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Become an Acne Specialist

Laura Cooksey February 2013 issue of Skin Inc. magazine
inflammed acne

It took four months to clear this client’s inflammed acne and pigmentation, using a combination of mandelic serum, vitamin A proprionate serum and benzoyl peroxide.

More and more, estheticians are choosing to specialize in a particular aspect of esthetics. Just as some are compelled to create a waxing-only clinic or to focus on just lash extensions and makeup, there are others who choose to specialize in the treatment of acne.

Estheticians and nurses who treat acne have been around for many years, but acne treatments are usually included in a laundry list of services offered. Now, many esthetic practices are entirely dedicated to treating acne-sufferers.

What dermatology lacks

Dermatologists are the logical first choice for someone suffering from acne. There is a common pattern in the protocol used by most physicians for treating acne. Acne patients are given oral antibiotics, topical antibiotics, and/or a choice of prescription retinoids to try. Sometimes benzoyl peroxide will be recommended. If those treatments fail, physicians will often recommend a cycle of isotretinoin. In many cases, these protocols leave the acne-sufferer disappointed and frustrated.

Oral antibiotics. An antibiotic for acne is, at best, a temporary solution. Research has shown that use of oral antibiotics has led to the development of resistant strains of Propionibacterium acnes bacteria.1 It is also well-known that overuse of antibiotics creates resistant strains of bacteria, such as Methicillin-resistant Staphylococcus aureus (MRSA). In addition, antibiotics do not address the root cause of acne. Acne expert James E. Fulton, MD, writes: “Even if some magic antibiotic could control 100% of the bacteria, you would have attacked only a fraction of the acne problem. I would estimate that oral antibiotics, at best, provide only 20–30% of the needed acne solution.” Antibiotics do not address the root cause of acne—it is the microcomedo that needs to be managed, not the bacteria.

Topical antibiotics. Clindamycin may have dangerous side effects and, just as with oral antibiotics, topical antibiotics are really only a temporary solution for acne. They don’t resolve the dead skin cell problem, and are, therefore, an ineffective long-term solution for acne management.

Retinoids. It seems logical that prescription retinoid preparations should work beautifully for acne. After all, they address the root cause of acne with their comedolytic action; they prevent the microcomedo from forming. However, one problem is that some acne patients are given the cream form of tretinoin that includes isopropyl myristate, a highly comedogenic ingredient. Even if patients are prescribed an appropriate retinoid, the retinoid often makes their skin so sensitive and irritated that they abandon using it before it becomes effective.

Isotretinoin. When the aforementioned strategies do not work, it seems the only choice left for the physician is to prescribe a round of isotretinoin. For many acne patients, the side effects are not worth the health risks. Although it can be the silver bullet for some acne-sufferers, one or multiple rounds of isotretinoin may be needed, only to break out again.

Get better results

An esthetician can be incredibly effective without the use of any prescriptions. More than ever before, skin care professionals have access to potent nonprescription active topical products. Product formulations with mandelic acid, lactic acid, vitamin A propionate, benzoyl peroxide and, to a lesser degree, glycolic acid and salicylic acid, can have a profound impact on acneic skin.

Research has shown that acne patients often do not adhere to physician-prescribed medication regimens and that more frequent visits by clients is associated with increased compliance.2 An acne specialist can take the time with acne clients that most physicians cannot by seeing them every two weeks for a two-to three-month period of time. This schedule makes the client compliance rate much higher—a key factor to getting results. (See An Effective Acne Specialist Can ...)

How to become an acne specialist

Most esthetician training focuses on spa and anti-aging treatments. Very few, if any, cosmetology schools sufficiently address acne concerns. To learn more about this aspect of esthetics, search for training that will give you the tools you need to get results with your acne clients. As an acne specialist, you will be able to do the following.

  • Recognize the grade of acne you are seeing, and have the ability to discern what is not acne, such as folliculitis, staph infections and/or steatocystoma multiplex.
  • Understand the properties of the active ingredients you are utilizing and discern which ingredients to use for each acne and skin type.
  • Become familiar with comedogenic ingredients.
  • Develop a sound protocol of home care for acne clients, starting slowly and adjusting as the skin becomes accustomed to product use.
  • Know which type of treatment to provide for clients’ acne type and skin condition, and know how to do proper extractions during these treatments.
  • Have a working knowledge of what exacerbates acne and how lifestyle changes will help the acne client.
  • Understand what to do when an acne client’s progress stalls.
  • Track your client’s progress and know how to handle client compliance issues.

Many skin care professionals are seeking specialized training in order to help their acne clients. Online groups such as “Acne Specialists” on LinkedIn are wonderful resources for aspiring acne specialists looking for information and support. Veteran acne specialist estheticians and nurses are eager to share what works for their clients. Ingredients, protocols and difficult cases are discussed in a product-neutral environment.

Although acne can be a frustrating condition for both the esthetician and client, with the correct training, any esthetician can become an acne specialist and achieve high success rates with even the most acne-prone skin. And because clients frequently suffer with acne for years before finding effective treatment, being an acne specialist is one of the most rewarding jobs a person can have. Helping people to achieve and maintain clear skin is the best feeling in the world—and once skin care professionals garner a good reputation for helping acne-sufferers, their businesses thrive. Make sure your skin care facility does not miss out on the opportunity to get real results for your clients with acne.


1. EA Eady, M Gloor and JJ Leyden, Propionibacterium acnes resistance: A worldwide problem, Dermatology 206 1 54–56 (2003)

2. M Patel, WP Bowe, C Heughebaert and AR Shalita, The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: A review, J Drugs Dermatol 9 6 655–664 (Jun 2010)

Laura Cooksey is an acne expert, educator, speaker and owner of Face Reality Acne Clinic in the San Francisco Bay Area. She has more than 20 years of experience in helping thousands of people to get clear skin and certifies skin care professionals to create successful practices with her comprehensive training DVD.

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Effective Acne Specialists Can ...

1. Educate clients on lifestyle issues, drugs/medications and comedogenic ingredients that can exacerbate acne. Acne specialists can also provide clients with personalized home care and treatment plans, and follow up to make sure clients understand what is expected of them.

2. Develop home care regimens for clients according to the type and severity of their acne. Knowing what formulation is best for each type of acne is critical.

3. Use benzoyl peroxide correctly, starting slowly so the skin won’t become irritated, then getting more aggressive as the skin adapts.

4. Make alterations to the home care protocol as clients’ skin adapts to product use. The biggest mistake that skin care professionals make in treating acne is to allow the skin to adapt to product use. Clients’ home care routines need to be adjusted at frequent intervals, such as every two weeks, to make sure the skin does not get too used to the routine. This usually means either increasing the frequency of use of a certain product or changing the products used. For example, it could mean that a client will be using an exfoliating serum twice a day instead of once a day.

5. Perform acne treatments that exfoliate the skin enough to control acne, but not so much that the client cannot use home care products the next day.

6. Perform acne extractions thoroughly and skillfully.

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