Hello Acne experts, I need some advice.  I have an acne client that I am following the proper protocols on our treatments with, and she swears she is doing her home care as directed, and I believe her.  She is very committed to getting clear skin, but we are not getting there.  I've been treating her for just under 2 months now, seeing her every 2 weeks.  Her acne is no longer inflammed, but it's still there.  I wonder if her very strict Vegan diet could be hindering her progress?  I believe she is using alot of soy in place of dairy, we had talked about soy milk and soy yogurt.   I'm not sure what else is involved with her diet, but I know she won't use anything with any animal products, including topically.   If anyone has any advice for me, I would love it.  I will only see her 2 more times before she goes away for the summer and I would love to send her off on her summer adventure with great skin!  

Thanks. 

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What homecare to you have her on?  Noninflamed acne is tough to clear....

We use CosMedix products and I have her on Purity Clean Cleanser and Clarity Serum. The serum has a small amount retinol and salicylic acid.   The main ingredient in the cleanser is Lactic acid. It also has soothing peppermint essential oil.   She is dehydrated, so I have her on an oil free Dermalogica moisturier to hydrate.  I advised her today to use the cleanser only at night, and use a gentle one in the mornings, I feel maybe I'm overtreating her and her skin is over-compensating.  And I'm still wondering if her diet is a contributing factor?  Thanks Laura! 

Jodi, I didn't see any mention of benzoyl peroxide.  Ihis part of her regimen?

hm, peppermint oil is anything but soothing, imo - it's quite a stimulant for skin.

In my experience, in order to get noninflamed acne under control you really need strong products and you really need to push the skin to clear.  Start slowly with a vitamin a propionate serum (every other day to start).  Add in bpo at night - starting at 15 minutes a night and double the wearing time every 3 days until they wear it overnight.  When they get dehydrated stop all active products for 3 days and just moisturize; then start again.  Check all her products for pore-cloggers:

http://facerealityacneclinic.com/articles/pore_clogging.php

Check here for foods she needs to avoid:

http://facerealityacneclinic.com/articles/acne_facts.php

If she's vegan, she could be eating a lot of peanut butter - a definite no-no for acne!

Jodi,

I totally believe there is an internal component to this.  Much as I admire the motivation to be a vegan, it's hard to have healthy skin when you are one.  The first thought that comes to my mind is that she is essential fatty acid deficient.  Somewhere on this group site is an excerpt I posted from an article written by my teacher and mentor, Florence Barrett Hill, about why every acne sufferer needs plenty of essential fatty acids in their diets, especially Omega 3 and 6.  It has to do with the break-down of the sebocyte (oil producing cells) in the follicle.  And I just read in Dr. Peter Pugliese's book on medical esthetics that those with acne have less linoleic acid in their sebum than those who do not have acne. 

Because animal sources are the easiest way to get complete Omega 3's, your client is very likely deficient in them.  For Omega 3, which should be taken in much greater quantity than Omega 6, fish oil is the best source, because it's the most complete, but flax, walnuts, soybeans and many of the sulfur-containing veggies like brocolli and cauliflower have less complete forms.   I have heard, but know absolutely nothing about, a vegetarian alternative for fish oil called Green Omega 3.   For Omega 6 (linoleic acid), sunflower, evening primrose and borage oils are great.

These "fats" will NOT make her skin worse, and in fact they are powerfully anti-aging as well.

You also mentioned she is dehydrated.  That is important to address internally, too.  The stimulation of the enzymes glycosidase and proteases that break apart the bonds that hold skin cells together (we have to have that functioning or too many skin cells accumulate) requires a highly aqueous environment.  Not enough water, not enough enzymes, too many skin cells.  Finally, those enzyme actions also work better in the correct pH environment, so beware of stripping the acid mantle with strong cleansers or abrasive scrubs.

Thanks everyone.  We aren't using BPO at this time as she was on Pro-Active and it didn't help.  Our CosMedix products are medical grade and strong.  I may talk to her about adding BPO as a spot treatment, but she is using the Clarity Serum as a spot treatment now.  I talked to her about peanut butter, she isn't eating a lot of it, so I don't think that is the issue.  I appreciate all the feedback.  I will check the links and see what else is there.  I'm doing a stronger peel on her at her next appointment, and  I'm hoping that will help jumpstart healing, as it may be the last time I see her before she goes away for the summer.  

BPO is really not for spot treating.  It is best used as a preventative to keep the microcomedones from forming in the first place.  Treating acne is about stopping what's going to come up 3 months from now which is about using the right products in the right way and accounting for skin adaptation.  That's why the Proactiv didn't help - it is on the right track but is a weak system and the skin adapts to it in 3 week's time.

I thought BPO was very drying.  I've never advised anyone to use it all over, only on active breakouts. 

Yes it is very drying AND the skin will adapt to it if you start your client slowly enough.  When the skin adapts to it, it won't be drying, honestly, it won't.  Most people make the mistake of spot treating with bpo - I'm here to tell ya that is the least effective way of using it.

Thanks Laura!  I will see if she is open to buying some BPO to take with her when she goes away for the summer.  

Make sure it's a noncomedogenic formula and without oils.  Here's a list of pore-clogging ingredients:  http://facerealityacneclinic.com/articles/pore_clogging.php

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