Each of the following products and product categories reflects state-of-the-art treatments for blemishes, acne, and blackheads. How to put them all together is addressed above in “The Basics” section.
All of the products described below address each of the factors that cause pimples. These are the best options for reducing oil production, disinfecting the skin, improving exfoliation, and for controlling hormonal activity, and are a potential cure for blemishes. Finding the combination that works for you is the first goal, and then you must focus on hitting all the steps and carrying them out consistently.
Gentle cleansing is the first place to start. I’ve already elaborated on the need for gentle cleansing, but let me say it one more time for added emphasis. Using a water-soluble cleanser gently cleans your skin without stimulating the oil glands, increasing redness, or creating dryness. This step is standard for any skin-care routine because it makes an instant difference in the appearance and feel of the skin, and it is essential for reducing breakouts. Once you stop using drying, irritating, pore-clogging soaps or bar cleansers, and you realize how nice your skin feels when it is no longer dry and irritated, you will never go back to the old way again. Just be certain the water-soluble cleanser you select doesn’t contain irritating ingredients and won’t dry out the skin. Using cleansers that contain exfoliating agents, topical disinfectants, or oil-absorbing ingredients is not the best option because the active ingredients would be washed away before they had a chance to have an effect on skin. Save these ingredients for another step.
Killing acne-causing bacteria comes next. There aren’t many options for disinfecting the skin. Alcohol (when used in the right concentrations) and sulfur can be good disinfectants, but they are too drying and irritating, causing more problems than they help, and that can generate more breakouts. Plant-derived disinfectants such as tea tree oil (melaleuca) are an option but there are no products currently being sold that contain a high enough concentration to reliably kill bacteria. Benzoyl peroxide is still the best over-the-counter disinfectant to consider, and is available over-the-counter in 2.5%, 5%, and 10% concentrations.
If benzoyl peroxide isn’t effective, a topical antibiotic or a topical antibiotic combined with benzoyl peroxide prescribed by a doctor are excellent options. If you are seeing a physician, one of typical treatments they might choose is to prescribe an oral antibiotic to kill stubborn, blemish-causing bacteria from the inside. However, an oral antibiotic should be a last resort because of systemic problems and problems with resistant bacteria. Oral antibiotics can indeed kill blemish-causing bacteria, but they also kill good bacteria in the body, causing yeast infections and stomach problems. In addition, P acnes in your body can develop resistant strains in a short period of time, making the antibiotic you’re taking ineffective, and then you have to move on to the next one, which reduces your choices of antibiotics should you need them for a serious illness.
Exfoliate! Because blemishes occur inside the pore and involve oil production, an effective 1% to 2% salicylic acid (beta hydroxy acid—BHA) product is a crucial over-the-counter starting point for exfoliating the skin. Salicylic acid is lipid soluble, which means it can exfoliate through oil, so it can get inside the pore and exfoliate the pore’s cell lining and improve its shape, plus it is extremely gentle. I recommend using BHA in a gel, liquid, or extremely light lotion formula because these formulas are unlikely to contain waxy thickening agents or emollients that can clog pores. Alpha hydroxy acids (AHAs) can be helpful for surface exfoliation, but they can’t affect the pore lining, and it’s essential to do that to deal with one of the root causes of a blemish.
Scrubs are an option for extra exfoliation, but because they typically come in thick formulations and those ingredients can clog pores, a washcloth with your gentle cleanser can provide the same benefit without any problematic added ingredients.
Improving cell production with retinoids is also very helpful. Tretinoins or other vitamin A prescription derivates, as found in Differin, are prescription options for generating healthy cell growth that can change the shape of the pore, allowing for normal oil flow. This improvement can eliminate the environment that allows the blemish to develop.
Absorbing or controlling excess oil is another consideration. Clay masks are an option for absorbing oil as long as they contain no irritating ingredients. Using milk of magnesia as a facial mask is a simple and effective way to absorb oil. Birth-control pills and hormone blockers can also equalize hormones, reducing or eliminating the source of excess oil production.
When all else fails, meaning your breakouts persist after you’ve tried these over-the – counter and prescription options, then you can still try photodynamic therapy or Accutane. Accutane is the only medication that can essentially cure acne and is essentially the last option in any experiment to deal with acne because of its serious side effects especially if a woman becomes pregnant while using it.