4 min|Dr. Maya Kuczma

An External Approach to Treating Acne

Wellness, Beauty, Skin Health
Acne typically develops due to a complex ‘perfect storm’ of multiple factors, such as increased sebum (skin oil) production, obstruction of pores, inflammation, and microbial imbalances. While we never advocate solely treating the skin externally, there are many healthy habits that can begin to target these factors from the outside in.

Limit Irritation

Rupturing the skin, via picking and squeezing, damages the integrity of the stratum corneum - the outermost layer of the skin - and can induce an infection, increase inflammation, and increase the likelihood of hyperpigmentation and/or scarring. Intense exfoliation, particularly with microbeads or an exfoliating brush, can have the same effect as picking due to abrasive damage to the stratum corneum. Irritation can result if make-up, bacteria, and environmental pollutants are not washed off before bed, or if we sleep on a dirty pillowcase, or neglect to wipe down devices and accessories that touch our face. Alternatively, over-washing can strip the skin of natural oils, leading to an overproduction of oil, increased inflammation and irritation. 

Quick Tips:

Wipe down your phone screen, glasses, headsets often.

Change your pillowcase at least a couple times per week.

Cleanse once a day, before bed, with a gentle cleanser.

Utilize Non-Comedogenic Products

Ingredients are rated on a comedogenicity scale from zero - least likely to clog pores - to five - most likely to clog pores.(1) Comedogenic products will not necessarily cause breakouts, but may be aggravating for those that are acne-prone. (2) Non-comedogenic products are formulated to limit pore blockages and breakouts, and are a preferred option for acneic skin. Many products that rank low on the comedogenicity scale will advertise this quality, via a ‘noncomedogenic’ or ‘nonacnegenic’ label. The comedogenic scale may also explain why certain ‘natural’ products are not ideal for acneic skin; for example, coconut oil ranks as highly comedogenic, and is typically listed as either a 4 or 5, depending on the source.

Quick Tips:

Look for ‘noncomedogenic’ or ‘nonacnegenic’ on skincare products.

Beware comedogenic ingredients such as coconut oil, soybean oil, D&C red, wheat germ oil, and PEG 2,16,200, 8, among many others (2).

Consider an Active Topical Ingredient

There are many active ingredients that can be used topically to address the various factors that contribute to breakouts:

Topical Retinoidsincrease cell turnover, decrease inflammation, lighten hyperpigmentation, and reduce acne scarring (3).
Topical Salicylic Acida beta-hydroxy acid, decreases sebum production and reduces inflammation (4).
Topical Azelaic Aciddecreases overproduction of keratin, has a degree of antibacterial activity, and acts as a free radical scavenger, which may lend to its anti-inflammatory properties (5,6)
Benzoyl Peroxideinhibits growth of microorganisms on the skin (7).
Niacinamideis anti-inflammatory, has a stabilizing effect on the skin barrier, and decreases sebum production (8).

Quick Tips:

Start small: begin using only one new active ingredient at a time.
Start slow: begin using an active ingredient only once or twice a week to see how your skin responds.
Prevention is key: treat the whole face, in anticipation of breakouts, rather than using active ingredients as ‘spot treatments’ when breakouts arise.
Moisturize: even if the skin appears oily, moisturizing after an active ingredient is necessary to maintain a healthy skin barrier.

Let There Be Light

Phototherapy utilizes specific wavelengths of light to treat skin conditions. Specifically, treatment with blue light appears to be beneficial in the treatment of acne, particularly in reducing inflammation. (9) However, this treatment is not an instant fix; improvements were observed following multiple treatments over time, such as twice a week over four to twelve weeks.(10) Although blue light appears to be a well-tolerated treatment that could be combined with various other topical skin treatments, accessibility can be an issue. (11) However, recent developments in handheld devices are enabling consistent home treatments of phototherapy. Additionally, many dermatologists and facialists are providing blue phototherapy within in-office treatments.

Quick Tips:

Blue light may be a helpful addition but cannot replace a gentle, targeted skincare regimen.

Don’t break the bank seeking expensive skin care devices or treatments, especially if you haven’t addressed internal factors contributing to skin health.

If you try phototherapy, be consistent and give it time.

Most importantly, patience is key

Switching products too frequently can muddy results, and waste your money. Eagerly introducing many active ingredients at once can irritate the skin, further exacerbating the inflammation-acne cycle. Many active ingredients take upwards of 8-12 weeks to reach their peak efficacy; trying a product for a few weeks will not provide adequate insight into how your skin may respond over time. Skin treatment - both internally and externally - requires consistency and patience.

Many of our Naturopathic Doctors at Integrative can work with you to develop a treatment plan that combines individualized internal and external recommendations to balance the tone, texture, and clarity of your skin over time. Contact us today - we’re ready when you are.

REFERENCES

1. https://pubmed.ncbi.nlm.nih.gov/6229554/
2. https://skinutritious.com/blogs/articles/comedogenic-ingredients-official-skinutritious-list
3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5574737/
4. https://onlinelibrary.wiley.com/doi/abs/10.1111/exd.13934
5. https://indexarticles.com/reference/american-family-physician/azelaic-acid-therapy-for-acne/
6. https://www.eurekaselect.com/174696/article
7. https://europepmc.org/article/med/23839205
8.http://www.download.lifvation.com/IcotZ_Clinical_EfficacyNiacinamide_DrKaymak.pdf
9. https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0781.2004.00109.x
10. https://www.tandfonline.com/doi/abs/10.1080/09546630500283664
11. https://europepmc.org/article/med/21637900