Askanesthetician's Blog

An esthetician explores skincare issues and concerns

Psoriasis Information March 13, 2013

Filed under: Skin Conditions — askanesthetician @ 7:30 am
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Lately I have come across a few articles about the skin disease psoriasis so I thought I would share the information here.  I’ve addressed the issue of psoriasis before in this blog (see my post August is Psoriasis Awareness Month), but I wanted to go into greater detail here about this disease.

Just what is psoriasis and how many people does it affect?  In the article The Biology Behind Eczema and Psoriasis in Skin Inc. Dr. Claudia Aguirre explains:

Psoriasis has been confused with eczema, lupus, boils, vitiligo and leprosy. Because of the confusing connection with leprosy in ancient times, psoriasis sufferers were even made to wear special suits and carry a rattle or bell, like lepers, announcing their presence. Only in the 19th century was a distinction made between psoriasis and leprosy, alleviating some of the psychosocial impact of this highly visible and distressing skin disease.9 As with eczema, it presents as itchy, red skin and involves altered immunity. However, its complexities reach far beyond the surface of the skin. People with psoriasis have an increased risk of cardiovascular disease, metabolic syndrome, obesity and other immune-related inflammatory diseases—even cancer. The mysteries behind this complicated and debilitating skin disease are only beginning to be unraveled. Psoriasis is a chronic, inflammatory multisystem disease affecting 1–3% of the world’s population.3 Whereas the rashes on eczematous skin can have irregular edges and texture, psoriatic lesions tend to be more uniform and distinct. Red or pink areas of thickened, raised and dry skin typically present on the elbows, knees and scalp. This presentation tends to be more common in areas of trauma, abrasions or repeated rubbing and use, although any area may be affected. Unlike eczema, psoriasis comes in five different forms: plaque, guttate, pustular, inverse and erythrodermic.

Plaque psoriasis affects about 80% of those who suffer from psoriasis, making it the most common type. …

It may initially appear as small red bumps that can then enlarge and form scales. The hallmarks of this type are raised, thickened patches of red skin covered in silvery scales. The other types are less common and present inflamed skin with red bumps; pustules; cracked, dry skin; and even burned-looking skin. Clients will most likely be under a physician’s care, who will diagnose the type of psoriasis present.

As of today, psoriasis has no cure. A single cause of the disease has yet to be uncovered, but it is known that developing the disease involves the immune system, genetics and environmental factors. In psoriasis, aberrant immune activity causes inflammatory signals to go haywire in the epidermis, causing a buildup of cells on the surface of the skin. While normal skin takes 28–30 days to mature, psoriatic skin takes only 3–4 days to mature and, instead of shedding off, the cells pile up on the surface of the skin, forming plaques and lesions. The underlying reason may be due to the hyperactivity of T-cells, which end up on the skin and trigger inflammation and keratinocyte overproduction. Although it is not known why this happens, it is known that the end result is a cycle of skin cells growing too fast, dead cell-debris accumulation and resulting inflammation.

Many psoriasis sufferers receive medication from their doctors but there is encouraging research that the use of OTC AHA (alpha hydroxy acids) can help improve psoriasis symptoms.  In the post How Alpha Hydroxy Acids Could Help Treat Psoriasis Rebecca Harmon writing on Future Derm explains:

In common plaque psoriasis, the overgrowth of skin cells that collect at elbows, knees, hands, scalp, face and other areas can cause embarrassment and in some cases can be painful as clothing catches and pulls on the dry skin patches.

During a particularly hard-to-manage outbreak in my late 20’s, I was desperate to avoid the greasy and expensive steroid cream ($50 for a small tube) and smelling like the back end of a large coal truck wasn’t working for me either.  My particular case was cosmetically disturbing but not medically-complicated so I decided to stop buying the $50 prescription cream and turned to the beauty industry which was just beginning to offer face cream with AHA’s.

I quickly became a fan as I discovered that the flaky psoriasis patches on my face disappeared with a skin care regimen that included a daily application of the AHA face cream. Those were my stay-at-home-with-babies days, and I was as far removed from research or academic writing as one could be, but I didn’t need the denial of a null hypothesis to tell me that this was working.  I used it twice daily on my face and then started rubbing it in to my elbows and knees.  I still laugh remembering the cosmetic rep who finally asked how much face cream I was using (I ordered a lot of this stuff!).

And, yet, the research is in my favor. One study of 12 patients found that a creams with 15% glycolic acid, as well as .05% betamethasone, respectively, were helpful in reducing erythema, transepidermal water loss (TEWL), and lowering Laser Doppler values (Dry Skin and Moisturizer). And alpha hydroxy acids mixed with betamethasone were found to be even more effective in treating psoriasis in a double-blind, split-face, single site clinical study (JEAVD).

I have experienced mild outbreaks of psoriasis since that period but have continued to treat them with AHA-based lotions with consistent results.

And Rebecca isn’t the only extolling AHAs as a psoriasis cure from personal experience.  In the post We Answer Cara Delevingne’s Skin SOS: Psoriasis Alexandra Owens writes in Allure that:

A few years ago, I accidently discovered that Bliss Ingrown Eliminating Pads relieved my symptoms even better than prescription creams I’d tried. I asked New York dermatologist Doris Day why they work so well. “The alpha and beta hydroxy acids [in the pads] would help thin out the plaques of psoriasis, and the oat extracts, witch hazel, and lavender oil would soothe and hydrate the skin—but I would still apply a moisturizer after using them,” she says. “The nice thing about the ingredients being in a pad is that it’s easy to apply to the affected areas.” Another nice thing: You don’t need to see a doctor to get your hands on them.

When it comes to treating clients with psoriasis at the spa keep things simple and gentle and place an emphasis on encouraging relaxation.  Once again I’ll turn to the Skin Inc. article mentioned above:

Both eczema and psoriasis clients have impaired barrier function and increased inflammation, so your goal will be to protect and repair. Remember to always check first with your client’s physician for contraindications to medications and therapies, because some ingredients may counteract each other. For example, salicylic acid may seem a likely choice for exfoliating psoriatic skin, but could, in fact, inactivate a common topical treatment for psoriasis.

Once a full consultation with the client and possibly her physician is completed, proceed with a treatment using minimal products and procedures. A good way to compensate for minimal skin treatment time is to add on stress-relieving techniques, because there is a psychological component to eczema and psoriasis. Complementary therapies, such as aromatherapy, acupressure, reflexology, massage and inhalation techniques can be coupled with skin treatments to lower stress hormones and control inflammation.

Gentle cleansing and exfoliation is crucial to allow the penetration of rich, emollient moisturizers used on dry, sensitive skin. Avoid harsh exfoliants and detergents, and look for ingredients, such as lactic acid. Use anti-inflammatory ingredients, such as red hogweed, ginger, oats and chamomile, coupled with barrier-repairing oils, including evening primrose, borage, argan and sea buckthorn. Finishing a treatment with a physical sunscreen, such as zinc oxide or titanium dioxide will ensure that harmful UV rays do not cause further damage.

Bottom Line:  Though there is currently no cure for psoriasis there are ways to keep symptoms under control.  Since stress makes psoriasis worse finding ways to reduce stress is an integral part of psoriasis treatment and estheticians can certainly be a positive part of that process.

Further Reading:

Image from worldinfo.info

 

13 Reasons You Should Get A Chemical Peel From An Esthetician April 11, 2010

I think chemical peels are great and not just because they are part of my repertoire as an esthetician.  I like to think of chemical peels as a “reboot” for your skin allowing healthy skin appear.  A series of chemical peels can help treat a myriad of skin issues.  There really is no reason not to try one.

This post addresses the issue of chemical peels performed by estheticians.  There are plenty of “peels” that are available for home use.  Peels that you use at home provide very superficial peeling, simply exfoliation, and can help you maintain even toned, healthy skin.  Chemical peels performed by estheticians have a lower pH than home use products so that they can penetrate much deeper into the skin, will normally cause you to turn red, a lot of time your skin will peel following a peel, and these peels, when performed in a series, can treatment skin conditions such as hyperpigmentation and acne.  Simply put – a chemical peel performed by an esthetician will do a lot more for your skin than a home use product called a peel.

What Are Chemical Peels?

There are many different types of chemical peels, and each company that sells peels has its own series of formulations.  Having said that the chemical peels used by estheticians are generally a solution that has a combination or sometimes just one alpha hydroxy acid (AHA) or beta hydroxy acid (BHA).   The solution is applied to the skin, normally in layers though some peels are simply one layer, like a treatment mask.  The peel is either removed at the end of the treatment or left on to self-neutralize.  The acids in the peel work to dissolve the top layers of the skin creating a controlled wound and thus allowing the skin to regenerate itself.

Reasons to get a Chemical Peel

A chemical peel will:

  1. Improve the texture of your skin
  2. Increase the cell turnover rate of your skin
  3. Improve your skin’s ability to hold moisture
  4. Help your skin produce more collagen
  5. Reduce fine lines
  6. Decrease hyperpigmentation
  7. Unclog pores and help clear up acne
  8. Leave your skin smooth
  9. Make your skin softer
  10. Make your skin look more even-toned
  11. Give you a “glow”
  12. Make your skin look dewy
  13. Improve minor scarring

A chemical peel cannot make dramatic improvements to deep wrinkles or very sagging skin.  Conditions like that need to be treated with lasers or cosmetic surgery.

Who Can Get a Chemical Peel?

Truthfully pretty much anyone can get a peel as long as they don’t have any of the contraindictions listed below for peels.  Generally people with darker skin need to take more precautions before getting a peel and must make sure that the peel they are receiving is formulated for their skin type.  The reason for this is that very strong chemical peels can actually cause more hyperpigmentation on darker skin.

Contraindications:  It is generally recommended that pregnant and nursing women not receive peels since there are no studies, as of yet, about the effects of peels on fetuses or nursing babies.  You cannot get a peel if you have been off Accutane for less than 6 months.  If you are prone to cold sores a peel can actually bring on an outbreak so you need to take anti-viral medication before, the day of, and the day after your treatment.  Also if you have a tendency to scar, are taking antibiotics, have cancer or an autoimmune disease, or have an open sore you cannot get a chemical peel.

Everyone’s skin will be more sensitive to sunlight following a peel so make sure that you have plenty of sunscreen on hand after your peel, and be sure to vigilantly apply and reapply your sunscreen after a peel.  Hopefully the esthetician who performed the peel will either include post-peel products in the price of the peel or have them available for purchase at a reasonable price.

Make sure that the esthetician who is performing the peel has asked you an extensive list of questions before going ahead with your peel.  An esthetician must keep many factors in mind before performing a peel so that the client gets the best possible result with the fewest possible side effects.  You will be asked questions about medical conditions, allergies, the products you are currently using, and the results you want to achieve.  You may also want to go with a lighter peel the first time you get a chemical peel and build up the strength of your peels from there.  All of these issues should be discussed with your esthetician before you receive your first peel.

How Are Peels Performed?

Before you get a peel you should exfoliate at home or have a professional microdermabrasion treatment so that your skin in properly prepped for the peel.  Your skin will be cleansed and “degreased” before the peel is actually applied.  This means that all surface oils and debris are removed so that the peel can penetrate properly.

How Does It Feel?

Generally you will feel a warmth over the area being peeled during the procedure.  The esthetician performing the peel will either fan the area being peeled or provide you with a small electric fan to hold over the area.  You may feel stinging, burning, and even itching while the peel in performed.  Those sensations will stop once the peel is over.  Your esthetician will check in with you throughout the peel so if you ever feel any great discomfort she or he will know to stop the peel immediately.

What to Expect After a Peel

As I already mentioned first and foremost your skin will be quite sensitive to the sun following a peel so be extra vigilant about sunscreen use following your peel.   Because of this it usually isn’t a good idea to get peels in the summer or right before going on a vacation to a warm climate.

Following a peel your skin will feel tight and then a little dry.  You may remain red for an hour or so following the peel.  If you peel after the chemical peel treatment peeling will begin approximately 3 to 5 days following your peel.  The extent of peeling varies according to the person and the depth of the peel.  Not everyone peels following a chemical peel actually.  Some people have some mild itching following their peels.

Keep In Mind

Because chemical peels are stimulating you actually need to modify your lifestyle behavior slightly following a peel so that you don’t cause any unneeded irritation or hyperpigmentation to your skin.  So following a peel avoid excessive exercise with sweating for a few days.  Don’t scrub or pick at your face.  You cannot use retinol products or AHA products for at least 10 days following your peel.  And avoid any sort of excessive heat source like a sauna or hot tub.

How Often Can You Get a Chemical Peel?

Generally it is best to get a peel every four to six weeks.  But if you suffer from acne there are some peels that you can do every two weeks until you get the results you want.  Generally it is a great idea to buy a series of four or five peels up front so that you can achieve the treatment results that you want.  Also when you buy a series of peels upfront you will probably receive a discount.  Consider buying a deal that allows you to get chemical peels interspersed with microdermabrasion treatments or facials.  The microdermabrasions and the facials will enhance the results of the peel by helping to exfoliate the flaky skin you have on your face.  These treatments will also help prep your skin for your next peel.

When Will You See Results?

Truthfully chemical peels can be a bit unpredictable.  Some people see results as little as 10 days after their peels.  Other people won’t see results until about three weeks following their peel.  And for people who receive many facial treatments a chemical peel may just enhance the normal way their skin always looks.

Sources and Further Reading

 

All About Exfoliation March 14, 2010

Everyone needs to exfoliate, and you’ll be delighted with the results if you do.

Why Should You Exfoliate?

First off, the term exfoliation refers to the removal, either by peeling, rubbing, or sloughing off, of dead skin cells on the outer layer of the epidermis -the stratum corneum.  The exfoliant is the product is that helps you with this process.  The benefits of exfoliation are numerous and include:

  • Smoother skin
  • Helps unclog pores – an essential benefit for anyone with acne
  • Improves the skin’s ability to retain moisture
  • Allows for better product penetration
  • Easier make-up application – no caking of your make-up
  • More even toned skin

If you suffer from breakouts exfoliation is a key step in your home skincare routine.  As I discussed in my earlier post How Acne Forms acne begins to form when your pores are clogged with dead skin cells and oil.  People who suffer from acne need to help their bodies slough off the dead skin cells so that they don’t clog the pore and so oil doesn’t get stuck in the pore as well.  Regular exfoliation is the key to keeping your pores unclogged.

As we age our cell renewal factor or cell turnover rate slows down.  The cell turnover rate is the process by which our skin produces new skin cells which travel from the lowest layer of the epidermis to the top layer and then shed off the skin.  Think about this – a baby’s cell turnover rate is 14 days, a teenager’s is 21-28 days, a middle age person’s 28 to 42 days, and someone who is in their 50s or older the rate is between 42 to 84 days.  That means that as we age the top layer of the skin, the one we see, touch, and even agonize over, becomes dull.  We lose our “glow”.  And think about this – if the top layer of your skin is really lots and lots and lots of dead skin cells (between 15 to 20 layers) how much of the antioxidant and retinol serums you are applying actually are getting through and doing what they are supposed to be doing?  We can help keep the top layer of skin from getting too thick with dead skin cells by exfoliating. 

Can You Over Exfoliate?

Actually you can over exfoliate.  As I’ve already mentioned exfoliation is an essential step in any skincare regime but it should be done gently.  If you over exfoliate you are actually causing your skin more harm than good.  By removing too much of the top layer of your skin you are opening yourself up to redness, irritation, dryness, and even infections.  So moderation is key.  Our skin needs that top layer to stay intact since it plays a very important role in protecting our skin.  We don’t want to remove it; we just want to keep it thin.

Also remember that using too many products with exfoliating ingredients will cause irritation and redness.  Unless you are a teenager with acne doubling up on products with AHA like glycolic acid will probably prove too irritating for your skin.

How Do You Exfoliate?

There are numerous ways to exfoliate and how you choose to exfoliate will depend on your age and lifestyle.  Since as we age our cell turnover rate slows down dramatically you can exfoliate more often and with stronger ingredients as you get older.  If you suffer from acne you might find that you also need to be exfoliate more than twice a week.  For people in their 20s and 30s with normal skin a twice weekly facial scrub might be all they need to keep their skin even toned and glowing.

 

Mechanical exfoliants are scrubs that rub dead skin cells off your body.  The beads in the scrubs that do the exfoliating can be made from crushed nutshells, oatmeal, or tiny synthetic beads.  Start by using the scrub only once or twice a week in the evening. 

 

Mechanical Scrubs to Consider Trying:

Exfoliating Lotions/Serums generally have beta hydroxy acids (salicylic acid) or alpha hydroxy acids (glycolic, lactic, citric, or malic acid – to name a few) in them and are applied in the evening after cleansing.  Depending on your skin needs you could apply the products every evening or only a few times a week.  You need to be the judge of what is best for your skin so you can get the great benefits of exfoliation without unneeded irritation.

 

Lotion/Serum Exfoliants to Consider Trying:

  • Paula’s Choice – I can only vouch for the BHA lotion.  It works great.  A good thing about Paula’s Choice is that you can buy samples for very little money so you can try her products without much of a monetary investment.

Cleansers and Moisturizers with AHA (alpha hydroxy acids) or BHA (beta hydroxy acids) are yet another way to exfoliate.  Using a product like this eliminates the need to buy a separate product just for exfoliation which is important for some people.  Just remember that these products can be strong – they are meant to exfoliate after all – so you might only want to use them a few times a week.  Everyone’s skin is different so some experimentation might be necessary to find the right balance for yourself.  See my post Amped Up Cleansers for more information about cleansers with added ingredients.

 

Cleansers and Moisturizers with AHA and BHA to consider using:

 

At-Home Peels should not be confused with professional peels since any product that is marketed for home use will be buffered so as not to cause irritation and/or peeling to the user.  You actually want to see peeling after receiving a professional peel.  Nevertheless this is yet another option for superficial exfoliation at home.

 

At-Home Peel Product to Consider Using:

 

Exfoliating Masks might not be a great choice for everyone, but they are another exfoliation option worth considering.  You can simply apply the mask before entering the shower and wash it off at the end of your shower. 

 

Exfoliating Masks to Consider Using:

 

Professional Exfoliation Treatments to Consider

Both microdermabrasions treatments and chemical peels are a wonderful way to exfoliate and treat the skin.  Be sure to get those treatments from a trained professional.  A series of treatments is usually needed to see more dramatic results, but even one microdermabrasion treatment or a chemical peel will leave your skin smoother, more even toned, refreshed, and glowing.

 

Though Mae West said “too much of a good thing is wonderful”, and I think she is right when it comes to chocolate cake, french fries, and cheese it certainly doesn’t apply when it comes to exfoliation.  Remember that exfoliating will make your skin more vulnerable to the sun’s rays so be extra vigilant about using sunscreen and reapplying throughout the day.  If you are using a retinol product be sure to go easy on the exfoliating in order not to irritate your skin. 

All things in moderation would be a better motto for exfoliation.  Find the right exfoliating product for your skin and stick to it.  Your appearance will thank you.

 

Sources and Further Reading:

 

No Mixing Allowed: Skincare Ingredient Combinations to Avoid February 13, 2010

So you’ve researched what skincare products to buy and finally made your purchase.   But did you know that if you use different skincare products at the same time you could actually cancel out the benefits of the very ingredients you purchased the product for?

Don’t mix copper peptides and vitamin C –  using the two together, even if they are in separate products, just cancels out the effects of both.

Don’t mix retinol and benzoyl peroxide – both ingredients are great for fighting acne but if they are used at the same time they simply counteract one another.

Don’t mix retinoids or hydroquinone with glycolic acid – once again if you mix these ingredients they become inactive. 

Hydroquinone and retinoids can only be combined together in specially formulated products like Tri-Luma (which is used to fight hyperpigmentation).

And sometimes too much of certain ingredients is just bad for your skin:

Be alert to signs of redness, irritation, or excessive and prolonged peeling if you use products with AHA (alpha hydroxy acids like lactic, glycolic, malic, etc.), vitamin C, and retinol all at once.  For instance all in one day you may use a cleanser with glycolic acid, a moisturizer with vitamin C, and a retinol cream or serum at night.  You may find that your skin becomes sensitive to the use of so many potent ingredients.  If that is the case cut out one or more of the products with the strong ingredients or stagger the use of the products (skip a day or use a product just once a week).

Source and Further Reading:

 

 

 
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