Unfortunately, many acne clients have already made poor choices regarding the treatment of their skin, while others are on the verge of forming future bad habits.
Psychologically speaking, a typical person with problem skin will explore and exercise any means believed to suppress, or eliminate the objective signs of acne. It is for this reason certain fundamental points should be outlined with a client when discussing what to avoid during at-home treatment of problematic skin.

Habits to Avoid:

Squeeze papules – Papules are essentially pores that have become irritated, red, and swollen generally due to hormonal factors. This type of lesion can form into a pustule after the body’s immune system has successfully destroyed underlying bacteria, but the papule itself is merely the beginning stage of a pustule. It is important, therefore, to explain to acne clients that a papule does not contain pus or any other form of dead matter, and will only cause unnecessary pain when squeezed. 
Self-extract pustules – Unfortunately, many individuals believe the only option for blemish control is squeezing. While a pustule is the advanced form of a pimple, where the immune system has destroyed bacteria and pus-formation is present, clients should never attempt self-extraction. 
If a person tries to extract a pustule via extrafollicular pressure, they may have initial success in emptying the pore of debris; the popping sensation commonly associated with self-extraction, however, could potentially be the rupturing of a follicle. When a follicular wall is broken, this allows pus and any remaining bacteria to spread beyond the confines of the pore, significantly increasing the likelihood of pit scar formation and other deep tissue damage. As with papules, clients should be warned to never squeeze… period!

Touch and scratch lesions – Though acne lesions are generated by the skin as an immune response to bacteria, skin bumps are still seemingly extraneous to most people. As with most foreign objects, it is only natural for the human mind to be drawn, whether consciously or subconsciously, to the object. 
Well the urge may be there, but continually touching lesions is still a major no-no. When a client touches a blemish there is no guarantee that hands are clean or free of excess oil, dirt, or bacteria. Repetitively making contact with an already irritated spot could transmit more oil or bacteria to the lesion, causing persistent inflammation. 
Occasionally scratching acne lesions is not uncommon, but this is another activity we want clients to avoid at all costs. While the client may believe that scratching diminishes the appearance of a pimple, or encourages the spot to go away quicker, this in fact does just the opposite. Scraping a lesion will cause a spot to become inflamed, exposing the area to any secondary bacteria that may be living under the fingernail. This usually results in a prolonged healing process and may make a blemish’s appearance more obvious by causing hyperpigmentation. It should also be noted that individuals who habitually scratch and pick at lesions run a high risk of developing ice-pick scarring (characterized by deep puncture-like depressions). 
If the aesthetician encounters a client that obsessively scratches lesions, generally noted by elongated scrapes, scars, and darkened pigment, the therapist may be dealing with acne excoriée. This issue is of a neurotic origin and is considered a form of obsessive compulsive behavior. An aesthetician is very limited as to how they may inform the client in controlling this matter, short of recommending psychiatric care. In general, it is best to avoid contact with such lesions and refer the client to a dermatologist for medical treatment. 
Use harsh astringents – Isopropyl alcohol, the key ingredient in many commercially available astringents, is noted for its drying properties and is commonly accepted within the skin care industry as being an irritant. 
The perifollicular inflammation caused by the drying action of isopropyl alcohol can obstruct a pore and block oxygen from reaching the base of a follicle; this in turn presents an ideal opportunity for bacterial proliferation, as propionibacterium acnes thrive in an anaerobic environment. Aside from this, an individual may experience subjective itching, pain, and redness from barrier function difficulties caused by astringent. It is for such reasons that astringent use may prove to be a counterproductive measure in treating acne. 
Tan – A common misconception among the general public is that regularly visiting a tanning salon will help reduce, or clear acne lesions. While this method may have proven effective for some individuals, tanning is not an ideal system for clearing problem skin. 
Many believe tanning will help boost the body’s immunity in order to better combat acne bacteria, when in truth, exposure to ultraviolet light causes the body’s immune system to become less resistant to antigens by inhibiting macrophage activity. When UV light is absorbed into the skin, irritation and subclinical inflammation occurs as a result, thus making any swollen acne lesions worse. 
It is true that UV light has antibacterial properties; it is also true that prolonged exposure will cause photo-damage and inflammation leading to premature aging. None of the aforementioned results of UV exposure is beneficial to acne skin. In other words, do not tan!

Use products not intended for skin – A client may resort to using personal-care commodities, food products, or any other non-skin care items in a desperate attempt to rid the skin of problem areas. For instance, an old remedy for clearing a pimple is to dab a bit of toothpaste on a lesion and wait overnight for the product to work as a spot treatment. 
This “alternative” form of treatment is a fluke if it works. While toothpaste does in fact contain antibacterial ingredients, this product cannot be recommended for use on acne lesions. Why? Because toothpaste is an oral dentifrice intended for use in cleaning a person’s teeth, and is not FDA approved for the topical treatment of acne. Irritation and inflammation is more likely to occur than blemish clearing. Besides, we certainly do not want our clients using mouthwash as toner and dental tools as comedo extractors.
Combine multiple products (product abuse) – Product abuse is another extreme measure many people may take in what seems to be an uphill battle with acne. For instance, say you have a new client who went to the dermatologist to receive to receive medical treatment for her acne. The doctor prescribed Retin-A to be applied as a topical spot treatment and tetracycline to be taken orally. A week before her doctor’s appointment, she visited your facility, received her monthly treatment, and purchased professionally recommended acne products. You were not made aware, however, that she would be visiting a dermatologist or that she had purchased several topical acne products from the local grocery store. 
After your client decides that Retin-A and tetracycline is not working fast enough, she begins to use a few professional products more frequently than advised. When her skin does not respond as originally thought, the products bought at the grocery store are then added to the equation. Before too much time, your client’s skin is irritated, inflamed, and altogether worse than before she began her new self-constructed “super-regimen.” 
Whether products are prescription, commercial, or professionally recommended, product abuse is never a good scenario. The end result is typically a damaged barrier function with flaking and inflammation. This severely compromised barrier then allows surface bacteria to have easier access to pores, usually causing acne to worsen. 
Therefore, it is important that clients be cautioned to never mix commercial items with products chosen and recommended by professionals. Clients should also be informed to make the aesthetician aware of any new prescription medications they are taking, so that appropriate changes can be made to the current skin care regimen.

Hide blemishes with comedogenic products – When a person with acne feels inadequate about their social image, masking the problem is a typical result. Unfortunately, if acne is being covered with pore-clogging cosmetics, the problem can become much worse. Many mass-marketed makeup products are oil-based and have a very emollient consistency. The occlusive quality of such cosmetics may not allow acne skin to aerate sufficiently, thus fueling bacteria by providing food (fatty acids from sebum) and not allowing much needed oxygen to enter pores. 
The thick consistency of many commercial makeup products also hinders the acne skin’s ability to desquamate, causing surface hyperkeratosis (topical retention of dead skin cells due to excessive oil). When these factors mix with the client’s genetic tendency to break out, an acnegenic reaction is likely to occur. 
Note: Non-comedogenic refers to any product that is thoroughly tested and verified to not clog follicles. Some skin care companies claim a formulation to be non-clogging simply because the end-product was not formulated with known comedogenic ingredients. A formulation cannot accurately be confirmed as non-clogging, however, unless the end-product was tested for comedogenicity by an independent third-party institution. 
It is very important, therefore, that acne clients who use makeup be advised to purchase cosmetics that have been documented non-comedogenic. Many spa-grade makeup brands and mineral cosmetics suffice as healthy alternatives. 
Buy into miracle cures – Gadgets, gizmos, and more importantly… gimmicks! It should be recommended to clients, and aestheticians alike, to avoid anything that sounds like an overnight fix to an issue requiring a series of treatments with at-home maintenance. 
Prior to my training in skin care, I recall a television commercial from the mid-90s advertising a small handheld device that produced an electrical current. The concept was that the machine would generate a mild electrical impulse when the metal aspect of the handheld attachment made contact with a blemish. The low-level current would internally travel to the base of a blemish, killing acne bacteria and causing the unsightly spot to disappear within days. All the user would experience was a mild discomfort. 
It may be cliché, but if something sounds too good to be true, it probably is! An aesthetician should always make it clear to an acne client that they are not dealing with a problem that can be fixed overnight. It is important to remember that regular at-home treatment is essential to gaining control over problematic skin, but cannot be effective if the client establishes or continues any counter-productive habits. 
So in general, what should the acne client be advised to do throughout the course of at-home treatment? Acne clients should: 
Use moderation – follow product guidelines as directed; no more, no less.
Replace mass-marketed with professional-recommended – a professional will generally recommend products known to produce results. Commercial products are not all bad, but may not be the ideal solution to a client’s problem. 
Be willing to commit to a regimen – there is no single product that can fix acne. Clients must use a series of products over a designated period to truly see results.
Maintain contact with the aesthetician – if a problem should arise, the client needs to feel comfortable to call the professional to seek advice or treatment. If the client is feeling the urge to squeeze a lesion, for example, they might call the aesthetician and schedule a special extraction session or mask application as a healthy alternative. 
Learn – obtaining information about acne will arm a client with the needed knowledge to take on the problem skin condition head-on. 
While the causes of acne are numerous, the effects of the condition can go far beyond a simple imperfection. Skin therapists should make every effort to understand both the physiological and psychological ramifications of the condition. Just as acne has different severities, affected people will have varying self-opinions and will attempt different methods to erase the objective effects of the condition. Advice offered to clients should not only cover appropriate products and techniques, but habits and activities to avoid as well. 
All in all, it is essential for the professional to arm their self with knowledge and always be ready to offer healthy, skin-friendly advice to people with acne.

Eli Jones is a renowned North Carolina aesthetics educator who currently serves as Director of Education for Mark Lees Skin Care in Pensacola, FL. With his years of experience as an undergraduate instructor, and well-established reputation in clinical skin care, Eli has worked to help students gain a better understanding of skin therapy from basic to advanced levels.