Acne: The Eras Tour

Acne has been around much longer than Taylor Swift. But like Taylor, acne and acne treatments have reinvented themselves over and over again.

In older acne eras, treatment focused heavily on drying, exfoliating, and antibacterial ingredients. Also, acne medications like topical and oral antibiotics, hormonal birth control, and Accutane became the norm as a way of treating internally — without little understanding of potential long-term consequences. In this newest era of acne, treatments often connect internal health with skin health in less of a band-aid approach than in earlier eras. Unfortunately, though, some people in this new wave approach fail to incorporate the old-school science ways of still treating the pore with important acne-fighting ingredients. 

To help you understand your acne, just like Taylor Swift, we are rereleasing the old acne theories from the past several decades to highlight their hits and misses – with our Skin MPLS spin. 

1. Acne, Self Titled

Acne-prone isn’t a skin type. Acne is a disease of the pores and is, most certainly, genetic. For those who experience acne, their pores have a condition called retention hyperkeratosis, which means they shed skin cells up to five times as fast as someone who doesn’t have acne. And that dead skin sticks in the pore and mixes with oil and certain bacteria, which causes pimples of all different shapes and sizes. While there are many acne triggers (even more triggers here), there is only one actual cause of acne – and it comes from your DNA. 

2. Dry, Irritated, and Red

One outdated way to treat acne is using only stripping, drying topicals and no moisturizer. Yes, acne is in part caused by oil production – but there are other key factors when it comes to what causes acne, so drying out the skin only addresses one component and leaves you red. You can still have the acne gene and normal, or even dry, skin. However, all acne-prone skin, dry or not, needs daily exfoliation to free trapped cells that will otherwise clog up the pores. 

It’s important to understand you can still use active ingredients AND be gentle to your skin. This comes from working with an expert to find the right products. The wrong products and lifestyle choices will dehydrate your skin. And, overdrying or dehydrating your skin will throw off your skin biome and create chapped, raw, and compromised skin.

When skin is compromised, it is much easier for the bad bacteria to flourish and create acne. Bad bacteria will have a harder time causing breakouts the more lubricated (AKA hydrated and moisturized) your skin is. This means drinking water and using water and hyaluronic-based hydrators to ward off acne. However, stay away from heavy creams that likely contain pore-clogging ingredients and can trap the acne bacteria. 

3. Acne Lover Ingredients 

In the 70’s Dr. Fulton created the comedogenic scale which tested popular cosmetic ingredients to rate their potential to clog pores and create comedones (pimples). Each ingredient was rated from 0-5 and Dr. Fulton recommended avoiding any ingredients rated three or above. 

The test included concentrated amounts of these ingredients and not products themselves, which certainly have smaller amounts of those pore cloggers. It is possible to safely use some products containing some comedogenic ingredients. However, if breakouts are your main concern, there’s nothing to gain by experimenting with comedogenic ingredients – just avoid them. It is 100% fact that products and makeup can cause acne – this is called acne cosmetica. Keep in mind that “clean” products can still clog the pores, non-comedogenic labels mean nothing (these terms aren’t regulated), and while you have active acne, the less you put on your skin – the better.

The internet is filled with misinformation about “good” and “bad” ingredients. It’s tough to label anything “good” or “bad” – these labels lack context and often come with a specific bias. It’s best to maintain a consistent routine and leave the science to the experts.

4. Antibiotics are Folklore
Acne is complicated, and prescribed medications are “hit and miss” for results. Acne-prone is a skin disease that doesn’t go away, and you should not take antibiotics long-term. And, as always, you’ll want to thoroughly understand the side effects and risks with any prescription you take. 

If you are up to date on the new theories about the link between your gut and skin, you understand that oral antibiotics mess with your GI (gut) health. Overuse of antibiotics can cause antibiotic resistance. Finally, there are more effective ways to treat acne that are safe long-term and also improve the appearance of your skin. You can opt to take healthy supplements, like these from Face Reality, that contain a specific gut-skin axis blend of probiotics to support your gut and omega 3’s to promote plump, healthy skin and reduce inflammation. Learn more here.

At best, antibiotics might kill the acne-causing bacteria, but you will likely still get blackheads and whiteheads (non-inflamed acne). And, as soon as you go off the prescriptions, your pores are just one acne trigger away from putting you back where you started. 

Topically treating the pore is more effective than solely treating the bacteria inside you. Use clinical-grade benzoyl peroxide, vitamin A, and mandelic acid from professional products to safely kill acne bacteria and normalize your skin cell turnover – and maintain healthy skin for the rest of your acne-prone days. 

5. Evermore Hormones? 

Remember, acne is genetic, and hormones control our oil production – so hormones are somewhat to blame and never go away. While some conditions like PCOS or off-balance numbers in your hormones can cause problems, for most of us, our hormones will fluctuate up and down throughout our lives. And yes, these fluctuations may show on our skin. It rarely means there is something wrong with your hormones if acne is your only symptom, so don’t spiral. One week before menstruation, progesterone levels rise – creating more oil, and because of that, often acne will be worse. This is just one example of how hormones, even normal ones, can affect acne. And in this new age of treating acne, we do so with hormone fluctuations in mind.

6. Does Dairy Deserve its Reputation? 

Dairy has been the acne scapegoat for many years now, but without cutting other triggers and using the right products – you may be unlikely to see much change by only eliminating dairy. Focus on eliminating all inflammatory foods like refined grains and sugar, follow a low glycemic lifestyle, and only eat grass-fed organic dairy – if stopping feels too tough. There are health benefits to good quality dairy, but there are no health benefits to refined sugar and grains. If you know your body reacts poorly to dairy, then you should give it up for both your body and skin! 

7. Speak Now, Tretinoin? 

You can get better results without it. In 1969, Dr. Fulton co-developed Retin-A (the original name brand name for Tretinoin) and eve he mostly stopped prescribing it by 1990. Retinoids can be confusing. To simplify, they are topical vitamin A – which help shed skin. Since acne-prone people shed skin up to five times faster, a topical retinoid can help keep the skin from getting impacted inside the pores. After Dr. Fulton made this huge medical breakthrough, he continued his work -- wanting to continue to perfect the formula to fix some of the flaws in the original drug – thus creating vitamin A propionate.

Prescription drugs are rarely reformulated because large pharmaceutical companies work in mass quantities and focus on cutting costs (so when they are reformulated, it’s often for a cheaper formulation!). It takes years to put a major change in place, so if they are getting decent sales – they won’t reformulate. We want better than decent for your skin!

Smaller skincare companies work closely with their patients’ and clients' skin to perfect their formulations and empower aestheticians to change skin. Tretinoin gets non-stop Reddit and TikTok love, proving it one of the most common acne treatments through the eras, but we see huge misses with it. The most common is severe dryness. Also, Tretinoin cream has isopropyl myristate, which clogs the pores! If you do choose to use Tretinoin, you really can’t use any other actives as your barrier will always be on the brink of irritation. So, say goodbye to your skincare game! Instead, try better breakthroughs.