Tip #: 


If you have inflammatory acne, you are not alone!!! This is the most common type of acne among adult women. I hope you have read my previous posts in “Tip #14” about knowing your acne and “Tip #15” discussing treating comedonal acne because that will help you better understand today’s advice. Today’s advice is not meant for pregnant or nursing women.

A quick note for those of you who have cystic acne (large lumps under your skin). You should really make an appointment with your dermatologist because cystic acne causes permanent scarring and the best treatment for scarring is prevention. Cystic acne usually requires prescription oral treatment as well as supervision of your progress by a dermatologist. But if you prefer not to go that route, you can benefit from today’s advice.

When using acne products, the best way is to use these treatments as preventions and not as spot treatments. These products are meant to be used in areas where you typically get acne even if that area is temporarily clear because there is likely something brewing that you are not even aware of. You should avoid areas where you do not get acne and areas that are overly dry or sensitive.

If you are new to the field of over-the-counter (OTC) treatments for inflammatory acne, the best place to start is with a benzoyl peroxide (BPO). BPO’s range from 2.5% to 10% and come in washes, solutions/pads/wipes, lotions, creams and gels. BPO’s have not only an antibacterial effect that helps with inflammatory acne, but they also have a keratolytic effect that helps break down comedones and comedones can lead to pimples, or inflammatory acne. Washes tend to be the least irritating but the least effective because of the short contact they have with the skin. Lotions and creams tend to be less drying than most solutions and gels. But, in general, solutions and gels tend to penetrate the skin better so they can be very effective if your skin tolerates them. BPO’s can cause irritation, redness, flaking and burning especially at the higher %’s. So like in my previous advice, I recommend starting out at a lower % (2.5% - 5%) product and to 2-3 times per week. If you tolerate the product after 1-2 weeks, I recommend working up in frequency of use (daily or twice daily) and then working up the % if you tolerate daily use. But take things slowly and don’t change things too quickly or you may end up with painful skin. Also, if, after a couple of weeks, your acne is getting better or at least not getting worse, you should consider sticking with that product instead of trying a stronger treatment. Remember, it can take 6-8 weeks to see the true results of the product you are using. One note on BPO’s: besides being irritating to the skin for some individuals, they also bleach fabric. So, if you are using them on your face, either use them during the day under your make-up (unless you are using a wash) and be sure to not let it touch your clothes or use a white pillow case at night. If you are using them on your back or chest, I recommend using them at night and wearing an old tee-shirt.

Because salicylic acids (SA’s) work primarily on comedonal acne and that is really their best use, they can also be effective for inflammatory acne. As I discussed in my previous advice, the comedone is the precursor to a pimple, even if you aren’t always seeing the comedone. So, I’d refer you to “Tip #15” discussing OTC treatment for comedonal acne. But, if you have primarily inflammatory acne with pimples, BPO’s are a better bet because they have both a keratolytic effect to break down comedones and an anti-inflammatory effect to help with the inflammation of pimples.

Sulfurs are also an effective treatment for inflammatory and occasionally cystic acne. OTC sulfur treatments for acne come in cleansers and soaps, lotions, creams, gels and masks. This category of treatment is usually quite drying and so I only recommend it for those of you with oily skin. If you like spot treatment these creams and gels can really dry up a pimple in a hurry. If you’ve already tried BPO’s and you have oily skin that usually tolerates drying treatments this is a good second choice for treatment. I would recommend starting with a soap or cleanser and then work up to lotions, creams and gels. But beware of masks unless you are experienced in this category. Also, sulfur acne treatments can sometimes be a little stinky (so read the reviews) and are more difficult to find than BPO’s and SA’s.

Let’s say you just have never been able to tolerate BPO’s, SA’s, and even the sulfur soap/cleansers are too drying. Then, I would recommend trying azelic acid. This comes as a prescription but you can also find it on the internet. It’s generally not drying or irritating, except you may experience a little tingling or stinging initially. Start once per day and work up to twice a day. I don’t recommend this for darker skinned individuals because it can lighten skin. Although this isn’t a terrific treatment for inflammatory acne, it’s something I recommend trying if you just can’t tolerate anything else and aren’t ready to see a dermatologist yet.

Finally there are combination products or products with more than one “active ingredient” such as a combination of BPO with SA or glycolic acid (see “Tip #15) in the same bottle or used together in different bottles as different “steps”. If you are new to any of these products I don’t recommend starting out with more than one active ingredient. This is because if you get a reaction to a combination product or a treatment with different “steps,” it’s difficult to know which ingredient you reacted to. So first start out with a product with a single active ingredient (only BPO, only SA or only GA). If you prefer buying acne treatments with different steps, use only a single step with an active ingredient (BPO or SA or GA) for the first 1-2 weeks and if you don’t have a reaction, then add another step with another active ingredient. It’s o.k. to use steps that don’t have an active ingredient right away in combination with other steps.

Other things to remember:

  • Do not scratch or pick at your acne.
  • Do not overwash or scrub your face.
  • I don’t recommend astringents because they make your skin less tolerable to the active ingredients in the above products.
  • Use a gentle wash (unless you are using and tolerating a medicated wash).
  • If you are dry, use a gentle moisturizer over or after you use your acne treatment and use moisturizer at times when you are not using acne treatment. I recommend CeraVe lotion for mild to moderate dryness, irritation and redness and CeraVe cream or Cetaphil lotion if you are experiencing more significant symptoms.
  • Finally, take “vacations” for 2-3 days from using your treatment if you are getting too dry or irritated.