Have a client with back and shoulder acne. Any ideas on treatment?

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What type of acne? Face reality is a good start!
Hmm..although I have experienced break outs on my face in the past, I have never experienced it anywhere else; but I have treated many clients with this problem with "back treatments". I can tell you what I like to do in my back treatments, and maybe it will give you a few ideas..
I treat back/shoulder acne very similar to how I treat face acne, except the difference is the body is obviously less sensitive than the face, skin is rougher, and can handle a bit more.

First I have the client lay down with their back & shoulders exposed, I let the steam run, and I cleanse with the appropriate cleanser, usually I use an oxygen cleanser...and then while I can use an exfoliating scrub with exfoliating gloves, for this skin condition, I prefer doing a peel instead, this way it doesn't spread the newly formed acne. I like to START with either an enzyme peel; or even better a Lactic Acid peel; the rougher skin in this area of the body can handle it and will benefit better from a stronger peel I think;
I know you like natural as do I, many Lactic Peel's aren't natural, however...a good skincare line named "Glo Theraputics" makes an awesome 15% lactic peel with very healthy ingredients in it such as Bilberry Extract. I used this when I worked at a medi spa; and clients lovvvved it. It's a little bit pricey but worth it, I actually want to upgrade from the lactic peel that I have now to Glo's.
Anyway...I tone the skin first with a peel-prep, let the peel sit for about 8 minutes; take off with a hot towel. Depending on how their skin reacts to the peel, and whether they might need something stronger or not, I may even layer the lactic peel over an enzyme peel their next visit, or jump up to a Salicylic Peel. After taking off the peel, I sometimes incorporate a little massage with healing and soothing extracts; but if there's a lot of acne, I focus more on extractions. I find the extractions are much easier to do after a good peel as well, since a layer of skin has been thourougly removed. When I'm done with extractions, if there's time, I use high frequency in the more challenged areas. Then I tone with a soothing toner, and apply a mask all over wholee area; as we've discussed before..Bentonite Clay. Or some type of detoxifying green french clay, I like using the clay alone on the back since once again, this area of the body can handle it. I will let that sit for a few minutes, & take off with a hot towel.
If there's a lot of acne, I find it best to just tone with a soothing & hydrating toner, maybe apply a "keep it calm" serum in the more irritated areas, but I leave the moisturizer out because I feel it's not necessary for this skin condition here; plus it's hard to retail such a small size product to the clients for such a large area of their body. I haven't come across a serum or moisturizer that would actually be beneficial for this skin condition in a larger sized bottle. You can find toners however, in larger sizes, which in my opinion allows their skin to breathe better anyway. If their skin has a lot of acne scarring on it, then I'd maybe suggest one that promotes exfoliation.

Hope this helps a little bit!

Thanks Nina! Once again, you're a gem!

I have had good luck with combining the Blemish Control Toner Pads from Skin Script, and the Lactic Acid + Retinyl Propionate body exfoliant from either Vivant or Lelexo.  If you have an LED panel, that would be a great add-on post extractions.  In-office, I would normally opt for a Salicylic Acid peel, being careful about the surface area covered.

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