IN TODAY’S SKIN CLINIC ENVIRONMENT many of the procedures we perform contribute to inflammation. Whether induced, or existing, it is imperative that we understand the role of nutrition in strengthening the immune system and supporting the healing and repair process of the skin. In this article Gay Wardle explains what is inflammation and key diagnostic considerations and nutritional factors that will help support and enhance skin repair.
WHAT IS INFLAMMATION?
Inflammation is the body`s immune system reaction and is essential for orderly, timely healing. Normal time frame for inflammation is 3-4 days sometimes lasting up to 7 days. Inflammation involves colour changes to the skin, for example, there will be erythema (redness), temperature changes (heat) and swelling. All of these are essential for inflammation, without them the wound will not progress and heal.
The reason for inflammation is to provide for hemostasis and the breakdown and removal of cellular, extracellular and pathogen debris. Macrophage cells (neutrophils) are involved in the initiation of inflammation.
Mast cells also play a crucial part of providing inflammation. These are all part of the immune system and will always mount a response in any injury, regardless as to how small or large that injury may be.
Cytokines and growth factors released at the time of injury within the wound communicate with other cells to assist in regulation and repair of the wound site.
The acute inflammatory phase involves and includes the following:
Coagulation cascade to achieve platelet activation and hemostasis
Mitogenesis and chemotaxis of growth factors
Controlled tissue degradation
Hypoxia and the regulatory function of oxygen to cells
Neutrophil, macrophage, mast and fibroblast cell function
All of the above are essential as to why we need to have inflammation with wound repair.
Peptides are growth factors and are sometimes referred to as cytokines. Growth factors deliver chemical messages that are released to non-immune cells and result in cell proliferation and migration, cytokines communicate with immune with immune cells and attract those cells to the site of injury. Growth factors provide key biochemistry for the wound healing process. Growth factors are critical to wound repair and occur in the inflammatory phase.
Without the actions of these cells, inflammation will be prolonged into a chronic stage. Chronic inflammation develops into infection that can take a long time to heal.
The role of nutrition is often the forgotten factor in wound repair. More than just food, nutrition includes nutrients, calories and fluids that is taken into the body, all of which are vital to the healing of wounds and the reduction in inflammation.
Poor nutrition and an inadequate diet are risk factors for prolonged inflammation. A well-balanced diet with adequate carbohydrate, protein, fat, water, vitamins and minerals are necessary to maintain skin integrity. And that is just internal, the same nutrition is required topically to maintain a healthy barrier function and skin biome.
SUPPORTING SKIN REPAIR
When assessing factors that will support skin repair, I would first take a look at proteins, water, zinc and vitamin C, as these are often promoted to assist with reducing inflammation and aiding with wound repair.
Let’s take a closer look at each of these factors:
Protein: Protein is essential and needed for tissue repair, as well as maintaining the integrity of tissue structure. Protein is responsible for the synthesis of enzymes, cell proliferation and the synthesis of connective tissue that are all needed for wound repair. If protein is inadequate in the diet then the time for a wound to heal will take longer, and therefore resulting in further scar formation.
On the other hand, if a person is digesting way more protein than they need, they will need to increase their fluid intake. If they do not increase their fluid intake inflammation will increase and wound repair will be prolonged.
It is important to understand that protein is an important component of the antibodies that are needed for a healthy immune system. And not just for internal nutrition, peptides that are the building block of proteins are also very essential to be used as topically applied actives prior to any clinical treatments. This will ensure that the inflammation that has been induced in a treatment is somewhat controlled.
Fluids: Water constitutes about 60% of an adult’s body weight. It is distributed in the body in three compartments:
When a person becomes dehydrated, their body does not have the capability to repair itself. Water is essential in helping to reduce internal inflammation. If the body does not have sufficient water, not only is the gut affected, but so are the hormones. When the hormones in the body are imbalanced, the risk of increased inflammation is higher. Internal inflammation will increase the risk of skin disorders as well as slow down wound repair.
Vitamin C: So why is vitamin C important in the repair process? The production of proteins by the fibroblast is greatly reduced if there is a deficiency of vitamin C. Another consideration is that the immune system will becomes greatly compromised if there is insufficient vitamin C in the tissues.
It is important to note that vitamin C cannot be stored in the body, therefore deficiencies can develop quickly if adequate intake is not maintained.
Zinc: We Zinc is a vital mineral for wound healing and skin repair and it is a well-known fact that most of us are zinc deficient. Zinc is essential because it plays a key role in the formation and function of white blood cells and lymphocytes. It is safe to say if we are low in zinc, wound repair will most likely be compromised.
I do not want to be misleading here and only talk about these few essentials that are vital to wound repair as these are just a few. We need to be mindful that the body and the skin need nutrition to maintain integrity and vital health.
There are many skin disorders where inflammation is persistent and often this is due to the fact that the skin biome is very unbalanced because of a lack of topical nutrition. Treatments alone is not enough, the skin needs to be regularly fed, with important nutrients to heal and flourish, just like your garden needs fertilizer.
RISK FACTORS FOR WOUND REPAIR
Intrinsic factors relating to a client’s medical status and physiologic wellbeing, can also affect skin integrity. Things to consider are age, disease, nutrition, digestive system, hormones, nervous system and the immune system will all have an impact on inflammation.
Inflammation, cell migration, proliferation and maturation responses all slow down with age. The skin also becomes much thinner as we age and the function of fibroblast cells slows down, this affects collagen and elastin production. There is atrophy to the dermis, which increases the risk of wound dehiscence.
Also, look out for steroid medications as these are immunosuppressive medications, that will influence skin integrity whether they are applied topically, or taken internally. Steroids will delay all phases of wound repair including inflammation, they reduce the immunity of both the body and the skin.
The role of stress will also have a strong contributing factor to inflammation. Stress can impact the body by interacting between the nervous system, endocrine system and the immune system and all these factors will link to how the body reacts to inflammation.
Negative emotions such as those evoked by depression or anxiety have the ability to change the functions of the skin. Stress and depression induce the release of pituitary and adrenal hormones that affects the immune function.
Cortisol stimulated by stress, can up or down-regulate pro-inflammatory mediators that affect and decrease macrophage and immune cell function, as well as suppress fibroblast cell proliferation. We must recognise that when high stress is present, it will increase inflammation and reduce wound repair.
Look for stress both through internal and external factors. Also, look out for environmental factors that may be externally stressing the skin and impacting the skin’s microbiome.
WHAT HAPPENS WHEN INFLAMMATION IS ABSENT?
The inability of the body to present an immune response to a wound is known as the absence of the inflammatory phase.
There are many causes for absence of the inflammatory phase – nutrition deficiency, immunodeficiency, cancer, diabetes, drug use, medications and radiation therapy – the list can be quite long.
This issue here is that the absence of an inflammatory response prevents the wound from progressing through the stages of repair, this will result with an infection and further scarring. For any wound to heal there needs to be inflammation, there is no progression to the further stages of wound repair without inflammation.
There are so many treatments being performed in today’s clinics that rely heavily on creating inflammation to reduce the signs of ageing. The use of light-sourced equipment, peeling, microdermabrasion, blading, stimulating massage all create inflammation.
During the skin and body consultation process it is so important to understand and identify the risks involved with these treatments if the skin and body is malnourished.
Internal and topical nutrition needs to be assessed before commencing clinical treatments.
With continued development of equipment and actives being used in clinics today, knowledge and a comprehensive understanding of wound repair and inflammation are essential.
The role of the aesthetician is not just to apply product and perform treatments, he/she must have a comprehensive understanding of all the systems of the body.
Consultations need to be thorough and potential risks need to be evaluated and addressed. And remember, excessive signs of acute inflammation is a huge red flag of impending wound infection.