Frequently asked questions

"The most common side effects of anti-acne drugs applied to the skin are slight redness, dryness, peeling, and stinging, and a warm feeling to the skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment. Other side effects should be brought to a physician's attention. Check with a physician as soon as possible if any of the following side effects occur:

1. Blistering, crusting or swelling of the skin.
2. Severe burning or redness of the skin.
3. Darkening or lightening of the skin. (This effect will eventually go away after treatment with an anti-acne drug ends.)
4. Skin rash.

Here is a quote from the National Institute of Health:

"People being treated for acne often need to change some of the cosmetics they use. All cosmetics, such as foundation, blush, eye shadow, and moisturizers, should be oil free. Patients may find it difficult to apply foundation evenly during the first few weeks of treatment because skin may be red or scaly, particularly with the use of topical tretinoin or benzoyl peroxide. Lip products that contain moisturizers may cause small, open and closed comedones to form. Hairstyling products that come in contact with the skin along the hairline can cause burning or stinging in people with acne. Products that are labeled as non-comedogenic (do not promote the formation of blemishes) should be used; in some people, however, even these products may cause acne."

I suggest discontinuing the use of make-up until you get completely clear. Then you can add in one product at a time and see how it affects you. For more discussion on make-up, see the make-up help message boards.

As a final note, several dermatologists and professors who I trust have recommended Almay as the safest, least comedogenic make-up brand.

You can visit the red marks message board for discussion and suggestions, but before you do, please read the biggest mistakes page. Try your best to avoid adding in products and new methods until you're completely clear of active acne. The most important goal regarding red marks is to prevent future acne and thus prevent future red marks from forming in the first place. Here is a quote from the American Academy of Dermatology and Roche Laboratories regarding red marks:

"A red mark on the skin called an erythematous macule will fade in four to six months after an acne outbreak - but it may get temporarily redder when your skin gets hot or when you exercise. This red macule is not a scar, and is not permanent. In a dark skinned person, the macule may appear as a darker patch on the skin. This is not a scar, either."

People with darker skin tend to suffer with these marks more often. For more information on post-inflammatory hyperpigmentation, click here.

I always recommend people who are new to the Regimen go ahead and moisturize from the very beginning since it can take a week or two for the dryness to set in. If you find your oiliness unbearable, consider buying oil absorbing cloths from the drugstore. You can use them to very gently dab away excess oil. Some members have reported that the brown paper towels in many school bathrooms do a good job with this as well.

Even if your skin is oily, you should find that regular moisturizing, especially with a moisturizer that contains jojoba oil, should help control your oil production.

The jury is still out. The majority of medical books I scoured for acne medication information specifically warn against the combination of salicylic acid with benzoyl peroxide, calling it "overly irritating". Several people on the Regimen have noted this. This warning is echoed when combining benzoyl peroxide with several other acne medications as well, resorcinol and sulfur to name two. Remember, irritation aggravates breakouts.

However, some Acne.org members have used salicylic acid with benzoyl peroxide successfully. If you want to try this, first use the Regimen without salicylic acid until you are completely clear. Then, feel free to add in one variable at a time such as the addition of salicylic acid.

Click on the video below for some shaving advice.

I recommend using a two blade razor. Single blade razors tend to pull at the hair and lend themselves to nicks, and three or four blade razors irritate badly. Blade shaving with a two blade razor is also far less irritating than any electric razor. My favorite two blade razors are the Gillette Sensor Excel and the Gillette Trac II. I have tried almost every razor out there, and these two are unparalleled in their gentleness. If you can't find either of these, try a disposable two blade razor such as the Gillette Good News. Once you've got your razor, I recommend using a generous amount of lather from your cleanser as shaving cream. If you must use a separate shaving cream, make sure it is non-comedogenic. Try shaving in the shower or immediately afterward so your skin is thoroughly moistened and prepared. While shaving, use gentle yet confident strokes, always going with the grain. This means for most people going down on most of the face and up on the bottom half of the neck. If you have a pimple or pimples to shave over, try to be gentle and if at all possible only shave over the area one time. One final note: shaving daily is less irritating than waiting a few days between shaves. The longer you wait, the more irritating shaving becomes. I recommend shaving daily.

Click here for a more detailed page regarding shaving.

Click on the video below to watch:

We assay every batch and carefully make sure it's uniform. Temperature can change the viscosity of the gel which can affect the way it appears. Also, the newer the batch is, the thicker it tends to be and the stronger the scent will be. It will get thinner over time and the smell will subside.

For me, AHA works wonders as a spot treatment. If I see the beginnings of a zit I'll use a 10% glycolic acid (AHA) lotion and apply it to that one spot after I apply the benzoyl peroxide. More times than not, this'll do the trick. This works best when I get it just as it starts emerging. If I wait too long pretty much nothing except for time will help. I'd like to know if it works as well for others as it does for me, so if you decide to give it a try, please reply in the poll on this page.

I strive to use the most inert ingredients possible while still preserving the products. When formulating products it is a delicate dance between making sure not to use ingredients that are harmful and at the same time preventing mold and bacteria growth in the product. Preventing this mold and bacteria growth is of paramount importance. The skin care industry learned this the hard way through inadequately preserved make-up which left several consumers blinded for life. It is dangerous to use skin care products which are not free of mold and bacteria. You want to be absolutely certain that your products are preserved well. I use preservatives in extremely small amounts (in the .1% range) which minimizes any adverse effects, while at the same time preserving the products well. I am always on the look-out for better preservatives. The ultimate goal is to preserve products with only organic compounds, but as of 2009 we do not have such a luxury. Rest assured I am on top of this issue and will be vigilant about protecting you guys, both from harmful preservatives as well as from mold and bacteria overgrowth.

You will not rinse off the benzoyl peroxide. Once it is applied, you will leave it on the skin.

I very highly recommend that you do not. Microdermabrasion creates unnecessary irritation. Irritation from microdermabrasion treatments can perpetuate the acne cycle. A much better way to exfoliate the skin is to simply add glycolic acid into the Regimen after 3-4 weeks. If you add it before this amount of time has passed, it can sting badly, so be sure to wait. Glycolic acid is an acid derived from sugarcane which provides incredible chemical exfoliation. I prefer chemical exfoliation to manual exfoliation because it helps you avoid irritation of the skin's surface. Plus, glycolic acid actually helps me with my acne symptoms and is a welcome addition to the Regimen.

A quote from The British Journal of Dermatology, 1990:

"So far no skin malignancies after the clinical use of benzoyl peroxide has been reported. A possible relationship between the use of the compound and the occurrence of malignant melanoma has been looked at in two case-control studies, both with negative results...However, since the average latent period for skin carcinogenesis is of the order of 15-25 years, this requires further follow-up...Thus, the question of carcinogenic potential of benzoyl peroxide is as yet not fully answered, but at the present time it seems likely that this compound is safe to use."

A quote from Regulatory Toxicology and Pharmacology, 1995:

"Topical benzoyl peroxide has been used in the treatment of acne for over 30 years, with no reports of adverse effects that could be related to skin carcinogenesis. Two case-control epidemiological studies have found a lack of association between the specific use of benzoyl peroxide and skin cancer. In addition to these findings in humans, 23 carcinogenicity studies in rodents with benzoyl peroxide, including 16 employing topical application, have yielded negative results. An increase in skin carcinomas was reported in 1 study in which benzoyl peroxide in acetone was applied to the skin of SENCAR mice for a 1-year period; however, this study did not employ adequate control groups to fully understand the unusual findings, and the results were inconsistent with those of 6 other similar studies."

A quote from "Acne and Rosacea: Third Completely Revised and Updated Edition," 2000:

"Following application to the skin, benzoyl peroxide is rapidly metabolized to benzoic acid, a harmless chemical. Extensive use in human beings has failed to demonstrate absorption. The drug is eminently safe."

After decades of research, a final ruling from the FDA Federal Registry, 2010:

"After reviewing the data, we now conclude that benzoyl peroxide can be adequately labeled to minimize the risks associated with benzoyl peroxide while delivering effective acne treatment...We, the Food and Drug Administration (FDA), are issuing this final rule to include benzoyl peroxide as a generally recognized as safe and effective (GRASE) active ingredient in over-the-counter (OTC) topical acne drug products."

The fact that BP bleaches fabric is in my opinion its biggest drawback. Sometimes there's not a lot you can do about it. However, these tips may help:

• Wash and dry hands thoroughly after handling benzoyl peroxide.
• Do not rub sweat from your face on your clothing.
• Put your clothes on first, then apply BP. If you apply BP first and then put on your clothes, hold your shirt neck holes open wide while pulling them so they don't touch the face. Do the same when removing your shirts.
• Use white towels.
• Wear a white t-shirt under clothing if you are treating your back/chest with BP.
• Dab sweat off with a clean dry towel to avoid run-off onto clothing.
• Take your shirt off before washing your face in the sink so the wash water doesn't get splashed onto your shirt by accident.
• When washing at the sink, if you have a carpeted bathroom, place a towel under your feet to catch any drips that may fall while you are washing.
• Use white pillowcases and sheets. In a pinch, an old t-shirt can also be used as a pillowcase.

We needn't view the sun as an enemy. We get our vitamin D through the sun, and it just plain makes many of us feel good. However, if you get too much sun exposure, you can damage your skin. While trying to get rid of acne it's important to prevent sun damage. As your skin repairs itself from sun damage, this process can cause a breakout to ensue. A breakout can occur about two weeks after overly exposing your skin to the sun.

There are a few reasons why tanning beds may be a bad idea for someone who is acne prone:

1. Exposure to UV light causes skin damage which can ultimately bite back with a breakout in the weeks following exposure as the skin attempts to heal itself. If you've ever noticed that you tend to break out mysteriously a week or two after using a tanning bed, the tanning bed may be the culprit.
2. Horizontal tanning beds force your back to come into contact with a glass surface for an extended period of time. That glass surface slowly gets sweaty. We know that prolonged irritation, especially when combined with sweat, can aggravate body acne. Add to this scenario the UV damage to your skin, and evidence starts emerging that horizontal tanning beds may be a close to perfect back acne recipe. I have personally found horizontal tanning beds to be off limits for myself for these very reasons. I've used them several times throughout my life, and broken out each and every time on my upper back.

For the sake of argument, there may be a reason or two that tanning beds are not so bad.

1. Tanning beds can ease the depression caused by lack of sunlight. Less stress can mean less acne.
2. Tanning beds can help provide vitamin D, a powerfully important nutrient in our bodies.

My best advice: If you are acne prone on your back, avoid horizontal tanning beds altogether. If you must tan in a tanning bed, choose a standing variety, and limit your time in the booth to one of the shortest durations available at the salon. Then, continue with an ongoing back acne treatment regimen to prevent post-tanning breakouts. If you are prone to acne on your face and neck, cover these areas or wear a non-comedogenic sunscreen (I vastly prefer zinc oxide based sunscreens) while inside a tanning booth. Then, after exposure, continue with an ongoing face and neck treatment regimen to prevent breakouts.

Proactiv is on the right track, but some major flaws seem to prevent it from delivering on its promises to many people. In my opinion, the cleanser they include is overly irritating. Furthermore, they tell you to wash for one to two minutes which adds to the irritation. The benzoyl peroxide they provide is 2.5% which is a good call. However, they recommend a "thin layer". For dramatic clearing, one needs to use a generous amount of benzoyl peroxide after a few weeks of slowly ramping up the dosage. When you do use a generous amount of Proactiv's benzoyl peroxide lotion, its scent will tend to nauseate.

It will prove cheaper and far more beneficial to buy an over-the-counter gentle cleanser, an unscented 2.5% benzoyl peroxide medication, and an oil-free moisturizer. However, if you currently own Proactiv Solution products, don't throw out the benzoyl peroxide lotion. If you can handle the smell, it should work fine, as long as you use it within the Acne.org Regimen and are generous with it. I would not recommend using their cleanser. The toner they include is probably fine to use, but is unnecessary.

Proactiv reviews

If you are new to the Regimen, we do not recommend starting out by including the AHA+ lotion. Give yourself at least three weeks or so to let your skin get accustomed to the benzoyl peroxide before you consider adding in the AHA+ lotion. If you have super sensitive skin, try only a small dab of it under the jaw line for a few days to make sure your skin reacts to it well. When you are ready, start out by using a small amount once daily, or every other day, for the first week or two so you can see how your skin is going to react to it. Then you may increase the amount and frequency as you see fit. Next, Alpha Hydroxy Acids can make the skin more sensitive to the sun, so it is important for you to use a sunscreen each day while using an AHA. This is no joke. My skin is definitely more sensitive to the sun after using AHA for a few days. Prevent burning by using a moisturizer that has SPF in it or a separate sunscreen. Lastly, be sure that no other products you are using have any AHA in them. This will most commonly be listed on the ingredient label as glycolic acid or lactic acid.

Note: I used to recommend Olay Complete for Sensitive Skin (plus a few drops of jojoba oil to make it more moisturizing) as the best SPF sunscreen, but Olay switched the active ingredient from zinc oxide to avobenzone in July, 2009. Due to an outcry from customers, they are switching back as of May, 2010. I am one of those customers who was upset. I've tried 5 avobenzone moisturizers in the past and each time I've broken out. It could be the avobenzone or it could be avobenzone's stabilizing ingredients that affect my skin negatively, but regardless, avobenzone based moisturizers have proven to be a poor option for me. I have heard similar stories from several of you regarding avobenzone based moisturizers. So, until May, the next best choice I see is Eucerin Everyday Protection moisturizer. The ingredient panel doesn't look perfect, but it may work in the interim until Olay switches back and/or I can make an SPF for us myself.