Under normal circumstances, acne can affect up to 50 million people in the United States.It can also be found in adults with over 50% of women and 40% of men suffering from acne in their adult years.1 This increase in acne has caused the number of acne incidences to become quite high.

Increase in stress can also cause acne exacerbation due to hormonal imbalances and increase in cortisol – the stress hormone.Recent studies have shown that stress levels have never been so high. According to one recent study, nearly seven in 10 employees indicated that the coronavirus (COVID-19) pandemic is the most stressful time of their entire professional career, resulting in marked increases in new prescriptions for antidepressant, anti-anxiety, and anti-insomnia medications.2

AVOIDING ISOLATING CLIENTS

Isolation and closure of skin care facilities have left many clients with untreated skin care concerns.If their concerns are serious, such as cystic acne and scarring, they may turn to the internet for advice.Many professionals have seen how unscrupulous professional product providers are selling professional trichloroacetic acid (TCA) peels to unlicensed individuals over the internet.TCA chemical peels are mid-level peels that involve applying trichloroacetic acid to the skin and must be performed in a medical setting. They are done on an outpatient basis but may require light sedation depending on the concentration of the acid used. Although TCA peels are applied in the same way as milder peels, the acid used in these peels is much more potent, causing a more significant burn. 

It is for this reason that skin care professionals must keep in contact with their clients, especially if they are in the midst of acne events.Professionals must advise on at-home treatments, as well as continued treatment at the spa.

Likewise, it is important to review the information on the most efficacious ingredients to treat clients’ skin concerns.While aestheticians cannot treat or diagnose medical conditions, there are many ingredients that can lessen the appearance and reoccurrence of breakouts.

OILY & PROBLEMATIC SKIN

When people think of this skin type, they think of teenagers, but it can affect many people through adulthood as well.Typically, teenage, problematic skin is triggered by hormonal changes brought on by puberty, specifically increased fluctuations in androgens, such as testosterone.This, in turn leads to an increase in sebum production which can start a cascade of events that lead to problem skin.

Environmental factors, increased stress, and hormonal fluctuations can all contribute to an increase in oily, problematic skin in all age groups.Adults with this skin type can be caused by fluctuating hormones as well, especially around menstruation, during pregnancy, after discontinuing or starting birth control pills, and at the onset of perimenopause.

PERIMENOPAUSE

Some estimate as many as half of all adult women experience some form of oily skin due to an increase in androgen and a decrease of estrogen in perimenopause.Perimenopause is the time period during which a woman’s body is transitioning to loss of fertility or menopause.A woman can enter perimenopause at different ages, usually occurring in the mid-40s but can begin as early as their mid-30s.It is during this time that there is a gradual shutdown of the ovaries, in which important hormonal changes take place.The woman’s body is thrown off balance due to the declining production of the dominant female hormones such as B-Estradiol, a common estrogen and progesterone.Although women produce only a small amount of the male sex hormones (androgens) due to the depletion of estrogen and progesterone, the effects become more dominant.This can lead to skin becoming excessively oily, as well as excessively dehydrated during different times of the month.

Hormonal fluctuations can be addressed internally by a medical doctor.For cases of moderate to severe acne or when acne manifests due to hormonal imbalances such as pregnancy or perimenopause, it is recommended to supplement facial treatments with a medical consultation to address hormonal challenges. 

FACTORS TO RECOGNIZE

With oily skin, there are three factors that contribute to the formation of acne: sebum, bacteria, and enclosure.Sebum is an oily substance that lubricates the surface of the skin and prevents surface dehydration. When there is an overabundance of sebum production, it fills the sebaceous duct. This extra sebum serves as nutrients for bacteria, which creates an environment for clogged pores (blackheads).This environment can invite and harbor harmful bacteria which can draw white and red blood cells to the area, causing inflammation and infection.Enclosure occurs when the wall of the sebaceous duct thickens with the formation of a keratinaceous or horny plug, which prevents the flow of sebum creating a closed environment, leading to blackheads and whiteheads.These can then lead to inflammation caused by the body’s response and eventually rupture the wall of the follicles to form pustules and cysts.This environment can lead to the proliferation of Propionibacterium acnes (c. acnes), a type of bacteria linked to acne.

It is known that overzealous cleansing and the treatment of acne can exacerbate the condition, particularly with harsh soaps.Soaps are made of alkali and fatty acid, with a pH ranging from nine to 10, usually more acidic than the natural acid mantle of skin.Daily use of harsh soap can compromise the skin barrier of the stratum corneum, resulting in transepidermal water loss (TEWL). 3

 On top of this, many acne clients will use exfoliating products, such as scrubs that are irritating, aggravating,and highly alkaline. It is important to use professional treatments designed and formulated to balance the condition, thereby keepingc.acnes at bay. These treatments should provide proper moisture level, as well as help in the reduction of pore sizeand result in hyperpigmentation due to scarring.

Key ingredients to look for in professional acne products and treatments include:

• seaweed
• zinc
• nicotinamide (also known as niacinamide)
• sulfur

• willow bark extract
• clays and muds
• diatomaceous earth
• ichthammol
• kojic acid

• tea blends
• calcium carbonate
• calamine

STRONGER ACNE INGREDIENTS

Alpha Hydroxy Acids

Alpha hydroxy acids are a group of hydroxy acids including glycolic, lactic, and citric acid. They work by thinning the stratum corneum, which removes surface layers of the skin, reduces dark spots and hyperpigmentation, and increases collagen synthesis within the dermis.Acne clients can see improved results with usage when combined with antibacterial and topical retinoids.4

Because alpha hydroxy acids promote desquamation and decrease corneocyte clumping, this prevents the formation of acne lesions andcomedones. Higher concentrations of alpha hydroxy acids (8% to 10%) can lead to both desquamation and the thickening of the dermis, while concentrations of 30% used in superficial peeling may help with persistent closed comedones.5

Mild peels can be performed at-home using low percentage glycolic acids, including lactic, citric, tartaric, marine, and fruit acids.These should have the optimum pH of three and a half, no more than 8% acid.These acids should be buffered with anti-inflammatory and antioxidant, ingredients such as seaweed extract, chamomile, and green tea.

Used in succession for up to 14 days, these can have a great effect on the skin; although, they only work on the very upper layer of skin.While not painful and have minimal side-effects, the results are not as long-lasting as professional or medical medium to deep peels.However, this peel can be performed repeatedly once a month, based on age and skin condition for ongoing, consistent results.

Beta Hydroxy Acid

The most common beta hydroxy acid is typical salicylic acid, an ingredient used in the treatment of acne.It is particularly effective because it is lipophilic (meaning it is oil-soluble and able to penetrate through sebum), making it effective in everything from cleansers to astringents and targeted lotions and creams.It is a natural keratolytic, helping to dissolve keratin plugs in the follicle.It is also able to seek out sebum and decrease comedone production, which significantly reducescomedone formation.6Over-the-counter salicylic acid acne treatments include concentrations of 0.05% to 5%. Higher concentrations are used for prescription medications and chemical peels. 

Benzoyl Peroxide

Benzoyl peroxide has been used in the topical treatment of acne for many years because of its keratolytic properties.Its ability to break down comedones and its antibacterial properties are noteworthy.Studies have found that benzoyl peroxide, when combined with a topical antibiotic,helps increase the antibacterial effect on c. acnes, in addition to a decrease in the emergence of new acne lesions.7

When selecting a benzoyl peroxide product for clients, start with a 2.5% concentration, as it causes less drying and irritation.Then move to a 5% concentration if minimal results are achieved after six weeks.

Retinol

Retinoids are a group of compounds derived from vitamin A.These compounds play important roles in biological and physiological functions including vision and tissue maintenance.Retinoids increase cell proliferation yet have a normalizing effect on the epithelium cells.8 Retinols are also antioxidant, helping protect against the damages of free radicals, as well as helping to promote collagen production. 

Vitamin A also can decrease inflammation and inhibit sebum production. Retinol and Retin-A do the same thing.Retinol is much weaker than Retin-A because it first must be converted into retinoic acid in order to be used by skin.9

Varying percentages of retinol can be used in skin care treatments. Percentages of 0.01% can be used at home to reduce the appearance of pore size. Retinol used at 0.04% to 0.1% may help speed up the process, showing results sooner, whereas a higher percentage of up to 1% can help with more recalcitrant symptoms of acne.

During these unprecedented times, clients need guidance, expertise, and knowledge more than ever.Make it a goal to stay in contact with them, to guide them through breakouts and skin concerns.Provide service remotely and at the spa and recommend proper skin care at home.This will not only benefit the client but the spa business as well. 

References

1. LorenCordain. “Acne Vulgaris.”Archives of Dermatology. JAMA Network, December 1, 2002.https://jamanetwork.com/journals/jamadermatology/fullarticle/479093#:~:text=ACNE%20AFFECTS%20between%2040%20million,individuals%20in%20the%20United%20States.&text=Although%20acne%20mainly%20affects%20adolescents,men%20older%20than%2025%20years.
2. “How Has COVID-19 Affected Mental Health, Severity of Stress Among Employees?” AJMC. Accessed January 27, 2021. https://www.ajmc.com/newsroom/how-has-covid19-affected-mental-health-severity-of-stress-among-employees.
3. Decker, Ashley, and Emmy M Graber. “Over-the-Counter Acne Treatments: A Review.” The Journal of clinical and aesthetic dermatology. Matrix Medical Communications, May 2012. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3366450/.
4. 4.BK;, TungRC;BergfeldWF;VidimosAT;Remzi. “Alpha-Hydroxy Acid-Based Cosmetic Procedures. Guidelines for Patient Management.” American journal of clinical dermatology. U.S. National Library of Medicine. Accessed January 27, 2021. https://pubmed.ncbi.nlm.nih.gov/11702315/.
5. 5.A;, Kaminsky. “Less Common Methods to Treat Acne.” Dermatology (Basel, Switzerland). U.S. National Library of Medicine. Accessed January 27, 2021.https://pubmed.ncbi.nlm.nih.gov/12566807. /
6. 6.“Home - PMC - NCBI.” National Center for Biotechnology Information. U.S. National Library of Medicine. Accessed January 27, 2021. https://www.ncbi.nlm.nih.gov/pmc/.
7. 7.EadyEA;BojarRA;JonesCE;CoveJH;HollandKT;Cunliffe WJ; “The Effects of Acne Treatment with a Combination of Benzoyl Peroxide and Erythromycin on Skin Carriage of Erythromycin-Resistant Propionibacteria.” The British journal of dermatology. U.S. National Library of Medicine. Accessed January 27, 2021. https://pubmed.ncbi.nlm.nih.gov/8745894/.
8. 8.Gans, LH, and EHKligman. “Re-Emergence of Topical Retinol in Dermatology.” Taylor & Francis, 2000. https://www.tandfonline.com/doi/abs/10.1080/09546630050517685.
9. 9.Leyden, James, Linda Stein-Gold, and Jonathan Weiss. “Why Topical Retinoids Are Mainstay of Therapy for Acne.” Dermatology and therapy. Springer Healthcare, September 2017. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/.

Lydia Sarfati is an international industry leader, with over 46 years of experience as a spa owner, consultant, and aesthetician. She is the founder and CEO of Repêchage, the first company to bring seaweed-based skincare treatments to the United States market and is the President of CIDESCO Section U.S.A, the world's major international beauty therapy association. She appears at industry tradeshows, is the author of “Success at Your Fingertips: How to Succeed in the Skin Care Business” and “The Repêchage Book of Skincare Science & Protocols”, and is a contributing author to textbooks, such as “TheMilady Standard Esthetics: Fundamentals, Twelfth Edition, and Oncology Esthetics.”