Acne am I cleaning my face enough

While it’s very common in teenagers, acne is a troubling condition for some adults too. Our natural reaction when we see large, inflamed spots appearing on our face is to vigorously clean the area and start applying creams, face masks and anything we can find to reduce the swelling. But is this over-cleaning doing more harm than good? And how often should I be washing my face?

Dr Moumita Chattopadhyay is a leading consultant dermatologist based in Birmingham who specialises in treating adults with acne. In this article, she explains the main causes of acne, how our cleaning habits might be exacerbating it and whether make-up can, in fact, make acne worse.

Why do some adults have acne?

There are several causes of acne in adults. In our skin, we have structures called hair follicles that have tiny sebaceous glands attached to them. These glands produce sebum (oil), which lubricates our hairs. If the glands produce too much sebum, it mixes with dead skin cells and clogs the follicles. This results in inflammation, whiteheads and blackheads on the surface of the skin.

Acne in women

Acne affects women much more than men, mainly due to their fluctuating hormone levels - a lot happens along a woman’s hormonal journey. Women might typically see an increase in acne during these times:

• Just before menstruation
• While taking contraception
• During the first few months of pregnancy
• Menopause

These periods of a woman’s life can stimulate the sebaceous glands to produce more sebum on the skin surface, and as we mentioned earlier, it can mix with dead cells and go into the hair ducts blocking the pores through which hair comes out. So there is nowhere for the sebum to escape, it builds up, irritates the skin and starts an inflammatory process resulting in red, enlarged spots, whiteheads and blackheads.

What else can trigger acne?

There are many possible triggers for acne flare-ups, such as:

• Certain diseases — polycystic ovarian disease is a condition that can affect women and cause imbalances in their hormones. Unfortunately, this can result in acne flare-ups
• Various medications — lithium is a drug to help treat depression and bipolar disorder which is known to cause spots. Also, steroid medications can trigger acne and this is particularly seen in male bodybuilders
• Genetics — your family history can mean you are more prone to developing acne
• Obese people — Hormones are raised in people who are very overweight and this is a risk factor for acne
• Smoking — studies show that smoking increases the sebum production in your skin

How is teenage and adult acne different?

While teenagers go through their own hormonal changes, a similar process does occur. The difference is spots will typically appear along the T-zone of the face in teenagers, which is where there is a maximum concentration of these sebaceous glands. Whereas in adults, they will find acne forming along the chin, jawline and neck.

Should I stop wearing makeup if I have acne?

No. You can wear makeup but just be cautious about the kind of makeup you put on your face. It shouldn’t be heavy, and you definitely shouldn’t be applying thick layers as this will only clog up your pores. Stick to gentle, matte finish and mineral powder-based products.

Oil-absorbing primers can also help; just don’t apply anything greasy to your face as you need to allow your hair follicles to breathe. If your skin is already producing a lot of oil, then the hair follicles are already struggling through the layer of sebum and bacteria, so adding more oily-based substances on top of this isn’t helping.

One important thing is you MUST remove your make-up before going to bed.

While we are sleeping our cells are renewing themselves; dead skins fall off and new cells form. This is the body’s natural exfoliation process and if you sleep with make-up on your skin, you aren’t letting the cells renew, and you’ll end up with dead skin, bacteria and make-up clogging up your pores.

To remove your make-up, I recommend lightly wiping your face with a very gentle skin cleanser, but be sure not to scrub your face. You can use gentle wipes if you have to, but nothing with a fragrance and definitely not alcohol-based.

Make sure you check the ingredients in the make-up products and cleaners before buying them. Always buy natural, gentle, water-based and light products that allow your skin to breathe.

What tips do you recommend for people with acne?

Although it is tempting, squeezing your spots and blackheads and exfoliating too much is bad. By doing this, you are pushing bacteria deeper into the skin and irritating it further. Not only does squeezing inflamed spots increase inflammation, but it can also leave permanent scars on your face too - so it’s best to leave them to naturally heal.

Additionally, maintaining hygienic and healthy habits is recommended. Wash your face gently with lukewarm water, but no more than twice a day. Washing it more can dry the skin and cause more sebum production.

Do not add anything to your skin that might irritate it; so no harsh facial cleansers or scrubs. For dry skin, it’s ok to put on a light moisturiser.

Does acne mean I’m not keeping my face clean enough?

It is not solely related to not keeping the skin clean. While we should remove the dirt and make-up from our faces, the pathology really lies beneath the skin: Acne is driven by a combination of hormones, excess sebum, bacteria, microbiomes of your skin (skin flora), etc. So it hasn’t got that much to do with cleanliness.

In addition, the process of inflammation that is going on beneath the skin is what contributes to the acne, rather than an infection occurring from not keeping your face clean.

The bottom line

• Let your skin breathe
• Do not wash your face more than twice a day, use lukewarm water, extremes of temperature irritate the skin
• Scrubbing and vigorously cleaning can make your acne worse
• Use gentle face cleansers, light water-based make-ups
• Never squeeze blackheads or whiteheads
• Always remove your make-up before going to bed
• Limit the use of exfoliation products

If you have tried the recommendations in this article and your acne is still persistent, you can visit Dr Moumita Chattopadhyay by going to her Top Doctors profile and booking an appointment to see her. You can discuss the various medications and treatments available.