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Page ii of 70 Learner Guide WRBCS409A Apply knowledge of skin science to beauty therapy treatments

© Service Industries Skills Council, 2005

This work is copyright, but permission is given to trainers and teachers to make copies for use

within their own training organisation or in a workplace where training is being conducted. This

permission does not extend to making copies for use outside the immediate training environment

for which they are made, or the making of copies for hire or resale to third parties.

Modification and distribution of this document is permitted within the terms specified in the

Service Skills Beauty Training Package Support Materials - electronic version: Licence

conditions document.

Except as permitted under the Copyright Act 1968 , all other rights are reserved. Requests for

permission may be directed to:Services Industries Skills Council

Level 10, 171 Clarence St

Sydney NSW 2001

Phone: +61 2 8243 1210 Fax: +61 2 8243 1299

www.serviceskills.com.au e-mail: [email protected]

The views in this work do not necessarily represent the views of the Service Industries Skills

Council. The Service Industries Skills Council does not give warranty nor accept any liability in

relation to the content of this work.

Published by: Services Industries Skills Council

Level 10, 171 Clarence St

Sydney NSW 2001

Phone: +61 2 8243 1210 Fax: +61 2 8243 1299

www.serviceskills.com.au e-mail: [email protected]

Title: Learner Guide WRBCS409A Apply knowledge of skin science to beauty therapy treatments

(electronic version)

ISBN: 1 74160 064 2

First published: April 2005

Printed by: SOS Printing, Sydney, Australia

Print Version No: 1

Service Skills acknowledges the work of the Victoria University of Technology in the

development of this resource.

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Table of contents

Getting started ................................................................................................................... 1

Section A Link the principles of skin science to beauty therapy treatments .................. 3

Section B Identify the causes of and treatments for skin disorders .............................. 33

Glossary .......................................................................................................................... 63

Assessment...................................................................................................................... 69

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Learner Guide WRBCS409A Apply knowledge of skin science to beauty therapy treatments Page 1 of 70

Getting started

Getting started

Information about this learner guide

This learner guide covers the unit of competency, WRBCS409A Apply knowledge of skin

science to beauty therapy treatments which is part of the WRB04 Beauty Training

Package.

It is a core unit for the following qualifications:

• WRB40104 Certificate IV in Beauty Therapy

• WRB50104 Diploma of Beauty Therapy

The guide has been designed to help you develop the skills and knowledge required to

apply the principles of skin science and skin disorders to beauty therapy treatments and it

covers the following elements of competency:

1. Apply knowledge of skin science to beauty therapy treatments

2. Apply knowledge of skin disorders to beauty therapy treatments

3. Promote skin health and care

A variety of learning activities have been included to support you in developing the skills

and knowledge you need to achieve competence in this unit.

Your will be expected to demonstrate that you have acquired the skills and knowledge

specified in the unit of competency. You may be asked to:

• answer written and/or oral questions

• demonstrate the practical skills you have acquired

• complete relevant workplace documentation

Assessment for this unit must be conducted by an assessor from a Registered Training

Organisation (RTO). Refer to the Assessment section at the end of this guide for more

information.

Use your trainer or supervisor as an additional learning resource. If you have any

problems with your learning discuss them with your trainer or supervisor at the earliest

opportunity.

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Page 2 of 70 Learner Guide WRBCS409A Apply knowledge of skin science to beauty therapy treatments

Getting started

Suggested resources

The following references may provide you with additional information and ideas as you

progress through this unit.

Books

Buxton, Paul K., ABC of dermatology 4th Edition, London : BMJ Books, 2003

Fleischer, Alan B., Feldman, Steven, Clayton, Elizabeth and Katz, Aaron 2000, 20

Common Problems in Dermatology, McGraw-Hill, Health Professions Division, New

York.

Poyner, Thomas F. 2000, Common Skin Diseases, Blackwell Science, Oxford.

Video

The Skin and Its Disorders 2000, Milady Thomas, New York.

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Section A

Link the principles of skin scienceto beauty therapy treatments

Section A Link the principles of skin science to beauty therapy treatments

What you will cover in this section

The four steps to Link the principles of skin science to beauty therapy treatments are:

Step 1 Identifying key stages in the development of the skin

Step 2 Identifying the inheritance of physical traits and conditions of the

skin

Step 3 Identifying the function of the main skin chemicals

Step 4 Identifying the importance of percutaneous absorption in relationto beauty therapy treatments

This section covers the main principles of skin science as they relate to the performance

of beauty therapy treatments.

Step 1 Identifying key stages in the development of the skin

Identifying how the skin grows and develops as well as changes that affect the skin over time, will help you to develop an understanding of the affects of a range of different

beauty therapy treatments and the techniques that are applied in the performance of these

treatments. For example facial treatments for mature skin may make use of products and

techniques that are different for a younger skin. Similarly different massage techniques

would probably be used on a more mature skin compared to a younger skin.

Growth is the progressive development of a living being or part of an organism from its

earliest stage to maturity. Development involves the series of changes by which the

individual embryo becomes a mature organism.

The basic processes of growth are:

Cell division (multiplication)

Cell division occurs throughout a human’s life. In any animal, cells are constantly divided

to form more cells, either to add new tissue to the existing organism or to replace

damaged tissue. This kind of cell division is called mitosis .

Cell di fferentiation

Cell differentiation is the process by which a general cell type changes to form a cell type

with a specialised function.

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Section A


Although the process for the way that cells achieve this is unknown, it is generally

believed that it involves switching mechanisms in the nucleus of the cell. Some pieces of

the information contained in the DNA within the nucleus are turned off while others are

turned on. Thus, although cell with a nucleus has the same chromosomes and DNA,

different cells use different parts of that information just as different students will use

different sections of a library.

The Growth of the Epidermis

The diagram below shows the different stages in the growth of the epidermis.

1. The layer of stem cells in the germinative layer of the epidermis

2. Cells produced in the germinative layer are pushed towards the surface, become

flattened and die.

3. The remains of the cells lose their identity and become converted into layers of

keratin. Eventually, these flakes of keratin are lost from the surface of the skin.

3

2

1

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Section A


Mitosis

Mitosis is the constant division of cells to form new cells. Each of the resulting daughter

cells is identical to its parent cells. This multiplication of cells occurs at a rapid rate until

growth is complete; thereafter new cells are formed to replace those which have died.

Mitosis consists of several well-defined stages:

• the interphase

• the prophase

• the metaphase

• the anaphase

• the telophase

Figure 2 – Stages of Mitosis in an Animal Cell

Late

Anaphase

Early

Telophase

Late

Telophase

Two Cells

Interphase Early

prophase

Late

prophase

Metaphase

Early

Anaphase

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Section A


Cell division in the epidermis, the skin’s outer layer, is essentially limited to the basal or

foundation layer. Following mitosis, one of the two daughter cells moves upwards. Cells

pushed towards the surface and further from their blood supply become flattened, lose

their nuclei and die. The remains of the cells lose their identity and become converted into

layers of keratin. Keratin-producing cells or keratinocytes form the stratum corneum, the

outermost layer of the epidermis and the body’s major chemical and mechanical barrier.

Ultimately, layers of keratin are lost from the surface of the skin by desquamation

(peeling off in scales). A range of beauty therapy treatments are designed to aid this

process through exfoliation of the skin where fresh cells are uncovered. For example

exfoliation of the skin is a key part of facial treatments and some body treatments such assalt glows.

The rate of skin growth adjusts to the rate of body growth, in other words, if the body

grows rapidly, skin grows to cover it. During pregnancy, striae gravidarum (stretch

marks) occur when abdominal skin growth cannot keep pace with body growth. However,

when adults lose weight, elasticity adjusts the skin to the decreased surface area and

growth decreases. In old age, skin loses elasticity and wrinkles occur.

Changes in the Skin from Foetus to Old Age

CellsDuring the phases of growth, different proportions of stem cells and differentiated cells

must be produced at different stages. Before birth, cell division is the main cause of

growth of the foetus; however, if this process in which each stem cell divides into two

more stem cells continued, the foetus would become a mass of unspecified cells.

Alternately, if every stem cell divided into two differentiated cells incapable of further

division, growth would stop. After birth, existing cells enlarge and the intercellular matrix

is formed. The intercellular matrix is the connective tissue filling the space between the

cells of skin, tendons, muscles and cartilage.

During the first two stages of growth, the number of stem cells in the germinative layer

must increase so that the growth of the skin keeps pace with the growth of the body itcovers. During these phases, the skin thickens, so that more differentiated cells must be

produced by the activity of stem cells.

In the adult phase of growth, cells are lost from the skin’s surface and are replaced by the

division of stem cells in the epidermis. Overall, these cells produce equal numbers of stem

and differentiated cells; hence, the stem cells continue the growth process and the

differentiated cells proceed to the skin surface and are shed.

In old age, the skin’s thickness decreases because the stem cells are no longer able to

balance cell losses from the surface of the skin. This has implications for the way beauty

therapy treatments are performed on thinner, mature skin. Some beauty therapy treatmentssuch as facials aim to assist cell renewal or mitosis in more mature skins where this has

decreased.

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Section A


Learning activity A1.1

Research two beauty therapy treatments which use techniques to assist cell renewal or

mitosis. Discuss how this process works with fellow colleagues or students. Make some

notes below.

Discuss how the beauty therapy treatments you have identified assists mitosis with you

trainer or supervisor.

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Section A


Hormones and Skin Growth and Development

Hormones are chemical messengers secreted from endocrine (ductless) glands. An

endocrine gland is a group of tissues which manufactures and secretes hormones directly

into the bloodstream. These hormones are carried in the bloodstream and act at sites in the

body distant from the site of their production. Here they influence growth and function of

tissue. A target organ or target cell is an area specifically influenced by the action of a

particular hormone. However, for the hormone to affect the target tissue, the cells in the

tissue must contain a specific receptor for that particular hormone.

During childhood, skin is smooth and unblemished. This is because the sebaceous glands

produce only small amounts of sebum at this time. Sebum is an oily substance which is a

mixture of fat and the debris of dead fat-producing cells.

With the onset of puberty, skin follicles become open-pored, oily and acne prone. This is

due to the formation of androgen, a hormone which increases sebum production.

Androgens are responsible for the earliest physical indicators of puberty, such as the

appearance of pubic and underarm hair. Androgens vary in strength and some skin areas

are able to convert weak androgens into stronger ones so that effects on the skin may be

significant.

With increased production of sebum, pores become larger, blackheads may develop and

skin and scalp become oilier. When the sebaceous gland is operating at an adult level,

development of problem oily skin and acne and unwanted hair growth on the face and

body may occur. Beauty therapy treatments such as facials treat skin conditions linked to

sebum production. A client may have overactive sebaceous glands so a beauty therapist

needs to use products and techniques that control sebum production. Epilation treatments

are performed to remove unwanted hair growth on face and body areas.

Ageing

Ageing is the ongoing process of changing over time. In terms of physiological features,ageing comprises three phases:

1. Development phase

2. Mature phase

3. Senescence phase

Some of this change is inherent in the passage of time; other change is due to degenerative

disease. It is impossible to fully distinguish between these types of changes. Changes in

the cells and tissues of the body may result in many of the major disabilities of old age.

These include defects in the processes of growth and in the replacement of damaged cells.

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Section A


Theories about Ageing

A number of theories try to account for degenerative changes in old age. There is no

strong evidence supporting one rather than another and in fact all may contribute to the

ageing process.

These theories include:

Genetic or Biological Clock Theory

This theory states that there is a maximum lifespan that is determined by the DNA

(genetic material) in cells. Under certain conditions, tissue culture cells display arepeatable finite number of cell divisions. Cultured cells will not survive indefinitely

unless they develop chromosome abnormalities similar to those seen in cancer cells.

Free Radical Theory

This theory argues that there is an environmental cause of ageing as opposed to an

intrinsic or genetic cause. The major difference between this theory and the genetic theory

is that the latter assumes a fixed lifespan, while the free radical theory argues ageing is

caused by free radicals (highly reactive chemical substances) which initiate damage to the

cells and systems of the body resulting in impairment of normal function.

Some free radicals, such as unsaturated fatty acids, are produced spontaneously in cells or as byproducts of the metabolism of oxygen in cells. Oxygen in biological systems is not

particularly reactive of itself, but a number of highly reactive species of oxygen can be

generated in cells. These include superoxide, hydrogen peroxide and peroxide radicals,

and singlet oxygen. Other free radicals are produced by environmental factors such as

light, radiation and pollutants.

Immunological Theory of Ageing

The immune system fights disease by recognising and removing or destroying foreign

substances and damaged or cancerous cells.

In the aged, the immune function decreases. The ability of the immune system torecognise any abnormal cells or foreign substances in the body is reduced; therefore, the

aged suffer a high incidence of cancer, infectious disease and degenerative auto-immune

disease such as arthritis.

‘Normal’ Ageing and Photoageing

Photoageing relates to changes promoted by exposure to sunlight and UV rays. Both

normal ageing and photoageing involve changes over time; therefore they share some

outcomes. However, many features are very different. For example, a 40 year old woman

with photoaged skin will not have skin like a 60 year old normally aged woman. The

distinction between normally aged and photoaged skin is confused because most people,depending on the level of sun exposure, experience degrees of both.

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Section A


The main differences between normal and photoaged skin can be seen in the following

comparisons.

Normal Ageing Photoageing

Appearance: Appearance:

smooth, unblemished leathery, blotchy

some deepening of wrinkles quite extensive deep wrinkling

some loss of elasticity quite significant loss of elasticity

Epidermis: Epidermis:

thinner thicker

fewer cells participate in mitosis; cells

regular

more cells participate in mitosis; cells

irregular

smoothing of basement membrane irregular basement membrane

Dermis: Dermis:

thinner thicker

elastin is thicker and cross-linked elastin is in thick, tangled, disorganised

lumps

collagen bundles heavily decrease in bundles and fibres of elastin

GAGs (Glycosaminoglycans: sodium salt

of Hyaluronic Acid) overall decrease

GAGs: large increase; change in ‘gel’

thickness

Cells of Dermis Cells of Dermis

hypocellular hypercellular

Cancers: Cancers:

uncommon very common

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Section A


Many beauty therapy treatments aim to minimise the effects of ageing and photoageing on

the skin. For example facial and body treatments exfoliate and introduce nourishing

products into the superficial layers of the skin.

Wound Healing

Wound healing or epithelialisation is a complex series of highly regulated biological

events following damage to the dermis or epidermis. Damage may be caused by chemical,

physical or bacterial means. For example body piercing causes physical damage to the

skin. Wounds and other manifestations of damage such as bruising, swelling, abrasions or

cuts as a result of recent operations are contra-indications to a range of beauty therapy

treatments especially those involving some form of massage where pressure is applied to

the surface of the skin. People who suffer from diabetes experience difficulty with wound

healing due to nerve damage resulting in loss of tactile sensation.

After the damage, an inflammatory response occurs, followed by tissue repair to either the

normal tissues or scar tissue; which of the two depends on the extent and ability of repair.

Repair extends over many months but strength is never the same as normal skin.

Open skin wounds may be classified as:

• Partial thickness when at least a portion of the dermis remains intact. In this instance,healing takes places by epithelialisation.

• Full thickness when the wound extends through the dermis. Healing is facilitated by

primary, delayed primary and secondary intention.

Primary intention is the immediate closure and abutment of wound margins. This can

occur when the cut has been clean, there is a good blood supply and there is a low foreign

organism count (below 100,000 per gram). The regular pattern of collagen renewal is

unimpaired.

Delayed primary closure may occur when there is a priority to treat other injuries. The

resultant final wound repair strength is not impaired and in fact is as strong as if primary

intention occurred.

Secondary intention occurs in the instance of large wounds associated with skin and/or

soft tissue loss (through burns, abrasion, or amputation). In this instance, blood supply

needs to be re-established either by normal vessel re-growth or surgically re-directed

vessels.

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Section A


Stages in Wound Healing

The wound healing stages are:

1. inflammation

2. contraction

3. collagen deposition

4.

epithelialisation.

Inflammation

Following an injury to the tissues, small vessels in the injured area soon dilate. This leads

to increased blood flow to the area. The permeability of capillaries in the area increases

and plasma fluid, proteins and other large molecules move into the inflamed tissues.

Accumulation of fluid takes place within these tissues, the viscosity of the blood increases

and erythrocytes (red blood cells) clump together. Resistance to blood flow increases, and

as inflammation progresses, blood flow through small vessels in the injured area slows

and sometimes even stops.

During inflammation, fibrinogen moves from the blood into the tissue spaces. Here, it isconverted to fibrin, an insoluble protein, and forms a blood clot that walls off the injured

area. This walling off effect can delay or limit the spread of toxic products or bacteria.

As erythrocytes clump together and blood flow to the inflamed area stops, leukocytes

(white blood cells) are displaced to the periphery of the bloodstream and come into

contact with the capillaries in the inflamed area. Eventually, the leukocytes adhere to the

vessel surfaces. This process is called pavementing.

Leukocytes migrate through the tissues in a direction determined by chemicals released at

the site of the injured tissues. This movement of cells in response to chemical factors is

called chemotaxis.

One of the benefits of inflammation is the engulfing of foreign material and debris by

leukocytes. This is called phagocytosis. Phagocytic cells attach themselves to foreign

materials and engulf them by forming a membrane. The goal of the inflammatory

response is to overcome the injury or invasion of the injured area and to clear this area for

tissue repair. However, sometimes the invasion is not overcome and an abscess or

granuloma forms. An abscess is a sac of pus sealed by a wall of fibroblasts or collagen.

An abscess will not diminish naturally and requires draining. A granuloma is a mass of

inflamed tissue formed when invading particles survive within the phagocytes. Layers of

phagocytic-type cells form and are surrounded by a fibrous capsule.

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Section A


The following table shows the symptoms of inflammation and their contributing causes.

Symptom Contributing Causes

Local

Redness Dilation of vessels, increased blood flow to injured area.

Heat

(increased temperature)

Dilation of vessels, increased blood flow to injured area.

Swelling (edema) Increased vessel permeability, and movement of fluid from

the circulatory system into the tissue spaces

Pain Increased pressure on sensory nerve endings in swollen

tissues; effects of some chemical mediators of inflammation

on nerve terminals

Systemic

Fever Endogenous pyrogens (fever producing substances) arereleased

Increased production and

release of leukocytes

(white blood cells)

Granulopoietin released from monocytes and macrophages

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Section A


Contraction

In normal contraction, the inward migration of myofibroblasts causes tension to draw the

wound margins together. If this occurs along the Langer Lines, the natural tension lines of

the skin, an ‘invisible’ scar will result. If contraction occurs across the Langer Lines,

movement may be limited and scarring may be obvious. Contraction may be lessened by

the direct use of Vitamin A and corticosteroids.

In assisted contraction, suturing, stitching, taping or gluing may need to take place. Such

procedures may result in further wounding, depending on the tension and direction of

stitches and the type of material used for the procedure. These materials include naturalgut, dissolving and non-dissolving synthetics, metal and silk.

Collagen Deposition

This follows a sequence of three stages: accelerated synthesis, deposition and degradation.

In normal skin, there is a balance of the production and degradation of collagen.

Epithelialisation

This is the final growth and differentiation in the wound healing process. Epithelial

regeneration before the restoration of the dermis will not be successful as the skin lacks

the essential mechanical strength to hold the wound together.

Non-Healing Skin Wounds

Factors which may delay wound healing include:

• poor diet

• vitamin C deficiency which may result in scurvy and cause old scars to re-open

• the influence of certain drugs such as high doses of corticosteroid and in certain

patients, especially the feeble, old and bedridden

• genetic factors.

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Section A


Ageing, Wound Healing and Beauty Therapy

There are varying means of combating ageing. Those described below are mainly surgical

and include the use of:

• Hormones, particularly the female hormone, oestrogen and the male hormone,

testosterone which have a significant impact on the texture and appearance of the skin.

• Dermabrasion which is the surgical removal of skin blemishes or imperfections by

abrasion using sandpaper or wire brushes. After the removal of the epidermis and the

upper portion of the dermis, new skin cells are regenerated, giving the treated area asmoother appearance.

• Collagen implants which may improve the appearance of facial lines and grooves

caused by loss of resilience due to sun damage and natural ageing. They can also be

used for lip definition, filling acne or chickenpox scars and to minimise frown lines

and grooves around the nose and mouth.

• Laser resurfacing which involves the removal of the epidermis and the upper portion

of the dermis. This is done using a controlled burning process. The new skin tends to

look smoother and less blemished.

• Skin grafting is the surgical implanting of living skin tissue. It is performed to cover large areas of wounded tissue or to cover scar tissue with full depth or split dermal

patches.

Beauty therapy treatments

With current knowledge and products available, ageing of the skin resulting from factors

such as excessive sun exposure, heat, cold weather, environmental pollutants such as

smoking and suntanning, poor diet, and stressful lifestyle can be reduced or slowed down.

Part of performing a range of beauty therapy treatments effectively also includes

providing the client with appropriate advice on how to minimise the impact of these

factors. Understanding the ageing process will enable you to identify effective treatments

and home products for your clients.

If the free radical theory of ageing is accepted then anti-oxidants should be the key to

defeating ageing. Anti-oxidants include uric acid, carotenoids, for example, beta carotene,

vitamin A and vitamin E.

Beauty therapists can perform a range of beauty therapy treatments to improve the quality

and appearance of aged and photoaged skin. These mainly include peeling procedures

which are available as part of facial treatments.

Light peels use a high concentration of glycolic acid (50-70%). The peel produces a hot

tingling sensation on the skin making it slightly pink. Some tenderness may occur for afew hours after the peel and visible flaking may take place over the following days. Light

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Section A


peels are used to treat scaly, blotchy and sun-damaged skin and in the treatment of

blackheads in younger skins. They may be repeated every 2 to 3 weeks.

Deep chemical peels can be done using trichloro-acetic acid (TCA) or other chemicals,

but have been replaced largely by laser treatments.

The Inheritance of Physical Traits And Conditions

The Gene Theory of Inheritance

The gene is the unit of inheritance. A gene is a sequence of DNA contained by and

arranged along a chromosome. Each gene transmits chemical information expressed as a

trait, for example one’s height or eye colour.

The gene theory of inheritance allows us to make predictions about the probability that the

offspring of two given parents will have a particular characteristic. These generalisations

are called Mendel’s Laws. Gregor Mendel, an Austrian monk, developed his theories in

1866, however the importance of his findings was not realised until 1900.

Mendel’s First Law, the Law of Segregation, states that genes exist in pairs. In the

formation of male and female germ cells or gametes, the two genes separate so that each

gamete has only one of each kind of gene. Mendel’s Second Law, the Law of Independent

Segregation, states that the segregation of each pair of genes in the process of gameteformation is independent of that of other pairs of genes. Hence, the members of the pairs

become randomly assembled in the resulting gamete. Therefore, great numbers of

characteristics are inherited simultaneously and offspring resembling one parent in certain

traits can resemble the other parent in different traits.

Mendel developed his theories before scientific knowledge of chromosomes. After

knowledge of chromosomes increased, Mendel’s principles were modified. For example,

Mendel’s studies emphasised genes that behave independently from one another during

transmission to offspring. We now know that genes are transmitted as components of

chromosomes, each of which carries many different genes. It has also been shown that

some characteristics are transmitted by genes carried by the sex chromosomes and that the

interaction of many genes is responsible for determining many of the traits of individuals.

By tracing the appearance of certain abnormal characteristics and blood groups through a

number of generations the hereditary pattern of these conditions has been traced.

The decoding of genetic information has led to an expansion of knowledge about the

genetic components of disease, physical characteristics, mental illness and personality.

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Section A


Dominant and Recessive Genes

Mendel experimented on several types of pea plants in his garden. He maintained records

of the inheritance of seven contrasting pairs of traits, such as yellow versus green seeds

and round versus wrinkled pods.

When Mendel crossed plants with two different characteristics, the plants in the next

generation, the F1 Generation, were like one of the two parents. The second or F2

Generation, included individuals of both parental types. For example, when Mendel

crossed tall plants with short plants, all the F1 Generation were tall; however, when two

of these F1 tall plants were crossed, the F2 generation included some tall and some short plants: 787 tall and 277 short or a ratio of 3:1. The recessive gene for shortness in the F1

Generation was overcome by the dominant gene for tallness.

Inherited Skin Disorders

Several common skin disorders are found in genetically pre-disposed individuals. These

include:

• Acne, which tends to run in families.

• Eczema or Atopic Dermatitis, a common skin condition that affects 5% of children,

85% of whom will have grown out of the disease by the age of 5 years. Eczema seemsto affect those with a family history of hayfever, asthma and very dry skin. There is an

unexplained association between these diseases and eczema.

• Seborrhoeic Dermatitis, which is found in genetically pre-disposed individuals

without obvious provoking factors.

• Pigmentation disorders such as Vitiligo or unpigmented skin which has a genetic

dominant inheritance and affects 1% of the world’s population.

• Hair Disorders such as Pattern Alopecia, a common dominantly inherited form of

hair loss. It develops symmetrically at specific sites on the scalp and can cause

complete scalp hair loss. It is more common in men, and may start in the late teens or early twenties.

Having an understanding of the above skin disorders will enable you to improve these

conditions by selecting and applying suitable treatment applications. Some of these skin

disorders may also be contra-indications in a number of beauty therapy treatments. This

may mean that you cannot perform some treatments or that you may need to modify the

application of others.

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Section A


The Function, Formation And Behaviour Of The Major Skin Chemicals

Major Skin Chemicals

The surface of the skin is dominated by two major classes of organic (carbon based)

chemicals. These are:

• Proteins including keratin, collagen and elastin.

• Lipids including fats, oils and vitamins.

Proteins are polymers or compounds of amino acids. There are around 23 naturallyoccurring proteins of which 8 are described as ‘essential’ amino acids. Amino acids join

when a base segment of one meets the acid group of another amino acid. They shed a

water molecule and form a peptide or strong covalent bond. A covalent bond occurs when

two atoms share one or more pairs of electrons.

Proteins are usually divided into:

• Soluble or globular. These proteins include albumins, enzymes and globins.

- Albumins are water-soluble proteins that occur in blood plasma or serum.

-

Enzymes are complex proteins that are produced by living cells and act ascatalysts for specific biochemical reactions at body temperatures.

- Globins are colourless proteins especially obtained from haemoglobin.

• Insoluble or fibrous. These include collagens, elastins and keratins.

- Collagen is the major structural protein in the dermis. It provides mechanical

support as its interweaving fibres promote strength.

- Elastin is the network of elastic fibres interwoven among bundles of collagen.

Elastin gives the skin its elastic properties.

- Keratins are fibrous proteins that form the chemical basis of epidermal tissues

such as the hair and nails.

Lipids are a diverse group of chemicals. Lipids produced in the epidermis consist largely

of ceramides, cholesterol and free fatty acids.

The epidermal lipids are arranged in a highly structured sequence of layers in the stratum

corneum. Ceramides form a protein/lipid envelope complex. This complex and the lipid

bilayers form the epidermal lipid barrier.

The Intercellular Matrix

After birth, existing cells enlarge and the intercellular matrix of connective tissue is

formed. The intercellular matrix is the material filling the space between the cells of

diverse tissues including skin, tendons, muscles and cartilage.

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Section A


Changes in Skin Proteins Through Ageing

Collagen and Elastin

Collagen is the major structural protein in the dermis. Collagen provides mechanical

support as its interweaving fibres promote strength. Its insoluble and non-elastic character

promotes structure and rigidity. Collagen also has an important role in wound repair. The

triple helical conformation of collagen is stabilized by vitamin C; therefore a deficiency of

vitamin C leads to defective connective tissue and poor wound healing.

In a 1 to 2 month embryo, thin fibrils of collagen exist, but no interlacing of these fibrils

occurs. By the third trimester of pregnancy, an interwoven network of fibres has formed.At birth, the fibrils are still relatively fine and contain a high water content. Most dermal

development occurs 3 to 5 months post-natally. At this time, the dermis contains more

insoluble collagen and the fibrils have increased in diameter.

Stable fibres of collagen are replaced throughout life; however, collagen content does

decrease by approximately 1% in adulthood, due partly to a decrease in the number of

fibroblasts (connective tissue cells).

In old age, there is a decreased number of collagen fibres. There is an increase in

thickness of these fibres due to increased crosslinking. These changes result in a

decreased ability for the skin to retain water and a rearrangement of fibres contributing towrinkle formation.

Tests have been conducted to determine the age of skin from amounts of extractable

collagen from total collagen. These tests have shown that in puberty, 50% of the total

collagen is extractable; at 45 years, one seventh is extractable, and at 60 years the figure is

10%. Conversely, the total decrease in collagen can be measured by age. Tests have also

shown that thin skin loses collagen at a faster rate in ageing women than in men.

Elastin is the network of elastic fibres interwoven among the bundles of collagen. Elastin

gives the skin its elastic properties. Elastic fibres consist of an outer coating and

microfibrillar protein.

The function of elastin is complementary to that of collagen. Due to the elastic nature of

its fibres, elastin is able to restore the normal fibrous array after deformation by external

forces. A portion of elastin is continuously degraded and replaced by newly synthesized

fibres. In the embryo, new fibres are composed almost entirely of microfibrillar protein.

Later in development, the proportion of elastin increases, and in a fully developed fibre,

more than 90% is elastin. Elastic fibres consist of an outer coating and microfibrillar

protein.

It appears that the balance between the breakdown and synthesis of elastin changes with

increasing age. The sub-epidermal rather than the deeper dermal layers show a marked decrease in elastin with age; the onset of wrinkles may be the result of this. The elasticity

of your client’s skin will affect the performance of some beauty therapy treatments. For

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example an assessment of a client’s skin elasticity will affect your choice of body

massage movements and techniques.

Beauty Treatments and Skin Chemistry and Surface

In the last few years, some manufacturers have included ‘skin enzymes’ in their products.

These ‘enzymes’ including lactose dehydrogenase seem to activate changes to the stratum

corneum texture. It has been suggested that this enzyme exists in the dead corneal layer in

a deactivated state. Reactivation of the enzyme may be triggered by the presence of

excess lactic acid.

Proteins or protein fragments are beneficial in providing moisturising qualities to the skin.

They provide good water binding sites and are able to crosslink strongly to the skin

surface proteins; in other words, they are highly substantive to the skin.

Collagen masks have been reported to have a noticeable effect up to 3 days later.

Proteins and polypeptides cross link and can form a protective blanket on the skin surface

if overlying oil and skin debris are removed. In this sense, products containing these

properties add protection to the skin.

Ceramides are unsaturated lipids and are very difficult to extract and include in a cosmetic product. Therefore, “ceramide” products are sealed in small plastic bubbles to prevent

oxidising molecules.

The Role of the Endocrine Glands and Hormones in The Body

Hormones are chemical messengers secreted from endocrine (ductless) glands. An

endocrine gland manufactures and secretes hormones directly into the bloodstream. These

hormones are then carried in the bloodstream and act at sites in the body distant from the

site of their production. A target organ or target cell is an area specifically influenced by

the action of a particular hormone. This area may also be called an effector organ/cell.

Aspects of skin structure and function which are influenced by hormones include:

• sebaceous gland secretion

• sweat secretion

• sense reception

• growth and healing

• hair growth and loss

• pigmentation.

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Sebaceous Gland Secretion

The sebaceous gland in the skin of mammals secretes an oily substance called sebum .

Sebum is a mixture of fat and the debris of dead fat-producing cells. These cells are

constantly replaced by new growth at the base of the glands. The rate of sebum production

depends on the size of the glands and the rate of cellular growth or division. Sebum

lubricates and protects the hair and skin and prevents drying and irritation of membranes.

The regulation of sebum production is hormonal and is affected by factors such as

puberty, sex differences and age. For example, sebum secretions increase by 6 times at

age 10, but in women of 50-59 the rate decreases dramatically. Excessive amounts of sebum may also result from poor hygiene or a diet rich in fats. These excessive secretions

may be related to acne and other skin disorders.

Hormones which increase sebum production include androgen which is secreted in

abnormally high quantities in women suffering from acne and hirsutism. Growth hormone

appears to work with androgens in puberty and MSH (melanin stimulating hormone) may

cause increased sebum production during pregnancy and breast feeding. Progesterone

appears to have no effect on sebum production in physiological doses, although large

doses may produce a response. Synthetic progesterones may stimulate enlargement of

sebaceous glands and contribute to penile enlargement and growth of pubic hair.

Oestrogen decreases sebum production. However, in women, the influence of oestrogen is

easily overcome by relatively small amounts of testosterone.

Sweat Secretion

Eccrine sweat glands are distributed throughout the human skin and are particularly

concentrated on volar skin, the skin of the palms and soles. Apocrine sweat glands are

larger glands which are particularly concentrated in the underarm region. Sweat secretion

is regulated by the Sympathetic Nervous System. This is true for both eccrine and

apocrine glands. However, if the nerve supply to the apocrine glands is cut off, sweat

secretion, stimulated by emotion such as pain or stress, still occurs. Hence, glands can bestimulated by hormones such as adrenaline (stress hormone) from the adrenal gland.

Emotional or physical stress increases sweating. Sweat secretion decreases with age.

Growth and Healing

Mitotic activity (cell division) increases during sleep and decreases during stress or

vigorous exercise. This is because the stress hormone, adrenaline, inhibits mitosis by

releasing or activating chalones. Chalones are secretions which reduce physiological

activity. Hence, skin growth is reduced during stress conditions.

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Hair Growth and Loss

Hormones regulate hair growth. In childhood, body hair is fine and downy. During

puberty, growth hormones lead to the coarsening of vellus hair, while androgens affect the

growth of facial, axillary (underarm) and pubic hair.

Hair growth is also affected by stress. Human hair follicles act independently of each

other, but sometimes, factors such as stress will cause a sudden thinning of scalp hair.

During pregnancy, the percentage of catagen and telogen hairs decreases to about 5%.

High levels of oestrogen in late pregnancy prolong anagen and scalp hair may grow more

quickly. Following childbirth, hair loss may occur. This condition usually occurs 2 to 3

months after childbirth and may completely recover after 6 to 12 months.

A number of hormones influence the activity of the hair follicle:

• Thyroid deficiency which results in loss of hair

• Corticosteroids which inhibit follicular activity

• Oestrogens which result in fine hair and decreased growth.

Baldness is an inherited trait, but occurs only when androgens are present.

Pigmentation

Melanin is a protective substance or pigment that can filter out ultra-violet radiation. It is

produced by cells called melanocytes. Melanocyte Stimulation Hormone (M.S.H.)

maintains melanocytes and with sunlight and U.V. exposure results in melanin synthesis

and darker skin.

Oestrogens also stimulate melanin production, for example, during pregnancy, nipples

and linea alba darken. Oral contraceptives may have the same effect.

The Menstrual Cycle

Hair and skin may become more oily just before a menstrual period. Many women notice

a ‘break out’ of pimples at this time. This may be due to production of progestogen in the

ovary which may stimulate oil glands. Pre-menstrual stress may trigger the production of

chemicals causing the adrenal gland to make more androgens. Pre-menstrual water

retention may lead to pore blockage, and hence skin problems.

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Age Related Hormonal Change and the Skin

Menopause

A woman’s skin may experience many changes during menopause and the years leading

up to and immediately following menopause. In menopause, ovulation ceases and

oestrogen levels and androgens previously produced in the ovaries decline. However, the

adrenal glands continue to produce androgens. Lack of oestrogen means that androgens

have greater influence on tissues. Some skin problems after menopause are due to excess

androgen stimulation. These include acne, hirsutism and androgenetic hair loss.

Hot flushes

During menopause, the monthly cycles of hormone production from the ovaries ceases.

Signals sent from the ovaries to the pituitary gland in the brain also cease. As a result,

levels of hormones produced in the pituitary gland increase. One of these hormones, FSH

or follicular stimulating hormone may be partly responsible for hot flushes which are

experienced by at least 50 per cent of menopausal women.

Symptoms include:

• a blotchy flushing of the face, neck and chest

• intense heat sensations

• profuse sweating

• palpitations

• night sweats.

Quality of skin in menopause

The normal chronological ageing photoageing effects on the skin usually become

pronounced around the time of menopause. Menopausal declines of oestrogen contribute

to skin dryness, thinning of the epidermis, breakdown of collagen, and loss of skin

elasticity. The T-zone of the face may become drier, and the skin on the lower legs may become scaly.

Because skin tends to be drier during menopause, some women may use more

moisturiser. This can result in the blocking of sebaceous glands which in turn encourages

blackhead formation. The dominance of androgens during menopause may also lead to

acne and hirsutism. Some women experience coarse hair growing from the chin and upper

lip during and after menopause and may require permanent epilation.

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The Effects of Drugs and Hormone Therapy on Skin Physiology

Hormone Replacement Therapy (HRT) is designed to counteract the effects of

decreased oestrogen during menopause. The effects of HRT include:

• increase in the thickness of the dermis

• decrease in collagen breakdown

• reduction in the severity of hot flushes.

In some women, the combination of hormones may produce detrimental effects. HRT

patches may cause irritations. Melasma, a pigmentation of the face, may develop due to

the oestrogen reacting with UV rays during sun exposure.

Anti-androgens incorporated into HRT may improve acne during menopause. They may

also reduce hirsutism. In this instance, anti-androgens work by blocking androgen; hence,

the follicle is not stimulated. The result is a decrease in hair growth and lighter, finer hair.

The hair on the chin, neck and upper lip is most responsive to anti-androgens. Results are

not usually seen for several months and the treatment is not permanent.

Some minor side effects of anti-androgens include sore breasts, fatigue and irregular or

light periods.

The contraceptive pill may improve the appearance of acne, due to the effects of

oestrogen on oil production. However, in some women, acne is worsened. A solution is to

switch to a contraceptive pill containing a progesterone that has no androgen-like effect.

Dilated capillaries occur more frequently in women taking the Pill.

Antibiotics such as tetracyclines used in the treatment of acne cause drops in oestrogen

levels; hence they diminish the effectiveness of oral contraceptives.

Thrush occurs more often in users of oral contraceptives and antibiotics. Thrush is theovergrowth of the yeast candida. Antibiotics destroy the normal protective barrier

allowing candida to flourish.

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Why is it important for you to understand the influence of the various hormones on the

skin? Discuss this with fellow students or colleagues and make some notes below.

Select two beauty therapy treatments and describe how the effects of biological changes

such as menopause and ageing would influence the objectives of these treatments and

how they are performed. Make some notes below.

Treatment 1

Treatment 2

Discuss your considerations in performing these treatments with your trainer or supervisor.

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Percutaneous Absorption

By weight, the skin is the largest organ of the body. Its volume is of the order of 3.6 litres.

Chemically it is very complex. A major function of the skin is to provide a protective

barrier to the underlying cells from bacteria, allergens and toxic substances as well as the

damaging effects of UV radiation. The skin also forms a barrier to reduce TEWL

(transepidermal water loss) which is the loss of water and electrolytes from body fluids

through the skin. Factors which aid skin barrier function include keratinized layers of cells

which act as a mechanical barrier and lipids produced in the epidermis.

Understanding the process of percutaneous absorption is critical for achieving theobjectives of many beauty therapy treatments. The core aim of these treatments is to

protect and enhance the health of the skin largely through moisturising. Even though the

skin acts as a barrier, to some extent, certain chemicals are able to pass through it.

Percutaneous absorption is the passage of substances through the skin into the dermis and

blood system. Generally cosmetic chemicals should not be percutaneously absorbed as

they are intended to function superficially. Chemical treatments may penetrate but should

not have an apparent effect on cellular activity.

Percutaneous absorption involves three separate chemical processes:

1. Diffusion

- Diffusion is the passage or movement of a chemical within a substrate (usually the

solvent).

2. Absorption

- Absorption is the invasion of the chemical into various layers of the skin.

3. Adsorption

-

Adsorption is the attachment of chemicals to the components of the skin(including large lipids or proteins, cell membranes and membrane receptors).

These interactions usually involve highly specific interaction and bonding. The

strength of the bonding will determine if the chemical is able to proceed. A

substantive chemical (one which can attach very strongly to the lipids and

proteins) cannot be removed or released from the chemical bond with washing.

At the base of the stratum corneum, a barrier boundary exists which contains a negative

electrical charge described as ionic. This electrical boundary effectively repels negatively

charged ions of certain chemicals and prevents their entry. Water can pass through easily

because it has both positive and negative charges on the one molecule. It is described as a

polar molecule. When electrical currents are applied to the skin they distort the boundary

layer. This property can be employed to push negative ions into the skin. For example

facial treatments such as galvanic therapy uses galvanic current to infuse active

ingredients deep into the dermis of the skin (iontophoresis) or as a method of deep

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cleansing (desincrustation). Oil soluble chemicals enter the skin via sebum while water

soluble chemicals enter via water paths, that is the sweat ducts.

Absorption pathways

The possible chemical absorption pathways are:

• Hair follicles through which oil soluble chemicals can pass

• Micro channels between the lipid layers in the stratum corneum through which water

soluble chemicals can move• Sweat glands down which water soluble chemicals can move.

• Lipid bilayers of the stratum corneum through which oil soluble chemicals can diffuse

• Corneocytes (cells of the stratum corneum) through which water soluble chemicals

can diffuse.

Through any of the pathways there are problems of solubility. In order to cross the barrier

of the stratum corneum, the chemical must transport itself through a 'dry' oily zone and

then encounter a 'wet' oil poor zone.

Rates of PenetrationThe rate of penetration can be affected in many ways:

The concentration of the chemical. Generally, as the concentration of a chemical on the

skin surface increases, so does the rate of diffusion of the chemical into the skin. There

comes a point where increasing concentration has no effect for several reasons. Firstly,

there may be limited pathways into and through the stratum corneum which can become

saturated with molecules. Secondly if the chemical becomes ad sorbed to a layer in the

skin this becomes a barrier to diffusion beyond this layer. When adsorption operates, the

surface might become quickly coated and no matter how much more chemical is added, it

remains sitting on the surface of the skin and will not penetrate further.

Duration of exposure. Generally, the longer the chemical is in contact with the skin, the

greater the likelihood and depth of entry.

The anatomical site. Different parts of the body absorb chemicals at quite different rates

according to the chemical and physical nature of the skin at those sites. For example a

decreasing degree of absorption occurs at body sites such as the limbs. In some cases it

may be desirable to deliver drugs (such as hormone replacement therapy, and angina

treatments) to these slow absorption sites.

Condition of the skin. Thin and broken skin naturally allows the entry of chemicals

much more easily than thicker intact skin. Moist or hydrated skin allows percutaneousabsorption more readily than dry, dehydrated skin. Clean skin is generally more

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permeable than greasy skin. This is why most beauty therapy treatments include cleansing

the skin as an essential first step.

The use of carriers These can be used to dissolve or hold desired chemicals in a form

which may assist the entry of the chemical into the skin. Carriers may be oils (ointments),

solvents (alcohol based lotion), water/oil emulsions (creams) or other substances. For

example aromatic plant oils are blended with carrier oils before they are applied to the

skin as part of aesthetic aromatic massage. Some carriers may also be used because they

prevent penetration of other ingredients.

Measuring Percutaneous Absorpt ion

It is important to be able to monitor the amount of penetration needed to have the desired

effect. The graphs below illustrate the amount and depth of chemical penetration. The first

graph shows a dramatic decrease in concentration with increasing depth of the skin.

The second graph reveals the complications involved as in vitro experiments are

compared to in vivo experiments. In vivo methods may show greater penetration of

material into the skin because of the effect of blood circulation in the dermis. If the

chemical reaches the dermis, it may be removed by the blood capillaries to other parts of

the body. This is called systemic absorption. If this occurs, then the concentration gradient

is maintained so that the test substance continues to diffuse through the epidermis. Testingthe same substance under in vitro conditions may result in less penetration as the deeper

200 1000

-------------dermis-------------

Skin depth,

concentration

epidermis

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layers of the epidermis may become saturated with the substance and diffusion will be

slowed down.

Enzymes active in living skin are not likely to remain active for long in in vitro samples.

Enzymes in living skin may metabolise (chemically change) the test substance. The

change may result in a complete loss of activity for the test substance. In other cases the

chemical change may be necessary to produce the active form of the test substance. In

either case it is unlikely to remain active in skin samples. Both in vitro and in vivo

experiments show that test chemicals may become 'locked up' at particular sites in the

skin because they interact with skin chemicals and cells. This may be desirable if the testsubstance has undesirable effects on other body tissues or its action is intended to be

specific to one part of the skin. This information has important implications for the

application of skin care products as part of various beauty therapy treatments.

Bioavailability Biological Activity

While some chemicals may be applied to the skin intact, they may change as they enter

the skin either through interaction with surface chemicals or through water evaporation.

Water evaporation may concentrate the remaining chemical or the chemicals may interact

with the proteins and acids of the skin surface. However, if the chemical passes into the

stratum corneum and beyond, chemical interactions with the extracellular components

may occur because the chemical may be changed and modified by being taken in and

metabolised by living cells. Ideally a skin targeted chemical should become 'locked up' in

the skin at the site of its action; action in other regions of the body may be undesirable. A

beauty therapist can assist the entry of skin enhancing chemicals.

10-4

10-3

10-2

100

Skin depth,

Concentrati

300 500 700 900 110010-5

in vitro

in vivo

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Methods of Moisturising Skin

Occlusion

This is the sealing and covering of skin with an oily substance to prevent moisture loss.

Occlusive moisturisers combine the softening effects of emollients with the moisture

retaining actions of humectants and the smooth coating activity of lubricants .

Occludents act as hydrophobic compounds which seal and trap free water molecules.

Types of occludents include:

• Hydrocarbons

- liquid paraffin

- petroleum jelly

• Lipids

- lanolin - a mixture of oils from sheep sebum which adheres to human skin well

- vegetable oil - rancidity problems mean that formulation is difficult and often the

product must be loaded up with preservatives

- Pseudoceramides which mimic corneal ceramides

- Fatty acids found in evening primrose oil and cold pressed sunflower and

safflower oils

- Fish oils such as squalene (shark liver oil)

- Vitamin A

- Vitamin E.

• Non organic oils (those which have no carbon):

- liquid silicones

- methicone

- dimethicones.

Humectancy

Humectants attempt to hydrate skin with externally applied water or water absorbing

agents. Humectants act by binding water molecules to atoms of oxygen.

Common types of humectants include:

• Glycerol – probably the most common humectant.

• Sorbitol – a milder and less aggressive humectant then glycerol.

• Polyethylene glycols – often used to keep a product moist in a container.

• Urea – often sold as a cream to treat dermatitis.

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• Proteins including polypeptides and amino acids.

• Natural moisturising factor (NMF) which is usually stabilised as the sodium salt

NaPCA and lactic acid plus sodium lactate.

• Glycosaminoglycans (GAGS) sodium salt of Hyaluronic Acid.


Select three skin care products that are applied to the skin as part of beauty therapy

treatments. Use the information on percutaneous absorption and that provided by the

product manufacturers to find more information about the purpose of these products and their effects on the layers of the skin. Make some notes below.

Discuss your findings with your trainer or supervisor.

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Notes:

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Identify the causes of andtreatments for skin disorders

Section B Identify the causes of and treatments for skin disorders

What you will cover in this section

The two steps to Identify skin disorders are:

Step 1 Identifying the causes of and treatments for skin disorders

Step 2 Promoting skin health and care

This section covers information about a range of skin disorders that you may encounter inyour clients. Information is given about the duration (course), causes (aetiology),

appearance, and treatments for each of these disorders and their implications for the

performance of a range of beauty therapy treatments.

Step 1 Identifying the causes of and treatments for skin disorders

The following skin conditions are not contagious. It is important that you have an

understanding of these conditions and how to recognise them as they may have

implications for the beauty therapy treatment you are performing and the techniques you

use. For example seborrhoea can be improved through the use of galvanic current as part

of a specific facial treatment. Some skin disorders can also be contra-indications to the performance of some beauty therapy treatments. For example, a spa salt glow treatment

should not be performed on a client who has eczema in the treatment area. It is important

to note that many skin disorders are treatable by medical professionals only. The beauty

therapist should recommend that the client seek appropriate professional advice.

Acne Vulgaris

The incidence of acne vulgaris in men and women is similar. For women the peak

incidence is 14 to 17 years old, and for men, 16 to 19 years old. In Caucasians, one third

of all adolescents will have some signs of the disease.

Some women develop comedonal acne in their early to mid twenties probably due to

cosmetics. Comedonal acne is typified by plugs of keratin and sebum within the dilated

orifices of hair follicles.

The disease usually takes 6 to 12 months to fully develop. As it progresses, pustules

become more frequent and increase in size. There is a tendency for disease remission in

summer. For women there can be a pre-menstrual flare 7 to 10 days before menses. After

several years the severity can decrease on the face but persists on the chin and neck. The

disease usually clears by age 23 to 25 in 90% of patients. 5% of women and 1% of men

still need treatment in their 30s or 40s.

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The disease is multifactorial. It is due essentially to a blocked and chronic inflammation

of the pilosebaceous follicles. “Pilosebaceous” pertains to hair and the sebaceous gland.

Some of the factors known to be involved include:

• Sebum secretion increases.

Note that patients with Parkinson’s Disease also have increased sebum production but

no acne. Therefore it is not the singular effect of increased sebum production, but a

multi-factorial condition.

• Hormones- Androgens from testes, ovaries and adrenals are the main hormones

stimulating sebum production.

• Increased sensitivity of sebaceous glands to hormones.

• Increased abnormal keratinisation.

• Excessive keratinisation may block the pilosebaceous follicle

• Bacteria.

Proprinobacterium acne is normally present on the skin. It colonises the pilosebaceous

ducts, breaks down triglycerides into free fatty acids and sends messages for

inflammatory cells via chemotaxis. The free fatty acids produced are irritants to the

skin and cause surrounding irritation.

• Genetic factors.

Acne tends to be familial and polygenic, that is, it tends to run in families and involves

more than one gene.

• Stress.

Acne is often worse before exams and other stressful situations.

• Heat and humidity.

These factors can exacerbate acne.

Lesions are limited to the face, (cheeks, lower jaw, chin, nose and forehead), shoulders,

upper chest and back.

Inflammatory papules, pustules, nodules and cysts can occur. Papules may be

inflammatory or non-inflammatory, and pustules may be superficial or deep. Superficial

pustules can persist for several days, while deep pustules can persist for two to five

weeks. Nodules are deep-seated dome shaped lesions persisting for 8 weeks or longer.

Cysts do not appear often in acne vulgaris, but occur more often in acne conglobata. They

may be several centimetres in diameter and contain a cheesy, heavy, yellowish material.

Large boggy masses occur when several cysts run together.

Seborrhoea is greasy skin caused by an abnormally increased secretion and discharge of

sebum. Open comedones are black heads caused by the plugging of pilosebaceousfollicles by sebum and keratin. Closed comedones are whiteheads caused by blocked

sebum and keratin further down the pilosebaceous follicle.

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Scarring can follow acne. Scars may be atrophic, hypertrophic (keloidal) or pointed

depressions (ice pick). Dandruff is often also present. Figure 1 below shows the areas of

the body commonly affected by acne vulgaris.

Drugs and Chemical Agents can cause acne, for example if androgens are given

therapeutically for any reason, acne can result. Glucocorticoids and corticosteroids such

as prednisolone, which can be used to suppress the symptoms of rheumatoid arthritis or

other chronic inflammation, can also induce acne. This type of acne is identifiable as all

the lesions are similar and at the same stage of development, unlike typical acne wherelesions are at different stages of development. Lithium, oral contraceptives and anti-

convulsant therapy may also contribute to acne.

Conglobata is severe acne with many abscesses and cysts, and which leaves severe

scarring.

Acne Fulminians is a type of conglobata accompanied by fever and joint pains.

Indurata is a type of acne vulgaris in which the lesions are hard and livid due to

perifollicular infiltration. It is very resistant to treatment.

Papulosa is a condition where lesions are very often seen on the foreheads of young

adults.

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Agminata are small dusky reddish papules which develop into pustules and leave scars

when healed. They are also called acnitis.

Rosacea is marked by hypertrophy, flushing, erythema, oedema, and telangiectasia (blood

vessel dilation).

Infantile acne is rare and is due to the placental stimulation of the infant’s adrenals. It

may last up to three years and can be a forerunner of adolescent acne.

Occupational acne may affect engineers, mechanics and factory workers who come into

contact with lubricating and cutting oils. It is often observed on the fronts of the thighs

and forearms.

Exogenous/Cosmetic acne is caused by some cosmetics which seem to aggravate the

skin. This aggravation may be due to comedo-inducing ingredients such as cocoa butter

and some mineral oils.

Chloracne is a severe form of industrial acne occurring in individuals who have been

exposed to complex chlorinated organic naphthalenic compounds and dioxin.

Excoriated acne is most often seen in young women. Small acne spots around the skin,

jawline and forehead are squeezed and picked and the resulting papules become moreinflamed than normal lesions.

Treatment

It is important to note that many skin disorders are treatable by medical professionals

only; and in these cases, you should refer the client to the appropriate professionals.

Comedo-papular acne is managed by local treatment alone. Pustular-cystic and scarring

acne require local and systemic treatment.

Local treatment includes:

• Regular washing with soap and water.

• Anti-bacterial skin cleansers containing chlohexidine or benzoyl peroxide (2.5% to

5%).

• Local antibiotics such as clindamycin and erythromycin.

• Retinoic acid is useful for comedonal acne as it reduces sebum production. Treatment

should be started at a low strength (0.05 or 0.01%) and applied to dry skin at night.

• Ultra violet B is a short-term treatment.

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Systemic treatment includes:

• antibiotics to be taken for at least 3 months; may be prescribed for several years.

Antibiotic treatments include oxytetracycline, minocycline and erythromycin.

• isotretinoin. This dramatically reduces sebum production and is given in a month long

course. Drying of the skin and mucus membranes often occurs, but is well tolerated.

Abnormalities of liver function can also occur. The main problem due to the high

vitamin A content is the tetragenic affect on foetuses. Females requiring it must

therefore have a negative pregnancy test and start the oral contraceptive pill a month

prior to treatment.

• hormonal treatment during which an anti-androgen/oestrogen pill is taken as an oral

contraceptive.

Retinoids

The retinoids are a family of chemicals related to Vitamin A.

Vitamin A is found in yellow and orange coloured vegetables, animal fats and fish oils. It

is responsible for growth, vision, reproduction and maintenance of epithelial tissues.

Vitamin A is stored in the liver and in high doses is very toxic.

Members of the retinoid family include:

• Retinol (most common form in the body, especially in the blood).

• Retinal (vision).

• Retinoic acid (can fulfil growth and maintenance function, but not reproduction or

vision).

Commercial names of retinoids are:

• Roaccutane: isotretionoin, used in the treatment of cystic and acne vulgaris

• Tigason/Etretinate: a derivative of retionic acid used for treatment of psoriasis

• Tretinoin: retinoic acid used for topical treatment of comedonal and papulopustular

acne

• Retin A/Retionoic Acid: a topical treatment for aged or damaged skin. It affects

epidermal keratinisation.

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Rosacea

This condition is often referred to incorrectly as adult acne.

Rosacea is most common in middle age. It mostly affects women between 30 and 50 years

old and in Celtic peoples and people from northwest Europe. It is occasionally seen in

darker skinned Mediterranean peoples.

The course of the disease varies. There may be a few recurrences followed by permanent

remission, or the disease may be steadily progressive and disfiguring. Typically thedisease is steady and progressive with brief remissions.

The cause of rosacea is unknown, but evidence of solar damage is usually present.

Historically, dietary excess, alcoholism, gastrointestinal inflammatory disease,

malabsorption, psychiatric disturbance and the Demodex mite have all been held

responsible. In the course of the disease, sebaceous glands are observed as enlarged, but

sebum production is normal. Inflammation occurs and fibrous elements of the dermis

appear thinner and less well organised.

The earliest change is a recurring and persistent redness of the nose and cheeks. The

redness then becomes constant varying only in intensity. Flushing occurs with the cheeks,chin and central forehead affected. Generalised lumpiness (papules) may develop. No

blackheads or whiteheads (comedones) are evident, but papules and pustules may appear.

Other symptoms include enlarged blood vessels or telangiectasia and a swollen and red

nose. In men this may become a severe “potato nose”. Blepharitis (inflammation of the

eyelids) and conjunctivitis can be complications. Skin can be oily and thickened. The

condition may worsen due to severe heat, alcohol and spicy food consumption and

emotional upset. Patients tend to blush more easily and deeply.

Treatment

This condition can be treated with topical antibiotics. Metronidazole can be used topically

in 0.75 to 1.5% preparations.

Oral antibiotics such as tetracycline or erythromycin are required in 4 to 6 week

treatments. 3 to 6 months is needed to achieve clearing. This is a suppressive not curative

treatment. Plastic surgery may be required for rhinophyma (swollen, red nose).

Topical steroids such as hydrocortisone may be used to reduce inflammation. However,

potent topical steroids may actually induce rosacea and may make existing rosacea worse.

Oral isotretinoin can be used if oral antibiotics fail; however lasting relief is not generally

achieved when treatment is stopped. Harsh cleansers or anything that increases blood flow

to the face such as alcohol, hot drinks, spicy foods and exposure to the sun should beavoided.

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Atopic Eczema/Atopic Dermati tis

In Australia the terms dermatitis and eczema are interchangeable. However the word

eczema is usually used when there is an internal cause.

Eczema is a common skin condition and affects 5% or more of children, 85% of whom

will grow out of eczema before they reach 5 years old.

Atopic dermatitis/eczema applies to an atopic group of people who may have a family

history of hayfever, asthma, and/or very dry skin. There is an unexplained association between these diseases and eczema. It is not contagious.

Atopic dermatitis follows a pattern of flare-ups and remissions. Almost any part of the

body can be affected at any time, but the distribution tends to follow distinct patterns

during infancy, childhood and adult life.

The cause is unknown. It is believed to be a genetic disorder with increased formation of

IgE antibodies. One theory is that there is a defect in the T lymphocyte system, which

may be related to the increase in IgE.

The infantile type of atopic eczema may be aggravated by foods such as egg whites,wheat, milk and oranges or by inhalants such as wool, house dust mites, cat and dog hair,

feathers and pollens. In adolescents and adults emotional stress and seasonal changes are

primary aggravating factors.

Infant Phase

Usually the condition begins on the face, most often the cheeks and the chin. As the baby

begins to crawl, thickening of the skin on the knees and ankles takes place. Crusting and

scaling of the lips and peri-oral area may be due to lip licking, thumb sucking or

dribbling. Repeated scratching may lead to lichenification. In many cases the

eczema/dermatitis clears by the age of 2 to 3 years, but it may recur at intervals.

Childhood Phase

During childhood the dermatitis occurs mostly in the folds of the knees and elbows and

sometimes around the wrists, ankles and neck. Thickening and darkening of the skin is

often noticeable, but regularly affected areas may be paler. The face and neck generally

improve but dermatitis may continue behind the ears and around the eyes. Secondary

infection is more common. Caution should be taken to avoid viruses such as herpes

simplex. Exacerbating factors are sweating, heat, cold, dry air and emotional stress.

Adult Phase

The adult phase begins near the onset of puberty. The dermatitis frequently returns to the

face and neck and persistence in the flexures is common. Hand dermatitis is the mostfrequently seen symptom and the eyelids are often thin and inflamed.

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After middle age the atopic dermatitis usually disappears, sometimes becoming a chronic

dermatitis of the hands and feet. Sudden changes in temperature and emotional stress

may induce flare-ups.

A simple diagnostic test for atopic dermatitis or eczema is to press the affected skin gently

but firmly. If the redness temporarily disappears and the skin appears white this suggests

atopic dermatitis. If the skin does not show whitening and there is no family history of

atopy then some other form of dermatitis is likely. The diagram below shows the areas on

the body most affected by atopic eczema.

Treatment

Treatments for atopic eczema include:

• Removal of the cause of irritant.

• Cortisone creams such as hydrocortisone (Sigmacort 1%), alclometasone-dipropionate

(0.05%), betamethasone valerate (0.02 % and 0.05%), triamcinolone (0.02% and

0.05%), mometasone furoate (0.1%).

• Tar creams.

• Moisturisers such as hydraderm or sorbolene applied 3 to 5 times a day.

• Calamine as it soaks up the exudate.

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Other Types of Eczema/Dermatitis

• Discoid dermatitis looks like ringworm.

• Juvenile eczema is characteristically on the soles of the feet.

• Lichen simplex is a form of eczema on redder skin.

• Lichen planus occurs on brown and darkened skin.

Seborrhoeic Dermatitis

Seborrhoeic dermatitis is a very common skin condition. It is more common in men than

women and is worse in winter.

The eruption typically begins at puberty and continues through adult life. It is rare in old

age.

The cause of seborrhoeic dermatitis is unknown. It is found in genetically pre-disposed

individuals and occurs without obvious provoking factors. Nutrition, hormones,

emotional stress and infection appear to play important roles in the occurrence and relapse

of the condition. Overgrowth of the yeast pityrosporum ovale occurs in the scales.

The eruption is formed by yellowish or greyish sharply marginated macules covered with

greasy scales. Lesions may group to form irregular patches. Advanced lesions may fissure

or crust. The eruption is greater where there are more sebaceous glands and is usually

bilateral or symmetrical. The scalp is almost always affected and may be the only site

involved. The eruption may also include the upper part of the forehead and can, in some

cases, cover the entire scalp. Crusting can also occur around the ear and the ear canal. The

face may show a “butterfly” pattern on the cheeks and over the bridge of the nose. Also

affected are around the nostrils (nasolabial folds) and eyebrows and beard. On the body

the lesions can be found in the presternal, interscapular and pubic regions. When found in

the axillae, groin, perineum, umbilicus and submammary areas, they tend not to have

scales but to be red. The diagrams below show the parts of the body most commonlyaffected by seborrhoeic dermatitis.

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Treatment

Tar shampoo or anti-yeast shampoo containing ketaconazole or miconazole should be

used. Low potency corticosteroids may also be effective. In severe cases, short courses of

oral corticosteroid may be required.

Al lergic Contact Dermati tis

A surprisingly large number of cases of contact dermatitis are produced by a small group

of substances. A comprehensive list of potential sensitisers would be enormous. These

include:

• Chromates: cement, matches, paints, varnishes, leather, fur dyes and electroplating

solutions.

• Nickel: electroplated metal objects, watches, earrings, bra clips, jean studs, zippers

and jewellery.

• Colophony: sticking plaster, collodion.

• Balsam of Peru: perfumes, citrus fruits.

• Parabens: preservatives in cosmetics and creams.

• Epoxy resin: resin adhesives.

• Rhus tree and poison ivy.

• rubber compounds: natural rubber rarely sensitises, but the products used in the

manufacture of rubber can. Clothing, tyres and shoes.

• paraphenylenediamine (PPD): this is still widely used as a hair dye and in leather and

fur dyeing.

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• formaldehyde: can be used to add bulk to materials and provide crease resistance.

Some polishes, glues, cosmetics and shampoos may also use formaldehyde as a

preservative.

• neomycin, benzocaine, clioquinol and several antihistamines are known as contact

sensitisers

As seen in the list above, some ingredients used in beauty therapy products can also cause

contact dermatitis when applied to the skin as part of a beauty therapy treatment. Beauty

therapists should consult with their clients to establish whether they are affected by any

allergic reactions so they can select suitable products to perform the treatment.

Urticaria - “ Nett lerash/Hives/Wheals”

Urticaria is extremely common. Most people have experienced some form of urticaria in

their life.

The plaques/papules arise suddenly, often within a few minutes and last 6 to 24 hours.

The hives are caused by a histamine release, the cause of which may be:

• Foods such as fish, prawns, wheat, nuts, crab, milk, chocolate, cheese, strawberries,

oranges.

• Food additives such as tartrazine, salicylates and yeast.

• Drugs such as penicillin, aspirin and opioids.

• Infection.

• Emotional stress.

• Systemic disorders such as lupus erythematosus.

• Pressure, angioedema/urticaria from belts, leaning on the rungs of a ladder, tight

clothing, sitting down.• Solar urticaria

• Cholinergic urticaria – exercise to the point of sweating provokes typical lesions.

• Stings from nettles, jellyfish and some insects.

Itchy red papules or plaques of variable size develop. Occasionally the lesions will last for

days and leave a brownish stain. Lesions often display blanching.

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Treatment

It is important to remove the irritating factor. Treatments include anti-histamines,

corticosteroids and calamine lotion.

Psoriasis

Psoriasis afflicts 1% to 3% of the general population. The scalp is affected in

approximately 40% of cases.

The course is chronic and unpredictable. Complete remission with or without treatmentmay occur, but this is unusual. Most cases eventually relapse.

The underlying cause of psoriasis is uncontrolled cell growth. Normally, keratinocytes (a

type of skin cell) have a life cycle of 28 days. Fourteen of those days are usually required

for the keratinocyte to fully develop and move from the lower layer of the skin to the

outermost layer. During the remaining 14 days the keratinocyte dies and is sloughed off.

During psoriasis, keratinocytes have a significantly accelerated life cycle, migrating to the

surface in only four days.

Psoriasis is a type of chronic skin disease in which itchy scaly red patches form on the

elbows, forearms, knees, legs or scalp. The lesions are rich red or salmon pink and thescales are dry silvery-white. Sharply demarked areas develop. The disease is usually

symmetrical. Pitting of the nails is also common. Psoriasis is characterised by thickening

of the epidermis, which reveals bleeding points upon removal of the scale. The diagrams

below show parts of the body which are commonly affected by psoriasis.

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Treatment

Local treatments include:

• Coal tar.

• Diathranol: cream applied to lesions that inhibits DNA synthesis; it is kept on for 30

minutes only.

• Calcipotriol/donovex - a vitamin D3 derivative which reduces epidermal proliferation.

• Topical corticosteroids.

• PUVA: Photochemotherapy with UVA Radiation.

A psoralen tablet is taken to increase sensitivity to UVA, then UVA treatment is used.

Usually only 2 to 3 treatments per week for a few weeks are needed. Exposure is only

for a few minutes.

• Systemic:

retinin/etretinate/tigason

• Methotrexate which blocks DNA production. It is very toxic.

• Cyclosporin A which is an immune suppressive agent used in organ transplantation.

Different Types of PsoriasisThe most common is nummular or discoid . Silver scaling and one or a number of plaques

develop.

Guttate occurs after a strep/throat infection; it is common in children and young adults.

Small drop-like lesions develop primarily on the trunk.

Rupioid lesions are covered with a cone-shaped accumulation of scales.

Flexural lesions occur in body folds. They are red sharply demarked plaques, sometimes

fissured, but usually without scales.

Erythrodermic psoriasis is a rare variety. The whole skin becomes red, oedematous and

covered in powdery scales.

Pustular lesions erupt most often on the palms and the soles.

Arthropathic psoriasis occurs with an association of arthritis.

Symptoms of psoriasis of the nails include pinpoint pitting, discolouration, subungal

hyperkeratosis and onycholysis.

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Contagious skin disorders

The following skin disorders are contagious and therefore have implications for the

performance of beauty therapy treatments and the application of infection control

measures. The beauty therapist must apply relevant legislation and workplace policies and

procedures to minimise the risk of cross infection. It is important to note that contagious

skin disorders are treatable by medical professionals only; in these cases, the beauty

therapist should refer the client appropriately

Bacterial Infections of the Skin

Disease Causative Agent Features

Impetigo

contagiosa

“School sores”

Staphylococcus

aureus

Haemolytic

streptococcus

• Red sore areas that may blister. Yellowish

gold crusts appear and spread within a few

days. Can appear over eczema. 1 to 3

centimetres in diameter.

• Contagious

• Can persist for long periods

• Usually affects pre-school children and young adults

• Cause can be poor hygiene, neglected minor

trauma.

Treatment

• Anti bacterial wash, plus antimicrobial

compound such as Betadine™. Systemic

antibiotic such as penicillin usually required.

Cellulitis Several • Diffuse inflammatory disorder of

subcutaneous tissues and skin

• Relatively common and seen on limbs

Treatment

• Broad spectrum antibiotics

Furuncles (boils)

& Carbuncles

Staph. aureus of

hair follicles

• Local, red tender and painful swellings.

• Can be large – up to 3 to 4cm in diameter

• May develop pus centrally

• If large produce toxaemia and pyrexia

• Diabetics are prone to these.

Treatment

• Antibiotics and lancing.

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Folliculitis Exposure to tar,

mineral oils,

adhesive plaster,

plaster occlusive

dressings.

Staph.

• Can occur in sportspeople, may also be due

to shaving, waxing and over use of coal tar.

• Hairy areas subject to moistness and friction

most affected.

• Infection of eyelash follicle = sty.

Treatment

• Anti-bacterial (diluted tea tree oil). Not ineye area.

Fungal Infections of the Skin

Fungus is the general term for the group of mushrooms, yeasts and moulds marked by the

absence of chlorophyll and the presence of a rigid cell wall. Cells have a true nucleus

bounded by a nuclear membrane within which lie the chromosomes. Organelles are

present in the cells.


Tinea Pedis T.mentagrophytes

E.floccosum

T.interdigitale

T.rubrum

• Fungal infection of the feet

• Invades toes and soles

• Usually chronic, found in young and

middle-aged adults

• Most active in the summer, can persist

through winter

• Incidence higher in tropics

• Pruritus, burning and stinging• Usually bi-lateral and symmetrical

• Often manifests as a fissure between the

4th and 5th toes

• Sodden white patches with scaling,

fissuring and debris between the toes.

Treatment

• Foot baths of: potassium permanganate

(1:10,000), silver nitrate (1% solution),

• Burows solution.

• Fungicidal creams: Lamisil, miconazole,

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or clotrimazole

• Ketoconazole

Tinea Unguium Tricphyton

T.mentagrophytes

T.interdigitale

T.rubrum

• Fungal infection of the nail plate caused

by various species of dermatophytes

• Most common in adult men

• Rare in people that do not wear shoes

• Always found with chronic tinea pedis

• Causes thickened, distorted, yellowish

nails with an accumulation of keratin

underneath

• Superficial infection may start with small,

well-outlined, whitish or yellowish spots

at the distal end of the nail. These may

remain stationary for years or slowly

spread to the proximal end • Friable nail plate, thickened, its distal

edge is ragged and brownish

• The infection seems to affect alternate

digits, with the one in between clear

• Infections of 20 to 30 year duration are

not uncommon

Treatment

• Terbinafine 250mg daily for 3 months

• Oral ketoconazole or griseofluvin.Toenails require 6 to 12 months of

therapy.

Pityriasis

versicolour

Pityrosporm ovale

P. orbicularae

• Mottling of the skin

• Mainly found on the chest and back and

its growth is most dense in areas of

greatest sebum production

• Lesions are macules of altered

pigmentation covered by a fine powdery

scale. Pale area is found on dark skin and

dark macules on fair skin.

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• Hot humid conditions favoured

• When the disorder resolves pale patches

are left at the sites of the lesions

• Fluoresce apple green under Woods light

Treatment

• Topical imidazole such as miconazole,

clotrimazole, econazole

• Tinaderm

• Selenium shampoos

• Sulphide and zinc

Candidiasis Candida albicans

Candida spp

• Infection of mucus membranes and moist

skin areas

• Persistent redness/ulceration and itchiness

• When host resistance is impaired candida

normally present may proliferate and become invasive. Factors that contribute

to candida overgrowth include antibiotic

therapy, diabetes, obesity, excessive

sweating, oral contraceptive pill, topical

cortisone therapy. Altered vaginal mucosa

of pregnancy and the oral mucosa of

infants are especially susceptible.

• Oral candidiasis: common in infancy,

affects the tongue and mouth, areas

covered with a curd-like material which is

easily wiped away to reveal a raw red

surface.

• Flexural candidiasis: produces macerated

flexural skin.

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Viral Infections

A virus is a minute infectious agent, which, with certain exceptions, is not resolved by the

light microscope, lacks independent metabolism and is able to replicate only within a

living host cell. The individual particle, (virion) consists of nucleic acid (nucleoid) – DNA

or RNA, but not both, and a protein shell.

Viral Infections of the Skin

These include:

• Herpes simplex which is caused by a small DNA virus of either Type 1 or Type 2.

Type 1 affects the face and oropharynx and Type 2 affects the genitalia.

• Herpes zoster (shingles)

• Chicken pox (varicella)

• viral warts

• Molluscum contagiosum

• Orf.

Type 1 Herpes Simplex – Cold Sores

Up to 20% of the population suffer from recurrent cold sores.

The lesions usually last 1 to 2 weeks; the initial infection usually occurs 2 to 12 days after

first contact with an infected person. The virus can remain dormant, with symptoms

recurring following mild infection, trauma, stress or sun and wind exposure, hence the

name “cold sores” as the sores often follow a cold.

The cause is a small DNA virus named herpes simplex Type 1.

Once contracted the virus will remain resident in the body. Future outbreaks may betriggered by activities that lower immunity such as:

• minor infections

• emotional stress

• poor diet

• environmental stress

• sun exposure

• other factors.

Symptoms include an initial burning, tingling or itching which develops into small often

painful fluid filled blisters on the skin and mucous membranes. It most commonly affects

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the mouth and lips and also the genital and eye area. Immune system support in the case

of a viral infection is important; therefore, dietary avoidance of concentrated and simple

carbohydrates, alcohol, processed foods, colas, coffee and tea is beneficial. Citrus fruits

and juices should also be avoided while the virus is active.

Treatment

Herpes is very prevalent, as after entering the body the virus never leaves. It can only be

kept under control. The virus can remain dormant, with symptoms recurring following

mild infection, trauma, stress or sun and wind exposure.

The most effective dietary treatment of herpes is to increase lysine rich foods and restrict

arginine rich foods. Research shows arginine aids in viral replication and lysine has anti-

viral activity and inhibits arginine activity. This dietary approach will inhibit recurrences

of herpes. Attached is a table of the arginine and lysine content of selected foods. The

foods with the worst arginine/lysine ratio are chocolate, peanuts and almonds and should

definitely be avoided.

Lysine-rich Arginine-rich

Meat Chocolate (1:2)

Potatoes Peanuts (1:3)

Milk Cashews, pecans and almonds

Brewer’s yeast Seeds

Fish Cereal grains

Yoghurt Cocoa

Poultry Carob

Legumes (lentils etc) Brown rice

Soy beans Oatmeal

Eggs Gelatine

Vegetables Raisins

Beans Popcorn

Aubergines

Tomatoes

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Lysine-rich Arginine-rich

Green peppers

Mushrooms

Coffee and caffeinated tea

Sugar

Sunflower and sesame seeds

Other treatments include:

• Acyclovir which prevents outbreaks in 91% of patients. Caution should be practised

if the drug is taken on a regular basis.

• Isoprinosine which is a derivative of vitamin A.

• Exovir-HZ Gel which helps keep the virus from spreading.

• Idoxuridine which is a viral metabolic antagonist; as a 5% lotion it is used four to six

times a day and can shorten the disorder if started on the first day.

Role of the Beauty Therapist

The beauty therapist cannot treat cold sores. However, you can provide the client with

advice on how to control or minimise outbreaks. (See next step). If in doubt, the client

should see their general practitioner.

Herpes Zoster (Shingles) and Chicken Pox (Varicella)

Chicken pox and shingles are caused by the same DNA virus. Shingles is due to the

reactivation of the virus in someone who has previously had it.

Varicella/Chicken Pox

This condition is contagious. It is spread by droplets and debris from the lesions. The

incubation period is 17 days. Generally there is no fever or malaise. Lesions are common

on the face and trunk and less common on the limbs. Papules and papulovesicles give way

to pustules which become crusted. These drop off 7 to 14 days later and can leave pock

type scars.

Herpes Zoster (Shingles)

This condition mostly affects those over the age of 50. It occurs due to the reactivation of a virus that has been sitting latent in the posterior root ganglion of a spinal nerve.

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It is contagious; it can be caught from somebody with shingles. There is generally pain in

the dermatomes, systemic upset, fever and lesions. These lesions are similar to chicken

pox, plus more inflamed and confined to skin innervated by the dorsal primary root(s)

infected. 25 to 30% of patients still experience pain after the lesions have disappeared.

Treatment for Zoster and Varicella

There is no specific treatment. Lesions must be kept clean. Acyclovir on day one of the

disorder can shorten the disease and reduce the severity.

Calamine lotion can also be used.

Viral Warts

A wart is a circumscribed thickening of the skin with a horny surface caused by HPV

(human papilloma virus).

Particular types of warts are caused by different antigenic types of the HPV virus, for

example, common warts of the hands and fingers are caused by HPV Type 2 and Type 4.

Plane warts are caused by HPV Type 3 and Type 10. It is likely that warts are caused by

direct contact of skin with wart-virus containing horny debris. Warts are contagious; they

can be auto-inoculated from one part of the skin to another, or from one person to another.

Types of warts include:

• Hand warts - brownish elevations with a rough uneven surface. They are common on

the fingers, elbows, knees and sites of minor trauma.

• Paronychial warts occur around the nail and nail bed.

• Plantar warts are painful, deep warts on the soles of feet.

• Mosaic warts are irregularly shaped lesions on the sole. They have a granular surface

and are formed from a number of plantar warts.

• Plane warts on the face are more uniform in shape and size; they are flat topped, and only slightly raised.

• Genital warts may vary greatly in size. They have been associated with cervical

cancer in women.

• Filiform warts (skin tags) are fine elongated outgrowths. They are frequently solitary

and occur on face, neck or axillae.

Small black dots representing thrombosed capillaries in elongated dermal papillae usually

form near the surface of the wart.

TreatmentAll warts disappear, but may take their time doing so. Treatment usually relies on local

tissue destruction. Cryotherapy is tissue freezing with liquid nitrogen or chemical

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destruction with preparations containing salicylic acid, lactic acid, podophyllin or

glutaraldehyde.

Pigmentation Disorders of the Skin - Vitiligo

Vitiligo has a worldwide distribution affecting all races. 1% of the world’s population is

affected. Approximately half of those affected develop the disease before they are

twenty.

The course is chronic and unpredictable. After onset the patches may remain stationary

for years. Gradually new lesions develop and join to form large

de-pigmented areas. Spontaneous partial re-pigmentation occurs in one third of those

affected. Total re-pigmentation is rare.

The cause is unknown, although vitiligo has a genetic dominant inheritance.

Depigmentation is caused by the destruction of melanocytes. The mechanism is unknown,

but it is thought to be auto-immune. Physical or emotional stress, severe sunburn or

trauma may trigger the onset, or advance a stationary case of vitiligo.

Areas of depigmentation occur, and any part of the body may be affected; however, the

most commonly affected areas include the face (especially around the nose, mouth and

eyes), the backs of the hands, in body folds and around body orifices (perianal, externalgenitals, nipples and navel). The inflammatory edge may be itchy. Hairs within the

patches may be de-pigmented. Most individuals with vitiligo are active, tense and

nervous. The diagrams below show the areas of the body commonly affected by vitiligo.

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Treatment

Treatment with topical psoralen (a photosensitising drug) is followed by graduated

exposure to light sources. A sunscreen is used to protect normal skin. Treatment may be

required from six months to two years. Potent topical corticosteroids can be applied, but

not to the face.

The beauty therapist can apply camouflage treatment with special cosmetics or stains.

Application of sunscreen is advised.

Hair Disorders

Scalp hair grows at about half an inch (1.25cm) per month. The active growing phase

(anagen) can last for several years, while the resting phase (telogen) can last from 3 to 6

months.

There are 100,00 to 150,000 hairs on the head. 80% to 90% of these hairs are growing,

while 10% to 20% are resting.

Internal problems that can cause sudden or gradual hair loss include:

• shock

• chemotherapy

• general anaesthetic

• crash diets

• cardio-vascular disease

• sudden vitamin deficiency

• bulimia/anorexia

• being vegetarian: due to not consuming enough fat soluble vitamins

• menopause

• genetic predisposition.

Hair disorders include:

• pattern alopecia

• alopecia areata

• diffuse hair loss

• telogen effluvium

• traction alopecia

• post-childbirth hair loss

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• menopausal hair loss

• hypertrichosis

• hirsutism.

Pattern Alopecia

This is a common, dominantly inherited progressive form of alopecia. It develops

symmetrically at specific sites on the scalp and can cause complete scalp hair loss. It is

more common in men. Hair loss starts at the front hairline and crown and may commence

in the late teens or early 20s. There is no effective treatment.

Alopecia Areata

This is an autoimmune stress based disorder of the hair. It starts quite suddenly as one or

two rounded patches from which the hair is lost. The hair loss continues over weeks until

all the hair from the affected sites has fallen. Area of hair loss varies from 1 to 2

centimetres to the whole scalp (alopecia totalis). Occasionally the body hair also falls out.

The most frequently affected ages are 15 to 30 years old. Regrowth occurs in most

patients; however the hair is usually finer and non-pigmented.

Diffuse Hair Loss

This affects middle aged and elderly men and women. The causes include pattern

alopecia, virilisation, hypothyroidism, systemic illness, anticancer drugs, retinoids, ageing

and iron deficiency.

Telogen Effluvium

After childbirth or sudden illness hair follicles may revert to the resting or telogen phase.

This results in a sudden loss of terminal scalp hair three months after the precipitating

factor. Hair regrowth gradually restores the scalp hair.

Traction Alopecia

Repeated tugging or pulling on the hair shafts may produce loss of hair in affected areas.

Post-Childbirth Hair Loss

This is a very common condition. There is usually a thickening of hair during pregnancy,

followed by a thinning after birth. This can last for a few months.

Menopausal Hair Loss

Patterns of hair distribution are largely under hormonal control. At menopause there is

often diffuse thinning of head hair with increased growth and coarsening of facial hair due

to a drop in oestrogen compared to testosterone.

Hypertrichosis

This is a condition where an excessive quantity of hair grows in a normal location on the

body.

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Section B


Hirsutism

This is a condition where there is excessive facial and body hair in women.

Skin Tumors

Australia has the highest incidence of skin cancer in the world. Two out of three

Australians develop skin cancer, one in sixty develop a melanoma and there are over 1000

deaths per year due to skin cancer.

Basal Cell Carcinoma Squamous Cell

Carcinoma

Malignant

Statistics Common

75% of all skin

cancers

Less common

20% of all skin

cancers

Rare

5% of all skin cancers

Course Grows slowly

Least dangerous

Grows in weeks to

months

May spread and

metastasise

More dangerous

Spreads quickly

Dangerous

Aetiology Multiple, including

exposure to sunlight

Multiple, including


Multiple, including


Appearance Flattened or round

lumps, pale or pearly

with blood vessels.

Scaly red, may bleed

easily, could ulcerate,

may present as an

unhealing sore.

Change in a freckle or

a mole. A new spot on

normal skin. Changes

in size, shape or

colour.

Treatment Remove

Curette

Diathermy

Radiotherapy

Surgery

Remove

Curette

Diathermy

Radiotherapy

Surgery

Remove

Curette

Diathermy

Radiotherapy

Surgery

Role of the Beauty Therapist

Refer the client to a general practitioner upon the slightest concern or suspicion of any

lesion on the client’s body.

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Section B


Learning activity B1.1

Review the above information on skin disorders/diseases and develop a reference list for

those conditions which are contra-indicated for the following aspects of beauty therapy

treatments. Explain why these conditions are contra-indications for these treatments.

• facial massage

• product use

• skin penetration procedures eg permanent epilation.


Use the information on skin disorders and conditions in this section as well as sourcing

other references to find the meaning of the words below. Add any other words and their

meanings that you feel may be useful in relation to describing skin disorders to the

glossary.

Terms Used to Describe Skin Lesions

Primary Lesions

Macule

Papule

Nodule

Plaque

Vesicle

Bulla

Pustule

Abscess

Wheal

Papilloma

Petechiae

Purpura

Ecchymosis

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Section B


Haematoma

Comedone

Telangiectasia

Secondary Lesions (evolving from Primary Lesions)

Scale

Crust

Ulcer

Fissure

Stria

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Section B


Step 2 Promoting skin health and care

In order to maintain its effective function and condition skin needs to be cared for. Skin

care should involve protection and treatment to minimise the effects of natural skin

processes such as ageing and photoageing. Skin requires protection against long-term

environmental effects such as sun, wind and water, as well as a treatment routine to

manage whatever happens to the skin on a day-to-day basis. It also requires the use of

appropriate skin care products and techniques especially when they are used to control or

reduce the effects of non contagious skin conditions. This means not using harsh skin

products that may aggravate any existing skin conditions.

Skin care and beauty treatments

Cleansing, exfoliating and moisturising are the key components of good skin health. Skin

care means preserving the integrity of the stratum corneum while removing sebum and

soiling and maintaining adequate hydration.

Beauty treatments such as facials, spa and some body treatments incorporate these

components to maintain optimum skin health. The aim of these treatments is to maintain

the skin’s balance and protective capabilities.

Most beauty tharapy treatments will use photoprotective products and hydrating agents to

protect the skin. Moisturizers perform several important functions. They enable lost water

to be replaced, and then help to keep it in the skin by the humectants (water-binding

agents) that they contain. Humectants are important because they help maintain the lipids

of the epidermis in good condition which is vital to its water-retaining properties. A good

moisturizer will deliver water to the skin effectively and keep it in the skin for as long as

possible.

Af tercare advice

Beauty therapists should provide skin care advice to assist clients to care for their skin.Advice can cover general areas such as product use, diet and lifestyle. Advice to clients

with non-contagious skin disorders can include advice such as:

• use of hypo-allergenic skin care products

• avoidance of possible irritants

• avoidance of soap, and products containing lanolin and perfumed products

• gently patting skin dry after bathing, not rubbing

• treating dry skin with emollients

• avoiding specific foods that may trigger or aggravate a skin condition.

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Section B



Select two beauty therapy treatments that generally have beneficial effects on specific

skin disorders. Use the information about skin disorders in this section and other sources

of information to describe how these treatments can benefit these skin disorders. Make

some notes below.

Discuss how the treatments you have selected benefit the skin disorders you have

identified with your trainer or supervisor.


Select three skin disorders and develop a checklist of care advice you can give your

clients on how to control or minimise the effects of each condition.

Discuss the advice in your checklist with your trainer or supervisor to ensure you havecovered all relevant points.

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Section B


Notes:

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Glossary

Glossary

Abscess Sac of pus sealed by a wall of fibroblasts or collagen.

Acne Disorder of the skin caused by inflammation of the skin

glands and hair follicles.

Adrenaline Stress hormone.

Ageing Ongoing process of changing over time: physiologically, it

involves 3 stages: the development, mature and senescence

stages.

Alopecia Loss of hair.

Androgen Hormone which increases sebum production.

Anti-oxidant Substance that inhibits oxidation or reactions promoted by

oxygen or peroxide; anti-oxidants include uric acid and beta

carotene.

Apocrine sweat glands Large glands particularly concentrated in the underarm

region.

Atom The smallest particle of an element that can exist alone or in

combinations (compounds).

Candida Parasitic fungi that can affect the mouth, vagina and

intestinal tract: also known as thrush.

Cells Smallest structural unit of living matter capable of

functioning independently.

Ceramides Unsaturated lipids.

Chalone Internal secretion inhibiting mitosis in a specific tissue.

Chemotaxis Movement of cells in response to chemical factors.

Chromosome DNA containing body which contains most or all of the

genes of an individual.

Collagen The major structural protein in the dermis.

Compound A combination of atoms.

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Glossary

Corneocytes Cells of the stratum corneum through which water soluble

chemicals can diffuse.

Covalent bond Chemical bond formed between atoms by the sharing of

electrons.

Dermabrasion The surgical removal of skin blemishes or imperfections by

abrasion.

Dermatitis Inflammation of the skin.

Dermis Lower layer of skin.

Desquamation Peeling off in scales.

Development The series of changes by which the individual embryo

becomes a mature organism.

Differentiation The process by which a general cell type changes to form a

cell type with a specialized function.

DNA Any of various nucleic acids that are the molecular basis of

heredity.

Dominant genes Influential genetic factor.

Eccrine sweat glands Glands distributed throughout human skin and particularly

concentrated on palms and soles.

Eczema Inflammatory condition of the skin characterized by redness,

itching and oozing lesions which become scaly, crusted or

hardened.

Elastin Protein which gives the skin its elastic properties.

Electron A subatomic particle which has a negative charge

Element The different basic atom types.

Emollients Substance used to soften skin.

Endocrine glands Group of tissues which manufactures and secretes hormones

directly into the bloodstream.

Enzymes Complex proteins produced by living cells and acting as

catalysts for specific biochemical reactions at body

temperatures.

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Glossary

Epidermal lipid barrier Structure of proteins, lipids and lipid bilayers in the stratum

corneum.

Epidermis The skin’s outer layer.

Epithelialisation The final growth and differentiation in the wound healing

process.

Erythrocytes Red blood cells.

Fibroblasts Connective tissue cells.

Free radicals Highly reactive chemical substances which initiate damage

to the cells and systems of the body resulting in impairment

of normal function.

GAGS Glycosaminoglycans; sodium salt of Hyaluronic Acid.

Gametes The formation of male and female germ cells.

Gene The unit of inherited characteristics; a sequence of DNA

contained by and arranged along a chromosome.

Glycerol Sweet syrupy alcohol which is one of the common

humectants.

Grafting Surgical implanting of living skin tissue.

Growth The progressive development of a living being or part of an

organism from its earliest stage to maturity.

Hormone Product of living cells that circulates in body fluids and

produces a stimulatory effect on cellular activity.

Humectant Substance used to hydrate skin through the binding of water

to atoms of oxygen.

Immune system System which fights disease by recognizing and removing

or destroying foreign substances and damaged or cancerous

cells.

Intercellular matrix Material consisting of connective tissue which fills the space

between the cells of diverse tissues including skin, tendons,

muscles and cartilage.

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Glossary

Keratin Fibrous protein that forms the basis of horny epidermal

tissue such as hair and nails.

Langer Lines The natural tension lines of the skin.

Laser treatments Treatments including laser resurfacing which removes the

epidermis and encourages less blemished skin to regrow.

Leukocytes White blood cells.

Lipid A complex group of chemicals including fats, oils and

vitamins.

Lubricant Greasy substance used to reduce friction.

Matter Substance of which a physical object is composed.

Melanin Protective substance or pigment that can filter out ultra-

violet radiation.

Melasma Pigmentation of the face.

Mendel’s Laws Generalisations which allow us to make predictions about

the probability of inherited characteristics; named after

Gregor Mendel.

Mitosis Division or multiplication of cells either to add new tissue or

to replaced damaged tissue.

Molecule Smallest unit of a chemical compound.

Neutron A subatomic particle which has no charge.

Occlusion The sealing and covering of skin with an oily substance to

prevent moisture loss.

Oestrogen Female hormone.

Pavementing Process which involves leukocytes adhering to vessel

surfaces during the inflammation of a wound.

Peels Procedure used to improve skin texture and appearance.

Percutaneousabsorption

The passage of substances through the skin into the dermisand blood system.

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Glossary

Periodic table Table representing the nature and order of atoms.

Phagocytosis The engulfing of foreign material and debris by leukocytes

during the inflammation stage of wound healing.

Photoageing Changes promoted by exposure to sunlight and UV rays.

Pigmentation Skin colouration.

Polymer Chemical compound or mixture of compounds consistingessentially of repeating structural units.

Progesterone Female sex hormone.

Protein Compounds of amino acids.

Proton A subatomic particle which carries a positive charge.

Recessive genes Less influential genetic factors.

Sebum Oily substance which is a mixture of fat and the debris of

dead fat-producing cells.

Sorbitol A mild humectant.

Stratum corneum The outermost layer of the epidermis and the body’s major

chemical and mechanical barrier.

Strae gravidarum Stretch marks which occur when skin growth cannot keep

pace with body growth (for example during pregnancy).

Substantive Ability to attach strongly to a substance.

Surfactant Detergents used in a number of shampoos to clean or

degrease hair.

Testosterone Male hormone.

Vitiligo Unpigmented skin.

Wound healing Complex series of highly regulated biological events

following damage to the dermis or epidermis.

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Glossary

Notes:

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Assessment

Assessment

For valid and reliable assessment of this unit, competency should be consistently

demonstrated over a period of time and observed by an assessor from a Registered

Training Organisation and/or a technical expert working in partnership with the assessor.

You may be:

• observed performing a range of tasks in a simulated work environment, over sufficient

time to demonstrate your handling of a range of contingencies. Tasks may include:

- identifying the principles of skin science and disorders- relating the performance of a variety of treatment processes to the principles of

skin science and disorders

• asked to answer written and/or oral questions to assess your knowledge and

understanding of skin science principles and their relationaship to the application of

beauty therapy treatments.

The assessor should inform you of the timing and location of your assessment. If you feel

you are not yet ready for assessment, discuss this with your trainer or supervisor.

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Assessment

WRBCS409A

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Transcript of WRBCS409A