Skin Drying From Proactiv, RetinA and Other Acne Treatment Products

Skin drying from acne treatment products is really common. Here are my simple tricks to fix it. 

Treat your acne without suffering from tight, dry, peeling skin that screams for a moisturizer.

A reader sent me this exact question as a blog comment. I know that so many people with acne share the same question, and I didn't want the answer to get lost at the end of a post, so I'm making an Ask Dr. Bailey article out of it.  It's a great question!

"Dear Dr. Bailey,

I recently started using tretinoin for my acne and this information in How Do You Layer Skin Care Products With Tretinoin has been very helpful! Is there a type of moisturizer you can recommend to use on really dry skin with acne? It doesn’t seem to matter how soon I apply moisturizer after washing my face, it always seems to end up feeling really tight. But I’ve always heard oily moisturizers made acne worse and I don’t want that either.

Thanks so much!!
Donna"

Hello Donna,

In my dermatology practice, the three most common reasons for why acne-treatment products cause skin dryness are:

1. One of the acne medicines in the products is causing irritation or allergic reaction (often salicylic acid or benzoyl peroxide).
2. The cleanser used for washing is too drying and irritating.
3. Tretinoin, if used, is being applied incorrectly.

Taking each of these one at a time:

Why do acne treatment ingredients cause your skin to feel dry?

There are three main non-prescription active-ingredients in acne products.

They are:

1. glycolic acid,
2. benzoyl peroxide, and
3. salicylic acid.

They are all wonderful and work miracles for acne, but they can be tricky to use. In fact, some people can be allergic to, or just have skin that's easily irritated by, one or more of these great ingredients.

Glycolic acid can be irritating, but allergy is uncommon.

The Glycolic Acid Face Cream that I've used for years on acne patients relies on this single ingredient to treat acne-prone skin in people allergic to the second two ingredients.

With a potentially-irritating ingredient like glycolic acid, the key is to find that sweet spot where you're treating the acne but not irritating the skin. It may be that alternate day-use or lower concentrations are needed, which is why there is a step-up program starting with a lower concentration and moving to a higher one if your skin can tolerate it.

Salicylic acid and benzoyl peroxide can be both irritating and an allergen

They can irritate skin, but more importantly, you can be allergic to one of them.  Popular acne-treatment products like Proactiv depend on benzoyl peroxide to treat pimples. Neutrogena's popular Oil-Free Acne Wash and Rapid Clear Treatment Pads depend on salicylic acid as its active acne-treatment ingredient. 

When you're allergic to one or both of these ingredients, your skin will never tolerate it. Any application results in a dry, chapped redness that gets worse and worse as you continue using the product.

While irritation and allergy can be problems, most people with acne actually tolerate the use of these three highly-effective acne-treatment ingredients. 

If you're not allergic, then using them is the fastest way to clear up acne and pimples without a prescription. It's why I have all three of them in my Ultimate Acne Solutions Kit.  My Acne Kits are the 911 Kits for bad acne, and I have tons of patients using them to control their acne.

Why do acne face cleansers cause skin dryness?

Acne cleansers often include acne-treatment medicines like salicylic acid, benzoyl peroxide or glycolic acid, and we just talked about why those ingredients can cause dryness. Also, they are usually designed to lift a lot of oil from the skin and can just plain be too strong of a soap for more sensitive skin types. 

The Foaming Acne Treatment Cleanser, that comes in my acne kit and that is also sold individually, is a good acne cleanser in a milder soap base. It still lifts off oil, dirt and makeup but does not overly strip the skin's natural oils. It is a pH balanced cleanser that does not contain the harsh foaming agent called sodium laurel sulfate, which is too much for most sensitive skin.

Another great cleansing option that introduces a unique ingredient into an acne routine is Calming Zinc Soap. This is usually an important skin cleanser for people with sensitive skin who suffer from acne. It's a naturally-made soap, meaning that the soap-making process begins with oils which are then magically converted to soap and glycerin. It includes another amazing ingredient called pyrithione zinc. This helps to control a common skin germ called Pityrosporum, which contributes to many people's acne, especially if they have dry skin. 

Calming Zinc removes oil, dirt and makeup without foaming agents like sodium laurel sulfate, making it perfect for sensitive skin; it never over strips your skin's natural oils.

I often use both these cleansers for my patients with dry, sensitive skin that have acne. In fact, this favorite acne treatment regimen is also a highly-effective anti aging regimen that helps to fight the development of fine lines and wrinkles.

How do dermatologist's treat acne in someone with sensitive skin? 

You always get the best results with a complete acne skin care routine that includes a lightweight oil-free and non-comedogenic moisturizer in addition to products designed to clear acne. There are also non-traditional ingredients that help control acne and oily skin such as green tea. Yes, green tea! A well-made green tea product will help reduce both acne and sebum production. It will also help fight skin redness. Sun protection is also important to hyperpigmentation from acne scars. The sunscreen you use must be non-comedogenic and preferably oil free.

An acne routine in my practice might look something like this:

In the morning:

CLEANSE: use my Acne Treatment Cleanser

CORRECT: apply Green Tea Antioxidant Skin Therapy

HYDRATE: apply my Daily Face Cream for Normal to Oily Skin

PROTECT: apply Sheer Strength Pure Physical SPF 50+ Matte Tinted Sunscreen or Invisible Sunscreen

Makeup is applied on top. My preference is mineral makeup instead of foundation because the liquid makeups add more product that can clog pores. My mineral powders cover complexion flaws without looking like powder. 

At bedtime:

CLEANSE: with Calming Zinc Bar Soap

CORRECT AND HYDRATE: Apply Green Tea Antioxidant Skin Therapy. Then, wait 15 minutes after washing skin and toweling dry before applying Retin A. After 15 minutes, apply tretinoin cream and turn out the light and go to bed (tretinoin is inactivated by light), or

CORRECT: apply Retinol Night Cream

HYDRATE: apply Daily Face Cream over the Retinol, turn out the light and go to bed

Why does Retin A (tretinoin) cause skin to seem dry and peely?

Many people don't know how to correctly apply tretinoin. The trick is to start with the lowest dose and work up. It's also important to wait 15 or 30 minutes after washing and applying other products before applying tretinoin.

Tretinoin is always to be used at night because it breaks down in light. I have written many posts on the subject to help people understand how to correctly use this wonderful medicine for acne and anti-aging skin care including:

How to Correctly Use RetinA (tretinoin) for Acne and Anti Aging Skin Care

How Do You Layer Skin Care Products with RetinA

How to Apply Tretinoin Cream: A Guide to Demystifying Its Use

Alternatively, retinol is in the same family as tretinoin (called retinoids) and has been proven to work similarly. It is much less irritating. When combined with green tea, as my Retinol Night Cream is, you can get the benefits of a retinoids with much less risk of skin dryness and peeling. It is actually a huge game-changer for people who struggle with tretinoin.

What Are the Best Face Moisturizers to Combat Dryness for Acne Prone Skin?

I always recommend using a skin moisturizer to help support your skin's important barrier. A well-made moisturizer also includes ingredients that hold moisture to your skin to keep it supple. I recommend the Daily Moisturizing Face Cream for Oily to Normal Skin. This face cream works beautifully for my acne patients.  It's oil-free, hydrates with ingredients like glycerin and feels light on the skin. 

The 5 key steps to treat acne without creating skin drying:

You need to create a skin care routine that,

1. protects skin barrier with a good moisturizer,
2. pick ingredients with less potential for skin irritation,
3. avoid ingredients you may be allergic to,
4. include a product that fights inflammation (such as green tea), and
5. combine them into a routine that heals acne and fights dryness.

Thanks for sending a great question!

Warm Regards,

Cynthia Bailey MD, Dermatologist

Disclaimer: Please realize that availing yourself of the opportunity to submit and receive answers to your questions from Dr. Bailey does not confer a doctor/patient relationship with Dr. Bailey. The information provided by Dr. Bailey is general health information inspired by your question. It should not be a substitute for obtaining medical advice from your physician and is not intended to diagnose or treat any specific medical problem (and is not an extension of the care Dr. Bailey has provided in her office for existing patients of her practice). Never ignore your own doctor’s advice because of something you read here; this information is for general informational purpose only.

References:

Suzana Saric, Manisha Notay, and Raja K. Sivamani, Green Tea and Other Tea Polyphenols: Effects on Sebum Production and Acne Vulgaris, Antioxidants, (Basel). 2017 March; 6(1): 2.Published online 2016 December 29. doi: 10.3390/antiox6010002 PMCID: PMC5384166

Elsaie ML, Abdelhamid MF, Elsaaiee LT, Emam HM. The efficacy of topical 2% green tea lotion in mild-to-moderate acne vulgaris. J Drugs Dermatol. 2009 Apr;8(4):358-64.