Should I use a comedogenic ingredient checking tool like CosDNA or Skincarisma?

One of the most important steps in getting and staying clear is to eliminate comedogenic, or pore-clogging, ingredients from your skincare, personal care care, household, and even your partner’s and baby’s products.  Unfortunately, just because a product claims to be non-comedogenic doesn’t mean it’s true for reasons I explain in my post Why non-comedogenic products are not necessarily good for acne.  Since non-comedogenic claims are unreliable, there is a multi-step testing process that we have our clients perform to determine if a product is actually acne-friendly or not and the first step in testing a product is to cross reference it against this list of comedogenic ingredients.  Because the list is long and can be a little intimidating, it’s understandable that many of our clients want to bypass this step by using ingredient checking tools online like CosDNA and SkinCarisma.  Unfortunately, there are no ingredient checking tools that are completely reliable at the currently.

TRUST THE PROOF

Anytime you are taking advice from someone or something about anything related to acne, the first thing you should ask yourself is whether or not this person or thing has proof that whatever advice or tool they are offering has actually helped people get clear for an extended period of time.  It is easy to get sucked into people, packaging, tools, and claims that seem convincing but the proof is always in the pudding.  When it comes to acne, you should only trust people and tools that have gotten AT LEAST a hundred people clear for at least a few years and they can show the results with bright, clear pictures.  Unfortunately, none of the ingredient checking tools online have proof that their comedogenicity checkers have actually been used to get people clear so although it might seem like a convenient and fast way to bypass our list, it could end up costing you more time in the end if you end up breaking out from a tool that seems fancy but that hasn’t actually actually been proven to work in real life.

MOST TOOLS ARE NOT RELIABLE FOR COMEDOGENICITY

There are lots of different comedogenic ingredient lists like this one and this one floating around the internet and there are more and more ingredient checking tools popping up all the time.  The problem is that all of the current lists and tools are based on different criteria from different sources so many of them are inaccurate.  The ingredients that different lists and tools check for might be based on different research studies or combinations of studies which is a problem in and of itself because most of the studies that have been done on comedogenicity are unreliable for reasons I explain in this post.  Additionally, the exact ingredients some of the tools check for and the basis for why they consider them comedogenic are not always disclosed so for all we know they could have been drawn out of a hat. I don’t trust any of the currently available tools and I make my clients check their products the old fashioned way using our list when they start our acne program because some of my clients have thrown out products because they checked it against an ingredient checking tool online even though I know they are acne-friendly because hundreds of my clients have used them and gotten clear.  On the other hand, there are products that I know are comedogenic that some of my clients thought were acne-friendly because some online tool said it was okay which tells me that the ingredients that tool is checking for are inaccurate.   As I mention in my e-course, the golden rule is that your real life experience trumps everything so if you start using a product because it didn’t contain any of the ingredients on a list or online checker but you begin to notice an increase in breakouts, it means it’s not acne-friendly for your unique skin so stop using it.

IS THERE ANYTHING INGREDIENT CHECKING TOOLS CAN BE HELPFUL FOR?

If you want to check a product’s ingredients for “ingredient safety”, tools like CosDNA and SkinCarisma can be really helpful because they check against a defined set of criteria validated by the EWG or CIR.  The problem with comedogencity is that there is no defined or reliable set of criteria set by any regulating agency so I tell my clients they can use ingredient checking tools as an initial scan.  If you check the ingredients of a product and any of the ingredients are flagged as being comedogenic, they then check it against our list and if those ingredients are on our list then they can avoid that product without having to do a deeper check.  However, if none of the ingredients match up with those on our list, they have to cross reference it one by one in the end anyways so it’s actually more time efficient to practice using the list and learning what the most common comedogenic ingredients are so that they can be a self-sufficient acne manager.

THE BOTTOM LINE

The bottom line is that managing acne takes work and effort and as much as I wish there were shortcuts not just for my clients but for myself since I still struggle with acne, there is no quick or easy way to get clear or stay clear.  If you are actually triggered by comedogenic ingredients, the safest way to insure you aren’t being exposed to any pore-clogging products is to find a list from someone who is reliable and who has proof their list has been used to actually clear people long term and to practice using the list so you can learn which ingredients to look out for.  The list might seem daunting at first but with practice, you will begin to learn the most common ingredients to look out for like coconut oil, shea butter, and sodium laureth sulfate.  Even after almost a decade of using the list, I still don’t have every ingredient memorized but I rarely have to use the list because there are 5-10 ingredients that can be found in the majority of personal care products on the market and just memorizing those will make the process quick and easy most of the time.  

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How to make sure a product is acne-friendly

Non-comedogenic is a term that is supposed to mean that a product won’t clog pores but as I explain in posts like this one and this one, companies can slap a non-comedogenic label on pretty much any product so it doesn’t actually mean that a product is acne friendly.  The FDA and FTC barely regulate personal care products and there are so many comedogenic lists and tools online now that it’s hard to know how to actually determine which products are actually good for acne and which aren’t. The studies that have been done to determine which ingredients are comedogenic are also highly flawed so how in the world are those of us with acne supposed to know which products to use and which ones to avoid?  Unfortunately, there is no easy way to determine which products are acne friendly or not but if you willing to put in a little time and effort, it is possible using this multi-step test (just checking ingredients is a great first step but it’s not enough). This is the test we use to test all of our own products and it’s been proven to work by the hundreds of clients we have gotten clear.

FIRST, SOME THINGS TO KEEP IN MIND

There are lots of different comedogenic ingredient lists like this one and this one floating around the internet and there are more and more ingredient checking tools like CosDNA and Skincarisma coming out that supposedly help you determine whether or not a product is good for acne.  Unfortunately, these are not reliable because they have not been proven to actually work on real life people with acne, they all check for different ingredients, and even if they checked for the right ingredients products in the US don’t always disclose every ingredient in personal care products. So checking ingredients by cross referencing a list or using an online tool is not enough. Also, everyone’s acne is different so the products that are friendly for your acne might not be friendly for someone else’s acne and vice versa.  This is why I don’t use the term “acne-safe” that so many other people use because I don’t believe there is such a thing as a product that is completely acne-safe.  There might be a product that is safe for you as an individual but it’s impossible to say that any product is safe for all acne.  Everyone’s triggers are also different so if you know that some or all comedogenic ingredients are not triggering for your unique type of acne then this is not a process you need to bother with.  Lastly, keep in mind that the amount of a trigger that each person has to be exposed to before breaking out is different and everyone’s delayed reaction time is different so it might take you a few days to break out from a product that takes a few months to cause a reaction in someone else.

STEP 1: CHECK THE INGREDIENTS AGAINST A RELIABLE LIST

When you are trying to determine whether a product is acne-friendly or not, the FIRST step (not the final step) is to check the ingredients against a list from someone that has proof their list works.  As I explain in my post Should I use a comedogenic ingredient checking tool online?, I recommend checking products against lists like ours that have actually been proven to work on real people with acne rather than ingredient checking tools that check for god knows what ingredients. A few things to keep in mind about this step:

• There is no perfect list because nobody could possibly keep up with every ingredient in this world that is acne-friendly. You need to find a list that has been proven to be good enough because it has been used to clear at least a hundred people for extended periods of time.

• Even if you find a good enough list, you still cannot use it to determine for sure if a product is acne-friendly or not because there are lots of loopholes in the United States that allow companies to not disclose the actual ingredients in products. Determining comedogenicity can only be proven by following the next 2 steps.

• Don’t pay attention to the number ratings that some lists have next to ingredients.  These numbers are supposed to indicate the degree to which a product is comedogenic but everyone is triggered by different things in different amounts so we recommend avoiding anything that has the potential to cause a breakout until you are clear regardless of any rating.  Once you are clear, you can perform a trigger test on ingredients with lower scores to determine if ingredients with lower ratings are actually triggering for you or not.  We discuss how to perform a trigger test as well as lots of other information about comedogenic ingredients in our e-course The 8 Steps To Clear Skin.

STEP 2: PERFORM A TRIGGER TEST 

Checking the ingredients on a product against a reliable, good-enough list is just the preliminary step in determining whether or not a product is actually acne-friendly or not.  Since it’s impossible for any list to be perfect and there are ingredients that are not required to be disclosed by the FDA, the only way to truly test a product for comedogenicity is to perform what I call a trigger test by testing it on your skin.  As I just mentioned, we talk about the proper way to perform an accurate trigger test in our e-course but one of the most important aspects of a trigger test is the next step.

STEP 3: WAIT THE DELAYED REACTION TIME

Another important concept we talk about in our e-course is the delayed reaction time which is just the idea that it takes time for acne to show up once you have been exposed to a trigger and this is one of the most important things to keep in mind when performing a trigger test.  When you are testing any type of trigger whether it’s a product or a food, you have to wait enough time before determining whether or not it is an actual trigger for you.  This is the same concept as gaining weight.  You wouldn’t eat a bunch of food during the holidays and decide the next day that whatever you ate doesn’t cause weight gain because you don’t see a different number on the scale, would you?  Of course not.  You know intuitively that it takes time for the food you eat to get processed in your body then show up as visible weight on a scale.  Well, for some reason, people think that eating chocolate or using a comedogenic product today can cause a pimple tomorrow which is just not logical.  Everyone’s delayed reaction time is different but the delayed reaction time for comedogenic products is usually days to weeks so if you notice an increase in breakouts a few days after using a product and that is the only trigger you have been exposed to then you can conclude that whatever product you are testing is comedogenic.  If you don’t notice a reaction right away, we recommend our clients wait 2-3 months to be able to determine for certain that a product is acne friendly or not. This seems like a long time but, believe me, it is way less time than it will take you to have to clear up any breakouts that might pop up from having tested a potential trigger too quickly.

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Why non-comedogenic products are not necessarily good for acne

Non-comedogenic products are products that, in theory, are supposed to not clog pores or lead to breakouts and avoiding them is one of the most important steps in getting and staying clear. Unfortunately for us acne sufferers, non-comedogenic is just one of the many terms like hypoallergenic, non-toxic, and natural that can be slapped on a personal care product without any basis or proof.  Here is some information to help you understand why you shouldn’t just take products that say non-comedogenic at face value.

STUDIES THAT TEST COMEDOGENICITY ARE UNRELIABLE

Decades ago, scientists finally realized that skincare products and makeup might contribute to acne.  Um, DUH. So they started performing tests on various ingredients that are used in topical formulations to determine how many comedones they were likely to cause.  The earliest tests were called REAs (rabbit ear assays) and they were done in the 70s and 80s on, you guessed it, rabbit ears.  The chemical being tested would be applied to rabbit ears and after a period of time, researchers would count the number of comedones that formed.  There have been other tests performed since then on humans but all of the tests performed since the 70s are hugely flawed and far from reliable.  First of all, testing rabbit ears is hardly a reliable way to determine how an ingredient will affect the acne prone skin of a human.  This seems like common sense but here is a study where a research substantiates this fact if you are one of those people that needs a scientist to validate common sense.  Additionally, human tests are often performed on skin on the back which is different from skin on the face and studies like this one are performed on such a small number of people that there is absolutely no way its findings could accurately represent as complex a condition as acne. And even if it was, there was no standardized procedure followed for any of the tests: the amount of substances they tested, the length of time they waited before evaluating a reaction, and the way that they counted the number of comedones all varied.

THERE IS NO STANDARD DEFINITION OF NON-COMEDOGENIC

Comedogenicity means different things to different people which is why there are so many different tools and lists out there based on varying types of criteria.  For example, you might see one list that claims that sunflower oil is comedogenic while another may not.  Some lists use ratings and some don’t.  “Non-comedogenic” has basically become a free for all and all different types of professionals, companies, and individuals who create and alter lists based on interpretations of data that are based on studies that aren’t reliable to begin with.

“NONCOMEDOGENIC” IS NOT A REGULATED CLAIM

The cosmetics and personal care industries are barely regulated by the FDA or FTC.  This means that not just the formulations that make up a product but the claims written on the outside of products are basically a free-for-all.   Much like the terms “clean” and “natural”, there is no definition offered by the FDA to standardize the meaning of the term “non comedogenic” and there are no regulations controlling how it is used.  So when a company slaps the term “non comedogenic” or “clean” on a product, it’s completely up to them what that means. This is really unfortunate for those of that suffer with acne because it means that just because a product says non comedogenic doesn’t mean it’s good for acne and conversely, many non-comedogenic products don’t necessarily claim to be non-comedogenic. 

INGREDIENTS AND ACNE ARE TOO COMPLEX TO STANDARDIZE

One of the concepts I talk about in my 8 Steps For Clear Skin e-course is that everyone’s triggers are different.  This means that some people are highly triggered by diet while others are triggered by products.  And even within the group of people that are triggered by comedogenic products, one person might be triggered by coconut oil while another might only be triggered by isopropyl palmitate.  And even within the group of people that are triggered by coconut oil, one person might be triggered if they apply it everyday while another person might experience a breakout if they only apply a little bit one time.  So even if the studies were perfect AND there was a standardized list of comedogenic ingredients AND there was a regulating agency that made sure that every product that claims to be non-comedogenic was actually non-comedogenic, it would still be flawed because acne is a condition that is too complex to make any rigid rules for.  Instead, acne has to be managed using an approach like our method that is comprehensive and that targets multiple factors at the same time while still allowing some flexibility for the differences that each person’s unique case presents. 

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What does comedogenic for acne products mean?

Whether you have acne or not, you have probably seen a lot of skincare products that claim to be non-comedogenic.  You might have even bought a product specifically because the label claimed to be non-comedogenic so you assumed that it must be good for acne without knowing what the term actually means.  The good news is that you were right in assuming that non-comedogenic is good for acne and as I discuss in my e-course The 8 Steps To Clear Skin, one of the most important steps in getting and staying clear is to use non-comedogenic skincare, household, and personal care products. The bad news is that just because a product claims to be non-comedogenic doesn’t mean it is and it’s nearly impossible to determine which products are actually non-comedogenic even if you use a reliable list like ours.  So what exactly does non-comedogenic mean and how do you determine whether or not a product is good for acne or not? 

WHAT DOES NON-COMEDOGENIC ACTUALLY MEAN?

In order to understand the term non-comedogenic, first you need to know what a comedo is because that is the root of that term.   Comedones are clusters of oil, dead skin cells, and comedogenic ingredients that clog the hair follicles.  I call them seeds because they literally look like tiny millet seeds and they are also figuratively the seeds from which all of the seven different forms of acne sprout.  So if a product is comedogenic, it contains an ingredient that contributes to the formation of comedones that lead to acne.  If a product is non-comedogenic, in theory, it shouldn’t clog your skin or lead to breakouts.  There are a few different interpretations of where the word “comedo” comes from.  Dr James Fulton whose book Acne RX greatly informs our approach to acne says the word comedo comes from the latin word for “fat maggot” because people historically thought that acne was caused by maggots.  If you do a Google search for the etymology of comedo though, most sites say that comedo comes the latin word for “eat up” that was given as a name for parasitic worms that resemble the wormy looking comedones that can be squeezed out of acne lesions.

JUST BECAUSE IT SAYS “NON-COMEDOGENIC” DOESN’T MEAN IT ACTUALLY IS

Unfortunately, the personal care industry is highly unregulated (especially in the United States) so there are lots of terms that can be slapped on product labels without actually being true.  Non-comedogenic, hypoallergenic, clean, and non-toxic are just some of the terms that marketers can claim on personal care products without any basis or proof.  This FDA article about hypoallergenic claims explains that the term means whatever a company wants it to mean and there is no standard definition or regulations around use of the term. Non-comedogenic claims are just as unregulated and although there have been a few studies performed over the years to determine comedogenicity, they are highly unreliable as I explain in my post Why non-comedogenic products are not necessarily good for acne. The personal care industry in the US is a joke so even if the FDA provided a standard definition and regulations around the term and there were reliable studies that produced a perfect comedogenic ingredient list that accurately listed every ingredient that had the potential to break you out, it still wouldn’t be enough because many products in the United States don’t disclose all of the ingredients in their formulations.  

COMEDOGENICITY AND IRRITATION ARE TWO SEPARATE THINGS

I have heard people say that non-comedogenic products are products that don’t irritate your pores and those people are either confused or ignorant because comedogenicity and irritation are two separate things.  Comedogenicity refers to the tendency of an ingredient in a product to clog your hair follicles and irritation is discomfort or inflammation caused in response to a substance.  Congestion can lead to irritation but irritation doesn’t lead to congestion.  For example, coconut oil is a highly comedogenic ingredient because it has the potential to clog the follicles and cause breakouts.  If you have acne, comedogenic ingredients are one of your triggers, and you use a shampoo that contains even just a tiny bit of coconut oil, you are asking for a breakout on the forehead, sides of the face, and body if you are prone to body acne.  But coconut oil is not usually irritating for people’s skin-it doesn’t usually lead to pain or burning or redness.  However, if you have a breakout from coconut oil and the lesions become inflamed then the product’s comedogenicity can inadvertently lead to irritation in the form of inflamed acne but the ingredient being comedogenic in and of itself didn’t cause it.  On the other hand, a product that is high in glycolic acid can be irritating for the skin and can cause burning or stinging because it’s an acid but it's not going to clog your pores unless the product contains other comedogenic ingredients.  In fact, glycolic acid can actually be a really useful ingredient for acne because it unglues comedones through exfoliation so this is a case where a potentially irritating ingredient can actually be really useful to help combat the effects of comedogenic products.  So non-comedogenic does not mean it won’t irritate pores and there are ingredients that can be comedogenic without being irritating and vice versa.

DON’T FOLLOW COMEDOGENIC RATINGS OR RANKINGS

You have probably come across lists like this one and this one that rate or rank comedogenicity on a scale of 0-5 with 0 supposedly meaning that an ingredient doesn’t have the potential to clog pores and 5 meaning that it is highly comedogenic.  The problem is that the ratings are based on studies that are unreliable for reasons you can read in this post and rating the comedogenic potential of an ingredient completely ignores the fact that every person with acne has a different level of sensitivity to comedogenic ingredients.  Different people also recommend different guidelines for following the rankings: some people recommend avoiding ingredients that rank 3-5, some recommend avoiding ingredients that rank 2-5, and some recommend avoiding them altogether.  The thing is, acne is a very complex and complicated multifactorial disease: Everyone’s acne triggers are different, how much of a trigger they need to be exposed to and for how long is different, and the time it takes between when they are exposed to a trigger and when they actually notice a visible breakout is different.  So even something with a high comedogenic rating might cause a breakout quickly for one person while having no effect on another while an ingredient with a low comedogenic rating might not cause a breakout for most people but may for others.  

NON-COMEDOGENIC SKINCARE IS NOT ENOUGH TO CLEAR ACNE

Even if all of your skincare products are non-comedogenic, it is very unlikely that you are going to achieve or maintain clear skin through that measure alone.  Acne is a multifactorial disease that is caused by a genetic condition called Retention Hyperkeratosis and triggered by many different internal and external factors like diet and lifestyle that we go over in our e-course so there are very few people who can get completely clear by managing just one type of trigger.  Also, even within the non-comedogenic product category, skincare is just one of many types of products that can affect breakouts.  Household products like hand soap, personal care products like shampoo, makeup, and even your partner’s and baby’s products can all make contact with your skin and break you out so don’t think that using non-comedogenic skincare products is enough to manage acne.

SO HOW DO I KNOW IF A PRODUCT IS NON-COMEDOGENIC?

Since non-comedogenic claims aren’t reliable, how on earth do you determine which products are acne-friendly?  Well, there is no easy or quick way but the first step is to cross reference the ingredients of a product against a list from someone you trust.   And that someone shouldn’t just be someone you trust because they seem trustworthy- you should trust them because they have proof that they have actually used the list to clear lots of acne sufferers for significant lengths of time.  If you want some help, you can check out my post Tips for finding a good acne professional you can trust. Once you have found a list from someone you trust, follow the last two steps in my post How to make sure a product is acne-friendly.

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Tips for finding a good acne professional you can trust

The fact that it’s 2020 and there are still so many people struggling with acne blows my mind.  Acne is one of the most common diseases in the world and there is no shortage of Dermatologists, Estheticians, Naturopaths, Acupuncturists, Nutritionists, and Coaches that claim to have what it takes to help acne sufferers get clear.  So why are so many people still suffering with acne?  And why are we suffering for such long periods of time even though we spend so much time and money on appointments with acne “professionals”?  There is only one explanation: most professionals don’t know what they are doing.  If they did, I would have gotten clear when I saw the first, second, third or fourth Physician.  If they did, I would not have suffered with acne for as long as I did.  Even though Dermatologists have fancy degrees and years of training to heal skin conditions, they still weren’t able to help me.  Not only did they not help me but they often made my acne worse AND added a whole host of side effects that I had to deal with.  Don’t get me wrong, I would have gladly endured those side effects if my acne was actually improving but having to deal with both was just brutal.  Now that I have made the full circle journey from acne sufferer desperately seeing acne professionals to an acne professional seeing desperate acne sufferers, I want to tell you what I wish I would have known back then when I was choosing the professionals to work with. 

FIND A GOOD LOGISTICAL MATCH

This point is probably an obvious one but before you make an appointment with an acne professional, there are some logistical factors that should be a good fit.  Their prices, location, schedule, and whether or not they have a waitlist are all factors that should be considered before anything.  For example, our prices are not the cheapest in our area so we always encourage people to find another clinic if they feel our prices are more than they want or are able to spend.    We are also quite busy so we often have a waitlist and we have very limited availability on evenings and weekends so we wouldn’t be a good match for someone who wants to get started right away or who can’t come for an appointment during the day.  Ask these practical questions at the very beginning so you don’t waste your time with a professional who isn’t a good logistical fit in the end.  

CHOOSE THEM BASED ON THEIR RESULTS, NOT CREDENTIALS OR MARKETING

When I think about the time and money I wasted seeing useless acne professionals, I wonder WHY?  Why did I keep seeing them even though they weren’t helping me?  I never had proof that they had ever cleared a single case of acne so why did I trust them so blindly?  The answer is that I trusted the Physicians because of their credentials.  Who wouldn’t trust a Dermatologist who went to school for over a decade to learn how to heal skin conditions?  And I chose most of the Estheticians I saw because their websites looked nice and they called themselves acne specialists.  I also tended to trust Estheticians who used marketing buzzwords like “natural” and “organic”.  None of that got me anywhere and what I learned is that there is no educational institution that teaches professionals how to effectively treat acne.  So what you are really looking for is RESULTS and results can only be demonstrated through pictures and reviews.

MAKE SURE THEY HAVE BIG, CLEAR, CLOSE UP PICTURES

Look for someone who has AT LEAST 5 good before and after pictures that are big, clear, and close up like the ones on our results page. You also want to see pictures that demonstrate a professional has not just gotten people clearer but they have gotten people clear.  I have seen a lot of before and after pictures where the person’s skin looks better at first glance but I can tell that there is still some level of congestion that wouldn’t be apparent to the average person’s untrained eye.  There are seven types of acne and lots of acne lesions, especially the non-inflamed types, are impossible to see in pictures unless they are big enough and close enough.  So don’t trust pictures on Instagram because they aren’t big enough to see the tiny bumps that might still be underneath the surface. I also see before and after pictures that are too grainy and dark to see the less noticeable bumps so make sure the pictures are bright and clear enough to be able to see all of the different types of acne.

MAKE SURE THEY HAVE LOTS OF GOOD REVIEWS THAT SHOW LASTING RESULTS

With all of the different rating and ranking websites out there, any professional with enough happy customers will have reviews online and it would be foolish to choose someone without checking their Yelp, Google page, or some other medium.  It’s okay if they have a few negative reviews-there are always a few people who write negative reviews for silly reasons that don’t really have anything to do with how effective a professional is at clearing acne.  And the more positive reviews a business has, the more likely they are to have negative reviews for statistical reasons and it’s actually a sign that their reviews are honest.  But you should check to make sure that they have at least 40 positive reviews and the ratio of negative to positive reviews should be significant.  You should also make sure that they have reviews from past clients that have not just gotten clear but that have stayed clear for a few years like the ones on our Yelp page.  

CHOOSE SOMEONE WHO HAS CLEAR SKIN (MOST OF THE TIME)

This also seems pretty obvious but apparently it isn’t because there are a lot of acne sufferers who listen to acne advice from influencers who still have acne???  It’s natural to feel a bond with people who have experienced the same kind of suffering we have and a lot of my clients choose me because they know I can relate to their acne struggle.  So if you can find an acne professional who knows firsthand what it feels like to have acne, awesome.  But if you want to get clear, you have to choose someone who has also, well, gotten clear.  Because acne is a chronic genetic disease, even those of us that have found a way to get clear will inevitably break out once in a while and I still break out when I am exposed to certain triggers.  But find someone who is clear most of the time and who can manage their own breakouts quickly when they do come up.

DO THEY GIVE A SH*T?

Do you know how many Dermatologists I kept going back to for years even though they clearly couldn’t care less about me or my acne?  Too many.  Most of the Dermatologists I saw didn’t spend more than a few minutes with me, they didn’t even pretend to look at me while they spoke to me, and they barely ever looked at my skin let alone touched it.  Apart from the fact that it’s really unpleasant to have an appointment with a professional who doesn’t even pretend to care about a condition that has such an impact on your life, it’s also a sign that this professional likely won’t be able to help you.  Acne is a multifactorial disease that requires a lot of thought and attention to get under control.  That means that it’s a complex condition that is affected by multiple factors and it’s also a disease that can manifest in many different ways.  So in order to help you get clear, a professional needs lots of information from every appointment by doing a thorough assessment of your skin and asking questions that will help them evaluate your diet, lifestyle, and products.  If a professional isn’t showing you that they care, it’s a sign they are not only rude but they are likely ineffective as well.

DO THEY PERSONALIZE THEIR PRODUCTS AND SERVICES?

My Dermatologist used to prescribe me one medication after another before she even had a chance to look at me.  It felt like she just had a list of medications and she was going down the list one by one rather than taking the time to determine whether or not each treatment plan was actually appropriate for where my acne and skin were at.  The problem is, there are so many variables that need to be considered when it comes to acne because every case of acne is unique.  When I work with a client, I am constantly assessing what type of acne is showing up on that particular day, how much inflammation they have, how dry or oily their skin is, what is triggering them, what type of skin they have, and the list goes on and on. After I assess what is going on which, again, requires giving a sh*t, then I personalize a plan of action or non-action based on my assessment.  There is no one size fits all solution for acne so if you notice that a professional is not taking the time and care into crafting a personalized plan, drop them.

DO THEY HAVE COMMON SENSE?

Another seemingly obvious point that I still feel the need to mention because so many of us ignore common sense when choosing an acne professional.  I remember one of the first Dermatologists I saw telling me that diet has nothing to do with acne.  Even as a clueless teenager, I knew that didn’t make any sense but I completely ignored my intuition about her because I thought she is the professional so she must know better than me.  If I would have listened to my gut telling me that this person wasn’t right because she isn’t even demonstrating common sense, I would have saved a lot of time and money.  If there is anything I learned from my acne journey, it’s that just because someone has a degree and wears a uniform doesn’t mean they know anything about acne so I encourage you to trust your gut above all else.

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How to prevent breaking out after cosmetic procedures

I recently had a client come in for her appointment completely broken out.  This would have been normal for an acne clinic except for the fact that she had just graduated from our acne program and been completely clear just a few months prior.  Her skin went from being practically 100% clear to being 50% broken out with pimples of all different shapes and sizes.  She was almost as broken out as she was when she first started the program!  As I do with all of my clients when they have a breakout, I did some detective work and discovered that she had recently done a thread lift.  Thread lifting, like most cosmetic procedures, isn’t a potential acne trigger in and of itself.  But if you are considering a cosmetic procedure whether it’s a laser, thread lifting, plastic surgery, or even just microdermabrasion, there are a few potential acne triggers that you might be exposed to before, during, and after your procedure that can cause a breakout. 

WATCH OUT FOR THIS POTENTIAL TRIGGER DURING COSMETIC PROCEDURES

The main type of trigger you are likely to be exposed to before, during, or after a cosmetic procedure are pore-clogging products called comedogenic products.  The numbing cream they apply to your face before the procedure or the products they apply during and/or after the procedure like a gel or an SPF can all contain pore-clogging ingredients that slip into your pores and contribute to the formation of microcomedones which are basically acne seeds.  As I mention in my 8 Steps To Clear Skin e-course, it only takes one ingredient in one product to touch your face one time to break you out and once acne seeds are planted in your skin it can take months to years to purge those seeds out.

YOU MIGHT BE AFFECTED BY THIS TRIGGER TOO

Comedogenic products that directly touch your face are not the only potential triggers you need to worry about.  Even when our clients are diligent about avoiding product triggers, we have had clients break out simply because they are not able to use our product kits for days or weeks after a procedure.  This typically happens when you have intense procedures that make the skin raw and sensitized so the Doctor might tell you to avoid using any skincare products while your skin is healing. But if you are using skincare products like ours that facilitate the clearing process and you skip applying them for a period of time, acne seeds have a chance to form deep beneath the skin that won’t show up on the surface for months later.  We call this an indirect trigger because you are not breaking out from something directly but you are breaking out from the effects of NOT doing something which, in this case, would be not using the products that facilitate the clearing process.  You can read more about this in my post Direct vs Indirect Triggers: What You Don’t Do Is As Important As What You Do.

CONSIDER THE DELAYED REACTION TIME

Another concept I discuss in my e-course is that there are delayed reaction times between when you are exposed to a trigger and when you actually see visible acne on the surface of your skin.  Basically, what you eat (or do or touch or don’t do) today is not going to show up tomorrow.  Just think about how long it takes to eat food and to see it as visible weight on the scale.  Just like with weight gain, it takes time for you to eat something or for a comedogenic product to touch your face and for that to contribute to the formation of an acne seed in your skin.  And then even once that acne seed is planted deep inside of the follicle, it takes months for acne seeds to travel to the surface of the skin.  So even if your skin looks clear the day after your procedure, you have to wait some time to actually determine whether whatever trigger you were exposed to did in fact contribute to a breakout. 

PORE-CLOGGING PRODUCTS HAVE A SHORT DELAYED REACTION TIME

Each category has a different delayed reaction time that we discuss in the course but product triggers tend to show up quickly.  So if your Doctor applies a numbing cream to your face that contains a comedogenic ingredient AND comedogenic ingredients are one your triggers (because everyone’s triggers are different) then you will likely see a breakout within days to weeks.  The reason why product triggers tend to show up fairly quickly is because they enter the skin from the top down so by the time those cloggy ingredients slip into your follicles and contribute to the formation of an acne seed, it’s already pretty high on the surface of the skin.  On the other hand, if you skip your product plan for two weeks you likely won’t see a breakout from that for weeks to months after since it’s an indirect trigger that has to get processed from the bottom up.  

HOW TO GUARANTEE AN ACNE FRIENDLY PROCEDURE

1. First, talk to your service provider beforehand and let them know that you have sensitive skin and need ingredient lists for any and all products that might touch your skin before, during, or after the procedure.  This includes any cleansers or toners. Don’t just ask them if the products they use are okay for acne prone skin because of course they are going to say yes.  Most Doctors and Estheticians think they know all about acne but most don’t actually know squat about it so they will likely tell you that their products are great.  Also, the more expensive and natural a product is, the more likely it is to clog pores so the higher end spas and clinics are even more likely to use pore clogging products than a cheap one that uses watered down products that are less thick and sticky in the follicles.  

2. Then check every ingredient in each product against the list of comedogenic ingredients to make sure they don’t contain any of the no-no ingredients.  

If any of the products contain potentially cloggy ingredients, ask them if they have alternatives or if you can bring your own.  If they don’t have alternative products and you cannot bring your own, ask if they can avoid using that product on you.  If they can’t, then you need to just prepare for a potential breakout weeks or months after the procedure and find a professional like us to help you get it under control.  We have acne programs at our San Francisco Bay Area clinic and virtual programs so you can get help wherever you are.

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Why clearing acne is like getting a six pack or growing a seed

If you have ever spoken to me, you probably know by now that I am really into analogies and there are two things I always compare the acne clearing process to: growing a seed in a garden and getting a six pack.  Since there are so many misconceptions and misunderstandings about acne, I have found that these comparisons make the acne clearing process easy to understand for people.

CLEARING ACNE IS LIKE TRYING TO GET A SIX PACK

I use the six pack analogy because it takes just as much time and work to get clear skin as it does to get a six pack and both processes require a multitargeted approach.  Both our skin and our bodies are affected by internal and external factors so they require a comprehensive approach that targets all of those different factors at once. For example, you can’t just get a six pack by doing cardio.  You have to do cardio AND strength training AND watch your diet AND pay attention to your lifestyle.  Well, you also cannot get clear skin by just using the right skin care products because acne is a multifactorial disease that is caused by Retention Hyperkeratosis and exacerbated by many other triggers.  So you also have to manage other factors like your diet, lifestyle, hormones, household products, and a bunch of other things that we go over in detail in my 8 Steps To Clear Skin e-course. 

THE ACNE PROCESS IS LIKE GROWING A SEED

In addition to being affected by multiple factors, acne also takes place in multiple stages which is why I use the other analogy of growing a seed.  Much like a flower, acne doesn’t just start and end as we see it.  It takes time for a flower to bloom and it has to first make its way through many stages: first, it starts as a seed then eventually sprouts into a bud then finally blooms into a flower that we see above ground.  Well, acne also takes a lot of time to make its way to the surface of our skin and develop into the pimples that we actually see and notice and it also starts as a little seed deep beneath the surface that we don’t see until later.

WHAT IS AN ACNE SEED?

The technical term for an acne seed is a microcomedone.  A microcomedone is a cluster of mostly dead skin cells that might be mixed with oil and comedogenic ingredients from pore-clogging products.  It’s called a micro-comedone because when it first forms, it is microscopic so it’s invisible to the naked eye.  And I call it a seed because it literally looks and feels like a sesame seed because it’s firm and white.  It’s also the seed from which all the different types of acne grow from.  This is basically the baby version of a pimple that gets planted beneath the surface of the skin.  As it matures, it also passes through different stages of growth: first as an open or closed comedone (blackhead or whitehead) then eventually a papule, pustule, cyst, and nodule which we go over in detail in our post about The Seven Different Types of Acne.  What is unique about our acne program is that we not only target the multi factors that contribute to acne but we target each of the multiple phases of acne.  We have acne programs available at our San Francisco acne clinic and worldwide through our virtual program.

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Direct vs indirect acne triggers: what you don't do is as important as what you do

When people are trying to figure out what is breaking them out, they tend to think about things they are eating, touching, or doing that might directly impact their skin.  For example, one of the most common things people blame their breakouts on are foods like chocolate or greasy food (which, by the way, are both actually not triggers at all).  What they don’t realize is that what you don’t do is just as likely to break you out as what you do. I often compare the clearing process to trying to get in shape so let’s use the analogy of trying to get a six pack as an example.  So if you were trying to get a six pack, there would be direct triggers that might directly impact your fitness like eating donuts three times a day or drinking lots of alcohol. But not working out can also indirectly affect your progress because you are missing the benefits of dropping calories and strengthening your muscles that working out would provide.  Just like the process of trying to get in shape, the clearing process is also affected by both indirect and direct triggers.

WHAT IS A DIRECT ACNE TRIGGER?

A direct acne trigger is a trigger that directly impacts the clearing process.  There are way more direct triggers than indirect triggers and we explain each of them in detail in our 8 Steps To Clear Skin e-course:

Pore clogging products
Products like shampoo, conditioner, and laundry detergent that contain comedogenic ingredients.

Lifestyle triggers 
Things like sun exposure and acne mechanica.

Ingestible triggers
Including diet and medications.

WHAT IS AN INDIRECT ACNE TRIGGER?

An indirect acne trigger is something that can break you out because you are not doing it.  Indirect triggers tend to take longer to cause a breakout than direct triggers but not always:

Not using your acne clearing products
If you are using products that facilitate the clearing process and you skip a few sessions, acne seeds have a chance to form deep beneath the skin that can take months or years to show up on the surface for reasons I will explain below.  There are many reasons why people might not be using their acne clearing products but the most common reasons I see with my clients are that they travel and forget their products, they run out of their products, or they decide they want to start playing around with new products.  

Not keeping up with acne treatments
If you stop or delay receiving treatments like ours that help clear out your follicles and accelerate the clearing process, this can also cause a slow backup of acne seeds that form inside of the skin.  This is also a trigger that may take months or years to build up so we have clients who don’t keep up with their maintenance treatments and then they come back a year later freaking out and wondering why they are broken out.  They usually start obsessing over potential direct triggers like diet too without realizing that they are breaking out from something they failed to do months or years ago.

DELAYED REACTION TIMES FOR DIRECT VS. INDIRECT TRIGGERS

As we also teach in our course, different trigger categories (ingestibles, lifestyle, products, etc) have different delayed reaction times.  So if you eat cheese, that typically takes longer to show up as a visible pimple on your face than stress would.  As I mentioned, indirect triggers tend to take longer to show up then direct triggers do.  So if your Doctor tells you to avoid your acne clearing skincare products while your skin heals after a laser procedure, it will take longer to break out from not those products than it would to break out if you use a pore-clogging liquid makeup.  Since indirect triggers have such a long delayed reaction time and people tend to attribute only direct triggers to breakouts, most of my clients won’t even connect the dots.  I had a client run out of one of her active products while she was traveling out of the country so she didn’t use her serum for 3 weeks.  She didn’t notice an increase in breakouts during those three weeks or immediately after so skipping her serum had actually planted seeds deep inside of her follicles.  When those seeds finally moved up towards the surface of the skin, she didn’t even think to attribute it to the serum she skipped months before and instead started obsessing about what she was eating instead. So the next you have a breakout, don’t just ask yourself what you have been doing.  Ask yourself what you haven’t been doing that might have triggered you and think months back, not days back.

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Is Microdermabrasion good for acne?

I first started seeing Estheticians after my Dermatologist told me they had nothing else to offer me after two failed rounds of Accutane.  The very first thing I was recommended by an Esthetician was a series of Microdermabrasion treatments and I had no idea what it was but it seemed like a harmless option after dealing with the side effects of Accutane.  Unfortunately, it didn’t clear my skin and my skin maybbbe looked a tiny bit better...maybe?...but the results were barely noticeable and they definitely did not offer the sustainable, long term effects that I later designed our acne program to offer once I became an Esthetician myself. As an acne specialist, I now know exactly why microdermabrasion didn’t clear my acne and I want to share it with you. If you don’t want to read the long version of this, I will give you the short version: there are very few instances where microdermabrasion is even safe for acne and even fewer instances where it’s actually beneficial for acne (or anything else for that matter) so don’t waste your time or money with it.  

WHAT IS MICRODERMABRASION?

Microdermabrasion is a procedure where an applicator with an abrasive surface is used to mechanically exfoliate and resurface the skin.  The applicator might be an instrument with microparticles or a diamond tipped wand that is passed over your skin while a vacuum sucks up the exfoliated skin cells as they are buffed off. Think of it like an intense version of a scrubbing cleanser or exfoliating brush.  I have heard many people say that it didn’t hurt at all but I remember it hurting plenty.  I mean, it’s basically like sand papering your face but I also don’t tolerate pain well so I am probably not the best person to listen to on that front.  The procedure is supposed to brighten and smooth the skin, clear pores, boost collagen, firm wrinkles, and lighten discoloration.  These supposed benefits are all exaggerated and unrealistic though for common sense reasons I will explain below.

WHY MICRODERMABRASION IS USELESS FOR ACNE

There are two kinds of exfoliation, chemical and mechanical exfoliation, that I discuss in detail in my post The Best Type Of Exfoliation For Acne.  And although exfoliation is an essential part of the clearing process because it helps unclog debris that gets backed up in our follicles when we are born with Retention Hyperkeratosis (the disease that causes acne), mechanical exfoliants like Microdermabrasion are basically useless for acne because they only break up dead skin cells on the surface of the skin.  Acne is not a surface skin problem and neither are wrinkles or discoloration or any signs of aging for that matter. These are problems that START deep down inside of the skin and END on the surface.  This is why I tell my clients that I don’t really care about the acne that we can actually see because by the time acne moves from the bottom of the follicle to the surface of the skin, it’s already at its last stage of life.  So you can scrub and rub your skin until it’s bleeding but whatever results you might see are going to be short lived because you have to target acne where it starts rather than where it ends in order to truly deal with it in a long term and sustainable way.  

WHY MICRODERMABRASION CAN ACTUALLY BE HARMFUL FOR ACNE

Not only is microdermabrasion useless for acne but it can actually be harmful, especially if you have an inflamed acne type.  Any physical exfoliant, even the most gentle ones, causes some level of abrasion to the skin which can cause micro tears that then lead to an increase in inflammation.  Inflammation is just a fancy word for your body’s natural response to injury so inflamed acne  acne is actually caused by a tear in the follicle wall that then sends a signal to your body that you are injured

NO SINGLE TOOL IS ENOUGH TO CLEAR ACNE LONG TERM

Even if Microdermabrasion was able to reach far enough below the surface of the skin to target acne where it starts, it still wouldn’t be enough to clear acne because there is no single solution that is going to work long term for most of us acne sufferers.  Acne is a multifactorial disease and although Retention Hyperkeratosis causes it, there are dozens of other triggers like oil, bacteria, diet and comedogenic ingredients that exacerbate it.  Since acne is a multifactorial disease, it requires a multifactorial approach to get under control. Sure, there are exceptions to every rule so I am sure there are some unicorns out there that tried some miraculous product or procedure and their acne went away forever.  Just like I am sure there are people out there who can get a six pack by just drinking smoothies without working out or maintaining a healthy lifestyle.  But acne is just like our bodies in that most of us need a comprehensive approach to get results.  This approach is exactly what I teach in my e-course The 8 Steps To Clear Skin.

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Is benzoyl peroxide good for acne and what if it irritates my skin?

Benzoyl peroxide (BPO) is one of the most common active ingredients in all kinds of acne products and it has been one of the most useful tools in helping clear our hundreds of clients.  Benzoyl peroxide can significantly reduce signs of inflammation like redness, swelling, pain, and pus and it can help wash acne-causing congestion out of the follicles. Our method is based on purging acne from the inside out so that clients are not just clear on the surface of their skin but they are clear deep down inside of the skin and our Clearing Treatment is one of the most helpful tools in facilitating this inside-out clearing process. Yet so many of our new clients start our program and say things like “I’m allergic to benzoyl peroxide,” or “benzoyl peroxide doesn’t work for me,” or “benzoyl peroxide makes me irritated”.  But after coaching hundreds of people with acne, I can tell you that I have had less than a handful of people who are actually truly allergic to BPO and the majority of people who think they are allergic or sensitive to it have actually just been using it wrong. Read on for my response to some of the most common complaints about BPO.

WHAT IF I AM ALLERGIC TO BENZOYL PEROXIDE?

When clients tell me they are allergic to benzoyl peroxide, I say, “Are you really though?” There are definitely people that are allergic to benzoyl peroxide but out of the hundreds of people with acne I have helped clear over the years, less than 5 have actually been allergic to benzoyl peroxide.  Most of the benzoyl peroxide products on the market have a concentration of 2-10% of active ingredients in them. So how do you know you aren’t allergic to one of the other 90-98% of ingredients? A benzoyl peroxide product is not a product with only benzoyl peroxide in it. It’s not even a product with mostly benzoyl peroxide in it. And even though benzoyl peroxide is listed as the “active ingredient”, that doesn’t even mean that is the ingredient that feels the most active.  For example, you could be allergic to something natural like aloe or wheat so if one of those is listed in the “inactive ingredients,” it will feel way more active than the BPO because you will likely break out in hives or a rash.  

WHAT IF BENZOYL PEROXIDE IRRITATES MY SKIN?

Does it though?  That is like someone telling their personal trainer “squats irritate my body”.  Sure, squats can hurt your body if you do them incorrectly or you do too many too fast. But they probably wouldn’t hurt if you had a personal trainer who made sure your muscles were properly stretched out and you were doing them with proper form and the number of squats that are appropriate for your fitness level.  Well, your skin is just like a muscle and how well your skin tolerates a product or an ingredient depends less on the product itself than it does on the condition of your skin, how slowly you integrate it, and whether or not your skin is healthy enough to tolerate it. And your skin’s health is largely dependent on the other skincare products you are using and whether or not they are nourishing, soothing, and hydrating your skin so that your skin can better tolerate active ingredients like benzoyl peroxide.

BENZOYL PEROXIDE DOESN’T HELP MY ACNE

Hmm I doubt that.  Back to the body analogy we go.  Someone saying “benzoyl peroxide doesn’t help my acne” is like someone saying, “running doesn’t help my fitness”.  Sure, running alone won’t help your fitness if that is all you are relying on and you are still eating donuts all day and not doing any other types of exercise.  But if you are taking a multi-targeted approach to fitness and running is a part of a comprehensive program that includes a well balanced diet and strength training then running with proper form and in the right amount can be tremendously helpful.  So, yes, benzoyl peroxide won’t help your acne if that is all you are relying on and you are still using comedogenic makeup, eating dairy, and not managing your stress. But if it is part of a comprehensive program like ours that aims to manage acne using a multi-targeted approach then it can be tremendously helpful. 

HOW TO FIGURE OUT IF YOU ARE ACTUALLY SENSITIVE OR ALLERGIC TO BENZOYL PEROXIDE

• Start slow

  Just like with a new exercise, you need to start slow to give your skin time to acclimate and adjust.  We teach our clients how to perform a patch test and integrate our Clearing Treatment slowly during their Initial Consultation or through our e-course.

• Strengthen at the right pace 

  We also teach our clients how to slowly level up the strength of their product plan.  For example, they might start with using it for 15 minutes at night then 30 minutes at night then eventually use it every other night.  You have to be able to assess where your skin is at and adjust your product usage accordingly.

• Stinging and burning is not a good sign

  So many people mistakenly think that if a product stings or burns, it means it’s working.  But that is absolutely not the case. Stinging and burning are a sign that something is wrong and it’s not necessarily a sign that you need to stop using your BPO product but it could be a sign that your skin wasn’t ready for the usage and dosage or that it needs more nourishment and moisture.  

• Nourish, soothe, hydrate

  You know how a simple walk could feel really terrible for someone who is really out of shape?  Well if your skin is not healthy, it doesn’t matter how slow you use an active product. If your skin is dry, sensitized or not well balanced, it could make even the most gentle product feel irritating so it’s important that you are also using other skincare products that are nourishing, soothing, and hydrating your skin.

• Use compatible products

  If you are doing squats, the rest of the exercises in your fitness plan need to be compatible with it.  For example, if your trainer doesn’t include enough stretching or makes you do too many hamstring curls right after doing squats than they can do more harm than good even if the squats were done with perfect form.  So even if your benzoyl peroxide is appropriate for your skin type and used properly, it doesn’t matter if your other products are not compatible with it.

• If you suspect you are allergic to benzoyl peroxide, consult your Physician before following anyone’s recommendations. 

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