Acne mechanicaWhen you have acne, it’s tempting to try to scrub it away. But decades of acne research shows us that physical irritation will actually cause acne. This is such a generally accepted condition amongst dermatologists and medical researchers that it has its own name: acne mechanica.

A recent article in the journal Dermatology once again reports on this problem. Three female patients presented with what can only be described as horrible acne. It came on fast and was in the area where they were scrubbing their face with various skin care products. The authors of the article considered the products to be non-comedogenic and ruled out the products themselves as the cause of the acne. In fact, in a nod to cosmetic companies, the authors state, “…nowadays, cosmetic companies are carefully testing their compounds for comedogenicity before marketing, and cosmetics are an infrequent cause of acne.” They go on to conclude, “…repetitive physical trauma could act as a trigger for severe inflammatory acne.”

The cases in this article are severe, but millions of people suffer with acne caused by everyday physical irritation. You can’t eliminate physical irritation altogether, and you shouldn’t aim to do this since it will likely drive you pretty crazy. Instead, take a few minutes to become aware of sources of physical irritation and try to reduce or eliminate them when you can. Then get on The Acne.org Regimen and add in some glycolic acid when needed and you will be nice and clear.

Helpful Links:
Sources of physical irritation
The Acne.org Regimen Instructions
How to use glycolic acid to combat irritation

References:

  • Seneschal J, et al. “Exogenous inflammatory acne due to combined application of cosmetic and facial rubbing.” Dermatology. 2012; 224(3): 221-3.

summer humidityI live in San Francisco where the weather is almost always temperate–cool with low humidity. However, I am in Pennsylvania right now visiting family. I forget how unforgiving hot, sticky summer weather can be to acne-prone skin until I am enveloped in it. I’ve had to be super strict with The Regimen since I’ve been here to stay clear. This is par for the course in hot, humid weather, however. Researchers have found that people in hot and humid climates have more incidence of acne and more severe cases of acne than those in temperate climates. This is not to say that you can’t still stay clear during summer. It just takes stricter adherence to The Regimen.

Tips to stay clear in hot/humid climates:

1. If you end up sweating, try to be gentle when you dry off. Dab your skin gently with a towel or napkin and do not rub the sweat off. Constantly wiping off sweat can be irritating to the skin and cause a breakout. More tips on how to avoid irritation here.

2. Be super strict with The Regimen. Do it twice a day, every day, use plenty of benzoyl peroxide, and moisturize even if you don’t feel that you need to. In the summer it is even more important to follow The Regimen to a T.

3. Try adding 10% glycolic acid (AHA) to The Regimen to bump up the effectiveness even more. Just be sure to adequately protect your skin from the sun if you decide to add in glycolic acid.

4. Since body acne can be aggravated by irritation, and sweat + irritation can make this worse, you may need to treat your body in the summer as well.

Now go out and have some fun! :)

Feather Light Touch
Lots of people will try a new skin care product and be sure it broke them out. They assume it is something in the product itself–a bad ingredients of some kind. However, people often miss a stealthy cause of breakouts: irritation.

Let’s say you are sensitive to acne on the back of your neck. You don’t normally use a sunscreen there but now that it’s getting sunny you started applying some sunscreen there each morning for the past week. Boom, you broke out. You are certain it is the sunscreen. What else could it be!? Well, it could be the irritation when you applied it. Your neck has been accustomed to being left alone. And acne-prone skin loves being left alone. Then whamo, for the past week you have been slathering on sunscreen and not being gentle at all. What you don’t realize is that you have been irritating your skin on a daily basis.

The moral of the story: Consider irritation as a potential cause of breakouts, not just products themselves. And always apply any product with a featherlight touch.

Now go have some fun in the sun :)

Don’t Scrub
I remember when I first got acne. I tried to scrub it away by using a washcloth several times a day and rubbing as hard as I could. This resulted in what were probably hundreds of tiny pimples, on my forehead and hairline especially. It didn’t take me long to realize that harsh scrubbing was getting me nowhere.

I have never seen a scientific study specifically attempting to gauge how physical irritation of the skin can cause acne, however. It’s abundantly clear that it does, both from my own personal experience, and the experience of hundreds of thousands of us on acne.org. If you’re not convinced, just wear a face mask for a sport and you will see how hard it is to keep this area clear.

In a recent article published in the journal Dermatology, authors observe three female patients who presented with severe inflammatory acne “due to the association of two factors: facial friction with cosmetic agents.” These young women were rubbing their faces in a “compulsory manner” with their cosmetics.

The authors conclude: “Because cosmetic face friction as a cosmetic care becomes more and more fashionable, dermatologists should be aware of this severe clinical condition, which can occur in patients without a person history of acne.”

Hey, at least this is something. It would be cool to see some sort of controlled clinical trial performed on the effects of physical irritation alone on the severity of acne in the future. In the meantime, if you want to clear up your skin, stay gentle!

References:

  • Seneschal J, et al. “Exogenous inflammatory acne due to combined application of cosmetic and facial rubbing.” Dermatology. 2012; 224(3): 221-3.

l'oreal go 360 clean

The L’Oreal go 360 Clean is a product that came out recently which has a scrubber that pops out which you can then use to scrub the cleanser into your skin. I tried it, and much like the Clarsonic, Wavesonic, and Olay ProX, it is fun to use, but creates unnecessary irritation. No matter how soft a scrubber is, it is no match for your bare hands.

To make matters worse, the second ingredient in this particular cleanser is Sodium Laureth Sulfate. While Sodium Laureth Sulfate is not as drying as Sodium Lauryl Sulfate, and can be a welcome addition to a cleanser if it is lower in the ingredient deck, the addition of Sodium Laureth Sulfate as the second ingredient is a concern. Dry skin is irritated skin, and especially if you are trying to clear up acne, you want to use only very gentle, non-overdrying cleansers.

But hey, props to L’Oreal for making such a fun product. If someone is not acne-prone, it could be a fun diversion to a daily cleansing routine.

cleansing devicesI’ve been saying for years never to use a washcloth because it can be irritating. The same holds true for hand held cleansing devices. I tried a few of them recently and while I do have to admit that they are quite fun to use, the irritation they present is unwelcome when it comes to acne-prone skin types. If you want exfoliation and like how a hand held device physically exfoliates, a better option is chemical exfoliation. 10% alpha hydroxy acid will exfoliate without the irritation and will improve the texture of acne-prone skin. My strong advice: leave cleansing to bare hands, and never use a device, washcloth or otherwise, to wash.

Benzoyl peroxide causes dryness. There is no way around it. And while the drying and peeling effect of benzoyl peroxide is part of what makes it incredible at clearing acne, the dryness it leaves behind must be put in check for the skin to remain balanced and clear. We’ve been on the topic of how to cope with this dryness for a while, but we haven’t addressed specifically what chronic dryness is and what it does to the skin. Once you understand it, you may see more clearly why it is absolutely essential to keep your skin hydrated.

In short, chronic dryness signals the immune system that irritation is occuring. The body responds to chronic dryness as it does to any irritation. The murky process can be tough to understand, even for modern scientists, so let’s take a look at it from another point of view.

dryness and irritation

Our main characters:

Madge: This is YOU. You are the owner of the club.

Dryness: One of benzoyl peroxide’s effects on the skin. Benzoyl peroxide and its effects are necessary for clear skin, but when dryness is allowed to become chronic, irritation will follow.
_____

Okay, let’s imagine your skin is a dance club. [Yeah…we’re going there…why not]

All the cool, laid back skin cells are at the club. The music is smooth, and the cells are groovin’. Everybody’s got rhythm. There seems to be just the right amount of cells on the dance floor all night. It never gets too crowded, and everyone is in a good mood.

Then, in walks Dryness. He always comes to the club. Shortly after he arrives, he starts drinking. Once he starts drinking he loses his rhythm and starts stumbling around the dance floor, bumping into the other cells. They get out of the groove too. Everybody starts to get irritated. Somebody calls the cops. A ton of cops arrive and turn off the music. The beat screeches to a halt, and everybody stops dancing and instead just start standing around. The club stops being fun. It gets ugly in there.

This is an extremely old-fashioned town. [Yeah…we’re going even further with this…] The law in this town is that anything that even irritates people is a huge deal. It’s strict. Doing anything that irritates other cells ends up with somebody calling the cops, and the cops respond hardcore every time.

Madge (YOU), the owner of the club, decides that this is getting old. She’s tired of this one irritating drunk guy ruining the night. She makes a new rule that he’s allowed to come, but after 15 minutes, he gets only water to drink.

The moral of the story: Dryness will show up at the party, but he needs to be watched closely and after 15 minutes he needs to be chilled out. In other words, after you apply benzoyl peroxide, you’ll experience dryness. It is always going to be there. But keep an eye on your dryness and after 15 minutes, be sure to apply plenty of moisturizer to make sure the dryness doesn’t become chronic and turn into irritation. It’s a common misconception that dryness is good for acne. It can even seem to make common sense. But you will find that the opposite is true. Hydration prevents irritation, and helps keep you clear. The next time you think to yourself, “I’ll go light on the moisturizer,” think twice. Be generous with moisturizer and your skin will be clearer for it.

(Note: The above story & moral is simplified and dryness is mentioned after applying benzoyl peroxide. However, as many of you note, after washing your face you also experience dryness. Your cleanser does not produce the majority of this dryness, assuming you are using a gentle cleanser. Rather, the dryness is mainly from you being on a benzoyl peroxide regimen. The same advice applies. 15 minutes after applying benzoyl peroxide, be generous with moisturizer and get your skin back into balance.)

Every time I get a cold or experience a bad bout of allergies and end up blowing my nose a lot, I’ll break out around my nose. It’s like clockwork. This is an example of how closely and predictably irritation and acne are related. You may have noticed something similar in your life. Ask any dermatologist or acne specialist and they will concur that when you irritate your skin, acne can result.

Check out the new interactive Irritation Page and have some fun learning about potential sources of irritation. Then, reduce or avoid them if you can. This may take some practice as you retrain yourself to stay more gentle to your skin, but in the end your skin will thank you.

We all know that irritation can aggravate acne. I talk about it all the time. However, throughout the years I’ve also read in multiple acne related books, and heard in multiple acne related classes which I’ve attended, that irritation plus sweat is even worse. I’ve found this to be very true in my own experience as well.

Let’s use me as an example for a sec. I often get tired at work or when sitting at a table somewhere and put my head down, resting my chin on the back of my hands. I rarely have any issues with that. But recently, I have been getting sun on my body and when I turn over to get some sun on my back, I end up resting my chin on the back of my hands. The difference is that outside in the sun there’s sweat in the mix. I got a “mysterious” breakout under my chin area recently and it perplexed me until I put this together. It was the sweat plus irritation combination that most likely caused the breakout.

Another good example of sweat mixing with irritation is chin straps. Not only do chin straps rub against the skin, they often cause sweatiness. Also, chin straps are worn during physical activity, which includes sweat. This is why for many people, it is especially important to treat that area during sports season. Helmets are another example. Backpack straps rubbing against the upper back in hot, humid weather is another. You get the idea…

I am not telling you this to make you paranoid. We all get sweaty, especially in the warm months, and there is no way to completely avoid irritation. I mention it just so you can become aware of what’s going on and try to mediate it if and when you can. If you end up experiencing sweat mixed with irritation in some area of your skin which tends to be acne prone, be extra careful to apply benzoyl peroxide judiciously in that area.

Let’s talk fundamentals for a moment, shall we? I spend a lot of time on the blog here talking about obscure acne related topics, but kinda like in basketball…sometimes you gotta just shoot free throws for hours, getting down the fundamentals, and it’s time well spent.

In acne treatment, I’d say there are two major fundamentals.

1. Using a generous amount of 2.5% benzoyl peroxide. This is what I want the world to know. Give me 10 seconds on Oprah, Good Morning America, and The View (lol), and I’ll say, “The secret is to use a ton of 2.5% benzoyl peroxide. It just plain works. When in doubt, use more.” It’s so simple. It’s really a very basic fundamental. If you load on 2.5% benzoyl peroxide, acne hardly stands a chance. It’s just too powerful. And if for whatever reason it doesn’t seem to be working, load on some more. Being super duper generous with 2.5% benzoyl peroxide does the trick almost every single time.

2. Reducing irritation. Really, regardless of what medication you’re using on your face, if you have inflammatory acne, the kind that gets red which most people struggle with, you’ll want to do everything in your power to reduce irritation. Inflammatory acne-prone skin is sensitive to irritation. Reducing that irritation goes a long way to keeping you clear. That’s why 2.5% benzoyl peroxide is important. It does the job without the excess irritation of a 5% or a 10% formula. Also, staying super gentle in application of your acne treatment is a huge fundamental. If I had another 10 seconds on Ellen, The Today Show, and Regis & Kelly (lol), I’d say, “Stay very gentle in application, being certain to moisturize afterward as well.” Staying exceedingly gentle, and I mean Exceedingly with a capital E, is the best way to go, and is crucial in reducing irrtitation. Moisturizing after benzoyl peroxide, or any other drying medication, will also keep the skin from becoming overly irritated, which will help end the irritation-acne cycle. I would also be remiss if I didn’t mention avoiding picking at the skin as well. Picking is a huge culprit not only in irritation, but also in acne scarring. Keep your skin untouched as much as you can.

OK, I’m gonna go play a game of H.O.R.S.E. now :)