Acne and Sensitive Skin


Acne is the most common skin disorder in the United States, according to the American Academy of Dermatology.1 It affects 40 to 50 million Americans and almost 85% of people will get some form of acne during their lives. Many clients with acne may also be experiencing sensitive skin issues—skin care professionals need to take steps to alter typical treatments used to treat acne for specialized treatment of this group of clients.

For those with sensitive skin, acne can be much more inflamed than it tends to be for those without sensitive skin. The initial intake form should attempt to pinpoint where acne is coming from—based on that, the skin care professional should utilize facial protocols and establish a home-care regimen.

Value of the intake form

Both internal and external inflammation can play a role in sensitive acne. The intake form is very important in getting the whole story from the client.

Internal inflammation. Asking the right questions will help determine why the acne possibly started.

Has the client had acne for a long time or is this something new? Depending on the cause, the breakouts could be a short- or long-term issue. Acne outbreaks occur in a variety of age groups—it is not just a typical problem for teenagers. Menstrual cycles can begin in young girls as early as 8-years-old and breakouts are extremely irritating for their delicate skin.

Is the client on medications? Commonly prescribed medications such as antidepressants, steroids and even medications for attention deficit disorder can cause various acne issues and inflammation in the skin.

Does the client have a metabolic disorder such as diabetes? Diabetes-related acne is caused by an overproduction of insulin or resistance to insulin. Examining diet, stress and other internal factors will provide insight on the best way to approach treatment.

External inflammation. Even if internal factors are regulated, external factors can also come into play. Pollution, exposures to certain chemicals and damaging UV rays from the sun can create skin inflammation.

Many clients report their acne improves when they tan. The sun doesn’t clear skin; it is just an illusion as the skin becomes darker in color, which makes acne outbreaks stand out less. The sun actually weakens skin’s barrier, creating moisture loss, which can lead to skin producing more oil. This can lead to more outbreaks, possible hyperpigmentation and can even darken old acne scars.

Ingredients in products used are important, as are the types of facials offered for this client. Skin care professionals need to set up a series of treatments that can help with controlling outbreaks, but also to calm skin inflammation.

Although intake forms are valuable, estheticians still need to complete a thorough skin analysis during the first treatment. The first facial should be a gentle, cleansing and hydrating facial. Any extractions should be very gentle, as sensitive skin can be more prone to scarring. The next treatments could be a series of enzymes and lighter peels with calming, hydrating facials in between. (See Treatment How-to: Sensitive Acne Facial.)

Choosing the right tools

While in the facial room think about the materials and machines being used. For example, while many clients do not like their skin care provider to wear gloves it is extremely important on the acne client to avoid the spreading of bacteria. Nitrile gloves are a great choice—as long as they are tight-fitting, they will feel natural against the client’s skin. Using a steamer directly on the face is discouraged as steam can intensify sensitive inflammation. A steamer may still be used, but it should be pointed away from the face. Microfiber cloths can be a proper alternative for a more gentle touch, and using luke warm to cool water, rather than hot water or steamed towels, will help calm the skin. The client may benefit from cool beauty globes rolled on the skin to sooth irritation and help reduce redness.

Products used in professional treatments need to be altered for sensitive acne clients, as the ingredients used on the average client are too aggressive. The Food and Drug Administration (FDA) recently issued a warning that the use of certain acne products containing the active ingredients benzoyl peroxide (BPO) or salicylic acid can cause rare, but serious and potentially life-threatening allergic reactions or severe irritation.2

Products used should include ingredients that are antimicrobial, antibacterial and anti-inflammatory. A wonderful ingredient for sensitive oily and acne-prone skin is mandelic acid. Like other alpha hydroxy acid (AHA) exfoliants, mandelic acid helps slough dead skin cells and assist cell turnover to help improve texture and complexion problems, such as wrinkles and uneven tone. What’s unique about mandelic acid is its ability to be as effective in treating a variety of skin conditions as glycolic acid, but with significantly less irritation and redness, especially for those with sensitive or darker skins. With added antibacterial and anti-inflammatory effects, mandelic acid is an ideal choice for a wide range of skin conditions and skin types to result in an improved appearance with fewer side effects.

There are a handful of new ingredients that will help sensitive acne and reduce the appearance of pore size without causing irritation. In the past, licorice has been used to treat hyperpigmentation, but a new form of this ingredient is being examined to treat acne: Lichochalocone—Glycyrrhiza inflata root extract—is a highly bioactive part of licorice root extract.3 Its anti-acne, oil-controlling and sebum-reducing abilities have tested as superior to BPO. Lichochalocone also has powerful anti-inflammatory effects—BPO, on the other hand, is harsh and can cause or worsen skin sensitivity.

L’Oreal recently conducted a study that revealed along with the concerns of the development of wrinkles, at least 45% of those polled were also concerned with their pore size.4 Sensitive acne pores can actually look much larger as they tend to be inflamed.

Lysophosphatidic acid is becoming more popular in various professional skin care brands as it improves keratinization and limits parakeratosis, which are results of inflammation. It was proven to reduce the appearance of large pore sizes by 20% in four weeks on individuals who used it twice a day.5

Vitamin D plays an important role in regards to how sebaceous glands function. Vitamin D is also anti-inflammatory, antibacterial, noncomedogenic and an antioxidant—characteristics helpful to sensitive skin with acne.6 Glutamylamidoethyl imidazole is a chronopeptide that simulates sun exposure on the skin to trigger circadian gene expression, helping synchronize skin’s circadian biorhythm. This biorhythm can become disrupted from aspects of life, such as lack of sleep and sun exposure, and jet lag or stress, thereby compromising cellular metabolism, regeneration and recovery. Use of this chronopeptide will help skin rest and return to a balanced biorhythm for optimized cellular function which can also help relieve sensitive skin issues.7

Home care for the client

While the client may go home with their skin calm and less inflamed after their facial, skin care professionals need to give them home-care tips and product suggestions to keep the outbreaks under control until their next treatment. Suggest simple actions they can take at home to help keep the inflammation and acne under control, such as using softer towels, refraining from using hot water or steam, and remembering to change linens frequently.

Getting clients to understand that using the professional skin care that estheticians suggest will be much more effective than many of the products sold at the local drug store. This is extremely important with sensitive skin.

More than likely, if the client has grades III or IV acne they are probably under a physician’s care, and if not, a skin care professional should suggest they see one. Many times, clients will still seek facials while on medications from a dermatologist because prescribed medications may make the acne more inflamed. Encourage them to use more gentle products that are less aggressive. Products to suggest should include ones that have: lower percentages of beta hydroxy acids or AHAs, gentle polishes, natural SPF, and ones that are in gel or serum form. Informing them that over-stripping and drying out the skin will actually do more harm than good, as it will cause inflammation and possibly more painful breakouts.

Skin care providers want to “do no harm,” and the sensitive skin acne client can be a tough one to treat. However, it is especially rewarding to help these clients with their skin concerns and offer some relief—whether acne is a short- or long-term issue for them. A thorough intake form and initial consultation will help to provide answers as to why acne and sensitivity have developed—whether due to health challenges, environmental, diet or hormones.

Altering this type of client’s facial treatment plan with less aggressive products and effective home care to keep skin in check between facials will help reduce their overall sensitivity. With sensitive skin on the rise, now is the time to add a sensitive skin facial to your treatment menu.


  6. WP Bowe, AC Logan, Clinical implications of lipid peroxidation in acne vulgaris: old wine in new bottles, Lipids Health Dis 9 141 (Dec 9, 2010
  8. L Walker, The Skin Care Ingredient Handbook: Revised and Expanded Edition, Allured Business Media, Carol Stream, IL (2014)

(All websites accessed Oct 10, 2014)

Kris CampbellKris Campbell is CEO of Tecniche, a skin care line dedicated to sensitive and health-challenged skin. Campbell trains, writes for trade publications and speaks at trade events on conditions that arise with health-challenged skin. She has worked for an FDA cosmeceutical lab helping clients create their own brands and currently formulates for Tecniche.



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