I have a 40-year-old female client with very severe and deep non-inflamed acne.  The problem is she also has pretty sensitive skin - turns pink quite easily, and already has a lot of dilated capillaries across her cheeks and around the wings of her nose.  She is very oily-skinned.

She took Accutane as a teen for severe inflamed acne on, of all places, her throat.  She has significant scarring there are a result. 

Her acne now manifests as deep closed comedones all over her face, sebaceous hyperplasias on her forehead, temples and cheeks.  Everything is so deep and closed over, that there is little that is extractable.

I use Face Reality products.  She's using Sensitive Skin Gel, Soothing Hydrating Toner, 5% Glycolic Serum (couldn't tolerate even Mandelic Light in our sensitivity test), and says she will start using Acne Med 2.5% this week.  She has been reluctant to use it due to past issues of getting REALLY dry and peely using BPO.  I promised her that with the timed schedule for introducing it, she should be fine.

She's very careful about eating a good diet, and using sun protection daily.

Any suggestions on how I can get this stuff to surface so I can extract it?

Thanks so much.

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I would start her on some Vitamin A Pro 1 in about 3 to 4 weeks.  Use it at night, have her wait 15 minutes and apply the bpo over the top.  Hopefully, the bpo will make her skin less sensitive over time - it almost always does.

I  have a gal that has large pores thru-out she is also seeing a doctor because of some hormonal issues. she has had a test and her cortisol levels were very low.  her doctor put her on something for that as well as hormones. she does have some pimples that can extract but most of the bigger stuff is on the chin and neck nothing to extract a couple of them  you can feel deeper in the skin. Now my problem is the product line at work I'm working with doesn't have bpo. We do however have salicylic's and lactic's and glycolic's. Will I truley be able to help her with her Acne? she was very dry and irritated when I fist saw her  and she now says her skin feels more hydrated, But not as clear as I would love for her to be. She does not have black heads at all even with he oily skin and large pores. Man this is really hard to determine what to do?  Also she has not bought the cleanser i have or moisturizer she is using over the counter something from nutragena  I have told her all about PH correct products and noncomedogenic products as well . she did purchase a zit stik and AHA/BHA pads so I'm really trying to help her .

 I know you have a great video Laura. I only wish I could afford it.Some day I will :) any help would be appreciated Thank you much   

Hi Cheryl

I would really need to see pictures of her skin.  Also, what are her goals with her skin?  I can give you a more definitive answer if you answer those two questions for me.

 Thanks Laura. I dont have a photo. I'll continue working with her and see how the glycolic and salicylic pads help her and go from there . She says her skin feels alot better so thats good and it is looking better as well not so dry and irritated. Thanks I will keep you posted :)

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