• ROSACEA • INFLAMMATION • ECZEMA
•SENSITIVE SKIN • HYPERPIGMENTATION
Is Skin Inflammation At The Root Of Skin Conditions?
Understanding Skin Inflammation in the Treatment Process
by Rhonda Allison
Inflammation, like many things in life, has good and bad qualities. Though it’s commonly perceived as an undesirable response that’s harmful to the body, inflammation — including skin inflammation — does in fact contribute to the body’s defensive and healing process.
It’s easy to perceive inflammation as a concern because it’s commonly associated with infections, wounds and increased susceptibility to other diseases. Up until the end of the 19th century, inflammation was thought to be extremely harmful to the body. At that point, important research revealed inflammation to be part of the body’s natural defense and healing process, and an important indicator of injury and disease.
Inflammation is a very complex part of the biological process, signaling the body to begin the healing process. Without inflammation receptors, wounds and infections would not heal. Inflammation becomes dangerous, however, when it is chronic, as this is when skin conditions like acne, psoriasis, eczema, aging and hyperpigmentation manifest.
There are two classifications of inflammation: acute and chronic. Acute is the body’s first response to initiate healing and it is critical to repair. Chronic is prolonged inflammation –– it’s a constant part of the physiology, or when the immune system mistakenly attacks normal tissues, and it has been linked as a primary contributor to most of the challenges that plague the skin. Several decades ago, scientists Albert Kligman, M.D., and Robert Lavker, Ph.D., suggested chronic inflammation was at the root of many cutaneous and systemic diseases, and this theory has since been scientifically accepted. Aging, hyperpigmentation, rosacea, and eczema are a few skin conditions that can also be traced to chronic inflammation.
During the inflammatory process, when plasma and leukocytes flood the area, several extracellular mediators and regulators are recruited to help control the process, including cytokines, growth factors and peptides. Which cells and mediators come to the site of injury or infection depends on numerous factors, including:
- The stage of the inflation (the initiating event)
- The type of pathogen (chemical, physical injury or auto-immune)
- The tissue or organ involved
- Whether the inflammation is acute or chronic
This is important to note because of inflammation’s role in the healing, restorative process. We now know it supports the skin and body from initiation through to restoration of normal appearance and function. However, when the issue is chronic, this is not the case, and understanding the type of inflammation you are dealing with is key to helping clients resolve it.
There are five principal indicators of inflammation, including pain, heat, redness, swelling and loss of function. Aside from indicators, however, inflammation may reveal itself in the form of a skin disorder.
Inflammation and skin issues
There are numerous stimuli that induce inflammation including burns, over exposure to UV rays, stress, trauma, toxins, medications, alcohol, immune reactions and infection by pathogens, foreign bodies such as dirt and debris… the list goes on. Skin inflammation caused by free radicals, however, degrades cells and slows collagen production. When this persists over time, it inhibits the body’s natural ability to repair itself, which in turn causes visual signs of aging.
When this is the case for clients, it’s best to eliminate as many of the proinflammatory stimuli as possible, and increase antioxidant and anti-inflammatory support. In the treatment room, enzymes and peels with ingredients such as cherry seed oil, turmeric, mandelic acid, L-lactic acid, azelaic acid, ursolic acid and salicylic acid deliver both. Topical antioxidants such as superoxide dismutase, resveratrol, heart of green tea and grapeseed extracts may be used at home to further support the healing process.
While the cause of acne remains a relative unknown, there is data that indicates acne vulgaris is a primary inflammatory disease, with much evidence suggesting that inflammation occurs at all stages of acne lesion development. Though there’s been much debate over the years about at which stage inflammation is involved, more recent research suggests inflammatory events may also be present in early acne development, even prior to the formation of a comedone or acne lesion.
Regardless of the stage at which inflammation is a factor, research has consistently shown that treatments that aim to provide anti-inflammatory support are effective in healing and repairing acne conditions. Ingredients such as retinol have proven effective for comedonal acne, and in conditions where chronic inflammation is present, combining retinols with an anti-inflammatory such as turmeric, salicylic acid, totarol, heart of green tea, mandelic acid or ursolic acid suppresses acne flare-ups while preventing the formation of additional microcomedones.
Post-inflammatory hyperpigmentation (PIH) commonly occurs as a result of skin inflammation due to acne, irritations, misuse or overuse of certain skin products, or over-stimulation from a corrective treatment such as a peel or microdermabrasion. This is typically temporary and is more common in skin of color, but something to be aware of in all skin types. When injury to the skin is more severe, it may result in postinflammatory hypopigmentation, which is usually permanent.
When skin inflammation occurs in the epidermis, it stimulates melanocytes to increase melanin synthesis. The pigment then transfers to surrounding keratinocytes. If the basal layer is injured, melanin pigment is released and may become trapped. Melanin suppressants such as azelaic acid and kojic acid are helpful in minimizing PIH, as is antibacterial and antioxidant support.
For other forms of hyperpigmentation, one of the most common causes is the sun. This, incidentally, is also an inflammatory trigger. Prevention is key, so urge clients to use a broad-spectrum SPF with a mineral base such as natural zinc. Other ingredients for supporting hyperpigmented skin and reducing skin inflammation include salicylic acid, L-arbutin, mandelic acid, licorice root, and naturally occurring acids from tomatoes, which also delivers antioxidant support.
Rosacea is a chronic and progressive disorder that may first be noticed as redness in the cheeks, nose, chin or forehead. While the cause is unknown, some research has shown it to be triggered by chronic and heightened inflammation levels. There are also different stages of rosacea. The first stage often manifests as frequent blushing or flushing when the skin becomes irritated by certain topicals, acne medications, chemical-based sunscreens and improper care and protection. The second and third stages are more chronic, with the second appearing as continuous reddening and expanded and surfaced capillaries. Papules or pustules may also appear. The third stage is a deep, persistent redness, often accompanied by dilated blood vessels, particularly around the nose. It is a systemic issue, and often requires addressing a deeper root issue.
In the treatment room, the goal for rosacea clients is to provide strengthening support without over stimulating the underlying inflammation. Stimulating circulation and lymphatic flow, along with low-strength AHAs, BHAs and retinols, and antioxidant, anti-inflammatory and antibacterial ingredients such as essential fatty acids, growth factors, rhodiola root, sea buckthorn, mandelic acid, organic stem cells and probiotics help bring rosacea skin back to optimal health. Also talk to clients about their diet, as some recent studies have shown an association between skin disorders such as rosacea and inflammation in the gastrointestinal tract.
While the exact cause of psoriasis isn’t fully understood, the red, flaky plaques are thought to be caused by chronic inflammation by way of an immune system disorder in which T cells and other white blood cells like cytokines (the body’s defenders) attack healthy skin cells by mistake.
In psoriatic conditions, T cells have shown to become overactive, increasing the production of healthy cells as part of the inflammatory process to fight off what it perceives to be an offender. This stimulates the production of cytokines, which proliferates blood cell formation. These become dilated, creating warmth and redness. As the cycle continues, new skin cells move to the outermost layer of the skin too quickly, causing cells to build up, resulting in thick, scaly patches on the skin’s surface.
If you detect psoriasis in your client, direct them to a physician right away, as psoriatic arthritis may manifest within five to 10 years following skin presentation.
Also referred to as atopic dermatitis, eczema impacts more than 30 million Americans. It appears on the skin as a red rash and may occur anywhere on the body. It is commonly confused with psoriasis, as both appear similarly in the skin. Like psoriasis, there is no known cause. If there’s any question as to what the condition may be, refer the client to a physician or dermatologist.
The goal with skin impacted by eczema or psoriasis is to heal, nourish and hydrate. Look to ingredients with anti-inflammatory properties such as linoleic and oleic acids, hyaluronic acid, arnica montana, witch hazel and growth factors.
While there is so much that we can do in the treatment room, the skin is an indicator or reflection of our overall health. Any of these skin issues could be a sign of inflammation occurring elsewhere in the body. Refer clients to a nutritionist or doctor to get to the root of underlying issues such as not properly digesting nutrients, food sensitivities or allergies, hormonal balance, and other systemic problems as a complement to your services.