Q: I have some success with my acne-prone skin, but after I’ve achieve some clearance, I seem to have reached a “treatment plateau”— my skin just stops staying clear. What can I do to help achieve long-term acne clearance and control?
A: Acne and other congested skin problems are conditions frequently seen in our treatment rooms. Acne and clogged pores (congestion) have a strong group of genetic factors that must be kept in mind when successfully treating problem skin.
While acne is not completely curable, control over these genetic factors, and other outside factors such as consistent treatment by both the esthetician and the client, is vital for continued and long-term clearance.
Acne-prone skin has a predisposition to retention hyperkeratosis, a genetic condition in which dead cells do not shed from the epidermis as normal skin would. This results in cell buildup on the skin and inside the follicles. This excess of dead-cell accumulation combines with excessive sebum (oil) produced by the sebaceous glands and results in follicle congestion, which blocks oxygen from entering the follicle. The follicle needs to be clear to provide aeration (emersion in oxygen) that will kill off anaerobic (propionibacterium acnes) bacteria. Excessive sebum production is also genetic. While we can use treatments and have the client use products that help with both cell buildup and oiliness, we can’t change the client’s genetics. Therefore, treatment must be consistently performed both in the treatment room and at home using a good product program to achieve continual clearance.
CLEARING THE CLOGS
Extraction treatments, as well as light salicylic peels, can help remove clogs, but the client must also care for the skin on a daily basis to achieve and maintain clearance. Clients with acne-prone and clog-prone skin must use a daily chemoexfoliant to continually slough and remove dead-cell buildup and clear clogs so air may penetrate the follicle. This kills anaerobic p. acne cells, which die when exposed to oxygen. Daily application of a leave on alpha hydroxy (AHAs like glycolic acid creams or lotions) and beta hydroxy (BHAs like salicylic acid) gel will help achieve this goal.
Benzoyl peroxide lotions or moisturizers can be added to help to kill bacteria in skin that has both clogged pores and frequent papules or pustules. Even after the clogged pores and acne have cleared, this treatment technique must be continued as cells continue to build up. In short, the AHA/BHA or benzoyl peroxide leave ons helps to break up existing congestion and helps prevent future congestion.
There is a direct correlation between the degree of excessive oiliness and severity of acne conditions. Using an oil-control face wash or cleanser with the appropriate amount of surfactant cleaning agent will remove excessive sebum that can also contribute to congestion. You should have several different strengths of cleanser available for varying oiliness levels. Some cleansers for acne will also contain antibacterials like benzoyl peroxide or salicylic acid.
AVOIDING COMEDOGENIC PRODUCTS
Some skin care ingredients can contribute to congestion by increasing the adhesion of the dead cells within the follicle. Known as comedogenic ingredients, these ingredients are often fats, fatty acids, fatty esters, oils, and waxes. They are used primarily in the product vehicle or spreading agent in the skin care product. Regular use of a product containing these types of fats may worsen an acne condition. This is particularly true for products that are worn for long periods of time. Moisturizers, serums, sunscreens, and even foundation and makeup products should be non-comedogenic. Lightweight, water-based skin care products that have been independently tested as non-comedogenic are an important part of any acne treatment program.
COMPLYING AT HOME
How well you follow your home care instructions can affect the success of any skin care program. Since some people will sometimes stop using products once their skin is clear, but you must see the importance of continual and consistent daily care for long-term success. You need to understand that it is vital to stay on the program and use products for continued clear skin and to prevent re-occurrence of the acne.
- Baldo, A., Bezzola, P., Curatolo, S., Florio, T., Lo, G. G., Lo, M. P., … & Pimpinelli, N. (2010). Efficacy of an alpha-hydroxy acid (AHA)-based cream, even in monotherapy, in patients with mild-moderate acne. Giornale italiano di dermatologia e venereologia: organo ufficiale, Societa italiana di dermatologia e sifilografia, 145(3), 319-322.
- Buel, S. (2019). Top 16 Best Glycolic Acid Lotions & Creams (Face & Body) in 2019. [online] Healthy Beautiful. Available at: https://healthybeautiful.com/the-best-glycolic-acid-lotions-for-the-face-body/ .
- Henry, M. (2019). Top 11 Best Benzoyl Peroxide Creams, Gels, Lotions of 2019 for Acne Spot Treatments. [online] Healthy Beautiful. Available at: https://healthybeautiful.com/best-benzoyl-peroxide-creams-gels-lotions-acne-spot-treatments/ .
- Sakuma, T. H., & Maibach, H. I. (2012). Oily skin: an overview. Skin pharmacology and physiology, 25(5), 227-235.