Case Clinic: The “Nothing Works Anymore” Client

A 34-year-old client presents frustrated with her skin.
Her main concern: “My skin used to respond to treatments… now it reacts to everything.”

Client Observations

  • Persistent dullness despite regular skin treatments

  • Increased sensitivity over the past 6 months

  • Breakouts along jawline and cheeks

  • Makeup no longer sits smoothly

  • Alternates between oily and dehydrated throughout the day

  • Lips frequently feel dry and tight

She reports stinging with products she previously tolerated well.

Skin & Health Background

  • Historically combination/oily, acne-prone

  • No diagnosed rosacea

  • Recently increased work stress and inconsistent sleep

  • Started exercising more frequently (daily sweating)

  • Has needed heavier lip balm more often recently

  • Under dermatologic care for adult acne

She mentions her dermatologist adjusted her acne management plan to microdose isotretinon about 5 months ago, and since then her breakouts have reduced in number but feel deeper and slower to heal.

Current Homecare

Morning:

  • Foaming cleanser

  • Vitamin C serum

  • Oil-free moisturizer

  • SPF 50

Night:

  • Cleanser (sometimes twice)

  • Retinol serum (5 nights/week)

  • Exfoliating toner (most mornings or nights, varies)

  • Spot treatment for breakouts

Treatment History

  • Monthly corrective treatments for years

  • Previously tolerated medium enzyme + mild acid combinations well

  • Last two treatments caused prolonged redness and post-treatment breakouts

What you see in treatment

  • Diffuse erythema across cheeks

  • Congested pores but impaired healing

  • Skin flushes easily under steam

  • Extraction sites stay red longer than expected

  • Surface dehydration with underlying oiliness

  • Corners of nose slightly flaky

Your Turn

What is the primary driver of this client’s current skin behavior?

How would you adjust:

  1. Immediate treatment approach

  2. 4-week treatment plan

  3. Homecare strategy