Modern science, cultural wisdom and Mother Nature supply myriad ways for day spas to address adolescent acne.

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Acne is the most common skin disorder in the United States, affecting 40 to 50 million Americans according to the American Academy of Dermatology. Nearly 85% of all people will have acne at some point in their lives. What’s more, adolescent acne is so common that our society refers to it as “a normal part of growing up.” But as a skincare professional, you understand the devastating effect acne can have on a young person, sometimes resulting in self-esteem issues that last for years, or even a lifetime.

The good news is, acne is better understood than ever before and in most cases can be controlled.

Adolescent vs. Adult

The difference between adolescent and adult acne is most readily apparent in the location of breakouts. In typical adolescent acne, breakouts begin to occur on the T-zone at around 12 years old. Adult acne more commonly appears on the lower part of the face, notably the jaw line and chin.

As for causality, dermatologists say that adolescents and adults can both point to hormonal changes as major culprits. According to Dr. Howard Liu, M.D., director of Cosmetic Dermatology at Cedars-Sinai Medical Group and assistant clinical professor at UCLA Division of Dermatology, these changes can trigger the involvement of three elements: oil, bacteria and abnormal shedding of the follicle surface. “Oil glands are attached to the base of the hair follicle,” the dermatologist explains. “When oil is pumped into the opening of the follicle, it pools and allows bacteria to feed from it and inflame the folicle. If the pore of the hair follicle can’t drain the oil efficiently [via normal shedding], it backs up.”

Adolescent acne begins during puberty when we experience significant changes to our hair follicles, in particular the size and amount of oil glands attached, explains Liu. “Sex hormones stimulate the oil glands to grow and become more active. This increase in oil production can clog pores and create acne.” When hormones are a catalyst for adult acne, however, it’s generally women who are affected, post notably in pre-menopause, when hormonal fluctuations tend to be most extreme.

The kind of acne present is determined by the severity of each of the three elements. If the primary problem is abnormal shedding, there will be white and black heads. However, if oil and bacteria are significantly involved, deeper cystic acne can develop.

All types of acne are exacerbated by stress, but adults may also develop rosacea in addition to the pimples, whiteheads and blackheads that typify acneic conditions. Recommended treatments for
acne also vary between the two age groups. Products containing drying ingredients like benzoyl peroxide can be effective for teens because the products are created for oily skin, a typical trait in adolescents with acne. For adults, however, whose skin tends to be dry or combination, such products may only succeed in causing irritation.

Conventional approaches to adolescent acne call for education about keeping skin clean; regular application of topical drying and shedding agents; and even topical or oral antibiotics (especially in cases of deep and cystic acne). Topical retinoids (vitamin A) are also commonly prescribed by dermatologists to combat mild to moderate acne.

“Retinoids are an excellent choice for whiteheads and blackheads because they normalize the shedding of the hair follicle,” Liu says.

Regardless of age, risk factors such as oily complexion, family history of acne, exposure to environmental toxins or irritants, use of inappropriate skincare products, high levels of stress, poor skincare habits and lifestyle factors are all considerations that complicate a skin professional’s ability to treat the problem. Add to any of these factors the biggest one of all—puberty—and the need for a multifaceted treatment approach becomes clear.

Clear Alternatives

Acne sufferers seeking alternatives to conventional treatments, which can be harsh and carry undesirable side effects, often show up at their local day spa or medical spa. But while the number of adolescent skincare clients in spas has increased, there are many young sufferers who aren’t educated about alternative treatment options. These include: microdermabrasion; medical-level laser treatments; LED therapy; specially designed facials and facial series; natural topicals; detoxifying treatments and products; nutritional supplements and regimens; aromatherapy; yoga; homeopathy; ayurvedic approaches; and traditional Chinese medicine, including acupuncture and acupressure techniques.

Metamorphosis Day Spa in New York City attracts young acne sufferers by mincing no words on its service menu: The Acne Attack Package includes four treatments that reduce oil production and break down blackheads and whiteheads by alternating two CoolTouch acne laser treatments with two microdermabrasion treatments. “We tailor our treatments for each client depending on the type of acne they have,” says owner Cleo Londono. “We try to go more natural for someone with severe acne, and more aggressive—with the Acne Attack regimen every two weeks, for example—for someone whose skin can handle it.”

“We give them step-by-step instructions on how to take care of their skin at home and improve poor habits. We also send them home with product samples. They see a change in their skin and come back to us.”

Particularly with the adolescent set, it’s important to provide education as a major part of the treatment. “Teenagers are actually really good about listening to us and following our advice,” Londono says. “We take the time to explain everything we’re doing and why. We give them step-by-step instructions on how to take care of their skin at home and improve poor habits. We also send them home with product samples. They see a change in their skin and come back to us.”

Neighboring New York City spa Le Cachet Holistic Skin Care Spa also enjoys a reputation for advanced acne treatments, offering blue light phototherapy, deep-pore and oily skin acne facials, and treatments designed specifically for African-American skin. All acne treatments are customizable to accommodate the teenage version. “We develop a six- to eight-week treatment course for each client that first addresses the cause of acne and then the symptoms,” says spa director Laszlo Friedman. “According to statistics, 70% of adolescent acne will reoccur if not treated properly. Using our approach, clients tend to remain acne-free even if they’ve had acne for most of their adolescent lives.”

If high-tech isn’t your day spa’s approach—or your clients’ preference—ayurveda presents a viable path to treating adolescent acne. The 5,000-year-old practice focuses on correcting the internal causes of the problem, rather than masking the external symptoms. “In ayurveda, each stage of our life is governed by one of three intelligences, or doshas: vata, pitta or kapha,” explains Rippan Sandhu, owner of Spa Ayurda in New Zealand. “Adolescence is dominated by pitta, a fire element, which is associated with heat, transformation and metabolism. The excess heat causes skin pH levels to change and increases sebum production, and the result is acne.”

The focus of ayurvedic treatments is to remove toxins from the skin and bring its core temperature down to regulate excess flow of sebum, and prevent future breakouts and scarring. Treatments begin with a skin consultation to determine the client’s dosha profile. Once the skin profile is determined, a therapist will create a regimen that includes an ayurvedic skincare product that works with the synergy of the skin and helps rebalance it; a series of regular facials to treat skin at a deeper level; and lifestyle tips to improve diet to feed skin from the inside out, create a skincare routine and manage stress.

“Teenagers should eat cooling and nurturing foods to build a foundation for healthy tissue and cells,” Sandhu says. “If they live on junk food, it will transform into toxins, giving rise to skin problems and other health issues.” The spa offers a dedicated menu for teens. Sandhu describes the ayurvedic skincare treatments as particularly effective because “they cause no side effects and work with the synergy of the skin for the most healing impact.”

Traditional Chinese medicine considers physical, emotional and environmental factors of the individual when treating skin problems, and focuses on making good food choices to help suppress acne flare-ups.

Traditional Chinese medicine (TCM) also considers acne a bi-product of excess internal heat and moisture, specifically from the lungs, stomach and spleen. In Chinese medicine, each organ has specific functions and is connected to a channel that runs from the skin’s surface internally to connect with the organ. The organs involved with acne are identified as such due to their function as well as location of their channels. For example, the lungs help regulate the opening and closing of pores, so skin disease might result from a problem in the lungs. The stomach aids digestion so it tends to be warm, and this propensity for heat can manifest as acne along the stomach channel, which runs along the chest and up to the face.

To make a diagnosis and create a treatment tailored to the client, a TCM practitioner will start by taking the client’s pulse, and observing their tongue and skin. Depending on the condition, treatment will consist of acupuncture, Chinese herbs or both. Mild acne will generally be treated by acupuncture alone, but more severe cases will often require herbs, as well.

In TCM, whiteheads and blackheads on the cheeks, nose, forehead, chest and upper back are attributed to lung and stomach heat. Skin will look oily and reddish, and the tongue will have a yellow coating. The goal is to clear heat from the stomach and lungs through acupuncture, by placing needles along these organs’ channels, which run along the arms and legs. Herbs such as pi pai ye, huang qin and sang bai pi, may be recommended in addition.

Traditional Chinese medicine considers physical, emotional and environmental factors of the individual when treating skin problems, and focuses on making good food choices to help suppress acne flare-ups.

Some spas choose comprehensive detoxifying treatments utilizing classic spa services to clear acne. Spirit, Soul & Body Day Spa in Tulsa, Oklahoma, offers Skin Detox and Acne Tune-Out treatments for the face and body, designed to stimulate the lymphatic system and cleanse interstitial cellular fluids that are feeding acne. A formula of fruit acids and whole leaf plants are used to remove debris and acne-producing bacteria at the cellular level.

At Body & Soul Massage in Sydney, Australia, body wraps are commonly used to treat acne through detoxification. The client is wrapped in hot linens, plastic sheets or mud wraps, in combination with herbal compounds, and left to rest. Some of the ingredients used to address acne include warm algae to nourish and detoxify, and clay or mud to cleanse pores and draw out impurities.

A few additional tools spas can incorporate into their acne-fighting treatments are aromatherapeutics such as tea tree oil, a natural antiseptic that can be applied directly to a pimple; acupressure in the stomach meridian, which influences skin function; reflexology to target the liver, adrenal gland, kidney, intestine, thyroid and diaphragm; and yoga poses that increase blood flow to the face, such as Seated Sun, Baby and Cobra.

Naturally Powerful

According to The National Center for Complementary and Alternative Medicine, the following herbs may benefit acne:
• Dried chasteberry prepared in a capsule or tablet
• Fresh or dried echinacea made into tea, juice, extracts or preparations for external use
• Tea tree oil applied topically

A number of skincare manufacturers have formulated ingestible supplements as part of an overall acne treatment regimen. Among these are M’lis, which offers Probiotic Synergized Acidophilus to improve the overall health of the skin by combating harmful bacteria (probiotics nutritionally help control acne and improve cell renewal); and Murad, whose Pure Skin Clarifying Dietary supplement provides nutrients needed to support healthy skin at the cellular level. These include vitamin A to stabilize cell turnover and help prevent clogged pores; yellow dock and burdock to help the body remove blemish-producing toxins; and zinc to help reduce skin irritation.

Robyn Emde is a freelance writer based in Los Angeles.

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