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skin THANKS 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 skin|thanks mom and dad! 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. skin|thanks mom and dad! 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 skin|thanks mom and dad! 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.