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I am 46 years old and have been dealing with Acne in some form since I was 12. At 24 I went on Accutane and it made a huge difference but I still have contended with plenty of pimples since then, through pregnancy and now hormonal perimenopause. I know many of the people reading this are much younger so I feel as if I finally have some good advice to share. I think the main problem with most regimens is that they do one or two things, but not the three most important things that I think are necessary to do all at once:
1.)
Clean out pores
2.)
Exfoliate and keep the oil on your skin to a minimum
3.)
Kill bacteria and reduce Inflammation

 

Warnings: The information below is for people with real acne. People with pimples here and there do not need this plan and may dry out their skin too much. Also if you have sensitive skin, go slow and be careful. And please note that nothing here is original - you can find information about all of these treatments on the Acne.org website and elsewhere. My take on it is that you need to be using a product in each category.
 

1.) Clean out pores: Charcoal is the best. I like Lush Dark Angels. Leave it on for a few minutes after scrubbing. 2nd choice is Biore Self Heating One Minute Mask. Also leave in for longer than 1 minute. These scrubs/masks should bring out whiteheads and blackheads and after you use the scrubs/masks you could/should pop them (as long as you have really cleaned your hands). I recommend this nightly or nearly nightly. There are other ways to clean out pores, like steam or getting facials or rotating brushes, but nothing works as well as charcoal in my opinion.

2.)
Exfoliate and reduce oil: The best products in this category are Vitamin A and acids.
a.)
Vitamin A: My favorite company is Vivant Skin Care and their best product is Exfol-A or Exfol-A forte. It is like Retin A without the prescription. In fact, the company was founded by Dr. Fulton, one of the inventors of Retin A. Follow the directions on Vivant’s website - you will start slow and then use the stronger products and start using them more frequently. Eventually you will use the Exfol-A nightly. I do not recommend prescription Retin A unless you can find one in a gel form. I think the cream that it comes in can clog pores.

b.) In addition or if the Exfol-A is too much for you, you should also use a salicylic acid or mandelic product. Many companies make pads or cleansers (Vivant has both and Proactiv has a toner). Some of the pads also contain glycolic acid. The pads are good for after sports before you can get home and wash. They can also be good in the morning instead of washing your face. They will take away excess oil and also help to gently exfoliate.
c.) Another acid treatment is peels. You can do these several times a week. But you probably should not do them if you are using the Exfol-A regimen nightly. It will be too much. Perfect Image makes several levels of peels for acne. Use their website to get information about frequency and strength and be very careful about how long you leave the acids on your face.

 

3.) Kill Bacteria and reduce inflammation: There are several routes you can take here - Benzoyl Peroxide or other topical creams, an oral antibiotic like Doxycycline, or Blue and Red Light therapy.
a.) Topical cream - My problem with these is that I never found them to be strong enough and they also can have other potential ingredients that clog pores. They can also be very drying. But maybe the Acne.org one is good. You should also look at one called Vanoxide which contains both an antibiotic and an anti inflammatory (hydrocortisone).
b.) Oral Antibiotics - These can work but they may have other complications like killing gut bacteria. Also how long do you need to be on them - maybe forever? But I have to confess this works best for me at a low dose.
c.) Blue Light and Red Light therapy - This works as well. Buy a mask or a wand. The problem is the treatment needs to be done every day and takes time. The mask also can make it hard to go to sleep at night and the wand is small and you have to keep moving it around. The blue light works to kill the bacteria (a multi-step process, read online) and the red light reduces inflammation.
 

Other options to clean pores and exfoliate: If you see a dermatologist, he/she may recommends facials where they open and clean out your pores and also do stronger peels. This will work but gets expensive as you will need it often in the beginning. You can also try microdermabrasion to exfoliate at home or in an office.There is a device online that is getting good reviews, however, I have only had a professional do it. Finally, you are going to have to moisturize. I truly hate this part because I am so oily that it makes me feel even greasier. However, it is necessary and you should consider a product with an SPF as well. Also make sure to look at the Acne.org list of ingredients to avoid in products. This is very important and is also recommended by Dr. Fulton. I use the Vivant product called Day Treatment Lotion with SPF as well as Allantoin.

 

This methodology above will take some time - a few weeks at least because many people will actually get worse before they get better. And you may have to go slowly and build up or try a few products in each category to find what you like and can tolerate. The key is to make sure you have a product in each category that works for you. If you try this and give it 3 months and you are not happy then I would call a doctor and consider Accutane. I hope this is helpful.

 
Edited by DogBeach
typos

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To add to my post: I forgot to mention icing. Icing will help with inflammation. It will make a difference right away. You can ice cystic acne to reduce the swelling. It can also prevent acne. You may want to get into the habit of doing it nightly after washing. Google it to read details. To make it easy: fill up small bathroom cups with water and put in freezer. Use them to ice and peel down the cup as the ice melts. 

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