What really determines whether an ingredient in a makeup (or skincare) product is likely to trigger a breakout is how much of an ingredient is present in the formula. A tiny amount of an ingredient, even mineral oil or a thickening agent, in your moisturizer, blush, foundation, or concealer is not going to cause or exacerbate a breakout. By the way, the researcher largely credited for developing the concept of comedogenic, Albert Kligman, said as much in his 1972 study, “Acne Cosmetica”:
“It is not necessary to exclude constituents which might be comedogenic in a pure state. The concentration of such substances is exceedingly important. To exile such materials as lanolin, petroleum hydrocarbons, fatty alcohols, and vegetable oils from cosmetics would be irrational. What is ultimately important is the comedogenicity of the finished product.” [66]
Like most of the beauty advice from the 1970s (for example, when we used baby oil to increase the effects of the sun to get a deeper tan while sunbathing), it’s time to retire the whole concept of “non-comedogenic.” It’s just not helpful, and how many of us have bought products claiming they won’t cause breakouts—yet we broke out anyway?
What to Avoid
OK, so we know that no one can say with certainty whether or not a product will or won’t exacerbate a breakout if you’re already prone to acne. What we can do is make your search easier by helping you identify the biggest culprits—namely irritating ingredients and products with thick, waxy textures. If you start experimenting by eliminating these from your skincare routine, we’re sure you’ll see important changes for the better.
Avoiding products that contain irritating ingredients is critical for everyone, but especially for those who have oily, acne-prone skin, because inflammation can worsen breakouts and oiliness.
The tricky part about irritation is that research has demonstrated that you don’t always need to see or feel irritation or inflammation for your skin to suffer damage.[2] Just because you don’t see redness on the surface doesn’t mean that damage isn’t taking place underneath the surface, silently hurting the skin in a variety of different ways. This fact explains why some people can use irritant-laden, anti-acne products, yet not suffer obvious signs of irritation.
It’s also important to understand that the effect of inflammation on skin is cumulative, and repeated exposure to irritants contributes to a weakened skin barrier, slower healing (including of red marks from acne), and a dull, uneven complexion. [67]
If that weren’t enough, inflammation in the skin plays a major role in increased breakouts and making oily skin oilier. [28,29] It’s really, really important to avoid alcohol-based or fragrance-loaded skincare and makeup products.
As discussed above, it’s also helpful to avoid any product with a thick, heavy, or creamy texture, such as some moisturizers and makeup products. If you’re acne-prone, thick or solid makeup products such as stick, pancake, cream, or cream-to-powder compact foundations and concealers should be on your “must avoid” list—or at least avoid using them on areas where you’re prone to breaking out. The problems with these kinds of products are that they’re harder to remove from skin and because the heavier waxes they contain can become stuck inside the pore lining, creating a clog.
The same goes for bronzers or blushes in stick, cream, or cream-to-powder forms. The types of ingredients that keep these products in a solid form are iffy for use by those with breakout-prone skin.
Over-the-Counter Acne Treatments That Work
When you’re battling acne breakouts, the key is to look for ingredients that are proven to combat acne effectively, yet gently. The two best over-the-counter acne-fighting ingredients, as demonstrated by peer-reviewed medical and scientific research, are salicylic acid (also known as beta hydroxy acid or BHA) and benzoyl peroxide. [33,68] Research has shown that these two ingredients are as beneficial, if not more so, as prescription-only acne medications for mild to moderate acne.
Salicylic Acid: Also known as beta hydroxy acid (BHA), salicylic acid is an amazing multifunctional ingredient that treats acne in several ways. It not only has potent anti-inflammatory properties, but also exfoliates to remove the buildup of dead skin cells on the surface of the skin as well as inside the pore. Salicylic acid also has mild antibacterial properties. [33,34]
Because salicylic acid is a derivative of aspirin (both are salicylates; aspirin’s technical name is acetylsalicylic acid), it also has some of aspirin’s anti-inflammatory properties. That means it reduces inflammation, redness, and swelling, helping skin heal. [33] This in turn helps prevent scarring, while also decreasing the chance of further breakouts. Salicylic acid’s antimicrobial properties also help kill the bacteria that cause acne. [69] Together, these properties make salicylic acid an MVP in the game of you versus your acne—a game we want you to win!
For salicylic acid formulas to be effective, they must have a concentration of at least 0.5%, although 1% to 2% is far more effective; plus, the formula’s pH is a critical factor, with a pH of 3 to 4 being optimal. [70] Surprisingly to us, many salicylic acid products for acne don’t meet these requirements, so they don’t work well, if at all, on acne and clogged pores.
In addition, the product must not contain any irritating ingredients because such ingredients cause inflammation as we’ve stated so many times (because it’s so important), potentially delaying healing and increasing oil production deep within the pore, keeping you on an endless cycle of clear skin–more acne, clear skin–more acne…Fortunately, well-formulated salicylic acid products do exist, and you’ll find them from Paula’s Choice and from other brands recommended at the end of this chapter.
Benzoyl peroxide is considered the most effective over-the-counter choice for a topical antibacterial agent in the treatment of acne. It penetrates into the pore and kills acne-causing bacteria, thus reducing inflammation. It does present a risk of irritation, but the risk is low compared with the benefits, and unlike antibiotics used to treat acne, it doesn’t have the potential to create bacterial resistance. [33]
The concentration of benzoyl peroxide in products usually ranges from 2.5% to 10%. A 2.5% benzoyl peroxide concentration is far less irritating than a 10% concentration (not irritating skin is always the goal), and it can be just as effective. If your skin doesn’t respond to the 2.5% concentration within a week or so of daily use, try a 5% concentration. [33]
Generally speaking, if your acne doesn’t respond to a 5% concentration of benzoyl peroxide, then the next step is to consider topical prescription options (such as a topical antibiotic mixed with smaller concentrations of benzoyl peroxide) before trying a product with 10% benzoyl peroxide. Concentrations of benzoyl peroxide over 5% have been shown to tip the scale in favor of irritation, causing dry, flaky, and inflamed skin. Not surprisingly, this causes more problems than it helps. [71]
Note: Research shows that combining benzoyl peroxide with topical antibiotics reduces the risk of the bacteria developing resistance to the antibiotic, which means the antibiotic will be effective over a longer period of time. [72] This combination also has been shown to reduce inflammation, making it a good ingredient in some prescription options for stubborn breakouts that aren’t responding to over-the-counter treatments such as benzoyl peroxide and salicylic acid. There are numerous topical prescription products that contain benzoyl peroxide + an antibiotic. Your dermatologist can help you determine which one is best for you.
Important note: When you’re struggling with acne, you must be consistent with your anti-acne treatments. For many, breakouts are an ongoing problem, not a “one and done”–type deal. Ongoing, consistent use of anti-acne treatments is required to maintain the results and to keep new breakouts from forming. Daily adherence to a treatment routine is essential for success!
When OTC Acne Treatments Aren’t Enough
Some