Let's talk about acne

Acne facts

I focus a lot on acne as it is a very personal topic for me. In the past, I made many mistakes in my acne fighting journey. I consistently followed all instructions that I received from dermatologists, estheticians, and random people from the Internet. This was not the right approach. I was driven by hope, not knowledge. Over time I started to distinguish facts from nonsense. I created a clear structured knowledge. Let’s look what the acne facts are:

  • Acne is a skin disease, meaning that, despite many claims, its treatment will need a focus on skin in the first place
  • Acne is a chronic condition that has no cure, however a regular, correct and consistent skincare routine can bring significant results
  • The cause of acne remains unknown
  • Acne is a multifactorial skin disease
  • Acne is not caused by toxins in the body!
Acne formation

Also known as acne vulgaris, acne has four factors that usually happen simultaneously:

1. Increased sebum production - linked to hormonal factors

2. Hyperkeratization - the inability of skin to naturally peel off dead skin cells. This has two negative impacts:

  • Dead skin cells clog pores
  • They create a crust layer over time over the skin's surface, preventing topical products from penetrating the skin

3. Overpopulation of bacteria C. acnes (Cutibacterium acnes. Previously known as Propionibacterium acnes) - this bacteria is naturally present in our skin, but can overpopulate in favorable conditions and is directly linked to acne vulgaris

4. Inflammation - the response of our immune system that results in red, painful bumps on our skin

Another indirect factor, yet still important fact, is that acne-prone skin naturally has higher pH level.

Knowing all the above, we can now focus on a topical skincare routine that eliminates these aforementioned factors.

In summary with acne-prone skin we need to target:

  • Sebum
  • Built-up dead cells inside pores and on the surface
  • Bacteria that cause acne
  • Inflammation
  • High skin pH

Now we can finally move to the specific products. I'll repeat that acne is a multifactorial disease requiring complex approach. There's no single product that can clear acne. I'll mention again that consistency and patience are key.

Sebum

In terms of sebum, we have two main goals:

  1. Dissolve excessive sebum from our pores - we should focus on oil solvable components as oil dissolves oil. The most common ingredients helping with sebum are derivatives of vitamin A (retinol, retinaldehyde or prescription retinoids such as adapalene and tretinoin) and salicylic acid (known as BHA, or betahydroxy acid)
  2. Decrease sebum production by inhibiting enzymes affecting the function of testosterone. The most common enzyme to target is named 5-alpha reductase. Ingredients that help to decrease sebum production are retinoids again, niacinamide, and azelaic acid

Dead cells

As previously mentioned, the problem with dead cells is that they clog our pores and build up on skin surfaces, thus making it impossible for our skin barrier to function properly.

  1. To target dead cells in the pores we again have to use products with oil soluable ingredients - retinoids and salicylic acid.
  2. To make sure that excess dead cells do not build up on our skin, we need to use products that increase epidermal cell turnover and thus help to peel off from the surface – again retinoids and AHA (alpha hydroxy acids): the most common acids are glycolic, mandelic, lactic. Other types of exfoliating products are: enzymatic peelings (extracts of papaya, pineapple, pumpkin).

Bacteria

Bacteria that cause acne is known as C. acnes bacteria (formerly P. acnes) - in case of their overpopulation, we need to use products that target them. Several known ingredients include benzoyl peroxide, sulfur, azelaic acid, and tea tree oil.

Inflammation

The result of the response of our immune system that causes red bumps on skin. Anti-inflammatory ingredients are azelaic acid, sulfur, salicylic acid. Furthermore cooling down affected areas is helpful and brings extra relief.

High pH

Typical for acne prone skin. Ingredients that can help to balance pH are alphahydroxy acids

Ready to give your face the treat it deserves?

Common acne myths and bad advice

✗ Acne is toxic, detoxification will help

✓ Puss caused by acne is only sebum, dead skin cells and bacteria — all three of which have to be targeted. Every element naturally occurs in our skin, but builds up due to a disfunction of natural processes.

✗ Food causes acne

✓ In actuality, the cause of acne remains unknown. Main factors that promote acne are the overproduction of sebum in pores, built-up dead skin cells, and the overpopulation of C. Acnes bacteria. Some types of food found to be acne flare triggers include: skim milk, whey protein, food with high glutamic index, sweets.

✗ Acne can be spread

✓ It cannot, neither on your own skin nor to other persons.

✗ Acne comes from the inside - there's a certain association between gut and skin microbiome

✓ The connection remains unknown due to complexity and is still the subject of research. Our skin is part of a triangle that is believed to have a strong connection with each other: skin, gut, and brain. In general, we should have healthier eating habits and take care of our mental health. Stress is one of the strongest acne triggers. An anxious controlling of one’s diet leads to more stress and can cause serious conditions such as anorexia nervosa. Another negative effect is the so-called clean eating disorder (orthorexia), characterized by an extremely restrictive diet and thus causes a lack of essential nutrients, minerals and vitamins, which l add worsens our overall health, including skin.

✗ Acne is dirty

✓ It's not. Read more in "Acne is toxic."

✗ Drink more water

✓ We should keep ourselves hydrated, but not excessively. Water won't clear acne but will positively contribute to our overall health."

✗ Cleanse more

✓ We shouldn't cleanse our skin more than twice a day in order to not disrupt our natural skin barrier. An evening cleanse is more important than in the morning.

✗ Get sunlight

✓ One of the oldest and worst pieces of advice. In fact, the sun is quite unhealhy for one's skin, especially for acne-prone skin. Due to sun exposure, sebum oxidizes and becomes thicker, clogging pores even more. Sunlight causes a decrease of our skin's immune system and promotes inflammation, making it easier for bacteria to overpopulate. Our skin barrier becomes much weaker over time.

✗ Use products to dry out acne

✓ The main and only approach until the late 1990s. Thankfully our knowledge of skin has tremendously grown in the past 25 years. Contemporary focuses for acne treatments usually include maintaining a healthy skin barrier function and the use of ingredients that have proved to work for acne locally.

✗ Don't see a dermatologist, it will go away on its own

✓ Try to find a good specialist as soon as acne starts. It'll help to set up the right routine and treatments from the very beginning and might prevent acne turning into a chronic condition.

✗ If you see an esthetician, you don't need a dermatologist

✓ Mild and medium acne outbreaks may not require a dermatologist's intervention. However persistent acne and severe conditions require the attention of a dermatologist, as they can prescribe stronger drugs that, in combination with a correct daily routine, will significantly improve one's skin.

✗ Acne only affects teenagers

✓ Older adults are also affected by acne. It's either an undertreated condition from our teenage years or a condition that occurs in adult life due to hormonal or environmental factors.

✗ Dairy causes acne

✓ This association was only made with skim milk and whey protein. Fermented dairy products are recommended. In case of a skin reaction to dairy products, it's recommended to have blood tests done to detemine lactose intolerance or for allergies. If acne occurs only after consuming dairy, it's not acne. One pimple here and there is not acne either.

✗ Sugar causes acne

✓ Sugar can act as a trigger for some people, but if we are talking about one or two pimples, it's not acne.

✗ Fat food causes acne

✓ It doesn't. It definitely doesn't make skin oilier either. Sebum production is directly linked to hormones.

✗ Fast food causes acne

✓ In general no, yet it depends on the regularity of consumption and the type of food. Pimples here and there, again, do not constitute acne.

✗ Only natural/DYI products can help clear acne

✓ It'll unlikely help and most probably will make things worse (allergic reaction, surface irritation, etc.).

✗ Once your skin is clear, you can stop using acne products

✓ Acne, in most cases, is a chronic condition. The use of acne products must be long term and consistent. Acne might improve and eventually go away due to hormonal changes as we age.

✗ Acne-prone skin doesn't need a moisturizer

✓ It doesn't need moisturizers rich in emollients and occlusives, but products rich in humectants (glycerin, hyaluronic acid) are a must as acne-prone skin is generally more dehydrated due to a damaged skin barrier.

✗ Don't use makeup, it clogs pores

✓ Today there are many oil free options available on the beauty and cosmetics market created specifically for acne-prone skin. Finding the right product is crucial, however. Facial products can provide additional protection from environmental pollution and many products have ingredients that are good for acne-prone skin (salicylic acid, niacinamide). A very important aspect that shouldn't be ignored is that covering pimples can provide psychological relief, especially among members of the young generation, who face stigma and misinformation on a daily basis.

✗ Only use professional/medical grade skincare products

✓ There's simply no such thing. All topical products are classified in two categories: cosmetics and drugs (that either require prescription or not). Concentrations of active ingredients are strictly regulated. Professional brands can't claim they use higher concentration of actives than what is allowed because this would be illegal. No cosmetic brand can make a drug claim either (e.g. our product will cure your acne).