We recently found a bunch of empty labelled 8oz. benzoyl peroxide bottles at one of our manufacturers. It was one of those moments where you have to think about what to do–should we practice what we preach regarding environmental stewardship and use them, even though most people, myself included, prefer the tube for the 8oz. BP? In the end, we decided to go ahead and use them.

We did something similar last year when we came across some extra blue bottles from when the products used to be blue. You guys seemed to agree that it was fine to use those blue bottles, even though it meant your products might not all match for a while.

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A quick rundown of our thinking:

Throwing the bottles away:
Benefits:  Continuity of packaging. Less customer service issues.
Drawbacks:  Costs money to haul them away and dispose of them. Guilt; it feels wrong not to use what we have.

Reusing the bottles:
Benefits:  Possibly save a bit of money by using everything we have. Less guilt.
Drawbacks:  Lots of people prefer the tube for the 8oz. size.

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To me, the decision isn’t very hard. It feels best to use what we’ve got, and it may save us a bit of money (we hope to at least break even once you account for extra customer service and other expenses involved in using the bottles). Thanks for supporting us with stuff like this when it happens. If you absolutely can’t stand the 8oz. BP bottles, let me know, but if you can stomach them for a little while, I think we can all feel pretty good about it.

In 2004, Dale F. Bloom wrote an interesting article which was published in the journal Medical Hypothesis. Mr. Bloom contends that acne may be evolution’s way of preventing us from reproducing before we are physically and mentally ready to take care of our offspring. My summary:

The brain: Our pre-frontal cortex, the part of our brain which makes us uniquely homo sapien, is only finished maturing in our early 20s. It develops last and is responsible for good judgement, impulse control, planning, and danger response–all of which help us raise healthy and safe children.

Adolescence: Our ancient ancestors needed to learn the tricky skills involved in hunting and gathering, and it is more than likely that the adolescent years were ground zero for learning these important life strategies. Once learned, a person would be much better prepared to raise his or her young.

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Acne’s role: Acne shows up at the onset of adolescence, and Bloom argues that unhealthy appearing skin may make a person less desirable to the opposite sex. Acne thus does the job of preventing conception. As acne subsides with the end of adolescence, a person is psychologically ready to raise children and has learned the skills needed to provide for his or her young.

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But what about adults with acne? Bloom hypothesizes that certain physical diseases such as polycystic ovary syndrome, various substances such as steroids, or chronic stress may result in hormonal imbalances which cause adults to suffer with acne. He goes on to entertain the notion that perhaps humans evolved adult signs of acne as a physical sign of chronic stress, thus reducing the likelihood that a chronically stressed individual would reproduce.

Today’s Hunter/Gatherers: Anthropologists have reported zero incidence of acne in two modern hunter/gatherer tribes from Papua New Guinea and Paraguay. Interestingly, the Paraguayan girls the anthopologists visited don’t get their first period until they are on average 16 years old. The average age in the U.S. is 12. The Peruvian girls, Bloom says, therefore have less need for acne in order to prevent early pregnancy.

Fascinating stuff to ponder. Thanks Mr. Bloom.

A bunch of you have expressed how you preferred the old pumps. We heard you and we agree. We went ahead and ordered the old pumps again and we forecast saying Buh-Bye to the current pumps and shipping products with the old pumps within the next 6 months.

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.

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.
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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.)

After a restful holiday break, I am back in the saddle and have resumed coaching people through The Regimen.  My fresh eyes can’t help but notice a string of similarities amongst my coach-ees:

1.  They go too fast.

Them: [Quickly move their hands over their skin]

Me: Whoa Nelly! When you go too fast, that creates irritation. Let’s slow it down. Here, let me show you. [I demonstrate washing very slowly]

Them: Wow, you want me to be that gentle?!

Me: Yes.  As you get more experience in performing The Regimen, your skill level will allow you to go more quickly and remain gentle.  For now, be patient and go slowly.

2.  They want to shorten the amount of time between steps.

Them: [3 minutes after washing] Can we do BP now!?

Me: Whoa Nelly!  The waiting periods are important.  Try to settle into a routine that includes doing dishes, saying goodnight to your kids, etc. while you wait between steps each morning and evening.  We want The Regimen to become part of your life and not make you feel like you are just “waiting.”

3.  They add in variables way too soon.

Them: Someone on the message board said a 4 blade razor works better, so I got the one they recommended.  I hope that’s OK.

Me: Whoa Nelly!  I need you to stick to The Regimen exactly until you are completely clear. That includes using only a 2 blade razor. Imagine you have blinders on. We want to get you completely clear before we add in any variables, and we know if you follow The Regimen precisely we’ll get you clear. Once you are completely clear, then you can add in 1 variable at a time, like trying a 4 blade razor.

4.  Once they are clear, they add in more than 1 variable at a time.

Them: I figured since I was clear that I would try to just use BP once a day.  Oh yeah, and I also started using this great new SPF I found.

Me: Whoa Nelly!  One at a time.  You’re going to be in the sun a lot in the next month or two, so let’s add in the SPF and see how it goes for at least 3 weeks.  If you’re consistently clear after 3 weeks we can try going to BP just once a day and see if you stay clear.

5.  They are emotionally attached to their unused, expensive products.

Them: I’ve got a really expensive department store acne scrub.  Can I use it with The Regimen?

Me: Whoa Nelly! Like most people, you are disposed to inflammatory acne. The last thing you want to do is scrub and irritate your skin. Why don’t we se how much you can get for that scrub on Ebay, shall we?

6.  They are clear.

Them: Wow, The Regimen really works.

Me: Good job! You listened to me, followed it exactly, and it worked.

Recently we’ve had a few members let us know that the new moisturizer is leaving a yellow hue on their white collars.  I have never noticed this myself, so thanks for the feedback. Both Acne.org Moisturizer and AHA+ contain an efficacious amount of licochalcone.  This means they are great at soothing and calming the skin, but this also means the products are bright yellow in color.

Once given about 30 seconds to absorb into the skin and dry they will not stain.  So, to avoid staining your collars, consider letting the products absorb before dressing. If you are already dressed when applying, take extra care to avoid light colored collars.

Vitamin D Questions and Answers:

What about fish oil?  It doesn’t contain vitamin D (with the exception of Cod Liver Oil), but since we’re talking about supplements, does fish oil break people out like some people say?

I can’t imagine a reason why fish oil would break people out.  Before agriculture came about, humans ate much higher amounts of omega-3 fats in their diets.  Omega-3s are an extremely natural part of the human diet.  I would urge people who think that fish oil is breaking them out to remain open minded and look for other variables that might be the culprit.  Supplementing with fish oil, or eating a diet rich in wild fish is a healthy lifestyle, and in my research seems to point toward a potentially positive impact on acne.

Why was the Vitamin D Council I linked to in my comment edited out?

We do not allow hyperlinking in blog comments.  Unfortunately, there are simply far too many spammers to allow it.  However, the Vitamin D Council is a great resource, so there’s a link.

Ancient History of Acne Questions and Answers (note:  there are lots of interesting responses in the comments section of that particular blog post):

Why is acne localized mostly on the face?

We have many more sebaceous follicles on the face than elsewhere on our bodies. Acne generates within these follicles.  The only place where we do not have sebaceous follicles is on the palms of our hands and soles of our feet, which is why it is impossible to get acne in those areas.

Maybe eating grains causes acne?

Humans have only been subsisting on agriculture for about 5,000 years.  We evolved as a species for hundreds of thousands of years prior to that, and ate very little or no grains. Studying a possible diet and acne link is interesting, but eliminating grains in one’s diet is almost impossible for any modern human.  We tried it here on Acne.org a few years ago, and out of 25 of us who attempted to eliminate grains entirely, only one or two of us managed to even come close, and in the end, we all ended up quitting.  It really is that hard.

What do you think of SMT_D002?

For those of you who are not familiar with it, SMT_D002 is an oral drug which its owners claimed may reduce sebum much like Accutane without the side effects.  This sort of claim sounds intriguing, but the drug appears to have only been entered into a small Phase 1 trial (18 subjects), and its owners have since dropped it in lieu of possibly developing a topical medication instead.  Of all the new drugs which show initial promise in treating a disease, an extremely small percentage make it through trials and to market.  At this point, I don’t know if it is worth much of our time keeping up with this one in particular, especially since the company has put it effectively on hold.

New Moisturizer Questions and Answers:

Whatever happened to the new labels?

The new labels are more of a long-term project at this point.  Please know that I have heard your input on them, and that we are working hard on transitioning to a new look eventually. For now, they will be remaining much the same.  If the Acne.org on there really bugs you, feel free to put a sticker on there.  I tried it just for fun to see how it would look and it actually doesn’t look bad at all.

What are your recommendations about using the AHA+ as an overall moisturizer?

The AHA+ is still a great moisturizer to use from time to time, even if you are now using the new Acne.org Moisturizer.  I still recommend using the AHA+ 2-3 evenings a week if you desire, but it is not mandatory.  It will improve skin tone and still provides extra insurance that your skin will appear smoother if you have an important event coming up.  Also, even though it is now approaching winter, remember that AHA will make you more sensitive to the sun, and it is still important to stay aware of this.

Do you still recommend adding jojoba oil to the new moisturizer?

I made certain that the new moisturizer has the same percentage of jojoba oil as the previous moisturizer.  Thus it is perfectly fine to continue adding a few drops of jojoba oil into the new moisturizer each time you apply it if you would like.  If you use a full two pumps of the new moisturizer, which I very highly recommend that you do, you may not require the additional jojoba.  If you still need more flakiness control, however, feel free to add jojoba into the mix.

I need a good eye cream.  Is it safe to use the new moisturizer under the eyes?

Absolutely, with this one caveat:  Anything that goes over benzoyl peroxide can bring the benzoyl peroxide along with it.  If you have sensitive skin around the eyes, be careful not to let this happen during application.

How does the new moisturizer work on oily skin?

It seems to work brilliantly on people with oily skin.  This makes sense because it contains jojoba oil and is specifically designed not to leave sheen on the skin.  Feel free to ask people on the messageboards or look through the reviews of the new moisturizer.

How do I know if I have the old version of the moisturizer or the new one?

The old one is white.  The new one is yellow due to licochalcone, the licorice root extract which is in the new formula.

Irritation Page Questions and Answers:

What about tissues that contain lotion?  Can they break you out?

Great question.  I did a search and it appears that the lotion contained in these tissues may be suspect.  At times they contain emollients such as isopropyl palmitate, which impart a silky feel to the skin, but which also present as top offenders in comedogenicity studies.  Other brands sometimes contain less offensive but still questionable ingredients such as shea butter.  I think it may be best to stay away from tissues with lotion until we get more feedback from Acne.org users on whether they do indeed break people out.  If you have used these types of tissues, please post your experience on the boards.  In the meantime, I’ll be sure to add this information to the irritation page.

SPF Questions and Answers:

I want the SPF now!  Can you just release it at a high price?

I feel more comfortable releasing this at an affordable price.  In these economically troubling days in particular, I think it is my responsibility to make sure we price things within reach.  I have no doubt this is possible, and I will make it happen.

Shaving Cream Questions and Answers:

Hey Dan, will you try (brand X) shaving cream?

I looked into each suggestion, and each one contained ingredients am not currently comfortable recommending, including either stearic acid, palmitic acid, SLS, or Cetearyl Alcohol + Ceteareth 20.  If you are completely clear and your skin looks good using these shaving creams/gels feel free to continue.  However, if you are experiencing any issues with your skin, your shaving cream/gel may be the culprit.  In that case I would very highly recommend you switch to simply the lather from a gentle cleanser for a while and see if that clears you up.

Historically, soap was used as shaving cream. Soap remained the mainstay in shaving technology for centuries, until the mid 20th century when modern chemistry introduced us to the products we see in drugstores today which combine cleansing ingredients with soothing emollients (moisturizers, oils). I’ve personally always shaved using the lather from a gentle cleanser as shaving cream and been happy with it. But I know a lot of guys like to use a modern shaving foam/gel/cream, so I decided to launch an experimentation–try as many shaving preparation products as I can and see if there is a good one out there to recommend. I tried 12 products over the past several months, and made sure to include a variety of foams, gels, and creams.

Foams/Gels (come in metal pressurized cans): These are normally made with stearic acid and/or palmitic acid (used in soap making), triethanolamine (a “surfactant” a.k.a. cleanser), and an emollient (a moisturizing agent such as glycerin). They all provided me with a good shave, but I tended to prefer the foams over the gels. Almost all shaving foams and gels are made with high amounts of stearic acid or palmitic acid. From what I have learned in cosmetic ingredient classes, frequent use of these ingredients at high concentrations can negatively affect the skin’s barrier. In my product testing, I personally noticed that the stearic/palmitic acid shaving foams and gels left my skin with a slight but disconcerting sting. While I do appreciate the intense foaming these ingredients provide, I recommend that acne-prone people avoid using products with high concentrations of these powerful foaming agents.

Creams (come in pump bottles and tubes): Since stearic and palmitic acid were a dealbreaker with all of the foams and gels, that left me with creams. Some creams also contain stearic/palmitic acid, albeit usually further down on the ingredient list which indicates they are used at a lower concentration. The creams which gave me the most comfortable shave without a stinging afterfeel happened to be the two which did not contain these ingredients–Kiss My Face Moisture Shave and Neutrogena Men Skin Clearing Shave Cream. The Kiss My Face cream, however, contains coconut oil as the 6th ingredient which may or may not present an issue for acne-prone skin. When dermatologists tested ingredients on rabbit ears for comedogenic (pore clogging) potential, coconut oil presented as a 4 (out of 5). While these comedogenicity tests are imperfect in several ways, nonetheless I personally choose to avoid ingredients above a 3 on comedogenicity tests unless they are listed far down on a product’s ingredient list. That leaves us with the Neutrogena Men Skin Clearing Shave Cream. It contains 1% salicylic acid and is advertised as “Skin Clearing”. Salicylic acid, while it is FDA approved as an acne medication and thus allows retailers to claim “skin clearing” in their marketing, in reality will not do a great deal to help clear acne. However, the nominal amount in this product should not present any problems. It would be my pick if I were to shave with an over-the-counter shaving prep product.

Still the best is: After my product trials, I find that I am still the happiest when shaving with the lather from the Acne.org cleanser. Since I would rather people not add in external variables to the Regimen, I still strongly urge people to shave with the lather from an approved cleanser (Acne.org Cleanser, Clean & Clear Foaming Facial Cleanser, Purpose Gentle Cleanser or Basis Sensitive Skin Bar/Purpose Cleansing Bar if money is tight and you must). Simple cleanser, which was the mainstay of shaving technology for centuries, is still the safest, most effective option I have come across. If lots of people on Acne.org review the Neutrogena Men Skin Clearing Shave Cream and give it the green light, that could be a nice option as well. I’ve gone ahead and added this Neutrogena product to the reviews pages. If you have tried it, please leave your feedback.