Do you hate all those makeup advice columns that assume you have perfect skin? Do you roll your eyes whenever a "natural" makeup tutorial assumes that a light application of tinted moisturiser/BB cream is enough to leave your skin flawless?
You probably have acne. Or rosacea. Or eczema.
This post deals with acne. Acne is thought by many people to be a skin condition affecting only teenagers. Mine didn't magically clear up on the stroke of midnight between my 19th and 20th years of life. It's still here.
I've held off doing a post like this for a long time, because there are so many out there and because I didn't feel I'd sorted out my skin routine enough to be giving advice to anyone. I'm very glad to say that that's changed! Makeup takes so much less time to apply when you have good (or just decent) skin.
It's been months and my skin is so much better than it has been in years. I don't need to spend 15 minutes just on covering up my blemishes, I don't need to go over my entire face in concealer and I haven't had cystic breakouts in 6 months. Major win!
This post will cover the basics about acne and the treatment options. I'll also outline some of the mistakes I made in trying to treat mine, and how I overcame them.
I'm going to start of with the basics, so please forgive me (and scroll) if you've heard/read this all before. I have a health background, so I have used some clinical language, but I have provided explanations when necessary.
What is acne?
Acne vulgaris is an inflammation (and often, infection) of the pilosebaceous units, most commonly affecting the face and trunk. It can manifest as comedones (blackheads/whiteheads), papulopustules, nodules and cysts. Acne can result in pitted, depressed or thick and raised scars.
The pilosebaceous unit is your hair follicle + the oil producing gland that goes with it.
Acne involves a faulty regulation of keratinisation (keratinocytes are the cells that make up most of your epidermis, the top layer of your skin). Basically, the pilosebaceous unit builds up keratinous material and blocks the passage of sebum (oil) from the pilosebaceous unit. This stage is called a comedone.
Inflammation results from a complex interaction between the keratin plugging, androgens (hormones; they stimulate the sebaceous gland to produce more oil) and bacteria (P. acnes is the bacteria most commonly involved; it's on everyone's skin).
Now, whether the comedone bursts on its own or you give it a 'helping' hand, the contents of that pilosebaceous unit (oils, keratin, bacteria) enter the skin's dermis (deeper layer) and provoke an inflammatory, foreign-body response and a papule (solid elevation of skin, small size, no visible fluid), pustule (these look white or red, they're small elevations of the skin containing pus) or nodule (greater than 5-10mm in width and depth; deeper than a papule) will form.
Rupture + inflammation = scars.
Exacerbations (worsening) of acne can be caused by emotional stress, occlusion and pressure on the skin (leaning your face on your hands, for example) and dirty makeup brushes and sponges re-infecting your skin with bacteria. Acne is not caused by chocolate or fatty foods. There have been no foods proven to cause acne.
How is it treated?
The most important thing (which I didn't fully appreciate at first) is to go see your doctor. Seriously. I didn't believe my doctor when she advised me about what kind of skin wash to use, what topical preparations to use, how often/where to apply them. I tried all sorts of things I read about in magazines and on the internet. All my trial and error led me to the same advice my doctor gave me in the first place. I could have saved myself so much time and effort if I'd just given the doctor's advice a go in the first place.
I'll talk you through the treatments, but here in Australia you can't get most of them without a prescription. They also have their own side effects and risks, so they shouldn't be taken without medical supervision.
So you've heard what causes acne: hormones + bacteria + hyperkeratinisation. Those are the three pathways targeted by acne treatments.
Hormones: the problem involves androgens ("male" hormones such as testosterone) resulting in too much oil production. This can be treated by the oral contraceptive pill. See your doctor for an assessment as to whether this treatment is suitable for you, and for all the risks and benefits of treatment with the OCP.
Bacteria: To reduce colonisation of bacteria on the skin there are two approaches: topical and systemic. You can try skin washes containing benzoyl peroxide, a non-specific agent that lyses (bursts) bacterial cells or topical antibiotics. You could also try a course of doxycycline (an antibiotic). Again, see your doctor for an assessment as to whether this treatment is suitable for you, and for all the risks and benefits of treatment.
Hyperkeratinisation: There are topical agents called keratinolytics, which break up keratin. These include topical retinoids. Again, in Australia you need a prescription for this, so (you guessed it) see your doctor. (Also- retinoids make your skin really, really sensitive to sun. If you're not up for wearing broad spectrum SPF 30+ every day, don't bother asking for retinoid cream.)
There are combination treatments which incorporate retinoid and benzoyl peroxide, such as Epiduo, and they require a script.
For severe acne, an agent which targets oil production and keratinization is oral isotretinoin. Again, see your doctor for an assessment as to whether this treatment is suitable for you, and for all the risks and benefits of treatment (pretty boring disclaimer, but necessary).
There are different classifications of acne- mild, moderate and severe. Different treatments are appropriate for different categories and it's best to see your doctor (I did).
What were my mistakes?
1. Over-doing it with the benzoyl peroxide and pimple cream (I used all sorts of brands- Garnier, Clean and Clear, Cetaphil). I used the strongest benzoyl peroxide preparation I could get my hands on when it came to face wash and pimple cream. Just so you know, there's no evidence that 5% is any better than 2.5% but I completely ignored this. I also used the face wash and the pimple cream every day. What happened to my skin? My skin became irritated and red. My face towels were also bleached (I washed it off as thoroughly as I could, but some still remained).
2. Applying the benzoyl peroxide pimple cream (and later, retinoid cream) over my whole face, every day, rather than just the areas I needed it on. This just irritates the skin not affected by pimples. Don't do it.
2. Following the advice of a beauty blogger who said retinoid + organic rosehip oil was a good idea and gave perfect skin. It's not a good idea. Yes, it helps the retinoid penetrate deeper into the dermis. Do you necessarily want that? No. Retinoid cream is meant to be taken as prescribed, not mixed with other agents. What did it get me? Flaky, red, PAINFUL skin. It took me a whole month to get my skin to calm down. I had completely ruined the top layer of my skin. My protective barrier was gone AND on top of that, as a reaction, I got more pimples. It also resulted in all of my usual skin cleaners being too harsh and causing me pain. I had to go look for the mildest cleanser I could find, and even that stung!
3. Using organic rosehip oil. This did not help my skin AT ALL. I used Bloom's, by the way. This never left my skin feeling good. It always felt dry yet greasy on top. In the end, I found that the oil had gone off within 3 months of being opened (and kept in a cool, dark place). There's bad news, too, in that some mineral oils are acnegenic (acne-causing) so you have to be really careful.
4. Persisting with products that caused break-outs because of the idea that the skin needs to "purge" and then it'll be OK. That's rubbish. If it's irritating your skin, stop using it. For me, this was the Garnier Pure range. I bought their cleanser, toner and moisturiser. It took me a month to stop using it, even after I broke out from it. That was stupid.
5. Popping pimples that hurt. Everyone knows this is really stupid. There are heaps of techniques out there to "safely and cleanly pop pimples" and I was using them. It's not a good idea, there's no way you can do it at home in a manner that 100% will not result in contamination of the surrounding dermis. Also, if you pop them, all your topical agents are useless anyway because they have nothing to work on. My skin became a lot better when I changed my routine (described below) to one that suited my face. It became even better when I stopped popping pimples.
6. Failing to moisturise. I thought that my oily skin didn't need moisturiser. I was wrong.
Tips for acne control
1. See your doctor and follow their advice, using the prescribed agents AS prescribed. I thought the advice the doctor was giving me was too simple, and the agents too weak to do anything to help my skin. When I first started out, I had mild acne. I attacked my skin as though I had severe acne. With all my mismanagement, I aggravated my skin and ended up with moderate acne (facepalm).
2. Don't be too harsh on your skin. Don't attack your skin with multiple agents. You could irritate your skin and make it worse, or if it does get better, you won't know which one is really working.
3. Do have a regular routine. Take care of your skin. Cleanse, tone and moisturise (plus whatever treatment you're using) every morning and night.
4. Remove every last scrap of makeup. Your skin is already clogging up on its own. Do you really want to leave makeup in your pores, too?
5. Give whatever treatment you're using time to work. Acne doesn't clear up overnight. It requires constant maintenance and treatment. Despite what the anti-acne ads tell you, your skin isn't going to look completely perfect after one use.
6. Regularly wash your makeup brushes, sponges and applicators. Don't keep spreading bacteria on your face. I use soap and warm water to wash my equipment. For sponges/anything that goes on my skin, I was each item after use. For eyeshadow brushes, if you're using the same colour over and over, I wash them once a week or if I want to use different colours, after each use.
I am well established in my routine now, and it works for me. I'm not saying you should follow this, I'm just outlining what works for me.
I use a mixture of products. I use a Clinique* face wash and toner (4) day and night. I always double cleanse. I put Epiduo on any pimples (ONLY on an pimple areas) if I have any. In the mornings, I use a Nivea Sun moisturiser with a broad spectrum SPF 30+. Then I apply my makeup.
At night, I make sure I take all my makeup off. I use theBalm's Balms Away makeup remover and I double cleanse and then use toner. I use Epiduo if I have a breakout. In terms of moisturiser, I use a baby cream on my face. It's very thick and not suitable for day use because it looks so oily on, but doesn't ever break me out. I first started using it to help repair and moisturise my skin during my rosehip oil + retinoid fiasco, and I've kept using it since. I also use theBalm's eye gel. That's not acne related, but I thought I'd add in. Once a week, I'll use Retrieve (retinoid cream).
The night-time routine is winter-specific. I have a lighter moisturiser from Clinique that I use during the summer months.
*I know that there's been a lot of bad stuff written about Clinique on the internet. Some people have had bad experiences with Clinique products that break them out. I also know that I've been using it for a year now with no problems, no breakouts. It's all skin-specific when it comes to skincare products. What works for one person, doesn't work for another. Whatever skincare routine you decide on, whatever brand it is, ask for samples and trial it first to see if it irritates your skin. Products take a while to improve your skin, but if they're not right for you, they'll make things worse pretty quickly :P
Anyway, that's a really long post. Sorry! I just wanted to get correct information out there, in a way that's easily understood.
What's your experience with acne? What products are you using at the moment? Are they working for you?