One of the biggest misconceptions I've had about breakouts is that they would stop at a certain age. In reality, my relationship with acne has spanned decades. From the odd pimple on my cheek to full-on hormonal breakouts along my jawline, I've seen and tried everything related to acne-fighting skincare products.
While I'm all for the skin positivity movement, I'd be lying if I said my self-confidence doesn't take a hit from a bad breakout — and I'm not alone. According to the American Academy of Dermatology (AAD), up to 50 million people in the United States experience acne every year. It reports that breakouts in adult women are also on the rise, affecting up to 15% of women.
Several misconceptions and myths about skincare routines for acne-prone skin have risen out people trying to get rid of pimples fast. Do all of the skincare products you're using have to be for acne? Are there any over-the-counter products that really treat hormonal acne? Corey L. Hartman, MD, an Alabama-board-certified dermatologist, says no to the above.
As for what your skincare routine for acne should look like, we checked in with Dr. Hartman as well as Vancouver-based board-certified Katie Beleznay, MD, for their expert tips.
Step One: Cleanse
"Washing your face twice per day can be used to remove any oil, dirt, and makeup — but it's important to remember that acne is not a result of 'dirty' skin, and over-washing can damage the skin barrier and aggravate acne," says Dr. Beleznay.
A gentle cleanser will get the job done without stripping skin. However, if you have more severe inflammatory acne, Dr. Hartman recommends looking for cleansers with benzoyl peroxide if your skin can tolerate it. "Products containing benzoyl peroxide may help reduce swelling and get rid of bacteria within the skin," he says. "These can also remove excess sebum."
We're fans of the CeraVe Acne Foaming Face Wash Cream Cleanser that's formulated with benzoyl peroxide, hyaluronic acid, and ceramides to target acne while still being gentle enough not to strip the skin of essential moisture.
To shop: $12; target.com
Step Two: Exfoliate
Both Dr. Hartman and Dr. Beleznay are fans of exfoliating the skin using ingredients such as alpha and beta hydroxy acids (AHAs and BHAs).
Dr. Hartman explains that BHAs, such as salicylic acid, are best for targeting non-inflammatory types of acne, like blackheads and whiteheads. "Salicylic acid is often marketed for acne in general, but it usually works best on non-inflammatory acne," he says. "It naturally exfoliates the skin, removing dead skin cells that can lead to blackheads and whiteheads."
"AHAs tend to be milder, and not only do they help with acne, but they also treat hyperpigmentation, fine lines, and wrinkles," adds Dr. Hartman. "Hyperpigmentation comes from the inflammation and acne itself. If you're not treating the acne effectively, the longer you let it sit, the more it's going to lead to hyperpigmentation, which will be more difficult to treat."
You can find both BHAs and AHAs in a range of skincare products including toners, serums, and cleansers. Cleansers like Glytone's Mild Cream Cleanser ($33, dermstore.com), a lathering cleanser that's formulated with and 3.5% glycolic acid and non-irritating surfactants, help cut down your daily skincare routine by combining two steps into one.
However, if you don't mind the extra step, Dr. Hartman recommends the Paula's Choice Skin Perfecting 2% BHA Liquid Exfoliant, which is a leave-on treatment that deeply penetrates pores to remove buildup and dead skin that causes breakouts.
To shop: $30; sephora.com
VIDEO: Here's All You Need to Know About Salicylic Acid
Step Three: Use a Retinoid Cream
Retinoids are the gold standard of skincare because they address common skin concerns like aging, texture, and acne.
"Retinoids are a mainstay of treatment for all types of acne, but do the most for non-inflammatory acne by increasing cell turnover," says Dr. Harman. However, they're great for combatting inflammatory papules and pustules, too, as long as you're using the right formula.
"I commonly recommend a retinoid (or retinol), with the strength of that based on a combination of the severity of the acne and what your skin can tolerate," says Dr. Beleznay. "Long-term consistent use of retinoids has been shown to help with acne, as well as stimulating collagen and improving fine lines, skin texture, and tone."
Over-the-counter options include retinol and adapalene (up to 1%), while prescription options include tretinoin, tazarotene, and isotretinoin — aka Accutane. Dr. Hartman explains that prescription retinoids, like Accutane, are typically used to help cystic acne. "It can treat and prevent nodules by decreasing oil gland size within the pores."
Whatever form of retinol you use, however, just don't use a retinoid as a spot treatment as it won't be as effective as it should be. "Some people think retinoids are to be used as a spot treatment and that's a misconception we have to dispel all the time," Dr. Hartman says. "Although they can be beneficial that way, we know they are even more beneficial as a means of stopping the buildup of dead skin cells, oil, and debris in the hair follicles, so pores don't get clogged and contribute to the development of inflammation and acne."
Dr. Hartman suggests Skin Better's AlphaRet Overnight Cream. "It helps with aging, discoloration, and acne, and it's great for patients who are retinoid naive. Or those with sensitive skin who have difficulty finding a retinoid they can tolerate," he says.
To shop: $125; skinbetter.com
Step Four: Moisturize
If the retinoid you use doesn't double as a hydrating cream, it's best to include a moisturizer in your routine. "Keeping your skin hydrated is important. This can help prevent your skin from getting too dry, and many of the treatments we use for acne can dry out the skin, Dr. Beleznay explains. "When your skin is overly dry and your skin barrier is compromised, your skin can overproduce oil to compensate, potentially leading to clogged pores, blackheads, and further exacerbate acne."
We recommend this moisturizer from La Roche-Posay as it's oil-free and non-comedogenic, meaning it won't clog pores.
To shop: $32; dermstore.com
Step Five: Apply Sunscreen
Sunscreen should never be skipped over, but it's especially important to protect your skin from UVA/UVB rays when you're using active ingredients for acne, which can sensitize the skin.
Dr. Hartman recommends a mineral sunscreen since chemical formulas can cause contact dermatosis in some people. "For people with acne, we tend to not so much see irritation from certain ingredients, but the vehicle it's in," he says. "Oil-based or heavier formulas can cause comedones, so then the sunscreen can make your acne worse." Look for a mineral SPF that's emollient, rather than heavy creams.
Supergoop!'s Mineral Sheerscreen also protects against blue light, in addition to UVA/UVB rays.
To shop: $38; sephora.com
Step Six: Use Spot Treatments
"Your best bet is to use your topical all over for prevention of acne as part of a long-term strategy," says Dr. Beleznay. "But if you happen to get an acne lesion that you want to try and deal with fast, topical benzoyl peroxide or salicylic acid can be used — just be sure not to overdo it."
This drugstore staple spot treatment contains 2% benzoyl peroxide to treat existing pimples and prevent bacteria from forming new ones.
To shop: $9; target.com
So, What About Hormonal Acne?
The hard truth is that there isn't a lot that can be done for hormonal acne at home.
"A dermatologist can inject one of those nodules with a steroid because they come out at the wrong time, but that goes to show you how few effective treatments there are," Dr. Hartman says.
Both Dr. Beleznay and Dr. Hartman call out spironolactone, a prescription pill, as a great option for treating hormone-induced breakouts. Additionally, contraceptive pills are sometimes recommended as a treatment option.
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