Acne Skin Care, At A Glance
- Best Results6-12 weeks
- Treatment RecoveryNA
- Procedure Time1-2 min daily
- Skin SpecialistDermal therapist, nurse
- Duration of ResultsVariable
- Back to WorkNA
Acne Skin Care
Simple acne skin care & good lifestyle modifications can treat over 80% of acne. Start with a good face wash, add ingredients including retinol or retinoids, niacinamide, ascorbic acid & beta hydroxy acids. It takes 6 to 8 weeks before optimal results are seen.
FactsFacts on Anti-Acne Skin Care
- Start with a good face wash
- Cerave & La Roche Posay make salicylic acid washes
- Add a retinol or a retinoid based product
- Consider azelaic acid or niacinamide to reduce skin inflammation
- Acne patches or hydrocolloid dressing are extremely useful especially for hormonal acne
- Give yourself 2 days make up free to allow your skin to breathe
- Add a well researched acne diet
- Give a structured skincare routine 6 to 8 weeks to work
What is the best skincare ingredient for acne prone skin?
Look for the following ingredients –
Retinol, retinaldehyde, hydroxypinacolone retinoate: These are retinoids that can be purchased without a prescription in Australia. They require conversion to retinoic acid (HPR exception). Start with a good formulation of 0.5%.
Adapalene: If you can get your hands on this, it is more effective than over the counter retinoids. Hint: this is available over the counter in the United States. This is classed as a third generation retinoid. In Australia, this requires a prescription. You can ask your GP for a script.
Salicylic acid: Best used as a face wash. See below for instructions. 2% wash, start once a day, increase as tolerated. La Roche Posay & Cerave makes great formulations.
Niacinamide: Or vitamin B3 can reduce redness, inflammation & aid in restoring barrier function. 5-10% recommended. Goes well with retinol and retinoids.
Benzoyl peroxide: Can be considered if you have nasty pimples & zits. It can be drying, so be careful. Good as a wash if you are treating larger areas such as the back, chest.
Azelaic acid: Can be bought without a prescription in Australia. Formulations range from 10 to 20%. Good for reducing inflammation & pigmentation associated with acne.
Ascorbic acid: Is awesome when you get your acne under absolute control. Do not mix this with other stuff or you will get skin irritation. Ascorbic acid or vitamin C can help repair scars & most importantly reduce pigmented scars; namely post inflammatory hyperpigmentation. This is one ingredient which you should get right in the context of good formulations. Think Obagi, Medik 8, Aspect Dr, The Formulated.
Tea tree oil: can be effective in some. Most dermatologists will go for mainstream treatment, however there is evidence that this essential oil can exert powerful anti-inflammatory effects. It is also bactericidal and fungicidal. Beware of skin irritation & allergies.
How long does it take skin care products to work?
Skin rejuvenation in Asian and ethnic skin types are much harder than treating Caucasian and light skin patients. This is because if energy levels are too high, the result can be worse than the treatment. Ethnic skin has a much higher tendency towards skin darkening- known as PIH or post inflammatory hyperpigmentation. This means that laser parameters have to be gentle and precise. Gentler treatment reduces the chances of PIH. Conversely Ethnic patients will need more treatments to achieve the same result.
Having a Specialist who treats Ethnic skin on a daily basis is advisable, as we can reduce the incidence of side effects, but provide the best outcomes.
What is the best ingredient for acne scars?
Firstly let us start with basics. Sunscreen is your best friend. This can reduce red and brown acne scars and can markedly reduce post inflammatory hyperpigmentation. This is especially important if you have darker skin type.
The next ingredient is a retinoid. If you have access to adapalene or Differin, apply this nightly as tolerated. This is OTC in the US, in Australia, ask your GP for a prescription. The second best option is a good formulation of retinol. Start at 0.5%, increase to 1.0% as tolerated.
Niacinamide & azelaic acid can be useful as this is anti-inflammatory. Best for red acne scars. You can use this in the morning, and retinol at night.
Brown acne marks can respond best to L-ascorbic acid. Again choose a good formulation at 10%, increase to a maximum of 20%. Ascorbic acid or vitamin C can suppress pigment cells & conversely stimulate collagen producing cells.
Recommended formulations include The Formulated, Aspect Dr, Medik 8, Obagi, & Skinceuticals. If you have sensitive skin, consider Murad.
What supplements can help with acne?
Zinc sulfate has many good papers behind it. It can help modify your immune system to help fight bacteria.
Probiotics can be considered if you are on long term antibiotics.
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What is a good face wash for acne prone skin?
You have 3 choices.
- 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.
- 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.
- 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.
How do I exfoliate?
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).
What are some moisturizers for acne prone skin?
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.
What other things can help with acne?
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.
What is hormonal acne & why do I get it?
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. How to manage? See below for suggestions.
Can skin care products help with 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
Why are acne patches awesome?
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.
Do LED & light masks work?
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.
When should I see a dermatologist for acne?
You may want to consider seeing a medical dermatologist when you have exhausted your options, or if you have-
- A family history of acne
- Clinical signs of acne scarring
- Ethic or darker skin type (acne is harder to manage, propensity to scar or pigment)
- Extensive truncal acne (back, chest)
- History of keloid or hypertrophic scars
- Family history of scarring
- Acne recalcitrant to topicals & conventional treatments by GPs
- Drug induced acne
- Early onset acne – childhood acne
- True endocrine hormonal acne
- Intracrine hormonal acne
- Picking acne – acne excoriee
- Acne with significant psychological and or social impact
- Acne in pregnancy
Dermatologists can assess your type of acne, provide necessary investigations & negotiate treatment options based upon 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 @cliniccutis. 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.
Davin’s viewpoint: acne skin care
The absolute majority of acne (80+%), can be treated with lifestyle modifications including good make up practices, product selection, diet, and really simple skin care. The minority of acne may require medical intervention by a general practitioner. Another small percentage may require management by a medical dermatologist.
A few practical hints. Never ever go by how you feel about the progress of your acne treatment, alway go by objective measurements , namely what your actual progress is (or lack off). Take a photo before you undertake a skin care routine. Count the amount of zits-pustules- papules. Record this down. Embark on simple acne directed skin care. This may include acne washes, retinoids, retinol, azelaic acid, & other topicals. Stick with this program for at least 6 weeks. Take another photo, then do a lesion count. Ideally you should improve by 20-30 % every 6 weeks. If not, swap your routine until you get a decline in lesions.
The next step? Seek an option from your general practitioner. They can prescribe topical retinoids such as tretinoin, adapalene, retinoids with BPO (Epiduo), as well as antibiotics & anti-hormones. If your acne fails to respond within 6 – 8 weeks a referral to a dermatologist may be prudent.
Dermatologists may approach your acne from another angle. We may investigate your acne, conduct a hormone profile, optimise your skin care & often prescribe anti-hormones, anti androgens as well as oral retinoids. Consider seeing a medical dermatologist for treatment if your acne is recalcitrant to normal management, if you have evidence of acne scarring, or if your acne has significantly affected your social & mental well being.
*Disclaimer: I am a procedural dermatologist, my work is focused around surgery,lasers, deep peels & complex injectables. I do not treat medical conditions including acne. Please see one of my colleagues @cliniccutis for management.
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