The Best Acne Treatment Routine

Published:  08/14/2016

Who doesn't want beautiful glowing skin?  As a registered dietitian, I feel to eating a whole-food based, Mediterranean-style diet with lots of antioxidant rich plant foods, avoiding a lot of sugar and other high glycemic foods, and staying hydrated is the best way to make sure you're eating a healthy skin diet. 

For more on the diet-acne connection go here.

If you are eating a healthy diet and acne persists, there are a number of specific skin treatments to treat acne and give a boost of glowing good health to your skin.

Unfortunately, there are many people that suffer with constant breakouts of acne. Aggressive acne often requires aggressive measures. 

I developed an aggressive acne treatment routine for my teenage son who was troubled by his acne. I am not a dermatologist but my strong science, chemistry background and interest in proven ingredients in skin care products led me to do extensive scientific research on evidence-based ingredients in skin care products.

The ingredients used in a treatment routine consist of well-researched acne-fighting ingredients: salicylic acid, benzoyl peroxide, glycolic acid and retinol. In addition, I have researched the best, high-rated products and have links to them within this article so that you can duplicate the routine.

What Causes Acne

Acne occurs when the pores in the skin become clogged with oil, dead skin cells, and bacteria. Several factors contribute to the development of clogged pores and subsequent acne:

• Excess sebum production: Sebaceous glands in the skin produce an oily substance called sebum, which helps keep the skin moisturized. However, excessive sebum production can lead to oily skin, making it more prone to clogged pores.
• Dead skin cells: The skin naturally sheds dead skin cells, but sometimes they can accumulate and mix with sebum, forming a plug that blocks the pores.
• Bacterial overgrowth: Propionibacterium acnes (P. acnes) is a bacteria that normally resides on the skin. However, when pores are clogged, it can multiply and contribute to inflammation and acne formation.
• Hormonal changes: Hormonal fluctuations, particularly during puberty, menstrual cycles, or hormonal imbalances, can increase sebum production, leading to an increased likelihood of clogged pores and acne.
• Cosmetics and skincare products: Certain makeup, lotions, or skincare products that are comedogenic (pore-clogging) can contribute to the formation of clogged pores and acne.
• Environmental factors: Exposure to pollutants, humidity, and certain occupational hazards, such as working in a greasy or oily environment, can also contribute to clogged pores.
• Genetic factors: Some individuals may be genetically predisposed to produce more sebum or have a higher risk of developing clogged pores and acne.

To prevent and manage clogged pores and acne, it is important to follow a consistent skincare routine that includes gentle cleansing, exfoliation to remove dead skin cells, and the use of non-comedogenic products. 

Types of Acne

There are several types of acne, including:

Fungal acne (pityrosporum folliculitis): Fungal acne occurs when yeast builds up in your hair follicles. These can be itchy and inflamed.

Cystic acne: Cystic acne causes deep, pus-filled pimples and nodules. These can cause scars.

Hormonal acne: Hormonal acne affects adults who have an overproduction of sebum that clogs their pores.

Nodular acne: Nodular acne is a severe form of acne that causes pimples on the surface of your skin, and tender, nodular lumps under your skin.

All of these forms of acne can affect your self-esteem, and both cystic and nodular acne can lead to permanent skin damage in the form of scarring. A dermatogist can help you determine what type you have and prescribe treatement. 

Acne Fighting Morning Routine

1.       Wash your hands and dry with a clean towel. Everything that touches your face including your hands and towels must be clean and bacteria free.

2.       Wash with Benzoyl Peroxide Acne Treatment Cleanser 10% and dry with a clean towel. 

3.       Swab the skin with 5% Glycolic Acid and 2% Salicylic Acid Acne Treatment Pads. Wait until it air-dries.

4.       Apply a thin layer of Benzoyl Peroxide Acne Treatment Cream 2.5% - 5%. Carefully avoid the delicate area around the eyes. Do not rub. Just allow your fingers to glide over your skin, spreading it around and letting it absorb on its own.

5.       Apply additional medications, an oil-free sunscreen, a moisturizer or makeup after the cream has dried.

6.       Sunscreen MUST be applied liberally when using a Glycolic Acid product. 

Acne Fighting Night Routine

1.       Wash your hands and dry with a clean towel. Everything that touches your face including your hands and towels must be clean and bacteria free.

2.       Wash with 2% Glycolic Acid/ 2% Salicylic Acid Cleanser and dry with a clean towel. If you need a stronger formula try a 10% Glycolic/2% Salicylic Cleanser.

3.       Swab the skin with 2% Glycolic Acid and 2% Salicylic Acid Acne Treatment Pads and wait until it air-dries.

4.       Apply a thin layer of a Retin-A or Retinol Cream. Carefully avoid the delicate area around the eyes. Do not rub. Just allow your fingers to glide over your skin, spreading it around and letting it absorb on its own.

5.       After putting on Retin-A or Retinol Cream wait 15 minutes before moisturizer to let it absorb.

6.       Apply additional medications, an oil-free sunscreen, a moisturizer or makeup after the cream has dried.

Try This If Your Skin Gets Too Dry

Discontinue the routine and only use a mild cleanser to wash and apply an oil-free moisturizer.

Once your skin has returned to normal, a mild cleanser, pads and cream (steps 2, 3 and 4) only once every other day and use a mild soap and moisturizer the other times you cleanse.

If no dryness develops, increase to once a day for steps 2, 3 and 4. If your skin remains free from dryness, you can go back to the routine twice a day.

If your skin ever becomes too dry, go through this process again until it normalizes, then resume again.

If you are unable to tolerate the products every other day then stop using the pads since they are the most drying. Use the cleanser and cream every other day as above and advance to once a day then twice a day as tolerated. You may be able to tolerate the pads in your tough oily areas of the forehead and around the nose and mid chin. The cheeks and jaw line are often more sensitive.

General Acne Skin Care Routine Guidelines

It’s always a good idea to consult with a dermatologist or skincare professional for personalized advice and recommendations based on your specific skin type and concerns. 

Here are the general skin care routine guidelines that can help in treating acne: 

1. Cleansing:

• Use a cleanser suitable for acne-prone skin.
• Wash your face twice daily, morning and evening, and after sweating.
• Avoid scrubbing your face aggressively, as it can irritate the skin and worsen acne.
• Always wash your face with clean hands, a clean, soft washcloth and a clean face towel to dry. Dirty hands or a dirty towel can introduce bacteria to your skin. 

2. Exfoliation:

• Include exfoliation in your routine 2-3 times a week to remove dead skin cells.
• Choose an exfoliant with ingredients like salicylic acid or glycolic acid, which can help unclog pores.
• Before applying a new product to your entire face, perform a patch test on a small area of skin to check for any adverse reactions or sensitivities.
• If you experience excessive dryness, redness, or irritation, discontinue use of the product and consult with a dermatologist.

3. Spot Treatment:

• Apply a targeted spot treatment containing benzoyl peroxide or salicylic acid to individual acne lesions.
• Follow the instructions provided and avoid applying it to unaffected areas of the skin.

4. Moisturizing:

• Use a non-comedogenic moisturizer to keep your skin hydrated without clogging pores.
• Look for oil-free or water-based formulations.

5. Sun Protection:

• Apply a broad-spectrum sunscreen with an SPF of 30 or higher daily, even if it's cloudy.
• Choose for oil-free, non-comedogenic sunscreens to prevent pore blockage.

6. Avoid Touching:

• Refrain from picking or popping acne lesions, as it can lead to scarring and worsen inflammation.
• Keep your hands away from your face to minimize the transfer of bacteria and oil.

7. Lifestyle Factors:

• Maintain a healthy lifestyle with a balanced diet, regular exercise, and sufficient sleep. 
• Manage stress levels, as stress can aggravate acne.

8. Makeup:

• Use non-comedogenic and oil-free makeup products labeled as "acne-friendly."
• Cleanse your face thoroughly to remove makeup before going to bed.

9. Shampoo regularly.

• The oil from your hair can cause acne on your forehead. If you have oily hair, shampoo more often than you do now and keep your hair away from your face.

Remember, consistency is key when it comes to skincare. It may take time to see improvements, so be patient and give your skin time to adjust. If over-the-counter treatments don't yield satisfactory results, consult a dermatologist who can provide personalized recommendations and prescribe suitable medications, if necessary.

A Word About Sunscreens

Using glycolic acid and/or retinol can increase sun sensitivity, so it's crucial to use sunscreen daily and limit sun exposure while using these products.

The best type of sunscreen to use depends on your individual needs and preferences. Here are some factors to consider when choosing a sunscreen:

Broad-spectrum protection: Look for a sunscreen labeled as "broad-spectrum," which means it protects against both UVA and UVB rays. UVA rays can cause skin aging and contribute to skin cancer, while UVB rays are responsible for sunburns.

Sun Protection Factor (SPF): Choose a sunscreen with an SPF of 30 or higher. SPF indicates the level of protection against UVB rays. Higher SPF numbers offer increased protection, but it's important to remember that no sunscreen provides 100% protection.

Physical (mineral) sunscreen or chemical sunscreen: There are two main types of sunscreens available:

Physical (mineral) sunscreens contain active ingredients like zinc oxide or titanium dioxide. They work by creating a physical barrier on the skin that reflects and scatters UV rays.

Chemical sunscreens contain ingredients that absorb UV rays and convert them into heat, which is then released from the skin.

Water-resistant formula: If you'll be sweating or swimming, consider a water-resistant sunscreen to ensure better protection. Keep in mind that even water-resistant sunscreens require reapplication after a certain amount of time or after towel drying.

A Note About Oxybenzone 

I avoid using Oxybenzone. Oxybenzone is an active ingredient found in some sunscreens and other personal care products that provide protection against UVA and UVB rays. There has been some debate and concern regarding the safety of oxybenzone. Here are some key points to consider:

Skin absorption: Oxybenzone can be absorbed through the skin and has been detected in the bloodstream after topical application. However, the concentration that is typically absorbed is considered low and has not been shown to cause significant harm in most people.

Hormonal effects: Oxybenzone has been found to have weak estrogenic activity in some studies, which means it can mimic the effects of the hormone estrogen. However, the level of exposure through sunscreen use is generally considered too low to cause hormonal disruption or adverse effects in humans. 

Allergic reactions: Oxybenzone has been associated with skin allergies in some individuals.

Environmental impact: Oxybenzone has also raised concerns regarding its potential impact on coral reefs and marine life. Research suggests that oxybenzone can contribute to coral bleaching, DNA damage in coral, and disruption of coral reproductive processes. 

It's important to note that the U.S. Food and Drug Administration (FDA) and the European Commission's Scientific Committee on Consumer Safety (SCCS), have reviewed the safety of oxybenzone and determined it to be safe for use in sunscreens within certain concentration limits.

Salicylic Acid

Salicylic acid is a beta-hydroxy acid (BHA) commonly used in acne treatments due to its effectiveness in treating various forms of acne. Here's how salicylic acid works for acne:

1.    Exfoliation: Salicylic acid is a chemical exfoliant that penetrates the pores and helps remove dead skin cells and debris. It works by dissolving the substance that holds skin cells together, promoting the shedding of these cells and preventing the buildup that can lead to clogged pores.
2.    Unclogging pores: Salicylic acid has the ability to penetrate deep into the pores, break down and removing excess oil (sebum), dirt, and other impurities that can clog them. By keeping the pores clear, it reduces the likelihood of acne breakouts.
3.    Anti-inflammatory properties: Salicylic acid has anti-inflammatory properties, which can help reduce redness, swelling, and inflammation associated with acne. It calms the skin and can help soothe the irritation caused by acne lesions.
4.    Oil control: Salicylic acid helps regulate sebum production, the natural oil produced by the skin. By controlling oiliness, it can help prevent the pores from becoming easily clogged with excess oil, reducing the occurrence of acne.
5.    Acne spot treatment: Salicylic acid is often used as a spot treatment for individual acne lesions. Applying a small amount directly on the affected area can help reduce inflammation and promote healing.

When using salicylic acid for acne, keep the following in mind:
•    Start with a low concentration: Begin with a product containing a lower concentration of salicylic acid, typically around 0.5% to 2%, to gauge your skin's response and tolerance.
•    Follow instructions: Read and follow the instructions provided by the product manufacturer. Typically, salicylic acid products are applied topically once or twice daily, but specific instructions may vary depending on the product.
•    Be consistent: Consistency is key when using salicylic acid. Results may take time, so continue using the product regularly for several weeks to see improvements.
•    Moisturize and protect: Salicylic acid can be drying, so it's important to moisturize your skin with a non-comedogenic moisturizer after applying the product. Additionally, use sunscreen during the day as salicylic acid can increase sun sensitivity.

Glycolic Acid

Glycolic acid is an alpha-hydroxy acid (AHA) that is commonly used in skincare products, including those targeting acne. It works in several ways to help improve acne-prone skin:

1.    Exfoliation: Glycolic acid is a chemical exfoliant that helps remove dead skin cells from the surface of the skin. By gently exfoliating the skin, it helps unclog pores, preventing the buildup of oil and debris that can lead to acne.
2.    Skin cell turnover: Glycolic acid helps accelerate the shedding of old skin cells and encourages the growth of new, healthier cells. This process can help prevent pore blockages and promote smoother, clearer skin.
3.    Sebum regulation: Glycolic acid can help regulate sebum production, which is the natural oil produced by the skin. By reducing excess oiliness, it can minimize the likelihood of clogged pores and reduce the occurrence of acne.
4.    Anti-inflammatory properties: Glycolic acid has anti-inflammatory properties that can help calm redness and inflammation associated with acne breakouts. It can soothe irritated skin and promote a more balanced complexion.

When using glycolic acid for acne, it's important to keep in mind the following tips:
•    Start with a lower concentration: If you're new to glycolic acid or have sensitive skin, it's advisable to start with a lower concentration and gradually increase it as your skin adjusts.
•    Patch test: Perform a patch test on a small area of skin before applying glycolic acid to your entire face to check for any adverse reactions or sensitivities.
•    Sun protection: Glycolic acid can increase sun sensitivity, so it's crucial to use sunscreen daily and limit sun exposure while using glycolic acid products.
•    Follow instructions: Follow the product instructions and guidelines provided by the manufacturer. The frequency of application and duration of use may vary depending on the product and your skin's tolerance.

Retinol

Retinol is a derivative of vitamin A and belongs to a class of compounds called retinoids. It is found in many over-the-counter skincare products. It is commonly used in acne treatments due to its effectiveness in addressing several factors that contribute to acne development. Retinol is a form of vitamin A that is f It is an antioxidant that helps to reduce wrinkles and improve the tone and texture of the skin.

Retin-A, AKA Tretinoin or retinoic acid), is available by prescription only. 

Here's how retinol works in acne treatment:

Exfoliation and pore unclogging: Retinol promotes exfoliation by accelerating the shedding of dead skin cells. This helps prevent the buildup of cells that can clog pores and contribute to the formation of acne lesions.

Decreased oil production: Retinol can regulate sebum (oil) production in the skin. By reducing excess oiliness, it helps prevent the pores from becoming easily clogged, minimizing the occurrence of acne breakouts.

Anti-inflammatory properties: Retinol has anti-inflammatory properties, which can help calm the inflammation associated with acne. It can reduce redness, swelling, and irritation, promoting a more balanced complexion.

Collagen production and skin regeneration: Retinol stimulates collagen production and promotes skin cell turnover. This can help improve the overall texture and appearance of the skin, as well as minimize the appearance of acne scars or post-inflammatory hyperpigmentation.

When using retinol for acne treatment, it's important to keep the following points in mind:

Start with a low concentration: Begin with a lower concentration of retinol to allow your skin to adjust and minimize the risk of irritation. Gradually increase the concentration over time as tolerated.

Follow instructions: Follow the instructions provided by the product manufacturer or consult with a dermatologist for personalized guidance. Retinol products are typically applied at night after cleansing and moisturizing.

Protect your skin: Retinol can increase sun sensitivity, so it's crucial to use sunscreen during the day and limit sun exposure. This helps prevent potential skin damage and adverse effects.

Be patient: Results from retinol treatment may take time to become noticeable. Consistency is key, and it may take several weeks or even months to see improvements in acne-prone skin.

It's worth noting that retinol can cause initial side effects such as dryness, redness, and peeling as your skin adjusts. If these side effects persist or are severe, it's recommended to reduce the frequency of application or consult with a dermatologist for further guidance.

Benzoyl Peroxide

Benzoyl peroxide is an effective topical medication commonly used to treat acne. Here's how benzoyl peroxide works and how it is used in acne treatment:

Antibacterial action: Benzoyl peroxide has potent antibacterial properties. It works by releasing oxygen when applied to the skin, creating an oxygen-rich environment that is toxic to the bacteria associated with acne, particularly Propionibacterium acnes (P. acnes). By reducing the number of bacteria, benzoyl peroxide helps to prevent and control acne breakouts.

Exfoliation: Benzoyl peroxide also helps to remove dead skin cells and unclog pores. It works by breaking down the keratin that holds dead skin cells together, promoting the shedding of these cells and preventing pore blockages.

Reduction of inflammation: Benzoyl peroxide possesses anti-inflammatory properties that can help reduce redness and swelling associated with acne lesions. By calming inflammation, it aids in improving the overall appearance of the skin.

When using benzoyl peroxide for acne treatment, consider the following:

Start with a low concentration: Begin with a lower concentration (typically 2.5% or 5%) to minimize the risk of skin irritation. Higher concentrations may be more effective, but they also have a higher potential for side effects.

Follow instructions: Read and follow the instructions provided by the product manufacturer or consult with a dermatologist for personalized guidance. Benzoyl peroxide is typically applied once or twice daily to the affected areas after cleansing.

Be cautious with clothing and fabrics: Benzoyl peroxide can bleach clothing, towels, and bed linens. Allow the product to dry completely before coming into contact with such items to prevent discoloration.

Moisturize and protect: Benzoyl peroxide can cause dryness and skin irritation. It is important to moisturize the skin with a non-comedogenic moisturizer to maintain skin hydration. Additionally, use sunscreen during the day as benzoyl peroxide can increase sun sensitivity.

Be patient: Results from benzoyl peroxide treatment may take time. Consistency is key, and it may take several weeks or even months to see significant improvements in acne-prone skin.

If you experience excessive dryness, redness, or irritation, discontinue the use of benzoyl peroxide and consult with a dermatologist for further guidance.