Critical Analysis of Make-Up Formulations for Vitiligo Skins

Laboratório de Pesquisa, Tecnologia em Cosméticos, FATEC Diadema “Luigi Papaiz”, CEP 09931-390 Diadema, SP, Brazil *Corresponding author: Carla Aparecida Pedriali Moraes, Laboratório de Pesquisa, Tecnologia em Cosméticos, FATEC Diadema “Luigi Papaiz”, CEP 09931-390 Diadema, SP, Brazil, Tel: +55-(011)-4092-2328; E-mail: [email protected].  Received: December 22, 2019 Published: August 07, 2020

ABSTRACT Vitiligo is a disease prevalent in one to two percent of the global population. It is characterized by non-pigmented blotches dispersed throughout the skin and can affect individuals of both genders and all age groups. Vitiligo affects only skin appearance; it is a non-transmissible disease and causes no further harm to the skin. There are several methods designed to treat and improve skin appearance; “camouflage” products are widely used to mask skin blotches. These products are of opaque color and are capable of covering a great extension of skin. The aim of this work was to critically analyze market products designed to treat vitiligo, describing and comparing their compositions to the ideal parameters described in scientific literature. Products of similar compositions and same key ingredients albeit with a huge price difference were identified; the price discrepancy is usually justified by the use of unusual active compounds. It is concluded that products aimed at treating vitiligo should be better and further explored in Brazil, evidencing there is market demand for such products. Also, the formulations of such products vary in composition.

Keywords: Vitiligo; Camouflage; Skin; Make-up INTRODUCTION Vitiligo is a depigmentation skin disorder; skin melanocytes, the cells responsible for the production of melanin, the pigment which confers color to the skin, undergo cell death [1-3]. Among skin diseases worldwide, vitiligo is the most prevalent, affecting 1 to 2% of the global population [2]. The disease affects a great portion of the young population; the first signs appear before they reach to 20 year of age. Children, individuals from all races, and both genders could affect equally [3,4]. It is still unknown the real cause for the disease, but there are several hypotheses which suggest the melanocytes of the patients are destroyed somehow. Other theories suggest autoimmune mechanisms, redox imbalances, genetic background oxidative stress, neural disorders and even influence from other autoimmune diseases such as diabetes and alopecia play a role on the development of vitiligo [5-8]. As there are several possible causes for the disease, it is difficult to find a proper treatment for it, even less likely a cure. As the disease develops, the patients reach out for different therapies in order to combat it, not because it harms their health, but because it damages their self-esteem by drastically affecting their appearance [8-10]. There are studies which have investigated the social and psychological effects of this disease, usually linked to low self-esteem and depression. There are some therapies which attenuate the development of skin blotches, such as the use of ultraviolet light, topical application of creams and corticoid drugs, depigmenting treatments and even the acquiring of permanent tattoos [10-13]. Cosmetic skin camouflage is efficient in improving overall satisfaction and self-esteem of vitiligo patients. Studies carried out assessing DLQI (Dermatological Life Quality Index) evidenced improvements in patient life after the use of cosmetic camouflage [13]. Vitiligo patients went through explanatory classes and made use of cosmetic camouflage for a month; DLQI improved from 5.90 to 4.48 (the lower the value, the lesser the impact on life quality of the individual) [9,13,14]. Camouflage in a general context means “hiding something”. The use of cosmetic camouflage started during World War II and continues till today. It was actually first used by individuals who are suffering from vitiligo [15]. Cosmetic camouflage of vitiligo blotches involves usually make-up, such as bases and other products designed with certain characteristics, which include color, opacity, long duration, being waterproof and resistant to sweat, having good adherence to skin, ease of application and removal, allergenicity, photosensitization and finally a viable cost [15,16]. The main aim of this work was to analyze and compare commonly commercialized make-up products designed to treat vitiligo, describing their composition according to ideal parameters for these products reported in scientific literature and also evidencing properties and functions of each product which stand out in comparison to other products. MATERIALS AND METHODS This work is a bibliographical review which was carried out using Google Scholar and Scielo platforms to look for studies in national and international scientific literature. The following key-words were used: camouflage, vitiligo, make-up, skin, raw materials, and cosmetics. These keywords were searched for in Portuguese, Spanish and English. Discussion and results were based on the products from eight brands which commercialize products designed to work as cosmetic camouflage to treat vitiligo. The brands chosen were the largest available in the world market which commercialize products for vitiligo that could be obtained in Brazil. Analysis consists of comparison between products, assessing their characteristics, formulation composition and market appeal. For such, key ingredients were assessed: consistency agents, emollients, sensorial modifiers, covering agents and active compounds. The choice of key ingredients relied upon the observation of ideal properties for these products. The research was comprised from 2010 to 2019. RESULTS AND DISCUSSION Camouflage make-up is developed differently from traditional make-up, as it is designed to neutralize or hide skin disorders. Some properties are important for the make-up to work as intended: (a) maintaining natural and opaque appearance; (b) not being transferable to clothes; (c) being water, sweat and heatproof; (d) being of long duration; (e) free of odors; (f) non-comedogenic; (g) being non-sensitizing; (h) having a wide range of available colors in order to appeal to all races and ethnicities; (i) good covering capabilities; (j) non-occlusive [15,17] The most common formulations for camouflage make-up include correctives and cream bases used in emulsions [17]. Such emulsions can be classified regarding the phases which compose them: water in oil (W/O), oil in water (O/W) or water in silicone (W/Si). W/O emulsions contain a greater amount of oil compounds and can suspend the pigments used in make-ups. O/W emulsions contain a greater amount of water content and are generally more fluid. W/Si emulsions have silicon as the external phase, and thus their sensorial properties are more pleasant; they also dry faster and can be more efficient in oily skins [16,17]. Beyond emulsions, anhydrous bases can be used in order for better waterproof products to be obtained. Several oily materials are incorporated into these bases such as silicon, mineral oil, vegetal oil, animal oil, fatty acids, fatty alcohols and synthetic esters associated with waxes of different melting points; the aim for the use of these compounds is improvement of texture and cream viscosity. High concentrations of pigments can be added to these formulations in order to properly cover skin blotches [18,19]. In liquid base formulations, the concentration of pigments varies from 25 to 50%, and in pasty formulations this concentration can increase to up to 60%. The most commonly used pigments are inorganic, obtained from minerals such as titanium dioxide and iron oxides. Beyond these, synthetic dyes can also be used, but are done so to a lesser extent in comparison to natural pigments [18,19]. As the technology is much advanced, pigments with specific characteristics were developed. These pigments can facilitate dispersion, make the formulation more pleasant to touch and generally feel more natural. Some pigments can also have optic diffusion effects, widely used to attenuate skin accidents [19,20]. There is a great range of make-up brands spread worldwide. Among these few are Lóreal (also responsible for the make-up brands Vichy and Lancome), Esteé Lauder (owner of MAC and Clinique), Shiseido (owner of Bareminerals, Laura Mercier and Nars) [21]. Thus, eight products designed for vitiligo camouflaging from different market brands were chosen and analyzed, as shown in table 1.