The ultimate guide to an acne-free skin
Acne-free skin is hard to achieve. This post will explain the main causes of acne and shows you example routines to help you have clear skin.
Good news is: you don’t need to stuff your bathroom with all the different products.
Let’s learn the basics and you’ll be good to go!
Raise your hand if your skin is freaking out right now. Now raise your other hand if you’ve been going through your skincare products a little faster than usual lately to get rid of the tiny, but frustrating reasons of said freak-out.
That’s where preventative skincare comes in, and it’s important to figure out the best skincare routine for acne ASAP.
What is acne and what are the causes of acne?
You must have heard many times that the development of acne is related to bacteria (specifically, for example, the bacterium P. acnes) or that it is hormonal. Have you ever wondered what the real reason is?
The fact is that there are both “deeper” and “direct” causes of acne.
Direct causes are that happens specifically on the skin, so for example, the action of P. acnes bacteria is a direct cause.
But there are usually some “deeper” reasons (such as the hormonal cause) why P. acnes bacteria malign on your skin.
What happens to the skin when an inflamed acne develops is a very similar process for everyone (we’ll describe it right away), and an acne cream or agent slows down that process in some way.
That is, no matter your age, whether you are a teenager or even an adult, the active ingredients and conscious skin care methods described in this article will help!
The deeper causes, on the other hand, can vary, and unfortunately it is not always possible to find out what they are.
But if you realize your own deeper cause, in addition to your acne skin care routine, lifestyle / diet changes can also make a nice difference.
In this article, we will focus on the immediate causes and the effective skin care routine that treats them, but I will also list a few common deeper causes for you, and in a later section I will also describe scientifically based diet tips to keep acne under control.
So let’s see the most common deeper reasons (several of which may apply simultaneously 😔 )
Hormonal cause of acne
The most common deep cause is associated with the hormones androgen and insulin.
A typical symptom is that the condition of your skin deteriorates significantly before menstruation, and if you did a hormone test, the hormone androgen tends to fall in the upper (but still normal!) range, while estrogen tends to fall in the lower range.
Androgen hormones stimulate more sebum production in our skin.
This type of acne can also be significantly affected by diet, which we will write about later in a separate section.
Inflammation in the body in excess of normal can also cause acne, which is surprisingly often related to intestinal health.
If you often feel uncomfortable after meals, have constipation, or diarrhea, and you have acne, there may be a link.
If your skin always deteriorates during the exam period, or as an adult, for example, if you experience stress at work, this is a significant factor for you.
Stress increases cortisol levels and inflammation in the body.
Unfortunately, managing and reducing stress is not an easy thing at all, we won’t even address it in this article, but general stress management and lifestyle tips, such as regular exercise, can help.
If you need help to deal with stress, check out my post: How to deal with stress as a teen.
Acne caused by physical irritation
It is an easily recognizable and manageable type, as it occurs where regular physical irritation, rubbing occurs.
For example, in winter, you get acne on your forehead under your hat, or on your back under the backpack strap, and so on. The thing is solved if we eliminate the physical irritation.
Hypersensitivity to makeup, irritating ingredients, in rare cases to certain foods; other allergies or medications. If you realize exactly what you’re hypersensitive to, it’s also easy to fix.
The processes that should be followed are similar to everyone, and whatever the deeper cause, conscious skin care methods can do a lot to improve your skin.
And if you know the deeper reason and complement the right skin care with a skin-friendly diet, you really have every chance of beautiful, clean skin! 🙂
The formation of acne - what happens on your skin
You should understand the process of developing acne because it will help you delay the process.
These are the main steps:
1. The pores become clogged
Sebum keeps the skin moist and acts as a shield from environmental factors.
The inside wall of the pores peels in the same way as the skin surface, but in skin types prone to acne, this exfoliation process does not go smoothly enough and unevenly peeling cells tend to stick together.
In addition to exfoliating cells, the problem skin type often produces more oil than it needs, which is denser than normal.
When there is an overproduction of sebum along with the build up of dead skin cells and dirt, your pores can get clogged.
Clogged pores can trigger an inflammatory response.
Dense fat + unevenly peeled epithelial cells easily form a plug and clog pores.
The clogged (but not yet inflamed pore) is called a comedo, which, when opened, oxidizes to a black color and it becomes a blackhead.
2. P. acnes bacterias multiply
The fat-rich and air-poor environment of clogged pores is a super breeding ground for bacteria, especially Propionibacterium acnes bacterium, which is a major cause of inflamed acne. Perceiving a pleasant environment, P. acnes begins to proliferate.
3. The Immune Response: Inflammation
The immune system detects that bacteria have multiplied and tries to fix things. Because of this, it begins to produce large amounts of white blood cells, which are responsible for defeating the bacteria. Inflammation actually consists of stacked carcasses of bacteria and white blood cells that have fallen in battle.
If there is too much bacteria + pus, the wall of the pore will not be able to withstand the load and “ruptures”, creating a large, inflamed acne.
Before we move on to what to do about acne, let’s take a quick look at the most common misconceptions and what NOT to do!
Misconceptions that only make acne worse
Unfortunately, there are a lot of misconceptions about acne, and a lot of people use products that look good in the short term, but not only don’t help acne in the long run, but even make it worse.
Overcoming acne is only possible consciously and cleverly, so it is important that you do not fall for these misconceptions!
Myth # 1: Acne can be dried off
In fact, you can only “dry out” the moisture content of the top layer of your skin, which has nothing to do with acne.
If you also “drain” water and other moisture-binding compounds from your skin, you are compromising your skin’s ability to regenerate and to be able to fight inflammation; and this favors the growth of bacteria.
Gently soaking up excess oil from the surface of the skin or pores is quite different from “drying out” your face with the help of ruthless active ingredients!
Myth # 2: Acne is caused just by dirt on your skin
This misconception often leads to obsessively cleaning the face with various soaps and aggressively foaming cleansers.
Unfortunately, while a squeaky clean feeling can be pleasant, it not only doesn’t help, but it also increases the chances of irritation and dryness.
“Treating acne prone skin with skin scrubs” is also a huge mistake, which can cause inflammation on the skin’s surface and even increase inflammation and lead to distribution of bacteria. Forget soaps, exfoliators, and very foaming, aggressive cleansers.
Myth # 3: Acne can be treated topically
Salicylic acid (BHA) or benzoyl peroxide-based products (more on both below) can reduce the redness and swelling of acne, but that doesn’t mean you can eliminate treating the cause of acne.
If you always treat only the visible bumps, nothing will prevent the full development of the still invisible but already developing acne.
Topical treatment of acne can be good for those who have acne rarely and to a limited extent; however, if you do not belong to this (lucky) group, it is better to focus on the causes!
Myth # 4: If it pinches or tingles, it works!
There is no scientific evidence that ingredients that irritate or sting your skin are more effective against acne or oily skin.
The most common of these ingredients are alcohol, menthol, peppermint, eucalyptus, or lemon, which can be found in the ingredient lists of many anti-acne products.
Contrary to the expected effect, these active ingredients cause irritation, which can only worsen the condition of your skin! This is because irritation stimulates the sensory nerve endings in the depths of the pores, which increases sebum production.
What NOT to do Against Acne
The secret to treating acne skin is gentleness and tenderness. Note that acne prone skin is also sensitive skin!
Never wash your face with soap or a solid cleanser
The ingredients that are responsible for their firmness can clog your pores. In addition, the soap dries your skin, and its high pH leads to the growth of bacteria.
Don't pick your pimples!
If they “burst” by touching them, you can squeeze them out, but remember: the way you treat them can make the difference between healing and scarring!
Nothing is worse than a scar that you can only eliminate at great cost.
If they don’t come out easily, never torment!
Never use too hot or too cold water
They do not promote the retreat of acne or the healing process. Instead, they can cause inflammation, which exacerbates the problem.
Lukewarm water is your good friend.
Do not use alcoholic tonics and cosmetics
Do not use alcoholic tonics and cosmetics, or those that contain essential oils, fragrances, or refreshing, cooling ingredients such as menthol, eucalyptus, or citrus extracts!
These ingredients are not friends for sensitive skin, and thus not for acne prone skin.
What to do for an Acne-Free Skin?
So what to do against your pimples:
Topically, with creams, you will be successful if you skillfully delay the process described in the acne formation section, preferably at every step. Let’s see how!
Minimize pore clogging (BHA exfoliator)
Let’s look at the top active ingredients that can help to keep the natural exfoliation of the pore wall smooth.
BHA or salicylic acid
BHA is an oil-soluble chemical exfoliating ingredient that is a true gold standard in the treatment of problematic, blackheads, acne prone skin.
By entering the pores, it normalizes the exfoliation of the pore walls, and in addition, it also has an anti-inflammatory effect, meaning it delays the process of acne at several points.
We recommend that you use it in liquid form as a tonic, after washing your face, once a day (morning or evening when it is comfortable).
When choosing a product, make sure you know the amount of BHA (ideally 1-2%), know the pH (ideally between 3-4), and the product is free of alcohol and irritants.
Retinol is a true superstar that is not only an anti-aging superstar, but also effective against acne, and was originally invented to treat acne.
It helps to keep pores clean by not allowing dead exfoliated cells to stick together and form a plug.
If you are young and need to choose, choose a BHA exfoliator first, but if anti-aging is already a consideration, then retinol is a super choice.
Moreover, you can combine the two, for example, by using a BHA exfoliator in the morning and a retinol serum in the evening, or wait a few minutes after BHA fluid in the evening and then apply your retinol serum.
(If both retinol and the BHA product are strong, the two together are more likely to cause irritation. Always watch your skin and, if it is visibly exfoliated, take back from the frequency and / or strength.)
Niacinamide is also a superstar ingredient that helps fight acne by normalizing fat production and pore size and it also reduces inflammation.
You can safely combine it with BHA and retinol, you can use it either in the morning, in the evening, or even twice a day.
Zinc PCA, sarcosine, and other fat-normalizing ingredients
Excessive fat production is difficult to curb with cosmetics (medications can be really effective), but it can be helped a bit by blocking one of the important enzymes that regulates fat production (5α-reductase).
Zinc PCA and sarcosine are two ingredients that may help, but next-generation plant extracts also promise to help.
They may be worth using as a supplement in addition to the three top active ingredients (BHA, retinol, niacinamide) written earlier.
Fight against P. acnes bacteria
It is called Propionibacterium acnes in its full name. This evil bacterium is found in a very large proportion of inflamed acnes.
If you have inflamed acne rather than blackheads, then this phase is hyper-super important in your case. Let’s see the top active ingredients:
Benzoyl Peroxide (BP)
It is freely available in the US and Paula’s Choice also has a super BP treatment, in the EU BP-containing treatments are only available in pharmacies.
You can get a cream called Akneroxid in pharmacies. (Always ask your physician before buying it!)
Available in both 5% and 10% versions, but 5% is enough, research shows it is just as effective as the 10% version but with fewer side effects.
BP is the most effective acne treatment known today, but unfortunately the super effect comes at a price because on the one hand it dries the skin strongly and on the other hand it is the opposite of pro-oxidant, i.e. antioxidant, so it also ages the skin when used long-term.
Try it when nothing else helps and combine it with the pore cleansing active ingredients described in the previous section.
The BHA-BP combination is a true gold standard and can help you amazingly, even in severe cases!
It is much gentler to the skin than BP, still a super active ingredient.
If the active substance is over 10%, it is only available with prescription (Skinoren).
You can try it by yourself if it is less than 10%.
In addition to its anti-acne effect, it is an excellent anti-inflammatory and normalizes “cell behavior” in the pores, thus preventing the formation of acne on several fronts.
You may want to look at whether azelaic acid works for you instead of BP, or if it isn’t enough alone, you can minimize the amount of BP you need by using it alternately with BP every other day.
You can use it as a maintenance ritual after an initial 2-3 month course of BP.
Sodium Ascorbyl Phosphate (SAP)
There are more and more promising researches on a vitamin C derivative called SAP.
It is effective against P. acnes in 1% amounts and has a comparable effect to benzoyl peroxide when used in 5%.
In combination with retinol, it works synergistically to fight acne.
SAP is great option that not only doesn’t hurt or age your skin, it is good for it!
It is worth using it at least as an additional active ingredient.
Reduction of inflammation
Remember, acne is an inflammatory disease, which is why it is extremely important to treat your skin gently.
Anti-inflammatory drugs are a great addition to acne treatments.
The aforementioned BHA (i.e., salicylic acid), azelaic acid, and niacinamide also work through their anti-inflammatory properties, but any gentle, fragrance-, alcohol-, and essential-oil-free serum or moisturizer with anti-inflammatory ingredients is a great addition to an acne routine.
It is also important to wash your face with a gentle, pH-correct cleanser, and especially if you use Benzoyl Peroxide, don’t forget about proper hydration. Dried, under-hydrated acne skin is much harder to regenerate, maintaining a healthy protective layer and proper hydration is also super important.
Finally, contrary to urban legends, the sun is not good for acne, at most they are less visible on tanned skin, but otherwise sunshine is as good for the skin as smoking is good for the body. Not at all. Be gentle with your skin and use sunscreen every day.
Dietary tips for acne-free skin
It is not easy to study the relationship between diet and acne with scientific accuracy, but recently there are more and more substantiated evidence proves that there is a relationship between diet and acne, especially in hormonal and inflammatory types of acne.
This, of course, doesn’t mean there’s a miraculous, acne-removing diet, or that there are some awful food that causes acne in everyone, but unfortunately it seems to the typical “western diet” is not ideal for skin health, and it varies from individual to individual which food worsens the skin.
Drink water and eat healthy, balanced diet to nourish your skin.
See my Best drinks for Acne-Free Skin post!
One of the best-known studies on the subject is examined two non-western populations (living on the island of Kitava in Papua New Guinea and the Ache hunter-gatherer ethnic group living in Paraguay).
Researchers have found that acne is a completely unknown in these ethnic groups.
Examining more than 1,000 people for an extended period of time, specifically no one had a single piece of acne.
The exact reason for this is hard to know of course, but researchers explain it with a diet that is completely different from the western diet.
So how do they eat and what can we learn from them?
Their carbohydrate intake is exclusively of the low GI / GL type:
GI shortens the glycemic index (and GL the glycemic load), and unfortunately everything that is very delicious (at least in our opinion, but specifically sugar and white processed grains), are things with a high GI / GL index.
You’ve probably read that “white carbs” aren’t healthy anyway, and it really seems to increase not only your weight, but also the number of acne, especially hormonal types of acne.
On the island of Kitava, yam root and sweet potatoes provide most of the carbohydrate intake, and they don’t eat seeded grains or foods made from them at all, i.e. wheat, flour and things made from them are unknown.
The added sugar is also unknown to them, they eat fruit, mainly guava, pineapple, banana, papaya, mango, and melon.
In Kitavan, most of the protein intake is provided by fish that is rich in anti-inflammatory omega-3 fatty acids.
You might have already heard that the proportions of omega-6 and omega-3 fatty acids in today’s Western diet have shifted greatly.
While it used to be close to 1: 1 in hunter-gatherer times, today the ratio is close to 15:1, which is harmful to our bodies and cause many diseases and also acne.
Taking into account today’s realities, getting the right omega fatty acid ratio from your diet is almost impossible (eating more fish is a cool thing, of course), but taking omega-3 fatty acids (sometimes run as fish oil) is advisable.
In Kitavan they do not consume dairy products.
Milk and dairy products, like high GI carbohydrates, raise blood sugar levels quickly, and milk also contains other hormones that are good for calves but not necessarily good for people.
Dairy products are often the biggest negatively influencing food groups causing hormonal acne.
Of course, this skipping dairy products doesn’t work for everyone, but if you haven’t tried it yet and are consuming a lot of dairy products, you may want to reduce your milk intake, or if you can, try a 3-4 week dairy-free diet to find out if it is a significant factor in your case or not.
Fortunately, the above mentioned three tips are absolutely beneficial not only against acne, but they also improve overall health as well.
If you can, strive for a generally healthy, low-sugar, low-GI, low-carbohydrate diet rich in vegetables, fruits, and omega-3 fatty acids, and your skin and overall health are likely to improve.
Additional things to try:
Take a zinc dietary supplement: 30 mg of zinc daily has been shown to reduce the number of inflamed acne by about 30% in 3 months.
That is, it will not work wonders on its own, but taking one zinc pill a day is not a big deal, with the right skin care routine + diet it will help you even more to keep your acne under control.
Taking pre- and probiotics: Especially if your intestinal health is not perfect and you feel that you might have inflammatory-type acne based on your symptoms, you may want to experiment with probiotics or increase your intake of fermented foods (eg sauerkraut, kefir, kombucha tea).
When Over-the-Counter Products are Not Enough
If you consciously care for your skin as described so far, you have every chance of achieving a dramatic improvement in the condition of your face, even when it comes to severe acne.
But unfortunately, sometimes it also happens that you do everything well, yet the pimples do not go away.
Once you have tried the options above, the next step is to visit your dermatologist, who can help you with even more prescription treatments.
Now, in short, without claiming to be exhaustive, we will also list these options for you so that you know about them and come to your dermatologist prepared. This, of course, is no substitute for your doctor’s opinion, talk to him or her about the opportunities, pros and cons, and always listen to what you advise!
Prescription Topical Antibiotics
There are a number of topical antibiotic gels or ointments that can help with acne.
Examples are Zineryt, Aknefug, Aknemycin and Davercin containing erythromycin or Dalacin containing clindamycin.
You can use the prescription antibiotic on its own, but you can even combine it with benzoyl peroxide to increase the result.
This is because BP speeds up the action of the antibiotic, increases the activity against inflammation and injury, and helps your body to tolerate the bactericidal product.
In short, it promotes the effectiveness of treatment.
For example, one of the most popular and effective treatments, Duac gel, contains 1% clindamycin and 5% BP together, and it can be a good choice if over-the-counter products do not work.
The disadvantage of antibiotics is that unfortunately they can also cause resistance, so they may not work after a while.
Consult with your dermatologist before using them!
High Dose of Azelaic Acid
Azelainic acid is a super ingredient against acne, and if you feel that the versions around 10% are useful, but not enough, you can switch to a stronger version with the help of your dermatologist.
Azelaic acid was officially approved in the United States in 2002 as an anti-acne agent.
It can also be used against rosacea (especially the so-called “acne rosacea”, which is a type of rosacea that is a bit like acne).
Azelaic acid irritates the skin less than prescription retinoic acid derivatives or higher concentrations of benzoyl peroxide.
Topically applied retinoids
Retinol has a prescription, “stronger” version.
Differin gel contains a vitamin A derivative called adaplane, which can fight wrinkles and acne in a 2in1 way.
Take care with it, because it is a strong active ingredient, a common side effect of dry skin, peeling and irritation, so it is worth using it gradually and pay attention to proper hydration.
Differin gel has various side effects so consult with your dermatologist before using it!
Although ingestible antibiotics can be extremely effective against acne, unfortunately their side effects are not negligible either.
Perhaps their biggest downside is that they also end up with the beneficial microbes along with the “bad bacteria”.
Continuous use of them can therefore lead to vaginal fungus and digestive problems.
In addition, the bacteria that cause acne will quickly get used to the drug and become resistant to it. This means that if you take an acne antibiotic for more than half a year, it will sooner or later have no effect! (However, its side effects still do not go away.)
Recent research, however, has shown that if only a small dose of the antibiotic is used, the development of resistance can be avoided. Prolonged use of a so-called “sub-antimicrobial” dose can improve the condition of acne prone skin, but at the same time significantly reduces the chances of the bacteria becoming resistant over time (i.e., the effect of the drug does not disappear with prolonged use).
The lower dose is thought to have an anti-inflammatory effect rather than an antibacterial effect, but this also seems to be enough against P. acnes bacteria.
Of course, this does not mean that your body will not suffer at all from this.
It is best to discuss the pros and cons with your dermatologist!
Both the famous Roaccutan and several generic imitations of it are vitamin A derivatives.
The active ingredient is isotretinoin, which can be incredibly effective in treating acne, but unfortunately the disadvantages are just as significant.
It is only used in the most severe cases and can truly work wonders. The most common side effects are that the pimples get worse at first, the mouth becomes extremely dry and potted, and the skin also becomes dry and sensitive as well as sensitive to the sun. Less commonly, headaches and muscle aches also occur.
The drug can also cause a serious birth defect, so special care should be taken not to get pregnant while taking it.
Before deciding to take an isotretinoin medicine, discuss the pros and cons with your dermatologist in detail.
Birth Control Pills
Some types reduce the number of acne and excessive sebum production by reducing the effects of androgenic hormones (which usually play a big role in the development of acne).
The birth control pill is a mixture of synthetic estrogen and progesterone (i.e. female hormones).
Some progesterones increase the body’s production of male hormone, while others, on the contrary, inhibit it.
Because androgen (a male sex hormone) affects the function of the sebaceous glands, blocking it may be helpful for oily skin and acne.
As a result, there are birth control pills that are accepted in the treatment of acne, but unfortunately most of their effects only last as long as you take them.
However, keep in mind that these pills also have setbacks (especially if you smoke – risk of thrombosis), so be sure to talk to your doctor.
Birth control pills alone are usually not the right tool to treat acne.
How to Build a Skincare Routine for Acne-Prone Skin - with Example Routines
If you read this post all the way until this point (thanks a lot! 😊 ), you already know a great deal about the top ingredients and methods to overcome your acne.
What you still need to know is that there is no miracle drug, a miracle method that is sure to work for everyone.
If it were, there would be no acne, and I shouldn’t have listed so many options in such a long post.
A conscious and effective skin care routine for treating acne is like a wardrobe, individual, and customized.
You need to be patient and try the active ingredients wisely to figure out which one works best for you.
Remember: for skincare, more is not better. Find what works for YOU!
Most of the products can be used during both day and night routines.
Contrary to popular belief, 4 weeks is unfortunately not enough, the upper layer of the skin is renewed in a month, but the pimples start underneath this layer.
Realistically it takes 8-12 weeks for each active ingredient to show whether it is useful or not.
Best products to choose from for acne-free skin
Let’s look at some possible example routines and combinations!
Skincare Routine for Acne-Free Skin - Basics
Skincare Routine for Acne-Free Skin - BHA + Azelain + Niacinamide combination
Cleanser: PC Clear Cleanser
BHA exfoliator: The Ordinary Salicylic Acid 2% Solution
Azelain Serum: The Ordinary 10% Azelain Serum
Skincare Routine for Acne-Free Skin - SAP + Retinol + BHA + Niacinamide combination
Daytime routine - products to choose from for acne-free skin
It is vital to get rid of oil, dirt, dead skin so they will not clog them and produce breakouts
Use a milder one that will not disrupt the skin barrier by washing off too many natural oils from your face. A cleanser with salicylic acid can help you get rid of excess oil.
Let the cleanser some time, about 2 minutes to do its job before washing it off.
Moisturizers nourish the skin and prevent damage from environmental factors. They act as a barrier to keep moisture in and pollutants out.
Yes, you need to use a moisturizer even if your skin is oily. Unfortunately, if you don’t moisturize your skin, it will think it needs to produce more sebum.
A lack of sebum will cause the skin to produce more to compensate.
Acne-treatments can also dry the skin.
Use lightweight and gel type moisturizers.
Dr. Dennis Gross Skincare Hyaluronic Marine Oil-Free Moisture Cushion
Always use SPF
Always end your daytime routine with SPF to protect your skin
The earlier you start using SPF the better. Sun can quickly add years to your skin.
If you have oily skin, use non-comedogenic, oil-free SPF products.
Nighttime Routine for Acne-Free Skin
It is very important to wash your face at night even if you don’t wear makeup because the moisturizers and sunscreens can attract dirt and mix with them.
Exfoliation - BHA or salicylic acid
Chemical exfoliants gently lift away stubborn dead skin cells.
Some chemical exfoliants can be too harsh for a teen. You can use a toner or moisturizer that contains BHAs like salicylic acid or willowbank. Teen acne will not magically disappear by using them, as hormones and lifestyle habits also contribute to acne.
Also, if you are a teen, you don’t need serums to hydrate your skin yet. Stick with toners and moisturizers.
Sodium Ascorbyl Phosphate
Masks for an Acne-Free Skin
Spot treatments for Acne
The battle can be won! There are quite a few ways to reduce or completely overcome acne.
Use gentle, high-quality cosmetics with special anti-acne ingredients.
Avoid anything that is irritating! Eat healthy! If that alone wouldn’t be enough, you can visit your dermatologist to deploy prescription superstars as well.
Patience, perseverance and awareness work wonders against acne, and if you are reading this here now, you have all three!
Choose what active ingredients you try first and stick to them for at least 8-12 weeks.
Thank you for reading my post. Share this post with your friends because if you share, you care and that is what motivates me.