COMMON SKIN PROBLEMS AND THE SOLUTIONS

Although every client is an individual and has unique needs, there are always common problems that they will bring to your salon. These are the “bread and butter “ skin problems of any beauty therapist’s clinic. On this occasion, I have chosen to cover four areas for you – the red stuff, the brown stuff, bumps and hair.

RED STUFF

By red stuff I mean any type of red discolouration of the skin. Most of us know that this generally comes from sun damage and prolonged periods of time in the sun and can take different forms. Many clients have a red discolouration can look like blusher across the cheek, around the chin and over the nose and the frown area. Some can present with “ red veins” or telangiectasiae (which in medical terms refers to broken capillaries). Often it is a combination of these two types of red skin problems.

And then you have the deep red skin across the cheeks and nose that gets worse in the sun, after coffee, alcohol and hot or spicy foods. This is Acne Rosacea, or Rosacea for short.

In dealing with the sun related red discolouration, some vitamins and botanicals can stabilise and help the appearance of redness. They do this by either acting as anti-inflammatories or as barrier enhancers.

Aloe vera and prickly pear can act as a mucilage (moist, viscous substance) to place a protective coating over the skin. In addition, aloe vera is rich in choline salicylate, an anti-inflammatory.

Other plant based anti-inflammatories include bisabol and allantoin.

There is actually a third category, which are those that reduce redness by improving the skin barrier – pantothenic acid ( Vitamin B5) is a humectant which hydrates and improves barrier function.

Finally, there are the anti-inflammatory polyphenols – the best studied is green tea which is the most potent.

Possible skin care ingredient recommendations for redness
1. Avoid toner or astringents as these products evaporate quickly form the skin and give the type of stimulation that could cause flushing and redness.
2. Use a cream based moisturizer ( rather than a lotion) with minimal water, so it doesn’t evaporate. Avoid ingredients that contain propylene glycol, glycolic acid, salicylic acid, strong perfumes, and extensive botanical cocktails as they can all irritate. Many sensitive skin moisturizers contain allantoin, bisabol and pantothenic acid.
3. Sunscreen should be a thicker cream labelled for sensitive skin and contain zinc oxide (a barrier sunscreen). Avoid chemical sunscreens such as oxybenzone because they work by absorbing UV radiation and converting it to heat – this may worsen facial flushing and redness.
4. The treatment moisturizer should contain green tea, as it’s the most potent botanical anti-inflammatory available. Also, consider good levels of petrolatum, dimethicone and low levels of glycerin so that water loss from the skin is prevented , skin hydration is enhanced, thus improving the skins barrier function.

Apart from a good skin regime to minimize the problem, the only treatment that does a good job of wiping this out is intense pulse light (IPL) treatment. IPL is a broadband of light whose technology is similar to that of laser technology, only instead of one single wave length there is a broadband of light often somewhere from about 600nm to 1200nm. This light selectively is attracted to the red discolouration, heats that area, effectively “cooking” the tiny vessels involved and eradicating it. It feels like a hot rubber band flicking the skin. Typically, after a facial treatment, the skin is somewhat blotchy for around seven days but afterwards the results are very good.

IPL treatment will get all of the “flush ‘ type redness and many of the very fine broken capillaries but will not treat bigger vessels. These vessels need to be treated with a dedicated vascular laser if that is available. If it is not available, depending on the size of the vein, it may be possible for the therapist to treat this with electrical cautery or using an epilation machine. If you wish to use an epilation machine you need to have had enough experience in doing this and know that you will not create any scarring of the skin afterwards.

Rosacea is a red facial rash that commonly occurs in people aged 30-60 years of age, who typically have fair skin, blue eyes and are of Celtic origin. This red rash can be quite deep and sometimes have lumps in it. It can affect the nose and therefore cause a thick “drinkers nose” and can even affect the eyes and create a blepharitis with flaking, scaling and inflammation of the eyelids. We don’t know the cause of rosacea but we do know that it is an inflammation within the skin that causes these dilated blood vessels, general redness and red bumps.

Rosacea is an important condition to get under control because if left unchecked it can, in extreme cases, cause scarring. If you are having difficulty getting control of the redness over the malar or cheek area, and across the nose, then you should suspect rosacea.

The treatment of rosacea runs from foundation concepts like diet and fish oil to avoiding the triggers that cause the problem to flare up. Rosacea triggers commonly include alcohol, spicy food, hot foods, strong emotion and sunshine. The doctor will give them oral antibiotics or when severe, even strong medication like isotretinoin.

Rosacea clients need to avoid oily creams because they will irritate the skin further. Water based creams are a good idea. As mentioned already, some botanicals may help this condition, but beware that this skin is even more sensitive.

IPL can help somewhat, with some of the more difficult cases needing a combined approach. In my clinic, I use a dedicated 1064nm laser (which selectively treats the deep redness), a vascular laser, and sometimes an IPL for this condition – the first two treatments are virtually painless, which is good for older clients.

Those of you who only have access to an IPL will still be able to significantly help this condition. It is important to remember that you must avoid treating a client with any light or laser treatments is they have been on oral Tretinoin ( Roaccutane) in the last 6 months

However, the most important thing about rosacea is to suspect it early when the redness is not responding to your treatment. You should then refer them to their family doctor, a dermatologist, or a medical clinic with the appropriate expertise.

Another unusual cause of redness across the cheeks that may not respond to your treatment and that is also sun sensitive is the rash associated with an autoimmune disease called systemic lupus erythematosis. This is one of the conditions where the skin becomes sensitive to sun and causes this redness across the cheeks and nose. Once again referral to the client’s family doctor will help them sort this out.

BROWN STUFF

In most cases clients will come with brown blotches on their skin that is directly related to sun exposure. The ones that you can treat are the ones that are completely flat. The ones that are bumpy might be seborrhoeic keratoses (also known as senile warts) which can be treated by the client’s family doctor with liquid nitrogen. Seborrhoeic keratoses are lumpy, greasy looking areas that can be on the face or body.

Of course we know that prevention of wrinkles and brown discolouration from a lifetime of sun exposure is done by advising them of the ideal skincare regimen in the first place.

However, once the brown blotches are there you can treat them by enhancing the person’s skincare regime and in addition advising certain products that contain the following ingredients.

Pigmentation that is epidermal is easier to treat than pigmentation that is dermal. Never promise anything!

However, a retinoid will not only reduce wrinkles, protect the skin from further ageing and ultraviolet light but will help educe brown discolouration. Retinoids available include vitamin A, Retinol and Retiniol Parmitate. Add to this hydroquinone, and you have the foundation of the depigmentation skincare.

There are concerns about hydroquinone, however, because it can be cytotoxic ( poisonous) to melanocytes, and can cause irritation, and there is a risk, especially in darker skins, of inflammatory hypopigmentation. This has caused the development of a variety of botanical and vitamin pigment lightening agents – Kogic acid, glabridin, azaelic acid show the best promise by all acting as tyrosinase inhibitors.

Combining skin lightening agents with penetration enhancers like glycolic acid help. Also add pigment lightening vitamins eg niacinamide ( Vitamin B3) , retinol.

Vitamin C is also a tried and true product ingredient that is known to protect the skin and reduce brown blotches. Research has shown that 10% or above will work.

With all skincare for pigmentation, adding in simple salon procedures can enhance its ability to work. MIcrodermabrasion or peels help with epithelial pigmentation. Needling helps the skin care ingredients to penetrate better.

Intense pulse light can be as useful for brown blotches as it is for red blotches, especially if it is epithelial. In dark skinned patients with skin type beyond Fitzpatrick type 3, IPL is not advisable because of the risk of hypopigmentation. These patients would particularly benefit with an ideal skincare regime, the addition of microdermabrasion and even needling to help with reducing the brown blotches. Peels are not advised in darker skins because of the risk of post inflammatory hyperpigmentation.

Dark circles under the eyes are related to several factors including lack of sleep and chronic stress - not to be forgotten. After that, it is most likely to be due to the thinning of the skin with age and in smokers.

Lifestyle changes and stopping smoking are obviously a priority. Skincare that helps in this area includes anything that will build collagen under the eyes and that can include copper peptides, antioxidants etc.

Other substances known to reduce discoloration under the eyes includes azaleic acid and kogic acid.

I have experience with a non ablative laser that is used to build collagen under the eyes called but I do not know of any other lasers that can do this with no pain or down time. When it comes to laser and light therapies, another approach could be the types of semi ablative treatments like fractionated laser that could also be useful.

BUMPS

Milia are seen all the time on many people. They are common benign keratin filled cysts under the skin and contain sebaceous material. Milia can often occur after blistering or trauma to the skin or disruption of the sweat ducts. It can also be part of some skin conditions including bullous pemphigoid, inherited and acquired epidermolysis bullosa, bullous lichen planus, porphyria cutanea tarda. It can also occur from skin trauma after radiotherapy, ablative laser treatment or even after use of a potent steroid cream on the skin.

As you know, these will not respond to squeezing and this should be discouraged. They can be safely left alone. However, if the client requests treatment there are various methods that can be used. The commonest method can be a sharp superficial incision with the cutting edge of a needle or blade and then expression gently with the fingers or an implement. Another method can include freezing them with liquid nitrogen or even light cautery. There is no skin care that will make milia go away.

If the milia looks unusual or seems to be in unusual places or part of other rashes, then a referral to a dermatologist may be necessary.

Acne causes bumps and this occurs in teenagers and adults. I have written about adult acne two issues ago. In summary, teenage acne fundamentals need to involve eradication of sugar and starch from the diet because acne is caused by inflammation in skin from these substances. Adding in a multivitamin and fish oil will help the teenager.

In an adult woman who has had acne all her life or in some cases whose acne has started later on in life, her hormones need to be suspected. She needs to be referred to her doctor for help with this. Aside from that, the skin care that helps acne includes a retinoid to normalise the skin and the pyelo-sebaceous unit. Using glycolic acid away from the retinoid (because they do not go well together) is a good idea and this could possibly be in the form of a morning scrub. Glycolic acid acts to exfoliate the surface of the skin and unblock the pores as well as balancing the oil.

Botannicals that can be useful with acne include anything that is anti –inflammatory or helps with excess oil. Niacinamide reduces oil when used on the skin. Salicylic acid unblocks pores and removes oily residue, in addition to being an anti-inflammatory. Witch hazel removes excess sebum from the skin. Papaya acts as an enzyme to remove oil ans desquamate corneocytes from the skin surface. Retinol normalizes the pilosebaceous unit.

Clinic treatments for acne that are useful can include anything that will help exfoliate the skin like microdermabrasion or a facial peel.

Skin scarring from trauma or old acne scars is also commonly seen in the salon. I believe your best tool to help clients with scarring is the use of your microdermabrasion machine and in the use of a good home programme of skin care together with a needle roller. In the salon, the suction aspect of the microdermabrasion stimulates the mid dermis to activate fibroblasts which create collagen. At the same time the physical side of the treatment is softening and moving the skin. Prescribing your client a good skincare programme along with a needle roller will further stimulate the mid dermis layer with the roller at home but the added bonus will be that the skincare ingredients will get into the skin better because of the use of the needle roller.

There are different types of needle rollers available. The type that you need is the facial roller for this type of work. The use of a roller may enable you and your client to get even better results on top of just using the microdermabrasion +/- peel treatment.

HAIR

When it comes to hair, women either have too much or not enough. When it comes to too much, this is where waxing, electrolysis and IPL and laser treatments come into play.

It is when the pattern of the hair starts to become unusual or excessive that you may wish to refer your client to their doctor. Women with polycystic ovarian syndrome ( PCOS) often have excessive hair as well as facial acne. These clients will thank you when you refer them for medical help for the underlying cause of their problems which will usually involve hormonal imbalance and insulin resistance.

Hormonal imbalance in PCOS usually involves inadequate progesterone in the second half of the cycle. This is preferably dealt with via bioidentical hormones which are safer than synthetic hormones. Synthetic progesterone, called Progestins, increase the risk of Breast cancer by increasing dangerous Estrogen metabolites.

Insulin resistance is where the persons insulin levels start to increase in response to poor glucose handling of the body. These people often have more abdominal fat, and can’t lose weight. A low starch and sugar diet, along with fish oil,, magnesium and other useful vitamins for insulin resistance will help.

These days we have women from many different cultures and although initially they may look overly hairy, it is often normal for their culture.

Alopecia is when hair falls out of places it should remain, e.g. the scalp or the beard in men. Alopecia Totalis is a condition where all of the body’s hair falls out at once.

The cause of alopecia can often be unknown, however, in men and premenopausal women it usually is due to stress, drugs or a vitamin deficiency. In the case of the scalp, look for a dermatitis or a fungal infection.

In postmenopausal women with hair loss, it is usually in relation to the change in their hormones. This can be remedied by helping improve the balance of their hormones.

In all cases of Alopecia, a referral to their family doctor, or a dermatologist is useful.

In dealing with the “bread and butter” of skin problems, your skills in being able to assess and treat your clients concerns come into play. Good knowledge of what works well for each condition will enable you to do the best job for each problem.

It is important to identify when a client is not responding to your treatment, or when their condition seems unusual. Referral for a medical opinion is not only in your client’s interests but in yours.