The science behind the multi-step cosmetic program for acne

Yes, I am talking about multiple layers of cream-based cleansers and cover-ups, which are advertised through the media and often available through Internet shopping with promotional bonuses.

How does the multi-step cosmetic program work for acne?

1. Cleansers in lotion or creams may contain a multitude of unnecessary ingredients, including medicated peelers, oils, fragrances and preservatives. Drugs commonly included are subtherapeutic or low doses of salicylic acid, sulphur or benzoyl peroxide.
2. Toner, usually water- or alcohol-based and may contain medicated ingredients such as alpha-hydroxy acids (e.g., glycolic acid, a mild comedolytic) or even glycerin as a humectant.
3. The intensive or repairing solution, usually lowest-strength combinations of peelers such as benzoyl peroxide, sulphur or salicylic acid, plus potentially sensitizing fragrances and preservatives, or oil-soluble sunscreens that are not identified on the label.

The disadvantage of the multi-step cosmetic program

1. Bases may have significant oil content. There may be additional products to supplement as necessary to the base routine of 3 steps, such as masks or spot treatments.
2. Multiple-step cosmetic programs are often costly and contain sub-therapeutic concentrations of ingredients that are not necessarily the first line. They should be avoided in favour of simple cleansers and more effective single-ingredient peelers, at optimal concentrations.

Simply saying in summary, they may contain many different medicated and non-medicated ingredients which may not be necessary, not in the right concentration and not first-line therapy.   

About Acne

Acne is the most common skin disorder typically starting at puberty, which is multifactorial, androgen-dependent and sometimes hard to treat. Although it is benign and most of the time self-limiting, it may cause major psychological disturbances.

Risk and Aggravating Factors

• Hormonal changes such as androgenic and antiestrogenic progesterone found in oral contraceptives
• Hormonal changes in pregnancy
• Menstrual cycles
• Application of some topical agents (topical acne), cosmetic or topical medications
• Physical pressure from headbands, violins, chin straps, sports helmet, … may cause localized acne

What should I avoid to limit my acne?

• Don’t wash your face too many times to remove surface oil. Lipids are deep in and cannot be removed by washing.
• Antiseptic cleaners only remove the surface dirt, oil and bacteria and can not affect the bacteria causing acne. Acne is not the result of a lack of cleansing.
• Men should shave their face as lightly and infrequently as possible to avoid nicking lesions.
• Don’t try picking, squeezing or excoriation of inflammatory lesions which may delay healing and promote scarring.
• Apply sunscreen with (SPF>30) with an oil-free base.
• Avoid heavy cosmetics and don’t try to mask your acne with cosmetics.

Of course, we all like to look nice but covering with cosmetics does not solve any problem and makes the acne worse than before.

After all, it’s ok people see we have acne in our face, about 80% of people have gone through this, nothing to be ashamed of.

Furthermore, I think most of the time people look at your personality through your words rather than your little pimples in your face.

However, there are some non-greasy cover-up cosmetics you may apply 2-3 times on pimples or the entire face, just be careful in choosing the products if you decide to use cover-up cosmetics. 

If you like to use your routine cosmetics try to look for oil-free cosmetics, not water-based products. Water-based products may contain a significant amount of oil that may worsen your acne.

Simple acne care

1. Wash your face not more than twice with mild soap or a soapless cleanser
2. Apply moisturizers and sunscreens that are oil-free rather than water-based

Therapeutic management of acne

Topical Agents

There are some medication you can purchase in your local pharmacy without prescription:

• Benzoyl peroxide is antibacterial and mildly comedolytic. You can start with lower concentration (2.5%) products since limited evidence shows efficacy similar to 5% and 10% formulations but with less irritation.
• Salicylic acid is comedolytic. Concentrations of 1–2% are tolerated but not as effective as topical retinoids. Higher concentrations are usually too irritating. It is most commonly found in nonprescription products.
• Topical retinoids are the most powerful comedolytic agents, yet still, take months to be effective.  You have to get them with a prescription as far as I know in Canada.

Retinoids may not be very good option if you have sensitive skin while having acne. They are normally irritating and photosensitizing.

Of the topical antibiotics, clindamycin is the most commonly used (with prescription). Use in combination with benzoyl peroxide reduces the risk of bacterial resistance.

Glycolic acid (an alpha-hydroxy acid) is mildly comedolytic and can be used when topical retinoids are not tolerated.

Systemic agents

All systemic agents have to be prescribed by a physician.

Antibiotic therapy, first line options are doxycyline, minocycline and tetracycline.

Hormonal therapy is useful option in women particularly those who have acne associated with their menstrual cycle. 

Oral contraceptives with minimal androgenic effects are especially useful in women with other signs of androgen excess. Never start contraceptives for your acne without consulting with your physician!!!

Isotretinoin is a systemic retinoid and the most powerful anti-acne agent with potentially serious side effects. Your doctor normally weighs the risk of potential side effects against the benefits of systemic therapy with isotretinoin.

It is very dangerous for the baby during pregnancy and women should avoid pregnancy one month before starting treatment with isotretinoin.

I’d like to know how you deal with acne? how do you deal with acne and sensitive skin?

Thank you for all your feedback!