can I treat cholesterol deposits and milia with peels and daily care?

Cholesterol deposits are fatty-looking, slightly raised plaques in the skin near the eyes. They are either just below the eye or, more commonly, in the upper eyelid near the inner corner of the eye. The medical term for these is ‘xanthelasma’ (pronounced zan-thu-laz-ma). They usually appear gradually, are not painful, tender or itchy. They are not dangerous, because they do not turn into cancer and they do not affect the function of the eye or the eyelids. They look fatty, because that is what they are. They are collections of cells called histiocytes, bulging with fat (usually cholesterol). In some people xanthelasmas can be indicative of a raised level of harmful fats in the blood, such as high cholesterol, and the physician may recommend that the patient have their cholesterol levels checked. The only sure way to get rid of xanthelasmas is to have them removed surgically. This could be risky in the delicate area near the eye, so should be performed by a qualified surgeon.

Milia (also known as milk spots or oil seeds) are very common, benign, keratin (protein)-filled cysts within the sudoriferous (sweat) glands that present as whitish, pearly bumps on the skin, usually across cheeks, nose, chin or gums, but milia can occur anywhere on the body. Sometimes milia are caused by trauma, such as deep laser treatments, which can cause damage to the sweat glands. Milia need to be extracted either by a physician or in some cases a licensed aesthetician. Many times a topical retinoid is required for at least two months before extraction can take place.

PCA SKIN^® has daily care products that can help with milia, but if you are prone to them, they may continue to appear. The products that are recommended for daily care use are: Clearskin, any one of our vitamin A products: Retinol Renewal with RestorAtive Complex, Intensive Age Refining Treatment: 0.5% pure retinol night, A&C Synergy Serum, Intensive Clarity Treatment: 0.5% pure retinol night; Gentle Exfoliant may be used weekly as well. If the milia are located on the eyelids or very close to the eyes, then consult a physician before using products that can get into the eyes. Alpha hydroxy acid-based peels will help to keep the skin exfoliated; however, do not apply peels to the delicate eye area. Treat once a month with peels appropriate for skin type.

    

frosting and blanching: understanding the difference

Many times these terms are used incorrectly by clinicians, and it is important to understand the difference.

Superficial frosting is a crystal residue of salicylic acid that accumulates on the surface of the skin and can be wiped away.  Although it is very fine in texture, these crystals can be seen when using Jessner’s solutions, the PCA Peel^® formulas and solutions containing salicylic acid. Many times the crystals are so fine they are barely visible to the naked eye, but they will fluoresce under a Wood’s Lamp, which makes it helpful to check for even application of the peel formulation.

Protein coagulation, also referred to as blanching usually occurs from deeper peeling, such as medium depth or deeper. A full-face blanch may be performed by physicians to treat deep wrinkling or scarring, but should not be performed by skin care clinicians who are not physicians or working under the advisement of a physician. Blanching of this nature will result in open skin and a physician-recommended occlusive lubricant should be applied to keep the area protected and moist.

On occasion, spot-blanching may occur when any peel has penetrated more deeply in areas where the skin is more sensitive (a patient may forget to inform the clinician of a recent waxing) or where an extraction was performed.  This area will appear very red initially, and then appear white.  This cannot be wiped off, as with frosting, and may or may not cause discomfort to the patient.  Advise the patient that they may peel more and will probably have some darkening at the blanch site, and to keep the area hydrated, use SPF and do not pick or pull at any exfoliating skin.

Keep in mind that if a patient’s peel penetrates deeper in specific areas, those areas will have a pH closer to blood (7.3-7.4) than intact skin (5.5).  Products must be chosen carefully to accommodate for this change in pH.  Once the area is re-epithelialized (approximately 48 hours) the patient may introduce Hydrating Serum and Silkcoat Balm^®. To create an environment that can effectively produce natural moisturizing factor (NMF).  Patients who experience minor surface blanching may continue using the PCA SKIN^® Post-Procedure Solution.

Summertime Clues

Ok, so it’s only the beginning of March, and you’re probably wondering why we are posting a blog about summer treatments….  Well, in a few months, the weather will be warming up, and your patients are going to be planning their summer vacations.  Sometimes chemical peels aren’t always the best type of treatment this time of year, mainly because it’s important to stay cool after a peel.  As a clinician, you need to be planning ahead in order to maintain the health of your patients’ skin and practice revenue in the commonly slower summer months.

Start talking to your patients about their vacation plans.  This way you can begin to plan treatments that will maintain their skin health and minimize any treatment risks.

Treatment masks are a great alternative to chemical peels during the summer months.  Masks are typically removed so there is less time on tissue.  As a result, they don’t penetrate as deeply.  Enzyme masks, such as pumpkin or papaya, work to dissolve keratinized skin cells on the surface of the skin; salicylic masks are also keratolytic, but salicylic also assists with sebum regulation and keeps the pores clear of debris.  Retinoid masks will assist with cellular turnover, pigment control and collagen production.  Clay-based masks help to detoxify the skin and refine pores.

If masks are not an option for some reason, consider an antioxidant treatment.  Summer brings increased UV exposure and increased pollution, which results in an increased need for antioxidants.  You may consider having patients come into your practice for one of these specialized treatments once a week.

Another thing to consider is to make sure your patients have enough daily care and SPF product to last them through any long-term vacations.  Many times patients will leave town, or even leave the country, and then call you in a panic because they are out of product.  Shipping costs may escalate depending on where they are, so they will appreciate your reminding them to order ahead which will save them the extra expense.

Our patients depend on us to keep their skin healthy…. Impress them by planning a couple of months ahead!

why doesn’t PCA SKIN recommend using acetone to prep for a peel?

To maximize the penetration and benefits of a chemical peel, peel solutions must be applied by a physician or licensed professional onto clean, degreased skin. As a strong and biocompatible solvent, it would seem that acetone would be a good choice for this purpose.  Although this is the selected method for some, acetone used prior to chemical peeling removes not only the excess sebum that could impede peel penetration, but it also removes an unnecessary amount of the essential cholesterol and lipids from the skin. This tends to leave the skin over-stripped and dry post-procedure, and in the weeks following treatment. A more gentle, yet highly effective option is Smoothing Toner.

PCA SKIN recommends Smoothing Toner to our Certified Professionals, as it is an exceptional choice for preparing skin for the application of any of the PCA SKIN peel solutions. After cleansing with Facial Wash Oily/Problem, this lactic and citric acid-based astringent gently removes any remaining debris or sebum that could reduce the penetration of the selected solution. This method has not only delivered excellent results for over 20 years, but it is a much more pleasant experience for the patient. Acetone is not an unsafe choice, but the dramatic removal of lipids from the skin can be uncomfortable on the skin. With peels that can be performed as frequently as every two weeks (depending on skin condition), an enjoyable treatment experience is obviously preferable. Achieving healthy, beautiful skin depends not only on the daily care a patient uses and the professional treatments you apply, but also relies on the compliance of the patient to return for their scheduled appointments.  Making your treatments pleasant as well as effective will help you deliver for your clientele.

why do I need to stay cool after a chemical peel?

PCA SKIN recommends remaining cool for 48 hours post-peel… buy why?

The epidermis is comprised of several layers known as the basal layer, squamous layer, granular layer and the cornified layer.  When a chemical peel is applied, even if it’s very superficial (stratum corneum only), it can cause a separation of these layers.  If your patient sweats for any reason, either from a work out, getting into a hot vehicle, playing golf or sitting on the patio, water can become trapped between these layers, which can lead to blistering.  Blistering can then cause hyperpigmentation, depending on the severity.

Another reason for staying cool is that internal heat can also lead to hyperpigmentation, which is especially a concern for those with melasma.

Many clinicians choose alternative treatments during the summer months due to the increased chances of thermal heat or sweating.  Others will offer chemical peel treatments later in the day, so the patient has less UV-exposure than they would at an earlier time.

Get to know your patients’ lifestyles, workout schedules, jobs (in case they work in a hot kitchen), and even their vacation schedule.  Taking note of this will enable you to treat their skin accordingly and avoid any heat-related complications post-treatment.

put your best face forward

Although the skin health industry faired better than many in the great recession, plenty of practices felt the pinch of patients holding on to – or losing – their disposable income. As consumer confidence and spending starts to rise, be sure you are maximizing your business’s exposure to bring those patients back, and for them to bring their friends.

The number one marketing tool for your skin health business is your own skin.  Your own beautiful, healthy skin shows your patients that the treatments and products you provide actually work.  Many clinicians started in skin care out of a desire to ‘fix’ their own skin.  If you were one of those people, have a picture of yourself before you resolved your skin challenges on hand to further illustrate the success that you could help them achieve.

Often, as professionals, we neglect ourselves in the rush and fervor of taking care of others.  If this is the case for you, now is the time to make a change.  Give yourself your favorite PCA SKIN professional treatment or trade services with a colleague.  It is important to put the same effort into your own skin as you do for others’.  And, the positive marketing side effect will naturally follow. The holidays are almost upon us, so be prepared!  Feel free to call us for answers to your questions or for suggestions to help your skin health business grow.

teens and chemical peels

Chances are you have young clients who are concerned with their skin.  Typically, teens want help with acne and breakouts.  Daily product use is essential, but what about chemical peels?

Breakouts can begin as early as age 11 and continue on into adulthood.  When parents bring their teenager in for a peel, it is recommended to get their consent and, if necessary, the permission of their physician or pediatrician.

Another concern is the child’s lifestyle and how compliant they will be with SPF use – especially after a chemical peel.  Also, if the child is involved in sports or PE class in school, they are likely to work up a sweat.  It is recommended to stay cool within the first 48 hours post-treatment, so this could be a concern. 

Clay-based, salicylic and enzyme masks are a great alternative to peels for treating teens.  Masks are removed resulting in less time on tissue than peels, and they don’t create as much visible exfoliation, which can also be a concern for teens.

When treating our teenage patients, dig a little deeper and ask a lot of questions.  This way, you will be able to provide the best treatments based on their unique needs and lifestyles.

the best in pigment control is now even better

The best in pigment control is now even better. We have enhanced our long-standing formulations with the addition of phenylethyl resorcinol for added brightening benefits and glutathione and silybin for antioxidant properties. These additions to the synergistic combination of lactic, kojic and azelaic acids and hydroquinone (only in the formuation with hydroquinone) provide unsurpassed lightening benefits, added cellular protection and reduced potential for irritation. It seems patients are always searching for that one miracle product that will cure all of their skin challenges. Unfortunately, it is almost impossible to address any skin condition with one active ingredient or one product. Hyperpigmentation is an excellent example of a skin condition that typically requires the use of multiple ingredients and multiple products for visible results.

The process of melanogenesis is a chain reaction that involves many separate actions. By using a combination of several ingredients that interact with different portions of this chain reaction, results can be achieved faster. We know that hydroquinone, arbutin, undecylenoyl phenylalanine, phenylethyl resorcinol, and kojic, azelaic and lactic acids inhibit melanin production in different ways, making them all important for different reasons. Unfortunately, it is impossible to formulate one product that contains all of these beneficial ingredients. Because of this, it is best to use a variety of ingredients in multiple products to clear hyperpigmentation.

 

Pigment Gel® and Pigment Gel® HQ Free are acidic products that contains ingredients with small, hydrophilic molecules that effectively target hyperpigmentation in the upper epidermis. The acidity of these products is designed to encourage exfoliation, which is also important to the pigment-lifting process. Conversely, Brightening Therapy with TrueTone is comprised of lipophilic molecules that are able to penetrate deeper into the skin. Because these two products penetrate into varying layers of the epidermis and interact with both the aqueous and lipid environments, they work in perfect combination.

Daily care products, such as Brightening Therapy with TrueTone, A&C Synergy Serum, Pigment Bar and Pigment Gel®, safely and effectively fade existing hyperpigmentation and inhibit future melanogenesis. In-office treatments, such as Sensi Peel® or the appropriate PCA Peel® can be used to accelerate results and provide added lightening benefits.

the power of pumpkin

This time of year, the thought of pumpkin is typically visions of pie.  Aside from is role in holiday desserts, this nutritious and delicious vegetable is also great for your skin. The natural enzymes found in pumpkin have excellent keratolytic properties and help release impacted cells from the stratum corneum, leaving the skin smooth and soft.  This is especially important in the winter months when colder temperatures and lower humidity can leave skin dry and flaky.

In the exfoliation of the skin, enzymes function differently from acids. Alpha hydroxy acids exfoliate by dissolving the bonds (desmosomes) holding cells together, while enzymes work by cleaving the bonds between amino acids that make up proteins.  Exfoliation with enzymes is typically a more gentle process than with single acid peels, and highly effective.

In addition to the excellent surface-smoothing action provided by its enzyme component, pumpkin is also a rich source of vitamins A and C, and a host of other beneficial nutrients.  Treat yourself and your patients to a professional pumpkin mask.  The result is smooth, glowing and healthy skin.  Find these ingredients in the PCA SKIN Pumpkin Peel Treatment. This treatment is especially good for acneic, breakout-prone patients or those with sluggish, dull complexions. Pumpkin Peel Treatments are a great choice for the holidays, and for healthy skin.

hydrate your skin with a chemical peel, really?

Yes, really. Unfortunately, the words ‘chemical peel’ often conjure images of a less than pleasant experience that leaves behind redness, irritation and downtime.  With the right treatment, performed by a trained professional, this outcome is not necessary.  Instead, your skin can be smooth, hydrated, healthy and glowing with no downtime at all.

One of the best ways to ensure that your moisturizers and other treatment topicals are able to penetrate into your skin to provide their intended benefit, is to minimize the amount of impacted skin cells that are lying on the surface of your skin.  A gentle blended chemical peel can do just that. Now, if it is just the removal of the dull surface layer that is the goal, that can also be accomplished with scrubs, enzymes, microdermabrasion and other exfoliation techniques.  The unique action of a well-formulated chemical peel is that it simultaneously releases the impacted surface layer while delivering hydrating, collagen-stimulating, strengthening and brightening ingredients into the skin.  This leaves skin healthy and hydrated.  Once the skin is free of the dull surface layer, any products applied topically will penetrate more efficiently to allow the skin to receive maximum benefits.

All of the PCA SKIN blended TCA peels are excellent choices for brightening, smoothing, strengthening and hydrating the skin.  There is an option for all skin types, Fitzpatrick type and skin challenge.  Sensi Peel(R), Ultra Peel(R) I and Ultra Peel(R) Forte are all excellent choices.  Call us for more information about our unparalleled chemical peels, and our educational opportunities that can prepare licensed professionals to be PCA SKIN peel experts.