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Identifying Inflammation

Annet King April 2010 issue of Skin Inc. magazine
woman with redness in skin

A woman enters your retail space and asks if you have products for sensitive skin. The question is a reasonable one—her skin feels prickly, itchy, tight, dry in patches and may even bristle with red blotches.

The term “sensitive” is one that has been in the consumer vocabulary for decades, yet it’s generally used incorrectly and is misunderstood as the basis for both professional treatment and product selection. When clients say that they have sensitive skin, this declaration is your cue not only to treat and recommend products, but also to educate.

According to Diana Howard, PhD, vice president of global education for The International Dermal Institute, “Sensitized skin is a reflection of a client’s environment, lifestyle and physiology. Pollution, stress, hormones, cosmetics, climate, alcohol, diet, medical procedures and other factors can all lead to sensitized skin, which is defined as skin that displays a more reactive response to substances that are tolerated by the general population. It is now known that this condition is the result of three key factors: a compromised lipid barrier layer, traditional immune activity and the newly discovered neurogenic response in the skin, which is a newer area of research studying the effect of the nervous system, and its relationship to inflammation and sensitive skin. Although all of these factors contribute to sensitized skin, each must be addressed individually to control this condition; otherwise, continued exposure to the stressor can result in inflammation that can lead to more serious skin disorders and premature aging.”

Defining terms

For years, the term “sensitive” has been used by skin care product manufacturers as shorthand for skin that is highly reactive and displays allergic responses to common ingredients. These manufacturers identify sensitive—as well as dry, oily and combination—as a skin types. This approach has contributed greatly to the current misinformation and confusion about the subject. The real downside is that often, a client’s skin is not correctly treated, so problems persist and sometimes worsen as a result.

“Skin type” is a simplistic term that persists in the language of manufacturers, and it serves as convenient for marketing purposes. Skin type is inherited from parents, similar to blue eyes or curly red hair. It’s genetically coded. More often than not, however, skin conditions are what cause trouble, and they are mutable, changing, and the result of interaction with outside forces, as opposed to what’s simply in a person’s DNA.

Every person’s skin is a fluid, dynamic river of shifting conditions that are influenced by environment, diet, stress levels and lifestyle. Skin is never just one type; it’s an array of changing conditions, and thus a moving target. Although it’s a retailer’s dream for clients to develop loyalty to a favorite product, ensuring solid repeat sales, the fact is that their skin requires regular professional monitoring in order to adjust product recommendations. This is the valued role of the professional skin therapist. Just a brief 10-minute visual and tactile exam every other month becomes the basis for informed and effective professional treatment and at-home care.

Correctly naming a skin condition is the first step to understanding and treating it. This identification process must go further than merely observing symptoms. This is especially true when dealing with inflammation, because this syndrome is present in a variety of conditions, including sensitivity, sensitization, rosacea and even acne. Thus, understanding a condition must begin with a forensic investigation of the condition’s origins, not simply noting its symptoms and their characteristics.

Distinctions between sources

Understanding the various causes of similar symptoms is the key step in not only treating present symptoms, but also halting the syndrome that generates future ones. This distinction is at the heart of the sensitive or sensitized skin diagnosis. It also applies to removing other syndromes that involve inflammation, such as rosacea, from the mix. Rosacea is a progressive inflammatory disorder that begins with scratchy sensations and flushing associated with specific triggers, but can later lead to burst capillaries, facial swelling, acneic-type breakouts and much more serious consequences, such as rhinophoma and ophthalmic rosacea, which can lead to blindness. Although the symptoms may appear to be similar, their origins are different, requiring differing treatments and possibly some medical intervention.

It’s no mystery that more and more clients claim to have sensitive skin when, in fact, sensitized skin is on the rise. Much of this is due to the increased emphasis upon exfoliation as an age-fighting skin care strategy.

Stopping inflammation

What common triggers often result in the escalation of inflammation? The list is maddeningly diverse: hot drinks, cold drinks, hot weather, cold weather, spicy food, stress, and artificial fragrances and colors.

One crucial key to addressing all of these concerns is supporting and maintaining healthy lipid barrier function. A defect in the skin’s protective outer layer, known as the lipid barrier layer, may allow irritants, such as microbes and allergens, to penetrate the skin, causing a domino effect of adverse reactions and symptoms. With this in mind, a threefold strategy makes sense for combating inflammation.

  1. Containment and the reduction of current symptoms
  2. Avoidance of known triggers
  3. Enhancement of skin’s natural lipid barrier

The skin’s barrier function is mainly attributed to the lipid components of its outermost layer, the stratum corneum, which effectively protects the body from drying out and prevents foreign substances from penetrating the skin. By maintaining the barrier lipid layer at its peak performance level, the damaging effects of environment and lifestyle on the skin can be controlled.

Easing up on exfoliation

The first—and possibly most urgent—step in helping clients recover from inflammation and to prevent future inflammation is to assess their exfoliation habits. Sensitization can occur as the result of aggressive procedures and products that are often used in reckless combination by clients without the supervision of a skin therapist.

When working with those who are suffering from inflammation, begin by taking a full history of their exfoliation practices. If the words “glycolic acid” and “do-it-yourself home microdermabrasion kit” pop up, the answer is clear. In any case, discuss all exfoliants used by the client at home and spa procedures they have experienced, as well as any other intrusive practices that may affect the lipid barrier. Then, depending upon the client’s skin condition, begin to build a program of restorative and protective treatments, and home-care products. See Ideal Anti-inflammatory Ingredients for components to consider when constructing this type of program.

Striking a healthy balance

As always, when developing an at-home program for clients, be sure to include comprehensive sun protection. Sensitized skin—especially that which has been abraded—will be highly reactive to ultraviolet (UV) exposure. The combination of inflammation and solar exposure greatly increases the likelihood of long-lasting hyperpigmentation, so be sure that clients are well-protected from additional photosensitivity.

Both therapist and client must practice greater awareness of inflammatory responses as a defense against intrusive procedures. Striking a healthy balance between exfoliation and lipid barrier protection will leave clients with skin that is polished yet resilient, and is able to defend itself against the continuous dermal assault of daily life.

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Ideal Anti-inflammatory Ingredients

Ingredients that are ideal for various aspects of the inflammation containment, recovery and prevention process include the following.

Boerhavia diffusa root extract (red hogweed). This stops the production of proinflammatory agents and limits neurogenic inflammation by favoring the production of the anti-inflammatory neurohormone MSH in order to restore tissue integrity.

Helianthus annuus (sunflower) seed extract. This contains ceramides, which play an essential role in maintaining the integrity of the skin and ensuring the proper cohesion of skin cells, minimizing skin dehydration. It optimizes the skin’s protective properties.

Hydrolyzed algin. Derived from brown seaweed, this ingredient has antioxidant and film-forming properties that help with skin’s protective function.

Oenothera biennis (common evening primrose) oil. This is a skin nutrient high in gamma linoleic acid, and is a fatty acid that is also required for intact epidermal lipid bilayers.

Persea gratissima (avocado) sterols. This has lipid moisturizer functionality and is a rich source of natural plant phytosterols that help maintain the lipid barrier layer.

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