How To Fight Acne

When it comes to acne, the deck seems to be stacked against us. According to recent statistics, 95% of people will have to contend with acne at some point in their lives, and 50 million Americans (that’s more than the amount of eczema, psoriasis and rosacea sufferers combined) are currently dealing with it. In fact, so desperate are we to combat acne, that we’re collectively spending 1.4 billion dollars a year on products and treatments that promise to do just that. In an effort to cut through the noise, we spoke to some of our favorite beauty experts to get intel on what we should and shouldn’t be doing for our acne.

There are, according to pioneering natural skincare formulator Marie Veronique, four main culprits which contribute to acne: hyper-proliferation of skin cells, presence of particular strains of bacteria, inflammation, and excess sebum production. Among teenagers, acne usually accompanies puberty’s hormonal firestorm—and tends to dissipate when those changes do—but in adults finding the cause can be a challenge. “Adults may not be producing as much sebum and often experience a type of inflammatory acne associated with dry, sensitive skin,” says Veronique. “The underlying causes may be attributed to hormonal fluctuations, or microbiome disruptions causing inflammation and dermatitis issues.”

So, while acne at both ages can be stoked by hormones, they’re different ones at work. “With teens, it’s often just a general increase of pubertal hormones and those oil glands waking up, but for adults it may be due to androgens and the relative dominance of the classically ‘male hormones’ like progesterone, testosterone, and DHEAs,” says Santa Monica-based dermatologist Dr Sonia Batra. Acne can present itself in various forms—comedonal (open ones are blackheads, closed are whiteheads) and inflammatory lesions (red bumps, pimples that pus, and deep cystic nodules). “As a teenager acne usually affects the entire face, with a predominance of blackheads and whiteheads in the T-zone,” says New York dermatologist Dr. Joshua Zeichner. In adults, acne tends to gravitate to the skin around the mouth and the jawline, and the pimples they develop are more red and angry.”

According to Zeichner, the three most common hero ingredients used to treat acne are benzoyl peroxide (“it kills acne-causing bacteria”), salicylic acid (“it removes excess oil and exfoliates dead cells from the surface of the skin”) and retinoids, the latter being a perennial dermatologist favorite for its multi-functionality. “They shrink oil glands and help increase cell turnover, which decreases the likelihood that cells are going to get clogged,” explains Batra. “They also stimulate collagen which is a nice side benefit because acne can be so destructive and retinoids mitigate some of the scarring.” For those with particularly sensitive skin, Batra recommends synthetic retinoids like adapalene (because it was recently deregulated you can get a 0.1% gel without a prescription now) and tazarotene. If you can stomach the intense scent, Batra is also a huge fan of sulfur for its calming, bacteria-killing ways.

And Veronique emphasizes the importance of lipids in an acne regimen, a category often incorrectly avoided. “People plagued with clogged pores often produce a sebum that is deficient in linoleic acid, causing it to clog pores,” she explains. “Applying oils like safflower or sunflower topically can act like Drano to clear clogged pores. And adding tea tree oil delivers a double whammy.” No matter what your treatment protocol, an SPF is especially key if you’re contending with acne, not simply to help curb any additional inflammation, but also to prevent potential pigmentation. “If you have acne and are not using an SPF, then any red or brown marks that are left behind are going to last for months,” says Batra. “Discoloration often lingers a lot longer than the acne spot itself would.”

Just as important as the advice for what you should be doing to treat acne, are the tips about what you should be wary of.

DON’T JUST TREAT PIMPLES YOU SEE
You’ll be fighting a losing battle if you just focus on spot-treating pimples if and when they emerge, says Zeichner. “The face is made up of thousands of pipes connecting oil glands to the surface of the skin and with acne we know that all of these pipes are slightly clogged, however we cannot predict which will become fully blocked leading to a pimple,” he says. “By treating only the pimples you see, you’ll always be playing catch-up.”

DON’T OVERDO IT
The biggest mistake acne sufferers make, often out of desperation, is to go overboard using high concentrations of active ingredients—which is a straight path to skin irritation. “When it comes to ingredients like benzoyl peroxide studies have shown that even lower concentrations (2.5%) are just as effective as the higher ones (10%),” says Zeichner. To further shield against potential irritation he recommends priming skin with a moisturizer before applying any acne medication.

GO EASY ON THE LAYERING
Like people, certain ingredients work better alone than in groups. Batra steers patients away from combining either benzoyl peroxide or any alpha hydroxyl acids (which also exfoliate and turnover cells) with retinoids.

OVER-DRYING IS NOT A GOOD M.O.
The antiquated advice for addressing acne was to dry it out, but nothing could be more detrimental than messing with the skin’s barrier function. “Your skin’s response will be to compensate by overproducing more oil, then your pores get blocked and you flare up,” explains Batra, who treads especially carefully when it comes to retinoids. “Some people will just blast their skin with retinoids and dry it out, calling it the ‘purge,’ but I try to ease my patients in, introducing it gradually, then ramping it up as they become more tolerant,” she explains.

BE WARY OF RELYING SOLELY ON ANTIBIOTICS
While oral antibiotics are frequently doled out by dermatologists to treat acne, New York nutritionist Daniela Turley warns of their cumulative effect on your body. “Though antibiotics will clear skin in the short term, in the long term it leaves the person with imbalanced gut flora and reliant on the medication,” explains Turley. “Most cystic acne cases I have treated in my practice have improved by addressing the gut microbiome.”

CHOOSE MAKEUP WITH CARE
Avoiding anything that isn’t non-comedogenic is a good idea, though what your skin reacts to is often determined through trial and error, says natural brand founder and esthetician Kristina Holey. Two ingredients she says are best avoided no matter what: coconut and mineral oil.

Speaking of the gut…. Studies have found that when there is systemic inflammation and an overgrowth of bacteria in your gut (a so-called leaky gut), it has a profound effect on the skin. “If there is intestinal inflammation it’s proven that it can lead to barrier dysfunction and microbial imbalance, creating a more vulnerable system for inflammation,” says Holey. What you eat, and how your body digests it, explains Holey, definitely impacts the quality of sebum you’re producing and, in turn, your risk for breakouts. “There’s also more research around how dairy and meat treated with outside sources of hormones and sugary, high-glycemic load foods can make acne worse,” says Batra. Those same studies, adds Turley, tend to show acne sufferers have a low fish intake and high saturated and trans-fat levels. Her advice: “Avoid sugar and high-glycemic index foods, cow’s dairy, and taking a probiotic would be the first step,” says Turley. “I would also recommend taking a dietary supplement containing zinc, b-complex, vitamin A, vitamin E and copper. Just the zinc, b-complex, copper combination has been shown to improve acne in 88% of patients in 8 weeks.”

Finally, research has backed up the idea that fluctuations in the cortisol hormone levels associated with stress can lead to acne. So, finding a way to chill out—whether that’s meditation or any kind of meditative activity—is critical.  

There are plenty of ways to supplement your acne-fighting regimen with treatments at your dermatologist’s office. “Blue light shows some effect in treating acne as it kills acne-causing bacteria and there are photo-pneumatic devices like Isolaz that combine suction to clear the pores along with light,” says Zeichner. For any post-acne scarring or discoloration Zeichner has had a lot of success with the resurfacing laser Fraxel. Batra’s go-tos are the V-Beam (now FDA-approved for scarring and acne), Theraclear (a combo suction IPL product) and a classic chemical peel or facial. “Chemical peels can be really nice adjunctive treatments because you’re helping fade discoloration and fluffing the outer layer of skin or a facial once a month with a skilled esthetician who can do gentle extractions,” adds Batra.

Zeichner reports that a company called Demira is in the process of developing a topical product to help reduce oil production. And Veronique says there are a number of promising new ingredients to consider in the treatment of acne. “Phloretin from apples has joined the bioflavonoids of promise category, along with epigallocactechin-3-gallate from green tea,” says Veronique. “We are also paying more attention to the role played by microorganisms populating the skin microbiome in limiting the ability of pathogens to invade. The best ingredients in the future are going to be those that harness the healing properties of the helper strains of bacteria.”