How to Help Your Clients Manage Acne Skin
Can customers contribute to the occurrence and severity of acne themselves? Despite the availability of professional treatments and effective methods of caring for problematic skin recommended by specialists, many myths persist, and we still hear about "miraculous" ways to get rid of imperfections.
Our clients are not always aware that acne is a chronic inflammatory disease of the sebaceous glands and hair follicles. When they come to our clinics with non-inflammatory lesions, such as blackheads, and inflammatory lesions, such as pimples, cysts, and nodules, which mainly affect the skin of the face, neck, and back, they are concerned about increased sebum secretion. It is known that increased sebum secretion creates ideal conditions for the growth of Cutibacterium acnes bacteria, which are responsible for the inflammatory phase of acne.
We can include the following pro-acne factors:
disrupted hormonal balance
genetic factors
chronic stress
disturbed circadian rhythm
use of certain medications, including antidepressants and corticosteroids
inappropriate skin care or lack of it
unhealthy diet, including high glycemic index foods (also rich in spicy seasonings, fried foods, and highly processed foods with lots of preservatives, colourings, and enhancers)
Hormonal acne
In the development and aggravation of acne in women, hormonal disorders play a huge role, especially in the context of polycystic ovary syndrome (PCOS). This is one of the most common endocrine disorders that often accompanies common acne. In PCOS, we observe strong fluctuations in glucose-insulin metabolism, excess androgens, hyperinsulinism, and insulin resistance. If we have such a client in the clinic (who often is unaware that she suffers from this condition), it is worth encouraging her to undergo appropriate diagnostics, with particular sensitivity to the occurrence of two of the following criteria:
increased androgen levels in the blood; these hormones stimulate sebum production
a polycystic ovary image on ultrasound
lack of ovulation or infrequent ovulation
Diet and physiological processes
The way we eat is fundamental for the development of acne. The following factors contribute to the development of inflammatory changes in the skin:
a high-carbohydrate diet with a high glycemic index, closely linked to the occurrence of insulin resistance, hyperglycemia, and reactive hyperinsulinemia; diet-induced hyperinsulinemia is a risk factor for acne development due to increased keratinization and excessive sebum secretion.
excessive consumption of dairy products, especially milk and yellow cheese, as well as protein supplements; dairy products have a high glycemic index and affect the increase in IGF-1 and insulin, while milk contains steroid-like compounds that can be transformed into the most active form of testosterone - DHT.
excess trans and saturated fatty acids, as well as the consumption of polyunsaturated fatty acids in incorrect proportions (the correct omega-6 to omega-3 ratio in the diet is 3:1 or 2:1).
Eating large amounts of meat.
A diet that is too high in calories compared to energy needs.
Practical advice: dairy in the diet is not a triggering factor for acne in every patient. It is an individual matter. If a client feels nauseous, constipated, bloated, has diarrhea, abdominal pain, and notices a deterioration in the condition of the skin after consuming dairy, it may be recommended to abstain from such products for a certain period and verify the impact of this change on the body. Typically, replacing dairy of animal origin with plant-based alternatives, such as coconut, oat, or almond milk, brings a visible improvement in the skin condition with a tendency towards acne.
Supplementation for acne
Vitamin D is effective for people with acne as it is responsible for the proper immunity of the skin barrier and protects the skin from harmful microorganisms.
Its active form - calcitriol (i.e. vitamin D3):
is responsible for regulating keratinocyte differentiation,
inhibits their proliferation,
normalizes the process of differentiation of epidermal cells, which is disturbed in acne-prone skin.
In inflammatory acne, reactive oxygen species produced by neutrophils are involved. In a healthy body, they are removed by cellular antioxidants such as catalase, but in people with acne, this process is disturbed. Oxidative stress can be a cause of strong inflammatory changes.
Therefore, an anti-inflammatory diet enriched with antioxidant supplementation is also effective for skin prone to acne, such as:
resveratrol, which has bactericidal properties, destroying Cutibacterium acnes bacteria that play an important role in the pathogenesis of acne; it can be supplied to the body through the diet, by choosing red and purple grapes, peanuts, berries, soy, cocoa, and tomatoes (it is found in their skin), or by appropriately supplementing this ingredient;
silymarin, which strengthens the liver's function, affects fat metabolism and the composition of sebum produced by sebaceous glands; it also has anti-inflammatory properties and regulates the process of epidermal keratinization;
berberine, which has strong anti-inflammatory and antibacterial effects, reduces the development of acne lesions by inhibiting the proliferation of epidermal cells;
5-α-reductase inhibitors, such as zinc, curcumin, biotin (vitamin B7), and evening primrose oil, which should be recommended to clients with excessive hormone conversion to DHT.
Custom therapies
There are some factors that are extremely important to manage therapies:
Regulation of the keratinization process: treatments using acids such as salicylic, glycolic, lactobionic, lactic, and trichloroacetic are an excellent solution because chemical peels, in addition to their exfoliating properties, help regulate the process of skin exfoliation.
Regulation of sebum secretion: I recommend treatments with salicylic acid, azelaic acid, and retinol. Rebuilding the hydrolipid barrier using ceramides, cholesterol, and unsaturated fatty acids.
Removal of post-inflammatory hyperpigmentation: excellent results in home care can be achieved with azelaic acid, thiamidol, and arbutin.
Reduction of the visibility of acne scars: depending on the type and depth of scars, effective treatments include TCA acid peels, microneedling mesotherapy, tissue stimulators, and microneedle RF.
Daily mistakes and their consequences
Incorrect skin cleansing. Inexpertly choosing a product for skin needs and incomplete execution of the first step of care. Very often, customers forget to thoroughly clean the hairline and the area around the ears. The products they use for daily skin cleansing are often too aggressive, have too low pH, contain inappropriate acids, enzymes, or too harsh particles that damage their sensitive skin.
Makeup removal with micellar water. Such a cosmetic contains micelles, surface-active agents that absorb impurities and oil. However, makeup removal done in this way only superficially cleanses the skin, and the pores remain dirty. As a result, this can cause undesirable phenomena (peeling, pimples, excessive sebum secretion, blackheads). We should ask clients about this and educate them to always wash off the micellar water with a foam or gel with a physiological pH.
Lack of moisturizing. When people struggling with acne notice their skin getting oily, they want to dry it out, forgetting about moisturizing. By acting on the skin only in a drying way, they stimulate excessive sebum production, achieving the opposite effect of what they intended. We should recommend lightweight, gel formulas for our clients, containing: ceramides, unsaturated fatty acids, cholesterol, vitamin E, trehalose, amino acids, panthenol, and gluconolactone.
Skin care is a marathon, not a sprint. Let's teach customers that if they want to introduce a product with acid, it's better to start with one. Use it once or twice a week and gradually increase the frequency. The cosmetologist should be a guide to the world of anti-acne treatments.