Eczema is a general term used to describe inflammatory skin conditions exhibiting one or more of the following characteristics (depending on the severity and type of eczema): dryness associated with redness and itching, raised patches, cracks,  swelling, small blisters, oozing of a pale yellow or transparent fluid, red or brownish grey patches, raised skin with greasy looking patches, crusty flakes, burning, rash, and scaling.

TYPES OF ECZEMA
There are several different types of eczema, such as atopic dermatitis, contact dermatitis, dyshidrotic eczema, nummular eczema, seborrheic dermatitis, and stasis dermatitis.

The most common types of eczema aestheticians will encounter are atopic dermatitis, contact dermatitis, and seborrheic dermatitis. We will discuss those in more detail.

Atopic dermatitis can range in appearance – from dry, itchy, red, raised patches to irritated, crusty, oozing, cracked, scaling, and discolored patches of skin – depending on the level of distress the skin has reached.

Contact dermatitis may often have the same symptoms as atopic dermatitis, but is the direct result of the skin coming into contact with an irritant. Once the irritant is identified and removed and the skin barrier is repaired, the skin will recover, so long as the irritant is not reintroduced.

Seborrheic dermatitis can vary in appearance, as well, depending on the level of distress the skin has reached. It can exhibit mildly, as redness with itching and burning, or can appear more severe, with swollen, raised, greasy-looking patches, often accompanied with white or yellowish crusty flakes. Seborrheic dermatitis generally appears where there are a lot of oil-producing sebaceous glands.

WHAT CAUSES ECZEMA?
Researchers do not know the exact causes of eczema, but concur multiple internal and external factors are likely involved.

People with eczema are likely to have a heightened or over-active immune response. This heightened immune response, when combined with a trigger inside or outside the body, can set off an inflammation cascade, resulting in chronic inflammation. It is this chronic inflammatory response that causes the painful symptoms associated with eczema.

Research shows that some people with eczema have a mutation of the gene responsible for creating the protein filaggrin. This protein helps our bodies maintain a healthy protective barrier in the epidermis. Without enough filaggrin to maintain the skin’s outer barrier, moisture escapes and the skin becomes prone to invasion by bacteria and viruses. A filaggrin deficiency is one of the reasons people with eczema tend to have very dry skin and, therefore, infection-prone skin.

IDENTIFICATION AND FACTORS TO CONSIDER
An initial client consult that includes a thorough intake form and interview, in addition to the physical examination of the skin, will serve as the basis for diagnosing the presence and type of eczema. The most important thing we can do as aestheticians in treating eczema is to have clients eliminate as many triggers as possible and recommend products that will repair the skin barrier. A client’s compliance and consistent homecare are critical to strengthening their natural barrier and reducing eczema flareups.

A note of caution: be clear with the client at what point the condition is manageable through aesthetic practices and at what point temporary medicinal solutions should be sought in order to return the skin to an aesthetically manageable level.

ELIMINATING TRIGGERS AND IRRITANTS
Environmental or “choice” irritants should be eliminated as best as possible. Have clients abide as follows:

• avoid products containing: artificial fragrance (natural or synthetic), artificial colorants, sodium lauryl sulfate, sodium laureth sulfate, alcohol, alpha hydroxy acids (with a pH below 4.5), or beta hydroxy acids (with a pH below 4.5)
• avoid any treatments or products that would further compromise the skin’s barrier, such as microdermabrasion, aggressive peels, scrubs, or dermaplaning
• use household surface cleaners and disinfectants with nitrile gloves to protect the skin.
• use laundry detergent that is fragrance- and colorant-free, avoiding chlorine bleach and dryer sheets
• avoid extreme heat and cold, allergens, chronic stress, foods that cause inflammation (processed), unprotected sun exposure, smoking, and over consumption of alcohol

REPAIRING AND STRENGTHENING THE SKIN BARRIER
Clients who suffer from eczema need to be educated that this is a condition they will likely be dealing with for life and need to treat it as such by focusing on keeping the skin healthy (inside and out) and the barrier intact.

The following protocol for treating eczema focuses on calming, comforting, nourishing, feeding, repairing, and fortifying the skin barrier. Focus on products that utilize nutritious plant oils, vitamins, mineral rich clays, gentle botanicals, and protective zinc oxide to meet standards for calming, nourishing, repairing, and ultimately protecting the skin.

IN-CLINIC TREATMENT PROTOCOL
Cleanse to remove makeup. Apply a calming cleansing oil to the client’s skin. Perform a cleansing massage adding water as needed. Gently remove the cleanser (using the press and pickup method) with a luke warm microfiber towel or damp 100 percent cotton four by fours.

Cleanse the skin again. Apply a calming cleansing oil or gentle cleansing cream to the client’s face, neck, and décolleté. Perform a gentle hydrating cleansing and relaxing massage for 10 to 15 minutes, adding product as necessary to maintain slip. Once more, gently remove the cleanser (using the press and pickup method) with a luke warm microfiber towel or damp 100 percent cotton four by fours.

Gently exfoliate the client’s skin. If their skin is in an extremely irritated state, skip this step. Apply a gentle enzyme mask with a fan brush to their face, neck, and décolleté, covering the client’s eyes with soothing eye pads and allowing the enzyme to sit 5 to 10 minutes, depending on the client’s skin condition. Gently remove the enzyme (using the press and pickup method) with a luke warm microfiber towel or damp 100 percent cotton four by fours.

Apply a blend of calming, nutrient-rich oil to the client’s face, neck, and décolleté and gently massage the skin for approximately 10 minutes.

Perform a pressure point massage to encourage lymphatic drainage for approximately 10 minutes. Remove excess oil with a damp 100 percent cotton four by four.

Apply a calming cream mask to the client’s face, neck, and décolleté with a fan brush. Allow the mask to sit for 10 to 12 minutes. Gently remove the mask (using the press and pickup method) with a luke warm microfiber towel or damp 100 percent cotton four by fours.

Apply the appropriate calming eye care, lip care, serum, moisture cream, and sunscreen.

BASIC HOMECARE TREATMENT PROTOCOL
Educate clients on the following protocol to supplement their treatments at home:

• calm and comfort the skin by cleansing twice daily with a calming oil cleanser, moving to a calming cream cleanser, if desired, once the compromised barrier has been repaired
• nourish by applying a calming eye cream twice daily
• repair the skin twice daily by applying a calming, nutritious oil serum, moving to a calming emulsion, if desired, once the compromised barrier has been repaired
• fortify the skin by applying a calming moisture cream twice daily
• protect the skin with zinc oxide or titanium dioxide broad-spectrum sunscreen daily

Michele Corley is the founder of Michele Corley Clinical Skin Care, a nationally-distributed, premium, professional-use-only skin care line based in Napa, California. Corley’s mission is simple: to provide efficacious products that deliver superior results and to back it up with exceptional customer service. Every Michele Corley Clinical Skin Care product is crafted with care and consideration to the health and well-being of the skin. Corley believes her clients’ success is as important as her own and values everyone she has the pleasure to work with.  She loves to say, “if my clients are successful, so am I.”