Should You Reconsider Your Acne Topicals? My Expert Opinion

When it comes to battling acne, you've probably encountered a myriad of topical treatments such as benzoyl peroxide, retinols, alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), and topical clindamycin. These treatments are often the go-to solutions recommended by dermatologists, skincare specialists, and well-intentioned friends. 

I get asked frequently about my experience and thoughts with topicals so let’s dive into the most common topical acne treatments, their pros, cons and my professional opinion!

The Benefits of Topical Treatments

1. Benzoyl Peroxide: Known for its powerful antibacterial properties, benzoyl peroxide acts as a warrior against acne-causing bacteria, effectively reducing their numbers on the skin's surface. When applied topically, this popular over-the-counter treatment penetrates the skin to attack Cutibacterium acnes, the primary bacteria responsible for acne inflammation. By decreasing the bacterial count, benzoyl peroxide helps to minimize redness, swelling, and the frequency of breakouts, delivering noticeable results often within just a few days. This makes it a go-to option for many looking for quick relief from acute acne flare-ups.
2. Retinoids: Retinoids, which are a synthetic version of vitamin A, are recommended by dermatologists to address a number of skin concerns. They are utilized not only for their ability to refine skin texture but also for their role in minimizing the appearance of fine lines and wrinkles. When it comes to acne, retinoids work by reducing inflammation in the skin and by unclogging pores, making them less hospitable environments for acne-causing bacteria to thrive. By promoting skin cell turnover, they help to prevent dead skin cells and sebum from blocking pores, thereby reducing the likelihood of breakouts. The rejuvenating effects of retinoids extend to fading acne scars and improving overall skin tone. Many of my acne clients were recommended to start retinoids as a first-line treatment by their dermatologist.
3. AHAs (Alpha Hydroxy Acids) and BHAs (Beta Hydroxy Acids)AHAs and BHAs: AHAs and BHAs are powerful exfoliating agents that work on different layers of the skin to revitalize its appearance. AHAs, such as glycolic and lactic acid, are water-soluble and focus primarily on the skin's surface. They are particularly effective for treating superficial acne and light scarring, as well as for improving skin texture and reducing the appearance of fine lines. BHAs, like salicylic acid, are oil-soluble, enabling them to penetrate deeper into the pores to remove dead skin cells and excess sebum. This makes BHAs a strong ally against more stubborn, deep-set acne. When used prudently, these acids can significantly improve the skin's complexion and clarity. They can even lighten acne scars and post-inflammatory hyperpigmentation, offering a more even skin tone. Both AHAs and BHAs contribute to faster skin cell turnover, which is crucial for preventing clogged pores and subsequent breakouts.
4. Topical Clindamycin: Topical clindamycin is a prescription antibiotic commonly used for combating severe cases of acne. Its primary function is to inhibit bacterial protein synthesis, effectively reducing the population of acne-causing bacteria, such as Propionibacterium acnes, on the skin. This leads to a noticeable reduction in inflammation, redness, and the number of acne lesions. One of the significant benefits of topical clindamycin is its targeted approach. Unlike oral antibiotics that affect the entire body, topical clindamycin directly treats the affected skin area, reducing the risk of systemic side effects. Moreover, it's often well-tolerated by those with sensitive skin or those who might have adverse reactions to oral antibiotics.

The Cons of Topicals: Common Adverse Reactions

1. Benzoyl Peroxide: While benzoyl peroxide can be effective in treating acne in the short term, long-term use comes with its own set of concerns. One of the major drawbacks is that it can disrupt the skin's natural microbial flora. This imbalance can reduce microbial diversity, which is essential for healthy skin. The change in microbiota can potentially make your skin more susceptible to various issues down the line. Another immediate concern is skin dryness and irritation. Benzoyl peroxide is a potent chemical that can strip the skin of its natural oils, leading to dry, flaky, and sometimes red skin.
2. Retinoids: One of the most commonly reported side effects is increased skin sensitivity to sunlight. This means you'll need to be extra diligent about applying sunscreen, even on cloudy days, to prevent sunburn or accelerated skin aging. Retinols can also cause skin dryness, redness, and peeling, especially during the initial stages of use. These symptoms can be distressing and might require an adjustment period or additional moisturizing products to mitigate.
3. AHAs and BHAs: Overuse or improper concentration can lead to skin irritation, causing redness and even chemical burns in severe cases. Additionally, these acids can make your skin more susceptible to the sun, increasing the risk of sunburn. If you're using AHAs or BHAs, it's crucial to incorporate a high-SPF sunscreen into your daily routine.
4. Topical Clindamycin: As an antibiotic, topical clindamycin is effective against bacterial infections but should be used cautiously. One of the major issues with antibiotic use, including topical forms like clindamycin, is the potential for developing antibiotic resistance. This not only makes the treatment less effective over time but can also contribute to a larger public health issue. Additionally, much like benzoyl peroxide, clindamycin can disrupt the skin's natural microbiota. This disruption can have long-term implications for your skin health, potentially leading to more severe skin conditions in the future.

As a Holistic Acne Expert, What’s My Take?

In my professional experience, Alpha and Beta Hydroxy Acids (AHAs and BHAs) can be excellent additions to a skincare routine if used wisely. These acids are superb for gently exfoliating the skin's surface and promoting cell turnover, which can help alleviate acne scarring over time. However, it's crucial to monitor your skin's response to ensure that these acids are not causing irritation or sensitivity. 

When it comes to retinoids, I advise a cautious approach. The market is flooded with various brands, but it's essential to opt for the cleanest, most reputable one available. Many retinoids contain preservatives that might raise red flags concerning long-term safety. Tools like the Environmental Working Group (EWG) app can help you scrutinize your product's ingredient list, ensuring you avoid harmful substances like Butylated Hydroxytoluene (BHT), which is sometimes found in prescription Tretinoins and may have long-term health implications.

As for benzoyl peroxide, I see it more as an emergency response tool rather than a daily skincare staple. It can be effective for spot treatments to reduce the severity of an acne breakout quickly. However, I would caution against incorporating it into your daily routine due to its potential to disrupt the skin's microbiome and its long-term drying effects. 

Lastly, while topical clindamycin might offer short-term relief from severe acne symptoms, I don't recommend it as a long-term solution. The risk of developing antibiotic resistance is too significant, and it also has the potential to disrupt the natural balance of skin flora, possibly leading to other skin issues down the line. As an alternative, I often recommend using a topical probiotic spray. These sprays help restore a healthy skin microbiome without the risk of antibiotic resistance, offering a more sustainable, long-term approach to managing acne.

Natural Alternatives

Switching to natural alternatives for your acne treatment isn't just a trend; it can be a beneficial change for your skin health. Here's a deeper dive into some of my go-to natural remedies and why they deserve a place in your skincare routine:

1. Topical Probiotic Spray: Probiotics aren't just for your gut; they can be wonders for your skin too. A topical probiotic spray aims to balance the skin microbiome, the community of microorganisms living on your skin. A balanced microbiome can better protect the skin, hold in moisture, and decrease inflammation, offering a holistic approach to treating acne.
2. Tea Tree Oil: This essential oil is a powerhouse when it comes to antiseptic properties. It's highly effective in killing off bacteria and reducing skin inflammation, making it an excellent spot treatment for acne. However, remember to use just 1 drop diluted in your other skincare products before applying, as it can be quite potent. Always patch test tea tree oil before use to check for skin sensitivity, particularly if you have sensitive or inflamed skin.
3. Clay Masks: These masks are fantastic for both full-face and spot treatments. The natural ingredients in clay can help to draw out impurities, absorb excess oil, and rejuvenate the skin. The specific formulation from Averra Aglow is tailored to be effective yet gentle on the skin, making it a fabulous weekly treatment to add to your skincare routine.
4. Pimple Patches: Though they might look like simple stickers, pimple patches are a genius invention for concentrated spot treatment. They work by absorbing pus and fluids, providing a physical barrier to keep you from picking at your skin, and usually contain active ingredients to help soothe and heal. They're a hygienic and effective way to treat individual zits without affecting the surrounding skin.
5. Blue Light Therapy: This high-tech option involves using blue light wavelengths to kill the bacteria responsible for acne. The great part about this treatment is that it's non-invasive and does not damage the skin, unlike some harsh topical treatments. This makes it a suitable option for those with sensitive skin or those looking to avoid chemical-based solutions.

By integrating one or more of these natural alternatives into your skincare routine, you're not only being kinder to your skin but also possibly avoiding some of the long-term downsides associated with conventional treatments.

Addressing the Root Cause

Common topical treatments, while effective in the short term, are often just a band-aid solution. Many of my clients have used these products for years or even decades, and still struggle with acne. These treatments could potentially cause deeper problems by damaging the skin barrier and its microbiome.

My approach always leans towards addressing the root cause of acne and considering topical treatments as the "icing on the cake" to improve your overall skin appearance and reduce hyperpigmentation.

In the quest for clear, radiant skin, it's crucial to remember that there's no one-size-fits-all approach. Finding a balance between conventional treatments and natural alternatives is key. Take it from someone who's been there—your skin is worth the effort.

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