The 17-Year-Old on Adapalene Who Wants a "Deep Clean" Facial
A 17-year-old girl comes to your salon alone and books the "Fruit Glow Facial": cleansing milk, apricot scrub, 10 minutes of steam, blackhead extraction, then a fruit pack. She needs it for a family function in three days. On the consultation card she writes that she has used adapalene 0.1% gel every night for six weeks, prescribed by a dermatologist for acne. On examination, her cheeks show red raised papules with no pus, her forehead has closed comedones, and the skin beside her nose is flaky. She says her last facial, two months ago, "was fine" - but that was before she started the gel. She has come without a parent, has ₹700 with her, and insists on the full package because "the steam makes it feel really clean". The facial is priced at ₹650 and the slot is 60 minutes.
1. Should you carry out the facial exactly as booked? Work through each step of the treatment and justify your decision.
Read the worked answer
No - the booked protocol must be modified, not simply delivered.
- Cleansing milk: acceptable, but use a mild, fragrance-free cleanser with tepid water and no cleansing brush.
- Apricot scrub: omit. Adapalene thins the stratum corneum for the first 8–12 weeks of use, so physical exfoliation can abrade the skin and leave post-inflammatory hyperpigmentation on cheeks that are already inflamed.
- Steam: reduce to 3–5 minutes at low temperature, or skip it. Heat increases blood flow and the penetration of the retinoid, which is the most likely reason her skin is flaky and reactive.
- Extraction: limit to soft, non-inflamed comedones. Never squeeze the red papules - pressure spreads bacteria and can scar.
- Fruit pack: read the label. Citrus and AHA-containing packs sting on retinoid-treated skin; substitute a calming aloe or hyaluronic mask and a non-comedogenic moisturiser.
Reasoning: the aim is to avoid insulting a barrier that is already compromised, while still giving her something pleasant and safe three days before an event. Tell her honestly that the result will be "calmer skin", not "deep-cleaned skin".
2. She is a minor attending alone and refuses to call a parent. What do you do about consent, and where does your role end and the dermatologist's begin?
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Consent: a 17-year-old is a minor. Salon policy - and ordinary prudence - require a parent or guardian's consent for treatment, particularly where the skin is inflamed. Phone the number on her card, explain in plain language what you propose to do, and record the name, relationship and time of the call on the consultation card. If no guardian can be reached, offer only the least invasive option (gentle cleanse and a calming mask) or reschedule. Do not simply proceed because she has money and is insistent.
Scope of practice: you are a beauty therapist, not a prescriber. You must not tell her to stop or reduce adapalene, and you must not diagnose her acne. What you can do is explain in practical terms that retinoids make skin more sensitive, that she should mention any facial to her dermatologist, and that she should return once the course is reviewed. Note in writing that you advised this and that she chose to proceed with the modified service. Referral is not a lost sale - it protects the client and the salon.
3. What aftercare and home advice would you give her for the next 72 hours?
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Aftercare should be short, specific and written down, because spoken instructions are forgotten within an hour.
- Today: no make-up for the rest of the day, no hot shower, no swimming pool chlorine, no sun exposure to the treated area.
- Cleansing: the same mild cleanser morning and night, pat dry - no scrubbing, no face brush, no home scrub for at least a week.
- Moisturiser: a fragrance-free, non-comedogenic cream applied while the skin is still slightly damp.
- Sunscreen: SPF 30 or higher every morning, because retinoid-treated skin burns more easily and pigmentation is the main long-term risk.
- What to avoid: waxing, threading, bleaching and self-tan on the face while she is on the gel, and any "brightening" pack with fruit acids.
- Red flags: spreading redness, pus, blistering or severe stinging - stop all products and see the dermatologist.
Explain the reasoning in one sentence: her skin is being deliberately thinned by the medicine, so everything you add on top must be gentle. Record the advice given and her agreement.