Being aware of what can affect skin will help skin care professionals determine why a client may be experiencing skin challenges. Often, skin conditions are due to more than just one influence. It is important that the professional is able to evaluate and identify both external and internal factors to help improve or correct the skin condition. Allergies, reactions, medications, medical conditions, and other extrinsic factors as well as habits, diet, lifestyle, and stress can all be reflected in skin’s health and appearance. Additionally, lack of exercise and sleep, tobacco and vapor use, and drug use will also have negative effects both inside and out. Sun damage is the main extrinsic cause of aging. Primary conditions, such as acne, aging, and hyperpigmentation, are the main conditions that clients are seeking help for as well as sensitive or reactive skin, rosacea, eczema, hypertrichosis, and psoriasis as they continue to have lasting effects on clients.
{mprestriction ids=”3,4,26,18,6,7,8,9,14,18,43,44″}
SENSITIVE VS. SENSITIZED
The topic of skin can be a touchy subject, especially for the growing number of people who report having sensitive skin. In fact, according to a study published in the International Journal of Dermatology, more than 44% of nearly 1,000 participants identified themselves as having sensitive or very sensitive skin.1 Sensitive skin may be a common issue today, but it is also one of the toughest to define.
On both a global and national scale in spas and at home, clients are often over-exfoliating or using too many forms of exfoliation, whether it is physical or chemical. It is important that professionals take the time to educate clients on the fact that skin needs to have sufficient time to heal naturally. Without that recovery time, inflammation increases, and sensitive skin is the result. In many spas today, skin may be labeled as sensitive when it is unclear what is causing the problem, and there are many triggers for sensitive and sensitized skin, ranging from a particular ingredient that causes the reaction to one of the many lifestyle factors that can create inflammation.
Sensitive Skin
When treating clients who define their skin as sensitive, it is crucial that professionals recognize the difference between sensitive and sensitized skin. Both sensitive and sensitized skin share several contributing factors, but their root causes differ. Sensitive skin can be a biological condition that readily reacts to a variety of factors, such as specific chemicals, airborne debris, or skin care ingredients, resulting in skin that appears blotchy, broken out, or excessively dry. Skin can easily become red and warm to the touch. It is also a common symptom of genetic conditions like eczema, psoriasis, and rosacea. Professionals cannot change a client’s skin type, but they can educate clients on how to adjust their daily habits and skin care routine to manage the occurring symptoms.
Sensitized Skin
Differing from sensitive skin, sensitized skin is a skin condition characterized by irritation that builds over time due to environmental influences and lifestyle choices. Sensitized skin can result from over-aggressive exfoliation or from exposure to aggressive environmental factors, such as cold temperatures, wind, low humidity, and air pollution.
COMMON CONDITIONS
Eczema
Eczema, characterized by red, itchy, dry, and crusted skin that can be cracked, swollen, oozing, or bleeding, affects about 32% of people in the United States, making it one of the most common skin conditions. Scratching and rubbing of affected areas should be avoided as this can further exacerbate the condition. Sufferers generally have an over-reactive inflammatory response to environmental factors from common skin irritants like soaps, detergents, disinfectants, or allergens. While eczema is a manageable, noncontagious condition, it can still cause considerable distress and embarrassment for those affected.
While clients suffering from eczema can still enjoy a day at the spa, body scrubs and both physical and chemical peels can exacerbate symptoms, so it is best to stick to facials that are formulated for sensitive skin. Facials can soothe inflamed skin and remove buildup, leaving clients feeling clean and beautiful.
Psoriasis
Psoriasis is a skin disease characterized by dry, scaly skin, especially on the elbows, knees, and scalp. Psoriasis is often confused with eczema, but the two conditions have some important distinctions. While eczema can cause intense itchiness, psoriasis often results in a stinging or burning sensation. Skin affected by psoriasis is also thicker and more inflamed than eczema. Clients should consult a qualified dermatologist to correctly identify which skin condition they are suffering from.
Because psoriasis is a chronic condition, treatment is aimed at managing symptoms and improving quality of life. Laser treatments and infrared and light therapy may decrease symptoms, as well as treatments involving minerals and mud. Massages with essential oils may also soothe irritated skin.
Rosacea
Rosacea is a chronic inflammation of the face from an unknown cause. It results in redness and visible blood vessels on the face that may flare up for weeks to months and then go away for a time. While rosacea can affect anyone, it is most common in middle-aged women with light skin. This condition can typically manifest as redness in the central area of the face, including on the cheeks and nose in a butterfly pattern, and is usually characterized by flare-ups and remissions. Overtime, this redness can become more apparent.
Left untreated, pustules and large inflamed nodules can result that are often misdiagnosed as acne. Triggers include sunlight, hot drinks, spicy foods, alcohol, exercise, hot baths, and stress. Prolonged use of cortisone creams can also worsen symptoms. Rosacea is incurable, so spa treatments are aimed at managing symptoms. Enzyme peels, soothing creams or alginate gel mask, silver balls or cold globes, cold towels, and freeze-dried collagen masks are great for redness and sensitive skin. Strong chemical peels, drying products, coarse manual exfoliation, and excessive heat such as steam towels and hot water should be avoided, as these can trigger flare-ups. Some spas offer specialized rosacea facials aimed at strengthening capillaries and balancing skin tone. Intense pulsed light (IPL) and laser therapy may also be used.
While skin care professionals cannot treat rosacea, it is important to know how to identify and properly treat a client with rosacea. Although professionals cannot treat or diagnose any medical conditions, and rosacea is considered a medical condition, knowing how to properly provide a facial for a client with rosacea is vital. Professionals should be able to identify and avoid those stimuli that provoke a sensitive, sensitized, or rosacea response and provide skin with topical application of ingredients that will help calm and soothe the appearance of skin.
Reading product labels is especially important for people with sensitive and sensitized skin as certain ingredients can easily irritate and inflame skin. If unsure, a patch test inside of the forearm can be done to check for a reaction. When developing a skin care routine for these clients to help with immediate relief, implement rich moisturizers that have ceramides and oils such as sea buckthorn, chamomile, and safflower seed oil. Look for products with ingredients such as aloe vera, azelaic acid, ceramides, CoQ10, hyaluronic acid, squalene, green tea, licorice extract, niacinamide, oats, vitamin C, and zinc. Implement probiotics like Lactobacilli or Bifidobacterium along with prebiotics and dietary changes to support conventional treatments and restore gut and skin health. Research on the skin microbiome is only now beginning to reveal the intricate relationship microbes have with the skin, gut, and immune system in maintaining healthy skin. When microbes are in a state of dysbiosis (imbalance in the gut microbial community that is associated with disease), they can have a profound effect on skin’s immunity and metabolism, supporting the onset of certain skin conditions.
Hypertrichosis
Hypertrichosis is excessive hair growth on a person’s face or body. It is often a congenital condition, meaning that it is present at birth, although it may also be acquired from certain cancer treatments or even eating disorders. Addressing the underlying cause can usually reduce the severity of symptoms. Hypertrichosis (also called Ambras syndrome) is hair growth on the body in an amount typically considered higher than normal. It can be local to a specific region or cover the entire body. Hypertrichosis can be a congenital condition, present at birth, caused by an extremely rare (less than 100 recorded cases) genetic mutation which is not fully understood, but the condition is more commonly acquired after birth.
Hirsutism
Hypertrichosis is often mistakenly classified as hirsutism, though hirsutism is actually a specific form of acquired hypertrichosis affecting women and children resulting from an excess of androgen sensitive hair growth. Hirsutism is fairly common, occurring in approximately 10% of women between the ages of 18 and 45. When properly diagnosed, it is generally treated easily by correcting the underlying androgen imbalance. In order to effectively treat the condition, it must be correctly identified by a licensed endocrinologist.
Hair removal is an effective option, either permanent or temporary in accordance with the client’s goals. A professional should be consulted before beginning treatment as each hair removal method has its own set of contraindications and possible side effects. In order to effectively treat the condition, it must first be identified by a licensed endocrinologist. Hair removal through chemical epilation, laser, light therapy, electrolysis, sugaring, or waxing is often effective. These treatments need to be repeated regularly as hair continues to grow back. Professionals should watch out for signs of scarring, dermatitis, or allergic reactions caused by hair removal and replace the offending practice with something less irritating. If clients’ sensitive skin symptoms do not improve or they feel like it could be due to a more serious allergic reaction, recommend them to their dermatologist or doctor. For most cases of sensitive skin, though, giving their complexion a little extra treatment, love, and care can help keep irritation at bay.
Acne
Acne vulgaris is perhaps the most common skin condition that professionals will encounter. Acne occurs when a person’s hair follicles become clogged with oil and dead skin cells. It most commonly affects adolescents but can occur in people of any age. Common causes of acne include hormones, genetics, stress, infections, and insufficient hygiene. Acne can cause incredible distress, and even depression, for those who are affected. The two culprits of acne are bacteria and inflammation.
Acne vulgaris is a chronic inflammatory disease of the pilosebaceous unit, mostly affecting the face, neck, chest, upper back, and arms. It is estimated to affect 50 million Americans every year. Nearly 85% of all people have experienced acne at some point in their lives. Physical and psychological morbidities include redness, scarring, low self-esteem, depression, and anxiety.
Uncontrolled androgen hormones can also cause overproduction of oil and slow shedding of dead skin cells, which can be a breeding ground for hormonal acne. Hereditary acne is the genetic tendency to overproduce sebum. Hyper keratinized skin then traps sebum and creates c. acnes bacteria, also known as Propionibacterium acne. Fungal acne is an overgrowth of yeast in the hair follicle (pore). There is an imbalance of bacteria and yeast in skin that is causing the acne, and this usually occurs because of the bacteria in the pores and not by the oil.
There is no magical cure for acne and there is no one size fits all cure. It is important that the professional knows and understands their client’s skin, body, and state of mind inside and out to see results. Additionally, professionals should set clear expectations to bolster a client’s self-esteem and make sure clients understand that the professional is there to help manage their acne, not cure it.
Spa treatment for acne vulgaris should begin with a comprehensive skin analysis to identify sensitivities and aggravating factors. Things that may help include recommending clients to avoid alcohol in products, to refrain from stripping their skin of oil and moisture, to not pick their skin, to avoid heavy moisturizers, to double cleanse, to incorporate antioxidants, to perform topical exfoliation, to keep their skin hydrated, to protect their skin against environmental stressors, dirt, grease, ultraviolet light, humidity, and pollution, to practice stress reduction and good nutrition, to have regular facials, and to, lastly, protect their skin with sunscreen.
Aging
Not so much a condition as an inevitability for everyone, aging can have major impacts on skin that are often visible to the naked eye. As people age, their skin loses elasticity and moisture, which results in wrinkles as well as an increased risk of skin tags, warts, and dark spots. Sun exposure is a major determinant of how a person’s skin will age. Those who regularly apply sunscreen will likely experience less visible signs of skin aging than those who do not.
In terms of spa treatments, electrotherapy modalities such as galvanic and microcurrent treatments along with microdermabrasion and gua sha massage can help reduce the appearance of wrinkles. Chemical peels, nano facials, oxygen facials, thermal masks, and light therapy are great treatments to consider. Regular facials can also help skin remain refreshed and looking youthful by balancing the skin’s acid mantle. Incorporating an extended massage with a moisturizing serum and cream will help reduce the appearance of fine lines and wrinkles. Moisturizing alone can improve the appearance of skin. It temporarily plumps skin, making lines and wrinkles less visible. Recommend moisturizers with active ingredients that offer additional benefits. These added ingredients are intended to improve skin tone, texture, fine lines, and wrinkles. Some common ones are peptides, hyaluronic acid, vitamin A (retinoid), vitamin C, vitamin E, niacinamide, alpha hydroxy acids, CoQ10, tea extracts (black, green, rooibos, and oolong tea), rosehip, squalene, sea buckthorn, marula, safflower oil, argan oil, and sunscreen.
Chloasma
Chloasma, also known as melasma or hyperpigmentation, is an acquired, chronic skin condition in which brown patches appear on the face, arms, or back. This can lead to considerable embarrassment and distress. Chloasma is more common in women than men, as well as those who have naturally darker skin. The hyperpigmentation is caused by the overproduction of melanin, which gets deposited in the dermis. Known triggers include sun exposure, pregnancy, oral contraceptive pills, and hypothyroidism.
Spa treatments for chloasma will look different from person to person, depending on the degree of darkening, skin sensitivity, and other factors. Preconditioning skin four to six weeks prior to treatments is recommended, using skin care with tyrosinase inhibitors such as azelaic acid, kojic acid, alpha arbutin, mulberry, licorice root, bearberry, topical vitamin C, and topical tranexamic acid in a liposomal base. Remember that over exfoliating can compromise the skin barrier and worsen the pigmentation. Some professional treatments that may help include chemical peels, microdermabrasion, laser treatments such as Q-switched ruby laser, Q-switched, fractionated laser, picosecond laser, Nd; YAG, and microneedling.
TACKLING LIFESTYLE
As a skin care professional, it is important to remember that all types of clients will walk through the spa doors over the years, each with their own, unique skin. Being informed on all skin conditions and what treatments options are available will help the professional provide their clients with the best service possible, though it can be tough to know what will set their skin off, especially when the choices they make every day affect how their complexion looks and feels.
These lifestyle tips can help manage a client’s skin. To soothe skin, tell clients to take shorter showers in warm, not hot water and use mild soaps that skip perfumes and other fragrances. Instruct them to be particularly careful with red areas, open cracks, sores, or rashes.
Diet
It is also a good idea to understand clients’ food sensitivities. An upset stomach is not the only way to determine if a client has a reaction to certain foods. Advise them to keep a food journal and track when skin sensitivities crop up after eating certain types of foods, such as gluten, eggs, or dairy. Being able to master the art of recommendation is the key to client retention and establishing trust with clients is the key to keeping them long-term. Understand their barriers. How much time do they have for self-care? Are they strapped for time? Start by suggesting two to three basic products, like a cleanser, moisturizer, and sunscreen, depending on their main concerns. A new product such as an exfoliator, mask, or serum can always be added on their next visit. Focus on their primary concerns and a product that will deliver results. Understand that each client is different and that each of their skin may respond differently to the same exact treatment or product.
While skin care professionals are not licensed to diagnose skin disorders, it is essential that they are able to identify anomalies in skin to avoid complicating the condition, and they should know when to refer the client to seek medical attention. Learning never ends and being a well-rounded professional means not only being able to identify these skin types but also being able to understand how to nurture skin health through diet and nutrition by applying more of an integrative approach.
References
- Misery, L., Sibaud, V., Merial-Kieny, C., & Taieb, C. (2011). Sensitive skin in the American population: Prevalence, clinical data, and role of the dermatologist. International Journal of Dermatology, 50(8), 961–967. https://doi.org/10.1111/j.1365-4632.2011.04884.x
- Bouslimani, A., da Silva, R., Kosciolek, T., Janssen, S., Callewaert, C., Amir, A., Dorrestein, K., Melnik, A. V., Zaramela, L. S., Kim, J.-N., Humphrey, G., Schwartz, T., Sanders, K., Brennan, C., Luzzatto-Knaan, T., Ackermann, G., McDonald, D., Zengler, K., Knight, R., & Dorrestein, P. C. (2019). The impact of skin care products on skin chemistry and Microbiome Dynamics. BMC Biology, 17(1). https://doi.org/10.1186/s12915-019-0660-6
- Bellefonds, C. de. (2022, August 29). What do probiotics have to do with your skin? Healthline. Retrieved October 20, 2022, from https://www.healthline.com/health/probiotics-skin-care
- Thurrott, S., Petrarca, M., Rapaport, L., Rekstis, E., Migala, J., Groth, L., & Lawler, M. (2022, June 10). Everything you need to know about the skin microbiome. EverydayHealth.com. Retrieved October 20, 2022, from https://www.everydayhealth.com/skin-beauty/everything-you-need-to-know-about-the-skin-microbiome/
- Hayden, K. P. (2020). The Science Behind Skin Care: A Guide for Estheticians. Independently published.
- Mahto, A. (2018). The skincare bible: Your no-nonsense guide to great skin. Penguin Books Ltd.
- Tager, M., & Day, D. J. (2022). Feed your skin: Your personalized nutrition plan for radiant beauty. Changewell Inc.
- Pivot Point. (n.d.). Fundamentals: Esthetics Coursebook.
- Deitz, S. (2004). The clinical esthetician: An insider’s guide to succeeding in a Medical Office. Thomson Delmar Learning.
{/mprestriction}
Beatrice Van, an award-winning aesthetics master educator, is an enthusiastic, positive, self-starter with over 17 years of progressive experience in the beauty industry. In addition to her role as Clinical Master Aesthetics Educator at Spectrum Advanced Aesthetics, she is the clinical director for Fearless Beauties, a certified advanced aesthetician, makeup artist, and nail specialist. On her days off, she works at Indie Esthetics, helping her clients look and feel like the very best versions of themselves, or travels throughout North America as an education ambassador for CND and Fearless Beauties. Her passion is to empower both students and beauty professionals to boldly invest in their education and strengthen their skills while elevating standards in the industry.
