Acne is one of the most complex skin concerns to treat. Treatment often involves a lot of trial and error and each case requires an individualized approach to achieve the best result. Patients may opt to treat the skin with pharmaceuticals (oral or topical), conventional skincare products, or with more natural options including supplements, gentle topicals, herbs, acupuncture, light therapy, etc.

Regardless of what you choose, here are several non-negotiable changes I recommend to acne patients in order to lay the foundation for healing the skin and preventing acne from returning.

Skincare

The skincare products we use can aggravate or heal the skin. I often encounter acne patients who are using multiple products from a variety of different brands. This can confuse and disrupt the skin’s natural physiology and hinder the skin’s ability to heal itself. Things to consider when it comes to skincare:

Do not touch or pick the skin - picking spreads bacteria and traumatises the skin. You will break out more and potentially cause scarring. Touching the skin can transfer bacteria and irritate the skin.

Hygiene - to limit exposure to skin-disrupting bacteria, always use a fresh facial towel after showers or cleansing and change your pillowcase daily. Wipe down or wash any surface or material that touches your face (your phone, hats, etc.) daily.

Simplify - simplifying routines and ingredient lists can vastly improve the skin. Selecting a gentle, non-foaming cleanser (milks can be excellent) and a simple moisturizer or oil (like jojoba oil which is similar to the skin’s natural oils) can give the skin a break, even if it is just for a few days. Choosing products that have a “non-comedogenic” label can also be helpful.

Avoid over-exfoliation - it is common for people with acne to look to exfoliation to help calm breakouts and clear pores; although this may help temporarily, I often see the skin barrier disrupted, leading to breakouts long-term. Limit the use of acids and physical exfoliants (products with exfoliating beads or debris) as they can strip the skin of oils and dry skin (all of the skin layers have a purpose, even dry skin). I also recommend avoiding the use of both acids and retinoids together unless specifically prescribed.

SPF daily - finding a clean, zinc oxide only SPF without chemicals and preservatives is a great place to start. Zinc oxide is also anti-inflammatory and can help to calm redness and breakouts. For more guidance, read my article on SPF here.

Diet

What we put on the skin is as important as what we put in the body. When acne is present, a few key dietary interventions include:

Pasteurized dairy elimination - the research demonstrates a connection between pasteurized dairy intake and an increased risk for acne. Because of this, strict pasteurized dairy elimination is the first place I generally start with acne patients. By consuming a diet rich in a variety of fresh fruits and vegetables, proteins, healthy fats, and whole grains, successful elimination of pasteurized dairy can be achieved without missing out on important nutrients. Dairy must be avoided for up to 6 months to see a result.

Inorganic animal products - if acne is caused by hormonal imbalance, it is important to be mindful of protein sources. A variety of animal sources is recommended, and choosing organic where possible can limit exposure to excess hormones.

Avoid processed foods - I always suggest doing the majority of your grocery shopping in the peripheral aisles of the grocery store: the fresh produce, meat and seafood sections are often located here. Additionally, choosing fresh, whole foods with an expiry date, and foods that look as close to their natural form as possible is key to reducing inflammation and providing the skin and body overall with the nutrition it needs to heal. Always read ingredient lists; if they are long or contain ingredients you do not know, do not choose these products. Limit fried foods and foods that are not prepared at home while the skin heals.

Beware of oils - extra virgin olive and coconut oils, and flaxseed oil (raw only) are recommended. Most other oils can elevate inflammation and wreak havoc on the skin.

Lifestyle

As with diet and skincare, the way we live lays the foundation for the health of the skin. Acne can positively respond to the following:

8-9 hours of sleep per night - when we sleep is when we heal. An absolute minimum of 8 hours is consistently required for clear skin. Being asleep by 10PM offers the additional benefit of allowing the body’s hormones to balance and for the body to enter healing mode more optimally.

Breathing - it is common to go through the day without paying attention to the breath. In Traditional Chinese Medicine, the lung system is directly reflected in the skin. 10 minutes of deep, gentle belly breathing twice a day can be very helpful in relaxing the nervous system and promoting healthy skin.

As with any health concern, acne best responds to individualised care. Although the above general recommendations are a great place to start, they do not replace the advice of your medical professional. Testing can be helpful to request as well in order identify the root cause of breakouts and provide your healthcare team with the information needed to assist you in healing your skin.

References:
https://www.mdpi.com/2072-6643/10/8/1049
https://pubmed.ncbi.nlm.nih.gov/33462816/