By Ivanna Chebli

This article is excerpted from Les Nouvelles Esthétiques Magazine - American Edition.

Do you know what to do and what not to do to protect yourself and your clients in the treatment room? Sometimes we don’t think of certain risks because they seem so far-fetched. When we think of skin care ingredients, we generally think of vitamins, moisturizing agents and the like—we don’t consider cow parts. Further, when we think of those commonly used ingredients, we may not realize that they could cause allergic reactions in some clients—but it’s possible. Some estheticians don’t think mixing products is a harmful practice—but it can be. And when we think of ways to protect ourselves and clients against infectious diseases such as HIV, hepatitis or herpes, we may overlook a simple precaution such as wearing disposable gloves or protective glasses during all services. You may find what’s ahead to be shocking, but it’s all true.

Mad cows-metics
Remember the little old lady who asked, “Where’s the beef?” Well, she would definitely be shocked to find out that it’s not just in her burger. From candy and gelatins to pharmaceuticals and cosmetics, there are cow parts in many of the products we use daily. For example, the lipids in lipsticks come from cows’ carcasses and some anti-aging creams imported from Europe contain lightly processed bovine brain and nerve tissue. Should the beauty industry be worried about mad cow disease?

Officially called bovine spongiform encephalopathy (BSE), mad cow disease flared in Europe and recently found its way to the United States. It’s a slowly progressive, degenerative and fatal disease affecting the central nervous system of adult cattle, according to the FDA, and people can be contaminated by eating the beef of cattle infected with the disease.

With all the hype about beef, did anyone pay attention to what was in their lipstick, anti-wrinkle cream or other skin care products, or to what the FDA said about BSE? Its statement about mad cow disease says, “FDA continues to implement policies to keep safe all FDA-regulated products, including food, food ingredients, dietary supplements, drugs, vaccines, and cosmetics from risk of any BSE-contaminated bovine material.”

The risk of contracting mad cow disease from lipstick or skin creams may be minute, but some countries have taken precautions nonetheless. In 2001, China banned the imports and sales of cosmetics from 13 BSE-affected European countries; Japan imposed a ban a year prior. In the United States in January, the FDA and the Department of Health & Human Services banned the use of dead or disabled cows in the products that the FDA regulates, including food products, dietary supplements and cosmetic ingredients, as well as the use of brains, spinal cord, eyes and other high-risk parts from cows older than 30 months.
So should we be worried? According to Dr. Gerald McEwen, vice president for science of the Cosmetic, Toiletry and Fragrance Association, cosmetics are safe. Further, Dr. McEwen said that by 1996, the industry stopped using raw ingredients made from herds that were not certified as being free of the disease or from high-risk parts of cattle.

Allergies to cinnamon and foods containing benzoic acid increases the chance of developing an allergic skin rash.

Take action to stop reactions
Picture this. You recommend a topical acne treatment to your client. She uses it for a few weeks without any problems. Then one day, she tells you that she’s allergic. You may be shocked and wonder, “How is that possible?” And you may find it especially strange when you learn her allergic reaction is to a common acne-fighting ingredient like benzoyl peroxide or salicylic acid.

There are two reactions that can occur following exposure to cosmetics. The first, irritant contact dermatitis, is the more common type and generally occurs at the site of contact with the irritating substance. The second is allergic contact dermatitis, which occurs in people who are allergic to a specific ingredient or ingredients. Allergic contact dermatitis is an immunological response from the body, meaning the immune system reacts against a specific substance that it considers foreign and harmful, and is not an immediate effect.

It may take days, or even weeks, of continued exposure to an irritant before symptoms appear. In some cases, a person can develop an allergic sensitivity to a product after years of use. Symptoms include redness, swelling, itching and fluid-filled blisters. Here’s a rundown of three common skin care ingredients that could cause such allergic reactions.

Hydroquinone is a skin-bleaching agent used to temporarily lighten skin. This ingredient may cause an allergic reaction in more than a third of patients who use it. Clients allergic to sulfites should not use hydroquinone. You can suggest skin lightening alternatives like kojic acid and azelaic acid to clients who are allergic. Further, the use of sunblock is essential for people using products containing hydroquinone.

Benzoyl peroxide is a common ingredient in treatments for mild to moderate acne. In more severe cases, it may also be used in conjunction with other acne treatments, and to treat other skin disorders. Some people may have allergic reactions to benzoyl peroxide, and a history of allergies to cinnamon and foods containing benzoic acid increases the chance of developing an allergic skin rash. Moreover, a benzoyl-peroxide percentage of 5 percent or higher can cause hyperpigmentation in patients with dark skin.

Salicylic acid is used to treat many skin conditions, including acne, dandruff, psoriasis, seborrhea, calluses, corns, common warts and plantar warts. It may be a good substitute for benzoyl peroxide for your benzoyl-peroxide-sensitive clients. However, it is a form of aspirin, so if your clients are allergic to aspirin, don’t use products containing salicylic acid or recommend them for home care.

Another common practice that you should be wary of is mixing products from different product lines. Most manufacturers advise against it, as it can cause adverse skin reactions. Product lines are formulated to work together and complement each other. If you mix products from different companies, the combined ingredients can cause an unwanted reaction. In addition, before suggesting products or treatments to your clients, make sure you know if they are taking any medications or supplements. For example, if a client is taking or has recently taken Accutane, he or she should not take vitamin A. Accutane’s side effects are similar to those that occur when vitamin A is consumed in excess. In addition, according to Rachel Furman, R.Ph., author of Drugs & Cosmetics: Combinations That Can Kill You, clients should not wax, have dermabrasion treatments or have steam treatments for at least 24 months after completing Accutane treatment.

Even though it can be inconvenient, doing a patch test is sometimes a good idea.

Viruses can spread
Do you know how viruses such as HIV, herpes and hepatitis spread? It may be shocking to hear, but a lot of the small precautionary details are easily overlooked during skin care treatments. For example, what would you do if you accidentally cut or scraped a client’s skin during an extraction? Ideally, you would already be wearing protective, disposable gloves to avoid touching his or her blood with your bare hands. And if you have a cut on your hand, you have to be extra careful about coming into contact with someone else’s blood or bodily fluids. You’re not just protecting yourself, you’re protecting your client.

No matter how clean your spa and tools look on the surface, it is important to take precautions to protect yourself and your clients from the spread of infectious diseases and viruses. It’s essential to sanitize, disinfect and sterilize implements and treatment areas (see Michelle D’Allaird’s article, “How Clean is Your Spa?”). Viruses such as HIV, hepatitis and herpes can spread in a spa or salon environment if you’re not extra cautious. Warts, also caused by viruses, are contagious and easily transmittable as well.

Human immunodeficiency virus (HIV) is the virus that causes AIDS. People can have HIV for many years without showing any signs or symptoms. A risk of contracting HIV in the spa or salon is created when there is direct exposure to blood, tissue or other bodily fluids. That’s why it is key to decontaminate instruments and surfaces between clients, as well wear gloves during treatments. Because you cannot tell if your clients are carrying HIV, you should not take any chances of becoming exposed to the virus.

Hepatitis is an inflammatory disease of the liver. There are many types, the more common ones being hepatitis A and hepatitis B. The hepatitis A virus can be spread through contaminated implements that have been in contact with saliva or other bodily fluids. According to Douglas D. Schoon in Milady’s HIV/AIDS & Hepatitis: Everything You Need to Know to Protect Yourself and Others, people infected with hepatitis A usually recover fully with no long-term damage to their health. Hepatitis B can be transmitted through contact with blood, blood serum, saliva or other bodily fluids and can cause permanent liver damage. A common symptom of hepatitis is jaundice, or the yellowing of the eyes and skin. There is a vaccine that prevents hepatitis B infection.

Herpes simplex is the cause of common cold sores, which generally appear on or around the mouth. You should avoid giving patients who are having a herpes outbreak facial treatments. Treatments such as chemical peels can possibly cause a herpes flare-up.

Warts are caused by viruses known as papovaviruses or veruccae. Warts are contagious, especially to the same individual, and can spread to another area of the body. If your client has warts, refer him or her to a dermatologist for treatment. Skin treatments should be avoided in areas where warts are present to prevent contracting or spreading them.

Preventive precautions
So what can you do to prevent these things from happening? As always, education is key. Educate yourself about your clients, their drug and treatment history, and their lifestyles. Stay on top of skin care issues and the latest industry news.

Once again, it’s important to always wear gloves when performing treatments. This ensures that you will avoid touching any scrapes, nicks or cuts your clients may have, and it will also protect them from exposure to any cuts you may have. You can play it safe by using the same infection control practices with all clients. This is known as taking universal precautions, and it’s the policy recommended by the Center for Disease Control meaning “the practice of treating everyone as if they are infected since it is impossible to tell if they are infected by merely looking at them.”

Further, even though it can be inconvenient for both you and your clients, doing a patch test is sometimes a good idea. Use your best judgment in deciding whether a client needs a patch test before you use a new product. If a client has sensitive skin or previous, known allergies, it might be helpful to ensure that the ingredients in your products won’t have an adverse effect on his or her skin. The general rule is that if there is no skin reaction after 48 hours, then the product is probably safe to use.

It really is primarily a matter of common sense, and if you think about it, that’s not so shocking after all.