Acne is the most common skin disorder in the U.S., affecting approximately 40 to 50 million Americans. While commonly associated with teenagers and puberty, according to the American Academy of Dermatology, acne is not restricted to any age group. In fact, adults in their 20s, 30s, 40s, and 50s can develop acne. Nearly 85 percent of all people have acne at some point in their lives, and according to Beth Bialko, global curriculum developer for Dermalogica and The International Dermal Institute, more than 17 million adults have been diagnosed with acne in the U.S.
Adult acne has become more prevalent due to internal and external factors. While temporary stress can cause occasional breakouts, chronic stress can increase hormone levels and cause continued flare-ups. According to Alex Khadavi, M.D., board-certified dermatologist and associate professor of dermatology at the University of Southern California, hormonal fluctuations like puberty, menstrual cycles, post-pregnancy, and pre-menopause, for example, can result in overproduction of dihydrotestosterone (DHT), which causes irritation to the oil glands and can lead to acne. An unhealthy diet can also cause acne, as can certain prescription drugs and low-quality skincare products, notes Christian Jurist, M.D., medical director of global education at Pevonia.
Often the first signs of acne are stimulated by puberty, at which time teens often develop blemishes in the T-zone and over the entire face. Adult acne, however, tends to appear on the chin, jaw, neck, back, and shoulders because of stress and hormonal fluctuations. According to Bialko, adult acne also differs from teenage acne in that it can be more persistent and susceptible to scarring, as aging skin loses its ability to easily repair and regenerate. Adult acne can flare up on either combination or oily skin, whereas teen acne tends to develop on those with excessively oily skin. Adult acne is also more prevalent in women, while teenage breakouts seem to be equally common in girls and boys. One of the biggest concerns and differences with adult acne is that adults tend to have more sensitized skin and additional skin conditions, and many acne-targeted skincare products are geared toward teens and can be too harsh for more mature skin. “Many adult women are dealing with anti-aging concerns, so their acne may be harder to treat, as they’ll be looking for products for anti-aging that may be contributing to their adult acne,” says Jennifer Karp, director of sales and education at Advanced Skin & Hair.
Spas need to be equipped with the knowledge and tools to help these aging and adult-acne-prone clients. In addition to conducting gentle extractions during facials to clear the skin, open pores, and help remove blackheads, estheticians should be sure to properly wash their hands before touching a client’s face, especially during a massage or after using lotions with fragrances. Harsh scrubs, intensive heat, and stimulating massage during treatments should also be avoided, as these can further irritate the skin and stimulate blood flow and sebaceous gland activity, says Bialko. In addition, care should be taken to not spread infection from one treatment area to another. “Meticulous work station sanitation must be maintained from one client to the next, gloves should be worn, and hands should be washed carefully between clients,” says Charlene DeHaven, M.D., clinical director at Innovative Skincare. “These precautions are especially important in our modern world, which has seen the development of antibiotic-resistant skin bacteria such as methicillin-resistant staphylococcus aureus (MRSA).”
It is also important for spas to have equipment on hand that can enhance the results of facials and help clear skin, such as direct high-frequency and galvanic desincrustation devices. The Celluma by BioPhotas is a lightweight, portable, and easy-to-use phototherapy device that contours to the face or body. It works by killing bacteria that cause breakouts while reducing the inflammation and redness associated with acne. While it is ideally suited for a spa setting, it can also be sold to clients for at-home use. The DermaLucent LED blue light treatment by Kate Somerville Skin Health Experts, which kills acne-causing bacteria, is an add-on option to the Universal Glow ($165, 60 minutes) facial at The Spa at Trump at Trump International Hotel & Tower Chicago. The facial uses Kate Somerville products to target acne breakouts while brightening and balancing the skin.
To best treat clients with acne, spas should ensure all acneic clients receive a thorough consultation prior to any services to find out what skincare products, treatments, and medications they are using at home, as certain formulas and ingredients, like retinol, can dehydrate clients’ skin and make it extra sensitive. “Many clients do at-home treatments that can cause the skin to become hypersensitive,” says Monique Deville, paramedical esthetician and owner of Birds of Paradise Skin Therapy (Granada Hills, CA) and lead esthetician at Dermatology & Laser Medical Center (Encino, CA). “Overtreating can result in weakened skin, overproduction of oil, breakouts, and even burned skin.” At Spa Grande at Grand Wailea—A Waldorf Astoria Resort (Maui, HI), estheticians consult with acneic clients to get a better picture of the current conditions and underlying factors related to guests’ skin before beginning a treatment like the Adult Acne Facial ($155, 50 minutes; $225, 80 minutes), which helps clarify impurities in the pores to rebalance the skin.
Post-treatment, it is important to educate clients on how to properly treat their skin with retail products and homecare. Also, remind clients that patience is key, and in order to see the best results, they must commit to participate fully in the recommended course of action. When it comes to choosing a product line to use in your spa and sell in the retail area, opt for simple regimens, which are easy for clients to follow. Also, products should help control the symptoms of acne and contain ingredients that are gentle but effective enough to mildly exfoliate, manage excess oil production, thwart bacteria, and heal the skin, as well as protect it and prevent recurring lesions, says Jurist. In addition, products should be fragrance-free and contain minimal preservatives and fillers. “For product use, benzoyl peroxide, tea tree oil, and salicylic acid are the best combination, as salicylic helps manage oil production and remove dead skin cells, benzoyl peroxide dries up cystic activity and helps prevent breakouts, and tea tree oil helps maintain hydration and offers some residual antimicrobial control,” says Tina Zillmann, esthetician, licensed laser professional, and executive founder and director of Advanced Rejuvenating Concepts.
According to Grant Bruce, director of spa and fitness operations at Trump International Hotel & Tower Chicago, choosing a product line with matching formulations for both professional use and retail is key to gaining loyal clients. “Guests will make a connection with the products in the treatment room,” he says. “They will experience how the products are used and the corresponding results. This will create loyalty for the professional treatments and reoccurring retail product purchases.” For clients with extreme cases of acne who require more than just spa treatments and at-home products, Eric Schweiger, M.D., founder and medical director of Clear Clinic (multiple locations, NY), recommends building a relationship with a board-certified dermatologist to refer clients to when medical treatment is needed.
While advice on treatment and the use of products at home can help clients on their journey to clear skin, it’s also beneficial to make clients aware of hidden acne-causing culprits. For instance, Zillmann recommends that clients use disposable sponges for applying makeup, because compact makeup applicators, brushes, and cleansing brushes can harbor bacteria that promote acne. Deville suggests noting where acne is prevalent on the face, because if a client has acne on one side of the face, it could be due to their cell phone. “Many people do not clean their phones properly, and this causes all the bacteria on the surface of the phone to enter the skin,” she says. “Having individual alcohol pads is a good choice to clean off germ-attracted areas.”
Schweiger advises active clients to thoroughly cleanse skin post-workout, as makeup, sweat, and other impurities can cause breakouts. A healthy diet can also help alleviate the condition, as acne is often related to consuming foods high in fat, or a fat allergy, according to Jurist. He recommends consuming sulfur-rich foods, such as cabbage, cranberries, eggs, garlic, horseradish, kale, onions, radishes, turnips, and watercress. Also, proper nutrition and diet can prevent constipation, which can cause acne, because it builds up toxins in the colon that leak into the bloodstream and try to escape through the skin.
To attract acne-prone clients to the spa and encourage them to take a proactive approach in achieving clear skin, Bialko suggests hosting events that focus on how to properly care for skin and distributing fact sheets with dos and don’ts on how to treat the skin, as well as ingredients to use and those to avoid. Also, stress the importance of refraining from picking and self-extracting, because it can cause more bacteria to enter the skin, making the situation worse and extending the healing time. Other effective marketing tools include social media pages, in which spas can share acne tips and product recommendations, and spa loyalty programs with rewards for products and treatments to help acneic clients maintain consistency and commit to a proper skincare regimen.
It’s important to remember that acne in all clients, especially adults, can take an emotional toll on their lives. It can cause low self-esteem or depression, and it can even affect a person’s behavior, their relationships with family and other individuals, and their career or professional development, says Jurist. Therefore, it is important to work with clients on creating a steady protocol to ensure maintenance and consistent results. Says Deville, “The plan of action is to help stimulate healthy cells and clear bacteria, debris, and clogged pores so the skin may thrive to reveal a healthy texture and glow.”