The effects of acne can go beyond the physiological to the psychological, impacting self-esteem. As aesthetic professionals, our desire is to support clients in seeing the beauty inside and out and achieving healthy glowing skin. Knowing how to support clients in combatting this uncomfortable, and oftentimes self-esteem debilitating, skin challenge is essential. Fortunately, there are a number of solutions at our disposal that work to manage or eliminate acne conditions and prevent long-term scarring.
Acne impacts approximately 85 percent of teenagers and young adults. Beyond youth, 25 percent of men and nearly 50 percent of women experience acne in adulthood. The good news is acne is a treatable disease.
Acne is defined as a skin disease that occurs as a result of inflamed or infected sebaceous glands in the skin – when the follicles, dead skin cells and sebum (a combination of squalane, wax esters and triglycerides) get trapped in pores and become infected with bacteria. While there are many theories as to the exact cause of acne, we do know there are a number of triggers including: hormonal imbalances, nutrient deficiencies, medications, stress, poor hygiene, and genetics. The key to proper treatment is proper diagnosis of the root cause for your client.

Common Acne Triggers

• Hormones – oil production is regulated heavily by hormones, specifically testosterone, which stimulates the development of sebaceous follicles and attached oil glands. This explains why acne is most common during puberty, pregnancy, menstrual cycles and menopause.
• Stress – stress is one of the top triggers of acne as it stimulates the adrenal glands to produce more cortisol, which can cause excess sebum and inflammation. Acne flare-ups can occur anywhere form 14 days to one month after the stress response.
• Medication – the hormones (adrenals) may be affected by some medications and drug use and can spur on blemishes.
• Nutrition – alcohol, caffeine and foods with iodides (salt, processed and fast foods, MSG, dairy in excess) can trigger existing acne.
• Face cleansing – when oil builds up on the skin, bacteria will form, which creates blemishes. Sleeping in makeup, along with exposure to debris from the day, sets up a perfect opportunity for more bacteria. Teaching your clients to cleanse properly and regularly will often eliminate their acne issues.
• Skin irritants – detergents, fabric softeners, certain shampoos and conditioners, and fragrances or dyes can irritate existing acne conditions.
• Picking – improper squeezing, picking and inept extractions may rupture the follicle wall, causing bacteria to spread. It may also lead to deeper impaction and scarring. Educate clients about icing as a way to reduce inflammation as soon as they feel the pressure of a lesion. In the treatment room and at home, icing can be very valuable.
• Drying – overuse of certain drying skin care products may cause the skin to over-produce sebum.
• Genetics – some may be predisposed to acne based on certain genes that are passed along, but it is believed it is polygenic, or a grouping of genes as opposed to one singular gene.

Be sure to talk to clients about the role lifestyle plays in the skin’s health. It is important that they eliminate as many antagonizers as possible, adopt a healthy, clean diet and reduce exposure to skin irritants by changing pillowcases often, thoroughly rinsing laundry to get rid of excess soap, and using healthy skin care products. Also remind clients to keep their hands off of their skin as this adds contamination to an already vulnerable area. Whenever there is a localized area of acne lesions, ask questions and determine if they are touching their skin, resting their hand on their face or even sleeping on that area.

Types of Acne
There are different types of acne, each stemming from different root causes and requiring a different treatment approach.

The primary types include:

• Acne vulgaris – the most common type primarily among adolescents. It is characterized by comedones, papules, pustules, nodules, cysts, and sequelae – such as pitted or hypertrophic scars. Acne vulgaris is caused by propionibacterium acnes, also known as p. acnes (bacteria). This usually involves a more in-depth acne program that includes professional treatments, an at-home system and lifestyle changes.
• Acne cosmetic – acne caused or stimulated by cosmetics. These are usually non-inflammatory indicated by small, slightly raised red lesions, whiteheads and occasional pustules. This is not as common today with the improvement of cosmetics and labeling such as “non-comedogenic,” but it is important to know every product your client is using to rule this out. This can usually be corrected by eliminating the acne-producing cosmetic and replacing it with a home regimen focused on cleanse, correct, rebuild.
• Acne mechanica – acne that forms as a result of friction and constant pressure, or repetitive physical trauma to the skin such as rubbing from hats or other materials, phones, sunglasses, and so on. Correct with professional enzyme treatments and a home-care regimen that includes blemish serum for spot treating.
• Acne rosacea – this primarily impacts adults and is more predominant in women than men. It is characterized by erythema with telangiectasia. Lesions tend to follow the blood vessel dilation with papules and pustules forming in the center of the face, cheeks and chin. They are typically large and painful. Acne rosacea is genetic, chronic and progressive. Eliminate irritants such as excessive spicy foods, caffeine, tobacco, alcohol, and saunas, and stress. Professional peel treatments will also be one of the best supports.
• Pseudofolliculitis barbae – this is more common in men and occurs when coarse, curved hair penetrates into the skin before it leaves the follicle. Also known as ingrown hairs. For treatment, focus on exfoliation – both physical and chemical.

Treating Acne in the Treatment Room and Beyond
Since acne is related to the overproduction of sebaceous gland lipids, and the severity of acne correlates to the amount of sebum that is excreted and obstructed, it is key to prevent the build up and thus the formation of microcomeodones.
Treating acne conditions requires a delicate balance of breaking the skin down, clearing clogged pores, reducing bacteria, as well as nourishing, hydrating and healing the skin to prevent future breakouts and scarring. Summed up as “peeling and healing.”

In the Treatment Room

• Skin preparation: cleanse skin with a salicylic or glycolic-based cleanser to start the exfoliation process. Salicylic acid will work as a surface exfoliant, and provide antiseptic and antioxidant benefits, while softening comedones and promoting cell turnover. Glycolic acid, an alpha hydroxy acid, provides rapid penetration and desquamation, and improves the structural integrity of the skin.
• Pre-treat: to help suppress melanin and provide antibacterial and antioxidant support, apply a solution containing arbutin (L), and kojic, azelaic and ascorbic (L) acids.
• Enzyme or peel treatment: papaya enzymes or a solution of hydrogen peroxide combined with salicylic, lactic and glycolic acids will help regenerate, brighten and heal acne skin. For a peel treatment, a tomato-based formula will provide regenerating, exfoliating and antioxidant benefits. Tomato contains lycopene, which is one of nature’s most powerful antioxidants, along with several acids that work to control acneglycolic, ascorbic, acetic, chlorogenic, malic, lactic and tartaric. This is also ideal for clients who may have acne-related scarring.
• Post-peel: finish with a blemish serum containing salicylic acid, resorcinol for antiseptic properties, B vitamins for tissue repair, and green tea, totarol and tea tree oil for antioxidant and antiseptic support. To soothe, protect and proliferate cell renewal, healing and tissue regeneration, apply a nourishing cocktail of epidermal growth factors, natural arnica and a zinc-based sun protection formula. Masks are also a good choice in the treatment room. Look to green tea, sulfur, bentonite and kaolin-based masks to heal, absorb excess oil and detoxify the skin. Additionally, after the enzyme or peel phase, extractions may be performed if necessary.

Managing Home Care
While the aforementioned potential culprits of acne are better avoided, one of the best tricks to preventing acne is cleansing. While this may seem rudimentary, most clients tend to gloss over this step. When creating a regimen for clients, drive home the importance of proper cleansing.

A good regimen might include:

• Creating a clean environment – send clients home with a green tea, salicylic or glycolic-based cleanser and instruct them to massage it into the skin for several minutes, rinse with warm water and white cloth. When the cloth wipes clean, the job is done. Cleansing pads may also be recommended for quick, in-between clean ups.
• Eliminate the build-up – you might recommend an AHA and green tea-based toner to balance and repair the skin and keep oil at bay.
• Correct and clean up the oil – balance is essential here. It can be easy to go overboard. Remind clients some oil is good and excess dryness can increase oil production. Bentonite clay and kaolin clay masks will help purify and detoxify the skin. Retinol will also promote cell turnover, strengthen capillaries and encourage collagen synthesis. Benzoyl peroxide, when applied to affected areas, will release oxygen deep inside clogged pores to breakdown the skin and sebum, while healing, preventing incidents of scarring, and diminishing p. acnes bacteria.
• Rebuild and protect – epidermal growth factor is essential for acne clients to use in any daily program. It will help promote the growth of new, healthy cells. Allantoin is a keratolytic agent that increases hydration in the extracellular matrix and enhances the desquamation of dead cells in the top layers. It increases cell proliferation, promotes wound healing and supports smooth, moisturized skin. It also soothes, protects and acts as an anti-inflammatory. Every client must be educated on the value of a good zinc-based SPF formula to protect and support overall skin health.

Other highly beneficial ingredients include totarol and eucalyptus oils. Totarol eliminates bacteria and provides antioxidant support, and is extremely effective in treating acne. Eucalyptus oil delivers potent antiseptic action and is highly therapeutic.
All of this said, there are many ingredients and topicals (too many to list in this article) that will support a skin facing the challenge of acne. That is the good news! We have many tools available to manage this disease that confronts millions of people.
Finally, caution clients not to perform extractions at home as improper technique may lead to deeper impaction, inflammation, pigmentation issues or scarring. My primary goal when working with an acne client was to get them through it unscathed. I assured them that while I could not stop what was going on internally, I would be there with them through the challenge, and if they followed my suggestions, we would prevent scarring. This is really, at the end of the day, what we want – to manage the breakouts so that no pitting and long-lasting damage is evident. With all of the customizable choices and wonderful undercover creams for guys and gals, we can get our clients through these difficult times.
While managing acne is not an overnight crusade, reassure clients there are solutions out there and with their commitment, the two of you can work together to achieve healthy, smooth, radiant skin.

Rhonda Allison, a pioneer in the skin care industry, is the Founder and CEO of Rhonda Allison Cosmeceuticals and RA for Men. She is also an author and internationally known speaker with more than 30 years’ aesthetic experience. www.RhondaAllison.com and www.RAmethod.com