Skin Basics, Part 2
Understanding Skin Conditions and Skin Diseases

By Patricia Heitz

Originally published in ASCP's Skin Deep, April/May 2007. Copyright 2007. Associated Skin Care Professionals. All rights reserved.

(Editor's note: this is the second in a series of articles on skin care basics. Part I is also available.)

While nothing can stop time from marching forward, improving the overall health of the skin will naturally make the skin look better.
Skin conditions change during your clients' lifetime and can be improved, possibly even repaired, depending on the severity of the condition. Examples of skin conditions that require your expertise and special care include:
- Aging/mature skin with facial lines and wrinkles
- Dehydration
- Hyperpigmentation
- Sensitivity (both a type and condition)
- Telangiactasia (distended capillaries)

Following are some tips for identifying and caring for these skin conditions.

Skin Condition: Aging and Mature Skin
Goal: To keep the skin lubricated and hydrated, and to create a smoother texture.

As your clients' metabolism slows with age, so too does the production of oil and the turnover of the skin. This means drier skin. Other factors contribute to making skin look more aged, including neglect and abuse (as in improper cleansing), sun damage, ill health, stress, extreme weight loss, medication, improper diet, alcohol abuse, and smoking.

While nothing can stop time from marching forward, improving the overall health of the skin will naturally make the skin look better. You can improve the function of your clients' skin, but obviously cannot completely reverse the damage.

Premature aging prevention, if done at an early enough age, can be realized with better home and professional skin care, with regular deep exfoliating (peels), and hydration treatments. Products with ingredients that help skin continually turn over and help it regenerate (such as alpha hydroxy acids), as well as products that help replace the barrier function (natural water and oil of the acid mantle), are good maintenance between professional chemical exfoliants (peels). I will cover this in greater detail in the June/July issue of Skin Deep.

Skin Condition: Dehydration
Goal: To improve moisture level on the surface of the skin.

This skin is easier to improve when it is just the surface that is dry. However, a dehydrated skin surface can be a component of both oily and dry skin types. The surface may be dry for a variety of reasons, including age and the attendant inability of the skin to hold water, use of harsh or stripping skin care products, ultraviolet radiation exposure, and constant exposure of the skin to heat. As most topically applied products act as a spackle as they fill in the lines and crevices on the surface of the epidermis, the most effective way to achieve longer-lasting moisturizing effects is through a series of chemical exfoliations (peels). Whether the skin is dry or oily, the AHA will penetrate further down into the stratum corneum layer to lift away dead skin and force newer skin to regenerate. Aged skin is only able to turn over or replace itself about every sixty to ninety days, so after two or three months of attacks by pollution, wind, and a variety of chemicals, skin loses its ability to retain its own water. By forcing skin to regenerate, it brings newer, younger skin cells to the surface with better water retention and natural moisture.

Skin Condition: Hyperpigmentation
Goal: To fade the melanin pigment on the surface of the skin.

Hyperpigmentation is an excess of skin pigment. Age-related hyperpigmentation is a direct result of environmental or ultraviolet radiation exposure from the sun or tanning beds.

Hyperpigmentation may also be found in oily/acneic skin, as a result of pustules and cysts from acne. When the skin is traumatized, it will defend itself with melanin production if there is enough pigment in the skin. Many acne sufferers also are darker skinned and are thus left with residual hyperpigmentation. Another cause of hyperpigmentation is hormonal imbalance. For example, some women develop a pregnancy mask around the mouth area, which disappears once the baby is delivered.

Hormonal hyperpigmentation can be difficult to treat as long as the hormones continue to be out of balance. For age-related and acne-induced hyperpigmentation, the suggested treatment is a melanin suppressant, such as daily use of hydroquinone.

Skin Condition: Sensitivity
Goal: To enhance the barrier function of the
skin by helping improve the lipid structure and oil coating.

As a condition, the ability to improve and manage sensitive skin is more attainable than when sensitivity is a skin type. When sensitivity is a skin condition, the skin has become that way because of age, disease, environmental conditions, use of harsh products or products with too many chemicals, or excessive exposure to saltwater or chlorinated water. Pinpointing and eliminating contributing agents can greatly improve sensitivity. Sensitive skin is usually thinner skin. There is less stratum corneum to protect, so nerve endings found in the dermis layer get closer to the surface, and sensitivity is acutely felt. Using chemical exfoliants (peels), like lactic acid specifically made for sensitive skin, helps build up the stratum corneum, allowing greater moisture retention and providing another form of skin protection. Using cleansing products with a cream basis, and strictly avoiding sudsy detergent cleansers will help coat the skin and keep it calm. We will cover this in more detail in part three of this series.

Skin Condition: Telangiectasia
Goal: To prevent further damage and calm skin areas nearest the condition.

This condition manifests itself as small, spider-like blood appearances on the skin. Couperose, a European term, is not used by the medical community in the United States, which prefers the medical term telangiectasia (tell-on-gee-oct-tasia). With this condition, capillary walls become weakened. At the weak point, blood leaks from the capillaries and rises into the stratum corneum, causing a spider-like appearance. Some of the causes of telangiectasia include smoking, alcohol consumption, and sun exposure. In the case of smoking, nicotine constricts the capillaries. The contraction and release to the normal size of capillaries weakens the walls of the capillaries. Similarly, alcohol consumption expands capillary walls, and that expansion and contraction to normal size again weakens the walls. Ultraviolet rays from the sun also cause capillary wall expansion. To care for this condition, there is nothing a skin therapist can do to alleviate the damage, short of using a laser. Educating clients on the causes of the condition can mitigate further damage.

Skin Disease: Acne
Goals: To keep the skin clean, free of oil and cellular buildup that blocks follicle openings, and to disinfect to prevent further eruptions.

Acne is a skin disorder and a disease. It can be chronic, with periods of clearing, or even be cured when the root cause is effectively treated. Hormone levels increase the oil flow as well as the amount of cell turnover in the skin. This results in increased oil flow and increased dead skin building up within the follicle and around the opening of the follicle. Depending on how severe, a blockage occurs, oil cannot flow freely, bacteria starts to accumulate within the follicle, and an infection begins. Depending on how severe, the blockage can be at the base of the follicle opening within the dermis, a cyst (in stage 4 acne) or near the surface as a pimple. In your analysis of this condition, you will see blocked follicles, pustules, pimples, and enlarged follicles on most of the face. This skin needs to be treated with caution, taking extreme care to avoid massage, which could further stimulate the sebaceous glands, spread infection, or both. As acne can progress from stages one through four, it's important to know the variables affecting it: hormone levels, products that can inflame and dry out the skin (disinfectants), and lack of regular cleansing and exfoliation. All these can exacerbate acne. A specific protocol for acne skin is never precise. Each acne case can be different, depending on body chemistry and lifestyle, so a protocol of acne can never be as precise as would be desirable. Skin care therapists can always make a difference, but in many cases managing the acne is the best that can be done. There are four stages of acne.

Acne--Grade 1
This is a low-grade acne characterized by excessively oily skin, blackheads, and many small pustules and pimples. It is most often referred to as teenage acne and is manageable by the skin care therapist. Salicylic acid is one of the most effective professional treatments offered, as it digests and disinfects the buildup of skin around the follicle opening and any infection or bacteria, or both. This allows the follicle oil to flow freely. The most important treatment for teenage acne is home care. Without consistent daily cleansing, bacteria will grow and create new infection sites. Many teenagers don't cleanse their faces daily, and this becomes the central challenge. With proper home care, this type of acne will see the greatest improvement.

Acne--Grade 2
This grade of acne is characterized by additional blackheads, pustules, and pimples becoming larger in size and further spreading on the skin. This type of acne also can be managed by the skin care therapist, but home care is also of utmost importance. Products with higher levels of disinfectant like benzyl peroxide and salicylic acid also clear dead-skin buildup on follicle openings and are the most effective for home care.

Acne--Grade 3
This grade, in addition to yet more pustules and pimples, is characterized by cysts. Cysts are infectious lesions in the papillary layer of the dermis that cannot easily be treated topically. This type of acne can be improved by the skin care therapist, but these clients should also be referred to a physician for medication. This type of acne can be managed and brought under control greatly when the skin therapist works in tandem with the physician. With medication and topical treatments and proper home care, the severe type of acne can see great improvement.

Acne--Grade 4
This is the most severe type of acne. Although the skin care therapist can help keep the skin clean with deep-pore cleansing, clients need a physician for either topical or oral antibiotics, or possibly Accutane. Best results are achieved when the skin care therapist and physician work together with deep-pore cleansing, exfoliation, and medication.

Skin Disease: Rosacea
Goal: To manage and improve skin with soothing and calming treatments.
Rosacea is both a disorder and disease of the skin. When you analyze the skin, you will first see flushing while the rosacea is in its early stages. Rosacea forms a butterfly effect across the top of the nose and cheeks. The second stage is telangiectasia. With further progression of rosacea, bumps and pustules will appear. This skin should not have any heat or temperature change that would cause blood to rush to the facial surface, causing further flushing. Stimulating massage also is contraindicated.

Fitzpatrick Skin Typing
After analysis of the skin to determine type, texture, and condition, the next steps are to determine how tolerant the skin is to ultraviolet radiation. The tool used to determine how much pigment is in the skin, and thus its tolerance to ultraviolet radiation is called the Fitzpatrick scale, after renowned dermatologist Thomas Fitzpatrick. The Fitzpatrick scale types skin from the lightest, which is most susceptible to sunburn and sun damage, to the darkest skin coloring, the most resistant to sunburn and cumulative sun damage.

Dermatologists and plastic surgeons use this scale before performing any aggressive peels or light therapies. A skin care therapist can employ it to anticipate reactions to and tolerance levels for such facial treatments as microdermabrasion and any other aggressive peels or treatments. The Fitzpatrick scale also can guide product selection for your clients' home care.

The more natural pigment the skin has, the greater its resistance to sunburn and environmental skin damage. Although dark skin can suffer from both sunburn and sun damage, it has greater resistance to potential damage. The melanin in the skin provides a natural and hereditary form of sunscreen. Darker skin types are much less likely to develop sun damage, sun-induced skin cancer, and wrinkles.

The thinner type I and II skin types tend to be more reactive to external and topical substances, including exposure to the environment, sun, heat, cold, and wind. Types I and II may also be affected differently by pigmentation disorders.

Hyperpigmentation is more likely to affect types IV and VI than the lighter skin types. Certain advanced skin treatments, including Jessner's exfoliation (peels), more than 5 percent benzyl peroxide, and resorcinol may irritate these skin types and cause or worsen pigmentation.

Medically speaking, laser and deep chemical peels are generally reserved for skin types I through III. These peels are considered trauma to the skin, which again, can result in greater production of melanin. This reaction is called post-inflammatory hyperpigmentation. Thus, with darker skin types, the very peel that is trying to fade hyperpigmentation, can actually cause the skin to produce more. Asian and Hispanic skin types are very susceptible to hyperpigmentation problems. Any injury to the skin can result in hyperpigmentation.

Patricia Heitz holds a CIDESCO diploma and is an esthetician, cosmetologist, empowerment trainer, author, consultant with KRS Salon/Spa Consulting Group, and consultant to Gerson/Lehrman Financial Analysts in New York. She can be reached at

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