The success of your treatment outcomes is depended on a thorough and accurate skin analysis on which you will determine an appropriate treatment plan. When addressing skin corrective strategies there are several considerations.
Dr Michael Freeman is a highly respected dermatologist and Associate Professor of Dermatology at Bond University in Queensland and a member of the Skin Cancer Foundation. Here he lays a foundation to key considerations when treating the skin and dermatological considerations.
Reviewing the epidermal barrier function
Let’s start with a review of the epidermal barrier function which takes place in the stratum corneum – the very top layer of the skin. As you are aware, the outer layer of the skin is structured like a brick wall with the cells being the bricks and the intercellular lamellar lipids being the mortar. This layer is flexible and semi-permeable and can regenerate if damaged. The protein matrix within the cells can bind water (the natural moisturising factor (NMF) but does not allow water to pass directly through them, therefore, the water loss through the skin is controlled. However, over-cleansing can reduce the NMF, together with the ageing process as well as UV light.
When the humidity drops, the skin can dry and this slows the breakdown of the attachments between the cells (corneodesmosomes). This can manifest scaling of the skin. The addition of a moisturiser, especially with an ingredient such as glycerine, can correct this process.
It is interesting to note that moisturisers actually put very little moisture into the skin, they simply slow the rate of moisture loss to normal. When attempting to restore the moisture levels of the skin there are key ingredients in a moisturiser that can benefit the skin. First, the most effective and most common occlusive ingredients to seal water loss are vegetable fats. Then a humectant binds water from the lower layers of the skin such as hyaluronic acid and glycerine. Emollients allow the preparation to feel good by filling in the cracks between the cells – jojoba and cetyl alcohol are common examples.
Effective skin treatment solutions
When it comes to the skin’s photo-ageing, as opposed to biological ageing, photo-ageing is much more preventable over a lifetime if you start young. Infrared radiation is now thought to speed the loss of elastin, so attention to preventing this needs to be considered with all skin protocol recommendations. Physical sunblock including makeup can help protect the skin from UV radiation and achieving this should be a priority.
Retinoids: When it comes to skin treatment ingredients common recommendations that have strong scientific validation are retinoids. These work at a profound level in the skin by affecting gene expression and causing enhanced collagen production, skin smoothing and also work on minimising pigmentation. However, retinoids will also thin the stratum corneum and should be used with caution, particularly with anyone who has significant ongoing exposure to the sun.
Peels: Peeling agents can be very helpful in increasing cell turnover and reducing surface oils in cases where this is a problem. Peels can be an effective strategy to improve the reflective quality of the dermis as well as help control acne. Try to use these at night so the stratum corneum has a chance to recover and better protect the skin from the sun.
Antioxidants: Studies confirm that antioxidants can reduce damage from UV radiation and pollution. Many agents are found naturally in most plants, vitamin C is just one of these. There is often an issue with how much is bioavailable to the skin, thus formulation is very important, this is why I have Atom Labs to design my product range to ensure the best possible bioavailability.
Peptides: Peptide serums are now able to increase collagen and elastin production. I believe new advances will only continue to improve formulations. Look for Matrixyl and Renovage as examples.
DNA Repair: The latest in the cosmeceutical toolbox are ingredients with proven efficacy for DNA repair. There are a number of these that I like. Plankton Extract is one. As it requires light to be activated make sure that formula with this ingredient is used as a morning preparation. On the other hand, Arabidopsis Thaliana Extract and Micrococcus Lysate work well both night and day.
Niacinamide a derivative of vitamin B3: Niacinamide is also known to augment DNA repair. More evidence is accumulating that this is becoming an essential ingredient in many preparations for Australian conditions unless it is already being taken orally.
Vitamin D3 ‐ can help with vitiligo, atopic dermatitis and chronic urticarial especially in darker skin types. The normal daily dose is 1000 to 1500 IU/day when taken orally.
Probiotics: Probiotics are live microorganisms, which, when administered in adequate amounts, confer a health benefit.
Prebiotics: On the other hand, prebiotics are non-digestible carbohydrates that act as food for probiotics, supporting their functions, so the probiotics and prebiotics have a synergistic effect. Prebiotics are produced through the injection of insoluble fibre.
In dermatology, probiotics have shown results with acne, rosacea, folliculitis, atopic dermatitis and a weak effect on psoriasis patients.
There are other potential benefits of using pro and prebiotics that are unrelated to skin such as in Alzheimer’s conditions as well as their role in neuroprotection for cardiovascular health and cardioprotection, diabetes and numerous other conditions.
When choosing probiotics, I recommend Lactobacillus and Bifidobacterium, as these have the most supporting evidence. Certain foods have these bacteria for example yoghurt, kefir, kombucha, and kimchi.
Turmeric: Turmeric is another well-researched nutraceutical and its use dates thousands of years back. Studies are suggesting that turmeric, when taken internally, can help in acne, alopecia, atopic dermatitis, psoriasis and vitiligo at a dose of 500 mg twice daily (ensure that the one you choose has pepper in it to improve the bioavailability).
Facial conditions that necessitate precautions, or a change from standard treatments
Here are a few simple solutions for conditions that can be easily treated with over-the-counter products – an example is a seborrheic dermatitis. This can be identified by the light scaling symmetrical patches around the nose and to the inside of the eyebrows. The common dandruff is actually seborrheic dermatitis. A simple over-the-counter product is Canesten cream, which can be helpful if combined with a good moisturiser.
For the scalp, Nizoral shampoo can be quite helpful. A word of caution, both atopic dermatitis together with any irritant dermatitis should not be treated with any peels. Any peeling therapy for such conditions would be dangerous. This is because the peels will penetrate deeper and potentially cause permanent damage. Ideally, these conditions need to be sorted out before proceeding with treatments.
Many other individuals may also experience irritations. A good example of this is retinoids and AHAs. If these agents are applied too often, rubbed aggressively into the skin, or in the case of AHA cleansers, simply left on too long, scaling dermatitis can be generated.
It is important to caution anyone with irritant dermatitis not to rub in their products. Friction is bad for the skin and only makes conditions like acne worse.
Irritant dermatitis in the skin can then encourage a true allergic reaction to occur. Allergic contact dermatitis can then cause redness, itching and scaling. There is often a delay by a day or two from applying the product and the appearance of the reaction. In extreme cases, it can take longer.
When one of these allergens is discovered and stopped it usually takes at least a fortnight to settle. However, you can speed up the healing with a steroid cream for example 1% hydrocortisone available over the counter.
The mistake to avoid is using the cortisone without first discovering the allergy. Allergy to products can occur only on the face or eyelids because the skin is more sensitive.
Preservatives and fragrances are the most common ingredients to cause allergy, however, there are many other sources to be considered. A few include acrylic nails, PPD based hair dyes and some sunscreen ingredients.
Dermatologists have patch tests available to discover an individual compound so as an alternative can be found. Without this testing, it is possible to swap to a different brand with the same outcome.
Some products will aggravate acne and should be avoided. These include scrubs especially with grit such as apricot, cold cream cleansers, occlusive makeups, cocoa butter and oil‐cleansing methods (most often done with coconut oil).
Physical therapies for addressing more stubborn conditions
Vascular lesions: Vascular changes are often the most ageing of the facial problems as they can be a distraction, making the skin and face look unsightly. While IPL will improve most of these, I will use the pulsed dye laser for the stubborn vessels and the vascular birthmarks as Dyschromia (pigmentation irregularities) has many causes.
Often solar lentigos progress to initially flat seborrheic keratoses. These are not helped by IPL. A more aggressive laser will often be required. A clue that they are beyond IPL is that they become considerably darker with a fake tan.
Fat reduction in the face: 10 years ago, I first trialled Belkyra in one of our many clinical trials for the treatment of classic double chin. The thing I like about this treatment is not just the fat reduction, but the skin tightening. This is why I prefer it to the cryogenic treatment of the fat in this area.
Collagen induction therapy: Skin needling has been a revolution in therapy. While it is not as effective per treatment as a fractionated laser treatment, its great benefit is the minimal inflammation so side effects like post-inflammatory hyperpigmentation are minimised.
Ultrasound: Another fractionated treatment I recommend is ultrasound which can give a useful lift to the face delaying the need for face lifting surgery.
While there are many new technologies and protocols available to help achieve results with your clients there are instances when the role of a dermatologist may assist you, the most obvious is the correct identification and treatment of underlying dermatoses that interfere with facial treatment outcomes. A collaboration with a dermatologist can be invaluable in achieving effective, long-term solutions to the more challenging skin conditions you may be experiencing in your salon or clinic.