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Acne. The bane of my existence.

As a teenager I was on Accutane THREE times.

Oh but my acne didn’t end with teenage years… I struggled well into my adulthood until I finally decided to put those biology/chemistry/nurse practitioner college degrees to use and understand what the hell I was putting on my face.

And it worked…

Here’s a breakdown of my research and how to apply it.

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Start with a gentle, hydrating cleansing routine.

Destroying your natural moisture barrier will only make you more vulnerable to break outs. Establish the basics so you have a well hydrated foundation to start with and this alone may work.

Destroying your natural moisture barrier will only make you more vulnerable to break outs.

Double cleansing (where you cleanse with an oil-based cleanser followed by a water-based cleanser) completely changed my skin. I believe the oil cleanser removed my makeup more effectively and then I was able to really cleanse my face when I used my water-based cleanser. Whatever the reason….it worked! (See post on skin care basics)

Oil-based cleanser:

Follow with a GENTLE water-based cleanser. Seriously…you don’t want your face to feel squeaky clean. Ever. Don’t buy the ones that say for ACNE or AGING. Those likely have a ton of drying, irritating actives in them. There’s a time for those later, but not now. Go for a hydrating cleanser. NO BAR SOAPS. And leave out the fragrance crap. It will only further irritate your skin.

• Wash twice a day (not more) and with lukewarm water.
• Wash with the pads of your fingers.
• No scrubbing. No physical exfoliating (ever) or apricot scrubs or fancy devices! No, no, no. You want your moisture barrier intact.
• Gently pat dry (I only pat my eyes and leave my face wet for my moisturizer).

Your skin should always feel supple and hydrated after cleansing. If it feels squeaky clean or dry/tight, you need a new cleanser.

Moisturize!

A myth I used to believe: using a moisturizer will clog your pores. NOT TRUE. If it does, you’re using the wrong one. It should be NONCOMEDOGENIC….meaning it won’t clog your pores.

If your skin is dry, cracking, dehydrated, or pissed off, then you’re giving bacteria an easy portal of entry into your skin.

Nurse your skin back to good health with a HYDRATING toner (if any), a good moisturizer applied onto wet/damp skin, and occlusives such as vaseline or cerave ointment on top if needed.

Gently cleansed, moisturized skin is the perfect starting point for minimizing breakouts.

TONERS: If my skin is super dry, then I’ll use a hydrating toner. After cleansing I’ll put some on my hands and tap it all over onto a wet face. Using on a wet face increases the absorption so apply onto wet face and then seal it all in with your moisturizer. If using multiple toners, use thinnest to thickest consistency. These toners are fragrance-free and gentle, well reviewed and super hydrating.

For those of you who don’t know, my holy grail forever and always moisturizer is the blue cerave in the jar. Gentle, noncomedogenic (non-pore-clogging), super moisturizing with ceramides (aide in healing your skin) and hyaluronic acid (holds 1000 times its weight in water so you want to use on wet skin). Can use on body and face. The BEST.

Other things to consider

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NOW let’s talk about treatments

Now that you have a solid routine in place for hydrated, non irritated skin, then we can start introducing actives…

If your skin is irritated or dry, hold off on using any treatment agents. Let it fully recover first. Otherwise you will further irritate it which leads to more acne, inflammation, and likely PERMANENT hyperpigmentation (dark spots).

Acne treatments

Make note that all of these are irritating so start slow and don’t apply to wet skin.

Benzoyl Peroxide

Super popular acne treatment. Basically puts oxygen into pores which kills the bacteria. They sell 10% benzoyl peroxide, but the lower percentages are shown to work just as well (with less irritation).

I mainly use a wash form. The wash is not a cleanser, so ensure that your skin is cleansed first. Occasionally I use a topical form used as a spot treatment on completely DRIED moisturized skin and tap it onto the spots I’m treating. I typically use the wash form in the shower in the am and then the topical at night (but not with my retinA).

BHAs (beta hydroxy acids)

This is salicylic acid. And I love love love.

I use the zapzyt salicylic acid wash every single morning, leave it on a few minutes, and then rinse it off. This stuff was SUPER drying at first for me and I could only use a few days a week. I occasionally use the stridex or CosRx if I have a lot of blackheads/clogged pores and I have time to let it completely dry. I use it (on completely dry skin) after cleansing and then let it dry for about 20min. Then I wet my face with my hada labo hydrating toner in order to apply my moisturizer onto a wet face. I also have The Ordinary’s peeling solution. It has both BHA and AHA in it and is STRONG. It burns. So be careful with that one.

Salicylic acid is my favorite active ingredient for maintaining clear skin. I LOVE!

AHAs (alpha hydroxy acids)

This is glycolic, lactic, and mendelic acid. BHAs were oil-soluble; AHAs are water-soluble. Acts as chemical exfoliant and works by de-gunking the cells so they can break apart and slough off (works more on the surface where BHAs penetrate deep into pores). Leaves smoother, brighter skin.

• Chemical exfoliant.
• Helps with acne, but also hyperpigmentation, dullness, texture, acne scars, and aging.
• Glycolic is the strongest, followed by lactic, and then mendelic.
• Must also wear sunscreen!
• Apply on dry skin and let it completely dry (15-20min) before using next product (ideally after cleansing but before moisturizing).

I love the salicylic acid wash so much that I haven’t fully committed to this one. But these all have great reviews. I definitely get brightening effects glycolic acid. I have the pixie glow tonic, however you get more for your money with The Ordinary glycolic acid. (Keep in mind the glycolic is the strongest of the AHAs. ) I recommend anything made by The Ordinary. Super affordable and you’re getting pure active ingredients without added crap in it.

After cleansing and after my skin has completely dried (typically mornings), I put some on my hands and kind of pat it on my face (use less product this way over using a cotton ball). Then let it dry for 20-ish minutes. It’s pH dependent so it’s actually important to let it fully dry. Then I would splash some water on my face so that I could apply my moisturizer onto a wet face.

Retinoids

There are tons of retinoid choices however I use prescription strength tretinoin (retinA). There is an OTC retinoid that is great for acne (not as strong as tretinoin but still the strongest OTC retinoid you can buy) called Differin. Most things labeled “anti-aging” have much weaker versions of these.

• Great for acne, blackheads, hyperpigmentation, evening out skin tone/texture, acne scars, fine lines/wrinkles, and prevents aging by increasing collagen.
• Buffer with moisturizer if needed (apply onto moisturized skin AFTER it has dried or mix it with your moisturizer (see retinoid post).
• Sunscreen is a MUST.
• Need a solid hydrating routine in place with a GREAT moisturizer.
• Do not use if pregnant.

Retinoids are great for anti-aging. Really the best. And it’s just a plus that it’s great for acne too! (I used retinA as a teenager for acne.) I currently use at night mixed with moisturizer only about twice a week.

Azelaic Acid

This is typically a prescription, however there are some OTC versions available.

I use it mostly when I have redness or rosacea that I want to treat. It does cause irritation, redness, and even itching when you first start using it…and when I say irritation, I mean it irritates the sh$% out of me. Itches SO freakin bad. I haven’t tried The Ordinary one yet, but apparently the itching is a normal, common thing and gets better with time.

I use it on DRIED moisturized skin in the morning. And then I quickly washed that sh&% off. And still continued to itch…

Antibiotics

Oral and/or topical antibiotics are helpful, however you can build resistance. So this isn’t a great long term choice in my opinion.

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My routine for break outs

If I don’t touch/pop it and I just pat some zapzyt topical gel on it once or twice a day, it usually goes away quickly. If I mess with it and pop it, it gets inflamed and takes at least a week and then I still have redness. The temptation though………

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This is what works for me. Everyone’s skin is different and responds to different things. Establish a basic, hydrating skin care routine first. Then pick an active to add. Stick with it and give it time. Build up tolerance. See if you like it or not. Then either switch or add another one. Go slow. Moisturize!

And ALWAYS, always wear sunscreen!