Thursday, 09 April 2009 13:51

Aesthetic Acne Care

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A common conundrum that takes many forms. Acne is a common skin condition that plagues a great majority of men and women. The term acne has been used to describe everything from the occurrence of mild centralized breakouts to severe inflammatory conditions that can affect the entire body. Although there is no shortage of publications on acne, there seems to be little information on what aestheticians can do to help alleviate this common skin condition. As the first line of defense against acne, aestheticians can suppress the visible signs of this condition with routine cleanings and treatments, and professional skin care products.

These treatments can benefit skin of all color and are the first step to alleviating this skin condition that may cause social and psychological impairment. The first section of this article describes how acne is formed, but stick with me; understanding acne is key to its relationship with diet and a persons well-being.

Understanding Acne

Before administering any type of treatment, it is important to first recognize the type of acne that is present on a client. The general categories for acne blemishes include blackheads, white heads, papules, pustules, nodules, and cysts. Most of these blemishes can present post-inflammatory hyperpigmentation or macules, and can be found on the face or body depending on the type of acne that is present. Acne vulgaris is the most wide spread form of acne that may be non-inflammatory or cystic and inflammatory. However, other strains of acne can develop over the skin and body: conglobata, fulminans, keloidalis nuchae, and acneiform eruptions. Although acne vulgaris is the most common, many of these other forms of acne are misdiagnosed and, in some cases, are not acne at all. Fungal and viral infections that are left untreated may present acne-like symptoms, and acne can develop from prescription drug use. When treating acne blemishes in general, take all aspects of the client into consideration. This is why client consultation and care is so important.

Acne cannot be “cured” by skin care professionals, only alleviated. Aestheticians can alleviate the signs of acne with chemical peels and professional skin care products designed to treat acne. Doctors can prescribe antibiotics, contraceptives, and topical prescription ointments to relieve the signs of acne. Currently, there is no known miracle drug that can remove acne from the skin. This prominent skin condition is caused by androgens – primarily testosterone that is naturally occurring in males and females. Once androgen receptors find their location on the sebaceous gland, acne begins to develop. There are essentially three main stages of acne blemishes: sebaceous hypersecretion, proliferation of keratinocytes, and inflammation.

Sebaceous hypersecretion: Characterized by an increase in sebum, sebaceous hypersecretion starts with androgen stimulation. Studies have found that sebum composition in acneic skin is deficient in linoleic acid and has high levels of squalene – a potentially comedogenic compound. This research finding opens the door to determining the probability that acne and diet may be related. In addition, these changes that are found in the sebum may relate to the formation and size of acne blemishes.

Proliferation of keratinocytes: This stage is marked by keratinocyte development that impedes the opening of the hair shaft and slows the movement of sebum to the skin surface. This process is the essential formation of the comedo.

Inflammation: Bacterial infection by Propionibacterium Acnes (P. Acnes) is the leading cause of inflammatory acne lesions. This bacterium activates the body’s immune system, which provokes inflammation. Redness and swelling are the result of an increase in blood flow and dilation of the capillaries. P. Acnes has been found, in turn, to produce its own antigens as a defense mechanism, thus resulting in an increased inflammatory response. Recent studies have found that keratinocytes contain their own defense mechanisms against P. Acnes. Once targeted, keratinocytes produce interleukin, antibiotic peptides (defensin), and metalloproteases that also participate in the inflammation response.

All three of these mechanisms play an important role in understanding the progression of acne and what results thereafter. Inflammation is essentially trauma that activates melanocytes to the area and induces post-inflammatory hyperpigmentation around acne lesions. The internal combat between the skin and P. Acnes affects the severity of acne lesions and relates to the scarring that can occur with deep cysts and nodules.

Diet and Acne

Proper nutrition is a key element in maintaining skin and body health and functioning. Fried foods, caffeine, candy, and chocolate do not cause acne – but can exasperate the problem. On the other hand, there is a positive association with milk and acne. A study published in the Journal of the American Academy of Dermatology found that milk and dairy products are linked to acne in teenagers and can increase acne by 22 to 44 percent (in skim milk, it doubles)! There have been two main causes for this increase in acne severity: hormones in lactating cows (not added) and iodine. Consuming less dairy products is beneficial for the skin, but should not be eliminated out of the diet. Simply drinking more orange juice and substituting soy will maintain needed calcium in the diet.

Another study published in the American Journal of Clinical Nutrition found that a low-glycemic-index diet reduced the amount of acne lesions and reduced inflammatory lesions by 45 percent. Scientists have found a direct correlation to hyperinsulinemia (high blood sugar) and an increased inflammatory response within the body. Lowering blood sugar levels not only assists with acne; participants in this study also experienced a reduction in weight and body mass index. The glycemic index (GI) diet is designed to either lower or raise blood sugar levels and is a valuable diet plan for diabetics. A low-GI diet consists of fruits, vegetables, legumes, and whole grains; whereas a high-GI diet contains more sugars, white flour, and rice. Maintaining a healthy balance toward the low-GI diet helps with weight loss and blood sugar levels, but that’s just the start. Think of all the rich antioxidants and essential nutrition the body can receive from a healthy balanced diet.

Emotional Impact

Acne has been commonly referred to as a condition that plagues pubescent adolescents. This is inherently true; however, there is an increasing amount of women who are developing acne between the ages of 25 and 35. The culprit is always the same: androgens. Ultimately, age does not matter when it comes to acne. As skin care professionals, aestheticians can help alleviate the signs, but also need to consider the clients mental health. Acne can be emotionally debilitating to both teens and adults, and can result in lowered self-esteem, embarrassment, social isolation, and interpersonal difficulties. When dealing with teen acne, the parent plays an important role in maintaining skin care regimens at home. If you have a teen client that may be suffering psychologically from acne, tell the parent. Social debilitation can prevent a child from participating in sports or other extracurricular activities. They may not look in mirrors or inversely be in the mirror picking at their face constantly. Ultimately, if acne goes untreated, the teen may feel as though they are “different” from normal society and have the potential to regress into destructive activities. Adults with acne are equally affected socially, but the context is different. Social inhibition and poor self-esteem can affect an individual’s employment or job performance and social life. As mentioned earlier, there are varying degrees of acne severity. The difficulty an individual may have socially because of his/her acne can – in most cases – be correlated to acne severity. Early signs of acne should not be ignored. Skin care treatments can alleviate the visible signs of acne and improve social interaction.

Effective Treatments

Skin care experts can effectively combat the visible signs of acne with advanced ingredients and skin care technology. Understanding the key ingredients and how to use them with technology to benefit the skin and prevent scarring takes education and practical knowledge. Aestheticians can visibly reduce the signs of acne with chemical peels and home care, but if a proper balance of exfoliation and moisture is not maintained, the skin can suffer from dehydration, hyperpigmentation, scarring, and premature aging. Circumstances in which a client suffers from cystic acne vulgaris or borders on a more severe form of acne as mentioned previously, a Dermatologists referral is recommended. In these circumstances, isotretinoin (Accutane®) or antibiotics is needed. Once a prescribed acne treatment has started, routine facial treatments and home care must be maintained with the aesthetician.

Chemical peels have been used for decades to rejuvenate the skin. When it comes to acne, effective treatments include salicylic acid, glycolic acid, modified Jessner solutions, microdermabrasion, and ultrasound. Chemical peels used in acne treatments should be light superficial peels that offer controlled exfoliation of the stratum corneum epidermal layer. Removing dead skin and debris that is found on this layer allows the pores to become supple, making extractions easier. Both glycolic and salicylic acids offer bactericidal properties to help destroy P. Acnes and thus reduce inflammation and the possibility of scarring.

Salicylic Acid: A lipid-soluble beta hydroxy acid, salicylic acid targets the sebaceous gland and dissolves excess oil while offering very superficial peeling. A reduction in sebum reduces acne blemishes, while superficial exfoliation removes dead skin and debris to make the pores supple and extractions easier. Clinical studies on Asian and African American skin have proven salicylic acid peels beneficial in acne treatments. On average a 20 or 30 percent salicylic acid with a pH of 2.0 to 3.0 is beneficial for both inflammatory and non-inflammatory acne blemishes.

Modified Jessner: This acid solution consists of a blend of salicylic acid, lactic acid, and resorcinol. In its full 14 percent strength, it is considered a light superficial to superficial peel. The modified solution is generally diluted to a seven percent Jessner that is left on the skin to target excess oil and acne blemishes.

Glycolic Acid: Regarded as a staple in the skin care industry, glycolic acid has been proven to offer many benefits to the skin. In the treatment of acne, this acid exfoliates superficial layers of the stratum corneum, makes the pores supple for extractions, and has bactericidal properties. Overall, it can help reduce inflammation, blemishes, and the occurrence of scarring.

Microdermabrasion and ultrasound are effective against acne by using different means. Corundum crystal is the key player in microdermabrasion. It is essentially blasted onto the skin surface and can become embedded in the skin. In addition to exfoliating the skin, corundum is a naturally drying and reduces sebum. Inversely, ultrasound uses wave vibrations on the skin surface. These vibrations, when combined with water, offer safe exfoliation for inflamed skin or acne rosacea, via the process of ablation. In addition, ultrasound vibrations can loosen impacted sebum and make the pores supple for a more easy method of extraction. Higher quality ultrasound machines will have the added benefit of heat and ultrasound. Most bacteria forms cannot survive in temperatures above 165°F (74°C). Heat offers many benefits for increased blood and lymphatic flow, and can significantly reduce the severity of cysts, papules, pustules, and closed comedones.

A more modern approach to acne treatments can be achieved with Phototherapy, Intense Pulsed Light, and Laser surgery. These methods can deliver dramatic results for acne blemishes, but provide temporary relief and are generally expensive when compared to ultrasound and microdermabrasion. Combining aesthetic technology with chemical peels can either benefit or aggravate the skin. Treatments should be designed to reduce the occurrence of acne blemishes while preventing inflammatory lesions and scarring.

Home Care Products

Without a strict home regimen to visibly reduce the signs of acne, skin care treatments are of no value. When treating acne at home, balance exfoliation with nutrition and moisture to prevent dehydration and premature aging. Cleansers and toners should be formulated to purify the skin by removing excess sebum, dirt, dead skin, and makeup. Key beneficial ingredients include witch hazel, hydroxy acids, and benzoyl peroxide. There is an existing safety concern when it comes to benzoyl peroxide. Simply use your best judgment when recommending products with this ingredient. Avoid high concentrations of ethanol, ethyl alcohol, isopropyl alcohol, methanol, and SD alcohol as these are drying agents and do not benefit the skin. On the other hand, cetyl alcohol, cetearyl alcohol, stearyl alcohol, and lanolin alcohol are not drying to the skin and benefit product consistency. When seeking an exfoliating serum for acne, follow the same general guidelines by looking for higher concentrations of witch hazel and hydroxy acids with little to no “bad” alcohols. Exfoliation for acne should always be in a serum form and never a scrub. Exfoliating scrubs can promote the spread of infection over other areas of the face and aggravate inflammation.

Moisturizers and skin nutrition is vital to any home care regimen – especially acne. Infection, inflammation, and a drop in linoleic acid levels foster a prevalence of free radicals within the skin. In addition, salicylic acid and benzoyl peroxide dry excess sebum on the skin resulting in a drop in natural moisture levels and the increased risk of dehydration. Topical L-ascorbic acid, alpha lipoic acid, spin trap, and many natural plant extracts offer antioxidant protection for the skin. A standard vitamin C serum and most anti-inflammatory serums are rich in antioxidants and help prevent damage to the cells. Individuals who suffer from acne have oily skin and, in most cases, do not like the feel or weight of most moisturizers. During the summer, the client should use a lightweight lotion as a moisturizer that contains natural plant extracts. Calendula, chamomile, and tea tree are natural ingredients that have antibacterial properties; licorice root and amaranth seed are natural anti-inflammatory ingredients. During the winter months, the air is drier due to climate change and indoor heating units, and the skin suffers from dehydration. Hyaluronic acid and essential fatty acids are necessary to hydrate the skin and foster retention. These too can be combined with natural plant extracts to offer additional antioxidant protection, prevent the spread of bacteria, and reduce redness and inflammation.

Modern science and technology has provided great relief to individuals who suffer from acne. Unfortunately, there is no cure – only suppression. It was not long ago when microdermabrasion and ultrasound treatments brought significant change compared to standard chemical peels. Our rapid technology development has brought about lasers and phototherapy to nearly treat the condition – temporarily. Believe it or not, scientists are theorizing on DNA sequencing to remove the hereditary link that causes acne! Until then, we know about many physiological aspects of acne development, diet, self-perception and esteem changes, and (more importantly) awareness. Treat the signs of acne early on with ingredients we know that work. 

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