Askanesthetician's Blog

An esthetician explores skincare issues and concerns

What Is Seborrheic Dermatitis? October 3, 2013

When I was in esthetics school we discussed skin diseases, and I do remember that seborrhea was mentioned.  According to my textbook from school (yes, I still have my textbook) they divide seborrhea and seborrhea dermatitis into two different categories:

Seborrhea: Severe oiliness of the skin; an abnormal secretion from the sebaceous glands

Seborrheic Dermatitis:  A common form of eczema

(From Milady’s Standard Fundamentals for Estheticians, 9th edition, page 203)

Before I became an esthetician I had come across a common form of seborrheic dermatitis which is cradle cap.  My son had had severe cradle cap as an infant so I was quite aware of what that was.  Yet once I was introduced to the concept of seborrhea as explained above, “severe oiliness of the skin”, I didn’t come across this condition at all while working in the US.  Then I moved back to Israel and I couldn’t believe how many people I encountered for facials that would tell me they had seborrhea.  I was surprised to say the least.  I couldn’t figure out how in one part of the world I had never come across this condition and in another part of the world I couldn’t seem to escape it.  I wondered if the definition of this skin condition had changed from country to country, from language to language.  The skincare companies that I worked with in the US never mentioned this condition to me or had products that treated it, unlike Israeli skincare companies that do both.  Truthfully I am still trying to figure this one out, but in the meantime I realized that I better brush up on my knowledge about seborrhea.

What is Seborrheic Dermatitis?

Dr. Carl Thornfeldt in his book The New Ideal In Skin Health defines seborrheic dermatitis as (page 86):

These lesions are usually found on areas of the body with more sebaceous glands, such as the forehead, eyebrows, around the nose and ears, scalp, midchest, and central trunk. It is characterized by greasy yellow scaling on erythematous patches of various thicknesses.  It usually has no itching.  It may be associated with rosacea.  Dandruff is a mild form on the scalp.  It is most common in infants (cradle cap) and elderly.  It may also be flared by physical and emotional stress.

Furthermore, according to the American Academy of Dermatology seborrheic dermatitis is characterized as:

The skin tends to have a:

  • Reddish color.
  • Swollen and greasy appearance.
  • White or yellowish crusty scale on the surface.

One or more of these rashes can appear on the body. Sometimes, the affected skin itches.

Seborrheic dermatitis can look like psoriasis, eczema, or a skin allergy.

What Causes Seborrheic Dermatitis?

The Mayo Clinic explains:

Doctors don’t yet know the cause of seborrheic dermatitis. Factors that may play a role include:

  • A yeast (fungus) called Malassezia. This fungus is one of the normal microscopic life forms that grow, along with certain bacteria, in your skin’s oily secretion (sebum). Creams, foams or lotions containing an antifungal agent, such as ketoconazole (Ketozole, Extina), often help reduce flare-ups, supporting the idea that this yeast is a contributing factor. But seborrheic dermatitis itself isn’t considered an infection, and it’s not contagious.
  • Change of season. Episodes are often worse in winter.
  • Neurological conditions. Seborrheic dermatitis may occur more frequently in people who have Parkinson’s disease and certain other neurological disorders.
  • Stress and fatigue. Stressful life events and situations may help trigger an episode or make it worse through mechanisms that aren’t yet understood. The role of neurological disorders and stress may be related through effects on the nervous system.
  • HIV/AIDS. Seborrheic dermatitis may occur more commonly and tend to be more severe in those with HIV/AIDS.

The American Academy of Dermatology expands on the causes and just who is affected by seborrheic dermatitis:

Who gets seborrheic dermatitis?

People of all colors and ages get seborrheic dermatitis. You have a higher risk if any of the following apply to you.

Age

People in these two age groups are most susceptible:

  • Infants 3 months of age and younger.
  • Adults between 30 and 60 years of age.

Medical conditions

Your risk increases if you have any of these medical conditions:

  • HIV (About 85 percent of people infected with HIV develop seborrheic dermatitis).
  • Acne, rosacea, or psoriasis.
  • Parkinson’s disease.
  • Epilepsy.
  • Stroke or heart attack (recovering from).
  • Alcoholism.
  • Depression.
  • Eating disorder.

Medical treatments

If you are taking any of the following medicines, your risk for seborrheic dermatitis increases:

  • Interferon.
  • Lithium.
  • Psoralen.

Facts about Seborrheic Dermatitis

For adults there is both good news and bad news about seborrheic dermatitis.  The good news is that the condition can be treated by a doctor and/or with proper home care.  The bad news is that this is chronic condition, with no cure. According to the Mayo Center:

Seborrheic dermatitis doesn’t affect your overall health, but it can be uncomfortable and cause embarrassment when it develops on visible parts of your body. It isn’t contagious, and it’s not a sign of poor personal hygiene. Seborrheic dermatitis tends to recur, but you may be able to manage flare-ups by recognizing its signs and symptoms and by using a combination of self-care steps and over-the-counter (nonprescription) medications.

How to Treat Seborrheic Dermatitis

First and foremost if you think that you are suffering from seborrheic dermatitis go see a dermatologist before trying to treat yourself.  The doctor can determine if you need prescription products or not to keep your condition under control.  Some skin conditions simply cannot be treated with over the counter products but with seborrheic dermatitis it depends on the severity of the condition.

The Mayo Clinic explains further how to treat this condition:

Seborrheic dermatitis tends to be chronic, and there’s usually no strategy that stops it permanently. But treatments — including many you can try at home — may control your signs and symptoms during a flare-up. The best approach for you depends on your skin type, the severity of your condition, and whether your symptoms affect your scalp or other areas of your body.

Creams and lotions that you apply to affected body areas and medicated shampoos are all mainstays of treatment. In very severe cases, physicians may prescribe oral medications with whole-body effects. Products are available with several kinds of active ingredients. Some preparations include active ingredients from more than one category.

The following over-the-counter treatments and self-care tips can help you control and manage seborrheic dermatitis.

  • Wash your hair with a medicated anti-dandruff shampoo according to the recommended schedule. If you don’t see results, try a shampoo with a different active ingredient.
  • Use an over-the-counter antifungal cream. Application of nonprescription-strength ketoconazole may be helpful.
  • Apply an anti-itch cream or lotion to the affected area. A short course of a nonprescription hydrocortisone cream containing at least 1 percent hydrocortisone can temporarily relieve itching.
  • Avoid harsh soaps and detergents. Be sure to rinse soap completely off your body and scalp.
  • Wear smooth-textured cotton clothing. This will help keep air circulating around your skin and avoid irritation.
  • Shave off your beard or mustache. Seborrheic dermatitis can be worse under mustaches and beards. If this is the case for you, shaving might ease your symptoms.
  • Avoid scratching whenever possible. Scratching can increase irritation, making you more uncomfortable and increasing your risk of infection.

What else can you do at home to keep your condition under control?  Dr. Thornfeldt recommends in his book using a gentle facial cleanser that doesn’t strip the skin’s pH.  He recommends that the homecare products that:

… contain ingredients such as low concentrations (<2%) azelaic acid, salicylic acid, zinc pryrithone and/or willow bark extract to help kill surface bacteria, reduce redness and scaling, and smooth skin texture.  (Page 87)

The American Academy of Dermatology recommends the following:

Adolescents and adults: Skin

  • Wash the skin daily with a soap that contains 2% zinc pyrithione.
  • Soften scale by:
    • Wetting the skin thoroughly before washing.
    • Applying a moisturizer after bathing.
    • Applying a tar cream, letting it sit on the skin for several hours before rinsing.
    • Applying a cream containing salicylic acid and sulfur.
    • Do not use petroleum jelly to soften the scales. It tends to worsen seborrheic dermatitis.

 

Bottom Line:  In adults seborrheic dermatitis is a chronic condition without an actual cure.  Proper home care coupled with prescription medications can help keep this skin condition under control.

 

Sources and Further Reading:

 

Image from http://www.aad.org

 

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

 

August is Psoriasis Awareness Month August 11, 2011

August is Psoriasis Awareness Month so I wanted to use this post to highlight some resources for those suffering from this skin disease.

 

What Is Psoriasis?

According to Dr. Ellen Marmur in her book Simple Skin Beauty (pages 230-231) psoriasis is a condition that is:

 … characterized by thick, red plaque with a white, silvery (micaceous) scale on top.  It’s itchy and painful and can create big fissures on the skin.  It tends to be on extensor surfaces, such as the elbows, knees, and scalp.  There are several types of psoriasis, and some can be quite severe, affecting the joints and causing something called “psoriatic arthritis”.  It can also be mild, manifesting itself as one patch of plaque on the body, such as dry, cracked elbows that don’t soften no matter how much moisturizer you put on.

Psoriasis is a genetic, chronic inflammatory disease where for some reason lymphocytes (immune cells) are attaching the skin, causing cell turnover to accelerate.  Therefore, the dead skin cells aren’t shedding as fast as the maturing cells are rising to the surface.  This pile-up creates a silvery scale on the surface.

Psoriasis Treatments

If you do suffer from psoriasis there are some things you can do at home to help prevent your condition from getting worse.   Once again, according to Dr. Marmur:

Don’t scratch or try to scrub off the scaly skin.  Instead, moisturize with a thick, occlusive cream or ointment twice a day.  Sweat will irritate the skin, as will fragranced products or perfume.  Psoriasis sufferers have to be careful about everything they put on their skin – even sunscreen can sting.  Even one patch of plaque should lead you to see a dermatologist, especially since it’s likely that you will develop others in the future.  It’s important to get a good treatment program to prevent a more extensive outbreak.

So what other treatment options are out?  According to Dr. Amy Taub, as quoted in the article August is Psoriasis Awareness Month; Is Your Spa Ready? online at Skin Inc. :

  • Laser. A 308nm laser provides targeted phototherapy treatment for psoriasis offering safe, effective and lasting results. This laser uses a focused beam of ultraviolet light on the affected skin area avoiding exposure to healthy skin.
  • Topical agents. In mild psoriasis, where less than 10% of the body surface is affected, topical creams, ointments, gels and lotions are often applied first. These usually consist of steroids, vitamin D derivatives, retinoids (vitamin A derivatives) and tar-based topical treatments. The most common is a steroid because of its anti-inflammatory properties and because it also decreases the redness and scaling relatively quickly.
  • Oral or injectables. When psoriasis is more severe or light treatments or topicals have failed, oral or injectable solutions may be considered. They work by decreasing the metabolism in overactive cells thereby decreasing the rapidity with which psoriatic skin is made helping to normalize it. In addition, sufferers now have biologic medications available, also known as “designer” drugs, which attack specific molecular targets in the immune system.

Dr. Taub tells SkinInc.com exclusively about possible psoriasis treatments that are currently in the works.

Awaiting U.S. Food and Drug Administration (FDA) approval, new biologic agents are being investigated at a very rapid pace. New receptor molecules have been identified as targets (called IL-23 receptors) that may be even more specific than the agents that are known about today. The older biologics have undergone many years of study, and the dermatologic community is finally feeling more confident about the long-term safety of these agents as a result of this data. In fact, there may even be some negative consequences of not treating psoriasis. More data is pointing to the fact that having unchecked psoriasis could lead to an increased risk of cardiovascular disease, leading many dermatologists to push more toward treatment as being more conservative.

If you think that you may have psoriasis see a dermatologist immediately in order to start a treatment plan before your condition worsens.  Please see below for lots of online resources for even more information about psoriasis.

 

Other online resources for information about psoriasis and treatment options:

 

Another Reason to Love Tim Gunn: He Helps Those with Psoriasis October 11, 2010

I’m a huge Project Runway fan.  I realized that I’ve actually seen every episode of every season except for the very first episode of the first season of the show.  I think this season of the show has turned out to be one of the best, and my favorite contestant is definitely Mondo (who I really hope wins it all).  Anyhow, any fan of Project Runway must have an opinion about Tim Gunn who functions as a mentor to the fashion designers on the show.  Personally I think Tim Gunn is great.  I even read his new book which was interesting to say the least (I mean how many people describe themselves as “asexual”?  If you like Tim Gunn read this book; you can read it in a day or two.  Gunn definitely has some mother issues to work out, but I do appreciate his honesty and integrity.)

But back to skincare issues.  I read a Skin Inc. online article about how Tim Gunn and Dr. Susan C. Taylor (who wrote the book Rx for Brown Skin) are helping people with psoriasis ( Tim Gunn Hosts Online Style Resource for Clients with Psoriasis).  Amgen and Pfizer have launched an online resource center called Address Your Psoriasis! for people suffering from psoriasis with an emphasis on style:  making good fabric choices and finding clothes that are comfortable and breathable.  By teaming up with Tim Gunn and making these tips available online the creators of the website hope to help psoriasis sufferers look good and feel confident about their appearance.

Why is looking good such an issue for psoriasis sufferers?  Let me explain (I’ll quote from the website):

 

Psoriasis is a noncontagious chronic disease in which the immune system causes the skin cells to grow at an accelerated rate. 

Approximately 7.5 million American adults suffer from psoriasis. Although there are several types of psoriasis, approximately 80 percent of patients have plaque psoriasis.

Psoriasis is commonly diagnosed in early adulthood. Certain people may be genetically predisposed to develop psoriasis. A “trigger” often seems to cause symptoms to appear. These triggers may include emotional stress, injury to the skin, some types of infection, or reaction to certain drugs.

While there are several types of psoriasis, the most common form is plaque psoriasis. Approximately 80 percent of patients suffer from plaque psoriasis, which is characterized by skin lesions that appear as patches of thick, red, or inflamed skin covered with silvery scales. Instead of being shed, skin cells pile up, causing painful and itchy patches, which are also referred to as plaques.

While the exact cause of plaque psoriasis is unknown, we know that it is a disease involving the immune system. Certain cells in the immune system become overactive and release proteins called cytokines. Overproduction of these cytokines plays a large role in causing inflammation that leads to development of often painful and sometimes debilitating skin plaques.

In addition to the skin symptoms, plaque psoriasis can also negatively impact people’s lives in other ways. It can:

  • Interfere with basic functions, such as sleeping, using hands, and walking, as well as sitting or standing for long periods of time.
  • Impact a person’s job performance, with many patients reporting missed time from work due to their condition.
  • Cause people to feel helpless, embarrassed, angry, frustrated, and/or self-conscious. This distress may lead to feelings of social isolation.

 

The better you look, the better you feel, right?  I’ve always believed that was true.  Since psoriasis can affect self-esteem so severely I was very happy to see these free online tips that can really help anyone with the condition feel much better about their appearance.   And now I have even more reasons to love Tim Gunn.

 

 
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