If you’re struggling with acne, you’re not alone. Acne affects an estimated 85% of people around the world at some point in their lives. I’m experiencing acne right now, and if you’re one of those 15% who have never experienced acne: what are you doing here? Are you just coming here to show off? Get your clear skin out of here!
But the good news is, if you have acne, you’ve clicked on the read you could find.
I’m going to talk you through everything you can do to treat acne, from lifestyle and over-the-counter options, all the way through to prescription creams and even tablets. Now that’s a lot of information to get through, but I also guarantee that you will have at least one laugh every three minutes.
But seriously, I think this video is the most comprehensive guide to acne treatment that exists on the internet, and make sure to stick around to the end, where I give you my specific recommendations on what YOU should use.
Your skin has oil glands in it, and the highest concentration of these are on the face, the chest, the shoulders, and the back. These “sebaceous glands” as they’re known, secrete oil onto the base of hair shafts, and this then travels all the way to the surface of the skin. The purpose of this is so that your skin remains nice and hydrated, and so that that barrier remains intact. But acne occurs when there is a blockage of that hair shaft and then there is a buildup of oil and fatty acids underneath the surface of the skin. Now, if the top of that blockage is closed, then you get what is known as a “closed comedone”, or a white head.
But if the blockage is open to the air, then those oily secretions become oxidized in a reaction with the air, and then they turn dark, giving you blackheads.
Now once you have this blockage underneath the surface of the skin, a specific bacteria known as “Proprionobacterium acnes” gets involved and causes a lot of inflammation. If that inflammation is severe and it is at a deep level, then you can also get nodular and cystic acne, not just those whiteheads and blackheads. And if these cysts rupture, then you can get long-term scarring and pigmentation. So in summary, the pathway is: oil glands secrete an oily secretion, you get a blockage of the hair shaft, bacteria gets involved and multiplies, and you have inflammation.
I’m going to keep referring back to this pathway throughout this video so that you know exactly where each treatment has its effect. So let’s start with lifestyle, and I’m intentionally focusing on this first because I think too often medical doctors jump straight to prescriptions rather than talking about lifestyle interventions that can help. But which of these interventions have real evidence that they can help with acne? 1) let’s start with diet, and there are certain foods that have a clear connection with causing acne flares.
These include whey protein, skimmed milk, and concentrated sugars.
And beyond this, even if there’s not clear scientific proof of certain foods causing acne flares, you probably know for a fact there are certain types of foods that even if you just *think* about them, you get an acne breakout. And for me, that’s pizza. Just saying the word gave me a new spot right here. 2) when it comes to lifestyle is stress, and stress worsens every kind of skin care condition, whether that’s eczema, psoriasis, or in this case acne. This is why you tend to have acne flares around exam times, when you’re travelling internationally, or when you have a wedding day coming up and a gigantic spot appears in a late play to become your maid of honour.
3) smoking. Now we don’t actually know why smoking increases acne severity but it does seem to. The best theory at the moment is that it has an impact on the type of oil that your skin produces making it slightly more sticky. And 4) is poor sleep.
Increasingly, we’re starting to become aware of the fact that having bad sleep increases the number of stress hormones in your body and that then worsens your acne.
So with all of that being said, the lifestyle interventions that you can implement to improve your acne are to make sure that you avoid those foods we talked about, not smoke, make sure you’re getting a good night’s sleep, and also to reduce your stress levels. “Oh, good one genius, I should just be less stressed.
I was actually trying to be MORE stressed, why did I think of that?” Okay, that’s a fair point, it’s not really helpful for me to tell you to stress less, but just so you know, it does worsen acne. Now, let’s talk about over-the-counter treatments, there are truly tens if not hundreds of thousands of different creams available over the counter targeting acne.
But rather than focus on specific brands, because there’s so much variation throughout the world, I’m going to talk about ingredients, and there’s really only a handful that have compelling evidence of being helpful.
This is why benzoyl peroxide is also really popular as a spot treatment, because it can turn down the volume on those angry red bumps. But be warned, this ingredient can feel very harsh on the skin.
Over-the-counter options of benzoyl peroxide come in 2.5, 5 and 10%, but I personally would never go near 10% when it comes to the face. That’s really designed for use on the body for things like “bacne”. The only time you might want to use 10% benzoyl peroxide on your face is if you’re going to a Halloween party the next day and you’re planning to dress as “The Thing”.
Next, let’s move on to retinoids.
Now anyone who’s been following for a while knows that I’m absolutely obsessed with retinoids, and I will find every opportunity to bring them up. Retinoids are a family of vitamin A related chemicals and they are the single best ingredient in the entire world of skincare. They have a bunch of different benefits including anti-pigmentation, anti-aging, even anti-cancer, but for the sake of this video, we’re going to focus on their anti-acne effects. Within the family of retinoids, there are over-the-counter and prescription options. The over-the-counter options contain retinyl esters, retinol, retinaldehyde, or adapalene.
Now just because they’re not prescription strength doesn’t mean these ingredients don’t work, and I actually always tell people, if you’ve never used a retinoid before, you should always start with an over-the-counter option because you’re going to risk side effects if you go straight to prescription strength tretinoin. Retinoids work across the entire acne pathway that we spoke about earlier. They reduce the size of your oil glands, they also make sure the oil secretions are less thick and sticky, they exfoliate to make sure there are no blocked pores, they kill P acnes the bacteria that causes acne, and they are directly anti-inflammatory.
I mean come on, what more do you want? But the main issue with topical retinoids is that they can feel harsh on your skin, especially when you first start using them.
I’ll do a whole video in future specifically talking about the best way to start using a retinoid product. I’ll also let you in on a little secret… I am working really hard at the moment on the manufacture and formulation of a retinoid cream that has all of the benefits we’re looking for, while still being more gentle on the skin, and that’s kind of the “Holy Grail” when it comes to a retinoid product.
I’ll put a link in the description below in case you want to leave your email and be notified whenever that product might be ready, if it’s ever ready, but for now: the most popular retinoid products are Differin gel and also Neutrogena Rapid Wrinkle Repair. But mark my words, I’m coming for that number-one spot in 2024. Someone clip it, you heard it here first.
Okay, so let’s wrap up with some quick fire ingredients now. AHAs or alpha hydroxy acids are things like glycolic acid, lactic acid, and mandelic acid, and these are gentle exfoliants that help to unblock pores.
Azelaic acid is another ingredient that kills bacteria, is anti-inflammatory, and also exfoliates. And finally, niacinamide reduces the amount of oil secretion from sebaceous glands and is anti-inflammatory. So let’s move on to the prescription category. Sometimes, no matter how perfect your over-the-counter skin care routine or your lifestyle interventions, your acne is going to be too severe and you are going to need prescription treatments.
Now why is that?
Well, it’s your parents fault. Don’t blame me, blame them! Jokes aside, genetics are a major determinant of not just how many oil glands we have, but their activity and the specific type and stickiness of the oil you secrete. So there’s no shame in needing to go see a doctor for your acne, it doesn’t mean you’re doing anything wrong, and it is way better to go there early. So what prescription options do we have to help acne?
So let’s start with clindamycin, and this is slightly more heavy duty of an antibiotic that targets P. acnes and can be used alongside benzoyl peroxide. Then we have prescription retinoids, and these are things like tretinoin of various concentrations as well as tazarotene. All of the same benefits we talked about with over-the-counter retinoids are applicable here, except the concentration is even higher. That means that the anti-acne effect is stronger, but also that those potential side effects of flaking and inflammation can also be worse.
Sso make sure you’re using a tiny amount, and maybe use it every other night for a few weeks, until ultimately you want to aim for every night.
Moving on to the next option, we have azaleaic acid, but available in 15 and 20% concentrations, whereas over the counter you can only get 10%. Prescription creams can also sometimes combine multiple of these ingredients together,
So that is all of the prescription creams, and we’re almost at the end of this video, but we have to talk about prescription oral tablets, and there are three main options for these, starting with number one, which is oral antibiotics. Doxycycline is by far the most popular option for this, and the way I want you to think about it is that if clindamycin and benzoyl peroxide target bacteria on the surface, kind of like shooting bows and arrows at it, then taking doxycycline as a tablet is a little bit like blowing up dynamite under the surface. It is far, far more effective at reducing the amount and the activity of P. acnes, and therefore it does a great job of reducing acne severity.
Doxycycline is also independently anti-inflammatory aside from its antibacterial effect, and so it can give amazing results when you’re taking it. However, because of the side effects of taking long-term oral antibiotics, including on your gut bacteria, you can only really take doxycycline for around three months, and although it’s very effective while you’re taking it, there’s actually no long-term benefit when it comes to acne reduction once you stop.
So moving on to tablet option number two, which is hormonal targeting treatments. These include oral contraceptive pills which reduce the amount of hormone surges in your body, and something called spironolactone which blocks the hormone receptor on your sebaceous glands. What that means is that no matter what’s happening with the hormone levels in your body, it’s not communicating through to your skin.
Androgen hormones like testosterone normally attach to specific receptors on sebaceous glands and tell them to produce more oil, and to produce thicker, stickier oil. As you can imagine, this dramatically increases your chances that you’re going to get a blockage in your pores, and therefore that you’re going to get really severe acne.
This is why classically acne is at its worst during puberty, because that’s a time where you’re having surges of these androgens. Now both of these hormonal targeting medications are only really an option for biological females, otherwise it causes a lot of unwanted side effects in biological males. And this is a great time to disclaim that you should always discuss all treatment options with your own doctor, this is not medical advice, this is education, all of that stuff, don’t sue me.
And let’s move on to oral medication option number three, which is Accutane. This is the big nuclear weapon in the fight against acne, the treatment to end all acne treatments, and this is also the treatment that has the worst reputation of all when it comes to social media users.
Accutane, also called isotretinoin, is, as the name suggests, part of that retinoid family I talked about earlier. But rather than being a cream which is specifically applied to the skin isotretinoin is taken as a tablet, and because of that, it’s absorbed throughout the body. Now the plus side of that is that isotretinoin is by far, by a million miles, the strongest and most effective treatment when it comes to reducing acne severity.
It reduces the size and activity of oil glands, permanently, meaning that once you complete your roughly five-month course where you take the tablet each day, your acne will be improved for life. The majority of people who take isotretinoin will never need more than one course in their entire lives.
But the downside of it being absorbed as a tablet is that it can have side effects on things like your cholesterol, your liver, and other parts of your body. I’ll do a full separate video about Accutane in the future, focusing on all of its benefits and its side effects when we look at the clinical trial data, but for now, just know that it is the end game of acne treatment offering potentially incredible results, but with the risk of side effects and therefore requiring a lot of blood work. Because of its potential danger when it comes to developing babies for biological females, you need to come in every month and get a pregnancy test done, and so the whole process can be a bit of a logistical nightmare for those five months that you’re taking the medication.
Wow, we did it! Well, I did it, you basically just sat there and watched. But that is every acne treatment in the world that is worth knowing.
So here’s specifically what you should do depending on the severity of your acne. If you have whiteheads, blackheads, and slightly oily skin, you should use a salicylic acid-based cleanser in the morning, and you should use an over-the-counter retinoid product at night.
It’s also a good idea to keep a benzoyl peroxide spot treatment around in case you get the odd angry bump. After two months of this regimen, for this type of acne, you’re usually really well controlled. If your acne persists even though you’re doing this, or if you have deep acne from the beginning which causes pigmentation or mild scarring, then then you should really go see a dermatologist and discuss prescription options. They’ll likely give you a prescription antibiotic cream in the morning and a prescription retinoid at bedtime.
If you have severe cystic or scarring acne, then go to your dermatologist and they will likely give you oral medications, whether that is a short-term oral antibiotic course, whether it’s a hormonal targeting treatment, or whether it’s Accutane right from the beginning depending on your severity.
And my last, most important, piece of advice is that if you have severe acne, I’m begging you, don’t try 50 different over-the-counter creams. They’re not going to fix severe hormonal or cystic acne, despite what these skincare companies say. Because honestly…
they’re liars. I’ve seen it firsthand: they will advertise these ridiculous before and after photos where someone goes from severe hormonal acne to clear in just one month using a night cream. That’s complete bullsh*t.
I’m telling you this as someone who is currently making a retinoid night cream, if you use my product, or any of these other products, for two to three months, and you’re not seeing benefit, stop buying it. “Have you lost your damn mind?
” For some people, even the world’s best over-the-counter cream, which mine will be, will still not be enough. And so you need to go see your dermatologist and get a prescription strength option. Don’t blame yourself for not changing your pillow enough, or think that just one more juice cleanse is going to take you from severe cystic acne to clear skin.
It’s not. And every month you wait, you’re increasing your chances of pigmentation and scarring which is so much harder to get rid of than it is to stop in the first place.
Thanks for reading