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MOM AND DAD!
ACNE VULGARIS IS A HIGHLY COMMON
pores become visible as whiteheads (closed com-
skin condition that is not the result of control-
edos) or blackheads (open comedos). In others,
lable factors such as a poor diet or dirty skin.
the pore tends to break down rapidly and white
Acne is genetic and occurs among members
blood cells stream in and release collagenase,
of the same families. At puberty, the hormones
the enzyme that digests the surrounding colla-
go into overdrive and stimulate the sebaceous
gen in the dermis. Finally, the foreign impaction
glands. The increased sebum provides nutrients
and the digested skin come out, leaving a scar.
that feed Proprionum acnes—commonly referred
The earlier the impaction is removed, the less
to as “P. acne”—a bacteria that activates flare-
severe the scarring is. However, care must be
ups. The free fatty acids that are released from
taken to gently remove the impaction, as inad-
the sebum stimulate epithelial cell production in
vertent picking can force it deeper into skin and
the follicle. For some acne sufferers, the impacted
cause additional inflammation and scarring. 4
BY JAMES FULTON, PH.D
Page 46 • www.LNEONLINE.com
Les Nouvelles Esthétiques & Spa • January 2010
photo: ©iStockphoto.com/Trinette Reed
ACNE AND PSORIASIS—GENETIC CURSES
January 2010 • Les Nouvelles Esthétiques & Spa
www.LNEONLINE.com • Page 47
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at right: before and after topical skin care of
Papulopustular acne. The client used benzoyl peroxide
cleanser, alpha hydroxyl toner and vitamin A conditioning
lotion. The complexion was improved after two
months of daily treatment and therapeutic facials.
Mallorca acne refers to
breakouts that are caused by
sunbathing. Acne excoriee,
or “mirror addict acne,”
is a psychomatic disease
characterized by a constant
picking at the face and body.
Sometimes, your client’s favorite cosmetic
products are exactly what is causing their breakout. That is why estheticians should educate
their clients on how to read the ingredient lists
of skin care products and avoid irritants like isopropyl myristate.
Hormonal changes that occur due to pregnancy or birth control pills can also accelerate a
breakout. Some drugs can cause problems as
well, such as the anti-seizure medication Dilantin
and Lithium, which can stimulate irritation that
leads to breakouts.
The inflammation of hair follicles can be a
side effect of steroid use, whether they are used
internally or topically. With topical steroids, the
induced acne appears as red papules and pustules concentrated in the area where the steroid
was applied. Steroids cause the thinning of the
skin’s outer layer, making hair follicles more susceptible to rupture. Lesions usually disappear
after steroid use ends. Sun exposure can either
improve or worsen acne.
External issues
Mallorca acne refers to breakouts that are caused
by sun bathing. Acne excoriee, or “mirror addict acne,” is a psychomatic disease characterized by a constant picking at the face and
body. Treatment for the condition must focus
Page 48 • www.LNEONLINE.com
Les Nouvelles Esthétiques & Spa • January 2010
bottom photo: ©iStockphoto.com/Amanda Rohde; before and after photos courtesy of James Fulton, Ph.D.
Papulopustular acne can be reduced with an
at home benzoyl peroxide cleanser, alpha hydroxyl
toner and vitamin A conditioning lotion.
There are many factors that aggravate the
condition. Stress can accelerate the inflammation. A lack of sleep or carbohydrate loading
can bring on breakouts. Recommended preventative measures that you can take include
getting a full eight hours of sleep and following
a low glycemic diet.
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on releasing these existing impactions and preventing new ones from forming. An effective
skin care regimen that is followed along with
therapeutic facials is beneficial in most cases.
For some, the results can be further improved
with systemic antibiotics, particularly the lipid
soluble Doxycycline. Taking one capsule each
day may reduce the inflammation in papulopustular acne. Those with persistent cysts
may be helped with isotretinoin (Accutane).
However, the regulations of the I Pledge program make administration troublesome, especially for the female patients. They must use
two different types of birth control. The residual
acne scars can be improved with Fraxel laser
treatments, combined with facial peels and
fillers. Hyaluronic acid is a recommended filler
that can yield great results for up to one year
and look very natural. A client should wait to
have either a facial or a peel for two weeks
after the injectable.
It is always best to treat the acne early to
avoid physical and emotional scars. Each variety of the condition is addressed in a different
way. For example, Papulopustular acne can
be reduced with an at home benzoyl peroxide
cleanser, alpha hydroxyl toner and vitamin A
conditioning lotion. After two months of receiving daily treatments and therapeutic facials, the
complexion improves. Cystic acne can be diminshed with topical products, particularly those
containing Isotretinoin, which is especially helpful in reducing sebum.
While the reason
is not understood,
we know that
weight gain can
promote psoriasis
and weight loss
can improve
the condition.
top photo: ©iStockphoto.com/Kutay Tanir; psoriasis: Ken Roberts
Another family tradition
Psoriasis vulagaris is another inherited skin
condition. One percent of the American population has the gene. It often begins early in life
as itching in the scalp or papules on the back,
elbows or knees. The papules will slowly grow
into plaques in the scalp and over the body.
The cell turnover is very rapid so the lesions
are quite scaly and white in appearance. Due
to the resulting white appearance they take on,
they are often called micaceous scales, named
after white mica.
Aggravating factors are trauma, sunburn,
weight gain and stress. While the reason is not
understood, we know that weight gain can promote psoriasis and weight loss can improve
the condition.
continues
January 2010 • Les Nouvelles Esthétiques & Spa
psoriasis on the elbow
www.LNEONLINE.com • Page 49
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When trauma induces psoriasis, the condition is called the Koebner Phenomenon, named
after an eccentric and renowned German dermatologist Heinrich Koebner, who lived in the
nineteenth century.
Professor Koebner describes psoriasis trauma as a situation where the condition continues
to develop on an individual’s skin during the
healing process.
Award winning country singer Leann Rimes
is very open about her personal struggles with
the disease. To raise awareness about the condition, Rimes leads a nationwide campaign
entitled “Stop Hiding from Psoriasis,” which
encourages psoriasis sufferers to openly share
their experiences of the disease to provide
support and information to each other. She has
suffered from psoriasis since the age of two.
Now age 26, Leann is just now learning how
to effectively manage her psoriasis. She attributes the improvement of the psoriasis to two
factors. First, Leann was determined to find an
effective treatment regimen for her psoriasis.
And secondly, she made her health a top priority, taking time every day to exercise, eat right
and manage stress.
Page 50 • www.LNEONLINE.com
Treatments must focus on reducing cellular
turnover with the help of topical steroid creams
or ointments. That can be potentiated with the
application of plastic wrap over the elbows
and knees at night. Systemic therapies include
anti-cancer drugs such as methotrexate and
new biologic therapies that involve injecting
antibodies to fight inflammation.
Today, the condition can be controlled but
not healed. Suggest to your clients that they
avoid the aggravating factors and use hydrocortisone cream covered in a plastic wrap. Develop
a monthly regime of stress reducing treatments
to help manage flare-ups. Remember that if
the psoriasis is open and weeping, it is better
not to treat it. If it is a truly severe case, refer
them to a local dermatologist who specializes
in psoriasis. n
James E. Fulton, Ph.D.,
is a leading researcher,
cosmetic surgeon and
dermatologist. Dr. Fulton
graduated from Tulane
University School of
Med­icine and received
a Ph.D. in biochemistry
from the University of
Miami. He is currently a
board certified fellow of both the American
Academy of Cosmetic Surgery and American
Academy of Dermatology. Dr. Fulton’s years
of experience have culminated into his own
patented product line, Vivant® Skin Care. He
is the author of Acne Rx, a valuable acne re­
source for estheticians.
Les Nouvelles Esthétiques & Spa • January 2010
photo: ©iStockphoto.com/Timur Arbaev
Treatments must focus on
reducing cellular turnover
with topical steroid creams
or ointments. That can be
potentiated with the application
of plastic wrap over the
elbows and knees at night.