Which ingredients and professional treatments are most effective for fighting acne?
Carla Cohen, owner and clinical esthetician, SKIN by Carla in West Hollywood, CA: A combination treatment using glycolic, lactic and salicylic acids is helpful: The lactic and glycolic exfoliate the skin, while the salicylic neutralizes bacteria and reduces inflammation. I find that blue LED light is wonderful for these clients as well, since it improves circulation and oxygenation, making it an antibacterial and antimicrobial treatment.
Sue Upton, owner and licensed esthetician, Your Best Skin in San Francisco: I recommend clients receive our customized Acne Treatments (50 min./ $100) every two weeks for three months— on average, most clients need at least six appointments. I primarily use BiON Research Skincare products and protocols in the treatment room, particularly the Antibacterial Cleanser, Inhibiting Gel and Mint Mask. These sessions include acid or enzyme exfoliation, extractions and hydration/balancing; sometimes clients’ skin needs more hydration, and other times it needs antibacterial prevention. Keep in mind that although acne products cleanse the skin and kill bacteria, they can also be very drying, so it’s critical that clients use the correct homecare products consistently as directed. I utilize two product protocols: mandelic acid with benzoyl peroxide; and BiON’s acne line, which is perfect for clients contraindicated for benzoyl peroxide.
Rachel Swendiman, esthetician, Spa Del Rey, The Ritz-Carlton in Marina del Rey, CA: Our Clarifying Facial (60 min./$150), designed to fight acneic and blemished skin, incorporates HydroPeptide products— including the Clarifying Toner, Redefining Serum and Purifying Mask—that contain bacteria-killing and anti-inflammatory ingredients: salicylic acid, tea tree oil, kaolin and bentonite clays, allantoin, bisabolol and healing peptides. We also add high frequency or blue LED light therapy to further kill P. acnes bacteria and balance oil production.
Djazia Belhocine, master esthetician, ZiZo Spa in Bellevue, WA: The real challenge is finding the right ingredients for each individual’s unique skin. Benzoyl peroxide and salicylic acid help clear minor cases of acne, but more severe cases will require a combination of products containing some of the following ingredients: propolis; witch hazel; jojoba, coconut and rose hip oils; lemon, rosemary, lavender and tea tree essential oils; and clay mud. I perform Pevonia’s facials for my acne clients: the Lacto-Flora Peel (30 min./$81), Soothing Propolis Concentrate Ampoule Treatment (30 min./$68), SpaTeen Blemished Skin In-Spa Treatment (60 min./$68) and Aromatherapy Facial (60 min./$68). I also recommend microneedling, which promotes rapid self-healing. It’s the most aggressive acne treatment, but has unparalleled results.
How do you approach hormonal acne versus acne caused by other factors?
Swendiman: There are several types of acne: comedonal, inflammatory and cystic. Determining which one is causing the breakouts is the first step toward treatment. Hormonal acne usually falls under the inflammatory acne category, so treating the skin with anti-inflammatory and soothing products can help reduce large, tender blemishes. If the hormonal acne is severe, I always advise the client to speak with their dermatologist. Sometimes the best solution is a prescription topical or oral medication in conjunction with a clarifying skincare regimen provided by an esthetician.
Upton: When it comes to hormonal teenage acne, I meet with each teen alone and find out how motivated they are to follow a consistent homecare regimen. If they’re not, they have no chance of success—and I won’t take them as a client. When acne is caused by stress or environmental factors, treating it can be more difficult: The necessary lifestyle change(s) may not always be easy to implement. I explain that these cases take more time, and as long as the mitigating factors are present, results aren’t guaranteed.
Cohen: Old school, bacteria-killing benzoyl peroxide combined with salicylic acid to unclog follicles is very helpful for hormonal teenage acne. Adult acne is a bit different— I don’t find benzoyl peroxide as effective. Instead, I suggest iS CLINICAL’s Active Serum, which contains natural sources of glycolic, lactic and salicylic acids, plus arbutin and mushroom extract. It evens out skin tone and does an impressive job of clearing acne caused by stress and environmental factors.
What skincare and lifestyle routines do you recommend for these clients?
Belhocine: Skin health is impacted by diet, stress and physical well-being. I give a list of do’s and don’ts to my acne-prone clients: Do wash your face morning and night, apply recommended topical products and sunscreen daily, get professional treatments twice a month, and perform aerobic exercises three times a week for at least 20 minutes; don’t touch your face with your hands, use the same towel to dry your face every day, eat foods high in processed sugar and preservatives, use the same pillowcase for more than two nights in a row, or use products with parabens. Although each individual’s skin is different and their recommended products will vary, these rules generally apply to everyone.
Swendiman: Clients must use a cleanser, toner and moisturizer in the morning and at night, as well as exfoliate twice a week. I also advise them to invest in high-quality products for their specific skin type—it makes a big difference when it comes to nourishing, healing and purifying skin. Lastly, I suggest that clients change towels and pillowcases frequently to avoid bacterial buildup.
Upton: In addition to ensuring clients are consistent with their homecare regimen, I recommend the following lifestyle choices: Get enough rest and reduce stress (stress stimulates the adrenal gland, which promotes oil production); stay hydrated; and exercise regularly to stimulate the lymphatic system to release toxins from the body.
Which ingredients should you counsel clients with acne to avoid?
Cohen: Those with acneic skin should definitely avoid lanolin and mineral oil- based products, since they clog follicles. I suggest they stick to a physical sunscreen with zinc oxide and titanium dioxide—my clients prefer the iS CLINICAL Eclipse SPF 50+ because it also has a matte finish, and acne-prone skin tends to look oily.
Swendiman: I tell my clients to steer clear of petroleum, mineral oil, isopropyl alcohol and harsh scrubs that could scratch and irritate their skin.
Belhocine: I encourage my acne clients to avoid parabens, synthetic colors and fragrances.
Upton: I give them a list of acne-aggravating skincare ingredients that includes specific pigments, alcohols, esters, fatty acids (such as lauric acid), natural oils (like cocoa butter) and minerals (potassium chloride, for example). I always warn these clients away from isopropyl myristate and algae extract, which can contribute to clogged pores. Acne-prone clients should also avoid: foods that contain iodine, such as certain vitamin supplements, sports drinks/bars, iodized salt, some types of fish and seafoods; fast food and dairy; ‘high androgen’ foods, which contain hormones that exacerbate acne; sugar; and progestin-dominant birth control, IUDs, implants or shots. I provide clients with a list of these and recommend they consult with their doctor.
–by Laura Beliz