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Battle Plans for Fighting Blemishes

By Paula Begoun

Paula's Choice Battle Plans for Fighting Blemishes

Battle Plan for Normal to Oily/Combination Skin Prone to Blemishes:

Paula's Choice Clear Skin Kit

One Step Face Cleanser for Normal to Oily/Combination Skin
1% Beta Hydroxy Acid Lotion
Blemish Fighting Solution
Essential Non-Greasy Sunscreen SPF 15 for Normal to Oily/Combination Skin (daytime)
HydraLight Moisture-Infusing Lotion (nighttime)
Skin Balancing Carbon Mask

Battle Plan for Moderate to Severe Blemishes

Paula's Choice Skin Balancing Anti-Blemish Kit:

Skin Balancing Cleanser for Normal to Oily/Combination Skin
2% Beta Hydroxy Acid Liquid
Extra Strength Blemish Fighting Solution
Essential Non-Greasy Sunscreen SPF 15 (daytime)
Skin Balancing Moisture Gel
Skin Balancing Carbon Mask (as needed after cleansing)

Battle Plan for Normal to Dry Skin Prone to Blemishes:

Paula's Choice Clear Skin Kit

One Step Face Cleanser for Normal to Dry Skin
Moisture Boost Hydrating Toner
1% Beta Hydroxy Acid Lotion
Blemish Fighting Solution (over areas that break out)
Skin Balancing Daily Mattifying Lotion SPF 15 (daytime)
HydraLight Moisture-Infusing Lotion (nighttime)

There is very little mystery about how a pimple is created. It essentially starts with hormones causing some amount of excess oil production in the pore. For some reason, the oil cannot get out in an even flow, possibly as a result of an abnormally shaped pore. This backed up oil, along with a buildup of dead skin cells in the pore lining, form a blockage and eventually, a clogged pore. A specific type of bacteria (called propionibacterium acnes) existing in the pore thrives on the oil and dead skin cells, flourishes, and as a result causes the skin to become inflamed. The inflammation and bacteria proliferation result in a pimple (Source: Drugs, 2003, volume 63, issue 15, pages 1579-1596 and Advances in Dermatology, January 2003, pages 1-10).

There are limited studies looking at the role diet plays in causing and/or treating acne. For some individuals an allergic reaction to certain foods such as nuts, salmon, or dairy products can trigger inflammation in the pore, resulting in blemishes. Research indicates that dietary supplements, such as zinc or vitamin A, are most likely not effective in the treatment of acne. These supplements may very well be unhealthy if too much is taken (Sources: Journal of Pediatric Hematology and Oncology, October 2002, pages 582-584; Journal of the American Academy of Dermatology, August 2002, pages 231-240; and European Journal of Dermatology, June 2000, pages 269-273).

For optimal results when fighting blemishes and acne:

Reduce oil to eliminate the environment that acne-causing bacteria thrive in.
Exfoliate the skin's surface and within the pore to improve the shape and function of the pore.
Disinfect the skin to eliminate acne-causing bacteria.

Over-the-counter and prescription options abound for fighting blemishes, which makes it a confusing battle to fight, because there isn't one routine or medication (or combination of therapies) that works for everyone. Finding the combination that works for you is the goal, and that requires experimentation.

Fighting Blemishes, Step-by-Step

CLEANSING THE FACE: Use a gentle water-soluble cleanser.

One of the most common myths in skin care is that a cooling or tingling sensation means that a product is “working,” which couldn’t be further from the truth. That feeling is actually skin irritation, and products that produce that sensation can actually hurt the skin's healing process, make scarring worse, and encourage the bacteria that cause pimples. Using cleansers that contain pore-clogging ingredients (like soaps or bar cleansers) can also make matters worse (Source: Dermatologic Therapy, February, 2004, Supplement, pages 16-25 and 26-34). The essential first step is finding a gentle, water-soluble cleanser.

If you are removing stubborn or waterproof makeup, you may need to use a washcloth to be sure you really remove all of your makeup. To prevent bacteria growth on that washcloth, use a clean washcloth every time you wash your face.

EXFOLIATING: Use a 1% to 2% beta hydroxy acid (BHA) product (or an 8% alpha hydroxy acid (AHA) product) to exfoliate the skin. As a general rule for all forms of breakouts (including blackheads), BHA is preferred over AHA because BHA is better at cutting through the oil inside the pore (Source: Cosmetic Dermatology, October 2001, pages 65-72). Penetrating the pore is necessary to exfoliate the pore lining. However, some people (including those allergic to aspirin) can't use BHA, so an AHA is the next option to consider.

A topical scrub or a washcloth can be used as a mechanical exfoliant. This can be helpful for some people to remove dead skin cells, but this does not in any way take the place of an effective BHA, AHA, or topical prescription treatment. Be careful never to over-scrub when using a mechanical scrub—too much abrasion can disrupt the skin’s ability to heal.

TOPICAL DISINFECTING: Benzoyl peroxide* is considered the most effective over-the-counter choice for a topical disinfectant to fight blemishes (Source: Skin Pharmacology and Applied Skin Physiology, September-October 2000, pages 292–296). The amount of research demonstrating the effectiveness of benzoyl peroxide is exhaustive and conclusive (Sources: American Journal of Clinical Dermatology, April 2004, pages 261-265; and Journal of the American Academy of Dermatology, November 1999, pages 710–716). Among benzoyl peroxide's attributes is its ability to penetrate into the hair follicle to reach the problem-causing bacteria and kill it—with a low risk of irritation. Furthermore, it doesn't pose the problem of bacterial resistance that some prescription topical antibacterials (antibiotics) do (Source: Dermatology, 1998, volume 196, issue 1, pages 119–125).

There aren't many other options for disinfecting the skin. Alcohol and sulfur can be good disinfectants, but they are also too drying and irritating and that can make matters for skin worse and hurt the skin's ability to heal. (Sources: American Journal of Clinical Dermatology, April 2004, pages 217-223 and Cosmetics & Toiletries Magazine, March 2004, page 6; and Infection, March-April 1995, pages 89-93).

Tea tree oil has some interesting research showing it to be an effective disinfectant. The Medical Journal of Australia (October 1990, pages 455–458) compared the efficacy of 5% tea tree oil, to that of 5% benzoyl peroxide for the treatment of acne. The conclusion was that "both treatments were effective in reducing the number of inflamed lesions throughout the trial, with a significantly better result for benzoyl peroxide when compared to the tea tree oil. Skin oiliness was lessened significantly in the benzoyl peroxide group versus the tea tree oil group." Unfortunately, most products on the market contain little more than a 1% concentration of tea tree oil, not the 5% strength used in the study.

For some people, a topical disinfectant may be enough, but that is generally the exception. Using a topical antibacterial and an exfoliant is a powerful combination in winning the battle against blemishes. Cleaning the skin without both exfoliating and disinfecting is less likely to have an impact on blemishes. You can get fairly good results using one or the other, but together they are a formidable defense against blemishes.

*Note: Benzoyl peroxide negates the effectiveness of most retinoids (i.e., Retin-A, Tazorac) and therefore cannot be used at the same time. To get both benefits, you can use benzoyl peroxide in the morning and the retinoid in the evening. However, Differin (adapalene) has been shown to remain stable and effective when used with benzoyl peroxide (Source: British Journal of Dermatology, Oct. 1998, page 139).

ABSORBING EXCESS OIL: This is perhaps one of the most difficult skin care problems to control. Because oil production is only triggered by hormones, there is nothing you can apply topically to stop them from making more oil. What you can do is not make matters worse by avoiding products that contain oils or emollient products. To absorb oil, forms of clay mask can help a lot, though avoid those that contain irritating ingredients. As strange as it sounds, Phillip's Milk of Magnesia can be used as a facial mask. It is nothing more than liquid magnesium hydroxide, which does a very good job of absorbing oil. How often to use a mask depends on your skin type, some use it every day; others, once a week.

Medical Options

RETINOIDS:Aside from exfoliation, prescription options for improving the shape of the pore include Retin-A(tretinoin), Differin(adapalene), and Tazorac (tazarotene). There is an immense amount of research showing these to be effective in the treatment of acne (Source: Journal of the American Medical Association, August 11, 2004, pages 726-735). Depending on your skin type, you can use these up to twice a day. You can also use these only at night in combination with using a BHA or AHA during the day. As an alternative, some dermatologists recommend applying the BHA or AHA first then applying Retin-A, Differin, or Tazorac. The thought is that the BHA or AHA boosts the effectiveness by aiding penetration of the other products. Again, talk to your doctor and experiment to see which frequency, combination, and order of application works best for your skin.

ORAL ANTIBIOTICS: If the nonprescription options previously discussed (gentle cleansing, exfoliants, and antibacterial agents) or the use of prescription retinoids don't provide satisfactory results, an oral antibiotic prescribed by a doctor is another option to consider. Several studies have shown that oral antibiotics, used in conjunction with topical tretinoins or topical exfoliants, can control and greatly reduce breakouts (Sources: Cutis, June 2004, pages 6-10; and International Journal of Dermatology, January 2000, pages 45–50).

However, as effective as oral antibiotics can be, they should be considered carefully. A serious, problematic side effect is that acne-causing bacteria can become immune to the antibiotic after a short period of time, causing the acne condition to return (Sources: Dermatology, January 2003, pages 54-56; American Journal of Clinical Dermatology, April 2003, pages 813-831 and March 2001, pages 135–141; and The General Meeting of the American Society for Microbiology, May 2001). Whatever course of action you take should be discussed at length with, and side effects monitored by, you and your dermatologist.

PHOTODYNAMIC THERAPY: Also called Light Therapy, has been shown to effectively treat acne (Source: Journal of Cosmetic Laser Therapy, June 2004, pages 91-95). This medical treatment uses a topical medication called aminolevulinic acid (a drug used for the treatment of precancerous skin conditions) in conjunction with non-skin-damaging lasers or a light source called blue light (Source: American Academy of Dermatology, www.aad.org). After the topical medication is applied, the patient sits in front of the light source for 15 to 30 minutes. It is often necessary to have three to five sessions over a period of time before lasting improvement is seen.

When All Else Fails

If your breakouts persist after you've tried the options I've described, it may be necessary to consider more serious treatment such as hormone blockers or birth control pills designed to reduce breakouts.

Accutane is one of the last options in this lineup of last resorts because of the very serious potential side effects, especially if a woman becomes pregnant while using it (I discuss these options at length in my book The Beauty Bible, 2nd Edition). However, Accutane is the only option that can potentially cure breakouts. All other methods simply keep the problem reduced or at bay. More than 50% of the people who take Accutane for one round never break out again, and it eliminates oily skin altogether. Those odds are increased significantly for people who take it a second time (Sources: Skin Therapy Letter, March 2004, pages 1-4; Expert Opinion on Drug Safety, February 2004, pages 119-129; and Journal of the American Medical Association, August 2004, pages 726-735).

If irritation occurs, you may need to cut back on the exfoliant, disinfectant, and/or facial mask you use. It doesn't mean the skin-care routine isn't working or won't eventually work for you, but perhaps your skin can't handle the frequency of application, at least not in the beginning. Patience and a willingness to experiment are the key to winning the battle against blemishes.

If you decide to try a prescription option such as Retin-A, Differin, or Tazorac, you would either apply it once a day instead of an AHA or BHA, or you can apply the AHA or BHA first and then apply one of the prescription options after.

If you decide to try a prescription antibacterial option you would apply that in place of the Blemish Fighting Solutions.

If you find any of these effective topical agents too irritating, rather than discontinuing use, consider cutting back how often you apply the products or switching to an alternative exfoliant or antibacterial. If you find Retin-A too irritating you can consider changing to Differin or Tazorac. The most important thing is consistency. It takes 4-6 weeks to see improvement in your skin (that is about the life cycle of a pimple).

Note: You cannot apply benzoyl peroxide at the same time as Retin-A; you would apply the Retin-A in the evening and the benzoyl peroxide in the morning. However, Differin can be used with benzoyl peroxide.

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