Dr Rachael Eckel looks at the nuances of treating male skin with cosmeceuticals
The male population seeking cosmetic improvement is swiftly growing. From 2000 to 2005, there was an overwhelming 44% increase in minimally invasive cosmetic procedures among males, according to the American Society of Plastic Surgeons.1 Similar to women, men hope to display an attractive, vibrant, and healthy outward appearance lending to improved self-confidence.2 There are, however, pivotal differences in expectations, motivations and decision-making. Men want a minimalistic approach and are intolerant of delayed downtime.2 Their decisions are made rapidly and centred less upon youthfulness and more upon increasing attractiveness and marketability in the workplace.1,2 It is important for clinicians to identify the discrete nuances when caring for male patients, which are both anatomical and psychological. Topical agents that are recommended should respect these biological differences, remaining simple yet effective. With a male skincare market worth £25 million in 2012 and growing 4% year on year, this is a demographic that necessitates attention (Table 1).3
Table 1: UK prestige skincare category value growth3
Cutaneous gender differences are extensive, primarily mediated by sex hormones.4 In men, the surge in androgens affects many functions of human skin and its appendages. The impact of testosterone on the sebaceous glands means that male skin is markedly oilier.5 Excess sebum clogs pores leading to blackheads and patulous follicles. Such textural irregularities are particularly prominent over the facial convexities where oil glands cluster. Seborrhoeic eczema is a common consequence classically observed peri-nasally and over the eyebrows.6 Male skin, both epidermis and dermis, is typically 20-30% thicker than that of females.4 This remains true for all ages with extent varying upon anatomical region.4 Similarly, vascularity and skeletal muscle mass are more pronounced. The comparative lack of subcutaneous adipose tissue, irrespective of age, gives a more defined, chiselled appearance to the male facial structure.4 Hormonal influences also affect the distribution of male hair. When present, it offers continuous photoprotection and maintains youthfulness. Conversely, when hair is absent, especially over locations such as the scalp and ears, the risk of developing skin cancer increases considerably.7 This is further compounded by these regions being difficult to self-examine, encouraging late presentations of advanced disease. The habits associated with male grooming (and specifically shaving) can lead to disease such as pseudofolliculitis barbae, which reaches an alarming 85% prevalence amongst males of African descent.8 Excess facial hair also permits an increased surface area for bacterial colonization. This may explain why acne presents more severely amongst males. A 2009 study published in Perception identified a noteworthy difference in skin contrast between genders.9 Regardless of race, female faces have lighter skin when compared to males; hence ‘the fairer sex’. The colour intensity of female eyes and lips however, match those of males, providing a more striking contrast to their lighter surrounding skin. Such juxtaposition influences our perception of the facial gender. This is the reasoning behind females applying makeup; to exaggerate sexually dimorphic attributes, making the face appear womanlier.9 Anatomical differences between sexes also result in ageing disparities. Men show fewer but deeper rhytids when they lose subcutaneous adipose with age.4 This is because of their thicker skin and prominent facial musculature. Conversely, females have more numerous and superficial expression lines, especially in the perioral region.4
There is a relative lack of male-specific studies in aesthetics. But clinical practice and market research strongly suggest that a gender specific stratagem is imperative. The male approach to dermatology and aesthetics tends to be reactive rather than proactive. Men are less concerned with anti-ageing, and present to clinicians with a specific problem, for example, rosacea.Dermatoses tend to be advanced and require numerous ancillary procedures to effectively remedy because of the late presentation. Behaviourally, I find men to be more passive dermatologic patients; they ask fewer questions and are less likely to highlight their concerns. Furthermore, their knowledge about skincare is often misguided and their daily topical regime reflects this disservice. This is particularly compelling with regards to their lack of photoprotection, which lends to men having remarkably higher rates of all types of skin cancer compared with women.7
Skincare in Execution
When men describe the skin they hope to achieve, they use adjectives such as clean, fresh, vibrant, clear and smooth. On a cellular level this translates into homogenous melanin distribution, effective keratinocyte turnover, ample collagen and elastin output, absence of active disease, natural hydration and intact barrier function. This, by definition, is healthy skin where all cutaneous cells are functioning optimally.5 The favoured male approach to achieving such holistic outcome is minimalistic.
A regime with few steps and maximal gains will yield the greatest compliance. Remembering that the male client is unlikely to be using an elaborate protocol already, initial topicals selected should focus on providing skincare fundamentals. This includes the removal of sebum and debris, enhancing keratinocyte exfoliation, repairing the barrier function, controlling inflammation and protecting against UV damage. These may be easily achieved by following five practical steps.
The following three daily steps are indispensible. Together they form the pillars for maintaining pilosebacious health through oil reduction, enhanced cellular exfoliation, and inflammation suppression. The skin’s delicate lipid bilayer that contributes to barrier function must be simultaneously respected and restored by selecting balanced formulations.
A comprehensive topical agent containing antioxidants, DNA repair enzymes and barrier replenishing agents should be applied to the skin daily. The reasoning for this is as follows:
Daily application of a broad-spectrum sunscreen with an SPF value of 30 or greater is advocated. A comprehensive formulation suited to the skin type and colour should be selected. Physical blocks (e.g. titanium dioxide, zinc oxide) are superior to their chemical counterparts because they are less irritating and last twice as long. Fractionated melanin is a novel ingredient to look for in sunscreen, providing 10 hours of continued protection against High Energy Visible (HEV) rays, which can be more injurious and penetrate deeper than UVA.
The most popular product purchased by men in the UK is a shaving lubricant.3 If facial grooming involves shaving, this should follow the exfoliating scrub step. It is ideal for the chosen product to be free from fragrance and colour to minimise irritation. The latter will also benefit patients with ‘designer beards’, permitting more precise grooming. Formulations replete with antioxidants (e.g. vitamin E) and anti-irritants (e.g. niacinamide) are particularly appealing to concurrently soothe the skin. The incorporation of physiologically relevant lipids (e.g. glycerin, mannitol) will preserve the delicate barrier function and mitigate the mechanical damage caused by razors.
Once the male has integrated these five basic steps successfully into their habitual daily practice, other topical agents can be supplemented to augment the regime efficacy. These should be introduced incrementally (e.g. every six weeks, one skin cell cycle) to capitalise on compliance. The following ingredients represent the most appropriate additions to consider:
Interestingly, geographic location has an impact on product selection and grooming attitude. Within the UK, men in London, the North West, Yorkshire/North East/Borders and Ulster display a more sophisticated outlook to skincare.3 In particular, London males are early adopters, and are more likely to purchase luxury items.3 With this in mind, the clinician may choose to adapt their recommendations to suit the cultural climate. Likewise, when cutaneous disease is present causing disfigurement and distress, the incremental approach may be dismissed. In such circumstances, male patients are keen to rapidly inactivate the condition and dedicate more time to skincare.
More lengthily regimes may instead be appropriate at the therapeutic onset, and reduced for maintenance.
The male market seeking cosmetic improvement is growing sizably and with this follows increased questions about skincare. In order to successfully treat this cohort, clinicians must remain aware of the existing anatomical and psychological nuances. Consultations should focus on education and this is especially critical in relation to the male skin cancer epidemic. To drive compliance, initial regimes must be minimalistic, focusing on fundamental skin health principles. These can be further supplemented incrementally to augment the programme efficacy whilst nurturing a habit. Topical agents selected should contain active ingredients that are science based with proven results. A holistic approach is advocated to achieve maximal skin health by restoring, protecting, and strengthening all cellular functions.