Touching Clients With Acne

If you associate face massage with lashings of thick massage cream and a good, firm European face massage, you’re not likely to turn to massage as one of your tools in your professional skin care arsenal when it comes to treating acne. Putting massage mediums and massage techniques aside, I invite you to explore the multiple benefits that massage and touch therapies can provide when treating acne-prone skin.

The Emotional Toll of Acne

We have learned acne is influenced by genetic and hormonal factors, internal and external contributors that aggravate it, and how to recognize the various acne lesions. However, how much did we learn about the invisible, psychological symptoms someone with acne may experience?

Embarrassment, guilt, shame and anxiety are some of the emotions acne sufferers feel on a daily basis. These feelings are fueled by negative thoughts and can result in personality traits such as low self-esteem, depression and social withdrawal, to name a few. Acne has a negative effect on self-esteem across all ages, but most strongly affected are women and those with severe acne.¹

James E. Fulton Jr., M.D., Ph.D. was a pioneer in the treatment of acne. He suffered as a teenager and understood the psychological side of this skin disease first hand. His research has shown teenage boys are reluctant to let others know how much their skin bothers them, yet a 40-year-old man who bears the scars of adolescent acne will tell you, “Yes, it was absolutely devastating.”

In his book, Acne Rx, Fulton writes “One of my patients summed up the feelings of many acne sufferers when she said, ‘Yes, I know everyone has some problem they have to live with. But if I had to have some illness, I would rather it be something on the inside, not on the outside where the whole world could see it.”²

Another of Fulton’s patients, a 23-year-old man from Arizona wrote, “I am writing to you….because I am desperate. After six years of acne, my life has been hell and it has greatly affected my social life and my jobs. My acne has affected me mentally and recently I became very much afraid of myself…of what I might do.”

Self-esteem and personal identity development are critical in young adults. A visible skin disease can make you feel unattractive, isolated and lonely. They may shrink from touching and being touched because they feel untouchable, un-huggable and un-kissable, making it difficult to form romantic relationships.

Emotions And Touch

While we may use a variety of ingredients and devices to treat the physical symptoms on the skin, in order to treat the invisible symptoms, we can utilize the power of our touch.

The need for human touch is one of our most basic, primal needs. Touch deprivation is correlated with negative health outcomes such as anxiety, depression and immune system disorders. Touch more than any other sense, is universal across cultures and species. It is the first sense to develop in the fetus and the last to fade in old age. Babies who are regularly held and touched gain weight faster, develop stronger immune systems, crawl and walk sooner, sleep more soundly and cry less than babies deprived of close physical contact. Children need touch for survival, their growth and development. Those who are given plenty of physical affection show more task orientated behavior, less solitary play and less aggression at school.³

Unfortunately, touch has, in many instances in society, become taboo. Teachers are no longer allowed to hug their students, nor pat them on the back for a job well done for fear of a lawsuit of sexual harassment. However, as estheticians, we have the opportunity, privilege and permission of our clients to give touch in a highly therapeutic way.

Massage and Stress Relief

There are multiple benefits of touch and even more with specifically skilled massage. Increased feelings of well-being, relaxation, improved sleep, less anxiety, pain relief, decrease in blood pressure, heart rate and helps relieves stress, to name a few.

As stress has been attributed to making an acne condition worse and massage helps relieve stress, there’s some convincing evidence that massage is worth including with all acne clients.

Anecdotal evidence for stress as being a contributing factor to acne has been known for years. Now there have been multiple scientific studies worldwide with strong supporting evidence that stress does worsen inflamed acne. Research found that 50-80%⁵ of the people with acne report a connection between increased emotional stress and worsened breakouts.

So, what causes stress? Psychological or emotional stress occurs because of a stimulus inducing reactions in the brain. It’s also highly individual. What makes one person feel anxiety, fear or anger could have no influence on another person. Whether it’s a job interview, conflicts in relationships or the number of breakouts you have, we all process emotions in different ways. Regardless of the cause of stress, the body copes with it in the same way.

In response to emotional stress, the hypothalamic-pituitary-adrenal (HPA) axis activates increased levels of cortisol release. This ultimately affects the function of the sebaceous glands in the skin (see Stress and Sebum).

When the body is stressed, the hypothalamus region of the brain secretes corticotropin-releasing hormone (CRH), which signals to the pituitary gland. Also known as the master gland of the endocrine system because it regulates activities of other hormone producing endocrine glands, the pituitary gland then secretes adrenocorticotropic hormone (ACTH). This hormone stimulates the adrenal glands to secrete cortisol, which causes a number of changes in the body so it can deal with the stressor. This process can cause an increase in blood sugar levels, heart rate and destroy immune cells.

The sebaceous glands have corticotropin releasing hormone receptors, so an increase of CRH in stress can stimulate the formation of sebum. CRH also induces cytokines lL-6 and lL-11 production in keratinocytes, leading to inflammation.

Peripheral nerves release the neuropeptide substance P in response to stress. Substance P has shown to stimulate sebaceous gland activity and increase sebum production.⁶

Using massage for stress reduction to help reduce cortisol levels and therefore reduce sebum production, also has positive effects on the following aspects of acne skin.

Massage and Immunity

As cortisol destroys immune cells and natural killer cells are a type of immune cell that can become more active and numerous as a result of massage. These cells are the front line of the immune system warding off bacteria and viruses. In the case of acne, there is an abundance of C. Acnes. A healthy immune system is vital for managing an acne condition. Cortisol, produced as part of the stress response, is also reported to kill immune cells.

Massage and Wound Healing

An acne skin is constantly in repair mode, and a healthy immune system is vital for optimum function. Cytokines are small signaling peptides produced by immune cells and play an important role of wound healing, inflammation and tissue repair.

Massage and Mood

Neurotransmitters and hormones such as dopamine, oxytocin and serotonin are released which have shown to improve mood, a sense of well-being, feelings of positivity and increase social interactions.

Incorporating Massage for Acne

Sometimes massage gets the reputation of being superfluous in modern skin care treatments. There is nothing frou frou about massage. Hippocrates said in 400BC that “Medicine is the art of rubbing,” a practice that came to be called massage therapy.

Many times, massage on acne is contraindicated, depending on the technique. However, massage need not be restricted to the face. Consider scalp, neck and shoulders and even hand massage as a way of introducing touch into your acne skin care treatments.

While a face mask is absorbing, simple firm finger effleurage applied from the hairline to the crown is deeply relaxing. The majority of people love visiting the hairstylist for their scalp to be touched.

Once you’ve applied an exfoliant that needs to work a while, thumb frictions across the upper shoulders feels great. Continue the movements up the back of the neck to the base of the skull.

If you incorporate an LED panel in your service, add a hand massage to your protocol. Focus your movements on the palm. This area of the skin is rich with Meissner’s Corpuscles, nerve endings that detect sensitivity and touch.

Hand massages can be incorporated into treatments for male teen clients who may be less resistant to being touched on the face, as this may be construed as intimacy.

At Home Exercises

Along with their skin care regime, encourage clients to exercise relaxation techniques to help manage their stress on a daily basis. Mindful breathing is a simple exercise to do. Set your phone for two minutes on timer, twice a day. Be still and close your eyes. Slowly inhale, feeling the cool air enter your nose and as you breath out, feel the warm air. Taking short breaks like this throughout the day helps keep the mind calm. Let’s remember the importance of touch and the impact it can have on reducing stress and impacting the invisible acne symptoms.

Gaynor Farmer-Katics is passionate about teaching estheticians how to refine their touch by increasing their repertoire of massage techniques. With almost 40 years of industry experience as an esthetician, massage therapist and educator, her business Enhanced Touch offers both online and in-person training. Find out more at www.enhanced-touch.com.