Building an Acne-Fighting Skincare Routine Step by Step

Skincare remains the backbone of successful acne management. However, many people are reluctant to try new acne skincare products due to the fear of acne purging or the temporary worsening of acne at the start of an acne treatment.

Improper use of even the mildest skincare can irritate and exacerbate breakouts. Over-exfoliation or the use of chemical exfoliators more than twice a day and/or starting at high concentrations, can strip your skin's natural barrier, leading to irritation and dry skin.

Safe Starting Concentrations for Skincare Acids

ACIDS	CONCENTRATION
1. Salicylic acid	0.5 to 2%
2. Azelaic acid	10%
3. Mandelic acid	5%
4. Polyhydroxy acids (PHAs)	3%
5. Glycolic acid1	2 to 5%
6. Lactic acid2	2 to 5%

 ¹ May cause burn spots when used in huge areas such as whole face. May be used for spot treatment for lesser risk of burn spots.
² May cause irritant contact dermatitis in darker skin phototypes such as Filipino skin.

Harsh ingredients, such as Benzoyl Peroxide, and those at high concentrations can trigger inflammation, causing redness, swelling, and stinging of the skin. Even well-intentioned layering of products can clog pores and fuel breakouts. Remember, less is often more when it comes to acne-prone skin. In this blog, we will teach you what you need to know about acne and skincare to help ensure a smoother acne journey.

 

What is Acne and what causes Acne flare ups?

While acne might seem like a random breakout, science says several factors play a role: Some people are simply more prone to acne than others because of genetics. There are multiple genes currently implicated in the development of acne but there is still no single "acne gene" that has been identified. While genetics play a role, they do not guarantee acne development. 

On a background of genetic predisposition to acne, the following are factors found to also contribute to acne flare-ups:

Internal Factors

• Hormonal fluctuations: Androgen hormones can increase sebum production and clog pores, contributing to acne flare-ups, especially during puberty, menstruation, and pregnancy.
• Stress: Psychological stress can worsen acne by triggering the release of hormones like cortisol, which can increase inflammation and oil production. Separately, mental health conditions can cause abnormalities in gut permeability and subsequent systemic inflammation, indirectly contributing to acne flare ups.
• Gut bacteria: Imbalances potentially linked to breakouts as proposed in the brain-gut-skin axis model

 

Potential Pathways of the Gut-Brain-Skin Axis in Acne Vulgaris: [1] Psychological distress alone or in combination with [2] high fat diet, processed comfort foods devoid of fiber, cause alterations to [3] gut motility and microbiota profile [4]. Loss of normal microbial biofilm (Bifidobacterium in particular) causes intestinal permeability and endotoxins gain systemic access [5]. Burden of inflammation and oxidative stress is increased, substance P is elevated, insulin sensitivity is decreased due to endotoxemia [6]. In those genetically susceptible to acne vulgaris, this cascade increases the likelihood of excess sebum production, exacerbations in acne and additional psychological distress. Both probiotics and antimicrobials may play a role in cutting off this cycle at the gut level."

Source: National Library of Medicine 

• Underlying medical conditions: Conditions like polycystic ovary syndrome (PCOS) can contribute to hormonal imbalances and worsen acne.

External Factors

• Improper skincare use: Over-exfoliating, using irritating ingredients such as hydroquinone, glycolic acid, lactic acid, and benzoyl peroxide (BPO), starting active ingredients at high concentrations, or neglecting gentle cleansing can damage the skin barrier and worsen acne.
• Comedogenic cosmetics: Makeup and skincare products containing pore-clogging ingredients like squalane, can exacerbate acne. Go for non-comedogenic and oil-free formulas. 
• Friction and pressure: Repeated touching or use of equipment like electric spinners or brushes rubbing against the skin can cause frictional dermatitis and trigger breakouts due to inflammation.
• Environmental factors: Humidity, pollution, and excessive sun exposure can worsen acne by irritating the skin and increasing inflammation.

• Medications, like corticosteroids, iodine, oral contraceptives, high dose Vitamin B12 or cyanocobalamin can trigger acne flare-ups in some individuals.
• Lifestyle: Individuals who smoke often manifest a more severe form of acne. Smoking may also delay response to acne treatment.
• Diet: Although research is evolving, some studies suggest links between high glycemic index foods (white bread, sugary drinks), dairy products, and acne flares. However, evidence remains inconclusive and individual responses vary.

Because of these considerations, a holistic approach focusing on managing hormones, stress, diet, together with gentle skin care practices is crucial for preventing and managing acne flare-ups.

The benefits of a skincare routine for Acne

Having a regular skincare routine offers several benefits that can contribute to the overall health and appearance of your skin.

1. Improved Skin Health: Consistent care provides your skin with the necessary ingredients such as ceramides, fatty acids, and cholesterol to maintain its barrier function, hydration levels, and overall health. This can help prevent issues such as dryness, acne, and sensitivity. Consider the Mission: Skin HydroLock Lite Moisturizing Cream which comes in a 1:1:1 concentration of ceramides, fatty acids, and cholesterol that mimic our skin barrier for skin barrier repair. 
2. Prevention of Skin Problems: Regular cleansing and treatment can help prevent the development of skin problems like acne, wrinkles, and sun damage. By addressing these concerns early, you can often avoid more complicated and expensive treatments in the future.
3. Aging Gracefully: A skincare routine that includes products with antioxidants, retinoids, and peptides can help reduce the appearance of fine lines and wrinkles, promoting a more youthful appearance.
4. Better Absorption: Regularly caring for your skin can maintain normal skin thickness, allowing the skin to better absorb and benefit from skincare actives.
5. Personal Time: A skincare routine can also serve as a form of self-care, a daily ritual that allows for personal time and relaxation. This can have positive effects on your overall well-being and stress levels. Skincare routines may have a therapeutic effect and may positively impact mental health.
6. Skincare Customization: A regular skincare routine allows you to track your skin’s response, allowing you to select products and modify use to suit your skin's needs, whether it's hydration, anti-acne, oil control, or anti-aging.
7. Cost-Effectiveness: Some skin conditions can cause cumulative damage and irreversible changes to your skin that manifest as acne scars and accelerated skin aging. Investing in a consistent skincare routine can be more cost-effective in the long run by preventing these changes that may require expensive treatments in the future.

In summary, a regular skincare routine is crucial for maintaining the health, appearance, and longevity of your skin, as well as offering psychological benefits through self-care practices.

Inconsistency with your skincare routine can lead to several downsides for your skin, ranging from minor setbacks to more significant issues.

1. Reduced Effectiveness of Treatments: Topical medications like retinoids require consistent use for at least 3 months to achieve their full effect. Inconsistency can lead to delayed results or even render them ineffective, leading to decreased ability in managing breakouts.
   
   Moisturizers not applied regularly will not allow proper healing of compromised skin barrier, making the skin more prone to irritation. Inconsistency with moisturizers can leave your skin feeling dry and flaky causing it to have an irregular skin texture.

Moreover, skipping sunscreen regularly increases the risk of sunburn, premature aging, hyperpigmentation, uneven skin tone, and even skin cancer.

1. Breakouts and Imperfections: Skipping or being inconsistent with cleansing can lead to a buildup of dirt, oil, and dead skin cells, potentially clogging pores and triggering breakouts. Irregular exfoliation can leave your skin feeling rough and uneven, while over-exfoliating can damage the skin barrier, making it more vulnerable to irritation and breakouts.
   
   Irregular exfoliation allows sticky skin cells in the hair follicles to build up and clump together and form skin plugs which leads to clogging of pores, accumulation of sebum and skin debris, leading to acne breakouts.
   
   
2. Compromised Skin Barrier: Bombarding the skin with multiple skincare actives and frequent product change decrease the skin barrier’s protective threshold, making the skin more susceptible to irritation, dryness, and environmental damage. Ideally, limit waking time routine skincare to 5 topicals and 3 topicals at bedtime.

Many skincare ingredients have cumulative effects that take time to show (at least 3 months for maximal effects). Inconsistency can prevent you from reaping the full benefits of your routine. Having an inconsistent skincare routine makes it harder to pinpoint which products or methods are truly effective for your skin, making it difficult to optimize your routine.

Remember, consistency is key to achieving and maintaining healthy, balanced skin. Sticking to a consistent routine tailored to your individual needs will help you see the best results and avoid potential downsides.

 

Morning vs Night Skincare - how to approach your skincare with Acne 

Patients who have acne prone skin have sensitive skin type therefore it is best to take note of the the following when approaching skincare with acne:

1. Choose skincare products with minimal ingredients because more ingredients can mean a higher chance of contact dermatitis.
2. Acne prone skin can clog easily. Use light weight products, preferring serum and creams over oils and ointments.
3. Layering with too many skincare can clog pores, leading to acne eruptions. Choosing active ingredients with multiple functions will decrease the need for over layering and decrease chances of clogging and irritation.

Acne prone skin has a compromised skin barrier to begin with. Avoid starting acids, retinoids, and other active ingredients at high concentrations and use moisturizers to dilute skincare actives.

Acne-prone skin has hyperactive oil glands. Focus on ingredients that are sebum-regulating and find skincare with ingredients that possess antimicrobial effects against acne-causing organisms like cutibacterium acnes and Pityrosporum ovale (fungus that may exacerbate acne flare ups).

Acne-prone skin is inflammatory and hyperreactive, therefore focus on skin soothing and free radical-fighting skincare ingredients.

Morning skincare can focus on cleansing, decreasing stickiness of skin cells, regulating sebum secretion, addressing microbial components, decreasing irritation with actives, protection from the sun, antioxidants

Night time skin care is for removing sunscreen or make up using light-weight cleansing oil or cleansing balm, healing with a skin barrier repair moisturizer, and using retinoids for acne treatment and acne scar prevention.  

 

Morning Skincare Routine for Acne Prone Skin

Morning Acne Skincare Routine

1. Cleanse: wash with a mild soap or gentle cleanser to remove sweat, oil, or product buildup from the night before. The proper use is the key as any mild soap or cleanser when improperly used can dry out and irritate the skin. Use fresh cool water to wash your face as warm, hot, or cold water can cause irritation and trigger inflammation. Wash the face gently (no scrubbing or rubbing) for a maximum of 20 seconds, twice a day only. Check out the Azelane Soap if you have no mild soap or cleanser yet.
2. Treat: use low concentration salicylic acid (SA), azelaic acid (AZA), or AZA derivative Potassium azeloyl diglycinate (PAD) containing products. Salicylic acid breaks down skin plugs to de-clog pores and breaks down stagnant sebum inside the pores. Potassium azeloyl diglycinate helps normalize sebum secretion. Both have anti-inflammatory and anti-microbial effects and when combined, address acne synergistically with decreased side effects compared to either alone. This is why we like recommending the Mission: Skin Acnoregulin Spray to our patients.
3. Address Inflammation: Apply an antioxidant skincare to protect your skin from free radical damage caused by UV rays, pollution, and inflammatory activity. Look for ingredients like vitamin C such as 3-O ethyl ascorbic acid. This safe and stable form of topical vitamin c, which can be found in the Etherius Ascor Vitamin C Serum.
4. Moisturize & Repair: Moisturize your skin and repair the skin barrier with a moisturizer containing ceramides, fatty acids, and cholesterol. Mission: Skin HydroLock Lite Moisturizer’s lightweight formulation is appealing to those with oily and acne-prone skin.
5. Protection: Choose a broad-spectrum sunscreen with at least SPF 30 and reapply every two hours, or more often if you are sweating or swimming. The Mont de Lur Crystal Serum SPF50 PA+++ Sunscreen and the Mont de Lur Crystal Silicone SPF50 PA+++ Sunscreen offer clear and light weight formulations that are suitable for acne-prone skin. Some patients like to have additional camouflage for acne marks plus additional anti-inflammatory and sebum-regulating effects and for this, we suggest the Mont de Lur Tinted Mousse SPF50 PA++++ Sunscreen.

 

Evening Skincare Routine for Acne Prone Skin

Nighttime Skincare Routine:

1. Cleanse:  You can use the same cleanser as in the morning to remove your makeup and sunscreen. For those who prefer a cleansing oil, cleansing balm, or micellar water as the first step to remove makeup, make sure to wash off the residues with your cleanser to avoid clogging of pores and irritation.
2. Treat: The highlight of the night is the gold standard topical treatment for acne: retinoids (eg. retinol, retinaldehyde, tretinoin, adapalene). Address acne, acne marks, and potentially prevent acne scars with regular use of retinoids. Invest in retinoids that are efficiently absorbed and optimally work in the skin with minimal irritation as seen with retinoids formulated with liposomal delivery system such as the Mission: Skin Retinol 1% Defender Cream.
3. Moisturize & Repair: Help your skin barrier regenerate while you sleep. Mission: Skin HydroLock Lite Moisturizer offers the full skin barrier repair ingredients with additional hyaluronic acid for more efficient absorption and additional hydration.

On a graveyard shift? No worries! Simply switch the morning routine as your waking time routine and the night routine as your bedtime routine.

Apply your skincare thinly, gently, with a single swiping motion, introducing them to your skin one at a time every 2 weeks. When changing to a new skincare routine, wash the skin with water only for 5 to 7 days, then introduce new skincare as described above. Use your fingertips to apply skincare, as this still remains the best way of skincare application.

Acne purging can last from 3 to 4 weeks, and if acne is not improving after 1 to 3 months of skincare use, consider oral acne medications such as Doxycycline or Isotretinoin.

 

Tips for Makeup Skincare with Acne

Wearing makeup when you are acne-prone can feel like a double-edged sword. While it can camouflage blemishes, some concerns exist:

1. Clogged Pores: Certain makeup products, especially heavy foundations, concealers, and cheek tints can clog pores, potentially worsening breakouts. Look for labels like "non-comedogenic" or "tested non-comedogenic." that are less likely to trap oil. Here are some brands frequently mentioned for their non-comedogenic offerings (this is not an exhaustive list and individual products within each brand can differ):
• Drugstore brands: e.l.f. Cosmetics, Maybelline New York, CoverGirl, and NYX Professional Makeup
• Mid-range: Clinique, CeraVe, Neutrogena, and Pacifica Beauty.
• High-end: BareMinerals, IT Cosmetics, Urban Decay, and Too Faced
2. Irritation: Some make-up ingredients can irritate sensitive, acne-prone skin that would otherwise not react with other skin types. Choose gentle, hypoallergenic formulas to minimize the risk. These are makeup ingredients that may trigger contact dermatitis, but reactions can vary depending on individual sensitivities: 
• Fragrances: cinnamaldehyde, citral, benzyl salicylate, linalool, galaxolide, cashmeran, Oakmoss, Treemoss extract, Eugenol, Geraniol, Limonene.
• Preservatives: methylisothiazolinone, formaldehyde-releasing agents (e.g., DMDM hydantoin) and parabens.
• Essential oils: Tea tree oil, mint oils, citrus oils, clove oil. Heavy oils: mineral oil and petrolatum.
• Others: sulfates, dyes, certain pigments such as carmine, red iron oxide, ultramarines, manganese violet.
3. Bacterial Buildup: Dirty makeup brushes and applicators can harbor bacteria, triggering further breakouts. Daily cleaning and disinfection are crucial if you have sensitive skin or are prone to breakouts. Consider cleaning your brushes after each use daily with a brush cleaner.
4. Exacerbating Inflammation: Harsh rubbing or picking at blemishes while applying makeup can worsen inflammation. Be gentle when applying makeup.

With acne-prone skin, a mindful makeup approach is key. Choose the right products, practice hygiene, and do not neglect treating your acne at its source for a clear skin, with or without makeup. Here is how to adjust your skincare routine for a clearer canvas and flawless makeup application:

1. Cleanse with care: acne-prone skin is friction and pressure-sensitive. Avoid facial scrubs and wash your face very gently to avoid triggering inflammation.
2. Exfoliate regularly: low concentration acids such as salicylic acid removes dead skin cells that can clog pores and worsen acne. Avoid physical exfoliation that can damage the skin barrier.
3. Spot treat: dry up acne lesions with Potassium azeloyl diglycinate (PAD) found in the Mission: Skin SpotLite Spot Acne Concentrate. Let the spot treatment fully absorb before applying makeup.
4. Moisturize: Emollients in moisturizers act like glue that fill gaps between dry skin cells, forming a cohesive and regular skin surface. This prevents makeup from accumulating on dry flaky skin, securing a smoother surface where to build up makeup on.
5. Look for labels: Choose non-comedogenic, oil-free makeup specifically formulated for acne-prone skin. Mineral makeup can be a gentler option. Look for labels like "hypoallergenic" and "fragrance-free" to minimize irritation.
6. Apply makeup lightly: Avoid heavy layering of makeup, as this can trap sweat and oil, worsening breakouts. Avoid rubbing or forceful application.
7. Don't sleep on it: Never sleep with makeup on! This traps dirt and oil, worsening acne. Always cleanse thoroughly before bed to allow your skin to breathe and repair itself.

For people with acne-prone skin, watch out for the following signs that indicate that it might be time to take a break from makeup:

Increased breakouts: Take a break from makeup if you notice a significant spike in breakouts within a week of starting a new makeup product or intensifying your makeup routine.

Worsening inflammation: Existing breakouts become redder, angrier, and take longer to heal. This suggests the makeup is likely irritating or clogging pores, contributing to acne breakouts

Stinging or burning: If your skin feels uncomfortable, stings, burns, accompanied by widespread redness when applying makeup, it is a clear sign of irritation. Remove it immediately and stop using the product.

Itchy skin: Itchiness could be due to an allergic reaction to a makeup ingredient. Discontinue use and consult a dermatologist if the itchiness persists.

Accelerated Oiliness: Your skin feels significantly greasier than usual after makeup application. This could be due to comedogenic ingredients clogging pores and trapping oil.

Important Points:

• Patch testing: For 2 to 4 weeks, regularly apply a new makeup product behind an ear or inner upper arm. Leave this on for several hours and remove with your cleansing method of choice. Select makeup products that do not elicit skin reactions.
• Gradual introduction: When trying new makeup products, introduce each one gradually every 2 weeks to decrease risk of complications.

Remember that individual responses to makeup ingredients can vary. Consult a dermatologist for personalized advice and patch testing for accurate diagnosis and management of makeup-related contact dermatitis.

 

Acne Skincare And You - Making Your Skincare Work For You

This guide equips you with solid skincare and make up strategies for acne prone skin, but remember, everyone's skin story unfolds differently! While we offer best practices, your acne journey is unique. Implement skincare and makeup that works for you. With mindful care and consistency, track your response, and adjust your routine like a personalized script. Don't hesitate to seek expert advice. Remember, beautiful skin thrives on tailored care.

For a targeted advice and personalized acne skincare plan, dive deeper with the DMD Glow Program.

Take control of your acne today and book a quick email consultation!