Last Updated on August 14th, 2020
By Dr. Jaggi Rao, MD, FRCPC, Double board-certified dermatologist
Common sense tells us that curing acne is a matter of drying up the skin. Countless skin care experts 👩🏻⚕️👨⚕️👨🏽⚕️👩🏾⚕️ tell us that everyone who has acne needs a moisturizer. And both pieces of advice are correct in their own way.
If you have acne, especially if you have the kind of acne that causes tiny red pimples on your forehead cheeks, and nose, you may see great improvement in your skin when you begin to use moisturizer. If you have naturally oily skin that gives you lots of whiteheads and great big blackheads, you also may occasionally need moisturizer. But not everybody who has acne needs the same moisturizer in the same amounts all the time.
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For centuries, people with acne were told that they needed to dry up the skin. It seemed just to make sense. Whiteheads and blackheads, after all, start as oily buildup in pores. Pimples ooze when you pick at them. Dry up your skin, and the acne should stop.
In the era before acne skin care products, the way to dry up your skin was to get more sun. Sunlight really can dry up acne, but it is specifically the visible blue and red rays of sunlight that make the difference. Blue light can kill acne bacteria. It cannot penetrate deep into pores, but it does not need to kill all the bacteria in a pore to make a difference. And red light can reach deeper into the skin and shrink the sebaceous glands, which produce the excess oil that partly clogs the pores.
The problem with the sunshine cure for acne is that too much sunshine can also cause sunburn. And if you have brown or black skin, sunlight causes both age spots and brown spots where acne has healed. That too much sun 🔆 can cause age spots was obvious, so clever cosmetics makers of another era came up with another way to “dry up” the skin, with alcohol.
There is no doubt that alcohol dries the skin. Typically the kind of alcohol applied to the skin is isopropyl alcohol, also known as rubbing alcohol, although ethanol, the kind of alcohol you drink, would have a similar effect. In the middle of the twentieth century, alcohol rubs and scrubs became a very popular way of treating acne. They definitely dried up the skin. Unfortunately, that isn’t all they did.
Alcohol-based products to treat acne also increase oil production.
There are some skin care experts, notably the venerable “cosmetics cop” Paula Begoun, who insist that the idea that alcohol increases oil production is ridiculous. Alcohol does not stimulate excess oil production, Begoun and other experts say, hormones stimulate excess oil production.
These experts are right. However, the irritation of the skin as it dries out the skin causes the skin to release a hormone known as corticotrophin stimulating hormone. This stress hormone triggers the release of histamine that irritates the skin and increases the activity of sebaceous glands. The sebaceous glands release oil to repair the irritation caused by alcohol.
It’s really ironic that there are many alcohol-based “moisturizers” for the skin. If you have very oily, chemical resistant skin, they may not cause additional skin damage. But there are no skin types for which alcohol moisturizes and improves the skin.
If drying the skin doesn’t fight acne, why would moisturizing the skin help? The answer is that moisture in the skin helps get rid of oil on the skin, and it is the oil on the skin that clogs pores trying to bring it (and dead skin cells and acne bacteria) to the surface.
The skin provides a protective barrier that is organized in a way that is reminiscent of a brick wall. Tough skin cells known as corneocytes are the bricks. 🧱🧱 Fats and fat-like substances, such as ceramides and triglycerides, form the mortar. Most of the contents of the human body are “watery,” so the combination of tough proteins and fatty lubricants protects the interior of the body from dilution or leakage.
Tiny amounts of water are found in the skin. The skin has to let very little water through, and moves water in and out very slowly. It uses carrier molecules known as aquaporins to transport water back and forth in the skin.
Just a splash of water on the skin may be more than enough to fill the aquaporins and add all the extra water the skin can hold—for an hour or two. Skin-identical ceramides and fats do a lot more to keep the skin moist and supple. They dilute the “mortar” holding skin cells together just enough to let the skin move with muscles beneath it and keep pores open so they don’t fill with sebum that becomes whiteheads, blackheads, and pimples.
The best moisturizers are some combination of oil in water or water in oil.
Just because you have oily skin, which is really having too much oil on your skin, does not mean that your skin may not need additional moisture. It just means that your skin probably needs more water than oil.
Countless cosmetics makers try to sell you additional products by claiming that the skin around your eyes, or on your nose, or on your neck, needs special skin care ingredients. Don’t buy only one moisturizer for your skin, these manufacturers will tell you. Buy at least two. But there is no scientific evidence that supports the idea that skin on different locations on your body requires different skin-moisturizing ingredients.
The difference between locations on your body is not what moisturizer they need, it’s how much moisturizer they need. Only people who have dry skin need moisturizer on their cheeks and forehead. Even people who have oily skin may need moisturizer on the sides of the faces from time to time. 🗓️ And even you need moisturizer all over your face, you may need more moisturizer or to use moisturizer more often on certain locations.
It’s easy to forget that the purpose of moisturizer is not just to add moisture to your skin, it is also to lock moisture in your skin. This means that you should not try to make your skin desert-dry before you add moisture to it.
It is best to apply moisturizer just after you have cleansed your skin. You want to pat your face dry so you don’t have any drips, but you want to apply moisturizer while your skin is still damp and soft to the touch. Use moisturizer before foundation and other makeup.
Don’t forget that water is a great moisturizer. If you don’t use makeup, a little clean water on your face a few times a day 🌊🌞🌛 can keep your skin tones bright and prevent flaking and peeling. The moisture in your skin helps pores drain.
Also, a splash of facial waters can help calm sensitive skin. Collected from mineral springs that contain water rich in natural selenium, magnesium, and/or sulfur, facial waters add minerals to your face that you can secure with moisturizer. Rinse off cleanser, and then spray your face with facial waters to calm red skin.
You can spend countless trips to the cosmetics counters and thousands of dollars finding the perfect moisturizer to add to your skin clearing routine. Or you can get moisturizers that work as a part of your comprehensive acne care system from Exposed Skin Care.
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