Acne 101

MY FACE IS A DISASTER, WHAT DO I DO

I was pretty lucky, I guess : I never had really dire cystic acne growing up. But I always had minor breakouts, and I always had congested and oily skin. I figured this would slack off with hormonal shifts in my twenties, right? “Nope.” Thirties? “Nope.” FUCKING FORTIES? “Lol.” At appx 43, my skin went completely haywire. I started reading a lot (a loooooottttt) of stuff about acne causes and prevention, and I tried a crap ton of different things. Please note that I am not a dermatologist, and I am by no means an expert. I’ve just had a lot of informative failures, and (finally) a few successes, which I shall share. Some of this may be “OH DUH?”-level for you, but a little refresher course never hurt, right? Also, note that this is going to be a “living document” — if I do additional research and learn something new, I’ll add it. If I find a new product in a particular category that I prefer, I’ll make a note of it. Science! Woo!

WHAT CAUSES ACNE AND BREAKOUTS?

Usually a confluence of contributing factors, like : buildup of skin gunk, keratin and un-shed skin cells. Buildup of oil and dirt. Genetics (some people are genetically predisposed, apparently). Hormones, particularly androgens like testosterone. Occlusive ingredients in skincare/makeup products, and/or ingredients you’re sensitive to. And, acne bacteria.

Just having oily skin will not give you acne. Having bacteria on your skin will not [necessarily] give you acne — your skin always has a ton of different bacteria on it, much of which is fine and healthy and necessary. So if you DO actually have acne, due to one or more contributing factors, where do you start?

CLEAN : Wash your face morning and night with a gentle non-stripping cleanser. Try ones that use more low-key surfactants rather than the usual sodium lauryl sulfate / sodium laureth sulfate (commonly referred to as SLS and SLeS). Totally stripping your skin of its natural oils won’t make it “overproduce” to compensate — your skin produces oil at its own rate, but it doesn’t actively work to keep oils at a certain level. But harsh cleansers CAN irritate your skin, which could aggravate breakouts and make them take longer to heal.

CLEAN : Wash your makeup brushes, sponges, puffs, applicators, washcloths, and any tools for skin-cleaning or product application that come in contact with your face. Dr Bronner’s castile liquid soap or bar soap (unscented) are inexpensive and effective. This means wash those items REGULARLY. If you use a brush for liquid face products like foundation or concealer, wash the brush EVERY SINGLE USE. Anything you use to wash your face with that can hold water (like a cotton or microfiber cloth or a sponge, not like a silicone scrubber) should be hung so that it can quickly and easily air-dry so as to discourage growth of mold or bacteria, and should also be washed regularly — like, every couple uses at least.

CLEAN : Linens. That means bath towels, face towels, sheets and pillowcases. If you’ve got two pillows in cases on your bed, that’s four clean pillow surfaces. I use each side of each pillow for a night or two then flip or swap them, and change my sheets every weekend. You wallow your face all over that fabric for eight hours a night! EW. Plus, oils and such from scalp and hair, as well as any [potentially heavy and occlusive!] hair products you’ve applied? You maybe don’t need that all over your face. Clean sheets are helpful AND they’re nice. Also, it’s never a bad idea to buy extra matching pillowcases whenever possible.

MAKEUP : Supposedly, many silicones and silicone derivatives are non-comedogenic. My face says “OH BULLSHIT” to that. Dimethicone seems to be fine (which is good, because it’s in the majority of moisturizers and sunscreens and foundations and serums and…) but actual silicone and some of its heavier variants — which are frequently in foundations, and almost always present in foundation primers or anything marketed as “pore-erasing” or “mattifying” — can give me absolutely horrifying zits.

So, if you’re trying to get your face under control, look at the ingredients in the makeup products you’re using. Skip the primer for a couple weeks, and try to find a foundation that doesn’t have silicone, or anything with “silic-“ or “silox-“ in its name really high in the ingredients list (common culprits : cyclomethicone, aka cyclopentasiloxane or cyclohexasiloxane). A lot of foundations are probably just fine — I think you typically find the heavier ‘cones in (ugh, of course) thicker high-coverage formulations and primers, but they’re also in the majority of K-beauty BB/CC creams I’ve looked at. And silicones might not even be problematic for you! But it’s fairly easy to eliminate them for a time,  and see if your skin improves.

TREATMENTS : The drugstore is full of them, as are Sephora and Ulta and your department store’s makeup section. None of the usual actives — salicylic acid, glycolic acid, benzoyl peroxide — did a damn thing for me, in any number of products and formulations ranging from Neutrogena to Mario Badescu to Dr Brandt. Salicylic serums and gels accomplished little to nothing that I could see, and benzoyl peroxide (in Persa Gel 10 form) made my breakouts appx ten times worse. Like, “a couple of small pimples on my cheek” turned into “huge cluster of 5 giant deep cysts that wouldn’t heal for a month.” That’s when I finally said “fuck this bullshit” and signed up for Curology.

Curology! Dot com! Neato! Upload pics of your skin, answer a brief questionnaire about your issues, and boom, you get a consult and a prescription from an actual medical professional. For twenty bucks a month, you get unlimited online consultations with your assigned doc, and a supply of prescription cream (one ounce shipped every three months, which is plenty). My initial scrip was niacinamide (which has anti-inflammatory properties and also decreases oil production), azelaic acid (anti-inflammatory, reduces keratin production, also has some effect on limiting the growth of acne bacteria specifically), and clindamycin (a topical antibiotic). It worked well, but I frequently got tiny breakouts under my jaw, on my neck, and even on my chest. Doc recommended we go to the Big Gun — tretinoin (same thing as Retin-A) — and while it gave me BEAUTIFUL results on my cheeks, it also gave me a raging case of dermatitis around my eyes and chin. Not “oh it’s dry and irritated” — I mean crusty, flaky, red, tender, with a billion tiny pimples or (ick) pustules? (And no, they were not milia.)

That shit continued to rage, even through a course of oral steroids (prednisone), and didn’t stop until I did “zero therapy” for a week or so. (Zero Therapy = leave it the hell alone. Wash with something gentle, or even just water, pat dry, NO TOPICALS. No ointments no creams no salves no treatments no actives. Like, the most basic moisturizer maybe, but just let it be. Incredibly, this actually works really well to calm down pissed-off skin.)

By this time, I’d been doing A LOT more reading. And I came to the conclusion that, screw it, I can get all kinds of OTC versions of niacinamide, and I found a topical 15% azelaic acid cream too (from Gigi, sold from Israel via eBay). So I started using those instead, and SURPRISE — great results, no prescription, costs less, AND I was no longer getting the weird little breakouts on my neck and chest, so I’m going to [unscientifically] assume those were a side effect of the clindamycin, which was also present in my prescriptions with tretinoin and probably aggravated tretinoin’s bad effects for me or vice-versa.

TL;DR Version : do you have stubborn acne or breakouts? Do all of the bullets above (CLEAN etc). Buy a niacinamide serum to help control oil — I’ve used Gia Naturals (about $16 on Amazon) and The Ordinary’s niacinamide + zinc ($6 plus shipping) and prefer the latter. (Gia is more of a lotion and feels moisturizing, but for day use, The Ordinary’s contains zinc and has better oil control/mattifying properties.) Buy an azelaic acid cream or serum — I’ve used the aforementioned Gigi ($30 w/shipping on eBay) and The Ordinary’s ($8 plus shipping) and prefer the former*.

*NOTE : According to good old Wikipedia (citing an actual study, mind you), azelaic acid needs to be applied at a 20% concentration to be effective against acne. However, I was getting GREAT results with the Gigi azelaic cream at 15%. Then I started using the 10% version from The Ordinary, and my face went absolutely bananas again. Even applying more or using it twice a day? Nope, CATASTROPHE ZITS all over my cheeks and chin. Switched back to the Gigi and it cleared right up. So either Ordinary’s concentration is too low and doubling the application amount is ineffective, or it’s got another ingredient my skin can’t tolerate — I suspect it’s the polysilicone-11. If the Gigi doesn’t work for you, or you want to try a 20%, Skinoren can be found on international retailers (including eBay) for about $15 an ounce. (UPDATE: I now prefer Skinoren. Stronger, lighter texture, no scent!)

SUPERSTARS

If this regimen doesn’t knock your skin into shape and you’d like to try a bigger gun without going the prescription route, Differin is now available over the counter, no prescription needed. Differin is a brand-name for adapalene, which is a retinoid (vitamin A derivative) similar to tretinoin, but it’s more stable, it’s as effective against acne in a much lower concentration than tretinoin requires, and it may be less likely to cause irritation. However, any anti-aging (improving texture and wrinkles) benefits haven’t yet been established in clinical trials, as they have with tretenoin. I haven’t yet tried Differin, because I’m still gun-shy about retinoids after my horrible tretinoin experience (even tho the clindamycin may be the culprit). But assuming clinical trials do show anti-aging benefits? Yep, I’ll probably give it a go. UPDATE : I tried Differin and it was absolutely useless. In fact, I think it made my skin slightly worse. Supposedly the prescription 3% is great, but the OTC 1% was a waste of 17 weeks of my life.

And lastly, the other thing you DEFINITELY NEED TO DO: Stop picking at your face. Seriously. I mean a tiny little surface pimple, okay. But the big deep cysts that you want to mess with because they’re hideous and also painful? NO TOUCH. Acne is bad enough, but the scarring is arguably worse, and a lot of the scarring comes from picking. Don’t pick!

This means that there’s one more thing YOU DEFINITELY NEED : hydrocolloidal bandages. They’re basically a self-adhesive bandage made of weird plastic-y gel that pulls unwanted liquid stuff out of skin. Originally used for burns and blisters and wounds to aid healing, but also AMAZING for zits. You can either buy large bandage-type ones from the drugstore and cut them up, OR you can buy actual ones made for pimples! These and these  are basically the same thing. Note that the little dots are much larger than necessary — for non-huge pimples, you can cut them in half.

Applied directly over pimple, these will absorb the nasty stuff out of it in six hours or so, or overnight (overnight is best). I wallow all over my face when I sleep, and I hardly ever have one come off. You can put them on after lotions and creams, just blot that tiny area with a tissue first to remove most of the surface moisture/emollients. You can also dab a tiny bit of powder on top after you apply it, to reduce any stickiness on the outer surface. These are legit amazing, and will take a big angry red zit down to a flat pinkish spot overnight. The only trick is that the pimple does need to be at or near the surface for it to work — so those deep still-forming cysts, you’ll have to wait until they’re surface-visible. MIRACLE STICKERS. They actually work, and they’ll prevent you from picking since they’re covering the spot and also because you feel like you’re Doing Something To It already.

OTHER OPTIONS : If you’ve tried all that and you’re still getting really troublesome breakouts : doctor. If you have the option, try to find one who specializes in acne or other skin conditions. You want a doc at this point because A) they can give you better input on what’s causing your breakouts on an internal level — diet, hormones, etc — and B) they can prescribe shit. You might want to first try eliminating things from your diet for at least a few weeks to see if that helps. Many people report great improvement just from removing sugar and/or dairy from their diet. I didn’t make a real attempt at this, because I need ginger snaps, and putting anything but half & half in my coffee is SACRILEGE. Also, cheeeeeeeeese.

What meds? Spironolactone may be an option for you — it’s a mild anti-androgen that can help decrease hormonal acne. Or, one of the seemingly infinite varieties of birth control pills (if you’ve got compatible plumbing) might fix you right up. Note that any/all medications can have side effects (mood shifts, libido changes, weight gain, increased frequency of urination, changes to blood pressure, etc, etc) so personally I prefer the topical route. I did try spiro for a while : I don’t think it had nearly as much effect as the topicals did for me, it made me have to pee a lot more often (extremely annoying, especially at night), and when I quit — very very gradually over the course of three months — I feel like I had more hair shedding than usual, though this could just be my own skewed perception and not true at all.

SHOPPIN'

Dermalogica Ultracalming Cleanser : lotiony and non-foaming, so it’s useless at removing makeup, but an excellent gentle morning cleanser, and definitely “calming” for skin that’s just been subjected to a hardcore treatment or acid.
Thank You Farmer Back to Pure foaming cleanser : gentle yet super effective (takes off makeup like WOOSH), non-stripping, sulfate-free. [heart emoji x 10]
Algenist Triple Action Micro Polish & Peel : glycolic acid, alguronic acid, fruit enzymes, tiny little smooth exfoliating crystals (not the evil plastic beads). UPDATE : I’ve been testing a LOT of exfoliants of all sorts!
Dermalogica Daily Microfoliant : spendy, but a little goes a lonnng way. Rice flour and salicylic scrubs and smooths gently.
Malin + Goetz SPF 30 moisturizer : I talked about this the other day. LOVE IT.
Algenist Anti-Aging Repairing Oil : “oils? I can use oils? really?” Fresh Seaberry oil broke me out. Josie Maran Argan Oil (and the light version) broke me out. Many, many others broke me out. But not this! Velvety smooth skin, A+ moisturizer, absorbs and doesn’t feel greasy, yum.
Squalane Oil : amazing. Super light, absorbs almost completely, works under foundation, my skin LOVES it.
Thank You Farmer True Water Deep Cream : when dry air or harsh treatments have made your face parched and flaky, oh boy does this stuff help like nothing else I’ve tried. Plush plump bouncy skin ALL DAY, no reactions, no breakouts.
Becca Evermatte primer : if you HAVE to use a primer, this one is pretty effective, with zero silicones.
Urban Decay All-Nighter setting spray : does help makeup last a bit longer, does not make my skin freak out.
Medca Acne Patches
Nexcare Acne Patches
The Ordinary 10% niacinamide + zinc : excellent for oil control and a bit of mattifying.
Gia Naturals 5% Niacinamide : more moisturizing/lotion-like than The Ordinary.
Gigi 15% Azelaic Acid cream : if you have acne and you only buy one thing mentioned in this article, azelaic acid for sure. Tho I now prefer …
Skinoren : It’s my ride-or-die. No single product I’ve tried has done more to keep my face clear(ish), without irritating my skin, being expensive, fighting with my makeup or other products, etc, etc. This stuff is about $20 including shipping from SolPharmacy in New Zealand, and it’s worth every cent.

Got a system? Fought your own battle with acne? Tell us what worked (or didn’t) for you!