Acne Treatment & Skincare for Acne-Prone Skin

Watch the IG Live session here

Dr. Teo answers the most common questions about skincare for acne and maskne in the Clozette x Mentholatum Acnes IG live. She shares her thoughts on which ingredients are best when it comes to oily, acne-prone skincare.

When it comes to choosing skincare products to tackle acne, should we choose natural ingredients or “chemical” ingredients?

As to whether chemical or natural ingredients are preferred in our skincare formulations, the answer is to focus on whether the active ingredient itself is evidence-based. Some of the examples of naturally-derived active ingredients that are beneficial, come in the form of potent plant-based antioxidants. Chemical ingredients that are beneficial include salicylic acid, benzoyl peroxide, retinol and retinoids. While these are all synthetic chemical structures, they have proven in studies to have beneficial effects in acne.

What are some of the ingredients that we can look out for acne?

Specific ingredients that can address inflammation, are plant-derived antioxidants. In particular, centella asiatica, also known as Cica or Indian Pennywort, has been well established to be a potent antioxidant. This mean that it reduces inflammation and promotes good healing of scars. Ingredients like those derived from avocado oil are rich in polyphenols and fatty acids such as oleic acid. These can certainly help in inflammation as well as in the healing of acne scars. 

In terms of treating excess oil production, some ingredients are particularly effective at reducing the activity of the oil glands. Salicylic acid, for instance, can have a good effect in terms of reducing oiliness of skin.

Many people have this misconception that cleansers should leave your skin not just clean, but squeaky clean.

Of course, it’s not wrong to want to cleanse your skin deeply. But it’s not ideal when your cleanser leaves your skin feeling you don’t dry and tight right? 

You’re absolutely right. So the function of a cleanser is to remove dirt, oil and grime that’s left on your skin at the end of the day. The importance of this is really to maintain a healthy bacterial load, also known as the skin microbiome. However, in individuals whose skin conditions such as acne, there is an imbalance in the bacterial load. Cleansing then becomes particularly important part of the skin routine. Now if the cleanser is too harsh on the skin, you’re going to aggravate these conditions. Because, it dries the skin out in terms of maintaining the skin barrier – which is not ideal.

On the other hand, if there is ineffective cleansing, it becomes a breeding ground for bacteria. Hence, the ideal cleanser is one that can effectively remove the oil dirt grime residue on your skin. At the same time, it preserves a layer of moisture. So if your cleanser is leaving a squeaky tight feel on your skin, it’s a sign that it’s far too drying. It also may not even address your concern of having oily skin. Instead, it may paradoxically lead to excess or production – a condition known as reactive seborrhea. 

What are amino acids in face wash?

Amino acid surfactants are distinct from traditional sulphate based cleansers in the sense that it has a much lower pH. For traditional sulphate base cleansers, the high pH environment of the cleanser leads to increased abrasiveness and dehydration of the skin. Over time, it reduces the skin’s ability to fight infection. Amino acid surfactants have a lower pH environment, which means that the skin is not disrupted. Hence, it’s better protected against the environmental allergens and pollutants.

AFP, CEA, PSA, VDRL, RPR, HIV antibody

Should adopting a full skincare routine be what is recommended?

In terms of a skincare routine, I would position it as a beneficial lifestyle choice akin to having a healthy diet or a regular exercise regime. The reason is because the skin is an organ that’s very accessible, which means that whatever topicals you apply on it, it can be absorbed and consequently, affect the physiological function of skin. So in terms of a good skincare routine, I will whittle it down to the following. A good gentle cleanser,  a moisturiser that is comfortable on oily skin -especially in a humid climate like Singapore. I would recommend serums or lotions over cream formulations which tend to be rather uncomfortable and occlusive for skin. Acne spot treatment, as well as a sunblock and sun protection is really important for reducing the hyperpigmentation associated with acne scars. 

Acne creams

Now zooming in a little bit on what Xinlin spoke about for spa treatment, I just want to share some of my tips. Now traditionally, a lot of people put up acne creams only where the acne develops. However, there is another way of using these acne creams as well. This includes applying a thin layer of this acne cream over the area where you’re acne prone. This can be over the chin, your T zone, the cheeks. Over time, this can help to reduce the formation of microcomedones due to the active ingredients present in the spot cream. However, in terms of the specific spot treatment of your pimple, do follow the manufacturer’s recommendations because certain ingredients contain astringents that can be very drying and dehydrating. If you apply that more often than it’s indicated, you could find yourself developing a condition known as irritant contact dermatitis.

Many people with acne prone skin or oily skin tend to skip the moisturiser because they think that their oily skin doesn’t need more hydration or that moisturisers can only make things worse. Is that the case? 

So the topic of moisturising and acne is very important. Skipping moisturisers, even if you have oily skin is definitely a myth. The reason is because even when your skin is oily or greasy, it may lack the lipid barrier that protects the skin from external environmental factors. This is very common in individuals who describe their skin as being oily as well as dehydrated. Now if you have oily skin and decide that you’re going to skip moisturiser and just use an extremely astringent dehydrating cleanser or toner, you may find that you have a paradoxical reaction. This is known as reactive seborrhea. This is when your oil glands are trying to overcompensate for what it feels as a defect in the skin’s lipid barrier because of over cleansing, as well as the use of astringent agents. So if you do have oily skin, the key thing is to choose a moisturiser with a correct formulation. One that is cosmetically acceptable for somebody with greasy skin would likely be in an emulsion, lotion or serum formula, as opposed to a cream formula.

How do you prevent acne from reappearing on the same spot?

Absolutely. So if you do notice that you have acne that keeps coming up over the same spot, the truth is, you may actually have something a little bit deeper than what you see. This is otherwise known as an acne cyst. Now the times when you find that the acne cyst gets a bit smaller or when you think it’s almost gone, is when the cyst reduces. Why we call it a cyst is because there’s really a wall that’s lining the surroundings of the collection of pus, dead skin and other material that’s causing the bump. Now when it gets inflamed, that’s when you notice that it reappears again. Another way to look at this condition is if you’re prone to getting acne over the entire T-zone area. For adult women and hormonal related acne, you tend to get it over the U-zone which is the jaw line, the chin area, then it may be helpful to use a prescription retinoid that can overall reduce the formation of micro comedones in that area.

Should we let our acne “breathe”?

A simple way to think about it is this. If you don’t have inflammed acne, then it is important for your skin to have some sort of breathability in terms of moisture-wicking comfort levels. Also because the presence and retention of heat and sweat can become a bacteria breeding ground. However, of you already have an inflammed acne bump, creating a moist wound healing environment can help to reduce inflammation. An example of this would be the hydrocolloid patches, or acne patches that can be applied over inflammed acne papules. These are examples of how moist healing environments can actually help the healing of acne.

Should you pop your pimples?

Popping a pimple is always a bad idea because it can get more inflammed. You’re also using your fingers to touch your skin which can introduce bacteria infections. What I suggest is this. If you can see that a pimple is coming to a head, after a warm shower, gently use a moist cotton pad and press aroudn the acne pustule until the contents are expressed. If this is not successful, certainly don’t use pressure to remove the bump- that’s going to cause even more inflammation and scarring.

What is the best type of fabric to prevent maskne? 

In terms of the best type of fabric to prevent mask acne, it actually seems like an easy question for me to answer, but it’s truly rather complex. The categories of fabrics can be broadly divided into firstly, the natural fibres. We’re familiar with cotton, linen, silk, as well as synthetic fibres, such as polyester. Polyester is typically the material that’s used in our medical grade personal protective equipment. The difference in reusable fabric masks worn by the public and is currently recommended and medical grade PPE is this. For the general public, we are recommending widespread reusable fabric mask wearing as a matter of social responsibility to prevent contamination of our environment with our biofluids. So our bio fluids refer to our respiratory droplets as well as our saliva, because COVID has been demonstrated to transmit via both droplet and aerosols. 

Now, in terms of this function, you have to take into consideration the fact that synthetic fibres are going to be waterproof and far more effective in terms of achieving the aim that the public health recommendation sets up to do. Whereas, you know, the natural fibres, while they may seem to be more breathable in terms of layperson understanding, these perform quite poorly in terms of preventing or protecting your environment from your respiratory droplets. What I’m currently recommending my patients, and is my area of research, is the concept of biofunctional textile. These are typically synthetic, durable textiles that have been treated to make them skin friendly. They also have certain antibacterial benefits that can reduce the incidence of mask acne.