Acne can be categorized in a few different ways in relation to the age group experiencing it: Adolescent acne in ages 10 to 19, young acne in ages 19 to 24, and adult acne in ages 25 or above. In addition to affecting more than 50 million people annually, acne is the most frequently occurring skin condition in people between the ages of 11 and 30 years old, and it is widely believed that acne affects about 80% or more of individuals in this age group.
ACNE PRONE
While adult acne has been steadily on the rise, an immense impact on teenage clients is still being seen. The activity of the pilosebaceous unit (the hair follicle, hair shaft, and sebaceous gland) is regulated by sex hormones. Teenage skin conditions are mainly related to fluctuations in hormone levels, specifically androgen hormones like testosterone and dihydrotestosterone. These androgen hormones can increase hyperkeratosis and sebum production, leading to the formation of the microcomedone (noninflamed open and closed comedones). If c. acnes bacteria are introduced, then the microcomedone will become an inflamed lesion (papules, pustules, cysts, and nodules). When treating teenagers, it is important to set the proper expectations. They can certainly achieve and maintain clear skin, but skin care professionals need to normalize that 100% clear skin 100% of the time is not realistic. Hormone fluctuations can have an impact on skin no matter how good a client’s skin care and lifestyle routines are.
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COMMON CONSIDERATIONS
It is not always the first choice of adult clients to seek out a skin care professional for their acne needs, so it typically is not a parent or guardian’s first thought for their kids either. Usually, when a teenage client comes in, they have already tried drugstore or prescription solutions. Both can cause issues on their own, especially when they go straight to the strongest percentages available because they are intentionally trying to dry their skin out. Once the damage has been done to the barrier, worsening acne, irritation and red or flakey skin among other issues can be seen. This gives young clients additional issues to worry about and address. It is so important to focus on barrier repair prior to introducing acids and benzoyl peroxide to clear a client’s acne. If these products are introduced too soon, the professional is only working against themselves and their client’s best interests. Throughout the clearing process, it is important to still focus on barrier health when introducing new or stronger products and treatments. A balanced routine is the key to clear, healthy skin.
EAT, CLEANSE, LOVE
With the many different lifestyle and diet factors influencing breakouts, it is so important that professionals educate and support teenage clients. However, when speaking about diet with younger clients, extra caution should be taken. Teenagers already have enough issues when it comes to self-esteem, body image, or fitting in, so it is important to avoid unintentionally giving them a complex around the food choices they make.
Younger clients may be especially struggling when they are presented with situations where they may not be able to avoid acne-triggering foods. This could be the case for several reasons, such as school cafeteria options, family preferences, or them not wanting to feel like the odd one out. Even though these situations are hard to avoid, moderation is still the focus and that is another important point to make when speaking to teenagers. They do not have to make perfect choices all the time or abstain from their favorite foods and desserts indefinitely. Like with all acne triggers, everyone reacts differently so they will need to keep an eye on what foods or beverages have an impact on them as an individual. It is really all about how often clients consume these foods rather than worrying whether they are or are not. Typically, professionals tell their clients that if they are consuming a trigger food seven days a week, try to cut back to three to four days a week and go from there.
Lifestyle management may also be harder for teenage clients. Topically, they may be at the mercy of whatever cosmetics, hair care, and laundry products the rest of the family uses. With acne and some acne imposters, they will need to avoid comedogenic ingredients and some heavy emollients in the case of fungal folliculitis, or fungal acne. Often, young clients have issues due to their hygiene after gym class and sports; they are not always given enough time in between classes to properly cleanse their skin after gym or sports practices. In some cases, it is unrealistic to expect young clients to want to perform their skin care routine again in the middle of the school day. A way around this is to have them take a Ziplock bag of cotton rounds presoaked in their toner of choice, preferably something with antibacterial properties, to quickly wipe their face when needed. For those that have sports after school, sometimes they are not always able to get home right after. This toner trick works well in those cases as well. For clients who can and will actually cleanse their skin after gym or sports, they can do a condensed mid-day routine consisting of a quick cleanse, moisturizer, and sunscreen.
THE ACNE-CORTISOL CONNECTION
In addition to hormone fluctuations, lifestyle, and diet, there is a direct connection between stress and breakouts. There are several things that occur when the body experiences stress that effect overall health and skin. This is because the body is sent into a fight-or-flight response and only the most essential functions of survival are considered. Skin is affected due to the stress hormone, cortisol. It disrupts functions, like insulin and blood sugar regulation, and disrupts hormones that regulate sebum production. This increase in sebum production coupled with increased inflammation in the body results in inflamed breakouts. Stress also slows down the body’s ability to heal, which can lead to worsening lesions and more lesions present at any given time. Stress can be hard to overcome, so this is another area to set clear expectations around breakouts.
HOME TEAM ADVANTAGE
80% of the acne clearing process is achieved at home with a proper homecare routine, diet, and lifestyle adjustments. The skin care routine being curated for clients should support their skin and Fitzpatrick type, while being able to tackle their acne type and severity. Factors, like acne type and severity change throughout the clearing process and seasonality, can affect how oily or dry a client presents, so be sure to constantly check in and adjust when necessary.
A full acne client routine can look like the following:
- Cleanser and toner based on skin type.
- Exfoliating serum based on acne type.
- Moisturizer and sunscreen based on skin and Fitzpatrick type.
- Benzoyl peroxide preventative based on skin type, Fitzpatrick, and acne severity.
The reality is not all teenagers are ready, maturity-wise, for a routine with five or more steps so the professional may find themselves having to be more creative when it comes to younger clients. As stated above, focus on barrier health first. It is a waste of time for both the professional and their clients to focus only on active products that will clear their skin because without supporting their barrier, that clear skin will not last long. It is okay if an acne client is only willing to cleanse and apply sunscreen; this is still a win. In some cases, starting with the bare minimum is best for clients to build habits and feel comfortable introducing more products later on. If service providers finds themselves having to provide only basic routines for young clients, they should ensure that the products provided pack a multifunctional punch when able. For example, opt for an active cleanser with mandelic acid, salicylic acid, or benzoyl peroxide instead of a basic gentle cleanser.
When curating a full routine for teenage acne clients, it is vital to pay attention to what their skin and acne are showing and not to worry so much about their age. While it is important to consider a gentler approach for young clients, active products are still beneficial. Something like mandelic acid, a gentle alpha hydroxy acid, makes an excellent starting point. Due to its large molecular weight, it provides even and slow penetration, so it is a much gentler option than a harsher alpha hydroxy acid, like glycolic. If skin cannot handle an exfoliating serum, look at other steps in the routine that can be strengthened. Acne fighting ingredients, like mandelic and salicylic acids, can also be found in cleansers and toners where the concentration will not be as aggressive in comparison to a serum. Customization is key for results.
ACCOUNTABILITY BUDDIES
It is important to constantly manage client routines to ensure the products are still suitable for the current acne, season, or other factors. It is not always convenient for clients to come in person, especially for teenagers who do not drive or who have activities after school or on the weekends. This is where the skin care professional needs to consider different ways to stay in touch. Having a client e-mail pictures regularly as a check-in is an extremely helpful practice, especially when that responsibility is passed on to the client and parent or guardian. Having virtual check-ins available is another helpful practice for those that need more guidance than what can be provided via e-mail. If the spa has a number of older teenage clients, they may have already experienced clients going off to college and coming back on vacation already experiencing breakouts again. It can be helpful to send college student clients off with some tips and important notes about lifestyle and diet, but again, set the expectation that they do not have to make perfect decisions. They just need to focus on moderation. Being able to offer guidance virtually if they run into any issues or changes is a great bonus. Spas must also ensure that they have the ability to dropship to clients or have their own e-commerce store established so clients can keep their homecare products on hand.
IN THE TREATMENT ROOM
Much like at home options, a client’s age is not a reason to refrain from performing acne treatments. Pay attention to what the client’s acne and skin type calls for but consider a gentler approach to start with. Enzyme treatments are an excellent choice for young and first-time clients. There are so many options out there that can be customized to start off gently and strengthen as treatments progress. Mild corrective peels are also an option for young clients. A good rule of thumb is to start low and slow with the strength and prepare skin prior to treatment, but as long as the skin type allows, even teenagers can benefit from regular peels. This is especially true for clients experiencing post-inflammatory erythema or pigmentation and texture resulting from their acne. While in-clinic consultations and treatments are important, having a virtual consultation available for those with busy schedules is incredibly helpful and opens new opportunities for the business owner.
Though skin care professionals have the best intentions for their clients, some things do not always go to plan. When experiencing compliance issues with young clients, it may be time to have a tough conversation with the client and parent or guardian. It can simply come down to one question, who wants the client to have clear skin – themselves or their parent or guardian? While parents and guardians have the best intentions when it comes to their kids, if the client does not care enough to put it in the work, then the process will be unsuccessful. If teenage clients are not bothered enough by their skin to do something about it, it is not the professional’s place to force their hand or shame their choices. That being said, for clients who do want to put in the work to transform their skin, the licensed professional has the tools needed to give them the skin of their dreams.
References
- Bergler-Czop, Beata, and Ligia Brzezińska-Wcisło. “Dermatological Problems of the Puberty.” Postepy dermatologii i alergologii, June 2013. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3834713/.
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Alex Hernandez, a licensed aesthetician of over six years, serves as the lead educator at Face Reality Skincare. In her role, she oversees professional educational training materials, protocols, and classes on a national level. Additionally, Hernandez supports other key departments including marketing, R&D, and Face Reality’s Acne Clinic. Alongside Laura Cooksey, owner and co-founder of Face Reality Skincare, she learned how to educate clients and professionals on the treatment of acne using the brand’s safe and effective signature adaptive protocol. Through diligent practical training and the completion of Cooksey’s personal training, Hernandez became a Face Reality Certified Acne Expert in 2018. Since then, she has worked with hundreds of professionals and acne clients in her aesthetics career and is a daily witness to the impeccable results achieved using Face Reality Skincare treatments and protocols.