Does Washing the Skin Help or Hurt Acne?
Washing Gently, Twice a Day, with a Non-irritating Cleanser Might Help to Some Degree
Proper skin hygiene and care is crucial to acne management and treatment. The goal of skin cleansing is to remove dirt, oil, and sweat from the surface of the skin in order to prepare the skin for treatment. This allows acne treatments to best penetrate into the skin.
However, while washing the skin is essential for the management of acne, it is necessary to choose a proper skin cleanser--one that is mild and slightly acidic. You can find this by looking for cleansers specifically made to wash the face. Look for the words "gentle" and/or "for sensitive skin" on the label.
Also, from the research we have thus far, washing twice a day is ideal. No more, no less.
How to wash: Wash exceedingly gently, for 10 seconds or less. The ingredients in almost any skin cleanser are powerful and do not need much time to do their job. The less time you wash and the gentler you are when you wash, the less irritation you will cause, and the better you will be able to stay clear.
Avoid soap: Soap is harsh and can damage the skin's fragile barrier, which can lead to more acne.
Acne is a complex disease that is caused by a variety of factors, including chronic inflammation. Washing the skin is unlikely to clear acne on its own, but research shows that as long as you wash gently with a non-irritating cleanser, it may help.
Selection of Appropriate Skin Cleansers
Depending on the cleanser that is used, washing the skin is a process that can be either helpful or harmful to acne-prone skin. Therefore, choosing an appropriate skin cleanser is crucial. When choosing a cleanser, it is necessary to choose one that is able to remove skin oil (sebum) from the surface of the skin without causing skin irritation.
How irritation can happen: The outermost layer of the skin surface protects us from the environment and ensures that our skin does not lose water. This outermost layer is composed tightly packed skin cells that are held together with lipids (fats). Skin irritation results when these lipids are disturbed, and irritation of the skin can lead to more acne, so it is important to choose a mild skin cleanser that can remove dirt, oil, and sweat from the skin's surface without stripping away essential lipids and irritating the skin.1
Scientists have performed several studies to identify what properties or ingredients cleansers must possess so that they remove only excess sebum and do not irritate the skin. They found that the best cleansers for acne-prone skin are those which do not damage the oils found in skin cells, keep the skin hydrated, and maintain the skin's normal acidity. They also found, in general, that cleansing the skin with a gentle cleanser may be beneficial for acne. However, while cleansing gently with a non-irritating cleanser may help reduce acne, the researchers also found that washing with soap or harsh cleansers can cause skin irritation and an increase in acne.
Expand to read details of studies
A 2004 review article published in the journal, Dermatologic Therapy, stated that the presence of harsh surfactants in skin cleansers was harmful to the skin. Surfactants are active substances found in detergents and easily can remove dirt and oil from the skin. However, common surfactants such as sodium lauryl sulfate cause "significant skin irritation." When used on the skin, some surfactants cause skin tightness, dryness, irritation, dehydration, and itching. Therefore, skin cleansers with harsh surfactants should be avoided, as they damage and dehydrate the skin. To decrease the harmful effects of surfactants, researchers created mild surfactants that are less irritating because of their decreased ability to interact with skin cells. Generally, these milder cleansers are sold in liquid form, are extremely gentle on the skin, and are safer to use on acne-prone skin.2
The same 2004 review article also commented on how the acidity of the cleanser affected the skin. The scientific way to measure the acidity of a substance is the pH scale. The pH scale ranges from 1 - 14, 1 representing an extremely acidic substance, 7 representing a neutral substance, and 14 representing an extremely basic substance. For example, the pH of stomach acid is 2, water 7, and baking soda 12. The skin maintains a slightly acidic pH of 5.5. Researchers have found that basic skin cleansers with a pH of 10 cause skin irritation, inflammation, and disrupt the oils found in skin cells. However, skin cleansers with a pH closer to the skin's normal pH are less damaging to the skin.
Skin cleansers are not the only products whose slight acidity is ideal for acne-prone skin. This applies to moisturizers as well, and such moisturizers also may be beneficial for acne-prone skin since they help to restore and repair skin cell oils that were damaged or lost during cleansing.2
A 1995 study published in the journal, Infection, investigated whether a slightly basic bar soap or a slightly acidic syndet bar was better for acne. Syndet bars are composed of laboratory-synthesized, mild surfactants that retain a slightly acidic pH. To perform this study, the researchers had 120 adolescents and young adults apply either bar to the skin for one minute, twice a day, for three months. Then they compared the severity of acne lesions on the face of the participants between the two groups. They found that those who had used the soap increased the average number of acne lesions from 14.6 to 15.3, while the participants who had used the syndet bar decreased the average number from 13.4 to 10.4. Further, 40% of those who used the bar soap reported skin irritation, and only 1.8% of the syndet bar participants reported skin irritation. The researchers concluded that the "acidic cleanser should be preferred for skin care in adolescents and young adults."3
A 2015 study published in the journal, Skin Research and Technology, investigated the ability of a specifically designed mild skin cleanser to improve acne. The researchers rated 18 male adults on a scale of 1 - 5 in terms of acne severity, 1 representing no acne and 5 representing severe acne. Skin dryness also was measured using the same scale. Then the participants washed their faces with the newly formulated, mild cleansers twice a day for four weeks. At the beginning of the study, 7 subjects had modest (1 - 1.5 on the 1 - 5 scale) acne; 9 had mild acne (1.5 - 2), and 2 had moderate acne (2 - 3). After four weeks of twice-a-day cleansing, 5 participants had no acne; 2 had mild acne, and 11 had modest acne. The researchers concluded that "[a] significant decrease in acne lesions was observed on every area of the face."4 However, it is important to keep in mind that this study was performed by the company that made the skin cleanser, and they used company employees as participants. More independent research is needed in order to confirm these findings.
Surfactants - the ingredients in cleansers that do the work: Cleansers contain ingredients called surfactants that remove dirt, oil, and sweat. Some surfactants are gentle, and others are harsh. Also, some surfactants are acidic and others are basic (alkaline). Overall, the best cleansers do not contain harsh surfactants and are slightly acidic. This is because the skin itself is slightly acidic, so cleansers that match the skin's acidity are gentler.
Choosing a safe cleanser: It may seem overwhelming to find a cleanser that has only gentle surfactants and is slightly acidic, but following these simple steps will allow you to find the right product:
- Make sure the cleanser is specifically made for the face
- Look for the words "gentle," "ultra-gentle," and/or "for sensitive skin"
- Choose a liquid cleanser over a bar
Proper Use of Skin Cleansers
Choosing the appropriate cleanser is crucial to ensure that washing the skin helps reduce acne. However, the frequency and intensity of skin cleansing is also important an important consideration. We only have one study so far that looks at frequency of washing and its effect on acne, and the study is small and performed only on men, but results show us that twice-daily washing may be best.
Expand to read details of study
A 2006 study published in the journal, Pediatric Dermatology, investigated whether the frequency of washing the skin improved acne or not. The researchers performed this study on 24 male patients with an average age of 19 years. For the first two weeks of the study, all participants washed their face with the same mild cleanser twice a day. After this two-week period, the subjects were divided into three groups, in which some washed their face once a day, others twice a day, and the rest four times a day. After each week, the researchers counted the number of acne lesions that were present on each participant. After the original two-week period, in which all the men had used the same cleanser, the researchers found that the mild cleanser decreased the number of whiteheads but increased the number of inflammatory acne lesions. After eight weeks, the men in all three groups noticed decrease in acne lesions, but there were slight differences among men in each group. Specifically, men who had washed their face just once a day experienced slightly more acne than those who had washed their face two or four times a day. The scientists observed no differences in the acne of the men who had washed their face two or four times a day. The researchers preferred twice-a-day washing in men who had acne.5 This research agrees with other studies which found that increased water contact can excessively dry the skin. The form of this that swimmers sometimes experience is called swimmer's xerosis.6 The twice-a-day washing schedule that this study found beneficial should ensure that over-washing the skin does not occur.
In addition to washing the skin twice a day using a mild cleanser, it is important to remain gentle when you wash. One common acne myth is that scrubbing of the skin several times a day reduces its oil content, but it actually removes important skin lipids necessary for water retention. This causes skin irritation and aggravates acne. Over-washing the skin and the acne it can produce even has it's own name: detergent acne.1
Proper skin hygiene and care is crucial to acne management and treatment. The goal of skin cleansing is to remove dirt, oil, and sweat from the surface of the skin in order to prepare the skin for treatment. Washing the skin is essential for the management of acne, but it is necessary to choose a proper skin cleanser, meaning it is mild, slightly acidic, and is used gently and twice a day.
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- Solomon, B. A. & Shalita, A. R. Effects of Detergents on Acne. Clin Dermatol 14, 95 - 99 (1996).
- Ananthapadmanabhan, K. P., Moore, D. J., Subramayan, K., Misra, M. & Meyer, F. Cleansing without compromise: the impact of cleansers on the skin barrier and the technology of mild cleansing. Dermatol Ther 17, 16 - 25 (2004).
- Korting, H. C. et al. The influence of the regular use of soap or acidic syndet bar on pre-acne. Infection 23, 89 - 93 (1995).
- Isoda, K. et al. Effects of washing of the face with a mild facial cleanser formulated with sodium laureth carboxylate and alkyl carboxylates on acne in Japanese adult males. Skin Res Tech 21, 247 - 253 (2015).
- Choi, J. M., Lew, V. K. & Kimball, A. B. A Single-blinded, Randomized, Controlled Clinical Trial Evaluating the Eﬀect of Face Washing on Acne Vulgaris. Ped Dermatol 23, 421 - 427 (2006).
- Blattner, C. M., Kazlouskaya, V., Coman, G. C., Blickenstaff, N. R., Murase, J. E. Dermatological conditions of aquatic athletes, World J Dermatol 4, 8 - 15 (2015).
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