All About Corneotherapy, and Why It’s Gaining Popularity

Being in the professional esthetic industry for over twenty years, I have witnessed many trends come and go – some harmless, some not entirely, and some just leaving me speechless. With that said, I’m happy to say that the current trend in skincare is oriented toward skin health - a much-needed break from constantly peeling, over-exfoliating, and overtreating the skin. Although still not enough people apply broad-spectrum sunscreen on a regular basis, there is now more awareness of the dangers of tanning beds and their link to skin cancer. Today’s consumers are less focused on gimmicky fragrances and opulent packaging and more educated than ever on the active ingredients in their products. Increasingly more skincare brands are shifting their philosophy toward healthy skin aging and a dewy, glowing skin that needs minimal makeup.

More estheticians and dermatologists than ever are embracing a gentler, less aggressive, and invasive approach to skin health, and their clients are thriving. Chronic conditions caused by both intrinsic and extrinsic factors, such as eczema and dermatitis, are alleviated, and confidence is restored. This healing approach to skin health is the basis of corneotherapy – a remedial skin treatment methodology with its core principle being the repair and maintenance of the skin barrier defense systems. The principles of corneotherapy may be applied for the prevention of premature skin aging, as well as to restore homeostasis and improve the function of the skin. Since a disrupted skin barrier leads to inflammation and trans-epidermal water loss (TEWL), corneotherapy’s three main pillars are “Replenish, Repair and Regenerate”.

As the name suggests, corneotherapy centers around the stratum corneum - the outermost layer of the epidermis, which serves as the body's first barrier from the external environment. It exists to protect the inner layers of skin and is primarily made up of corneocytes – compacted, flattened, dead skin cells that have lost their nucleus and most cellular organelles, making them non-viable. The corneocytes are closely packed and bound together by a matrix of lipid bilayers, forming a protective barrier on the surface of the skin. Most areas of the stratum corneum are about 15- 20 layers of cells thick. As corneocytes move to the outermost layer of the stratum corneum, they become progressively more flattened and densely packed with keratin, contributing to the skin's protective function.

There are several cell layers in the epidermis - stratum basale, stratum spinosum, stratum granulosum, stratum lucidum and stratum corneum. Without the stratum corneum, the acid mantle, and the multilamellar lipids, the epidermis and dermis would be exposed to allergens, germs, pollution, and environmental stressors.

Corneotherapy places a strong emphasis on the importance of the skin barrier since a healthy skin barrier is crucial for protecting the skin from external environmental factors, preventing TEWL, and maintaining a thriving microbiome and overall skin health.

The first pillar – repair, is centered around healing the barrier with therapeutic actions working from the outer layers of the epidermis inward, avoiding unnecessary stimulation. Maintaining the skin's pH balance is essential in corneotherapy. The acid mantle has a slightly acidic pH (typically around 4 - 5.5), which helps protect against pathogens and maintains the barrier function. Corneotherapists often recommend skincare products that are pH-balanced to support this acidic environment.

Harsh skincare ingredients and protocols that may disrupt the skin's barrier, such as aggressive exfoliation, using strong acids, not using sun protection, and washing the face with hot water are discouraged. Instead, anti-inflammatory ingredients and a gentle and non-irritating approach to skincare are preferred.

Replenishing the skin is the next step. Vital nutrients may be supplied both topically and through internal supplementation to create a resilient and viable cell membrane, with active and passive transfer of oxygen, hormones, nutrients, and waste elimination.

Proper moisturization is essential in corneotherapy. hydrating the skin helps to maintain its elasticity and suppleness, which are crucial aspects of a healthy skin barrier. Lipid-rich skincare products may serve to replenish the lipids in the stratum corneum. Even though there are cleansing products with foaming and lipid-rich properties, products free of re-fattening agents will take better care of the skin and are generally better tolerated by sensitive skin. Lipids should be avoided in formulations for perioral dermatitis, but small doses are allowed for treating rosacea. Artificial fragrances and dyes in daily skincare products should ideally be avoided.

Regeneration is the process once repair and replenishment have been achieved. After the healing work has been completed, we may start moving down to the dermis to start addressing skin laxity and rebuilding collagen. It's important to note that while corneotherapy may support collagen preservation and overall skin health, the direct stimulation of collagen production often requires specific treatments and ingredients, such as retinoids, Vitamin C, peptides, amino acids, and growth factors, which may not be the primary focus of corneotherapy.

Corneotherapy is not just about addressing immediate skin concerns but also about promoting long-term skin health and preventing future issues, so a comprehensive and consistent routine should be established. Through the promotion of balanced pH levels, gentle skincare practices, lipid barrier repair, and personalized treatments, corneotherapy empowers individuals to achieve and maintain healthy, resilient skin. 

As we continue to delve deeper into the complexities of skincare science, corneotherapy serves as a reminder that the key to achieving a balanced and supple integument doesn’t lie in aggressive interventions but in the gentle care and preservation of our skin's natural protective shield.