIS

DER

MIS

SUBCUTAENOUS

• Protects vs. UV, microbes, chemical agents, trauma

• Prevents water evaporation/absorption (TEWL)

• Performs biochemical synthesis• Communicates with environment

• Supports/connects epidermis Regulates Heat

• Performs wound healing• Papillary & Reticular layers

• Cushions/absorbs impact• Retains heat• Excretes waste• Stores fuel molecules

• Dryness• Roughness• Pigmentation• Skin Cancer

• Enlarged Pores• Inflammation• Compromised Immunity

• Wrinkles• Sagging

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The Epidermis

STRATUM CORNEUM

STRATUM LUCIDIUM

GRANULAR LAYER

SPINEY LAYER

BASAL LAYER

• 14 layers (depth of a human hair)• Corneocytes and Lipids• Forms Barrier

• 3-5 layers• Callusing (palms/soles)

• 4-5 layers• Lipid granules & Langerhans cells

• Several layers• Lipid granules & Langerhans cells• Has “spines” for cellular adhesion• Early keratin production site

• 1 layer• Produces keratinocytes• Melanocytes

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The Dermis

PAPILLARY

RECTICULAR

• Composed of collagen Type 1 (80% in skin) and elastin

• High tensile strength “snap back”• Locale for sagging

• Composed of thinner, more elastic, more densely packed Collagen Type III

• Gives skin shape• Locale for wrinkles

COLLAGENS are fibrous, structural proteins produced by FIBROBLASTS and made up of amino acids proline and lysine.

There are over 14 types of COLLAGEN in the human body. BASIS Medical Technologies 2012

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Important Skin Appendages

• Hair follicles– Located in dermal layer– Produce hair– Role in touch sensation and thermoregulation

• Sweat Glands – Role in thermoregulation

• Sebaceous Glands– Associated with hair follicles – Secrete sebum– Role in waterproofing and moisturisation

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Important Cell TypesCELL LOCATION FUNCTION EFFECT

Corneocytes Stratum Corneum Form barrier Prevent & protect

Langerhans Granular Layers Trigger immune responses Protect against infection and disease

Keratinocyte

Formed in basal layer & migrate to SC where

they become Corneocytes (95% of

cells in epidermis)

Produce lipids, enzymes and hormones, including keratin

Implicated in wound healing, UV protection,

immunity, structure

Melanocytes Basal layer Produce pigment Give skin it’s colour, help protect vs. UV

Fibroblasts Dermal LayerSynthesizes collagen, elastin,

collagenase, elastinase, GAGs and MMPs

Formation and function are critical to the healthy, youthful appearance of

skin

Adipocytes Dermis/Hypodermis Stores and metabolizes fat Provides energy

Macrophages DermisWhite blood cells that eat

foreign bodies and old tissue products

Clean up debris from inflammation & infection

for immunity

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Extracellular Matrix (ECM)• Gives skin its turgor• Reservoir of growth factors that affect cell proliferation and production• Destination for cell adhesion: cells migrate through and proliferate in it• Contains macro and micro molecules

Fibrous structural proteins

Adhesive Glycoproteins

Proteoglycans and Hyaluronan

Matricellular Proteins

Collagen Fibronectin SPARC

Elastin Laminin Thrombospondins

Fibrillin Integrins Osteopontin

Elastic Fibres Transmembrane Glycoproteins

Tenacin family members

Collagen

Collagen is thought to degrade, losing its turgor, adhesion and causing the skin to thin and appear to sag

• Produced by Fibroblasts• Triple helix of 3 polypeptide

alpha chains• High tensile strength• Among strongest proteins in

nature

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CollagenType Characteristics Location

I High tensile strength 80% skin, 90% bone, tendons & other organs

II Thin fibrils 50% cartilage

III Thin fibrils- pliable Blood vessels, uterus, skin (10%)

IV Amorphous (non fibrillar) Basement membranes

V Amorphous/fine fibrils Interstitial tissue (5%) blood vessels

VI Amorphous filaments Interstitial tissue

VII Anchoring filaments Dermal-epidermal junction

VIII Amorphous Endothelium

IX Role in maturation of cartilage Cartilage

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Elastin, Fibrillin & Elastic Fibres• Elastin is also produced by Fibroblasts as

tropoelastin• Elastic fibers found in skin, blood vessels & uterus• Ability to stretch to several times their length and

return to normal

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Elastin, Fibrillin & Elastic Fibres

• Fibronectin: large glycoprotein produced by fibroblasts and other cells– Directly involved in attachment, spreading & migration through ECM

• Laminin: most abundant glycoprotein– Mediates attachment to connective tissue– -defects manifest in dystrophy

• Integrins: cell surface receptors that mediate cellular attachment to ECM• Proteoglycans: core protein linked to GAGs.

– Regulates connective tissue structure, cell growth & differentiation• Hyaluronan: macromolecule found in ECM

– Can bind to large amounts of water to form viscous, hydrating gel that gives connective tissue turgor, resilience and lubrication

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SPARC, Secreted Protein Acid and Rich in Cystein, Thrombospondins, Osteopontin and Tenacin

• Proteins that interact with:– ECM– Cell Surface Receptors– Growth Factors– Proteases

• Do not have a structural component• Vital role in collagen binding• Activates MMPs• Contribute to tissue remodeling

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MMPs• Matrix Metallproteinases (MMPs)– Family of protein degrading enzymes activated by

presence of surrounding enzymes– Cleave most constituents of ECM– Involved in normal biological processes and pathological:

• Inflammation• Angiogenesis• Embryonic development• Wound Healing• Cancer• Tissue destruction

– Act as regulatory molecules

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Biochemical Compounds• Cytokines

– Small proteins released form cells– Stimulate and regulate cell growth, development &

communication• Growth Factors (GFs): small proteins important to cellular

growth, proliferation & differentiation• TGB-B1 (Transforming Growth Factor-Beta 1)

– Angiogenic and fibroblastic growth factor believed to inhibit endothelial proliferation leading to cell death during angiogenesis and wound healing

– Causes fibroblasts to mitigate and proliferate to produce Type I and III collagen

• Interleukins: expressed by white blood cells to regulate inflammation and immunity by promoting growth and development of other white blood cells

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Fitzpatrick Skin TypesSkin Type Characteristics UV Exposure

I Pale white skin, blue/hazel eyes, blond/red hair

Always burns, does not tan

II Fair skin, blue eyes Burns easily, tans poorly

III Darker white skin Tans after initial burn

IV Light brown skin Burns minimally, tans easily

V Brown skin Rarely burns, tans darkly, easily

VI Dark brown or black skin Never burns, always tans darkly

In addition to UV tolerance, Fitzpatrick types may vary in terms of how they respond to injury (including pigment and

scar formation) and visible aging processes.

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Sales Tools OverviewPhysician Awareness Clinical PR Patient Awareness

Biretix • Studies• BASIS Website/Brochure • DTC Website

Endocare • Sell Sheet • Studies• Protocols

• DTC Website• Pending PR efforts

Lumixyl• Sell Sheet• Trade Media

Editorials• Lumixyl.net/.ca

• Studies• Protocols • Media Pics • Lumixyl.net/.ca

Revitaleyes • Sell Sheet • Lumixyl Studies • Lumixyl sites

Strataderm • Brochure• Studies• Guide to

Studies• Case Studies

• Pending PR Efforts

• Website/Social Media

Stratamed • Brochure• Studies• Guide to

Studies• Case Studies

• Pending Ferndale Trade marketing

Stratmark • Pending Brochure • Study Protocol • Pending PR Efforts• DTC Website