Some comments about Skin Conditions

Skin conditions are defined as an abnormal appearance, texture or coloring of the skin. The causes include both intrinsic and extrinsic factors that affect the skin.

The intrinsic factors include:
Free radicals, dehydration, vitamin deficiency, hormones/menopause, smoking, improper nutrition, alcohol, caffeine, lack of sleep, stress, response from some medications or the symptom of an inflammatory response.

The extrinsic factors include:
Sun damage, environmental exposure, pollutants, humidity, poor skin care and misuse of skin care products. Also allergies, genetics/ethnicity, and medical conditions such as, heart conditions, diabetes, lupus, and pregnancy are considered extrinsic factors.

Skin Conditions

Being able to distinguish between a skin type and a skin condition is necessary in providing a facial treatment. Making this an important point in their education is the International Dermal Institute, which offers postgraduate education in skin and body therapy, www.dermalinstitute.com . As part of their education, five skin conditions are presented enabling the skin therapist to effectively identify and help to correct with the use of Dermalogica products for treatment. These conditions are the following:

• Dehydrated
• Sensitized
• Pigmentation
• Aging/Premature
• Congested/Breakouts

The most common skin condition is adult acne.

The following skin conditions are also of concern and are seen most often by estheticians:

• Milia: whiteheads filled with oil and dead skin cells beneath the surface of the skin.
• Erythema: redness caused by inflammation.
• Keratosis: a rough hardened texture resulting from a build-up of cells.
• Seborrhea: oiliness of the skin caused by over production of the sebaceous glands.
• Telangiectasias: dilated blood vessels particularly common on the nose resulting from weakening of capillary walls, sun exposure, rosacea, alcohol consumption, pregnancy, and birth control pills.
• Hyperpigmentation: brown discoloration in irregular patches.
• Hypopigmentation: white discoloration in irregular patches.
• Rosacea: characterized by redness confined to central part of the face; papules and pustules, swelling of the nose, and spider veins.
• Asphyxiated: a dull, sallow, yellowish color skin with clogged pores and wrinkles common with smokers.
• Wrinkles/aging: deeper facial lines and signs of sun damage; poor elasticity.

African American Skin
Certain skin conditions are more common among African Americans:

• Post-inflammatory hyperpigmentation - area of skin darkens after a cut/scrape or in cases of acne.
• Vitiligo - pigment cells are destroyed resulting in irregular white spots or patches on the skin.
• Keloid scars – develop when a raised scar spreads beyond the size of the original wound.

Overall, improving your knowledge of skin conditions and understanding what can affect the skin, better prepares you for treating your client and helping them cope with their concerns.

What's the skinny on skin types?

Skin type is determined by genetics and ethnicity. The amount of oil secretion in the skin is a key factor for defining a skin type. The cosmetic giant Helena Rubenstein was the first to divide skin into four categories: Normal, Combination, Dry and Sensitive.

The distinction regarding skin type is whether or not you have excessive oil production. This factor determines if you can use products that contain oil. Today, licensed estheticians and skin therapists work with these five skin types:

• Dry skin: Feels dry and tight, has a dull color, small tight pores, texture can be rough, spots of flakes, and prone to wrinkles. This skin type does not produce enough oil.

• Normal skin: Feels soft, moist, and plump. Free of blemishes, normal pore size, and has a healthy color. Little or no wrinkles or fine lines. This skin type has a good oil balance.

• Combination skin: Feels a little dryer or oilier a short time after cleansing. Forehead, nose and chin, (T zone area) is oilier with larger pores in this area. The outer areas of the face can be dry. This skin type has oily and dry areas at the same time.

• Oily skin: Feels greasy, looks shiny, and pore size is larger over most of face. Skin texture is course with comedones and possible breakouts. Little wrinkling is present. This skin type has excessive oil production.

• Sensitive skin: Feels delicate, thin, and blood capillaries can be visible. Erythema (redness) is present. Vulnerable to skin reactions. Easily irritated through friction, or heat. This skin type has areas of dry or areas of balanced oil production.

The advanced field of dermatology has emerged with a broader range of skin differences. Dr. Leslie Baumann, author of The Skin Type Solution, and Director of Cosmetic Dermatology at the Miller School of Medicine identified sixteen skin types, http://www.drbaumann.com/. The Baumann Skin Typing System (BSTS) measures four factors for typing your skin:

• oily vs. dry
• sensitive vs. resistant
• pigmented vs. non-pigmented, and
• wrinkled vs. tight.

BSTS reports four very different subtypes of sensitive skin:

1. Acne subtype: develops acne, blackheads, or whiteheads
2. Rosacea subtype: develops recurring flushing, facial redness, and hot sensation
3. Stinging subtype: develops stinging or burning of skin
4. Allergic subtype: develops redness, itching, and flaking of skin.

Dr. Wendy Roberts, a specialist in cosmetic dermatology and the needs of ethnic skin, is founder of Desert Dermatology Skin Institute and pioneered the Roberts Skin Type Classification System (RSTCS) http://www.wendyrobertsmd.com/. The RSTCS identifies skin type characteristics and provides data to predict the skin’s likely response to insult, injury, and inflammation for individuals of global skin types.

Having knowledge and information about your skin type empowers you to know how to care for your skin, by using skin care products that are most beneficial for your skin type.

Exfoliation allows new skin layers to emerge

The process of removing excess accumulations of dead cells from the corneum layers of the epidermis includes superficial peeling, exfoliation, keratolysis and desquamation.

Exfoliation is defined as the peeling or sloughing of the outer layer of skin. We exfoliate to speed up the breakdown of dead keratinocytes, which are scale-like cells found on the skin’s surface. This is accomplished manually (scrubs) or chemically, by the use of specific products (glycolic acid) formulated to achieve specific results.

Cell Renewal Factor

A natural process that slows down with age is the cell renewal factor (CRF). CRF is what keeps cells from building up. Dead cells made primarily of soft keratin called keratinocytes, are continually shed and replaced by new cells coming to the surface of the corneum.

The average CRF rate for adults 50 years and older is 42-84 days. This may appear normal. However, when the adult CRF rate is compared to the CRF rate of babies which is 14 days; adolescents, 21-28 days; and then middle-age adults which is 28-42 days; the need to exfoliate once or twice a week is clearly understood. Gentle exfoliation helps the skin to look more alive and healthy.

Two types of exfoliation treatments

Mechanical is a method of rubbing dead cells off the skin by granular scrubs, or by the use of brushing machines. This is done once or twice a week depending on the skin type. Exfoliate occasionally if you have rough or dry skin.

Mechanical exfoliating ingredients such as, polyethylene and jojoba beads are added to cleansers or granular scrubs to physically rub dead cells off of the skin. Newport Cosmeceuticals, Buffing Granules is one such product, www.newportcosmeceuticals.com.
Pevonia Botanica, Gentle Exfoliating Cleanser combines soapwort, horse chestnut and chamomile to eliminate dead cells, www.pervonia.com. These products can be found at salons and spas.

Chemical exfoliation dissolves dead skin cells by chemical agents. Alphahydroxy acids (AHAs) and betahydroxy acids (BHAs) work by loosening the bond between cells “intercellular glue” in the surface of the corneum. Enzyme peels are designed to digest the dead cells on the surface. They can be a cream or powder that produces a more even peeling of cell-build up. Peels use keratolytic enzymes that break down the keratin protein in the skin. The most often used are papain and pancreatin.

Benefits of Exfoliation:

• Increases cell turnover rate more rapidly
• Improves the skin’s ability to retain moisture
• Facilitates effective delivery of product ingredients into the epidermis
• Stimulates blood flow
• Produces smoother skin

With any good thing, one needs to be careful. Over-exfoliation can cause irritation, damage the skin and capillaries, and impede normal cellular functions.

An important note, skin care therapists/estheticians use treatments designed to penetrate only the epidermis. Dermatologists, use procedures designed to penetrate the dermal layer of the skin.

Acne at any age can be a problem

Both adults and teens are troubled by acne. Quoting GlyMed Plus, “Acne is the most common dermatological problem faced by physicians and their patients in the U.S. today. Stress, diet, puberty, sunlight, pregnancy, cosmetics, menopause – all of these and more, contribute to the many types of acne that plague most of us at some time in our lives.”

GlyMed Plus is an acne management skin care product line intended for use as part of a supervised skin care program. http://www.glymedplus.com

Acne is a chronic inflammatory disorder of the sebaceous (oil) glands, characterized by comedones (blackheads) and blemishes. A genetic disease also referred to as Acne Simplex or Acne Vulgaris. Acne is found on the face, back or chest and the skin appears greasy. It ranges from mild breakouts to disfiguring cysts and scarring. Flare ups usually begin when reaching puberty however, adult acne is quite common.

A progressive deterioration includes the following:

• Lesions: any mark or abnormality.
• Comedones: clogged pores filled with oil and dead skin cells. Blackheads are dark because they are exposed to air.
• Papules: a pimple containing no fluid.
• Pustules: an inflamed papule containing pus.
• Scarring: light-colored mark formed by tissue loss after a lesion has healed.
• Nodules: small bumps caused by scar tissue, fatty deposits, or infections.
• Cysts: nodules made up of pockets of infection.

Since acne is triggered by hormonal changes, having a good understanding of its causes is important.

Causes:

Clogged pores - dead skin cells that haven’t shed and the pores are filled with sebum (oil).

Bacteria –an overproduction of oil causes a buildup of additional cells. Inflammation occurs.

Cosmetics and product ingredients - Certain ingredients like waxes, oils, heavy emollients can trigger acne.

Hormones, stress, and foods - Stress causes hormonal fluctuations which increases sebum production. Processed and packaged foods, especially fast foods can irritate acne. Foods high in iodine such as, shellfish, seaweed, iodized salt, MSG, kelp, cheese can lead to breakouts.

The severity of acne is determine by the amount/number of lesions, comedones, papules, pustules or cysts present. Acne is classified into four grades.

Grades of Acne:

• Grade I -Minor breakouts, open comedones , a few papules and pustules.
• Grade II -Many open and closed comedones (whiteheads), and more papules and pustules
• Grade III -Skin is red and inflamed. Many papules and pustules
• Grade IV -Inflammation is present. Cysts with comedones, papules, and pustules.
  This grade is called Cystic Acne. Larger lesions have the appearance of ice pick scars; thick, deep, and narrow where the pore is stretched.

Grades III and IV can only be treated by a physician or dermatologist.

Acne can have a permanent effect on the appearance and condition of your skin. Most importantly, it can affect your self-esteem and sense of well-being throughout your life.

Grades I and II acne are treated by licensed estheticians/skin therapists with regular facial treatments and recommended home care products.

A few good comments about facial cleansing.

How many of us know someone using regular bar soap to clean their face? When was the last time a client told you they have been using soap for years?

One of the first things learned in esthetics school is how highly alkaline soap can be to the face. It can damage the acid mantle and cause dryness. The acid mantle is a protective barrier on the skin formed by sweat and sebum. The pH of the acid mantle is between 4.5 and 6.2. It’s important to keep the pH at a safe level and skin care products are designed to produce a safe and non-irritating product to the skin.

Why do we cleanse?

We cleanse to remove dirt, oil and makeup. Cleansers dissolve makeup and prepare the skin for other products. Dermatologist Dr. Neal B. Schultz, author of It’s Not Just About Wrinkles writes, “Cleansers range from very moisturizing to very drying and should be chosen to match your skin type. A lot of cosmetic companies market lipid cleansers because they are very effective in removing oily makeup. These cleansers leave an oily residue and are especially effective on dry skin. They are also gentle and effective for mature or sensitive skin. However, highly alkaline soaps and detergents are extremely drying and should be avoided.”

There are many cleansers on the market designed for all skin types and skin conditions. For instance; cleansers containing ingredients like glycolic acid hydrate, exfoliate, and moisturize the skin and antioxidants help prevent wrinkles.

Cleansers come in three basic forms:

• Face washes
• Lotions
• Creams

Foaming cleansers are face washes and have a slightly acidic pH. Oily or combination skin types usually like foamy cleansers.

Cleansing lotions are water-based emulsions for normal and combination skin.

Cleansing creams are oil-based emulsions. They are heavier than cleansing lotions and usually used to dissolve makeup.

Most facial care products recommend cleansing in the morning and evening however, avoid over cleansing, for this can cause the skin to dry out. It may be necessary to adjust your cleansing routine slightly according to the season, for your skin can change in different environments.

Cleansing the eyes

This area needs to be carefully cleaned. The eyelid skin is very thin and sensitive to irritation. It contains few sebaceous glands and can be prone to dryness. Eye cleansing products containing humectants can help to prevent drying of the eyelid.

Benefits of Cleansing

• Removes dirt from unblock pores.
• Softens dry skin especially cleansers with emollients.
• Helps certain skin problems due to the cleanser ingredients.
• Prepares the skin for applying makeup.

Use a product that rinses clean with water and is not too harsh for your skin.
Peter Thomas Roth has a product line of Creamy Cleansers and Gel Cleansers. www.peterthomasroth.com.
M.D. Forte’ cleansers are free of soap and fragrance. www.mdforte.com

What's the buzz with UVB and UVA rays?

A neighbor of mine mentioned that she'd been to a tanning salon since the weather didn't allow for her to sun bathe at the pool. Even though she's aware of sun damage to the skin, the look of white winter flesh in a black dress at a wedding overruled caring for her skin. How many women would choose the same alternative regardless of knowing the damage caused by ultraviolet light?

Dermatologist Dr. Leslie Baumann, author of The Skin Type Solution writes, "When UV light hits the skin, it stimulates an increased production of skin pigment, which is what we call tanning. This is the skin's major defense against further UV damage. In addition to tanning skin, ultraviolet light worsens melasma and causes sun pots (solar lentigos)."

UVB and UVA

The sun and its ultraviolet light reach the skin in two different forms and influences the skin at two different levels. When frequent doses of UV light penetrate the skin it can alter melanin. Melanin is designed to protect the skin from the sun.

UVB rays cause immediate sunburn. Often referred to as "burning rays." They cause tanning of the skin by affecting melanocytes, (cells that produce pigment granules).

UVA rays cause long term damage. Often referred to as "aging rays." They weaken the skin's collagen and elastin fibers, which causes wrinkles and sagging in the tissues.

The sun and UV rays have a huge affect on how our skin ages. According to MD Formulations, "Even though our skin does "naturally" age, research has shown that 90% of premature aging is due to harmful environmental elements particularly UV radiation or sun exposure."

Most importantly, apply the sunscreen. A broad spectrum sunscreen protects from both UVA and UVB rays. The Sun Protection Factor (SPF) number indicates how many times longer you can stay in the sun before starting to burn while wearing sunscreen than if you were not wearing any sunscreen protection. With a higher SPF number, the concentration of ingredients is higher. Look at the active ingredients listed. The chemicals in sunscreens either interact with skin to prevent the sun from burning it, or physically block the sun. Blocking sunscreens are less common than chemical sunscreens.

Physical sunscreens prevent the sun's rays from penetrating the skin by blocking and reflecting the sun's rays from reaching the skin's surface. All of the sun's rays whether they are ultraviolet A or B are blocked. Two points:

1. Most effective when the ingredient silicone is added to them.
2. Active ingredients: Titanium Dioxide and Zinc Oxide

Chemical sunscreens provide a protective layer of sunscreen ingredients that are quickly absorbed by the skin and can be both waterproof and sweat proof. Several points:

1. Provides Ultraviolet B ray protection or
2. Provides additional protection against ultraviolet A rays
3. Active ingredients: Parsol 1789 and Oxybenzone

Best protection is one with an SPF number greater than 30 and offers protection against ultraviolet A rays.

Check out Dermalogica Solar Defense product line. To find a salon near you visit: http://www.dermalogica.com/