Skin Conditions Archives - Page 2 of 2

What Does a Compromised Barrier Look Like?

When we have a compromised barrier function our skin becomes more vulnerable to external attacks from things such as pollution, pathogens, microorganisms, the weather etc. It also loses the ability to hold onto the natural hydration in the skin. This hydration is vital to keeping our skin healthy, inflammation down, and its ability to fight attacks from those external forces. Our overall cellular functioning throughout the skin also requires moisture, and I always find a more hydrated skin is more tolerant to most things especially active skincare.

So what are the symptoms of a compromised barrier function? I have listed these below, this list is by no means exhaustive but these are the most common signs.

Skin tightness (constant/after cleansing)
Flaking, dehydrated skin
Oiliness combined with flaking/tightness
Redness or sensitivity
Dullness
Breakouts
Under the skin bumps/spots
Premature ageing
Dermatitis

Desquamation

I thought it was important to mention this as this process in the skin can be dramatically reduced due to our barrier being disrupted. The process of desquamation is the natural shedding of those old skin cells on the surface of the skin to allow for the cycle of the epidermal cells to keep going. Our epidermal cells start off at the base layer of the epidermis and move up, as they do this they become hardened and more resilient to allow for the protective ability needed at that top layer. Once they have reached the top, a chemical process dissolves the bonds between these cells to allow them to shed off and become house dust. This chemical reaction requires moisture to happen, and if our barrier is impaired we lose that all-important moisture and the desquamation process is affected. This results in our skin looking dull, flaky, and our whole epidermal skin cycle slowing down.

What can impair your barrier function?

You might have read the list above and thought that your skin is experiencing some of the signs of an impaired barrier, but what might be causing it?

Below I have listed a few factors that can cause the skin to become compromised, again this is not an exhaustive list but if you feel you are currently suffering from the symptoms it is always a good idea to get professional advice.

Over-exfoliation
Incorrect cleansing products
Sun damage
Pollution
Cold weather/wind
Hormones
Stress
Smoking
Diet
Dry atmosphere
Medication
Diet

As you can see there are many elements that can affect the resilience of our skin, and we probably encounter more than one of these on a daily basis. Our skin is designed to cope with a lot and sometimes all that is needed is to maybe just stop using a certain product and leave your skin to repair and rebuild on its own, other times it may need help. I have included a few products below that are my go-to remedies for compromised skin. But remember this is a general recommendation and without a skin assessment you won’t get individual advice.

Dermaviduals DMS Cleansing Milk

I see so many compromised skins due to incorrect cleansing products used, so your cleanser is the foundation of your skincare regime and a big player in the integrity of your barrier. The Dermaviduals cleanser is gentle, effectively removes makeup and impurities without negatively affecting the skin. There is nothing in this cleanser that the skin doesn’t recognize or that can upset the protective element of the skin.

Skin Omegas

Our skins natural lipids are made up of these essential fatty acids, so adding these supplements into your diet will help keep those lipid levels high and your lipid bilayer making up the skins barrier function nice and strong.

Byonik Supreme Seal

This product is a must for repairing barrier disruption. Containing a high content of ceramides, fatty acids and cholesterol that make up our barrier lipids. It reduces that water loss and restructures the skin’s barrier. It’s also a great product for healing conditions such as eczema and dermatitis.

Byonik Concur Cream

Another product full of those essential lipids, the Byonik anti-pollution Concur cream Contains repairing, healing, and hydrating actives as well as the powerful anti-ageing peptide Matrixyl Synthe 6 promoting the production of collagen, elastin and the all important Hyaluronic acid for hydration.

These are just a few of my recommendations for compromised skin, but my advice is to always see a professional that can give you individual recommendations for your skin and investigate why your skin is behaving the way it is.

To make an appointment to see myself please click here, I offer virtual consultations during lockdown or for anyone that cannot get into clinic to see me. If you are interested in purchasing any of the recommendations above please email me here.

Thank you for reading

Rebecca x

Are those black dots on your nose really blackheads???

The quick answer is probably not.

A couple of nights ago I posted a photo on my Instagram of a client’s sebaceous filaments on her nose before and after extractions and asked whether people knew that these weren’t blackheads. I got an astounding response asking to know why they weren’t blackheads. This is a familiar confusion I get on a regular basis with clients wanting to “get rid of the blackheads” on their nose.

So let me tell you a little something about those ‘blackheads’ on your nose…they are not blackheads, they are in fact sebaceous filaments.

And here’s the difference:

Sebaceous Filaments

The nose is one of the places on the face that usually produces the highest levels of oil (sebum). Over time these pores become more enlarged due to the constant production of the sebum and the slow degradation of the skin’s structure reducing the ability to keep them tight. For example, if you look at a child’s nose you won’t see a visible pore, this is because their adolescent hormones haven’t kicked in to start producing higher levels of oils and their collagen is probably the best its ever going to be keeping those pores so tight they are invisible!

Our pores produce sebum as part of the protective acid mantle and to help keep the microbiome healthy, this sebum flows out of the pore onto the skin’s surface. When the sebum reaches the opening of the pore it becomes oxidised and changes from creamy colour to dark grey-black. This is where the mistake in thinking they are blackheads happens.

Blackheads

The technical name for blackheads is open comedones. These can be found anywhere on the face but are usually spread out or maybe just a random one here or there. These are a blockage of the pore/follicle and are caused by a build-up of sebum and skin cells within it. The black colour of them again comes from the oxidisation. If you run your finger across a blackhead you can sometimes feel a slight lump under the skin and these are usually bigger than a sebaceous filament.

So that is the difference between the two, but I know what your next question will be…how do I get rid of them?

So blackheads we can extract and hope they don’t return, this will require actives within the skincare such as salicylic acid or mandelic (always seek advice). But sebaceous filaments, like I said are pores that have a constant flow of sebum from them, they are a natural part of a healthy skins functioning. Also, pores are not doors, so you cant open and close them. What can help improve their appearance is using actives to help control sebum production, such as Retinol, and trying to improve the structure of the skin to tighten them a little…but they will never disappear (this is a good thing).

If you need help with any issues regarding large pores, blackheads or any other concern please get in touch. Even if you are not local to me I can still help virtually. To contact me please either email me here or my book online to see me in clinic or a virtual consultation here.

Thanks for reading.

Rebecca x

Are you suffering from ‘Maskne’?

So over the past couple of months under lockdown, I have had a few people get in touch that are working either on the front line or in a place of work where they need to wear a face mask. The issue a lot of these people are getting is their skin is breaking out. Even if they aren’t prone to spots, some have never had a spot in their life but the constant wearing of these face masks are causing them to get consistent breakouts.

The condition that is being caused by these masks is what we call acne mechanica. This type of acne is caused by the friction and heat from wearing the mask for long periods of time, even if you are not prone to acne or have an existing condition. If you are wearing make-up under the mask this can exacerbate the condition causing the pores to clog up even further. If your skins natural barrier function is compromised this may cause you to be more prone to having this condition. The condition presents as papules or pustules and may even progress to the more severe cysts that are a characteristic of grade 5 acne.

To treat acne mechanica, our first approach would obviously be removing the trigger, which in this case would be the face mask. This is not possible in most cases at the minute and may not be for many months or even years to come if you are working within the NHS. Many people may reach for the harsh acne fighting products, but this is likely to cause more irritation and impair the barrier function further.

My approach here will be initially to repair and support the barrier function and work on reducing the infection. I would start slow and gently to not cause any further irritation from skincare that is too active if you have a busy skincare regime you may need to step it back a little. A gentle cleanser that is going to cleanse the skin effectively yet support the barrier function, remember we don’t want a squeaky clean feeling from our cleanser, this is an indication of dehydration and a compromised skin. A hydrating non-comedogenic moisturiser, I always recommend Dermaviduals, their approach in treating the skin via the principle of corneotherapy is perfect for this skin condition. My go-to acid would be a low % salicylic acid initially; this is an oil-soluble acid that will gently clear out the pores and help to reduce any inflammation.

Avoid wearing make-up at times when wearing the face mask, this will just add to the clogged pores and make the ‘Maskne’ worse. Changing your mask frequently will also benefit the skin, once the mask gets damp this is the perfect breeding ground for bacteria.

Once you have finished your shift or period of wearing a mask, give your skin a good cleanse to remove any bacteria or excess skin cells hanging around.

I hope if you are reading this and suffering from ‘Maskne’ you found it useful, if you feel you need a little more support and advice on your skin please don’t hesitate to get in touch. My online consultations are free until the 4^thJuly and you can book one here, we can discuss your skin concerns and get you on the road to beautiful skin!

Treating Dehydration

In my previous post, I discussed that the most common reason for dehydration was a compromised barrier function. So initially this is what we want to focus on and restore. Once the barrier has been restored the skin will be able to hold the moisture within the skin and prevent trans epidermal water loss (TEWL).

Most people will go straight to products containing Hyaluronic acid to solve dehydration but this alone will not be enough.

The first thing to look at is your cleanser. These can be the main culprits, especially in clients with oily or acne skins. I find these clients tend to be after that squeaky clean feeling, but this tight, clean feeling we get after cleansing can be a sign of dehydration. Our cleansers need to be gentle but effective, not stripping, and maintain the skins natural PH. If your cleanser is giving you the tight feeling then its time to change!

Exfoliation is also a biggy. How often, what type, and the strength of your exfoliant is important to get right. Exfoliation and acids are a big thing at the minute with some skincare brands focusing on just that. However, if we go back to the barrier function we don’t want to overdo it and take off those layers that are part of that lipid bilayer within the stratum corneum. Exfoliation advice is as individual as you are so speak to your skincare professional who will advise you on how much your skin needs.

Hyaluronic acid is usually the go-to for dehydrated skin. However, don’t rely solely on this products to solve all your problems. In fact, in some cases, it can make those problems worse. Don’t get me wrong I love HA but under some circumstances, it’s not my immediate go-to active. HA is a humectant, which means it draws moisture in from where it can. This is great if you’re living in a humid environment, but if you’re sat at home or in an office with central heating or air-con, these create a dry environment. In these conditions what HA will do is draw up the moisture from the dermis into the epidermis, and that then maybe evaporated out of the surface with the rest of the moisture.

If we get our barrier function nice and strong and our environment isn’t too dry (turn down that thermostat) Then this active will definitely be on the list as a hydrator. HA can hold up to 1000 times its own weight in water, so get the above right and your skin will not only thank you but look dewy, fresh and plump all at the same time.

Avoiding occlusive products. Our skin needs a certain level of trans epidermal water loss (but not too much) to allow for more to be produced in the lower layers. If we use creams that are too occlusive this creates a barrier for that TEWL and our skin stop producing its own levels of moisture.

Diet. We can get extra moisture within our diet but this may not necessarily reach your skin. So up your water intake, it’s not the most effective way to hydrate your skin but what it will do is help drain out those toxins from the body and create healthier skin. It is also important to include the essential fatty acids within the diet, oily fish, avocado, nuts etc. all contain these or get extra through supplements. These EFA are components of our lipid bilayer, which makes up our barrier function.

Avoid any foods that will cause inflammation, and this may vary from person to person. But higher levels of inflammation can have an impact on how our body and skin functions. It can impact on barrier function, the natural production of hyaluronic acid, and how each and every cell in the skin functions.

So as you can see automatically reaching for the Hyaluronic acid will not solve all your problems when it comes to dehydration, it’s a case of combining all of the above to get you results.

Are you feeling dehydrated? or not sure what’s happening with your skin, and need help? I am offering FREE online consultations during lockdown so click here to book and we can get you on the track to hydrated, healthy, happy skin

Are you Dehydrated?

Dehydration is one of the most common conditions I see in my clinic. I would say 95% of new clients that come in to see me display varying degrees of dehydrated skin.

This condition can sometimes be confused with dry skin, but it is very different. Dry skin, I normally refer to as Lipid Dry skin, is a skin ‘type’ rather than a condition. So you would have been born with dry skin and it is usually genetic. A lipid dry skin is a skin lacking in the right levels of lipids and secretions (sebum). Dehydrated skin is a skin lacking in moisture. You can be both lipid dry and dehydrated or in fact any skin type, for example, oily skin can be dehydrated. Dehydration is a condition, which, the good news is it can be resolved

How does a dehydrated skin look?

The appearance of dehydrated skin is normally a dull, lacklustre complexion that can feel rough to touch. It is also common to get a tight feeling once you have cleansed like you need to apply your moisturiser to relieve it. So dehydrated skins can have an issue with closed comedones, small spots that lie under the skin. This can be due to the fact that the skins natural desquamation (shedding) process has become sluggish due to the low levels of moisture. The chemical reaction that happens within the skin to allow those top layers of skin cells to shed and become house dust needs moisture to happen.

The most common reason our skin can get dehydrated is due to a compromised barrier function. When our barrier is compromised it is incapable of doing one of its main functions; keeping the moisture within our skin. This moisture loss is referred to as trans epidermal water loss (TEWL) and even though we need a certain amount of TEWL to keep the cycle of the skin producing moisture going when we lose too much the skin can’t keep up in making enough to replace what is lost.

Reasons we may get a compromised barrier function

Harsh/unsuitable cleanser
Over exfoliation
Environment e.g. central heating
Inflammation
Medication/illness
Menopause
Using occlusive products

It is important to correct dehydration as left to prolong can go on to cause further issues, such as sensitive, reactive skin, further inflammation, congestion and even premature ageing. In my next blog, I am going to discuss how we can treat dehydration, but in the meantime, if you are reading this and it sounds familiar you may be suffering from dehydrated skin, a consultation with myself would confirm this. My online consultations are free of charge whilst on lockdown so click here to book yours today!

April is Rosacea Awareness Month

What happens in a Rosacea skin?

Rosacea is an inflammatory skin condition and is defined as facial erythema. This normally presents on the central face area and can display as diffused redness, telangiectasia (visible capillaries) with a blue undertone, small bumps and pustules and in extreme cases Rhinophyma (bulbous nose).

Our bodies have an innate immune system that kicks in the defence mechanisms when needed. In rosacea skins this immune system can be in a constant state of high alert, so the slightest thing can trigger the inflammatory response. Imagine an overly sensitive car alarm that goes off when someone walks past it.

Rosacea skins also have problems turning off the inflammatory response. The specialised enzyme responsible for turning off this response in normal skins doesn’t always happen in the skin with this condition. Therefore the skin is in a constant state of inflammation. Over time this can affect our barrier function making it compromised and the skin even more reactive and sensitive, so exasperating the condition.

Symptoms of Rosacea:

Persistent redness
Telangiectasia (visible capillaries)
Skin feeling hot to touch * Red, bumpy appearance, sometimes shiny
Sore and sensitive skin

Rosacea Triggers

So with Rosacea being an inflammatory skin condition, anything that causes inflammation or vasodilation within the body, or further compromises our barrier function can increase the skin’s reactivity or cause a flare-up of the condition.

Here are a few of the common aggravating factors that can cause the skin to worsen. Note: all skins are different and what aggravates one rosacea skin may not aggravate another so below ore just examples of common factors.

Hot foods
Spicy foods
Alcohol
Exercise
Sun exposure
Changes in temperature (hot-cold)
Saunas
Incorrect skincare
Stress

A lot of these factors are stimulants that either causes inflammation or vasodilation of the blood vessels. Add a few of these factors into a skin that is already super sensitive can cause it to flare up.

I always recommend keeping a skin diary to record everything you have eaten that day, what environment you have been in, what your mood/stress levels are, and how your skin has been that day. This way we can pinpoint anything that stands out as causing a ‘bad skin day’ and remove from your diet or lifestyle if possible. There’s is no point in trying to treat the skin from the outside if there are still many aggravating factors happening from the inside.

Rosacea Treatments

There is no definite cure for Rosacea but it can be managed. Most of the management of the symptoms will be down to you at home, but of course under my guidance and I am always here for my clients to be able to get in touch if they need me.

The following points will help you manage the condition

Know your triggers- this will usually involve a skin diary to record your eating, lifestyle, mood, and environment, and to make a note of how your skin has behaved the day. This allows us to work out any triggers and aggravating factors.
Skincare – With this, we will work on a seal before we heal principle. The barrier function will be the focus initially and working on restoring this with your home care, this will reduce any unnecessary sensitivity that may be making the condition worse.
Take it slow- this applies to the skincare regime. So I will not be prescribing you a full regime to start with it will just consist of a couple of products that we can then add to as the skin shows us it can tolerate those. This way it makes it easier to identify what active your skin doesn’t like.
Sunscreen???? so in normal cases, sunscreen will be a staple product in your skincare regime. However, I have seen in some Rosacea clients that the sunscreens can sometimes irritate the skin exasperating the condition. I might not always start you on sunscreen until your skin is showing signs of improvement and this might then just be a trial to see if it can tolerate it.
Try to act early- don’t leave the condition to get severe before seeking out help.
Treatments- LED is one of the most effective treatments on the market for this condition. It helps to strengthen, calm, reduce inflammation and increase hydration.
IMPORTANT – Be patient. This is a condition that is constantly unpredictable. It can be a case of trial and error as every skin and every rosacea skin is different. Listen to your skin, treat it with care, be consistent but patient. Results don’t come overnight, and it is more important in rosacea skins than any other that we work progressively to try and make a change.

If you are dealing with any of the symptoms above and would like some help in managing the condition, get in touch. My online consultations will help me understand your skin in order to create you a skin regime to manage your symptoms, Click here to book yours.

And once we can all get back to work it would be lovely to see you in clinic for a full skin analysis.

Rebecca x

Frequently Asked Questions…

So we are in self Isolation due to Covid-19 and I thought I’d asked on my Instagram Stories for any questions relating to skin and skincare. If clients can’t come to me then I can still help virtually. Here are some of the questions I got asked:

My skin feels really tight once I have cleansed, why is this?

This is a sign that your skin may be suffering from dehydration. I would normally have a look at the cleanser you are using, as this can be the culprit. Many cleansers can be too harsh for the skin and disrupt the delicate barrier function and acid mantle so resulting in the skin becoming compromised. Once the barrier function is compromised we get something called Trans Epidermal Water Loss, where we lose the natural moisture levels within our skin as they escape through the compromised barrier.

If our skin is dehydrated this has a knock-on effect to all the skins functioning. All cellular functions within the skin need moisture to happen, so if we are lacking then our skin is not functioning to the best of its ability. This can eventually result in issues such as sensitivity, reactive, inflammation, problematic skin and premature ageing.

To remedy this see a skincare professional that can advise on how you can restore your barrier function and hydration levels.

2. I have always thought I am an oily skin type but I get flakey patches too, does this mean I’m dry?

It is really important to know your real skin type to be able to treat and use products correctly, so a skin care professional can help with this. However, if you are an oily skin type but are getting dry, flakey patches on the skin this again can be a result of dehydration. Our skins natural desquamation process (shedding) needs moisture to happen. If our skin is lacking in moisture the chemical reaction that takes place when those top layers of the Stratum Corneum (top layer of the epidermis)are ready to shed will not be able to effectively break those bonds between the skin cells allowing them to come off. A result of this would be old tired skin cells still hanging on to the surface of the stratum corneum causing flakey patches and a dull appearance to the skin.

3. I have always had problematic skin (acne), I have tried everything, will my skin ever get any better?

The majority of acne is caused by hormones, it can usually be managed and improved but it may never completely go. I see many clients with this problem and there are usually underlying issues. A common one is stress, this can increase the level of hormones that are connected to our sebaceous activity. I recently wrote a blog on psychology and the skin which talks about this issue click here to read.

What I do see with clients that have problematic skin is their skincare regime is usually all wrong for their skin type which is exacerbating the acne condition, so once we get them on the right products they start seeing improvements pretty quickly.

4. I get little bumps/spots under my skin what can I do for these?

Without analysing the skin it’s a difficult one but it does sound like the skin is crying out for a little exfoliation. Sometimes when our skin doesn’t desquamate itself very well it needs a little help. There may be a blockage of skin cells within the pores that are causing this bumpy rough texture. Feeding our skin with extra hydrating products also will help keep the skin working and functioning well, including that natural shedding process that has probably become sluggish.

5. Should I exfoliate my skin at home, if so what should I use?

This is a great question at a time when I am seeing so many skins over exfoliated. The frequency that you should exfoliate is individual to your skin type and condition, but there are not many clients that I tell to exfoliate daily, however, I see this happening a lot.

The best types of exfoliators are AHA or BHA exfoliators, my favourite being Lactic Acid or Salicylic for more oily skin types. The way these acids work is by mimicking the chemical reaction that happens in our skin to desquamate our skin cells, this encourages that process and gently removes those old skin cells to reveal younger fresher cells of the Stratum Corneum.

If you are a lipid dry skin then I would recommend Enzyme exfoliators. Unlike AHA’s these do not break those bonds to release the cells, instead, they act like a Pac Man across the skin’s surface munching on any excess skin cells that are past their desquamation date. Lipid dry skins have a tendency to have a compromised barrier function and be quite fine and delicate. So we want to keep that Stratum Corneum intact and with a good thickness to maximise its ability to protect.

The Skin and Psychology

If you follow me on social media you will have seen that last weekend I attended Aesthetic Medicine Live Clinical Conference in London. One of the subjects talked about which really resonated with me was Skin and Psychology. The psychological impact of skin conditions really cannot be underestimated and in my clinic I often find myself on the front line of this.

Dr Raj Thethi, an aesthetic doctor from Leeds talked about a new concept ‘psychodermatology’ which refers to skin conditions that are linked to psychological health.

From very early on in our lives, in fact from just 2 weeks into conception there is a link between our brain and skin. The Ectoderm in the embryo forms the epidermal skin cells along with the nervous brain tissue.

This link with the brain means that our skin really can shows signs of what is going on in someone’s head. Psychodermatology looks at the links between skin problems that may be affected by stress or emotional states of mind, or psychological problems that have been caused by having a skin disorder.

In my consultations I will always ask the client about their stress levels or any factors that may contribute to stress, this is one of the main psychological factors that can have a big effect on the skin. If we have high stress levels we will get a rise in the Cortisol hormone within our body, this increases our Testosterone levels and results in more sebum being produced which in turn can cause spots and breakouts. This can then become a vicious cycle as the skin condition that has now manifested on the skin can have an effect on our moods and behaviour.

An example, if we have a look at the statistics for acne; 80-95% of adolescents suffer from acne. Acne and acne scarring have been directly linked to issues such as depression, suicide, anxiety, low academic performance, and even unemployment.

Dr Raj presented a case he had worked on recently, a client who had suffered with acne and eczema since the death of her brother. She had tried everything in terms of clinical treatments, dermatology, and medicine but to no avail. Dr Raj took on this client and gave her a combined treatment plan that not only included homecare products and clinical treatments but also psychological help. The result was clear skin!! Her conditions had completely cleared up! Not only that, you could almost see the improvement in the clients state of mind by just looking at the expression on her face in the after photo compared to the before.

“In a vicious circle, stress, depression, and other kinds of psychological problems can exacerbate the skin problems. The common dermatological issues that have been documented to be made worse by stress include acne, rosacea, psoriasis, itching, eczema, pain and hives, just to name a few.”

American Psychological Association

I often say the skin is the window to what’s going on inside and this couldn’t be more apparent after listening to Dr Raj on Sunday. I always take a holistic view when treating skin conditions, which not only includes lifestyle, diet, health, environment, but stress and wellbeing are big factors too.

Looking at peoples past and present is the key to getting the skin they want for the future. And once we start getting those results they begin to fall in love with their skin again and we break that vicious cycle.

If you are having issues with a skin condition please get in touch today, and lets get you started on your journey to your future skin.