For a professional to accurately diagnose their client’s skin type and condition, they must fully understand the basics: the basics of how skin functions, what is going on in the live layers of the skin, and if the conditions you are seeing are from self-inflicted bad habits. Skin types are determined mostly from genetics and the size of the sebaceous gland. Skin conditions are also determined from genetics, as well as hormones and environmental factors.

1. Tuberculin skin tests are valid and acceptable for use during pregnancy. Active tuberculosis infection is associated with adverse fetal outcomes, including intrauterine growth restriction, low birth weight, preterm birth, and perinatal death (Esmail 2018; Miele 2020), as well as adverse maternal outcomes, including increased risks for anemia.
2. Skin testing training is available to help you and your office staff confidently administer skin tests. Watch the Skintestor OMNI TM demonstration video below, or learn more about the Stallergenes Greer Skin Testing Proficiency Program. Please click here for Package Inserts with full Prescribing Information, including Boxed Warnings.

Skin testing is now recommended only for groups at high risk to progress from infection to disease. Routine TB skin testing is no longer recommended for students in Florida schools or universities, pregnant women, teachers, school bus drivers, workers at daycare center, food handlers, and certain others.

Skin Types

Skin type is the description of how and why your skin looks, feels and behaves as it does. The four most common skin types used in the cosmetic/skin care industry are:

1. Normal: This skin type displays a smooth texture and a rosy, clear surface, with fine pores. There are no visible blemishes, greasy patches or flaky areas. Sebum production, moisture content, keratinisation and desquamation are well-balanced. Normal skin is often found in young persons.
2. Oily: Skin of this type is characterized by an increased amount of lipids on the skin surface due to overactive sebaceous glands. It is shiny and thick, often with enlarged pores. Oily skin is prone to blackheads and other blemishes. It occurs more often in men than in women, and it predominantly affects adolescents and younger persons.
3. Dry: Characterized by a lack of moisture in its corneous layer, dry skin results in tightness and even flaking. The skin appears dull, especially on the cheeks and around the eyes. It may lack elasticity, with accentuated fine lines and wrinkles. In more severe cases, itching and burning may occur. Extremely dry skin shows signs of cracking and fissuring.
4. Combination: Combination skin is rather dry in some parts of the body and oily in other localizations. Mixed facial skin tends toward dryness on the cheeks and around the eyes while being oily in the t-zone (nose, forehead, chin). The dry parts and the oily parts require different skin care regimens.

First, skin type is not always the same. The variations that are taking place in your skin cannot only change season to season but month to month and even weekly. Normal, oily, dry and combination are good basics to start out with, but they still do not cover every nuance. They can change and fluctuate with everything from the weather to stress levels. Why is finding out what skin type your client has important? Because different skin types require different formulations. Even though many skin types may need the same active ingredients (such as sunscreen agents, antioxidants, cell-communicating and so on), the base and delivery agents (lotion, cream, gel, serum or liquid) should correlate with the needs of your clients skin type.

What influences skin type? Almost anything and everything can influence skin type, which is why it can be tricky to detect a single skin type to what you see under the magnification lamp when examining clients. Both external and internal elements can impact the way skin looks and feels. To effectively evaluate your client’s skin and determine the correct skin care routine, here are some of the factors that need to be considered.

Internal Influences:

• Hormonal changes (Menopause, pregnancy and menstrual cycles can cause the skin to fluctuate from oily to breakouts, skin discoloration and dryness.)
• Skin disorders (rosacea, dermatitis, psoriasis)
• Genetic predisposition
• Medications
• Diet (Research shows a diet high in antioxidants and omega-3 can improve the appearance of skin.)

External Influences:

• Climate/weather (cold, warm, moist, dry)
• Skin care routine (Routines such as over-exfoliating, over-moisturizing, or using irritating/drying ingredients can create skin problems that were not there before.)
• Sun exposure (major cause of hyperpigmentation)
• Pollution (creates free radical activity that damages collagen)

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Skin Conditions

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When performing skin analysis, it is easy to identify obvious skin issues. Everyone has a skin type classification; however, not everyone has a skin condition. There is a distinct difference between type and condition. Conditions occur in many different skin types and include dehydration, dryness, sun damage, hyperpigmentation, telangiectasia, wrinkles and acne, among other skin conditions.

Dehydration
Indicators of dehydration are visible fine lines and feeling of tight skin. When it is determined that a client’s skin is experiencing dehydration, which is a condition verses a dry skin type, the professional can then decide a plan of action. A service focusing on correcting the dehydration through light exfoliation would be the best treatment option. Using a gentle enzyme exfoliator will digest the dead skin cells along with allowing the treatment products to absorb more efficiently in the skin. A hyaluronic acid based serum with a rich antioxidant moisturizer is best to recommend for daily use.

Sun Damage/Hyperpigmentation
Sun damage and over-exposure to harmful sun rays can usually cause hyperpigmentation. Pigmentation is not always visible to the naked eye. Deeper pigmentation can be seen through a Wood’s lamp. Another form of hyperpigmentation is a pregnancy mask, which is a common hormonally determined example of hyperpigmentation that often occurs during pregnancy and worsens with sun exposure. To start, consistently apply a well formulated sunscreen to treat skin with sun damage and hyperpigmentation. Next, a low percentage chemical exfoliation should be applied daily, followed by a series of stronger chemical peels administered by a well-trained aesthetician. And finally, applying a serum containing lightening ingredients, such as the chemical compound known as hydroquinone 2% can be effective and safe. However, due to the controversy behind this ingredient it is imperative that a skin care professional oversee its application and progress. For clients who are interested in an alternative to hydroquinone, a vitamin C serum is a great option – keeping in mind that vitamin C is likely to oxidize if not properly contained in
airless packaging.

Fine Lines and Wrinkles
How the skin ages and wrinkles is a very complicated process that involves an almost limitless range of physiological occurrences. There is not one cause that can be addressed with a product to erase the inevitable, because the aging process itself is so complex. Skin, by itself, ages in many ways. There is not one “miracle” ingredient to stop this natural process. Years of extrinsic factors (sun damage, pollution, free radical damage, smoking, et cetera) and intrinsic factors (genetics, chronological aging, change of hormones, immune’s suppression, et cetera) combine and culminate what we define as aging skin. The good news is that there is hope to diminish the appearance of aging and even slow the process with the right treatments, home care regimens and simple lifestyle changes. The time to detect how serious a new client is about accomplishing their skin care goals is during their initial consultation. Create a plan of action, with an end in mind, for the dedicated clients that are committed and willing to take your professional advice on how to reverse and prevent the signs of aging. Make sure to have clear communication between yourself and the client concerning their desired results. Planning a series of professional treatments based on the depth of damage in the skin is a great way to start. If your client is experiencing deep wrinkles with a loss of elasticity and sun damage, recommend a series of chemical peels, preferably a combination of glycolic and lactic acid. Gradually move up in strength to build the skin’s tolerance. For the concern of deep wrinkles and loss of elasticity, recommend the correct formulations for their skin type; but you will find the same active ingredients will be the same for the skin condition. Ingredients that will improve the skin’s structure are peptides, retinol, vitamin C, and hyaluronic, glycolic and lactic acid. Explain that a series of treatments will be extremely beneficial but that the client will have to be accountable for consistently treating her skin at home. Consistence is key when following a home care regimen and actually wanting results. Would you go to the dentist every six months, not brush your teeth daily, and expect the health of your teeth to be top notch? No you would not. It is our job as skin care professionals to educate clients on this same concept in regards to skin.

Acne
Acne occurs when the pores of the skin become clogged, most often on the face, neck, back and chest. Dermatologist and researchers do not know exactly why this happens, but we do know that testosterone plays a part, as does heredity. Once a pore becomes clogged, it traps skin oil inside. Bacteria grows in this oil and can cause an inflammatory response in the skin. Acne lesions can be small and hardly noticeable, appear as a small whitehead or blackhead, or can appear red with a white/yellow center. Sometimes a clogged pore will become so inflamed that it can lead to larger, more painful lesions (nodules or cysts), which can ultimately scar. Working with clients that are experiencing acne can be a very sensitive topic and can even affect self-esteem. As a skin care professional, approaching this condition with a positive, understanding attitude will take you far when building client/professional trust. Recommend a series of salicylic acid peels to clear the pores of sebum, dirt and bacteria. Acne clients are typically an oily skin type and should be using lightweight ingredients that will not clog their pores. Ingredients like salicylic acid, benzoyl peroxide, retinol and sulfur work beautifully in clearing current blemishes and preventing future acne lesions.
Dealing with different skin types and conditions on a daily basis will reinforce just how complex the largest organ of the body is and how there is not just one answer for each skin type. It takes trial and error. Never give up hope on improving a stubborn condition. Never assume the client you see on a consistent basis will have the same skin type as their last visit.

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Kristina Valiani is a licensed aesthetician and educator for a leading skin care brand. Valiani conducts professional training courses in addition to teaching continuing education classes for aestheticians around the nation.
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