Case Study 2 – Inflammatory Skin Condition

This gentleman came to me in September 2021 looking for help with his inflammatory skin condition that affects his forehead. He was using topical steroid treatment to keep the redness down. However, he wanted to no longer be reliant on the steroid cream.

After his initial consultation, where we looked at his triggers and overall skin health, we began working on barrier repair and reducing the inflammation. Some of the triggers were unavoidable, such as stress, his job can at times be stressful, and it was an extremely stressful period in his life that triggered the condition initially, so this would be a case of managing the condition whilst those triggering factors were still there.

He started his skincare regime very gradually, focusing on barrier repair and the in-clinic treatments started immediately. In the beginning, the treatments were fortnightly until the skin was staying consistently calmer, and we currently treat once a month. We are 6 months into his program, and his skin has made excellent progress. It no longer has the angry, red, dry patches and is much more tolerant of the triggers that would once flare the condition.

This gentleman is extremely happy with his results so far. He may have the odd flare-up now and again, however, through our education, he understands why his skin becomes red and is able to manage the condition better.

To squeeze or not to squeeze, what do we do about spots being squeezed?

Spots being squeezed

The subject on today’s agenda is acne and spots being squeezed. I get asked if they should be squeezed a lot, and since I’ve done several extractions this week I felt this is a perfect time to give you a little advice on this.

What do we commonly do with spots?

I realise the worst thing in the world is having to walk out the door with a great big whopping white head on your face. Not only does it look bad but it can affect your short term mental health, making it hard to enjoy your day.

So, what’s the alternative. Often it’s spending 10 minutes in front the mirror squeezing the hell out of said white head, removing all the pus with the hope of making it disappear. In truth, all you do is replace the spot with a massive, inflamed weeping crater that is equally as hard to cover up with makeup.

What causes a spot?

Spots are caused by several factors, including hormones, genetics and the environment. The most common cause is hormones and acne is often the result of too much sebum production in the skin. In simpler terms, acne is when the pores are clogged with oil and dead skin cells. These clogged pores are called blackheads or whiteheads. The bacteria in the skin then produce an inflammatory response which leads to redness, swelling and pus production.

In regards to spots being squeezed there’s no real medical benefit, but it’s just so hard to not want to squeeze the hell out of them.

What can we do?

So, what sort of spots can we get away with squeezing and which ones do we need to leave well alone?

If the spot is inflamed, red, painful, has no whitehead leave well alone. All you will do is make that area of your face sore and painful to touch. When I’ve squeezed these in the past, I find myself touching and poking it for hours afterwards to see if it’s weeping or still painful.
Small non-inflamed whiteheads are ok to have a quick squeeze. But make sure your going to go for it, get all the pus out. If it becomes inflamed leave it alone.

The Method

Ideally, we want to leave them all alone, but I realise this is near impossible for some, even me sometimes! So, here’s a few little tips to help you out if you’re an avid squeezer.

Wash your hands thoroughly before.
Cleanse the area.
Wrap tissue around the end of each finger that will be doing the squeezing or use the ends of cotton buds.
Place fingers either side of the spot, but not too close together. Almost like you are going to squeeze from underneath the spot.
Gently squeeze, not for too long, don’t cause too much trauma for the skin, DO NOT draw blood.
If anything comes out remove from the skin immediately.
If nothing comes out, walk away, it’s not ready and you will cause more issues trying.
Wipe over or hold a pad on the area with a tonic or product containing salicylic.
Do not apply makeup to the area for at least 4 hours.

Point 9 is very important. Most people try to cover up the area immediately with make up. But your adding dirt and grease back into the wound where the spot was, giving it all the ingredients it needs to regrow.

Blackheads

When it comes to blackheads, and I mean blackheads not sebaceous filaments (see the difference here) using the same methods, however, use your fingers to push down towards the skin rather than together. And again, if it doesn’t come out after a few attempts (a few not several) leave it to a professional.

Conclusion

If in doubt see a professional, I can guarantee with most, its our favourite part of our job! So, we welcome extractions a plenty. Thank you for reading, and as ever me or anyone at the clinic are here for any advice, just reply with any questions.

Case Study: Repairing the skins barrier function to help overcome anxiety

Repairing the skins barrier function to help overcome anxiety

This client first approached me in lockdown, so the beginning of her program was carried out virtually until I could see her in clinic. She had tried lots of different products on the market and her skin would never improve. She had persistent breakouts around her lower face and chin that were pustular and could sometimes become inflamed and itchy. She had a lot of anxiety over her skin which would exacerbate the condition.

Using the wrong skincare products

Down to using the wrong skincare, the skin was also presenting as dehydrated and compromised, the condition of her skin, due to this impairment and low hydration levels was making the breakouts worse, more inflamed, and slower to heal.

Repairing the skins barrier function

We initially worked on repairing the skins barrier function to help reduce inflammation and increase hydration levels within the skin. Due to lockdown this was done just using skincare only. The skin quickly became less itchy and sore, and the pustules would heal much faster.

We then slowly introduced some actives into the skincare that would target the pustules and breakouts.

Once we were able to resume in clinic treatments this lady’s skin had already improved in terms of the overall health, hydration levels and in its healing capacity. This skin was therefore in a better place to be able to tolerate and respond to an acne targeted approach.

The after photo was 5 months after the clients initial online consultation

Treating Acne with Nutrition – Video

Acne is a common skin condotion I see in clinic with around 50% of my clientelle suffering from some degree of acne, be it a long term issue, hormonal breakouts around the ‘time of the month,’ or the more recent ‘Maskne’. Its a condition that can really affect confidence, and leave people feeling really down or stressed about their skin.

A lot of my ladies will say “I’m an adult and I cant beleive I have acne, it’s something that happens to teenagers.” But in fact statitics show that around 80% of adults will suffer with acne at some point in their adult life.

So, yseterday I was lucky enough to be joined live on Instagram by Emilia Papadopoullos. Emilia is a nutritionist specialising in treating acne through nutrition.

Myself and Emilia recently worked together with a client to help her achieve clear skin.

By taking a holistic approach, treating the condition from the inside (Emilia) and from the outside (me) it can really accelerate results.

Press play below to watch the live replay of us discussing the subject.

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!