Anatomy, Physiology & Healing
Anatomy and Physiology
In our basic course we gave you all the information on the anatomy, fibroblasts, and additional structures and functions of the skin. This section is to continue to familiarize your knowledge of elements of the skin.
Appendages of the skin
Hair: hairs are dead structures that are made of a hardened protein called keratin and grow out from follicles. Most of the body is covered with hairs, with the exception of the palms of the hands and the soles of the feet. They help to keep the body warm and are also a form of protection. The eyelashes prevent substances from entering the eyes, and the hairs that line the nose and ears help to trap dust and bacteria. The hair is made up of three layers:
Cuticle – is the outer part of the hair and consist of a single layer of scale-like cells. These cells overlap like tiles on a roof. No pigment is contained within this layer.
Cortex – lies inside the cuticle and forms the bulk of the hair. It contains melanin, which determines the color of the hair. The cortex helps to give strength to the hair.
Medulla – is the inner part of the hair and is not always present. Air sacs in the medulla determine the color tone and sheen of the hair because of the reflection on light.
Hair follicles – is an indentation of the epidermis with the walls of the follicle being formed and extended into the dermis.
• Arrector pili muscle – are small muscles attached to the hair follicles. When we are cold or frightened the contraction of these muscles causes the hairs to stand on end. This results in the appearance of goose bumps. Air is trapped between the skin and hair and is warmed by body heat.
• Sweat Glands – Sweat consists of 99.4 percent water, 0.4 percent toxins and 0.2 percent salts. There are two types of sweat glands in the body:
- Eccrine glands – which excrete sweat and are found all over the body. The sweat duct opens directly on to the surface of the skin through an opening called a pore. Sweat is a mixture of water, salt and toxins. Ethnically darker skin tones contain larger and more numerous sweat glands than white skin tones.
- Apocrine glands – these are found in the armpits, around the nipples and in the groin area. They secrete a milky substance. These glands are larger than eccrine glands and are attached to the hair follicle; they are controlled by hormones and become active at puberty. The break-down of the apocrine sweat by bacteria causes body odor. Substances called pheromones are present in this milky substance; the smell is thought to play a part in sexual attraction between individuals and the recognition of mothers by their babies.
• Sebaceous glands – are small, sac-like structures that produce a substance called sebum. These glands are found all over the body except for the soles of the feet and the palms of the hand. They are more numerous on the scalp and areas of the face, such as the nose, forehead and chin. The glands are attached to the upper part of the follicle and its duct enters directly into the hair follicle. Hormones control the activity of these glands and, as we get older, the secretion of sebum decreases, causing the skin to become drier.
• Sebum – is a fatty substance and is the skin’s natural moisturizer. It keeps the skin supple and helps to waterproof. Men secrete more sebum than women. Sebum and sweat mix together on the skin to form an acid mantle. The acid mantle maintains the pH (acid/alkaline level) of the skin.
• Blood and capillary network – blood is supplied to the skin by small blood vessels known as blood capillaries, these enter the lower regions of the dermis and rise to supply the pilo-sebaceous follicles and the sub-epidermal network, which also supplies the epidermis. The blood flow within the skin operates as an aid to vital respiration. Capillaries also help with the heat regulation by dilating (widening) and constricting (narrowing) to prevent body heat losses.
• Sensory Nerves – the skin contains sensory nerve endings that detect changes in the environment and send messages to the brain. These nerves respond to touch, pressure, pain, cold and heat and allow us to recognize objects from their feel and shape.
• Motor Nerves – the skin contains motor nerve endings that convey impulses from the brain, through the spinal cord and to the muscles, glands and smooth muscular tissue.
• Fibers Nerves – are cordlike structures carrying impulses from the periphery, muscles and joints to the brain and spinal cord. Messages pass along the nerve fibers as electrical impulses via a network of interlocking fibers surrounding the upper part of the follicle, forming a collar. Fibers extend to the sebaceous glands, epidermis, arrector pili and sweat glands.
The Lymphatic System: A system of fluid balance and immune defense.
When plasma passes out of capillary walls into the surrounding tissues, it is called interstitial fluid and provides the necessary nourishing substances for cellular life.
This interstitial fluid contains proteins that help draw fluid across the capillary wall.
Here, it will be drawn to the hyaluronic acid content of the glycosaminoglycans gel, aiding the support of collagen, elastin fibrils, and the many other cells that reside in the dermis. Some fluid will move up through the dermal/epidermal junction towards the epidermis to aid the hydration of the epidermal cells and become part of the trans-epidermal water loss (TEWL) of the epidermis.
After bathing the cells, 90-98% of the interstitial fluid re-enters the capillaries, returning to the heart through the veins. The other 2-10% returns via the lymph capillary system, which is a system of dead-end capillaries that extend into most tissues, paralleling the blood capillaries.
Lymph fluid is the nourishing fluid of the cells. The lymphatic system is not only a reservoir of organic fluids and defense system against microbial invasion: Lymph fluid is also the healer of wounds, the builder of tissues and regenerator for the body.
Sugar attaches to proteins; a process called glycation, and the proteins collagen and elastin become linked. Whereas protein strands normally slide over to one another, become attached to the glucose and cannot move about freely.
Role of Glycation in ageing
Perhaps the worst consequence of glycation is linking, which is the formation of chemical bridges between proteins and other large molecules.
A material that undergoes linking usually becomes harder, less elastic and has the tendency to become brittle and fragile. In an aging skin, glycation causes the loss of resiliency (bounce back) and feeling of adhesion (hardening) under the skin and stiffening joints.
Advance glycation end products (AGE’s)
AGE’s exert their harmful effects on two levels; most obviously, they physically impair protein, DNA and lipids, altering their chemical properties. They also act as cellular signals, triggering a cascade of destructive event when they attach to their cellular binding sites.
A sagging and inflexible skin is a result of this process; aggravating the appearance of aging in addition it can have a detrimental effect on microcirculatory system of the skin.
Immune system cells called macrophages, which combat glycation.
The only apparent draw back to this defense system is that it is not complete and levels of AGE’s increase steadily with age.
One reason is that kidney function tends to decline with advance age; another is that macrophages become less active, thus having a negative effect with the skin immune system.
Once AGEs form they can directly induce the linking of collagen, even in the absence of glucose and oxidation (free radical) reactions.
The natural di-peptide carnosine may be another answer to the aging process, especially glycation. Carnosine is a multiple function di-peptide made up of a chemical combination of amino acids beta- alanine and L-histidine. Carnosine has the remarkable ability to rejuvenate cells, restoring normal appearance and extending cellular life span. It also inhibits the formation of AGE’s, it can protect the normal proteins from toxic effects of AGE’s that have already formed. Carnosine is by far the safest and most effective natural anti -glycation agent. Studies have shown that carnosine inhibits damaged protein from damaging healthy proteins, and helps the proteolytic system dispose of damaged and unneeded proteins. The main dietary source of carnosine is red meat, poultry and fish so take note during the consultation process of your clients eating habits to ensure they are balanced.
(phase 1-5 day)
The moment the skin tissue is damaged, mast cells in the tissue release histamine to trigger the inflammatory response. At the same time, the capillaries and arterioles begin dilating and release blood plasma into the area as part of the inflammatory response to injury.
The plasma contains nutrients, oxygen, antibodies and white blood cells to help flush away any foreign matter from the area. After the initial rush of the inflammatory response, leucocytes and the later arriving macrophages, remove the dead tissue and foreign material, then fibrin lay down and the tissue is dissolved.
Fibroblastic phase (5-28 days). Also, the Regenerative phase
Once the wound is ready to move into the regenerative phase, a sequence of events occurs called “collagen synthesis”. Collagen, however, cannot be synthesized in the abundance of oxygen and nutrients, and if the blood supply has been damaged, it will need to be replaced.
New Collagen Production
To produce new collagen tissue, the fibroblasts that are found in low numbers in the dermis proliferate and migrate to the base of the wound with the help of growth factors and a very important glycoprotein called fibronectin.
Fibronectin acts as a conduit for fibroblasts, and it binds both the wound and the fibroblast together to allow the fibroblast to stay in place (the fibronectin) and take up residence in the wound.
Once in the wound, fibroblasts begin to synthesize collagen fibers and produce fibronectin, and GAGs like hyaluronic acid. This dermal remodeling will continue for up to two years from the original injury, with this time varying based on the individual and their age. Unfortunately, the scar is rarely as strong as the tissue it replaced.
Post Inflammatory Hyperpigmentation
History can include infestation, allergic reactions, mechanical injuries (picking acne lesions) or reactions to medications, phototoxic eruptions, burns, bruising and inflammatory skin diseases from eczema/dermatitis family.
This type of pigmentation can darken with exposure to UV light and with the use of various chemicals and medications, such as tetracycline, bleomycin, doxorubicin, 5-fluorouracil, busulfan, arsenicals, silver, gold, anti-malarial drugs, hormones and clofazimine.
Dermal pigmentation caused by trauma:
A combination of the inflammatory response and ultraviolet causes the inflammation to disrupt the basal cell layer, a combination of melanin pigment being released and subsequently trapped by macrophages in the papillary layer. Once the wound healing has completed and the junction repaired the melanin pigment granules caught within the dermal layer have no way of escape and thus a more difficult type of pigment granule to eliminate.
Post-Inflammatory Hyperpigmentation is a darkening of skin that is the result of acne scarring or skin injury due to the inflammatory response in skin. The cells associated with melanin production are closely linked with the skin immune system cells; meaning one cannot be stimulated without the other being stimulated.
Post inflammatory hyperpigmentation can be seen after endogenous or exogenous inflammatory conditions. Essentially any disease with cutaneous inflammation can potentially result in post inflammatory hyperpigmentation in individuals capable of producing melanin.
Several skin disorders such as acne, atopic dermatitis, allergic contact dermatitis, incontinent pigment, lichen planus, lupus erythematosus, and morphea have post inflammatory hyperpigmentation as a predominant feature. Exogenous stimuli, both physical and chemical, can cause injury to the skin followed by PIH. These include mechanical trauma, ionizing and nonionizing radiation, heat, contact dermatitis, and phototoxic reaction.
Optimal treatment for PIH includes prevention of further pigment deposition and clearing of the deposited pigment. Chemical peels work best when used in combination with topical bleaching regimens. Laser therapy should be used with extreme caution and care. Given the propensity of darker-skin types to develop post inflammatory hyperpigmentation, superficial peels work best, while minimizing complications.
Tyrosinase inhibitors, such as Vitamin C, arbutin, kojic acid and mulberry, have been favored for their ability to inhibit melanin by targeting the tyrosinase enzyme, which covers the amino acid phenylalanine into the melanin precursors.
Effective topical vitamins include niacinamide and several forms of vitamin C, including L-ascorbic acid, magnesium ascorbyl phosphate (MAP) and tetrahexyldecyl ascorbate, an oil soluble version.
In addition to having a direct skin-lightening effect, Vitamin C can help protect against sun damage by neutralizing free radicals that contribute to hyperpigmentation. Studies have shown that Vitamin C and E in combination can improve the efficacy of sunscreen. A great all-around skin vitamin, Vitamin A helps pigmentation problems by treating slight discoloration and evening skin tone. Vitamin A can be taken orally as well as applied topically in the form of a retinol cream or other retinol.
If a client suffers from PIH they need to be using a tyrosine inhibitor one-two weeks before treatment to avoid further PIH.
Post inflammatory hyperpigmentation:
Setting Up Your Space for Success
It is most important that you present the best impression of yourself, whether that is in your own treatment room, in a salon or at a client’s home. The following information should help you to ensure the best impression is always provided.
The first impression your client receives will depend upon the manner in which she/he is greeted and the surroundings they are placed into. A professional atmosphere should be presented at all times, with sufficient room to discuss the record card/consultation form and write observations. Your client should feel comfortable, warm and relaxed.
Calm efficiency and organization should be clearly apparent to the client from her first contact with you, as this will instill confidence in the professional skills you will be offering. It is essential that you have an excellent "reception" technique, together with a knowledgeable response to any questions the client may raise.
A tentative enquiry, if dealt with in a calm, efficient and knowledgeable manner, can become a regular client booking. Client satisfaction will result from fulfilling the requirements of the client in a professional and efficient manner. You should refrain from pressuring a client into taking treatments or buying product, you should recommend and educate, not push.
Preparation of the working area prior to the client’s arrival is vital, not only to provide the right impression to the client, but also to ensure that the treatment provided can be completed in the given timeframe.
A therapy room should be relaxing and welcoming. The working area should have a good supply of light. When you do use artificial lighting it should not be too bright and should be indirect so that it does not shine into your client’s eyes. If you light candles always remember to extinguish them!
The room you work in should be adequate in size and allow you to walk freely around your client.
The floor should be of a material that is easily cleaned or vacuumed and is not slippery, noisy or cold.
Always make sure that the room you’re working in is clean and tidy. Remember, first impressions last. If your toilet and the room it’s in are not clean, it gives your client the wrong impression of you and could lead them to question your own hygiene practices.
A comfortable chair should be provided with suitable back support for the client. Ensure that the height of the chair is suitable for your height as if the chair is too low; you will not be able to stand straight to perform the treatment and may cause damage to your back in the process. You need to be comfortable and relaxed yourself to provide a good treatment.
Temperature and ventilation: Your room must be warm enough for the client not to become chilled but not so warm that it’s uncomfortable for you to work. It should be ventilated to prevent it becoming stuffy.
A small bowl should be provided for the client to put her jewelry in when she undresses so that there can be no loss following the treatment
It is important to have on some low, calming music in the background to further relax the client.
Refreshments: Always offer your client a drink of water before leaving. Water is key to expedite healing
At the end of the day, if your client has a relaxing and pleasant treatment, they are more likely to come back.
At your station you need to have the following:
Chlorhexidine Gluconate Wipes
Aftercare Placenta Stem Cream
Saline or Sterile Water
LED Red Light
Device Cleansing Wipes
Sterile Plasma Tips
Professional Ethics and Confidentiality
It is essential to develop a trusting and confident relationship with your clients by using a professional attitude and an excellent work standard. This can only be achieved through hard work and practice. Your knowledge and skill base will be the deciding factor for a client returning to you for treatments.
This intensive training course will provide knowledge of the treatment, which will help you to provide an excellent service; but this is only the beginning, and it will take many hours of practice to master the technique. You must be prepared to spend the time to develop your skills and techniques to enable you to always provide the best treatment possible to your current and future clients.
Your standards must be exemplary at all times. You should always strive to be the best you can be – your work promotes not only yourself, but also your salon and colleagues. So, ensure that you always provide treatments to the best of your ability, in a totally professional manner. You should always work to the following Code which is recognized within the industry:
Always work within the law
Do not ever treat or claim to be able to treat a medical condition – any concerns should be referred to the clients’ general practitioner (GP)
Client confidentiality should be respected at all times
Always show respect for related professions by referring clients appropriately, i.e. to a GP, Chiropodist etc.
Always maintain high standards of hygiene and safety in your work
Ensure that, where necessary, certain treatments are only undertaken with written permission of the client’s GP
Always be respectful and helpful where possible to other beauty therapists
You should never try to poach other therapists clients, or undermine their work/ability.
You should always undertake your work in a professional manner, particularly when working with members of the opposite sex
You can help maintain client confidentiality by:
Carrying out the consultation in private, or as privately as possible
Ensuring that all consultation and treatment records are stored in a secure place and never left lying around
Never discussing a client’s personal details or their treatment with another person
Safety and hygiene standards should always be as high as possible whenever any form of treatment is carried out. It is vital that hygiene and cleanliness are prime considerations; not only for the satisfaction of the client but also to comply with legal requirements.
Cross contamination must be avoided at all times. By thoroughly checking for contraindications it is possible to avoid working on people who have obvious infections. However, clients are not always aware that infection is present. It is therefore necessary for the safety and well-being of both client and practitioner that sound hygiene measures are strictly adhered to.
When performing any type of therapy treatment where very little equipment is used, there are a range of hygiene measures that should be implemented:
Surfaces and equipment should be washed daily with antiseptic wipes/solution.
Tools should always be sterilized.
Floors should be swept and mopped daily.
Caps and lids on bottles and jars should be immediately replaced when you have used them to avoid spillage.
Towels and any linen should be changed for each client.
First aid kit should be available
All paper waste should be disposed immediately into a covered container and disposed at the end of each day. Waste bins should be disinfected daily.
Toilets and sinks should be cleaned daily with the appropriate chemicals.
All oil spills should be wiped up immediately.
Disposable gloves should be available and used during treatment.
Use antibacterial hand wash between each treatment, or wash your hands.
Wipe massage chair / couch with antibacterial spray after each treatment