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Brow Lamination For Clients on Long Term Steroids

By Morag Currin

Several skin reactions can occur at both a low and high dose glucocorticoids, although the risk increases with the higher doses plus one needs to consider how long the client has been taking glucocorticoid therapy. These skin reactions are usually of most concern to the patients.

Short-term use of ‘steroids’

The structure and function of the epidermis is altered even with short-term topical glucocorticoid treatment; it affects components of the stratum corneum, therefore affecting skin barrier integrity. The dermis is altered by directly inhibiting fibroblast proliferation, reducing mast cell numbers, and loss of support; there is depletion of mucopolysaccharides, elastin fibers, matrix metalloproteinases, and inhibition of collagen synthesis. Atrophogenic changes can be found also in hair follicles, sebaceous glands, or dermal adipose tissue specifically from topical use.

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Long-term use of ‘steroids’

Long-term side effects also present with numerous skin-related issues, which may require estheticians to proceed with extreme caution, to suggest an alternative, safer option, or to employ the expertise of the client’s health care professional. Most people on a systemic steroid for more than a month can suffer adverse effects such as infections, hypertension, diabetes, osteoporosis, avascular necrosis, myopathy, cataracts, and glaucoma. 

From a skin standpoint, the adverse effects from long-term systemic steroids can include:

  •   Bacterial infections: cellulitis, wound infection
  •   Fungal infections: tinea, candida, pityriasis versicolor
  •   Viral infections: herpes zoster
  •   Skin thinning-fragility, petechiae-purpura-ecchymosis (bruising), telangiectasia-facial erythema, and slow wound healing, especially in sun-damaged areas
  •   Stretch marks (striae) under the arms and in the groin
  •   Steroid acne
  •   Hypertrichosis and hair loss or thinning/mild hirsutism
  •   Impaired wound healing
  •   Perioral dermatitis
  •   Bone density loss/osteoporosis
  •   Swollen, puffy face (Cushing’s syndrome) 

Skin thinning, fragility (atrophy)

Steroid-induced skin atrophy is thinning of the skin resulting from prolonged exposure to steroids.

Skin atrophy is one of the most prevalent side effects, with changes found in all skin compartments:

  • Marked hypoplasia (a lack of cell growth)
  • Elasticity loss with tearing
  • Transparency, or a
  • Dysfunctional skin barrier
    • Services that can cause trauma to thin, fragile skin
      • Exfoliating services (mechanical and chemical)
      • Gommage
      • Hair removal services such as waxing
      • Extractions
      • Taping
    • Spa support and services can include:
      • Corrective topical products
        • Moisturizers to help prevent the skin from dryness, cracking, etc.
        • Sun protection
        • Vitamin A/retinol support
      • Nutritional support (internal)
        • Omega 3
        • Vitamin C
        • Water
  • Micro or dermal needling* (know what contraindications exist for this service)

Petechiae, purpura, ecchymosis (bruising)

Bleeding into the skin can occur from broken blood vessels that form tiny red dots (called petechiae). Blood also can collect under the tissue in larger flat areas (called purpura), or in a very large bruised area (called an ecchymosis).

Extravasated blood usually breaks down and changes color over a few weeks from purple, orange, brown, and even blue and green.

    • Services that can cause bruising
      • Hair removal services (application/rubbing) such as waxing, sugaring, and others
      • Pressure during massage
      • Microblading, dermal needling, permanent makeup, or any invasive service
    • Spa support and services can include:
      • Manual lymphatic drainage
      • Camouflage and/or corrective makeup

 

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Telangiectasia-facial erythema

Telangiectasia is a condition in which there are visible small linear red blood vessels (broken capillaries). This condition is generally harmless. Clients may seek a service due to their unsightly appearance. 

    • Services that can cause further redness or telangiectasia visibility
      • Heat services, or products causing ‘heat/warmth’ to the skin
      • Inflammatory causing services such as hair removal service, extractions
    • Spa support and services can include:
      • Soothing/hydrating facial services with products that contain ingredients that are anti-inflammatory and anti-redness
      • Electrodesiccation*
      • Intense pulsed light (IPL)*
      • Vascular laser treatment*
      • Camouflage and/or corrective makeup 

*Work within the scope of your certification or license.

 

Interesting to note:
Corticosteroids are absorbed at different rates depending on the thickness of the stratum corneum. A mild topical steroid that works on the face may achieve little on the palm. But a potent steroid may quickly cause side effects on the face. 

For example:

  •   Forearm absorbs 1%
  •   Armpit absorbs 4%
  •   Face absorbs 7%
  •   Eyelids and genitals absorb 30%
  •   Palm absorbs 0.1%
  •   Sole absorbs 0.05%

Q&A

Question:
I have a new client that is currently cancer-free but she has been on steroids long-term. From what she has told me she has an impaired skin barrier. I have not seen her yet, however, she mentioned she recently waxed her eyebrows, and skin was lifted where waxing was performed. 

She asked if it would be safe to have her brows laminated at this time. I do not offer the service, but my instinct is to say no. She is a cosmetologist and recently waxed her brows lifting some skin. Am I correct in telling her this?

Answer
Brow lamination is an alternative to microblading. It is a ‘perm’ for the brow hairs, as it gives them a set, uniform shape for about 4-6 weeds. Instead of curls, a setting lotion helps brow hair stay brushed up and lifted upward. 

The process of brow lamination is as follows:

The service starts off with the esthetician applying a lifting cream onto the client’s brows. This lifting cream creates a chemical process that breaks down bonds in each hair, allowing them to be moved into a new shape, and then the brow hairs are brushed up into place. Once that is done a neutralizer is applied to the brow hairs to reform the bonds into their new shape. This service is completed with a nourishing oil for moisture replenishment. 

Since the lifting product creates a chemical process – would this affect the skin in the brow area?

It might be in your best interest to do a patch test. I would also question how long ago she had the brows waxed? Has the skin healed over completely? Is the skin sensitive in this area? Ensure the skin is no longer inflamed, and no longer has skin tears, redness, or swelling. 

Of course, with brow lamination, the brow hairs can be damaged from the chemical process and if not done correctly and be sure to avoid getting the product into the client’s eyes, and remember the skin on the lid and under the brow is the thinnest. 

As long as both the client and esthetician understand the pros and cons, and if the skin can handle this service and is intact, this can be safely performed.

References:
https://www.ncbi.nlm.nih.gov/books/NBK531462/
https://www.dovepress.com/glucocorticoid-induced-skin-atrophy-the-old-and-the-new-peer-reviewed-fulltext-article-CCID
https://dermnetnz.org/topics/telangiectasia
https://dermnetnz.org/cme/dermatitis/corticosteroids

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