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Skin Abnormalities: Separating Harmless From Harmful



By: Jennifer Linder, MD
Posted: January 28, 2011, from the February 2011 issue of Skin Inc. magazine.

Clients rely on skin health professionals to answer their questions accurately and honestly. Clinical estheticians are often faced with treating more than hyperpigmentation, acne, rosacea and visible aging because additional dermatological irregularities and curiosities are commonly brought to their attention. Although many cutaneous concerns should be treated by a physician, being able to identify various lesions can be helpful to the esthetician in developing treatment plans and determining when to refer to a physician for suspicious abnormalities. There is often a fine line between conditions that are dangerous and those that are merely cosmetically bothersome—understanding the difference is crucial to healthy, happy clients.

As the protective barrier for the body, the skin is constantly exposed to various offenders. The amount of stress placed on this vital organ often results in various physiological changes. The pathway in which these conditions are formed—and whether or not they spread and damage surrounding tissue—determines the level of threat they are to the overall health of the client. Noncancerous skin growths, such as seborrheic keratoses, sebaceous hyperplasias, cherry hemangiomas and verrucae planae (flat warts) are examples of skin concerns that are visually unappealing but not considered harmful. Cancerous lesions such as basal cell carcinomas, squamous cell carcinomas and melanomas, as well as those lesions with the potential of progressing into skin cancer, such as actinic keratoses, can be life-threatening in some circumstances.

Cause for concern

Skin cancer is the most common type of cancer in the United States, and its various presentations can make it difficult to identify without proper physician examination. Cancerous lesions invade and destroy surrounding normal skin cells and tissues and, although prevention by using daily sunscreen and antioxidants is best, appropriate treatment is crucial once any type of skin cancer develops. Any and all questionable skin growths should be examined by a dermatologist before topical treatment is applied.

Actinic keratoses (AK). These are abnormal growths resulting from overexposure to UV rays. AK are considered pre-cancerous and, if left untreated, they can develop into squamous cell carcinomas (SCC). The appearance of AKs is rough and scaly, and they can be tan, red, pink or flesh-colored. Studies show that up to 60% of SCC begins as AK.1 They can be treated by physicians in several ways, including cryosurgery (freezing of the lesions), curettage (scraping of abnormal surface tissue), 5-aminolevulenic acid photodynamic therapy (PDT), surgical excision and topical destructive cream medications. Clinical studies have also shown chemical peels, such as Jessner’s solutions and trichloroacetic acids (TCA) preparations, to be effective treatments as well.2

Basal cell carcinoma (BCC). They can be as simple as a tiny, clear, pearly or flesh-colored bump or may be more apparent, such as an open sore or shiny red, pink, brown or black lesion that can be mistaken for a mole. Although BCC is considered the least threatening form of skin cancer because it grows the slowest and is the least likely to metastasize, or spread, it can be incredibly locally destructive or disfiguring.

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