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The Essential Truth About Acne

By: Kristina Valiani
Posted: December 4, 2013, from the December 2013 issue of Skin Inc. magazine.

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Inflammatory lesions are typically known as papules and pustules. A pustule is a follicle filled with pus. Pus is a fluid comprised of millions of white blood cells mixed with follicular debris. A papule is a red bump on the skin that will typically turn into a pustule. A nodule is a very deep lesion, similar to a papule, only deeper in the dermis, and has the ability to reach the subcutaneous layer of the skin. Nodules often occur when the rupture in the follicle wall is very deep in the structure. Nodules often involve more than one follicle, which develops large pockets of infection.

A cyst is a pocketlike nodule that has a epithelial lining and a large amount of inflammation. White blood cells form a boil-like lesion that eventually ruptures. Typically, scarring is an after-effect of cystic acne. Cysts can be treated by a dermatologist who may inject the lesion with cortisone, reducing the inflammation and allowing the cyst to reduce in size. This treatment can prevent scarring.


Scars form when the skin is dealing with the inflammation and infection caused by stress-inducing lesions. Enzymes trigger white blood cells to destroy collagen while trying to recover the ruptured follicle. The enzymes, along with other immune reactions, continue to dissolve the tissue causing the scarring to occur. The immune system can also activate fibroblasts, which are collagen-producing cells, in an attempt to repair the damage from the inflammation. The collagen is produced in abundance in order to repair and replace the damaged areas. The series of events causes the collagen to clump, becoming raised and discolored. Scarring can often be improved by intralesional cortisone injections performed by an experienced dermatologist or plastic surgeon. Skin care professionals should educate their clients of all ages about the side effects of picking at lesions, also known as excoriating. This behavior can cause significant damage to the skin and rupture lesions, leading to cysts, scarring and even hyperpigmentation.

An esthetician's role

An esthetician can do nothing to change the hereditary factors that cause acne. Problem skin and acne can be brought under control to the point where there are no visible lesions for long periods of time. Clients may still have an occasional lesion, but the combination of a strict home-care regimen and a plan of action with a qualified skin care professional can greatly reduce the chances of acne returning. When you have a new client concerned with the acne lesions on her skin, one of the first questions you should ask is: “What are you currently using at home in terms of skin care and cosmetics?” Her answer will provide you with the following information:

  • Why she may be experience acne;
  • If she is open to investing in high-quality products based on brands she is already purchasing; and
  • How educated she is regarding skin care.

Clients who have very oily skin need aggressive cleansers to remove the excess oil—foaming cleansers tend to be more aggressive. Instruct your clients to use a cleanser twice daily that removes excess oil and assists in killing acne-causing bacteria, but that is not so harsh that it will the strip the acid mantle, causing more oil production to compensate for the stripping and irritation of the stratum corneum. Recommend products to your clients that exfoliate the follicle and prevent the formation of future comedones. Medicated antibacterial agents that kill P. acnes bacteria include benzoyl peroxide gels that can vary in percentages (2.5%, 5% and 10% concentrations), and sulfur and salicylic acid in gel or liquid form. Alpha hydroxy acids (AHAs), including glycolic and lactic acids, are also excellent follicular exfoliants. For acne-prone skin, AHAs are lightweight in a gel or liquid formulation. Salicylic acid is a beta hydroxy acid and is more efficient for an acne client because it has the ability to reach inside the follicle and loosen the buildup of dead skin cells while acting as an anti-inflammatory.