So I've already griped and moaned about all the trouble I've gone to over the years for clear skin. Oh if only if only I had something to show for it.
So now I will lay out every single type of treatment I've attempted and will tell you my thoughts.
1. Toners, astringents, cleansing foams: These are of the "dry it up" variety. Basically what they do is temporarily sap all oil from the skin surface, which can help minimize comedones in the short term. However, long term they make the condition worse, because any time the skin is so stripped, it receives a signal to porduce more oil to moisturize itself. And off course more oil leads to more zits. This is part of how I have so permanently destroyed my skin.
2. Sulfur: For some it's a godsend, for others like myself, after each and every sulfur mask and treatment, there is just plain disapointment afterward. Sulfur is also a dry it up type of thing, but it's more common in spot treatments (Proactiv's refining mask, Mario Badescu's drying lotion, DDF's sulfur mask) because it REALLY absorbs oil. But for some reason only on certain people. It has never done a single thing for me, besides smell really bad. However you may luck out so definitely try it at least once, because it irritates very few people.
3. Benzoyl Peroxide: Benzoyl is an antibacterial that is particularly effective on p.acnes and is used in a wide variety of over the counter and drugstore acne products (the Clean and Clear line is pretty much based on it). It is effective and the results are quick, however for some of us there are too many down sides. It's not preventative, it's a spot treatment. I've used it in face lotions to prevent and I found it creates a horrible texture on the skin and makes any makeup cake. However it also bleaches sheets (and your eyebrows). Over time it leads to oxidation in the skin and dehydration, which encourages skin to age prematurely. For the vast majority of people it is also irritating and leads to some degree of tightness, redness and inflammation. It is available in concentrations between 2 and 10%, however past 5 it just irritates more than it does disinfect.
4. Salicylic acid: One of my personal favorite ingredients. It too works very quickly to reduce any current pimples however it also prevents. It's a BHA so it is actually capable of going inside the pore to exfoliate and clean it out (Neutrogena's acne line is almost entirely based on it, which is part of why Neutrogena is my favorite drugstore brand). It is also used in some anti-aging formulations because of its exfoliating and clarifying properties. However many people find it irritating in the usual 2% formulation, which is why it may be worth it to look for 1% concentrations. For those who like me are lizards and react to nothing, layering salicylic products may be the solution, starting with a cleanser, than a spot treatment and then a lotion. I have found this to help me at times. However this BHA is also somewhat drying (not nearly as much as Benzoyl or toners) so I would only layer in emergency situations.
5. AHA's: These are primarily used in anti-aging formulations because they increase sluggish cell turnover, brighten skin tone, deliver moisture to the skin cells and over time increase collagen production. The most common ones are Glycolic and Lactic acids. I blogged about Mandelic Acid recently and I am very excited to try it because it's an AHA but also an anti-bacterial. Their use in cleansers can help acne sufferers too. A cleanser with exfoliating properties can be a great way to skip a step in the morning and something that overall cleans up the dead skin on top of the skin is a great pre-cursor to a moisturizer with another acne ingredient. AHA's too can be irritating and I've actually found that skin gets "addicted"to them. As in after constant use for an extended period of time, skin becomes dependent on it's exfoliating action to renew itself and seems to get confused and disoriented trying to exfoliate itself. I am a personal testament to this, even though I've switched to scrubs a year or so ago, without a lot of aggressive cosmetic help, the dead skin cells just pile up on top and seem to glue themselves with my oil and stick there. I am still trying to get rid of the horrible breakout spree my skin went on when Neutrogena's Microdermabrasion cream was temporarily taken off the market this past year. So if you're going to try AHA's tread lightly unless you want to be dependent on them for the rest of your life.
Retinol and prescription Tretinoin: Both are derivatives of Vitamin A that are useful for both aging and acne, because again, chemical exfoliant (but also one of the very few cosmetic ingredients that have been proven, time and time again to increase collagen production, which is why all of Olay's various lines are based upon it). Retinol is the over the counter version found in a wide variety of lines, from dirt cheap to astronomical. Tretinoin needs to be prescribed by a doctor in the form of one of the many many different types of treatments (Renova, Retin-A, Differin, etc etc). My skin just says pfft to retinol, it's too tough for that, though many many people find it very irritating. Prescription Renova is the ONLY thing that's ever caused a reaction in me (I was so scared that I immediately threw out the tube, my skin reacts to nothing, seriosuly) and it was a bad one. Redness, peeling, tightness, inflammation. The worst thing was the fact that I could not use anything on top to moisturize unless it was a pure oil, because any tiny little thing set off the burning (for a moment I knew what it was like to be one of the unfortunate women who react to anything, preservatives, sulfates, synthetic sunscreens). Both retinol and tretinoin cause ridiculous photo-sensitivity, which requires a broad spectrum sunblock with as high an SPF as you can find, with only physical blocks (zinc oxide and titanium dioxide) because synthetic sun products are very irritating to spuer sensitive skin. If you have tried everything else and are desperate, go see a derm for a tryout of a tretinoin product, it just may save you. But be veryveryvery careful with every other product you use.
Topical prescription antibiotics: These are basically ultra strong versions of OTC antibacterial products. My favorite is clindamycin because it's clear, absorbs like water and has no side effects besides slight stinging and irritation (and on me, nothing). They are very potent against bacteria themselves, but may be drying for those with normal or drier skin. Still worth a try, because it's the most side effect free prescription treatment.
Accutane: Another prescription product and the only one that has ever completely cured acne. How? Because it is a pill that you ingest and it saps up every single little bit of oil in the body. If there is no oil, skin cannot clog. It is also the only acne treatment on earth I have never tried. This is because it's been strongly linked to increased depression and thoughts of suicide (and many actually HAVE killed themselves while on it). Considering I've been battling depression since the age of 12, I thought it best not to do anything that might send me over the edge. I will never recomend this, to even the happiest person. Nothing is worth the torture a family goes through when someone close commits suicide, least of all something as trivial as clear skin, and the risk is just too high. Try something else.
Laser skin resurfacing: A type of treatment available at a derm's office that is most frequently used to fight aging, but is also commonly targeted to acne. There are many many different types of lasers and only a proffesional can determine what kind would be most appropriate for each type of case. What they all do however is exfoliate, renew collagen formation and basically let you start out with a new face. The side effects are many, like prescription retinoids, skin can have a red, tight, burnt, flaky finish and find itself irritated by anything and everything. However, for many people the benefits are worth it. This can get veeeerrrrryy expensive, because it is literally thousands of dollars and it needs to be repeated. If you have a bottomless pocketbook (adopt me?) try it out at least.
Light therapy: There are certain wavelengths of light that can have different effects on skin. Blue light has been proven to kill p.acnes and help prevent future accumulation. This is the technology that the Thermaclear, Zeno and Tanda acne systems are based on. It is available in derm's offices and certain medical style spas and it is one of my favorite treatments due to the low incidence of irritation. I mean it's literally gliding a light over the face and the light kills zits. The results can be very fast, when I had a facial which incorporated the light I walked out with half the zits that I came in with. Which is part of why I want to get the Tanda or the Thermaclear system at home
Chemical peels: These are derm level AHA treatments. There are varying strengths available but all of them exfoliate to a ridiculous degree. Off course the side effects can get pretty bad too, like all the other exfoliating treatments I described there will be redness, sensitivity, peeling, tightness etc etc.
Manual exfoliation/scrubbing: This is my favorite method of treatment (my skin was at it's very clearest when I scrubbed day and night with Neutrogena's Microdermabrasion cream and then applied prescription clindamycin, while moisturizing with primer). There are vary vary varied levels of treatment. The harshest would be getting proffesional microdermabrasion, then at home microdermabrasion products, than hard grain types such as apricot kernel and the gentlest being buffing/jojoba bead additives in cleansers. The great thing about scrubbing rather than using acids, is that there is less of a chance of skin addiction and pressure can be controlled. If there are particularly rough spots, that's where you would concentrate your scrubbing efforts and only lightly graze anywhere more sensitive.
Tea tree oil and other essential oils: Any essential oil that has antibacterial, cleansing, clarifying, detoxifying or antifungal properties can help with acne, but tea tree oil is the most famous and beloved because it's the strongest. Like any synthetic acids or treatments it should never be applied to the skin on it's own because it can cause severe reactions. But when diluted with moisturizing ingredients it's potency is still strong, however the incidence of irritation goes waaayyy down. Other essential oils with similar properties include rosemary and all the citruses. Adding a few drops of one of these to an inflammatory and moisturizing cream is my recomendation for anyone that considers their skin sensitive. Experiment with different concentrations and see what your skin likes best. If this doesn't make a big enough difference see about some other options, but always make sure to monitor reactions very carefully.
I hope I've helped de-mystify some of these treatments for the un-initiated and reminded others like me (long time cosmetic obsessed sufferers) of some treatments they haven't yet tried.
And don't do Accutane.
Image courtesy of bam.gov