Laura's non-inflamed acne regimen for congested skin and blackheads

In my 17 year's of experience in treating acne, I have found that the toughest kind of acne to get under control is acne that is primarily congested skin, often with blackheads present. By congested skin, I mean the kind of acne that looks like lots of bumps underneath the skin which never seem to surface. I have found that most people who primarily get this kind of acne have certain characteristics that are common.

Characteristics of non-inflamed acne

• Bumps (closed comedones) under the skin - redness absent, simply bumps themselves
• Blackheads
• Excessive oil
• Pebbly appearance when the skin is stretched
• The skin is generally more tolerant to stronger products
• Acne lesions tend to "camp out" in the skin and never go away
• Majority of lesions are congestion/blackheads but a few pimples/pustules may be present

If your skin is truly not on the sensitive side, and your acne is almost entirely either under the surface of your skin and/or blackheads, these are the products you'll need to perform a regimen that works for most of my clients:

PRODUCTS YOU'LL NEED:

1. A scrub containing uniform beads. I do not recommend sharp edged scrubs including shells and/or seeds. This type of skin needs exfoliation more than anything else. Manual exfoliation with a good scrub is a great start - not enough to get you clear however. I do not have a particular brand that I recommend. Hopefully you guys can agree on a good one on the message boards. I use a uniform polyethylene scrub in my office but it is not widely available over-the-counter.
2. Any good non-alcohol based toner. This is a recommended, but not necessary product to prepare your skin for the acid-based serum you put on next in your routine. Why a toner? Cleansers are normally alkaline in order to better degrease the skin. A toner brings your skin back to an acid pH so the acidic exfoliants you put on next in your regimen will not be diluted by the alkalinity of your skin. Be sure not to get a toner has alcohol in it - that would be way too drying and irritating to the skin.
3. A good topical exfoliant. For blackheads I suggest a 5% to 10% glycolic acid serum depending on how your skin tolerates it. A safe way to go is to proceed with a 10% serum by doing a patch test on a small area of your skin. If your skin burns above a 3 on a scale of 1-10, wash off the serum immediately and patch test a different area with a 5% serum. I recommend using a professional brand - the department/drugstore brands tend to be watered-down and not usually strong enough to have an impact on the skin. Some experts say that salicylic acid is better for blackheads, but you can only buy it in a 2% which is not exfoliating enough in this author's opinion. One of the newer exfoliants on the market is mandelic acid - an alpha hydroxy acid made from bitter almonds. It can also be quite effective on blackheads. It tends to be more expensive than glycolic acid, but it can be more effective for some people. It can also be a bit difficult to find.
4. Benzoyl peroxide. To further peeling inside the pore, I also recommend benzoyl peroxide. Products like benzoyl peroxide that keep the pores from clogging up in the first place are highly effective in a non-inflamed acne situation. If you can tolerate a 10% benzoyl peroxide, go straight to using a 10% benzoyl peroxide solution. Again, a patch test is a good idea.

5. Day moisturizer with sunscreen. You will need sunscreen in your morning routine for two reasons:

   • To protect your skin from sun damage - you will be exfoliating the top layers of your skin which will leave you more vulnerable to sun damage.
   • To help keep your skin hydrated - acne products that are strong enough to get non-inflamed acne under control are almost always dehydrating. It's important to keep the skin hydrated.
6. Light nighttime moisturizer. You will only use this for the first two weeks of your program so you don't need a lot of it. Make sure it is non-comedogenic and made for the face and not the body.

Now, you need to know how to use these strong products - this is THE most important part of this article!! If you don't allow your skin to get used to such potent products, your skin will become irritated, dry and dehydrated and the routine will not work. You need to follow these instructions closely and be very consistent if you want to get results. As it is with most things in life, what you put into this is what you'll get out of it.

NON-INFLAMED ACNE REGIMEN:

First Two Weeks:

Weeks 3 & 4:

After the first two weeks of this routine, you will now wear the glycolic acid every morning instead of every other morning. In the evening, you will wear benzoyl peroxide all night as you sleep. At this point you should also stop applying a nighttime moisturizer. In my experience with my non-inflamed acne clients, not wearing a nighttime moisturizer tends to allow the benzoyl peroxide to work better. If your skin starts peeling too much, you can back off the routine for a couple of days, going back to just two hours of benzoyl peroxide application, but try to use it every night if you can. This routine works to prevent new lesions from forming, so if you skip even one day, you may experience a breakout up to a month later. It sometimes takes 30 or more days for acne lesions to form and come to the surface, so those days that you skip could manifest in acne a whole month later.

Weeks 5 & beyond:

After two weeks of wearing glycolic acid every morning and benzoyl peroxide every night, you will now continue to up the regimen by wearing your glycolic acid twice a day - once in the morning and once in the evening. In the evening you will cleanse and tone as usual, then apply glycolic acid, wait for 15 minutes, and then put your benzoyl peroxide on over top of it.

This routine should keep new blackheads from forming, but what do you do about your existing blackheads? Good question. They usually don't go away by themselves - it is best to get an appointment with an esthetician and have them do extractions for you. Don't try to get them out yourself - believe me, it is hard enough with an extraction tool. Most people end up "digging" blackheads and non-inflamed lesions out. This leaves a scab that will stay red for much longer than if you let someone do it for you. You can also scar from doing this, so leave it to the pros.

Congested skin and blackheads can be very challenging to get under control and you will have to be very diligent in doing your routine. It might be at least three months before you see a noticeable difference in your skin. Just because you don't see a difference right away, or you still have some breakouts, doesn't mean this routine is not working. The products help prevent new non-inflamed lesions (bumps and blackheads) from forming, so it is a very gradual process of getting your skin clearer bit by bit.

Lifestyle Considerations

In my opinion, acne is a genetic disorder. I do not believe the following things cause acne, but I do think they can make an existing case of acne worse:

• Stress.
• Not enough sleep.
• Foods high in iodides - salty foods, seafood, seaweed (especially kelp), milk and dairy products, organ meats. You do not need to eliminate these completely, but it may be a good idea to keep them in mind and see how your acne reacts.
• Foods high in androgen hormone levels - peanuts, peanut oil, peanut butter, shell fish, organ meats. When it comes to nuts, I am just referring to peanuts here. Peanuts are actually not nuts, they are a form of legume. Other nuts such as almonds, macadamia nuts, and walnuts should be OK. Again, I am not trying to set out a list of off-limits foods. Instead, eat them in moderation. Knowledge is power.
• The use of fabric softener - do not use fabric softener in the washer or the dryer. The waxy residue it leaves on cloth may clog pores.
• Low-estrogen birth control pills.

In-Clinic Treatments That Can Make a Difference

As I mentioned before, non-inflamed acne can be one of the most frustrating types of acne to manage. There have been times when the routine I outlined above is enough - I have had long-distance clients that cleared up their skin beautifully with this routine. However, there are times when not only will you need professional extractions done, your skin will need some extra help with stronger exfoliants than used in your homecare.

We usually do a low-dose type of chemical peel in our clinic, but every so often we have to go even deeper with a medium-depth TCA type of peel. The particular medium-depth TCA peel I use is the Propeel developed by Dr. James Fulton, renowned acne expert and co-inventor of Retin-A. It can really help to turn the tide against very stubborn acne. If you need this type of peel, look for someone in your area that carries Vivant Pharmaceutical Skin Care and most likely they will be doing Propeels.

Conclusion

Non-inflamed acne can be frustrating, but with the right program you can get it under control. I am able to consistently get my clients 90% clear.

- Laura Cooksey

Owner - Face Reality Acne & Skin Care Clinic

© 1997 - 2009 Daniel W. Kern

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