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Demystifying the Science of Corneotherapy

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As an educator in aesthetics and a practicing corneotherapist, one of the questions I get asked the most is: What is corneotherapy?

It suffices to say that corneotherapy is not your mainstream skincare approach, and even our industry does not understand this science all too well because it seems almost too simple to be true. 

Where did corneotherapy come from?

The “father of corneotherapy,” professor Albert Montgomery Kligman, is an American dermatologist, perhaps better known as the co-inventor of Retin-A. 

Late in the 1960s, Kligman and his associates demonstrated that one could achieve substantial clinic effects by treating the disrupted barrier of the skin through repeated application of substances that had humectant and emollient properties. When these substances were blended into creams, they became known as ‘moisturizers’ and were perhaps one of the most important cosmetic discoveries of the 20th century. Repeated application of these moisturizers improved common cornification and skin barrier disorders, such as atopic dermatitis.

Corneotherapy has become known as an innovative and progressive skin treatment approach that has proven that healthy skin with an optimally functioning innate immune system can be achieved by preventing or reducing structural inflammation of the skin. It is accomplished by using preventative interventions targeted at the correction and the restoration of the stratum corneum and barrier defense systems. What this approach does is lead the skin to homeostasis and the improved function of the entire protective layer, thus protecting against harmful microorganisms and substances, all while keeping the epidermis intact at all times. 

How do I know if I need corneotherapy?

Corneotherapy uses skincare and treatment approaches that are directed to correcting and building crucial skin barrier defenses that have become defective or impaired by reasons such as disease and intrinsic (hereditary) or extrinsic (lifestyle) factors. 

Corneotherapy is the individualized skincare and clinal treatment approach of the future and is always adapted to the specific needs of the individual’s skin. It is the primary preventative measure against skin aging conditions, skin barrier disorders, and cornification disorders, including, but not limited to: 

  • Essential fatty acid deficiency
  • Xerosis (abnormally dry skin)
  • Ichthyosis (thick, dry skin)
  • Eczema

At the time of Kligman’s research in the 1960s, corneotherapy did not garner much attention in the pharmaceutical or cosmetic industry. It was not until his article “Evidence-Based Corneotherapy” by Jann Lübbe was published in Dermatology in 2000 that more attention was sparked in this field of cosmetic science. 

Kligman spoke of an “outside-in therapy,” in contrast to treating skin with pharmaceutically active agents such as steroids or typical inflammation inhibitors that have an “inside-out therapy” and first must penetrate the stratum corneum (also known as the horny layer) to become effective.

Corneotherapy may offer effects like a medical drug. More recently, skin-caring active substances have increasingly become the focus of attention for the treatment of barrier and cornification disorders. This includes natural substances like ceramides, proteins, and their synthetically produced analogous substances like peptides. This makes up part of this physiological concept of corneotherapy.

Corneotherapy broken down:

Skincare professionals who follow this methodology have an integrated understanding of the keratinocyte life cycle. The keratinocyte is the king of skin cells and undergoes a keratinization process to transform into a corneocyte and ultimately shed in a never-ending renewal process. It is when this process compromised or impaired that the immune system can be compromised. 

The keratinocyte communicates with other cells in the skin, such as: 

  • The fibroblast – responsible for collagen and elastin production
  • The melanocyte – responsible for producing pigmentation

However, the other cells of the epidermis only communicate back to the keratinocyte and not among each other. 

For this reason, much emphasis is placed on the keratinocyte, and its integrity is protected at all times. 

What to expect when receiving this treatment:

A practicing corneotherapist is a skincare professional who follows the principle of maintaining or repairing the skin’s integrity. 

The treatment and skincare journey starts by nurturing the skin and ensuring the skin is balanced with the necessary components, allowing the skin to function optimally. It is only after this step that corrective measures are taken and treatment modalities chosen that are non-ablative (not destructive to the skin barrier). 

It’s not the first option skincare professionals choose, but if more invasive measures are necessary, they are always supported by adequate pre- and post-care protocols that aim at restoring the skin. 

As for product lines considered corneotherapeutic, they must adhere to guidelines set by the International Association for Applied Corneotherapy. 

The composition of good skincare includes the following components:

  • Water
  • Moisturizers (commonly referred to as humectants or lipids, which are also known as emollients)
  • Auxiliary substances (stabilizers)
  • Active agents

Effective skincare formulations should be able to restore skin barrier function. In addition, effective treatments and homecare protocols should improve corneocyte compaction. These formulations also carry a bio-affinity if considered truly conrneotherapeutic.

What a corneotherapeutic formulation should contain:

The components that are critical to skin barrier functions include free fatty acids, ceramides, and cholesterol. 

Skin Barrier Lamellae >> Desired bio-mimicking components in a product

  • Triglycerides >> Triglycerides (from palm oil) 
  • Squalene >> Squalane (from olives) 
  • Ceramides >> Ceramides (from yeast) 
  • Cholesterol >> Phytosterols (from shea butter) 
  • Phospholipids (e.g. Phosphatidylcholine) >> Phosphatidylcholine [PC-H] (from soybean)
  • Fatty acids >> Fatty acids, released from PC 
  • Natural Moisturising Factor (NMF) >> Moisturizer

What a corneotherapeutic does NOT contain: 

  • Preservatives
    • While many preservatives are authorized for use in cosmetic formulations, they are also known to create negative consequences for persons with chronic skin-barrier challenges. As the percentage of individuals with dry skin is steadily increasing, it’s no wonder that the allergy rate rises to the same degree. 
    • Furthermore, there are alternatives available that are kinder to the skin and/or carry a bio-affinity with the skin. Unfortunately, they are not commonly used, as the cost is much higher. In corneotherapy, however, these more expensive options are the desired choice.                              
  • Emulsifiers                                                        
    • They are free from emulsifiers that cannot be degraded in the skin. They cause a wash-out of natural protective substances of the skin during skin cleansing. Exceptions are rinse-off products such as skin-cleansing products.
    • They are also free from emulsifiers that are incompatible with the skin barrier or do not correspond to the physiology of the skin.
    • They are free from surface-active substances that feel pleasant on the skin despite a disordered skin barrier. Example: representatives of re-fattening substances in skin- cleansing products (PEGs, silicones).
  • Fragrances
    • A significant skin sensitizer.
  • Colorants
    • A known skin sensitizer for compromised skin.
  • Mineral Oil and Silicones
    • No strong bio affinity with the skin and long-term use has adverse effects such as dehydration.
  • Silicones
    • No strong bio affinity with the skin and long-term use has adverse effects such as dehydration.
  • Amines
    • Amines are auxiliary substances that neutralize anionic emulsifiers or adjust the pH, and they can form carcinogenic nitrosamines. They are, therefore, not used in corneotherapeutic products.
    • One exception is amino acids which belong to the natural moisturizing factor (NMF). They moisturize the skin and can protect the skin against atmospheric radicals.                 

Where to go from here:

Corneotherapy has seen an increase in popularity particularly over the last decade. Sadly, this popularity came after the passing of Kligman. He died of a heart attack in 2010 at the age of 93. 

Today, those who follow this approach to skin see a move toward giving the skin what it requires for lunch, using ingredients with a natural affinity to the skin barrier lamellae and replacing nutrients diminished by lifestyle and modern living factors such: 

  • Pollutants
  • Free radicals
  • Increased ultra-violet rays caused by the gap in the ozone layer

It resembles the move we are witnessing in the food industry of going back to eating real food. For example, people following diets like paleo, high fat low carb, and those moving to growing vegetables again and seeking free-range options of sources where no additives are fed to food sources like cows or chickens. 

The opportunity in this is that we are by no means sacrificing any scientific advances in ingredients or technology that help obtain the goals of healthy skin. Rather, the corneotherapy approach is where beauty meets science for sustainable skin health. 

About The Author
René Serbon

René is an international skin expert passionate about corneotherapy. After creating her own business around this groundbreaking form of skincare, René began helping solo estheticians and clinic owners scale their business and generate long-term clients