Skin care professionals experience the challenge of eliminating acne from the lives of clients on a regular basis. It is a physical condition that takes an emotional toll on those affected by it, so the challenge requires both a scientific mind and a compassionate heart. When a professional succeeds, there may be pride and satisfaction in the accomplishment, but the greater reward is the overwhelming gratitude from clients whose lives have been improved because of their work. This can make them more determined than ever to create great results, so it is frustrating when stubborn acne will not budge. At times, acne may seem like the most difficult skin condition to treat. That is where LED comes in.
ACNE: IT’S COMPLICATED
Before an understanding can be gained about how LED can help treat acne, it is essential to understand the condition itself. The Merriam-Webster Dictionary defines acne as, “a disorder of the skin caused by inflammation of the skin glands and hair follicles – specifically, a form found chiefly in adolescents and marked by pimples, especially on the face.” Basically, the hair follicles get plugged with oil, dead skin cells, and bacteria, which can lead to acne lesions. Although the majority of individuals affected by acne may be adolescents, people of all ages suffer from this condition, which can appear as blackheads – small, flat spots with dark centers –or whiteheads – small, flesh-colored bumps. Both types of clogged pores can become swollen, tender inflammations (or pimples) or deeper nodules that are associated with more severe cases of acne (like cystic acne) that can become inflamed, painful, and infected. If left untreated, acne can also lead to hyperpigmentation and permanent scarring. When treating acne, just like any other skin condition, all aspects of what is being treated must be considered.
Acne can take many forms, have varying degrees of severity, and be triggered by a number of intrinsic and extrinsic factors, including hormones, diet, pollution, and stress. Any successful acne treatment protocol includes killing the surface bacteria and minimizing excess oil (if it exists), as well as, reducing inflammation, redness, and discomfort, while creating healthy skin tissue so the skin can heal. There are many stories of unsuccessful attempts at alleviating acne lesions, in which the professional focused solely on eradicating the bacteria and the oil. This approach can be unsuccessful, since there are other aspects of the condition to consider and the options to remove the bacteria and oil might also aggravate the inflamed skin and contribute to compromised skin tissue.
An example of this is someone who is advised to use topical products to reduce oil or increase cell turnover (like tretinoin or salicylic acid) along with antibacterial agents (like benzoyl peroxide) to kill the bacteria, but is not taught that the skin might also need hydration (like a water-based formula containing hyaluronic acid), anti-inflammatory ingredients (like tea tree oil), sun protection (because of the increased sun sensitivity caused by those products), and antioxidants (like vitamins C and E). The addition of these skin care products can not only resolve some of their symptoms (like dehydration and redness), but can also combat the unwanted side effects of those products intended to reduce oil and increase cell turnover.
Acne can feel like a never-ending cycle that is frustrating for both the professional and the client, but there are so many innovative options available to take advantage of in modern aesthetic culture. Regardless, it is still important to remember that each case is unique and there is no cookie cutter protocol that works for everyone. So, before considering all the treatment options, it is recommended to conduct a formal consultation.
CLUEING IN THROUGH CONSULTATION
In order to formulate an effective treatment protocol for an acne client, it is imperative to understand their specific concerns. The power of observation can also contribute to the ultimate plan, but what the client says and what the professional sees are equally important. It may seem obvious that the client has open or closed comedones, papules, pustules, or nodulocystic acne and appears to have grade I, II, III, or IV acne. His or her skin may be oily, dry, dehydrated, or a combination of all of three. Redness, inflammation, pitted scarring, and hyperpigmentation may all be visible, but it is valuable to find out what bothers the client the most. Consider what cannot be seen. Is the acne painful? Does the client have acne on his or her body that is covered by clothing and is not visible? Is visible acne worse that day, better, or typical for the client’s breakouts? His or her age, physical activity, stress level, and general health are also relevant and should be considered as steps taken for an effective solution. The client’s concerns will guide the treatment process, but the consultation is a perfect opportunity to educate the client on their particular skin condition, how they can be helped, why aggressively scrubbing their face daily using harsh topical agents and skipping a moisturizer or avoiding sunscreen is not a good idea, and what they can do at home to expedite a resolution.
BRINGING LED THERAPY TO LIGHT
If acne as a skin condition has multiple symptoms to be resolved and is unique to each individual, then where does the professional start? In many cases, the areas of concern are red, painful, and inflamed. Should acid or harsh chemicals really be applied onto those areas as a first step, likely triggering more trauma? No. It makes more sense to reduce the inflammation and calm the skin down before doing anything else. This can create a dilemma for skin care professionals who have a limited amount of non-inflammatory procedures that will create a satisfactory change to the skin. Sometimes beginning with a comprehensive skin care program before pursuing any treatments is beneficial, but when someone comes in for help, they want a resolution as soon as possible and it takes time before topical products will produce those results. This is where LED swoops in to save the day. LED light therapy can be an excellent place to start.
One great benefit of LED therapy is that painful extractions do not have to be done on the first visit with acne clients. Instead, the professional can gently cleanse and exfoliate their skin and have them relax calmly under the LED lights, which will begin to kill off P. acnes bacteria and reduce inflammation in a way that is perfectly comfortable and non-threatening. Skin care professionals sometimes forget how uncomfortable and intimidating it can be for new clients to take those first steps to seek treatment, make their appointment, and entrust a stranger to resolve their skin issues. A few LED treatments, which will demonstrate some relief in their symptoms comfortably, can allow some time to build a relationship with a new client and establish a trusting partnership. The best outcomes require thoughtful solutions, patience, and time, but if the options chosen to pursue on a client’s initial visit cause pain or make them uncomfortable, then it is possible that they will not come back.
So, how does LED therapy work? LED, which stands for light-emitting diode, is the application of specific wavelengths of light to tissue to obtain therapeutic benefits. LED, also known as low-level light therapy, is therapeutic, not invasive, and should not be confused with lasers (light amplification by stimulated emission of radiation), which are intense beams of coherent monochromatic light. LED light therapy does not use thermal energy that heats up the tissue in order to generate a cellular response. Rather, the light source emits photons, which are the smallest particles of light. These photons are absorbed into the body through the cell membrane and into the mitochondria (the power plants of the cells), which causes an elevation of adenosine triphosphate (ATP) synthesis. ATP is essentially the fuel center for cells or cellular energy. When ATP is increased or up-regulated, it causes a cascade of metabolic events resulting in biochemical and cellular changes. And, the good news is, light therapy only affects cells that are under-functioning, so it is not possible to over-treat the tissue.
There are a variety of cells that can be affected by LED therapy, including the P. acnes bacteria and fibroblast cells. The type of cells affected is dependent on the specific wavelengths of the light source – and wavelength determines the depth of penetration. Think of it this way: shorter wavelengths of light will affect cells that are more superficial and longer wavelengths affect cells that reside deeper in the tissue. So, blue light, which has a wavelength between 405 and 470 nanometers (nm) and is the most superficial light, can trigger a response in more superficial cells, including the P. acnes bacteria. Red light, in contrast, has a wavelength of 630 to 700 nm, which can reach down into the dermis and prompt the fibroblast cells that live there to stimulate the production of collagen and elastin fibers. The color of the light chosen will always depend on the type of cells hoped to be reached.
AN ENLIGHTENING EXAMPLE
Once the complexity of acne and the science of LED therapy is understood, it is much easier to generate a customized LED acne protocol. The consultation process will influence the acne treatment plan, but it can be useful to imagine potential scenarios, for the sake of education. For example, let’s explore the case of a male, 19-year-old client who has moderate, inflammatory acne (grade III) primarily on his face, which includes both open and closed comedones, as well as papules, pustules, and occasional nodulocystic acne. His skin is irritated, tender, and dehydrated, with patches of oiliness. He is a college student who lives in a dormitory and is stressed about final exams. He runs five days per week and is relatively healthy, but has been known to eat poorly when he is away at school. Luckily, the school year is almost over and he is able to commit to an acne program for the summer and will be at home eating a healthier diet. What should be recommended? Here is an example treatment plan:
First, recommend a series of 10 LED treatments (two times per week for five weeks with at least 48 hours between treatments). His acne is moderate, so it will probably take that many treatments to see good results and he has the time, so twice per week is ideal. Treating him with a polychromatic LED device is preferable (which is more advanced LED technology and allows multiple wavelengths to run simultaneously), so the blue light could be run (the shorter wavelength) to kill the P. acnes bacteria, the red light (a little bit longer) to knock down the inflammatory response, and the near-infra red light (even longer) to increase microcirculation for a healing response, all at the same time. If only one color of light can be chosen (which is the case with a monochromatic LED device), start with the blue light and focus on killing the bacteria initially. Then, perhaps, switch to the red light or near-infrared light when the superficial bacteria has subsided or alternate between lights, if preferred.
The treatment itself can be simple: cleanse, exfoliate, perform extractions (if it is not too painful), and position the client under the LED device for the appropriate length of time (each device will vary). The skin should be clean, dry, and free of any reflective substances (ensure there is no barrier between the lights and the skin) before powering on the lights. The proximity of light energy to skin tissue is also very important, so proper positioning is essential to maximize potential benefits. It is important that the client is as close to the lights as possible, which is often easier when using a flexible LED panel. Some are flat and more rigid than others, but when dealing with the face and body (that has natural curves), better results can be achieved if it can be molded to fit around the area being treated. A hands-free device may also be preferred, so it is possible to do other things while the client is relaxing under the lights. Once the LED portion of the treatment is complete, apply appropriate treatment products, which may include a superficial enzyme peel, antioxidants, peptides, moisturizers, and sun protection.
No acne treatment program is complete without a comprehensive skin care program. If the client happens to be skin care savvy, then start them on a complete regimen from the beginning. However, in this case, the 19-year-old college student is not. So, it would be ideal to gradually build his skin care program over the course of his five-week LED program, suggesting one product to enhance the results of his treatments at each visit. Eventually, that would include, but is not limited to, an antibacterial cleanser, a water-based moisturizer, a reparative antioxidant serum, and a non-comedogenic sunscreen.
HEALING AT HOME
Treating acne will always be most effective when it is viewed as a partnership. There are many tools at the professional’s disposal, but there are also lifestyle choices that only the client has control over when they leave. So, give them some tips to take home with them. Remind them to be compliant and that following their prescribed skin care program is essential for healthy skin and good results. Additionally, express the value of eating healthily. They should consider removing common allergens from their diet (like dairy, eggs, and gluten) and inflammatory foods (especially those that contain processed sugar). Emphasize that the client should maintain proper hygiene. For instance, they should change pillowcases at least twice per week and should not reuse a washcloth, as it can harbor bacteria – the same is true for re-wearing dirty clothes. The client should also be reminded to wear sunscreen. Acne and sun do not mix. Lesions are more vulnerable to ultraviolet light and that damage can lead to permanent scarring. Tell the client they can use ice when they see inflammation to reduce the redness. Last, discuss LED for home. If getting to a skin care specialist is difficult, buying their own LED device is always an option.
As professionals increase their understanding of acne and the benefits of implementing LED into treatment options, they will find they are more equipped to help clients address this difficult skin condition.
Gina Thompson has over 20 years of experience in the medical aesthetic industry. Her diverse positions include: aesthetic educator for Celluma Light Therapy, medical skin care specialist, makeup artist, marketing director, business consultant, health coach, researcher, content writer, and public speaker. As a true insider in this industry, Thompson is able to provide unique educational and marketing strategies that are based on her personal experience with skin care, plastic surgery, and dermatology patients. She is passionate about her profession and believes that happy patients lead to financial success.