Part 1: HealtH-cHallenged Skin
By Mórag Currin
The professional skin care industry
is often in a better position
Diabetes mellitus, commonly known simply as
diabetes, is a chronic health condition where the body
medical industry to deliver preventive health
is unable to produce enough insulin and properly break
care recommendations, providing services in an
down sugar (glucose) in the blood. Glucose comes from
environment that can actually help people make
food and is used by the cells for energy. Glucose is also
long-lasting lifestyle changes, which is the most
made in the liver. Insulin is a hormone produced by the
effective path to disease prevention and optimal health.
pancreas, and it is needed to move sugar into the cells
In order to fulfill these needs, skin care facilities
where it can be used for energy necessary for the body's
must consider adjusting their business models to
encompass fitness, complementary medicine and
According to Merriam-Webster, type 1 diabetes
spirituality/mental health treatments. Because people
is a form of diabetes mellitus that usually develops
today are living longer, more are developing health
during childhood or adolescence, and is characterized
issues as a result of their lifestyles. Knowledge about
by a severe deficiency in insulin secretion resulting
common diseases and syndromes makes a visit to
from atrophy of the islets of Langerhans, and causing
the spa for clients with illnesses far safer and more
hyperglycemia and a marked tendency toward
acceptable. In Part I of this article, diabetes will
ketoacidosis. Type 2 diabetes is a common form of
be discussed, including the type of skin reactions
diabetes mellitus that develops especially in adults and
experienced, as well as ingredients and modalities that
most often in obese individuals, and is characterized
are safe to use with this client. Not every person is
by hyperglycemia resulting from impaired insulin
going to have the same set of reactions as the next, so
utilization coupled with the body's inability to
each client needs to be addressed based on their own
compensate with increased insulin production.
personal issues resulting from their diseased state.
Throughout time, diabetic clients develop skin
Editor's note: This article is based on the book Health-challenged Skin: The Estheticians' Desk Reference (Alluredbooks, 2012) by Mórag Currin, which is available for purchase at www.Alluredbooks.com. Also, a presentation based on this article by Kris Campbell of Tecniche will take place during the Advanced Education Conference Program at Face & Body® Midwest in Chicago on March 9, 2013. To register, log on to www.FaceandBody.com/midwest/register.
February 2013 Skin Inc. www.SkinInc.com
Reproduction in English or any other language of all or part of this article is strictly prohibited. 2013 Al ured Business Media.
for Diabetic Clients
complications from the long-term effects of diabetes on the microcirculation and on skin collagen. Infections
Skin care products containing some of the
in the skin are more common in type 2 diabetes, while autoimmune-related lesions are more common in type 1.
following ingredients would be beneficial for many
Diabetic clients who have had this disease for many
years have a tendency to develop complicated skin problems. Skin problems can also arise in the short-term
• L-Carnosine Benfotiamine. This is a
from insulin and oral hypoglycemic drugs. One of the
patent-pending, chirally correct endogenous
biggest problems with diabetes-related skin lesions is that
free-radical scavenger and antiglycation
they may serve as a port of entry for secondary infections.
complex. During glycation, reactions between sugars and proteins lead to intramolecular
Skin issues from diabetes
cross-links called advanced glycation end
Several of the skin problems that can be encountered
products (AGEs). This cross-linking throws
by skin care professionals working with diabetic clients
off key enzymatic processes and harms their
include the following.
ability to protect from oxidative stress, which allows for inflammation. The final impact of
Acanthosis nigricans. This condition presents as
this process is for collagen and elastin proteins
hyperpigmented, velvety plaques in body folds. The
to stiffen and lose elasticity. The issue with
dark color is due to the thickening of keratin-containing
glycation can be improved with this ingredient.
superficial epithelium. Although these lesions are
• Calophyllum inophyllum (tamanu seed
generally asymptomatic, they can be painful, smell bad, or soften and become thinner. The most effective treatment
oil). This ingredient features potent collagen
is a change in lifestyle, which includes weight loss and
synthesis activity, and helps heal and prevent
exercise to reduce insulin resistance. This condition is
stretch marks, broken capillaries and problem
reversible with weight loss if it is seen as a complication
skin. It supports wound-healing and fragile skin,
of obesity. If the lesions are asymptomatic, they need no
which are problems common to diabetic clients.
treatment. Ointments containing salicylic or retinoic acid
• Scrofularia nodosa (figwort extract). This
can be used to reduce thicker lesions in areas of
ingredient reduces itching, irritation and
softness/thinning in order to decrease odor and promote
stinging, as well as decreases skin reactivity.
comfort. Systemic isotretinoin improves acanthosis nigricans, but it recurs when the drug is discontinued.
Skin tags. These are small, stalklike, soft,
often-pigmented lesions occurring on the eyelids, neck and underarm area. Treatment is not necessary, but skin tags can be removed with cryotherapy or electrodessication. They may be a sign of impaired glucose tolerance, diabetes and increased cardiovascular risk.
Skin-thickening. This may increase with aging
diabetic clients. At first, this condition is generally
Acanthosis nigricans presents as hyperpigmented, velvety plaques
asymptomatic, but there is measurable thickening
in body folds that can be painful, smell bad, or soften and become
that often becomes apparent in the skin on the fingers
and hands. There is also a form of thickening called diabetic scleroderma, where the dermis of the upper
Scleredema diabeticorum. This condition is
back becomes noticeably thickened. The thickening
characterized by a noticeable thickening of the skin on
of the skin on the hands may occur with 20–30% of
the back of the neck and the upper back, and can extend
all diabetic clients, regardless of the type of diabetes
to the shoulders and lower back area. A peau d'orange
from which they suffer. Skin manifestations can range
appearance of the skin can occur, often with decreased
from pebbled knuckles to diabetic hand syndrome.
sensitivity to pain and touch.
Pebbled knuckles manifest through multiple minute
www.SkinInc.com February 2013 Skin Inc.
Localized itching is often caused by diabetes and can be caused by a yeast infection, dry skin or poor circulation. Several kinds of bacterial infections can
activity. Intermediate-acting insulin taken in the early
also occur in people with diabetes. These include:
morning allows for a safe spa treatment mid-afternoon, whereas rapid-acting insulin allows for a safe spa treatment approximately one-to-three hours after
• Styes (infections of the glands of the eyelids);
There are many other skin manifestations to
• Folliculitis (infections of the hair follicles); and
take into consideration if the skin care professional is working with the appendages of diabetic clients.
• Infections around the nails.
(See Additional Skin Manifestations.) Dealing with
pedicures requires more knowledge about diabetes
Several kinds of fungal infections can occur with
and risks. Training is available for nail technicians to
diabetic clients, including:
deal with diabetes through a variety of organizations, such as the International Pedicure Association. There
• Candida albicans (yeastlike fungus);
is more and more awareness about diabetes in the professional skin care industry, and more training
opportunities are becoming available on the topic.
• Athlete's foot; and
Some studies have suggested that regular massage
• Ringworm (ring-shaped itchy patch).
may help normalize blood glucose in diabetic clients, as well as reduce anxiety, headaches, depression, work stress and anger. However, further studies are needed to clarify the benefits that massage may have as a complementary treatment for diabetes. Although
papules found on the fingers, especially where they are
there is no evidence that massage itself is harmful or
stretched or straightened out on the knuckles. Stiffness
contraindicated for people with diabetes, some aspects
is common with diabetic hand syndrome, and it can
of the condition mean that massage for diabetics should
start to limit joint mobility. Skin on the hand may also
be chosen carefully to prevent any adverse effects.
present as waxy.
Professional skin care treatments must be dictated
by the client's current condition at the time of
Vitiligo vulgaris, or hypopigmentation. This occurs
treatment. The client may require many adjustments to
more often during type 1 diabetes. These clients should
any treatment provided. Only by working hand-in-hand
be advised to avoid the sun and to use broad-spectrum
with clients will the right course of treatment be
sunscreens at all times, particularly in the areas
hypopigmentation is occurring.
In Part II of this article, which will appear in the
March 2013 issue of Skin Inc. magazine, the skin issues
related to clients with celiac disease and systemic lupus
When a diabetic client considers professional skin
erythematosus will be detailed, along with ingredient
care treatments, there will always be questions, such
and treatment suggestions when working with these
as: "Does the skin care professional know anything
types of clients.
about diabetes?" and "Can she safely perform a spa treatment on a diabetic client?" One of the biggest concerns with diabetes is neuropathy, due to a lack of
Mórag Currin is an esthetic instructor
feeling in localized areas during electrolysis, pedicures
with more than 19 years of spa industry
and waxing. Clients need to be asked if they are aware
experience, and more than 10 years
of any open wounds, especially on the hands and feet.
of training and training management
Also, it is crucial to use and recommend products
experience. She pioneered the Oncology Esthetics
with beneficial ingredients for this condition. (See
advanced training for spa professionals, and is the
Beneficial Ingredients for Diabetic Clients.)
author of Oncology Esthetics: A Practitioner's Guide
Ask your diabetic clients if they have a continuous
(Alluredbooks, 2009; www.alluredbooks.com) and
glucose meter (CGM) placed into their skin. These
Health-challenged Skin: The Estheticians' Desk Reference
cannot be used in and around water. Also ask when
insulin was last taken, because skin care treatments should not be performed during the peak of insulin
February 2013 Skin Inc. www.SkinInc.com
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Case report of oral melanoma in a king penguin (Aptenodytes patagonicus) found by cooperation between Kosei Inui1, Miyuki Hamaguchi1, Satomi Yonezawa1, Makiko Nishizawa1, Takeshi Wada1, Kazutoshi Takami2 1: Naniwa-Hone-Hone-Dan, Osaka Museum of Natural History 2: Osaka Municipal Tennoji Zoological Gardens AZEC 2013, Fukuoka King penguin (Aptenodytes patagonicus)