Best Acne Skincare Routine: Dermatologist-Recommended for Hormonal Acne

What is a dermatologist-recommended skincare routine for acne?

In a nutshell, when it comes to acne skincare routines, here’s what I’d recommend. I’ll also explain how newer acne skincare ingredients differ from traditional skincare actives. 

Daily treatment:

1. A gentle, hydrating and oil balancing cleanser
2. Serum: antioxidant and sebum regulation 
3. Non-irritating pimple cream with anti-inflammatory ingredients 
4. Hydrocolloid patch 
5. Moisturising mist, emulsion 

Hormonal acne skincare routine

@drteowanlin When will my skin stop purging? I answer your acne purging questions in this video tutorial. For more get my skincare blueprint 👆🏻 How to treat purging skin Skin purging process How to stop skin purging Skin purging vs breaking out Dealing with purging Acne purging phase acne purging cause acne purging experience acne purging should heal acne after purging tretinoin results What does purging look like #acnepurging #acnetreatment #acneskin #tiktoksg🇸🇬 #sgtiktok #sgdoctor #learningisfun #learnontiktok #dermatologist ♬ original sound – Dermatologist Dr.TWL

Hormonal acne is mostly associated with adult women diagnosed with polycystic ovarian disease. However, all acne is actually hormonal in nature. Except in teenage acne, we consider that physiological. The surge in testosterone in both males and females triggers the production of sebum. In those who are genetically prone, acne develops. The dermatologist recommended acne skincare routine for all subtypes of acne is standard. The key principles are:

1. Stabilise the microbiome with a good balance of bacteria 
2. Regulate oil production instead of drying skin out
3. Reduce inflammation to prevent new formation of pimples
4. Encourage quick healing of pimples to reduce scarring i.e. post-inflammatory hyperpigmentation and deeper dermal scars like ice pick, box car type scars

Fungal acne skincare routine

Fungal acne is a misnomer. Fungal acne is actually not acne at all. It’s folliculitis, which is inflammation of the hair follicles. It can be associated with infection, but most of the time it is an immune reaction that occurs. Pityosporum folliculitis is the accurate scientific name for fungal acne. The fungus in this case is a yeast known as malessezia furfur, which is a commensal on healthy skin. This means that it lives on human skin without causing any problems. However, in those who have too much of this yeast, a condition caused by genetics, environmental factors such as excess heat and humidity, the fungus causes this acne-like condition.

The condition can occur on the forehead, near the hairline and also the jawline. It can look quite similar to comedonal acne. When around the jawline, it is sometimes mistaken as hormonal acne. Treatment is with anti-dandruff shampoos applied on the scalp to reduce the population of yeast on the scalp. Prescription anti-dandruff shampoos include ketoconazole, also known as Nizoral. However, these can be quite drying and sensitising when used long term. Non-prescription anti-dandruff shampoos are helpful for long term treatment and maintenance. These contain zinc pyrithone, salicylic acid which helps to inhibit the growth of the yeast. When the dandruff symptoms improve, fungal acne around the face will also resolve.

In more severe cases or when there is an overlap with true acne conditions, oral medications may be necessary. Oral erythromycin, doxycycline prescribed exert an anti-inflammatory effect which works well for both fungal acne and acne vulgaris itself. For severe cases, oral isotretinoin which stops all sebum production may be prescribed. However it is important to note that oral isotretinoin itself can disrupt the balance of skin bacteria. The disturbances in the skin microbiome can cause folliculitis as well. Seek medical advice if you think you have been affected. 

The best acne skincare routine explained by a board-certified dermatologist, including tips on managing hormonal acne. 

Acne skincare routine step #1

How it works:

• A gentle, hydrating and oil balancing cleanser

The goal of an acne skincare routine is to harmonise the skin microenvironment. Acne is genetic and driven by inflammation as well as excess sebum production. Addressing the latter 2 factors is the goal of an ideal acne skincare regimen. 

Options: botanical emulsifiers and amino acid surfactants are gentler options of acne face washes compared to SLS-laden cleansers.

If you wear makeup, double cleansing is necessary. Choose a milk or emulsion makeup remover cleanser for the first step. Milk cleansers are preferred over micellar face washes for acne prone skin because of the following:

• Gentler and leaves moisturising layer
• Easier to remove without friction on skin

Makeup wipes are detrimental for acne prone skin. The harsh surfactants damage the skin barrier.

• Serum: antioxidant and sebum regulation 

The 2 essentials are a vitamin C serum and hyaluronic acid.

Antioxidants like vitamin C change the skin microenvironment. Lipid peroxidation is due to increased sebum on skin of acne-prone patients. This process worsens skin inflammation and formation of whiteheads/blackheads. When comedones get infected, red bumps like papules emerge. Acne cysts are when the papules get infected at a deeper level, causing the skin cells to form a wall around the infection. This requires injections with intralesional steroids like triamcinolone. But in serious cases when the cyst recurs over many months, surgery may necessary.

Acne skincare routine step #2: How vitamin C serums work for acne treatment

• Reduce inflammation 
• Decrease bacteria count 
• Reduce scarring, post-inflammatory hyperpigmentation 

The bacteria Cutibacterium causes acne. Reducing growth improves acne flare-ups. 

Hyaluronic acid is a humectant molecule that attracts moisture from the environment and traps it under the skin. Moisturising oily acne-prone skin is important because it sends a signal to skin to regulate oil production. Oily skin occurs when there is excess stimulation of the oil glands known as sebaceous glands. When oily skin is stripped of moisture with strong lathering agents, the skin barrier is also damaged. This triggers sebaceous glands to produce even more oil, a condition known as reactive seborrhea. It is a paradoxical condition whereby oily skin feels dehydrated and tries to compensate. 

Acne skincare routine step #3

• Non-irritating pimple cream with anti-inflammatory ingredients 

Traditional acne treatments involved creams that dried up the skin barrier. The idea that oily skin is the cause of acne is outdated. In fact, dermatologists know acne is caused by a combination of genetics, excess oil triggered by hormones at puberty, bacteria and inflammation. Benzoyl peroxide, tea tree oil and salicylic acid all dry up the skin. However, it worsens inflammation. This may be the reason why you find your acne bump redder, more inflamed after applying your acne cream.

Retinoids are usually prescribed for comedonal acne. However, retinoids worsen inflammation and should not be applied on actively inflamed acne bumps like papules and cysts. This is one reason why individuals experience acne purging.  

Topical antibiotics should be avoided, i.e. erythromycin, clindamycin. These quickly breed resistance and lose effectiveness. Combinations with benzoyl peroxide, also known by trade names Epiduo commonly cause irritation. A side effect known as irritant contact dermatitis is actually due to skin barrier damage. Antibiotic resistance can also be a serious problem 

Choose botanical actives that treat inflammation. Berberine, chlorella and argan oil are the actives used in our pharmacy recommended acne spot creams. Berberine in particular acts on multiple pathways. It is naturally antibacterial without the same risks of antibiotic resistance common to topical antibiotics. There are additional benefits which include antioxidant properties, this makes the acne bacteria less likely to thrive. In addition, anti-inflammatory effects help the pimples resolve faster. There is also an effect on comedogenesis. This means that blackheads and whiteheads are less likely to form. The key advantage is the absence of irritating side effects which are associated with traditional acne creams. 

Acne skincare routine step #4

• Hydrocolloid patch 

I recommend pimple patches as spot treatment. First of all it helps to reduce picking and squeezing. There are many other benefits:

• Reduces inflammation with antibacterial effect
• Encourages healing with the ideal skin microenvironment 
• Rapid healing means a lower risk of scarring

Hydrocolloid patches that come with infused medicated oils or essences can irritate skin, avoid these. Choose plain hydrocolloid patches or ideally, one that is formulated with skin barrier repairing ingredients like glycerin. The hydrocolloid patch from our pharmacy contains glycerin and urea. Urea is a keratolytic which means it breaks down dead skin cells. In acne, there is retention of keratinocytes which are dead skin cells—this leads to comedone formation via a process known as follicular plugging. 

Acne skincare routine step #5

• Moisturising mist, emulsion 

A moisturising mist or emulsion is the best moisturiser for oily, acne prone skin types. Cream formulations or ointments are too heavy on oily skin to be comfortable. Definitely avoid paraffin, common in skincare trends known as slugging. That occludes skin and increases flare ups of acne. 

Look for these ingredients in your facial mist:

• Hyaluronic acid
• Polyglutamic acid
• Botanical extracts like rice bran 
• UV protective antioxidants i.e. portulaca oleracea

Layer your emulsion or face lotion with facial mists:

• Use your facial mist before, after or anytime in between your skincare steps 
• When used before and after facial lotions, it increases absorption of moisturising skincare actives

The ideal face moisturiser for acne prone skin should contain 

• Panthenol
• Niacinamide
• Glycerin
• Hyaluronic acid & polyglutamic acid

These synergise to repair the damaged skin barrier. 

Acne skincare routine step #6: Sunscreen

If you are using prescription retinoids, it may not be enough to just use sunscreen. It is wiser to also practice sun avoidance. However here are some important things to bear in mind when choosing a sunscreen for acne-prone skin:

• Lightweight texture 
• Easily absorbed, does not leave a sticky residue 
• Non-comedogenicity 

In general, sunscreen is quite a tricky skincare product for those who suffer from acne. It is true that some sunscreens can worsen acne. This is because of the oil vehicle as well as chemical sunscreen components which sometimes irritate areas of broken skin. My best advice is to sample sunscreens if you are not sure. The sunscreen formulation at our pharmacy has been tested on those with acne prone skin with good clinical outcome. 

In summary

The ideal acne skincare routine is one that addresses the following 

1. Skin hydration levels to repair skin barrier damage
2. Treats the acne microbiome to reduce growth of bad bacteria 
3. Regulates oil production to prevent excess oil on skin 
4. Anti-inflammatory to reduce comedone formation, post inflammatory hyperpigmentation and scarring 

All these strategies are important for long term treatment and prevention of acne. Medical treatment must be used in conjunction with an acne skincare routine as maintenance therapy.

Weekly skincare routines (up to thrice weekly)

Exfoliation

Exfoliation addresses the build up of dead skin cells. Physical exfoliation with abrasive beads damage the skin barrier and are especially bad for those with active acne. Instead choose chemical exfoliation or enzymatic exfoliation. Acids such as glycolic, lactic and salicylic acids target cell renewal and inflammation. However, in sunny climates depending on where you live can cause photosensitivity. Using sunscreen is essential. A newer form of exfoliation exists—which is my preference. Enzyme peels based on papain and bromelain, these are derived from papaya and pineapple respectively. Besides breaking down and exfoliating dead skin cells for skin radiance, enzyme peels for acne also have additional benefits of reducing inflammation, scars and have minimal side effects. 

Masking

Masking in acne prone individuals is mainly to improve skin barrier function. This can help to regulate oil production. However there are added functions when certain active ingredients are included: 

• High doses of Vitamin C

This is possible in a wash off gel mask, as leave on formulations like vitamin C serums tend to have lower concentrations. Overall, an antioxidant rich skin treatment can help reduce growth of acne causing bacteria.

• Anti-inflammatory 

Botanicals in face masks can synergise to improve the skin microbiome and reduce inflammation.

I developed the mask peel range to address both exfoliation and masking in 1 step. There are no abrasives and natural botanical extracts are selected to maintain optimal skin health by strengthening the skin’s immune system—a concept known as skin resilience. 

Use of textiles

1. Face masks (if applicable)
2. Pillowcases

Textiles are a new advancement in skincare. I discussed this in my paper—as a good therapeutic option for those with acne-prone skin. Biofunctional textiles help to reduce the growth of bacteria without causing antibiotic resistance. Additionally the release of ions such as copper nanoparticles from materials embedded in pillowcases can also improve scars and reducing formation of acne marks. 

Incorporate blue light LED therapy Into your acne skincare routine

Blue light for acne is one of the most underrated treatments. The reason being, it is traditionally offered in dermatologist’s offices and the costs per treatment could really add up. Let me go into how blue light works. Essentially, research shows that twice a week 30-minute durations of blue light therapy in-office for a month, confers antibacterial effects similar to traditional oral medication therapy for acne. 

Hand-held devices do not produce sufficient energy for treatment and LED face masks without eye protection could be dangerous for the eyes. Consider latest designs which are modelled after in-clinic machines but created for home users. An example is the AURORA light therapy machine for acne which has a small footprint and includes options for treatment of body acne and acne scarring. 

Frequently asked questions

Skincare routine for acne-prone sensitive skin 

Acne-prone sensitive skin needs to be understood this way. There are 3 potential problems going on: 

1. Acne vulgaris 
2. Eczema/dermatitis caused by a damaged skin barrier
3. Misdiagnosis

• Acne vulgaris 

We understand this to be a multi-factorial condition which is affected by genetics, bacteria, excess oil producing and hormonal factors.

• Eczema/dermatitis caused by a damaged skin barrier

Those with both acne-prone and sensitive skin may be suffering from side effects of acne treatments. Topical retinoids and retinols commonly prescribed for acne also damage the skin barrier. This can result in sensitive skin reactions such as burning, stinging, pain, flaking and redness. 

• Misdiagnosis

Sometimes it is not acne. Rosacea and perioral dermatitis can look similar—this is why visiting a dermatologist is important. Medical treatments are slightly different. If your acne-prone sensitive skin does not seem to get better—get a specialist diagnosis. 

This article caters specifically for those with acne-prone sensitive skin. The skincare routine steps are applicable for all skin types. If your condition is moderate-severe, topical skincare alone may not be sufficient. You will need adjunct medical therapy. However, an acne skincare routine is still essential for long term maintenance and prevention of flare-ups.

Am and pm skincare routine for acne prone skin 

Apart from sunscreen use in the daytime only, there are no differences in the am and pm skincare routine for acne prone skin according to the regimen prescribed here. 

An acne skincare routine is an essential component of acne treatment. If your acne is moderate-severe, or you have co-existing, overlapping skin conditions such as sensitive skin, rosacea or perioral dermatitis, you may wish to consult a dermatologist for a clinical examination and diagnosis.