As acne is not a direct result of dirt, scrubbing at your skin will not improve your complexion. And don’t think for one minute that acne is a sign of unloved skin: the chances are that you will have spent a lot of time, money and effort on treating your skin so far.
Looks can be misleading. In fact, many people with acne will actually go to such lengths to cure their acne that they can create more problems for their skin – over-zealous cleaning can often lead to dry, irritated or inflamed skin.
If your skin does become irritated, this may lead to the breakdown of the normal epidermal layer, resulting in the skin becoming open to infection from bacteria, fungi and viruses, and possibly causing further skin problems.
Back to basics
The best way to care for skin with acne is to treat it with a little gentle cleaning every day. It is advisable to cleanse the skin gently before using any form of topical medication – that is, medication that is directly applied to the skin. Steer clear of products that may be too astringent or drying for your skin.
In most instances, a non-perfumed foaming cleanser or mild soap is suitable for most acne-prone skin. Wash off the products with warm water and gently pat your face dry. It is best not to use a flannel, sponge or other kind of washcloth, as these can also irritate the skin and you may be tempted to scrub harder.
Cleansing the skin guards against infection and odors, but excess washing can easily dry it out, especially if you are already prone to dry skin, and may cause loss of oil in the outer layers of skin. Generally you don’t need to clean the skin any more than twice a day, although the exception is if you get very hot and sweaty, such as after exercise, when it is worthwhile washing as soon as you can to help prevent further irritation and inflammation.
If your hair is oily, or if you have scalp or forehead acne, then wash it regularly with non-comedogenic hair products. Remember, any hair products you use to style your hair, such as gel, may increase comedone formation.
For oily skin, using a gentle toner or astringent, ideally alcohol-free, to cleanse the skin is usually sufficient to remove surface dirt and dead cells. You can use a cleanser afterwards if you want, but make sure it is gentle and non-comedongenic.
If your job or hobby means your face is covered with grease or oil, then use a non-perfumed foaming cleanser or mild soap and clean hands, rinsing off with warm water and patting your face dry. There are a number of over-the-counter soaps, creams, scrubs, lotions and gels for acne, most of which will contain the active ingredients benzoyl peroxide, alpha-hydroxy acids and salicylic acid.
As many topical treatments can dry and irritate the skin further, apply a moisturizer regularly after use. Look for moisturizers containing glycerin, jojoba and linoleic oil, as they help to hydrate the skin. It is worth bearing in mind that glycerin does not suit all skin and may irritate the skin further, so if you feel your acne is getting worse then change the product.
Bear in mind that the environment can make dry skin even drier – central heating, air conditioning and the weather can increase moisture loss, which in turn may lead to skin irritation, so do aim to moisturize on a daily basis.
However, even if your skin is very dry, do not be tempted to overuse creams as this can increase oil production. It is not just your face which may need moisturizing. If you have acne on the body then it is worthwhile moisturizing this too, especially after a shower or bath. And make sure the water is not too hot, as this can remove moisture from the skin.
Whatever your skin type it is worthwhile exfoliating the skin, as this helps to remove dead surface skin cells which may clog the pores. Exfoliation is generally best done at night, after gently cleaning the skin. It is important not to overdo this treatment – twice a week is generally sufficient.
And, as with cleaning, you should go gently and not rub too hard, otherwise you are likely to cause further inflammation and irritation.
There are two types of exfoliants, physical and chemical. The physical exfoliants include scrubs, abrasive pads, granules and natural ingredients, such as oat bran. Chemical exfoliants contain an enzyme or acid, such as alpha-hydroxy acid and beta-hydroxy acid, which loosens the skin’s dead cells; they are generally more suitable for acne skin.
Tea tree oil is an alternative face and body wash for acne-prone skin. An essential oil of the Australian native tree Melaleuca alternifolia, it is known for its antibacterial, antifungal and antiseptic qualities.
It has been compared to benzoyl peroxide for helping to combat acne, and research has demonstrated that in treating moderate acne, 5 per cent of tea tree gel, compared with 5 per cent benzoyl peroxide, has a significant effect in reducing inflammation and comedones.
It has also established that tea tree gel has fewer side-effects than benzoyl peroxide. However, undiluted tea tree oil should not be applied directly to the skin, as it can cause irritation, redness, over drying and blistering.
A tea tree oil solution of 5 ml tea tree oil to 95 ml water is recommended, or tea tree gel can be bought over the counter.
Skin needs to be healthy on the inside to be healthy on the outside, so a good, nutritious diet with plenty of fruit and vegetables is recommended. Cutting back on sugar, carbohydrates, fast food and caffeine is beneficial.
Fresh air and sunshine help too, but remember to use a sunscreen. Water helps to maintain hydration of the skin and improves the complexion, and giving up smoking will improve not only your skin tone but also your overall health. All lifestyle factors will help to give your skin the best possible chance of staying healthy.
Acne in other places
It’s not just the face that can succumb to acne: the chest, back and even the buttocks can suffer too. The reason for an outbreak in other areas is generally similar to facial acne – an abnormality in the over production of sebum.
However, very often clothing, perspiration and friction may irritate skin and cause a break-out of spots. Treating acne elsewhere on the body does not differ from treatment for facial acne, though a few other factors may need to be considered as well.
- The chest is generally more sensitive than the back or buttocks to antiseptic washes, and irritated skin or a rash may occur if the treatment is too harsh.
- It’s helpful to wear loose-fitting clothing, which won’t chafe the skin.
- Washing more regularly to help get rid of perspiration, for example after vigorous exercise, will help stop irritation of the skin – though, as always, be gentle and don’t overdo it.
- Applying medication such as benzoly peroxide to your own back can be difficult, so if you suffer from back acne ask one of your nearest and dearest to help.
- Bear in mind that scrubbing at the skin with a loofah or similar can also cause inflammation. A simple gentle cleaning product can be used, and the body should be patted dry with a towel, rather than rubbed, afterwards.
- Apply a non-comedogenic moisturizer to the body after washing, just as you would with facial acne.
- Rucksacks and backpacks can often irritate and rub the skin on the back and shoulders, and should be removed if an outbreak of spots occurs.
- The buttocks are particularly difficult to clear from spots, especially if you have to sit down for most of the working day. Again, avoid tight-fitting clothes. All clothing, including underwear, should ideally be made from cotton or other light breathable fabric.
Being outside in the sunshine not only improves your well-being but also helps the body to manufacture vitamin D, enabling the absorption of calcium and improving bone health. However, it is important to protect yourself from the sun’s harmful ultraviolet A (UVA) and ultraviolet B (UVB) rays. Watch the video as Dr.Schultz of DermTV explains the harmful effects of the sun’s ultraviolet rays.
These rays have the potential to burn the skin and cause rashes and prickly heat. Sunburn is also implicated in skin cancer. While small amounts of exposure to the sun can help to improve acne, unfortunately sunlight can also worsen it. Striking a balance can be difficult.
Too much exposure to the sun can cause sunburn, which will irritate your skin and increase the acne. The skin’s surface thickens and the dead skin cells won’t exfoliate as quickly, leading to more blocked pores and more spots.
Choosing the right sunscreen is vital when you have acne. Sunscreens are, unfortunately, a common cause of acne breakouts. Oil-free non-comedongenic products, with a UVA and UVB minimum factor of 15, are advisable, and you may find gels more suitable than creams. In the video below, Dr.Schultz explains how to choose the right sunscreen.
It may be worth gently cleaning your skin before you apply your sunscreen, and although your acne may be irritated or even break out after using your sunscreen, it is always advisable to wear it.
Some acne medications, such as antibiotic therapy, make the skin more susceptible to the sun’s rays, and in these instances it may be necessary to apply sunscreen on a daily basis. Be careful not to consider moisturizers with sunscreen as suitable protection, as many have minimal effect.
Your GP or dermatologist should be able to advise you on this when providing you with your acne medication. If you are using topical retinoid treatment, apply your sunscreen directly afterwards.
Remember: only use these at night and wash off in the morning. They are photosensitisers and make the skin more sensitive to the sun, so it is important not to go out in the sunshine with the retinoid on.
For acne-prone skin, the British Association of Dermatologists recommends applying factor 15+ sunscreen, with broad-range spectrum protection from UVA and UVB rays, every two hours, even if there is partial sun or cloud cover. It is also advisable t to apply sunscreen more frequently if you are swimming, or perspiring heavily.
If exercising outside you may be more prone to sweating, but be careful not to apply too much sunscreen to your forehead, as any excess may run and drip into your eyes, causing irritation. Be careful not to use sunscreen or moisturizing products containing lanolin, a by-product found in sheep’s wool. This is very oily and known to affect acne skin adversely, especially in those whose acne is genetic.
A suntan may give the appearance of health. Indeed, much emphasis in the Western world is placed on the golden colour of skin, and some people will go to extremes to achieve a tan, from excessive sunbathing to sunbed use. The British Association of Dermatologists does not recommend sunbeds. It is thought that they give little benefit and may have potentially damaging effects on the skin. So, having second thoughts about sunbeds? Watch this video.
Remember, the more you look after yourself, the healthier your skin will appear.
While there is no guarantee that a facial will improve your acne, people with mild acne may find they benefit from a professional facial, especially if done regularly. If your acne consists mainly of blackheads or whiteheads and is non-inflammatory, then very often a facial will produce good results.
During a facial, the skin is cleaned thoroughly and manual extractions may be performed to clear blocked pores. Mechanical extraction of comedones is not, however, without its downside, as scarring may occur if this is too vigorous.
Steam should be avoided as steam from facial saunas, steam rooms or conventional saunas can induce acute blockage of the pore by swelling the microcomedone and this can result in an acute breakout of acne.
Facemasks and facial massage may also be incorporated into the treatment, and moisturizer applied to soothe and hydrate the skin.
If your acne is moderate to severe, with nodules or cysts, then consult your GP or dermatologist for advice first, particularly if you are using topical or oral medication such as Accutane or Retin A, as these forms of acne should not be treated with facials.
Usually facials are carried out at beauty salons by qualified therapists who should be able to offer a suitable facial for your acne, but if you are unsure it is worthwhile discussing this with your dermatologist, who may be able to recommend someone for you.
‘Shaving bumps’, otherwise known as Pseudofolliculitis barbae, are not acne but a persistent inflammation of the skin caused by shaving. After the hair has been shaved it sometimes curls into the skin as it regrows, causing an inflammatory reaction.
This form of acne tends to occur more in males with curly hair. Treatment includes allowing the beard to grow for a period of three to four weeks or, if this is not possible, shaving every other day, which will also help to improve the condition. The use of an alcoholic solution containing 1 per cent clindamycin has been shown to be effective in treating this condition, when it is used immediately after shaving.
While shaving itself does not cause acne, certain factors, such as using the wrong shaving cream or blade for your skin type, can irritate or cut the skin, causing infection and an acne-like rash. If the skin has been cut, it is worth changing the razor blade daily to prevent cross-infection.
Not shaving if you don’t have to will help the skin to heal. Using a tea tree-based shaving gel, or one for sensitive skin, may help to lessen the inflammation, and although it may be difficult, try not to shave over the sports for a few days.
Electric shavers also need to be cleaned regularly to prevent infection. Experimenting with a wet and a dry shave, to see which works best for your skin, is also worthwhile. The shaving products you use should be alcohol-free, as alcohol-based products will not only dry the skin but can be painful if applied directly to the spots.
Moisturizing after shaving will help to keep the skin hydrated but, again, use non-comedogenic moisturizers.
Cosmetics and fragrances
It is thought that up to 30 per cent of skin cosmetic users have acne-prone skin, which is why cosmetic acne is on the increase in the Western world. Acne cosmetic results in small red spots or bumps that can last from a few days to several months.
Sometimes it occurs as a reaction to a new skin product, or because the products are comedogenic. Cosmetics may also be labeled ‘oil-free’, but synthetic oil substitutes may affect acne-prone skin because of the chemicals they contain, such as stearic acid and isopropyl myristate.
These chemicals are often added to cosmetics products and skin lotions to give them a sleek, sheer feel. Other chemicals to avoid in cosmetic products include isopropyl palmitate, isopropyl isothermal, putty state, isostearyl neopentonate, myristyl myristate, decyl oleate, octyl sterate, octyl palmitate, isocetyl stearate and PPG myristyl propionate.
Crude coal tar, lanosterin, sterolan, and D and C red dyes, common in blushers, should also be avoided.
If you suffer from this condition, it is best to use non-comedogenic cosmetic products. Ideally, make-up should not be worn every day. When you do wear it, it should be removed as soon as possible, while make-up brushes are best washed regularly in mild shampoo and thoroughly dried.
If your acne is over your forehead and in your scalp, change your hair products to non-comedogenic products and try to keep them away from the skin at the front of the hairline until the spots have cleared up. To help clear existing spots, exfoliate regularly and use a cleaner or make-up removal wipes with salicylic acid.
However, as with any form of acne, if you have changed all your products and the spots are still there after six to eight weeks, then see your doctor.
Fragrances found in cosmetics and hair products can cause skin reactions and adversely affect acne skin. Even fragrances applied directly to the skin may cause a reaction which can lead to the development of acne.
Cosmetic products labeled ‘unscented’ may still include fragrances to mask the smell of other ingredients. Products labeled ‘fragrance-free’ or ‘hypo-allergenic‘ are more suitable. The most common acne-inducing fragrances are bergamot, ambrette and the musk family.