Case Study:

A post-menopausal client comes in for a facial. During draping, you notice her chest looks irritated. When you ask what regime she is using for her décolleté, she complains that it itches and feels tight. You believe her skin is dehydrated.

As a skin care professional, what solution do you propose to treat this case study?

Solutions:

Eli Jones, director of education for Mark Lees Skin Care

"Due to a decreased production of estrogen, dryness is common in the post-menopausal client's skin. The nature of dryness is, of course, to allow dehydration through transepidermal water loss (TEWL) which is often accompanied by subjective itching. In order to get relief, the client may want to scratch. Unfortunately, this would only contribute to the issue through the production of inflammation and reduction of barrier function – making for an unpleasant loop of perpetual itchiness, tightness and irritation. Being as the client dodges our question regarding regime by merely describing her skin's level of discomfort, it's safe to assume that she is not using products necessary to address the issue. So what's the solution? An emollient moisturizer with ingredients to calm itching (bisabolol and aloe), reduce tightness through moisture retention (sorbitol and sodium hyaluronate), and create a barrier (dimethicone and cyclopentasiloxane) should be used in the treatment room and recommended for at-home use."

Dr. med. Christine Schrammek-Drusio, managing director of Dr. med. Christine Schrammek Cosmetics

"The skin feels tight and dry? This is a common skin condition! The cause: lack of moisture – but also lipid deficiencies or a lack of surface oils. Water is continually evaporating through the outer layer of skin – a normal occurrence. However, when TEWL is more than the amount of liquid taken in, the balance is disturbed. Environmental factors, effects of sunlight, indoor heating and air conditioning, as well as age-related factors can lead to this imbalance. Neck, décolleté and breasts are often affected in particular since they are commonly ignored in skin care. The skin in these areas are thinner and more sensitive than on the face. A special treatment in the form of a holistic, anti-stress program (not just for neck and décolleté) is appropriate here, which would make dry skin more resistant as it has a lower irritation threshold. Massage creams and facial packs made with a base of cream that reinforces the skin barrier and with intelligent ingredient systems offer quick relief. Warm occlusion treatments, such as clay or foil treatments, reinforce the results."

Douglas Preston, owner of Preston, Inc.

"First, I would question the client for probable causes: recent sun exposure, hotter showering in wintertime, any new body products, medications, recent rashes, et cetera. If the skin only appears irritated but in fact is merely excessively dry (which can cause itchiness and redness if the client has been scratching the area), I would perform a moderate enzyme exfoliation followed by a hyaluronic serum and collagen mask overlay for about 15 minutes. The treatment would be completed with a hydrating peptide repair cream and SPF. For home care I would suggest reducing the shower temperature, gentle skin exfoliation with an appropriate product, and regular use of a highquality body lotion without a strong artificial scent."

Alexandria Zani, owner of Aesthani Education Pathways

“Dryness and itchiness on the décolleté are most likely symptoms of something greater.  At this age, her skin cells and structures are functioning very differently than when she was younger. Your task is to determine the leading cause of her condition prior to treating. Following a systematic pathway of analysis, review intrinsic and extrinsic factors.  Examine her recent health history including taking medications, phototype, and lifestyle including dietary habits, environmental exposure, and tendency for arthritis or allergies. There are many skin conditions that are influenced by the chronological age of skin cells, especially over the age of 50. Oxidative stress, lipid peroxidation and reduced or abnormal cell functioning – including an impaired skin barrier and the lack of essential fatty acids – can be attributing to her appearing dry and/or sensitive.  She also may be experiencing an allergic reaction to a perfume or even a laundry product.  Depending upon the degree of irritation, something more severe may require medical intervention to rule out any dermatological condition.  Otherwise, gentle care is recommended to help repair the area.”

Bamby Duong, national educator for Lélexo™ skincare

“With pun intended, menopausal itching can disrupt your sleep, work and even intimacy period! Fluctuations and depletion of hormones during this stage may lead to itchy, inflamed, flakey, and/or broken-out skin. Menopausal itching may appear anywhere in the body, including the vagina. As the body produces less estrogen, this hormone is a vital component in the skin’s collagen growth. The body will retain less moisture, thus attaining dehydrated skin as well. Simple lifestyle changes like taking omega-3 fatty acids, vitamin B, and drinking a minimum of 64 ounces of water a day will assist in alleviating the itch, hydrating the skin, and improving the texture. Take warm showers and moisturize right afterwards to lock in the moisture. Use topical products that contain antioxidants and non-detergent cleansing agents, like green tea, oatmeal or a milky cleanser.  Always apply a broad-spectrum sunscreen and avoid long periods of sun exposure. Furthermore, seek a medical professional to treat the hormone fluctuations at the source, as this may be a symptom of something more serious.”