In our first newsletter of 2023, we'll discuss the answer to a question that I get asked more and more often: "Can you help my son or daughter with their acne?" With two young adults of my own, this topic is near and dear to me, and the answer is "yes". The demand for effective treatment options is ever apparent right now.
Not all acne cases are the same for sure, but there are some things you and your children can do to establish good habits and "exhaust all options" before going down the path of antibiotic prescriptions and Accutane. Sometimes those medications are necessary; however, you want to be sure you are using something other than products that are working against your goal of clear skin.
Now, I will pretend I'm consulting with a teenager. These are the 3 steps I follow through the course of a typical conversation:
- Let's take an inventory of the products you currently use on your face.
Go through the list of ingredients in each product (if not available, we Google it) and make sure all the products are FREE of the following: benzoyl peroxide (too drying), mineral oil, petroleum, shea butter, cocoa butter, nut butters in general, and sweet almond oil - all of these can cause acne.
Below are EXAMPLES of some products with ingredients you should NOT be using so you can see how prevalent they are:
-Clinique Dramatically Different Moisturizing Lotion (mineral oil)
-LaMer (petroleum) Buttah (shea butter)
-Cetaphil Advanced Relief Lotion (shea butter)
-AmLactin – (mineral oil)
-Winlevi – a prescription androgen receptor inhibitor that actually causes acne because it contains mineral oil!
You would be surprised by the number of teens and young adults I talk to that are using one of these products! It is worth the effort to take a deep dive into your current products' ingredients.
BevTip: Benzoyl peroxide is too drying, leading your skin to increase its oil production to counteract the dryness; you can end up with some pretty cystic bumps underneath a thicker dry, dead skin layer. It's like your skin is playing tug-of-war with oily and dry. Not a good way to calm down your skin.
- Next, I ask, "Are you committed to 2X daily cleansing the skin, treating, moisturizing, and using sunscreen? (Buy-in is required for success.) If so, start slowly and build a routine that works for you.
- Based on their skin type and the information gathered, we work towards a routine, starting with creating good habits early on, resulting in more normalized, healthy skin.
Favorite cleansers:
For oily skin with acne, I prefer those containing glycolic and salicylic acid, as well as scrubs containing these same ingredients. For dry skin with acne, I recommend soothing antioxidant (green tea, for example) cleansers.
Favorite "treatment" ingredients:
Salicylic acid - effective at removing excess oil; gently exfoliates to keep fresh, healthy skin on the surface; and keeps pores clear of dead skin cells and oil that cause clogs.
Glycolic acid - low pH glycolic kills p.acnes bacteria cells by rupturing the membrane; a great exfoliant of dead skin cells clears excess oils and debris, softens the look of acne scars, and balances moisture in the skin.
Lactic Acid - a great exfoliant of dead skin cells.
Retinols and/or tretinoin prescription - help reduce pore size and increases skin cell production and turnover. They do not penetrate the sebaceous glands, so they do not affect sebum production.
Favorite moisturizers:
Some favorites are oil-free moisturizers that contain helpful, calming ingredients, such as green tea and niacinamide. Heavy moisturizing creams can lead to clogged pores in oily skin types. Oily skin may not need this extra hydration because it makes its own moisturizer. Skipping this step and using a treatment serum geared toward lightening skin or other anti-aging concerns is sufficient.
BevResearch: A double-blind, placebo-controlled study of 100 subjects revealed topical 2% niacinamide significantly lowered sebum excretion rates after two and four weeks of use. One small study with 22 patients applying a 3% green tea emulsion for eight weeks saw a significant reduction in sebum production compared to baseline.
Favorite sunscreens:
100% physical mineral (ZINC - not mineral oil) sunscreens may help to manage sebum production and reduce inflammation; it does not have to be formulated in oil. However, chemical sunscreen ingredients require an oil component. Mineral sunscreens are best for UVA AND UVB protection, work well for after-school sports (don't sting the eyes), and establish healthy habits for life.
A GOOD SKINCARE REGIMEN FOR ACNE MIGHT LOOK SOMETHING LIKE THIS:
Morning
- Cleanse with a soothing antioxidant cleanser, our Gly/Sal cleanser, and/or our AHA/BHA Exfoliating Scrub.
- EltaMD Skin Recovery Toner (optional)
- Use one of the Clear Skin Acne Correction Pads over the entire face, chest, or back area (wherever there is acne)
- Apply Elite Ultra Light Facial Moisturizer followed by a 10% Glycolic Acid Cream (other strengths are also available)
- Finally, use the ISDIN Actinica untinted mineral sunscreen or a tinted mineral sunscreen ISDIN Ageless, Suntegrity 5-and-1, or EltaMD UV40 Restore
- Cleanse with a soothing antioxidant cleanser, our Gly/Sal cleanser, and/or our AHA/BHA Exfoliating Scrub.
- EltaMD Skin Recovery Toner (optional)
- Apply Blemish Correcting Serum w/salicylic acid
- EltaMD PM Therapy with 5% niacinamide
- Finally, use a Retinol 1.0 or prescription tretinoin 0.025% or 0.05%
This routine can appear daunting and be too long for many to start with, and that's ok. Begin at a slower pace and incorporate products as you like them. This approach is beneficial because the routine becomes your own. The above guidance is meant as an example of how to use the products and an order of application.
At the same time, this is not an exhaustive list. Other ingredients can help control p.acnes bacteria, such as oxygen and stem cells, depending on what other factors may present (rosacea, extreme dryness, etc.). A full list of products suitable for acne-prone skin can be referenced on my website.
What if we need to be more successful at controlling the acne?
This sometimes happens (usually very cystic "grade 3" or higher acne). Increased sebum production is one of the causes of acne, which is under androgen control. Acne subjects have significantly greater sebum production than subjects without acne, and this relates to acne severity. After months on a routine, if it is determined that progress is not satisfactory enough - sebum production needs to be reduced. I will then refer you to your dermatologist to discuss other options.
Note that oral spironolactone and other hormonal medications, such as oral contraceptives, can affect sebum secretion. The most potent oral medication to decrease sebum production is isotretinoin, a prescription form of vitamin A (formerly brand-named Accutane). Isotretinoin must be used under a doctor's supervision.
You can still continue your good skincare habits and treatments while incorporating your doctor's recommendations. By then, you will have already learned so much about safe products and those to look out for. You will have made tremendous strides toward repairing your skin's barrier, increasing cellular turnover rate, and making it healthier and less susceptible to acne.
For a printable version of this blog post, click here (PDF).