As you may know, I suffered from adult acne for a few years, and tried so many different treatments, read a bunch of books about acne, and saw several Dermatologists. It took about three years of trial and error before I was able to “cure” my acne. I put the word “cure” in quotes because there is not actually a true cure for acne, but it is possible to get to the point of having clear skin indefinitely. I do worry my acne may come back one day, but I’ve been clear of it for several years now, and feel I now have the tools to control it. On a scale of 1-5, where 1 is minimal acne, and 5 is cystic acne, I was about a 3. I can only speak from personal experience, so since I did not have cystic, extremely severe acne, I do not know if my guide will help with cystic acne. If your acne is severe, I would definitely seek out a Dermatologist. I also had dry skin when I had my acne, and was in my late 20s when I developed it, just so that you have some background on my skin.
If you haven’t read them yet, here are my other acne posts that tie into this article:
Acne treatments that didn’t work
How I cured my adult hormonal acne
The pill to treat hormonal acne
How to prevent cosmetic acne
Acne is complicated, and for most people, several different things need to be done to get rid of it. This is why just using a Clearasil product, or even a system like Proactiv, is generally not effective.
Acne is caused by several factors:
2) Overproduction of oil by the oil gland
3) Irregular or excessive shedding of dead skin cells – on the surface of the skin, and inside the pore
4) A buildup of bacteria in the pore
5) Some cosmetics, and ironically some skin care and acne products themselves, if they contain pore-clogging ingredients
6) Less common – certain medications, or a sensitivity to skin care products, or certain foods
To get rid of acne, you need to: control hormonal activity and oil production, exfoliate the skin and pores, kill the bacteria that causes the infection, and eliminate factors that make acne worse (like pore-clogging skin care products).
Systemic – treat your whole body
I believe in treating acne not only on the surface of your skin, but systemically (treating your whole body, from the inside out).
You always hear that food doesn’t cause acne, and that’s true in a basic sense (you will not breakout just because you eat a chocolate bar), but eating a bad diet can absolutely make acne worse. A lot of foods are not good for you, and they cause inflammation in the body, and this inflammation makes acne worse. I will write more about this in future posts. In short, you should cut back a lot on processed or fried foods, sugar, and simple carbs like white bread, for example. As the saying goes – garbage in, garbage out. Eating foods high in antioxidants, and high in nutrients will help keep inflammation down. An excessive amount of iodine can make acne worse, so avoid foods high in iodine (sea kelp, shellfish are a few), and know that iodine pills can worsen acne. Smoking can also make acne worse.
Oral antibiotics can reduce bacteria, thus helping to eliminate pimples, however it’s not safe to be on antibiotics for a long time. I was on antibiotics for acne, and it did help, however this is a short-term solution. It will only get rid of your acne while you are on it, and you can build up a resistance to antibiotics, or incur side effects like yeast infections.
• Birth Control Pills
For women, I believe birth control pills can work wonders for acne. Low androgen pills, like Yasmin, or Ortho Tri-Cyclen, reduce oil production. I have had great success with Yasmin, and plan to remain on it for the long-term to control my acne. You need to research the side effects of birth control pills, though, because the side effects (such as hair loss) can be severe. I do worry that long-term use of the pill can be harmful, but at this point I personally find the benefits outweigh the negatives. Be careful about pills that are high in androgens, because they can make acne worse.
Accutane is a prescription pill that is used for severe acne, and it can eliminate acne for most people. The results aren’t always permanent, though, so it may only work for a few years. The side effects can be extreme, so I personally wouldn’t go on Accutane until I’ve exhausted other options. Talk with your Dermatologist, and make sure you extensively research Accutane before you go on it. You will need monthly blood tests, and cannot get pregnant while taking it. It is most likely the best treatment for severe, cystic acne, though.
Topical skin care treatments for acne
The first rule of skin care is to be gentle and do not do harm to your skin. Use lukewarm water (not hot, or super cold, and no ice cubes). If you have acne, you may think you need something harsh to get rid of acne, but that is not true!
• Avoid irritating products
Say NO to products that contain SD alcohol, Alcohol Denat, Isopropyl Alcohol, and Menthol. A lot of products can irritate your skin, causing inflammation, and worsening acne. Reference my list of irritating and pore-clogging product ingredients. Guess what – most toners contain these bad ingredients! I cannot begin to tell you how MAD I am at skin care companies that sell products that make acne worse! It really is upsetting, because not only do you waste your money and not help your acne, but you make it worse. These ingredients may feel good on your skin, or feel like they are working because your skin burns, but they are hurting your skin!
• Prevent cosmetic acne
You may be shocked to discover most skin care products (including ones to treat acne), and a lot of cosmetics, can clog your pores!!! How can you get rid of acne when the very products you use make it worse?? Again, I get LIVID when I look at the ingredients of some acne skin care products at the store. I believe skin care products for acne should do no harm (like the “do no harm” oath doctors take). When I was researching product ingredients during my struggle to cure my acne, I discovered almost every product I owned had ingredients on my pore clogging list. Just eliminating bad products can make a huge difference in your skin. It may seem like a pain to take the list with you to the store, or read about product ingredients online before you shop, but it’s worth it!
I don’t care what a product label says – all natural, won’t clog pores, Dermatologist tested, oil-free, non-comedogenic, for acne – those words mean nothing! You must read the ingredients of a product, and make sure it doesn’t contain pore clogging ingredients! Also stay away from bar soaps because they can clog pores.
• Exfoliation – on the surface of your skin, and from inside the pore
Exfoliation is a must if you have acne. You want to keep the outer layer of your skin as smooth as possible, so that there is nothing clogging your pores externally.
- Physical exfoliants
I use a soft washcloth, and GENTLY rub it to dry and exfoliate my face morning and night. I have a big stack of cheap washcloths, and use a different one each day to prevent bacteria from building on it. If you have acne, you don’t want to use products that have harsh physical exfoliants (like scrubs with seed kernels in it) because that will irritate your skin and acne, and can cause bacteria to spread. Even scrubs with little beads may be too harsh and can aggravate acne.
A physical exfoliating scrub I’ve had great success with is Philosophy Microdelivery Peel. You can use it twice a week to gently dissolve the top layer of your skin, and it has Vitamin C crystals that gently slough off dead skin. By keeping your skin exfoliated, products can also penetrate your pores better.
- Chemical exfoliants
2% Salicylic Acid is a gentle chemical exfoliant that penetrates your pores to clean them from the inside out. You want to make sure the product you use is pH balanced properly, or the Salicylic Acid won’t be effective. I recommend Paula’s Choice 2% Beta Hydroxy Acid Gel. It also comes in a lotion and liquid form. Aside from buying pH strips (like you use in Science class), there’s no way to know if a product has the correct pH, which is why I use Paula’s Choice, since she says hers is between the correct pH of 3 to 4. You don’t want to use Salicylic Acid if you are allergic to aspirin. If that’s the case, you can use an 8% or 10% Glycolic Acid instead.
• Improve cell turnover and production
Another crucial step toward curing your acne is to use a Retinoid-based product. Retinoids cause your skin to “shed” faster, and they promote healthy cell growth, which can unclog pores. I personally use the prescription Differin, but Retin-A Micro or Tazorac can be good options as well. Differin Gel has caused me no side effects at all, which is why I like it. I haven’t tried Tazorac, and Retin-A Micro can cause a lot of initial peeling, but that should taper off after regular use. I strongly urge you to talk to your Dermatologist about getting one of these prescriptions. You want to stay away from the regular Retin-A or Renova, because they contain pore clogging ingredients.
If you don’t want to see a Dermatologist, you can try a strong over-the-counter Retinol. I would recommend TxSystems Afirm. It comes in three strengths, and if you don’t have extremely sensitive skin, you can try the 3x strength, or work your way up from the lower strength versions. Your skin will probably initially peel a bit from this, but that should go away in a week or two of regular use. There are some other good Retinol-based products out there, but a lot of products with Retinol contain a very small amount of it, which isn’t going to do much.
• Kill bacteria
Benzoyl Peroxide, which is what’s in Proactiv, Clearasil, and a host of other acne products, will help kill the bacteria on your skin, and it has the ability to penetrate into your pores. A 2.5% Benzoyl Peroxide product is usually fine and causes minimal irritation. There are 5% and 10% options, but they can sometimes cause irritation, which isn’t good for acne. I use Paula’s Choice Blemish Fighting Solution. You only need to apply the product where you have acne, and there’s no need to apply it to your nose if you only have blackheads, since it doesn’t work on blackheads.
There are additional prescription antibiotic topical products that kill bacteria, which can be used by themselves, or with Benzoyl Peroxide. Long-term use isn’t recommended, though, because you can develop a resistance to antibiotics. Tetracycline, Clindamycin, and Erythromycin are popular prescription topicals. I didn’t need a prescription topical antibiotic once I followed my self-designed “acne cure.”
• Hydrate skin if you have dry skin
If you have oily skin, your skin may not need additional moisturizers to keep it hydrated. The goal with treating acne is to not overly dry it out with bad products, and then need to artificially moisturize your skin. If you live in a dry climate, or have dry skin and acne, then it is crucial to keep your skin hydrated, so that you can keep the outer skin barrier healthy. None of the products and steps I’ve mentioned should dry your skin out very much (except your initial uses of Retin-A Micro or a strong Retinol), but if you have naturally dry skin, a moisturizer is essential. I like Clinique Moisture On-line because it keeps my skin hydrated and plump, and it lasts for most of the day. If your skin isn’t super dry like mine, then any moisturizer that doesn’t contain pore clogging ingredients should be fine. Also drinking enough water will help keep you properly hydrated, which is good for your body as a whole.
• Tips for oily skin
As an adult I haven’t had oily skin, so I haven’t had first-hand experience with it. If you have oily skin that bothers you, you can use a clay mask twice a week to combat the oil. Just make sure it doesn’t have irritating ingredients in it. Paula Begoun also recommends doing a mask with Milk of Magnesia, which I haven’t tried, so I don’t know if it works. You buy plain Milk of Magnesia at the drugstore (it’s sold for upset stomachs), and apply it in a thin layer, wait for it to dry, and rinse it off. Also, there’s no need to use a moisturizer if you have oily skin. There are makeup primers you can use that can help absorb excess oil, and you can also blot throughout the day with a tissue or blotting paper.
• Use sunscreen
I recommend always using sunscreen, no matter what, and it’s especially important when you use products like Retinoids that make your skin more sensitive to the sun. People may think the sun helps with acne, but while it may in the short-term, it makes your skin way worse in the end. The sun inflames your skin, and remember inflammation is bad for your skin, and it of course causes wrinkles. Acne eventually comes back after sun exposure, so just say no to the sun! My favorite sunscreen – Shiseido Ultimate Sun Protection Cream For Face dries with a matte finish, and it doesn’t clog pores, so it can be a good option for oily or dry skin. Its main ingredient Zinc Oxide also has anti-inflammatory properties, so it can actually calm inflammation.
• Other acne tips
Change your pillowcase twice a week or more so that you aren’t putting your face on oiliness all night. Also wipe down your phone and cell phone at least once a week with a cleansing wipe to get rid of bacteria. Get in the habit of not touching your face, which can put bacteria on your face, or spread it. Don’t pick at your pimples, especially if they are red! I can’t tell you how many times I’ve picked at red pimples, and either got a tiny scar, or a red dot – which lasted for two years. When my acne was really inflamed, I used to take Advil, which is an anti-inflammatory. I don’t know if this really calms acne, so I pretty much took it on a hunch. Talk with your doctor before taking anti-inflammatory pain medication.
How to put all the steps to curing acne together to create a day-to-day plan:
-If you are female and are on the pill, but are on one that is high in androgens, talk with your doctor about switching to a low androgen/high estrogen pill. Read up on the pill (and its side effects) if you aren’t on it, but would consider taking it. I cannot give medical advice, but will just tell you the pill has made a tremendous difference in my skin, and I have not incurred any side effects from it. I do have hair loss problems, but have no definitive proof that it was caused by long-term use of the pill. The pill doesn’t work overnight, and there is a chance your skin can get slightly worse before it gets better. After two months you should see definite results, and it will take at least three months to see maximum results.
-Start thinking about what you eat every day, and realize that eating healthy will not only improve your skin, but it will improve your body as a whole. Read up on healthy eating and do your best to cut back on sugar, simple carbs, and processed food. If you smoke, consider stopping.
Here’s a sample daily skin care regimen:
-Wash with a gentle cleanser. For dry skin, I recommend Philosophy Purity Made Simple, and for oily or normal skin, I recommend Neutrogena Healthy Skin Anti-Wrinkle Anti-Blemish. These don’t contain pore clogging ingredients. The Neutrogena has Salicylic Acid in it, which is good, but because a cleanser only stays on your face for 30 seconds, I doubt the Salicylic Acid does much. Finding a cleanser that doesn’t clog pores, and that is gentle and cleanses well, but doesn’t strip your skin, is the most important factor. You can also use a soft washcloth to gently exfoliate and pat dry your skin.
-Apply Paula’s Choice 2% Beta Hydroxy Acid Gel (or your pH balanced 2% Salicylic Acid product of choice). Remember that you must find a product that doesn’t contain pore clogging or irritating ingredients.
-Let the Salicylic Acid dry, and then apply a thin layer of 2.5% Benzoyl Peroxide – Paula’s Choice Blemish Fighting Solution is my choice. If you choose another Benzoyl Peroxide, make sure it doesn’t contain pore clogging ingredients.
-If you have dry skin, apply a moisturizer (without pore clogging ingredients) like Clinique Moisture On-line, or Olay Regenerist Deep Hydration Regenerating Cream. Skip this step if you have oily skin.
-Apply a non-pore clogging sunscreen, such as Shiseido Ultimate Sun Protection Cream For Face.
-Apply your makeup as usual, and make sure you check all your makeup (even the powder) for pore clogging ingredients! I have great results with Maybelline Pure Makeup Shine-Free Foundation, and top that with Neutrogena Healthy Skin Pressed Powder. As a concealer, I use Maybelline Age Rewind Under Eye Concealer.
-Cleanse with the same cleanser you used in the morning, and use a soft washcloth to gently exfoliate as needed.
-Wait until your skin is completely dry, and apply your Retinoid (Differin, Tazorac, or Retin-A Micro) or Retinol (TxSystems Afirm) product. Talk with your Dermatologist, but initially you will build up to using the Retinoid nightly, but you may start out by using it every other night.
-Wait a few minutes, and if your skin is dry, apply a moisturizer like the Olay Regenerist from your morning routine. You don’t want to apply a moisturizer that has any “active ingredients” in it, so check the label.
Twice a week, at night:
-Use a gentle exfoliating treatment like Philosophy Microdelivery Peel after your cleanse, and before you apply your Retinoid product. Remember you must apply the Retinoid to dry skin. The first few weeks of using your Retinoid product, your skin may be too sensitive to use this peel, so skip it if that’s the case. If you are using Differin as your Retinoid, you might not have any skin sensitivity at all, so you may be able to use the peel right away. Just be gentle and massage the peel very lightly into your skin.
-If you have super oily skin, once or twice a week on nights you aren’t using the gentle exfoliating scrub, you can apply your non-pore clogging/non-irritating clay mask or Milk of Magnesia after you cleanse. I just noticed Paula Begoun has a Skin Balancing Carbon Mask. I haven’t tried it, but Paula makes a lot of good products, so it might be a good option.
-If you have super dry skin, Paula’s Choice Skin Recovery Hydrating Treatment Mask is a nice way to hydrate your skin once or twice a week.
If you give this whole routine a month and are not seeing any results, then you could consider an oral or topical antibiotic from your doctor. But remember that the results aren’t long-lasting with antibiotics, which is why I would avoid them if they aren’t needed. If your acne is severe and is not responding to this series of treatments, then you could consider Accutane, but again, this is a last resort. I realize not everyone will respond as well as I did to my routine, and I do believe the birth control pill (which not everyone will, or can take) is a big factor in my success in curing my acne. But just by eliminating all the bad products you may be using, and using the better products and ingredients I’ve recommended, I think you should see real results. A note on blackheads: Unfortunately, I have not been able to get rid of them. Even though Salicylic Acid and Retinoids should help with them, I still have them on my nose. When I find a way to get rid of them, you will be the first to know! If you want, I can compile a bigger list of possible product choices. I recommend the ones I do because I have personally tried them and have had great success with them.