Adolescent Acne: Marketing & Treating Teenage Acne
This post first appeared in Dermascope.com’s July 2020 edition
AN INTRO TO ACNE
Acne is a disease of the pilosebaceous unit — blockage or inflammation of this unit will result in acne. Oil glands are found in the highest density on the face, back, and chest and these are the most common sites of acne development.
Sebum is a food source for bacteria called propionibacterium acnes (p. acnes) that reside in the skin. As these bacteria proliferate, they attract white blood cells, which is an immune response that can damage the follicle walls, forming debris and dead cells that result in pimples and sometimes pustules.
Acne can manifest in many ways. It can be noninflammatory, where sebum and dead skin cells easily become trapped within the follicle. This accumulation of cellular debris and sebaceous matter forms a hard plug that obstructs the pore opening. This obstruction is called a comedo. It manifests itself as a non-inflamed bump or blackhead on the skin's surface.
Over time it can become more inflamed where small red bumps (papules) or pus-filled spots (pustules) occur. In more severe forms, deep, red, tender spots known as nodules or cysts develop. This form is also known as cystic acne, which can result in scarring of the skin.
It is important to remind clients not to self-pop, squeeze, pick, or poke at their acne lesions as they can result in post-inflammatory hyperpigmentation (PIH), post-inflammatory erythema (PIE), or scarring.
Acne is graded on a scale of one to four.
Grade 1 acne is the mildest form of acne, whereas Grade 4 acne has progressed to consistent breakouts and deep cysts that require medical intervention.
Many things can influence the development of acne. The exact cause is unknown, but genetics, hormones, environment, diet, sleep, stress, and cosmetics can all contribute to acne.
Hair stylings products (such as waxes or gels which contain ingredients like lanolin, beeswax, or wearing headbands, hats, backpacks petroleum jelly and cocoa butter, medications, medical conditions) can affect acneic breakouts as well.
While acne can occur at any age, teenagers and young adults are more likely to get acne breakouts, thanks to an influx of hormones.
This can feel overwhelming to a teenage client during a stage of life when they are already experiencing a lot of changes.
According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, a whopping 80% of young people experience acne breakouts before the age of 30.
As Dr. Andrea L. Zaenglein, professor of dermatology and pediatrics at Penn State reported recently in The New England Journal of Medicine,
“The psychological effects of acne can be profound, and persons with acne are at risk for substantial, negative effects on quality of life.”
Acne affects how teenagers feel about themselves and can increase their risk of depression, anxiety, and social isolation.
According to Dr. Robert P. Dellavalle, professor of dermatology at the University of Colorado in Denver,
“Acne is one of the most debilitating diseases in dermatology. It is not a killer, but it can scar people literally and psychologically.”
CONSULTATION
Skin care professionals cannot cure acne, but can help clients keep it under control, as well as prevent scarring with a combination of professional skin treatments, solid homecare routine recommendations, and best practices.
One of the most challenging aspects of acne treatment in teenagers is lack of compliance — getting teenagers to adhere consistently to an established regimen.
The best approach is keeping their routine as simple as possible - the simpler the better.
Before treating a client, conduct a thorough consultation, including a concise medical history intake; standard face diagram charting outstanding facial features, scars, wrinkles, and so on; and a diagnostic history used to establish the cause of the skin condition being presented for treatment.
Also, questions on the consultation form should provide enough information to give the professional a clear picture to assess health and suitability for the treatment.
Questions should cover general medical, diet, skin, hormones, lifestyle, medications, supplements, and even how regular their bowel movements are. The consultation should also include a baseline reference point for later developments and means by which to measure client progress.
Before and after pictures are vital for recording the skin's initial condition and to observe changes in skin tone, texture, and resilience. The consultation also establishes reasonable expectations of how the client and practitioner will perceive the end results.
TRIED & TESTED TREATMENTS
Here are recommendations for a progressive approach to treating a client with acne.
Treatment 1: Include steam, extractions, cold rolling, high frequency, red and blue LED therapy, followed with an enzyme mask or peel such as papaya or pumpkin.
An enzyme mask or peel is a gentle version of a chemical peel that will infuse skin with nutrients and hydration while treating acne with a delicate touch. An enzyme peel helps exfoliate and detoxify skin, while refining pores, smoothing the skin, and encouraging the blemishes to heal. Papaya contains the enzyme papain, which is known for its skin cleansing properties that help in removing impurities out of the clogged skin pores. This provides relief from acne and pimples.
Plus, the exfoliating agent, papaya is also effective for getting rid of dead and dry skin cells. Pumpkin contains vitamins A, C, and E and is full of B vitamins such as niacin, riboflavin, B6, and folate. It also contains zinc, which will control oil production; this, in turn, reduces acne and facilitates healing of the skin. Vitamin A content helps minimize acne scarring by supporting cell regeneration and vitamin E will assist in optimal barrier function, as well helping control sebum production.
Treatment 2: Include steam, extractions, cold rolling, high frequency, red and blue LED therapy, followed with a large molecule alpha hydroxy acid (lactic acid, mandelic acid, or malic acid).
Treatment 3: Include steam, extractions, cold rolling, high frequency, red and blue LED therapy, followed with a salicylic acid peel.
Treatment 4: Include steam, extractions, cold rolling, high frequency, red and blue LED therapy, followed with a glycolic acid peel of high pH – low percentage.
Once the acne is under control, if it is within the skin care professionals scope of practice after the fourth treatment, they can start incorporating laser or collagen induction therapy (CIT) treatments to support scar reduction and additional acne treatment.
Before combining treatments, make sure to perform each treatment individually to see how their skin tolerates the treatments independently before dual treating.
As mentioned in a previous article, Collagen Induction Therapy is great partnered with other non-ablative treatments such as post-LED (light emitting diode) therapy, hydradermabrasion, dermaplaning, microdermabrasion, chemical peels, enzyme masks, lymphatic drainage, microcurrent, and laser or intense pulsed light.
POTENT INGREDIENTS
You cannot treat acne as a "one size fits all” approach as it manifests in many different forms.
It is important to treat teenage clients with a progressive (not an aggressive) approach.
Treatments will vary from one client to another. Understanding the different types of acne lesions, as well as correct ingredients, will help determine how to address the condition, as well as avoiding exacerbating the skin, minimizing skin injuries, and exercising the skin prior to treatment.
When treating blackheads, look for ingredients such as salicylic acid, retinoids, charcoal, or kaolin clay, as well as alpha hydroxy acids such as glycolic acid, lactic acid, kojic acid, and azelaic acid.
When treating whiteheads, use salicylic acid, retinoids, and alpha hydroxy acids like glycolic acid, lactic acid, and benzoyl peroxide.
For papules and pustules, use salicylic acid, retinoids, alpha hydroxy acids, niacinamide, sulfur, and topical probiotics.
Lastly, when treating cysts and nodules, use salicylic acid, retinoids, alpha hydroxy acids, sulfur, topical probiotics, cortisone cream, and possibly refer them to a physician, nutritionist, or dietician for further treatments.
Do not overtreat the skin by using all the above ingredients in one treatment session. While treating current acne lesions, the professional can simultaneously treat the client's post-inflammatory hyperpigmentation (PIH) by recommending and using tyrosinase inhibitors, such as licorice root, turmeric, mulberry extract, kojic acid, vitamin C, azelaic acid, bearberry, arbutin, and hydroquinone.
HOMECARE
Homecare recommendations include washing their skin daily — especially after working out, wearing sunscreen, or playing sports.
Have them purge their medicine cabinet and throw away all expired skin care and makeup. Encourage acne clients to keep two sets of makeup brushes and wash them daily. They should change out pillowcases regularly, switch to using a copper pillowcase (there have been studies showing that copper battles bacteria, heals skin, reduces, and prevents wrinkles, and reduces friction damage to hair and skin).
“Copper is naturally antimicrobial,” says Susan Bard, MD, a New York City-based, board-certified dermatologist. “In this case, the copper may help keep bacterial counts low, and users prone to acne have reported improvement with copper pillow use.”
When inflamed acne does pop up, they should cold roll or ice blemishes to reduce redness and swelling, as well as ease pain for the particularly painful cysts.
Depending on the quality of the razor, recommend clients change out their razors one to six times a month.
Finally, rain or shine, always recommend they wear sunscreen. Recommend light, foam, or gel-like formulations. Avoid facial and body products that have thick, creamy textures and high comedogenic ingredients such as special denatured or denatured alcohol, coconut oil, isopropyl myristate, emollients, facial makeup with red dyes, silicones including dimethicone, polyethylene glycol, and cocoa butter.
Recommend they skip on makeup when possible to let their skin breathe — a great time for this is on weekends, when working out, or playing sports.
They should avoid direct sunlight or at least wear sunscreen and a wide-brimmed hat when exposed to sun. They should not over-wash their face with active ingredients, which can become over-drying and irritating when used in excess. A great recommendation is to cleanse after playing sports, working out, and wearing makeup.
If anything, they should always cleanse their face before going to sleep. Scrubbing the skin with a physical exfoliant can feel great, but it could be creating microtears in the skin, spreading bacteria, and creating additional inflammation and infection. Recommend clients a gentle exfoliant they can use once per week.
Finally, stress to clients that they should not squeeze or pick blemishes. Popping pimples can drive acne bacteria deeper into the skin, creating additional inflammation and increasing the longevity of the infection. Picking can also lead to more inflammation, post-inflammatory erythema, post-inflammatory hyperpigmentation, and permanent scarring.
MEDICAL ATTENTION
Skin care professionals know they cannot cure acne, so when it is time to throw in the towel?
There is no simple way to answer this. If the skin care professional has exhausted all their resources, completed a series of treatments, got the client on a solid homecare routine, and all the recommendations have failed to work and the client did not respond to the treatments as well as hoped, an honest conversation with them is needed.
Refer the client to a physician, dermatologist, nutritionist, or dietitian for further diagnosis.
TREATMENT FOR DIETARY INFLUENCES
Aestheticians are not nutritionists or dieticians unless additional training and education has been obtained, but professionals can encourage clients to eat a healthy balanced diet and drink plenty of water.
Suggest clients see a specialist for dietary changes that may improve the health of their skin.
According to nutritionist Dana Martin, MS, LE, “A key driver in acne is internal inflammation - caused by hormones, food allergies, and sensitivities, stress, lack of sleep and a poor gut microbiome. Nutrition can help regulate inflammation significantly, likely reducing acne.”
She continues,
“In order to support hormones, which are certainly going through the ringer during puberty, maintaining blood sugar levels is necessary.
Consuming foods that are high in fiber and nutrients like vitamins and minerals, such as fruits and vegetables, stabilizes blood sugar levels.
Complex carbohydrates such as whole grains, lentils, and legumes are all great sources of fiber and are slowly digested by the body.
When blood sugar spikes from processed foods such as cookies, white bread and pasta, candy and soda, hormones also increase.
In females, when blood sugar levels rise, the levels of insulin-like growth factor-1 and insulin also increase. Insulin stimulates the ovaries to create testosterone which leads to an excess production of keratinocytes, sebum, and inflammation, also known as acne.
In males, the increased insulin from highly refined carbohydrates and sweet foods will do the same thing and stimulate acne."
She also mentioned,
“Food allergies and sensitivities cause significant inflammation when continually eaten. When a food is eaten that the body recognizes as a pathogen the body's immune system will attack it, leading to acute inflammation. When the food is consistently eaten, it lends a hand to chronic inflammation which is a key driver in many diseases and disorders later in life. Sensitivities and allergies are often expressed on the skin through rashes, dermatitis, and acne. If you suspect your teenager may have a food allergy or sensitivity, blood testing is a great way to learn more. Working with a nutritionist or dietician on an elimination diet is another method for finding any concerns. When trigger foods are avoided, the body can reduce inflammation and heal, leading to fewer inflammatory markers on the skin.”
She stressed the importance of a healthy gut, saying that,
“Many studies have linked intestinal health to skin health. The gut microbiota supports the immune system, with about 80% of the immune system located in the gut.
The tiny microbes, which number in the trillions, support breakdown of food, digestion, and absorption of nutrients. Eating a diet rich in high-processed foods and carbohydrates, saturated fat, sugary snacks, candy, and soda support unhealthy bacteria to proliferate in the gut.
When the bad gut bacteria overwhelm the good bacteria, intestinal damage can occur leading to increased inflammation and intestinal microbes finding their way into the bloodstream that should stay in the gut.”
Finally, Martin mentioned a bit about stress and sleep habits and how they can affect the skin.
“Stress and sleep can be addressed in conjunction with one another. Teenagers experience a lot of stress - from expectations with grades, navigating school with friends, volunteering outside of school, in addition to one or more sports and applying for college — it is no wonder teenagers are stressed.
All of the stress and lack of sleep increase cortisol levels in the body, which causes increased acne severity and number of breakouts due to both short- and long-term stress. Reducing stress through exercise, meditation, relaxation, and other healthy methods will be important in reducing the long-term effects of low-grade chronic inflammation, as well as the severity and appearance of acne.
Adequate sleep allows the body to regenerate, calm down, and do damage control. Without adequate sleep — at least seven hours for most adults and more for growing teenagers, the body cannot adequately do it is important work. This of course will lead to increased inflammation, further driving the cycle related to hormones, gut permeability, and can even increase cravings for unhealthy foods that provide a quick blood sugar rush — candy, carbohydrates, and sugar."
MARKETING APPROACH
Knowing how to communicate and market to the teenage clientele is key.
Customer reviews and ratings, before and after pictures, products in the price range of $10 to $50, social media platforms such as Tik Tok, Instagram, and Twitter are all things teenagers gravitate towards.
Simple and clean looking packaging, as well as educating them on the what, the why, and the how in less than one minute played a role as well.
According to Illumination Marketing,
“To successfully market your skin care products and treatments you must consider these key marketing strategies.
1. Understanding the skin care market trends and needs.
2. Talk about ingredients and the process.
3. Get and publish customer reviews.”
They also mentioned,
"Marketing skin care products successfully, brands should have a much more comprehensive strategy. The days of being able to just use print and magazine advertising are long gone. Skin care brands must embrace search engine marketing (SEM) with all the methods used to be effective online and with ecommerce websites. To be successful today, marketing skin care products must include a variety of tactics and strategies.”
WILL THEY GROW OUT OF IT?
In conclusion, the success of a client's results rest on a few factors, such as determining the underlying cause of their skin condition and establishing if it can be addressed or not.
Product selection is crucial to the efficacy of the treatment. Topical products serve to switch off inflammation, kill bacteria, reseal the skin's defense barrier, moisturize and supply nutrients to the skin. Product ingredients that are known to cause inflammation should be avoided.
Teenagers with acne should be offered support as it is recognized that the condition can lead to altered body image and low self-esteem. This can often be overlooked by both family and health professionals alike.
Teenagers are often told they will eventually “grow out of it” — almost as though acne is an insignificant phase. Therefore, supporting teenagers with professionals in nutrition, dermatology, and aesthetics, so they do not have to experience the detrimental loss of self-esteem when experiencing uncontrollable, damaging, and painful breakouts.
Beatrice Van is an award-winning aesthetics master educator and enthusiastic, positive, self-starter with over 17 years of progressive experience in the beauty industry.
In addition to her role as clinical master aesthetics educator at Spectrum Advanced Aesthetics, she is the clinical director for Fearless Beauties. She is also a certified advanced aesthetician, makeup artist, and nail specialist.
On her days off, Van is at Indie Esthetics helping her clients look and feel like the very best versions of themselves or off traveling throughout North America as an education ambassador for CND and Fearless Beauties. Her passion is to empower both students and beauty professionals to boldly invest in their education and strengthen their skills, while elevating standards in the industry.