Last Updated on September 20th, 2019
Many acne care products can kill acne bacteria. The problem with some of these products is that they can also kill the skin. This article reviews the 10 most commonly used products for getting rid of acne infections, their pros and their cons. But first let’s take a closer look at how acne bacteria cause, or don’t cause, blemished skin.
Article Table of Contents
Most of the time the acne bacterium Propionibacterium acnes is a natural fixture on human skin2. The skin makes an oil called sebum to keep it flexible and lubricated. The skin produces extra sebum when the skin is stressed. This production of extra oil can be part of a generalized reaction of the entire body to stress, or it can be part of a specialized reaction with the skin to stressors that only affect the skin itself, such as allergens, irritant chemicals, rubbing, or heat.
Acne bacteria feed on sebum3, but they are only naturally active when there is too much sebum on the skin. When “fresh” sebum is overabundant, acne bacteria have an abundance of food. As sebum production declines, “stale” sebum begins to release essential fatty acids. These are useful for the skin’s health, but toxic to acne bacteria. Most of the time acne infections are self-limiting. They are only a problem when the passage of oil and bacteria to the surface of the skin, where they can both be washed away, is blocked by tightening of the skin or hardening of sebum.
When pores are clogged, acne bacteria have a way of “breaking out” of the pore so their descendants can go to live in another pore. They release chemicals that sensitize skin cells to the immune system. When the immune system attacks the bacteria, it also kills healthy skin cells. This reddens and inflames the skin, and at some point, some bacteria will escape when the pimple bursts open. That is, they will escape if the pimple bursts open. Mashing or squeezing pimples presses bacteria into the skin so that healthy skin traps them inside the skin for good. The result is replacing pimples with nodules and cysts.
Many products prevent the formation of nodules and cysts by killing the skin. This works, but it leaves scars, and it’s not very pleasant for the user of the product! Some acne products, however, control acne infections without causing irritation or inflammation or damaging the skin. Let’s take a closer look.
1. Benzoyl peroxide.
Benzoyl peroxide4, also known as BP, or, since the BP oil spill, as BPO, is the active ingredient in the majority of acne products you can buy over the counter or get by prescription. Benzoyl peroxide breaks down into two compounds that both kill bacteria and reduce the sensitivity to the skin to the immune system. Almost all the bacteria in a pore will die within 48 hours of exposure to BP.
The downside to benzoyl peroxide is that it only stops the new inflammation. It does nothing to remove existing inflammation, and it also can dry out the skin. Drying out the skin tightens it and creates new clogged pores elsewhere. If benzoyl peroxide is all you do for you skin, that is, you do not have an effective blemish treatment program, you’ll just get rid of pimples in one place and create whiteheads and blackheads in another. Still, used with the right cleanser and moisturizer, BP can do most acne sufferers a lot of good, especially in treating acne on the back and chest.
2. Tea tree oil.
Tea tree oil5 is the leading herbal remedy for acne breakouts. Like benzoyl peroxide, it kills acne bacteria in pores, although it takes about 72 hours instead of only 48. Unlike benzoyl peroxide, tea tree oil also is anti-inflammatory6. It “gets the red out.” Tea tree oil also does not dry out the skin and does not cause new blemishes7.
The downside of some tea tree oil products is that they contain enough tea tree oil to smell good but not enough tea tree oil to fight acne bacteria. Usually a product has to be at least 5% tea tree oil to do any good. There is a single report in the medical literature about tea tree oil possibly interfering with the way hormones work in boys who have not entered puberty, so just to be on the safe side, don’t use this product for acne in babies or in children under 12. Always test a dab of tea tree oil on the forearm and wait 12 hours to make sure there are no allergic reactions.
Calendula is the botanical name of chrysanthemum petals. This natural ingredient is used in skin care soaps and washes for eczema and insect bites as well as acne.
Calendula contains natural anti-inflammatory compounds related to aspirin8. It also contains compounds that kill both acne bacteria and staph bacteria. Staph infections create bumps that look like especially nasty pimples, with circles of yellow pus visible in the center. You will get better results from a gel left on your skin than from an acne wash. Always test for possible allergic reactions before you use the product for the first time.
Triclosan9 in higher concentrations can kill both bacteria and skin cells by breaking down their outer membranes. In lower concentrations it kills bacteria by shutting down their ability to use fatty acids. Since acne bacteria feed on fatty acids, triclosan causes them to starve.
The issue with using products that contain triclosan, such as Body Shop Tea Tree Clearing Lotion, is that using it at high concentrations damages the skin, and using it at low concentrations kills acne bacteria but has no effect on staph bacteria. Triclosan just removes the bacteria that compete with staph bacteria for moisture and food, so instead of pimples, you may wind up with boils caused by staph infection. Don’t rely on products based on triclosan to get rid of acne on your skin. They may just cause you even worse problems.
5. Topical tretinoin (Retin-A and Avita creams applied directly to the skin).
Tretinoin, the active ingredient in topical Retin-A and Avita10, does not actually kill acne bacteria. This potent acne treatment works primarily by stimulating the growth of the skin so that pores open and their contents can drain. It also counteracts the effects of stress on the skin and desensitizes skin cells to the immune system, reversing their sensitivity caused by bacteria. There are many potential side effects of tretinoin treatment, and it must always be used under medical supervision.
6. Isotretinoin (Accutane, taken as a pill).
Isotretinoin11, also known as Accutane, is another potent acne-fighting drug that stimulates growth of the skin. By shrinking sebum-producing glands, however, it slowly starves acne bacteria as it helps open pores. Like Retin-A, Accutane has many potential side effects, and it should only be used under medical supervision.
7. Adapalene (Differin)
Sold under the trade name Differin12 and available as a cream, gel, or pledget (small compress), adapalene opens pores and counteracts the inflammation caused by acne bacteria. The bacteria are removed, however, as pores open and they can drain to the surface. Adapalene13 has little or no direct antibacterial action.
This antibiotic14 is commonly prescribed for acne in teens in the United States but usually not prescribed for acne in teens in Europe. It fights both acne and other common skin infections, but it has the side effect of staining the teeth brown, gray, black, or blue, especially along the gum line. American doctors typically don’t give the drug to young acne patients who still have their “baby teeth,” but European doctors seldom give it to anyone under the age of 22.
This antibiotic used to be very popular for treating acne15. The problem with tetracycline and many related antibiotics is that they have potential for kidney damage. If you use any antibiotic for acne you should also use benzoyl peroxide or tea tree oil to kill the especially resistant bacteria they may leave behind.
10. Medicinal honey.
Medicinal honey16, especially Manuka honey, is available in sanitary skin preparations—you don’t have to dip your fingers in the jar. It fights a wide range of bacteria, yeasts, and molds that can contaminate the skin. Manuka honey, in particular, is collected from hives of bees that feed on the plants used to make tea tree oil, and offers all the benefits of tea tree oil plus the power to kill a broader range of infections.
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