Simple skin care is best for managing acne
Dermatologist Dr Phillip Artemi says everyone's skin is different, but a simple skin care routine is always best. Focus on three main steps: cleanse, treat, protect.
And, you don't need to spend a lot of money on skin care products!
Cleanse, treat, protect
This is a simple routine to help manage acne. Add to this some tips on what to avoid and how to use make-up to camouflage those spots and you’ve got the keys to good skin care.
Follow the skin care steps and recommendations below – unless your health professional says otherwise.
To stop redness, help skin heal and reduce oil production it is essential to wash once or twice a day with an appropriate cleanser.
Look for a mild 'soap free' liquid face cleanser that’s pH balanced at 5.5 or slightly acidic to match that of the skin. It should also be free of abrasives, detergents and alcohol.
If you have oily skin, look for a cleanser with 'high rinsability'. It won't leave a surface film and contains only enough moisturiser to protect the skin from irritation and damage during cleansing. Options include Cetaphil Oil Control Foam Wash.
If you have combination, dry, sensitive or irritated skin, or if you're using acne treatments containing benzoyl peroxide, tretinoin, adapalene and/or tazarotene, look for a 'gentle oil-free plus moisturising' liquid cleanser.
Moisturising liquid cleansers have added moisturisers (e.g. cetyl alcohol or glycerine) that help protect the skin and speed up its repair and recovery if it's dry and irritated. Examples include Cetaphil Gentle Skin Cleanser and Neutrogena Visibly Clear.
It’s best to avoid moisturising cleansers that have high levels of paraffin, mineral or fragrant 'natural' oils.
Salicylic acid containing cleansers
Salicylic acid works by getting into sebum – where it's needed to help unblock pores. Cleansing products that contain salicylic acid are available from Neutrogena, L'Oreal and Garnier.
Salicylic acid helps dissolve, remove and prevent the formation of the keratin plug, which can help speed up the clearing of pimples and improve long-term control.
For people with mild acne, a cleanser with salicylic acid might be all you need for your everyday control of acne. Remember to speak with a pharmacist or doctor before combining this with any other medicated products (such as prescription acne products or those containing benzoyl peroxide).
This includes over the counter creams, gels or lotions, and those prescribed by your GP or dermatologist.
It’s best to apply these after your skin has completely dried after cleansing. If treatments are applied to moist skin they’re more likely to cause irritation.
You’ll get the greatest benefit if you apply your acne cream, gel or lotion to the entire skin region where you normally develop pimples. This is because these treatments also help to prevent new pimples from forming. A small pea-sized amount is usually all you need to treat the entire face.
Be careful not to apply these treatments to sensitive skin areas (which are not usually affected by acne) such as the skin immediately around your eyes, lips and nostrils.
It’s important to follow the instructions for applying these treatments and to be aware of any possible side effects such as increased sensitivity to the sun or possible staining of clothing.
This step includes using make-up and/or sunscreen during the day and possibly a moisturiser at night to protect your skin against environmental factors such as sunlight, wind, pollution and dryness.
Make-up, moisturisers and sunscreens should be applied on top of your morning or evening acne treatments.
Many moisturisers and cosmetic products can worsen or cause acne. Products labelled ‘oil free’ and suitable for ‘acne prone skin’ are a good start, but even some of these can make acne worse for some people.
Products labelled ‘non-comedogenic’ have been specially tested in people prone to acne and proven not to clog pores and worsen acne. These are the best products for you to try. You may have to trial a few before finding one that suits you.
If you’re having trouble finding moisturisers, make-up and/or sunscreens suitable for your skin, a dermatologist is your best source of advice.
In Australia, the harmful effects of sunlight far outweigh any minor benefits in treating acne. Good sun protection and sun avoidance practices will help reduce your risk of developing skin cancer and are even more important in those being treated for acne.
Most acne treatments (creams and tablets) increase the skin’s vulnerability to the harmful effects of sunlight including sunburn, pigment changes and photo ageing of the skin (lines and wrinkles, drooping sagging skin, blotchy pigmented spots and skin growths). This is because they make the skin more sensitive to ultraviolet light and particularly ultraviolet A (UVA) which is the part of the sunlight spectrum most involved in skin ageing.
Acne scars are particularly sensitive and prone to the harmful effects of UVA. Without good UVA protection the scars can rapidly photo age, losing their elasticity and collagen support. This results in loose, sagging facial skin making a person with acne scarring at risk of looking old, well before their peers.
In the morning, apply a sunscreen to all exposed areas before spending a lot of time in direct sunlight. Consider applying a face cream or lotion with an SPF of 30 to the skin of your head and neck if you are likely to only spend brief periods in the sun.
Sunscreens for acne prone skin
Sunscreen gels, liquids and sprays (not creams) are best suited for oily, acne prone skin.
Newer sunscreen ingredients have been developed that provide a better, longer lasting, broader spectrum of protection against the harmful effects of ultraviolet light. They’ve enabled the formulation of creams that are lighter than products using older technologies. Importantly, they’ve also passed a very high level of safety testing.
Benefits of the latest sunscreens include:
- Won't clog pores (non-comedogenic)
- Unlikely to cause skin allergy (hypo-allergenic)
- Provide longer lasting protection
- Provide very good UVA and UVB protection
Good UVA and UVB protection is very important for people using benzoyl peroxide, tretinoin, adapalene, isotretinoin or doxycyline for their acne. These treatments increase sensitivity of the skin to the harmful effects of UVA which include sunburn, wrinkles, blotchy pigmentation, skin growths, broken capillaries and thinner, more fragile skin.
Physical blockers (titanium dioxide and zinc oxide which give the sunscreens containing them a white opaque look) also provide good UVA protection. Many ‘oil free’ SPF30+ broad spectrum sunscreen products containing physical blockers are relatively heavy creams and may worsen acne. Only those labelled as non-comedogenic are suitable for acne prone skin.
Cream formulations are improving with new sunscreen ingredients. Look for sunscreens that have mexoryl SX and XL (La Roche Posay), bisoctrizole and/or bemotrizinol in the list of active ingredients and/or those that use ‘Helioplex’ technology (Neutrogena).
Tips for moisturising
Most people with acne have overly oily facial skin so moisturisers are unnecessary. A gentle cleanser with a light moisturising action is all that is necessary in most people with acne. However, a light, oil-free and non-comedogenic moisturiser can be beneficial if you have combination, dry sensitive or irritated skin.
It’s very important not to over-use moisturisers because this can make acne worse.
In the evening, only apply a moisturiser to acne affected areas if they are dry or irritated (red, flaky, and/or itchy). You may also want to apply to sensitive skin areas not affected by acne such as around the eyes, sides of face, and the skin next to lips and nostrils, along with the neck.
For mildly irritated skin you should normally apply your oil-free, non-comedogenic moisturiser over the top of acne treatment creams.
If irritation remains a problem or is causing you symptoms (e.g. skin that stings, burns or itches), try applying the moisturiser prior to applying your acne medication.
Wearing make-up can make you feel more confident – especially if it helps conceal acne redness and blemishes. Most cosmetic brands carry products designed for acne prone skin so you don’t have to worry about making your skin worse.
These products are typically labelled as oil-based, water-based, oil-free, oil-control or matte-finish. Where possible, choose oil-free and matte-finish products (which tend to be oil-free). The oil-control products are not necessarily oil-free but they contain blotting ingredients such as talc, kaolin or starch to help absorb excess sebum.
Face powders used to be something our grandmothers wore straight over their moisturisers until liquid foundations became the norm. Now powders are back big time especially with the popularity of mineral make-up ranges. Powders are great because they help conceal skin imperfections. Mineral powders don’t settle into the pores of the skin and are therefore non-comedogenic. They give a matte finish and smoothness and also help control oil. They also give good coverage and reduce the redness associated with acne. Some also have additional soothing agents. Mineral make-up also contains physical sunscreens such as titanium or zinc oxides.
You might need a range of concealers in your make-up kit. A lightweight concealer may be sufficient for everyday use but a heavier concealer may be the go for problems areas. Concealers with a green base help camouflage redness. Some also contain acne fighting ingredients such as salicylic acid so they can help treat your acne at the same time as hiding it.
Some of the red colour in blush comes from ingredients known as D&C pigments,. This can cause pores to block so it’s best avoided in people with acne. Instead, look for products that use carmine as the colourant. Powders and gels are better than heavier cream blush. Also avoid shimmery products – an effect caused by mica particles in blush and eye shadows. Mica can block the pores and cause skin irritation.
Despite the major temptation, squeezing, picking or scratching your acne will only make things worse. Treatment will work slower and you risk both pigmentation and scarring.
Toners are a ‘no go’ zone when treating acne
Toners may help to remove make-up, but they also irritate the skin and add to the inflammation associated with acne. Micellar water is a better option for removing make-up. It leaves skin feeling soft and hydrated without causing irritation.
Micellar water is great for all skin types too and is particularly suited to people with oily or sensitive skin.
When acne involves the beard area, careful shaving is the key to avoiding irritation and inflammation that will worsen your acne. Some helpful tips include:
- Moisten the hairs for a few minutes prior to shaving by applying a liberal coating of moisturiser
- Use a shaving cream or gel designed for sensitive skin, mixing it with a small amount of warm water before applying onto the skin
- Stick to double or triple blade razors
- Apply light pressure as you shave. Two light passes are better than one aggressive pass
- Change the blade or device regularly to ensure the blades always remain sharp
- Shave over and around pimples, not through them!
Avoid giving up on treatments too soon
Your acne will not respond to treatment and good skin care in a day or two or even a week or two. Over the counter and prescription medication need a minimum of 6-12 weeks before you’ll see a significant improvement with your acne but you should see some improvement along the way.
More is not better
Applying more skin care or treatment than recommended doesn't mean your acne will clear any quicker. Instead, over treating may lead to stinging, irritation and dermatitis which will make you look worse and slow down overall improvement.