Power of The Skin care Consultation

Florence Barrett-Hill

There are many components to a successful skin analysis, with much of the most valuable information being supplied by the client during the consultation process; however one of the most beneficial pieces of information to be gathered during the consultation is details of the client’s phototype, genetic and UVR exposure history. There are important reasons why the professional skin treatment therapist needs to know this information; firstly, it will ascertain any pre-dispositions to certain intrinsic cellular disadvantages, and secondly, it will also provide you with a clear picture of what level of cellular damage can be expected for their age. With this knowledge, you will not only have a clearer picture of what clinical interventions may be required, but also a more realistic view of what level of remedial improvement can be achieved.

Skins that suffer from cellular ageing beyond their years will be more difficult to achieve the same results from similar treatments than skins with less damage. One of the most detrimental things a therapist can do for their own confidence and reputation is over-promise and under-deliver when it comes to skin treatments. So many of the treatment modalities used today involve chemicals, heat, and light or electrical impulses, all of which, if not controlled, can burn, pigment or scar the skin. Therefore, the clarification of the skin photo type, skin colour and burn time should be established early in the skin analysis process. This classification will dictate the treatment protocols chosen at the end of the consultation and when preparing a treatment program for the client.

The original Fitzpatrick index (or Fitzpatrick scale) established the “minimal erythema dose,” also known as the MED.  One MED was the point of reference used to describe the time it took for a skin colour to burn, and it is still used as an indication of a sunscreen’s sun protection factor also known as the SPF. What we have learnt more recently about skin colour is called the “minimal melanogenic dose,” or MMD.  This MMD is the terminology used when describing the melanocytes ability to protect skin, and it has been proven that even the fairest skin can accumulate melanin within the epidermis over a period of a summer. We refer to MMD as the skin’s ability to tan or the epidermis’s ability to accumulate melanin. With the mixed ethnicities of the world today, there are many hidden dangers, and hair and eye colour as an indication of photo type is now misleading.

The MC1R (Melanocortin 1 receptor) gene, or redhead gene, as it is often called, can also be hidden which means that the clients’ risk of skin cancer may not be obvious. If the genetic history has a combination of the ability to tan and the red head gene, it should be considered a recipe for disaster, because the ability to tan often means that the skin has long hours of unprotected exposure. This could culminate into skin cancer and pigmentation as the melanocyte and keratinocyte cells age.

There are a number of skin conditions that have primary causes from one or a combination of intrinsic/extrinsic factors. Information gathered during the consultation can provide you with data to determine the leading cause of the skin conditions your client comes to you with. Figure 1 below, shows the leading causes of UVR history linked to skin conditions that usually result from sun exposure, along with the effect on cells and systems.

Fig 1: Genetics and the influence of the MC1R gene


Figure 2, below shows the leading causes linked to genetic history, and the resulting skin conditions (with effects on cells and systems) from living in more aggressive climates than genetically intended.

oxidative stress
Fig 2. Oxidative stress effects on UV exposed skins

Important information to gather during the consultation

Let us walk through each of the intrinsic or extrinsic factors we need to know about, and the reason or rationale.

Genetic heritage: 

Darker skins naturally come with risk for pigmentation (photo type 4 to 6) however the photo type 3 can also tan into the photo type 4 because of minimal melanogenic dose (MMD).
Where did the client live for the first 25 years of their life? If the client was born in New Zealand, South Africa, Australia, Polynesia, or environments around the equator, the chances of their skin being more aged or more pigmented earlier in life is high because of the extended sun exposure.

Tanning ability: 

It is during the teenage years when most people will have gained a tanning experience; use this timespan to determine skin’s tanning ability. Include sunburn history into this story to gain knowledge about body areas that may have been repeatedly sunburnt. You can then check these areas for other skin anomalies.

Redhead gene: 

Carries the potential for the red pigment pheomelanin to oxidise and create the superoxide anion radical which can then damage the mitochondria DNA of the melanocyte; this may lead to the risk of skin cancer.

Sunbed usage: 

Because the bandwidth of UV that is used in many sunbeds is UVA, it is a given that sunbeds will cause pigmentation, we also know that this bandwidth of light will accelerate ageing by increasing the enzyme collagenase.
This enzyme will denature the supporting collagen fibril of the dermis and accelerate vascular damage. It has been postulated that for every ten sunbed sessions the skin will age forward by one year.

risk factors
Flow chart showing Intrinsic and Extrinsic factors



The reason for skin analysis is to establish the leading causes of why the client’s skin is in less than perfect condition. What we have been looking at are some of the intrinsic and extrinsic diagnostic clues, found during a complete consultation process. We know that the intrinsic factors cannot be changed; however, no major improvements can be made to the skin if the client is not prepared to make changes to the extrinsic factors that cause oxidative stress. For the client to do this, the therapist must practice informed consent by giving the client every option and every choice to make an informed decision. The client must be given all information and protocols for daily care for their skin, and be made to understand that over 70% of the skin’s improvement will come from the use of home care products and a change to their work/play lifestyle. The balance will come from a course of clinical services.

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