Slacking on homecare and abandoning lifestyle changes once the acne clears will lead to the formation of micro-comedones deep in the follicles and full-blown acne in less than three months. Keeping in close contact with acne clients every month or two helps the professional monitor homecare product compliance, discuss the lifestyle issues that affect acne, assess the need for professional treatments, and provide product refills – a solution where everyone benefits.

1.  Stress – The wear and tear of daily living and the changes that take place in a person's life can cause stress; every effort should be made to reduce that stress. Lack of sleep causes severe physical stress and makes it difficult to control acne. Night shift jobs, broken sleep, social media, cell phone notifications, sleeping with infants or small children, insomnia, hormonal changes in mid-life, and long plane trips or crossing time zones are all examples of stressful sleep environments. Most adults need at least seven hours of sleep.

2.  Cosmetic Ingredients and Fragrances – Clients should avoid comedogenic hair and body products and sunscreens that contain tropic oils and fragrances. Clothing and workout wear should be cotton or a cotton blend and laundered in fragrance-free detergent with no fabric softener.

3.  Clothing – Clients should choose laundry products that are free of perfume and dyes and avoid fabric softeners, especially waxy sheets. Launder all new clothing and bedding at least twice to remove any toxic chemicals used during the manufacturing process to cut down on mold, wrinkling, and insect infestations when they are stored and shipped in containers, especially from overseas. Most imported clothing is sprayed with toxic fungicides, pesticides, and formaldehyde, which can cause body acne, skin infections, and rashes.

4.  Foods and Supplements – Foods and supplements that can incite inflammation include iodized sodium, hormones and/or inflammatory substances found in dairy, peanut products, fast food, processed foods, salty snacks, soups, sports drinks, supplements that contain biotin, maca root, conjugated linoleic acid, spirulina, seaweed, kelp, algae, chlorella, iodine, testosterone precursors, and protein drinks that contain whey and sea plants. Sugar and simple carbohydrates intake is a major concern for diabetics, pre-diabetics, and clients who are insulin-resistant, or have a condition like polycystic ovarian syndrome. Out-of-control sugar can mean out-of-control acne.

5.  Picking, Scrubbing, and Skin Tampering – Picking acne pushes pimples deeper into the follicle, slows the healing process, introduces airborne bacteria, invites secondary infection, and causes hyperpigmentation and scarring. The larger red or brown blemishes from picking take longer to heal and fade and often cause permanent scarring. Compulsive picking can even damage the basal layer and cause a permanent loss of skin pigment. Hot showers and over-scrubbing can make existing acne more inflamed, cause severe irritation and rebound oiliness, and make it difficult to tolerate homecare products.

6.  Acne Washes – Acne washes do not work well as stand-alone acne treatments because they are on the skin for such a short time. They do, however, help pre-exfoliate the skin so leave-on acne products can be better absorbed. Body cleansers contain benzoyl peroxide, salicylic acid, mandelic acid, glycolic acid, and sulfur. Take shorter showers in warm water, cleanse gently without scrubbing, and blot the skin dry. Do not stand close to heat sources.

7.  Pressure, Friction, and Occlusion – Acne mechanica can be caused by restrictive clothing, tight bra straps and bands, heavy shoulder bags and backpacks, occlusive workout wear, putting too much pressure on one side of the buttocks while sitting, and over-scrubbing and rubbing with a towel. To avoid irritation, wear looser clothing made from natural fibers and shower immediately after workouts.

8.  Sun Exposure and Tanning – Sun exposure damages the follicles over time and causes increased clogging, skin cancer, and severe skin discoloration. Post-inflammatory hyperpigmentation can be addressed gradually with peels and topical skin brighteners. Solar lentigines – the brown spots caused by direct, prolonged exposure to ultraviolet rays – do not respond well to topical skin care and require laser treatments that selectively target brown pigmented lesions on the surface and in the dermal layer. These treatments must be repeated as new spots surface and are not appropriate for all skin tones.

9.  Skin Peels and Back Facials – Professional treatments boost homecare efforts and help produce faster results. They exfoliate dead skin cells, help fade dark spots left by residual acne, and make extractions of pimples and blackheads easier to perform. Glycolic, lactic, and mandelic acid peels are safe and effective when chosen carefully according to sensitivity, homecare used, peel percentage, and pH. Back facials using enzymes and steam help exfoliate surface cells, soften impactions, and leave the skin smooth and hydrated. Enzyme peels provide an alternative for those unable to tolerate alpha hydroxy acid or beta hydroxy acid peels. When performed correctly, light chemical peels and enzymes are generally safe for sensitive skin, darker skin tones, and dry skin. Brushing techniques and microdermabrasion create friction and can aggravate active acne.

10.  Topical Skin Care Products and Lifestyle Changes – Benzoyl peroxide is possibly the most effective acne medication available and differs from other topic acne medications because it has the ability to penetrate deep into the pores, release oxygen, and the kill P.acnes bacteria. Benzoyl peroxide also causes a desirable peeling effect deep in the follicle, inhibiting the formation of new comedones. A 10 percent benzoyl peroxide medication can be applied to the affected area at bedtime after a gentle cleansing and allowed to dry. If the ingredient is used, bedding and clothing must be white and laundered in fragrance-free products with no fabric softener sheets. The benzoyl peroxide should be showered off in the morning and should not be worn in sunlight or if one expects to perspire. The skin will rapidly acclimate to benzoyl peroxide and dryness will subside if it used consistently. In the absence of irritation, a topical alpha or beta hydroxy acid gel can be introduced and applied during the day. Mandelic acid is a good choice because it exfoliates with minimal irritation, has antibiotic properties, and can help brighten dark spots. Because the chest and back produce a large amount of oil, salicylic acid is another viable choice as it helps emulsify sebum, de-clog the pores, and inhibit bacteria. Since the sun can darken acne blemishes, avoid unnecessary sun exposure. Apply a non-comedogenic sunscreen when outdoors and reapply often.

Kathryn Leverette is a licensed aesthetician, acne specialist, and ethnic skin care expert in the San Francisco Bay Area. Her skin care practice, Clinically Clear™ Skin Rehab Center, is dedicated to acne, pigmentation, and ethnic skin.