×

Warning

JUser: :_load: Unable to load user with ID: 31566

X Marks the Spot

Written by Austine Mah

In working with acne in skin of color, the best tools in your aesthetic “tool kit” are an understanding of acne, an understanding of post inflammatory hyperpigmentation, ingredient knowledge, and most of all a partnership with your client to progressively achieve healthy, balanced, beautiful skin.

The initial trouble with acne in skin of color is the actual lesion. The acne lesion is often observed as an unsightly spot. However, from the acne lesion the greater problem for skin of color is the dark spot, the X, marking the site of trauma and inflammation from the initial acne lesion.

This dark spot is often referred to as post inflammatory hyperpigmentation (PIH).

The acne and PIH are important concerns for skin of color clients. An acne lesion often causes emotional distress; the appearance of an acne lesion often leads to feelings of poor self image and lack of confidence. PIH only exacerbates these feelings as the site of trauma from the acne lesion continues to be marked and evident for weeks and sometimes months after the acne lesion is healed in skin of color.

 

Acne

Whether it is a comedo, pustule or another type of lesion, acne is a common disease involving the sebaceous gland. It is important to identify the origin and development of the acne lesion(s) to determine the recommended professional treatment and home care regimen.

For example, a comedo, a blackhead, is a combination of keratinized and lipid materials congested in the follicle as a result of a change in the cell turnover cycle and pattern. As such, it is best cared for with an ingredient like an alpha hydroxy acid (AHA) to aid in the exfoliation of the keratinocytes. A pustule is similar to a comedo, it is a combination of not only keratinized and lipid materials, but also proprionibacterium acnes (p. acnes) congested in the follicle. It is best cared for with an ingredient that will oxygenate the follicle, like benzoyl peroxide, and change the environment of the congested follicle so that the p. acnes cannot proliferate and induce greater trauma and inflammation to the skin causing greater PIH.

Understanding the pathogenesis of acne and ingredient use and benefits will allow the skin care professional to create the most effective professional treatment and home care regimen for successfully addressing acne in skin of color.

 

Post Inflammatory Hyperpigmentation (PIH)

Epidermal PIH is the response of the epidermis to inflammation and trauma and can be addressed by an aesthetician. Epidermal PIH can be detected by a Wood’s Lamp. With progressive and serial professional treatments and a dedicated home care regimen, PIH can be resolved. For dermal PIH, aestheticians should follow the NCEA Code of Ethics and “refer clients to the appropriate qualified health practitioner”.¹

PIH is the release and oxidation of many products, including fatty acids to chemical messengers like arachidonic acid to prostaglandins, that change the immune and melanocyte cells as a result of the stimulation. Melanocytes respond by producing melanosomes containing melanin (skin color pigment) and the end result is the transfer of melanosomes to the keratinocytes creating the PIH.

This PIH is created when the melanosomes are stimulated through trauma, inflammation, and heat. An inflamed acne lesion or an overly stimulated and picked at acne lesion will create the PIH marking the spot of a healed acne lesion.

 

 

Working In Tandem with a Partnership Commitment

While acne is a disease and PIH is a condition, both disease and condition can be cared for by a skin care professional. The key to working with skin of color is to find the balance between aggressive early intervention and gentle treatments to avoid irritation and greater inflammation.² An early start caring for the acne lesion will help reduce the amount of trauma, inflammation, and heat to the skin resulting in the degree of PIH.

This balance is most successful when a partnership is formed between a dedicated skin care professional and a compliant client working with great patience. Torrie Jakes, Louisiana Licensed Aesthetician, finds “the main ingredient in any hyperpigmentation regimen is patience.” Creating the formula for success is patience plus commitment, resulting in the sum, achievement of the goal.

 

During a consultation, having a client join you, the skin care professional, in signing a commitment agreement can encourage the partnership structure. This commitment holds no financial or legal value. Its sole purpose is having the client understand the joint goal of achieving healthy, balanced, beautiful skin and committing to the same agenda as the skin care professional in working with acne and skin of color.

 

_________________________________________________________________________________________________________________________________________

 Sample Skin Care Commitment for Working with Acne in Skin of Color

 

I, _____________________________________________________________________ ,

commit to working with _______________ of (Business Name) ____________________

to address my acne and skin care concerns. I agree to follow the recommended home

care regimen to optimize the benefits of my professional treatments. I agree to

arrive on time for my regularly scheduled professional treatments and to follow a

series of professional treatments as advised by my skin care professional to meet

the goal of achieving healthy, balanced, beautiful skin.

 

Signature of client _______________________________________Date _____________

 

Signature of skin care professional __________________________Date _____________

_________________________________________________________________________________________________________________________________________

 

 

Clients seek results and the expertise of a skin care professional. With results comes dedication from a client. Helping the client trust in your professional expertise will help them be a more compliant client, a long term key to patient success. Ensuring clients are diligent with their home care regimens will allow the good results to continue in the treatment room with progressive and serial treatments.

 

Ingredient Use and Benefits in Home Care and Professional Treatment Regimens

The combination of both home care and professional treatment regimens is successful with the right combination of ingredients in the products. A noncomedogenic home care regimen founded on products that are for more sensitive skin, a characteristic of skin of color, should contain gentle exfoliation and skin brightening ingredients. The basic regimen should consist of a cleanser, a hydrator or a moisturizer, a melanocyte suppressant product and a sun protection product. Added to this regimen are specialty ingredients or products featuring these specialty ingredients formulated to target the acne lesion or brighten the skin and reduce the degree of PIH.

Sukhi Bingham/Johal, Owner of Spa Manjoh, Westwood Village, Calif. advises skin care professionals to work slowly and gradually on clients with skin of color. By progressively introducing clients to specialty ingredients, clients experience good results with little irritation. Bingham/Johal says, "Clients want quick results, yet quick, aggressive treatments with high concentrations of performance ingredients in a low pH can cause even more problems as the skin of color clients have sensitive skin and are not prepared for such aggressive treatments". Working progressively with a good home care regimen and using a mid range product to a more aggressive product leads to better results with less irritation and trauma to the skin and most importantly less risk of inducing PIH.

In designing progressive professional treatments and home care regimens, specialty ingredient use is most important. A few acne specialty ingredients include benzoyl peroxide, salicylic acid and AHAs. Benzoyl peroxide works by oxygenating the hair follicle where the proprionibacterium acnes (p. acne) can only survive in an oxygen free environment. Benzoyl peroxide will deliver oxygen to the hair follicle preventing the growth of the p. acne bacteria therefore reducing the amount of inflammation and trauma resulting in PIH. Benzoyl peroxide is best used as a spot treatment or as a specialty ingredient in the basic home care regimen.

Salicylic acid, often classified as a beta hydroxy acid (BHA), derived from wintergreen and birch bark, is lipid-soluble and therefore able to penetrate the congested follicle and exfoliate the skin with its keratolytic and antimicrobial actions. Like lactic acid, it is an excellent ingredient for use as a specialty ingredient an SPF product should be recommended for collaborative use with salicylic acid as this ingredient will exfoliate the skin and leave it more susceptible to trauma and PIH.

Lactic acid, an AHA, derived from sour milk, has a large molecular structure and while it is as effective as glycolic acid, another AHA, derived from sugar cane, it does not penetrate as deeply and is therefore better able to exfoliate the skin where the PIH damage resides. Lactic acid is another excellent ingredient for use as a specialty ingredient. As it is an AHA, the skin care professional must recommend collaborative use of an SPF product with an AHA product.

A few skin brightening ingredients include azelaic acid, vitamin A, vitamin C, and kojic acid. Originally developed as a topical acne treatment, azelaic acid inhibits tyrosinase used for melanin production. It does not have a depigmentation effect on normally pigmented skin. By using this specialty ingredient in a home care regimen, skin of color clients will observe skin lightening and especially the reduction of PIH.³ When used with an Alpha Hydroxy Acid (AHAs), the benefits of these combinations in ingredients leads to an exponentially greater result. As this is a skin lightening ingredient and especially if used in collaboration with AHAs, use of an SPF product is highly recommended. Azelaic acid is a specialty ingredient that may be used in a cleanser, hydrator, moisturizer or specialty melanocyte suppressing product.

Vitamin A is an antioxidant and is known for its ability to exfoliate and improve the appearance of fine lines and wrinkles. It is also good for its ability to increase collagen production and elastin formation. Most importantly for skin of color clients, vitamin A is known to aid in pigmentation concerns. It is often used as a specialty ingredient.

Vitamin C, also an antioxidant and a tyrosinase inhibitor, is a specialty ingredient with a variety of uses. As an independent antioxidant ingredient or as a specialty ingredient, vitamin C serves many purposes. It does tend to be more photosensitive and like melanocyte suppressing ingredients, should be stored with care in a dark and cool environment as this ingredient is more prone to quick oxidation.

Kojic acid inhibits the activity of tyrosinase. It is known to be irritating and for this reason should be used with great care. As it is a skin brightening ingredient, it is imperative to use an SPF product to maintain the skin brightening benefits.

Hydroquinone is a skin-bleaching ingredient recognized by the United States Food and Drug Administration (FDA). It is often considered the most effective specialty ingredient. The over-the-counter (OTC) use is limited by the FDA to 2 percent, however; caution should always be used as there is an adverse effect, exogenous ochronosis. This condition is a darkening of the area treated by hydroquinone, the opposite effect of the goal of lightening the PIH. For this reason, many skin care professionals prefer to use skin brightening ingredients until their clients are accustomed to working with a skin care professional experienced in working with this ingredient.

As with all home care regimens, the use of a sunscreen is always important. Sun exposure will reverse the benefits of the skin brightening ingredients and will only stimulate not suppress melanocyte activity. A minimum SPF 15 product should be used on a daily basis and should the client be exposed to sun and outdoor activity, it is highly recommended to be in the sun in the early morning and the late evening while wearing a hat and using sun protective clothing and coverings with a SPF 30 product applied to the skin.

From home care to professional treatments, clients will find that using a home care regimen prior to, during, and after professional treatments will allow the skin care professional to work with greater success by optimizing the professional treatments with less irritation to the client and visible results in the reduction of acne lesions and PIH.

For optimum results, perform a professional exfoliation treatment every 12-14 days to ensure the collagen has reached its optimal level of stimulation and to ensure the skin is not overly exfoliated and therefore irritated leading to trauma and PIH. Pamela R. Springer, Licensed Educator and Founder of The Skin & Makeup Institute of Arizona, Peoria, Ariz., shares her success in the professional treatment room. Depending on the severity of the acne in skin of color clients, Springer says, “my most successful treatments are when the client is committed to weekly or bi-weekly treatments. These treatments vary and are conducted by rotating mild to moderate exfoliation services.” Professional serial lactic acid and salicylic acid exfoliation treatments are excellent for skin of color clients.4

In working with acne in skin of color, progressive combinations of specialty ingredients and aggressive early intervention and gentle treatments will help you in working with this specialty. Partnering with your clients will ensure a committed professional treatment and home care regimen for the successful achievement of healthy, balanced and beautiful skin of color.

Austine Mah is an Asian American who successfully works with skin of color, especially her own. She is an accomplished methodologist and facilitator, dedicated to advancing the understanding of therapeutic skin treatments through continuing education. Technically knowledgeable, Austine extends her commitment to excellence and awareness from treatment room to home care. She regularly consults, educates and writes for the aesthetic industry. Learn more about Austine at www.austinemah.com.

 

REFERENCES

¹ National Coalition of Estheticians, Manufacturers/Distributors and Associations. 15 June 2006.

² Callender, Valerie D. (2004) Acne in ethnic skin: special considerations for therapy. Dermatologic Therapy 17 (2), 184-195.

³ Rodriguez Prieto, M.A., P. Manchado Lopez, I. Ruiz Gonzalez, and D. Suarez. Treatment of lentigo maligna with azelaic acid. Int. J. Dermatol. 32:363-364, 1993.

4 Grimes, Pearl. (1999) The safety and efficacy of salicylic acid chemical peels in darker racial-ethnic groups. Dermatologic Surgery Jan; 25 (1):18-22.

Related items

  • Dallas Based Entrepreneurs Launch Medical Hologram B+A and Marketing Assistant Serving the Aesthetic Community Dallas Based Entrepreneurs Launch Medical Hologram B+A and Marketing Assistant Serving the Aesthetic Community

    Aestheia Imaging, a hologram content management, and advertising subscription company introduced its disruptive technology at the American Society for Aesthetic Plastic Surgery last week at The Aesthetic Meeting in New Orleans. The company breaks the mold of in-practice marketing with the unveiling of XTHEIA; an interactive hologram display toting a Virtual Consult Assistant for medical office waiting rooms. Aestheia's launch poses a resolution to poor patient awareness; an underserved focal point of product education in the aesthetics industry.
    The company is led by Austin JM Podowski, CEO and accomplished Dallas Healthcare Business Tech executives Mike McDonald, President and Paul Herchman, Advisory Board Member. Well known Plastic Surgeon and photographer Dr. Barry DiBernardo of New Jersey Plastic Surgery leads the companies Medical Advisory Board and will continue to work to enhance upon the application. The company offers a connected holographic media platform to story map the patient journey to brand and product education. Through the research and development of Aestheia's Medical Advisory Group, the company will offer holographic before and afters to patients so they can see pre-operative and post-operative procedure outcomes in true 3D, not previously available in the space.


    "We are dedicated to providing novel and ground breaking product innovation for the entire Aesthetic Community," comments McDonald. The company today offers a fully-automated and comprehensive holographic playlist for physician waiting rooms tethered to a cloud-based solution developed by the management team.
    "We are changing the way medical companies and physicians communicate with their customers and patients. The ALEXA of Aesthetics is now in the room," states Podowski. The team has also designed a customer facing iPad Pro application that allows a physician to remote control the device offering an in-app camera for patient photos. Mr. Podowski later comments, "The response received at ASAPS The Aesthetic Meeting affirms that our vision and product meet a need and resuscitate a lost connection with the consumer."
    The management team is dedicated to further pioneering advancements in hologram, AI, and AR in the evolving medical practice of the 21st century. The company is finalizing a third-round capital raise and will begin placement of their technology throughout Plastic Surgery Offices in North America in July 2019. The technology will also be on display in direct to consumer retail kiosks throughout the United States later this year. To get a sneak peak of Aestheia, follow the team's development, or learn more about the technology, follow @aestheiaimaging or visit www.aestheiaimaging.com.
      www.aestheiaimaging.com

  • Test Blog Edited Test Blog Edited

    Lorem ipsum dolor sit amet, consectetur adipisicing elit, sed do eiusmod tempor incididunt ut labore et dolore magna aliqua. Ut enim ad minim veniam, quis nostrud exercitation ullamco laboris nisi ut aliquip ex ea commodo consequat. Duis aute irure dolor in reprehenderit in voluptate velit esse cillum dolore eu fugiat nulla pariatur. Excepteur sint occaecat cupidatat non proident, sunt in culpa qui officia deserunt mollit anim id est laborum.

  • Micropigmentation Procedure October 2010
    By
    Micropigmentation Procedure October 2010

    Micropigmentation Procedure Helps Breast Cancer Survivors Regain Self-Esteem & Confidence!

    Cranberr facial mask

    Cranberr facial mask
    According to the American Cancer Society (ACS), it is estimated that in 2009 there were 192,370 new cases of invasive breast cancer diagnosed among women, and approximately 1,910 new cases in men. For the many men and women who have been, and will be diagnosed this year, the battle to get through treatment and surgery is only the beginning of the journey to survive. Although the feeling of survival is unsurpassed, the physical scars at times may leave some survivors anxious with their new appearance. Ruth Swissa has taken her passion and artistic expertise in the permanent makeup industry to provide areola pigmentation for breast cancer patients post reconstruction to help renew self-confidence and boost self-esteem.

    "Many of my patients have said that waking up every morning, and looking in the mirror is a constant reminder of their battle, which although comes with a sense of pride, it also at times causes insecurities because they don't feel like themselves," says Swissa.

    Micropigmentation is an alternative method of creating a realistic nipple and areola after a mastectomy, to achieve a more symmetrical shape and even coloring using artistic light and shade effects. Swissa works closely with her patients in order to achieve the desired coloring and size to create a natural looking effect. This procedure takes less than an hour and is usually painless.

    Ruth uses a customized medical tattooing technique for applying permanent makeup for areola pigmentation. This unique method proves to be more exact, very gentle, and less invasive than traditional cosmetic tattooing. The results look more natural and subtle in appearance.

  • Five Ways to Find Safe and Natural Relief from Osteoarthritis October 2010
    By
    Five Ways to Find Safe and Natural Relief from Osteoarthritis October 2010


    Five Ways to Find Safe and Natural Relief from Osteoarthritis

    by Deirdre Shevlin Bell

    Cranberr facial mask


    The search for safe and effective relief from osteoarthritis (OA), a condition that occurs when joint cartilage wears down over time, can feel like an uphill battle. Certain natural remedies can bring lasting relief from OA according to the Arthritis Research Council (ARC) study and other experts. That is good news, since the pain, stiffness, and loss of flexibility from arthritis makes it the nation's most common cause of disability.

    One massage, and call me in the morning
    Spa-lovers with osteoarthritis will be pleased to learn that all those massages that leave you feeling loose and limber are doing more than just helping you relax. According to a 2006 study published in the Archives of Internal Medicine, Swedish massage improves flexibility, decreases pain, and increases range of motion in individuals with osteoarthritis of the knee.

    Low-impact exercise
    "When people start to hurt, they tend to cut back on exercise," notes Michele Olson, Ph.D., professor of exercise physiology at Auburn University Montgomery and Fellow of the American College of Sports Medicine. But that is a mistake, as inactivity can make pain and stiffness even worse. Olson recommends Pilates and swimming or doing aqua-aerobics, but she emphasizes the importance of choosing gentle, weight-bearing exercise. Michael Murray, N.D. suggests that a person should find something they love, and find a way to continue doing it: If walking on concrete sidewalks is too hard on the joints, walk on the golf course.

    Spice rub
    Using a gel containing capsaicin, the active ingredient in chili, is very effective at providing temporary relief from osteoarthritis pain. Studies have found that capsaicin can deplete the substance that acts to transmit pain signals from nerve endings to the brain and cause inflammation in the joints.

    Healing herbs
    An ARC study evaluated several herbs and herbal combinations and found that one stood above the rest. Phytodolor, a branded combination of three herbs – aspen (Populus tremula), common ash bark (Franxinus excelsior), and golden rob herb (Solidago vigaurea) effectively manages the pain and inflammation associated with OA. Some studies have shown that aspen contains a substance that when ingested inhibits the production of certain prostaglandins in the nerves, resulting in pain relief. Common ash bark and golden rob herb also have pain-relieving properties, and common ash bark is an antioxidant – meaning it may reduce oxidative damage in the joint. The combination of the three herbs has been shown in animal studies to reduce inflammation. No major adverse effects have been reported, though some people do experience diarrhea, stomach upset, or skin reactions.

    The SAMe Game
    First discovered in 1952 and widely investigated for its usefulness in treating depression, S-adenosylmethionine (SAMe) is now showing promise as a treatment for OA. SAMe is a chemical compound that occurs naturally in the body, where it contributes to the synthesis of hormones and neurotransmitters. Studies suggest that when taken as a supplement, SAMe reduces pain and also stimulates the synthesis of collagen and proteoglycans, which are the major components of joint cartilage. Adverse effects are infrequent and mild, but can include nausea, restlessness, headache, dry mouth, and stomach upset. People with depression should consult with a healthcare provider before taking SAMe, as some incidences of anxiety and mania have been reported.

    Copyright© HealthyLifestyles.com

  • The Impact of Psoriasis on Personal Relationships October 2010
    By
    The Impact of Psoriasis on Personal Relationships October 2010


    The Impact of Psoriasis on Personal Relationships Survey Fact Sheet

    This survey was created in partnership with the National Psoriasis Foundation and Galderma Laboratories, L.P.

    Within this issue, as well as our November and December 2010 issues, we will be printing important findings revealed from the recent survey, "The Impact of Psoriasis on Personal Relationships." This survey, sponsored by Galderma Laboratories, was distributed to the National Psoriasis Foundation membership database via Survey Monkey. The survey was completed by approx 1,520 people; statistics below represent the percentage of people who answered a specific question (not always all 1,520 respondents). Statistics are rounded to nearest percentage point and percentages may not add up to 100 percent depending on the structure of the question. Not every respondent answered every question.i Below is a list of findings relating to psoriasis and its impact of social relationships.

    Nearly 80 percent (78.7%) of question respondents feel that psoriasis has had a negative impact on their personal relationships.ii

    Social Relationships

    • When having a psoriasis flare-up, 63.3 percent of respondents are less likely to go out socially iii and 53.6 percent have declined social invitations or cancelled plans because of a flare-up.iv Nearly 70 percent (69.6%) feel that psoriasis has impacted their social relationships.v
    • When meeting someone new, 74.3 percent of question respondents worry that the person will notice their psoriasis,vi and 72.1 percent of respondents are concerned that people that notice will think of them less favorably.vii
    • When going out for social occasions, 79.5 percent of respondents usually only wear outfits that cover up
      their psoriasis.viii
Login to post comments

More in Skin Care

Featured Company

  • Bio France LabBio France LabDescription:   With 25 years of successful industry experience in both skincare and retail, Claudio DiFiore created Bio France Lab, offering superior natural and botanical luxury skincare product at an affordable cost. Combined exposure to both product development ...

Acne

Next-Level Learning

  • Christine Valmy International School of Esthetics & CosmetologyChristine Valmy International School of...Description: Christine Valmy International School of Esthetics & Cosmetology offers a quality education in the beauty industry, based on the teachings of the Founder of Esthetics in the United States—Ms. Christine Valmy. Ms. Valmy opened her very first school ...