Acne
What is acne?
There are 2 main types of acne: pimples/cysts (inflammatory acne) and blackheads/whiteheads (comedonal acne). Most people have both types, so to get the best results, most people need to treat both types. But, the acne aisle at the store is overwhelming with hundreds of options. So, what do you buy? First, price ≠ results. Just because it is more expensive doesn’t mean it works better. The most expensive routines often have the exact same active ingredients as the store brands.
How do I treat acne?
Most people with acne will benefit from a simple two-step treatment plan:
Adapalene gel (Differin, Effaclar, AcneFree, ProActiv) – this needed a prescription 10 years ago but is now over-the-counter. It works well for comedones (blackheads/whiteheads). It is the best over-the-counter option to help shrink pores. Use it at bedtime. See instructions below.
Medicated acne wash – I recommend benzoyl peroxide (BP) or azelaic acid over other options, and I prefer a liquid wash used in the shower to simplify your skincare routine. Most skincare companies make a BP product, and some are very expensive, but remember: higher price ≠ better results. Also, higher percent products (10%) dry you out more without extra benefit, so stay below 5% BP.
My favorite medicated acne wash right now is CeraVe Acne Foaming Cream Cleanser (4% BP). I also like AcneFree’s 2.5% wash. Azelaic acid appears to be the safest ingredient for acne in pregnant women but helps teens as well. My favorite option here is The Ordinary’s azelaic acid suspension or azelaic acid cream. Salicylic acid is fine, but, in head-to-head studies, benzoyl peroxide worked better than salicylic acid. See instructions below.
Additional tips:
Clinique’s Redness Solutions base is excellent for decreasing the redness of acne while waiting for the acne to clear. I find it works better than the acne cover-up patches.
Reduce stress: Acne gets worse with stress. This site has lots of simple, helpful tips for reducing stress. When you have a big deadline at school or work, a relationship issue, or an illness or death, expect your acne to break out. If you know a stressful event is coming up, start treating your problem areas before they flare.
Eat healthier: When people with acne eat poorly (fast food, junk food), their acne flares. Often we eat worse when we are stressed. A good way to improve acne and reduce flares is to switch as many meals as you can to whole-food, plant-based options.
At bedtime, dab the adapalene gel on the outside of your face (forehead, sideburns, chin). Massage it into the outside of your face first. Then, with the tiny bit left on your fingers, massage it over and around the nose, cheeks, and lips (these are more sensitive areas to peeling and redness).
NOTE: This will dry you out. It dries everyone out! The goal is to minimize the red and flaky skin until your skin gets used to the adapalene after a few weeks.
WARNING: Adapalene gel should not be used if you are pregnant. It is a retinoid, and retinoids can cause problems to growing babies in the womb.
Right after applying adapalene gel, apply a lot of moisturizing cream or ointment. My favorites are CeraVe cream, Vanicream cream, or straight Vaseline (#SlugLife). Put a thick layer of cream on, and it will soak into your skin more while you sleep.
NOTE: It takes a month to see results, so you have to stick with it for at least 30 days! As a side benefit, adapalene is in the retinoid family, which are the best anti-aging ingredients.
Steps for using a medicated acne wash:
Once you get into the shower, rinse your face (and chest and back, if you have acne there).
Apply the benzoyl peroxide wash and leave it on for at least 5-10 minutes for the medication to soak into your skin before rinsing off.
Benzoyl peroxide wash or azelaic acid wash can be used once or twice a day as your face wash. You do not need another face wash. Avoid exfoliating face washes.
NOTE: Benzoyl peroxide will dry you out. Apply lots of moisturizing cream to fight the dryness until your skin gets used to the benzoyl peroxide and your acne starts to improve after a few weeks. Also, benzoyl peroxide can bleach towels and clothing.
My face is peeling with adapalene. What do I do?
This is very common. Many people tell me that their skin is too sensitive for adapalene or that it made their skin peel. The right way to use adapalene is NOT how we naturally want to use it. Most people use too much adapalene or only put it on their problem areas.
Adapalene does NOT fix any acne you already have on your face. It is preventative. It helps new skin grow more evenly so you have fewer newer spots, AND it takes a full month for your skin to grow out from the base layer, so it takes a full month to start seeing the results.
The problem is that adapalene starts making the skin dry and red right away, and you have to deal with this for a full month before you see any benefits. This first month is when most people give up and tell me that adapalene doesn’t work for them.
TIPS for proper adapalene use:
Don’t use too much. A pea-size amount is enough for the whole face. Follow the steps above.
Start on the outside of your face, not the center. If your skin is peeling at your hairline, it is much less bothersome than around your nose and lips.
Moisturize! You cannot over-moisturize. Fight the dryness and peeling until your skin gets used to the adapalene.
Stick with it! You need to do this every night for a month to see the benefits. And the benefits are great! It shrinks your pores, makes acne better, and helps with aging!
If you can’t do it every night, then apply it every other night. Just be consistent!
What if my acne isn’t getting better?
Usually, the steps above can help most people get their acne better. Sometimes prescription creams or pills are needed, especially if there is scarring. For severe acne or scarring acne, sometimes isotretinoin (known as Accutane) is the best option. If over-the-counter options are not working, look for a board-certified dermatologist in your area. If you are in or near Utah, see me virtually with Honeydew or one of my excellent colleagues at the University of Utah.
DISCLAIMER
The statements expressed and content of this website are not intended to be a substitute for professional medical advice. Readers should seek their own professional counsel for any medical condition or before starting or altering any treatment, exercise, or dietary plan. Please see our full disclaimer here.