You have 3 choices. 

1. If you have normal to oily skin, the ingredient of choice is salicylic acid. Start with a good formulation, 2%. Use in the evening for the first two weeks. If tolerated you can gradually increase the frequency to twice a day. Do not exceed this. Salicylic acid is an anti-inflammatory exfoliant.
2. If you have lots of pustules (pimples, zits), you may consider BPO or benzoyl peroxide. The most common formulations are between 2.5 to 5%. This should be used once a day, increasing as tolerated. Follow as directed, remember to leave on for at least 60 to 90 seconds before washing off. BPO is especially effective & useful for treating large areas. For example the chest, & back.
3. If you have super sensitive skin or dry skin, choose a bland cleanser. Examples include Cetaphil, Neutrogena, QV or Cerave. Don’t try to use actives or your skin will react.

Exfoliation is especially important if you have blackheads and congestion. Broadly, there are two ways to achieve this, either physically or chemically. The most important thing is not to over do it as exfoliation can compromise your skin’s barrier function.

Skin care ingredients such as salicylic acid, retinol, retinoids & AHAs are examples of chemical exfoliants. A sensible way to incorporate these exfoliants is in a wash. You can add a physical cleansing agent such as a washcloth or a sponge. The former is preferred as you can ‘recycle’ wash cloths, namely two cloths per day, one in the am one in the pm.

Physical exfoliants include brushes, the most famous is Clarisonic. Do they offer an advantage over clothes & sponges? No, but they can be nice to use.

My suggestion, keep things simple. Start with salicylic acid 2% wash, gentle pressure with a face cloth, start nightly, increase as tolerated. Once you have maxed out with no skin irritation, you can consider pulsing higher strength AHA lotions (15 to 23 % buffered glycolic-lactic-salicylic acid).

As you would have guessed, choose a light to medium moisturizer if you have acne prone skin.

Read the label carefully: The two most important phrases you’re looking for on your moisturizer are “oil-free” or “non comedogenic.’’

Mind the texture: If you’re on the drier side (or have combination skin) and have acne, opt for a cream base. Those with oily skin should go for a lightweight lotion or gel.

Look for SPF: Many moisturizers for acne-prone skin are fragrance-free and contain chemical-free, non-irritating sunscreens, which help reduce the development of long-lasting blemishes including red as well as dark spots.

Here is my list-

• La Roche Posay Toleriane Fluide.
• Obagi Hydrate
• Cetaphil Moisturising lotion
• La Roche Posay Effaclar Mat Moisturiser
• Cerave line of moisturisers

The ideal moisturiser may change when you use certain ingredients. For example you may need to swap to a more heavy duty moisturizer when you use salicylic acid, BPO or retinol or retinoids as these ingredients may increase dryness.

Buy here.

Never underestimate the value of lifestyle changes. This includes-

Acne diet. You will find a guide on this website. Essentially eat healthy, reduce sugar and refined foods, eliminate dairy. Supplement with zinc. 

Make up practices: Consider mineral over oil based makeup, have 2 days make up free & always remove makeup before sleeping.

Stress can definitely flare up acne. Talk to your doctor or psychologist about ways to destress.

Products: Choose a good sunscreen that doesn’t occlude your pores. Light non-comedogenic moisturizers are also useful. Change your cleaner to a salicylic acid based one, La Roche Posay Micropeel Effaclar is a good one. It has 2% salicylic acid and is super affordable at around $22 AUD. That will last 6-12 weeks.

Hormonal acne is a common subset of acne. It presents as deep, often painful lumps and bumps around the jawline area. Another name for this type of acne is female jawline hormonal acne. 

The cause of this acne is multifactorial, including stress, diet, skin care, hormones, genetics & environmental factors. In the vast majority of cases hormone levels are normal (in contrast to true hormonal acne where there may be elevated levels of 17 hydroxyprogesterone, DHEAS, testosterone, prolactin, etc..) This type of acne is termed intracrine dysfunction, namely oil glands sensitive to normal levels of hormones. Hence this explains the monthly fluctuations of activity. More on hormonal acne.

Products can be of benefit in some cases of hormonal acne. Here are some hints-

Retinol can reduce or even eliminate acne outbreaks. You should use retinoids as field or prevention treatments & not spot treatments. This is because this ingredient works by prevention.

Spot treatments include azelaic acid (10-20%), salicylic acid (patches are best), or high strength BPO or benzoyl peroxide.

Acne patches are simply brilliant. They can reduce your urge to pick, and hence can reduce scarring. Additionally hydrocolloid dressings can dry out acne pimples within 36 hours. They are best used for pimples & zits that are more on the surface of the skin. Patches cost around $5 AUD & can be purchased from most pharmacies. Microneedle darts are special patches that can deliver ingredients such as niacinamide, hyaluronic acid, arbutin, citric and salicylic acid to help reduce pigmentation changes from acne.

For persistent & resistant cases of hormonal acne, consider seeing a medical dermatologist for treatment.

*Disclaimer: I am a procedural dermatologist, I do not treat acne. My work involves lasers, peels, injections & surgery. Please see my colleagues @cliniccutis

Acne patches or pimple patches are simple hydrocolloid dressings that cost between 5 to 20 cents each. They can be purchased from most pharmacies. These dressings absorb pus & fluid, in addition they provide an optimal environment for skin to heal. This can decrease scarring, pigmentation & aid in faster resolution of pimples. Importantly they can prevent patients from picking pimples.

Micro Darts or nanoneedles are high tech patches that contain hundreds of tiny darts. These darts dissolve over a period of hours, slowly releasing hyaluronic acid, salicylic acid, niacinamide, & pigment inhibitors. There is some evidence that these darts can decrease pigment & speed up resolution of acne.

Yes, to a certain extent. LED or LLED (low laser light emitting diodes) work by reducing inflammation & bacterial counts. The spectrum of light that works best includes Blue & Red at around 420-440 nm & around 630-633 nm. Light masks can be bought online. Neutrogena makes an affordable one. In the US this has taken off the market for concerns regarding cataracts.

Another sensible method of getting blue and red light is to apply sunscreen first (as this blocks UV but lets visible light through), then expose your acne prone areas for 20 to 30 minutes of mid morning or mid afternoon sun. Obviously be sensible with sun exposure, and don’t forget your sunscreen. This can activate porphyrins produced by the bacteria in your pimples, which results in destruction of zits.

IMO Kleresca is a super expensive treatment. It does have science behind it, however it is more marketing. PDT is virtually the same. 

You are better off consulting a naturopath if you are seeking this route. Most dermatologists would agree that if your acne is cured with naturopathic or homeopathic remedies, that is one less patient they need to prescribe heavy duty drugs to.

My POV? Agreed. Homeopaths, naturopaths & alternative holistic care can help some patients. There are case reports of gluten free diets, zinc supplementation, gut cleansing, as well as organic remedies such as witch hazel & tea tree oil, herbs, plants, flowers & fairy dust that can treat acne. Majority of dermatologists do not prescribe alternative medicine.

You may want to consider seeing a medical dermatologist when you have exhausted your options, or if you have-

Dermatologists can assess your type of acne, provide necessary investigations & negotiate treatment options based on the clinical findings, and personal history.

*Disclaimer: I am a procedural dermatologist, I do not treat acne. My work involves lasers, peels, injections & surgery. Please see my colleagues at Cutis Dermatology. If you present to me for acne scars & have clinically significant acne, I have a duty of care to refer you on to my colleagues for medical management. This is in your best interest for many reasons, including safety ( I don’t like to provide invasive treatments in an infected field), as well as best practices. Scars do not heal up as well with background inflammation. I am NOT fussed as to how you control acne, this includes medical therapy, diet, supplements, naturopathic, acupuncture, mediation, colonic irrigation, etc… Scar revision in a sterile field gives more predictable results.