I had cystic acne as a teen. I was on Accutane twice as well as internal anti-biotics and numerous prescription topicals. My own odyssey to clear skin has helped me better help our patients. The following are from my own personal experience and what I have observed from my patients. I am not an allopathic doctor and the following are simply my opinion.
It is important to approach skincare from the viewpoint that beautiful skin is an expression of health. Ideally topicals should support the health of the skin, and in so doing, clear the skin. Be a careful and honest observer of your own skin. If it becomes rough or inflamed you need to modify what you’re doing. There is a tendency to get frustrated with your acne. The problem is that when you “attack” the acne, you are attacking your own skin with it. What we recommend for our patients.
Benzoyl peroxide is a common topical ingredient in prescription and over the counter products. My experience is that it will initially dry up acne very well.Then within 1-3 months or so the skin begins to develop a crust of dryness while still being oily underneath. This is eventually followed by more severe rebound acne. Long term, benzoyl peroxide deeply unbalances the skin. It can take several months to repair the skin from long term benzoyl peroxide use, after which the acne still needs to be addressed. This is one ingredient I strongly believe in avoiding at all costs.
Exfoliants work by “ungluing” the outer layer of dead skin cells, allowing healthier cells to come to the surface. Removing this dead layer can improve skin texture and color, unclog pores, and allow moisturizers to be better absorbed by the skin. There are several classes of exfoliants: mechanical versus chemical, and acid versus non-acid.
This refers to scrubs which, when rubbed on the skin, mechanically remove the outer layers of skin. The downside of scrubs is that they are often used with a heavy hand causing irritation. Scrubs can also cause uneven exfoliation. Devices like the Clarsonic brush also fall into this category. Microdermabrasion is a professional version of a scrub.
Chemical Exfoliants – Acid-Based
I do not recommend acid exfoliants on more than a weekly basis and would rather they be used in professional treatments only. There are two main categories of acids: fat soluble and water soluble. Beta hydroxy acids (notably salicylic acid) are fat soluble, making them ideal for use on oily acneic skin. Salicylic acid is a common ingredient in washes, topicals and in peels (in higher concentrations). Alpha hydroxy acids (AHAs) are water soluble and are also commonly found in acne products, as well as anti-aging and lightening topicals. Common AHAs include glycolic acid, lactic acid, citric, tartaric, and mandelic acid. Glycolic acid is waning in popularity as it tends to cause irritation and more physical discomfort than the others.Chemical exfoliants allow for more uniform exfoliation and, when dosed correctly, can be extremely effective in controlling acne.
Chemical Exfoliants – Non-Acid Based
Non-acid exfoliants are enzyme-based. Papaya enzymes and bromelien (from pineapple) are the most common. These can be used up to 3-4 times a week as necessary. Enzymes also ease extractions. Enzyme exfoliation can be very effective in home care when used responsibly.
Topical retinoids (Vitamin A) are a key ingredient in repairing all types of skin issues. They actually alter the health and rate of new cell formation. Retinoids also function as an exfoliant in that they increase cell turnover. When used in excess they cause flaking and irritation. Retinoids can be found in many forms. The chart below shows the different forms of Vit A used topically. In short, retinoic acid on the right hand side of the chart is the form in which Vit A is utilized by the skin.
Retinyl palmitate <=> Retinol <=> Retinaldehyde => Retinoic acid
The other forms will convert up and down the chain. There is a limit to how much retinoic acid your skin can use. Unused retinoic acid hangs out on the surface of the skin and causes irritation. More active forms of Vit A work faster but have more side effects that may negate the benefits. Care must also be taken not to overuse retinoids. We typically recommend their use 1-3 times a week. read more
Note: Retinoids should be avoided by pregnant or lactating women.
Reducing Inflammation, Avoiding Clogged Pores
What you avoid is just as important as what you use. Acne is an inflammatory process. It is key to avoid applying anything that irritates your skin.
Makeup is a common culprit that leads to a vicious cycle of trying to mask problem skin which blocks pores and causes more inflammation which leads to heavier makeup. The best makeup for acneic skin is a simple, clean mineral makeup. Unfortunately these do not offer the best camouflaging.
Harsh cleansers containing detergents such as Sodium Laurel Sulfate (SLS) and Sodium Laureth Sulfate (SLES) can be extremely drying and irritating to the skin. Acid-based cleansers should be used sparingly and not be the main cleanser. Simple gentle cleansers that clean without irritation are the best, with more active ingredients being reserved for the serums you apply after. These cleansers will not lather up as nicely as the detergent-based ones but your skin will appreciate the difference.
Moisturizers tend to be another trouble spot. It is important to keep your skin hydrated. You may have to do a little more trial and error in finding a moisturizer that doesn’t aggravate your skin. For me personally this was the most challenging category to find the right product. In general try to find simpler, chemical free products. At our clinic we suggest Hylunia Healing & Restoring Cream (I know it says its a body cream, but it is an amazing face cream for drier skin with acne) and 302 Ointment Rx.
A note on internal treatments:
We are an alternative health clinic so my bias is clear. 🙂 I believe anti-biotics are a miracle when you need them. In my case they were ineffective and unbalanced my body. I personally haven’t seen them to be helpful longterm.
Hormonal irregularities are a aggravator of adult acne. Stress is often an underlying cause. At our clinic we use a combination of acupuncture, herbs, and nutritional counseling for this.
Internal Vit A (such as Accutane), is an extreme solution. However. when someone has severe, scarring acne that isn’t responding quickly enough, it may be the right solution. Acne scarring (and I mean pitting here, not hyperpigmentation) is virtually impossible to fix after the fact. It may be worth an extreme measure to halt the acne with the intention of then relying on good skincare habits and resolving what was causing the acne in the first place. Note that cleansing and building the body back up internally is crucial as internal Vit A is harmful to the Liver.