Today, I am going to discuss the things you can do at home, without seeing your dermatologist, if your main problem is comedonal acne. My following posts will discuss what you can do at home about inflammatory acne (although today’s advice can also be helpful for inflammatory acne), as well as when it’s time to see your dermatologist and what things you should ask when you do see your dermatologist. You should read my previous post “Knowing Your Acne” to help you best understand today’s advice. And, if you are pregnant or nursing, today’s advice is not meant for you.
If you have comedonal acne there are a few good topical treatment options that you should consider for your medicine cabinet. Topical treatment consists of using topical creams, lotions, washes, solutions and gels. The best options are salicylic acids (SA’s) and benzoyl peroxides (BPO’s). Of these, SA’s are better for purely comedonal acne. (I will talk about BPO’s later.) SA’s unclog “pores” and can help with the mild to moderate forms of comedonal acne. SA’s do this by exfoliating or sloughing off keratin material…and the keratin plug is part of the problem with comedones. But SA’s can cause flaking, dryness and even irritation. This is because they can’t tell the difference between the normal keratin layer (that covers the entire skin surface) and the keratin plug of a comedone. So, it sloughs everything leading to these side effects in some sensitive individuals.
Salicylic acid products range from 0.5-2% over-the-counter. If you have sensitive skin, I would recommend starting with a mild salicylic acid (0.5%). Washes tend to be the least irritating but the least effective; that’s because they are considered “short contact,” meaning they are only on your skin for a short while during the time you are washing your skin. Lotions and creams tend to be less drying than solutions and gels, but at the same time solutions and gels typically penetrate the skin better rendering them more effective but sometimes more irritating at the same time. I recommend starting with a lower strength SA once a day but initially only 2-3 times per week. Gradually work up to daily use and if you are still tolerate them, you can increase the strength of your treatment or increase the “vehicle” strength. By increasing veheicle strength I mean switching from a wash to a lotion or cream, for instance, or from a lotion or cream to a solution or gel at the same strength percent. This is a very safe way to go but takes patience!
Glyclolic acids (GA) (typically 3-10% over-the-counter) may also be helpful for some people with comedonal acne. Their action in unplugging plugged pores (or comedones) is similar to SA’s but they are less effective. So I almost always recommend starting with an SA over a GA for comedonal acne unless your main complaint is skin discoloration. In this case, GA’s are probably a better choice. GA’s are better at treating skin discoloration but SA’s are better at treating comeedonal acne. GA’s have the same side effects as SA’s and come in the same vehicles (washes, lotions, creams, gels, solutions). The same strength comparison between washes, lotions and creams, gels and solutions holds true for GA’s. I recommend starting with a low % (3-5%) treatment 2-3 times per week and working up to daily just like with SA’s . You can also increase vehicle strength (washes->lotions and creams->solutions and gels) like with SA’s.
If you have inflammatory acne in combination with comedonal acne, you are not out of luck! Because the comedone is the initiating step to developing a pimple (even if the comedone is not visible to the naked eye), SA’s and, to a lesser extent, GA’s are also useful for treating inflammatory acne!! What a bonus! But I will talk about other, typically more effective treatments for treating predominately inflammatory acne on my next post. Inflammatory acne is the most common type of acne in adult female acne.
In summary, I recommend starting with a salicylic acid for comedonal acne but glycolic acids may be a better place to start if you also have discoloration left by acne. In general, start with weaker products infrequently and work up first in frequency to daily or even twice daily and then you can go up in strength. If you know your skin and you think you can handle it you can start with a higher strength product but I still recommend using it only 2-3 times a week and working up. If you get dry or irritated, it’s o.k. to use non-medicated lotion or cream on top of or after using a SA or GA.
Moisturize with light lotions such as CeraVe lotion for mild dryness or CeraVe cream or Cetaphil lotion for more significant dryness. Stay away from astringents and avoid over washing and scrubbing! Use a gentle cleanser (more on these later).