Article: Blocking Blackheads

***Leza1121*** · 10-05-2006, 02:50 PM

Dear all,

I've gone to one of my favorite skin care sites called "Les Nouvelles Esthetiques". The article below was written by Dr. Mark Lees.

Btw, if you feel it's too technical or boring, please let me know (it's actually written for estheticians).

I hope you enjoy it.

This month’s Featured Archive Article:
Blocking Blackheads

Create a Professional Plan
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By Mark Lees, Ph.D., M.S.

Every client dreads blackheads and clogged pores. They are the main reasons clients seek the services and advice of estheticians.
Technically called comedones (one lesion is a comedo), there are several types. Open comedones are what most people call “blackheads.” Closed comedones appear as small bumps just under the skin. The anatomical difference between an open and closed comedo is the dilation of the ostium—the opening of the follicle onto the skin.

Blackheads occur frequently in people with oily skin areas. They begin as a build-up of dead epidermal cells on the walls of the follicle. This phenomenon is known as retention hyperkeratosis, a hereditary condition in which the cells do not shed normally, thus forming a “build-up” lining the follicle. This build-up is coated with sebum that solidifies, forming a clump-like mass in the bottom of the follicle, known as a microcomedo. From this beginning, either an open or closed comedo is formed.
Release the grease

A second, hereditary factor in clog-prone skin is overproductive sebaceous glands. Excessive sebum is produced, making these skin areas oilier and furnishing sebum that can easily coat the cell build-up and solidify in the follicle. Acne bacteria easily break down sebum into fatty acids. And fatty acids are the favorite “food” of acne bacteria.
Closed comedones can easily become an acne papule or pustule because of the lack of oxygen in the follicle. Propionibacterium acnes bacteria are anaerobic and thrive in an environment void of oxygen. Open comedones are not attractive, but rarely evolve into a more serious or inflammatory acne lesion.

The small clogged pores on the nose are not classic comedones. They are called sebaceous filaments and are mostly just solidified sebum. Oxidation causes the black part as sebum is exposed to oxygen. Closed comedones do not have a black color because they are not exposed to air. Sebaceous filaments form quickly because of the volume of sebum produced in oily areas like the nose.
Extraction

Professional extraction can easily remove open comedones. The skin should be softened with a desincrustation product that is slightly alkaline in pH. The alkalinity softens the hardened sebum. Galvanic treatment can further break down the fatty plugs deeper in the skin and is appropriate for oilier and acne-prone skin types. Once the sebaceous mass is softened, it is much easier to extract.
Professional extraction steps

1. Always wear a pair of latex or vinyl gloves during treatment.
Cleanse the client’s face thoroughly using a lightweight, non-greasy cleansing milk.
A second cleansing using a light-foaming cleanser is appropriate for excessively oily skin.
Avoid using toner before extraction, because toning constricts the follicle opening.
Exfoliation using a gommage, granular exfoliant or gentle AHA exfoliant will help remove surface dead cells for easier extraction. Avoid using very strong (pH less than 3.0) AHA treatments. Do not use more than one exfoliation technique, as this can inflame the skin.
Apply a professional desincrustant product, and allow it to sit on the clogged areas for eight to 10 minutes, depending on the product directions.
If desired, galvanic current can be applied over the desincrustant, depending on the product directions. This is a good treatment technique for excessively oily and clogged skin. Remove any excess desincrustant.
Extraction can be accomplished with a comedo extractor, cotton-wrapped fingers or cotton swabs. Using one of these techniques, gentle pressure should be applied to the sides of each open comedo, and the technique should be repeated as necessary around all sides of the comedo, until the comedo expels from the follicle. The same technique can be used for sebaceous filaments. Closed comedones should be dilated with a sterile, disposable lancet before extraction. Professional, hands-on instruction should be sought in this technique before attempting follicle dilation.

Note: Consult your state board of cosmetology with regard to extraction. Some states do not allow licensed estheticians to perform any type of extraction.
Exfoliate

Extraction can remove existing comedones, but it does not stop the formation of more comedones. Cells continue to build up, and sebum continues to solidify. The control of the microcomedo is the real key to controlling comedone development and, in many cases, comedonal acne.

Using exfoliants daily, like alpha hydroxy and beta hydroxy acids in a liquid gel, helps flush cellular debris from the follicle. A mixture of glycolic and salicylic acids (and sometimes other AHAs) helps break loose cell buildup and helps prevent build-up form recurring. In more severe cases of acne, benzoyl peroxide and mixtures of sulfur and resorcinol can be used.

The client must be educated that development of clogged pores and blackheads is a chronic condition and must be treated constantly at home. Once the visible clogs are gone, treatment must continue at home, or the comedones will return.
Use of professional AHA exfoliation treatments can be very helpful in clearing clogged pores, but must be accompanied by a home care AHA treatment and professional extraction.
Avoid clogging products

Clients must avoid using any facial product or cosmetic that is comedogenic. Comedogenic products contain oils, certain waxes, fats, fatty acids or esters that can penetrate the follicle and cause clogged pores from the outside. These fatty materials can be present in almost any product, but are most often found in moisturizers, creams, makeup foundations and powders. Comedogenic fatty materials are used in products as emollients and spreading agents and to add softness to products. Emollient ingredients are appropriate for dry skin types that do not produce enough sebum.

A non-comedogenic product does not contain these fatty emollients and is generally very light in texture and thickness. Look for products that have been independently tested to ensure that they are non-comedogenic. Be aware that there is no law requiring such testing. It is best to check with your product supplier and to research textbooks to understand more about comedogenic ingredients.

Be especially careful with “anti-aging” products, as they are often designed for more mature skin that does not produce enough sebum.
All products used by the client must be non-comedogenic. Anything left on the face should be suspect. This includes moisturizers, foundations, powders, serums, sunscreens and blushes.

Besides avoiding comedogenic and oil-laden products, a good foaming cleanser will help dissipate oiliness and excessive sebum. An acid-balanced toner used after cleansing will help remove further surface residues.
Avoid any product that is oily or heavy. Many of these are comedogenic, and adding oil to already-oily skin can contribute to clogging.
Morning home care

Wash the face with a foaming, rinsable cleanser. Ammonium lauryl sulfate and disodium lauryl sulfosuccinate are examples of cleansing ingredients that remove excess oil without causing excessive stripping. There are, of course, varying degrees of oiliness that require different levels of cleansing and, therefore, different concentrations of cleansing agents. Estheticians should carry several to fit the various levels of oiliness in their clients.
Apply a toner that has a pH of around 4 to 4.5. Alcohol in toners is only appropriate for excessively oily skin.
Apply an AHA/BHA gel or serum. These should contain 10 percent alpha hydroxy acid and up to 2 percent salicylic acid. These lightweight gels should absorb quickly and not be sticky on the skin.
Apply a broad-spectrum sunscreen (SPF 15 or higher) that has been found to be non-comedogenic. This should be very lightweight in texture.
Eye cream should also be tested for comedogenicity as eye creams tend to drift during wear to clog-prone upper cheeks.
If makeup is applied, choose a liquid makeup that is non-comedogenic. Some “mineral” makeup products are non-comedogenic, but make sure you check the ingredients. Any powder product in a cake form is “pressed” with some form of fatty agent to keep it in cake form. Stay away from cream and oil-based makeup for this skin type. Powder and blush should also be checked. Blush should be free of D & C red dyes, many of which are comedogenic.

Home care for the evening

Remove makeup using a lightweight, non-comedogenic cleansing milk. For oilier skin, follow by using a rinsable foaming cleanser, as in the morning routine.
Use toner as in the morning routine.
Apply an AHA/BHA product. Spot treat papules and pustules with a benzoyl peroxide gel or a sulfur/resorcinol product. If skin has many acne papules or pustules, apply a very small amount of benzoyl peroxide gel to all areas except the eyes.
If skin is extra-sensitive, apply the AHA/BHA product at night only, or apply small amounts of benzoyl peroxide only every second or third night. Avoid using both AHA/BHA and benzoyl peroxide at the same time on sensitive skin.
Apply a non-comedogenic, hydrating fluid and massage into the skin.
Apply eye cream as in the morning routine.

Dos and Don’ts

Do sell clients effective, yet mild cleansers to control and remove excess oil.
Do have clients use a mild 10 percent alpha/beta hydroxy gel daily. This will loosen existing clogged pores and help to prevent the cell build-up that will cause new clogged pores to form.
Do perform extraction treatments, but let the home care work for you. Using AHAs, proper cleansers and avoiding clogging products will help loosen the clogged pores. Perform minimal extractions in the first visit. Extraction should be much easier during the second treatment.
Don’t overextract! Ten minutes is sufficient time for extraction. If you need to do more than 10 minutes, the client is not visiting often enough! Overdoing extraction can be painful and inflammatory to the skin.
Don’t extract anything you are not sure about. Refer the client to a dermatologist if you see lesions and conditions that are atypical.
Do always wear gloves during any extraction treatment!
Don’t over-dry the skin. Too much exfoliation and drying can cause inflammatory reactions, resulting in more papules, pimples and “surfacing”—flares of acne after a treatment.

A ‘program’ approach

A single facial or only professional treatments will not provide any long-term results for the client. A complete home care program, along with periodic salon treatments, will produce real results. An organized, comprehensive treatment plan with great client education is the best bet for clearer, clog-free skin!

Source: LNEONLINE - The Leading Magazine for Skin Care and Spa Professionals