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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 diabetic clients.
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
Case report of oral melanoma in a king penguin (aptenodytes patagonicus) found by cooperation of zoo and museum
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)