How to : Treatment and Management of Acne

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Ahhh, acne. How we love to hate you. Especially when you hideously appear before picture day or a wedding or the day of a big, important date. Here you are – red, screaming, and very pitifully apparent. What can we do? Wear a paper bag over our heads and hope the photographer doesn’t notice?

Luckily there are some things you can do to help the situation, no paper bag required! First and foremost, you need to take gentle care of the skin. An acne blemish is typically a response to some kind of external event: scrubbing too hard, excessive bacterial proliferation, using drying soaps and washes, failing to use moisturizer … despite what you’ve been told, your skin needs kindness and gentle care to flourish and look its best.

Cleansers for Acne

The first step to any tried and true routine, even for acneic skin, is the cleansing step. You might be tempted to use a foaming cleanser that strips your face of oils and creates the dryest, tightest feeling you can possibly tolerate for your skin. This is a mistake. Stripping the skin with harsh cleansers is a fallacy that’s been perpetuated by cleansing companies for decades. Neither oily nor acneic skin needs to be punished into submission by scrubbing away every last ounce of oil and moisture. Oil by itself doesn’t cause acne – acne is a multifactorial disease with a complex pathology.

What you want to use is the most gentle option you can find. For those that love the bubbles,  don’t worry – I’m nottelling you you’re not allowed to use them because there are gentle foaming cleansers out there. It’s important that you understand that using something like antibacterial hand soap, clarifying shampoo, or painfully drying, overly foaming cleansers have great potential to contribute to your skin problem. If you want to know why people avoid sodium lauryl sulfate (aka SLS – ring any bells?), it’s because it’s one of the most stripping foaming agents and so it’s super, super drying.

What you might not know is acneic skin does have some special considerations when it comes to cleansers – the most common of those are pH balanced cleansers, benzoyl peroxide cleansers and salicylic acid cleansers.

pH balanced cleansers are manufactured to be at a similar pH of skin (typically around 5.5). These are great for acneic skin as barrier function tends to be compromised when one uses high pH cleansers. High pH cleansers tend to also raise the pH of skin over time which can then lead to the proliferation of p. acnes bacteria as well as other pathogenic bacteria and increased acne overall. So pH balanced cleansers are especially helpful for those suffering from acne. An example of a pH balanced cleanser is Sebamed Foaming Cleanser (see? you don’t need to totally avoid foaming cleansers if you like them).

Benzoyl Peroxide and Salicylic Acid Cleansers

On the other hand, benzoyl peroxide cleansers and salicylic acid cleansers, have acne-fighting ingredients included in the cleanser. You can read more details below about how these ingredients work. Needless to say, they’re incredibly beneficial to acne sufferers. An example of a benzoyl peroxide cleanser is PanOxyl 4% Acne Creamy Wash. This wash and its 10% concentration cousin are also great for back or chest acne problems when normal body washes just aren’t cutting it. As for salicylic acid, a recommended product option is Olay Total Effects Daily Cleanser plus Blemish Control.

Chemical Exfoliants

Just about anything can cause acne – from problems with shedding, to inflammation, to bacteria. Luckily there are treatments that not only handle all those issues (Seriously! All of them!), but can also add hydration, reduce hyperpigmentation or even make skin just glow.

Chemical exfoliants like glycolic or salicylic acid are so incredibly great for skin – I simply can’t stress that enough. And if you don’t believe me (or you want to know more), saunter on over to Anna’s post on chemical exfoliants.

Spot Treatments

When it comes to acne treatment for newly developing blemishes, spot treatments are the solution you seek. Spot treatments are specialized products that are used in select areas to treat acne. They can be used overnight to completely prevent an acne blemish from forming or they can drastically shorten the lifespan of a pimple. In some cases, if you’re able to successfully treat your acne with a daily topical or a prescription, you won’t even need to use a spot treatment.

But say you get a blemish anyway and you’ve done all you could to prevent it. Now it’s time to take out your spot treatment tools and start treating this thing. The top tools to treat acne are: benzoyl peroxide, salicylic acid, sulfur, tea tree oil, neem oil, and hydrocolloid bandages.

Benzoyl Peroxide

What it does: Benzoyl peroxide (BP), “has been a popular choice for the treatment of AV [acne vulgaris] due to its keratolytic, moderate comedolytic, and antibacterial properties, which include the reduction of p. acnes and staphylococcus aureus on skin.” Translation: BP is effective at breaking down the outer layer of skin (keratin), preventing acne (comedones), and it’s antibacterial.

How to use it: BP can come in various forms. Usually you’ll see it in a cream and occasionally in a cleanser. Both are effective at treating acne. More often than not though, you’ll find BP to be a cream. Just apply some cream to the tip of your finger and spot treat as you see fit. I like to gently tap it into my skin, but you can rub in however you want (no seriously- there’s no magic application that’s better than another).

Potential side effects: The major drawback to BP is how irritating it can be. Thankfully, the lower the concentration of BP, the less irritating it is and studies have shown that the lower concentration (2.5%) is just as effective in fighting acne blemishes as the higher one (10%). One thing to keep in mind, though, is that BP can bleach fabrics. Yikes. So BP judiciously (and use white towels!).

Salicylic Acid

What it does: Salicylic acid is mostly known as a chemical exfoliant, but it is also anti-inflammatory and mildly antiseptic. In this way, salicylic acid is incredibly helpful when it comes to fighting acne. Salicylic acid exfoliates differently than alpha hydroxy acids, like glycolic acid or lactic acid. Instead of dissolving the bond between cells, salicylic acid breaks up comedones or ‘degunks pores.’ That’s why it’s so wonderful for acne.

How to use it: Salicylic acid comes in a multitude of iterations, namely cleansers and liquid exfoliants (like a toner or liquid soaked pads). Typically, you’ll find it in it’s liquid form. When you think of a toner, this is what a salicylic liquid treatment looks like. To use, simply cup your hand and add about a dime (ish) size of liquid to your hand, rub your hands together, and apply all over. Or you can soak a cotton ball/pad with the liquid. But I find this to be wasteful. If it comes on soaked cotton pads, just smooth the pads over your skin.  Simple as pie.

Potential side effects: Salicylic acid is one of those few, special products that can cause a reaction the first time you use it. What I mean is, the way it acts on your cells causes it to potentially break you out. In the case of salicylic acid, try to give it some time if you start to react (or purge). If after a month it’s still breaking you out, you might want to try a different product. SA also belongs to the same drug class as aspirin (salicylates); so if you’re allergic to aspirin, don’t use salicylic acid. This familial connection is also why people think applying a paste of aspirin will work in the same way as salicylic acid for their acne- spoiler alert, it doesn’t.

Sulfur

What it does: Sulfur is keratolytic (noticing a pattern?) and antibacterial. Sulfur is often more effective when used in combination with benzoyl peroxide, salicylic acid, and sodium sulfacetamide. So you’ll often see sulfur alongside these ingredients.

How to use it: Sulfur comes in soaps, lotions, creams, and ointments.

Potential side effects: While tremendously well tolerated, sulfur is incredibly stinky. But, lucky you! Living in the modern age! New cosmetic formulations of sulfur have since been developed that are far more cosmetically elegant than their predecessors. So you can enjoy the wonderful success of sulfur without the debilitating stink and annoyance. The most you’ll need to look for when using a sulfur product is excessive dryness.

Tea Tree Oil

What it does: Tea tree oil is an amazing product in the fight against blemishes due to its antimicrobial and antibacterial activity. When comparing benzoyl peroxide and tea tree oil, researchers have found that they have similar levels of efficacy, but without the irritation that benzoyl peroxide can cause.2

How to use it: When using essential oils (like tea tree oil), you want to exercise caution and not apply these oils neat (that means pure). Mix 5% tea tree oil with a carrier oil, such as mineral oil (but anything that doesn’t cause your skin to react is a good choice). You can also try adding a drop (just a drop!) to your usual lotion for all over acne treatment.

Potential side effects: Tea tree oil can be drying. Using any essential oil undiluted on the skin can potentially lead to contact dermatitis or severe irritation (so always dilute!).

Neem Oil

What it does: Neem oil is antibacterial and “contains salicylic acid-like substances that reduce redness and inflammation.”

How to use it: Unlike tea tree oil, neem oil isn’t comprised of sensitizing volatile compounds so it is safe to use it undiluted on the skin. To apply, just soak a cotton ball in neem oil to put on a single blemish or put some in your hand to apply all over. Be sure to do some hefty hand washing after your put it in your hand, though. Neem oil smells like a dumpster full of rotting Thai food on fire. And it tastes worse than it smells. And it burns if you get it in your eye.

Potential side effects: Besides potentially croaking from stink? Not much. But don’t think that neem oil is perfect. Neem oil still has the potential to make acne worse. Your mileage may vary is one of our mantras for a reason. If you find that happening, discontinue use. Neem oil does not cause purging.

Hydrocolloid Bandages

What it does: Hydrocolloid bandages suck out all the exudate (what’s inside the blemish) and speed up healing time.

How to use it: Once your blemish has popped (either naturally or you simply couldn’t help popping it yourself – I understand, sometimes I just can’t stop myself either), you remove the backing to the bandage and securely apply it on top. You can wear them during the day (though they’re pretty obvious) or overnight and let them work their magic. The longer you wear them, the longer they have to work to flatten your blemish. And when it’s nice and flat, you’ll have a far easier time covering the area with makeup and no one will have any idea that you’ve had this blemish to begin with.

Potential side effects: Hydrocolloid bandages are pretty safe to use. The biggest worry you have with regards to side effects is adhesive allergy. Well, that, and maybe looking a little silly.

Prescription Options

I know you might think that acne isn’t worth the trouble of seeing a doctor, but it is a medical condition. If you’ve tried all the OTC remedies and nothing is working, or if you just want to skip the OTC products and go straight for the big guns, a dermatologist (or even a GP) is always worth consideration for any skin conditions. A doctor may prescribe you pills (oral antibiotics are common) or topicals (like clindamycin or tretinoin). You won’t know what you need in your fight against persistent acne until you see a doctor.

But maybe you don’t have time to wait to see a dermatologist or you don’t have access to one. Many Addicts are utilizing PocketDerm, an teledermatology service that provides online consultations and mails prescription medication directly to you.

A Special Note

When acne is at it’s most frustrating, you might be tempted to do just about anything. I know how you feel, I’ve been battling acne for over a decade. It’s an awful condition; it can be embarrassing and scar one for life.

I’ve put every folk remedy and every passing suggestion from friends (and strangers!) on my face and I need to let you in on a little something – none of them are right for your skin. Toothpaste? Nuh-uh. Baking soda? Nope, nope, nope. Rubbing alcohol? Are you trying to kill your skin?

It’s rough having acne. I know. But completely nuking your skin from orbit is not the answer. Let the Addicts help you in achieving your best skin.

On that note, let’s rehash the suggested treatments:
TreatmentHow it WorksPossible Side Effects
Benzoyl PeroxideAntibacterial, anti-inflammatory, increases cell turnoverIrritation (which is less likely with the lower concentration), drying/burning skin, bleaches fabrics
Beta Hydroxy Acid (BHA)Anti-inflammatory, antiseptic, and “degunks pores”Can be drying and irritating (patch test!), likely requires an adjustment period
Hydrocolloid BandagesRemoves exudate from a blemish, promotes wound healingAdhesive allergy
Neem OilAntibacterial, anti-inflammatory, more hydrating than typical acne treatmentsGagging from the horrendous smell, increase in acne (it’s not a miracle for everyone – patch test!), tastes awful (don’t ask me how I know)
SulfurAntibacterial, antifungal, mild keratolytic (aids in softening and shedding the outer layer of skin)Pretty rare, but essentially limited to possible dryness and horrible stink
Tea Tree OilAntimicrobial, antibacterial, and as effective as benzoyl peroxide but less irritating if used properly (i.e. diluted)Can be drying, contact dermatitis (rashes, inflammation, and sensitivity) if you don’t dilute it

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