Diagnosis and treatment of diseases belong in the hands of experienced dermatologists. But even if beauticians are not allowed to provide therapy, knowledge about diseases such as psoriasis, rosacea or neurodermatitis is an essential part of good cosmetic training.
Beauticians should be able to correctly identify and classify skin diseases such as psoriasis, rosacea or neurodermatitis so that they cannot refer their customers to the dermatologist unnecessarily or deliberately. In cooperation with dermatologists, there are also successful synergies.
Characteristics and assignment of skin diseases
Psoriasis is a genetic, immune-mediated, inflammatory disease. Visible through sharply defined, raised, plate-like skin changes with silvery, firmly adherent, coarse scales on reddened skin. Severe itching is very common. The skin lesions are typically found on the extensor sides (elbows and knees) and on the scalp.
Depending on the severity, small areas of skin up to large parts of the body surface can be affected. In certain special forms, the armpits, the navel, the groins or the bottom fold can be affected. The face, on the other hand, almost always remains free of symptoms. Psoriasis can also appear on the nails. What many do not know is that psoriasis can also lead to joint inflammation (psoriatic arthritis) in around 30 % of those affected.
Those affected are often severely restricted psychologically in their quality of life. There is also an increased risk of cardiovascular diseases and the so-called metabolic syndrome, which is why a holistic view and sufficient control of the disease activity are very important.
In neurodermatitis, the immune system reacts genetically excessively to normal substances in the environment such as pollen, food, animal hair. There is also a disturbed barrier function and generally dry skin. Itching is also present.
What helps to distinguish it from psoriasis is the different distribution pattern: In neurodermatitis, the flexor sides (crooks of the arms and the back of the knees) are particularly affected, but the face and neck are also affected. The skin can be reddened or inflamed to varying degrees (blurred eczema). Acutely, the skin is often weeping and sore. Fine scales form during the healing process. After prolonged inflammation, the skin can thicken like leather as a result. In the customer survey, allergies, hay fever and asthma can often be found as an accompaniment (atopic triad).
The disease rosacea, which progresses in phases, occurs primarily in light skin types (Fitzpatrick type I and II). In the case of the precursor form of couperose, facial redness occurs, especially in the area of the cheeks and nasolabial area, triggered by various trigger factors. This redness, also known as “flush”, can be accompanied by an unpleasant feeling of heat, burning or stinging and usually stops on its own after a short time. In the further course, permanent reddening in the cheek area and dilated veins (telangiectasia) can appear.
The papulopustolosa stage shows reddish nodules (papules) and pustules, especially in the middle of the face. This must not be confused with acne! Open or closed comedones (only present in acne) serve as a guide. In the case of a very severe course of rosacea, inflammatory, thickened skin with proliferation of connective tissue and sebaceous glands can occur in the long term, especially in the area of the nose (rhinophyma). As a special form, the eyes can be affected (inflammation of the lid margins or conjunctiva, foreign body sensation).
In addition to basic care, many other external medicinal creams and ointments containing cortisone, retinoids, vitamin D derivatives, as well as urea and salicylic acid can be used in the treatment of psoriasis. Other medical treatment options are phototherapy or light therapy with UVB rays and a combined light-chemo treatment (PUVA).
If the disease is severe, internal therapy (systemic therapy) is carried out.
With systemic therapy, the drugs can act throughout the body and thus also on the entire skin, but they also have more side effects. Fumaric acid esters, vitamin A derivatives and immune-modulating active ingredients are used for this purpose. In certain situations, modern biologics (in syringe form) can be used.
These biologics block messenger substances that trigger psoriasis and its associated diseases, stop the inflammation and thus control the disease very well. Since the skin in psoriasis regenerates much faster than normal (three to seven days instead of 28, cause of the thickened, silvery scaly skin),
An essential part of therapy for neurodermatitis is regular basic care to strengthen the skin barrier. Acute conditions with pronounced inflammation of the skin (eczema) are also treated with topical cortisone. Since cortisone preparations should only be used for a short time, cortisone replacement preparations (calcineurin inhibitors) are used to maintain the improved condition of the skin. They are a good alternative because they have an anti-inflammatory effect similar to cortisone and are also suitable for long-term use. In severe cases, systemic therapy is carried out, for example with cortisone tablets, immunosuppressive drugs or a special biological agent. Light therapy can also be used at times.
Rosacea is also treated with topical topicals or tablets (depending on the severity). Light emulsions should be chosen for local application, because greasy bases can worsen rosacea (this also applies to cosmetics). Locally applied drugs such as brimonidine, azelaic acid or ivermectin are used.
Cortisone, on the other hand, has a negative effect on rosacea. Flat facial redness or dilated vessels (telangiectasia) are sometimes also treated with IPL or laser. The treatment by the dermatologist can be supplemented by supporting cosmetic therapies. It is not without reason that many dermatologists cooperate with beauticians.
In addition to treating the skin problems that are unfortunately clearly visible, the experienced cosmetics professional – in comparison to most people – also approaches the customer without fear of contact. This leads to a relaxed atmosphere and trust among those affected. The complementary treatment and dermatologically developed products can help, especially with regard to redness, itching and a feeling of tightness. In the customer consultation, the importance of the right basic care to strengthen the skin barrier can be discussed.
In the case of psoriasis, rich care products with ingredients such as hyaluronic acid, glycerin and vitamin E can be used to care for the skin to make the skin more supple. Care products with keratolytic active ingredients such as salicylic acid or with a higher percentage of urea (at least 10 percent) have also proven effective in reducing scaling. Skin irritations, especially mechanical ones, should be avoided because they can trigger new psoriasis sites (Köbner phenomenon). Oils, such as olive oil, can be used to dissolve dandruff on the scalp.
In the case of neurodermatitis, even cleaning the skin incorrectly can be a cofactor of acute flare-ups. Instead of foaming, surfactant-rich and thus drying washing gels, it is better to choose moisturizing, soap-free cleaning products. Skin care for neurodermatitis should be done with moisturizing and moisturizing creams that also strengthen the skin barrier.
All care products should have low-irritant bases without colorants and fragrances, mild preservatives in small doses, no mineral oil or PEG-containing emulsifiers). Preparations for sensitive skin are often well suited.
Natural oils are particularly suitable as active ingredients. With their high proportion of unsaturated fatty acids (e.g. gamma-linolenic acid), they are able to strengthen the cement substance of the stratum corneum and also the skin's barrier function. This makes the sensitive epidermis less permeable to irritants that can quickly damage the skin. Evening primrose oil is great for treating itchy skin and eczema. Echium oil also has a particularly high content of essential fatty acids, especially stearidonic acid. It is popular for its excellent anti-inflammatory properties. Balloon vine extract also has a soothing effect on stressed skin. In pharmacy, it is used as an anti-inflammatory and anti-itch herbal counterpart to cortisone. This anti-inflammatory, irritation-reducing effect is also used in cosmetics. Urea has proven itself as a moisturizer. It keeps the moisture in the skin, makes it more supple and even relieves itching.
Cosmetic treatments can be particularly helpful in the early stages of rosacea. Due to the skin's increased readiness to react, cosmetic treatments should calm the skin, stabilize superficial blood vessels and, if necessary, inhibit inflammation. Cleaning must be done with mild products and must not irritate the skin or blood vessels (always use lukewarm water to avoid extreme temperatures).
Always use manual lymphatic drainage (ML) instead of classic massages. Since lymphatic congestion with tissue swelling often occurs in rosacea, ML can not only decongest the blood and lymphatic system of the skin, but also ensure improved metabolic function.
Light creams with extracts from horse chestnut, witch hazel and ivy that strengthen the blood vessels are recommended for daily skin care. You can "train" the skin and its unstable vessels. Special preparations with brown or green pigments can conceal redness and at the same time have a calming and anti-inflammatory effect. Consistent daily sun protection with sun protection factor 50 is a must for rosacea sufferers!
dr med Christine Schrammek-Drusio , dermatologist, allergist, managing director of Dr. medical Christine Schrammek Cosmetics GmbH, Essen
Christina Drusio, specialist in dermatology and venereology, member of the management of Dr. medical Christine Schrammek Cosmetics GmbH,