The Best Acne-Fighting Skincare Routine, According to Dermatologists
Treating adult acne is a balancing act. You need to use the right products and ingredients to address acne while simultaneously hydrating and protecting your skin barrier. Your skincare strategy to fight breakouts now is not the same as a teenager’s game plan. “After the age of 25, treating acne is not about stripping your skin of oil,” says Joshua Zeichner, M.D., a board-certified dermatologist in New York City. “You want to use gentle formulations that have hydrating ingredients that respect the skin barrier because if your skin is dried out, then there’s potential for inflammation, which exacerbates acne breakouts.”
The goal with an adult acne skincare routine is to prevent breakouts with right active acne-fighting ingredients and hydrating ones at the same time. The right products (we’ll get to those in a minute) can improve acne, protect and hydrate the skin barrier, even your skin tone, and even reduce the appearance of fine lines. Yes, they really can! Read on to learn why acne happens in your 30s, 40s, and up, and how to cear your skin and baby it at the same time. Let’s start with the basics.
What causes acne?
You’re old enough to be using anti-aging products, but you’re breaking out like a high schooler (even if you never had acne as a teen). The fact is, the battle against blackheads, whiteheads, pimples and cystic acne can carry right through to menopause. Why is adult skin prone to breakouts? One reason is hormones. Hormonal acne is very common in adults, says Howard Sobel, M.D., an attending dermatologist at Lenox Hill Hospital and founder of Sobel Skin, who explains that pregnancy, your menstrual cycle and starting or changing birth control pills can speed up oil production, causing pimples to form. Stress hormones like cortisol can also impact the oil glands to produce more sebum.” (And nothing adds to stress like a big, angry zit!)
Additionally, skin cell turnover slows down as you get older, and those dead cells can clog pores and cause pimples. Finally, your own skincare routine could be breaking you out. “Over-scrubbing and stripping the skin with drying cleansers and acne-fighting active ingredients can dry the skin and impair barrier function, making it more susceptible to irritation that triggers inflammatory breakouts,” says Zeichner.
The most effective acne-fighting ingredients
“There are 3 main tools that we use over-the-counter for acne,” says Zeichner. “These are salicylic acid, benzoyl peroxide, and the retinoid called adapalene, which is now available OTC in 0.1%. Salicylic acid is a beta-hydroxy acid that’s oil-soluble, so it can remove oil and dead skin cells that block pores. Adapalene is a mighty multitasker that speeds up skin cell turnover, so it helps the skin to shed sticky dead cells and has the added benefit of boosting collagen production over time to improve fine lines.” Benzoyl peroxide is a well-studied and FDA-cleared OTC topical ingredient that’s been used for decades to treat acne by killing p. acnes bacteria in the pores.
A note about benzoyl peroxide safety
In March of this year, the independent lab Valisure requested that the FDA recall and suspend sales of products with benzoyl peroxide (BP) after their testing showed that benzoyl peroxide acne treatments can break down at high temperatures and generate the carcinogen benzene. The study has understandably caused controversy and raised a lot of questions about the safety of acne products containing benzoyl peroxide. (Interestingly, Valisure has a patent pending on a method to prevent BP from breaking down in a formula.) So, is topical OTC benzoyl peroxide safe to use for acne? “If you’re using an OTC benzoyl peroxide product at a low concentration like 2.5%, and it’s stored at the temperature recommended on the packaging and discarded it after the expiration date, then it’s unlikely that the formula has degraded to release benzene at levels that are worrisome,” says Zeichner. But there are also plenty of effective acne products that don’t contain BP, if you want to press pause on that ingredient for now.
What’s the best skincare routine to prevent adult ccne?
This dermatologist-recommended AM and PM skincare routine is easy to follow, won’t irritate your skin, and has multiple benefits besides keeping acne breakouts in check.
Step 1: Wash your face – or just rinse!
Though you may be tempted to scrub away at your face in an effort to get rid of zits, that can actually make things worse, says Elyse M. Love, M.D., of Spring Street Dermatology in New York. “Often patients believe that acne is a result of excess dirt or oil on the skin and they attempt to over-cleanse and over-exfoliate the skin,” she says. “Although routine cleansing is important, acne is an inflammatory condition, so this over-cleansing can actually irritate the skin and further exacerbate the problem.”
Dermatologists recommend washing your face with a gentle cleanser, such as Neutrogena Ultra Daily Face Wash for Sensitive Skin. (Zeichner suggests simply rinsing your face with cool or lukewarm water in the morning, unless you have oily skin.)
Derm tip: If you’re in a morning rush, you can skip the Step 2 acne treatment and use a gentle cleanser that contains an acne-fighting ingredient. If you have whiteheads or blackheads, look for a one with salicylic acid to slough off dead skin cells (try Skinfix 2% BHA Cleanser). If you have red, inflammatory acne look for a cleanser that contains benzoyl peroxide, which targets surface bacteria. (CeraVe Acne Foaming Cleanser contains 4% benzoyl peroxide plus hydrating niacinamide and ceramides, which Dr. Jaliman recommends for combination skin since it’s non-stripping.) When using a cleanser with active ingredients, apply it to damp skin, and massage gently for 30 seconds to allow the ingredients time to penetrate and do their job, says Zeichner.
Step 2: Apply an acne treatment
If you choose to use a simple cleanser or rinse in step 1, here's your chance to spot treat with a targeted active ingredient like salicylic acid. Apply a lightweight, oil-free serum, such as Skinceuticals Blemish + Age Defense with 1.5% salicylic acid, or The Ordinary Exfoliating Salicylic Acid 2% Solution. Apply one of these to the acne-prone area, like your t-zone, to keep pores clear. “To treat red, angry pimples, I recommend applying La Roche-Posay Effaclar Duo Dual Action Acne Treatment with 5.5% benzoyl peroxide as a spot treatment,” says Zeichner. “Studies have shown that lower concentrations of benzoyl peroxide are as effective as higher ones in treating inflammatory acne, and are less irritating.”
Step 3: Apply a lightweight moisturizer with sunscreen
When you're worried about oily skin and clogged pores, moisturizer may seem unnecessary, but the opposite is actually true: “Moisturizers help keep the skin's oil production in balance," says Dr. Love. "It also helps acne suffers tolerate acne medications, which are often drying. The key is to stick to oil-free, non-comedogenic moisturizers." And, instead of adding on another separate layer of sunscreen, just use a daily moisturizer that has added broad-spectrum sun protection in it, like Cetaphil Derma Control Oil Absorbing Moisturizer SPF 30. Like many derms, Jaliman loves water-based EltaMD UV Clear Broad Spectrum SPF 46 because it contains anti-inflammatory niacinamide, which reduces redness.
Why is sunscreen so important if you have acne?
“Some acne products and ingredients, like benzoyl peroxide and retinoids, can make your skin more sensitive to the sun, so you’re at higher risk for UV damage,” says Zeichner. “Not to mention that sun exposure increases inflammation, which can lead to more breakouts.”
PM ROUTINE
Step 1: Cleanse again at night
When you cleanse at night, you'll want something that can gently remove the makeup, oil and debris your face has accumulated during the day, says Dr. Sobel, who recommends a gel-based, surfactant-free cleanser, like Vichy Normaderm Phytoaction Daily Deep Cleansing Gel, which contains salicylic acid and is a favorite of the GH staff. Dr. Love recommends doing a double cleanse by using micellar water first — try the ones from Avene or Bioderma — then following that up with your cleanser.
Step 5: Use an ultralight moisturizer
“I see a lot of patients who are breaking out but have dry skin,” says Zeichner. Products with acne-fighting active ingredients can be drying, so it’s important to use a noncomedogenic moisturizer that has hydrating ingredients like hyaluronic acid, glycerin, and ceramides.” He recommends Eucerin Face Immersive Hydration Night Cream for his patients. For more top-tested recommendations from the Good Housekeeping Institute Beauty Lab, check out our list of the best moisturizers for acne-prone skin.
Step 6: Apply an acne-preventing retinoid
“Adapalene is a retinoid that’s used to treat acne, and the OTC version is 0.1% and extremely effective,” says Zeichner. It works by speeding up skin cell turnover, which prevents dead cells from accumulating in the pores. It also helps shed pigmented cells from the surface of the skin to even skin tone, and retinoids are proven to stimulate the production of collagen over time, and that helps soften fine lines and firm skin in the long run.” It’s win-win for both acne prevention and antiaging. Two to try: Differin Adapalene Gel or La Roche-Posay Effaclar Adapalene Gel. “Combining multiple agents in the same 24-hour routine, such as salicylic acid in the daytime and adapalene at night, is a safe and effective strategy.
Derm Tip: To prevent irritation, Zeichner suggests sandwiching a retinoid as a second layer after a lightweight moisturizer.
Can the right OTC skincare routine really clear acne?
By zeroing in on the right acne products and sticking to a consistent skincare routine, it is possible to achieve not only a clear complexion, but also prevent fine lines and dark spots too. The key is to use products that won’t irritate sensitive skin and use them day and night. “I tell my patients that we can definitely get an acne problem under control, but it’s like exercise — you have to be consistent with your routine every day,” says Debra Jaliman, M.D., an assistant professor of dermatology at Icahn School of Medicine at Mount Sinai and author of Skin Rules: Trade Secrets From a Top New York Dermatologist. With the endless array of products out there claiming to deep-clean your skin and banish acne forever, though, it can be overwhelming to narrow it down to a simple, workable system. So, we asked top dermatologists to break it down for you.
When should you see a doctor for acne?
The best way to discern what is causing your breakouts is to check in with your dermatologist. Zeichner suggests making an appointment if your OTC topicals are not working after 4 weeks. “If you’ve been diligently using a good skincare routine for acne, one that contains a mild cleanser, a retinoid or a salicylic acid product, or both, and you’re still breaking out, then a dermatologist can prescribe a topical or oral medication that can help. “There are many new FDA-approved topical and oral medications for treating moderate to severe acne.”
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