WRBCS409A

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: info@serviceskills.com.au 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: info@serviceskills.com.au 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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Learner Guide WRBCS409A Apply knowledge of skin science to beauty therapy treatments
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
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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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 science to 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 Step 2 Step 3 Step 4 Identifying key stages in the development of the skin Identifying the inheritance of physical traits and conditions of the skin Identifying the function of the main skin chemicals Identifying the importance of percutaneous absorption in relation to 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 humans 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 differentiation
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
Link the principles of skin science to beauty therapy treatments 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.
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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
Metaphase
Interphase
Early prophase
Late prophase
Early Anaphase
Two Cells Late Telophase Early Telophase Late Anaphase
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Section A
Link the principles of skin science to beauty therapy treatments Cell division in the epidermis, the skins 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 bodys 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 as salt 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
Cells During 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 it covers. 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 skins 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 skins 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 treatments such 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 a repeatable 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 to recognise 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.
Learner Guide WRBCS409A Apply knowledge of skin science to beauty therapy treatments Page 9 of 69
Section A
Link the principles of skin science to beauty therapy treatments The main differences between normal and photoaged skin can be seen in the following comparisons. Normal Ageing Appearance: smooth, unblemished some deepening of wrinkles some loss of elasticity Epidermis: thinner fewer cells participate in mitosis; cells regular smoothing of basement membrane Dermis: thinner elastin is thicker and cross-linked collagen bundles heavily GAGs (Glycosaminoglycans: sodium salt of Hyaluronic Acid) overall decrease Cells of Dermis hypocellular Cancers: uncommon
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Photoageing Appearance: leathery, blotchy quite extensive deep wrinkling quite significant loss of elasticity Epidermis: thicker more cells participate in mitosis; cells irregular irregular basement membrane Dermis: thicker elastin is in thick, tangled, disorganised lumps decrease in bundles and fibres of elastin GAGs: large increase; change in gel thickness Cells of Dermis hypercellular Cancers: very common
Section A
Link the principles of skin science to beauty therapy treatments 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 is converted 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 Local Redness Heat (increased temperature) Swelling (edema) Pain Dilation of vessels, increased blood flow to injured area. Dilation of vessels, increased blood flow to injured area. Increased vessel permeability, and movement of fluid from the circulatory system into the tissue spaces Increased pressure on sensory nerve endings in swollen tissues; effects of some chemical mediators of inflammation on nerve terminals Contributing Causes
Systemic Fever Increased production and release of leukocytes (white blood cells) Endogenous pyrogens (fever producing substances) are released 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 natural gut, 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 a smoother 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 a few hours after the peel and visible flaking may take place over the following days. Light
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Section A
Link the principles of skin science to beauty therapy treatments 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 ones 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 Mendels Laws. Gregor Mendel, an Austrian monk, developed his theories in 1866, however the importance of his findings was not realised until 1900. Mendels 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. Mendels Second Law, the Law of Independent Segregation, states that the segregation of each pair of genes in the process of gamete formation 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, Mendels principles were modified. For example, Mendels 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 seems to 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 worlds 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 naturally occurring 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 as catalysts for specific biochemical reactions at body temperatures. Globins are colourless proteins especially obtained from haemoglobin. 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.
Insoluble or fibrous. These include collagens, elastins and keratins.
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.
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 to wrinkle 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 clients skin will affect the performance of some beauty therapy treatments. For
Section A
Link the principles of skin science to beauty therapy treatments example an assessment of a clients 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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Section A
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 be stimulated 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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Section A
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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Section A
Age Related Hormonal Change and the Skin
Menopause A womans 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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Section A
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 the overgrowth of the yeast candida. Antibiotics destroy the normal protective barrier allowing candida to flourish.
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Section A
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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Section A
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 the objectives 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
Section A
Link the principles of skin science to beauty therapy treatments 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 Penetration The 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 adsorbed 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 percutaneous absorption more readily than dry, dehydrated skin. Clean skin is generally more
Section A
Link the principles of skin science to beauty therapy treatments 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 Absorption
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.
epidermis
-------------dermis-------------
concentration
200 Skin depth,
1000
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. Testing the same substance under in vitro conditions may result in less penetration as the deeper
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Section A
Link the principles of skin science to beauty therapy treatments 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 test substance 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.
10-2
10-3
in vitro
Concentrati
10-4
in vivo
10-5 100 300 500 Skin depth, 700 900 1100
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.
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Section A
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 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. liquid silicones methicone dimethicones.
Lipids
Non organic oils (those which have no carbon):
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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Section A
Link the principles of skin science to beauty therapy treatments 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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Section A
Notes:
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Section B
Identify the causes of and treatments 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 Step 2 Identifying the causes of and treatments for skin disorders Promoting skin health and care
This section covers information about a range of skin disorders that you may encounter in your 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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Section B
Identify the causes of and treatments for skin disorders 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 Parkinsons 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 pilosebaceous follicles by sebum and keratin. Closed comedones are whiteheads caused by blocked sebum and keratin further down the pilosebaceous follicle.
Section B
Identify the causes of and treatments for skin disorders 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 where lesions are at different stages of development. Lithium, oral contraceptives and anticonvulsant 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.
Section B
Identify the causes of and treatments for skin disorders 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 infants 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 more inflamed 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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Section B
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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Section B
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 the disease 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 be avoided.
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Section B
Atopic Eczema/Atopic Dermatitis
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 most frequently seen symptom and the eyelids are often thin and inflamed.
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Section B
Identify the causes of and treatments for skin disorders 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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Section B
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 commonly affected by seborrhoeic dermatitis.
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Section B
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.
Allergic Contact Dermatitis
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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Section B
Identify the causes of and treatments for skin disorders 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 - Nettlerash/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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Section B
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 treatment may 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 the scales 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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Section B
Identify the causes of and treatments for skin disorders 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 Psoriasis The 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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Section B
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 Impetigo contagiosa
Causative Agent Staphylococcus aureus Haemolytic streptococcus
Features 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.
School sores
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.

Section B
Identify the causes of and treatments for skin disorders Disease Folliculitis Causative Agent Exposure to tar, mineral oils, adhesive plaster, plaster occlusive dressings. Staph. Features 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 in eye 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. Disease Tinea Pedis Causative Agent T.mentagrophytes E.floccosum T.interdigitale T.rubrum Features 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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Section B
Disease
Causative Agent
Features or clotrimazole Ketoconazole 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
Tinea Unguium
Tricphyton T.mentagrophytes T.interdigitale T.rubrum
Treatment Terbinafine 250mg daily for 3 months Oral ketoconazole or griseofluvin. Toenails require 6 to 12 months of therapy. 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.
Pityriasis versicolour
Pityrosporm ovale P. orbicularae
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Section B
Disease
Causative Agent
Features 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 Candidiasis Candida albicans Candida spp Tinaderm Selenium shampoos Sulphide and zinc 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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Section B
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 be triggered 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
Section B
Identify the causes of and treatments for skin disorders 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 antiviral 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 Potatoes Milk Brewers yeast Fish Yoghurt Poultry Legumes (lentils etc) Soy beans Eggs Vegetables Beans
Chocolate (1:2) Peanuts (1:3) Cashews, pecans and almonds Seeds Cereal grains Cocoa Carob Brown rice Oatmeal Gelatine Raisins Popcorn Aubergines Tomatoes
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Section B
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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Section B
Identify the causes of and treatments for skin disorders 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. Treatment All 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
Section B
Identify the causes of and treatments for skin disorders 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 worlds 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, external genitals, 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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Section B
Identify the causes of and treatments for skin disorders 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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Section B
Identify the causes of and treatments for skin disorders 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
Identify the causes of and treatments for skin disorders 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 Statistics Common 75% of all skin cancers Grows slowly Least dangerous Squamous Cell Carcinoma Less common 20% of all skin cancers Grows in weeks to months May spread and metastasise More dangerous Multiple, including exposure to sunlight Scaly red, may bleed easily, could ulcerate, may present as an unhealing sore. Remove Curette Diathermy Radiotherapy Surgery Malignant Rare 5% of all skin cancers Spreads quickly Dangerous
Course
Aetiology Appearance
Multiple, including exposure to sunlight Flattened or round lumps, pale or pearly with blood vessels.
Multiple, including exposure to sunlight Change in a freckle or a mole. A new spot on normal skin. Changes in size, shape or colour. Remove Curette Diathermy Radiotherapy Surgery
Treatment
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 clients 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
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 skins 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.
Aftercare 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 have covered all relevant points.
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Section B
Notes:
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Glossary
Glossary
Abscess Acne Adrenaline Ageing
Sac of pus sealed by a wall of fibroblasts or collagen. Disorder of the skin caused by inflammation of the skin glands and hair follicles. Stress hormone. Ongoing process of changing over time: physiologically, it involves 3 stages: the development, mature and senescence stages. Loss of hair. Hormone which increases sebum production. Substance that inhibits oxidation or reactions promoted by oxygen or peroxide; anti-oxidants include uric acid and beta carotene. Large glands particularly concentrated in the underarm region. The smallest particle of an element that can exist alone or in combinations (compounds). Parasitic fungi that can affect the mouth, vagina and intestinal tract: also known as thrush. Smallest structural unit of living matter capable of functioning independently. Unsaturated lipids. Internal secretion inhibiting mitosis in a specific tissue. Movement of cells in response to chemical factors. DNA containing body which contains most or all of the genes of an individual. The major structural protein in the dermis. A combination of atoms.
Alopecia Androgen Anti-oxidant
Apocrine sweat glands Atom Candida Cells Ceramides Chalone Chemotaxis Chromosome Collagen Compound
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Glossary
Corneocytes Covalent bond Dermabrasion Dermatitis Dermis Desquamation Development Differentiation DNA Dominant genes Eccrine sweat glands Eczema
Cells of the stratum corneum through which water soluble chemicals can diffuse. Chemical bond formed between atoms by the sharing of electrons. The surgical removal of skin blemishes or imperfections by abrasion. Inflammation of the skin. Lower layer of skin. Peeling off in scales. The series of changes by which the individual embryo becomes a mature organism. The process by which a general cell type changes to form a cell type with a specialized function. Any of various nucleic acids that are the molecular basis of heredity. Influential genetic factor. Glands distributed throughout human skin and particularly concentrated on palms and soles. Inflammatory condition of the skin characterized by redness, itching and oozing lesions which become scaly, crusted or hardened. Protein which gives the skin its elastic properties. A subatomic particle which has a negative charge The different basic atom types. Substance used to soften skin. Group of tissues which manufactures and secretes hormones directly into the bloodstream. Complex proteins produced by living cells and acting as catalysts for specific biochemical reactions at body temperatures.
Elastin Electron Element Emollients Endocrine glands Enzymes
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Glossary
Epidermal lipid barrier Structure of proteins, lipids and lipid bilayers in the stratum corneum. Epidermis Epithelialisation Erythrocytes Fibroblasts Free radicals The skins outer layer. The final growth and differentiation in the wound healing process. Red blood cells. Connective tissue cells. Highly reactive chemical substances which initiate damage to the cells and systems of the body resulting in impairment of normal function. Glycosaminoglycans; sodium salt of Hyaluronic Acid. The formation of male and female germ cells. The unit of inherited characteristics; a sequence of DNA contained by and arranged along a chromosome. Sweet syrupy alcohol which is one of the common humectants. Surgical implanting of living skin tissue. The progressive development of a living being or part of an organism from its earliest stage to maturity. Product of living cells that circulates in body fluids and produces a stimulatory effect on cellular activity. Substance used to hydrate skin through the binding of water to atoms of oxygen. System which fights disease by recognizing and removing or destroying foreign substances and damaged or cancerous cells. Material consisting of connective tissue which fills the space between the cells of diverse tissues including skin, tendons, muscles and cartilage.
GAGS Gametes Gene Glycerol Grafting Growth Hormone Humectant Immune system
Intercellular matrix
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Glossary
Keratin Langer Lines Laser treatments Leukocytes Lipid Lubricant Matter Melanin Melasma Mendels Laws
Fibrous protein that forms the basis of horny epidermal tissue such as hair and nails. The natural tension lines of the skin. Treatments including laser resurfacing which removes the epidermis and encourages less blemished skin to regrow. White blood cells. A complex group of chemicals including fats, oils and vitamins. Greasy substance used to reduce friction. Substance of which a physical object is composed. Protective substance or pigment that can filter out ultraviolet radiation. Pigmentation of the face. Generalisations which allow us to make predictions about the probability of inherited characteristics; named after Gregor Mendel. Division or multiplication of cells either to add new tissue or to replaced damaged tissue. Smallest unit of a chemical compound. A subatomic particle which has no charge. The sealing and covering of skin with an oily substance to prevent moisture loss. Female hormone. Process which involves leukocytes adhering to vessel surfaces during the inflammation of a wound. Procedure used to improve skin texture and appearance. The passage of substances through the skin into the dermis and blood system.
Mitosis Molecule Neutron Occlusion Oestrogen Pavementing Peels Percutaneous absorption
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Glossary
Periodic table Phagocytosis Photoageing Pigmentation Polymer Progesterone Protein Proton Recessive genes Sebum Sorbitol Stratum corneum Strae gravidarum Substantive Surfactant Testosterone Vitiligo Wound healing
Table representing the nature and order of atoms. The engulfing of foreign material and debris by leukocytes during the inflammation stage of wound healing. Changes promoted by exposure to sunlight and UV rays. Skin colouration. Chemical compound or mixture of compounds consisting essentially of repeating structural units. Female sex hormone. Compounds of amino acids. A subatomic particle which carries a positive charge. Less influential genetic factors. Oily substance which is a mixture of fat and the debris of dead fat-producing cells. A mild humectant. The outermost layer of the epidermis and the bodys major chemical and mechanical barrier. Stretch marks which occur when skin growth cannot keep pace with body growth (for example during pregnancy). Ability to attach strongly to a substance. Detergents used in a number of shampoos to clean or degrease hair. Male hormone. Unpigmented skin. 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
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Service Industries Skills Council, 2005 This work is copyright, but permission is given to trainers and teachers to make

Information about this learner guide

What you will cover in this section

Figure 2 Stages of Mitosis in an Animal Cell

Two Cells Late Telophase Early Telophase Late Anaphase

Hormones and Skin Growth and Development

Ageing, Wound Healing and Beauty Therapy

The Function, Formation And Behaviour Of The Major Skin Chemicals

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

Age Related Hormonal Change and the Skin

The Effects of Drugs and Hormone Therapy on Skin Physiology

Learning activity A1.2

200 Skin depth,

10-5 100 300 500 Skin depth, 700 900 1100

Bioavailability Biological Activity

Non organic oils (those which have no carbon):

Learning activity A1.3

Discuss your findings with your trainer or supervisor.

What you will cover in this section

Atopic Eczema/Atopic Dermatitis

Contagious skin disorders

Disease Impetigo contagiosa

Causative Agent Staphylococcus aureus Haemolytic streptococcus

Treatment Antibiotics and lancing.

Treatment Anti-bacterial (diluted tea tree oil). Not in eye area.

Fungal Infections of the Skin

Tricphyton T.mentagrophytes T.interdigitale T.rubrum

Pityrosporm ovale P. orbicularae

Type 1 Herpes Simplex Cold Sores

Role of the Beauty Therapist

Remove Curette Diathermy Radiotherapy Surgery

Learning activity B1.1

Learning activity B1.2

Promoting skin health and care

Learning activity B2.1

Abscess Acne Adrenaline Ageing

Alopecia Androgen Anti-oxidant

Elastin Electron Element Emollients Endocrine glands Enzymes

Mitosis Molecule Neutron Occlusion Oestrogen Pavementing Peels Percutaneous absorption

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