Most of us think of acne pimples as a teenager’s problem and that, as adults, we’ve left all that far behind. But adults can get acne too… and it can be just as distressing as it is for teens! The strategies for controlling acne, however, are the same no matter what your age.
What causes acne?
Acne occurs when skin pores become blocked, with oil and bacteria inside. It’s all about inflammation…caused by bacteria breaking down the oil that is trapped inside the pores of the skin, creating irritating fatty acids that cause inflammation and swelling.
So, reducing the amount of oil on the skin, killing skin bacteria and keeping pores open will all help to reduce the formation of acne pimples. And reducing inflammation in the body helps too. Changes in hormones can trigger increased oil production in the skin that promotes acne, and dramatic hormone shifts occur with puberty and with menopause so that’s why we see more problems at these ages. Some people have called menopause “puberty part II”!
Blackheads are plugs of oil that have become trapped in the skin pores and have oxidized, causing them to turn dark. Removing oil by cleansing the skin helps to prevent blackheads. Whiteheads are just blackheads that haven’t oxidized yet. But there are efficient ways of removing them without damaging the skin that I’ll tell you about too!
So, the 3 main strategies to prevent and improve acne are:
Cleanse to remove oil
Keep pores open so bacteria and oil won’t get trapped inside, and
Kill bacteria so it can’t break down skin oil into irritating fatty acids
Cleansing
I talked about skin cleansing last week and, if you have acne, you likely have more oily skin. Washing with only water probably won’t be enough to help although, if you have a mixed complexion with oily and dry areas, you might want to only use a cleanser on the oily area (often these are located in the “T” area of the face, the forehead, nose and chin).
It’s best to cleanse twice daily, morning and night, to remove excess skin oil effectively and reduce bacteria. Any treatment creams should be applied after cleansing.
Opening pores
Salicylic acid is a commonly used “keratolytic” agent, a chemical that loosens surface cells and helps them to slough off. While this type of ingredient is often marketed to help skin look fresher and younger by removing fine lines and surface wrinkles, it also helps to keep pores open, preventing acne by removing dead surface skin cells around the pore openings.
It’s available in cream form and in cleansﻌers. I’ve been using a liquid face cleanser with 2% salicylic acid for the past few years and find it works well for me, as I generally have oily skin with pores that tend to clog easily.
Other keratolytics are available too, such as the water-soluble alpha hydroxy acids, glycolic acid, lactic acid and citric acid. But salicylic acid, a Beta Hydroxy acid, offers the advantage of being oil soluble. This allows it to penetrate oil-clogged pores more easily, helping to dissolve forming blackheads and whiteheads (blackheads that haven’t oxidized and turned dark yet). Salicylic acid is often less expensive than some of the other similar agents also.
If you have a lot of blackheads on an area of the face, they can be efficiently removed without damaging the skin by using blackhead removal strips, such as Bioré. A home-remedy that is almost as good, is a mixture of 2 tsp unflavoured gelatin and 2 tsp milk. Heat in the microwave for 10 seconds, let cool slightly, then apply to the skin. Let it set, then peel off, removing blackheads at the same time, similar to how the commercial strips work. And I’ve heard you can even use Elmer’s White Glue in the same manner (no need to heat) with similar results!
Killing bacteria
Benzoyl peroxide is the best non-prescription antibacterial I know of for the skin. It’s available in 5% (non-prescription) and 10% (non-prescription in the US, prescription in Canada but, in some provinces, pharmacists can prescribe it). As well as killing the bacteria that cause acne, it also has a mild peeling action that helps keep pores open. It was a small miracle when I discovered benzoyl peroxide 10% as a teenager, as the 5% and several other remedies had made little difference for me. And I still use it today whenever I see any sign of a blemish starting.
However, if you have sensitive skin, you should try 2.5 to 5% first, as it can cause irritation. Also, use it with caution near sensitive areas like the eyes and mouth, and wash your hands well after applying to avoid inadvertent contact with eyes.
Benzoyl peroxide is also an ingredient in some cleansers, combining all of the above actions into one product for milder cases of acne. But be aware that it acts like a bleach…I accidentally created big white splotches on my mom’s green towels when I first tried one of these cleansers as a teenager! However, this problem is easily solved by using white towels and facecloths…
Of course, using benzoyl peroxide as a cream or gel is more effective for active acne, as the ingredient will stay on the skin longer and in a higher concentration. A dab of 10% cream on a newly forming blemish can stop it in its tracks within a few hours. Amazing stuff!
Anti-inflammatory diet
The amount of inflammation your body creates in response to the irritating fatty acids produced by the action of bacteria on skin oils depends on how many inflammatory chemicals your body produces. Inflammation throughout the body can be reduced by following an anti-inflammatory diet.
Simply described, an anti-inflammatory diet involves avoiding any foods you are allergic or sensitive to, plus eating foods that are known to be metabolized into anti-inflammatory substances in the body while reducing those that are made into inflammation-promoting substances. Oils in fatty fish, nuts, flax, hemp, and green leafy vegetables are broken down in the body into the omega-3 oils, EPA and DHA which are used to make anti-inflammatory substances. Fats in corn oil, safflower oil, sunflower oil, soybean oil, dairy products, and traditionally raised meats and poultry are metabolized into omega-6 oils that are subsequently made into pro-inflammatory substances in the body. Olive oil and canola oil are considered neutral.
So, the balance of omega-3 to omega-6 oils in your diet can affect the amount of inflammation your body can produce. This affects not only your skin, its blemishes and aging, but also inflammation throughout the body. An anti-inflammatory diet can help reduce asthma symptoms, inflammatory bowel disease, heart disease and many other inflammation-related conditions. But that’s a topic for another blog…
Another tip I read recently--zinc tablets 10 -50mg daily can help reduce inflammation and speed healing of blemishes and might be worth considering when trying to heal a more extensive case of acne. They are inexpensive, available without prescription and can be found with the vitamins and minerals in any pharmacy. Take with food, as zinc can irritate the stomach.
As well, a mild non-prescription cortisone cream, such as Hydrocortisone 0.5 to 1%, could be used sparingly for a short time to reduce inflammation in highly inflamed areas of acne. Be aware, however, that long-term use of steroids on sensitive facial skin can make the skin thinner over time, allowing blood vessels to show through the skin as fine red lines. Use only a small amount for a short time, and only on very inflamed areas to prevent this from occurring.
If all else fails…
If acne doesn’t respond to a consistent skin care regimen, similar to what is described above, it’s worth seeing your doctor. Be sure to tell them what you’ve already tried, and they will work with you using available higher-level treatments. This could involve prescription creams, such as retinoids that increase the turnover and shedding of skin, injections of cortisone (a potent anti-inflammatory) directly into deep acne cysts, antibiotics by mouth to more effectively kill skin bacteria or other strategies.
References:
The Ultimate Omega-3 Diet – Evelyn Tribole
The Clear Skin Prescription – Dr. Nicholas Perricone
Alpha Hydroxy Acids – FDA https://www.fda.gov/cosmetics/cosmetic-ingredients/alpha-hydroxy-acids
Beta Hydroxy Acids – FDA https://www.fda.gov/cosmetics/cosmetic-ingredients/beta-hydroxy-acids
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