Setting a Standard of Care for Teenage Clients

Written by Jennifer Linder, M.D.

Instilling in clients a standard of care in a daily routine ensures that healthy skin habits are embraced at a young age to avoid unnecessary sun damage, minimize the risk of premature aging and, in some cases, control a skin condition before it gets out of control. Addressing the skin conditions most commonly seen during the teenage years, including acne, oily skin, and atopic dermatitis, while also introducing a simple and easy-to-follow daily care regimen, can encourage teenagers to care for their skin at an early age.

With all of the advancements in skin health science, there are many suitable combinations of daily care products available to address the common concerns of teenage skin, while helping to make caring for the skin easy for young clients.

Acne
Acne breakouts are almost a rite of passage as a teenager; however, proper skin care can be implemented before this condition becomes unmanageable. Understanding the main causes of acne and the best ways to minimize its effects can keep breakouts under control.

Acne Mechanica
bacneAcne mechanica, or sports-induced acne, is instigated by heat, pressure, or occlusion of the skin, due to equipment or garments worn during sporting activities. Teenagers participating in sports that require protective helmets or headgear generally experience breakouts around the hair line and chin where the gear is fastened. Those participating in football or hockey may also experience active acne breakouts on the back, shoulders, and chest due to the protective pads worn. Tight-fitting uniforms made of synthetic fabrics tend to hold in perspiration, dirt, and oil, which can become the perfect breeding ground for the P. acnes bacteria to proliferate. Since wearing protective gear is non-negotiable, it is best to direct the teenager to adopt proper care for their skin to keep breakouts to a minimum.
Immediately following a sporting event, teenage clients suffering with acne mechanica should remove protective gear and garments and shower using a cleansing bar of soap with acne-fighting ingredients. Bars of soap contained inside a jar with a lid are ideal, since they travel easily inside a gym or sports bag and can be used on the face or body. Ingredients that are effective at treating acne mechanica include salicylic, azelaic, lactic, and kojic acids; benzoyl peroxide; tea tree oil; and bakuchiol, due to their ability to control sebum production while minimizing P. acnes bacteria, two key contributors to acne mechanica.

Acne Cosmetica
Acne cosmetica is triggered primarily by makeup, dirty makeup brushes, hair styling products, or heavy conditioning products. Acne cosmetica afflicts both males and females, even if they have not experienced breakouts previously. This particular form of acne develops over weeks or months and is often found in areas to which cosmetics or personal care items are applied. These rash-like, small pink bumps are typically present on the forehead, hairline, and cheeks and can become irritated or itchy. The condition will persist or worsen until a change is made to the client’s daily care regimen and the use of makeup products or personal care items.
Another key factor is teaching teenage girls early on about the appropriate makeup products to use for their skin type and about hygienic makeup application practices. It is common for teenage girls to share makeup and makeup brushes, which harbor bacteria if not cleaned properly. Another health concern to instill into a teenager’s mind is cross-contamination. This can occur when sharing makeup brushes or products without sanitizing between uses. It is best not to share makeup or makeup brushes and applicators at all.
The best way to drastically reduce or, in some cases, avoid acne cosmetica is to identify the culprit. Once the offending product has been identified and removed from the client’s daily regimen, they can take several steps to control the condition. The first step is to introduce the teenage client to a gentle cleanser that contains ingredients such as lactic and citric acids. Cleansing twice daily will ensure the cosmetic product is removed from the skin, ultimately reducing acne cosmetica. Secondly, introduce disposable applicators whenever possible. It is easier than ever to purchase disposable eyeshadow applicators, mascara wands, lipstick brushes, and so on. When using non-disposable makeup brushes and applicators, encourage teenage clients to wash makeup implements daily with a gentle antibacterial soap and allow them to air dry.

hormonal-acneHormonal Acne
Hormonal acne begins with the onset of puberty and can have detrimental effects on both males and females alike when it comes to maintaining clear skin. Puberty marks the end of adolescence and the beginning of adulthood. Females typically begin puberty between the ages of nine to 14 and lasts an average of four years. Puberty for males typically starts between the ages of 10 to 17 and can last up to seven years. This hormonal influx is particularly important in order to mature into an adult and to one day have children. This shift in hormones involves estrogen, progesterone, and testosterone, the androgen hormone. Females produce primarily estrogen while males produce primarily testosterone. The dominant androgen hormone testosterone can be responsible for an increase in sebum production in both sexes, making acne a common concern for teenagers, especially males.
More than just a necessity for reproduction, a woman’s menstrual cycle brings about a host of hormonal shifts. During the first seven days of menstruation, estrogen levels are at their lowest, but they steadily start to rise. Although testosterone levels stay relatively steady all month, during the first week of menstruation when estrogen levels are low, testosterone takes a dominate role and sebum production is increased, leading to acne breakouts later in the month. During the second half of menstruation, estrogen decreases and progesterone levels increase, allowing for fertilization to occur. This fluctuation causes tissues to swell, which constricts pores, trapping excess oil and debris within the follicle. This combination creates the perfect environment for acne breakouts to occur each month.
quotesBecause of all the hormonal shifts taking place, hormonal acne is one of the more challenging skin conditions to overcome during teenage years. Although we cannot control hormonal changes, we can implement a consistent daily skin care routine to offset some of the effects hormone imbalances can have on the skin. In the case of hormonal acne, controlling the inflammatory response caused by the hormone shifts with topical anti-inflammatory ingredients like niacinamide, borage seed oil, marigold extract, and bisabolol can provide relief to teenage clients. This, coupled with spot-treatment products containing salicylic acid or benzoyl peroxide, can significantly reduce the size and severity of lesions while controlling inflammation.
Teenage girls suffering with hormonal acne may receive a prescription for oral contraceptives from their doctor. Skin care professionals may not able to provide medications to clients, but can refer them to a physician for a consultation. When developing an effective treatment plan, understanding how medications affect the skin is vitally important. The purpose of adding birth control to help skin health is to minimize the effects of testosterone, allowing estrogen to become the predominant hormone. Birth control will also increase the sex hormone-binding globulin (SHGB) protein, releasing free testosterone in the bloodstream, leaving less testosterone to cause acne. Another prescription that a doctor may write for a female client suffering with hormonal acne is called spironolactone, which can help lower testosterone levels, which, in turn, lowers the amount of sebum production. Be sure to ask teenage clients about any medications they may be using to control their acne breakouts to ensure your treatment plan is appropriate.

oily-skinOily Skin
Oily skin is another common skin concern of teenage clients, especially males. When puberty commences and androgen hormone levels skyrocket, oily skin is often the result. Increased oil production is commonly found on the face, scalp, back, and chest of males and females. Although oil production alone does not necessarily lead to acne breakouts, it does provide a food source for P. acnes bacteria. Increased oil production, along with increased keratinization within the follicle, leads to blockage of the follicle opening, providing the perfect anaerobic environment for P. acnes to proliferate.
Teenagers dealing with oily skin conditions are drawn to products that will over-dry their skin. Washing more than twice per day or using products containing alcohol can deplete the skin of its natural moisture content and healthy lipid content. This causes the skin to overcompensate by producing excessive amounts of skin-irritating sebum, leading to even more breakouts. The use of natural astringents without the addition of alcohol can be an effective means of controlling oil production and keeping the pores clear. Natural astringents to consider are marigold, goldenseal, or cucumber extracts, all of which assist in refining the pores and hydrating the skin to avoid over-production of sebum. Proper hydration is also important when trying to control oil production. There are several beneficial oils to look for in a lightweight evening moisturizer, including but not limited to, borage seed oil, grape seed oil, and wheat germ oil, which all help balance oily skin by keeping it properly moisturized.

Eczema
Eczema is a common skin concern that typically starts in childhood. Nearly half of all children diagnosed with eczema will not have it into adulthood, but that does not make it any less bothersome for teenagers suffering with the condition. Eczema is often brought on by environmental and food allergies, asthma, pollution, or genetics. Although there is not a cure for this skin condition, there are several ways to control and minimize symptoms.
If the irritant is identified and avoided, typically the eczema is controllable; that is easier said than done, in most cases. Locking in moisture with a hydrator containing both humectant and occlusive ingredients can help to mitigate dry, itchy skin. Humectant ingredients draw moisture from the dermis to hydrate the epidermis in order to maintain proper balance in the skin and avoid the over-production of oil. Humectant ingredients include sodium L-pyroglutamate (sodium PCA), glycerin, or hyaluronic acid. Occlusive ingredients form a film on the surface of the skin to prevent moisture loss. Occlusives work in conjunction with humectants to provide optimal moisture levels in the skin. Commonly used occlusives include shea butter, zinc oxide, and light oils, such as squalane, rose hip seed oil, and borage seed oil. If the condition worsens, recommend that the client seek out the help of a dermatologist for topical or oral medications. For clients who have a more generalized condition that affects a larger surface area, phototherapy may be implemented to treat the condition. The most commonly used form of light therapy is narrowband UVB light, which behaves similarly to UVB radiation from the sun and comes with the same risk of burning, skin aging, and skin cancers.

disposablesDaily Skin Care Regimen
When working with teenage clients, a skin care professional’s goal should be to educate them on the standard of care to which they should aspire when it comes to daily care regimens and professional treatments. Today’s teenager is busier than ever with a rigorous school curriculum, extracurricular sports and activities, and the stressors of an ever-changing world. Creating a skin care regimen that is simple to use and follow is the key to success with teenage clients. Start teenagers out on a basic, four-step regimen until they are ready to add more steps. This will ensure compliance and keep from overwhelming them. A basic regimen should include the
following steps:

  • Cleanse – This pivotal step sets the tone for the rest of the products used in the regimen. Teenagers tend to respond well to foaming, gel-based cleansers, and bars that can be left in the shower or taken along in their bags. Encourage them to keep their cleansing to twice a day since multiple cleanses per day can result in an increase in sebum production and likely more breakouts.
  • Correct – Recommend no more than two corrective products to specifically address their skin condition. Products to consider may include an acne spot treatment, a hydrating serum, or an oil-controlling serum. 
  • Hydrate – Even those suffering with acne need to keep their skin hydrated. This step should consist of a lightweight moisturizer that hydrates the skin while providing oil control.
  • Protect – Implementing a routine of daily broad spectrum sunscreen use will keep the skin healthy well into the adult years. Although all clients need a broad spectrum sunscreen, clients suffering with acne need sun protection to avoid sun-induced inflammation, which can worsen acneic conditions.

Setting a standard of care for teenagers can be challenging, but when the daily care regimen is simple and targeted to their specific skin concerns, positive results can be achieved. Education is vitally important with this client group because they are easily misled by peers and websites lacking a medical basis. Skin care professionals should take the time to explain the importance of the client’s compliance with a daily care routine and how that will translate to helping them achieve and maintain healthy, beautiful skin.

Jennifer-LinderJennifer Linder, M.D., serves as chief scientific officer for PCA SKIN®, guiding all product development and clinical trials for the company. A board-certified dermatologist and a fellowship-trained skin cancer surgeon using the Mohs micrographic technique, Dr. Linder is one of the foremost U.S. experts in the use of the cosmetic filler, Sculptra®. She holds a clinical faculty position in the department of dermatology at the University of California in San Francisco.

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