Last time we talked about the different types of acne, how it forms, and potential triggers. Clearing breakouts requires patience, and once skin clears, you must continue treatment to keep it clear. A blemish takes a minimum of eight weeks to mature. This is why you must use a treatment consistently for at least two to three months before you can determine its effectiveness. Too often people get frustrated and quit or switch up their approach, keeping them in a frustrating cycle where nothing seems to work. Even prescription treatments require a few months to do their thing.
The key to reducing acne is prevention. Once a pimple appears, medication can speed healing. But solely focusing on existing blemishes (“spot-treating”) does nothing for developing acne you can’t yet see. Topical treatments should be applied all over the face (or acne-prone area) to prevent breakouts altogether.
Most acne will improve with a consistent regimen of gentle cleansing, exfoliation, and application of a topical treatment twice a day. Moderate to severe inflammatory acne requires medical intervention to completely clear.
How acne treatments work:
- Salicylic acid (BHA or beta hydroxy acid) is a mild acid that increases cell turnover and eliminates pore-clogging dead skin cells.
- Benzoyl peroxide is a topical antibacterial
- Retinoids change the way skin cells are formed and shed, plus reduce inflammation.
- Prescription topical or oral antibiotics kill P. acnes bacteria.
- Medications to balance hormones are an option if hormone imbalance is causing excess oil.
- Oral isotretinoin (formerly known as Accutane) is a last resort for severe inflammatory acne. It plays a role in eliminating oil.
- Certain lasers (like Aerolase) kill acne bacteria. Continued treatment is required to keep acne from returning.
- Blue and red light therapy kills acne bacteria and reduces inflammation. Best combined with other treatments to keep acne from returning
Treatment for non-inflammatory acne
Non-inflammatory acne can be managed without medical intervention but requires a consistent skincare regimen.
Step 1: Cleanse
Gently wash your face or affected areas with your bare hands and a gentle water-soluble cleanser twice daily and after sweating.
A water-soluble cleanser rinses clean with water (as opposed to leaving a film behind). They’re usually clear, not creamy. A washcloth or cleansing brush is not recommended, as you want to avoid irritation. Remember that irritation can lead to acne.
Some face washes intended for acneic skin include ingredients like benzoyl peroxide or salicylic acid. While these ingredients can benefit acne, in a cleanser they’re in contact with your skin so briefly that their effect is fleeting. (And the cleansing agents in face wash will irritate skin if left on too long.) The best cleanser is one that’s mild and removes excess oil, makeup, and debris; clearing the way for active ingredients.
My dermatologist recommends Cerave Foaming Face Cleanser or Neutrogena Fresh Foaming Facial Cleanser:
Step 2: Exfoliate
Apply a salicylic acid (BHA) product once or twice daily after cleansing.
A lot of people think exfoliation means scrubbing. But salicylic acid gently exfoliates the surface of the skin and into the pore lining (Bye bye blackheads!) without the need for roughing up your face. Salicylic acid has antimicrobial properties and soothes inflammation and redness–making it an ideal choice for acne prone skin.
Alpha hydroxy acids (AHAs) like glycolic or lactic acid exfoliate the surface of the skin. They can’t cut through oil and into the pore the way BHA can, so they’re better for dry or aging skin. Chemical exfoliants (AHA/BHA) improve the appearance of all skin types because they increase cell turnover, which slows as we age.
You may experience some peeling when you start using a BHA. Begin with once daily use, and gradually increase to morning and night. Your skin will acclimate.
Salicylic acid ranges from .05 to 2% in over the counter products. If your skin is very oily, go for the 2% variety. The pH of BHA products is also important–a pH of 3 to 4 ensures efficacy. Salicylic acid can come in a liquid, gel, or lotion.
Some BHA products that have the proper pH and no irritating ingredients:
Step 3: Treat
After your BHA soaks in and dries, apply a thin layer of benzoyl peroxide all over the affected area (avoiding eye area).
The most effective over-the-counter antibacterial topical for treating acne is benzoyl peroxide (BPO), but some people don’t know the proper way to use it.
BPO products range in strength from 2.5% to 10%. Research shows that 2.5% BPO is just as effective as higher concentrations without the excessive dryness and irritation.
BPO penetrates pores to kill P. acnes bacteria, and bacterial resistance never develops like it can with prescription antibiotics. Besides the possibility of dryness and irritation, BPO can bleach clothing, towels, and linens.
Acne.org makes large sizes of 2.5% BPO. At the drug store, the average BPO product is around $10 per ounce versus $2.41 per ounce for the Acne.org brand. Purchasing a larger size allows you to apply a thin layer all over twice a day without running out in a week. Acne.org estimates that eight fl oz will last one month if used for the face only. It goes on clear and won’t clump up with moisturizer or sunscreen. Paula’s Choice also makes a cosmetically elegant BPO that retails for $8 an ounce:
Step 4: Moisturize
After the BPO has fully absorbed and dried (five to fifteen minutes,) gently apply a non-comedogenic moisturizer and avoid rubbing skin. Although there are established ingredients that generally clog pores, technically anything can clog your pores. Sometimes finding what agrees with your skin can be a process of trial and error.
Since dryness and peeling are common side effects of several acne treatments, a moisturizer is essential. It may seem counter-intuitive if you have oily skin, but drying out skin only perpetuates the acne cycle. Dryness is a form of irritation, and you must keep your skin balanced.
Sunscreens tend to be moisturizing and are often enough of a moisturizer for people with oily skin in the a.m. Moisturizers that include sunscreen don’t generally have a high enough SPF. (I’ll suggest some sunscreens in the next step.)
Here are a few suggestions for basic moisturizers that shouldn’t cause breakouts for most people:
Step 5: A.M. Apply Sun-protection
In the morning, your sunscreen may double as your moisturizer. Most acne treatments increase sensitivity to UV rays. Choose a sunscreen with a broad-spectrum SPF of 30 or higher. Zinc-based sunscreens offer excellent protection and can soothe inflamed skin as well. Read more about choosing a sunscreen here.
Step 4 or 5: PM (optional) Differin:
Differin was only available from a physician until the summer of 2016 when it was approved for sale over the counter. It’s a vitamin A derivative or retinoid, and the only medical grade retinoid you can get without a prescription. Dermatologists consider retinoids the primary therapy for initial acne treatment. They help regulate skin cell turnover to keep pores from clogging. Retinoids also restore texture and tone to aging or sun damaged skin. Read more about them here.
If applying Differin before moisturizer results in too much peeling or irritation, you can try doing it after moisturizing to “buffer it.” Spread a pea-sized amount over your face. Start with every third night, and work your way up to every other night. You may or may not be able to tolerate nightly use. Read more about how to use retinoids and managing irritation here. Also, be sure to read the included instructions carefully. Retinoids are potent medications that require judicious use.
Apply BPO in the morning and Differin in the evening. It can take skin time to become tolerant of these products, so give your face a break if necessary. (More than two nights off isn’t recommended if you’re trying to build tolerance, but pay attention to how your skin looks and feels.) Overdoing it can cause irritation that can lead to more acne.
Retinoids increase your sensitivity to UV rays, so be sure you’re applying a sunscreen with SPF 30 or higher every day.
Consistent use of a gentle cleanser, salicylic acid, benzoyl peroxide, and a non-comedogenic moisturizer should improve mild to moderate acne considerably. Adding Differin to your routine can enhance results. Follow this regimen twice daily for two to three months before making an evaluation. If skin peels excessively or becomes irritated, decrease the amount of product, strength, or frequency. You never want to stop altogether. Continue to cleanse your face twice a day and use salicylic acid at least once daily. Reintroduce other treatments once every other day and then once a day. Build up your skin’s tolerance so that you can control your acne.
If your acne is inflammatory or doesn’t respond to an unwavering three-month skincare regimen, it’s time to see a dermatologist. In my next post, I’ll cover medical intervention for acne, including what worked for me.
(I know I initially said this would be a two-part post, but it turned into three–sorry! There was lots more to go over than I previously realized.)