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.

Hey you guys.  It’s Thanksgiving tomorrow. I want to take this opportunity to remark on how thankful I am to have your feedback on the site and the products. We take your comments under careful consideration. Nothing gets past you guys, and that’s awesome because it keeps our team here abreast of every possible issue.

The new pumps: Recently we switched to a new pump because some of you told us your products were arriving with broken pump heads.  The new pumps we ordered come with neck closures which help prevent breakage during transit.  We made sure the pumps have have-extra wide heads too since you guys tend to prefer that style.  However, you never know when you switch from one manufacturer to another if you will find variances, and in this case it appears that the new pumps dispense a little less per pump than the old pumps did.

Dispense 3 pumps now

We carefully measured, and to dispense exactly the same amount as before, you will need to dispense 3 pumps of each product instead of the usual 2. Aim for a quarter sized amount. Especially when it comes to benzoyl peroxide, it is absolutely vital that you are generous in application.  The moisturizer is also designed for generous application.  When in doubt, use more.

We will work to change the wording on the web site to reflect 3 pumps.  2 pumps is ideal, however, so we have already begun working with the manufacturer to make sure the next set of pumps dispenses slightly more.

Happy Thanksgiving and keep the feedback coming!  We really appreciate hearing from you guys.

Edit:  You guys wanted to see a comparison of old vs. new pumps.  I just took a quick pic so you can see:

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.

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.

SPF: We’ve nailed a formula. The good news. And it’s really good news because it’s taken about 128 formulas, and several years to get there. The bad news is that I’m finding it is super expensive to produce. The quotes I’m getting from suppliers are so high that I don’t feel right passing it on to you guys. We want products that are the very best in the world, but also affordable. I’m determined to make it happen, and we will launch this, but I want to do it affordably. I’ll keep negotiating with suppliers until we get the price into an acceptable range–while compromising nothing in regards to quality of course.

Spot Treatment: The last group of testers gave me mixed feedback. We have good news and bad news again. The good news it that most people are saying this is a spot treatment which actually works. The bad news is that it’s not working well when it is applied before benzoyl peroxide. When people put it on before BP it can become very slightly curdled. So I went back into the lab this week and made a few more iterations in all different types of bases: creamier, more water-y, and more serum-esque, in an effort to remedy this. I kept all of the important active ingredients in there. In the meantime, if you want a spot treatment, the AHA works really well for me and lots of people on Acne.org. Just be certain to catch a zit at the very earliest stages.

keratinocytes: human skin cells
Thanks to modern medical science, we know that for some reason, acne follicles tend to overproduce cells, which in turn stick together and cause a clogged pore and ensuing zit. But why does this happen? Scientists have performed very few studies in an attempt to figure this out.

I just got through reading what was only the second study to ever attempt to scientifically understand what happens inside acne follicles vs. control follicles. Researchers from the University of Leeds in England performed the study back in 1994. Unfortunately, I think this control follicles were poorly selected. The researchers took biopsies of acne follicles from the upper back of patients who were an average age of 22. The control follicles were taken from the chest of people who were an average age of 41 during open heart surgery. In my opinion, the vast difference in age and location of biopsy between the acne follicles and control follicles largely discounts this study. Regardless, the researchers did make a couple of interesting points when discussing what might cause acne-prone skin to overproduce cells.

1) When sebum production increases, as it often does in acne-prone individuals, the sebum, as it leaves the follicle, takes with it too many of the cells lining the follicle wall. The follicle then reacts by overproducing cells to counteract this loss.

2) Linoleate (a.k.a. linoleic acid, an essential fatty acid) deficiency in sebum: Researchers have discovered that sebum in acne-prone skin contains less linoleate than normal. One hypothesis is that when sebum increases, linoleate content is diluted, and this decrease in linoleate signals overproduction of cells.

But in reality if you asked these researchers to tell you what cases acne, I think if they’d honestly reply, “well heck, who knows…”

The more you read about the potential cause of skin cell overproduction and clogged pore formation, the more complex it becomes. We have the hormone system to look at, sebum overproduction, the skin’s inflammatory response, systemic vitamin and mineral deficiency, bacteria over-proliferation, or a combination thereof…the possibilites are endless and the list goes on and on.

So, if and when science does finally figure it out, will we uncover a silver bullet? Or is the cause of acne a combination of factors? I’ll keep reading and let you know what I find. Please do the same if you can and let me know what you find out.

We’re hiring a full time Web Developer to keep Acne.org thriving and to implement lots of cutting edge stuff we have planned. It will be a challenging and fulfilling job. I’m posting the help wanted ad online in several places, but ideally I’d love someone right from the community here at Acne.org or at least someone who you guys refer to me. Here’s the ad:

Web Developer

This position directly assists in the implementation and maintenance of our web site and shopping cart. A successful candidate would be a task-oriented hard worker who gets things done and is comfortable in a fast paced atmosphere. Candidate must be fiercely and naturally detailed and take direction extraordinarily well.

Required skills and experience (5+ years):

- PHP
- JavaScript
- HTML
- MYSQL
- Advanced Photoshop skills a plus
- Invision Board (IPB) experience a plus
- E-commerce experience highly preferred

Responsibilities:

- Professionally program and implement multiple concepts to an extremely high level.
- Perform regular web maintenance.
- Maintain server.
- Keep a can-do attitude at all times, concentrating on how to make a project work.
- Be open to anything. Everyone on our team pitches in when needed, no matter how big and no matter how small the task may seem.

Location:

- Our office is in San Francisco, but we are open to working remotely for the right candidate.

How to apply:

Please send a copy of your resume with cover letter (both as attachments) with “Web Generalist:0150-1″ in the subject line to humanresources@acne.org

We can only offer $5 shipping for inside the U.S. Auto-Ship orders, but I’m looking to see if there’s anything we can do for International Auto-Ship orders as well. Just wanted to chime in and let you guys know I haven’t forgotten about you. I’ll report back if and when we’ve figured something out. No promises, but we’ll try our best.

As far as distributing internationally, that is something that I sincerely would like to see happen at some point. It’s a big world after all. It’s on our roadmap, but we’re not quite there.