Tuesday, 28 October 2014 06:51

The Key Three: Be Prepared for These Disorders

Written by   Kristina Valiani, L.E.

Aestheticians are in the unique position to observe many skin disorders and some diseases. Even though it is out of the aesthetician’s scope of practice to treat skin diseases, having knowledge is power, and skin care professionals should be able to recognize disorders and diseases that require medical referral to a physician or dermatologist. Many chronic conditions require treatment from both a physician and aesthetician; these include keratosis pilaris, acne, rosacea, and skin sensitivities. Many clients struggle with three common skin diseases that are not properly understood by aestheticians.

Dermatitis
Dermatitis is a general term that describes an inflammation of the skin. Although dermatitis can have many causes and occurs in many forms, this disorder usually involves an itchy rash on swollen, reddened skin.Main2

Contact Dermatitis
Contact dermatitis activates when skin comes into contact with a sensitizing agent. The result is an immune response that causes inflammation in the tissue. Allergic contact dermatitis, also known as ACD, is one type of contact dermatitis and is an allergic reaction in the skin due to contact with a specific substance. The rash could be caused by an allergy or by damage to the skin.
If it is caused by an allergy, the client’s immune system is involved. After skin touches something, the immune system mistakenly thinks it is under attack. It jumps into action, making antibodies to fight the invader. A chain of events takes place that causes a release of chemicals like histamine. In this case, that is what causes the allergic reaction, an itchy rash – allergic contact dermatitis.
Usually, a client will not get a rash the first time their skin is touching something to which they are allergic. But it sensitizes the skin and a client will have an allergic reaction the second time their skin touches it. If a client gets a rash the first time, it is likely they were exposed to the allergic trigger previously and did not know it. Common allergic reaction triggers are:

  • Poison ivy, poison oak, and poison sumac
  • Hair dyes or straighteners
  • Nickel, a metal found in jewelry and belt buckles
  • Leather (chemicals used in tanning leather)
  • Latex rubber
  • Citrus fruit, especially the peel
  • Fragrances in soaps, shampoos, lotions, perfumes, and cosmetics
  • Medications that are applied to the skin
  • Fabric softener
  • Pesticides

Main3Treatment For Contact Dermatitis
Aestheticians should not treat contact dermatitis; the client should be referred to a physician or dermatologist to properly diagnose and create a treatment plan. Physicians treat contact dermatitis topically with evaporative measures. These measures include the application of cycles of cool water compresses followed by drying. Once the excretion has stopped, the client can apply potent topical steroids two to three times a day to affected areas for two to three weeks. The medications are generally prescribed by the client’s physician. If the area of involvement is too extensive to make topical treatment practical, it may be necessary to treat with oral systemic steroids for two to three weeks. It will usually take two to three weeks for the allergen to be entirely removed from the skin so that the rash resolves entirely. It is recommended that all aesthetic services be delayed until the client’s physician releases them for skin care treatments.

Allergies In The Skin Care Business
Eventually, all skin care professionals will have to handle a client with allergic contact dermatitis, even when the skin care treatment is given exactly as the protocol states while practicing safety and sanitation. The most common type of allergen in skin care products and cosmetics is fragrance. Reactions are not always caused by fragrance, but with the chances so high, it is common to use skin care products with little to no fragrance for best results. Preservatives are another common cosmetic allergen. Individuals have reactions to formaldehyde-releasing preservatives like imidazolidinyl urea, diazolidinyl urea, and quaternium 15.

Atopic Dermatitis
Atopic dermatitis (also referred to as eczema by physicians) is a condition that makes skin red and itchy. While it is common in children, it can occur at any age. Atopic dermatitis is chronic and tends to flare periodically and then subside. It may be accompanied by asthma or hay fever. Scientists have yet to discover a cure for atopic dermatitis, but treatments and self-care measures can relieve itching and prevent new outbreaks. Almost anything can trigger atopic dermatitis, preceding excessive itching, scratching, and rashes. Common triggers for atopic dermatitis are:

  • Wool
  • Shampoos
  • Hair dyes
  • Nail polish
  • Jewelry
  • Deodorant
  • Excessive heat or air conditioning 
  • Bathing too often or using harsh soaps (stripping skin of protective lipids)Main4

Skin care professionals can educate clients who frequently suffer from atopic dermatitis to maintain a healthy surface barrier function, preventing dry or irritated skin. When the protective barrier is damaged, it leaves the skin more vulnerable to dangerous invaders and allergens. The use of a gentle cleanser, along with gentle toners and moisturizers filled with antioxidants and anti-inflammatories, will be helpful in preventing breakouts. Instructing clients to discontinue prolonged hot showers and the use of jacuzzis will also increase their chances of keeping the skin from a breakout. Common triggers found in skin care products are:

  • Peppermint oil
  • Menthol
  • Alcohol
  • Camphor
  • Eucalyptus
  • Synthetic fragrance 
  • Essential oils
  • Bath salts

Main5ROSACEA
Rosacea is a stubborn skin disorder that is frustrating and difficult for the client and aesthetician to treat. Rosacea develops over a period of time and is typically not addressed to a physician until many years after seeing the symptoms. There are a few theories, but research has not discovered what exactly causes rosacea. Several lifestyle factors can make rosacea worse, such as eating spicy foods, drinking hot liquids, exposure to extreme temperatures or sunlight, alcohol consumption, stress, and smoking.

Skin Care Treatment For Rosacea
Skin care professionals can perform treatments on clients diagnosed with rosacea when the skin is not flared. Avoid any heat throughout the treatment, use cold compresses instead of hot towels, and eliminate the use of a steamer completely. Aggressive massage, excessive extractions, and cleansing with a harsh cleanser should be eliminated due to over-stimulating the skin. A massage technique that can be used for rosacea clients is light effleurage and tapotement.
The objective with a skin care treatment for rosacea clients should be to cleanse the skin and calm any redness. The client should complete a health care form. Be sure to inform the client on possible side effects of treatment and how it can affect their disorder.
Tools and supplies should include gloves, 4 by 4 inch cotton guazes, cotton rounds, disposable sponges, a spatula, cryoglobes, and a mask brush. During the treatment, certain products should be preferred, such as: a fragrance-free cleanser with soothing properties; a moisturizing toner; a gentle enzyme exfoliator (skin if the skin is too sensitive for the enzymes); a soothing serum; a hydrating gel mask; and a soothing day cream with SPF 15.
Treatment protocol:
Cleanse – Choose a fragrance-free cleanser with soothing ingredients such as aloe vera, matricaria, or chamomile. Apply cleanser directly to skin with gloves and use small, circular movements and light pressure. Using a brush or other device during the cleansing step will likely activate sensitivity.
Cleanser Removal – Remove cleanser, using cool wet cotton. Apply hydrating toner with cotton round.
Analyze – Carefully examine the skin beneath a magnifying lamp. Take notes of your analysis. Ask your client questions that will help you understand how and what they need education on: How long have you been diagnosed with rosacea? What has your physician recommended for treatment and prevention of flares? What skin care products are you currently using?
Cool Steam and Enzyme Exfoliator – As mentioned before, using warm steam is not recommended when working with rosacea clients. If your steamer has an option for cool steam, that can be used. Using an enzyme exfoliator is optional depending on how your client reacts to stimulation. Rinse exfoliant with cool compresses.
Extractions – When working on a client with rosacea for the first time, it is best to skip extractions all together. The initial treatment is meant to fully understand the client’s skin and how sensitive the skin reacts. If you are established with your client, gentle extractions are appropriate. Apply a hydrating toner after extractions.
Treat and Massage – Apply a fragrance-free hydrating fluid or light cream to the skin. Gently massage the fluid/cream into the skin with pressure from your fingertips, using effleurage movements. Light tapotement is beneficial as well. If the skin begins to redden, discontinue massage. 
Main7Cryoglobes – Unfold a gauze square and lightly apply it across the face. Gently secure it to the skin with light pressure. Apply cryoglobes (small plastic or glass handheld globes that contain a refrigerant fluid that retains the cold). These should be kept in the freezer while not being used. Gently glide the globes in a symmetrical pattern with equal amounts of pressure on each side of the face.
Mask – Apply a cooling gel mask to the skin. The mask will help hydrate and cool the skin, reducing redness. Do not use a mask that can harden. Remove mask with cool gauze.
Tone – Reapply the hydrating toner with a cotton round.
Hydrate and Protect – Apply soothing day cream with SPF 15 to protect the skin’s transepidermal water loss and sun damage.

PSORIASIS
Psoriasis is a medical condition that occurs when skin cells grow too quickly. Faulty signals in the immune system cause new skin cells to form in days, rather than weeks. The body does not shed these excess skin cells, so the cells pile up on the surface of the skin and cause lesions to form.
Psoriasis is not contagious. You cannot get psoriasis from physical contact. Psoriasis is much more complex. It is so complex, in fact, that scientists are still studying what happens when psoriasis develops. What we know is that a person’s immune system and genes play key roles in developing the disease. Scientists discovered that when a person has psoriasis, the T cells (type of white blood cell that fight unwanted invaders such as bacteria and viruses) mistakenly trigger a reaction in the skin cells. This is why you may hear psoriasis referred to as a T cell-mediated disease.
This reaction activates a series of events, causing new skin cells to form in days, rather than weeks. The reason T cells trigger this reaction seems to lie in DNA. People who develop psoriasis inherit genes that cause psoriasis. Unlike some autoimmune conditions, it appears that many genes are involved in psoriasis.
Scientists have also learned that not everyone who inherits genes for psoriasis gets psoriasis. For psoriasis to appear, it seems that a person must inherit the right mix of genes and be exposed to a trigger. Some common triggers are a stressful life event, skin injury, and having strep throat. Many people say that that psoriasis first appears after experiencing one of these. Triggers are not universal. What triggers psoriasis in one person may not cause psoriasis in another.

Types Of Psoriasis
Psoriasis appears in several forms. Plaque psoriasis is found to be the most common and scaly and papule-like skin. Other forms include guttate psoriasis, which is small and dotted in appearance and all over the body. Pustule psoriasis looks more intense because of its excessive scales. Lastly, erythrodermic psoriasis is characterized by severe sloughing and inflammation of the skin.

Nail Psoriasis
Even though flaky, red lesions on the surface of the skin are the most obvious traits of psoriasis, nails can be affected over 50 percent of the time. The nails can be affected in the form of pitting, lifting of the new nail away from the nail bed, white discoloration, and ridges.Main8

Skin Care For Psoriasis
As with any sensitive skin disorder, skin should be treated with gentle skin care products. Since psoriasis is an inflammatory condition, use products that contain no fragrance and many antioxidants and anti-inflammatory ingredients. Gentle cleansers, instead of scrubs, as well as avoiding anything that dries the skin and disrupts the skin’s barrier, are an essential starting point. Protect the skin’s barrier with emollients, antioxidants, and cell-communicating ingredients like peptides and retinol. This allows skin to heal and maintain its natural defense that healthy skin provides.

Psoriasis And Sun
Psoriasis is one of the only skin diseases that benefits from sun exposure. According to the National Institute of Health, natural sunlight can significantly improve or even clear psoriasis. Ultraviolet light from the sun suppresses the skin’s immune response and damages production of skin cells, slowing the overproduction of cells and reducing inflammation. Using the sun as a way to clear psoriasis should be cautiously practiced. Daily, short, non-burning exposure to sunlight with adequate sun protection is crucial. Sun protection is vital, not only to prevent sunburn, which may make psoriasis worse, but also to reduce damage to the skin. This approach is commonly referred to as climatotherapy or phototherapy. Some clients battling psoriasis travel to Florida, Hawaii, the Caribbean, or even the Dead Sea in Israel where special clinics offer treatments specifically for psoriasis.

Prescription Treatments
Coal tar is an old effective remedy and a great deal of research shows its success when treating many forms of psoriasis. Coal tar is a topical medication available to clients, both over the counter and by prescription. The difference between the two options is its potency and the amount of coal tar the medication contains. What does coal tar do exactly? It inhibits certain substances that trigger cell proliferation and reduces the appearance of psoriasis. Coal tar can make the skin more sensitive to ultraviolet light; extreme caution is advised when combining the use of coal tar and ultraviolet therapy.
Anthralin is used to inhibit cell proliferation. The medication has few serious side effects but can irritate the surrounding affected area. The medication also stains almost anything with which it comes in contact.
Vitamin D3 has a great deal of published research to support its claims to treat psoriasis. Vitamin D3 is not the same compound found in vitamin D supplements that are commonly ingested. Vitamin D3 inhibits cell proliferation and enhances cell differentiation in the skin of clients with psoriasis, but also appears to have effects on immunologic markers that play a role in psoriasis.
Prescription topical corticosteroids have been used for years as a first-step approach to treating psoriasis. Cortisones reduce inflammation, itching, and reduce cell buildup. Side effects can be burning, irritation, dryness, acne, thinning of the skin, and dilated blood vessels.
Topical retinoids have been shown to have a positive effect on psoriasis, particularly in combination with other treatments. Side effects include irritation, burning, and flaking skin.
Salicylic acid in strengths of one to three percent is approved by the Federal Drug Administration as an over-the-counter treatment for psoriasis. Since salicylic acid is a keratolytic, desmosomes can break down proteins, which hold the cells together. This encourages cell turnover. Salicylic acid is related to aspirin; it has anti-inflammatory properties and can reduce the redness and inflammation associated with psoriasis. Salicylic acid is found in several forms such as liquid, gel, lotions, and creams. A well-formulated salicylic acid product is a great option to have available at a spa for many skin conditions, especially clients battling psoriasis.
Derived from the argan tree, argan oil has been used for the treatment of psoriasis and has a popular following for a more natural solution. However, there is no published research showing it has any benefit more than being an emollient.
Methotrexate is a systemic anti-cancer drug that can reduce the overproduction of cells, which is helpful in the treatment of psoriasis. However, studies show conflicting research concerning its effectiveness despite its use during the last three decades. Long-term and adverse adverse effects of methotrexate are well known. The most frequent side effect is abnormal liver function, nausea, and gastric complaints.
Cyclosporin is a strong immune-suppressant drug and a primary medication used to prevent the rejection of transplanted organs such as the liver, kidneys, and heart. In skin diseases, cyclosporine acts by reducing inflammation in the skin and reducing cell proliferation by blocking immune factors that may be generating the problem. Studies have shown cyclosporine to be effective and well tolerated during short-term treatment of severe psoriasis.
Oral retinoids are used to treat psoriasis by blocking the overproduction of skin cells. The substantial amounts of data on the clinical effectiveness of these treatments, either alone or in combination with other therapies such as sunlight or etanarcept, makes them great options, according to the European Journal of Dermatology.

Combination Therapy
The most commonly used combination therapy for psoriasis is something called PUVA, which involves the use of a prescription medication called psoralen and exposure to UVA light, hence the initials PUVA. It is also referred to as photochemotherapy because psoralen functions similar to other types of chemotherapy used for cancer treatment.

Dermatologists dedicate years to understanding skin disorders in order to properly differentiate symptoms. Since so many skin disorders and diseases have many similar symptoms (itching, burning, redness, flakey, and so on), it has been said that dermatologists have a very complex specialty. As skin care professionals, we are not required to know every skin disorder and disease, but we can often be the first person to bring light to a skin concern if it is referring a client to a physician or recommending a product to cope with the disorder’s symptoms. I encourage skin care professionals to devote time to continue learning and refreshing their memory on these skin diseases that we see all too often in clients.

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Kristina Valiani is a licensed aesthetician and national sales manager for leading skin care brand B. Kamins. Valiani conducts retail and business courses to spa professionals across North America, while serving on the Washington State Aesthetician Advisory Board. This email address is being protected from spambots. You need JavaScript enabled to view it.

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