Cosmetological facial cleansing: procedure algorithm

Ekaterina Glagoleva, cosmetologist, scientific editor of the 1nep.ru portal, scientific consultant of the EsteLife portal, owner of the beauty bureau Come Mode (Russia)

But they often disagree: at initial appointments I see dozens, or even hundreds, of faces with traces of autoscarification and stagnant spots after unsuccessfully squeezed out pimples, which spoils the visual picture much more than the presence of acne itself.

Every time we talk about acne, we want to return to the classic definition. Acne (acne vulgaris) is a chronic recurrent skin disease, mainly of young people, which is the result of overproduction of sebum and blockage of hyperplastic sebaceous glands with subsequent inflammation.

In preparation for writing this article, I looked at scientific resources and professional forums, and then plunged into a whole world where acne patients debate the question of “to press or not to press?” Perhaps doctors need to realize that classic facial cleansing is not a thing of the past, and the emergence of numerous products that successfully work against acne does not eliminate the need for extraction of comedones and the fight against pustular elements “here and now.” So, I think we need to talk again about such a procedure as facial cleansing - a procedure surrounded by many more myths than an actively practicing cosmetologist can imagine.

The algorithm is in charge

Acne therapy includes many different stages and begins with making a diagnosis, determining the severity, type of acne and identifying or excluding concomitant somatic diseases. The next stage is the appointment of rational dermatological therapy and selection of optimal home care, identification of provoking factors and internal triggers and maximum elimination of these components. Then we move on to dynamic observation and professional procedures, which may include combined chemical peels, mechanical and ultrasonic facial cleansing.

In my practice, I rarely use isolated methods; I generally prefer to combine them. And of course, speaking about cleansing, first of all it is necessary to address the issue of adequate skin preparation.

Chemical peels

In combined acne therapy, acids play a huge role. The choice and combination remains with the doctor and the specific clinical case.

Many peels used to treat acne contain salicylic acid. In professional chemical peels its concentration reaches 20−30%, in home care products – 0.5−10%.

In my practice, I most often use chemical peels containing salicylic, pyruvic and lactic acid as a stage in preparing the skin for cleansing and in complex acne therapy. In particular, salicylic acid affects the arachidonic acid cycle, which promotes anti-inflammatory effects. It is also important that when using peeling with salicylic acid, less pronounced skin irritation is observed than when performing peeling with glycolic acid. Also, a clear advantage when choosing salicylic acid in the case of patients with comedonal acne is the lipophilic properties of salicylic acid, which has a more pronounced comedolytic activity than glycolic acid. Thanks to this property, it is able to penetrate through sebum into the hair follicle and enhance the desquamation of cells in the pores.

Peels based on glycolic acid are very popular in cosmetology and are widely used. When comparing glycolic and salicylic acids directly in terms of clinical effects in the treatment of acne, the leadership remains with the latter. The main disadvantages of glycolic acid-based peels in patients with acne can be considered manifestations of skin irritation and cases of manifestation of perioral dermatitis.

Chemical peels should be prescribed and performed with great caution in patients receiving topical retinoid therapy, since the use of topical retinoids is often a relative contraindication to peels. We use a combination of methods, but are initially prepared to obtain a brighter skin response, taking into account the history.

Microdermabrasion

Very often during consultations I hear that patients with moderate and moderately severe acne have undergone salon, professional microdermabrasion procedures. During the session, the skin is treated with special abrasive materials (aluminum oxide crystals) or polished with special brush attachments. Most patients note a worsening of acne after a course of microdermabrasion procedures. However, at the same time, patients who received a combination of microdermabrasion procedures and glycolic and salicylic peels noted improvements in their clinical picture.

In a review work on the topic of microdermabrasion conducted by Karimipour DJ and co-authors, it is noted that dermabrasion has proven itself as a method of working with post-acne and in combination with the main anti-inflammatory and antibacterial therapy for acne, but is not a monomethod. Histologically, patients after dermabrasion show thinning of the stratum corneum, swelling of the dermis and perivascular inflammation. The last points can aggravate the process, and this is worth paying special attention to.

Vaporization

A widely known, one might say, classic stage of mechanical cleaning. Is it needed? What is the rationale for using thermal procedures in acne treatment? And what are the alternatives?

Vapozon has long become a symbol of a beauty salon, and many older patients can remember how they went to hover their faces over a “cosmetology bath unit” in negligees. But, like any technique, vaporization has pros and cons.

Pros: opening of pores, facilitating extraction of their contents.

Disadvantages: a powerful vascular reaction, often provoking inflammation, the risk of hyperextraction and, as a result, worsening compensatory circles, that is, the more sebum is removed, the more is secreted.

The optimal low-traumatic alternative can be considered the use of non-abrasive enzyme compositions containing amylase, lipase, trypsin and chymotrypsin, as well as papain and bromelain. They can be used under occlusive film. In the case of thick, porous, very oily skin, it is also recommended to use hot towels as compresses or vaporization at low temperatures.

Mechanical facial cleansing

This is a stumbling block for dermatologists and cosmetologists. Some people say that it is absolutely forbidden to crush acne. Others argue that if the cosmetologist does not do this, observing the rules of asepsis and antiseptics, then the patient will do it. I consider myself to be a specialist who holds the latter point of view. You need to come to terms with the fact that all patients, even those with a high degree of consciousness, press on their faces. Therefore, the task of the dermatocosmetologist at the appointment is to remove those acne that can be easily removed, and identify those that should not be pressed under any circumstances, and prescribe local anti-inflammatory and antibacterial therapy.

Work with objections

While writing the article, I collected a variety of arguments and observations from patients, and here is a short, contradictory selection:

“On the contrary, I didn’t push the pimples, but the scars still appeared. Why?"

Comment: Long-term inflammation can lead to excessive accumulation of pus in the hair follicle and its breakthrough, leading to the penetration of bacteria and dead cells into the dermis. In severe cases, this process may result in scarring.

“Yes... I got caught like this several times. It seems that if you press, it will come out like clockwork, but no, it doesn’t, it sits there and sits, and as a result, the skin is torn off and the pimple becomes even larger...”

Comment: the cosmetologist must clearly differentiate those elements that absolutely cannot be touched, and explain to the patient that if light pressure on both sides of the medial surfaces of the first phalanges, wrapped in sterile napkins, has no effect, then there is definitely no need to insist. This will lead to excessive trauma, formation of stagnant spots and scarring.

“One hundred percent: under no circumstances should you squeeze! I am now being treated by a former deputy. ex. beauty center, my grandfather is about seventy or eighty years old, and, as he explained, when squeezing out any type of pimple (be it an acne, an abscess, etc.), the internal sac (internal canal) is broken and the infection from one pimple spreads, and in place one of you, the next day (or within two or three days), several of his friends appear, and, by the way, I really followed this... So, guys, if you put pressure, you get a vicious circle! You get rid of one, you get a couple more! Well, why is this necessary? Wouldn’t it be easier to just endure a couple of days?”

Comment: for moderate to severe acne, when purulent, pustular drainage elements predominate, cleansing the face will only worsen the situation. In this case, you need to start with external or systemic rational therapy, normalize basic care and use chemical peels with minimal tissue trauma.

It would seem that cosmetology, as a science, is increasing its pace, new high-tech methods and methods of aesthetic medicine are being discovered, but the question is “to squeeze or not to squeeze acne?” remains relevant. Cosmetologists and dermatologists may rant at round tables and congresses, but patients will be looking for a way to quickly and effectively get rid of acne. And it is important for a cosmetologist to:

• have knowledge about the pathogenesis and basic treatment of acne;
• be able to prepare the patient’s skin for extraction;
• follow the rules of asepsis and antiseptics;
• follow the rules of minimal trauma to the underlying and surrounding tissues;
• prescribe anti-inflammatory therapy;
• teach the patient the techniques of “SOS help”;
• emotionally prepare the patient for the fastest response to therapy;
• support in the most difficult moments.

First published: Les Nouvelles Esthetiques Ukraine, No. 2 (84), 2014