Sensitive skin is a common condition that affects a majority of people and commonly has predisposed factors such as ethnicity. Factors such as an impaired skin barrier, a weakened immune system, inflammation, and digestive health can also contribute to the skin’s sensitivity. The skin is constantly going through a repair process, so it is necessary to strengthen the function of the stratum corneum in order to strengthen sensitive skin.

There are numerous exfoliation options for strengthening sensitive skin, with physical exfoliation being the least effective. Physical exfoliation can actually irritate the skin and cause the skin to become even more sensitive. With sensitive skin, chemical exfoliation is a much better option and can actually have multiple benefits. In the case of hydroxy acids, some are chemically compounded and have properties that can benefit and strengthen sensitive skin. Chemical compounds that have a large form molecule, such as lactic acid, penetrate the skin at a slower rate and are less irritating to the skin. Lactic acid has great moisture binding properties and prevents evaporation of moisture in the skin. Lactic acid may have multiple benefits for aging and oily skin conditions, darker skin phototypes, and clients who have sensitive skin conditions.

MANDELIC ACID

Hydroxy acids, such as mandelic acid, have a large form molecule, as well, and cause less irritation to the skin. Mandelic acid has numerous benefits to the skin and can be used to manage various skin conditions such as acne, aging, hyperpigmentation, and rosacea. With acneic conditions, mandelic acid has powerful antibacterial properties, which makes this an ideal acid to treat rosacea or acneic skin conditions. As a lipophilic and hydrophobic agent, mandelic acid is ideal for exfoliating the sebaceous follicle and retaining moisture in the skin, therefore, reducing oil production by the sebaceous glands. Ideally, mandelic acid has the ability to inhibit tyrosinase, which is an enzyme located in melanocytes that converts the amino acid tyrosine into melanin. As a tyrosinase inhibitor, mandelic acid is ideal in lightening and preventing hyperpigmented conditions such as melasma, post-inflammatory hyperpigmentation, and sun damage. In clinical studies, mandelic acid has proven results which are comparable to and often better than topical prescription strength hydroquinone. Mandelic acid has multiple benefits when treating skin conditions and is ideal for dark skin phototypes or those who are prone to hyperpigmented conditions.

POLYHYDROXY ACIDS

The latest in chemical exfoliation includes the discovery of polyhydroxy acids. With polyhydroxy acids, the process of desquamation differs from alpha hydroxy acids. Polyhydroxy acids are not traditional keratolytic agents that nonspecifically dissolve skin’s bonds from the top downward. Instead, polyhydroxy acids affect the process of keratinization and help to normalize the thickness of the stratum corneum. Unlike most alpha hydroxy acids, polyhydroxy acids are powerful humectants and have potent antioxidant abilities. Larger polyhydroxy acid compounds include bionic acids such as lactobionic acid and maltobionic acid, which are derived from natural sugars. Bionic compounds have a large form molecule that penetrates gradually into the skin and are gentle and non-stinging. Polyhydroxy acids are less irritating than alpha hydroxy acids and their chemical composition make them ideal for all skin types, especially those with compromised, sensitive, or dark skin phototypes.

ENZYME EXFOLIATION

Enzyme exfoliation is another ideal option for exfoliating sensitive skin types. Enzymes are natural compounds commonly composed of digestive fruit acids, such as papaya, pineapple, or pumpkin, and are proteolytic agents that work differently than alpha hydroxy acids. Enzymes work by dissolving cellular material in the stratum corneum and are optimized in a neutral or alkaline pH. Proteolytic agents are ideal to manage aging, couperose, inflamed acne, rosacea, or sensitive skin types and can be safely used on dark skin phototypes. Ideally, enzyme exfoliation can be synergistically combined with hydroxy acids for optimal results.

When treating sensitive skin conditions, the professional should consider and address numerous factors, such as predisposed ethnicity, an impaired skin barrier, a weakened immune system, digestive health, inflammation and diet, vitamin and mineral deficiencies, and underlying health conditions and medications, which can contribute to the sensitive skin condition. Sensitive skin conditions commonly have internal factors that exasperate the condition and should be addressed along with strengthening the skin barrier and function of the stratum corneum by reducing transepidermal water loss.

Exfoliating dead, keratinized cells contained in the stratum corneum and retaining moisture in the skin is key to improving the skin barrier and strengthening sensitive skin types.

Linda Gulla is a NSPEP physician-endorsed master aesthetician and is a published writer in cosmetic dermatology, whose material has been reviewed and endorsed by dermatologist Dr. Eric Schweiger, as well as the renowned Dr. Abdala Kalil. As a published writer, Gulla’s expertise can be found in the Milady Advanced Esthetics 2nd Edition. Gulla has shared her expertise with family physicians and dermatologists as an adjunct instructor with the National Procedures Institute, where her material was reviewed by over seven medical review boards and was ACCME accredited. Gulla is founder of the Institute of Advanced Aesthetics and Health Sciences and is recognized as an approved provider with the NCEA COA. Her online self-study program can be found at iaahs.com. 

Prior to chemical peel application, there are important risk factors to consider. Understanding these risk factors will help to reduce side effects and will help to achieve optimal clinical outcomes. Risk factors are especially crucial to consider with layered peel application and caution should be taken with certain ethnic groups. When treating ethnic skin, it is essential to have a thorough understanding of skin histology, darker toned ethnic groups, and the side effects of inflammation ultimately leading to melanogenesis and post-inflammatory hyperpigmentation.

INFLAMMATION
There are two types of inflammation that can occur after a peel procedure. Acute inflammation is common and is short in duration. If left untreated, acute inflammation can continue and progress to chronic inflammation. Chronic inflammation can last for days and is commonly found with layered peels or medium depth chemical exfoliation. Chronic inflammation should be addressed with topicals that can resolve the inflamed tissue and assist the skin during the repair process to avoid permanent pigment scarring.

The inflammatory process is involved with cosmetic procedures, such as chemical exfoliation, and is the skin’s natural defense to repair itself. The inflammatory process occurs as a response of the body’s innate immune system, where white blood cells are alerted to respond and defend against small inflammatory processes. It is during the inflammatory process where fibroblasts are stimulated to rebuild new collagen. The inflammatory process that a number of inflammatory mediators, including prostanoids, cytokines, chemokines, as well as reactive oxygen species. In the dermis, inflammation can disrupt the basal layer of the epidermis causing melanocytes to become trapped in the macrophages of the papillary dermis. As a response to the chemical peel, the inflammatory response can alter the activity of melanocytes and immune cells in both the epidermis and dermis, thereby increasing production of melanin, ultimately leading to melanogenesis and post-inflammatory hyperpigmentation.

MELANOGENESIS
Melanogenesis is the process in which skin cells produce melanin. It begins within melanocytes, which are the cells that create pigment found in the skin, eyes, and hair. Melanocytes produce melanosomes and comprise approximately 10 percent of the cells in the basal layer of the epidermis. Synthesis of melanin occurs exclusively in melanosomes from melanocyte activity. The difference between fair skin and dark skin is not due to the quantity of melanocytes, but is due to the size and the level of activity of melanocytes. Darker racial ethnicities are at a higher risk of melanogenesis due to an increase in melanocyte activity during the inflammatory stage.

TYROSINASE
Tyrosinase is an enzyme that is produced during melanogenesis, from the amino acid tyrosine, and is required for melanocytes to produce melanin. Studies have found that a protein complex formed by the enzyme tyrosinase and dopachrome tautomerase is mainly found in dark skin melanocytes which induces sustained tyrosinase activity. The sustained tyrosinase activity can result in hyperpigmented conditions commonly found with skin phototypes III to VI. With chemical exfoliation, agents that interfere or block the production of tyrosinase should be considered essential therapy prior to chemical exfoliation to help inhibit melanogenesis during the inflammatory stage. This is especially important for those of darker racial ethnicities or for those who are prone to post- inflammatory hyperpigmentation.

OPTIMAL PROTOCOL
With chemical exfoliation and medium depth peels, keratinocytes within the epidermis are responsible for restoring the epidermis through a process called epithelialization, which is an essential component of the repair process. Chronic inflammation that may occur postoperative chemical exfoliation may impair the process of epithelialization and re-epilation of skin cells. Re-epilation of skin cells involves the migration and proliferation of keratinocytes, which depends on the interaction of keratinocytes with dermal fibroblasts and the extracellular matrix.

Assisting the skin through the repair process with tissue-regenerating topicals will help to reduce risk factors and offer optimal clinical outcomes. Clinical-based ingredients, such as GHK-Cu copper peptides, atelocollagen, human growth factors, and processed skin cell proteins, will assist the skin during the re-epilation stage and are ideal postoperative therapy after a chemical peel procedure. With any type of chemical peel, conditioning the skin weeks prior to the procedure with alpha hydroxy acids or retinols will help to reduce risk factors with dark skin phototypes. Enzyme peels or alpha hydroxy acids composed of a large form molecule, such as lactic acid or mandelic acid, will provide optimal results for dark skin phototypes with little irritation. Hydroxy acids, such as polyhydroxy acids, are ideal for sensitive skin and dark skin phototypes and will help to improve the skin barrier. Tyrosine inhibitory topicals such as kojic acid, arbutin, mandelic acid, or retinols will help to inhibit tyrosinase and increased melanogenesis stimulated as a result of inflammation.

Linda Gulla is a NSPEP physician-endorsed master aesthetician and is a published writer in cosmetic dermatology whose material has been reviewed and endorsed by dermatologist Dr. Eric Schweiger, as well as the renowned Dr. Abdala Kalil. As a published writer, Gulla’s expertise can be found in the “Milady Advanced Esthetics” 2nd Edition. Gulla has shared her expertise with family physicians and dermatologists as an adjunct instructor with the National Procedures Institute, where her material was reviewed by over seven medical review boards and was ACCME accredited. Gulla is founder of the Institute of Advanced Aesthetics and Health Sciences and is recognized as an approved provider with the NCEA COA. Her online self-study program can be found at iaahs.com. Professionals can obtain additional reference material that covers this entire series on Chemical Resurfacing in Dermatology and Advanced Layered Peels by visiting her website at iaahs.com.

The stratum corneum is the skin’s barrier and is the top layer of the epidermis. In the epidermis, keratinocyte stem cells reside in the basal layer, which is the lowest layer of the stratified epithelia. These cells divide further and differentiate as they move upwards in the epidermis towards the stratum corneum. Found within the stratum corneum are corneocytes which are dead keratin-filled squamous cells that are tightly bound to hydroxyl molecules. Studies have shown that corneocytes are encased by cornified envelopes. These envelopes contain intercellular spaces that are filled with layers of hydrophobic and hydrophilic structures, which are formed by various intercellular lipids and act as a protective skin barrier. These spaces also include various enzymes (proteases) that control desquamation and processing of antimicrobial peptides. The antimicrobial peptides act as a microbial barrier and help to control the growth of both commensal and pathogenic bacteria. In addition, the intercorneocyte space provides a pathway which external lipophilic substances pass to reach the stratum corneum sublayers of the epidermis.
With age or unhealthy skin, the stratum corneum barrier thickens with dead keratinized skin cells and disrupts the function of the stratum corneum, making the skin unhealthy and compromised. Results of a thickened stratum corneum include lack of cell nutrients and cell protection, weakened skin immune cells, altered lipid composition and organization, and less protection from ultraviolet radiation and environmental irritants. Studies have shown that the function of the stratum corneum is crucial in barrier function and lipid composition.

NATURAL DESQUAMATION PROCESS
The desquamation process of the stratum corneum involves several enzymes that degrade the corneodesmosomes in a specific pattern. Corneodesmosomes are a class of proteins that hold the corneocytes together. It is believed that the activity of these enzymes are influenced by trans-epidermal water and the pH of the skin. The skin barrier function is maintained through this process. The lipid structure plays an important role in the natural desquamation of the skin and plays a role in the mechanism of compromised skin conditions. With skin disease, the natural desquamation of the skin can become disrupted, contributing to diseases such as eczema, dermatitis, and many other skin diseases.

IMMUNE RESPONSE, DISRUPTED SKIN BARRIER
A disruption in the skin’s barrier and function can occur as a result of an innate or adaptive immune response. Innate immunity is present at birth where certain defenses in the immune system are naturally present in the body. Innate immunity is non-specific to pathogens. Adaptive immunity is developed after an infection or vaccination, where the body can recognize to fight off a specific infectious pathogen. Cells such as tissue resident memory T-cells (TRM) are capable of producing cell-signaling cytokines and play a critical role in the development of some skin diseases. Clinical studies suggest that epidermal TRM T-cells are retained in cutaneous diseases, such as psoriasis. Immunity has a direct impact on the natural desquamation of the skin and should be considered when assessing the underlying causes of skin disease.

BARRIER INTEGRITY
Research has shown that the function of the stratum corneum is crucial with onset of disease and when managing skin conditions. Strengthening the stratum corneum will help to strengthen the skin’s barrier and function. The skin barrier can be strengthened by exfoliating dead keratinize skin cells of the stratum corneum that build up over time. This can improve skin conditions that have been compromised due to a disruption in the natural desquamation process. Exfoliating will thin the stratum corneum and stimulate new skin cells, as well as thicken the underlying layers of the epidermis. Stimulating cell renewal will encourage better product penetration and moisture retention and will stimulate a stronger and more intact protective barrier.

EXFOLIATION
Exfoliation can be either chemical or physical and usually includes the use of hydroxy acids, enzymes, or herbal peels. Chemical exfoliation is actually gentler on the skin compared to physical exfoliation. Chemical peels that contain hydroxy acids are keratolytic agents that dissolve the cellular bonds that hold dead keratinized cells together, which can help to normalize the natural desquamation process. Exfoliation with hydroxy acids can create histological changes in the epidermis and dermis and allows the skin to become more permeable, allowing optimal penetration of topical cosmeceuticals. Chemical exfoliation can help to improve the skin’s barrier and function, strengthen the epidermis, stimulate cell renewal, and increase moisture retention in the skin. Ideally, chemical exfoliation of the stratum corneum can be used to manage and improve a variety of skin conditions.

Linda Gulla is a NSPEP physician-endorsed master aesthetician and is a published writer in cosmetic dermatology, whose material has been reviewed and endorsed by dermatologist Dr. Eric Schweiger, as well as the renowned Dr. Abdala Kalil. As a published writer, Gulla’s expertise can be found in the Milady Advanced Esthetics 2nd Edition. Gulla has shared her expertise with family physicians and dermatologists as an adjunct instructor with the National Procedures Institute, where her material was reviewed by over seven medical review boards and was ACCME accredited. Gulla is founder of the Institute of Advanced Aesthetics and Health Sciences and is recognized as an approved provider with the NCEA COA. Her online self-study program can be found at iaahs.com.

The endogenous cannabinoid system is one of the most important physiologic systems involved in establishing and maintaining human health. Endocannabinoids and cannabinoids are connected to other body systems, which allows communication and coordination between different cell types. Endocannabinoids and their receptors are found throughout the body in the brain, organs, connective tissues, glands, and immune cells. In each tissue, the cannabinoid system has various functions that work together to create homeostasis within the body. Homeostasis is the maintenance of a stable internal environment despite fluctuations in the external environment. The endocannabinoid system is a complexed system that works together with the immune system, nervous system, and all organs within the body.

The endocannabinoid system is involved in regulating a variety of physiological and cognitive processes – such as fertility, pregnancy, prenatal and postnatal development, regulation of appetite, pain sensation, mood, memory, learning, and immune system function – and in mediating the pharmacological effects of phytocannabinoids.

Cannabinoid Receptors

Cannabinoid receptors are embedded in cell membranes and are believed to be more numerous than any other receptor system within the body. When cannabinoid receptors are stimulated, a variety of physiologic processes occur. Researchers have identified two cannabinoid receptors: CB1 and CB2. CB1 receptors are predominantly found in the brain and nervous system, as well as in peripheral organs and tissues. CB1 receptors are the main molecular target of the endocannabinoid binding molecule, anandamide. CB2 receptors are predominantly found within the immune system and associated structures of the immune system. Many tissues contain both CB1 and CB2 receptors, each linked to a different action.

Endocannibinoids

Endocannabinoids are found within the endocannabinoid system and are endogenous lipid-based neurotransmitters that are released from cells within the body which activate and bind to cannabinoid receptors and cannabinoid receptor proteins. Endocannabinoids are localized, and have a short life before being degraded by enzymes such as the fatty acid amide hydrolase (FAAH) and monoacylglycerol lipase (MAGL).

Anandamide

Anandamide and 2-arachidonoylglycerol (AG2) are endocannabinoids that are synthesized on demand from cell membrane arachidonic acid derivatives. Anandamide is an endogenous analogue of tetrahydrocannabinol (THC) which binds to CB1 and CB2 receptors and is known to activate TRPV-1 receptors. TRPV-1 receptors are ion channel brain receptors activated by chemical irritants, inflammatory mediators, and physical mediators of tissue damage. The TRPV1 receptors are found in skin, tissues of the airways, gastrointestinal linings, and the outer coverings of the eye. The endocannabinoid anandamide has been identified in various areas of the brain and is thought to have a central role in neurogenic inflammation.

Endocannabinoids and the Blood Brain Barrier

Endocannabinoids can effectively penetrate the blood brain barrier, which is a highly selective semipermeable border that separates the circulating blood from the brain and extracellular fluid in the central nervous system. The blood brain barrier acts effectively to protect the brain from circulating pathogens, and may become leaky in select neurological diseases such as epilepsy or brain trauma. The blood brain barrier becomes more permeable during inflammation, allowing antibiotics and phagocytes to move across the blood brain barrier. When the blood brain barrier becomes more permeable due to inflammation, bacteria and viruses are then able to infiltrate the brain.

Human Microbiome and the Endocannabinoid System

Science is studying the effects of the gut (enteric nervous system) and the medulla (brainstem). Research shows that the quality of bacteria in the gut known as the human microbiome, is strongly implicated in the advancement of diseases and related mitochondrial dysfunction. The microbiome consists of a variety of microorganisms including eukaryotes, archaea, bacteria, and viruses. Bacteria – both good and bad – influence mood, gut motility, and the brain.

Studies have shown that there is a strong connection between the human microbiome and the endocannabinoid system. Gut microbiota modulate intestinal endocannabinoids, as well as endocannabinoid signaling. Gut microbiota mediates communication between the central and the enteric nervous systems known as the gut brain axis. The enteric nervous system (gut) consists of a mesh-like web of neurons that covers the lining of the digestive tract. The enteric nervous system generates neurotransmitters and nutrients, sends signals to the brain, regulates gastrointestinal activity, and plays a major role in inflammation.

The Human Microbiome, Mitochondria, and Disease

The human microbiome also plays an important role in the health of mitochondria, which are present in every cell in the brain and body, except red blood cells. Mitochondria function as each cell power plant and are involved in regulating cell repair and cell death. Dysfunction of the mitochondria results in high levels of oxidative stress and is intrinsic to neurodegeneration and various disease states, including many neurological and metabolic disorders, obesity, type-2 diabetes, and Alzheimer’s. Studies have shown that gut microbes have the ability to produce inflammatory chemicals that can seep into the bloodstream and damage mitochondria. Damaged mitochondria caused by inflammatory chemicals were shown to contribute to disease pathogenesis.

Endocannabinoids and the Central Nervous System

Endocannabinoids are endogenous lipid based neurotransmitters that are released from cells within the body which activate and bind to cannabinoid receptors and cannabinoid receptor proteins. Cannabinoid receptors are expressed throughout the central nervous system which includes the brain and spinal cord. The central nervous system receives, processes, and sends information to the peripheral nervous system.

Peripheral Nervous System

Cannabinoid receptors are also found within the peripheral nervous system which is connected to the central nervous system. The peripheral nervous system includes all of the nerves that branch out from the brain and spinal cord and extend to other parts of the body including muscles, limbs, organs, and the skin. The peripheral nervous system plays a vital role in how information is communicated throughout the body.

The Effects of Cannabinoids on Neural Function

In clinical studies, cannabinoids have shown to play an important role in maintaining and regulating the processes of neurogenesis and neurodegeneration. In clinical studies, cannabinoids have been known to alleviate symptoms of stroke and traumatic head injuries, which provides an important link between cannabinoids and the immune system. With the onset of inflammation, cannabinoids work with immune cells to reduce the release of pro-inflammatory substances. In this way, cannabinoids can help to minimize pain, reduce damaged tissue, and promote regeneration of neural pathways (neurogenesis). Studies have shown that cannabinoids can help to reduce inflammation and are able to balance the immune system and functionality.

Cannabinoids and Psychological Homeostasis

In addition to regulating the body’s internal and cellular homeostasis, cannabinoids can influence human behavior with the external environment. Administration of cannabinoids was shown to alter human behavior in a positive way by mediating neurogenesis, neuronal plasticity, and learning. The cannabinoid system is a mechanism that works with states of consciousness to promote health or disease.

The Cutaneous Endocannabinoid System

The skin is an organ that possesses all the elements of the endocannabinoid system, such as endocannabinoid compounds anandamide (AEA) and 2-arachidonoylglycerol (2-AG), as well as CB1 receptors and CB2 receptors. The skin also contains TRPV-1 receptors of cannabinoids and the enzymes involved in the synthesis and metabolism of endocannabinoids, such as FAAH and MAGL. In the skin, TRPV-1 receptors are activated as a response to chemical irritants, inflammatory mediators, and physical mediators of tissue damage.

Various elements in the endocannabinoid system are involved in key mechanisms of skin regulation, such as controlling the growth of the epidermis and skin annexes, cell survival, immune and inflammatory responses, the transmission of sensory stimuli to the central nervous system, and the synthesis of lipids, among other functions.

Naturally Found Cannabinoids

Omega-3

In the body, cannabinoids are produced naturally from omega-3 fatty acids. According to studies by the National Academy of Sciences, cascading chemical reactions within the body convert omega-3 fatty acids into cannabinoids that bind to CB2 immune system receptors demonstrating anti-inflammatory benefits.

Phytocannabinoids

Naturally occurring cannabinoids, such as phytocannabinoids, are plant substances that have the ability to stimulate cannabinoid receptors in the body. Most phytocannabinoids have been isolated from the plant cannabis sativa, which depends on its own cannabinoids for survival and to prevent disease. Cannabinoids found in phytocannabinoids have potent antioxidant properties that protect the leaves and flowers from ultraviolet radiation by neutralizing free radicals. In the body, phytocannabinoids provide antioxidant protection from free radicals that can cause aging, cancer, and impaired healing. Antioxidants found in plants have long been promoted as natural supplements to prevent free radical damage, and are commonly used to protect the skin from aging and skin cancer.
Phytocannabinoids, such as cannabidiol (CBD) and cannabinol (CBN), have been isolated from the cannabis sativa plant and have shown the most potential in demonstrating healing properties. The latest in medical science are the benefits of cannabis oil, also known as CBD oil. Cannabis oil can contain over 113 cannabinoids and is known for its medicinal benefits and potent anti-inflammatory abilities.

Phytocannabinoids can also be found in plants and essential oils, as well as found in flavonoids. Flavonoids are found in polyphenols, such as green tea, and have potent antioxidant properties. Medicinal herbs, such as echinacea purpura, have been found to contain non-psychoactive cannabinoids, as well.

Terpenes and Sesquiterpenes

Phytochemicals, such as terpenes and sesquiterpenes, are known to act on a variety of neurotransmitters and receptors in the body. Terpenes are commonly converted to linalool, which is found in lavender oil, and is known for healing skin burns with little-to-no scarring. Sesquiterpenes, such as beta-caryophyllene, has shown to stimulate CB2 cannabinoid receptors. Sesquiterpenes are not only a terpene, but are the first known cannabinoid that is non-exclusive to hemp. Sesquiterpenes can be found in essential oils, which have the ability to penetrate the blood brain barrier with numerous therapeutic benefits.

Topical Herbal Cannibinoids

Studies have shown that the skin has cannabinoid receptors and can be managed and improved with the use of topical herbal cannabis. In clinical studies, the immune inhibitory effects of topical THC influenced the interaction of T-cells, keratinocytes, and myeloid immune cells, and has shown to reduce contact allergic swelling and myeloid immune infiltration. Topically applied, THC was shown to effectively reduce contact allergic inflammation by decreasing keratinocyte-derived pro-inflammatory mediators that have stimulated by myeloid immune cell infiltration and independent of CB1 and CB2 receptors. Topical phytocannabinoids were shown to reduce inflammation and may be optimal in managing inflammatory skin diseases, such as rosacea or atopic dermatitis, as well as autoimmune skin diseases, such as psoriasis and scleroderma.

Synthetic Cannibinoids

Other types of cannabinoids are synthetic cannabinoids, which are produced in laboratories and can be used to control severe seizure disorders and anxiety. Synthetic cannabinoids are FDA-approved and are commonly prescribed in the medical field to manage disease states.

The endocannabinoid system is designed from conception to create and maintain homeostasis balance within the body. A functional endocannabinoid system works with various systems in the body to reduce inflammatory responses and strengthen immunity and is essential for overall health.

In clinical studies, phytocannabinoids do interact with the body’s endogenous cannabinoid system by signaling the body to make more cannabinoid receptors. More cannabinoid receptors produced by the body will help to increase the body’s sensitivity to cannabinoids.

Scientific inquiry, as well as treatment outcomes, indicate that herbal cannabis has superior medicinal benefits compared to synthetic cannabinoids. Herbal cannabis contains over 113 natural cannabinoids which cannot be duplicated with synthetic derivatives. Studies have shown that phytocannabinoids can enhance the body’s own endocannabinoid system, providing optimal health and preventing disease. Herbal cannabis can be administered through supplements or vaporizers or can be applied as a topical salve to manage inflamed skin conditions. Integrating phytocannabinoids for overall health, as well as homeostasis and health of the integumentary system, is now the latest in medical and dermatological science, with further research ongoing for overall skin health.

Linda Gulla is a NSPEP physician-endorsed master aesthetician and is a published writer in cosmetic dermatology whose material has been reviewed and endorsed by dermatologist Dr. Eric Schweiger, as well as the renowned Dr. Abdala Kalil. As a published writer, Gulla's expertise can be found in the Milady Advanced Esthetics 2nd Edition. Gulla has shared her expertise with family physicians and dermatologists as an adjunct instructor with the National Procedures Institute, where her material was reviewed by over seven medical review boards and was ACCME accredited. Gulla is founder of the Institute of Advanced Aesthetics and Health Sciences and is recognized as an approved provider with the NCEA COA. Her online self-study program can be found at iaahs.com.

When young aestheticians start out in their new journey, the opportunities are endless as to the direction of their career. At first, newly licensed aestheticians are eager to begin their careers and experience the fulfillment of her learning. As their careers progress over time, these aestheticians will discover what they love most about their field and may choose to pursue extensive schooling in one aspect of the field. When deciding to change career direction, these aestheticians have various avenues that can be chosen.

Problem: Rosacea

Rosacea is a chronic skin disorder that primarily effects facial skin. Those afflicted with rosacea are often plagued by persistent symmetrical flushing and redness on their cheeks, forehead, chin, and nose. The redness may be accompanied by small, red, solid bumps or pimples and visible blood vessels at the surface of the skin called telangiectasias or spider veins. Other symptoms may include eye irritation, facial burning or stinging, very dry appearance to the skin, raised red patches of skin, skin thickening known as hyperplasia, and edema. Rosacea can manifest in a variety of ways.