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How to Handle a Product Reaction
By: Carl Thornfeldt, MD
Posted: February 28, 2011, from the March 2011 issue of Skin Inc. magazine.
This is a pustular reaction to an aggressive superficial peel of 30% salicylic acid after microdermabrasion.
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Unusual reactions can include the following.
- A red or purple, scaly or crusty rash that develops after product use—especially if areas where product was not applied are affected. The latter indicates the reaction is severe and usually requires prolonged prescription therapy.
- Clear blistering, especially if it is painful, strongly suggests herpes simplex, staphylococcal bullous impetigo or severe allergic reaction; this is a medical emergency and requires a dermatologist’s assistance for prescription treatment.
- If skin has become extremely sensitive, tender and photosensitive after product use, this could be an indication of contact allergy or irritant reaction.
- Cystic acne breakouts and/or furuncles occur that may result in scars. Prescription antibiotics and red light LED are very helpful, as well as an ice cube application and an acne heating device for directly heating the lesion. Prescription steroids also help to speed clearing.
- Swelling and hives with itching or stinging indicate an allergy, so a topical anti-inflammatory or over-the-counter (OTC) oral antihistamine may be needed.
- Pustules, deep scabbing, crusting or weeping usually indicate an infection. To determine the cause, cultures for bacteria, virus and yeast must be performed. Refer the client to a physician if the condition persists for more than 48 hours, is moderate to severe or has a painful reaction. Begin cleansing with an OTC antiseptic antimicrobial skin cleanser, then apply ice packs or ice water compresses for 10–30 minutes. Next, use OTC clotrimizole or miconazole cream, followed by an antibiotic ointment three times daily.
- Systemic reactions such as headache, dizziness or fever indicate more severe reactions, so notify a physician as soon as possible.
For destructive procedures such as chemical peels or dermaplaning, determine the following.
- What was the pre-care regimen?
- What was the exact protocol followed? Was a spot test conducted before the peel?
- What was the application method—textured gauze, cotton swabs/balls, cotton pads or a brush?
- Which chemical peeling compound was used, and what was its concentration (percentage/pH)?
- How much peel solution was used; how many layers were applied?
- How long was the peel solution left on before neutralizing?
- Did hot spots of bright white or blisters occur, or could the client detect certain areas that were excessively painful or tender during the procedure?
- What was the immediate post-care regimen?
Encourage your client to see you in person in order to actually view the reaction that is taking place. Try to take a picture to document the client’s response and subsequent healing process. If the client cannot come in person, sometimes using a cell phone with camera capabilities to send you a quick photo via e-mail is a good solution.
How to test for an allergy
Allergies to a specific ingredient can happen at any time, even when an client has been using the same formula for years. Many herbal ingredients will cross-react with others. For example, tea tree oil—one of the most common allergens—cross-reacts with lavender. Patch testing can be done by a spa professional, and you can test a product by applying it twice daily to the inner upper arm or thin skin in front of the elbow for up to two weeks. A reaction with itching in four days’ time indicates contact allergy, especially if a hive or blister occurs. Redness and tenderness on day five or later usually means it is a contact irritation.
Contact irritation occurs when an excessive chemical concentration or amount is applied. The procedure can be used again, but at no higher than 30% of what was previously used. All notes, treatments and products in use must be documented. Once all the details have been gathered, the answer may become clear.