Second only to anti-aging treatments, I think that acne treatment is the greatest client concern today. So we must raise the bar for ourselves, and learn, for instance, when and how to exfoliate acneic skin, whether extractions are ever appropriate, and when the severity of the condition mandates a referral to a medical doctor. Because acne scars both psyche and skin, these are not decisions to be made lightly; as always, ongoing education is the key.
Skin therapists and dermatologists will agree, I think, that the condition is still imperfectly understood. Yet its omnipresence demands that skin therapists learn how to talk with clients about acne, how to analyze the condition in terms of its severity, and how to treat it successfully with every tool and method available to us, including some alternative therapies such as Chinese Facial Diagnosis, upon which the most advanced skin analysis and consultation are partially based in the U.S. as well as in Asia.
We do know this for sure: there are at least three clear contributing factors to Acne Vulgaris (this doesn't mean you're a vulgar person, by the way-the Latin simply means commonplace, which has never been more true). There appears to be a strong genetic or inherited element, about which we can do nothing. External or topical factors also contribute significantly, and these are among the easiest to control through hygiene and treatment.
Then there are the internal factors which do not appear to be inherited. The most obvious of these factors is hormonal. According to the ancient Chinese system, each area of the face corresponds to an internal organ. For instance, the ears correspond to the kidneys; the cheeks correspond to the lungs. Thus, if the ears are red and hot, there may be distress (what the Chinese would call heat, or some other imbalance) in the kidneys. Additionally, each of these internal organs is also associated with a specific emotion. For instance, the kidneys are associated with fear, while the lungs are associated with grief. Truly, the implications are staggering.
We are just scratching the surface here of a vast, subtle, and exquisitely nuanced system of approaching client health. But given that many or most of your clients are female, pay special attention to where and when her acne outbreaks occur. Keep a very specific face-map and record. It is worth noting that if female clients have repeated outbreaks around the mouth and chin, all areas associated with a woman's reproductive organs and functions, the implications are very different than if the outbreaks were on the back or chest. (Just for the record, outbreaks on the forehead would be associated in the Chinese system with the liver-signaling perhaps too much rich food on a physiological level, as well as unresolved anger on an emotional level).
Skin therapists are neither sociologists nor psychologists, but we can all benefit from even the most superficial knowledge of the Chinese system in terms of sharpening our powers of observation and consultation. Always start with the superficial. Someone with persistent acne may be bringing some of it upon themselves by contaminating and agitating the epidermis in some way, and repeatedly introducing bacteria or other irritants to the skin.
Adolescents often unwittingly do this in their sleep. Teens love hair-styling products-pomades, pastes, styling muds, sprays, etc.-and these sticky, gooey, gummy, occlusive and comedogenic products often end up layered upon their pillowcases, into which they mash their lovely young faces for seven, eight or more hours each night. Prolonged contact with these products in tandem with the tumultuous hormonal cascades of puberty can indeed exacerbate a tendency toward acne. Likewise, clients who use fabric softeners may experience the same: the fabric softener coats the fiber of the pillowcase with a waxy substance, which is an irritant to the skin for many people, especially when it is heavily fragranced!
Prescriptive nutrition is an area where there is virtually no professional agreement, so I don't recommend making any hard-core judgments or offering any "absolute" advice. However, suggesting that a client give up each of these foods in sequence (not all at once-you want to observe changes based on eliminating each potential source of acneic aggravation) as a sort of informal acne-allergen exercise can't hurt, and may uncover valuable insight.
We live in a pharmaceutical age, and there is no turning back. Speaking as a mother, there have been moments when I have been immensely grateful for Western medicine: sorry, but a two-year old with a raging 102-degree fever and an ear infection will not be helped by quartz crystals, chanting, or burning sage. That said, powerful drugs ranging from birth control pills to antibiotics are often prescribed by MDs for acne. There are instances when this is absolutely appropriate and necessary, but I would like to encourage skin care professionals not to regard these drugs, which may have side-effects in the long-term, as the best or only treatment. Perhaps the real wisdom of studying Chinese Facial Diagnosis is not the technical expertise and interpretative framework which it offers, but the technique of sophisticated analysis and looking beyond the surface which it encourages in the practitioner. When you look at a client's forehead under a mag lamp, do you know you're reading the journal of her childhood?