How to Build the Best Acne Skincare Routine

For many of us, acne is the reason why anyone starts paying attention to their skin in the first place. This taboo subject plagues so many of us—teenage blunder years, anyone? Annoyingly acne can even be a continual skin concern well into your 40s. Moderate to severe acne will require you to team up with a dermatologist to truly tackle breakouts. However, there are thousands of acne topicals available in drugstores to help you try to zap the buggers. So, let’s try to make sense of this massive category to filter out the acne duds and establish some ground rules for your acne-fighting routine.

The Root Causes of Acne

Forget what you’ve heard about how bacteria growth is the root cause of acne. Historically, many people believed that acne is caused by an overgrowth of bacteria called Propionibacterium acnes—now renamed Cutibacterium acnes (C. acnes). This misconception inevitably resulted in regimens packed full of oral and topical antibiotics. In the end, C. acnes turned out to be only a piece of the puzzle, and these treatments alone are not going to cut it. 

So, let’s dive deeper and take a look at the sebaceous gland, the main site of acne growth.

Sebaceous glands are crucial to healthy skin because they secrete antimicrobial lipids, upregulate antioxidants, maintain pro- and anti-inflammatory responses, and secrete sebum. However, they also happen to possess just the right scenario for acne growth for two specific reasons:

1. Annoying hormones

Sebum secretion is promoted by an increase in androgens—which is why acne is a classic trademark of puberty. This class of hormones is responsible for triggering sebaceous-gland growth and sebum production, prime material for acne breakouts. They also are responsible for hyperproliferation (aka excessive cell growth,) which can cause buildup within the follicle. Double trouble!

2. Triggered inflammation

Sebaceous glands do have pro-inflammatory lipids, which help as a defense mechanism but can also makes an acne situation worse. In fact, it can even cause acne without any sort of C. acnes overgrowth.

All of this means that C. acnes is more the result of an unhappy sebaceous gland than the cause. The takeaway here is, acne is truly a complex condition that isn’t easily solved by washing your face four times a day or dousing breakouts in super-concentrated topicals. We now understand that acne can stem from various triggers such as genetic disposition, hormonal imbalance, and stress, with links to androgens and pro-inflammatory lipids. With this multitude of factors, acne has forever been a frustrating and lengthy process for treatment, requiring a lot of patience, diligence, and constant trial and error.

When Should You Consult A Dermatologist?

As we’ve mentioned, acne breakouts are not easily solved with just drugstore topicals. Ultimately, if breakouts become unmanageable, a derm will be your one true partner who can guide you through prescription treatments. Let’s run through a quick checklist of when to consult a derm!

If you’re experiencing any of the following scenarios, it’s time to seek a derm!

  • Drugstore topicals are causing significant irritation.
  • Your longtime topicals aren’t cutting it anymore; your breakouts show no improvement.
  • There’s a drastic change for the worse in your acne breakouts.
  • The number of acne lesions is increasing.
  • Acne lesions are red or painful to the touch.
  • Lesions are forming deeper in the skin.

How To Build Your Acne Skincare Routine?

When you’re at the drugstore, you may be overwhelmed by the plethora of acne topicals available over the counter. Before breaking down the ingredients, claims, and formulations, we should go over some important points:

  1. Treating acne typically requires a cocktail of ingredients: You will most likely need multiple ingredients to team up and tackle your breakouts. Like other active treatments, introduce your acne-fighting products one at a time. Take the time to see how your skin reacts before trying to add in the next actives treatment.
  2. Refrain from exorcising your face of all oil: A lot of acne products are all about being “oil-free,” often touting oil reduction or oil control. But all skin needs oil! Even if you have acne. The lesson here is, try not to get crazy with all of these oil-control products. Acne-prone skin is delicate and easily compromised, so don’t wash your face too many times a day, use clay masks too often, or constantly reapply oil-absorbing powders.
  3. Try not to pick at lesions: We get it—sometimes you just can’t help but pop a pimple. If you absolutely can’t help yourself, please wash your hands, keep it sterile, or just leave it to the professionals—a.k.a. aestheticians!
  4. Cleansers with actives are helpful here: For acne, actives in cleansers have been shown to be a helpful mode of treatment. That means you have one more slot in your routine to add in another acne-targeting active, since cocktails of multiple actives are important here for managing breakouts.

Here, we’ll lay out a framework for how you can build your acne routine. Ultimately, you’ll want to hit a diverse group of goals:

  1. Healthy cell turnover to expedite acne lesion healing
  2. Antimicrobial to minimize C. acnes overgrowth
  3. Soothers to keep skin calm while dealing with acne and strong topicals
  4. Post-acne fighters to manage residual pigmentation

If you’re using prescription topicals, that’s even better! Not only do you have tailored topicals prescribed by an expert, but you’ve also got an expert on hand to run through your routine with you. In fact, bring in your products with you when you visit the derm so they can give you the green light on your routine with their prescribed treatment.

Day Routine

In your day routine, you have two possible steps for acne ingredients: cleanser and treatment step. For daytime, try to keep it simple with ingredients like salicylic acid and benzoyl peroxide. One product that acne-prone skin types purposely like to forget is sunscreen. We get it —the texture, shine, and oiliness make you want to do a hard pass, but sunscreen is really important for post-acne healing. Too much sun can lead to those spots darkening. On top of that, a lot of these acne-fighting ingredients make you more sensitive to the sun, so let’s sunscreen, people! To keep things light, you can consider forgoing your moisturizer step for sunscreen if you’re struggling with oiliness.

Below is a summary of the steps you need to follow in your day routine:

  1. Cleanser
  2. Treatment
  3. Moisturizer
  4. Sun protection

Night Routine

Adapalene or other retinoids are great night-treatment additions. These tend to be more aggressive and can cause irritation or dryness. A helpful step to troubleshoot is to start your routine with a soothing serum.

Below is a summary of the steps you need to follow in your night routine:

  1. Cleanser
  2. Soothing serum (optional)
  3. Treatment
  4. Moisturizer

Acne-fighting Ingredients

Ingredients Concentration Description Chemist Notes
Adapalene 0.10% A new OTC retinoid with promising data against acne but significantly diminished side effects compared to tretinoin  Suggestions of a synergistic effect with BPO. Consider pairing these two in your routine.
Benzoyl Peroxide 2.5-10% OTC ingredient that can be a great spot treatment. Get ready for bleached pillowcases With the BPO offering, it’s easy to want to reach for the max-strength 10% benzoyl peroxide option. But there are some studies that suggest more doesn’t actually equal better. 5% is a good starting point as a stand-alone topical for sparse breakouts and general acne maintenance. 
Azelaic Acid 20% Convenient that this ingredient also has great data on combating PH 20% azelaic acid is pretty hard to find in stores. Instead, you’ll often find a 10% option. At 10%, consider this more as an acne-maintenance ingredient than an effective breakout treatment.
Sodium Ascorbyl Phosphate 5% Vitamin C derivative often found in serum form Can serve as a dual-purpose pigmentation and acne treatment for those acne-prone-skin types looking to incorporate some vitamin C into their routine. 
Tea Tree Oil Max 10% An essential oil that surprisingly has some results in minimizing breakouts In pure form, this essential oil can be very irritating for skin, so be sure to properly dilute it. Can suffice as a spot treatment. 5% tea tree oil was found to perform on par with 5% benzoyl peroxide but required longer treatment time. 
Salicylic Acid 0.5-2% OTC regulated. This is the ingredient that gets dumped into every product. Typically better as a support product to another topical. Try starting at the lower end of the spectrum. High-level 2% SA topicals positioned for acne can often be very drying, which can further aggravate inflamed acne. Decode the ingredient list to find a less drying version. 
Alpha Hydroxy Acids (AHAs) 5-15% daily AHAs include glycolic, lactic, and mandelic acids. Aid in increasing cell turnover, which can be helpful for speeding up acne recovery.  Typically better as a support product to another topical. 

A Note on Postacne Care

It’s easy to want to panic when looking at your pigmentation after acne has come and gone. Good thing the pigmentation section is up next! And for those wondering if it’s an acne scar, any change in skin topography is considered acne scarring, and a derm will be better able to assess your type of scar and which in-office procedure is best. Most scars won’t be solved with just topicals alone, which makes a great case for us to stop picking at those pimples.

A weekly clay mask can serve as a dual-purpose step here. Not only can it help absorb excess oils, but also, removing the excess layer of oils can improve the penetration of your topicals.

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