Tips for a teenager with combination skin and acne.

Hi! I'm a teen girl. I have an oily t-zone, and cheeks that are more dry and get red easily, so I have to be careful with products that are not over drying. I also have blackheads Lately I've been getting more acne. So, I bought a clarisonic to use 3x a week. If I am using a clarisonic, do I need to use an acid toner (pixi glow tonic?) for helping with blackheads? Or if I use salicylic acid how frequently can I use it in conjunction with the brush. If acids are too irritating with the brush, is there any other ways I can reduce/prevent blackheads and keep skin exfoliated. Basically, what is the balance with chemical and physical exfoliation?

Acne is a lot more complicated than many people think! Anyone who’s really had or has acne knows this. Especially tough, is the combination of dry skin and acne, because many of the effective acne meds dry skin more. Acne is a hormonal disease! It starts at puberty and pretty much ends at menopause, unless there are hormone interventions. Your questions are great!

The 4 kinds of acne:

Dermatologists think about acne like this:

Grade I – just plugged pores like black heads and white heads (open and closed comedones) . Does not cause permanent scars.
Grade II – Grade I PLUS little red, inflamed bumps (papules). No permanent scarring occurs.
Grade III – Grade I & II PLUS red bumps with pus and slightly deeper red bumps (pustules and small cysts) In some patients, this type can cause shallow permanent scars
Grade IV – All of the above PLUS deeper, very inflamed cysts (nodulocystic acne) – often deeper, pitted permanent scars.

Tips for treating acne and blackheads without drying out skin

1. The Balance Between Chemical vs. Physical Exfoliation:

This is determined by YOUR skin. Experiment carefully until you find the right balance. Some have very tough, oily, not easily irritated skin and others the opposite. Most are in between.

2. Exfoliate gently:

I love that Clarisonic, but use the gentle heads on it. A gentle salicylic acid cleanser (gentle chemical exfoliation) with it is a good idea. You may be able to use this daily. But you’ll be able to tell if it’s too much, and can slowly find the right balance for you. Remember that harsh exfoliation or over exfoliation just causes irritation and doesn’t get you where you want to go. Your goal is to loosen and remove the plugs, and reduce inflammataion.

3. Get a great skin care routine:

Try the Juice Beauty Blemish Clearing Serum. The new probiotic cleansers like the Eminence Probiotic Cleanser, may be helpful to you to maintain the natural skin biome. You don’t need a toner. If your cheeks are dry, use extra noncomedogenic moisturizer on your cheeks twice a day. Remember that many topical prescriptions like Renova, Retin A, Differin, Tazorac – all retinoids – also cause chemical exfoliation also. So do OTC glycolic lotions. Beware home remedies! Here are home remedies never to try, as well as some harmless options.

4. Consider options for clogged pores:

A good aesthetician who can do extractions helps with blackheads and whiteheads. Microdermabrasion is great for plugged pores. Don’t use it if you are very inflamed.

Acne and your hormones:

With menstruating women, our hormones are often different every month. If our ovaries release two eggs instead of one, it’s different. If we don’t release an egg at all that month, it’s different. You get the picture. This accounts for why we might go months without much trouble, and then suddenly, 2-3 months of mega breakouts. Then add stress into the mixture. Stress puts us more into fight/flight mode. This means more cortisol production, which in turn can affect other hormone levels. Diet may affect some, but there’s not a lot of proof for this. But skin is an organ, our largest organ, so it makes sense to me that junky snack foods, sugar, too much alcohol, white flour treats, etc. aren’t so great for it. All things to consider when thinking about acne. You can read more in my resource on acne here.

Hope this helps, Dr. I