Wednesday, 27 January 2021 10:38

Compromised Connections: Diagnosing and Working with A Compromised Barrier

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Most aestheticians face clients with a compromised barrier several times a day.To provide the best services and achieve the ideal outcomes without inflaming the client’s skin, it is essential that every aesthetician knows the signs of a compromised barrier.Once this has been identified, it is also critical to know what limitations are necessary in such cases.

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BARRIER FUNCTION

The epidermal barrier provides five important functions, including protection from infection, prevention of absorption of unwanted substances, protection from the elements, prevention of moisture loss, and durability with daily contact and activities.The bottom line is that an intact barrier is critical for good skin health, including proper moisture levels, reduced ultraviolet damage, and aging.A known philosophy is that if a client is exfoliating away their barrier lipids and layers every day or many times a week, their skin is being forced to work even harder to maintain itself.This means that valuable nutrients related to dermal collagen and maintenance are being diverted away for this newly created burden.The skin’s cellular turnover rate does not need outside help.The only reason skin slows down its turnover rate is because it has a limited supply of the nutrients it needs, and it may take 40 days to complete a turnover cycle. This is not a defect of the skin, it is an intelligent response to the ever-shrinking supply of vitamins, fats, minerals, and proteins that drop by about 1% a year in adulthood.Exfoliating often only serves to drain that supply even further. Alcohol or acid-based toners, physical devices or scrubs, and certain ingredients like acids, most retinols, and other chemicals are all guilty of weakening the barrier.

For compromised barriers that are not self-induced, the starting point is to remember that the skin works around the clock.The barrier can be limited by physiologic or nutrient shortages resulting from chronic inflammation (rosacea) or a weak immune system (from disease or medication mostly) that limits the skin’s activity. Rosacea often results in a constant state of inflammation and repair that can steal from what is needed for an intact barrier.Similarly, when an individual is sick, the focus of the immune system (which is inseparable from the skin’s immune system) can be elsewhere, and this preoccupation prevents healthy repair and maintenance activity of the skin.Both of these sources of a compromised barrier can be deduced from taking a skin and health history, as well as through an examination.

EXAMINATIONS

A physical examination of the skin is best done after cleansing because that is when it is easier to see mild peeling, contact-generated redness, and other possible signs like dull, oily, or texture changes in skin.If a client says they are sensitive to many different types of skincare products or ingredients, that is a strong indicator.If they describe having an oily T-zone, there is a pretty good chance that they have dehydrated skin overall and that is often a sign of barrier issues. For oily skin and T-zones, the first question to ask is about their daily routine with product and ingredient choices as part of the consultation.About half of oily skin cases are from dehydrated skin increasing sebum output as a protective mechanism to their overly exfoliated, dry skin and half are from estrogen toxins causing a testosterone imbalance, resulting in more oil in their skin. The client’s skin history will help figure this out.

FACIAL TREATMENTS

Facials should be focused on products that preserve or support barrier health for these clients.One should be careful not to overstimulate their skin with actives.Homecare should exclude exfoliation going forward.A lipid for temporary barrier protection is phosphatidylcholine because it does not trigger a slowing of turnover like ceramides have been shown to do.It clinically proves moisture support and ultraviolet-B protective properties.Superfoods like sea buckthorn oil can be a great source for feeding a healthy barrier from within. With inflammatory skin conditions, the key for their barrier health is to address the internal sources of their issue and to calm the skin from the surface.Face masks can contribute to dryness, sometimes from constant rubbing of those areas, but is more likely the client’s barrier was compromised beforehand, and the mask is only serving to exacerbate the problem. Moisturizers are also not the solution, as they can increase moisture losses because of the emulsifiers they contain. Focus on gut health for rosacea sufferers because that is the source of their condition. 

Always take an inside-out approach to barrier challenges for best results since topicals provide only temporary relief at best. Even so, it is still important to take a knowledgeable approach when working with clients who have compromised skin barriers. Overstimulation is often the culprit, and it can be difficult to understand that less is sometimes more. 

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