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Acne Update

June is acne awareness month. It’s a good time to revisit how you are caring for your acne prone skin. Acne is a skin condition that has been experienced by countless people with also seemingly countless approaches as to how to treat it.

Acne was once thought of as something you just had to dry up, but harsh detergent based cleansers (often containing sodium lauryl sulfate) have been found to only exacerbate this condition. It’s time to consider a holistic approach to acne, which not only treats the acne but also improves overall skin health.

What is acne?

Acne is an inherited disorder of the pores in our skin. Acne-prone skin sheds five times more dead skin cells than normal skin. This results in cell retention in the pores which is called hyperkeratosis. These skin cells (keratinocytes) mix with the excess oil that is commonly produced by acne-prone skin. The interaction creates a sticky kind of consistency that is difficult for the skin to purge properly. The abnormal shedding and sticky sebum ultimately leads to the formation of microcomedones.

When the opening of the pore is blocked by sticky sebum it often oxidizes from contact with air. The oxidized sebum turns dark forming a blackhead. When the pore opening is blocked by keratinocytes (skin cells) oil and dead cells back up behind that layer of dead skin. The oil does not turn black because air hasn't touched the sebum to oxidize it and make it turn black. This kind of clogged pore forms a closed comedo, milia, or whitehead. Both open and closed comedones are considered non-inflammatory acne.

Acne becomes inflamed when bacteria inside the pore feeds off the oil and dead cells. Inflammation occurs when the immune system perceives this as an attack and goes on the defensive, bringing in white blood cells to the area to fight the bacteria. Tiny capillaries called arterioles expand to allow the larger white blood cells to pass into the area. This is when you see redness and feel pain. These lesions are called a papules. When the dead cells and dead bacteria rise to the surface it creates a pustule. When all this happens in deeper layers of the skin a cyst can form. Papules, pustules and cysts are considered inflamed acne. Papules should not be extracted as the infection can spread to surrounding areas.

To exfoliate and clear the pores try ingredients that have a proven track record like salicylic acid which is both oil soluble and antibacterial. Make use of other anti inflammatory ingredients like licorice root which is a calming antioxidant. This can be great as a spot treatment. Salicylic based masques combined with licorice root are perfect for particularly vulnerable areas, especially when used prophylactically. I choose salicylic acid over other acne treatment ingredients (like benzoyl peroxide) because salicylic acid is gentler and less irritating for the skin types. When dead cells and bacteria form a pustule, now is the time to have your esthetician do some extractions. At home you can help this process along with a mild drying lotion that is used as a spot treatment for pustules.

Some skin types have weaker capillary walls which leak bacteria and inflammatory cytokines to surrounding tissues, thus increasing the likelihood of more inflamed blemishes. This can also be true for fragile cell walls that line the sebaceous gland, where a break in the wall results in a leakage of oil and bacteria. Some skins are hypersensitive which causes excessive inflammation. These skins may have androgens in their sebum which are even more pro-inflammatory, specifically a type of testosterone called Dihydrotestosterone (DHT). This reminds us that the causes of inflammatory acne are more than just what is going on on the surface of your skin. We must take a holistic approach when trying to treat the problem of acne.

Avoid a one size fits all acne approach. Most acne skincare routines focus on drying up the oil. It doesn’t consider skin sensitivity or the likelihood to become inflamed. Using a scrub on sensitive problem skin may lead to more breakouts, although particles that are specifically designed to be perfectly smooth, small and gentle can sometimes be an exception. If there is sensitivity and inflammation you need to deal with the inflammation first! Inflamed acne appears just how it sounds: as red or pus filled lesions that are often painful. Deeper inflamed nodules may require a dermatologists help. Non-inflamed comedones need to be softened before they are extracted. Closed comedones need a pathway for the oil to escape before cleaning. Your esthetician can be very helpful in recommending treatments and homecare that will soften clogged pores instead of hardening the skin's surface, causing sebum and dead cells to back up in the pores. This is a time where professional help from an esthetician to do extractions can be especially effective. The point being that a good esthetician knows how and what should be extracted. Beneficial treatments include: Peels (which one depends on your skin type), Desincrustation (a solution to soften oil), Steam (which helps liquefy sebum), and Light Massage that can be beneficial to detoxify and melt hardened oil.

Blue Light Therapy

Blue LED light treatments are invaluable. Blue LED light waves target the skin's surface and reach deep into the pores. In doing so the blue light kills acne causing bacteria and reduces sebum production. Adding in a little bit of red light therapy to the treatment reduces inflammation and promotes healing. A good LED device should be FDA approved. The LED lights should be more like tiny computer chips rather than just colored light bulbs. LED light waves have different ranges that are measured in nanometers. Blue light therapy in the 400–470 nm light range offers the best antimicrobial effect. Red light therapy (620-700 nm) goes deeper into the skin to encourage wound healing, collagen production, and to soften wrinkles. These LED therapies should not be confused with damaging ultraviolet rays (100-380 nm) from sunlight that contribute to premature aging. The most advanced treatments are offered by estheticians and dermatologists. Ask if your esthetician is using a medical grade device. For optimal results one should have blue light treatments of 2-3 times a week for a total of 12 or more sessions. One can enhance the effects by using a reputable home device that contains both blue and red LED.

Moisture to Support a Healthy Barrier

Because the most common approach to clearing acne is using dry, harsh products, it is commonly believed that acne needs to be "dried out". In fact, drying the skin out to clear up acne will work against efforts toward achieving clear skin. Optimal skin health requires a healthy skin barrier. A compromised barrier can lead to greater inflammation issues. Adequate hydration is necessary for acneic skin to balance out the use of antibacterial ingredients. Hyaluronic acid will increase moisture content without adding additional oil. An oil free moisturizer is also important for protecting the skin barrier and allowing it to heal. Drinking water is important to keep skin well hydrated, although this is not the complete answer to alleviating dehydration. As the water that many people drink is absorbed by vital organs first and does not always make its way to the tissues of the skin. Lemon water first thing in the morning helps detoxify your skin. Adding lemon to the water helps balance your pH. Since acne likes an alkaline environment, creating a slightly acidic environment will help limit acne causing bacteria.

A Holistic Approach

While acne is a skin condition, it is affected by internal factors of the body. Though acne cannot be cured, it can be controlled through targeted skin care and lifestyle adjustments. Acne can be managed with thoughtful dietary choices. Cutting back or limiting intake of triggering food is recommended. Note that acne triggers can be highly specific to each person. I recommend keeping a food diary to keep track of specific foods that might be causing your acne. For instance, foods high in saturated fat, trans fats and sugar, can cause inflammation in the body and therefore cause inflammation in the skin. Increased sugar in the blood will increase bacteria in your skin. Over-consumption of omega-6 fatty acids like corn oil, safflower oil, and sunflower oil are also inflammatory. Olive oil is a monounsaturated fat. It is anti-inflammatory and stimulates cell energy for repair via the oleic acid it contains. Iodides, which are found in things like simple table salt, soy products and seaweed may be pervasive acne triggers for your skin.

Dairy products are a well known acne trigger. Dairy products like milk, cheese, and yogurt can exacerbate breakouts. Even organic dairy products are still high in IGF-1 growth hormone, which increases sebum production, changes the viscosity of the sebum (making it thicker) and causes inflammation. Dairy consumption is doubly problematic. Dairy's high glycemic index triggers increased levels of glucose in the blood and the release of the IGF-1 hormone. These are both pro-inflammatory. Other ingredients like peanut butter (opt for almond or other nut butters) and organ meats are high in androgens and can create a similar problem. The diet of an acne-prone individual should be as anti-inflammatory as possible and rich in antioxidants like green tea and dark leafy green vegetables. Omega 3 fatty acids found in salmon, white fish, and nuts (especially almonds and walnuts) help lower inflammation. You may need to supplement with Omega 3s. Turmeric (rich in curcumin) is also anti-inflammatory. Below is a great recipe for a Turmeric Latte. Drink it daily to help manage your inflammation:

Turmeric Latte

  • 2 cups of oat milk (oat milk has no hormones and is very calming)

  • 1 tsp turmeric (super anti-inflammatory)

  • 1 pinch of ground black pepper (helps turmeric get absorbed by the body)

  • 1/2 tsp each cinnamon and ground ginger (optional)

  • 1/2 tsp locally made honey to taste (said to have an antimicrobial effect)

Add ingredients to a small saucepan over medium heat.

Whisk until steaming and frothy.

Pour into mug and enjoy.

What else is irritating your skin?

Fragrance in laundry detergents as well as the chemicals in dryer sheets can contribute to flare-ups. Even the bacteria that builds up on your pillowcase can be a culprit. Buy several soft natural pillow cases and change them daily to avoid bacteria buildup that you could reintroduce to your skin.

You are thoroughly removing your makeup each night, right? Makeup left on overnight is sure to clog the pores and create heat in the skin which adds to the proliferation of bacteria and inflammation. Try a double cleanse at night. First cleanse with a milky cleansing emulsion containing some astringent oils that will melt your makeup for better removal. Rinse Well. Follow up with a non-foaming gel cleanser appropriate for your skin type.


Sebum production is driven by hormones. Androgens (male hormone) can highly affect your skin by increasing inflammation along with a certain type of sticky sebum that increases clogging. Stress increases the hormone cortisol, which also increases this type of sebum. You may need to see an endocrinologist to help balance these hormones. Try stress reduction techniques like meditation and yoga to lower stress hormones. Some clients have good results with drinking spearmint tea (especially on those days leading up to your period) which purportedly helps to balance hormone fluctuations.

Skin Therapy

Skin Therapy that targets clogged pores with anti-bacterial peels; gentle extractions, and soothing masques will provide positive results, especially when the treatment focuses on anti-inflammatory modalities like oxygen therapy to cool the skin and kill anaerobic acne bacteria. LED Light Therapy should be considered and performed by your esthetician to ensure beneficial improvements for your acne prone skin. A seasoned esthetician will provide positive treatments, careful observation and useful communication about your skin.

Elizabeth believes in "Longevity Skincare", the idea that beautiful skin can endure throughout one's lifetime when utilizing the best that science and nature has to offer. LONGEVITY is a science-based skincare line that appreciates skin of all ages. LONGEVITY by Elizabeth Renee provides hydration, nutrition and protection from environmental aging. Your skin will receive high performance ingredients to help energize and repair its cells, resulting in a healthy skin with an enduring, vital glow.


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