This is a guest post from skincare store and informative blog JustGlow. Learn more about what causes acne and potential solutions from an evidence-based perspective here.
Myths about the use of cosmeceuticals for acne treatment have been persistently perpetuated by sensationalist popular press and as part of many brands’ marketing agendas. As the word indicates, these myths often originate from widespread common beliefs. As they lack any form of scientific foundation, they can become highly misleading for both patients and professionals within the area of dermatology.
This article will be mainly based on Zoe D. Draelos’s (2015) findings with regards to acne cosmeceutical-related misconceptions. Her research encompasses the perspectives of several dermatologists who experienced (or, at least, witnessed) the consequences of these myths both in the context of their professional practice and throughout dermatology training. In a nutshell, and in line with Draelos’s work, this article aims to provide some insights regarding acne-related myths, with hopes to uncover some of the science behind this condition.
If cosmeceuticals are labelled noncomedogenic or nonacnegenic, that ensures they will not produce acne
According to Draelos, the terms noncomedogenic and nonacnegenic correspond fundamentally to fabrications originated by marketing. However, when one exhaustively analyses the effects of noncomedogenic and nonacnegenic products on acne-prone skin, one realises that these terms, when applied to cosmeceuticals, are close to meaningless.
It has been proven by scientific research (namely the one conducted by the author mentioned above) that, even when one uses cosmeceuticals that are claimed to be noncomedogenic/nonacnegenic, the formation of comedones and acne manifestations may still occur. The testing process of products of this sort is frequently inaccurate. That is mainly because, in order to test the nonacnegenic and noncomedogenic potential of a cosmeceutical, the finished formula should be clinically tested (ideally through human testing). Nevertheless, many laboratories outline the safety profiles of each individual ingredient in the formulation and move on to attributing the above-mentioned labels to the finished product without conducting further tests.
This is, in short, the fundamental reason why the terms nonacnegenic and noncomedogenic should be regarded as problematic by dermatologists and researchers within the field.
Mineral oil has comedogenic properties
Mineral oil is one of the most frequent components within cosmetic/skincare products. However, for one to fully understand this myth, one needs to first acknowledge the existence of two different types (that ought to serve two different purposes) of mineral oil. Their distinction is clarified in the context of Draelos’s study.
The mineral oil that is used for industrial purposes (mainly as a lubricant) is likely to be comedogenic. However, it lacks the purity required to integrate the formulation of high-quality skincare products. Therefore, quality manufacturers use cosmetic-grade mineral oil (the purest form of mineral oil, without any of the contaminants that might be present in the mineral oil used industrially) instead. Cosmetic grade mineral oil is, thus, the only type of mineral oil traced in cosmetic products. Studies have consistently denied, nevertheless, the potential comedogenic effects of cosmetic grade mineral oil.
Sunscreen generates acne
Draelo observed several patients who have experienced symptoms related to acne breakouts 24 to 48 hours after using facial sunscreen and presented an interesting hypothesis as to why this might happen. Most sunscreens contain a high percentage of UVB-absorbing ingredients (e.g., oxybenzone, homosalate, etc.), whose function can mainly be described as the transformation of UV radiation into heat energy. Many of the patients analysed by Draelo noticed this phenomenon, as they claimed that using sunscreen lotions/gels would make them feel hot. The researcher believes that the increased levels of sweat experienced by these patients (most likely caused by this reaction to sunscreen, often accompanied by warm weather) may boost the activity of eccrine glands (responsible for thermoregulation).
This seems to be in line with the arguments presented in Zaidi et al.’s chapter (2019), which refers to this matter. Consequently, heat rashes (miliaria rubra) may occur – more information on this topic can be found in Gierch et al.’s chapter ‘Minor Heat Illnesses’ (2019). The sunscreen-induced formation of the papules and pustules that may originate potential breakouts seems, in this context, to be connected to eccrine glands’ activity (and, in some cases, to the skin occlusion that waterproof sunscreens tend to generate) without involving any activity of sebaceous glands (the ones responsible for acne breakouts) – cf. Zaidi et al. (2019).
Capsules of vitamin E improve the appearance of scars
Many people who are not formally trained within the dermatology field believe that opening vitamin E capsules, extracting their oil and applying it to their scars helps improve their appearance. This is not deemed as a reasonable practice by Draelo, as the oil present in these capsules is meant to be ingested and absorbed across the digestive mucosa. When vitamin E is applied as described above, there is no way it can be absorbed through the skin. Instead, massaging the scars with an appropriate moisturiser is recommended.
Applying glycolic acid to skin can reduce pore size
Even though glycolic acid is classified as an exfoliant, the fact that it is water-soluble makes it unable to exfoliate within the pore, due to its inability to enter the oily environment that characterises the pore. As this acid has a smoothening effect when applied to the skin surface, it can often create an illusion of reduced pore size, but, in fact, it does not measurably do it.
Contrarily to glycolic acid, salicylic acid is an oil-soluble exfoliant that can remove the debris from the pore and provide the skin a look of optimal smoothness (cf., Saxena & Yadav, 2020). Similarly to glycolic acid, it is not, however, able to decrease pore size (even though it contributes to improving their appearance). According to Draelo, there is no cosmeceutical ingredient able to measurably reduce the size of pores. Nevertheless, though their physical size is virtually unchangeable, it is possible to shrink the size of dilated pores (which is normally caused by debris accumulation); salicylic acid peels are the most recommended form of therapy for this issue.
The topical application of tretinoin helps the treatment of acne scarring
The effects of tretinoin in terms of acne scarring treatment is a rather controversial topic among dermatologists. It is safe to state that tretinoin normalises follicular keratinisation, which subsequently may contribute to the attenuation of pustules, papules and superficial acne (Draelo, 2015). Treating the acne itself may lead to the smoothening of the skin surface and, thus, have a positive effect on the scarring caused by acne.
Nevertheless, there is markedly a lack of research with regards to whether tretinoin does, in fact, help to treat acne scarring. As far as what is indicated currently, tretinoin is recommended for the treatment of acne; there are no indications in this regard for acne scarring treatment.
Complex skincare regimens, composed of multiple products, are necessary for clear skin
Approaches to skincare may vary depending on many factors, one of them being culture and ancient beliefs. Skincare rituals may oscillate between more minimalistic, straight-forward approaches (the most direct example of this is the soap bar + water routine), and complex, intricate regimens which may involve more than 20 skincare steps. Some observational studies have elaborated on the possibility that these over-dense skincare rituals may overload the skin and increase its overall sensitivity, occasionally contributing to conditions such as atopic dermatitis.
Special skincare treatments need to be provided to women who experience breakouts after the age of 30
The incidence of acne breakouts in women after the age of 30 is becoming increasingly common. The hormonal fluctuations that occur during menopause/perimenopause may be the main cause of this (cf., Baumann & Keri, 2009). The lesions experience in contexts of this sort tends to have an inflammatory nature (inflammatory papules/pustules) and to be located in the lower epidermis and/or the dermis.
For this reason, no form of special skincare treatment is likely to positively affect the treatment of these lesions. The most recommended options for acne treatment for women above 30 tend to be oral antibiotics and hormonal therapy (e.g., birth control pills).
It is not possible to conduct reliable comedogenicity testing for cosmeceuticals
Comedogenicity used to be tested in rabbit ears, which seemed to emulate human skin quite accurately. Nevertheless, as concerns regarding animal testing have been increasingly raised over the last few decades, human volunteer testing has started to be preferred (and deemed as more accurate). Cosmeceuticals’ final formulations are currently tested for 14 consecutive days through its application to the volunteers’ upper backs – one of the requirements for being accepted to participate in this testing processes, as a human subject, is the person’s capability of forming comedones on the upper back area (so as to test the product’s efficacy).
The final formulation is classified as comedogenic if any increase in the formation of comedones after the 14-day application of the formula is reported. The comedogenicity of cosmeceuticals is, therefore, testable, and reliable testing is possible providing the panel of human subjects participating in the product trial is accurately selected (Draelo, 2015).
Over-the-counter scar gels contribute to acne scarring treatment
Many over-the-counter products that claim to be helpful in terms of acne scarring treatment are currently available. Draelo (2015) conducted an evaluation of a considerable number of products of this sort and concluded that their formulation tends to be identical to the one identified in most moisturisers, with a few ingredients added (one of the most common ones is onion extract – most likely due to its antioxidant and anti-inflammatory features).
It is commonly stated that, after the lesion is completely epithelialised (i.e., covered with epithelial tissue) these products should be gently massaged to skin three times a day. This massaging process, when done consistently, has been described as a contributor to the improvement of the appearance of acne scars. It is, though, important to highlight that this does not mean that these product help treat acne scarring itself. Scars may simply look shinier as a consequence of the application of moisturiser, but this is not equivalent to a permanent improvement of the scar.
It is, therefore, to ensure the consumers are fully informed of the products’ content and effects, so as to ensure their expectations regarding such products are kept realistic.
If you would like to obtain information regarding the main causes for acne and for of treatments for this condition which have been backed by scientific studies, read this article on JustGlow website: https://www.justglow.co.uk/blogs/news/acne
JustGlow blog also provides insights on how food/diet may impact acne and overall skin health. Find out more about this topic here: https://www.justglow.co.uk/blogs/news/nutrition-and-acne
- Baumann, L. & Keri, J. (2009) ‘Acne (Type 1 Sensitive Skin)’ In L. Baumann, S. Saghari & E. Weisberg (Eds.) Cosmetic Dermatology: Principles and Practice (pp. 121-127). US: McGraw-Hill Companies.
- Draelo, Z. D. (2015) ‘Acne Cosmeceutical Myths’ In Z. D. Draelos (Ed.) Cosmeceuticals (pp. 183-186). US: Elsevier.
- Gierch, G. E. W. et al. (2019) ‘Minor Heat Illnesses’ In W. Adams & J. Jardine (Eds.) Exertional Heat Illness (pp. 137-147). Switzerland: Springer Nature.
- Saxena, V. & Yadav, K. (2020) ‘Glycolic Acid, Lactic Acid, Mandelic Acid, Salicylic Acid, Citric Acid, Gluconolactone: Skin Exfoliators in Combination Therapy of Acne Vulgaris’ International Journal of Research in Engineering, Science and Management, 3(10), pp. 54-55.
- Zaidi, Z. et al. (2019) Disorders of the Sebaceous, Sweat and Apocrine Glands: A Practical Guide, In Z. Zaidi, K. Hussain & S. Sudhakaran (Eds.) Treatment of Skin Diseases (pp. 191-209). Denmark: Springer Cham