Your Accutane course has ended, but your acne has returned! What do you do?
This is the exact scenario that I was in. I took a course of Accutane in 2019 and after a blissful 8 month period of being acne-free, all of it came back. With a vengeance. I had lost all hope. If Accutane couldn’t clear my skin, what could? If you find yourself in this situation, know that there is a solution.
1. Don’t Panic: Stress Will Make It Worse
The relationship between acne severity and stress levels have been actively studied in the scientific community. Not to mention, many adults suffering from acne have personally noticed an increase in acne inflammation when they are stressed out. One study of female medical students showed a positive correlation between increased stress levels and the severity of their acne (1). This phenomenon has also been shown in a study of students in Singapore, in which increased stress levels were correlated with an increase in acne flares (1).
Why Does Stress Make Acne Worse?
When the body experiences stress, cortisol is released. This is a type of hormone. The corticotropin-releasing hormone (CRH) is involved in this stress response (1). CRH promotes sebum production in the skin, a factor that influences the appearance of acne. In addition, an increase in CRH promotes an increase in pro-inflammatory molecules in the skin, such as cytokine IL-6, which contributes to acne (1).
2. Start From Scratch: Nourish The Skin
Throw out everything you know about acne. Your best bet is to scale back, start from scratch, and work hard to build a customized skin care routine that will work with your skin to clear your acne for good.
Here are the steps you need to take NOW to start your journey to clear skin:
Evaluate Your Skin
There are a number of different skin types that you can have. Here are a few that may pertain to you.
Dry skin is characterized by a low amount of water in the stratum corneum (2), otherwise known as the outer layer of the skin. Symptoms include skin flakes, rough texture, peeling skin, a feeling of tightness after washing, and may sometimes feel itchy or irritated.
Oily skin is the result of an increased amount of sebum (a wax-like substance) on skin (3). Symptoms include increased shine on the skin, enlarged pores, clogged pores, and acne.
The overall appearance of the skin does not lean one way or the other. You may be slightly oilier in certain areas of the skin (e.g., forehead), but feel comfortably moisturized and balanced otherwise.
You get the best, or worst, of both worlds. This skin type experiences symptoms of dry skin and oily skin. Oily areas generally include the “T-Zone.” The T-Zone includes your forehead, nose, and chin. You may feel dry or have irritated skin elsewhere.
Once you have an idea of what type of skin you have, it will be much easier to choose skincare products that will work for you. See below for examples of what types of ingredients you should look for depending on your skin type.
Stop The Harsh Scrubs
Sometimes frustration kicks in, and all you want to do is scrub all of your acne away. There are two types of exfoliation of the skin: Physical and chemical exfoliation.
This is the one you want to stay away from. Physical exfoliation involves the act of scrubbing your skin, either with a cloth, brush, or other equipment, or with an abrasive product that includes hard particles, such as walnut shells, sugar or sea salt. So, what’s the issue? The problem with physical exfoliators is that they do not provide uniform exfoliation of the skin. Often, certain areas of the face will be focused on more, thus leading to irritated skin. Depending on how abrasive the scrub is, you may also damage the skin, causing redness, inflammation, and increased dryness.
Chemical exfoliation involves the use of products containing certain acids in order to improve the skin’s appearance by promoting an increase in collagen and a reduction in pigmentation (4). These acids include AHAs (Alpha Hydroxy Acids) and BHAs (Beta Hydroxy Acids). They provide uniform exfoliation of the skin and the strength of the acids can be changed to conform to your skin’s needs. This is definitely a better option between the two types of exfoliation. However, it’s important that you do not incorporate a chemical exfoliator into your routine until you have established a basic skincare routine as follows …
3. Stick to the Basics
This is the single most important point you will come across. I did not clear my acne until I took a step back and started with basic (but beneficial!) skincare products. By this point, my family and I had easily spent $1000 or more on skincare products, treatments, and medications. It does not matter if you currently have a 10 step routine. It does not matter if you have tried hundreds of products up until this point. Scale it back. Start from the beginning. You must start (or restart) with only these three skincare products:
There are numerous cleansers on the market. Your best bet is to find a gentle cleanser that has a minimal ingredient list. The smaller the ingredient list, the less ingredients there are to irritate your skin. On the flip side, it will also be easier to identify common ingredients that could possibly irritate your skin.
Do not skip this step. Whether your skin is oily, dry, normal or combination, you need to use a moisturizer. However the type of moisturizer you use will vary depending on your skin type. For oily skin, your best bet is to use a lightweight moisturizer, such as a gel moisturizer. For dry skin, opt for something a bit thicker. Learn all about moisturizers and the ingredients you need to look for here.
It took me quite some time to find a sunscreen that didn’t break me out. It is tough to find a sunscreen that works for your skin, does not leave a white cast, doesn’t sting your eyes, and feels lightweight enough to reapply frequently.
If you have sensitive and acne-prone skin, it is recommended that you use a mineral sunscreen (also known as a physical sunscreen). These sunscreens contain zinc and/or titanium dioxide. These work to physically block UV rays from entering the skin. On the other hand, chemical sunscreens contain UV filters such as oxybenzone, avobenzone, and octinoxate, as well as a few newer chemical filters like Tinosorb S or Uvinal A Plus. These work by absorbing UV rays, creating heat that may irritate your skin. Read about The Ordinary’s Sunscreen to see if it’s a good choice for you.
Once you have established a basic skincare routine using all three types of products (cleanser, moisturizer, and sunscreen) and have tested it out for at least 2 consecutive weeks, then the next step is to incorporate an acne treatment. One option is benzoyl peroxide, which is best for inflamed acne and large pustules. Other options include salicylic acid or azelaic acid, which both work to lessen acne lesions. You can start by using one treatment at a time, a few times a week to get your skin acclimated to the product.
4. Focus On Full-Body Health
Full body health not only constitutes your physical health, but also your mental and emotional well-being. It is imperative that acne sufferers tend to all aspects of our health to not only reduce the severity of acne, but also to mitigate the long-term mental and emotional effects that come with facing the world each day. Although acne is quite common, the immense pressure to be perfect in society’s eyes seems to always influence our perception of ourselves, and whether or not we’re good enough.
The Health Effects of Acne
A 2016 study showed that acne had significant effects on a person’s daily activities, relationships, and emotions (5). Physical symptoms like soreness or itching were experienced among the participants. In addition, many avoided socializing with others due to feelings of embarrassment and feeling self-conscious about their skin (5). Many were shown to experience social anxiety and even a decreased interest in sporting activities.
Improve The Health of Your Skin
It is incredibly important to be aware that these feelings are completely valid and felt by many all around the world. There are ways to help you navigate these feelings. For one, regular exercise is a wonderful way to decrease anxiety, depression, improve sleep and lower stress levels (6). As mentioned above, lower stress levels can help reduce the severity of your acne. A good diet is also important in improving your overall well-being and can have a positive impact on the health of your skin. Read the Ultimate Accutane Survival Guide to learn about nutrients found in food that help to improve your skin.
At the end of the day, your skin will respond to different treatments in different ways, compared to others. If your acne returns after Accutane, there is a solution to your problem – Starting with basic skincare, finding ingredients that work for your skin, and being consistent with your routine. You will beat this! See a summary of this post below:
(1) Zari S, Alrahmani D. The association between stress and acne among female medical students in Jeddah, Saudi Arabia. Clin Cosmet Investig Dermatol. 2017 Dec 5;10:503-506. doi: 10.2147/CCID.S148499. PMID: 29255370; PMCID: PMC5722010.
(2) Proksch E, Berardesca E, Misery L, Engblom J, Bouwstra J. Dry skin management: practical approach in light of latest research on skin structure and function. J Dermatolog Treat. 2020 Nov;31(7):716-722. doi: 10.1080/09546634.2019.1607024. Epub 2019 Jun 19. PMID: 30998081.
(3) Maia Campos PMBG, Melo MO, Mercurio DG. Use of Advanced Imaging Techniques for the Characterization of Oily Skin. Front Physiol. 2019 Mar 26;10:254. doi: 10.3389/fphys.2019.00254. Erratum in: Front Physiol. 2020 Oct 15;11:602226. PMID: 30971936; PMCID: PMC6443891.
(4) Soleymani T, Lanoue J, Rahman Z. A Practical Approach to Chemical Peels: A Review of Fundamentals and Step-by-step Algorithmic Protocol for Treatment. J Clin Aesthet Dermatol. 2018 Aug;11(8):21-28. Epub 2018 Aug 1. PMID: 30214663; PMCID: PMC6122508.