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6 Tips for Treating Persistent Acne

All acne, whether adult acne or teenage acne (acne vulgaris), begins when excess sebum clogs pores. This means acne starts deep down in the follicle, below the reach of anti-acne cleansers, masks and lotions.

Since a pound of prevention is worth an ounce of cure, using oils rich in omega-3 and -6 essential fatty acids is a very effective way to treat acne. Rather than stripping the skin of surface oils, omega-3 and -6 facilitate deep penetration to dissolve congestion and prevent the formation of comedos (blackheads). You can also head off comedo formation by supplementing with pantothenic acid (vitamin B5), by using salicylic acid washes and masks to unclog pores (as long as you aren’t allergic) and by using a topical retinol/retinoid product.

Many conventional treatments use benzoyl peroxide (BP) to target Propionibacterium acnes (P. acnes), which is a main player in acne formation. But there are serious downsides to prolonged BP use—it disrupts microbial balance, the key to keeping skin healthy, and is a powerful generator of free radicals and can seriously accelerate skin aging. We suggest avoiding benzoyl peroxide treatments.

Ultimately, an individual’s personal chemistry and immune system function determine acne development because, like most skin disorders, its primary root lies in inflammation. The more we learn how the interactions of skin microbiota and mechanisms of action in the epidermis and dermis keep skin healthy, the more real progress can be made in treating acne. It's all part of the paradigm shift we are seeing: microbiome research has shifted focus from killing “bad” microbes to cure disease to enlisting "good" bacteria to create health. 

Follow these tips to start your path to permanently clear skin:

  1. Cleanse: Do wash your face once or twice a day to get rid of excess grime using a gentle liquid soap with a pH around 4-5. Don't use soaps and cleansers that are too alkaline (high pH). They dry out your skin, disrupting barrier function which works to minimize pathogenic assault. Cleansers containing triclosan or other antimicrobials will disrupt microbiota balance—if you use too much triclosan and kill P. acnes without killing Staphylococcus aureus, you may even end up with boils instead of pimples.
  2. Tone: Do use toners that keep the skin’s pH on the low side (3-4) because Strep and Staph pathogens prefer high pH environments. Don't use alcohol or other harsh toners that dry out your skin as they compromise the lipid barrier that protects you from pathogenic attack.
  3. Oil: Do prevent sebum build-up in pores with oils high in linoleic and linolenic essential fatty acids. Linoleic acids, the omega-6s, are especially important for maintaining proper sebum flow. Your topical oil blend should also contain omega-3 (linolenic acid) oils in the proper balance. Omega-3 oils, including flaxseed and chia seed, inhibit production of prostaglandins, naturally occurring hormone-like substances that can increase inflammation. Oils high in EPA (eicosapentaenoic acid) are valuable for anti-inflammatory effects, and can be found in fish oil, krill oil and some algae oils. Don't use oil-free moisturizers. They'll give you the illusion of moisturizing your skin, but ultimately deprive it of the oils it needs to stay healthy and acne-free.
  4. Vitamin A: Do find the vitamin A derivative (retinoid or retinol) that is right for your skin. Vitamin A is the skin vitamin, proven to improve acne and wrinkles. It is the essential ingredient in keeping skin clear and youthful. Don't make choices based on misinformation about retinol/retinoids and how they work. Find the right information here.
  5. Exfoliate: Do exfoliate with cleansers and masks containing lactic acid and sodium salicylate. Sodium salicylate, the salt of salicylic acid, has anti-inflammatory effects. Salicylic acid is a beta hydroxy acid that eats protein from the outside in, which assists in unplugging pores. Be aware of the FDA- issued warning about severe allergic reactions—though very rare, they are serious. If you experience swelling, excessive redness or a rash when using a mask or cleanser containing SA, discontinue its use immediately. Don't exfoliate with scrubs that contain sharp particles. These particles can cause microscopic tears in the skin, inviting invasions from unfriendly microbes like Stapylococcus aureus and Streptococcus pyogenes.
  6. Vitamins: Do  take your vitamins—some are to be taken internally, some applied topically and some, both. Vitamin B5 (or pantothenic acid) is at the top of the acne sufferer’s list. The body draws from the available pool of B5 to not only make hormones, but to make Co-enzyme A which is used to break down fats and sebum. During times of peak hormonal activity like puberty, the body’s top priority is generating hormones, often leaving nothing left over for sebum and fat breakdown. This is why you see so many teenage boys with acne. B5 can be taken internally and applied topically—for mild adult acne, topical treatment is often enough, but teenagers with moderate to severe acne should consider taking oral supplements, as well. Don’t take too many supplements, especially oil-soluble vitamins like vitamin A.

    Other vitamins:
    1. Vitamin B3: Anti-inflammatory. Apply topically.
    2. Vitamin D3: Regulates sebaceous gland activity and sebum production, decreases overactive cell turnover rate to help keep pores clear. Take internally only.
    3. Vitamin C: Anti-inflammatory, builds up capillary linings. Take with vitamin E as they support each other’s antioxidant function. Both can and should be taken internally and applied topically.

    Additional supplements:

    1. Omega-3 essential fatty acids, especially fish or algae oil high in EPA: Anti-inflammatory. Can be taken internally and applied topically.
    2. Zinc: Reduces sebum and anti-inflammatory. Take internally as zinc gluconate. Take topically as zinc oxide in your sunscreen.
    3. Probiotics: Rebalances the skin microbiome. Take internally and apply topically, by using yoghurt as a cleanser, moisturizer or mask.