Nearly 85% of people will experience some form of acne during their lifetimes. According to the American Academy of Dermatology (AAD), acne is the most common skin disorder in the United States, affecting 40–50 million Americans at one time.¹ When people think of acne, they think of teenagers, but acne can affect many people throughout adulthood, as well. Some estimate as many as half of all adult women experience some form of acne due to an increase in androgen and a decrease in estrogen during perimenopause.

Looking good and feeling good go hand in hand—this is why it can be so difficult for clients who suffer from acneic skin. Acne can have a devastating effect on self-esteem and confidence, and many acne sufferers withdraw socially and even experience depression. The good news is that most acne can be treated with outstanding results. Treating acne can be one of the most rewarding experiences for you as an esthetician.

Acne is an inflammatory lesion of the sebaceous glands and the first signs usually show up during puberty when there is an increase in the hormone androgen, which is especially active in stimulating the amount of oil produced by the sebaceous glands in the skin. This results in the extra production of sebum that combines with dead skin cells and other debris and becomes trapped, creating a plug that blocks the hair follicle. As the ducts of these glands become plugged with the waxy oil, comedones (blackheads) and milia (whiteheads) form. They are frequently infected with bacteria, causing welts, deeper lumps and pimples.

Sebaceous glands are the glands situated at the root of the hair follicle in the dermis. They can be found all over the body, except on the palms of the hands and the soles of the feet. These glands secrete sebum or oil. When the oil is mixed with perspiration, the skin’s surface becomes slightly acidic. This keeps some bacteria and fungi from embedding in the skin and, at the same time, helps to retain water in the tissue by slowing down evaporation from the skin. When the sebaceous glands are stimulated, a process known as retention hyperkeratosis occurs. This may be triggered by the onset of puberty, hormonal fluctuations, pharmaceutical agents, stress, heat and humidity.

In acne, the dead cells stick together, along with excess sebum and bacteria, to form an impaction plug. This first stage impacted follicle is often referred to as a microcomedone. As the bacteria digest the sebum, they produce fatty acid waste products that irritate the lining of the follicle, causing a proliferation of cells to accumulate in the impacted follicle. At this point, the disease may result in noninflammatory lesions, and simply produce closed comedones. When they eventually turn into open comedones and expel their contents, inflamed lesions may also result, whereby the follicle wall ruptures forming a papule. White blood cells invade the area and inflammation ensues. If the break is close to the surface of the skin, a pustule results—if it is deeper, a nodule forms. In some cases, a membrane entraps the infection and a cyst forms.

There are three factors that cause acne: sebum, bacteria and enclosure. When you encounter these factors together, it creates an environment for inflamed, irritated and congested skin.

Today, acne can be treated without the harshness and discomfort of traditional treatments that leave the skin red and irritated. First, to treat any form of acne, you have to deal with the three main factors—sebum, bacteria and enclosure. This can be done by using a three-tiered approach of professional esthetic treatments, a home care program and a healthy diet that includes nutritional supplements. Acne-prone skin can be addressed by controlling the excess sebum production and maintaining a proper moisture level.

Prevention often is not enough to avoid the mainfestation of acne, however, so when it does occur, there are several methods that can be used to remove acne lesions. Desincrustation is the process of softening the keratinaceous horny plug that allows extractions to proceed easily with minimal trauma to the surrounding tissue.

Manual extractions using vinyl gloves and wrapped index fingers are a very effective measure in removing comedones. If they don’t remove immediately when using slight pressure from side to side, use alternating angles to gently lift the comedone. Another gentle and effective way to remove a comedone is with sterile cotton swabs. If the contents are not expelling, simply go to another section and leave it for the next treatment. Remember that comedones did not occur in one day and, many times, it will take more than one treatment to clear up all of them.

Estheticians also can remove closed and open comedones and milia with the use of lancets. The use of lancets, however, is not approved in all states, so check with your local state board to confirm whether it is permissible. However, cysts and nodules must be treated by dermatologists. As an esthetician you can still administer acne treatments that will help cystic skin, but you won’t be able to remove those lesions. (Editor’s note: The contact information for each state board can be found at www.SkinInc.com/education/statelicensing.)

High frequency is an excellent and versatile tool for the esthetician to use when dealing with acne. This electrical unit contains an electrode that uses UVC germicidal rays and has antibacterial properties. The machine also decreases inflammation, allows for faster healing time for lesions and helps prevent secondary infections. Although high frequency is a great tool, it should not be used on clients who are pregnant, who have high blood pressure or a heart condition, who have epilepsy or asthma, or those with braces, metal implants or heavy dental work. See How-to: Acne Skin Treatment for step-by-step instructions about how to offer this service in your spa.

Knowledge is the key to treating acne. Educate your client about the importance of in-spa treatments, as well as following a home care program designed especially for them. Inform clients that picking and squeezing pustules will only make their acne worse because picking can spread acne-causing bacteria and squeezing can result in pushing infected material deeper into the skin, causing more inflammation and even scarring.

Another misconception is that acne can simply be washed away, but over-washing will further irritate the skin. Educate your clients about the myths of acne, such as acne is caused by chocolate. There is no evidence to support that claim. Maintaining a healthy lifestyle, home care program, nutritional supplements and professional acne treatments will lead to healthier, more radiant skin at any age.

1. www.aad.org/media/background/factsheets/fact_acne.html