The following review and test on Skin Needling is free of charge from BeautyEdge LLC.

To take the certified test on Skin Needling and receive (1) continuing education credit, follow the NCEA link and instructions > > > NCEA ******************************************************************************************

Skin Needling

Skin needling can also be referred to as micro-needling therapy, collagen induction therapy (CIT), percutaneous collagen induction (PCI), derma rolling, dry tattooing, and intradermabrasion. A minimally invasive nonsurgical and non-ablative procedure, it involves the use of a micro-needling device to create minute, yet controlled skin injury.

There are a number of different skin-needling device brands in the market today. This review is a broad stroke study of the skin-needling process in general. This review does not provide proof or permission that estheticians should be providing micro-needing services. Estheticians should check state regulations for microneedling guidelines before rendering any services.

Before starting any micro needling procedures, patients need to be fully informed of the potential complications. It is imperative that they sign an informed consent form. This protects both patient and clinician in the event of an adverse result.

The purpose of the design of micro needles is to cause a measured degree of damage to the skin thus triggering the skin to heal, stimulating collagen development. The length of the needle will determine which area of the skin will be affected to trigger best aesthetic results.

Skin needling is not comparative to chemical peels, dermabrasion, or laser treatments, as skin needling directly targets specific skin layers, cells, and trigger points within the skin to produce the desired end result.

There are various skin-needling device designs available on the market. Some design options are needles secured on a circular roller that are rolled over the skin, needle stampers, and pens with cartridges with a cluster of needles at the tip.

Micro-Needling FDA Classifications: There are three classes for medical devices under FDA ruling. Class I includes devices with the lowest risk, and Class III includes those with the greatest risk. No matter the classification level, the FDA does not automatically approve a medical device just because of its named classification by the manufacturer.

Skin-Needling Process: Fine needles puncture the skin, creating a channel or minute wounds. It is the skin’s own physiological response to that damage that develops the desired aesthetic result. Once the skin is wounded, and depending on the depth and location of the wound, the skin’s regenerative potential brings about remodeling and the formation of new structures, eventually resulting in repair of the affected skin structure. Improvement is seen with multiple treatments; however, results can still be limited based on variables such as an individual’s age, health, skin type, skin quality, and extent of existing skin damage.

Needle Length and Performance: All sizes of needling cause injury to skin; however, according to Aust, Baithe and Fernandes, authors of the book, Illustrated Guide to Percutaneous Collagen Induction: Basics, Indications, Uses (Aesthetic Methods for Skin Rejuvenation), the length of the needle mainly determines if the device is cosmetic, medical, or surgical, and thus whose hands should administer the procedure.

• Cosmetic Needling or micro-needling extends to just below the stratum corneum (0.1–0.3mm needles; this type of needling does not cause percutaneous collagen induction [PCI]; it is merely a method to enhance penetration of topically applied active ingredients). No anesthesia required.

• Medical Needling extends into the papillary dermis. Medical needling (1–2mm needles; at this depth one can expect PCI). Local anesthetic cream is used. Performed on an outpatient basis.

• Surgical Needling extends as far as the reticulardermis or subcutis. Surgical needling (3mm needles; PCI). General or regional anesthesia is required.

Esthetician Regulations: It is recommended that skincare professionals know their scope of practice within their state and obtain the proper training before offering any new treatments or services.

Esthetician Guidelines:

Follow state regulations if allowable and under what conditions.
Quality instruments should be used. Poor quality instruments may lead to breakage of needles in skin.
Gain training on the device being used.
Client education: Review treatment plan and expectations pre-treatment.
Client consent: Ensure client understands and signs agreement.
Documentation of the treatment procedure in client chart.
Client post-treatment: Review at-home product use and updates.

Symptoms and irregularities that can be treated by micro needling vary depending upon:

size of needle
depth of needle penetration
the angle that the needle penetrates the skin
the angle that the needle withdraws from the skin
the speed at which the needles enter and leave the skin

Benefits of skin needling:

reduction of scars
reduction of wrinkles
reduction of acne
reduction of hyperpigmentation
reduction of hypopigmentation
improvement in skin texture, firmness, and hydration
reduction of hypertrophic scars caused by acne, surgery, thermal burns
fading of stretch marks
reducing fine lines and deep wrinkles
improvement in dyspigmentation/melisma
reduced risk of hyperpigmentation and scarring, therefore safe on darker skin

Possible Side Effects: The goal is to have minimal pain, redness, and discomfort to the patient/client receiving a skin-needling procedure. Generally, the procedure is well tolerated depending on the area to be treated and the severity of the problem. However, in cases where a longer needle is used and the treatment is facilitated by a physician, surface bleeding can occur.

Normally, the treated areas recover rapidly from skin needling. However, there are occasional side effects, which include:

Oozing and swelling during the recovery phase
Skin infection or herpes simplex
Milia development
Acne flare
Post inflammatory hyperpigmentation
Use of topical formulas with the treatment can sometimes produce undesirable skin reactions.

Post-procedure care: Skin needling is well tolerated by most patients, but dryness, scaling, redness, and swelling may be seen after treatment, lasting for several days or longer, depending on the depth of penetration of the needles. Clients can gently cleanse the area treated and, depending upon desired skin improvement, topical formulas and/or topical antibiotics can be recommended and prescribed.

Rejuvenation of skin may be seen as soon as one to two weeks and as long as six to eight months after the medical procedure. Burn scars are slow to respond. It can take up to six months to one year to see the final results from a single treatment.

Necessary follow-up treatments depend on the individual skin condition and desired results. Individuals must be evaluated on a case-by-case basis.

Resources:

http://www.dermalinstitute.com/ir/library/77_article_Skin_Needling_Hurting_or_Helping_.html

http://medestheticsmag.com/microneedling-classification

http://modernaesthetics.com/2015/04/microneedling-alegal-perspective-for-physicians

http://modernaesthetics.com/2015/06/rollers-and-thefda-fact-vs-fiction

http://www.kvmmedizinverlag.de/out/media/Illustrated_Guide_Percutaneous_Collagen_Induction.pdf

http://www.dermnetnz.org/procedures/needling.html

http://barefacedtruth.com/2014/10/21/cosmeceuticalsapplied-skin-microneedling-safety-efficacy-restorationsanity/

https://beautymagonline.com/sample-pages/1185-needling-09-1

TAKE THE TEST BELOW !!

You are always a student, never a master. You have to keep moving forward. Conrad Hall

The following test on Sensitized Skin is free of charge from BeautyEdge LLC. To take this NCEA certified test and receive (1) continuing education credit from the National Coalition of Estheticians, Manufacturers/Distributors & Associations, follow this link and instructions > NCEA

LEARNING OBJECTIVES

After reading this article and taking this test, the skin care professional will be able to:

1. Understand the cause of sensitized skin and how to lessen the chance of skin reactions.

2. Understand the sensitive skin product claim, and facial treatment options.

INSTRUCTIONS FOR THE FOLLOWING TEST:

1. Read the article below.

2. Scroll to the bottom of article to take the test.

3. Your average results will be visible at the end of the test.

SENSITIZED SKIN ARTICLE

About Sensitized Skin: The term allergic reaction is sometimes misused to describe the symptom of a sensitive skin condition. An allergic reaction and sensitive skin are not one in the same, however, they can have overlapping physical and visual results.

Background: According to Mintel’s Global New Products Database (GNPD), thus far in 2014*, sensitive skin claims represent 25% of total skincare claims, compared to 15% in 2009. What’s more, 71% of facial skin care users say they are interested in ultra-gentle products.

This review will focus specifically on sensitive skin or over sensitized skin, not rosacea, specific dermatological conditions or diseases, although they are common diagnosis’ to sensitive skin conditions.

Understanding Sensitive Skin Product Claims: Skin care formulas that are typically not problematic for the general population can cause intense stinging, burning, and redness in individuals with sensitive skin. When the claim suitable for sensitive skin is on the product’s label, the formula itself is tested, not the individual ingredients within the formula. There should be clinical support from the manufacturer that the formula was specifically tested on individuals that claim they have sensitive skin.

“Known to” claims means that a formula can contain an ingredient “known to” soothe sensitive skin. This does not mean that the formula itself soothes sensitive skin.

Some products are labeled hypoallergenic, a marketing term recognizable to the consumer, but again, there really is not an industry standard to measure the claim hypoallergenic. Generally, with this type of formula the manufacturer has taken measures to remove known allergens from the formulas yet irritants may still be present.

How Healthy Skin Becomes Sensitized: Skin contact with a formula or surface known as the irritant can create skin sensitivities or contact irritant dermatitis. This contact is not the same as contact that causes an overactive immune response with the release of antibodies (histamines) like an allergic reaction does. What happens is that the stratum corneum has been damaged creating a condition for the epidermal barrier to be affected.

When treating sensitive skin, keep in mind that skin becomes sensitive through physical and emotional causes.

Sensitive skin with sensitized being a better descriptor, is not necessarily a skin type, but a symptom of a skin’s condition. Sensitive skin has become a common term to describe the condition rather than a medical diagnosis. When referred to in skin care it describes reduced tolerance to the application of cosmetics and personal care products. Dry, mature, combination, oily, and acne skin types can have symptoms of sensitivities.

Sensitive Skin Stimulants:

Lifestyle - Busy schedules, physical/emotional stress, poor diet, over-indulgence in alcohol or drug consumption, extreme perspiration with exercise, and certain medications.

Climate - Heat, humidity, sun exposure, cold, forced air, pollution.

Aggressive Contact - Excessive friction, brushing, rubbing, scrubbing, scratching, chemical peeling, overuse of cosmetic products.

Improper Hygiene - Improper facial cleansing, or not cleansing skin at all before bed leaving behind irritants from the day.

Improper Cosmetic Product Use - Skin can become over-sensitized by layering multiple skin care products on it, practicing multiple cleansing steps, continually switching skin care products or applying too many products on a daily basis.

Cosmetic Ingredients - Individuals can be sensitive to a substance or ingredient that does not bother other people. SLS and SLES are included in many cleansers on the market to deep cleanse and to give the foaming and sensorial experience during cleansing. Fragrance and parabens can be culprits as well.

Additionally, natural or organic ingredients in a facial formula does not necessarily mean that a product will not cause a reaction for an individual with sensitive skin.

Hormonal Fluctuations - Female monthly changes.

Age - As skin matures, physiological protective and repair functions slow down.

Physical sensations resulting in sensitized skin includes: redness, erythema, inflammation, itching, stinging, burning or extreme dryness. However, there are cases where an individual can suffer from the physical burning or stinging, but there may not be a visual counterpart of these manifestations.

Sensitive skin can be clinically compartmentalized in two ways:

1. Subjective/sensory irritation, also known as sensorineural irritation - This is characterised by sensory discomfort such as itching, stinging, tingling or burning, but in the absence of any clinical or histological evidence of inflammation. Involvement of nerves and blood vessels contribute to the development of the symptoms. It is generally of acute onset. (http://www.dermnetnz.org/reactions/sensitive-skin.html#ed)

2. Non-erythematous irritation, also called suberythematous irritation

This form of irritant contact dermatitis differs from subjective irritation in that, although the person experiences similar symptoms and no rash is visible, there are changes of inflammation seen on skin biopsy. It often develops slowly and discomfort is experienced with multiple chemicals. (http://www.dermnetnz.org/reactions/sensitive-skin.html#ed)

Stratum Corneum: The process that causes skin to be sensitive or more sensitized is the weakening of the stratum corneum which provides a protective barrier to help defend against environmental/physical aggression. This weakened layer allows external aggressors to penetrate more easily and cause a reaction.

Epidermal Barrier: Impairment of the epidermal barrier, the outermost compartment of the skin, is the breakdown of skin’s ability to defend and repair itself. Transepidermal water loss, UV exposure, free radicals, high pH products all contribute to the breakdown of the skin’s barrier.

This barrier can be divided into three lines of defense: the physical barrier against pathogens and mechanical injuries, the chemical/biochemical barrier with antimicrobial activity, and a barrier against the unregulated loss of water and solutes. The skin barrier is formed by differentiating keratinocytes Int. J. Mol. Sci. 2013, 14 6722 Cytokines and the Skin’s Barrier

Treating Sensitized Skin: The first order of action for a client experiencing sensitized skin is for the client to receive a dermatological assessment. The reason for this is that sensitive skin can also have underlying skin reaction patterns that may require topical medications to address the inflammation, itchiness, and redness and to help rebuild the skin’s barrier.

Precautions During Facial Treatments:

● Use mild cleansers with clean hands to cleanse the face; no cloths, no brushes, no scrubbing.

● Use fragrance free products.

● Avoid cleansers with sodium lauryl sulfate.

● Avoid foaming cleansers, look for non-foaming or milky cleansers.

● Avoid over stripping the skin mantle, for example, use one cleaner, do not cleanse, then deep cleanse, then exfoliate. This may over exacerbate the skin adding to skin sensitivities and barrier breakdown.

● Avoid aggressive granular exfoliants, look for gentle exfoliants that are lightly rubbed off of skin, or ingredients that exfoliate other than acids.

● Avoid excessive hot facial steaming.

● Avoid over manipulation of the skin with massage, this may bring up more redness in the skin.

● Review the formula ingredient list. Take into account that one ingredient may not be the culprit. The formula itself needs to be tested on the client's skin. Sample the product to the client before purchase and instruct the client to use the product on one small area on the face multiple days to ensure that the skin can tolerate the new product.

Strengthening The Epidermal Barrier: A strong barrier makes skin less permeable. There are no leaky ‘holes’ or cracks. The aim in management of sensitive skin is to restore the barrier function through the application of ceramides, and nutritive lipids to improve the lipid content that holds the skin cells tightly together.

The most effective lipids are the one’s that are most similar to skin’s natural lipid composition. They are ceramides (sphingolipids), cholesterol, and fatty acids.

The lipids in skin are found in:

- The Stratum Corneum layer of the epidermis. They are located in the stacked lipid bilayers. Lipids form around the corneocytes and acts like the glue that holds the corneocytes (dead skin cells) together and traps water in the skin.

- The Granular layer of the epidermis located in the intercellular matrix. Lipds here exist in the form of free fatty acids, cholesterol, and sphingolipids as they are released from lamellar bodies in the keratinocytes that are in the process of breaking down into corneocytes.

- Cell membranes.

- Sebum – this is the oil produced by the sebaceous glands attached to follicles.

Patients and clients with sensitive skin still require cleansing hygiene. Synthetic detergent cleansers, also known as syndets, provide the best skin cleansing while minimizing barrier damage. These products may contain water, glycerin, cetyl alcohol, stearyl alcohol, sodium laurel sulfate, and occasionally propylene glycol. They leave behind a thin moisturizing film and can be used effectively in persons with excessively dry, sensitive, or dermatitic skin.

Moisturizers should create an optimal environment for barrier repair, while not inducing any type of skin reaction. The best moisturizers are simple emulsions for sensitive skin. The fewer ingredients the better.

Resources

http://www.medscape.org/viewarticle/839478_4

http://www.justaboutskin.com/skin-barrier-function/

http://www.skininc.com/skinscience/physiology/Making-Sense-of-Skin-Sensitivity-311022341.html

http://www.synergieskin.com/skin-irritation-and-skin-allergy/

http://www.oapublishinglondon.com/article/615

http://www.zoedraelos.com/articles/skin-care/#main

http://www.dermnetnz.org/reactions/sensitive-skin.html

https://rosacea-support.org/syndets-and-lipid-free-cleansers-what-are-they-do-they-work.html

Patch tests - http://www.dermnetnz.org/dermatitis/standard-patch.html