Keep Calm…

Our Alchimie Forever marketing calendar says that April is the month of Calm. As in calm skin, and calm spirit.

Calm skin. April is National Rosacea Awareness month. Those who suffer from rosacea know this is the antithesis of calm. Red, angry, irritated, uncomfortable, are words that describe rosacea skin; calm is not. Helping to calm your skin looks like this:

  • Avoid triggers. These will vary somewhat individually: heat, alcohol, spice, and more.
  • Protect your skin. From the sun (always), but also from the cold and the wind.
  • Treat your skin gently. Avoid harsh products, cleansers and otherwise. Look for anti-inflammatory ingredients. Remember that less is more.
  • When all else fails, apply makeup to cover up the red. I so rarely recommend makeup other than for color… but sometimes it really is necessary.
  • Your dermatologist is your friend. Listen to his / her recommendations, follow his / her prescriptions, trust the expert.

Calm spirit. Is there a calm spirit month? This is the time of year when my spirit is the antithesis of calm. Tired, overwhelmed, irritated, uncomfortable, are words that describe an agitated spirit; calm is not. Helping to calm my spirit looks like this:

  • Avoid triggers. I know what mine are, I trust you know yours.
  • Protect my energy. Be more quiet. Spend more time in nature (as I write from the gardens of Salamander Resort & Spa).
  • Treat myself gently. Sleep more, drink less, exercise more. Cancel appointments (responsibly).
  • When all else fails, smile until I make it. A Saturday with absolutely zero commitments is 3 days away. Tinos is 64 days away…
  • My therapist is my friend. For me, that means my massage therapist… thank you Brian!

Calm – of skin and spirit!

 

Sensitive skin: what is it and what can we do about it?

Sensitive skin: myth or reality?

In Europe, the United States and Japan more than half the population reports suffering from sensitive skin. That fact alone warrants a better understanding of this condition, how to diagnose it, evaluate it, and treat it. Alchimie Forever’s heritage makes this topic particularly near and dear to my heart, as our origin was in post-procedure skin care, meaning the treatment of sensitized skin.

Men or women? 

We women are more sensitive than men overall, that is common knowledge… and as a result, we typically report sensitive skin more often than men do. While this was previously thought to be due to the fact that our epidermis is slightly thinner than that of men, and due to specific hormonal differences,  recent objective testing has found that sensitive skin is just as prevalent for men as it is for women.

What is sensitive skin? 

We can define sensitive skin as a hyper reactive response of the skin to an external source that results in inflammation. The source of irritation can be environmental conditions, cleaning products, personal care products, clothing, or anything that comes in contact with the skin. The symptoms concerned are often one or a combination of the following sensations: itching, burning, erythema (redness), tingling, flaking (scaling), tightness, and dryness.

Causes of Sensitive Skin

So why is sensitive skin… so sensitive?  An exaggerated response to an external source may be caused by a compromise in the skin barrier’s protective function: specifically, a thinner stratum corneum and reduced corneocyte area. A thinner barrier makes it easier for water soluble chemicals to quickly traverse the stratum corneum and cause irritation, making the skin more sensitive than normal to environmental factors.

Neural transmission and structural changes to receptors in the epidermis can also contribute to sensitive skin. A study shows that all sensitive skin, when compared to non-sensitive skin, was found to have more nerve growth factors in the stratum corneum.2 This could explain hypersensitivity even when the skin’s barrier appears intact: sensory neurons are activated and we see an inflammatory response.

Evaluating Sensitive Skin

At times, sensitive skin symptoms are easily detectable, such as in the case of redness or scaling, but sometimes symptoms like burning, tingling and a sensation of tightness can be difficult to evaluate and quantify. Because of the presence of symptoms that are difficult to evaluate, sensitive skin is often a self-diagnosed condition, which does not make it any less serious (indeed, studies show that self-perceived symptoms of hyper-reactivity reliably precede the appearance of clinical signs). Apart from self perception, clinical assessment of redness, dryness, discoloration, transepidermal water loss (TEWL), and hydration, as well as engineering methods of Doppler flowmetry can be used to evaluate skin sensitivity. However, when there are no observable clinical signs, it can be a challenge to quantify and evaluate sensitive skin. This is one of the key reasons why this subject is not yet fully understood.

Sensitive Skin vs. Sensitized Skin

Many people who report having sensitive skin may in fact have sensitized skin. The difference is in genetics. People with sensitive skin have a genetically thinner or compromised stratum corneum barrier, which makes them more sensitive to factors that normal skin is protected from.

Sensitized skin is rather a result of external influences damaging the skin’s protective barrier, or of chronic exposure to damaging conditions wearing down the skin’s natural protection. A sensitized condition is a temporary state of sensitivity that can be reversed by ceasing exposure to the irritant and creating an ideal environment in terms of moisture and temperature so that the skin can restore its protective barrier.

A genetically sensitive condition is permanent and irreversible; exposure to provoking factors should be limited in order to avoid irritation. Extra steps should also be taken to protect sensitive skin.

Sensitive Skin vs. Irritated Skin

Sensitive skin is a condition, irritated skin is the result. Sensitive and sensitized skin can result in irritation. Irritated skin can be caused by any physical or chemical factor damaging the skin.

Sensitive Skin and Age

Children tend to have generally more sensitive skin than adults; their protective skin barrier is thinner and becomes thicker as they age. However, adults are chronically subject to conditions that can lead to sensitization with age.

Factors provoking irritation of Sensitive Skin

There are a variety of factors that have been found to provoke sensitive skin irritation. These factors affect people differently and irritation can result from a chronic or acute exposure.

  • Household or Self Care Products or Treatments: alcohol, soaps, dyes, abrasive and harsh products, aggressive cosmetic treatments and more.
  • Environmental: cold, heat, frequent and significant changes between temperatures, pollution, dryness in the air, indoor heating or air conditioning.
  • Lifestyle: Emotions, stress.

Managing Sensitive Skin

There is no standard treatment for sensitive skin, it is a genetic condition and irritation is due to so many different factors. But there are some ways to protect and avoid irritation.

  • Avoiding exposure to provoking factors.
  • Using anti-irritant products that have a cooling, soothing, anti-inflammatory, or healing effect helps repair the skin barrier to its unique optimal state (my favorite is the Kantic+ intensely nourishing cream).
  • Protecting your sensitive skin year-round with UVA and UVB sunscreen. I love our Protective day cream SPF 23 and its lightweight texture.

(Thank you to my fabulous Geneva intern Rachel for your help researching this blog post; references available upon request.)

National rosacea awareness month

Rosacea affects 14 million people in the US, men more severely than women, including famous figures such as Bill Clinton and W. C. Fields. However, to this day, 78% of Americans have no accurate knowledge of this condition and wouldn’t know how to recognize it.

April is National Rosacea Awareness Month, which is the perfect excuse and opportunity to review this skin condition, and share some tips about how to best manage the symptoms of rosacea (unfortunately, there is no cure for rosacea).

Causes of rosacea: The pathogenesis of rosacea is multi-factorial (translated in English: we don’t really fully understand what causes rosacea). Indeed, rosacea is precipitated by multiple causes including:

  • Genetic factors
  • Vascular factors
  • Immune-mediated factors
  • Emotional factors
  • Environmental factors
  • Infectious factors

There are various triggers that will aggravate this condition, including:

  • Environmental stimuli:
    • Exposure to temperature extremes
    • Moving to a warm or hot environment from a cold one
    • Heat from sunlight and severe sunburn
    • Cold wind
  • Emotional stimuli:
    • Stress
    • Anxiety
  • Physiological stimuli:
    • Some foods and drinks, including alcohol, caffeine, spicy foods
    • Strenuous exercise
  • Exogenous stimuli:
    • Microdermabrasion
    • Chemical peels
    • Products containing alcohol, witch hazel, menthol, peppermint, eucalyptus, clove oils, and other irritants

Diagnosis of rosacea: When diagnosing rosacea, it is important to look for the following:

  • Presence of one or more of the following primary features:
    • Flushing (transient erythema)
    • Long-lasting erythema
    • Papules and pustules  (red or yellow little bumps)
    • Telangiectasia (visible broken red blood vessels)
  • May include one or more of the following secondary features:
    • Burning or stinging
    • Plaque
    • Excessive dryness
    • Edema
    • Ocular manifestations (burning, redness)
    • Peripheral locations (rosacea on areas other than face)
    • Phymatous changes (e.g. rhinophyma) enlarged nose extremity

Rosace is typically classified in three stages:

Stage 1: Mild rosacea

  • Predominantly vascular symptoms
  • Characterized by recurring flushing on the face, neck and upper chest
  • May include facial edema and erythema
  • Telangiectasia may appear

Stage 2: Inflammatory rosacea

  • This stage is marked by the appearance of follicular-based papules and pustules
  • In addition to the symptoms of Stage 1 rosacea, there are also increasingly prominent facial pores

Stage 3: Severe rosacea

  • Characterized by a proliferation of sebaceous, connective, and vascular tissue
  • Typically results in the bulbous hypertrophy of the nose known as rhinophyma
  • This stage is most commonly found in men

Treatment options The first treatment option is truly behavioral, focusing on avoiding all of the triggers identified above. A typical treatment course for severe rosacea will however also include medications, such as:

  • Oral antibiotics (tetracycline, doxycycline, minocycline)
  • Topical antibiotics such as metronidazole (Metrogel)
  • Topical azelaic acid such as Finacea (15%) or Skinoren (20%) may help reduce inflammatory lesions, bumps and papules
  • If papules and pustules persist, isotretinoin can be prescribed

Finally, for the treatment of the erythema and redness specifically, the pulsed dye laser remains the gold standard.

From a product standpoint, it is essential to use products formulated for sensitive skin and to avoid harsh ingredients such as acids or vitamin C (and certainly no peels!). Furthermore, vaso-constrictors (ingredients that tighten our red blood cells and protect their capillary walls) are ideal for rosacea-prone skin (think blueberries for example). Finally, from a cosmetic standpoint, makeup bases that have some green in them will help to alleviate the look of redness.

For a webinar on how to treat rosacea-prone skin, please click here.

Sources: National Rosacea Society, The Treatment of Rosacea with Glycolic Acid, Cleveland Clinic Foundation, JAAD, April 2002, Vol 46, Number 4, JAAD, June 2004, Vol 50, Number 6