The Science of Acne

Close to 85% of people will experience some form of acne in their lifetime. According to the Academy of Dermatology, acne is the most common skin disorder in the United States affecting 40-50 million Americans at one time.4 When people think of acne, they think of teenagers, but acne can affect many people through adulthood as well. Some estimate as many as half of all adult women experience some form of acne due to an increase in androgen and a decrease of estrogen in peri-menopause.

Looking good and feeling good, do go hand in hand. This is why it can be so difficult for clients who suffer from acne skin. Acne can have a devastating effect on the self- esteem and confidence. Many acne sufferers withdraw socially, and even experience depression.

The good news is that most acne can be treated with outstanding results. And as you help your clients improve their skin, you’ll also improve their confidence and self-esteem. Treating acne can be one of the most rewarding experiences for you as an esthetician

What is Acne?

Acne is an inflammatory lesion of the sebaceous glands. The first signs are usually during puberty, where there’s an increase in the hormone Androgen, which is especially active in stimulating the amount of oil produced by the sebaceous glands in the skin. This stimulates extra production of sebum, combined with dead skin cells and other debris, become trapped and creates a plug that blocks the hair follicle.

Acne is defined as a condition resulting from the increased production of the hormone Androgen, which is especially active in stimulating the amount of oil produced by the sebaceous glands in the skin. As the ducts of these glands become plugged with the waxy oil, comedones (black heads) and whiteheads (milia) form. They are frequently infected with bacteria, causing welts, deeper lumps and pimples (cysts or nodules).

Sebaceous glands are the glands situated at the root of the hair follicle in the dermis. They can be found all over the body except for the palms and soles. These glands secrete sebum or oil. When the oil is mixed with perspiration, the skin’s surface becomes slightly acidic. This keeps some bacteria and fungi from embedding in the skin and at the same time helping to retain water in the tissue by slowing down evaporation from the skin. When the sebaceous glands are stimulated, a process known as retention hyperkeratosis occurs. This may be triggered by the onset of puberty, hormonal fluctuation, pharmaceutical agents, and stress, as well as heat and humidity.

In acne, the dead cells stick together, along with excess sebum and bacteria to form an impaction plug.

This first stage-impacted follicle is often referred to as a micro comedone. As the bacteria digest sebum, they produce fatty acid waste products that irritate the lining of the follicle causing a proliferation of cells to accumulate in the impacted follicle. At this point, the disease may result in non-inflammatory lesions, and simply produce closed comedones. When they eventually turn into open comedones and expel their contents, inflamed lesions may also result, whereby the follicle wall ruptures forming a papule. White blood cells invade the area and inflammation ensues. If the break is close to the surface of the skin a pustule results. If it is deeper, a nodule forms. In some cases, a membrane entraps the infection and a cyst forms.

Latest research has found that there are three factors that cause acne: Sebum, Bacteria, and Enclosure. And when you encounter these factors together, it creates an environment for inflamed, irritated and congested skin.


1. Keratinized plug blocks sebum from wicking out along the hair shaft

2. Stagnant sebum is broken down by bacterial enzymes into short chained fatty acid

3. Irritation of a papule is formed

4. Increased blood flow activates the immune system

5. White blood cells are rushed into to deal with the foreign matter

6. Pustules are formed


Levels of Acne – Level 1

Microcomedo: A comedo formed below the epidermis and can’t be seen by the naked eye. Feels like small, hard bumps. As it enlarges, it looks like tiny white bumps just below the surface of the skin.

Closed Comedo (Whitehead): firm white papule

Open Comedo (Comedones): A hard plug composed of sebum and dead skin cells. This is the mildest form of acne.

Levels 2-3

Papule: Inflamed lesions – Small, solid slightly raised areas of the skin less than half an inch in diameter. They may have varied appearance: rounded, smooth or rough, skin-colored or red, pink or brown.

Milia: Also known as epidermal cysts, these are small, firm white papules usually found in clusters on upper cheeks and around the eyes.

Pustule: A small, pus-containing skin blister often found at the opening of hair follicles. More visible inflammation than a papule

Levels 4-5

Nodule: large painful solid lesion extending deep into the skin

Cysts: In some cases, a membrane entraps the infection and a cyst forms. Cysts are inflamed pus filled lesions.

What can be done?

Today, acne can be treated without the harshness and discomfort of traditional treatments that leave the skin red and irritated. First to treat any form of acne, you have to deal with the three factors (Sebum, Bacteria, and Enclosure). This is done with a three- tier approach of professional esthetic treatments, home care program, and diet with nutritional supplements.

Regardless of which form of acne is prevalent on the client, it is known that sebum production or oil is the catalyst for the series of events that results in acne or skin blemishes. As skin care professionals, we know that excess sebum is often associated with enlarged pores, a tendency toward follicle congestion and an oily “T-zone”. We can treat acne prone skin by controlling the excess sebum production, and maintaining proper moisture level.

Common Acne Types

Acne Conglobata: Severe hereditary acne that generally causes scarring on the face and back. It appears as irregularly joined nodules; at earlier stages hard, then with a soft fluid feel.

Acne Detergents: Acne caused by overuse of abrasive cleansers.

Acne Excoriee: A psychosomatic disease involving neurotic picking of the face.

**Photo provided by Karen Burke., MD., PHD.

Acne Mallorca: Caused by excessive sun exposure. It’s often seen in people who work outdoors.

Acne Mechanica: Acne caused by mechanical irritation (such as under the chinstraps in football players).

Acne Medicamentosa: Acne caused by medications.

Chloracne Acne: Caused by constant exposure to certain industrial chemicals, such as aromatic halogenated compounds, and the hydrocarbons found in motor oil.

Steroid Acne: An inflammation of hair follicles caused by internal steroids or from topical corticosteroids on the face.

Acne Cosmetica: A condition caused by comedogenic ingredients found in hair styling products, conditioners, certain sunscreens and makeup. Acne Cosmetica lesions are of the same shape and size, and can be avoided by switching to non-comedogenic products.

Cystic Acne: A severe type of acne condition when the sebum together with dead cells and bacterial products ruptures through the follicle wall, causing an inflammatory reaction that may end in scarring. It appears as a large rubbery nodule, often skin colored and surrounded by red inflamed tissue, 5-20mm in size.

Acne Vulgaris: Most common form of acne, most common in teenagers. It is a direct result of an increase in the male hormone Androgen. Normally develops at puberty and can be triggered at any age. Characterized by a variety of lesions, being visible at any time.

**Photo provided by Karen Burke., MD., PHD.

Removal of Acne Lesions

Desincrustation: Desincrustation is the process of softening the keratinaceous horny plug and allows extractions to proceed easily with minimal trauma to the surrounding tissue.

Lancets: Estheticians can remove comedones (closed and open) and milia with the use of lancets (check with your local state board if it is permissible). Papules and pustules, however, cysts and nodules must be treated by dermatologists. As an esthetician you can still administer acne treatments that will help cystic skin but you won’t be able to remove those lesions.

Comedone extractions:

Manual extractions using vinyl gloves and wrapped index fingers is very effective in removing comedones. If it doesn’t remove immediately, with slight pressure from side to side, use alternating angles to gently lift the Comedone.

Another gentle and effective way to remove a Comedone is with sterile cotton swabs.

If the contents are not expelling, simply go to another section and leave it for the next treatment. Remember the Comedones did not occur in one day and many times it will take more than one treatment to clear them all up.

Esthetics Tools in Treating Acne

High Frequency

High Frequency is an excellent and versatile tool for the esthetician. This electrical unit contains an electrode that uses UVC germicidal rays.

High Frequency:

· Has anti bacterial properties

· Decreases inflammation

· Allows for faster healing time for lesions

· Prevents Secondary infections

Contraindications when working with high frequency machine, they are:

· Do not use on pregnant clients

· Do not use on people with high blood pressure or heart condition

· Epileptics

· Asthmatics

· Clients that have braces, metal implants or heavy dental work

Educating your Client

Education and knowledge is the key in treating acne. Educate your client on the importance of in salon treatments and following a home care program especially designed for them.

As you know picking and squeezing pustules will only make their acne worse. Picking can spread acne-causing bacteria and squeezing can spread infected material deeper into the skin causing more inflammation and even scarring.

Another misunderstanding is the acne can simply be washed away. But over-washing will further irritate the skin. Educate your clients on the myths of acne, such as acne is caused by chocolate. There is no evidence to support that claim. Maintaining a healthy lifestyle, home care program, nutritional supplements and professional acne treatments will lead to a healthier more radiant skin at any age.

4 American Academy of Dermatology,

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