Acne-prone skin is not treated with aggression: the routine that works and the mistakes that ruin it

At the pharmacy, more and more often I see women of 30 and 40 with breakouts along the chin and jawline and the same bewilderment: my time for acne has passed. It has not. Adult acne is increasingly common, especially in women, and its mechanism is the same as in teenagers. Four things happen at once: the sebaceous glands produce more sebum, dead cells clog the pore, the bacterium Cutibacterium acnes multiplies in this environment and the skin responds with inflammation.

It is important to understand: acne does not come from dirty skin. That is why the most common reaction, to wash more diligently and more aggressively, is the first mistake on the list below.

The goal of cleansing is to remove excess sebum, make-up and pollution without destroying the skin's protective layer. When the barrier suffers, the skin answers with even more sebum and even more inflammation: exactly the opposite of what you want.

The rule: morning and evening a gentle cleansing gel for oily and combination skin, with cool water, with the fingertips, no sponges and brushes. In the evening, if you wear make-up or sunscreen, first a micellar water for oily skin, then the gel. After washing the skin should feel clean but not tight. The feeling of squeaky cleanness is a signal that you have overdone it.

After cleansing comes the working part: a serum with exfoliating acids that dissolve the clogging of the pore and speed up skin renewal. Concentrated serums for problem skin usually combine salicylic acid with other acids and give a visible result on blackheads, closed comedones and uneven texture.

Two safety rules. First, introduce it gradually: the first two weeks every other evening, then every evening if the skin tolerates it. Slight tingling at the start is normal, burning and redness are not. Second, acids make the skin more sun-sensitive, so the next step is not a recommendation but an obligation.

Here is a truth you rarely hear: the sun does not cure acne. Yes, after the beach the pimples look less red for a few days, because the sun slightly suppresses inflammation and the tan masks the contrast. Then comes the payback: the skin thickens on the outside, the pores clog more easily and the acne comes back worse. And the marks left after every pimple harden and darken for months under ultraviolet rays.

That is why with acne-prone skin sunscreen is applied every day, but not just any: non-comedogenic, with a mattifying effect and preferably a gel-cream or light texture that adds no grease. And do not forget: reapply it after sweating, washing or towelling off. I explained in detail why texture decides everything in the article on sunscreen textures.

You can wear make-up with acne, as long as it is the right one. The key word on the packaging is non-comedogenic: formulated not to clog pores. There are also foundations created specifically for oily, acne-prone skin that mattify, cover and do not complicate the problem.

The conditions are three: clean brushes and make-up sponges, washed at least once a week, removing make-up every evening without exception, and no masking of a newly appeared pimple with a thick layer, because that clogs it even more.

Squeezing is number one: it pushes the bacteria deeper, increases the inflammation and leaves scars and marks that take months to heal. Alcohol toners dry out the surface and the skin answers with more sebum. Coarse scrubs traumatise the inflamed pimples. Sleeping with make-up on is a direct clogging of the pores for the whole night.

And two habits rarely thought about: the pillowcase accumulates sebum and bacteria and should be changed at least twice a week, and the conditioners and hair masks that trickle down the forehead and neck are a frequent hidden cause of pimples exactly along the hairline.

Two links are relatively well documented. High glycaemic index foods, that is white flour, sugar and sweet drinks, worsen acne in some people, as the studies by Smith et al. show. And skimmed milk, strange at first sight, is also linked to more acne in several large studies, including those by Adebamowo.

Chocolate and fat do not have the same evidential link, despite the myth. The practical advice: not drastic diets, but two weeks without sweet drinks and with less skimmed milk, and observation. The skin speaks for itself.

There are situations in which cosmetics are not the solution and honesty requires me to say it: deep painful nodules under the skin, scars that are already forming, acne on the back and shoulders that does not subside, or a picture that does not change after 8-12 weeks of consistent care. In these scenarios the dermatologist has medicines with proven effect, and the earlier you go, the fewer scars remain.

Acne is a medical condition, not a hygiene flaw and not a reason for shame. And it is certainly not solved with aggression. If you are wondering which step to start with or how to combine the products, ask me in the chat: I answer personally and free of charge after a quick registration.

American Academy of Dermatology (AAD): guidelines on the treatment and care of acne. European guidelines on acne (EADV). Smith R. et al., studies on glycaemic index and acne. Adebamowo C. et al., studies on dairy products and acne. Data on the pathogenesis of acne: the four factors according to current dermatological literature.