Recently an Acne.org member wrote to me asking if I could look into niacinamide, an ingredient which may be beneficial for acne prone skin and which is included in some over-the-counter products, especially moisturizers due to its water loss prevention properties. Knowing that over-treatment of the skin can lead to irritation and the perpetuation of acne, he asked if I could explain whether niacinamide could potentially interfere with the effectiveness of the Regimen.

What is it: Niacinamide (a.k.a. Nicotinamide or Nicotinic Acid Amide) is a close chemical compound to Vitamin B3 (niacin) which can be taken orally or applied topically. Based on the published research I have uncovered, this ingredient may be a welcome addition to a skin care product ingredient deck and will most likely not prove to be an unwelcome variable.

Evidence: For the purposes of this post, I am speaking of topically applied niacinamide. Topical niacinamide may have measurable anti-inflammatory, anti-irritation, and skin turnover properties. In one study testing topically applied 4% niacinamide (brand name Nicomide), it was shown to reduce acne symptoms as much as 1% clindamycin, a widely prescribed topical antibiotic. Keep in mind that clindamycin produces unimpressive results, even if significant over placebo. In another study, in order to test for niacinamide’s effect on skin oil production, researchers applied 2% niacinamide to Japanese and Caucasian subjects. At least some of the Japanese subjects experienced somewhat reduced skin oil production.

Mixing it with other meds: Normally, it is wise to keep the amount of active ingredients one uses to a minimum to prevent over-treatment of the skin, and resulting irritation. However, since the skin reacts very minimally to niacinamide and it tends to cause so few side effects, it may prove a welcome passenger alongside other ingredients.

Beware of “label claim”: It is a general practice in the cosmetics industry to include ingredients in products at tiny amounts for what is referred to as “label claim.” Manufacturers will very often add one or two drops of an ingredient into huge hundred gallon batches so they can write on their label that the desired ingredient is in the product. If you see niacinamide in a product, check its placement within the product’s ingredient list. As an example, it is the fourth ingredient in Olay Complete All Day Moisturizer – Normal. The higher an ingredient is listed, the more of that ingredient is included, so its fourth place showing is promising. If you see it listed toward the end of an ingredient list, chances are it may be in the product only for label claim.

A final note: In my years of researching promising acne fighting ingredients, I have come across hundreds of ingredients which show promise in fighting acne. Studies of these ingredients are often small, and results, while scientifically significant, are often unimpressive. In other words, it is not time to lobby skin care manufacturers to be certain to include niacinamide in their products. Rather, be sure you have the basics in place–a non-overdrying cleanser, a 2.5% benzoyl peroxide, and a moisturizer which does the trick of bringing the skin back into balance. When used within the Regimen, these products alone should get you 100% clear. However, if you do see niacinamide on the label, I don’t see any reason at this point to worry that you will be over-treating your skin.

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As we move forward here at Acne.org, I will keep niacinamide in mind when formulating, along with all of the other promising ingredients available to us. I’ll also keep checking research as it emerges regarding this ingredient.

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.

An article released this month in the British Journal of Dermatology took a look at the evidence scientists have boldly gathered from 1950 through 2010 regarding when and where acne bacteria tends to exist and in what amounts. The patterns they found are intriguing and seem to suggest that acne bacteria, known as P. Acnes, may not cause clogged pores.

Over the past 60 years, various researchers have taken biopsies of “normal” skin, acne prone skin, and inflamed and noninflamed acne lesions, and then counted the bacteria they found. It turns out that across the vast majority of the 14 studies of this nature, acne bacteria is not always present, even in active acne lesions. A small but compelling percentage of acne lesions are “sterile” and contain no bacteria whatsoever.

Faced with this kind of consistent evidence, the authors hypothesize that acne bacteria does not initiate acne. How could it, they seem to ask us to ponder, if it doesn’t exist in all acne lesions?

However, the authors go on to state that after a pore has become clogged, acne bacteria can make the situation worse through a number of means, including increasing the skin’s cell production, causing stickiness inside the pore, and kicking inflammation into higher gear, amongst others.

So what causes acne? Is it our body’s immune response? Inflammation? Genetics? Vitamin/Mineral deficiency? The search continues…but as we move forward, let’s keep this evidence regarding bacteria in mind.

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.

Grrr. I have the distinct displeasure to inform you guys but after months of costing out the SPF, the pricing is still not working. I have certain principles that I won’t compromise. The first is I won’t launch a new product that I don’t feel is equal to my OCD perfectionism, including instructing our lab to formulate with only the very best USP grade ingredients. OCD perfectionism can be detrimental when you find yourself reading phone texts 4 times for grammar and punctuation before pressing send–not that I do that ;),  but when it comes to products used on inflammatory acne-prone skin, this type of perfectionism is warranted. Next, I want all Acne.org products to be within reach of everyday people. The Regimen is not just for the rich. As some of you noted, I could release the SPF at a high price, but it just doesn’t feel right. In fact, that feels kinda gross.

In the meantime I am going to keep pressing forward on aggressive USP grade raw ingredient pricing. I am keeping this project on the top of our list of priorities, to the point where my coworkers are giving me threatening stares–but have no timeline I can give for now. A reminder of good UV-protection options in the meantime:

1.  Hats:  A wide brimmed hat provides 100% UVA blockage.

2.  Olay Complete all day UV moisture spf 15 sensitive skin + 5-6 drops of jojoba oil: Olay is my one and only recommendation for over-the-counter SPF support at this time. Be sure to add 5-6 drops of jojoba oil to help combat the flakiness you may experience from the Olay.

A final summary note: As the sun blazes higher in the sky, remember to become aware once again of increased sensitivity to the sun from AHAs and retinoids.

*Acne.org is in no way connected with Olay or any other product or company. This link is provided for convenience of readers only. Acne.org receives no payment or compensation in any form for this recommendation.

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.
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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.)

SPF: We have been painstakingly sourcing each ingredient from around the world in an attempt to keep the price on the SPF within reason and within reach. We’re making good progress, and it’s my goal (perhaps I should say prayer since it’s not entirely up to me) to put a sample into FDA required stability testing soon so it can be out for at least part of this summer’s season. No promises, but we’re working on it every day. Depending on certain ingredient lead times and availability, my fingers are crossed that we can make this happen sooner rather than later.

Spot Treatment: The last spot treatment we designed seemed to have everything going for it, and then wham, our testers tried it under BP. It balled up and looked like mini cottage cheese curds on the skin. At the same time, my mind got piqued regarding other potentially beneficial ingredients, and I have been reading about some of them while having a team of people gather research on others. The spot treatment appears to be more of a long term project at this point. I want to launch a spot treatment only when it is revolutionary and amazing since the AHA+ already works so well for me. However, it is very much on the radar.

Moisturizer: For quite some time now, because of my extreme schedule and inability to read through the message boards as much as I would like, Brandy and C’est La Vigne have been updating me regularly on your posts. Rest assured that if you express your concerns to C’est or Brandy, they are likely to be expressed to me. Lately, Brandy and C’est have been telling me that several of you would like me to bring the old moisturizer back. I am hearing you and understand your frustration. However, with my apologies, I’m afraid this is not possible. First, since I would not be recommending it or mentioning it on the web site, I would need to produce it in very small amounts. This is an extremely expensive proposition on several levels–small label runs & small production runs would run the cost into an entirely new “private label” placement in which prices would reflect expensive boutique brands. Next, our full-time team is swamped with current products, and we do not have the resources to relaunch a product at this time. Finally, I feel more comfortable with people using the new moisturizer. While the new formula requires more generous application (at least 3 pumps), the increased gentleness and soothing ingredients that the new moisturizer keep me steadily on board with strongly recommending it over the previous version. For those of you who are experiencing increased dryness with the new moisturizer, please read this post for my recommendation on how much to use, but keep in mind that our current batch of pumps dispense a bit less, so you will need at least 3 full pumps, not 2.

Are any of you wondering why it seems like your moisturizer isn’t working as well as it used to? You’re not alone. Every year around this time people come to me complaining that their moisturizer just doesn’t seem to be as powerful as it used to be. “Aha!,” I’ve exclaimed, in the nicest way possible of course, “It is not your moisturizer! It’s just winter.” It’s true that people experience increased dry skin in the winter. But this year I decided to do a little more digging to find out exactly why. As it turns out, there is startlingly little scientifically sound explanation to be found, and myths abound.  As is often the case, it falls to us to sift through the nonsense and make some sense of this issue.

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First, let’s dispell the myths:

When weather gets cold, it gets dry. This is claimed so often and by so many “reputable sources” that I almost took it at face value myself. But when I decided to double check this pervasive claim, it completely fell apart. I looked at historical charts of humidity levels across the United States throughout the seasons.* It turns out that humidity levels show no particular trend from summer to winter. In fact, in many cities, even Northern cities, humidity levels are higher in the freeze of winter than in the bask of summer.

The winter is blustery and wind dries out the skin. Many of us can recall experiencing our share of cold, windy winter days, and could swear that we experience “windburn”, characterized by dryness, redness, and irritation after being outside on these blustery days. But a look at the evidence forces us to consider other possible causes. The only experiment I could find was performed all the way back to 1937, and was published in Popular Science. Scientists founds through using a wind tunnel that wind alone does not create “reddening or chapping” of the skin. Furthermore, upon browsing through historical wind speed charts, I found that that much like humidity levels, wind speeds show no yearly trend. There is no evidence of higher winds in the winter months. Regardless of all this evidence against the wind creating redness, dryness, and irritation, many sources not only talk about the existence of windburn, but will even explain why it occurs. The most widely used explanation is that wind removes surface lipids (oils) from the skin. Exactly how the wind performs this feat is conspicuously absent from all of these articles. Furthermore, if wind is just as strong in the summer, why don’t people seem to experience windburn as much in the summer? Another common explanation that attempts to explain windburn, which is the current explanation on Wikipedia, is that windburn is actually just sunburn caused by the wind removing surface lipids (oils) which help protect us from UV rays (another claim I am yet to find evidence to support). While the wind can remove some of these surface lipids year round, they say, the removal of the surface lipids in the winter coincides with a season when we do not protect our skin as valiantly from the sun. Thus the redness and irritation people experience is simply a sunburn. This explanation is incomplete at best, and completely misinformed at worst. Yet another explanation, albeit less frequently posited, claims that wind removes sweat, which normally helps filter UV rays. Again, how sweat helps filter UV rays is conspicuously absent.

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Whew. So, now that we have gone through the myths, the fact remains that many people experience dryer skin in the winter. Why? After looking at all of the available evidence, I have a hunch it can be attributed almost entirely to:

Artificial heat: Mother nature can heat up or cool down the great outdoors while keeping humidity levels steady, but when we heat indoor areas, this lowers humidity. When you look at the science of relative humidity (I won’t bore you), this is how it works. For an everyday example, notice how when you heat your bathroom while taking a shower there is less steam in the air. Since most of us live and work in artificially heated indoor environments in the winter, it’s likely we experience long-term exposure to lower humidity environments during the winter months. This dries out the skin, causing many of us to wonder why our moisturizer isn’t working as well as it used to. Back to my original point, “It’s not your moisturizer!” And introducing my new, improved answer, “You’re living in lower humidity indoor environments in the winter!”

And what about the cold? Strangely, none of the authors or reporters writing about winter and dry skin mention the effect cold air itself has on the skin. However, I have a hunch extreme temperatures may figure into a complete explanation of why some people experience dry skin in the winter. When we expose our skin to freezing temperatures, the skin reacts through natural protective methods, most prominently by withdrawing blood from the surface of the skin to protect core temperature. This is the first step which ultimately leads to the skin freezing which causes frost bite and cell death. My hunch is that perhaps even during shorter duration exposure to freezing temperatures which people sometimes experience on cold days, the skin still reacts through a more mild form of cell death. This mild cell death, while not as apparent as the blisters caused by frostbite, is evidenced by flakiness or dryness as the dead cells flake off. The redness experienced by many people after exposure to winter weather, while it would require further research for me to be more definitive, could be the result of cell death or simply the body returning blood to areas where it has been withdrawn.

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So, what can we do about it?

1.  Humidify your home/workplace. Install a humidifying system into your central heat. Alternately, if you use wood burning stoves or kerosene heaters, you can place pots of water on top and let the water evaporate, then repeat. You can always boil a large pot of  water on the stovetop as well, being careful to keep a close eye on it of course. There are commercially available electric stand-alone humidifiers as well. 60% humidity is a good general goal to shoot for. You can measure humidity with widely available humidity measuring devices which are available at most hardware stores, or you can be more relaxed about it and just notice how you–and your skin–feel. When the humidity reaches a comfortable level you will feel less dry and generally more comfortable. You should also notice less static electricity, less shocks, and less frizz to your hair. An easy way to tell if you’ve gone too far and over-humidified your space is if your windows start to pool water at their bases.

Perk: Adequately humidified air feels warmer than dry air at the same temperature. In other words, you can get away with heating to a lower temperature.

2.  Use more moisturizer: An extra pump or two of moisturizer each time you apply should help.

3.  Add jojoba oil: Since jojoba oil does not evaporate, 5-6 drops of jojoba oil added into your moisturizer each time you apply it will provide a boost of all-day moisture support.

*Yes, I know. There is more to the world than the United States, but…well, okay fine, I have no excuse. I’ll make a note to look outside the U.S. for my next research-related blog. :-)

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.