Acne is one of the most common conditions in the United States, with an estimate of up to 50 million people being affected at one time or another in their lifetime. While commonly thought of as an adolescent condition, most present in ages 12 -24, over the past 10 years the average age of those experiencing acne has expanded to individuals into their 30s and even 40s. With this new demographic of acne sufferer, it is time to start looking at the topicals we use to treat this difficult condition.

When we dive into the current arsenal of topical options, we learn that acne treatments work by reducing oil production, speeding skin cell turnover, fighting bacterial infection and/or reducing inflammation in the skin. Salicylic acid is a beta hydroxy acid, in fact the only acid which is classified as a “beta.” Salicylic acid is lipid soluble, meaning it can penetrate the skin through the sebaceous follicles and in turn target oily skin with open comedones. BHA has also been found to act as an anti-inflammatory thus soothing the affected area and reducing the spread of bacteria. Benzoyl peroxide has limitations in that it should not be used for long periods of time and in high concentrations due to excessive dryness and irritation to the skin.
It is very effective in killing the bacteria that causes acne but is best recommended for short term, low dose use. There are many forms of retinoids and retinoid-like topicals being used to treat acne as well. Vitamin A, retinol, retin-A, tazarontene, adapalene; these are all topicals that, when used daily, prevent the plugging of the hair follicle and increase cellular turnover.

Salicylic acid, benzoyl peroxide and retinoids continue to be the go-to ingredients when it comes to the topical treatment of acne. But, with an increase in adult acne and now environmental stressors becoming a more prevalent cause of this difficult condition, one must ask “are there any better options?”

Some of the latest options for treating acne may not be new or cutting-edge ingredients at all but ingredients that are being utilized differently to help combat inflammation, the proliferation of bacteria and the reduction of sebum production.

Azelaic Acid

Has incredible anti-inflammatory powers, but it is also known to ease acne-prone skin. The antibacterial
qualities help to prevent clogged pores by killing any bacteria to reduce white and blackheads. Azelaic acid is also very effective in treating post-inflammatory hyperpigmentation (PIH) which can occur on the skin as blemishes start to heal.

Kojic Acid

Although Kojic acid is primarily thought of as a skin lightener for sun spots, age spots and scars, it is also an antimicrobial and anti-inflammatory. This may help to reduce the bacteria associated with acne as well as help to reduce PIH.


This beautiful purple plant works well as an astringent, helping to combat oily skin. Lavender has also been observed to reduce inflammation, to help cut down on redness and to soothe skin.

Cocktailed Ingredients

One of the newer options for treating specific skin conditions are “ingredient cocktails.” One such cocktail is called Granactive™ Acne. With a botanical combination of a patented antimicrobial peptide (Oligopeptide-10), boswellia and honey extract, this powerful cocktail when used in combination with salicylic acid or benzoyl peroxide can help boost the efficacy of each of these ingredients, while offering anti-inflammatory benefits. This is a much-needed option especially for higher grades of acne, because of the FDA banning the combined use of salicylic acid and benzoyl peroxide in 2014 due to reported excessive skin irritation and allergic reactions.


Healthy bacteria known as probiotics are emerging not only as an important factor in gut health but also as another option to promote healthy skin from the inside out. Topical use is now showing promise as well, especially with the increase of environmental stressors now being linked to acne and inflammatory skin conditions. Factors such as pollution, heat and humidity can cause clogged pores which may lead to papules or even pustules. Cold and dry air can cause skin problems as well. When the skin becomes dehydrated, the natural defense mechanism is for the sebaceous glands to produce more oil, again leading to congested pores and acne flare-ups.

Probiotics are essential bacteria that work to combat environmental stressors, fight infection, boost immunity and even balance pH levels. They also help to stabilize conditions such as acne as they have a calming effect on the skin by helping to prevent the immune system from attacking organisms in the body. These attacks often appear on the microbiome of the skin and appear as breakouts, rashes and other inflammatory conditions. Probiotics seem to support and strengthen the skin’s microbiome and aid in the skin’s natural defenses.

Now that we have taken a closer look at topical options for acne sufferers, let’s look at how the professional can help to curb this difficult condition in the treatment room. Generally, some of the same ingredients that we talked about earlier will carry over into the treatment room but in higher percentages. Although there are a few enzymes as well as cocktailed acid solutions that are available for professional use only that will boost results also.

Prepping the Skin

Prepping the skin prior to treating acneic skin with chemical peels is imperative. In most cases, the client’s skin is sensitive, inflamed and is exhibiting active breakout. Starting with a basic, balanced home care regimen and an enzymatic treatment is the perfect way of easing compromised skin into more aggressive treatment options.

Pre-treatment Home Care Regimen

It’s simple. Five ingredients to prepare the skin; AHAs or BHAs to encourage mild cell turnover, skin
brightening and anti-inflammatory ingredients such as azelaic acid or kojic acid, retinol to reduce acne outbreaks by preventing dead cells from clogging pores and nutritional antioxidants to replenish the skin and protect the skin with SPF.

Pumpkin Enzyme

This active enzyme is an effective pre-treatment treatment. Enzymes are a great way of easing sensitive skin conditions into stronger acid peels and begin the healing process. Pumpkin helps to purge impurities while infusing vitamins and nutrients into the skin.


For most professionals, the go-to in the treatment room for acne is salicylic acid, which is a great option. But as mentioned earlier, with growing numbers of adult acne cases, often you may not only be treating the breakout, your client may also want you to address signs of aging. In this case, a great option would be a cocktailed solution of AHA and BHA. Glycolic acid, in combination with salicylic acid, not only addresses the breakout but helps to balance the skin, address collagen support and the reduction of fine lines and wrinkles. Another effective acid combination is glycolic acid and retinol peel solution. It gives skin a radiant glow, reduces the appearance of pores, fades discoloration, helps prevent and treat breakouts and improves the overall texture of the skin.

Clearly, there are many options when treating acne. The objective is finding the correct solution for the individual client. Consultation, skin evaluation and prepping of the skin prior to beginning a treatment series is essential to success. Knowing and understanding the multiple benefits that different ingredients offer will help bring healthy and clearer skin to fruition.

By the Image skin care team.